Mark Stuart, Dezhi Wang, Rong Han, Dora Chan

Published in the Pharmaceutical Journal UK, 2008

The Polyclinic in the Beijing Olympic Village was the impressive focal point of the Olympic medical services. Along with a fully stocked pharmacy, there was a comprehensive collection of specialist departments including: radiology with 2 MRI machines, X-ray, emergency medicine, surgery and internal medicine, sports medicine and ENT. In addition, there was a physiotherapy department with over 100 treatment beds and an optometry department, which dispensed hundreds of pairs of glasses during the Games. For the first time in an Olympic polyclinic, a Chinese acupuncture clinic was available to the athletes.

The Olympic pharmacy had a prominent position near the entrance of this impressive state-of -the-art medical complex, with a design that facilitated an efficient patient journey. A team of nurses in the reception area coordinated the patient registration, notification of test results, and the generation of the prescriptions for the pharmacy.

The Olympic pharmacy

The athlete would be greeted by a pharmacist in the reception area, who would transpose the details from a handwritten prescription of a team doctor into the Polyclinic medical system. This would then generate a prescription containing a barcode. If the prescription came from a doctor within the Polyclinic, the prescription would be electronically generated.

In the dispensary, the pharmacist would scan the barcode and a dispensing label would be generated, which contained the status of the medicine according to the World Anti-Doping Agency (WADA) 2008 Prohibited List. 112 prescriptions were dispensed on the Opening Ceremony day, but this number increased considerably as the Games went on.

The Beijing Olympic pharmacy was open from 8 am to 11pm. Over the Olympic period, a total of 9 pharmacists from 6 public hospitals around Beijing volunteered their services. In any one day, 5 pharmacists would cover two shifts. In addition to this team, there were 10 pharmacy students from Beijing Capital Medical University who volunteered their assistance. For the Paralympic Games, 9 pharmacists and 5 pharmacy students staffed the pharmacy.

For the equestrian events in Hong Kong, three fully-stocked pharmacies were needed and were run by 41 pharmacists. These were in the Olympic Equestrian Village, Media Village and Olympic Family Village. The Hong Kong pharmacists were all recruited from local public hospitals.

Olympic formulary

At every Olympic Games, a specific drug formulary is compiled. This covers the full spectrum of medicines needed to cover most medical scenarios. In Beijing and Hong Kong, the formulary contained 150 drugs, which could be prescribed by the doctors of the Beijing Organizing Committee (BOCOG) and the team doctors from each of the 204 countries. If team doctors required any drug that was not contained on the formulary, the pharmacy team would help to locate the drug from one of the official designated Olympic hospitals, and assist the team doctor to obtain it at their own expense.

For the first time at any Olympic Games, a supplementary set of an additional 96 medicines were available. This list was developed by the local doctors in order to offer more comprehensive treatment options if required. These non-formulary medicines were only available to visiting team doctors if there was an important clinical need.

Chinese medicines

This is the first Olympic Games where traditional medicines have been available. The Beijing and Hong Kong pharmacies stocked 4 traditional Chinese medicines: ‘Ren Dan’ and ‘Huoxiang Zhengqi’ for heatstroke, ‘Tiger Balm’ ointment for relief from insect bites, and ‘Golden Throat Lozenges’, a popular Chinese remedy for sore throats.

Although these traditional medicines were available from the Olympic Pharmacy, they were not dispensed routinely to athletes. This was primarily because they were not on the official Olympic formulary, and also because WADA recommends caution to athletes about the use of herbal preparations, whose composition cannot always be guaranteed.

Dispensing software

The pharmacists in Beijing worked with software developers to create a bespoke dispensing system for the Polyclinic. To do this, all medicines on the formulary were broken down into dose, formulation, route and quantity – this was then used to populate the database. This pharmacy software integrated with the official IOC medical record system, which is now supplied to all Olympic Games by the IOC and which contains links to the athlete accreditation database.

In Hong Kong, the existing hospital clinical management and dispensing system was adapted for use at the Equestrian Olympic Village. The clinical management system was linked up with each of the designated Olympic hospitals, which provided a one-stop platform for patient registration and laboratory and diagnostic ordering and reporting. Drugs on the Olympic formulary were flagged on the dispensing system with warnings reflecting the prohibitive drug status.

Medicines information

Martindale was used by the pharmacists in Beijing and Hong Kong as the primary reference source for global drug information. This was mainly used to access information on international drug names, and for information about foreign medicines that athletes presented with. Access to MedicinesComplete was donated by Pharmaceutical Press for use in Hong Kong. In addition, Micromedex China was used in Beijing to access patient leaflets.

Designated Olympic hospitals

There were 21 hospitals in Beijing and 2 hospitals in Hong Kong that were designated official Olympic hospitals. Each Olympic hospital appointed an Olympic affairs officer who coordinated the care of visiting patients.

If any athlete, official or Olympic Family member was admitted, their care was coordinated through a ‘green passage’ process, which meant a speedy and priority service was provided. The designated Olympic hospitals were also able to provide the Olympic pharmacies with any medicines not stocked in the Village.

Training for Olympic medical staff

The Beijing organisers provided an extensive medical education programme. This was provided not only to the medical professionals working in the Olympic Village, but also to every healthcare professional in the Beijing area. This was an impressive undertaking on a city-wide scale.

All doctors, pharmacists and nurses in each of the Beijing Olympic hospitals received specific training on the WADA list of prohibited drugs in sport, on the protocol of care for Olympic visitors, and training in English medical terminology. Some hospitals also created tools for staff to use, including lists of all prohibited drugs and the IOC notification requirements should they be prescribed to an athlete. Training leaflets were distributed to every doctor, nurse and pharmacist on prohibited drugs in sport.

The medical team also prepared cue cards to help staff communicate with non-Chinese or English speaking patients. These contained words for common medical conditions and medication counselling terminology translated into languages including Arabic, Russian, Japanese, Korean, Spanish and German.

In Hong Kong, all of the doctors, nurses, pharmacists and ambulance staff attended a number of training days in February, and were required to attend a series of operational briefings for each event. In addition, members of the UK Equestrian Association visited Hong Kong to help prepare the medical teams for the challenges of trauma management for spinal and head injuries, which are an ever-present risk at equestrian events.

This comprehensive preparation meant that all Olympic visitors to Beijing and Hong Kong received an exceptional standard of care, and athletes could be confident that the local doctors and pharmacists were well versed with the treatment of sports injuries and the restrictions of drugs in sport.

Quality testing of all drugs

The Chinese government went to admirable lengths to ensure the quality of medicines used for the Beijing Olympics. After the Organising Committee selected the wholesaler (Beijing Medicine Stock Company) by an open tender, the expected quantity of medicines to be used for the Olympic and Paralympic period was estimated. The wholesaler then sent three times this amount for quality control testing to ensure that the composition complied with strict pharmacopoeia standards. This testing was in addition to the standard Chinese quality assurance testing that the drugs had already passed.

The full quantity of medicines expected to be used was stored in a warehouse on the top floor of the Beijing Polyclinic, and the excess medicines that had passed the quality tests were stored outside the Village. During the Games, the consumption of some medicines exceeded the expected amount—this was able to be quickly replenished from the off-site stock. In Hong Kong, medicines for both the competition venues and the villages were supplied by the designated hospitals in close proximity.

This setup was quite different to the supply chain at the Sydney 2000 Olympics and the Manchester 2002 Commonwealth Games, where daily deliveries from pharmaceutical wholesalers posed logistical challenges because of the tight security, delivery and accreditation requirements to get goods inside the village.

Ancient Chinese traditions for Olympic prescribing

China has a long history of using carved stamps, or seals, as a form of a signature – traditionally known as a ‘chop’. The hundreds of visiting team doctors who were granted temporary prescribing rights by BOCOG for the duration of the Games were all issued with a personalised Chinese stamp. When writing a prescription, the pharmacy would require the doctor’s seal, as well as a written signature, to endorse the prescription. The pharmacy kept a record of each of the unique stamps issued to visiting doctors, which could be used as an added security measure to validate the prescription.

Only local BOCOG doctors had the authority to prescribe controlled drugs (only morphine and pethidine) in the Polyclinic. Specifically, only emergency doctors, sports medicine doctors, and internal medicine specialists could use them – the unique Chinese stamp ensured that the prescribing of these substances could be tracked securely.

A unique Olympic prescription form is always used at Olympic Games. These differ from regular prescriptions by the type of information that the IOC specifies must be recorded. Doctors must document the athlete’s accreditation number and country. If a restricted drug is prescribed, approval by the IOC must be obtained and shown to the pharmacy – the signatures from the athlete, doctor, and pharmacist are obtained before dispensing to indicate the informed consent of the athlete.

Satellite pharmacies at the Bird’s Nest Stadium

Each Olympic venue had a number of medical stations, including integrated facilities for the athletes and spectators inside each stadium, and medical stations outside the venues. Each public medical station contained a satellite pharmacy stocked with close to 100 drugs, mostly for emergency situations. These drugs were managed by the doctor on duty. Single doses were administered to spectators, who would be referred to a designated hospital if further treatment was required.

Emergency medicine for equestrian events

The equestrian events, particularly cross country, are undoubtedly the most dangerous of Olympic sports. In Hong Kong, 24 medical teams were positioned at any one time along the 5.7 km competition track to attend any medical emergencies during the event. Each medical team was equipped with a drug suitcase containing over 30 emergency drugs and a variety of medical equipment and consumables.

The pharmacy services of the 2008 Olympic Games were, undoubtedly, one of the best organised and executed services in Olympic history. The services have incorporated a number of new approaches to Olympic pharmacy in terms of quality assurance, medicines distribution and dispensing technology, which will provide a model of excellence for future Games.

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Dora Chan is a pharmacist at the Chief Pharmacist’s Office coordinating the Hong Kong Olympic Pharmacy and Paralympic Pharmacy Services.

Dezhi Wang is a pharmacist at the Peking Union Medical College Hospital, Beijing, and was a pharmacist for the Beijing Olympic Village Pharmacy.

Rong Han is a pharmacist at the Beijing Tiantan Hospital, and was a pharmacist for the Beijing Olympic Village Pharmacy.

Mark Stuart is deputy editor of BMJ Best Practice. He developed the medical training programme for the Hong Kong Olympic equestrian medical team.