Identification of waste: DOWNTIME in the outpatient prescription services at the pharmacy installation of Rumah Sakit Islam Siti Hajar Mataram

Background: The hospital pharmacy installation is a health service unit that is required to provide professional services and improve quality which is oriented towards achieving patient satisfaction. Waste identification in pharmaceutical services is important because it has an impact on stakeholder satisfaction. Objective: Identifying waste using the DOWNTIME method for the outpatient prescription services at the pharmacy installation of Rumah Sakit Islam Siti Hajar Mataram. Methods: The study used the cross-sectional design, with the population being all outpatients who were provided with pharmaceutical services during February – April 2019 as well as all staff. Data were tabulated and analyzed descriptively. Critical waste was obtained through questionnaires and the root causes of critical waste were obtained through in-depth interviews with 5-why methods. Results: Waste waiting had the highest rate compared to other wastes, reaching 44% or 53 out of 121 respondents, followed by inventory (26%), extra processing (19%), transportation (14%), defects (14%), motion (13%), over production (8%), and non-utilized skills (7%). Meanwhile, from the staff respondents, waiting was also the highest waste (18%), followed by inventory (16%), motion (13%), over production (12%), transportation (12%), non-utilized skills (10%), extra processing (10%), and defects (9%). The root cause of waste waiting was the frequent drug unavailability due to delays in payment of services from the cooperating party to the hospital as well as the narrow service areas. Conclusion:Waste waiting became the critical waste with the highest percentage of dissatisfaction in the patient respondents (44%) and staff respondents (18%). Keywords: Waste, DOWNTIME, outpatient prescription services, pharmacy installation of RSI Siti Hajar Mataram

Implementation of Lean Kaizen to Reduce Waiting Time for the Indonesian Health Social Security Agency Prescription Services in Hospital Pharmacy InstallationImplementation of Lean Kaizen to Reduce Waiting Time for the Indonesian Health Social Security Agency Prescription Services in Hospital Pharmacy Installation

BACKGROUND: The second largest Health Social Security Agency (BPJS) outpatients visits in Hospital Pharmacy Installation, Indonesia, has reached 450-600 visits / day between 2017 and 2018. This has an impact on the number of prescriptions to be served. Simultaneous doctor practice schedule and less human resources are the reasons for not achieving the service standard time set by the Ministry of Health (≤60 minutes for concoctions and ≤30 minutes for non-concoctions). AIM: The purpose of this study was to determine the waiting time for BPJS prescription services in the current state and future state after the implementation of lean kaizen through Plan-Do-Check-Act (PDCA) approach at Grha Permata Ibu (GPI) Hospital. METHODS: The research method is operational research with qualitative and quantitative approaches through direct observation and in-depth interviews. RESULTS: The implementation of lean kaizen decreased the lead time from 135.31 minutes to 9.11 minutes in scenario-1 and 7.49 minutes in scenario-2 and a decrease in lead time from 185.17 minutes to 31.09 minutes in scenario-1 and 29,15 minutes in scenario-2 for the concoctions. PDCA in lean kaizen is for use in conditions where waste is most closely related to human behavior, but there is still a waste motion that has not been intervened. CONCLUSION: This study suggests an updating information to prioritize changes in pharmaceutical layout, carry out continuous monitoring, and encourage IT to develop IT-based pharmaceutical services.

ANALISIS WAKTU TUNGGU PELAYANAN RESEP PADA PASIEN RAWAT JALAN DI RSUD DR. H. ABDUL MOELOEK PROVINSI LAMPUNG

Pharmaceutical services are health services in hospitals that are expected to meet minimum service standards (SPM) in an effort to improve the quality of services to patients. One of the pharmaceutical service categories in the minimum service standard (SPM) in hospitals is the waiting time for prescription services in the form of nonconcoction drugs is the grace period from the time the patient submits a prescription to receiving non-concoction drugs with a minimum standard set by the Ministry of Health that is ≤ 30 minutes, whereas the waiting time for prescription concoction services is the grace period from the time the patient submits the prescription until receiving the concoction drug that is ≤ 60 minutes. This research was conducted to analyze the waiting time for outpatient prescription services in Dr. H. Abdul Moeloek based on hospital minimum service standards (SPM) as an overview of prescription services, evaluation materials and pilots in an effort to improve the quality of pharmaceutical services. This research will be conducted at the pharmacy outpatients Dr. H. Abdul Moeloek in August - September 2019 with a sample of 172 recipes, consisting of 98 non-concoction recipes and 74 recipe concoctions. Based on the research that has been done, the results of waiting time for non-concoction prescription services in the Outpatient Installation of Dr. H. Abdul Moeloek is in accordance with the SPM at the Hospital with an average waiting time of 11 minutes. Waiting time for prescription concoction services in Dr. Outpatient Hospital Installation H. Abdul Moeloek is in accordance with the SPM at the Hospital with an average waiting time of 19.4 minutes. Keywords: Pharmaceutical services, waiting time, pharmaceutical service standards.

Effect of depression on health service utilisation in men: a prospective cohort study of Australian men aged 35 to 80 years

ObjectivesTo examine the relationship between depression burden, health service utilisation and depression diagnosis in community-based men.DesignProspective cohort study.SettingCommunity-based.ParticipantsMen aged 35–80 years at recruitment (2002–2005), randomly selected from the northern and western suburbs of Adelaide, Australia, without depression at baseline, who attended follow-up visits (2007–2010) (n=1464).Primary and secondary outcome measuresDepression symptoms were categorised into high burden (total score of ≥13 for the Beck Depression Inventory (BDI) or ≥10 for the Centre for Epidemiologic Studies Depression Scale (CES-D) or low burden (<13 for the BDI or <10 for the CES-D). Diagnosed depression was determined by patient-reported physician diagnosis. Frequent general practitioner (GP) visits were those occurring 5+ times over the preceding year. Use of national medical and prescription services (Medicare Benefit Schedule and Pharmaceutical Benefit Scheme; MBS and PBS) was assessed through data linkage.ResultsFrequent attendance and depression diagnosis was more common in men with a high than low burden of depression symptoms (45.9% vs 29.3%–18.7% vs 1.9%, p<0.001). Depression diagnoses were also more common in frequent GP attenders compared with low-average attenders (5.1% vs 2.2%, p<0.001). Among men with high burden of symptoms, there was no age-adjusted or multi-adjusted difference for likelihood of depression diagnosis between non-regular and frequent GP attenders. Annualised MBS and PBS expenditure was highest for men with undiagnosed depression.ConclusionsMen with a high burden of depression symptoms have commensurate use of health services when compared with those with a low burden, but only half report a physician diagnosis of depression. Undiagnosed depression led to a higher usage of medical and prescription services.

Evaluation of Waiting Time for Outpatient Prescription Services at the Pharmacy Installation at the Universitas Sumatera Utara Hospital

The pharmacy installation is one of the units in the hospital that provides. service products and services in the form of prescription services. Prescription service asthe front line of pharmacy services to patients must be managed properly becausethe quality of pharmaceutical prescription service which is generally associated with the speed ingiving service. This research is a descriptive type of research with prospective data collection from March-June 2019 to evaluate the waiting time for outpatient prescription services at the Hospital Pharmacy Installation of the Universitas Sumatera Utara. The data taken were 357 outpatient prescriptions.The results of this study indicate the total average length of time waiting for outpatients for the provision of non-fake drugs at the Pharmacy Installation of Outpatients at the University of Sumatera Utara Hospital at 09.00 - 11.00 is 29.10 minutes, at 11.00 - 13.00 is 34.44. minutes and at 13.00 - finished 42.60 minutes. The average length of waiting time for outpatients for the provision of compound drugs at the Outpatient Pharmacy Installation of the University of Sumatera Utara Hospital at 09.00 - 11.00 is 51.67 minutes, 11.00 - 13.00 hours is 62.27 minutes and at 13.00 - completion was 65.71 minutes. The waiting time for prescription services is ≤ 60 minutes.Based on the results of research conducted at the Outpatient Pharmacy Installation at the University of Sumatera Utara Hospital, non-concocted prescription drugs meet the requirements if the service time speed is ≤ 30 minutes and the concocted drug prescription fulfills the requirements if the service time speed is ≤ 60 minutes.

TUGAS POKOK DAN FUNGSI (TUPOKSI) APOTEKER DI PUSKESMAS DALAM PELAYANAN OBAT MENURUT PERATURAN PERUNDANG-UNDANGAN

Puskesmas is a health service facility that aims to improve public health, which is related to the role of pharmacists in providing good pharmaceutical services. Pharmaceutical services are direct services that are responsible for pharmaceutical preparations in order to achieve quality improvement in patient life. The main duties and functions of pharmacists in health centers include pharmaceutical services regarding drug services and have been regulated in laws and regulations. In practice, it is not yet fully implemented because it is not considered a priority. Various cases of inappropriate drug use have emerged. For this reason, it is necessary to carry out a study on the functions of pharmacists in health centers based on statutory regulations. The method of writing this article is based on literature study through legal rules and regulations which are then linked to cases that occur in society. Various laws have been made by the government to regulate the responsibilities of a pharmacist in carrying out their duties and functions in matters related to pharmaceutical services such as drug services so that they are expected to be able to minimize drug-related cases that occur in the community. The duties and functions of pharmacists which are regulated by law include prescription services, counseling, dispensing, PTO, MESO, and PIO.

HUBUNGAN ANTARA WAKTU TUNGGU PELAYANAN RESEP TERHADAP TINGKAT KEPUASAN PASIEN DI PUSKESMAS GAMBUT

The waiting time for prescription services is one of the services that can affect patient satisfaction. The main aspect that becomes an effect is that the faster the waiting time for prescription services, the patient will be satisfied. In terms of evaluation and service improvement, it is necessary to know the description of the waiting time for prescription services and the relationship between waiting time for prescription services to the level of patient satisfaction. This method of research is non-experimental with prospective data retrieval. The population are patients or families of patients who await in the service of prescription. Samples used consecutive sampling is obtained 169 respondents. Data collection using questionnaires and observation sheets. Data analysis using SPSS 16.0 is the Spearman test. The results showed that the waiting time for the non-blend recipe service and recipes blends as a whole meet the standard SOP Puskesmas Gambut. The level of patient satisfaction on the Reliability dimension with a percentage of 74.06% is in satisfied category. Responsiveness dimensions with a percentage of 76.33% are in very satisfied category. There is no (signification 0.306 > 0.05) relationship between the prescription service waiting time of the patient's satisfaction level in Puskesmas Gambut.

EVALUASI WAKTU TUNGGU PELAYANAN RESEP PASIEN RAWAT JALAN DI RUMAH SAKIT ANWAR MEDIKA

<em>The waiting time for finished drug service is the grace period from the time the patient submits the prescription until receiving the finished drug with a minimum standard set by the Ministry of Health is ≤ 30 minutes, while the waiting time for concoction drug service is the grace period from the time the patient submits the prescription until receiving the concoction drug that is ≤ 60 minutes. This study aims to determine the average waiting time for outpatient prescription services at Anwar Medika Hospital. This research was conducted with a cross sectional descriptive method. Primary data was collected through direct observation and recording of prescription service waiting times in the waiting time recording form on February 10, 2020 to February 11, 2020. Data taken were 384 outpatient prescriptions consisting of 346 non-concoctions and 38 prescription concoctions. In this study, 384 recipes were used as the research sample consisting of 346 for non-concoction recipes and 38 for recipe concoctions. The average time needed to complete a non-concoction recipe is 18.7 minutes and the time required to complete a recipe concoction is 30.9 minutes. Based on the results of research that has been done, it is found that the average waiting time for prescription services at Anwar Medika Hospital has fulfilled the requirements according to the minimum service standards at the hospital.</em>

The Impact of COVID-19 on the Management of Heart Failure -A United Kingdom Patient Questionnaire Study

AimThe coronavirus disease 2019 (COVID-19) pandemic has created significant challenges to healthcare globally, necessitating rapid restructuring of service provision. This questionnaire survey was conducted amongst adult heart failure (HF) patients in the United Kingdom (UK), to understand the impact of COVID-19 upon HF services.Methods and ResultsThe survey was conducted by the Pumping Marvellous Foundation (PMF), a UK HF patient charity. “Survey Monkey” was used to disseminate the questionnaire in the PMF’s online patient group and in 10 UK hospitals (out-patient hospital and community HF clinics). 1050 responses were collected (693/1050-66% women); 55% (579/1050) were aged over 60 years. Anxiety level was significantly higher regarding COVID19 (mean 7±2.5 on anxiety scale of 0 to 10) compared to anxiety regarding HF (6.1±2.4; p<0.001). Anxiety was higher amongst patients aged ≤60 years about HF (6.3±2.2 versus 5.9±2.5 in those aged >60 years; p=0.005) and COVID-19 (7.3±2.3 versus 6.7±2.6 those aged >60 years; p<0.001). 65% respondents (686/1050) reported disruption to HF appointments (cancellation or postponement) during the lockdown period. 37% reported disruption to medication prescription services and 34% reported inability to access their HF teams promptly. 32% expressed reluctance to attend hospital (25% stated they would only attend hospital if there was no alternative and 7% stated that they would not attend hospital at all).ConclusionsThe COVID-19 pandemic has caused significant anxiety amongst HF patients regarding COVID-19 and HF. Cancellation or postponement of scheduled clinic appointments, investigations, procedures, prescription and monitoring services were implicated as sources of anxiety.