During my rotation, I had the opportunity to be involved in the different steps of drug distribution. At Langley Memorial Hospital, orders are prepared via a pharm tech order entry and pharmacist verification system (pharmacists are also able to do both order entry and verify). Drugs are distributed as automated unit doses (AUD) and if it is not a bulk item, wardstock or excluded drug, scheduled drugs are packaged by the Langley Pharmacy Drug Distribution Centre (PDDC). Fill lists run at 6:30pm daily (Pharmacy closes at 6pm) and the rolls are ready by 4:30am. Rolls arrive in the morning (with the patient’s name header on the top, followed by the patient’s scheduled meds) and pharmacy technicians sort the rolls and deliver them to the ward by 800hr. When delivering, they also collect the previous day bins and any pharmacy returns (incl. fridge items) which are sorted for recycling in the morning. For orders that are faxed throughout the day – pharmacy has to prepare and deliver an interim supply of scheduled and PRN meds until the rolls can come in from PDDC the next morning. If later during the hospital stay, the patient requires more PRN meds – the ward will send down a prescription refill request form (has patient’s name and medication) and pharmacy will check Rx Audit (to see previous debits/refills and assess quantity to send) and debit the quantity, print a label and send the supply to the ward.
When verifying new orders, pharmacists highlight the orders that require an interim supply and the order goes to the filling station where it has to either be filled and checked by 2 separate pharmacy technicians or 1 pharmacist (who would have to initial on the order and on the label). One difference between checking in community and hospital is that the label does not contain the DIN and brands are generally interchangeable, so there is no double check with the DIN. If they are not stat orders, the interim supplies are placed into their ward-specific bin to be delivered throughout the day. If it is a stat, the supply is delivered as soon as possible by the pharmacy technician and is either placed into the pharmacy bin, given directly to the clinical pharmacist or given directly to the nurse taking care of the patient. If it is a fridge item, it will be placed in the fridge in the room-specific bin. For extended care, drivers come by to pick up the interim supplies and patient profiles documenting the changes at certain times of the day.