The Pharmacy

On Tuesday morning I spent a couple of hours in the military hospital’s pharmacy, watching the pharmacists dispense patient’s ARVs. Now, I realize that this does not sound like an interesting way to spend one’s morning....but it actually was. Being behind the scenes in what is essentially a paper-based hospital (there are two computers with data entry people, but pretty much everything is still done on paper) is fascinating. This is how the system worked for patients who were coming to pick up their medication.....

When patients arrive at the Day Hospital the first stop is the receptionist’s desk, where they get their ARV tracking sheet, called a FRIDA, from the receptionist (who gets it out of their “processo” – a big white envelope that has their name written on it in marker and contains all of their medical paperwork. They go to the pharmacy window and hand the pharmacist their FRIDA, which shows the names of the medications they are taking, the dates of all of their medication pick-ups, how many pills were dispensed each time, and what day they were supposed to return for their next batch. This essentially serves as a way to track patient’s adherence – because the pharmacists give patients exactly one month’s worth of pills at a time, they know that if a patient does not come for their refill after a month’s time, they have missed doses somewhere along the way.

So the pharmacist gives the patient their medication, often in a small ziploc bag with the name of the medicine written on the front, and schedules their next pick-up, marking it on the patient’s health card (which they keep with them). The FRIDA stays with the pharmacist, who registers the visit in the daily log book. Then the pharmacist records the name of the patient in a big agenda on the date of their next pick-up (so that if they don’t show up on that date they know they missed their appointment). Then the FRIDA gets handed off to the data people, who input any important data into the computer, and then return it to the receptionists who put it back in the patient’s file.

Now that I’m typing this out, it doesn’t actually seem like that much work...but the Day Hospital has approximately 100 patients turn up every day to collect medication. And when you think about the fact that every patient’s name and ID number have to be written in both the daily log book and the agenda.....that’s a lot of writing. I sat in the pharmacy for about 3 hours and one of the two pharmacists spent every minute of those three hours recording the stack of FRIDAs from the day before. Imagine....a whole morning of work devoted to writing people’s names down.