compounding & dispensing pertemuan 4

Rencana Program Kegiatan Pembelajaran Profesi Apoteker

Fakultas Farmasi Universitas PadjadjaranSemester Ganjil 2009/2010

Topik/Pokok bahasanTopik/Pokok bahasan Pendahuluan Praktek Kefarmasian:

1.DEVELOPING PHARMACY PRACTICE

Paradigma baru tentang praktek kefarmasian i.Latar belakang ii.Paradigma sehat iii.Dimensi baru dari praktek kefarmasian/profesi iv.Apoteker sbg “health care team” v.Komitmen atas perubahan

2.A Practical giude to Pharmaceutical care i.Practise Skills ii.Profesisional Practise Development iii.Practise Site Development iv.Standar Pelayanan Kefarmasian di Apotek

3.Good Pharmacy Practise n Good Dispensing Practise

4.Interpersonal skill communication5.Diskusi kelompok

A Practical giude to Pharmaceutical care:

1.Practise Skills 2.Profesisional Practise Development

3.Practise Site Development

4.Standar Pelayanan Kefarmasian di Apotek

1.PRACTISE SKILL1.1.Studi Kasus Ph Care:1.Janice,pasien diabetes umur 43 th.Apotek tempat dia membeli obat sudah biasa menyediakan obat2 diabetes untuk Janice selama 5 thn terakhir.Hari ini,resep yg diberikan tertulis Humulin 70/30,35 unit setiap pagi.Selain Humulin Janice mendapatkan obat2an untuk glaucoma dan hypothyroid.Janice biasanya mendapatkan obat2an nya lewat mail order.2.Ketika anaknya Pak Andi mengambil obat untuk ayahnya,dia minta agar diberikan 50 mg Demerol inj untuk ayahnya yang biasa digunakan setiap malam agar ayahnya bisa tidur.3.Edith menelpon apotek ketika petugas pengantaran masih berada di rumahnya.Edith sangat terkejut ketika dia tidak sanggup membayar karena Lorazepam tablet yg biasa dia beli harganya naik hingga 2x dari biasanya.

Pada studi kasus tsb:1.Apoteker dapat berindak sbg “decision maker”2.Apoteker tidak peduli pada situasi tsb3.Apoteker tahu apa yg seharusnya dikerjakan,tapi tidak berusaha untuk memberitahu kepada pasien4.Apoteker sebagai “care giver” dapat berkomunikasi dengan dokter untuk menyelesaikan masalah2 tsb5.Apoteker dapat berkonsultasi dengan dokter dan selanjutnya membantu pasien dalam mencapai tujuan dari pengobatannya

Azas Ph Care:Apoteker bertanggung jawab atas keselamatan pasien dan memberikan solusi yang terbaik untuk pasien.

Compounder and dispenser

(Product oriented)

i.PERUBAHAN PERAN APOTEKER

1990,Charles Hopler and Linda Strand:Drug therapy manager

(patient oriented) berazas Pharmaceutical care

“DRUG DON’T HAVE DOSES” PEOPLE HAVE DOSES(1986)Robert Cipolle: “Clinical Problem solver”

What is pharmaceutical care?

Why should pharmacists bother?

Pharmaceutical care:

“The care that a given patient requires and receives which assures safe and rational drug use”

Mikeal et al., 1975

“The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve the patient’s quality of life.”

Hepler and Strand, 1990

Pharmaceutical is a philosophy,not a form or fixture.At the heart it is about caring

Providing ph care means that,at the end of the day,pharmacist measure they succeess by how many people they have helped,not by how many prescription they have filled

1.Care cycle2.Drug therapy problems,not medical

problems3.Discovering drug therapy problems

4.Beyond counseling5.Cause of drug therapy problem

6.Actual and potential drug therapy problems7.Case study

1.2.1THE CARE CYCLE

Patient Medication Record (PMR)

1.2.2.Drug therapy problems,not medical problems A Medical problems is desease

states;that is ,a problem relatedto alltered physiology that result in clinical evidence of damage

A drug therapy problem,is a patient problem that is either caused byor may be treated with a drug.

1.2.3.Discovering drug therapy problemsDrug interactionsTherapeutic duplicationProblems related to doseDosage intervalDuration of therapy

Not all drugs therapy problems can be identified from

prescription

Ph care practitioners make a point of gathering additional information to ensure that the intended outcome of therapy is achieved and that no drug therapy problems occurPMR

1.2.4.Beyond counseling(the APhA Principles for Ph Care)Five steps in the pharmaceutical care process

Five key drug-related needs of patients

1.A professional relationship with the patient

2.PMR mut be collected,organized,recorded and maintained.

3.PMR must be evaluated and drug therapy plan developed mutually with the patient

4.The pharmacist must ensure that the patient has all supplies ,informations and knowledge necessary to carry out the drug therapy plan

5.The pharmacihst must review,monitor and modify therapeutic plan with patient and health care team.

Parmacist must ensure the following needs:

1.Indication for every drug2.patient’s drug therapy is

effective3.Patient ‘s drug thera py is

safe4.Patients can comply with

drug therapy and other aspects

5.Patients have all drug therapy necessary to resolve untreated indic ation.

As a Pharmacist :i.Gather history,ii.evaluate data

iii.Identify drug therapy problemiv.Determine the cauuse of each problem.

DRUG THERAPY PROBLEM

CAUSE

1.Unnecessary drug therapy

No medical indicationsAddiction/rcreational drug useNondrug therapy more appropiateDuplicate therapyTreating avoidable adverse reaction

2.Wrong drug Contra indicationsDosage form inappropiateCondiction refractory to drugDrug not indication for conditionMore effective drug available

3.Dosage too low Frequency inappropiateWrong dosageIncorrect administrationDrug interactionIncorrect storage

4.Adverse drug reaction Allergic reactionUnsafe drug for patientIncorrect administrationDrug interactionDosage increased or decreased too quicklyUndesirable effect

5.Dosage too high Wrong doseFreuquency inappropiateDuration inappropiateDrug interaction

6.Inappropiate compliance

Cannot afford drug productCannot afford drug productCannot swallow or otherwise administer drugDoes not understand intructionsPatient prefers not to take drug

7.Needs additional drug therapy

Untreated conditionSynergestic therapyProphylactic therapy

DRUG THERAPY PROBLEM

CAUSE

2.6.Actual and potential drug therapy problems :

The Pharmacist informs the physicians of a such potential problems ,but theThe most physicians unless The interaction is potentially lethal

The patient interview,esp.refill prescriptionGood interpersonal interactions in interview:

Good communication and accurate information gathering

Other information to collectSuch as: patient interview,other pharmacy

record,the patient’s medical/medication record and input from the patient’s other

health care providerUsing PMR

Systemic approach,either a casual or careless approach

Comparing problem and treatment:Are all conditions being managed? Or are

all the drug therapies managing a condition?Untreated condition

Indication for each drugSafety,efficacy and compliancee.g:Dosage schedule,duration of

therapy,dosage form,contraindications

Setting therapeutic goalsImplementing care plans

Organizing follow up monitoring

Types of documentation system:e.g: Computer in pharmacy practice :input,system function,output (to meet pharmacy needs)

Formulating questionsSearching for information:

To be effective,health professionals must maintain clinical competence and awareness of the most effective therapy for

preventing and treating illness.Formulating a response

Communicating the responseDocumentation and follow up

Basic drug information library or internet

Overall result: pharmacists suddenly had to justify their existence

Pharmacists saw that there were unmet needs:

Patient information and counseling, optimizing therapy, preventing medication errors, educating prescribers on the cost and comparative (dis)advantages of therapeutic options, …..

STUDI KASUS:Ny.W umur 53 thn,penderita kasus GORD (Gastrointestinal Acid Related Disorder)Ny.W juga penderita asma,hypertensi dan Duodenal Ulcer.Obat2 yg diberikan tdd:1.Amlodipine 10 mg ,diminum pagi hari2.Salbutamol inhaler (2 spray,bila diperlukan)3.Beclometasone inhaler (200 mcg twice daily)4.Theophylline (300 mg twice daily)Ny.W mengalami kegagalan terap terhadap H.pylory dan Ny.W juga perokok 10 batang per hari.BMI 35 tapi bkn peminum alkohol.Lakukan:1.Skrining Resep SK Menkes 10272.Identifikasi:a.Lifestyle factors:BMI 35 obesitasb.Drug factors: Ca channel blocker dapat menurunkan oesophagal spincter tone yang dp menyebabkan reflux asam lambungc.Desease factors: GORD dan asthma dapat menyebabkan reflux as.lambung3.Pelayanan Informasi Obat

CHECK LIST PELAYANAN RESEP BERDASARKAN SK MENKES 1027 TH. 2004 APOTEK KIMIA FARMA 43 JL. BUAH BATU NO. 259 BANDUNG

No Resep : Nama : Jenis Penyakit : Skrining Resep

Item Parameter Pemeriksaan Kriteria Pemeriksaan Check

List Drug Related Problem (DRP)/

Medication Error

Penerimaan Resep

Keabsahan Resep: a. Persyaratan Administratif

1. Nama Dokter

2. SIP

3. Alamat Dokter

4. Tanggal Penulisan Resep

5. Tanda Tangan / Paraf Dokter Penulis Resep

6. Nama, Alamat, Umur, Jenis Kelamin & Berat Badan Pasien

7. Nama Obat, Pontensi, Dosis, Jumlah Yang Diminta

8. Cara Pemakaian Yang Jelas

9. Informasi Lainnya

a. Kesesuaian Farmasetik

1. Bentuk Sediaan

2. Dosis Obat

3. Potensi Obat

4. Stabilitas

5. Inkompatibilitas

6. Cara & Lama Pemberian

a. Pertimbangan Klinis

1. Adanya Alergi

2. Efek Samping

3. Interaksi

4. Kesesuaian (Dosis, Durasi, Jumlah Obat, dll)

Diperiksa Oleh: Tanggal:

2.PROFESSIONAL PRACTISE DEVELOPMENT…………………………2.1.developing collaborative relationships2.2.Pharmaceutical care for patients with spesific desease2.3.self care as a pharmaceutical care practice2.4.wellness and health promotion