Medication Distribution System
Introduction
Despite the evolving role of pharmacists in clinical management of patients (such as medication reconciliation and drug therapy optimization), medication dispensing will remain a vital responsibility.
Currently, Ministry of Health hospitals employ 3 drug distribution systems:
- Floor stock (traditional system)
- Patient prescription system (i.e. unit-of-use)
- Unit dose system
NOTE: Both unit-of-use (UoU) and unit-dose (UoD) medication dispensing systems typically utilize a cart-fill system. This involves preparing and filling medication carts for individual patients.
Floor Stock System
The floor stock system is a decentralized system where a limited quantity of medication is stored in designated storage area on each nursing unit. This system is often used for medications that are frequently used or needed immediately in emergency cases.
- The pharmacy and the ward/unit collaboratively determine the floor stock medication list, which should be reviewed periodically.
- While the list typically includes most commonly used medications, it excludes rarely used or expensive drugs, ensuring a quick access to essential medications at any time.
- Floor stock levels are maintained within established minimum and maximum limits.
Nurses are responsible for preparing and administering oral and IV medications from floor stock, according to physician order.
- This system requires minimum pharmacy resources.
- While it achieves the goal of prompt medication delivery, it may increase the risk of medication errors due to fewer checks and balances.
Patient Prescription System (Unit-of-Use)
The patient prescription system involves a pharmacist reviewing the patient's medication order and preparing a 2- to 5-day supply of medications. These medications are then delivered to the nursing unit for administration by the nurses.
- In this system, pharmacists have limited access to comprehensive patient information, which restricts their ability to fully access the appropriateness of the medication order.
Unused medications in prescription containers are returned to the pharmacy when a drug is discontinued or the patient is discharged.
- However, this unit-of-use system can increase workload related to medication reconciliation and medication waste if previously prescribed drugs are not finished due to prescription changes or if they are not returned to the pharmacy.
Unit Dose System
The unit does system features medications packaged in unit dose, ready for administration, with no more than a 24-hour supply delivered or available on the patient care unit at any given time.
- Essentially, the pharmacist dispenses patient-specific medications for administration by the nurse, eliminating the need for the nurse to prepare the doses.
In 1971, the U.S. General Accounting Office concluded that the unit dose system is the most cost-effective distribution system, especially when considering the entire medication use process.
Advantages
- Reduction in medication errors
- Improved drug control and drug-use monitoring
- More accurate patient billing for medications
- Reduction of inventories maintained on nursing units
Disadvantages
- Manual packing of unit dose is time-consuming and labour-intensive.
- Increase pharmacy workload requires more pharmacists to manage the dispensing process
- Frequent ordering is necesary, as orders are processed daily.
Summary
The optimal drug distribution system for a given hospital depends on several factors, including hospital size, patient volume, patient turnover rate, and available resources.
- Supplying medications for more than a day can lead to numerous medication returns, creating a significant handling burden, especially for wards with rapid patient turnover or frequent medication plan changes (e.g., intensive care units).
- Floor stock medications require regular monitoring of expiration dates to prevent waste.
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