Hospital Pharmacy: Drug Distribution and Clinical Services

Posted on Mar 11, 2025 in Other university degrees and diplomas

Drug Distribution in Hospitals

Drug distribution is defined as the physical transfer of drugs from a storage area in the hospital to the patient’s bedside.

Inpatient Drug Distribution

This can be done through several methods, including:

  • Unit-dose dispensing: Providing each patient with individually packaged doses of medication, labeled with the patient’s name, medication name, and dosage. This helps prevent medication errors.
  • Ward stock: Storing medication on the patient’s ward. Nurses or other healthcare professionals can access the medication as needed.

Outpatient Drug Distribution

Outpatient drug distribution methods include:

  • Retail pharmacies: Patients obtain medication from a retail pharmacy, in-person or by mail order.
  • Specialty pharmacies: These pharmacies specialize in medication for complex medical conditions, such as cancer or HIV.

Advantages of Individual Prescription Orders

  • Reduces medication errors: Medication is packaged and labeled for the individual patient.
  • Convenient for patients: Medication is packaged for easy administration.

Disadvantages of Individual Prescription Orders

  1. Cost: Can be more expensive than other methods.
  2. Time-consuming: Packaging and labeling each dose is time-consuming.

Floor Stock Method

The floor stock method involves keeping a certain quantity of inventory items on hand to meet customer demand. This method is commonly used in retail stores selling fast-moving consumer goods. The retailer keeps a quantity of each product on the shelves. When a customer purchases an item, it’s removed from inventory.

Unit Dose Drug Distribution Method

Medications are prepared by a pharmacist or pharmacy technician and packaged so each dose is clearly labeled with the patient’s name, medication name, dosage strength, and administration instructions. Advantages include:

  • Accuracy: Individually measured and labeled doses reduce medication errors.
  • Convenience: Easy administration, especially in busy settings.

Disadvantage:

  • Increased packaging waste.

Drug Basket Method

A clinical trial design where patients receive a combination of drugs (“drug basket”) for a specific disease.

Advantage:

  1. Efficiency: Allows simultaneous testing of multiple drugs.

Disadvantage:

  1. Complexity: Requires careful selection and dosing, increasing the risk of interactions.

Drug Distribution in Critical Care Units

Intensive Coronary Care Unit (ICCU)

Patients with myocardial infarction or unstable angina are commonly admitted. Aspirin is the most commonly prescribed medicine. Promethazine, heparin, hydrocortisone, buprenorphine, streptokinase, metaprolol, pentazocine, and frusemide are commonly used injections.

Intensive Care Unit (ICU)

Commonly used emergency medications:

  • Adenosine
  • Amiodarone
  • Atropine
  • Epinephrine
  • Lidocaine
  • Procainamide
  • Sotalol
  • Vasopressin

Neonatal Intensive Care Unit (NICU)

Common reasons for NICU admission: organ immaturity, congenital disease, or birth-related problems. Medications commonly administered include ampicillin, furosemide, dopamine, azithromycin, sildenafil, ibuprofen, and fluconazole.

Emergency Ward

Errors can occur with incorrect prescriptions, illegible prescriptions, or misheard verbal orders. Emergency trolleys stocked with medications like adrenalin, salbutamol, atropine, furosemide, hydrocortisone, insulin, lidocaine, and medical oxygen help mitigate these issues.

Automated Drug Dispensing Systems

Types of automated drug dispensing systems:

  1. Robotic dispensing systems: Use robots to dispense medications.
  2. Bar code scanning systems: Use bar code technology to ensure correct medication dispensing.

Narcotic and Psychotropic Substance Management

Definitions:

a) Narcotic Drugs: Addictive drugs that reduce pain perception and induce euphoria. They have a high potential for abuse and addiction.

b) Psychotropic Drugs: Drugs that affect the mind, emotions, and behavior.

Storage: Narcotic and psychotropic drugs must be stored under lock and key in a separate cupboard. Strict compliance with statutory requirements (Narcotic Drugs Rules, 1985; Drugs & Cosmetics Act, 1940; Drugs & Cosmetics Rules, 1945; Pharmacy Act, 1948) is mandatory. Dispensing must be done by a pharmacist against a proper prescription.

Compounding in Hospitals

Compounding is preparing and mixing medications in a controlled environment. This includes creating new formulations, adjusting strengths, or combining medications.

Bulk Compounding

Preparation of large quantities of medication. Examples include creating a batch of ointment or preparing a large quantity of an IV solution.

IV Admixture Services

Preparation of medications for intravenous administration, including mixing different medications into a single solution (IV admixture).

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Incompatibilities: Situations where medications cannot be mixed due to chemical reactions. These reactions can include precipitation, oxidation, or neutralization.

Total Parenteral Nutrition (TPN)

Providing nutrients intravenously. Indications include short bowel syndrome, malabsorption, intestinal surgery, and inflammatory bowel disease. Risks include blood clots, infection, vein inflammation, liver dysfunction, and metabolic imbalances.

Radiopharmaceuticals

Drugs containing radioactive isotopes used in medical imaging and therapy.

Storage: Store in a secure, designated area, well-ventilated, with low background radiation, and limited access. Clearly label the area.

Dispensing and Disposal: Verify patient identity. Use protective equipment (gloves, gowns, shields). Dispose of radiopharmaceuticals according to regulations, potentially returning unused portions to the supplier or using a licensed radioactive waste disposal facility.

Computers in Hospital Pharmacy Practice

  1. Medication Management: Computerized systems manage medication administration, prescriptions, and inventory.
  2. Clinical Decision Support: Tools to aid clinical decisions regarding drug therapy.
  3. Electronic Medical Records (EMRs): Allow access to patient records, aiding in identifying drug interactions.

Electronic Health Records (EHRs)

Benefits: Improved patient safety, increased efficiency, improved communication, and better care coordination.

Information Included: Medical history, medications, allergies, lab results, imaging studies.

Privacy and Security: EHRs must comply with privacy and security regulations.

Software Used in Hospital Pharmacy

  • Electronic Health Records (EHR): Digital patient records.
  • Clinical Decision Support Systems (CDSS): Provide patient-specific information.
  • Barcode Medication Administration (BCMA): Tracks medication administration.

Clinical Pharmacy

Clinical pharmacy optimizes medication therapy and promotes health and disease prevention.

Scope of Clinical Pharmacy in India

Clinical pharmacists guide physicians in safe and rational drug use and assist in cost reduction.

Scope in Other Countries

  1. United States: Clinical pharmacists are essential healthcare team members.
  2. Canada: Clinical pharmacists play a vital role in patient care.

Specialized Areas of Pharmacy Practice

Pediatrics

The branch of medicine dealing with the health and medical care of infants, children, and adolescents.

Common terminologies:

  1. Growth charts: Track a child’s growth.
  2. Vaccines: Protect against infectious diseases.
  3. Developmental milestones: Skills achieved by a certain age.
  4. Pediatric dosing: Medication amount based on age and weight.
  5. Respiratory distress: Difficulty breathing.
  6. Failure to thrive: Not growing as expected.
  7. Neonatal intensive care unit (NICU): Care for premature or critically ill newborns.

Geriatrics

Medical specialty for older adults.

Common terminologies and significance: Pharmacists can help prevent drug-related problems, assess a patient’s ability to adhere to a drug regimen, and teach patients how to take certain drugs.

Antenatal Care

Care from health professionals during pregnancy.

Common terminologies:

  • Antenatal/Prenatal: During pregnancy.
  • Obstetrician: Doctor specializing in pregnancy and childbirth.
  • Midwife: Healthcare professional for pregnancy and childbirth.
  • Fetal development: Fetus growth during pregnancy.
  • Ultrasound: Imaging of the fetus.
  • Gestational age: Age of the fetus.
  • Fundal height: Uterus measurement.
  • Fetal heart rate: Fetal heartbeat monitoring.
  • Amniocentesis: Testing amniotic fluid.

Significance: Access to micronutrient supplementation, hypertension treatment, tetanus immunization, HIV testing, and medications to prevent mother-to-child HIV transmission.

Postnatal Care

Care during the 6-week period after childbirth.

Common terminologies:

  • Postnatal/Postpartum: After childbirth.
  • Postpartum depression: Depression after childbirth.
  • Lactation consultant: Breastfeeding support.
  • Neonatal: Up to 28 days of age.
  • Neonatal jaundice: Yellowing of skin and eyes.

Significance: Support and monitoring for women and newborns, as most maternal and infant deaths occur in the first six weeks.

Key Concepts in Clinical Pharmacy

  1. Clinical pharmacy: Optimizing patient outcomes with pharmaceutical knowledge.
  2. Medication therapy management (MTM): Optimizing medication use.
  3. Pharmacotherapy: Using medications to treat disease.
  4. Drug interaction: Effect of one medication on another.
  5. Adverse drug event (ADE): Harm from medication use.
  6. Pharmacokinetics: How medications are processed by the body.
  7. Pharmacodynamics: How medications produce effects.
  8. Therapeutic drug monitoring (TDM): Measuring medication concentrations in the blood.
  9. Clinical decision support (CDS): Computerized tools for clinical decision-making.
  10. Formulary management: Selecting and managing medications.

Pharmaceutical Care

Definition: Direct, responsible provision of medication-related care to improve a patient’s quality of life.

Principles and procedure:

  1. Assessment: Assess medical history, medications, allergies.
  2. Goal setting: Set therapy goals with the patient.
  3. Plan development: Develop an individualized, evidence-based plan.

Medication Therapy Management (MTM)

A comprehensive approach to patient care that optimizes medication use.

Requirements for MTM Programs:

  • Ensures optimum therapeutic outcomes.
  • Reduces the risk of adverse events.
  • Developed with pharmacists and physicians.

Home Medication Review (HMR)

A pharmacist checks medications at home.

During an HMR, the pharmacist checks:

  1. Medication history.
  2. Current medical history.
  3. Medication adherence.

Medication History

Detailed information on all medications a patient has taken or is taking.

Goal: Gather information for case discussion and compare medication profiles.

Procedure:

  1. Introduction: Introduce yourself and explain the purpose.
  2. Current Medications: List all current medications.
  3. Dosage and Frequency: Note dosage and frequency.
  4. Reason for Taking: Understand the medical condition.
  5. Adverse Effects: Ask about adverse effects.
  6. Medication History: Ask about allergies or past reactions.
  7. Medical History: Ask about past and current medical conditions.

Poison Information

Information about toxic effects of chemicals, household products, overdoses, and toxins.

Procedure (Drug Information):

  1. Request: Healthcare provider or patient requests information.
  2. Gathering information: Gather information about the drug.
  3. Evaluation: Evaluate information and provide recommendations.
  4. Communication: Communicate information clearly.

Procedure (Poison Information):

  1. Initial assessment: Assess the situation.
  2. Information gathering: Gather information about the substance’s toxicology.
  3. Treatment recommendations: Provide treatment recommendations.
  4. Follow-up: Follow up with the patient or provider.

Adverse Drug Reaction (ADR) Monitoring

ADRs are noxious and unwanted effects produced by a drug.

Classification of ADRs:

  • Type A (Augmented)
  • Type B (Bizarre)
  • Type C (Chemical)
  • Type D (Delayed)
  • Type E (Exit/End of treatment)
  • Type F (Familial)
  • Type G (Genotoxicity)
  • Type H (Hypersensitivity)
  • Type U (Unclassified)

Methods for Identifying ADRs:

  1. Case Record Review
  2. Drug Chart Review
  3. Laboratory Data
  4. Computerized ADR Reporting System
  5. Attendance at Ward Rounds
  6. Interviewing Patients

Patient Counseling

Providing information, advice, and assistance to help patients use medications.

Ward Round Participation

Definition: A visit by a medical professional to inpatients to review their progress.

Goal: Assess and manage the patient’s condition.

Objectives: Understand the patient’s status and provide drug therapy information.

Procedure: Healthcare team visits the patient, reviews history, examines vital signs, and discusses progress.

Treatment Chart Review

A pharmacist reviews the patient’s drug treatment during hospital admission.

Goal: Minimize the risk of medication errors.

Procedure: Evaluate if medications are appropriately indicated, effective, safe, affordable, and if the patient can take them as intended.