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Medication

distribution system

level (3) - lecture (6)

Pharmaceutical
Services Offered in
Hospitals
Product Researc Teachin
g
h
Service
Service Service
s
s
s
In-patients
(hospitalize
d)

Outpatients
(ambulatory
)

Suppor Clinical
Services
t
Service
s

In-patients
(hospitalized
)

Out-patients
(ambulatory)
2

(2) Product services

Introduction :

Are provided to ensure the quality of


the drugs used within the hospital
It includes mainly:
Drug

storage
Preparation for administration
Distribution to the patient care units

Product Services for


Hospitalized Patients
Medication
Distribution
Systems

Floor Stock Distribution


System

Patient Prescription
System

3
4

Combined System
Unit Dose Distribution
System

Intravenous
Admixture
System

TPN compounding
Service
Oncology Pharmacy
Service

Radiopharmacy
Service
Intravenous Additives
Services

3
4
5

Medication Distribution
Systems
(MDS)
1
2

Floor
Stock
Patient
Distributio Prescripti
n System on System

Combined
Stock-Patient
Prescription
System

Unit Dose
Distributio
n System
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Floor stock
distribution system :

Nurses order drugs in bulk supplies from


the pharmacy; the drugs are stored in a
medication room on the ward. Nurses
prepare medication cups for each patient
during medication administration cycles.
The correct number of pills must be taken
out of the correct medication container for
each cycle and taken to the patient for
administration (Liquids also)
Nurses are responsible for any necessary
labeling.
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Floor stock :

This system delegates drug order


interpretation, drug inventory, and drug
preparation on the patient care units to the
nurse.
Compounding I.V admixture mostly by
nurses
The pharmacist sees only transcribed drug
requisitions sent by nursing personnel.
The pharmacist dispenses multiple doses,
bulk supplies of drugs which are not labeled
for a specific patient
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Floor stock :
Advantages of floor stock system:
1- Availability of medicine at nursing
site.
2- Reduction in the number of
pharmacy personnel .
3- Reduction in the number of orders
received in the pharmacy

Floor stock :
Disadvantages:
1. High incidence of
medication errors

wrong patient
wrong drug
wrong dose
wrong route
wrong time
Prescription monitoring

2. No clinical role for


Patient counseling
the pharmacist
Drug therapy monitoring
Doctor contact
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Definitions :

Medication error
Drug misadventure
Medication administration record
(MAR)
Inventory
Cost-effectiveness
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Ward drug storage


areas

Controlled drugs cupboard


Cupboard for medicines intended for internal use
Cupboard for medicines intended for external
use
Area to store disinfectants
Refrigerator to store drugs: temperature
controlled with thermometer being used
calibrated, clean and lockable
Clean area for intravenous fluids.
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Monitoring ward
stocks

Pharmacy staff should establish a working


relationship with nurses and ward manager
Ensure cleanliness and hygiene
Advise on appropriate storage conditions
Remind ward staff to carry out stock
rotation when new stock is received
Correct stock levels
Ensure appropriate monitoring of
refrigerators
Check controlled drugs cupboard.
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Patient prescription
system :

The nurse rather than the pharmacist


continued to play the major role in drug
preparation and drug order evaluation
The nurse transcribes this order onto a
Medication Administration Profile (MAP)
and generates a drug order for pharmacy
The pharmacist dispenses a (2 5) day
supply of medications which is labeled for
a specific patient
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Advantages of Patient
Prescription System over FSS
:
Starting clinical role for
the
Prescription monitoring
pharmacist
Reduce medication
errors

drugs are labeled

MAP

Limit the supply to prevent


continuing treatment without review
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Patient prescription
system :

Disadvantages:
Limited

clinical role for the pharmacist

No

sufficient information necessary to


devise a PMP

Applicable

only in small hospitals


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Combined stockpatient prescription


system
: medicines are supplied as
In this system,
floor stocks for those drugs in more or
less frequent use and as prescription
dispensed items for all others.

The advantages and disadvantages of this


combined system are similar to those of
the complete floor stock and prescription
order systems
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Unit dose distribution


system :

when physicians write orders for inpatients, these


orders are sent to the central pharmacy (by
pharmacists, nurses, other personnel, or
computer). Pharmacists verify these orders and
technicians place drugs in unit-dose carts. The
carts have drawers in which each patients
medications are placed by pharmacy technicians
one drawer for each patient. The drawers are
labeled with the patients name, ward, room, and
bed number. Before the carts are transported to
the wards, pharmacists check each drawers
medications for accuracy
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Unit dose distribution


system :

Unit dose is a system in which


medications are dispensed to wards
for administration to a specific
patient, in a specific dose, at a
specific time, on a regular basis.
In this system, each dose is
individually prepared, packaged,
and labeled
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Unit dose distribution


system :

Unit dose is any physical quantity of a drug


specified by a physician to be administered
to a patient at one time, and not requiring
any significant physical or chemical
alterations before being administered

The unit dose system is the most cost


effective of all pharmacy distribution
systems when the entire spectrum of drug
delivery activities within a hospital is
considered
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Unit dose distribution


system :
The key elements of unit dose drug
distribution are as follows :
1. The pharmacist receives the physician
original order
2. A pharmacist review the medication order
3. Medications are in single-unit packaging
4. Medications in as ready-to-administered
form
5. Not more than a 24 hours
6. Patients medication profile is maintained
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Methods of unit dose :

There are two main way that a


pharmacy can be structured to
provide unit dose services :
1. centralized model
2. decentralized model

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1. Centralized model :

Emanate from the main pharmacy


The medication order received in central pharmacy, and
all of the processing for patient occurs there (order,
packaging, cart filling and medication dispensing)

Advantages :
All resources can be localized in one area
Drug inventory can be minimized
Disadvantages : (the biggest one)
The pharmacist is not able to directly interact with the
physician and nurse
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2. Decentralized model
:

Characterized by pharmacy satellites


distributed evenly throughout the institution
A physician order is routed to this satellite
The pharmacist there process the order and
dispense the first dose of the medication
directly to the nurse unit
Centralized pharmacy still exist to provide
cart fill and serve the decentralized satellite
The Pharmacist can go into the patient care
areas speak with a patient or provide clinical
services
Very easy for health care professional to ask
questions
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2. Decentralized model
:
Advantages :
Fewer dispensing error (medication error)
Increase nurse and physician satisfaction
The pharmacist-physician interactive role
began to emerge
The pharmacist has a more active role in
the medication cycle
Expansion of clinical services
Decrease floor stock
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Unit dose system :


Disadvantages:
Increased cost
Time consuming
Increased staff
Frequent ordering

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Unit dose trial (1) :

Bates et al identified :
530 medical errors
10,070 orders
5.3 error
100 order/51 days
(in 3medical unit)
Of the 530 errors :
5 (0.9%) resulted in an ADEs

The most common reason for an error was a


missing dose of medication, which occurred in 53%
of orders
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Trial (2) :
In a systems analysis of 334 errors (in 2
hospital) causing
264 adverse drug events
130 errors (39%) resulted from physician
ordering
40 (12%) involved transcription and
verification
38 (11%) reflected problems with
pharmacy dispensing
126 (38%) were from nursing
administration
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Trial (3) :

In further research, the


investigators found that :
errors resulting in preventable
adverse drug events were more
than likely to be those in the
administration stage (34%) than
those in the dispensing stage
(4%) of the medication use
process.

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Trial (4) :
Medications use spans multiple stages:
Prescribing and ordering
56%
Dispensing
4%
Transcribing
34 %
Administrating
34%
Monitoring
?%

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Benefit risk ratio :

Because the advantages of the


unit dose system far outweigh the
disadvantages

most hospitals have converted to


the unit dose system
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