HOSPITAL PHARMACY

Def  Branch of pharmaceutical sciences that deals with the pharmacy profession and the
role of pharmacist inside the hospital.
 Department of hospital which deals with procurement, storage, compounding,
dispensing, manufacturing, testing, packaging and distribution of drugs.
 It is also concerned with education and research in pharmaceutical services.
 Hospital Pharmacy is directed by a professionally competent and a qualified
pharmacist
Pharmacy as the knowledge system that offers a health service through knowledge obtained from drugs
knowledge and their effects either physiological, chemical, physical or behavioural
system
Distribution of  Distributed to physicians, pharmacists and other health care professionals as well
Pharmacy as to the general public
Knowledge  Knowledge of drug products, their benefits and side effects will contribute to the
health of individuals and the welfare of the society
HP Roles  Preparation of IV admixtures
 Daily clinical rounds
 Provision of drug information
 Sterile prescription compounding
 Supervision of medication technicians
 Coordination of unit-dose operation
Goal  Integration with the health care team of the hospital
 Integration and cooperation with other hospital pharmacists
 To fulfil the best health care service that could be offered to the patients
Abilities  A wide knowledge of drugs and their actions
required for  Accurate knowledge of drug control procedure
hospital  Ability to develop a manufacturing program
pharmacist  Ability to share in research
 Ability to conduct teaching programs
 Ability to manage a hospital pharmacy and ability to be expert in any
pharmaceutical area
Objectives of  Ensure the availability of right medication at the right time in the right dose at the
hospital minimum possible cost
pharmacy  Act as a counseling department for medical staff, nurses and for patient
department  Act as a data bank on drug utilization
 Participate in research projects
 Implement decisions of the pharmacy and therapeutics committee
 Coordinate and cooperate with other departments of the hospital

Structure of Director of  Maintains an adequate drug supply

hospital the pharmacy  Participates through the pharmacy and therapeutics committee in
pharmacy staff developing of a current hospital formulary
 Participates in orientation and continuing education ofall persons
responsible for preparation or administration of sterile parenteral
medications and fluids
 Cooperates in any hospital teaching or research programs.
 Establishes specifications for the procurement of drugs.
 Responsible for the preparation, sterilization and labelling of
parenteral medications and solutions manufactured in the hospital
 Responsible for emergency drugs and antidotes throughout the
hospital Attends all meetings of the pharmacy and therapeutics
committee and implement their decisions
 Assists in the current education of the nursing, medical and other
appropriate hospital staff.
Associate or  Helps the director of the pharmacy in the operation of the
assistant pharmacy
director of  Supervising sterile products room, and directing pharmacy
pharmacy purchasing
Staff have daily responsibilities for physician order review and filling unit dose
pharmacists carts, checking parenteral admixture clinical duties including monitoring
drug-drug interactions
Clinical Play major role in monitoring and evaluating drug therapy
Pharmacists
PHARMACY Definition  An advisory group of the medical staff acts as the organizational
AND link of communication between the medical staff and the
THERAPEUTICS pharmacy department.
COMMITTEE  It is composed of physicians, pharmacists, and other health care
professionals selected by the medical staff.
 It is a policy-recommending body to the medical staff and the
administration of the hospital on matters related to the
therapeutic use of drugs.
Purpose 1. Advisory (development of policies)
The committee assists in the formulation of policies regarding the
evaluation, selection, and therapeutic use of drugs and related
devices in hospitals.
2. Educational
It recommends or assists in the formulation of programs designed
to meet the needs of the professional staff for complete current
(updating) knowledge on matters related to drugs and their use.

PTC AGENDA subjects that related to the drug therapy should be prepared by the
secretary (pharmacist) and sent to all members of PTC before meeting to
properly review the material for discussion.
Organization  It should be composed of at least 3 physicians, a pharmacist, a
 and operation representative of the nursing staff, administrators and QA
coordinators. The members are either appointed or elected.
 The hospital administrator should be a member in the committee.
A chairman is appointed from physicians and the pharmacist is
usually designated secretary (backbone of the committee).
 The committee should meet regularly at least 6 times per year and
when necessary.
 The committee should invite to its meetings persons within or
outside the hospital who can contribute specialized or unique
knowledge, skills, and judgments.
 Minutes of the committee meetings should be prepared by the
secretary and maintained in the permanent records of the
hospital.
 Recommendations of the committee should be presented to the
medical staff or its appropriate committee for adoption or
recommendation.
 Relation with other hospital committees concerned with drug use
(e.g., infection control, medical audit) should be maintained
Functions and  Advisory role to the medical staff and hospital administration in all
scope matters concerning the use of drugs Develop a formulary of drugs.
 The selection of items to be included in the formulary will be
based on objective evaluation of their therapeutic merits, safety
and cost.
 The committee should minimize duplication of the same basic drug
type, drug entity, or drug product.
 Make recommendations concerning drugs to be stocked To
establish or plan suitable educational programs for the hospital
professional staff on matters related to drug use.
 To study problems related to the distribution and administration of
medications
 To control and evaluate adverse drug reactions that may occur in
the hospital and do their best to prevent their occurrence.
 Developing policies that permit the rational use and effective drugs
in the hospital.
 Supervise the proper storage conditions of drugs to maintain the
maximum effect of the drugs

HOSPITAL FORMULARY
Definition Formulary is a list of drugs (and associated information) which are recommended or
approved for use by a group of practitioners in organized healthcare setting (e.g., a
hospital, managed care or homecare operation).
Main use Provides the information for procuring, prescribing, dispensing, and administering of drugs
under nonproprietary or proprietary (brands) names in instances where drugs have both
names
Advantages  Ensure quality and effectiveness of drug used in the pharmacy
 encourage the use of therapeutic protocols
 Cost effective prescribing
 Better stock management
 Educational system for junior doctors
 Rational drug use
 Improvement in communication between prescriber and pharmacist
Disadvantages  Deprive the physician of his right to describe and obtain the brand of his choice
 Permit the pharmacist to act as the sole judge of which brand of the drugs are to be
purchased & dispensed
GUIDELINE OF SAFETY, EFFICACY COST AND ACCEPTABLE TO PATIENT
DRUG
SELECTION
Generic Substitution of drug products that contain the same therapeutic moiety in the same
Substitution chemical form, dosage form, dose strength, and given by the route of administration but
differ in the inactive ingredients.
Therapeutic Pharmaceutical equivalents + Bioequivalence
Equivalence
Are pharmaceutical equivalents which when administrated to the same individuals in the
same dosage regimen will be expected to have the same clinical effect (efficacy and /or
toxicity profile)
Pharmaceutical Same API, route of administration, dosage form, and strength
equivalents
Bioequivalence The rate and extent of absorption do not show a significant difference
when given at the same dose as the brand.
Hospital Primary Information on drug Information on hospital policies & procedures
Formulary objectives: Special information about drugs
content & Main  Hospital policies &procedures
organization composition  Drug products listing
 Special information
Hospital policies  Drug use
&procedures  Description of PTC
 Hospital regulations about prescribing, dispensing &
administration of drug, rules for Medical Reps, emergency drugs
 Pharmacy operating procedures Information on using formulary
Drug products Items  Alphabetically by generic name
listing  Alphabetically within therapeutic class
Type of  Dosage form, strength, Packaging Active
information ingredients, uses and toxicology.
 Adult/pediatric dose.
  Route of administration.
 Cost
Indexes to  Generic name/brand name.
the drug  Therapeutic /pharmacological index
products
listing
Special  Equivalent dosages of similar drugs.
information  Hospital approved abbreviations.
 Rules for calculating pediatric dosages
 List of sugar free drugs.
 List of dialyzable poisons
 Tables of metric weights and apothecary and household
equivalents.
 Tables of common laboratory values.
 Poison control information.
 Table of drug interactions
Preparation of  Title page
Hospital  Names & titles of the members of the PTC
Formulary  Table of contents
 Information on hospital policies & procedures concerning drugs.
 Products accepted for use at hospital Appendix
Responsibility of  Drug selection.
hospital  Promoting formulary adherence
pharmacist  Review and take action on all non-formulary drug use in the hospital.
 Provide a copy of the hospital formulary to all doctors in the hospital.
 Involve the medical staff in various formularyimplementing programs.
 Give much advertisement and publicity regarding formulary.
 Revision of formulary
Formulary  Listing of drugs by their generic names followed by information on strength, form,
posology, toxicology, use & recommended quantity to be
 Prepared locally by its own clinical staff.
 Information provided is subject to local needs and desires
Drug list  Containing generic names followed by data on strength & form
 Information provided according to their pharmacological properties
 Prepared by country’s outstanding clinicians, pharmacologists and Pharmacists

Hospital Pharmacy Facilities

FACILITIES  Pharmacy location
 Office for director of pharmacy
 Pharmacy area as there should be adequate floor space for all pharmacy
 operations.
 Storage area as storage of pharmaceuticals should be in satisfactory location and
provided with proper lighting and ventilation.
 Parenteral admixtures.
 Area for consultation.
 Drug information resources.
 Library and filing equipment to make information for drugs available to both
pharmacists and physicians.
 Special locked spaces for narcotics, controlled drugs and alcohol.
 Refrigerator for thermolabile products
LOCATION  Central and convenient for providing service to many departments
 Near the elevator, outpatient and center of the activities of the hospital
 Easily accessible by any person who make daily use of the pharmacy
AREA 50-bed  the area should not be less than 25 m2, in which a combination of
hospital administration, dispensing, manufacturing, and other
pharmaceutical services are done.
 Separate room should be present for the preparation of sterile
products if present
100-bed  Two rooms are required, one for administration, dispensing, and
hospital manufacturing.
 Also a separate room for parenteral preparations and a store room
200-bed  Separate area for out-patient service.
hospital  An office for the chief pharmacist.
 A manufacturing room.
 A store room.
 A sterile products room.
 A separate area for drug information.
 Separate area for in-patient services
500, 1000, or  Waiting room Office for the secretary and book keeper
more beds  Manufacturing laboratory.
hospital  Formulation and research laboratory.
 Prepackaging and labeling
 Radiopharmaceutical laboratory.
 Alcohol and volatile liquids room.
 Narcotics, investigational drugs and controlled drugs.
 Additional bulk storage facilities.
 Analytical and quality control laboratory
Refrigerating Cold place: is one having a temperature not exceeding 8 °C.
facilities  Refrigerator, temperature is held between 2° and 8° C.
 Freezer, temperature between -20 and -10°
 Room temperature: between 15° C and 30°
 Cool place: temperature between 8° C and 15°
 Excessive heat: temperature above 40° C
Ventilation Air conditioning of the pharmacy
 Prevents contamination upon opening windows or doors.
 Reduces temperature that may arise due to various autoclaves and ovens.
 3. Air conditioning permits the maintenance of a temperature, which is compatible
with official storage requirements for drugs on year-round irrespective of the
climatic conditions
Electric lighting Sufficient lightening must be provided for the various work areas and library
The pharmacy In planning the hospital pharmacy, a library should be available
library and drug
information
center
Pneumatic tube Def Modern engineering technology has made available a means of
systems transporting nearly every item from the pharmacy to its hospital
destinations.
Advantages Save money and time and increase staff efficiency. as for example during
surgery, when a blood product or a sample result is needed urgently
Limitations  Unstable medications (e.g. albumin, insulin).
 Medications too large for the tubes. Medications restricted by
Hospital policy (e.g. narcotics)
Storage Normal largest portion of the pharmacy inventory, such as liquids, tablets,
storage area capsules and injectable drugs
25°c
REFRIGERATED  Large hospitals should have a walk in refrigeration
STORAGE  A separate freezing compartment should be available within this
room to house biological and other such drugs
Antiseptics: & stored separately from internal and injectable medications
Other drugs
for external
use and
disinfectants
Narcotics National regulatory standards should be followed (separate, Proper
recording to be maintained, always to be kept under lock and key).
Flammable stored in an underground bunker outside the hospital
storage
Out dated or should be identified and their distribution and administration prevented
unstable drugs
Emergency The pharmacist should be responsible both for the contents of
drugs emergency medication carts, kits, and for inspection procedure to be
used.
Metric – Weight and measure conversion charts should be available to those professional
apothecaries individuals who may require them.
Materials and necessary for the administration of the pharmaceutical service should be provided.
equipment Effective messenger and delivery service should be provided for the pharmacy
Sterile area for parenteral medicine preparation:
There should be a suitable area for the manipulation of the parenteral medication as
laminar airflow hoods

Sutures and Ligatures

Suture This term refers either to sewing the tissues together or refers to materials that use to close
the wound such as catgut, silk
Ligature It means Suture that is tied around a blood vessel to occlude the lumen.
Characteristic ● It should be suitable for using in any operation, easy to handle and inexpensive.
s of ideal ● Tissue reaction to suture should be minimal.
suture ● The tensile strength should be high.
materials ● It is knot should be hold security without cutting.
● It should be easy to thread and sterilize and should not shrink in tissue.
● It should not be capillary , electrolytic, allergenic, toxic, carcinogenic and corrosive.
● It should be absorbed with minimal tissue reaction after having served its purpose.
● Should be very strong but simply dissolved in body fluids.
● Should be totally biologically inert.
Classification According to 1. Natural.
of suture their origin 2. Synthetic.
material 3. Metallic
According to 1. Absorbable suture materials.
their behavior 2. Nonabsorbable suture materials
in tissue
According to 1. Monofilament
their structures 2. Multifilament
According to Absorbable This suture undergoes degradation and rapid loss of tensile strength within
their behavior 60 days.
in tissue Nonabsorbable The Suture is not absorbed by the body and retain its tensile strength more
than 60 days.
According to Monofilament • It is made of single strand and they have less tissue drag and don’t have
their interistics that may be harbor bacteria.
structures • are smooth and slide well in the tissues (plastic surgery).
• The injudicious use of forceps or needle holders can result in
microfractures formation within the monofilament
Multifilament It’s made of several filaments twisted together and more flexible and may
be coated to enhance handling characteristics.
have a surface area of several thousand times that of monofilament
sutures, hence they are easier to handle and have good knotting qualities.
However, they tend to drag as they are drawn through the tissues; some
sutures are lubricated with beeswax to avoid this.
They can also result in capillary action, with the potential for the interstices
of the suture to become colonized by bacteria

Examples of Synthetics Natural

Absorbable suture . Polyglycolic acid (40-60) days surgical gut (catgut)
materials . Polygalactin or vircyl (90) days Collagen
(according to its
. Polydioxanone (90) days Kangaroo tendon
origin)
Kangaroo tendon
Natural Cat gut Def It is derived from the submucosal layer of sheep or the
serosa of cattle intestine. Consists of 4 types ( A, B, C and
 D).
Types Consists of 4 types ( A, B, C and D).
Uses Types B, C and D are treated by chromic acid for:
1. Increase the time of absorption.
2. Increase the tensile strength.
3. Decrease the soft tissue reaction to suture material
MOA 1. Loss of tensile strength .
2. Digestion and absorption by proteolytic enzymes which
occur during the last stage of implantation.
3. Accelerated absorption may occur in patients with
fever, infection or protein deficiency
Advantages 1. Good handling when it is wet..
2. It is valuable in situations such as in joints, the biliary
tree and the urinary tract.
3. In suturing the mucosa of the gastro - intestinal tract
where a nonabsorbable suture might cause chronic
ulceration or hemorrhage.
4. In certain situations it might be used as a skin suture .
In this situation removing a non -absorbable suture might
be painful
Disadvantages 1. Weakness and poor knot security.
2. Its preparation is complex and The source is
undeniably septic and sterilization is a problem.
3. It tends to lose its tensile strength quickly and cannot
be used where continued support is necessary because
healing is naturally slow, as in fascia.
4. It frequently tends to cause an intense tissue reaction
(inflammatory and sensitivity reactions) which is not
always desirable.
COLLAGEN Def It is multifilament process from the bovine flexor tendons, absorption like
catgut
Uses in ophthalmic surgery less inflammatory reaction because of uniformity of
the tissue components .
Treated by n is treated with aldehyde which cross -links and strengthens the suture
and make it more resistant to enzymatic degradation
FASCIA LATA Source Is obtained from beef cattle and is prepared in strips
Uses Is obtained from beef cattle and is prepared in strips
Synthetic Absorbable S.M
POLYGLYCOLIC Def It is braided and multifilament resulting from polymer of glycolic acid
ACID Characteristic 1. It is absorbed by hydrolysis.
2. It is relatively strong and high tensile strength than catgut
Disadvantage  They tend to drag as they are drawn through the tissues.
 They can also result in capillary action, with the potential for the
 interstices of the suture to become colonized by bacteria
Polygalactin Def It is braided fiber composed of glycolic and lactic acid in ratio 9-1
Vicryl Characterisitic 1. It is absorbed by hydrolysis.
2. Tensile strength loss in high temperature and under alkaline condition
3. It is stronger than catgut.
Uses Facilitaie knot tying
Reduces tissue drag, however this coating reduces knot security and may
require use of extra throws
-POLY Def It is monofilaments suture derived from the polymer of paradioxanone
DIOXANON Characteristic 1. It is absorbed by hydrolysis.
DEXON 2. It causes minimal tissue reaction.
3. It is useful as a buried suture coz requires 210 days for complete
hydrolysis.
4. It is safe for use in CVS, plastic, orthopedics and urologic surgery.
5. More expensive than Vicryl & PGA.
6. Non-antigenic, so of minimal tissue reactivity.

Non- Absorbable suture materials

Examples of Non- Natural Synthetic Metallic
Absorbable suture Silk Nylon Stainless steel
materials (according Cotton Polymerized caprolactum Tantalum
to its origin)
Linen Polyster fiber Bronze, aluminum
Polypropylene Silver
Polyethylene Cupper and gold
 Natural
silk Def It is obtained from the cocoon of silk worm and it is braided or tested
multifilament, it may be treated by emersion either wax or oil or
silicone to decrease the tissue drag.
Advantages 1. It is higher tensile strength.
2. Easy to handle.
3. Has good knot security. 4. It is inexpensive .
Disadvantages It causes ulceration in GIT if the suture is protruded in the lumen of the
GIT.
Contraxdications Not used in urinary bladder and gall bladder because it is serve as nidus
for the formation of calculi.
Cotton Def the most common use of cotton in large animal is as umbilical cotton
tap it is produced from the filament of cotton plant
Advantages It is well tolerated by the tissue and causes less tissue reaction than silk,
it is inexpensive with capillarity and has good knot security and can be
autoclave but prolonged autoclaving will decrease the tensile strength
when wet.
Disadvantages  capillarity and tendency of bacterial growth.
 It sticks to wet surgical gloves making it more difficult to handle.
It is used in suture of perineal region for prolapsed of uterus
vagina and rectum.
Synthetic nonAbsorbable suture materials
-NYLON: Advantages It is either monofilament or multifilament. It has minimal tissue
(DERMALON reaction (inert) when implanted to tissue and has more tensile
strength
DISADVANTAGES knot is not good and mostly used in skin suture.
-Polymerized Source The twisted fiber are made from material related to nylon and is
caprolactam coated, it has more tensile strength than nylon and.
Uses  Used in veterinary surgery only and it is twisted multifilament
of nylon family
 used in skin suture
Polyethelene It is polymerized monofilament with highly tensile strength and have poor knot security
Polypropylene Source It is polymerized and monofilament and it is derived from polymer
propylene
Characteristic  High tensile strength(inert),
 great knot security
 lead to less thrombogenic sutures and
 use in vascular surgery
Disadvantage Slippery
Metallic
-Stainless steel Composition Iron, chromium(17%), nickel(10%) and molybdenum(2-4%)
Characteristics it is available either monofilament or multifilament. it is biologically
inert and non capillary, easily sterilized and autoclave
 Uses it is good for suture of the tissue that healing slowly such as tendon,
flat bone
Advantages It has the high tensile strength, greater knot security
Disadvantages poor handling , it cannot stand repeated bending
Tentalum, Silver, Uses Use as a mesh for hernia repair and knot security highly with stand
Aluminium repeating bending
Sterilization  autoclave sterilization with free access of
Techniques used  water vapor,
 applicable only for those sutures that are not harmed by this process.
 Dry heat at 310º F ;
 ethylene oxide
 irradiation sterilization using either β or γ rays.
Other Steristrips Are an alternative to skin sutures. These self-adhesive tapes cannot
techniques be used if there is any tension or significant moisture on a wound.
they are suitable for superficial lacerations of the face and fingers.
Tissue composition Composed primarily of fibrinogen and thrombin,
adhesives or fibrin sealant glues are used to support sutured anastomoses or are
‘glue sprayed on cut surfaces (such as the liver during liver resections) to
aid hemostasis
Uses when applied to a wound, forming a firm and adhesive bond.
Wound The wound should be clean, dry, and be able to be approximated
requirements without tension. The wound edges should be approximated
accurately before applying the adhesive because polymerization is
very rapid.
Staples Composition are made from titanium and confer high tensile strength with low
tissue reaction
Uses They can be placed faster than sutures and have a lower
predisposition to infection because they do not penetrate entirely
through the wound and do not produce a complete track from one
wound edge to the other. However, they can be uncomfortable and
require a special instrument to remove them.

Pharmaceutical services in hospitals

Services  In – patient pharmacy services.
 Out – patient pharmacy services.
 Pharmaceutical procurement and control services.
 Pharmaceutical services in hospitals Drug information services.
 Pharmaceutical development services
 Clinical pharmacy services.
 Rational pharmacy services.
  Educational and training services.
 Drug – drug interactions and handling of cytotoxic drugs
procurement • Purchase all drugs.
and control • Receive, store and distribute drugs.
services • Interview medical service representatives
Drug • Provide drug information on drug, drug therapy to the health care team.
information • Maintain literature files.
services • Maintain the drug information center.
Out – patient Def is defined as those patients who are not occuping bed in hospital but
attend hospital to receive medical care as emergency patients
Services • Compound and dispense out-patient prescriptions.
include • Provide patient counselling
In-patient Def as those patients who require hospitalization.
Services Drug distribution systems
include Intravenous admixtures and total parenteral nutrition
Drug monitoring
Drug Def s Physical transfer of drugs from storage area in the hospital to the patient’s
Distribution bedside
systems
Types  Floor or Ward Stock System
 Individual Prescription order system
 Combined Stock individual Prescription order system
 Unit Dose Distribution System
CHARGE FLOOR • These are drugs for which patient is charged for every single dose administered to him.
STOCK DRUGS • Selection of these drugs is made by PTC.
• An envelope is used to dispense such drugs
NON-CHARGE • These are medicaments placed at the nursing station for the use of all patients on the
FLOOR STOCK floor.
DRUGS • Selection of drugs under this class depends on cost, frequency of use ,effect of hospital
budget
• Adrenaline, atropine so4, digoxin
• Drug basket method.
• Mobile dispensary unit
Floor or Ward Def Drugs on the nursing station Operated in some hospitals as a
Stock System decentralized pharmacy under the direct supervision of a pharmacis
Advantages ● Ready availability of the required drugs.
● Reduction of drug order transcriptions for the pharmacy.
● Reduction in number of personnel required
Disadvantages ● Medication errors resulting from lack or review by pharmacist for each
patient order.
● Financial loss due to greater chance for pilferage.
● Limited capacity for proper storage facilities in nursing units in many
hospitals. ● Reduction in Increased danger of unnoticed drug
 deterioration that threatens patient safety
Individual Uses This system is traditionally used in the small and/or private hospitals.
Prescription These medications are labeled with individual patient's name and the
order system instructions for dosage.
How is it 1- Physician writes a prescription order
performed 2- Nurse transcribes this order and generates a drug order for
pharmacy
3- In this system, all medications are dispensed by the pharmacist on
individual prescription order.
Advantages • All prescriptions are directly reviewed by the pharmacist.
 A chance for close liaison between pharmacist, nurse, and
physicians in pharmaceutical matters.
 Enable investigation of possible medication errors.
 The pharmacist ensures that treatment is not continued
indefinitely without review.
Disadvantages  Consumption of excessive nursing manpower in the preparation of
doses.
 Since the nurse may administer the medications to the patient
without any reference to the prescription sheet, any change or
cancellation on this document may not be seen.
 A large number of containers are on the ward under this system
and this causes increased potential for medication errors .
 Over come: place the containers in a trolley with drawers labeled
for individual patient.
 High cost
 Delay in time
Combined How is it In this system, medicines are supplies as floor stocks, for those drugs in
stock individual performed more or less frequent use or individually dispensed items for all others.
prescription Aim In the individual dispensing system, the aim is to provide the maximum
order system number of treatments as individually dispensed items, whereas in the
combined system, a positive decision is made to restrict these, usually to
minimize pharmacy
Advantages By supplying stock items as prepacked units, there were sufficient saving
in pharmacist tim
Unit dose How is it Medications which are ordered, packaged, handled, administered, and
distribution performed charged in multiples of single dose units containing a predetermined
system amount of drug or supply sufficient for one regular dose, application or
use. Not more than 24 hours supply of doses should be available at
patient care area at any time.
Advantages 1. Safer for the patient.
2. More efficient and economical for the hospital.
3. More effective method for utilizing professional resources.
METHODS OF CUDD • All in-patient drugs are dispensed in unit doses and all the drugs are
DISPENSING (Centerized stored in central area of the pharmacy and dispensed at the time the dose
UNIT DOSES unit dose is to be given to the patient
dispensing) • Drugs are transferred from the pharmacy to the indoor patient by
medication carts or pneumatic tubes are required
DUDD This operates through small satellite pharmacies located on each floor of
the hospital. The main pharmacy is for procurement, storage
manufacturing and packing
Pneumatic tube Def Modern engineering mean of transporting items through a tube by the
force of compressed air as the force from pharmacy to various
departments in the hospital
Advantages ➢ Save money and time and increase staff efficiency.
➢ For example during surgery, when a blood product or a sample result is
needed urgently
Limitations 1. Unstable medications (e.g. albumin, insulin, IVIG).
2. Medications too large for the tubes.
3. Medications restricted by Hospital policy (e.g. narcotics)
Novel drug distribution methods

. Adherence ➢ Each patient receives a medication strip with individual doses in individual pouches
packaging ➢ It is clearly marked with Patient name, Medication name and strength, Time of
administration and Barcode.
Automated ➢ It is placed in wards, ICU rather than in central pharmacy and used only by authorized
dispensing users
cabinet
Robotic drug ➢ The robot can store up to 35000 medicines and dispense around 12 prescription in less
dispensing than a minute.