Hospital pharmacy in Taiwan

Let me first introduce Taiwan. It is an island country close to south eastern part of mainland China, between Japan and the Philippines. We have 23 million residents. In Taiwan, we have more than 30 thousand pharmacists, about 22% of them work in hospital. In average, every hundred thousand population has 143 registered pharmacist, that is far more than the average of OECD countries. The OECD is the abbreviation of Organization for Economic Co-operation and Development. And you might know that Taiwan do not have pharmacy technician. Let me show you some characteristic about the medical care system in Taiwan Taiwan has a world famous national insurance system which used limited budget but provide comprehensive coverage of most diseases and reimbursed most medications.

All the residents only pay a little but get convenient health care all over the country. The residents are very easy access to medical institutes. As you may know, Taiwan is an IT island, so the hospital largely employ the IT incorporated in the whole processes of pharmacy practice. We also have already set up the national standard of practice with regular accreditation mechanism. In recent 10 years, a lot of hospitals in Taiwan passed accreditation by Joint Commission International. Since the practice of prescription and dispensing are not fully separated and the policy of patient stratification also weak in Taiwan, so we keep a lot of ambulatory patients in hospital.

In Taiwan, you can always see a lot of patients crowded in hospital outpatient building. The pharmacists in hospital have huge workload in dealing with ambulatory care prescriptions. In a national survey in 2015 about 82% of pharmacists work in Medical Institute and only 60% work in pharma industry. Among the pharmacist work in medical institutions, 26% are employed by a physician in clinics. 34% work in community pharmacies and as I mentioned before only 22% work in hospital.

In terms of the pharmacy manpower in Taiwan Comparing the manpower in hospital setting in different countries. Here we use the number of pharmacy staff per country as the unit. If Taiwan is one, you can see Japan is 2, Australia is 1.5 to 2.2, and the United State is 7 to 15 Which means we pharmacist in Taiwan and limited manpower in hospital In the following three slide, I will introduce you the history of institutional pharmacy practice in Taiwan follow the years sequence for the last four decades the mark here represent Taipei Veterans General Hospital.

Taipei Veterans General Hospital plays an important role in the development of institutional pharmacy practice in Taiwan Since she always the new changes in act as a pioneer in many field of hospital pharmacy practice. She’s indeed a symbolic Hospital in the development of institutional pharmacy practice in Taiwan In the year 1981, the Unit Dose Dispensing System introduce in Taiwan, Taipei Veterans General Hospital was the pioneer to introduce the UD practice Since UD system need integrate with IT three years later hospital computerization was initiated in this hospital In the year 1987, Computerized Prescription Order Entry system abbreviated as CPOE, started in outpatient service in TVGH. Now, almost 100% hospital in Taiwan use COPE system.

In the same year, Taiwan Society of Health-System Pharmacists established. The first president was the director of pharmacy from TVGH. In the same time, the National Hospital Accreditation started in Taiwan and the Therapeutic Drug Monitoring Services launched in hospital. The Pioneer pharmacy is Taipei Veterans General Hospital and Tri-service General Hospital. In the year 1988, Good Manufacturing Practice was implemented in Taiwan. In the same time, Therapeutic Drug Monitoring became mandatory service in the national accreditation. 5 years later, automatic dispensing machine was introduced in TVGH for UD dispensing. In the year 1995, Taiwan Guideline of Good Dispensing Practice was published by the government. In the same time, the Total Parenteral Nutrition dispensing automatic machine was setup in Taipei Veterans General Hospital.

In the same year. The milestone event was the National Health Insurance launched in Taiwan The next year, Taipei Veterans General Hospital Pharmacy website was established. In the year 1997, the policy of separation for dispensing and prescribing was announced by the government, but unfortunately, we still on the half-way. In the same year, staffing of clinical pharmacists in Intense Care Unit was required in accreditation

In the year 1998, Taiwan National Adverse Drug Reaction Reporting Center established. Initially it was supported by Taiwan Society of Health System Pharmacists. In the year 2001, the system was managed by Taiwan Drug Relief Foundation. In the year 1999, Joint Commission of Taiwan was established and the purpose is to promote, execute and certify the nation’s healthcare quality policies. To assist in conducting healthcare quality assessment and accreditation. In the year 2001, our hospital led a national revolutionary innovation of medicine bag. The quality of provision of patient information made a huge progress. Since then, the Pandora box of medical information was open to the public. We will talk it more later.

In the year 2005, Hospital Pharmacy Internship Preceptors Training Programs launched, the pharmacist in hospital who are precepting undergraduate pharmacy student required to get training certificate and renewal is required. In the next year, Joint Commission International was introduced to Taiwan. In the year 2007, the law of pharmacy practice was amended and “pharmaceutical care” as the role of pharmacist was enforced. In the year 2013, the Pharm-Cloud System was developed by Taiwan National Health Insurance Administration. This system can integrate patient’s medication records from different institutes and could avoid duplication of medicine, promote rational use of drugs. In the year 2015, PIC/S-GMP implementations in Taiwan.

PIC/S is the abbreviation of the logo used to describe both the Pharmaceutical Inspection Convention and the Pharmaceutical Inspection Co-operation Scheme operated together in parallel. In the year 2016, Active Pharmaceutical Ingredient GMP was required for all licensed drugs. All of the above-mentioned event are the milestone symbolize the progress of pharmacy practice in Taiwan. The hospital has better training system and resources in Taiwan. The following are some milestone in academic and Continuous Pharmacy Profession Development in Taiwan. The 1st pharmacy school in Taiwan was school of pharmacy, National Defense Medical Center. It is transferred from mainland China in the year 1949. In the year 2008, Post-graduate Training Program in hospital was required to pass Teaching Hospital Accreditation. In 2009, Six years Pharm.D.

program initiated in school of pharmacy, National Taiwan University. Today, we have more than 5 pharmacy schools in Taiwan have 6-year PharmD program. In 2010, 150 hours continue education credit was required for license renew; it was reduced to 120 hours thereafter. In 2011, 4 level hospital pharmacist proficiency ladders, that is, Hospital Pharmacist P1 to P4 Advancement Program announced by Taiwan Society of Health System Pharmacist. In 2013, 640 hospital internship hour were required before pharmacist license exam.