Hospital Pharmacy Part-3 Shiekha AlAujan Msc.

Purchasing & Inventory Control

Managing the Purchesing & Inventory Control System The Hospital Formulary System is the cornerstone of purchasing inventory control maintained by P&T committee the products on the formulary dictate what the hospital pharmacy should purchase & keep in inventory prescribe, lay down, impose, set down, order, command, decree, ordain, direct, determine, decide, control, govern.

Managing the Purchesing & Inventory Control System Managing the Purchasing & Inventory Control System: Some pharmacies employ a FEW specialized individuals responsible for managing the purchasing & inventory process, others use MANY individuals. Limiting the number of individuals to few specialized: Permits greater expertise & efficiency. Other staff uninformed and unengaged. So, with high turnover rate, it would be a problem. Best, Cross training individuals in Purchasing & Inventory Control

Managing the Purchesing & Inventory Control System Now, computers & internet technology are used to manage purchasing & receiving of pharmaceuticals from a drug wholesaler. Bar codes Hand-held computer devices Benefits of Using Computer Technology: Up to-the-minute product availability information. Comprehensive reporting capabilities. Accuracy Tighter inventory control & efficiency Complying with various pharmaceutical purchasing contracts by keeping track of terms & reminding about deadlines, & contract pricing deals.

Manufacturer OR Wholesaler?!

Purchasing & Inventory Control Manufacturer or Wholesaler ?! **The disadvantages of direct purchasing from a manufacturer outweigh the advantages. Therefore, most pharmacies primarily purchase through a drug wholesaler. Some drugs , however, i.e. those that require unique control or storage conditions can be purchased only directly from the manufacturer. 

Purchasing & Inventory Control Advantages of Direct Purchasing from Manufacturer: 1. Not having to pay handling fees to a third party wholesaler. 2. The ability to order on an infrequent basis (once a month). 3. Less demanding system for monitoring inventory. 

Purchasing & Inventory Control Disadvantages of Purchasing from manufacturers: 1. Need to order larger quantities to take advantage of manufacturer discounts. 2. need for more capacity to store additional inventory. 3. More cash tied up in inventory. 4. More complicated drug return & crediting. 5. The need to spend more time to prepare & pay purchase orders to many different companies. 6. The manufacturer may be distant to the pharmacy, creating problems with long product delivery.

Receiving & Storing Pharmaceuticals Receiving medications from the suppliers is one of the most important parts of the pharmacy operation A poorly organized receiving system put patients at risk and elevate health care costs Example .. Misplaced or out-of-stock product: harm the patient lower the efficiency of the department Wrong concentration is received by the pharmacy.. Lead to dosing error or delay in therapy

Receiving & Storing Pharmaceuticals The Receiving Process: By Receiving personnel, to verify the shipment is complete & intact before putting items into circulation or inventory. Check for missing or damaged items Some pharmacy follow the policy that requires the person who receives pharmaceuticals be different from the person ordering them Important for controlled substances

The Receiving Process 1- Checking of damaged shipment or incorrect box counts Receiving personnel play a critical role in protecting the pharmacy from financial responsibility for damaged products in the shipment, products not ordered ,and products not received. Products with a cold storage requirement should be processed first Performed in the presence of delivery person Any damage, should be documented when signing the order

The Receiving Process 2- Checking the delivered products against the receiving copy Done after the delivery person has left Ensures that the products ordered have been received The name, brand, dosage form, size of the package, concentration strength, and quantity of the product must match the purchase order Expiration date should be checked, minimum of 6 months is acceptable

The Storing Process store properly at temperature & humidity levels recommended by manufacturers. Depending on size & type of the pharmacy operation, the product may be placed in bulk, central storage area or into the active dispensing areas of pharmacy. Expired products in stock should be removed. Products near expiry should be highlighted & placed in the front of the shelf (stock rotation).

The Storing Process Stock Rotation: The process of placing newly acquired products behind currently stocked medications on the shelf. Help in using the products before they expire First-in, first-out

The Storing Process All stocks should be stored at temperature and humidity levels recommended by the manufacturers and defined by the United States Pharmacopoeia (USP) Freezer -25 to -10°C Cold (refrigerated) 2 to 8°C Cool 8 to 15°C Room temperature The temperature of working area Controlled room temperature 20 to 25°C Warm 30 to 40°C Excessive heat Above 40°C

Inventory Control Pharmacy Inventory: The stock of drugs & components which will be used to fill prescriptions. A business wants sufficient inventory to meet customer need, but does not want inventory which has already been paid for, sitting on the shelf unused (potential for out-of-date). **A key goal of inventory management is to maximize inventory turns (products should be used & not remain on the shelf) Verb: جرد Noun: stock , مخزون

Inventory Control ** The higher the # of inventory turns, the more profitable the business. At the hospital pharmacy, the inventory is restricted by the formulary system which is constructed by the P&T committee.

Inventory Control 1. To save money The reasons for restricting the # of drugs stocked by the pharmacy are: 1. To save money 2. To assure the patients receive the most effective drugs As restricting to 1 type of beta blockers instead of three

Inventory Control ** Managing the inventory requires a team effort in a pharmacy; all employees who order, receive, check, stock, dispense, sell, or restock products must make accurate entries to the inventory system. Asmaking entry of the actual no of tablets that dispensed

Inventory Control **Using computer technology to maintain a continuous status of the inventory: An initial inventory of products is loaded into the computer & as each item is sold or dispensed, the computer automatically subtracts amount of the item sold from the present inventory.  **Perpetual Inventory: For prescription drugs **Point of Sale Inventory: All items prescriptions & otherwise 

Borrowing Pharmaceuticals Borrowing of medications between pharmacies Restricted to emergency situations Limited to authorized staff A Borrow form is used to provide a detailed directions on the process. A secure procedure is required

Drug Recalls A manufacturer or FDA occasionally recall pharmaceuticals from pharmacies. Reasons for recalling that harm the public health include: Mislabeling Microbial contamination Presence of forign substances Content uniformity failure Subpotency pH failure Dissolution failure Deviation in good manufacturing process Stability data does not support expiration date

Hospital Pharmacy Source of Drugs Wholesaler Other Pharmacy Drug Company Purchase Borrow Recall Expired

I.V. Admixtures

I.V. Admixtures - Intravenous: within the vein. - Additive: The drug that added to an IV solution. - IV admixture: The completed preparation. Improper compounding May be associated with critical problems. So appropriately qualified pharmacists & technicians are responsible to prepare IV admixtures Establishing a centralized pharmacy IV admixtures service is essential to ensure: 1. Sterility by applying aseptic technique 2. Stability 3. Accurate pharmaceutical calculations 4. Avoid incompatibility

I.V. Admixtures Advantages of IV Admixture Service: 1. Centralizes the responsibility of the preparation, dispensing, & controlling of parenteral admixtures. 2. Eliminates the need for nurses or physicians to prepare & dispense IV preparations providing them additional time for their professional responsibilities. 3. Increases the safety of parenteral medications.

I.V. Admixtures **All IV fluids sent from Pharmacy should be labeled under standard format produced automatically by computer. The label contains the following information: 1. Patient’s name & location 7. Scheduled hang time 2. Patient’s medical record # 8. Any special storage conditions 3. Patient date of birth 9. Date prepared 4. Active ingredient(s) & quantity of each 10. Expiration date & time 5. IV solution (diluent) 11. Initials of pharmacist 6. Run rate or frequency

 Quality Control

Quality Control or Quality Assurance (QA) program A program that defines medication errors & learn from them how to prevent recurrence of the error. Aim: to establishes an acceptable level of performance & identify when standard of performance is not met. ** prevent medication error by: Analyzing individually & collectively data collected in response to medication error to assess the cause & any contributing factors.

 Quality Control Quality Control includes all activities that contribute to: Defining, assessing, designing, monitoring & Improving the quality of health care Principles to guide QA in Health Care: 1. Focus on the patient 2. Focus on the system & processes 3. Focus on measurement 4. Focus on treatment  

Pharmacy Satellites

Pharmacy Satellites **The satellites needed for: 1.Operating Room 2.Oncology for Chemotherapy 3.Pediatrics 4.The Emergency Room  

Pharmacy Satellites Functions: 1. First-dose distribution (orals & IVs) 2. Routine drug distribution (cart filling) 3.Compounding parenteral agents 4.Drug therapy monitoring 5.Order review, editing, & computer entry 6.Provision of DI to professionals 7.Cardiopulmonary resuscitation team participation 8.Distribution of controlled substances 9.Consultation with physicians & nurses

Education/ Training / Research

Education/Training/Research 1.Offering Continuous Education CE Programs to pharmacists, physicians, nurses. 2.Training pharmacy students (internship) 3.Providing residency programs 4.Hospital pharmacists may participate in research conducted in the hospital 5.Publishing newsletters accessible to staff & public

Education/Training/Research **Importance of Research in Hospital Pharmacy: 1. Promotion 2. Better service for patients 3. Better opportunities for pharmacist career 4. Gain knowledge 5. Prosper for the country

Education/Training/Research **Elements of Research in Hospital Pharmacy: 1.Abstract 2.Introduction 3.Methodology 4.Results 5.Discussion 6.Conclusion