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Storage and administration standards

That are the requirements about dispensing. Now we move to the standard of medication storage. GPP guidelines require that pharmacists should ensure proper storage conditions for all medications. In Taiwan hospital accreditation standard, it also require that pharmacy should provide sufficient and appropriate space and equipment to ensure the good quality of pharmacy practice. The independent storage or display space for medications is needed with controlled temperature. So we design appropriate storage space and standard dispensing area and medication layout at both pharmacy warehouse and dispensing area. The picture shows our standard dispensing area in the outpatient pharmacy. All drug boxes are well labeled with brand name and generic name and the strength. Red labels are for injections and green are for oral drugs.
For high alerting drugs such as hypoglycemic agents and controlled drugs, we put special alerting tags on the upper left corner of label. We also put alerting tags for drugs with multiple strengths or multiple dosage forms. The dispensing area has central air conditioner system to ensure the temperature is below to 25 degrees Celsius. For drugs are needed to be stored below room temperature, we also monitor the storage temperature by computer. The computer can automatically alert when abnormal temperature is detected.
In addition, we deliver daily medication by using the drug cart. To ensure the security and safety during drug distribution, the drug carts are designed with locks. For chemotherapy drugs, we use drug carts with doors to avoid chemo drug spillage. For new orders or immediately use order, the medication is not delivered by cart. The ward staff will come to collect these drugs, so drugs will be temperately stored at a locked box. Staffs from the ward have keys to open their own stored box and collect medications. Then, let’s move to the practice standards in patient administration.
In GPP guidelines, pharmacists should have a role in the preparation and administration of medications, in establishing procedures in their work setting with respect to the administration, and in monitoring the outcomes of medical administration. In Taiwan, the administration is usually done by nurses. But the pharmacists have the role to monitor and establish the procedures of administration.
Taiwan hospital accreditation standard requires that the medication should be administer correctly. Staffs should confirm and make records of patients’ name, drug name, dosage, indication, route and administration time upon administrating medications for each administration. In our hospital, we apply electronic medication administration record. Previous studies have reported that using BCMA system could reduce medication errors, such as reducing wrong dose error by 62%, reduce missed dose errors by 70%, reduce wrong administration time by 87%, reduce patient mix-ups errors by 93%, and reduce dispensing errors by 75%. So, the pharmacy department establish our own barcode medication administration system together with the nurse department. Pharmacists would also monitor the patient response after administration.
In our hospital, when the nurses goes to administer medication to patients, they bring the nursing cart with a computer. So, the nurse can use this barcode-assistant medication administration record system to check and record each administration and also check drug information. The nurse firstly scan the barcode on patients’ band and also scan the barcode on drug packages to identify the right drug to the right person. Through this scan, they can also complete the administration record at the same time. The nurse can also use this system to look up drug information. By using this system, nurses can efficiently complete their administration record and also reduce the administration errors.
Taiwan hospital accreditation standard requires that pharmacists should conduct and make records of medication reconciliation. It means that pharmacists should check the previously and currently received medication therapy of patients and avoid drug omit, unnecessarily duplicate existing therapies, or incorrect dosages, and so on. Pharmacists should also monitor clinical response to medication therapy including therapeutic effects and adverse effects. In our hospital, we use the electronic medical records, so we can check previous medication history to perform medication reconciliation. In addition, our government establish a pharmacloud system. Pharmacloud is a patient-centered system, it collects inpatient and outpatient medication records from the national healthcare insurance information system and set up online system.
So, physicians and pharmacists can use pharmacloud to online review all medication history in different hospitals or clinics in the latest 3 months to perform medication reconciliation. In our hospital, we also develop a warning system linking to pharmacloud to avoid cross hospital duplicate medication errors. To monitor treatment response, our clinical pharmacists work with medical teams and attend medical rounds with physicians to monitor treatment response and discuss possible adverse effects with physicians. In our pharmacy, we establish pharmacist service system in 2010. After medical rounds, our clinical pharmacists use pharmacist service system to record patient treatment response. These pharmacy notes can be uploaded to hospital system, so physicians can read pharmacy note and know what we have done for the patients.
The pharmacy service system also link to other reporting system, such as records of consulting service, adverse drug reaction, and medication error reports system. So pharmacists can easily make all records in the pharmacy service system.
Our hospital also set up electronic medication error reporting system and adverse drug reaction reporting system. All hospital staffs can report events to these two system, but most of events are still reported by pharmacists. These online reporting systems lead staffs to record all relevent information, so these systems can regularly perform statistic analysis. The adverse drug reaction reporting system also can transform the e-report to a formal adverse drug reaction report and send to the national reporting center. In conclusion, to establish a safe and effective pharmacy practice, all medication use process need a national standard to guide pharmacy staffs.
Even though the pharmacy practice is never the same, the GPP guideline has set up essential requirements for the international pharmacy society to establish national standards in their pharmacy practice. You can always find a medication distribution system to fit your hospital facilities and workflow. After this lesson, I hope our practice and national standards can give you some examples and ideas to to establish your own practice standards. But always remember that the key of success is accuracy and reliability. So, you should ensure that you establish a reliable system to help you provide accurate medication to patients. Thank you for your attention. Goodbye.

Storage and administration are also well-regulated in the standards. To conclude this activity, Ms Chou goes over the standards of drug storage, delivery, and administration and elaborates on the requirements set by GPP and the Taiwanese government.

In this video, we also illustrates the importance of recording each administration, and keeping data on a platform shared across all hospitals in Taiwan. This allows statistical analysis and information extraction at ease. She ends off by highlighting the 2 factors of successful medical delivery: accuracy and reliability.

Recently, vaccination of COVID-19 get a lot of attention. After viewing the video, we would like you to look into the storage and administration requirements of the various vaccines for COVID-19. Please leave your comments in the next step.

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Good Pharmacy Practice: Introduction to Medication Delivery Systems

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