Medication Distribution System
Introduction
Despite the evolving role of pharmacists in clinical management of patients (such as medication reconciliation and drug therapy optimization), the distribution of medicines will continue to be a vital part of the pharmacist's responsibility.
Currently, there are 3 drug distribution systems employed in Ministry of Health hospitals.
- Floor stock (traditional system)
- Patient prescription system (i.e. unit-of-use)
- Unit dose system
Floor Stock System
The floor stock system is a decentralized system in which limited quantity of medications are stored in individual storage area on each nursing unit. This system is often used for medications that are frequently used and needed immediately in emergency cases.
- The medication list for the floor stock system is agreed upon by the pharmacy and the ward/unit and should be reviewed periodically.
- The level of floor stock items should be more than the minimum limit but should not exceed the maximum limit.
Under the floor stock system, the nurses are responsible for preparing and administering the patient medications for both oral and IV use, based on physician order.
- This system is utilized because it requires minimum pharmacy resources and it is assumed that this distribution system is safe.
Patient Prescription System (Unit-of-Use)
The patient prescription system involves the pharmacist to review the patient order and prepares a 2- to 5-day supply of medications for the patient. The medications are then delivered to the nursing unit for administration by the nurses.
- In this system, the pharmacist has limited access to pertinent patient information, so they will place only limited judgment on whether the patient order is correct or appropriate for the patient.
When the drug is discontinued or the patient is discharged, the prescription containers with the unused drugs are returned to the pharmacy.
- Nonetheless, unit-of-use often results in increased workload to do medication reconciliation and wastage if the earlier prescribed drugs are not finished due to change of prescriptions or not return to the pharmacy.
Unit Dose System
The unit dose system is characterized by medications contained in unit dose packages, dispensed in ready-to-administer form, with not more than a 24-hour supply delivered or available on the patient care unit at any time.
- In other words, the pharmacist dispenses patient-specific medications to be administered, not prepared, by the nurse.
In 1971, the U.S. General Accounting Office concluded that the unit dose system is the most cost-effective of any distribution system, especially when the entire medication use process is considered.
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 volume of work in pharmacy, more pharmacists are needed around for the whole dispensing process.
- Frequent ordering as orders are done on daily basic.
Summary
The best drug distribution system for a particular hospital will depend on a number of factors, including the size of the hospital, the number of patients and the available resources.
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