Evaluasi sistem peresepan Online di Bangsal rawat inap RSU Muhammadiyah Purworejo

HIDAYAH, Ulfah, Prof.dr. Hari Kusnanto, DrPH

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat (Manaj. Rumah Sakit)

Volume pelayanan yang besar terutama pada jam–jam sibuk (12.00-14.00) menyebabkan keterlambatan pelayanan dan terjadinya resiko kesalahan pembacaan resep, terutama akibat tulisan dokter yang tidak jelas, tidak lengkap dan kesalahan penulisan resep, hal tersebut dikhawatirkan menyebabkan terjadinya medication error, serta ketidak sesuaian resep dokter terhadap formularium dan kecepatan dispensing obat yang masih rendah akan berakibat pada kualitas pelayanan obat. Diharapkan dengan sistem peresepan online/komputerisasi penulisan resep dari bangsal rawat inap langsung terkirim ke Instalasi Farmasi, akan bisa mengatasi masalah-masalah tersebut diatas. Meningkatkan akurasi penulisan resep dokter, meningkatkan kesesuaian resep dokter terhadap formularium, mempercepat waktu pelayanan obat, mengamati penerimaan dan kesiapan petugas terhadap teknologi informasi. Penelitian ini menggunakan rancangan kuasi eksperimen untuk membandingkan pre test–post test design tanpa kontrol. Yaitu pada penelitian untuk membandingkan akurasi resep dokter, kesesuaian resep dokter terhadap formularium dan kecepatan waktu pelayanan obat. Untuk mengetahui persepsi petugas terhadap kegunaan dan kemudahan sistem peresepan online, akan dilakukan survey dengan pengambilan data secara cross sectional. Penelitian sebelum peresepan online didapat hasil dari 256 sampel resep, akurat 233 (90,80%), tidak akurat 23 (9,20%), yang sesuai formularium 244 (95,40%), tidak sesuai formularium 12 (4,60%), waktu I=8,2 menit, waktu II= 5,6 menit. Sesudah peresepan online didapat hasil dari 256 sampel resep, akurat 256(100%), tidak akurat 0 (0%), yang sesuai formularium 251 (98,10%), tidak sesuai formularium 5 (1,90%), waktu I= 4,8 menit, waktu II= 4,10 menit. Dari hasil penelitian dengan membandingkan sebelum peresepan online dan sesudah peresepan online hasilnya semua signifikan, artinya tulisan resep menjadi akurat, kesesuaian resep terhadap formularium meningkat, waktu dispensing obat menjadi cepat. Untuk persepsi petugas terhadap peresepan online didapat hasil yang signifikan, yaitu variabel persepsi kemudahan penggunaan dan kegunaan memiliki kontribusi terhadap kepuasan sebesar 51,8%, sedang petugas apotek mempunyai persepsi kemudahan penggunaan lebih tinggi (beda mean) 0,4403 dan persepsi kegunaan lebih tinggi (beda mean) 0,5949 dibandingkan dengan petugas bangsal. Dengan sistem peresepan online terbukti tulisan mudah dibaca, kesesuaian resep terhadap formularium tinggi, dispensing obat lebih cepat serta beban kerja petugas lebih ringan terutama petugas apotek. Kedepan agar sistem ditingkatkan menjadi sistem peresepan elektronik, yaitu peresepan komputerisasi yang dikembangkan dengan penambahan data pendukung dasar seperti alergi, interaksi obat, data dari hasil laborat atau hasil pemeriksaan lain dan analisis sistem informasi untuk membuat peringatan, serta untuk kedepannya bisa berintegrasi dengan rekam medis elektronik secara lengkap.

Background: Illegible prescriptions of doctors may cause their reader to assume, make a guess and force himself/herself to read which can bring high risk for errors. A preliminary study at PKU Muhammadiyah Hospital of Purworejo indicates there is as much as 9.3% of illegible and incorrect prescription within a month (24R) so that near miss frequently occurs and service gets longer. There is also as much as 6.6% drugs beyond the formulary (17R) and waiting time for 20 minutes. Online computerized prescription system which directly sends prescription from inpatient ward to pharmacy installation is expected to solve the problem. Objective: To assess accuracy of prescription writing, relevance of prescription with formulary, time needed for drug dispensing and acceptance and preparedness of staff with information hospital technology. Method: This was a quasi experiment with pre test-post test without control design to compare accuracy of prescription, compliant of prescription to formulary and time needed for drug dispensing. The study also used a survey approach with cross sectional data to identify perception of staff about the benefit and ease of online prescription system. Result and Discussion: Before online prescription system was implemented, out of 256 prescription samples as many as 233 (90.80%) were accurate and 23 (9.20%) were inaccurate; as many as 244 (95.40%) were compliant to formulary and 12 (4.60%) were not available in the formulary ; time needed was I=8.2 minutes and II=5.6 minutes. After online prescription system was implemented, out of 256 prescription samples as many as 256 (100%) were accurate, as many as 251 (98.10%) were compliant to formulary and 5 (1.90%) were not available in the formulary ; time needed was I=4.8 minutes and II=4.10 minutes. The result of comparison before and after the implementation of online prescription system showed that all points were significant, i.e. prescription was accurate, compliant with formulary increased, drug dispensing was faster. The result of survey on staff was also significant; perception about ease of use and benefit contributed as much as 51.8% to satisfaction, meanwhile staff at pharmacy department had higher perception of ease of use as much as 0.4403 (mean difference) and benefit as much as 0.5949 (mean difference) than staff at the inpatient ward. Conclusion and Suggestion: Online prescription system facilitates prescription reading, compliant of prescription with formulary and faster drug dispensing possible and workload of staff particularly pharmacy staff become less. In the future the system should be developed to electronic prescription system; i.e. computerized prescription with additional supporting data such as allergy, drug interaction, laboratory examination result or other examination results as well information system analysis to give notification and in the long run the system could be integrated with electronic medical records comprehensively.

Kata Kunci : Sistem Informasi Manajemen Rumah Sakit, Instalasi Farmasi, Sistem Peresepan, online prescription, prescription accuracy, drug formulary, drug dispensing, perception