Transcript Medication Distribution System

Nouf Aloudah
Reference
 Chapter 18
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Pharmacy is responsible for the safe and
effective use of medication throughout the
entire hospital
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Product selection
Procurement
Storage
Preparation for administration
Distribution to the patient care units
Appropriate prescribing
Guidelines are in place
“All medication cycle are managed properly”
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Product dispenser
to one of expanding
clinical responsibilities
We were completely isolated from patient care
areas, never had the opportunity to react to the
actual medication order written by the physician
Repackaging bulk supplies of medications orders
by requisition from nurses (who were the
ultimate interpreters of all medication orders and
prepared the medication for administration to the
patients)
The pharmacist had no opportunity to use his or
her extensive education to enhance the quality
and safety of drug therapy
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1960s the beginning of significant changes in
the medication distribution systems as few
hospitals experimented with a concept under
which the pharmacist assumed the
responsibility for preparing all doses of
medication for patients and routinely
monitored the appropriateness of all
prescribed drug therapy
Genesis of drug distribution system
Changes continue! increased automation……
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This lecture focuses on those distributive
activities that transpire between the time a
medication order is written until the prepared
package is delivered by pharmacy to the
nurse, physician or other health care
professional for administration to the patient
BACKGROUND
 Historical overview
The pharmacy signal function were the
compounding, repackaging, and relabeling of
multiple dose supplies of medications into
containers for subsequent dispensing and
storage on a patient care unit (PCU)
BACKGROUND
 Historical overview
There were two systems
1. Floorstock system
2. Patient prescription system
BACKGROUND
 Historical overview
1. Floorstock system
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More commonly used
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The pharmacist dispensed multiple dose,
bulk supplies of drugs to the PCU, where
nurses prepared all doses of medication
intended for administration to the patient
(including compounding of IV admixture)
BACKGROUND
 Historical overview
1. Floorstock system
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Not labeled for a specific patient and could
therefore be used for several doses for
numerous patients
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It was common for 150- 200 medication to
be stored in a minipharmacy on each PCU
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The pharmacist sow only transcribed drug
requisitions sent by nursing personnel
BACKGROUND
 Historical overview
2. Patient prescription system
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The physician wrote a prescription order, the
nurse transcribed this order onto a medication
administration profile and generated a drug
order for pharmacy, the pharmacist dispensed a
2 to 5 days supply of medication, and the nurse
maintained the bottles in stock and used a
reminder system to determine when the
medication was to be administered
BACKGROUND
 Historical overview
2. Patient prescription system
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The pharmacist review order (but not
relevant information about patient )
Unit dose system
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The university of Iowa hospitals and clinics and
the university of Arkansas medical center in the
middle 1960\s designed, implemented, and
measured several indicants associated with a
concept known as the “unit dose drug
distribution system”
More active role of the pharmacist in the
medication cycle with the patient reaping the
benefits of a trained medication practitioners
responsible for the medication cycle and the
return of the nurse to patient care
responsibilities
Unit dose system
The pharmacist review an actual copy of the physician
order
 Oversee all medication preparation steps
 Maintain patient specific drug profiles that detail
allergy, organ function indices, and patient response
data
 Pharmacist-physician interactive role began to
emerge
 US general accounting office concluded that
“The unit dose system is the most cost effective of all
pharmacy distribution systems when the entire
spectrum of drug delivery activities within a hospital
is considered”
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Unit dose system components
 The pharmacist review a copy of all
medication orders written by the physician
prior to dispensing medications
◦ Triggered the success of the unit dose system
◦ Given birth to clinical pharmacy practice (the
pharmacist intervene with inappropriate drug
prescription)
Unit dose system components
 Pharmacist review the order by transcribing the
prescription content to pharmacy recorders, or
FAX it
 Others used structural, multiplay medication
order form which requires that medication orders
be written within columns labeled for drug name,
dose, route of administration and interval
◦ (no transcribing improved efficiency)
◦ Eases the transition to automation entry bec. Simplifies
order entry process
◦ Pharmacist and the nurse interpret order more efficiency
and accurately
Unit dose system components
 So a copy reach the pharmacy
 The Pharmacist review it and compare it with
previous drug order and information kept in
patient specific medication profile, intervene
with inappropriate prescription
 A pharmacy technician prepares the
medication needed during coming 24 hr
period
Unit dose system components
 The pharmacist check it after preparation for
accuracy and authorization to go to PCU
 The majority of medications are dispensed via
a specially designed medication
administration cart, which positioned in PCU
until administration time
 Nurse document in medication administration
record after administration
Unit dose system components
 It is a unit dose packaging
 Each dose into separate package that bear a
label listing drug name, strength, or
concentration, batch no, expiration date
(many drugs available commercially)
Unit dose system components
 In PCU drugs are stored in med cart that can
be accessed only be authorized personnel
Unit dose system component
Medication that are needed prior to the med
cart is scheduled delivered to PCU via
different method
◦ Pneumatic tube carrier
◦ Pharmacy courier system (every 30-60 min)
Unit dose system component
PRN delivered by
 Fulfilling of specific need requests sent to
pharmacy by the nurse
 Automatic placement of predetermined supply of
PRN medication into the patient\s drug bin
located on the med cart
 Placement of select floorstock supplies of
medication on the PCU
 Limited floorstock supplies of medications with
low toxicity potentials are placed onto the med
cart so that the nurse can quickly and easily
administer a dose when needed by the patient
Unit dose system component
Controlled substances (drug enforcement
agency (DEA) schedule II,III,IV,V drugs has a
substantial potential for abuse and must be
securely stored in the pharmacy and PCU
Handled separately
Medication order cycle is the same
Limited floorstock storage in a secure area of
the PCU
Unit dose system component
Drugs of “blue code”
Preassembled emergency drug kit to all PCU’s
of the hospital
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Unit dose system design
What is the scope of the pharmacy services
that will be provided is it
◦ Unit dose system?
◦ Unit dose packaging and distribution program?
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Unit dose system design
◦ Unit dose system:
 One that includes clinical pharmacy services along with
drug distribution activities; that is, the two
components go hand on hand
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Unit dose system design
◦ Unit dose packaging and distribution program:
 If the scope is essentially confined to drug distribution
activates
 Which requires only that pharmacy prepare doses of
medication , use unit dose packaging, and deliver
patient specific supplies of medication to PCU on a
routine basis (negligible clinical pharmacy)
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Unit dose system design
◦ Unit dose system:
 Requires greater personnel recourses, includes high
level of job content for pharmacy staff, and has a
greater impact upon the quality of medication therapy
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Emerge from a central location :Centralization
Or one or more decentralized pharmacy will
be established :decentralization
Centralization
 Services are provided from a single, self
continued location within the hospital
 In hospital with limited space, small size, or
vertical design,
Decentralization
 Two or more dispensing locations commonly called
“satellite”
 At minimum provide pharmacist order review and
first dose dispensing
 Act as the base from which clinical pharmacy services
are provided
 Usually he central pharmacy provide services such as
unit dose medication cart fill, medication
repackaging, IV admixture compounding, and
controlled substance distribution, then transferred to
the satellite for final delivery it to the PCU
 200 m2, near one or more PCU’s, serves from 60-120
pt. for 16 hour a day
Decentralization
 Staffing includes one or two pharmacists and
two pharmacy technician per each day and
evening shifts
 Staffing is normally reduced during night
hours
 Actual no depend on
◦ Patient population
◦ Spectrum of clinical services provided
◦ Presence or absence of centralized pharmacy
support services
Decentralization
Space requirements are affected by
 Scope of distribution services to be provided
from the satellite
◦ Complete distribution services or provision of only
first dose)
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Type of patient population being served
Decentralization
Specialized pharmacy satellite
Particular service objectives are identified
relative to specific clinical services such as
pediatrics, oncology, critical care, emergency
room
Personal responsibilities
 Professional staff
◦ changed dramatically with unit dose system
◦ Many of the activity once performed by the nurses
have been assumed by pharmacy personnel
◦ A study showed that it allowed the saving in
nursing labor attributable to one pharmacy satellite
serving 130 general medicine beds to be equivalent
to 5.5 full time registered nurse positions
Personal responsibilities
 Professional staff
◦ From simple, recurring mechanical duties to
professional services responsibilities for the
hospital’s complete medication order cycle
◦ Become highly visible member
Personal responsibilities
 Pharmacy technician
Evaluation of unit dose services
 Cost analysis
 Improved patient care
Improved patient care can lead to decreased of
hospitalization and during these days of
prospective payment system decreased cost
Evaluation of unit dose services
 Actual cost savings are based upon decreased
expenditures for drugs and nursing personnel
time associated with medication related
activities. Although cost of purchasing and /or
preparing unit dose med. Is higher , this cost is
offset by reduction of drug inventories necessary
to stock each PCU under a unit dose system
 Smaller inventories on each PCU lead to reduced
drug wastage, as dose the packaging per se, bec
the ability to return unused doses to stock
Evaluation of unit dose services
 Nursing personnel requirements in
medication related activities can be reduced
and reassigned existing staff to other patient
care duties
 A teaching hospital witness a 12%
improvement in medication charting
accuracy, which at that time translated into
an annual increase in revenue of over $1
million
Evaluation of unit dose services
 Reduction in the medication errors is
sometime the basis for implementing the unit
dose system
◦ Double checking of each dose
◦ Safety element of labeling
Evaluation of unit dose services
 Greatest positive impact is the subsequent
enhancement of overall clinical pharmacy
services
Enhancement of clinical role
 The unit dose system has led to greater use of the
pharmacist’s drug therapy expertise and in turn improved
patient care
 With this system the pharmacist assumes responsibilities
not only for delivery a carefully prepared drug product to
the patient in a safe, accurate, and timely manner but also
the monitoring all prescribed drug therapy to assess
appropriateness of dose, suitability of therapy in light of
the patient’s condition, cost effectiveness of therapy, and
the potential for drug interactions
 These combined activities form
the foundation of
clinical pharmacy practice
Evolution of other pharmacy activities
 Patient care services
 Quality assurance
 Productivity monitoring
 New technologies
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Robot in pharmacy
KFSH & RC robot pharmacy report
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The future