Organisation Information Central Hospital is a developed and leading Tertiary Care Private Hospital in central part of Sri Lanka. It functions with full multispecialty units for 24 hours a day and 365 days a year. It also delivers Out-patient Care, Inward care Units, Cardiac surgery unit, General surgery unit, Eye unit and Theatre and a newly developed Neurological Unit. It has three pharmaceutical supplying units for every individual department. Central Hospital is a busy hospital where all the specialist doctors from all over the Island come for channelling, surgerie s, rehabilitation,counselling and inpatient consultation for all the referrals.
Due to the busiest environment in Central Hospital a massive purchasing and selling of medicines takes place every month. The purchasing of drugs, injections, gels, creams, and miscellaneous medical and non-medical items were purchased daily and weekly. Especially the injections for the theatre unit such as anaesthetic drugs and post-operative care unit drugs had been ordered in massive numbers. The pharmaceutical department is divided into three categories.
One is the out-patient pharmacy, second is indoor pharmacy and the last main one which is pharmacy storage. The chain of request and supply occurs every day between department and stores. Every division has a pharmacist who requests for drugs from store and the store releases the same day to the units. The out-patient pharmaceutical unit and the indoor unit is subdivided under the pharmacy store. The Challenge Expiring or wastage of huge number of medicines in Central Hospital every month. In Central Hospital every month there were about five hundred thousand rupees worth of drugs expired and thrown away.
Though the hospital was busy, the proper identification and usage of medicines and the chain of purchasing and procurement was not developed. However, the day to day operations kept running and after few months the wastage of drugs started increasing. Every month end in the management meeting this issue was taken and discussed but a solution was not found to resolve this issue. Times later the wastage declined but it was declined by reducing the numbers of drugs purchased, but this did not help as they ran out of medicines quickly and there were times where patients were turned back without medicines for their treatment.
Many pharmaceutical companies import drugs monthly in a particular quantity to supply their customers. When Central Hospital purchased in small quantity, other competitors bought drugs continuously in bulk amount. Once the supplier runs out of stock the hospital had to wait until they purchase their next stock. Wastage of medicines became an issue and challenge to reduce the expiry and wastage of drugs was not commenced by the management.
The proper inventory management system was not introduced even after they lost plenty of money by expired medicines. REASONS.
The fundamental reason and factors contributing to the expiry were medicine procured with short shelf life while purchasing without planning, plenty of same generic drugs appeared with different company names and the doctors do not prescribe the same group more than once, though the law says the doctors should prescribe the generic names only, but it is not 1 practised yet (Nakyanzi et al, 2010). Wilcock (2005) support the argument of Nakyanzi et al (2010) by stating an incident in Uganda.
Thirty percent of expired medicines were given to municipality due to short shelf life, medicines effected by abrupt cessation of use or the government medicine policy change, medicines with unpleasant taste, oncology drugs and some donated medicines. These contributing factors has to be analysed in order to reduce the wastage of medicines.
For example, cancer patients tend to go to government funded hospitals as the medicine for cancers are highly expensive and some cannot claim through their insurance. Due to these factor the drugs remain in shelf and expires (Fasola, Aprile, Marini, Follador, Mansutti, & Miscoria (2014). With all these rationales there is also an issue in distribution within the hospital itself.
When purchasing, every purchase of the same company drug should have a batch which has to be maintained by the hospital, each batch will contain different expiry dates, ignorance of this will lead to wastage by using the recently purchased earlier and missing the previously purchased drugs (Tumwine et al, 2010). The impact and consequence of this issue was major. Because unlike other industries hospital industry has connection with human life. The human life is worth more than billions. When becoming short of medicines the day to day operations in a hospital environment become collapsed.
The daily process of utilisation of medical drugs may be scattered. For instance, consultant surgeon receives a patient who has a lump and he/she decides to operate with local anaesthesia in the room itself. The procedure is arranged after consultation and while preparing the nurse found that there is lignocaine with adrenalin which were expired and there were no other dated drugs in the stock. The consultant specialists will not welcome such management and the other doctors will also come to know about this incident. This disturbs the smooth process of central hospital (Perera, Hyam, Taylor & Chapman, 2009).
The mission and the goal of Central Hospital is to be a leading and multispecialty hospital in Sri Lanka in 2020. The improper supply chain management which disturbs the process and day to day operations will strictly loose the doctor’s interest on the hospital and decrease the income of it. There were more than five private hospitals in the same area and a simple mistake and negligence will make the patients to choose some other facility instead of central hospital. Some doctors visit for consultations in all these hospitals and if they do not have a facility in one hospital they will take the patient to the other.
The patient will no longer object as far as the same doctor is giving the treatment. Review According to Nakyanzi, Kitutu, Oria and Kamba (2010) the expiry of medicine in the supply chain is a serious issue. Most of the developing countries are depending on the medicines as the supply of medicines are imported from other countries. They say the supply cycle should be well managed to prevent from misuse and expiry. The expiry of medicines highlights the problem in supply chain management which includes selection of medicines, quantity of the medicines, procurement, storage and distribution to the units (Nakyanzi et al, 2010).
The population in most of the developing countries are massive and hospitals occupancy rate will be full, in other case the patient will not like to stay at hospital and request to get treatment from home. When drugs prescribed to them, the utilisation of the drug is not maximum. Most of the medicines were left aside until expired. The hospital struggle to treat many others with limited stock of medicines (Perera et al, 2009). 2 According to Chaudhary, Garg, Bhalotra, Anand, & Girdhar, (2012) the operative room has also been identified as a place where anaesthetic drugs been wasted.
The cost of anaestheticdrug s are expensive and the wastage will hit mostly the private hospitals. The amount of drugs required by anaesthetist is prepared and kept in syringe and the remaining is kept in the vials. The injected amount is noted in the chart at the end and the remaining vial is thrown away. Patient is charged for the used quantity of medicine. Some hospitals they charge for the whole vial of drug even if they use one tenth of it as they have to dispose later. This will affect the poor. Meaningful Solution The solution for the issues will be sorting the causes one by one.
Medicines which are procured have to be checked upon receiving and the short dated medicines have to be returned then and there. Buying various medicine with the same generic and with different company names have to be reduced. Purchasing can be made if the company offers a consignment based deal or sell or return policy (Stanger, Yates, Wilding & Cotton, 2012). According to Nakyanzi et al (2010) developing a good coordination between key stakeholders improves the drug wastage.
Even though a proper procurement and supply management is held and absence of coordination leadminimum stock level is the best option to reduce the wastage. To reduce the ignorance of batched items, following the FIFO which is first in first out method, will help to reduce the wastage of drugs. This helps to clear the firstly purchased drugs then the next in order (Wilcock, 2005). Government cessation of medicines has to be declined, the Food and Drugs Authority has to analyse the medicines before allowing them to sell in the market.
If the FDA continues to maintain a standard then the wastage of drugs due to sudden cessation will decline. The best solution for maintaining the drugs and reducing the wastage according to Odo, Olotu, Agbonile, Esan & James (2013) is having a pharmacy management system or a inventory management system.
This should have options for entering the expiry date and cost of the medicines. The system should prompt the list of medicines which are going to be expired in three months or six months. Then the drugs can be rotated with the company or can request the doctor to prescribe that medicines instead of other named drugs with same generics. This system will help the hospital to reduce the wastage by seventy percentage.
Central hospital should follow these solutions to minimise their wastage of drugs and lose of profit unnecessarily as in a long run this will be an expected expenditure for the balance sheet. 3 REFERENCES Chaudhary, K. , Garg, R. , Bhalotra, A. R. , Anand, R. , & Girdhar, K. K. (2012). Anesthetic drug wastage in the operation room: A cause for concern. Journal Of Anaesthesiology Clinical Pharmacology, 28(1), 56-61. doi:10. 4103/0970-9185. 92438 Far, R. , Rad, F. , Abdolazimi, Z. , & Daneshi Kohan, M. (2014). Determination of Rate and Causes of Wastage of Blood and Blood Products in Iranian Hospitals.
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