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CHAPTER 11

Dispensing to
Inpatients
IN PATIENT

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“A patient who is retained in a

Hospital Pharmacy By Noman ul Haq


hospital so that he/she occupies
a bed in hospital for medical
care is called an inpatient.”

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DISPENSING, DISTRIBUTION AND ADMINISTRATION
Dispensing: Dispensing is a pharmacy act and
consists of the removal of two or more doses from

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a bulk drug container and placing them in
another (dispensing) container/envelop for

Hospital Pharmacy By Noman ul Haq


subsequent use by a patient.
Distribution: The supply, delivery, and transitory
storage of drugs at patient-care areas (nursing
stations) other than main hospital pharmacy for
subsequent patients' utilization is called
distribution.
Administration: The administration is a nursing
act consisting of removal/withdrawal of a single
dose from drug container and its administration3
to a patient on the order of a prescriber.
METHODS OF DRUG DISTRIBUTION
Individual Drug Order System: This is also termed as

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individual prescription order system and is used generally
by the small and or private hospitals due to desirability of
an individualized service and for availability of a reduced

Hospital Pharmacy By Noman ul Haq


manpower.
Benefits:
1. Possibility of a direct review of medication orders by the
pharmacist.
2.Provides a better interaction among pharmacist, doctor
and the patients.
3.Provides a closer control of inventory.
Drawbacks:
1. Results in a delay in obtaining the required medication.4
2. Increased cost to patients.
Floor Stock System: The floor stock drug
distribution is a traditional drug distribution
system and involves a separate storage facility in
a secured area on each patient care floor.

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Generally, each nursing area has limited (10 to
100) dosage forms on hand for patient dispensing
by nursing staff.

Hospital Pharmacy By Noman ul Haq


Charge floor stock drugs: The medications that
are stocked on the nursing station at all the times
are charged to the patient's account after they are
administered.
Non-charge floor stock drugs: These drugs
represent group of medications that are placed at
the nursing station for use in inpatient-care area
without direct charging to the patients' account
but costing in the per day cost of the hospital
room. 5
Drug basket Method: Under this system, night nurse
checks medicine cabinet, utility room and drug
refrigerator inventory of supplies against a master list
provided by pharmacy.

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Mobile Dispensing Unit: A mobile dispensing system, also
called medication cart system utilizes a specially

Hospital Pharmacy By Noman ul Haq


constructed stainless steel truck with appropriate
dimensions to hold all sort of the drugs and is equipped
with swiveling wheels.

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Merits of Floor Stock System:
 Ready availability of required drugs at nursing station.
 Reduction in nursing time consumed by frequent trips to
pharmacy to obtain medications/ancillary supplies.

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 No drug returns to the main pharmacy. ,
 Reduction in the number of drug order for the pharmacy.

Hospital Pharmacy By Noman ul Haq


 Reduction in pharmacy workload and in number of
pharmacy personnel required.
Demerits of Floor Stock System:
 Increased chances of medication errors due to the
elimination of a pharmacist review on medication orders.
 Increased drug inventory on the patient-care area.
 Increased chances of drug pilferage (theft).
 Increased chances for drug deterioration due to lack of
proper storage facilities.
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 Requires excessive nursing time.
UNIT DOSE DISTRIBUTION SYSTEM
 The unit dose distribution (UDD) system for
medication supply is a pharmacy coordinated

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method and controlling medications.
 Under this system medications are ordered,

Hospital Pharmacy By Noman ul Haq


packaged, handled, administered and charged in
multiples of single dose units containing a
predetermined amount of drug sufficient for one
regular dose.
 The unit dose distribution system has been
developed to reduce medication errors and this
system guarantees pharmacist medication review
and individual patient dispensing.
 It has largely replaced the floor stock system. 8
Advantages of unit dose dispensing:
1. Improved overall drug control and drug-use monitoring.
2. Reduced chances of medication errors.
3. Helps cut pharmacy costs by eliminating floor stock

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medication supplies and reusing certain doses and
decreased total cost of medication-related activities.
4. Reduction in the size of drug inventories located in

Hospital Pharmacy By Noman ul Haq


patient-care areas as floor stocks of drugs are minimized
and limited to drugs for emergency use and routinely
used safe items such as mouthwash and antiseptic
solution.
5. Greater adaptability to computerized and automated
procedures.
6. Greater pharmacist control over pharmacy workload
patterns and staff scheduling.
7. Efficient usage of the time of pharmacy and nursing
personnel, allowing a time to perform their respective
tasks i.e., dispensing by pharmacist and administration9
by nurse and thereby a direct patient care involvement
by both professionals.
Centralized unit-dose distribution (CUDD)
system:
 Under this system, all drugs stored in central

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pharmacy and are dispensed in unit-doses.
Decentralized unit-dose distribution (DUDD)

Hospital Pharmacy By Noman ul Haq


system:
 The decentralized unit-dose distribution system,
unlike the centralized system, operates through
small satellite pharmacies located on each floor of
the hospital.
 The main pharmacy in this system is responsible
for the procurement, storage, manufacturing and
packaging centre serving all the satellites. 10
A typical sequence of the drug dispensing to the patient
is as:
 Sending of the medication orders to the pharmacist.
 Entering of the medication order on to the patient

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profile card.
 Checking of the medication order for allergies, drug-
interaction, drug laboratory test effects and rationale

Hospital Pharmacy By Noman ul Haq


of therapy.
 Coordination of dosage schedules with the nursing
station.
 Picking of medication order by the pharmacy
technician and placing drugs in bins of the transfer
cart per dosage schedule.
 Checking of the cars by the pharmacist before release
for transfer to the inpatient care area.
 Administration of the medication by the nurse and
making of the appropriate entry on the nurse
medication record. 11
 Rechecking of the cart on returning to the pharmacy.
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12
AUTOMATED DISPENSING SYSTEM
(CAD)
THE END
Next Chapter
Chapter 12
Out Patient Dispensing

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