Reshaping Smart Pharmacy in TCM Hospitals via High-Reliability Organization Theory

The advent of digital intelligence technologies has offered innovative solutions for drug data mining and efficacy prediction, facilitated the development of clinical pharmacy information systems, and enabled intelligent decision support for rational medication use. Nevertheless, current technological innovations and application studies have yet to establish a systematic framework for the comprehensive management and application of pharmaceutical services. In particular, pharmacy services in traditional Chinese medicine (TCM) hospitals remain relatively underdeveloped due to the distinctive characteristics of TCM.

Based on high-reliability organization theory, we construct an intelligent pharmaceutical service system with TCM characteristics to guarantee operational safety and reliability, and implement digital and intelligent management for pharmaceutical services.

The present study constructs a smart pharmaceutical service system with distinct TCM characteristics, grounded in HRO theory. Targeting the operational characteristics and service demands of clinical pharmacy in public hospitals, we established a digital intelligent pharmaceutical system with a "one center, two supports, six platforms" architecture under the guidance of high-reliability organization theory. Relevant evaluation indicators were compared pre- and post-implementation of the system, covering drug return rate, average approval turnaround time, clinician satisfaction, medical record compliance rate, PPI rational use rate, appeal review success rate of clinicians, proportion of ADR reports with proactive warnings, and monthly ADR reporting volume.

Grounded in High Reliability Organization Theory, the smart pharmacy system integrates the functional modules of six major platforms and the unique strengths of traditional Chinese medicine. This system encompasses the entire spectrum of pharmaceutical service processes, including pre-event prevention, in-event intervention, and post-event evaluation, thereby forming a complete closed-loop quality management system. The Internet-based Hospital Quality Control Platform reduced the annual rates of refunds and drug returns. The Multidimensional Tiered Drug Scientific Management Platform shortened the average approval processing time and improved clinical physicians' satisfaction. The Personalized Pharmacy Clinic Workstation enhanced the compliance rate of medical record quality control. The Homogenized Evaluation System increased the rational usage rate of proton pump inhibitors (PPIs) while reducing the success rate of clinical physicians' appeals against evaluation results. The Adverse Drug Reaction (ADR) System raised the proportion of proactive monthly ADR reports as well as the total volume of ADR reporting.

By coordinating six major platforms, the smart-intelligent system achieves full-process and standardized management of pharmaceutical services. This framework not only enhances the quality and efficiency of pharmaceutical services in TCM (integrated) hospitals but also provides both theoretical underpinnings and practical pathways for the transformation of pharmaceutical service models.