DEBRETABOR ZONAL HOSPITAL

BEST PRACTIC IN PHARMACY

SERVICE
By

Ashagrie abere( B.Pharm)

D/T hospital( pharmacy head)
April,2013
debretabor
 Presentation out line
• Back ground information

• Gap identification process

• Best practice

• Importance
 Back ground information

• Debretabor zonal hospital is situated at d/t

town found in south gonder zone .one of the
11zone in amhara region .
• it is the only hospital in the zone built in
1923e.c by Norwegian physician dr.ogambic
and his colleagues. currently the hospital
provides health service to more than 2.3
million population in its catchment.
• The hospital has 94 beds for inpatient
service(medical, pediatric, surgery, delivery)
TB, dental ,ophthalmic, pharmacy, laboratory
 MISSION OF THE HOSPITAL
• provision of quality, efficient and equitable
health service using government and non
government organization by full community
participation ,so that the people can contribute
for national economic development.
• In pharmacy dep ;to insure uninterrupted
supply of essential, quality and cost effective
pharmaceutical in the hospital and to give
quality pharmacy service to community.
 VISSION OF THE HOSPITAL
• to see the people of south gonder health and
productive citizens.
• In pharmacy dep;pharmacy department is
bench mark(as a model )in all pharmacy
service in nation.
 Gabs in
pharmacy service
1. no policy for drug management

2.Poor counseling

3.Poor drug availability

4.Poor Pt flow (services are not one stop

shopping)
 Cont….
Policy
• no policy for drug management (pharmacy
services )dispensing, prescribing , patient
using
• No standards operation procurers
• No drug procurement policy
• No policy for pharmaceutical waste
management and MEMC
 Cont….
drugs availability
• quantification not base on data
• Drugs are not auditable
• no regular stock monitoring (sc &bc)
• Many expiry drugs
• No policy related to pharmaceutical
procurement policy
• Poor record keeping
 Cont…..
counseling
• Not patient medication profile to assist in
patient counseling (chronic illness)and
detection and report among patient.
• No instruction to achieve the intended
therapeutic response and evaluate the patient
understanding of the counseling information.
• No separate patient counseling room for
patient confidentiality and privacy
 Cont…
Poor Pt flow
• Poor infrastructure
• Dispensing areas not have enough space for
counting tab, labeling and arranging
pharmaceuticals
• services are not one stop shopping
• Poor professionals and patient satisfaction
 1, developed policy for drug
management
Policy
-develop and implement intervention to
improve medicine use by prescriber ,dispenser
and patient trough the investigation and
monitoring of medicine use.
1,prescribe indictor(no medicine ,generic name,
no antibiotic ,no injection no drug from EML)
 Cont…
2,patient care indictor(consultation time,
dispensing time, no actual dispensed ,labeling)
3 ,health facility indictor (availability of EML,
Availability of STGS)
Based on this investigation we developed
d/tabor hospital drug use specific policy
( more than 10page)
 Cont…
• RDU assessment and investigation done then
policy developed
 Cont…
• Prepared standard operation
procedure(Medical equipment maintenance,
inventory ,DTC ..etc)
• extemporaneous preparation (9 )
• sop for DIS service and clinical pharmacy
• maximize drug safety trough monitoring,
evaluation and thereby preventing adverse
drug reaction and medication error Totally we
prepared ----page policy
 2,counseling

Pharmaceutical care
(proper patient
counseling ,
Amharic version leaflet,
DIS ,EDT &
clinical pharmacy
implementation )
 cont…

clinical pharmacy
• patient not taking medicine known to have a high
risk of toxicity and narrow therapeutic index.
• Patient allergies ,previous adverse drug reaction
should also be checked before administering.
• Monitoring the patient's progress in achieving the
out comes and documented in the care plan.
• Shall not prescribe higher level before lower level
antibiotic to avert the development of resistance.
• Patient not taking medicine which may interact,
 Cont…
• . የደብረታቦር ሆስፒታል መድሃኒት ቤ ት
• የመድሃኒት አጠቃቀም መመረያ
• ሜትሮንዳዞል mg#----------- caps/tabs/ml
• -----------ጠዋት በ-----------ሰዓት ይውሰዱ
• ----------- ቀን በ------------ሰዓት ይውሰዱ
• ------------ሌሊት በ---------ሰዓት ይውሰዱ ለ-------------ቀናት
• ሊደረጉ የሚገባ አስፈላጊ ጥንቃቄዎች፡-
• 1.ከታዘዘው አስበ-ልጠው ወይንም አሳንሰው አይውሰዱ
• 2.ሰዓቱን ጠብቀው ይውሰዱ
• 3.ከሌላ ሰው ጋር አይጋሩ
• 4.ከባለሙያ ትእዛዝ ሌላ መድሃኒት አይውሰዱእየወሰዱ ከሆነም ያሳውቁ
• 5.መድሃኒቱን ወስደው ያልተለመዱ አደገኛ ምልክቶች ካጋጠሞት ለባለሙያው ቶሎ ያማክሩ
• 6.ጊዜ ያለፈበት ወይንም የብልሽት ምልከት ያሳየን መድሃኒት አይጠቀሙ
• 7.ማንኛውም መድሃኒት ሁልጊዜ በራሱ መያዣ በደንብ ተከድኖ ብርሃን
• በማይደርስበትና ደረቅና ቀዝቃዛ ቦታ ያስቀምጡ
• 8.የመድሃኒቱ የጎንዩሽ ባህሪ ምግብ ፍላጎት መቀነስ፤እራስ ህመም
• (አፍላይ ብረት ብረት) እና ማቅለሽለሽ
• 9.የማይወሰዱ ምግቦችና መጠጦች ጠላ አረቂ ቢራ
• የታዘዘለት ሰው ስም እና ቀን
 Cont…
electronic dispensing tool
(EDT)implementation
• Patient profile
• Adherence follow up
• Stock status information
• Clinical information(ADR, AMR, drug
interaction etc..)
 3,drug availability
• regular stock monitoring(max, mos,min,EOP)
• implementing integrated pharmaceutical
logistic system(Ipls)100%( Bc,Sc &IFRR)
• We developed drug selection, quantification
and procurement policy that compatible with
EHRIG( Ethiopian hospital implementation
guideline )
 Cont…

• Increase drugs availability

• Increase budget allocation
• Reduction expiry drugs by Implement drug
management policy ,APTS and IPLS
• Procure safe, cost effective and good quality
medicine and sustainability of drugs
throughout the year
Drug availability
Reduced expired drugs
 4,ABC/VEN Reconciliation
ABC/VEN Reconciliation summery at debretabor
hospital (SEP 01/2001-AUG30/2003)
Relevant factor % total %class A in %class B in % class C in ABC
factor ABC ABC

Total vital drug 24.71 8.04 8.04 8.62

Total essential drug 52.01 13.22 10.63 28.16

Total non essential 26.15 1.72 1.15 23.28

drug

Vital and essential 76.72 21.26 18.68 36.78

drug

Non formulary drug 0.57 0 0 0.57

% formulary drug 99.43 22.99(100) 19.83(100) 56.6(98.99)

 ABC/VEN Reconciliation...
100

90

80 % Total % class A in ABC

70

% class B in ABC % Class C In ABC

60

50

40

30

20

10

0
s s s s s ed s
r ug r ug r ug r ug r ug as r ug
lD sD lD ld yd r c h
yD
ta al tia tia ar pu ar
lV
i ti en n ul s ul
ta en ss se rm ug m
ss ne Es fo r or
To l E
o nd n fD F
ta lN la no o %
To ta t a ss
Vi % la
To C
%
 ABC/VEN Reconciliation...
• Class A, B and C medicines consumed 75.73%,
15.47% and 8.8% of the total medicines budget
respectively.
• The ABC analysis revealed that 76.72% of the drug
budget was spent on either essential or vital
medicines indicating the presence of optimal budget
utilization. This is due to the availability of facility
specific drug list which is segregated by VEN.
• The percentage of vital drug is highest in class C than
A and B. the reasons may be class C drugs are high in
quantity and inexpensive (low budget).therefore,
high budget drugs may not always life saving (vital).
 ABC/VEN Reconciliation...
• Almost all drugs were purchased based on hospital
drug formulary list 348(346, 99.43%).
• From class A and B ABC value analysis 6 and 4 drugs
were non essential respectively, but others were
either vital or essential. This also indicated fair
budget allocation.
• From out of 348 drug and medical supplies lent
insulin holds the highest budget (7.8%).The reasons
may be expensive ,there may be misuse by
patients(most patients receive freely).
• From class C only 2 drugs were purchased out of
drug formulary list
 4,implement APTS
Steps followed to implement APTS
1, preparation
• manpower; Training of staffs on APTS
( pharmacists, accountants, auditors and
cashiers ) RHB and USAID SIAPS
• Vouchers and registration
• Office and stationary materials
• Use of regional regulation as source document
 Steps followed to implement APTS…

• . Committee establishment , base line data

collection and action plan development
• Infrastructure
Arrangement of infrastructure (Birr 230,000.00)
 Merging of 3 rooms in to one
 Shelving of the room with standard materials
Steps followed to implement APTS…
Steps followed to implement APTS…
2,Initiation
 Arrangement and registration of items ( store and
dispensary)
 Inventory taking (store and dispensary) and
confirmation
 Two groups
 Coding of items(alpha numeric variable system)
 Price setting
 Start actual implementation (February 12,2013)
During inventory time store and dispensary
Store dispensary
Drug arrangement at new dispensary room
Steps followed to implement APTS…
 Steps followed to implement APTS…

3, Actual implementation
. Follow up activities (M&E)
 Daily summary
 Monthly and quarterly reports
 Annual report
 Documentation and filling
 Auditing
 Importance of best practice in pharmacy
service
• Efficient budget utilization

• Improved customer satisfaction

• Generate reliable information for decision making

• Effective work force development and deployment

• Transparency and accountability (auditable)

• Avoid brand prescribing
 Importance…
• Services are available at Emergency, inpatient and
OPD and Cashiers are assigned at each service point
• Reduce antimicrobial resistance
• Increase rational drug use
• Improve that pharmacy staff are involved in
detecting ,assessing , managing and reporting
potential ADRS and drug interaction
• Effective drug supply management system (6 basic
function)98% available drugs
 Importance…
• We have 0 stock out duration of tracer drugs(11+5(qunine
inj/tab,adrenalineinj,human/regular
insuline,hydralizine inj,dextrose 40%inj)
• Increased pt satisfaction (standard survey & town hall
meeting)
• 100% EHRIG pharmacy standard achieved (12)
• Clinical pharmacy(Decrease medication misadventure,
Increase patient compliance to therapy, Decrease heath
care cost and demand
• Maximized therapeutic benefit , minimize risk ,reduce cost
and support patient choice .
 Importance …
• Good counseling,
patient
Medication
profile and
improve patient
Adherence
( chronic illness)
 Importance …
• Conduct performance assessments based on tools
developed
 Indicators (patient load, and others)
 Stock status analysis
 Stock turn over analysis
 Decrease in damage and expiry/wastage minimization
 Patient satisfaction
 ABC/VEN analysis, DUE and others
 good Record keeping
 Importance…
• Increase staff satisfaction(Pharmacy Staff
satisfaction from 69% to 98%)
• Improve counseling service
• Improve record keeping
• Drugs are auditable
• Pharmacy department Commitment, interest to
apply the system,
– Shared responsibility
– Trust among staffs
 Importance of APTS…
Financial report

Name of Reporting Section: Out Patient Reporting Month Yekatit 12-29, 2005 E.C
SU Parameters Add Less
Total cost of beginning stock at dispensing outlets/ Service delivery units 75795.93
Total cost of stock received from store during the month 24296.18
Dispensaries/SD Units

Cost of stock available for sale

Cash 28397.05
Total cost of medicines Credit 5480.30
dispensed/administered Free 5159.90
Total 39037.25
Total cost of medicines damaged 7.60
Total cost of medicines expired 185.380
Total cost of ending balance (calculated) 70098.15
Reconciliation Total cost of stock on hand (Inventory) 70330.34
Discrepancy, if any no
Total cost of beginning stock at the pharmacy store 1486050.51
Total cost of stock received by the pharmacy store 150419.82
Pharmacy Store

Cost of stock available for sale 1636470.33

Total cost of medicines issued to dispensing outlets & SD units 24296.18
Total cost of medicines damaged 1027
Total cost of medicines expired 7339.38
Total cost of ending balance (calculated) 1603757.77
Reconciliation Total cost of stock on hand (inventory) 1603757.77
Discrepancy, if any no
 Importance of APTS…
Financial report(2)
parameters Add Less
156184
Total cost of beginning stock (Store + Dispensary + SD Units)
6.44
156419.
Total cost of stock received (by the Pharmacy Store)
82
Cost of stock available for sale 1712266.26
Total cost of medicines dispensed at dispensing outlets & service 29800.9
delivery units (converted from total sales into cost) 5
Total cost of medicines damaged (Store + Dispensary + SD Units) 1037.63
Total cost of medicines expired (Store + Dispensary + SD Units) 6397
Total cost of ending balance
(calculated) 1674033.67
Reconciliation Total cost of stock on hand (inventory) 1674088.11
Discrepancy, if any no
39037.2
Total Sales (at selling price) = sum of daily sales of the month
5
29800.9
Total Cost of goods/stock sold (Credit, Cash, free) = Total Sales/1.31
5
Gross profit= Total Sales – Total Cost of goods/stock sold= 9236.3
Total Expenses = (Salary, Stationery, Telephone, Transportation, etc.) 3598
Net income = Gross profit –Total Expense 5638.3 Month=11276.6
 Importance of APTS…
Service report
No indicators Results remark
1 Number of patients Served in 14 days 1618
Number of patients served by cash 1246
Number of patients served by credit 154
Number of patients dispensed free 218
2 Average number of patients per dispenser/month 404
3 Average number of patients per dispenser per day 29
4 Average no of patient served by individual dispenser and -
counseling
5 Number of medicines use counseling sessions held 752
monthly per dispenser
6 Number of consultations held monthly per health facility 3006
7 Average number of medicines per encounter or patient 1.86 last year
2.1
 Importance of APTS…
Service report (2)
No Indicators results remark
8 Average price of medicines dispensed per 24.43
patient (excluding ART)
9 Average price of a single medicine 12.99
10 Affordability of medicines dispensed in the health Birr 24.13 WHO
facility Birr 45.00
11 Percentage availability of indicator medicines (at 100%
least 15 medicines used to treat 10 top diseases)
12 Stock turnover rate 0.41 14 days
13 Consumption to stock ratio Disp.=29.77% 14 days
Store=1.82%
14 Wastage (expired + damaged) rate in percent 0.5%
 Center of excellence
• Currently engaged in different hospital reforms (HCF,
HMIS, BPR, EHRIG etc)

• Center of excellence in HIV services & awarded by RHB

& Jhpigo

• LEAD hospital for Ethiopian Hospital Alliance for

Quality (EHAQ) & awarded by MOH

• Awarded for HCF project by FMOH & USAID

Together we can make a difference!!!

We are committed to Quality!!!

Thank you so much!!!