DRUGS STORE MANAGEMENT

Dr. Nirmal Gurbani

 Objectives
• To understand various steps in receiving, handling
and storage of medicines and related supplies
• To understand means and patterns of storage,
stock control and expiry monitoring and minimize
losses through expiration and deterioration
• To understand how storage of medicines directly
affects their quality
• To protect from loss, damage, theft, or wastage
• To maintain reliable and continuous supply from
source to user
• To keep accurate inventory records
• To provide stock movement information for
forecast needs
 Discussion 1

Cross Cutting Issues:

Why do we need to have a medicine store ?

Isn’t it easier to buy from the local pharmacy or local
distributor ?
 Introduction: WHY ?
• To ensure that stocks are available when and where
needed
• To capitalise on bulk purchases
• To enforce contract adherence by default
• To use stocks efficiently and minimize waste
• To keep stocks safe from damage
• To ensure that appropriately trained staff are
responsible for supplies management without
duplication of capacity
Drugs are the link between the patient and health
services. Their availability or absence contributes to the
positive or negative impact on health
 Medical Stores : A necessity
• All drugs and consumables procured
cannot be readily consumed

• Storage is inevitable

• Present at all levels down the

distribution system
 Basic Principles
• Must be divided into zones which provide
a range of environmental conditions and
security

• Appropriate zone to suite every item to

be stored

• Items should be stored within each zone

using an orderly system
 Basic Principles
• Stocks should be off floor – on pallets / racks/
shelves

• Good Housekeeping – cleaning and inspection,

disposal of expired stock, storage conditions and
protocols, security and protection – to be ensured

• Trained and disciplined staff

• Clearly written procedures and handbooks

• Periodic audits and stock verifications

 Issues in Stores Management

• Regular uninterrupted access to medicines along with

appropriate dispensing by the pharmacist is one of the
prime requirements for the success of any health program
• A reliable supply system to ensure availability of
medicines in right conditions (quality, safety and efficacy)
will be the major need
• Drugs consumes maximum budget next only to the
manpower, Need to optimize on Procurement, Storage,
Distribution and Use
Major focused activities under
store management
• Receiving and Accounting
• Quarantine and checking of stocks
• Establish appropriate procedures for
indenting, dispensing and recording
• Means and patterns of storage
• Stock control and expiry monitoring
• Disposal of expired drugs
• Records and reporting
 Functions of Medical Stores
• Receive the ordered materials and account for them

• To provide space and provisions for proper storage and

preservation of received items

• The meet the demands of the consuming departments or

organizations by timely issues and accounting

• To ensure good housekeeping to enable adequate material

handling, material preservation and stocking.

• To Minimize obsolescence, surplus and scrap through proper

codification and standardization

• Assist in verification and provide supporting information for effective

purchasing
 Receiving Medical Supplies
• Adequate Storage Space

• Designated storage space , prepared

and cleaned for storage

• Inspection procedure for checking the

supplies
Unloadi
ng and
Checkin
g

Goods
Unpacki Receive
ng and d Note Storage
Inspecti
ng

Disposal
 Arrangement of Stores
• Zoning

• Stocking within Zones

• Stock Classification

• Codification
Inspection Checklist for Medical
Supplies
 Zoning
• Most basic way in which the supplies
would be arranged within the store with
regards to
– Environmental Requirements
– Security / control considerations

• Physical levels / Storage Considerations

– Separate building/Room
– Locked Cupboard
– Refrigerator/Freezer/Cold Room
Manufacturer’s Specification and
Zoning
• Manufacturer’s instructions on storage must
be strictly followed
• In case instructions cannot be followed :
– Consult before violation
– Discuss actual Storage setup
– Find out how long product will survive
– Store is the most suitable conditions that can be
provided
– Use at the earliest
 Normal Storage Conditions
• If no conditions have been specified
– Normal Storage Conditions

• Storage in dry, well ventilated premises at

temperatures of +15oC to +25oC to , or
depending on climatic conditions, up to +30oC.
(WHO , 2003)

• Each storage zone should have a thermometer

and daily record of temperature to be done at the
hottest time of the day
 YOU CAN BE A THERMOMETER

If you feel hot, your medicines probably too

feel the same.
 Storage and Temperature
• Cold:
– 2C to 8C (Vaccine, serum, antibiotics, hormones, vitamins &
minerals)
• Cool:
– 8C to 25C (….by A/Cs … label “Store in cool place”)
• Room Temperature:
– Temp of working area 8C to 30C (not to exceed 30C)
• CONTROLLED Room temperature:
– 20C to 25C
• FREEZER:
– -20C to -10C
 Temperature and Security
Zones
Category A B C D
Normal High Flammable Corrosive
Security Security

1. Uncontrolled
Temperature X X X X

2. +15oC to +25oC -
+30oC X X
(Controlled Humidity)
3. 0 to +8oC
X X

4. -20oC
X X
 Flammables
• Separate room away from main room but not
more than 20m from main store

• Fire fighting equipment should be easily

available.

• A small stock of flammables may be kept in a

steel cabinet in a well-ventilated area, away
from open flames and electrical appliances.

• Always store flammables in their original

container.
 Flash Point
• The minimum temperature at which the liquid
gives off vapor in sufficient concentration to
form an ignitable mixture with air near the
surface of the liquid.
– Acetone and anesthetic ether : –18°C.
– Undiluted alcohols : 18° to 23°C.
– Kerosene : 23° to 61°C.

• Control Evaporation, store in the coolest

possible place, never in direct sunlight
 Corrosives
• Common Corrosive or oxidant substances :
– Trichloracetic acid, Glacial acetic acid, Concentrated
ammonia solutions, Silver nitrate, Sodium hydroxide
pellets

• Store away from flammables

• Use appropriate industrial-type protective gloves

and eyeglasses when handling these items.
 Stock Arrangement
• Arrange cartons so arrows point up and
identification labels, expiry dates, and
manufacturing dates are visible.

• If this is not possible, write the product

name and expiry date clearly on the
visible side.
 Stacking Cartons
• at least 10 cm (4
inches) off the floor

• at least 30 cm (1
foot) away from the
walls and other
stacks

• no more than 2.5 m

(8 feet) high (general
rule).
• Follow the manufacturer or shipper’s directions when stacking, and
follow labels for storage conditions.

• Place liquid products on the lower shelves or on bottom of stacks.

• Store products that require cold storage in appropriate temperature

controlled zones.

• Store high security/high value products in appropriate security zones.

• Separate damaged or expired products from the usable stock without

delay, and dispose of using established disposal procedures.

• Always store all commodities in a manner that facilitates FEFO policy for
stock management.
 Stock Rotation
FEFO
 The order in which products are
received may not necessarily be
the order in which they will expire.
• Always issue products that will
expire first, ensuring they are not too close to or past their expiration date.

• The shelf life remaining must be sufficient for the product to be used before the
expiry date.

• To facilitate FEFO, place products that will expire first in front of products with a
later expiry date.

• Write expiry dates on stock cards, so stocks can be sent to facilities at least 6
months before they expire.
 Stock location within Zones
• Fixed Location

• Fluid Location

• Semi-fluid Location
 Fixed Location System
• Each item allocated to a fixed area
– Pellet Racking
– Shelves
– Area

• Space empty in absence of item

• Large space for all items including Buffer

Stock
 Advantages
• Easy stock administration
Disadvantages
 Stock area relatively inflexible
 New items may not have assigned areas
 Wastage of store space
 Likelihood of theft
 Fluid Location System
• Procurement Unit provides information on type,
volume and weight of goods arriving

• Storekeeper will assess which locations will be

empty when new stock arrives and assigns
appropriate location.

• If insufficient space is available, other goods may

be moved to create space

• The stock control records are updated

 Fluid Location System
• System allocates a unique identifier code to each
item and each location

• Each batch of an item will indicate item ID and

physical location

• Different batches of the item may be stored in

different locations

• Computerized bin location and storage system

makes it extremely efficient
 Example
• Ciprofloxacin 500 mg
• Item Number : 160-03-11
• Physical Location : B1-B
• Another Batch : 160-03-13 : C2 - B
•
Semi Fluid Location
Combination of Fixed and Fluid Systems
System
• Each Item is assigned a fixed space for picking stock

• Demand is issued from this assigned area by order

picking staff

• Reminder of stock is filled on fluid location system

• When picking stock runs low, the fixed picking area is

restocked using items from fluid locations
 Advantages
• Movement is limited to the picking area

• More flexible to changing requirements

than the fixed location system

• As new products are introduced picking

bays may be subdivided to provide relevant
space
Codification and Classification
• Classifying /organizing the items into
categories

• Communication to all the staff about the

system

• Codification to define each item held in

stock
• Alphabetical Order

• Therapeutic or pharmacologic category

• Dosage form

• System level

• Frequency of use

• Random bin
 Alphabetical Order

• Generic names

• Good for small stores

• Labeling needs to be updated with change

in Essential Medicines list

• May not help in optimal use of space

Therapeutic or pharmacologic
category
• Useful in smaller stores / Dispensaries

• Good knowledge of Pharmacology is

required
 Dosage form
• Arranged as per different dosage forms, such
as tablets, syrups, injectables, ointments and
creams.

• Within the area for each form, a fixed, fluid, or

semi-fluid system is used to store items

• Easy to recognize forms when receiving stores

and also allows for optimal use of space
 System level
• Items for different levels of the health
care system are kept together.

• This works well in stores at a higher

level when storage of kits is required.
 Frequency of use
• Frequently used products that move
quickly or often through the store should
be placed in the front of the room or
closest to the staging area.
 Random bin
• Identifies a specific storage
space or Section with a
code that corresponds to its
aisle, shelf, and position on
the shelf.

• Unique storage space in a

rack or shelf is identified
with a code
 Codification
• Alphabetical System
• Numerical System
• Decimal System
• Combined Systems
• Bar Coding
• 10 digits Kodak System
• 3-4-3 (xxx-xxxx-xxx)
• All numerical
• All materials are divided into 100 basic
classifications numbered 0-99 (first two
numbers)
– Raw materials/mechanical products/ cutting tools
• Next number is the sub class (Third Digit)
• Kinds of items (4th & 5th numbers)
• Types of item (6th and 7th )
• Sizes (8th and 9th)
• Minor variations (10th )
 XXX-XXXX-XXX
• XX : Class

• X : Sub Class

• XX : Kinds

• XX : Types

• XX : Sizes

• X : Minor Variations
 Brisch System
• All items are divided into specific
classes

• Subdivisions into next lower levels

ensuring no overlaps

• XXXX-XXX
 Bar Coding
• Bar Coding machine
• Bar Code Reader
• Black and white bands reflect light which
are read by reader into the numerical
codes
• Various Information can be stored
– Product name
– Date of receipt
– Location of product
 Advantages of Codification
• Avoiding duplication of items

• Systematic grouping of items

• Easy retrieval and accounting

 Stores Documentation
• Why Documentation

• Five main Activities of Stores

– Receipt of materials,
– Inspection of materials,
– Issue of materials,
– verification of stores
– Material Control

• Dynamic nature of activities

Documents in Stores
Bin Card
 Bin Card

• Bin card specifies the identity and quantity of an individual item

stored within a medical store .

• Bin – Designated storage space for an item

• Supposed to be hung against each bin.

• Must contain the history of all receipts and issues of the item.

• The bin card gives a record of current stock held and helps in
verifying the stock.
Stock Card
 Stock Card

• Stock cards are collectively maintained at

the store office.

• Maintain the same purpose as bin cards

Stores Ledger
Stores Ledger

• Main Record of stores account

• Double entry booking – Receipt side and issue side

• Supposed to be updated every day

• Code / Nomenclature/ Min/Max qty/ Reorder level

Stores Day Book
 Stores Day
Book

• This is a day to day register maintained in order to keep

a watch over the various kinds of stores that are
received, and also to ensure that these are accounted
and debit accepted for each.

• Maintained in addition to the stores ledger

• Should Link to the entries in the stores ledger for

receipts and issues
 Physical Verification of stock
• Monthly basis

• Physical Check / Physical Inventory

• Physically checked and tallied with

entries on Bin Card
Important activities in Stores
Documentation
Guidelines for checking / damaged poor
quality supplies
 General
a)  Single entry (safety)

b)  Windows : Steel grills and wire mesh ( to

prevent pilferage)

c)  Main switch board : Near entrance

(emergency)

d)  Receipt area : Stocks received, Counted,

tallied with vouchers
 Environmental requirements
• Vaccines, sera, biologicals and blood products
and number of other drugs etc. need to be kept
in cold rooms regardless of climate
• Internal temperature should be reliably
maintained below 25 0C.
• Uncooled wards should be well ventilated.
• In hot climates, avoid storing pharmaceuticals
next to poorly insulated external walls that are
exposed to solar radiation.
 REFRIGERATION
• Temperature
• Frost free
• Separate doors
• Door closed tightly
• Not kept open for long
• Ice packs for
transporting
• Cleaning/ maintenance
 Guidance on Usage of Near Expiry of Drugs
1. Always issue drugs based on First Expiry First out basis
and not on First in first out basis because in relocations
stocks of late expiry may be received.
2. Accidental usage of expired drugs can create a big
problem so extra caution is to use in this respect.
3. The drugs being issued should have at least appropriate
days left for expiry from date of issue.
4. THE DRUGS ARE ISSUED FOR ONE MONTH, so if a
drug has expiry in August 2010, it can be used till 31st
August 2010. Hence, this can theoretically be issued to
patients with one month remaining in expiry i.e. before 31st
of July 2010 
5. Guide patients to use drugs before expiry and return
unused drugs if not used due to any reason.
 Guidance on disposal of expired drugs
Unless specified, do not send these drugs to source. These
should be destroyed at the centre itself as per laid down
instructions. In general, following the procedure adopted in
hospital for disposal of drugs that expire in the hospital
• Forming a committee of two-three persons including Nodal Officer
• Listing out the drugs expired along with batch no. and quantity expired (with
date of expiry)
• Separating the tablets from bottles
• Destroying the tablets in incinerator
• Removing the labels from the bottles (may be dipped in water for some time
to separate out the labels)
• The empty bottles to be disposed off after removing labels in the municipal
waste
• The quantity of expired drugs to be reduced from the balances and reported
in the report. Details for the same are to be sent to source as required
 Agents of damage to goods
Possible agents of damage to goods in any store are:
 Air
 Heat
 Dust and dirt
 Cold
 Water [rain, flooding, humidity]
 Sunlight
 Pilfering and theft
 Bats, Rats and mice
 Ants and termites
 Winged insects
 Bad work habits
Safety Measures & Housekeeping
• Palletting
• No smoking Zone
• Cleaning
• Pest control
• Inspections
• Fire precautions & FF equipments
• Insurance cover
• Security- Locking, Sealing System and
Custody of the Keys
 Hazardous Drugs
• It is defined as an agent that presents a danger to
healthcare personnel due to its inherent toxicity. These
drugs are identified based on one or more of the four
following characteristics:
– They are carcinogenic
– They are genotoxic
They are teratogenic
There is evidence of toxicity at low doses in animal models or
treated patients
• Hazardous drugs include
– antineoplastic and cytotoxic agents,
– immunosuppressants, and
– antiviral medications.
• A list of hazardous drugs that require special handling
should be posted in every facility that provides drug
preparation and administration services.
 Hazardous Drugs
• The manipulation required to prepare hazardous
drugs for administration may also lead to
environmental contamination.
• Leaks, spills, and the creation of aerosols of liquid
drugs can occur during dose preparation.
• The process of priming IV tubing may lead to
inadvertent environmental contamination if the
priming process is not performed appropriately.
• During drug administration, tubing and injection port
connections that are not properly secured may lead to
leakage of the prepared agent.
 Impact of Hazardous Drug
Exposure
• Some epidemiological studies suggest
that spontaneous abortions and fetal
malformations suffered by nurses who
worked in environments in which
hazardous drugs were prepared and
administered may be related to
occupational exposure to these agents.
 Suggested Safe Handling
Methods

• Three critical elements involved in the

safe handling of hazardous drugs:
1. personnel,
2. equipment, and
3. strict adherence to policies and
procedures.
 1. Personnel
• Only authorized and adequately trained personnel
should receive, prepare, transport, or administer
hazardous drugs.
• Personnel must be made aware of the unique nature
of these agents and the potential risks associated
with exposure to them.
• All employees must be educated regarding the
appropriate steps to take in the event of accidental
exposure to a hazardous drug.
• Employees who are pregnant or breast-feeding
should be reassigned to areas where contact with
these drugs will be avoided.
 2. Equipment
• Class II contained vertical flow biohazard cabinets, or
biological safety cabinets (BSC), are currently
recommended for preparing hazardous drugs.
• All workers should wear powder-free, disposable
gloves with reasonable thickness, good fit, and
adequate tactile sensation.
• A low-permeability, lint-free disposable protective
gown with a closed front, long sleeves, and tight-
fitting elastic or knit cuffs should be worn at all times
when preparing hazardous drugs.
• This garment should not be worn out of the
immediate drug preparation or administration area.
 2. Equipment
• Syringes and IV administration sets with Luer-lock
type fittings should be used to prepare and administer
hazardous drugs to reduce the potential for
accidental leaks or separation of the fittings.
• The development of positive pressure in drug vials
and syringes must be avoided to reduce the
possibility of drug aerosols being introduced into the
workspace.
• A closed system for the preparation, administration,
and disposal of injectable hazardous drugs
 Policies and Procedures
• Specific policies and clearly defined
procedures are critical in guiding personnel to
appropriately handle hazardous drugs.
• Every employee who comes into contact with
hazardous drugs or their containers must be
educated regarding departmental policies and
procedures
• be routinely evaluated for compliance with
these important safety practices.
 Controlled drugs
• Narcotics – opioids
• Benzodiazepines
• Phenobarbital
 Safe custody requirements of
controlled drugs
• Drugs requiring safe custody should be
stored under lock and key in a safe/cabinet
• Stock should be kept to a minimum and
nothing should be displayed outside to
indicate that controlled drugs are kept
within that receptacle
 Drugs Received
• Show the date received
• Show the name and address of the person or
pharmacy from whom they are received
• Show the amount received, the form and strength
Drugs supplied/administered:
• Show the date on which the supply was made
• Give the name of the person for whom it was
prescribed
• Give the name of the prescriber
• Record the amount supplied
• Show the form and strength in which supplied
• Two members of staff to sign the register, one of which
would be a witness.
 The CD Register
• Be in a bound register (not loose-leaf version)
• Be written in indelible ink
• Be in chronological order
• Have separate sections for each class of drug
• Show the class of drug at the head of each page
• Be made on the day of transaction or on the following
day
• Have no cancellations or obliterations or alterations
(corrections must be made in indelible ink in the
margin or as a footnote and must be signed and
dated)
• Be kept on the premises to which the register relates
and be available for inspection at any time
• Be kept safe for 2 years from the date of the last entry
 Prescribing requirements for
controlled drugs
• Show the Doctor’s full name (and GMS no.)
address and phone no.
• Hand written in indelible ink – by the GP and
SIGNED and DATED (not computer
generated)
• And clearly stating:
• The patient’s full name, address and, if
appropriate, D.O.B., if another family member
shares the same name.
 Prescribing requirements for
controlled drugs
• The name and form of the drug.
• The strength of a preparation (where
appropriate)
• The dose to be taken
• The total quantity to be supplied in words and
figures
• Prescriptions for controlled drugs are valid for
14 days only.
• It is not permitted to prescribe controlled
drugs by the ‘repeat’ method.
 Procedure for a missing or
unaccounted for CD
• Inform all Practice staff about missing
controlled drug .
• Enter the time and date of the discovery of
the missing drug on the appropriate page
• Spot check count of all controlled drug stock
• The Controlled Drug procedure should be
reminded to all staff.
 SUMMARY GUIDELINES FOR
PROPER STORAGE
1. Clean and disinfect store room regularly, and take precautions
to discourage harmful insects and rodents from entering the
storage area.
2. Store health commodities in a dry, well-lit, well-ventilated
storeroom, out of direct sunlight.
3. Protect store room from water penetration.
4. Keep fire safety equipment available, accessible, and
functional, and train employees to use it.
5. Store latex products away from electric motors and fluorescent
lights.
6. Maintain cold storage, including a cold chain, as required.
Contd…..
 Contd…….SUMMARY GUIDELINES FOR PROPER STORAGE

7. Limit storage area access to authorized personnel and lock up

controlled substances.
8. Stack cartons at least 10 cm (4 in.) off the floor, 30 cm (1 ft.) away from
the walls and other stacks, and not more than 2.5 m (8 ft.) high.
9. Arrange cartons with arrows pointing up, and with identification labels,
expiry dates, and manufacturing dates clearly visible.
10. Store health commodities to facilitate "first-to-expire, first-out" (FEFO)
procedures and stock management.
11. Store health commodities away from insecticides, chemicals,
flammable products, hazardous materials, old files, office supplies, and
equipment; always take appropriate safety precautions.
12. Separate damaged and expired health commodities from usable
commodities, remove them from inventory immediately, and dispose of
them using established procedures.
 Conclusions
• The proper storage of medicines is a critical in the
distribution cycle
• Proper storage, stock control and expiry monitoring helps in
minimizing losses through expiration and deterioration of
supplies
• Storage of medicines directly affects their quality, therefore
store the medicines appropriately and STORE THEM RIGHT
• Take adequate steps to protect supplies from loss, damage,
theft, or wastage
• Optimum stock should be maintained to avoid stock out and
expiry of medicines
• Keep accurate inventory records to provide stock movement
information for forecast needs