AGA KHAN UNIVERSITY HOSPITAL PROMOTES RATIONAL MEDICINES USE THROUGH PHARMACY AND THERAPEUTICS COMMI - PowerPoint PPT Presentation

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AGA KHAN UNIVERSITY HOSPITAL PROMOTES RATIONAL MEDICINES USE THROUGH PHARMACY AND THERAPEUTICS COMMI

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Opportunities & Challenges in Hospital Pharmacy Practice in Kenya ... Tramadol 100mg Inj. Zantac 50mg Inj. Rationale for Removal of Three Injections ... – PowerPoint PPT presentation

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Title: AGA KHAN UNIVERSITY HOSPITAL PROMOTES RATIONAL MEDICINES USE THROUGH PHARMACY AND THERAPEUTICS COMMI


1
AGA 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

2
Presentation 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

3
AKUH(N) Human Resources and Number of Patients
Served
4
Mission 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

5
Strengths 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

6
Strengths 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

7
Responsibilities 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

8
Accomplishments 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

9
Accomplishments 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

10
Successful 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

11
Promoting 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

12
Methods 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)

13
WHO-INRUD Prescribing Indicators

Sample Size 50 prescriptions x 6 days 300
Prescriptions
Baseline January 2006
May 2006
2.4 43 37 10
14
Formulary 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

15
Rationale for Removal of Three Injections
16
How 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.

17
Savings 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
18
Lessons 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

19
Lessons 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

20
Conclusions
  • 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

21
Conclusions
  • 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

22
Acknowledgements
  • Pharmacy Therapeutics Committee at AKUH
  • Rational Pharmaceutical Management (RPM) Plus
    program of Management Sciences for Health (MSH)
    for their technical assistance
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