DRUG

RELATIONSHIP
DISTRIBUTION, B/W
PURCHASING, DISTRIBUTION &
CLINICAL PHARMACY
SERVICES
DRUG DISTRIBUTION

 The supply, delivery & transitory storage of drugs at patient-care areas(nursing stations) other than main
hospital pharmacy for subsequent patient’s utilization is called distribution.
 It occurs in two ways:
 Directly; issue to the patients on doctors prescription
 Indirectly; issue to the patients as ward & department stock
 Once prescribed by a doctor, inside a hospital, the drug, or more precisely the decision of its prescription
will follow a complex circuit, involving numerous intermediates (human and technical) leading to drug
dispensation and follow-up.
 Regulatory guidelines and rules harmonise and standardise this drug pathway in hospitals. Any
weakness in this distribution system will be the source of nosocomial drug iatrogenic.
 The goal is to ensure that each dose of medication administered to each patient is exactly that
which was intended by the prescriber.
CLASSIFICATION

For in-patients

For out-patients
DRUG DISTRIBUTION FOR IN-PATIENTS

 An inpatient (or in-patient), on the other hand, is "admitted" to the hospital and stays overnight or for
an indeterminate time, usually several days or weeks, though in some extreme cases, such as with coma for
years.
 Treatment provided in this fashion is called inpatient care.
 The admission to the hospital involves the production of an admission note. The leaving of the
hospital is officially termed discharge, and involves a corresponding discharge note.
IN PATIENTS
METHODS OF DRUG DISTRIBUTION FOR IN-PATIENTS

 Individual drug order system

 Floor stock system
 Complete floor stock system
 Combined individual drug order-floor stock system
 Unit dose distribution system
INDIVIDUAL DRUG ORDER SYSTEM

 It is also termed as individual prescription order system.

 It is used by small or private hospitals due to desirability of an individualized service & for availability of
a reduced manpower.
 It provides better interaction among physician, patient & pharmacist.
FLOOR STOCK SYSTEM

 It is a traditional system, involves separate storage facility at each floor.

 The nursing area has limited (10 to 100) dosage forms
 It may include many bulk supply of medications
 All selection is approved by pharmacy & therapeutic committee.
 The medications include;
 Charge floor stock drugs
 Non-charge floor stock drugs
CHARGE FLOOR STOCK DRUGS

 These are drugs for which patient is charged for every single dose administered to him •
 Charge floor stock drugs are stored at various nursing stations •
 An envelope is used to dispense such drugs.
 Examples;
 Anti-allergies; Prednisolone tablet
 Antibiotics Penicillin G inj.
 Anticoagulant heparin
NON-CHARGE FLOOR STOCK DRUGS

 These drugs are placed at nursing stations for use without direct charging to patient’s account but
costing in per day cost of the hospital room.
 The selection of these drugs is based on cost of drugs, frequency & quantity of drugs
used.
 Examples;
 Glucose
 Normal saline
 Paracetamol
COMPLETE FLOOR STOCK SYSTEM

 The nursing station pharmacy caries both charged & non-charged medicines.
 It operates in two ways;
 Floor stock system under supervision of a nurse
 Satellite pharmacy
COMBINED INDIVIDUAL DRUG ORDER-FLOOR STOCK SYSTEM

 It is a type of drug distribution system that uses individual prescription or medication order system as
their primary means of dispensing along with a limited floor stock system.
 It is commonly used in hospitals.
UNIT DOSE DISTRIBUTION SYSTEM

 A unit-dose drug distribution system is in place for all dosage forms to provide patient-specific,
individually packaged medications, which minimizes nurse/caregiver drug product manipulation (e.g.,
cutting in half) in order to arrive at the correct dose prior to administration.
 These unit doses of medication are also dispensed with individually labelled bar code packaging to
enable nurse scanning of the medication at the bedside just prior to medication administration.
METHODS OF UNIT DOSE DISTRIBUTION

De-centralized unit
Centralized unit dose
dose distribution
distribution system
system
CENTRALIZED UNIT DOSE DISTRIBUTION

 The drugs are stored at central pharmacy & distributed in unit doses while receiving the medication
order.
 DECENTRALIZED UNIT DOSE DISTRIBUTION:
 In this system the distribution operates through small satellite pharmacies at each floor.
 The central pharmacy is involved in procurement, storage, manufacturing & packaging services.
 The medication order is received by the Pharmacist who check it for interactions & allergies, then
the drugs are sent to the nursing stations for administration.
DRUG DISTRIBUTION FOR OUT PATIENTS

 An outpatient (or out-patient) is a patient who is hospitalized for less than 24 hours. Even if the
patient will not be formally admitted with a note as an outpatient.

 Treatment provided for out patient is called ambulatory care. Sometimes surgery is performed
without the need f.or a formal hospital admission or an overnight stay. This is called outpatient
surgery.
OUT-PATIENT
AMBULATORY CARE

 Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis,
observation, consultation, treatment, intervention, and rehabilitation services.
 It has three categories:
 Primary care
 Emergency care
 Referral /tertiary care
 Primary care:
 Primary care is the day-to-day healthcare given by a health care provider. Common chronic illnesses
usually treated in primary care may include, for example: hypertension, angina, diabetes, asthma,
depression and anxiety, back pain, arthritis or thyroid dysfunction.
 Emergency care:
 The emergency department must provide initial treatment for a broad spectrum of illnesses and
some of which may be life-threatening and require immediate attention.
 Referral/ tertiary care:
 In medicine, referral is the transfer of care for a patient from one clinician or clinic to another
 Tertiary care is usually done by referral from primary or secondary medical care personnel.
LOCATION OF OUT-PATIENT DRUG DISTRIBUTION AREA

INDEPENDENT OUT- IN & OUT-PATIENT

PATIENT COMBINED
PHARMACY PHARMACY
INDEPENDENT
OUT-PATIENT
PHARMACY

 A separate set up with

specialized function for
provision of out-patient
pharmaceutical
services
operating under the main
pharmacy.

Disadvantages
 Need of separate staff &
;
consumption of time .
IN & OUT-PATIENT COMBINED PHARMACY:

 In this type of pharmacy both in & out-patients services are provided.

 It eliminates the disadvantages of independent pharmacy & there is a greater degree of supervision.
 TYPES;
 Combined pharmacy with one window; where both in & out patients can be served.
 Combined pharmacy with separate windows; separate windows for in & out patients.
RELATIONSHIP BETWEEN PURCHASING AND DISTRIBUTION

 Our basic concern is with planning , organizing and controlling the flow of materials from their initial
purchase through internal operations to the service point through distribution.
 Purchasing and distribution is a main function of hospital pharmacy.
DRUG DISTRIBUTION

 At the health centre level , drug distribution concerns mainly dispensing drugs to patients.
 This requires an understanding of the patients ( who may not speak or understand the language of
the dispenser ) and practical skills in dispensing and record keeping.
 The other aspect of distribution of drugs at health centre is the return of overstocked and
nearly expired drugs to the medical store.
DISTRIBUTION NETWORK

 The drug travels from the manufacturer to the purchaser and then to the distributor.
 From the distributor to the pharmacies and health centers.
PURCHASING RELATED TO CLINICAL PHARMACY SERVICES

 It includes :
 Maintain drug inventory control
 Purchase all drugs
 Receive, store and distribute drugs
 Interview medical service representatives
PURCHASING SYSTEMS IN CLINICAL PHARMACY

 It might be independent purchasing and group purchasing

INDEPENDENT:
A single entity establishes a contractual agreement with a
pharmaceutical manufacturer or whole seller
GROUP:
Agreement between a manufacturer and a group of entities
PURCHASING SUPPORT FOR CLINICAL PHARMACIST

 The clinical specialist should work very closely with the purchasing agent
 Tell them what they do not know
 Think outside the package
 Know the formulary and empower yourself
ROLE OF
PHARMACIST
CLINICAL

 While regular pharmacists normally work in

a pharmacy, a clinical pharmacist works
directly with medical professionals and
patients, usually in a medical center,
hospital or health care unit. The job of
the clinical pharmacist is to determine the
best medications for a given symptom for a
patient at a given time
MEDICATION USE EVALUATION

 Medication use evaluation (MUE) is a performance improvement tool that can be used when there is
uncertainty regarding whether a medication will be beneficial. It is particularly useful when limited
evidence is available on how best to choose between two or more medications. MUEs can analyze the
process of medication prescribing, preparation, dispensing, administration, and monitoring. MUEs can
be part of a structured or mandated multidisciplinary quality management program that focuses on
evaluating medication effectiveness and improving patient safety.
THERAPEUTIC DRUG MONITORING

 Therapeutic drug monitoring is a branch of clinical chemistry and clinical pharmacology that specializes
in the measurement of medication concentrations in blood. Its main focus is on drugs with a narrow
therapeutic window.
ADVERSE
REACTION
DRUG
REPORTING

 Established in 1968, The

WHO Program for Internati
onal Drug
Monitoring(PIDM) provides
a forum for WHO Member
States to collaborate in
the monitoring
of drug safety, and notably,
the identification and
analysis of new adverse
reaction signals from data
submitted to the
WHO global individual case
safety report (ICSR) ..
PAIN MANAGEMENT

 Pain management, pain medicine, pain

control is a branch of medicine employing
an interdisciplinary approach for easing the
suffering and improving the quality of life of
those living in misery
PHARMACEUTICAL
CAR
E
 Pharmaceutical care is the
responsible provision of
drug therapy for the
purpose of achieving
definite outcomes that
improve a patient's quality
of life . These outcomes are
 cure of a disease;
 elimination or reduction of
a patient's symptomatology;
 arresting or slowing of a
disease process; or
 preventing a disease
or
symptomatology
NUTRITIONAL SUPPORT

 The provision of enteral or parenteral nutrients to treat or prevent malnutrition. Nutrition

Support Therapy is part of Nutrition Therapy which is a component of medical treatment that can
include oral, enteral, and parenteral nutrition to maintain or restore optimal nutrition status and health.
CHEMOTHERAPEUTIC DRUG MONITORING

 Therapeutic drug monitoring is not routinely used for chemotherapy agents. There are Several reasons,
but one major drawback is the lack of established therapeutic Concentration ranges. Combination
chemotherapy makes the establishment of Therapeutic ranges for individual drugs difficult, the
concentration-effect relationship for a single drug may not be the same as when that drug is used in a
drug combination. Pharmacokinetic optimization protocols for many classes of cytotoxic compounds
exist in specialized centers, and some of these protocols are now part of large multi center trials.
INVESTIGATIONAL DRUG SERVICES

Some of these services includes

 Integrity of blinding
 Regulatory compliance
 Prevention of errors involving study drugs
 Dispensing of investigational products in a timely
manner
 Contribution to study design and data integrity
 Randomization and study drug accountability
 Sterile preparation and distribution
 Drug and supply procurement as needed
 Preparation of Drug Data Sheets for study medications
 In-services and education for inpatient studies
REFERENCES:

 https://www.slideshare.net/rajusanghvi1/drug-distribution-in-hospital-pharmacy
 https://www.ncbi.nlm.nih.gov/pubmed/12422558
 http://apps.who.int/medicinedocs/documents/s19622en/s19622en.pdf
 Book; Hospital Pharmacy, Nadeem Irfan