81st FIP World Congress of Pharmacy building a sustainable future for healthcare – Aligning goals

Pharmacy
and Pharmaceutical to 2030
Sciences
Name and number session: LSWE-04 Basel Statement Update
Brisbane, Australia
24-28 September 2022
Speaker name: Yulia Trisna
Title presentation: Basel Statements Implementation in Indonesia
CONFLICTS OF INTEREST

I have no conflicts of interest to declare

INDONESIA

• Archipelago (17,508 islands)

• 38 provinces
• Population: 278.7 million
• Hospitals: 3,121
Not determined yet: 29 A: 69
Rural Hosp: 57 B: 434

D: 868

Hospital Classification:
A: Academic Medical Centre/Tertiary Hospital >250 bed;
B: >200 bed; C: > 100 bed; D: >50

C: 1664
Indonesian Hospital Pharmacy Practice VS Basel Statements?
Ministry of Health Regulation:
 Standards of Pharmaceutical Services in Hospital (since 2004, now 2016 revision)
 Standards of Hospital Accreditation: Pharmaceutical Services and Medication Use, 2022
.
.

Trisna Y, 2019
 SCORES FOR IMPLEMENTATION OF GOOD HOSPITAL
PHARMACY PRACTICE BASED ON ACCREDITATION SURVEY

CLINICAL PHARMACY 6.31

.
DISTRIBUTION/DISPENSING 6.82 1,725 hospitals
STORAGE 7.98 Class A; 3%
B: 21%
PROCUREMENT 8.31
C: 53%
SELECTION 6.05 D: 23%
0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00

Trisna. Y, 2019
 Scores for Implementation of Clinical Pharmacy
PATIENT EDUCATION FOR SELF ADMINISTRATION 4.22

ADR MONITORING 7.19

.
DRUG THERAPY MONITORING 7.29

PRESCRIPTION REVIEW 7.85

MEDICATION RECONCILIATION 5.97

MEDICATION HISTORY TAKING 8.12

0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00
Skor Rata-rata
Basel Statements Self-Assessment Survey

Courtesy of Mr. Rob Moss and Dr. Ryan Forrey

 23 respondents (17 Academic Medical Centres; 6 Community Hospital)

 Overall score: 37.96%
 Caution!
misinterpretation of the questionnaires
overestimation vs underestimation
 Overarching Statements

Accessible to all health care providers at all

6. Hospital pharmacists should serve 96.15%
times
as a resource regarding all aspects
of medicines use and be accessible
as a point of contact for patients
and health care providers. Accessible only at certain times of the day
3.85% and/or to only certain health care providers
 Overarching Statements

.
8. Hospital pharmacists should 19.23% All patients monitored on a daily basis
monitor patients taking medicines
to assure patient safety, appropriate All patients monitored when changes are made to a patient's
medicine use, and optimal outcomes 11.54% therapy
for inpatients and outpatients. When
resource limitations do not permit
pharmacist monitoring of all patients 65.38% Some patients monitored based on patient selection criteria
taking medicines, patient-selection
criteria should be established to guide
pharmacist monitoring 3.85% No patients are monitored by pharmacists
 Pharmacist ward round at a Private Hospital

Multidisciplinary ward round at an Academic Hospital

Overarching Statements

9. Hospital pharmacists should 100% Yes

be allowed to access and
document in the full patient
record.
0% No
 Overarching Statements

.
57.69% Every patient with new medications
10. Hospital pharmacists should
ensure that patients or care givers
are educated and provided Only high risk patients or high risk
38.46%
written information on the medications
appropriate use of medicines.

3.85% No patient counseling by pharmacists provided

.

Outpatient medication counseling Bedside counseling

 Overarching Statements
.

23.08% The majority of hospital pharmacists

13. Hospital pharmacists should
actively engage in research into
new methods and systems to 50.00% A minority of hospital pharmacists
improve the use of medicines
and of human resource needs in
hospital pharmacy. Currently, not engaged in researching new methods
23.08% and systems to improve the use of medicines
 Overarching Statements

11.54% The majority of hospital pharmacists

13. Hospital pharmacists should
actively engage in research into
new methods and systems to 57.69% A minority of hospital pharmacists
improve the use of medicines and
of human resource needs in
hospital pharmacy. Currently, not engaged in researching new methods
23.08% and systems to improve human resource needs
Overarching Statements
ACTIVITIES %
Review, interpretation, and validation of all prescriptions prior to dispensing or administration (#7) 100.00
Providing orientation, drug information and education to nurses, physicians, and other hospital staff regarding best 80.77
practices for medicines use (#11)
Management and disposal of waste related to the medicine use process (#14) 73.08
.
Providing advice on the disposal of human waste from patients receiving medicines (#14) 7.69
Selection of technologies that support the medicine use process (#15) 84.62
Implementation of technologies that support the medicine use process (#15) 80.77
Maintenance of technologies that support the medicine use process (#15) 57.69
Ensuring proper storage to maintain the quality, safety, and security of medicines across the supply chain (#16) 96.15
Assessment of clinical decision support systems and informatics used for guiding the medicine use process (#17) 50.00
Development of clinical decision support systems and informatics used for guiding the medicine use process (#17) 38.46
Implementation of clinical decision support systems and informatics used for guiding the medicine use process (#17) 61.54
Maintenance of clinical decision support systems and informatics used for guiding the medicine use process (#17) 42.31
A contingency plan for medicine shortages or emergency purchases (#18) 76.92
Procurement

19.23% Daily
.

21. Procurement practices must be

supported by strong quality
7.69% Weekly
assurance principles, regularly
reviewed and adapted to fit
different settings and emerging
needs in the most appropriate and
61.54% Monthly
cost effective way.

11.54% Yearly
Procurement

. ACTIVITIES %
Procurement of strong quality assurance medicines (#20) 100
Ensuring a transparent process of procurement of medicines and health products, in 100
line with best practices and national legislation (#20)
Procurement of standard concentrations of high-risk medicines, including electrolytes 61.54
(#22)
A reliable information system for procurement that provides accurate, timely, and 61.54
accessible information (#23)
Influence on Prescribing

26.92% All care areas

.

27. Hospital pharmacists should

be an integral part of the
23.08% Most care areas
multidisciplinary team responsible
for therapeutic decision making in
all patient care areas.
46.15% Some care areas

3.85% A few care areas

Influence on Prescribing

??? 19.23% All

.

29. Appropriately trained and

15.38% Most
credentialed hospital
pharmacists should participate 15.38% Some
in collaborative prescribing.

19.23% A few

26.92% None
Influence on Prescribing

ACTIVITIES %
.
A Formulary system (local, regional, and/or national) (#24) 96.15
Serving on the hospital Pharmacy and Therapeutics Committee (#25) 100.00
Policies addressing off-label use (#25) 34.62
Educating prescribers on the access to and evidence for optimal and appropriate use 57.69
of medicines (#26)
Transferring patient medicines information as patients move between and within 88.46
sectors of care (#28)
Preparation and Delivery
ACTIVITIES %
Storage, preparation, dispensing, and distribution of all medicines, including investigational medicines (#30) 96.15
Ensuring proper dispensing of all medicines (#30) 88.46
.
Determining which medicines are included in ward stock (#32) 80.77
Ensuring quality compounding of injectable admixtures and non-commercially available formulations (#33) 92.31
Pharmacist managed preparation of hazardous medicines, including cytotoxics (#34) 76.92
Automated prescription filling (#35) 38.46
Unit dose distribution (#35) 88.46
A bar coding system or other machine scannable codes at administration (#35) 15.38
Policies addressing the use of medicines brought into the hospital by patients (#36) 96.15
Policies addressing the use of herbal and dietary supplements (#36) 42.31
System for tracing medicines dispensed by the pharmacy (#37) 76.92
Storage of concentrated electrolyte products outside of patient wards (#38) 88.46
 UNIT DOSE DISPENSING

.
NUCLEAR PHARMACIST SPECIALIST
.
 Administration

30.77% All
. medicines administration
48. The
process should be designed such
that transcription steps between the 15.38% Most
original prescription and the
medicines administration record are
eliminated 15.38% Some
S2.04 - To what extent do prescriptions
require transcription steps between the 23.08% A few
original prescription and medicines
administration record? Example: verbal
orders, written orders, transcribing from
one computer system to another
15.38% None
 Administration
ACTIVITIES %
Education/training on the use of the medicine for all health care professionals responsible for administering 88.46
injectable medicines and/or chemotherapy (#44)
Education/training on the hazards involved with the medicine for all health care professionals responsible for 92.31
administering injectable medicines and/or chemotherapy (#44)
.
Education/training on the necessary precautions with the medicine for all health care professionals responsible 84.62
for administering injectable medicines and/or chemotherapy (#44)
Ensuring patient's medication allergies, drug interactions, contraindications and past adverse events are accurately 84.62
recorded and evaluated prior to medicine administration (#41)
Packaging of medicines (#42) 100.00
Labeling of medicines (#42) 100.00
Policies and strategies to prevent wrong route errors (eg. Enteral feeding catheters, labeling of intravenous tubing 38.46
near the insertion site) (#46)
Labeling Individual patient medicines with at least two patient identifiers (example: patient name and date of 100.00
birth), name of medicine, route, and dose (#43)
Appropriate and current information resources to ensure safe preparation and administration (#40) 69.23
Independent checking of chemotherapy doses against the original prescription by a pharmacist and one additional 65.38
health care professional at the point of care prior to administration (#45)
Utilization of the observation method at drug administration to detect errors and identify potential areas for 46.15
improvement (#47)
 Monitoring

50.00% Always
.
54. Pharmacists’ clinically-relevant
activities should be documented,
collected and analyzed to improve
15.38% Most of the time
the quality and safety of medicines
use and patient outcomes. Activities
which significantly impact individual 26.92% Sometimes
patient care should be documented
in the patient record.

7.69% Rarely
Monitoring
ACTIVITIES %
. system for Defective medicines (#49)
Reporting 92.31
Reporting system for Adverse drug reactions (#50) 88.46
Reporting system for Medication errors (#51) 92.31
Safe medication use (#52) 96.15
Appropriate medication use (#52) 100.00
Cost-effective medication use (#52) 88.46
Data collected and trended against internal benchmarks and/or best practices in other institutions (#52) 26.92
Review of hospital medication practices by an external quality assessment accreditation program (#53) 80.77
Trigger tools for adverse drug events and optimal medicines use (#55) 46.15
Human Resources, Training and Development

. ACTIVITIES %
A human resource information system that contains basic data for planning, training, 50
appraising, and supporting the workforce
Key Factors of the gaps

.
A. not yet incorporated in MoH Regulation and/or Hospital Accreditation
Standards
B. were already incorporated in MoH Regulation and/or Hospital
Accreditation Standards, but lack of hospital management support
C. Lack of empowerment of human resources/competency
D. Lack of facilities, technology
Areas for Improvement

Activities A B C D
Clinical
. pharmacy (patient monitoring, patient
education, documentation)
Member of clinical team for therapeutic decision
making
Transcription process elimination
Involvement in design, development,
implementation, maintenance of CDSS & Informatics
Active involvement in research to improve
medication use and human resource needs in
hospital pharmacy
 Stakeholders’ role

Association of
Indonesian Indonesian
Pharmacists Pharmacy Higher
Hospital BOD
Association Education

Indonesian Hospital
Pharmacists Association Hospital Pharmacists
Take Home Messages

 . The wide gaps between the Indonesian Hospital Pharmacy Practice and
the Basel Statements should be improved by involving the stakeholders
 Competency and empowerment of hospital pharmacists should be
promoted
 The use of Information Technology should be optimized to improve
quality and safety of the services