Kajian Medication Error kasus Stroke di RS PKU Muhammadiyah Surakarta tahun 2004

MUTMAINAH, Nurul, Dr. Imono Argo Donatus, SU.,Apt

2005 | Tesis | S2 Ilmu Farmasi (Farmasi Klinik)

Kejadian medication error sering terjadi di rumah sakit, dengan angka kejadian cukup bervariasi, berkisar antara 3-6,9% untuk pasien rawat inap. Tingginya angka kematian akibat stroke di RS PKU Muhammadiyah Surakarta mendorong dilakukannya penelitian ini. Penelitian ini bertujuan untuk mengkaji adanya kejadian medication error pada terapi stroke di RS PKU Muhammadiyah Surakarta selama Januari-Oktober 2004 pada dua periode pengamatan. Dilakukan penelitian non-eksperimental dengan rancangan penelitian deskriptif evaluatif. Subjek penelitian adalah pasien stroke yang menjalani rawat inap di RS PKU Muhammadiyah Surakarta periode Januari- Juli 2004 (studi retrospektif) dan pasien stroke yang menjalani rawat inap di RS PKU Muhammadiyah Surakarta periode September-Oktober 2004 (studi prospektif). Dari data yang diperoleh dilakukan kajian penggunaan obat dan outcome pasien yang memberi petunjuk telah terjadinya medication error; dilakukan kajian penggunaan obat meliputi ketepatan terapi dengan indikasi, pedoman (guideline) yang berlaku, dan evidence based medicine, ketepatan dosis, cara, dan frekuensi pemberian; dilakukan kajian mengenai penggunaan obat dan perkembangan kondisi pasien dilihat dari tanda-tanda vital dan keluhan pasien, pemeriksaan laboratorium, dan pemeriksaan penunjang yang memberi petunjuk telah terjadinya efek samping obat maupun interaksi obat. Pada studi retrospektif ditemukan adanya kejadian medication error dengan tipe prescribing error (26,09%), wrong administration technique (68,12%) dan monitoring error (5,9%). Prescribing error yang terjadi meliputi penulisan obat dengan dosis yang lebih besar (4,35%), dosis yang lebih kecil (1,45%), kesalahan penulisan aturan pakai (1,45%), kesalahan penulisan nama obat (1,45%), kesalahan penulisan bentuk sediaan (1,45%), dan adanya interaksi obat (15,94%). Penggunaan antibiotik yang kurang tepat ditemukan sebesar 92,31%, penanganan hiperglikemi pada stroke yang kurang tepat sebesar 45,45%, dan tidak ada data yang menunjukkan telah terjadi efek samping obat. Pada studi retrospektif tidak diperoleh data untuk mengungkap terjadinya medication error tipe improper dose error, wrong dosage-form error, wrong drug-preparation error, deteriorated drug error, dan compliance error. Dari studi prospektif ditemukan kejadian medication error dengan tipe prescribing error (25%) dan wrong administration technique (75%); penggunaan antibiotik yang kurang tepat sebesar 78,6 %, penanganan hiperglikemi pada stroke yang kurang tepat sebesar 12,5 %; dan kejadian efek samping obat sebesar 1,92%. Dari penelitian ini dapat disimpulkan bahwa dari 52 pasien stroke pada bulan Januari-Juli 2004 ditemukan 49 pasien (94,23%) mengalami kejadian medication error, sedangkan dari 18 pasien stroke pada bulan September-Oktober 2004 ditemukan 16 pasien (88,89%) mengalami kejadian medication error.

The medication error often happen at hospitals, with incidence enough vary between 3-6,9% in patient hospitalized. Mortality height of stroke at The Hospital of PKU Muhammadiyah Surakarta conducting of this study.This study is aimed to study the event of the medication error case towards the stroke therapy during the period of January – October 2004 on the two observation periods. The non-experimental study was done by applying the evaluative descriptive design. Subject of the study was the stroke patients who were hospitalized during the period of January-July 2004 at The Hospital of PKU Muhammadiyah Surakarta (retrospective study) and the stroke patients who were hospitalized during the period of September-October 2004 (prospective study). From the data taken, the study of drug usage and the patients’ outcome were done to give a clue that there would have happened the medication error; the study of drug usage was done by covering the accurate therapy with the indication, the performed guidelines, evidence based medicine, the dose accuracy, administration route and frequency given; the study of drug usage and the improvement of the patients’ condition were also done by having the laboratory examination, the supporting examination, the vital signs, and the patients’ complaints which indicated that there was a side effect of drug or drug interaction. From the retrospective study had found medication error with type prescribing error (26,09%), wrong administration technique (68,12%) and monitoring error (5,9%). The prescribing error that happened including the prescribing drug with the higher dosage (4,35%), the lower dosage (1,45%), the wrong prescribing in direction for use (1,45%), the wrong prescribing name of drug (1,45%), the wrong prescribing dosage form (1,45%), and the drug interaction (15,94%). The inappropriate use of the antibiotic was found 92,31%, the inappropriate hyperglycaemia handling toward the stroke was 45,45%, and there was not any data to show that there had been side effect found. There was not any data taken from the retrospective study to find out the medication error with types of improper dose error, the wrong dosage form, the drug-preparation error, the deteriorated drug error and the compliance error. From prospective study had found medication error with type prescribing error (25%), and wrong administration technique (75%); the inappropriate antibiotic use was 78,6%, the hyperglycaemia handling toward the stroke 12,5%, and the side effect of drug 1,92%. From this study it was concluded that from the 52 stroke patients during the period of January- July 2004, it was found 49 pasien (94,23%) experiencing medication error. While from 18 patients during the period of September-October 2004 found 16 pasien (88,89%) experiencing medication error .

Kata Kunci : Farmakologi Klinik,Medication Error,Stroke, stroke; medication error