4. Medication Distribution Systems
Background
One of two methods of distribution was employed by pharmacy departments to deliver medications to
patient care units (PCU):
1. Floorstock system: it was more commonly used method. In this system, the pharmacist dispensed
bulk supplies of drug to the PCU, where nurses prepared all doses of medication (included the
preparation of IV admixture) intended for administration to the patient. The medications sent were not
labeled for a specific patient and the pharmacist saw only transcribed drug requisitions sent by nurses.
2. Patient prescription system: in this system, the physician wrote a prescription order, then, the nurse
transcribed this order onto a medication administration profile and generated a drug order for
pharmacy, the pharmacist dispensed a 2-5 day supply of medication and the nurse maintained the
bottles in stock and used a reminder to determine doses’ time. In both systems the nursing personnel
were responsible for most step of medication cycle. Thus, the pharmacist did not have the opportunity
to effectively monitor drug therapy and influence optimal prescribing.
The Unit Dose System
It was designed and implemented in the middle 1960’s as a response to a perception that the pharmacist
is educated and capable of providing professional services. The fundamental difference between the
unit dose system (UD) and older, traditional distribution methods is the more active role of the
pharmacist in the medication cycle with the patient reaping the benefits of a trained medication
practitioner and return of the nurse to patient care responsibilities. This UD system enabled the
pharmacist to review an actual copy of the physician medication order, oversee all medication
preparation steps and maintain patient-specific drug profiles. Also, the pharmacist-physicians
interactive role began to emerge as a direct result of this system. In addition, studies showed that the
UD system is the most cost effective of all pharmacy distribution system.
Unit Dose System Components
The pharmacist reviews and edits an original copy of all medication orders written by the physician
prior to dispensing medications. Next, a pharmacy technician prepares the medication needed during
the forthcoming 24-hour period. Then, the pharmacist check each corresponding dose of medication
prepared by the technician for accuracy and authorizes these medications to be delivered to PCU. After
the physicians writes the chart order, all medication orders are transcribed by the nurse onto a
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medication administration record (MAR). Before administering each dose, the nurse compares the
medication label on the drug product with the appropriate MAR entry. The nurse then administers the
dose to the patient and records the fulfillment of the order on the MAR.
The physical concept of the unit dose distribution program is unit dose packaging, that is, the
placement of each dose of medication into a separate package that bears a label listing drug name,
strength or concentration, lot or batch number, and expiration date. The delivered medication to the
PCU is securely stored on a unit dose medication administration cart (med cart). This lockable cart with
its series of sliding drawers and removable trays can be accessed only by authorized personnel. It
houses storage space for auxiliary supplies and a series of patient-labeled bins arranged in room and
bed sequence. On a routine basis (usually once daily) at a predetermined time the replacement supply is
taken to the PCU, the bins that held the previous day’s doses are returned to the pharmacy for new
filling.
Medication that are needed on demand or prior to the time of scheduled med cart must be delivered via
different mechanism. They may be prompted via a newly written medication order or a written
communication form. Unit dose distribution may be enhanced when selected stable medications are
delivered to the PCU by placement of limited floorstock supplies. In addition, medications needed for
code blue cases must be provided in preassembled emergency drug kits or trays to all PCU’s of the
hospital.
Unit Dose System Design
The unit dose system is defined as one that includes clinical pharmacy services along with drug
distribution activities; that is, the two components go hand in hand. If the scope is confined to drug
distribution activities only, it may be classified as “a unit dose packaging and distribution program”.
On the other hand, the unit dose system requires greater personnel resources, includes a higher level of
job content for pharmacy staff, and has a greater impact upon the quality of medication therapy.
Centralization
Centralized unit dose services are generally provided from a single, self-contained location within the
hospital. Centralization of services may be useful to hospitals with limited space, small size or vertical
design with quick and easy access to all patient care areas. Centralization has the advantage of
requiring a smaller technical and professional staff than that of decentralized services.
Decentralization
A decentralized unit dose distribution system operates from two or more dispensing locations
commonly called “pharmacy satellites”.
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Personnel Responsibilities
Professional Staff
The floorstock and patient prescription systems required nurses to perform many medication-related
activities that are now the responsibility of pharmacists. The evolution of the unit dose system has
dramatically changed the pharmacist’s responsibilities from simple, recurring mechanical duties to
professional service responsibility for the hospital’s complete medication order cycle. As a result, the
pharmacist has become a highly visible member of the healthcare team who is responsible for the
quality of medication-related activities from the time of the drug is purchased to the time it is
administered to patient, and to the assessment of outcomes of therapy.
Pharmacy Technicians
The technician performs most duties related to medication preparation and delivery, but the pharmacist
supervises all work completed and ensures the integrity and safety of each dose dispensed. Because
most of the time-consuming tasks of drug preparation have been delegated to technicians, the
pharmacist has been freed to pursue the development and expansion of clinical pharmacy practice.
Quality Assurance
The activities performed in the course of medication preparations and distributions are routinely
monitored using predetermined criteria to guarantee that assigned standards of performance are met.
Quality assurance is used to evaluate the performance of several distributive activities, including:
1. unit dose med cart filling/checking
2. creating/updating patient medication profiles
3. prepackaging unit dose medication
4. compounding parenteral admixtures
5. reviewing medication administration records
Routine monitoring of these activities identifies existing problems and allow pharmacist to take actions
necessary to correct the problem.
Productivity Monitoring
It is a program to document all product and nonproduct contributions to patient care and monitor the
total quantity of services that the pharmacy personnel provide. The data derived from these programs
can be used to quantify the workforce necessary to serve each PCU and to reallocate resources to those
areas of greatest need and subsequently enhance quality and efficiency. An example of such program is
PharmaTrend® productivity monitoring system.
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