The following article was written by Mr Ong Aik Liang, Ward Supply Pharmacist at Pusat Perubatan University Kebangsaan Malaysia. He was one of the recipients of the FAPA Travel Scholarships which enabled him to attend the FAPA2010 conference in Taiwan. Below is his description of the pharmacy practice in Taiwan
I was one of the awardees who were given the opportunity to attend this congress. I was honored as I got the chance to meet many delegates from around the world that were there in Taiwan. I was keen to find out the latest developments in pharmacy management and also the pharmacy practice in one of the most established hospitals in Taiwan, the National Taiwan University. This hospital was designed to support the concept of “patient-centered” care where all treatment is given at the bedside whenever possible.
To get more details of the hospital please visit http://www.ntuh.gov.tw/.
Visit National Taiwan University
Together with other delegates, we arrived at the hospital and were greeted by Associate Prof. Fe Lin Lin Wu, the Director of the Graduate Institute of Clinical Pharmacy of National Taiwan University. We were given a briefing about the organization of the pharmacy department. I was impressed by the number of pharmacists in NTU.
For other facts please refer to the following table to see the exact comparison between NTU hospital and UKMMC. Looking at the number of pharmacists, it is apparent that it is a huge structured organization but the comment from the director is that they are still suffering from a lack of manpower. Obviously, Prof Fe Lin Wu is a person with vision and her ultimate goal is to improve patient care. This is something many of us should learn.
|No of pharmacist||19||174|
|No of bed||874||2649|
|No of prescription/day for In patient||350||13,607|
The NTU is using ‘unit of dose’ while my hospital is based on the ‘unit of use’ system for drug distribution. In their setting, they do not rely on the pharmacy assistant to do the work. This can be observed by the daily service carried out by the pharmacists, including filling and topping up the medication trolley. It is a great commitment shown on their part resulting in zero dispensing errors but a collective amount of near missed errors.
Back in 2008, NTU extended their In-patient service hour to 24 hours. They also started their online verification order system in 2009. They came about the ongoing plan to improve their computerized pharmacy system in order to become more interactive while pushing for the pharmacist’s recommendation to become a part of the medical record (especially the interventions on patient care). They also proposed that in near future all medical records will be paperless including the prescription.
Information technology and drug safety
I remember in one of the Symposiums, Dr Fe-Lin Wu gave a lecture on improving drug safety through the use and Application of Information Technology. The pharmacist would work actively with IT professionals to construct a more reliable and efficient IT system in order to facilitate drug use and guarantee patient safety. Another speaker, Dr Pauline Lai from University of Malaya Medical Centre also agreed that the use of electronic prescribing improves the efficiency of the prescribing process through online drug availability and formulary benefits at the optimal points between the doctor and patient. I could not agreed more on this as UKMMC was the pioneered back in 2000 in implementing the pharmacy on line system. This can be strengthened more with especially in view of the limited number of pharmacists on duty in our hospital till now.
Taiwan is well known for its high technology industry. Thus, it is not unusual they fully utilized their technological expertise in the hospital setting. The central pharmacy store was using this system called Electronic Inventory Control and Warehouse management system back in 2009. It is so effective and accurate in getting the right medication which houses more than 1300 medication. Whenever the request from pharmacy were processed, the system will indicate the right item to collect from the shelf through the light (LED) indication. The system will actually verify the collector by asking to enter staff code. With this system, more than 1 staff can carry out the similar process at the same time without mixing with other staff’s collection. As compared to general hospital in Malaysia, we are still relying much on the limited staff to work on manually.
Additionally, since 2007, they have started using a system known as Personalized e-Drug information. All the current and previous medications of a patient are recorded in this system. Patients are able to access to the database from anywhere which are accessible to internet and retrieve the information. Patient medication counseling is their focus and medicine pamphlets can be downloaded from the system to obtain further details on the proper drug usage which are up to date. This has also further improved patient medication compliance and enhances the understanding of the drug usage. On numerous occasions during the Warfarin clinic, my patients repeatedly complain to me regarding their difficulty in identifying the type of medication to administer and worse still, they often become confused having so many types of medications to take in a day. With this personalized guidance, I believe that patients can really begin to understand their own medication.
Medication Reconciliation model
A central committee in NTU was in the process of carrying out a study and their plan is to implement it across all the hospitals. It is known that many studies have shown the benefit of medication reconciliation. Pharmacists play a significant role in achieving the best use of medicines. By definition, the Joint Commission for International Accreditation said that, medication reconciliation is a process of comparing a patient’s medication orders to all the medications that the patient has been taking. It also has the role in avoiding medication errors such as omissions, duplication, dosing errors or drug interactions. This process should be carried out at every transition of care regardless of private/government hospital, clinic and pharmacy in which new medications are ordered or existing orders are rewritten.
According to my colleagues who work under the Ministry of Health, this procedure was implemented in selected hospital and carrying out for admitted patients. Pharmacists are directly involved in this process as they provide an insight on the implementation and are instrumental in identifying flaws along the process as well as setting a benchmark for the outcome. As for the rest of us who are still in the planning stages of implementing similar processes, these experiences are important in setting an achievable target. We can start up slow with selected populations such as high risk patients, high alert medication, poly-pharmacy and intensive care unit patients to reduce our trial periods. The issues of double prescription or patients having similar medication from different health care centre can be solved and this can act as an effective measure.
In conclusions, FAPA Taipei had successfully met its objective in bringing pharmacists in different segment from all over the world in sharing the latest advancement in term of profession, technology, issues and pharmaceutical care as a whole. Representing Malaysia as a young pharmacist has provided me with the sense of where we are now compared to other developed Asia countries. To my pleasant surprise, the progress of Malaysia is not far behind; in fact we are one of leading health care providers in the region. Nevertheless, there is always room for improvement. As a young pharmacist, we do have the ultimate goal which is to make our profession respectable and recognized in the community. We should have the vision and the goal to improve the current practices so that we will benefit not only in terms of workload relief but also entire health care system.
This is an opinion piece and therefore subjective by nature. The opinions expressed here are the opinions of the individual author and are not necessarily the views of the Young Pharmacist Chapter or the Malaysian Pharmaceutical Society unless expressly described as such. The Chapter does not take responsibility for any errors or misleading statements.