pengantar farklin dan komunitas
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CLINICAL PHARMACY
Hansen N, S.Si., Apt., Sp.FRS
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2
Its not the strongest speciesthat survives, nor the mostintelligent, but the ones mostresponsive to change
(Charles Darwin)
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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
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Gaps TrendsClinicalPharmacy
FutureNeeds
UCSFs
Story
Model Works Well in Hospitals
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Dr. Donald Brodie, 1965 :
The ultimate goal of the
Services of Pharmacymust be
the SAFE USE of DRUGS
by the Public
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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
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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
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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
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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
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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
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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
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Therapeutic advisors
Patient education
Drug use review and policy
Formulary work
Medication safety
Gaps TrendsClinicalPharmacy
FutureNeeds
UCSFs
Story
Model Works Well in Hospitals
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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
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Dispensing in hospital
Patient
DoctorClinical
Pharmacist
Pharmacy
technician
Dispensary
Robot
Only large teaching hospitals
electronic
prescription
dispensed
drug
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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
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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
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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
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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
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Kurikulum S1 farmasi inggris
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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.
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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)
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Clinical Pharmacy Services
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2. EDUCATION
TALKS TO DOCTORS AND NURSES
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HUKM Pharmacy Counseling Week
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Selama peresepan
Konseling
Patient
Pharmacist
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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
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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
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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
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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
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KEP. MENKES 1197 TH. 2004
PELAYANAN FARMASI
RUMAH SAKIT
BERORIENTASI PADA :
PELAYANAN PASIEN
PELAYANAN FARMASI KLINIK