Pengantar Farklin Dan Komunitas

7/30/2019 Pengantar Farklin Dan Komunitas

1/34

CLINICAL PHARMACY

Hansen N, S.Si., Apt., Sp.FRS


2/34

2

Its not the strongest speciesthat survives, nor the mostintelligent, but the ones mostresponsive to change

(Charles Darwin)


3/34

Pharmacists are the most highly trained experts on drugs and

drug products

Best professional to:

Promote rational drug prescribing

Teach patients to use drugs appropriately

Identify and prevent medication problems

Gaps TrendsClinicalPharmacy

FutureNeeds

UCSFStory

Silverman, M and Lee, PR:

Pills, Profits, and Politics

UC Press 1975

Clinical Pharmacy Philosophy


4/34


5/34


FutureNeeds

UCSFs

Story

Model Works Well in Hospitals


6/34

Dr. Donald Brodie, 1965 :

The ultimate goal of the

Services of Pharmacymust be

the SAFE USE of DRUGS

by the Public


7/34

Historical Milestones in the Clinical

Pharmacy Movement

1944- Clinical Pharmacy as an educational tool

first used

University of Washington, Prof. L. Wait Rising

Disapproved by AACP and ACPE in 1946

1969- the term Clinical Pharmacy comes to

be used to denote patient-oriented pharmacy

practice


8/34

Decentralized Pharmacy Services:

The Satellite Pharmacy Concept

Brought pharmacist into the patient care

environment

Health care professionals could put a face

to a name

Pharmacist was easily accessible to assistwith drug-related problems


9/34

Decentralized Pharmacies:

made it possible for the physician, if he sowishes, to discuss drug usage with thepharmacists at the time the decision is beingmade

and

provided students with adequate experience

in applying scientific and professional

knowledge gained in the classroom to thepractical aspects of drug usage in therapeutic

situations

Day, RL, et al. DICP 1991;25:308-314


10/34

What is a Clinical Pharmacist?

1981- All pharmacists are clinical

pharmacists (ASHP)

1981-American College of Clinical Pharmacy

counters with a pharmacists duties define

whether he is a clinical pharmacist


11/34

Clinical Pharmacy

(in the early years):

is a concept or a philosophy

emphasized the safe and appropriate use of

drugs in patients

focused on patient and not product

placed responsibility for drugs therapy on all

health disciplines who are in any way

concerned with drugs


12/34

Clinical Pharmacists Functions in the

Drug Use Process

Medication history taking

Drug therapy advisor

Drug therapy monitoring

Patient drug counseling

Drug usage review Drug therapy management

McLeod, DC, Am J Hosp Pharm 1976;33:904-911


13/34


14/34

Therapeutic advisors

Patient education

Drug use review and policy

Formulary work

Medication safety


FutureNeeds

UCSFs

Story

Model Works Well in Hospitals


15/34

Hospital practice admission

Pharmacists attend pre-admission clinicsfor planned admissions

Assess patients needs for medicines to be

prescribed during their stay, write theirprescriptions, provide any advice on whatshould be stopped before surgery

For unplanned admissions, pharmaciststake medication history, may writeprescription Some pharmacists have trained to

prescribe


16/34

Dispensing in hospital

Patient

DoctorClinical

Pharmacist

Pharmacy

technician

Dispensary

Robot

Only large teaching hospitals

electronic

prescription

dispensed

drug


17/34

Hospital practice

during hospital stay Pharmacists check prescriptions regularly frequency depends on type of ward and correctany errors by discussion with prescribers

Pharmacists provide advice to prescribers as required

Some pharmacists select drugs and doses forpatients and write prescriptions

Pharmacists monitor quality of prescribingSome nurses have trained to prescribe


18/34

Hospital practice - discharge

Pharmacists check discharge prescription to makesure it is correct and all items are clinically indicated,may write discharge prescription

Pharmacists assess patients ability to administertheir own medicines and provide advice to patientsprior to discharge

Hospital pharmacists discuss patients with

community pharmacists before discharge if required


19/34

Primary care practice

Pharmacists are based within medical practices(like PCU) most are part-time

Pharmacist may provide services directly to

patients and prescribe for them Warfarin management (INR testing)

COPD clinics (spirometry)

Medication reviews

Pharmacists advise other prescribers Primary care pharmacists discuss patients with

hospital pharmacists if required

doctors and nurse

prescribers


20/34

Community pharmacy Pharmacists must provide advice with all

prescriptions and purchased medicines

Pharmacists all keep patient medication records

Many pharmacists provide medication reviews need to complete training

Some also trained as prescribers, provide specialistclinics

Some provide screening for diabetes, hypertension,

osteoporosis


21/34

Kurikulum S1 farmasi inggris


22/34

Definisi Pharmaceutical care menurut

Federation International Pharmaceutical

Ph care is the responsible provision of pharmaco-therapy forthe purpose of achieve definite outcomes that improve ormaintain a patients quality of life. It is a collaborative processthat aims to prevent or identify and solve medicinal productand health related problems. This is a continous quality

improvement process for the use of medicinal products.


23/34

Pharmaceutical Care ?Hepler and Strand (1990)

from: Am. J Hosp Pharmacy 47,533-543

Is the direct responsible provision of medication related carefor the purpose of achieving definit outcomes thatimprove patients quality of life

Outcomes:

kesembuhan (cure of disease)

pengurangan gejala penyakit (elimination or reduction

of patients symptoms) perlambatan proses terjadinya penyakit (arresting orslowing of a disease process)

pencegahan penyakit atau gejala penyakit (preventinga disease or symptoms)


24/34

Clinical Pharmacy Services


25/34


26/34

2. EDUCATION

TALKS TO DOCTORS AND NURSES


27/34

HUKM Pharmacy Counseling Week


28/34


29/34

Selama peresepan

Konseling

Patient

Pharmacist


30/34

Karakteristik praktek farmasi klinik

Berorientasi kepada pasien Terlibat langsung di ruang perawatan di rumah sakit (bangsal)

Bersifat pasif, dg melakukan intervensi setelah pengobatandimulai atau memberikan informasi kalau diperlukan

Bersifat aktif, dg memberi masukan kpd dokter sebelumpengobatan dimulai atau menerbitkan buletin2 informasi obatatau pengobatan

Bertanggungjawab terhadap setiap saran atau tindakan yangdilakukan

Menjadi mitra dan pendamping dokter


31/34

Kendala

Kurangnya pengetahuan teknis Kurangnya kemampuan berkomunikasi

Tekanan kelompok kerja/ketidaknyamanan kerja

Kurangnya motivasi dan keinginan untuk berubah

Kurang percaya diri

Kurang pelatihan dalam arus kerja yg sesuai

Peningkatan persepsi tentang tanggung jawab

Kurangnya staf di Instalasi Farmasi


32/34

Bagaimana di Indonesia ??

Kegiatan manajerial merupakan kegiatanutama merupakan sumber pemasukanuang terbesar di RS

Kegiatan klinik masih relatif sangatsedikit dilakukan banyak kendala (apa?)

Farmasis belum banyak dilibatkan dalamtim kesehatan tidak dianggap sebagaitenaga kesehatan, tapi lebih sebagaipenunjang medis


33/34

Faktor sejarah : farmasi termasuk ilmu MIPA padahal

farmasi adalah profesi pelayanan kesehatan Farmasis kurang kompeten mengapa ? (dulu)

Pendidikan farmasi tidak fokus farmasis ada di mana-mana, tapi tidak terasa adanya

Farmasis belum bisa menunjukkan kemampuannya dibidang klinis, tidak percaya diri, dan kurang bisamenjalin kerjasama dgn tenaga kesehatan lain

Kebijakan direktur RS tidak mendukung : Jumlahfarmasis terbatas, disibukkan dengan kegiatan

manajerial Belum ada reward yang sepadan dengan pekerjaan

But dont worry kebijakan yang diusulkan BinaFarmasi Klinik dan Komunitas Depkes : 1 farmasis untuk30 bed


34/34

KEP. MENKES 1197 TH. 2004

PELAYANAN FARMASI

RUMAH SAKIT

BERORIENTASI PADA :

PELAYANAN PASIEN

PELAYANAN FARMASI KLINIK

Pengantar Farklin Dan Komunitas

Documents

Transcript of Pengantar Farklin Dan Komunitas