Abstract
The aim of the study was to test a new model of drug distribution known as unit-dose drug distribution including the effects of implementing this system on total drug consumption, especially in curbing antimicrobial use.
The study was carried out in the Department of Surgery at the University Clinical Center in Nis, Serbia. During the first six months of the study (comparative period), drugs were delivered directly from the pharmacy to the urology and orthopedic wards in the traditional way (ward stock system). During the next six months (study period), drugs were delivered directly from the pharmacy to the patients (unit-dose drug distribution system). Drug consumption was measured using the statistical unit defined daily dose (DDD) per 100 bed days according to the anatomical-therapeutic-chemical classification of drugs. Following implementation of the unit-dose drug distribution system, total drug consumption was reduced by 24.34% in the urology ward and by 21.43% in the orthopedic ward. During the comparative period, in the urology and orthopedic wards, systemic antiinfectives (group J) comprised 263.54 and 227.61 DDD/100 bed days or 43.05% and 25.52% of total drug consumption respectively, whereas, during the pilot study period this group of drugs comprised 191.63 and 173.52 DDD/100 bed days or 41.37% and 24.96% of total drug consumption respectively.
The unit-dose distribution system of drugs in hospitals leads to a control of drug consumption and substantial savings. Also, the pharmacist-physician interaction began to emerge as an important factor as a direct result of the changes in the drug distribution system.
[1] American Society of Hospital Pharmacists: “ASHP statement on unit-dose drug distribution”, Am. J. Hosp. Pharm., Vol. 46, (1989), p. 2346. Search in Google Scholar
[2] American Society of Hospital Pharmacists: “ASHP technical assistance bulletin on hospital drug distribution and control”, Am. J. Hosp. Pharm., Vol. 37 (1980), pp. 1097–1103. Search in Google Scholar
[3] C.A. Pedersen, P.J. Schneider and D.J. Scheckelhoff: “ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education-2003”, Am. J. Health Syst. Pharm., Vol. 61, (2004), pp. 457–471. Search in Google Scholar
[4] C.A. Pedersen, P.J. Schneider and J.P. Santell: “ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing-2001”, Am. J. Health Syst. Pharm., Vol. 58, (2001), pp. 2251–2266. Search in Google Scholar
[5] K.A. Parrott: “Drug waste in long-term care facilities: impact of drug distribution system”, Am. J. Hosp. Pharm., Vol. 37, (1980), pp. 1531–1534. Search in Google Scholar
[6] R.P. Evens and V. Yanchick: “Unit-dose systems: drug waste and drug processing time in a long-term care facility”, Hosp. Formul., Vol. 19, (1984), pp. 454–458. Search in Google Scholar
[7] K. Warrian and J. Irvine-Meek: “Cost-benefit of a clinical services integrated with a decentralized unit-dose system”, Can. J. Hosp. Pharm., Vol. 41, (1998), pp. 109–112. Search in Google Scholar
[8] S.H. Spooner and P.K. Emerson: “Using hospital pharmacy technicians to check unit-dose carts”, Hosp. Pharm., Vol. 29, (1994), pp. 433–437. Search in Google Scholar
[9] World Health Organization Collaborating Centre for Drug Statistics Methodology: Guidelines for ATC Classification and DDD Assignment, 5th ed., World Health Organization, Oslo, Norway, 2002. Search in Google Scholar
[10] S. Natsch, Y.A. Hekster, R. de Jong, E.R. Heerdink, R.M. Herings and J.W. van der Meer: “Application of the ATC/DDD methodology to monitor antibiotic drug use”, Eur. J. Clin. Microbiol. Infect. Dis., Vol. 17, (1998), pp. 20–24. http://dx.doi.org/10.1007/BF0158435810.1007/BF01584358Search in Google Scholar
[11] R. Sommers, G. Kephart and I.S. Sketris: “Evaluation of Thrombolytic Drug Use and Expenditures in Nova Scotia Hospitals using the World Health Organization’s Defined Daily Dose (DDD) Methodology (abstract)”, Presented at the: Canadian Health Economics Research Association Conference, May 22–25, 2002, Halifax, Nova Scotia. Search in Google Scholar
[12] J.J. Stoiker, E.R. Heerdink, S.E.J. Pullen, F.W. Santman, A.H. Yechiel, H.G.M. Leufkens and F.G. Zitman: “Determinants of psychotropic drug usage in general intensive care unit”, Gen. Hasp. Psychiatry, Vol. 20, (1998), pp. 371–376. http://dx.doi.org/10.1016/S0163-8343(98)00048-610.1016/S0163-8343(98)00048-6Search in Google Scholar
[13] R.A. Kiivet, M.L. Dahl, A. Llerena, M. Maimets, B. Wettemark and R. Berecz: “Antibiotic use in 3 European university hospitals”, Scand. J. Infect. Dis., Vol. 30, (1998), pp. 277–280. http://dx.doi.org/10.1080/0036554985016093610.1080/00365549850160936Search in Google Scholar PubMed
[14] P. McManus, M.L. Hammond, S.D. Whicker, J.G. Primrose, A. Mant and S.R. Fairall: “Antibiotic use in the Australian community, 1990–1995”, Med. J. Aust., Vol. 167, (1997), pp. 124–127. Search in Google Scholar
[15] World Health Organization: WHO global strategy for containment of antimicrobial resistance, WHO, Geneva, 2001. Search in Google Scholar
[16] “Factors contributing to resistance”, In: World Health Organization report on infectious diseases 2000: overcoming antimicrobial resistance, WHO, 2000, Chapter 3, www.who.int/infectious-disease-report/2000. Search in Google Scholar
[17] M.B. Robertson, J.G. Dartnell and T.M. Korman (on behalf of the Victorian Drug Usage Evaluation Group): “Vancomycin and teicoplanin use in Victorian hospitals”, Med. J. Aust., Vol.171, (1999), pp. 127–131. Search in Google Scholar
[18] M.B. Robertson, T.M. Korman, J.G. Dartnell, L.L. Ioannides-Demos, S.W. Kirsa, J.A. Lord, L. Munafo and G.B. Byrnes (on behalf of the Victorian Drug Usage Evaluation Group): “Ceftriaxone and cefotaxime use in Victorian hospitals”, Med. J. Aust., Vol. 176, (2002), pp. 524–529. Search in Google Scholar
[19] N.F. Col and R.W. O’Connor: “Estimating worldwide current antibiotic usage: report of task force 1”, Rev. Infect. Dis., Vol. 9, (1987), pp. 232–243. Search in Google Scholar
[20] C.M. Kunin, H.L. Lipton, T. Tupasi, T. Sacks, W.E. Scheckler, A. Jivani, A. Goic, R.R. Martin, R.L. Gurrenat and V. Thamlikitkul: “Social, behavioral and practical factors affecting antibiotic use worldwide: report of task force 4”, Rev. Infect. Dis., Vol. 9, (1987), pp. 270–285. Search in Google Scholar
[21] R.A. Kiivet, M.L. Dahl, A. Llerena, M. Maimmets, B. Wettermark and R. Berecz: “Antibiotic use in 3 European university hospitals”, Scand. J. Infect. Dis., Vol. 30, (1998), pp. 227–280. http://dx.doi.org/10.1080/0036554985016084610.1080/00365549850160846Search in Google Scholar PubMed
[22] American Society of Health-System Pharmacists: “ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery”, Am. J. Health Syst. Pharm., Vol. 56, (1999), pp. 1839–1888. 10.1093/ajhp/56.18.1839Search in Google Scholar PubMed
[23] S.D. Fihn: “Acute uncomplicated urinary tract infection in woman”, N. Engl. J. Med., Vol. 349, (2003), pp. 259–266. http://dx.doi.org/10.1056/NEJMcp03002710.1056/NEJMcp030027Search in Google Scholar PubMed
[24] E.M. Perfetto, K. Keating, S. Merchant and B.R. Nichols: “Acute uncomplicated UTI and E.coli resistance:implications for first-line empirical antibiotic therapy”, J. Manag. Care Pharm., Vol. 10, (2004), pp. 17–25. Search in Google Scholar
[25] L. Nicolle: “Best pharmacological practice: urinary tract infections”, Expert Opin. Pharmacother., Vol. 4, (2003), pp. 693–704. http://dx.doi.org/10.1517/14656566.4.5.69310.1517/14656566.4.5.693Search in Google Scholar PubMed
[26] http://www.zdravlje.sr.gov.yu. Search in Google Scholar
[27] D.A. Talan, W.E. Stamm, T.M. Hooton, G.J. Moran, T. Burke, A. Iravani, J. Reuning-Scherer and D.A. Church: “Comparison of ciprofloxacin (7 days) and thrimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis in women: a randomized trial”, JAMA, Vol. 283, (2000), pp. 1583–1590. http://dx.doi.org/10.1001/jama.283.12.158310.1001/jama.283.12.1583Search in Google Scholar PubMed
[28] F. Ansari: “Use review of systemic antiinfective agents in a teaching hospital in Tehran, Iran”, Eur. J. Clin. Pharmacol., Vol. 57, (2001), pp. 541–546. http://dx.doi.org/10.1007/s00228010035010.1007/s002280100350Search in Google Scholar PubMed
[29] C.M. Kunin, K.S. Johansen, A.M. Worning and F.D. Daschner: “Report of a symposium on use and abuse of antibiotics worldwide”, Rev. Infect. Dis., Vol. 12, (1990), pp. 12–21. Search in Google Scholar
[30] European antimicrobial consumption: http://www.ua.ac.be/ESAC. Search in Google Scholar
[31] A.W. Bauer, W.M.M. Krby, J.C. Sheris and M. Turck: “Standardized Disc Susceptibility Test”, Federal Register, Vol. 39, (1974), pp. 19182–19184. Search in Google Scholar
[32] C. Doughty, R. Martin and B. Greenberg: “Treatment of hospital-acquired infections with amikacin”, Am. J. Med., (1977), pp. 376–382. Search in Google Scholar
[33] R. Janknegt, A. Oude Lashof, I.M. Gould, J.W.M. van der Meer: “Antibiotic use in Dutch hospitals 1991–1996”, J. Antimicrob. Chemother., Vol. 45, (2000), pp. 251–256. http://dx.doi.org/10.1093/jac/45.2.25110.1093/jac/45.2.251Search in Google Scholar PubMed
[34] N. Martini, G. Scroccaro, M.L. Sala and P. Olivencia: “Antiinfectives consumption in a group of hospitals in three Mediterranean countries”, In: N.F. Muller (Ed.): Progress in Clinical Pharmacy, Eighteenth European Symposium on Clinical Pharmacy, The Netherlands, 1990, pp. 220–221. Search in Google Scholar
[35] S.H. Spooner and P.K. Emerson: “Using hospital pharmacy technicians to check unit-dose carts”, Hosp. Pharm., Vol. 29, (1994), pp. 433–437. Search in Google Scholar
[36] P.J. Ambrose, F.G. Saya, L.T. Lovett, S. Tan, D.W. Adams and R. Shane: “Evaluating the accuracy of technicians and pharmacists in checking unit-dose medication cassettes”, Am. J. Health Syst. Pharm., Vol. 59, (2002), pp. 1183–1188. Search in Google Scholar
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