Pharmacists can attain decision making authority with knowledge and leadership skills

Pharmacists can attain decision making authority
with knowledge and leadership skills

They must improve their Attitudes, Behaviour and Communication
Skills and have confidence in themselves

KARACHI: Pakistan Society for Health System Pharmacistsorganized its 4^th annual meeting on September 5^th 2015. Mr. Osama Tabbara Senior Director, Dept. of Pharmacy Services at Cleveland Clinic Abu Dhabi from UAE was the Key Note speaker. Current Technological Advancements and Practices in Pharmacy Practices was the theme of the conference. The topic of Mr. Osama Tabbara’s presentation was Establishing World Class Pharmacy Services. Speaking on the occasion Mr. Tabbara called upon the Muslim World to depend on them rather than depending on the West.  We have the brain, leaders and we are capable. The pharmacy service we have established at Abu Dhabi is one of the greatest places to work and learn. However, it is important to go for proper planning to have a pharmacy.

At the Cleveland Clinic in Abu Dhabi, Mr. Osama Tabbara said, there are five centers of excellence in the disciplines of cardiovascular diseases, vascular medicine, neurology, respiratory diseases, ophthalmology and critical care. We have one hundred seventy physicians, ninety pharmacists and seventeen hundred nurses. It is a 360-Bed facility which can be expanded upto 490-beds. Here patient comes first. Every life Mr. Osama Tabbara opined deserves first class care. Our mission is safe, optimal therapy and we provide highest quality of care. We have world class leaders in patient care. We provide quality, passionate care.  Designed medication use with high technology can reduce the technical clerical work. He did not agree with the term being used as clinical pharmacists. Pharmacists, Mr. Osama Tabbara opined, is a clinician. When he achieves some special expertise, he or she becomes a pharmacotherapy specialist. Our objective is to spread culture of medication safety at regional level. We meet all regulatory accreditation standards. We have established an IVPN Experts Network in the Gulf Region which has five hundred sixty members, six of which are form Pakistan.

Continuing Mr. Osama Tabbara said that with good leadership and vision you can achieve wonders with scarce resources.  Continue the struggle and never give up. It is unfortunate that we are facing some logistic, regional political and economic instability but even then we must look at  turnaround time in OPD pharmacy, look at stock shortages, we must know what is happening in IV room, how to prevent medication errors, maintain employee engagement. He then discussed at length what makes pharmacists awake at night, ambulatory pharmacy, IV Room, In Patient pharmacy, Satellite Pharmacy and planning for a pharmacy. When the patient talks to the doctor, they are sitting face to face but when they come to the pharmacy, there is a barrier between the pharmacists and the patient which is an insult to you as well as to the patient, he remarked. He also talked about the sterilize preparation center, selection of staff which is committed, distinguished people. We look at their attitude, background and communication skills. They should not think of working from eight to five. Our experience shows that ladies are more committed. He then referred to Star Interviews and said that during the last four years they had selected sixty eight caregivers. He described the Healthcare professionals as care givers and patients as care seekers. In our service, we have thirty nine pharmacists, twenty seven technicians and two analysts. Almost 50% of them are North Americans. Operational part, he said, was more important than clinical.  He was of the view that low turnover retards career growth.

In the days to come, you will see robots working in pharmacy. He then talked about medication safety, accountability, workflow manpower, prescription growth, changing culture, inventory module and said that training was extremely important.  We have twenty nine IT specialists in the pharmacy staff. He also referred to implementing bar codes in pharmacy. For one hundred beds, there should be fourteen technicians and twelve pharmacists.   If you add another hundred beds, you should add ten more pharmacists and ten technicians. Bar coding helps in medication administration.  With thorough automation, we can do miracles. At our healthcare facility, anti coagulation clinic is run by the pharmacists. Engagement of staff ensures that they are more involved, enthusiastic and committed to work.  We must have a mentorship programme and spend half the time in developing leaders, he concluded.

It was followed by a Video presentation which depicted the crisis the pharmacists are facing in Pakistan. It has resulted in constant brain drain. There are no jobs for pharmacists in hospitals and there are barriers to practice. Aga Khan University Hospital and Shaukat Khanum Cancer Hospital have state of the art pharmacy services which are indeed commendable. At present over three thousand pharmacists are being produced annually and 50% of them are going into the Pharma industry. Pharmacists, it was stated are vital members of the healthcare team. Patient care and patient safety is our mission was the message conveyed through this video.

Earlier Mr. Jamshed Ahmad General Secretary of Pakistan Health System Pharmacists in his introductory remarks stated that we wish to develop most professional manpower. Drug interactions can cause death of the patient. Here the role of pharmacists is extremely important. However, in Pakistan, the role of the pharmacists has not yet been fully recognized. We have no political or personal agenda. All pharmacists are united. Pharmacists have in depth knowledge of drugs but they do not take the initiative to tell the doctors and the patients what is right for them.  Pharmacists, he opined, can attain authority of decision making with knowledge, confidence and leadership skills. We have to be role models.  He urged the pharmacists to improve their knowledge, basic as well as advanced keeping themselves abreast of latest developments in pharmacy. They must maintain integrity and honesty because with corrupt practices you cannot have ingredients of a role model. Role models, Mr.Jamshed Ahmad said, can be nurtured for excellence. With corrupt practices no one is going to listen to them.  Our main objective is empowering pharmacists, improving healthcare and providing role models. We should be working to build knowledge base, professional capacity, and leadership skills. We must learn how to communicate. We are working to create more opportunities for them convincing hospital owners to ensure patient safety by employing qualified pharmacists at the pharmacy. Most hospitals should have qualified pharmacists and we are making them empowered.  In the recent past we have been able to induct fifty pharmacists in healthcare facilities. He concluded his talk by narrating the following couplet:

Mr. Mohsin Shah Nawaz Ranjha, Parliamentary Secretary for Ministry of Information, Broadcasting and National Heritage who was the Guest of Honour on this occasion in his speech said that we in Pakistan are currently going through a transition phase. Health and Education deserve special attention and we need strong regulations. People’s expectations have increased. Patient safety is more important. Pharmacists should get knowledge to get empowered.  Doctors have a role in healthcare and to assume that role you should have knowledge to get empowered. He emphasized the importance of training programmes for the pharmacists to gain knowledge to get empowered.

Mr. Mohammad Aslam Chief Executive Officer of Drug Regulatory Authority of Pakistan (DRAP) in his address said that DRAP has now become autonomous. Health is a Right and to provide it is the government responsibility.  People must have access to medications when in need. What we need is safe and effective drugs available at affordable prices. Our approach should be patient oriented. All those involved in healthcare are partners. We require capacity building. We are assured by WHO. In order to have accredited institutions, gaps have been identified and we will try to fill them. CDL is being equipped and improved to get WHO accreditation. It will also help us improve our drugs exports. At present pharmacists are missing at all the healthcare facilities, he added.

Mr. Aslam Pechuho Additional Secretary Government of Sindh in his speech said that we are inducting more pharmacists. At present there are fifteen institutions producing pharmacists and the time has come to utilize this talent.

Progressive role of
Pharmacists in Patient Safety

Members of the Experts Panel in this panel discussion included Dr. Abdul Bari Khan from Indus Hospital, Dr. Mazhar Nizam from Patel Hospital, Dr. Tufail Bawa from Memon Medical Institute and Mr. Naser from Pharmacy services in Liaquat National Hospital. Ms. Sameena Badar Manager Pharmacy at SKMCH was the moderator. In her presentation Ms. Sameena Badar highlighted the shared responsibility between doctors, nurses, pharmacists in patient care. Speaking about the role of pharmacists in ensuring patient safety, she said that with pharmacists at the helm of affairs, there has been 66% reduction in adverse drug events, 99% physicians accept intervention by pharmacists. She also talked about quacks, self medication and drug interactions, medication errors, counterfeit drugs, look alike and sound alike drugs, drugs with similar labeling, near misses and medication errors. No one accepts error if you punish them. We all make mistakes everyday hence preventive action should be designed. We must adopt technology and use physicians electronic ordering system thereby we can reduce the errors. We need to identify system failures and promote culture of safety with non-punitive system. The system failure should be acknowledged and improved. As regards patient safety, we need to have high alert medications, implementation of TPN/IV administration, implement ADRs in hospitals, document pharmacist’s interventions and work on enhancing clinical competencies of all healthcare stake holders.

Prof. Abdul Bari Khan pointed out that pharmacists are not performing the role which they should be. They have gone into the shell. They are there to dispense medicines. We encourage them but they are reluctant to communicate and interact with the physicians. Majority of the hospitals give due respect to the pharmacists but many do not realize their importance. Indus Hospital has realized their importance and their role in patient safety.

Dr. Tufail Bawa said that there is lot of gap between what we say and what we see in reality. We need versatile pharmacists who can work as manager; in fact we need all rounders. Clinical Round gaps should be met. Sameena Bader opined that it was their responsibility to create opportunities for everyone including pharmacists. Dr. Bari remarked that pharmacists have to create their importance to get their rights. You delegate your responsibility to others.  Healthcare is a team work in which physicians do not know much about ADR and medical errors. Physicians do not look at drug interactions if there are already too many drugs on the patient chart. Pharmacists have to come forward and take up this role. Get yourself recognized. Pharmacists occupy important role in healthcare, they must come forward and take it further.  Dr. Mazhar Nizam opined that pharmacists must be prepared to take up multiple roles. They should have these qualities. It was also pointed out that it was the responsibility of the hospitals to get them trained for such roles. Take care of their CME/CPD, if this is not done, who will stay in Pakistan and this brain drain will continue. Dr. Bari opined that there is no short cut in any profession. You have to sacrifice something. Any institution requires a team. For progress, pharmacists should take responsibility and remember with opportunities, responsibility also comes. Mr. Nasir said that AKU has played a vital role in training of pharmacists. It is the responsibility of the leaders to develop department of pharmacy at all the healthcare facilities.

Effective role of Pharmacists,
Roadblocks and opportunities

This panel discussion was moderated by Mr. Tassawar Baig from Ziauddin University. Members of the expert’s panel included Mr. Khalid Yousuf, Mr. Mohammad Abrar, Mohammad Aslam Siddiqui, Mr. Qaiser and Ms. Shahrukh Haider. In his introductory remarks Mr. Tassawar Baig said that at present 55% of the pharmacists are working in Pharma industry, 15% in hospitals and 15% in sales and marketing and only 10% in community pharmacy. It was pointed out that at present there is no opportunity in the community pharmacy. In fact there is no set up at community level. There is need to create more jobs for them in government institutions. Mr. Khalid said that almost every one wishes to join the Pharma industry and no one seems to be interested in community pharmacy. There are opportunities in hospitals, capacity is there. It is responsibility of the institutions to provide opportunities to the pharmacists. There is no harm in going aboard, go but must come back with knowledge. Pharmacist’s role can be diversified in the Pharma industry. They can be absorbed in pharmacovigilance, clinical trials. Mr. Khalid opined that where there are drugs, there should be pharmacists. Future of pharmacists is bright but they must be confident and trust themselves.

Role of Pharmacists in
ensuring high-level of cGMP

Mr. Obaid Ali moderated this panel discussion in which the expert’s panel consisted of Mr. Anis Shah, Mr. Haroon Qasim, Mr. Sultan Ghani, Dr. Iftikhar Jafary and Dr. Abdullah. Mr. Sultan Ghani opined that community pharmacy should be given preference. Hospital pharmacy should be developed. Curriculum development is not proper and pharmacy council needs to take it up and address this issue. Mr. Anis Shah highlighted the importance of collaboration between hospitals and Pharma industry. At present it is purely theoretical training and no practical experience.  It is faculty’s responsibility to start interacting with employers. Training and development is your own responsibility, hence take it up. We have never refused internship training at Abbott to anyone, though there may be some waiting period. It is essential that we protect our own moral, organize and provide more opportunities for training and development. Sky is the limit and it is upto the pharmacists where they wish to go, he remarked.

Mr. Haroon Qasim remarked that pharmacists are serving the Pharma industry. They play an important role in management of drugs. There is lot of room to make progress. They can play a role in community pharmacy. Pharmacists should play their role in patient safety, protecting the consumers, serving the hospitals and with added knowledge; the entire health sector will get a big boost. Dr. Iftikhar Chaudhry said that pharmacists get lot of opportunities for internship. They must excel themselves. With the five years course, they will have more opportunities to learn more. They must be devoted to their profession, continue to serve it and do not leave this profession, he remarked.

Dr. Abdullah said that at present there seems to be no role for pharmacists and we need to create awareness about their role.  All those working in health sector should be told what pharmacists can do for them. There is a court ruling that for every fifty beds, there should be one pharmacist and one drug inspector at Tehsil level. Government of Baluchistan has recruited four hundred seventy pharmacists and sixty seven drug inspectors. Punjab has done a lot but the Sindh Government was sleeping. It has done nothing. Almost 80% of kidney failure, hepatitis is due to drug interactions and drug induced. We need to do something to wake up the Sindh Government. Responding to a question regarding bioequivalence studies and setting up an accredited laboratory by Pharma industry, Mr. Haroon Qasim said that it was not economically viable and there was also a conflict of interest. Pharma industry cannot do that. We need to improve our labs and bioequivalence should be included in pharmacy curriculum. We also need to move in clinical research and work there.