Developing hospital pharmacy services based on unit dose drug distribution

There are many examples in the literature of conventional or traditional drug distribution systems in hospitals which possess many shortcomings with reference to medication errors, the amount of time spent by nursing personnel in medication-related duties, inventory losses, the preparation of intravenous admixtures, and the lack of adequate drug usage records. These deficiencies primarily are due to the pharmacist's minimal influence over the control of the traditional drug distribution systems. An analysis and evaluation of the present pharmacy services at St. Paul's Hospital, Vancouver, B.C., similarly identified a traditional distribution system subject to many of the aforementioned potential problems. Using information based on existing unit dose systems as reviewed in the literature and data collected from a general questionnaire, new pharmacy services based on unit dose drug distribution are projected for St. Paul's Hospital. The required facilities and personnel for a progressive unit dose drug distribution system, an intravenous (I.V.) admixture preparation service and a drug surveillance program are projected accordingly. It would appear that a "centralized" approach to implementing unit dose distribution is most appropriate for St. Paul's Hospital's present requirements. This would involve the preparation and distribution of all drugs to nursing units in single dose packages from a central pharmacy area. A similarly centralized intravenous admixture service and a decentralized drug surveillance program also are described. These services commonly feature a greater responsibility being placed with the pharmacy department for preventing therapy problems such as admixture incompatibilities, drug interactions, adverse drug reactions and inappropriate drug selection. The effect of the above services on the responsibilities and number of pharmacy and nursing personnel is estimated based on results in similar programs. These changes also reflect extended hours of coverage in each area. Finally, a potential phasing plan and time schedule for the implementation of the proposed unit dose drug distribution system, I.V. admixture preparation service and drug surveillance program at St. Paul's Hospital is suggested.Pharmaceutical Sciences, Faculty ofGraduat