Mercy Ships Formulary 20062007

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Mercy Ships Formulary2006-2007
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The Good Samaritan parable (1)

• Luke 1030-35
• The Good Samaritan and Scarce Medical Resources
• Reproduced by permission from
• Christian Scholar's Review XXIII3,
• March 1994, pp. 360-373.

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The Good Samaritan parable (2)

• Sanctity the respect of humanity
• Compassionate care
• Just care
• Scarcity limited resources
• Be honest acknowledge our limitations
• Be humble acknowledge our interdependence

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The Good Samaritan parable (3)

• Scarcity Need for Stewardship
• Rational selection of treatment options
• Maxillofacial Surgeries
• Eye Surgeries Care
• Dental Surgeries Care
• VVFs Orthopaedics
• Community Health

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The Good Samaritan Parable (4)

• Scarcity Need for Stewardship
• Rational selection of medicines
• WHO essential medicines list www.who.int/medicines
  /
• IDA available generics
• www.idafoundation.org
• Annual regular donor sources
• Optimise resources (financial/human)
• procurement inventory management
• medicines administration, dosing prescribing
• Optimise space
• Minimise wastage (esp. expired meds)

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Mercy Ships Formulary

• History of development
• July 2002 first essential drugs LIST established
  from M/V Anastasis 2002 outreach experience
• Sep 2002 work started on first formulary BOOK
  draft
• Dec 02 - mar 03 first draft review proof
  reading
• Apr - Jun 2003 test pilot during active
  outreach, volunteers
• Continuous feedback from field IOC
• Jul - Aug 2003 final draft review proof
  reading
• Aug - sep 2003 200 copies printed at USD 3.00
  per book
• Nov 2003 training materials and books distributed
  to ships, IOC and other land bases

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Mercy Ships Formulary

• History of development
• 2003 - 2004 continuous feedback and update of
  LIST (e.g. New MSL requirements,
  different availability in IDA catalogues,
  changes from WHO recommendations.)
• Jan 2005 work started on second BOOK edition
• July 2005 latest WHO essential list published
• Sep 2005 attended WHO/UNICEF essential medicines
  technical briefing seminar in Geneva,
  decision to include WHO notes/guidelines
• Dec 2005 final draft review proof reading
• Feb 2006 200 copies printed for distribution

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Mercy Ships Formulary

• Review involved current and ex-volunteers, of
  long short term experiences, from developed
  developing countries
• Proof reading involved 32 personnel, including
  administrators, anaesthetists, surgeons,
  physicians, nurses, pharmacists,
  radiographers/lab technicians
• IT printing support
• Second edition proofreaders include health
  professionals of diverse backgrounds and
  specialties outside of MSI
• Third edition planned in two years, formulary
  list to be reviewed and updated every six months

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Mercy Ships Formulary

• Dosages based on
• WHO model formulary 2004/6, www.who.int/medicines/
  
• British national formulary, www.bnf.org
• The Micromedex healthcare series online,
  www.micromedex.com
• Essential drugs practical guide,
• Doctors without borders or MSF www.msf.org
• Online networks  HIF-net at WHO ,
  www.inasp.info  E-DRUG , www.essentialdrugs.org/
  edrug
•  Afro-net , SATELLIFE www.healthnet.org

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Mercy Ships Formulary

• First edition made available for free
  downloading on www.drugref.org since November
  2003.
• 3229 reads of the article
• 1053 downloads of the formulary .doc file
• 931 downloads of the formulary .pdf file.
• Also available on www.ms-information.org and the
  Anastasis intranet
• Requests for use include
• community health centres in Kenya, hospital in
  Nigeria, university in India, hawaii
  www.wheelchair-kauai.com

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Mercy Ships Formulary

• Formulary (F) medicines
• 336 items former list 327 items 126
• Outreach-critical medicines
• Consistent availability
• Sought actively as donations
• Purchased from the international dispensary
  association (IDA) www.idafoundation.org
• Assured quality generics, supplier to
  agencies/NGOs e.G. UN, UNICEF, MSF

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Mercy Ships Formulary

• Donation (D) medicines
• Additional 55 items former list 37 6
• Medicines totally dependent on donations
• Regular donors
• E.G. Tylenol, Alcon eye preps
• High cost
• Third-line treatments
• Drugs with generic alternatives

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Mercy Ships Formulary

• Hands-on session

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Mercy Ships Formulary

• Table of contents
• Preface how to use the book
• EML WHO essential medicines list item
• MSL mandatory sailing list item
• N/CD narcotics/controlled drugs
• PS psychotropic substances
• Legal requirements for records stock

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Mercy Ships Formulary

• Bibliography acknowledgements
• Introduction to essential medicines
• Prescription writing guidelines
• See abbreviations at the end of the book
• Main chapters 1-14 BNF model
• Gastrointestinal system, anaesthetics
• (New) WHO notes and recommendations
• e.g. Treatment of dehydration

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Mercy Ships Formulary

• Appendices prescribing in children, pregnancy,
  breastfeeding, elderly
• (New) table of drugs to avoid or use with caution
  in pregnancy breastfeeding
• Index search by -
• Generic name (acetaminophen or paracetamol)
• Brand name example (Tylenol)
• Pharmacological category (NSAIDs)
• (New) disease or indication (angina)
• Table of values, conversions units
• Abbreviations

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Mercy Ships Formulary

• Chapters, listed by physiological systems
• E.G. Cardiovascular system, ENT --- BNF model
• Sections, listed by pharmacological categories
• E.G. Antacids, Penicillins --- BNF model
• Medicines, listed A-Z by generic name (with brand
  name examples)
• E.G. Ketoconazole (Nizoral)
• Comment/cautions notes

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Mercy Ships Formulary

• Features to be considered for addition in future
  editions (feedback from first ed.)
• Table of Drug Interactions
• Table of Drugs vs. Pregnancy - done
• Table of Drugs vs. Breast-feeding - done
• Search by diseases/indication in Index - done

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Mercy Ships Formulary

• Feedback suggestions
• Formulary Editor/Pharmacist kae.trouilloud_at_mercysh
  ips.org
• Current Pharmacist
• Current Crew Physician
• Current Ward Supervisor

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Mercy Ships Formulary

• Go and do likewise.
• Luke 1037