1. Dr. Rosaline Kinuthia Clinical pharmacist KNH

2. 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 2 9/18/2015

3.  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 3 9/18/2015

4.  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 4 9/18/2015

5. 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. 5 9/18/2015

6.  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 6 9/18/2015

7.  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 7 9/18/2015

8.  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 8 9/18/2015

9.  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 9 9/18/2015

10. 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) 10 9/18/2015

11.  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 11 9/18/2015

12. 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 12 9/18/2015

13.  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 13 9/18/2015

14.  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 formulary 14 9/18/2015

15. FIP President, Sept 2008 “The goal must be that whenever and wherever medicines are discussed, a pharmacist must be WANTED and PRESENT” 15 9/18/2015

16.  Dr. S Muniu  Dr. Z Kiambi  Dr. P Mule 16 9/18/2015

17. Thank you 17 9/18/2015