Injectable stock and expiry control

Injectable stock is the most expensive asset in an orofacial harmonization (HOF) clinic and, at the same time, the easiest to lose silently. A vial that expires in a drawer, a box that sat out of the fridge for hours, a lot that was not noted in the patient record: none of these events makes noise at the time, but all of them become a problem later, financial or sanitary.

This page proposes a simple control method, at an operational level, for small and midsize clinics. It does not replace each product's instructions for use or the requirements of the local health authority, which should be consulted directly.

Why does stock in HOF need a method?

Three characteristics of the field make control more critical than for other kinds of stock:

1. Short shelf life and high cost: many products have a set expiry and a high price per unit.
2. Sensitivity to storage: some require refrigeration, and a temperature failure is not always visible.
3. Traceability required in practice: in the event of a complication or a health alert, you need to know which lot was used on whom.

Each product's instructions for use define its storage conditions. See how to read an injectable's instructions for use. For toxin-specific routines, see botulinum toxin storage and managing botulinum toxin vials.

How do you organize stock physically?

Organization reduces errors and saves time. The principles are few:

• Defined, limited location: a cabinet or fridge used only for health products, away from food and from public access.
• Separation by category: fillers, toxins, biostimulators, anesthetics, hyaluronidase, and disposables in separate areas.
• First expired, first out (FEFO): the product closest to expiry goes in front, and the newest goes behind.
• Visible label: product name, lot, and expiry date, even if the box already shows them, for quick checking.
• Quarantine area: a separate space for expired, damaged, or storage-doubtful product, labeled and out of use.

How do you take care of the cold chain?

The cold chain is the set of precautions that keep the right temperature from the manufacturer to the point of use. The weakest links are transport, receiving, and the clinic's refrigeration. See the glossary entry on cold chain.

If the temperature went out of range, do not decide on your own. Consult the product's instructions and the manufacturer's customer service. If in doubt, take the lot out of use, record the event, and keep the evidence.

How do you control expiry and lot?

Control has two ends: stock and the patient record.

In stock, keep a spreadsheet or a simple system with columns such as product, lot, expiry, quantity, location, and date received. Update it with every item in and every item out. A monthly check, with a fixed date and an owner, avoids surprises.

In the patient record, record the product, lot, expiry date, and area at every visit. This information supports traceability (see traceability of injectables) and lets you act fast if there is an alert about a lot. Reinforce the habit with the page on patient record and documentation in HOF.

The frequencies are organizational suggestions, and the local health authority or the technical lead may require a different interval.

How much should you buy? How do you avoid losses to expiry?

Buying a lot to get a discount often turns out costly if the product expires before it is used. To calibrate, look at:

• real turnover: how many units of each product went out in the past few months;
• remaining shelf life on arrival: prefer lots with a comfortable expiry date;
• seasonality of the schedule, with busier and slower periods;
• size of the product range: the more items, the greater the chance of some sitting idle on the shelf.

Hypothetical example: if a product moves two units a month, buying a year's worth at once may mean losing part of the stock to expiry. A smaller stock and more frequent reordering may cost a little more per unit but reduce waste.

For hyaluronidase, the reasoning changes: it must be available, within its expiry date, even if rarely used, because it is an emergency item. See hyaluronidase in the clinic and HOF clinic emergency kit.

What should you do with expired, tampered, or doubtful product?

The correct destination depends on the type of product and local regulations. In general terms:

1. Remove it from active stock immediately and place it in the labeled quarantine area.
2. Record the product, lot, expiry date, quantity, and reason.
3. Dispose of it under the clinic's waste management plan. See disposal of sharps and PGRSS in HOF.
4. Notify the supplier in case of a problem lot and, where appropriate, report it to the health authority (see adverse event reporting: Notivisa, Brazil's health surveillance system).

Never reuse an opened vial, leftover product from another patient, or a used syringe. The rule also applies to products of uncertain origin: always check the health registration as described in how to check an injectable's registration with Anvisa.

Who should be responsible for stock?

In small clinics, the practitioner does everything, and that is a risk. Assign one person responsible for stock, with a backup, and write the procedure down. The technical lead keeps oversight, but the daily routine should be shared so it does not depend on memory.

If you use Harmy, remember that the app does not control stock: it helps with planning and quoting with the patient, through an illustrative projection and a PDF with the price per area. The planned volume in ml in the app is a reference for the conversation, and the actual product consumption is still recorded by you in the patient record.