How Do You Dispense Drugs To In-Patients?

How Do You Dispense Drugs To In-Patients

One of the vital functions of a hospital pharmacy department is to provide services to in-patients. All hospital invariably offers in-patient services, though they may or may not offer services to out-patients. An in-patient is “admitted” to the hospital and stays in the hospital till he recovers or is discharged by the doctor. The patient's stay in the hospital can extend from overnight to an indeterminate time, as in the case of coma patients.


The objectives of the drug distribution system for in-patients are: 

1. To provide drugs for all in-patients of the hospital on a 24 hours per day basis. 

2. To inspect and control the distribution of drugs in all treatment areas.

Location Layout and Planning 

The unit should be located at such a place in the hospital that is readily accessible to all departments and free from disturbances. The various sections of the in-patient pharmacy should be continuous. The unit should be well equipped. The physical plan of this department should be well planned by considering the future growth of the hospital and avoiding further modifications. The facilities and equipment’s used to store the drugs should be designed in such a way that it facilitates the routine inspection of the drugs before their administration and these are readily available to the physician and pharmacist. 

In-patient pharmacy is a multi-function department – storage, dispensing, manufacturing, IV fluids, parenterals, etc. These functions form a continuous whole and bear a direct vertical relationship. In recent years, there is a tendency to operate satellite pharmacies either at the level of wards or based on doors. This is a case of decentralized service. Each of these pharmacies is operated by a professional pharmacist.

Personnel for In-patient Services 

There is no standard rule for the requirement of personnel. Manpower requirements are a function of the type of services provided by the pharmacy and the capacity of the hospital.  Generally, manpower is correlated to the number of beds. The following table is illustrative:

Table.1: Pharmacists Requirement in Hospital Pharmacy 

Capacity in Bed

No. of Pharmacists Required

Up to 50 beds


Up to 100 beds


Up to 200 beds


Up to 300 beds


10 Up to 500 beds



In terms of job specification, they must have professional qualifications and a proven track record. The chief executive pharmacist is a thought-bred professional, with some managerial training. In addition, if there is a manufacturing facility attached to the pharmacy, technical persons in related areas like; tableting, liquid orals, parenterals, ointments, etc. are also part of staffing. They should get back up to operative and maintenance personnel.

The Side Head with Types of Drug Distribution System 

Within the general hospital practice four systems are used to distribute drugs from the pharmacy to the wards:

Individual Prescription Order (for each patient) System 

Small and private hospitals adopt this system since it can be operated with less manpower, economic consideration, and under the direct supervision of a pharmacist. Here, the drugs are dispensed and labeled for each patient. The prescription sheets are usually sent to the pharmacy. Pre-packaged doses are generally very useful. The nurses are advised by the pharmacist about proper storage labeling and accounting of the drugs. If on administration, there are untoward reactions, there is a system of contacting the physician as well as the pharmacist, so that immediate corrective action can be taken. 


• Reduces manpower requirement. 

• All prescriptions are directly reviewed by the pharmacist. 

• Opportunity for close interaction between the pharmacist, nurse, and physician. 

• It provides close control of stock. 

• Medication errors can be spotted. 

• Facilitates charging of private patients. 


• Possibility of delay in obtaining medication. 

• Increases in the cost of drugs to patients. 

• In cannot be practiced in big hospitals.

Complete Floor or Ward Stock System 

Under this system, the nursing station carries both “charge” and “non-charge” patient medication. According to this system, the drugs are stored at the nursing station and are administered by a nurse according to the chart order of the physician. Only the commonly used drugs in considerable quantities are stocked on the floor stock or in the ward (ward stock). Rarely used or costly drugs are not included in the floor stock but are dispensed when the order is received for the individual patients. Mainly this system is used in hospitals where the charges are not made to patients. 

Since these drugs are used in large quantities, they are pre-packed in standard containers. Nursing staff from each floor or ward sends their written demands of drugs according to the list provided to each floor and ward, daily to the hospital pharmacy or through a messenger and collects the medicines from the pharmacist. 


• These are readily available for administration. 

• Minimum return of drugs. 

• Reduced in-patient prescription orders. 

• Reduction in the number of pharmacy personnel required. 


• Increase in chances of medication errors due to lack of review by pharmacists. 

• Greater opportunity for misuse of drugs resulting in financial loss. 

• Increase in drug inventory. 

• Increased chances of drug deterioration due to lack of proper storage facilities. 

• Increased work load on nurses due to medication activities. 

Ward No. 3 A 

Ibuprofen-Paracetamol Tablet 


Ibuprofen - 400 mg

Paracetamol – 325 mg

Fig.1: Labelling of Floor Stock Drug 

The drugs in the nursing station are known as Floor Stock Drugs. They are classified into two parts: 

1. Charge floor stock drugs. 

2. Non-charge floor stock drugs. 

Dispensing of Charge Floor Stock Drugs: 

• Charge floor stock drugs are those for which the patient is charged for every single dose administered to him. Selections of these drugs in various wards are decoded by “The pharmacy and Therapeutics Committee”.

• Once the floor stock list is prepared, it becomes the responsibility of the hospital pharmacist to make the drugs available. 

• Charge floor stock drugs are stored at various nursing stations. 

• The patients are charged mostly because of the high cost of such drugs. Such drugs include injections or other unit dosage forms. 

• An envelope is used to dispense such drugs at nursing stations. 

• Under this system, pre-labeled envelopes are filled with a pre-determined quantity of specific drugs and are placed at the disposal of the nursing unit. 

• When the drug is administered, the patient’s name and room number are entered on the envelope and sent to the pharmacy for records. 

Ward                                                                                     Patient 

Phenobarbitone Tablets 

Each tablet contains

Phenobarbitone - 50 mg


  XYZ Hospital Pharmacy, Mumbai 

Fig.2: Label for a Charge Floor Stock Medication 

Dispensing of Non-Charge Floor Stock Drugs: 

Non-charge floor stock drugs are the medicaments that are placed at the nursing station for the use of all patients on the floor. For these drugs, there shall be no direct charge from the patient's account. 

• Non-charge floor stock drugs consist of a pre-determined list of medications available in every nursing unit of the hospital. The non-charge floor stock drugs are selected based on the cost of drugs, quantity required frequency of use, etc. 

• ‘Drug basket method’ is adopted where nurses check the medicines in all rooms and the refrigerator and prepare a master list for the pharmacy. 

• Nurses fill out a requisition form for the delivery of drugs to their floor. 

• When there is an empty container, the nurse places it in the drug basket. 

• Once the procedure is completed the drug basket containing the empty containers and requisition for floor stock supplies are then sent to the pharmacy. 

• Immediately in the morning, the pharmacy staff commences to fill each container and dispense the requested drugs. 

• Once the basket is completed, it is delivered to the floor via messenger services. 

• Alternatively, a Mobile Dispensary Unit can be utilized: It is a specially constructed stainless-steel truck measuring 60 inches high, 48 inches wide, and 25 inches deep. It is mounted on bottom tires, four of which are swivel type.


Ferrous Sulphate Tablets 


Each tablet contains

Ferrous Sulphate – 0.3 gm

XYZ Hospital Pharmacy, Mumbai 

Fig.3: Label for Non-Charge Floor Stock Medication 

Combination of Individual Drug Orders and Floor Stock System 

This system is used in those hospitals where patients pay for their hospitalization and the hospitals use the individual prescription order system as their primary means of dispensing but have several drugs in the floor stock. 


1. All the drug procurement is one system so the pharmacy assistant and patient’s time can be saved. 

2. As per respective medical specialties and ward units like cardiology, neurology, nephrology, urology, etc first line, and follow-up drugs can be dispensed and refilled through proper selection of inventory control methods. 

3. Combination leads to better patient medication adherence, counseling, and interventions. 


1. Extra space and cabinets may be required. 

2. Staff pharmacy (assistant, pharmacy technician) and wages including extra framework and infrastructure is required hence, the budget requirement is another typical task. 

3. Special care division may be affected. 

4. Storage space may be required more. 

Unit Dose Dispensing System 

In unit dose dispensing, the multiples of single-dose administration of medication are prepared by the pharmacist who is ready for administration to particular patients by a prescribed route and the prescribed time rather than supplying containers of drugs to nursing units where the nurse is required to prepare the drug for administration. A single unit package contains one complete pharmaceutical dosage form, e.g. one tablet, one capsule, or 10 ml oral liquids, etc. Liquids are pre-measured, powders are accurately weighed and diluted, and parenterals preparations are suitably diluted and accurately measured into sterile syringes ready for administration. 


• Patients receive improved services round the clock and are charged for only those doses which are administered to them. 

• All doses of medications required at the nursing station are prepared by the pharmacy thus allowing nurses more time for direct patient care.

• Medication errors are decreased because of direct checks by the pharmacist. 

• Excessive duplication of orders and paper work at the nursing station and pharmacy is eliminated. 

• Contamination due to handling is eliminated. 

• It eliminates the wastage of drugs and pilferage. 

• More efficient utilization of professional and non-professional personnel is promoted. 

• More space is available in nursing units by eliminating bulky floor stock. 

• Extends pharmacy coverage and control throughout the hospital from the time the physician writes the order to the time patient receives the unit dose. 

• Communication of medication orders and delivery systems are improved. 


• It requires more space since packaging material increases the bulk of the dosage forms. 

• It requires an increased number of skilled and lay people in the pharmacy. 

• The cost of medication is increased to the patient due to increased handling charges.

Unit Dose Drug Fulfillment Process

Fig.4: Unit Dose Drug Fulfillment Process

The unit dose dispensing concept may be introduced into the hospital in either of two ways: 

1. Centralized unit-dose drug distribution system (CUDD). 

2. Decentralized unit-dose drug distribution system (DUDD).


Centralized Unit-Dose Drug Distribution System (CUDD): 

• All in-patient drugs are dispensed in unit doses and all the drugs are stored in the central area of the pharmacy and dispensed at the time the dose is due to be given to the patient. 

• To operate the system as an effective delivery system various medication carts are used to carry unit doses to the patients and also to send a copy of the physician’s original medication order to the pharmacy for direct interpretation and filling. 

Decentralized Unit-Dose Drug Distribution System (DUDD): 

• This operates through small satellite pharmacies located on each floor of the hospital. 

• The main pharmacy is for procurement, storage, manufacturing, and packaging. It serves all the satellite pharmacies. 

• This type of system is used in a hospital with several buildings. 

The following procedure is adopted in a hospital when a decentralized unit dose system is adopted: 

• Patient profile card containing full date, disease, and diagnosis, is prepared. 

• Prescriptions are sent directly to the pharmacists which are then entered into the patient profile card. 

• Pharmacist checks medication orders for allergies, drug interactions, drug laboratory tests, etc. 

• Dosage schedule is made and coordinated with nursing personnel. 

• Patient profile card and prescription order is filled by pharmacy technicians. 

• Pharmacist then checks cards before their release. 

• The nurses administer the drugs and make the entry in their records. 

• Upon return to the pharmacy the cart is rechecked.  This process requires the availability of a pharmacist for consultation by doctors and nursing staff.

Comparison of Key Features of Drug Distribution Systems

Fig.5: Comparison of Key Features of Drug Distribution Systems 

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