The Roots Cause of the Drug Shortage and Expired Drug Problem at Hospital X
DOI:
https://doi.org/10.18196/jmmr.v13i1.46Keywords:
Drug stockout, Expired drug, Fishbone diagram, Hospital pharmacy department, InterviewAbstract
Good drug management in the Hospital Pharmacy Installation is the key to the smooth running of pharmaceutical services. The availability of the necessary drugs at the right time and place affects patient safety and satisfaction. Empty drugs and expired drugs are problems in drug management, mainly Hospital X. Empty drugs result in the replacement of drugs in prescriptions, thus increasing the burden on pharmaceutical services and creating risks for patient safety. Expired drugs cause hospital losses. This study aims to describe the root cause of drug shortages and expired drugs in Hospital X. The research used a qualitative approach to dig deeper into these complex problems—elicitation of data using semi-structured interviews supported by secondary data from the hospital. Data were analyzed using a Fishbone diagram to get a systematic overview of the root causes of problems based on specific domains. The root causes of expired drug problems and empty drug substitution in Hospital X are materials/inputs, methods, people, machinery/equipment, measurement (process evaluation), and the pharmacy facility environment domains.
References
Advistasari, Y. D., Lutfan, & Pudjaningsih, D. (2015). Evaluasi Sistem Informasi Manajemen Farmasi Menggunakan D & M Is Success Model Untuk Mendukung Pengelolaan Obat Di RSUD Kota Semarang. Jurnal Manajemen Dan Pelayanan Farmasi, 5(4), 219–224. https://jurnal.ugm.ac.id/jmpf/article/view/29512
Al-Dosaari, D., Al-Zaagi, I., Salem, S., Al-Bedah, A., & Qureshi, N. (2016). Medication Errors and Root Causes Analysis: Emerging Views and Practices in King Saud Medical City, Riyadh, Saudi Arabia. British Journal of Pharmaceutical Research, 13(1), 1–18. https://doi.org/10.9734/BJPR/2016/28742
Al-Zaagi, I., Al-Dossari, D., Salem, S., & Qureshi, N. (2015). Medication Safety Unit Programs in King Saud Medical City, 2012 – 2013: Safe Medication Management and Use with a Focus on Patient Safety. British Journal of Medicine and Medical Research, 8(5), 384–407. https://doi.org/10.9734/BJMMR/2015/17221
Alnahas, F., Yeboah, P., Fliedel, L., Abdin, A. Y., & Alhareth, K. (2020). Expired Medication: Societal, Regulatory and Ethical Aspects of a Wasted Opportunity. International Journal of Environmental Research and Public Health, 17(3), 787. https://doi.org/10.3390/ijerph17030787
AlRuthia, Y. S., AlKofide, H., AlAjmi, R., Balkhi, B., Alghamdi, A., AlNasser, A., Alayed, A., Alshammari, M., Alsuhaibani, D., & Alathbah, A. (2017). Drug shortages in large hospitals in Riyadh: a cross-sectional study. Annals of Saudi Medicine, 37(5), 375–385. https://doi.org/10.5144/0256-4947.2017.375
Alruthia, Y. S., Alwhaibi, M., Alotaibi, M. F., Asiri, S. A., Alghamdi, B. M., Almuaythir, G. S., Alsharif, W. R., Alrasheed, H. H., Alswayeh, Y. A., Alotaibi, A. J., Almeshal, M., Aldekhail, S. N., Alhusaini, A., Alrashed, S. A., Alrumaih, A. M., Dahhas, M. A., Alghamdi, M. A., Aleheidib, M. S., Alhaidari, M. H., … Alshamsan, A. (2018). Drug shortages in Saudi Arabia: Root causes and recommendations. Saudi Pharmaceutical Journal, 26(7), 947–951. https://doi.org/10.1016/j.jsps.2018.05.002
Antari, N. P. U., Agustini, N. P. D., & Suena, N. M. D. S. (2021). The Performance Differences Between High and Low Sales Turnover Community Pharmacies. Jurnal Administrasi Kesehatan Indonesia, 9(2), 135. https://doi.org/10.20473/jaki.v9i2.2021.135-149
Bachtiar, M. A. P., Germas, A., & Andarusito, N. (2019). Analisis Pengelolaan Obat di Instalasi Rawat Inap Rumah Sakit Jantung Bina Waluya Jakarta Timur Tahun 2019. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI), 3(2), 119–130. http://ejournal.urindo.ac.id/index.php/MARSI/article/view/545
Batari, A. D., & Amir, A. (2021). Penerapan Failure Mode Effect Analysis (FMEA) pada Pengadaan Obat untuk Menurunkan Kejadian Obat Kosong di Rumah Sakit umum Daerah Pusat DR. Wahidin Sudirohusodo Makassar. The Journal of Hospital Accreditation, 04, 45–50.
Boboia, A. (2019). Research on Applying Risk Management in the Field of Quality in Order to Improve the Pharmacy Activity. I. Applying Quality Management Methods to Highlight the Causes That Can Lead to Risks of Errors in Activities Performed by the Pharmacist in Pharmacy. FARMACIA, 67(6), 1106–1115. https://doi.org/10.31925/farmacia.2019.6.25
Bowles, S. K. (2019). Drug Shortages: More than Just Background Noise. The Canadian Journal of Hospital Pharmacy, 72(1), 3–4. https://doi.org/10.4212/cjhp.v72i1.2860
Byrne, D. (2022). A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Quality & Quantity, 56(3), 1391–1412. https://doi.org/10.1007/s11135-021-01182-y
Caulder, C. R., Mehta, B., Bookstaver, P. B., Sims, L. D., & Stevenson, B. (2015). Impact of Drug Shortages on Health System Pharmacies in the Southeastern United States. Hospital Pharmacy, 50(4), 279–286. https://doi.org/10.1310/hpj5004-279
Ceylan, Z., & Bulkan, S. (2017). Drug Inventory Management of a Pharmacy using ABC and VED Analysis. Eurasian Journal of Health Technology Assessment Corresponding Author: Zeynep CEYLAN, 2(1), 13–18.
Chen, E., Goold, S., Harrison, S., Ali, I., Makki, I., Kent, S. S., & Shuman, A. G. (2021). Drug shortage management: A qualitative assessment of a collaborative approach. PLOS ONE, 16(4), e0243870. https://doi.org/10.1371/journal.pone.0243870
Daina, L. G., Sabău, M., Daina, C. M., Neamțu, C., Tit, D. M., Buhaș, C. L., Bungau, C., Aleya, L., & Bungau, S. (2019). Improving performance of a pharmacy in a Romanian hospital through implementation of an internal management control system. Science of The Total Environment, 675, 51–61. https://doi.org/10.1016/j.scitotenv.2019.04.231
Dave, C. V., Pawar, A., Fox, E. R., Brill, G., & Kesselheim, A. S. (2018). Predictors of Drug Shortages and Association with Generic Drug Prices: A Retrospective Cohort Study. Value in Health, 21(11), 1286–1290. https://doi.org/10.1016/j.jval.2018.04.1826
De Weerdt, E., De Rijdt, T., Simoens, S., Casteels, M., & Huys, I. (2017). Time spent by Belgian hospital pharmacists on supply disruptions and drug shortages: An exploratory study. PLOS ONE, 12(3), e0174556. https://doi.org/10.1371/journal.pone.0174556
Dewi, E. K., Dahlui, M., Chalidyanto, D., & Rochmah, T. N. (2020). Achieving cost-efficient management of drug supply via economic order quantity and minimum-maximum stock level. Expert Review of Pharmacoeconomics & Outcomes Research, 20(3), 289–294. https://doi.org/10.1080/14737167.2019.1633308
Dyahariesti, N., & Yuswantina, R. (2017). Evaluasi Keefektifan Penggelolaan Obat di Rumah Sakit. Media Farmasi Indonesia, 14(1), 1–8. http://stifar.ac.id/ojs/index.php/MFI/article/view/109/90
Eme, O., Ugboaja C. A., U., Uwazuruike, F. O., & Uka Ukpai, C. (2018).Computer–based Drug Sales and Inventory Control System and its Applications in Pharmaceutical Stores. International Journal of Education and Management Engineering, 8(1), 30–39. https://doi.org/10.5815/ijeme.2018.01.04
Fatima, S. A., & Khaliq, A. (2017). A Survey Regarding Drug Shortage in Tertiary Care Hospitals of Karachi, Pakistan. Journal of Pharmacy Practice and Community Medicine, 3(4), 262–266. https://doi.org/10.5530/jppcm.2017.4.69
Febreani, S. H., & Chalidyanto, D. (2016). Pengelolaan Sediaan Obat Pada Logistik Farmasi Rumah Sakit Umum Tipe B di Jawa Timur. Jurnal Administrasi Kesehatan Indonesia, 4(2), 136. https://doi.org/10.20473/jaki.v4i2.2016.136-145
Gizaw, T., & Jemal, A. (2021). How is Information from ABC–VED–FNS Matrix Analysis Used to Improve Operational Efficiency of Pharmaceuticals Inventory Management? A Cross-Sectional Case Analysis. Integrated Pharmacy Research and Practice, Volume 10, 65–73. https://doi.org/10.2147/IPRP.S310716
Hariani, H., Fitriani, A. D., & Sari, M. (2022). Manajemen Pengelolaan Obat di Instalasi Farmasi Rumah Sakit Umum Daerah dr. Zubir Mahmud Kabupaten Aceh Timur Tahun 2021. MIRACLE Journal, 2(1), 49–66. https://doi.org/10.51771/mj.v2i1.242
Himawan, V. B., Fitriasari, N., & Widyassari, A. (2018). System Effectivity of Pharmacy Services Queue Time in Outpatient Pharmacy Depot RSD Dr. Soebandi Jember. Health Notion, 2(5), 602–606. http://heanoti.com/index.php/hn/article/view/hn20517
Indarti, T. R., Satibi, & Yuniarti, E. (2019). Pengendalian Persediaan Obat dengan Minimum-Maximum Stock Level di Instalasi Farmasi RSUP Dr. Sardjito Yogyakarta. Jurnal Manajemen Dan Pelayanan Farmasi (Journal of Management and Pharmacy Practice), 9(3), 192–202. https://doi.org/10.22146/jmpf.45295
Indonesian Ministry of Health. (2014). Peraturan Menteri Kesehatan RI Nomor 56 Tahun 2014 tentang Klasifikasi dan Perizinan Rumah Sakit.
Indonesian Ministry of Health. (2016). Peraturan Menteri Kesehatan Republik Indonesia Nomor 72 Tahun 2016 tentang Standar Pelayanan Kefarmasian di Rumah Sakit. In Kementerian Kesehatan Republik Indonesia. Kementerian Kesehatan Republik Indonesia. http://farmalkes.kemkes.go.id/?wpdmact=process&did=NDA5LmhvdGxpbms=
Kamba, P. F., Ireeta, M. E., Balikuna, S., & Kaggwa, B. (2017). Threats posed by stockpiles of expired pharmaceuticals in low- and middle-income countries: a Ugandan perspective. Bulletin of the World Health Organization, 95(8), 594–598. https://doi.org/10.2471/BLT.16.186650
Karimah, C., Arso, S. P., & Kusumastuti, W. (2020). Analisis Pengelolaan Obat pada Tahap Pengadaan di Rumah Sakit Roemani Muhammadiyah Semarang. Jurnal Kesehatan Masyarakat (e-Journal), 8(2), 182–187. http://ejournal3.undip.ac.id/index.php/jkm
Kuruc Poje, D., Kifer, D., Huys, I., Miranda, J., Jenzer, H., Miljković, N., Hoppe-Tichy, T., Bochniarz, M., Frontini, R., Schwartz, D. G., Vujić-Aleksić, V., Nežić, L., Rinaki, E., Tzimis, L., Green, K., Jovanić, J., Carić, B., Mandić, D., Vilić, K., … Marušić, S. (2021). Patients perspectives on drug shortages in six European hospital settings – a cross-sectional study. BMC Health Services Research, 21(1), 689. https://doi.org/10.1186/s12913-021-06721-9
Kusmini, K., Satibi, S., & Suryawati, S. (2016). Evaluasi Pelaksanaan e-purchasing Obat pada Dinas Kesehatan Kabupaten/Kota di Jawa Tengah Tahun 2015. JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice), 6(4), 277. https://doi.org/10.22146/jmpf.357
Liliana, L. (2016). A new model of Ishikawa diagram for quality assessment. IOP Conference Series: Materials Science and Engineering, 161(1), 012099. https://doi.org/10.1088/1757-899X/161/1/012099
Liska Marlindasari, MGS Aritonang, & Tedy Herdiana. (2020). HUBUNGAN PENGELOLAAN OBAT INSTALASI FARMASI TERHADAP KUALITAS PELAYANAN KESEHATAN DAN DAMPAKNYA TERHADAP KINERJA RSUD XYZ. Borneo Journal of Pharmascientech, 4(1), 71–79. https://doi.org/10.51817/bjp.v4i1.284
Mahdiyani, U. et al. (2018). Evaluasi Pengelolaan Obat Tahap Perencanaan dan Pengadaan di RSUD Muntilan Kabupaten Magelang Tahun 2015 – 2016. JMPF, 8(1), 24–31.
Mahmodabadi, A., D., Langarizadeh, M., Mehrjardi, M., H., M., & Emadi, S. (2019). Development of managerial key performance indicators for a hospital pharmacy digital dashboard. Iranian Journal of Pharmaceutical Research, 18(4), 2124–2130. https://doi.org/10.22037/ijpr.2019.1100822
Mahmodabadi, A. D., Langarizadeh, M., Mehrjardi, M. H. M., & Emadi, S. (2019). Development of managerial key performance indicators for a hospital pharmacy digital dashboard. Iranian Journal of Pharmaceutical Research, 18(4), 2124–2130. https://doi.org/10.22037/ijpr.2019.1100822
Mauliana, M., Wiryanto, W., & Harahap, U. (2020). Evaluation of Drug Management Achievement in Pharmacy Installation of Langsa General Hospital. Asian Journal of Pharmaceutical Research and Development, 8(1), 86–93. https://doi.org/10.22270/ajprd.v8i1.648
Michael, I., Ogbonna, B., Sunday, N., Anetoh, M., & Matthew, O. (2019). Assessment of disposal practices of expired and unused medications among community pharmacies in Anambra State southeast Nigeria: a mixed study design. Journal of Pharmaceutical Policy and Practice, 12(1), 12. https://doi.org/10.1186/s40545-019-0174-1
Nina, Y., & Hakim, I. M. (2020). Lean Hospital Approach for Improving The Process of Taking Drug Services in Outpatient Pharmacy Installations. IOP Conference Series: Materials Science and Engineering, 1003(1), 012105. https://doi.org/10.1088/1757-899X/1003/1/012105
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for Reporting Qualitative Research. Academic Medicine, 89(9), 1245–1251. https://doi.org/10.1097/ACM.0000000000000388
Obeidat, B. Y., Al-Hadidi, A., Tarhini, A., & Masa’deh, R. (2017). Factors affecting strategy implementation. Review of International Business and Strategy, 27(3), 386–408. https://doi.org/10.1108/RIBS-10-2016-0065
Phuong, J. M., Penm, J., Chaar, B., Oldfield, L. D., & Moles, R. (2019). The impacts of medication shortages on patient outcomes: A scoping review. PLOS ONE, 14(5), e0215837. https://doi.org/10.1371/journal.pone.0215837
Poulsen, J. H., Dieckmann, P., Clemmensen, M. H., & Nørgaard, L. S. (2022). Drug shortages in hospitals: Actors’ perspectives. Research in Social and Administrative Pharmacy, 18(4), 2615–2624. https://doi.org/10.1016/j.sapharm.2021.05.001
Pratomo, G. S., Umaternate, A., & Febriani, T. (2018). Evaluasi Ketersediaan Obat Instalasi Farmasi Rumah Sakit Islam PKU Muhammadiyah Palangka Raya. Borneo Journal of Pharmacy, 1(1), 51–55. https://doi.org/10.33084/bjop.v1i1.400
Purwidyaningrum, I. ka. (2011). Analisis Distribusi Obat Rawat Inap di Instalasi Farmasi RSUD Tarakan Jakarta Pusat. Jurnal Farmasi Indonesia, 8(1), 12–19.
Saha, T., Bhuiya, R. H., Masum, Z. U., Islam, M. R., & Chowdhury, J. A. (2018). Hospital Pharmacy Management System and Future Development Approaches in Bangladeshi Hospital. Bangladesh Pharmaceutical Journal, 20(2), 180–187. https://doi.org/10.3329/bpj.v20i2.37883
Said, A., Goebel, R., Ganso, M., Zagermann-Muncke, P., & Schulz, M. (2018). Drug shortages may compromise patient safety: Results of a survey of the reference pharmacies of the Drug Commission of German Pharmacists. Health Policy, 122(12), 1302–1309. https://doi.org/10.1016/j.healthpol.2018.09.005
Saputra, W. A., Puspandari, D. A., & Kurniawan, M. F. (2019). Evaluasi Pengadaan Obat dengan e-purchasing melalui e-catalogue di Rumah Sakit Jiwa Grhasia Daerah Istimewa Yogyakarta Tahun 2017-2018. Jurnal Kebijakan Kesehatan Indonesia, 8(3), 113–120.
Seetharaman, B. (2016). Sampling and Methods of Data Collection in Qualitative Research. 17(2).
Shaban, H., Maurer, C., & Willborn, R. J. (2018). Impact of Drug Shortages on Patient Safety and Pharmacy Operation Costs. Federal Practitioner : For the Health Care Professionals of the VA, DoD, and PHS, 35(1), 24–31. http://www.ncbi.nlm.nih.gov/pubmed/30766319%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC6248141
Shukar, S., Zahoor, F., Hayat, K., Saeed, A., Gillani, A. H., Omer, S., Hu, S., Babar, Z.-U.-D., Fang, Y., & Yang, C. (2021). Drug Shortage: Causes, Impact, and Mitigation Strategies. Frontiers in Pharmacology, 12(July), 1–18. https://doi.org/10.3389/fphar.2021.693426
Siswishanto, R., Kristin, E., & Aluicius, I. E. (2022). MANAJEMEN PERSEDIAAN OBAT DENGAN PENDEKATAN PERIODIC REVIEW SYSTEM. Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management), 24(04), 115–121. https://doi.org/10.22146/jmpk.v24i04.4167
Susanto, A. K., Citraningtyas, G., & Lolo, W. A. (2017). Evaluasi Penyimpanan dan Pendistribusian Obat di Gudang Instalasi Farmasi Rumah Sakit Advent Manado. Pharmacon Jurnal Ilmiah Farmasi, 6(4).
Taddele, B. W., Wondimagegn, A. A., Asfaw Asaro, M., Sorato, M. M., Gedayi, B. G., & Hailesilase, A. A. (2019). ABC-VEN Matrix Analysis of the Pharmacy Store in a Secondary Level Health Care Facility in Arbaminch Town, Southern Ethiopia. Journal of Young Pharmacists, 11(2), 182–185. https://doi.org/10.5530/jyp.2019.11.38
Vogler, S., & Fischer, S. (2020). How to address medicines shortages: Findings from a cross-sectional study of 24 countries. Health Policy, 124(12), 1287–1296. https://doi.org/10.1016/j.healthpol.2020.09.001
Yigit, V. (2017). Medical Materials Inventory Control Analysis at University Hospital in Turkey International Journal of Health Sciences and Research Medical Materials Inventory Control Analysis at University Hospital in. International Journal of Health Sciences and Research, 7(1), 5–10.
Zwaida, T. A., Pham, C., & Beauregard, Y. (2021). Optimization of Inventory Management to Prevent Drug Shortages in the Hospital Supply Chain. Applied Sciences, 11(6), 2726. https://doi.org/10.3390/app11062726
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