Biofarmasetikal Tropis (The Tropical Journal of Biopharmaceutica.
2024, 7.
, 41-51 e-ISSN 2685-3167 p-ISSN 2828-6685 Analysis of Medicine Management in the Pharmacy Installation at Hospital X of Tomohon City Hanna M.
Rumagit1* .
Friska M.
Montolalu1 .
Mitra W.
Timburas1 Department of Pharmacy.
Faculty of Mathematics and Natural Sciences.
Christian University of Indonesia in Tomohon Corresponding author.
hanna_rumagit@yahoo.
Accepted: 16 September 2024.
Approved : 25 Oktober 2024
ABSTRAK
Penelitian ini bertujuan menganalisis efisiensi pengelolaan obat di RS X Kota Tomohon dengan menilai berbagai indikator, seperti seleksi, pengadaan, distribusi, dan penggunaan obat.
Metode deskriptif digunakan dengan data retrospektif dan wawancara untuk mengukur kesesuaian praktik dengan standar Depkes RI.
WHO, dan Permenkes.
Hasil menunjukkan bahwa tahap seleksi hanya mencapai 55,65% kesesuaian dengan Fornas, sementara pengadaan menunjukkan alokasi dana 25,08%, yang masih di bawah standar.
Distribusi obat menunjukkan kesesuaian penuh pada beberapa indikator, seperti persentase kecocokan fisik obat dengan kartu stok .
%) dan frekuensi kesalahan dokumentasi .
%).
Penggunaan obat menunjukkan hasil yang bervariasi.
peresepan antibiotik mencapai 30,2%, melebihi standar WHO O22,7%, mengindikasikan potensi ketidakrasionalan.
Studi ini menyimpulkan bahwa, meski distribusi dan beberapa aspek pengadaan memenuhi standar, perbaikan diperlukan pada tahap seleksi dan penggunaan obat untuk meningkatkan efisiensi dan kepatuhan terhadap regulasi.
Kata kunci : Standar Pelayanan Kefarmasian.
Instalasi Farmasi Rumah Sakit.
Kota Tomohon
ABSTRACT
This study aims to analyze the efficiency of medicine management at Hospital X in Tomohon City by evaluating such indicators as selection, procurement, distribution, and use of drugs.
It employed a descriptive method to examine retrospective data gleaned from interviews to assess the compliance of medicine management with the standards set by the Indonesian Ministry of Health.
WHO, and Regulations of the Ministry of Health.
The results indicated that the selection phase only reached 65% compliance with the National Formula, while procurement showed a budget allocation of 08%, which was below the standard.
The distribution of drugs demonstrated full compliance on several indicators, such as the percentage of physical drug matching with stock cards .
%) and documentation error frequency .
%).
Drug use showed varied outcomes in that antibiotic prescribing reached 30.
2%, exceeding the WHO standard of O22.
To some extent, this indicated potential irrationality.
The study concludes that while the distribution and some aspects of procurement have satisfied the standards, the selection and use of drugs require improvement to enhance efficiency and regulatory compliance.
Keywords: Pharmaceutical Service Standards.
Hospital Pharmacy Department.
Tomohon City INTRODUCTION provision of quality and affordable pharmaceutical supplies, medical devices, and disposable medical materials for all community levels, including clinical pharmaceutical Medicine management in hospitals significantly influences the hospital's progress, particularly in healthcare services, the quality of The Regulation of the Minister of Health of the Republic of Indonesia (Permenkes RI) Number 72 of 2016 on Standards of Pharmaceutical Services in Hospitals states that pharmaceutical services in hospitals are an integral part of the health service system.
These services are patient-oriented and include the Biofarmasetikal Tropis e-ISSN 2685-3167 p-ISSN 2828-6685 (The Tropical Journal of Biopharmaceutica.
2024, 7.
, 41-51 concurrent data, obtained from primary and secondary sources.
Primary data analysis was conducted through interviews with relevant Secondary data were analyzed by calculating the values corresponding to compliance with the stages of medicine .
election, distribution, and usag.
Capturing the medicine management stages .
election, procurement, distribution, and usag.
, research data were analyzed for efficiency using the standards from the Indonesian Ministry of Health .
WHO .
, and Regulations of the Ministry of Health .
medicines, and their availability 2 .
The allocation of 50Ae60% of a hospital's total budget to the procurement of medicines and medical devices underscores the critical importance of implementing efficient strategies for the management of pharmaceutical supplies and medical equipment3.
Inefficiencies in medicine management can adversely impact hospitals, such as wastage, unavailability of medicines, poor distribution, and damaged drugs 4 .
In response, hospitals have to implement the principles of effective and sustainable medicine management.
Pharmaceutical services including selection, procurement, distribution, and usage are essential components that require meticulous attention and execution through a multidisciplinary approach in coordination with hospital staff5 .
Furthermore, strong support and collaboration from all stakeholders are crucial for the optimal implementation of hospital pharmaceutical services, resulting in improved pharmaceutical service quality, patient safety, and overall public health4 .
As such, systematic medicine management in hospitals is critical to ensure that quality medicines are sufficiently available to support high-quality healthcare Assessing medicine management against efficiency indicators helps hospitals measure the performance of medicine management, evaluate its effectiveness, and identify issues where improvements or changes are needed to enhance the quality of medicine management8 .
Considering the crucial roles of medicine management, the present study investigates medicine management at hospitals in Tomohon City.
This study aims to contribute to achieving quality pharmaceutical services, cost efficiency, inventory control, patient safety, treatment adherence, and regulatory compliance.
RESULTS AND DISCUSSION
The research results demonstrated that several indicators did not meet the standards.
The selection stage did not cohere with the National Formulary (Forna.
or the standard Additionally, in the drug utilization stage, the number of drug items per prescription sheet and the percentage of antibiotic prescribing also fell short of the standard indicators.
Albeit these findings, the study revealed that private hospitals, owned or managed by foundations or individuals, managed to maintain more flexible management in policy-making or decision-making than state-owned ones.
This is possible as they are not strictly bound by government regulations.
In addition, private hospitals are generally funded by investments from investors, overall medical service fees charged to patients, private insurance, and the national health insurance program (BPJS).
These multiple sources of funding allow private hospitals to offer premium healthcare services with the latest medical technology and a higher level of comfort9 .
The table below presents the research findings alongside the efficiency standards of the Indonesian Ministry of Health .
WHO .
, and the Regulations of the Ministry of Health .
RESEARCH METHODS
Data collection was conducted using a descriptive method through retrospective and Table 1.
The compliance rate of medicine management with the efficiency indicator standards.
Stages Selection Indicators The conformity of available drug items with the National Formulary 1 Objective To determine the drugs listed in the National Formulary.
Calculation X: Total number of drug items in National Formulary Results 55,65% Biofarmasetikal Tropis e-ISSN 2685-3167 p-ISSN 2828-6685 (The Tropical Journal of Biopharmaceutica.
2024, 7.
, 41-51 Procurement Distribution Percentage of the Percentage available capital funds compared to the total funds Frequency each drug item per To determine how much of the hospital's funds are allocated to IFRS.
To determine the extent to which funds are allocated to the pharmacy.
To determine how many times these drugs are ordered in a year.
Frequency SP/ Percentage of drug compared to those To determine how To determine the accuracy of the Percentage physical quantity of drugs and the stock To determine the warehouse staff.
Turn Over Ratio
(TOR)1
To determine the capital turnover in Y: Total number of Z: (X/Y) x 100% X: Total drug funds Y: Total hospital budget Z:
(X/Y) x 100% X: Available funds Y: Actual fund Taking a random sample of the drug stock cards and many times the drug is ordered per Taking the SP for 3 months and matching it with the invoice.
"X: Total number of drug items in reality Y: Total number of items in the plan Z: (X/Y) x 100% Taking the drug stock card .
rug stock dat.
and matching it with Calculating the number of drug items that match the stock card (X) with the physical drug count (Y).
Percentage: Z = (X/Y) x 100%.
Annual turnover at cost of goods sold
(COGS) = X,
Average value of drug inventory = Y.
TOR = X/Y 25,08% 84 times 21,84 Biofarmasetikal Tropis e-ISSN 2685-3167 p-ISSN 2828-6685 (The Tropical Journal of Biopharmaceutica.
2024, 7.
, 41-51 Percentage and To determine the value of expired extent of the and/or damaged hospital's losses.
Level of drug Percentage of dead Use Based on the annual records of expired drugs, the expired stock is calculated using (Value of Expired Drugs (X)/Value of Stock Opname (Y)) x 100% To determine the The drug coverage medicines (A) is calculated using the formula (X Y)/ (Z y 1 To identify unused medication items over the past 3 Number of To measure the medication items degree prescription polypharmacy.
Where current stock.
Y is medicine usage, and Z is the average monthly The percentage of medication is calculated using the formula Z=(X/Y)y100%, where X is the number of unused medications over the past three months.
Y is the total stock, and Z is the percentage of unused The medication items per prescription is calculated using the formula X/Y, where X is the total number of medication items 14 months Biofarmasetikal Tropis e-ISSN 2685-3167 p-ISSN 2828-6685 (The Tropical Journal of Biopharmaceutica.
2024, 7.
, 41-51 Percentage prescribing with generic names11 Average required to deliver outpatient patients To measure the prescribe generic To determine the speed of pharmacy service at the Percentage prescriptions that can be delivered 11 Presentation To measure the medication items antibiotic usage prescriptions, and Y is the total The percentage of medication items calculated using Z=(X/Y)y100%, where X is the medication items names, and Y is the total number items prescribed.
The processing prescriptions (Z) using the formula
Z=(YOeX)/total received, where X
is the time the prescription enters the pharmacy and Y is the time it is received by the patient (Y) The percentage of medication items (Z) is calculated by using the Z=(X/Y)y100%, where X is the total number of prescribed items and Y refers to the total number of The percentage of prescribed (Z) is using this formula
(X/Y) X 100%,
8 minutes for and 12 minutes for compounded Biofarmasetikal Tropis e-ISSN 2685-3167 p-ISSN 2828-6685 (The Tropical Journal of Biopharmaceutica.
2024, 7.
, 41-51 Presentation of To assess the medications that are supervision fully labeled 11 information that has to be written on the label.
Selection Stage Compliance of Available Drugs with the National Formulary (Forna.
Based on the findings in Table 1, retrospective data analysis of all drug items in the pharmacy installation at Hospital X in Tomohon City showed 55.
65% compliance with the efficiency indicator standards.
Drug procurement in pharmacy installations in Indonesia must adhere to Fornas, a list of essential drugs compiled and regulated by the Ministry of Health (MoH).
Fornas serves as a reference for drugs funded under the National Health Insurance (JKN)1 program.
Interviews with the head of the pharmacy installation at Hospital X revealed that the hospital collaborates with BPJS, various insurance providers, and also serves private However, as a private hospital, it prioritizes profitability, leading to drug procurement decisions based on the lowest where X is the total number of prescribed that are O 22.
7% of the total prescribed medications, and Y is the total medication items The percentage of medication items patient's name and usage instructions (Z) is calculated using this formula Z=(X/Y)y100%, where X is the medication items that meet the criterion, and Y is the total number items given to the (PBF.
Furthermore, hospital policies established by the Pharmacy and Therapeutic Committee (KFT) limit physicians to prescribing only three patented drugs.
Based on the research findings at Budi Setia General Hospital, the compliance level of drug items with the efficiency indicator was 28%, which does not meet the established efficiency standard.
This common issue in private hospitals arises due to procurement policies prioritizing discounts or low prices for both generic and patented drugs, with an additional focus on ensuring drug availability, particularly for BPJS patients.
Procurement Stage Percentage of Drug Procurement Budget Allocation As presented in Table 1, the percentage allocation of the drug procurement budget was 25.
08%, falling short of the Biofarmasetikal Tropis (The Tropical Journal of Biopharmaceutica.
2024, 7.
, 41-51 efficiency indicator standards established by MoH in 200810 .
This outcome is attributed to the use of consumption and epidemiological/morbidity methods in procurement planning.
The consumption method relies on the previous period's straightforward, is often combined with epidemiological methods that consider disease patterns over specific periods in a Percentage of Available Funds vs.
Total Required Funds Table 1 indicates that 100% of the required funds were available, meeting the MoH efficiency standards10 .
This demonstrates accurate budgeting by the hospital to meet the pharmacy installationAos needs for drug and medical equipment procurement.
According to interviews, procurement occurs twice monthly, based on consumption and However, occasional nationallevel shortages can still lead to specific drug unavailability.
Based on previous research at the Regional General Hospital (RSUD) of North Sulawesi Province, drug procurement aligns with the regional budget (APBD) and is categorized as The procurement process is conducted based on proposals from the Hospital Pharmacy Installation (IFRS) and coordinated with the Health Department12 .
Frequency of Drug Procurement per Item Annually As shown in Table 1, the procurement frequency for each drug item was 17.
times per year, classified as moderate according to the Permenkes .
standard, which categorizes frequencies as low (<12/yea.
, moderate .
Ae 24/yea.
, or high (>24/yea.
While the frequency falls within acceptable standards, ongoing monitoring essential to ensure optimal procurement e-ISSN 2685-3167 p-ISSN 2828-6685 Frequency of Incomplete SP/ Invoices/ Order Compliance Table 1 highlights a 0% error rate, practices that align with recommended pharmaceutical management standards.
Based on previous research conducted at the Pharmacy Installation of Pemalang Regency Hospital, upon the arrival of pharmaceutical supplies, checks were carried out to match the invoice with the delivered items and to ensure the ordered pharmaceutical supplies were still in acceptable condition13 .
The 2019 Technical Guidelines for Hospital Pharmaceutical Services recommend that all incoming supplies undergo thorough inspections to ensure accuracy in type, quantity, and quality14 .
Percentage of Planned vs.
Procured Drug Items The study findings indicate 100% alignment between planned and procured drug items, consistent with the standard range of 100Ae120.
This reflects the hospitalAos effective planning and precise procurement that minimizes risks of overstocking or stockouts15.
The results align with the 2019 technical guidelines for pharmaceutical services13 .
Distribution Stage Accuracy of Physical Drug Count vs.
Stock Cards As shown in Table 1, distribution-stage compliance reached 100%, meeting WHO .
This reflects the precision of warehouse staff and managers in stock management11 .
Interviews revealed that monthly stocktaking is conducted by pharmacy staff, ensuring alignment between physical inventory and the hospital's pharmacy information system (SIM).
Similar findings were reported in previous research conducted at RSDK Purwokerto General Hospital, where a 100% compliance rate was achieved due to meticulous recording and verification of Biofarmasetikal Tropis (The Tropical Journal of Biopharmaceutica.
2024, 7.
, 41-51 stock cards against the physical inventory by the staff16 .
Turnover Ratio (TOR) With a TOR of 21.
times per yea.
, the hospital met the efficiency indicator standards .
Ae23 times/yea.
as per Permenkes .
High TOR values indicate efficient inventory turnover, whereas low TOR values suggest sales issues that could result in financial losses due to tied-up inventory3 .
Interviews with the pharmacy manager revealed that fastmoving drugs are ordered in large quantities, while slow-moving items are procured based on periodic usage.
Percentage of Expired or Damaged Drug The 0% percentage of expired and damaged drugs indicates compliance with the Ministry of Health's efficiency However, a high percentage of expired or damaged drugs typically suggests issues with drug needs planning, inadequate storage, or unforeseen changes in disease patterns and In the case of IFRSU X in Tomohon City, an agreement with the pharmaceutical wholesaler to return drugs 3 months prior to expiration has helped mitigate losses for the hospital.
Previous research at hospital X in North Sulawesi revealed inefficiencies in this area, with a significant reduction in expired and damaged drugs from 2019 to These drugs included various dosage forms such as tablets, capsules, powders, ointments, creams, and even Drug Availability Level This indicator aims to evaluate the sufficiency of drug supply in the hospital, with the Ministry of Health's efficiency standard of 12-18 months.
IFRSU X in Tomohon City achieved a drug availability level of 14 months.
This 14month coverage indicates a stable and standard level, ensuring that the hospital can meet patient needs.
Furthermore, the research findings show a drug availability level of 16 months, which falls within the standard range of 12-18 months.
This e-ISSN 2685-3167 p-ISSN 2828-6685 indicates that the hospital's drug inventory management is optimal.
good level of drug availability is crucial for effective pharmaceutical services18 .
Percentage of Dead Stock The 0% dead stock percentage signifies efficient inventory management and effective stock rotation, aligning with the Ministry of Health's indicator10 .
This finding contrasts with similar research reporting a 4.
24% dead stock percentage, attributed to the absence of a Pharmacy and Therapeutics Committee (PFT)3 .
The PFT plays a vital role in creating a hospital formulary, guiding prescribing practices among medical staff.
Interviews with IFRSU X staff in Tomohon City revealed that drug procurement adheres to the hospital formulary and PFT decisions, preventing inconsistencies in prescribing, fluctuations in drug needs, and the occurrence of dead stock19 .
Usage Stage Number of Drug Items per Prescription A retrospective analysis of 2023 prescriptions revealed an average of 3.
drug items per prescription, exceeding the WHO's recommended range of 1.
This indicates inefficient prescribing practices.
Appropriate drug Studies have shown that irrational prescribing, often characterized by the use of non-essential drugs, can lead to adverse drug events, particularly in patients taking multiple medications3, 20 .
Percentage of Generic Prescriptions The study aimed to assess the prevalence of generic prescribing among doctors.
Retrospective data analysis revealed a 25% generic prescribing rate, aligning with the WHO's recommended range of 82-94 .
This finding is in contrast to previous research, which reported a lower generic prescribing rate.
The discrepancy may be due to the limited availability of Biofarmasetikal Tropis (The Tropical Journal of Biopharmaceutica.
2024, 7.
, 41-51 Prescription Dispensing Time The Indonesian Ministry of Health mandates a maximum waiting time of 60 minutes for compounded and 30 minutes for non-compounded prescriptions10 .
recent study at RSU X in Tomohon City found significantly shorter waiting times, averaging 8 minutes for compounded and 12 minutes for non-compounded This efficiency was attributed to adequate staffing and a continuous service system, even during break times.
In contrast, a previous study at Siti Rahmah Islamic Hospital reported much longer waiting times, exceeding the standard by a significant margin, highlighting the impact of insufficient staffing on service delivery22 .
Percentage of Prescriptions Fulfilled A retrospective analysis of prescriptions from 2023 revealed a 100% compliance rate, meeting the WHO's recommended range of 76-100 .
This high compliance rate is attributed to efficient drug management and procurement practices at IFRSU X in Tomohon City, which are aligned with consumption and epidemiological data.
The pharmacy department's focus on patient safety23 and satisfaction has contributed to RSU X's reputation as a preferred healthcare facility in Tomohon.
Percentage of Antibiotic Prescriptions The study found an antibiotic prescribing rate of 30.
2%, exceeding the WHO's recommended threshold of 22.
Interviews indicated that the absence of routine laboratory tests prior to antibiotic prescription contributed to this high rate, as doctors relied primarily on clinical The antibiotic prescribing indicator is a useful tool for evaluating irrational prescribing practices, as excessive antibiotic use can lead to antimicrobial resistance.
In Indonesia, the overall antibiotic prescribing rate is reported to be 43%3 .
Percentage of Completely Labeled Medications e-ISSN 2685-3167 p-ISSN 2828-6685 The 100% compliance with the WHO's 1993 standard for complete drug labeling indicates a high level of accuracy and attention to detail among pharmacy staff in preparing labels for both topical and oral medications11 .
This finding aligns with the Department of Health's 2008 which emphasize the importance of verifying prescription accuracy, label completeness, dosage instructions, and the overall consistency of the dispensed medication with the original prescription10 .
CONCLUSION
The medicine management at Hospital X in Tomohon City has demonstrated some alignment with standards, such as in the distribution and procurement of medicines.
However, improvements are needed in the selection stage and the use of antibiotics, as the selection has not entirely complied with Fornas.
In addition, the prescription of antibiotics exceeds the limits recommended by WHO.
Overall, the system already holds a strong foundation, but it requires improvements in several areas to enhance efficiency and compliance with standards.
ACKNOWLEDGMENTS