EDICATION DISTRIBUTION SYSTEMS

History

50 years ago:
Space was small
Few personnel
Pharmacists role - purchase and prepare
medications
Two distribution methods:
1. Floor stock system
2. Patient prescription system
Distribution Methods: Floor Stock System
Consisted of individual storage area on each nursing unit called drug
room
Pharmacist responsible for stocking
- never sees the physicians order
Nurse reads the physicians order
- selects the drug
- prepares medication
- administer to the patient
Required minimal pharmacy resources
Assumed safe
Patients charged for drugs administered to them/billed per diem
Distribution Methods: Patient Prescription System

Nurse prepares the medication

Pharmacist reviews patient order
- dispenses and charges the patient a 2 to 5-day
supply of medications
- do not have the access to patient information
Unit Dose System
Pharmacy-coordinated method of dispensing and controlling
medications in health care institutions
Pharmacist - dispenses medications contained in unit dose
packages, ready to administer, not more than 24-hour supply
Nurses administer medications, not prepare
Safe
Offer more opportunities for pharmacists to help improve the
medication use cycle
Most cost-effective (U.S. General Accounting Office, 1971)
Floor stock and individual prescription system were error-prone
Floor Bulk containers stored on unit indefinitely
Stock Containers not patient-specific
No review of drug order by pharmacist
Patient Patient-specific containers with 2-day to 5-day
Prescription supply of drug stored on unit
Drug order transcribed by the nurse and reviewed
by pharmacist
No patient information available to pharmacist
Unit Dose Medications contained in unit dose packages
and dispensed to ready-to-administer form
No more than a 24-hour patient-specific
supply on unit at any time
Pharmacist reviews every order and checks
against patient records
ole of Unit Dose on Drug Use Control
Advantages of Unit Dose System

1. Reduction of Medication Errors

2. Efficient use of pharmacy and nursing personnel
3. Decrease in total cost of medication-related activities
4. Minimization of credits for drugs
5. Improved drug control and drug use monitoring
6. More accurate patient billing
7. Greater control by pharmacist over work patterns and
scheduling
8. Reduction of inventories maintained on nursing units
What did Unit Dose System Do?
Duplicate Carbon Copies of Original Orders: prevented
transcription errors
Patient Medication Profile: provided the pharmacists an
access to patient-specific information:
Patients name and location
Generic name of the drug
Dosage in metric system
Frequency of administration
Route of administration
Signature of Prescriber
Date and hour the order was written
Unit Dose System

Developed the credibility of pharmacists

to provide clinical pharmacy services by
demonstrating reliable and responsive
distribution of medication for patients
upon the foundation of excellent
medication distribution system
Unit Dose Process
New order is On the unit,
Medication is entered to MAR nurse checks the
written and by the nurse: medication
sent to Medication against the
pharmacy Administration patients MAR
Record

Medication is
Pharmacist Nurse
delivered to the
receives the administers the
unit by courier,
order and medication to
pneumatic tube,
reviews it the patient
or by a nurse

Nurse records
the when and
Order is entered Technician fills
how the drug
to the patients the order and
was
medication checked by
administered to
profile pharmacist
the patients
MAR
Order Delivery

Courier
Pneumatic Tube System: pressurized tubes that
move small containers throughout institutions
Decentralized pharmacy satellites
Computerized Prescription Order Entry (CPOE):
Pharmacists can review order any place they have
computer access to patient specific information
Will most likely become the primary form of order
delivery
Medication Administration Record
Updated on the nursing unit
Linked with the patients medication profile
In completely computerized record keeping system:
MAR is instantaneously updated with each new order
entered in the pharmacy medication profile
Some cases: a hard copy of MAR is printed every 24
hours with each new order
Unit of Use Package
Aka Unit dose packages
Reduces the burden of nurses in the administration
process
Contains:
Correct dose
Ready-to-administer form
Label:
Name of the drug
Strength
Expiration Date
Bar code identifier
On the nursing unit

Medications are stored in:

1. Automated dispensing cabinets
.Access is restricted
2. Locked medication carts
.Two sections: common area where bulk
medications and floor stock can be stored, and
individual patient medication bins
Unit Dose Cart Exchange System

Patient medication bins are filled by the pharmacy

technicians and checked by a pharmacist before
being exchanged
Each day, medications in this cart are exchanged
with new ones for the day
Any unused medication from the cart is evaluated:
credited to the patient since many systems charge
upon dispensing
Cart replenishment process starts again, where
medications are placed in the cart for the next day
For new medication order

Pharmacist receives the new medication order from

the patient or nurse
Pharmacist provides medication to the floor before
the next cart exchange
Drugs will be delivered either through a courier
or pneumatic tube system
Pnuematic Tube System
- reduce manual labor
- staff can focus more on patient-care
activities
Other Drug Delivery Methods and Storage

For PRN (as needed) medications

- Kept in pharmacy and dispensed upon request
- Send small amount to each patients
medication drawer
Emergency drugs
- available throughout the hospital
- placed in tamper-evident boxes or carts crash or code carts
- are in ready-to-administer form
 Locked cabinets
- Limited access (nurse-in-charge)
- Prior to giving controlled medication doses, the nurse takes
an inventory of the medication and documents the doses
removed
- Discrepancies are reported immediately
- Inventory at each shift change is done to ensure that no
diversion takes place
Automated Dispensing cabinet
- Located on patient care areas to replace traditional floor
stock systems and unit dose cart exchange systems
- Allow nurses to have quick drug access
 Models of Unit Dose Delivery
Centralized Decentralized
Main pharmacy- Pharmacy satellites- physicians
orders and dispensing of first
Medication orders, drug
dose of the medication
packaging, cart fill, and Can offer clinical services
dispensing. Specialized services in
pediatrics, oncology, critical
care, emergency room and
operating room
Needs to be supported by a
central pharmacy
Centralized Model
Advantages Disadvantages

Pharmacist is not able to

All resources can be localized
interact with physician and
into one area nurse
Drug inventory can be Clinical services are limited
minimized
Decentralized Disadvantages
Drug inventory control within the
Advantages
department is more complex
Faster order filling
because of multiple pharmacy
Drugs are immediately available for
administration to the patient location for the same drug,
Increased physician and nursing particularity infrequently
satisfactory prescribed drugs
Expansion of clinical services More equipment is required
Fewer dispensing errors
Decreased need for floor stock medications
Use of technology to automate
Drug control and accountability are greater and mechanize the drug
distribution system component
of pharmacy service will require
more hardware and software
 Rise of Technology to Assist Drug
Distribution
Pharmacy robot
Centralized
Bar-code
packaging
 Pharmacy robot
Pharmacy patient profile Bar code is
system transferred to the generated for the
robot patient

Robot scans
barcode
Next patient

Places medication in Robot recognizes

the bin and puts it on patients
a conveyor belt medication needs
Pharmacy Robot
Advantages Disadvantages
Special preparations are
Replaces manual cart fill
needed before it can be loaded
Accurate because of the bar-
into the filling system
coding
All medications should be in
Frees up time for pharmacist
unit dose packages that can be
and technicians held by the robot
Inventory cost is reduced Maintenance
 ADCs (automated dispensing
cabinets)
Decentralized
Patient care areas
Allows nurses to have
quick access to the drugs
but may have full
accountability for audit
trail
ADCs
Advantages Disadvantages
Fast order filling while maintains
control of medication use Reduced pharmacy oversight of
When linked to a pharmacy drug medication use that could lead
profile, pharmacist can control first to medication errors
doses of new drug orders Increase of drug inventory in
Drug waste reduction patient care areas
Control narcotic drugs by providing
drawer types with restrictions
uture of the medication use system
As technology progresses many Manual tasks involved
with the medication distribution system like:

Fill the medication cart(manually)

Replenish the robotic dispensing device
Refill the ADC

Automation will further decrease the number of people

involved with the dispensing of medication.
Who would provide the drugs to nursing units?

In the future, drugs may be provided to nursing units from

pharmacy within the institution or it can be outsourced
to wholesalers or another providers.

Most pharmacies will likely maintain a mix of centralized,

decentralized, and ADC.
 Sources of medication for nursing units

OUT SOURCING wholesal

er

Automate
d Decentrali
Dispensin Nursin zed
g Cabinet g Unit Pharmacy

Central
IN SOURCING Pharmacy
Pharmacists value

The pharmacists' value lies in using professional

judgment in the:
Profiling of medication order
Monitoring the medication use process
Taking medication histories
Conduction discharge counseling and the like
Technicians value

The technicians value lies in the distribution

process.
 Requirements of any Good
Medication Distribution System
1. Pharmacists must always maintain quality control over
drug use in institution where patients are assured of
receiving the right drug at the right time in the right
way.

Pharamcists need to be involved:

. Efforts to prevent the diversion of drugs
. Reduce medication errors and waste
. Minimize adverse drug events
. Ensure that drugs maintain potency through proper
storage and handling
2. Any system must be efficient in how it achieves drug
use control.

Trade-offs may need to be made in some tradtional

practices that may not be cost-effective.
3. Current and future medication distribution systems
must always attend to the needs of those served by
these systems:
Patients
Physicians
Nurses

The systems need to reduce the effort and inconvenience

associated with the medication use process and
enhance patient outcomes.