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Inventory Management of Medical Store in a Selected Tertiary Public Hospital

ARTICLE DETAILS Background: The inventory management of medical store is needed to protect medicine from damage, loss, theft or wastage and to ensure the availability of necessary medicine for saving patients life in a hospital. Materials and Method: A cross sectional study that carried out in Dhaka Dental College Hospital from January to December 2019. The respondents were all the workers working in the medicine store, from them data were collected through face to face interview by a pre-tested semi-structured questionnaire and observational checklist. Result: About 85.71% respondents said drugs were purchased from Essential Drug Co. Ltd and 14.28% respondents said drugs purchased from Central Medicine Store Depot. All the respondents of medicine store mentioned about maintaining receipts and vouchers during drug purchasing. Also all respondents mentioned about presence of medicine receiving authority after delivery and confirmed expiry date checked during receiving medicine. About 87.71% respondents said record keeping methods were mainly manual in medicine store. Medicine store was well ventilated, air conditioner and refrigerator was present. But there was no humidity and pest control facility seen in medicine store. Inventory analysis was found to be done only by ABC method. Conclusion: Depending on the opinion for challenges of management practice, there was lack of training; insufficient staff and less invest on modern technologies got priority. The study recommends ensuring implementation of modern technologies and 5S concept and arrangement of training program for the inventory personnel to increase their efficiency and improve quality service.


I. INTRODUCTION
Inventory management is fundamentally about determining the size and arrangement of loaded products. Inventory management or Stock administration is needed at various areas inside an office or inside different areas of a stockpile organization to ensure the regular and arranged course of creation against the arbitrary unsettling influence of running out of materials or products. Inventory or stock is characterized as a stock or store of goods [1] .These products are kept up available at or almost a business' area with the goal that the firm may satisfy need and satisfy its Explanation behind presence. Characterizes inventory as "crude materials work in advancement, completed goods and supplies needed for making of an organization's goods and services" [2]. Inventory management is very essential in a developing country like Bangladesh. Bangladesh is a country of scarce resources and it is the primary responsibility of each hospital to ensure optimum utilization of available resources to provide good service or quality patient care. Usually, the hospital management is faced with choosing the alternative of either lowering the quality of care or adopting ways and means to reduce the cost of inventories. An inventory control situation guarantees that the correct product are procured, in the right amounts, screens their quality, and limit the complete variable expense of tasks. A stockroom management framework screens the actual progression of products inside the framework, for example, receipts, stockpiling and issues. A performance observing framework watches that the frameworks are working effectively [3]. Roughly 35.0% of yearly hospital budget spent on purchasing materials and supplies, including medications [4].This require prudent and effective management of the medical stores. The medical store is quite possibly the most broadly utilized facilities of the hospital and one of few regions where a lot of cash is spent on buy on a repetitive basis. This accentuates the requirement for arranging, planning and coordinating the medical store in a way that bring about effective clinical and managerial work [5]. The objective of the hospital supply framework is to guarantee that there is satisfactory stock of the necessary things so a continuous supply of all fundamental things is kept up. The data framework should remember information for items entering and leaving the medicine store, items in stock, items on hand and approaches to screen the advancement of requests in the stockpile or supply pipeline. Twenty years back, most public supply or stockpile frameworks depended totally on manual stock records, yet now, numerous projects have changed to modernized frameworks. Indeed, even with computerization, in any case, numerous nations still keep a manual framework, particularly during the change to computerization. There is a broadly held belief that computerization tackles the issue of stock control. This belief is misinformed. The medical store should keep up effective communication with providers, with procurement and inventory stock control units, with health facilities, and with administrators from the service of health. Intermittent meetings with the staff individuals from customer offices can help guarantee great communication and a more viable supply framework. Drug inventory administration focuses on cost regulation and improved effectiveness [6]. Stock or inventory examination tries to accomplish maximal output with negligible venture input, on the basis of the financial guideline of extending the restricted way to meet limitless end. Everything might be viewed as basic and there is seen need to supply exceptionally elevated levels of administration [7]. The inventory or stock control can achieve generous improvement in patient consideration as well as in the ideal utilization of assets. Therefore, in the present study the researcher interested to assess the state of inventory management of medical store in a tertiary public hospital. Sampling Technique: Convenient sampling technique was followed for the selection of the respondents. The 7 respondents were achieved within the time frame of data collection.

II. MATERIALS AND METHODS
Eligibility criteria: Employees working in medical stores at least six months of Dhaka Dental College Hospital, Dhaka.
Research Approach: Data were collected by face to face interview with the help of Semi-structured questionnaire and an observational check-list was used.
Data Processing and Data analysis: All the data were checked and edited after collection. Data were then entered in to computer, with the help of SPSS for windows (IBM SPSS, Statistics for Windows version 26). Data analysis initiated with descriptive analysis. Mean and Standard deviation was calculated for continuous variables. Frequencies and percentages were calculated for categorical variables.

Ethical implication
After receiving ethical approval from the Institutional review board and applied for permission for data collection in Dhaka Dental College and hospital, Dhaka. After getting permission data collection was started. Respondents were briefed properly and motivated to participate. A written informed consent in Bengali was used for taking consent from respondents. Data were collected from those who gave their consent. No intervention was given in this study.

III. RESULT
The study result has three parts which are-sociodemographic information, inventory management process and opinion for challenges of inventory management practices. Table-1 shows that, 42.9% were in the age group between 41-50 years. About 14.2% respondents was in the age group between 21-30 years and Another 14.2% was in the age group between 31-40 years with mean = 44.07 and SD = ±10.69. Among 7 respondents, 85.7% of them were male and other 14.2% respondent was female. Out of total, 42.85% respondents completed Diploma and 14.28% for each respondent completed Post Graduation, Graduation, H.S.C, S.S.C qualification. From the respondents, 57.14% were working in the live for 21-30years, 14.28% was Corresponding Author: Saida Rashid Kochi working for 1-10 years in life, other 14.28% was working 11-20 years and also 14.28% was working for 31-40 years. Maximum respondent that is 71.42% did not receive any training on inventory management. Rest 28.57% respondents obtained training and among 7 respondents, there was one Assistant Director 14.28%, One SLLPP 14.28%, Three Pharmacist 42.85%, one Instrument Caretaker 14.28%, and One MLSS 14.28%.  Table 2 shows that, in medicine store, among 7 respondents 57.14% mentioned list prepared by doctor is the basis of listing for purchase. On the other hand, 28.57% respondents mentioned self-made list is the basis of listing for purchasing drugs and chemicals. And 14.28% respondent mentioned essential drug list for basis of listing of purchasing drugs and chemicals. From the total respondents, 57.14% were mentioned quantity of order determination of medicine needed is done by availability of fund and 42.85% Were mentioned past consumption. Among 7 respondents 71.42% mentioned annual purchase, other 28.57% mentioned perpetual purchasing of medicine. Maximum of respondents 42.85% receive medicine 1-2 weeks after an order is placed, 28.57% receive medicine within 1 week and 14.28% was received 3-4 weeks and also 14.28% was received medicine after 4 weeks. And about source of medicine, 85.71% were mentioned about EDCL and 14.28% was mentioned about CMSD.    Figure 1 shows that, 28.57% respondents said that drug is distributed from store on requisition basis, 42.85% respondents said that drug distribution is early expiry first Out method, and 28.57% respondents said that, drug distribution is first in first out method.

Figure 1. Distribution of respondents on the basis of drug distribution from medicine store (n-7)
Figure 2 shows, In medicine store, among respondents,85.71% respondents said electronic door lock system is absent in medicine store, and only 14.28% respondent said electronic door lock system is present in medicine store.

Observation by Checklist
On basis of location, the medical store was located close to the hospital main building, on ground floor, not in separate building and not in convenient access. Fire extinguisher was present in medical store, but smoke detector and fire alarm system was absent. Presence of flammable trash was observed in medicine store. And also 'No smoking' sign was present there. Security guards were present in medical store for 24 hours. CCTV was also present there and electronic door lock system was absent in medical store. In case of structural design, damp free wall was absent in some place, and non-slippery, non-moist floor was observed in medicine store. Rainfall resistant roof was present and door was not broad enough but the door was well secured. In case of storage system, sufficient space was not observed but temperature and ventilation control system was in medical store. Humidity control system was not observed but the pest control was observed in medical store. It was observed that 5S concept was not implemented. Standby emergency power supply was present in medical store but there was no disposal room. There was absence of bin card and barcode reading facility in medical store. But they maintained ledger system in medical store. Fully computerized record keeping system and integrated automated software based record keeping system were absent in medical store.

IV. DISCUSSION
Medical store management in hospitals is a tedious and time consuming chore with limited resources. Today in different hospitals in many countries are giving priority on inventory management by efficient personnel. In every steps of inventory management process modern technologies are being implemented. The study, 'Inventory management of medical store in a selected tertiary public hospital' was conducted in medicine store in Dhaka Dental College & Hospital which is a tertiary level hospital in Dhaka Metropolitan with a vision of providing quality health care services to the patient.
To assess the state of management of inventories some criteria were selected. In this condition, variables were selected as socio-demographic characteristics of the respondents, also variables related to physical facilities, procurement method, and storage system and distribution process. The study shows the scenario of inventory management process that is practiced in this hospital. In case of purchase list preparation majority of the respondents that is 57.14% in medicine store, mentioned about prepared by doctor list that they maintain. In case of source of procurement, majority of respondents that is 85.71% in medicine store mentioned about EDCL and 14.28% respondent mentioned about CMSD (Central Medical Store Depot). But our national policy dictates that public sector medicines will be purchased from EDCL (70%), CMSD (25%), and local sources (5%). But this study finding is not quite similar with national policy. Namibia operates a classic Central Medical Stores (CMS) distribution system with a CMS and two regional medical stores [3]. Regarding purchase timing, in medicine store, maximum respondents 71.42% mentioned about annual purchasing and 28.57% mentioned about perpetual purchasing. In case of quantity of order determination of medicine needed, majority of respondents that is 57.12% in medicine store mentioned about availability of fund and 42.85% respondents mentioned about past consumption. The study revealed that, maximum of the respondents mentioned that commodities are received between 1-2 weeks after an order is placed, that is 42.85% in medicine store. In Particular, an assessment of lead times in distribution systems offers numerous opportunities for improvement [8]. It was seen that receipt and vouchers were properly maintained during purchasing. Receiving authority is present there and during receiving delivery, expiry date check is done thoroughly to ensure quality service.
Regarding record keeping, majority of the respondents which is 85.71% in medicine store mentioned about manual record keeping method still being maintained in their store. Whereas 14.28% in medicine store, mentioned about presence of computerized method. It was observed that, Bin card is not maintained in medicine store also there is presence of ledger system. Stock records are therefore used to track down the movements of item from the time they enter the storehouse to the time of issue to users for the intended purpose [9]. Respondents also confirmed that any automated software based integrated inventory management system (IHIS) is still absent there. As we are living in advanced information technology era, inventory authority should give attention to implement computerized system. There is complete absence of any smoke detector mentioned by 100% respondents. And there is no fire alarm system said all of the respondents 100%. This is a negative finding of this study. Because both smoke detector and fire alarm system is essential for medicine store as these can save valuable medicine and life. Presence of flammable trash that is cartons and boxes are observed in medicine store. There was presence of 'No-Smoking' sign in medicine store. Flammables must be stored in special building or rooms. Corresponding Author: Saida Rashid Kochi

V. CONCLUSION & RECOMMENDATIONS
Inventory management ensures that the hospital does planning ahead of time to avoid shortages and make sure that right quality of materials are at the right place at the right time. The procurement in hospital is mostly from EDCL and very few from CMSD. It has been seen that, ABC technique of inventory control is being used there, which gives more attention on effective management of inventories. Most of the respondents did not get any training. In case of record keeping system, still they are following manual record but they don't maintain electronic record keeping method. The automated software based integrated hospital inventory system is absent in medicine store. There is no separate place for cytotoxic and dangerous drug. Fire extinguisher is present and they are functioning. But fire alarm and smoke detector is absent, so it may be arises serious situation at any time. As the security system of medicine store is well maintained, there is no theft issue. Along with some negative aspect, this study shows that the inventory management in Dhaka Dental College hospital is enough satisfactory to ensure quality health service to patient.

RECOMMENDATIONS
1. Fire alarm and smoke detector system should be introduced and work properly 2. As there is no electronic door lock system, it is necessary to implement it. And it will increase security strength. 3. Medicine should not be kept on direct contact of floor, should place in shelves. 4. There is no separate place for cytotoxic and dangerous drug. Because if it is not kept separately it can lead to serious situation. 5. Bin card and bar code reading facility should be introduced in medicine store. 6. Fully computerized and integrated automated software based record keeping system should be implemented to meet the demand of modern technology. 7. Training and refreshed training program should be arranged for inventory personnel, so that they become more efficient in provide quality service.