PST Level 4 Semester 2

NTA Level 4 • Semester 2 • PST04212 Stock Control Practice Medical Stores Keeping • Source Session/Topic 10 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 Activity/ Step Time Content Method 1 5 minutes Presentation Introduction, Learning Tasks Definitions of Common Terms Used in Stock Presentation 2 10 minutes Control of Medicines and Medical Supplies Buzzing Presentation Stock Control Records and Documents Used in 3 10 minutes Brainstorming Physical Inventory 4 40 minutes Presentation Process of Stock Taking and Reconciliation Process of Recording and Reporting the 45 minutes Presentation 5 Unserviceable Stocks Small Group Discussion 6 5 minutes Presentation Key Points 7 5 minutes Presentation Evaluation 73 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; o Inventory  The stock on hand at any given time o Lead time  The time interval between when new stock is ordered and when it is received and available for use o Pull (request) system  In a pull system, quantities to be issued are determined by personnel who receive the supplies o Push (allocation) system  In a push system, quantities to be issued are determined by personnel who issue the supplies o Re-order level  Is the level of stock when you place an order o Buffer stock/Safety stock  I s a stock used during lead time o FEFO  First expiry first out 74 o FIFO  First in first out o Stock taking  Is a process of counting physically o 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: o Ledger books o Bin cards o 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. 75 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 •

NTA Level 4 • Semester 2 • PST04212 Receiving Medicines and Medical Supplies Medical Stores Keeping • Source Session/Topic 9 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 Activity/ Step Time Content Method 1 5 minutes Presentation Introduction, Learning Task Definition of Receiving of Medicines and Medical 10 minutes Presentation Supplies 2 Brainstorming Presentation/ Procedures for Receiving Medicines and Medical 3 25 minutes Buzzing Supplies Stock Records Required for Receiving Medicines 4 10 minutes Presentation Presentation Filling and Completing Receiving Forms Used in 5 60 minutes Small Group the Facility. Discussion 6 5 minutes Presentation Key Points 7 5 minutes Presentation Evaluation 64 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 o 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: o date of received medicines and medical supplies o the name of the supplier o 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 65 • 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 30th June 2009, with less than 3 months shelf life remaining. Expiry date 30th 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 66 67 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? . 68 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 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 69 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

NTA Level 4 • Semester 2 • PST04212 Ordering of Medicines and Medical Supplies Medical Stores Keeping • Source Session/Topic 8 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Task 10 minutes Definition of Ordering of Medicines and Medical Presentation Supplies 2 Buzzing 25 minutes Presentation Procedures for Ordering Medicines and Medical 3 Buzzing Supplies 10 minutes Stock Records Required for Ordering Medicines 4 Presentation 60 minutes Presentation Filling and Completing Order Forms Used in the 5 Small Group Facility. Discussion 6 05 minutes Presentation Key Points 7 05 minutes Presentation Evaluation 55 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 o 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 56 • 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 o Very important tools used to control the stock movement of items in the store o Each item has its own bin card and should be displayed on the shelf where the product is located o It is necessary to do actual counts of stock on hand to check the stock balance on regular basis (monthly) o The inventory taking should certify that the recorded transactions are accurate • Store ledger o Usually kept in the office of the store in-charge o Contains information similar to bin cards o 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) o 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 o This is the book which used to record medicine dispensed 57 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 1st 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 30th September 2008 the physical inventory for SD Bioline was 24 kits, Determine 1 kit, Unigold 3 kits • For the period of October 1st to December 31st 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

NTA Level 4 • Semester 2 • PST04212 Factors Affecting the Quality of Medicines and Medical Supplies During Storage Medical Stores Keeping • Source Session/Topic 7 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 Activity/ Step Time Content Method 1 05 minutes Presentation Introduction, Learning Tasks 10 minutes Definition of Medicines and Medical Presentation 2 Supplies Brainstorming 15 minutes Factors Affecting Quality of Stored Presentation 3 Medicines and Medical Supplies Buzzing 30 minutes Presentation Consequences of Poor Storage of Medicines 4 and Medical Supplies 35 minutes Presentation Ways to Avoid the Effects of Medicines and 5 Small group Medical Supplies Deterioration. discussion 15 minutes Presentation Identification of Signs of Deteriorated 6 Medicines 7 5 minutes Presentation Key Points 8 5 minutes Presentation Evaluation 49 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 o 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 50 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 51 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 52 • Heat o Store should be built in the shade or