Their names sound vaguely similar. Their packaging and colours are similar too. But they might not be, so how can one tell the difference?

That is the problem that many patients face when asked by their dermatologists about the topical medications they are using. But since last year, patients who are seen at Singapore General Hospital’s (SGH) Clinic J for skin problems have been able to communicate more effectively with their doctors to get the right medication, thanks to an initiative by a team led by Senior Staff Nurse Wong Wanjun.

Ms Wong, 30, and her team devised a pictorial catalogue of topical medications to enable patients to quickly and accurately identify the medicine that they have been taking. This helps them to avoid being prescribed medicines that have not worked for them in the past, and get those that are effective.

Patients with common chronic skin conditions such as eczema and psoriasis may be prescribed topical medications that come in gel, cream or lotion form. For severe cases, steroid-based topical medications of different strengths might also be given. During consultations, the dermatologists might ask their patients what had worked well for them before and what did not.

“Patients with a long history of skin conditions might have tried a number of therapies, so their doctors will ask them what they have used and what was good for them to avoid prescribing something which might not be so effective,” said Ms Wong.

When the patient isn’t able to give a definitive answer, the doctor will have to trawl through his medical notes, a time-consuming task.

Pointing it out

“Some patients ‘doctor-hop’, so their records won’t be with us,” said Ms Wong. In such cases, the doctor might give the patient something without an active pharmaceutical ingredient, such as a moisturiser, to avoid prescribing something that might be ineffective or have an adverse effect on the patient. The patient is then asked to bring the medication he has been using to his next appointment, or to return another day. Many steroid medications, said Ms Wong, are available in different strengths and different forms. Their names might also be similar.

The fact that many patients with such conditions are elderly doesn’t help. “We thought of something more pictorial which the patient can just point to,” she said, recalling that the project was sparked off by a casual chat she had with Dr Koh Hong Yi, Associate Consultant, Department of Dermatology, SGH, a member of the SingHealth group, over lunch. They noted how younger and more tech-savvy patients often took photos of their medications with their smartphone cameras to show their doctors.

The team, which includes Clinic J’s manager, Nurse Clinician Lisa Chew Li Yong, and Ms Yeo Shuan Khiag, Assistant Manager, Specialist Outpatient Clinics – Operations, SGH, took about a month in late 2013 to come up with the concept and produce the charts. The final product is an A4-size catalogue of the 120 to 150 topical medications most commonly prescribed by the clinic’s dermatologists, and has been in use since early 2014.

The team’s efforts to improve patient safety clinched them a Singapore Health Age-Friendly Award last year. The project had earlier won second prize in the Singapore Healthcare Management 2014 Congress Poster Competition, in the Risk Management category.

Benefits for both patients and staff

The catalogue, said Ms Wong, has saved time for both patients and hospital staff. Having a patient flip through the catalogue and point to a picture of the topical medication that he is using takes five to 10 minutes, compared to the 15 to 20 minutes that it takes for a doctor or nurse to probe him.

As a result, the clinic’s dermatologists are able to use their time more productively now. Patients also benefit from shorter waiting times to see their doctors, and may also require fewer consults.

There is also less confusion. “Sometimes, it is only when patients go to the pharmacy to fill their prescriptions that they realise that the carton that is physically in front of them is the wrong medicine, one that hadn’t worked before, or is not the one that they prefer to use. These patients then have to go back and consult the doctor again,” said Ms Wong.

Nurses used to get five to 10 calls a month regarding wrong prescriptions, which require them to spend time retrieving the patients’ case sheets, but the number has dropped by half since the catalogue was introduced, said Ms Wong.

Describing the Singapore Health Age-Friendly Initiative Merit award as a pleasant surprise, she said: “We didn’t expect it as our project was a very simple initiative. More importantly, we feel that this chart can help our patients and doctors,” she said.

Ref. Q15