Seminar 4 – Drug distribution – an update

Abstract:

Unit-dose dispensing (UDD) systems are effective in decreasing error rates affecting drug prescription, validation, dispensing and administration.

However, some drug-distribution problems need to be solved: delays in the prescriptions’ arrival, slowness in new medical orders’ response, frequent prescription changes obliging to repeat the workflow, missed doses, increasing number and amount of drugs kept in wards, communication flaws between Pharmacy and the clinical units, etc. Robotics, informatics and automation are clinically and economically effective alternatives for the institutions, playing an important role in Pharmacy Departments’ activities and services.

Medication use in hospitals is complex, involving numerous steps. Technology has the potential to minimize medication errors by reducing complexity and, if properly designed and implemented, improving efficiency and patient care. It can also be a cost-effective tool for improving quality.

New technologies apply to the whole pharmaceutical scope of activity in medicines information, clinical-decision support systems and computerized physician order entry (CPOE), facilitating and optimizing medical prescription as well as pharmaceutical validation, storage and dispensing among others.

Automated dispensing machines (ADMs) are drug-storage devices or cabinets that electronically dispense medications in a controlled track use. They can improve drug safety and management, and when interfaced with a CPOE-system and pharmacist validation, permit to change the UDD model for inpatients, decentralizing the dispensing-system. Although they can shorten the time to first dose administration, establishing how and when nurses will retrieve medications is mandatory to avoid retrieval of not-ordered medications.

Ramon y Cajal Hospital’s Pharmacy Department considered that its distribution system needed reengineering to enable pharmacists to devote more time to pharmaceutical care. The unit-dose drug-distribution system in this 1070-bed, third-level hospital where ADMs and traditional dispensing system (both interfaced to CPOE) coexist, will be presented.

University Medical Center Hamburg Eppendorf has got 1.500 beds and offers medical care at maximum level. With the introduction of a comprehensive electronic patient record the drug distribution system was changed from a traditional ward stock to a unit-dose supply using a Baxter FDS system. CPOE combined with unit-dose technology and electronic registration of administration provides medication safety at high level. Accompanying a clinical pharmacy service was introduced. Every single ward is visited once a day by a clinical pharmacist who supervises the medication process from admission to discharge. Clinical pharmacists care for changing home medication to hospital formulary medication, dose adjustment, drug-drug interaction, compliance with guidelines etc. Pharmacists’ advices are very well accepted by nurses and physicians.

We will discuss the decision-making to prioritize the change from the traditional to the new model, the institutional cultural change, the investment required, and the pros and cons.

Although automation decreases errors’ amount and frequency, our experience demonstrates that they cannot be completely eradicated and even new error types can emerge. The results of a six-month prospective study performed to analyze errors and their contributing factors in our coexisting dispensing-systems will be presented.

Teaching Goals:

• Motivation for introducing patient related distribution systems such as unit-dose systems
• Requirements and tools for a successful introductionRole of the clinical pharmacist
• Different technical options for unit-dose supply
• Alternative drug distribution systems for increasing medication safety
• Discussing the pros and cons of unit-dose distribution
• Discuss the necessities of other drug supply processes e.g. filling ward stock, supplying just in time, supplying individually prepared drugs

Learning Objectives:

After attending the seminar participants should be able:

• to understand the impact of patient related drug distribution on medication safety
• to understand the role of the clinical pharmacist within a unit-dose process
• to name the technical and organizational requirements for a successful implementation of a patient related drug distribution system
• to decide which process of drug distribution is the safest and best in the hospital environment in their country