Title: AGA KHAN UNIVERSITY HOSPITAL PROMOTES RATIONAL MEDICINES USE THROUGH PHARMACY AND THERAPEUTICS COMMI
1AGA KHAN UNIVERSITY HOSPITAL PROMOTES RATIONAL
MEDICINES USE THROUGH PHARMACY AND THERAPEUTICS
COMMITTEE Sital ShahBSc, M.PharmS
- Opportunities Challenges in Hospital Pharmacy
Practice in Kenya - The Panafric Hotel, Nairobi, March 24, 2007
2Presentation Outline
- Aga Khan University Hospital, Nairobi (AKUH-N)
- Pharmacy Therapeutics Committee (PTC)
- Effective implementation of responsibilities
- Recent accomplishments of PTC
- Promotion of rational use of drugs
- Evidence and experience of using WHO-INRUD
prescribing indicators - Successful formulary management
- Performing DUEs
- Lessons Learned
3AKUH(N) Human Resources and Number of Patients
Served
4Mission Statement of AKUH(N) - Pharmacy Services
- At The Aga Khan Hospital, pharmacists improve
medicine use by working with the
multidisciplinary ward team, including the
patient, and providing advice and information
that promotes safe, rational and economic
medicine use - PTC effectively works towards this mission
statement
5Strengths of the AKUH(N)-PTC
- Established in 1998
- PTC works towards hospitals mission
- Wide representation (12 members from multiple
disciplines) - Clear terms of reference
- Frequent PTC meetings (12 in 2005 15 in 2006)
- Good attendance in meetings (average - 80)
- All PTC meetings documented through minutes and
are archived
6Strengths of the AKUH(N)-PTC
- PTC staff are well trained
- Chief Pharmacist (PTC secretary) trained in
International Drug Therapeutics
Committee-Training of Trainers course in Nov-Dec
2005, in Malaysia - Organized by University of Science Malaysia and
RPM Plus program of Management Sciences for
Health in collaboration with WHO - Member of recently established Antibiotics
Consensus Group of Kenya
7Responsibilities of AKUH(N)-PTC
- Advise other departments on drug use issues
- Develop drug policies and procedures
- Evaluate and select drugs for the formulary
- Assess drug use to identify potential problems
- Promote effective interventions to improve drug
use (including educational, managerial, and
regulatory methods) - Manage adverse drug reactions
- Manage medication errors
8Accomplishments of AKUH(N)-PTC
- Selected effective, safe, high quality,
cost-effective drugs for the formulary- a formal
process is in place - Improved drug procurement and inventory
management - Management of drug costs- ABC analysis
- Improved the use of drugs by intervention studies
e.g. prescribing indicators - coupled with
feedback education to improve quality of
patient care treatment outcomes
9Accomplishments of AKUH(N)-PTC
- Increased staff and patient knowledge-
newsletters and in-service education - Managed antimicrobial resistance- established an
antimicrobial sub-committee, working on
antibiotic guidelines, performed DUEs - Decreased adverse drug reactions (ADRs) and
medication errors- monitored though reporting
10Successful Formulary Management
TrainingExperience Sharing by PTC
- Two day training was organized on formulary
management for AKUH staff from Mombasa, Kisumu
and Dar es Salaam in November 2006 - 3 pharmacists, 6 doctors and 3 CEOs
- Best practices in managing the drug formulary
discussed through case studies, examples and
cost-effective measures - Each hospital was asked to provide action plan
11Promoting Rational Use of Medicines Experience
of PTC
- Setting AKUH(N) Outpatient (PHC) Department
- Average of 1400 drugs dispensed each day
- Average of 400 patients seen each day
- The Problem
- High incidence of injection use observed
- Irrational use in some cases
- Evidence in numbers was lacking
12Methods What was the Intervention?
- PTC approved conducting drug use study at
outpatient department - WHO-INRUD prescribing indicators were applied and
data was shared in PTC meeting involving the head
of outpatient department - The PTC decided to remove three injections and
provide education on rational use for six other
injections - Five months later, prescribing indicators were
applied again (May 2006)
13WHO-INRUD Prescribing Indicators
Sample Size 50 prescriptions x 6 days 300
Prescriptions
Baseline January 2006
May 2006
2.4 43 37 10
14Formulary Management for Injections
- Removed
- (March 2006)
- Aspegic 500mg Inj
- Augmentine 1.2g Inj
- Paracetamol 300mg Inj
- Education provided (April 2006 onwards)
- Buscopan 20mg Inj
- Hydrocortisone 100mg Inj
- Metoclopromide 10mg Inj
- Diclofenac 100mg Inj
- Tramadol 100mg Inj
- Zantac 50mg Inj
15Rationale for Removal of Three Injections
16How was Education Provided for the Six
Injections?
- Critical review of the use of these injections
were discussed by PTC - Bioavailability studies reviewed between oral and
intramuscular forms - Guidelines were developed for these six
injections - Where absolutely necessary the injection was
administered after considering oral option.
17Savings to Hospital (drug administrative
costs)Comparison of Two Periods
Education provided from April 06 onwards
Savings 122,000 Ksh
Savings 101,028 Ksh
Savings 57,351 Ksh
18Lessons Learned
- Use of evidence such as Prescribing Indicator
studies helped the PTC learn about irrational use
of injections - Support from the Head of the outpatient
department was vital, contributing to the success
of the intervention - Irrational use of injections in the outpatient
clinic (PHC) made it necessary to develop
specific guidelines for use
19Lessons Learned
- Prescribing Indicators are a valuable tool to
monitor use of certain medicines in the PHC - Quarterly reporting by casualty pharmacy
supervisor and team leaders in the outreach
centers contribute to improved drug use - Monthly reporting results in sustainability of
the intervention and capacity building of staff
20Conclusions
- PTC at AKUH(N) is effective and has demonstrated
that it can improve the use of drugs - Effective multidisciplinary teamwork, leadership
and support from senior management is vital - Pharmacy professionals are important in a PTC and
in improving the quality of healthcare
21Conclusions
- Periodic training of key staff in concepts of a
PTC and methods to improve drug use is necessary - This presentation clearly demonstrates results
from participating in International DTC training
courses knowledge transfer - For every challenge, there is an opportunity
22Acknowledgements
- Pharmacy Therapeutics Committee at AKUH
- Rational Pharmaceutical Management (RPM) Plus
program of Management Sciences for Health (MSH)
for their technical assistance