1. AFAMS EO 006.03 Receiving Medication and Pharmaceutical Stock (Dari) 11/09/2013

2. AFAMS Importance of Lesson (Dari) When receiving an order for medications there are numerous steps that you must be aware of to ensure that the medications received are of appropriate quality and quantity. If an issue with an order is discovered you need to be aware of the necessary processes to undertake to have the deficiencies corrected. The purpose of this lecture is to teach you how to properly receive and account for a medication order. AFAMS Insert Dari

3. AFAMS Overview EO 006.03 (Dari) Verifying Stock Invoices Verifying conditions of medications Reporting discrepancies Stocking medications appropriately Accounting for returns Review Game AFAMS Insert Dari

4. AFAMS Verifying Stock Invoices Dari

5. AFAMS Verify

6. AFAMS Verify MoD Form 9 vs Medications Received Any medications included on the MoD Form 9 but, not in the supplied medications needs to be indicated to be investigated.

7. AFAMS Verify Condition of Medication

8. AFAMS Expiry Date/ Name of Medication

9. AFAMS Signs of Counterfeit Drugs Dari Areas of inspections: 1.Packaging a.Container and closure b.Label c.Leaflet or package insert 2.Physical characteristics of tablets/ capsules a.Shape/ size/ colour b.Markings c.Breaks/ Cracks/ Splits d.Presence of empty capsules e.Smell

10. AFAMS Signs of Counterfeit Drugs Dari 1. Packaging (Container): Compare to known product. Quality Assurance and Safety of Medicine (WHO)

11. AFAMS Signs of Counterfeit Drugs Dari 1. Packaging (Label): Quality Assurance and Safety of Medicine (WHO)

12. AFAMS Signs of Counterfeit Drugs Dari 1. Packaging (Label): Quality Assurance and Safety of Medicine (WHO)

13. AFAMS Signs of Counterfeit Drugs Dari 1. Packaging (Label): Quality Assurance and Safety of Medicine (WHO)

14. AFAMS Signs of Counterfeit Drugs Dari 1. Packaging (Label): Quality Assurance and Safety of Medicine (WHO)

15. AFAMS Signs of Counterfeit Drugs Dari 1. Packaging (Label): Quality Assurance and Safety of Medicine (WHO)

16. AFAMS Signs of Counterfeit Drugs Dari 1. Packaging (Leaflet): Quality Assurance and Safety of Medicine (WHO)

17. AFAMS Signs of Counterfeit Drugs Dari 2. Physical Characteristics: Quality Assurance and Safety of Medicine (WHO)

18. AFAMS Signs of Counterfeit Drugs Dari 2. Physical Characteristics: Quality Assurance and Safety of Medicine (WHO)

19. AFAMS Signs of Counterfeit Drugs Dari 2. Physical Characteristics: Quality Assurance and Safety of Medicine (WHO)

20. AFAMS Reporting Counterfeit Drugs Dari Upon discovery of a counterfeit drug (No to any of the previous questions) : Contact a Pharmacist or Contact the Chief of Pharmacy

21. AFAMS Transported Correctly Can it be transported in a truck?

22. AFAMS Lot number/ Batch Number/ Expiry Date

23. AFAMS

25. Examples of Counterfeit Drugs  It can be very difficult to see the difference.

26. AFAMS See the difference?

27. AFAMS MoD Form 9 vs MoD Form 14 Verify the MoD Form 9 against: The MoD 14: –Any medications not on the Form 9 should be added to the Due-in log. –Notify the Pharmacist. The Due-in Log: –Any medications received not on the MoD 14 should be compared against the Due-in Log.

28. AFAMS Update MoD Form 4 The receipt of the MoD Form 9 must be recorded on the unit’s MoD Form 4 for tracking purposes.

29. AFAMS Update MoD Form 1 Each drug received will have a MoD Form 1. Drugs received for the first time will require a new form created. Document indicator numbers from the MoD Form 9 will be used for tracking. Update MoD Form 1 with new quantity.

30. AFAMS Update Stock Card When stocking the medications ensure the stock card for each medication is updated with the MoD Form 9 document control number and the new quantity.

31. AFAMS Stock Cards tablets Remarks Metoprolol 100mg Date Issues Balance Expiry Date Out In W93A21 5199 0001 20024 Sep 14 05 Sep 13 0 0 Previous quantity 40031 Oct 14 05 Sep 13 200 0 To Pharmacy Dispensary 20024 Sep 14 08 Sep 13 0 200 Order Document Number Ie. MoD 9

32. AFAMS Stock Cards tablets Remarks Metoprolol 100mg Date Issues Balance Expiry Date Out In W93A21 5199 0001 20024 Sep 14 05 Sep 13 0 0 Previous quantity 40031 Oct 14 05 Sep 13 200 0 To Pharmacy Dispensary 20024 Sep 14 08 Sep 13 0 200 Recorded in MoD Form 1 Must match MoD Form 1 qty on hand

33. AFAMS Due-Out Log If your unit has sub-units: –Check MoD Form 1298 Due-out Log –Prepare MoD Form 9 to fill their orders

34. AFAMS Storage Conditions  Ensure all medications are stored in accordance with the manufacturer instructions (package, leaflet) or ANA policies:  Refrigerated vs non- refrigerated  Under controlled medications

35. AFAMS Report Discrepancies 1.Have all suspected discrepancies verified by another individual. 2.Notify the Quarter Master Pharmacist to notify the supplier. 3.Any supplier acknowledged discrepancies should be added to the MoD Form 1299 (Due-in Log)

36. AFAMS Documentation All documentation is to be maintained by the Quartermaster.

37. AFAMS Organize Medications Dari Organizing medications by generic name First-in, First-out vs Expiry Date Identify soon to expire medications

38. AFAMS Organize Medications Dari This should improve efficiencies within the pharmacy by making medications easier to stock and to find.

39. AFAMS Organize Medications Dari Example: –Colour of bins represent categories: Oral IV Inhalation, etc. –Each category arranged in alphabetical order by generic name.

40. AFAMS Organize Medications Dari Example: –Same concept is applied to refrigerated items.

41. AFAMS Learning Check Put the following drugs in the correct order by category on the shelf: (Generic Name) o atenolol 50mg tabs o ramipril 10mg caps o metoprolol 100mg tabs o fluticasone 150mcg inhaler o vancomycin 500mg vial o NPH insulin 100units/ml (refrigerate) o cefazolin 1000mg vial o moxifloxacin 400mg vial o human papilloma virus vaccine (refrigerate) o ventolin 100mcg inhaler

42. AFAMS Learning Check Oral: o atenolol 50mg tabs o metoprolol 100mg tabs o ramipril 10mg caps Inhalers: o fluticasone 150mcg inhaler o ventolin 100mcg inhaler IV: o cefazolin 1000mg vial o moxifloxacin 400mg vial o vancomycin 500mg vial Refrigerated: o NPH insulin 100units/ml (refrigerate) o human papilloma virus vaccine (refrigerate)

43. AFAMS First-in, First Out Consumables without expiry date: Organize on shelves to allow for selection of the item that has been on the shelf the longest to be used first. (First-in, First-out) Consumables and Medications with expiry date: Each type of item is stored with the shortest expiration date placed at the front so it may be used prior to its expiration date. (Expiry date based) –Decreases waste and costs –Requires expiration dates to be checked when stocking order

44. AFAMS Identifying Soon to Expire Medications soon to expire should be marked to: Help identify medications to be used first (waste, cost) Allow for easy identification of expired medications (safety) Methods of identifying soon to expire medications should: Be readily identifiable (e.g. colour, sufficient size, standardized, known to staff) Easy to use (i.e. not labour intensive) Do not cover important information (e.g. drug name, strength, expiry date…)

45. AFAMS Identification of Expiry Dates Make the expiry date visible Colour code each month for easy identification

46. AFAMS Accounting for Returns Dari MoD Form 14 (From Returning Unit) Permission to return received Upon receipt of returned items: –Inspect expiry date (if necessary) –Packaging is intact –Verify storage conditions of item Update the following forms: –Stock card –MoD Form 1 –MoD Form 4 –MoD Form 9

47. AFAMS Accounting for Returns Dari MoD Form 14 (From Returning Unit) Supported units wishing to return an item to a supporting logistics unit must first request permission via a MoD Form 14. The supporting unit (e.g. FSD) will authorize the supported unit to return the item.

48. AFAMS Accounting for Returns Dari Upon receipt of returned items: –Inspect expiry date (if necessary) –Packaging is intact –Verify storage conditions of item If any of these conditions are unsatisfactory then the items need to be segregated and inspected by a pharmacist prior to being received and used.

49. AFAMS Accounting for Returns Dari Update the following forms: –Stock card –MoD Form 1 –MoD Form 4 –MoD Form 9

50. AFAMS Quantity turned into Depot

51. AFAMS The Supporting Unit will issue a negative quantity MoD Form 9 to Supported unit when the returned item is received.

52. AFAMS Review Dari

53. AFAMS Quiz (Assessment) Dari Formative Assessment: Not marked Used to assess the students understanding of lectures material. Quiz will consist of two parts (Part A and Part B). Instructor will provide a debrief after the scenario. Insert Dari

54. AFAMS Quiz Part A: Question Dari Part A : Put the following steps for receiving a supply order in the correct sequence: 1.Stock medications appropriately on shelves 2.Verify expiry dates of medication 3.Verifying MoD Form 9 against received items. 4.Report discrepancies 5.Verifying MoD Form 14 against MoD Form 9 6.Update MoD Form 4 7.Check Due-out Log 8.Check Due-in Log 9.Update Stock card  15 minutes Insert Dari

55. AFAMS Quiz Part B: Question Dari Part B : List six common signs of counterfeit drugs.  15 minutes Insert Dari

56. AFAMS Quiz Part A: Answers Dari Part A : Put the following steps for receiving a supply order in the correct sequence: 1.Verifying MoD Form 9 against received items. 2.Verify expiry dates of medication 3.Verifying MoD Form 14 against MoD Form 9 4.Update MoD Form 4 5.Update Stock card 6.Check Due-in Log 7.Report discrepancies 8.Stock medications appropriately on shelves 9.Check Due-out Log Insert Dari

57. AFAMS Quiz Part B: Answers Dari Part B : List six common signs of counterfeit drugs. Improperly sealed packaging or container Inappropriate container or closure for the drug No safety seal Label does not match packaging label Illegible and edible information Misspelled trade/ generic name or other information The drug cannot be legally sold in the country No ® after the trade name Dosage is not clearly indicated Does quantity on label make packaging Manufacturer’s label is incorrect Hologram does not change colour at different angles No expiry date listed Tablets are not uniform in shape/ size or colour Package inserts match original Non-uniform coating on tablets Markings are not uniform or identical Tablets have breaks, cracks, splits or pinholes Insert Dari

58. AFAMS End of Lecture Dari