• Several items are being procured and issued by the government hospitals and simultaneously patients are also asked to buy those very items themselves.
• It must be an accepted fact that resources will never be sufficient to provide each and every item to all the patients. Therefore, it needs to be cleared as to which items the hospital must supply and which items the patients must buy.
CGHS
• It's a welfare scheme run by the government for its employees.
• It's not an insurance scheme.
• Relation between the government and the employees is of employer and employees.
• If the medicine is not available and he is asked to buy than the cost must be reimbursed.
• CGHS came into existence only to end the cumbersome system of reimbursement in 1954. So the system of local purchase is followed in the dispensaries.
Guidelines for procuring medicines from local chemists
• Medicines available should not be indented.
• Prescriptions should be signed and stamped by the specialist if out of CGHS formulary drugs are prescribed.
• Prescriptions should be signed and stamped by the specialist in case out of CGHS formulary drugs are prescribed.
• Only valid prescriptions are to be indented, if time barred fresh opinion of specialist is essential.
• The prescriptions of recognized hospitals are only to be entertained.
• Prescriptions and local purchase indents must be legible.
• Advertised and food products, cosmetics, ayurvedic drugs prescribed by allopathic physician, inadmissible items declared and imported drugs should not be indented.
• H O D items of formulary must be prescribed or countersigned by consultants only.
• Quantity indented must not be more than the quantity prescribed and the strength of each item must be indicated.
• The index card of the beneficiary should be invariably being checked from the record.
• Date and the quantity indented and supplied should be written legibly in the prescripti
• A photocopy of prescription required in case of- cost more than Rs 1000/- per medicine
• These photocopies of prescriptions should be paged, numbered, indexed and got properly bound month wise.
Medicines should be supplied in full by the local chemist.
• Write clearly and legibly and in capital letters and mention the strength of medicine. To bring transparency in the system give code to each medicine. Code should also be different in case of same medicine but different strength. (Suggestion and example lorvas storvas 10 to 40)
• Avoid overwriting and all cuttings should be verified by cmo i/c.
• Quantity of indented/ supplied medicines to be written in words also.
• Mention the name of "prescribing doctor" along with hospital in the relevant column.
• Medicines not supplied to be indicated as not available.
• Substitute medicines should not be received. Substitute means medicines of different company/ strength.
• The pharmacist should also sign along with his name.
• The indent should be entered in register with the following columns
• No. And date of indent
• No. Of items indented.
• No. Of items received
• No. Of pages sent
• Remarks
• Local chemist should indicate batch no/ company name/ mfg. Date/ exp. Date, mrp, local tax and the quantity in the prescribed columns while supplying to the dispensary. Mrp and local tax should be shown separately.
• Local chemist should not supply the inadmissible items. Pharmacist receiving the medicines should also ensure it.
• While receiving the indent, pharmacist should check the batch no, expiry date, mrp and strength of the medicines.
• Medicines should be kept separately day wise for one week. The medicines, left undistributed, should be kept separately. After 15 days unclaimed medicines should be taken on charge and to be distributed to the first beneficiary came for the indent. A separate register should be maintained for above purpose.
• The pharmacist should verify the name and address of the beneficiary from the token card.
• Listed items should be taken on charge and separate register should be maintained for the purpose. No separate chit is required. Beneficiary should not be asked to get registered for the purpose. The pharmacist should submit the list of beneficiaries to the entry clerk at the end of the day.
• Weekly summery of listed drugs and if possible of out of formulary medicines should be made. This summery will be useful for taking the medicine under the formulary and for the provisioning at a later stage.
• `to avoid the misuse and to bring transparency in the system, all the medicines should be leveled as CGHS supply not for sale and all the sealed items should be handed over to the beneficiary after breaking the seal in front of him as per the store procedures. Medicines should be leveled in such a way that name batch number expiry date etc should always be visible clearly.
• Re circulated medicines should not be accepted and matter should be brought to the notice of cmo i/c.
• The pharmacist should be polite and also explain the doses duration, frequency of medicines to be taken. And any adverse reactions expected to the beneficiary in their language.
• Local chemist should write the different rates uniformly on the indent forms i.e. He should write ones under ones, tens under tens, hundreds under hundreds etc.
• Bills should be checked thoroughly .rates has been already checked while receiving the indents so more attention can be given to calculations horizontally as well as vertically.
• Where the packing size is different than the usual 10 more attention is to be given in horizontal calculations.
• Costly medicines are also to be checked. Here we can apply ABC analysis and HML analysis.
• Find out the 10% items where 70 % of budget is consumed and pay more attention to those items rates and calculations.
• Out of others (hml analysis) take the costly items and check thoroughly.
• From the rest, the random items may be checked.
• Items like loprin which has very less value, in single /double figures; putting single digit in front is very easy not to get noticed. Take steps to prevent that. Ask the chemist to put 0 under hundreds. Tens as the case may be.
• Always recheck from the dispensary copy.
• Keep all the L P vouchers month wise and if possible get it bounded.
DR G R MARWAH
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