ADVANCE GLOBAL COLLEGE

DEPARTMENT OF PHARMACEUTICAL SCIENCES

MEDICINE COUNTER ASSISTANT

MODULE 4

DOCUMENTATION AND INVENTORY CONTROL

PHARM ABILBA FRIEDA

DOCUMENTATION

“Documentation refers to all patient-specific information, the clinical decisions,

and the patient outcomes that are recorded for use in practice. This includes
everything written down in long-hand, or entered into a computer program that
becomes data and is used to facilitate the care of patients.”

Types of documentations

There are basically three formats for documentation namely: Manual

documentation, Electronic and mixed method.

IMPORTANCE OF DOCUMENTATATION

Documentation is a key element of every health profession’s standard of practice

and one of the most basic professional responsibilities. The significance of
documentation includes:

i) It makes one demonstrates accountability and responsibility for their

actions,
ii) It creates evidence of the application of their medication and medication
therapy management
iii) For retrieval of information

EXAMPLES OF ITEMS CONSIDERED AS DOCUMENTS IN THE

PHARMACY
Prescriptions, receipt books, sales /cash books, invoices etcs

TOOLS USED IN DOCUMENTATION

Some of the things employed in documentation are: folders, files, computers,

books, etc.

DRUG MANAGEMENT

A Drug may be defined as:

• A chemical substance that affects the processes of the body or mind;

• any chemical compound used on or administered to humans or animals as an aid

in the diagnosis, treatment or prevention of disease, or other abnormal condition,
for the relief of pain or suffering, or to control or improve any physiologic or
pathologic state; OR

• A substance used recreationally for its effects on the central ner vous system.

WHAT IS MANAGEMENT?

Management is the act or art of being responsible or in charge and conducting or

supervising something with a degree of skill and address. It is the judicious use of
means to accomplish an end. Management can also refer to the collective body of
those who are responsible for an entity or who exercise executive, administrative
supervisory and regulatory control.

Therefore drug management is the act of being responsible or in charge of taking

care of the movement of drugs within a facility.

IMPORTANCE OF DRUGS MANAGEMENT

To prevent shortages of drug ( increase accessibility of drugs), prevent wastage of

drug and improve patient confidence in the health system.

Drug Management Cycle

The selection of drugs for use at facility is usually determined by the manager ,
head of the pharmacy or at the national level by the Ministry of Health and is based
on a number of factors. After determination of the quantities required, based on
price, delivery conditions and quality, the selected drugs go through a procurement
process. After storage and distribution, the use of the drugs requires prescribing,
packaging, dispensing and counselling. These tasks require qualified health
workers or other relevant personnel with appropriate skills and attitudes.
Management support tools are important for the acquisition of relevant skills in
drug management.

DRUG MANAGEMENT CYCLE

Drug management functions are undertaken in four principal phases, which are
interlinked and are reinforced by appropriate management support systems (i.e.
tools). From drug selection to drug use, passing through procurement, storage and
distribution, a whole range of management capacities are required and necessitate
using the appropriate tools within a given legal and policy framework.

SELECTION OF DRUGS

Ministries of health normally determine the types of drugs and dosage forms that
are selected for use in a country for government hospital and managers or owners
of health facility also determine for private facilities. Such selections ensure that
available financial resources are used wisely provide a limited list of drugs and
dosage forms that are appropriate to the health problems of a country or
community. All levels of health care institutions are, thus, catered to:

• Primary,

• Secondary

• Tertiary.
CRITERIA FOR SELECTION OF DRUGS WHEN PURCHASING

Some criteria used in selecting drugs and their dosage forms, include the
following:

• Keeping costs of drugs and dosage forms affordable and cost-effective so as to

optimize the use of financial resources;

• Having drugs available for the treatment of most prevalent diseases, ailments,
sicknesses and so forth at the levels of care provided;

• Availability of safe, effective and good-quality drugs.

Patterns and prevalence of diseases

GENERIC NAMES

International nonproprietary names (INNs), also known as generic names, are

normally used in identifying selected drugs. However, the choice of drugs by
generic names requires the existence of an effective Drug Regulatory Authority to
ensure the availability of good-quality, safe, effective and affordable drugs. The
unique name of a dug given to it by the company is the trade name or brand
name.The generic name is used in writing prescriptions as well as in purchasing
drugs. The use of the generic name for these purposes has certain advantages:

• There is easy recognition of the type of drug, especially where many selected
drugs exist in that class (e.g. all benzodiazepines have INNs ending with “-
zepam”);

• Drugs can be purchased from multiple sources, thus giving the advantage of
buying at a competitive price;

• Product substitution is easy where bio-availability presents a clinical problem;

• The confusion associated with the use of brand names can be avoided.

Examples of generic and brand names

Generic (INN) Brand Names

Acetyl salicylic acid Asprin®,

AlbendazoleZentel®

Ampicillin Penbritin®

Benzl benzoate Ascabiol®

Benzylpenicillin Megacillin®,

Cimetidine Tagamet®

Clotrimazole Canesten®

Cloxacillin Orbenin®

Cotrimoxazole (sulphametoxazole + trimethoprim)Septrim®

Dexamethasone Dexone®

Diazepam Valium®

DoxycyclineDoxigram®,

GriseofulvinFulcine®

Ibuprofen Brufen®

Promethazine Phenergan®

Penytoin Dilantin®

Phenobarbital Gardenal®

Propranolol Inderal®

Panadol®Salbutamol Ventolin®

Sulfadoxine + pyrimethamine Fansidar®

PURCHASING OF DRUGS

Requisition for drug and dosage form is made after due consultation with
prescriber and buying trends in the community pharmacy. Purchasing is the art of
ordering for goods and services. It is important to understand the knowledge about
the pharmaceutical market, the ability to do /make price comparism of products
from different companies ,proximity of places to buy drugs, transportation,
communication ,and bargaining for discount . Experiences in all these fields add
up to make a good purchase.

SUPPLIERS

Suppliers in the pharmaceutical industries are referred to as wholesalers. Some sell

non drugs whiles others sell drugs. Choice of wholesalers depends on t he
following:

1. Price
2. Closeness
3. Delivery time
4. Quality of product

ESTIMATION OF DRUG REQUIREMENTS FOR MAKING DRUG

ORDER

It is important to know when to make an order. When preparing to make an order

for drugs, dug not available in the facility are usually written down in a shortlist
book (a book for recording drugs that have run out from the facility and those that
that are not available but requested by clients.)The estimate of the drug and dosage
forms required for a purchasing order is done by the purchasing officer or the
manager or owner of the facility. It is necessary to estimate properly to prevent the
following:

To avoid shortages (out of stock) and ensure credible health care service, to
prevent excess stock and avoid waste (loss or mismanagement of financial
resources) .
DETERMINING DRUG TYPES AND QUANTITIES REQUIRED

Factors that influence choice and quantity of drugs include: Population which the
health institution serves, Disease pattern, Seasonal variation in disease pattern,
Monthly (rate of) drug consumption, Knowledge of quantity of each dosage form
that is regularly consumed, Delivery (lead) time, Time lag between placing orders
and receiving the orders, Request indicator (re-order level i.e Quantity of drug
product that serves as a signal for re-ordering) .

In this section, three factors-delivery (lead) time, monthly consumption and request
indicator-are considered as the basis for calculating the appropriate quantity of a
particular drug to be ordered.

MONTHLY CONSUMPTION

Monthly consumption may be collected or gotten with data obtained from:

• Bin (stock/ tally) cards: this is a card used for tracking movement of drugs within
the pharmacy store (where bulk drugs are stored).it makes a system perfect bu t
very difficult and cumbersome to use.it shows when an item was received, how
much more has been added or issued out and what is remaining for a particular
drug.

• Daily use record, daily cash record: this is a book for recording of daily sales. It
usually designed to have description of the item, the quantity sold out, the unit
price and the total cost amount.it can tell the drugs or items which are fast moving
and slow moving ones. Also it can tell which season of he years gives a peak sale
or lean sale. It is important to always reconcile physical cash with recorded cash at
the end of each work period and the margin of error calculated. Errors usually
occur due to omission in recording sales due to the presence of many clients at a
given time and service rendered by one person at that said period. The physical
cash should always be more than the recorded amount due to some generous
clients who tend to leave change behind.

• Drug register: this is a book which has a record of all drugs in the facility

REQUEST INDICATOR (RE-ORDER)

The request indicator (RI) is the level of drugs in stock; it indicates when fresh
orders should be made. It is the quantity that is calculated to last between the
period of placing the order and the delivery of the

In each case above, if previous data show that the number of patients would
increase (e.g. malaria cases due to seasonal variations), then the quantities should
be increased proportionally.

If the number of patients is expected to double, then the quantity should be

multiplied by 2.

If the number of patients is expected to drop by half, then the quantity should be
multiplied by 1/2.

PRICE OF DRUGS

The prices of drugs are usually determined by the manager of a facility, the owner
of the facility or at national level(NHIS).it is usually a mark up decided by the said
personnel’s of the institutions. The factors to consider in determining price
include: Purchase price, Shipping cost, clearing and custom charges,
Transportation charges, Markup to cover administrative and other costs.

In determining the price, a factor is also included to take care of inflation so that
the revenue generated will not be eroded with time. This is important for the
sustainability of the drug fund.

DRUG REQUEST
Drugs that are ordered for use in the facility must be approved for use in the centre.
Drugs in the facility should be relevant to the pattern of endemic diseases as well
as the type of services being provided in the facility.

It is advisable to request drugs on a regular basis to prevent shortages. If drugs are

not always available, patients may lose confidence in the facility and will be
discouraged from visiting it. It is important to make requests on a regular basis, as
drugs will only be delivered when requested. The delivery time should be taken
into consideration in ensuring that drugs are not in short supply.

RECEIPT OF DRUGS AT DISPENSARY

The consignment must come with two copies of the stores requisition/delivery
(issue) form.

• Check that the quantity issued actually corresponds to the quantity indicated on
the stores requisition/delivery (issue) form.

• Check off each drug after checking.

• Take note of the unit price of each drug and compare it to the previous unit price.

• Check that all original boxes, tins or bottles are unopened and are in good
condition.

• Check the labels and ensure that there are no expired drugs being received.

• Any drugs already expired or soon to expire that cannot be consumed before
expiration or drugs not in good condition should be returned for destruction or
redistribution to other centres.

• Sign two copies of the stores requisition/delivery (issue) forms if the above
procedure have been completed.

• Return one copy of the signed stores requisition/delivery (issue) form to the
medical stores, and place another copy in the “drug order” file.
• Place drugs with shorter expiration dates in front of the shelf so that they can be
reached and used first.

• Remember to record the new stock on the respective stock (bin) cards and
appropriate forms.

DISCREPANCIES WHEN RECEIVING DRUGS

Where there is a difference in the quantities of drugs issued and the quantities
actually received, request the delivery team to give an immediate explanation and
make the necessary correction on the stores requisition/delivery (issue) form. If
there are broken bottles or leaking packages, hand these over to the delivery team
along with an internal drug return (IDR) form.

Discrepancies should always be recorded in the Remarks column on the stores

requisition/delivery (issue) form and also be reported to the manager or head of the
facility.

NOTE

It is important that drugs are not allowed to expire in the facility because of
changes in disease pattern or for any other reasons.

• Items that can be used elsewhere should be transferred immediately

• Expired or spoiled items should be transferred immediately using for destruction.

• Excess stock should normally be transferred at least 3 months before expiration to

another facility if possible

DRUG DONATIONS AND HANDLING OF EXPIRED DRUGS

Expiry date is date of the product on which the drug or item becomes
unwholesome for consumption. It is often necessary to check and remove expired
drugs from the shelves. Expired drugs can be controlled by constantly checking of
the expiry dates of drug and also buying products with longer expiry dates. Also
you can use computer soft wares that prompt you when product is about to expire.
Donated drugs should be screened and separated into expired or poor -quality
drugs, those approved for use at the health facility and those not approved. Those
approved for use at the health facility should be retained and entered into the stock.
The rest (expired drugs and those not wholesome) must be sent to be destroyed by
the food and drug authority upon payment of fees charged.

PROPER DRUG STORAGE

Drugs are stored in a specially designed secure area or space of a building in order
to: Avoid contamination or deterioration, avoid damaging of labels, Maintain
integrity of packaging and so guarantee quality and potency of drugs during shelf
life, Prevent or reduce pilferage, theft or losses, Prevent infestation of pests(rats,
mice, cockroaches) and vermin.

STORAGE ENVIRONMENT

The storage environment should possess the following: Adequate temperature

(25°c), Sufficient lighting, Clean conditions, Humidity control, Cold storage
facilities, Adequate shelving to ensure integrity of the stored drugs.

ARRANGEMENT OF DRUGS ON SHELVES

A shelve is a plane surface for displaying or storage of items. Shelves are mostly
made of steel (metal), glass, or treated wood. Shelves should be strong and robust.
Drugs are arranged in alphabetical order of generic names. When arranging drugs
the ‘first to expire first’ out rule should be applied not ‘first in first out’. To have
access to drugs with shorter expiration dates first, put these in front of the shelves.
Those with longer exp iration dates should be placed behind those with shorter
dates.

Each dosage form of drug is arranged in separate and distinct areas. Sufficient
empty space should demarcate one drug or dosage form from another.

It is important to ensure the following rules in the dispensary and the store attached
to the dispensary:
 Keep the environment clean. Always put lids properly on tins always and at the
close of the day. Put drugs in a dry place protected from light and heat. Store
liquids on a pallet on the floor or on the lowest shelf. The store must be cleaned
daily and mopped.

Avoid dispensing wrong drugs by arranging drugs on the table in alphabetical

order so that the drug being dispensed is not confused with another. Always close
drug containers from which drugs are not being dispensed to prevent spillage or
dispensing the wrong drug.

PRESCRIPTION

A prescription is a set of instructions written by a qualified prescriber to a

dispenser for supply of drugs after counselling the patient on how to us e the drug.
It is very important that prescriptions are clearly written. A prescription should
have the following:

Name of the patient and age (especially if a child), Date, Instructions about the
prescribed drugs, including: Generic name and dosage form, Dose, Frequency of
administration, Duration of treatment,

Prescriber’s signature and name .

CORRECT DRUG DISPENSING

Correct dispensing ensures that:

1. The right patient is served,

2. A desired dosage form of the correct drug is given,
3. The prescribed dosage and quantity are given,
4. The right container that maintains the potency of the drugs is used,
5. The container is appropriately labelled,
6. Clear instructions are delivered verbally to the patient.

DISPENSING PROCEDURE FOR A PRESCRIPTION

 Ensure that the prescription has the name and signature of the prescriber and the
stamp of a health facility. Ensure that the prescription is dated and has the name of
the patient. Avoid dispensing without a prescription or from an unauthorized
prescriber. Check the name of the prescribed drug against that of the container.
Check the expiration date on the container. Note Dispensed drugs should be
appropriately labelled so that the patient can benefit optimally from the use of the
drug. Expired drugs should not be dispensed. Calculate the total cost of the drug to
be dispensed on the basis of the prescription where applicable. Inform the patient
about the cost of the drug. Issue a receipt for all payments. Hand over the
dispensed drug as

GUIDING PRINCIPLES IN DISPENSING ON CASH BASIS

Dispense drugs only on payment. Do not give free drugs to any person in the
community, no matter what the person’s social standing. Issue receipts for drugs
sold either electronic or manual. Display a price list of drugs for transparency and
accountability, and to help patients crosscheck.

PACKAGING OF DRUGS FOR PATIENTS

All drugs should be put in suitable and appropriately labelled containers to ensure
correct use and maintain potency and quality during the period of use.

STOCK TAKING

This is talking all count of physical present drugs available in the facility at a given
time period. Most facility takes stock annually, half yearly, quarterly or monthly
basis. Stock taking should be done within the shortest possible time frame. ( a day
or two which in which ideally the pharmacy should not be opened to the public).
Stock taking can be used to develop monthly reports for the facility. Do not use
fingers to count tablets as this can lead to contamination of drugs.Use a spoon to
put tablets and capsules onto a counting tray. Do not mix different drug items in
one container. Keep the spoon clean at all time

BOOK KEEPING
.

Bookkeeping is the work of a bookkeeper (or book-keeper), who records the day-
to-day financial transactions of a business. They usually write the daybooks (which
contain records of sales, purchases, receipts, and payments), and document each
financial transaction, whether cash or credit, into the correct daybook.

Bookkeeping refers mainly to the record-keeping aspects of financial accounting,

and involves preparing source documents for all transactions, operations, and other
events of a business.

Process

The bookkeeping process primarily records the financial effects of transactions. An

important difference between a manual and an electronic accounting system is the
former's latency between the recording of a financial transaction and its posting in
the relevant account. This delay, which is absent in electronic accounting systems
due to nearly instantaneous posting to relevant accounts, is characteristic of manual
systems, and gave rise to the primary books of accounts—cash book, purchase
book, sales book, etc.—for immediately documenting a financial transaction.

Daybooks

A daybook is a descriptive and chronological (diary-like) record of day-to-day

financial transactions; it is also called a book of original entry. The daybook's
details must be transcribed formally into journals to enable posting to ledgers.

Daybooks include: Sales daybook, for recording sales invoices, Sales credits
daybook, for recording sales credit notes, Purchases daybook, for recording
purchase invoices, Purchases debits daybook, for recording purchase debit notes,
Cash daybook, usually known as the cash book, for recording all monies received
and all monies paid out. It may be split into two daybooks: a receipts daybook
documenting every money-amount received, and a payments daybook recording
every payment made.
A petty cash book is a record of small-value purchases before they are later
transferred to the ledger and final accounts; it is maintained by a petty or junior
cashier. This type of cash book usually uses the imprest system: a certain amount
of money is provided to the petty cashier by the senior cashier. This money is to
cater for minor expenditures (hospitality, minor stationery, casual postage, and so
on) and is reimbursed periodically on satisfactory explanation of how it was spent.

A ledger is a record of accounts. There are three different kinds of ledgers that dea l
with book-keeping: Sales ledger, which deals mostly with the accounts receivable
account. This ledger consists of the records of the financial transactions made by
customers to the business.

Purchase ledger is the record of the purchasing transactions a company does; it

goes hand in hand with the Accounts Payable account.

RECORD KEEPING

Record-keeping is an important part of drug management and the.e art of taking

count of the items in a particular place is call inventory .Records are subject to
auditing from time to time or when there is information of improper record-
keeping or there has been a burglary, fire or flood. Mistakes on records should be
neatly crossed out and signed for but not obliterated. Records should be completed
in the dispensary on a daily basis, and not later than a week after the event. This
will enable easier compilation of drug consumption and cash receipts. The
following stock management records should be completed in the order described in
the following sections.

CONSUMPTION RECORDS TO BE KEPT AT THE STORE

Maintain a stock (bin or tally) card for each dosage form of drug in the store where
drugs are kept. Stock (bin) cards are important for good accountability of stock
movements. The cards should be made of stiff cardboard and be p laced near the
drug products that they refer to on the shelves. If one dosage form is available in
two different strengths, open separate stock cards for each strength. Stock, bin or
tally cards are very useful tools in the management of stores. Follow these
procedures:
Maintain a stock (bin or tally) card for each drug or dosage form of a drug in the
store where drugs are kept. Enter quantity of seed stock in the “in” and “balance”
columns with date, price and supplier. Enter quantity of any new stock in the “in”
column with date, price, supplier and delivery number. Enter balance of stock
brought for ward in “balance” column with date. Entries of receipt and issue of
drugs are made after the event. Always have a balance of stock entered in the
“balance” column with date. Always issue out full containers of drugs from the
store and enter the quantity of drug issued in the “out” column. Physically check
the actual balance of stock against current balance in stock card from time to time
to detect any discrepancy. Keep spoons and measuring cups within reach for
dispensing.

DISCREPANCIES

Discrepancies should always be recorded in the “REMARKS” column (as in

Diagram 9). Discrepancies may arise for one of the following reasons: Some of the
tablets may have been crushed into powder or broken. A shortage may result from
a mistake by the manufacturer. A shortage may occur in the containers when
tablets issued are not recorded in the daily use record sheet. Arithmetic errors may
result in shortages or excess stock.

RECEIPTS FOR DRUGS DISPENSED

• When payments are made for the drugs dispensed, it is advisable that the fees for
the dispensed drugs are collected and receipts issued before the drug is given to the
patient Every dispensary should have a receipt book in duplicate form. Every
patient should be issued a receipt for drugs purchased . Use carbon paper to
produce a duplicate copy. Stamp the original receipt with “PAID” on receipt of
cash payment for the dispensed drugs. Give the original receipt to the patient and
retain the duplicate in the receipt booklet.

DAILY USE/CASH RECORD

The daily use/cash record has to be filled on a daily basis and in particular when
payments are made for dispensed drugs. The following data could be transferred
from the duplicate copies of the receipt book to the daily use/cash record sheet
when the last patient (client) for the day has been served: Date, Name of patient,
Receipt number, Quantity of each drug dispensed, Money collected from the
patient.

Draw a line under the last entry for the day in your daily use/cash record sheet
using a red pen. The quantity of drugs is expressed as number of tablets (for
tablets) or volume in ml. (for liquids) dispensed. Add up the quantities of each
drug dispensed and cash collected to give the details of daily transactions.

MODEL EXAMPLE OF AN OFFICIAL RECEIPT FORM

00673

………………20..

Received from……………………………………………….

The sum of ……………………………………………………

………………………………………………………..pesewas

Being ……………………………………………………………

…………………………balance…………………………….

Cash/cheque………………

……………………………..

signature

MONTHLY RETURN FORM

The monthly return form is used at the end of each month to collect data for the
medical store or the community pharmacy or drug shop. This data will help the
store to assess monthly consumption in the facility and determine future purchases
at the facility. This financial progress of the dispensary in relation to attendance at
the centre can also be assessed with the data. The information on the monthly
return form is: Cash collected for the month. Total number of patients that
attended the health facility. Information provided by the head of the facility.
Quantities of each drug dispensed for the month

INVENTORY

An inventory is a procedure by which records of items are kept by quantities. This

can be drugs or non drugs.

Both shortages and excesses can be found in the exercise. In either situation, a
thorough investigation needs to be done (e.g. reviewing all additions and
subtractions in the inventory sheets). It is advisable to carry out an inventory
exercise at six-monthly intervals (or even quarterly) in order to identify any
problems early enough rather than waiting for the end of the year.

The following activities should be carried out during the inventory:

1. Any cash in hand should be counted first and included in the inventory
figures.
2. Any supply made before the inventory must be counted with the other
items.
3. Count all drugs in the store and dispensing area and record the numbers.
Use a tablet counter to prevent contamination.
4. Do not open full tins and packages to count the contents.
5. Verify all full tins and packages to make sure that their contents are intact.
6. Calculate the total value of stock by adding the values of all it ems.
7. Compare this number with the current balance .The two should correspond
if there has been efficient management of stock and cash during the period
being audited.
8. These figures will be used by an external auditor to prepare a balance sheet
for the dispensary.
9. The worker should pay for any deficits established at the end of the audit.

Example of Inventory Form

Place: _____________ Date: ____________________

Item Quantity Unit Price Total Cost
30
Acetylsalicylic
acid 500 mg tablet
Cotrimoxazole 800
400/800 mg tablet
Benzyl benzoate 500
25% lotion B/100
ml
Folic acid 5 mg 5
tablet

STORAGE OF DOCUMENTS

For easy reference, documents should be numbered and put into different files.
Various colours of files may be used for easy reference. The following documents
should be put into different files:

1. Daily use/cash record,

2. Financial documents
3. Requisition/delivery form,
4. General correspondence,
5. Miscellaneous.

Keep all used documents (e.g. receipt booklets, prescriptions, stock cards, etc ) in
safe custody for at least five years before they are thrown away.

WHAT TO DO IN CASE OF ROBBERY OR THEFT

If there is any burglary in the dispensary, follow this procedure:

1. Do not go into the dispensary, and do not make any sale.

2. Write and inform the head of the facility and the chairman of the health
committee.
3. Follow up so that the head of the facility reports immediately to the police.
4. An inventory of the dispensary should be done in the presence of the police
or any other person designated by the head of the facility.
5. Compare the inventory stock with the stock on the bin (stock) cards or daily
use/cash record so as to assess the quantities of drugs stolen.
6. A copy of the report of inventory should be sent to the head of the health
center and to the medical store.
7. The health committee should immediately reinstate the necessary security
measures to prevent further burglary.
8. Start sales only after the head of the facility and the health committee so
authorize.

THE COMPUTER AS A TOOL FOR DOCUMENTATION

The computer is one of the most widely used tools when it comes to
documentation in the pharmacy. It is advisable to always have stored backup
information on the computer in other storages devices such as pen drives, google
drive, hard drive, c.ds and emails.