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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

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