Distribution Drug Services for Long Term Care Facilities
Susan L. Lakey, PharmD 1/11/06
Drug distribution
The process:
Receipt / transcription of order Interpretation / evaluation of order Filling and packaging order and checking it Delivery Administration
New orders
Can be verbal or written, electronic, fax, or via phone Involves communication between
Physicians Nursing staff Pharmacists Patient
1
Evaluation of orders
Prospective review Ensure appropriate:
Indication Dosage and dosage form Route of administration Dosing interval
Check allergy profile, concomitant disease states, other medications Assess interactions drug, disease, food
Filling and packaging
Manual and semi manual systems
Vials Unit dose and cassettes Modified unit dose Medisets
Automated systems
Traditonal vials
Advantages
Time effective for pharmacy Less costly
Disadvantages
Time consuming for facility Increased chances for errors More medication waste
2
Unit Dose Systems
First used in the 1960s in the hospital setting Used to decrease errors, support nursing in medication administration, and reduce medication waste Standard of practice in hospital settings today
Unit Dose and Modified Unit Dose Systems
Advantages
Less waste Easy to track usage Decreased errors of commission and omission Decreased nursing time
Disadvantages
Increased pharmacy time More storage space Increased cost
Unit Dose / Modified Unit Dose examples
Manufacturer unit dose Blister packs / bingo cards Medication cassettes
3
Manufacturer unit dose
Medication cassettes
Blister / Bingo cards
4
Medisets
Advantages
Less waste Flexibility Less nursing time Ease of use for patients
Disadvantages
Cost of medisets Increased pharmacy time Difficult for nursing to check for accuracy Increased errors
Mediset examples
Automation
Advantages:
Decreased pharmacy assimilation time Reduce medication errors by decreasing dispensing errors Authorized access only enhances security Availability of medications where needed Improved pharmacy inventory
Disadvantages:
Does not effect decrease nurse administration time Training considerations System downtime Expensive!
5
Automation considerations
Dispensing rate Flexibility and dose capabilities Labeling capabilities Accuracy and quality assurance safeguards Reporting and documentation capabilties Training requirements Cost
Automation examples
Small systems
Baxter ATC Script-pro 200 Pyxis medstation
Larger systems
Baker cells Baxter international bottle filler
Baxter ATC
Usually installed in the pharmacy Medications stored in calibrated canisters. An order is sent to the system and the medication is dispensed from the correct canister. Packages unit dose tablets and capsules into labeled and sealed strip packs Found to be 99.98% (vs. accurate 92.62% for manual filling) Kratz K. Hosp Pharm 1992.
6
Baxter ATC
Script-pro 200
Usually installed in the pharmacy Fills vials directly from dispensing cells Can print prescription and auxillary labels
Pyxis medstation
Kept on nursing unit Nurses can access medications out of drawers Pharmacy responsible filling unit with medications
7
Baker cells
In pharmacy system Counts a 30 count vial in 3-5 seconds Option to use software that dispenses medication after prescription is scanned
Drug delivery and administration
Drug delivery
On time delivery to correct facility Correct nursing area / staff Ensure emergency back-up
Medication administration
Correct:
Patient, Dose, Dosage form, Route, and Time
Documentation of drug administration
The medication administration record (MAR)
Monthly record of dispensed medications for each patient List of medications and administration times List of PRNs to chart usage Nursing/facility staff sign/initial when med dispensed Tracks missed doses and changes in medications
8
Emergency Kit
Supply of short term emergency meds tailored to specific nursing facility needs Gives dispensing services to facility to be used when pharmacy services not available Contents determined by nursing facility and pharmacy. Guided by state regulations. Box is sealed and locked when delivered to NF Broken seal indicates usage Nurse documents usage and returns records inside emergency kit to pharmacy for refill
Medication distribution errors
Human Error
Medication orders
Omissions, incorrect transcription
Interpretation/evaluation
Dose appropriateness, concurrent meds and diseases, drug interactio...