“The National Cheng Kung University Hospital (NCKUH) is the largest university affiliated medical centre and the most well-equipped teaching hospital in the south of Taiwan. As such, my expectations towards the pharmacy department have naturally become a benchmark for many other hospital pharmacies,” Associate Professor Cheng Ching-Lan said in enthusiasm when she was asked about her present role as the Director of Pharmacy at NCKUH.
A lifelong career in pharmacy research
When Director Cheng was still pursuing her Master’s degree in clinical pharmacy at NCKUH, she met her mentor, Professor Kao Yea-Huei. Professor Kao is the Founding Director of the NCKUH Pharmacy Department. She also set up the first research institute on clinical pharmacy in Taiwan and raised funds for its Fellowship program to boost the training and expertise of fellow pharmacists and researchers.
Under the Fellowship program, Director Cheng was able to receive clinical training focusing on pharmaceutical care in the pediatric department of NCKUH between years 2002 and 2003. After which, she headed to Pennsylvania for an internship at the Children’s Hospital in Philadelphia. Upon return, she began her PhD to continue her expedition in the realm of pharmaceutical science.
The contrast between the US and Taiwan healthcare systems
In Pennsylvania, Director Cheng learned that the US has adopted a completely different workflow from Taiwan. “Many US hospitals at that time had already automated their drug dispensing processes. The main responsibilities of pharmacists were prescription review and clinical care. Conversely, in Taiwan, the amount of prescriptions that needed to be dispensed at the outpatient level is so huge; pharmacists cannot verify everything and advise physicians to make changes when necessary,” Director Cheng noted.
Besides, US hospitals have dedicated technicians to prepare ready-to-use medicines in the exact dosages required by in-patients under the supervision of a pharmacist. So, nurses can readily administer these drugs when needed. However, in Taiwan, nurses are the ones who handle both the doses and administration of drugs. This not only increases their workload but is also likely to result in errors.
“I learned through my internship, the American healthcare has surpassed Taiwan in terms of automation and how valuable it would be to have a smart system providing prescription and dispensing assistance. So that, regardless of whether I am looking for a particular medication, confirming a repeat prescription, or verifying drug interactions and dosages, I would remain efficient and accurate. I believed this would relieve the work and psychological burdens of clinicians,” Director Cheng continued.
Reflecting on the challenges faced by Taiwan pharmacists, medication errors are hard to avoid. Director Cheng added, “for neonatal and pediatric patients, which represents a vulnerable population, additional care and detailed dosing information is essential. I have come across a case of a premature baby. The physician-in-charge made a prescription error that was not picked up by the pharmacist or the system. Fortunately, the error was discovered later during one of the follow-ups and no major mishap took place.”
The decision to use Medi-Span® Clinical
After taking over the role as the Director of the NCKUH Pharmacy Department, Director Cheng realised even though the Taiwanese hospital system has improved over the years, significant manpower is still required to maintain the vast amounts of drug information. The current system is unable to cope and address user acceptance challenges.
Director Cheng believes Medi-Span® Clinical is the perfect tool she envisioned since her internship day. Medi-Span® Clinical is an automated clinical screening solution from Wolters Kluwer which aims to support clinicians with making better informed medication-related decisions across the continuum of care. Director Cheng explained Medi-Span® Clinical has several unique features that can overcome specific challenges faced by present-day clinicians and pharmacists.
Firstly, pharmacists spend a significant amount of time maintaining and updating the medication database. The task can be daunting and stressful when pharmacists are not able to find time from their usual clinical duties. Medi-Span® Clinical is supported by a multidisciplinary editorial team with medical and pharmaceutical expertise to deliver best-practice evidence and recommendations and alleviate the burden of having to manually review drug decisions.
The database of Medi-Span® Clinical is continuously updated, giving users a global perspective on the most up-to-date regulations, medication use and safety advice. It’s equivalent to having an army of expert support, backed by novel application programming interfaces and a modular design for quick and easy deployment.
Secondly, Director Cheng said Medi-Span® Clinical has a smarter medication warning system and it helps medical professionals to conquer “alert fatigue”. The current dilemma encountered by the Taiwan pharmacists is, the existing warning systems are too rigid, and trigger the same alerts regardless of the clinician’s practice and situation. This causes clinicians to be frustrated and to ignore these warnings. Medi-Span® Clinical enables users to tailor its alert settings to preserve notifications that are deemed most critical to patient safety.
Improve the professional level of pharmacists
Director Cheng also highlighted an incident at the initial stage of adopting Medi-Span® Clinical. She mentioned pharmacists were the first batch of healthcare professionals exposed to the solution at NCKUH because there were concerns around user acceptance. A doctor accidentally prescribed a new drug meant for treating heart failure to a non-cardiac patient as the names of drugs were too similar. Fortunately, Medi-Span® Clinical alerted the pharmacist of the inappropriate drug usage. After reviewing the alert, both physician and pharmacist realised the wrong drug was prescribed. This incident, Director Cheng believed, had expedited the acceptance of the solution greatly.
Director Cheng said although the NCKUH quality assessment centre meets once every six months to monitor and reassure drug safety. Incidents like the one cited above are likely to be greatly reduced once Medi-Span® Clinical is built into the electronic medical record for users to prescribe and dispense drugs without having to access multiple systems at once.
As a teaching hospital, every semester, NCKUH accepts 30 to 40 student interns into their six-year-long undergraduate pharmacy course, on top of new pharmacists. It is crucial for students and interns to quickly learn and become familiar with the workflow, interpreting a prescription and obtaining relevant information on a particular drug. Alas, pharmacists in Taiwan need to focus on their frontline duties, so it is difficult to improve the overall professional knowledge without a good system.
Hence, a solution like Medi-Span® Clinical serves as a “senior”, assisting at the point of care, supporting decisions by offering vital insights like drug-to-drug interactions, and dosage, providing important learnings for both interns and frontline pharmacists alike. The up-to-date and reliable information will allow pharmacists to better communicate with physicians and counsel with patients with confidence.
“One of the most important tasks for pharmacists is ‘ensuring medication safety’,” Director Cheng asserted. “Medi-Span® Clinical, with its advanced features and knowledge base, will become invaluable in supporting clinicians ‘decisions, reduce alert fatigue and improve clinical effectiveness. With the successful implementation in NCKUH, I look forward to promoting patient cares in the pharmacies across Taiwan”.#
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