med.dist.system.pptx

Introduction
Historical overview
Types of Medication Distribution systems
Floor stock system
Patient prescription system
Unit Dose System
Technology and Medication Distribution Systems
Future of distribution systems
2

- Pharmacy department is responsible for the
safe and effective use of medication throughout
the entire hospital .
So , One of the primary responsibilities of the
hospital pharmacy is to provide the patient with
an appropriate medication in an acceptable
dosage form available at the appropriate time to
facilitate easy administration .
Introduction
3

- Although this sounds relatively simple, the
system required to perform this task is complex
and involves considerable organization .
- The evolving drug distribution system used by
hospital pharmacists reflects the expanding
pharmacist’s role , advancement in technology
and the increasing complexity of drug products .
4

- The role of the hospital pharmacist 50 years ago
was primarily confined to the basement . This
location reflects the role of the pharmacist had in
the medication use cycle .
compounding, repackaging, and relabeling of
multiple dose supplies of medications into containers for
subsequent dispensing and storage on a patient care unit
(PCU) .
Historical Overview
5

- There were at least two distinct distribution
methods the pharmacist would utilize for the
nurse to obtain the medications for patient use .
- One was referred to as the floor stock system
and the other was the patient prescription
system
6

- In the early 1960s of the last century, it became
apparent that more sophisticated distribution
systems would be required. During this period,
unit dose as a new drug distribution system, was
introduced.
- Several university hospitals in USA were, in
part, responsible for laying the foundation and
providing the force for shifting to UD.
- What transformed the hospital pharmacist into
an integral member of the health care team is
the unit dose system .
7

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PRESCRIPTIONS
DISPENSING
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STAFF
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-The Floor stock system was the more common
used method .
- It was a duplication of a small pharmacy on the
nursing unit. Drugs were stored so the nurse
would prepare drugs for patient administration.
- The pharmacist was responsible for stocking
nursing unit .
10

Floor Stock System (continued)
- The pharmacist would place bulk containers of
medications on the unit often called medication
room .
- The nurse was the professional responsible for
preparing patient specific medications for both
oral and intravenous use .
11

-Medications were Not labeled for a specific
patient and could therefore be used for
several doses for numerous patients .
- It was common for 150- 200 medications to
be
stored in a minipharmacy on each PCU .
-The pharmacist would see only transcribed
drug requisitions sent by nursing personnel .
12

Advantages of floor stock system:
1- Availability of medicines at nursing site.
2- Reduction in the number of pharmacy personnel .
3- Reduction in the number of orders received in the
pharmacy.
4-Minimized return of medications.
13

Disadvantages of floor stock system:
1. Increased medication errors .
2. Increased drug inventory on the pavilions
3. Greater opportunity for pilferage.
4. Increased hazards associated with drug
deterioration.
5. Lack of proper storage facilities.
6. Greater nurses time is spent on drug dispensing.
7. Minimal pharmacy-doctors contact.
8. Pharmacist can not make drug monitoring.
14

- After the physician wrote a medication order,
the nurse would transcribe the medication order
and sent it to the pharmacy for preparation, the
pharmacist would prepare a 2 to 5 days supply
of medication for the patient , the nurse would
store the medication on the nursing unit .
15

Disadvantages of Patient prescription system :
- While not as disadvantageous as the complete
floor stock system, this method is also discouraged.
- Some of the disadvantages include:
1. increased potential for medication errors due to
the lack of checks in the distribution of medication
doses and to the inefficiencies inherent in the
procedures used to schedule, prepare, administer,
control, and record during the drug distribution
and administration process.
16
Patient Prescription System (continued)

2. Consumption of excessive nursing manpower in
the preparation of medication doses and in
conducting other medication-related activities.
3. Increased potential for drug loss due to waste,
obsolescence, and deterioration.
17
Patient Prescription System (continued)

- Several researchers studied the medication use
process and found that the floor stock system and
individual prescription system were error-prone .
- Because it was believed that the hospital
pharmacist could play a larger role in the
medication use cycle, a few hospitals began
experimenting with the unit dose system because it
seemed a safer system.
-This placed the pharmacist in a position to begin
affecting a patients medication therapy.
18

- In 1975, ASHP issued a statement of unit distribution.
- The unit dose system is defined as a pharmacy-
coordinated method of dispensing and controlling
medications in health care institutions .
19
Unit Dose System (continued)

This system is characterized by :
1- Medications are contained in, and administered
from, single unit or unit dose packages.
Unit Dose (UD) Package: is a package that contains
the ordered amount of a drug in a dosage form
ready for administration to a particular patient by
the prescribed route at a prescribed time. (e.g., the
physician ordered 500mg Ampicillin the UD
package can be one single-unit package of 500mg
capsule or tow single-unit packages of 250mg
capsules) .
20

Single-Unit Package is one which contains one
discrete pharmaceutical dosage form,( e.g., one
tablet, one capsule, or one 30ml liquid quantity).
21

22

23

24

2- Medications are dispensed in ready-to-
administer form to the extent possible.
3- For most medications, not more than a 24-
hour supply of doses is provided to or available
at the patient-care area at any time.
4- A patient medication profile is concurrently
maintained in the pharmacy for each patient.
25

The unit dose system is very different than the
previous methods discussed. The pharmacist
dispenses patient-specific medications to be
administered, not prepared, by the nurse .
26

- The U.S. General Accounting Office concluded in
1971 that the unit dose system was the most cost-
effective of any distribution system—more cost-
effective in fact than any other pharmacy system
when the entire medication use cycle is
considered .
27

28

Articles have evaluated the reduction of medication errors when transitioning from the floor
stock system to the unit dose system . The table below lists a comparison of some of these
studies and their specific outcomes .
29

Advantages of unit dose system:
1. Reduction of medication errors.
2. Reduction in total cost of medication.
3. More efficient usage of pharmacy and nursing
personnel.
4. Improved overall drug control and drug use
monitoring.
5. More accurate patient billing for drugs.
30

6. Great control over pharmacy workload
pattern and staff scheduling.
7. Reduction in the size of drug inventories
located in patient care areas .
8. Greater adaptability to computerized and
automated procedures .
31

Disadvantages of unit dose system:
- High initial cost which could be compensated by
time.
32

:
33
Medication cart

:
34
Medication cart

:
35
Medication cart

36
Pneumatic Tube
System

- There are two main ways that a pharmacy can
be structured in order to provide unit dose
services:
- centralized model .
- decentralized model .
37

Centralized Model
- A centralized model emanates from the main
pharmacy (a centralized location) .
- The medication order is received in the central
pharmacy and all of the processing for patients
occurs there: order processing, drug packaging,
cart fill, and medication dispensing.
38

Advantages and Disadvantages of centralized model :
- The advantages of this model are that all
resources can be localized into one area and
drug inventors can be minimized .
- The biggest disadvantage is that the pharmacist
is not able to directly interact with the physician
and nurse. Clinical services are limited since the
pharmacy is not closely located to patient care
areas .
39

Decentralized Model
- The decentralized model is characterized by
pharmacy satellites distributed evenly throughout
the institution. A physician order is routed to this
satellite.
- The pharmacist there processes the order and
dispenses the first dose of the medication directly
to the nursing station.
40

- Since satellite pharmacies are closely located to
patient care areas, it is very easy for a health care
professional to stop by to ask a question. The
pharmacist can also go into the patient care
areas to speak with a patient or provide clinical
services.
41
Decentralized Model

- In addition to the pharmacy satellite ,
a centralized pharmacy still exists to provide cart
fill and serve the decentralized satellites . Also,
the centralized pharmacy remains open all the
time , providing services for the satellites when
they close. These satellites can be focused on
pediatrics , oncology, critical care, the emergency
room, and the operating room.
Specialized pharmacy satellites
42

- The advantages with a decentralized model
compared to a centralized model include reduced
turnaround time, increased physician and nursing
satisfaction, expansion of clinical services, fewer
dispensing errors, and decreased floor stock.
43

Table below lists a sample of delivery methods and
doses needed for a typical tertiary care hospital .
44

- The unit dose system has led to greater use of the
pharmacist’s drug therapy expertise and in turn improved
patient care .
- With this system the pharmacist assumes responsibilities
not only for delivery a carefully prepared drug product to the
patient in a safe, accurate, and timely manner but also the
monitoring all prescribed drug therapy to assess
appropriateness of dose, suitability of therapy in light of the
patient’s condition, cost effectiveness of therapy, and the
potential for drug interactions .
- These combined activities form the foundation of
clinical pharmacy practice .
45

- Automated pharmacy systems, including
medication storage and distribution devices, had
become an integral widespread part of the
medication-use process. They are defined by the
American National Association of Boards of
Pharmacy (NABP) as “including, but not limited to,
mechanical systems that perform operations or
activities, other than compounding or
administration, relative to the storage, packaging,
dispensing, or distribution of medications, and which
collect, control, and maintain all transaction
information.”
46

- These systems have many advantages as
1- They free pharmacists from labor-intensive
distributive functions .
2- Help pharmacists provide pharmaceutical care .
3- Improve the accuracy and timeliness of
distributive functions .
47
Technology and Medication Distribution (continued)

- Several manufacturers produce automated
devices with a variety of configurations and
software capabilities that may interface with the
pharmacy’s and the health care organization’s
information systems. These devices could be
deployed in selected areas as emergency room
where floor stocks are used a lot, or for selected
drug categories as for controlled drugs that
need time for documentation and tracking, or
throughout patient care areas as with many
healthcare organizations.
48

Historical Overview
Brewer system
- The original attempt to automate the drug
distribution system ( 1961 ) .
- was located on the nursing unit and it provided
individual doses with labels, charge slips, and an
accounting report .
49

Baxter ATC-212
- located in a central place, packaged individual
doses upon demand .
- This system interfaces with the computer
containing the fill list. This information is
transferred to the machine. which instructs it to
package and dispense medications in the order
it is generated. It is usually operated by
technicians.
50

- This system has been demonstrated to
significantly reduce technician time with cart fill,
by saving 0.36 technician FTE and significantly
reducing error rate (from 0.84% to 0.65%). It had
no effect on reducing pharmacist time in cart
checking .
- They demonstrated accuracy and reduced
medication errors .
51

ROBOTS
- Another device that has widespread
utilization is the use of robots. These are a
centralized automated dispensing devices used
to fill medication carts. It contains a medication
selection station, a bar-code reader, and
packaging and bar-coding equipment .
52

- The benefit of the system is that it replaced
the manual activity of the cart fill. The
assumption is that this would also be a more
accurate system, since it is completely bar-code
driven. It removes confusion over sound-alike
drug names, skipping a medication, or choosing
the wrong strength. It also freed up technician
and pharmacist time to become more involved
in other activities within the institution.
53
ROBOTS

Automated Dispencing Cabinets
-Types :
- non-profiled ADC ( modified floor stock .) .
- Profiled ADC ( containing accurate , up to date patient
specific profile) , Logs onto the system with a unique
password or by using bio-ID scanning of fingerprint .
-Configuration :
-Restrictive : only housing the medication of interest
-less restrictive : gaining access to all of the
medications in this drawer, trusting the nurse to choose
the correct medication .
55

56
ADC

Future of medication use system
electronic prescribing
& administration
ward-based
automated storage
Ward
based
Pharmacy
Team -
Pharmacist
Technician
Support
worker Direct to ward
medicines delivery
Dispensing patient meds
locker
57

Summary
- In summary , the unit dose system and the
development of automation for medication
distribution has had a profound impact on elevating
the practice of hospital pharmacy, The unit dose
system reduced medication errors and aided in the
introduction of the concept of clinical pharmacy .
Technology has further enhanced the distribution of
medications, allowing pharmacists to become more
involved with patient care. The future of technology
should further reduce medication errors while
maintaining the pharmacist oversight of the process
and allow the pharmacist to better care of patients .
58

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