Dr. Rosaline KinuthiaClinical pharmacist

KNH

• Optimize patients outcomes through the judicious, safe, efficacious, appropriate and cost effective use of medicines

• Should be engaged in all steps of the medicine use process

• The core of pharmacy activity involves: Supply of medication and other health care

products of assured quality Appropriate information and advice for the

patient Monitoring the effects of medicine use

204/19/23

Physiological changes due to acute stress affects disposition and response to drugs

- renal and hepatic blood flow, organ failure, protein binding etc

Large number of drugs hence increased interactions

Fluid restriction - consider in drug dilutions Drug incompatibilities and limited sites of

access Available dosage forms, intended use, gut

status, duration of action, urgency, hemodynamics

304/19/23

Management of medicine use Ensure an appropriate selection of

medicines is stocked and readily available

Ensure proper and safe storage of medicines and applicable nutritional products in and out of pharmacy

Review medication orders for appropriateness

404/19/23

Advise on drug reconstitution, dilution, rates of administration

Checking and advising on y-site or iv incompatibilities for iv medicines

Identify and advise on drug- drug, drug-disease, drug-nutrient interactions

Prevention, detection and correction of medication errors.

504/19/23

Monitoring patient therapy Medication history taking and relating that

with current patient’s condition/ treatment

Attend ward rounds and clinical meetings with other healthcare givers

Advising on suitability of therapy for individual patient based on lab results, organ function and risk to feotus, gestation etc

Culture results interpretation and advise on choice of antibiotic

604/19/23

Pharmacovigilance Monitoring adverse drug reactions and

poor quality medicines and reporting to relevant authorities

Provide drug and poison information to other medical practitioners and patients

Monitoring for efficacy and toxicity of medicines

704/19/23

Management of High alert medicines (HAMs)

HAMs bear higher risk of harm when used in error

Concentrated electrolytes, anticoagulants, inotropes, opioids

Processes for handling, admixtures, administration, monitoring

Awareness, safeguards, manage incidents

804/19/23

Neonatal pharmacotherapy Most drugs used in neonates are off - label High potential for errors due to small

doses/ unusual levels of dilution Mostly intravenous route - ensure

maximum bioavailability Immature liver/ renal function - slow

elimination, consider dose intervals Constant review of doses required TDM for narrow therapeutic index drugs

904/19/23

• Managing neonatal drug formulations

Advise on IV drug administration- dose, flow rates, appropriate concentrations, hypertonicity

Advise on reconstitution and dilutions for neonates. Ensure proper diluents and techniques to avoid errors.

Consider sterility and stability of iv preparations

Medicine manufacture and compounding - Alteration of dosage forms

- extemporaneous preps ( vehicle of use, crushing, mixing, stability of reconstituted drugs)

1004/19/23

Collaborate with nutritionist on appropriate pediatric nutrition formulations- volume, strength, content, monitoring, interactions

Formulation of policies and guidelines with other stakeholders

Conduct research and audits to improve service

Training on use of medicines Involved in infection control Manage emergency kits for specific obstetric

conditions

1104/19/23

• Inadequate staff levels• Availability of medicines especially pediatric

formulations/ off label prescribing• Non- formulary prescribing• Inadequate equipment and trained personnel• Lack of TDM facilities for low therapeutic index

drugs• Delays in procurement procedures• Manual record keeping

1204/19/23

Incorporate pharmacists into clinical teams

Involve pharmacists in development of policies and guidelines on patient care

Improve pharmacy infrastructure and equipment

Improve on compounding of drugs by providing appropriate equipment and staff - high alert medicines, nutritional supplements, neonatal formulations

1304/19/23

Automation of patient records for ease of reference and intervention

Provide appropriate medicine management software to reduce errors

Improve on staffing levels and appropriate deployment to ensure continuation of care

Offer TDM services

Neonatal formulary1404/19/23

FIP President , Sept 2008

“The goal must be that whenever and wherever medicines are discussed, a pharmacist must be WANTED and PRESENT”

1504/19/23

Dr. S Muniu Dr. Z Kiambi Dr. P Mule

1604/19/23

Thank you

1704/19/23