Hospital drug logistics and supply chain: procurement, storage, distribution, automated dispensing, narcotics
This domain tests whether you can keep the right drug in the right condition at the right place, and prove it. The examiner looks for system thinking plus the specific Swiss narcotics and cold-chain rules.
Procurement and inventory control
Classify the assortment (ABC by value, XYZ by consumption variability), set order points from lead time, safety stock and average consumption, and review slow movers with the formulary committee. Tenders and group purchasing must document quality criteria - not price alone - plus delivery reliability and recall responsiveness. Keep a substitution list for supply shortages and a defined process for change communication.
Storage
Temperature mapping (not just a single logger), 2–8 °C cold chain with data loggers and a documented excursion assessment, freezer monitoring, light and humidity control, separation of high-alert drugs, look-alike/sound-alike labelling, and quarantining of recalled or expired stock.
Narcotics (BetmVV-EDI / BetmKV)
Separate locked storage, restricted access, receipt and dispensing records reconciled regularly, prescription retention per cantonal rules, documented returns and witnessed destruction, and an escalation path for any discrepancy. Wastage of a partially used ampoule must be documented with a witness.
Distribution
Ward stock versus unit dose versus automated dispensing cabinets with closed-loop barcode verification; restocking intervals based on consumption; expiry management strictly FEFO (first expired, first out); returns only if the cold chain and integrity can be proven.
Worked example
Bevacizumab 25 mg/mL vials are supplied at 100 mg and 400 mg. A regimen of 15 mg/kg for a 68 kg patient = 1020 mg per cycle. Reasoning: two 400 mg plus three 100 mg vials = 1100 mg; if vial sharing under aseptic conditions is validated and same-day use is documented, the residual 80 mg can serve another patient - otherwise it is wastage. Order quantity is calculated from cycle scheduling, not from a single prescription, and shelf-life after puncture constrains vial sharing.
Traps
- Confusing FIFO with FEFO - the exam looks for the expiry-driven rule.
- Assuming a temperature excursion is acceptable without a product-specific stability assessment.
- Forgetting that narcotics destruction requires a witness and a record.
- Ignoring that automated cabinet stock levels drive purchasing and expiry risk.