1. Introduction
A drug distribution system in a hospital is the organized process by which medications are procured, stored, prepared, and delivered to patients with the primary aim of ensuring rational, safe, and timely drug therapy. This system plays a central role in the hospital’s therapeutic and administrative activities. The hospital pharmacy serves as the pivotal department responsible for managing this system effectively and ensuring that the right drug reaches the right patient in the right dosage, form, and time.
Efficient drug distribution systems are vital for ensuring optimal therapeutic outcomes, minimizing medication errors, and maintaining financial and inventory control. A well-structured drug distribution system not only promotes effective patient care but also supports the hospital’s economic stability, prevents drug misuse, and enhances coordination between the pharmacy, nursing, and medical departments.
2. Objectives of a Hospital Drug Distribution System
The main objectives of an effective hospital drug distribution system are as follows:
- To ensure accurate drug delivery: The correct medication, in the correct strength and dosage form, should reach the correct patient.
- To maintain accountability: Proper documentation and record-keeping should be maintained for each drug dispensed or administered.
- To minimize medication errors: A system that minimizes human errors through cross-checking, pharmacist review, and proper labeling.
- To ensure economic and rational use: Avoid wastage, overstocking, or misuse of medicines.
- To ensure proper storage: Maintain ideal environmental conditions such as temperature, humidity, and light for preserving drug potency.
- To ensure patient safety: Prevent adverse drug events, drug incompatibilities, or contamination.
- To integrate technology: Use computerized systems, barcode scanning, and automated dispensing units for speed and accuracy.
- To comply with legal and ethical requirements: Adhere to hospital policies, Drug and Cosmetics Act, WHO Good Pharmacy Practice (GPP) guidelines, and national accreditation standards such as NABH or JCI.
3. Dispensing of Drugs to Inpatients
3.1 Definition
Dispensing of drugs to inpatients refers to the preparation, packaging, labeling, and supply of medicines prescribed by the hospital’s medical practitioners for patients who are admitted to the hospital (inpatients). In this system, the medication is not handed directly to the patient but is administered by nurses under the supervision of the physician.
3.2 Process of Inpatient Dispensing
The process of inpatient dispensing is systematic and involves several well-defined steps:
Step 1: Receiving the Prescription
- The physician writes the prescription on the patient’s case sheet or enters it electronically using the Hospital Information System (HIS) or Computerized Physician Order Entry (CPOE).
- The prescription includes the patient’s name, age, hospital number, ward, diagnosis, and details of all prescribed drugs (name, dosage, frequency, route, duration).
Step 2: Pharmacist Review and Validation
- The pharmacist verifies the prescription for accuracy and appropriateness, ensuring:
- Correct drug name and strength
- Appropriate dosage and frequency
- Absence of drug interactions or duplications
- Suitability for the patient’s age, condition, and comorbidities
- Compliance with the hospital formulary
Step 3: Processing the Prescription
- The validated prescription is entered into the pharmacy records or electronic system.
- A drug requisition slip is generated for that specific patient or ward.
Step 4: Drug Preparation
- The drugs are picked from inventory shelves and checked for expiry date and batch number.
- If reconstitution is needed (e.g., IV antibiotics), it is done in the sterile preparation area of the hospital pharmacy.
- Liquid preparations are measured and poured accurately into labeled bottles.
Step 5: Labeling
- Each dispensed medication is labeled with the patient’s name, drug name, strength, dosage, frequency, route, and any specific warnings (e.g., “shake well before use,” “keep refrigerated,” “for external use only”).
Step 6: Distribution to Wards
- Drugs are packed according to ward requirements and sent via pharmacy assistants or pneumatic tube systems to the respective nursing stations.
- Nursing staff receive the medicines, verify quantities, and sign the receipt.
Step 7: Administration and Documentation
- The nurse administers the medications to the patients as per the physician’s orders.
- Every dose given is recorded in the Medication Administration Record (MAR).
Step 8: Return and Disposal
- Any leftover, discontinued, or expired medications are returned to the pharmacy.
- Damaged or expired items are disposed of according to hospital waste management policies.
3.3 Importance of Inpatient Dispensing
- Ensures timely and correct drug therapy.
- Promotes monitoring of patient medication regimens.
- Reduces errors by providing pharmacist oversight.
- Controls wastage and ensures accountability of drug use.
- Facilitates patient safety and hospital compliance with standards.
4. Types of Drug Distribution Systems in Hospitals
Different hospitals adopt different drug distribution systems based on size, infrastructure, staff, and patient load. The major types are described below:
4.1 Individual Prescription Order System
Definition:
Each patient’s prescription is individually processed by the pharmacist, and the medication is dispensed in quantities sufficient for a short duration (usually 24–48 hours).
Procedure:
- Doctor writes a prescription.
- Pharmacist reviews, prepares, and dispenses the required drugs.
- Drugs are sent to the ward for that specific patient only.
Advantages:
- Personalized service ensures accuracy.
- Pharmacist can check for drug interactions.
- Easier to identify medication errors.
- Good for hospitals with fewer inpatients.
Disadvantages:
- Labor-intensive and time-consuming.
- Increased workload on pharmacy staff.
- Delay possible in urgent cases.
- Not economical for large hospitals.
Best suited for: Small or medium-sized hospitals where patient numbers are manageable.
4.2 Floor Stock System
Definition:
In this system, a stock of commonly used medications is maintained in each ward or nursing unit. Nurses use these drugs for patients as prescribed by physicians.
Types of Floor Stock Systems:
- Charge Floor Stock System:
- Each time a drug is used, the patient’s account is charged.
- Record maintained by the nurse and verified by pharmacy staff.
- Non-Charge Floor Stock System:
- Drugs are supplied in bulk and not directly charged to individual patients.
- Used for inexpensive or emergency medications.
Advantages:
- Rapid drug availability for emergencies.
- Reduced pharmacy workload for routine drugs.
- Convenient for nurses.
Disadvantages:
- Lack of strict control leads to wastage and pilferage.
- Increased chances of medication errors.
- Difficulty in cost allocation.
- Expired or unused drugs often accumulate.
Best suited for: Emergency wards, intensive care units (ICUs), or high-turnover departments.
4.3 Unit Dose Drug Distribution System (UDDS)
Definition:
A system in which medications are dispensed in single-use packages, each containing the exact dose required for one administration to one patient at one time.
Procedure:
- Pharmacist prepares and labels each individual dose.
- Unit doses are delivered daily (usually for 24 hours).
- Nurses administer and record each dose.
Advantages:
- Greatly reduces medication errors.
- Improves accountability and documentation.
- Reduces drug wastage and overall cost.
- Enhances pharmacist participation in clinical monitoring.
- Simplifies administration for nursing staff.
Disadvantages:
- Requires additional space, equipment, and trained staff.
- Higher initial setup cost.
- Requires precise coordination between pharmacy and nursing.
Example:
A 500 mg paracetamol tablet for Patient A in Ward 3 will be packed, labeled, and delivered for one-time administration only.
Best suited for: Medium and large hospitals emphasizing patient safety and quality care.
4.4 Centralized vs. Decentralized Distribution Systems
| Parameter | Centralized System | Decentralized System |
| Definition | All dispensing occurs from one central pharmacy. | Drugs are dispensed from smaller satellite or ward-level pharmacies. |
| Control | Centralized control ensures consistency and accountability. | More flexible and provides faster service. |
| Speed of Delivery | Slower for remote wards. | Faster, especially during emergencies. |
| Cost | Lower operating cost. | Higher staffing and inventory cost. |
| Best suited for | Small or medium hospitals. | Large multispecialty hospitals. |
4.5 Satellite Pharmacy System
Definition:
A miniature pharmacy located near patient care areas (e.g., ICU, oncology ward). It operates as an extension of the central pharmacy.
Advantages:
- Faster response to urgent needs.
- Improved communication between pharmacists and physicians.
- Better supervision of drug administration.
Disadvantages:
- Requires additional manpower and space.
- Costly to maintain multiple satellite units.
4.6 Automated and Electronic Drug Distribution Systems
Modern hospitals employ automation and computerized technologies such as:
- Automated Dispensing Cabinets (ADCs) – Secure electronic cabinets located in wards where nurses can retrieve medications after authentication.
- Barcode Medication Administration (BCMA) – Barcodes are scanned before administration to ensure the right patient, right drug, and right dose.
- Electronic Medication Records (eMAR) – Digital records ensure full traceability of each medication administered.
- Pharmacy Robots – Used for automatic dispensing, labeling, and packaging in advanced hospital settings.
These systems improve speed, safety, and accuracy while significantly reducing medication errors.
5. Charging Policy in Hospital Pharmacy
5.1 Definition
A charging policy is the hospital’s strategy for determining how medication costs are billed to patients. It ensures accurate accounting, financial transparency, and control of drug utilization.
5.2 Objectives
- To ensure that the cost of all drugs used is recovered appropriately.
- To maintain transparency between pharmacy, nursing, and accounts departments.
- To minimize losses due to uncharged or wasted medicines.
- To facilitate insurance claims and third-party reimbursements.
5.3 Methods of Charging
1. Direct or Individual Charging
- Each drug dispensed is billed to the patient’s individual account.
- Most accurate and transparent method.
- Commonly used in the unit dose and individual prescription systems.
2. Floor Stock Charging (Charge System)
- Drugs kept in wards are charged to patients based on actual use recorded by nurses.
- Pharmacy audits these records periodically.
3. Non-Charge Floor Stock
- Drugs are not individually billed.
- Their cost is included in the overall bed or treatment charge (e.g., basic analgesics or disinfectants).
4. Automated or Computerized Charging
- Integrated with Hospital Information Systems (HIS).
- Automatically adds the cost of drugs to the patient’s bill as soon as they are scanned or dispensed.
- Reduces manual error and increases efficiency.
5.4 Importance of an Efficient Charging Policy
- Prevents financial losses to the hospital.
- Provides transparency in billing and patient satisfaction.
- Ensures accountability and traceability of each drug used.
- Supports accurate pharmacy budgeting and audit trails.
6. Labeling of Dispensed Drugs
6.1 Definition
Labeling refers to the process of preparing and affixing an identification label on the drug container that provides essential information about the medicine and its usage.
6.2 Objectives of Labeling
- To provide accurate and complete information to healthcare providers.
- To ensure proper administration of drugs.
- To prevent medication errors and misuse.
- To comply with legal and regulatory requirements.
6.3 Information to be Included on Inpatient Drug Labels
For inpatient drug supplies, each label must contain the following details:
- Patient Details
- Name, hospital ID number, ward, and bed number.
- Drug Information
- Generic and brand name.
- Strength and dosage form.
- Quantity dispensed.
- Administration Details
- Route of administration (oral, IV, IM, SC, topical, etc.).
- Frequency and time of administration.
- Storage Conditions
- e.g., “Store below 25°C,” “Keep refrigerated,” or “Protect from light.”
- Warnings or Precautions
- e.g., “Shake well before use,” “For External Use Only,” “May cause drowsiness,” “Do not consume alcohol.”
- Dispensing Details
- Date of dispensing.
- Name and signature/initials of the pharmacist.
- Batch number and expiry date.
6.4 Importance of Labeling
- Prevents administration errors and ensures patient safety.
- Helps in identifying drugs easily.
- Provides instructions for correct use and storage.
- Facilitates traceability in case of recalls or adverse reactions.
- Mandatory for compliance with pharmacy regulations and quality audits.
7. Modern Trends in Hospital Drug Distribution
7.1 Computerized Physician Order Entry (CPOE)
- Replaces handwritten prescriptions with digital entries.
- Reduces transcription and interpretation errors.
7.2 Automated Dispensing Cabinets (ADC)
- Provides controlled, electronic access to medications in wards.
- Records every transaction for audit purposes.
7.3 Barcoding and RFID Systems
- Each drug package is barcoded or RFID-tagged.
- Ensures right patient–right drug–right dose–right time–right route.
7.4 Integration of HIS and Pharmacy Management Systems
- Synchronizes drug inventory, billing, and patient records.
- Facilitates real-time data access for pharmacists and clinicians.
8. Conclusion
The hospital drug distribution system is the heart of pharmaceutical services within a healthcare institution. Its efficiency directly affects the quality of patient care, economic management, and safety of drug therapy.
Among all systems, the Unit Dose Drug Distribution System (UDDS) is regarded as the most effective and safest, though it requires advanced infrastructure, trained personnel, and high coordination. Modern technological advancements—such as automated dispensing cabinets, barcoding, RFID systems, and electronic records—have revolutionized drug distribution, ensuring accuracy, accountability, and patient-centered care.
Thus, the success of any hospital drug distribution system depends upon continuous supervision, interdepartmental cooperation, adherence to good pharmacy practices, and integration of technology with professional expertise.