WHY IS UNIT DOSE DISPENSING

(UDD)
DIFFICULT TO IMPLEMENT?
Case study in three public hospitals

Naswir1 & Sri Suryawati2

INRUD—Padang, Indonesia
Department of Clinical Pharmacology, Faculty of
Medicine, Gadjah Mada University, Yogyakarta.
ABSTRACT
Problem Statement: Unit-dose dispensing (UDD) is a system of drug distribution in hospitals that aims to
increase efficiency, cost-containment, and the quality of drug delivery. Many studies at the national and
international level have shown that this system provides advantages to the quality of service, to the patients
and also to the hospitals. Yet at the time the study was undertaken, there were no hospitals in Indonesia
that were using the system comprehensively. It was suspected that some inhibiting factors were behind
this, which need to be identified and resolved.
Objective: To find obstacles and opportunities for successfully implementing UDD.
Design: Case study
Setting and population: Three public hospitals in Indonesia which have already implemented UDD for at
least 3 years in a particular ward.
Outcome measures: Qualitative data obtained from observation, in-depth interview, and questionnaire with
hospital directors, head of pharmacy departments, health providers, and patients.
Results: The main inhibiting factors included the lack of facilities in the ward, incapability of staff responsible
for drug distribution in the ward, and the most important, the lack of political will from the hospital
management. The lack of facilities in the ward included inavailability of equipments for UDD implementation,
assigned room for UDD activities, etc. The lack of incapability of staff included insufficient knowledge about
UDD concept among health providers, and communication problem between provider and patient, or among
providers. The lack of political will from the hospital management mainly due to the conflicts of interest
between making profit and promoting efficient use of medicines, which are not yet solved properly.
Conclusions: Although UDD has been proven useful, it is still very difficult to implement. Political will of the
hospital managers, with a strong support from the director is the key factor of UDD implementation. To
achieve this, the concept of UDD should be understood, by the hospital managers. To anticipate conflicts of
interest, managerial intervention, such as improving the mechanism of incentive – desincentive, is also very
much needed.
Funding Source: self-funded
INTRODUCTION
What is Unit Dose Dispensing (UDD)?
 Drugs distribution system for inpatients in hospitals
 Drugs which are packed in single dose and single package.
 Drugs which are given in one unit or one time using.
 Drugs which are available to use in 24 hours.

Advantages (ASHP,1986):
 A reduction in the incidence of medication errors.
 A decrease in the total cost of medication related activities.
 A more efficient usage of pharmacy and nursing personal, allowing for
more direct patient care involvement by pharmacist and nurses.
 Improved overall drug control and drug use monitoring.
 More accurate patient billings for drugs.
 The elimination or minimization of drug credits.
 Greater control by the pharmacist over pharmacy work load pattern
and staff scheduling.
 A reduction in the size of drug inventories located in patient care
areas.
 Greater adaptability to computerized and automated procedures.
INDONESIA EXPERIENCE

 Successful pilot studies:

 To reduce the cost of medication for patient (Irmawati,
1993).
 To increase efficiency of drug management (Sujarwoto,
1997).
 To eliminate medication error (Widayati, 1998).
 To reduce the time for UDD preparation (Budiarti, 2000).

 Despite success in small-scale pilot studies,

no hospital in Indonesia is nowadays
implements UDD in hospital scale.
Objective

To find obstacles and

opportunities to
institutionalize the
UDD implementation.
Design
 Case study in three public hospitals
Identifying underlying factors of UDD
implementation

Management function (inputs, process, outputs)

Of UDD implementation

OPPORTUNITIES OBSTACLES

Evaluation and recommendation

How to implement UDD hospital-wide

Data collection
 Types of data: qualitative, covering input, process,
output
 Method of data collection: observation, in-depth
interview, questionnaire.
 Data sources:
 documents of drugs management in hospitals
 employees including hospital director, head of
pharmacy installation, health providers
 patients
 Data collector: staffs of drug distribution,
pharmacist, nurses, pharmacist technicians
Characteristics of hospitals
Hospital A
 Type A Hospital, located in Surabaya, East Java Province
 Teaching hospital with 1150 patient beds.
 Bed Occupation Rate (BOR) ± 65%.
 Has 19 specialist and 14 sub specialist Departments.
 Has implemented UDD in a part of Pediatric Ward (74 beds) since 1988.
Hospital B
 Type B Hospital, located in Padang, West Sumatera Province
 Teaching hospital with 650 patient beds.
 Bed Occupation Rate (BOR) ± 70,56%.
 Has 17 specialist and 6 sub-specialist Departments.
 Has implemented UDD in a part of VIP Ward (90 beds) since 1980.

Hospital C
 Type C Hospital, located in Brebes, Central Java
Province
 District Hospital with 213 patient beds.
 Bed Occupation Rate (BOR) ± 62,41%.
 Has 5 specialist Departments
 Has implemented UDD in one Ward since 1995.
FINDINGS: HOSPITAL A
Facilities
 Equipments to support UDD are not enough. To serve 74 beds, 5
trolleys are available
 Inadequate room for UDD preparation
 In parallel with UDD, patients also receive medications from other
sources
Staffing
 3 pharmacists, 4 pharmacy technicians and 1 non-medical staff
 In continuous education about UDD concepts among health providers
 Poor communication between provider-patient and providers-providers
Managerial supports
 No enforcement for UDD implementation
 No explicit budget allocation for UDD implementation
 Imbalance incentive-disincentive system, resulting in serious conflict of
financial interest
FINDING: HOSPITAL B
Facilities
 Inadequate equipments to support UDD. To serve 90 beds, 12 small
trolleys are available
 Inadequate room for UDD preparation
 In parallel with UDD, patients also receive medications from other
sources
Staffing
 3 pharmacists, 13 pharmacy technicians
 Routine education about UDD concepts among health providers (twice a
year)
 Poor communication between providers-providers, due to frequent
absence of the doctors

Managerial supports
 Enforcement for UDD implementation in a form of written Director
Instruction
 Inadequate budget allocation for UDD implementation
 Conflict of financial interest still exists
FINDINGS: HOSPITAL C
Facilities
 Lack of equipments to support UDD. No medicine trolley, inadequate
drug packaging
 No room for UDD preparation
 A private drug outlet exists in the Ward
Staffing
 1 pharmacists, 1 pharmacy technicians
 Education about UDD concepts was addressed to few health
providers
 Poor communication between providers-patients
Managerial supports
 Enforcement for UDD implementation in a form of written Director
Instruction
 No budget allocation for UDD implementation
 Imbalance incentive-disincentive system, resulting in serious conflict
of financial interest
Conclusions
Facilities
These three hospitals do not provide adequate equipments and
rooms for UDD implementation. Lack of this support indicates
that UDD implementation is not a priority.
Staffing
Most hospitals have inadequate number of pharmacists and
pharmacy technicians to support UDD implementation, and the
concepts of UDD does not disseminated thoroughly to all
providers. Again, lack of this support indicates that UDD
implementation is not a priority.
Managerial support
In most hospitals, there is practically no political supports from
the hospital managers. Unwillingness to implement UDD is
mostly due to serious conflict of financial interest.
Recommendations
 Efforts should be sought to improve the
understanding of hospital managers on the
importance of good dispensing practices
without sacrificing the hospital income.
 Better balance between incentive and
disincentive should be promoted by hospital
managers to eliminate the conflict of
financial interest.
 Improving rational use of medicine should
be supported by improving the work
environment
Thank You