Medical Center

Chief

Chief Training
Officer

Medical Finance Office Admin Office Nursing

Dentistry Budget Human Resource Surgery

Emergency Room Cash Collection Physical Resource Medical

Ophthalmology Accounting General Services Pediatric

Radiology Billing & Claims Procurement Out Patient

Pediatrics Pharmacy
Medical Center Chief
Supports and approves all requirements necessary for the operation and
management of the hospital pharmacy
Chief Training Officer
Helps facilitate and accelerate learning throughout the organization. The CTO
directs the organization’s education, training, and development programs to empower
staff and ensure their maximum effectiveness and contribution to meet organizational
goals.
Admin Office
Supervises the overall operations and regulatory compliance of the hospital
Medical Department:
Closely coordinates with the pharmacist though the Pharmacy and Therapeutics
Committee on the selection and the proper use of drug.
Nursing
Regularly monitors medicine stored in wards. The provide the pharmacist, data
on medication errors, adverse drug experiences and other drug related concerns.

Cash Collection
Provides the Official Receipt to patients/ clients and presented to the pharmacist
as confirmation of payment for the drug
Budget Section
Provides allocation and Obligation Slip ALOBS as a assurance of funds for the
purchase of pharmacy supplies and requirements
Procurement
Facilitates procurement of supplies and materials needed in the hospital
pharmacy

Finance
 Analyzes the financial reports submitted by the pharmacist a that are used as
basis for the hospital pharmacy budget estimate.

Strength
An average pharmacist have an average of 6.5 years working in the hospital
18 out of 24 pharmacists are well experienced pharmacist. Most of them have 6.5 years
of experience in dispensing and organizing medicines. They are well trained in accounting and
dispensing the medicine needed by the public hospital, and they have earned the trust and
confidence of its patients. With its long years in operations, the organization is well experienced
in running the hospital. The Management Team of RMC can provide timely and appropriate
directions and guidance to the members of the organizations such that, it can implement
improvements and changes in the hospital in an orderly manner. They are able to share their
experience to the new pharmacist in Rizal Medical Center.

Years of Length of
Service Service

1-3 6

4-6 5
7-10 4
11-13 4
14-17 3

18-20 1
>20 1
 Years of
Personnel Education Back Ground
Experience
BS Pharmchy & MSc in Public
Felix Macandili 25
Management
MSc in Pharcmancy; BSc in
Amelia Manuel 19
Pharmacy
Norine Hernandez 16 BSc in Pharmacy
Angeline Pador 11 BSc in Pharmacy
Sanchita Bullido 12 BSc in Pharmacy
Lawrence
Tanagon 12 BSc in Pharmacy
Joy Falcon 10 BSc in Pharmacy
BSc in Pharmacy; Master in
Alvin Calucin
4 Business Administration
Eugenio
Sandoval 7 BSc in Pharmacy
Eloise Tura 4 BSc in Pharmacy
Mary Love Salve 3 BSc in Pharmacy
Emerson Viray 5 BSc in Pharmacy
Maria Segovia 6 BSc in Pharmacy
Julius Hermosa 4 BSc in Pharmacy
Princess Singh 5 BSc in Pharmacy
Dyan Geronimo 2 BSc in Pharmacy
Mark Daryll
Reyes 2 BSc in Pharmacy
Karen Salvador 1 BSc in Pharmacy
Marnelli Chan 1 BSc in Pharmacy
Karyl Dimaun 5 BSc in Pharmacy
Kevin Santiago 1 BSc in Pharmacy
Paul Legaspi 2 BSc in Pharmacy
Mark Galvez 3 BSc in Pharmacy
Domingo
Conulta 1 BSc in Pharmacy
 Years of
Personnel Education Back Ground
Experience
BS Pharmchy & MSc in Public
Felix Macandili 21
Management
MSc in Pharcmancy; BSc in
Amelia Manuel 17
Pharmacy
Norine Hernandez 12 BSc in Pharmacy
Angeline Pador 9 BSc in Pharmacy
Sanchita Bullido 7 BSc in Pharmacy
Lawrence
Tanagon 11 BSc in Pharmacy
Joy Falcon 8 BSc in Pharmacy
BSc in Pharmacy; Master in
Alvin Calucin
6 Business Administration
Eugenio
Sandoval 7 BSc in Pharmacy
Eloise Tura 15 BSc in Pharmacy
Mary Love Salve 4 BSc in Pharmacy
Emerson Viray 5 BSc in Pharmacy
Maria Segovia 6 BSc in Pharmacy
Julius Hermosa 4 BSc in Pharmacy
Princess Singh 5 BSc in Pharmacy
Dyan Geronimo 2 BSc in Pharmacy
Mark Reyes 8 BSc in Pharmacy
Karen Salvador 2 BSc in Pharmacy
Marnelli Chan 1 BSc in Pharmacy
Karyl Dimaun 1 BSc in Pharmacy
Kevin Santiago 1 BSc in Pharmacy
Paul Legaspi 2 BSc in Pharmacy
Mark Galvez 1 BSc in Pharmacy
Domingo
Conulta 1 BSc in Pharmacy
 Length of Service

>20

18-20
Lenth of Service

14-17

11-13

7-10

4-6

1-3

0 1 2 3 4 5 6 7 8
Number of People

The Pharmacy is 95% labelled

They Pharmacy is well labeled. They were able to label the racks layer by layer. The
medicine separator was carefully labeled; each cell has a label. Inside the refrigerator, the
transparent refrigerator was labeled. Nevertheless, they were not able to label their palettes.
These pallets are extra container that handles some of their big volume liquids.
Weakness
Almost 18.89 % of the doctor’s prescription are not readily available for inhouse patients
Since the major source of medicine stocks is the DOH, it is dependent on the government
agency's processes and timing, which is currently unstable, and on the quality of stocks. This
resulted to a total of 64,221 Emergency purchase in 2017 for in house patients to sustain. In some
cases, the pharmacy cannot provide the medicines needed since the supplier has not delivered
or not offered their products yet. The pharmacy can effectively dispense up to 79% of the
medications needed by the patients.
Month Filled UnFilled Filled Ratio
JAN 19804 4701 0.8081616
FEB 25492 5037 0.83500934
MAR 31432 7387 0.80970659
APR 25981 7533 0.77522826
MAY 16916 4329 0.79623441
JUN 18965 4365 0.81290184
JUL 21565 5412 0.79938466
AUG 27420 6495 0.80849182
SEP 28831 6186 0.82334295
OCT 27283 5196 0.84001971
NOV 22895 4640 0.8314872
DEC 11285 2940 0.79332162
277869 64221 0.8111075
Average

In the fiscal year of 2017, the pharmacy lost 216, 994 pesos due to expired medicine

A total of 1058 units medicine got expired. They are mostly vials an bottle form. These a mostly
in liquid form and they have a high value price per unit. They are mostly in Bottle form or in vials, some
are in tablet form but with a regular price only. The average price of these medicine around 120 pesos
each. The most expensive is the suction cutter since it’s a medical supply. The pharmacy was able to
avoid expiration of medicine during march, July, August September and October.

Date Qty Unit Description Price Total Cost

Dec-16 7 Bot Cetrizine Sysrup 500 mg ₱ ₱ 560.00
80.00
Jan-17 1 vl. Hepatitis B vaccine (Ped) ml. 90 ₱ 90.00
Feb-17 168 tab Famotidine 20 mg tab 35 ₱ 5,880.00
Feb-17 9 bot Cetirizine 10 mg/ml oral drops 85 ₱ 765.00
Feb-17 9 vial Hepatitis B: Vaccine 90 ₱ 810.00
Feb-17 1 bot PLR 500cc 30 ₱ 30.00
Apr-17 1 vl. Doxorubicin HCL 10 mg 150 ₱ 150.00
Apr-17 103 vl. Cefoxitin 1g Vial 285 ₱
29,355.00
May-17 5 pc Suction catheter f.12 7000 ₱
35,000.00
 Jun-17 16 vl. Rocuronium Bromide 10 mg/ml, 5 300 ₱ 4,800.00
ml
Jun-17 6 bot. Balance Multiple Replacement for 39 ₱ 234.00
Adult 1L
Jun-17 358 vl. Calcium Folinate 50 mg 200 ₱
71,600.00
Nov-17 9 bot.s Mebendazole 50 mg/ 10 ml 35 ₱ 315.00
Suspension
Dec-17 3 Vials Measles Vaccine 300 ₱ 900.00
Dec-17 19 Vials Amphotericin B 50 mg 3000 ₱
57,000.00
Jan-18 186 tab Methylergometrine maleate 30 ₱ 5,580.00
Jan-18 157 cap. Cefixime 200 mg 25 ₱ 3,925.00
Total ₱216,994.00
II. Review of Related Literature

The Department of Health (DOH) is responsible for developing health policies and programmes,
regulation, performance monitoring and standards for public and private sectors, as well as provision of
specialized and tertiary level care.

2.1 Introduction

This chapter discusses the importance of inventory management in public government hospitals.
Covering inventory models used in a public facility and inventory management practices used in public
hospitals is the main focus in this study to help manage and address the issue on expired medicines.
Redesigning, reengineering, and improving the inventory methods and optimization of consumable
medical supplies are also included to better analyze and improve system control. Finally, inventory
management will relate business process engineering, total quality management, automated computer-
based inventory system, and lean Inventory to the system study.

2.2 Inventory Management Principles

Inventory Management determines the time to restock critical medical items specifically medicines.
These items are surely and undoubtedly needed by patients once they enter and are recorded admitted
and accounted as confined in the hospital. As for non critical items such as supplies, they use a
deterministic inventory model in determining the quantity of medical items to restock. A deterministic
model assumes a constant rate of demand of medical items. In contrast, other critical medical items use
stochastic inventory model to predict the number of limited medicines that must be replenished. At
present, Jurado et. al. (2015) observed that stock management is a common problem in almost all
companies and organizations due to the uncertainties in the demand and delays in the deliveries. A
conservative solution must be made to avoid stockout in the inventory system. From the point of view
of healthcare sector, medicine management is the ability of healthcare and pharmaceutical
organizations to optimize the pharmaceuticals use. Some authors state that an appropriate
management of medicines must ensure patient safety in accordance with the five "R": the right product
or the right service to the right patient at the right time using the right way and in the right quantity
(Romero 2013).

2.3 Inventory Model used in Public Hospitals

According to Delaert and Poel (1996) Nowadays, there is much more interest in the actual costs of a
patient, but also in the purchasing costs and holding costs of the hospital's inventories. Public Hospital
are thinking of ways to account most of costs and find ways as to how can control these extra costs to
their healthcare institution. At present, Liu (2010) observed that general hospitals adopt the
fundamental inventory systems such as EOQ, JIT and ROP as their inventory practice. They are
commonly used by hospital to regulate the inflow and the outflow of materials in the hospitals. Each
Inventory systems have their own advantages and downsides. Among the three inventory systems
mentioned, Reorder point is the most commonly used because its parameters can easily determine the
timing as to when the material needs to be replenished the exact amount needed at the time of the
demand. However this model only limited to the demand distribution of an inventory. A model
predictive control can be used to handle multi-variable interactions, constraints on the problem
variables, and optimization requirements in a systematic manner(Jurado et. al. 2015).

2.4 Inventory Practice in Public Hospitals

According to Zhao Qian (2015), Public Hospitals do not really monitor the source of goods thus the
product offered by hospital are above the quality level. Public Hospitals struggling with under qualified
medicines since they have a low budget and full of inhouse patients. Another study showed that only
49% of the health facilities did not have out of stock of the tracer medicines. It only means that there is
more than half of the time that shortages of essential medicines, delayed deliveries, expiry of essential
medicines, concerns about quality of the medicines in the facilities and accumulation of unwanted and
expired medicines (Okira et. al. 2013).

Zhao and Olsen (2016) cited one approach to fight expiration is to rotate reserve products to hospitals in
the absence of an outbreak. This is based on the observation that hospitals often hold similar supplies
and have a regular demand for them. However, there are no specific guidelines for such rotation.
Though anecdotal evidence suggests some small-scale rotation exists, current rotation if any is based on
personal experience or some heuristics that are not specified in written documents.
2.5 Optimization of Medical Supplies

According to Mete & Zabansky (2008) Stochastic programming is an appropriate tool for planning in the
preparedness phase due to its ability to handle uncertainty by probabilistic scenarios representing
disasters and their outcomes. For the stochastic demand case, he develops a simulation-based
optimization approach to find policy parameters and estimates the long-run average cost of the defined
policy. His basic problem setting is for a single item and he later extends the basic model to consider
multiple items (Parsa et al. 2011).

2.6 Computer Based Inventory Systems

Computer-based system is a complex system wherein information technology plays a major role. It
makes the work easier, faster and more accurate. Due to that fact,the automated scheme has become
essential to small and big companies for they are expected to give the best services possible.

2.7 Lean Inventory

According to Castaldi et. al.(2016), Lean philosophy has been implemented in many facets of medicine
from outpatient areas to critical care units to ancillary services. There has been some doubt about the
applicability of this process outside of large private medical centers particularly in relationship to
operating room services. We describe the success of the Lean process for the surgical services of a
public, inner-city hospital. Hence, a lean inventory management system allows a distributor to meet or
exceed customers’ expectations of product availability with the amount of each item that will maximize
the distributor’s net profits. Inside a lean system, a significantly high inventory indicates a warning to the
factory that it needs to remodel its inventory flow. The aim for each company is to have the least
possible inventory of raw material and supplies.

Thesis Title: A System Study of Rizal Medical Center (RMC) Hospital Pharmacy Department on Their
Inventory Management to Minimize Drug Expirations

JAN ( freq) FEB

(freq)
ASPIRIN 80MG TAB 17 A
BLOOD GLUCOSE TEST STRIP 50'S STRIP 16 A
BUDESONIDE 250MCG 13 BUDESONIDE 250MCG NEBULE 15 A
NEBULE
CARVEDILOL 6.25MG TAB 10 CARVEDILOL 6.25MG TAB 24 A
FUROSEMIDE 2ML AMP 15 CELECOXIB 200MG CAP 13 A
IPRATROPIUM 2ML 12 CLOPIDOGREL 75MG TAB 11 B
NEBULE
IPRATROPIUM - 17 DOBUTAMINE 250MG VIAL 12 B
SALBUTAMOL
500MCG/2.5ML NEBULE
LACTULOSE 10 FUROSEMIDE 2ML AMP 31 C
3.35G/120ML SYR
METRONIDAZOLE 100ML 9 IPRATROPIUM 2ML NEBULE 19 C
VIAL
PARACETAMOL 500MG 9 IPRATROPIUM -SALBUTAMOL 500MCG/2.5ML 27 D
TAB NEBULE
PARACETAMOL INJ 2ML 16 ISOSORBIDE DINITRATE 10ML VIAL 14 F
VIAL
PHYTOMENADIONE 11 LACTULOSE 3.35G/120ML SYR 15 F
10MG AMP
PIPERACILLIN- 13 LEVOFLOXACIN 100ML VIAL 10 F
TAZOBACTAM
4G/500MG VIAL
LEVOFLOXACIN 150ML VIAL 11 I
METRONIDAZOLE 100ML VIAL 20 I
N
NIMODIPINE 30MG TAB 12 I
OMEPRAZOLE 40MG CAP 15 K
OXACILLIN 500MG TAB 19 L
PARACETAMOL 500MG TAB 9 L
PARACETAMOL INJ 2ML VIAL 29 M
POTASSIUM CHLORIDE 750 MG TABLET 16 M
SODIUM BICARBONATE 650MG TAB 12 N
SPIRONOLACTONE 25MG TAB 9 O
SPIRONOLACTONE 50MG TAB 9 O
P
Mean 12.272727 Mdn 15 P
Mdn 12 Mean 16.04167 P
P
S
S
T
V

M
M
 JAN ( freq) FEB
(freq)
ASPIRIN 80MG TAB 17
BLOOD GLUCOSE TEST 16
STRIP 50'S STRIP
BUDESONIDE 250MCG NEBULE 13 BUDESONIDE 250MCG 15
NEBULE
CARVEDILOL 6.25MG TAB 10 CARVEDILOL 6.25MG 24
TAB
FUROSEMIDE 2ML AMP 15 CELECOXIB 200MG CAP 13

IPRATROPIUM 2ML NEBULE 12 CLOPIDOGREL 75MG 11

TAB
IPRATROPIUM -SALBUTAMOL 17 DOBUTAMINE 250MG 12
500MCG/2.5ML NEBULE VIAL
LACTULOSE 3.35G/120ML SYR 10 FUROSEMIDE 2ML AMP 31

METRONIDAZOLE 100ML VIAL 9 IPRATROPIUM 2ML 19

NEBULE
PARACETAMOL 500MG TAB 9 IPRATROPIUM - 27
SALBUTAMOL
500MCG/2.5ML
NEBULE
PARACETAMOL INJ 2ML VIAL 16 ISOSORBIDE DINITRATE 14
10ML VIAL
PHYTOMENADIONE 10MG AMP 11 LACTULOSE 15
3.35G/120ML SYR
PIPERACILLIN-TAZOBACTAM 13 LEVOFLOXACIN 100ML 10
4G/500MG VIAL VIAL
LEVOFLOXACIN 150ML 11
VIAL
METRONIDAZOLE 20
100ML VIAL
Median 12 NIMODIPINE 30MG 12
TAB
OMEPRAZOLE 40MG 15
CAP
OXACILLIN 500MG TAB 19
PARACETAMOL 500MG 9
TAB
PARACETAMOL INJ 29
2ML VIAL
POTASSIUM CHLORIDE 16
750 MG TABLET
 SODIUM BICARBONATE 12
650MG TAB
SPIRONOLACTONE 9
25MG TAB
SPIRONOLACTONE 9
50MG TAB

Mean 12.272727 Mdn 15

Mdn Mean 16.04167

JAN ( freq) FEB (freq)

ASPIRIN 80MG TAB 17

BLOOD GLUCOSE TEST STRIP 50'S STRIP 16

BUDESONIDE 250MCG NEBULE 13 BUDESONIDE 250MCG NEBULE 15

CARVEDILOL 6.25MG TAB 10 CARVEDILOL 6.25MG TAB 24

FUROSEMIDE 2ML AMP 15 CELECOXIB 200MG CAP 13

IPRATROPIUM 2ML NEBULE 12 CLOPIDOGREL 75MG TAB 11

IPRATROPIUM -SALBUTAMOL 500MCG/2.5ML NEBULE 17 DOBUTAMINE 250MG VIAL

12

LACTULOSE 3.35G/120ML SYR 10 FUROSEMIDE 2ML AMP 31

METRONIDAZOLE 100ML VIAL 9 IPRATROPIUM 2ML NEBULE 19

PARACETAMOL 500MG TAB 9 IPRATROPIUM -SALBUTAMOL 500MCG/2.5ML NEBULE

27

PARACETAMOL INJ 2ML VIAL 16 ISOSORBIDE DINITRATE 10ML VIAL 14

PHYTOMENADIONE 10MG AMP 11 LACTULOSE 3.35G/120ML SYR 15

PIPERACILLIN-TAZOBACTAM 4G/500MG VIAL 13 LEVOFLOXACIN 100ML VIAL 10

LEVOFLOXACIN 150ML VIAL 11

METRONIDAZOLE 100ML VIAL 20

Median 12 NIMODIPINE 30MG TAB 12

OMEPRAZOLE 40MG CAP 15

OXACILLIN 500MG TAB 19

PARACETAMOL 500MG TAB 9

PARACETAMOL INJ 2ML VIAL 29

 POTASSIUM CHLORIDE 750 MG TABLET 16

SODIUM BICARBONATE 650MG TAB 12

SPIRONOLACTONE 25MG TAB 9

SPIRONOLACTONE 50MG TAB 9

Mean 12.27272727 Mdn 15

Mdn Mean 16.04166667

JAN ( freq) FEB (freq)

ASPIRIN 80MG TAB 17
BLOOD GLUCOSE TEST STRIP 50'S STRIP
16
BUDESONIDE 250MCG NEBULE 13 BUDESONIDE 250MCG NEBULE 15
CARVEDILOL 6.25MG TAB 10 CARVEDILOL 6.25MG TAB 24

FUROSEMIDE 2ML AMP 15 CELECOXIB 200MG CAP 13

IPRATROPIUM 2ML NEBULE 12 CLOPIDOGREL 75MG TAB 11
IPRATROPIUM -SALBUTAMOL
500MCG/2.5ML NEBULE 17 DOBUTAMINE 250MG VIAL 12

LACTULOSE 3.35G/120ML SYR 10 FUROSEMIDE 2ML AMP 31

METRONIDAZOLE 100ML VIAL 9 IPRATROPIUM 2ML NEBULE 19
PARACETAMOL 500MG TAB 9 IPRATROPIUM -SALBUTAMOL 500MCG/2.5ML
27 NEBULE
PARACETAMOL INJ 2ML VIAL 16 ISOSORBIDE DINITRATE 10ML VIAL14
PHYTOMENADIONE 10MG AMP 11 LACTULOSE 3.35G/120ML SYR 15
PIPERACILLIN-TAZOBACTAM
4G/500MG VIAL 13 LEVOFLOXACIN 100ML VIAL 10
LEVOFLOXACIN 150ML VIAL 11
METRONIDAZOLE 100ML VIAL 20
NIMODIPINE 30MG TAB 12
OMEPRAZOLE 40MG CAP 15
OXACILLIN 500MG TAB 19
PARACETAMOL 500MG TAB 9
PARACETAMOL INJ 2ML VIAL 29
POTASSIUM CHLORIDE 750 MG TABLET
16
SODIUM BICARBONATE 650MG TAB
12
SPIRONOLACTONE 25MG TAB 9
SPIRONOLACTONE 50MG TAB 9

Mean 12.272727 Mdn 15

Mdn 12 Mean 16.04167