Four things you can do to rationalise your practice’s dispensary stock

Are there too many meloxicam brands in the dispensary? Or an unmanageable choice of parasiticides? Or medicines that go out of date because they are never used? Or is there a need to change the way antibiotics are used in the practice?

In most veterinary practices, the range of products on the shelves is probably the result of a combination of unconscious evolution and rational decision. It is not uncommon for individual vets to favour certain products, so that sometimes after a particular vet has left the practice, a product remains on the shelves collecting dust until expiry!

Why sort out the dispensary?

There is much to gain from rationalising dispensary stock. Reducing the number of products decreases the likelihood of medicines expiring, so minimises waste and generates cost savings. A streamlined product range also makes it easier for prescribers to become familiar with available options, promoting more confident and consistent prescribing. In turn, this reduces the risk of prescribing and dispensing errors. Furthermore, limiting stock can support rational prescribing practices — such as the inappropriate use of broad-spectrum antibiotics — through controlled availability.

I've been involved in promoting the rational use of medicines for over 40 years, in both the human and veterinary medicine sectors. Here are four things almost any practice can do to rationalise their stock.

1. Monitor expired medicines.

Make a record of what expires each month, and review it regularly. This will help identify medicines that are stocked unnecessarily and which expire and have to be discarded. It could be a particular strength or pack size of the medicine, or a drug that is used to treat a condition that rarely presents to the practice.

2. Remove duplicate products

There is often a choice of several brands (generics) of the same drug. There should be a clear rationale for keeping more than one brand. Sometimes there are small but important differences between different brands, so it may be useful to keep more than one brand of the same drug. This means that it is important to choose carefully,

3. Rationalise choice within a therapeutic area

In some therapeutic areas, there is a large choice of products that contain different active ingredients that do the same job. For example, antimicrobial eye and ear products, artificial tears/eye lubricants, NSAIDs, and parasiticides. It should be possible to simplify the range of products stocked while ensuring that there is a choice when needed.

4. Develop prescribing policies

Prescribing policies are a useful way of standardising prescribing habits in a practice. In other words they are treatment-specific standard operating protocols or guidelines for specific therapeutic areas. They are especially useful when there is a wide range of clinically-similar products available on the market, such as parasiticides. Such guidelines can help narrow the choice offered at the practice. They can also be used to support prescribers in the responsible use of antimicrobial therapy.

Somewhere to start

The following product areas in which there is a wide choice might be a good starting point.

Drugs for which there are several generic brands

(the list is by generic name of active drug ingredient)

• Amoxicillin + clavulanic acid tablets

• Cefalexin tablets

• Clindamycin oral formulations

• Dexamethasone solution for injection

• Maropitant solution for injection

• Meloxicam oral formulations and solution for injection

Therapeutic areas in which there are several similar products

• Antibiotic products for use in eyes

• Antibiotic/antifungal/steroid combinations for use in ears

• Leptospira vaccines

• Non-steroidal anti-inflammatory drugs (NSAIDs)

• Parasiticides

Non-medicinal product groups with multiple similar products

• Artificial tears/lubricant eye products

• Ear cleaners

Conclusion

Rationalising your dispensary stock can not only save space and money, it can improve the quality of prescribing. It’s good for the environment too. It sounds like a faff but by tracking what medicines get thrown away and making careful choices you can ensure you only stock what is really needed. You can also prevent an avalanche of Meloxibrands next time you go to grab a pack of meloxicam!