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actual consumption of ethical drugs for medical administration purposes. Thus, it is
impossible to determine the accurate picture of healthcare expenditure strictly from
the billings.
Adopting the unit control of medical supplies and recording the exact medical
treatment and procedures will allow for real cost accounting. However, checking
the unit controlled medical supplies by scanning barcodes may increase the burdens
on healthcare practitioners. Personnel costs comprise nearly half of medical
expenditures (Ministry of Health Labour and Welfare Health Policy Bureau Eco-
nomic Affairs Division 2009 ); thus, increasing the burdens on practitioners will put
pressure on management to refine business analyses and practices. A medication
checking system must require the least amount of personnel labor possible.
6.2.3 Operating Issues with Regard to the Ordering System
Healthcare services around a Japanese medical ward are limited due to poor
housing conditions (Ministry of Health Labour and Welfare 1995 ). The lack of
resources makes it difficult to build a cost effective and timely delivery system of
maintaining a stock of ethical drugs at the ward and distributing them efficiently.
Common practice is to have the pharmaceutical department arrange the delivery
date for the drug order and deliver the drugs at the appointed time. The ordering
system is recognized as a tool for reserving or backordering drugs over a long
period (Tomohiro 2005 ). The real computer-based injection designation system has
recently emerged.
Tanaka et al. reported that among all intravenous infusions at the hospital in
2007, less than 1 % of treatments were not authenticated, due to an emergency order
by a physician (Kaihara et al. 2009 ). Among authenticated orders, 55 % were
changed or canceled. This study shows that even when put on alert, nurses have
tendency to repeatedly enforced some orders to be authenticated. The fact that 4 %
of the override actions were the cause of malpractice incidents indicates that the
healthcare workers are too close to medical accidents. Medical treatment cannot
always be scheduled. A failsafe design in the checking system at a ward is very
important. In addition, the long time span between dispensing drugs and
administering treatment can also cause frequent order changes and cancellations.
Lacking a supply system that supports sustainable and prompt delivery for
urgently required ethical drugs, practitioners have a tendency to order extra drugs
so as to have them on hand. To change the focus from ordering resources to
indications for medical treatment, the system should shorten the time between
dispensing a drug and administering it. Collecting the log of authentication, the
list of medicated ethical drugs, and the log of treatment time will enable realtime
stock forecasting and better stock control.
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