Business Accent

The New Age Indian Hospital Pharmacies

One must have a documented policy and procedure for Storage of Medications in retail pharmacy, pharmacy central stores and all sub-stores

"Ensure all emergency medications are available in crash carts in all nursing stations and critical areas" - Uday Tewary Assistant General Manager (Pharmacy) Dr LH Hiranandani Hospital

Each hospital pharmacist need to utilise the resources of the pharmacy department to match the patient's expectations. Patient care is multi-disciplinary in nature; hence the role of the pharmacist in a hospital setting is of critical importance. The pharmacist supplements the treating doctor's time and effort for improving the patient's wellbeing.

With the ever-increasing product line from pharmaceutical companies, any pharmacist would find it difficult to be updated on the latest brands available. Today, there are over 80,000 brands available in the Indian pharmaceutical market. The prescriber has the liberty to vary the brands as per his/her choice. Various cocktail formulations are regularly launched in the Indian market and often claimed as to be the first in the country.

Medical errors happen in hospitals/clinics/pharmacies and patient's homes. Medical errors can involve a whole range of medical services including pharmacy.

Steps to Tackle Medication Errors

• Have a documented policy and procedure SOP for 24 X 7 pharmacy services. Have a well-staffed in-patients department, out patient department and minimal number of sub-stores (for emergency medicines). An SOP would include all the operational needs to the minutest detail, so that there is quality in service.
• Develop an in-house Hospital Medicine Formulary. The list must be updated on an annual basis. All should prescribe the listed brands only. Any in-between additions in the formulary should be justified and should be technically superior to the existing medicines. Inclusion should be approved by the Drug and Therapeutic committee of the hospital. Success in implementation of such a policy would be high where 90 per cent of the prescribers are full time consultants.
• Have a documented policy and procedure for 'Storage of Medications' in retail pharmacy, pharmacy central stores and all sub-stores. Stock medicines as per the pharmacy policy of storing in racks, shelves, cupboards, drawers, etc. The storing areas must be well lit, well ventilated and well labeled.
• Have an appropriate software where high risk, emergency medicines, narcotic medicines sound alike and look alike pops up. This would serve as a check, both during the time of indents from the nursing stations as well as issue of the requested medicines from pharmacy and sub stores.
• A sound inventory control practice would help in managing the assigned space, available stocks and funds. Thus an automated re-order level for sub stores (like retail pharmacy/casualty/operation theater stores/ICU/ICCU stores etc to pharmacy central stores, and pharmacy central stores to approved pharmaceutical suppliers/ vendors). This would optimise stocks with zero stock out situations. Hence chances of wrong strengths of medications issued as alternates would be bare minimum. Use of VED and ABC list helps in optimising inventory.
• Ensure all emergency medications are available in crash carts in all nursing stations and critical areas. There should be compliance from the nursing staff to charge as per use and replenish the issued quantity by way of approved indents. This will ensure that there is no replacement of medicines and the stock would match with respect to quantity and expiry dates. Thus system stock reports would be accurate.
• Have a policy and procedure for medication recall, like up to three months expiry medicines stock must be sent back to the pharmacy. The pharmacy must seek help form the hospital doctors to liquidate such stock on priority.
• Have a well-designed Adverse Dr.ug reporting format, withdraw current batch and replenish stocks of alternate batch or alternate brand of the same generic drug. This would ensure that quality medicines are available to the patients. A note should be made in the patients file /discharge card regarding suspected adverse reaction for the medication in question. This would help patients requiring treatment in future, with a caution.
• Ensure that the right medication is dispensed to the right patient as per the medicines prescribed. For in-patients medications, have software which converts medicines requirement to pharmacy medicine bill. This will reduce manual on screen selection errors.
• For OPD prescriptions, if computerised prescription is not possible, and, the prescriber's handwriting is not clear, do not hesitate to check with the doctor on phone. Only if the pharmacist is 100 per cent sure, should he/ she dispense the medicines. It is important that a senior pharmacist checks and hands over the medicines to the correct patient. In an ideal situation, the patients should show the medicines to the prescriber to be 100 per cent sure regarding the right medication / right strength.
• Hospital pharmacies should upgrade themselves by employing clinical pharmacists. Well-trained clinical pharmacist (M Pharm/ B Pharm) should accompany doctors during their rounds and ensure correct medicines, drug-drug interactions, drug food interactions if any. They would also provide excellent patient counseling and enhance medication compliance and reduce medication errors.
• With the support of the CEO, Medical Director and consultants, pharmacy HODs can ensure better strike rate for the prescribed medicines, aim for 'zero medication errors' and also improve patient's compliance / satisfaction levels.

The writer is Assistant General Manager (Pharmacy) Dr LH Hiranandani Hospital
uday.tewary@hirananandanihospital.org