DGAFMS MEDICAL MEMORANDUM

ACCOUNTING OF DRUGS AND STORES IN WARDS AND DEPARTMENTS

CONTENTS

1. Introduction

2. Drugs and Stores to be accounted for

3. Accounting Procedure

4. Non-Expendable Medical Stores

5. Breakage and Loss Book

6. Instructions for Implanted Devices

7. Action by the Commandants / Commanding Officers

8. Action by Inspecting / Visiting Medical Officers

DGAFMS MEDICAL MEMORANDUM

ACCOUNTING OF DRUGS AND STORES IN WARDS

AND DEPARTMENTS
INTRODUCTION

1. The purpose of this memorandum is to lay down the instructions to be followed in

accounting of drugs and medical stores in various wards and departments. These instructions
are intended to check any misuse, pilferage, premature deterioration and abnormal expenditure
of drugs and stores.

2. These instructions will also apply to field medical units except when engaged in actual
operations and are in addition to instructions contained in the various Defence Service
Regulations and Directives issued by the DGAFMS from time to time, on the procedure for
indenting, stocking, issue, accounting and turn over of medical stores and equipment.
DRUGS AND STORES TO BE ACCOUNTED FOR

3. The items of medical stores falling under the following lists/groups will be strictly
accounted for in expense books by every ward and department/MI Rooms/Sick
Bays/SSQs/Family Welfare Centers: -

(a) Drugs and injections covered by Schedule ‘E’ of Drugs Act-1940, i.e. Narcotics and
Dangerous Drugs (D/D items).

(b) All NIV (Not-In-Vocabulary) items.

(c) All PVMS items with suffix ‘N’ in their PVMS numbers.

(d) Expensive and easily pilferable items as per list issued by the DGAFMS from time to
time.

(e) Items so identified by the Commandants/Commanding Officers of units (eg DGLP

items etc).
4. The above-mentioned category of items will be stocked and issued only from medical
stores and not from dispensaries.

ACCOUNTING PROCEDURE

5. For the purpose of accounting of stores two separate indent books will be maintained in
each ward/department, one each for demand of stores on medical stores and dispensary
respectively. Quantity of items to be demanded will be fixed every year by a Board of
Officers based on the average monthly consumption during the preceding twelve months. In
order to avoid exaggerated demand of various items from the wards/depts with a view
that the Medical Store will invariably issue a lesser qty than the qty projected, it would
be ensured by the MOIC ward that only realistic demands are projected based on the
MMF and the actual requirement of the ward, hoarding of dead stocks is minimized and
casual indenting is eliminated. The OIC Medical Store would in turn ensure that the
demand is met in full as far as possible, till the time the stock of the said item is in critical
short-supply.

6. Indent Books: Indent books will be printed by the Commanding Officers /

Commandants of the units concerned out of the I&M Grant allotted to them and use of
improper registers, books, pads etc will be avoided. The cover of the indent books must
have the following proforma printed on it:
(a) Indent Book No________

(b) Name of the MI Room/Sick Bay/SSQ/Unit/Hospital______________

(c) Name of the ward/dept_______________

(d) This indent book contains __________ pages duly initialled by the MO/IC ward.

(e) Indent book for _____________ indents. (For eg Urgent/DGLP/NIV indents etc).
The indent book will have the following columns: -
 (a) Name of the item (Nomenclature).

(b) Accounting units (A/U).

(c) MMF.

(d) Quantity held on the date of indent.

(e) Quantity projected in the demand (current demand) (to be entered in both words
and figures).

(f) Quantity issued by the medical stores/dispensary (to be entered in both words and
figures).

(j) Quantity received by ward/department.

A specimen of the indent sheet is shown below:-

S. Nomen- A/ M Balanc Qty Recd

N Clature U MF e held Qty Demanded Qty Issued in ward /
o in the Currently dept (in
ward Figures Words Figure Words words)
s
1. Tab N 100 Nil 1000 One 1000 One One
Disprin o 0 Thousand Thousand Thousand

Prepared by: Checked & Issued by: Sig of OIC Received by:
Indented by : Med Store
Signature____ Signature_____ Signature__With Rubber Stamp)
Signature____

Pers No_____ Pers No_______ Pers No____ Pers

No_____

Rank_______ Rank_________ Rank______

Rank_______

Name_______Name (MOIC Ward) Name (NCO IC Issue

Name________

_________________ Sec/Dispensary)____

7. Indents will be prepared in TRIPLICATE. All THREE copies will be sent to the
Medical Stores. After endorsing the quantity issued on all the three copies of the indent,
TWO copies will be sent back to the concerned ward / dept after retaining the original
copy in the Medical Store. One of the copies sent to the ward/dept will be sent back to
the Medical Store as the ‘RECEIPTED COPY’ after the actual quantity issued is
thoroughly checked by the Nursing Officer IC and found correct in all respects. The
Medical Store will keep all such receipted copies attached with the original copies of the
indents for accounting and maintenance of expense ledgers.

8. The quantity issued by medical store and the quantity received by the
ward/department must tally. If for any reason quantity demanded together with the quantity
held in stock is more than the quantity as per MMF, the indenting medical officer will give
reasons for this additional demand. If the quantity issued by the medical store/dispensary is
less than the correctly demanded quantity, the reason for the under issue will be given by the
OIC Medical Stores. It will be ensured by the OIC Medical Stores as well as the
indenting Medical Officer that the endorsement of quantity demanded and quantity
issued in figures must tally with the respective endorsement in words, to avoid any
discrepancies at a later date.

9. Suggested frequency of indenting is as follows (for NORMAL / ROUTINE indents

ONLY) :

(a) ICU / CCU : Weekly

(b) All acute wards : Fortnightly

(c) All chronic wards : Monthly

10. Medical stores/dispensaries will issue the stores showing quantities issued on all three
copies of the indent against each item. Wards/departments will arrange collection from
medical stores/dispensary. Items not issued will be clearly marked as ‘NA’ and quantity
issued column will not be left blank under any circumstances.

11. On receipt of fresh stocks from the medical stores / dispensary, the Nursing Officer IC
ward / department will:-

(a) Scrutinize both the copies of the indents and satisfy herself that the stores indented
for and issued by medical stores/dispensaries have actually been received in her
ward/department and sign on the second copy in token of receipt of all items correctly,
after ensuring that there is no discrepancy. The same will then be returned to the
medical stores/dispensary, as mentioned in para 7 above. It will be ensured by the
MO IC ward / Nursing Offr IC ward that the receipted copy of the indent is sent
back to the Medical Store at the earliest for their record and accounting. In case
such receipted copy is not received by the Medical Store, no further issues will be
made to that particular ward/dept on any subsequent indents, till the time the
receipt of the previous indent is confirmed.

(b) Initial on the office copy of the indent in token of such checks.

(c) To ascertain the reasons for short issue/non-issue from medical stores/dispensary.

(d) Ensure that items covered by para 3 above are promptly taken on charge in the
expense book.

12. Urgent Indents: Indenting of drugs / expendables through urgent indents will be
restricted only to the ICU/CCU and other Acute Wards. All other wards / depts must
plan their normal indents meticulously so that the need of urgent indents is completely
eliminated.

13. Indenting of Drugs for Superspeciality Centers/wards (Oncology/Renal

Transplantation/Endocrinology etc): Indents for drugs like Anti-cancer drugs and
drugs used in super-specialized centers will be sent to the Medical Stores ONE day in
advance so that the drug is made available to the patient in the morning of the day of
initiation / continuation of next phase of therapy.

14. Indenting of selected / expensive drugs: Certain selected expensive drugs of

PVMS / DGLP stores, as decided by the Commanding Officer / Commandant of the
hospital, will be indented along with a Case Summary of the patient(s) signed by the MO
IC ward. The Case Summary should contain the following details:-

(a) Particulars of the patient

(b) Diagnosis

(c) Very brief justification of the drug to be used for that particular patient.

(d) Dosage schedule of the indented drug in detail.

Such Case Summaries are intended to ensure justified and realistic indenting of
expensive drugs, prevent hoarding and subsequent pilferage of such drugs.

15. Drugs nearing expiry: All wards / deptts will intimate the stock position of all
drugs / expendables to the Medical Store which are about to expire, at least three months
before their printed date of expiry, which are unlikely to be consumed within this period,
so that necessary disposal can be arranged and loss to the state is avoided.

16. Every ward/department including MI Rooms/Sick Bays/SSQs/Family Welfare Centers

will maintain a Treatment book. This book will give daily details of the patients treated, the
disease and the treatment ordered and carried out. A total tally of drugs and injections
covered under para 3 above, expended for the treatment of each patient against each
drug will be entered in the last column of the treatment book and signed by the Nursing
Officer / Nursing staff responsible for carrying out the treatment, as and when the
treatment is changed or the patient is discharged / transferred / has expired.
Subsequently, these items will be charged off from the expense book and initialled by
MO- in-charge ward/department. The drug expense book and the treatment book will
be checked periodically by the Matron-in-charge wing / Matron on duty / other
Administrative Medical Staff. For this purpose all wards/depts will maintain the
following types of expense books:

(a) For PVMS items

(b) For NIV Drugs and expendables.

(c) For other specialized expendable medical stores viz for Nephrology, Cardiology,
Pathology (Lab Kits etc), Radiology (MRI & CT Scan films, Contrast media) etc.
17. In order to safeguard against pilferage in the ward, only the custodian of stores should
have access to the stores. Only such quantities of drugs will be issued by the ward
sister/stores in-charge to the Nursing Assistants / other staff concerned, as are needed for day
to day consumption.
In case there is an additional demand during off-duty hours when the custodian of the
drugs is not available, all Medical wards can take the required item on loan from the
Acute Medical ward, where the drug stores are available for 24 hours, and return it
during working hours of the hospital. Similarly, all Surgical wards can take required
drugs on loan from the Acute Surgical ward. Drugs not available even in the Acute
wards can be obtained either from the ICU on loan, or even from the Medical Stores on
an urgent indent in extreme cases.

18. Before signing the monthly expense vouchers of the medical stores, the Commanding
Officer / Commandant of the hospital will detail a Board of Officers once a month to check a
percentage of the receipted copies of indents and chits from the wards and departments held by
the medical stores with those of the office copies in the wards/departments to ensure that there
are no discrepancies between the two and also to cross-check their entries and the day-book of
the medical stores. If any discrepancies are discovered, the Board of Officers will report the
matter to the Commanding Officer / Commandant in writing giving the details of such
deficiencies / surplus. A register will be maintained for this purpose. The Presiding
Officer of the board will enter therein that he has physically checked the indents and chits and
discovered no discrepancies. The Board of Officers detailed for monthly check will also
scrutinize the treatment book maintained as per para 9 above and verify that the quantity of
drugs consumed as shown in column (c) of the indent book mentioned in para 5 is justifiable.

19. Computerization of accounting: Till the time satisfactory software is made

available to all hospitals / units for complete accounting of stores in the Medical Store as
well as wards / depts through LAN, all wards / depts should preferably maintain their
local accounts of drugs and equipments on computers, if available.

NON-EXPENDABLE MEDICAL STORES

20. (a) Inventories of non-expendable stores issued to all wards and departments will be
maintained in duplicate, one copy with the ward/department and other with the medical
stores. Both copies will be signed by the Officer-in-charge ward/deptt and OIC Medical
Stores.

(b) A physical check of all items issued to wards/deptts and MI Rooms will be carried out
according to the inventories at the time of handing-taking over by in-charge
wards/deptts and at the time of the Annual Stock Verification, in association with the
OIC Medical Stores.

(c) The physical check will not be confined to the number of stores issued but will include
their serviceability as well. Any store found unserviceable will be replaced on clear
exchange basis on the day of the check, subject to its availability in the medical stores.
Replacement of lost/broken items will be made after making necessary entries in the
breakage book.

(d) In order to check/confirm the accounting of parts/components of electromedical/

sophisticated equipments held in the hospital, the Commanding Officer/
 Commandant of the hospital may, under his jurisdiction, request the services of the
ATEO / CRC of that particular Command.

(e) Log Books: All wards/deptts will maintain log books for all eqpts costing >
Rs 10,000/- and all life saving equipment. The log books will have the following
columns:

(i) Nomenclature & Source (Whether DGAFMS supply/NDF/AG’s Fund/CI Ops

Fund/Gift Supply etc).

(ii) Catalogue Number / PVMS No / NIV No.

(iii) Date of acquisition

(iv) Cost of the eqpt

(v) Warranty clause with validity / AMC (Yes / No). If yes, Validity?
(vi) Name of Manufacturer

(vii) Name of Supplier

(viii) Date of defect / cessation of function

(ix) Nature of defect

(x) Date of call for repair

(xi) Date of completion of repair

(xii) Signature of MO/IC Ward / Dept.

BREAKAGE AND LOSS BOOK

21. (a) Each hospital/medical unit will maintain a Loss and Breakage Book for medical
stores. All losses and breakages will be entered in this book under the following
headings:-
Date Wd/ Item Broken/ Loss/ Brief Indivi Signa- Remark Order
Dept Lost/ Breakage circum- dual ture of s/Recm of
Unservice- noticed/ stances of respo MO d of Comdt/
able discovered loss/break nsible OIC CO
by age for Medical
Store
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

(Recmd=Recommendations)

(b) The breakage and loss book will be maintained by Officer In Charge Ward/Dept.

(c) Replacement will be made as soon as entry is made in this book, signed by the
 Medical Officer in Charge ward/deptt and after obtaining the necessary
instructions from the Commandant/CO.

(d) The OIC Medical Stores will prepare the loss statement from the Breakage Book.

INSTRUCTIONS FOR IMPLANTED DEVICES

22. Any device implanted or recovered from the patients in the course of treatment will be
accounted for in the treatment book maintained by wards/departments where such devices are
implanted and/or recovered. In the case of implanted devices recovered, the specialist
concerned will indicate their condition on recovery and they will be taken on charge as such
by the wards/departments. These devices will be sent to the medical stores on proper
vouchers for re-use, repair or disposal depending upon their condition. These transactions
will be countersigned by the CO / Commandant / Offg Comdt of the hospital.

ACTION BY THE COMMANDANT / COMMANDING OFFICERS

23. During his periodical rounds, the Commandant / Commanding Officer of the hospital
will carefully scrutinize representative treatment books and indents and satisfy himself that
quantities indented for are justified by their expenditure.

24. He will investigate all cases of indents made out for abnormal quantities.

25. The Comdt / CO of the concerned hospital will ensure before the visits of
Inspecting/Visiting Officers that the instructions contained in this medical memorandum
are being strictly followed in letter and spirit.
ACTION BY INSPECTING / VISITING MEDICAL OFFICERS

26. During their visits the Inspecting / Visiting Medical Officers (ADsMS/DDsMS/Addl
DGAFMS (E&S)/DDG (Prov)/Any Rep of the DGAFMS) will confirm that the
instructions contained herein are being strictly followed. They will include specific
remarks on these subjects in their tour notes.

27. They will, by scrutiny of the accounts for representative items, satisfy themselves that
the expenditure of these items in that hospital/MI Room/Sick Bay/SSQ is borne out by the
number of patients treated therein. They should also compare the expenditure of drugs and
stores incurred in hospitals of equal bed strength and responsibilities and investigate cases of
any abnormal expenditure.

28. Inspecting / Visiting Medical Officers will issue suitable instructions for correcting
any abnormal trends.

Date:
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