ABSTRACT: Efficient management of the pharmacy and good stock control ensures that the right medicine is available at the right place and the right time and that capital is not tied up unnecessarily. It also protects against problems arising in the supply chain.

It is good practice to:

set stock levels to allow accurate stock holding

have a named person responsible for stock control

store medicines in a logical order and in their original packaging supply a product leaflet or summary of product characteristics (SPC) with all medicines dispensed dispense medicines with the shortest expiry date first store medicines with the same batch number, together.

The date of delivery from the manufacturers or wholesalers should be recorded, unless this information is on the invoice or delivery note which is retained. Packs with damaged or defaced packaging and out-of-date stock should be stored separately whilst awaiting disposal.

Once stock has been dispensed, it should not be accepted back into the medicines 

store as the storage conditions cannot be checked once off your premises. The date of ‘first use’ of each batch should be recorded by writing the date the bottle was breached, on the label.

Premises licensing and inspections

From April 2009, all premises where veterinary medicinal products (VMPs) are stored or supplied, must be listed on a register maintained by the Royal College of Veterinary Surgeons (RCVS) on behalf of the Veterinary Medicines Directorate (VMD). The VMD will be able to inspect these premises.

Those practices that are members of the RCVS Practice Standards Scheme (PSS) will not currently be inspected by the VMD inspectors, as their pharmacies will be inspected as part of the PSS. The supply of medicines will be checked to ensure that there is an effective stock control system in operation and that out-of-date, damaged or returned medicines are disposed of correctly. Out-of-date medicines are not used or supplied to clients. All medicines are supplied and labelled correctly.

Injection bottles require the date of broaching recorded on them

Controlled drugs

Under the Misuse of Drugs Regulations, 2001, Controlled Drugs are classified into five Schedules according to the required level of control. A veterinary surgeon has the authority to supply Schedule 2, 3, 4 and 5 Controlled Drugs.

Storage of Scheduled drugs

Schedule 2 and 3 Controlled Drugs should be kept in a locked cabinet.

This cabinet should conform to British Standards and be attached to the fabric of the building. The specifications with which safes, cabinets and rooms must comply are given in detail in the Misuse of Drugs Regulations 2001 (available from The Stationery Office).

Chiller cabinets can be used for the storage of vaccines, and prevent excessive changes in temperature each time you open a fridge door

For any veterinary surgeon carrying Controlled Drugs in their car, a locked glove box does not qualify as a suitable storage place. Special storage boxes are available that can be secured to the car for storage of Controlled Drugs.

Access to the Controlled Drugs cabinet should be restricted, with keys kept by a responsible person(s) at all times. It is not acceptable to have a communal key kept in a drawer or other non-secure place.

In our practice, the key is kept in a safe, to which only the vets have access.

A key register can be used to pass responsibility from one key holder to another, for example, for overnight and during the day. Alternatively, each veterinary surgeon can be issued with his or her own key for which they are responsible.

If a practice is found not to be complying with the Misuse of Drugs Regulations 2001, it can be prevented from keeping Controlled Drugs by the Home Office.

Management of health and safety at work

The Health and Safety Executive (HSE) asks businesses to:

assess risks in the workplace consult with and involve employees take suitable precautions to avoid risk review and revise risk assessments as necessary.

The areas of risk that need to be assessed in the dispensary include:

general medicines handling – who in the practice is allowed to dispense handling cytotoxic drugs – consider wearing gloves when unpacking the order as residues have been found on the outside of packaging spillage of medicines – a spillage kit should be available in the dispensary manual handling: accessing high shelves, moving drug order, etc. – heavy item should be stored on the ground trip hazards waste disposal.

A risk assessment should be carried out for each of these activities, preferably by the staff directly involved, and reviewed annually. As a result of the risk assessment, standard operating procedures (SOPs) should be drawn up and staff trained in their use.

The dispensary area should be kept clean and organised at all times

Control of substances hazardous to health

Under the Control of Substances Hazardous to Health (COSHH) Regulations, 2002, practices should assess the risk to health and safety from veterinary medicines and other substances used in the practice.

Drugs and substances should be classified according to risk – low, medium and high.

Low- and medium-risk substances

Low- and medium-risk substances can be grouped by therapeutic group, type or route of administration. Standard measures (including protective clothing and correct administration of drugs) to control exposure can be used for the whole group; examples of groups include: antibiotics vaccines

injectable anaesthetics

 inhalation anaesthetics

steroids

disinfectants.

Any specific risks within the groups must be identified (e.g. allergy to penicillin).

High-risk substances

High-risk substances must have an individual detailed assessment. These substances include: oil-based vaccines cytotoxic drugs glutaraldehyde disinfectants hormones tilmicosin.

Measures to control exposure to these high-risk substances must be explained to staff. These measures include: wearing the correct protective clothing i.e. gloves, apron, mask and goggles as appropriate and in some instances, using sealed units to handle drugs. Correct disposal rules must be adhered to.

Data sheets and summaries of product characteristics

Safety data sheets must be provided for all drugs stocked. These are available

Containers

Medicines should be stored in their original packaging with the lid tightly closed.

Where possible, medicines should be dispensed in their original container. If a medicine is repacked or prepared extemporaneously, it should be placed in a container suitable for the medicine and the user.

All containers should be stored in such a way that they remain free from contaminants.

Expiry dates

Stock rotation should ensure expiry dates and use by dates are adhered to. A named person should be in charge of date-checking the medicines store once a month.

A log should be kept of this check. Short-dated stock should be marked as such and brought to the front of the shelf to be used first.

Any stock that has gone out of date should be separated and recorded before destruction.

Multi-dose vials should be marked with the date of first opening and the date of expiry. Bright stickers can be useful to draw attention, but all multi¬dose vials with an in-use shelf-life now have a space to write this information. Any drug left in the vial after the specified time must be discarded.

Any medicine remaining in a single use ampoule should be discarded once the required dose has been withdrawn. Administering a medicine that is past its expiry date or obscuring the expiry date is an offence.

An electronic copy of the summary of product characteristics (SPC) for all veterinary authorised medicines can also be found on the Veterinary Medicines Directorate (VMD) website. The SPC includes safety warnings, what to stock, how to organise and categorise medicines on the shelves and storage, including refrigerated products.

Storage conditions

Medicines should be stored at the temperature recommended in the SPC, usually under 25°C (ambient room temperature) or between 2°C and 8°C in a refrigerator. Any medicine requiring refrigeration should be removed from the delivery cool chain protection as soon as possible and placed in the refrigerator.

Biological samples and food should not be stored in refrigerators used to hold medicines. Fridges should be checked daily by a named person and a log made of maximum and minimum temperatures. This log can be recorded on paper or electronically.

If the refrigerator temperature goes outside 2-8°C, information should be sought from the manufacturer(s) as to the safety of the medicine(s) for use and the new expiry date(s). Cars should be fitted with refrigeration units and the temperature of these should be checked daily.

To protect medicines from extremes in humidity, autoclaves should not be used in the medicines store. Many medicines are sensitive to light, so blinds should be fitted at any windows and medicines should be stored in their outer protective containers.

Flammable medicines must be stored in an appropriate flammables cupboard, preferably situated on the floor to prevent breakages. 

Temperature monitor devices contain a USB port to download the temperature information

Temperature monitoring devices can be used to monitor environmental temperatures

Author(s)

Amanda Rock bvsc mrcvs pgce

Amanda graduated from Liverpool University in 1998 and has since worked as a veterinary surgeon in Cornwall, first in mixed practice and later in critical care and emergency work. She enjoys writing for the veterinary press and has contributed to several nursing textbooks.

Nicola Ackerman

BSc(Hons) RVN CertSAN MBVNA

Nicola works as the senior medical nurse at The Veterinary Hospital in Plymouth. Nicola graduated from Hartpury College with an honours degree in Equine Science, and subsequently qualified as a veterinary nurse. Nicola is past officer of the BVNA, but now is the vice-chair of The Pet Obesity Taskforce, and sits on the VMD's appraisal panel for suspected human adverse reactions.

 

Veterinary Nursing Journal • VOL 25 • No6 • June 2010 •