Introduction to hospital accreditation

Let’s start to introduce the standards of hospital pharmacy practice in Taiwan from physician ordering. In Taiwan Good Dispensary Practice standards, it requires that prescriptions should contain complete information and pharmacists should sign or affix personal seal on the prescription after dispensing. In Taiwan hospital accreditation standard and Taiwan Good Dispensary practice, they all require the elements of a complete order, including patient’s name, age, gender, and diagnosis. Physicians’ information is also required, including doctor’s name, license number, signature or seal, and also the health organization’s name, address, and telephone number.

For medication information, the order should contain correct medication name, dosage form, and unit dose, the quantity of each medication, administration instruction, including dose and frequency. For other information, the order should show the prescribing date and refill information, such as times of refill and duration. This is the example of our prescription sheet. All information shows on it, including patient information, such as patient name, age, sex, height, and weight, patient’s diagnosis, drug name, including brand name, strength, single dose and frequency, duration and quantity.

Physician’s name and license number is automatically printed on the order. However, the physician still need to stamp on it. Our pharmacist also need to stamp on the order after completing the full dispensing process. The prescribing date, refill information, and health organization’s information are also automatically printed on the order.

Because nearly all hospital in Taiwan use computerized physician order entry system, as known as the CPOE system, so in Taiwan hospital accreditation standard, it set up essential requirements for CPOE system. First, physician order entry system should simultaneously show both generic name and trade name, the unit dose, and provide an easy access to drug appearance images in order to aid doctor-patient communication. Second, the CPOE system should incorporate medication error warning system, such as warning on maximum dose, drug interaction, medication duplication and allergies. In addition, the warning system should design for special population, such as for pregnant women, children, and the elderly. And these warning system should be reviewed and analyzed the performance regularly.

In our pharmacy, we develop the prescribing policy and list it in our hospital formulary to meet the above mentioned requirements. This prescribing policy defines the elements of a complete order or prescription and the types of orders that are acceptable. All physicians should attend this prescribing training in their first month in our hospital. And our IT staffs also integrate these policies into the CPOE system with clinical decision supporting system, as known as the warning and information system.

This is the prescribing screen in our physician order entry system. All medication shows both generic name and trade name with dosage form, unit dose, and indication. High alert drugs, controlled drugs, and Look Alike, Sound Alike drugs are marked with symbols. We integrate drug information into CPOE system, physicians can easily check drug formulary, package insert, and drug pictures by clicking the link button. If physician need to check drug classification, there is a quick link to link drug list in the same drug classification. In addition, for some medications with special dosage form, such as the liquid form, eye and ear drops, nasal spray and so on, we put a special mark in front of the drug name.

We additionally green highlight the child-specific form and show the clinical uses to avoid wrong prescribing. In the CPOE system, we integrate clinical supporting system in it. More than 40 error-proofing mechanisms in the CPOE systems. As I mentioned, we integrate query systems for look up formulary and so on. We also integrate auto-checking systems to examine the duplication, drug interaction, maximum dose, contraindication, allergy and so on. Those warning can meet the requirement in our GDP and GPP guideline. Before the warning system integrated to CPOE system, prescriptions are checked by pharmacists. It is impossible to check all prescriptions, it is also impossible that pharmacists know all interactions and adverse drug reaction.

So, we develop these warning system to improve the efficiency and reduce medication errors. Because of the successful warning system, in 1916, among thirteen million prescribed drug items, we avoid about fifty-seven thousand inappropriate events.