“We are surprisingly busier than ever, even though our Specialist Outpatient Clinics have postponed non-urgent appointments, and there are notably fewer patients at our outpatient pharmacy,” said Senior Principal Clinical Pharmacist Kong Ming Chai. This is because more of his regular patients are switching to tele-consultation.
Ming Chai and his team run the Anticoagulation clinic (ACC) where they monitor and review patients’ medical condition and use of medication such as warfarin. They are granted clinical privileges to change warfarin dosage if needed, prescribe warfarin and order the International Normalized Ratio (INR) blood test.
Previously, 5 to 10 patients will use ACC’s virtual clinics per week. Since COVID-19, the number of patients opting for telephone consultation has gone up to 50 per week, constituting about 50% of patients. On some days, it may even reach 90%.
“The virtual clinic is popular with younger patients as it saves them time. However, some older patients still prefer to come in person for face-to-face consultation and then collect their medication over the counter,” said Ming Chai.
At ACC, patients need to do regular INR blood test for their warfarin dose to be managed and titrated. When they opt for virtual clinic, they can leave once their blood test is done and wait for the pharmacists to call them when their INR results are ready.
After clinically reviewing the results and providing consultation over the phone, the pharmacist will generate the prescription and the new INR blood test form for the patient. These are then passed to the Medication Delivery Service (MDS) team to arrange for home delivery.
A usual 10-minute face-to-face consultation may now take up to 45 minutes at the virtual clinic, because the pharmacist also has to manage additional subsequent services like billing, scheduling of next appointment, confirming delivery details and mode of payment. On top of that, some patients are simply not contactable, or reply to calls only after a few hours. “And if they have not done any INR test, we have to remind them to come back for it or even schedule another appointment for further follow-up,” said Ming Chai.
“Whether over the phone or at the counter, we will take time and effort to check individual records carefully to make sure all patients are safe and have accurate and timely medications.
The Medication Delivery Service team: We make sure our patients have the correct medication delivered on time! [Photo taken before safe distancing measures]
At ACC, we make sure all our patients have sufficient stock of warfarin, even if they do not turn up for their appointments. This is to ensure our patient care continues, even during a disease outbreak! This is a standard we have upheld since 2017 at outpatient pharmacy - we have achieved close to 100% medication reconciliation and clinical review for all patients, to ensure safe and accurate medication supply,” emphasized Ming Chai.
With Covid-19, our pharmacy also sees a surge in requests for Medication Delivery Service. As our SOC postpones non-urgent appointments, the clinic assistants and nurses call regular patients to explain and arrange for medication refills. Many of these patients opt for MDS. From the norm of about 2,500 MDS requests per month, the number has almost doubled, said Nah Szu Chin, Principal Pharmacist in-charge of the service.
Compared to over-the-counter self-collection, MDS involves the additional tasks of calling for information verification, time and address of delivery, as well as payment mode; followed by packing and parceling. It is more time consuming, and Pharmacy has deployed more staff to MDS, especially on Sundays to prepare for the next day’s deliveries. On weekdays, pharmacy staff work overtime to make sure all parcels scheduled for the next day go out punctually.
Picking and packing medicine for delivery to patients
Despite the extra work and longer hours, our pharmacy staff value these services. “It is our responsibility to ensure our patients have the correct medications delivered on time. With this outbreak, especially, the virtual clinics and MDS help to minimise our patients’ exposure and save their time. We are glad to have these services in place,” said Szu Chin.
With 20 years of experience in SGH, Ming Chai has seen the whole team growing to almost triple in size. With the higher staff strength, the department is in a better position to put in place business continuity plans to ensure care is not disrupted even under trying circumstances. “Personally, I feel grateful and confident as we are more prepared this time, compared to SARS,” he said.
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