DRUG
DISTRIBUTION
SYSTEMS
MEDICATION
ORDER
Medication Order
It
is the equivalent to the prescription in the
retail pharmacy.
All
medications including prescription and
over-the-counter (OTC) , ordered in a hospital
require a medication order.
Medication
process begins in the pharmacy
department when a copy of the original
medication order is received in the
department. The original physicians order
can be a carbon copy or an electronically
Medication order
It
must contain the following information:
1.
Patients name, height, weight, date of birth, medical record
number, medical condition, and known allergies
2.
Drug and dosage schedule
3.
Instructions for preparing the drugs
4.
The exact dosage form of the drug
5.
The dosage strength
6.
Direction for use
7.
Route of administration
Types of Medication Orders
1.
Scheduled medication order given on a
continuous schedule according to medication order
2.
Scheduled intravenous (IV)/Total Parenteral
Nutrition (TPN) solution order given by the
injectable route and must be prepared in controlled
environment
3.
PRN (as needed) medication order may be given
in response to a given parameter or condition. If the
medication does not occur, the medication is not given.
Types of Medication Orders
4. Controlled substance medication order request for
narcotic that requires controlled documentation of
procurement, dispensing and administration.
5. Demand/Stat medication order a medication that is
needed for a rapid response to a given medical condition.
6. Emergency medication order A medication that is
needed in response to a medical emergency e.g. cardiac
arrest.
7. Investigational medication order A medication that is
given under the direction of research protocols.
DRUG
DISTRIBUTION
SYSTEMS
Drug Distribution Systems
In
the early days of institutional pharmacy,
the pharmacists role was distributional
developing systems of drug delivery that
reduced the waste and medication errors.
As
the time progressed, pharmacists have
become more and more involved in clinical
responsibilities.
Despite
the expanding clinical role of
pharmacists, distribution of drug products will
continue to be an important responsibility of
Drug Distribution Systems
The
Floor Stock System
Patient prescription System
Unit dose Drug Distribution System
Automated Drug
FLOOR STOCK
SYSTEM
Floor Stock System
It
was developed because of the increased
demand for utilization of hospitals coupled
with the growing shortage of professional
personnel.
The
idea was to scrutinize present procedures
and develop new systems for the distribution
and dispensing of drugs.
Since
then, Floor Stock System was
developed.
Floor Stock System
1. No Charge Floor Stock Medications
It consists of a predetermined list of medications that are available in the patient
care area of the hospital for use at no specific charge to the patient
Usually these items are inexpensive pharmaceuticals that have common use
(Example: alcohol, lotion, water for injection, normal saline, etc)
2. Charge Floor Stock Medications
They are medication that are available at patient care area of the hospital and
for which a charge is made to the patient.
Certain medications for Example: emergency/Operation room medications that
are required to be used almost immediately after the physician prescribes them,
and it is not practical to wait until the nurse dispenses them from the pharmacy
Emergency Drug List /Crash Carts/Code Carts
Floor Stock System
Process:
In the floor stock system,
the role of the pharmacy in the medication
Drugs
process is product related only.
Drug are
purchase
d in bulk
and
multidose
dosage
forms.
are
issued to
patient
care
units via
a bulk
drug
order
from and
are
stored in
medicati
on
Once
placed in
medication
room, drugs
for
administrati
on to
patients are
prepared by
a nurse.
A
medication
could be
used for
more than
one
patient. In
this system
the nurse is
responsible
for most
steps in
medication
Disadvanta
Advantages
ges
Ready availability of the required
drug
Potential for medication errors
Elimination of drug returns
Potential for drug diversion and
misappropriation resulting in
economic loss
Reduction of drug order
transcriptions for the pharmacy
Greater opportunity for pilferages
Reduction in the pharmacy
personnel required
Increased inventory needs
Provides opportunity for clinically
oriented pharmacist
Inadequate space for medication
storage on the patient care unit
INDIVIDUAL
PATIENT
PRESCRIPTION
SYSTEM
Generally used by the small and or private
hospital because of the reduced manpower
requirements and the desirability for
individualized service
The
nurse
orders
medicati
on on a
specific
patient
form.
The
pharmac
ist
dispens
es a 3day
supply
of
medicati
on
The
nurse
still
prepare
s the
medicati
on for
administ
ration to
the
patient
When the
drug was
discontinue
d or the
patient was
discharged,
the unused
drugs were
credited to
the
patients
account
Advantages
Disadvantag
es
All medication orders are directly
reviewed by the pharmacist
The pharmacy has little patient
information and cannot properly
monitor medication utilization
Provides for the interaction of
pharmacist, doctor, nurse, patient
Possible delay in obtaining the required
medication
Provides closer control of inventory
Increase cost of the patient
UNIT DOSE DRUG
DISTRIBUTION
SYSTEM
Unit dose drug distribution
system
UDDDS
medications are medications
which are ordered , packaged, handled,
administered and charged in multiples
of single dose units containing a pre
determined amount of drug or supply
sufficient for one regular dose.
Unit dose drug distribution
system
Key Elements:
1.
The pharmacists receives the physicians original order
2.
A pharmacist reviews the mediation order before the
first dose is dispensed
3.
Medications are contained in single-unit packaging
4.
Medications are dispensed in as ready-to-dispensed
form as possible
5.
Not more than 24-hour supply of doses is delivered or
available at the patient care area at any time
6.
A patient medication profile is concurrently maintained
for each patient
PATIENT
MEDICATION
PROFILE
Patient Medication Profile
It
is the primary record used by pharmacists to document patient
medications.
This
allows pharmacists to gain access to patient-specific information
including the following:
1.
Patients name and location
2.
Generic name of the medication
3.
Dosage in metric system
4.
Frequency of administration
5.
Signature of physician
6.
Date and hour the order was written
Purpose of Patient Medication
Profile
To
help improve drug prescribing practices by
promoting safe and rational use of drugs
To
detect and prevent potential drug
interactions
To
detect and prevent potential Adverse Drug
Reactions in sensitive patients
To
detect and prevent Iv additive
incompatibilities
To
detect and prevent potential drug
toxicities
MODELS OF UNIT
DOSE DELIVERY
UDDDS
Centralized Unit Dose
Dispensing
Emanates from the main pharmacy
(a centralized location)
Medication orders are received in
the central pharmacy, and all of the
processing for patients occurs
there: order processing, drug
To operate the system effectively deliver system
such as medication carts, dumbwaiters,
pneumatic tube system or other means are
required to send a copy of the physicians original
medication order to the pharmacy for direct
interpretation and filling.
Advantages:
Resources
Drug
can be localized into one area
inventory can be minimized
Disadvantages
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
UDDDS
Decentralized Unit Dose Dispensing
It operates through small satellite
pharmacies located on each floor of the
hospital. The main pharmacy in this system
becomes a procurement, storage,
manufacturing and packaging center serving
all satellites.
Decentralized Unit Dose Dispensing
A physician
order is
routed to a
designated
satellite
where the
pharmacist
there
processes
the order
The
pharmacist
dispenses
the first
order of
medication
directly to
the nurse
station
Since
pharmacist
s are
closely
located to
patient
care areas,
it is very
easy for
physicians
and nurses
to stop by
and ask
Decentralized Unit Dose
Dispensing
Advantages:
Faster
order filling
Increased
physician and nurses satisfaction
Better
professional relationship between
pharmacy and other departments
Expansion
Fewer
of clinical services
dispensing errors
Decreased
need for floor stock medications
Unit Dose Order Process
Medication orders written
and sent to pharmacy
Pharmacist receives and
reviews order
Order is entered into the
drug profile
Procedure in Decentralized Unit
Dose System
Order is filled by technician and
checked by pharmacist
Medication is sent to floor by
courier, by pneumatic tube or
with a nurse.
New order is recorded onto the
MAR
Procedure in Decentralized Unit
Dose System
On the unit, nurse checks the
medication against the patients
MAR
Nurse administers the medication
to the patient
Nurse records when and how the
drug was administered on the
patients MAR
Procedure in Decentralized Unit
Dose System
Upon return to the
pharmacy, the cart is
rechecked
Throughout the entire sequence, the
pharmacist is available for consultation by
the doctors and nurses. In addition, He is
maintaining surveillance for discontinued
orders.
Medication Administration Record
It
is a record of all current medications prescribed
for each patient.
It
contains information on the drugs, administration
times, and direction for use.
It
is used by nurses to know what medication for
each patient should receive at what time and how.
It
is also used to document that the drug was given
by whom and what time.
Pharmacy
Medication Profile and the nursing MAR
are linked with each institutions computerized
medication system
Equipment used
Solid oral packaging machine
Filling Machines
Hand Capper
Advantages
Patients
receive improved pharmaceutical service 24 hours a
day and are charged for only those doses which are
administered to them
Allowing
the nurse more time for direct patient care
Reducing
medication errors because it allows the pharmacist
to check or interpret a copy of the physicians original order.
Eliminates
duplication of orders and paperwork at the
nursing station and pharmacy
Eliminates
credits
Conserves
space in nursing units
Eliminates
pilferage and drug waste
Advantages
Extends
pharmacy coverage and control
throughout the hospital
Communication of medication orders and
delivery systems are improved
The pharmacist can get out of the
pharmacy and onto the wards where they
can perform their intended function as
drug consultants and help provide the
team effort that is needed in better
patient care.
AUTOMATED
DISPENSING
SYSTEMS
Robotic Fill System
Use of robots to fill medication carts
Advantages:
It replaces tedious manual cart fill
Accuracy
Bar-Codes
removes confusion over sound-alike/lookalike drugs
Extra time for personnel
Overall
inventory cost is reduced
Robotic Fill System
Use of robots to fill medication carts
Disadvantages:
Special preparation is needed before
medication can be loaded
Money and effort on the part of the
pharmacy
Robotic breakdowns or routine
maintenance
Automated Dispensing Cabinets
It
is a point of use medication storage device located on
patient care areas. They allow nurses to have a quick drug
access to medications but provide accountability by having
audit trail for all medications removed.
Advantages
Quick
Waste
order filling while still maintaining control
is reduced because the nurse only needs to remove a
dose from the cabinet is needed (Increase level of accuracy)
Disadvantages
Reduced
pharmacy oversight of medication use
Increase
drug inventory on patient care areas
Increase
burden for nurses on medication use
