[india-drug] Unnecessary wasteage of medicines (15)

["beneanand paramadhas" <anandbene@yahoo.com>]

  Dear readers,
   
 Unnecessary wasteage of medicines (15)
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I wish to add a bit more on the discussion on wastage of medicines. Although I am not sure of what practices were followed to minimize wastage in different states, and due to the feeling that these basics which came in my mind would help some of you to make better decisions.
   
  In general, wastage of or in drugs for any one is unnecessary. The truth is we cannot totally eliminate wastage from any type of distribution, clinical or dispensing setting. Wastage can happen at any stage of the product cycle, it may occur at procurement, storage, distribution and so on. But wastage can be limited to an agreed percentage or amount in a situation where there is adequate control and proactive measures to limit its value. 
   
  In a public health delivery system the wastage of drugs could be more pronounced if the public procurement, distribution and the dispensing units do not have adequate policies in place to coordinate its functions.
   
  Usually disease and drug sensitivity patterns vary from clinical setting to setting. 
  Periodical evaluation or study of such patterns should be done to analyze the change, and policies should be put in place to ensure that the Essential Drugs List (EDL) and the treatment guidelines are reviewed accordingly to provide an affordable range of drugs to cater the wide range of population.
   
  Especially on antimicrobial therapy, lack of such analysis and policies would promote empirical regimens, allow clinicians to challenge conditions with a wide range of drugs known, which would be a waste on value and quality, and on the other end harmful to the patient. The principles of optimization and individualization if applied would be of great benefit both to the patient and the providers.
   
  Calculation of Average Monthly Consumptions (AMC) of each drug in every dispensing facility would be a valuable tool to forecast the requirement for procurement, although its use is limited by the changes in prescribing patterns (if any). These AMCs should be periodically reviewed as well, and such revisions would augment better judgment to procure a sensible quantity. Centralized buying and decentralized distribution with well coordinated data management would positively minimize wastage.
   
  A good integrated network in distribution system is essential to ensure drug availability. Quiet a number of developing countries fail to minimize wastage due to lack of this integration. One end of the country would keep the drug in excess leaving to expire, on the other end there may be critical shortage contributing to increased morbidity and mortality. Integrating the distribution system with the dispensing facilities to rotate such excess or short dated stocks would help improve drug availability and reduce wastage on expiries. 
   
  In this modern technology era, computers can be used as an effective tool to network the distribution sites and interface them with the dispensing facilities. This interfacing should provide access to the end users to browse the availability in the country/state and be able to borrow or inter-transfer those needed/excess/short dated stocks. 
   
  At every Dispensing facility apart from calculating the AMCs, the First-In-First-Out (FIFO) principle may be followed to ensure that the first in or short dated items moves out first (whichever appropriate).This may be followed at every stage like, receiving the items from medical stores, during storage, issuing to dispensary and while dispensing to patient as well.
   
  A Minimum Reorder Level MRL has to be set for each item based on the average monthly consumption. MRL can be 3 x AMC or can be altered according to the supplies schedule and shelf life of products.
   
  In conclusion, policies to study the disease and drug sensitivity patterns periodically are essential; revision of the EDL and the treatment guidelines would provide an optimized armentarium which would minimize wastage.
  Good distribution network, integrated with dispensing facilities and efficient materials management would definitely bring about a valuable drop in wastage
   
  Bene D Anand Paramadhas
  Senior Pharmacist
  Nyangabgwe Referral Hospital
  Botswana
  anandbene@yahoo.com
   

 
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