Over the past decade the U.S. Food and Drug Administration has approved numerous new drugs for the treatment of diseases of the retina. This cornucopia of new, and often expensive, drugs has underscored the vital need for efficiency and accuracy in managing drug inventories. An inventory management system must be able to account for each drug vial from the time it’s ordered to when it’s administered to a patient.

A successful inventory system tracks the ordering, receiving, supply and usage of all medications. It can be managed at the practice or individual office level.

What the Job Involves

The practice should determine if it can handle its current volume of drugs using a manual system (typically on Excel spreadsheets) or if it needs an automated system that uses barcodes or radio frequency identification devices. It’s advisable to have one employee in the practice responsible for ordering all drugs. If the practice has multiple locations open all week, having a responsible person at each office may be a good idea.  

The practice should establish reorder points for each drug. To accomplish this, review the utilization of each drug in each office over a six-month period, and calculate the average use per week per drug. Reorder points can then be set for weekly ordering at the average weekly utilization rate plus a percentage to allow for fluctuations. Consider the reorder point a guide that can be modified if necessary to allow for physician time out of the office. The same person should order and receive drug shipments to ensure each order is correct and properly entered into the inventory system.

Upon receipt of an order, the inventory manager should check a few things: make sure the order is not damaged; that it was delivered at the appropriate temperature; the quantity is correct; the lot numbers on the invoice and the individual vials match; and that the expiration date has appropriate dating. Drugs that will expire in a relatively short time frame should not be accepted.

An automated drug inventory system that uses
barcode technology can reduce the risk of lost drugs.
(Courtesy Physician Office Drug Inventory System)
Each refrigerator or freezer containing drugs should have medical thermometers with alarms and they should be monitored daily. Some of the newer inventory systems automate this process by creating a cloud-based log-in and portal as well as alarms that can trigger a text message or e-mail to a specific person.

Tracking Supply

Besides a count of how much of each drug is in inventory, the system should record drugs dispensed, cost, lot number, expiration date and the patient’s name who received the drug. Ideally, it will also match the reimbursement for each dose.  

An actual physical count of the drugs should be done on a regular basis to ensure the system numbers are accurate or corrected as needed.  

The true difficulty is in selecting the right type of drug. That is, picking between a purchased drug, a sample or a patient-specific drug from a specialty pharmacy. The system should maintain and store each of these types of drugs separately.

A best practice is a drug “timeout” immediately before the injection. This involves the doctor, technician and patient all pausing to agree on the eye being injected and the drug being used.  

A drug may become contaminated if it’s dropped, if the syringe is touched or in other ways. When this happens, the inventory system must report it. In most cases, the manufacturers of FDA-approved drugs have replacement polices for contaminated or spoiled drugs. Any contaminated or spoiled drug must be removed from inventory. When the replacement drug arrives, it should be entered into the system to account for the one removed.
A complete inventory system can save staff time, reduce the risk of lost drugs and improve the drug injection process as well as the work environment in the practice.  RS

Mr. Laurita is chief operating officer at Retina Associates of Cleveland Inc. in Ohio.