Department of Pharmacy Policies & Procedures

Number:   5:01.46

Effective Date: May, 1990   

Revisions:   12/98; 4/02; 9/09

Approval:   4:02

Subject:   UNIT DOSE DRUG DISTRIBUTION SYSTEM

A. POLICY

The UAMS Medical Center Pharmacy Service provides drugs for all patients in the hospital in individual pre-packaged, pre-labeled containers. The unit dose system will be supported from the Central Pharmacy.  Dose packaging systems will be standard for the process used to prepare and administer the medication.  If a different system is required, education on its use will be provided to caregivers.

B. PROCEDURE

1.  The automated dispensing machines (ADMs) are the primary supply source for medications and it is controlled by medication entry to the patient profile after review by pharmacy.

(a) Supplies to the ADM are replenished daily according to a refill pick list generated off of minimum stock levels. 

(b) The drugs on the refill pick list are pulled for each nursing unit by the technician.  Each drug is placed in a separate zip-lock plastic bag.

(c) The pharmacist checks all drugs against the refill pick list and initials the list.

(d) The drugs are refilled into the ADM in the plastic bag using the refill function on the machine.

(e) Nurses on the unit may empty the plastic bag when accessing the medication, providing a check of the refill function.         

2.  The secondary method of distribution for the unit dose system is the individual patient medication cassette bin.  For each patient, there are two cassette bins.

(a) The cassettes are exchanged every 24 hours. The full cassette bin is delivered to the nursing unit and exchanged with the previous day’s cassette bin, which is returned to the pharmacy to be refilled the following day.

(b) For the majority of adult patients, the cassette exchange time is between 1430 and 1500 daily.

(c) The neonatal nursery receives all oral unit dose medications on a once daily delivery at 0400.  This unit does not have ADM.

(d) Overnight Recovery and the Short Stay Units cartfills are sent to the floor by 0400.

3.  New medication orders are processed throughout the day.  If the drug is in the ADM, it will cross the interface onto the ADM profile and the nurse can obtain the drug on the patient.  If the drug is not in the ADM, it will either be loaded or the appropriate amount of medication is dispensed until the next cassette exchange.  All controlled substances will be stocked in the ADM.

4. The cassettes are filled between 0700 and 1000 each day.

5. The picking procedure involves the following steps:

(a) A “Cart Fill Report” prints at 0600 listing a 24 hour supply of drugs for each patient. 

(b) The technician pulls the drugs as they appear on the report for each patient.  These drugs are placed in the patient’s bin.

(c) At 1130 and 1330, a "Cart Fill Catch-Up Report" prints. The drugs on this list are pulled and added to the appropriate patient bins.

(d) All new orders received between 1330 and 1430 will be filled for the initial dose as well as the doses needed for the next day (up to 1430).

(e) Additions are made to the patient bin as needed.

(f) All drugs dispensed will be in a unit dose, unit-of-use form with the exception of topical drugs, some oral suspensions, and a few injections.

(g) Multiple dose containers will be stored in the patient bin, labeled with the patient's name, and exchanged with each cassette exchange.

(h) Doses requiring multiples of the same strength of drug will be placed in a plastic bag and labeled "Note Dosage Strength".  Dosage information will also be placed in the MAR comments section.

(i) Dosages requiring different strengths of the same drug will be separated into individual doses, placed in plastic bags and labeled "Note Dosage Strength". Dosage information will also be placed in the MAR comments section.

(j) When all of the cassettes for a nursing unit have been filled, the technician will initial the top page of the “Cart Fill Report” and the “Cart Fill Catch-Up Report”.  A pharmacist checks each cassette for accuracy of fill and also initials the top of the “Cart Fill Report” and the “Cart Fill Catch-Up Report”. 

(k) A “Cart Fill Report” for the Neonatal Nursery prints at 1500.  At 0200, a "Cart Fill Catch-Up Report" prints. All new orders received between 0200 and 0400 will be filled for the initial dose as well as the doses needed for the next day (up to 0400).

(l) A “Cart Fill Report” for Overnight Recovery and the Short Stay Units prints at 2300. The medications for each patient are placed in a zip-lock plastic bag and tubed to the unit by 0400.

6.  Changes in Patient Status Prior To Cassette Exchange

(a) Discharges and Transfers

All discharges or transfers are signaled by a label which is generated through the ADT system.  Reconciliation of the patient bin for all new orders prior to cart exchange is handled through the “Cart Fill Catch-Up Report” as noted above.  All discharges automatically are posted to the patient profile and the ADM by the ADT system. 

(b) New Orders and Order Changes

As new orders are entered into the computer, a label is generated indicating a sufficient quantity to send to the nursing unit to last until the next cart exchange. Reconciliation of the patient bin for all new orders prior to cart exchange is handled through the ““Cart Fill Catch-Up Report” as noted above. 

(c) New Admissions

When a patient is admitted to the hospital, a label is generated in the pharmacy by the ADT system.  This label may be used to prepare cassette labels for patient medication cassette bins.  The ADT information is also transferred to the MRX on the admitting unit.  As new orders are entered into the computer, a label is generated indicating a sufficient quantity to send to the nursing unit to last until cart exchange. Reconciliation of the patient bin for all new orders prior to cart exchange is handled through the “Cart Fill Catch-Up Report” as noted above. 

7. Order Message Queue

a) The Message Queue enables nurses to send messages to the pharmacy when in the context of an order. The message queue displays the messages, the patient name, order number and the message text. The pharmacist can respond to these messages in various ways and send messages back to the floor.

b) The message queue is used for replacement doses for drips and for missing doses.

c) This communication log is saved in the electronic patient profile.

8.  Patient Medications Brought into the Hospital

Patient medications brought into the hospital at the time of admission and not sent home shall be handled as in policy 5:17.

9.  Processing Medication on Patient Discharge

(a) If the bed is filled prior to cart exchange, the nurse on the unit is to take the medications from the cassette and place them in a bag along with the cassette bin label.  The bag can be placed in the "in/out" tray for pick-up by pharmacy or tubed to the central pharmacy.

(b) Unused medications may be returned to stock in accordance with public health allowances.