A Presentation on the concep and context of Safe Medicines/Pat

1. Safe Medicines for Nigerians:
Young Pharmacists Care!

2. Introduction...Greetings from San Diego!

3. Know your Speaker......
Who is Remi ADESEUN?
According to the According to me...
Organisers...
1. A Pharmacist
1. Seasoned
Pharmacist 2. Young (at heart
at least!)
2. Industrialist
3. Inclined to
3. Communicator
Innovation
par excellence
4. Interested in
4. Pioneer
networking
President of
NIROPHARM

4. Young Pharmacists Forum..
 Add to the organisers’ 4 reasons for
inviting me as guest speaker tonight,
the event itself has 4 main elements:
1. Guest Lecture
2. Quiz
3. Inauguration of Young Pharmacists
Group
4. Dinner
Remi ADESEUN

5. Why are we here?
 “address various issues that militate
against Young Pharmacists’ delivery
of safe medicines to Nigerians”, to
wit:
1. Indiscipline
2. Unethical Practices
3. Impatience
4. “Register and Go”
Remi ADESEUN

6. 4 Key Issues
1. Safe Medicines for Nigerians
2. Role of the Pharmacist
3. Role of the Young
4. Values, Virtues, Ethics & Professionalism in
Pharmacy Practice

7. In the final analysis,...
 Adopting the following 4 Cs’ as Young Pharmacists,
will help us “move the Pharmacy profession from
the growing pessimism and gloom to sustainable
professional fulfilment” (OAKPCO 2012).
1. Conviction (based on regularly updated
knowledge and built on strong values, virtues,
ethics and professional foundation.
2. Communication (with patients as the
centrepiece)
3. Collaboration (Intra and Inter-Profession)
4. Common Good

8. Safe Medicines For Nigerians...
 Who Cares?
 Individuals
 Patients
 Society
 Healthcare Professionals
 Government
 International Bodies/NGOs/Advocacy Groups
 Young Pharmacists Care!

9. Safe Medicines...Patient Safety
 Concept:  Patient safety is
 Health
defined as the
 Preservation prevention of
 Prevention harm to
 Treatment patients,
 Use of Medicines including
 Diagnosis through errors
 Prescription
 Procurement
of commission
 Dispensing and omission
 Storage  Goes beyond “safe
 Usage medicines”

10. Safe Medicines...Challenges
 Major Challenges:
 protection of consumers against
counterfeit or contraband medicines
 Securing the medicines supply chain
 Physician/Pharmacist Error
 Patient Error
 Self-Medication
 Prescription Medicine Control

11. Medication Error...Definition
 "any preventable event that may cause
or lead to inappropriate medication use
or patient harm while the medication is
in the control of the health care
professional, patient, or consumer”.
 *The definition of "harm" includes both
 "temporary or permanent impairment of
body function/structure requiring
intervention and
 an error resulting in death"

12. Medication Error...Context
 May be related to:
 professional practice
 health care products
 procedures, and systems including:
 Prescribing
 Order communication
 Dispensing
 Product labelling; packaging; and
nomenclature; compounding; distribution
 Use
 administration; education; monitoring

13. Medication Error...Index
Type of Error Category Result
NO ERROR A Circumstances or events that have the capacity to cause error
ERROR, NO
HARM B An error occurred but the medicine did not reach the patient
An error occurred that reached the patient but did not cause patient
C harm*
An error occurred that resulted in the need for increased patient
D monitoring but no patient harm*
An error occurred that resulted in the need for treatment or
ERROR, HARM E intervention and caused temporary patient harm*
An error occurred that resulted in initial or prolonged hospitalisation
F and caused temporary patient harm*
G An error occurred that resulted in permanent patient harm*
An error occurred that resulted in a near-death event
H (e.g.anaphylaxis, cardiac arrest)
ERROR,
DEATH I An error occurred that resulted in patient death

14. Medication safety...1
 a) improvement of packaging  d) safer prescribing of
and labelling of medicines as medicines, helped by the
well as the proprietary and availability of complete patient
non- proprietary naming, in records, electronic prescribing,
cooperation regulators and the decision support and clinical
industry; pharmacy services ;
 b) safer selection and  e) safer medicines preparation,
procurement of medicines, by minimizing the preparation
including a medication errors in clinical areas and supplying
risk assessment of medicines ready-to-use medicines;
during formulary and  f) safer dispensing of
purchasing decisions ; medicines, enhancing the
 c) safer storage of medicines in ability to intercept medication
clinical areas in hospitals and errors, and reducing dispensing
community where high risks errors by the use of automated
medicines stock should be dispensing systems;
restricted ;

15. Medicine Safety...2
 g) safer administration of  i) independent, updated and
medicines, helped by the clear accessible information on
and legible label of medicines medicines must be available to
up to the point of care, health care providers and
barcoding, patients, and considered with
 minimising the storage of high patient information when
risk medicines and the use of prescribing, dispensing, and
standardised procedures; administering medication;
 h) safer monitoring of  j) and patient education for a
medicines supported by regular safer medicines’ use,
medication reviews and the considering patients as active
proactive detection of adverse partners in their care;
drug events ;  k) safer communication about
medicines for individual
patients between health care
providers.
Remi ADESEUN

16. Role of the Pharmacist...1
 the guardians/safeguards against
"poisons"
 Preventing Medication Error.
 responsibility to ensure that when a patient
receives a medicine, it will not cause harm.
 the involvement of pharmacists in patient
safety can be as early at the prescribing
phase and up to the administration of the
medicines.

17. Role of the Pharmacist...2
 Individual
 making appropriate intervention at each
stage of the medication-use process
 National
 working with other healthcare professionals,
governments and regulatory agencies
 Global
 working with pharmacy organisations on a
global basis, e.g. FIP

18. Role of the Pharmacist...3
 Individual
 Commit to & Promote a “Safety Culture”
 acknowledgment of the high-risk, error-prone
nature of an organisation’s activities
 a blame-free environment where individuals are
able to report errors or close calls without fear
of reprimand or punishment
 an expectation of collaboration across ranks to
seek solutions to vulnerabilities
 a willingness on the part of the organisation to
direct resources for addressing safety concerns
 Innovation and Collaboration

19. Role of the Pharmacist...4
 National
 PSN commitment to “Access to Safe
Medicines as a Human Right”
 Collaboration with the National Human
Rights Commission
 Collaboration with Regulatory Authorities
 PCN, NAFDAC, NDLEA
 Collaboration with Patient Groups,
Consumer Protection Organisations

20. Role of the Pharmacist...5
 Global
 FIP STATEMENT OF PROFESSIONAL STANDARDS
MEDICATION ERRORS ASSOCIATED WITH PRESCRIBED
MEDICATION
 complementary to the FIP Statement of Professional
Standards in Pharmaceutical Care and should be used in
conjunction with that Statement

21. The Role of the Young Pharmacist
Definition Character Traits
 ≤ 5 years post-grad?  Innovation
 ≤ 35 years age?  Collaboration
 Malleable
 Change Agent
Remi ADESEUN

22. The Role of the Young Pharmacist
 Concerns:  Solution:
1. Indiscipline 1. Values
2. Unethical 2. Virtues,
Practices 3. Ethics &
3. Impatience 4. Professionalism
4. “Register and Go”
Remi ADESEUN

23. Ethics & Integrity in Nigeria….A Call to Action
 To Paraphrase Emeritus Prof.
O.O.Akinkugbe:
 “The topic we engage today reflects the
cumulus in our present sky:values upturned,
integrity short-changed, discipline outraged
and merit marginalised. A dawn is upon us
and each Nigerian must make some
contribution to the total national effort”.
 Of Monks & Monkeys-The Wages of Integrity in Nigeria’s Polity.
1999. Government College Ibadan 70th Anniversary Lecture

24. The Importance of Ethics &
Integrity in the Nigerian Context
 “National Ethics” is item 23 in
Chapter II of the Constitution of the
Federal Republic of Nigeria 1999.
 Code of Conduct is item 209 under
section C Part “ (State Executive)
 ..states inter alia: “A Person in the
Public Service of a State shall observe
and conform to the “Code of Conduct”

25. Ethics & Integrity….Many Questions
 What is “Ethics”? “Integrity”?
 How does Ethics contrast with Law?
 Why the Focus on Ethics & Integrity?
 What is the nexus between Ethics,
Integrity, Leadership & Good
Governance?
 What is the goal of Good Governance?

26. What is the Goal of Good Governance?

27. Nigeria
Remi ADESEUN

28. What is the Goal of Good Governance?

29. What does ETHICS mean to you?
 “Ethics has to do with what my
Feelings tell me is right or wrong”
 “Ethics has to do with my Religious
beliefs”
 “Ethics is doing what the Law
requires”
 “Ethics is the standard of behaviour
Society accepts”
We are what we repeatedly do. Excellence, then, is not an act, but a habit.
Aristotle

30. What is ETHICS?
 Ethics refers to:
 well founded standards of right and
wrong that prescribe what humans
ought to do, usually in terms of
rights, obligations, benefits to
society, fairness, or specific virtues.
 the study and development of one's
ethical standards.

31. How does Ethics contrast with the Law?
Ethics Ethics is the study of Law
right or wrong
Is the collection of
conduct in situations
rules of conduct
where there is a
imposed by an
choice of behavior
authority
involving human
values

32. Relationship between Ethics and the Law
• With ethics, human values are the primary binding social mediator
• With law, rules of conduct are the primary binding social mediator
Purpose
• Societies, communities and people
Target
• People to live well together
Goal
• Ethics governs society’s moral standards, a realm that the law can’t always reach
• The law imposes a specific conduct on society, a realm that ethics can’t always
Need reach

33. Ethical Principles
Obligations Consequences
Respect Values

34. Integrity in Relation to Value Systems & Ethics
 What is Integrity?
 A concept of consistency of actions, values,
methods, measures, principles, expectations, and
outcomes.
 A value system may evolve over time while
retaining integrity provided those who espouse the
values account for and resolve inconsistencies.
 A Person can be described as having ethical
integrity to the extent that everything that person
does or believes (actions, methods, measures &
principles) all derive from a single core group of
values.

35. Integrity in Modern Ethics
 3 key requirements:
 Discerning what is right and what is wrong
 Acting on what you have discerned, even at
personal cost
 Saying openly that you are acting on well
founded standards of what is right and what is
wrong
 Benefits:
 Leads to increased performance for individuals,
groups, organisations and societies.
 Results in improved quality of life and value-
creation for all

36. What is an Ethical Culture?
An ethical culture is an intangible
structure of organizing and
characterizing a group of people to
constitute a framework influencing
the behavior of each individual in
the group

37. How to Evaluate an Ethical
Culture
 Collect feedback from:
 Front-line employees
 Established confidential or anonymous reporting
mechanisms
 Human Resources Department
 Evaluate whether:
 Ethical values are properly interpreted, clear and
working as desired
 A swift and consistent way to deal with ethical
concerns exists
 Ethical values provide a sense of trust and confidence
in the public
 Ethical values are enforceable and revisable, or not

38. Remi ADESEUN
How to Evaluate an
Ethical Culture
• Benchmark with data you
collect from peer
institutions
• Perform ethics audits

39. Influences of Ethical Behavior
 Personal values
 Credible enforcement of ethics violations
 Attitude and behavior of supervisors
 Attitude and behavior of senior
managers
 Friends and co-workers
 Internal drive to succeed
 Ethics related legislation

40. Pressures that Compromise
 Following boss’s directive
 Meeting aggressive financial
objectives
 Helping the organization survive
 Meeting scheduled pressures
 Wanting to be a team player
 Saving jobs

41. Pressures continued
 Advancing boss’s career interest
 Rationalizing that others do it
 Feeling peer pressure
 Resisting competitive threats
 Advancing own career interests

42. Why Ethical Lapses Occur
 The “Bad Apple”
 Corrupt Individual; Eliminate
 The “Bad Barrel”
 Organisational/Societal Culture; Overhaul, Commit to
adequate personal integrity
 Competitive Pressures
 Short-term focus, unsustainable
 Opportunity Pressures
 Temptation; the greater the reward or the smaller
the penalty, the greater the probability of unethical
conduct
 Globalisation of Business
 Negative cultural “cross-pollination”

43. What is a Conflict of
Interest?
A conflict of interest is a situation where a public
office holder exploits relationships with the
institution for personal financial or other gain, which
may compromise or have the appearance of
compromising professional judgment when making
decisions or influencing the decisions of other public
office holders.

44. Types of Conflicts of
Interest
TANGIBLE INTANGIBLE
The personal gain is
The personal gain is
professional or non-
financial/material
material

45. Potential Conflicts of
Interest
 Conflict of effort or conflict of obligation is when
work time is spent on a secondary personal activity
 Conflict of conscience is when personal, political, or
religious views influence objectivity
 Political conflict of interest is when one responds
positively to an idea/proposal/person because it
represents or is presented by a person/group with
whom one is politically affiliated, or where one may
act to delay/prevent access or opportunity of an
alternative idea/proposal in order to strengthen the
interested individual or group’s chances

46. Potential Conflicts of
Interest
 Using institutional facilities, resources or time for
personal gain and/or activities for which one is paid
by anyone other than the employer, except when
such activities have been approved in compliance
with institutional policies and procedures
 Accepting or soliciting any gift, hospitality, favor,
service, benefit, or monetary award that one should
reasonably know is offered to influence decisions or
actions (bribes, kickbacks, etc)
 Doing personal business with the institution,
employees or trustees, or their immediate family
members or business partners

47. Potential Conflicts of
Interest
 Participating in the hiring of or having
supervisory authority over a family member
or a relative
 Accepting additional employment which
competes or conflicts with one’s primary
duties
 Excessively browsing the web, participating
in social media, or participating in
entertainment or leisure activities during
official time and for reasons not related to
official duties

48. Accountability
 Appoint Organisation’s Compliance
Officer
 Internal Audit Team
 Training
 Highest Level Mgt Responsible

49. Code of Conduct
 An outline of responsibilities of or
best practice for an individual or the
organization
 Set of principles of good
organisational behavior adopted by
the Organisation

50. Training and Communication
 Ethics and Integrity
1. New employee orientation
2. Policy and/or employee handbook
3. Periodic discussions in meetings
4. Formal annual communication
5. Performance reviews
6. Employee hotline

51. Encourage Whistle-blower
 A whistleblower is an employee, former
employee, or member of an organization,
especially a business or government agency,
who reports misconduct to people or entities
that have the power and presumed
willingness to take corrective action.
 Generally the misconduct is a violation of
law, rule, regulation and/or a direct threat to
public interest -- fraud, health, safety
violations, and corruption are just a few
examples

52. Discipline
 The punishment should fit the crime
 Unintentional
 Write-up
 Impact on performance review
 Deliberate
 Termination

53. Imperatives
 Establishing & Maintaining High Ethical and
Socially Responsible Standards must be a
Priority
 Organisations must be aware of and committed
to enthroning conditions and structures that
are favourable to the development of integrity
and ethical behaviour
 Leaders must recognise the key role they play
in influencing the people’s ethical behaviour.
The Leaders’ actions speak louder than words.

54. Characteristics of a Professional
A good professional is one who:
1 2 3 4
5 6 7 8
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55. Characteristics of a Professional
1 Has a good image:
Image is the way a person presents his physical
self to the others. A good image helps the
professional to portray confidence and positive
attitude.
The key aspects of image are:
o Clothing: An employee must wear clean,
well-ironed formal or semi-formal clothes.
o Footwear: Shoes should be coordinated
with clothing.
o Accessories: Should be minimal.
o Hair and Nail: Should be clean and
trimmed.
o Makeup and Perfume: Should be light.
o Everything else from head to toe:
Should be appropriate for corporate

56. Characteristics of a Professional
2
Has a good attitude:
• Respect supervisor and seniors
• Be friendly with all colleagues
• Have a ‘win-win’ approach
• Work hard, work smart

57. Characteristics of a Professional
3
Takes ownership and responsibility:
• Meet Deadlines
• Complete work effectively and efficiently
• Accept your faults and be open to learning
• Be open to taking more responsibilities

58. Characteristics of a Professional
4
Is prompt and orderly:
• Keep office space clean and hygienic
• Respond to meeting requests, emails, calls
promptly
• Respect other’s as well as your time
• Organize tasks , events and manage work in
a calm and orderly way

59. Characteristics of a Professional
5
Uses proper speech:
• Avoid abusive, defamatory, offensive or
obscene language
• Avoid informal abbreviations, language
• Avoid sensitive and racist comments
• Respect others and be courteous

60. Characteristics of a Professional
6
Follows office etiquette, rules and policies:
• Smile and greet others
• Follow queue system
• Do not fight in work floor
• Do not speak loudly
• Rise up when a senior comes to your desk
• Understand company policies and procedures
and follow them at all times
• Be respectful to women

61. Characteristics of a Professional
7
Has Integrity and honesty:
• Do not steal or misuse office resources.
• Do not participate in any dealings which
compromise your honesty and integrity
• Report any issues that are questionable to HR
or Supervisor
• Do not indulge in any malicious actions that
can risk company’s or your credibility

62. Characteristics of a Professional
8
Is a good Communicator:
• Follow etiquette for verbal
communication(email, telephone, meeting)
• Be aware of Non-Verbal communication and
Body language
• Be an active listener

63. Conclusion: 4Cs 4 Safe Meds!
 Adopting the following 4 Cs’ as Young Pharmacists,
will help us “move the Pharmacy profession from
the growing pessimism and gloom to sustainable
professional fulfilment” (OAKPCO 2012).
1. Conviction (based on regularly updated
knowledge and built on strong values, virtues,
ethics and professional foundation.
2. Communication (with patients as the
centrepiece)
3. Collaboration (Intra and Inter-Profession)
4. Common Good

64. Thank You!
Contact Information:
Remi ADESEUN
Chairman
Rodot Group
.Healthcare
.Water Technology
.Architecture
.Consulting
08057713769/07065156473
r.adeseun@rodot.org
kojere@yahoo.com