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File: Stores Management Pdf 194816 | Mds3 Ch44 Medicalstores Mar2012
part i policy and economic issues part ii pharmaceutical management part iii management support systems planning and administration organization and management 43 security management 44 medical stores management 45 hospital ...

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                     Part I:  Policy and economic issues          Part II:  Pharmaceutical management         Part III:  Management support systems
                                                                                                              Planning and administration
                                                                                                              Organization and management
                                                                                                                43  Security management
                                                                                                                44  Medical stores management
                                                                                                                45  Hospital pharmacy management
                                                                                                                46  Pharmaceutical management for health facilities
                                                                                                                47  Laboratory services and medical supplies
                                                                                                              Information management
                                                                                                              Human resources management
                     chapter 44
                     Medical stores management
                     Summary  44.2                                                                     illustrations
                     44.1  Information for materials management    44.2                                Figure 44-1  Checking received goods    44.6
                             Manual versus computerized systems  •  Procurement                        Figure 44-2  Storage and load-handling equipment    44.14
                             information  •  Stock records  •  Performance monitoring                  Figure 44-3  Good stores management    44.16
                             and reporting  •  Communications                                          Figure 44-4  Poor stores management    44.16
                     44.2  Flow of stock and information                    44.5                       Figure 44-5  Medical stores organizational chart                 44.18
                             Stock receipt  •  Planning for space requirements  •  Stock               Table 44-1       Inspection checklist for medicine receipts             44.7
                             storage  •  Stock control using FIFO and FEFO  •  Order                   Table 44-2       Temperature and security zones    44.9
                             allocation  •  Order picking  •  Order assembly  •  Order                 Table 44-3       Typical requirements for an effective cold 
                             dispatch and delivery  •  Inventory taking                                                 chain  44.11
                     44.3  Zoning stock within the store                  44.9                         Table 44-4       Contents of a procedures manual for a central 
                             Storage at uncontrolled room temperature  •  Storage                                       pharmaceutical supply system    44.19
                             at controlled temperature and humidity  •  Cold                           box
                             storage  •  Secure storage  •  Flammables                                 Box 44-1         Examples of monitoring and evaluation targets  
                     44.4  Stock location within a zone                  44.10                                          and indicators  44.5
                             Fixed location  •  Fluid location  •  Semifluid location
                     44.5 Stock classification  44.12                                                  country study
                             Therapeutic or pharmacological category  •  Alphabetical                  CS 44-1          Central medical stores inventory control system 
                             order  •  Dosage form  •  Random bin  •  Commodity code                                    operations in Namibia    44.3
                     44.6  Stock storage and handling                  44.13                           annexes
                             Packaging specifications  •  Shelving  •  Floor 
                             pallets  •  Block-stacked pallets  •  Pallet racking  •  Load             Annex 44-1  Sample stock record card    44.21
                             handling                                                                  Annex 44-2  Sample bin/stock card    44.22
                     44.7 Housekeeping  44.15                                                          Annex 44-3  Sample receiving report    44.23
                             Cleaning and pest control  •  Inspection  •  Disposal of                  Annex 44-4  Sample requisition/issue voucher    44.23
                             expired or damaged stock  •  Fire precautions  •  Security                Annex 44-5  Sample delivery voucher    44.24
                     44.8  Human resources management in medical                                       Annex 44-6  Sample register of requisitions                44.24
                             stores  44.17
                             Staff training and the medical stores procedures 
                             manual  •  Staff supervision and discipline  •  Career 
                             development
                     44.9 Staff facilities  44.17
                             Sanitary facilities  •  Staff rest areas  •  First aid
                     References and further readings                  44.19
                     Assessment guide  44.20
                     copyright   management sciences for health 2012
                                 ©
            44.2    ORGANIZATION ANd MANAGEMENT
                       suMMary
                       This chapter discusses medical stores management at               The following are characteristics of a well-managed 
                       central-level stores and at regional or district-level stores     stores operation—
                       that are independent from health facilities. This supply            •	 The store should be divided into zones that provide 
                       model represents the traditional top-down system that                  a range of environmental conditions and degrees of 
                       is operated by a governmental or parastatal entity or a                security.
                       nongovernmental organization; however, a number of                  •	 There should be an appropriate zone to suit every 
                       countries have now decentralized many of their pharma-                 item to be stored.
                       ceutical sector operations, including stores management.            •	 Stock should be arranged within each zone accord-
                       Chapter 8 discusses supply chain options, including the                ing to some orderly system.
                       trend toward decentralization. In addition, many supply             •	 Stock should be stored off the floor on pallets, on 
                       systems contract out certain operations to private-sector              pallet racks, or on shelves. Each of these systems 
                       companies. Managing contracts requires skills such as                  requires specific types of handling equipment.
                       defining and monitoring performance indicators and                  •	 Good housekeeping—cleaning and inspection, the 
                       negotiating payment and service terms. See Chapter 39                  disposal of expired and damaged stock, recording 
                       for more information on contracting. The tenets of this                of stock movements, and the management of secu-
                       chapter, therefore, apply to stores operating in either the            rity—should be maintained.
                       public (often called central medical stores) or nonpublic           •	 The management structure should be clearly 
                       sectors.                                                               defined.
                       Medical stores management should assist both the flow               •	 Staff should be appropriately qualified, trained, dis-
                       and reliability of supplies from source to user as eco nomi-           ciplined, and rewarded.
                       cally and reliably as possible, and without significant             •	 Clearly written procedures and handbooks should 
                       wastage, loss of quality, or theft. The primary purpose                be available.
                       of a store is to receive, hold, and dispatch stock. This            •	 To promote efficiency, staff should have good work-
                       materials management process is implemented through                    ing conditions and facilities.
                       inventory control and warehouse management systems,                 •	 Stock should be verified regularly and periodic 
                       which may be manual or computer based. The primary                     audits should be conducted.
                       purpose of inventory control is to manage stock and               Although the essential characteristics of materials man-
                       ensure the smooth flow of goods by determining what,              agement are the same for all systems, the level of sophis-
                       how much, and when to order stock. Consequently, it               tication of medical stores varies widely, and each store 
                       provides essential information for procurement manage-            approaches its system and documentation differently. 
                       ment. Warehouse management comprises the physical                 Therefore, the basic features presented in this chapter are 
                       movement of stock into, through, and out of a medical             adaptable, depending on the complexity of the medical 
                       store warehouse. The systems should also be designed to           stores management operation.
                       provide information for performance monitoring.
                     44.1  Information for materials management                            2.  A warehouse management system monitors the physi-
                                                                                              cal flow of goods within the system, such as receipts, 
                     The goals of medical stores management are to protect                    storage, and issues.
                     stored items from loss, damage, theft, or wastage and to              3.  A performance monitoring system checks that the sys-
                     manage the reliable movement of supplies from source to                  tems are operating effectively.
                     user in the most economical and expeditious way. Effective 
                     management of information is the key to achieving these               Information is essential to management (see Chapter 
                     goals. The integrated process is known as materials manage-         49). Collecting, processing, and disseminating informa-
                     ment. A fully developed system has three key components—            tion may seem costly, but the cost of developing and main-
                                                                                         taining an information system should be balanced against 
                      1.  An inventory control system ensures that the right             the costs of ineffective inventory control (see Chapter 23). 
                          goods are acquired, in the correct quantities, monitors        The design of the information system is important, but its 
                          their quality, and minimizes the total variable cost of        success depends primarily on well-trained, organized, and 
                          operations (see Chapter 23).                                   supervised staff. Country Study 44-1 describes some of the 
                                                                                                                  44  /  Medical stores management           44.3
                 inventory control system challenges to the central medical            to be accomplished more rapidly, accurately, economically, 
                 stores in Namibia.                                                    and flexibly. Even with a computerized system, data must 
                                                                                       be entered, manipulated, and interpreted by skilled and 
                 Manual versus computerized systems                                    knowledgeable staff.
                 The information system must include data on products  Procurement information
                 entering and leaving the warehouse, products in stock, 
                 products on order, and ways to monitor the progress of  The procurement process (Chapters 18–21) involves medi-
                 orders in the supply pipeline. Key elements of the system are         cal stores input at all levels of the distribution system. These 
                 well-designed forms, computerized information systems,  inputs are described below.
                 and clearly defined procedures.                                          Procurement can be handled from a department within 
                    Two decades ago, most public supply systems relied  the medical stores or from an external unit. The medical 
                 completely on manual stock records, but now, many pro-                stores unit provides the (internal or external) procurement 
                 grams have changed to computerized systems. Even with                 unit with a list of the types and quantities of medicines 
                 computerization, however, many countries still maintain  needed for its operation. After a supplier is selected and a 
                 a manual system, such as bin cards, as a backup, espe-                purchase order is placed, the procurement unit informs the 
                 cially during the transition to computerization. There is a           medical stores unit about suppliers, unit prices, the quanti-
                 widely held belief that computerization solves the problem            ties on order, the expected arrival dates of shipments, and 
                 of inventory control. This belief is misguided. A computer            other vital information.
                 is not a substitute for trained staff; it is simply an addi-             The procurement unit tracks information on inventory 
                 tional tool for staff to use (see Chapter 50). Both manual            status, new shipments received and taken into stock, issues 
                 and computerized systems perform the same fundamental                 made to health facilities, expired medicines, damaged medi-
                 information-processing tasks: data input, data storage, data          cines, and audit data from physical stock checks.
                 processing, data retrieval, and data dissemination. The dif-             The medical stores unit also tracks issues to individual 
                 ference is that a computerized system enables some tasks              health facilities, noting methods of transport, delivery 
                     Country study 44-1 
                     Central medical stores inventory control system operations in Namibia
                    Namibia operates a classic central medical stores (CMS)            A computerized inventory control system had been 
                    distribution system with a CMS and two regional medi-              installed at the CMS several years earlier, but most of the 
                    cal stores. Administratively, the regional stores do not           staff members who were initially trained to use it had left 
                    have any links with the CMS—the relationship between               the public service; remaining staff members, therefore, 
                    them is one of customer and client. The CMS distrib-               were not using the system to its full advantage. Many 
                    utes medicines and supplies to the two regional medical            functions that could have been handled by the system 
                    stores, all district hospitals, and local hospitals and clinics    were done manually or with spreadsheets. Moreover, 
                    in the surrounding regions, while the regional stores and          management personnel reported that they did not have 
                    district hospitals are responsible for distributing to other       enough time to acquire the additional skills that would 
                    facilities within their geographic jurisdictions.                  help them use the system. 
                    Facilities are expected to order products from CMS every           As a result of the CMS assessment, a number of recom-
                    six weeks, and it usually takes CMS about four weeks               mendations to improve the inventory control system 
                    to process and deliver the order. An assessment of the             were made: conduct complete physical inventory counts 
                    CMS distribution showed, however, that stock records               at all levels and use the results to update or introduce 
                    were not adequately maintained and physical inventory              stock records; develop standard operating procedures for 
                    counts did not correspond with either stock records or             store management; and train staff on how to maintain 
                    computerized records. Because the regional stores and              stock records and use the computerized inventory con-
                    health facilities had no effective systems for deciding            trol system to their best advantage.
                    when, what, or how much to order, most facilities ended            Source: Management Sciences for Health/Rational Pharmaceutical 
                    up placing many emergency orders within the six-week               Management Plus Program.
                    order period, which stretched the capabilities of the 
                    already overburdened CMS.
            44.4     ORGANIZATION ANd MANAGEMENT
                     times, and confirmation of receipts from user units. This                When a shipment of medicines is received at the CMS, it 
                     tracking should generate information on the monthly and               is inspected to ensure that it meets the specifications in the 
                     annual value of total issues, issue quantities, details of spe-       supply contract. If the shipment is satisfactory, the receiving 
                     cific products, and how budget allocations are used.                  section of the warehouse produces a receiving report (see 
                        After an order has been placed, its progress should be             Annex 44-3). This report brings the procurement lead-time 
                     monitored until it is received at the central medical stores          period to an end.
                     (CMS). A good monitoring system makes it possible to                     Individual health facilities are the end users of medi-
                     estimate realistic delivery times and to decide whether any           cal supplies. Maintaining information from health facili-
                     supplementary or emergency orders are needed, well before             ties is essential in order to monitor consumption, forecast 
                     a stockout occurs.                                                    pharmaceutical requirements, and make other manage-
                        Both manual and computerized systems should identify               ment decisions. Many medical stores information systems 
                     milestones during the lead-time period to facilitate com-             also keep general information on facility location, facility 
                     munication with suppliers and to prompt corrective action             status, population served, method of distribution, delivery 
                     if required. Important milestones of the procurement lead             schedule, value of issues, and extent of current budget uti-
                     time are—                                                             lization.
                        •	 Order initiating date                                           Performance monitoring and reporting
                        •	 date of award to supplier (for tenders)
                        •	 Letter of credit information                                    A store should monitor and evaluate its operations to 
                        •	 Shipment information and date                                   identify problems in the system that need to be addressed. 
                        •	 Arrival at port                                                 Record-keeping and reporting systems should be designed 
                        •	 Port-clearing date                                              to make the collection of data for routine monitoring as 
                        •	 date of issuing a receiving report                              simple as possible (see Chapter 48). Stock records are a 
                                                                                           vital source of information on how effectively the dis-
                        An effective supplier information system should include            tribution system is being managed; therefore, maintain-
                     general information on suppliers and products, lead times,            ing these records accurately and keeping them up-to-date 
                     merit ratings, value of purchases, product quality, payment           is vital. They provide detailed evidence of how prod-
                     methods, and prequalification based on good manufac-                  ucts flow through the system and can be used to identify 
                     turing practices. Information about supplier performance              where problems are occurring so that corrective action 
                     should be compiled throughout the procurement cycle to                can be taken. Operational indicators can track progress 
                     assist in choosing future suppliers. Chapter 21 discusses             at two critical levels: from the supplier to the store, or 
                     the features of a procurement information system in more              “upstream,” and from the store to clients, or “downstream.” 
                     detail.                                                               Upstream information includes lead-time from supplier 
                                                                                           to the store, number of medicines procured, and monthly 
                     Stock records                                                         stock status reports. At the downstream level, the store 
                                                                                           should collect routine lead-time information; distribution 
                     Stock records contain information about suppliers, custom-            information by facility, district, and product; client sat-
                     ers, prices, stock receipts, stock issues, stock losses, and stock    isfaction and consumption data; and order-fill rate. Box 
                     balances. These data are essential for planning distribution.         44-1 shows a list of sample indicators. The medical stores 
                        A stock record (manual or computerized) must be main-              should prepare regular reports on stock and order status, 
                     tained for each item in the inventory. The stock record docu-         such as those described in Chapter 23, and send them 
                     ments all transactions relating to an item. It may contain            to relevant parties such as the ministry of health, pub-
                     information about reorder level, reorder interval, reorder            lic health programs, donors, lower-level warehouses, and 
                     quantity, lead time, stock on order, and estimated consump-           health facilities.
                     tion rate. Many stores also maintain bin cards for each prod-
                     uct in each storage area to record information on issues,             Communications
                     receipts, and stock balances. In some stores, this bin card 
                     is the most current and accurate record of inventory move-            The medical stores must maintain effective communica-
                     ment.                                                                 tions with suppliers, with procurement and inventory con-
                        The design of stock cards and bin cards depends on the             trol units, with lower-level warehouses and health facilities, 
                     choice of inventory control system. For details regarding             and with managers from the ministry of health. Periodic 
                     the design, selection, and use of different types of inventory        meetings with the staff members of client facilities can help 
                     control systems, see Chapter 23; examples of a stock record           ensure good communications and a more effective supply 
                     card and a bin card are provided in Annexes 44-1 and 44-2.            system.
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...Part i policy and economic issues ii pharmaceutical management iii support systems planning administration organization security medical stores hospital pharmacy for health facilities laboratory services supplies information human resources chapter summary illustrations materials figure checking received goods manual versus computerized procurement storage load handling equipment stock records performance monitoring good reporting communications poor flow of organizational chart receipt space requirements table inspection checklist medicine receipts control using fifo fefo order temperature zones allocation picking assembly typical an effective cold dispatch delivery inventory taking chain zoning within the store contents a procedures central at uncontrolled room supply system controlled humidity box secure flammables examples evaluation targets location zone indicators fixed fluid semifluid classification country study therapeutic or pharmacological category alphabetical cs dosage for...

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