Interview transcript to start creating themes.

on PIMS (Interview 002.m4a)

(Lemlem T.) Question: What can you tell me about this system we have in place?

Johnson: with what I know about this system is that it is a system that we use electronically so that we manage the drug supply so that we avoid the waste of drug. This is what I know so far about this.

Speaker 2: to add on what Johnson said, this system which is in start. For me, the way that I have understood is to also capture all the persons coming in the facility and to help us not to be repeating registering this people in the system. This is how I understand.

Speaker 3: to add on what my colleague has said, for my side I think this system of drug management is very important because it also reflects which drugs used most in the facility than the other. For instance, which conditions are common and because the condition will indicate which drugs are consumed highly in the facility. Also, it attracts how we are using the medicines so is it being used the right way? Or the wrong way? So, it captures all the information regarding the medicines then that makes us know to request the medicines on time if we see certain medicines are finished to request on a timeframe. It helps us to capture the number of patients as my colleague has said. For instance, if somebody comes several times in the facility then that will make us aware of the condition to make more assessments on that patient to know what the problem is.

Speaker 4: another additional point on the system is that what my colleague says is what we thought about the system. Another thing I think would also be important of the system is it may help to decide to generate  easy report: monthly or weekly. Seeing the information available in the system electronically then it will be very easy to generate this.

Speaker 5: The way I understood this system, it is all about the measurement assessment especially the quantity of drugs given to the patient and the one remaining in the pharmacy. This tells to really know how much they are taking in those medications; how much are they taking, and how frequent is the patient coming to the facility. Thank you.

(Lemlem T.) Next Question: What do you think PIMs have contributed towards the improvement of our overall pharmaceutical’s services to our beneficiaries? What additional value? What additional benefit do you think PIMs has brought to our service when it comes to our service to our beneficiaries?

Speaker 1 (Laurence Steven- POC 3): what I am seeing about benefit of service is drug maintenance. Secondly, it makes the work easy. When you enter in the name, all the patient’s information is shown.

Speaker 2 (Nurse in charge- POC 3):  to me, the system helps to know which type of drug you need in the facility and when the patient comes and need that drug. If the patient comes and need that drug and the drug is not available, the pharmacist will know that this drug is in need, and they will bring it.

When we request a drug, how many drugs we request and how many drugs we dispense and how many drugs we demand.

Even for patients, the patient comes in the morning and again at night we know not to give them the same medication for that patient. We would re-assess the patient. The pharmacist will tell the patient that it is the same medication that they took in the morning. Injectable drugs, the number of patients that need that medication these days, the system helps us reduce the replication of drugs with patients.

Speaker 3: the system helps to identify the drugs not only by the supervisor but also staff. The system is really helping like before only the supervisor would know that the drug is expiring but now people have access to know, the system is really helping.

Speaker 4: Based on the system, I think the impact here most importantly to the pharmacy staff because it helps them in the management of drugs especially in the pharmacy. So, exactly as the information is available in the software, it helps them which kind of commodities are available and helps when they request. Again, it is a modern way of managing drugs. The importance of it is that we are moving into modernization like my colleague says with the duplication of drugs, this is important.

To benefit the beneficiaries, the system will help to avoid the shortage of drugs in the facility because the drug will be requested on time since we will know which drugs are reduced for us to request. The beneficiaries will get an effective treatment because we will know which condition is prevailed in that particular place because all the data is kept there, we know which condition is common. So as far as the conditions that are common, they will be out of consumption for that medicine. Patients would get effective treatment and enough medicine to cover the conditions that are prevailing the area.

Speaker 5: Another point I can touch on, identify the drug interaction. It is not everyone who can understand the drug interaction, but the system could identify if you give a certain drug then the system will notification that it is a medication that cannot be given at the same time. When you are dealing with a person especially here and for you to explain the side effects of the drug will take time, so the system is notifying you to not give this medication at the same time which is helping not like the way we are using it manually.

(Lemlem T.) Question: How do you think PIMs is affecting the availability of essential medicines in this POC clinic? So, if you can elaborate how or whatever observations/ examples you have in making sure essential medicines are always available? Do you think PIMs has impacted that and how do you think it has  impacted?

Speaker 1: I think based on my understanding on the question is that there is too much outgoing of the drugs. So, drugs go outside more frequently before the system was introduced in the health facility but when the system is introduced in the health facility, it reduces the unnecessary prescription of the drug and helps in the management of stuff by the way. Sometimes anybody can admire a kind of medication then you can use it in your own way even without a doctor’s prescription but when the system is available, no medication is taken without the system. You have to first go through the system then the medication is given to the patient meaning it is reducing the waste of the drug especially in the health facility so this something I have observed before the system and when the system exist. What I mean by more drugs going outside, we have a supervisor in the department has to request a number of medications from central pharmacy then from there you use from your department without director. Meaning the large number of drugs will be used but not reported in most of the cases. At this most, there is no use of large amounts of drugs in each of the department meaning everyone has to go through the system to get drugs. This means the drugs are now available in central pharmacy more than the departments.

Speaker 2: To add on what my colleague have said, the impact of this system that has been in place is very important because previously in 2019 down to 2016-2017, you would find any clinical officer will just rush inside the pharmacy and pick whichever drug they want. As my colleague has said it has not been recorded but ever since this system has been introduced, it has controlled all this misuse and mismanagement of drugs. Before, at night people could come and just take drugs like when they were given certain units of drugs to be used for a particular day, you would find it wouldn’t last for one week. Before that one week, the drugs are finished. Now, since the system has been introduced, I have never had people complaining that we are giving medicines that does not reach the intended time. It has reached the time that it is supposed to be and when it is not finished and then they will also go back to request more. This system has helped in such a way especially the central pharmacy supervisor and other pharmacists who are dispensing drugs to manage drugs to help.

Speaker 3: In this system, we keep the drugs because the system can prevent the duplication of drugs that means the one patient you cannot give the same drugs or two times the same drug. When they come today or tomorrow, the system will say no, and the medicine is still. If you give for 10 days, the system will say still 10 days that means that the drugs will still be there. Before, the patient used to come everyday and take the medicine out like that.

Speaker 4: In relation to the question, I remember in 2021, the same community here (in the POC in general) they were complaining of the staff in the IMC that they are the one using the drug. Meaning instead of the beneficiaries using the drug, it is the staff using the drug, that was before the system. Nobody knows if it is the wrong or right claim. But, at this point, I think our community have realized that there is a system in place that answers their question of 2021 meaning that when they come., they first need to go to the registrar then the consultant then from there they go to the pharmacy and see a computer. Before, there wasn’t a computer, so they must ask what is the use of the computer? Meaning the system has helped the community invest their confident that the organization has answered their question that they are now getting the drug in the right way.

Speaker 5: (…) I think now the community for them before the ones that are taking the medications taking for their own benefits. It has given a limitation over drugs irrationally. For them they used to say, “if you don’t give me a drug for my condition” (…) Now if we are using the system, they will believe that what we are doing it is all going through a system, thank you.

Speaker 6: Let me add something, before system we used to only paper and to keep document was too difficult because sometimes if you put in somewhere, it gets lost. Now, we are going to keep all the information for reporting and that is good in pharmacy. Now, through the system you will see the name of the patient and it will not get lost. This is the benefit.

Lemlem T.: I think you have answered the availability of essential medicine, what I wanted to know is ‘’are medicines available all the time?’’. You told me through the avoiding of the wastage, the irrational prescribing and the unnecessary practices that we had that made medicines be distributed to different places and not being accountable has contributed to make sure medicines are available at the facility all times. We also get feedback from the community confirming to that, did I get that correct?

(Lemlem T.) Question: How do you think PIMs has resolved issue of irrational prescribing and dispensing, if there was any and how did it increase quality of service and care that we provide to beneficiaries?

Speaker 1: Based on the question you asked and how I understood the data. The system helped us in this way: one, is that when a patient come with a condition sometimes you might come with a headache but as a clinician, do I need to give you an injection because of headache? So I need to give you a right diagnosis then write prescription. This will help (..) for example if I prescribe wrong condition then the person in the pharmacy is going to correct that because the information are available and the pharmacy is going to correct my error as a clinician. Then, another thing is about the pharmacists themselves. I think one of the points was said before, so there is first “expiry” then “first out”, this is something that we need to use. Sometimes when we know the drugs are expiring soon then we give them out to the beneficiaries so that we have rather drugs (..) this helps us in the irrational use of the drug because if we spend the drug that the expiry time is longer then we allow the drug to expire. This is unnecessary use of the drug, then another thing is that it is going to help in the storage of the data so sometimes in the procurement, it helps with which commodities needs to be procured. That is my contribution (speaker laughs).

Speaker 2: The system will help to reduce the irrational use of drug in case of duplication. So, it will reduce, and we are able to use one medication. The system is controlling the drugs, regulating to make sure we use the drugs effectively. It is not used in a right way, I think that is how it can help in the irrational use of medicine.

Speaker 3: I’m not a doctor. From my social  worker understanding, I have seen before the system was stored you may find a technician would prescribe antibiotics, etc. (…) but ever since the system has been stored, I don’t receive complaints. One day I was by passing and a person came to me and asking “now I came because I have a headache but now these people are giving me amoxicillin (other drugs…) “and I don’t have this system. (…) I went to the technician and told him “sir, I think there is a misunderstanding somewhere. Maybe you are rushing but please attend to this person again and listen to what they wanted to tell. Get to know what he is explaining to you.” (…) So why am I saying this? Because that time this system was not there but now the system is helping and if the technician by mistake put more antibiotics now the person will go to the pharmacy and the system will indicate that the antibiotic cannot be given to the same person.

Speaker 4: Yes, ah, we still don’t know the system, but we are seeing what it is.  Based on the question is that   it is going to increase the clinician knowledge principle of drug administration. Especially, when you talk about right patient, right dose so meaning if sometimes clinicians are exhausted due to large amounts of patients, he/she see in that time. You might be exhausted, and you prescribe large amount of milligram to the patient. Sometimes the pharmacist which is controlling the system because the milligrams and the dosages they are available in the system. So, when clinician due to exhaustion prescribe too many dosages to the patient then the pharmacist can correct that and prescribing high like dosages of irrational use of drug meaning the pharmacy is going to help clinicians in correcting that. When it is not corrected, there are going to be patient overdose which will be another problem. The system increases the knowledge of principle of drug administration.

(Lemlem T.): My understanding is that the system has increased the knowledge of the pharmacist and clinicians and encourages good communication between pharmacists and clinicians. To take care of issues of rational prescribing, over usage of antibiotics, over usage of injectables and to have a good consultation process between a clinician and pharmacist so that we provide quality service to our beneficiaries. Did I get the point right or do you want to elaborate more on that?

Again, I know few of you have also touched up on how the system is efficient by avoiding any wastage, expiration. Again, I want to go deeper on how you see PIMS and think PIMS impacted in making our service cost effective and efficient at the same time increase the satisfaction of the communities that we are serving. (…) you see if we avoid expiration that means that it is avoiding wastage and means we are increasing cost effectiveness. Those of you who haven’t spoken, can take the lead.

Speaker (male): Based on the question and what I understood so far, you mention something on drug expiry. Based on my knowledge, the system is using internet, right? Yes, the system is using internet meaning there is a system that update the pharmacists about or exactly the expiring time of your drug and the drug that you are missing. Again, that one also impacts and increase the satisfaction of the community in a way that if a community is consuming meaning when you are given a drug that is not out of date meaning it works effectively and cures the condition. The central point of my contribution is that is that it helps the pharmacists to control the drug to know which is up to date and which is expiring soon. The community benefit by getting the right quality medication. This is just my contribution.

Speaker (female): The effectiveness of this system how it helps our beneficiaries. Also, it helps in the pharmacy because as my colleague have said, the medicines are captured so they will help them to see the expiry date. This happened in 2017, people are lacking drugs and the technicians are not aware of what is happening in the pharmacy so most of the drugs that are supposed to be given to the beneficiaries and because they are not aware of this, all the medicines expired. Around 25 boxes were expired, and they took these medicines back to where it is supposed to be. (…) Because of this system, it will help people to check every time which medicines are there, which will expire. It has helped them to manage, and I don’t hear from last year until now the medicines are going to get expired from the clinician. (…) This system helps a lot, and we appreciate this system to be continually.

Speaker: Yes, to me. Time ago we do not know which drug get expired. Right now, it has given the overview of the drug. Another thing, a few months ago I was working in IDP. If I give you paracetamol yesterday and you come back with feedback that the child’s illness has not been subsided doesn’t mean that the medication we have given to the child has not worked, I have to follow up if the medicine was given properly or administer the medicine here and see the effect, the system has helped to see which medicine was given out and avoid duplication of treatment.

Speaker: The cost effectivity of the drugs. So, from my side when you supply the medication, we supply the medicine that are being used in that place. Instead of supplying the medicine, she has not used in the facility. So, it avoids the waste of the medicine because all the expired date will be detected earlier and maybe we can use the drugs more than the one that have expiry dates are still effect. It can help us to balance the prescription like for instance we have different types of antibiotics, and most antibiotics are doing the same thing. But we can see the ones that are almost expired or low quantity we can prescribes those ones then prescribe the ones which are low quantity. (…) All the medicines can be used effectively in a good way.

(Lemlem T.) Question: in your experience- since one year this POC clinic has PIMS. If you must rate system on a scale of 1-5,1 being the lowest and 5 being the highest mark. How do you rate it?

Speaker 1 (female): For me I will say 4 because it has in the rational use of drug and has helped with the pharmacies to see the expiry of drugs.

Speaker 2 (male): I can tell you 4, ok because now the community is complaining about delay in pharmacy. This is what I am seeing but overall is it good for medicine or making the pharmacy busy. Now, the work is going well is what I am seeing

Speaker 3 (female): I rate system 4 although it supposes to be 5 but 4 because that system if you get it in reception and consultation, it would have been a complete system, now we only have it in the pharmacy.

Speaker 4 (male): I think every system, every policy, anything when it is newly initiated it has positive qualities, we all understand. Despite the complaint of the community about increasing or waiting time. I can rate the system 5/5 because the impact that it has brought is more important than the complaints. The system can increase the knowledge of clinician on rational use of drug, increase positive minimum use of drug, increase communication between these two departments especially consultation, pharmaceutical, and even the registration desk. It will help in drug wastage, storage of the data especially when the pharmacy supervisor wants to procure a drug for the site, so it helps him easily generate a report of the drug. I rate the system 5/5 if you see all the changes, it is so important.

Speaker 5 (female): to me I would mark it as 4/5. One it is because the system ahs given us a limitation of drugs. Second, keeping a record for future reference. It looks great and wasting time writing on paper and even your hand will get tired so that is also a good thing on it. Other thing is a person that is not comfortable with it and gets frustrated, but this only happens because people are not used to computers. We are working slowly because we are trying to practice it, we were not using it before but with time it will be okay. That’s my reason for giving it a 4/5

Speaker 6 (male): I rate for it to be 5. We have just begun the system and what I know is people will get use to it and it will run very well. So now, some staff has not been used to enter the computer to put in data because it will take time so that is why there is delay or it takes time for the patient to wait for their medicine (…) it helps us to request the medicine on time and helps to avoid the wastage of drugs as some colleagues has said because everything will be controlled. With this system, there is no more improper  drugs distribution where someone can use the drug not in the right way. Also, it will help improve the knowledge.