Category Archives: Latest News

October 27^th 2017: The day the US declared the opioid crisis a national emergency.

President Donald Trump declares the Opioid Epidemic a national emergency, a 5-point plan is put in place by the U.S. Department of Health and Human services (HHS) and warnings are issued to clinics, practices and hospitals across the country. It is crisis that is currently killing more people per day in the U.S. than people dying from car crashes and shootings combined.

What actually is the Opioid epidemic and why is it so important that it is tackled effectively?

The Opioid epidemic is defined as the ‘rapid increase in prescription and non-prescription addiction to opium based drugs. Opioid drugs include legal drugs such as morphine, diamorphine, fentanyl, oxycodone, codeine and also illegal drugs such as heroin.

Over the last few years the Opioid crisis has been covered extensively by news outlets across the world, and more so since it has been declared a national emergency. You’ve probably all heard about it, read about it or seen it being shared on social media platforms. Remember the shocking photo of the 4-year old boy sat in the back seat of a car whilst his parents overdosed on heroin? That photo went viral and for good reason.

It’s shocking, its gut wrenching and the fact that this epidemic has no boundaries and has been linked to people of all races, backgrounds and socioeconomic backgrounds makes it even scarier. This can affect anyone.

It is having a catastrophic effect on people in the U.S. and around the world, and the facts are hard to fathom.

• More than 100 people per day die in the U.S. as a result of addictions either to prescription or non prescriptive opiods. This is more than the number of people who die in car accidents and shootings combined.
• The life expectancy of adults in the U.S. has dropped for a second year running, and for the first time in more than half a century. This drop has been largely attributed to the overdoses occurring from opioid use
• 2 million people in the U.S have become dependent on or abused prescription pain killers and illegal drugs.
• More babies than ever are being born to mothers with opioid addictions.

How has the usage of opioid painkillers reached such unprecedented levels that its use and overuse resulted in it being declared a national emergency in the world’s biggest superpower? It has been implied that the overenthusiastic prescribing of strong painkillers in the U.S. from the mid 90s to mid 00’s are to blame. Drug companies marketing strong opioid based painkillers in this time period saw a huge increase in their prescribing use, and whilst the highly addictive properties of the drugs only became apparent after its use became widespread. What we are witnessing now is the surge of these addictions and the aftermath of these prescribing trends.

Prescription/non prescription addiction

Should we be distinguishing between the two? As a pharmacist I naturally feel uneasy about grouping these two addictions together. I’ve been accustomed to treating the addiction to non-prescription medication and addiction or ‘dependency’, (as it would be called) to prescription medication quite differently. Should we be seeing a more similar approach in the treatment of both these addictions? Studies show that up to 30% of people who are prescribed opioids misuse them, 80% of people who use Heroin first misused prescription medications. And how can we pick up these dependencies and addictions quicker? The Controlled drug requirements in the U.K. are strict and we are seeing more opioid or opioid similar medications being put in the Controlled drug category. Tramadol, being one of the more recent ones. Its highly addictive and dependent properties are now being abled to be more closely controlled and monitored.

Should we be reserving opioids only for palliative patient and picking up and challenging its use in chronic pain settings?

The U.K. is likely to see a similar crisis

The U.K has been issued a warning by Ambassador William Brownfield, Assistant Secretary of State for International Narcotics and Law Enforcement Affairs. ‘The U.S. crisis came on very suddenly and very unexpectedly and the same could easily happen in Britain’ it is imperative that the UK learn from the trends and mistakes that the U.S. has faced to prevent a similar outcome in the U.K.

In 2015, the annual European Drug Report recorded from the national office of statistics reported 330,445 high risk opioid users in the U.K. The highest number in Europe.

Is this a wake up call and time to get real?

Share your thoughts below, id love to hear them!

Maiya Ahmed, Clinical Pharmacist and Director.

Climate change: what’s that got to do with health?

A lot it seems. But what exactly do we mean by climate change? Climate change as defined by the Met office is ‘ a large-scale, long-term shift in the planet’s weather patterns or average temperatures.’ One of the most important and worrying aspects of the changes in our climate is its detrimental affects on health. The psychological, social, and physical health of people is predicted to take affect in a largely negative way.

Human activities, such as burning fossil fuels, our industrialised lifestyles, and our overt consumption of meat has released significant quantities of carbon dioxide into the atmosphere. The latter has resulted in an increase in the overall temperature. So much so that the overall temperature of the world has increased by 0.85^oC.

Other direct and indirect effects of the rise in global temperature is; poor air quality, polluted water systems, decreased vegetation and insecure shelters. All of these changes affects our health in some way or another.

Between 2030 and 2050, the WHO predicts that climate change is expected to cause approximately 250,000 additional deaths per year from malnutrition, malaria, diarrohea, dehydration, and heat stress.

This seemingly small, but massively significant increase in temperature affects everything. For instance, rising sea levels and extreme weather will likely destroy homes, medical facilities, and essential services. Consequently, forcing people to leave and migrate away from their homes, which in turn heightens the risk of mental health disorders to communicable diseases.

An increase in temperature will also increase the incidence of infection. For example, water-borne diseases and diseases transmitted through insects, snails or other cold blooded animals will likely increase. The incubation period for these diseases will persist for longer periods of time. Malaria and Dengue fever is highly sensitive to climate conditions. Current studies conclude that climate change will continue to increase the exposure of dengue.

Extreme heat is predicted to bring about an increase in cardiovascular and respiratory disease, especially among the most vulnerable in our societies; the elderly, disabled and very young.

Variable or the reduction in rainfall levels affects the supply of fresh water: a lack of fresh water affects hygiene, which in turn increases the incidence of diarroheal diseases. While in extreme cases, water leads to drought and famine.

A current example is Cape Town where the water levels are approaching day Zero: the taps will be switched off on April 12^th, making it the first modern city to completely run out of fresh water. It is, as Davos in Switzerland states: “a climate change disaster”.

Who is at risk of these detrimental effects of climate change? All populations it seems, but it will particularly affect those who are most vulnerable, such as people living in small islands, young children under 5 years of age, and those of us who are living in countries with a weak health infrastructure

 All doom and gloom?

Perhaps, however it is still possible to slow down these affects, in particular those of us living in counties that have a more developed health infrastructure, paying attention to the small, significant changes we can make to our everyday lifestyles. Reducing our transport uses, reducing our meat consumption, contributing to recycling products, and being prepared to forgo some of our excess consumerism all will contribute to this. But is this the top of our priorities?

The WHO has endorsed a work plan focusing on climate change and health, much of that it seems to be focused on us as individuals and policy change makers to raise awareness and in shared partnership goals. To read more, see https://www.who.int/mediacentre/factsheets/fs266/en/

Are we doing enough? Or do we know enough about how climate change affects our health?- Leave a comment, would love to hear your thoughts!

Maiya Ahmed, Director

A report by the BBC states that up to 70% of women who take Sodium Valproate did not know the risks of the drug in pregnancy. It has been estimated 20,000 children born to mothers that are taking Sodium Valproate have been harmed since the 70s. Harm mostly focuses on a reduced IQ, learning difficulties and Autism.

I am a huge fan of the podcast ‘Inside Health’ by the BBC which also addressed the issue.  The reason I chose to write about this topic is because it is not new information. The effects of Sodium Valproate on fetal development are some of the many facts I learnt for my pre-reg exam.  ‘Neural tube defects’ and ‘women of child-bearing age’ were buzz words in questions that would have me positively screaming Sodium Valproate. Therefore, I am confused as to why it has been so prominent in the press of late. Perhaps it has come to the surface that this is not just a theoretical risk, and with three charities surveying 2000 women, the results are hard hitting.

As healthcare professionals, specifically pharmacists, when should we be questioning these prescriptions? How can parents and prescribers make the decision on behalf of young female children to use a drug that could control their seizures but could risk future children with such strong evidence? Being up to date with health news is crucial and it will be interesting to follow if the release of these results influences prescribing of anti-epileptics for female paediatric patients.

Kathryn Lang

Clinical Pharmacist, U.K.

Armed with a green pen and transcription sheets I walked up to my assigned ward both excited and terrified. I set myself up at my computer to get a hand over and a nurse came over clutching a bundle of charts. She asked if I was the pharmacist, to which I had a moment of elation before I answered, ‘yes I am indeed’. To my dismay she demanded I order medication which never arrived up to the ward and why pharmacy were so incapable of sending the medications that were needed.

As the week went on, I can only say that I was pleasantly surprised and unbelievably pleased with the scope that a registration number had given me. I got to know all the doctors and by the end of the week left them lists of queries and changes for them to come back to after lunch and the nurses knew exactly where to pounce on me. Was it a scary week? Most definitely. I completed my checking and screening logs quickly to realise although it was great to have them out of the way, the reality was no one was second checking me, my signature released whatever drug it was put. As a pre-reg, I can admit that I found the constant checking of drug charts that hadn’t changed boring. As a newly qualified, I calculated every creatinine clearance and platelets while screening VTE prophylaxis, if I couldn’t understand a drug’s indication I would go through years worth of notes to see exactly why we were continuing Omeprazole 40mg and occasionally without warning I would run from my desk to flick back through a chart I just finished with. Take away message from the first week, there is a lot more to the profession I thought I knew. My bedtime for my first week was on average 9:30pm as my brain was struggling to hold the information gained each day without losing consciousness. I was knackered, flustered and at times intimidated. But, I literally could not have asked for a better introduction to clinical pharmacy as a junior. It’s hard work, stressful and at times frustrating but our input boosts patient safety extensively without the patient’s themselves knowing. It used to bother me that pharmacists never got a shout out on thank you cards, but knowing my input has drastically improves care has a personal satisfaction that is greater than a card.

Written by

Kathryn Lang

Clinical pharmacist, U.K

Having come back late from abroad I awoke to messages telling me to check my email. As I opened them, I was still so drowsy I had not given myself time to get nervous. The first line I saw was, ‘Congratulations you have passed’, and with that I patiently waited for my mum to wake up to tell her the good news.

The reason I didn’t feel nerves before my registration assessment results was that I had come to terms with the fact that if I had not passed it did not reflect on my abilities as a newly qualified pharmacist, more that I had not revised the correct material. I realised, since starting work, what was deemed as ‘worth’ was a lot less based on exam results rather what you bring to the table as an individual.

My pre-registration year was a rollercoaster to put it in short. Having graduated on a complete high from university a part of me definitely thought that the hardest times had past. How wrong was I. I had obtained the hospital pre-reregistration post I had so desired all be it a little further south than had been preferred. The first 4 weeks was induction and all the thrill and excitement of a new job drained by the hour with the monotony. But soon came our first rotation and to my surprise I had maternity as mine. I had been told that this was a trial rotation with many people questioning its place in a pre-registration programme however this rotation was an important learning curve for me. There are always positives to take from situations that seem less favourable. As a first rotation, although pharmacologically there was not the same magnitude of complicity general medical wards had, it’s a speciality many fear. I can confidently say that from this rotation I am quietly confident with Obstetrics. My drug history taking skills were not developed and I rarely had to transcribe anything, but I could definitely pick up on VTE prophylaxis errors with confidence and had a good working relationship with the midwives. Furthermore, I met an inspiring pharmacist who taught me so much more than a BNF ever could.

Moving towards Christmas and the New Year I rotated onto general medicine wards which was a shock to the system to say the least. I feel throughout my year I have been very fortunate with those I have worked beside. What I think is one of the most important things I have learnt is that you will learn just as much from those you aspire to be than the practitioners that you aspire not to be. On the medical wards, I had charts snatched out of my hands, colleagues walk away when I was trying to have a conversation with them and a patient’s relative shout at me, her face an inch from mine. I don’t know if it was the 2 hours of sunlight a day or the constant bed pressures which were splashed across every newspaper but Christmas put doubts in my mind. I wondered weekly possibly daily at points if this was for me. Why did I go to university for 4 years for a qualification that the vast majority of people don’t understand what you actually do? Sticking labels on boxes is the cliché of the pharmacy world but it still makes me angry. The end of 2016 to the start of 2017 was a tough time because the word ‘revision’ kept being thrown about and I had my own personal doubts in the direction of my career.

Pushing through towards the end of January, I got the little pick up I needed in the form of 2 weeks in a community pharmacy. It gave me a break from hospital and also reaffirmed that although hospital work is challenging, community pharmacy is most definitely not for me. That said I had a great 2 weeks with the staff there. Their pre-registration pharmacist was from close to where my home is which also helped boost my moral, as the Scottish accent is only ever charming!

From there to the end of my rotational year saw me move into paediatrics, aseptics and medicine information. With the year coming to a close saw the exam move ever closer. I was fortunate in the timing of my MI rotation as there was time for reading in-between inquiries and the inquiries themselves were often relating to pregnancy and breastfeeding which is quite a hot topic in the exam.

Having completed my pre-registration year I believe my concise advice would be; keep your cool. The biggest thing I have learnt personally is that it’s okay not to be okay all the time. There are days you don’t want to even look at a patient let alone talk to them but you will get through it and come out the other side. It’s a tough year mentally and physically which I don’t think I took into account so cut yourself a bit of slack. Most importantly, it is not about the exam. If you actively learn all the way through the year I genuinely feel like revision won’t come as a complete shock to the system. Yes I didn’t know all the medicines that colour your urine (comes up every year!) but what I did learn was solidified as if you put the theory into practise you don’t have to learn it, you know it. Identify a stroke patient and look at the management plan because then when challenged with a question, a picture of that drug chart will float to the top of your head leaving the rest of your brain free for facts about how many cubic metres of medicine waste can be held in community.

I have grown so much as an individual this year and if that wasn’t enough I am now a GPhC registered pharmacist ready to raise the profile of an incredible profession that keeps us all safe.

Kathryn Lang, Clinical Hospital Pharmacist U.K.

Tuesday 2^nd of May 2017,

University of Gondar, Ethiopia

Global Allied solutions designed and lead a workshop titled ‘A Practical introduction to Clinical Pharmacy’ In the University of Gondar, Ethiopia.

This workshop is the first of a series of workshops offered and is aimed at newly qualified pharmacists, clinical pharmacists wanting to refresh their knowledge and pharmacists from a community pharmacy background wishing to gain a better understanding of clinical pharmacy. The workshop covers topics, such as the roles and responsibilities of the clinical pharmacist, medication errors and their prevention and medicines reconciliation.

Each topic was researched and compiled according to the target audience and delivered accordingly, and was delivered by using a mixture of activities and teaching aids.

The workshop was carried out over a full 6-hour day and included practical group exercises including clinically screening in-patient prescriptions, case based discussions and medicines reconciliation.

Discussions around these topics were lively, engaging and interactive and it was interesting to note the similarities (and also taking note) of the differences between clinical pharmacy practices in the U.K and in Ethiopia. Discussions shedding light on the aspirations of this young innovative and highly knowledgeable team of students and staff was inspiring and very forward thinking. Elaborating with them on the challenges of their current practice and also on the positives steps being undertaken was very thought provoking.

In total 45 MSc students, final year pharmacy students and staff members attended the workshop and feedback from the participants was excellent, with all participants feeding back that the workshop was either excellent or very good.

Some comments from the participants included

“ Actually very interesting to have and share this experience but we need more partnership with your organisation to continue this”

“Excellent and timely presentation was given to us and it will be useful for all of us in our future career”

“ It was an excellent workshop and I really enjoyed it”

Over 90% of the participants felt that the most useful topics covered that day were medication errors and their prevention and medicine reconciliation. 90% of participants felt that the workshop was definitely or mostly applicable in their work and for their future career. 100% of the participants reported that the workshop achieved the program objectives and over 90% reported that the workshop met their expectations.

Global Allied Solutions would like to thank the University students and staff of Gondar University and it was an absolute pleasure to deliver this workshop and we look forward to future collaborations and workshops.

If you are an organisation or hospital and feel you would benefit from tailored Clinical Pharmacy workshops varying from introductions to specialities up to advanced levels, please get in touch.

All our training and courses are lead by our specialist clinical pharmacists with 10 + years of experience in their respective fields.

Maiya Ahmed, Founder and Director of Global Allied Solutions

The Royal Pharmaceutical Society of Great Britain (RPSGB) has recently published recommendations to increase the involvement of pharmacists in providing healthcare for patients with chronic illnesses. Currently there are more than 15 million people living with one or more chronic illnesses in England and this number is set to rise partly due to an ageing population but also due to unhealthy lifestyles and inadequate healthy living knowledge. This figure is predicted to rise to 18 million by 2025. The burden on caring for patients with chronic illnesses is putting its toll on the NHS (National Health Service) and subsequently funding spent on caring for chronic illnesses accounts for 70% of the total health and social budget of England. In addition, waiting times for GP (General practitioner)  and hospital appointments are staggeringly high, often resulting in delays for patients who should be seen more urgently.

A Case for more pharmacy involvement..

What if more responsibility in caring for patients with chronic illnesses was given to pharmacists? Pharmacists are easily accessible to the general public and are usually the first port of call for patients wanting a quick resolution to a minor ailment or expert medication advice. If their skills can be utilised by including repeat prescribing and consultations for patients with chronic illnesses then they can reduce the workload of GP surgeries, prevent unnecessary admissions to hospitals and overall improve patient medication education. 50% of GP visits in England are due to patients suffering from chronic conditions such as asthma, vascular diseases and hypertension, may of these repeat visits are due to patients running out of their medications and requiring repeat medicines.

In addition, considering there was £15 billion spent on medications alone in 2015, optimal use of the expertise of Pharmacists’ knowledge can be fundamental to reducing this phenomenal cost. A report by NICE (National Institute of Clinical Excellence) has reported that 30-50% of medications prescribed to patients suffering from chronic illnesses are not taken correctly. Unnecessary and incorrect medication usage, which sometimes can lead to unplanned hospital admissions all contribute to the increasing burden on the NHS. A study carried out by the School of pharmacy in York, concluded that £500 million can be generated if medications were used appropriately in five therapeutic areas, including; Asthma, diabetes and hypertension.

Aside from in a U.K health context, globally, the WHO states that chronic conditions, such as heart diseases, cancer, stroke and chronic respiratory diseases are the leading causes of mortality in the world. In 2014, 60% of all mortality in the world was due to chronic diseases which can often be prevented and the subsequent progression of many chronic diseases can be stalled by good patient education, improvement of effective use of current medications and healthy lifestyle initiatives.

All areas that pharmacists have been trained extensively and have the expertise.

We look forward to where these recommendations take the pharmacy community.

For a link to the report by the RPSGB, please see below.

https://goo.gl/mtEM8i

Maiya Ahmed, founder of Global Allied Solutions and paediatric clinical pharmacist specialist from the U.K. attended the recent annual GCC Pharmacy conference in Dubai, U.A.E. which took place on the 31st of October and 1st of November 2016.

Now in its third year, the GCC conference organised by Maarefah events and supported by the Ministry of Health UAE focused on the advancement of pharmacy practice in the region with a particular focus on clinical pharmacy (predominately hospital pharmacy) and community pharmacy. The conference was split into two streams, hospital and community practice and attracted pharmacists from across the GCC region (Gulf Cooperation Council) with representatives, speakers and participants from the U.A.E, Bahrain, Oman, Qatar and Saudi Arabia.

It was both interesting and inspiring to see what is currently being done in the region to enhance pharmacy services and the real dedication for the improvement of patient centric practice, reinforcing the need to review services from a patient perspective. Subsequently, much of the discussions focused on changing the way we approach healthcare delivery and on ensuring patient safety, education and satisfaction is achieved. Changing our etiquette of behaviour and language in day to day practice was discussed and was something that although would seemingly be obvious was nevertheless interesting to discuss, in particular differences in details of communication variables for the region.

The need for standardised practice across the region was touched upon several times in different presentations and was also evident to myself being a pharmacist not practising in the region. It was obvious that different hospitals had different clinical pharmacy practices and standards of practice, ranging from a very robust clinical pharmacy delivery to minimal clinical pharmacy to complete lack of clinical pharmacy. Although arguably one can suggest that all pharmacy graduates working in some capacity in patient care are clinical pharmacists.

Some of the presentations from pharmacy departments showcasing what is currently taking place in their departments and their vision was very impressive, in particular the work done around antimicrobial stewardship. In addition, some hospitals are using Clinical Decision Support Systems (CDSS) to provide a more concise method of drug administration, prescribing and medical information.

Medicines reconciliation was a topic which generated much dialogue and was discussed in a panel setting whereby different hospital pharmacy managers shared their opinions of ‘Who’s responsibility is medicine’s reconciliation?’ The discussion involved viewpoints from different hospitals on their current practice and on their experiences on medical doctors and nurses being involved in the medication reconciliation.

The subsequent benefits and limitations of these medical professionals conducting medication reconciliation in place of pharmacists particularly during out of hours was interesting and gave much food for thought. Ensuring that a complete medication history of patients current and former medication is documented is an issue in particular as there is no set IT system that is accessible to all healthcare providers, and which can be used to check which medication was prescribed at any given clinic. This can lead to an incomplete medication history and a potential issue in current prescribing in particular when previous regular medication and one off medications used in the past are not taken into consideration for the patient’s current treatment.

The conference took place over two days and although it was difficult to attend both streams the presentations and discussions taking part in the hospital stream were thought provoking, practical and relevant to the practice in the region. The next conference takes place on the 19^th-21^st October 2017, details on the website at www.gccpharmacongress.com