AGA KHAN UNIVERSITY HOSPITAL PROMOTES RATIONAL MEDICINES USE THROUGH PHARMACY AND THERAPEUTICS COMMITTEE Sital Shah BS

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 DUE’s • 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 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

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 DUE’s] • 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 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

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. 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

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