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OBJECTIVE To build an “integration of drug storage and dispensing” intelligent drug validity management system in outpatient pharmacy， and to evaluate the effect of this system. METHODS The information technology was used to connect the drug information in the primary storage， the intelligent secondary storage and the rapid dispensing machine； an “integration of drug storage and dispensing” intelligent drug validity management system was constructed. At the same time， the implementation effects of drug validity management system in outpatient pharmacy of our hospital were evaluated one year before and after the construction of the system. RESULTS By using information technology， intelligent closed-loop management of batch number and expiration date information throughout the entire process of drug circulation in outpatient pharmacy of our hospital had been achieved， making it easy to track and trace drug information. After the establishment of the intelligent system， the time spent on managing drug validity every month was reduced from 103 people·h to 8 people·h； the number of near-expired drugs per month had decreased from （30.67±1.10）types to （17.67±1.17）types（P＜0.05）. CONCLUSIONS The intelligent drug validity management system in outpatient pharmacy based on the mode of “integration of drug storage and dispensing” makes the drug validity management in the outpatient pharmacy more scientific， reasonable and efficient.
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Objective To construct the auxiliary system of outpatient drug distribution, reduce errors and improve the quality of outpatient pharmaceutical service. Methods The bar code technology was used to independently develop outpatient pharmacy dispensing assistant system. The system design and function are introduced. The practical application effect of the system was evaluated on dispensing errors, efficiency and pharmacist evaluation. Results Based on the special network environment of the hospital, the system integrated the functions of drug check, prescription right management, expiration date management and medication instruction. After using the system, the number of dispensing errors decreased from 84 to 25. The waiting time for patients to receive medicine decreased by 151 seconds. All pharmacists surveyed agreed that auxiliary system was helpful to pharmacists’ work. Conclusion The system reduced the medication dispensing error in outpatient pharmacy, improved work efficiency and the quality of pharmaceutical care.
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Pharmacy services in grassroots medical institutions provide professional pharmacy services for patients. This service not only expanded the scope of primary care delivery, but also meets the residents′need for appropriate medication. At present, the majority of grassroots medical institutions in China provide outpatient pharmacy services by means of pharmacy service alliance, and foreign grassroots medical institutions mainly provide pharmaceutical outpatient services with drug treatment management as the core for patients by granting pharmacists partial prescription rights.In recent years, pharmaceutical outpatient services in grassroots medical institutions had achieved good results in improving patient clinical outcomes, enhancing medication rationality, and enhancing patient compliance. However, there were many unresolved issues, including low public awareness, shortage of pharmaceutical talents, and imperfect guarantee systems. The author suggestted that efforts should be made to increase the publicity of pharmaceutical outpatient services, improve the training mechanism for pharmacists, strengthen cooperation between pharmacists and clinical physicians, include pharmacists in the contracted service team of family doctors, and improve various guarantee systems, in order to provide reference for promoting the sustainable development of pharmaceutical outpatient services in grassroots medical institutions in China.
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Background: Analysis of prescription of doctors is done to determine, evaluate, and improve the care of patients in a well-organized way and it estimates on-going practice against a defined standard. Aim and Objective: The aim of the study was to provide the broad outline of performance and delineate parameter as per the check list of prescription audit. Materials and Methods: An observational and non-interventional study was carried out from July 2021 to November 2021 at peripheral medical college, Gujarat. Randomly, we have selected 500 prescriptions. This prescriptions were evaluated as per World Health Organization prescribing indicators and then it were analyzed for errors in prescription writing. Results: In this study, total 500 prescriptions were analyzed and total 1839 drugs were prescribed. Average number of drugs per prescription was 3.67. The percentage of drugs prescribed by generic name was 94.6%. The percentage of encounters with an antibiotic prescribed was 29%. In our prescription audit study, 39.16% (1762 count) prescriptions were non complete and 60.84% (2738 count) prescription were having complete details. Conclusion: If the drug is prescribe by generic name and from essential drug list chances of dispensing error decrease and hand out of incorrect drug to patient is reduced. Minimizing drug per prescription attenuates chances of drug-drug interactions. Regular prescription audit should be conducted regularly which increase the awareness in prescriber and effective, safe, and economics therapeutic practice.
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Objective To understand the current situation of dispensing errors and effective prevention and control measures in outpatient pharmacies in domestic hospitals, in order to further improve the quality of drug dispensing. Methods The Chinese journal database was retrieved from 2015 to 2020 for the literature on the dispensing errors of outpatient pharmacies and the continuous improvement of the quality after the measures were taken in secondary and tertiary hospitals. Results Of the 146 literatures retrieved, 13 were included in the analysis (11 in tertiary hospitals and 2 in secondary hospitals). Before the improvement, the median of the drug dispensing error rate was 5.1‰, and after the improvement it was 1.1‰. Before and after the improvement, the types of drug dispensing errors were mainly quantity errors (52.5% vs. 51.3%), variety errors (28.3% vs. 28.7%), specifications and dosage forms errors (6.2% vs. 6.7%), and labeling errors (2.1% vs. 2.9%). The improvement measures taken for the reasons of dispensing errors have a high overlap rate, and they are concentrated in two aspects: personnel factors and drug factors. Conclusion The use of continuous quality improvement tools in hospital outpatient pharmacy to control and prevent dispensing errors is still a hotspot of current research. The composition of the types of errors after improvement has basically not changed. The implemen-tation of standardized operating procedures and other continuous improvement comprehensive measures can effectively reduce the incidence of dispensing errors, and contribute to the implementation of the “Expert Consensus on Medication Error Management in China”.
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OBJECTIVE：To explore the closed-loop management mode of drug valid date in the intelligent outpatient pharmacy，and to provide reference to improve the management level of drug valid date and ensure the safety of drug use in patients. METHODS ：The model and practice of closed-loop management of drug valid date in the intelligent outpatient pharmacy were summzired from the aspects of dispensing system ， logistics system ， temperature and humidity monitoring system ， management of drugs to be about to expired ，internal quality control and performance evaluation. The patients ’satisfaction degree of the indicators were compared between the new and old hospital districts. RESULTS ：The intelligent drug dispensing system ， logistics and information flow system ，temperature and humidity monitoring system were established in the new district of our hospital，and management system of drugs to be about to expire ，internal quality control and performance evaluation system were established. The workflow of drug validity management was optimized ，the pharmacy working environment was improved ，and the pharmaceutical service quality and pharmacy management level were improved. The results of satisfaction survey of outpatients in new and old distrcts showed that the indicators of patients ’satisfaction（service attitude ，work quality ，drug consultation ，waiting time）in new distrct were improved to different extents ，compared with old district. The satisfaction of special storage tips and waiting time in new district were all significantly higher than old district ，with statistical significance （P＜0.05）. CONCLUSIONS ： The design and management concept of intelligent outpatient pharmacy in our hospital has been significantly improved ，the drug valid date management is more scientific and reasonable than before ，and the patient satisfaction is improved.
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OBJECTIVE：To investigate the problem s and improvement measures in the application of automatic drug delivery system in outpatient pharmacy of our hospital ，and to provide reference for the construction of automatic drug delivery system in outpatient pharmacy. METHODS ：Combined with the pharmacy module function of HIS system in our hospital and the actual needs of the pharmacist in drug delivery process ，the automatic delivery system of our hospital （including automatic delivery machine ， prescription dispensing and delivery mode ，intelligent medicine basket ）was established for operation and optimization. RESULTS ： After six months of running period ，the hardware of the automatic dispensing machine had been stabilized ，and the software functions had been optimized ，including the mode of pre-dispensing ，drug storage ，system prompt ，quantity of dispensing ， management of the drug period of validity ，and the mode of dispensing at the peak of drug taking. At the same time ，the emergency plan was formulated for automatic dispensing system. The application of the automatic dispensing machine shared 80％ of pharmacists ’prescription dispensing on an average day ，saved labor cost （reduce the labor cost of about 2 pharmacists）， shortened patients ’waiting time for drug-taking （down from 7.45 min to 6.61 min on average ，P＜0.01），reduced prescription dispensing error rate （down from 0.040 9％ to 0.019 5％ on average ，P＜0.01）. CONCLUSIONS ：The establishment of automatic drug delivery system in our hospital has reduced the workload of pharmacists ，improved the work efficiency ，decreased prescription dispensing error and promoted the quality of pharmaceutical care.
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Objective To strengthen the system of drug supply chain collaborative service platform in drug supply, decrease drug inventory backlog, and improve the outpatient pharmacy management capacity in outpatient pharmacy.Methods Failure mode and effects analysis (FMEA) method was used to discover the potential risks in the drug supply chain collaborative service platform and formulate the corresponding improvement measures.Results The number of drug-receiving errors dropped from 137times to 32times and the risk reduction rate was 76.64％after improving the procurement process of the supply chain service platform, which significantly reduced the risk of contracting errors.Conclusion FMEA method could help to figure out the loopholes and hidden dangers of the pharmacy system, which made the outpatient pharmacy more reasonable and accurate by constantly improving the measures of the drug supply chain collaborative service platform.
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OBJECTIVE:To promote the informatization of adverse drug event(ADE)management in outpatient pharmacy so as to reduce the risk of drug use. METHODS:From the aspect of the construction of two information platforms as problematic prescription management and ADR monitoring record and report,the practice of the informatization of ADE management in outpatient pharmacy of our hospital was introduced;the effects of information management were evaluated by real-time online record for the number of dispensing error and ADE and the number of ADR reported by outpatient pharmacists. RESULTS:The application of ADE management module for outpatient pharmacy developed by our hospital realized the following functions as real-time online record of"suspected prescription",problematic prescription inquiry and summary,ADE report without delay, electronic ADR monitoring and reporting. 148 times of dispensing internal errors during Apr.-Jun. 2017(accounting for 0.035% of total prescription)and 15 ADEs during Jun. 2016-Jun. 2017(accounting for 0.008‰ of total prescription)were recorded in outpatient pharmacy of our hospital. There were 82 ADR cases reported by outpatient physicians using user-friendly electronic ADR monitoring and reporting(accounting for 36.94% of total ADR). CONCLUSIONS:The construction of informatization promotes timely record of related error and adverse events,targeted management and ADR reporting and reduces the risk of drug use.
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OBJECTIVE:To reduce drug repercussion of outpatient pharmacy,and to promote safe drug use.METHODS:By quality control circle (QCC),the data of drug repercussion were selected from outpatient pharmacy of our hospital in Sept.2016.The drug repercussion reason check list was designed to master the situation of drug repercussion in outpatient department,formulate improvement measures and confirm effect through field inspection.The case number of drug repercussion and the improvement of circle members' ability were compared one month before and after QCC (Mar.2017).Finally,the effects of QCC were evaluated.RESULTS:Referring to the reasons for the repercussion of adjunct drugs for inspection and the repercussion of unsuitable drug use in our hospital,those problems were improved by formulating manual for drug use examination project,optimizing and examining drug delivery process in the department,etc.The case number of drug repercussion in outpatient pharmacy decreased from 31 cases per month to 12 cases per month;the rate of goal achievement was 119％;the rate of improvement was 61％.The ability of QCC members to solve problems and the ability to use QCC skills were increased positively.CONCLUSIONS:The development of QCC activity in our hospital reduces case number of drug repercussion and optimizes drug delivery process in outpatient pharmacy,and promotes safe drug use.
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OBJECTIVE:To reduce the dispensing errors of similar drugs in hospital outpatient pharmacy,and realize the drug traceability. METHODS:Based on adding drug electronic regulatory code field in drug dictionary background database of hospital information system (HIS), prescription dispensing process in outpatient pharmacy of our hospital was improved. Drug electronic regulatory code was added for scanning code review before secondary review dispensing, and drug terminal traceability was real-ized based on it. Through comparing the dispensing outing error rate before and after 12 months of improvement, ratio of"special abnormal data"related with dispensing error of similar drugs in checking, patients'waiting time and other indicators, the pre-scription dispensing quality of outpatient pharmacy before and after improvement was evaluated. RESULTS:After adding drug elec-tronic regulatory code for scanning code review, the dispensing outing error of similar drugs was decreased from 22 cases to 1 case (accounting for 0.0197‰, 0.0103‰, respectively), number of"special abnormal data"was decreased from 836 to 436 (accounting for 31.5%, 16.8%, respectively), and the average waiting time of patients had no obvious extension(10.85 min, 10.88 min, respectively). It had achieved the traceability inquiry of most outpatient drugs from the pharmacy to the patients. CON-CLUSIONS:The drug electronic regulatory code can reduce the dispensing outing error of similar drugs in outpatient pharmacy, which is conducive to the establishment of drug traceability chain and has improved the quality of pharmaceutical care.
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OBJECTIVE:To reduce the dispensing errors of similar drugs in hospital outpatient pharmacy,and realize the drug traceability. METHODS:Based on adding drug electronic regulatory code field in drug dictionary background database of hospital information system (HIS), prescription dispensing process in outpatient pharmacy of our hospital was improved. Drug electronic regulatory code was added for scanning code review before secondary review dispensing, and drug terminal traceability was real-ized based on it. Through comparing the dispensing outing error rate before and after 12 months of improvement, ratio of"special abnormal data"related with dispensing error of similar drugs in checking, patients'waiting time and other indicators, the pre-scription dispensing quality of outpatient pharmacy before and after improvement was evaluated. RESULTS:After adding drug elec-tronic regulatory code for scanning code review, the dispensing outing error of similar drugs was decreased from 22 cases to 1 case (accounting for 0.0197‰, 0.0103‰, respectively), number of"special abnormal data"was decreased from 836 to 436 (accounting for 31.5%, 16.8%, respectively), and the average waiting time of patients had no obvious extension(10.85 min, 10.88 min, respectively). It had achieved the traceability inquiry of most outpatient drugs from the pharmacy to the patients. CON-CLUSIONS:The drug electronic regulatory code can reduce the dispensing outing error of similar drugs in outpatient pharmacy, which is conducive to the establishment of drug traceability chain and has improved the quality of pharmaceutical care.
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OBJECTIVE:To provide reference for the establishment of work mode of automatic dispensing system in large-scale integrated pharmacy. METHODS:Introducing the establishment and optimization situation of the automatic pharmacy dispensing system in the outpatient pharmacy of our hospital,changes of related deployment indexes before and after optimization were compared,and the main measures for improving the work efficiency of automatic dispensing system were explored. RE-SULTS:Based on setting and regularly adjusting stored drug varieties,numbers of occupied tracks and unbundled drug factors,de-signing deployment operation mode that the system automatically dispensing preparations to immediate-dispensing and pre-dispens-ing windows,establishing operational specifications and management refinement,the outpatient pharmacy had established automat-ic dispensing system with prescription deployment number more than 12000 pieces/d and optimized work mode. Compared with be-fore optimization,host,auxiliary and smart cabinet varieties were increased in the case of the same number of total staff,immedi-ate-dispensing windows were increased and pre-dispensing windows were decreased. Proportion of full-automatically-dispensed pre-scriptions was increased (up from 41.18% to 48.32%) in the case of total prescription increasing in peak hours,and numbers of hourly prescription deployment were increased in both immediate-dispensing and pre-dispensing windows. Average time to wait for medicine of patients was shortened(down from 5.63 min to 5.18 min),supplemental medicine error and inner errors rate of deploy-ment (down from 0.48% to 0.44%) were decreased (P<0.05). CONCLUSIONS:The established automatic dispensing system mode can meet the needs of prescription deployment in large-scale integrated outpatient pharmacy,and improve the work efficiency by continually optimization.
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OBJECTIVE:To provide reference for further standardizing and perfecting the management of drug unpacking in outpatient pharmacy.METHODS:A total of 6 primary and secondary health institutions (4 community health service centers and 2 secondary hospitals) were selected from 2 districts in Shanghai to conduct a questionnaire survey on the use of their drugs and drug unpacking in outpatient pharmacy.The survey data was analyzed statistically.RESULTS:Totally 6 institution questionnaires and 6 pharmaceutical staff questionnaires were sent out,all were received with recovery of 100％.In 2015,the average number of essential medicines in community health service centers and secondary hospitals were 496.50,542.00,respectively,and the average number of varieties sold were 530.75,1 052.00.In outpatient pharmacy of surveyed community health service center,the number of unpacked drugs was 10-21 which were essential drugs and class A medical insurance drugs,and the consumption sum of unpacked drug ranged 5.56-16.70 ten thousand yuan.In outpatient pharmacy of 2 two secondary hospitals,the number of unpacked drugs were 17 and 23,respectively,most of which were essential drugs and class A medical insurance drugs,and the consumption sum of unpacked drug ranged 13.19 to 158.06 ten thousand yuan.The proportion of unpacked drugs was less than 5％ of the total number of varieties sold,and the proportion of consumption sum of unpacked drugs was less than 1％ of total consumption sum.Estazolam tablets and Alprazolam tablets took up the top 5 in the list of consumption sum of unpacking drugs in 2 types of intervi ewed instiutions.All the surveyed institutions were not equipped with drug dispensing machine in the outpatient pharmacy,still depended on manually unpacking.There were four institutions to regularly arrange the unpacking,unpacking frequency was usually 1 to 3 times a week,supplemented by the need to arrange unpacking,and another two to implement a daily unpacking.There were 5 institutions to develop a drug unpacking mechanism in the institutions,but the relevant system was not perfect.CONCLUSIONS:The enthusiasm of pharmaceutical saff in primary and secondary health institutions in Shanghai to carry out or engage in unpacking work need to be improved,the instructions for unpacked drugs are not available on request,and the way to unpack drugs still needs to explore.
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OBJECTIVE:To provide reference for further promoting the implementation ofseparation of prescribing and dis-pensingpolicy which fit China's national conditions. METHODS:Based on literature review,informant interview,and filed in-vestigation the development ofseparation of prescribing and dispensingwere compared between typical eastern and western coun-tries. Constraints ofseparation of prescribing and dispensingin China were explored,international successful experiences were summarized to inspire appropriate implementation of this policy in China. RESULTS & CONCLUSIONS:There are four con-straints in the implementation ofseparation of prescribing and dispensingin China. Firstly,the legal foundation is yet established for the professional development of pharmacists. Secondly,the medicine pricing and hospital financing systems are unreasonable. Thirdly,patients'ownership of prescriptions and right of dispensing options are monopolized by hospitals. Fourthly,safety of medi-cines use is yet ensured.Separation of prescribing and dispensingshould follow the rules of social and economic development and should be adjusted to adapt local conditions.Separation of prescribing and dispensingpolicy itself may not help to achieve the objectives of cost containment and rational use of medicines. To achieve the intended objectives,legislation of Pharmacist Law should also be accelerated to clearly define the role of pharmacist and guide the behavior of prescribers with economic levers.
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OBJECTIVE: To analyze retrospectively the drug use in elderly outpatients in the west campus of our hospital in 2014 - 2015. METHODS: Through the hospital information system (HIS), the full prescribing information for 40 working days in Mar. 2014 and Mar. 2015 was collected. The data statistics was summarized and analyzed by Excel 2010.RESULTS: The statistics showed stable medication use in elderly patients, and the number of prescriptions for elderly patients accounted for about 1/3 of the total outpatient prescriptions. There were nearly 1/4 elderly outpatients who used six or more drugs. Oral drugs accounted for more than 80% of all the drugs. Drugs for the treatment of cardiovascular and cerebrovascular diseases accounted for the largest part. CONCLUSION: The drug use in elderly patients in our hospital basically accords with the design of outpatient departments. The dosages of drugs used in the elderly patients comply with the normal dosages in general. The statistical data of medications in elderly outpatients provides a support to further study the existing problems in the medication in elderly patients.
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The purpose of this research was to clarify the factors influencing the approval or disapproval and evaluative opinions of the public concerning separation of dispensing and prescribing functions. We conducted a Web survey with 2006 participants (September 2016). We conducted multiple logistic regression analysis and quantitative analysis of freely recorded their reasons about approval or disapproval. The approval rating was 29.2％ in persons who had had some prior experience with at the pharmacies (n＝1,778) and 41.9% in participants who made regular clinic visits and always filled prescriptions at the pharmacy (n＝430). Multiple logistic regression analysis of the data of participants who visited pharmacies (n＝1,778), identified that compared to participants who experienced side effects (OR＝1.34), the frequency of used pharmacies (OR：Odds ratio＝1.47), the filling burdened by having to fill prescriptions at the pharmacy (OR＝0.19, 1/OR＝5.18), there was a significant positive association for the approval. Analysis of qualitative data of the group that approved identified many labels related to ‘quality of results’, however no labels related to ‘quality of results’ were generated in the group which disapproved. Public approval or disapproval of non-hospital based prescription is mainly determined based on the burden or inconvenience incurred (due to waiting times, mobility-incurred time and energy, inconvenience associated with travel, inconvenience of repeated visits) when filling prescriptions at the pharmacy rather than on opinions regarding the pharmacy’s drug therapy service. Measures are required to increase the level of merit compared to the burden experienced in the use of pharmacy.
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OBJECTIVE:To develop the drug traceability management system in outpatients of medical institutions,and gradu-ally improve its traceability management. METHODS:Based on barcode technology,drug traceability management system in outpa-tients of medical institutions was independently developed,introducing it from system environment,framework design and system function,and the application results were evaluated in terms of differences in dispensing time,deployment error,drug withdrawal treatment and applicability investigation. RESULTS:The system was developed on hospital information system network environ-ment,which was designed by combination of client/server(C/S)network system(B/S)and set function modules as follows as role rights management,data extraction,information control,data acquisition and data query. The system can match with drug electron-ic surveillance code,commodity code and other traceable barcodes,achieve drug tracing from hospitals to users through software interaction,as well as the computer-aided calibration in dispensing to effectively reduce outpatient's dispensing error. The average time for each outpatient prescription prolonged 9 s after using the system;24 dispensing errors and 4 non-normal withdrawals were prevented within 1 month;100% surveyed pharmacists expressed approval for the system's applicability. CONCLUSIONS:The system can achieve the drug suitability management in outpatients,which has shown good applicability and further improved drug safety management and control capabilities in medical institutions.
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OBJECTIVE:To improve automatic outpatient pharmacy drug delivery system in our hospital,and to promote the efficiency of automatic drug delivery. METHODS:The outpatient pharmacy automation system of our hospital was introduced in terms of main structure,working process and application. The work efficiency,safety and error were compared between automatic drug delivery mode and manual drug delivery mode. Drug delivery machine was improved to increase the rate of drug delivery. RE-SULTS:The outpatient pharmacy automation system of our hospital included 2 boxed drug delivery machine and 1 drug dispensing machine,etc. Compared with manual drug delivery mode,automatic drug delivery mode improved drug delivery efficiency,health security and use security,and reduced drug delivery error. Through adjusting the time setting and step of drug delivery of gearing in drug delivery machine,idle time of transmission equipment was utilized effectively,and the quantity of delivered prescriptions was increased,increasing from 220 to 320 each hour. CONCLUSIONS:The reasonable improvement of outpatient pharmacy auto-mation system makes outpatient pharmacy automation system play a bigger role,and further optimize resources.
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OBJECTIVE:To provide reference for informationized construction of outpatient narcotic drug management in the hospital. METHODS:The narcotic drugs management system,which consisted of the hospital information system and the intelli-gent management machine of narcotic drugs were introduced in working procedure and informationized management,and its effects were evaluated. RESULTS:After informationized construction,the recycling of empty ampoules and used patches was included in compulsory management procedure;informationized management would be achieved completely from safety management,prescrib-ing and dispensing property management,prescription management,batch number management,outcoming and incoming manage-ment,five specialmanagement,etc. Compared with traditional dispensing mode,the dispensing time of each prescription was shortened under informationized dispensing mode,decreasing from(174±32.3)s to(128±30.7)s(P<0.05). Pharmacists could communicate with physicians online by the system;drug application,incoming,use,inventory reconciliation,special book for reg-istration and special book of account were all completed by electronic recording and electronic registering;the system could auto-matically complete the report form of prescription information for evaluation. CONCLUSIONS:It is feasible of the informationized mode of outpatient narcotic drug management in our hospital.