Decongestion of RK Khan pharmacy : A Unique Initiative!

The Pharmacy Department at R. K Khan Hospital has successfully embarked on an innovative decongestion project whereby Community Centers in Chatsworth, temples, churches, halls and private pharmacies; plus facilities within the hospital are being utilized for the dispensing of chronic medicines. This project, a “first of its kind” is unique to RK Khan and as far as we know, has not been tried anywhere else in the world!

12 facilities are being utilized outside the hospital including the hospital Gateway Clinic, Express Clinic and the General Pharmacy.

Elimination of queues and congestion
Instead of queuing at the hospital for hours and congesting the waiting area, patients visit these community centers close to their homes to collect their monthly medicines. Patients only return to hospital on their review dates. These facilities offer a far more relaxed atmosphere. At some centers, refreshments are provided and patients have the added benefit of having their blood pressure and blood sugar checked by health professionals from the community.

Mr Dan Maistry, Control Pharmacy Assistant and Mr Brian Pillay, Pharmacy Manager - initiators of this initiative

Stable patients on chronic medicines (pink cards) have their medicines dispensed at the hospital pharmacy on their initial visit (review day). Thereafter they are screened and referred to the most convenient centre to collect their repeat scripts. All that is required of them is to report to the facility on the scheduled dates, produce their hospital carrier cards & ID and collect their medicines.

The chronic medicines are pre-dispensed by pharmacists and issued at these facilities by post basic pharmacy assistants. Patients are counseled appropriately on the use of their medicines. The outreach programme which commenced in August 2007 has progressed steadily and now utilizes 14 different outlets.

Prior to the commencement of the project, 1800 - 2000 patients were visiting the hospital daily. The waiting area was very congested with long patient delays and it was not uncommon to have in excess of 450 patients waiting at any one time. Staff had to work extended hours to cope with the load and this resulted in patients and staff becoming frustrated. The perpetual shortage of pharmacists compounded the problem and made conditions at the hospital very chaotic.
With the introduction of the outreach facilities, congestion at the hospital has decreased significantly. At present, more than 15000 patients per month have been down referred to these centers, which operate either daily or weekly from 07h30 to 10h00.

Patients have welcomed the change and have benefited from the project in the following ways:

Most of them walk to these facilities and thus save on transport costs.
The delay at most facilities is minimal
Refreshments are provided at some facilities by the community organizations concerned
Blood pressure and blood sugar monitoring is done at some facilities
Patients are more relaxed at these centers and can be counseled appropriately.

Patients who do not collect their medicines on their scheduled dates are listed as defaulters. Their pink cards are returned to the Card Office for filing and they have to report to hospital to collect their medicines. No medicines are stored at the facilities. At present, the default rate ranges from 1% to 7 %.

The support and assistance of the following personnel is greatly appreciated:

RK Khan Pharmacy staff who work tirelessly to meet the daily challenges and to ensure the continued success of the project;
the leaders of the religious and other community organizations who graciously offered their premises at no charge
volunteers at these facilities who offer invaluable assistance regularly
Esplamed Pharmacy, a chronic dispensing facility, who assist with pre-dispensing for 6 of the facilities
The Transport Section at RK Khan for transporting medicines and staff daily
Hospital CEO, Dr. Subban and Ethekwini District Pharmacy Manager Ms Bongi Mkhize

Public Private Partnership

Part of this project also involved a public private partnership with 3 retail pharmacies in the area. This project, which commenced in January 2008 was co-coordinated by a task team comprising pharmacist representatives from Head Office, District Office, regional hospitals, the Municipality, Esplamed and MSH, a private company. The task team, under the leadership of Mr. Peter Avery, was formed to look at setting up a Central Chronic Medicine Dispensing Unit for the province. At these meetings, it was decided that retail pharmacies could also be considered as alternative areas where hospital patients could collect their chronic medicines. After meeting with pharmacists from the Durban South Guild, a pilot project involving RK Khan Pharmacy and 3 private pharmacies (Chatsworth Pharmacy in Arena Park, Medina Pharmacy in Westcliff and Montford Pharmacy in Montford) was started.

The pilot project was scheduled to run for 6 months at no cost to the state. It was to involve a maximum of 50 stable chronic patients being screened and referred from RKK Pharmacy to each private pharmacy. The retail pharmacist was to perform blood pressure and blood sugar checks where necessary before issuing the pre-dispensed medicines with counseling. Esplamed Pharmacy was tasked to dispense the medicines for these patients.
The pilot, which was very successful, was extended to almost 2 years with the number of patients per site increasing steadily. At the end of the pilot, a report on the processes involved as well as the potential benefits and costs in formalizing and expanding the project was compiled by the task team and presented to provincial authorities. The decision on whether funding is available to support the project is awaited.
The effort by Mr. Peter Avery and members of the task team as well as the 3 retail pharmacists in making the project a success is greatly appreciated. Even though the project ended, Chatsworth Pharmacy continues to assist RKK with issuing medicines for down referred patients.

Thanks and appreciation to the following organizations and volunteers

Sathya Sai Sudhar, Clinic Moorton
Chatsworth Pharmacy, Arena Park
Medina Pharmacy, Westcliff
Montford Pharmacy, Montford
Aryan Benevolent Home, Arena Park
Havenside Community Hall, Havenside
Montford Community Hall, Montford
Peoples Church of God, Chatsworth Main
Sarva Dharma Ashram, Welbedacht
Gospel Outreach Assembly, Moorton
Bayview Christian Fellowship, Umhlatuzana Township
Church of the Epiphany, Westcliff

Checking of blood pressure and blood sugar

Preparation of medication for collection

Dispensing to a patient

Mr Brian Pillay and his team

The Team Work of all pharmacy staff has made this project a success!

Article by Mr Brian Pillay, Pharmacy Manager RK Khan hospital

RK Khan hospital

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