Today I visited the practice site that I hope to be working in. The head of the pharmacy dept Prof Chan, Joyce, and I visited Tan Tock Seng Hospital. We met with two other pharmacists, Annie and Yee-May to talk about the opportunities in their hospital.
It sounds like I’ll likely be doing inpatient and/or outpatient anticoagulation. In the inpatient setting, patients who have previously been on warfarin therapy, new starts, and some heparin patients are monitored. The service seems very similar to UCSF in that a patient roster is generated each morning who were ordered warfarin the night before and each patient’s chart is reviewed for notes, medication orders, and resulting AM lab values. Recommendations are made only when necessary and notes are written in the chart. If no recommendations or notations needed then no note is left. The pharmacist is in charge of providing warfarin counseling and setting up outpatient follow-up. The only major difference is that pharmacist can order lab draws for the patient, the PT/INR. Pharmacists cannot write medication orders, they do not have prescribing rights in Singapore.
The outpatient setting is different than UCSF in that they do not use point of care tests, all patients require a lab draw. Also, prescriptions must always be co-signed by a physician. Things like verbal orders do not exist here in Singapore and there is a national clinical pharmacy anticoagulation protocol which is located here if you are interested. Also, patients are not followed for their lifetime even if they require lifelong anticoagulation, these patients can “graduate” from clinic and be seen by their primary doctor less frequently if they become stable on their warfarin dose.
Oh, and there are only 3 strengths of warfarin here: 1mg (brown), 3mg (blue), and 5mg (pink)! So any pharmacists out there reading this blog, keep a watch out for patients from Singapore and them saying the take a brown warfarin tablet, there is a potential for medication error!!
It’s all very different but very interesting, I don’t think I’ll ever get bored.
Now I just have to work on getting my application into the Singapore Board of Pharmacy which I hope to complete soon so I can start my “pre-registration” training, sounds like I’m going to be an “intern” for at least 3 months.
After our visit, Prof Chan treated me and Joyce to coffee and snacks at Starbucks. TTSH is a very different hospital, it houses approx 1200 patients but it’s building is so large that is also houses a large outpatient pharmacy, outpatient clinics, a huge food court, shops (like Starbucks, McDonalds, 7-eleven), and probably lots of offices. It’s also across the street from a mall and right across the street from the Novena MRT station. It’s almost hard to tell that it’s a hospital.
I’m sure I’ll have plenty more to share once I start working, I can’t wait!