Purchasing and Inventory Control

**Important; essential elements of the medication use system

Fundamental to patient safety impacts the ability of system to provide the
right drug, to the right patient, in the right amount, by the right route of
administration, and at the right time and frequency.
To be effective it requires understanding and active participation of all
pharmacy staff

The Formulary System

-cornerstone of purchasing and inventory control system
-***developed and maintained by a committee of medical and allied health staff
(Pharmacy and Therapeutics [P&T] committee).
-The products on the hospital formulary dictate what the hospital pharmacy should
purchase and keep in inventory.
-Third-party prescription drug benefit providers will also establish plan-specific
formularies for their ambulatory patients. Ambulatory retail pharmacy staff
frequently encounters insurance plan-specific drug formularies in serving their
patients and adjust their inventory accordingly.
-the concept of formulary management differs greatly depending on the practice
setting( ( hospital is different from retail pharmacy)
-hospital formulary generally available in print or online formats
- ***produced exclusively for all health practitioners involved in prescribing,
dispensing, and monitoring medications,
-***formatted generally to inform users of product availability, the appropriate
therapeutic uses, and recommended dosing of medications.
- organized alphabetically by the generic drugs name but in most cases the drug
name of the drug. Therefore, the formulary can help the pharmacy personnel
determine if a product is stocked in the pharmacy and where it would be shelved.
-***drugs are added and deleted from the formulary on a regular basis
-***Formulary publications should be updated every 12 to 18 months at minimum
-***loose-leaf formularies and those maintained online can be updated continuously
in a timeline manner
-***Formulary handbooks rely on supplementary updates or publication of serial
editions
-***Important information available in the formulary: dosage form, strength, and
concentration; package size(s); common side effects; and administration
instructions.[ some hospitals also indicate the actual or relative cost of a given item
to guide the prescribing of the most cost effective alternatives,
-When selecting a drug product from inventory, the technician must consider all
product characteristics, such as name, dosage form, strength, concentration, and
package size.
-In practice settings where and electronic medical record system (EMR) is
employed real time access to online formulary publications at the point where and
when the provider places a medication order. Detailed review and consideration of
each listing helps minimize errors in product selection.
Managing the Purchasing and Inventory Control System
-Some pharmacies employ a few specialized individuals charged with managing the
purchasing and inventory process of pharmaceuticals, while others utilize many
individuals in the role. ***Limiting the number of individuals to a specialized few
permits greater expertise and efficiency, but it can also keep the remaining
pharmacy staff uninformed and unengaged. Cross training individuals can help

them better understand the system and ***make better decisions in daily practice
to support patient care.
-State-of-the-art practice uses computer and internet technology to manage
purchasing and receiving of pharmaceuticals from a drug wholesaler. This
technology includes using bar codes and hand-held computer devices for online
procurement and purchase order generation and for electronic receiving processes
- Benefits for using computer technology: up to the minute product availability
information, comprehensive reporting capabilities, accuracy, tighter inventory
control and efficiency, also helps in complying with various pharmaceutical
purchasing contact by keeping track of terms and reminding about the deadlines
and contact pricing deals.
RECEIVING AND STORING PHARMACEUTICALS
-receiving medications from suppliers is one of the most important parts of the
pharmacy operation. ***A poorly organized and executed receiving system can put
patients at risk and elevate health care costs. (give example)
The Receiving Process
-Some pharmacies follow policies that require the person who receives
pharmaceuticals be different from the person ordering them. This process is
especially important for controlled substances because it effectively establishes a
check in the system to minimize potential drug-diversion opportunities
-In a reliable and receiving system, the receiving personnel verify that the shipment
is complete and intact (check for missing or damaged items) before putting items
into circulation or inventory
-(1)Begins with the verification of the boxes containing pharmaceuticals delivered
by the shipper. The person receiving the shipment first verifies that the name and
address on the boxes are correct and that the number of boxes matches the
shipping manifest. **Drug wholesalers use rigid plastic crates to deliver orders
because they protect the contents of each shipment better than foam or cardboard
boxes. These crates are eco-friendly bc they can be reused. Each box should be
inspected if it has damage.
-Products with a cold storage requirement should be processed first. The shipper is
responsible for taking measures to ensure the cold storage environment during the
shipment process and will generally package these items in a shippable foam cooler
that includes frozen cold packs to keep products at the correct storage temperature
during shipment.
-Receiving personnel play a critical role in protecting the pharmacy from financial
responsibility for products damaged in shipment, products not ordered, and
products not received. Any obvious damage or other discrepancies with the
shipment, such as a breach in the cold storage environment or delivery of an
incorrect product, should be noted on the shipping manifest, and, if warranted, that
part of the shipment should be refused. Ideally, identifying gross shipment damage
or incorrect box-counts should be performed in the presence of the delivery person
and should be well-documented when signing for the order. Other problems
identified after delivery personnel have left, such as mis-picks, product dating, or
internally damaged goods, must be resolved according to the vendors policies.
Most vendors have specific procedures to follow in reporting and resolving these
sorts of discrepancies.
-(2) next step, checking the newly delivered products against the receiving copy of
the purchase order. This generally occurs after the delivery person has left. A
purchase order, created when the order is placed, is a complete list of the items

that were ordered. It will be executed in multiple copies: an original file copy, a
copy used in the receiving process, and a copy for the supplier.
-the person responsible for checking products into inventory uses the receiving
copy. This ensures that the products ordered have been received, The name, brand,
dosage form, size of the package, concentration strength, and quantity of product
must match the purchase order.
-Once the accuracy of the shipment is confirmed, the purchase order copy is
generally signed and dated by the person receiving the shipment. At this point, the
expiration date of products should be checked to ensure that they meet the
departments minimum expiration date requirement. Frequently, departments will
require that products received have a minimum shelf life of 6 months remaining
before they expire. Otherwise, the products may expire before use and have to be
destroyed or returned to the supplier. Sometimes the manufacturer /wholesaler ship
an excess quantity of an ordered product to the pharmacy so the ethical response is
to notify the manufacturer/ wholesaler of this situation immediately.
-Controlled substances require additional processing on receipt. Regulations specific
to Schedule II controlled substances require Drug Enforcement Administration (DEA)
Form 222 to be completed on receipt of these products and filed separately with a
copy of the invoice and packing slip accompanying each shipment.
The Storing Process
-once the product has been received properly, it must be stored properly. Depending
on the size and type of the pharmacy operation, the product may be placed in a
bulk, central storage area or into the active dispensing areas of the pharmacy. In
any case, the expiration date of the product should be compared with the products
currently in stock. Products already in stock that have expired should be removed.
Products that will expire in the near future should be highlighted, marked and
placed in the front of the shelf or bin. The newly acquired products will generally
have longer shelf lives and should be placed behind packages that will expire before
them. This is a common practice known as stock rotation. It is an important
inventory management principle that encourages the use of products before they
expire and helps prevent the use of expired products and waste.
-It is safe to assume the first-in, first-out (FIFO) method of inventory management is
applied when it comes to pharmaceutical products.
-All stock should be sorted at temperature and humidity levels recommended by
manufactures and defined by the USP. [Table 12-1]. Periodic checks of refrigeration
and other storage areas should be conducted to ensure they fall within
recommended ranges.