To Improve Workflow Efficiency with Triage

Competency for Outpatient Pharmacy

Janice C.H. LIM, KK Women’s and Children’s Hospital
Alan N.H. CHUI, KK Women’s and Children’s Hospital
Evelyn MACARAIG, KK Women’s and Children’s Hospital
XU Rujia, KK Women’s and Children’s Hospital
CHIN Chee Kwong, KK Women’s and Children’s Hospital
Jasper W.K.TONG, KK Women’s and Children’s Hospital

A survey of 260 prescriptions requiring interventions & rework To expand the role of triage staff so that downstream interventions
at the Outpatient Pharmacy over 5 days in Jan 2012 showed & rework can be prevented
47 (18%) can be prevented if required information(s) or
intervention(s) were done by triage (prescription drop off
counter) staff before prescriptions were processed
Breakdown of ‘Others’
Triage Related Interventions
2, 7% Benefit Card
1, 4%
Triage Partial 2, 7% Rx Validity
Supply
28, 27% 8, 30% First Timer
Typing of labels
Others
6, 22%
76, 73% MSW
Packing & labelling *19 cases of 8, 30%
of medications partial supply Paeds Weight
were
Checking & Patient preventable Other
counselling

Triage Competency was devised by a team from Preventable Interventions

Outpatient Pharmacy (OP) comprising :-
1. Customer Service
2. Knowledge of different prescriptions Trained Triage
3. Validity of prescriptions 6, 21%
4. Screening of prescribed medications Untrained
5. Handling of benefit cards and billing documents 22, 79% Triage
6. Issue queue number to different categories of
patients Trained vs Untrained Triage Staff
7. Directing patient to wait area 250
80 67 199
8. Handling enquiries 54 200
60 135
150
 Training conducted for 4 identified staff 40 100
Trained Trained
 Observation & survey carried out post training 20 Triage 50 Triage
over 5 days in Feb 2012 on the 4 trained triage 0 Untrained 0 Untrained
staff No of Triage Time Spent Triage
 Results were compared with untrained staff Interventions (min)
 Total no of interventions collected = 181
 Staff satisfaction survey was done on  A reduction of 19% in intervention numbers & 32% time
Pharmacists & Pharmacy technicians at OP savings.
 Further review of the training materials &  Staff felt more confident & competent in handling triage
identification of the core competency elements duty after training

TRIAGE COMPETENCY

No Title Page No No Title Page No Greetings 1. Smile upon eye contact ? Portray good gesture to welcome ? Foot Prints from entrance to
2. Use a Simple greeting by patient “Registration Counter”
1 Greetings 7 Handling of missed “Q” acknowledging patient
2A Screening for correct patient 8A Handling of benefit cards 1
3. Receive Prescription from
2B Screening of all prescription for legal validity 8B Handling of MSW memorandums Patient
2C Screening of paediatric prescriptions for all oral 9A Handling of partial supply
medications Screening for correct 1. Screen for correct patient ? A screen process to determine
2D Handling of wrong patient’s name on prescription 9B Handling of prescriptions containing only OTC products patient presenting with correct the needs of individual Patient as
2E Handling of unsigned prescriptions 9C Handling of prescription containing extemporaneous prescription by verifying name the Triage is the first line of
preparations and residential address of screening for wrong prescriptions
2A patient.
2F Handling of expired prescriptions 9D Handling of prescriptions containing sample items ? Prescription or photocopy will be
3A Issuing of “Q” number for single prescription 9E Handling of prescriptions containing medications for 2. Other identifiers: Patient’s NRIC retained for documentation
purpose.
husbands
3B Issuing of “Q” number for family with multiple 9F Handling of prescriptions containing controlled drugs
prescriptions Screening of all 1. Check for the presence of the ? Legal Requirement for the supply ? Other referencing: Outpatient
4A Operation of Qmatic system and Qmatic pad 10A Handling of requests for non-drug products i.e. retail, prescription for legal following on the prescription with of drugs as stated in Poisons Act Counselling and Dispensing
homecare, pessary ring, glucometer rental validity the Patient or Caregiver (Chapter 234, Rule 15, Section (P&P 63750-0104)
a. Patient’s Name 3)
4B Changing of Qmatic paper roll 10B Handling of requests for purchase of pharmacy only
medication (P-medication) b. Patient’s address ? Original, valid prescription needs
to be kept by Pharmacy for 2
5 Handling of patient waiting time 11A Checking for availability of item c. Date of prescription must be
years (3 years for controlled
6A Handling of staff E-Prescription (Not issued by Staff 11B Checking for price of item valid within 1 year of issue (1
drug) after dispensing as records
month for prescription
Clinic) of sale of drugs, subjected to
containing controlled drug)
6B Handling of External Prescription 11C Checking for legal category of drug (GSL/P/POM) 2B HSA audit.
d. Prescriber’s name and
6C Handling of Pet’s prescription ? NRIC no is not a requirement for
signature
validity but for facilitation of
Abbreviation e. Address of prescriber typing
f. Drug name, dose and
- DM – Duty Manager - P-medication form - Patient information for purchase of Pharmacy only Quantity/duration-simple and
- E-prescription – Electronic Staff Prescription form medication (For P-medication) common dose and frequency
- GSL - General Sales List - POM - Prescription Only Medication g. All text on prescription must
- KKH – KK Women's and Children's Hospital - Prescription form (For POM) be clear and legible
- QM – Queue Manager - QM - Queue Manager
- P-medication - Pharmacy Only Medication - Missed Q - Queue being missed Issuing of “Q” 1. Issue queue number ? Enable Statistical collection of ? Pharmacy Prescription form
- TGAM – Assigned Morning Duty Triage number for single patient count based on O&G and (Phar-0033 R1)
3A a. 3000 series – O&G
prescription Paediatrics patients ? P medication: Patient
b. 5000 series – Paediatric
? Allow tracing of patient information for purchase of

A standardised triage competency training is important, beneficial & improves operational efficiency, staff knowledge, overall staff &
patient satisfaction.