Assessing the prevalence of expired medications in hospital wards at Queen Elizabeth Central Hospital(QECH), Malawi  from July 2023 to June 2024.

Assessing the prevalence of expired medications in hospital wards at Queen Elizabeth Central Hospital(QECH), Malawi from July 2023 to June 2024. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessing the prevalence of expired medications in hospital wards at Queen Elizabeth Central Hospital(QECH), Malawi from July 2023 to June 2024. Bernard Sindani Kathewera, Cecilia Tembo, Silvia Lodzani, John Ndaferankhande This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5381357/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Proper management of medication expiry is essential for ensuring patient safety, operational efficiency, and cost-effectiveness in healthcare facilities. Even with strict inventory monitoring, expired medications can still present serious risks if not properly handled. Objectives The goal of this study was to quantitatively examine the occurrence of expired medications in different departments of Queen Elizabeth Central Hospital (QECH) between July 2023 and June 2024. Specifically, we quantified the prevalence of expired medications across the wards, identified the most common medications and wards where expirations occurred. Method We looked back at medication records and also the storage rooms to find out which medications had expired within the time frame of the study. Information collected included the names of the drugs, where they came from, how many were on hand, and when they had expired. The analysis included statistical methods to determine how often medications expired, average quantities of expired medications, and patterns in which medications expired Results Over the duration of the research: Instances of Expired Medications: 34 cases of expired medication were observed in various wards at QECH. The most common expired drugs: The medication that most frequently expired was Diazepam, with 26 vials expiring in multiple occurrences. Glucose came next, with 4 instances of expiration involving 4 vials. The largest quantity of expired medications was Phenytoin tablets, with 19,000 tablets expiring in April 2024.Wards with Highest Frequencies: The Paeds Special Care (PSC) ward had the highest number of expired medications, with 16 cases. The Mercy James ward(MJC) had 6 instances. Average Quantity per Expiration: It was found that tablets accounted for 98.9%, vials for 0.73%, ampoules for 0.09%, and suppositories for 0.28%. Conclusion The study found that there were a significant number of expired medications at QECH, especially in the PSC ward and MJC wards. This highlights the importance of improving inventory management and monitoring to address the risks related to expired medications. Figures Figure 1 Figure 2 Introduction Efficient handling of medication expiration is essential in medical facilities to guarantee the safety of patients, streamline operations, and save costs(1). The expiration of medications presents considerable dangers such as possible harm to patients, financial setbacks, and wastage of essential resources(2). Even with stringent inventory control systems in place, expired medications may still find their way into hospital wards and storage areas, underscoring an ongoing issue in pharmaceutical management(3). Queen Elizabeth Central Hospital (QECH) is a significant healthcare facility that manages a substantial number of medicines in different departments. The presence of expired medications in this hospital not only impacts patient treatment but also indicates flaws in inventory management and monitoring systems. Analyzing the reasons behind medication expirations at QECH can help improve pharmaceutical practices and reduce associated risks(4). The primary objective of this study was to measure the occurrence of expired medications in various departments of QECH from July 2023 to June 2024. Specifically, we aimed at quantifying the prevalence and types of expired medications by identify the most frequently expired medications and the average quantity of expired drugs per ward. The study also aimed at identifying the wards with the highest frequency of expired medications and also to analyze root causes and propose improvement strategies. Methods From July 2023 to June 2024, a retrospective study was carried out at QECH to investigate medication expiration. The research included a review of medication records and an examination of storage areas to detect any expired medications during the mentioned period. The data collection process concentrated on expired drug names, their source stock quantities, and expiration dates. By taking this comprehensive method, researchers were able to gain a deep insight into the patterns of medication expiration in various wards. Descriptive statistics were used to measure the prevalence and number of expired medications. The goal of the study was to determine which medications expired most frequently and which wards had the highest rates of expiration. By sorting and examining this data, the study sought to make informed conclusions about the efficacy of current inventory management practices and pinpoint areas in need of enhancement. This systematic method guaranteed that the results were precise and could be used to take action. The data collected consisted of the quantity of medication that had expired, the particular medications that had expired, and the units where these expirations took place. The findings were methodically arranged to emphasize important trends and patterns. This organized method offered a comprehensive view of the frequency of medication expirations at QECH and identified crucial areas for intervention. Results Due to a small sample size this study targeted all wards that frequently order drugs and have a high patient turnover, such as the Cancer Ward (2A), Medical Wards (3B, 4A), Pediatric Special Care Ward (PSC), High Dependency Respiratory Ward (HDRU), Gynecological Ward, Mercy James Ward, Surgical Wards (5A, 5B), and Renal Ward (3A). Some wards did not give consent to participate in the study. Data indicated significant medication expirations, particularly in busy wards. A total of 24,411 expired tablets were found, representing 98.9% of the expired medications. This was followed by 180 vials, which accounted for 0.73%, 70 suppositories at 0.28%, and 22 ampoules representing 0.09% of the total expired drugs identified during the study period. The table below is an indication of the data corrected during the study period. Table 1 expired drugs from the wards Drug Name Ward Expire Date Discovery Date Quantity Vecuronium PSC ward 11-2023 10/11/2023 5 vials Glucose PSC ward 10-2023 12/12/2023 1 quantity Diazepam PSC ward 10-2023 12/12/2023 19 vials Tranexamic acid PSC ward 04-2022 12/12/2023 5 vials Ethambutol PSC ward 04-2023 15/12/2023 3 vials Oxytocin Gynecological Ward 10-2023 15/12/2023 22 vials Aspirin Tablets Gynecological Ward 05-2023 06/06/2023 115 tablets Phenytoin tablets 4A 04-2024 06/06/2024 19,000 tablets Naloxone 3B 05-2024 06/06/2024 12 ampoules Azithromycin Tablets 2A 03-2024 06/04/2024 6 tablets Albendazole 3B 11-2023 06/06/2024 110 tablets Albendazole 4A 11-2023 06/06/2024 800 tablets Diazepam 3B 09-2023 06/06/2024 7 vials LA MJC 12-2023 02/01/2024 1,800 tablets Glucose PNW 10-2023 02/01/2024 3 vials Dexamethasone phosphate HDRU 10-2023 02/01/2024 18 vials Magnesium sulfate injection HDRU 05-2023 02/01/2024 11 vials Benzathine HDRU 06-2023 02/01/2024 3 vials Sterilized water for injection HDRU 09-2023 02/01/2024 17 vials Labetalol Injection HDRU 07-2023 02/01/2024 1 vial Lignocaine injection HDRU 05-2023 02/01/2024 1 vial Fluphenazine 4A 11-2023 21/07/2024 50 vials Naloxone injection 5A 05-2024 06/06/2024 5 ampoules Benzathine penicillin P. A + E 05-2024 21/07/2024 12 vials Vecuronium bromide IV MJC ward 11-2023 20/01/2024 1 vial Propofol MJC ward 05-2024 21/06/2024 2 vials Midazolam injection MJC ward 04-2024 21/06/2024 3 ampoules Potassium chloride injection MJC ward 04-2024 21/06/2024 2 ampoules Atorvastatin 3B 07-2023 22/06/2024 40 tablets Digoxin 4A 10-2023 22/06/2024 40 tablets Propanol 4A 10-2023 22/06/2024 1,000 tablets Glycerin suppository 3A 10-2023 15/02/2024 70 Losartan 3B 07-2023 15/02/2024 1,000 tablets Praziquantel 3A 09-2023 15/02/2024 500 tablets Discussion The results of this research expose substantial difficulties in handling medication expirations at Queen Elizabeth Central Hospital (QECH) from July 2023 to June 2024. The high occurrence of expired medications, especially in busy wards like the Pediatric Special Care (PSC) ward and MJC, highlights the need for enhanced inventory management and monitoring procedures (Brown, 2018). One notable discovery was the significant number of expired Diazepam vials, with 2 occurrences documented. This indicates possible problems with predicting demand and turnover rates for inventory. Ideally, Diazepam, a frequently used medication, should have a quick turnover to lower the chances of expiration. The substantial amount of expired Phenytoin tablets, totaling 19,000 in April 2024, underscores a significant deficiency in inventory management processes. This issue not only leads to financial losses but also jeopardizes the availability of crucial medications. Additionally, these expired medicines can compromise patient safety, as using them may lead to ineffective treatment or adverse effects(5,6). The PSC ward, MJC and HDRU, which had 5 instances of expired medications, and the medical wards, i.e., 3B and 4A ward, with instances, were identified as the wards most impacted by medication expirations. These wards serve vulnerable populations such as children and neonates, for whom prompt access to medications is crucial. The significant number of expired medications in these wards indicates underlying inefficiencies that may jeopardize patient treatment. Factors contributing to this issue could include excessive stocking, inadequate storage conditions, and the absence of live inventory monitoring systems. On average, the number of expired medications involved 256 units, showing a significant waste of medical resources. This average demonstrates a systematic problem where a large amount of medication is not used before it expires, suggesting overestimation in ordering and possible issues in the supply chain. The substantial waste emphasizes the importance of strong inventory management procedures, such as precise demand prediction, continuously updated inventory monitoring, and efficient rotation of stock. Enhancing medication management at QECH necessitates a comprehensive strategy(7). To begin with, the introduction of sophisticated inventory management systems that offer up-to-date information on stock levels and expiration dates can assist in reducing the possibility of medications expiring. Educating healthcare personnel on effective inventory management techniques and ensuring their compliance with these methods is crucial as well. Furthermore, conducting routine evaluations of medication supplies and utilization trends can pinpoint areas of inefficiency and aid in adjusting inventory control procedures. Cooperation between pharmacy employees and medical teams is important in dealing with these difficulties. Productive communication about medication usage patterns and expected requirements can aid in matching supply with real demand, thus lowering the possibility of excess inventory and expired products. Additionally, participating in ongoing quality improvement projects can promote a sense of responsibility and a proactive approach in managing medications. In summary, the research emphasizes the urgent requirement for improved inventory management methods at QECH, especially the wards to overcome the problem of medication expirations. Implementing stricter inventory control procedures, utilizing technology for live tracking, and promoting teamwork among healthcare workers can greatly decrease medication waste, guarantee patient safety, and improve overall operational effectiveness at QECH. The findings of this study offer a solid basis for creating specific strategies to enhance pharmaceutical management and healthcare services at QECH. Declarations Ethics approval and consent to participate This study was excluded from full ethics review as it does not involve human subjects. Consent for publication The Authors give permission to the journal to publish the manuscript Corresponding Author Name Bernard Sindani kathewera, Queen Elizabeth Central hospital (QECH), Malawi Funding No funding to be declared, the project was self-funded. Author Contribution B.S.K came up with research plan, data collection, analysis, manuscript writing, submissionC.T. and S.L came up with research plan, data collection, analysisJ.N . did manuscript editing, journal identification Acknowledgement We would like to thank Queen Elizabeth Central Hospital (QECH) and the Pharmacy department for allowing us to do this project. Additionally, we would like to acknowledge the contributions of John Ndaferankhandwe, whose expertise greatly enhanced the quality of this manuscript. Lastly, we extend our heartfelt thanks to our family and friends for their unwavering encouragement and support during this journey. Availability Of Data And Materials N/A Conflict of interest The authors have no conflicts of interest to declare. All supervisors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication. References Alnahas, F., Yeboah, P., Fliedel, L., Abdin, A.Y. and Alhareth, K., 2020. Expired medication: societal, regulatory and ethical aspects of a wasted opportunity. International journal of environmental research and public health , 17 (3), p.787. Ebrahim, A.J., Teni, F.S. and Yimenu, D.K., 2019. Unused and expired medications: are they a threat? A facility-based cross-sectional study. Journal of primary care & community health , 10 , p.2150132719847857. Rachmania, I.N. and Basri, M.H., 2013. Pharmaceutical inventory management issues in hospital supply chains. Management , 3 (1), pp.1-5. Wajid, S., Siddiqui, N.A., Mothana, R.A. and Samreen, S., 2020. Prevalence and Practice of Unused and Expired Medicine—A Community‐Based Study among Saudi Adults in Riyadh, Saudi Arabia. BioMed Research International , 2020 (1), p.6539251. Daher, M., 2024. Enhancing Pharmaceutical Waste Management: Insights from Pharmacists' Perspectives on the Drug Take-Back Program E ltaib L, Alanazi SA, Ali SE. Practices and attitudes concerning expiration date, unused, and expired medication disposal. Int J Med Sci Public Health 2020;9(7):431-438 Kanyepe, J., 2022. Inventory management strategies and healthcare delivery in hospitals in the Mashonaland region of Zimbabwe. Transport and Logistics: The International Journal , 22 (52), pp.2406-1069. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 Nov, 2024 Editor assigned by journal 04 Nov, 2024 Submission checks completed at journal 04 Nov, 2024 First submitted to journal 03 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5381357","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":374506504,"identity":"095c9aa8-bccc-493e-919c-9b12afa76684","order_by":0,"name":"Bernard Sindani Kathewera","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYBACAwjFDKR5IEx+EJFQQIwWNqgWyQaQFgNStBgcQBLHBszZe589+LnH2ph/fu/BxzwV9+SNz69O/PDAgEGeX+wAVi2WPcfNDXuepZtJHONLNuY5U2y47cbbzRJAhxnOnJ2A3WE30tgkeA4ctmE4xmMmnduWwLjtxtkNIC0JBrdxaLn/jE3yD1CL/DEe89+5/xLsN884u/kHXi032NikgbaYGQBtYc5tSEjcwN+7Da8tlj1pbNIyB9KNDY/lGEv/OZaQPOMG7zaLBAMJnH4xZz/GJvnmgLXhvMNnDD/OqEmw7e8/u/nmjwobeX5p7FqwAAmwSglilYMA/wFSVI+CUTAKRsEIAACc0V8yV0ZJGwAAAABJRU5ErkJggg==","orcid":"","institution":"Queen Elizabeth Central Hospital (QECH)","correspondingAuthor":true,"prefix":"","firstName":"Bernard","middleName":"Sindani","lastName":"Kathewera","suffix":""},{"id":374506506,"identity":"14a176d9-dfe8-4a23-bc58-88f97daf4263","order_by":1,"name":"Cecilia Tembo","email":"","orcid":"","institution":"Queen Elizabeth Central Hospital (QECH)","correspondingAuthor":false,"prefix":"","firstName":"Cecilia","middleName":"","lastName":"Tembo","suffix":""},{"id":374506507,"identity":"ee8c29a2-7c4a-4d03-9ae7-5b4cc0535a4e","order_by":2,"name":"Silvia Lodzani","email":"","orcid":"","institution":"Queen Elizabeth Central Hospital (QECH)","correspondingAuthor":false,"prefix":"","firstName":"Silvia","middleName":"","lastName":"Lodzani","suffix":""},{"id":374506508,"identity":"2195cb85-bb5a-4f5d-b263-8aba4f71336f","order_by":3,"name":"John Ndaferankhande","email":"","orcid":"","institution":"Malawi Liverpool Wellcome Programme (MLW)","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Ndaferankhande","suffix":""}],"badges":[],"createdAt":"2024-11-03 09:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5381357/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5381357/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70385381,"identity":"b40f1778-99d7-49d6-90b7-f299fa549d8d","added_by":"auto","created_at":"2024-12-02 17:08:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":246770,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency of expired drugs\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5381357/v1/5bfa277c4b034ec52d635686.png"},{"id":70385356,"identity":"122b8360-ee82-4229-821b-522fdea1dd79","added_by":"auto","created_at":"2024-12-02 17:07:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":110709,"visible":true,"origin":"","legend":"\u003cp\u003eData from the wards\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5381357/v1/5047fecad4269a6390ff5b8b.png"},{"id":70387574,"identity":"e4ee41fa-0f1f-472f-9515-60cce754595f","added_by":"auto","created_at":"2024-12-02 17:24:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":720396,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5381357/v1/7751d571-88ed-41cd-a9cf-f08483f89a9a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing the prevalence of expired medications in hospital wards at Queen Elizabeth Central Hospital(QECH), Malawi from July 2023 to June 2024.","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEfficient handling of medication expiration is essential in medical facilities to guarantee the safety of patients, streamline operations, and save costs(1). The expiration of medications presents considerable dangers such as possible harm to patients, financial setbacks, and wastage of essential resources(2). Even with stringent inventory control systems in place, expired medications may still find their way into hospital wards and storage areas, underscoring an ongoing issue in pharmaceutical management(3).\u003c/p\u003e \u003cp\u003eQueen Elizabeth Central Hospital (QECH) is a significant healthcare facility that manages a substantial number of medicines in different departments. The presence of expired medications in this hospital not only impacts patient treatment but also indicates flaws in inventory management and monitoring systems. Analyzing the reasons behind medication expirations at QECH can help improve pharmaceutical practices and reduce associated risks(4).\u003c/p\u003e \u003cp\u003eThe primary objective of this study was to measure the occurrence of expired medications in various departments of QECH from July 2023 to June 2024.\u003c/p\u003e \u003cp\u003eSpecifically, we aimed at quantifying the prevalence and types of expired medications by identify the most frequently expired medications and the average quantity of expired drugs per ward. The study also aimed at identifying the wards with the highest frequency of expired medications and also to analyze root causes and propose improvement strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eFrom July 2023 to June 2024, a retrospective study was carried out at QECH to investigate medication expiration. The research included a review of medication records and an examination of storage areas to detect any expired medications during the mentioned period. The data collection process concentrated on expired drug names, their source stock quantities, and expiration dates. By taking this comprehensive method, researchers were able to gain a deep insight into the patterns of medication expiration in various wards.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to measure the prevalence and number of expired medications. The goal of the study was to determine which medications expired most frequently and which wards had the highest rates of expiration. By sorting and examining this data, the study sought to make informed conclusions about the efficacy of current inventory management practices and pinpoint areas in need of enhancement. This systematic method guaranteed that the results were precise and could be used to take action.\u003c/p\u003e \u003cp\u003eThe data collected consisted of the quantity of medication that had expired, the particular medications that had expired, and the units where these expirations took place. The findings were methodically arranged to emphasize important trends and patterns. This organized method offered a comprehensive view of the frequency of medication expirations at QECH and identified crucial areas for intervention.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDue to a small sample size this study targeted all wards that frequently order drugs and have a high patient turnover, such as the Cancer Ward (2A), Medical Wards (3B, 4A), Pediatric Special Care Ward (PSC), High Dependency Respiratory Ward (HDRU), Gynecological Ward, Mercy James Ward, Surgical Wards (5A, 5B), and Renal Ward (3A). Some wards did not give consent to participate in the study. Data indicated significant medication expirations, particularly in busy wards. A total of 24,411 expired tablets were found, representing 98.9% of the expired medications. This was followed by 180 vials, which accounted for 0.73%, 70 suppositories at 0.28%, and 22 ampoules representing 0.09% of the total expired drugs identified during the study period. The table below is an indication of the data corrected during the study period.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eexpired drugs from the wards\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug Name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWard\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExpire Date\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDiscovery Date\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQuantity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVecuronium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePSC ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e11-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10/11/2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePSC ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e10-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12/12/2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 quantity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiazepam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePSC ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e10-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12/12/2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTranexamic acid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePSC ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e04-2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12/12/2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthambutol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePSC ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e04-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15/12/2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxytocin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGynecological Ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e10-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15/12/2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAspirin Tablets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGynecological Ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e05-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e06/06/2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e115 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhenytoin tablets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e04-2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e06/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19,000 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNaloxone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e05-2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e06/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 ampoules\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzithromycin Tablets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e03-2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e06/04/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbendazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e11-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e06/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbendazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e11-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e06/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e800 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiazepam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e09-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e06/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMJC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e12-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e02/01/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,800 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePNW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e10-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e02/01/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDexamethasone phosphate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHDRU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e10-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e02/01/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMagnesium sulfate injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHDRU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e05-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e02/01/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenzathine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHDRU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e06-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e02/01/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSterilized water for injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHDRU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e09-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e02/01/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabetalol Injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHDRU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e07-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e02/01/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 vial\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLignocaine injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHDRU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e05-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e02/01/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 vial\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFluphenazine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e11-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21/07/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNaloxone injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e05-2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e06/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 ampoules\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenzathine penicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP. A\u0026thinsp;+\u0026thinsp;E\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e05-2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21/07/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVecuronium bromide IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMJC ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e11-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20/01/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 vial\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropofol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMJC ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e05-2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 vials\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidazolam injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMJC ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e04-2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 ampoules\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotassium chloride injection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMJC ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e04-2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 ampoules\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtorvastatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e07-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigoxin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e10-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropanol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e10-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22/06/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,000 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlycerin suppository\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e10-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15/02/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLosartan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e07-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15/02/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,000 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePraziquantel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c3\"\u003e \u003cp\u003e09-2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15/02/2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e500 tablets\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this research expose substantial difficulties in handling medication expirations at Queen Elizabeth Central Hospital (QECH) from July 2023 to June 2024. The high occurrence of expired medications, especially in busy wards like the Pediatric Special Care (PSC) ward and MJC, highlights the need for enhanced inventory management and monitoring procedures (Brown, 2018).\u003c/p\u003e \u003cp\u003eOne notable discovery was the significant number of expired Diazepam vials, with 2 occurrences documented. This indicates possible problems with predicting demand and turnover rates for inventory. Ideally, Diazepam, a frequently used medication, should have a quick turnover to lower the chances of expiration. The substantial amount of expired Phenytoin tablets, totaling 19,000 in April 2024, underscores a significant deficiency in inventory management processes. This issue not only leads to financial losses but also jeopardizes the availability of crucial medications. Additionally, these expired medicines can compromise patient safety, as using them may lead to ineffective treatment or adverse effects(5,6).\u003c/p\u003e \u003cp\u003eThe PSC ward, MJC and HDRU, which had 5 instances of expired medications, and the medical wards, i.e., 3B and 4A ward, with instances, were identified as the wards most impacted by medication expirations. These wards serve vulnerable populations such as children and neonates, for whom prompt access to medications is crucial. The significant number of expired medications in these wards indicates underlying inefficiencies that may jeopardize patient treatment. Factors contributing to this issue could include excessive stocking, inadequate storage conditions, and the absence of live inventory monitoring systems.\u003c/p\u003e \u003cp\u003eOn average, the number of expired medications involved 256 units, showing a significant waste of medical resources. This average demonstrates a systematic problem where a large amount of medication is not used before it expires, suggesting overestimation in ordering and possible issues in the supply chain. The substantial waste emphasizes the importance of strong inventory management procedures, such as precise demand prediction, continuously updated inventory monitoring, and efficient rotation of stock.\u003c/p\u003e \u003cp\u003eEnhancing medication management at QECH necessitates a comprehensive strategy(7). To begin with, the introduction of sophisticated inventory management systems that offer up-to-date information on stock levels and expiration dates can assist in reducing the possibility of medications expiring. Educating healthcare personnel on effective inventory management techniques and ensuring their compliance with these methods is crucial as well. Furthermore, conducting routine evaluations of medication supplies and utilization trends can pinpoint areas of inefficiency and aid in adjusting inventory control procedures. Cooperation between pharmacy employees and medical teams is important in dealing with these difficulties. Productive communication about medication usage patterns and expected requirements can aid in matching supply with real demand, thus lowering the possibility of excess inventory and expired products. Additionally, participating in ongoing quality improvement projects can promote a sense of responsibility and a proactive approach in managing medications.\u003c/p\u003e \u003cp\u003eIn summary, the research emphasizes the urgent requirement for improved inventory management methods at QECH, especially the wards to overcome the problem of medication expirations. Implementing stricter inventory control procedures, utilizing technology for live tracking, and promoting teamwork among healthcare workers can greatly decrease medication waste, guarantee patient safety, and improve overall operational effectiveness at QECH. The findings of this study offer a solid basis for creating specific strategies to enhance pharmaceutical management and healthcare services at QECH.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eThis study was excluded from full ethics review as it does not involve human subjects.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e The Authors give permission to the journal to publish the manuscript\u003c/p\u003e \u003c/p\u003e\u003ch2\u003e \u003cb\u003eCorresponding Author\u003c/b\u003e \u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eName\u003c/strong\u003e \u003cp\u003eBernard Sindani kathewera, Queen Elizabeth Central hospital (QECH), Malawi\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding to be declared, the project was self-funded.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eB.S.K came up with research plan, data collection, analysis, manuscript writing, submissionC.T. and S.L came up with research plan, data collection, analysisJ.N . did manuscript editing, journal identification\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e \u003cp\u003eWe would like to thank Queen Elizabeth Central Hospital (QECH) and the Pharmacy department for allowing us to do this project. Additionally, we would like to acknowledge the contributions of John Ndaferankhandwe, whose expertise greatly enhanced the quality of this manuscript. Lastly, we extend our heartfelt thanks to our family and friends for their unwavering encouragement and support during this journey.\u003c/p\u003e\u003ch2\u003eAvailability Of Data And Materials\u003c/h2\u003e \u003cp\u003eN/A\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare. All supervisors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication.\u003c/p\u003e\u003cp\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlnahas, F., Yeboah, P., Fliedel, L., Abdin, A.Y. and Alhareth, K., 2020. Expired medication: societal, regulatory and ethical aspects of a wasted opportunity. \u003cem\u003eInternational journal of environmental research and public health\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(3), p.787.\u003c/li\u003e\n \u003cli\u003eEbrahim, A.J., Teni, F.S. and Yimenu, D.K., 2019. Unused and expired medications: are they a threat? A facility-based cross-sectional study. \u003cem\u003eJournal of primary care \u0026amp; community health\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e, p.2150132719847857.\u003c/li\u003e\n \u003cli\u003eRachmania, I.N. and Basri, M.H., 2013. Pharmaceutical inventory management issues in hospital supply chains. \u003cem\u003eManagement\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), pp.1-5.\u003c/li\u003e\n \u003cli\u003eWajid, S., Siddiqui, N.A., Mothana, R.A. and Samreen, S., 2020. Prevalence and Practice of Unused and Expired Medicine\u0026mdash;A Community‐Based Study among Saudi Adults in Riyadh, Saudi Arabia. \u003cem\u003eBioMed Research International\u003c/em\u003e, \u003cem\u003e2020\u003c/em\u003e(1), p.6539251.\u003c/li\u003e\n \u003cli\u003eDaher, M., 2024. Enhancing Pharmaceutical Waste Management: Insights from Pharmacists\u0026apos; Perspectives on the Drug Take-Back Program\u003c/li\u003e\n \u003cli\u003eE ltaib L, Alanazi SA, Ali SE. Practices and attitudes concerning expiration date, unused, and expired medication disposal. Int J Med Sci Public Health 2020;9(7):431-438\u003c/li\u003e\n \u003cli\u003eKanyepe, J., 2022. Inventory management strategies and healthcare delivery in hospitals in the Mashonaland region of Zimbabwe. \u003cem\u003eTransport and Logistics: The International Journal\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(52), pp.2406-1069.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5381357/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5381357/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eProper management of medication expiry is essential for ensuring patient safety, operational efficiency, and cost-effectiveness in healthcare facilities. Even with strict inventory monitoring, expired medications can still present serious risks if not properly handled.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThe goal of this study was to quantitatively examine the occurrence of expired medications in different departments of Queen Elizabeth Central Hospital (QECH) between July 2023 and June 2024. Specifically, we quantified the prevalence of expired medications across the wards, identified the most common medications and wards where expirations occurred.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eWe looked back at medication records and also the storage rooms to find out which medications had expired within the time frame of the study. Information collected included the names of the drugs, where they came from, how many were on hand, and when they had expired. The analysis included statistical methods to determine how often medications expired, average quantities of expired medications, and patterns in which medications expired\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOver the duration of the research: Instances of Expired Medications: 34 cases of expired medication were observed in various wards at QECH. The most common expired drugs: The medication that most frequently expired was Diazepam, with 26 vials expiring in multiple occurrences. Glucose came next, with 4 instances of expiration involving 4 vials. The largest quantity of expired medications was Phenytoin tablets, with 19,000 tablets expiring in April 2024.Wards with Highest Frequencies: The Paeds Special Care (PSC) ward had the highest number of expired medications, with 16 cases. The Mercy James ward(MJC) had 6 instances. Average Quantity per Expiration: It was found that tablets accounted for 98.9%, vials for 0.73%, ampoules for 0.09%, and suppositories for 0.28%.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study found that there were a significant number of expired medications at QECH, especially in the PSC ward and MJC wards. This highlights the importance of improving inventory management and monitoring to address the risks related to expired medications.\u003c/p\u003e","manuscriptTitle":"Assessing the prevalence of expired medications in hospital wards at Queen Elizabeth Central Hospital(QECH), Malawi from July 2023 to June 2024.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-02 16:13:50","doi":"10.21203/rs.3.rs-5381357/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-05T17:54:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-04T08:58:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-04T08:57:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-11-03T09:14:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2fefa6b3-e8e6-466a-bfa1-dcc4e9302408","owner":[],"postedDate":"December 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-03-24T10:23:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-02 16:13:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5381357","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5381357","identity":"rs-5381357","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}