SELF-MONITORING INSTRUMENT TO IMPROVE THE EFFICIENCY OF DRUG MANAGEMENT IN HOSPITAL PHARMACY

1. SELF-MONITORING INSTRUMENT TO IMPROVE THE EFFICIENCY OF DRUG MANAGEMENT IN HOSPITAL PHARMACY Pudjaningsih D1 & Santoso B 2 1PKU Muhammadiyah Hospital, Yogyakarta 2Departement Clinical Pharmacology, Faculty of Medicine,Gadjah Mada Univercity, Yogyakarta

2. 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 self-assessment 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.

3. 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.

4. Study Objective • To develop and field-test the efficiency of indicators in selection, procurement, storage and distribution stages in hospital drug management

5. Methods Workshop Involving 50 Hospital Drug Managers Draft II -Nominated Indicator Draft I Reviewed by 12 Hospitals Managers STEP I Literature Reviewed Recommended Indicators Set of Indicators I Set of Indicators II STEP II Output: Final Indicators Field-test in Six Hospitals

6. The Final Set of Indicators

7. Calculation

8. Result: field-test of indicators in 6 Hospitals Selection Procurement

9. Result: field-test of indicators in 6 Hospitals (continued) Storage

10. Result: field-test of indicators in 6 Hospitals (continued) Distribution

11. 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

12. 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

13. 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