Inventory of Drug Samples in a Health Care Institution: RESULTS

14 Dec
2010

health care facilities

Of the 84 identified locations, drug samples were found in 21 locations, all intended for ambulatory patients (i.e., outpatient clinics and day centres). No drug samples were found in inpatient care units.

Overall, the number of doses of drug samples (n = 78 955 doses) was 2.4 times greater than the number of doses of drug floor stock (n = 32 987 doses) (Table 1). The outpatient clinics with the largest stocks of drug samples were (in decreasing order) pneumology, obstetrics and gynecology, pediatrics, dermatology, and otorhinolaryngology, and these clinics accounted for 80% of the sample doses. The distribution of drug floor stock among the various clinics differed from that for the drug samples (Table 1).

At least 1 person was identified as being in charge of managing drug samples in 11 of the 21 locations. A total of 13 different types of storage areas were identified: examination rooms (n = 7), nurses’ offices (n = 5), nursing stations (n = 4), doctors’ rooms or offices (n = 3), rooms for measuring patients’ weight and height (n = 2), reception areas (n = 2), storerooms (n = 2), floor pharmacy (n = 1), photocopy room (n = 1), common work room (n = 1), test room (n = 1), corridor (n = 1), and recovery room (n = 1). Fourteen of these 31 storage areas did not have a lock. Six types of storage were identified: cabinet (n = 20), office area (n = 3), drawer (n = 3), storage shelf (n = 3), pantry (n = 1), and refrigerator (n = 1).

According to interviews with the contact person at each location, the reasons for handing out samples included (in decreasing order) avoiding costs for the patients (n = 8), trying a treatment (n = 7), starting a treatment (n = 5), facilitating a treatment (n = 4), alleviating pain or fever (n = 4), providing patient education (n = 3), treating health care staff (n = 3), deciding between 2 treatments (n = 1), evaluating side effects (n = 1), providing a quantity of medication sufficient to last until the next planned prescription renewal (n = 1), responding to a relative’s request (n = 1), and using the sample simply because it was available (n = 1). cialis professional

Table 1. Comparative Profile of Drug Samples and Drug Floor Stock by Location


Drug Samples


Drug Floor Stock


Location (Clinic) No. of


Storage Areas with Drug
Samples


No. of Doses


Annual No. of


Outpatient Visits


No. of Doses Per Visit


No. of Storage Areas with
Drug Samples


No. of Doses


No. of Doses Per Visit


Pneumology


1


19 553


3 788


5.16


2


1 505


0.40


Obstetrics and gynecology


5


16 383


31 557


0.52


2


1 621


0.05


Pediatrics


2


11 977


9 475


1.26


1


1 452


0.15


Dermatology


3


9 131


6 112


1.49


1


2 648


0.43


Otorhinolaryngology


1


6 056


9 451


0.64


1


5 575


0.59


Hepatology and gastroenterology


1


2 450


5 431


0.45


1


1 356


0.25


Dialysis


1


2 114


250


8.46


1


1 082


4.33


Endocrinology


1


1 900


2 032


0.94


1


110


0.05


Adolescent medicine


1


1 592


2 489


0.64


1


273


0.11


Emergency


1 482


67 580


0.02


10 874


0.16


Allergy


1


1 439


3 496


0.41


1


566


0.16


Ophthalmology


1


1 379


15 923


0.09


1


1 045


0.07


Urology


1


1 050


4 143


0.25


1


768


0.19


Dental medicine


747


6 177


0.12


1


238


0.04


Neurology


1


653


5 521


0.12


1


284


0.05


Development


1


433


2 576


0.17


1


115


0.04


Diabetes


1


348


2 714


0.13


1


166


0.06


Orthopedics


1


142


16 666


0.01


1


1 422


0.09


Daycare centre


1


88


5 329


0.02


1


778


0.15


Neonatalogy


24


771


0.03


1


10


0.01


Renal transplantation


1


14


5 521


< 0.01


1


1 107


0.20


Total


31


78 955


207 002


NA


29


32 995


NA


Minimum


1


14


250


< 0.01


1


10


0.01


Maximum


5


19 553


67 580


8.46


10 874


4.33


Median


1


1 439


5 431


0.25


1


1 045


0.15


The drug samples were classified in 23 therapeutic classes (Table 2) and came from 62 different pharmaceutical companies. The companies represented by the greatest number of samples were Wyeth Ayerst (25 different products), Stiefel (17), Sanofi-Aventis (10), Novo Nordisk (10), Eli Lilly (10), and Glaxo-Smith Kline (10). The companies represented by the greatest number of distribution units and number of therapeutic classes were Wyeth Ayerst (28.5% of distribution units, in 6 therapeutic classes), Stiefel (7.4% of distribution units, in 1 therapeutic class), Merck Frosst (5.3% of distribution units, in 2 therapeutic classes), Galderma (4.7% of distribution units, in 1 therapeutic class), Johnson & Johnson (3.3% of distribu­tion units, in 4 therapeutic classes), and Baush & Lomb (3.3% of distribution units in 2 therapeutic classes). canadian antibiotics

A comparison of inventoried stock with declarations archived in the pharmacy revealed that only 3.5% (n = 302) of the drug sample distribution units had been declared to the pharmacy department according to established policy. Generally speaking, the samples were given to physicians, nurses, or clerks or were dropped off by pharmaceutical sales representatives in locations where samples were already present, or they were sent by regular mail, sometimes at the request of hospital staff.

Table 2. Comparative Profiles of Drug Samples and Drug Floor Stock by Therapeutic Class

Drug Samples

Drug Floor Stock

Therapeutic Class (AHFS no.)

No. of Companies

No. of Products

No. of Doses

%
Expired Doses

Total Cost (Can$)

% of Doses
Not on Formulary

No. of Products

No. of Doses

Total Cost (Can$)

Hormones and

synthetic
substitutes

(68:00)

15

45

25 043

2

11 831

37

5

790

87



Autonomic drugs
(12:00)





5





12




14 913




6




10 614





43





41




1 573





1 776



Skin and mucous membrane
agents

(84:00)





25




73





9 294




12





7 830





70





24




3 931





1 372

Vitamins
(88:00)

3

8

7 344

<1

1 409

52

5

142

285

Central nervous



system agents
(28:00)





9





23




5 162




9





1 891





60





22





663





1 599

Eye, ear, nose, and throat

preparations
(52:00)

14

32

4 912

7

4 563

81

40

5 778

1 435



Gastrointestinal drugs

(56:00)





14





25




3 142




22




3 213





57





0





0





0

Electrolytic, caloric, and water balance

agents
(40:00)

5

10

2 178

0

486

76

3

3

114

Blood formation, coagulation, and thrombosis



agents
(20:00)





3





4





2 038




0





594




100





13





589





474



Respiratory tract agents

(48:00)





5





11





1 658




2




1 913





70





0





0





0

Smooth muscle relaxants (86:00)

5

5

862

17

1 126

83

1

5

45





Antihistamine drugs (4:00)





2





5





757




0





446





18





41





5 273





1 867



Miscellaneous therapeutic
agents

(92:00)





1





1





588




0





545




100





23





4 782





545

Anti-infective

agents
(8:00)

4

6

535

30

858

38

2

3

310



Diagnostic agents
(36:00)





1





1





280




0





57





0





33




1 187





1 928



Enzymes
(44:00)





1





1





200




100





21




100





7




135





265





Cardiovascular drugs (24:00)





1





1





21




0





25





0





1





10





6

Serums, toxoids,

and vaccines

(80:00)

2

2

19

100

145

0

7

63

4 854



Contraceptives (foams,
devices)

(32:00)





1





1





9




0




1 217




100





24




4 146





2 095

A total of 159 generic entities and 266 different brands were counted. In decreasing order, by proportion of distribution units of the generic entity, the most important drugs were ibuprofen (15.4% of all distribution units), multivitamins (8.1%), dorzolamide/timolol (4.1%), fluorescein (3.2%), adapalene (2.4%), metronidazole for topical administration (2.4%), hydroquinone (2.0%), cetirizine (1.9%), tretinoin (1.9%), and calcium-vitamin D (1.9%). In monetary terms, the total value of the sample distribution units, including expired units, was Can$48 783, based on the unit prices in effect in October 2007. In comparison, the value of authorized drugs in the clinics’ stock was Can$21 813.
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Of the identified stock, the inventory showed that 732 (8.3%) of the distribution units were expired; the most common expired drugs were anti-infective agents, enzymes, gastro-intestinal medications and sera, antitoxins, and vaccines. Furthermore, 5226 (59%) of the drug sample distribution units identified during the inventory were not on the hospital’s local formulary, as approved by the Pharmacology and Therapeutics Committee.

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