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Clinical Pharmacy Services at a public sector hospital. The Children’s Hospital & Institute of Child Health, Lahore. Zaufishan Rahman. The Children Hospital & Institute of Child Health. State of the art - Tertiary care hospital Centre of Excellence - PowerPoint PPT Presentation
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CLINICAL PHARMACY SERVICES AT A PUBLIC SECTOR HOSPITAL
Zaufishan Rahman
The Children’s Hospital & Institute of Child Health, Lahore
The Children Hospital & Institute of Child Health
State of the art - Tertiary care hospital Centre of Excellence 45 different specialties in medicine, surgery and
diagnostics 418 beds strength The hospital OPD operationalized in May 1995 and
emergency in October 1996 In-patient services were first initiated in December
1998
Department of Pharmaceutical Services
How the Pharmacy Services are different today?
In changing times…. a need for pharmacists to shift their focus a need to target outcomes that matters a need to take responsibility for outcomes
....thereby, a need to provide patient centered care
Patient Centered Care
Pharmaceutical care is:
“The cooperative and responsible provision of drug therapy for the purpose of achieving definite outcomes that improve the patient’s quality of life”
PHARMACEUTICAL CARE PLANS
Key elements
Drug Individualization All pediatric patients need weight based dosing;
hence at increased risk of adverse events
Monitoring of Drug Interactions Monitoring of In-Vitro and In-vivo drug
interactions
Monitoring and Reporting of potential ADRs
Pharmaceutical Care Planning
Patient Category Pharmacist’s Role
1. Patients on polypharmacy
To check each drug for indication, effectiveness, safety, and compliance.
To suggest reduction of doses or drugs
To advice on how to minimize adverse effects, and on best timing to take each drug in relation to other drugs, meal times, daily activities, etc
Pharmaceutical Care Planning
Patient Category Pharmacist’s Role
2. Patients with actual orpotential DRPs
To follow a structured process to identify actual or potentialdrug-related problems and
To develop a plan to eliminate or minimize these problems and maximize desired outcomes
Patient Category Pharmacist’s Role
3. Patients who requireeducation to improve theircompliance with drugtherapy
To discuss the issues with patients to gauge the reasons for poor compliance and
Devising plans to improve compliance and concordance
Pharmaceutical Care Planning
Pharmaceutical Care Planning
Patient Category Pharmacist’s Role
4. Patients on medicines which require the use of Devices as- Asthma inhalers- Glucometers
To identify problems with how thepatient use the drug givingdevices and
To train the patient on the properuse of devices to maximizethe benefit of the drugs.
Pharmaceutical Care Planning
Patient Category Pharmacist’s Role
5. Patients on potentiallyharmful drugs which requireeducation and monitoring(warfarin, steroids,chemotherapy)
To educate the patients on theuse of drug with potentialfor serious adverse effectsor for drug-drug or drug foodinteractions, and alsothose drugs which requiremonitoring to avoid harmfuleffects
Pharmaceutical Care Planning
Patient Category Pharmacist’s Role
6. Patients referred by theirclinicians
Clinicians may wish to refer specific patients to the service when they identifyan issue where the pharmacist might haveappropriate input
Extended Scope of clinical pharmacy services
Participation in clinical rounds Drug information centre services Poisoning & Drug Overdose management services Total Parental Nutrition (TPN) Extemporaneous Preparations Clinical training program Hospital Clinical Committees
Participation in Rounds
1 Working in a multidisciplinary team Interaction with patient’s other
healthcare providers Ensuring best clinical outcomes Preparation and Implementation of
Pharmaceutical Care Plans
Drug information Centre Services
2Provision of unbiased, scientific and up to
date information to health care professionals
Concept Paper Protocol Tools:
DIC Query Form – A DIC Query Form – B DIC Query Referral Form - C
Clinical Pharmacist as Information Manger:….….Assessing the Evidence Where and When you need it!
Developing Liaison with other Drug Information Centres and creating a network of knowledge banks, nationally & globally.
Poisoning & Drug Overdose Management
3 24/7 Presence of Pharmacist in Emergency
Department Availability of antidotes Backup support from Drug Information Centre Examples:
Management of Kerosine oil poisoning Management of patient who has ingested milk with
a lizard
Total Parental Nutrition (TPN)
4 First of its kind in any public sector hospital
in Punjab Caters individual needs of patients Plays a significant role in reducing the
morbidity and improving the quality of life of patients
Ensuring aseptic environment with use of Laminar Flow Hoods
Provision of services to other hospitals
TPN During last 1 year i.e. December 2010 to
November 2011: A total of 1202 calls have been received by TPN
department More than 244 pediatric patients benefited
Dispensing an average of 100 calls per month Dispensing an average of 5 TPN calls per patient
Extemporaneous Preparations
5Sr.
No
Preparations Used in/ for
1. Zinc Sulphate Sachets Zinc deficiency with diarrhea
2. Zinc Acetate Sachets Wilsons Disease
3. Jouli’s Solution Hypo-phosphatemia Rickets
4. Hydrosol, Eusol Solution Wet dressings (Irrigation Solution)
5. Sodium Benzoate Solution Urea cycle defect and hyperammonemia
6. Dexinal Mouthwash Oncology Patients
7. Morphine Suspension Oncology Patients
8. Shohl’s Solution (Polycitra, Polycitra-K, Bicitra)
Renal tubular acidosis
9. Tablet dilutions of Digoxin, Sildenafil, Indomethacin, Spiromide
Pediatric Cardiology Unit
Clinical Training Programs (>400 students/ year)
6 Clinical Pharmacy Residency Program
Eligibility: Graduates and Awaiting result students
Clinical Pharmacy Projects Eligibility: 5th Professional Students
Clinical Pharmacy Internship Program Eligibility: 4th Professional Students
Hospital Clinical Committees
7 Pharmacy & Therapeutics Committee
Comprises of all department heads, Assistant and Associate Professors, Pharmacists and administration.
Hospital Infection Control Committee:Pharmacists as key members of team for effective infection control measures
Clinical Pharmacy Services
CASE SCENARIOS
“… and if anyone saved a life; it would be as if he saved the life of whole mankind”
Case 1: Thalasemia Major Patient Name: Sarfaraz Age : 6 years Weight: 18 kg History of present illness:Patient is presented in OPD with generalized body aches,
abdominal distention due to massive splenomegaly and significantly darkened skin tone.
Pharmacist’s Intervention:Patient’s attendants are counseled for regular and consistent use
of agents that treat Iron overdoe (Deferasirox) and regular Serum Ferritin test
Case 2: Bronchial Pneumonia Patient Name: Zihan Age: 7 months Weight: 5kg Current Medication:
Paracetamol, Cefuroxime, Amikacin Nebulize with Aprint, N/Saline and
Clenil
Pharmacist’s Intervention:Patient’s mother education and
counseling on proper nebulizing technique
Case 3: Pericardial Effusion Patient Name: Minahil Age: 2 months Weight: 3.2 kg Current Medication:
Inj. Ceftrioxone, Inj. Lasix, Inj. Vancomycin
Pharmacist’s Intervention:Patient at increased risk of ototoxicity with combination
of Ceftrioxone and Furosemide; Close monitoring is recommended after consultation with doctor
Case 4: Pneumonia and Sepsis Patient Name: Iman Fatima Age: 21 days Weight: 2.2 kg Medication:
Inj. Meropenam and Inj. Vancomycin are prescribed to patient after resistance to Ciprofloxacin, Ceftrioxone, Amikacin and Amoxicillin
Pharmacist’s Intervention: Pharmacist ensured that culture sensitivity test is done before prescribing
the third line therapy. Culture was positive for Klebsella and Enterobacter Separate administration of Ceftrioxone and Amikacin was recommended
to nurse as these drugs can interact when administered together.
Case 5: Nephrotic Syndrome with Acute Renal Failure
Suspected Meningococemia Patient Name: Abdul Malik Age: 16 months Weight: 10kg Medication:
Inj.Benzyl Penicillin, Inj. Solucortif, Inj. Ceftrioxone 500mg IV 12 hourly, Syp Mucain 1tsf 8 hourly, Inj Ranitidine 5mg IV 6 hourly and others
Pharmacist’s Intervention:- Dose of Ceftrioxone and Ranitidine is correct for normal patient
but should be reduced to half for patient with severe renal impairment
Case 6: Pseudo- Pancreatic Cyst
Patient Name: Zainab Age: 2.6 years Body weight:
On 1st day of admission her body weight was 9.2kg. On 24th day of hospital stay on 3 December, 2011 she was NPO since last 31 days and all the required nutrients are being given to her through central and peripheral lines as parental nutrition.
Her last recorded body weight is 10kg.
Patient maintained body weight with significant improvement in clinical outcomes and resumed oral feed
Way Forward
WHAT'S NEXT?
Extension of Clinical Services Workshop on Identification of potential ADRs monitoring and reporting
Doctors, Pharmacists and Nurses
Workshop on Poisoning and Drug Overdose Management
Drug Utilization Reviews Utilization review of Meropenam – In Process Others - In design phase
Impact Assessment Studies Impact assessment study of TPN in improving quality of life of neonatal
patients
Access to healthcare is a fundamental human right!
“Of all forms of inequality, injustice in health care is the most shocking and inhumane”
Martin Luther King, Jr
Every Single Life is Valuable….!
UNICEF Missing Mothers a video message on maternal mortality.mp4
THINK GLOBAL ….…. ACT LOCAL!Thankyou!
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