DISPENSING TO IN

PATIENTS
• A patient who is retained or admitted in a hospital so that he/she
occupies a bed in hospital for medical care is called Inpatient
• Dispensing:
• Distribution:
• Administration:

• Medication order taken by nurse or messenger to pharmacy

• Pharmacist fill the order and dispense
• Sent to the nursing unit
• Nurse administer and record in patient profile
Distribution
• The supply, delivery, and transitory storage of
drugs at patient care areas (nursing Units/
Satellite pharmacies) other than main hospital
Pharmacy for subsequent patients utilization is
called Distribution
 In every distribution system, some guidelines
must be followed
• Before the initial dose of medication is administered the
pharmacist should review the prescriber’s original order or a
direct copy.
• Drugs dispensed should be as ready for administration to the
patient as the current status of pharmaceutical technology will
permit, and must bear adequate identification including (but not
limited to); name or names of drug, strength or potency,
routes(s) of administration, expiration date and such other
special instructions as may be indicated.
• Facilities and equipment used to store drugs should be so
designed that the drugs are accessible only to physician,
pharmacists or his nominee, or to nurses authorized to
administer such drugs.
• Facilities and equipment used to store drugs should be designed
to facilitate routine inspection of the drug prior to the time of
administration.
• When automated system is in use as dispensing tool, it is
mandatory that provision be made to provide suitable
pharmaceutical services in the event of failure of the device.
• The In house packing or packaging must permit and facilitate
drug use and ensure its stability
Methods of Distribution
depends upon size of hospital, availability of professional
personnel, and budgets

(i) Individual Prescription Order System.

(ii) Floor Stock System.
(iii) Combination of (i) and (ii).
(iv) The unit dose method.
Individual Prescription Order System.
• Small and or private hospitals---- because of the reduced
manpower requirement and the desirability for individualized
service.
• Physician prescribe and patient obtained from hospital
pharmacy
• Benefits
• All medication orders are directly reviewed by the pharmacist.
• Provides better interaction of pharmacist, doctor, and patient.
• Provides closer control of inventory.
• Drawbacks
• Possible delay in obtaining the required medication and the
increase in cost to the patient, increase workload on pharmacy
Floor Stock System
• Traditional system of drug distribution. Involves separate
storage facility in a secured area on each patient care floor.
• May include many bulk supplies of medications
• Limited selection of drugs is approved by the PTC
Charge Floor Stock Drugs
• Stocked at patient care area and charged to the patient’s account
after administration
• Selection of charge floor stock drugs:
• Responsibility of PTC with consultation with Pharmacist and
administration
• Responsibility of Pharmacist after determination of list of floor
stock is.
• Availability of drugs
• Enforcement of decision of PTC
• Periodical submission of list to PTC for re-evaluation

• Demand is made on a requisition form that contains name,

dosage form and route of administration and sent to Pharmacy.
• The pharmacist dispense and prepare charges to the patient
account
• Non-Charge floor Stock Drugs:
• Placed at nursing stations and administered to the patient
without direct charging to the patient’s account
• Cost is included in the per day cost of the hospital room
• Include single doses of the drugs and frequently used drugs
with low costs.
• Selection of non- charge floor stock drugs:
• Based on cost of preparation, frequency of use, quantity used
and effect of the hospital budget. Usually this list is small.
• PTC
 Complete Floor Stock System
• Both charged and non charged medicines are placed at nursing
units/pharmacy cabinets
Advantages of floor stock system:
• Ready availability of the required drugs.
• Elimination of drug returns.
• Reduction in the number of drug order for the pharmacy.
• Reduction in the number of pharmacy personnel required.
Disadvantages of floor stock system:
• Medication errors may increase because the review of medication orders
is eliminated.
• Increased drug inventory on the pavilions.
• Greater opportunity for pilferage.
• Increased hazards associated with drug deterioration.
• Lack of proper storage facilities on the ward may require capital cost to
provide them.
•
 To overcome demerits of floor stock system,
• decentralised pharmacies (Satellite Pharmacy) under direction
of pharmacist are operated.
• Use of unit dose system also resolves problems associated with
floor stock system
Combination of individual drug order-floor
stock system
• This system utilizes simultaneously an individual drug order
system as primary means of dispensing along with a limited
floor stock system
• Used now a days in most hospitals and is modified to include
unit dose medications
Automated dispensing system
• Nurses or messengers carry medication order to pharmacy and
pharmacist evaluate the order before dispensing.
• This is a time consuming procedure
• To over come this problem now a days computer based automated
system is established computer aided dispensing (CAD)
• This include networking between prescriber, pharmacist and
nurse’s computer
• The prescriber enters the medication order which is displayed on
the computer of pharmacist.
• Pharmacist evaluate the order and after assurance about the
correction of order, print the required labels and automatically the
inventory is adjusted. The message is conveyed to the nursing unit
computer about the dispensed order.
• After administration, the nurse enters this fact into patient
medical record.
• If account branch is also connected with this network, charge is
entered into patient’s account.
• CAD helps prescriber to know about the drug in inventory, not
prescribed correctly according to formulary and also alert nurse
if she fail to administer the drug within time.
• CAD saves time of nurse, messenger and minimizes delay in
distribution. Reduces chances of medication error.
• CAD also alerts about the inventory.
• Alternative method should be there in case of failure
of the system