Cost-effectiveness of two technology-assisted manual medication picking systems versus traditional manual picking in a hospital outpatient pharmacy.

OBJECTIVE: To evaluate the cost-effectiveness of two technology assisted manual medication picking systems vs traditional manual picking. METHODS: This was a retrospective observational study comparing three outpatient pharmacies of a tertiary referral hospital in Singapore, where a light-emitting diode (LED-guided) manual picking system, an LED-guided manual picking plus lockable drawer (LED-LD) system, and traditional manual picking were implemented, respectively. The primary outcome measure was the incidence of medication near-misses over the observation period. The incremental cost-effectiveness ratio (ICER) per near-miss avoided was also determined. Data on medications picked and near-misses reported between September 2017 and June 2018 were retrieved from electronic databases. The incidence of medication near-misses from the LED-guided and LED-LD systems, relative to traditional picking, was compared using logistic regression. We compared annual operating costs between manual medication picking systems, and reported ICERs per near-miss avoided, to evaluate the cost-effectiveness of each picking system. RESULTS: A total of 358 144, 397 343 and 254 162 medications were picked by traditional manual picking, LED-guided and LED-LD systems, respectively. The corresponding near-miss rates were 8.32, 4.08 and 0.69 per 10 000 medications picked, respectively. Medication near-miss rates were significantly lower for the LED-guided (OR 0.49, 95% CI 0.40 to 0.59, p<0.001) and LED-LD systems (OR 0.08, 95% CI 0.05 to 0.13, p<0.001) compared with traditional picking. The annual operating costs of traditional picking, LED-guided and LED-LD systems were S$60 912, S$129 832 and S$152 894, respectively. The LED-guided and LED-LD systems yielded ICERs of S$189 and S$140 per near-miss avoided, respectively, compared with traditional manual picking. CONCLUSION: The LED-LD system is more cost-effective than both the LED-guided and manual medication picking systems in reducing medication picking near-misses.

The use of portfolio to support competency-based professional development of pharmacists in a Singapore tertiary hospital.

This article was migrated. The article was marked as recommended. Competency frameworks is implemented to support continuing professional development in an academic medical centre, with the aims of establishing and retaining a competent pharmacist workforce; and is described using Kotter's change management framework. The desire to provide a clear developmental route with defined criteria to identify and bridge competency gaps through systematic training of our pharmacists and meeting JCI requirements for documented continued competence gave impetus to the establishment of the General and Advanced Level Frameworks. To aid implementation, a series of roadshows were organized to communicate the vision to pharmacists and experts from the UK were invited to share experience and to "train-the-trainers". Clinical groups were set up to provide learning platforms for the advanced pharmacist practitioners to coach the pharmacists. Competency assessment was conducted biyearly using workplace based assessment tools. Formative feedback was provided post-assessment and learning objectives and training plan for the next assessment cycle would be discussed. The implementation of competency frameworks provides an opportunity for pharmacists to identify competency gaps and plan their training and development to achieve higher standards of practice. The portfolio and competency-based developmental frameworks enable systematic approach to evaluate and facilitate performance management.