The floor stock system

The first distribution model is Floor Stock System. It started before 1960. In the past, only few staffs were involved in drug distribution. The pharmacist’s primary role was to purchase and prepare medications to be used on the nursing unit. In Floor Stock System, the commonly used medications are stored at a small area on the nursing unit, which is like a mini pharmacy at the nursing unit. Therefore, most of the pharmacies in hospitals were located at the basement, and the space was usually small.

Because the medications are stored on the nursing unit, nurses can easily and quickly prepare patient medication after a physician prescribe an order. So we say that the turnaround time between prescribing and administering medication is shorter in Floor Stock System.

Most drug rooms at the nursing unit are small, only few medications can be stored in it. So usually the commonly use medications are stored in drug room, depending on hospital’s policy. Once the patient start a new medication which is not stored at the drug room, nurses would send the request to the pharmacy to stock this new medication on the nursing unit. So basically, the room is stored all patients’ medications on this ward for their regular treatments.

The equipment required for the Floor Stock System is very simple in the past. We only need containers and storage space. The medication are kept before the nurse come to prepare them to administer to patients. The drug bottles are not patient-specific. There are multiple doses in each bottle to supply all patients receiving that drug on the nursing unit.

In this process, the nurse would collect many different medications from different drug containers for one patient’s daily regimen. So the labels of containers only show the drug name without individual patient’s information. Because the Floor Stock System required minimal pharmacy resources, it becomes a major distribution system in the past. However, many medication errors could happen if we use Floor Stock System without the pharmacists involving in verifying and dispensing, such as drug duplication, wrong drugs due to similar drug names.

So it could only work when we assumed that this distribution system was safe. As for the billing in the Floor Stock System, only drugs to be administered was charged, or patients were billed a daily fee for the drugs.

The working process in Floor Stock System is like that: the nurse read physicians prescriptions, then they walk into the drug storage room select medications and prepare patients’ drugs. The nurse is the only healthcare staff for preparing the patient’s medications for all medications, including oral and intravenous use. When the medications are run out, or the patient starts a different medication, nurses would send request to pharmacists for medication supply. So, pharmacists are usually responsible for refilling the stock. They usually don’t have opportunity to review prescriptions.

Let’s summarize the advantages of the Floor Stock System. Because the drug room is located on the nursing unit, and the nurses are responsible for reading orders and collecting medications, the medication is available immediately after prescribing. It shortens the turnaround time between prescribing and administering the medication. In addition, the unused drugs are still in stock and nurses don’t need to return unused medications to the pharmacy. Because the drug room is not located in the pharmacy and pharmacists are not responsible for dispensing; therefore, we say that it only needs minimal pharmacy resources. In general, the Floor Stock System is suitable for certain situations where need immediately prepare medications to patients, such as for emergency department, or operation rooms.

Nurses can immediately get medications for emergency use. In addition, some high volume, low cost, and low patient safety risk medications are also suitable to be stored at nursing unit. On the other hand, the Floor Stock System also has some disadvantages. First, the nursing unit usually is an open space, so drugs has potential to be stolen. And nurses need to do extra work to well manage these medications. For example, nurses need to regular check the expiry date, and there needs proper equipment to keep the medication under proper temperature and humidity in drug room to maintain medications’ quality.

For example, most of medications should be stored at the temperature under 25 degrees Celsius, and some medications such as insulin need to be stored at a refrigerator. So, a thermometer is needed in the drug room and in the refrigerator. And staffs usually should regularly monitor the room temperature. Unfortunately, the nursing units usually lack proper equipment. And because the drug room is usually small, so only commonly used medications are stocked in drug room. The rarely used drugs, may not be immediately available. The nurse need to send request to pharmacy, so it may delay the treatment. And pharmacist usually does not have opportunity to review orders and monitor patients’ therapy. Only nurses can read the prescriptions.

However, nurses only receive little pharmaceutical training. In addition, nurses have lots of works on nursing care that can make them to give medication preparation less attention than desirable. So, this system may result in many medication errors during the dispensing process. However, Floor Stock System is still applied nowadays because some of above disadvantages can be overcome by a well management. For example, pharmacists can involve in verifying prescriptions in advance. It could reduce errors of drug duplication, or regulate the limited drug items on the nursing unit. It could reduce errors of wrong drugs. Requiring regular medications checking could prevent patients from taking expired medications.

In our pharmacy, we apply Floor Stock System only for emergency medications, commonly used medications with high volume and low cost, and controlled medications. For the emergency medications, they put in an emergency cart on the nursing unit. To well manage these medications, our pharmacy make the rules for the emergency cart. To avoid too many medications in a cart, only 10 drug items are allowed to put in the emergency cart. And each drug should be put in its own labeled box. Preventing expired drugs in stock is an important part in drug management, so nurses need to regular checking the expiry date for these medications and remove expired drugs.

Our pharmacists regularly audit the checking documents and recheck the expiry date of the medication. For the commonly used medications, some high volume and low cost medications such as normal saline infusion bottles can be stored on the nursing unit. We only allow less than 10 drug items storing at each nursing unit for better management. For the controlled medications, we should ensure the controlled medications are stored at a safe area. So they should be stored at a drawer with locks. Every time when a nurse dispense these drugs, this nurse and the second nurse should signed on the administration record. In addition, nurses should check quantities of the controlled drugs in every shift. Again, our pharmacists regularly audit these records.