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KENYATTA NATIONAL HOSPITAL

KENYATTA NATIONAL HOSPITAL. PROMOTING RATIONAL USE OF ANTI-RETROVIRALS (ARV) AT KENYATTA NATIONAL HOSPITAL (KNH) IN KENYA. BY OGILE ELIZABETH BPharm Pg Cert EDM & RDU MPSK. Authorized Establishment -6,212 In-post -5,225 KNH has a total of 9 pharmacies.

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KENYATTA NATIONAL HOSPITAL

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  1. KENYATTA NATIONAL HOSPITAL

  2. PROMOTING RATIONAL USE OF ANTI-RETROVIRALS (ARV) AT KENYATTA NATIONAL HOSPITAL (KNH) IN KENYA BY OGILE ELIZABETH BPharm Pg Cert EDM & RDU MPSK

  3. Authorized Establishment -6,212 In-post -5,225 KNH has a total of 9 pharmacies

  4. INTRODUCTION AND PROBLEM STATEMENT • HIV/AIDS has been viewed to affect productivity of workers and also to increase health treatment cost. KNH also faced a similar problem. ( Ref Kenya HIV/AIDS business Council Report ) . • In Feb1998 the KNH management decided to avail free ARV treatment to staffs as non – scheduled/ Extraformulary drug. • In June 1999, the situation was getting out of hand. • There were no clear guidelines for prescribing and dispensing the ARVs. • There were no proper records. Staff collected drugs from any pharmacy. The buying and supply of ARV was very erratic. • Further investigations revealed that ARV prescribing was from other sources, not specialists only. A number of prescriptions were not genuine. There was no monitoring and follow up on the genuine patients. • Frequent stock out periods.

  5. The hospital management mandated the Medical Advisory Committee ( MAC) to review the situation and then make recommendations.

  6. OVERALL GOAL • MAC came up with the following policy interventions to be implemented at prescribing and pharmacy levels.

  7. SETTING AND POPULATION • Kenyatta National Hospital. • Staffs diagnosed to be HIV/AIDS positive and presented with prescriptions in the pharmacy ( about 100 patients )

  8. INTERVENTIONS ( MARCH 2000 ) • MAC recommendations were implemented at prescribing and dispensing level. PRESCRIBING • Limiting prescribing to only 3 appropriately trained clinical specialists and ensuring that each patient had a specific file opened. • The staffs had to take their prescriptions for countersigning by the Deputy CEO ( Clinical Service ) for verification.

  9. INTERVENTION The following procedures were implemented:- • The hospital management decided that prescribing of ARVs be limited to only 3 appropriately trained clinical specialists and based on hospital approved treatment schedules. • Introducing a requirement that authority must be sought from deputy Chief Executive Officer (clinical services) before a prescription is dispensed.

  10. INTERVENTION….CONTD DISPENSING • Dispensing was centralized to one pharmacy. • The dispensers ensured that prescriptions were countersigned and also had the recommended combinations. • Patients were required to purchase an item out of stock and bring to the pharmacy to receive available drugs ( Provision for reimbursement ). • Computerized record keeping system was introduced in the pharmacy. • ARV monitoring form was introduced in march 2001.

  11. RESULTS • Preliminary results show that 16% of the ARV prescriptions as at June 1999 were not genuine ( not real patients ). • The situation as at March 2001 show that there was still about 2% of ungenuine prescriptions. • We have created a database for monitoring ARV therapy and for controls.

  12. KENYATTA NATIONAL HOSPITAL ARV THERAPY MONITORING FORM Personal Details Patient Number: Patient Name: Gender: Address: Age: Tel: Weight: E-mail: BSA: Clinical Parameters

  13. Antiretroviral Therapy

  14. Dispensing

  15. LESSON LEARNT • It is difficult to manage ARV treatment of staffs by staffs. • Simple policy interventions can be used effectively to promote Rational ARVS usage. BUT …….. The patients were getting tired ( complaining ).

  16. CONCLUSION • Comprehensive care unit was set in October 2002 • Comprehensive care unit ( CCU ) borrowed the concepts of the policy interventions. • In April 2003 the staffs HIV/AIDS management programme was intergrated into CCU program.

  17. THANK YOU special support Dr. Mary Ojoo Mr. Mwangi Maina

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