A

Summer Project Report

On
“STUDY OF TURN AROUND TIME IN IN – PATIENT
PHARMACY ”

NANAVATI HOSPITAL

In the partial fulfillment of the Degree of

Master of Management Studies (Operations)

under the University of Mumbai

By
Dhanashree Dalvi
Class: MMS- A & Roll No: 17

Specialization: Operation
Batch: 2018-20

Under the Guidance of

Prof. Ganesh Apte

(Internal Guide)

Malad-Marve Road, Charkop Naka, Malad (West), Mumbai 400 095.

1
 STUDENT DECLARATION

Name: Dhanashree Satish Dalvi

Organization: Nanavati Super Specialty Hospital

Project Title: Study of Turn Around Time in In-patient Pharmacy

Declaration:

I hereby declare that the project entitled “Study of Turn Around Time in
In-patient Pharmacy’” has been submitted during the year 2018-2020 under the
guidance of Prof. Ganesh Apte at Atharva Institute of Management Studies, in
partial fulfilment of the requirements of the Master of Management Studies in
Operations (MMS-Operations) degree from Mumbai University.

I hereby confirm that the project I have provided is solely my own effort. I have
not copied from any other student or from any other source either against payment
or free, and I did not provide any plagiarized material in any section of my report.
I further confirm that the documents provided are genuine and have been issued
by the authorized person in the organization.

______________________________________
Dhanashree Dalvi
MMS – A
Roll no. 17

2
 CERTIFICATE

This is to certify that the Project entitled ‘Study of Turn Around Time in
In-patient Pharmacy’ by Ms. Dhanashree Satish Dalvi, is the bonafide work
completed under my supervision and guidance, hence approved for submission in
Partial Fulfilment of the requirement for the Degree of Master of Management
Studies in Operations (2018 – 20).

Date:__________

Signature of Director Signature of Guide

Dr. Sujata Pandey Prof. Ganesh Apte

3
4
Acknowledgement
I take this opportunity to express my gratitude to the people who have been
involved in the completion of this project.

First and foremost, I would like to thank Ms. Reshma Nathani, HR Manager,
Human Resources Department and Mr. Prashant Pikle, VP, Materials and
Supply, who gave me the opportunity to carry out the major concurrent project, as
well as all other employees of the organization who helped me either directly or
indirectly in this undertaking. I would also like to thank Mrs. Rutuja Jadhav,
Clinical Pharmacist for her guidance throughout this project.

My sincere thanks to Dr. Sujata Pandey, Director, of Atharva Institute of

Management Studies, Mumbai and to Mr. Rajesh Jamwal, Head of Placements
and Training, AIIMS, Mumbai for allowing me to undergo the major concurrent
project.

I am extremely thankful to my internal guide, Mr. Ganesh Apte, Assistant

Professor, AIIMS, Mumbai, for his constant and timely support and supervision
during my project.

I heartily thank the all the teaching and non-teaching staff members of AIIMS,
Mumbai, who have helped me either directly or indirectly during the training
period.

_____________________________________

Dhanashree Dalvi
MMS – Operations, Batch 2018-2020.
Division – A, Roll No. 17.
AIIMS, Mumbai.

5
 Table of Content

Sr. No. Content Page No.

01 About Nanavati 08
02 Abstract 10
03 Introduction 12
04 Literature Review 14
05 Aim and Objective 16
5.1 Material and Methods 17
5.1 Study Design 17
5.3 Sample Size 17
5.4 Parameters of study 18
5.5 Data Collection 19
5.6 Study Procedure 19
5.7 Inclusion and Exclusion 20
5.8 Data Analysis Method 20
06 Observations 21
6.1 In-Patient Pharmacy work flow 21
6.2 Turnaround time for In-patient pharmacy department 23
07 Review 25
08 Recommendations 29
09 Conclusion 31
10 References 32

6
 11 Annexure 35

Abbreviations

Abbreviations Full Form

ADR Adverse Drug Reaction

WHO World Health Organization

TAT Turnaround time

IP Pharmacy In-patient Pharmacy

ICCU Intensive Critical Care Unit

DTC Drug and Therapeutic Committee

DUR Drug Use Review

MAR Medical Admission Record

SOP Standard Operating Procedures

PICU Paediatric Intensive care unit

HMIS Hospital Management Information System

RMO Resident Medical Officer

NDPS Narcotic Drugs and Psychotropic Substances Act,

1985

NABH National Accreditation Board for Hospital and

Healthcare providers

QC Quality Control
7
About Nanavati Hospital

The iconic healthcare institution of Mumbai, Dr. Balabhai Nanavati Hospital

was inaugurated by India’s 1st Prime Minister Jawaharlal Nehru in 1950,
is currently reintroduced as Nanavati Super Speciality Hospital.

Nanavati Super Speciality Hospital has been at the forefront of care for sixty

five years. Today the 350 bed facility housing fifty five speciality departments
offers a superfluity of services in much each field of contemporary drugs and
health care.
Our well-equipped hospital rooms, progressive departments and technologically
advanced systems area unit all backed by the experience and name of over 350
consultants, one hundred resident doctors, 475 nursing employees and
1500 employees. The hospital’s progressive Imaging Centre, spanning
over ten,000 sq.ft, homes three Tesla thirty two channel wide
bore resonance Imaging (MRI) scanner with man target hunting
targeted Ultrasound Surgery and High-Intensity-Focused-Ultrasound, sixty
four slice antielectron Emission picturing–Computed Tomography (PET CT)
with cardiac capability. The Catheterization laboratory at Nanavati Heart
Centre that is that the 1st of its kind in metropolis, incorporates a team
of extremely practised and qualified college providing 24x7
Interventional internal organ Services.

Nanavati Cancer Centre provides comprehensive Cancer Care with organ

specific specialist groups in an exceedingly holistic manner. It offers
unconventional services for the treatment of heart conditions together
with minimal Access internal organ Bypass Surgery. The Bariatric Surgery
(Weight Loss Surgery) program at Nanavati is one in all the most
important within the region. The hospital provides a good spectrum of Super
Speciality Services within the field of Neurology, operation, Urology, excretory
organ Transplant, Nephrology, medical specialty and Surgical medical
specialty, Liver Transplant, medical science together with Spine Surgery, Joint
Replacement , Cosmetic and comprehensive Mother Care.
8
In addition, method driven vital Care services, at the side of the
foremost advanced Diagnostic and Imaging facilities, give the
mandatory backbone for holistic, comprehensive and up to date patient care.

Besides being the leader for therapeutic services, the Hospital additionally has

region’s largest medical post-graduation program with over seventy seats in
DNB and cycle per second aimed to form well-trained, ethical, skilled,
resourceful leaders dedicated to the fervour of healing that may empower the
longer term medical fraternity.

Vision

To create a patient-centric tertiary care organisation targeted on non-intrusive

quality care utilizing fore front technology with a person's bit.

Mission

• Achieve professional excellence in delivering quality care

• Push frontiers of care through research and education
• Obey to national and global standards in healthcare
• Ensure care with integrity and ethics
• Deliver quality healthcare to all sections of society

With AN aim to realize skilled excellence in delivering quality

care whereas pushing the frontiers of care through analysis and education and
adhering to the national and international standards in
healthcare, Nanavati Super Speciality Hospital provides quality care to all or
any sections of the society.

9
Abstract

Turnaround time (TAT) is the total time taken in between the submission of a
process for completing and the return of the complete output to the users.
Monitoring medication turnaround time in inpatient settings allows organization to
measure the impact of their efficiency of patient care. Reduction of medication
turnaround time can improve efficiency, patient safety, and quality of care in the
hospital setting.

A multidisciplinary team of healthcare personnel provides better patient care,

individual possessing a characteristic skills set appropriate to his/her allotted
duties. For high-quality and safe patient care, the team should work cooperatively,
remain focused, and professionally communicate. It is the health care service
comprising of choosing,, storage, compounding, and dispensing medicines and
medical devices, advising health care professionals and patients on their safe and
effective use. It forms an integrated part of patient health care in a health facility.

An observational study was conducted in In-patient pharmacy at a tertiary care

hospital. 600 randomly taken medicine indents were observed and audited. The
collected data was analyzed and interpreted consecutively. It was found that the
average time taken to dispense the routine indent was 25 mins. This value was
more than the SOP values. The indents were delayed. It was also found that the
peak hours of the indent order were 10:00 am to 12:00 pm.

10
Introduction

The major expectation from the in-patient pharmacy is to make appropriate and
correct drugs available at the right time. Any delay in this has a huge impact on the
patient care and hence the smooth functioning of the pharmacy. A standardized
formulary forms the basis of the drugs that are stored and dispensed in the in-
patient store. This enhances therapeutic opportunities for pharmacists and also
assists the prescribing doctors to know about the availability of drugs for better
inventory control. Drug Inventory control is an essential element of Health care
management, and its significant activity to achieve efficient patient care in a health
care. Drug shortages have been rising since the early 2000s and are predictable as a
global problem by the WHO. Drug supply shortages can be defined as a
shortcoming in the supply of medications which makes it impossible for suppliers
to meet the demand for the product at the patient level. They inculcate barriers to
safe and effective medication regimen on a daily basis. A common practice during
a drug shortage is to select an alternative drug to continue patient care without
disruption. The regular availability of the required medicines is the topmost
priority for any hospital.

Monitoring medication turnaround time in inpatient pharmacy department allows

organizations to measure the impact of their quality on the increased efficiency of
patient care. Medication turnaround time is considered the interval from the time a
medication order was composed to the time the medication was delivered.
Minimizing the medication turnaround time can promote efficiency, patient safety
and quality of patient care.

11
A multidisciplinary team of healthcare personnel provides better patient care,
individual possessing a characteristic skills set appropriate to his/her allotted
duties. For high-quality and safe patient care, the team should work cooperatively,
remain focused, and professionally communicate. Health care team rely upon
communication across departmental limits for effective functioning.

Hospital pharmacy is the health care service which comprises of choosing,

preparing, storing, compounding, and dispensing medicines and medical devices,
advising health care professionals and patients on their safe and effective use. It
forms an integrated part of patient health care in a health facility.

It was observed that the indent demand to the IP pharmacy of a tertiary care
hospital was in excess than the ideal required amount. The main reason for this was
over ordering of indents from the wards and later all the extra, unused medications
were returned back to the IP pharmacy store. The returned indent was of large
quantity and required one person (pharmacist/helper) to be continuously appointed
to receive returned indent drugs from each ward and ICU’s. This study was
conducted to determine the medication TAT and state causes about the findings.

12
Literature Review

Medication turnaround time can be defined according to the literature as time when
the medication was ordered by the physician or health care provider to the
medication delivery to patient (Jensen, 2006; Wietholter, Sitterson, & Allison,
2009). There is a direct connection between reducing medication turnaround time
and patient safety. The quicker the medication delivery process is; the better
patient outcome will be accomplished which will also be reflected on the quality of
care and reduction of cost (Naylor et al., 2011). With the development of
information technology in health care field, many health care organizations raced
to adopt different kind of technologies to improve the workflow and health care
processes; such as e-Prescribing, Digital Scanning and Computerized Physician
Order Entry (Cunningham, Geller, & Clarke, 2008). With departments such as
pharmacy that have a heavy workload to supply medications to all other areas
within health care organization; the use of technologies and automation of routine
preparations will have tremendous impact on patient outcomes by reallocating
pharmacists to patient-centered care. Furthermore, this will reduce human related
errors and improve the efficiency and productivity particularly in times of staff
shortage (Sikri et al., 2006). Evaluation of health information systems (HIS) is an
essential part to be done before and after implementation to ensure that the
information system is meeting the objectives of its use. The process of evaluation
can be defined as “the act of measuring or exploring properties of a health
information system (in planning, development, implementation, or operation), the
result of which informs a decision to be made concerning that system in a specific
context” (Ammenwerth, et al., 2004, p. 480). Evaluation in healthcare is a complex
process since it has to answer questions related to safety and effectiveness as well

13
as efficiency from different perspectives: clinical, administrative and decision
making (Friedman & Wyatt, 2006). Health information system evaluation process
starts with an evaluation question that will be the basic for defining the scope of
evaluation and the determining the objectives of the stakeholder. Depending on the
stage of HIS in the system life cycle, either summative or formative evaluation can
be applied. Collective evaluation is used when the system is installed and working
in the environment while formative evaluation is used when the system is at the
early stage of development and not installed for formal operation yet (Yusof et al.,
2008). There are various evaluation frameworks in the literature that address
multiple aspects of HIS, including technical, organizational and clinical. The
direction now is not to focus only on technical dimension in evaluation but more of
how the information system is integrated into the clinical workflow and its impact
on patient outcomes and quality of care. Therefore, generic framework is preferred
to be used for identifying the evaluation dimension than specific ones depending
on the objectives to be achieved because it is comprehensive to cover all
dimensions. (Lau, Hagens, & Muttitt, 2007; Yusof et al., 2008). There are two
approaches for evaluation: objectivist and subjectivist approaches. The decision to
use either approach depends on the evaluation questions and objectives. The
objectivist approach deals with objective assessment of data and variables with
numerical outcomes; a good example is the randomized controlled trials. The
subjectivist approach deals with user and expert opinions regarding a system with
emphasis on the verbal description as a basis to analyze and evaluate the
information system from various prospective. (Yusof et al., 2008). Evaluation
methods can be either quantitative, qualitative or mixed of both based on the
measurements and how comprehensive the evaluation intended to be.

14
Aim and Objectives

1.1. Aim

Study of Turnaround time (TAT) in In-patient Pharmacy of a Tertiary care

hospital.

1.2. Objectives

 To determine the average total time (TAT) consumed in dispensing drugs and
medical consumables to the patients in an In-patient pharmacy setting.

 To observe the pharmacy to gain insight on the current medication turnaround

process.

 To create awareness about the indenting process amongst the nursing staff and
promote proper use of HMIS for the same.

 To identify commonly indented medications.

15
Material and Methods

1.3. Study Design

Study Setting: Nanavati Super Specialty Hospital

This study was conducted because it was observed that the indent demand to the
IP pharmacy of a tertiary care hospital was in excess than the ideal required
amount. Later all the extra, unused medications were returned back to the IP
pharmacy store. This study was conducted to determine the medication TAT and
state causes about the findings.

1.4. Sample Size

Calculation of Turnaround time: An observational study was conducted in the

In-patient Pharmacy department of a tertiary care hospital. A sample of 600
indents was observed by random sampling for calculating the TAT. The samples
were collected for a period of 30 days. Both primary and secondary data has been
used in the study. The secondary data was obtained from the software system,
which was used in the pharmacy.

16
1.5. Parameters of study

The In-patient Pharmacy department received indents from the following areas of
the hospital:

A WING D WING CRADLE

A WING CRADLE DAY CARE
BMT UNIT DAY CARE CHEMO
CRITICAL CARE UNIT 1 DELUXE WING B
CRITICAL CARE UNIT 2 DELUXE WING B CRADLE
CRITICAL CARE UNIT 3 DELUXE WING C
CRITICAL CARE UNIT 4 EICU
D WING NHHI-ICCU
PICU/NEON WARD NO. 1
WARD NO. 1 CRADLE WARD NO. 10
WARD NO. 10 CRADLE WARD NO. 11
WARD NO. 4 WARD NO. 6
WARD NO. 8 WARD NO. 8 CRADLE
WARD NO. 9 WING C CRADLE

600 random indents were taken for observation. The time required to prepare the
medication after receiving the indent was studied.

1.6. Data Collection

Turnaround Time: The first observation of the pharmacy was to gain direct
insight into the current medication turnaround process. The time required to
prepare the medication after receiving the indent from the respective departments

17
by the assistants of the pharmacy was recorded in Microsoft Excel 2010 in the
below given format. The details on the time of ordering the indent, by nursing
staff, were recorded manually.

Table 1: Data entering format

Sr. No. Date Bill No. Indent Time Punch Time Dispense Time Difference (Mins)
1 5/9/2019 IPP1920/262099:38 9:56 10:08 30
2 5/9/2019 IPP1920/262039:41 9:46 10:08 27
3 5/9/2019 IPP1920/262089:50 9:55 10:12 22
4 5/9/2019 IPP1920/262139:59 10:04 10:13 14
5 5/9/2019 IPP1920/262129:59 10:03 10:13 14
6 5/9/2019 IPP1920/2621110:00 10:03 10:13 13
7 5/9/2019 IPP1920/2624510:53 10:55 11:13 20
8 5/9/2019 IPP1920/2624610:52 10:57 11:15 23
9 5/9/2019 IPP1920/2624811:02 11:03 11:25 23
10 5/9/2019 IPP1920/2625011:04 11:06 11:37 33
11 5/9/2019 IPP1920/263812:59 3:28 3:36 37
12 5/9/2019 IPP1920/263743:16 3:23 3:41 25
13 5/9/2019 IPP1920/263763:18 3:25 3:41 23
14 5/9/2019 IPP1920/263683:16 3:19 3:42 26
15 5/9/2019 IPP1920/263663:14 3:17 3:45 31

18
Proper permissions were taken from the authorities to extract the details of the time
of issue of indent from the software.

1.7. Study Procedure

The time taken for the preparation of medications for the respective wards was
observed and the average turnaround time was calculated for 600 randomly
selected indents for a month.

1.8. Inclusion and Exclusion:

Inclusion:
Only In-Patient indents received in the pharmacy.
All age groups.
Both Male and Female patient’s indents were observed.
Indents signed by authorized prescriber with a date and time.

Exclusion:
Indents composed during weekend (Sunday).
Out-patient Prescriptions from all areas.

19
1.9. Data Analysis Method:
Data collected was analyzed using Microsoft Excel 2010.
Medication turnaround time is defined as the interval from the time a medication order is written
(manually or electronically) to the time the medication was prepared for delivery.
The average turnaround time was calculated as

Average TAT= Dispense Time – Indent Time

No of indents observed

20
Observations:

1.10. In-Patient Pharmacy work flow:

The process starts from the ward, nurse indenting or placing order for drugs and
non-drugs like (gloves, syringes, catheters etc.) in electronic patient medical record
software system till assistant(runner) supplying the drugs in the respective wards.
These will be carried out in a step-wise following manner:

1. Indent for the patient is prepared in hospital management information system

electronically by the in charge nurse.

2. Indent received at In-patient pharmacy.

3. Indent printed in the Pharmacy department. The format is displayed in

Annexure1.

4. Preparing the indent for the patient. The pharmacist should check the indents
for:
Patient name and admission number, date of expiry of medicine (near expiry
medicines are dispensed first), Drug name, batch number and quantity of items.

5. Keeping the collected drugs in bags according to respective wards.

6. Verification of the collected drugs and dispatching.

7. Medication reaching the wards.

21
 Physician/ RMO writes the medication order

Nurse goes through the file and places an indent

order in HMIS

Order collected & verified by pharmacist

Available Medication Unavailable Medication

Check in other Pharmacy Check alternative list

Select proper batch of the medication

Medication is sent from the pharmacy

Entry is closed in the indent by pharmacist

Medicine is administered to the patient

22
 Figuretime
1.11. Turnaround 1: Work
for flow of In-patient
In-patient Pharmacy
pharmacy department:

N = 600
Turnaround time for Dispensing Indent is 20 mins as per SOP guidelines.

It was found that the average time taken to dispense indent was 25 minutes. The
indents were delayed.

No of Indents
2500
2089
1939 1912
2000 1737 1753 1763 1722
1538 1625 1588
No of Indents

1500

1000

500

0
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9 Day 10
Days

Figure 2: Number of Indents per day

The average number of indents per day was found to be 1766.

23
 Peak hours of indent order
450 413
400
350
300
250 208 192
200 158 161 168
150 106 120
100 52 53 54 43
50
0
am am am am 0a
m
2p
m
2p
m
4p
m
6p
m
8p
m
0p
m am
-2 -4 -6 -8 -1 -1 - - - - -1 -12
am m m m m m m m
12 2a 4a 6a 8a
m am 12
p 2p 4p 6p 8p
m pm
10 10

Figure 3: Number of Indents in various time intervals

It was also found that the peak hours of the indent order were 10:00 am to 12:00
pm. This means that the number of staff should be high during this time.

Table 2: Commonly Indented items

Item No of
Indent
NS 100ML IV STERIPORT 3435
HOSPIMOL 100ML IV 1034
DIANORA 2ML INJ 879
NS 500ML IV STERIPORT 828
PAN 40 INJ 607
DYTOR 10MG INJ 2ML 583

The table above indicates commonly indented drug/non drug items. There is higher
demand of these items and that is why an extra stock can be kept at the nursing
stations (ordered by Department Indent) to reduce the number of indents order.

24
Review

Few issues, which come out from the study, the medication turnaround time for all
indents was higher than SOP standards. This delayed the delivery of medications to
the respective wards which affects the quality of patient care. Evidence, from
others studies, suggests that decreasing medication turnaround time can improve
patient care, particularly for medications that have a critical impact on patient
outcomes. For example, timely administration of antibiotics prescribed for
community-acquired pneumonia, sepsis, and meningitis has decreased mortality
rates and length of stay.

The primary objective of the study was to determine turnaround time and the
difference between the TAT mentioned in the SOP with the actually observed time.
The average turnaround time for dispensing indent was found to be 25 minutes.
This value was more than the SOP values. Hence, delivery of indents was delayed.

Few reasons that were observed for delay in delivery of medication are as
follows:

1. Delay occurs in dispensing of medicines due to stock variability. In other

words, availability of stock of any item shown by the software but actually,
when the assistant searches for the medicine he finds that particular item is
physically unavailable in the pharmacy. Errors occur in reflecting the
transferred medications to the OP Pharmacy, Surgical stores in the system
and as a result the system shows availability of such items but those are
physically unavailable.

2. Lot of load on the department as compared to the availability of staff.

25
3.Sometimes the medicines, which have been dispatched from the pharmacy does
not reach the respective wards in time due to excessive crowd in the hospital.

4. Sometimes more than one indent is ordered for the same patient.

5. Some of the other reasons were due to the delay in dispensing of the medication.
The main responsible factors for this were.

i. Negligence of employees.
ii. Staff shortage on some days.( because of illness and other personal
reasons of the staff.
iii. Out of stock medicines.
iv. Software issues. (indents not being received in department)
v. The employees seem to neglect the indents being received in the
department and do their own work rather than clearing out the indents
being received in the department.
vi. The dispensing of Narcotic substances according to the NDPS Act,
requires documentation which consumes a lot of time of the pharmacists.
vii. The medications not used by the patients in the wards are returned to the
pharmacy. Excessive return medicines due to indenting errors by the
nursing staff increase the workload of the pharmacists.

The secondary objective was to identify wards ordering highest number of indents.
Highest number of indents was ordered from Ward N.6, NHHI-ICCU and Critical
unit. 3 which increased the chances of errors. Nurses often issue more than 1
indent for the same patient on the same day. Proper training should be given to the

26
nursing staff about indenting practices and use of hospital information system.
Also, this can help in reducing the medicines that are returned to the pharmacy.

Department indents are ordered at the start of the day which should include the
commonly indented items. The commonly indented items included NS, Hospimol
and Dianora, extra stock of which should be maintained at the nursing stations of
respective wards.

It was also seen that after collection of drugs, it is kept in the rack for long time,
though it is ready to be dispatched. Major reasons for the above problem were:

 Lack of Manpower (Pharmacists as well as assistants)

 Assistants who are supposed to deliver medicines to the respective wards are
busy in collecting the drugs for other indent
 Assistants are on leave (less number of relivers)
 Assistants who are supposed to deliver the medications do not arrive on time
after the delivery is done.

Another important issue that was observed was frequent miscommunications

between nursing and pharmacy staff was also seen in the studies. This results in
missing and duplicate medications. In addition, there was a continual stream of
secondary communication between pharmacy and nursing staff over the ordered
indent. This is time consuming and a distraction from other value-added tasks. The
poor communication leads to constant checking from nurses to make sure that the
medications they have requested were not forgotten. The pharmacists and

27
pharmacy technicians waste time checking and reassuring nurses that medications
are on the way.

A lot of telephone calls are made to the pharmacy department in regards to

clarification of any doubts about the medication, clearance for discharge of
patients, from vendors of different medications, from the nursing staff, from
doctors and other departments. A lot of time is also wasted in answering calls from
these different departments. This is in line with other studies. This leads to the
overall increase in the medication turnaround time.

28
Recommendations

 The drugs can be dispatched in the paper bags with the details (Name,
Admission no. and wards) of respective patients so that at the nursing unit, less
time will be consumed in segregation of medicine and non-drugs.

 Colour coded bags can be used to prioritize the urgent prescription.

Eg. Red coloured bags to denote Urgent Indent and it should be delivered
quickly.
Green coloured bags to denote Regular Indent. Purple coloured bags can denote
expensive medication or special order and should be handled with care.

 Items for urgent indents should be immediately dispatched after collection and
not be kept in rack as per the department.

 For dispatching immediately, manpower should be checked and priority should

be given for urgent indents.

 The nurse ordering drugs for patient should indent the complete order (bulk
order) at once, instead of indenting numerous incomplete orders.

 Training should be given to the nurses about the indenting process. They should
be aware of the difference between urgent, routine and discharge indent and
colour coding for the same should be known which is used by the hospital
system (Annexure 2).

29
 Regular training should be given for each staff (involve in indenting) and part
of induction program for new employees.

 Regular store audit should be done in order to check any discrepancy between
the stock shown in the system and what is actually present physically.

 The staff should be increased if it is feasible. Leaves should be given only when
reliever is arranged.

 Standard delivery routes can be designed/ allocated so as to reduce time of

transportation by the delivery assistants.

30
Conclusion

Through this study, various points of delays were identified, which were occurring
while dispensing indents to the patients. The results of the study revealed that the
indents were delayed; which became the major area of concern. In addition, if
hospital follows indenting practices by the nursing staff, than the training for
nursing staff is essential requirement regularly, to overcome this problem. Also
novel scanning processes can be used to improve the TAT.

Everyone within the circle of care, first one has to ensure patient safety in every
step of process from the initial step of selecting the appropriate medication to
prescribe, to dispensing the medication is improved to prevent delays in therapy
and medication errors.

Eventually, it is most important that effective communication takes place to ensure

accurate prescriptions and optimal patient care. This study can be used to conduct
further studies to improve the TAT. Interdisciplinary interventions are necessary to
reduce the total turnaround time.

31
References

1. Vijay Pratap Raghuvanshi, Himanshi Choudhary, Medication Turnaround Time

In Hospital Pharmacy Department, International Journal of Research and
Development in Pharmacy and Life Sciences, August - September, 2013, Vol.
2, No. 5, pg 626- 630.

2. Singh Vishavdeep & Singh Harwinder & Singh Sukhjeet. Drug Inventory
Management of A Pharmacy Store by Combined Abc- Ved Analysis.
International Journal on Mechanical Engineering and Robotics (IJMER). 2015;
(3), 19-22.

3. Milena McLaughlin, Despina Kotis, Kenneth Thomson, Michael Harrison et al.

BCPS AQ-ID. Effects on Patient Care Caused by Drug Shortages: A Survey,
Nov-Dec 2013 Vol. 19, No. 9.

4. Medication Turnaround Time in the Inpatient Setting, AHRQ Health IT.

5. Asma Begum, Asra Fatima et al. Analysis of Drug and Non-Drugs indents for
Turnaround Time (TAT) and shortage received in In-patient pharmacy from
various departments in a Tertiary care hospital, Adv J Pharm Life sci Res, 2017;
5;3:9-17.

6. Hospital Pharmacy Management, World Health Organisation, Chapter 45, 45.2.

32
7. American Pharmacists Association (2013), APhA Career Pathway Evaluation
Program for Pharmacy Professionals – pharmacist.com, Health System
Pharmacy: Inpatient.

8. David Troiano. A Primer on Pharmacy Information Systems. Journal of

Healthcare Information Management, 1999; (3), 43.

9. Naylor H, Woloschuk D M, Fitch P, & Miller S. Retrospective Audit of

Medication Order Turnaround Time after Implementation of Standardized
Definitions. The Canadian Journal of Hospital Pharmacy, 2011;(5).

10.Neville H, Nodwell L, & Alsharif S. Decreasing Medication Turnaround Time

with Digital Scanning Technology in a Canadian Health Region. The Canadian
Journal of Hospital Pharmacy, 2014;(6).

11.Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Timing of antibiotic

administration and outcomes for medicare patients hospitalized with
community-acquired pneumonia. Arch Intern Med. 2004;164(6):637–44.

12.Battleman DS, Callahan M, Thaler HT. Rapid antibiotic delivery and

appropriate antibiotic selection reduce length of hospital stay of patients with
community-acquired pneumonia: link between quality of care and resource
utilization. Arch Intern Med. 2002;162(6):682–8.

13.Alexandra Lai, Alexander Stern. Analysis of Medication Turnaround in the 6th

Floor University Hospital Pharmacy Satellite. University of Michigan Health
System, 2011;(9).
33
14.Carswell J, Dipiro C, Gomez T, Phillips M, Herrington B. Evaluation of
Turnaround Time for Medication Order Processing with Use of a Novel
Scanning System. Hospital Pharmacy. 2006;41(3):249-253.

15. https://pdfs.semanticscholar.org/7d81/158aea139bf02b69ae807b969f405912c8
48.pdf

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