Download Role of pharmacy in critical care of mothers and infants

Dr. Rosaline Kinuthia
Clinical 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
•
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 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
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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
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 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, drugdisease, drug-nutrient interactions
 Prevention,
detection and correction of
medication errors.
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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
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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
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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

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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
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•
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)

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 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
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•
•
•
•
•
•
•
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
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 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
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 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
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FIP President , Sept 2008
“The goal must be that whenever
and wherever medicines are
discussed, a pharmacist must be
WANTED and PRESENT”
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 Dr.
S Muniu
 Dr. Z Kiambi
 Dr. P Mule
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Thank you
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