Series of theme Facing Death – Part 3: FV Hospital: Medical ethics is to “Pry” what patients do not see

“There is no fake medication at this hospital.” – Who dares to commit that? The General Director of FV Hospital, Dr. Jean-Marcel Guillon, firmly asserted above statement. His determined eyes inspired me to visit FV Pharmacy Department.

According to Dr. Guillon, the situation of counterfeit drugs appearing at a hospital is due to lack of good medication management procedures. What’s the “good process” that  convinces Dr. Guillon, who is well-known for his carefulness? That is JCI – the golden seal that all world-class hospitals want to achieve.

There are many standards in the world for evaluating hospitals according to different criteria and priorities. With JCI, the top priority is the patient’s safety – a criterion that entails a series of extremely strict requirements, including medication management. That is why FV leaders insist that no fake drugs present at FV hospital. As a talented manager and custodial physician, Dr. Guillon has redeemed his peace of mind by standardizing all the procedures and activities in the hospital with the guideline that he has always follows: patient safety.

Dozens of eyes to follow each pill

FV Hospital is very beautiful! FV Hospital is very clean! FV Hospital has a very friendly staff team! And over time, the patient recognizes that this is a very good team of doctors! But how can patients feel assured that each pill they received from FV is a real drug? Perhaps no one can thoroughly understand this, they only place their trust in what they see and believe in those coming from tangible values.

I was determined to find out this special procedure, then was so surprised about a huge process but include particular minutiae, and involve carefully examining the path of each pill before   reach to the patient. The process is not just to make sure every pill is authentic one, but more importantly, to ensure that it is the most accurate medication the patient needs to take, a medication that is “money’s worth with it” for each person.

Head of FV Hospital Pharmacy department, Mr. Mohd Fazli Shuib, showed me a copy of the doctor’s proposal sending to the pharmacy whenever there an offer to add new medication to the list. It includes many parts to fill in, such as reasons for the offer, advantages and disadvantages evaluation, safety level, etc. At pharmacy department, pharmacists evaluate drugs based on a standards of 10 to 15 criteria depending on each type, including the registration of drugs (in which country registered), safety records (any reports on side effects, toxicity, eviction, etc.), cost-effectiveness comparison with other drugs in the same class to define the most affordable one for the patient. The pharmacist works diligently on clinical studies, independent third-party sources such as the World Health Organization (WHO).

“Go through” all the above procedures, the capacity of the medication supplier will be evaluated by FV hospital board. Part of the process is to go to the provider’s factory to check the operating system, storing information and medication. With the drugs requiring special storage conditions such as vaccines, FV Hospital will also check the storage during transportation in details.

Every two months, once all of the above information has been confirmed, the FV Board of Medicines and Medical Supplies, including the chief medical officer, the head of pharmacy department, the physician and nurse’s representative, JCI Quality Assurance Division… review each medication to determine if it could qualify to add in the list.

Cross check to gain belief

Check to believe is the culture of FV Hospital: each individual must work with the highest level of responsibility to be trusted. Their decisions are supported, cross-checked at the same time by co-workers, direct managers and hospital directors – through an unhidden standardized process.

There is still present another eye: JCI. This outstanding certification is only valid for 3 years. After that time, JCI will return to re-evaluate and could extend 3 more years only in the case that the hospital maintains the standards achieved. Every three years is the time when JCI imposed new standards, increasingly more strict to the hospital. JCI may visit the hospital at any time by random, without forewarning. They will remove JCI accreditation immediately if the hospital violates even one standard. In addition, when any serious incident occurs, the hospital is obliged to report to JCI and state the solution. If the hospital does not report and was found out by JCI, the JCI certification is also stripped immediately. If the problem is related to the medication, the smallest step in the path of any pill will be traced back. That means JCI accreditation can be withdrawn out of FV Hospital just because of one unsafe tablet! Each doctor, nurse, laborer… of FV Hospital understands this matter. It might be for this reason that Mr. Fazli remembers CEO Guillon’s words to staffs: “I’m sure you do not want to be the person responsible for failing the JCI or failing in ensuring the safety of patients.” That is FV Hospital: JCI or any other criteria are all for the ultimate goal as a longstanding culture ingrained in the flesh and blood of every employee: patient safety comes first!

 “FV Hospital is never satisfied”

The path of each drug from FV Pharmacy to the patient is also carefully examined through a cross-check process, from the time the doctor finished the prescription on the computer. Before being printed out, it’s checked about the dosage, indications, ingredient, side-effects by many eyes in the pharmacy procedure and by medication management software. Any mistake, or sometimes just a lack of completion in the prescription, many people will share the same responsibility. The risk of mistake then is reduced to the minimum.

For more perfection, Mr. Fazli’s also testing the software that alerts drug interactions in the system while the doctor is in the process of prescribing. There is also a scanner for in-patient bar code with medication bar code – an additional check-up tool to ensure that nurses receive the correct medication prescribed by the doctor.

“At FV Hospital, we are never satisfied with ourselves” Dr. Guillon once said so in an interview.

Patients do not see all of these extremely strict procedures, but Mr. Fazli and 40 members in the pharmacy department know that medication safety is safety for patients. They also understand that drug errors could exchange for a life and health of patient. Their medical ethic is to follow the smallest process, whether it’s seen by any patients or not.