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HOSPI > Drug Delivery System > Flashcards

Drug Delivery System Flashcards

1
Q

The act of the pharmacist in supplying one or more drug products to a patient, usually in response to an order from a prescriber, utilizing his/her professional knowledge, judgment, and skills.

A

Dispensing

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2
Q

In dispensing, the pharmacist ___ , ___ , ___ and ___ the maintenance and delivery of medicines along with the information needed for its proper storage and administration.

A

plan, develop, control and monitor

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3
Q

Dispensing in hospital pharmacy is intended for its ___ and ___ at all economic levels.

A

in/out patients and the general public

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4
Q

RESPONSIBILITIES OF THE PHARMACISTS

The ___ and ___ of medicines on a 24-hour service, including dangerous and investigational drug products.

A

distribution and control

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5
Q

RESPONSIBILITIES OF THE PHARMACISTS

To ___ of an adequate supply of medicines for the patients of the hospital.

A

ensure the availability

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6
Q

RESPONSIBILITIES OF THE PHARMACISTS

To ensure rational drug therapy and patient pharmaceutical care through the application of the ___ .

A

“rule of right”

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7
Q

Dispensing is the major activity of the pharmacy service as governed by the ___ , ___ , ___ , and ___ .

A

Generics Acts of 1988;
Dangerous Drugs Act;
Food, Drugs, Devices and Cosmetics Act;
Pharmacy Law

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8
Q

Dispensing is used to describe the various methods by which the pharmacy service ___ , ___ and in turn, ___ to the patients care areas

A

receives drug orders;
prepares the drug for distribution;
distributes the drugs

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9
Q

DISPENSING PROCESS

The consistent and repeated use of good dispensing procedure is vital in ensuring that errors are noticed and corrected at all stages of the dispensing process. Before dispensing a drug product, the pharmacist must clearly understand which medicine is being requested. Prescriptions must be ___ ; if not, ask the prescribing physician for clarification. ___ shall only be entered on emergency cases.

A

legibly written;
verbal order

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10
Q

Dispensing Process: (5)

A
  1. Receive and Validate prescription
  2. Understand and Interpret prescription
  3. Prepare items for dispensing
  4. Record issuance in the stock card
  5. Issue medicine to patient with clear instructions and advise
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11
Q
  1. Receive and Validate prescription
  • Check if the prescription is appropriate for the ___ , ___ , and ___ of the patient.
  • Check if the medications prescribed are appropriate in ___ , ___ , and ___ .
  • Confirm ___ since there might be a risk of mixing-up prescriptions as there are people with similar names.
A

age, weight and sex;
form, dosage and strength;
name of patient

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12
Q
  1. Understanding and Interpret prescription
  • The pharmacist must ___ and ___ before withdrawal from stock bottle, shelf or drawer.
  • If the prescription is not complete, ___ and ask him/her to complete the prescription before dispensing.
A

read the label of a drug product at least three times and compare it with the prescription;
contact the prescriber

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13
Q
  1. Prepare items for dispensing: (5)
A

a. Write the label
b. Pick the right medicine from shelf
c. Measure/count quantity from the stock container
d. Pack and label medicine
e. Check dispensed medicine against prescription and stock container

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14
Q
  1. Prepare items for dispensing

A. Write the label

Every prescription for internal and oral use shall bear a ___ . Prescription for external use, shall bear a ___ indicating the components of such prescription and the word “For external use only” at the bottom of the label. (Section ___ )

A

white label;
red label in blank ink;
(Section 31 R.A. 5921- Pharmacy Law)

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15
Q
  1. Prepare items for dispensing

A. Write the label

For poisonous substances, the pharmacist must affix to the box, bottle or other package another label or ___ upon which shall be printed in large letters the word ___ and a vignette representing a skull and bones before delivering it to the purchaser (Section ___ ).

A

red paper;
“POISON”;
Section 34 R.A. 5921- Pharmacy Law

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16
Q
  1. Prepare items for dispensing

A. Write the label

Must be affixed to the drug containers to remind other health personnel to take extra caution in handling, delivery and administering the medications concerned. These labels are used for high alert drugs, chemotherapeutics, and parenteral admixtures.

A

Auxiliary labels

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17
Q
  1. Prepare items for dispensing

A. Write the label

In dispensing unit dose products which are no longer in their original containers but have been transferred to small bottles, cans, boxes, plastic and/or paper envelopes and the like, the pharmacist shall place legibly on the label the following information

A

A.O. No. 63 s. 1989 Labeling Requirements

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18
Q
  1. Prepare items for dispensing

Labelling Requirements: (8)

A
  • Name of the Patient
  • Generic Name of the Drug
  • Brand name, if any
  • Manufacturer
  • Dosage Strength
  • Expiration Date
  • Direction for use
  • Name of the Pharmacist
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19
Q
  1. Prepare items for dispensing

A. Write the label

Must be printed clearly. In addition, the pharmacist must fully explain to the patients and/or relatives the written instructions for them to understand.

A

Labels

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20
Q
  1. Prepare items for dispensing

B. Pick the right medicine from shelf

A

Read the label of the container and check it with the prescription.

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21
Q
  1. Prepare items for dispensing

C. Measure/Count quantity from the stock container

For capsules/tablets in container, hands must never be in direct contact with the medicine. Counting can be done with a ___ , ___ , ___ .

Labels should be rechecked for the drug name and strength.

A

clean piece of paper and spatula;
tablet counter;
lid of the container in use or other clean surface

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22
Q
  1. Prepare items for dispensing

D. Pack and Label medicine

Tablets and capsules should be packed in a sealed ___ .

Liquids require ___ and ___ . Never mix two liquids together.

A

plastic dispensing bag;
clean bottles and caps

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23
Q

Drug Distribution Systems (2)

A
  • Out-Patient Services
  • In-Patient Services
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24
Q

OUT-PATIENT DRUG DISTRIBUTION

Usually in an uncontrolled environment where vital signs are not routinely recorded between clinic visits, and medications may sometimes be taken erratically by the patient.

A

Ambulatory Patient

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25
Q

OUT-PATIENT DRUG DISTRIBUTION

It becomes apparent that the medication-related problems of ambulatory patients may often differ from those typified by ___ . The ambulatory patient may often be responsible for his/her own health care

A

hospitalized patients

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26
Q

OUT-PATIENT DRUG DISTRIBUTION

In addition, with regard to prescribed drugs, it is possible that the patient may be taking ___ obtained from outside pharmacies or other retail outlets or medications obtained from family members or friends. Therefore, it is likely that no single health professional may be completely aware of the patient’s total medication regimen.

A

over-the-counter medications

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27
Q

OUT-PATIENT DRUG DISTRIBUTION

Face with these potential problems, the hospital pharmacist should, in addition to properly dispensing prescription, provide extended pharmaceutical services like ___ . This type of service will guide the patient in the proper use of medication and a better understanding of the medication he/she is taking

A

drug counseling

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28
Q

LOCATION OF DISPENSING AREA

There are three (3) equally suitable provision for this area:

A
  • A separate out-patient pharmacy
  • A combined in-patient and out-patient unit service provided from the same window
  • A combined in-patient and out-patient unit with service provided from separate windows
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29
Q

LOCATION OF DISPENSING AREA

A
30
Q

LOCATION OF DISPENSING AREA

The most important consideration should be for the out-patient pharmacy to be near to the ___ and ___ . If the clinics are distantly removed from the in-patients area, it is necessary for the out-patient pharmacy to be isolated from the in-patient pharmacy.

A

out-patient clinics and the general public

31
Q

LOCATION OF DISPENSING AREA

This will require planning for ___ and ___ from the main pharmacy, to the outpatient pharmacy or it may require separate ordering for the outpatient pharmacy. It will also require additional manpower to provide an efficient and effective pharmaceutical care.

A

transporting drugs/medicines and supplies

32
Q

DISPENSING PRACTICES

Dispensing pattern in filling out-patient and discharge prescriptions is similar to that of the community pharmacy. The difference particularly lies in large volume out-patient pharmacy which follows this assembly line procedure. (4)

A
  • One person receives the prescription from an “in window”
  • Another person types the labels
  • Passes to the pharmacist who fills the prescription
  • Hands it to the patient at the “out window”
33
Q

ADDITIONAL EXTENDED SERVICES: (4)

A
  • Patient Counseling
  • Patient Education
  • Developing Patient Medication Profiles
  • Provide Drug Information
34
Q

ADDITIONAL EXTENDED SERVICES

The out-patient pharmacy may provide one or more services depending on the available staff and time. (4)

A
  • Patient Counseling
  • Patient Education
  • Developing Patient Medication Profiles
  • Providing Drug Information
35
Q

ADDITIONAL EXTENDED SERVICES

A special counseling area or room may be used and reserved initially for those patients having the potential for certain medication-related problems such as patients taking multiple medications or having certain diseases.

A

Patient Counseling

36
Q

ADDITIONAL EXTENDED SERVICES

The pharmacist is intimately involved with medications, it is logical that educational services may be provided to patients receiving potentially dangerous medications, those prescribed on confusing schedules or administered by unusual means.

A

Developing Patient Medication Profiles

37
Q

ADDITIONAL EXTENDED SERVICES

The pharmacist may provide general drug information which will assist patients in gaining a better understanding of their medications and how to take them.

A

Providing Drug Information

38
Q

Out-Patient Activity:

A
  1. Received by pharmacist
  2. Filling of prescription
    • selection
    • labelling
    • pricing
  3. Dispensed to patient
    4.1. Receipt of payment
    • statistics and reports (free, cash, charge)
      4.2. Prescription filed
    • regular prescription file
    • narcotic prescription file
39
Q

IN-PATIENT DISTRIBUTION SYSTEM

The hospitalized patient is usually confined in a specific section where ___ , ___ , and ___. The pharmacist focuses in providing medications on a 24-hour basis.

A

environment is controlled,
vital signs are routinely recorded,
and medications are scheduled and administered by trained professionals

40
Q

IN-PATIENT DISTRIBUTION SYSTEM

Methods: (4)

A
  1. Individual Prescription Order System
  2. Floor Stock/Ward Stock System
  3. Combination of Individual Prescription Order and Floor Stock System
  4. Unit Dose Drug DIstribution System (UDDDS)
41
Q
  1. INDIVIDUAL PRESCRIPTION ORDER SYSTEMS

Advantages: (4)

A
  • Allows the pharmacist to directly review medication orders.
  • Provides interaction among pharmacists, physicians, nurses, and patients.
  • Provides proper charges and bill of all medications issued to patients.
  • Provides an efficient inventory control.
42
Q
  1. INDIVIDUAL PRESCRIPTION ORDER SYSTEMS

Disadvantages: (4)

A
  • Possible delay in obtaining the required medication.
  • Increased personnel requirements of the Pharmacy Service, which is necessary for the individual prescription dispensing function.
43
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

A ___ of each drug product is stored in the nursing station in advance. The nurse is totally responsible for all aspects of the unit dose preparation as well as administration and refill of used item from the pharmacy.

A

bulk supply;
nurse

44
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Issuance of medicines must be controlled quantities for emergency use in treatment areas ( ___ , ___ , ___ , ___ ). Used most often in government hospitals in which charges are not made to the patient.

A
  • Operating Room (OR)
  • Recovery Room (RR)
  • Delivery Room (DR)
  • Intensive Care Unit (ICU)
45
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Advantages: (5)

A
  • Ready availability of the required drugs for the patient.
  • Elimination of unused drug returns to the pharmacy service.
  • Less responsibility for the pharmacist.
  • Reduction in the number of drug order transcriptions for the pharmacy service.
  • Reduction in the number of pharmacy service personnel required.
46
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Disadvantages: (7)

A
  • Increase medication errors incidents as pharmacists has lesser chance to review medication orders.
  • Increased drug inventory at each nursing station or other patient care areas.
  • Increased hazards associated with drug deterioration/expiration.
  • Greater opportunity for pilferage.
  • Additional capital funds may be necessary to provide proper storage facilities for medicines in every patient care area.
  • Additional nurse’s time required for handling medicines.
  • May result to inaccurate patient charges.
47
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Drugs on the nursing station are known as Floor Stock Drugs: (2)

A
  • Charge Floor Stock Drugs
  • Non-Charge Floor Stock Drugs
48
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Are those medications that are stocked on the nursing station at all times and are charged to the patient’s account after they have been administered.

A

Charge Floor Stuck

49
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Are group of medications that are placed at the nursing station for use of all patients on the pavilion and for which there may be no direct charge to the patient’s account.

A

Non-Charge Floor Stock

50
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Dispensing of Charge Non-Floor Stock Drugs: (4)

A

Charge Plate
Envelope System
Drug Basket Method
Mobile Dispensing Unit

51
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Dispensing of Charge Non-Floor Stock Drugs:

Making use of plastic or metal card prepared on patient’s admission.

A

Charge Plate

52
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Dispensing of Charge Non-Floor Stock Drugs:

The pharmacist fills pre-labeled envelopes with specific drugs and places a predetermined quantity on the nursing unit. When the drug is administered to the patient, the nurse places the patient’s name and room number on the envelope and places it in her “out” basket. This is later picked up by the messenger service and is delivered to the pharmacy where it is priced and forwarded to the accounting office.

A

Envelope System

53
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Dispensing of Charge Non-Floor Stock Drugs:

The night shift nurse checks the medicine closet, utility room and drug refrigerator inventory of supplies against a master list provided by the pharmacy through the nursing station. The nurse places a check mark on the number required for each drug on the requisition for floor stock supplies. Where there is an empty container, she places it in the drug basket. Once the procedure is completed, the drug basket containing the empty containers and the requisition for floor stock supplies is then sent to the pharmacy service.

A

Drug Basket Method

54
Q
  1. FLOOR STOCK/WARD STOCK SYSTEM

Dispensing of Charge Non-Floor Stock Drugs:

Utilizes a specially constructed stainless steel truck; (60 inches high, 48 inches wide, 25 ½ inches deep, 8 inches balloon tires). Two mobile units are put into operation in order to permit one unit to be use while the other is being serviced.

A

Mobile Dispensing Unit

55
Q
  1. COMBINATION OF INDIVIDUAL PRESCRIPTION ORDER AND FLOOR STOCK SYSTEM

Under this system, the primary means of dispensing is the use
of ___ but utilizes or combined
with limited number Floor Stock items (common nonprescription medicines like Paracetamol and other drug products such rubbing alcohol, disinfectants).

A

Individual Prescription Order System

56
Q
  1. COMBINATION OF INDIVIDUAL PRESCRIPTION ORDER AND FLOOR STOCK SYSTEM

Restricting ___ to such items provide best control to reduce the chance of error. Deciding which medicines should be placed on the floor stock list depends on the need of the patients in the ward. Most commonly used in hospitals for unit-dose dispensing and individually charge patients for drugs.

A

floor stock drug products

57
Q
  1. UNIT DOSE DRUG DISTRIBUTION SYSTEM (UDDDS)

Flow of Unit-Dose Dispensing:

a. ___ is sent to the pharmacy.
b. Pharmacist verify the orders and place drugs in ___ .
c. For accuracy, the pharmacist must ___ before the carts are transported to the wards.
d. A ___ is placed on top of the cart. The nurse uses this form to check and then affix his/her signature on the time of each medication administration.
e. The next day, the ___ from the wards and the pharmacist fills with unit doses for the next 24 hours.

A

Physician’s medications order;
unit-dose carts;
check each drawer;
medication administration recording form;
carts are retrieved

58
Q
  1. UNIT DOSE DRUG DISTRIBUTION SYSTEM (UDDDS)

Basic Aspects of Unit Dose System:

  • Medicines are contained in ___ .
  • They are dispensed in as “ ___ ” form as possible.
  • ___ of doses is delivered to or available anytime at the patient area.
A

single unit packages;
ready-to-administer;
less than 24-hour supply

59
Q
  1. UNIT DOSE DRUG DISTRIBUTION SYSTEM (UDDDS)

Advantages:

  • Improved pharmaceutical service, ___ are issued and charged to patients.
  • Creates a ___ by allowing pharmacists to interpret or check a copy of the physicians’ original order before dispensing, and nurses to check dispensed medications before administering, thus, reducing medication errors.
  • ___ from the issuance to administration. It is a major safety measure that helps reduce drug distribution errors and also helps in retrieving the package in the event of a drug recall.
A

24-hour doses of medications;
double check system;
Ensures identification of a drug product

60
Q
  1. UNIT DOSE DRUG DISTRIBUTION SYSTEM (UDDDS)

Advantages:

  • Extends ___ throughout the hospital from the time the physician writes the orders to the time the patient receives the unit dose.
  • Transfers the responsibility of intravenous preparations and drug reconstitution to the ___ .
  • Since all doses of medications required at the nursing station are prepared by the pharmacy service, the nurses are ___ for direct patient care.
A

pharmacy service coverage and control;
pharmacy;
allowed more time

61
Q
  1. UNIT DOSE DRUG DISTRIBUTION SYSTEM (UDDDS)

Advantages:

  • Eliminates ___ at the nursing station and pharmacy service.
  • Eliminates ___ .
  • Eliminates ___ .
  • Reduces ___ ;
  • Promotes more efficient ___ ;
  • Pharmacists can perform their intended function as ___ through provision of professional advises needed for better patient care.
A

excessive duplication of orders and paper works;
returns/credits;
pilferage and drug waste;
revenue losses;
utilization of professional and non-professional personnel;
drug consultants

62
Q

Methods of Dispensing Unit Doses: (2)

A
  • Centralized Unit Dose Dispensing (CUDD)
  • Decentralized Unit Dose Dispensing (DUDD)
63
Q
  1. Unit Dose Drug Distribution System (UDDDS) Methods: (3)
A
  • Centralized
  • Decentralized
  • Combination of Centralized and Decentralized
64
Q
  1. UNIT DOSE DRUG DISTRIBUTION SYSTEM (UDDDS)

Where all drug products are stocked and distributed to patients taken directly from the Central Pharmacy.

A

Centralized

65
Q
  1. COMBINATION OF INDIVIDUAL 4. UNIT DOSE DRUG DISTRIBUTION SYSTEM (UDDDS)

Where the drug products are distributed to patients taken from satellite pharmacies.

A

Decentralized

66
Q
  1. UNIT DOSE DRUG DISTRIBUTION SYSTEM (UDDDS)

Refill doses, packaging and IV
additive preparations.

A

Centralized (Central Pharmacy)

67
Q
  1. UNIT DOSE DRUG DISTRIBUTION SYSTEM (UDDDS)

Only for starter and emergency
doses.

A

Decentralized (Satellite Pharmacy)

68
Q

GUIDELINES ON FILLING OF ORDINARY Rx

  • Where the generic name is not indicated;
  • Where the generic name is not legible and a brand names which is legible is indicated;
  • Where the brand name is indicated and instructions added (such as the phrase “no substitution”) which tend to obstruct, hinder or prevent proper generic dispensing).

Shall not be filled. The pharmacist shall advise the prescriber on the problems to be able to get the proper prescription.

A

Violative Prescriptions

69
Q

GUIDELINES ON FILLING OF ORDINARY Rx

  • Where the brand name precedes the generic name;
  • Where the generic name is the one in parenthesis;
  • Where the brand name is not in parenthesis.
  • Where more than one product is prescribed on one prescription form

Shall not be filled. Such prescriptions shall be kept and reported by the pharmacist to the authorized official for appropriate action.

A

Erroneous Prescriptions

70
Q

GUIDELINES ON FILLING OF ORDINARY Rx

  • When only the generic name is written but is not legible;
  • When the generic name does not correspond to the brand name;
  • When both the generic name and the brand name are not legible;
  • When the drug product is not registered with the FDA.

Shall not be filled. The pharmacist shall advise the prescriber of the problems to be able to get the proper prescription.

A

Impossible Prescriptions

HOSPI (6 decks)

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