Chemotherapy pharmacy and emergency department pharmacy

In our chemotherapy pharmacy, we also adopt Unit Dose System. Unlike the process in inpatient pharmacy, we develop chemotherapy dispensing working process with 9 checking points. After physicians prescribing an order, the printer in the pharmacy print out the drug stickers and prescriptions. Clinical pharmacists would review the order. And if the order is appropriate, pharmacists would start to prepare medications, diluents, and syringes. And compound the medications, and then paste their specific stickers on them. We apply barcode system in our checking points. After completing the compounding, we weight the final product to ensure the estimated total volume. When the nurse receive the final product, they could calculate the proper infusion time according to the estimated volume. We also adopt Patient Prescription System.

In Patient Prescription System, pharmacists review prescription and dispense 2 to 5 days medication into a patient-specific container. And nurses prepare each dose of medication and administer to patients. This model is suitable for our emergency. Patients usually visit emergency and stay less than 3 days. So in emergency pharmacy, we adopt Patient Prescription System. For most patients who need to stay in emergency, physicians usually prescribe a 3 day medications to them. The printers receive physicians’ prescriptions via CPOE system and print out the medication bags. Medication bag is considered as a patient-specific container, so pharmacists dispense medication and put into medication bags. On the medication bags, it print patient essential information and drug information as well.

Patients bring the original prescriptions and give to pharmacists, then pharmacists can review prescriptions and hand out patients’ medications. For oral medications, we hand out the medications to patients, and patients can take medications by themselves according to the instructions printed on medication bags. For injections, the nurse will bring the orders to our pharmacy and collect injections, and administer to patients according to physician’s order. We allow some medications storing at the nursing unit to facilitate the process, such as infusion bags, controlled drugs, and drugs for emergency use. The nurse could dispense these drugs immediately after physician prescribing. This model is like Floor Stock System. However, in current practice, we apply technology to manage these medication more efficiently and safely.

First, our physician prescribe orders via CPOE system, which also link to inventory management system, so the computerized system could automatically calculate the consumption of these drugs and inform the pharmacy or the pharmacy warehouse to refill these medications. In addition, these orders are also shown on patient’s daily drug profile, so pharmacists could review these orders and could ensure the appropriateness of these prescriptions. In order to well management these medications, we set up some rules. First, we only allow less than 10 drug items stored on the nursing unit. For example, only top 10 most commonly used infusion bags and top 10 commonly used controlled drugs can be stored on the nursing unit.

However, each nursing unit may stock different infusion bags and controlled drugs. Second, to avoid dispensing error, each drug must be stored at specific container with labels. In addition, controlled drugs should be stored at specific drawers with locks. Third, to ensure the quality of these medications, nurses need to regularly check and record the expiration date of these stored medication. And adopt first-in-first-out principle. Pharmacists should regularly recheck the expiration date and these records. Through the experience in Taipei Veterans General Hospital pharmacy, we knew that although each distribution system exists some disadvantages, each system still has their advantage in different situations. Pharmacists should understand and overcome these shortage by new technology or by a well-designed working process and adopt proper distribution systems.

However, when adopting and using new technologies, policies, and procedures must seek pharmacy oversight on medication use and reduce cognitive burden on nurses. This is today’s lecture. Thank you for your attention.