MEDICATION SAFETY DI OK DAN ICU

AA Raka KarsanaBali International Convention Centre, Nusa Dua – Bali, 10-12 Juli 2019

Sesungguhnyaseperti apakahsituasi di OK?

BEDANYA DG RUANGAN LAIN

NYARIS TIDAK ADA DOUBLE CHECK

PENGGUNAAN OBAT DI OK

ERROR RATE

Nanji KC, Patel A, Shaikh S, Seger DL, Bates DW. Evaluation of perioperative medication errors and adverse drug events. Anesthesiology 2016; 124:25–34

127 dari 277 Pembedahan

1 dari 2.2 Pembedahan

79.3% = Preventable

Atau

Apa saja errors yg sering...?

salah dosis (kalkulasi), konsentrasi, kec infus;

Substitusi/salah identfikasi (syringe atau ampule/vial swap);

repetisi (extra dose) dan omission (missed dose).

Salah rute,

Salah programming pd infusion pumps,

Memberikan obat yg diketahui alergi,

Salah flushing line stlh pemberian obat,

…………..?.

Sisabupivacaine &

Neost+Glikopirolat disimpan

di saku

P 58, Cangkok bypass arteri aortoiliac, epidural analgesia post-op

Bupivacaine 12 mLDlm Syringe X mL, 4mL diinjeksikan

8Ml Komb Neost +Glikopirolat dlmsyringe X mL

Sisabupivacaine &

Neost+Glikopirolat disimpan

di saku

Pd akhir op, Neuromus-

cular blockade Reserve: 6 mL

Pasientetap

LEMAH, hrs inj lg

BARU DisadariSALAH OBAT –vol obat

tetap 8mL

ISMP: Key Medication Errors in the Surgical Environment, Apeil 13, 2016

Medication error Di OK

W 68 th, TKR

Plan : As Tranexamat inj

unt bleeding risk; bupivacaine-pain

management

MaksudnyaEpidural

Analgesia dg BUPIVACAINE

AS TRANEXAMAT diinjeksikan

INTRATHECALL

PS KEJANG Ekstremitas

Bawah+ fenitoin. VT

ISMP: Key Medication Errors in the Surgical Environment, Apeil 13, 2016

ICU,; Rehabilitasi

fisik

“There has been a terrible mistake.” This is what the parents were told after it was discovered that epinephrine (adrenaline) instead of lidocaine(Xylocaine™) was found to be in the syringe that had been used to locally infiltrate the ear of a seven year old boy.

The incident led to a cardiac arrest and death of the child.

2010

STRATEGI MEDICATION SAFETY DI OK

STRATEGI MEDICATION SAFETY DI OK

Medication reconciliation

Time out: Allergies, antibiotic given, etc.

Protocols dan kelengkapan untuk malignant hyperthermia, cardiac arrest dll.

Drug trays in anaesthesia carts:

Terstandard, label jelas.

Manajemen high risk/dangerous drugs

No conc. drugs , satu konsentrasi obat di cart/OK

Label

Multidose vial, perlu

PENGAWET

BENZYL ALCH :

LEMAH OTOT KAKI

The International Spine Intervention Society’s Patient Safety Committee

PHENOL & FORMALIN : DISORIENTA

SI

MET & PROPYL PARABEN: CHRONIC ADHESIVE

ARACHOIDITIS

STRATEGI MEDICATION SAFETY DI OK

Regional anaesthetic solutions dipisah dari obat i.v.

Tiap obat diberi label dg nama, tgl, konsentrasi

Unlabeled syringe segera dikeluarkan

Verifikasi high risk med dan weight based doses oleh 2 orang

Teknik Aseptis

Baca dan verifikasi setiap label vial, ampul, syringe sebelum pemberian :

Sistem barcode digunakan dengan isyarat suara dan visual

STRATEGI MEDICATION SAFETY DI OK

Smart pump digunakan untuk semua infus; distandarisasi di seluruh unit; memiliki “drug libraries dg guardrails dan alerts” –menghindari kelebihan dosis 10-100 kali lipat -insulin, heparin, propofol, dan vasoactive medications

Ohashi K, Dalleur O, Dykes PC, Bates DW. Benefits and risks of using smart pumps to reduce medication error rates: a systematicreview.DrugSafety2014;37:1011–2

Identifikasi dg jelas pemberian:

Administration sets untuk rute khusus (epidural, i.v., etc.); Kode warna (kuning = epidural, merah = arterial);

STRATEGI MEDICATION SAFETY DI OK

Colour-Coding to Indicate Route of Administration

Hanya 1 obat masuk sterile field,

Jika ada obat tanpa label- “discarded”

Segregasi cairan topical atau irigasi dari sedparenteral.

Non-punitive QA system untuk pelaporan, analysis, dan intervensi insiden

Kebijakan tertulis untuk medication safety; teaching ttg kebijakan tsb untuk staf baru

Supervisi, TEACHING dan pelatihan Yang memadai

STRATEGI MEDICATION SAFETY DI OK

Membangun budaya menghargai dan kolaborasi yang mendukung keselamatan pasien dan membangun kepatuhan

DR MAHIBAN THOMASMaxillofacial and oral surgeon,

Royal Darwin Hospital.

Ada Apoteker yg ditugaskan di OK;

Apoteker berpartisipasi dlm pendidikan;

Apoteker OK mendapat pendidikan khusus(specialized education)

Obat baru?

Unique i.v. solutions (glucose, heparin, hypertonic, sterile water, epidural solutions) disimpan terpisah dg regular i.v. solutions

STRATEGI MEDICATION SAFETY DI OK

Consensus Recommendations for Improving Medication Safety in the Operating Room

MEDICATION SAFETY DI ICU

Latar belakang

TERAPI OBAT DI ICU

STRESSFUL

COMPLEX

CHANGING

BANYAK PPA

PS KRITIS

The greatest risk of error Multicentered studies (Ridley and colleagues

and Calabrese and colleagues)

Faktor Risiko medication errors di intensive care unit

Medication Reconciliation

NSAIDs

• HTN

Amlodipin

• Ankle Edema

Furosemide

• Nausea

Metoklopramid

• Movement disorder

Levodopa

Drip fentanyl IV tdk

distop: Ileus

memburuk

Tonic-clonic seizures

selama terapi imipenem

pseudomonal pneumonia

Contoh strategi untuk mencegahmedication errors

Optimalisasi medication process

1. Standarisasi obat – Formularium, CP/PPK

2. Computerized physician order entry dan clinical decision support

3. Bar code technology & RFID

4. Computerized intravenous infusion devices

5. Medication reconciliation

MEDICATION RECONCILIATION

MTEs = Medication transfer errors

Menghilangkan faktor risiko situasional

1. Hindari jam kerja yang berurutan dan kumulatif yang berlebihan

2. Minimalkan interupsi dan distraksi

3. Supervisi trainee

Contoh strategi untuk mencegahmedication errors

Mencegah kelalaian dan error

1. Intensivist participation in ICU care

2. Adequate staffing

3. Pharmacist participation in ICU care

4. Incorporation of quality assurance into academic education

Contoh strategi untuk mencegahmedication errors

Peran PPA

Intensivist di ICU menurunkan medication errors dari 22% sampai 70%, komplikasi sampai 50%, ICU mortality, ICU length of stay, dan hospital length of stay serta meningkatkan patient safety.

Apoteker, berperan penting dlm medication safety di ICU. Sediaan IV diprepare di IF oleh Apoteker dg proses

terstandar dan kons obat terstandar. Meningkatkan patient safety dg menurunkan

preventable ADEs 66% sekaligus memperpendekLOS, menurunkan mortality, dan menurunkan biayaobat

………………………

Pharmacist participation in ICU care

Patient history Pain score &

management

Switching drug/dosage

form/Stop

Antimikrobadan marker

infeksi

Dose adjustment

Drug interaction &

incompatibility

Usulpemeriksaan

penunjang………?

Pharmacist Participation in ICU Care

Take Home Messagges

OK dan ICU merupakan unit kerja dengansituasi High Risk.

Ada beberapa Risk Factors yg dapatmenimbulkan MEDICATION INCIDENT di OK dan ICU.

Banyak best practices yang terbukti dapatmeningkatkan MEDICATION SAFETY di OK dan ICU, termasuk OTOMATISASI.

APOTEKER dapat memberi kontribusisignifikan dalam mewujudkan MEDICATION SAFETY di OK dan ICU.

TERIMA KASIH