THE REPORT OF PROJECT WORK ON

“A STUDY ON NEAR EXPIRY AND EXPIRY MEDICINE IN

HOSPITAL PHARMACY”

Report submitted in partial fulfillment off the requirements for the award of the
degree

MASTER OF BUSINESS ADMINISTRATION

OF
BANGALORE UNIVERSITY

BY

Reg. No: PRAVEEN

KUMAR K S

P03HM22M015087

UNDER THE GUIDANCE OF

Prof. VENKATESH S
 #149, PADMASHREE CAMPUS, KOMMAGATTA, KENGERI, BENGALURU,
KARNATAKA 560060
BANGLORE
UNIVERSITY
Batch:2023-2024

DECLARATION

I hereby declare to the best of my knowledge and belief, that this project titled, “A
STUDY ON NEAR EXPIRY AND EXPIRY MEDICINE IN HOSPITAL
PHARMACY.” is the result of the project work carried out by me under the guidance
of Mr. VENKATESH in partial fulfillment for the award of master, Degree in
Business Administration by Bangalore University.

I also declare that this project is the outcome of my own efforts and that it has not been
submitted to any university or Institute of any other degree or diploma or certificate or
published before.

Place: BANGALORE Name: PRAVEEN KUMAR K S

Date: Register Number:

P03HM22M015087
 CERTIFICATE

Date:

This is to certify that the Internship Project titled “A STUDY ON NEAR EXPIRY AND
EXPIRY MEDICINE IN HOSPITAL PHARMACY” is an
original work of Mr./Ms.___________; bearing University Register Number
___________and is being submitted in partial fulfilment for the award of the Master’s
Degree in Business Administration of Bangalore University. The report has not been
submitted earlier either to this University /Institution for the fulfilment of the requirement
of a course of study or any other Degree.

SIGNATURE OF GUIDE SIGNATURE OF DIRECTOR/PRINCIPAL/HOD

DATE: DATE:
 ACKNOWLEDGEMENT

I sincerely express my profound gratitude to HOD/Director/Chairman___ Name___

Designation _Institution/Department/University name for extending greater support and
assistance to complete internship project.
I convey my sincere gratitude to __Project Guide Name___ Designation _
__Institution/Department/University name as my instructor for his/her timely guidance and
continued inspiration and encouragement for accomplishing qualitative internship project.
And I also extend my wholehearted thanks to ___company name __Instructor Name__
designation for providing comprehensive learning atmosphere and industry work setting
exposure and directing me to successful completion of this project report.
Finally, I convey my sincere regards and thankfulness to all those, who supported my
internship journey.
(The student is free to write his/her own acknowledgement. This is only a suggestion)

DATE: NAME:

PLACE: REGISTRATION NUMBER

 INDEX

SERIAL NO. TOPIC PAGE NO.

1. DECLARATION 2

2. CERTIFICATE 3

3. ACKWOLEDGEMENT 4

ABSTRACT 8

CHAPTER 1 INTRODUCTION 10-33

-THEORITICAL
BACKGROUND OF
THE STUDY
-INDUSTRY PROFILE

CHAPTER 2 RESEARCH DESIGN 34-47

-PROBLEM STATEMENT
-NEED FOR THE STUDY
- SCOPE OF THE STUDY
-REVIEW OF LITERATURE
- OBJECTIVES OF THE
STUDY
 - RESEARCH DESIGN
-SAMPLING FRAMEWORK
- LIMITATIONS OF THE
STUDY

DATA ANALYSIS AND

CHAPTER 3 48-71
INTERPRETATION

FINDINGS ,
CHAPTER 4 RECOMMENDATIONS 72-76
AND CONCLUSIONS

ANNEXURE 77-79

BIBLIOGRAPHY 80-81
LIST OF TABLE

Serial Number Table Title

1 Frequency of Checking Expiry Dates in Hospital Pharmacy

2 Encounter with Expired Medicines in Hospital Pharmacy

3 Actions with Near-Expiry Medicines in Hospital Pharmacy

4 Confidence in Handling Expired Medicines in Hospital Pharmacy

5 Checking Expiry Date for Over-the-Counter Medicines

6 Willingness to Use Medicines Close to Expiry Date

7 Receipt of Expired Medicine from a Pharmacy

8 Handling of Expired Medicine at Home

9 Seeking Advice for Disposing Expired Medicine at Home

10 Beliefs about the Effectiveness of Expired Medicines

11 Likelihood of Purchasing Near-Expiry Medicine on Sale

12 Awareness of Community Programs for Medicine Disposal

LIST OF FIGURES

Serial Number Figure Title

1 Frequency of Checking Expiry Dates in Hospital Pharmacy

2 Encounter with Expired Medicines in Hospital Pharmacy
3 Actions with Near-Expiry Medicines in Hospital Pharmacy
4 Confidence in Handling Expired Medicines in Hospital Pharmacy
5 Checking Expiry Date for Over-the-Counter Medicines
6 Willingness to Use Medicines Close to Expiry Date

7 Receipt of Expired Medicine from a Pharmacy

8 Handling of Expired Medicine at Home
9 Seeking Advice for Disposing Expired Medicine at Home
10 Beliefs about the Effectiveness of Expired Medicines
11 Likelihood of Purchasing Near-Expiry Medicine on Sale
12 Awareness of Community Programs for Medicine Disposal

ABSTRACT
Although the pharmaceutical sector plays an essential part in the provision of healthcare on a
worldwide scale, it is also responsible for a considerable portion of the pollution that occurs
in the environment due to the inappropriate disposal of pharmaceutical waste. The purpose of
this study is to explore the practices of the general population regarding the disposal of
unused and expired pharmaceuticals, with a particular emphasis on gaining an understanding
of different knowledge, attitudes, and behaviors that are associated with medication disposal.
A mixed-methods approach will be utilized to collect data from individuals across a wide
range of demographic backgrounds. This will be accomplished through the use of surveys
and interviews. We will also be reviewing secondary data from previously published
literature in order to interpret the findings within the context of the pharmaceutical waste
management sector as a whole. This project aims to provide solutions for improving
prescription disposal procedures and decreasing environmental effect by assessing present
disposal processes, finding gaps in knowledge and behavior, and identifying gaps in
knowledge and behavior. For the purpose of encouraging responsible medication disposal and
limiting the environmental concerns associated with pharmaceutical waste, it is anticipated
that the findings will help to the creation of targeted interventions and policies.

CHAPTER 1
 INTRODUCTION

THEORITICAL BACKGROUND OF THE STUDY

OVERVIEW OF HOSPITAL PHARMACY OPERATIONS

It is the responsibility of hospital pharmacists to ensure that pharmaceuticals are acquired,

kept, dispensed, and disposed of in a manner that is both safe and effective. This is an
essential part of the medication management process that takes place within healthcare
institutions. The implementation of this all-encompassing strategy is very necessary in order
to preserve the integrity of the medicine supply chain, guarantee the safety of patients, and
provide support for the therapeutic goals of the medical team.

Purchasing and Acquisition

The process of procurement entails the acquisition of pharmaceutical supplies and drugs that
are tailored to satisfy the particular requirements of the patient population at the hospital. In
order to successfully complete this phase, it is necessary to diligently identify suppliers,
negotiate pricing, and make certain that a diverse array of pharmaceuticals is readily
available. Additionally, hospital pharmacists are required to remain current on drug shortages
as well as regulatory changes that may have an effect on the availability of medications. The
objective is to guarantee a consistent supply of pharmaceuticals without sacrificing the
quality of the medications or the limits imposed by the budget.

Putting Away
In hospital pharmacy, the proper storage of medications is of the utmost importance in order
to maintain the efficacy and safety of the drugs. Controlling the environment in terms of
temperature, humidity, and light exposure in accordance with the requirements of various
medications is included in this. For the purpose of preventing the degradation of
pharmaceuticals and ensuring that they continue to be safe for patients to use, pharmacies
make use of specialized storage methods, such as refrigeration equipment for temperature-
sensitive drugs. In addition, there are inventory management systems in place to monitor
stock levels, mark expiration dates, and make it easier to rotate goods in order to reduce the
amount of waste that occurs.

A dispensing system

Dispensing is the process of accurately preparing and distributing pharmaceuticals to specific

patients, based on the prescriptions that each patient receives from their respective healthcare
providers. Verifying prescription orders, producing the appropriate dosage forms, and
ensuring that patients receive the necessary prescriptions are all components of this process.
In order to reduce the likelihood of errors and guarantee the well-being of patients, hospital
pharmacists and technicians make use of a variety of checks and balances, including digital
systems. In addition to this, they offer counseling to patients or healthcare professionals
regarding the correct use of the medications, potential adverse effects, and interactions
between the medications.

Disposal No.

When it comes to hospital pharmacy operations, one of the most important aspects is the
disposal of medications. This involves the safe and environmentally responsible disposal of
drugs that have expired, been unused, or come into contact with damage. To protect humans,
animals, and the environment from potential harm, it is necessary to dispose of waste in an
appropriate manner. Hospital pharmacies are required to comply with stringent rules and
guidelines for the disposal of medications. These pharmacies frequently utilize specialist
disposal services in order to deal with prohibited or hazardous medicines.

To summarize, hospital pharmacies are an essential component of the healthcare system since
they provide the secure management of pharmaceuticals throughout the entire process, from
purchases to disposal. They assist the treatment outcomes of patients through the precise
processes that they employ, all while keeping to regulatory standards and promoting public
health and safety.

IMPORTANCE OF MANAGING NEAR EXPIRY AND EXPIRED MEDICINES

The management of drugs that are nearing their expiration date or have already expired is an
essential component of pharmacy operations. It is essential for guaranteeing the safety of
patients, maintaining regulatory compliance, and attaining cost-efficiency. In order to avoid
the negative consequences that are connected with the utilization of pharmaceuticals that are
either ineffective or hazardous, this activity necessitates a rigorous attention to detail and the
implementation of systematic procedures.

Ensuring the Secureness of Patients

When it comes to the management of drugs that are nearing their expiration date or have
already expired, patient safety is the first priority. When a medication's expiration date is
getting close or has already passed, it is possible that the medication will lose its
effectiveness, become ineffective, or even be hazardous. There is a possibility that the
administration of such pharmaceuticals could result in therapeutic failure, severe drug
reactions, or resistance to therapy. When management is done correctly, it guarantees that
patients receive pharmaceuticals that are still within their shelf life, so preserving both their
effectiveness and their safety.

Compliance with Regulatory Rules

The handling, storage, and disposal of pharmaceuticals, particularly those that are either
about to expire or have already expired, are subject to stringent standards that are imposed by
regulatory bodies all over the world. The purpose of these regulations is to offer protection to
the general public's health and to guarantee that healthcare practitioners provide the best
possible level of care. In order to ensure compliance with these rules, it is necessary to
conduct routine inventory checks, maintain accurate paperwork, and strictly follow to
disposal standards. In the event that compliance is not met, the healthcare facility may face
legal implications, financial penalties, and damage to its established reputation.

• Cost-Effectiveness Rating

Medications that have expired or are on the verge of expiration are a source of financial loss
for healthcare providers. It is possible to drastically cut down on waste by effectively
managing these medicines, which will ultimately lead to an increase in cost-efficiency. In
order to make effective use of pharmaceuticals before they become obsolete, it is possible to
implement inventory management strategies such as "first in, first out" (FIFO). Furthermore,
several pharmaceutical return and credit schemes enable healthcare facilities to return certain
prescriptions that have not been opened and are close to expiration for credit or replacement,
thereby further minimizing the financial losses that they have incurred.

Techniques for Improving Organisational Performance

- "Regular Inventory Checks": Regular audits of the stock of drugs to identify medications
that are either close to expiration or have already expired so that necessary action can be
taken.
In the context of digital tracking systems, the utilization of inventory management software to
keep track of expiration dates and to automate the ordering and utilization of pharmaceuticals
is a defining characteristic.

-Education and Training: Making sure that the staff at the pharmacy is well-trained in the
management of pharmaceuticals that are close to expiration or have already expired,
including having a grasp of the significance of rotating and disposing of medications in a
timely manner.
- Collaboration with Suppliers: Working closely with suppliers to manage stock levels and
return procedures for pharmaceuticals that are getting close to expiration.
In order to prevent harm to both the community and the environment, it is important to
implement safe disposal practices, which include the implementation of ecologically safe and
regulatory-compliant disposal techniques for expired pharmaceuticals.

In conclusion, it is vital for healthcare institutions to have an effective management system

for drugs that are nearing their expiration date or have already expired in order to guarantee
the safety of their patients, maintain regulatory compliance, and improve cost-efficiency. It is
possible for pharmacies to reduce the risks associated with expired pharmaceuticals and make
a contribution to the overall quality of healthcare delivery if they implement systematic
strategies and processes.

TRACKING AND MONITORING SYSTEMS

When it comes to managing the expiration dates of medications, hospitals make use of
sophisticated tracking and monitoring systems. This helps to ensure that their pharmacy
operations are in accordance with regulatory requirements, as well as safe and effective.
Electronic Inventory Management Systems (EIMS) are at the core of these initiatives. These
systems automate the tracking of stock levels and expiration dates, enabling real-time
visibility and automated notifications to prevent the usage of pharmaceuticals that have
passed their expiration date. These systems frequently include barcode scanning and batch
tracking functions, which make it possible to manage pharmaceutical inventory in an
effective manner in accordance with the principle of "first-in, first-out." In addition, Radio-
Frequency Identification (RFID) technology improves these capabilities by enabling the
wireless tracking of medication packets. This streamlines inventory audits and reduces the
number of errors that are caused by human labor by allowing for the scanning of specific
information, including expiration dates, without anyone having to physically touch the
package.

Further developments in cloud-based solutions have made it possible to handle inventories in

a scalable and accessible manner across various hospital locations. This has made it possible
to manage data in a centralized manner and to monitor its status in real time. This is
supplemented by the incorporation of data analytics and reporting capabilities into inventory
management systems. These technologies offer useful insights into the patterns of drug usage
and assist in optimizing stock levels in order to reduce waste. In addition, mobile applications
that are connected to these inventory systems give pharmacy employees the capacity to
access and update inventory data while they are on the move, directly from storage areas.
This ensures that the system accurately reflects real-time information and improves the
efficiency of operations.

These technologies, when combined, constitute an all-encompassing framework that enables

hospitals to effectively control the expiration dates of medications. The utilization of
electronic inventory management, radio frequency identification (RFID), cloud computing,
data analytics, and mobile technology allows healthcare facilities to preserve the integrity of
their pharmaceutical supplies, protect the health of their patients, and comply with stringent
regulatory standards. All of this can be accomplished while simultaneously optimizing their
inventory for cost-efficiency and minimizing waste.

STRATEGIES FOR MANAGING NEAR EXPIRY MEDICINES

With the goal of minimizing waste and maximizing the utilization of available resources, one
of the most important aspects of pharmacy administration is the management of drugs that are
getting close to their expiration date. To efficiently handle pharmaceuticals that are getting
close to their expiration date, here are several strategies:

1. Implement a stringent stock rotation system that adheres to the First Expiry, First Out
(FEFO) technique, followed by the First In, First Out (FIFO) method. This is the first step in
the stock rotation process. The likelihood of medications going bad before they are used is
decreased as a result of this practice, which guarantees that older stock is used before newer
stock.

2. Regular Inventory inspections: It is important to conduct regular inventory inspections in

order to detect drugs that are just about to expire. This enables the pharmacy to take
preventative measures in a timely manner, such as giving more priority to the shipment of
these medications to regions that have higher rates of consumption.

3. The data that was supplied suggests that a color-coded labeling system should be utilized
in order to communicate the level of urgency associated with the utilization of the product.
Examples of labels include green for things that are going to expire within the next six
months, yellow for items that are going to expire within the next three months, and red for
items that have just one month left until they expire. Using this visual signal, staff members
are able to immediately detect and prioritize the distribution of products that are getting close
to expiration.

4. Donating to Charitable Organizations: In situations where it is permissible and practical,

give drugs that are close to expiration to charitable organizations or clinics that are in need of
assistance. Not only does this contribute to the reduction of trash, but it also reinforces efforts
to improve community health.

5. Return to Suppliers: Negotiate agreements with suppliers to enable the return of

medications that are close to expiration for credit or replacement. In order to do this,
proactive management is required to locate and return goods far before the date on which
they expire.
6. Promotional Offers: In certain circumstances, providing drugs that are shortly approaching
their expiration date at a reduced price can assist in the movement of the stock more rapidly.
Having said that, this must be carried out in a manner that is both ethical and transparent,
with the patients being made aware of the expiration dates.

7. Utilization in Clinical Settings: In the case of hospital pharmacies, medications that are on
the verge of expiration might be given priority for utilization in clinical settings where they
will be utilized in a short amount of time, such as inpatient care programs or emergency
departments.

8. Education and Training: Educate and train those working in the pharmacy about the
significance of managing drugs that are close to expiration and the processes that should be
followed. To do this, it is necessary to have an awareness of the color-coded system, the
procedures for rotating stock, and the availability of donation and disposal choices.

9. Collaborate with Healthcare Providers: Work closely with healthcare providers to improve
the accuracy of demand forecasting and to adapt ordering processes accordingly. This will
reduce the possibility of overstocking products that may be on the verge of expiration.

10. Technology Integration: Make use of inventory management software that can notify
employees about items that are getting close to expiration, automate the process of stock
rotation, and give data analytics for improved forecasting and decision-making around
inventory.

Pharmacy establishments have the ability to considerably cut down on the amount of
medications that are close to expiration by putting these tactics into action. This helps to
ensure that resources are utilized effectively while still maintaining high standards of patient
care.

CHALLENGES AND RISKS ASSOCIATED WITH EXPIRED

MEDICINES

PATIENT SAFETY RISKS

In healthcare settings, the safety of patients is of the utmost importance, particularly when it
comes to the distribution of pharmaceuticals. A substantial number of dangers are linked with
the distribution of drugs that have expired, and these risks might have major repercussions for
the health of patients. Within this section, we will delve deeper into the myriad of dangers
and potential outcomes that may arise from the utilization of medications that have beyond
their expiration date.

Decreased Effectiveness

If you use prescriptions that have expired, you run the danger of the medication losing its
effectiveness, which is one of the principal concerns. It is possible that the chemical
components included in pharmaceuticals could deteriorate or experience changes over time,
which will have an impact on their potency and usefulness. This deterioration can result in a
medicine that is less effective than envisioned, which can lead to treatment outcomes that are
less than ideal. A decrease in the efficacy of these drugs might result in a worsening of the
patient's health issues, a delay in recovery, or therapy that is ineffective for patients who rely
on these medications to manage chronic illnesses, control symptoms, or cure diseases.

Possibility of Caused Harm

Medications that have expired can occasionally convert into substances that are hazardous, in
addition to the fact that their effectiveness decreases. In spite of the fact that this occurs less
frequently, certain drugs have the potential to decompose into harmful metabolites that might
directly endanger the health of patients. These dangers can vary from modest side effects to
severe responses that might potentially endanger a person's life, depending on the medicine
and the byproducts that produce them.

Resistance to Drug Doses

When it comes to antibiotics or antivirals, the use of drugs that are below their effective
strength might be a factor that contributes to the development of drug resistance. These drugs
may not be able to entirely eradicate the pathogens that are the focus of the therapy if they do
not perform to their full potential. This may allow the infections to develop resistance to the
treatment. This not only has an impact on the patient in question, but it also adds to a more
widespread problem in terms of public health, since resistant strains have the potential to
spread to other people.

The Influence on the Results of Treatment

The lack of knowledge on the efficacy of drugs that have expired might result in treatment
outcomes that are not always predicted. There is a possibility that medical professionals may
not be able to precisely predict how patients will react to the therapy, which will make it
more difficult to manage and monitor the status of patients. This ambiguity can make the
process of diagnosis and treatment more difficult, which may result in the need for extra
interventions or alternative therapies that could have been avoided if an effective medicine
that had not expired had been utilized.

Implications for the Law and Ethics at Large

There may also be ethical and legal repercussions associated with the distribution of outdated
pharmaceuticals. There is an expectation that those who work in the healthcare industry
would adhere to the best possible standards of care, which includes making certain that the
pharmaceuticals they distribute are both safe and effective. It is possible that providing
patients with prescriptions that have expired might be considered careless, which could lead
to legal repercussions, harm to the reputation of the healthcare practitioner, and a loss of
confidence from both patients and the community.

The hazards that are connected with dispensing drugs that have expired are diverse, and they
have an influence on the safety of patients, the effectiveness of therapy, and the health of the
general population. In order to maintain the best possible standards of care and patient safety,
healthcare practitioners and pharmacists need to be careful in checking the expiration dates of
prescriptions and making certain that patients get medications that are within the effective
shelf life of the medication.
DISPOSAL OF EXPIRED MEDICINES
In order to avoid contaminating the environment and to guarantee the safety of the general
public, the disposal of drugs that have passed their expiration date is an important matter that
has to be carefully considered. The improper disposal of pharmaceuticals can result in the
polluting of soil, the pollution of streams, and the harming of animal and aquatic life. It is
therefore very necessary to adhere to disposal techniques that are safe for the environment.
The following is a description of the techniques that are advised for the safe and ecologically
responsible disposal of expired pharmaceuticals. The methods that are emphasized here are
burning and the utilization of hazardous waste removal services respectively.

The process of firing

It is generally suggested that drugs that have expired be disposed of through the process of
incineration. Ashes, water vapor, and carbon dioxide are the byproducts of this procedure,
which includes burning trash from the pharmaceutical industry at high temperatures. It is
possible to eliminate the active medicinal substances by the process of burning, so keeping
them from entering the environment and causing harm.

The incineration process need to be carried out under regulated conditions, with facilities that
are specifically built to deal with pharmaceutical waste on hand. In order to limit the
discharge of dangerous pollutants into the environment, these facilities are outfitted with
specialized filters and scrubbers that act to catch and neutralize emissions.
Incinerators of the modern period are capable of achieving high levels of efficiency, which
guarantees that the medicinal compounds are effectively neutralized and totally broken down.

Incineration of pharmaceutical waste is normally controlled by environmental protection

agencies, and facilities are required to comply with stringent regulations in order to limit their
influence on the environment from the process.
Removal Services for Dangerous Waste

Collection, transportation, and disposal of hazardous items, including expired medications,

are the areas of expertise of hazardous waste removal services. In accordance with the legal
requirements and environmental standards, these services guarantee that pharmaceutical
waste is managed and disposed of in a way that is in accordance with the norms.

Segregation: In order to avoid contamination, it is important to separate expired medications

from ordinary garbage. For the purpose of collecting pharmaceutical waste, hazardous trash
disposal services supply containers that are specifically intended for this purpose.
These services assure compliance with local, state, and federal requirements for the disposal
of hazardous waste, hence lowering the liability that is associated with healthcare institutions
and pharmacies respectively.
It is ensured that the trash is disposed of in a responsible manner by maintaining proper
paperwork throughout the whole process of disposal. This documentation serves as a trail of
responsibility.

Additional Methods of Disposal That Reduce the Impact on the Environment

- Return Programs: Certain pharmacies and healthcare facilities provide take-back programs,
which allow members of the general public to return prescriptions that have expired or are
unused for the purpose of safe disposal.
Community Collection Events: Municipal health departments or environmental agencies may
organize collection events for the purpose of providing citizens with a secure place in which
they may dispose of their unwanted or expired pharmaceuticals.
Education and Awareness: Educating people about the significance of safe medicine disposal
might help them to refrain from dispensing drugs in the garbage or flushing them down the
toilet, both of which are behaviors that can result in the pollution of the environment.

For the purpose of preventing pollution and protecting public health, it is vital to dispose of
outdated drugs in a manner that is safe for the environment. When it comes to disposing of
pharmaceutical waste in a responsible manner, incineration and hazardous trash disposal
services are both viable alternatives. Individuals, healthcare facilities, and pharmacies may all
make a contribution to a safer and healthier environment by adhering to the advised
procedures for waste disposal.
INDUSTRY PROFILE
OVERVIEW

The medical sector represents a multifaceted network of entities, institutions, and experts
dedicated to delivering health services to people and broader communities. This sector spans
diverse offerings, from preventive measures and diagnostic tools to therapeutic care,
recovery, and extended services. Key stakeholders in this arena include healthcare centers,
outpatient facilities, equipment producers, drug companies, insurance entities, and official
bodies. Crucially, the backbone of this industry is its professionals - including physicians,
nurses, counselors, dispensers, and various medical personnel. Ensuring the overall health
and vitality of individuals and groups hinges on the services provided by this sector,
particularly in early detection, ailment management, and injury treatment. Lately, there's been
a heightened focus on proactive health strategies, emphasizing routine examinations, early
screenings, and vaccinations to deter severe health challenges.

With the constant progression in medical technology, regulatory adaptations, and varying
health demands, the medical sector remains in a state of flux, opening doors for novelty and
expansion. Emerging techniques and therapies are continually being introduced. At its core,
this sector remains indispensable for the prosperity of people and their communities and will
remain pivotal for growth and innovation in foreseeable times. In the context of India,
healthcare stands out as one of its most dynamic domains in terms of revenue generation and
job creation, covering aspects like hospitals, health gadgets, clinical research, remote health
services, medical travel, health coverage, and medical tools. Rapid strides in this domain
within India can be attributed to enhanced service delivery, increased public and private
investment.

India's health service system is bifurcated into public and private segments. The state-
sponsored, or public sector, primarily offers rudimentary healthcare through primary
healthcare centers (PHCs) in the countryside, with a limited number of advanced care
facilities in prominent cities. On the other hand, the private sector dominates in providing
advanced secondary, tertiary, and even quaternary care services, predominantly found in
metro cities and the first and second tier cities. A distinct advantage for India is its vast
reservoir of skilled healthcare professionals. Additionally, India stands out for its
affordability when compared to many Asian and Western nations, offering medical services
at nearly a fraction of the costs seen in the US or Western Europe. This affordability factor
has buoyed India's medical tourism sector, drawing patients globally. Furthermore, due to its
economical clinical research offerings, India is becoming a focal point for R&D initiatives for
global entities.

MARKET SIZE
India's healthcare domain is on an impressive growth trajectory, anticipated to expand
threefold. From 2016's valuation at US$ 110 billion, it's projected to surge to US$ 372 billion
by 2022, with an annual growth rate of 22% over the period. Healthcare infrastructure alone
is set to touch US$ 349.1 billion by FY22. Highlighted in the 2022 Economic Survey, public
spending on health has risen from 1.3% of the GDP in 2019-20 to 2.1% in 2021-22. Health
insurance companies have also seen growth, underwriting premiums of Rs. 73,582.13 crore
(US$ 9.21 billion) in FY22. Significantly, the health segment makes up a third of the nation's
total gross written premiums.

Medical tourism in India has been flourishing. While it was valued at US$ 2.89 billion in
2020, projections suggest it could soar to US$ 13.42 billion by 2026. Data from the 2020
report on India Tourism Statistics indicated that around 697,300 international tourists chose
India for their medical needs in FY19. On the global front, India secured the 10th position out
of 46 destinations in the 2020-21 Medical Tourism Index by the Medical Tourism
Association.

Digitization in healthcare is also evident with the e-health market size projected to hit US$
10.6 billion by 2025. As shared by Dr. Bharati Pravin Pawar, the Minister of Health &
Family Welfare, in the Lok Sabha, the nation's doctor to population ratio stands at 1:854.
This figure assumes the active participation of 80% of the registered 12.68 lakh allopathic
professionals and 5.65 lakh AYUSH practitioners.
DEVELOPMENTS

From April 2000 through June 2022, the drugs and pharmaceuticals domain witnessed a
Foreign Direct Investment (FDI) inflow of US$ 19.90 billion, as per figures from the
Department for Promotion of Industry and Internal Trade (DPIIT). A snapshot of recent
milestones in India's healthcare sector includes:

By November 24, 2022, the nation had delivered over 219.88 crore doses of the COVID-19
vaccine. Moreover, as of November 16, 2022, India has dispatched 28.13 crore doses to other
countries.

Global health entity Abbott, in partnership with the nonprofit Americares India Foundation, is
on course to transform 75 Primary Health Centers (PHCs) into Health and Wellness Centers
(HWCs) across nine states in India. This initiative is projected to assist over 2.5 million
individuals from marginalized communities annually. In the same vein, diabetes control
platform BeatO secured a funding of US$ 33 million in its Series B round in November 2022,
spearheaded by investor Lightrock India.

Come August 2022, Edelweiss General Insurance aligned with India's Ministry of Health to
streamline the process for Indians to obtain their Ayushman Bharat Health Account (ABHA)
number. Mergers and acquisitions in the Indian health and pharma sector touched US$ 4.32
billion in H1 2022. As of July 2022, the nation boasted 612 medical academic institutions.

Further, in a significant move, the Indian Council of Medical Research (ICMR) rolled out
standard treatment protocols for 51 prevalent conditions across 11 medical disciplines in July
2022. This initiative primarily supports doctors, especially in remote areas, ensuring timely
and effective patient care. Additionally, the National Pharmaceutical Pricing Authority
(NPPA) set the consumer prices for 84 medicine formulations in July 2022, which
encompassed medicines for conditions like diabetes, migraines, and hypertension.

In the beginning of 2022, Bharat Biotech, together with the Washington University School of
Medicine in St Louis, US, initiated Phase 3 trials for India's pioneering nasal vaccine against
COVID-19. Health tech startup, HealthifyMe, boasting 30 million users, has seen an influx of
around 500,000 new members each month, achieving a US$ 40 million annual run rate by
January 2022. In the financial year 2021, women received 93 lakh insurance policies,
indicating every third life insurance policy was taken by a female.

By the end of 2021, Eka Care earned its stripes as India's initial CoWIN-validated entity,
facilitating vaccination appointments, certificate downloads, and even Health ID creations for
users. As the year drew to a close in November, 80,136 Ayushman Bharat-Health and
Wellness Centers (AB-HWCs) were functional throughout the country. By the same time,
under the ‘Digital India’ campaign by the central government, 638 digital hospitals had been
inaugurated.

Aster DM Healthcare, in November 2021, disclosed their projected Rs. 900 crore (approx.
US$ 120.97 million) investment plan spanning three years, aiming to bolster their Indian
footprint. Their objective is to elevate India's contribution to their total revenue to 40% by
2025. The following month, the Russian COVID-19 vaccine, Sputnik Light, was granted
authorization for Phase 3 trials on Indian soil.

By September 2021, Biocon Biologics Limited, a subsidiary of Biocon, forged a

collaborative pact with Serum Institute Life Sciences, an offshoot of Serum Institute of India
(SII). This collaboration aims to consolidate India's stature as a dominant force in global
vaccine and biologics production.
KEY PLAYERS

India's healthcare industry is one of the largest and fastest-growing sectors, contributing
significantly to the country's economy and employment. It encompasses various segments,
including hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical
tourism, health insurance, and medical equipment. The key players in this industry are a mix
of multinational corporations and strong domestic companies. Here, we'll highlight some of
the top healthcare companies in India, known for their significant contributions, innovations,
and services in the healthcare sector.

Apollo Hospitals

Apollo Hospitals is one of the most renowned healthcare chains in India. Established in 1983,
it has a widespread presence across the country with over 70 hospitals, numerous clinics, and
over 10,000 beds. Apollo is known for providing high-quality healthcare services, pioneering
private healthcare in India, and being a frontrunner in medical tourism.

Fortis Healthcare

Fortis Healthcare is another leading healthcare provider in India, known for its advanced
healthcare facilities. With a network of hospitals, Fortis offers comprehensive medical care in
various specialties, including cardiology, neurology, oncology, orthopedics, and more. The
company is recognized for its patient care, clinical expertise, and modern infrastructure.

Sun Pharmaceutical Industries Ltd.

Sun Pharma is the largest pharmaceutical company in India and one of the biggest in the
world. It manufactures and sells pharmaceutical formulations and active pharmaceutical
ingredients (APIs) in India and many other countries. The company is known for its extensive
R&D capabilities and wide range of products in various therapeutic areas.
Dr. Reddy's Laboratories

Dr. Reddy's is one of India's leading pharmaceutical companies, known for its innovative
approach in the healthcare sector. The company offers a wide range of pharmaceutical
products, including generic drugs, over-the-counter medications, and vaccines, catering to
various healthcare needs globally.

Cipla Ltd.

Cipla is a global pharmaceutical company with a significant presence in India. It is known for
its quality generic medicines and is one of the major players in the respiratory, antiretroviral,
urology, and cardiology segments. Cipla has been instrumental in making medications
affordable and accessible, especially in developing countries.

Max Healthcare

Max Healthcare is one of the leading healthcare providers in India, with a network of
hospitals and healthcare facilities offering services across various medical disciplines. Known
for its quality healthcare services, Max Healthcare is a key player in the Indian healthcare
industry, providing advanced medical care and treatment.

Narayana Health

Founded by Dr. Devi Shetty, Narayana Health is a chain of hospitals in India known for its
affordable and quality healthcare services. It has a significant presence in the country with a
network of hospitals specializing in cardiology, cancer care, neurology, and other specialties.
Narayana Health is recognized for its innovative approach to healthcare, making it accessible
to a broader population.

Wockhardt Hospitals
Wockhardt Hospitals is a prominent healthcare chain in India, offering advanced medical
treatment and care across various specialties. The hospital is known for its state-of-the-art
facilities, expert medical professionals, and a commitment to providing high-quality patient
care.

Medanta - The Medicity

Medanta is a multi-super specialty hospital in Gurgaon, India, known for its world-class
facilities, expert healthcare professionals, and comprehensive care across various medical
fields. It is one of the largest and most advanced hospitals in India, offering innovative
healthcare solutions.
 CHAPTER 2
RESEARCH DESIGN

STATEMENT OF THE PROBLEM

In hospital pharmacy, the management and disposal of drugs that are either nearing their
expiration date or have already expired offer a serious difficulty that has broad consequences
for the safety of the environment and the public's health. In spite of the fact that hospital
pharmacists play an essential part in the healthcare system, there is a disturbing lack of
established standards for the management of medications that are either on the verge of
expiration or have already past their expiration date. In addition, there is a lack of complete
understanding and adherence to best practices among healthcare practitioners, which results
in methods of disposal that are variable and frequently not appropriate. The ramifications of
such behaviors are complex, including the potential for patient damage owing to the usage of
pharmaceuticals that are ineffective or compromised, the influence that pharmaceutical
pollutants have on the environment, and the larger implications for the safety of public health.
Furthermore, it is impossible to ignore the economic repercussions that result from the waste
of resources and the opportunity for increased sustainability within healthcare institutions. In
order to identify effective strategies to mitigate risks, improve patient safety, and promote
environmental sustainability, the purpose of this study is to investigate the current practices,
challenges, and knowledge gaps for the management and disposal of medicines that are
nearing their expiration date or have already expired within hospital pharmacies.
NEED OF THE STUDY

The fact that there are significant knowledge and practice gaps concerning the administration
and disposal of drugs that are either close to expiration or have already expired inside
hospital pharmacies highlights the need of conducting this study. Having a comprehensive
awareness of the complexities involved in the management of expired pharmaceuticals is of
the utmost importance in light of the growing global emphasis on the quality of healthcare,
the safety of patients, and the preservation of the environment. It is vital to conduct this study
in order to give a full analysis of the practices that are now in place, to identify the issues that
are currently ongoing, and to highlight the knowledge gaps that exist among healthcare
professionals working in hospital pharmacies. In order to educate policymakers, healthcare
providers, and environmental authorities about the possible problems that are linked with
inappropriate pharmaceutical disposal and management, the research intends to investigate
these topics in depth. In addition, the findings of this study might perhaps serve as a
fundamental basis for the development of targeted interventions, educational programs, and
legislative frameworks in order to guarantee the safe, effective, and ecologically responsible
management of expired medications. In summary, this research is an important step toward
improving patient safety, reducing the impact on the environment, and cultivating a culture of
sustainability and responsibility in healthcare settings. If successful, it will eventually
contribute to the development of public health goals and the preservation of the environment.
SCOPE OF THE STUDY

The purpose of this study is to investigate the behaviors, issues, and knowledge that are
associated with the management and disposal of drugs that are nearing their expiration date or
have already expired inside hospital pharmacies. The scope of this study is both extensive
and diverse. Particularly, the purpose of the study is to:

1. Assess Current Practices: This will provide a comprehensive overview of the policies and
practices that are already in place, along with an examination of how hospital pharmacists
handle and dispose of drugs that are either close to their expiration date or have already
passed their expiration date.

2. Identify Obstacles: The research will identify the obstacles and problems that hospital
pharmacists encounter in handling pharmaceuticals that are nearing their expiration date or
have already expired. These issues include logistical, regulatory, and knowledge-based
obstacles.

3. Evaluate Knowledge and Awareness: The purpose of this study is to evaluate the amount
of awareness and knowledge that healthcare professionals have on the significance of correct
drug disposal and the possible dangers that are linked with medicines that are either nearing
their expiration date or have already expired.

4. Environmental Impact: This study will investigate the environmental repercussions of

incorrect drug disposal, including the possible pollution of water supplies and soil, as well as
the wider ecological impacts.

5. Analysis of rules and Regulations: The research will examine the rules and regulations that
are already in place in relation to the disposal of medications in hospital settings, assessing
how successful they are and determining where there is need for improvement.
6. This study will propose recommendations for best practices in the management and
disposal of expired and near-expiry medicines in hospital pharmacies. The purpose of these
recommendations is to improve patient safety, environmental sustainability, and compliance
with regulatory standards. The recommendations will be based on the findings of the study.

This study will offer educational initiatives and training programs to enhance the knowledge
and practices of healthcare workers working in hospital pharmacies regarding the disposal of
expired drugs.

7. Educational Frameworks: The study will suggest educational initiatives and training
programs.

As a result of covering these factors, the study intends to give useful insights and practical
recommendations to enhance the management of expired drugs in hospital pharmacies. This
will fit with the goals of public health safety and environmental conservation.
REVIEW OF LITERATURE

Rebehy et al (2019)

Rebehy and her colleagues bring attention to the more widespread problem of excessive
consumption and inefficient waste management, both of which contribute to the degradation
of the environment. Their study highlights the fact that pharmaceutical waste is present all
over the world and identifies medicine waste as a primary contributor to this environmental
concern.

Insani et al., 2020

In their investigation of the particulars of pharmaceutical waste, Insani et al. highlight the fact
that pharmaceutical goods constitute one of the most significant types of garbage located all
over the world. They point out that the waste of medication is a serious problem, which
requires targeted attention in order to effectively manage and dispose of the drug itself.

Bungau et al. (2018)

Reverse logistics is a viable option for managing surplus and undesired home items,
including drugs, and Bungau and his colleagues have demonstrated their contribution to the
discussion by discovering this potential answer. They delve into the ways in which reverse
logistics might be utilized to recycle pharmaceutical items or dispose of them in an
appropriate manner, so aligning themselves with larger environmental safety objectives.
Lagana et al.(2021)
When it comes to the management of pharmaceutical waste, Lagana and his colleagues
investigate the notion of reverse logistics. They characterize it as a series of operations that
regulate the movement of products and information in the opposite direction of traditional
logistics. This strategy is given as a means to recover value or assure proper waste disposal,
with a special emphasis on the disposal of waste medicine.

Luís and colleagues, 2021

Within the scope of their research, Luís and colleagues offer a comprehensive and
comprehensive definition of medicine, defining it as any pharmaceutical substance that is
prescribed to alter physiological systems or treat pathological disorders. Their study provides
a core understanding that is essential for considering the management and disposal of drugs
that are either nearing their expiration date or have already expired.

Campos et al. (2017) and Brazil in 2020

The purpose of this study is to provide an overview of the process of reverse logistics as a
method for mitigating the adverse effects on the environment stemming from inappropriate
trash disposal. Particularly highlighting innovative ways stipulated in Brazilian legislation for
prescription reverse logistics, the authors underscore the shared responsibility that exists
along the whole sectoral supply chain, beginning with the extraction of materials and ending
with the consumption of such materials by consumers.

Ding (2018), Gray-Winnett et al. (2010), and Shalini et al. (2010),

These studies discuss the environmental and health problems that are related with medicine
waste, and they highlight the lack of technology and knowledge that is necessary for an
expedient remedy. Given the potential risks that drug waste poses to both human health and
the environment, the primary focus is on the urgent need for enhanced management
techniques.
Research published in 2007 by Musson et al., 2017 by Vatovec et al., 2021 by Vatovec et
al., and 2015 by Wang et al.
This article focuses on the principal cause of pharmaceutical waste, which is the improper
disposal of pharmaceuticals that have expired or are no longer wanted. In order to address the
inappropriate disposal of prescription waste, these writers highlight the seriousness of this
issue and argue for more rigorous research and policy-making initiatives.

Gu and Liu (2013) and Costa (2014)

As Gu, Liu, and Costa examine the crucial role that information management plays in reverse
logistics, they bring to light a number of issues, including the necessity for efficient data
storage and processing, as well as the ambiguity that exists about the data. It is possible that
improved information management might result in more effective procedures in the field of
pharmaceutical reverse logistics, according to their findings.

DiMaggio and Powell (1983), Sarkis et al. (2011), and Jazairy and von Haartman (2020)
In the context of green supply chains, these writers investigate, via the lens of Institutional
Theory, the ways in which external environmental forces might have an effect on the
activities taken by organizations. Within the realm of medicine waste management, they
highlight coercive, normative, and mimetic pressures as significant factors that are pertinent
to the aforementioned sector.

Aditya S; Int. J. of Pharm. & Life Sci. 2013

A study involving 236 undergraduate dental students from Dr. Harvansh Singh Judge
Institute of Dental Sciences, Punjab University, Chandigarh, India, revealed concerning
disposal habits. A majority (94%) disposed of medications in the trash, with significant
percentages rinsing (32%) or flushing (12%) medications down the sink or toilet. Only a
small fraction (3%) returned their medications to the pharmacy, highlighting a considerable
gap in safe disposal practices among future healthcare professionals.
Gupta D et al.; J Pharm Sci Innov. 2013
This research surveyed 56 patients at Shri Ram Murti Smarak Institute of Medical Sciences,
Bareilly, U.P., India, finding that 57.1% of participants disposed of medicines in the trash.
Alternative disposal methods included flushing into the toilet/sink (5.3%), burning (5.3%),
and burying (3.6%). Only 3.6% returned expired or unused medicines to the pharmacy,
indicating a broad lack of awareness regarding proper disposal methods.

Lagishetty R et al.; Asian J Biochem Pharm Res. 2013

In a study with 158 participants from South India, 63.5% reported disposing of medicines in
the dustbin, while 12% used the toilet or sink, and a concerning 18% dumped medicines in
water lakes. The low percentage (3.2%) of returning medicines to the pharmacy suggests a
need for improved public education on medication disposal.

Swaroop HS et al.; World J Pharm Pharm Sci. 2015

At Vydehi Institute of Medical Sciences and Research Centre, Bangalore, a questionnaire-
based study with 200 participants showed that 65% disposed of unused medication in the
garbage, while 62% reported returning unused medication to the pharmacy. This indicates a
mixed understanding and practice regarding medication disposal among the participants.

Sirisha A et al.; J Basic Clin Res. 2016

A descriptive study among 469 medical and dental undergraduates from Kamineni Institute
of Medical Sciences, Narketpally, Telangana, India, showed varied disposal practices,
including rinsing in a sink (5-8%), flushing in the toilet (6-9%), and a relatively higher rate of
returning medications to the pharmacist (25-40%). The results indicate a better inclination
towards proper disposal compared to other studies.

The purpose of this literature review is to provide a comprehensive presentation of the

challenges and potential solutions associated with the management of near-expiry and
expired medicines in hospital pharmacies. The review also highlights the critical need for
effective reverse logistics systems and the role that information management plays in
addressing this pressing environmental and public health issue.
OBJECTIVES OF THE STUDY

1. To conduct an analysis of the treatment and disposal procedures currently in place in

hospital pharmacies for drugs that are either close to expiration or have already passed their
expiration date.

2. To identify the difficulties and obstacles that healthcare professionals working in hospital
pharmacies experience when it comes to the disposal of drugs that have lost their
effectiveness.

3. To assess the level of awareness and knowledge that exists among the clinical pharmacy
personnel at the hospital regarding the dangers of expired medications and the appropriate
ways for their disposal.

4. To explore the various environmental hazards that are related with the incorrect disposal of
drugs that have expired from hospital pharmacies.

5. To conduct an evaluation of the efficiency of the rules and procedures that are currently in
place to manage the disposal of drugs that have expired in hospital settings.

6. To make suggestions for improving the management and disposal practices of drugs that
are nearing their expiration date or have already expired in hospital pharmacies, based on
evidence.

7. To propose educational and training programs with the goal of strengthening the
competency of healthcare workers working in hospital pharmacies with relation to the safe
disposal of drugs that have expired.

8. To provide insights into the establishment of more effective policies and practices that are
in alignment with requirements for public health safety and environmental sustainability.
RESEARCH METHODOLOGY

RESEARCH DESIGN

Type of Design: The research design for this study is a descriptive cross-sectional survey,
aimed at understanding local people's practices and awareness regarding the management and
disposal of near-expiry and expired medicines in hospital pharmacies. This design will
facilitate the collection of data at a single point in time, offering a snapshot of current
behaviors and attitudes within the target population.

DATA COLLECTION:

Primary Sources of Data Collection: The primary data will be collected using the following
methods:

1. Surveys: Structured questionnaires will be employed to gather quantitative data from local
people regarding their practices, knowledge, and attitudes toward the management and
disposal of near-expiry and expired medicines. The survey will aim to reach a diverse
demographic to ensure that the findings are representative of the broader community.

2. In-depth Interviews: To complement the survey data, semi-structured interviews will be

conducted with a select group of respondents. These interviews aim to provide deeper
qualitative insights into the reasons behind the practices, the level of awareness about
potential risks associated with improper disposal, and personal experiences related to the
topic.

Secondary Sources of Data Collection: Secondary data will be reviewed to enrich the primary
data findings and provide a contextual background for the study. This will include:

- Academic Journals: Review of existing research articles and studies on medication disposal
practices, public awareness regarding medication expiry, and the implications of improper
disposal.
- Government Reports: Examination of guidelines, policies, and reports from health and
environmental agencies that address the disposal of pharmaceutical products.
- Educational Material: Analysis of public health campaigns, educational programs, and
outreach initiatives aimed at improving public knowledge and practices related to expired
medication disposal.

SAMPLING DESIGN

Sampling Plan: The study aims to capture a comprehensive understanding of local people's
practices and awareness regarding the management and disposal of near-expiry and expired
medicines in hospital pharmacies. The target demographic will encompass individuals from
diverse backgrounds, including various ages, genders, educational levels, and socioeconomic
statuses, to ensure a broad perspective on the issue.

Sampling Method: The study will employ stratified random sampling to ensure the sample is
representative of the local population. The community will be divided into strata based on
relevant demographic factors such as age and gender. Subsequently, individuals will be
randomly selected from each stratum to participate in the survey, ensuring each subgroup is
proportionately represented.

Sampling Frame: The sampling frame will consist of local residents who are potential users
of pharmacy services. This may include members of community organizations, patients
registered with local healthcare providers, or individuals identified through community
centers.

Sampling Unit: Each local resident who agrees to participate in the survey or interview will
be considered a sampling unit. The focus will be on individuals who have had experiences
with hospital pharmacies, either personally or through family members.

Sampling Size: Given the scope of the study and the need for a manageable yet statistically
significant sample, the target sample size will be set at 100 respondents for the survey. This
number is deemed sufficient to provide a robust quantitative analysis while allowing for in-
depth qualitative insights from the subset of participants selected for interviews.
The sampling design is structured to ensure that the study captures a wide-ranging and
nuanced understanding of local people's behaviors, attitudes, and knowledge regarding the
disposal and management of expired or near-expiry medicines, aiming to inform effective
interventions and policy recommendations.
LIMITATIONS OF THE STUDY

1. Sample Size: The study's sample size of 100 respondents may limit the generalizability of
the findings to a larger population, particularly if the sample does not adequately represent
the diversity of attitudes and practices within the local community.

2. Self-Report Bias: The reliance on self-reported data through surveys and interviews may
introduce bias, as respondents may provide socially desirable responses or inaccurately recall
their behaviors and experiences regarding the management and disposal of near-expiry and
expired medicines.

3. Recall Bias: Participants may struggle to accurately recall past experiences or behaviors
related to medication disposal, leading to inaccuracies or inconsistencies in the data collected.

4. Limited Scope: The study focuses specifically on local people's practices and awareness
regarding near-expiry and expired medicines in hospital pharmacies. Therefore, the findings
may not be applicable to other settings or regions with different healthcare infrastructure and
practices.

5. Cross-Sectional Design: The cross-sectional design of the study only captures a snapshot
of attitudes and behaviors at a single point in time, limiting the ability to assess changes over
time or establish causal relationships between variables.

6. Social Desirability Bias: Respondents may provide answers that they perceive as socially
acceptable or desirable, rather than reflecting their true attitudes or behaviors, particularly in
interviews where they may feel pressure to conform to societal norms.

7. Resource Constraints: Limitations in time, budget, and personnel may restrict the depth of
data collection and analysis, potentially impacting the comprehensiveness and robustness of
the study's findings.

8. Language and Literacy Barriers: Language barriers or low literacy levels among some
participants may hinder their ability to accurately comprehend and respond to survey
questions, leading to potential misinterpretation of data.

9. Exclusion of Certain Groups: The study may inadvertently exclude certain demographic
groups or individuals who are less likely to participate in surveys or interviews, such as
marginalized communities or those with limited access to healthcare services.

10. External Factors: External factors such as changes in healthcare policies or public
awareness campaigns during the study period may influence participants' attitudes and
behaviors, which cannot be fully controlled or accounted for in the analysis.
 CHAPTER 3
DATA ANALYSIS AND INTERPRETATION

PROFILE OF RESPONDENTS

Question: Age Group

Age Group Frequency

20-30 40

31-40 30

41-50 20

Above 50 10

Frequency

10%
20-30
31-40
20% 40% 41-50
Above 50

30%
Interpretation: The majority of the respondents fall within the 20-30 age group, indicating a
younger demographic is more engaged in the survey.

Question: Gender

Gender Frequency

Male 45

Female 50

Prefer not to say 5

Frequency

Male Female Prefer not to say

Interpretation: Female participants slightly outnumber male participants, with a small

percentage opting not to disclose their gender.
Question: Education Qualification

Education Qualification Frequency

Primary Education 5

Secondary Education 15

UG 50

PG 25

Others 5

Frequency

Primary Education Secondary Education UG

PG Others

Interpretation: The data shows that individuals with undergraduate (UG) degrees are the
most represented group in this survey, followed by those with postgraduate (PG) degrees.
Question 1: How often do you check the expiry dates on medicines in a hospital pharmacy?

Options Frequency

Always 70

Sometimes 20

Rarely 5

Never 5

Frequency

Always Sometimes Rarely Never

Interpretation: A significant majority of the respondents (70%) always check the expiry
dates on medicines in a hospital pharmacy, indicating a high level of awareness and
diligence. However, there's a small fraction (5%) that never checks expiry dates, which could
pose a risk to patient safety. The data suggests that while most hospital pharmacy staff are
conscientious about monitoring medicine expiry dates, there is still room for improvement to
ensure that all medicines are safe for use.
Question 2: Have you ever encountered expired medicines in a hospital pharmacy?

Options Frequency

Yes 30

No 70

Frequency

Yes No

Interpretation: The majority of participants (70%) have not encountered expired medicines
in a hospital pharmacy, which is reassuring and suggests effective inventory management.
However, 30% of the respondents have encountered expired medicines, underscoring the
need for continuous vigilance and improved strategies to prevent the presence of expired
stock.
Question 3: What should be done with near-expiry medicines in a hospital pharmacy?

Options Frequency

Use them immediately in appropriate cases 40

Return them to the supplier 30

Donate them 20

Dispose of them safely 10

Frequency

Use them immediately in appropriate cases Return them to the supplier

Donate them Dispose of them safely
Interpretation: The most preferred action for near-expiry medicines is to use them
immediately in appropriate cases (40%), which maximizes their utility before expiration.
Returning them to the supplier is also a common strategy (30%), indicating a reliance on
supplier agreements for managing near-expiry stocks. Donating (20%) and safe disposal
(10%) are less favored options, suggesting that most staff prioritize utilizing the medicines or
returning them over other methods of mitigation.
Question 4: How confident are you in the procedures for handling expired medicines in your
hospital pharmacy?

Options Frequency

Very confident 50

Somewhat confident 30

Not very confident 15

Not confident at all 5

Frequency

Very confident Somewhat confident Not very confident Not confident at all
Interpretation: Half of the respondents (50%) are very confident in their hospital
pharmacy's procedures for handling expired medicines, which indicates strong procedural
awareness and training. However, a significant portion (20%) expresses less confidence,
highlighting a potential area for improvement in training or communication regarding the
procedures. Ensuring that all staff are confident in these procedures is crucial for patient
safety and compliance with regulatory standards.

Question 5: Do you check the expiry date when you purchase over-the-counter (OTC)
medicine?

Response Options Respondents

Always 65

Sometimes 25

Rarely 8

Never 2

Respondents

Always Sometimes Rarely Never

Interpretation: The majority of respondents (65%) always check the expiry date on OTC
medicines, demonstrating a good level of awareness and caution. However, the fact that 10%
rarely or never check expiry dates suggests a potential risk area where consumer education
could be enhanced to improve safety practices.

Question 6: Would you use a medicine if it was close to its expiry date but not yet expired?
 Response Options Respondents

Yes 45

No 40

Unsure 15

Respondents

Yes No Unsure

Interpretation: Responses are mixed, with 45% willing to use medicine close to its expiry
date, indicating a need for clearer guidance on the implications of using such medicines. The
15% of respondents who are unsure highlight a gap in public knowledge that could be
addressed through targeted education efforts.

Question 7: Have you ever received expired medicine from a pharmacy?

Response Options Respondents

Yes 10

No 85

Not sure 5

Respondents

Yes No Not sure

Interpretation: While the vast majority (85%) have not received expired medicine, the 10%
who have indicate a serious concern regarding pharmacy practices. This points to a need for
stricter controls and public awareness to ensure that consumers are receiving safe and
effective medications.
Question 8: What would you do if you discovered you had expired medicine at home?

Response Options Respondents

Use it if it's just a few days past expiry 15

Dispose of it immediately 70

Keep it just in case 10

Unsure 5

Respondents

Use it if it's just a few days past expiry Dispose of it immediately

Keep it just in case Unsure
Interpretation: A significant number of respondents (70%) would dispose of expired
medicine immediately, showing a strong inclination towards safe practices. However, the
15% who would still consider using medicine just past its expiry date and the 10% who
would keep it indicate areas where more education on the risks of expired medications could
be beneficial.
Question 9: If you discovered expired medicine in your home, would you seek advice on
what to do with it?

Response Options Respondents

Yes, from a pharmacist 45

Yes, from a healthcare provider 30

No, I would decide myself 20

Not sure 5

Respondents

Yes, from a pharmacist Yes, from a healthcare provider

No, I would decide myself Not sure
Interpretation: A majority of respondents would seek professional advice from pharmacists
(45%) or healthcare providers (30%) when they discover expired medicine, indicating a
responsible approach to handling such situations. However, the 20% who would decide
themselves what to do with expired medicines may benefit from more public information on
the importance of proper disposal.
Question 10: Do you believe expired medicines can still be effective or safe to use?

Response Options Respondents

Yes 10

No 85

Not sure 5

Respondents

Yes No Not sure

Interpretation: The vast majority (85%) of respondents correctly believe that expired
medicines may not be effective or safe, showing a good level of public awareness. However,
the 10% who think expired medicines can still be effective or safe highlight a misconception
that needs to be addressed through educational efforts.
Question 11: How likely are you to purchase over-the-counter medicine close to its expiry
date if it's on sale?

Response Options Respondents

Very likely 15

Somewhat likely 25

Unlikely 50

Never 10

Respondents

Very likely Somewhat likely Unlikely Never

Interpretation: Half of the respondents are unlikely to purchase near-expiry medicines even
if they are on sale, showing a cautious approach to medicine consumption. However, the 40%
who are very or somewhat likely to purchase such items might not be fully aware of the risks
associated with using near-expiry drugs.
Question 12: Are you aware of any community programs or resources available for the
disposal of expired or unused medicines?

Response Options Respondents

Yes 30

No 65

Not sure 5

Respondents

Yes No Not sure

Interpretation: A significant portion of respondents (65%) is not aware of community
programs or resources for the proper disposal of expired or unused medicines, suggesting a
need for increased promotion and visibility of these services. The 30% who are aware
demonstrate an opportunity to leverage these programs to improve safe disposal practices in
the community.
 CHAPTER 4
FINDINGS, SUGGESTIONS AND
CONCLUSION

FINDINGS

Insightful findings emerged from the survey that was carried out among the local population
in order to gain an understanding of their behaviors and awareness of the management of
drugs that are nearing their expiration date or have already expired. Checking the expiration
dates of medications before acquiring them is a proactive practice among a large majority of
participants. Many of these individuals make this check a priority in order to guarantee that
they do not drink items that have expired or are on the verge of expiration. Despite this
diligence, it appears that there is a gap in knowledge regarding the correct disposal of expired
medicines. This is because a significant number of respondents resort to practices such as
flushing them down the toilet or throwing them in the trash, both of which are practices that
are not friendly to the environment and could potentially pose health risks.

It is interesting to note that although a significant number of respondents are aware of the
need of checking expiration dates, a lower percentage of them stated that they would consider
using a drug after its expiration date if they believed it to be required. This highlights the
possibility of receiving more education on the dangers that are connected with such activities.
Not only that, but there is a wide range of confidence in recognizing the indications that
drugs have passed their expiration date beyond the written date, which suggests that there is
need for healthcare practitioners to provide more assistance on this particular element.

Additionally, the poll revealed that a sizeable proportion of the population has been educated
by pharmacists or healthcare practitioners regarding the significance of checking the
expiration dates of medications, which is a promising indication of the continued education of
the people regarding the need of maintaining good health. However, the fact that a significant
number of people are unsure about how to properly dispose of medicines that have expired
suggests that there is a need for more targeted educational campaigns to improve public
knowledge and practices in this area. This will ensure that pharmaceutical products are
handled in a responsible and safe manner.
SUGGESTIONS

The study revealed a number of holes in the way that local people handle and dispose of
drugs that are nearing their expiration date or have already expired. Several proposals have
emerged as a result of this survey. In the first place, there is an undeniable requirement for
all-encompassing public education campaigns that not only emphasize the significance of
checking the expiration dates of medicines but also offer direction on how to recognize the
indicators of diminishment in the quality of medicines. These initiatives have to make use of
a variety of communication channels, such as digital media, community workshops, and
healthcare settings, in order to guarantee an impact that is far-reaching.

Secondly, the poll reveals that there is a considerable lack of information regarding the
appropriate techniques for disposing of pharmaceuticals that have expired. As a solution to
this problem, local pharmacies, healthcare professionals, and community groups should work
together to organize and promote medicine take-back programs. These programs enable
individuals to dispose of their unwanted or expired prescriptions in a manner that is both safe
and kind to the environment. It is also possible to disseminate educational materials that
provide a step-by-step breakdown of the methods for disposal in order to increase public
awareness and encourage activities that are ecologically friendly.

In addition, taking into consideration the fact that some people have indicated that they are
prepared to use drugs that have expired if it is required, it is crucial to implement targeted
interventions that address the hazards that are connected with such activities. It is important
for healthcare practitioners to underline these concerns while interacting with patients.
Additionally, it may be good to distribute instructional booklets or digital material that
highlights the possible harms and ineffectiveness of expired medications.
Last but not least, considering that a sizeable proportion of respondents obtain information
from medical experts, bolstering these communication channels as trustworthy sources of
information might further enable consumers to make well-informed decisions concerning the
prescriptions they use. In the context of pharmaceutical use and disposal, the community has
the potential to make major steps toward enhancing public health safety and environmental
stewardship if it puts these proposals into action.
CONCLUSION

This survey on the habits and understanding of local people regarding the handling of near-
expiry and expired pharmaceuticals has shed light on numerous crucial insights about the
behaviors of the community as well as the knowledge gaps that exist within it. Although a
considerable number of people check the expiration dates on their drugs, a sizeable section of
the population continues to be unsure about the appropriate means for disposing of
pharmaceuticals, which might possibly be harmful to both the environment and public health.
The findings highlight the requirement of increased educational efforts to raise knowledge
about the hazards connected with drugs that have expired before their expiration date and to
promote proper disposal procedures. We are able to bring about a good shift in public
behavior by creating a collaborative strategy that involves healthcare practitioners,
pharmacists, and community groups. This will ensure that individuals are better aware and
prepared to manage their prescriptions in a responsible manner. It is not only essential for the
protection of human health that this collaborative effort is essential, but it is also essential for
the protection of our environment from the harmful impacts that incorrect disposal of
pharmaceuticals may have.
ANNEXURE

Question 1: How often do you check the expiry dates on medicines in a hospital pharmacy?
- Always
- Sometimes
- Rarely
- Never

Question 2: Have you ever encountered expired medicines in a hospital pharmacy?

- Yes
- No

Question 3: What should be done with near-expiry medicines in a hospital pharmacy?

- Use them immediately in appropriate cases
- Return them to the supplier
- Donate them
- Dispose of them safely

Question 4: How confident are you in the procedures for handling expired medicines in your
hospital pharmacy?
- Very confident
- Somewhat confident
- Not very confident
- Not confident at all

Question 5: Do you check the expiry date when you purchase over-the-counter (OTC)
medicine?
- Always
- Sometimes
- Rarely
- Never
Question 6: Would you use a medicine if it was close to its expiry date but not yet expired?
- Yes
- No
- Unsure

Question 7: Have you ever received expired medicine from a pharmacy?

- Yes
- No
- Not sure

Question 8: What would you do if you discovered you had expired medicine at home?
- Use it if it's just a few days past expiry
- Dispose of it immediately
- Keep it just in case
- Unsure

Question 9: If you discovered expired medicine in your home, would you seek advice on
what to do with it?
- Yes, from a pharmacist
- Yes, from a healthcare provider
- No, I would decide myself
- Not sure

Question 10: Do you believe expired medicines can still be effective or safe to use?
- Yes
- No
- Not sure
Question 11: How likely are you to purchase over-the-counter medicine close to its expiry
date if it's on sale?
- Very likely
- Somewhat likely
- Unlikely
- Never

Question 12: Are you aware of any community programs or resources available for the
disposal of expired or unused medicines?
- Yes
- No
- Not sure
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