The unit dose system of medication distribution is a pharmacy-coordinated method of dispensing and controlling medications in organized health-care settings.
It is a system of drug distribution in which a portable cart (medication trolley) containing a drawer for each patient’s medications is prepared by the hospital pharmacy with a 24-hour supply of the medications.
It is safer for the patient, more efficient and economical for the organization, and a more effective method of utilizing professional resources.
How to order a medication for a patient?
The requested medications will be prescribed in the patient Medication Administration Record (MAR) with clear handwriting. With full medication information including: patient name, drug name, strength, dosage in metric units, route of administration, frequency, start and stop date, and time of administration.
All orders for Medications are transcribed & entered electronically on an automated unit dose order with full patient’s information and the name of the nursing unit. A print out of the order will be generated then checked, signed and stamped by an Authorized Licensed physician.
Electronic Medication orders should include: date and time ordered, Diagnosis, Allergy history, drug name, and doses in metric units, route of administration, frequency, start and stop date, and time of administration.
-Unit dose Medication orders will be received in the pharmacy for verification ,checking and reviewing medications before dispensing and must confirm that: the prescribed
medications shall be matched with the diagnosis ,the dosage is appropriate, No allergy history, No drug or food interaction and no incompatibilities.
Medication Reconciliation form must sent to the Pharmacy upon patient admission, in order to review the pre medication list for the patient and compare it with the admission medication.
-When a patient is transferred to/from a different level of care (e.g. MICU, SICU) all medications should be Hold in MAR and the computer system. Then medication shall be Revived in the MAR and the computer by an Authorized Licensed Physician or his designee.
All Medications that are ordered for admitted patients are subjected to automatic stop process to ensure that the potent drugs are reviewed in a timely fashion.
If the physician decides to continue the medication after the stop date, he /she should initiate a Re-order that is authorized by his signature and stamp.
Types of orders:
An order, for an urgently required medication, which is filled immediately within 20 minutes from the time of ordering (e.g. Aspirin 300mg tablet STAT means: one dose immediately)
An order contains new medication prescribed to the patient in a regular frequent manner. (e.g. Aspirin 300mg tablet PO TID for (7days)
An order allowing the continuation of the same medication for the same patient after reaching the discontinue date.
A notification order to stop the medication.
Order given by telephone when the doctor is unable to be present in the nursing unit to write then enter the formal order, this includes reporting of critical test results.
Verbal Orders :
Order given verbally when the doctor is unable to write the actual order in the patient’s file.
- The Use of Telephone/Verbal orders should be extremely rare. And only during extreme emergency when immediate action is required and the Doctor is unable to write the actual order.
- Telephone orders are not permitted for:
- Narcotic/controlled medications & High Alert Medication (Except in ICU)
- The prescribing physician must sign the unit dose computerized order Within 24 hours.
The order of PRN must have the followings:
- Indicate a frequency and the dose range
- Include the reason for the PRN medication.
PRN Doses Dispensed by Unit Dose Section:
Sufficient doses will be dispensed to cover the patient until the next scheduled refill. In case where the order written by the physician is not a fixed schedule, the following policy will be adhered to:
- If ordered on the fixed scheduled and PRN, two extra doses are to be dispensed unless it is exceeding the maximum dose.
- If ordered on an hourly schedule (i.e. 4-6 hours), base your supply on the maximum doses possible as if it had been written every 4 hours.
Automatic Stop Orders (ASO) shall be enforced for all antibiotics unless the exact numbers of doses have been clearly specified by the treating physician.
- Prophylactic Antibiotic 24 hours “or one dose only”
- Empiric Antibiotic 72 hours
- Therapeutic Antibiotic 7 days
All Antibiotics orders should be written in the Antibiotic order form, which is part of the MAR.
Restricted antibiotics Dispensing of restricted antibiotics have to be approved by the microbiology consultant.