Improvement of the management system of the pharmaceutical service of the health care institution

Abstract

When providing medical care, harm to patients' health associated with the use of drugs occurs in 10-40% of cases. The issue of ensuring safety in the field of health care is a global problem. The relevance of the problem of improving the quality of pharmaceutical care and estimating the costs of medical care requires research. The purpose of the work is the formation of principles for improving pharmaceutical management in a health care institution by monitoring and analyzing prescription errors at all stages of drug use. The study was conducted on the basis of LLC "Endotechnomed", surgical clinic "Garvis" in the period 01.09.2019-29.02.2024 and was approved by the commission on biomedical ethics. The bibliographic method and retrospective analysis were used. In the study, the level of errors in appointment lists was calculated, their dynamics and relationship with the costs of medical care for the corresponding period were analyzed. The method of increasing the interval was used, and statistical significance was checked using the non-parametric Mann-Whitney test. The non-parametric method of Spearman's rank correlation is used to determine the characteristics of the relationship between the level of errors in appointment lists and the amount of drug costs for one patient. Statistical processing of the results was carried out using the methods of descriptive and analytical statistics using the integrated Jupyter Notebook development environment. A value of p<0.05 was considered statistically significant when testing all statistical hypotheses. The level of errors over 4.5 years significantly (p<0.002) decreased by 78.44% compared to the initial value (from 139.62‰ to 30.10‰), which was at the global level (10%). These indicators confirm the results of research by Chinese scientists, who prove that properly organized work in an inpatient medical institution can reduce the frequency of errors when prescribing drugs from 6.94% to 1.96%. A statistically significant negative rank correlation of average strength was observed between the amount of expenses for medical care of one patient and the level of errors in prescribing medicines for the considered period (r= -0.49; 95% CI (-0.67)–(-0.26); p<0.001), which contradicts the generally accepted notion and, according to the authors, is related to the uniqueness of the situation during the considered period (first the pandemic, then the war). Therefore, it can be concluded that the introduction of new approaches to control the prescription of medicines led to a significant (p<0.002) reduction in the level of errors in appointment lists over 4.5 years by 78.44% compared to the initial value; the higher level of errors in appointment lists corresponds to lower costs for medical care, which is a consequence of the unstable situation on the drug market during the pandemic and the war in Ukraine; the improvement of pharmaceutical service management processes was directed to the following areas of work: planning, control, implementation and functioning of the information system, personnel management, performance evaluation, involvement of interested parties for the formation and implementation of decisions.