Issuing Medicines and Balancing the Ledger

The steps

The curriculum lists five steps for issuing medicines:

1. File the requisition from the requesting unit.
2. Evaluate the requisition.
3. Issue the medicines.
4. Balance the ledger for each item, by subtracting the quantity issued from the previous balance.
5. Make sure the receiving unit signs the receipt voucher.

Step 1: The requisition

A requisition is the written request from a ward, clinic or unit for medicines from the store. It must be complete, legible, signed and approved by the authorising officer. File it with a serial number, so that every issue can be traced to a request.

Do not issue on a verbal request alone, except in a real emergency, and then record it properly afterwards.

Step 2: Evaluating the requisition

Before issuing, check:

Worked example

A clinic asks for 1 000 tablets. It uses about 300 a month, has 400 in stock, and the interval is 1 month.

• Needed for the month = 300. It already has 400. So it needs no more for this interval, or only a small top-up for safety stock.

The request is far too large. Query it with the unit and the authorising officer. Do not just issue it, or the stock will be wasted, or the store will run short for other units.

If the store has less than the whole request, issue a fair share by need, and record what is owed (dues-out).

Issues outside the schedule

Most units receive supplies on a distribution schedule, which sets a regular date and quantity. If a unit asks for more, or at another time, ask:

• Why is more needed (an outbreak, a rise in patients, a loss)?
• What is the unit's current stock and use?
• Is the authorising officer's approval given in writing?

The quantity outside the schedule is decided from the real need and the stock available, and is recorded.

Step 3: Issuing

1. Take the medicines using FEFO, so stock with the earliest expiry date goes first.
2. Count the quantity twice, or have a second person check it.
3. Check the expiry date, batch number and condition of every item.
4. Pack the medicines safely. Keep cold-chain items cold, and keep controlled drugs secure.
5. Complete the issue voucher: the unit, the date, the items, the batch numbers and the quantities.

Step 4: Balancing the ledger

Subtract the quantity issued from the previous balance, on both the bin card and the ledger.

new balance = previous balance − quantity issued

Example. Ledger balance 750 tablets. Issue 200 to Ward A.

• New balance = 750 − 200 = 550 tablets

Do this at the time of issue, not at the end of the day, so the record is always right.

Step 5: The signed voucher

The receiving unit signs the receipt (issue) voucher, after checking the items against the voucher. This proves the unit received the medicines.

Often the voucher has several copies:

Different services call these forms by different names, such as the issue voucher (IV) and receipt voucher (RV).

Checking for proper balancing

Regularly check that:

• the bin card balance equals the ledger balance;
• both equal the physical count;
• every issue in the ledger has an approved requisition and a signed voucher;
• the totals of receipts less issues equal the closing balance.

Example. Opening balance 500. Receipts 300. Issues 200 + 150 = 350.

• Closing balance = 500 + 300 − 350 = 450

Any difference must be traced and explained.

Common mistakes