Pharmaceutical Services & Sciences

Personalized medication management unit (PMMU) is one of a kind unit in the Middle East and it’s considered as one of the most important and unique sections in CCHE 57357 clinical pharmacy.

PMMU is concerned with tailoring medication doses according to patients needs through therapeutic drug monitoring and genotyping for certain genes that affect drug metabolism which is a novel approach, both practices being carried out the in pharmacokinetics lab.

Pharmacokinetics lab is mainly concern with therapeutic drug monitoring for several medications as (Methotrexate, Cyclosporine, Amikacin, Vancomycin, Phenytoin, Valproic acid and Digoxin) through immunoassay techniques which take less than 60 minutes to determine the drug concentration in the blood sample.

In addition, there are some medications such as Voriconazole, Posaconazole, Busulfan, Mercaptopurine metabolites and others that require using different detection methods other than the immunoassay such as liquid chromatography.

In addition, chromatographic methodologies can be used for quality control on certain medications to confirm the active ingredients concentration with the labeled concentration.

On another front, 57357 started Pharmacogenetics implementation in 2015. As per the Clinical Pharmacogenetics Implementation Consortium (CPIC), the Children’s Cancer Hospital Egypt is listed as one of few hospitals worldwide applying clinical pharmacogenetics. The Clinical Pharmacogenetics unit allows us to modify the patient medication doses according to his own genes.

At the PMMU, after getting the patients' TDM or PGX (if these are abbreviations of therapeutic drug monitoring and Pharmacogenetics please write them in the above mentioned places) we feed the results to Cerner’s HIS (Hospital informatics system) along with the dose modification recommendation if the patient requires that.

Now we can optimize the patient doses according to the level of the medication in the patient body in addition to the patients' genes and clinical status in a complementary way.

Infectious diseases pharmacists have an established role in optimizing antimicrobial use in our hospital through four vital roles:

• Direct patient care

Our ID pharmacists are responsible for designing comprehensive antimicrobial therapy plan for patient-specific problems and persuasively justifying recommendations based on patient-specific pharmacologic, pharmacokinetic, pharmacodynamic, pharmacogenomic, pharmacoeconomic, ethical, legal and evidence-based information.



• Antimicrobial stewardship (AMS)

Our ID pharmacists work together with ID consultants and fellows to ensure that antimicrobials are used appropriately to improve patient outcomes and to minimize resistance, adverse events, eliminate unnecessary usage, and decrease costs.



• Research

As an integral part of the infectious diseases study team, our ID pharmacists participate in a number of research activities in the field of infectious diseases. Furthermore, they participate in developing guidelines, policies, and other monitoring and intervention strategies for antimicrobial use and streamlining prophylactic, empiric, and definitive antimicrobial therapy.



• Education

Our ID pharmacists are responsible for a number of educational activities that include educational sessions for pharmacists, physicians, and nurses on topics related to antimicrobials and infectious diseases. Moreover, they are responsible for training PharmD students and IPPR residents during their infectious diseases rotations.

Nuclear Pharmacy is a niche speciality area of pharmacy that is concerned with production and use of radiopharmaceuticals for diagnosis and treatment of various diseases. Our nuclear pharmacy at the CCHE-57357 is the first nuclear pharmacy in the MENA region. We don’t only provide conventional production services, but also a unique clinical service that we are the first to apply worldwide.

The clinical nutrition support pharmacist is responsible for optimizing outcomes and providing safe and effective nutrition therapy for patients who cannot sustain adequate nutrition through oral intake.

The nutrition support pharmacist works as part of the healthcare team in reviewing the parenteral nutrition physician order including patient demographics and PN indications, calculating caloric requirements, route of administration (central or peripheral line), osmolarity, fluids and electrolytes, and monitoring daily laboratory, nutritional supplementation and daily oral intake.

Parenteral nutrition (PN) therapy is a high alert medication, complex and critical therapy that requires the knowledge, skills, and practical experience of the nutrition support pharmacist to avoid errors in prescribing, compounding, and clinical management of patients.

The nutrition support pharmacist reviews the feeding including type of formula prescribed, patient tolerance to formula, rate, and caloric intake whether through enteral or oral feeding.

As such, each of these practices help to support the delivery of safe and effective nutrition therapy to patients, improve nutritional status and clinical outcomes of patients; prevent and resolve PN-associated complications, and enhance quality of PN services.

Inter-disciplinary collaboration between clinical nutrition department and the pharmacy provides parenteral nutrition interventions in an ideal safe way.

57357’s OR Pharmacists are the first resident clinical pharmacists assigned to operating rooms in Egypt and the Middle East. They have a significant role at each stage of the admittance of a patient in the Operation Room.

• In Preoperative Area

OR Pharmacists are responsible for checking patient’s medical history, cultures, allergy profile, previous drugs, clinic notes, drug interactions, hepatic functions, renal functions, complete blood count, cardiac profile, chest profile and antibiotic medications which depend on culture, anesthetic medications, and preparation in a laminar flow cabinet to ensure sterility& stability of medications.




OR pharmacists also participate in Policy of Antimicrobial Prophylaxis in Preoperative Patients requiring surgeries (Neurosurgery, General Surgery, Orthopedic Surgery, Ophthalmology Surgery )



• Inside the Operation Room

OR pharmacists effect rounds every 30 minutes in all Operation Rooms to check the situation inside the rooms and help Anesthetic and Surgeon if needed with respect to medications or re-dosing for Antimicrobial and available Antidote and dosage in the case of overdosed Anesthesia




They also provide drug information to health care professionals through monitoring with the Anesthetic and Surgeon for side effects of any medications taken during the surgery and method of Management of related adverse reactions.



• In Postoperative Area

The resident pharmacist is responsible for assisting with pain management for pain medication availability and doses. Giving a quick review to round pharmacist especially if an uncommon event occurs to patient before the transfer of the case to the inpatient section. Informing and counseling the family about discharge medication to check doses, drug Interactions and frequency and precaution of administration.



• Surgical Intensive Care Unit

The resident pharmacist effects clinical rounds with registrar and consultant to set up the pharmaceutical care plan for the patient to ensure correct doses of medications, time delivery, administration and to identify, prevent and solve all patient drug related problems.




The resident pharmacist is also responsible for updating doses of medications according to change in their level performed in pharmacokinetic or according to hormonal profile or electrolytes disturbance and updating the plan according to patient condition.

The pharmacist plays a key role in patients counseling, serving both the outpatients and inpatients for ensuring strict adherence to medication intake guidelines and maximizing patient's outcomes.

This pharmacist is always in direct contact with the patient to provide him with every possible information about their medication and answering any inquiries the patient could have about directions of use, advice on side effects, precautions, storage, diet and life style modifications through the use of a Patient Education checklist.

The main role of the patient counseling pharmacist can be summarized in the following:

1. Make sure that the medication prescribed meets the indication by asking the patient questions about his condition.
2. Giving clear information about the dose and the frequency of the medication
3. Clarifying any food drug interactions to the patient and if the medication should be taken before or after food
4. Following the patient’s adherence and compliance to the medication
5. Enabling the patient to become an active participant in disease treatment and self-care management.
6. Prevention of home medication errors.

• The patient counseling pharmacist provides patient counseling service for outpatients and inpatients, with special attention to new cases, reviewing the protocol medication map. Medication information is shared orally or in written form with the patients and their representatives.


• Patient counseling is considered the last line of defense as pharmacists do not only educate the patients but also discover and solve medication errors.


• Pharmacists are also responsible for reviewing and printing the Arabic patient education brochures and stickers in Arabic for most dispensed medication.

The radiology pharmacist has the responsibilities of the clinical pharmacist in both the Radiology and Radiotherapy Departments.

The radiology pharmacist is responsible for reviewing and verifying all medication orders ensuring that patient receives the proper dose of contrast media with minimal risk of adverse events. Reviewing patient’s history for medication allergy, drug-drug interactions and drug-disease interactions – enhances the patient safety and decreases the risk of contrast media related adverse events.

The risk of Contrast Induced Nephropathy (CIN) is decreased by the evaluation of renal function prior to contrast media administration and using the minimal dose that produces optimal contrast enhanced images.

With respect to pharmacoeconomics, using optimal doses decreases the cost of the diagnostic exam and the cost of overcoming the possible adverse drug effects.

Pain

Clinical Pain Pharmacists have the responsibility of optimizing outcomes and providing safe and effective analgesia for patients who are suffering from pain.

The Pain pharmacists work as part of the healthcare pain team in evaluating the pain symptoms and pain scores during the daily morning rounds, escalating or deescalating pain medication doses.

With respect to narcotic drugs, pain pharmacists are responsible of the following:

• Verifying and dispensing narcotic drugs for the patients throughout the hospital.
• Preparing and delivering daily narcotic medication syringes to the nursing team
• Dispensing the needed floor stock for all concerned departments such as Operation room, Recovery room…etc.
• Auditing on different departments possessing narcotic stocks to ensure adequate handling and dispensing.
• Calculating dispensing rates of the narcotics, and getting the necessary approvals on quantities and allowed items to be purchased

Palliation

Clinical Palliation pharmacists have the responsibility of monitoring pain scores and evaluating and improving the quality of life for the palliative patients through the following:

• Optimizing the outcomes of symptom management through the expert provision of evidence based, patient centered medication therapy as an integral part of an interdisciplinary team.
• Recommending, initiating, modifying, and discontinuing pharmacotherapy for pain and symptoms.
• Ensuring safe use of medication.

Clinical pharmacists, through their unique training and practice focused on medication use, are positioned to have an important role for patients of the cardiovascular care team, engaging in the optimization of drug use and the avoidance and prevention of adverse drug events.

Specific responsibilities:

• Adverse Drug Reactions (ADR) prevention and intervention
• Critical pathway design and implementation pertaining to cardiovascular disease states
• Therapeutic drug monitoring (e.g. digoxin)
• Dose adjustments based on renal function, hepatic function, and potential drug interactions.
• Appropriate titration of medications based upon evidence-based guidelines and potential for adverse effects (e.g. beta blockers, diuretics, and aldosterone antagonists).
• Improving guidelines adherence
• Identifying and avoiding contraindicated drugs based on patient specific parameters
• Identifying drug-disease interactions
• Improving communication in transitions of care environments
• Identifying effective medication substitutions
• Improving patient knowledge of cardiovascular medications, adverse effects, and self-care skills through education.
• Adherence to Joint Commission Core Measures and best practice standards.
• Providing support to heart failure teams through research
• Pharmacotherapy-related education about cardiovascular medications to student pharmacists, medical students, and residents.

Patient care

• Interact effectively with health care teams to manage patients taking medication therapy for psychiatric and neurologic disorders. Using effective communication skills with patient and his family members to obtain patient information when patients are unable to provide the information.


• Collect, analyze and assess information on which to base safe and effective medication therapy to patients with psychiatric and neurologic disorders. Including:
• Patient assessment ( include, but are not limited to, physiologic monitoring, laboratory values, microbiology results, diagnostic imaging, procedural results, and scoring systems (e.g., psychometric testing).
• Pharmacogenomics and pharmacokinetics information, if available.
• Adverse drug reactions and Risk factors and Medication adherence and persistence.


• Design or redesign safe and effective patient-centered therapeutic regimens and monitoring plans (care plans) for patients with psychiatric and neurologic disorders.
• Best evidence-based and clinical experience.
• The therapeutic goals established for the patient.
• Dose adjustment for each patient.
• Follow appropriate titration and escalation of neuro-psych medication.
• Avoiding any drug-drug interaction specially between neurology and psychiatry medication also drug-food interaction.
• The patient’s and caregiver’s specific needs.
• Patient-specific issues, including physical, mental, emotional, and financial ones.


• Ensure implementation of therapeutic regimens and monitoring plans for patients with psychiatric and neurologic disorders by taking appropriate follow-up actions.
• Appropriately initiates, modifies, discontinues, or administers medication therapy as authorized.

Advancing Practice and Improving Patient Care

• Prepares or revises a drug class review, monograph, treatment guideline, or protocol related to care of patients with psychiatric and neurologic disorders, including proposals for medication-safety technology improvements.
• Applies evidenced-based principles.
• Consults relevant sources.


• Implements a quality improvement research project to improve care of patients with psychiatric or neurologic disorders or a topic for advancing the pharmacy profession or psychiatric pharmacy.


• Participates in a medication-use evaluation related to care of patients with psychiatric and neurologic disorders. By using evidence-based principles to develop criteria for use.


• Participates in the review of medication event reporting and monitoring related to care for patients for improvement of the medication-use. So, developing a plan and research protocol for a quality improvement practice or research project for the care of patients with psychiatric or neurologic disorders or a topic for advancing the pharmacy profession or psychiatric pharmacy.

Leadership and Management

• Demonstrates personal, interpersonal, and teamwork skills for effective leadership in the provision of care for patients with psychiatric and neurologic disorders.


• Applies a process of ongoing self-evaluation and personal performance improvement in the provision of care for patients with psychiatric and neurologic disorders.


• Manages one’s own psychiatric pharmacy practice effectively.

Teaching, Education, and Dissemination of Knowledge

• Provides effective medication and practice-related education related to care of patients with psychiatric and neurologic disorders to caregivers, health care professionals, students, and the public (individuals and groups).


• Designs effective educational activities related to care of patients with psychiatric and neurologic disorders.


• Uses effective presentation and teaching skills to deliver education related to care of patients with psychiatric and neurologic disorders.

Management of Psychiatric Emergencies

• Recognizes and responds appropriately to psychiatric emergencies.


• Effectively assesses safety concerns, including safety of the patient, staff, and other individuals during a psychiatric emergency.