Drug Distribution System

Drug Distribution System


       Different hospital drug distribution systems

       Central sterile supply system in hospital

       Purchasing and warehousing procedure


After completion of this lecture, student will be able to:

       Describe the different hospital drug distribution systems

       Explain hospital central sterile supply system

       Explain purchasing and warehousing procedure

Drug Distribution System


       Supply of drugs in the hospitals and other clinics for the treatment of indoor and outdoor patients by indent system

In-patient Services


       Individual prescription order system

       Complete floor stock system –

                                Charge floor system and

                                Non charge floor stock system

       Combination of individual drug order and floor stock system

       Unit dose dispensing system

       Charge non-floor stock system

Individual Prescription Order System

       Used by small and private hospitals because of reduced man power requirements

       Physician writes the prescription for individual patient who obtains the drugs prescribed by paying own charges


       Medicines orders are directly reviewed by the pharmacist

       Provides interaction with pharmacist and other medical staff and patients

       Provides clear control of inventory

The Complete Floor Stock System

       Often used in the government  hospitals

       The drugs are given to the patients through nursing stations and the pharmacy supplies from the drug store of the hospitals

       Drugs on nursing station or ward may be divided into

a)      Charge floor stock drugs

b)      Non charge floor stock drugs

Charge floor stock drugs:

       Medicines (stocked in nursing stations) are charged to the patient’s account after they have been administered

       Selection of “charge” stock drugs: Decision as to which drug shall be placed should rest with the PTC

       The list of drugs may vary from hospital to hospital

       In the same hospital the list of drugs may change from time to time as per the recommendations of the PTC

                                e.g. Antiallergics-hydrocortisone sodium succinate

                                        Antibiotics-penicillin G.

                                        mannitol injections, dextrose 50%, 25%

Non charge floor stock drugs:

       Used by patients in  unit ward and for which there may be no direct charge to the patient’s account

       Cost of this group of drugs, is calculated as, per day cost of room or ward

Selection of non-charge stock drugs:

       Consideration is given to

        -the cost of preparation,

        -the quantity used, and

        -effect on hospital budget

        -reimbursement from third party payers    

        (Employees’ state insurance scheme)

       It varies from hospital to hospital

Ampoules: Digoxin, Adrenaline

Tablets: Aspirin, Paracetamol


       Easy and fast availability of drugs

       Elimination of returns of drugs to the store or pharmacy

       Reduction in number of drug transcriptions for the pharmacy

       Reduction in the number of pharmacy staff required


       Increase in medication error (due lack of review of medicines order)

       Greater chances of pilferage

       Increase drug inventory in the ward

       Greater work load for nurses

       Increase drug deterioration

       Lack of proper storage facilities

Drug basket system:

Used currently by hospitals for stocking non charge floor stock drugs and selected products in the wards

Mobile dispensing unit:

Used in hospitals to take medications to the patients bedside for carrying out dressings and also drugs to be administered 

Combination of Individual Drug Order and Floor Stock Systems

       Uses individual prescription as primary means of dispensing but also utilize a limited floor stock

       Most commonly  used in hospitals of our country

       Modified to include use of “unit medications”

Unit Dose Dispensing System

       Those medications which are ordered, packaged, handled, administered and charged in multiples of single dose units

       These single doses containing a predetermined amount of drug or supply sufficient for one regular dose, application or use


Depending upon the hospital and its pharmacist’s choice. They are:

       Central unit dose drug distribution system (C.U.D.D.)

       Decentralized unit dose distribution system (D.U.D.D.)   

Centralized Unit Dose Dispensing

       Inpatient drugs are dispensed in unit doses

       Drugs are stored in a central area of pharmacy

       Dispensed at the time the dose is due to be given

       Medication carts and waiters are needed

       Necessary to send a copy of original medn. order to the pharmacy for the direct interpretation and dispensing

Decentralized Unit Dose System

       Operates through small satellite pharmacies (A branch of main pharmacy) located on each floor of the hospital

       Wards obtain their required drugs instead of going to the main pharmacy

       Main pharmacy feeds the medicines to the mini pharmacies

       The delivery system is accomplished by use of  medication carts

Advantages of Unit Dose Dispensing

       Improved pharmaceutical services for the patients

       Allow the pharmacist to interpret a copy of medn. order there by reducing medication error

       Eliminates labeling mistakes, duplication of order and paperwork at nursing area and Pharmacy

       It transfers I.V. preparations and drug reconstitution procedures to the pharmacy

       It eliminates pilferage or drug waste by partial usage of drugs

       It can save the time both in pharmacy and nursing service

       Promotes efficient utilization of professional and non-professional personnel

Dispensing of Charge Non Floor Stock Drugs

       Ordering, dispensing and accounting of drugs consume a lot of time on nursing services and pharmacy personnel

       One method adopted to identify  the patient is the charge plate prepared on the admission to hospital where the nursing time is saved

       All newly printed hospital forms usually reserve a suitable place in the upper right or left hand corner of the form for information on the identification plate (plastic or metal card)

       All charge stations are equipped for using this time saving device which yields an important by-product viz. legibility of identity

       Items with an extremely heavy demand have specific card with all the information pre-printed

       All that is necessary is the patient’s identity which is quickly supplied through the use of the charge plate

The Envelope System

       In this system, an envelope may be used to dispense drug to the wards

       It can also be used to indicate the charges for the drugs for the patients to pay

Bed Side Pharmacy

       They are essentially locked medication drawers

        Located in patient servers

       Specially designed supply closets build into the hall wall at the entrance to each patient’s room

Central Sterile Services

       Operates centrally

       Supplies entire requirement of sterile materials of the hospital and all things needed to the sterile area of the hospital (operation theatre)

       Includes non sterile materials needed to the operation theatre

Out-patient Services

       The term out door patients or ambulatory patients refers to patients not occupying beds in hospitals or those who are not admitted in the hospitals or to other in-patient settings

They are of three types 

  1. Emergency care: patients involved in accidents, suffering from serious illness and immediately require specialized care
  2. b. Primary care : Involves preventive health   maintenance  and evaluation and management on     confirming basic general discomfort, early   complaints , symptoms and other aspects of disease
  3. c. Tertiary care: servers rendered to patients who have been advised to go the hospitals by doctor, primary health centers and dispensaries

Objectives of Out-patient Services

  1. Providing general medical services

       Preventive services


       Follow up of discharged patients


  1. Family welfare services and  counseling
  2. Health education

Location of Out Patient Dispensing

       In majority of hospitals the out-patient’s dispensing is done from the same dispensary  whether for outdoor or indoor patients

       Three equally suitable provisions are made for this area:

A. A separate outpatient pharmacy may be set up

B. Combined in-patient and out-patient unit service provided from the same window

C. Combined in-patient and out-patient unit service provided from separate window

The Dispensing Routine

       Prescription written by the doctor

       Taken by the patient to the pharmacists

       The prescription and the label are numbered

       The directions and pertinent information are entered on the label

       A check for accuracy is conducted 

       Finally the container is handed to the patient giving them directions, regarding the proper use of the preparations supplied

Dispensing to Emergency Patients

       Dispensing of drugs to emergency ward of a hospital is carried out after the patient receives treatment in that ward and is given a prescription

       Hospitals use special cabin containing medication bins which stores selected and limited quantity of drugs packaged in these bins

       The system provides for punched cards containing information on the drug and are used for billing and re-ordering purposes 


       Drug distribution system is Supply of drugs in the hospitals and other clinics for the treatment of indoor and outdoor patients by indent system

       There are 5 types of distribution systems.

       Objectives of out-patient services.

       Dispensing to emergency patients.

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