Drug Distribution System

Pharmacy services in a hospital can be defined as ‘Premises licensed for the retail sale or supply to the hospital outpatient department and/or inpatient areas of drugs which have  qualified licensed persons & indulge in compounding of drugs’

The obvious roles and responsibilities of a pharmacy department are demand estimation , compounding and manufacturing of sterile and non-sterile products, quality control of drugs purchased  and of those compounded and manufactured in the pharmacy, supply of drugs to inpatients ,wards ,various sensitive patient care units like ICU,OT, Accident and Emergency, maintenance of drug formulary system ,in-service training ,teaching , research , clinical trials and sometimes even patient education. The following illustration describes these roles further.

Illustration 1

 

There are three main types of drug distribution systems in use in hospitals. They are the floor stock system, individual patient order system and the unit-dose method.

 Illustration 2

 

Floor Stock System is maintained by nursing staff that are responsible for administering and reordering of drugs. Stock is maintained at the patient care division or the floor level.  Even though this system gives easy access to stock by the nurses, it is labour intensive for them, lacks effective control, is space occupying, nurses may not be qualified to administer alternative drug in case the drug prescribed may not be available and leaves large nursing inventories.

In Individual Patient order System, pharmacy request for each drug ordered by the physician for the patient is sent to the pharmacy by the nurse and the pharmacist fills the order with a multiple day supply and dispenses it to the ward. The nurse removes the drug from multiple dose packing, prepares identification labels if needed and administers the drug. By use of this method, Inventory is reduced in the nursing unit and the drug prescription of each Patient gets addressed bed wise. But usually, delays are experienced between drug ordering and having them dispensed and also give rise to medication errors.

 In the Unit dose method, the pharmacist receives a direct copy of physician’s drug order or prescription. Medications are packaged and dispensed in ready to administer form from the pharmacy. In this method, not more than 24 hours of supply is sent to the wards at one time. This method is Safer for the patients is safer for the patients as chances of medication errors are low and is more efficient and economical for organization .

Pneumatic chutes are used these days by the pharmacy to send medication required for patients to the wards thus reducing the need for movement and saving on time.  Electronic prescription and computerized physician order entry CPOE) systems in modern hospital information systems are other upcoming trends.

Any drug distribution used by a hospital should aim primarily at nullifying and controlling medication errors which may be due to prescriptions by physician, indenting, noting of drugs, dosage, strength etc., drug dispensing and administration. Some control measures could be prescription audit, use of hospital information system, CPOE, e-prescription, standard noting practice. Pharmacy Policies should clearly state supervisor’s roles and authorities and define the rights of drug administration.

Illustration 3

 

Besides these, hospital formulary should be carefully developed by the therapeutic committee and audited periodically. Periodic and annual stock verification should be performed with care and caution. Audit and monitoring of prescriptions, medication, administration and adverse drug reaction rate should be done.