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Background and objective: Warfarin has been a high alert drug due to its narrow therapeutic index. Its use review and feedback may improve the medical staffs’ service quality in efficiency and safety. Objective is to review its use in: justification for use, process indicators, complications and their managements, and outcome indicators in order to develop the institute’s proper warfarin use guideline.Methods: Warfarin use guideline was developed based on the literature review and the experts’ opinion. The drug use review of warfarin in complete medication chart was done in warfarin-using patients in medicine ward, Srinagarind Hospital, who were admitted during January 2004 and December 2007 in Srinagarind Hospital, Khon Kaen, Thailand, comparing with the guideline.Results: In a total of 85 patients, we found that 54.1% of them were female, aged 53.9 ±14.4 year-old. At the time of admission, 68% had been using warfarin, however, their INRs were within optimal range in only 16%. Ninety-five percent of the patients, the use of drug had justified indications. There were lack of necessary laboratory evaluations including hematocrit, platelet count, and ALT/AST in 14%, 16%, and 35%, respectively. There were proper starting and adjusting, when compared to proposed guideline, in 71% and 68%, respectively. There were drug interactions in 27%. On admission, major bleeding and minor bleeding were found in 10% and 9%, respectively. Outcome indicator of warfarin using (INR) met its goal in only 25%.Conclusion: Most of the warfarin use problems that we found in this study could be prevented, if proper guideline is formulated and most of these problems and their related complications could be managed.Keywords : warfarin, guideline
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Background: Although modern Thai women have more education and knowledge, from variety sources of information including cervical cancer prevention, cervical cancer screening coverage rate in them is still low at only 5%. Therefore, limitation of their knowledge should not be the cause. Authors did this study to examine all the causes remained after extensive health education given.Objective: To examine reasons why Thai women still do not have Pap smear after extensive health education was providedMethod: We have examined reasons that might be the causes of Pap smear lack after periodically educating 200 women, aged 35-60 years-old, in an inner city community for at least twice within 1 year and asking the ones who still did not have Pap smear at 8-12 months for their reasons.Design: Interventional cohort by health education and descriptive study for their reasons of Pap smear lackSetting: Samliem inner city community, Khon Kaen, ThailandResult: At 8-12 months after extensive health education for at least twice, 63% (126/200) of educated women still did not have Pap smear. The reasons were as follows; busy (67.5%), embarrassment (32.5%) and no symptom (20.6%).Conclusion: Thai inner city women are too busy to have Pap smears. Embarrassment is the second reason. Screening-based cervical cancer prevention programme still needs other supporting strategies to build up an occasion for them.
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Background: Standard time study and manpower determination are the systematic processes in learning about individualûs working performance. This includes method study and stopwatch time study to heighten the effectiveness of management in human resources.Objective: To determine the standard time used to finish a job, and to use such data in determining the manpower for the outpatient dispensing pharmacy service at Srinagarind hospital.Methods: Stopwatch time study was used to directly measure standard time. This standard time study involved two main jobs: dispensing and prepacking.Design: Descriptive studySetting: Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Results: The total standard time for dispensing one prescription, which contained three to four items of medicines, was 227.86 seconds or 3.80 minutes. The prescription filling accounted for the maximum period of time in dispensing, which was 38.31% of the total standard time. For prepacking, the tasks in machine turning off consumed the maximum period of time, which was 801.82 seconds or 13.36 minutes. The standard time of each job and the pharmacy service workload were used to estimate the manpower for the outpatient dispensing pharmacy service. The result indicated a need of 2.14 pharmacists, 2.13 pharmacy assistants, and 10.06 workers for the service.Conclusion: The results from this study could serve as a basis for pharmacy managers in allocating the manpower appropriately for the workload responsible by the outpatient pharmacy service, as well as in increasing the work efficiency for achieving the organization goals. Keywords: Standard time study, manpower determination
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Background: Work study is a systematic process for learning about individual’s working performance. This includes a study of work procedures and work measurement. Work study is aimed to improve human management. Work study is a process that helps to manage working time by proper time assignment and wasted time decrement.Objective: To determine the personal work proportion classified as productivity and non-productivity work, and then manpower requirement was determined.Methods: This study was performed during July to October, 2006. Work sampling technique, performed every 5 minutes interval, was used for observing the activity of pharmacists, pharmacy assistants and pharmaceutical department officers.Design: Cross-sectional studySetting: The Drug Dispensing Unit, Department of Pharmacy Services, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandResults: The proportion of productivity and non-productivity of all officers were 83.6% and 16.4 %, respectively. The maximum ranged proportion of productivity work was drug dispensary (75.9%). The maximum ranged proportions of non-productivity work were absent (55.6%) and personal activities (32.8%). The standard times of outpatient and inpatient drug dispensary were 6.7 and 8.2 minutes per prescription, respectively. Outpatient and inpatient drug dispensary services took 38,023 and 19,904 manhours, respectively. The appropriate manpowers for outpatient and inpatient dispensing service should be 23 and 12, respectively.Conclusion: The proportion of productivity and nonproductivity of all officers in Drug Dispensing Unit, Department of Pharmacy Services, Srinagarind Hospital, were 83.6% and 16.4 %, respectively. Data from this study can be used for deciding the appropriate manpower. The appropriate manpower calculated could be further used to improve effectiveness and quality of the dispensary service.Keywords: work measurement, work sampling technique
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Background: Quality assurance of drug distribution, which covers the systems of selection, purchasing and storage of, is to assure that drug products distributed to patients have standard qualities. Department of Pharmacy service, Srinagarind Hospital, has established the self reporting system of drug product defects since 2004. However, data analysis regarding types of problems and possible measures to rectify problems has not yet been reported.Objective: To study the incidence, types of problems of drug product and managements from the established self-reporting system in Srinagarind Hospital.Materials and methods: Author had collected data from the self reporting forms since January, 2005 to July, 2006, calculated the incidence, analyzed the kinds of problems and corrective measures.Study design: Descriptive study.Affiliation: Drug Information Center, Department of Pharmacy Service, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University.Results: The incidence of drug product defects found in Srinagarind Hospital was about 3 reports per month. There were 60 reports of drug product defects during19 months of study. Types of them were 36 physical defects, 18 packaging defects, 2 associated device defects, 2 quality inconfidences defects, 1 labeling defect and 1 keeping process defect. Importantly, 41 defects could be classified into class 1, which is the most dangerous. The related managements were 1) reporting back to the manufacturers requesting for exchange (49 times), 2) requesting for explanations of the problems from the pharmaceutical company (8 items) and 3) survey and surveillance of the remain drug products that had defects’ history (10 items).Conclusion: The established self reporting system had formed the clear analysing and management system of the problems. The hospital could decrease the expenses related to drug loss. In addition, the obtained information will be useful in the selection of drug items of the Srinagarind Hospital.Keywords: drug product defects
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Background and Objective: The recurrence of drug allergy was classified as preventable drug related problem might result in life-threatening allergic symptoms. The difference in drug allergy knowledge and understanding might lead to an awareness of drug allergy and drug allergy card carried by patients. The aim of the study was to assess the knowledge, understanding of drug allergy and drug allergy card carrying behavior of patients with drug allergy in Srinagarind Hospital.Methods: A 3-month cross-sectional descriptive study was conducted. Self-administered questionnaires was distributed by post to drug allergic patients from pharmacy database and patients who were diagnosed with anaphylaxis, maculopapular rash, erythema multiforme, Stevens- Johnson syndrome and toxic epidermal necrolysis.Results: A total of 288 questionnaires were evaluated. There were 137 patients (47.9%) had moderate knowledge level (mean+S.D.=3.19+1.03; total score of five).Moreover, 38.8% of the patients were unable to address the name of allergic drug and 85.7% of them answered the importance of drug allergy card incorrectly. The management of drug allergy was answered correctly in 86.4% of the patients. The majority of patients (76.1%) always carried their drug allergy cards and about 73.3% of the patient always showed their drug allergy card at health care services. Furthermore, 40.3% of the patients had received their drugs from non- healthcare professionals. Conclusion: Most of the patients knew the management of drug allergy. However, one-third of patients failed to recall the name of allergic drug and neglected to carry drug allergy card all the time. The continuing patient education might improve drug allergy knowledge and drug allergy card carrying behavior.Keywords: knowledge, understanding, behavior, drug allergy, drug allergy card