Planning Equipments and Supplies in Nursing Care Unit - Copy

SEMINAR ON

MATERIAL

MANAGEMENT

SUBMITTED TO :

MRS. BALALEKSHMI

PROFESSOR

THE OXFORD COLLEGE OF

SUBMITTED ON :

NURSING

8.7.11

SUBMITTED BY :

SEENA MARY ALEX

II nd MSc(N)

1

SL NO CONTENT PAGE NO

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

INTRODUCTION

DEFINITION

IMPORTANCE OF WARD MANAGEMENT

PURCHASE OF SUPPLIES AND EQUIPMENT RESPONSIBILITY OF NURSE ADMINISTRATOR

AIDS IN KEEPING AND ADEQUATE SUPPLY ON HAND

METHOD OF ORDERING SUPPLIES

DELEGATION OF RESPONSIBILTY FOR THE HANDLING OF SUPPLIES AND EQUIPMENT

EDUCATION OF PERSONNEL IN ECONOMICAL USE OF HOSPITAL PROPERTY

CONCLUSION

3

3

6

7

8

9

11

13

15

16

2

PLANNING EQUIPMENTS AND SUPPLIES IN NURSING CARE UNIT:

INTRODUCTION :

Materials are essential resources to achieve the objectives of a health care organization. It is

appear that hospital spend from 15 to 20 percent of their annual budget on the supplies and

equipments , exclusive of linen and food , which are used in the ward of the hospital . The

proper management of materials inventories is extremely important in the proper

functioning of a hospital. The hospital administrator will have to play a vital role in making

sure that adequate material in right quantity and quality are made available to various units of

the hospital

DEFINITION :

Supplies are expendable items or those articles which are used up and must be reordered

periodically such as soap, paper towels, stationery ,food, sterile goods . These are the

material required in the hospital for diagnosing and treating of aliments or activities. Some of

the materials used in the hospital are :bandages ,gauze, dressing materials, syringe ,needles,

forceps ,plaster, linen ,utensils which are directly to the treatment of various types, various

chemicals and reagents or ready kits for pathological biochemical or microbiological

investigation ; x – ray plates, radio diagnostic materials and drugs used in radiology

department .

Equipments includes more permanent articles and may be classified as fixed or movable.

Fixed equipments is not a part of the structure of the building but is attached to its walls or

floor such as strelizers and sinks. Movable equipment includes furniture , instruments,

syringes, dishes. The other equipments includes the following :

Refrigator

Air conditioners

Tables, screen, labour room tables

3

IV stands, bed side lockers

Other diagnostic equipments like

Auto analyzers

Cell counter

Eliza readers

Aterial blood gas analyser

Pulse oximeter

Defibrillator

Cardiac monitors

Specialized endoscopes

Boyle ‘s apparatus

Oxygen and nitrous gas cylinder

Cooking LP gas cylinders

Incinerators for biowaste management

For eg. ESSENTIAL EQUIPMENTS FOR A 50 BEDDED DISTRICT HOSPITAL (WHO)

1) Scope of services

Essential clinical services- medicine, surgery, paediatrics., OBG,  and acute

psychiatry (when necessary)

Optional clinical services – oral surgery, orthopaedic surgery, otolaryngology,

neurology and psychiatry.

Essential clinical support- anaesthesia, radiology and clinical laboratory

Optional clinical support services- pathology and rehabilitation including

physiotherapy.

2) Essential medical equipment

Diagnostic imaging equipment –it include x-ray and ultrasound equipment. X-ray

equipment can be stationary in one room or mobile

laboratory equipment –

o microscope

o blood counter

o analytical balance

4

o calorimeter( spectrophotometer)

o Centrifuge – a small centrifuge that can accommodate six 15ml tubes should

be available.

o Water bath – used for stabilising temperature at 25, 37, 42, or 56degree

Celsius.

o Incubator/oven- a small hot air oven to carry out standard cultivations and

sensitisations.

Refrigerator – an ordinary household refrigerator with a freezer unit, for storing

preparations, vaccines, blood etc.

istillation and purification apparatus - it should be made of metal that resists acid, and

alkali and should be free standing.

3) Electrical medical equipment.

Portable electrocardiograph

Defibrillator( external)

Portable anaesthetic unit – 2 small aesthetic units should be obtained, complete with a

range of masks.

Respirator – it should be applicable for prolonged administration during post

operative care.

Dental chair unit- a complete unit should be available to carry out standard dental

operations.

Suction pump –one portable and one other suction pump are required.

Operating theatre lamp- one main lamp with at least 8 shadows lamp and an auxiliary

of 4 lamp units.

Delivery table- it should be standard and manually operated.

Diathermy unit – a standard coagulating unit which is operated by hand or foot

switch, with variable poor control.

4) Other equipment

autoclave – for general stabilisation

Small sterilisers- for specific services- eg. Stabiliser

cold chain and other preventive medical equipment

ambulance

5

5) Small , inexpensive equipment and instruments

Equipment and instrument, such as BP apparatus, oxygen manifolds, stethoscope,

diagnostic sets and spotlights.

IMPORTANCE TO GOOD WARD MANAGEMENT :

Supplies and equipment are highly important contributing factors to a smooth running ward

which in turn reflects directly on the quality of patient care.

MATERIALS MAY BE INADEQUATE IN AMOUNT:

An undersupply of materials on the ward results in the use of substitutes which may be

more costly than the proper item. If a sheet is substituted for a pillow case or a gauze square

for a cotton pledget the supply of the substitute may be depleted and thus further shortages

will occur. Unattractive, careless work frequently results from the lack of materials. When

rubber protectors are not available , mattress ,pillow sheet may be soiled. If trays for giving

treatments are hard to find nurses may lose the habit of using them. If the supply of material

is inadequate , the care of the patient may be jeopardized. The patient ‘s comfort and welfare

are greatly influenced by the adequacy of supplies and equipments.

EQUIPMENT MAY BE OUT OF REPAIR :

Equipment which is not in good repair or ready for use is often more troublesome than if

it were missing altogether. The nurse or doctor and the patient may be ready for a treatment

and the light will not work , the stove fails to heat, scissors refuse to cut. The situation is not

only embarrassing but is wasteful of time and wearing on the nerves of all concerned.

Unclean or unsterile equipment causes delay especially if discovered after all else is in

readiness for a treatment .

SUPPILES AND EQUIPMENT MAY BE INACCESSIBILE :

It is probably necessary to lock up excess supplies to prevent the loss and waste which

may occur if the supply is abundant but there should always be enough available for use

and the key to the locked cupboard or drawer should be accessible at all times to the nurse

who is in charge.

MATERIALS ARE SOMETIMES INCONVENIENTLY LOCATED :

6

The preparation for a single treatment may take the nurse to several rooms for

equipments. This is unnecessary use of time and energy .For convenience in working, all

necessary equipments and supplies for a particular treatment should be kept in one unit

even though it may mean the duplication of materials in more than one place. For eg. , a

hot water bag, cover, thermometer and a pitcher for filling the bag should be in one room

near the source of water supply. If trays for sterile treatments are prepared in one room

and unsterile treatment in another there needs to be a supply of rubber protectors, draping,

and cleansing materials in both rooms.

PURCHASE OF SUPPLIES AND EQUIPMENT

The purchase of supplies and equipments in a hospital is carried out through;

1. General store

2. Dietary department and

3. Pharmacy department

When planning for the purchase of articles , budgeting is done not only for the actual price of

articles  but also for the additional costs that are involved such as ;

Transport charges ( local delivery reduce the transport charge)

Incidental costs

Cost of chemicals and other consumable  to be used with the equipment (eg; ECG

paper   for an ECG machine )

Operating cost (hiring a technician )

Cost of maintenance service; 10-20% of hospital equipment may remain idle if

serving is not done periodically.

Cost of technology obsolesces: when a better quality appears in market there is

tendency to discard the old model.

Replacement cost of equipment

Selection of article- while buying articles it has to meet the standards. Indian Standards

Institution is the national agency set up to bring standardisation of articles in India. Articles

that meet the criteria specified by the Indian Standard Institution will be marked by ISI

markings. The articles bought should provide safety to the patient and personnel. Faulty

7

instruments and equipments cause not only inconvenience in the patient care, but also it may

cause the loss of life.

Purchasing article:

The material used for any equipment should be durable, non-corroding, non toxic and

safe for use.

Should have standard shapes and dimensions to fit into  various situations

Reparability and spare part availability of the article

Interchangability of the article

All surgical instruments used in  a hospital should be sterilisable  and they should

stand the tests for leakage , hydraulic pressure tests for bursting etc

Should have accuracy in measurements

Should have ease of operation

The central supply service

Most hospitals have a central department where equipments and supplies are stored and from

which they are distributed to the units. The type of materials that is kept in the central supply

room varies from hospital to hospital. In some hospital the central soppy room deals with

only the sterile supplies and ward trays. In other hospitals all types of equipment such as

oxygen, suction, ward trays, catheters, syringes etc are stored here.

RESPONSIBILITY OF NURSE ADMINISTRATORS :

The nurse administrator responsibilities in relation to supplies and equipments may be stated

as follows :

a) To keep an adequate supply of materials on hand at all times in good condition ,

available for use , and conveniently located

b) To delegate to someone the responsibility for handling supplies and equipments

c) To be observant of waste and misuse

d) To educate nurses , doctors and other personnel in the economical use of material

AIDS IN KEEPING AN ADEQUATE SUPPLY ON HAND :

These will be discussed under four separate headings :

8

Standards

Exchange system

Inventory

Requisitions

STANDARDS :

These are established quantities which are required to meet the needs of a particular ward

division. For eg. A ward may have a standard of six 2 cc. Syringe which is the number the

head nurse should keep on hand at all times. when is broken the pieces are exchanged for a

new one if this is the system which exists in the institution. If one is lost , it should be

replaced, but total number should not exceed six which is the standard for her ward.

FACTORS TO BE CONSIDERED TO DETERMINE THE STANDARD:

1. The bed complement for equipment, the census for supplies. Supplies being

expendable, are ordered frequently, either daily or weekly as a rule. More will be needed if

the ward is fully occupied than if it is half or three-fourths full of patients. For supplies, in

other wards, the standard is not a set figure but is fixed only to the extent of a given number

per patient. Equipment, on the other hand ,is provided on the basis of the maximum number

of patients, that is the bed complement.

2. Type of service: A surgical ward will need more instruments and dressings, a medical

ward more syringes and physical examination equipment.

3. Age of patients: Children need different types and amounts of equipment and supplies

than adults require.

4. Sex: Men and women sometimes require different kinds of equipment.

5. Degree and types of illness : Neurologic patients may require more bedsides, rubber

mattresses, and linen than patients with another type of illness.

6. Cost of items: A head nurse might have as large a standard of inkwells as she wishes

whereas she probably will be limited to one costly ophthalmoscope.

EXCHANGE SYSTEM :

9

Many hospitals maintain an exchange system for equipment replacement in order to

prevent overstocking or the lowering of equipment standards. The system requires that a

broken or worn piece of equipment be returned to store room before a new article will be

issued. This prevent an increase beyond the standard. It also assists the head nurse to know

when replacements are necessary and obviates the necessity for making weekly counts of all

items of equipment. The advantage of the exchange system is to study the amount and type of

breakage or deterioration with a view to determining whether it was caused by inferior

quality of material or by careless handling.

INVENTORY :

An inventory is a detailed list of all articles on the ward, their specification and

standard number of quantity. The specification make it possible to identify the article by size,

number or description. The standard indicates the quantity that should be kept on the floor.

When inventory is taken the count is checked against the standard and correction made as

necessary. Not only does the taking of inventory give an opportunity to determine the

standard has been maintained but it provides a good chance to dispose of excess and obsolete

material to recommend changes in standards to determine the condition of article of

equipment and to order repair or replacement if necessary. It also is an ideal time to return

equipment to its proper place.

REQUISITIONS :

A requisition is a written order for supplies and equipment or for their repair, Requisitions

are made by the individual who is responsible for the maintenance of supplies and equipment.

This may be the head nurse or someone else specifically delegated the responsibility. She

should be wholly familiar with the needs of the ward and the method of ordering. It is

important that the same individual do the ordering from week to week in so far as possible

because she will have a better knowledge of the ward's needs.

Ideally there would be just enough supplies on a ward to meet the day's demands.

Reordering is generally done when the amount on hand reaches a prescribed minimum. The

minimum is set so that there will be a small reserve on hand when the new stock arrives.

FREQUENCY OF ORDERING :

Hospitals usually designate specific times for ordering certain types of materials

depending upon the following factors :

10

1. Perishability : foods, such as milk, eggs, fruit must be ordered daily.Sterile

supplies which may become outdated are also ordered each day or every other

day.

2. Storage space on the wards. There may not be room enough for more than a

week's supply of some items.

3. Cost and convenience of handling and filling requisitions and of transportation . It is

not often practical to have deliveries more frequently than once a week for most

nonperishable supplies. New equipment to 'ring up the standard is often ordered on a

special day such as the first ordering day of each month.

Requisition Forms .:

The forms used for ordering vary with the hospital. Some have one form for all

supplies and equipment with a separate one for repairs or construction. Some have

different colors designating from which department the supplies come—storeroom,

dietary department, surgical supply room, laboratories, housekeeping department, linen

room, pharmacy. Some hospitals use printed forms, one for each department, listing

available articles and the quantities to be ordered . Sometimes standards for ordering, such

as. five pounds soap powder per ward per week, one cake of soap per patient per week are

included. According to this standard and the amount on hand the head nurse indicates the

quantity needed.

.

Requisitions for Exchange Items :

Articles for exchange may be listed on the regular requisition form or a special one.

Complete specifications are necessary as with other requisitions. Duplicate copies of the

order may be required, one to accompany the articles for exchange, the other to be sent

with the set of requisitions for approval.

Requisitions for Replacements :

To bring up the supply to standard or to increase the standard, requisitions accompanied

by a statement explaining their need may be required .

Requisitions for Repair or Construction:

These are usually written on a special form and give an exact description of the job to be

done.

Method of Ordering Supplies.

11

Before writing the order a systematic check needs to be made to determine the amounts

which are on hand. The check may be made by an aide or the ward clerk. The head nurse then

considers her expected needs, compares them with the amounts on hand and the list of

standards for ordering, determines the amount needed, and writes the requisition. She allows

a small margin for emergencies. As she gains in experience she will be able to judge needs

fairly accurately. If she. inadvertently orders incorrect items or an oversupply, they usually

cannot be returned if the hospital keeps a perpetual inventory. Materials in this way may be

wasted. This is one of the important reasons why ordering should be done by the same

individual consistently and certainly never by one who has not received complete instructions

and supervision

Ordering Linen.

Methods of ordering linen often vary from those of other supplies.

METHOD 1.

Sometimes each ward is issued a standard supply of linen in which case it is labeled with

the name of the ward and the date of issue. The latter helps to determine the life of the article.

After laundering, the linen is sorted and returned to the proper win. Maintaining standards is

achieved by inventory and replacements for worn or lost linen in the same way as other

equipment is replaced. This system requires the time of maids to sort it by wards and it also

permits linen to be stocked on the shelves when the census is light. A larger total supply is

therefore needed than would otherwise be necessary.

METHOD 2.

Some hospitals consider it less expensive and more efficient to use a central linen room.

The linen which is issued is marked with the name of the hospital but is not designated for a

specific ward. All linen is returned after laundering to the central linen room, Sorting of torn

articles is done either to the laundry or in the linen room, preferably the former because tears

are more easily detected as articles are being folded. Mending is done in the sewing room.

When a central linen room is used distribution to the wards may be accomplished by one of

several methods. One method requires a requisition from the head nurse who estimates the

ward needs on the basis of a standard; that is, one sheet per patient per day plus enough extras

for patients who need an additional supply and enough to make up fresh beds following the

discharge of patients. A daily shelf count must be made as a guide in ordering. This method

involves considerable time on the part of the head nurse and is apt to lead to shortages due to

hoarding on wards where needs are not accurately estimated.

12

METHOD 3.

TO overcome these disadvantages another distribution method is sometimes used. Linen

issued to the wards daily or at periodic intervals in accordance with a fixed standard in

relation to the number and type of patients and the number of discharges. The calculation of

needs is made in the linen room. A shelf count is made on each ward by a member of the

linen room staff or by the ward maid and the amounts on hand are deducted from the

estimated needs. This method saves considerable time for the head nurse and works in a

satisfactory manner in many institutions where it has been tried. Sometimes linen is put up in

bundles, one for each patient, containing the usual daily allotment of a sheet, pillow case,

face towel, and such. An extra supply of each item is sent for emergency use and for patients

who may require additional linen. Complete sets of linen each containing the items necessary

to make up a unit are also sent, the number corresponding with the number of patients to be

discharged. To minimize handling and save time for the ward staff the daily bundles may be

delivered directly to patient's rooms the afternoon or evening before they are to fee used

DELEGATION OF RESPONSIBILITY FOR THE HANDLING OF

SUPPLIES AND EQUIPMENT :

In a busy ward, the head nurse cannot carry responsibility for all details of ward

management. Indeed if she tries to do so she will not be a very successful administrator.

Some aspects of management in regard to supplies and equipment can easily be delegated to

other individuals. A student nurse may have a short experience in assuming responsibility for

supplies and equipment, usually in connection with her treatment room assignment. In some

instances a nurse's aide or the ward clerk can perform the mechanical aspects of this function.

A non-nurse assistant could relieve the head nurse of the entire responsibility in this area

KEEPING SHELVES STOCKED .

Any one of these individuals could easily keep a check on the amounts in cupboards or on

shelves ready for use making sure that there is always enough available. The excess is kept in

storage and a small amount removed at a time to keep the shelves stocked Workers should be

13

instructed to see that the oldest supplies are placed where they will be used first and to

remove outdated surgical goods for resterilization. Supplies need to be kept well labeled and

arranged so that they can be easily located and quickly identified. Both equipment and

supplies must be protected against damage or deterioration.

KEEPING THE T REATMENT ROOM IN ORDER .

If equipment is sterilized on the ward, this responsibility as well as the task of

keeping the treatment room in order and the cupboards and drawers clears can be

specificallv delegated to a nurse with a maid or aide to assist her. It should be the definite

responsibility of one individual to make sure that ample supplies are available for the

evening and night nurses, especially when it is difficult to obtain materials from a central

source after certain hours.

T AKING INVENTORY .

The individual assigned to the task of handling supplies and equipment may also take

the periodic (daily and weekly) counts of equipment as necessary to keep track of it. She

keeps the head nurse informed of losses and misplacement of equipment and shortages in

supplies. She also may make the daily or weekly report of supplies on hand to be used by

the head nurse in writing requisitions. Preparation of broken or worn equipment for

exchange and compiling the necessary lists is a function the head nurse herself need not

perform.

NEED FOR A ROUTINE PROCEDURE :

The only way to ensure the efficient management of the activities associated with

supplies and equipment is to establish a definite routine and set up specific directions for

its accomplishment. This material should be placed in writing and used for teaching the

person to whom the duties art delegated. Directions should be in usable form and located

conveniently for reference. Time is saved when methodical measures are adopted for

mechanical functions.

REPORTING DEFICIENCIES .

It should be the function of every individual to report breakage, equipment which is in

need of repair and low stocks of material. Again, if there is to be efficiency, a definite

system for reporting should be instituted. Preferably a written memorandum is made of

14

the information to be reported. A notebook or a spindle with pencil and paper at hand are

useful if they are located in a convenient place, are checked daily, and if necessary

measures are taken to correct the shortages. A system for tagging impaired equipment and

a definite place for depositing it should be known to all. Here again it is advisable that a

uniform system be adopted throughout the hospital to save confusion. Daily review of

supplies on hand and frequent checking of the condition of electric, plumbing and other

equipment will minimize the amount of reporting which the staff will need to do.

EDUCATION OF PERSONNEL IN ECONOMICAL USE OF

HOSPITAL PROPERTY.

It is the duty of the nurse administrator to impress on every member of the ward staff the

need for economy in the use of supplies and the proper use and care of equipment. She will

find that there are many means by which she can interest the doctors, nurses, and other

personnel in economy. The following are suggestive of methods which have been found of

value:

1. Instruction in the causes of breakage and deterioration as well as the proper care

of equipment

The head nurse will find it advisable to review with nurses who are new to the ward

the care to equipment which is specific for the service, stressing the points which experience

has shown to need emphasis. If she can arrange to give orientation conferences for new

interns and medical students, information relative to the doctors' responsibility for the care of

equipment and economical use of supplies may be included in the discussion. Conferences of

this nature pay large dividends in general good feeling and cooperation as well as in

economies.

2. Preparation of lists which give amounts and types of sterile goods needed for

dressings and treatments characteristic of the service :

It is wise to come to agreement on matters of this type with the resident of the service.

The lists should be signed by both the head nurse and the resident and kept in an accessible

place. They may be posted on a bulletin board in the treatment room or placed on cards in a

file box. A very convenient method is to encase them in sheets of washed x-ray film and file

15

them in a loose-leaf notebook. This permits the lists to be used easily and prevents soiling

and wear.

3. Use of illustrative material and bulletin boards to emphasize the costs of

equipment and the need for its careful handling.

Attractive posters and line drawings can be very effective A display of damaged materials

indicating their costs attracts a great deal of attention. Comparative studies of the cost of sup-

plies or broken equipment are challenging if the information is made attractive enough to be

read. Posters or statements indicating ways in which wasted money could have been

profitably spent are of interest to all groups. It is well known that any material on a bulletin

board must be attractive to be noticed and changed frequently if it is to be read. Posters can

often be saved and re-used as new groups of students and interns are assigned to the service.

4. Group conference are an effective method of teaching :

Report on amount of breakage , if short and presented is an interesting way, can produce

discussion which leads to greater awareness of the problem a display of the broken and worn

equipment ready to be sent for exchange may be accompanied by a discussion of causes and

prevention of destruction

CONCLUSION

Health care services are the result of a number of materials used in the process. Supplies and

equipment are a vital factor in the hospital economy. The hospital must all times be supplied

to meet daily needs and any emergency situation. At the same time it must realize that idle

materials represent a cash outlay which brings no return. Supplies and equipment contribute

in an important way to the efficiency of the ward and to the quality of patient care.

BIBLIOGRAPHY :

Jean Barrett, Ward Management and Teaching, Konark publishers, fourteenth edition,

2003

Dr A G Chandorkar, Hospital Administration and Planning, Paras medical publisher,

first edition, 2004

http://currentnursing.com/nursing_management/planning_equipments_and_supplies_in_hospitals.html

16

THE SUPPLY PROCESS AND ITS PITFALLS :

Logistics is the science of procuring, maintaining and transporting supplies. It involves

delivering large amount of supplies on schedule to many people located in numerous

different places. In drug supply it includes all aspects of the process required to bring a drug

from the supplier to the dispenser and ultimately , to the individual patient. Logistic system

17

are truly system in that they require the coordinated efforts of many individual units inside

and outside the government. When separate task are performed not as part of a system but

independently and disjointedly , cost rise , shortage become commonplace and patient suffer.

The logistic cycle :

1. Drug selection : includes issues such as what products should be available and in what

quantities and standardization of drugs , variety reduction and classification of drugs.

2. Procurement : includes purchasing methods , finance , terms of payment , source of

supply , quality assurance and decision to make buy a product . it also includes

demand estimation , economic order quantity estimation and ordering time schedules.

3. Distribution includes import management , inventory control, storage , waste

management and transport

4. Use includes prescribing and dispensing practices , packaging and labelling , training

auxiliary personnel and educating consumers.

Selection : is often inefficient , especially where pharmaceutical knowledge is lacking

, information on current therapeutics is unavailable or the process for selecting drugs

is disjoined or haphazard. The result can be :

Purchase of too many products : an unnecessarily large variety of items may

duplicate each other , consume limited inventory capital and complicate distribution ;

Purchase of unnecessarily expensive products – there are frequently cheaper , equally

effective alternatives available

Purchase of inappropriate products – limited funds are expended on new drugs whose

clinical efficiacy has not been established , on unproven combination products and

on symptom relief preparation when there are insufficient quantities of more essential

drugs such as antibiotics and vaccine and

Purchase of inappropriate quantities- requirement may be overestimated for some

items and underestimated for others.

2. Procurement : refers to obtaining pharmaceuticals , not only through purchase , but also

through donation and government production . problem are frequent with regard to :

Supplier selection – unreliable supplier withdraw or change their offer during the

tender process , deliver substandard product or goods near their expiration dates or

fail replace bad batches ;

18

Contract terms – supplier contracts do not provide adequate product specification ,

set labelling and packaging requirement , establish firm price and currency

exchange condition or provide a mechanism for holding supplier accountable for

their errors.

Quality assurance – inadequate attention is paid to drug quality prior to purchase

and there is a lack of careful monitoring of port , warehouse , in country transport

and peripheral storage condition

Make or buy options – production possibilities and pursued in areas which are too

technical , too expensive or both , while feasible opportunities for limited local

production go unrecognized

Financing – procurement is limited by lack of funds , while the public, even in

remote areas, buy drugs at high commercial prices

3.Distribution : is a complex and highly varied function. In some programme commercial

distribution networks and relied on for most deliveries , while in other programs the

government assumes the entire responsibility for moving drug from a central national

warehouse all the way to the farthest health post and community health worker. Analysis of

distribution networks often reveals difficulties with :

Information mismanagement – too much information is recorded, too little

information is used , or the information obtained from consumption records , vital

statistics , accounting records and other information sources is misused

Pot- clearing – failure to obtain proper import documents or inexperience

with the port –clearing process results in demurrage charges, increased losses from

spoilage and theft and unnecessary delays

Storage – spoilage is hastened by overcrowded , disorganized warehouses and

customs sheds, inadequate moisture, temperature and regional distribution facilities

even more poorly maintained , limited space is used sub optimally ; inadequate

security leads to further losses from theft

Transportation – disorganized public transport scheduling ,poor maintenance and

failure to consider private sector system slow delivery and increase costs

4.Use – of pharmaceutical is influenced by factors both inside and outside the public

health programs. the ability of the logistics system to meet public health needs is highly

related to usage patterns. Common problems with the use of drug include :

19

Poor packaging and labelling- containers may be unsuitable for the environment,

labels unreadable by the consumer or packaging quantities inappropriate for

dispensing or patient use

Careless dispensing practices – dispensing is carried out under unsanitary

condition with dirty utensils, creams and liquids are dispensed into unwashed

bottles and pills are simply wrapped in paper, patients often receive oral

instruction

Irrational prescribing – lack of mechanism to promote uniform prescribing habits

results in rampant over or under use of drugs, use of ineffective drugs or un

indicated multiple prescripitions require the supply system to procure and deliver

unnecessary items

Patient use- there is noncompliance with treatment due to inadequate instruction ,

the quantity dispensed or unrealistic dosage schedules.

20