PHARMACEUTICALS AND LABORATORY SERVICES LINDA OELOFSE DISTRICT PHARMACIST - BOJANALA DISTRICT, NW 15TH SEPTEMBER 2015 “HOW TO TURN THE ELEMENTS GREEN”

PHARMACEUTICALS AND LABORATORY SERVICES

LINDA OELOFSE DISTRICT PHARMACIST - BOJANALA DISTRICT, NW

15TH SEPTEMBER 2015

“HOW TO TURN THE ELEMENTS GREEN”

SUB-COMPONENT 12 - MEDICINES AND SUPPLIES

• Pharmacists throughout the country have been conducting Medicine Supply Management Training for the last 15 years.

• The NCS and the IDEAL CLINICS SCALE UP is a big bonus for us as this is being enforced at facilities. (It was previously not taken as seriously)

• With Management support and the elements included in the Ideal Clinic Components there is a drastic improvement in the management of medicines and supplies at clinics

Background

Element 77 : There is at least one functional wall mounted minimum/maximum room thermometer in all rooms where medication is kept VITALCurrent Case Scenario (generalised)

• Some room thermometers are not minimum/maximum – many have dial thermometers. • Some are not being read correctly• Some are broken

Ideal Case Scenario (green – compliant)

• All pharmacy stores must have functional minimum/maximum thermometers.

• Facility Manager must ensure that the correct thermometers are available and in good condition.

• Sub-District managers to ensure that funding is available for essential equipment.



Element 78 : The temperature of the rooms where medication is kept is recorded twice daily VITAL

Current Case Scenario (generalised)

• Generally we find that the room temperature in the bulk pharmacy store is recorded twice a day (green) and this is marked compliant.


• Facility Manager is to allocate a responsible person to record the temperature twice a day .

• Temperature recording charts must be available

• Facility Manager must ensure that the delegated person is trained and recording the temperatures correctly, and not just filling the gaps in weekly .

• Refer Annexure 31 (pg 186 of Ideal Clinic Manual - Signature needed for both a.m and p.m recordings


Element 79 : The temperature of the rooms where medication is kept is constantly within the safety range VITAL


• The medicine store rooms have air conditioners which are mostly functional and within the safety range.


• Allocated staff member to alert manager immediately if temperature out of range and activate contingency measures

• Facility Managers must ensure that they have a functional air-conditioner in their pharmacy stores

• Medication must be stored below 25 degrees at all times


Element 80 : There is a contingency plan to manage inappropriate room temperatures IMPORTANT


• Some clinics are scoring red for this during the summer assessments as air conditioners break down and maintenance budget is spent.

• Only a few facilities have generators


• Facility Manager is to ensure that she has a contingency plan to manage high temperatures

• Ensure that pharmacy store air-conditioner is fully functional and serviced regularly

• Obtain generators for clinics and ensure that the Pharmacy Store air-conditioner and fridge is attached to generator


Element 81 : The temperature of the medicine refrigerator is recorded twice daily VITAL


• We are compliant and achieving a green for this.

• Most of our fridges have fridge tags which give records for the last 30 days so that we can monitor if adverse temperatures were reached at any time.

• Regular training is conducted on cold chain management and staff take care of their stock.


• Fridge thermometer is available and functional at all times

• Facility Manager to allocate a responsible person to record the refrigerator temperature twice a day

• All staff involved with cold chain management need training

• All pharmacists and cluster managers need to monitor cold chain management with each facility visit.


Element 82 : The temperature of the medicine refrigerator is constantly within the safety range VITAL


• We score GREEN at all facilities.• The fridge tags serve as a double check

but it is still essential that temperatures are charted and signed off twice a day for all medicine refrigerators on premises


• Facility Manager must have a contingency plan to manage cold chain in the event of long power failures or fridge failure.

• Monitoring of recorded temperatures charted will assist manager in adjusting settings on fridge which is needed with change of seasons

• Cool boxes with ice packs need to be available in the event that stock needs to be moved to another facility in the event of a breakdown.


Element 83 : There is access to an automated supply chain system for medicines ESSENTIAL


• RED -We do not have an automated supply chain management system at clinics.


• We have been in discussion with MSH (SIAPS) regarding Rx Lite, but nothing has been finalised for the province at this stage.

• This will be addressed as a matter of urgency

• Possibly other provinces have already piloted the system.


Element 84 : All medicines on the Essential Medicine List (EML) are consistently available VITAL


• We have a lot of YELLOWS at the moment due to the changes in contracts and suppliers awarded the contracts not able to meet demands.

• Many chronic patients have had to change treatment since awarding of new Tablet tender 2014 – training and communication ongoing.

• We have weekly stock out reports for most facilities and provincial teleconferences to manage situation.


• All medicines on the PHC EML must be available at all facilities

• Facility Manager to ensure that all staff are empowered to deal with the changes in products on EML.

• Stock-out reports must be an ongoing practise.

• Arrangements must be made to obtain stock from pharmacy or nearby facility in case of stock-out.


Element 85 : The facility has sufficient stock to dispense chronic medication for 2 months VITAL


• We have REDS, YELLOWS AND GREENS at the moment .

• Many clinics have inadequate storage space, but most have managed to issue chronic medication to patients for 2 months, esp. ART Treatment

• I believe the REDS are due to the depot not always able to supply in time, resulting in limited stock being shared among patients until stock is available (borrowing from other hospitals and even provinces where necessary)


• Ideal situation will be to have adequate storage facilities in all clinic pharmacy stores, to overcome challenges when suppliers cannot supply (without overstocking).

• Posts for Pharmacist’s Assistants need to be activated on the Clinic Structures so that a lot of the work involved with managing stock levels can be removed from the Professional Nurses at the facilities.


Element 86 : Re-ordering stock levels (min/max) is determined for each item on the EML VITAL


• We have REDS, YELLOWS AND GREENS• In many clinics the Min/Max levels

need to be reviewed using disease profile at facility and DHIS.

• We always trained using consumption but the staff stack so much stock in their consulting room cupboards, leaving the store relatively understocked. They re-order which results in overstocking and expiry eg family planning stock


• The ideal situation where re-ordering is done correctly will be when we see a vast reduction in expired stock being returned from facilities.

• Ongoing Medicine Supply Management Training to be conducted within Sub-districts

• We need to appoint pharmacist assistants at facilities to manage this effectively. (a pharmacist visiting the clinic once a month cannot manage this effectively)


Element 87 : Medicines that expire within three months are returned to the depot ESSENTIAL


• We have mostly yellows and greens and staff return the stock that they believe is overstocked at facility.

• We have received a lot of short-dated stock from companies through our depot but this is being addressed.


• Ensure that FEFO is practised at all times in facilities.

• Clinics should be issued stock with good expiry dates at all times

• Facility Manager to return stock soon to expire if it is noted that it will expire at facility.


Element 88 : A list of required basic surgical supplies (consumables) indicating the re-ordering stock levels (min/max) is available ESSENTIAL


• This is generally in place but due to lack of Tenders for many of the surgicals at the moment we do struggle with supplies.

• Provincial Depot has to buy many items out on quotation, and this results in delays with supply of surgicals at facilities

• Min/Max levels available for all surgicals at facilities is available


• Facility Manager is to ensure that re-ordering levels (and Min/Max) is in place for all items and that adequate stock is available

• National Tenders to be available for all basic surgical supplies that are used at Clinic Level.

• This will improve availability of surgicals at clinics

SUB-COMPONENT 13 - LABORATORY SERVICES

Element 89: The PHC Laboratory Handbook is available ESSENTIAL


• According to the information available on performance it is noted that the handbook is not available at all clinics


• The PHC Laboratory Handbook is available from NDoH and at NHLS.

• Sub-District Managers to ensure that all clinics have the handbook available.


Element 90 : Specimens are handled according to the National Health Laboratory Services Handbook ESSENTIAL


• We are mostly GREEN for this element but are all staff in facilities adequately trained to handle specimens correctly?


• Facility Manager is to ensure that all staff are handling specimens in accordance with the NHLS guidelines.

• Training to be strengthened at all facilities where shortcomings are noted.


Element 91 : Required functional diagnostic equipment and concurrent consumables are consistently available VITAL


• Our indicators are mostly GREEN but is this reality?

• Supply Chain Management Systems are in place for consumables

• Diagnostic Equipment is in place but concerns are raised regarding functionality and delays in repairing items


• Supply Chain Management Systems need to be strengthened in facilities experiencing stock outs of consumables.

• Min/Max stock levels for all consumables need to be established.

• Facility Manager needs to monitor equipment regularly to ensure that it is fully functional.

• Maintenance Plans and funding must be in place for all diagnostic equipment


Element 92 : The PHC laboratory results are received from the lab within 72 hours ESSENTIAL


• Mostly GREEN but some YELLOW• We need to define how we count the

hours as we do not get delivery over weekends


• Facility Manager to monitor time lapse between collection of bloods, etc and delivery of results.

• Facility Manager to meet with NHLS Branch Manager and staff to discuss challenges with delays in delivery of results.

• Facilities should all have access to 3G and e-mail and arrangements should be in place to receive results electronically.


Element 93 : Laboratory results are filed in the client's record within 24 hours after receiving them from the lab ESSENTIAL


• This is not happening at all facilities• Generally recorded as YELLOW.• When you go to some facilities you find

a whole packet of results Staff say that the results will be easily retrievable when the patient comes to the clinic.

• Volunteers are filing the results at some facilities


• Facility manager needs to allocate a responsible person to file all results in patients files within 24 hours.

• Facility Manager needs to monitor the practice to ensure that filing is kept upto date

Documents

PHARMACEUTICALS AND LABORATORY SERVICES LINDA OELOFSE DISTRICT PHARMACIST - BOJANALA DISTRICT, NW 15TH SEPTEMBER 2015 “HOW TO TURN THE ELEMENTS GREEN”