4.

DRUG DISTRIBUTION
 Contents

Basics of OPD and IPD

Dispensing of drugs to inpatients and outpatients

Drug distribution system in Hospital

 Drug
Distribution
System

Out Patient In Patient

Services Services
Out Patient Services (OPD)

Out patient refers to patients not occupying beds in a

hospital, clinics, health centers

 Types of outpatient
 General outpatient-
Service - preventive health care, diagnosis and treatment
Confirms- discomfort, complaints, symptoms
Not comes- emergency or referred case

 Referred outpatient-
Patient - referred directly- OPD by attending physician- specific
treatment
Returns to practitioner- further treatment

 Emergency outpatient-
Emergency or accidental care- immediate medical attention
 Reasons of developing OPD

 Demand by community

 Need- hospital and physician- control on patients

 Rising cost of hospital care

 Lack of sufficient physicians

 More-Social health service

 Location of Outpatient dispensing

 No specific rule-location of outpatient dispensing

 3 provisions-

 Separate outpatient dispensing pharmacy

 Combined unit service- same window

 Combined unit service- different window

 Layout of Outpatient service

Racks for storing drugs

Refrigerator Dispensary

Out patients In patients

Office

Windows for dispensary

Seating arrangement
 Two windows

 Waiting area

 Clean, ventilated

 Comfortable seats

 Books, Magazines, News papers

 Posters
Out Patients Activity Chart
 Receipt and Issue system

 First visit of patient in OPD of Physician

 Registration counter- case paper

 General check up area- signs and symptoms recorded

 Basis of symptoms- Physician Write prescription- case paper

 Case paper – Pharmacists

 Issues Token

 Selection, Compounding, packaging, labeling, pricing

 Record- prescription
 In-Patient Services (IPD)

 Patient who stays in a hospital for treatment or admitted in

hospital for treatment

 Medications- all in-patients- 24 hrs per day.

 Make sure- receive the right medication at the right time

 Methods

1. Individual prescription order system

2. Complete floor stock system

3. Combination of above methods

4. Unit dose dispensing method
INDIVIDUAL PRESCRIPTION ORDER SYSTEM

 Medicines- regular treatment

 Prescription sheet- send to pharmacy

 Pharmacist –Dispensing of drugs

 Used- small or private hospitals

 Advantages:

 Reduced manpower requirements

 All prescription- reviewed directly- pharmacist

 Closer interaction- pharmacist, physician & nurses

 Better control- stock of drugs

 Disadvantages:

 Possibility of delay- obtaining required medications

 Increase in cost to the patient

 COMPLETE FLOOR STOCK SYSTEM

Drugs- kept at nursing station

Drugs-Administered by nurses- chart given by physician

Charge Floor
Stock Drugs

Non-charge
Floor Stock
Drugs
 Advantages:

 Drugs- Readily available for administration

 Minimum return of drugs

 Reduced in- patient prescription orders

 Reduced- number of pharmacy personnel

 Disadvantages:

 Increase in chances of medication errors

 Increased drug inventory

 Increased chances of drug deterioration

 Increased workload on nurses

 CHARGE FLOOR STOCK DRUGS

 Drugs supplied by nursing station

 Charged- patient account after each dose administration

 Charged- for every single dose administered drug

 PTC- Selection of drugs- List of charged floor stock drugs

 Stock maintained- Hospital pharmacist

 Envelope is used to dispense such drugs

 Eg-Penicillin G, Reserpine, Anti-allergic drugs, Heparin, Digoxin

 NON-CHARGE FLOOR STOCK DRUGS

 Selection of non-charged drugs based on-

 Quantity of drugs used

 Frequency of use

 Cost of drug

 Effect on hospital budget

 Methods

 Drug basket method

 Mobile dispensary unit

 Drug Basket Method
 Nurses checks requirement of medicines per day
 Nurse fill- requisition form
 Sent Empty container with requisition form -to pharmacy
 Pharmacists fill container – delivered to floor
 Mobile Dispensary Unit

 Specially constructed stainless steel truck

 It measures

 60 inches high,

 48 inches wide

 25 inches deep
 UNIT DOSE DISPENSING

 Medications which are ordered , packaged, handled, administered

and charged
 Multiples of single doses units containing predetermined amount

of drugs or supply sufficient for one regular dose

ADVANTAGES

 Patient receives improved services

 Charged- only those doses which are administered

 Nurses get more time- direct patient care

 Medication errors are reduced

 It eliminates wastage of drug

 Avoids duplication of orders

 Accounting become easier

 Paper work is less at nursing unit

DISADVANTAGES

 Require more space

 Packaging material increases the bulk

 Requires- more number of skilled personnel in the pharmacy

 The cost of medication - increased to the patient

 Increased handling charges

 Centralized Unit Dose Dispensing

 For In-patients- drugs- dispensed in unit doses

 Drugs- stored in central area of the pharmacy

 Dispensed – at time- dose is given to the patient

 Drug Delivery devices

 Pneumatic tube system

 Decentralized Unit Dose Dispensing

 Other name- Satellite pharmacy

 Located on each floor of the hospital

 Patient profile card prepared after admission to the hospital

 Prescription - sent directly to the pharmacist- enters data in patient

profile card.
 Pharmacist- monitors complete drug therapy

 Junior pharmacists fills Patient profile card and prescription order

 Pharmacist check cart before release

 The nurses administer the drugs and make the entry in their records.
 Packaging Programme

 Each patient receive medication strip with individual doses in

individual pouches.
 Information on pouch- Date, time of administration and

medication name
 All patients needs to do is to tear and open pouch at right time as

prescribed and take medications

 Medicine pouch

Packaging Machine
Distribution of drug to ICCU/ICU/NICU/ Emergency ward

ICCU: The Intensive Coronary Care Unit (ICCU) is a place

where patients are given a considerable amount of medications
Cardiac disorders like heart attack, Cardiac arrest.

ICU: (Intensive care unit): Critically ill or injured patient

NICU: (Neonatal intensive care unit): Specilize care unit for
infants of first 28 days
Distribution of drug to ICCU

 The majority of the medications prescribed were from the

WHO's essential drug list.

 Tablet aspirin is the most usually prescribed medicine.

Promethazine, heparin, hydrocortisone, buprenorphine,

streptokinase, metoprolol, pentazocin, and frusemide are
among the reatment most commonly utilized injections.
The and her proportion of drugs prescribed by their for at
generic names is lower.
 The generic name of a drug should be used when prescribing

it.
 The cost of medications is considerable for patients.

 Antibiotics are used less frequently.

 The death rate is very low.

 Intensive Care Unit (ICU)

The following is a list of the eight most commonly

utilized medications in emerging situations.

Adenosine Epinephrine Amiodarone

Lidocaine Atropine Sotalol

Vasopressin Procainamide
 What skills do ICU nurses require?

 Advanced cardiac life support

 Intensive care

 Resuscitation of the heart and lungs (CPR)

 Patient care is important

 Patient education

 Life-saving assistance Trauma

 Telemetry
 Neonatal Intensive Care Unit (NICU)

 organ immaturity, congenital disease, or birth related problems

are the most common reasons that neonates, especially preterm

and very preterm neonates, are brought to the Neonatal
Intensive Care Unit (NICU)
 Exposure to potential drug-drug interaction (DDI) is a
significant risk related with ADE occurrence in the NICU.
 A potential DDI is described as a prospective rise or reduction

in the activity of a specific medicine as a result of concurrent

administration of another drug,
 which could affect the pharmacological treatment's outcomes.

and finally lead to unwanted clinical consequences and even

death.
 Medications most commonly administered include ampicillin,

gentamicin, caffeine citrate, furosemide, dopamine,

azithromycin, sildenafil, ibuprofen and fluconazole
 Emergency Ward 

 Emergency Ward Medication errors are problems that result in

the inappropriate distribution of medications or the risk of patient

damage.
 As of 2014, pharmaceutical errors in the emergency department

(ED) were responsible for roughly 3% of all hospital-related

adverse effects; between 4% and 14% of drugs administered to
patients in the ED were inaccurate, putting youngsters at
particular risk
 Errors can occur if a doctor prescribes the incorrect

medication,
 if the prescription intended by the doctor is not the one

communicated to the pharmacy due to an illegibly written

prescription or a misheard verbal order,
 if the pharmacy dispenses the incorrect medication, or if

the medication is then given to the incorrect person.

 one of the ways to improve the situation is use of emergency

trolleys. In an otherwise chaotic environment, the orderly

emergency trolleys give structure, save time, and reduce confusion
 Every effort should be made to make the refilling of used or

missing items on the emergency trolley as efficient as possible. All

wards are always fulfilled with emergency medications such as
adrenaline, salbutamol puff, atropine, aspirin, furosemide,
hydrocortisone, insulin, lidocaine, and medical oxygen.
AUTOMATED DRUG DISPENSING SYSTEMS AND DEVICES

They are called as unit-based cabinet Automated Dispensing Devices

(ADD) 
Pharmacists need to implement methods to provide safety and

efficiency in medication use process

Optimization of drug delivery through Automated Dispensing Systems

(ADS)
ADS allow medications to be stored and dispensed near the point of

care;
while controlling and tracking drug distribution.
 :

Clinical and economic advantages of ADS adoption

 Before ADS implementation, nurses received boxes of

medications on the ward and refilled medicine cabinet daily
 Nurses were responsible for inventory management restocking,

checking, for expiry drugs and acquiring missing medications

 Computer controlled ADS meant that most of the medicines stored

directly in patient care unit and each drug delivery was recorded.
 The cabinets were locked and their access was gained through

passwords or fingerprints identification

 Nurses accessed all medicines stored in cabinet. After they had

selected the patient name, nurses selected prescribed medications

from the global list of medications for this patient.
 The ADS computer recorded the time, the nurse identity, the

patient name and the medications removed ADS compartments

reloaded daily on the wards by the pharmacy technician.
Implementation of ADS requires training for nurses.
 Automatic dispensing Cassettes (ADC):

 Patient specific cassettes filled with unit dose medications are

provided by hospital pharmacy and delivered to nursing drug

stations.
 The cassettes are stored in medication cabinets/carts ADCs were

introduced in 1980's. Implementation of ADCs as a part of

decentralised or hybrid medication distribution system can
improve patient safety.
 The system safely store, account for and dispense individual doses

of medications at the point of care. Restricting individual drugs

such as high risk medications and controlled substances to unique
drawers within the cabinet, the medication security can be
improved the system safely store, account for and dispense
individual doses of medications at the point of care.
 Though pharmacies are using ADC technology since 1980's

manufacturers are constantly improving ADCs to meet changing

needs and health standards in the industry.
Automated Dispensing Cabinet
 Comparative account of ADS and floor stock system

Sr.N Automated Dispensing System Floor stock System

o
01 Nurses spend less time doing Nurses spend much time in
related activities collecting. storing, inventorying,
checking and travel between
pharmacy and patient care unit
02 Pharmacists spend more time. Pharmacists spend much less time.
03 Rational utilization of both nursing Optimal utilization of both nursing
& Pharmacy Services and pharmacy services is not
possible
04 Equipment cost is high also No such expenditure on equipment
development of interface software is and software but cost of drug
costly storage is high costly.
05 Cost of expired drugs is greatly Cost of expired drugs is high
reduced
Sr.N Automated Dispensing System Floor stock System
o
06 Reduction in number of missing missing medicine number is
medicine high
 DISTRIBUTION SUBSTANCES OF NARCOTICS AND
PSYCHOTROPIC SUBSTANCES

 The term controlled drug is defined as "substances, products or

preparations including certain medicines, that are either known to

be or have the potential to be dangerous or harmful to human
health, including being liable to misuse or cause social harm
 examples of such substances of natural origin are morphine and

allied alkaloids of opium. Coca leaves, cocaine and resins of

cannabis indica and synthetic or semi-synthetic derivatives of
morphine like heroin and pethidine
 Narcotic Drugs and Psychotropic Substances Act, 1985 has been

passed, wherein stringent provisions have been made. The records

regarding purchasing and distribution are required to be kept in
prescribed formats and maintained at different levels of operations
 For patients admitted in the hospital, prescriber must write the

medication order of controlled drugs in patients controlled drug

order sheet of patients chart. The following information is
mandatory in such drug order sheet
1. Date
2. Patients full name.

3. Patients hospital admission number.

4. Name of the drug ordered with strength.
5. Total number of doses.

6. Doctor's name and signature.

7. Signature of nurse administering the drug.
 For prescribing and dispensing controlled drugs to ambulatory

patients, the provisions specified in Rule 65 (9) and Rule 65 (21)

of Drugs and Cosmetics Rules 1945 concerned with drugs
specified in Schedule X (Narcotic Drugs and Psychotropic
Substances) be complied. These are as follows:
1. Rule 65 (a)

2. Rule 65 (21)
THANK YOU……