150219 Pg Stock Management ENG › Documents › ...Management_ENG.pdf · = 1 presentation = 1...

STOCK MANAGEMENT

ITM

2014Philippe GilletHilde De Boeck

STOCK MANAGEMENT: Exercice (1)

• Timing: 5’ Introduction

40’ Exercice

40’ Restitution

40’ Conclusion

• Execution: role-play and results

"Receive and store a medical order"

STOCK MANAGEMENT: Exercice (1): order

STOCK MANAGEMENT: Exercice (1) : packing list

• Check the conformity between the order and what is received,

• Check the conformity of the packing list with the parcels received,

• Check the conformity of products + expiry date, shipment

conditions, integrity, etc.

• Prepare a report of receipt,

• Arrange storage of products received (storage conditions, stock

cards, etc.., ...).


"Receive and store an medical order"

What should you do:

= 1 presentation

= 1 expiry date

= 1 batch/lot. N°

1 card = 1 product

1 movement = 1 row

c.f. :TLM_PRO_004_V01_Use of stock cards RDTs.pdf

TLM_F_001 Version 002: STOCK CARD – FICHE DE STOCK


Tasks Group 1

Group 2

Group 3

Group 4

items 1 - 8 9 - 15 16 - 22 23 - 29

1

2

3

4

5


Opening packages + conformity packing list

Conformity order

Conformity product and arrange

Stock card

Report of receipt

GROUP 1 GROUP 2 GROUP 3 GROUP 4

NAING THIRI MOHAMED Ashi Abdi AUNG The TheHMUNG LYAN Freddy Sui

KAMAU Njunguru Jessee WYLIE Carol PESISCH Corina VONG-HOGETERP Stacia

AVELLANEDA Diana USENOVIC Nikola KOUM BESSON Emilie ZURGA Mohammed

ANUNIBE Joshua AMANDE Mathieu LAVREYS Thomas MARCIL Alexandra

VAN BREEVOORT Adriana WIJNANT Gert-Jan BECK Dominique NELIS Géraldine

STOCK MANAGEMENT

Introduction: Organization (Central) Stock

1. Stock manager

2. Storage Conditions

3. Tools (forms)

(Standard) product List

Stock Card

Consumption Report

Monthly Report

Registers (expired products, stock-outs, narcotic&psychotropics, …)

4. Physical inventory

5. Orders (replenishment)

6. Distribution

7. Indicators

Introduction

STOCK MANAGEMENT..

Own experiences…

What is good stock management?

Introduction

? Stock Card

Introduction

What is good stock management?

• All drugs, consumables, reagents and equipments needed

• Good storage conditions (WHO)

(Temperature [cold chain], humidity, safety, security, arrangement)

• No stock-out (few, non critical items?)

• No (few) over stock

• No (few) expired products

• A stock buffer for x months of activities

Good storage practices are part of a quality assurance system (GSP / GCLP)

Introduction

What influences your stock management?

�Structure: size and level (National procurement centre, hospital, health

center)

� Activities: routine, study, emergencies, activities load

� Policies & rules: country, organization (NGO,..),

� Supply chain: local, international, donations, ..

� HR, facilities, management tools

� Frequency of distribution

Introduction

• What influences your stock management?

Protocols/SOPStandard product list

Estimation of the needs

Introduction

How to start?

Introduction

How to start?

Analyze the situation:

� Infrastructure and management tools

� Responsibilities: Who? Stock manager?

� Needs: standard product list (procedure/SOP + activities)

� Supply chain: How? Who? Frequency? Budget?

� Donations: National Program? How to apply?

� Current situation: Inventory + activities

� Future: Introduction new tests, new protocols?

Even for a study :• Stock• Weekly distribution

For studies : (buffer) stock not included in the routine

1.Stock manager

Responsibilities (need of job description):

� Storage conditions

� Security and Safety

�Organization

�Reception

�Delivery

�Management of expiry dates/expired product

� Inventory

� Stock level follow-up

�Orders (validation of the orders needed)

�Traceability and product quality

1.Stock manager

JOB DESCRIPTION:

DAILY – WEEKLY – MONTHLY TASKS

Activity planning with chronogram

BEWARE: who validates clients orders and deliveries?

Only 1 responsible (and 1 key)

+ 1 back-up (1 key)

2.Storage conditions

Organize the place

� Office

administration, document control

� Reception area

verify quantity and quality

� Delivery area

preparation for expedition

� Stock

different categories (temperature, safety, security..)

� Circulation

RESTRICTED ACCESS

ADAPTED TO ACTIVITIES

1/3 arrival-departure-office1/3 storage

1/3 circulation+ quarantine, destruction


Classification:

1. Storage conditions (“normal”, keep cool, dangerous, regulated products,)

1.1 Type/categories (orals, injectables, IV fluids, diagnostic tests, liquids, powders, consumables, equipments, administrative material, … )

1.1.1 Alphabetically (standard list)

General rules:

� First expired – first out !! (FEFO)

� First in - first out !! (FIFO)

� Liquids lower shelves

� Clearly identify (INN) – expiry date

� Discard expired (how?)

2. Storage conditions

According to the label

1 « normal »

� Temperature

Daily follow-up (min-max.)

Protection direct sun-light, max.30°C

� Ventilation

� Humidity

No direct contact walls and floor

Relative humidity < 65 %

� Light

Protection direct light

� Pest-control measures

Rats, insects, ...



2 « keep cool »

� Fridge/freezer

� Daily follow-up (min-max.)

� (Logger)

�Maintenance

Also during transport

And action if needed…



3. « dangerous »

� Secondary containment for liquids

� Physical separation between incompatible products (acid><base)

� Material Safety Data Sheet (MSDS)

4. « regulated products » (psychotropics, narcotic…)

� Locked cupboard

� Specific IN/OUT register

� (if rules require) keep empty vials

� Restricted list of clients

New labels

DANGEROUS

SYMBOLS

Globally Harmonized System of Classification and Labelling of Chemicals (GHS)

http://www.unece.org/trans/danger/publi/ghs/pictograms.htmlhttp://ec.europa.eu/enterprise/sectors/chemicals/classification/index_en.htm


Deadline (Europe)For substance December 2010. For mixtures June 2015.

DANGEROUS

SYMBOLS

Globally Harmonized System of Classification and Labelling of Chemicals (GHS)


EXAMPLE

MSDS

• Material Safety Data Sheets (MSDS)http://www.merck-chemicals.com/is-bin/INTERSHOP.enfinity/WFS/Merck-

International-Site/en_US/-/USD/ViewSearch-SearchMSDS


�� CHEMICAL STORAGE:

http://www.lbl.gov/ehs/chsp/html/storage.shtml

Chemical Is Incompatible with:

Acetic acid

Chromic acid, nitric acid alcohols, ethylene glycol, perchloric acid, peroxides, permanganates

Chlorine

Ammonia, acetylene, butadiene, butane, methane, propane, hydrogen, benzene, powdered metals

Incompatible products : example



According to the labelling

3. « dangerous »

Tips :

VentilationFirst aid

3. Tools: forms

KEEPING TRACK….

How much do we need??

When do we need??

How to place an order???

�� Avoiding rupture

�� Avoiding expiration

?

???

?

3. Tools: Stock card

Priority n°1 !!

WHY ?

� Follows every stock movement

� Record physical inventory

� Basis for the order calculation

How to use ?

c.f.: 110929_BB_STOCK FICHE_V02.pdf

= 1 presentation= 1 expiry date= 1 Batch n°

1 card = 1 product

1 movement = 1 row

c.f. :TLM_PRO_004_V01_Use of stock cards RDTs.pdf

3. Tools (Standard List)

Complete list of products:

International Non-proprietary Name (INN), dosage, formulation, packing unit, reference N°.

!! For lab items > add: description, manufacturer, [distributor], brands.

� According to the National Essential Medicines List or

(if absent) the WHO one Developed with the physician

� Dynamic (but not too much! : reviewed max twice/year)

� It impacts on the order management and on rational drug use

� Basis for other forms

Protocols/SOP

Standard list of essential medicines

Regional Hospital of Man

Central stock

Out-patient dpt.

In-patient dpt.

Operatory Ward

Delivery Room

Center for Family

Planification

Emergency Ward

Dressing Room

Maternity dpt.

Medicine dpt.

Paediatric dpt.

Surgery dpt.

Médicaments oraux x x x x x x xACICLOVIR, 800 mg, comp. x x xACETYLSALICYLIQUE ACIDE, (Aspirine) 300 mg, comp. x x xACETYLSALICYLIQUE ACIDE, (Aspirine) 500 mg, comp. x x xALBENDAZOLE, 400 mg, comp. x x x xALUMINIUM HYDR. 400 mg,+ MAGNESIUM HYDR. 400 mg, comp. x x x xAMINOPHYLLINE, 100 mg, comp. x x xAMITRIPTYLINE, 25 mg, comp. x x xAMOXICILLINE+AC.CLAVULAN.25 mg/5 ml, 100 ml s. oral x x xAMOXICILLINE+AC.CLAVULAN., 500+ 125 mg, comp. x x xAMOXYCILLINE, 125mg/ml, poudre pr 100 ml susp, oral., fl. x x xAMOXICILLINE, 250 mg. , comp. sécable x x xAMOXICILLINE, 500 mg. , comp. x x x xARTES + AMOD, 50mg + 153mg; comp.ENFANT x x x xARTES + AMOD, 50mg + 153mg; comp. ADOLESC. x x x xARTES + AMOD, 50mg + 153mg; comp. ADULTE x x x x

3. Tools: Essential Medicine List (per level)

Médicaments injectables x x x x x xAMINOPHYLLINE, 25 mg/ml, 10 ml, amp. x x x xAMOXICILLINE 1g + AC. CLAV 200 mg, poudre , IV + perf. x x xAMPICILLINE, 1 g, (IM-IV), fl. poudre x x x x xAMPICILLINE, 500 mg, (IM-IV), fl. poudre x x xARTEMETHER, 20 mg/ml, 1 ml, amp. x x xARTEMETHER, 80 mg/ml, 1 ml, amp. x x xATROPINE SULFATE, 1 mg/ml, 1 ml, amp. x x x x xBUPIVACAINE, 5 mg/ml, 20 ml. , 0,5% , flacon x x x xBUPIVACAINE rachianesthesie/hyperbare, 5 mg/ml, 4 ml, amp. x x x xCALCIUM GLUCONATE, 100 mg/ml, 10 ml, amp. x x x x xCEFAZOLINE, 1 g poudre, fl. x x xCEFTRIAXONE, 1 g, , fl. poudre x x x x

Solutés de perfusion x x x x x x x xGLUCOSE, 5%, 1 l, poche plastique, x x x xGLUCOSE, 5%, 500 ml, poche plastique x x x x xPLASMA SUBSTITUT, gélatine , 500 ml, fl. plast. x x x x x

Pansements x x x x x x x x x x x xBANDE ADHESIVE, élastique, 10 cm x 3 m x x x xBANDE CREPE (Velpeau), 10 cm x 4 m x x x x x x xBANDE DE GAZE, 8 cm x 4 m, avec lisières x x x x x x x xBANDE PLATREE, 15 cm x 3 m x x x xBANDE, JERSEY, TUBULAIRE, 10 cm x 25 m x x x xBANDE, JERSEY, TUBULAIRE, 5 cm x 25 m x x x xCOMPRESSE DE GAZE, 10 cm, 12 plis, 17 fils, non stérile x x x x x x x x x

Daily distribution of individual

prescription from the IPD pharmacy

3. Tools: Weekly/Monthly Consumption form

= Indicates monthly consumption per service per product

Interest?

� Basis for the weekly/monthly order

� Calculate average monthly consumption

� Correlation with services’ activity

� Visualize evolution (forecast)

!!! Stock rupture �� month not included for the item !!!


Interest?

� Summary of essential information

�Global view consumption

�Allows analysis

� Identifies problems and needs

Contains:

� Remaining stock

� Security level

� Validity of stock (expiry date)

Monthly consumption follow-up

Health center:

RMKS. Description jan feb march april may june july sept october november december tot

ORAL DRUGS


3. Tools: Order form

3.Tools: Pharmacy dashboard

4. INVENTORY

1. Fix date (no IN or OUT )

Preprint inventory list

2. Choose responsible: if possible

> 2 persons (count and note)

double-check

3. Check organization:

FEFO or FIFO

remove expired

assure product visibility

4. Count products: number of total units

5. Correct stock card: date, inventory use different color

6. Take action if necessary !!!

7. Discuss/report results: differences, identification and resolution of problems.

INVENTORY

Hide the stock card

5. ORDER

How to place an order???

What are the needs??

How much to order???

5. ORDER

Depends on:

• Frequency: time between orders

• Delay of delivery: time between placing the order and

reception

• Means of transport (air, sea,…)

• Security Stock

• Shelf life

• What left in stock… => Inventory

• What is in the pipeline (back orders)

5. ORDER

INVENTORY:

= Manually count numbers left

� Verify what’s really left in stock

� Identify problems discrepancies

� Verify expired or deteriorated products

5. ORDER

Calculation:

Monthly consumption x Period to cover

– left over in stock - Pipeline

Period to cover (in months) :

• Frequency

+ Delay of delivery

+ Security stock

Seasonal diseasesVariation of activitiesAvaibility of products

Shelflife$

!!! Stock rupture �� month not included for the item !!!

forecast

How much do we need??

• Microscope slides: 1 slides per smear

• Giemsa stock: 0,5 ml (1/10) per slide

1 liter=2000 slides

• Buffer: 5 ml per slide

10 tab=10 liter=2000 slides

• Methanol: 0.5 ml per slides

1 liter=2000 slides

• ….

Example: Malaria smears

Protocols/SOPStandard list

Estimation of the need

6. DISTRIBUTION: reception or order

VERIFY:

Conformity with order

� Origin

� Quantity

� Expiry date, batch n°

Integrity

ORGANISE:

� INN

� Label

� FIFO/ FEFO

� Fill in stock card

� Fill in other documents (freight manifest, …)

Open all box

Immediately

6. Distribution

Tips

Open box

For diagnostics, distribute by

« kit »

6. Distribution: unit of distribution

Primary packaging

Tertiarypackaging

Secondarypackaging

Unit of distribution:- Secondary packaging (HC, services)- Primary packaging (patient)

Secondarypackaging

Primary packaging

Primary packaging

Unit of distribution:- Secondary packaging (HC, services)- Primary packaging (patient)

6. Distribution: unit of distribution

• Label rules changes across countries

• Manufacturer and country of origin is not necessarily mentioned

• Product information not always mentioned

• Mandatory: INN, expiry date, batch no., license owner

6. Distribution: label

7.Indicators

• Stock-out = 0

• Expired items values < 10% (?)

• Inventory discrepancies < 5% (?)

• Numbers of intermediate orders = 0

(outside or inside)

Web links and other documents

• WHO guidelines for the storage of essential medicines and other health commodities: http://apps.who.int/medicinedocs/en/d/Js4885e/

• Chemical storage:

http://www.lbl.gov/ehs/chsp/html/storage.shtml

• Material Safety Data Sheets (MSDS)http://www.merck-chemicals.com/is-bin/INTERSHOP.enfinity/WFS/Merck-International-Site/en_US/-/USD/ViewSearch-SearchMSDS

• Example of stock card

110929_BB_STOCK FICHE_V02.pdf

• Use of stock card :

TLM_PRO_004_V01_Use of stock cards RDTs.pdf

• Excel documents (in french) : 090913_ITM-JJ_Outils de gestion_Stock.xls

Example 1

Fridge…

Comments ?

Example 2 Comments ?

Example 3 Comments ?

Exemple 4 Commentaires

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