Medication Distribution: Hospital Pharmacy Logistics

Hospital pharmacies play a critical role in patient care by ensuring the safe and effective distribution of medications. The traditional model of drug distribution involves a pharmacy fulfilling the medication requirements of individual hospital units, with limited control over the amount administered to patients. However, modern systems, such as unit-dose and multi-dose distribution, aim to improve drug management and patient safety by providing individually prepared doses. These systems offer advantages in maintaining control throughout the distribution process and reducing medication errors. Additionally, centralized distribution in hospital pharmacies allows patients to be monitored by a single pharmacist throughout their therapy, fostering a relationship that ensures proper therapy adherence and patient education. Effective medication distribution in hospital pharmacies involves complex considerations, including legal regulations, cost management, and collaboration between medical professionals.

Advantages of centralized distribution

Centralized medication distribution has been a long-standing model in the healthcare industry. In this model, the pharmacy processes orders for each medication and then sends the medications for that day to the patient care areas. Medication rooms in these facilities generally only store a few drugs for emergency use. This approach can optimize medication storage and reduce costs.

However, the COVID-19 pandemic exposed the limitations of centralized medication distribution. As a result, many healthcare facilities switched to decentralized medication distribution.

Despite this shift, centralized distribution has several advantages. Firstly, centralized distribution allows for the establishment of a relationship between the patient and a single pharmacist throughout the patient's therapy. This ensures proper monitoring of therapy and provides the patient with a reference person to answer questions about their treatment. The pharmacist can also interface with the treating doctor, resolving any problems that may arise during therapy.

Secondly, centralized distribution can optimize medication storage and reduce costs. Centralized pharmacies manage a broader inventory of medications, allowing them to stock a variety of drugs that can be distributed to different locations as needed.

Thirdly, centralized distribution can help ensure patient safety and improve the quality of care. An automated unit-dose distribution system, for example, allows for control at every stage of distribution, from the purchase of the drug to its administration.

Lastly, centralized distribution can be beneficial in certain situations, such as when a hospital pharmacy manages medication distribution for all departments in the hospital. This approach allows for immediate access to medications and pharmaceutical services tailored to patients within specific areas.

Unit-dose distribution systems

In unit-dose distribution systems, medications are dispensed in single doses, in packages that are ready to be administered to the patient. This system can be used for medicines administered by any route, but oral, parenteral, and respiratory routes are the most common. It provides a fully closed-loop process where the patient, the drug, and the healthcare professional are identified by machine-readable codes, and the drug administration process is linked directly to the electronic prescription and fully recorded.

Unit-dose systems also provide greater security and better inventory management compared to common drug stock or ward stock systems. Unused unit doses can be easily returned to the pharmacy, encouraging recycling. Additionally, unit-dose dispensing eliminates the need for "note strength" labels and further dosage calculations or manipulations at the point of administration.

When doctors write orders for inpatients in a unit-dose system, these orders are sent to the central pharmacy. Pharmacists verify these orders, and technicians place the drugs in unit-dose carts. Each patient's medications are placed in a separate drawer, labelled with the patient's name, ward, room, and bed number. These drawers can be easily inserted into wheeled medication carts used by nurses during their medication administration rounds. Alternatively, electronic medicine storage cabinets can be located on wards and attached to medication carts.

Several tools and resources are available to assist hospitals in implementing unit-dose distribution systems, including toolkits, business cases, and guidelines. These resources provide guidance on conducting preliminary assessments, planning, and implementing unit-dose systems, as well as case studies and best practices.

Drug distribution monitoring

One recommended method is the "just-in-time" (JIT) model, which delivers medicinal products at the required time and in the necessary quantities. This approach helps optimize inventory and minimize stock, reducing costs and improving efficiency. Another modern distribution system is the automated unit-dose distribution system, which mechanically prepares and distributes ready-to-administer, individualized doses for patients from a central pharmacy. This system provides control at every stage of distribution and improves patient safety by reducing medication errors.

To effectively monitor drug distribution, hospitals can utilize tools such as databases and information technology (IT) solutions. These tools help predict drug demand, optimize purchasing, and facilitate therapy control. For instance, Italy has implemented a strategy where drugs are distributed through the hospital channel, resulting in significant cost savings. Additionally, Prescription Drug Monitoring Programs (PDMPs) are electronic databases that track controlled substance prescriptions, aiding in the identification of inappropriate behavior and supporting clinical decisions.

PDMPs, operated by state health authorities, provide valuable information on prescribing practices and patient behaviors. They help identify potential drug abuse, diversion, and misuse. However, limitations exist, including the exclusion of illegally obtained medications and data accuracy and timeliness issues. To address these challenges, the CDC has emphasized the importance of real-time data and access for state health departments to combat the opioid epidemic.

In conclusion, drug distribution monitoring in hospital pharmacies is essential for patient safety and cost-effectiveness. By adopting modern distribution systems and utilizing tools like databases and PDMPs, hospitals can improve visibility, control, and patient care while optimizing drug inventory and minimizing stock. These measures ultimately contribute to the overall quality of patient care and help meet the standards of service provision by hospital pharmacies.

Medication errors

Other common causes of medication errors include workload, interruptions, lack of support staff, insufficient time to counsel patients, and incorrect diagnosis. To reduce errors, it is crucial to have clear and specific instructions on doses, the number of pills, and how and when to take the medication. Open communication between the clinician, patient, and pharmacist is essential. Implementing modern distribution systems, such as automated unit-dose distribution, can help maintain control at every stage of drug distribution and improve patient safety.

Furthermore, medication errors often go unreported due to the fear of repercussions, such as loss of licensure or even imprisonment. This lack of reporting can lead to further harm to patients, as the underlying system causing the errors may not be identified and corrected. To improve patient safety comprehensively, both errors of commission and omission must be addressed through process improvement efforts.

Differences between classical and modern distribution systems

The distribution of medications in hospital pharmacies varies, with some hospitals relying on classic methods of drug distribution and others employing modern, automated systems. The classical distribution system, also known as traditional or mainline distribution, involves each hospital within a health system purchasing its own medications and performing its own services. This includes managing medication compounding and par levels in automated dispensing machines (ADMs). Hospitals with classic ward first aid kits also require pharmacists to conduct routine checks on drug storage conditions, especially for psychotropic and potent drugs.

In contrast, modern distribution systems in hospital pharmacies are highly automated and technologically advanced. These systems aim to improve drug management and patient safety, while also reducing medication errors and optimizing therapy quality. One such modern system is the automated unit-dose distribution system, which mechanically prepares and distributes drugs in ready-to-administer, individually prepared doses. This system offers advantages in comprehensive drug management, including in individual hospital departments.

Another key difference is in the procurement process. In the classical model, hospitals buy directly from manufacturers, whereas modern systems often utilize wholesalers who act as middlemen, simplifying the buying process for hospitals. Wholesalers hold pharmacy licenses and supply a range of products, from brand-name drugs to generics and medical supplies.

The implementation of modern distribution systems, however, is not without its challenges. Some countries, like Poland, still rely predominantly on classical methods due to low technological advancement in hospitals. This can result in a lack of optimization in therapy quality and cost rationalization. Additionally, the adoption of modern systems may face obstacles in terms of technical issues, management, efficiency, safety, hygiene, and costs.

Furthermore, the concept of Consolidated Service Centers (CSCs) has emerged as a strategy to centralize supply chain infrastructure, processes, and inventory management for multiple hospitals. This approach allows for standardized distribution, purchasing, and services, as well as improved labor utilization by consolidating tasks performed by individual hospital pharmacy teams.

Frequently asked questions