Managing a remote clinic dispensary

Space for 2 fridges
Lockable door, duress alarm, security screens on all windows, no public access, telephone with external line
Good lighting
Constant room temperature (less than 25°C) with good air circulation. Air conditioners should be connected to back-up power supply
Shelving — clearly labelled, enough room to store and display medicines

Workbench with waterproof top, large enough for at least 2 practitioners to prepare medicines for dispensing

Computer with access to internet and electronic file notes
Label printer
Stainless steel sink, elbow control taps, soap dispenser, paper towel holder
Equipment for dispensing medicines — purified water, measuring devices, medicine cups, paper cups, syringes, tablet cutters, mortar and pestle (for crushing tablets), tablet counter (eg triangle)
Equipment for packaging medicines — dose aids, labels, cartons, bottles, time of day (sun and moon) stickers, warning labels
Containers for return of unwanted medicines (RUM)

Safe attached to wall, large enough to store all controlled drugs and prescription medicines that can be misused (eg benzodiazepine, codeine)
Drug register for recording supply and use of all restricted S4 and S8 medicines

2 fridges — should be large enough to allow free air circulation around medicines

Plugged into back-up power supply
If the fridges can not be stored in the drug storage room — must be lockable and remain locked when not in use
Display current Vaccine Cold Chain Graph

Best-practice guidelines — (eg Standard Treatment Manual, Women's Business Manual)

Supplying pharmacies should provide written procedures and forms for ordering imprest and chronic diseases medicines. Contact pharmacy if these are not available
Submit orders for wet season or events (eg ceremonies, sports carnivals, mass treatment programs, clinical trial) in advance, to give pharmacy time to organise stock

Remember: Check medicine stocks in your emergency kit and ambulance as well

Store and transport medicines at recommended temperatures — under 25°C for shelf medicines, 2–8°C for fridge medicines
Unpack and store medicines as soon as possible after delivery

Store in categories by active ingredient in alphabetical order
Label shelves with generic names of medicines
Document how your medicine stock is organised to make it easier for all staff, including visiting doctors, nurses

Use local guidelines and protocols to help decide what medicines to keep
Keep order quantities at levels that reflects twice your order period usage, for example if you order monthly — keep 2 months worth of stock. This covers you for any delays in delivery or unexpected high use

If using imprest list — keep list in same order as medicines on shelves. Makes it easy to fill your order. Fill imprest list as you check along shelf
Keep medicine containers neat and clean so easy to find, labels easy to read
Circle use-by/expiry date on new stock or write clearly on container
Put new stock behind current stock — try to make sure older stock (first to expire) is used first
If use-by/expiry date only printed on outer package, keep stock inside package until it is going to be used

OR if items must be taken out of original packaging — write use-by/expiry date on each separate item

Stock should be regularly checked for short-dated or expired stock, check the policy for this process. Make this part of your routine clinic checklist

Supporting resources