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Detector: Jurnal Inovasi Riset Ilmu Kesehatan
Vol. 2 No. 3 Agustus 2024
e-ISSN : 2963-2005 dan p-ISSN : 2964-6081, Hal 109-132
DOI: https://doi.org/10.55606/detector.v2i3.4151
Available online at: https://ejurnal.politeknikpratama.ac.id/index.php/Detector
Received Juli 03 2024; Received Juli 20, 2024; Accepted Agustus 01, 2024; Published Agustus 03, 2024
Analysis of the National Formulary Drug Supply Chain with Its
Availability in the Pharmacy Installation of the Government General
Hospital (RSUD) Dr. Sitanala Tangerang City
Hercien1*, Mutia2, Idrus3
1Program Magister Administrasi Rumah Sakit Universitas Esa Unggul, Jakarta, Indonesia
Email :cien3789@gmail.com1, mutia_192@yahoo.com2, idrus.jusat@esaunggul.ac.id 3
Alamat: Jalan Arjuna Utara No.9, Kebon Jeruk, Jakarta Barat
Korespondensi penulis: cien3789@gmail.com *
Abstract. This study explores the pharmaceutical supply chain management of the National Formulary at RSUP
Dr. Sitanala in Tangerang City, aiming to identify obstacles to drug availability and formulate effective and
efficient solutions. Acknowledging quality healthcare as a fundamental human right and a critical investment for
a nation's future, this research emphasizes the importance of high-quality healthcare services. These services
encompass not only treatment but also health promotion and disease prevention through the adoption of clean
and healthy living habits. Drug availability is a major pillar in the provision of quality healthcare services.
Effective and efficient management of the pharmaceutical supply chain, particularly regarding National
Formulary drugs, is crucial in ensuring the availability of medications at healthcare facilities. This research
employs a comprehensive analysis of the supply chain processes at RSUP Dr. Sitanala, examining stages such as
drug selection, demand planning, procurement, receipt, storage, distribution, drug control, therapy monitoring,
prescription preparation, drug dispensation, and medication administration. The study's methodology involves a
case study approach, integrating theoretical management principles and interdisciplinary pharmacy management
with compliance to regulations, as outlined in Permenkes No. 76 of 2016. Findings from RSUP Dr. Sitanala
indicate that the hospital's pharmaceutical management practices align with contemporary health and pharmacy
management theories, emphasizing structured systems, stringent verification, and effective interprofessional
communication to ensure medication safety and efficacy. The study identifies challenges in information technology
and interdisciplinary coordination as areas needing improvement. Nonetheless, a commitment to continuous
improvement and adherence to regulatory standards reflects RSUP Dr. Sitanala's dedication to enhancing the
quality of pharmaceutical management and healthcare services. The implications of this research extend beyond
RSUP Dr. Sitanala, offering valuable recommendations for improving drug supply chain management in other
healthcare institutions in Indonesia. By enhancing access to and the quality of healthcare services, this study
contributes to the broader goal of achieving the highest possible level of health for individuals, reflecting the
perspective of human rights and investment in the nation's future health.
Keywords: Pharmacy Management, Medicine Availability, Health Management, Supply Chain
1. INTRODUCTION
In the context of sustainable health development, high-quality healthcare services
become a fundamental need for every individual. This reflects not only a human right but
also a crucial investment for the future of a nation. As articulated by Arpan (2022), the
primary goal of health development is to enhance awareness, willingness, and the
capability to live healthily for everyone, thereby achieving the highest possible level of
health. This effort encompasses not merely treatment when sick but also health promotion
and disease prevention through the adoption of clean and healthy living patterns.
According to Mailoor et al. (2017), healthcare services encompass various efforts
that can be undertaken individually or collectively within an organization. Its goals are not
limited to maintaining and improving health but also preventing diseases, as well as
Analysis of the National Formulary Drug Supply Chain with Its Availability in the Pharmacy Installation of
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110 DETECTOR - VOL. 2 NO. 3 AGUSTUS 2024
restoring health conditions for individuals, families, groups, and the broader community.
In achieving these goals, the role of logistics management in healthcare, especially in drug
management, becomes highly significant.
The availability of effective and efficient drugs is one of the main pillars in
providing quality healthcare services. Nesi & Kristin (2018) emphasize the importance of
ensuring the availability of drugs in the right types and quantities as per the needs, to avoid
shortages and excesses that can affect healthcare services. Furthermore, Septi (2022)
underscores that access to medication is a human right, where the availability of drugs at
healthcare facilities becomes a primary determinant in quality health access.
Amid global challenges, the pharmaceutical industry plays a crucial role in
supporting drug availability. Significant dynamics within the pharmaceutical industry, as
revealed by Kusumo et al. (2022), impose new demands on payers, providers, and
manufacturers. In the context of Indonesia, challenges become increasingly complex given
the relatively low drug consumption per capita compared to other ASEAN countries,
indicating a significant potential for improving access to affordable and quality drugs
(Kemenperin, 2021).
In line with this, effectiveness and efficiency in drug supply chain management,
especially for National Formulary drugs, are key in ensuring drug availability at healthcare
facilities. This research takes the Public General Hospital Dr. Sitanala in Tangerang City
as a case study to delve deeper into the National Formulary drug supply chain process and
its impact on drug availability in the hospital's Pharmacy Installation.
The focus of this research is on the case study of the Public General Hospital Dr.
Sitanala in Tangerang City, which faces specific challenges in procuring National
Formulary drugs. The issue of drug shortages, both in the formulary and in the e-
Catalogue, often becomes a major obstacle, directly impacting the quality of service to
patients. This situation indicates the need for an in-depth analysis of the drug supply chain
system to identify barriers and formulate effective and efficient solutions.
Through this comprehensive analysis, the research aims to provide deep insights
into every aspect of the National Formulary drug supply chain and its impact on drug
availability at RSUP Dr. Sitanala, Tangerang City. The findings are expected to offer
valuable recommendations for improving drug supply chain management, not only for
RSUP Dr. Sitanala but also for other healthcare institutions in Indonesia, to enhance access
and the quality of healthcare services to the community.
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2. CONCEPTUAL FRAMEWORK AND THINKING FRAMEWORK
Picture 1. The conceptual framework
The conceptual framework described above serves as a structural guide for research
on the management of the National Formulary drug supply chain at Dr. Sitanala Public
General Hospital in Tangerang City. This framework is based on the supply chain
management definition by Michael Hugos (2003), which he defines as the coordination of
production, inventory, location, and transportation among the parties involved in the
supply chain to achieve the best balance of responsiveness and efficiency for the market.
Utilizing this framework, researchers can identify critical areas requiring attention and
improvement to enhance the effectiveness and efficiency of drug provision, in alignment
with the National Formulary standards and the specific needs of the hospital.
Picture 2. The conceptual framework
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The conceptual framework presented summarizes the logistics management system
within the Pharmacy Installation, which is essential in the management of drugs and
medical devices in healthcare institutions. This system begins with inputs that include
trained human resources, adequate budgeting for facilities and infrastructure, and standard
operational procedures. The logistics management process encompasses a series of stages
from selection, planning, procurement, reception, storage, distribution, to prescription
management and medication administration, concluded with control measures to ensure
effective and efficient use. The output from this entire process is expected to be the
effective and efficient availability of drugs and medical devices, supporting the
improvement of healthcare service quality and patient satisfaction in treatment.
3. RESEARCH METHOD
This research was conducted at the Pharmacy Installation of Dr. Sitanala Public
General Hospital in Tangerang City, with the research process commencing in July 2023.
A qualitative approach was chosen based on the principles of appropriateness and
sufficiency of information obtained from purposively selected informants. These
informants comprise individuals directly involved in the management of drug
administration at the hospital, including the Head of the Pharmacy Installation, the Person
in Charge of the Pharmacy Warehouse, Pharmacy Staff, Drug Budgeting, and the Drug
Logistics Division, each holding a crucial role in the drug management process.
To collect data, techniques such as in-depth interviews, observation, and
documentation were applied to extract detailed information on practices and challenges
within the national Formulary drug supply chain and its relation to availability at the
pharmacy installation. Primary data were collected directly from interactions with
informants, while secondary data were obtained from documents related to drug
management and availability.
Data analysis was performed using the Miles and Huberman model, which includes
data reduction, data display, and the drawing of conclusions and verification. Data validity
was tested through various strategies such as extended observation, increased research
precision, triangulation of sources and techniques, and the use of references. Credibility,
transferability, dependability, and confirmability are the primary criteria in assessing the
validity of data for this qualitative research, ensuring that the research findings are
trustworthy and relevant to the actual conditions on the ground.
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4. RESULTS AND DISCUSSIONS
Determination of Informants
In this study, the expert judgment technique was utilized as a method to identify
and evaluate risks in the drug supply chain management at a pharmacy installation. This
method involves identifying experts with in-depth knowledge of operations and
management in the pharmacy installation, particularly concerning drug distribution and
management in the hospital pharmacy warehouse. These experts were selected based on
their expertise to provide assessments of potential risks in the project.
The process began with the selection of appropriate experts, followed by the
preparation and execution of structured interviews to gather detailed information on
potential risks, including those related to schedule, cost, performance, and collaboration
with other institutions or organizations. Interviews focused on each individual's area of
expertise to verify and deepen the information on identified risks. The outcomes of the
expert judgment technique were then integrated into a research instrument that
encompasses all aspects of the drug supply chain, from selection to administration, to
ensure that the study covers all relevant risk areas in drug supply chain management. The
interviewed informants have characteristics as follows:
Table 1. Information on identified risks
No.
Informant
Name
Occupation
Characteristics
1.
Ella
Head of Pharmacy
Installation
Has responsibility for the
management and operations
of the Pharmacy Installation
2.
Arnia
Pharmacist in Charge of the
Pharmacy Warehouse
Play a role in pharmaceutical
aspects, including drug
management and distribution
3.
Ethel
Companion Pharmacist
Involved in pharmacy tasks,
such as drug monitoring and
distribution
4.
Tuti
Administration
Involved in preparing the drug
budget
5.
a. Riska
b. Sari
Pharmaceutical Technical
Personnel Responsible for
Warehouse
Responsible for activities
related to drug management in
the hospital pharmacy
warehouse
6.
Rian
Head of Logistics
Involved in shipping and
receiving medicines at the
Pharmacy Warehouse
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Question Formulation
After determining the appropriate experts, the next step involves selecting
informants who meet the criteria of experts for this research. The results can be observed
in the determination of informant characteristics at Dr. Sitanala Hospital. Below is the
agreement on questions that have been acknowledged by several expert judgments as
follows:
Table 2. Question Formulation
No
Questions
1
Drug Selection:
a. How do you determine which drugs to include on a hospital formulary?
b. b. What are the main criteria you consider in selecting drugs for hospital use?
2
Planning:
How do you plan medication needs for a certain period?
3
Procurement:
What is your strategy for drug procurement, including price negotiations and
collaboration with suppliers?
4.
Reception:
How is the drug receipt process organized to ensure quality and safety?
5.
Storage:
How do you maintain compliance with proper medication storage standards in a
pharmacy setting?
6
Distribution:
a. How is the drug distribution system organized to ensure speed and accuracy?
b. b. Do you have an automated system to support medication distribution throughout
the hospital?
7.
Recipe:
How is the process for recording and verifying prescriptions carried out in pharmacy
installations?
8.
Giving:
What steps are taken to ensure medication is administered by health workers as
prescribed?
9.
Drug Therapy Control and Monitoring:
a. How is the drug therapy monitoring system organized in the hospital?
b. b. How is the drug control system organized in the hospital?
10
Administration:
How do you organize the medication administration process to ensure efficiency and
safety?
Results
1) Medicine Selection
The drug selection process at the hospital under study shows a close
collaboration between the Head of the Pharmacy Installation, doctors, and nurses as
key in choosing effective medications for patients. Initially, doctors fill out a new
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drug request form, which is then evaluated by the Head of the Medical and Facilities
Subdivision based on accurate information. The final decision is made during the
Pharmacy and Therapeutics Committee (PTC) meetings, taking into consideration
medical and therapeutic aspects. However, there are challenges in this process,
including changes in doctors' decisions after a drug is approved, difficulties in
coordinating PTC meetings due to members' busy schedules, and challenges in
choosing between brand name and generic drugs.
The entire process of drug selection and management reflects the importance
of interprofessional collaboration in healthcare and compliance with the Ministry of
Health Regulation No. 76 of 2016. The challenges encountered indicate areas that
require improvement to enhance the quality of pharmaceutical services in
accordance with established standards.
2) Medicine Planning
The drug requirement planning process at Dr. Sitanala Public Hospital
underscores the importance of coordination among various hospital parties,
including the Head of the Pharmacy Installation, doctors, and nurses. The structured
drug planning procedure involves evaluating needs based on usage trends and
historical data, as well as consultations with the medical team. Meetings of the
Pharmacy and Therapeutics Committee (PTC) are a key step in this process, where
decisions are made based on accurate medical and therapeutic considerations.
However, there are obstacles such as changes in doctors' decisions and
difficulties in coordinating PTC meetings that impede the drug selection process.
Despite these challenges, collaboration among staff and effective communication are
emphasized as solutions to navigate these issues and achieve optimal drug planning.
This process, in alignment with Ministry of Health Regulation No. 76 of 2016,
reflects Dr. Sitanala Public Hospital's efforts to ensure that the drug supply not only
meets medical needs but also complies with safety and quality standards.
3) Procurement
The drug procurement strategy at Dr. Sitanala Public Hospital begins with
budget planning by the pharmacy installation, detailing the types and quantities of
drugs needed as well as cost estimates. This budget subsequently requires approval
from various levels of hospital management and coordination with the Budget
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Authority Holder (BAH) for endorsement. This process determines the allocation of
funds for drug procurement, which must be adjusted if there is a discrepancy between
the proposed budget and the approved one.
In procurement, setting the Own Estimate Price (OEP) in line with market
prices is crucial to attract vendor participation in the tender. Challenges arise when
the OEP is set too low, making vendors uninterested in participating. The use of an
e-catalog as a reference for drug prices and specifications is prioritized over non-e-
catalog sources to simplify the procurement process. Warehouse management is
well-prepared to accommodate the storage of drugs, including large tonnage drugs
and heavy liquids, to ensure the efficiency and effectiveness of drug availability. The
overall drug procurement process reflects Dr. Sitanala Public Hospital's commitment
to implementing well-considered strategies in line with health policies, despite
facing procurement and warehouse management challenges.
4) Reception
Dr. Sitanala Public Hospital implements a detailed and systematic drug
reception system to ensure the quality and safety of medications to be dispensed to
patients. A thorough verification process of critical documents such as invoices and
purchase orders marks the initial step in the reception procedure, followed by a
physical inspection of the drugs, which includes checking expiration dates and
packaging integrity. Drug storage is conducted in compliance with temperature
standards and appropriate environmental conditions to maintain drug quality. These
preventive actions aim to prevent the entry of counterfeit or expired drugs that could
harm the healthcare system. Adherence to applicable pharmacy warehouse
guidelines and principles of modern pharmaceutical research underscores the
importance of rigorous verification and control processes in the drug reception at the
hospital.
5) Storage
The drug storage procedure in the pharmacy warehouse at Dr. Sitanala Public
Hospital is managed with a priority on maintaining appropriate temperature
standards for various types of medications. Sari emphasizes the importance of
keeping room temperatures below 25 degrees Celsius and adjusting refrigerator
temperatures for certain medications, with monitoring conducted twice daily.
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Additionally, constraints such as limited space are overcome through good
coordination with manufacturers or suppliers, demonstrating adaptability in drug
ordering based on space capacity, cycles, and usage needs. Riska adds that the
system for monitoring drug expiration dates is a critical part of warehouse
management, ensuring that medications nearing or past their expiration dates are
handled correctly, maintaining safety and quality of drugs for patients. This overall
approach demonstrates the hospital's commitment to adhering to health standards
and adaptability in drug stock management.
6) Distribution
The drug distribution process in the researched hospital involves steps from
drug procurement through e-catalogs to reception and verification in the pharmacy
warehouse. Major challenges faced include a lack of information from suppliers and
difficulties in stock control, especially for drugs that are out of stock or nearing their
expiration date. Stock control and evaluation are conducted through manual
recording and reporting, with the inventory pharmacist playing a crucial role in
addressing stock shortages. The transition to a new administration system poses
challenges, particularly when the system encounters technical issues that do not
allow for extensions, thus requiring adjustments and more frequent stocktaking.
Despite efforts toward modernizing the drug administration system, the hospital still
relies on manual recording methods and faces challenges in adapting a more
automated and efficient system for drug distribution management.
7) Prescription
The prescription management process at the Pharmacy Installation of Dr.
Sitanala Public Hospital in Tangerang City implements a series of strict verification
steps, effective communication with medical staff, patient education, as well as
monitoring and reporting of drug side effects. It begins with the verification of the
authenticity and completeness of the prescription issued by the doctor, including
checking signatures and medication usage instructions. Any ambiguity in
prescription information is followed up with direct communication with the doctor
to obtain confirmation or clarification. Prescription information is then entered into
the pharmacy information system, followed by conveying important information to
patients regarding medication usage, potential side effects, and the importance of
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medication adherence. This process also includes monitoring drug inventory to
ensure adequate availability, as well as the collection and reporting of drug side
effects as mandated by policies and regulations. Through this systematic process, the
Pharmacy Installation of Dr. Sitanala Public Hospital in Tangerang City
demonstrates its strong commitment to enhancing medication safety and
effectiveness for patients.
8) Giving
The medication administration process at Dr. Sitanala Public Hospital in
Tangerang City is carried out with high precision and caution, underscoring the
crucial role of this procedure in patient care. The stages of this process begin with
the preparation and packaging of medications by pharmacy personnel, followed by
controlled delivery to the relevant units. The primary focus during the delivery and
receipt of medications is to ensure the integrity and safety of the drugs. Verification
of patient identity, checking of dosages, and instructions for medication use are
thoroughly conducted by healthcare personnel before administering medications to
patients. Detailed education about medication use, the correct dosage, and
information about potential side effects are also provided to patients. In the face of
challenges such as patient non-compliance, drug interactions, or side effects, the
health team at Dr. Sitanala Public Hospital is prepared to offer further education,
adjust dosages, or consult with doctors again. Through the implementation of this
structured and systematic medication administration process, Dr. Sitanala Public
Hospital is committed to ensuring safety, effectiveness, and adherence to medical
care standards in patient treatment.
9) Drug Therapy Control and Monitoring
Drug therapy management at Dr. Sitanala Public Hospital is conducted
through a holistic approach that emphasizes the pharmacist's role in ensuring the
safety and effectiveness of medication use. The implemented procedures include
prescription verification, checking drug availability, and providing counseling to
patients regarding side effects and the correct way of using medications. Monitoring
side effects and reporting are integral aspects of this process, in line with the
standards of Ministry of Health Regulation No. 76 of 2016. Pharmacists are
responsible for meticulously reviewing patient data and medical history before
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medication administration, as well as providing education on the importance of
adherence to medication use. The comprehensive steps of prescription verification
and counseling by pharmacists affirm the hospital's commitment to responsible
medication use management, highlighting the significance of interprofessional
collaboration in patient care and patient education as keys to enhancing safety and
effectiveness in drug therapy.
10) Administration
The medication administration process at Dr. Sitanala Public Hospital is
conducted through a series of structured procedures that emphasize collaboration
between the pharmacy team and service units in determining and planning
medication needs. Accurate record-keeping and reporting are key to maintaining
administration accuracy, with the use of invoice copies as proof of receipt and
medication stock monitoring through stock cards and information systems for real-
time tracking. Emphasis on reporting drug side effects supports the evaluation of
medication use and patient safety. Challenges such as transitioning to a new
administration system and difficulties in conducting quarterly stocktaking highlight
the importance of flexibility and adaptation in medication management. The
medication administration at Dr. Sitanala Public Hospital, in compliance with
Ministry of Health Regulation No. 76 of 2016, reflects the hospital's dedication to
medication management efficiency and enhancing patient safety, despite facing
various operational and technical challenges.
Discussion
Throughout the process, it is crucial to maintain the availability of medications
according to patient needs, ensure the quality and safety of the medications, and conduct
ongoing evaluations of medication use.
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Table 3. Drug Supply Solutions or Mitigation Strategies
No
Aspects of Constraints
in the Drug Supply
Process
Mitigation Solutions or Strategies
1
Changes in Physician
Practices Regarding Drug
Selection
Develop active communication strategies with
physicians to understand and address changing
preferences. Careful stock management.
2
Obstacles in PFT Meeting
Coordination
Use technology or online tools to facilitate meetings,
create meeting schedules that are accessible to all
members, and prioritize meeting agendas.
3
Brand Name vs. Brand
Preference Generic
Make decisions based on generic drug principles, but
consider availability and patient needs. Effective
communication with physicians to understand
preferences.
4
Changes in Drug
Procurement Budget
Planning
Adjust the drug procurement process to the approved
budget, involving the pharmaceutical installation
and related parties in budget adjustments if
necessary.
5
Errors in Self Estimate
Pricing (HPS)
Involves the technical team and users in determining
accurate and reasonable HPS, taking into account
appropriate market prices. Evaluate related
regulations and policies.
6
Limited Medicine Storage
Process and Space
Constraints
Active communication with manufacturers or
suppliers to store some drugs, monitoring stock
regularly, and evaluating additional storage needs.
7
Control and Evaluation of
Drug Availability
Monitoring and reporting through detailed
documents such as defect books and stock cards, as
well as using alternative systems when problems
occur.
8
New Administration
System Migration
Collaborating with IT and management to complete
system migration, as well as adjusting and reporting
data in stages.
9
Temperature Monitoring
and Storage Constraints
Regular temperature monitoring, involvement of
inventory pharmacists in stock recording, and active
communication with factories or suppliers.
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In observing the drug procurement and management processes at Dr. Sitanala
Public Hospital in Tangerang, several aspects can be identified that align with the
principles found in the Regulation of the Minister of Health of the Republic of Indonesia
No. 76 of 2016 on Pharmaceutical Services Standards in Hospitals. The budget planning
process for drug expenditures starts from the pharmacy installation as the primary user.
This plan involves considerations of patient needs and approval stages from various
management levels, in accordance with the requirements of the regulation. The approved
expenditure budget plays a crucial role in ensuring the availability of drugs according to
needs.
In the context of pricing, determining the Own Estimate Price (OEP) at Dr. Sitanala
Public Hospital in Tangerang is recognized as an essential element. Errors in setting the
OEP can become obstacles in the drug procurement tender process, in line with the
regulation's provisions that emphasize the importance of OEP accuracy. The drug selection
process at Dr. Sitanala Public Hospital in Tangerang involves doctors, medical
considerations, and internal meetings of the Pharmacy and Therapeutics Committee
(PTC). Drug selection is conducted with reference to the National Formulary and Hospital
Formulary, in line with the principles of the regulation.
Regarding the monitoring of temperature and drug storage, Dr. Sitanala Public
Hospital in Tangerang maintains the storage layout according to established standards.
Temperature monitoring is conducted regularly to ensure the quality and safety of
medications. The administration and evaluation of drugs involve meticulous recording and
reporting through various documents, including defect books and stock cards. Despite
challenges, such as migrating to a new administration system, efforts are made to ensure
drug availability and maintain administrative quality.
Overall, the practices described in the drug procurement and management
processes at Dr. Sitanala Public Hospital in Tangerang reflect efforts to comply with the
provisions of Regulation No. 76 of 2016. It is important to note that the implementation of
this regulation may vary among hospitals, and further evaluation can be conducted by
detailing internal policies and procedures at the hospital level.
In summary, the drug procurement and management processes at Dr. Sitanala
Public Hospital in Tangerang emphasize the central role of the pharmacy installation,
coordination among related units, and ongoing evaluation to ensure the availability of
drugs according to patient needs. In the context of regulations, the implementation of these
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practices complies with the principles regulated by Regulation No. 76 of 2016, which
emphasizes pharmaceutical service standards in hospitals.
Conformity to Theory and Regulations
1) Medicine Selection
The drug selection practices at Dr. Sitanala Public Hospital in Tangerang
City demonstrate the effective application of health management and
interdisciplinary pharmacy theory through collaboration between the Head of the
Pharmacy Installation, doctors, and nurses. This approach aligns with the findings
of research by Manojlovich et al. (2016) and Mekonnen et al. (2016), which highlight
the importance of interprofessional communication in enhancing medication safety
and reducing medication errors. These practices are also in accordance with the
principles outlined in Regulation of the Minister of Health No. 76 of 2016,
emphasizing the importance of comprehensive and effective drug management in
healthcare facilities. Thus, Dr. Sitanala Public Hospital not only adopts best practices
based on the latest theories and research in the field of pharmacy and health
management but also complies with government regulations to ensure the provision
of effective, efficient, and safe services to patients, in accordance with applicable
health policy standards.
2) Medicine Planning
The drug needs planning process at Dr. Sitanala Public Hospital
demonstrates the application of a structured and effective pharmacy management
model, aligned with pharmacy management theory and the standards of Regulation
of the Minister of Health No. 76 of 2016. The interdisciplinary collaboration
involving the Head of the Pharmacy Installation, doctors, and nurses underscores the
importance of team cooperation and effective communication, supporting theories
presented by McLaughlin & Kaluzny (2017) and research findings by Pedersen et
al. (2016). This practice illustrates how the integration of pharmacy services with
healthcare services can create an evidence-based and efficient service provision
system. Despite facing challenges such as changes in doctors' decisions and
difficulties in coordinating Pharmacy and Therapeutics Committee (PTC) meetings,
this indicates room for improvement in risk management and quality control aspects,
referring to the principles outlined in the Regulation of the Minister of Health. This
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reaffirms the importance of ongoing evaluation and adjustment in the pharmacy
management system to achieve optimal and safe service standards for patients.
3) Procurement
The drug procurement strategy at Dr. Sitanala Public Hospital reflects the
application of supply chain management and effective pharmacy management
principles, in line with existing theories and the regulations of Ministry of Health
Regulation No. 76 of 2016. The process includes structured budget planning, setting
realistic Own Estimate Prices (OEP), using e-catalogs, and efficient warehouse
management, following principles described by Schneller and Smeltzer (2006). The
approach emphasizes the importance of interdepartmental coordination, planning
based on accurate data, and fair pricing to ensure efficiency in drug procurement.
Moreover, the drug procurement strategy at Dr. Sitanala Public Hospital also adheres
to Ministry of Health Regulation No. 76 of 2016, highlighting the importance of
transparent procurement, drug quality monitoring, and the utilization of information
technology to improve the quality and safety of medication use. These practices
demonstrate Dr. Sitanala Public Hospital's commitment to implementing efficient
pharmacy management in compliance with health standards, ensuring that patient
needs are met in a responsible and sustainable manner.
4) Reception
The drug reception procedure implemented by Dr. Sitanala Public Hospital
underscores the importance of strict and structured procedures to ensure the quality
and safety of medications. Steps that include document verification, physical
checking of medications, and storage that meets temperature requirements and
environmental conditions reflect the application of effective pharmacy management
and quality control theories. This approach is supported by research in the field of
pharmacy, as outlined by Niazi (2019), which emphasizes the necessity of accurate
drug reception processes to eliminate the risk of counterfeit or expired drugs.
Furthermore, this practice aligns with Ministry of Health Regulation No. 76 of 2016,
which demands rigor in the reception and management of drugs in healthcare
facilities. Thus, Dr. Sitanala Public Hospital demonstrates the integration between
good pharmacy management principles, recent research, and adherence to national
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regulations in its drug reception procedures, showing their commitment to providing
safe and quality healthcare services.
5) Storage
The drug storage management in the pharmacy warehouse at Dr. Sitanala
Public Hospital reflects the application of efficient pharmacy management
principles, aligned with pharmacy theories related to drug stability and efficacy, and
complies with the standards of Ministry of Health Regulation No. 76 of 2016.
Practices such as appropriate temperature regulation and strict monitoring of
medication expiration dates emphasize the importance of maintaining storage
conditions to ensure drug safety and quality, in accordance with research by Khan &
Khan (2016). Ministry of Health Regulation No. 76 of 2016, which stresses the
maintenance of proper storage conditions and adaptive stock management, serves as
a crucial reference in the operations of the pharmacy warehouse at Dr. Sitanala
Public Hospital. Adherence to these standards demonstrates the hospital's
commitment to meeting drug safety and quality standards, highlighting the
importance of implementing good and adaptive pharmacy management practices to
enhance quality healthcare services.
6) Distribution
The drug distribution process at Dr. Sitanala Public Hospital demonstrates
alignment with pharmacy management and health logistics theories, as well as
compliance with Ministry of Health Regulation No. 76 of 2016. Drug procurement
through e-catalogs and meticulous inspection in the pharmacy warehouse underline
the importance of an organized procurement system, accurate stock control, and the
implementation of information technology to achieve efficiency and accuracy in
pharmacy management. Support for the transition to a more automated and modern
administration system is crucial, in line with research by Leape et al. (2012) that
highlights the limitations of manual recording methods in effective drug stock
management. This practice is consistent with Ministry of Health Regulation No. 76
of 2016, which emphasizes the importance of accurate procurement, reception,
recording, and reporting, as well as the use of information technology. Challenges
in adapting new technology reflect obstacles in following regulations and standards,
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underlining the need for systematic improvements in pharmacy management at Dr.
Sitanala Public Hospital.
7) Prescription
The prescription formulation process at Dr. Sitanala Public Hospital in
Tangerang City implements principles of prescription management and clinical
pharmacy, aligned with national health regulations. Strict prescription verification
steps, effective communication between pharmacy staff and medical personnel, and
patient education on medication use and side effects, are efforts to ensure safe and
effective treatment. This approach is supported by clinical pharmacy research by
Bates et al. (2018), demonstrating the importance of prescription verification and
interprofessional communication in reducing medication errors and enhancing
patient safety. The entire procedure also reflects compliance with Ministry of Health
Regulation No. 76 of 2016, which emphasizes the importance of disciplined
prescription management, patient education, and monitoring of side effects as crucial
aspects of hospital pharmacy practice. The practices at Dr. Sitanala Public Hospital
illustrate the application of current theories and regulations in clinical pharmacy
management to improve healthcare service quality.
8) Giving
The medication administration process at Dr. Sitanala Public Hospital in
Tangerang City is carried out by adopting strict and organized procedures, reflecting
the application of pharmacy management theory and clinical medication
administration practices, as well as complying with the standards of Ministry of
Health Regulation No. 76 of 2016. The procedural stages, which include preparation,
packaging, and delivery of medications, are executed with detailed checks to ensure
the safety and effectiveness of treatment. Patient education on how to use
medications and information about potential side effects emphasizes the importance
of the educational aspect in clinical pharmacy. Research by Bates et al. (2009)
supports this practice, indicating the significance of meticulous verification
procedures and patient education as key factors in reducing medication errors and
enhancing therapy success. The approach taken by Dr. Sitanala Public Hospital in
medication administration demonstrates a clear priority towards patient safety and
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126 DETECTOR - VOL. 2 NO. 3 AGUSTUS 2024
treatment success, in line with current principles in pharmacy management and
medication administration.
9) Drug Therapy Control and Monitoring
The drug control and therapy monitoring system implemented at Dr. Sitanala
Public Hospital demonstrates a comprehensive practice, in accordance with
principles of pharmacy management and quality control. This process involves
regular monitoring of drug stock, verification of physical conditions, as well as
monitoring expiration dates and side effects, supporting the principles of medication
safety and quality as emphasized by O'Leary et al. (2012) and Flynn et al. (2012).
An integrated reporting system supports continuous improvement initiatives in drug
management, reflecting compliance with national pharmacy management standards
as set out in Ministry of Health Regulation No. 76 of 2016. Although these practices
show a commitment to medication safety and quality, challenges such as policy
inconsistencies and limitations of information technology indicate a need for
improvement, especially in staff training and technology integration aspects.
10) Administration
The medication administration process at Dr. Sitanala Public Hospital in
Tangerang City implements principles of pharmacy management and health logistics
efficiency, in line with existing theoretical frameworks and Ministry of Health
Regulation No. 76 of 2016. The structured steps undertaken, from ordering to
information management, demonstrate the application of good pharmacy
management principles. The integration of information technology in the medication
administration process underscores Dr. Sitanala Public Hospital's efforts to enhance
efficiency and safety in drug management, supporting the findings of Poudel &
Nissen (2016) on the benefits of information technology in pharmacy management.
The consistency of these practices with pharmacy management theory and national
health regulations indicates the hospital's commitment to improving the quality and
safety of healthcare services.
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5. CONCLUSIONS
Conclusions
The research conducted at Dr. Sitanala Public Hospital in Tangerang City has
demonstrated that the pharmacy management practices at this hospital are overall in
alignment with the principles of health management and interdisciplinary pharmacy
theory, as well as compliance with the regulations set forth in Ministry of Health
Regulation No. 76 of 2016. From the process of drug selection to administration, all stages
emphasize the importance of a structured system, strict verification, and effective
interprofessional communication to ensure the safety and effectiveness of treatment.
Specifically, the processes of drug selection, needs planning, procurement,
reception, storage, distribution, drug control, and therapy monitoring, prescription
formulation, medication administration, and drug administration have been designed to
ensure the quality and safety of medications provided to patients, in line with the principles
of patient education and side effect monitoring. The alignment with pharmacy
management and quality control theories, as well as the application of information
technology, indicates efforts to enhance efficiency and accuracy in pharmacy management.
Challenges such as those in information technology and interdisciplinary
coordination indicate areas requiring improvement. However, the commitment to
continuous improvement and adherence to the standards of Ministry of Health Regulation
No. 76 of 2016 reflects Dr. Sitanala Public Hospital's dedication to enhancing the quality
of pharmacy management and providing better healthcare services.
In conclusion, Dr. Sitanala Public Hospital in Tangerang City has implemented a
comprehensive and efficient pharmacy management system that supports patient safety
and treatment effectiveness, in accordance with current principles in pharmacy and health
management, as well as applicable national health regulations.
Implications
This study makes a significant contribution to the development of drug supply
chain management theory in the hospital context, highlighting the importance of
integrating the National Formulary, the drug procurement process, availability in e-
catalogs, and the analysis of price and quality in optimizing drug management.
Furthermore, these findings shed light on how the local context affects the implementation
of national policies such as the National Formulary (FORNAS) and other health
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regulations, inviting a deeper perspective on the adaptation of drug supply chain strategies
by hospitals according to their unique needs and characteristics.
From a managerial standpoint, the results of this study offer valuable guidance in
the aspect of drug management, emphasizing the need for efficient drug inventory
management. This includes considerations for drug availability in e-catalogs, affordability,
handling shortages of generic drugs, and adapting to local disease patterns. These
implications suggest the importance of tailoring the Hospital Formulary with
considerations for local disease patterns, patient economic levels, and hospital
specifications. The adoption of modern technology such as e-catalog and e-purchasing
systems is highlighted as a key factor in enhancing efficiency and transparency in drug
procurement. In addressing financial constraints, particularly related to drug pricing, a
collaborative strategy between managers and the quality and cost control team is
recommended to ensure effective and efficient drug purchasing.
Suggestions
Based on the analysis and findings from this study, several strategic
recommendations and future research directions for Dr. Sitanala Public Hospital in
Tangerang City and other healthcare institutions are identified. First, enhancing
collaboration with health associations at various levels can enrich knowledge and practices
in health management, facilitating the exchange of resources that can improve service
quality. Second, continuous investment in health information technology, such as advanced
patient data management systems, electronic medical records, and telemedicine platforms,
is necessary to enhance service efficiency and accessibility. Third, the development of
human resources through ongoing training and education for both medical and non-
medical staff is crucial to ensuring high-quality healthcare services.
Furthermore, future research could focus on analyzing the impact of the Hospital
Formulary on patient outcomes, treatment costs, and drug procurement efficiency.
Comparative studies of Formularies in hospitals with different characteristics could
provide deeper insights into the influence of disease patterns and economic levels on drug
selection. Additionally, analyzing the role of technology in the drug and medical
equipment procurement process, such as the effectiveness of e-catalogs and e-purchasing,
will offer further understanding of how to improve procurement processes to achieve better
efficiency, transparency, and cost control.
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