International Journal of Engineering Business

and Social Science

Vol. 1 No. 06, July-August 2023, pages: 673-681

e-ISSN: 2980-4108, p-ISSN: 2980-4272

https://ijebss.ph/index.php/ijebss

673

Drug Logistics Service Management

In Regional General Hospital Pharmacy Installations

(Hospital) Undata Palu

Angriani

, Nuraisyah Ambo

, Nawawi Nasir

, Nuraisyah

Dandan Haryono

, Abdul Rivai

, Nasrullah

, Ani Susanti

1,2,3,4,5,6,7,8

Universitas Tadulako, Indonesia

Email: angr[email protected] , nuraisyah[email protected] , dandanharyono@gmail.com

Keywords

Abstract

Management, Planning,

Organizing, Directing,

Supervision

This study aims to determine and analyze the Management of Drug Logistics Services

at the Pharmaceutical Installation of Undata Palu Regional Public Hospital (RSUD). The

theory used in this study is Siagian's theory which suggests that management is an

activity of planning, organizing, directing and supervising carried out by each

organization coordinating various data sources owned to achieve the goals set effectively

and efficiently. This research method uses qualitative research that produces descriptive

data through in-depth interviews in the form of written or oral statements of people and

their observable actions. The location of this research is at the pharmaceutical installation

of Undata Palu Regional Public Hospital. There were 5 informants selected using

purposive methods. Data collection is carried out by interviews, observation, and

documentation. Based on the results of the analyzed research in accordance with the

management function ranging from planning, organizing, directing and supervising, at

the planning stage in terms of procurement, storage and distribution of drugs has not

gone well. Procurement of drugs in delivery takes 2-3 weeks, It is due to the expedition

route from outside the city of Palu. This results in drug vacancies, consequently patient

prescriptions are not served. Drug storage has not been maximized with less large

warehouse space. The distribution of drugs has not been maximized seen from the empty

drug stock. Organizing has been done effectively with human resources as expected. The

direction is carried out by the head of the pharmaceutical installation who coordinates

with the supporting fields in directing employees to work properly. Supervision is carried

out through internal meetings and quarterly meetings that discuss performance reporting,

achievements and constraints that occur in the field by coordinating with supporting

fields.

for possible open access publication

under the terms and conditions of the Creative Commons Attribution (CC BY SA)

license (https://creativecommons.org/licenses/by-sa/4.0/).

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1. Introduction

Towards a healthy Indonesia 2025 is a health development goal in increasing awareness, hope, and advantages

of healthy living for all people so as to achieve an increase in the degree of public health. The creation of a society

that lives morally in a healthy environment, is entitled to good, balanced, comprehensive health services, and has the

highest level of health in the world. I Territory of the Republic of Indonesia (Ministry of Health of the Republic of

Indonesia, 2009).

Health efforts in supporting and improving health aimed at realizing good health conditions for the

community. Health efforts are carried out through methods of health promotion (promotion), prevention (prevention),

treatment (treatment) and recovery (rehabilitation), which are carried out comprehensively, integrated, affordable and

sustainable. The concept of unity of health efforts is a guideline for health institutions in Indonesia, one of which is

hospitals. The hospital is a health service referral with the main function in healing and recovery. (Bramantoro, 2017)

Health services in hospitals are in the form of outpatient unit services, inpatient, emergency room and medical

services and medical support services. One of the medical support services is pharmaceutical services that have been

regulated in the Indonesian Constitution Number 44 of 2009 concerning Hospitals. Pharmaceutical services have been

regulated in PERMENKES Number 58 of 2014 concerning Pharmaceutical Service Standards. Pharmaceutical

installations are an important sector in the main health services of hospitals. Hospitals cannot work properly if the

hospital does not have medicine. Pharmaceutical installations have a major impact on hospitals and various other

healthcare organizations. (Permenkes No. 58 of 2014)

Pharmaceutical services are supporting services that provide (revenue center) revenue center for hospitals,

seeing that more than 90% of health services in hospitals use pharmaceutical supplies ranging from drugs, chemicals,

radiology materials, medical devices consumables, medical devices, and medical gases. 50% of all hospital income

comes from pharmaceutical supply management (Satrianegara et al., 2018)

Drug management in hospitals is very important because more than 90% of medical services in hospitals use

drugs, so the availability of drugs is a very important indicator. Drug vacancies, running out of drugs or stacking drug

storage can affect economically and medically, so it requires good effective and efficient drug management (Satibi,

2016).

Based on initial observations that the management of drug services at the Undata Palu General IFRS has not

been optimal. Starting from the planning, from the aspects of procurement, receiving, storing, distributing, eliminating,

and evaluating. Planning for drug needs every year has not been carried out effectively according to the available

budget. Drug procurement has not been carried out efficiently because there are still problems regarding delayed or

empty drug availability stocks at pharmaceutical service depots. This causes there are still patients who have to

postpone giving their drugs and have to buy drugs to outside pharmacies, as a result prescriptions are not served and

there are still many drugs needed by patients are not available so that it seems that the hospital is not able to carry out

drug management properly so that it has an impact on the delay in patient first aid, so that the level of patient trust in

hospital services is reduced (Terry, 2010).

From the problems mentioned above, siagian theory can be used in studying existing problems. Siagian (2009)

suggests that management is an activity of planning, organizing, directing, and supervising carried out by each

organization coordinating various resources owned to achieve the goals set effectively and efficiently. Until the author

is interested in raising the title "Management of Drug Logistics Services at Regional General IFRS (RSUD) Undata

Palu (Siagian, 2003).

2. Materials and Methods

This research was used to gain a deeper understanding of drug logistics service management in hospitals at

Undata Hospital Palu. This study uses qualitative research that produces descriptive data through in-depth interviews

in the form of written or oral statements of people and their observable actions. The informants in this study are:

1. Head of Pharmaceutical Installation Undata Hospital Palu

2. Head of Support

3. Chief Logistics Officer

4. Head of Outpatient Depot

5. Technical Implementation Officer of Activities

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The data collection process is the most important process in research because the main purpose of research is

to obtain data. A data source is anything that can provide information about related research. The data used in this

study used two types of data sources, namely: primary data and secondary data (Lexy, 2007).

The data analysis technique in qualitative research is the data analysis of the Miles and Huberman model.

According to Miles and Huberman (Sugiyono, 2018) stated that, "Activities in qualitative data analysis are carried out

interactively and take place continuously until complete". Data analysis techniques used by the study using the Miles

and Huberman model: data collection, data reduction, data presentation, and data verification.

This research refers to the theory of Siagian (2009), which explains that the management function is planning,

organizing, directing and supervising, then the conceptual definition of this research is the implementation of drug

logistics service management at the pharmaceutical installation of Undata Palu Hospital which includes planning,

organizing, directing and supervising (Siagian, 2003).

3. Results and Discussions

Pharmaceutical services in hospitals have been regulated in PERMENKES Number 72 of 2016 concerning

Pharmaceutical Service Standards in Rumah Sakit. Pharmaceutical installations are an important part of the hospital

sector. Hospitals will find it difficult to carry out activities if drugs are not available in the hospital. The management

of drug services was carried out at the Faramasi installation of Undata Hospital Palu as explained by Siagian (2009),

who explained that the management function is planning, organizing, directing and supervising.

1. Planning

Planning is a process that involves various kinds of efforts made to anticipate future or future trends and

determine the right strategy to realize the targets and goals of the organization or institution. Planning carried out at

the Pharmaceutical Installation of Undata Hospital, Central Sulawesi Province, is usually carried out planning starting

from the source of funds, human resources, obstacles faced and what steps must be taken. Drug and medical equipment

and consumables (BMHP) planning is made in the annual Requirement Proposal which will be used for the next year's

drug expenditure budget. The next year's drug needs must be based on the Hospital formulary and have been calculated

based on the Drug Needs considered from consumption patterns, memorability patterns and pharmaceutical supplies

that are still available and approved funds. (listed in the list of work unit budgets/DASK).

The informant named Bahria Ridwan, SKM. S.FT., M.A.P as Head of Medical Support stated:

"So the drug planning process at pharmaceutical installations has been made 1 year before the current year,

for example, drugs for 2023 mean that planning activities have been budgeted from 2022, usually at the beginning of

the year activities have started for spending from proposed needs every month." (interview, November 21, 2022).

The results of the interview proved that drug planning had been carried out at Undata Hospital Palu before an

order was made which was taken from the proposal for annual needs given by the Head of Pharmacy installation.

Planning from the aspects of procurement, restoration, storage, distribution, and deletion is very important. This is

needed to overcome in finding obstacles that hinder the implementation of the planned program.

The informant named Yunus Tobing, S.Si, Apt as Head of Pharmaceutical Installation stated:

"For planning for 1-year drug needs recorded, recapitulated based on the needs of each service unit or depot,

both doctors and other health workers" (interview, December 12, 2022)

The results of the interview conducted with the Head of Pharmaceutical Installation of Undata Hospital Palu

are that it is true that drug planning will be carried out 1 year before the procurement process takes place. Planning

based on the needs of each service unit.

Determine the amount of drug needed based on field needs.

The informant named Yunus Tobing, S.Si, Apt as Head of Pharmaceutical Installation stated:

"In determining the number of drug needs, it is based on the last drug stock, then based on the analysis system

by adjusting the number of patients. The number of patients treated is recorded recapitulative and determines the need

for drugs in the disease the most. From the number of doctor's prescriptions and how many drugs are often used, I as

the head of the installation will propose to the Kabid as a knowing person to proceed to PPTK to continue ordering"

(interview, December 12, 2022)

The results of the interview proved that the determination of the amount of drugs was based on the last drug

stock and the amount of drug use according to a doctor's prescription.

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The results of interviews conducted with informants, that planning is very important in determining the

amount of drug availability according to patient diagnoses, in the planning process it is necessary to have cooperation

from doctors and pharmaceutical depots in hospitals in the process of service management in pharmacies if in the

planning process there is an error it will cause problems that will be faced later where there will be drug vacancies in

pharmaceutical depots (Ketaren et al., 2023).

2. Procurement

The realization of the implementation of drug procurement and BMHP needed by hospitals is carried out by

the technical implementation committee of activities (PPTK) in coordination with IFRS and service units. PPTK

procures goods in accordance with the plans and requests from IFRS.

The logistics officer makes proposals for pharmaceutical needs according to the use and demand for

pharmaceutical needs from satellites, pavilions, poly, and other units by considering the existing hospital fomularium

and recording in the pharmacy briefing book. PPTK conducts procurement in accordance with the plan or request

needed. At the Pharmaceutical Installation of Undata Hospital, Central Sulawesi Province, procurement of drugs

through official distributors (verified and validated) was carried out by PPTK based on proposals from the

Pharmaceutical Installation. This is in accordance with the results of the study:

The informant named Yunus Tobing, S.Si, Apt as Head of Pharmaceutical Installation stated:

"Procurement of drugs is made according to the needs of users such as doctors, nurses and other health

workers and in the procurement process there is a so-called PPTK can correct drugs that are ordered a lot or a little.

I only submit proposals per month that see a lot of patient diagnoses and drug vacancies in the warehouse". (interview,

December 12, 2022)

From the results of procurement interviews conducted at Undata Hospital according to needs. Doctors, nurses

or other health workers are made in need every month. PPTK in this case helps to carry out the correction of drugs

ordered a lot or a little.

The informant was named Apt. Muhammad Tamrin Tahir. as the Technical Implementation Officer of Activities

stated:

"Procurement is carried out according to monthly proposals from pharmaceutical installations, many factors

must be considered and must be quickly executed because distributors for shipments come no longer than 2-3 weeks.

So that there can be a vacancy in the pharmaceutical warehouse" (interview, December 12, 2022

From the interview results, it is proven that the procurement process is carried out through monthly proposals

from pharmaceutical installations. However, there are obstacles faced by the procurement party such as the occurrence

of drug vacancies or the slow delivery process carried out by drug distributors, therefore hospitals must have solutions

in dealing with these problems.

One of the hospital solutions also collaborates with pharmacies outside the hospital, in this case, Apotik Kimia

Farma to overcome if the hospital's drug stock is empty.

The informant named Apt. Yerry Kuingu, S, Si, M.Kes as the Head of the Outpatient Depot stated:

"If empty drugs are given a delay sign and the telephone number of the person in charge of hospital drug logistics in

the etiquette and we also cooperate with Kimia Farma Pharmacy just in case the stock of drugs in the pharmaceutical

depot runs out / empty. If the drug is not also available in the pharmaceutical pharmacy, then we still provide the drug

if later the drug has entered the warehouse" (interview, January 24, 2023)

The results of the interview proved that there was cooperation with pharmacies to maintain drug vacancies at

the pharmaceutical installation depot. Empty drugs are given a delay mark on the etiquette or direct the patient to the

pharmaceutical chemical dispensary.

The informant named Apt. Enni Ratnasari, S.Farm as the Head of Logistics stated:

"Usually if there are empty drugs in the warehouse and there is a request from the pharmacy depot, it is

usually directed to the Kimia Farma Pharmacy, if indeed there is also no one in the Kimia Farma pharmacy, we delay

giving the medicine while waiting for the drugs to come in from PBF. (interview, January 09, 2023)

The results of the interview proved that, drug vacancies in pharmaceutical warehouses and pharmaceutical

depots directed patients to pharmacies kimia farma, if there were no kimia farma pharmacies, there would be delays in

administering drugs until waiting for drugs to enter from PBF.

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Procurement of drugs entering from PBF must also be considered and considered when purchasing starting

from the application accompanied by an inspection certificate, hazardous materials must include material safety data

sheets and pharmaceutical preparations, medical devices and consumables must have a distribution permit label and

an expiration period of at least 2 (two) years except for some drug preparations, medicinal products and edible

medicinal products (antibiotics, reagents, etc.).

The informant named Apt. Enni Ratnasari, S.Farm as the Head of Logistics stated :

"Drugs ordered according to the amount, the quality of the drug must be considered, the old expiration date,

packaging from distributors through expeditions keeps the goods undamaged" (Interview, January 9, 2023)

From the results of the interview conducted with the head of logistics in charge, namely the procurement of

drugs ordered according to the quantity, quality considered, and long expiration date. This is necessary to minimize

the occurrence of damage or a lot of expired drug buildup.

The results of interviews conducted with informants, in the procurement process at Undata Palu Hospital,

namely the procurement process carried out through E-catalog, in the procurement process are usually adjusted to

existing needs or according to planned needs. In the procurement process, PPTK can reduce or exceed the number of

drugs according to existing circumstances, but this procurement must also look at the quality of drugs and drug

expiration dates in order to reduce losses and must pay attention to the very long delivery process so that there is a

void of drugs in service.

Acceptance

Acceptance is an activity to ensure the suitability of the type, specifications, quantity, quality, delivery time

and price stated in the contract or order letter with the physical condition received.

The informant named Yunus Tobing, S.Si, Apt as Head of Pharmaceutical Installation stated:

"Before the goods are received, they must be checked by PPHP and the head of the person in charge of

logistics. Receipt of goods must be in accordance with the order letter, judging from the invoice when the goods arrive,

it is checked whether it is in accordance with the name, quantity and price according to the order letter.

Pharmaceutical supplies that do not comply with standards are returned to the distributor" (interview on December

12, 2022)

In the interview results, it was stated that the receipt of goods would take place through the PPHP inspection

process and the head of the logistics handler. Which goods must be in accordance with the order letter seen from the

quantity and name that matches the order because if it is not in accordance with it will be returned to the distributor.

Storage

Storage carried out using a fix position/location system means that the location of pharmaceutical supplies

remains as long as procurement is still being carried out and must not be shifted/moved when the condition of the

goods is empty. Grouping of pharmaceutical supplies by type of warranty, type of goods, dosage form, and storage

temperature.

The informant named Apt. Enni Ratnasari, S.Farm as the Head of Logistics stated:

"In the warehouse, drug storage is distinguished by the types of goods and preparations, even though the

storage exceeds the warehouse capacity and must be stored outside the warehouse, it is still distinguished and spaced

between doses of drug supplies from one another" (interview on January 9, 2023)

From the results of the interview, drug storage in the warehouse is dissected based on the type and preparation,

drug storage that exceeds the warehouse capacity so that storage outside the warehouse is still distinguished and given

a distance between doses of drug supplies from one another so that they can be distinguished.

Storage of drugs in medicine cabinets carried out at Undata Hospital, Central Sulawesi Province by classifying

drugs starting from the name of the drug, type, ambient temperature, FIFO / FEFO system and alphabetical system to

facilitate retrieval.

The informant named Apt. Enni Ratnasari, S.Farm as the Head of Logistics stated:

"Drug storage in our warehouse uses the FIFO (First In First Out) system rarely uses the First Expire First

Out (FEFO) system because the drugs ordered are still far from the ED time, store them alphabetically, enter and exit

drugs are recorded and entered in the system on the computer, store according to SOP even though there are still

shortcomings with less large warehouse space" (interview, January 09, 2023)

The results of the interview proved that the logistics storage of drugs in warehouses using the FIFO (First In

First Out) system rarely uses the First Expire First Out (FEFO) system because the drugs ordered are still far from the

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time of the ED, drugs in and out are recorded and entered in the system on the computer, the storage is alphabetical

(alphabet), if there is a drug name that is almost the same name, similar appearance and speech are marked LASA

(Look Alike Sound Alike, Storage is in accordance with SOP even though there are still shortcomings with less large

warehouse space.

Based on the interview conducted with the informant, that the drug storage carried out by pharmacy officer

RS Undata was in accordance with applicable regulations by storing drugs in accordance with applicable regulations.

Storage requires maintaining drug quality, avoiding unnecessary damage, maintaining continuity of supply, and

supporting drug availability. Storage is in accordance with SOP even though there are still shortcomings with less

large warehouse space.

Distribution

Distribution of drugs at the Pharmaceutical Installation of Undata Hospital, Central Sulawesi Province, to

patients according to individual prescriptions, be it outpatients, inpatients, IBS, IRD / IGD depots.

The informant named Apt. Yerry Kuingu, S, Si, M.Kes as the Head of the Outpatient Depot stated:

"Outpatient depot services serve based on a doctor's prescription and based on the prescription th