Vitis Vini Fera Ratna Utami

 Konsep baru.
 The cost of inappropriate drugs use may even
exceed initial expenditures of drugs therapy.
 Ada negative therapeutic outcomes.
 Tingginya angka ADR yang dialami pasien dan
angka kematian pasien karena ADR.
 > 20% of all hospitalizations are related to drug
misadventures.
 Cost of drug related morbidity dan mortality
could reach $136,8 billion
 Adanya bahaya pada bagaimana obat dipakai,
(mulai dari diresepkan hingga dipakai,
keteledoran, human error).
 One fifth of hospitalized patient experience drug
therapy problems.
 The provision of ph.care improves patient
outcomes : < 60%  84%
 Adanya Medication Error, LOS meningkat 5

hari  biaya bertambah

 6.5% nonobstetric patient suffered an ADR

(30% serius)
 Beddel 1991, 64% cardiac arrest di teaching

hospital karena kesalahan pemakaian obat

 Angka terjadinya Medication Error rata2

menjadi turun.
 1. Traditional Drug Distribution Stage
 2. Transisional/clinical Pharmacy stage

(1960)
 3. Patient focused / Ph. Care (1990)
 1. Traditional Drug Distribution Stage
 Memasuki awal abad 20
 Apoteker = druggiest
 Meracik obat/membuat obat
 Meluntur ketika produksi obat diambil alih
oleh industri obat

 2. Transisional/clinical Pharmacy stage (1960)

 Pengetahuan obat semakin kompleks
 Kebutuhan tentang informasi obat
 Periode transisi
 Partisipasi dalam pelayanan pasien
 Ada pionir-pionir
 1960  1990 terjadi
 Ledakan jumlah dan jenis obat
 Angka kematian dan hospitalization

meningkat
 20% perawatan dikarenakan kecelakaan obat

yang seharusnya dapat dihindari (50%)

 45%-65% pasien memakai obat tidak sesuai

dengan yang dianjurkan.

 Danger&risk are found in how drug used, not

simply in their chemical composition.

 3. Patient focused / Ph. Care (1990)
 Pharmacokinetic measurement&aplication,

dosing
 Peracikan formula nutrisi
 Komplikasi sejarah pengobatan
 Pemantauan terapi.
 Mikeal et al 1975 : the care that a given
patient requires and receives which assures
safe and rational drug usage.
 The American society of Health-System

Pharmacists (ASHP) : is the DIRECT

RESPONSIBLE of medication related care on
the purpose of achieving definite outcomes
that improve patient’s QOL
 Strand dkk 1997 : Ph. Care is a PRACTICE in
which the practitioner takes RESEPONSIBILITY
for a patient’s drug related needs, and is held
ACCOUNTABLE for this COMMITMENT.

 KEPMENKES 1027/MENKES/SK/IX/2004 :
Pelayanan Kefarmasian (Ph.Care) adalah
bentuk pelayanan dan tanggungjawab
langsung profesi apoteker dalam pekerjaan
kefarmasian untuk meningkatkan kualitas
hidup pasien.
 Is a practice
 Patient focused
 Direct interaction with the patient
 Rational drug therapy (tepat, efektif, aman,

nyaman, rasional)
 Quality of life
 Definite outcome
 Terdokumentasi
 DRP
 The practitioner takes time to determine the
patient’s specific wishes, preference, and
needs, concerning his health and illness

 The practitioner makes a commitment to

continue care, once it is inititiated.
 Hubungan mendasar perawatan pasien.
 Trust dan wewenang farmasis
 Commitment and competency

 Develop a patient trusting and collaborative

relationship with health care providers
 Terapi obat
 Keputusan-keputusan yang akan dibuat :
 1. pemakaian obat
 2. pertimbangan pemilihan dosis, rute,

metode
 3. pemantauan terapi obat
 4. pemberian informasi
 5. pemberian konseling
 Fokus dari care adalah merawat, peduli, dan
menolong.
 Interaksi langsung dengan pasien
 Patient focused  promotes the patient’s

participation in the therapeutic process

based on dialogue and commitment
 Bekerja sama dengan staf kesehatan lain :
1. Merancang
2. Melaksanakan
3. Memantau therapeutic plan
4. Perbaikan kualitas hidup pasien yang pasti.
Hubungan individual farmasis :
1. Professional
2. Personal
3. Commitment
 Karakter hubungannya :
 Mutual respect
 Honestly
 Open communication
 Cooperation
 Empathy
 Sensitivity
 Promotion on patient independence
 Exercising patience and understanding
 Seeing patient as a person
 Putting patient first.
 Offering reassurance
 Advocacy
 Supporting the patient
 Kepastian perbaikan kualitas hidup
1. Curing the disease
2. Eliminating/reducing sign and symptoms
3. Arresting/slowing a disease progress
4. Preventing a disease
5. Achieving desired alteration in physiological
processes.
 Untuk mencapai outcomes, farmasis harus :
 Identifikasi DRP
 Memecahkan DRP aktual
 Mencegah DRP potensial
 Suatu penilaian yang lengkap mengenai
kualitas hidup
 Quality of life is the extent to which a
patient’s normal life activities have been
compromised by disease and treatment.
 How much the disease and its treatment
interferes with the activities of daily living (i.e
: sleeping, eating, going to work, recreational
activities)
 Component : physical functioning,
psychological status, social functioning, and
disease-or treatment – related
symptomatology
 Penilaian QOL adalah penilaian yang obyektif,
subyektif dan pasien dilibatkan dalam
pengukurannya.

Accountable
Terdokumentasi
(semua proses pelayanan yang dilakukan)
 Remember..

Drugs don’t have doses..

People have doses