MEDICINE STORAGE by Dr Chelangat patrick. This document is a very educative document that one can use to expand their understanding on medicine, however it may not contain all the knowledge on medicine storage

EDUCATIVE

1. Storage BY Patrick Chelangat Medicines and Health Supplies Management

2. 2 outline Storage principles—how to organize a medical store and how supplies are organized Storage conditions and systems of storage Cleanliness and hygiene Good storage practices

3. 3 Session Objectives By the end of this session, participants will be able to: Describe the importance of good storage practices Describe the procedures of ensuring good storage practices Demonstrate how to organise supplies in a facility store List indicators for assessment of storage practices

4. Introduction “ drug” : substance or preparation used or intended to be used for internal or external application to the human or animal body either in the treatment or prevention of disease or for improving physiological functions, or for agricultural or industrial purposes; Medicine: a preparation for the treatment or prevention of disease Medical supplies:  health care materials which is primarily and customarily used to serve a  medical   purpose. 4

5. 5 Definition of key terms Drug/Medicines Store ; A place in the facility where pharmaceuticals and other health supplies are stored Shelf life (expiry date ) ; Life of the product under appropriate storage conditions “Safe life” for that product Good storage Condition;

6. Diagnostic Equipment Medical imaging machines: radiography (X-ray machine), computed tomography (CT scan), magnetic resonance imaging (MRI scan), ultrasound, and echocardiography, stethoscopes Treatment Equipment: Infusion Pumps, Surgical caps, gowns, gloves, or glasses (for the surgical team), Gauze and drapes 6

7. Life Support Equipment: Heart-lung Machines, Dialysis Machine, Incubators Durable Medical Equipment (DME ): wheelchairs, Hospital beds, Walkers , crutches, Nebulizers, Lifts, Bili lights and blankets, portable oxygen tanks Medical Laboratory Equipment: Blood gas analyzers, Chemistry analyzers, Blood collection supplies, Electrolyte analyzers, Drug testing analyzers, Coagulation analyzers, Hematology analyzers, Urinalysis analyzers 7

8. 8 Storage Importance of good storage practices: Reduced waste Money saved Time saving

9. 9 Qualities of a good medical Supplies Store A secure room or cupboard Burglar bars and locks Away from dispensing area Heat A ceiling below the roof Fan or air vents Open windows when working inside the store No pests Store dusted and cleaned Humidity Good drainage outside—no leaks in roof or walls Goods stored off the floor Containers closed and undamaged Light—curtains, paint

10. 10 Preparing a Store at Your Facility (1) Choose a secured room to be your store Keep the store in good condition: Control temperature in the store so it does not exceed 27° Celsius Control the light that enters, e.g., paint windows or use curtains Control humidity and water damage — ensure that there is good drainage Keep the store free of pests

11. 11 Preparing a Store at Your Facility (2) Keep the store clean and organized: Clean the store and keep it tidy Store supplies on shelves. Do not put boxes directly on the floor. If there are no shelves, make temporary ones from boxes or stacked bricks and boards If there is a refrigerator, keep it in good condition; record the temperature daily Store narcotics and other controlled drugs in a double-locked secured place

12. 12 Activity 1—Preparing Your Store Give at least three examples of essential medicines and health supplies (EMHS) that may be damaged by heat. Give at least two examples of EMHS that spoil if stored in direct light. Give at least three examples of EMHS that are likely to deteriorate due to high humidity.

13. 13 Organizing a Store and Its Supplies (1)

14. 14 Organizing a Store and Its Supplies (2) Store similar items together on the shelf—similar refers to form of administration (external, internal, or injectable) and formulation (dry or liquid medicines) Use the generic name of each medicine in your store Arrange supplies and label the shelves, e.g., alphabetically, therapeutically Follow first expiry, first out (FEFO) when storing medicines and supplies Use first in, first out (FIFO) for those medicines without expiry dates and those with the same expiries delivered at different times Remove expired or poor quality drugs

15. 15 Activity 2 – Are These Good Stores? In the next few slides you will see pictures of actual stores. Is each picture an example of a good store? Why or why not? Write down what is good and bad about the store.

16. 16 Store #1

17. 17 Store #2

18. 18 Store #3

19. 19 Store #4

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21. 21 Store Requirements Should have secure cupboard or room Windows are okay, but make sure there are burglar bars Main store should be kept separate from dispensary Store should be lockable Clear procedures/responsibilities for ordering and issuing of supplies

22. 22 Organizing the Medicines Medicines are expensive and dangerous if quality is not maintained. They must be stored appropriately! Reduce degradation/prevent deterioration Avoid contamination Manage more easily Reduce mistakes Ensure security and reduce theft

23. 23 Direct light Humidity Temperature Cleanliness What can affect the quality of medicines in the storage area?

24. 24 Reduce Degradation/ Prevent Deterioration Light—how does light affect medicines? Humidity—H2O Heat—excessive Q. What’s the difference in stability between tablets and liquids? A. Liquids deteriorate faster when exposed to strong light or heat due to hydrolysis

25. 25 Why Control Light Exposure? Some items deteriorate when exposed to direct light: Multivitamins Furosemide injection Latex products (e.g., gloves and condoms) X-ray films

26. 26 How to Control Light Exposure Check that items sensitive to light are packaged adequately to protect them from light Take these additional precautions: Use window curtains or blinds Store liquids in tinted glass Keep light-sensitive items in their original packaging Store items in a cupboard Keep items in a shady corner Store items in closed boxes P aint windows white Why paint windows white and not black?

27. 27 How to Control Humidity Ensure good drainage Have sufficient ventilation (windows) Repair leaks Don’t store medicines directly on cement floors Keep sachets of desiccants around Keep lids on

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29. 29 How to Control Temperature Refrigerators should be at 2–8°C (not freezing) The ceiling should be in good condition to reduce direct heat from the metallic roof Fan/air vents Open windows while in the store

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33. 33 Avoid Contamination Clean up spilled items Avoid/remove broken containers Keep containers/bottles closed Clean the store: Sweep and dust regularly Don’t eat or keep any food in the store Trap any pests you see Which pests are the most common?

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35. 35 Manage More Easily (1) Appropriately organize the supplies: One room of supplies of the same type (do not split) Medicines are easy to find if: Similar types are together Restricted supplies are kept separate Shelves are used

36. 36 Manage More Easily (2) Bulky, heavy items and corrosive liquids should be on lower shelves – why? Flammable items in metal box on ground (ether/alcohol) Label shelves with the generic name Organize to count in groups, e.g. groups of 10

37. 37 Manage More Easily (3) FEFO FIFO items with no expiry date Store expired supplies separately—make sure they are clearly marked “expired” Get rid of expired supplies Redistribute excessive stock

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39. 39 Assessment of Storage Practices (1) (Tick only one Very clean & tidy (score=1) Acceptable clean /tidy (score=0.5) Not clean/ untidy (Score=0) Comments The dispensary is: The Main store is: Cleanliness of the pharmacy (dispensary and main store) Score: the sum of score for dispensary + storage area divided by 2 = ______ Percentage: __________

40. 40 Assessment of Storage Practices (2) 1/0/NA Comments Are toilet facilities available? b) Are the toilet facilities acceptable, hygienic and functioning? c) Is there toilet paper? d) Are hand washing facilities acceptable, hygienic and functioning? e) Is there soap for hand washing? Hygiene of the pharmacy Ask to be shown the toilet and hand washing facilities used by the pharmacy (dispensary & store) staff. If there are no toilets, write ‘NA’ only for b) and c). Score: the sum of a) to e) divided by 5 minus any ‘NA’: _____ Percentage: __________

41. 41 Assessment of Storage Practices (3) 1/0/NA Comments Are medicines stored on shelves and /or in cupboards? b) Are stock cards kept next to the medicines on the shelves? c) Are medicines stored on shelves or in cupboards stored in a systematic manner (alphabetic, therapeutic etc)? d) Are the shelves labelled? System for storage of medicines and supplies Ask to be shown around the pharmacy (main store) and observe the following conditions Score: the sum of a) to d) yes (1) divided by 4: _____ Percentage: _________

42. 42 Assessment of Storage Practices (4) 1/0/NA Comments No signs of pests/harmful insects/rodents seen in the area (Check traces, droppings etc from bats, rats, ants, etc) b) Are the medicines protected from direct sunlight (Painted glass, curtains or blinds – or no windows)? c) Is the temperature of the storage room monitored? d) Can the temperature of the storeroom be regulated (Ventilation, heater, air-condition, windows)? e) Roof is maintained in good condition to avoid water penetration? f) Is storage space sufficient and adequate? g) Is the store room lockable and access limited to authorised personnel? h) Fire safety equipment is available and accessible (any items for promotion of fire safety should be considered) i ) Is there a functioning system for cold storage (Refrigerator)? j) If yes, are only medicines stored in the refrigerator – no food or beverage? k) Are vaccines placed in the center of refrigerator (not in the door)? l) Is the temperature of the refrigerator recorded? Storage conditions Ask to be shown around the main store and observe the following conditions Score: the sum of a) to l) yes (1) divided by 12 minus NA’s: _____ Percentage:___________

43. Assessment of Storage Practices (6) 43 1/0/NA Comments Store Boxes are not on the floor in the store? b) Is there a record for expired drugs (Check)? c) Is there a place to store expired medicine separately? d) Is FEFO adhered to? (Check 20 randomly selected medicines) Dispensary e) Are opened bottles labelled with the opening date? f) Do all tins/bottles that have been opened have a lid on (dispensary)? Storage practices of medicines in the pharmacy (stores & dispensary) Score: the sum of a) to f) yes (1) divided by 6: _____ Percentage: _________

44. 44 Activity 3 State three steps that should be taken to minimize the risk of theft. What should be done to treatment rooms in rural areas to ensure security of drugs? Where should expensive but rarely used drugs be stored? Where should expensive but commonly used drugs be stored?

45. 45 Activity 4 – Storage Conditions Divide into groups of three people. Find the storage conditions checklist in your Participant’s Guide. Given the results in the checklist, describe how you would advise the in-charge of the health center.

46. 46 What are your good and bad experiences ? What advice you would like to share?

47. Activity 5 Group Work Group 1- Look/examine the store and find areas for improvement Group 2- Organize the store using storage principles that you have learnt Group 3- Re-examine the store to see if there are still any issues that need to be addressed 47

48. 48 Key Points Store drugs safely protecting them from heat, light, humidity, and pests Keep the store tidy and clean Organize in a systematic manner Label shelves Ensure security Keep good storage practices—FIFO/FEFO Get rid of expired and excessive stock