Dispensing of Drugs To Inpatient: Inpatients are those who get hospitalized for treatment of disease, surgery, and rehabilitation. Dispensing of drugs to inpatient falls within four categories are as follows:
- Individual prescription order system.
- Complete floor stock system (Charging Policy).
- Combination of Individual Prescription Order System and Complete Floor Stock System.
- Unit dose dispensing method.
1. Individual Prescription Order System
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This system is generally used by small and/or private hospitals because of the less manpower requirement and the appeal for individualized service.
- All medication orders are directly reviewed by the pharmacist.
- Easily interaction of pharmacist, doctor, nurse, and patient in the medication matters.
- Medication errors could avoid.
- Possible delay in obtaining the required medication and the increase in cost to the patient.
- This system cannot be used in big hospitals.
- Difficulty in dispensing of the drug in absence of a pharmacist.
2. Complete Floor Stock System (Charging Policy)
- Under this system, both pharmacy and nursing are responsible for drug distribution to patients.
- According to this system, the drugs are stored at the nursing station and administered by the nurse according to the order of the physician.
- Commonly used drugs in significant quantity are stocked on the floor stock or in the ward.
Drugs that are dispensed in a complete floor stock system are categorized as:
- (a) Charge floor stock drugs
- (b) Non-charge floor stock drugs
This system is generally used by governmental and other hospitals in which charges are not made to the patient or when the all-inclusive rate is used for charging. It does not have applicability to the general hospital.
(a) Charge Floor Stock Drug:
- Charge floor stock drugs are those where a patient is charged for every single dose administered to him.
- The selection of these drugs in various wards is decided by the pharmacy and therapeutic committee.
- Examples of drugs in this stock are antibiotics, antihypertensive drugs, anticoagulants, antiepileptic, antidepressants, diphenhydramine.
Method of Dispensing Charge Floor Stock Drugs:
- Envelop Method: In this system, the pharmacist fills prelabelled envelopes with needed drugs and gives them to a nursing ward. The nurse after receiving the envelopes writes the name and room number of patients on the envelop and put them into her basket and sent them to a pharmacy for costing and forwarded it to the billing section of the accounting office.
(b) Non-charge Floor Stock Drugs:
Drugs are dispensed to all patients on the floor on a non-charged basis.
Method of dispensing non-charge floor stock drugs:
- Drug Basket Method: This method is adopted where nurses verify the availability of medicines in all rooms as well as in the refrigerator and accordingly prepare a master list for the pharmacy. Nurses fill demand forms for the delivery of drugs on the floor. When there is an empty container, the nurses take it in the drug basket. Once the procedure is completed, the drug basket containing empty containers and demand form for floor stock supplies are sent to the pharmacy. Immediately in the morning, the pharmacy staff initiates to fill each container and dispense the requested ampoules and vials as ordered and in demand. Once the basket is completed it is delivered to the floor via messenger services.
- Mobile Dispensary Unit: It consists of a specially constructed stainless-steel trolley that is mounted on bottom tiers. According to requirements, patients get the medicine via this unit.
Advantages of Complete Floor Stock System:
- The ready availability of the required drugs.
- Minimize the return of drugs to the pharmacy.
- Reduction in the number of pharmacy personnel required.
Disadvantages of complete floor stock system:
- Medication errors may increase.
- Increased drug inventory on the porches.
- Increased hazards associated with drug deterioration.
- Lack of proper storage facilities on the ward may require capital outlay to provide them.
3. Combination of Individual Prescription Order System and Complete Floor Stock System
It is used in those hospitals, where patients have to pay for their hospitalization. In this system, they are primary means is to dispense the drugs according to the individual prescription order system. Today most the hospital uses this system. Some hospital modifies it to include the use of unit dose medications.
4. Unit Dose Dispensing
Unit dose medications are those which are ordered, packaged, and administered in single or multiple units containing a predetermined amount of drug and doses.
Advantages of Unit Dose System:
- Patients receive better health services and have to charge for those drugs and doses which are administered to them.
- Nurses get more time for patient care because all doses of medication are prepared by the pharmacist.
- To reduce the medication errors pharmacist allow checking a copy of the physician’s original order.
- Elimination unwarranted repetition of orders and paper work at the nursing station and pharmacy.
- Eliminates recognitions.
- Encourages more proficient utilization of professional and non-professional personnel.
- Reduces revenue losses.
- Preserves space in nursing units by removing bulky floor stock.
- Eliminates waste of drug and dosage.
- The system has control throughout the hospital from the time of writing of medication ordered by a physician to time up to patient receives the unit dose.
- Communication of medication orders and delivery systems are improved.
Dispensing Procedure in Unit Dose System:
This system could be followed by two ways: Centralized Unit Dose Distribution System [CUDDS] and De-centralized Unit Dose Distribution System [DCUDDS].
(a) Centralized Unit Dose System:
In this system, all the drugs are stored in the central area of the pharmacy and the drugs are dispensed to all inpatients in unit doses.
To operate the delivery system effectively, various medication carts are used to transport unit doses to the patients and to forward a copy of the physician’s original medications order to the pharmacy for direct explanation and filling.
(b) Decentralized Unit Dose System:
Unlike the centralized system, the decentralized unit dose system function through small satellite pharmacies which are located on each floor of the hospital.
In this system, the core pharmacy becomes a procurement, manufacturing, storage, and packaging center which provides all medicine to all the satellites pharmacies.
The delivery process of this system is accomplished by the use of medication carts. Such type of system can be used for a hospital with separate buildings.
Following are the step-by-step outline procedures necessitated in a decentralized unit dose system.
- During the admission of the patient in a hospital, all the patient’s related data such as diagnosis profile, medication history, any allergies, and other applicable data are entered onto the patient profile card.
- Afterward, direct copies of medication orders are sent to the pharmacist.
- Entry of all medications ordered made into patient profile card.
- Pharmacists verify the medication order for allergies, drug interactions, drug laboratory test effects, and rationale of drug therapy.
- The dosage time table is organized with the nursing station.
- According to the medication order pharmacy technician insert the drugs in baskets of the transfer cart.
- The medication cart is filled for particular dosage schedule delivery.
- Before releasing the medication cart pharmacist checks the cart.
- At the time of drug administration by a patient the nurse supervises the medication and makes appropriate entries on her medication record.
- Before sending the cart to a pharmacy for refilling it get rechecked by a nurse. A pharmacist is available for consultation throughout the complete process. In addition, he is maintaining supervision for discontinued medical orders.
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