DRUG DISTRIBUTION

SYSTEM
Dispensing to In-patients
Saima Asghar
[email protected]
Chapter contents
• Introduction
• Methods of drug dispensing
• Individual drug order system
• Floor-stock system
• Combined individual drug order and floor-stock system
• Unit dose dispensing
Introduction
• Drugs dispensed should be as ready for administration to the patients
as the current status of the pharmaceutical technology permits.
• It must bear adequate identification including; name(s) of drug,
strength or potency, route of administration, expiration date and such
other special instructions which are indicated in good dispensing
practices.
Methods of drug dispensing
Basically there are 4 systems for dispensing of medicines to in-patients.
These may be classified as follows:
1. Individual prescription order system
2. Complete floor stock system
3. Combination of 1 & 2
4. The unit dose dispensing system
Individual prescription order system
• It is a type of prescription system where physician writes the
prescription for individual patient, who obtain the prescribed drugs
from a pharmacy by paying own charges.
• This system is generally used by small/private hospitals.
• Require less workforce and desirable for individualized service.
Advantages and disadvantages of
individual prescription order system
Advantages Disadvantages
• Medication orders are directly • Delay in obtaining the required
reviewed by pharmacist. medicine and increase in cost to
• Provides better interaction the patient is common.
between healthcare providers.
• It provides clear control of
inventory.
Floor stock system
• It involves separate storage facility in a secured area on each patient
care floor.
• Floor stocks may include many bulk supplies of medications carried
out in hospital pharmacy.
• This system is used to supply medicines for ward use outside of the
office hours.
• Floor stock list must be recorded and reviewed periodically to avoid
overstocking and misuse of medications.
Types of floor stock system

Non-charged
Charged floor
floor stock
stock system
system
Medicines are not directly charged
Medicines are charged to patient’s
to the patients
account
Cost is added to per day cost of
Selection of medicines is by P&TC
hospital room
Once list of medicines is prepared,
Suitable for single doses of less
availability should be assured by
cost and frequently administered
hospital pharmacist
medicines
Drug basket method
• Under this system, night nurse checks the medicine cabinet, utility
rooms and drug refrigerator inventory against a master list provided
by pharmacy.
• Nurse fills the requisition form for the delivery of drugs at their floor
stock supplies.
• When there is an empty container, nurse place it in the drug basket
and this is sent to the pharmacy.
• Upon opening in the morning, pharmacy staff fill each container and
dispense requested medicines to the floor.
Mobile dispensary unit
• Utilizes a specially constructed stainless steel trucks with appropriate
dimensions to hold all sorts of drugs and equipped with swiveling
wheels.
• The main compartment of cart is provided with two locked sliding
doors, a handle for steering and pushing, a heavy duty steel and
rubber protective bumper and 2 inch rim on the top to permit
carrying empty containers being returned to the pharmacy.
• The interior of unit consists of shelves which allow for the transport of
containers of all sizes.
Combined individual drug order and
floor stock system
• This system utilizes simultaneously an individual drug order system as
primary means of dispensing along with a limited floor stock system.
• This system of drug dispensing is probably the most commonly used
in hospitals and is modified to include the use of unit dose
medications.
Unit dose dispensing
• Those medications which are ordered, packed, handled, administered
and charged in multiples of single dose units containers, in a
predetermined amount of drug or supply, sufficient for one regular
dose.
• A single dose package is one which contains one complete
pharmaceutical dosage form.
• First used in 1960’s to reduce medication errors by nursing staff, and
to decrease medication wastage.
Advantages
• Improved pharmaceutical service
• Patients are charged for only doses, which are administered to them
• All doses required are prepared by pharmacy thus allowing the nurses
more time for direct patient care
• Allow pharmacists to interpret or check a copy of the physician’s
original order thus reducing medication errors
• Elimination of excessive duplication of orders and paper work at nurses
station and pharmacy
• Transfer IV preparation and drug reconstitution procedures to the
pharmacy
• Promotes more efficient utilization of professional and non-
professional personnel
• Reduce revenue losses
• Conserves space in nursing units by eliminating bulk floor stock
• Eliminates pilferage and drug waste
• Extends pharmacy coverage and control throughout the hospital
• Central location of drugs
• Medications are ready for administration
• Patient safety
Disadvantage
• More pharmacy processing time and equipment cost
• Requires more storage space
Two methods of dispensing unit doses
Centralized unit dose drug distribution Decentralized unit dose drug
system (CUDD) distribution system (DUDD)

• All in-patient drugs are • This operates through small

dispensed in unit doses and all satellite pharmacies located on
the drugs are stored in central each floor of the hospital
area of the pharmacy and
dispensed at the time when
dose is due to be given to the
patient via messenger service
Other concepts of drug dispensing
• Patient server concept
• Automated dispensing system
Patient server concept
• In this method, specially designed supply closets are built into a wall
entrance of patient’s room, which can be opened from another room
also.
• This means that each drawer has 2 access from patient room and
from another room under the use of a pharmacist.
• This allows the pharmacist reach without leaving his room and nurse
access to patient’s medications and chart without leaving the
patient’s room.
• Costly and impractical
Automated dispensing system
• The process of drug dispensing is initiated with medication order.
• Nurses or some messenger carry these medication orders and obtain
drugs from pharmacy.
• The time of all personnel can be saved by the use of a computer
dispensing system known as CAD.
• CAD utilizes computer networking among physician, pharmacist and
nurses.
• The prescriber enters a medication order in computer and by pressing
of a button , entire series of event take place.
• The order is displayed at the pharmacy’s computer
• A pharmacist checks this medication order and by using appropriate
computer software evaluates drug interactions and pharmacy entry is
adjusted.
Advantages
• Automated dispensing cabinets, which can potentially handle
hundreds of different medications, available from a number of
manufacturers.
• Automated cabinets can also enable providers to record medication
charges upon dispensing, reducing billing paperwork.
• Decreased wait time for medication can lead to less frustration for
nursing staff and prevent conflict between the pharmacy and nursing
staff.
• Shorter waiting time ensures improved patient comfort and care.