Improving medication procurement management in tertiary hospitals during a pandemic in Malaysia: a case study of COVID-19

Abstract

The COVID-19 pandemic had a profound impact on healthcare systems globally, with an initial supply chain disruption rapidly escalating into a multifaceted crisis. Hospital pharmacists played a pivotal role in managing drug supply and distribution amid severe shortages, while simultaneously adapting to evolving clinical practices as new medications were introduced and others phased out. The first objective was to examine changes in medicine purchase patterns during the pandemic through a retrospective analysis conducted at a tertiary referral hospital in Malaysia. Two distinct periods were analyzed: pre-pandemic phase (January 2018 – December 2019) and pandemic phase (January 2020 – December 2021). Of the 266 medicines assessed, the majority (n=131; 49.2%) exhibited a decline in purchasing trends. However, demand for critical care medications surged, with procurement increases observed for cisatracurium besylate 2 mg/ml injection (1583.3%), vasopressin 20 IU/mL injection (796%), vitamin B and C injections (672.9%), and the oral antipsychotic olanzapine 5 mg (534.4%). Leveraging on these findings, the second objective employed a cross-sectional online survey design targeting hospital pharmacist to identify key barriers and facilitators affecting medicine availability, distribution, and pharmacists' roles during the pandemic. The questionnaire was developed through an extensive literature review, pre-tested, and validated by 25 hospital pharmacists before implementation. A total of 367 hospital pharmacists participated in the study. The most frequently reported barrier related to knowledge and skills was difficulty in analysing trends and usage patterns of COVID-19 medicines (n=183; 49.9%). The most pressing supply chain constraint was the global medicine shortage (n=314; 85.6%). Clinical challenges included the underway of clinical trials to identify effective treatments against COVID-19 (n=282; 76.8%), while the most significant departmental barrier was the challenge of predicting medicine usage based on previous purchasing data (n=262; 71.4%). Despite these obstacles, nearly all respondents (n=354; 96.5%) acknowledged that specialized training on COVID-19 treatments significantly enhanced their preparedness and response capabilities. Findings from the first two studies underscored the vulnerabilities in the pharmaceutical supply chain, highlighting the need to reassess hospital medicine procurement workflows. This led to the third study and objective, which aimed to design and validate an optimized procurement workflow to mitigate these challenges and strengthen facilitators. The third study consists of two key phases: (1) development of the workflow through expert consultation and (2) validation by clinical and procurement pharmacists using quantitative assessments. The proposed workflow introduces a structured, two-part approach that enhances collaboration with clinical teams to improve procurement accuracy while integrating thorough market research and strategic supplier selection. The workflow’s validity was confirmed after a single round of the Delphi method, achieving strong face validity (n=11, 96.4%) and high content validity (I-CVI ≥0.78, SCVI- Ave: 0.98, S-CVI-UA: 0.8). By streamlining procurement processes and addressing supply chain inefficiencies, this workflow seeks to improve medicine availability and distribution, particularly during health emergencies.