Across Europe over the past few years, hospital wards and departments have received inpatient medicines as stock items. Hospital pharmacies not only acted as secondary wholesalers but also set up repacking units to break down bulk supplies from the pharmaceutical industry into manageable quantities. This process was time-efficient for the pharmacy, but wards became overstocked and medicine administration was drawn out because nurses had to select appropriate medicines for each patient from a “mini pharmacy” housed in the medicines trolley. Administration errors were frequent.
Individual inpatient dispensing has now become fashionable as a means of reducing administration errors. In the UK, original packs lasting up to 28 days are now dispensed for a patient, while other European countries have adopted the American model of unit-dose dispensing, which issues a maximum of three days supply. Medicine trolleys with individual patient drawers have been introduced that aid the selection of the right medicine for the right patient.
As a result of individualised dispensing, nurses spend less time administering the medicine but pharmacy workload has increased. At the same time, patient stays in hospital have fallen and patient throughput has increased. Pharmacies are finding it difficult to cope with the additional dispensing load.
In most European countries, patients are not given medicine on discharge from hospital.
The supply is handled by community (private) pharmacies. In the UK, the situation is different. One-stop-dispensing programmes have been developed in the UK to resolve a situation where patient discharge from hospital was delayed because the hospital pharmacy could not cope with the ever-increasing dispensing workload of patients going home. By labelling medicine packs for patient use, self-medication programmes could be introduced in many areas, although it may not be suitable across all specialities.
One-stop-dispensing has some important benefits according to the Audit Commission Report, A Spoonful of Sugar. A patient will receive a 28-day supply of medication on admission to hospital and, in most cases, at least two weeks supply will remain for the patient to take away on discharge. It is claimed that dispensing costs will drop as the medicine is dispensed only once. It is also more convenient for the patient, as there will be no delay in discharge.
One-stop-dispensing is based on the assumption that the medication prescribed for patients on admission will not change during their hospital stay. In practice this is not always the case. What happens to the part-used patient packs when they are returned to the pharmacy? Are they relabelled and reused, or are they destroyed? Either way, has the cost of these processes been evaluated?
Automation of drug distribution and dispensing is now established. Optical identification of medicines, through barcoding or radiofrequency identification (RFID) tagging, is on its way. With the introduction of automation and electronic identification of product and patient, could the reintroduction of ward-stocks in the form of original manufacturer packs be an option? A full audit trail of every dose supplied can be set up, with ward stock replacement managed by a pharmacy robot.
Planning for the future of hospital pharmacy in the new technological age is paramount. Is the
model that has evolved over the past ten years suitable for the next era? Does the current system “make do”, or can we do better?