The Evaluation of Drug Management and Improvement Strategies Using the Hanlon Method in the Pharmacy Installation of the Bahteramas Hospital Southeast Sulawesi

Drug management is a drug management cycle which includes these stages as follows: selection, procurement, distribution and use. Ineffectiveness and inefficiency may negatively impact hospitals both medically and economically. This study aims to evaluate drug management in the selection, procurement, distribution and use of drugs at the Bahteramas Hospital, Southeast Sulawesi, 
 with Hanlon method as strategic improvement. This study has done with a descriptive method with data collected retrospectively in 2022 and prospectively, both primary (management record) and secondary (interviews). Results of this study about drug management showed there were 4 indicators that do not comply with standards. Meanwhile, other 10 indicators could comply with the standards. The improvement strategy using the Hanlon method in drug management is to prioritize repairing problems sequentially starting from the average percentage of drug waiting time, suitability of the national formulary and hospital formulary, as well as the percentage of dead stock.


INTRODUCTION
The hospital pharmacy service system has any standards to contribute to the presentation of valuable pharmaceutical supplies to patients, including clinical pharmacy services at minimal costs for all members of the public.Controlling and administering medicines includes selection, planning for the needs, procurement, receipt, storage, distribution, destruction and withdrawal from circulation (RI Minister of Health Regulation NO 72, 2016).Pharmaceutical technical personnel are someone who assists pharmacists in their duties, including pharmacy graduates, pharmacy analysts, intermediate pharmacy experts and pharmacist assistants (Regional Minister of Health Regulation No. 72, 2016).
Drug management in hospitals is an important part of drug management as the basis for ensuring drug needs through the stages of selection, procurement, distribution, and use.In this phase, during the planning stage, many efforts can be made to overcome problems with the drugs obtained.Then, supervision is completed by making efforts to regulate drug supplies and ensure drug accessibility.The management cycle must be maintained at all stages so that its activities are equally strong in the same direction and balanced.Therefore, if an error occurs at one stage, the cycle may not be distributed evenly, resulting in waste, unaffordability of medicines, and so on.(Quick et al ., 2012).
Hanlon method is a strategy for determining problem priorities based on four criteria, namely: the magnitude of the problem, the seriousness of the problem, the ease of handling the problem, and factors that determine whether the program can be implemented or not.This technique is an instrument for comparing various health cases relatively and not absolutely, based on a framework, objectively and fairly (George et al., 2008) Another research conducted at one of the RSU Budi Setia, Minahasa Regency, by Rumagit (2020), stated that from the selection to use stages there were important sectors that resulted in inefficiencies, including non-compliance with national forums, inappropriate allocation of funds for procurement, percentage and value of expired or damaged medicines, still low, concocted prescriptions and non-concocted prescriptions are still not on time.Another research conducted by Burhanudin (2018) at the Surakarta City Hospital Pharmacy Installation in 2017 based on research results showed that at the selection stage the nonconformity with the National Formulary was 86.83% with a standard indicator of 100%, this shows that the percentage of suitability of drugs available in the Home Formulary Illness with the National Formulary is not good, when compared with the 100% Hospital Formulary, this shows that the percentage of conformity of drug items with the Hospital Formulary is running well.
The problems that occurred at the Bahteramas Regional Hospital, Southeast Sulawesi in 2022, based on an interview with one of the outpatient pharmacy staff via cell phone, were that the availability of generic medicines was still low and there were still many prescriptions for branded generic medicines, inconsistencies between annual drug planning and purchasing due to ups and downs in drug use, as well as damaged or expired drugs.Research regarding the evaluation of drug management in the Pharmacy Installation at Bahteramas Regional Hospital, Southeast Sulawesi has never been carried out, so researchers want to do it in the hope that drug management can run optimally.Indicators for drug management in hospitals can be used to measure the performance or pharmaceutical quality of a hospital.In observations made by researchers, in terms of clinical pharmacy services in hospitals, they have not been running well, because all indicators have not achieved results that are in accordance with established standards.According to one of the outpatient pharmacy staff, the Covid-19 pandemic resulted in minimal stock of medicines.
Based on the introduction above, the researcher is interested in conducting research on the Evaluation of Drug Management at the Bahteramas Regional Hospital, Southeast Sulawesi, in accordance with the indicators that have been included.The quality indicators for drug management consist of the selection, procurement, distribution, and use stages.This research conducted to find out the priority problem that arise based on Hanlon's analysis of drug management at that hospital.With this research, the researcher hope that the results of this research will provide input and strategies for improvement using the Hanlon method in achieving quality implementation of drug management in the Pharmacy Installation of Bahteramas Regional Hospital, Southeast Sulawesi.

Hospital
According to Republic of Indonesia Law Number 44 of 2009 Article 1 concerning hospitals, a hospital is a health service institution that provides comprehensive individual health services that provide inpatient, outpatient and emergency services.The duties and functions of hospitals are regulated in Republic of Indonesia Law Number 44 of 2009 about Hospitals.Good and attractive organization of pharmaceutical supplies and drug management in hospitals will develop the quality of health services (Martins et al., 2019).
Bahteramas Regional Hospital is a referral hospital in the Southeast Sulawesi region.The current status of Bahteramas Regional Hospital is a Hospital with Plenary Accreditation (5 Star) by the Hospital Accreditation Committee (KARS) and also as a Class B Teaching Hospital and functions as a Teaching Hospital for doctors and other health workers.( Profile of Bahteramas Regional Hospital, 2020).

Hospital Pharmacy Installation
A hospital pharmacy installation is a part of a hospital that is led by a pharmacist as the person in charge and is a place or facility for providing health services that guarantees the availability of safe, quality, useful and affordable pharmaceutical preparations, medical devices and consumable medical materials (Siregar and Amalia, 2004;Indonesian Minister of Health, 2016).

Medication Management in Hospitals
The drug management system is a complex series of activities which constitute an interrelated cycle, basically consisting of four basic functions, namely selection, planning and procurement, distribution and use (Satibi, 2014).According to Quick (1997) drug management in hospitals is an important element in the overall managerial function of hospitals, because inefficiency will have a negative impact on hospitals both medically and economically.
The aim of the importance of drug management in hospitals is so that the necessary drugs are available whenever needed, in sufficient quantities, guaranteed quality and at affordable prices to support quality services (Quick, 1997).Hospitals must develop policies regarding effective management of drug use.The policy must be reviewed at least once a year.Reviews really help hospitals understand the need and priorities for continuous improvement of the quality and safety system for drug use (Minister of Health of the Republic of Indonesia, 2016).
Drug management in hospitals includes the stages of selection, planning and procurement, distribution and use, which are interrelated to each other, so they must be well coordinated so that each can function optimally.The disconnection between each stage will result in inefficient systems for the supply and use of existing drugs (Quick, 1997).

Hanlon Method
The Hanlon method is a technique or method used to determine problem priorities using 4 groups of criteria, such as the size of the problem, emergency of the problem, ease of problem solving, and factors that determine whether or not the program can be implemented.
The PEARL factor consists of: P = Appropriateness , E = Economic Feasibility , A = Acceptability , R = Resource availability , L = Legality .Test each problem with the PEARL factor, there are 2 answers "Yes = 1" "No = 0" (Nugroho et al., 2022).The Hanlon strategy is generally used in drug management evaluation assessments because the procedure is simple and the calculations are easy to determine using weightings that determine problem criteria (Hasanuddin, & Marzuki, 2019).
Based on the description above, the empirical information in this research is as follows:

Implementation Stage
This research was carried out by observing and collecting data to evaluate drug management at the Bahteramas Regional General Hospital, Southeast Sulawesi in 2022, as well as conducting interviews with the relevant hospitals.
Secondary data was obtained by evaluating the efficiency of drug management in IFRS, namely by measuring aspects of selection, procurement, distribution, and use using drug management efficiency indicators and developing improvement strategies for indicators that are not yet efficient.This evaluation was carried out by measuring the process of selection, procurement, distribution and use of drugs for approximately 1 month.
The selection measured is the percentage of conformity of available drug items with DOEN.The suitability of available drug items with DOEN is the match between the number of drug items (X) and the number of available drug items (Y).Calculation: (X/Y) X 100%.The procurement can be measured with these points below: a. Frequency procurement items drug, ie How many time medicines required ordered every year.Calculation: take a 10% sample of drug stock cards randomly, observed How many time items drug ordered ( x time).b.Frequency of delays in payment for medicines in the hospital at that time agreed.Calculation: observe the debt list and match it with the payment list (X day).
Distribution can be measured with these points below: a.
Percentage match between physical quantities of drugs in accordance with the reality of the card stock.Suitability card stock (X) with the physical amount of the drug according to reality (Y) is compatibility between amount something type of drug on a stock card with a physical count of drugs.Data was randomly collected for 7 days prospectively with method take 10% samples regularly proportional to the dosage forms available in the pharmacy that meet the fast criteria moving.Calculation: (X/Y) X 100%.b.
Percentage drug expired and damaged.The calculation a with method calculate mark drug expired and damaged in rupiah (X) compared to the number of stocks hospitalization in rupiah (Y) multiplied by 100% or (X/Y) X 100%.Data collection done retrospectively from the search drug data is damaged And expired as well as stock hospitalization in year 2022.c.
Dead stock percentage, namely drug items that have not been used for 3 months by calculating the number of unused drug items for 3 months (X) by the number of items in stock (Y) multiplied by 100%.
Use can be measured with these points below: a.
Number of drug items per prescription sheets.From all, take 10% of the sample.Calculate the total number of medicinal items written on the prescription (X) and the number of prescription sheets (Y).Average: X/Y. b.
Percentage of prescriptions with generic drugs.From the generic drug writing report, count the number of drug items with generic names (X).
Count the number of medication items prescribed (Y).Calculation: (X/Y) X 100%.
c. Average time spent serving a prescription.Data was collected prospectively for 7 days during service hours 08.00-16.00WITA.The calculation is done by recording the time the prescription was entered (I) and the time the medicine was handed over to the patient (J), (IJ/number of all prescriptions entered).d.
Percentage of drugs that cannot be served.Data collection was carried out retrospectively from tracking data in the form of prescriptions for 2022.The calculation was by recording the number of drug items that were not submitted by the patient, (X) compared to the number of drug items prescribed (Y) multiplied by 100% or more precisely (X/Y) 100%.e.
Percentage of medications that are correctly labeled.Data was collected prospectively for 7 days during service hours 08.00-16.00WITA.The calculation is carried out by recording the number of labels containing the patient's name, and the rules for taking/using medication (X) and the total number of medication items given to the patient (Y) multiplied by 100% or (X/Y) X 100%.

Data Analysis Stages
Researchers must carried out any calculations on each indicator and compared them with standard values and interpreted the results of interviews to analyze drug management in the Southeast Sulawesi Regional General Hospital Pharmacy Installation.Data obtained from: Primary data, namely data obtained based on interviews using question sheets, direct notes and voice recordings from policy makers and people responsible in the field, including: Hospital Director, Head of IFRS, Head of Planning and Procurement, Head of Warehouse Logistics and Drug Distribution Officers.
Secondary data is any data obtained from evaluating the efficiency of drug management in IFRS using all documents including drug inventory reports, invoices, hospital formulary books and national formularies, reports on the use of generic drugs/drugs for national formularies and hospital formularies, purchase books, reports of damaged/expired medicines, letters of order for a list of partners are carried out by measuring the selection process, distribution procurement and use according to indicators of drug management efficiency.
The data obtained will be classified into qualitative data and quantitative data.Qualitative data is based on the identification of findings along with the results written in textual form in the form of narratives.Quantitative data is presented in the form of tables and narratives to make it clear if there are changes visually.Next, data from each stage of drug management that does not comply with indicator standards and then an improvement strategy is carried out.

Data Analysis
The data processed from the research results include, among other things, data collection in the management of drug storage and distribution which according to the indicators: Pharmaceutical warehouse, outpatient distribution unit, inpatient distribution unit, procurement service unit, and administration unit.From each unit, documents such as stock cards, product labels and recipes were observed, as well as interviews with the staff (human resources) responsible for these units.The assessment of each indicator is compared with existing standards to assess the efficiency of managing the storage and distribution of outpatient and inpatient medicines.The data obtained was classified into two groups, namely qualitative data and quantitative data.Qualitative data was carried out using content analysis based on identification of findings and the results were presented in textual form in the form of narratives.Quantitative data is presented in tabular form using the Microsoft Excel program and narratives to visually clarify if changes occur.
Provide clear and concise versions of your methods of conducting research, population and samples, and data analysis tools.

RESEARCH RESULT Selection Stage
The measurements carried out at the selection stage, namely the suitability of drug items available in the national and hospital formulary, can be seen in Table 1 and Table 2

Selection Stage
The measurements carried out at the selection stage, namely the suitability of drug items available in the national and hospital formulary, can be seen in Table 1 and Table 2

Procurement Stage
Frequency of procurement of each drug item per year, can be seen in Table 3.Meanwhile, frequency of delayed payments by hospitals can be seen in Table 4.

Distribution Stage
Table 5 shows that the number of drug items in the pharmacy installation warehouse at Bahteramas Regional Hospital, Southeast Sulawesi is in accordance with the physical quantity.medicine and stock cards are 100%.Meanwhile Table 6 shows that the percentage value of expired and damaged medicines is 0.02% according to standard values.In addition, Table 7 shows about the percentage of the dead stocks.

Use Stage
Table 8 shows that the results of research on the number of drug items per prescription sheet in outpatient pharmacy installations is 1.32%.Meanwhile the other tables from Table 9 to Table 14 show about percentage of prescriptions for outpatient at hospital.

Selection Stage
Selection is carried out at the beginning of each year to prepare standardization of drugs that will be used in the year concerned according to proposals from all Functional Medical Staff, taking into account standardization of drugs from the previous year, reducing unused drug items by replacing new drugs that will be used in the proposed year.Table 1 shows that the percentage of drug availability with the national formulary is 32.36%.The research data has not yet reached the standard value.Based on the results of interviews with the head of the hospital pharmacy installation, there is national formulary data amounting to 32.36% which was due to drug availability limited market, long estimated drug delivery, increasing number of patients and changes in therapy.
Table 2 shows that the percentage of suitability for drugs included in the hospital formula list is 81.82%, which has not yet reached the standard value.When compared with previous similar research regarding the availability of drug items in the hospital formulary studied by Indriana (2021) at the RSUA Surabaya pharmacy installation, it was 72%.The research results show a value below the standard, namely 100%.The standard value for drug availability in IFRS with the national formula according to the Indonesian Ministry of Ice Regulation is 100%.

Procurement Stage
Table 3 shows that the frequency of procurement of each drug item is 30 times a year.Data obtained from interviews.There are 2 types of procurement carried out at Bahteramas Regional Hospital, Southeast Sulawesi, including annual procurement and monthly procurement.Annual procurement is prepared towards the end of the new fiscal year for budget formation, based on the amount used in the 2021 drug budget, it can be adjusted to price increases and the budget plan provided by referring to the drug standardization list.Based on the results of an interview with the Head of Planning at Bahteramas Regional Hospital, Southeast Sulawesi, the annual budget procurement is carried out once a year.This aims to prevent accumulation of medicines that have not yet been used and to avoid the accumulation of costs.Research conducted by Indriana (2021) at RSUA, namely 9 times a year and in the low category, while other research conducted by Burhanudin (2018) at Surakarta Regional Hospital was 12 times a year and was in the medium category.
Table 4 shows that the frequency of delayed payments by the hospital is 8 times a year corresponds to the standard value of 0-25 times.Based on the results of interviews with the head of the hospital planning department, regarding payment times that have been agreed upon by the hospital and the PBF, payments in 2022 have been delayed 8 times a year, because the funds provided were not sufficient.There are other studies conducted by Burhanudin (2018) at the Surakarta Regional Hospital, namely 0 times, and research conducted by Karimah (2020) at the Roemani Muhammadiah Hospital, Semarang, namely 42 times, which exceeds the standard value that has been set, namely 0-25 times.The cause is the delay in payment claimed from BPJS funds.The impact that occurs if payment is delayed from the hospital is that the hospital will face cash flow difficulties.

Distribution Stage
Table 5 shows that the number of drug items in the pharmacy installation warehouse at Bahteramas Regional Hospital, Southeast Sulawesi is in accordance with the physical quantity.medicine and stock cards are 100%.WHO (1993) stated that the match between drug stock in the warehouse and the physical quantity of drugs is 100%.Based on other research conducted by Indriana (2021) at RSUA is 80%, showing that drug management in terms of accuracy of drug quantity data with drug stock cards at Bahteramas Regional Hospital, Southeast Sulawesi is in accordance with standard values compared to other studies.
Table 6 shows that the percentage value of expired and damaged medicines is 0.02% according to standard values.Even though it meets the standard values , the types of drugs and the number of drugs included in the expired or expired drug list damage is unknown because the hospital has not used the SIM application in 2022, so what is known is only the value of expired and damaged medicines and the value of final inventory in 2022.Based on the results of the meeting with the head of the pharmaceutical logistics room and the pharmaceutical goods storage officer, this is due to the employee's thoroughness hospital pharmacy installations in recording expired medicines and stock taking, as well as focusing on RKO and previous storage because there are medicines that are inserted so that medicines cannot be prescribed, the solution is by implementing the FIFO and FEFO systems.Meanwhile, in research conducted by Indriana (2021) at RSUA, the percentage of expired drug values was 1.71%, exceeding the standard value.
Based on table 7, it shows that dead stock is 8.33%, this result shows that it is higher than the standard value of 0%.It can be seen from the monitoring results that the availability of medicines in the medicine warehouse is still not running well, as well as communication between hospital pharmacy installations and pharmaceutical logistics staff is not running optimally, causing some medicines to experience dead stock .Based on research results , dead stock in hospital pharmaceutical installations is higher, namely 8.33%, which does not meet the standard r value, compared to research conducted by Indriana (2021) in RSUA dead stock was 14%, this was due to excess drug supplies from the previous year which were not utilized by specialist doctors in practice momentum.The treatment for this problem is to apply FIFO and FEFO optimally and provide information to the doctor to prescribe medication that has been stopped for 3 months.

Use Stage
Table 8 shows that the results of research on the number of drug items per prescription sheet in outpatient pharmacy installations is 1.32%, this shows that every 1 prescription sheet on average consists of 3 types of drugs.This is compared to other research conducted by Indriana (2021) at RSUA, namely 2.5%.Write the number of each drug item as small as possible to avoid interaction effects between drugs and side effects which pose a risk of harming the patient because when more drugs are consumed, there is a risk of unwanted side effects.
Based on monitoring results, Table 9 shows that the percentage of drugs with generic names prescribed in outpatient pharmacy settings is 64.46% , this value is still below normal, namely ≤ 82-94%.So, there is a fundamental reason, namely because hospitals have special guidelines for treating patients, so generic drugs are only provided for JKN patients.Meanwhile, patent medicines are prescribed for general patients.The main reason is because doctors' lack awareness in prescribing generic drugs to patients during service hours.Based on the results of interviews with the head of the pharmaceutical logistics room, this is related to community rejection especially in private hospitals, so there is a tendency for patients to use patented medicines, so hospitals also procure patented medicines with a cost ratio that is not much different from generic medicines.So, even though the hospital provides patent medicines, it provides patent medicines at an economical price.Then, in outpatient services the number of JKN and non-JKN patients is almost equal, in fact in recent times the number of non-JKN patients for outpatient care has been higher, namely 66% compared to JKN patients.This certainly increases the use of non-generic medicines.
Based on table 10, it shows that the percentage of antibiotic drug prescriptions in outpatient pharmacy services is 35.55%,lower than the standard value of 22.7%-63%.This results show that the consistency of the doctor in charge of the patient in writing antibiotic prescriptions has been efficient, in accordance with the PPRA (Antibiotic Resistance Control Program) group in the hospital which has collaborated with the hospital's KFT and PPI teams.WHO recommends that doctors do not simply prescribe treatment for every disease diagnosis.Based on the results of interviews with the head of the pharmaceutical logistics room, it was stated that doctors always prescribe antibiotics with 2 classes of drugs, namely penicillins and cephalosporins.Quinolones and macrolides are also sometimes prescribed, but penicillins and cephalosporins are the most commonly prescribed.
Based on table 11, the research results of prescribing injection drugs in outpatient pharmacy installations were 31.40%according to WHO (1993) provisions of 0.2-48%.The results of interviews and monitoring of outpatients can be seen from the patient's condition or from the diagnosis of the disease, for example patients in the ER who experience nausea and vomiting will often use injection preparations.So, to limit the use of excessive amounts of injection drugs, patients in the emergency room are transferred to the ward, if their condition has recovered, but at the same time the patient can undergo outpatient treatment.So, patients can be given oral medication to reduce the use of injectable preparationsi.The most commonly used injection drugs for inpatient care, an example of a commonly used injection drug is cefotaxime, which is indicated for infections caused by bacteria, joint infections, pelvic inflammation, meningitis, pneumonia, UTI, sepsis, genorrhea.The dose of cefotaxime prescribed by the doctor after completing a thorough examination of patients who have bacterial infections.
Table 12 shows the results of the average percentage of time used to serve prescriptions to the patient, measuring the average time taken during drug prescription service hours at the outpatient pharmacy installation depot with the number of prescriptions obtained from 100 prescriptions obtained at 61 minutes for concocted prescriptions and 37 minutes for non-concocted ones, at this stage the average waiting time at the Bahteramas Hospital Pharmacy Installation, Southeast Sulawesi does not meet the Indonesian Ministry of Health's standards 2008 and does not comply with the hospital's SPM (Minimum Service Standards).However, This is due to the fact that the number of personnel in pharmaceutical services is not sufficient to serve prescriptions so that they have not reached the standard time set for non-concocted prescriptions of ≤30 minutes and concocted prescriptions ≤60 minutes.
Based on the results in table 13, the percentage of drug value that can be handed over is 100%, according to WHO (1993) the standard value is 76%-100%.Thus, these results indicate that the percentage level of drugs that can be delivered is effective when compared with the standard.The research results contained in the indicator of the percentage of drugs that can be delivered with a value of 100%, this is because the strategy of the Bahteramas Regional Hospital, Southeast Sulawesi has been able to provide the best prescription according to the level of treatment needs at the Bahteramasi Regional Hospital, Southeast Sulawesi, thus preventing losses for the hospital and losses to patient.
Based on table 14, the percentage of drugs that are fully labeled reaches 100%, which means the value meets the standard (WHO 1993), namely 100%.This is because drug indicators that are fully labeled are always cross checked or the patient's drug prescription is checked repeatedly until it reaches the patient, to provide information on how to use the drug correctly and the patient's full name, this is done when the pharmacist is providing drug information to the patient.or the family of a patient who is taking medication at an outpatient pharmacy depot.This shows that the pharmaceutical technical staff and Pharmacy Installation staff at Bahteramas Regional Hospital, Southeast Sulawesi have labeled the labels correctly and accurately.Before a prescription can be given to a patient, the pharmacist usually checks it first and provides drug information to the patient regarding the use of drugs that the patient is not aware of, this creates good communication between the pharmacist and the patient so that it can help the patient to minimize errors in drug use in the drinking regimen.and storage of medication when the patient has received the medication.

Improvement Proposal Framework using the Hanlon Method
Based on the results of monitoring and interviews conducted by researchers regarding drug management procedures in the Pharmacy Installation of Bahteramas Regional Hospital, Southeast Sulawesi, it appears that there are still several indicators that are not working well.Thus, researchers suggest several steps to improve drug management in the Pharmacy Installation of Bahteramas Regional Hospital, Southeast Sulawesi.The suggested improvement framework for medication management is designed by considering the problems and solutions that hospitals can use to overcome the problems.To get good results, it is necessary to prioritize the problem, so that it can be done by improving the Hanlon method on drug management indicators that are not working well .Then, scores/weights are given using criteria A, B, C, and D (PEARL).
Table 15 weighting with use method Hanlon done for obtain mark form numbers and shows scale possible priorities overcome existing problems so solution problem can be done in a way orderly.Furthermore, count mark Basic Priority Rating (BPR) and Overall Priority Rating (OPR).
Good drug management by ensuring the availability of needed drugs, the quantity of drugs that are met, and ensuring quality in supporting quality services in hospitals.Based on monitoring and interviews carried out by researchers with several relevant parties at the location regarding drug management at the Pharmacy Installation at Bahteramas Regional Hospital, Southeast Sulawesi, it was found that there were several problems with drug management so that they could be resolved in order to support sustainable services at the hospital.Thus, researchers provide several suggestions for efforts to improve drug management in hospitals.The framework for efforts to improve drug management is prepared based on problem findings and improvement strategies that can be carried out by hospital management to overcome existing problems, which can be seen in Table 16.
In table 16, this table describes the problems that exist in drug management at the Pharmacy Installation of Bahteramas Regional Hospital, Southeast Sulawesi, so that improvements to the hanlon strategy can be made by determining the problem priority score.
Improvements can be made using the Hanlon method, namely: the average percentage of waiting time for medicines to reach the patient, with the improvement solution: recruiting pharmaceutical technical staff and pharmacist staff.Conformity with the national formulary & conformity with the hospital formulary, with improvement solutions, namely: proposing to the KFT to discuss as an evaluation the previous consumption method, ordering drugs by considering waiting times and safety stock , and improving communication between doctors, IFRS officers and drug distribution parties to avoid stock

Table 1 . Compatibility of Available Medicines with the National Formulatory
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Table 1 . Compatibility of Available Medicines with the National Formulatory
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Table 7 .
Percentage of Dead Stock