nouf aloudah. reference chapter 18 pharmacy is responsible for the safe and effective use of...

Medication Distribution System

Nouf Aloudah

Reference Chapter 18


Pharmacy is responsible for the safe and effective use of medication throughout the entire hospital◦ Product selection◦ Procurement◦ Storage◦ Preparation for administration◦ Distribution to the patient care units◦ Appropriate prescribing◦ Guidelines are in place

“All medication cycle are managed properly”


Product dispenser to one of expanding clinical responsibilities

We were completely isolated from patient care areas, never had the opportunity to react to the actual medication order written by the physician

Repackaging bulk supplies of medications orders by requisition from nurses (who were the ultimate interpreters of all medication orders and prepared the medication for administration to the patients)

The pharmacist had no opportunity to use his or her extensive education to enhance the quality and safety of drug therapy


1960s the beginning of significant changes in the medication distribution systems as few hospitals experimented with a concept under which the pharmacist assumed the responsibility for preparing all doses of medication for patients and routinely monitored the appropriateness of all prescribed drug therapy

Genesis of drug distribution system Changes continue! increased

automation……


This lecture focuses on those distributive activities that transpire between the time a medication order is written until the prepared package is delivered by pharmacy to the nurse, physician or other health care professional for administration to the patient


BACKGROUND Historical overviewThe pharmacy signal function were the

compounding, repackaging, and relabeling of multiple dose supplies of medications into containers for subsequent dispensing and storage on a patient care unit (PCU)


BACKGROUND Historical overviewThere were two systems1. Floorstock system2. Patient prescription system


BACKGROUND Historical overview1. Floorstock system More commonly used The pharmacist dispensed multiple dose,

bulk supplies of drugs to the PCU, where nurses prepared all doses of medication intended for administration to the patient (including compounding of IV admixture)


BACKGROUND Historical overview1. Floorstock system Not labeled for a specific patient and could

therefore be used for several doses for numerous patients

It was common for 150- 200 medication to be stored in a minipharmacy on each PCU

The pharmacist sow only transcribed drug requisitions sent by nursing personnel


BACKGROUND Historical overview2. Patient prescription system The physician wrote a prescription order, the

nurse transcribed this order onto a medication administration profile and generated a drug order for pharmacy, the pharmacist dispensed a 2 to 5 days supply of medication, and the nurse maintained the bottles in stock and used a reminder system to determine when the medication was to be administered


BACKGROUND Historical overview2. Patient prescription system The pharmacist review order (but not

relevant information about patient )


Unit dose system The university of Iowa hospitals and clinics and

the university of Arkansas medical center in the middle 1960\s designed, implemented, and measured several indicants associated with a concept known as the “unit dose drug distribution system”

More active role of the pharmacist in the medication cycle with the patient reaping the benefits of a trained medication practitioners responsible for the medication cycle and the return of the nurse to patient care responsibilities


Unit dose system The pharmacist review an actual copy of the physician

order Oversee all medication preparation steps Maintain patient specific drug profiles that detail

allergy, organ function indices, and patient response data

Pharmacist-physician interactive role began to emerge US general accounting office concluded that “The unit dose system is the most cost effective of all

pharmacy distribution systems when the entire spectrum of drug delivery activities within a hospital is considered”


Unit dose system components The pharmacist review a copy of all

medication orders written by the physician prior to dispensing medications◦ Triggered the success of the unit dose system◦ Given birth to clinical pharmacy practice (the

pharmacist intervene with inappropriate drug prescription)


Unit dose system components Pharmacist review the order by transcribing the

prescription content to pharmacy recorders, or FAX it

Others used structural, multiplay medication order form which requires that medication orders be written within columns labeled for drug name, dose, route of administration and interval ◦ (no transcribing improved efficiency)◦ Eases the transition to automation entry bec. Simplifies

order entry process◦ Pharmacist and the nurse interpret order more efficiency

and accurately


Unit dose system components So a copy reach the pharmacy The Pharmacist review it and compare it

with previous drug order and information kept in patient specific medication profile, intervene with inappropriate prescription

A pharmacy technician prepares the medication needed during coming 24 hr period


Unit dose system components The pharmacist check it after preparation

for accuracy and authorization to go to PCU The majority of medications are dispensed

via a specially designed medication administration cart, which positioned in PCU until administration time

Nurse document in medication administration record after administration


Unit dose system components It is a unit dose packaging Each dose into separate package that bear

a label listing drug name, strength, or concentration, batch no, expiration date (many drugs available commercially)


Unit dose system components In PCU drugs are stored in med cart that can

be accessed only be authorized personnel


Unit dose system componentMedication that are needed prior to the med

cart is scheduled delivered to PCU via different method◦ Pneumatic tube carrier◦ Pharmacy courier system (every 30-60 min)


Unit dose system componentPRN delivered by Fulfilling of specific need requests sent to pharmacy by

the nurse Automatic placement of predetermined supply of PRN

medication into the patient\s drug bin located on the med cart

Placement of select floorstock supplies of medication on the PCU

Limited floorstock supplies of medications with low toxicity potentials are placed onto the med cart so that the nurse can quickly and easily administer a dose when needed by the patient


Unit dose system componentControlled substances (drug enforcement

agency (DEA) schedule II,III,IV,V drugs has a substantial potential for abuse and must be securely stored in the pharmacy and PCU

Handled separatelyMedication order cycle is the sameLimited floorstock storage in a secure area of

the PCU


Unit dose system componentDrugs of “blue code”Preassembled emergency drug kit to all

PCU’s of the hospital


Unit dose system design What is the scope of the pharmacy services

that will be provided is it ◦ Unit dose system?◦ Unit dose packaging and distribution program?


Unit dose system design◦ Unit dose system:

One that includes clinical pharmacy services along with drug distribution activities; that is, the two components go hand on hand


Unit dose system design◦ Unit dose packaging and distribution program:

If the scope is essentially confined to drug distribution activates

Which requires only that pharmacy prepare doses of medication , use unit dose packaging, and deliver patient specific supplies of medication to PCU on a routine basis (negligible clinical pharmacy)


Unit dose system design◦ Unit dose system:

Requires greater personnel recourses, includes high level of job content for pharmacy staff, and has a greater impact upon the quality of medication therapy


Emerge from a central location :Centralization

Or one or more decentralized pharmacy will be established :decentralization


Centralization Services are provided from a single, self

continued location within the hospital In hospital with limited space, small size, or

vertical design,


Decentralization Two or more dispensing locations commonly called

“satellite” At minimum provide pharmacist order review and first

dose dispensing Act as the base from which clinical pharmacy services are

provided Usually he central pharmacy provide services such as unit

dose medication cart fill, medication repackaging, IV admixture compounding, and controlled substance distribution, then transferred to the satellite for final delivery it to the PCU

200 m2, near one or more PCU’s, serves from 60-120 pt. for 16 hour a day


Decentralization Staffing includes one or two pharmacists

and two pharmacy technician per each day and evening shifts

Staffing is normally reduced during night hours

Actual no depend on◦ Patient population◦ Spectrum of clinical services provided◦ Presence or absence of centralized pharmacy

support services


DecentralizationSpace requirements are affected by Scope of distribution services to be provided

from the satellite◦ Complete distribution services or provision of only

first dose) Type of patient population being served


DecentralizationSpecialized pharmacy satelliteParticular service objectives are identified

relative to specific clinical services such as pediatrics, oncology, critical care, emergency room


Personal responsibilities Professional staff

◦ changed dramatically with unit dose system◦ Many of the activity once performed by the

nurses have been assumed by pharmacy personnel

◦ A study showed that it allowed the saving in nursing labor attributable to one pharmacy satellite serving 130 general medicine beds to be equivalent to 5.5 full time registered nurse positions


Personal responsibilities Professional staff

◦ From simple, recurring mechanical duties to professional services responsibilities for the hospital’s complete medication order cycle

◦ Become highly visible member


Personal responsibilities Pharmacy technician


Evaluation of unit dose services Cost analysis Improved patient careImproved patient care can lead to decreased

of hospitalization and during these days of prospective payment system decreased cost


Evaluation of unit dose services Actual cost savings are based upon decreased

expenditures for drugs and nursing personnel time associated with medication related activities. Although cost of purchasing and /or preparing unit dose med. Is higher , this cost is offset by reduction of drug inventories necessary to stock each PCU under a unit dose system

Smaller inventories on each PCU lead to reduced drug wastage, as dose the packaging per se, bec the ability to return unused doses to stock


Evaluation of unit dose services Nursing personnel requirements in

medication related activities can be reduced and reassigned existing staff to other patient care duties

A teaching hospital witness a 12% improvement in medication charting accuracy, which at that time translated into an annual increase in revenue of over $1 million


Evaluation of unit dose services Reduction in the medication errors is

sometime the basis for implementing the unit dose system◦ Double checking of each dose◦ Safety element of labeling


Evaluation of unit dose services Greatest positive impact is the subsequent

enhancement of overall clinical pharmacy services


Enhancement of clinical role The unit dose system has led to greater use of the

pharmacist’s drug therapy expertise and in turn improved patient care

With this system the pharmacist assumes responsibilities not only for delivery a carefully prepared drug product to the patient in a safe, accurate, and timely manner but also the monitoring all prescribed drug therapy to assess appropriateness of dose, suitability of therapy in light of the patient’s condition, cost effectiveness of therapy, and the potential for drug interactions

These combined activities form the foundation of clinical pharmacy practice


Evolution of other pharmacy activities Patient care services Quality assurance Productivity monitoring New technologies


Robot in pharmacy KFSH & RC robot pharmacy report


The future


Thanks

nouf aloudah. reference chapter 18 pharmacy is responsible for the safe and effective use of...

Documents

patient slide

doses of medication

medication orders

admixture slide

medication cycle

actual medication order

patient care unit pcu

background historical