MEDICAL STORES

MANAGEMENT
Felix Khuluza, MSc, BPharm
 Objectives
At the end of this session, trainees should be
able to—
– Discuss the various aspects of good storage
practices
– Identify special storage conditions for certain
types of pharmaceuticals
– Identify storage problems at the facilities where
they work and suggest adequate solutions
 Information for Materials Management
• Goals of Medical stores management are to
protect the stored items from loss, damage, theft,
or wastage and to manage the reliable movement
of supplies from source to user in the most
economical and expeditious way.

• Primary purpose of a store is to receive, hold and

dispatch stock a process controlled by an
inventory control system which may be manual or
computerized
• Effective information management is the key
to achieve the goals of medical stores
management.
• The whole process is materials management.
• Materials management has 3 components
1. Inventory control system: obtaining the right
goods in the correct quantities, monitoring
their quality, and minimizing the total
variable cost of operation
2. Warehouse management system: flow of
goods within the system
3. Performance monitoring system:
• Manual vs. Computerised systems: to
manage data of products on entering &
leaving the warehouse, products in stock,
products on order, & ways to monitor the
progress of orders in the supply pipeline.
• Procurement information:
– suppliers, unit prices, the quantities on order,
expected arrival dates and other info.
– Medical stores tracks issues to individual health
units, noting modes of transport, delivery times
and confirmation of receipts from user units. It
should lead to monthly and annual values of
total issues, issue qty, details of specific
products, & how budgets allocation are used
• Stock records
• Performance monitoring and reporting
• Communication
• Characteristics of a well –managed stores
operation

 Store should be divided into zones that provide a

range of environmental conditions and degrees of
security

 Stock should be arranged within each zone

according to some orderly system

 Stock should be stored on pallets on the floor,

pallet racks, or on shelves
 Good house keeping- cleaning and inspection,
disposal of expired and damaged stock, and
management of security – should be maintained
 The management structure should be clearly
defined
 Staff should be appropriately qualified, trained,
disciplined, and rewarded
 Good working conditions and facilities
 Flow of Stock and Paperwork
1. Receiving (stock receipt);
arrive in receiving room, quarantined,
inspected and entered into stock recording
system

2. Storage:
Accepted goods are moved to their allocated
storage positions in the warehouse, FIFO or
FEFO ( to avoid accumulation of expired or
obsolete stock)
3. Allocation of stock:
manager determines whether or not to
allocate the complete quantities requested
when a requisition is received depending on
stock status and on review of facility
consumption patterns ( and in some cases, on
budget status)

4. Order picking:
Order-picking list is prepared (which may be the
original requisition), and is used to identify and
collect the allocated items from the warehouse.
5. Order assembly:
individual orders are assembled and checked in
the packing area. They are then packed for
delivery. Delivery documentation is prepared.

6. Dispatch and delivery:

The packed goods are loaded onto the transport
and dispatched, accompanied by necessary
documentation, including a packing list recording
all items and quantities. Signed delivery notes are
checked when the vehicle returns. If errors or
damage has been reported, appropriate action is
taken.
 Zoning stock within the store
Drugs & essential medical supplies are located in a
part of the store with correct combination of
temperature and security
• Flammables
• Storage at Controlled Temperature and Controlled
Humidity
• Cold Storage
• Secure storage
• Storage at Uncontrolled Room Temperature
 Stock Location within a Zone
• Fixed Location
• Fluid Location
• Semi-fluid Location
 Ways of Stock Classification
1. Therapeutic or pharmacological category

2. Clinical indication (problem – drugs with

multiple clinical indications)

3. Alphabetical order (by generic name)

4. Level of Use….? problems

4. Dosage Form (e.g. tablets& capsules kept
separate from injectables)
5. Random Bin – a unique storage space
identified by a code. E.g. a shelving unit can
be divided vertically and horizontally into
cells, each with a unique location code. B its
bays B1 & B2
6. Commodity Code based on a unique article
code combined with a unique location code.
Article codes can be designed to specify
therapeutic class, clinical indication or level of
use.
 Stock Storage and Handling
4 basic systems for storage: Shelves, Floor pallets,
Block-stacked pallets, and pallet racks.

Choice of system depends on;

• Total quantity of products to be stored
• Average volume of each product
• Internal height of the storage building
• Local availability of mechanical handling
equipment and the skills to use and maintain it
 Good
Arrangement

Good Quality
Control and Maintenance
Rotation Good
Record-
Keeping

Proper Assured
Disposal Security
How to Arrange the Storage Area (1a)

Photos by Gabriel Daniel, Management Sciences for Health,

Rational Pharmaceutical Management Plus Program
 How to Arrange the Storage Area (1b)
Before After

Photos by Judy Wang MSH/SPS

How to Arrange the Storage Area (2)
Windows

Shelves at this level are for items that are—

• Lighter
Mezzanine/second level
• Less sensitive to high temperature
• Less sensitive to light

Stairs Reception area

S
Staging area AI H
S EL
L V
E
E
Entrance

Forklift Cool room, refrigerator,

Steel cabinets freezer
Quarantine area
Access-controlled storage:
Dispensing area
Offices and staff facilities double-locked cabinet
Rooms
Windows Entrance or window
Basic Storage Systems

Direct storage of cartons on the

warehouse floor must be avoided.

1. Shelves
2. Floor pallets
3. Block-stacked pallets
4. Pallet racking
 Shelves: Basic Rules
• Heavy and Batch No:
Expiry:
Batch No:
Expiry:
Batch No:
Expiry:

fragile items on Batch No:

Expiry:
Description
Batch No:
Expiry:
Description
Batch No:
Expiry:
Description

the lower Batch No: Description

Description
Expiry:
Batch No: Description
Expiry:
Batch No:
Expiry:
shelves Batch No:
Description
Batch No:
Description
Batch No:
Description
Expiry: Expiry: Expiry:

• Frequently Description Description Description

picked items at Reserve Stock Reserve Stock

waist height
• Extra stock on Batch No:
Expiry:
Batch No:
Expiry:
Batch No:
Expiry:

the upper Description Description Description

Batch No: Batch No:
Expiry: Expiry:
shelves (if it is Batch No: Batch No: Batch No:
Expiry: Expiry: Expiry: Description Description
not too heavy) Description Description Description

• Boxes tidy and

closed as much Batch No:
Batch No: Expiry:
as possible Expiry:
Description
Description

Fragile Items Fragile Items Heavy Items Heavy Items

 Pallets: Basic Rules
c m
30

Description: Description: Description: Batch No:

Expiry:
Description
Description: Description: Description:
Batch No:
Expiry:
Batch No:
Description
Description: Description: Description: Expiry:
Description

Batch No: Batch No:

Description:
Batch No: Batch No: Batch No:
Expiry:
Expiry: Expiry:
Expiry: Expiry:
Description: Description: Description: Description: Description:
Description: Description: Description:

Batch No:
Batch No: Batch No: Batch No:
Expiry:
Expiry: Expiry: Expiry:
Description: Description: Description: Description:
Description: Description: Description:
Description:
Batch No: Batch No:
Batch No: Batch No:
Batch No:
Expiry: Expiry:
Expiry: Expiry:
Expiry:
Description: Description: Description: Description: Description:
Description: Description:
Description:
30 cm

Block-stacked pallets
• Light goods
• Items without expiry dates
• Items with very high
turnover
Special Precautions: Flammables and Corrosives
• Always store flammables
in their original
containers.
• Large amount of stock:
Use a location away from
main storeroom.
Never store in direct sunlight.
• Small amount of stock:
Steel cabinet Use a steel cabinet that
will contain any spillage. Do not store
flammables with
• Display international
corrosives.
hazard symbol.
• Use coolest location.
• Avoid build-up of
pressure.
• Control evaporation rate.
• Use industrial gloves to
handle corrosives. Store flammables
away from pallets.
Special Precautions: Controlled Substances
• Double-locked
cabinet
• Special register
recording—
– Of each receipt or
issue with two
signatures
– Physical counting
after each entry
– Signatures at
“handover” and
“takeover”
• Independent audit
Maintain Quality
• Inside the storage area …

• …what can affect the quality of the medicines?

Cleanliness Temperature

Humidity Direct light

Staff Facilities and Housekeeping
 Provide adequate staff facilities.

 Prohibit the consumption of food in

areas where stock items are stored.

 Clean the storeroom areas regularly.

 If needed, implement pest control

measures such as poison, but use
proper precautions.
 Security: General Rules
• Set rules so that all staff who handle supplies are
equally accountable for their actions.
• Maintain good control of stock cards and registries to
detect theft.
• Use double doors and double locks on entrance.
• Use burglar bars on windows.
• Control entry to the pharmacy.
• Fire and safety precautions
– Provide fire extinguishers or buckets of sand & smoke detectors, and
inspect them regularly
– Make sure the emergency exit is not blocked or inaccessible
– Dispose of flammable trash.
Disposing of Expired or Damaged Items
 Expired medicines may no longer be
effective and may be dangerous.
 Damaged or expired stock should be
placed in a designated salvage area.
 A written record of all stock consigned to
this area should be maintained.
 Expired or damaged stock must be
destroyed in accordance with local
regulations.

Photos by Gabriel Daniel, Management Sciences for Health,

Rational Pharmaceutical Management Plus Program
 Ensuring Good Control of Stock through
Good Record-Keeping
• Stock cards
• Ledgers or stock books
• Computer
Maintain stock records of
each item to ensure
accuracy and
accountability.
Adequate Stock Rotation: Minimize
Losses Due to Expired Medicines
 Apply FEFO.
 Monitor expiry
dates closely.
 Give excessive
stock to DHO for
redistribution.
 Evaluate Your Storage Practice and condition

Develop checklist to monitor and evaluate storage practice and condition

 PHARMACEUTICAL
MANAGEMENT FOR HEALTH
FACILITIES
 PHARMACEUTICAL MANAGEMENT
FOR HEALTH FACILITIES
• Managing drug supply at the facility level directly
affects the quality of health care
• Each facility must have systems to ensure;
 Secure storage
 Storage in correct environmental conditions
 Accurate record keeping
 Effective reordering
 Effective stock rotation and expiry monitoring
 Effective fire and theft prevention
The purpose of inventory control at the facility
levels is to;
To Prepare effective orders
Maintain records in accordance with local requirements
Adjust inventory levels to respond to new
morbidity trends and changes in STG
 Maintain sufficient stock-levels within budget
limits
Provide appropriate, safe, and secure storage
Prevent expiry of drugs
 Benefits of a successful inventory control
system at the facility level

• Patients receive drugs promptly

• Stock-outs can be prevented even when deliveries
are delayed
• Supplies can be replenished at scheduled
intervals
• Saving on administrative costs and transport time
• Patients have confidence in the facility and seek
help when they are ill
• An effective inventory system keeps track of and
ensures accountability for supplies.
 Problems arising from poor stock
control?

• Overstocking of certain items may tie up a

substantial portion of drug budget
• Overstocked drugs often expire
• Poor storage conditions may result in spoiled
stock
• Poor stock records and poor security make theft
easier
• A change in prescribing policy or practice may
make a drug obsolete
 Managing the storage area
Good inventory control requires careful thought of:
• Dimensions and design of the storage space
• Appropriate conditions for storage
• The importance of stock rotation and systematic
arrangement of stock, as well as attention to
• Cleanliness, fire-prevention measures, and
security within store.
• Sizing
Due to increased use of disposable medical supplies,
more storage space is needed.
One square meter of storage area per bed for one
month supply

• Receiving bay
A weather-protected area designated for receiving
supplies should be close to the storage area.
Often raised from above the ground level to facilitate
unloading from large delivery vans.
 Storage of supplies
Most products can be kept at uncontrolled room
temperature 15 – 25oC
Categories
 Items needing storage in a controlled environment e.g.
adrenaline inj, some suppositories, X- ray films and
chemicals
 Items needing freezing or refrigeration E.g. vaccines
 Controlled drugs e.g. narcotics – Pethidine
 Attractive items; non-controlled items but prone to theft,
abuse, or misuse, e.g. certain antibiotics, equipment
such as scissors and safety razors.
 Flammables and corrosives
Stock rotation and Expiry monitoring
• FIFO and FEFO systems
• Expiry dates should be noted on the stock record upon
receipt, and regularly monitored

Arrangement of stock
• Organizing stock systematically saves time when ordering
and locating items.
• Could be by; therapeutic category, clinical indication,
or dosage form with products arranged alphabetically
within those categories

Cleaning, Fire prevention and security

Inventory control within health facility

Most important record is the stock card - should

have – space for item description & its stock #,
unit of issue, expiry date, columns & rows to
document receipt and issue of stock.
 Ordering stock
• Simple system of ordering for health facilities
is by Imprest or Topping-up system
– Particularly useful for hospital wards and small
h/facilities that receive supplies frequently

• Another system for ordering is based on

consumption vs. maximum stock level
Quantity to order= maximum stock- stock on
hand

Maximum Stock= Average monthly consumption

X Maximum stock factor

Maximum stock factor is affected by lead time

and frequency of ordering
• Receiving Stock: there should be clear
procedures for receiving stock. Person in-
charge is responsible even if the job is
delegated

• Unpacking & Checking stock

– Two people should perform thorough check of the
items and report for any discrepancies e.g.
• Missing boxes; missing items
• Open boxes wrong items
• Damaged, broken, or poor-quality items
• Qty different from the one shown on the packing list
 Distributing Stock from the Storeroom
• Small health facilities
• Hospital pharmacy departments
– Pre-packaging for OPD
• Use containers suited for maintaining drug quality
• Avoid contamination or mixing different batches of
drugs
• Label containers appropriately and assign a new expiry
date
– Supplying In-patients
– Emergency
What are the advantages and disadvantages of
Collection vs. Delivery Systems?

How can we improve management of

CMS ?