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Pharmacy Bulletin

V O L U M E 6 ( I S S U E 2 / 2 0 1 1 ) H O S P I T A L T A I P I N G

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New Service Available at our Farmasi Klinik Pakar (FKP) Ubat Melalui Pos 1Malaysia (UMP 1Malaysia)
What is UMP 1Malaysia? This service aims to deliver follow-up
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Ubat Melalui Pos 1Malaysia

Benefits of UMP 1Malaysia

Medications are sent directly to location of choice (home, office, etc.) Assures continuous supply of medications Saves time

Quality Use of Medicines for the Consumer (QUM-C) Adverse Drug Reaction Reporting Mental Health Pharmacy Services

medications by PosLaju to the patients location of choice in Malaysia. Patients who choose this service must fulfill several criteria. A postal charge of RM5

should be paid directly to PosLaju staff upon delivery of the medication.

How to obtain the service? 1. Collect your first months supply from the hospital pharmacy counter. 2. Inform your pharmacist that you wish to sign up for the UMP 1Malaysia service.

EDITORIAL BOARD
Advisors: Pn. Narimah Md. Yusoff Pn. S. Nirmala Devi Chief Editors: Rema Panickar Sun Gaik Peng Editors: Khoo Hui Wen Liew Ze Tong Mohd. Izzat Ong Su Ling Teo Liu Chiew
our ome y e welc k and W ac feedb ions: ggest com su yahoo. lletin@ bu pharm

3. Provide details as required. (Payment is to be made on delivery). For further details, please consult the pharmacist at Counter 1 of the Farmasi Klinik Pakar, or call 05-8408093 / 8095.

Action Plan 2011: Implementing

in the Pharmacy Department

In accordance with the pharmacy departments action plan for year 2011, we will be implementing 5S throughout the whole department by year end. In practising 5S, we are moving towards continuous improvement in quality and productivity. With improved cleanliness at work place and systematic visual control, we are creating an organization which promotes togetherness, discipline and teamwork along with improvement in all aspects of work within the organization.

What is 5S? See page 4 for more information.

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What is it?
Patients receive individualized medications appropriate to their clinical needs, and the lowest cost to them and their community- (WHO, 2001 )

Causes of low QUMC


Irrational prescribing & dispensing by doctors & pharmacists Lack of information, education and communication on rational drug use to providers and consumers Lack of political will and leadership to promote rational use

Why is QUMC important?


To avoid inappropriate use of medicines.

Consequences of low QUMC


Patient does not receive full benefit of available medicines Ineffective treatment, sometimes unnecessary and
harmful adverse effects of medicine

Common types of low QUMC


Polypharmacy Inappropriate use of antibiotics Prolonged use of injection medicine even though the patient can tolerate orally. Patients often take less medicine than prescribed

Increased morbidity & mortality Increased antibiotic resistance leading to use of


stronger and more expensive antibiotic treatment

Increased economical burden to households & the government

12 keys to promote QUMC


1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Establishment of a multidisciplinary national body to coordinate policies on medicine use The use of clinical guidelines The development and use of National Essential Medicines List Establishment of drug and therapeutics committees in districts and hospitals Inclusion of problem-based pharmacotherapy training in undergraduate curricula Continuing in-service medical education as a licensure requirement Supervision, audit and feedback Use of independent information on medicines Public education about medicines Avoidance of perverse financial incentives Use of appropriate and enforced regulations Sufficient government expenditure to ensure availability of medicines and staff

Announcement:
Since 2010, new indenting system for emergency trolley items has gradually been introduced in most wards. With this new system, wards will be supplied with medications in a pre-packed bag with a clear expiry date. Each prepack is meant for single-use only. Any unused quantity of the pre-pack together with the plastic bag needs to be sent back to Ward Supply Pharmacy for exchange.

Ne

Advantages

wP re-p

Prevents medication errors. Reduces the number of missed expiry dates. To ease daily checking of quantity of emergency items.

ack s

Further enquiries, please contact: Mr. Foo Mun Hon (Ext. 8282) Ward Supply Pharmacy, Hospital Taiping

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Right Patient
Advising patient on following: Do not share medication Store medications for pets separately Use safety caps to keep small children out Store medications out of reach of small children Do not give a child a medication bottle as a toy

Right Medicine
Advising patient to: Read the medication label even if you think you know which bottle it is Put on eyeglasses and turn on lights to read label For OTC medications, read the ingredients list Know the name of all medication you prescribe Know what medications are used for

Right Dose
Advising patient to: Read the directions on the label Know how many tablets or doses should be taken each day Know how long the medication should be continued Know the abbreviations for tablespoon and teaspoon Use a medication measuring cup or spoon for liquid, rather than a household spoon Taking extra medication is not always better

Right Time
Advising patient to: Follow the label Know if the medication should be taken at a specific time of day Know if the medication will interact with food or other medications Take medication at the same time each day Know what to do if a dose is missed

Right Route
Advising patient to: Read the label Remember that not all tablets should be swallowed Know if the tablet can be chewed or crushed or if it should be swallowed whole

Scenario 1: Pharmacist getting medication history from patient in the ward. The patient was previously prescribed 10 types of medication. Pharmacist: Sir, did you bring in your medicines from home? Patient: Yes, here they are (lifts out a huge jar containing an assortment of pills, all mixed together.) Pharmacist: Wow. Do you know which drug is for your diabetes? Patient: No. Pharmacist: How do you know which medicine to take at what time? Patient: I just open the bottle and take one tablet every day, whichever it may be. Pharmacist: ??!!....

Scenario 2: Pharmacist counseling a patient on how to use her inhaler. Pharmacist: Good morning maam. Could you just show me how you normally use your inhaler? Patient: Ahh, Ive been using it for 20 years. You dont have to try and teach me. Pharmacist: Please, just show me once. It will only take a second. (Patient gets out her inhaler and demonstrates confidently). Pharmacist: So, do you feel the medication working? Patient: Yes, I feel the effect now. Pharmacist: Maam, you actually forgot to remove the cap on your inhaler the whole time.

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Website: http://www.bpfk.gov.my

Reporting Me

chanism

MADRAC (Malaysian Adverse Drug Reactions Advisory Committee) was established under the Drug Control Authority (DCA) to ensure the safety of the public consuming registered products. The function of MADRAC is to promote adverse drug reaction (ADR) reporting throughout Malaysia, provide information to health care professionals on ADRs and participate in the WHO ADR monitoring programme. Based on the ADR reports received, the committee will suggest labelling changes on the certain product inserts or packaging recommend restriction on usage, and implement drugs recalls or withdrawal.

ADR Form

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What is 5S?
5S is the short form for 5 Japanese words namely: Seiri, Seiton, Seiso, Seiketsu and Shitsuke which in Bahasa Melayu means Sisih, Susun, Sapu, Seragam and Sentiasa Amal. The main aim of 5S in pharmacy service is to reduce errors in the process of dispensing medications and to increase patient satisfaction towards the service provided. Besides, this practice will also create a positive and dynamic work culture, as well as promote

Impacts of 5S

Better arrangement of medications/ stocks in pharmacy/store Hasten and ease finding of drugs/ -drugs Reduce drug wastage by reducing numbers of expired drugs Safer and more conducive work environment, leading to increased productivity non

Better cooperation between pharmacy staff Improve motivation and staff morale

teamwork at all pharmacy facilities.

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According to reports and clinical trials done by GlaxoSmithKline Canada, there were 17 incidences of myocardial ischaemia reported which were related to the use of salbutamol injection to delay premature labour . Although salbutamol and other beta agonist products are not indicated for this purpose in Canada and Malaysia, they have been used as an off-label use. Hence, MADRAC has decided the following warning statements must be included in the product information leaflet for these drugs:

For injectable and oral products: Careful attention should be given to fluid balance and cardio-respiratory function , including ECG monitoring. If signs of pulmonary oedema and myocardial ischaemia develop, discontinuation of treatment should be considered. Due to the risk of pulmonary oedema and myocardial ischaemia that has been observed during the use of beta2-agonists in the treatment of premature labour, assessment is required before the product is given to the patient.
Information Source: MADRAC Bulletin August 2008

Since May 2006 to April 2010, 14 ADR reports related to the use of promethazine injection have been received by the National Centre of ADR Monitoring, where 12 out of 14 patients recovered without any sequelae. One adult patient with a mild skin reaction has recovered at the time of reporting while the remaining infant whose mother received promethazine for sedation had no outcome. Hence, in April 2010, Health Canada notified health care professionals and the public regarding changes to the prescribing information for promethazine hydrochloride injection, as follows: Respiratory depressionPediatrics Promethazine hydrochloride injection should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. Post-marketing cases of respiratory depression, including fatalities, have been reported with use of promethazine in pediatric patients less than 2 years of age. Caution should be exercised when administering promethazine hydrochloride injection to pediatric patients 2 years of age and older Severe Tissue Injury, Including Gangrene Promethazine hydrochloride injection can cause severe chemical irritation and damage to tissues regardless of the route of administration. Irritation and damage can result from perivascular extravasation, unintentional intra-arterial injection, and intraneuronal or perineuronal infiltration. Adverse reactions include burning, pain, thrombophlebitis, tissue necrosis, and gangrene. In some cases, surgical intervention, including fasciotomy, skin graft, and/or amputation have been required. Due to the risks of intravenous injection, the preferred route of administration of Promethazine hydrochloride injection is deep intramuscular injection. Subcutaneous injection is contraindicated.
Information Source: MADRAC Bulletin August 2010

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Special Pharmacy Services for Mental Health

This service was established in 2009 at Taiping Hospital. We were one of the first in the country to initiate the Home Medication Review service for mental health patients. This service is now also conducted by Hospital Bahagia Ulu Kinta, Perak (HBUK). Under this service, a Home Care Psychiatry Team consisting of a pharmacist, driver, medical assistant, and staff nurse will visit mental health patients in their own homes. We currently serve about 100 patients at various locations around northern Perak, covering a radius of 10-15km around Taiping. During the visit, the patients balance medication will be counted to check compliance, new medication will be dispensed, problems identified, and counseling given to patients or caretakers. When the service was first established, there was significant medication cost-saving as the pharmacist was able to check and reuse the patients own medication which had been accumulated at home. The pharmacist visit takes place every Monday, with each patient being visited about once a month. Any problems identified will be recorded by the pharmacist and discussed with the clinical psychiatrist at Taiping Hospital for further action.

Venue: Psychiatry Outpatient Department Operation hours: Thursdays, from 8.00 a.m. to 1.00p.m.