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

www.themegallery.com
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-
perawat-apoteker-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

2
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
Medication errors
errors may
may increase
increase
4
Increased
Increased hazards
hazards associated
associated
2 with drug deterioration
with drug deterioration
Increased
Increased drug
drug inventory
inventory on
on
the pavilions
the pavilions
5
Require capital outlay to
3 provide proper storage facilities
Greater
Greater opportunity
opportunity for
for pilferage
pilferage on the ward

6
Greater
Greater inroads
inroads are
are made
made
upon the nurses time
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
 Floor inspection

Pharmacy responsible for all drug

storage in hospital
Monthly audit by RPh
Drug storage
Expiration date
Drug Deterioration
 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

Medication
Supply Divide
into unit
dose

Dispensing Administe
Prepare Phar Nurse ring Adminis
and label macis ter to
patient
t

Review Evaluation
Physician order
Individual Prescription System
DELIVERY BY PNEUMATIC TUBE
 Review resep

Review:
Appropriateness of drug, dose,
route, schedule.
Drug interaction (drug-drug, drug-
disease, drug-food).
Formulary adherence
Availability
 Review resep (PMK 58/2014)

Persyaratan administrasi meliputi:

a.nama, umur, jenis kelamin, berat
badan dan tinggi badan pasien;
b.nama, nomor ijin, alamat dan
paraf dokter;
c.tanggal Resep; dan
d.ruangan/unit asal Resep
 Review resep (PMK 58/2014)

Persyaratan farmasetik meliputi:

a.nama Obat, bentuk dan
kekuatan sediaan;
b.dosis dan Jumlah Obat;
c.stabilitas; dan
d.aturan dan cara penggunaan
 Review resep (PMK 58/2014)

Persyaratan klinis meliputi:

a.ketepatan indikasi, dosis dan
waktu penggunaan Obat;
b.duplikasi pengobatan;
c.alergi dan Reaksi Obat yang
Tidak Dikehendaki (ROTD);
d.kontraindikasi; dan
e.interaksi Obat.
 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. Jumlah obat kurang

2. Jumlah obat berlebih
3. Obat salah karena sound alike
4. Obat salah karena package alike
5. 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. Salah bentuk sediaan
9. Salah dosis/kemasan tapi obat sama
10. Salah kantong/salah etiket (wrong
bag/label)
11. Ada obat berbeda dalam kantong yang
sama
12. 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 Ny. Waginah (RM 123456), 73 th, yang
dirawat di bangsal Interna dengan no
kamar 10:
Concor (Bisoprolol) 1,25mg 1x1,
Captopril 25 mg 2X1,
Cefotaxime 1 gr 3x1
Novorapid 3x8 unit,
Metformin 500 2x1,
Furosemide 40mg 1-0-0,
Omeprazole 40mg inj 1x1 tiap 24 jam,
Lipanthyl Penta (Fenofibrat) 145mg 1x1.
 Contoh 2
Px Tn. Suryono (RM 567890), 75 th,
bangsal Interna, no bed 12
Aspilet 80 mg, satu kali sehari, 10 tablet
Irbesartan 150 mg, satu kali sehari, 10 tablet
Furosemid, satu kali sehari, 10 tablet
Isosorbid dinitrat, bila perlu, 20 tablet
Warfarin 5 mg, 1 kali sehari, 20 tablet
Antasida, tiga kali sehari, 20 tablet
Omeprazole 20 mg, dua kali sehari, 20 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

pharmacy-coordinated 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. A reduction in the incidence of medication errors.

2. A decrease in the total cost of medication-related
activities.
3. A more efficient usage of pharmacy and nursing
personal.
4. Improve overall drug control and drug use
monitoring.
5. More accurate patient billing for drugs.
6. The elimination or minimization of drug credit.
7. Greater control by the pharmacist over pharmacy
workload pattern and staff scheduling.
8. 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% Semakin banyak RS di

Amerika yang
61,1%
menggunakan sistem
distribusi dosis unit
38,2%

17,5%

1975 1978 1982 1987

TT dengan UDs
 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.
 Patient Medication Profile

1) Patient information
2) Allergies
3) Admiting Diagnosis
4) Medication profile:
a. Drug name
b. Drug strength
c. Drug route
d. Time of adminitration
Unit Dose Distribution System
 Medication profile

Medication profile.xlsx
 Unit Dose System

Medication in
Delivery unit dose
Double
to the
check
floor

Prepare Dispensing Administe

into unit Phar Nurse ring Adminis
dose utk @ macis ter to
px patient
t

Review 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.
 E:\My Videos\TAIWAN\TAIPEI HOSPIT
AL\UDD.MPG
Unit Dose Distribution
UDD
UDD
Unit Dose Distribution
 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 24-hr supply (UDs)
medications
2. Unstable scheduled Delivery 1 hr before administration
medications 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
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 Tugas DUE

Mhs dibagi mjd 8 kelompok, masing-

masing mencari hasil penelitian terkait
evaluasi penggunaan obat di rumah sakit.
Penelitian dilakukan pada tahun 2011-
2016 dan dipublikasikan melalui jurnal
yang sudah dikenal baik, seperti pubmed,
elsevier, bmj, dll. Penelitian yang dipilih
adalah penelitian yang menggunakan
analisis statistik untuk mengukur
efektifitas penggunaan obat.