14ab1t0019 drug distribution

Drug distribution

1. DRUG DISTRIBUTION Presented by P.Deepthi 4 th Pharmd 14AB1T0019 Under the guidance of Dr.G.Ramesh Department of Pharmacy Practice VIGNAN PHARMACY COLLEGE, VADLAMUDI 1

2. INTRODUCTION TYPES OF DRUG DISTRIBUTION INDIVIDUAL PRESCRIBTION ORDER FLOOR STOCK SYSTEM COMBINATION OF INDIVIDUAL AND FLOOR STOCK METHOD UNIT DOSE DISPENSING FLOW CHARTS OF OUT PATIENT AND IN PATIENT. CONTENTS

3. Drug distribution is defined as, “Physical transfer of drugs from storage area in the hospital to the patient’s bedside”. This involves two types of drug distribution. They are: In-patient distribution Out-patient distribution INPATIENT DISTRIBUTION The drug distribution to the in patient department can be carried out from the out patient dispensing area. The pharmacists involved in dispensing the drugs for out patient can dispense drugs for in patients too. The pharmacist employed for drug distribution to the in patient wards should be well skilled and qualified staff. DRUG DISTRIBUTION

4. Out patient refers to the patients not occupying beds in hospital or in clinics, health centres and other places where out patients usually go for health care. No medicaments should be issued without the prescription . After the issue has been made the quantities supplied must be recorded . In short form the out patient department was called as OPD. TYPES OF DRUG DISTRIBUTION SYSTEMS: There are five different systems in use for drug distribution in hospitals: OUTPATIENT DISTRIBUTION:

5. Individual prescription order system Complete floor stock system Combination of individual prescription and floor stock system Unit dose system Non-floor stock system INDIVIDUAL PRESCRIPTION ORDER SYSTEM : It is a type of drug distribution system wherein physician writes the prescription for individual patient who obtains the drugs prescribed from any medical store or hospital dispensary by paying own charges.

6. This system is generally used by the small and/or private hospitals because of the reduced man power requirements and desirability for individualised service . ADVANTAGES: All medication orders are directly reviewed by pharmacist. It provides the interaction of pharmacist, doctor, nurse & the patient. It provides clear inventory control . DISADVANTAGES : Wrong errors, illegible writings of the physicians. Physician may write high economic drugs in the prescription or cost effective drugs.

7. Drugs are given to the patient from the nursing station& the pharmacy supplies from the drug store . The way of floor-stock distribution includes 2 types They are: Charged floor-stock system Uncharged floor-stock system 1 ) Charged floor stock system : In this method medicines which are stocked in the nursing stations all the times& charged to the patients account after administered to them. FLOOR-STOCK SYSTEM:

8. The patient is charged for every single dose administered to him. Once the floor-stock list is prepared it is the responsibility of the hospital pharmacist to make the drugs available . Pharmaceutical & related preparation Category Preparation Anti-allergies Prednisolone tablet Antibiotics Penicilin. G inj Anticoagulants Heparin Cardiovascular agents Digoxin.Inj

9. 2) Non charged floor-stock system: These system includes the medicaments placed in the nursing station that are used by all the patients on the floor. A label for a charged floor-stock system: Patient ward: _________ Phenobarbitone tablets Each tablet contains phenobabitone dose of 50gms VIGNAN HOSPITAL PHARMACY

10. There shall be no direct charge from the patients account. This is divided into two methods. They are : Drug basket method Mobile dispensary unit Drug basket method : Nurses fills a requisition form for the delivery of drugs at their floor. When there is an empty container, the nurses place it in the drug basket. Once the basket is completed, delivery of drugs is done via messenger services.

11. It is specially made up of stainless steel 60 inches height 48 inches wide & 25 inches deep It is mounted on bottom tyres. Label for non charged floor-stock drugs Mobile dispensary unit: Ward:__________ Ferrous sulphate tablets Each tablet contains Ferrous sulphate dose of 0.3gms VIGNAN HOSPITAL PHARMACY

12. Ampules:   Capsules: Tablets: Solutions: Powders: Adrenaline Dulcolax Atropine sulphate Tin. Bellodona Glucose Digoxin Multi-viamins Paracetomol Cator oil Sodium bicarbonate Lidocaine HCL Digitalis Nitroglycerine Tin. Benzoin compound   Talc Aminophilin   Elixir kcl List of non-charged drugs:

13. Differences between charged floor-stock & non floor-stock system Charged floor-stock The charges are made into the patients account after they have been administered. Every dose of the drug administered to the patienare charged. Only the dose of the drug charged which are expensive & rarely used. Floor-stock list is prepared which is sent to make the drugs available at all the nursing stations. Non charged floor-stock system The drugs are not made in the account directly even after the drug have been administered. Charges are made indirectly to the patient. The cost of the drugs are not as high as the drugs ued are tablets & capsules. A pre-determined list is prescribed by the nursing station.

14. This system is followed by all government hospitals and also private hospitals those run on the basis of no -profit and no loss . Surgical items are given to the patients, who purchases and deposit those items in a hospital wards on rooms under the supervision of registered headness . 4. UNIT DOSING DISPENSING: Those medications ordered, stored, packed, handed, administrated and charged in multiples of single does units containing a predetermined amount of a drug or supply sufficient for one regular dose. A single unit package is one which contain one complete pharmaceutical dosage form. EX- 1 tablet or 1 capsule. 3.COMBINATION OF INDIVIDUAL AND FLOOR STOCK METHOD:

15. Better financial control It prevents loss of partially used medications. Does not require storage facilities at nursing stations. DISADVANTAGES: Irregular dosage skill physician is required for administration of drug. Regular monitoring is required . TYPES OF UNIT DOSE DRUG DISPENSING SYSTEMS : TYPE A- CENTRALISED UDDDS TYPE B-DECENTRALISED UDDDS ADVANTAGES:

16. All inpatients drugs are dispensed in unit doses and all drugs are stored in central area of pharmacy and dispensed at a time of dose that is to be given to the patient. 2) TYPE B-DECENTRALISED UDDDS : This is operated through satellite pharmacies located on each floor of hospital . PROCEDURE : Patient profile card containing full data ,disease, diagnosis, is prepared. Prescriptions are sent directly to the pharmacist which are then entered in patient profile card. 1) TYPE A- CENTRALISED UDDDS:

17. Pharmacist check the medication order is filled by pharmacy technicians . The nurse administeres the drug and make entry in their record. ADVANTAGES: Easy for admission of staff. Accounting becomes easier in certain cases. DISADVANTAGES : High cost Consumption is more time . Will occupy more space for sorting out ledger posting and inventory control problem.

18. GENERAL FLOW CHART FOR IN-PATIENTS Prescription written by Doctor Pharmacy Prescription copied by nurse Inpatient discharge medications Returns to credit Inpatient medication orders Prescription received by pharmacist Filling of prescription Dispensing prescription Prescription received by pharmacist Filling of order Dispensing order Credit issue Free Cash Credit Charge Statistics and control

19.   OUT-PATIENT ACTIVITY CHART Prescription written by Doctor Received by pharmacist Filling of prescription Dispensing of patient Prescription Payment Prescription filled Receipt of payment Cash Change Static and report Regular prescription file Narcotic Prescription file

20. Dr . Ramesh K. Goyal, Dr. R. K. Parikh, Dr. Mayur M. Patel – A Text book of Hospital Pharmacy, Pg.no: 101 – 103 H. P. Tipnis , Amrita Bajaj – Hospital Pharmacy, Pg.no: 89 – 91 http://www.srmuniv.ac.in www.researchgate.net Textbook of hospital pharmacy 2 nd edition by of page number:166-168 REFERENCES :