Chapter 2: Overview supply
chain, pharmacy service and
Medical Equipment
Management
1
Chapter Objective:
2 At the end of this chapter the participants will be able to
describe supply chain, pharmacy service and medical
equipment management standards.
Enabling Objectives: At the end of this chapter, participants
will be able to:
Identify hospital supply chain and pharmacy service
operational standards
Identify hospital medical equipment management
operational standards
Describe implementation guidance for pharmacy service and
supply chain operational standards
Describe implementation guidance medical equipment
management operational standards
Chapter Outline:
3
Introduction
Pharmacy service and supply chain operational standards
Implementation guidance for pharmacy service and supply
chain operational standards
Medical equipment management operational standards
Implementation guidance for medical equipment management
operational standards
Chapter summary
4
Implementation guidance for pharmacy
service and supply chain operational
standards
a. Pharmacy Service Organization and
5 Management
Pharmacy services of the hospital should be organized as
1. Outpatient pharmacy services unit,
2. Inpatient pharmacy services unit,
3. Emergency pharmacy services unit,
4. Drug supply management unit,
5. Drug information services unit,
6. Compounding services unit.
Each unit should be directed by a registered pharmacist.
Other units shall also be established depending on the
hospital complexity
b. Resource Needed for Pharmacy
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Service
1. Human resource:-
Hospital pharmacies should have at least the positions and
professional mix of Pharmacy Services Director/Head, Pharmacy Unit
Coordinators, pharmacist, Pharmacy Accountants, Cashiers, Porters,
Cleaners, Patient assistant and Admin assistant.
2. Premises, Equipment and Facilities:
Sufficient space for the storage, compounding, counseling & dispensing
of medicines and for administrative activities and
Sufficient basic equipment and/or facilities to enable delivery of proper
pharmacy services
c. Drug and Therapeutics Committee (DTC)
Each hospital and health center is expected to establish a functional Drug and
Therapeutics Committee (DTC) having multidisciplinary representative members
composed o
medical,
pharmacy and
administrative departments)
Health facility DTC has the responsibility of promoting the safe, rational and cost
effective use of pharmaceuticals.
DTC is an essential component of a health facility’s effort to improve availability and
ensure rational use of medicines.
d. Hospital Specific Drug List / Medicines
8 Formulary Manual
All hospitals and health centers should develop hospital specific
pharmaceuticals list categorized by VEN.
This list should be prepared by multi-disciplinary team of health
professionals.
The selection of pharmaceuticals should be based on:
The local pattern of disease
STGs
National Drug List
Type of health services given by the hospital
Availability of expertise in the hospital (specializations)
Diagnostic capacity of the hospital
e. Drug Supply Management
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To ensure uninterrupted supply of safe, effective and quality pharmaceuticals,
the health facilities needs well organized and functioning Logistics Management
Information Systems.
Drug supply management at hospitals involves the following basic functions:
selection, quantification, procurement, storage, distribution, use and LMIS.
Reading assignment (selection, quantification, procurement, storage, distribution, use)
Logistics Management Information System (LMIS)
Its purpose is to collect, organize, and report information to other levels in the system in
order
To make decisions that govern the logistics system and ensure that all six rights are
fulfilled for each client.
Three essential data items required to run a logistics system are Stock on Hand,
Losses/Adjustments and Consumption Data
Logistics Management Information System (LMIS)…
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Records and Reports Used in Managing Pharmaceuticals are:
a. Bin Card:- track stock in storage and kept with item
b. Stock card: - track stock in storage and kept in the Cabinet in the office of the
pharmacy head
c. Health Post Monthly Report and Re-supply Form
d. Internal Facility Report and Resupply Form
Report & Transaction- Report essential data items Issue and receive pharmaceuticals within
a health facility
e. Report & Requisition Form
Report essential data items, Order pharmaceuticals from PFSA
Submitted every other month to PFSA with copy to WoHO (Health Centre) or RHB/ ZHD
(Hospital
f. Cost analysis worksheet for RRF
To prioritize purchased products based on budget availability. Feedback reporting format
(RHB/ZHD/ WoHO) and PFSA
f. Good Dispensing Practice
11 It is the process of preparing medicines and distributing it to
users with provision of an appropriate information and
counseling.
Deliver the correct drug and medical supply:
To the right patient,
In the required dosage and quantities,
In the package that maintains acceptable potency and
quality for the specified period with clear drug information.
The dispensing process includes evaluation of prescriptions,
billing and payment, processing, packaging, labeling, and
counseling of patients on appropriate use of medicines.
f. Good Dispensing Practice
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The following are six dispensing steps:
Receiving, validation, interpretation and checking
appropriateness of a prescription
Billing and recording transactions
Selection, manipulation or compounding of the medicine
Packaging and labeling of the medicine
Provision of medicines with counseling
Filing the prescription and transaction documents
The dispensing practice and environment should be organized
in a manner that reduces waiting time and ensures patient
convenience safety, confidentiality and ultimately achieve
greater patient satisfaction.
g. Auditable Pharmaceutical Transactions and Services
13 APTS is a data driven package of interventions designed to
establish accountable, transparent and responsible pharmacy
practice.
Through improving recording and documentation, it generates
reliable and consistent information for decision making.
APTS has five result areas:
Efficient budget utilization
Transparent and accountable transactions,
Reliable information,
Effective workforce development and deployment
Improved customer satisfactions.
h. Drug Information Services
All hospitals should establish and provide drug information services (DIS)
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The DIS provides information for health professionals, patients and members of the
public
Regular drug information publications such as drug alerts, newsletters,
monographs, and therapy updates shall be prepared and distributed
It also notifies availability of pharmaceuticals to the hospital staff.
The DIS should have room that has sufficient space and appropriate furniture and
equipment including telephone, computer, printer, filing cabinets and internet
access.
The DIS should have a current collection of national and international authoritative
reference materials
The DIS should be staffed by appropriately skilled drug information pharmacists
that are trained in the provision of drug information.
I. Clinical Pharmacy Services
Clinical pharmacy services are patient-oriented services developed to
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promote the rational use of medicines, and more specifically, to maximize
therapeutic benefits, minimize risk, and reduce cost.
Pharmacists assess patients, identify drug therapy needs and problems,
propose care plan, recommend choices, and monitor outcomes.
The service should be well integrated with all clinical departments in which
health managers should significantly play a role.
Clinical pharmacy services should be properly recorded on standard formats,
filed properly and reported periodically to relevant bodies.
The recording forms should be part of the permanent medical record
(treatment chart) of the patient.
The formats include: Inpatient Medication Profile Form, Pharmaceutical Care
Progress Recording Form and Medication Reconciliation Form.
j. Compounding Services
A hospital pharmacy should prepare non-sterile preparations such as
16 prescription-based ointments and creams and bulk preparations (e.g. alcohol of
different strengths) which are not available commercially but needed for patient
care.
k. Monitoring Medication Use and Safety
Each health facility should implement medication safety programs including :
adverse drug event (ADE) monitoring and reporting,
performing medication reconciliation activities,
identifying high alert medications, and
implementing new and existing national standards and systems.
The DIS is responsible for monitoring medication use and safety
To monitor the use of medications at health facilities, should implement the
following activities periodically.
Monitoring of prescriptions
Aggregate data methods (ABC, VEN)
Indicator study methods
L. Pharmaceutical Waste Management
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Pharmaceutical wastes are all wastes that are generated from
the health facility in the use of pharmaceuticals during
diagnosis, treatment, immunization, and compounding.
Handling, transportation and disposal of pharmaceutical
wastes should be guided by FMHACA’s pharmaceutical wastes
disposal guideline to protect patients, health workers,
supportive staff, community, and the environment.
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Implementation Guidance for
medical equipment management
standards
a. Medical Equipment Management Unit
19 Each Hospital should establish a medical equipment management unit that is
appropriately staffed and led by trained biomedical personnel with activities
like;
maintenance workshop equipped with the necessary materials
Establish and maintain the medical equipment inventory and History Files
for all equipment
Conduct acceptance testing and installation of new equipment
Provide staff in-service training on the correct and safe use of equipment
Track equipment inventory, service history, and work orders
Ensures sufficient funds for regular and incident based maintenance
budget, including spare parts.
Develops and maintains a procedure describing the processes for risk
managing, improving safety and quality.
Establishes automated and centralized documentation system that tracks
all equipment and spare parts
b. Medical Equipment Committee
20 Each hospital should establish Medical Equipment Committee (MEC)
that advices the management of medical equipment in the facility.
The MEC is chaired by the medical director of the hospital and the head
of medical equipment management unit should be the secretary.
The MEC should be composed of hospital a medical director and
representative of nurses, pharmacists, laboratory, administrative
personnel and biomedical personnel basis.
The MEC is responsible to:
Oversee establishment of a medical equipment inventory
Develop a model medical equipment list
Monitor the implementation of policies, standards and guidelines for:
Planning and procurement of medical equipment
Donation of medical equipment
Disposal of medical equipment
Review incident reports related to medical equipment
c. Medical Equipment Maintenance
workshop
Hospitals should establish a medical equipment maintenance workshop based on their level
21 Maintenance workshop including space for:
Administration offices
Electrical/Electronic Work Area
Biomechanical Work Area
Test , Measuring equipment, Tools, Spare parts, and Personal Protective Devices Store
Staff Training Room
d. Medical Equipment Inventory
Medical equipment inventory is a list of the technology on hand, including details of the type and
quantity of equipment and the current operating status.
Accessories, consumables and spare parts inventories are directly correlated with the main medical
equipment inventory.
The Medical Equipment strategy should give a clear definition of medical equipment that should be
included in the medical equipment inventory
A small team should be established for the inventory of medical equipment.
An inventory database should be established to record and manage all items of equipment. This can
be paper based or computerized, with paper back up.
The inventory should be reviewed and checked annually, with regular updates during the year when
new equipment arrives or is removed from service.
All equipment should be labelled with its inventory number preferably using a water proof PVC sticker.
Hospital policy should prohibit use of medical equipment without inventory tags/stickers.
e. Equipment History File
An individual file/folder should be established for each item of equipment.
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This file should be held in the equipment maintenance department.
The file should contain:
Inventory Data Collection Form
The address of the manufacturer
The address of the supplier and local agents
Details of any maintenance contract and maintenance contractor (if relevant)
Copy of warranty (if relevant)
Price paid/Copy of invoice
List of consumables required to run machine and recommended spare parts
Acceptance test log sheet
Medical Equipment Risk Assessment Form
SOPs for operation and maintenance of the item
Planned preventive maintenance schedule
Corrective maintenance reports
f. Model Medical Equipment List
23 Each hospital should establish a model medical equipment list that describes the
‘ideal’ number and types of equipment required by the hospital.
A multi-disciplinary team will determine Model Equipment List of all items that are
necessary to provide essential service.
g. Medical Equipment Development Plan
is a plan to define goals for acquisition, maintenance, and replacement of equipment
in the short term and long term.
The medical equipment development plan (EDP) brings attention to:
Current stock and condition of equipment: which pieces need to be replaced or rehabilitated,
which pieces need to be disposed
Shortfalls in equipment: missing equipment that needs to be purchased
What action is needed to rehabilitate, replace or purchase equipment
Short-term (1 year) and long-term (2-5 year) goals to ensure that the hospital has all
necessary equipment for current and future services
The EDP should be developed by the MEMU and approved by hospital management.
h. Accusation /Procurement of Medical
24 Equipment
In Medical equipment Procurement process the following steps should
be considered.
Need assessments and Justifications,
Planning and Budgeting
Technology Assessment, preparation of technical specification and
Selection
Cost of ownership( Maintenance, Spare part, consumable etc) costs
After sale services
Human resource
Procurement
When purchasing new equipment enough spare parts and accessories
to last at least 2 years should also be purchased.
The hospital MEMU should strictly follow National Medical Equipment
Donation Directive for the receipt of donated medical equipment.
i. Preparing for Equipment Delivery and
Commissioning
When an order has been placed to purchase a new item of equipment, or a
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donation has been accepted, preparations must be made for receipt of the item.
This is to ensure quick and efficient installation, commissioning, training, and
eventually placement into service. Pre-installation work involves the following:
Site Preparation
Organizing Lifting Equipment
Organizing Warehouse Space
Preparation for acceptance testing and installation
Preparation for User Training
j. Acceptance Testing and Installation
All medical equipment, purchased or donated, should be inspected upon delivery and
tested prior to initial use.
Acceptance testing and ensures that delivered medical equipment is complete,
undamaged, in good operating condition, accompanied by manuals and spare parts,
satisfies safety criteria, and meets specifications of the purchase order.
Final payment should be made after the item has undergone acceptance testing,
commissioned and all agreed services (e.g. installation or training) have been provided..
k. Standard Operating Procedures
A guide that describes how to use the equipment, instructions for care of the equipment,
26 and basic safety and troubleshooting procedures.
The SOP should be based on the manufacturer’s user manual (if available).
SOPs should be kept attached or adjacent to the item and a copy should be included in
the Equipment History File
l. Calibration, Inspection, Testing and Maintenance
To ensure medical equipment are reliable, safe and available all time when it is needed
for diagnostic procedures, therapy, treatments and monitoring of patients.
such activities prolong the useful life of the equipment and minimize the repair related
cost of equipment.
Disinfection and sterilization of equipment and tools is required.
Incident report is performed
There is a schedule for regular inspection, testing and preventive maintenance for each
piece of equipment as per the manufacturer's service manual.
Corrective maintenance is performed whenever medical equipment breaks down.
There is a schedule for calibration of medical equipment (for high risk equipment) as per
the manufacturer's service manual.
m. Disposal of Medical Equipment
27 The hospital should establish Medical Equipment Disposal
Committee
to oversee the disposal of all medical equipment that are no
longer required by the hospital, including medical equipment.
A policy for the disposal of fixed assets should be established
by the hospital and approved by hospital management.
n. Training in equipment use and maintenance
all clinical staff should be trained to operate each medical
device that they use.
The MEMU is responsible for overseeing all user training for
medical devices, whether in-service or conducted by
suppliers/external parties.
The Human Resource Department and MEMU are responsible
for keeping records of all
O. Budgeting for Medical Equipment Management
To effectively manage all medical equipment careful planning and budgeting is
28 essential.
It is essential that entirety of costs for all medical equipment—existing and
planned purchases—are
P. Medical Equipment Incident Reporting
The hospital should establish a process to report and investigate all critical
incidents, including incidents that arise from the use of medical equipment.
An Incident Officer should be assigned to investigate all incidents and to
ensure that any required follow up action is implemented.
