Module Session

Session 1: Arrangement of Medicines and Medical Supplies
in a Store

Total Session Time: 120 minutes + 2 hours visit to a pharmacy store

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Define Medical Store

· Describe Common Systems for Arranging Medicines and Medical Supplies in the Store

· Describe Common Equipment Used for Medicines and Medical Supplies Storage

· Describe Arrangement of Medicines and Medical Supplies in the Store

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

· Handout 1.1 Arrangement and Organization of a Store

· Worksheet 1.1 Pictures of Store Equipments

· Field Trip Guide 1.1 A guide for a Visit to Hospital Pharmacy Store

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	05 minutes	Presentation	Introduction, Learning Tasks
2	10 minutes	Presentation Brainstorming	Definition of a Medical Store
3	20 minutes	Presentation Buzzing	Common Systems for Arranging Medicines and Medical Supplies
4	30 minutes	Presentation Small Group Discussion	Common Equipment Used in a Store
5	30 minutes	Presentation Small Group Discussion	Arrangement of Medicines and Medical Supplies in the Store
6	05 minutes	Presentation	Key Points
7	10 minutes	Presentation	Evaluation
8	10 minutes	Presentation Visit to a store	Pharmacy Store Visiting

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of a Medical Store (10 minutes)

Activity: Brainstorming (5 minutes)

ASK students to pair up and buzz on the following question for 5 minutes

What is a Medical Store?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

A medical store is a room where medicines are kept under lock and key for the security and safety of medicines and medical supplies.
It is an area set aside into which all the items and materials required for production, sale/distribution are received, where they are housed for safekeeping, and from which they will be issued as required.
Also refers to a service department headed by a store-keeper who is responsible for a proper storage, protection and issuing of all kinds of material.
The organization of the store depend up on the size, layout of the factory, nature of the material stored, frequency of purchases and issue of material
The functions of a storekeeper

o To organize medicines and medical supplies in a store and maintaining storage condition

o To keep and maintain proper records of medicines and medical supplies

o To select and determine items and quantities to be ordered as per requirements

o To receive items in a store, arranging them properly and issue them as required

o Checking expiry and proper disposal of unwanted items.

STEP 3: Common System for Arranging Medicines and Medical Supplies (20 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 10 minutes

What are the common systems used in arranging medicines and medical supplies?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their responses on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

· The Common Systems for Arranging Medicines and Medical Supplies includes:

Alphabetical by generic name: the medicines are arranged in the shelves according to their alphabetical names, e.g. medicines starting with A- Albendazole, Amoxicillin, Aminophylline, Ampicillin, with B- Bisacodyl, Bisoprol.
Pharmacological/therapeutic: this is a classification or grouping of medicines with similar pharmacological effects, for examples all Analgesics are grouped together, or Anti-bacterial grouped together
Dosage form: this is a system of classifying medicines based on dosage forms used in stores, for example Tablets and capsules are stored together, a separated area or location is reserved for say oral liquids, Injections, creams and Ointments etc.
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. This system should be used in combination with another system
Commodity coding: this system is based on a unique article code combined with a unique location code. For example therapeutic class/clinical indication in certain location name; MSD Item is an example; 01300 7544 i.e.01300 item Code, and 7544 location code.

STEP 4:Common Equipment Used in Store (30 minutes)

Activity: Small Group Discussion ( 15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

What are the common equipment used to store medicines and medical supplies in a store?

REFER students to Worksheet 1.1: Pictures of Store Equipments

ALLOW students to discuss for 15 minutes

ALLOW groups to present their opinions

CLARIFY and SUMMARIZE by using the contents below

· Medicines/products are stored so that they are easily accessible and protected against damage

· The four basic equipment used for storage are Shelves, Floor pallets, Block stacked pallets, and pallet racks.

Shelves

§ Storage on shelves does not require mechanical handling equipment and is a suitable choice when the volume and weight of individual items are too small to justify pallets, the internal height of a building is not large enough for multitier pallet racking and shelving can be used on its own or in combination with floor pallets or two-tier racking.

§ Manual goods handling is locally more reliable or economical than mechanical handling.

§ If shelving is used in a warehouse more than 4.5 meters high, it may be possible to install an independent mezzanine flooring system supporting a second tier of shelving.

§ This can increase the available shelving volume up to 100 percent, at the expense of some inconvenience in material handling. Obliviously, if this is done, high –quality construction is critical to avoid injury to staff and damage to stored goods.

Floor pallets

§ Floor pallets are good solution in warehouse with ceiling height of less than 3 meters and in store where the cost of pallet racking and forklifts cannot be justified.

§ Many heavy or bulky items, such as rolls of cotton, drug kits, or large hospital equipment, require floor location.

§ Floors should be marked to indicate pallet and aisle position.

Block stacked pallets

§ Pallets containing light goods may be stacked on top of one another in blocks.

§ Blocks-stacked pallets should be used only for items without expiry dates or with very high turnover, because the first-in terms are the bottom of the stack.

§ Block stacking is a cheap and space efficient method of storage and no racking is required

Pallet racks

§ Simple pallets racks generally have two or three tiers.

§ Two tiers of racking require a clear height of about 3 meters, and three ties require a clear height of about 4.5 meters

§ It is possible to have several more tiers to have several more tiers but sophisticated mechanical handling equipment is then required

STEP 5: Arrangement of Medicines and Medical Supplies in the Store (30 minutes)

Activity: Small Group Discussion ( 10 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

How do you arrange medicines and medical supplies in a store?

ALLOW students to discuss for 10 minutes

ALLOW groups to present their opinions

CLARIFY and SUMMARIZE by using the contents below

· Supplies should be arranged according to:

o First expiry/first out (FEFO)

§ Supplies which expire first should be in front and be issued first in preference to those with longer expiry dates

o First in first out (FIFO),

§ Always issue first those medicines which have been in the store the longest

§ Place newly received items on the shelves or pallets so that those present automatically move to the front and are issued first

§ This applies especially for drugs with none expiry dates

o Category or formulation

o In alphabetical order

Refer students to Handout 1.1: Arrangement and Organization for further reading.

STEP 6: Key Points (5 minutes)

· A medical store is a room where medicines are kept under lock and key for the security and safety of medicines and medical supplies

· The functions of a store keeper is to organize and maintain storage conditions, keeping records and maintain availability of medicines to store

· Common systems for arranging medicines and medical supplies in a store includes, alphabetical by generic name, pharmacological/therapeutic, dosage form, frequency of use, random bin and

· The four basic equipment of storage of medicine and medical supplies are, Shelves, Floor pallets, Block stacked pallets, and pallet racks.

STEP 7: Evaluation (10 minutes)

· What is a medical store?

· What are the common systems used in arranging medicines and medical supplies?

· What equipment are used to store medicine and medical supplies in a storeHow do you arrange medicines and medical supplies in the store?

STEP 8: Visit to a Store (10 minutes)

Activity: Visit to a store (120 minutes)

PREPARE for a visit to a hospital store

ORIENT the students on objectives and guide of the visit

REFER students to Field Trip Guide 1.1: A Guide for a Visit to Hospital Pharmacy Store

DIVIDE students to manageable small groups

TAKE students to the site to learn about pharmacy store arrangement.

PREPARE students for feedback of the visit

References:

Jessop, D and Morrison (1994) Storage and Supply of Materials, (6th ed.), Prentice Hall

Laurie L, Editor, (2003) Guidelines for the Storage of Essential Medicines and Other Health Commodities. John Snow, Inc./DELIVER in collaboration with the World Health Organization

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd ed.).West Hartford, Connecticut, USA: Kumarian Press

Management Science for Health and World Health Organization. (2012). Managing Access to Medicines and Health Technology, (3rd ed.). Kumarian Press

Shirima, L. L (1988): Basic Store-keeping and Warehouse Management. General Publication

World Health Organization (WHO), Regional Office for Africa Brazzaville 2004, Management of Drugs at Health Centre Level Training Manual.

Handout 1.1: Arrangement and Organization of a Store

Proper Arrangement and Organization`

Requirements for Proper Arrangement

· Storage area or the store should be clean

· Must be arranged in an orderly manner so that each item is easily accessible

· Supplies should be stored according to manufacturer’s storage requirements (e.g. light, temperature and humidity)

· Medicines in store rooms are arranged according to the specified management principles of the organization

· Drugs and medical supplies must be properly stored in order to maintain their stability and quality up to the end of their stated time of use

Classification of Drugs in the Store

· Medicines are also grouped according to the pharmacological classification; this provides a useful reference point with which a health worker can easily recognize individual products

· Put frequently used items at waist height

· Store extra stock on upper shelves (if not too heavy)

· Top shelf should be used to store dry medicines (tablets, capsules, oral rehydration packets)

If the top shelf is near the ceiling or out of your reach, use that shelf to store items that are NOT sensitive to heat and are NOT used regularly

· Middle shelf should be used to store injectable and ointments

· However, note that liquids and syrups can also be stored but with caution as they can leak

· Lower shelves can be used to store other supplies, such as surgical items, laboratory supplies and condoms

· Level of use (i.e. for fast moving medicines) must be placed where they are easy to reach

· Labels for product name can be put on shelves where that item is located for easy access

· Consider the labels on the items carefully, these indicate the storage requirements

· The store should be located in a place that is not easily reached by flooding

· It should be accessible to transport and secured from theft and fire

Storage and Use Procedures

· All stock should be checked for expiration dates at regular intervals (monthly)

· Items with shorter expiration dates should be issued first (FIFO)

· Reduce waste caused by drug expiration by sharing with the nearby facilities (this must be agreed with the Hospital Therapeutic Committee)

Note: Items should never be placed on the floor.

Worksheet 1.1: Pictures of Store Equipments

Field Trip Guide 1.1: A guide for a Visit to Hospital Pharmacy Store

Introduction

This guide will help a student to understand better on common system for arranging medicines and medical supplies in a store also to build more capacity on how to arrange medicines and medical supplies in a store by visiting to a hospital pharmacy store and observe by visualizing what is real done by store workers.

Student should be divided into small group may be of 5 to 10 members to simplify managing them once they are passing from one area of studying to another within a store.

Each group should have a Chairman, a recorder and a reporter

Learning Tasks

· Identify common system for arranging medicines and medical supplies

· Identify arrangement of medicines and medical supplies in the store

Activity

· Students to prepare themselves by having important tools like pen, notebook, overall coat, boots and any other related material for the visit

· Locate four basic arrangement of storage: Shelves, Floor pallets, Block stacked pallets, and pallet racks.

· Observe common system for arranging medicines and medical supplies

· Observe arrangement of medicines and medical supplies in the store

At the end of this activity the groups of students will submit a report of what they have learned from this study tour of a hospital pharmacy store

Each group will present their learning experiences in the class.

A facilitator will summarize and make more elaboration on important issue

Session 2: Record Keeping on Medicines and Medical
Supplies in a Store

Total Session Time: 120 minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Keep records of medicines and medical supplies

Define Medicines and Medical Supplies Records
List Records of Medicines and Medical Supplies
Explain the Importance of Records of Medicines and Medical Supplies
Demonstrate Ability to Record and Keep Medicines and Medical Supplies

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

· Ledger, Bin Card, Issue voucher, Receipt voucher, and Requisition forms

· Handout 2.1: Records of medicines and medical supplies

· Figure 2.1: Samples of medicines and medical supplies records

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	05 minutes	Presentation	Introduction, Learning Tasks
2	10 minutes	Presentation Buzzing	Definition of Medicines and Medical Supplies Records
3	15 minutes	Presentation Brainstorming	Records of Medicines and Medical Supplies
4	20 minutes	Presentation	Importance of Medicines and Medical Supplies Records
5	60 minutes	Presentation Small Group discussion	Recording and Keeping Medicines and Medical Supplies
6	05 minutes	Presentation	Key Points
7	05 minutes	Presentation	Evaluation

SESSION CONTENTS

STEP1: Introduction, Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Medicines and Medical Supplies Records (10 minutes)

Activity: Buzzing (5 minutes)

Ask students to pair up and buzz on the following question for 2 minutes:

What is medicines and medical supplies records?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

Medicine and medical supplies records

· Is the records which contain important information concerning:

What items are available
How much is available of each item
How much is used on a regular basis
When and how much of an item should be reordered

· They are used to record information about medicines and medical supplies in storage.

· They must contain the quantity of medicines and medical supplies on hand; the quantity of losses; and the quantity of adjustments, by individual product.

· The medicines and medical supplies records are completed by anyone who receives or issues stock from storage, and by anyone who takes a physical count of medicines and medical supplies in stock, service delivery point (SDP) staff.

STEP 3: Records of Medicines and Medical Supplies (15 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

What are the records for medicines and medical supplies?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

· Records for medicines and Medical supplies

Store Ledger
Bin Cards
Issue voucher
Receipt voucher
Requisition form

· Stores ledger

o Stores ledger is a stock keeping record forms bound like a book that containing the information about the products regarding quantities in the store.

o It also records dates and quantities from who received into the store as well as quantities to whom issued from the store.

o It is a legal document used by auditors, stock-verifiers to assess validity of stocks.

o The Government policy in most countries requires the use of stores ledgers for accountability , because commodities are considered assets of the government or organizations and should be accounted for carefully

· Bin Card

o It is an individual stock keeping record that holds information about all the lots of a single product.

o One Bin Card is for each product

· Issue vouchers

o Issue vouchers are used where the issuing facility determines the quantity to be sent and issues the supplies to the receiving facility.

· Receipt voucher

o A Receipt Voucher lists the items and quantity issued from supplier and received by a facility.

o It also includes a separate column for the quantities received in case any items are lots or damaged en route

o The issuing facility completes the date and quantities issued, signs the voucher

· Requisition forms/ vouchers

o A requisition voucher is completed by facility staff by listing the items and quantities requested by a facility.

o It also includes a column for the quantity actually issued.

REFER students to Handout 2.1: Records of Medicines and Medical supplies for further reading.

STEP 4: Importance of Medicine and Medical Supplies Records (20 minutes)

Importance of Medicine and medical supplies records are:

o They reflect/show quantities of the items at the store ( stock in hand )

o They protect the store keeper from rumours of misuses or fraud of the medicines and medical supplies in the store.

o They provide information on the consumption rate, for deciding what to order and the quantity to order.

o They are used for accountability of medicines and medical supplies regarding quantities received, issued and to whom they were issued.

o They indicate the value of assets of an institution

o They are used as legal requirement for accountability during auditing, stock verification.

o They are also required by professional bodies like pharmacy council, for accountability of sources and movement of medicines and medical supplies ( legal sources and uses)

STEP 5: Recording and Keeping Medicines and Medical supplies (60 minutes)

Activity: Small Group Discussion ( 30 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

· What is the most important reasons for having stock keeping records?

ALLOW students to discuss for 30 minutes

ALLOW few groups to present and the rest to add points not mentioned

REFER students to Hand Out 2.1 for further reading.

CLARIFY and SUMMARIZE by using the contents below

STEP 6: Key Points (5 minutes)

· Records contain important information which are used to record information about medicines and medical supplies in a store.

· Records for medicines and Medical supplies include Store Ledger, Bin Cards, Issue voucher, Receipt voucher, Requisition form.

· It is important to ensure that all medicines and medical supplies kept in the store to be recorded

STEP 7: Evaluation (5 minutes)

· What is medicines and medical supplies records?

· What are the records for medicines and medical supplies?

· What are the importance of records of medicines and medical supplies?

References

Management Science for Health and World Health Organization. (2012). Managing Access to Medicines and Health Technology, (3^{rd ed}.). Kumarian Press

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd ed.).West Hartford, Connecticut, USA: Kumarian Press

World Health Organization (WHO), Regional Office for Africa Brazzaville 2004, Management of Drugs at Health Centre Level Training Manual

Shirima, L. L (1988): Basic Store-keeping and Warehouse

Management. General Publication United Republic of Tanzania, Public Procurement Act, 2004, Dar es Salaam

Jessop, D & Morrison (1994) Storage and Supply of Materials, (6th ed.). Prentice Hall

Laurie L, Editor, (2003) Guidelines for the Storage of Essential Medicines and Other Health Commodities. John Snow, Inc. /DELIVER in collaboration with the World Health Organization

Handout 2.1: Records of Medicines and Medical Supplies

What is the most important reason for having stock keeping records?

They are used to record information about products in storage.

What essential data items do stock keeping records contain?

They must contain the quantity of stock on hand; the quantity of losses; and the quantity of adjustments, by individual product.

Who completes the stock keeping record?

It is completed by anyone who receives or issues stock from storage, and by anyone who takes a physical inventory of the stock, including the warehouse manager and other warehouse staff, and service delivery point (SDP) staff. Pharmacies store stock; the staff should also use stock keeping records. The pharmacist and other pharmacy staff are responsible for completing these stock keeping records.

When are entries made to stock keeping records?

They are recorded on the stock keeping record whenever products are received or issued. Entries are also recorded when stock is counted during a physical inventory, or as soon as a loss is noticed. When the stock keeping record is full, a new record is started, using the ending balance from the previous record.

How are the data on a stock keeping record organized?

They are organized by date and transaction reference (the unique number of the corresponding transaction record for a receipt or issue, and/or the name of the facility from which products are received and issued). They record receipts, issues, losses and adjustments, and the balance on hand. They also record the results of physical inventories (when items are counted to verify the quantity in storage).

What are some examples of formats of stock keeping records?

The most common formats for stock keeping records are individual stock cards and stores ledgers. Types of stock keeping records include stock cards, inventory control cards, and bin cards.

What is a bin card?

It is an individual stock keeping record that holds information about a single product by lot number or batch number (see figure 2-2). Every item in that lot will have the same expiration date. For example, one bin card would hold information about a single lot of paracetamol at a storage facility. The card should note the stock on hand of paracetamol for that lot only, as well as any losses and adjustments for that lot. Bin cards are usually displayed at the bins (or shelf or pallet position) where the lot is found.

What is a stores ledger?

It is a stock keeping record that contains the same information as the inventory control card described above. Unlike inventory control cards, a stores ledger is bound like a book; it is used instead of the individual card format. Government policy in some countries requires the use of stores ledgers. (Managers may think that binding the pages increases accountability, because missing pages are obvious.) However, the ledger format is less desirable than individual cards, because it is easy to run out of space for an individual product. It is also hard to add new products—you can alphabetize a set of individual inventory control cards as new cards are added, but you cannot alphabetize pages within a bound book. In many countries, the format of stock keeping records is determined by the Ministry of Finance and is used by all government units because commodities are considered assets of the government and should be accounted for carefully.

What is an inventory control card?

It is an individual stock keeping record that holds information about all the lots of a single product. You should keep one inventory control card for each product. The inventory control card may be a summary of many bin cards for a particular product. For example, one inventory control card could hold information about all the paracetamol in a storage facility. It should note the total stock on hand of paracetamol in the warehouse, as well as the total losses and adjustments, without regard to lot number or where the product is located in the warehouse. See figure 2-3 for an example of an inventory control card. To ensure that each lot is managed correctly in larger warehouses, which may have many lots of each product stored in different places, it is usually advisable to maintain both inventory control cards and bin cards. In smaller storerooms, you can keep a single stock keeping record, such as a stock card or inventory control card.

How and where do stock-keeping records move?

Stock-keeping records do not usually move; they stay where products are stored (e.g., the warehouse, pharmacy, or storeroom).

What are some examples of formats for transaction records?

The most common formats are bills of lading; receiving records; issue vouchers; receipt vouchers; and combined requisition, issue, and receipt vouchers. The content of the transaction record will depend on how many transactions and which parts of the transaction are tracked on the record. The format of the transaction record may also depend on whether the system is pull or push. In all cases, a preprinted voucher number on each transaction record helps track individual shipments.

What is an issue and receipt voucher (IRV)?

An IRV lists the items and quantity issued to a facility. It also includes a separate column for the quantities received in case any items are lots or damaged en route. IRVs are used in a push system; the issuing facility determines the quantity to be sent and issues the supplies to the receiving facility.

Figure 2.1: Samples of Medicines and Medical Stores Records

· Store ledger

o The Stores Ledger is a register for recording movements of stock kept in the facility. It is used to record receipts and issues of stock.

· Requirements

o It MUST be kept up to date

o Separate Stores Ledgers should be kept for pharmaceutical supplies and non-pharmaceutical supplies.

· How to fill a store ledger

o Record immediately, (i.e. without delay), every receipt or issue of stock. Records for every item MUST be on a separate page in the ledger. Supplies should be differentiated by generic name (Panadol vs. Paracetamol),The strength of the product (e.g., Amoxicillin 500mg), The form (e.g., Tablet, suspension).Example Amoxicillin Capsules 250mg.

o A consistent unit of issue must be applied to all entries in the ledger. Record entries by the dispensing unit instead of pack sizes. All supplies must be entered in alphabetical order for the supplies in a single storage area within the facility.

o Each ledger should start with a table of contents page that will help to find the product page quickly.

o Write page numbers of the ledger. When the page in use is full, indicate on this page as to which page you have transferred the data and indicate on the new page as from where the information has been transferred.

STORE LEGDER SAMPLE

FACILITY CODE NUMBER: ………………………………..

FACILITY NAME …………………………………….............

TYPE OF FACILITY (GOV/NGO/FBO/OTHER) ……………

NAME OF COUNCIL /REGION …………………………….

DATE LEDGER BOOK OPENED……………………………..

DATE LEDGER BOOK CLOSED………………………….....

· Bin card

o It is an individual stock keeping documentation tool that holds information about a single product by lot number or batch number. Every item of the lot have the same expiration date.

o For example, one bin card would hold information about a 500mg paracetamol tablet at a storage facility. The card note the stock on hand of paracetamol for that strength only, as well as any losses and adjustments.

o Bin cards are usually displayed at the bins (or shelf or pallet position) where the lot is found

· Items on a stock card/bin-card include:

DATE when item is received into store or issued out of store
RECEIVED FROM (usually MSD)
QUANTITY RECEIVED (number of units received at store)
ISSUED TO (name of patient to whom the item will be dispensed)
QUANTITY ISSUED (number of units issued out of store)
ADJUSTMENT (number of unit expired ,lost/stolen)
BALANCE IN STOCK (number of units remaining in store)
REMARKS Important information about movement of item, batch numbers, expiration dates, borrowed from or returned to other health facility etc.
SIGNATURE of the person who records the movement of the item

Note: During practicum session students should fill/complete stores ledger, Bin cards, R&R and Requisition/issue voucher.

· Issue and receipt voucher ( IRV )

o An IRV lists the items and quantity issued to a facility. It also includes a column for the quantities received in case any items are lost or damaged.

o IRVs are used in a push system/kit system where the issuing facility determines the quantity to be sent and issues the supplies to the receiving facility. An IRV should be completed in triplicate (three copies).

IRV flow between facilities

Step one.

The issuing facility completes the date and quantities issued, signs the voucher, and sends the top two copies (1 and 2) to the receiving facility, with the supplies.

The bottom copy (3) is often called the reminder copy because the issuing facility keeps the bottom copy of the issue voucher as a reminder that it is waiting for verification that the supplies were received.

Step two.

The receiving facility verifies the quantity received, signs the form, and returns the top copy (1), and keeps the middle copy (2) for its files.

Step three

The top copy (1) arrives at the issuing facility, which then disposes of the reminder copy (3) and keeps the top copy for its files and thus each of the facilities will have a completed copy.

Session 3: Introduction to Housekeeping of Medicines and
Medical Supplies Store.

Total Session Time: 120 minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Define Housekeeping of Medicines and Medical Supplies Store

· Describe Housekeeping Tasks for Store

· Explain the Importance of Housekeeping in the Store

· Explain the consequences of Poor Housing Keeping

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	05 minutes	Presentation	Introduction, Learning Tasks
2	10 minutes	Presentation Brainstorming	Definition of Housekeeping of Medicines and Medical Supplies Store
3	45 minutes	Presentation Small group discussion	Description of Housekeeping Tasks in Medicine and Medical Supplies Store
4	25 minutes	Presentation Buzzing	Importance of Housekeeping in Medicines and Medical Supplies Store
5	25 minutes	Presentation Buzzing	Consequences of Poor Housing Keeping in Medicines and Medical Supplies store
6	05 minutes	Presentation	Key Points
7	05 minutes	Presentation	Evaluation

SESSION CONTENTS

STEP1: Introduction, Learning tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Housekeeping of Medicines and Medical Supplies Store (10 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

What is housekeeping of Medicines and Medical Supplies store?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

Housekeeping

o This is the tasks in a store which include the following activities cleaning, pest control, a regular inspection system, disposal of stock, precaution against fire, and strict security measures.

STEP 3: Description of Housekeeping Tasks in Medicines and Medical
Supplies Store (45 minutes)

Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

· What are housekeeping tasks in Medicines and Medical Supplies store?

ALLOW students to discuss for 20 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

· Cleaning and pest control

The store should be kept tidy and should be cleaned two or three times a week.
Pest control can be difficult task, but to avoid possible contamination and physical damage to stock.
It’s necessary to keep insect, mice and other pests out of the storage area. If needed, pest control measure such as poison should be implemented with proper precaution.

· Inspection

Senior staff should inspect the store regularly. The chief storekeeper must make sure that store room employees check the shelves and pallets daily and for deterioration due to climatic condition. Store keepers should open suspect containers and reports problems to managers.

· Disposal of expired or damaged stock

Damaged or expired stock should be placed in a designated salvage area to wait authority for disposal. A written record of all stock consigned to this area should be maintained. It’s recommended that each item be valued at its acquisition cost. The responsible authority should be informed in writing that stock is to be written off. Disposal may be delayed if a committee decision is required, and substantial storage space and May needed for junk stock. Once destruction is authorized, the inventory control clerk must adjust the stock records. All drugs and other potentially toxic products should be disposed of in accordance with local regulation in a manner that does not pose not pose a risk to public health.

· Fire precaution

Flammable trash, such as cartons and boxes, must not be allowed to accumulate in the store. Smoking must be strictly forbidden, with “No smoking” signs posted throughout the store. Senior staff must obey the rule as strictly as junior staff, and penalties should be imposed on these who ignore the rules. A smoking area outside the warehouse should be designated. Management must ensure that fire-detection and fire-fighting equipment is regularly inspected and that staff receive adequate training in fire -fighting technique and emergency action. There should be regular fire drills to reinforce the training.

· Security

Ideally, the chief storekeeper’s office should have windows that overlook the loading bay, the compound entrance, and the store itself. A storekeeper who sits behind a closed door with curtains drawn cannot observe what is happening on the site. No vehicles should be allowed into the store compound unless they are authorized by the chief storekeeper or senior staff member. A list of authorized vehicles should be prepared for the compound gate-keeper.

STEP 4: Importance of Housekeeping in the Store (25 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 5 minutes

What are the importances of housekeeping in Medicines and Medical Supplies store?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

· The following are the importance of housekeeping in the store

Promotes quality safety productivity
Decreases fire hazards
Makes the store looks neat and orderly and eases flow of drug and supplies
Improves morale among workers
Better control of drugs and supplies, including inventory maintenance
Better hygienic conditions leading to improved health
More effective use of space
Reduces drug and supplies damage
Reduces tripping and slipping accidents in clutter-free and spill-free work areas
Minimize workers exposures to hazardous substances (e.g. dusts, vapors)

STEP 5: Consequences of Poor Housing keeping (25 minutes)

Activity: Buzzing (10 minutes)

ASK students to pair up and buzz on the following question for 10 minutes

What are the consequences of poor housekeeping in Medicines and Medical Supplies store?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

· The followings are the consequence of poor house keeping

o Injuries, when employees trip, fall, strike or are struck by out-of-place objects

o Makes the store looks untidy and messy

o Time consuming when picking item from a poorly arranged store

o Fire due to improper storage of inflammable or combustible materials and wastes

o Risk of medicine deterioration as may be subjected to unfavourable conditions

o Compromise workers efficiency due to unconducive environment

STEP 6: Key Points (5 minutes)

· Housekeeping tasks in a store include cleaning, pest control, a regular inspection system, disposal of stock, precaution against fire, and strict security measures.

· Importance of housekeeping in medicines and medical supplies include promotion of quality safety production, decreases fire hazards and makes the store looks neat and orderly and eases flow of drug and supplies

· Consequences of poor housing keeping include Injuries, when employees trip, fall, strike or are struck by out-of-place objects

STEP 7: Evaluation (5 minutes)

What is housekeeping of medicines and medical supplies store?
What are the housekeeping tasks in medicines and medical supplies store?
What are the importance of housekeeping in medicines and medical supplies store?
What are the consequences of poor housekeeping in medicines and medical supplies store?

References

Management Science for Health and World Health Organization. (2012). Managing Access to Medicines and Health Technology, (3rd ed.). Kumarian Press

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd ed.).West Hartford, Connecticut, USA: Kumarian Press

World Health Organization (WHO), Regional Office for Africa Brazzaville 2004, Management of Drugs at Health Centre Level Training Manual.

Shirima, L. L (1988): Basic Store-keeping and Warehouse Management.

General Publication

Jessop, D and Morrison (1994) Storage and Supply of Materials, 6th Edition, Prentice Hall

Laurie L, Editor, (2003) Guidelines for the Storage of Essential Medicines and Other Health Commodities. John Snow, Inc. /DELIVER in collaboration with the World Health Organization

Session 4: Issuing Medicines and Medical Supplies from a
Store

Total Session Time: 120minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Define Issuing of Medicines and Medical Supplies From a Store

· Identify the Documents Used for Issuing Medicines and Medical Supplies From a Store.

· Explain the Procedure for Issuing of Medicines and Medical Supplies

· Filling Documents Used in Issuing Medicines and Medical Supplies

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

· Worksheet 4.1 Issue voucher

· Worksheet 4.2 Issue voucher

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	5 minutes	Presentation	Introduction, Learning Task
2	10 minutes	Presentation Brainstorming	Definition of Issuing Medicines and Medical Supplies From a Store
3	15 minutes	presentation	Documents Used for Issuing Medicines and Medical Supplies From a Store.
4	30 minutes	presentation	Procedure for Issuing of Medicines and Medical Supplies
5	50 minutes	Presentation Small group discussion	Filling Documents Used in Issuing Medicines and Medical Supplies
6	5 minutes	Presentation	Key Points
7	5 minutes	Presentation	Evaluation

SESSION CONTENTS

STEP1: Introduction, Learning tasks (5minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Issuing Medicines and Medical Supplies From a Store
(10minutes)

Activity: Brainstorming (5 minutes)

ASK students to pair up and buzz on the following question for 5 minutes

What is issuing medicine from a store?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

· Issuing of medicines from a store

Issuing of medicine from a store is the process of distributing a specific amount of an item from store to different department of the health facility.

· STEP 3: Documents Used for Issuing Medicines From a Store(30 minutes)

· Document that is common used in health facility for issuing medicines from a store is issue voucher.

· Issue voucher is a document used when you issue items to another health unit or to department in your unit. It records :

o The date of issue

o The item requested and quantity

o The items issued and quantity

o The department receiving

o Signature of the receiver and issuing officer

· STEP 4: Procedure for Issuing of Medicines and Medical Supplies

(30 minutes)

· Medicines and related supplies should be issued within or moved out of the facility by following agreed procedure

Requisition officer has to identify requirement of needed supplies
Requisition has to be clearly written on the standard requisition form
On reaching the store, the requisition has to be examined by a store keeper and any necessary change made and initialed.
Store keeper should issue the supplies accordingly.
The assembled order has to be checked by the storekeeper.
All records should be documented on bin card and ledger book with all necessary details completed on the same date.
Types, name and quantity of the required items, signature of the receiving and issuing officer and the date should appear on the issue voucher.
Store keeper has to ensure proper handling of the supplies to requisition officer.

STEP 5: Filling Documents Used in Issuing Medicines and Medical Supplies
(50 minutes)

Activity: Small Group Discussion ( 30 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

· How to fill issue voucher used in issuing medicines and medical supplies?

ALLOW students to discuss for 30 minutes

ALLOW few groups to present and the rest to add points not mentioned

REFER students to work sheet 1 and 2 for further reading.

CLARIFY and SUMMARIZE by using the contents below

· Filling documents used in issuing medicines and medical supplies require a trained personnel

· The following below documents shall be filled as follows

Requisition officer

§ Write the full name, designation and official signature of the person requesting supplies.

Serial number (S/N)

§ Write the numbers of items requested in sequence order.

Description of item

§ Write generic name of the product, strength and dosage form e.g. Paracetamol tablet 500mg

Unit

§ Write unit of measure of item ( pack size )

Quantity required

§ Write the quantity of the items required

Quantity issued

§ Write the quantity of item to be supplied out of store

Remarks

§ Write important information about movement of item, batch numbers, expiration dates, borrowed from or returned to other health facility.

Date

§ Write the date when the supplies were issued.

Issuing voucher

§ Write designation and signature of the issuing officer.

NOTE. The line shall be drawn below the last item to be issued to avoid tempering.

STEP 6: Key Points (5minutes)

· Issuing of medicine from a store is the process of distributing a specific amount of an item from store to different department of the health facility.

· Document which is common used in health facility for issuing medicines from a store is issue voucher.

· One of the Procedures for issuing of medicines and medical supplies include identifying the correct quantity required to be supplied.

· Documents used in issuing medicines and medical supplies shall be properly filled with generic name, quantity of the required items, signature of the receiving and issuing officer and the date on the issue voucher.

STEP 7: Evaluation (5 minutes)

· What is issuing of medicines and medical supplies from a store?

· What are the documents used for issuing medicines from a store?

· What are the important procedures for issuing of medicines and medical supplies?

References

Ministry of Health and Social Welfare (MOHSW). Modular course in district health management: module 7. Dar es salaam TZ. Ministry of Health and Social Welfare.

Guidelines on the storage of essential drug in eastern and southern Africa (1991) by WHO with the cooperation of the pharmaceutical industry through the International Federation of Pharmaceutical Association IFPMA

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd e.d.).West Hartford, Connecticut, USA: Kumarian Press

Worksheet4.1: Issue Voucher

Instructions : verifying the content of the issuing document and keep record on proper file

Worksheet4.2: Issue Voucher

Instructions : verifying the content of the issuing document and keep record on proper file

MINISTRY OF HEALTH

ISSUE VOUCHER

No………

Requisition officer…….

S/N

Description of item

Unit

Quantity required

Quantity issued

Remarks

Date……………………….

ISSUING OFFICER

Signature………..

Designation……..

REQUISITION OFFICER

Name…………...........................................

Signature………..

Designation……..

Session 5: Premise Suitable for Storage of Medicines and
Medical Supplies

Total Session Time: 120 minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

Define Storage of Medicines and Medical Supplies
Explain the Importance of Proper Storage of Medicines and Medical Supplies
List Requirements of Premises for Storage of Medicines and Medical Supplies

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	05 minutes	Presentation	Introduction, Learning Tasks
2	20 minutes	Presentation Brainstorming	Definition of Storage of Medicines and Medical Supply
3	40 minutes	Presentation Small Group Discussion	Importance of Proper Storage of Medicines and Medical Supplies
4	45 minutes	Presentation Brainstorming	Requirements of Premises for Storage of Medicines and Medical supplies
5	05 minutes	Presentation	Key Points
6	05 minutes	Presentation	Evaluation

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Storage of Medicines and Medical Supplies (20 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

What is storage of Medicines and Medical Supplies?

ALLOW few students to respond?

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

· Storage of medicines and medical supplies

o Is the safekeeping of medicines and Medical Supplies to avoid spoilage and losses

STEP 3: Importance of Proper Storage of Medicines and Medical Supplies

(40 minutes)

Activity: Small Group Discussion ( 40 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

What are the importance of proper storage of Medicines and Medical Supplies?

ALLOW students to discuss for 20 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

· Proper storage of Medicines and Medical Supplies are important in order to:

Avoid contamination or deterioration
Avoid disfiguration of labels
Maintain integrity of packaging and so guarantee quality and potency of Medicines and Medical Supplies during shelf life
Prevent or reduce pilferage, theft or losses
Prevent infestation of pests and vermin

STEP 4: Requirements of premises for storage of Medicines and Medical
Supplies (45 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

What are the requirements of premises for storage of Medicines and Medical Supplies?

ALLOW few students to respond?

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

· The following are requirements of premises for Medicines and Medical Supplies:

o Capacity/space: storage facilities must have the capacity for both storage and handling

o Cold storage: in larger facilities it is more efficient to use cold rooms rather than numerous refrigerators or freezers (which generate heat)

o Secure storage: all Medical stores should have a secure storage area for product that are likely to be stolen or abused

o Ventilation: the location designed should ensure maximum air circulation to avoid concentration of fumes or gases and to prevent condensation of moisture on products or walls

o Roof: design a slanting roof to allow water runoff

o Ceiling: install a double ceiling to provide insulation and ensure that supplies are kept cool

o Walls and floor: the walls and floors should be permanent and smooth for easy cleaning

o Doors: plan doors wide enough to allow for the free and easy movement of supplies and handling equipment

o Lighting: plan the storeroom with as much natural light (sunlight) in the day as possible to avoid the use of florescent or incandescent bulb lighting

o Windows: plan windows that are high and wide to allow adequate ventilation

o Cupboards: provide cupboards for the storage of specific products that must be kept free from dust or light

o First aid: keep well stocked first aid kits to treat employees or visitors who are injured in your facility

o Shelves: arrange shelves and racks in lines with a passage way not less than 90 cm wide

STEP 5: Key Points (5 minutes)

· Storage of Medicines and Medical Supplies Is the safekeeping of medicines and Medical Supplies to avoid spoilage and losses

· Proper storage of Medicines and Medical Supplies are important in order to maintain the their quality during the whole period of their shelf life

· Requirements of premises for Medicines and Medical Supplies include: capacity/space, shelves, first aid kit, cupboards, windows, lighting, doors, walls and floor, ceiling, roof, ventilation secure storage and cold storage

STEP 6: Evaluation (5 minutes)

What is the storage of Medicines and Medical Supplies
What are the importance of proper storage of Medicines and Medical Supplies?
What are the requirements of the suitable premise of Medicines and Medical Supplies

References

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd ed.).West Hartford, Connecticut, USA: Kumarian Press

Shirima, L. L (1988): Basic Store-keeping and Warehouse

Management. General Publication United Republic of Tanzania, Public Procurement Act, 2004, Dar es Salaam

Njau, E. (2002). Pharmacology and Therapeutics (2nd ed.). Nairobi: African Medical and

Research Foundation

Session 6: Zoning of Premises/Store for Storage of Medicines
and Medical Supplies

Total Session Time: 120minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Define Zoning

· Explain Zoning of Stock Within the Store

· Describe Criteria for Establishing Zones Within a Store

· Identify Types of Stock Location Within a Zone

· Describe Stock Classification

· Describe the arrangement of Stocks in Zones

Resources Needed

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	5 minutes	Presentation	Introduction, Learning Task
2	5 minutes	Presentation Brainstorming	Definition of Zoning
3	20 minutes	Presentation	Zoning of Stock within the Store
4	10 minutes	Presentation	Criteria for Establishing Zones within a Store
5	30 minutes	Presentation Group discussion	Types of Stock Location Within a Zone
6	30 minutes	Presentation	Stock Classification
7	10 minutes	Presentation Buzzing	Stock Within a Zone
8	5 minutes	Presentation	Key Points
9	5 minutes	Presentation	Evaluation

SESSION CONTENTS

STEP1: Presentation of Session Title and Learning Tasks (5minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of zoning (5 minutes)

Activity: Brainstorming (3 minutes)

ASK students to brainstorm on the following question

What is zoning?

ALLOW few students to respond

WRITE their answers on flip chart/ board

CLARIFY and SUMMERIZE by using the content bellow

· Definition of zoning

Is the process of separating an area (building or room, a locked cupboard, a refrigerator, a freezer, or a cold room), which should provide distinct environmental conditions, a certain level of safety or the required level of security.

STEP 3: Zoning of Stock within the Store (20 minutes)

· Medicines and medical supplies must be stored in a zone/part of the store with the correct combination of temperature and security as well as the required level of safety and security. This initial zoning process is the most basic way in which supplies can be arranged.

· Follow to the extent possible, the product manufacturer’s storage conditions

· If no specific storage conditions are given, normal storage conditions apply. Normal storage conditions for medicines have been defined as storage in dry, well-ventilated premises at temperatures of 15ᴼC-25ᴼC , or depending up climatic conditions, up to 30ᴼC (WHO 2003).

· The 15ᴼC to 25ᴼC-30ᴼC temperature zone is assumed to be air-conditioned and humidity controlled. In temperate climates this temperature range can be achieved without air-conditioning, but humidity control may still be necessary

· Each storage zone should have at least one thermometer, and temperature should be recorded daily at the hottest time of the day.

· Storage at uncontrolled room temperature:

o Many stocks can be safely stored at uncontrolled room temperature.

· Cold storage:

example of drug products which usually require refrigeration:

§ insulin

§ Ergometrine for injection

§ vaccines,

§ antitoxins

§ sera and blood products

§ test kits/diagnostic tests

These must be stored in refrigerator or cold chains because their potency depends on cold storage.

· Secure storage:

o This is necessary to protect drug products, which have higher risk of theft, or to comply with national laws

o Narcotics and other controlled drugs should be kept in a secure room, a safe or steel cupboard/ cabinet to prevent access to unauthorized persons

o The keys to the secure store should be kept in a safe by a store in-charge

o Entry to the store must be controlled or restricted

· Flammables e.g. alcohol/spirit, halothane, ether, must be stored in special buildings or rooms. A separate building is the best because it greatly reduces the risk of a fire spreading to the main store. The flammables store must be well ventilated and fire proof; use water paints on the walls.

STEP 4: Criteria for Establishing Zones within a Store (10minutes)

· The selection of the storage zones (as well as suitable storage equipment) is determined by various criteria:

Required storage temperature and humidity
Size of the product
Volume of batch
Weight of batch
Requirement for special storage equipment
Dangers posed by products
Required level of security
Requirements of national legislation

· The required level of security for internationally controlled drug products is determined by national legislation and regulations.

· The level of security will also depend on the risk of theft which may be high for internationally controlled drug products as well as antibiotics, for example.

· The number of items requiring specific storage conditions as well as their average stock levels will determine the required size each zone should have. For example a medical storage facility may require only a small steel safe or a reinforced vault for storage of internationally controlled drug products. Cold chain loads may require only a single refrigerator or require a walk-in cold room.

· Every product must be put away in the zone with the storage conditions recommended by the manufacturer and indicated on the packaging as well as according to the requirements by national drug legislation.

· While the storage in refrigerators or locked rooms leaves no choice, many health care stock items can be stored on floor pallets or on shelves. This choice is determined by the volume of batch of each product.

· Possible changes in the need for different zones as well as the capacity of individual zones should be taken into account from the very beginning. The zoning plan should be as flexible as possible to allow future changes such as extension of the cold room with a minimum of structural changes to the building.

STEP 5: Types of Stock Location within a Zone (30 minutes)

Activity: Small Group discussion(15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

How are stock items arranged in fixed, fluid and semi-fluid location systems?
What are the advantages and disadvantages for each of the systems above?

REFER students to the recommended references

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add point not mentioned

CLARIFY and SUMMERIZE by using the content below

· Types of location within zones:

Fixed location
Fluid location
Semi-fluid location

· Fixed location:

In fixed location system, each stock item is allocated to specific shelves, pallet racking or an area of floor. For this system to work well, the store has to be large enough to accommodate the maximum possible level of stock for every item, including safety stock. As stock is used up, the storage location is emptied and left vacant until a new shipment of the item is received.
Advantage:

§ Simplest to manage/ stock administration is relatively easy because each stock item can always be found in the same place.

Disadvantages:

§ Fixed location systems are inflexible. If there is a change in the quantity ordered or a change in packaging, the assigned location may become too large or too small.

§ If a new item is ordered, there may be no place to store it.

§ Theft may increase because all store staff are familiar with the locations of valuable items.

§ Storage space may be wasted, because at times it is largely empty

· Fluid location

The store is divided into many designated locations. Each location is assigned a code. Individual items are stored wherever space is available at the time of delivery.
Administration for a fluid location system works as follows:

§ The procurement unit provides information on the type, volume, and weight of goods arriving.

§ The store keeper asses which locations will be empty when the new stock arrives and assigns an appropriate location. These data are recorded in the stock control system.

§ If insufficient space is available, other stock items may be moved to create more space

§ The stock control location records are updated.

Fluid location systems require a classification system that allocates a unique identifier code to each stock item and to each location. Also the stock record for each batch of each item must always indicate the physical location of the item in the store.
In a fluid location system, different batches of a particular item may be stored in several different places (give an example).
This systems benefit immensely from the use of a computerized bin location and storage system, which improves productivity and optimizes storage capacity. Such systems identify locations of items and the best locations for storing an incoming consignment within the storage areas.
Advantages:

§ It uses available space efficiently because none of the places has to be reserved for any specific item.

§ Batches of items never have to be moved or relocated to maintain a certain order.

Disadvantages:

§ It requires sophisticated stock administration due to the difficulty of keeping track of the storage places of all batches.

§ Different batches of the same item may be stored in different places which makes strict stock rotation and FEFO/FIFO management difficult.

§ In case of errors, stock may be lost

· Semi-fluid location:

A Semi-fluid location system is a combination of the fixed and fluid systems.
Each item is assigned a fixed space for picking stock. When an order is prepared, the order-picking staff members know where to find each item.
The remainder of the store is filled on the fluid location principle. When the picking stock runs low, the fixed locations are restocked using items from the fluid locations.
Advantages:

§ Picking stock is always kept in the same place

§ Picking stock is stored at a convenient height, eliminating the need for mechanical handling during order picking in stores that issue in relatively small quantities.

§ If demand increases for a particular item, the picking stock can be replenished more frequently

§ As new products are introduced, picking bays may be subdivided to provide sufficient space.

Disadvantages:

§ It is not as space-efficient as a fluid location system.

§ Risk exists (though less, unlike in a fixed location) that changing requirements will disrupt the system.

STEP 5: Stock Classification (30minutes)

· Items should be clearly organized within each zone of the store. Such organization makes it much easier for store personnel to control stock, take periodic stock inventory and pick orders.

· Some common systems for arranging medicines include:

o Therapeutic / pharmacological category

o Alphabetical order by generic name

o Dosage form

o Random bin

o Frequency of use

o System level

o Commodity code

o Combination

· Therapeutic category:

May be an effective way of organizing medicines in smaller stores and in the dispensaries of small clinical facilities where the store-keeper is the dispenser and also very knowledgeable about pharmacology. It is not an advantage in large stores.
Disadvantage:

§ Applicable only to drug products

§ Ambiguous

· Clinical indication:

Similar to therapeutic category and may be convenient in small warehouses.
All hypertensives are together as are all antidiabetics or other drugs with a common clinical indication.
One problem is that many drugs have multiple clinical indications.
A clinical indication system therefore requires a level of professional knowledge that stores staff are unlikely to have.
If staff do acquire this knowledge, theft may become a problem

· Alphabetical order by generic name:

Is also attractive in peripheral store that keep a small number of items, but often seen in both large and small facilities.
When using this system, the labelling must be changed when the National Essential Medicine List is revised or updated
Advantages:

§ Requires no knowledge about nature and use of items

§ Applicable to any item

Disadvantages:

§ Mixes very different items

§ Does not consider appropriate zones (temperature, safety, security etc.)

· Dosage form:

Medicines come in different forms, such as tablets, syrups, injectable, and external use products such as ointments and creams. In this system, medicines are categorized according to their dosage form.
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.
Advantage:

§ The forms are easy to recognize when receiving stock items-does not require much skill

§ Allows optimal use of space

Disadvantage:

§ Applicable only to drug products

· Random bin

Identifies a specific storage space or cell with a code that corresponds to its aisle, shelf, and position on the shelf.
For example, a shelving unit can be divided vertically and horizontally into cells, each cell with a specific location code. A unit of shelving might be labeled “B”, its bays “B1” and “B2” and its shelves “A,” “B” and “C”. A specific cell would be identified, for example as B1-B, this cell is called a bin.
This method can combine the methods described above. For example, items are placed alphabetically within therapeutic classification. Generic names are used throughout. If there is more than one brand of the same generic drug preparation, all are stored in the bin for that type.
This system requires computer automation.

· 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.
Advantage

§ Reduce time required for put-away and order picking

Disadvantage

§ Level of use need to be determined for each item

§ More storage space is required because many commonly used items appear at more than one level.

§ Distribution on a FIFO/FEFO basis becomes more difficult to achieve

§ One of the other methods of organization is needed within each level of use to avoid chaos

· 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. This system should be used in combination with another system.

· Commodity coding

Each item has its own article and location code. This system has the greatest flexibility, but it is also the most abstract.
It is based on a unique/specific article code combined with a unique/ specific location code
Store keeping 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 flammability or clinical indication, level of use or any other relevant data.
Changes in the national medicine list can easily be introduced by assigning unique article codes to new products.
This system works well in computerized inventory control systems.
The location code is totally independent of the article code and is similar to the random bin principle.
Codes can be designed to incorporate any number of characteristics including

§ Correct storage temperature for the product

§ Correct security level for the product

§ Whether the product is flammable

§ The building where the product is located

§ Pack size

§ Pharmaceutical form

Advantage:

§ Same logical order inherent in the coding

§ No pharmaceutical knowledge needed

§ Groups often correspond to required storage conditions

§ Applicable to all items

§ Increases security, but still allows items to be identified by those staff who have access to the coding key.

Disadvantages:

§ Codes must be known or looked up

§ Order may not be entirely consistent

STEP 6: Arrangement of Stock within a Zone (10minutes)

· Organizing stock systematically saves time when ordering or locating items and prevents stock from being lost.

· The systems most often used in health facilities are organization by therapeutic category, clinical indication or dosage form with products arranged alphabetically within those categories.

· Liquids for internal use must be kept separate from those for external use

Activity: buzzing (5 minutes)

ASK students to pair up and buzz for 5 minutes on the following question

What is the importance of arranging liquids for external use and internal use in different zones?

ALLOW few pairs to respond

WRITE responses on the flip chart/ board

CRALIFY and SUMMERIZE by using the content bellow

STEP 7: Key Points (5 minutes)

· Zoning/setting up of stock within the store: Medicines and medical supplies must be located in a part of the store with the correct combination of temperature and security. This initial zoning process is the most basic way in which supplies can be arranged.

· Criteria for establishing zones within a store include required storage temperature and humidity, size of the product, volume of batch, weight of batch, requirement for special storage equipment, dangers posed by products, required level of security and requirements of national legislation.

· Types of stock location within a zone are fixed, fluid and semi-fluid locations.

· Stocks may be classified or organized by the following methods; therapeutic / pharmacological category, alphabetical order by generic name, dosage form, random bin, frequency of use, system level, commodity code or a combination of other methods.

· Arranging stocks systematically saves time when ordering or locating items and prevents stock from being lost.

STEP 8: Evaluation (5minutes)

· Define zoning?

· What are the criteria of establishing zones within the store?

· What are the stock locations within a zone?

References:

Management Science for Health and World Health Organization. (2012). managing access to medicines and health technology, (3rd ed.). Kumarian Press

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd ed.).West Hartford, Connecticut, USA:Kumarian Press

World Health Organization (WHO), Regional Office for Africa Brazzaville (2004), Management of Drugs at Health Centre Level Training Manual.

Shirima, L. L (1988): Basic Store-keeping and Warehouse Management. General Publication

Jessop, D and Morrison (1994) Storage and Supply of Materials, (6th ed.), Prentice Hall

Laurie L, Editor, (2003) Guidelines for the Storage of Essential Medicines and Other Health Commodities. John Snow, Inc./deliver in collaboration with the World Health Organization

Guire G. Mc (2011), handbook of humanitarian health care logistics: designing the supply

network and managing the flows of information and health care goods in

humanitarian assistance during complex political emergencies (2^nd ed.). Retrieved

fromwww.humanitarianhealthcarelogistics.com

Session 7: Factors Affecting the Quality of Medicines and
Medical Supplies During Storage.

Total Session Time: 120 minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Define Quality of Medicines and Medical Supplies

· List Factors Affecting Quality of Stored Medicines and Medical Supplies

· Explain the Consequences of Poor Storage of Medicines and Medical Supplies

· Describe Ways to Avoid the Effects of Medicines and Medical Supplies Deterioration.

· Identify Signs of Deteriorated Medicines

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	05 minutes	Presentation	Introduction, Learning Tasks
2	10 minutes	Presentation Brainstorming	Definition of Medicines and Medical Supplies
3	15 minutes	Presentation Buzzing	Factors Affecting Quality of Stored Medicines and Medical Supplies
4	30 minutes	Presentation	Consequences of Poor Storage of Medicines and Medical Supplies
5	35 minutes	Presentation Small group discussion	Ways to Avoid the Effects of Medicines and Medical Supplies Deterioration.
6	15 minutes	Presentation	Identification of Signs of Deteriorated Medicines
7	5 minutes	Presentation	Key Points
8	5 minutes	Presentation	Evaluation

SESSION CONTENTS

STEP1: Introduction, Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Quality of Medicines and Medical Supplies

(10 minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

What is quality of medicines and medical supplies?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

· Quality of medicines and medical supplies

Quality of medicines and medical supplies can be defined in terms of suitability for the intended use. Thus, several aspects are of importance are efficacy and safety of the product conformity with specifications in terms of identity strength, purity and other characteristics as specified in pharmacopoeia or pharmaceutical regulations.

STEP 3 Factors Affecting Quality of Stored Medicines and Medical Supplies
(15 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 5 minutes

What are factors affecting quality of stored medicines and medical supplies?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

The following are factors which affect the quality of stored medicines and medical supplies

· Heat

· Temperature

· Moisture

· Light

· Microbial contamination

· Air

· Humidity

· Cold

· Rats and mice

STEP 4: Consequences of Poor Storage of Medicines and Medical Supplies

(30 minutes)

· Heat

o Heat leads to chemical decomposition, protein denaturation

· Temperature

o Temperature may cause some compound to melts e.g. ointment and become useless.

· Moisture

o Moisture can cause tablet to crumble

· Light

o Strong light will damage many medicine

· Microbial contamination

o Microbial contamination may contaminate with medicines ingredients and cause infection

· Air

o The chemicals in drugs can slowly react with the oxygen in the air

· Humidity

o Too high humidity may cause growth of fungus and mould in the stored medicines

· Cold

o In very cold condition liquid medicine may freeze. Some vaccines, if they have been frozen should not be used.

· Rats and mice

o Can chew through containers made of most materials around the content to become contamination

STEP 5: Describe Ways to Avoid the Effects of Medicines and Medical Supplies Deterioration (35 minutes)

Activity: Small Group Discussion ( 15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

· What are the ways to avoid the effect of medicines and medical supplies deterioration?

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

· Temperature

o Temperature effect is avoided by storage in cold conditions, refrigerator, room temperature and other temperature depending on a specific type of drug.

o In the storage room one must

§ Maintain a refrigerator temperature 2-8 C using thermometer

§ Keep freezers and refrigerators in shady, ventilated area

§ Record temperature in room and refrigerator three times a day

§ Compare the recorded temperature with the recommended temperature of their medication

§ Minimize frequency and duration of opening the refrigerator

§ Keep the refrigerator well organized

§ Use refrigerator exclusively for medical product, not for food

· Humidity

o In humid climate, dehumidifiers are used for preventing moisture damage

o If there is no dehumidifiers use ventilating fans or opens windows

· Light

o Keep liquids in tinted glass

o Keep light sensitive items in their originally package

o Protect from sun

· Air

o Well-fitting lids on containers

o When you open containers keep it open for the shortest possible time

o Replace their lids securely and promptly

· Rats and mice

o Make your store as “rat-proof”,

o Use fine wire mesh in wall cracks and windows

o Stores good in pallets or shelves not on the floor

o Use rats trap or poison to kill rats

· Moisture

o Moisture effect is avoided by ensuring aeration in the store, ensure the store is dry, some drugs contain sachets, ensuring drugs are retained in their original container, drying of hands when handling drugs, the use of pellets

· Heat

o Store should be built in the shade or nearby trees

o Supplies should be kept out of direct sunlight

STEP 6: Identification of Signs of Deteriorated Medicines (15minutes)

· Some damage can easily identified by looking at the damaged drugs or containers. A close examination of some damaged medicines can results the following

Medicines Sign of damage

1 – Compressed tablets swollen, crumpled and damp

2 – Ointments melted

3 – Adrenaline injection changes to brown colour

4 – Any medicine moulds or fungus growing

5 – Medicine containers holes or marks

6 – Tablets broken

STEP 7: Key Points (5 minutes)

· Quality of medicines and medical supplies refers to suitability for the intended use.

· Factors which affect the quality of stored medicines and medical supplies include heat, temperature, humidity, light, air, etc.

· Medicines and medical supplies that are deteriorated can easily identified by looking at the damaged medicines or packaging materials

STEP 8: Evaluation (5minutes)

· What are special storage conditions applicable to medicines and medical supplies?

· What are the factors that affect quality of stored medicines and medical supplies?

· What are the ways to avoid the effect of poor medicines storage?

· What are the consequences of poor storage of medicines and medical supplies?

· What are identification signs of deteriorated medicines

References

Ministry of Health and Social Welfare (MOHSW) ( 1997 ). Wizara ya Afya na Ustawi wa Jamii cha muongozo wa utoaji sahihi na dawa . Dar es salaam : Tz Ministry of Health and Social Welfare

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd ed.).West Hartford, Connecticut, USA: Kumarian Press

Session 8: Ordering of Medicines and Medical Supplies

Total Session Time: 120 minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Define Ordering of Medicines and Medical Supplies

· Explain the Procedure for Ordering Medicines and Medical Supplies

· Identify Stock Records Required for Ordering Medicines

· Practice Filling and Completing Order Forms Used in the Facility.

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· Handout 8.1. Ordering of Medicines and Medical Supplies

· Worksheet 8.1.Sample of report and Request Form

· Worksheet 8.2: Answers for Small Group Discussion

· LCD projector and computer

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	05 minutes	Presentation	Introduction, Learning Task
2	10 minutes	Presentation Buzzing	Definition of Ordering of Medicines and Medical Supplies
3	25 minutes	Presentation Buzzing	Procedures for Ordering Medicines and Medical Supplies
4	10 minutes	Presentation	Stock Records Required for Ordering Medicines
5	60 minutes	Presentation Small Group Discussion	Filling and Completing Order Forms Used in the Facility.
6	05 minutes	Presentation	Key Points
7	05 minutes	Presentation	Evaluation

SESSION CONTENT

STEP1: Introduction, Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Ordering of Medicines and Medical Supplies

(10 Minutes)

Activity: Buzzing (5 minutes)

Ask students to pair up and buzz on the following question for 2 minutes:

What is ordering of medicines and medical supplies?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

· Ordering of medicine and medical supplies

Is a process of placing a request to a supplier to get needed stock.

· Things to consider while planning to order new stock are

o What to order

o When to order

o How much to order

STEP 3: Procedures for Ordering Medicines and Medical Supplies

(25 Minutes)

Activity: Buzzing (5 minutes)

Ask students to pair up and buzz on the following question for 2 minutes:

What are the procedures for ordering medicines and medical supplies?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

· The ordering process starts with pharmaceutical personnel and medical officers in charge of the facility filling out a monthly/quarterly R&R (Report and Request) form

· The completed form is sent to the District Medical Officer for approval and with the assistance of District Pharmacist these forms are compiled together and then sent to MSD

· MSD reviews the order and delivers the required items with sales invoice to the District

· The District Medical Officer/Pharmacist receives the medicines and related supplies for the district and distributes them to the facilities according to the order

· The ordering of medicines is normally done quarterly or monthly

· Excessive stock is wasteful and should be avoided and on the other hand ordering too little will result in shortages

Refer students to Handout8. 1. Ordering of Medicines and Medical Supplies for further reading

STEP 4: Stock Records Required for Ordering Medicines (10 minutes)

· Stock record and Bin Cards

Very important tools used to control the stock movement of items in the store
Each item has its own bin card and should be displayed on the shelf where the product is located
It is necessary to do actual counts of stock on hand to check the stock balance on regular basis (monthly)
The inventory taking should certify that the recorded transactions are accurate

· Store ledger

Usually kept in the office of the store in-charge
Contains information similar to bin cards
Each item has its own page and in additional to a part where one has to fill in the amount of medicine expired, broken or lost and the remarks.

· Report and Request Form (R&R)

A form used for reporting the movement of medicines and commodities through the facility, and also requesting quantities of stock needed to replenish supplies

· Dispensing register

This is the book which used to record medicine dispensed

STEP 5: Filling and Completing Order Forms Used in the Facility. (60 minutes)

Activity: Small Group Discussion ( 30 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

Today is 1^st of January 2008 and it is time for Jamhuri hospital of Kisarawe district to complete R & R for HIV test kits. The following information was obtained for the past three months usage data. The facility code is 00475534

Group work

· The store ledger shows that by 30^th September 2008 the physical inventory for SD Bioline was 24 kits, Determine 1 kit, Unigold 3 kits

· For the period of October 1^st to December 31^st 2008 the facility received 16 kits, of SD Bioline, 1 kit of Determine and 0 kit of Unigold

· During the same period daily usage records from VCT/PITC indicates that 355 tests of SD Bioline, 21 of Determine and 4 of Unigold were used whereas from PMTCT 250 tests of SD Bioline, 21 of Determine and 3 of Unigold were used for PMTCT purposes

· For the same period the usage record from lab indicated that 250 tests of SD Bioline, 10 of Determine and 5 of Unigold

· A nearby health centre called Mwendapole Health centre borrowed 100 tests (given: 1 kit of SD Bioline has 25 tests, Unigold as 25 tests, Determine 100 tests)

ALLOW students to discuss for 15 minutes

ALLOW few groups to present and the rest to add points not mentioned

REFER students to worksheet 8.2 for answers.

CLARIFY and SUMMARIZE by using the contents below

STEP 6: Key Points (5 minutes)

· Effective ordering ensure access to constant supply of quality medicines and medical supply

· Proper documentation of medicines is essential to ensure good supply of medicines

· Medicines should be ordered by generic names

· Order quantity shall be based on estimate of the actual needs

STEP 7: Evaluation (5 minutes)

· Define ordering of medicines and medical supplies?

· Explain the procedure for ordering medicines and medical supplies?

· Identify stock records required for ordering medicines?

References

Ministry of Health and Social Welfare (MOHSW) (1997). Wizara ya afya na ustawi wa jamii cha muongozo wa utoaji sahihi na dawa. Dar es Salaam: Tz Ministry of Health and Social Welfare

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd ed.).West Hartford, Connecticut, USA: Kumarian Press

	Handout 8.1: Ordering of Medicines and Medical Supplies

Ordering by Dispensaries and health centers under the ILS, dispensaries and health centers will submit orders quarterly (every 3 months) to the DMO for the supplies to meet the needs of their clients. The facility in- charge determines the quantities of supplies they need and ensures that the quantities they order can be paid for and respond to the level of services that are provided by qualified health care workers.

The principles described below guide aspects of the ordering process. Detailed instructions can be found in the Job Aid:

Completing Form 2A: Dispensary or Health Center Report & Request for priority medicines and related supplies and equipment.

Form 2B: Hospital Report & Request for Priority Medicines and Related Supplies and Equipment.

Form 2C: Blank Report & Request for Additional Medicines and Related Supplies and Equipment at the Dispensary or Health Center, or Hospital.

1. Ordering is done through Form 2A: Dispensary and health center Report & Request for priority medicines and related medical supplies and equipment (R&R) and form 2C:

Blank Report & Request for additional medicines and related supplies and equipment. The Dispensary or health Center storekeeper determines the quantity of each product to order using Form 2A:

Dispensary and health center Report & Request for Priority and related medical supplies and equipment. The names of the products, MSD code, unit of issue, and price for each item are pre-printed on the R&R form.

The storekeeper or health facility in-charge is required to order all priority supplies each quarter, unless the product is already at or above its maximum stock level. (See the explanation below on maximum stock levels.) That is because priority supplies are the most important supplies to keep in stock.

If the facility does not ever use a specific product (e.g., some facilities may not ever issue intrauterine devices (IUDs) due to a lack of trained staff), it should not be ordered.

2. Calculating the Quantity Requested To determine how much to request, Form 2A: R&R includes a formula for ordering. That formula is based on logistics data, which is about quantities of supplies (as opposed to numbers about people or services, often called demographic or service statistics data). The logistics data needed to make orders are collected on Stores Ledgers (or MTUHA book 4 if it is being used) and are taken from the previous

The logistics data that will be taken from these forms and transferred to the R&R include:

Opening Balance The opening balance is taken from the ending balance for the facility from the previous quarter‘s Form 2: R&R (or the closing balance for the MTUHA book 4 for the facility ordering the first time.)

Quantity received this reporting period the quantity received this period is taken from Stores Ledger and includes all receipts of supplies received by the dispensary or health center from the district.

Lost/Adjusted Losses and adjustments are taken from Stores Ledger and would reflect the total net change in stock for the quarter due to expiration, damage, transfers (issue on loan/receipt on loan), clerical error or other reasons. For example, if there were a loss of 50 and a transfer in of 100, the total adjustment recorded on Form 2: R&R would be +50 (a positive sign for quantity gained and a negative sign for quantities lost).

Closing -Balance The closing balance for the facility tells how much of each product the facility currently has available for use. The ending balance should always be taken from a physical inventory conducted at the end of the month. See Section VIII-C for information on conducting a physical inventory.

Estimated Quarterly Consumption The estimated quarterly consumed quantity is the estimated total quantity of a product put in the hands of a client during the quarter. While it would be possible to collect the actual data by reviewing all registers and client cards for the entire quarter, that method would be extremely time-consuming. Consequently, a simpler formula for estimating consumption for the ILS has been developed. That formula is:

Opening balance + Received This Period ± Lost/ Adjusted Closing Balance =

Estimated Consumption

The estimated consumption has to be adjusted for products for which there has been a stock out during the reporting period. Stock outs are expected to be rare if products are appropriately ordered to the maximum stock level.

Refer to Job Aid: Handling Stock outs when Completing Form 2 A-C R & R

If there are frequent stock-outs, then try to find out why the stock-outs are occurring. Are they due to increased dispensing? Are they due to loss, expiry or damage? Were the order quantities for those supplies reduced due to insufficient funds? If a particular cause can be identified for the stock-outs, try to address and resolve the issue.

Quantity Needed: Based on a System of Maximum-Minimum Inventory control method of determining stock levels

The maximum stock level for priority medicines and medical supplies in the ILS is fixed at 7 months of stock. The use of 7 months of supply as the maximum is based on the fact health facilities will order all priority supplies every 3 months. A 7 month maximum will provide a facility sufficient stock of each priority supply to use during the quarter (3 months of supply), two months of supply while orders are being processed and shipped, and two months of buffer stock in the event that the need for any supply increases. Therefore, a 7 month maximum should help ensure that no priority supply will be stocked out at any time.

Worksheet 8. 1: Sample of report and Request Form

Instructions :Filling of R and R form


	Worksheet 8. 2: Answers for Small Group Discussion

Instructions: Student shall make comparison of their answers with the answers provide below.

Session 9: Receiving Medicines and Medical Supplies

Total Session Time: 120 minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Define Receiving of Medicines and Medical Supplies

· Explain the Procedures for Receiving Medicines and Medical Supplies

· Identify Stock Records Required for Receiving of Medicines and Medical Supplies

· Practice Filling and Completing Order Forms Used in the Facility

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

· Handout 9.1: receiving of medicines and medical supplies

· Worksheet 9.1: Sample of Good Received Note

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	5 minutes	Presentation	Introduction, Learning Task
2	10 minutes	Presentation Brainstorming	Definition of Receiving of Medicines and Medical Supplies
3	25 minutes	Presentation/ Buzzing	Procedures for Receiving Medicines and Medical Supplies
4	10 minutes	Presentation	Stock Records Required for Receiving Medicines
5	60 minutes	Presentation Small Group Discussion	Filling and Completing Receiving Forms Used in the Facility.
6	5 minutes	Presentation	Key Points
7	5 minutes	Presentation	Evaluation

SESSION CONTENT

STEP1: Introduction, Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Receiving of Medicines and Medical Supplies

(10 Minutes)

Activity: Brainstorming (5 minutes)

ASK students to brainstorm on the following question:

What is receiving of medicines and medical supplies?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

· Receiving of medicine and medical supplies

Is a process of receipt medicine and medical supplies from selected qualified vender.

· When receiving medicines and medical supplies the following information should recorded in the store ledger and bin card:

date of received medicines and medical supplies
the name of the supplier
quantity of medicines and medical supplies received Unit price

STEP 3: Procedures for Receiving Medicines and Medical Supplies

(25 Minutes)

Activity: Buzzing (5 minutes)

Ask students to pair up and buzz on the following question for 2 minutes:

What are the procedures for receiving medicines and medical supplies?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

· Within a facility, items should be received by the pharmaceutical personnel and approved by Hospital/health facility Therapeutic Committee (HTC)

· Products received should also be entered into stock cards/bin cards and the store ledger

· Delivery note and sales invoice should be used for comparing with the actual receipts

· If any discrepancy is observed, verification claim forms must be filled out and sent to MSD or other suppliers

· A room for keeping pharmaceutical products should meet all the specification required

· , Keep medicines and medical supplies in their appropriate storage conditions e.g. refrigerated medicines to be kept in the refrigerator

Refer students to Handout 9.1 Receiving of Medicines and Medical Supplies for further reading

STEP 4: Stock Records Required for Receiving Medicines (10 minutes)

Stock records required for receiving medicines in a store are:

o Verification and claim form

o Goods Received Note ( GRN )

REFER students to worksheet 9.1 for further reading.

STEP 5: Filling and Completing Receiving Forms Used in the Facility.

(60 minutes)

Activity: Small Group Discussion ( 30 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

INSTRUCT students to fill in verification and claims form for the exercises 1 and 2 below.

Exercise 1:

100 tins of Lamivudine 150mg, ordered, listed on the MSD sales invoice but not received.

Use the name of any facility, supplier, transporter and driver that you know. Assume the

ordered quantity was 500 tins in the form number 034.

Exercise 2:

3 tins of Abacavir 300mg tablets, received on 30^thJune 2009, with less than 3 months shelf life remaining. Expiry date 30^th September 2009

ALLOW students to discuss for 30 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

STEP 6: Key Points (5 minutes)

· Receiving of medicine and medical supplies is a process of receipt medicine and medical supplies from selected qualified vender.

· Within a facility, items should be received by the pharmaceutical personnel and approved by Hospital/health facility Therapeutic Committee (HTC)

o Stock records required for receiving medicines include verification and claim forms and goods received note ( GRN )

STEP 7: Evaluation (5 minutes)

· What is receiving of medicines and medical supplies?

· What are the procedures for receiving medicines and medical supplies?

· What are stock records required for receiving of medicines and medical supplies?

References

Ministry of Health and Social Welfare (MOHSW) (1997). Wizara ya afya na ustawi wa jamii cha muongozo wa utoaji sahihi na dawa . Dar es Salaam: Tz Ministry of Health and Social Welfare

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd e.d.).West Hartford, Connecticut, USA: Kumarian Press

Handout 9.1: receiving of Medicines and Medical Supplies

A. Dispensary and Health Center Level

It is the responsibility of the DMO to ensure that the pre-packaged supplies received

Quarterly from MSD are delivered to each facility in time. The process by which the supplies are received at the facility.

1) Facility waits for supplies from district until week 3 of month 3 of the quarter.

According to the delivery schedule in Section V-Ordering, supplies should be delivered from the DMO to health centers and dispensaries by the end of the third week of the third month of the quarter. (For example, if the quarter is Feb/Mar/Apr, the expectation is that the order will be received within the third week of April.)

2) Is delivery on time? The Facility-In-charge should check to see if the truck coming from the district is on time.

2a) Shipment at district?—If the supplies do not arrive on time, the facility in-charge should contact the district to determine if MSD has delivered the facility‘s order to the district.

2b) Wait until shipment at district.—If the facility‘s order is not at the district, the facility should wait until it has arrived.

2c) Shipment at the district but not delivered to the facility on time? -Facility in charge should follow up with the DMO. Determine if the District can arrange to deliver the shipment in good time, otherwise, arrange pick up.

3) Facility receives shipment, noting date on the district generated transaction record. The facility should maintain records of the GRN or the district generated transaction record to enable monitoring of deliveries. The district should deliver these cartons, intact, to the facilities. At the facility, the facility in-charge will count the number of cartons and sign for that receipt. The contents of the cartons will not be known until they are opened later.

4) Open cartons with a Village Health Committee (VHC) member and two other

Witnesses present As soon as possible after the shipment arrives at the facility the in-charge should notify the VHC and arrange for a member(s) to be present for the opening of the carton. It is necessary that this step be completed immediately after the receipt of the sealed cartons. If no member of the Village Health Committee is available, the facility in charge should contact the village government which would name a person to be a witness. Both the facility in charge and the village health committee member and witnesses should compare what is delivered with what is on Form 4: MSD Sales Invoice In case of any discrepancies, unacceptable shelf life, or damage, the facility in-charge should fill out and sign Form7.Verification and Claims Form in triplicate (packed inside one of the cartons) to be signed by all three witnesses. A copy of Form 7 is retained at the facility, a copy is sent to the DMO and the original sent to MSD. To MSD.

The box will also contain Form 5: Customer Statement of Account which should be given to the Facility In charge. The statement of account will be used to determine the amount of the central allocation that can be spent for the next order.

5) Record receipt in Stores Ledger. All acceptable supplies should be recorded the Stores Ledger/MTUHA Book 4. Unacceptable supplies should be quarantined (separated) into a special area to ensure that they will not be dispensed. Facilities should return unacceptable supplies to the district. Unacceptable supplies returned from the district will be returned to MSD, during the next MSD delivery.

6) Store supplies appropriately —See Section VIII, Storing Medicines and Related Supplies. Remember to store supplies so that the supplies first to expire are first to be issued (FEFO, first expiry, first out).

7) Inform Prescribers and Dispensers of arrival of supplies. These staff member should be informed so they are aware of the new shipment, particularly if a product was previously stocked out.

B. The Hospital Level

The process by which district hospitals, regional hospitals, and referral hospitals receive supplies from MSD is essentially the same with the following minor differences. Orders from MSD should be received by the hospital by the end of the 2 week of the 3^rd month of the quarter. The hospital should take their order directly to the MSD Zonal Store and can pick up the supplies directly. Otherwise, MSD will deliver the order to the hospital.

The sub-HTC should witness the receiving of shipments in accordance with their responsibilities as specified in the functions of the HTC.

Worksheet 9.1: Sample of Good Receiving Note

Session 10: Stock Control Practice

Total Session Time: 120 minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Define Common Terms Used in Stock Control Of Medicines and Medical Supplies

· List Stock Control Records and Documents Used in Physical Inventory

· Explain the Process of Stock Taking and Reconciliation

· Explain the Process of Recording and Reporting the Unserviceable Stocks

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

· Handout 10.1: S.F 15 Form

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	5 minutes	Presentation	Introduction, Learning Tasks
2	10 minutes	Presentation Buzzing	Definitions of Common Terms Used in Stock Control of Medicines and Medical Supplies
3	10 minutes	Presentation Brainstorming	Stock Control Records and Documents Used in Physical Inventory
4	40 minutes	Presentation	Process of Stock Taking and Reconciliation
5	45 minutes	Presentation Small Group Discussion	Process of Recording and Reporting the Unserviceable Stocks
6	5 minutes	Presentation	Key Points
7	5 minutes	Presentation	Evaluation

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definitions of Common Terms Used in Stock Control of Medicines and Medical Supplies (10 minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

What is

o Inventory?

o Lead time?

o Pull system?

o Push system?

o Re order level?

o Buffer stock?

o FEFO?

o FIFO?

o Stock taking?

o Unserviceable stock?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

· Terms Commonly Used in Stock Control of Medicines and Medical Supplies include;

Inventory

§ The stock on hand at any given time

Lead time

§ The time interval between when new stock is ordered and when it is received and available for use

Pull (request) system

§ In a pull system, quantities to be issued are determined by personnel who receive the supplies

Push (allocation) system

§ In a push system, quantities to be issued are determined by personnel who issue the supplies

Re-order level

§ Is the level of stock when you place an order

Buffer stock/Safety stock

§ I s a stock used during lead time

FEFO

§ First expiry first out

FIFO

§ First in first out

Stock taking

§ Is a process of counting physically

Unserviceable stock

§ This include products with one or more of the following characteristic, expired, damaged, has contaminated items, has items instituted for recall, un repairable or obsolete for medical equipment’s and prohibited

STEP 3: Stock Control Records and Documents Used in Physical Inventory (10 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

What are the stock control records and documents used in physical inventory?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

· Common stock control records and documents used in physical inventory include:

Ledger books
Bin cards
Stock taking sheets

STEP 4: Process of Stock Taking and Reconciliation (40 minutes)

Checking the Stock

The store keeper makes a physical count of the stock, and makes an entry on the card. The stock check can be done on the routine basis for all stock (e.g. Once a month)

It is better if the stock count is done without looking at any other stock information and then any differences can be investigated later.

To calculate the theoretical balance which should be present, the formula used

Theoretical Balance = Opening balance – Stock Issued + Stock Received

If stock count and theoretical balance agree, then the stock is said to be reconciled

If the stock count and theoretical balance do not agree, then the stock is not reconciled

When the stock is not reconciled, that is when there is a difference between the stock count and the theoretical balance, it is vital to investigate the reasons for the difference. There may be a simple explanation (accidental breakage),but it may be that there is some theft or pilfering occurring, and if this is so, then random and unannounced spot checks on the stock balance should be made.

STEP 5: Process of Recording and Reporting the Unserviceable Stocks

(45 minutes)

Activity: Small Group Discussion ( 20 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

· What are the processes of recording and reporting the unserviceable stocks?

ALLOW students to discuss for 20 minutes

ALLOW few groups to present and the rest to add points not mentioned

Refer students to Handout 10.1: S.F 15 for Further Reading

CLARIFY and SUMMARIZE by using the contents below

Health facilities should conduct inspection and physical inventory for their medical stores monthly.
During the inspection and physical inventory the medical stores in charge should look for the following criteria that may render the product unserviceable

o Expiry

o Damage

o Contaminated items

o Items instituted for recall

o Un repairable or obsolete medical equipment

o Prohibited

Any item deemed to be unserviceable should be separated from usable items, removed from normal stores ledger and recorded into the Unserviceable goods ledger.
A separate marked area should be identified. All unserviceable medical stores should be in an identified separate marked area For easy access and verification
All health facilities in charges with unserviceable medical stores should report to the District Medical officer’s (DMO) office using form S.F 15(Refer below) and should ensure that these products are submitted to the DMO’s office every quarter by the 10^th day of the next quarter through reliable means of transport.
Facilities in charges should liaise with the DMO’s office for the most efficient method of submitting S.F 15 and if possible delivery of unserviceable medical stores to the DMO’s office.
Issuance of unserviceable medical stores should be through the use of local issue voucher
For pharmaceuticals the facility in charge should initiate the redistribution of all products that will not be dispensed by the facility within the next three months to the nearby facility within the council as per laid out procedures to avoid expiries.

NOTE: This process is carried out at all levels of health facilities, i.e. dispensaries/health centres, District Hospitals, Regional referral hospitals, Special hospitals, zonal hospitals, and National hospital. The difference lies at the reporting centre (District, region or Accounting officers) and the personnel reporting.

Refer students to Handout 10.1: S.F 15 for Further Reading

STEP 6: Key Points (5 minutes)

Terms commonly used in stock control of medicines and medical supplies include inventory, lead time, pull system, push system, re order level, buffer stock etc.

Stock control records and documents used in physical inventory are Ledger books, Bin cards and stock taking sheets

During the inspection and physical inventory the medical stores in charge should look for the following criteria that may render the product unserviceable

o Expiry

o Damage

o Contaminated items

o Items instituted for recall

o Un repairable or obsolete medical equipment

o Prohibited

STEP 7: Evaluation (5 minutes)

What are common terms used in stock control of medicine and medical supplies?
What are the stock control records and documents used in physical inventory?
What are the processes of recording and reporting the unserviceable stocks?

Which criteria are used to render a product unserviceable

Reference

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd ed.).West Hartford, Connecticut, USA: Kumarian Press

Ministry of Health and Social Welfare (2013) Guidelines for Management of

Unserviceable Medical Stores in Health Facilities Tanzania Mainland, Dar-

Es-Salaam

W.H.O (1991) Guidelines on the Storage of Essential Drugs in Eastern and Southern

Africa

Handout 10.1: Form S.F 15

To…………………….

…………………….

Form S.F 15

THE UNITED REPUBLIC OF TANZANIA

SCHEDULE OF UNSERVICEABLE STORES

Ledger Folio	Quantity	Unit	Articles	Date of issue or approximate period in use	Rate	Value		Nature of and reason for unserviceability and recommendations for disposal
Ledger Folio	Quantity	Unit	Articles	Date of issue or approximate period in use	Rate	SHs	Cts

NOTES Signature of Officer-in- Charge of Stores

A line must be drawn

Immediately beneath the …………………………………………...

Last entry.

In the case of allocated Date……………………………………….

Stores the original rate

And value are required

Session 11: Process of Handing Over of the Store

Total Session Time: 120minutes

Prerequisites

· None

Learning Tasks

By the end of this session students are expected to be able to:

· Define Handing Over of a Store

· Explain the Importance of Handing Over of the Store

· Explain the Process of Handing Over of the Store

· List Stock Records Documents Used in Handover of a Store

Resources Needed:

· Flip charts, marker pens, and masking tape

· Black/white board, chalk and whiteboard markers

· LCD projector and computer

· Worksheet 11.1Handover Note

SESSION OVERVIEW

Step	Time	Activity/ Method	Content
1	05 minutes	Presentation	Introduction, Learning Task
2	10 Minutes	Presentation Buzzing	Definition of Handing over of a Store
3	30 minutes	Presentation Small group discussion	Importance of Handing Over of the Store
4	60 minutes	Presentation	Process of Handing Over of the Store
5	05 minutes	Presentation	Stock Records Documents Used in Handover of a Store
6	05 minutes	Presentation	Key Points
7	05 minutes	Presentation	Evaluation

SESSION CONTENTS

STEP1: Introduction, Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Handing Over of a Store (10 minutes)

Activity: Buzzing (5 minutes)

Ask students to pair up and buzz on the following question for 2 minutes:

What is handover of a store?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

· Handing over is the process of transferring of key issue, tasks and changes in Management plan from one care professional to another.

· Handover Notes are documents created by staff members who are about to leave their position, or permanently to assist their successor to carry out their duties.

STEP 3: Explain the Importance of Handing Over of the Store(30 minutes)

Activity: Small Group Discussion ( 15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

· What are the importance of handing over a store?

ALLOW students to discuss for 10 minutes

ALLOW few groups to present and the rest to add points not mentioned

CLARIFY and SUMMARIZE by using the contents below

The importance of the handing over report enable to prepare scope of duties to be performed is vast for their position.

The report also helps the newly joined person to understand the Safety and General condition of the working place.

The report assists in understanding the documentation of pharmaceutical records.

It helps the new joiner to plan his work accordingly.

It helps the person to understand the average consumption of each item in a store

A handing over report can also be used as a reference if an officer is stuck while performing a job, as details of duties

STEP 4: Process in Handing Over of the Store (60minutes)

· In charge of the store is accountable for the safekeeping of the stock in hand. Hence, should be required to conduct stocktaking exercises at specified intervals. If there is a change of staff, both the incoming and outgoing stores officers are recommended to take the following steps

All items held in stock should be checked to ensure they tally with the records.
If it is not practicable to check all items during the handover, the incoming officer should select randomly a number of items for checking, particularly those of high value.
Any surpluses or shortfalls of items identified should be documented and reported to senior officers.
The outgoing and incoming officers should sign a handover report for record purposes

Refer students to work sheet 11.1: filling handover note.

STEP 5: List Stock records and documents used in Handover of a store

(5 minutes)

Bin cards
Ledger book
Requisition book
Issue voucher
Job description
Handover note

STEP 6: Key Points (5 minutes)

Handing over is the process of transferring of key issue, tasks and changes in Management plan from one care professional to another.
Importance of handing over include to help the newly joined person to understand the Safety and General condition of the working place, to help the new joiner to plan his work, to help the person to understand the average consumption of each item in a store accordingly, etc
Stock records and documents used in Handover of a store includebin cards, ledger book, requisition book, issue voucher, job description and handover note

STEP 7: Evaluation (5 minutes)

· What is handover of a store?

· What are the importances’s of handing over a store?

· What are the steps in handing over of the store?

References

Management Science for Health and World Health Organization. (2012). Managing Access to Medicines and Health Technology, (3^{rd ed}.). Kumarian Press

Management Science for Health and World Health Organization. (1997). Managing Drug Supply, (2nd ed.).West Hartford, Connecticut, USA: Kumarian Press

World Health Organization (WHO), Regional Office for Africa Brazzaville 2004, Management of Drugs at Health Centre Level Training Manual.

Shirima, L. L (1988): Basic Store-keeping and Warehouse

Management. General Publication United Republic of Tanzania, Public Procurement Act, 2004, Dar es Salaam

Jessop, D and Morrison (1994) Storage and Supply of Materials, 6th Edition, Prentice Hall

Laurie L, Editor, (2003) Guidelines for the Storage of Essential Medicines and Other Health Commodities. John Snow, Inc. /DELIVER in collaboration with the World Health Organization

Worksheet 11.1:.Handover Note

Instructions : filling handover note

Handover Note

Template

Name: Index number:

Job Title:

Date of Handover Note:

Duration of Assignment (include start and end date):

Brief Description of Duties:

This section may be kept brief when up-to-date terms of reference (TOR) are attached.

…………….

Supervisor and reporting procedures:

Regular/re-occurring meetings, reports or procedures:

……………………….
………………………..

Key Documents/reference material to read (attach when possible):

……………..
……………..

Status of recent and current projects/reports/meetings:

Name of project/report/meeting

Status
Action needed
Partners
Budget (if applicable)
Critical issues/challenges/priorities

Repeat as many times as necessary. Indicate priority projects.

Where to find files (hardcopy and electronic):

Calendar of major activities and/or events (optional):

Contacts (internal and external):

Name	Organization	Phone	E-mail	Comments

Your contact information after departure:

Phone

Session 5: Premise Suitable for Storage of Medicines and Medical Supplies

Session 8: Ordering of Medicines and Medical Supplies

Session 9: Receiving Medicines and Medical Supplies

Session 5: Premise Suitable for Storage of Medicines and
Medical Supplies