DISTRIBUTION OF WORKLOAD BETWEEN PHARMACY UNITS IN PKD HULU LANGAT - Esther Ng, Pharmacist U41, PKD Hulu Langat
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DISTRIBUTION OF
WORKLOAD
BETWEEN
PHARMACY UNITS IN
PKD HULU LANGAT
ESTHER NTT, NORLIDA I, AHAMAD J,
PEJABAT KESIHATAN DAERAH HULU LANGAT
PRESENTER Esther Ng, Pharmacist U41, PKD Hulu Langat
Contents
2
Introduction
Research objectives
Problem identification
Methodology
Results and Discussion
Conclusions
Prescribers Receiving of prescription
INTRODUCTION
ERROR Screening for errors
Accurate filling, recording
and labeling
Counterchecking &
Role of out patient Dispensing of medication
pharmacy
Counselling of devices
Assisting clinicians with
therapeutic information
and prescribing decisions
3
upon request
Insufficient stocks Ordering stocks
INTRODUCTION
Receiving stocks
Issuing stocks
Role of Prepacking of medicine
store
pharmacy Arrangement at counter
Stock checking
4
Additional Outpatient Pharmacy Services
5
Patient medication counseling to improve
treatment outcome
Medication
Therapy Adherence Clinic
Home Medication Review
Dissemination of medicine information to promote
quality use of medicines
Compounding of extemporaneous and repacking
of medicines
Research Objective Research Hypotheses
6
To study the workload at the outpatient
pharmacy of each health clinic pharmacy in
PKDHL
Problem identification
7
Increased workload due to unavailability of stock
and staff to accommodate medication supply
requirements of Malaysia Health Ministry
Limited
budget due to increasing drug prices
1-2 months supply
8
Analysis of current data collection form
Identifying its limitations
METHODOLOGY
Comparison with other hospital/PKD practice
Drafting of new data collection and summary form
Approval from pharmacists-in-charge of each clinic
Implementation for month of June and July
Analysis and evaluation of results
Discussion
9
ConclusionLimitations of current data
collection form :-
Only able to give an account
Analysis of pharmacy workload without
respect to availability of staff,
of or trend of medication supply
to patient (ie. Per month basis,
current etc)
data Unable to monitor budget
justification of each clinic (ie.
collection How many percentage of
hypertensive patients arrive at
form pharmacy?)
10Analysis of current data collection form
Identifying its limitations
METHODOLOGY
Comparison with other hospital/PKD practice
Drafting of new data collection and summary form
Approval from pharmacists-in-charge of each clinic
Implementation for month of June and July
Analysis and evaluation of results
Discussion
11
ConclusionComparison with other hospital/PKD
12
Hospital Kajang
According to Department (MOPD,
Ortho, etc)
KK Seri Kembangan
QMS and recording according to
items
5 items – III ; 3 items - IIAnalysis of current data collection form
Identifying its limitations
METHODOLOGY
Comparison with other hospital/PKD practice
Drafting of new data collection and summary form
Approval from pharmacists-in-charge of each clinic
Implementation for month of June and July
Analysis and evaluation of results
Discussion
13
ConclusionCVS DM Respi
• Dyslipidemia • Diabetes I&II • COPD
• Hypertension • Asthma
New •
•
CHD
IHD
Data
Collection OPD Lain-lain
Form • URTI
• Acute
• SPUB
• KIA
management • Dental clinic
• Gout
• Pain
14Daily Data Summary Form
Borang Harian
CVS DM Respi OPD Lain-lain JUMLAH
Tarikh PS item PS item PS item PS item PS item PS item
JUMLAH
15Monthly Data Summary Form
Kajian Maklumat Kaunter Pendispensan Farmasi Pesakit Luar
Klinik Kesihatan :
Bulan/Tahun :
Bilangan Purata Peratus
Bilangan Jenis Perkhidmatan Farmasi Pesakit Luar Bilangan anggota farmasi
kaunter masa Bekalan
CVS DM Respi OPD Lain-lain JUMLAH PF PPF Lain-lain yang buka menunggu < 30 min
Pesakit (Pt)
Preskripsi (Ps)
Perkara (Item)
Ratio PS
(∑ Ps / ∑ Pt)
Ratio Item
(∑ Item / ∑ Pt)
Perhatian:
Pesakit (Pt) adalah bilangan pesakit yang didaftarkan di pendaftaran. Sila dapatkan angka dari reten pendaftaran
Preskripsi (Ps) adalah bilangan pesakit/preskripsi yang diterima oleh pihak farmasi
Bilangan anggota farmasi (lain-lain) termasuk PRA, PPK, pelajar sangkutan, etc.
16Analysis of current data collection form
Identifying its limitations
METHODOLOGY
Comparison with other hospital/PKD practice
Drafting of new data collection and summary form
Approval from pharmacists-in-charge of each clinic
Implementation for month of June and July
Analysis and evaluation of results
Discussion
17
ConclusionDiscussion among pharmacists
18
Approval from
pharmacists-in-
charge of each
clinic
Discussion to
improve the form,
and clarify doubtsAnalysis of current data collection form
Identifying its limitations
METHODOLOGY
Comparison with other hospital/PKD practice
Drafting of new data collection and summary form
Approval from pharmacists-in-charge of each clinic
Implementation for month of June and July
Analysis and evaluation of results
Discussion
19
ConclusionImplementation for June and July
20
Cross-sectional data collection
Population data (n = 109,644)
Every patient arriving at pharmacy in the month of June
and July
Collected from eight health clinics of PKDHLPOPULATION DATA
21
No. of patients arriving at pharmacy in the months of June and July 2011
CVS DM OPD Lain-lain JUMLAH
AMPANG 4831 6644 16700 1380 29555
KAJANG 1338 1947 9055 1457 13797
BATU 9 741 603 4336 676 6356
BANGI 679 560 3746 980 5965
SEMENYIH 1733 3759 6001 2092 13585
BATU 14 451 1096 3635 1004 6186
BERANANG 1781 1490 4060 734 8065
BDR SERI PUTRA 3422 7514 12128 3071 26135
JUMLAH 14976 23613 59661 11394 109644Inclusion Criteria Exclusion Criteria
22
Prescriptions of Prescriptions from
patients arriving at Respiratory category
pharmacy regardless Due to inconsistency
of age, race, sex and of MDI dispensing
religion on PRN basisAnalysis of current data collection form
Identifying its limitations
METHODOLOGY
Comparison with other hospital/PKD practice
Drafting of new data collection and summary form
Approval from pharmacists-in-charge of each clinic
Implementation for month of June and July
Analysis and evaluation of results
Discussion
23
ConclusionDefinition of parameters
24
Patients arriving at • Categorised according to diagnosis at
pharmacy registration counter
Number of patients • Based on the monthly statistic of
arriving at clinic outpatient department
• Based on the prescriptions arriving at the
Number of pharmacy, regardless of whether it is
prescriptions from a repeat patient or otherwise
Number of items • Number of items dispensed to a patient
in reference to their prescriptionData was analysed by comparing:
25
Frequency of visits to the pharmacy after the patient is
registered at the counter
Number of items prescribed by a healthcare professional in a
single prescription
Average waiting time
Percentage of prescriptions dispensed under 30 minutes
Pharmacy staff to patient ratioThe table defines the frequency of visits to the pharmacy after the patient is
registered at the counter
•< 1 ; patient did not arrive at pharmacy to receive medication;
patient was not reviewed by doctor OR registered for procedures only, hence
no prescription
• > 1 ; depends if patient TCA in 3 months, but pharmacy dispense monthly
supply, the frequency of visits is 3.
Frequency of visits to the pharmacy after the patient is registered at the counter
CVS DM OPD Lain-lain JUMLAH
AMPANG 1.78 1.83 0.95 0.09 0.78
BANGI 1.21 1.77 0.78 0.17 0.60
SEMENYIH 1.01 0.67 0.87 0.34 0.74
BATU 9 1.65 2.31 0.81 0.28 0.79
BATU 14 3.14 2.25 0.91 0.29 0.99
BERANANG 0.92 2.25 0.56 0.39 0.62
BDR SERI PUTRA 2.42 1.73 0.99 0.53 0.87
KAJANG 1.42 3.33 0.68 0.57 0.94
26 •Kajang and Batu 14 : supply on monthly basisData was analysed by comparing:
27
Frequency of visits to the pharmacy after the patient is
registered at the counter
Number of items prescribed by a healthcare professional in a
single prescription
Average waiting time
Percentage of prescriptions dispensed under 30 minutes
Pharmacy staff to patient ratioThe table defines the average number of items prescribed by a healthcare
professional in a single prescription
Number of items prescribed by a healthcare professional in a single prescription
CVS DM OPD Lain-lain JUMLAH
AMPANG 3.39 3.65 2.94 1.89 3.11
BANGI 2.67 4.39 2.54 2.16 2.77
SEMENYIH 2.84 4.24 3.08 2.38 3.08
BATU 9 3.98 4.89 2.65 1.64 3.28
BATU 14 3.10 4.93 2.99 2.06 3.29
BERANANG 2.41 4.67 2.59 1.89 2.82
BDR SERI PUTRA 2.27 4.81 2.66 1.40 2.61
KAJANG 3.14 1.99 3.88 2.46 3.07
•Batu 9 more chronic patients for CVS; Batu 14 for DM
•Kajang doctors prescribe more OPD, Lain-lain items than other
doctors
28Data was analysed by comparing:
29
Frequency of visits to the pharmacy after the patient is
registered at the counter
Number of items prescribed by a healthcare professional in a
single prescription
Average waiting time
Percentage of prescriptions dispensed under 30 minutes
Pharmacy staff to patient ratioRatio of
Average Percentage Ratio of PPF :
No of Patients Pharmacist :
waiting prescriptions Type of Patient
counter served Patient
time dispensed < 30 clinic
open per day Recomm Recomm
(min) mins Current Current
ended ended
AMPANG 3 6.55 99.07% 746 2 249 44 186 53
BANGI 2 6.00 100.00% 349 3 174 45 174 56
SEMENYIH 2 10.51 91.18% 162 4 162 43 81 50
BATU 9 2 17.11 85.47% 343 3 172 45 114 56
BATU 14 1 10.80 100.00% 206 4 206 43 103 50
BERANANG 1 9.84 100.00% 157 4 157 43 157 50
BSPUTRA 2 3.95 99.24% 151 4 151 43 151 50
KAJANG 2 11.635 96.57% 657 2 219 44 131 53
•Batu 9 serves Methadone patients
(approx 150 pts)
•Methadone Pharmacist unavailable during morning
session
•Pharmacist to patient compensated ratio: 343 (highest
among clinics)
30Analysis of current data collection form
Identifying its limitations
METHODOLOGY
Comparison with other hospital/PKD practice
Drafting of new data collection and summary form
Approval from pharmacists-in-charge of each clinic
Implementation for month of June and July
Analysis and evaluation of results
Discussion
31
ConclusionNot just Dispensing?
32
“Every health clinic Outpatient Pharmacy shall
establish Drug and Poison Information Service
(DPIS), medication counseling service, MTAC, HMR
and pharmacy education services”
Quoted from Requirement for the Development of
Pharmacy Facilities in Hospitals, Health Clinics and Other
Health Facilities, Ministry of Health, Malaysia,
Pharmaceutical Services Division. The Health Ministry has allocated pharmacists for
each of these roles:-
33
Head of Department
Procurement & Supply
Counseling
DIS & Pharmacy Education
Outpatient Department
Medication Therapy Adherence Clinic
Home Medication ReviewExample
34
Ratio of
Average Percentage Ratio of PPF :
No of Patients Pharmacist :
waiting prescriptions Type of Patient
counter served Patient
time dispensed < 30 clinic
open per day Recomm Recomm
(min) mins Current Current
ended ended
343 45 114 56
BATU 9 2 17.11 85.47% 343 3
(343:1) (500:11) (343:3) (500:9)
11
9
Quoted from Requirement for the Development of Pharmacy Facilities in Hospitals, Health Clinics and Other Health Facilities, Ministry of
Health, Malaysia, Pharmaceutical Services Division.Limitations Further Investigations
35
Standardisation of Short research
categorising patients duration
at registration counter 2 months average
Different registration insufficient to conclude
clinics categorise for a year
patients differently To extend for 6 monthsAnalysis of current data collection form
Identifying its limitations
METHODOLOGY
Comparison with other hospital/PKD practice
Drafting of new data collection and summary form
Approval from pharmacists-in-charge of each clinic
Implementation for month of June and July
Analysis and evaluation of results
Discussion
36
ConclusionConclusions
37
The current workforce at
PKDHL Pharmacies is
insufficient to
accommodate the daily
dispensing of medications
More pharmacists should
be employed to pave way
for new implementations of
healthcare support such as
Medication Therapy
Adherence Clinic (MTAC),
DPIS, HMR, etc.Thank You
Acknowledgements:
Pharmacy staff of
Hulu Langat Health District Office
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