Abstract
The Future Hospital Pharmacy Consensus Statements was approved in the 68th Annual Congress of the International Pharmaceutical Federation (FIP). In order to obtain the comments on the Consensus Statements from the pharmacists over the Western Pacific region, the Western Pacific Pharmaceutical Forum (WPPF) has placed questions derived from the Consensus Statements on the official website and welcomes all the pharmacists to log on the webpage posting their opinion. Taiwan Society of Health-system Pharmacist (TSHP) as the representative of hospital pharmacists in Taiwan answered the questions as printed in this article. Hopefully more pharmacists from Taiwan could log on to the WPPF website and give comments on the answers or provide his/her new perspectives.
Key words:
FIP global conference, hospital pharmacy.
Introduction to the FIP Global Conference on the Future of Hospital Pharmacy Consensus Statements
On the 30th and 31st of August, 2008, the International Pharmaceutical Federation (FIP) hold its 68th Annual Congress in Basel, Switzerland with the main theme of Reengineering Pharmacy Practice in a Changing World.1 One of the major workshops in the Congress was the Global Conference on the Future of Hospital Pharmacy which was organized and conducted by the Hospital Pharmacy Section. The Global Conference participated by 348 hospital pharmacists from 98 countries spent 16 hours and finally developed 74 consensus statements in which expressed the ideal practices in the future hospital setting. The Consensus Statements comprehensively included every aspect of the medication use in hospitals, such as the selection, purchase, and inventory of medication in an institution; prescribing, dispensing, and administration of drugs; and the monitoring of drug response in patients. In all of the aspects mentioned above, patient safety was the utmost principle penetrating through. The Consensus Statements also included the management of human resources and training, because the knowledge and skills were also the focus of patient safety.
Why Answer the Questions
There are six regional forums in FIP, which are African Pharmaceutical Forum in African region, EMROPharm Forum in Eastern Mediterranean region, EuroPharm Forum in Europe, Pharmaceutical Forum of the Americas, SEARPharm Forum in South East Asia, and WPRPharm Forum in Western Pacific region. Taiwan is belong to the region of Western Pacific. In order to obtain the comments on the Consensus Statements from the pharmacist over the Western Pacific region, the Western Pacific Pharmaceutical Forum (WPPF) has placed questions derived from the Consensus Statements on the official website and welcome everybody to log on the webpage and post your opinion.2 Taiwan Society of Health-system Pharmacist (TSHP) as the representative of hospital pharmacists in Taiwan answered the questions. Followings are the three questions and the answers. The answers were posted on the webpage already. Hopefully more pharmacists from Taiwan could log on to the WPPF website and give comments on the answers or provide his/her new perspectives.
Questions and Answers
Statement 5:
Health authorities should ensure that each hospital pharmacy is supervised by pharmacists who have completed specialized training in hospital pharmacy. a) Tell us what sort of training your hospital pharmacy staff undergoes? b) Do you have pharmacists in all your hospitals? c) Do they have extra qualifications? d) Why do you think hospital pharmacists need“special training”?
Answer:
To be a hospital pharmacist in Taiwan requires to complete formal pharmacy education in pharmacy schools and pass the licensure examination. The basic degree to be accepted as a staff pharmacist is a bachelor degree in pharmacy. Some and more than before of the graduates with bachelor degree will goes on further education, such as master degree or doctor of philosophy degree in an academic field, e. g. pharmacology, pharmaceutics, and medicinal chemistry, etc. There are a few graduates from pharmacy schools having gained a doctor of pharmacy degree and completed pharmacy residency program abroad in the United States. For most of the graduates with bachelor or master degree, one year of on-site training in a hospital pharmacy is usually required before he or she can function independently if the individual has never had any practice experience in hospital pharmacy. After 3-4 years of working experience (the discussion of four-level hospital pharmacist proficiency ladder is undergoing), a pharmacist could have the chance to be promoted as a section leader to supervise a group of staffs.
All hospitals in Taiwan are required by law to have registered pharmacists as the professionals dealing with all medication-use processes. There are many different functions in the product- and patient-related responsibilities. Different hospitals may require different extra qualifications for the different functions or positions. Those pharmacists who are responsible for mainly product-related tasks, for example, handling prescriptions, dispensing, and drug delivering, usually are not necessary to have extra qualifications. In some hospitals, it is a prerequisite to have master degree in clinical pharmacy or doctor of pharmacy degree for being accepted as a clinical pharmacist whose major duties are in monitoring clinical use of drugs and patient care.
According to the above descriptions of current status, most of the staff pharmacists working in hospitals are not required to have extra qualifications in hospital pharmacy in Taiwan except the continuing education of 48 credit hours every 2 years. However, some specialized position in hospital pharmacy may need advanced degree to be qualified because the education in undergraduate pharmacy school does not provide adequate amount of knowledge and skills for those areas such as clinical pharmacy, pharmacotherapy, etc. In the future, when the hospital pharmacists' practice patterns in Taiwan switch toward more patient-oriented services, hospital pharmacy residency may become a necessity.
Statement 49:
Pharmacists should ensure that strategies and policies are implemented to prevent wrong route errors, including for example, labeling of intravenous tubing near insertion site to prevent misconnections, and use of enteral feeding catheters that cannot be connected with intravenous or other parenteral lines. This statement had seven countries disagree with this. a) What do you think? b) Do you have policies in your country? c) Is it the responsibility of pharmacists?
Answer:
Like other seven countries, the pharmacists from Taiwan would probably disagree with this statement. Currently, there is no such polices written in national level, but some hospital may have placed similar policy and procedure due to the occurrence of mistakes. Most of the pharmacists in Taiwan would regard this issue as a responsibility of nursing staff. Intravenous or enteral tubing is closely related to the administration of medication and nursing staffs are the professionals supposed to be most familiar with all the procedures. It is very reasonable for nursing staffs to play the major role in developing the policies and procedures of labeling the tubings and pharmacists are in a position of providing consultation in medication-related aspects.
Statement 57:
The medicines administration process should be designed such that steps between the original prescription and the medicines administration record are eliminated. a) Do you transcribe in your hospital? b) Electronic prescribing has been shown to decrease errors in the US but increase them in the UK. What are your thoughts on this?
Answer:
Due to the abundance of negative experience in making medication errors, medical and pharmacy societies in United States started the plan in promoting computerized physician order entry (CPOE).3 In this way, the original prescription information could be undistorted and transmitted through the whole medication-use processes. Computerized order entry system has been prevalently used in hospitals in Taiwan where the prescription information was transmitted throughout the dispensing and administration processes, but in many situations the pharmacists may no longer be forced to verify the appropriateness of the orders that may lead to errors. There are very few hospitals in Taiwan still transcribing physician's handwritten orders. While this practice seems very out-of-date, but the old-fashion system does force the pharmacists to take time to read physician's order cautiously and prevent lots of harm to the patients.
Our opinion is that electronic prescribing system has much potential to decrease transcribing errors, but it is prone to ignore the duty of pharmacist in patient safety. Electronic order entry system is necessary to be implemented and the design of the system should be intervened whenever necessary in the processes to allow pharmacists verifying the appropriateness of prescriptions, so that the optimal use of drug, which is more important, could be achieved by the contribution of pharmacists.
The End
You, a hospital pharmacist from Taiwan, are invited to answer the Western Pacific Pharmaceutical Forum's Topic 1 of the Pharmacists' Forum on the WPPF website, please visit: http:\\www.wppf.org, click on“Pharmacists' Forum” on the left column. You would need to register for access to the Pharmacists' Forum on the WPPF website in order to post your answers on the Pharmacists' Forum, please follow the guidelines as given on the website.
Reference:
1. FIP Global Conference on the Future of Hospital Pharmacy Successfully completed. http://www.fip.org/globalhosp/. Accessed October 10, 2009.
2. Pharmacists' forum webpage. http://www.wppf.org/. Accessed October 10, 2009.
3. Landmines and pitfalls of computerized prescriber order entry. http://www.ashp.org/Import/PRACTICEANDPOLICY/PracticeResourceCenters/PatientSafety/LearnMore/ComputerizedPrescriberOrderEntrySystemsdup0109065420800/LandminesandPitfallsofComputerizedPrescriberOrderEntry.aspx Accessed October 10, 2009.
摘要
第六十八屆世界藥學會年會通過「醫院藥學的未來共識文」，內含七十四項共識條文。西太平洋藥事論壇為了提高這個區域的藥師對於此共識文的認識，特別在論壇的網站放置了相關的問題，並且歡迎所有的藥師上網提供意見。臨床藥學會代表台灣醫院藥局藥師，已經針對其中三個問題提出回應。盼望更多藥師因為閱讀本篇文章後，可以親自上網，針對此三個問題提出進一步的意見。
關鍵字：世界藥學會、醫院藥學
作者
和信治癌中心醫院藥劑科藥師 姜紹青
Shao C. Chiang, R. Ph., Pharm. D.,
Department of Pharmacy, Koo Foundation Sun Yat-Sen Cancer Center
