RENCANA PROGRAM DAN KEGIATAN PEMBELAJARAN
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RENCANA PROGRAM DAN KEGIATAN PEMBELAJARAN SEMESTER (RPKPS) MATA KULIAH FARMASI KLINIK & KOMUNITAS Oleh Hansen Nasif, S.Si., Apt., Sp.FRS Prof Dr. Surya Dharma, MS, Apt. Dr. Dedy Almasdy, MS, Apt Dr. Husni Muchtar, Apt FAKULTAS FARMASI UNIVERSITAS ANDALAS 2014 A. PERENCANAAN PEMBELAJARAN 1. Nama Mata Kuliah : Farmasi Klinik dan Komunitas 2. Kode Mata kuliah : FAR 461 3. SKS :2 4. Sifat : Wajib 5. Prasyarat : Farmakoterapi 6. Semester : VII 7. Perkiraan banyaknya peserta : 120 mhs 8. Deskripsi singkat mata kuliah Farmasi Klinik dan komunitas: Mata kuliah ini mempelajari mengenai sejarah dan perkembangan farmasi klinik, Kegiatan kegiatan farmasi klinik meliputi: wawancara riwayat pengobatan, physical examination, interprestasi data lab, pemantauan terapi, pilihan terapi pada berbagai kondisi khusus, rekomendasi farmasi, teknik intervensi farmasi dengan contoh-contoh kasus dan solusinya serta peran farmasi dalam terapi sederhana menggunakan obat sesuai kewenangan farmasi pada kasus penyakit tertentu 9. Tujuan Pembelajaran: Tujuan pembelajaran Farmasi Klinik adalah mahasiswa memahami dan menguasai pengertian farmasi klinik dan kegiatan-kegiatannya. Bagi mahasiswa dengan minat Farmasi Klinik dan Komunitas, mata kuliah ini salah satu ilmu utama yang nantinya akan diaplikasikan dalam memberikan pelayanan kefarmasian. Mahasiswa juga diharapkan mampu mengintegrasikan berbagai ilmu terkait. Selain itu, dengan prinsip evidencebased medicines, maka tenaga kesehatan, termasuk farmasis, harus selalu mengikuti fakta terbaru mengenai penggunaan obat untuk nantinya dapat memberikan pelayanan farmasi klinik. Karena itu, tujuan pembelajaran juga untuk memotivasi mahasiwa untuk terus belajar secara mandiri dan terus mengikuti perkembangan dunia kesehatan secara berkesinambungan (lifelong-learning), khususnya bidang kefarmasian dan obat obatan yang berkembang sangat cepat, jika ingin profesional dalam pelayanan farmasi klinik dan komunitas. 10. Tujuan Pembelajaran khusus Setelah mengikuti perkuliahan ini, mahasiswa diharapkan dapat : 1. Mengetahui perkembangan farmasi klinik di Indonesia dan dunia 2. Memahami macam-macam kegiatan pelayanan farmasi klinik B. PELAKSANAAN PEMBELAJARAN Minggu ke (1) 1 Topik (Pokok Bahasan) (2) Pengantar dan Pendahuluan farmasi klinik & Komunitas Metode Pembelajaran Substansi Materi (3) Sejarah farmasi klinik dan komunitas Batasan farmasi klinik dan komunitas Tahap-tahap farmasi klinik da komunitas (4) Ceramah, Tanya jawab Fasilitas Ket (5) (6) Laptop, LCD viewer Monitoring Efek Samping obat Pengenalan efek samping obat Klasifikasi efek samping obat Membantu pasien agar mengerti resiko efek samping obat Bagaimana melaporkan efek samping obat Pencegahan dan penatalaksanaan efek samping obat. Pengenalan Rekam medik Fungsi rekam medik Pharmacy worksheet Intervensi farmasi Rekomendasi farmasi Persentasi, diskusi Laptop, LCD viewer Persentasi, diskusi Laptop, LCD viewer Persentasi, diskusi Laptop, LCD viewer Persentasi, diskusi Laptop, LCD viewer Persentasi, diskusi Pentingnya pengetahuan Physical examination Vital sign Nervous system Respiratory system Cardiovascular system Abdominal examination Fungsi sejarah penderita Riwayat penyakit dahulu Riwayat penyakit sekarang Demografi Riwayat penyakit keluarga Riwayat alergi Sejarah penggunaan obat Peran data lab pada suatu terapi Peran Urea, BUN, Kreatinin Albumin, Bilirubin Glukosa, As.Urat, Enzym Kimia darah Laptop, LCD viewer Kertas kerja farmasi Format rekomendasi Analisis kasus dan Persentasi, diskusi Laptop, LCD viewer Penggunaan obat pada ibu hamil Keadaan hamil Perubahan farmakokinetika obat pada kehamilan Obat yang sering dikonsumsi pada saat hamil Permasaalahan pemberian obat pada kehamilan Pilihan pemberian obat pada kehamilan. Persentasi, diskusi Laptop, LCD viewer 2 3 Problrem Oriented Medical Record Physical examination 4 Pharmacyst History taking 5 Interprestasi data lab. 6 7 Perkembangan farmasi klinik dan komunitas di Indonesia maupun di seluruh dunia. Ketrampilan farmasi klinis dan komunitas Aktifitas farmasi klinik dan komunitas Pharmacy Worksheet kasus 8 Penggunaaan obat pada usia lanjut 9 10 11 12 Penggunaan obat demam pada bayi/ anak Penggunaan obat analgetik pada nyeri Penggunaan antijamur pada tinea infeksi Penggunaan obat antitukak peptik 13 Penggunaan obat antimual dan muntah 14 Keadaan usia lanjut Perubahan farmakokinetika obat pada usia lanjut Obat yang sering dikonsumsi pada saat usia lanjut Permasaalahan pemberian obat pada usia lanjut Pilihan pemberian obat pada usia lanjut. Persentasi, diskusi Laptop, LCD viewer Batasan demam Prevalensi Etiologi Keluhan yang disampaikan pasien Gejala klinik Pilihan terapi Batasan nyeri Prevalensi Etiologi Keluhan yang disampaikan pasien Gejala klinik Pilihan terapi Batasan infeksi jamur tinea Prevalensi Etiologi Keluhan yang disampaikan pasien Gejala klinik Pilihan terapi Batasan antitukak peptik Prevalensi Etiologi Keluhan yang disampaikan pasien Gejala klinik Pilihan terapi Persentasi, diskusi Laptop, LCD viewer Persentasi, diskusi Laptop, LCD viewer Persentasi, diskusi Laptop, LCD viewer Persentasi, diskusi Laptop, LCD viewer Batasan antimual dan antimuntah Prevalensi Etiologi Keluhan yang disampaikan pasien Gejala klinik Pilihan terapi Persentasi, diskusi Laptop, LCD viewer 2. Metode pembelajaran dan bentuk kegiatan Perkuliahan diberikan dalam bentuk penjelasan oleh dosen di depan kelas dengan berbagai alat bantu seperti LCD viewer, Laptop, dan white board. Selain itu juga diterapkan casebased learning di mana dipresentasikan berbagai contoh kasus farmasi klinik dan komunitas untuk dibahas di dalam kelas. C. PERENCANAAN EVALUASI PEMBELAJARAN 1. Hasil pembelajaran Kriteria penilaian mengacu pada beberapa kriteria berikut ini : - mahasiswa dapat memahami prinsip-prinsip dalam materi perkuliahan Farmasi Klinik, dan menjelaskan kembali materi perkuliahan tersebut, - kemampuan mahasiswa menganalisis dan mempresentasikan kasusnya di depan kelas Penilaian tersebut akan dilakukan melalui ujian tertulis dan aktivitas diskusi. Ujian tertulis dilakukan pada akhir semester. Adapun prosentase unsur penilaian dan kriterianya adalah sbb: Unsur - unsur Tugas Quiz Ujian tengah Semester Ujian Semester Total Persentase ( %) 15 15 20 50 100 - Kriteria penilaian untuk mata kuliah ini sesuai dengan yang berlaku pada universitas andalas yaitu dari yang terendah nilai E sampai yang tertinggi nilai A+ 2. Evalusi Proses pembelajaran dari mahasiswa Untuk mendapatkan masukan dari mahasiwa mengenai keseluruhan proses pembelajaran, akan dibagikan kuesioner yang berupa SKALA KEPUASAN MENGAJAR. D. DAFTAR PUSTAKA 1) Wiffen, P, et all, Oxford Handbook of Clinical Pharmacy, 1 th edition,University Press, UK, 2007 2) Barber N (ed),Clinical Pharmacy, 2 th edition, Churcill Livingstone, UK, 2007 3) Rutter, P, Community Pharmacy, 1 th edition, Churcill Livingstone, UK, 2005 4) AHFS Drugs Informations 2008 5) BNF, 56 editions, 2008 6) USPDI, Drugs Information for health care proffesionals, in Harisson Principles of Internal Medicines, 15 th edition CD-ROM, Micromedex, ( www. Harissononline.com) 7) Dipiro, JT, et all, Pharmacotherapy : a pathophisiologic approach, 7 th ed,McGrawHill Company, USA 2008 KONTRAK PERKULIAHAN Nama Mata Kuliah Kode Mata kuliah Pengajar SKS Semester Hari Pertemuan/Jam Ruang Kuliah : Farmasi Klinik dan Komunitas : PAF 461 : Hansen Nasif, S.Si., Apt., Sp.FRS Prof Dr. Surya Dharma, MS, Apt. Dr. Dedy Almasdy, MS, Apt Dr. Husni Muchtar, Apt :2 : VII : Selasa/ 08.00-09.40 WIB : Lokal C 1.Manfaat Mata Kuliah Mata kuliah ini diberikan pada mahasiswa agar dapat memahami dan menguasai pengertian farmasi klinik dan kegiatan-kegiatannya. Bagi mahasiswa dengan minat Farmasi Klinik dan Komunitas, mata kuliah ini salah satu ilmu utama yang nantinya akan diaplikasikan dalam memberikan pelayanan kefarmasian. Mahasiswa juga diharapkanmampu mengintegrasikan berbagai ilmu terkait. Selain itu, dengan prinsip evidencebased medicines, maka tenaga kesehatan, termasuk farmasis, harus selalu mengikuti fakta terbaru mengenai penggunaan obat untuk nantinya dapat memberikan pelayana farmasi klinik. Karena itu, tujuan pembelajaran juga untuk memotivasi mahasiwa untukterus belajar secara mandiri dan terus mengikuti perkembangan dunia kesehatansecara berkesinambungan (lifelong-learning), khususnya bidang kefarmasian dan obat obatan yang berkembang sangat cepat, jika ingin profesional dalam pelayanan farmasi klinik dan komunitas. 2. Deskripsi Perkuliahan Mata kuliah ini mempelajari mengenai sejarah dan perkembangan farmasi klinik, Kegiatan kegiatan farmasi klinik meliputi: wawancara riwayat pengobatan, physicalexamination, interprestasi data lab, pemantauan terapi, pilihan terapi pada berbagai kondisi khusus, rekomendasi farmasi, teknik intervensi farmasi dengan contoh-contoh kasus dan solusinya serta peran farmasi dalam terapi sederhana menggunakan obat sesuai kewenangan farmasi pada kasus penyakit tertentu 3. Tujuan Instruksional Setelah mengikuti perkuliahan ini, mahasiswa diharapkan dapat Mengetahui perkembangan farmasi klinik di Indonesia dan dunia serta memahami macam-macam kegiatan pelayanan farmasi klinik 4. Organisasi Materi Organisasi materi dapat dilihat pada jadwal perkuliahan 5. Strategi Perkuliahan Strategi Instruksional yang digunakan pada mata kuliah ini terdiri dari : a. Urutan kegiatan instruksional berupa : Pendahuluan (TIU dan TIK, cakupan materi pokok bahasan, dan relevansi ), penyajian ( uraian,contoh, diskusi , evaluasi ) dan penutup ( umpan balik, ringkasan materi, petunjuk tindak lanjut, pemberian tugas di rumah, gambaran singkat tetang materi berikutnya ) b. Metode Instruksional menggunakan : metode ceramah, demonstrasi, tanya-jawab, diskusi kasus dan penugasan 1. Ceramah berupa penyampaian bahan ajar oleh dosen pengajar dan penekanan-penekanan pada hal-hal yang penting dan bermanfaat untuk diterapkan 2. Tanya jawab dilakukan sepanjang tatap muka dengan memberikan kesempatan mahasiswa untuk memberikan pendapat atau pertanyaan tentang hal-hal yang tidak mereka mengerti atau bertentangan dengan yang mereka pahami sebelumnya. 3. Diskusi kasus dilakukan dengan memberikan contoh kasus/kondisi pada akhir pokok bahasan, mengambil tema yang sedang aktual di masyarakat dan mengajak mahasiswa menganalisisnya 4. Penugasan diberikan untuk membantu mahasiswa memahami bahan ajar, membuka wawasan, dan memberikan pendalaman materi c. Media Instruksionalnya berupa LCD Projector, Laptop, spidol, Whiteboard,artikel ilmiah di surat kabar/ internet, jurnal ilmiah, handout, dan kontrak perkuliahan. D Waktu : 5 menit pada tahap pendahuluan, 40 menit pada tahap penyajian, dan 5 menit pada tahap penutup. 6. Materi/ Bacaan Perkuliahan 1. Wiffen, P, et all, Oxford Handbook of Clinical Pharmacy, 1 th edition,University Press, UK, 2007 2. Barber N (ed),Clinical Pharmacy, 2 th edition, Churcill Livingstone, UK, 2007 3. Rutter, P, Community Pharmacy, 1 th edition, Churcill Livingstone, UK, 2005 4. AHFS Drugs Informations 2008 5. BNF, 57 editions, 2009 6. USPDI, Drugs Information for health care proffesionals, in Harisson Principles of Internal Medicines, 15 th edition CD-ROM, Micromedex, ( www. Harissononline.com) 7. Dipiro, JT, et all, Pharmacotherapy : a pathophisiologic approach, 7 th ed,McGrawHill Company, USA 2008 7. Tugas Dalam perkuliahan, diberikan beberapa tugas sebagai berikut : 1. Materi perkuliahan sebagaimana disebutkan dalam jadwal perkuliahan harus sudah dibaca sebelum mengikutitatap muka. Apabila ada, handout sudah akan diserahkan pada mahasiswa sbelum hari kuloiah 2. Evaluasi mahasiswa dilakukan dengan mengadakan quis dengan waktu yang tidak ditentukan, ujian mid semester dan ujian semester dengan format soal essay 3. Penugasan, jika ada yang sesuai dengan pokok bahasan harus sudah diselesaikan sebelum ujian semester dimulai 8.Kriteria Penilaian Nilai Akhir Nilai Mutu Angka Mutu ≥85-100 A 4,00 Sebutan Mutu Sangat cemerlang ≥80<85 A- 3,50 Cemerlang ≥75<80 B+ 3,25 Sangat baik ≥70<75 B 3,00 Baik ≥65<70 B- 2,75 Hampir baik ≥60<65 C+ 2,25 Lebih dari cukup ≥55<60 C 2,00 Cukup ≥50<55 C- 1,75 Hampir cukup ≥40<50 D 1,00 Kurang <40 E 0,00 Gagal 1. Pembobotan nilai adalah sebagai berikut : Unsur - unsur Tugas Quiz Ujian tengah Semester Ujian Semester Total Persentase ( %) 15 15 20 50 100 2. Bagi mahasiswa yang sudah pernah mengikuti mata kuliah ini sebelumnya namun mengambil mata kuliah ini selanjutnya harus mengikuti perkuliahan ini seluruhnya 3. Untuk memacu kreativitas mahasiswa dan mendapatkan update dalam keilmuan ini maka semua quiz dan ujian pada mata kuliah ini, adalah open book dan dibolehkan melakukan koneksi internet. BAHAN AJAR In 2004, the Joint Commission of Pharmacy Practitioners (JCPP) and the eleven national pharmacy organizations that comprise its membership endorsed a future vision of pharmacy practice: Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes. Need for a Standardized Method The purpose of this document is to provide pharmacists with a standardized method for the provision of pharmaceutical care in component settings of organized health systems. Since the introduction of the pharmaceutical care concept1 and the development of the ASHP Statement on Pharmaceutical Care,2 considerable variation in pharmacists’ provision of pharmaceutical care has been noted. ASHP believes pharmacists need a standardized method for providing pharmaceutical care. This document describes a standardized method based on functions that all pharmacists should perform for individual patients in organized health systems. The use of this method would foster consistency in the provision of pharmaceutical care in all practice settings. It would support continuity of care both within a practice setting (e.g., among pharmacists on different work shifts caring for an acutely ill inpatient) and when a patient moves among practice settings (e.g., when an inpatient is discharged to home or ambulatory care). Further, a standardized method would establish consistent documentation so that patientspecific and medication- related information could be shared from pharmacist to pharmacist and among health professionals. The need to identify the functions involved in pharmaceutical care and the critical skills necessary to provide it was discussed at the San Antonio consensus conference in 1993.3 Functions for the provision of pharmaceutical care were identified by the practitioner task force of the Scope of Pharmacy Practice Project.4 Those functions have been defined in more detail in the pharmacotherapy series of the ASHP Clinical Skills These Guidelines are not specific to any practice setting. ASHP believes this standardized method can be used in acute care (hospitals), ambulatory care, home care, long-term care, and other practice settings. Functions can be tailored as appropriate for a given practice setting. It is recognized that the degree of standardization and tailoring appropriate for a given work site will depend on the practice environment, the organization of services (e.g., patientfocused or department-focused), working relationships with other health professionals, the health system’s and patient’s financial arrangements, and the health system’s policies and procedures. ASHP believes the use of the systematic approaches encouraged by these guidelines will assist pharmacists in implementing and providing pharmaceutical care in their work sites. Functions of Pharmaceutical Care ASHP believes that a standardized method for the provision of pharmaceutical care should include the following: Collecting and organizing patient-specific information, Determining the presence of medication-therapy problems, Summarizing patients’ health care needs, Specifying pharmacotherapeutic goals, Designing a pharmacotherapeutic regimen, Designing a monitoring plan, Medication Therapy and Patient Care: Organization and Delivery of Services–Guidelines 167 Behavioral/lifestyle Diet Exercise/recreation Tobacco/alcohol/caffeine/other substance use or abuse Sexual history Personality type Daily activities Social/economic Living arrangement Ethnic background Financial/insurance/health plan Objective and subjective information should be obtained directly from patients (and family members, other caregivers, and other health professionals as needed). A physical assessment should be performed as needed. In addition, information can be obtained by reviewing the patient’s health record and other information sources. Information in the patient’s health record should be understood, interpreted, and verified for accuracy before decisions are made about the patient’s medication therapy. With access to the patient’s health record comes the professional responsibility to safeguard the patient’s rights to privacy and confidentiality. The Privacy Act of 1974,10 professional practice policies,11,12 and policies and procedures of organized health systems provide guidance for the pharmacist in judging the appropriate use of patient-specific information. The patient (as well as family members, caregivers, and other members of the health care team as needed) should be interviewed. This is necessary for the pharmacist to establish a direct relationship with the patient, to understand the patient’s needs and desired outcome, to obtain medication- related information, and to clarify and augment other available information. Pharmacists in many practice settings, including ambulatory care, may need to perform physical assessments to collect data for assessing and monitoring medication therapy. Information, including clinical laboratory test results, gathered or developed by other members of the health care team may not be in the patient’s health record. Therefore, to ensure that the patient information is current and complete, other sources should be checked. Other sources may include medication profiles from other pharmacies used by the patient. Although it is ideal to have a comprehensive database for all patients, time and staffing limitations may necessitate choices regarding the quantity of information and the number of patients to follow. Choices could be determined by the health system’s policies and procedures, by clinical care plans, or by disease management criteria in the patient’s third-party health plan. Systems for recording patient-specific data will vary, depending on pharmacists’ preferences and practice settings. Electronic documentation is recommended. Some information may already be in the patient’s health record. Therefore, when authorized, the additional information gathered by the pharmacist should be recorded in the patient’s health record so that it can be shared with other health professionals. Abstracted summaries and work sheets may also be useful. Determining the Presence of Medication-Therapy Problems. Conclusions should be drawn from the integration of medication-, disease-, laboratory test-, and patient-specific information. The patient’s database should be assessed for any of the following medication-therapy problems: Medications with no medical indication, Medical conditions for which there is no medication prescribed, Medications prescribed inappropriately for a particular medical condition, Inappropriate medication dose, dosage form, schedule, route of administration, or method of administration, Therapeutic duplication, Prescribing of medications to which the patient is allergic, Actual and potential adverse drug events, Actual and potential clinically significant drug–drug, drug–disease, drug–nutrient, and drug–laboratory test interactions, Interference with medical therapy by social or recreational drug use, Failure to receive the full benefit of prescribed medication therapy, Problems arising from the financial impact of medication therapy on the patient, Lack of understanding of the medication therapy by the patient, and Failure of the patient to adhere to the medication regimen. The relative importance of problems must be assessed on the basis of specific characteristics of the patient or the medication. Checklists, work sheets, and other methods may be used to determine and document the presence of medicationtherapy problems. The method should be proactive and should be used consistently from patient to patient. Summarizing Patients’ Health Care Needs. The patient’s overall needs and desired outcomes and other health professionals’ assessments, goals, and therapy plans should be considered in determining and documenting the medicationrelated elements of care that are needed to improve or prevent deterioration of the patient’s health or well-being. Specifying Pharmacotherapeutic Goals. Pharmacotherapeutic goals should reflect the integration of medication-, disease-, laboratory test-, and patient-specific information, as well as ethical and quality-of-life considerations. The goals should be realistic and consistent with goals specified by the patient and other members of the patient’s health care team. The therapy should be designed to achieve definite medication-related outcomes and improve the patient’s quality of life. Designing a Pharmacotherapeutic Regimen. The regimen should meet the pharmacotherapeutic goals established with the patient and reflect the integration of medication-, disease-, laboratory test-, and patient-specific information; ethical and quality-of-life considerations; and pharmacoeconomic principles. It should comply with the health system’s medication-use policies, such as clinical care plans and disease management plans. The regimen should be designed for optimal medication use within both the health system’s and the patient’s capabilities and financial resources. 168 Medication Therapy and Patient Care: Organization and Delivery of Services–Guidelines Designing a Monitoring Plan for the Pharmacotherapeutic Regimen. The monitoring plan should effectively evaluate achievement of the patient-specific pharmacotherapeutic goals and detect real and potential adverse effects. Measurable, observable parameters should be determined for each goal. Endpoints should be established for assessing whether the goal has been achieved. The needs of the patient, characteristics of the medication, needs of other health care team members, and policies and procedures of the health care setting will influence the monitoring plan. Developing a Pharmacotherapeutic Regimen and Corresponding Monitoring Plan. The regimen and plan developed in collaboration with the patient and other health professionals should be systematic and logical and should represent a consensus among the patient, prescriber, and pharmacist. The approach selected should be based on consideration of the type of practice setting, its policies and procedures, practice standards, and good professional relations with the prescriber and patient. The regimen and monitoring plan should be documented in the patient’s health record to ensure that all members of the health care team have this information. Initiating the Pharmacotherapeutic Regimen. Depending on the regimen and plan, the pharmacist could, as appropriate, implement all or portions of the pharmacotherapeutic regimen. Actions should comply with the health system’s policies and procedures (e.g., prescribing protocols) and correspond to the regimen and plan. Orders for medications, laboratory tests, and other interventions should be clear and concise. All actions should be documented in the patient’s health record. Monitoring the Effects of the Pharmacotherapeutic Regimen. Data collected according to the monitoring plan should be sufficient, reliable, and valid so that judgments can be made about the effects of the pharmacotherapeutic regimen. Changes in patient status, condition, medication therapy, or nonmedication therapy since the monitoring plan was developed should be considered. Missing or additional data should be identified. Achievement of the desired endpoints should be assessed for each parameter in the monitoring plan. A judgment should be made about whether the pharmacotherapeutic goals were met. Before the pharmacotherapeutic regimen is adjusted, the cause for failure to achieve any of the pharmacotherapeutic goals should be determined. Redesigning the Pharmacotherapeutic Regimen and Monitoring Plan. Decisions to change the regimen and plan should be based on the patient’s outcome. When clinical circumstances permit, one aspect of the regimen at a time should be changed and reassessed. Recommendations for pharmacotherapeutic changes should be documented in the same manner used to document the original recommendations. Pharmacist’s Responsibility An essential element of pharmaceutical care is that the pharmacist accepts responsibility for the patient’s pharmacotherapeutic outcomes. The same commitment that is applied to designing the pharmacotherapeutic regimen and monitoring plan for the patient should be applied to its implementation. The provision of pharmaceutical care requires monitoring the regimen’s effects, revising the regimen as the patient’s condition changes, documenting the results, and assuming responsibility for the pharmacotherapeutic effects. Principles Introduction The United States government, individual state governments, and private health care systems are moving toward reforming the way that they provide health care to their citizens or beneficiaries. As they do so, policy makers must improve their medication-use systems to address problems of access, quality, and cost of medicines and pharmaceutical care services. This document offers principles for achieving maximum value from the services of the nation’s pharmacists. Although pharmaceuticals and pharmaceutical care are among the most cost-effective methods of health care available, there is evidence that the public is not currently realizing the full potential benefit from these resources. Illnesses related to improper medication use are costing the health care systems in the United States billions of dollars per year in patient morbidity and mortality. Pharmacists are prepared and eager to help other health providers and patients prevent and resolve medication-related problems, and health care systems should facilitate and take advantage of pharmacists’ expertise. These principles are offered to guide health policy makers in their deliberations concerning the inclusion of medications and pharmacists’ services in health care systems. Principles Principle I. Health care systems must make medications available to patients and provide for pharmaceutical care, which encompasses pharmacists’ health care services and health promotional activities that ensure that medications are used safely, effectively, and efficiently for optimal patient outcomes. Principle II. Careful distinction must be made between policies that affect pharmacist reimbursement and policies that affect pharmacist compensation. Health care systems must reimburse pharmacists for the medications they provide patients (including the costs of drug products, the costs associated with dispensing, and related administrative costs). Health care systems also must compensate pharmacists for the services and care that they provide to patients, which result in improved medication use and which may not necessarily be associated with dispensing. Principle III. Patients differ in their needs for pharmaceutical care services. The method of compensating pharmacists for their services must recognize the value of the different levels and types of services that pharmacists provide to patients based on pharmacists’ professional assessments of patients’ needs. Principle IV. Pharmacists must be enabled and encouraged to use their professional expertise in making medicationrelated judgments in collaboration with patients and health care colleagues. Health care systems must not erect barriers to pharmacists’ exercising professional judgments; nor should health care systems prescribe specific services or therapies for defined types of patients. Principle V. Pharmacists should have access to relevant patient information to support their professional judgments and activities. Pharmacists should be encouraged and permitted to make additions to medical records for the purpose of adding their findings, conclusions, and recommendations. Pharmacists will respect the confidential nature of all patient information. Principle VI. Health care systems must be designed to enable, foster, and facilitate communication and collaboration among pharmacists and other care providers to ensure proper coordination of patients’ medication therapies. Principle VII. Quality assessment and assurance programs related to individual patient care should be implemented at local levels through collaborative efforts of health care practitioners rather than through centralized bureaucracies. Quality assessment and assurance procedures for medication use (such as pharmacy and therapeutics committees, formulary systems, drug-use evaluation programs, and patient outcomes analyses) are most effective when the professionals who care for covered patients are involved in the design and implementation of the procedures. Moreover, such programs must recognize local variations in epidemiology, demography, and practice standards. Information related to quality assessment and assurance activities must be held in confidence by all parties. Principle VIII. Demonstration projects and evaluation studies in the delivery of pharmaceutical care must be enabled, fostered, and implemented. New services, quality assessment and assurance techniques, and innovative medication delivery systems are needed to improve the access to and quality of medication therapy and pharmaceutical care while containing costs. Principle IX. Health care policies that are intended to influence practices of those associated with pharmacy, such as the pharmaceutical industry or prescribers, should address those audiences directly rather than through policies that affect reimbursement, compensation, or other activities of pharmacists. Patient-focused care is a term applied to a range of sitespecific multidisciplinary work designs ideally intended to improve patient care outcomes and patient satisfaction while also improving efficiency and reducing costs. Patient focused care has primarily been implemented in hospitals, although it could be applied in integrated health care systems and other settings as well. The term arose because of the perception that hospital functions have traditionally been “department-focused” in order to optimize the scheduling and efficiency of compartmentalized service units. This department focus often results in complex logistical processes, communication problems, delays in patient care, idle time for some employees, and numerous hospital employees interacting with the patient. Patient-focused care typically reorients functions, task assignments, and schedules to the needs of the patient through the use of various techniques, including (1) work redesign to eliminate unnecessary steps and documentation; (2) organizational restructuring, including significant decentralization of high-volume patient care services; (3) interdisciplinary patient care work teams; (4) cross-utilization of staff to carry out work previously done by specialists and to minimize the number of different staff members having unnecessary contact with a single patient; and (5) case management using multidisciplinary clinical care plans.1 These management tools (interdisciplinary patient care work teams and case management in particular) may also be implemented in specific work sites independent of any reference to patient-focused care. Some of these tools might also be used to facilitate positive change within a pharmacy independent of any organizationwide initiative. Patient-focused care evolved primarily from a consulting firm study, which concluded that a significant percentage of dollars was spent by hospitals to cover the logistics associated with scheduling direct patient care, documenting that the care was given, and paying for “structural idle time,” such as time spent by specialized department- based staff waiting for orders or requests for service.2 ASHP supports the concept of patient-focused care when it (1) is planned and implemented with pharmacists’ involvement; (2) fosters the provision of pharmaceutical care3; and (3) is motivated by a goal of improved patient care. Some patient-focused care arrangements, however, do not meet these criteria and have been perceived as detriments to the provision of pharmaceutical care. The effect of patient-focused care on pharmacy practice can vary substantially by site. From a broad perspective, the idealistic goals and approaches to patient-focused care can be quite compatible with pharmaceutical care and, in fact, may facilitate its implementation. The elimination of some time-consuming documentation, scheduling, and idle time and the decentralization of services to the patient care unit may help to overcome major obstacles to pharmaceutical care, including access to patients, access to patientspecific clinical information, and access to other health care professionals. Conversely, patient-focused care can be implemented with a less favorable effect on the pharmacy. Cost control and staff reduction are sometimes the primary intended outcomes of patient-focused care initiatives. In the negative extreme, organizations may be forced to undergo radical staff reduction, reorganization, and cross-training of staff to the point of misapplication of valuable professional talent and curtailment of important professional services. A central message of this ASHP Statement is that pharmacists should become involved early and assertively in all aspects of patient-focused care when it is initiated or contemplated for their work sites. In general, pharmacists who have established some success in the provision of pharmaceutical care before patient-focused care is begun seem more likely to be positioned well for full involvement and invitation into the planning of such projects. ASHP recommends that pharmacists review published literature on patient-focused care and that they consult with other pharmacists who have successfully adapted to patient-focused care and used it in furthering pharmaceutical care. Some general ideas regarding pharmacists’ participation in patient-focused care follow. 1. Patient-focused care should be designed and implemented in ways that enhance or expand the capacity of pharmacy staff members to provide pharmaceuticalcare.1 2. Patient-focused care should be designed and implemented in ways that foster the pharmacist’s adherence to established standards of professional practice, prevention of drug misadventures, and fulfillment of legal responsibilities.1 3. Pharmacy staff members assigned to patient care teams must be philosophically committed to the concept of interdisciplinary patient care and be prepared to contribute to the work of the teams.1 4. Pharmacists should be involved in the development of clinical care plans that involve medication use.1 5. The prevention, detection, and resolution of drugrelated problems should be a high-priority function of patient-care-team pharmacists.1 6. Pharmacy staff members assigned to a specific patient care team should be consistently available for that team so that the number of different staff members working on a specific team is minimized.1 7. Pharmacy managers should anticipate efforts to simplify the drug distribution process for most medication orders.1 Pharmacists should be open to experimentation with medication-use system changes. However, they have a professional obligation to consider the patient-safety implications of prospective changes. 8. In planning for patient-focused care, the role of pharmacy technicians in patient-focused care teams should be addressed. Different roles may be appropriate with respect to cross-training and cross-utilization of technicians with advanced credentials (e.g., certification or graduation from an accredited training program). 9. In patient-focused-care decision-making, special diligence should be exerted to consider the systemwide implications (especially patient safety implications) of decisions about products and procedures. 10. Pharmacy staff members, including pharmacy technicians, working on patient care teams may be asked to assume cross-functional roles.1 Requisite preparation and documented credentials should be obtained by staff members who are not trained, educated, or experienced in performing a particular task. Clear documentation of the roles and duties should exist in position descriptions and organizational policies and procedures. 11. If nonpharmacy personnel are used to perform tasks traditionally carried out by pharmacy personnel, this must be accomplished without compromising patient safety or violating laws or regulations. Appropriate oversight by pharmacists must be provided. 12. In some patient-focused care arrangements, the use of automated dispensing devices may be viewed as a justification for staff reduction and cost control. These devices have the potential for misuse if the system does not provide for an adequate review of the medication order by a pharmacist before the medication is administered to the patient. 13. In patient-focused care, charting by exception is sometimes proposed as a work simplification measure. This is an approach to patients’ medical records in which it is assumed that all ordered medications have been administered and that they have been administered according to medication orders unless a record to the contrary is made. The safety of such an arrangement is questionable. Substantial safeguards would have to be in place for it to be acceptable. Unless such safeguards can be devised, overt charting of all doses of medications administered is seen as a safer procedure. 14. Organizational re-engineering associated with patientfocused care can be applied to different levels in an organization. It may be applied, for example, primarily at the patient care level and result in the formation of multidisciplinary care teams of professionals and others in direct contact with patients. In some cases, it has been applied organizationwide. In some extraordinary cases, entire departments, departmental structures, and departmental directorships have been abolished. When pharmacists have input into such decisions, they are encouraged to consider carefully which pharmacy functions may be better (including more safely) accomplished centrally or on a decentralized basis. 15. Consultants experienced in implementing patientfocused care may present data and experiences from one contract site as an indication of what can be achieved in a subsequent contract site. This may be useful information, but pharmacists are encouraged to carefully analyze the accuracy and applicability of the information in their own sites. Pharmacists should make every effort to educate consultants on the pharmaceutical care role of the pharmacist in health systems. SILABUS MATA KULIAH FAR 461 Farmasi Klinik & Komunitas Prasyarat : Farmakoterapi Mata kuliah ini mempelajari mengenai sejarah dan perkembangan farmasi klinik, Kegiatan kegiatan farmasi klinik meliputi: wawancara riwayat pengobatan, physical examination, interprestasi data lab, pemantauan terapi, pilihan terapi pada berbagai kondisi khusus, rekomendasi farmasi, teknik intervensi farmasi dengan contoh-contoh kasus dan solusinya serta peran farmasi dalam terapi sederhana menggunakan obat sesuai kewenangan farmasi pada kasus penyakit tertentu Buku Pegangan 8) Wiffen, P, et all, Oxford Handbook of Clinical Pharmacy, 1 th edition,University Press, UK, 2007 9) Barber N (ed),Clinical Pharmacy, 2 th edition, Churcill Livingstone, UK, 2007 10) Rutter, P, Community Pharmacy, 1 th edition, Churcill Livingstone, UK, 2005 11) AHFS Drugs Informations 2008 12) BNF, 56 editions, 2008 13) USPDI, Drugs Information for health care proffesionals, in Harisson Principles of Internal Medicines, 15 th edition CD-ROM, Micromedex, ( www. Harissononline.com) 14) Dipiro, JT, et all, Pharmacotherapy : a pathophisiologic approach, 7 th ed,McGrawHill Company, USA 2008 FARMASI KLINIK Contoh Saol dan jawaban : Soal : 1. Pak Ali adalah seorang pasien, usia 50 tahun dengan keluhan serta riwayat asma yang disertai demam dan batuk dan dirawat di SMF Paru RSUD Dr. Achmad Mochtar Bukittinggi. Pada pemeriksaan fisik didapatkan data BB 50 kg, tinggi 165 cm, T,39 derjat C, TD, 130/85, Nadi 86, Leukosit 12.000, BTA Positif, Foto thorax menunjukkan positif KP ( kelainan paru ). Dokter memberikan obat Rifampisin 450 mg 1 x 1, Inoxin 400 ( INH 400 mg + vit B6 10 mg), Efedrin 25 mg 2 x 1, aminophilin 200mg 2 x 1, ambroxol 30 mg 3 x 1, parasetamol 500 mg 3 x 1. Beri pendapat anda sebagai ahli farmasi pada penanganan pasien tersebut. 2. Ibu Ani, penderita kanker payudara yang telah dilakukan operasi namun dokter tetap ,masih ragu terhadap hasil operasi tersebut, sehingga diberikan ajuvant khemoterapi dengan 8 seri Siklofosfamid 800 mg/ m2 dan Doksorubisin 30 mg/ m2 dengan jarak seri 2 minggu. Pada pemberian seri pertama sebelum diberikan sitostatika ini diberikan profilaksis anti muntah dengan primperan injeksi 10 mg, namun setelah diberikan sitostaika kepada pasien ini, dalam dua jam berikutnya pasien mual dan muntah”. Dokter meminta konsul farmasi, apa yang akan saudara rekomendasikan? Jawab: 1. Gunakan alur berpikir seorang klinikal farmasi, akan ditemukan pilihan obat yang tidak tepat pada keadaan TB dan asma, Obat TB tidak sesuai standar yang direkomendasikan WHO maka rekomendasikanlah sesuai standar tersebut, efedrin juga bukan first of choice pada kasus ini 2. Rekomendasikan 5HT3 + Dexamethasone + Aprepitant
