Bicol Medical Center
Best Practice Focus Area/s
Strategy, Citizens / Customers, Operations
This is a GBPR entry
Bicol Medical Center (BMC) is faced with issues such as a lack of medicines, a 150% bed occupancy rate, and medication time delays. A one-drug-one prescription policy was also one of the complaints raised by resident physicians, as preparing prescriptions have taken most of their time, compromising patient care time (BMC SWOT Analysis 2011). Because of this, the BMC started its clinical pharmacy section and electronic prescribing to improve service delivery for medication and ensure patient safety.
Background and Problem
BMC is an ISO-certified, five hundred 500-bed capacity government training hospital. The major challenges of BMC are lack of medicines and delayed medication time. The one-drug-one prescription policy is receiving complaints from resident physicians, compromising patient care time. There was also a problem with bed occupancy with a 150% bed occupancy rate.
Solution and Impact
A clinical pharmacy section was the strategy identified and reconstitution of the Pharmacy and Therapeutics Committee. The Pharmacy Department was a dispensing unit with two groups of pharmacists. The nurses were tasked with getting medicines from the pharmacy to the wards. Under these changes, BMC started its clinical pharmacy section and Electronic Prescribing. The 12-month pilot study started in July 2016 with two (2) clinical pharmacists attending three wards with the most patients. They performed a chart review of medication orders in the Medical, Medical Annex, and Communicable Disease wards. They prepared patient profiles, recorded daily orders of medicines to be ready, and checked the availability of drugs and timely medication for patients.
Ten months into the study, four (4) more clinical pharmacists came in, and electronic prescriptions started after 1 1⁄2 months. The program was evaluated by comparing pre and post intervention measures, wherein the baseline was six (6) months before July 2016. The period from July to December 2016 was Phase 1, January to June 2017 was Phase 2, and they compared both phases at the end. They took the date in point from January-June 2018 and January-June 2019 Clinical Pharmacy findings wherein the same variables are available for both times.
The following findings were: ordering/prescribing errors were 11% (502) and decreased to 6% (164). The prescribed wrong drug was reduced by 0.31% (21 to 4 reported), and it dropped the prescribed wrong dosage form by 0.63% (44 to 9 reported). Meanwhile, the prescribed contraindicated drugs were reduced by 0.02% (1 to 0 reported). Failure to update the medication chart of patients decreased by 4.3% (215 to 11 reported). Prescribed medications without S2 were reduced by 0.7% (3 to 0 reported).
The data presented showed positive trends with more available medicines and better monitoring of patients’ medication. There was more efficient use of time and resources as pharmacists were able to focus on medication safety, maintained a single account, and used electronic prescriptions. An established clinical pharmacy with electronic prescribing in government hospitals appears beneficial for patient safety and should be further studied.
The Clinical Pharmacy service started with three wards last July 2016. Two Clinical Pharmacists were initially doing the ward visits, then ten months into the study, four additional Clinical Pharmacists were trained to handle new wards. Last May 15, 2017, electronic prescription started with one ward (Medical Ward), which later moved to cover 22 nursing units of BMC by July 1, 2017, with 18 clinical pharmacists on board. Since BMC implemented this practice, prescribing errors decreased by 49.6% from Phase 1 of 134. Data for identified medication errors decreased by 39.9% from 4576 identified errors in January 2018–June 2018 to 2752 identified errors from January 2019 to June 2019.