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AGA KHAN UNIVERSITY HOSPITAL PROMOTES RATIONAL MEDICINES USE THROUGH PHARMACY AND THERAPEUTICS COMMITTEE Sital Shah BSc, M.PharmS

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AGA KHAN UNIVERSITY HOSPITAL PROMOTES RATIONAL MEDICINES USE THROUGH PHARMACY AND THERAPEUTICS COMMITTEE Sital Shah BSc, M.PharmS. Opportunities & Challenges in Hospital Pharmacy Practice in Kenya The Panafric Hotel, Nairobi, March 24, 2007. Presentation Outline.

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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

presentation outline
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 DUE’s
  • Lessons Learned
mission statement of akuh n pharmacy services
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
strengths of the akuh n ptc
Strengths of the AKUH(N)-PTC
  • Established in 1998
  • PTC works towards hospital’s 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
strengths of the akuh n ptc6
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”
responsibilities of akuh n ptc
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
accomplishments of akuh n ptc
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]
accomplishments of akuh n ptc9
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 DUE’s]
  • Decreased adverse drug reactions (ADRs) and medication errors- [monitored though reporting]
successful formulary management training experience sharing by ptc
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 CEO’s
  • Best practices in managing the drug formulary discussed through case studies, examples and cost-effective measures
  • Each hospital was asked to provide action plan
promoting rational use of medicines experience of ptc
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
methods what was the intervention
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)
slide13

WHO-INRUD Prescribing Indicators

Sample Size:

50 prescriptions x 6 days = 300 Prescriptions

Baseline – January 2006

May 2006

2.4

43%

37%

10%

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

Formulary Management for Injections
how was education provided for the six injections
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.
savings to hospital drug administrative costs comparison of two periods
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

lessons learned
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
lessons learned19
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
conclusions
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
conclusions21
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
acknowledgements
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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