hospi phar reporting
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group 4 phar 5TRANSCRIPT
Chapter 7MEDICATION
DISTRIBUTION SYSTEMS
KEY TERMS AND DEFINITIONS:
ADC – medication storage devices located in patient care areas designed to allow nurses to have quick but accountable access to medications
Centralized Pharmacy Services- distribution of medication from a centralized pharmacy location
Decentralized Pharmacy Services – distribution of medication from a decentralized satellite pharmacy located in or near a patient care area.
KEY TERMS AND DEFINITIONS:
Floor Stock System – consisting of an individual storage area on each nursing unit where drugs are stored prior to preparation and administration by the nurse.
MAR – record of all current medications prescribed for each patient.
Medication profile – primary record used by pharmacist
KEY TERMS AND DEFINITIONS:
Patient prescription system – anti-quated system of medication distribution that consists of patient specific containers with 2 or 5-day supply of drugs.
Unit dose system – characterized by medications contained in unit dose packages, dispensed in ready-to-administer form and no more than a 24-hour supply available/delivered.
Unit of use package – exact dose in a ready-to-administer form
History of Medication Distribution
systems leading to the unit Dose
Concept
Role of the Hospital Pharmacist 50 years ago
Confined to the basement Purchase and prepare
medications to be used on the nursing unit
Repackaging and compounding of Medication except IV admixtures
2 distinct distribution methods:a. Floor Stock System
Consists of an individual storage area on each nursing unit
the nurse was the professional responsible for preparing the patient-specific medications for both oral and intravenous use.
this system was utilized because it required minimal pharmacy resources and it was assumed that this distribution system was safe.
2 distinct distribution methods:
b. Patient Prescription System involved the pharmacist to a greater
extent than the floor stock system by requiring a review of the patient order.
the pharmacist would place only limited judgment on whether it was correct or appropriate for the patient.
Unit Dose System A pharmacy coordinated method of
dispensing and controlling medications in health care institutions
Pharmacist dispenses drugs to be administered (not prepared) by the nurse
It is the most cost-effective of any distribution system.
Studies have shown the reduction in medication errors when transitioning from floor stock to be 2% to 11% of all orders studied.
In this system medications are:
contained in unit dose packages dispensed in ready-to-administer
form not more than 24-hour supply
being delivered on the patient care unit at any time
Advantages of the Unit Dosedistribution method:
Reduction in medical errors
Decrease in total cost of medication-related activities
More efficient use of pharmacy and nursing personnel
Improved drug control and drug use monitoring
More accurate patient billing for medications
Minimization of credits for drugsGreater control by pharmacist over work
patterns and schedulingReduction of inventories maintained on
nursing units
Floor Stock
Patient Prescription
Unit Dose
-Bulk containers stored on unit indefinitely
-Patient-specific containers with 2-day to 5-daysupply of drug stored on unit
-Medications contained in unit dose packagesand dispensed in ready-to-administer form
Floor Stock
Patient Prescription
Unit Dose
-Containers not patient-specific
-Drug order transcribed by the nurse andreviewed by the pharmacist
-No more than a 24-hour patient-specific supplyon unit at any time
Floor Stock
Patient Prescription
Unit Dose
-No review of drug order by pharmacist
-No patient information available to pharmacist
-Pharmacist reviews every order and checksagainst patient records
Role of Unit Dose onDrug use control
Unit dose placed pharmacists front and center in the medication cycle
Pharmacists are required to review every medication order prior to dispensing
Duplicate carbon copies of the original orders were provided to pharmacists
Pharmacies are required to maintain a patient medication profile
Patient medication profiles allowed pharmaciststo gain access to the following patient-specific
information:
Patients name and locationGeneric name of medicationDosage in metric systemFrequency of administrationSignature of the PhysicianDate and hour the orders were written
UNIT DOSE PROCESS The process of unit dose varies with each institution
Orders are written on the patient care area and sent to the pharmacy through various methods.
Couriers that routinely go to nursing unitsPneumatic tube systems (pressurized tubes that
move small containers throughout institutions)
Some orders are delivered to decentralized pharmacy satellites located near or within nursing units
Increasingly, physician orders are sent through CPOE
Advantages
Pharmacists can review orders any place they have computer access
likely become the primary form of order delivery
Medication orders written and sent to pharmacy
Pharmacist receives and reviews order-clarifies any discrepancies with the
prescriber
Order is entered into the drug profile (medication profile in the pharmacy
information system)
Order is filled by tech and checked by pharmacist
a label is generated and filled by technician for enough doses until the next cart fill
the technician sends the medication to the unit after the pharmacist has checked it for accuracy and
appropriateness
Medication is sent to floor by courier, by pneumonium tube or with a nurse
New order is recorded onto the MAR After each physician order, the nurse updates
the MAR on the nursing unit
On the unit, nurse checks the medication against patient’s MAR
this is prior to giving the medication to the patient
to ensure that the medication is appropriate
Nurse administers the medication to the patient
Nurse records when and how the drug was administered on the patient’s MAR
Pharmacy medication profiles and the nursing MARs are linked within each institution’s computerized medication system
Any changes in the patient medications are updated manually on the nursing unit until the next computerized MAR is delivered
UNIT USE PACKAGE/UNIT DOSE PACKAGE
reduce the cognitive burden on nurses in administration process
The majority of drugs in institution can be purchased from manufacturers in this kind of package
Medications from bulk bottles can also be repackaged into unit dose
On the nursing unit, medications are typically stored as automated dispensing cabinets or locked medication carts
Common area (bulk medications and floor stock)
Individual patient medication bins
2 major sections of medication carts:
Carts have wheels but usually kept stationary
Carts have flat surface
Medications in the carts are exchanged each day with new ones
The cart replenishment process medications are placed in the cart the carts are filled by the pharmacy
technician and checked by pharmacist before being exchanged
If receives a new medication order or a dose request from the nurse, the pharmacist provides the medication on the floor before the next cart exchange.
Prior to giving controlled medication doses, the nurse takes an inventory of the medication and documents removed
Discrepancies are reported immediately
Nursing also takes an inventory at each shift change to reconcile the number of orders against the number of medications given
Although time intensive, this process efficiently reduces diversion
PRN Medications• Handled according to different institution-
specific methods:
a. Keep them in the pharmacy and dispense upon request Provides the most control over medication
distribution Rarely used because of the time burden and
delays
b. Send up a small amount of PRN medications for each patient in their medication drawer If the patient requests a dose, the
nurse retrieves the medication from the medication cart
Many doses are sent daily to the nursing unit and returned unused
Inefficient
Most hospitals now use a limited floor stock system where medications with low potential for misuse and patient harm are stored in small quantities in the medication cart.
Medications with greater risk potential may be kept in individual patient bins or locked in ADC
Emergency Medications
Select number of drugs needed to be kept on-site to respond immediately to patients who deteriorate quickly
Must be available instantlyMade available throughout the hospital in
tamper-evident boxes or carts (sometimes called “crash or code carts”)
typically contain nondrug items, intravenous solutions, and medications.
medications are in ready-to-administer form and located on nursing units
checked periodically
Models of Unit Dose Delivery
Two main models:a. Centralized modelb. Decentralized model
Centralized Model Emanates from the main pharmacy
(a centralized location)
Medication orders are received in the central pharmacy
All of the processing for patients occur there: order processing drug packaging cart fill medication dispensing
Centralized ModelAdvantages: Disadvantages:
All sources can be localized into one area
Drug inventory can be minimized
Pharmacist is not able to directly interact with the physician and nurse
Clinical services are limited
Decentralized ModelCharacterized by having pharmacy satellites
located throughout the institutionA physician order is routed to a satellite where
the pharmacist there processes the order and dispenses the first dose of the medication directly to the nursing station
It is very easy for physicians and nurses to stop by to ask a question
Decentralized ModelPharmacists can also go into the patient care
areas
Still needs to be supported by a centralized pharmacy
Can provide services in pediatrics, oncology, critical care, the emergency room, and the operating room
Decentralized Model
Faster order fillingIncreased physician and nursing satisfactionBetter professional relationships between
pharmacy and other departmentsExpansion of clinical servicesFewer dispensing errorsDecreased need for floor stock medications
Advantages:
Robotic fill technology centralized automated dispensing device
Benefit replaces tedious manual cart fill
accuracy time and overall inventory costs are reduced
Disadvantage special preparation needed
medications need to be placed on unit dose packages read and handled by robots
robotic breakdowns and routine maintenance
RISE OF TECHNOLOGY TO ASSIST DRUG DISTRIBUTION
ADC (Automated Dispensing cabinets) located on patient care areas designed to
replace traditional floor stock systems and unit dose cart exchange systems
useful in controlling narcotic usecan provide tracking by the DEA and
store narcotics in safe locations where distribution is limited
Benefit permits quick order
filling while still maintaining control of the medication uses
system waste is reduced
more accurate patient charges and minimizes the number of credits
processed
Disadvantage similar to floor stock
system ( increase medication
errors though evidence is not clear)
increases drug inventory on patient
care areas
Minimized disadvantages by linking ADC systems with pharmacy information
systems
controlled at computer terminals with up-to-date patient specific profiles
allows accurate patient billing and maintenance of a perpetual drug inventory
Future of the Medication Use
System Automation will further decrease the
number of people involved in medication dispensing
Mix of centralized, decentralized and automated dispensing
Future of the Medication Use
System Outsourcing may become more
widespread
Bar-code technology
Pharmacist’s value lies in using professional judgment
Requirements of any good Medication
Distribution system
Always maintain quality control System must be efficient in how it
achieves drug use control Medication distribution system must
always attend to the needs of its users