Adaku Efuribe – A clinical Pharmacist/UN SDGs Advocate
“Safe and effective medicines for all” is the theme of this year’s World Pharmacists Day. (25th September 2019).The theme aims to promote pharmacists’ crucial role in safeguarding patient safety through improving medicines use and reducing medication errors.
“Pharmacists use their broad knowledge and unique expertise to ensure that people get the best from their medicines. We ensure access to medicines and their appropriate use, improve adherence, coordinate care transitions and so much more. Today, more than ever, pharmacists are charged with the responsibility to ensure that when a patient uses a medicine, it will not cause harm”, says FIP President Dominique Jordan.
I believe Nigerian pharmacists are better placed to safeguard patient safety through medicines optimisation and patient centered care. I have observed that this service tends to be lacking in our primary and secondary care facilities because there is a lack of multidisciplinary team approach in some settings. We need to start having these conversations and change the status quo.We need to embrace integrated healthcare. A lot of patients using clinical facilities, do not come in contact with a pharmacist, they do not get their medicines reconciled or reviewed, resulting to exposure to adverse drug-drug interactions and lack of concordance.
As long as we still have some clinicians in Nigeria diagnosing, prescribing, dispensing medication and ‘hiding’ the name of the medicine from the patient; duplication of therapy, adverse drug reactions and drug-drug interactions are inevitable.
Patients have the right to know the medicines they are taking to help achieve concordance and prevent medication errors and overdose.
Pharmacists led medicines review, reconciliation/ optimisation prevents medication errors & adverse drug reactions.
Medicines reconciliation is a process whereby patient’s medicines are reconciled as they move between different stages of healthcare, from primary – secondary care interface. Pharmacists are better placed and equipped to complete the medicines reconciliation process.
Pharmacist led medication review tends to be more in-depth ,capturing all the essence of patient centred care as it offers more time for the patient to ask medicines related questions which enhances concordance.
Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc.
According to the Royal Pharmaceutical Society ‘Medicines optimisation represents that step change. It is a patient-focused approach to getting the best from investment in and use of medicines that requires a holistic approach, an enhanced level of patient centered professionalism, and partnership between clinical professionals and a patient’.
I believe medicines optimisation is about ensuring that patients receive the right kind of medication at the right time. It focuses on making patients get the best out of their medicines. Evidence has shown that a good number of medicines prescribed end up not being taken due to lack of concordance and compliance.
My experience with patient returned medication has shown that patients who do not understand the rationale for prescribed medication are more likely not to use the medication. Also medication used for preventative measures are at a higher risk of non-compliance as patients do not appreciate the benefits of taking such medication.
The gains of patient centered care cannot be overemphasised, all medical needs have to be tailored to the individual patient, considering their personal circumstances, other co-morbidities, and sometimes frailty comes into consideration for some elderly patients as well.
In some clinical settings, a lot of patients do not know what regular medicines they are taking or the reason why it has been prescribed, their indication or side effects to expect and they have never had their medication reviewed by a pharmacist since their long term condition was diagnosed.
Part of the role of the pharmacist in a clinical setting is to complete medicines reconciliation and medication reviews especially for patients taking regular medication for long term condition like Hypertension, Diabetes, Arthritis, Asthma etc.We need to create the enabling environment for this to be achieved.
For instance, a patent living in Kaduna with a history of hypertension, takes antihypertensive –Calcium channel blocker (CCB) – amlodipine tablets prescribed by his local doctor.
Patient travels to Lagos on official assignment and falls ill, patient gets admitted to a hospital ,diagnosed with very high blood pressure(HBP), patient receives treatment and gets discharged with three other medicines which includes another –CCB-Nifedipine , without being asked about his past medication history or told what medicines to stop /continue.
Patient continues to take two CCB –nifedipine and amlodipine at the same time and suffers hypotension (low blood pressure), which makes his condition worse. Patient is re-admitted to hospital in Kaduna, his medication is reviewed by a pharmacist, and he is told to stop Nifedipine and continue taking only Amlodipne.
Learning points- We need to utilise the expertise of pharmacists in all clinical settings.
A medication reconciliation process with a pharmacist during the hospital admission/discharge process in Lagos could have prevented the hypotension resulting from a duplication of therapy.
Evidence has shown that when patients understand the side effects of the medication they take, they are more likely to comply with the dosage regimen.
The gains of patient centered care cannot be overemphasized; all medical needs have to be tailored to the individual patient, considering their personal circumstance. Pharmacists are better placed to undertake this piece of work.
In the course of completing a medication review with one of my patients, It came to light why patient’s chronic obstructive pulmonary disease (COPD) was not well managed .This patient happened to be visually impaired and was unable to read the small typed instructions on the dispensing label and so assumed tiotropium capsules needed to be swallowed whole and not inserted into the inhalation device. After I offered education, guidance and support to this patient, the patient was able to use her inhaler as intended and her COPD symptoms were well controlled eventually. In this case a possible COPD exacerbation or even hospital admission/death was prevented.
Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc.Annual blood tests are routinely checked because if dosage regimens are not adjusted or vital blood checks are not made, this may lead to increased harm to the patient or even death.
As we work towards achieving SDG3 and universal health coverage in Nigeria,
The following simple steps could help reduce the risk of medication errors and medicines related deaths in Nigeria:
- We have to develop and implement a nationwide strategy which will bring about the desired change in the healthcare system.
- We need to optimise integrated healthcare and patient centred care using a multidisciplinary team approach.
- We need to begin to put the patient at the centre of care and utilise the pharmacists expertise and input if we must provide safe and effective medicines for all.
The Ministry of health needs to develop and enforce policies around medicines reconciliation and medication reviews especially for patients with long term conditions who need regular medication to improve their quality of life and increase life expectancy and they must ensure that the ‘drug experts’ are given the opportunity to bring their expertise to the table.
Nigerian Clinicians need to work together to ensure adequate measures are put in place and everyone contributes their own quota towards effective healthcare delivery.
The role of the pharmacist in medicines optimisation and patient centred care cannot be overemphasized.
Article by Adaku Efuribe- A clinical Pharmacist/UN SDGs Advocate
How Working Mothers Can Find A Life-Career Balance
Image credit: womenshealth.gov
Its 5am. Linda relaxes into her seat in the staff bus, took a deep breath and adjusted her hair. It was her first day at work after the 8-week maternity leave.
As she finally settles into the resumption process, she gets a memo from Mr Johnson to resume in the Administrative department.
‘But Mr Johnson, what then happens to all the Sales targets I achieved even while away on leave? I have been building my career in Sales, achieved my monthly target: $800,000 why would the company take me on this transfer?’ she asked Mr Johnson, the assistant Head of Human Resource Department.
‘I am sorry this is happening Linda, you should take a second look at the company’s policies on issues like this’ Johnson said to now devastated new mom.
Few minutes after, she gets a call from Mama, her mother-in-law complaining about how her baby refused food since she resumed.
‘Mama, I dropped this baby with you days ago, just so she could get used to eating from the bottle’ she responded, her voice now laden with tears.
‘But wait a minute. It is truly not all Mama’s fault. I never planned my baby would reject the food at this time, she thought to herself, ‘I think I am depressed already, Today is not a good day,’ She thought to herself as she grudgingly proceeded to her new office.
Linda’s story pictures that of most everyday Nigerian women who have to wean and raise healthy children while still building their careers to become financially independent.
Many a women now have had to single-handedly care for their families, either due to a job loss of their spouses, increasing cost of living and so on.
At the child-bearing age, they are often faced with leaving their homes earlier in the day, whilst domestic helps have to care for their babies whom they sometimes return home to find asleep.
In the midst of the gender parity issues in the workplace which is characterized largely by lower pay than her male counterparts, the woman is more likely to work twice as hard as the man to earn the same.
It has become more imperative that more young women need to understand how to manage growing their careers and business while raising children.
For some of the women who are not able to manage this end up abandoning their jobs to go after the race of entrepreneurship in industries some of them know nothing about.
Here are my top 5 tips on how women can balance their careers and raising healthy babies after maternity leave:
1. Set clear career growth goals: Asides just sending out job applications, women need to set realistic career goals for themselves with considerations of their maternity leave periods. A rule of thumb would be 3 to 4 years, depending on the number of children she wishes to have. Analyse your top skills and update your CV.
2. Prepare for breastfeeding and complementary feeding: You don’t want to start getting incessant calls about your baby’s poor eating habits, so it’s best to begin early enough. Get a breast pump in preparation to express breastmilk and of course begin your child with natural foods that exposes your baby’s taste buds to healthier food tastes. I highly recommend Augustsecrets foods and I know you can almost guess why!
3. Carve a professional niche: After you must have set clear career growth paths, another thing that helps is carving out a niche. With this, you are able to pitch yourself as an expert in a particular field and this keeps you more competitive in the workplace.
4. Live close to the office: Sometimes it looks expensive living a few miles away from the office, but at the end of the day, the stress, less productivity, and commuting costs of living too far away from your workplace are a lot more. If you can afford the options of living closer to your workplace, it would help you become more productive.
5. Buy support: One of the factors that help working women find the right balance is support. There are no awards for the most hardworking mother. I used the word ‘buy’ because with the high rate of rural-urban migration these days, it gets harder to find trusted hands to assist you with domestic chores if not paid for.
The best bet is to get professional domestic workers or request for live-out domestic help services. It is certainly easier in most African cities for women to get professional domestic helps.
It is suffice to say that the cost of getting professional help to care for your child should be seen as an investment in your career. This way, you are able to focus on further studies, building your career or business, while still raising wholesome children.
I hope this helps some woman out there.
Credit: Toyin Onigbanjo – is an award-winning Kids’ Chef, Author, and Founder, Augustsecrets ; A growing child nutrition company producing natural cereals, recipes and support for young mothers and families
Amref and Awash Bank Sign Agreement to Improve Health and Well-being of Communities in Ethiopia
Amref Health Africa and Awash Bank the leading private bank in Ethiopia signed a long term partnership agreement to work jointly towards improving the health and well-being of communities, supporting progress towards Universal Health Coverage (UHC) and collaborating to narrow gender inequity gaps in Ethiopia.
As part of this partnership agreement and its first initiative working with Amref Health Africa, Awash Bank will provide financial support for the construction of 10 sanitation facilities to be implemented by Amref Health Africa in selected government schools in Addis Ababa.
The project is expected to improve sustainable and equitable access to Water, Sanitation and Hygiene – WASH for more than 20,000 school communities. This first phase intervention is a key milestone to address sanitation and hygiene problems of school children in their school setting; and thereby contribute to the Sustainable Development Goals.
Working together under this partnership agreement will also serve as an important platform for both to further identify opportunities for long term strategic partnership and future impact investment projects.
With its Corporate Social Responsibility (CSR) program, Awash Bank has been contributing a lot to public development programs for the last 25 years.
Since its inception, the bank has invested hundreds of millions of Birr to support vulnerable and marginalised sections of communities in Ethiopia. The Bank will soon mark its silver jubilee in collaboration with its sister company – Awash Insurance with a series of colourful events.
Amref Health Africa, headquartered in Kenya, is the largest Africa based international non-governmental organisation (NGO) currently running programs in over 35 countries in Africa with lessons learnt over 60 years of engagement with governments, communities and partners to increase sustainable health access in Africa. Amref Health Africa also incorporates programme development, fundraising, partnership, advocacy, monitoring and evaluation, and has offices in Europe and North America as well as subsidiaries; Amref Flying Doctors, Amref Enterprises and the Amref International University.
Amref Health Africa Kenya Partners with Sisu Global Health and Surgipharm to improve access to blood
Nairobi, Kenya, 17 September 2019 – Amref Health Africa in Kenya, Sisu Global Health and Surgipharm have today unveiled a partnership to improve access to blood and safer surgical outcomes during medical missions and emergencies in Kenya.
The partnership is aimed at increasing blood access in all hospitals to reduce internal bleeding-related deaths through the adoption of HemafuseTM, an innovative medical device that allows clinicians to reuse a patient’s own blood gathered from internal bleeding.
This initiative comes in the wake of the recent move by the US President’s Emergency Plan for AIDS Relief (PEPFAR) to stop its annual funding of KShs2 billion for blood collection and testing services in Kenya. This development comes at a time when the country is facing a chronic shortage of blood as the collection of blood has been plagued by the lack of funds for screening tools and human resources to collect and store blood.
“Blood access is critical to safe surgery. Standard surgical practices require two units of blood on-hand before surgery commences, but there is a severe shortage of blood in the country. Surgeries may be delayed or not performed due to a lack of blood, resulting in increased illness and death. This partnership will make use of an innovative solution that will ensure that patients with internal bleeding have a chance of survival,” said Amref Health Africa in Kenya’s Country Director, Dr Meshack Ndirangu.
HemafuseTM, a product by Sisu Global Health, can filter and pump blood from an internal haemorrhage into a blood bag, allowing it to be re-transfused to the same patient. The device can also be reused up to 25 times. This provides an alternative to donor blood.
“It is inspiring to see Hemafuse used to save lives. With this partnership with Kenya, we look forward to enabling thousands of more clinicians to save more lives across the country. The work we are doing is incredibly important and we are proud to have such a strong partnership with Amref to provide access to blood across Kenya,” said Sajju Jain, Chief Operating Officer at Sisu Global Health.
Speaking at the event, Mr Rakesh Vinayak, Director-Sales & Marketing at Surgipharm, said that the pharmaceutical industry has a critical role to play in finding effective and sustainable solutions to providing access to today’s most pressing health concerns. “Surgipharm has a highly specialised and experienced management team and our relationships with different players in Kenya’s health sector complements and strengthens our existing skill set in logistics across the country. We are excited about the prospects that this partnership brings.”
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