Rencana Program Kegiatan Pembelajaran Profesi Apoteker Fakultas Farmasi Universitas Padjadjaran Semester Ganjil 2009/2010

Topik/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 communication 5.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 SKILL 1.1.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 tsb 3.Apoteker tahu apa yg seharusnya dikerjakan,tapi tidak berusaha untuk memberitahu kepada pasien 4.Apoteker sebagai care giver dapat berkomunikasi dengan dokter untuk menyelesaikan masalah2 tsb 5.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.

i.PERUBAHAN PERAN APOTEKER

DRUG DONT HAVE DOSES PEOPLE HAVE DOSES (1986) Robert Cipolle: Clinical Problem solver

Compounder and dispenser (Product oriented)

1990,Charles Hopler and Linda Strand: Drug therapy manager (patient oriented) berazas Pharmaceutical care

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 patients 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 cycle 2.Drug therapy problems,not medical problems 3.Discovering drug therapy problems 4.Beyond counseling 5.Cause of drug therapy problem 6.Actual and potential drug therapy problems 7.Case study

1.2.1THE CARE CYCLE

Why do anything (identify the problem)

How will you know to do it? (Monitor and follow up)

What do you want to do? (set goals)

How will you do it? (develop a care plan)

Patient Medication Record (PMR)

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

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

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

1.2.3.Discovering drug therapy problems

Drug interactions
Therapeutic duplication Problems related to dose Dosage interval Duration 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 occur

PMR

1.2.4.Beyond counseling (the APhA Principles for Ph Care)

Five steps in the pharmaceutical care process
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.

Five key drug-related needs of patients

Parmacist must ensure the following needs: 1.Indication for every drug 2.patients drug therapy is effective 3.Patient s drug thera py is safe 4.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 problem iv.Determine the cauuse of each problem.

DRUG THERAPY PROBLEM 1.Unnecessary drug therapy

CAUSE

No medical indications Addiction/rcreational drug use Nondrug therapy more appropiate Duplicate therapy Treating avoidable adverse reaction Contra indications Dosage form inappropiate Condiction refractory to drug Drug not indication for condition More effective drug available Frequency inappropiate Wrong dosage Incorrect administration Drug interaction Incorrect storage Allergic reaction Unsafe drug for patient Incorrect administration Drug interaction Dosage increased or decreased too quickly Undesirable effect Wrong dose Freuquency inappropiate Duration inappropiate Drug interaction

2.Wrong drug

3.Dosage too low

4.Adverse drug reaction

5.Dosage too high

DRUG THERAPY PROBLEM

CAUSE

6.Inappropiate compliance

Cannot afford drug product Cannot afford drug product Cannot swallow or otherwise administer drug Does not understand intructions Patient prefers not to take drug
Untreated condition Synergestic therapy Prophylactic therapy

7.Needs additional drug therapy

2.6.Actual and potential drug therapy problems :

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

The patient interview,esp.refill prescription Good interpersonal interactions in interview:

Good communication and accurate information gathering Other information to collect Such as: patient interview,other pharmacy record,the patients medical/medication record and input from the patients other health care provider Using 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 drug Safety,efficacy and compliance e.g:Dosage schedule,duration of therapy,dosage form,contraindications

Setting therapeutic goals

Implementing 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 questions Searching 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 response Documentation 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 hari 2.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 1027 2.Identifikasi: a.Lifestyle factors:BMI 35 obesitas b.Drug factors: Ca channel blocker dapat menurunkan oesophagal spincter tone yang dp menyebabkan reflux asam lambung c.Desease factors: GORD dan asthma dapat menyebabkan reflux as.lambung

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 Keabsahan Resep: a. Persyaratan Administratif 1. Nama Dokter 2. SIP 3. Alamat Dokter 4. Tanggal Penulisan Resep Penerimaan 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 Kriteria Pemeriksaan Check List Drug Related Problem (DRP)/ Medication Error

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 relationships 2.2.Pharmaceutical care for patients with spesific desease 2.3.self care as a pharmaceutical care practice 2.4.wellness and health promotion