Volume 1 No. 1
Pharm Gazette Advance Pharmacy Practice for Optimal Health Outcome
What is new about Pharmacy Practice? Ali Al-Blowi, B.Sc. (Hons), M.Sc., Ph.D., PLA, MHA Director of Pharmaceutical Services
Preventing HIV Transmission to Newborns Ashwag Baghdadi, Pharm D, RPh PICU & PCICU Clinical Pharmacist
Workspace Optimizations for High Productivity Muna Al-Zahrani, Pharm D, RPh Sterile Compounding Clinical Pharmacist
Pharmacy Residency Accreditation Hala Al-Buti, Pharm D, RPh Asst. Director for Clinical Pharmacy Services
Pharmacy celebrates residency program accreditation
What is new about
Pharmacy Practice? Ali Al-Blowi, B.Sc. (Hons), M.Sc., Ph.D., PLA, MHA
Pharmacy practice is changing dramatically in recent years. The practice of pharmacy moved to a more
clinically driven, patient-oriented profession with pharmacist becoming integrated into multidisciplinary teams. Historically, the role of pharmacist grew from compounding, preparing and dispensing medication to unit dose system to clinical pharmacy and then to the era of pharmaceutical care. This transition of pharmacy practice is a challenging situation in our culture where the pharmacist has more responsibility for assuring patient quality care.
Pharmaceutical care Pharmaceutical care was first conceptualised in 1990 by Hepler and Strand as “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life”. These outcomes are the cure of a disease, arresting or slowing of a disease process, and reduction and prevention of patient’s symptomatology. Pharmaceutical care can reduce drug-related morbidity and mortality, and the cost of care, by the process of identifying, resolving and preventing drug-related problems.
(ASHP) endorsed this philosophy to obtain trust in the profession and mandated pharmacists to respond to these pharmaceutical problems that harm patients. In 1998, pharmaceutical care was defined by the International Pharmaceutical Federation (FIP) as “the responsible provision of pharmacotherapy for the purpose of achieving definite outcomes that improve or maintain a patient’s quality of life”. It is a collaborative process that aims to prevent or identify and solve medicinal product and health-related problems. This is a continuous quality improvement process for the use of medicinal products. Pharmacists can fulfil these responsibilities by the use of a systematic, comprehensive and efficient process to achieve the goals of therapy. This process is the process of patient care. It involves three major steps: assessment of patient drug therapy; development of a
The basis of the definition goes back to pharmacists’ involvement in the drug use process. Drug-related problems were thought to be not due to the drugs themselves but to the way the drugs are prescribed, dispensed and used. This has led to such care that aimed to control and prevent such problems and to achieve the proposed outcome of drug therapy. American Society of Health-System Pharmacists
care plan to achieve therapeutic goals; evaluation and reassessment, and continuous follow-up.
relationships, collecting of patientsâ€™ information, evaluating and developing a plan, providing patients with their needs of supplies, information and knowledge, and lastly, monitoring and reviewing the therapeutic plan.
To practise such care, a pharmacist needs to carry out certain steps which involve establishing professional
Pharmacy Practice Model Initiative In 2010, The Pharmacy Practice Model Initiative (PPMI) was implemented in the US by ASHP. The goal of the initiative was to significantly advance the health and well-being of patients in hospitals and health systems by developing and disseminating optimal pharmacy practice models that are based on the effective use of pharmacists as direct patient care providers. The Objectives of the PPMI were 1. Ensure the provision of safe, effective, efficient, and accountable medication-related care for patients in hospitals and health systems, taking into account the education and training of pharmacists, the prospect of enhancing the capacity of pharmacy technicians, and the current and future state of technology.
systems by patients and caregivers, healthcare professionals, healthcare executives, and payers. 4. Identify existing and future technologies required to support optimal pharmacy practice models in hospitals and health systems. 5. Identify specific actions that hospital and healthsystem pharmacists should take to implement optimal practice models.
2. Identify core patient-care-related services that should be consistently provided by departments of pharmacy in hospitals and health systems.
6. Determine the tools and resources needed to implement optimal pharmacy practice models in hospitals and health systems.
3. Foster understanding of and support for optimal pharmacy practice models in hospitals and health
Practice Advancement Initiative In 2016 ASHP embrace Practice Advancement Initiative (PAI) as the new philosophy of pharmaceutical care services. PPMI was expanded to include more pharmacy practice settings. The vision of ASHP Pharmacy practice set out in the PPMI and recently PAI focuses on new technologies of automated dispensing systems and robots becoming state of the art in pharmacy practice, as this should free pharmacists to provide more direct patient care. This vision aspires
to transform how pharmacists care for patients by empowering the pharmacy team to take responsibility for medication-use outcomes. PAI philosophy is concentrated on integrating pharmacists into health-care teams, leveraging the skills of pharmacy technicians, promoting pharmacist credentialing and training, encouraging the appropriate use of medication-safety technology, and ensuring pharmacists are leaders in medication use.
Conclusion Pharmacists are moving from traditional dispensing roles to more clinical patient-centred care. It has been shown that these new practices have an essential and positive effect on patient outcomes. Pharmacists need to eliminate the mystery of â€œbehind the counterâ€? and move to take an active role in direct patient care. The goal is to ensure the provision pharmaceutical care by providing safe, effective, timely, and accountable medicationrelated care.
Preventing HIV Transmission to
Newborns Ashwag Baghdadi, Pharm D, RPh
he transmission of human immunodeficiency virus (HIV) from an HIV-positive mother to her child during pregnancy, labour, or breastfeeding is called mother-to-child transmission (MTCT). In the absence of any intervention, transmission rates range from 15% to 45%. This rate can be reduced to less than 5% with effective interventions during pregnancy, delivery and breastfeeding.(Krist & Crawford-Faucher, 2002). Newborn prophylaxis can be achieved through reduction of HIV vertical transmission of HIV, recognizing neonatal HIV infection early, preventing opportunistic infections, and addressing psychosocial issues. All newborns exposed to HIV should receive antiretroviral (ARV) drugs in the neonatal period to reduce perinatal transmission of HIV, with selection of the appropriate type of ARV regimen guided by the level of transmission risk. The most important contributors to the risk of HIV transmission to a newborn exposed to HIV are whether the mother has received antepartum/intrapartum ARV drugs and her viral load. ARV drugs should be initiated as close to the time of birth as possible, preferably within 6 to 12 hours of delivery. The rate of MTCT declined from 2.1% to 0.46% (P=0.01), because earlier initiation of ARV prophylaxis drugs. (Townsend et al., 2014)
Newborn Antiretroviral Management According to Risk of HIV Infection: Category
Low Risk of Perinatal Mother adherent to standard ARV with HIV Transmission sustained viral suppression Higher Risk of Perinatal HIV Transmission
Neonatal ARV Management 4 weeks of ZDV
6 weeks ZDV and 3 doses of NVP Did not receive antepartum and intrapartum (NVP prophylaxis dose given within 48 hours of birth, 48 hours after first ARV drugs. dose, and 96 hours after second dose) Received only intrapartum ARV drugs. or Received antepartum and intrapartum ARV Empiric HIV therapy consisting of ZDV, drugs but have detectable viral load near 3TC, and NVP (treatment dosage) delivery. Have acute HIV infection during pregnancy.
Presumed Newborn HIV Exposure
Mothers with unknown HIV status with positive test at delivery or postpartum.
Similar to high risk newborns management should Newborns have a positive HIV antibody test. be discontinued immediately if supplemental testing confirms that mother does not have HIV.
Newborn with Confirmed HIV
Confirmed positive newborn HIV virologic test/NAT
3 drug combination ARV regimen at treatment dosage
3TC = lamivudine; ARV =antiretroviral; IV = intravenous; NAT = nucleic acid test; NVP = nevirapine; ZDV = zidovudine.
Newborn Antiretroviral Dosing Recommendations: Drug ZDV Treatment and Prophylaxis Dosage Note: For newborns unable to tolerate oral agents, the IV dose is 75% of the oral dose while maintaining the same dosing interval.
Dosing ≥35 Weeks’ Gestation at Birth Birth to 4–6 Weeks: 4 mg/kg/dose orally twice daily ≥30 to <35 Weeks’ Gestation at Birth Birth to 2 Weeks: 2 mg/kg/dose orally twice daily 2 Weeks to 4–6 Weeks: 3 mg/kg/dose orally twice daily <30 weeks’ Gestation at Birth Birth to 4 Weeks: 2 mg/kg/dose orally twice daily. 4–6 Weeks: 3 mg/kg/dose orally twice daily.
3TC Treatment and Prophylaxis Dosage NVP Prophylaxis Dosage
NVP Treatment Dosage
≥32 Weeks’ Gestation at Birth: Birth to 4 Weeks: 2 mg/kg/dose orally twice daily 4–6 Weeks: 4 mg/kg/dose orally twice daily Birth Weight 1.5–2 kg: 8-mg dose orally once daily Birth Weight >2 kg: 12-mg dose orally once daily ≥37 Weeks’ Gestation at Birth Birth– 6 Weeks: 34mg/kg/dose orally twice daily. 34 to <37 Weeks’ Gestation at Birth Birth–Age 1 Week: 4 mg/kg/dose orally twice daily. Age 1–6 Weeks: 6 mg/kg/dose orally twice daily.
3TC=lamivudine; IV= intravenous; NVP = nevirapine; ZDV = zidovudine
References: Antiretroviral Management of Newborns with Perinatal HIV Exposure or Perinatal HIV Management of Infants Born to Women with HIV Infection Perinatal. (2018). AIDSinfo. Retrieved 19 February 2018, from https://aidsinfo.nih.gov/guidelines/html/3/perinatal/187/ antiretroviral-management-of-newborns-with-perinatal-hiv-exposure-or-perinatal-hiv Krist, A. H., & Crawford-Faucher, A. M. Y. (2002). Management of newborns exposed to maternal HIV infection. American Family Physician. Mother-to-child transmission of HIV. (2018). World Health Organization. Retrieved 19 February 2018, from http://www.who.int/hiv/ topics/mtct/about/en/ Townsend, C. L., Byrne, L., Cortina-Borja, M., Thorne, C., De Ruiter, A., Lyall, H., … Tookey, P. A. (2014). Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000-2011. AIDS, 28(7), 1049–1057. https://doi.org/10.1097/ QAD.0000000000000212 US Public Health Service Task Force Recommendations for the Use of Antiretroviral Drugs in Pregnant Women Infected with HIV-1 for Maternal Health and for Reducing Perinatal HIV-1 Transmission in the United States, February 25, 2000, by the Perinatal. (2000). HIV Clinical Trials, 1(2), 39-64. http://dx.doi.org/10.1310/3unn-lh5n-mcul-65gq
Early infant diagnosis 2016, unaids.org
Workspace Optimizations for
High Productivity Muna Al-Zahrani, Pharm D, RPh
he spaces we occupy have significant consequences on our psychological well-being and creative performance. Organizing and optimizing the workspace could be beneficial as many of us spend years working in the same room, or at the same desk. Based on psychology and neuroscience findings, here are some simple and effective steps to improve productivity.
Lighting One of the most important factors in staying focused and inspired is proper illumination. An office with poor lighting can contribute to eye strain, headaches, fatigue, and overall irritability. Dark spaces can even trigger depression.
Colors Studies show that colors can affect a person’s mood and behavior. Some colors that could improve working conditions are: • Pink reduces feelings of aggression, irritation, and loneliness. • Red increases blood flow and heart rate while improving energy and attention. • Orange boosts enthusiasm and self-esteem. • Yellow increases creativity, alertness, productivity, and clarity. • Green helps promote efficiency and also decreases fatigue. • Blue enhances feelings of stability, trust, calmness, and confidence. It also encourages focus and creativity.
Comfortable furniture An employee’s productivity depends on how well their body can execute their performance. Below are some quick ergonomic checks for the office furniture. • Desk: The desk should be built at the ideal height resulting in an employee’s feet to be flat and firm resting on the floor. • Chair: A comfortable chair must have armrests, which should allow the shoulders to relax and the elbows to bend at least 90 degrees. A slightly reclined chair can also reduce pressure on the spine. • Computer screen: The eyes should be 24-36 inches away from the monitor. The top of the computer screen should also be below or at the eye-level.
Minimize clutter As clutter contributes to anxiety, it is important for an established system within the office to reduce clutter. Color-coded folders and files or organizational routines for each person can help with time management and organization of tasks.
Residency Accreditation Hala Al-Buti, Pharm D, RPh
esidency training aims to create better prepared clinic workforce to meet the challenging needs of the complex healthcare system. The pharmacy department, which is led by Brig. Gen. (Dr.) Ali Al-Blowi, recently celebrated the SCFHS accreditation for the General Clinical Pharmacy Residency program. His excellency Maj. Gen. (Dr.) Ibrahim Al-Nasser, King Fahad Armed Forces Hospital Director and many hospital officials joined the celebration at the new pharmacy in the speciality clinic. The aim of the residency program is to create experienced clinical providers who have the ability to manage patients’ drug therapies, irrespective of the clinical complexity. Quality pharmacy residency training is the need of the hour for developing pharmacists who are poised to meet the rising demands of the Saudi Arabia healthcare system. The program is aimed at helping qualified pharmacists gain knowledge beyond the degree program. With the changing environment of the global healthcare system, pharmacists are increasingly being evaluated based on clinical outcomes in addition to providing safe and effective patient care.
Outcome of Residency Training • Improving clinical and communications skills in various practice environments • Providing consultative and drug information services • Obtaining necessary professional experience, skills development, and maturity for advanced specialty practice residencies. Pharmacists are now taking on a greater role and being more involved in overall patient care and medication therapy management. Residency training offers knowledge and experience at the ‘point-of-care’ and also provides an opportunity for i nterprofessional collaboration. As the profession of pharmacy is increasingly becoming a clinically focused profession, individuals are expected to possess clinical decisionmaking abilities. This can be achieved by a wellstructured and streamlined residency training program. The program will ensure that the residents
are actively involved in patient care to gain first-hand experience. Saudi Arabia is committed to focus its efforts towards meeting the increasing demands of the complex healthcare system, and pharmacists are now playing a greater role towards overall patient care. Quality patient care is increasingly becoming dependent on the knowledge and experience gained by a pharmacist. A well-trained pharmacist will deliver optimal patient care with the application of problem solving skills, social skills, and therapeutic knowledge.
The residency accreditation is a huge leap for the pharmacy department as it will contribute towards improvement in the clinical pharmacy services and help increase the number of well-trained clinical pharmacist in Saudi Arabia’s healthcare system.
Advance pharmacy practice for optimal health outcomes