Download Case study in three public hospitals

SELF-MONITORING INSTRUMENT TO IMPROVE THE
EFFICIENCY OF DRUG MANAGEMENT IN HOSPITAL
PHARMACY
Pudjaningsih D1 & Santoso B 2
1
PKU Muhammadiyah Hospital, Yogyakarta
2 Departement Clinical Pharmacology, Faculty of Medicine,Gadjah Mada
Univercity, Yogyakarta
ABSTRACT








Problem Statement: The operational budget of hospital pharmacy service is relatively high, representing
approximately 40%-60% of hospital’s total budget. In order to ensure appropriate use of these funds, appropriate
drug management must be monitored and enforced. Drug management consists of selection and quantification,
procurement, and storage and distribution, each of which must be assessed for efficiency. The instrument used
must be valid, specific, and sensitive.
Objective : to develop the efficiency indicators for use in rapid-assessment of hospital drug management.
Design: The study consisted of two steps. The first step was the development of indicators, involving 50 drug
managers. The final draft of the indicators was then field-tested in 6 hospitals. This abstract described the results of
the field-tested.
Setting and population: Fifty pharmacists working as drug managers in 50 hospitals in 5 provinces were involved
during the development of the indicators. The finals draft of the indicators instrument was then field-tested in 6
hospitals in Yogyakarta province.
Intervention: The literature was searched for potential indicators, resulting in Draft I. A workshop involving 12
hospital managers was conducting to evaluate Draft I and nominate specific indicators to adapt for use in hospital,
producing Draft II. .The draft II was then further developed, and 50 drug hospital managers were invited for
comments; the result of this step was the Draft III (final draft). The final draft consisted of three indicators for the
selection stage, three indicators for procurement stage, four indicators for storage stage, and six indicators for
distribution stage. This finals draft of indicators was then field-tested in rapid self-assessments conducted at six
hospitals.
Result: The results showed that rapid self-assessment was feasible in one day when all of the needed information
was available. level of drug management and information management varied among the six hospitals. Rapid selfassessment in private hospitals are faster than those public hospitals because the private hospitals could more
easily access the information needed. The indicator instrument was able to detect that any serious problems and to
determine the quality of drug management. Respondents found the instrument easy to use, if provided all
information needed was available. Two indicators in the procurement stage were considered not sensitive,
whereas, the other indicators were proven valid, sensitive and specific.
Conclusion: Appropriate hospital drug management depends on access to complete information. This instrument
is considered useful in detecting problems and measuring the quality of drug management . Continuous
improvement can be achieved if the indicators are used regularly.
Funding Source: PKU Muhammadiyah Hospital, Yogyakarta, Indonesia.
Background & Setting
 The operational budget of hospital pharmacy service is





relatively high, approximately 40%-60% of hospital budget
To ensure the efficient use of these funds, appropriate drug
management must be monitored and enforced.
Drug management consists of drug selection and
quantification, procurement, storage, and distribution
The quality of drug management must be assessed for
efficiency by using instruments or indicators
The indicators must be valid, specific, and sensitive to minor
changes
Setting and Population:
 Development of indicators: 50 drug managers from 50
hospitals in 5 provinces
 Field-test: 3 private and 3 public hospitals in Yogyakarta,
Indonesia.
Study Objective
 To develop and field-test the efficiency of
indicators in selection, procurement,
storage and distribution stages in
hospital drug management
Methods
STEP I
Literature
Reviewed
Draft I
Reviewed by
12 Hospitals
Managers
Recomme
nded
Indicator
s
STEP II
Draft II
Nominate
d
Indicator
Set of
Indicators
II
Field-test
in
Six
Hospitals
Workshop
Involving
50
Hospital
Drug
Managers
Set of
Indicators
I
Output:
Final
Indicators
The Final Set of Indicators
Stage of
drug
managemen
Selection
Procurement
t
Storage
Distribution
No
Indicator
Standard Value
1
Availability of drug budget
2
Ratio of planning and consumption
3
Average percentage of drug consumed
1
Average procurement frequency
2
Frequency of incomplete drug order
0
3
Frequency of delayed hospital drug payment
0
100 %
1:1
100 %
Depends on optimal balance between space and quantity
2
Conformity of records to phisical checks on drug
quantity
Turn over ratio
8 - 12 x
3
Percentage of drugs placed in shelf properly
100 %
4
Percentage of damaged and expired drug
1
Percentage of generic drug use
2
Percentage of outpatient complaints
0%
3
Percentage of doctors complaints
0%
4
Time to fill prescription
5
Percentage of prescription which are not filled
0%
6
Percentage of non-formulary drugs
0%
1
1
0%
>80 %
<30 minutes
Calculation
Indicators
Availability of drug budget
Ratio of planning and consumption
Unit
%
ratio
Calculation
Available budget at a time divided by the total fund needed for drugs in one year x 100%
Total drug items planned in the beginning of the year : total drug items used at the end of the year
Average percentage of drug
consumed
%
Randomly select 10 drug items, calculate the percentage of the quantity consumed over quantity
planned for each item, calculate the average
Average procurement frequency
x
Randomly select 10 drug items, calculate the frequency of purchase during the last 1 year for each
item, calcukate the average
Frequency of incomplete drug
order
x/mon
th
Take all drug order forms in the last 1 month, identity the number of mistakes in writing the
orders
Frequency of delayed hospital
drug payment
x/year
Calculate the number of invoices during the last 1 year, check with the due date of payment,
calculate how many are overdue in the respective year
Conformity of records with
phisical checks on drug quantity
%
Randomly select 10 drug items at the time of visit, check the record with the physical quantity,
calculate how many items of the 10 are incorrect, x 100%
Turn over ratio
x
The total value (Rp) of drug income in the last 1 year divide by the total value (Rp) of drugs on
stock at the end of the year
Percentage of drugs placed in
shelf properly
%
Randomly select 10 drug items, check the order of purchase, check the placement of the drugs.
The first in (or the first expired) must be in the front rows. Calculate the number of items placed
incorrectly, divide by 10, x 100%
Percentage of damaged and
expired drug
%
Calculate the value of damaged and expired drug s (Rp), divided by the total value (Rp) of drugs in
stock, x 100 %
Percentage of generic drug use
%
Calculate the number of R/ in generic in the last 1 month, divided by the total R/ in the respective
month, x 100%
Percentage of outpatient
complaints
%
Interview 30 out-patient exits, calculate the percentage of patients who are not satisfied with the
pharmaceutical services
Percentage of doctors complaints
%
Interview 10 doctors on the day of visit, calculate the percentage of doctors who are not satisfied
with the pharmaceutical services
minute
s
Randomly select 20 out patients in the pharmacy service area, calculate the average time spent to
get the prescription ready
Percentage of prescription which
are not filled
%
Calculate the number of prescription filled during the last 10 days, divided by the total number of
prescriptions written during the same period, x 100%
Percentage of non-formulary
drugs
%
Observe all prescription during the last 10 days, calculate the number of R/ which is not from the
hospital formulary, divided by the total R/ of the same period, x 100%
Time to fill prescription
Result: field-test of indicators in 6 Hospitals
Selection
No
Indicator
Private
Hospital
1
Private
Hospital
2
Private
Hospital 3
3
Public
Hospital
4
Public
Hospital 5
5
Public
Hospital 6
6
1
Availability of drug budget
100 %
100 %
100 %
39 %
N/A
73 %
2
Ratio of planning and
consumption
1 : 1.1
1:1.1
1 : 1.1
1 : 1.4
N/A
N/A
3
Average percentage of drug
consumed
16 %
4%
26 %
280 %
N/A
N/A
Private
Hospital
1
Private
Hospital
2
Private
Hospital 3
3
Public
Hospital
4
Public
Hospital 5
5
Public
Hospital 6
6
1–2X
3-4X
1X
N/A
1X
4X
Procurement
No
1.
Indicator
Average procurement
frequency
2
Frequency of incomplete drug
drug order
9X
1X
9X
N/A
2X
N/A
3
Frequency of delayed hospital
hospital drug payment
25 X
N/A
N/A
10 X
N/A
N/A
Result: field-test of indicators in 6 Hospitals (continued)
Storage
No
Indicator
Private
Hospital 1
Private
Hospital 2
Private
Hospital
l3
Public
Hospital
l4
Public
Hospita
al 5
Public
Hospital
l6
100 %
100 %
100 %
N/A
100%
100 %
11 X
23 X
12 X
4 X
7X
N/A
1
Conformity of records with
phisical checks on drug quantity
2
Turn over ratio
3
Percentage of drugs placed in
shelf properly
100 %
100 %
100 %
N/A
10 %
20 %
4
Percentage of damaged and
expired drug
0.2 %
0.05 %
0.06 %
0.75 %
0.24 %
0%
Result: field-test of indicators in 6 Hospitals
(continued)
Distribution
Private
Hospital
3
Public
Hospital
4
Public
Hospital
5
Public
Hospital
6
3%
16 %
68 %
57 %
60 %
3%
5%
0%
0%
0%
0%
Percentage of doctors
complaints
3%
50 %
10 %
28 %
0%
40 %
4
Time to fill prescription
30 ‘
24 ‘
18 ‘
42 ‘
16 ‘
10 ‘
5
Percentage of prescription
which are not filled in
22 %
24 %
0%
27 %
1%
2 %
6
Percentage of nonformulary drugs
0%
0.4 %
0%
8.2 %
0%
6.6 %
N
o
Private
Hospital 1
Indicator
1
Percentage of generic
drug use
17 %
2
Percentage of outpatient
complaints
3
Private
Hospital
2
Qualitative Findings
 The rapid self-assessment was able to be conducted in one
day if all information needed was available
 Rapid self-assessment in private hospitals are faster than
thay in public hospitals, because in private hospitals the
information was more instantly available
 The indicators were able to detect serious problems in drug
management
 Respondents found the instrument easy to use, provided that
all information needed was available
Discussions
 The final indicators showed its validity, sensitivity, and specificity:
 Valid to measure the quality of drug management
 Sensitive to determine any problem, either in the process or
outcome
 Specific to detect if there is a problem
 The indicators are easy to use for:
 Determining problems in drug management
 Motivating hospitals to improve the management information
system
Conclusions
 This instrument is considered useful in detecting problems and
measuring the quality of drug management, and is able to show the
difference among hospitals
 Regular use of this set of indicators will be useful in improving the
quality of drug management
 Although none of the hospitals showed a good quality of drug
management, the private hospitals showed a slightly better drug
management than the three public hospitals