Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Improving Medicine Supply Management in ILembe District,
ordered ; expiry dates not checked on receipt • No implementation plans are made when
changes to policy/ protocols; no District PTC • No feedback to staff on expiry checks
People • Attitude • Skills • Honesty
Environment • Decisions taken to meet targets and deadlines.
Pressure to phase in new items with poor planning.
• Patients prioritized – more time spent dispensing than checking and monitoring stock
Expired stock accounted for 0.18% of medicine
expenditure at hospitals and CHC
Expired stock accounted for 0.29% of medicine
expenditure at PHC clinics
PROCESSES & PROCEDURES
Stakeholder Analysis
Pharmacy Managers &
Pharmacy Staff
Doctors and Nurses
Senior Management
Patients
Institutional and District PTC
Stakeholder Analysis Stakeholder Role How Engaged?
Pharmacists and Pharmacist Assistants
• Check expiry dates on receipt of stock • Conduct expiry checks in wards ,
consulting rooms • Comply with MSM policies • Provide support to PHC
• Regular departmental meetings
• Feedback reports on progress
Doctors • Adherence to STG • Co-operation when changes in STG
• District and institutional PTC Internal correspondence
Members of PTC ( district and institutional)
• Medicine utilisation reviews • Implementing plan for the phasing in of
new items • Adherence to STG
• Monthly PTC meetings / quarterly District PTC
Stakeholder Analysis Cont.
Stakeholder Role How engaged?
Patients • Correct use of medicines
• Inform pharmacy staff when medicine is in excess at home
• One on one counselling • Health education
sessions
Institutional Senior Management
• Support the project
MISSION
To provide pharmaceutical services based on principles of rational drug use ; cost-effective quality care to all
stakeholders in ILembe
Re-order levels not maintained at facilities
Expiry checks not done when receiving stock
from depot/ supplier
Policies not implemented ( PFMA; EML, MSM)
Expiry checks done but not actioned
Staff attitude- commitment vs compliance
No planning for phasing in of new items
No District PTC
Review re-order levels quarterly
Implement & monitor 6 MSM SOP’s
Monthly Distribution plan for excess &
short dated stock in the district
Regular feedback to staff
Performance Management
Commenced with District PTC
Phasing in plans via PTC
Current Situation
Expired stock accounted for 0.18% of medicine expenditure at hospitals and CHC
Expired stock accounted for 0.29% of medicine expenditure at PHC clinics
VISION
Quality pharmaceutical services for a happy healthy ILembe
Measurable Result
Reduce expired stock ( open and closed) from 0.18% at hospitals/CHC & from 0.29% at PHC clinics, to < 0.1% of the ILembe District quarterly medicines expenditure , by the end of June 2015.
Root Causes
Priority Actions
M&E Plan Measurable Result : Reduce expired stock ( open and closed) from 0.18% at hospitals/CHC & from 0.29% at PHC clinics, to < 0.1% of the ILembe District quarterly medicines expenditure , by the end of June 2015.
Indicator/s Definition Data Source (from which
source?)
Data Collection Method (how?)
Frequency of data
collection (how often?)
% expired medicine
Value of expired stock in ILembe district per quarter/ Total medicines expenditure per quarter for ILembe district
Board of survey from Plankmed; Open stock costing; PPSD expenditure reports report
Captured daily at point of discovery ; during stock takes
Daily At month end
Rand Value of expired medicines
Rand Value of expired stock ( open and closed) per quarter for ILembe
Board of survey from Plankmed; Open stock costing
Captured daily at point of discovery ; during stock takes
Daily
M&E Plan contd. Measurable Result : Reduce expired stock ( open and closed) from 0.18% at hospitals/CHC & from 0.29% at PHC clinics, to < 0.1% of the ILembe District quarterly medicines expenditure , by the end of June 2015.
Indicator/s Definition Data Source (from which
source?)
Data Collection Method (how?)
Frequency of data
collection (how often?)
Rand Value of Relocated stock (short dated)
Rand value of short dated with < 6 months expiry that has been relocated to another facility
Time Expiry sheets; requisition from facility
Costing of requisition
Monthly
Rand Value of Relocated stock (excess stock)
Rand Value of excess stock that has good expiry but cannot be used up timeously by the facility and has been relocated to another facility
High Stock report from Plankmed; requisition from facility
Costing of requisition
Monthly
Key Interventions
1. Identify areas where medicines are expiring
2. Monitor Programme needs
3. Encouraged Honest reporting of expired stock to detect the extent of the problem within the district
4. Proper documentation of expired medicines.
1. Regular monitoring of both open and closed stock.
2. Monitor phasing out of old stock when STG changes
3. Reinforced health care worker pledge to patients & need for accountability for expired medicines.
4. Records of both open and closed stock
4.
INTERVENTIONS METHODS
Key Interventions
M & E
1. High stock reports & expiry checks done monthly
2. Improved monthly & quarterly pharmacy reports
CLINICAL STAFF/PERSONNEL
1.Engaged with stakeholders (nursing; pharmacy; doctors; district PTC)
2. Rational prescribing in accordance with EML
(changing prescribing trends)
BUDGET IMPACT
1.Relocated stock, reduce fruitless expenditure
(sub-districtdistrict KZN)
PROCEDURES
1. Re-order levels adjusted
2. Changed costing of expired stock (include both open and closed stock)
Monitoring of Closed and Open Stock
Examples of Phasing Out Plans
Item to be phased out Item to be phased in Plan
Cefixime no longer in STI guidelines –PHC EML 2014
Ceftriaxone Use all existing stock of cefixime Redistribute excess to other institutions in district
Doxycycline no longer on STI Guidelines ( PHC EML 2014)
Azithromycin Relocate existing stock of doxycycline to hospital and CHC in district
Gliclazide 80mg tablets ( PHC EML 2014)
Glimepiride tablets Newly diagnosed out patients to be prioritised. Reserve stock of gliclazide for chronics whilst awareness and education increases.
Engaging with nurses at PHC
Patient Counselling & Education
Results /Findings
HOSPITALS & CHC - Rand Value of Expired Stock & % Expired Stock ( Qtr1 and Qtr2 of 2014-2015)
Best Practices • Select excess or short dated items for district focus
• Circulate excess/ short dated lists before PPSD orders are due
• Plan and manage phasing in of new items due to STG changes
• Encourage honest reporting to give true reflection of challenges.
Limitations Challenge Impact
Transport – Insufficient Vehicles due to combined trips with other health care workers to PHC
Some trips to clinics have to be cancelled if no vehicles available ; little or no pharmacy support or reduced time spent at PHC
Lack of Full time PAs at Clinics Roving PAs have limited time for adequate stock monitoring.
No Electronic System to monitor expiry dates (Plankmed does not contain expiry date trackers)
Short dated stock has to be identified manually ( time consuming and less effective as electronic)
Board of Survey Committees not sustained at clinics and all institutions
Non compliance with regulation for destruction and disposal of expired stock (PFMA)
Lack of commitment of Stakeholders MSM policies not fully implemented
Progress in ILembe
Before 2012
2012-2013
2013-2014
2014-2015 2015-2016
PHC reported nil, all hospitals/CHC not reporting
PA’s visiting clinics; PHC values for expired stock still added on to hospital values
reporting improving; awareness increasing
MSM Training , SOPs, Project commences; start to identify what items expiring and why; open or closed stock
Now we know: • Where ? • What ? • Why ? • Open or closed ? • What class ? • EML/non EML ? • Excess vs short
dated ?
Scaling up interventions within the district
• Closer monitoring is still required in clinics
• Monthly reports (Pharmacy Managers District Pharmacy Manager)
• Regular feedback to stakeholders
• Improve participation of nurses
Sustaining the project
Phased implementation of
MSM policies; STG/EML changes
and consistent monitoring thereof
Policy must be institutionalized and awareness
campaigns broadened
Design interventions to
target therapeutic classes with high
expiries
Ongoing communication with relevant stakeholders with regards to rational medicines prescribing,
and medicines management
Roll out project to other districts
Acknowledgements
• Provincial Pharmaceutical Services
• MSH / SIAPS
• Institutional Senior Management
• District & Institutional PTC members
• Operational Managers & PHC Supervisors
• Pharmacy & Nursing Staff
• Fellow Pharmaceutical Leadership & Development Programme (PLDP) participants and colleagues
Acknowledgements • This project was carried out as part of the
Pharmaceutical Leadership Development Program (PLDP) facilitated by the USAID funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS)
• This presentation is in memory of our team member and Pharmacy Manager, Mr. N. Thela who passed away tragically on 17 April 2016