Drug distribution system in Hospital

Definition, Types of drug distribution systems, Dispensing of drugs to ambulatory (outdoor) patients, Distribution of controlled drug, Novel drug distribution methods

1. Drug Distribution System in Hospital Dr. Subhash R. Yende Asst. Professor Gurunanak College of Pharmacy, Nagpur (MS)

2. Introduction Physical transfer of drugs from storage area in the hospital to the patients bedside. Dispensing and compounding of prescription requires scientific knowledge as well as skill and art. 2 Dr. Subhash R. Yende GNCP, Nagpur

3. Involves shipments, inventory control, invoicing, payment and accounts In hospitals, drugs are obtained from medical store and are supplied to wards, OT, X-Ray and other dept for treatment of Indoor as well as Out door patients by indent system. Should prepare SOP for distribution of drug within the hospital 3 Dr. Subhash R. Yende GNCP, Nagpur

4. Types of drug distribution systems Individual prescription order system 2. Complete floor stock system 3. Combinations of individual drug order and floor stock system 4. Unit dose dispensing system 5. Non floor stock system 4 Dr. Subhash R. Yende GNCP, Nagpur

5. 1. Individual prescription order system Used in small or private hospitals with lesser manpower and economic consideration It is a type of prescription system where the physician writes the prescription for individual patient who obtains the drug prescribed from any medical store or hospital dispensary by paying own charges. Advantages: All medication orders are directly reviewed by pharmacist provides the better interaction of pharmacist-doctor, nurse and the patient. It provides clear control of inventory. Disadvantages: May delay in obtaining the required medications May Increase in the cost to the patient 5 Dr. Subhash R. Yende GNCP, Nagpur

6. 2. Complete floor stock system Under this system, the drugs are given to the patient through the nursing station and the pharmacy supplies from the drug store of a hospital. Drugs on the nursing station or ward may be divided in to- Charge floor stock drugs Non charge floor stock drugs 6 Dr. Subhash R. Yende GNCP, Nagpur

7. Advantages: The drugs are readily available for administration Minimum return of drugs to store Reduced in-patient prescription orders Reduction in number of pharmacy personnel required Disadvantages: Increase in chance of medication errors Increase in drug inventory in wards Increase chances of drug deterioration due to lack of proper storage facilities and due to unnoticed drug degradation Increased workload on nurses 7 Dr. Subhash R. Yende GNCP, Nagpur

8. Charge floor stock drugs: Medicines which are stocked on the nursing station at all times and charged to the patient’s account after they have been administered to them. Patient is charged for every single dose administered to him Selection of charge floor stock drugs- Decided by PTC Drug should be always available as immediate use drugs of proven efficacy Necessary to administered to patients Examples- Anti-allergic, Antibiotics, antiepileptics , antihypertensive, etc 8 Dr. Subhash R. Yende GNCP, Nagpur

9. Non-charge floor stock drugs: Non charge floor stock drugs are the medicaments that are placed at the nursing station for the use of all patients on the floor. there shall be no direct charge from the patients account for these drugs Methods: a. Drug basket method b. Mobile dispensary unit Selection of Non charge floor stock drugs- Consideration is given to cost of preparation, quantity and frequency of use and effect on hospital budget Commonly used medicine includes normal saline solution, dextrose inj., absorbent cotton, antiseptics, disinfectant etc. Examples – adrenaline, Atropine sulphate , Tin. Belladona , digoxin , multivitamins, paracetamol , Sodium bicarbonate, Lidocaine etc. 9 Dr. Subhash R. Yende GNCP, Nagpur

10. 3. Combination of individual and floor stock system This system is fallowed in the government and also in private hospital who run on the basis of no profit and no loss. Individual prescription or medication system is fallowed as a major means. Requirement of drugs or surgical items are given to the patient who purchase and deposit these items in hospital wards or rooms under supervision of registered nurse. 10 Dr. Subhash R. Yende GNCP, Nagpur

11. 4. Unit dose dispensing Those medications which are ordered , packaged, handled, administered and charged in multiples of single doses units containing predetermined amount of drugs or supply sufficient for one regular dose, application or use. A single unit package is one which contains one complete pharmaceutical dosage forms Ex-one tablet, capsule 11 Dr. Subhash R. Yende GNCP, Nagpur

12. Advantages: Patient receives improved services and are charged for only those doses which are administered Nurses get more time for direct patient care Medication errors are reduced It eliminates labeling mistake, wastage of drug Disadvantages: It requires more space since packaging material increases the bulk of the dosage forms. It requires increased number of skilled personnel in the pharmacy The cost of medication is increased to the patient due to increased handling charges 12 Dr. Subhash R. Yende GNCP, Nagpur

13. Methods of dispensing unit doses: A. Centralized unit-dose drug distribution system (CUDD): All in-patient drugs are dispensed in unit doses and all the drugs are stored in central area of the pharmacy and dispensed at the time the dose is due to be given to the patient. Drugs are transferred from the pharmacy to the indoor patient by medication cards. B. Decentralized unit dose dispensing: This operates through small satellite pharmacies located on each floor of the hospital The main pharmacy is for procurement, storage, manufacturing and packing 13 Dr. Subhash R. Yende GNCP, Nagpur

14. 5. Charge Non floor stock system Semi-automated system to streamline the paper work involved in charging. Save time of supplying the non floor stock drugs from pharmacy store Charge plate system and the envelope system is used to dispense such drugs Charge Plate system: Plastic or metallic card or plate is prepared for patients identification A separate drug form is prepared (in triplicate) and submit to pharmacy, accounts and nursing unit. The envelope system : pharmacist fills a prelabled envelope with specific quantity of specific drugs and given to the nursing unit 14 Dr. Subhash R. Yende GNCP, Nagpur

15. Dispensing of drugs to ambulatory (outdoor) patients Out-patient - patients not occupying beds in a hospital or in clinics, health centers and other places Emergency : A person given emergency or accidental care for conditions which require immediate medical attention, suffering from serious health conditions or illness. Tertiary care: Directed to OPD by his attending medical practitioner for specific treatment other than an emergency treatment. Primary care: a majority care, used by patients who are ambulatory i.e are able to move about freely. 15 Dr. Subhash R. Yende GNCP, Nagpur

16. Location of out-patient dispensing: It should be located on the ground floor of the building, provided with proper facility such as seating arrangement May be separate OR combine inpatient and outpatient unit with service provided from the same window OR combine inpatient and outpatient unit with service provided from the different window 16 Dr. Subhash R. Yende GNCP, Nagpur

17. Dispensing to out-patient: Similar to retail pharmacy store Compounded (if necessary) and dispense drug as per prescription written by physician Number the prescription Labeling of container or use unit dose form Record the prescription detail, quantities supplied in register maintained for accounting. Record of narcotics, poisons, and costly drugs should maintained Give information regarding dosage, frequency, mode of using, precaution, side effects and storage condition to patients Handle emergency patients prescription, research program etc 17 Dr. Subhash R. Yende GNCP, Nagpur

18. Distribution of controlled drug Scheduled X drugs These drugs should kept under lock and key A separate register should be maintained to register them Record regarding purchase and distribution in prescribed form by store keeper, pharmacist and nurses. The administrative head of the hospital is responsible for the proper safeguarding and the handling of controlled substances within the hospital 18 Dr. Subhash R. Yende GNCP, Nagpur

19. Hospital control procedures: Preparation of order : Responsibility for controlled substance in the Order of Doctors for administration of controlled drugs Ordering ward stock controlled substances from pharmacy Information on daily controlled drug administration sheet: Date, Amount given, Patient’s full name, Patient’s hospital number, Name of doctor ordering, Signature of nurse administering, Frequency and route of administration Telephonic orders: Procedure in case of waste, deterioration or contamination: Miscellaneous procedure: 19 Dr. Subhash R. Yende GNCP, Nagpur

20. Most Commonly Abused Rx Drugs: Pain relievers ( opioids , narcotics) Central nervous system depressants (sedatives, tranquilizers, hypnotics) Barbiturates and benzodiazepines Stimulants (used to treat attention deficit disorders, narcolepsy, and weight loss) Dextroamphetamine 20 Dr. Subhash R. Yende GNCP, Nagpur

21. Novel drug distribution methods Adherence packaging : Strip with individual doses in individual pouches;   Includes Patient name, Medication name and strength, Time of administration , Bar cod etc. Automated dispensing cabinet : a computerized drug storage device or cabinet; provides proper storage , inventory control and security for pharmaceuticals at the point of care; It can be used only by authorized users who are authenticated by password Robotic drug dispensing: The dispensing process will be paper free as the robot will store the prescription as soon as a doctor documents it electronically 21 Dr. Subhash R. Yende GNCP, Nagpur

22. Reference RK Goyal & RK Parikh. Text book of Hospital Pharmacy, B S Shah Prakashan Ahmedabad . HP Tipnis & A Bajaj. Hospital Pharmacy, Career Publication, https:// www.slideshare.net/rajusanghvi1/drug-distribution-in-hospital-pharmacy https:// www.slideshare.net/VishwanathAnkola/drug-distribution-methods Dr. Subhash R. Yende GNCP, Nagpur 22