Ms Kathy Lai-ki MAK, MR Ivan Chi-hung WONG, Ms Daisy Chiu-ling
CHIA
Pharmacy Department, Tseung Kwan O Hospital
Integrated Inpatient and Outpatient Dispensing Section in Pharmacy
Department
Tseung Kwan O Hospital, Hong Kong
Background
Tseung Kwan O Hospital is a new hospital and commenced its operation in late
December, 1999. It was built as a general acute hospital with 458 in-patient beds and 140
day beds. The scope of services includes 24 hours accident & emergency service,
inpatients and outpatients services of various clinical specialties and allied health services.
The core service of pharmacy department is to provide inpatient and outpatient
dispensing services. Other supporting services include clinical pharmacy service,
procurement of drugs and dressing items, drug distribution and manufacturing of
pharmaceutical preparations. The department is operated with three pharmacists, fifteen
dispensing staff and five supporting staff.
Expectation from the patients on public health care services is growing in recent years.
Waiting time for collection of medications for outpatients is one of indicators to the
efficiency of pharmacy service. The goal of our department is to provide service with
quality and efficiency. Therefore, it is our target to maintain the waiting time for
outpatient prescriptions to not more than fifteen minutes. Another initiative to improve
patient care is to capture a complete drug history for each inpatient. All prescribed
medications are recorded into the computer including ward stock items. A complete drug
profile is an essential tool for the screening of potential drug interactions and overdose.
As a result, innovation and reengineering of the traditional pharmacy workflow is
necessary to sustain the service standard. Therefore, the concept of integrated inpatient
and outpatient dispensing section is introduced.
Methods
During commissioning phase of the pharmacy department, minimal fixtures such as
workbenches or shelves were installed. It allowed more flexibility in the later stage of
planning to design the layout of the dispensing area to meet the actual operational need.
In the original design, the outpatient and inpatient dispensing sections were supposed to
be separated at the two ends of the pharmacy in an open area. (Diagram 1) As a result, the
two sections would be located far apart. To facilitate ease of dispensing, two separate
working stores for medications and two teams of staff would be required to carry out the
dispensing duties.
Issuing Counters
Concrete Pillar
Diagram 1: Separated Inpatient &Outpatient Sections
In order to achieve our targets, we integrated the two sections by moving the inpatient
dispensing section right next to the outpatient dispensing section. The medication
workstations procured for the dispensing areas are very versatile and flexible. We
converted one side of outpatient workstation for medications to workstation for inpatient
data entry. (Diagram 2) All non-parenteral medications are stocked in the outpatient
section as they are commonly used for outpatients, whereas parenteral medications are
stocked in the inpatient section. Express Dispensing System (EDS) is employed in the
outpatient section. The concept is to locate items of different strengths, similar drug
names or packaging far apart on different workstations. All items are then assigned with a
unique location code. The labels will be generated at preset printers according to the
location of the drugs.
Issuing Counters
Diagram 2: Integrated Inpatient &Outpatient Section
Results
If a separate working store is to be set up for inpatient dispensing section and all the nonparenteral preparations are stocked, then the number of item-locations kept in integrated
section versus that in separated section is shown as follows:
Number of Items
Separated section
Integrated section
Less number of item-locations
The integrated section reduces the store management workload such as stock
replenishment, expiry date monitoring by about 50%. In addition, less holding stock is
required in working store because there is only one location per item. Less replenishment
1384
934
450
activities will also reduce certain dispensing errors which are caused by mistakes in
replenishment. Since the two sections are integrated right from the start, we do not have
any data of dispensing error for separated sections for comparison.
With the present setting, the average waiting time for outpatient prescriptions is
maintained within fifteen minutes except for those require further clarification. For the
inpatient section, the medication administration records are usually processed within one
hour. Our pledge to complete the refill prescriptions for inpatients before one o’clock in
the afternoon can always be achieved.
Discussion
The significant reduction in item-locations relief the stock management workload and
achieve a better stock control. The manpower saved can be deployed to other value added
activities.
One main extrinsic factor to the success of the integration of the inpatient and outpatient
dispensing sections is the distribution of workload of the two sections. The peak
workload period for inpatient is in the morning as the ward rounds by doctors normally
start in the morning. Most computer data entry of patient’s medication profile and
dispensing of refill medications are done in the morning. On the contrary, the peak
workload period for outpatient is in the afternoon when most of the specialist outpatient
clinics operate.
The proximity of the two sections also allows flexibility in deployment of staff. For
example, during lunch hour and between six to seven p.m., only three staff are sufficient
to manage both sections. In addition, all dispensing staff are fully aware of the labels
generated from any of the printers and will perform the dispensing promptly because of
the nearness of the two sections.
The operation with one team of staff also has other intangible benefits. The workload is
evenly distributed among all staff and the possible discontent arise between two teams
can be avoided. The dissemination of information is more efficient and all staff are well
informed of policy changes. The training and rotation of staff are more efficient and they
are usually well trained within four weeks. The supervision is also more effective because
of the proximity of the two sections.
Conclusions
The integration of the inpatient and outpatient dispensing section results in a more
organized and efficient workflow arrangement. The peak and trough workload of the two
sections is well matched so that the staff can be deployed timely to achieve the maximal
throughput. As a new pharmacy department without any burden of norms, it is easy to
cultivate our own culture that there should not be any distinction between the two
sections. As a result, our goal in providing service with quality and efficiency is achieved.