Chapter 7: medication distribution systems – phar 5 lecture 5.

Medication is set to floor by courier, by pneumatic tube,

or with nurse
The role of the pharmacist has always been to ensure that patients receive the 6. New order is recorded into the MAR (medication
appropriate medication in an acceptable dosage forms that facilitates safe administration record)
administration and improved outcomes 7. On the unit, nurse checks the medication against the
patient’s MAR
Medication Distribution Methods 8. Nurse administers the medication to the patient
9. Nurse records when and how the drug was administered
1. Floor stock system on the patient’s MAR
 consisted of individual storage area on each nursing unit where
medications were kept prior to nurse preparing them to Medication delivery from pharmacy to patient care unit
administer to patients Medication category Delivery/storage method
 medications were largely unsecured Stable scheduled medications A 24-hour supply is kept in a patient-
 pharmacist’s role specific bin on the medication cart in
- place bulk containers of medications in the unit the unit
storage area -> Drug room Unstable scheduled medications Automatic delivery of medications to
- there were multiple doses in each bottle to supply the unit 1 hr before administration
all patients receiving the drug on the nursing unit time
 nurse’s role Scheduled IV/TPN solutions Automatic delivery of medications to
- prepare the patient-specific medications for both the unit before administration time
oral and IV use PRN (pro re nata – as required) A limited supply is kept in a patient-
- would read the physician order, go into the drug medications specific bin on the medication cart
room to select the drug and prepare it, and then Controlled medications A limited patient- specific supply is
administer it to the patient secured in an automated dispensing
- would request new medication (for new orders) to cabinet or in a medication cart
be stocked in the nursing unit STAT (immediately) medications Delivered by the pharmacy in response
 other characteristics to a request form the unit
- pharmacist would never see the physician order
Emergency medications Emergency drug kits are located on
- pharmacist would stock the medications
units and replaced by the pharmacy in
- it required minimal pharmacy resources
response to a request from the unit
- it was assumed to be safe
Investigational medications Per investigational drug protocol
- patients were charged for the drugs administered to
them or were billed a daily fee (per diem) for the
Models of UDS
drugs
a. Centralized
2. Patient prescription system
 Emanates from the pharmacy (centralized location)
 Involved the pharmacist to a greater extent by requiring a
 All processes occurs in the main pharmacy – order
review of the patient order
processing, drug packaging, cart fill, and medication
 Physician writes>nurse transcribes>pharmacist prepares
dispensing
 Pharmacist prepares a 2 to 5 day supply of medications for the
 Advantage:
patient
 All resources can be localized into one area
 Patients are charged for the medications dispensed
 Drug inventory can be minimized
 Pharmacist’s role
 Disadvantage:
- Review the patient order
 Pharmacist is not able to directly interact with the
- Place only limited judgement on whether it was
physician and nurse
correct or appropriate to the patient
 Clinical service is limited
 Nurse’s role
b. Decentralized
- Store the medication in the nursing unit
 There are pharmacy satellites located throughout the institution
- Prepare the individual dose for the patient
 Order is routed to a designated satellite, processed by the
- Contact pharmacist to send refills
pharmacist and dispenses the first dose of medication directly
3. Unit dose system
to the nursing station
 Pharmacy-coordinated method dispensing and controlling
 Pharmacists are closely located to patient care areas
medications in health care institutions
 There is still a need for a centralized pharmacy
 Medications contain in unit dose packages, dispensed in ready-
 Advantages:
to-administer form and not more than 24-hour supply being
 Faster order filling
delivered
 Increased physician and nursing satisfaction
 Pharmacists dispenses patient-specific medications to be
 Better professional relationships between pharmacy
administered, not prepared, by the nurse
and the departments
 Advantages
 Separation of clinical services
- Reduction in medication errors
 Fewer dispensing errors
- Decrease in total cost of medication-related
 Decreased need for floor stock medications
activities
- More efficient use of pharmacy and nursing
personnel
- Improved drug control and drug use monitoring
- More accurate patient billing for medications
- Greater control by pharmacists over work patterns
and scheduling
- Reduction of inventories maintained on nursing
units
 Other characteristics
- Placed pharmacists front and center in the
medication use cycle
- Required pharmacists to review every medication
order prior to dispensing
- Duplicate carbon copies were provided to
pharmacists to prevent transcription errors
- Required the pharmacy to have and maintain a
patient medication profile
- Carts are filled by technicians and checked by
pharmacists
 Process:
1. Medication orders written and sent to pharmacy
2. Pharmacist receives and reviews order
3. Order is entered into the drug profile
4. Order is filled by tech and checked by pharmacist