A non-hypertensive and non-diabetic 89 years old lady walked into a hospital with a complaint of respiratory spasm caused by crackers smoke was admitted and administered a nebulizer, IM/IV bronchodilators and a course of steroids along with an IV drip. On the 4th day her blood test revealed high sugar level. She was administered an anti-diabetic tablet at night on the advise of the MD. By morning the patient became restless and was struggling for life. The MD was informed, immediately the patient was loaded with glucose IV and by afternoon the patient looked quite relaxed. The MD who visited her in the evening approved the treatment given. The night staff ritually went through the case sheet and administered all the medicines that included the said 'anti-diabetic' tablet. The patient fell back into the same crisis irreversibly in spite of the efforts of the hospital staff. The patient breathed her last by afternoon. The otherwise hale and healthy lady who had walked into the hospital had to be carried out for final rites.
This tragedy could have been averted had there been prescription scrutiny by a pharmacy before administering the drug, as the hyperglycemic status was a self-limiting temporary one due to steroid therapy!
A professor of urology examined a 10-year-old boy complaining of painful micturition and handed over prescription to the father. The father combed all leading medical stores in Bangalore city whole day only to learn that the company had withdrawn the drug many years ago. The process of contacting the professor and convince him to get modified prescription delayed the treatment by over twelve hours. The parents moved on to another doctor.
This ordeal could have been avoided had there been a 'hospital and clinical' pharmacy to keep the clinicians updated.
The drug market in India is full of multi-drug formulations, majority of them being 'Irrational' ones and 'By-pass' ones (the ones intended to by-pass the DPCO). The clinicians are patronizing them either due to ignorance or succumbing to the powerful pharma promotional strategies.
Our country has no enforceable 'National drug policy' to control and regulate the irrational formulations. The pharma consumer force, unlike that of consumer goods market, is very weak to resist enforce self-discipline on the pharma industries. There is no independent system worth the name to study, monitor and generate a strong unbiased database for the use of the clinicians and the government to decide rationale or otherwise of a pharma product.
The entry and exit of coxib group of NSAIDs [Roficoxib, Valdecoxib etc] is an example that raises several question and speaks volumes on our drug policy and on our clinicians approach towards new drug molecules. These drugs entered the market on the basis of some research in the west and found its exit on some findings again in the west. We in India blindly accepted both the results.
Had there been a network of therapeutic committees at various level under the 'hospital and clinical' pharmacy system, all clinicians including the government would have become wiser much earlier. A once in a way meeting 'Drugs Technical Advisory Board' that invariably depends on the database provided by the manufacturer themselves cannot be a substitute to the 'hospital and clinical' pharmacy.
Millions of rupees are being spent annually on drugs for use in the community hospitals [both government and private] yet these hospitals find themselves wanting for one or the other life saving and commonly used drugs. The irony is lakhs of rupees worth of drugs that are either obsolete or expired or the rarely needed are found in stock in many of the community hospitals in India. The data like: Number of patients turned away for want of drugs, Number of cases failed including fatal ones for want of appropriate drug/for want of quality in drugs, Drugs not used and their value, Drugs indented but not received, receipt of Substituted/un-indented drugs and the reasons there on - are never recorded and monitored in any hospitals.
The 'hospital and clinical' pharmacy is a pharmaceutical practice based on "Good Pharmacy Practices' (GPP). Documentation is the basis of GPP. The main functions of 'hospital and clinical' pharmacy are Rational Drug Management on very broad logistical data base, Motivation for Rational Use of Drugs, monitoring and issuing of guidelines on Adverse Drugs Events, Total involvement in 'Therapeutic committees', Drugs Information Services, Prescription analysis and auditing, Dispensing with patient counselling, Standardization of clinical trial documentation under a well designed Standard Operating Procedure, Preparation of Standard Treatment Guidelines, hospital formulary and promoting essential drugs concept - ensuring utmost transparency in drugs management and drug therapy and generation of valuable database for references and planning. All leading to safe, rational and economical approach in therapy.
Thus, the 'Hospital and clinical' pharmacy is the only solution to many ills of drugs management and therapy as it can support the hospital technically and administratively, help the clinicians to understand the myths and reality of the pharma products besides providing ready reference on any drug profiles and indirectly protect the patients besides helping inherently the trade and industry for their healthy development.
- (The author is former Deputy Director (Pharmacy), Health & Family Welfare Services, Government of Karnataka, Bangalore.)