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MEDICATION
DISTRIBUTION
SYSTEMS
Endang Yuniarti, S.Si.,M.Kes,Apt

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Contents

Floor Stock Distribution System

Individual Prescription System

Unit Dose System

Hospital Pharmacy

Selection
Procurement
Storage
Preparation for administration
Distribution to the patient/patient
care unit

Hospital setting

The hospital pharmacist working

with other professionals
accepted responsibility to
purchase, prepare and distribute
drug products so they were
available to the nurse to
administer to the patient as
prescribed by the physician

The role of the pharmacist

Providing the patient with an

appropriate medication in an
acceptable dosage form to
facilitate easy administration.

DEFINISI
Distribusi Obat adalah suatu proses
penyerahan obat mulai dari sediaan
disiapkan oleh IFRS sampai obat diserahkan
oleh perawat, dokter, apoteker dan tenaga
kesehatan lain kepada pasien
Sistem Distribusi Obat adalah tatanan
jaringan sarana, personel, prosedur dan
jaminan mutu yang serasi, terpadu, dan
berorientasi pada pasien dalam kegiatan
penyampaian sediaan obat

Sistem Distribusi Obat Yang Baik

Menjamin ketersediaan obat
Mutu dan kondisi obat tetap stabil
dalam proses distribusi
Kesalahan obat minimal dan
keamanan maksimum pada pasien
Kerusakan obat dan kadaluwarsa obat
minimal
Efisien dalam penggunaan sumber
daya, baik sarana maupun SDM
Pencurian dan kehilangan obat
minimal

Sistem Distribusi Obat Yang Baik

IFRS memiliki akses dalam semua tahap
proses distribusi untuk pengendalian,
pemantauan dan penerapan farmasi klinik
Memungkinkan interaksi dokter-perawatapoteker-pasien
Mencegah pemborosan dan
penyalahgunaan obat
Harga terkendali
Mampu meningkatkan penggunaan obat
yang rasional

SISTEM DISTRIBUSI OBAT DI RS

1. Floor stock system (sistem
persediaan lengkap di ruangan)
2. Individual prescription order system
(sistem resep perorangan)
3. Unit dose system (sistem dosis unit)

Floor Stock System

A duplication of a small pharmacy

(often called the drug room) on the

nursing unit where drugs were
stored prior to the nurse preparing
drugs to administer to patients.
The pharmacist was responsible for
stocking the nursing unit (routine
visit to ward check expiry, stock
rotation and storage; deliver & top
up to shelves)

Floor Stock System

The nurse would read the

physician order, go into the drug

room to select the drug and
prepare it, and then administer it
to the patient.
The pharmacist would likely never
see the physician order but would
stock the medication on the floor
solely from the nursing request.

Floor stock system - advantages

1
Ready availability of the required drugs

Elimination of drug returns

3
Reduction in number of drug order
transcription for the pharmacy
4

Reduction in the number of pharmacy

personnel required

Floor stock system - disadvantage

1
Medication errors may increase
4
2
Increased drug inventory on
the pavilions
5
3
Greater opportunity for pilferage
6

Increased hazards associated

with drug deterioration

Require capital outlay to

provide proper storage facilities
on the ward

Greater inroads are made

upon the nurses time

Floor stock system

After pharmacy office hours
Obat-obat yang biasanya didistribusikan dgn
sistem floor stock:
1. Obat-obat life saving dan emergency
2. Obat-obat yang banyak digunakan dengan
harga yang relatif murah (top up shelves)
3. Cairan infus dasar
4. Bahan dan alat medis habis pakai.

Emergency kit

Emergency kit

Emergency trolley

Life saving drugs storage

Top up shelves

Basic Solution

Basic Solution

After pharmacy office hours

After pharmacy office hours

INDIVIDUAL PRESCRIPTION SYSTEM

Merupakan sistem distribusi obat dimana dokter
menuliskan resep per individu pasien untuk
beberapa hari (2-5 hari) dan obat disiapkan di
farmasi
Dapat digunakan untuk pasien rawat inap dan rawat
jalan
Alur Pelayanan :
Dokter menuliskan resep
Perawat membawa resep ke farmasi RS
Farmasi menyiapkan obat
Perawat mengambil obat yang telah disiapkan atau
obat diserahkan kepada perawat di ruang perawatan
Perawat memberikan obat sesuai order/instruksi
dokter
Bila obat dihentikan, obat dikembalikan ke farmasi
dan tidak dibayar oleh pasien

Individual prescription order system

Advantage:

1. All medication orders are

directly reviewed by the
pharmacist
2. Provides for the
interaction of pharmacist,
doctor,
nurse and
patient
3. Provides closer control of
inventory

Individual prescription order system

Disadvantage:
The possible delay in
obtaining the required
medication and the increase
in cost to the patient
Need personnel time of
nurse to divide medication
Medication error is still
possible

Individual prescription order system

Even though the pharmacist
had the opportunity to review
the patient order, the
pharmacist would place only
limited judgment on whether
it was correct or appropriate
for the patient.

Individual prescription order system

This system did not provide
sufficient information
necessary to devise a
medication profile. Thus, the
pharmacist did not have the
opportunity to effectively
monitor drug therapy and
influence optimal prescribing.

Individual Prescription System

Supply

Dispensing
Prepare
and label

Medication

Pharma
cist

Nurse

Review

Divide
into unit
dose

Administe
ring

Adminis
ter to
patient

Evaluation

Physician order

Individual Prescription System

Individual Prescription System

DELIVERY BY PNEUMATIC TUBE

Individual Prescription System

Review:
Appropriateness of drug, dose, route,
schedule.
Drug interaction (drug-drug, drug-disease,
drug-food).
Formulary adherence
Availability

Penyiapan obat
Lama penyiapan mempengaruhi terjadinya
medication error, semakin cepat proses
penyiapan semakin memperbesar peluang
terjadinya error
Tempat kerja dan fasilitas yang memadai
(automatic dispensing machine, barcode,
dll)
SPO (Standar Prosedur Operasional)

Penulisan etiket/labeling
Cek ulang penulisan label, cek terhadap resep,
cek terhadap obat (segitiga emas)
Label

Obat

Resep

Penulisan etiket/labeling
Automatic dan Electronic labeling lebih
menjamin px safety
Penggunaan gambar direkomendasikan

Penyerahan obat (Supply)

Pastikan obat yang diserahkan baik jenis,
jumlah maupun cara pakai sesuai dengan
resep (penggunaan bar code
direkomendasikan)
Libatkan perawat untuk memastikan obat
yang diserahkan benar dan akan digunakan
pasien dengan tepat

DIspensing Error
1.
2.
3.
4.
5.

Jumlah obat kurang

Jumlah obat berlebih
Obat salah karena sound alike
Obat salah karena package alike
Obat berbeda tapi masih dalam kelas terapi yang
sama
6. Obat berbeda dari kelas terapi yang berbeda
7. Obat berbeda tapi memiliki sifat farmakologi

yang sama

Dispensing Error
8.
9.
10.
11.
12.

Salah bentuk sediaan

Salah dosis/kemasan tapi obat sama
Salah kantong/salah etiket (wrong bag/label)
Ada obat berbeda dalam kantong yang sama
Obat salah karena letak obat yang terlalu
berdekatan
13. Obat dengan nama dagang yang berbeda (zat
aktif sama)
14. Lain-lain

Contoh 1:
Distribusikan obat-obat berikut dengan sistem
individual prescription untuk pasien an Tn.
Rahmat (RM 123456), yang dirawat di
ruang/paviliun Zam-zam dengan no kamar 10:
- Glimepiride 2 mg, satu kali sehari, setiap pagi, jumlah
10 tablet
- Metformin 500 mg, tiga kali sehari, jumlah 30 tablet.
- Simvastatin 10 mg, satu kali sehari, jumlah 10 tablet
- Alprazolam 1 mg, bila perlu, jumlah 10 tablet
- Paracetamol 500 mg, bila perlu, jumlah 10 tablet

Contoh 2
Px Ny. Anisah (RM 567890), 75 th, ruang rawat
Arofah, no bed 12
Aspilet 80 mg, satu kali sehari, 10 tablet
Captopril 25 mg, tiga kali sehari, 30 tablet
Bisoprolol 2,5 mg, satu kali sehari, 10 tablet
Meloxicam 7,5 mg, dua kali sehari, 20 tablet
Omeprazole 20 mg, dua kali sehari, 10 tablet
Cedocard 5 mg, 1 tablet bila perlu, 10 tablet

Individual prescription to Unit Dose

Beberapa penelitian menunjukkan sistem
distribusi floor stock dan resep individu,
rawan terjadinya medication error.
Perlu dikembangkan sistem distribusi yang
lebih aman dan melibatkan peran Apoteker
yang lebih luas dalam proses pengobatan
pasien Sistem distribusi obat dosis unit.

Unit Dose Distribution System

The fundamental difference between the
unit dose system and older is the more
active role of pharmacist in the medication
cycle with the patient reaping the benefits
of a trained medication practitioner
responsible for the medication cycle and
the return of the nurse to patient care
responsibilities

Unit Dose Distribution System

The UD System is defined as a pharmacycoordinated method of dispensing and
controlling medications in health care
institutions.
This system is characterized by medications
contained in unit dose packages, dispensed in
ready-to-administer form, and not more than
24-hour supply being delivered or available on
the patient care unit at any time.

Unit dose distribution system

Advantage:
1.
2.
3.
4.
5.
6.
7.
8.

A reduction in the incidence of medication errors.

A decrease in the total cost of medication-related
activities.
A more efficient usage of pharmacy and nursing personal.
Improve overall drug control and drug use monitoring.
More accurate patient billing for drugs.
The elimination or minimization of drug credit.
Greater control by the pharmacist over pharmacy
workload pattern and staff scheduling.
A reduction in the size of drug inventories located in
patient care areas.

Unit dose distribution system

DIsadvantage:
1. Memerlukan personel farmasi yang lebih
banyak (terutama Apoteker), atau
2. Teknologi yang lebih advance
High invest

Perkembangan UDs di AS

73,8%

61,1%
38,2%

17,5%

1975

1978

1982

TT dengan UDs

1987

Semakin banyak RS di Amerika

yang menggunakan sistem
distribusi dosis unit

Unit Dose Distribution System

Less expensive
Safer
Placed the pharmacist in a better position to be
involved in patient care
Increased role of the pharmacist to be able to
evaluate the px order helped propel clinical
pharmacy services impacting px drug therapy
The unit dose system requires the pharmacy to
have and maintain a patient medication profile.

Unit Dose System

Delivery
to the
floor

Prepare
into unit
dose utk
@ px

Dispensing

Medication in
unit dose

Pharma
cist

Nurse

Review

Double
check

Administe
ring

Adminis
ter to
patient

Evaluation

Physician order

UDDS
Actively placing the pharmacist in the middle
of the medication use process
Each medication is placed in a unit of use
package, as the correct dose for the patient in
a ready-to-administer form, not requiring any
preparation or selection by the nurse.
The medication will have a label that bears
the px name , the name of medication, the
corresponding strength, and the administering
time.

UDDS
For a new medication order for a patient or a
dose request from the nurse, the pharmacist
provided the medication to the floor before the
next cart exchange, either through a courier or
pneumatic system.
Narcotics were usually stored in a locked cabinet
with limited access. Prior to giving the dose, the
nurse had to take an accurate inventory of the
medication and document doses removed.
Pharmacy would reconcile it.

UDDS
As needed (PRN) medications :
- keep them in the pharmacy and dispense them
upon request, or
- using a limited floor stock system, especially
medications that had a low potential for
misuse and patient harm (laxative, antacids,
antipiretik)

Medication Delivery from Pharmacy

Medication Category

Delivery Method

1. Stable scheduled medications

24-hr supply (UDs)

2. Unstable scheduled medications

Delivery 1 hr before administration time

3. Scheduled IV/TPN Sol

Delivery 1 hr before administration time

4. PRN Medications

UDs in limited supply; limited floor stock

supply; delivered in response to request by PCU

5. Controlled medications

UDs Limited and secured supply ,

limited floors tock supply

6. STAT Medications

Delivered in response to request from PCU

7. Emergency medications

Emergency kits in PCU; delivered in

response to request from PCU

8. Investigational medications

Per dispensing protocol

Cases
Distribusikan kepada pasien rawat inap
dengan sistem Unit Dose utk contoh soal di
atas.

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