DRUG DISTRIBUTION

SYSTEM
 Outline:
◦ OUT PATIENTS:
✔ Definition and types of Outpatient
◦ 1. Emergency, 2.Tertiary care, 3. Primary care
✔ Location and layout of out –patient dispensing
✔ Scope of the activities of pharmaceutical services
✔ Minimum standards for ambulatory care pharmaceutical services
✔ Out patients dispensing routines

◦ IN PATIENTS:
✔ Definition and types of in-patients services
◦ 1. Individual prescription order system, 2. Complete floor stock
system, 3. Combination of individual and floor stock system, 4. Unit
dose dispensing
✔ Step by step outline of unit dose procedure
Out-patient:
◦ Out patient refers to patients not occupying beds in a
hospital or in clinics, health centers and other places .

◦ out patient load into three categories.

1. Emergency
2. Tertiary
3. Primary care
1. Emergency:
❑ A person given emergency or accidental care for conditions
which require immediate medical attention

❑ Suffering from serious health conditions or illness

❑Such as RTA, MI or any kind of emergency

2. Tertiary care:
❑ He is directly to outpatient department by his attending medical
practitioner for specific treatment other than an emergency
treatment

❑ Such as patient suffering from chronic diseases like

carcinogenesis, cardiovascular problems, arthritis, asthmatic
etc.
 3. PRIMARY CARE:
❑ Primary care is majority care

❑ It describe for meeting the great majority of daily personal health

needs

❑ Most primary care is used by patients who are ambulatory i.e. are
able to move about freely

❑ This majority includes the needs for preventive health maintenance

and evaluation and management on continuing basis of general
discomfort, early complaints, symptoms, problems, and chronic
aspect of diseases
Location of out-patient dispensing:

❑ It should be located on the ground floor of the building.

❑ The out patient dispensing area should be provided with

proper seating arrangement.

❑ The pharmacy receives its supplies from medical stores

weekly but emergency supplies can be obtained at any
time.
 Layout of out-patient
department(OPD)
◦
◦
Racks of storing
drugs
◦
Refrigeration Dispensary

Offic
e

Windows for dispensing

Seating arrangement for

◦ patients
SCOPE OF THE ACTIVITIES OF
PHARMACEUTICAL Services:
◦ The scope of the activities of pharmaceutical services in ambulatory
care settings may vary with practice, but commonly includes-
❑ Obtaining and documenting patient medication histories.
❑ Monitoring the safety and efficacy of drug therapy through the
maintenance of medication profiles
❑ Providing drug information to prescribers and other health care
practitioners
❑ Assisting prescribers in the proper selection and adjustment of the
drug therapy through application of pharmacokinetic and other
principles
❑ Utilizing assessment skills in the management of acute and chronic
diseases and providing appropriate referrals to the other health
care providers
 Scopes….
❑ Detecting and reporting adverse drug reactions,
◦ interactions, and non-compliant patient behaviour
❑ Educating and counselling patients and general public in the proper
use of medication
❑ Participating in the drug-use review, patient care audits, and
clinical drug investigation
❑ Participating in the education program of the health care provider
❑ Supervising the storage, preparation, dispensing and administration
of medications in the patient care area
❑ Developing systems for the delivery of pharmacy services in the
institutional settings and the community
❑ Developing and utilizing systems for fiscal managements and
reimbursement
 Minimum standards for ambulatory
care pharmaceutical services:
◦ Services to ambulatory patients are an important part of many
institutional pharmacy programs. The essential elements of any
ambulatory care pharmaceutical service program are as follows:
❑ The ambulatory care pharmacy program must be directed by a
qualified pharmacist.
❑ All medications dispensed to patients will be completely and
correctly labelled and packaged in accordance with all applicable
regulations and accepted standards of practice.
❑ Upon dispensing a new medication, the pharmacist will ensure that
the patients or his representative receives and understand all
information required for proper use of drug.
❑ All drugs in ambulatory care services areas will be properly
controlled.
Out patients dispensing routines:
• The dispensing pattern involved in providing clinic patients as
well as those patients being discharged with “take home drugs” is
identical with that carried on by a community pharmacy.

• In both instances, a prescription is written by the physician and

he patients takes it to the pharmacy where it is compounded by a
pharmacist.

• If there is to be waiting period, the will make use of a prescription

call check which numerically identified the patients, and the
finished prescription.
◦
In-patient:
◦ In-patients are those patients ,who require hospitalization i.e
get themselves admitted in the hospital, stay there for
treatment till they are discharged.
◦ They are four systems in general use for dispensing drugs for
inpatients. They may be classified as follows;
1. Individual prescription order
2. Complete floor stock system
3. Combination of individual & floor stock system
4. Unit dose system

◦
1. Individual prescription order
system:
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 pharmacists

❑ It provides the interaction of pharmacist-doctor, nurse and the patient

❑ It provides clear control of inventory

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 drugstore of a hospital.

• Drugs on the nursing station or ward may be

divided in to-

A . Charge floor stock drugs

B . Non charge floor stock drugs.

A. Charge floor stock drugs.

⮚ These are medicines that are kept stocked at all

times in the nursing station.

⮚ The patient gets charged for each dose of medicine

they receive.

⮚ The hospital's Pharmacy and Therapeutics Committee

(PTC) decides which medicines will be included in
this stock for different wards.

⮚ Once the list is made, it's the hospital pharmacist's

job to ensure these medicines are always available.
B. Non charge floor stock drugs.

Non charge floor stock drugs are the medications that

are placed at the nursing station for the use of all patients
on the floor.
It is divided into two methods.

a. Drug basket method.

b. Mobile dispensary unit.

In simple terms, charge floor stock drugs are those for which
patients are billed individually for each dose they receive, while
no charge floor stock drugs are available for all patients on the
floor to use without direct billing.
Drug basket method:

• Nurse fill a requisition form for delivery of drugs at their

floor;
• When there is an empty container, the nurse place it in the
drug basket.
• Once the basket is completed, it then delivered to the floor
via messenger service.
Mobile dispensary:

⚫ Alternately drug mobile dispensary can be use.

⚫ It is specially constructed stainless steel

⚫ 60 inches high

⚫ 48 inches wide and 25 inches deep

⚫ It is mounted on bottom tires

Advantages / Disadvantages of
complete floor stock system
◦ Advantages:

1. Ready availability of the required drugs

2. Elimination of drug returns

3. Reduction in the number of drug order transcriptions for

the pharmacy

4. Reduction the number of pharmacy personnel required

 Disadvantages:
1. Medication errors may increases because the review of
medication orders is eliminated

2. Increased drug inventory on the pavilions

3. Greater opportunity for pilferage

4. Increased hazards associated with drug deterioration

5. Lack of proper storage facilities on the ward may require

capital layout to provide them and

6. Greater inroads are made upon the nurses time.

Difference between Charge floor stock
system Non-charge floor stock
◦ Charge floor stock system ◦ Non-charge floor stock
• The charges are made in the system
system patients account after
• The charges are not made
the have been administered
in the account directly
from the stock drugs.
even after the drug have
• Every dose of the drug been administered.
administered to the patients
• This system charges are
are charged .
made indirectly to the
• Only those dose are charged patients.
which are expansive can
• The cost of the drugs are
rarely used.
not high as they are mostly
• Floor stock list is prepared used in tablets, capsules.
which is sent to make the
• A pre-determined list is
drugs available to all the
prepared by nursing
nursing station drug have
station.
been administered
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 prepared 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 .
4. Unit dose dispensing:
Those medications which are ordered ,packed ,handled
administered and charged in multiples of single dose units
containing a predetermined amount of drug or supply
sufficient for one regular dose

❑ A single unit package is one which contains one complete

pharmaceutical dosage forms

e.g.- tablet, capsule.

Advantages of unit dose system:

• Patients received improved services round the clock and are

charged for only those dosages which are administered to
them

• All doses of medications required at the nursing station are

prepared by the pharmacy, thus allowing nurses more time for
direct patient care

• Medication errors are decreased because of direct check by

the pharmacist

• Excessive duplication of orders and paper work at the nursing

station and pharmacy are eliminated

• A decrease in the total cost of medication related activities

Advantages….
• Improved overall drug control and drug use monitoring

• More accurate patient billing for drugs

• The elimination and minimization of drug credits

• Greater control by the pharmacist over pharmacy workload

patterns and staff scheduling

• Greater adaptability to computerized and automated procedure

regarding medication orders and delivery system.

• The pharmacist can get out of the pharmacy and onto the wards
where they can perform their intended function as drug consultants
and help providing the team effort that is needed for better patient
care
Disadvantages:
• It requires more space since packaging material increases
the bulk of dosage forms

• It requires increased number of skilled and lay personnel in

the pharmacy

• The cost of medication is increased to the patient due to

increased handling charges.
❑ Two methods of dispensing unit doses are:

1. Centralized unit-dose drug distribution system (CUDD)

2. Decentralized unit dose drug distribution system (DUDD)

1.Centralised 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 re transferred from the pharmacy to the indoor

patient by medication cards
2. Decentralized unit dose dispensing:
This operates through small satellite pharmacies located on
each floor of the hospital.

Procedure:

▪ Patient profile card containing full date, disease , diagnosis is

prepared

▪ Prescription are sent directly to the pharmacist witch are

then entered in the patient profile card

▪ Pharmacist checks medication order

▪ Patient profile card and prescription order is filled by

pharmacy technicians
Step–by step outline of unit
dose procedure
• Upon admission to the hospital, the patient is entered into the
system. Diagnosis, allergies and other pertinent data are entered
on to the patient profile card
• Direct copies of medication orders are sent to the pharmacist
• The medication order are entered on to the patient profile card
• The pharmacist checks medication order for allergies, drug
interactions etc.
• Dosage schedule is coordinated with the nursing station.
• Pharmacy technician picks medication orders, placing drugs in
bins of transfer cart per dosage schedule
• Medication cart is filled for particular dosage schedule delivery
Step by step outline….
• Pharmacist checks cart prior to release

• The nurse administers the medication and makes appropriate

entry on the medication record.

• Upon return to pharmacy, the cart is rechecked.

• Throughout the entire sequence, the pharmacist is available for

consultation by the doctors and nurses. In addition he/she is
maintaining surveillance for discontinued orders.
Reference-Hospital and Clinical Pharmacy by
Pratibha Nand , Dr. R. K. Khar