E-drug: Recipe per patient (cont)
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Hi all
Despite the explanations provided of why a "recipe per drug"
system might ever be promoted, I find it difficult to see any overall
benefits to such a system. Perhaps the most difficult though is to
answer this question in general terms, as so much depends on the
specific logistic and financial characteristics of the healthcare
delivery system.
Accepting that a "recipe per drug" system will allow for easy paper-
based stock management, here are some reasons for favouring the
more conventional "recipe per patient":
1. The prescription as a whole represents the intentions of the
prescriber in so far as the drug-related needs of the patient are
concerned. If that prescription is to be "dispensed" in the true
meaning of the word, then the overall rationality of the intended
drug therapy needs to be assessed by the pharmacist (e.g. using
the 8 actual or potential "drug-related problems" as a checklist
against which the prescription is judged, combined where
necessary with information gleaned from the patient; see Strand L
et al Ann Pharmacother 1990; 24: 1093-7). If only parts of the
puzzle are presented, then this step is not possible. The challenge
in fact is to increase the information at the disposal of whoever
dispenses the prescription, not to limit it even further. For example,
South African pharmacists are trying to ensure that the ages of
paediatric patients are shown on the prescription, and where
possible, the diagnosis made by the prescriber.
2. The copy of the dispensed prescription retained or recorded in
the pharmacy represents a powerful source of information. In a
medico-legal sense it might record which brand of the product has
been dispensed (where generically prescribed or where substitution
is allowed), by whom, and when and also which drugs, if any, were
not dispensed/purchased - a paper trail for future reference. If
captured in a patient profile system, it adds to the knowledge of
that patient's drug history. This might also be attained by the use
(as in many public sector, less computerised settings in this
country) of facility-retained patient records that combine the
clinician's notes and the prescription. Even where patient-retained
records are used, having the "whole" prescription tied to the
patient's identity and the date of consultation is invaluable. Beyond
the medico-legal use of the records, they are also useful for drug
utilisation review. As far as I can see, a "recipe per drug" system
would make retrospective review impossible (e.g. trying to retrieve
data on many of the classic INRUD indicators, such as number of
items per Rx).
As I noted above, the one obvious advantage of the "recipe per
drug" is in allowing for simple, paper-based stock management in
the dispensary. This system appears to be an attempt therefore to
overcome the resource needs of a non-computerised system that
is trying to account for real-time stock balances in the dispensing
area. In other words, if at any stage the stock on hand of an item is
to be checked, this figure can be obtained by substracting the total
issues (on each individual "prescription") from the last recorded
value. At set intervals, issues can be collated and reflected on
stock records. An alternative system that takes account of such
resource deficits is in operation in the State pharmacy sector in
South Africa. It is not without problems, but can provide some
measure of stock control while retaining the integrity of the
"prescription". In military parlance it refers to A-class (accountable)
and E-class (expendable) stocks. A-class stock is the bulk stock
kept under strict lock and key, and accounted for on a stock card
system (which may be computerised is necessary). Since fewer
issues are made from that stock to patient care areas (either a
dispensary or directly to nurses stations in primary care clinics), a
paper-based system is feasible. This provides the necessary data
for stock management (such as historical demand data), as well as
data on supplier performance (lead times etc). Issues from the
dispensary (E-class) are not directly recorded, but copies of the
prescriptions issued are kept, allowing for retrospective review. The
major disadvantage is the risk of stock diversion, but we are
looking at ways of integrating data from various available sources to
identify facilities where stock movement is excessive (similar to
methods that track the ratio of contraceptive stock issues to
patient numbers).
regards
Andy
Andy Gray
Division Chair: Pharmacy Practice
School of Pharmacy and Pharmacology
University of Durban-Westville
PBag X54001 Durban 4000
South Africa
Tel: +27-31-2044358
Fax: +27-31-2044792
email: agray@pixie.udw.ac.za
or: andy@healthlink.org.za
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