By Frances Huang
Using closed-loop way to manage the High-alert medication, Taiwan created a new medication supply model
Medications errors takes a major part in medication accident, how to avoid medication error, providing the proper medication and safe treatment to improve patient safety has raising people’s attention these years. Expert and medical workers also try to solve the problem and lower the potential risk of medication error by applying new technology supporting medical workers’ workflow to optimize the process.
Pharmacotherapy Management of High-alert Medicine in Japan
Dr. Tomohiro Terada briefing how Kyoto University Hospital applied dispensing equipment to support pharmacist operations, by using a verifier terminal to dispense tablets, managing High-risk medication with a computer-controlled cabinet so the auto system can make sure the medication be kept in a proper storage environment. Kyoto University Hospital had adopted fully automatic tablet dispensing system to reduce the work loading of pharmacist and let pharmacist focusing on double checking the prescription and the medication is proper and correct before handing to patient. These systems are common in many general hospitals in Japan. After adopting these systems, human errors related to dispensing drug had significant reduced.
In Japan, Hospital like Kyoto University Hospital is categorized as Special Functioning Hospital, it means the hospital which provides advances medical care, develops advanced medical technologies, conducts advanced medical care training compared to other hospital. Lately people focusing on Protocol-Based Pharmacotherapy Management (PBPM), it helps optimized the process of pre-order related pharmacotherapy such as Warfarin therapy, dosage adjustment of anti-MRSA drugs, adverse event management in anticancer drugs. At the meanwhile, Kyoto University Hospital also focus on the pre-order of outpatient prescriptions brought to hospital, pharmacist will interview with the patient to have further information about their medical history, to check the prescription is proper for the patient or not.
Ministry of Health, Labor, and Welfare (MHLW) of Japan had issued a statement for multidisciplinary approach to medical care in 2010. After that, collaboration between physicians and pharmacist in pharmacotherapy has progressed and enhanced. It’s how PBPM has developed. By the collaboration of physicians and pharmacist, we believe the strategy may contribute to improving the patient safety. According to the research, the PBPM-based clinical pharmacist-managed warfarin therapy was clinically safe and significantly well controlled.
According to the clinical research, it is important to create clinical evidence from the pharmaceutical perspective, not only from the physician or nurse. Dr. Tomohiro Terada believes that perspectives from pharmacist often lead to improve patient safety. Now, with the system’s support, before patient initial the treatment of high-risk medication can be identified, the physician and pharmacist can double check the dose make sure it’s the right dose for the patient. It helps prevent adverse events and improve therapeutic outcome. To improve the safety of medication and patient safety in large scale, it is necessary integrate daily clinical practice and results into the health insurance system.
After the Medical Service Law had revised, unestablished medical services are now required to undergo prior screening and monitoring. Dose and usage of unapproved medications and off-label are involved in the unestablished medical service in special functioning hospital. Which allows hospital which plays a major role can improve their development of advanced medical service and solution to improving the medical and treatment safety to protect patient from uncertainty risk.
Operating Room Medication Safety Management
National Taiwan University Hospital (NTUH) is the Top 1 Hospital in Taiwan, there are 3438 inpatients, 7361 outpatients and 292 ER visits per day in average, but there’re only 249 pharmacists providing medical service at the hospital. Operating Room is a high volume, high risk, high complexities area in the hospital, in National Taiwan University Hospital there are 200 to 240 operations per day.
Before surgery, nurses must gather and prepare medications from floor stock supply in the OR suite, most of the adverse event were caused by human error due to the similar outlook or name of the medication. To avoid the human error and optimize the work floor, NTUH had adopted Operating Room Medication Safety Strategy by using Tray exchange system since 2012 which is a new medication supply model in Taiwan. Instead of the Floor Stock system, NTUH applied Controlled substance pack to improve and enhance the safety of medication in operating room, it’s a close-loop way to manage the medication. It requests form co-signed to confirm the prescription or treatment is proper for the patient and for perioperative use, the whole process involves the physician, pharmacist, and nurse. To avoid human error on medication, the drugs are labeled beyond-use dates. Nowadays, NTUH using RFID system, while medical workers preparing the medication for operations, they need to verify their hospital ID card before setting medication packs or trays, the items will be screened and reviewed before sending to operating room, it creates instant records in the system.
The webinar shows how medical service and hospital evolve with the times in America, Japan and Taiwan. Health care and medical workers keep developing new model or technology to improve the quality of medical service and the patient safety. Working with technology is not only a trend but an irreversible fact like our daily lives. Sure the technology had reduced a lot of human labor and reduce the complexities of pharmacist’s task in the hospital, but we also have to be aware of the potential risk of new type of risk or technical error. Apply new technology or system as a tool but not rely on it. So the professional medical workers can focusing on providing accurate and high quality of medical service.
The Joint Commission of Taiwan(JCT) established the Health Smart Taiwan (HST) , a one-stop portal designed to promote Taiwan's high-quality smart healthcare solutions since 2019. HST combines Taiwan's cutting-edge smart healthcare solutions with the demo site in Taiwan, helping visitors to fully understand the application and development potential of smart healthcare, while creating a new model for smart hospitals. In addition, JCT also welcomes healthcare partners from all over the world to come to Taiwan for face-to-face exchanges on the application of innovative medical technologies.