Mercy Ships Formulary 2006-2007

1. Mercy Ships Formulary2006-2007

2. The Good Samaritan parable (1) • Luke 10:30-35 • The Good Samaritan and Scarce Medical Resources • Reproduced by permission from Christian Scholar's Review XXIII:3, March 1994, pp. 360-373.

3. The Good Samaritan parable (2) • Sanctity – the respect of humanity • Compassionate care • Just care • Scarcity – limited resources • Be honest: acknowledge our limitations • Be humble: acknowledgeour interdependence

4. The Good Samaritan parable (3) • Scarcity – Need for Stewardship • Rational selection of treatment options • Maxillofacial Surgeries • Eye Surgeries & Care • Dental Surgeries & Care • VVFs & Orthopaedics • Community Health

5. The Good Samaritan Parable (4) • Scarcity – Need for Stewardship • Rational selection of medicines • WHO essential medicines list www.who.int/medicines/ • IDA available generics www.idafoundation.org • Annual regular donor sources • Optimise resources (financial/human) • procurement & inventory management • medicines administration, dosing & prescribing • Optimise space • Minimise wastage (esp. expired meds)

6. Mercy Ships Formulary • History of development • July 2002 first essential drugs LIST established from M/V Anastasis 2002 outreach experience • Sep 2002 work started on first formulary BOOK draft • Dec 02 - mar 03 first draft review & proof reading • Apr - Jun 2003 test pilot during active outreach, volunteers’ Continuous feedback from field & IOC • Jul - Aug 2003 final draft review & proof reading • Aug - sep 2003 200 copies printed at USD 3.00 per book • Nov 2003 training materials and books distributed to ships, IOC and other land bases

7. Mercy Ships Formulary • History of development • 2003 - 2004 continuous feedback and update of LIST (e.g. New MSL requirements, different availability in IDA catalogues, changes from WHO recommendations.) • Jan 2005 work started on second BOOK edition • July 2005 latest WHO essential list published • Sep 2005 attended WHO/UNICEF essential medicines technical briefing seminar in Geneva, decision to include WHO notes/guidelines • Dec 2005 final draft review & proof reading • Feb 2006 200 copies printed for distribution

8. Mercy Ships Formulary • Review involved current and ex-volunteers, of long & short term experiences, from developed & developing countries • Proof reading involved 32 personnel, including administrators, anaesthetists, surgeons, physicians, nurses, pharmacists, radiographers/lab technicians IT & printing support • Second edition proofreaders include health professionals of diverse backgrounds and specialties outside of MSI • Third edition planned in two years, formulary list to be reviewed and updated every six months

9. Mercy Ships Formulary • Dosages based on: • WHO model formulary 2004/6, www.who.int/medicines/ • British national formulary, www.bnf.org • The Micromedex healthcare series online, www.micromedex.com • Essential drugs practical guide, Doctors without borders or MSF www.msf.org • Online networks: « HIF-net at WHO », www.inasp.info « E-DRUG », www.essentialdrugs.org/edrug « Afro-net », SATELLIFE www.healthnet.org

10. Mercy Ships Formulary • First edition made available for free downloading on www.drugref.org since November 2003. • 3229reads of the article • 1053 downloads of the formulary .doc file • 931 downloads of the formulary .pdf file. • Also available on www.ms-information.org and the Anastasis intranet • Requests for use include: • community health centres in Kenya, hospital in Nigeria, university in India, hawaii www.wheelchair-kauai.com

11. Mercy Ships Formulary • Formulary (F) medicines: • 336 items [former list 327 items] 126 • Outreach-critical medicines • Consistent availability • Sought actively as donations • Purchased from the international dispensary association (IDA) www.idafoundation.org • Assured quality generics, supplier to agencies/NGOs e.G. UN, UNICEF, MSF

12. Mercy Ships Formulary • Donation (D) medicines: • Additional 55 items [former list 37] 6 • Medicines totally dependent on donations • Regular donors • E.G. Tylenol, Alcon eye preps • High cost • Third-line treatments • Drugs with generic alternatives

13. Mercy Ships Formulary • Hands-on session

14. Mercy Ships Formulary • Table of contents • Preface: how to use the book • EML – WHO essential medicines list item • MSL – mandatory sailing list item • N/CD – narcotics/controlled drugs° • PS – psychotropic substances° °Legal requirements for records & stock

15. Mercy Ships Formulary • Bibliography & acknowledgements • Introduction to essential medicines • Prescription writing guidelines • See abbreviations at the end of the book • Main chapters 1-14 – BNF model • Gastrointestinal system, anaesthetics • (New) WHO notes and recommendations e.g. Treatment of dehydration

16. Mercy Ships Formulary • Appendices: prescribing in children, pregnancy, breastfeeding, elderly • (New) table of drugs to avoid or use with caution in pregnancy & breastfeeding • Index: search by - • Generic name (acetaminophen or paracetamol) • Brand name example (Tylenol) • Pharmacological category (NSAIDs) • (New) disease or indication (angina) • Table of values, conversions & units • Abbreviations

17. Mercy Ships Formulary • Chapters, listed by physiological systems • E.G. Cardiovascular system, ENT --- BNF model • Sections, listed by pharmacological categories • E.G. Antacids, Penicillins --- BNF model • Medicines, listed A-Z by generic name (with brand name examples) • E.G. Ketoconazole (Nizoral) • Comment/cautions notes

18. Mercy Ships Formulary • Features to be considered for addition in future editions (feedback from first ed.): • Table of Drug Interactions • Table of Drugs vs. Pregnancy - done • Table of Drugs vs. Breast-feeding - done • Search by diseases/indication in Index - done

19. Mercy Ships Formulary • Feedback & suggestions: • Formulary Editor/Pharmacist kae.trouilloud@mercyships.org • Current Pharmacist • Current Crew Physician • Current Ward Supervisor

20. Mercy Ships Formulary ‘Go and do likewise.’ Luke 10:37