School of Pharmaceutical Sciences, USM
PHARMACY MANAGEMENT CLERKSHIP
Academic Session 2010/2011
(Penang Hospital)
GROUP B (30 /8 - 3/9/2010)
LIM KOK HAN
MD HASHIMIE BADDRUDIN BIN MAT HASSAN
SURESKUMAR A/L HARISKRISHANAN
CHAI YEE YIEN
CHUA SUE HOON
NABILAH BINTI JAMALUDIN
NIK NUR NASEELA FATHIN BINTI NIK MOHD SABRI
NUR FADHILAH ARSHAD
NUR HAIDAR BT AKBAR
TAN SIN YEIN
MOHAMAD SYAHIR BIN FADZIL
MOHD JAUZE BIN KOMA RUDIN
MUHAMMAD IMADUDDIN BIN CHE MOHD NASIR
Lecturers: Dr. Mohamed Azmi Hassali l Dr. Asrul Akmal Shafie l Dr. Mahmoud Sadi Al
Haddad
0
CONTENT
 INTRODUCTION
2
 SCOPES AND DISCUSSION
6
1. Pharmacy Organizational Management
6
2. Human Resource Management
14
3. Financial Management and Control
22
4. Pharmaceutical Procurement and Inventory
28
 CONCLUSION
35
 REFERENCES
36
1
INTRODUCTION
One day-clerkship on topic Pharmacy Management at Hospital Pulau Pinang (HPP) was
conducted at Stor Integrasi (Integration Store) under Pharmacy Department of HPP and assisted
by Puan Noraini Binti Ab Kadir & Cik Rohaizan bt Mohd Hanafiah who are the pharmacist there. We
were informed that this pharmacy integration store is among the largest and highly active store in
Malaysia.
The activities were divided into 2 sessions, on the morning session we were explained in details
about the store management and organization at HPP which function as central core in
distribution of pharmaceutical and non-pharmaceutical items to sub-units in the Hospital. Be a
main store of the hospital, the management of store is thus very important to ensure smooth
functioning of the organization and any deficiencies of stock in the store significantly affect the
other units which are receiving ‘sources’ from this store.
Then on the afternoon session, we were guided to visit the division of the Stor Integrasi in closer
manner, which includes the different store rooms for different items and also to the general
administrative office to have a look on important documents, systems, etc involved.
First and foremost, we were introduced about the general Operational Store categories.
Government stores are divided into three (3) categories as shown below:
1) Center Store (national or state level)
Stores that provide , manage and supply of goods /products to
customers through a network storage levels states, districts,
divisions, branches and units.
2) Main Store (example Integration store of
HPP)
Store that create, manage and supply goods for
customers the state, regions, divisions, branches and
agencies.(substores)
3) Store Unit (sub-stores)
Store to store and supply goods for short-term
needs or use directly for the purpose of
operations and maintenance to the end customer.
2
Terms:
Stor basically a place to implement the receiving, recording, storage, maintenance, operation and
production regarding to stock.
Stock means the unused goods that kept for operational or maintenance purposes.
Types of goods/items managed by this Stor Integrasi or Integration Store of HPP which act as
main store for distribution to sub-stores(store unit) include: medicines, vaccines, non-medicine
items, chemical agents, medicinal gases (oxygen, nitrogen dioxide, etc), asset/inventory, etc.
The effect of weak, disorganized and inefficient store management can result in large
government losses due to wastage bound in the form of capital stock, obsolescence, shrinkage,
etc.
Store Management Objectives
Store management should be implemented properly, efficiently and effectively to ensure that:
i)
Stocks are always available when required and meet the requirements of customers
and
ii)
Quality of stock is guaranteed by providing protection, proper care and maintenance
during the storage.
Store Features
Store function is to supply services to customers by performing the following duties: i)
Receive goods ordered from the supplier in conformation to established regulations
ii)
Stock storage methods/procedures and the locations of storage determined in
appropriately as outlined in the guideline
iii)
Continued care and maintenance of the stock
iv)
Issuing stock according to customer need
v)
Maintain records of all transactions in and out of stocks accurately, systematically
and get updated
vi)
Plan and manage stock to ensure availability of stock in accordance with the
prescribed pattern
vii)
Handling packaging and shipping of stock to customers
3
viii)
To carry out inspections to detect and identify any weaknesses that lead to conflict
stock, damaged stock, obsolete, expired period of use, immobile,etc
ix)
Provides security and fire control systems and hygiene maintenance stores;
x)
Taking appropriate action on the disposal of obsolete stocks, damaged, expired items,
items that cannot be used, not required, not moving to avoid wastage of space storage
and
xi)
Managing the appropriate action in the case stock missing.
Organization Management Store
Organization this Stor Integrasi can be divided into four (4) main divisions, namely:
i)
Supply Division, Control and Accounts
-Responsible for plan and manage supply of stock for customers, stock control, check
and ensure that each form Stock Production Order is organized and correct,stock
inspections, records, database, etc
ii)
Receipt Division
- Responsible for checking and receiving of goods from the suppliers to ensure that
the procedure followed before confirming acceptance
iii)
Storage Division
- Operate and maintain the current stock in storage, to ensure the safety and
cleanliness of the store
iv)
Packaging and Delivery Section
-Responsible for packing and distributing items to customers in accordance with
procedures prescribed
4
Stock Control Management
Stock control is crucial to ensure that the stock level requirements can be provided to meet
customer (patients, health care professionals, etc) needs at all times. For the purpose of the use of
storage space, costs order, the purchase price and the capital assets involved should be taken into
account so that the excess stock and wastage can be avoided.
Efficient management of stock control and provide effective the following benefits:
i) The shortage of stock can be avoided
ii) More economical use of capital budget and the lack of money bound in the form of stock
iii) Stocks that are not moving, expired, damaged and aging can be reduced and storage space
can be optimized
5
SCOPES & DISCUSSIONS
1. PHARMACY ORGANIZATIONAL MANAGEMENT
1.1 Use of organizational charts/structures
An organizational chart is a diagram that shows the structure of an organization as well as the
relationships and relative ranks of its positions. Organization charts are an effective way to
communicate organizational, employee and enterprise information. When fully utilized, org chart
allow managers to make decisions about resources, provide a framework for managing change
and communicate operational information across the organization.
Diagram below shows the organizational chart of Stor Integrasi (Integration Store) of HPP:
Chief pharmacy officer
Normah bt Musa
Vice Chief Pharmacy Officer U52
Pharmacy Officer U48
Drug
Non drug
Pharmacy Officer U44
Ruhaizan Bt Hanafiah
Pharmacy Officer
U41
Pharmacy Officer U41
Assistant Admin
Officer N32
Assistant Admin Officer N27
Assistant Admin Officer N27
Admin Assistant N22
General Office
Worker N1
Admin Assistant N22
Admin Assistant N17
Admin Assistant N17
Public Worker R1
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General responsible of pharmacist at Stor Integrasi:
Pharmacy officer are responsible to ensure the smooth functioning of the integration store. The
general roles of pharmacy officer in integration store are as follow:
i)
Control and manage the store procurement and management to ensure store activities
run smoothly, orderly and systematically and in accordance to the rules and
regulations established.
ii)
Ensure that all the procurement activities are conducted as in the planning to avoid
any wastage of resources.
iii)
To ensure the capital assets to be properly maintained and to ensure the inspection of
these capital assets and inventory conducted in accordance to the rules and
regulations established.
iv)
To ensure disposal activities are done as needed so that storage space can be
optimized
v)
To ensure stock calculation, stock examination and store verification is conducted as
in Tatacara Pengurusan Stor (Pekeliling Perbendaharaan Bil 5 5/2009)
vi)
Pay attention to the safety and cleanliness of the store as well as the problems
associated with services and welfare of the staffs.
Assistant Admin Officer and Admin Assistant are responsible on store administration, financial
management, asset management and human resource management. General Office Worker N1 is
responsible on recording, documentation, and general office works. Public Worker R1 is
responsible on handling and keeps the store stocks.
1.2 Importance of planning
Planning represents the purposeful efforts taken by an organization to maximize its future
success. Planning has been described as one of the four key functions of managers which are
along with organizing, leading, and controlling.
7
Table below shows type of planning and its importance:
Strategic
Important to ensure that the organization is doing the right things and addresses
planning
what business the organization is in, or ought to be in, provides a framework for
more detailed planning and day-to-day decisions.
Operational
Important to ensure that the organization is prepared perform the immediate
planning
tasks and objectives to meet the goals and strategy of the organization. To
ensure that the organization is doing things right.
Business
Important to determine the feasibility of a specific business or program.
planning
Business planning is used to make a decision about investing in and moving
forward with a program.
Resource
Important to ensure the resources necessary to achieve the goals and strategy of
planning
the organization. Resource planning can be comprehensive which are all
resources needed to achieve goals and strategic plan of the organization or can
focus on a specific type of resource.
Organizational Important to ensure that an organization is organized appropriately to meet the
planning
challenges of the future and the key elements include reporting relationships,
definition of responsibilities, and definition of authorities.
Contingency
Important to provide a fallback option or direction should the original strategy
planning
of the organization fail or should something unexpected occur1.
TABLE 1 : Types of planning
Adapted from:
Shane P. Desselle, David P. Zgarrick. Pharmacy Management Essentials for All Practice
Settings. 2nd ed. Mc Graw Hill:2009.
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1.3 Importance of effective communication and leadership
Apart from good planning skills, an effective communication skills and leadership is essential in
an organization.
Communication is the sharing of information, ideas, thoughts and feelings. It involves not only
the spoken words but also information, which is conveyed through inflection, vocal quality,
facial expression, body posture and other behavioral responses (Verbal Communication
& Non-Verbal Communication)
Pharmacists are the triage between the patients and the medical practitioners and after all helps in
taking medicines safely and appropriately by the patients. Pharmacists should possess good
communication skills to correct weakness and strengthen confidentiality in disseminating
information.
An act of poor communication can be associated with various sarcastic problems as incomplete
drug information may be provided to health care professional, incomplete advising for
medication use to patients and inappropriate advising on dispensing.
An effective communication is important in establishing the pharmacist-patient relationship.
Pharmacists in all practice settings have opportunities to interface with patients, whether it is
through counseling, interviewing, or educating. This relationship is built on the foundation of
trust and an open exchange of information; it is a collaborative relationship. This relationship
establishes a covenant between pharmacist and patient. Pharmacists promise to utilize their
clinical knowledge and skills to provide the best care for their patients. Patients, in turn, provide
pharmacists with the information needed to effectively manage their drug therapy.
On the other hand, leadership is a learned behavior, is teachable, occurs at all levels of the
organization, does not require a charismatic personality, is a relational process, is culturally
influenced, requires followership, involves purposeful change that satisfies collective needs and
aspirations, includes the components of effectiveness and ethics, and develops over life.
Leadership is an important concept in health care professions which may lead invention of new
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technologies and dosage forms, changes in the delivery of health care, enhancement of patient
outcomes and quality of life, and success of their specific health care organization.
Leadership is a critical component for positive change within pharmacy organizations and the
profession. Within their practice settings, leaders will make changes within their practice setting
prior to other pharmacists within their immediate vicinity, such as implementing. Leadership in
each of these areas is important to provide effective patient care, to enhance the quality of life of
patients, to advance the profession of pharmacy, to make for a healthier community and for the
pharmacist’s own self-worth and actualization.
1.4 Quality Assurance program
Quality assurance has been defined as “a program for the systematic monitoring and evaluation
of the various aspects of a project, service, or facility to ensure that standards of quality are being
met” (Merriam-Webster).
In Penang General Hospital (HPP), the Stor Integrasi( the pharmacy store) need to undergo the
quality assurance audit in order to monitor and evaluate the quality and performance of the
services provided by this store. Auditing can be defined as an examination, analysis and
evaluation of continuous and systematic reviews of the financial statements, records, operations
and administration of an organization to determine whether the general principles of accounting,
management policies, regulations and procedures are followed. The importances of conducting
the audit are as follows:

To ensure that the requirements of the laws and regulations have been complied.

To reveal the factors that does not lead to the efficiency, effectiveness and economy in
respect of accounting

To give a review whether the financial statements show a true and reasonable statement
on the status and accuracy of records in accordance with applicable auditing standards

To review the organization’s assets and interests are safeguarded against loss, fraud and
abuse
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
To find any needs for any improvement in the systems to ensure a consistent good quality
products or services. For example, the needs of application for increasing the budget, ask
permission for get rid of the expired products etc
Some audit activities are conducted by internal auditors and some are performed by external
personnel assigned by authority. Internal audit is commonly conducted at each instiution by the
audit teams assigned by the higher management. In the case of “Stor Integrasi”, the internal
auditors would be pointed by the Jabatan Kesihatan Negeri Pulau Pinang and is done at the end
of every year. Generally, before the internal audit is conducted, the store staff would be informed
in advance 1-2 weeks time. Meanwhile, an external audit, the auditors are from the Jabatan Audit
Negara, or Kementerian Kewangan. Usually, the external audit would be carried out without a
prior notice, in the case if there are some issues in concern that need to be investigated or instant
verification is required to make analysis.
At “Stor Integrasi”, the auditors would check the physical stocks, bin card, the computer record
system, etc. In preparing for audit of the pharmacy store, the calculating of stocks (Pengiraan
stok), checking of stocks (Pemeriksaan stok) and the verifications of stocks (Verifikasi of stok)
should be performed. The purpose is to detect and identify weaknesses that resulted in excess
stock, less stock, damaged, expired, etc so that action can be taken. If they found anything that is
unreasonable from the auditing, the store staff would be query and surcharges would be imposed.
Besides the finance and accounts, the compliance audit also is performed. The compliance audit
is to ensure that organization is meeting the legal and regulatory requirements. It includes the
cleanliness and neatness of store, recording of data and etc.
Besides, there is Asset Store Management Unit which functions:

To conduct store inspection to ensure the department follows the rules and regulations.

To organize store and asset management courses and seminars

To manage the process of asset disappearance/lost, asset verification (based on lost cases).

To conduct asset inspection at least once a year

To ensure spot check will be done at store at least once in a 6 months’ time.
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1.5 Rules and Policy
In hospital management including the store pharmacy, Stor Integrasi management in Penang
Hospital (HPP), some standard guidelines has been used to manage the pharmacy department
and Stor Integrasi.
In managing the human resources at the pharmacy department and the “Stor Integrasi” of HPP,
the rules and policy used mainly is similar with the other govermental institutions. The rules and
policy implemented was based on a few guidelines listed below:

“Perintah-perintah am dan arahan pentadbiran”

“Pekeliling-pekeliling perkhidmatan awam”

“Pekeliling-pekeliling Kementerian Kesihatan Malaysia, KKM”
In managing the store efficiently, “Stor Integrasi” needs to follow the guidelines below:

“Tatacara Pengurusan Stor Bil 5/2009” that has been issued by the Kementerian
Kewangan Malaysia

“Pekeliling-Pekeliling Perbendaharaan” released by Perbendaharaan Malaysia

“Garis panduan pengurusan stor farmasi di hospital dan klinik kesihatan” by Kementerian
Kesihatan Malaysia
The guidelines provide general overviews and instructions to be complied. However, to ensure
the better management, each guideline has been detailed out and applied and suited according to
the situations. Here, the experience and wisdom are important to be able to manage efficiently
along with the guidelines. For example, in the guidelines, there is stated the amount of the day
leave that can be taken per year by a staff but not continously or depends on themselves when
they want to take the leave. The staffs need to apply the leave from the upper officers to be
approved first. Here, the officer in charge should consider it wisely. If there is too many staff on
leave, and there is not enough staff left which might affect the efficiency of the services, the
officer should not approve the leave application. Other examples, the minimal qualifications of
post in the department has been outline in the guideline, however, the officer have authority to
choose any candidates that have more than minimal qualifications to fill the post.
This
consideration goes similar with other things.
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1.6 Common Problems in Management of Pharmacy Department
Some common problems occurred in the management of Stor Integrasi at HPP include:
i)
insufficient allocation and shortage of staffs – for example, in Stor Integrasi there is emptiness
in Timbalan Ketua Pegawai Farmasi U52 and Pegawai Farmasi U48 position
ii)
limited budget provided by the Ministry of Health- the budget allocated each year is limited,
and this forces the Store management to wisely manage the budget for optimized outcomes.
Shortages of certain types of medications on particular time may cause patient to get their
medication from other hospitals or sources.
iii)
staff’s attitude – related to the disciplinary behavior among the staffs which may affect the
overall functioning of the organization and thus need urgent attention and solution from higher
management.
iv)
lack of infrastructures- Limited space of the storage room sometimes lead to “store
congestion”, thus appropriate management is needed to maintain adequate storage space for the
items received and stores.
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2.HUMAN RESOURCE MANAGEMENT
Manpower management and planning build the central core of human resource management and
deals with the human resources of an organization. It consists of the process of selection of
appropriate individuals as employees based on their knowledge/skills, making sure they are
smoothly fitted into their assigned roles and the overall system, to ensure a smooth functioning
of the organization. Besides selecting suitable employees, human resource management need
‘manpower planning ‘ – to deal with the process of upgrading the existing employees.
The human resources are the most valuable asset of any organization as they contribute to the
realization of its business/organization/institution objectives. It is the human resources who
contribute their time and expertise to the welfare of their organization. Thus, the process of
manpower
planning and
staffing is
crucial
to
the
business
development
of
an
organization. Motivating the workers, helping them update their work knowledge and
maintaining the attrition rate to a minimum, are some of the other objectives of manpower
management.
Management of Human Resource in HPP which include service, hiring, discipline, training and
so on for the staffs in hospital is very crucial for effective and efficient control of overall ongoing activities in the this health care.
List of services in Human Resource HPP:
o Service Unit
o Hiring Unit
o HRMIS Unit
o Discipline Unit
o Training and course Unit
o Property Declaration Unit
o Performance Evaluation Unit
HPP which is a large organization, consist of many departments and units, aimed to ensure the
hospital can provide the best service to the patients as outlined in goals/vision & missions of
hospital.The general organization chart of HPP is shown as below:
14
Figure 1: Organization Chart of HPP
2.1 Identify Manpower Needs
The manpower is needed to make sure the organization run smoothly as what it should be, for
example the pharmacy department in HPP which includes outpatient, inpatient, TDM, DIS, TPN,
ward, counseling and others. When there is increased workload of the organization, increment of
manpower is needed to avoid shortage of manpower and thus affect the overall functioning of the
organization. In HPP, Chief of Pharmacy is responsible to manage the human resource in
pharmacy department. He or she may need to adjust the number of staff based on the work load
15
of the hospital. If there is new services needed in pharmacy department, chief of pharmacy need
to assign the additional staffs and provide/arrange training for them.
2.2 Recruiting, selecting, interview, hire and orient pharmacy personnel
The qualification that a professional pharmacy who works in the government hospital includes
the people need to has the certificate for bachelor of pharmacy from the government of the
institutions of higher learning or equivalent qualification. In addition, the pharmacist needs to
register with the Pharmacy Board of Malaysia.
Starting from 2th September 2004, pharmacist apply for registration is required to serve in the
public services for a continuous total period of not more than three years which referred as
compulsory service. The pharmacy graduate candidates apply to Pharmacy Board for Provisional
Registration on Form 1. In addition, the candidates should apply to Suruhanjaya Perkhidmatan
Awam (SPA) on Form 8 for employment in the government sector. The SPA will inform the
applicant on the date of interview. There are several documents need to be submitted during
interview which include the original as well as a copy of Identity card, Birth certificate, SPM
certificate, degree or final result transcript and probationary registration certificate from the
Malaysian Pharmacy Board. Then the applicant will have to wait for appointment letter from
SPA. The successful candidates will receive their offer letter on the day of the interview. The
applicant should forward a copy of the appointment letter to Pharmacy Board Malaysia so that
the board can proceed with Provisional Registration. After that, the pharmacy board will issue
the Provisional Registration Certificate to the applicant. The Ministry of Health Malaysia issues
a posting order to the applicant to report to the place of work. Lastly, the provisionally registered
pharmacist reports for work as a public servant.
For the fully registered pharmacists, they need to serve in the public services and the period of
service shall be continuous total period of not more than three years. The pharmacist applies to
Pharmacy Board of Malaysia for Full Registration on Form 5. The provisional registered
pharmacist can apply for full registration 2 months before they finish their provisional
registration so that the administration process for the full registration certification can be carried
out while the provisional registered pharmacist in the process of finishing his term. PBM will
issue the Full Registration Certificate to the applicant. The Ministry of Health Malaysia will
issue a posting order to the provisional registered pharmacist to report to the place of work. The
16
provisionally registered pharmacist reports for work as a fully registered pharmacist in the
government service.
2.3 Distribution of Manpower:
There are 12 units under Pharmacy Department in Hospital Pulau Pinang:
1. Outpatient unit
2. Inpatient unit by using conventional system
3. Satellite pharmacy unit located near to ward
4. Store integration unit where place to obtain and provide drugs and consumable
5. Therapeutic Drug Monitoring (TDM)
6. Drug Information Service (DIS)
7. Total Parenteral Nutrition (TPN)
8. Manufacturing production unit
9. Counseling department
10. Ward pharmacy (critical care, oncology, pediatric, cardiothoracic, nephrology,
respiratory, cardiology, neurology, endocrinology, infection disease
11. Medication therapy adherence clinic unit, (HIV, diabetes, warfarin, methadone,
rheumatology, respiratory, renal transplant)
12. Nuclear pharmacy unit
It is crucial to have a good manpower planning, distribution and management so as to fulfills the
need of each units.The chief of pharmacy in HPP is responsible to distribute the personnel to
each unit to make sure the pharmacy service work efficiently and effectively. For example, in
outpatient unit there will be receiving more than 2000 prescriptions per day thus more manpower
is needed as compared to DIS unit. Besides, he also needs to manage the actual number of
personnel in each unit especially if staff needs to take leave then need to make sure the unit able
to perform its function without significant interruption from the problems. However, if there is
shortage of manpower at particular time like staff on leave, manpower transferring in temporary
might be able to solve the problem.
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2.4 Training Pharmacy Personnel and employee development program
Training can be defined as a systematic development of the attitude, knowledge, and skill pattern
required by a person to perform a given task or job adequately. Purposes of training can be
summarized as below:

Help employees to meet the changing demand of a pharmacist.

Benefits both the organization/ hospital in this case as well as the employee

Make the whole job process much more interesting and meaningful and lead to greater
morale and sense of accomplishment.
To accomplish an excellent pharmacy service organization, both training and development of the
employees is required. Development is defined as the growth of the individual in terms of ability,
understanding and awareness. Training differs from development in aspect that training is meant
to improve employee performance with current tasks and jobs, whereas development prepares
employees for new responsibilities and positions.
.
Training comes in two primary forms:

orientation training

job training
Orientation training
Job training
Purpose:
Purpose:
- To welcome new employees
- Help current employees learn new
- Providing a positive impression and information and skills to fulfill their jobs
information that is useful regarding their -Refresh
responsibilities
-
Establish
capabilities
that
may
have
diminished over time.
early
expectation
performance and behavior.
of - Keep updated with the changing nature of
medical and business practice in the
- Familiarize with the companies or pharmacy field.
department’s mission, goals, cultural norms Thus,
requires
continual
and expectations.
throughout their careers.
Example activities:
Example of activities:
training
- Discussion of performance objectives of - A pharmacist might attend a continuingpharmacy job
education program offered by a pharmacy
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- Review of departmental policies and school to fill a perceived gap in knowledge
procedures
about a disease state and its treatment.
- Description of behavioral expectations.
In Penang General Hospital, some programs have been organized for the pharmacist to improve
their performance and skills in certain aspect such as attending seminars or computerized
training. For example, two programs that is held in Penang General Hospital are “ Kursus
Orientasi Pegawai Perubatan Latihan Siswazah” and “Kursus Pemantapan Bahagian
Pengurusan”. Others form of training includes that each Provisional Registered Pharmacist
(PRP) has to undergo a one year training based on modules set by the government before they
can be registered as Fully Registered Pharmacist (FRP).
2.5 Employees Performance Appraisal System and Disciplinary Action
A performance appraisal is a formal assessment of how well employees are performing their jobs
and formal communication in order to improve the performance of each and every employee
within an organization.
It is important in documenting employees’ progress towards achieving the goals and managing
on how to improve performance. Documentation is necessary to demonstrate fairness in
promotion and termination practices. Performance appraisal system has become a tool where
organization members used it to achieve collective goals.
Employees working performance is one of the important factors to determine the quality and
quantity of work that being done in the organization or the work place. In Malaysia public
service system, Surat Pekeliling Perkhidmatan has been introduced to enhance the
improvement in employees performance appraisal system or penilaian prestasi perkhidmatan
awam .
19
All employees are expected to meet performance standards and behave appropriately in the
workplace. Disciplinary or corrective action is a process of communicating with the employee to
improve unacceptable behavior or performance and is taken by management correct
inappropriate work behavior. Enhancements in certain rules and regulation have become the
guidelines for the employees to follow. The regulations include:

Perintah-perintah am dan arahan pentadbiran

Pekeliling-pekeliling Perkhidmatan Awam

Pekeliling-pekeliling Kementerian Kesihatan Malaysia
For instance, certain common criterias that must be fulfilled by all staff are be punctual to work,
proper attire code, non-smoking during work time and do not misuse the organization’s facilities.
Responses by management to undesirable behavior become progressively severe until the
employee either improves, resigns, or is terminated from the position.
The disciplinary actions consist of some steps: verbal warning, written warning, suspension and
termination. Suspensions are punitive actions meant to demonstrate the seriousness of a situation.
The actions taken depend on the severity of the mistakes of the employees. If the first warning
letter is neglected, the next action taken will be much more severe.
Overall,the aim of the disciplinary action should be an improvement in the team member's
actions or attitude, although dismissal may indeed be an outcome in serious cases. It’s also
important
to
prevent
misconduct.
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3) FINANCIAL MANAGEMENT AND CONTROL
3.1 Budget Planning
A budget is a detailed plan, expressed in quantitative terms, that specifies how resources will be
acquired and used during a specified period of time. The most obvious purpose of a budget is to
quantify a plan of action. The budgeting process forces people who make up an organization to
anticipate or react to changes in the environment. The budget is a key tool for planning, control,
and decision making in virtually every organization.
Objectives of budget planning

To ensure that the financial requirements for the organization is allocated and
distributed according to requirements that are planned for programs and activities

To ensure that the process of budget management, revenues, pre-payment and
account records are managed efficiently, integrity and effectively and
respectively follow the financial rules and policies and aligned with national
standards and customer’s charter.
To establish the budget planning for a hospital, several factors must be considered, some of
which are:
1) Total number of inpatients
Total number of inpatients means the total number of patients who stay in the wards. It can
be approximated from the total number of beds in hospital. If there is increasing of number of
patient in the ward, the drug requirement will also be increased. By taking into account the
total number of beds for respective year, we can forecast the total inpatient for the next year.
2) Total number of outpatients
The total number of patients who come to the outpatient department is considered as the total
number of outpatients. For each hospital, there is a pattern of group of patients who come to
21
the outpatient department. From this pattern, we can assume the drug requirement for the
following years. Every increase in number of outpatients will be taken into consideration for
the drug supply for the next year.
3) New services
When there is a new service to be served to the patients or public, new drugs will be required
and this will influence the budget planning.
4) Drug cost increase
Cost of the drugs will not be maintained throughout the year. Some companies may increase
their price for the drugs but this usually depends on the economic status of the country.
5) Drug usage rate
Drug usage rate depends on the prescribing pattern of doctor while the prescribing pattern
depends on the case. If the drug usage rate is increase, the budget will also increase.
As a general rule, there are several steps in budget planning:
1. Setting goals
2. Gathering relevant information
3. Analyzing the information
4. Constructing a financial plan
5. Implementing the strategies in the plan
6. Monitoring implementation and reviewing the plan
From our visit to the Penang General Hospital, we have been exposed to the financial
management of the integrated store. Firstly, there will be an exposition of the yearly budget
in the parliament. The Ministry of Finance will come up with a budget and hands it down to
the Ministry of Health upon approval from the cabinet. The Ministry of Health will then
distribute the budget to the Health Department of every state; in this case Penang State
Health Department will act as intermediary department to distribute the budget to hospitals,
community clinics & other associated health centres in Penang State, including Penang
22
Government Hospital. This budget includes the salaries for the workers, money for utilities,
travels, assets, rents , etc.
Types of financial budget of pharmacy department basically can be divided into:
i)
New Policy Budget (Peruntukan Dasar Baru)
- will be made when there is needed for new project/service expenditure. The hospital authority
will apply for the financial budget 2 years in advance before any new services start to be
implemented. This type of budget is prepared for 1 year’s duration and the budget will turn into
Operation Budget in the subsequent years.
ii)
One Off Budget
- allocated for new project/services/asset such as need for additional meeting’s table, air-cond,
etc. This budget is planned according to the needs of pharmacy department in a year ahead, and
the budget is only given once.
iii)
Operation Budget (Peruntukan Pembangunan)
-this type of budget is approved based on project requested, for example Projek Hospital Baru.
Pharmacy department itself, they need to carefully review the budget (based on expected current
need and previous year’s experience) and prepare a complete report to Hospital General
Committee for the request for the amount of budget to be given to pharmacy department. In
Penang hospital, pharmaceutical procurement and inventory unit which is under pharmacy
department will act as financial manager of purchasing both drug and non-drug items on behalf
of various departments in the hospitals.
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3.2 Financial Management And Control
Budget Control And Monitoring
Good financial management in any institutions or organizations is important to keep track of
where the money is coming from and where it has gone. It is one of efficient ways to avoid any
corruption from the allocated budget. Effective in year budget control and monitoring reports
provides vital information about spending patterns that helps management to make realistic
forecasts of year-end under or overspends.
Every year, pharmacy department of Penang Hospital obtains annual budget of approximately 60
million from the Ministry of Finance via Penang State Health Department. Large percentage of
the budget (about 70-80%) is allocated for drugs items and the rest is for non drugs items
(surgical and disposable items). The given budget should be spent wisely before the end of the
year because it cannot forwarded to the following year. At the same time, the expenditure
estimated should not exceed the budget provided.
A system called Modified Budget System is currently used by our government to monitor and
control the allocated budget where a Public Account will be opened to record all the flow of
money allocated. This account will be closed at 12midnight of December 31th every year, and
any payment or claim must be done before that date.
The record of drug expenditure and consumption at Penang Hospital will be monitored every
year and an annual action plan with corresponding budget requirement will be prepared by the
responsible pharmacist in order to request the annual budget allocation from the hospital
financial department.
There are three essential parts in the financial control and monitoring. They are:
1) Budgetary Control - Budget holders are responsible to their head of department for the
income and expenditure appropriate to their budget.
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2) Financial Information - The Director of Finance is responsible for supplying budgetary
reports on all aspects of the hospital’s finances to the finance committee on a basis
determined by the finance committee.
3) Treatment Of Year End Balance- At Penang Hospital, the balance amount of budget
cannot be forwarded to the following year. Thus, the budget should be managed properly
and wisely to avoid any wastage.
A ‘Mid Term Review’ of budget will be carried on the middle of year (end of May) to recheck
the spending budget and plan for next half-year allocation of budget. In the case where the
budget for the next half-year is expected to be not sufficient, application or request for additional
allocation need be done with the perquisite by the end of May 70% of budget allocated to the
“Integration Store (Stor Integrasi)” have to be consumed.
Pharmacy department will not buy
drugs that are not requested by out-patient department or doctors, sometimes requests from
doctors to buy certain drug will be rejected also due to budget constraint problem.
The Pharmacy Department manager has to monitor the balance of the budget through the ‘Vote
Book’. Vote book contains all the record of budget allocation, expenditure, liabities and balance.
This book needs to be checked frequently to make sure that the expenditures do not exceed the
budget. Essential documents needed for any payment activities of the store include LPO and
invoice.
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General Methods of Financial Management and Control:
PROCUREMENT
SUPPLY AND
DISTRIBUTION
STORAGE
•Obtain supplies, equipment and services at the lowest possible cost
consistent with quality, delivery requirements and sustainability,and in
accordance with sound business practice.
•Supply is the provision of stock necessary for maintenance and
operation. Drugs and non-standard items will be supplied and
distributed to different departments in the hospital, including aseptic
dispensing unit, out-patient department, satellite pharmacy,
pharmaceutical preparation unit.
•There are two types of drug supply. They are scheduled/schematic
supply and supply based on patient’s needs.
•The stock can be arranged according to several strategies, which include
first in, first out (FIFO), last in, first out (LIFO) and first expired, first out
(FEFO).
•Stock control is important to minimise the cost of holding these stocks whilst
ensuring that there are enough supply to meet patient demand.
•Poor stock control can lead to problems associated with overstocking or
INVENTORY stock-outs.
CONTROL •Efficient stock control allows us to have the right amount of stock in the right
place at the right time.
ROUTINE
CHECKING
•Routine checking is necessary during items receiving and supplying.
• inspect/check for any signs of damage or tempering.
•The spillage of product can be determined from physical apperance of box.
•Expiry date is the date given on the individual container of a drug product
designating the date up to which the product is expected to remain within
EXPIRY DATE specifications, if stored correctly.
•It is important to avoid any evitable wastage of items and directly avoid the
wastage of money.
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4. PHARMACEUTICAL PROCUREMENT AND INVENTORY
4.1 Drug Inventory System and Card-based System
Over at Penang General Hospital, Miss Rohaizan talks to us and give brief introduction about the
hospital inventory system (HIS) and stock-controlled card.
The purpose of recording the transactions and the received stocks are;

To locate the stored items

To check the quantity and the price of the received stocks

To control the stock level

To ensure the maximum and minimum quantity of the stocks
HIS software is developed by Pharmaniaga Sdn Bhd and the objective of HIS implementation is
to reduce the cost of administrative and clinical transactions. HIS automates the process of
collecting, and retrieving patient information.
From our observation, the HIS software are preinstalled on the computers at the main store office
and also other units (limited to certain hospitals only). HIS can be used only by registered users
at each unit through local network and/or intranet. Each users need to use specific PIN to access
the software.
Apart from using HIS, Penang General Hospital also use square card KEW.PS-4 also known as
Bin Card. Bin Card need to be placed next to the stocks and must be numbered. For chemicals,
flammable or cold storage stocks, the Bin Card need to be kept separately.
Pink Card is used for stocks that have expiry date and the expiry date is printed on the stocks.
Green Card is for stocks that has no expiry dates.
Red-inked Pen is used to take note on received stocks, Black or Blue inked Pen for issued
stocks and Green inked pen for audit.
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4.2 Drug Purchasing and Procurement Activities
If drug supplies to wards reached the minimum amount, the units will submit request to the store
personnel to make new orders of drug stocks. Then, the store personnel will evaluate the
requested items. After evaluation, store personnel need to get quotations and calculate the costs
in order to purchase new stocks.
Store personnel will inform the calculated costs to the store department. The store department
will decide whether to make new purchases and if the purchases are important then they need to
check the allocations. If the (money) allocations for drug purchasing are not enough, department
will send request to hospital admin asking for additional allocation.
Next, hospital admin need to get additional allocation from state or from Ministry of Health. If
the allocations are now enough, the purchasing activities can be done. Department will put indent
to the store through HIS.
The drug procurement can be processed via ePerolehan and also eSPKB. There are 3 ways used
in purchasing activities:
1) Concession (already in standard Ministry of Health list)
2) Contract, with MOH or between Hospital
3) Local Purchase
In procurement processes, it is very important to choose the company that sells quality drugs and
goods at reasonable prices, and usually one out of three companies (3 are minimum, by the way)
are chosen based on their business proposal with the Hospital.
When the procurement processes are finished, and later the ordered stocks are received, the store
personnel will supply through department and department will redistribute the supplies to the
wards. That’s how drug procurements activities are done.
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4.3 Drug Supply and Distribution to Other Units within the Hospital and Other Institutions
Pulau Pinang General Hospital plays important role in providing diagnostic and curative services
to patients, increase the effective use of drugs and make it necessary for hospital to maximize
drug use rational. Drug Integration Store in Penang GH responsible in procurement, receiving,
storing and distribute the drugs, IV drip, gaseous and consumables tools for pharmacy unit in
Penang GH, Government Health Clinics and Government Dental Clinics in Timur Laut district,
Pulau Pinang. Drug Integration Store under direction of pharmacist is responsible for controlling
distribution of drugs within the hospital and other institution thus promoting their appropriate
and safe use of drugs. This department also responsible in distribute the drugs and nonmedication within the hospital to other pharmacy unit in hospital which is:
1. Outpatient pharmacy
2. Satellite pharmacy
3. Oncology pharmacy
4. Pharmacy ward (Pediatric, Cardiothoracic, Nephrology, Respiratory, Cardiology,
Neurology, Endocrinology and Infectious Disease)
5. Clinical Pharmacokinetic Services
6. Therapeutic Drug Monitoring (TDM)
7. Total Parenteral Nutrition (TPN) and IV Admixture
8. Pharmaceutical galenical and extemporaneous
9. Medication Therapy Adherence Clinic, MTAC (HIV, Diabetes, Warfarin, Methadone,
Rheumatology and Renal Transplant)
10. Nuclear Pharmacy
Distribution activities are based on Nota Keluaran Barang (NKB) that has been approved by
pharmacy officer according to regulations state on the Tatacara Pengurusan Stor, TPS (Store
Management Regulation). The earliest drugs or inventory item purchase are the first inventory
items distribute to match the cost of the inventory value on the balance sheet with actual flow.
This inventory method called first-in, first-out (FIFO) which has been used in managing the
procurement and distribution of the drugs.[1]This system may minimize the drugs from expired
date before distribute to pharmacy unit in the hospital or other institution.
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Integrated Drug Dispensing System (SPUB)
For patient receiving long term therapy from hospital, SPUB facilitate the patient to obtain their
next medication refill supply. Patient may get the medication from drive through unit where they
no need to queue in pharmacy and just need to bring their prescription with SPUB referral stamp.
This service objective is to bring medication supply service closer to home, facilitate for long
term therapy and promote compliance and to ensure the medication supply is not interrupt.
4.4 Entertaining Requests from Other Pharmacists and Doctors Regarding Drug Supply
Pharmaceutical services in the general hospital should have great inter-professional perspective
in terms of medicine management and relevant information to guide in prescribing and use of
drugs. Integration Store activities must match these needs in order to satisfy others members of
healthcare team and patients. For doctors and pharmacists who want to order medication and non
medication tools from Integration Store, they need to fill Distribution Order form. Medications
can be ordered monthly and the orders should be sent a week before queue order. For nonmedications tools such as surgical scissors, catheters and others, orders can be made by filling
the Procurement Application Tools form that can be getting from each pharmacy unit in the
hospital. Only qualified officer can make order from Integration Store.
Some doctors prefer a pharmacist to assist them while prescribing drugs because they believe
they have insufficient feedback on their drug prescribing practices and they also believe with
great interaction with pharmacist. Some doctor also felt that pharmacists’ interventions
challenged their authority because they believe they need no further information on medicine
prescribing. When doctors order older drugs, pharmacist will recommend the replacement of
other drugs that have same mechanism of action with fewer adverse drugs reactions and more
efficacies. A new drugs list that will replace with older drugs will be distribute to all pharmacy
unit in the hospital to improve the quality of patient care with involvement of pharmacist in
medication review and feedback of prescribing patterns to doctors.
30
4.5 Discussion With & Entertaining Drug Detailers
Drug detailers are representatives commonly from pharmaceutical companies who come to the
Integrated Store Unit to promote their new products (drug and non-drug item) .Manager in the
Pharmacy Department is the authorized personnel to deal with drug retailers, and thus she/he
must possesses good communication and rationalize skill. The manager has to take this
opportunity to obtain necessary information about new drugs in the market, but cost-effective
products will be the top priority.
Information given by drug detailers can be of bias, thus, information verification may be needed
in particular issues, which can be done thru the clinical references and other reliable sources.
One of the standard clinical references has been used in GHPP is Micromedex.
Regarding to entertain drug detailers, time allocation is the critical aspect that the manager
should aware of. Sufficient time for discussion with drug retailers is needed in order to fully
obtain the information needed, and critically to make decision. A single appointment may not
sufficient to clarify certain issue or topic of interest, thus a series of appointment may be needed.
4.6 Drug Storage System
The integration store of pharmacy department uses ordinary conventional system for storing
drugs and consumable products and some rooms are equipped with special conditions to meet the
requirement of certain types of drugs. The main objective is to preserve drug condition to its
normal value while receiving and to maintain drug stability (to prevent deterioration of
susceptible drug products).
Different items are stored in different areas/room based on their common features and specific
characteristics. A proper strategy is needed and a systematic handling of drugs to ensure
effective drug storage system.
31
The ground floor has a loading bay which is use for the purpose of loading and unloading
products.
Storage room in Integration store can be divided into:
i)
Common Room
The drugs that come in large quantity are mostly fast moving products and will be placed first in
common room before any movement is carried out. The condition in this room is maintained at
room temperature (~25°C).
Most of new arrival drug and non-drug items (mainly those not heat-labile) will be stored in
common room including the cytotoxic and dangerous drugs. The storage space for cytotoxic and
dangerous drugs are separated from others and labeled differently.
Most of the products stored in this room are those products from Pharmaniaga. However,
products from Pharmaniaga have their own storage room called Bulk Drug Store. This room is
located at the 2nd floor.
ii) Cold Room
This room is designed for heat-labile items or items that need to be kept at low temperature due
to stability concern will be placed in cold room .Temperature in this room ranging from 2°C8°C, which is controlled automatically by computer system. Example of drugs/items that is
stored in this room is vaccine, insulin products and Sandimmun®. Assigned staff needs to make
sure that the temperature in this room is within the range. And if any changes to the condition of
rooms or items are notified, immediate correction actions need to be taken to solve the problem.
The cool room is located at the ground floor.
iii)Strong Room
This room is designed for most of the Dangerous and psychotropic drugs. As compared to
common room, this room is locked most of the time except required to be opened for
storage/distribution/inspection activities and only pharmacist/provisional pharmacist are allowed
to hold the key for this room. Thus for any activities need to be done in this room, it must gone
thru the assigned pharmacist. The drugs stored in this room include tablet, liquid for injection
32
and capsule and the temperature is maintained at 25 degree Celsius. There are also separated
rooms for storage of non-drug items such as surgical equipments (cotton wood, soap, syringes,
etc).
Cold room (bilik sejuk)
Store A/P
a storage room on the ground floor
inside strong room
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4.7 Disposable of Expired Drugs
Expiry date is the date given on the individual container of a drug product designating the
date up to which the product is expected to remain within specifications, if stored correctly.
Expiry date is established by the manufacturer for each batch by adding the shelf-life period to
the date of manufacture.
Normally when the Integration store of GH Penang want to purchase any items especially
drugs, they will make sure that the expiry date of the item is around 18 months. So when the
expiry date is about 2 month, the in-charge pharmacist will take an action by informing the
supplier to change the item. However for items with expiry date less than 18 month from the day
of receiving, guarantee letter must be obtained from the supplier. The guarantee letter may
include the return/exchange system for expired items. The expired items may be exchanged with
same items, different items with same price or exchanged with money. For example today is 2
Sept 2010 and our Pharmaniaga Bethamethasone N 15g stock item will expire on 1 Nov 2010.
So the responsible person in charge will inform the manufacturer to replace if the items can’t be
finished. 1
4.7.1 Quality Assurance for Pharmaceutical Purchases
On reception at the store, the number of boxes and the state in which they are received
should be checked immediately (note any signs of damage or tempering). The items delivered
should be ensured that they are corresponding to the items ordered, and that the quantities
conform to those on the delivery note. The spillage of product can be determined from wetness
of box. Besides, the expiry date of items also needed to be checked. The boxes with no problem
are then brought in and processed. When the items are being arranged on the shelves, the amount
of items brought in and date are recorded in bin card (green card).
34
4.8 Inventory Management and Distribution
The objective is to minimise the cost of holding these stocks whilst ensuring that there are
enough supply to meet patient demand. Poor stock control can lead to problems associated with
overstocking or stock-outs. If a pharmacy store holds too much buffer stock (stock held in
reserve) or overestimates the level of demand for its drugs, then it will overstock. Excess of stock
increases costs for the pharmacy department as holding stocks is considered as an expense for
the hospital pharmacy for several reasons:

Increases space of the store needed

Higher insurance and security costs needed

Stocks may be damaged or become expired

Money tied up in the stocks could have been better spent elsewhere
Besides that, the items should be arranged according to the several factors such as:

Stock rotation

Type of items (ie: drugs and non-drugs).

Storage condition

Controlled substances.

Attractive items

Flammable and corrosives.
Those stated factors are important to ensure the quality of the item before distribute to the
desired customer.
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CONCLUSION
Through this clerkship, we have been exposed to the management and administration activities
of a hospital pharmacy especially Integration Store of Pharmacy department of Hospital Pulau
Pinang as well as the job scope of the pharmacists at the pharmaceutical procurement and
inventory unit. We have learned the general aspects of management in a hospital pharmacy
which include the role and importance of organizational structure and leadership, rules and
policy that need to be alert of, operational and planning aspects of a pharmacy department
especially the Integration Store. Last but not least, exposure to the roles and responsibilities of
pharmacist as well as all activities and processes involved at the pharmaceutical procurement and
inventory unit of Integration Store has broaden our mind on the issues of concern. Interpersonal
and management skills are the key factors for the success of an organization.
36
MAIN REFERENCES:
1. Chisholm-burns Marie A., Marie A. Chisholm-Burns, Allison M. Vaillancourt, Marv Shepherd,
Pharmacy Management, Leadership, Marketing and Finance. Publish by Jones and Bartlett
Publisher 2010
2. Desselle S.P, Zgarrick D.P; (2009) Pharmacy Management: Essentials for All Practice Settings,
Second Edition. Published by McGraw-Hill Professional.
3. Randy P. McDonough, PharmD, MSa and Marialice S. Bennett, Improving Communication Skills
of Pharmacy Students Through Effective Precepting, American Journal of Pharmaceutical
Education.
4. Shane P. Desselle, David P. Zgarrick. Pharmacy Management Essentials for All Practice
Settings. 2nd ed. Mc Graw Hill:2009.
5. Tatacara Pengurusan Stor Kerajaan. Kementerian Kewangan. Pekeliling Perbendaharaan Bil.5
Tahun 2009. KK/BKP10/535/36-B (38)
Websites:
6. JABATAN
FARMASI
DAN
BEKALAN
(11/8/2010)
http://hpp.moh.gov.my/modules/xt_conteudo/index.php?id=184 [review date: 2/9/2010]
7. Kementerian Kewangan Malaysia [http://www.treasury.gov.my]
8. Jabatan Audit Negara [http://www.audit.gov.my]
9. PEMANTAPAN PENGURUSAN SISTEM PENILAIAN PRESTASI PEGAWAI PERKHIDMATAN
AWAM [http://www.jpa.gov.my/docs/spp/2009/02/spp022009.pdf]
10. Human
resource
management-article
introduction;
[http://www.accel-
team.com/human_resources/hrm_00.html]
11. Laman web rasmi Hospital Pulau Pinang [hpp.moh.gov.my]
Thank you®
Report prepared by: GROUP B
PHARMACY MANAGEMENT CLERKSHIP 2010/2011
HOSPITAL PULAU PINANG
37