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Medical St or es Managem ent Tr aining
Developed by :
Contents
1 Preface
2 A word about CDMU-Odisha.
3 Why this Medical Store Management Training.
4 Why CDMU-Odisha has taken up initiatives to do the
“Medical Stores Management Training”.
5 What the participants will learn from the “Medical Stores
Management Training”.
6 From whom the training was designed.
7 Routine Warehouse or storeroom management tasks.
8 Receiving and arranging commodities.
9 Keeping track of products in your storeroom.
10 Maintaining the quality of your products at your Disposal.
11 Setting up your medical store.
12 How to Manage a Drug Store in Peripheral Level
13 Storage of vaccines & monitoring with special emphasis on
Immunization.
14 What are the books available in CDMU on “Medical Stores
Management”
15 Case Study.
Guide Mat er ials for Medical St or es Managem ent Tr aining 2
Preface
This manual was developed by CDMU- Odisha, having obtained technical
inputs from the manuals of UNICEF, WHO, DELIVER, DSPRUD and
Government of Odisha. We hereby acknowledged the contribution of all of
them to help CDMU to develop this manual.
Drugs and medical supplies are dispensed at the cutting edge level of the
interface between the public health system and the people. Availability or lack
of it brings either credit or discredit to the public health system. The primary
reason for holding stocks of medicines and medical supplies in a proper
scientific manner is to ensure continuous and uninterrupted availability to
prevent stock-outs, especially of critical items of supply while at the same time
ensuring that stocks of medicines do not get expired. An efficient inventory
management is a pre-requisite for optimal stock management. It enables the
management of health facilities to know the current pattern of consumption of
drug trends over a period of time and also variances. The environmental
control of the drugs and other medical supplies play an important role to keep
the products' efficacy intact. Some medicines and vaccines need special
storage temperature, otherwise, there may be wastage. The quality of the
medicines can be adversely affected by poor storage, transportation and
distribution. Thus, maintaining proper storage condition for health
commodities is vital for ensuring their quality. So, by this training, CDMU wants
to educate different people dealing with medicines and equip them for the
roles they have to perform efficiently so that the wastage does not take place
or can be minimized.
The Rational Use of Medicines and supply of essential generic medicines is an
important area to make any health program successful and economical with
quality. This training on “Medical Stores Management” will help the
participants to understand the issue better so that they can maintain their
respective medical stores better. Hope, this manual will help the participants
and the readers will find it useful.
With hope, for and on behalf of the CDMU E.C. & RUM Board:
Prof. Dr. Mrs. T. R. Swain, Associate Prof., SCB Medical College, Cuttack
Prof. Dr S. N. Pandey, VSS Medical College, Burla
Prof. Dr. Tapas Bhattacharyya, NRS Medical College, Kolkata
Mr. Tarak Banerjee, Administrative Officer, CDMU-Odisha
Email: - cdmuorissa@satyam.net.in , cdmuodisha@gmail.com
Phone N0:- 0674-2595013 Fax: 0674-2595405, Mobile No:- 7205001797
Guide Mat er ials for Medical St or es Managem ent Tr aining 3
In this era of modern Medicines, where every day lots of medicines (there has been a
proliferation of number of medicines) and subsequent phenomenal increase in data about
medicines and therapeutics emerge, there has remained a serious lacunae of organizations
those are meant exclusively for disseminating unbiased and accurate information on Medicines
and their prescribing information. The major activity of C.D.M.U, Odisha is to provide reliable and
qualitative Essential Medicines to the health programmers of NGOs and charitable institutions
working for the benefit of the poor at affordable cost. Besides that, for safe, effective and better
use of Essential Medicines, C.D.M.U, Odisha makes available relevant and reliable unbiased
information to the member partners. C.D.M.U believes in the concept of Co-operation and
mutual understanding among the partners covering whole of Odisha and thus develop a trustful
relation with the members to fulfill the concept of Rational Use of Medicines.
VISION:-
“To make available the right drugs that is administered in right dose, at right time, for right
duration at an affordable cost to the common people of Rural Odisha” in normal as well as in
emergencies.
Guide Mat er ials for Medical St or es Managem ent Tr aining 4
MISSION:-
1. C.D.M.U, Odisha would create direct access to the rural consumers, especially the
vulnerable sections such as women, tribal and the people living below poverty line.
CDMU, Odisha would act as the collective agency of these sections to accelerate
leverage of their bargaining capacity.
2. C.D.M.U, Odisha would develop gender sensitive approaches to enable women for
taking decisions regarding their own health.
3. C.D.M.U, Odisha would use demand – based approach in distribution of drugs and
medicines by generic name to keep prices to the minimum. It is especially important
when this segment accounts for 25% of the market share that people may choose to
procure medicines in the generic name in place of the branded medicines.
GOALS:-
1. Building capacities of communities by promoting community-based organisation (CBO)
to manage the distribution and sale of medicines at user end. There would be emphasis
on gender equity and linkage to prevalent referral system of the locality.
2. Institutional Development and involvement of its partner's organisation, viz. (CBOs,
NGOs, private hospitals and Associations) through networking processes.
3. To provide trained manpower such as health service providers to work in rural areas.
4. Reduction of transaction costs in the distribution chain of medicines and drugs to provide
an enabling environment for sustainable supply.
5. Development of decision support system to foster trust among members of its
distribution network as well as improve their process capacity.
6. Policy advocacy in Rational Use of Medicines (RUM) in line with and concomitant to, its
Vision, Mission and Goal.
7. Provide emergency services during medical emergencies and promoting the concept of
emergency medical management.
OBJECTIVES OF CDMU:-
? Collect and disseminate medicine related information to the member organizations and
the Community people.
? Advise member organizations on different aspects of Rational Use of Medicines.
? Make available essential, generic quality medicines on time at economic rate.
? Maintain central store for members.
? Ensure quality by different means.
? Capacity building on medical store management.
(A) DAILY/WEEKLY:-
o Monitor storage conditions.
o Clean receiving, storage, packing and dispatching areas.
o Sweep or scrub floors.
o Remove garbage.
o Clean bins, shelves, and cupboards, if needed.
o Ensure adequate ventilation, environmental control and cooling.
o Ensure that products are protected from direct sunlight, rain water and moisture.
o Monitor store security and safety.
o Check the store roof for leaks, especially during the rainy season and during or after a
storm.
o Monitor product quality (visually inspect commodities and check expiry dates).
o Ensure that products are stacked correctly (Are the cartons below being crushed?)
(B) DAILY/WEEKLY:-
o Update stock records and maintain files.
o If rotational counting, conduct physical inventory and update stock keeping records.
o Monitor stock levels, stock quantities and safety of stocks.
o Place emergency order (as needed, using local guidelines).
o Update back-up file for computerized inventory control records.
o Update bin cards.
o Separate expired stocks and move to secure area.
© MONTHLY:-
o Conduct physical inventory or cycle count and update stock keeping records.
o Run generator to ensure the system is working correctly; check the level of fuel, if
needed.
o Check for signs of rodents, insects or roof leaks.
o Inspect the structure of the storage facility for damage, including the walls, floors, roofs,
windows and doors.
Guide Mat er ials for Medical St or es Managem ent Tr aining 8
o Conduct physical inventory or cycle count and update stock keeping records.
o Use established procedures to dispose of expired or damaged products.
o Visually inspect fire extinguishers to ensure that pressures are maintained and
extinguishers are ready for use.
Every 6 months; -
o Conduct fire drills and fire safety procedures.
o Inspect trees near the medical store and cut down trees with weak branches.
Every 12 months: -
o Service fire extinguishers and smoke detectors.
o Conduct complete physical inventory and update stock keeping records.
o Reassess maximum/minimum stock levels and adjust if needed.
Pharmaceutical Procurement
Acquiring of supplies from Public suppliers or aid agencies or purchase from manufacturers, retailers or
specialized Government and Non Government approved distribution agencies is known as
pharmaceutical procurement.
I) Efficient Management:-
Efficient management of drugs supply ensures sustainable access to and availability of essential
medicines in public.
Effective Procurement:-
An effective procurement can be achieved by adopting following methods:-
o Procure the right medicines in the right quantities.
o Obtain the lowest possible purchase price.
o Ensure that all medicines procured must meet recognized standard quality.
o Arrange timely delivery to avoid shortages, overstocking and stock outs.
o Ensure supplier reliability with respect to service and quality.
o Set the purchasing schedule, formulas for ordering quantities and maintain safe stock
levels to achieve the lowest total cost at each level of the system.
o Achieve these objectives in the most efficient manner possible.
Preparation of “ EML” : -
Before preparation of “Essential Medicine List “it is important to select the medicines by studying
the morbidity patterns and patient profiles at the health care units & latter on
Some steps should be followed which are as follows: -
A) Drafting by Expert committee.
B) Review of draft by Expert committee
C) Revision by the Experts
D) Finalization by the committee
E) Publication and popularization
F) Updating of the list periodically (e.g. every 3 yrs)
G) Revision form to be used for addition/modifications/deletions proposed by others.
Guide Mat er ials for Medical St or es Managem ent Tr aining 11
o Follow the manufacturer or shipper's directions when stacking and follow labels for
storage conditions.
o Place liquid products on the lower shelves or at bottom of stacks.
o Store products that require cold storage in appropriate temperature controlled
zones.
o Store high security / high value products in appropriate security zones.
o Separate damaged or expired products from the usable stock without delay and
dispose of using established disposal procedures.
o Always store all commodities in a manner that facilitates FEFO policy for stock
management.
o Arrange cartons as arrows point up and ensure that 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.
Guide Mat er ials for Medical St or es Managem ent Tr aining 13
Stock Rotation
When issuing products, it is important to follow the FEFO policy.
o Always issue
products that will
expire first,
ensuring they are
not too close to or
past their expiry
date. The shelf-life
left must be
sufficient for the
product to be used
before the expiry
date.
o To facilitate FEFO, place products that will expire first in front of products with a later
expiry date.
o Write expiry dates on stock cards, so stocks can be sent to facilities at least with a later
expiry date.
o Write expiry date(s) on stock cards, so stocks can be sent to facilities at least 6 months
before they expire.
Remember, the order in which you received products is not necessarily the order in which they
will expire. Products you received most recently may expire sooner than the products you
received earlier. So it is extremely important to always check the expiration dates and to make
sure the dates are visible while the products are in storage.
(a) Dosage Form: - Medicines come in different forms, such as tablets, syrups, injectables and
external use products such as ointments and creams. In this system, medicines are
categorized according to their dosage forms. Within the area for each form, a fixed, fluid or
semi-fluid system is used to store items. Any of the other methods of categorizing can be
used to organize the items more precisely.
(b) System Level: - Items for each level 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 very often through the
store should be placed in the front of the room or closest to the staging area. This system
should be used in combination with another system.
(d) Random Bin:-Identifies a specific storage space or cell with a code that corresponds to its
aisle, shelf, and position on the shelf. This system requires computer automation.
(e) Commodity Coding: - Each item has its own article and location code. This system has the
greatest flexibility, but it is also the most abstract. Stores staff do not need any technical
knowledge of the products to manage this system because the codes contain the information
needed for storing products properly, such as temperature requirements, level of security
and inflammability. This system works well in computerized inventory systems.
Psychotropic Drugs:-
Usually the group of drugs called “benzodiazepines”, the more common being diazepam,
temazepam, Lorazepam, nitrazepam, flunitrazepam and oxazepam. Clonazepam, used to treat
epilepsy, may be found under a different class and is not always under the same restriction.
Strong tranquilizing medicines, such as chlorpromazine may also be found under this heading.
o Some of the medicines mentioned above are controlled substances, which are
medicines handled under international control. These medicines need greater attention.
There are specific procedures in place for the procurement, reception, storage,
dispensing and administration of controlled substances. Special ordering forms should
be used.
o Note: Other medicines including antiretroviral used to treat HIV/AIDS may need storage
in a controlled facility, because they are scarce, expensive, and in high demand.
Flammables
Corrosives
? Corrosive or oxidant substances commonly found in hospitals or other high-level health
facilities include trichloracetic acid, glacial acetic acid, concentrated ammonia solutions,
hydrogen peroxide, silver nitrate, sodium nitrate and sodium hydroxide pellets.
? Always store corrosive substances away from flammables, ideally in a separate cabinet
to prevent leakage. Use appropriate industrial-type protective gloves and eyeglasses
when handling these items.
Guide Mat er ials for Medical St or es Managem ent Tr aining 17
o Do not order for products that are not on the standard list unless you have special
permission. You should not accept deliveries of products not on the list unless special
circumstances have been identified.
Stock Records
The minimal information that should be collected on stock records for medicines and other
health products includes
o Product name/description (including the form [e.g., capsule, tablet, liquid suspension,
etc] and strength)
o Stock on hand/ beginning stock balance.
o Receipts
o Issues
o Losses/ adjustments
o Closing/ ending balance
Depending on the system, stock records might also include additional product information such
as-
o Special storage conditions (e.g. 2degree –8 degree centigrade)
o Unit prices
A logistics information system must have three different types of records: stock keeping records,
transaction records, and consumption records.
Guide Mat erials f or Medical St or es Managem ent Training 18
Inventory control card- Stock records might also include certain calculated data items. These
are determined by mathematical formulas, that depend on system design parameters (e.g. how
often orders are placed). Calculated data items include-
o Consumption data, such as average monthly consumption (AMC)
o Lead times for ordering / requisition
o Maximum and minimum stock levels
o Emergency order point
A storage and distribution system may not necessarily use all these forms, but it will need forms
to record stock keeping data and product transactions. Standard forms used for inventory
control include-
o Stock cards
o Bin cards
o Requisition /issue vouchers
o Receiving forms (packaging slip/freight bill)
o Delivery /issue vouchers
o Expired stock disposal forms
o Physical inventory forms
o List of approved medicines and prices
Stock on hand:
On a periodic basis, count each item for which stock on
hand is at or below the minimum inventory level. This
method may be faster, since there are smaller quantities
to count.
If cyclic physical inventory is used, count each product at least once during the year. Count fast-
moving items and full supply products more frequently.
Guide Mat er ials for Medical St or es Managem ent Tr aining 19
(1) Plan
o For a complete physical inventory, schedule the day(s) and time.
o For a cyclic or random physical inventory, identify which products will be counted and the
corresponding time period for those products.
o For either of the above, identify, document, and correct the cause of the problem.
(7) Discuss the findings of the inventory with the facility staff:
Injectables:
o Liquid does not return to suspension after shaking
o Transparant injectables (glucose,saline etc)developing suspension or sediments.
Capsules:
o Discoloration.
o Stickiness
o Crushed capsules
Tubes:
o Sticky tube (s)
o Leaking contents
o Perforations or holes in the tube
Foil Packs:
o Perforation(s) in packaging
Chemical reagents
o Discoloration
Damaged products should never be issued to facilities or dispensed to clients. If you are not sure
if a product is damaged, check with someone who knows. Don't issue or dispense products that
you suspect are damaged.
Report any defects and send the defective products back to facility that issued them to you. If an
inspector visits your facility, report any problems to him or her.
(See on waste management for additional information)
22
Dirt:-
Write and paste the schedule and instructions for cleaning the storeroom in multiple locations
around the facility. Sweep and mop or scrub the floors of the storeroom regularly. Wipe down
the shelves and products to remove dust and dirt. Dispose of garbage and other waste often, in
a manner that avoids attracting pests. Store garbage in covered receptacles.
Infrastructure:-
Ensure the storeroom has easy access to a water inlet and outlet for cleaning. If no running
water is available, set up a system, for example, several 55-gallon drums on an elevated
platform connected to pipes running into the store. Refill the drums regularly. When
rehabilitating an existing storage facility or constructing a new structure, install water inlets in
several locations inside the structure so that water is easily available from any location in the
storeroom.
Cleaning Materials:-
Keep a budget for buying cleaning materials. Use industrial detergents when possible,
particularly for larger facilities, although imported detergents can be expensive. Try to use
locally available detergents, particularly for smaller or more remote facilities. Clean with
chlorine bleach regularly (once a month, for example).
Outside the facility:-
Bury or Burn garden rubbish and cardboard cartons, etc., when garbage collection is not
available. Use the necessary precautions to keep the fire under control, and do not burn
materials close to the building. Make sure the wind is not blowing towards the building.
Guide Mat er ials for Medical St or es Managem ent Tr aining 23
5. Be sure medical store staffs are trained in how to use fire extinguishers
Pull the pin at the top of Aim the nozzle toward the base S q u e e z e t h e h a n d l e t o Sweep the nozzle back and forth
The extinguisher. of the fire. discharge the extinguisher at the base of the fire
(stand approximately 2.5 m [8 ft]
away).
The P.A.S.S. method is accepted for some dry chemical and CO2 extinguishers; however, other
methods are needed when using water and other extinguishers and with special fires, such as
flammable liquids. Additionally, the P.A.S.S. method may not be appropriate for all dry chemical
and some CO2 extinguishers. BE sure to carefully read the instructions for the extinguishers in
your facility.
Reptiles (Snakes and Lizards etc.): Most snake species are innocuous and can be managed
with noisemakers and by keeping the outside of the facility clear of bushes. If snakes are an
especially difficult problem in your area, you can construct a snake–proof fence around the
perimeter of the facility .The fence should be made with heavy, galvanized metallic screen with
6mm wire mesh.
The fence should be 90cm tall with the lower end buried at least 10-16 cm in the ground. The
above ground portion of the fence should be slanted at a 30-degree angle outward from the base
and away from the building, using supporting stakes inside the fence. Also, spraying of Carbolic
Acid around your premises is advisable.
CONTROLLING TEMPERATURE
Humidity:
When product labels say, “protect from moisture,” store the product in a space with no more than
60% relative humidity. To reduce the effects of humidity consider-
Ventilation:
Open the windows or air vents of the storeroom to allow air circulation. Ensure all windows have
screens to keep out insects and birds, and either have bars or are not open wide enough for
anyone to climb in. Put boxes on pallets and ensure there is space between pallets and the walls
of the storeroom.
Guide Mat er ials for Medical St or es Managem ent Tr aining 27
Packaging:
Secure all lids. Never open a new container unless necessary.
Heat:-
Remember that heat will affect many products. It melts ointments and creams and causes other
products to become useless. Following the guidelines listed earlier for protecting products from
humidity and sunlight will also help protect products from heat.
It is important to have thermometers in various parts of the storeroom to monitor temperature
(see section on monitoring temperature). But, even if you feel hot, your products are probably
hot, too.
Monitoring:-
Consistently and Regularly monitor
the temperature of the different areas
within the storeroom.
o Ke e p t h e r m o m e t e r s i n
various places for monitoring.
o Keep the storeroom well
ventilated (see section on
humidity). For better
ventilation, store boxes on
pallets and leave room /
space between rows of
stacked boxes
o Under ideal conditions, rooms with multiple refrigerators and /or freezers should have air
conditioning. Refrigerators and freezers generate large amounts of heat, which can
damage the equipment over time.
o If it is not possible to have air conditioning, install fans around the equipment to increase
airflow. If installing fans, remember to place the fans in such a way that the air also flows in
the spaces behind the refrigerators.
o Ideally, larger facilities should have a cold room rather than numerous refrigerators.
Power supply:-
Arrange for a solar panel generator or alternative supply of electricity to ensure uninterrupted
power supply for cold rooms and refrigerators if the main source of electricity is not reliable. If the
generator is not Solar-powered, maintain a stock of fuel sufficient to run the generator for at least
a few days (see section on storing flammables). Run the generator on a regular basis (at least
once a month) to ensure the system is working properly. Larger facilities may want to contract
out/source out the maintenance of the generator and electrical system.
If your electricity supply is unreliable, use kerosene or solar powered refrigerators. Kerosene
dependant appliances require frequent maintenance. Trim the wick regularly so the flame is not
too high, clean the chimney monthly, and keep a back-up supply of kerosene (see section on
storing flammables). Place the refrigerator away from the wall on a balanced and level surface.
The appliance must be placed on a level surface or it will not function properly. Monitor the
temperature regularly. The flame on a kerosene appliance should always be blue; if it is yellow,
trim the wick.
Common Terms:-
The following terms relate to temperature and medical supplies. It is important to follow the
manufacturer's recommended storage conditions for all products.
(a) Store frozen: Some products, such as certain vaccines, need to be transported within a cold
chain and stored at-20o C (4o F). Frozen storage is normally for longer-term storage at higher-
level facilities.
Guide Mat er ials for Medical St or es Managem ent Tr aining 30
o o o o
(b) Store at 2 -8 C (36 -46 F): Some products are very heat sensitive but must not be frozen.
These are usually kept in the first and second part of the refrigerator (never the deep freezers).
This temperature is appropriate for storing vaccines for a short period of time.
(c) Keep cool: Store between 8o-15oC (45o-59oF)
o o o o
(d) Store at room temperature: Store at 15 -25 C (59 -77 F).
(e) Store at ambient temperature: Store at the surrounding temperature. This term is not widely
used due to significant variation in ambient temperatures. It means “room temperature” or
normal stage conditions, which means storage in a dry , clean, well ventilated area at room
temperatures between 15-degrre to 25-degree Centigrade(59-degree-77-degree Fahrenheit)
or up to 30-degree Centigrade, depending on climatic conditions.
Medicines with stability problems under tropical conditions:
Oral Solids (tablets):
Acetylsalicylic acid
Amoxycillin
Ampicillin
Penicillin V
Retinol
Oral Liquids (syrups):
Paracetamol
Injections/ Injectables:
Ergometrine
Methylergotamine
Adrenalin
Reconstituted antibiotics
At Storage facilities:-
o Limit access to only designated staff.
o Limit the number of keys made for the facilities; keep a list of people who have keys.
o Secure all locks and doors. Make unannounced spot checks. Provide for independent
stock count / inventory control.
In Health Centers:-
o Lock the storeroom / cupboards.
o Have inventory control cards for each product
o Set maximum dispensing quantities
o Have dispensers' records, individual prescriptions and maintain prescription or
dispensing registers.
o Limit dispensing to authorized staff members only.
2. Cold storage: In larger facilities, it is more efficient to use cold rooms rather than numerous
refrigerators or freezers (which generate heat). Ideally, larger facilities should have one
room with a negative temperature for frozen products (-200C) and another room with a
positive but cold temperature (2o-8oC) for products requiring refrigeration.
3. Secure Storage: All medical stores should have a well secured storage area for products
that are likely to be stolen or abused. A locked cabinet or cupboard may be sufficient for
some facilities, while other facilities may require a vault or cage.
4. Ventilation: The location and design should ensure maximum air circulation to avoid
concentrations of fumes or gases and to prevent condensation of moisture on products or
walls. Use an extractor fan to remove gases, fumes and moisture.
5. Roof: Design a slanting roof to allow water run-off. Extend the roof over the windows to give
extra protection from rain and direct sunlight.
6. Ceiling: Install a double ceiling to provide insulation and ensure that supplies are kept cool.
7. Walls and floor: The walls and floors of a medical store should be permanent and smooth
for easy cleaning. Walls preferably should be constructed of brick or concrete blocks.
Perforated or bored bricks might be used for the upper portion of the wall to allow ventilation.
But, these should be screened to prevent the entry of rodents and other pests. Construct or
treat floors of larger facilities to ensure they can withstand the frequent movement of heavy
products and equipment. This should be done with the guidance of an engineer.
8. Doors: Plan doors wide enough to allow for the free and easy movement of supplies and
handling equipment. Large facilities such as those at the central level, often use forklifts and
other handling equipment. Ensure doors are strong and reinforced to provide adequate
security. Fit them with strong locks, and install metal grills for extra protection.
9. Lighting: Plan the storeroom in such a way that as much natural light (indirect sunlight) in
the day as possible can come to avoid the use of either florescent or incandescent bulb
lighting. Florescent lighting emits ultraviolet rays, which have a negative effect on certain
products. Incandescent bulbs emit heat. At the same time, take care to ensure that products
are not in direct sunlight.
10. Windows: Plan windows that are high and wide to allow adequate ventilation. They should
be high enough not to be blocked by shelves, have wiremesh to keep out insects and be
burglary proof.
11. Cupboards: Provide cupboards for the storage of specific products that must be kept free
from dust or light.
Guide Mat er ials for Medical St or es Managem ent Tr aining 34
12. First aid: Keep a well stocked first aid kit to treat employees or visitors who are injured in
your facility. Place the first aid kit in a central location that is easily accessible to all
employees and all are aware of its location and contents.
13. Shelves: Arrange shelves and racks in lines with a passageway not less than 90cm wide.
Avoid placing shelves only around the edge of the room, which wastes a lot of space. Place
the shelves 90cm from the walls of the storeroom to ensure they are accessible from both
sides. Ideally, use adjustable shelves.
1. Shelves and cupboards: Use shelves and cupboards to store smaller products. Adjust
the shelves as needed to allow space for packages of different sizes.
2. Tables in the packing area: Provide large tables in the packing area for staff to use
when assembling and packing shipments. Keep the tables clean.
3. Pallets: Pallets are used to store bulk items and larger cartons. They keep things off the
floor and can be used with forklifts or dolly to move around groups of larger items. Pallets
are generally used only in larger facilities because storing and moving pallets can be
expensive. Smaller facilities might have a few pallets left in place to ensure air circulation
and keep products off the floor.
o Always inspect pallets before loading them with material. Ensure that pallets are
solid and sturdy with no loose or cracked boards and no protruding nails. Damaged
pallets can break while being lifted and cause serious injuries and product damage.
o If possible, keep pallets indoors, away from elements that can gradually break
down the wood.
Regardless of the material they are made of; pallets increase the risk of fire because they
provide open space for oxygen to fuel a fire to burn. Always follow the safety precautions
discussed in the fire protection section of this guide.
Shelves, cupboards, tables, and pallets can be made of wood, metal, and plastic. Metal shelves,
cupboards, and pallets may be steel, stainless steel, or aluminum. These tend to cost more, but
are stronger, more durable, and less flammable
Guide Mat er ials for Medical St or es Managem ent Tr aining 35
The aim of material management is to maximize the availability of material of right quantity at
right time at the right place for accomplishing the objective of an organization. Therefore,
material management is to develop a system of supplies which will ensure right quantity of stock
of items properly stored and distributed for usage at its peripheral units. The system consists of :
o Material Planning & estimation of right quantity
o Procurement of estimated material as per demand
o Storage of the material
o Issue from store for use
o Maintenance.
Learning Objective: -
1. Describe the need for management of Drugs and other supplies;
2. Estimate quantity of drug and vaccines required for the defined area, served;
3. Procure drugs, vaccines and other material in right quantity and at right time;
4. Store drugs, vaccines and other materials properly till their utilization (issue these to the
peripheral units for proper disposal and use)
5. Maintain all types of consumable (expandable) and capital (non-expandable) materials
& equipments;
6. Maintain stock register for all items supplied to you and issued to peripheral units.
DEMAND ESTIMATION:- Should be prepared at organization (unit) level based on
identified service and submitted for necessary approval and supply. The regular supply
should be provided on quarterly basis.
Requirement of vaccines, drugs and materials will be dependent on the work- load of the
services provided at the unit and at peripheral level within its jurisdiction. Since there are no
fixed targets imposed from the higher level, each health worker at the periphery is expected
to estimate service needs for the community members of the catering area and prepare an
estimation of required vaccine, drugs and materials. Usually, the following categories of
materials are required:
o Drugs & Vaccines
o Medical Supplies & Family Planning Supplies
o Non-medical supplies
o Equipments & Instruments
o Facilities
These materials need to be supplied according to the estimated requirement submitted as
Annual Action Plan.
Guide Mat er ials for Medical St or es Managem ent Tr aining 36
ESTIMATION:-
Iron & Folic Acid Tablets (IFA):-
For Pregnant mothers:
Suppose, number of mothers registered (or, planned to be covered) is 100;
100 tablets for each mother-100x100=10,000 (for prophylaxis);
50% (or, more?) of the mother - 50/100x100=50 expected to be anaemic and would need double
the dose.So, additional requirement of IFA will be =50x100=5000.
Hence, the total requirement of IFA tablets would be =10,000+5000=15,000
In case more IFA tablets for some of the IUD, MTP and tubectomy cases are required, indent this
extra amount.
IFA tablets (small) for children:-
IFA small tablets are required for children between the ages of 1 to 5 years, who show visible
signs of anemia (rural areas, ESP.). Each child is to be given 1 tablet/day for 100 days.
Let, the total number of the children (1 to 5 years) in the covered area is 400 (Approx). Number
expected to show the visible signs of Anemia (50%) =50/100x400=200;
Requirement of IFA (small) is then 200x100=20,000
ORS Packets:
A child under 5 years of age, suffers on an average 3-4 episodes of diarrhea every year. Thus, in
the same community, 400x4 (upper limit) =1,600 episodes of diarrhea is expected. One packet
of ORS (usually) is required for each episode. That means 1,600 packets will be required for
those children. However 10% of these episodes are with such dehydration which would require
an additional packet of ORS. That means 10/100x1, 600=160 more episodes will require
another 160 packets. Thus, the total requirement of ORS packets in every year will be
1,600+160= 1,760 packets.
However, all children may not report for each episode. In view of the past performance, usually a
pre-determined amount is supplied. In case you fall short you can always ask for more packets.
Sudden increase in reporting and consumption of ORS packets is an alarming sign for
anticipating epidemics of diarrhoeal diseases.
Co-trimoxazole (Paediatric) tablets:
The total episodes of acute respiratory Infection (ARI) at the rate of 4 episodes per child (1 to 5
years) in a year would be equal to diarroeal episodes of 1,600 cases as calculated above. Only
10 percent of the episodes of ARI are pneumonia requiring antibiotic therapy. Thus
10/100x1,600=160 episodes of pneumonia will on an average need 20 tablets (4 times a day for
5 days) of Co-trimoxazole each. Hence, the total annual requirement of Co-trimoxazole Tablet
would be 160x20 =3,200. Compare all these estimates with the estimates and actual use of the
last year and verify whether the same has increased by 5-25 percent.
Guide Mat er ials for Medical St or es Managem ent Tr aining 37
Collect all the action plans prepared by each unit, note down this requirement and add these up
with the estimated requirements for the sessions to be conducted. This will be total vaccines and
drugs required for your central unit.
Since, existing practices are changed, you have to give quantity of each material/ supply used in
previous year, the amount /quantity available in stock and the amount required for the next year.
PROCUREMENT:
This means indenting from your central unit. Having prepared the total requirement the next step
is to fill the action plan form along with the Materials & Supplies required.
Submit this to your central unit Officer-in-charge from where you will receive the supply. You
MUST ENSURE that the supplies sent from the central unit or the other supplier, as the case may
be, are PHYSICALLY verified, CHECKED and only then received.
“Lead-time” is the time lag between the placement of an order and getting supply against the
same order. Hence, the time lag between submission of your annual action plan along with the
estimation of material required and supply of these will be referred as 'lead-time' for your
supplies. You may receive your supplies in 4 installments on quarterly basis. However, if you
exhaust your stock (explain), you may ask for replacement earlier.
STORAGE:
Material after being inspected, verified, checked and received are stored in the storeroom till its
consumption. It is usually specified if the material (medical) need to be stored at a particular
temperature. You must store those materials at 2-80c which needs to be stored at low
temperature, others can be stored at room temperature. Try to arrange the supplies on rack with
both front and back sides open, so that you can fill this rack from back-side and take out from the
front. This helps in maintaining the principles of 'first-in-first-out' (FIFO) - for use of those
materials first which are received earlier and avoid getting material old, stale and even expired!
The stock of usable material is also referred to as 'inventory'. Inventory control is one of the major
responsibilities in materials management. Aim of inventory control is to avoid 'out of stock'
situation. Amongst the various methods, two widely known methods such as 'Two-Bin method',
and 'Buffer-stock' can be used for proper inventory control and maintenance of emergency
stock.
Two-Bin Method:
The entire stock is separated in two boxes. One box contains the main stock and the other holds
the quantity required during the 'Lead-time'. As soon as the main box gets empty, another order
should be placed for replacement.
In many places, it is practised to issue a sub-stock for a week or month from the main stock to the
pharmacist who maintains the daily consumption of each item. Based on this average daily
consumption, it is easily estimated the quantity required during the 'lead-time'. This amount
should be kept separately in the second box.
Guide Mat er ials for Medical St or es Managem ent Tr aining 38
Buffer-stock:
Buffer-stock is the emergency stock for meeting the demand during unforeseen situation
resulting from either sudden increase in consumption of a particular material/drug or under
extension of 'lead-time', e.g. failure of timely supply.
For maintaining Buffer stock- identify those items which you consider very crucial for providing
your committed services and keep about 10% of the total requirement of these items as 'Buffer
stock' whereas for the rest of the items 5% of the local stock is adequate as Buffer stock.
Storage of Vaccines:
Sl.No. Vaccines Temperature Duration for which vaccines Remarks
remain potent from the date
of manufacture
0
1 Oral Polio -20 c 1 year Avoid repeated thawing,
0
Oral Polio 4-8 c 3 months Keep on ice while using
ISSUES/DISTRIBUTION PROCEDURE:-
Store officer has to provide drugs/materials to all the peripheral units under his control. He
receives these supplies from his higher authorities and supplies those to peripheral units on
quarterly basis. Replacement, if needed, would be made even earlier. ALWAYS ENSURE that
there is a stock for one or two months at each peripheral unit. Larger quantities of stock at any
peripheral unit should be taken back for either over-indenting or non-performance or under-
utilization of services provided.
Stock-Register:-
Maintain stock register by making entries with dates of supplies/ procured from higher authority.
Quantity issued to the peripheral units for timely use must be entered in this main stock register.
Peripheral units must maintain a separate register for entering daily use of each drug in separate
entires. If you issue any extra or premature supply from your main stock before the schedule
then this quantity must be entered in the main stock register.
At the end of each month, CHECK the balance and compare it with the usage by way of
PHYSICAL VERIFICATION.
Managing equipments:-
Usually two types of equipments and materials are supplied. These are consumable or
expendable and capital or non –expendable. Consumable equipment is that which is used within
a short time. These are also called as recurring equipment or material. Non-expandable or
capital equipment is such equipment, which lasts for several years and used repeatedly. These
are also known as non- recurring equipment. These need care and maintenance for extending
its use for long time e.g, furniture, refrigerator, vaccine carrier, weighing scale,
sphygmomanometer, instruments, vehicle etc. Consumable equipment includes materials like
cotton, gauze, bandage, chemicals, syringes, needles etc. The management of these including
estimation of each item required, placing an indent and procuring that from higher ends or other
suppliers and proper storage is equally important.
Prepare an estimation of each item based on services planned for coming year. You must
compare this estimation with the consumption during the previous year and ensure that it is at
least 10% higher than that. For non- recurring items, a fair consideration should always be given
towards their depreciation values.
These items are usually supplied quarterly or on half- yearly basis. These also can be
replenished if the stock exhausted. Try to ensure economic use of material to avoid wastage or
over-use and establish a 'control' mechanism to prevent pilferage.
Storage of equipment:-
Equipment is stored in two places:
o A main or reserve store (stock of usable but idle items, i.e. the items waiting to be used)
o At the place of use.
The new items of equipment are always received and stored in the main store
Guide Mat er ials for Medical St or es Managem ent Tr aining 41
Cold Box:-
Cold boxes are big insulated boxes. They come in two sizes; 5 liters and 20 liters. They are
supplied with requisite number of ice-packs. The 5 liters cold box can hold one month's vaccine
supplies of a 30,000 populations. 20 liters cold box have enough space to transport one month
supply for one lakh population.
Uses:-
o Collect large quantities of vaccines
o Transport large quantities of vaccines by vehicle to out- reach sites;
o Store vaccines for transfer up to five days' requirement if necessary for out-reach sites or
0
when there is power cut. The hold over time is more than 90 hours at +43 C ambient
temperatures. You can also store vaccines in it while ice-packs are being prepared in
freezer.
o Store vaccine properly in a different place in case of break down of the refrigerator.
To pack:-
o Place fully frozen ice packs side by side against the inside walls and floor of the cold box.
o Stock vaccines and diluents in the box;
o Place packing material between DPT/DT/TT vaccines and the ice-pack to prevent
vaccines from becoming frozen.
o Secure the lid tightly.
Vaccine Carriers:-
Vaccine carriers can be used for carrying small quantity of vaccines (16-20 vials) to the area the
vaccine carriers are made of insulated material. The ice-packs for lining the sides of the carriers
should be fully frozen and the lid of the carriers should be closed tightly. The vials of DPT, DT and
TT vaccines should not be in direct contact with frozen ice-packs. Before using or packing the
vaccines in the vaccines carrier, the precautions need to be observed:
o Take out vaccines carriers and conform that there are no cracks in its body;
o Take out the required number of ice-packs and wipe them dry;
o Place fully frozen ice-packs in the carrier and wait for few minutes for temperature to fall
to less than 80Celsus.
Guide Mat er ials for Medical St or es Managem ent Tr aining 43
o Put vaccines vials and ampoules in a polythene bag and close it.
o Stock vaccines and diluents in the carrier;
o Place some packing material between DPT vaccines and the ice-pack to prevent them
from touching the ice-packs;
o Close the lid tightly.
Key points:
o Estimate the quantity of drugs and vaccines based on estimated quantum of services to
be provided at each peripheral units as well as the central unit.
o Do not stock vaccines for more than one-month's requirement
o Arrange your store in such a way that it helps you in maintaining the principles of FIFO.
o Maintain Two-Bin method or arrange items in two different shelves to maintain reader
level.
o Maintain buffer stock of emergency drugs to avoid out-of-stock out of positions
o Maintain non-consumable/non-recurring equipment in good condition for longer use.
o Maintain stock register for each item of material and equipment.
o Try to avoid over use, misuse and pilferage of materials.
o The 80% of the drug budget (plan and non-plan) meant for central purchase will be
allotted to the Purchase Officer/ Administrator. This will be utilized for purchase,
transportation and quality testing of drug and medical consumable for deliveries to the
different medical stores (ware house)
o 20% of the drug budget will be spent by the peripheral unit.
PROCUREMENT:
o All drugs (except for 20% of the budget earmarked for peripheral unit) will be purchased
by the State Government through the Purchase Officer/ Administrator under the
supervision of the committee earmarked for this specific purpose and distributed to the
different medicine stores (warehouse)
o All the items except those included in the Emergency Purchase Medicines rate contract
list will be purchased by open tender every year through National/ Regional/ State
Competitive Bidding.
o Open tender should be called only of drugs listed in the Essential Drugs List (EDL).
o After finalization of the tenders, an “Approved List” shall be drawn up containing the
names of the drugs, the names of the supplier, and the cost of the drug.
o All drugs and medical consumables will be purchased in generic names.
o No brand name will be mentioned anywhere in the strip/ box/ carton/ packet/ foil/ vial etc.
This condition may be relaxed for drugs and surgical items where the purchase order is
less than a predetermined annual sum.
o All the drugs and medical consumables and surgical and suture items should be
purchased directly from the manufactures. Only manufactures should be eligible to
quote in the tender.
o In case of non-supply of any item either from valid approved list, it can be purchased from
the DGS and Drug rate contract holding units.
o Firms having I.S.O/ I.S.I and W.H.O/ G.M. P will be given preference to other firms.
Guide Mat er ials for Medical St or es Managem ent Tr aining 45
o Certain drugs and medical consumables are earmarked by the State Government for
purchase from approved local S.S.I units. These will be purchased only from the
approved local S.S.I units taking there past performance (i.e. quality, timely supply) and
capacity of production into consideration. For this, local S.S.I units should have:
o A valid drug and manufacturing licence.
o A valid E.P.M. rate contract.
o The costing of items will be done in consultation with the Expert Committee, from time to
time taking the recent I.P/B.P/U.S.P and the packing standard into consideration, to
ensure that quality is maintained. The costing will be approved through a State Level
Committee (EPM).
o All the items (except, Emergency Procurement) will, unless otherwise specified, be
delivered at the Central unit.
o Where the EMP rates stipulate “inclusive of transportation charges” no transportation
cost can be claimed by the S.S.I units.
o The S.S.I. units will start supply of items within 30 days and complete the supply within 60
days from the date of issue of purchase order or in case of emergency the time given by
the Administrator / purchase Officer. Otherwise the firm will be declared part supplier/
non-supplier and the Organization can purchase the same items by calling open tender/
quotations.
o If S.S.I Units supply two or more than two NSQ (Not of Standard Quality) items or can not
supply as per specification, the Organization may revise the policy from time to time and
delete the items including in the rate contract list and put it in the “Exclusive list” in the
interest of encouraging competition.
o The Administrator should be allowed to go for quotation/ tender and purchase the same
items for the benefit of the patients.
Waste Management
Considering waste Management:-
Ground of and around the storage facility, including the area around health centers, must remain
free of health care waste and other garbage. Maintaining a clean environment where
pharmaceuticals and other health supplies are stored will reduce the number of pests-insects
and rodents-and reduce the number of people, including children, who may be injured or
infected/affected by used medical equipment or discarded medicines.
Check with local officials about laws that pertain to health care waste management and
environment protection before instituting a disposal technique.
Plan storage, transportation and disposal techniques that are practical, cost-effective and
simple. Monitor disposal practices on a regular, frequent basis.
Types of Waste:
Different types of waste that must be destroyed safely and effectively and their methods of
disposal include-
1) Non-medical waste:-
© Ordinary rubbish:-
Where municipal solid waste disposal facilities exist, dispose of rubbish in the municipal
dump. Otherwise, burn or bury it.
Guide Mat er ials for Medical St or es Managem ent Tr aining 47
When operated by staff trained in correct use and maintenance, incineration in a device like this
one-
o Completely destroys needles and syringes.
o Kills microorganisms.
o Reduces the volume of waste.
o Causes less air pollution than low temperature burning.
o
Low-temperature burning: Burning devices not exceeding 400 C include single-chamber
brick hearths, drum burners, and burning pits. They burn incompletely and do not fully destroy
waste. They may not kill microorganisms. Given these shortcomings, low-temperature burning
should be used only as a short-term solution.
Burn and bury: Pit burning is a low-cost but relatively ineffective means of waste disposal. A
fence should surround the pit to prevent children, animals, and others from coming into contact
with waste. The pit location should avoid walking paths (high-traffic areas). The fire, usually
started with a petroleum-based fuel and allowed to burn, should be supervised by designated
staff and located down-wind of the facility and residential areas. The low temperature fire emits
pollutants, and ash and remaining material should be covered with 10-15 cm of dirt.
Other methods: In addition to the common methods, other methods are used in some settings,
including needle removal/ needle destruction, melting syringes, stem sterilization (autoclaving
and hydro laving), and micro waving ( with shredding).
Managing health care waste is a comprehensive program that requires support at all levels of the
health care system. Staff involved in health care waste management must be given training and
support.
Pharmaceutical Disposal:-
It is very important to dispose of pharmaceuticals properly because there can be very negative
consequences to improper disposal. Improper disposal can result in-
o Contaminated water supplies.
o The diversion and resale of expired or inactive medicines.
o Improperly incinerated products, which can release toxic pollutants into the air.
Guide Mat er ials for Medical St or es Managem ent Tr aining 49
The usual disposal methods for various categories of pharmaceuticals are identified in the
following table.
Safety Boxes:-
Safety boxes or sharps containers are puncture- and water-resistant, impermeable containers.
When used in correctly, they produce the risk of skin-puncture injuries that may spread disease.
o Do not recap syringes before disposal.
o Place the syringe and needle in the sharps box immediately after use.
o Keep the sharps box where the injections are given.
o Do not over fill the sharps containers (about ¾ full).
o When 3/4th full, close box tab completely to cover the opening and tape it shut.
o Store the box in a safe and secure location until ready for final disposal.
o Do not empty and refill sharp boxes. Fill once and discard immediately.
Apart from these books there are so many soft copies available in the market to maintain the
medical store in computer. The individual members can develop soft packages suitable for their
Guide Mat er ials for Medical St or es Managem ent Tr aining 51
individual need of the hospitals, clinics, medical stores for retailers or wholesalers.
However, some of the soft packages available in the market are:
1 Trade Link Packages, B-II Software's.
2 MSupply for inventory management
3 Tally 7.2
4 Tally special package for medical shop & others.