Propose solutions to reserve drugs ready to use in the new situation at the Military Hospital

Nội dung text: Propose solutions to reserve drugs ready to use in the new situation at the Military Hospital

1. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 PROPOSE SOLUTIONS TO RESERVE DRUGS READY TO USE IN THE NEW SITUATION AT THE MILITARY HOSPITAL Pham Ngoc Bin h1,2, Chu Tien Cuong3, Nguyen Son Nam2 SUMMARY Objectives: To develop and propose solutions to military hospitals at the strategic line, in the strategic area to reserve a number of ready-to-use drug bases to ensure that military units in the region are protected in the new situation (2020 - 2021). Subjects and methods: Developing and proposing the contents of the solution for military medical to serve a ready-to-use drug base; consult experts who are working at the Department of Military Medicine, the Military Hospital at the strategic line, in the strategic and campaign areas, the Logistics Department, the Military Medical Division at the military zone; officers of the military medical warehouse and division at strategic and campaign levels, the Military Medical Academy are related to the management of the military medical industry, teaching, research, and use of military medical facilities. Results: The percentage of experts who commented, evaluated, and agreed with the proposed content of the solution: “The 5-step process of sourcing, packaging, and stocking combat-ready drugs at a military hospital” (90%); “The 4-step process of rotating, changing the number of drugs ready to fight at the hospital” (92%); select 3 types of hospitals (strategic lines, strategic areas, and campaign lines) to carry out the method of stockpiling drugs for combat readiness (82%); Types of reserve bases assigned to hospitals at strategic lines (BV, K), strategic areas (BV, K, Y), campaign lines (K, Y) (100%); “It is recommended to assign the number of each specific type of radix to each hospital” (60%); “The Military Medical Department has written specific guidelines for hospitals to replace and transfer drugs accordingly for consistency in the whole army” (78%). Conclusion: The percentage of experts agreeing with 6 proposals for military medical hospitals to stockpile combat-ready drugs reached from 60% to 100%. The research results are the basis for requesting the Military Medical Department for permission to pilot the solution of military medical hospitals to implement the method of stockpiling drugs ready to fight in the new situation, then expand to the whole army. * Keywords: Drug base; Combat readiness; Reserve; Military hospital. INTRODUCTION was used by the military medical sector to ensure military medicine for campaigns During the wars of resistance against and battles in organizing rescue operations the French, the US, and the encroachment that effectively treat and transport on the northern and southwestern borders, wounded and sick soldiers and prevent the number of military medical personnel epidemics for the army [1]. 1Vietnam Military Medical University 2Military Central Hospital 108 3Department of Military Medicine, General Department of Logistics Corresponding author: Pham Ngoc Binh (ngocbinh108@gmail.com) Date received: 10/7/2021 Date accepted: 20/7/2021 123
2. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Since 1985, the military medicine to store a number of ready-to-use drug industry has always paid attention and bases not only for military medical invested in doing researches, improvement, detachments, medical facilities, etc. and development of new types of military Military medicine is assigned to both medical facilities to further improve the hospitals by the Ministry of Defense and content, form, and packaging [2, 3]. be ready to use in emergency situations Regarding the method of storing military to provide security for Military units in the medical facilities ready to use, the Military region. At the military hospital, every year Medical Department assigned 02 strategic the quantity and type of drugs used for warehouses 708 and 706, to prepare, emergency treatment for military and store, pack, and supply for the army to civilian patients are large, rich, and maintain the available reserves to be diverse (except for few drugs with specific ready to use and prevent epidemics at all characteristics only used in the army for levels (strategic, campaign, tactical) first aid and treatment of wounded according to the Directive of the General soldiers). This is one of the favorable Staff and the order of the General conditions for the creation, storage, Department of Logistics. circulation, renewal of medicinal products Investigating the situation of stockpiling in the bases. In addition, military hospitals of drugs was ready to use at 2 strategic have a pharmacy department and an warehouses and campaign warehouses abundant medical and pharmaceutical of military zones 1, 2, 3, and 4. It human resource with high professional shows that about the number of drugs qualifications, knowledge of military stored at strategic warehouses and the medicine and experience in clinical campaign lines were strictly implemented, medicine and pharmacology, so it is the Y, K, and BV bases ensured adequate convenient for the establishment and reserves in accordance with the directives packing of the radix; drug warehouses of the General Staff, the orders of the and equipment warehouses of hospitals General Department of Logistics. all meet GSP standards... The recent However, most inadequacy of the investigation also shows that strategic warehouses is that when circulating and and campaign military hospitals store a changing the terms of the bases, they number of drugs ready for the battle must go through the military hospitals in 6 under the direction of the General Staff, months before being rotated by the the order of the General Department of hospital and use for the patients, so the Logistics and the instructions of the warehouses do not meet the GSP (Good Military Medical Department. The Storage Practices) standard by the research aims at: Building and proposing Ministry of Health. Therefore, it will have a solutions to the military hospital at the certain influence on the quality of drugs in strategic line, in the strategic area, in the the bases. While at strategic and campaign line to serve a number of campaign-line military hospitals, there are ready-to-use drugs for military units in the sufficient conditions, potential, and capacity new situation (2020 - 2021). 124
3. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 SUBJECTS AND METHODS Director of Military Medical/Military Zone; 1. Subjects, location, and time of in charge of the military medical study warehouse division of the general * Research subjects and location: logistics warehouse/military zone; Dean, Experts are cadres who are working at the Vice Dean of Faculty, Department, Military Medical Department, 108 Military Lecturer of the Faculty of Military Medical Central Hospital, 103 Military Medical Advisory Command and the Department Hospital/Military Medical Academy; Military of Organization and Management of Medical Hospital 105, 354/General Drugs/Military Medical Academy. Subjects Department of Logistics; Military Hospital consented and voluntarily participated in 110/military zone 1; 109/military zone 2; the study. 7/military zone 3; 4/military zone 4; * Research period: The academic year Military Medical Division, Logistics 2020 - 2021. Department of Military Zones 1, 2, 3, 4; 2. Methods Faculty of Command and Staff of Military * Research design: Build, propose Medicine and Department of Organization solutions, and consult experts. and Management of Medicine/Military * Sample size and sample selection: Medical Academy Criteria for selection of positions/titles: Director, Deputy Director, Purposely select the subjects that are Head of Pharmacy Departments, Advisory experts according to the defined criteria. - Planning, Treatment, Director of the Priority will be given to officers with high Institute for Research in Pharmaceutical academic titles, degrees, and scientific and Medical Equipment; Warehouse titles directly related to the management, manager 708, 706; Vice president; Director training, research, and use of combat- of pharmacy department of military hospital; ready military medical facilities. As a Deputy Director of Logistics Department, result, 50 experts were selected (Table 2). Table 1: The number of experts consult on solutions. Field Number (n) Rate (%) Military medical management agency; Specialized training in Military 22 44.0 Medical Command Organization and Drug Management Organization Commander of the hospital, commander of the pharmacy department of 17 34.0 the hospital Director of Logistics Department, Chairman; In charge of the military 11 22.0 medical/military division Total 50 100.0 125
4. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 * Research content, variables, and levels and propose the contents of the indicators: solution of the military hospital to stockpile - Develop and propose 12 solutions to the number of drugs ready to fight in the "Military Hospital stockpiling a number of new situation, so that the experts have combat-ready drugs (Y, K, BV) in the new enough necessary data as a basis for situation on based the actual situation making comments, fair and objective investigation. Within the scope of the assessment. research, the article only introduces 6 3. Data analysis and processing contents, including: The questionnaire was calculated + Steps to source, pack and stock up and processed by Excel - 2013 and on drugs ready to use at the hospital; The conventional biomedical statistical methods. process of circulating and changing the number of drugs ready to serve at the 4. Research ethics hospital; The study was approved by the Head + 3 types of hospitals implement the of the Military Medical Department, the method of stocking drugs ready for the Head of the Logistics Department, and battle; All kinds of combat-ready drugs the Military Medical Division of the studied are assigned to hospitals to reserve for military zones; Commanding military military units in the region; medical research hospitals. The research + Number of ready-to-use drugs subjects fully explained the content and assigned to each type of hospital; purpose of the study and consented and Measures to solve some difficulties of the voluntarily participated. All research hospital when creating sources, storing, information and data at military medical circulating, and changing the number of warehouses/sub-departments and military combat ready bases. medical hospitals are kept strictly - Asking for opinions of experts to confidential according to the regulations evaluate and comment on proposed on confidentiality of documents and data solutions, through the percentage (%) of of the Ministry of National Defense and experts’ agreement, disagreement, and only for use by the Ministry of National have no answer. Defense for research purposes only. * Methods and techniques for data RESULTS collection: According to the questioning 1. Proposing steps to source, pack, method, the expert opinion form is and stock ready to use drugs at a designed and sent directly to the experts military hospital to ask for opinions on “Solution for the military hospital to stock drugs ready to (1) Step 1: Every year according to the use in a new situation”. Enclosed with the target assigned in the guiding document expert opinion form is the reference of the Military Medical Department to document to provide all data to implement the directive of the General investigate the actual situation of Staff and the order of the General stockpiling of combat-ready drugs at a Department of Logistics on stockpiling number of military medical depots and combat-ready drugs on the battlefield, military hospitals at strategic and operational the hospital directs the General Planning 126
5. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Department (Department) to assume the on the ability to ensure the necessary prime responsibility and coordinate with medical conditions, kind of drug base the Pharmacy Department and the ready to fight; (3) Step 3: Organize Finance Department (Department) in bidding to purchase drugs and formulating an implementation plan and consumables according to the approved submitting it to the Hospital’s Board of list; (4) Step 4: Transfer drugs and Directors for approval; (2) Step 2: Review consumables according to the order to the list of drugs and consumables in reserve ready for battle to the hospital's service of medical examination and ready stock warehouse; (5) Step 5: Open treatment, compare them with the quantity or fully pack a number of ready to serve of each type of medicine and for distribution according to situations consumables, and make a detailed plan (10%), the rest will be left. Table 2. Experts’ opinions on “the 5-step process of sourcing, packaging, and stocking ready to use drugs at a military hospital”. Commander Management and The head of the military of the hospital and training agencies medical zone of the military General hospital pharmacy (Military Medicine zone; warehouse (n = 50) Comments department Department, Military management/department of (n = 17) Academy) (n = 22) military medicine (n = 11) n % n % n % n % Agree 16 94.1 20 91 9 81.8 45 90.0 Disagree 1 5.9 1 4.5 2 18.2 4 8.0 No answer 0 0.0 1 4.5 0 0.0 1 2.0 Total 17 100 22 100 11 100 50 100 Comments 1 (in turn) 3 (in turn) 0 4 (in turn) The majority of experts (90.0%) agreed with the process of "5 steps to source, pack, and stock ready to use drugs at the military hospital"; 8.0% disagreed, and 2.0% did not have the answer. 2. Proposing the process of circulating and changing the number of drugs ready to serve at the Military Hospital (1) Step 1: The Committee (Administrative Team) helps the Dean of the Pharmacy Department to firmly grasp the quantity, quality, and expiry date of drugs and consumables in the reserve of drugs ready to fight according to the target assigned; (2) Step 2: Faculty of Pharmacy plans to circulate and change the term of drugs and consumables from 6 to 9 months before the time limit and put them into regular use; (3) Step 3: The Pharmacy Department transfers drugs and consumables with expiry dates of 18 months or more according to the list to ensure the reserve quantity according to the prescribed quota; (4) Step 4: The hospital requires the units that have been issued, to transfer the drugs and consumables that have reached the expiration date (from 6 to 9 months) to the hospital for replacement or replacement radix set to replace the new radix. 127
6. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Table 3: Experts’ opinions on the "4-step process of rotating and renewing the number of ready-to-serve drugs at the Military Hospital". Commander Management and The head of the military of the hospital training agencies medical zone of the and hospital (Military Medicine military zone; warehouse General Comments pharmacy Department, management/department (n = 50) department Military Academy) of military medicine (n = 17) (n = 22) (n = 11) n % n % n % n % Agree 16 94.1 21 95.5 10 90.9 47 94.0 Disagree 1 5.9 1 4.65 1 9.1 3 6.0 No answer 0 0.0 0 0.0 0 0.0 0 0.0 Total 17 100 22 100 11 100 50 100 Comments 2 (in turn) 0 1 (in turn) 3 (in turn) - The majority of experts (94.0%) agreed with the process of "4-step rotation and renewal of the number of ready-to-use drugs at the military hospital"; 6.0% of the participants disagreed. 3. Proposing 3 types of military hospitals to implement the method of source, pack, and stock of drugs ready to serve (1) Strategic military hospital; (2) Military hospital in the strategic area; (3) Military hospital at the end of the Military zone. Table 4: Experts’ opinions on selecting 3 types of military hospitals to implement the method of source, packaging, and stocking of drugs ready for the battle. Commander The head of the Management and military medical zone of the hospital training agencies of the military zone; and hospital General (Military Medicine warehouse Comments pharmacy Department, Military management/depart (n = 50) department Academy) (n = 22) ment of military (n = 17) medicine (n = 11) n % n % n % n % Agree 17 100 16 72.7 8 72.7 41 82.0 Disagree 0 0.0 6 27.3 2 18.2 8 16.0 No answer 0 0.0 0 0 1 9.1 1 2.0 Total 17 100 22 100 11 100 50 100 Comments 0 4 (in turn) 1 (in turn) 5 (in turn) The majority of experts (82.0%) agreed with the proposal to choose 3 types of military medical hospitals (strategic line, strategic line area and military zone end line) 128
7. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 to implement the method of source generation, packaging, and storage. drug base ready to fight; 16.0% disagreed; 2.0% did not respond. 4. Proposing the type of drug stockpile ready to use to be assigned to military medical hospitals to ensure military units in the region. (1) Strategic hospital (BV, K); (2) Strategic hospital area (BV, K, Y); (3) Campaign hospital (K, Y). Table 5: Experts’ opinions on “ready to serve stockpiles of drugs assigned to military hospitals”. The head of the Management and Commander of the military medical zone training agencies hospital and of the military zone; (Military Medicine General hospital pharmacy warehouse Department, Comments department management/depart (n = 50) Military Academy) ment of military (n = 17) (n = 22) medicine (n = 11) Frequency % Frequency % Frequency % Frequency % Strategic hospital 15 88.2 17 77.3 8 72.7 40 80.0 (BV, K) Strategic regional 9 52.9 18 81.8 9 81.8 36 72.0 hospital (BV, K, Y) Campaign hospital 14 82.4 16 72.7 8 72.7 38 76.0 (K, Y) Campaign hospital 0 0.0 4 18.3 2 18.2 6 12.0 (K, Y) Comments 2 (in turn) 4 (in turn) 1 (in turn) 7 (in turn) - 80% of experts agreed with the proposal of the type of ready to serve drugs assigned to the military hospital at the strategic line; 72.0% agreed with the proposal of allocating combat-ready drugs to the military hospital in the strategic area and 76.0% agreed with the proposal of allocating combat-ready drugs to military hospitals. The last line of the military zone implements the method of source generation, packaging and storage. 12% did not choose/do not answer all 3 proposed options. 5. Proposing the number of ready to use stockpiles to be assigned to military hospitals - Should assign the number of each specific type of radix to each hospital. - Depending on the needs and annual plan to deliver the quantity of each type. 129
8. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Table 6: Experts’ opinions on “quantity of each type of drug base ready to fight assigned to military hospitals” (n = 50). Plan n % Should assign a specific number of each type of radix to each 30 60.0 military hospital Depending on the needs and annual plan to deliver the quantity of 11 22.0 each type Do not choose/ do not answer 9 18.0 Total 50 100.0 Comments 5 (in turn) 60.0% of the experts agreed with the proposal of the option "The number of specific types of radix should be assigned to each military hospital", accounting for the highest percentage, followed by the agreement with the option “Depends on demand and annual plan to deliver a quantity of each category” (22.0%) and the disagreement with the two options above (18.0%). 6. Proposing measures to address some specific drugs included in the list of ready to serve bases that do not match the hospitals’ list of treatment drugs or are no longer used/very limited use by hospitals Table 8: Experts’ opinions on “resolution measures by Military Medical Hospital to ensure an adequate list of drugs as prescribed for base”. Commander Management and The head of the military medical of the hospital training agencies zone of the military and hospital (Military Medicine General zone; warehouse pharmacy Department, Solution management/depart (n = 50) department Military Academy) ment of military (n = 17) (n = 22) medicine (n = 11) Frequency % Frequency % Frequency % Frequency % The Ministry of National Defense/General Department of Logistics/Military Zone 12 70.6 3 13.6 3 27.3 18 36.0 provides funds for hospitals to actively buy (create sources) The Military Medical Department is responsible for 2 11.8 4 18.2 0 0.0 6 12.0 providing additional supplies to hospitals 130
9. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 Commander Management and The head of the military medical of the hospital training agencies zone of the military and hospital (Military Medicine General zone; warehouse pharmacy Department, Solution management/depart (n = 50) department Military Academy) ment of military (n = 17) (n = 22) medicine (n = 11) Frequency % Frequency % Frequency % Frequency % The Military Medicine Department has written specific instructions for hospitals to change 11 64.7 19 86.4 7 63.6 37 74.0 drugs accordingly for consistency throughout the army Do not choose/do not answer all 3 measures 0 0.0 0 0.0 1 9.1 1 2.00 above Comments 2 (in turn) 3 (in turn) 5 (in turn) - The opinion of experts who chose the measure "The Military Medical Department has written specific instructions for alternative hospitals to switch drugs accordingly for consistency in the whole army" accounted for the highest percentage (74.0%), followed by “The Ministry of National Defense/General Department of Logistics/Military Region provides funds for hospitals to actively buy (create sources)” (36.0%), the measure “Military Medicine Department is responsible for additional allocation to hospitals” (12.0%). No answer to all 3 options above was 2.0%. DISCUSSION choose the appropriate method. Steps 1, - Regarding the proposed steps to 2, 4, and 5 remain as suggested. source, pack, and stock ready to use We keep the open packing in Step 5 drugs at a military hospital: The results as suggested (Step 5: “Open packing or show that 45/50 of the experts (90.0%) fully pack a ready to serve stock base to agreed with the "5-step" process of source, be ready to dispense under the pack, and stock ready to use drugs at circumstances (10.0%), the rest will be military hospitals; 8.0% disagreed and left”. The packaging and opening of the 2.0% did not answer. There were 4 base of war drugs, namely base BV - 012 specific comments and we adjusted and at military hospitals, has also been supplemented. Step 3: Organize bidding directed, guided, and allowed by the to buy drugs and consumables according Military Medical Department to implement to the approved list. For items on the "Content of base BV-012 is built open hospital's drug list, the hospital's bidding direction so that a number of items can results are used for procurement. For be stockpiled interchangeably, suitable items that are not on the hospital drug list, for actual use in the unit, convenient 131
10. Journal OF MILITARY PHARMACO - MEDICINE N06 - 2021 for management, circulation and expert opinion: “All Military Medical replacement [4]. hospitals in the Army can be assigned to - Regarding the “4-step process of create resources; packing, stockpiling the rotating and changing the number of reserve drugs ready to fight under the drugs in reserve ready for combat at direction and guidance of the Military military hospital”: The results of consulting Medical Department”. However, we still experts showed that 46/50 experts recommend 3 types of Military hospitals to (92.0%) agreed. "The 4-step process of pilot, then learn from experience and then circulating, changing the number of drugs replicate it to the whole... in ready to serve at the Military Hospital"; - Regarding the proposal on the type and only 8.0% disagreed. There are 3 of combat-ready drug base assigned to turns of specific expert comments. There military medical hospitals to reserve for is an expert opinion on "Step 1: Research military units in the region: (1) Strategic from the Board (Administrative Team) hospital (BV, K); (2) Strategic hospital because in some hospitals there is no area (BV, K, Y); (3) Campaign hospital such department, you can use another (K, Y). The results showed that 80% of more appropriate word or write directly as experts agreed with the proposal of the a warehouse (division/ warehouse) to type of combat-ready drugs assigned to assist the Dean of the Faculty of the strategic military hospital; 72.0% Pharmacy ”. Acquiring expert opinions, agreed with the proposal of allocating we have revised “Step 1: In charge of the combat-ready drugs to military hospitals warehouse (warehouse division) to help in the strategic area and 76.0% agreed the Dean of the Pharmacy Department with the proposal of types of combat- firmly grasp the quantity, quality, and ready drugs assigned to them. The expiry dates of the drugs and military hospital at the end of the military consumables in the project stockpile of zone implements the method of source drugs ready to fight according to the generation, packaging and storage. There assigned target”. are 7 specific expert opinions. It is worth noting that there are 2 opinions of 4 - Regarding the proposal of 3 types of experts suggesting that "Military Medicine military hospitals to implement the method Department assigns military medical of stocking drugs ready for combat, hospitals to reserve according to the including: (1) Strategic military hospital; direction of the General Staff and the (2) Military hospital in strategic area; (3) order of the Director of the General Military hospital at the end of the military Department of Logistics, depending on zone. The results of consultation with the ability to of each unit”; “Can be experts showed that 41/50 (82.0%) assigned to military hospitals to reserve experts agreed that “3 types of military all kinds of bases: Y, K, BV. It is not hospitals implement the method of necessary to prescribe for each type of stockpiling combat-ready drugs”; 16.0% hospital”. Based on the above comments, disagree and 2.0% do not answer. There we still maintain the above proposal and are 5 turns of specific experts’ comments. have added “Depending on specific It is worth noting that there are 3 times of conditions, it is possible that military 132