ZHOU Yan-ping, LIAN Gui-yu



On Digital Drug Management in One Hospital Pharmacy

ZHOU Yan-ping1,2, LIAN Gui-yu1

Objective To explore the digital drug management model in hospital pharmacies and to ensure the drug use safety. Methods Digital drug management was studied by combining with the practices of drug management in one hospital pharmacy. Results and Conclusion The digital drug management of hospital pharmacies can optimize operation flow, improve the quality and efficiency of management, decrease dispensing errors, reduce the loss rates and improve the patients’ satisfaction.

hospital pharmacy; drug management; digital management model

Hospital pharmacy is an important window through which people can learn about the hospital. The management of hospital pharmacy can affect the image of hospital. The hospital of the author is one Grade Three Class A military hospital of infectious diseases and its outpatient pharmacy is responsible for providing drugs for emergency patients and discharged patients. The daily average number of outpatient treatment is about one thousand. Due to the large quantity of drug varieties, the staff is busy everyday. From production of outpatient prescription information to multispectral transmission, all the outpatient pharmacy work is done through the “No.1 Military Hospital Information System (HIS) digital platform. Other work such as automated production of drug labels and auxiliary management of drug bar code and digital medicine inventory management are also done with this system. At the same time, Germany ROWA automated drug delivery system was applied for drug delivery, which improved the efficiency and quality of dispensing work. The author provides some references for pharmacy drugs management based on the practice of hospital outpatient pharmacy drugs management.

1 Drug distribution management

All departments in the hospital are connected to the overall LAN and the doctor’s prescription will be fed to computer which will deal with the information automatically. Patients can pay with the printed receipt in the pay department, pharmacist will examine information and scans bar code on printed paper (includes name, ID number, and some notes on medicines). Then patients can get drugs. If the prescription is unreasonable, pharmacist should fill the information in “the physician contact card” so that patients and physicians can communicate more accurately to avoid the tension between doctor and patients caused by poor communication[1].

With the help of digital drug management, mistake made by staff and dispensing errors were greatly reduced. After giving the drugs to the patients, pharmacists should tell patients what they should do when they take these drugs, such as the dosage and requirement. For refrigerated drugs, refrigerated sign stickers should be posted on the drug and patients should be informed of storage conditions. After drug dispensing, prescription information must be confirmed again and then computer will deduct the amount of drugs from the inventory automatically.

2 Drugs management module

The outpatient dispensary can receive medicines from the storeroom twice a week, and the corresponding minimum inventory alarming line can be set for each medicine in the dispensary in the computer based on the daily consumption so that medicine purchase orders are automatically generated and submitted to the storeroom. The storeroom prepares and dispenses medicines according to requisition orders transmitted from the dispensary, while the outpatient dispensary and storeroom have double check on medicines and can solve any problem timely. Medicines for emergency shall be received once there is a demand so as to meet the needs of patients. Digital management of drugs and the standardization are the basis of the modernization of dispensing of drugs, which makes the past simple management to the precise management integrating variety, quantity, and amount into one. Therefore, it eliminates many disadvantages in the management and improves the level of pharmacy management[2].

Medicines can be divided into oral medication, injections, and medication for external use by the route of administration and medicines of each category shall be placed according to the pharmacological effects. The medicines produced by the same manufacturer shall be separated by different specifications. Based on frequency of use and the actual situation, the commonly used medicines shall be put on the place where it is easy to get, while the heavy medicines are placed on the lower layer of the shelf. The space number and barcode number of medicines shall be compiled and fed into medicine inventory management system so that the efficiency can be improved greatly. The shelves shall be posted with corresponding medicine labels, including barcode, name, size, manufacturer, storage method, validity and so on. Medicines that are prone to cause confusion shall be photographed and publicly displayed in warning signs.

The outpatient dispensary takes medicines that cost more than 100 Yuan as costly medicines. ABC classification management is conducted based on daily usage of medicines. A List Of Costly Medicines is made and the top 20 in category A shall be counted at every shift so that any problem can be traced timely. The top 100 costly medicines in category B shall be counted in every night shift. Other costly medicines in category C shall be counted once a week by the appointed person. In case of discrepancies, the records shall be retrieved timely to find out the causes so as to ensure the actual consistency with the computer inventory.

Special medicines include narcotic medicines, psychotropic substances and high-risk medicines. Five special methods are applied for narcotic and psychotropic medicines which are in accordance with Prescription Administrative Policy strictly, that is, daily clearing and settlement must be done with these medicines, medicines must be in consistent with the inventory, the prescription sheets should be bound according to classification and be stored separately, the distribution of special medicines should be supervised strictly. Small safes for narcotic medicines shall be equipped for the staff that is on duty alone; the medicines shall be counted at every shift and the base medicines shall be replenished timely. The high-risk drug management system must work properly and high-risk medicine labeling should be highlighted in the inventory maintenance management system; Special zones shall be set up for storage of high-risk medicines divided in A, B, and C by risk level and warning signs should be posted on shelves, special attention must be paid when the high-risk medicines are being dispensed.

The normal, cool and cold zones shall be set to meet medicine storage requirements. A temperature warning system shall be installed in each refrigerator with visual digital system to display real-time temperature. Once the temperature does not meet the requirements, the alarm will work to alert pharmacists. Daily inspection and registration of refrigerator temperature shall be done by appointed personnel to ensure that medicine storage conditions are perfect. Medicines that should be kept from light, such as the injections in glass bottles without outer package, shall be covered with shade cloth; injections with outer packaging shall retain the original packaging; and injections that need to be unbundled shall be placed in original packaging or in dark box that enjoy priority in use.

We shall adjust the quantity of medicines timely according to consumption so as to prevent medicine from becoming invalid and result in unnecessary losses. The expiration date of each medicine shall be checked when we apply for it, and medicines that approach the date of expiration shall be placed in the forefront of shelves for use in priority. Administration of medicine shelves shall be assigned to certain persons by zones for regular review of the basic situation of medicines. Medicines which are due within half a year shall be recorded monthly and pasted with a red dot for warning and a label for “use in priority”. The chief of the pharmacy shall make a list of expiring medicines so as to transmit the information timely to the storeroom and corresponding clinical departments; the storeroom is responsible for the allocation of the medicines to avoid wastes. Since we have ​​various homemade medicines that are mostly due within one year, while our patients are mostly chronic patients and some patients are from other cities, the patients can purchase enough medicines to last for three months and this often causes the expiration of some medicines. Digital management system can prevent this from happening. When dispensing medicines, pharmacists will see a dialog box pop up on the computer informing the expiration dates and remind pharmacists whether the medicines will be valid at the end of the patients’ medication. Therefore, no expired medicines will be dispensed.

Prescription Administrative Policy provides that once the medicine has been dispensed, it shall not be returned so that the safety of patients in medication can be guaranteed, but in reality, medicine return has occurred from time to time. We have developed a strict management system for medicine return. Except for special circumstances such as serious adverse reactions during use, unreasonable medication or prescription errors, changes in medication regimen,, the return is impossible. To return medicines, patients shall ask the doctor who made the prescription to fill out the return application form, and then it can be approved by the head of the corresponding department and Medical Department, after that the dispensary and pharmacist must have double check of the invoices and information in the computer, the medicines and the approval number and batch number. Then the package will be checked to see if there is any stain, damage, deformation or illegibility. At last, pharmacist can fill out another form and sign a list of returned medicines so that patients will take it with invoices to the cashier for refund. At the beginning of each month, the dispensary shall report the return cases to the medical department, and the medical department can implement punishment on physicians involved in medicine return in accordance with the actual situation. This system not only improves the physicians’ responsibility, but also reduces the number of medicine return cases.

At the end of each month, pharmacists shall print a list of all medicines in the storeroom and check all medicines by zones. Any discrepancies shall be promptly reported to the person in charge of pharmacy who shall check the medicines one by one with accounts, for instance, he will check the running accounts and retrieval of surveillance video at the dispensing window,Once the dispensing error is identified, pharmacists responsible for errors shall promptly contact the patients for replacement to minimize the losses. Error review seminars shall be held monthly, pharmacists that have made errors will analyze the reason for their mistakes in front of all pharmacists. Suggestions for dealing with the errors will be given to avoid the same mistakes in the future. By doing so, pharmacists will attach great importance to the dispensing quality to prevent similar incidents from happening.

3 Conclusions

When all is said and done, after the implementation of the digital drug management, work efficiency and patients’satisfaction have been improved greatly in our hospital pharmacy. What is more, the monthly drug inventory discrepancy rate has been reduced from the original 0.8 ‰ to 0.02 ‰[3], and the patients can get their medicines within three minutes. However, there is still a long way to go before we can make the system perfect. At present, our hospital medicine management is making full use of information technology to avoid the blindness and arbitrariness of traditional management; it provides a good opportunity for hospital pharmacy development[4].

[1] XIE Yan-ping, XU Ping. The Elaborating Management of Hospital Outpatient Pharmacy Study [J]. Journal of Chinese Pharmacy, 2013, 20 (17): 1578.

[2] XIE Jin, LIU Rui, LIU Li-ping,. The Management of Outpatient Pharmacy [J]. The Medical Journal of the People’s Liberation Army, 2011, 23 (4): 84.

[3] WANG Xiang-dang. Some Experiences of Hospital Pharmacy Management [J]. Journal of Medical Information, 2009, 22 (6): 1036.

[4] LIU Li-ping, HAN Jin, LIU Jun,. Study of Digital Hospital Pharmacy Model [J]. Journal of Chinese Pharmacy, 2013, 24 (29): 2732.

Author’s information: LIAN Gui-Yu, Associate professor. Major research area: The development of pharmaceutical industry. Tel: 024-23986549, E-mail: lianguiyu@163.com.