An insider's look at the practice of clinical pharmacy in Egypt from my own experience.
As well as tips on how to prepare for starting a new practice.
Prepared and Presented by Pharmacist/ Mamdouh Ezz Samy
6. High-Dose MTX
• Osteo-sarcoma in pediatrics up to 12 grams
1 mg/ml
Further Reading:
Google: high dose methotrexate protocol in osteosarcoma
7. What is Clinical
Pharmacy?
• An area of pharmacy concerned with the
science and practice of rational medication
use. ( ACCP)
• The activities and services of the clinical
pharmacist to develop and promote the
rational and appropriate use of medicinal
products and devices. ( ESCP)
11. Clinical Pharmacy Goal
1. Maximizing the clinical effect of medicines,
i.e., using the most effective treatment for
each type of patient.
2. Minimizing the risk of treatment-induced
adverse events.
3. Minimizing the expenditures for
pharmacological treatments, trying to
provide the best treatment alternative for
the greatest number of patients.
12. Level of Action of Clinical
Pharmacists
1. Before the prescription
2. During the prescription
3. After the prescription
14. DURING the
prescription
• Choice of treatment by physicians
• Patient Profile evaluation for interactions or
errors
• Dosage Calculation*
15. After the prescription
• Patient Counseling
• Preparation of unit doses*
• Patient awareness, check and improve
patient compliance.
• Outcome research
19. How to Get Started?
1. Study and document the current status of
practice.( very important)
2. Look for special weakness points and needs
3. Start studying drugs and diseases
used( protocols, if any).
4. Try to look for solutions to current problems
5. Approach doctors with respect offering your
proposed solutions and ask for a chance to
help.
6. Gather lots of books to use as references
By: Ph/ Mamdouh Ezz
Samy
20. How to Get Started?
( cont.)
7. Try to contact similar practices in other
hospitals and ask for help and cooperation,
visit them and ask them to visit back.
8. Build good relations with doctors, nurses and
administration.
9. Offer to help others and be nice to them
10. Start creating cheat sheets and making them
available to everyone for free.
11. Focus on problem drugs and devices.
By: Ph/ Mamdouh Ezz
Samy
21. How to Get Started?
( cont. 2)
12. Focus on high-risk drugs, expensive ones or
hard to calculate doses as a start.
13. Look for need to apply dose modifications in
case of renal problems or liver diseases.
14. Look for signs of toxicity and interactions with
other drugs the patient might be taking.
15. Talk to nurses and discuss the problems they
face and try to offer solutions.
16. Document and report every activity you do.*
17. Study Study Study...
By: Ph/ Mamdouh Ezz
Samy
39. What is Clinical
Pharmacy?
• Clinical Pharmacy includes all the services
performed by pharmacists practicing in
hospitals, community pharmacies, clinics and
any other setting where medicines are
prescribed and used.
• The term "clinical" does not necessarily imply an
activity implemented in a hospital setting. It
describes that the type of activity is related to the
health of the patient(s). This implies that
community pharmacists and hospital
pharmacists bothPh/ Mamdouh Ezz clinical pharmacy
can perform
By:
activities.
Samy
40. Community Pharmacy
• Check drug and dose before dispensing,
don't dispense if not 100% sure.
• Make sure the patient understands how
and when to use his medicine.
• Ask if he told the doctor about other
medicines he uses and herbs as well
• Give information leaflets, if available
• Demonstrate use of devices, if needed.
By: Ph/ Mamdouh Ezz
Samy
41. Community Pharmacy (2)
• Make sure to have references available.
• Have good relations with doctors and
contact them regularly.
• Be careful when measuring blood
pressure or blood sugar at the pharmacy.
By: Ph/ Mamdouh Ezz
Samy
42. What YOU get for FREE
Give for FREE
And Give Credit
By: Ph/ Mamdouh Ezz
Samy
What’s the difference?
Sterile, multiple-use, bio-safety, individual protection.
Chemotherapy risks to pregnant women
First unit established in Egypt 1996 in the NCI.
Dr. Sherif and Dr. Kamal Sabra
Do you know what this is used for?
Dose? 12.5mg per week
How about this one? 250mg
1gm and then 5gm
The discipline of pharmacy embraces the knowledge on synthesis, chemistry and preparation of drugs
Focus on stock, inventory, profit and sales…
Clinical pharmacy is more oriented to the analysis of population needs with regards to medicines, ways of administration, patterns of use and drugs effects on the patients.
Maximising the clinical effect of medicines, i.e., using the most effective treatment for each type of patient
Minimising the risk of treatment-induced adverse events, i.e., monitoring the therapy course and the patient's compliance with therapy
Minimising the expenditures for pharmacological treatments born by the national health systems and by the patients, i.e., trying to provide the best treatment alternative for the greatest number of patients.
Explain each in detail
Are doctors against clinical pharmacy?
What do you think?
Story...
How to approach?
How do you sort those?
Dr. Hatem
Patient by name, and all details written and checked.
Stability and savings and better doses.
Optimal storage for each medication
Watch for maximum doses for each drug and antibiotic
Protocol sheet;
Patient info
Dose calculation guidelines
Duration and dates of protocol
All cycles in one sheet
Dilution of each med and method of adminstration
Self reporting of errors by staff,
Aim is to correct them not punish the person who makes a mistake.
Propose suggestion for prevention in the future.
Discussed in privacy.
Not the one we eat
Errors reach the patient when team have similar qualities and way of thinking and knowledge.
Adding Pharmacists prevents errors due to their experience and different weakness points so together they block errors.
Supplies,
Books
Savings
Each order is checked prior to dispensing to patients.
Packed separately with patient info on it and then handed over to ward.