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Patient Partnerships and Medicines Safety by changcheng2

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									LWI
LiveWell Initiative




      Patient-Partnerships – An
    Essential Tool for Improving
     the Safe Use of Medicines

                         Bisi Bright, MPH,FPCPharm,FPSN
                      CEO LiveWell Initiative LWI
                                                                      1


                                                          www.livewellng.org
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          The Patient as a Partner
 LiveWell Initiative




• Patient Partnerships are ‘win-win’ patient-
  practitioner collaborations which are
  mutually beneficial to the patient, the
  practitioner, and to governments alike

• They are the strategic bedrock of
  healthcare, without which health systems
  will not thrive
                          - LiveWell Initiative LWI          2


                                                 www.livewellng.org
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 LiveWell Initiative
                       Medicines Safety
This involves two key areas:

• Safe Medicines

• Safe Use of Medicines



                                                      3


                                          www.livewellng.org
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 LiveWell Initiative




  WHO TAKES RESPONSIBILITY FOR:


• Safe Medicines - government

• Safe Use of Medicines -
  consumers – healthcare givers
 (doctors, pharmacists, nurses) and end
                                      4
 users (patients)
                               www.livewellng.org
 LWI

                  Safe Medicines - government
 LiveWell Initiative




• Drug Regulation : This ensures that safe
  medicines are produced
• Clinical Trials: Among the protocols for
  ensuring safe medicines are: preclinical trials,
  phase I – III clinical trials
• Post-Marketing Surveillance: This is a
  statutory requirement
• Pharmacovigilance: An ongoing initiative by
  governments, to safeguard the medicines use
  process and prevent or minimise iatrogenecity 5
                                         www.livewellng.org
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                      Clinical Trials Phase I-III & Post-Registration
LiveWell Initiative




                                                                                     6

           www. who.int/medicinedocs/documents/s6164e/p1.jpg&imgrefurl   www.livewellng.org
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 Challenges to Safe Medicines
 LiveWell Initiative




• Poor Regulatory and Enforcement mechanisms

• Faking and Counterfeiting

• Poor Adherence to GLP, GMP and GDP
  Guidelines

• Poor Governance
                                                7


                                    www.livewellng.org
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    LiveWell Initiative
                          Faking and Counterfeiting
• This is a global menace
• A significant problem in developing countries
• Fake drugs were first noticed in Nigeria in 1968
• “Fake drugs were not only killing people [but] the drugs
  were also killing businesses. ”…”It is not yet
  ‘Uhuru’…Even 1% fake drugs is not good enough,
  because every life is important.”….Prof Dora N.Akunyili,
  former DG NAFDAC
• In West Africa,the WADRAN (West African Drug
  Regulatory Authority) is working very hard to bring the
  faking of drugs to a ‘zero’level
                                                              8
• Although reasonably controlled,the fake drug cartel
  subsists…….                                     www.livewellng.org
    LWI
    LiveWell Initiative


Safe Use of Medicines - consumers

– healthcare givers and patients
•    doctors
•    pharmacists
•    nurses
•    carers
•    patients
                                               9


                                   www.livewellng.org
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LiveWell Initiative

               SAFE USE OF MEDICINES
               DOCTORS’ roles
                        • Legible and Clearly written
                          prescriptions
                        • Avoid unclear abbreviations
                        • Patient-Doctor Communication
                        • Appropriate Drug Information
                          Services required
                        • Pharmacy & Therapeutics
                          Committee essential
                        • Drug Formulary as an ideal
                          Guide
                                                      10
                        • Use of Compendia and
                          Reference Books
                                             www.livewellng.org
LWI
LiveWell Initiative
                      ABBREVIATIONS NEED TO BE CLEARLY WRITTEN

    Abbreviation            Why it's a problem                            Alternative

    U (unit)                Mistaken for zero, number                     Write “unit”
                            four or cc

    IU                      Mistaken for IV or number                     Write “international
    (international          ten                                           unit”
    unit)
    QD (daily)              Mistaken for QID                              Write “daily”

    QOD (every              Mistaken for QID and QD                       Write “every other
    other day)                                                            day”
    Trailing zero           Decimal point is missed                       Write X mg
    (X.0 mg)
    Lack of leading Decimal point is missed                               Write 0.X mg
    zero (.X mg)                                                                                      11

     For a complete list developed by the Institute for Safe Medication Practices, go
     tohttp://www.ismp.org/tools/errorproneabbreviations.pdf                              www.livewellng.org
  LWI
 LiveWell Initiative




GUESS THIS PRESCRIPTION ?
Handwritten prescriptions may be difficult
to decipher.
For example, in the prescription below,
the drug name Avandia (antidiabetic /
insulin sensitizer) was incorrectly
interpreted as Coumadin (anticoagulant /
blood thinner)

                                                 12


                                     www.livewellng.org
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    SAFE USE OF MEDICINES
                      PHARMACISTS’ roles


                            • Good Dispensing Practice
                            • Pharmacovigilance
                            • Empathy
                            • Good Patient communication
                              skills
                            • Updated Therapeutic Dialogue
                              and Intervention skills
                            • Clinical Pharmacy skills 13

                                               www.livewellng.org
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 LiveWell Initiative
                       …contd..
• Discharge Counselling
• Patient Empowerment
• Information on non-prescription
  supplements and other medicines being
  used by patient
• Auxilliary labelling and counselling
• Medication Check-up
• ADR Reporting and Monitoring                14

• Look-Alike, Sound-Alike Medicines
                                  www.livewellng.org
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    Look Alike, Sound Alike Medicines
    LiveWell Initiative




•    Zyrtec and Zantac
•    Diclofenac and Diflucan
•    Cotrimoxazole and Clotrimazole
•    Lorsatan and Lexotan
•    Buscopan and Brinerdin –
•    A CASE STUDY AT NIGERIAN PORTS AUTHORITY, 1991…
      An ‘illegible prescription’ for Buscopan (antispasmodic) was mistaken for Brinerdin
     (antihypertensive); the patient, had presented with a tummy ache. The patient
     experienced ‘flushing’ due to the sudden drop in blood pressure and, he collapsed
     soon after taking the Brinerdin; however he was luckily revived after a CPR and
     emergency medical intervention.                                                      15


                                                                          www.livewellng.org
LWI

        SAFE USE OF MEDICINES
LiveWell Initiative



                      NURSES’ roles
                         • Safe use of injectables
                         • Safe use of Ward Medicines
                         • Responsibility for integrity of
                           medicines in the emergency
                           tray
                         • Expiry of Ward Stock
                         • Patient Counselling
                         • Discharge Medication
                         • Polypharmacy and in-ward
                                                        16
                           Substitution of Medicines
                                              www.livewellng.org
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           SAFE USE OF MEDICINES
                      CARERS’ roles
                         • Strict Adherence to prescribed
                           regimens
                         • Empathy, not Sympathy
                         • Trust, Positive Reinforcement
                         • Good communication line with
                           the patient
                         • Good communication line with
                           clinic
                         • Proper storage of medicines
                                                             17
                         • Identifying high-alert medications
                                                 www.livewellng.org
LWI

                SAFE USE OF MEDICINES
LiveWell Initiative




                      PATIENTS’ roles
                        • Using medicines correctly
                        • Proper storage of medicines ,
                          away from children
                        • Ask what side effects to expect
                        • Declaring the details of other
                          medicines being used
                        • Ensuring Compliance and
                          Adherence
                        • Reporting any side effects as
                                                             18
                          quickly as possible, even if minor
                        • Ask me 3…              www.livewellng.org
     LWI
        Who takes Responsibility ???
     LiveWell Initiative



• Governments have to strengthen structures – they need to
  institute Adherence, Concordance and Clinical Governance in
  the health sector.
• This is key to the successful and safe use of medicines,
  especially in developing countries where the structures are
  weak, governance is totally absent, and enforcement is ‘distal’
  miles away
• Healthcare Practitioners have to take ‘more’ responsibility for
  outcomes in the drug use process – the doctor, pharmacist,
  nurse…they all play a key role in the outcomes; thus it is not
  sufficient to blame counterfeit medicines.
• Patients – the end ‘users’ of medicines, have to be informed
  and empowered to achieve optimal outcomes in the drug use    19
  process, through new innovations and positive reinforcement
                                                   www.livewellng.org
    LWI
    LiveWell Initiative
                          CONCLUSION.
• The Patient is a Partner in the Medicines Use
  Process; he or she is a major stakeholder

• Empowering the patient will not only eliminate the fake
  and counterfeiting of medicines,…it will ensure the
  incorporation of health-sector governance through
  proactive stakeholder engagement

• Thus, the Safe Use of Medicines can and will be
  achieved, Globally.
                                                        20
                          THANK YOU.
                                            www.livewellng.org

								
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