RE: [e-drug] When is quality and safety assured? (3)

E-DRUG: When is quality and safety assured? (3)
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Dear colleagues,

I guess the operative words on this subject is Quality and Safety.
This subject also touches on the current debate on using expired drugs
once the undergo validation. We are assuming that patients in any part
of the world, will be very knowledgeable about the need to store drugs
properly in order to preserve the status of the drug. Anyone who has
done a home- delivery of drugs to house- bound patients may agree with
me that not all patients are that conscientious in how they store
their prescription drugs, irrespective of whether these patients can
read or not. Also, some of us who have had the sometimes shocking
experience of receiving drugs for destruction from patient's home,
will attest to the very poor state such drugs arrive in.

So, based on that experience, I would hesitate to promote the transfer
of past prescription drugs from home to hospital use, unless one can
fully satisfy oneself that the patient did indeed use and keep the
medicine in accordance with recommended storage. I would therefore
also not promote such practice in other countries or certainly to
public health programmes in developing countries where at best the
quality assurance environment is itself very poor. Years ago I had the
sad experience (as a regional pharmacist) of participating in the
visiual screening (that is all we could do at that time) of literally
a van load of donated drugs from some Western donor group that arrived
at a mission hospital. Indeed, some products appeared to have come
from some one's home (very well meaning, of course). The outcome of
that exercise was that we could not bring ourselves to adding that
consignment to stock, and had to have the lot destroyed (at cost to
MoH). It was only the right thing to do, and both MoH and hospital
management agreed to that action. We were assured by hospital
management that they'd apply the guidelines on donations in future.

I go back to what Atieno contributed last week in respect to the use
of expired drugs: If we can invest in proper procurement and
distribution planning, we would not have the need to use either
suspect drugs that are still in date but come from some ones' home, or
indeed, time- expired drugs.

Regards,

Bonnie
Bonface Fundafunda PhD, MBA, B.Pharm(Hon)
21 Beverstone Road,
Thornton Heath,
Surrey CR7 7LL
England
bcfunda@hotmail.com

E-DRUG: Reducing stockouts as well as burden of expired items
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Dear e-drug users,

Dr. Atieno promised to answer the issue of how she reduced the burden of expired medicines during her practice. Given strife at places of work in most developing countries, how did she perform her duty? How about minimizing extent of stock outs at service delivery points in a resource constrained setting?

Maybe Dr. Atieno wants to share her experience to our benefit?

George Kibumba, MPS(Uganda)
Msc. Student (Sept 2004/5),
Pharmaceutical Services and Medicines Control,
University of Bradford,
Flat A3, Room 1, Wardley House,
Little Horton Lane,
Bradford, West Yorkshire
BD5 0AE
e-mail: kibumba@yahoo.com

E-DRUG: Reducing stockouts as well as burden of expired items (2)
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I do not want to rewrite the famous yellow book - Managing Drug Supply 2nd edition - by JD Quick et al. [Kumarian Press, USA].

I put it into practice with a little bit of creativity, flexibility and people skills

At the risk of being too simplistic, it means putting to practice what you know about good drug supply management and not accepting the usual excuses that are peddled around. Every situation is unique and warrants special thought and consideration- challenges are there to be overcome!

Good drug selection of active ingredients, formulations, pack sizes, etc, Good supplier selection (prequalification based on desired criteria, at which point, price is at the bottom of your checklist-all this is in the Yellow book),VERY GOOD procurement planning-Estimating requirements based on both previous consumption and morbidity (Up to date Data is paramount) and then creating a business relationship with suppliers that allows on demand orders( with agreed lead time) after tenders are awarded, specifying remaining shelf life required for a product on arrival at each level of the distribution network (this is dynamic depending on consumption levels) and having a product return policy (Agreed between the supplier and you again, so as to allow the supplier time to redistribute returned stocks, which usually would be minimal if demand driven ordering is done) are the basic minimum.

Those who are lucky have computer software that can do most of these things, but we were able to do them using manual stock cards, plus a simple in house access data base (Stock cards were still the prefered method!)

All this requires 200% commitment of the person involved and the willingness to face a lot of opposition (Lots of diplomacy, negotiation and people skills needed ,a subject I hope to write about soon). One may need to start by creating an enabling environment......

I remember asking a similar question in the WHO EDM Monitor in 2000 and the response I got was not very positive-too many obstacles. I still went ahead and tried to put these things into practice and it worked

I am a bit of an optimistic person and so, I believe that I can make something good out of every situation. Strife is caused by and solved by Human beings and those who manage drug supply are no lesser human beings-you can market and sell your solutions in a win-win scenario. I also believe that I can be the change that I wish to see in the world (Paraphrase from Gandhi) by making a difference in my sphere of operation- as the Chinese saying goes-the journey of a thousand miles begins with one step!

I hope this inspires you to read the yellow book and work towards putting some of it in practice

Atieno Ojoo
atisojoo@yahoo.co.uk

E-DRUG: Reducing stockouts as well as burden of expired items (3)
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Hello, Colleagues

Efficient use of the limited available funds for drug
financing is premised on maximal reduction of wastage
(expired products, spoilage and pilferage) through a
sincere and careful planning, execution and mointoring
of drug selection, quantification, procurement, storage,
distribution and usage. The key "mesh" that wire these
processes together include the professional
determination and sincerity which is embedded in the
overall vision of ensuring equity, accessibility
(geographic and economic) and sustainability of public drug supply in
resource-limited setting.

Furthermore, a thorough situation analysis using S.W.O.T and a functional drug management information system is a sine-qua-non of an efficient and patient-friendly public drug supply system.

Sincerely
Kazeem B Yusuff
Dept. of Clinical Pharmacy
Faculty of Pharmacy
University of Ibadan
Nigeria
yusuffkby@yahoo.co.uk