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RESEARCH ARTICLES
Analysis of Drug Logistics Management in the Pharmacy Installation of the DR Sam Ratulangi Regional General Hospital
Tondano
Analysis of Logistics Management Drugs In Pharmacy Installation District
General Hospital Dr. Sam Ratulangi Tondano
Novianne. ER Malinggas
1)
Sam Ratulangi University Postgraduate Program, Manado
2) Faculty of Medicine, University of Sam Ratulangi Manado
Abstract
Drug management is a very important and
interrelated aspect of hospital management which
starts with the selection, procurement, receipt,
planning, storage, distribution,and
destruction
withdrawal, control, and administration needed for
pharmaceutical service activities in the provision of
health services as a whole, due to inefficiencies and
Inadequate drug management impact
will have
on the
a hospital,
negative
both
medically, socially and economically. The aim of the
study was to analyze the logistics management of
drugs in the pharmaceutical installation of RSUD DR
Sam Ratulangi Tondano.
This study uses a qualitative research
method that aims to obtain more in-depth information
about drug logistics management at the pharmaceutical
installation of RSUD DR Sam Ratulangi Tondano.
Informants were selected in this study based on the
principles of suitability and adequacy. The informants
of
this study were Hospital Directors, Head of
Administration, Hospital Planning Section, Heads of
Medical Support, Specialists, Heads of Pharmacy
Installations, Pharmacists, Pharmacist Assistants,
and Nurses. The data were analyzed using the
content analysis method, namely comparing the
research results with existing theories.
The results showed that drug selection was
made based on the 10 most common diseases and
in accordance with the National Formulary and based
on the E-Catalog. This is due to the ineffectiveness of
the duties and functions of the Pharmacy and
Therapeutic Committee. Drug planning is carried out
based on the use of the past period and added
10-20% stock buffer. Medicines are received by the
goods receiving committee. After the drugs are
received, the drugs are stored in
448
1) J. Posangi 2) T. Soleman 1)
pharmaceutical warehouse. The existing constraints
on pharmaceutical warehouse facilities and
pharmaceutical installations are not adequate,
resulting in accumulation of drugs. Drug distribution
by individual prescription method. Destruction and
withdrawal of damaged or expired drugs have never
been carried out and have not been reported.
Evaluation of drug use and drug destruction is still not
up to standard. Administration in terms of recording
and reporting has not run optimally. This happened
because of the lack of control and evaluation from
hospital management.
From this study it can be concluded that the
management of drug logistics at the pharmaceutical
installation of RSUD DR Sam Ratulangi Tondano has
not been running in accordance with the Standards
for Pharmaceutical Services in Hospitals stipulated in
the Minister of Health Regulation Number 58 of 2014.
The suggestion that can be submitted is that it is
necessary to re-establish the Pharmacy and
Therapeutic Committee and making a Hospital
Formulary and making SOPs in accordance with the
Pharmaceutical Service Standards in Hospitals
stipulated in the Regulation of the Minister of Health Number 58 of 2014.
Abstract
Medication management is one aspect of
hospital management which is very important and
interrelated that started the selection, planning,
procurement, receipt, storage,anddistribution,
withdrawal,destruction
control,
and administration necessary for the activities of
pharmaceutical services in the provision of health
services as a whole, because of inefficiency and lack
of launch drug management will have a negative
impact on the hospital, either medically, socially and
economically. The purpose of this research is to
analyze the drug logistics management in the hospital
pharmacy installation of DR Sam Ratulangi Tondano.
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Malingas, Posangi and Soleman, Drug Logistics Management Analysis
This study used a qualitative research method
that aims to gain a more in-depth information about the
logistics management of drugs in pharmaceutical
installations Hospital Dr.
Sam Ratulangi Tondano. Informants were selected in
this study based on the principle of suitability and
adequacy. Informants of this study are the Director of
the Hospital, Head of Administration, Hospital Planning
Division, Head of Medical Support, Physician Specialist,
Head of Installation Pharmacy, Pharmacist, Pharmacist
Assistants, and Nurse. The data were analyzed using
the content analysis method to compare the results with
existing theories.
The results showed drug selection was done
based on the 10 most prevalent diseases and in
accordance with the National Formulary and based on
the E-Catalog. This is due to the ineffectiveness of the
duties and functions of the Pharmacy and Therapeutics
Committee. Planning is done by the use of drugs in the
previous period and added 10-20% buffer stock. Drugs
goods received by the admissions committee. Once the
drug is received, the drugs are stored in the pharmacy
warehouse.
Existing constraints warehouse facility pharmacy and
pharmacy inadequate resulting in the accumulation of
drugs stock. Distribution of prescription drugs based on
individual methods.
Culling and withdrawal from drugs that have been
damaged or expired date is never done and not
reported. Evaluation of drug use and destruction of the
drug is still not up to standard. Administration in terms
of recording and reporting is not running optimally.
These happened, due to a lack of control and evaluation
of hospital management.
From this study it can be concluded that the
drug logistics management in the hospital pharmacy
installation of DR Sam Ratulangi Tondano does not run
in accordance with the Standards of Pharmaceutical
Services in Hospitals specified in the Ministry of Health
Regulation No. 58 Year 2014 The suggestion that need
re-establishment of Pharmacy and Therapeutics
Committee and make the hospital formulary and create
SOP compliance with the Pharmaceutical Services in
Hospitals specified in the Ministry of Health Regulation
No.
58 Year 2014.
Keywords: Management, Drugs Logistics,
Pharmacy.
Introduction
Health services are the rights of every
person guaranteed in the law
The 1945 Constitution of the Republic of
Indonesia which must be realized by
efforts to increase health status
449
the highest society.
A hospital is a health service institution for
the community with its own characteristics
which are influenced by developments in
health science, technological advances,
and the socio-economic life of the
community which must continue to be able
to improve services that are of a higher
quality and are affordable to the community
in order to realize the highest degree of
health (Anonymous , 2009).
Hospital pharmacy services are one of
the activities in hospitals that support
quality health services. In the Minister of
Health Regulation Number 58 of 2014
concerning Pharmaceutical Service
Standards, it states that hospital pharmacy
services are a direct and responsible
service to patients related to drugs with
the aim of achieving definite results to
improve the patient's quality of life.
The hospital pharmacy installation is one
of the units in the hospital that is fully in
charge and responsible for managing all
aspects related to drugs circulating and
used in the hospital.
Drug management
is a very important aspect of hospital
management in the provision of health
services as a whole, because inefficiency
and inefficiency in drug management will
have a negative impact on the hospital,
both medically, socially and economically
(Siregar, 2004).
According to Suciati and Adisasmito
(2006), pharmaceutical services are
supporting services and are at the same
time the main revenue center. This is
considering that more than 90% of health
services in hospitals use pharmaceutical
supplies (medicines, chemicals, radiological
materials, consumable medical device
materials, medical devices, and medical
gas), and 50% of all hospital revenues
come from
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JIKMU, Vol. 5, No. April 2b 2015
of pharmaceutical supply management.
The most important aspect of
pharmaceutical services is optimizing
drug use, this must include planning to
ensure the availability, safety and
effectiveness of drug use. For this reason,
if the problem of pharmaceutical supplies
is not managed carefully and responsibly,
it can be predicted that hospital revenue
will decrease.
Pharmaceutical services are
activities aimed
related
at identifying,
problems.
and resolving
preventing
drug-
The demands of patients and society for
improving the quality of pharmaceutical
services require an expansion from the
old paradigm that is product-oriented
(drug-oriented) to a new paradigm that is
patient- oriented (patient-oriented) with a
philosophy of pharmaceutical care
(pharmaceutical care).
(Anonymous, 2014).
Logistics management in the hospital
is one of the important aspects in the
hospital. The availability of drugs is
currently a demand for health services.
Drug logistics management in hospitals
which includes the stages
procurement,
of planning,
storage, distribution, deletion, evaluation
and monitoring which are interrelated
with one another, so they must be well
coordinated so that each can function
optimally. The disconnect between each
stage will result in inefficiency of the
existing drug supply system, this will also
have a negative impact on the hospital
both medically and economically (Quick
et al, 1997).
One of the most influential factors in
drug supply in hospitals is controlling the
amount of drug stock to meet demand. If
the drug stock is too small, the demand
for use is often unfulfilled so that patients/
consumers are dissatisfied
450
profit can be lost and additional costs are
required to obtain medicinal ingredients
quickly to satisfy patients/consumers.
If the stock is too large, it will cause
storage costs that are too high, the
possibility that the drug will be damaged/
expired and there is a risk if the price of
the material/drug drops (Seto, 2004).
The importance of drug management
in pharmaceutical installations in
achieving optimal health services in
hospitals, so it is necessary to monitor
the drug management process to find out
the weaknesses and strengths in its
operational implementation so that
corrective action can be taken immediately
in terms of the implementation of drug
management which is still considered not optimal.
Regional General Hospital DR. Sam
Ratulangi Tondano is the only hospital
owned by the Regional Government of
Minahasa Regency which is a type C
hospital which is a referral from 21
puskesmas in Minahasa Regency which
serves JKN participant patients (National
Health Insurance) and general patients
(non JKN participants). Regional General
Hospital DR.
Sam Ratulangi Tondano has passed
accreditation in December 2010 with 5
types of service categories namely
medical services, nursing services,
emergency unit services, medical record
services and administrative services. The
services provided are inpatient, outpatient
and emergency services.
RSUD DR Sam Ratulangi Tondano
has a pharmacy installation headed by a
pharmacist and assisted by 3 assistant
pharmacists, 4 assistant pharmacists, 1
sanitation worker, 1 physiotherapist and
4 administrative staff. Pharmacy
installations provide medicines for
inpatients and outpatients as well as
emergency patients.
Based on the initial survey through
interviews with one of the assistants
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Malingas, Posangi and Soleman, Drug Logistics Management Analysis

pharmacists at the pharmacy installation at RSUD The drug storage system in this pharmaceutical
DR Sam Ratulangi Tondano that, since the installation uses the FIFO (First In First Out) and
enactment of the National Health
(JKN) organized
Insurance
Social
by
system
the FEFO (First Expired First Out) methods. Before
Security Administration Agency (BPJS) on January being stored, drugs that enter the pharmacy
by
1 2014 there has been an increase in the number
of warehouse are checked by the goods receiving
inpatients, outpatients and emergency patients who committee.
come to visit this hospital. Drug storage facilities, both in pharmaceutical
installations and pharmaceutical warehouses, are
inadequate, so that the arrangement of fast moving
or slow moving drug types or drugs with similar
Based on hospital profile data, there was an drug names is not neatly arranged, so it is prone to
increase in BOR from 62.23% with an average errors in drug exchange and can result in drug stock
outpatient visit of 174 people per day in 2013 to buildup.
65.71% with an average outpatient visit of 225
people per day in 2014. This causes the demand
for drugs to increase. Pharmacy installations distribute drugs to
patients, both inpatient, outpatient and emergency
Initially,
departments using the individual prescription
the supply of drugs in the pharmaceutical installation
method, namely patients redeeming drugs by
could not meet the needs of every patient who
bringing a doctor's prescription to the pharmacy
came to visit RSUD DR Sam Ratulangi Tondano,
installation. Oral drug prescriptions for inpatient and
both JKN participant patients and general patients
emergency room care are given 3 (three) days and
(non-JKN) so that there were still many JKN
for parenteral 1 (one) day, while for oral medication
participant patients who bought their own medicines
outpatient 7 (seven) days. This method for
at other pharmacies and asked for refunds. to the
hospitalization can increase medical costs because
finance department of the hospital by bringing
any remaining drug that is no longer used by the
receipts for drug payments ( reimbursement
patient is not returned to the pharmacy.
system). However, as time goes by, the drug
procurement stage at the pharmaceutical installation
can meet the drug needs so that the reimbursement
system decreases, only for certain drug items. Also based on interviews with the former head
of the pharmaceutical installation that so far, he has
never destroyed drugs that have expired dates or
withdrawn damaged drugs, even though so far
there have been drugs with expired dates. This
With the implementation of the duties and
shows that the supervision and evaluation of drugs
functions of the Pharmacy and Therapeutic
has not gone well, even though the recording and
Committee which was formed since the accreditation
reporting of drug stocks has been carried out both
of this hospital with 5 services, from drug selection,
per day, per month and per year.
planning, and procurement of drugs has not run
effectively because there is no official hospital
formulary used as a therapy guide, only refers to
national formulary. This also results in many drugs
prescribed by doctors, especially branded (patented) Based on the background above, the goal to
drugs, which are not available in pharmacy be achieved from this study is to analyze the
installations. logistics management of drugs in the pharmaceutical
installation of RSUD DR Sam Ratulangi

Tondano

451
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JIKMU, Vol. 5, No. April 2b 2015
Method
This study uses a qualitative method
that aims to obtain more in-depth information
about
drug logistics management in the
pharmaceutical installation of RSUD DR
Sam Ratulangi Tondano.
The
research was carried out at the pharmaceutical
installation of RSUD DR Sam Ratulangi
Tondano. Implementation time from
December 2014 to April 2015. The sample
selection in this study was based on the
principles of suitability (appropriateness)
adequacy (adequacy). and
Suitability is a sample selected based on the
knowledge possessed related to the research
topic. The principle of adequacy referred to
in this study is that the number of samples is
not the main determining factor, but the
completeness of the data is important. Based
on this principle, the informants who were
directly or indirectly involved in the
implementation of drug logistics were
selected, with a total of 9 (nine) informants,
namely the Director of the Hospital (1), Head
of Administration (1), Hospital Planning
Section (1), Head of Medical Support (1),
Specialist Doctor (1), Head of Pharmacy
Installation (1), Pharmacist (1), Pharmacist
Assistant (1), and Nurse (1). The research
instruments used by researchers in this
study were in-depth interview guidelines and
observation guidelines. The interview guide
consisted of a list of questions regarding
drug logistics. The observation guide is used
as a guide in observing document variables
related to the implementation of drug logistics
management at the Pharmacy Installation of
RSUD DR Sam Ratulangi Tondano. The
data that has been collected through in-
depth processing by making a transcript of
the results of the conversation.
Interview
Furthermore, the data was analyzed using the
method of content analysis (content analysis).
452
Results and Discussion
1. Selection of drugs at the DR Sam Ratulangi
Tondano Hospital installation
In Permenkes Number 58 of 2014 it is
explained that drug selection is an activity to
determine the type of drug according to
need. Drug selection is based on formularies
and treatment standards/diagnosis and
therapy guidelines, established drug
standards, disease patterns, effectiveness
and safety, evidence-based treatment,
quality, price, market availability.
Based on In- Interview
depth results, it can be concluded that the
selection of drugs carried out by the
pharmaceutical installation of RSUD DR
Sam Ratulangi Tondano is based on disease
patterns, based on the 10 most common
diseases in the hospital and based on the
national formulary set by the minister of
health and e-catalog for health services
especially the use of drugs in health facilities
in hospitals. The national formulary and
benchmark for the 10 most common diseases
in this hospital serve as a guideline for drug
selection because RSUD DR Sam Ratulangi
Tondano does not yet have a hospital
formulary.
This is because the Pharmacy and
Therapeutic Committee which was formed
since the accreditation of this hospital with 5
(five) services did not carry out its duties and functions.
One of them and
is conducting
compiling aclinical
hospitalpharmacy
formulary
together with pharmaceutical installations in
monitoring drug side effects and medication
errors.
The policy adopted by the hospital in
terms of drug selection, namely if there are
drugs that are not included in the national
formulary but these drugs are needed in the
process of healing the disease and are used
by doctors for patients, then these drugs are
chosen to be procured such as ambroxol.
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Malingas, Posangi and Soleman, Drug Logistics Management Analysis
The results of direct observation by
searching documents through guidebooks,
namely the national formulary, found drugs
that were included in the national formulary
but were not available. The majority of
drugs in pharmaceutical installations are
generic drugs. There are also patent drugs/
branded drugs for which there are no
generic preparations on the market.
Drug selection has not been carried out in
accordance with hospital pharmacy service
standards because there is no hospital
formulary which is the basis of treatment
for each hospital on the basis of an
agreement between the prescriber and the
drug provider at the hospital. This can
result in losses for the hospital because
when the selection of drugs does not match
the pattern of existing diseases and is not
suitable for the user, it will result in stocks
of medicines piling up and there will be
either excess stock or insufficient stock.
However, if the hospital formulary is
completed and circulated to doctors at
RSUD DR Sam Ratulangi Tondano, there
will be guidelines for drug use in accordance
with the diagnosis and compliance of the
prescribing doctor and the pharmaceutical
installation as the drug provider.
From the results of direct observation
and documents, it was found that there
were still prescriptions for drugs that were
not included in the national formulary
which are written by doctors.
in generic Those
preparations aredrugs
included in the list of the national formulary,
but in practice the drug prescriptions are
written under trademark names. This is
due to the absence of a hospital formulary
that forms the basis of therapy guidelines
in accordance with the criteria listed in the
pharmaceutical service standards in
hospitals, namely by prioritizing the use of
generic drugs, having the most beneficial
risk -benefit ratio , quality guaranteed
including stability and bioavailability,
practicality in storage and transportation,
453
practical in use and dispensing,
advantageous in terms of adherence and
acceptance by patients, has the highest
benefit-cost ratio based on direct and
indirect costs and other medicines that are
scientifically proven to be the most effective
and safe (evidence based medicines) most
needed for services at affordable prices.
2. Medication planning at the pharmaceutical
installation of RSUD DR Sam Ratulangi Tondano
In Permenkes Number 58 of 2014
needs planning is an activity to determine
the amount and period of drug procurement
in accordance with the results of selection
activities to ensure the fulfillment of the
criteria for the right type, right amount,
timely and efficiently.
Planning is carried out to avoid drug
shortages by using methods that can be
accounted for and the basics of planning
that have been determined include
consumption, epidemiology, a combination
of consumptionand methods and epidemiology
are adjusted to
available
the
budget.
The results of in-depth interviews with
drug planning show that drug planning for
the next year or next period follows the use
of the previous year or period and then
adds 10-20% buffer stock. Several
informants stated that so far there has
never been a shortage of funds for
medicinal needs. However, in direct
observation and documents carried out,
there are still drugs that are not available
in the pharmaceutical installation, which
results in patients having to buy drugs
outside the pharmaceutical installation,
even though the drug is included in the
national formulary. BPJS participant
patients get a refund from the hospital if
the drugs purchased are included in the
national formulary list, and non-BPJS
patients buy drugs that are
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JIKMU, Vol. 5, No. April 2b 2015
not available in hospital pharmacy
installations. This is considered to be
detrimental to the hospital in line with
research conducted by Suciati and
Adisasmito (2006), namely pharmaceutical
services are supporting services and at
the same time are the main revenue
center because 50% of all hospital
income comes from managing
pharmaceutical supplies.
Drug planning is the initial stage of
drug management and drug procurement
activities which are the biggest factors
that can cause waste, it is necessary to
make efficiency and cost savings.
Inefficient drug supply management will
have a negative impact on the hospital,
both medically and economically (Quick
et al, 1997).
Drug planning in Permenkes Number
58 of 2014 states that it must take into
account the available budget, priority
setting, remaining supplies, past period
usage data, waiting time for orders and
development plans.
Based on the results of direct
observation and document observation,
it was found that in practice there were
still drug shortages at certain times. This
happened because there was no drug
procurement planning calendar. According
to Anif (1997) good drug planning time
must be supported by the basics of
planning, namely as an annual / monthly
forecast from marketing, calculating the
materials needed, and compiling a list for
the purchasing department, because of
the impact that can occur if the hospital
cannot When planning drug needs, there
will be drug vacancies at certain times.
The plans that have been made must
be corrected using the ABC value
analysis method for corrections to the
economic aspects, because of something
454
This type of drug can eat up a large
budget because it uses a lot or is
expensive. With this ABC value analysis,
it is possible to identify the types of drugs
starting from the class of drugs that
require the most costs. Basically drugs
are divided into three groups, namely
group A if the drug has a value of
approximately 80% while the amount of
drug is not more than 20%, group B if
the drug has a value of 15% with the
amount of drug around 10% - 80%, and
group C if the drug has a value of 5%
with the amount of drug around 80% -
100% (Quick et al, 1997).
3. Procurement of Medicines at the pharmaceutical
installation of RSUD DR Sam Ratulangi Tondano
The results of in-depth interviews and
direct observation as well as tracing
documents found that drug procurement
was only purchased directly from
Pharmaceutical Wholesalers (PBF)
without a tender system. This is supported
by existing invoices for each type and
quantity of drugs ordered. It is concluded
that there is no right time in drug
procurement. Medicines ordered to PBF
are paid by way of debt in advance and
paid when due. Procurement of drugs is
based on an order letter (SP) from the
head of the installation and addressed to
the PBF who provides the drugs.
In the implementation of drug procurement,
it is often delayed due to a lack of drug
supply at e-catalog prices, so that drugs
that have the same stock are sought at
PBF which provide affordable prices at e-
catalog prices. In procuring drugs,
pharmaceutical installations have never
received drug donations or grants.
There was one informant who said that
in ancient times he had produced his
own boorwater as a wound wash.
However, since the last 15 (fifteen) years,
there has been no independent drug
production.
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Malingas, Posangi and Soleman, Drug Logistics Management Analysis
Direct observation and document
observation found that there were drugs
that were purchased with an expiry date
close. This is not in accordance with the
standard of pharmaceutical services in
hospitals in Permenkes Number 58 of 2014
which states that:
The research results obtained that the
procurement of drugs in the pharmaceutical
installations are all drug supplies for JKN
patients. Even though in practice, these
drugs are also given to non-JKN patients.
Funds for buying medicines come from
funds from BPJS claims and APBD funds.
The availability of existing funds turned out
to be able to meet the need for medicine so
far. The problem is, there are still drugs that
are not available on the national pharmacy
list and there are still drug shortages. This
is due to the absence of an official drug
purchase schedule.
To minimize the lack of drug
procurement, pharmaceutical installations
and hospital management need to know
clearly the need for drugs as in Permenkes
Number 58 of 2014 states that procurement
is an activity intended to realize planning
needs. Effective procurement must ensure
availability,affordable
quantity and
price
theand
right
according
to time at an
quality
standards. Procurement is a continuous
activity starting from selecting, determining
the amount needed, adjusting between
needs and funds, selecting procurement
methods, selecting suppliers, determining
contract specifications,
monitoring the procurement process, and
payment.
Procurement of drugs in government
agencies, especially hospitals, must be
transparent, fair, responsible, effective,
efficient, prudent, independent, integrity
and good corporate governance as stipulated in
455
Presidential Regulation No. 54 of 2010
concerning procurement of government
goods and services applies to drug
procurement financed by the State Budget
(APBN) and Regional Revenue and
Expenditure Budget (APBD), to determine
the procurement system in considering the
type, nature and value of goods/ existing
services.
4. Reception of drugs at the pharmaceutical
installation of RSUD DR Sam Ratulangi Tondano
Acceptance in Permenkes Number 58
of 2014 is an activity to ensure the suitability
of the types, specifications, quantity, quality,
delivery time and prices stated in the
contract or order letter with the physical
conditions received. All documents related
to the receipt of goods must be stored
properly.
The results of interviews with all
informants showed that the drugs ordered
before being entered into the pharmacy
warehouse were received by the goods
acceptance committee according to type,
quantity, expiration date, and existing
invoices to be used as hand documents by
the pharmaceutical installation and goods acceptance com
From the results of direct observation and
documents, it was found that the
implementation of receiving drugs had not
run optimally because there were still
communication errors between the goods
receiving committee and the pharmacy
warehouse staff or pharmacy installation
staff. The constraints were that the
committee for receiving goods only had 1
(one) person who worked as a pharmacist
and the others were administrative staff
and nutrition workers. This can be a problem
that may be encountered in the acceptance
process where the lack of knowledge of the
acceptance committee who is not a
pharmacist profession regarding the quality
of the goods to be received.
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JIKMU, Vol. 5, No. April 2b 2015

5. Medicine storage in the pharmaceutical medication errors occur.

installation of RSUD DR Sam Ratulangi Tondano
The results of in-depth interviews found
that the method of storing drugs carried out
by the pharmaceutical warehouse was based
on the FIFO and FEFO methods, while drug
storage in pharmaceutical installations was
arranged alphabetically. The lack of existing
facilities and infrastructure results in drug
accumulation both in pharmaceutical
warehouses and pharmaceutical installations.
The arrangement of medicines in both the
pharmaceutical warehouse and pharmaceutical
installations is not in accordance with good
drug storage standards, due to the mixing of
oral and injectable drugs. Medicines that
require cold temperatures are stored in
refrigerators, either in the pharmacy
warehouse or in the pharmaceutical
installation. For medicines in an emergency
that are not stored in the emergency unit,
they are only available at the hospital
pharmacy installation. This is due to the fact
that initially there was a supply of emergency
drugs in the emergency department, but no
reports of the use of drugs were made by the
emergency department.
The results of direct observation and
document observation concluded
storage that drug
in pharmaceutical
installations did not meet pharmaceutical
service standards in accordance with
Permenkes Number 58 of 2014 specifically
drug storage which stated that the
pharmaceutical requirements referred to
included stability and security requirements,
sanitation, light, humidity, ventilation, and
classification of drugs. The storage method
is
carried out based on therapeutic class,
dosage form,
alphabetically
and type ofbydrug
applying
and isthearranged
First
Expired First Out (FEFO) and First In First
Out (FIFO) principles accompanied by a
management information system. Storage of
drugs that are similar in appearance and
labeling (LASA, Look Alike Sound Alike) are
not placed close together and must be given
a special label to prevent
Hospitals must be able to provide emergency
drug storage locations for emergency
conditions. Storage areas
accessible andmust be easily
protected from
misuse and theft.
6. Drug distribution at the pharmaceutical
installation of RSUD DR Sam Ratulangi
Tondano
According to standard hospital
pharmaceutical services, drug distribution is
a series of activities in order to distribute/
deliver drugs from the storage area to the
service unit/patient while still guaranteeing
quality, stability, type, quantity, and timeliness.
Hospitals must determine a distribution
system that can guarantee the implementation
of drug monitoring and control in service units.
The results of the interviews revealed
that the drug distribution system carried out
by the pharmaceutical installation at RSUD
DR Sam Ratulangi Tondano is an individual
prescription system, namely prescriptions for
outpatients and inpatients via the
pharmaceutical installation.
The results of direct observation and
documents show that by applying the
individual prescription distribution method,
during doctor visits and when the polyclinic
for outpatient care was opened, there was a
buildup of patients and patient families to
take medicine. In practice, medicine for
outpatients is given 7 (seven) days and for
inpatients 3 (three) days. This method can be
detrimental to the hospital if the drugs for
inpatients are no longer used, but the drugs
are not returned to the pharmacy installation.
The lack of existing human resources is an
obstacle in changing drug distribution
methods, especially inpatient distribution
methods. But based on Permenkes Number
58 of 2014 the Unit Dose distribution system

456
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Malingas, Posangi and Soleman, Drug Logistics Management Analysis
Dispensing (UDD) is highly recommended for
inpatients considering that with this system the
medication administration error rate can be minimized
to less than 5% compared to floor stock systems or
individual prescriptions which reach 18%.
7. Destruction and Withdrawal of Drugs at the
pharmaceutical installation of RSUD DR Sam
Ratulangi Tondano
In Permenkes Number 58 of 2014 the destruction
and withdrawal of drugs that cannot be used must be
carried out in a manner that is in accordance with the
provisions of the applicable laws and regulations.
Drugs are destroyed when: The product does not
meet the quality requirements, it has expired, it does
not meet the requirements for use in health services
or for scientific purposes, its distribution permit is
revoked.
Drug recalls are carried out for products whose
distribution permits have been revoked by the Food
and Drug Supervisory Agency (BPOM). Drug recalls
are carried out by BPOM or the original manufacturer.
The hospital must have a recording system for
withdrawal activities.
From the results of in-depth interviews and
document observation, no documents were found
containing reports of drug destruction, even though
there were drugs that had expired and were damaged
which were no longer suitable for use. This concludes
that there is no supervision and evaluation carried out
and is not in accordance with pharmaceutical
standards in the hospital. With no reports of
extermination and drug withdrawal and destruction
never carried out, the pharmaceutical installation of
RSUD DR Sam Ratulangi Tondano has not met
pharmaceutical standards in the hospital.
457
8. Control of drugs in the pharmaceutical installation
of RSUD DR Sam Ratulangi Tondano
Several informants stated in in-depth interviews
that they had never received an evaluation report on
drug use, even the results of hospitalization. The
results of direct observation and documents obtained
were evaluation reports on drug use so far and stock
hospitalization only last year during the handover of
the head of the old and new installations, only in the
form of stock cards for drug intake and expenditure.
Evaluation was not carried out because there was no
KFT. The initial and final stock reports made by the
head of the installation per month, quarterly and
annually are only to be reported to the regional
hospital and financial management department for
checking drug stocks. There is a lack of control and
no evaluation, so it is concluded that it is not in
accordance with the standards of pharmaceutical
services in hospitals stipulated by the minister of
health in Permenkes Number 58 of 2014 which states
that the type, amount of supply and use of drugs
controlled and evaluated by pharmaceutical
installations must be together with Pharmacy and
Therapeutic Team (TFT) in Hospital.
9. Administration of drugs in the pharmaceutical
installation of RSUD DR Sam Ratulangi Tondano
The results of the interviews showed that
recording and reporting of drug use was always made
and reported to hospital management. In direct
observation and documents, there are records of
incoming and outgoing drugs both from warehouses
and from pharmaceutical installations. Financial
administration is not carried out because the
pharmaceutical installation does not manage its own
finances. Administration of write-off of unused drugs
has never been made. This shows that the
management of drug administration in pharmaceutical
installations has not run optimally. With
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JIKMU, Vol. 5, No. April 2b 2015
lack of control and evaluation makes it
difficult to identify what problems are going
on and how to overcome problems as
stated by Anshari (2009).
It can be concluded that administrative
management, both recording and reporting,
financial administration and write-off
administration, are not in accordance with
pharmaceutical standards in hospitals in
accordance with Permenkes Number 58 of
2014 which states that administration must
be carried out in an orderly and continuous
manner to facilitate tracing of past activities.
Administrative activities consist of (a).
Recording and Reporting Recording and
reporting of drug management activities
which include planning needs, procurement,
receipt, distribution, inventory control,
returns, destruction and withdrawal of
drugs. Reports are made periodically by
the Pharmacy Installation within a certain
period of time (monthly, quarterly, semester
or yearly). The types of reports made are
in accordance with the applicable
regulations. Recording is carried out for 1)
Ministry of Health/BPOM requirements 2)
basis for hospital accreditation 3) basis for
hospital audit and 4) pharmaceutical
documentation. Reporting is carried out as
1) communication between management
levels 2) preparation of a comprehensive
annual report on activities in pharmaceutical
installations and 3) annual report. (b).
Financial administration, if there is a
hospital pharmacy installation, it must
manage finances, it is necessary to carry
out financial administration.
Financial administration is setting budgets,
controlling and analyzing costs, collecting
financial information, preparing reports,
using reports related to all routine or non-
routine pharmaceutical service activities in
monthly, quarterly, semiannual or annual
periods. (c). Deletion administration
458
is a settlement activity for drugs that are
not used because they are expired,
damaged, quality does not meet standards
by making recommendations for drug
elimination to related parties in accordance
with applicable procedures.
Conclusion
Based on results study
showing that:
1. The duties and functions of the Pharmacy
and Therapeutic Committee are not
working, there is no Hospital Formulary
and the drug selection that has been
carried out so far is still based on data
on the 10 most common diseases and
is based on the national formulary
using e-catalogs.
2. Drug planning is based on past period
or year usage data and added buffer
stock.
3. The drug procurement system is by
purchasing directly from Pharmaceutical
Wholesalers (PBF) at an uncertain
time.
4. Acceptance of drugs at the pharmaceutical
installation is carried out by the hospital
goods reception committee.
5. Drug storage facilities and infrastructure,
namely pharmaceutical installations
and pharmaceutical warehouses, are
inadequate.
6. The drug distribution method for both
outpatients and inpatients is the
individual prescription method, namely
by directly taking the drug at the
pharmaceutical installation by the
patient or the patient's family.
7. Destruction and withdrawal of drugs that are
damaged and have expired dates have never
been carried out.
8. Control over the evaluation of drug use,
unused drugs or slow moving drugs is
not carried out. Stock taking is only
done at the time of handover
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Malingas, Posangi and Soleman, Drug Logistics Management Analysis
accept the position of head of the pharmaceutical
installation.
9. The administration of both recording and reporting
of drug management activities is carried out
but not yet in accordance with pharmaceutical
standards in the hospital.
Financial administration is not carried out by
pharmacy installations.
Drug write-off administration has never been
carried out and
thenot
pharmaceutical
reported. The
that
installation
function
is not of
optimal has resulted in patients still taking
drugs outside the hospital pharmacy
installation, which should be the hospital's
revenue center .
Suggestion 1. Hospital Management Dr. Sam
Ratulangi Tondano a. Make a new SOP in
accordance with Pharmaceutical Standards in
Hospitals according to Minister of Health
Number 58 of 2014. b. Re-establish the
Pharmaceutical and Therapeutic Committee
to periodically monitor drug-related issues. c.
Creating a Hospital Formulary as a basis
for therapeutic guidelines for drug use at
Dr. Sam Ratulangi Tondano. d. Make a
recruitment plan for additional pharmacy staff
at RSUD Dr. Sam Ratulangi Tondano to
serve an increase in JKN and non-JKN
participant patients.
2. Head of Hospital Pharmacy Installation Dr.
Sam Ratulangi Tondano a.
Propose improvements to pharmaceutical
installation facilities and infrastructure and
pharmaceutical warehouses. b. Perform
clinical pharmacy activities. c. Changing the
drug distribution system for inpatients by using
a unit dose system.
459
d. Controlling and evaluating the use of drugs
in pharmaceutical installations. e. Report
drugs that are expired and damaged and
make reports on drug destruction. e. Make a
report on every drug logistics activity in a
pharmaceutical installation. 3. For
educational institutions. It is necessary to carry
out further research on the causal factors
related to the analysis of drug logistics management
in hospital pharmacy installations.
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