A Focus on Ghana

In 2023, we travelled to Ghana twice. In February 2023, a small group of health partners provided an early post-hospital opening visit to observe and support the new staff of the Leyaata hospital. During that two-week mission, the pharmacy team focused on workflows of both inpatient and outpatient pharmacy services. The pharmacy staff at that time consisted of 6 pharmacy technicians and 2 pharmacists. The pharmacy technician scope of practice allows for independent technician practice and therefore the outpatient pharmacy services are almost exclusively handled by the technicians. The technicians also support inpatient services by dispensing and delivering medications to the inpatient wards, emergency department and the maternity satellite pharmacy. We worked with the lead pharmacist to complete a SWOT analysis and develop a list of priority short term (next 3 to 6 months), medium- and long-term objectives. One of the apparent opportunities observed that could be addressed was a need for therapeutic management resources. This was requested by the technicians in the form of textbooks and clinical teaching via inservices or webinars. Another important and immediate opportunity addressed during this visit was the handling of patient-specific medications for admitted patients. Initially, the medications were being placed on the bedside table of each patient. The hospital had previously received several donated used medication administration carts. We were able to work collaboratively with the nursing leadership to establish the implementation of the policy regarding patient medication storage in patient-specific drawers in a controlled manner and dispensing of each dose at prescribed time. We were also able to update and organize the wardstock, as well as how the use of this stock is documented. Several issues with the medical record were identified during the visit that are being addressed by the program developers. We hosted the first virtual in-service at Leyaata hospital. A neonatal pharmacist provided a lecture on dosing in neonates that included case scenarios and calculation practice. This was attended by the midwives, physicians, physician assistants and all pharmacy staff. It was a very busy and enlightening experience. Being in a brand new hospital and witnessing the opening hurdles and how enthusiastic the staff were to face them together as a fledgling hospital team.

We left the pharmacy team with a list of clinical topics for in-services. Each technician was assigned a topic. We joined these presentations virtually and provided feedback during and after each presentation to the team. A lot of work went into these presentations and the technicians took a lot of pride in creating useful learning information for their peers.

A second visit to Leyaata was planned for the late fall of 2023. The objective of this mission was to address some of the areas of the hospital that were preparing to open. Some of the major deliverables of this mission included: a training program for all clinical staff on emergency and pediatric nursing; a casting program, an eye clinic and training of on-site staff, dental support of new dental clinic, observation, and support of radiology services particularly in ultrasound and CT techniques and interpretation. The pharmacy department objectives for this mission were to revisit the inpatient and outpatient services given the expansion of services to recommend areas for improvement and a primary focus on a launch meeting for a hospital-wide Antimicrobial Stewardship (AMS) program. In preparation for the AMS launch, I provided the pharmacist lead with a number of tools and resources to read as the basis of our planning. I was able to connect with a Ghanaian pharmacist who is involved with AMS at the national level and has done research within Ghanaian hospitals on the topic. This connection will be invaluable in moving this initiative forward. Prior to and during the first week of the mission we collected local data on antimicrobial consumption and prescribing patterns.

During the second week of the visit, we had an all staff meeting to launch the initiative. This meeting was also attended by the Director of NEA and CEO of Leyaata Dr. David Mensah, as well as all members of the Leyaata management team. We were able to have the external pharmacist expert in AMS, as well as an infectious diseases physician who is part of the national AMS action plan committee join us virtually to offer advice and words of encouragement to the Leyaata team. Perhaps the most impactful part of the session was the breakout group discussion of “what can we (Leyaata staff) do now to improve antimicrobial use/prescribing”. The notes from this discussion will inform the Leyaata AMS committee to identify and prioritize activities. One resounding message was an overwhelming need for community education regarding use of antimicrobials. Additionally, the lead pharmacist and I did a webinar with PSF about the project and the hospital.

We were able to address a couple of the priorities identified by the staff during the spring visit as well. We brought the staff and eBook with one textbook on pharmacotherapy already loaded onto it. The intent is that this eBook could have further books added to it over time. The hospital is also very conscious of environmental impact and strives to be as paperless as possible. An eBook supports this hospital value. In addition, we purchased 3 step-down power converters allowing the small label printers that we had used previously during the mobile medical missions to be utilized in printing patient labels for both inpatient and outpatient prescriptions, thus decreasing handwritten labelling substantially.

Once again during this mission we surveyed the pharmacy staff for support needs. Once again support for gaining better clinical therapeutic knowledge was requested by the staff. Since our return we have delivered several presentations on inhalers, diabetes, hypertension, and stroke. These were all recorded via Zoom and made available to the Leyaata pharmacy department to share as relevant.