C H A P T E R                                                            25                      Community Pharmacy Manage...
DEFINITION                                        375                 In a literal meaning, community pharmacy means any p...
376                            25. COMMUNITY PHARMACY MANAGEMENT              Role of a Pharmacist in CPM              Pha...
SCOPE                                              377              5. Clinical Skills Training              To develop th...
378                            25. COMMUNITY PHARMACY MANAGEMENT                  Patient or attendant is interviewed to i...
SCOPE                                         379              Intervention and/or Referral              During the follow...
380                           25. COMMUNITY PHARMACY MANAGEMENT              MODERN TECHNOLOGIES              The computer...
MODERN TECHNOLOGIES                                        381              Pharmasoft              Simple yet sophisticat...
382                             25. COMMUNITY PHARMACY MANAGEMENT                 In view of many experts, pharmacies that...
MATERIAL MANAGEMENT                                       383                  Investment income                  Financin...
384                           25. COMMUNITY PHARMACY MANAGEMENT              products) as is needed and minimizing shrinka...
DRUG STORE MANAGEMENT                                              385              Personnel Team              The person...
386                            25. COMMUNITY PHARMACY MANAGEMENT              HML (heavy, medium, light): Within the racks...
DRUG STORE MANAGEMENT                                     387                3. The storage area should have sufficient spa...
388                                  25. COMMUNITY PHARMACY MANAGEMENT              Revision Questions                1. D...
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Sample chapter Practice of Hospital, Clinical and Community Pharmacy by Aqil To order call sms at +91 8527622422

  1. 1. C H A P T E R 25 Community Pharmacy Management Himanshu Gupta and Mohd. Aqil O U T L I N E Definition Financial Management Objectives Material Management Process Staff Management Scope Drug Store Management Modern Technologies In biological terminology, community represents a group of interacting organisms sharing an environment. In human communities, intent, belief, resources, preferences, needs, risks and several other conditions play a significant role in affecting the identity of the participants and their degree of cohesiveness. The word community is derived from the old French term communite, which is derived from the Latin word communitas, a broad term for society or an organized society. Community pharmacy means any place that comes under the direct supervision of a pharmacist where the practice of pharmacy occurs or where prescription orders are compounded and dispensed other than a hospital pharmacy. Community pharmacy in India is known as retail pharmacy or a medical store or simply a drug store. On the other hand, in developed countries, the concept of community pharmacy is well understood; it serves as a link between health care professionals and patients. A community pharmacy with a helpful staff truly believes in promoting good health for the community. It provides a variety of health products that includes both modern and conventional medicines and devices. It serves as a great resource for the health information for the diverse community of customers. The retail pharmacy staff wears different roles with responsibilities such as patient counselling regarding drugs and dosage forms, maintaining patient medication history records, and providing and home delivery of health care products.Chapter-25.indd 374 9/22/2012 3:13:33 PM
  2. 2. DEFINITION 375 In a literal meaning, community pharmacy means any place under the regulation of a pharmacist where practice of pharmacy occurs to serve, fulfil, compensate the society’s needs and requirements for drug products and services. On the other hand, in legal ethical meaning, community pharmacy is one that is not owned (or operated) by a publicly traded company, but these are operated by independent individuals associated with each other to form an organization in order to coordinate, share and transform information as well as services related with drug products and their use. Pharmacist-owned community pharmacies are privately held businesses in different practice settings, such as single-store operations, long-term care facilities, pharmacist-owned multiple stores, franchise, speciality and supermarket pharmacy stores, offering prescription-based services as well as nonprescription health products. DEFINITION Community pharmacy management (CPM) represents all activities involved in the organization and direction of getting people together to accomplish desired goals and objectives of pharmacy enter- prisers. The major objective of this management is to set or establish a key relationship between community pharmacist, the patients and the physicians. But the practice of CPM has taken a new turn and is now known as medication therapy management (MTM). It is a combined activity of the phar- macist, the patient or their caregiver and other health care professionals that help in promoting the safe and effective use of medications to achieve the targeted outcomes from medication therapy. This quality practice demonstrating the benefits of pharmacist interventions demands the need for change and has led to the recognition of pharmacists as providers of MTM services. The Medicare Modernization Act of 2003 in the US offers an opportunity to the profession of pharmacy: the opportunity to fulfil the vision and practice of pharmaceutical care with the endorsement of the federal government, and the challenge to demonstrate that community pharmacy is the ideal setting for these services. OBJECTIVES The primary goal in the management of a business organization is to establish the goals, objectives, missions and values to start with. The key objectives envisaged in the management of a community pharmacy are categorized as follows: Primary objectives Secondary objectives To compare the proportion of patients To describe the role of nonprescription receiving the treatment and services medicines in patient care management To quantify the health gain by describing To set the opinion between stakeholders change in patients such as patients, physicians and commu- To evaluate the total cost changes on mon- nity pharmacists etary basis To provide and share guidelines between To conduct medicines management intervention and control groups interventionChapter-25.indd 375 9/22/2012 3:13:33 PM
  3. 3. 376 25. COMMUNITY PHARMACY MANAGEMENT Role of a Pharmacist in CPM Pharmacists are the professional pharmacy graduates who play a significant role in the management and functioning of community pharmacy. The management activities of pharmacists include the following: Handling of day-to-day problems and crises related to medicines Monitoring of adverse drug reactions Making people aware regarding the side effects, toxicities, dosage regimens of drugs Ensuring all health workers to develop a social conscience and assume more responsibility for the economic effect of their activities Transferring health-related information and services from one place to other Pharmacists must reorganize appropriate space, time and resources to deliver new services Pharmacy owners should also be cognizant of the need to include their whole staff in the imple- mentation process, even for a service that is ostensibly delivered by the pharmacist alone PROCESS The traditional practice of CPM was based on the temporary handling of problems as they arise in consistency with the nature or responsibilities of modern practice. Because of the increased volume of operations and community expectations for more efficient delivery of pharmaceutical services and products, this system of CPM is obsolete nowadays. The seven basic steps of modern practice of CPM include the following. 1. Community Pharmacy Marketing to Stakeholders A specific way has been designed to convince the stakeholders of the services that community pharmacy has on offer to patients and health care professionals. 2. Documentation Writing Pharmacy management, that is composed of in-house team of experienced pharmacists, designs and documents pharmacy incentive schemes and service agreements. 3. Launching Development Programme Pharmacy management organizes and facilitates various events inviting different community pharmacy speakers with proven success record in health care delivery. 4. Management Skills Training Accredited training sessions by qualified management trainers help develop key management skills in trainees especially in time management, project management and negotiation skills.Chapter-25.indd 376 9/22/2012 3:13:33 PM
  4. 4. SCOPE 377 5. Clinical Skills Training To develop the knowledge base of community pharmacists participating in local health care schemes, accredited training sessions may be provided by skilled clinical pharmacists. 6. Monitoring Community pharmacy activities are monitored and outcomes are evaluated by the management. 7. Project Management To ensure that agreed objectives and timelines are being adhered to; pharmacy management allows project managers to work with health care professionals. SCOPE The following activities may be carried out as part of a comprehensive CPM programme. Medication Therapy Review (MTR) MTR is an important component of CPM. The pharmacist conducts an MTR consultation with the patient or caregiver, preferably in person. The face-to-face interaction of a pharmacist with patient establishes a relationship and allows the pharmacist to observe signs of patient’s health problems, such as insomnia, dermatitis, gastrointestinal symptoms, drug interactions, anxiety and confusion. These observations and the MTR consultations provided in various settings have resulted in early detection of medication-related problems and thus reduce emergency room visits, hospitalizations, and medication misadventuring and overall health care costs. Pharmacists have been shown to obtain more accurate medication-related information from patients. For a specific medication problem, MTR can be comprehensive or specific. In a comprehensive MTR, the patient apprises of all current medications to the pharmacist that include all prescribed and nonprescribed medicines, herbal formulations and dietary supplements. The pharmacist assesses appropriate medication therapy in consultation with the patient and/or prescriber, counselling the patient to improve self-management of his or her medications. Specific MTR addresses with pharmacist intervention the new medication problems or ongoing medication issues during follow-up visits. The pharmacist analyses the specific therapy problem and provides appropriate information and education to the patient and/or the prescriber. The MTR is customized according to the individual patient’s needs on each visit. Depending on its scope, the MTR can include following intervention(s): On the basis of all available clinical information, the pharmacist may assess the patient’s overall health status, including past and current ailments. Education level, patient’s choice, language barriers, cultural issues and other characteristics of the patient’s communication abilities that could adversely affect therapy outcomes are also assessed.Chapter-25.indd 377 9/22/2012 3:13:33 PM
  5. 5. 378 25. COMMUNITY PHARMACY MANAGEMENT Patient or attendant is interviewed to identify adverse events caused by any of the current medications. Assessing, identifying and resolving medication therapy problems related to the following: The clinical appropriateness of each medication being taken by the patient The appropriateness of the dose and dosing regimen of each medication, including consideration of indications, contraindications, potential adverse effects and potential problems with concomitant medications Therapeutic duplication or other unnecessary medications Adherence to medication therapy (persistence and compliance) Untreated diseases or conditions Medication cost considerations Monitoring and evaluating the patient’s response to therapy, including safety and effectiveness Interpreting, monitoring and assessing patient laboratory results, when available Providing education and training on the appropriate use of medications and monitoring devices, the importance of medication adherence and understanding treatment goals Communicating appropriate information to the physician or other health care provider, including consultation on the selection of medications. Personal Medication Record (PMR) The patient receives a PMR after a comprehensive MTR that includes the following: Patient’s name or identity Physician identity and contact information Pharmacist identity and contact information Medication name and strength The intended use of the medication (e.g. for high blood sugar level) Directions for use (e.g. one capsule thrice daily), including duration of treatment (e.g. 5 days or one week) Warning or precautions, if required (e.g. flammable, keep away from naked flames) Start date of ongoing medications Medication-related events and interventions with date (if any) Person responsible for action Result of intervention Stop date of withdrawn medications Date of generation of PMR and of updates (if any). The PMR is used by patients in self-medication, and they also share it with their health care providers during all appointments for guided health care. Patients are also advised to carry the PMR on being admitted to a hospital or if they need to visit an emergency room or a pharmacy. The PMR should be updated manually or electronically each time the patient receives a new medication, an ongoing medication has been withdrawn, an instruction has been changed, a new over-the-counter (OTC) medication or dietary supplement has been started and on any changes in medication regimen.Chapter-25.indd 378 9/22/2012 3:13:33 PM
  6. 6. SCOPE 379 Intervention and/or Referral During the follow-up MTR visits to the pharmacy, the pharmacists provide counselling services to address medication problems of the patients and, if necessary, they may also refer the patients to other health care providers. Pharmacist interventions include working with the patient or his/her representative to address specific medication problems or consultation with other health care professionals to resolve existing medication problems. Some patients suffer from complex medical conditions or highly specialized medication therapy and need individualized MTR services. In such cases, pharmacists may provide additional care according to their knowledge and expertise, or may refer the patient to the most appropriate health care professionals. Situations that require referral to additional health care providers are as follows: New problems discovered during MTR may require physician evaluation and diagnosis. Some chronic diseases, such as diabetes and hypertension, require properly guided management, so patients may require consultation with other health care providers to help them manage such chronic diseases. Patients who require therapeutic drug monitoring for medications such as warfarin, theophylline and digoxin may need counselling by pharmacists with specialized training. Documentation and Follow-up Documentation of MTR services is done in a consistent manner by the pharmacist and in a manner appropriate for evaluating a patient’s progress and sufficient for billing purposes. The application of core documentation elements will help establish consistency in professional documentation and sharing of information among members of the health care team. MTR documentation should include the following categories of information: Patient identifier Known allergies, diseases or medical conditions A chronological record of all prescribed and OTC medicines, and herbal and dietary supplement products Medication therapy problems and interventions for resolution Therapeutic drug monitoring performed Referrals made, if any Counselling received Follow-up appointment schedule Quantum of time spent with patient Feedback to health care providers or patients Well-timed feedback to health care professionals and prescribers involved in a patient’s care is part of thorough MTR documentation. Documentation and regular follow-up ensure better patient care.Chapter-25.indd 379 9/22/2012 3:13:33 PM
  7. 7. 380 25. COMMUNITY PHARMACY MANAGEMENT MODERN TECHNOLOGIES The computers, as in all walks of life, have also found their applications in CPM as described hereunder. Computer-Based Technologies Computer is now found to be the most effective mode of technology used worldwide for improved services. In the area of CPM, it plays a role in better management of community pharmacy function. Thus CPM is now known as software pharmacy management (SPM). Several software programmes used widely in management of community pharmacy functions are discussed below. AbacusRx In the pharmacy software industry, Abacus has been a major force since 1984. In today’s state- of-the-art pharmacy software systems, its software product line has been responsible for introducing many of the standard features. Its firstline product, the Pharmacy Plus has been the preferred choice for the pharmacists and further interventions are possible in pharmacy automation. BestRx Best Computer Systems introduced the BestRx system into the community pharmacy practice. This system offers cutting edge pharmacy management solutions for single and chain community pharmacies. The BestRx system requires little to no training and is very user friendly. CarePoint CarePoint is a cutting edge, advanced, pharmacy software system providing technology products that empower pharmacists to take complete control of information flow and communication requirements in their rapidly expanding business. Its dispensing, pharmacy management, workflow and patient care systems take full advantage of the most advanced technologies. The advanced feature set combines maximum productivity with the highest standards of security and medicine utilization safeguards. WinRx System Computer-Rx has been providing pharmacy software to the independent pharmacy community for more than 23 years. Today pharmacies in 29 states across the USA use the Windows-based WinRx system. Datascan DATASCAN (DCS Pharmacy, Inc.) has been serving the needs of community pharmacies for over 20 years. They provide both hardware and software solutions designed to help the pharmacy become more profitable and operate more efficiently.Chapter-25.indd 380 9/22/2012 3:13:33 PM
  8. 8. MODERN TECHNOLOGIES 381 Pharmasoft Simple yet sophisticated, PHARMASOFT (Essel Software and Services) is a versatile software solution that cuts down reports generation time and increases quality and accuracy of the information. Margin on item(s) or customer(s), sales invoice, party ledger, batch-wise stock position report, sales analysis report, customer/supplier enquiry, debit note, credit note, etc., can be generated at the press of a key. PHARMASOFT has special features like enquiry, zooming and analysis with full security features. KeyCentrix KeyCentrix, Inc. (RxKey Pharmacy Management Software) provides the pharmacy technology tools necessary to increase the profitability of clients and lower the cost of prescription medicines. Combining pharmacy industry knowledge with business analysis, KeyCentrix, Inc. creates fast and flexible software that serves chain, community and mail order pharmacies. PROscript 2000 PROscript 2000 was developed by Prodigy Data Systems, Inc. (PDS), a pharmacy management software system that enables the pharmacy to have a competitive edge with comparatively more services offered than pharmacies without such a system. Internet-Based Pharmacy Services Since the year 2000, the number of internet pharmacies (also known as online pharmacies) has been growing worldwide. The primary difference between them and the physical community pharmacies is the method by which the prescriptions are received and processed. Internet pharmacies are also referred to some patients by their GPs if they must leave the station. The website of the online pharmacies can serve as a utility service, displaying information about the pharmacy location, hours, staff and services on offer. It can also serve as a medium for patients for refill requests and useful information for physicians to help in rational prescribing, or for pharmacists to assist patients with right drug administration and medication-related problems. There are multiple online facilities such as e-mail, blogs, forums, chat rooms, video conferencing and other web communication modules to promote interaction between pharmacist and patients. Some drug information websites are launched by community pharmacies through which patients can track accurate and reliable information about their medications. While most of the internet pharmacies sell medicines by prescription, some of these sell medications without prescription. Thus, customers have facility of ordering medicines without actually visiting the pharmacy premises. A big concern with internet pharmacies is the ease with which people can get controlled drug substances (e.g. heroin) without a prescription issued by a physician. In view of the rapidly growing number of fake internet pharmacies, community pharmacists must guard against people misusing this important mode of drug delivery. As a regulating measure, many countries have enacted and implemented statutes for online pharmacies, and guidelines have been drafted on the quality of drug information on the internet. Some online services, such as Australia’s Medicine Name Finder, present comparative information on price and the effectiveness of generic drug alternatives.Chapter-25.indd 381 9/22/2012 3:13:33 PM
  9. 9. 382 25. COMMUNITY PHARMACY MANAGEMENT In view of many experts, pharmacies that combine a traditional retail operation with a responsible internet-based business-to-consumer (B2C) model are poised to become the most successful type of pharmacy ventures in the future. Medscape It is a popular web station used by health care providers for timely and reliable medical information for many years. MEDSCAPE membership gives free, unlimited access to a broad network of resources customized to member’s area of specialization, including the following: In-depth specialty-focused medical news Worldwide conference information Free full-text access to articles from hundreds of leading journals Peer-reviewed clinical referenced information on more than 6000 topics Complete access to MEDLINE and other drug information portals Expert comments, discussion forums, blogs, etc. PharmaClik It is a comprehensive web-enabled order-management system, which further reduces manual processes related to managing pharmacies’ inventory of pharmaceuticals, OTC and consumer products. Pharmacy Services Through Media Electronic (television and radio services) as well as print media (newspapers, magazines, etc.) can be used to disseminate information related to drug products (indications, proper use, adverse effects, toxicities, their management, etc.) in a better way. Key activities of broadcasting organization that makes it powerful in CPM include the following: Successful communication in an emergency situation Identifying and grading responses from a local incident to a business critical crisis FINANCIAL MANAGEMENT Cash is life blood of a business. It involves capital investment which is expenditures made during a particular period to acquire or improve long-term assets such as a building, delivery van or dispensing equipment. It is necessary for paying bills, making changes, paying employees and making any other financial transaction in which the pharmacy is involved. Cash Budget It predicts the change in cash balances between receipt of cash and the disbursement of cash at a point in time. The receipt or sources of cash are as follows: Cash sales Collection of accounts receivableChapter-25.indd 382 9/22/2012 3:13:33 PM
  10. 10. MATERIAL MANAGEMENT 383 Investment income Financing Sale of assets Contributions The uses of cash or disbursements include the following: Salaries Payments to vendors Payments on debt Investments Purchases of land, buildings and equipment Maintenance of Cash Flow The basic means of improving cash flow consists of decreasing amount of cash invested, decreasing the amount and rate of cash flowing out of the pharmacy, and increasing the amount and rate of cash flowing in. This can be accomplished by the following means: Investing idle cash: The pharmacy manager must consider risk, return and liquidity when deciding where to invest excess cash. They would want to be sure that the investment will not be lost as the common stocks are very risky, whereas the government-backed bonds and money market accounts are less risky. Maintaining gross margin: It is the difference between the price at which community pharma- cies buy merchandise and the price at which they sell it. Pharmacies must maintain sufficient gross margins to ensure adequate cash flow. They can maintain or improve gross margins by emphasizing higher margin pharmacy. Because most of the pharmacy pricing and billing is done by computers, this becomes a matter of updating drug cost as quickly as possible, e.g. increasing price to patients and payers as soon as suppliers initiate price hike gives pharmacy the benefit. Properly controlling accounts receivable: Operating a credit programme hampers cash flow in a number of ways. For example, the pharmacy will have to invest substantial amount of cash in the programme. It is a long-term investment as long as it continues to offer credit; the initial investment will remain tied up in accounts receivable. Moreover, the pharmacy incurs number of costs in operating a credit programme. These include mailing bills, keeping records of charges and payments, and paying someone to do these tasks. MATERIAL MANAGEMENT Every organization has a need to maintain their supply of materials, manpower, spares, stock material, etc., for proper functioning. If there is any shortage of abovementioned things, they can cause problems and affect the work of the organization. For good material management in a community pharmacy, inventory control plays an important role. Proper inventory control consists of having only as much inventory (raw materials and finishedChapter-25.indd 383 9/22/2012 3:13:33 PM
  11. 11. 384 25. COMMUNITY PHARMACY MANAGEMENT products) as is needed and minimizing shrinkage. Inventory control serves the following important purposes: 1. To ensure that the medicines are supplied at the right time in the pharmacy drug store 2. To avoid wastage and shortage and to maintain optimal stock 3. To reduce investment STAFF MANAGEMENT Several teams may be constituted in the community pharmacy to perform various duties and responsibilities, and they are described as follows: Buying Team The buying team decides what needs to be carried in the pharmacy by researching new products and considering customer requests. It is the buying team’s responsibility to make sure that all the products sold are of high quality and priced reasonably. Dispensary Team The dispensary team manages and consults on the prescription medicines to be dispensed in pharmacy. The pharmacists and pharmacy technicians make sure community pharmacy runs smoothly as a reliable resource of medicines for the customers and their doctors. The pharmacy staff ensures that medicines ordered on doctors’ prescriptions or bought over the counter are correctly and safely supplied, with appropriate patient counselling on their use and potential side effects. They also advise on a variety of health care issues, for example, cessation of smoking, healthy diet and family planning, etc. Business Team The business team manages the recordkeeping and financial status of community pharmacy. They interpret the data of their sales and expenditures and develop budgeting strategies to promote pharmacy’s growth in the future. Mail Order Team The mail order team fills and ships mail orders all over the country. The customer services are carried out over the phone, e-mail and surface mail. Merchandising Team The merchandising team looks after the pharmacy’s aesthetic and logistical integrity. They design and create displays and signage, arrange product shelves, initiate store layout and fixture changes, and keep the store clean and comfortable.Chapter-25.indd 384 9/22/2012 3:13:33 PM
  12. 12. DRUG STORE MANAGEMENT 385 Personnel Team The personnel team maintains the healthy work environment by facilitating open communication between co-workers. They hire and train new staff and coordinate regular dialogues with established co-workers to make sure that all get the most out of their work experience. The community pharmacy also encourages its staff to seek additional qualifications and specializations. Advertising Team The advertising team creates community pharmacy’s unique print, radio and TV ads. They keep an eye on customer and product trends, as well as seasonal issues, and advertise to a variety of communities through local newspapers and electronic media. The team extends the health information resource aspect of the pharmacy into the community, coordinates lectures and workshops, writes informational pamphlets and allocates pharmacy donation budget to local organizations. DRUG STORE MANAGEMENT Drug store management belongs to a necessary function of CPM programme as proper maintenance of pharmacy drug store and related services affects its performance. The drug store manager is responsible for its operation in toto. Layout of a Drug Store The layout plan of a pharmacy drug store is illustrated below (Fig. 25.1). Inspection area Inspection area A drug store must be located on the ground floor, close to the pharmacy. It should have two entrances: one for receiving and other for issuing of materials. M Racks are used for storing materials and closed bins 1 A B C D E F G H 1 A B C D E F G H 2 A B C D E F G H a 2 A B C D E F G H for costly items. Medicines and other products are identified on the basis of special codes. For example i bin card code system in which each item is assigned a 3 A B C D E F G H n 3 A B C D E F G H unique code which bears four characters, e.g. A7D3, 4 A B C D E F G H P 4 A B C D E F G H which means: panel A, row 7, rack D and bin 3 (cf. a Fig. 25.1). These codes are entered on bin cards, 5 A B C D E F G H 5 A B C D E F G H which are kept by the store manager like the library 6 A B C D E F G H s 6 A B C D E F G H catalogues by a librarian. The above system helps in s easy identification and location of stored items. 7 A B C D E F G H a 7 A B C D E F G H Various arrangements are possible to store 8 A B C D E F G H g 8 A B C D E F G H materials in a pharmacy drug store: e FSN (fast moving, slow moving, nonmoving): In this arrangement, the fast moving materials are Cold storage Tables for employees placed near the exit while nonmoving items are kept far away from the exit. FIGURE 25.1 Layout plan of a drug store.Chapter-25.indd 385 9/22/2012 3:13:33 PM
  13. 13. 386 25. COMMUNITY PHARMACY MANAGEMENT HML (heavy, medium, light): Within the racks, heavier items are kept in at the lowermost bin, whereas the lighter items are stored in the top bin. FIFO (first in first out): The materials received first in the store are issued on priority. Other arrangements: The materials can also be stored in the store in alphabetical order. But this arrangement may be confusing as many drugs have synonyms and are known by different names (e.g. paracetamol is also called acetaminophen). Alternatively, they may be stored alphabetically on the basis of therapeutic uses, e.g. analgesics and antipyretics followed by bronchodilators, cardiotonics, diuretics, etc. Organization of a Drug Store The organizational structure of a drug store varies by the size and type of the business it is engaged in. The various types of business involved are wholesale business or retail business. The small or independent retail stores may combine many sectors together under one division, while larger stores create various divisions for each particular function along with many levels of management staff for smooth functioning. Organization of a drug store may start by identifying all the tasks that need to be performed. Then responsibilities are divided among various individuals. Each task is grouped and classified into a job with a title and description. Finally an organizational chart is developed. Stock Rotation of Medicines The following strategies may be adopted for stock rotation of medicines in a drug store: 1. First to expire first to be out (FEFO) procedure must be followed. 2. Short expiry date product must be stored in front. 3. Expiry date must be written on product card. 4. For those items that do not have an expiry date, first in first out (FIFO) principle will be followed. 5. Newly received items should be put at the back of existing stock 6. Expired and poor-quality stock must be removed from the store. 7. Overstocked items and items not in use must be noted to prevent the overbalance and may be distributed to other facilities. Storage Conditions The following provisions may be made for storage of medicines in a drug store: 1. All pharmaceutical products should be stored at appropriate temperatures and conditions in accordance with manufacturer recommendations. If no storage requirements are established, then it must be stored at controlled temperature, as defined in an official compendium, to help ensure that its identity, strength, quality and purity are not adversely affected. 2. The storage area should be clean and dry with acceptable temperature limits. The special storage conditions are given on the label (e.g. temperature and humidity). The information must be checked regularly.Chapter-25.indd 386 9/22/2012 3:13:33 PM
  14. 14. DRUG STORE MANAGEMENT 387 3. The storage area should have sufficient space to store various categories of products, namely bulk products, finished products, quarantine products, released products, rejected products and returned products. 4. The storage areas must be clean and free from accumulated waste and vermin. A written sanitation programme must be available to show the methods used to clean the premises and storage areas, and frequency of cleaning. 5. There should be a written performa for pest control. The name of the agent used for the pest control must be safe with no risk of contamination of the products. 6. For drug store organization, receiving and dispatch area shall protect products from the weather. Reception areas should be designed and equipped to allow incoming products. The containers must be cleaned before storage. 7. The dangerous and/or hazardous products such as radioactive materials, chemotherapeutics, narcotic and explosive products should be stored in a separate area, which requires additional safety and security measures. It must be consistent with the requirements mentioned in the regulatory guidelines. 8. The damaged, deteriorated, misbranded or adulterated products should be opened and stored in a physically separate, clearly labelled portion of the storage area. Types of Materials Stocked It is essential to follow the product manufacturer’s storage instructions depending on the type of material stocked. If this is not possible, the product must be stored at the recommended conditions and consumed as quickly as possible. For deviations in specified storage conditions, the product manufacturer must be consulted to determine for how much time the product will remain safe and effective under the altered storage conditions. Indian Pharmacopoeia describes the storage conditions for some official substances that are likely to deteriorate, if not stored properly. It must be important to follow the instructions given by manufacturers for storage of products. The various conditions for storage under definite meaning of the pharmacopoeia are given below: 1. Store frozen: Some medicinal products, such as vaccines, need to be transported under cold storage conditions and must be stored at –20°C. 2. Keep cold: Store these medicinal products at any temperature not exceeding 8°C and usually between 2 and 8°C but must not be frozen. These are usually kept in the first and second part of the refrigerator (never in the freezer). 3. Storage at ambient temperature: This term is not widely used due to significant variation in ambient temperatures. It means room temperature or normal storage conditions, which means storage in a dry, clean, well-ventilated area at room temperatures 15–25°C or up to 30°C. 4. Protect from moisture: These products are meant to be stored in normal humidity at room temperature (relative humidity less than 60%). 5. Protect from light: Photosensitive medicines may be stored in a light-resistant cupboard/ drawer; to be provided by the manufacturer in a light-resistant container.Chapter-25.indd 387 9/22/2012 3:13:33 PM
  15. 15. 388 25. COMMUNITY PHARMACY MANAGEMENT Revision Questions 1. Define community pharmacy. What are the objectives and functions of community pharmacy? 2. What are the basic steps of modern practice of community pharmacy management? 3. Discuss in detail the scope of community pharmacy management. 4. Give an account of modern technologies used for community pharmacy management. 5. How the finances are managed in community pharmacy? 6. Present the management of material and staff in community pharmacy. 7. Present the layout and organization of a drug store. 8. Write short notes on the following: (a) Stock rotation of medicines in a drug store (b) Storage conditions in a drug store 9. Write short notes on the following: (a) Medication therapy review (b) Personal medication record Suggested Readings 1. Troy DB. Community pharmacy economics and management. Remington: The Science and Practice of Pharmacy. 21st ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2006. 2. Hillary GA, Jr. Definitions of Community: Areas of Agreement. Rural Sociology. 1955;20(4):111. 3. McClellan MB. Medicare Part D: opportunities and challenges for pharmacy. J Am Pharm Assoc. 2005;45:328–335. 4. Kotter JP, Cohen DS. The Heart of Change: Real-Life Stories of How People Change Their Organizations. Boston, MA: Harvard Business School Press; 2002. 5. Matheson C, Bond CM, Tinelli M. Community pharmacy harm reduction services for drug misusers: national service delivery and professional attitude development over a decade in Scotland. Journal of Public Health. 2007;29(4):350–357. 6. Zgarrick DP, Talluto BA. Development of a community pharmacy management elective rotation. American Journal of Pharmaceutical Education. Spring 1997;61:66–73. 7. Holmes ER, Tipton DJ, Desselle SP. The impact of the internet on community pharmacy practice: a comparison of a Delphi panel’s forecast with emerging trends. Health Mark Q. 2002;20(2):3–29. 8. Christensen DB, Farris KB. Pharmaceutical care in community pharmacies: practice and research in the US. Ann Pharmacother. 2006;40(7–8):1400–1406. 9. Agarwal G. Community pharmacy. Meerut: Pragati Prakashan; 2008. 10. Sibbald B. Understanding controlled trials: Why are randomised controlled trials important? British Medical Journal. 1998;316:201. Available at http://www.bmj.com/cgi/content/full/316/7126/201. Accessed 5 September 2012. 11. NCPA-Pfizer Digest, 2007. 12. http://en.wikipedia.org/wiki/Community_Pharmacy. Accessed 5 September 2012. 13. http://pharmacychoice.com/marketplace/category.cfm/listing/Pharmacy_Management_Software. 14. Basak SC. Why community pharmacy practice? http://www.pharmabiz.com/Newsdetails.aspx?aid=309078sid=9. Accessed 5 September 2012. 15. Pharmacy Marketplace Software (Pharmacy Management). Omincare: Prescription for positive outcomes. Available at http://www.pharmacysoftwarereviews.com. Accessed 5 September 2012. 16. Reading Material on Drug Store Management & Rational Drug Use For Medical Officers, Nurses & Pharmacists. State Institute of Health & Family Welfare, Rajasthan. December, 2010. Available at http://sihfwrajasthan.com/ Studies/Drug%20Mgmt.pdf. Accessed 5 September 2012. 17. El Tayeb WA. Hospital Pharmacy. Riyadh, KSA: Department of Pharmacy.Chapter-25.indd 388 9/22/2012 3:13:33 PM