Drug Distribution system in

hospital and otc drugs

SUBMITTED BY:
AMIT KUMAR KUSHWAHA
I.D NO: 17BPH088
subject: pharmacy practice
Sub code:BP703t
B.PHARM (7th SEM)
SHUATS/SIHAS
Contents:
• Introduction
• Dispensing of Drug to Inpatients
• Types of Drug Distribution System
• Charging policy and Labelling
• Dispensing of Drugs to Ambulatory
patients
• Dispensing of Controlled Drugs
• Satellite Pharmacy services
• Over the counter Drugs (OTC drugs)
Introduction

 Towards development of new and improved drug

distribution system, traditional methods of
distributions are now recognised into new system.
In hospital, the procedure of drug distribution
may be categorised into two groups:
• Ambulatory/ Outpatient Services
• Inpatient Services
DISPENSING OF DRUGS TO INPATIENT
 In patient: In patients are those who get hospitalized for the purpose of
treatment of the diseases , surgery and rehbitation.
 Drug distributions to inpatients falls within four categories are as follows:
• Individual prescription order system.
• Complete floor stock system ( Charging policy).
• Combination of above.
• Unit dose dispensing method.
1. Individual Prescription Order System:
This system is generally used by the small or private hospital because of the
less manpower requirement and the appeal for individualized service.
Advantage:
• All medication order are directly reviewed by the pharmacist.
• Easily interaction of pharmacist, doctor, nurse and patient in the
medication matters.
 Disadvantage:
• 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 drug in absence of 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 administerd by nurse according to the order of physician.
Drugs which are dispensed in complete floor stock system are categorised as:
1. Charge floor stock drugs
2. Non- charge floor stock drugs
a) Charge Floor Stock Drug:
• Charge floor stock drugs are those where patient is charged for every single
dose administered to him.
• Selection of the drugs in various wards is decided by pharmacy and
therapeutic committee. E.g of drugs are antibiotics ,antihypertensive drug,
anticoagulant, antiepileptic, antidepressant.
Method of dispensing charge Floor Stock Drugs:
 Envelop Method: In this system, pharmacist fills a prelabelled envelops
with needed drugs and gives it to nursing ward. The nurse after receiving
the envelops, writes the name and room number of patients on the
envelop and put it into her out basket and sent to pharmacy for costing
and forward to billing section of accounting office.
b) Non-Charge Floor stock Drugs:
Drugs are dispensed to all patients on floor on non- Charged basis.
Method of Dispensing non- charge floor stock drugs:
 Drug Basket Method: This method is adapted where nurses verify the
availability of medicines in all rooms as well as in the refrigerator and
accordingly prepare a master list of pharmacy .Nurses fill demand
form for delivery of drug at the floor. When there is empty container
, the nurses take it in the drug basket . ones the procedure is completed ,
the drug basket containing empty container and demand from for floor
stock supplies sent to pharmacy.
 Mobile Dispensary Unit: It consists of specially constructed stainless-
steel trolley which is mounted on bottom tiers . Accordingly to
requirement , patients get the medicine via this unit.
Advantage of complete floor stock system:
• Ready availability of the required drugs.
• Minimize the return of drug to pharmacy.
• Reduction in the number of pharmacy personnel required.
Disadvantage of Complete floor stock system:
• Medications errors may increase.
• Increased drug inventory on the porches.
• Increased hazards associated with drug deteriotation.
• Lack of proper storage facilities on the ward may require capital outlay to provide them.
c) 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, their primary mean is to dispense the drugs according to individual prescription order
system. Today most of the hospital uses this system. Some hospital modifies it to include the
use of unit dose medications.
d)Unit Dose Dispensing:
 Unit dose medications are those which are ordered ,packaged and
administrated in single or multiple units containing predetermined amount
of drug and doses.
Advantages of Unit dose system
• Patients receive better health ,service and have to charge for those drug 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 original order.
• Encourages more proficient utilizations of professional and non –
professional personnel.
• Reduces revenue losses.
• Preserves space in nurshing units by removing bulky floor stock.
Dispensing procedure in Unit dose system:
This system could be followed by two ways: Centralized Unit Dose Distribution
system [CUDDS] and De- centeralized unit dose Distribution
system[DCUDDS]
a)Centralized unit Dose system:
In this system, all the drugs are stored in central area of 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 paitents and to forward a copy of the physician
original medications order to the pharmacy for the direct explanation and filling.

b) Decentralized Unit Dose system:

Unlike the centeralized system , decenteralized 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 satelites pharmacies. To delivery process of this system is
accompolised by the use of medications carts. Such type of system can be used for a hospital
with separate buildings.
DISPENSING OF DRUG TO OUTPATIENT/ AMBULATORY
PATIENTS
 It is also called ambulatory services and refers to those patients who are
not occupying beds in hospitals or in clinics , health centers and other
places when they come for consultation and diagnosis, treatment.
Categories of Ambulatory Services:
1. Emergency Outpatients: For emergency outpatient, 24 hours services
are given who requires immediate care for the survival.
2. Referred Outpatient: These patients are reffered to the hospital for a
specific purpose due to lack of facilities available with the private clinic
practioners or patient needs extra care.
3. Special outpatient : After compilation of general check up the paitents
are asked to go for accurate diagnosis by the cinical , pathological or
radiological examination. After receiving the test report of examination
medicine is given to him.
4. General outpatient: These patients come for the general checkup and
medicines are prescribed to him. They may either undertake minor
surgery ,superficial surgery or dressing at hospital.
 Outpatient decides the image of the hospital as per the services received by them. Thus, it is essential
to look into the following aspects while designing the hospital care service.
• Separate waiting room with appropriate seating facilities.
• Sufficient number of service windows and separate facility for women.
• Provision for adequate light and ventilation.
Social aspect must be considered to carry out dispensing services.

office Refrigeration Dispensing

Windows for dispensing

Seating arrangement for patient

Fig:1 Typical layout of an O.P.D

Routine Dispensing of Out- patient:

• Patients take written prescription by the the physician, which

is given to the pharmacist where it is dispensed.
• Pharmacist guarantees that patient gets right medication.
• Pharmacist gives instructions to patient about dispensed
medicine.
• Labelling of medicine.
• Manufacturing of payments by pharmacist.
• Finally, Payment by medicine.
Out- Patient Activity chart:
SATELLITE PHARMACY SERVICES:
• Multi-speciality hospitals are generally design for the diagnosis and treatment of number
of diseases so the concept of satellite pharmacy is adopted in such hospital which have
multi-stored building in a single premises.
• Every day in morning as well as evening it become very difficult to cope up with
distribution of drug to all the wards. So such cases hospital runs Satellite pharmacy in the
form of mini pharmacies, which is situated on each floor.
• According to the hospital policies few days stock of medicine is stored in hospital. While
main pharmacy supplies all medicine to satellites pharmacies.
Advantages:
• Efficiently drugs can be distributed.
• Time of drug distribution could be reduced.
• Errors in drug distributions could be stop.
Disadvantage:
• Effect on the financial statement of hospital.
• Additional manpower is required.
 Dispensing of controlled drugs:
 Controlled subsatances is a drug or chemical which ownership,manufacture or
use is the absolutely regulated by a respective government of country such as
illegally used drugs or prescription medications. These laws enforcement leads
to prevention in the unauthorized use of such medications. These laws
enforcement leads to prevention in the unauthorized use of such
subsatances/drugs such as central analgesics (opoids), anaesthetic, steroids, etc
 These controlled substances are listed following schedules.
SCHEDULE:
• Schedule 1: The drugs under this schedule have high potential for abuse and
have no accepted medical use in the treatment ( e.g Marijuana , raw opium).
• Schedule 2: The drugs under this schedule have less as compare to above
potentials for abuse, accepted for medical treatment and have less physical
dependence and psychological dependence (e.g benzodiazepine and painkiller,
phenobarbitone codeine, steroids).
• Schedule 3: The drugs under these schedules have less as compare to above
potentials for abuse, accepted for medical treatment and have less physical
dependence and psychological dependence (e.g benzodiazepine and painkiller,
phenobarbitone, low strength codeine, steroids etc).
Hospital control procedure:
 Following procedure and person/department is responsible for manufacture and record of
control substances in hospital.
• Pharmacist in chief: Responsible for the purchase, storage accountability, and appropriate
dispensing of the control substances in the hospital.
• Head nurse : Responsible for the record of proper storage.
• Aminstration head: Responsible for the proper safequarding and handling of controlled
substances.
POLICIES AND PROCEDURE FOR ORDERING OF CONTROLLED SUBSTANCES
• Preparation of orders: Order of the control substances, should be made by using ink or
incredible pencil, typing and duly sign by the respective doctor.
• Doctors orders for administration of controlled drugs: order of control substances for
ward stock must on physician order sheet or patient chart. If the control substances for
ward stock must write on physician order sheet or patient chart .If the control substances
are not in ward stock.
• Pro Re Nata orders ( PRN order): This type of order must be discouraged except under
special circumstances.
Verbal orders: In emergency cases a doctor may give a verbal order of control substances and the nurses may write such order sheet and later duly sign by doctor within 24 hours.

• Ordering non- ward stock-controlled drugs from pharmacy: Ordering of the control
substances for non-ward stock done by doctor sign and if more substances are again
needed then doctor may sign again.
• Ordering ward stock- controlled substances from pharmacy: Ordering of the control
substances from pharmacy must be taken on the ward stock from which is completed by
placing a check mark on the opposite the name, and strength. This order from must be duly
sign by the doctor.
Procedure for Dispensing of controlled substances for In patients:
Doctors order for administration

Ordering of ward stock from pharmacy

Narcotics and controlled drugs on wards by nurse

 charges for narcotics to the paiteint

Prescribing of control Drugs in Out patient Department (OPD)

Dispensing of the controlled drugs for outpatient from pharmacy must be the made on the
prescription only by clearly mentioning the strength and the quantity with duty sign of doctor.
The information for such order includes:
1. Date.
2. Details of patients.
3. Patients hospital number.
4. Amount of drug ordered.
5. Strength.
6. Name of the prescriber and their signature.
Dispensing of control drugs for house use when pharmacy is closed:

When the patients are discharge from hospital or emergency ward at the time of closed of
pharmacy. Occasionaly such patients require drugs for use at home and such cases dispensing
of drug can be done by only on prescription which must be signed by the staff who is a
registered medical practioner and also authorized to prescribe control substances for this
purpose.
OVER THE COUNTER (OTC) DRUGS:
Over the counter drugs are available without
prescription from physicians. They are used for minor
diseases. Patients make their own choice of
drugs/brands for particular common mild diseases.
Sometimes physicians also prescribe OTC drugs for
minor aliments. Pharmacists also suggest/advice
patients for minor diseases. Over the counter drugs
OTC drugs is loose and legally undefined term. It does
not find a mention in the drugs and cosmetics Act, 1940
or the drugs and cosmetics Rules, 1945. As per the
united states Department of Food and Drug
Administration (FDA) defines OTC drugs as “drugs that
are safe and effective for use by the general public
without seeking treatment by the a health professional”.
LABELLING OF OTC DRUGS
REFERENCES:
• https://
www.researchgate.net/publication/11043023_Drug_distribution_system_in_hospitals
• https://www.ashp.org/-/
media/assets/policy-guidelines/docs/technical-assistance-bulletins/technical-assistance-bull
etins-hospital-drug-distribution-control.ashx
• Dr.Sachin V.Tembhurne,Dr.Ashwini R . Madgulkar, A Text Book of Pharmacy
Practice,First Edition,Published by Nirali Prakashan,Abhyudha Pragati,1312, Shivaji
Nagar, Page no: 51-60