Downloaded 11 times
![• Conducted in appropriate technique especially sterile to
ensure efficacy & safety of products [IV admixture for
PCA & epidural cocktail]
• Extemporaneous should be done according to
formulation MOH Extemporaneous Formulary & proper
reference [Syrup Morphine]
14
Preparation](https://image.slidesharecdn.com/pfpthepharmacistrole-221219062755-664bbb99/85/PFP-The-Pharmacist-Role-pptx-14-320.jpg)
More Related Content
Similar to PFP The Pharmacist Role.pptx
PFP The Pharmacist Role.pptx
- 1. ROLE OF PHARMACISTSIN PAIN MANAGEMENT SEE JIAN MING PHARMACIST, HOSPITAL PORT DICKSON
- 2. • Pain FreeProgram • Multidisciplinary Healthcare Team • Roles of pharmacists in pain management • Pain Medication Therapy Management (MTM) Services • Training programme for pharmacist in pain management • Pain Medication Therapy Management (MTM) Guideline for Pharmacy • Reporting Of Pain MTM Services 2 Overview
- 3. 3 Pain Free Program 2011 Painas the 5th Vital Sign Pain Free Program Pain Free Hospital Concept . 2008 2017
- 4. • Different disciplinesin healthcare team works together: • Ensure a better assessment and understanding in managing patient • Proven to be efficient in pain management 4 Multidisciplinary Healthcare Team Patients & Family
- 5. • Pharmacist expertise understanding in pharmacology, pharmacokinetics, and therapeutic efficacy of medications. • Therefore pharmacist play an essential role to safeguard cost effectiveness and safe practice of pain medications while improving quality of life for patients. 5 Multidisciplinary Healthcare Team
- 6. 48% 29% 10% 7% 6% National Pharmaceutical RegulatoryAgency (NPRA), Malaysia had stated 1,575 ADR cases were reported in year 2017 involving 14 types of NSAIDs. Source : Noorleen Mohamed Ali, NPRA Eye disorder Respiratory, thoracic & mediastinal disorder Administration site reactions Gastrointestinal disorder Skin & subcutaneous disorder
- 7. 7 Roles of Pharmacistin Pain Management • Obtain, store, secure. • Distribute. • Prepare & dispense Technical Provide effective Pain Medication Therapy Management (MTM) Clinical • Improve Health Care System and Public Health • Plan and implement CPD General “Joint FIP / WHO Guidelines on GPP : Standards for Quality of Pharmacy Services”
- 8. ROLE OF PHARMACISTIN PAIN MANAGEMENT TECHNICAL ASPECT
- 9. 9 Role of Pharmacist Technicalaspect OBTAIN, STORE AND SECURE PREPARE & DISPENSE DISTRIBUTE Establish an effective distribution system 02 03 01
- 10. 10 Obtain, Store &Secure Prepare list of essential medications needed for pain management 01 Coordinate with relevant pharmacist (Sub- store OPD & Logistics) 02 Ensure sufficient stock availability 03 Proper storage condition 04
- 11. 11 Common Medications Non Opioid Paracetamol •Paracetamol 500 mg Tab • Paracetamol 250mg/5ml & 120mg/5ml Syrup • Paracetamol 125 & 250mg Supp • Paracetamol 1g/100ml Injection NSAIDs • Non Selective NSAIDs • Cox-2 Inhibitors • Celecoxib 200mg Capsule • Etoricoxib 60,90 & 120mg Tablet • Parecoxib 40 mg Inj
- 12. 12 Common Medications Opioid Weak Opioid •Tramadol • Ultracet (KPK) Morphine • Morphine 10mg/ml Injection • Morphine SR 10mg, 30mg & 60mg • Aq. Morphine 10mg/5ml Oxycodone • OxyNORM 10mg/ml Injection • OxyNORM 5mg & 10mg capsule • OxyNORM 1mg/ml Syrup (KPK) • OxyCONTIN 10mg, 20mg, 40mg PR Tablet Oxycodone + Naloxone • OxyCONTIN + Naloxone (TARGIN) 5/2.5mg, 10/5mg, 20/10mg, 40/20mg Tablet Fentanyl • Fentanyl 50mcg/ml Injection • Fentanyl 12mcg, 25mcg, 50mcg/hr Transdermal Patch •Methadone • Sy Methadone 5mg/ml (KPK)
- 13. 13 Common Medications Adjuvants &Topical Application Tricyclic Antidepresant (TCA) • Amitriptylline 25mg & 10mg (KPK) • Nortriptyline 10mg & 25mg (KPK) Anticonvulsants • Gabapentin 100mg, 300mg &600mg • Pregabalin 50mg, 75mg & 150mg cap •SNRI • Duloxetine 30mg & 60mg Topical Application • Lignocaine gel & Patch • EMLA Cream • Ketoprofen & Diclofenac Gel
- 14. • Conducted inappropriate technique especially sterile to ensure efficacy & safety of products [IV admixture for PCA & epidural cocktail] • Extemporaneous should be done according to formulation MOH Extemporaneous Formulary & proper reference [Syrup Morphine] 14 Preparation
- 15. • Dispensing –Good Dispensing Practice should be practiced • Ensure patient receives enough medication • Guideline on dispensing of analgesic – Quantity need to be supplied. • Mechanism to differentiate pain management prescription • Pain stamp on Rx 15 Dispensing Bedside dispensing
- 16. ROLE OF PHARMACISTIN PAIN MANAGEMENT CLINICAL ASPECT
- 17. • A specializedpharmacy service. • Provide by trained pharmacist. • At MOH facilities including hospitals and health clinics that implement Pain as 5th Vital Sign 17 Pain Medication Therapy Management (MTM) Services
- 18. 18 Pain Medication TherapyManagement (MTM) Services • To optimize pain therapy (controlled/ reduce pain) by recommending individualized pain regimen 1 • To minimize adverse events and medication errors by reviewing patients’ past and current medications. 2 • To counsel patients on appropriate use of pain medications and to increase patients’ understanding on their medications. 3 • To collaborate and to provide information to healthcare providers on pain medications. 4 Objectives
- 19. Provision Of PainMTM Service Assessing patients’ health status and medication history Managing patients’ medication therapy Establishing pharmaceutical care plan to address identified PCI Monitoring patients’ progress, outcomes of treatment and medication safety issues Providing information about medicines and other health related issues 19
- 20. 20 Pain MTM Servicein Ambulatory & Inpatient setting Ambulatory Setting Pain MTM Clinic Pre Anaesthetic MTM Clinic Medication Counseling (Pain) Inpatient Setting APS/ Multidisciplinary Pain Team Round Medication Counseling (Pain)
- 21. 21 Pain Medication TherapyManagement (MTM) Clinic • Conducted by pharmacists in collaboration with other healthcare providers • Pain Specialist • Family Medicine Specialist (FMS) • Educate and guide patients in managing and controlling their pain through pharmacotherapy approach • Referred by pain specialist/ FMS or selected by pharmacist at the clinic. Ambulatory Service
- 22. 22 Pain Medication TherapyManagement (MTM) Clinic Patient Selection • Newly started on analgesics & adjuvants (first time seen by pain specialist) • Therapeutic goals not achieved with current pain medication regimen • Chronic pain requiring long term use of pain medication and regular monitoring • Patient referred to Pain MTM Clinic • Changes in pain medication regimen • Experiencing side effects or complications due to their pain medications. • On strong opioids therapy. • Poor understanding on pain medication regimen.
- 23. Pain MTM Workflow:Initial visit 23 Assessment by clinician Refer to Pharmacist Initial assessment Intervention Medication education & counseling Provide next TCA Documentation Communicate with clinician
- 24. Pain MTM Workflow:Subsequent visit 24 Follow up assessment Intervention Medication education & counseling Provide next TCA Documentation Pain assessment Medication knowledge assessment PCI Intervention Plan Communicate with clinician
- 25. Medication education andcounselling Treatment goal Detail of medication Side effect & precaution Storage Missed dose Round the clock Vs PRN 25 Elaborate & reinforce Follow up counselling • Name • Dose • Frequency • Indication • Time & method of administration
- 26. 75.0% 73.1% Not awareof the side effects caused by painkillers. Had not been informed regarding the side effects of the painkillers by healthcare Did not know the name of the ingredient of the painkillers that they had taken. 58.5%
- 27. Strong Opioid: Patient InformationLeaflet 27 Important information: - Swallow whole, capsule cannot be opened. - Not to moisten/ dissolve/ cut/ crush/ chew SR Tablet. Opioid tapering information. Side effects & precaution. - Avoid driving/ handling heavy machinery. Safe storage & disposal.
- 28. 28 Pain Medication TherapyManagement (MTM) Clinic • Identify any Pharmaceutical care issues (PCI) • Assess & intervene. • Drug related problem: • Identify available therapeutic alternative • Formulate individualized action plan • Address safety concern • Make an appropriate recommendations
- 29. 29 Pain Medication TherapyManagement (MTM) Clinic Discharge Criteria Discharged from pain clinic or transferred to other facility. Wean off from pain medication Achieved treatment goal and no further PCI Patients request Defaulted follow up for 1 year
- 30. 30 Pre Anaesthetic MTMClinic • Provided during Pre-anaesthetic clinic (PAC) day. • Pre-operative medication assessment of patients scheduled for surgery. Ambulatory Service
- 31. 31 Pre Anaesthetic MTMClinic • Medication history taking and medication review. • Include herbal remedies and OTC. • Providing education on post-operation pain regimen. • Compliance • Allergies • Side effects Scope of service
- 32. Pre Anaesthetic MTMClinic Workflow 32 Pre Anaes assessment by clinician Assessment by pharmacist Intervention Medication education & Counseling Documentation Communicate with clinician
- 33. 33 Acute Pain Service(APS)/ Multidisciplinary Pain Team Round Review patients’ medication during Acute Pain Service (APS) or multidisciplinary pain team round/ discussion. Inpatient setting APS ward round Multidisciplinary meeting
- 34. Acute Pain Service(APS)/ Multidisciplinary Pain Team Round Workflow: 34 Prepare list patient Follow ward round Relevant documents pass to the pharmacist i/c of the ward Documentation
- 35. 35 Acute Pain Service Activitiesduring ward round CP1 • Medication history taking CP2 • Case Clerking CP3 • Identifying and intervening PCI BK • Medication counselling CP4 • Referring discharged patients who require follow up counselling Ward round
- 36.
- 37. 37 Medication Counselling (Pain) •This service is applicable to both ambulatory and inpatient settings of hospital or health clinic that has implemented P5VS at their facility and unable to provide specialized Pain MTM Services. Pain medication counseling
- 38. Medication Counselling (Pain): Patient criteria for counselling Complex analgesic regimen Multiple comorbidities Special Population Poor Understanding On long term analgesic Referred from other healthcare facilities 38
- 39. 39 Home Medication Review •Palliative care population - one of the groups who are at the highest risk of medication misadventure and adverse events, and consequently hospital admissions • Involvement of pharmacist – • Ensure better therapeutic outcomes in the overall management of the patient
- 40.
- 41. ROLE OF PHARMACISTIN PAIN MANAGEMENT GENERAL ROLE
- 42. 42 Improve the effectivenessof Health Care System and Public Health • Public exhibition & education. • Public campaign Know your medicine campaign
- 43. 43 Improve the effectivenessof Health Care System and Public Health • Research collaboration with other healthcare provider. • Publish/ present share research findings with others. • Improve in process of care.
- 44. Research area • Assessthe appropriateness and the rational use of drugs Drug utilization • Identify adherence and factors influencing adherence Patient empowerment • Inappropriate use of analgesic & its complication • Patients' knowledge, attitude and practice towards analgesic Drug safety • Long term effects and the risks of abuse and misuse in long term opioid users with chronic non-cancer pain Substance Abuse 44
- 45. 45 Continuing Professional Development •Training • Workshop • Seminar
- 46. TRAINING PROGRAM FORPAIN PHARMACIST
- 47. 47 Training Program ForPharmacist in Pain Management • At recognized training center: • Hospital Raja Permaisuri Bainun, Ipoh • Hospital Sultan Ismail, Johor Bahru
- 48. 48 Training Program ForPharmacist in Pain Management • Two weeks attachment (80 hours) • Pain MTM Clinic • APS ward round • Pre Anaesthetic MTM Clinic • Teaching materials Training Module
- 49. • FRP • Interestin pain management • Have been in pain management at least 1 year • Application is supported by KPF & TPKNF • Conduct echo training at least 6 months after completion of training • Ready to serve in pain management for at least 2 years at the same facility 49 Training Program For Pharmacist in Pain Management Criteria
- 50.
- 51. 51 Permohonan kepada Bhgn.A&P Farmasi Negeri pemohon Memenuhi kriteria? Permohonan kepada Bhgn. A&P Farmasi Negeri pusat latihan Setuju? Pemohon menjalani latihan Hantar buku log kepada Bhgn. A&P Farmasi Negeri pusat latihan Lulus? Keluarkan sijil tamat latihan Kemaskini Registri Maklumkan kepada fasiliti pemohon Maklumkan kepada Bhgn. A&P Farmasi Negeri pemohon KJF/PFK Fasiliti Pemohon Bhgn. A&P Farmasi Negeri Pemohon Bhgn. A&P Farmasi Negeri Pemohon Bhgn. A&P Farmasi Negeri Pusat Latihan Preseptor Preseptor Bhgn. A&P Farmasi Negeri Pusat Latihan Bhgn. A&P Farmasi Negeri Pusat Latihan Bhgn. A&P Farmasi Negeri Pusat Latihan Workflow
- 52. 52 Pharmacy Pain Management Guideline •Published by Pharmaceutical Services Programme, MOH • 1st edition - 2016 • 2nd edition – 2018 • Content : Pharmacy Pain Management Services in MOH facilities • Accessible at website: www. pharmacy.gov.my – Publications www. moh.gov.my – Publications
- 53. 53 Pharmacy Pain Management Guideline FirstEdition, 2016 Second Edition, 2018
- 54. • Letter fromPharmaceutical Services Programme KKM.600-34/3/11(25) Jld 4 dated 16th March 2018 54 Reporting Of Pain MTM Services
- 55. • Data collectionform for Pain Medication Therapy Management (MTM) services carried out by the pharmacist at a Pain Free Hospital (starting 2018) • The statistical report will be sent by the Head of pharmacy department (KPF)/ appointed Pharmacist (PF YM) to Bahagian Amalan & Perkembangan Farmasi, KKM via Timbalan Pengarah Kesihatan Negeri (Farmasi) in each state 55 Reporting Of Pain MTM Services
- 56. 56 Pain MTM Pelaporan AktivitiPain Medication Therapy Management (MTM) Negeri : _____________ Tempoh/ Bulan : _____________ Hospital / Fasiliti Bil. Pegawai Farmasi1 Klinik Pain MTM2 Kaunseling selain di klinik MTM (Khas untuk pain management) 3 Bilangan Kes4 Bilangan Pesakit di kaunsel di Klinik Anaesthetik5 Adverse drug Reaction (ADR) 6 Medication Error (ME) 7 Bil. Pesakita Bilangan Kaunselingb Acute Pain Service (APS) Multidisciplinary Pain Team Round Sepenuh Masa Separuh Masa Baru i Pesakit Susulan ii Opioidi Antidepressant/ Anticonvulsant/ Other(s)ii Jan – Mac Pada 10 April 2018 Jan – Jun Pada 10 Julai 2018 Jan – September Pada 10 Oktober 2018 Jan – Disember Pada 10 Januari 2019 Nota: TPKN(F) akan menghantar borang ini ke Bahagian Perkhidmatan Farmasi, KKM setiap 3 bulan
- 57. 57 Summary • Pharmacists playan important role in facilitating seamless care to promote better pain management and overall health outcomes. • Pharmacists can play an active part in management of both acute and chronic pain; • Ensuring safe and appropriate use of medications. • Counseling and educating patients, caregivers and other health care team about medication therapy.
- 58.
- 59. This is aninitiative by the Pain Pharmacy Committee of Pharmaceutical Services Programme, Ministry of Health Malaysia. Would like to express our heartfelt gratitude the committee members of the reviewers, contributors and all those involved for their valuable and constructive59 Acknowledgement