All material supplied through pharmacy should be subjected to all rules and procedures of materials management.
1. Purchase:
Whenever possible, pharmacy stores purchase and storage should be centralised. Such an arrangement allows staff, storage facilities and quantities purchased to be optimised.
On adoption of the hospital formulary and final decision about drugs to be stocked, the procurement action with a study of:
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i. ABC analysis, VED analysis, FSN analysis,
ii. Reorder levels,
iii. Possible lead times, and
iv. Stocking levels in operational units, viz. wards, OT emergency department, etc.
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If the hospital is situated in a large city, supplies can be obtained at short notice because stockiest, distributors or agents of almost all well-known firms are located in such cities. This can be of help to reduce the size of the inventory.
It is necessary to maintain a list of manufacturers, and suppliers. There may be only one manufacturer or supplier in respect of few items, but in most of the items there are a sizeable number of manufacturers and suppliers.
All orders should be placed in writing, indicating the terms of supply, specifications of items, quantity, cost, pack size, time of supply.
Orders on suppliers should normally be completed in triplicate and one copy sent to the stores department if the purchase and store departments are separate.
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There will be occasions when life-saving and emergency drugs will have to be obtained at short notice on telephonic orders from local suppliers. In such cases, telephonic orders must be followed up with written supply orders as soon as possible.
Independent check of invoices should be done by the staff of the purchase and stores departments if they are separate. The check should cover such matters as prices, quantity, pack sizes and dates of expiry.
Many of the drugs have a short life of six months to a year. The date of expiry assumes great significance if all the stock cannot be used before the date of expiry.
All items must be entered in the stock register noting all particulars as in the invoice. For short life items, an important requirement is to have a dated drug register or short life stock detail register. A routine monthly check of this register will obviate the possibility of inadvertently accumulating items that are nearing their date of expiry.
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2. Size of Inventory:
A general hospital with a number of specialties will have to cater for a large number and variety of items. Its turnover will also be greater as compared to a specialised hospital catering for one particular type of patients, like eye, maternity, orthopedic, tuberculosis, etc.
A general hospital located in a large city has the opportunity to reduce its inventory by taking advantage of the location of agents, stockiest, distribution and manufacturer’s representative in such cities, and the availability of drugs and suppliers at short notice.
3. Turnover:
In the pharmacy stores a system must be evolved which will ensure an adequate turnover of stock. Certain items have limited life and failure to use these before they are out of date can be very costly.
The principle of first-in, first- out should invariably be adopted. It should be possible to load store shelves from the back so that old stock is moved towards the front from where goods are picked.
Where items are stored in bulk containers, marking of the date of receipt clearly on the container so that it can be seen at a glance, helps to ensure a proper turnover.
Efforts should be made to persuade users to accept old stock until it has been cleared, when a change of trend makes stock items no longer popular with the users.
There should be a periodic review of all slow moving stock to prevent deterioration and obsolescence. Items which are obsolete should be ruthlessly weeded out from the stores, and disposed off.
4. Storage Facility:
It is important to ensure that the most appropriate combination of storage facilities is made use of. Fixed location racks with adjustable shelves offers suitable storage facility.
If the inside surfaces of shelves are painted in a light colour, a better light reflection is obtained for clear identification of the marking on stocks.
5. Stock Location System:
The ‘sequence system’ of stock location is most suitable for pharmacy stores. Items are located in alphabetical or numerical sequence without regard to issue frequency.
In dispensing solely for outpatients, the ‘popularity location’ system is more suitable, where material are so placed that more popular items are located in the most advantageous positions.
6. Issues:
Drugs will be required to be dispensed to both inpatients and outpatients. When drugs are dispensed directly from the pharmacy, this is usually done direct from the doctor’s prescription or treatment card.
The dispensing of “take home” drugs accounts for a big number of prescriptions individually dispensed by the pharmacy. These should never be issued from ward stock.
Every prescription must be checked for correctness of dosages and strength and its validity by the doctor’s signature.
There are many drugs with closely similar names but entirely different actions. Dispensing should be done in proper containers—original packing if possible—or in paper packets with labeling and instructions.
When a particular drug prescribed by brand name is not available and an equivalent in the formulary is available, the pharmacist should substitute it only after informing the treating doctor personally.
7. Wards:
The range and quantity of drugs held by wards or departments should be agreed between pharmacy, medical and nursing staff. The basis of the ward stock will be the regularly used drugs without special storage problems. In each ward, there should be an up-to-date drug inventory.
Ward stocks should be appropriate for the needs of the ward and be subject to regular checking by chief pharmacist who should maintain close contact with nursing staff in the ward.
There should be effective control of drugs kept inwards, each having a standard drug list which is kept under regular review. Supervision of drug stocks in user units by chief pharmacist is important for:
i. Ensuring that statutory and other requirements in relation to dangerous drugs schedule and drugs liable to be misused are complied with,
ii. Ensuring that stocks are kept in proper conditions,
iii. Determining, in association with the users, that stocks are adequate in range and quantity, and
iv. Arranging for the return to pharmacy of items which are no longer in regular use, and thus avoiding wastes and unnecessary hoarding.
Issues to wards and departments can be made with ease if a preprinted requisition form is used. No issues should be made without written indents.
Another system of issue to wards is the topping system, wherein ward stocks are topped up at periodic intervals by the pharmacy staff.
This minimises paperwork and loss of time of nurses and technical staff. The timing of the topping up round should be planned to cause least interference with the ward routine.
8. Emergency Drugs:
It is necessary to place emergency cabinets, stocked with appropriate emergency drugs and antidotes ready for use in each patient care unit. Particular attention needs to be given to intensive care unit, postoperative recovery and emergency/casualty room.
It needs to be emphasized that unless it is checked daily by the ward sister and periodically by pharmacy staff, and kept under strict control, the contents tend to grow until it ceases to be simply an emergency supply.