Module 6 Drug Distribution System

Question 1

Sum of processes performed by a pharmacist from reading, validating, and interpreting prescriptions, preparing, packaging, labeling, record-keeping, dose calculation, and counseling or giving information in relation to the that dispense or provision of the pharmaceutical products with or without prescription or medication order

Answer 1

Dispensing

Question 2

•Drug distribution
•Major activity of the pharmacy service
•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 professional knowledge, judgment and skills.
•Dispensing in hospital pharmacy is intended for its in/out patients and the general public at all economic levels.

Answer 2

Dispensing

Question 3

Roles and Responsibilities of RPhs

Answer 3

*Assure compliance with all legal and regulatory requirements to effectively render drug distribution/dispensing
*Distribute and control medicines on a 24-hour service, including dangerous preparation or drug preparation containing controlled chemical and investigational drugs
*Ensure availability of affordable, quality, safe, and efficacious medicines/drug products
*Ensure that medications are delivered safely and efficiently
*Ensure rational drug use and optimum patient care through the application of the “rule of right”
*Provide drug information to physicians, nurses, allied medical staff and patient
*Counsel or educate patients on the use, adverse reactions, and side effects of medications prescribed and over-the-counter medicines

Question 4

Ensure an effective form of the correct medicine is delivered to the right patient, in the correct dosage and quantity, with clear instructions, and in a package that maintains the potency of the medicine.

Answer 4

Good Dispensing Practices

Question 5

Dispensing Process:

Answer 5

1. Ensure clean, uncontaminated and organized dispensing environment
2. Receive and validate prescription
3. Understand and interpret prescription
4. Prepare items for dispensing
5. Label the medicine
6. Make a final check - IRR of RA 10918
7. Confirm patient’s identity
8. Issue medicine with clear instructions and advice through counseling

Question 6

Types of In Patient Drug Distribution Systems:

Answer 6

• Patient Prescription System/Individual Prescription Order
• Floor Stock or Ward Stock System
• Combination of Individual Rx Order and Floor Stock System
• Combination of Floor Stock System and Unit Dose Drug Distribution System
• Unit Dose Drug Distribution System

Question 7

• All medicines are retained in the pharmacy until receipt of the physician’s initial order
•The nurse remains responsible for most aspects of the preparation of unit doses.
•One-day supply of medication is dispensed.
•This system facilitates a convenient method for instituting patient drug charges and it provides individualized patient service.
•Possible delay in obtaining the required medication and the increased personnel requirements of the Pharmacy Service, which is necessary for the individual prescription dispensing function.

Answer 7

Patient Prescription System
- Individual Prescription Order System

Question 8

•Selected drug products are stored in the nursing station in advance
•The nurse is responsible for all aspects of unit dose preparation, as well as administration and refill of used item from the pharmacy.
•Issuances of medicines must be in controlled quantities for emergency use in treatment areas (OR, RR, DR, ICU).

Answer 8

Floor Stock System
- Ward Stock System

Question 9

Under this system, the primary means of dispensing is the use of the PPS but combined with a limited number of floor stock items (common non-prescription medicines). Restricting floor stock drug products to such items provide best control to reduce the chance of error.

Which medicine are to be placed on the floor stock list depends on the need of the patients in the ward.

Answer 9

Individual Rx Order + Floor Stock System

Question 10

Mainly, the UDDDS is used. However, the floor stock is utilized for emergency situations.

Answer 10

Floor Stock System + UDDDS

Question 11

A pharmacy-coordinated method of dispensing and controlling medication in organized healthcare settings depending on the specific needs of the hospital. It can be used for medications administered by any route.

Though most pharmaceuticals could be purchased in a pre-packages, unit-dose medications, other drug products can still be purchased in bulk supplies of tablets and capsules. These can be repackaged in unit doses at the central pharmacy.

Answer 11

Unit Dose Drug Distribution System

Question 12

Basic Aspects of Unit Dose Drug Distribution System:

Answer 12

•Medications are contained in single unit packages.
•They are dispensed in “ready-to-administer” forms as possible.
•24-hour supply of doses is delivered to or available anytime at the patient care area.
•Monitoring of therapy through Patient’s Medication Profile

Question 13

The UDDDS may be applied following any of these methods:

Answer 13

•Centralized - where drug products are distributed to patients directly
from the Central Pharmacy

•Decentralized - where drug products are distributed to patients from satellite pharmacies.

•Combination of centralized and decentralized - Only starter doses and emergency doses are taken from the satellite pharmacies, refill doses are taken from the central pharmacy, as well as other operations such as packaging and IV additive preparation.

Question 14

where drug products are distributed to patients directly from the Central Pharmacy .

Answer 14

Centralized

Question 15

where drug products are distributed to patients from satellite pharmacies.

Answer 15

Decentralized

Question 16

Only starter doses and emergency doses are taken from the satellite pharmacies, refill doses are taken from the central pharmacy, as well as other operations such as packaging and IV additive preparation

Answer 16

Combination of centralized and decentralized

Question 17

Flow of Unit-Dose Dispensing:

Answer 17

1. Physician’s medication order is sent to the pharmacy.
2. Pharmacists verify the orders and place drugs in unit-dose carts.
   • Drawers in the carts are labeled with patient’s full name, ward, room & bed number
3. For accuracy, the pharmacist must check each drawer before the carts are transported to the wards.
4. A medication administration recording form is places on top of the cart. The nurse uses this form to check and initial on the time of each medication administration cycles.
5. The next day, the carts are retrieved from the wards and the pharmacist fills it with unit doses for the next 24 hours.

Question 18

Duties of RPh in-charge:

Answer 18

1. Read the Px’s chart and prepare the medication profile
2. Record doctor’s order
3. Read the nurse’s medication administration record
4. Record time of administration
5. Sign the medical chart

Updating of PMP

Question 19

The ambulatory patient is usually in an uncontrolled environment where vital signs are not routinely recorded between clinic visits, and medications may sometimes be taken erratically.

Due to these, the hospital pharmacist should also provide extended pharmaceutical services, like drug counselling.

Answer 19

Out Patient Drug Distribution

Question 20

Location of Outpatient Dispensing Area - 3 Equally Suitable Provisions:

Answer 20

•A separate outpatient pharmacy
•A combined in and outpatient unit with the same window
•A combined in and outpatient unit with services provided from separate windows. The most important consideration should be for the outpatient pharmacy to be near the outpatient clinics and the general public.

Question 21

Dispensing Practices for Outpatients:

Answer 21

Dispensing pattern is similar to that of the community pharmacy.

Process:
•Pharmacist receives the Rx
•Fills prescription
•Dispense medicine to the patient. Though dispensing is facilitated, it is prone to errors if not properl checked. The pharmacist should also explain the signa and any precautionary information.

Question 22

Distribution of Vaccines
The following steps should be taken to ensure that vaccines are properly collected and transported:

Answer 22

*Obtain the right amount of vaccines needed by preparing an inventory report and calculating your vaccine requirements for a specific period. *Make sure that you have enough storage facilities for your collected vaccines.
*Check the type and amounts of vaccine diluents and ice packs.
*Check the expiry date of the vaccines. Do not accept expired vaccines.
*Put fully frozen ice packs or cold packs around the sides and bottom of the transport box.
- DTP and Tetanus Toxoid vaccines are damaged by freezing hence regular monitoring of these vaccines should be undertaken by the pharmacist. Place frozen ice packs on table for five to ten minutes before packing so that the temperature of the ice packs will not be lower than 0°C.

Question 23

•Pack the vaccines and diluent into the cold chain container quickly and properly.
•Take the shortest route to your destination.
•Transfer vaccines and diluent immediately to cold chain facilities (refrigerators, freezers, cold room). In case there are no refrigerators or freezers then transport box maybe used for temporary storage for not more than five days.

Answer 23

Distribution of Vaccines

Question 24

Guidelines for the Acceptance of Returned Medicines:

Answer 24

Hospital pharmacies may accept returns of medicines purchased for purposes of refund/bill adjustment. The following requirements must be checked first before accepting the returns:

•The medicines must be in good condition in the original package and should be returned within the period specified by the hospital policy.

•The manufacturer’s seal must not be torn or broken.
•The label is intact and readable. The lot number and expiry date indicated on the label must be the same as those of the stocks in the pharmacy.
• Loose tablets/capsules and refrigerated medicines are not acceptable.
• The official receipt must be presented/submitted.
•Justification letter from the prescriber indicating the reason for return must be attached. A photocopy of Death Certificate may be required as deemed necessary.