Kajian drug related problems pada penatalaksanaan pasien hemodialisis di RSAL Dr. Ramelan Surabaya

IRAWATY, Yenny, Dra. Widyati, M.Clin.Pharm., Apt

2009 | Tesis | S2 Magister Farmasi Klinik

Latar Belakang: Hemodialisis merupakan salah satu alternatif terapi pasien gagal ginjal terminal. Terapi yang diberikan pada pasien hemodialisis mempunyai risiko timbulnya masalah terkait obat, sehingga diperlukan kerjasama dokter, perawat, apoteker, pasien, dan keluarga pasien untuk mencapai therapeutic outcome yang baik. Tujuan: Penelitian ini bertujuan untuk mengetahui apakah terjadi DRPs pada penatalaksanaan pasien hemodialisis, mengetahui kelompok obat yang menyebabkan DRPs, mengetahui outcome klinis pasien yang mengalami DRPs, dan mengetahui hubungan antara jumlah obat yang dikonsumsi pasien dengan jumlah kejadian DRPs. Metode: Penelitian dilakukan dengan rancangan studi cross-sectional yang dikerjakan secara prospektif terhadap suatu populasi terbatas, yaitu seluruh pasien hemodialisis rawat jalan di RSAL Dr. Ramelan Surabaya periode 10 September- 10 Desember 2008. Data pasien hemodialisis rawat jalan didapat dari rekam medik di unit hemodialisis. Kekurangan rekam medik dilengkapi dengan melihat catatan perawat, melihat kondisi pasien langsung dengan mengikuti visite dokter, dan wawancara pasien atau keluarga pasien. Data yang diperoleh dilakukan kajian DRPs dengan acuan guidelines NKF-KDOQI yang ada, dihitung persentasenya. Hasil Penelitian dan Kesimpulan: Lima puluh dua pasien hemodialisis rawat jalan, 47 pasien (90,38%) mengalami DRPs. Jenis DRPs yang terjadi adalah failure to receive drug (32,20%), diikuti subdose drug (20,34%),adverse drug reaction (14,41%), improper drug selection (13,56%), drug interaction (8,47%), untreated indications (5,93%), overdose drug (3,39%), dan drug without indications (1,70%). Kelompok obat terbanyak penyebab DRPs adalah eritropoietin (38,98%), antihipertensi (38,98%). Outcome klinis pasien yang mengalami DRPs adalah risiko penyakit kronis (53,39%), tidak terjadi apa-apa (21,19%), dan kegagalan terapi (13,56%). Terdapat hubungan yang signifikan sedang antara jumlah obat yang dikonsumsi pasien dengan jumlah kejadian DRPs.

Background: Hemodialysis is an alternative choice of therapy for end-stage renal disease patient. Drug Therapy in patients with hemodialysis are at risk to experience many drug-related problems, so the good cooperation among physicians, nurses, pharmacists, patient, and patient’s family is needed to get better therapeutic outcome. Aimed: The study aimed to identify the occurence of DRPs among hemodialysis patients, to identify the most frequent drug classes involved, to identify the clinical outcome in patient who have DRPs, and to know the relationships between the number of drug taken by patient and the number of DRP occurence. Method: The study used an analytical cross-sectional design conducted prospectively to limited population, i.e. all outpatient hemodialysis at dr. Ramelan navy hospital Surabaya from 10th September until 10th Desember 2008. Data were records from medical record in hemodialysis unit. Incomplete medical record were minimized by looking at nurse’s note, the condition of the patient by following doctor’s visits, interview with the patient and patient’s family. Data obtain were studied on DRPs using NKF-KDOQI guidelines, and calculated their percentage. Result and Conclusion: 52 outpatients hemodialysis,47 patients had drug related problems (90,38%). Type of DRPs were failure to receive drug (32,20%), diikuti subdose drug (20,34%),adverse drug reaction (14,41%), improper drug selection (13,56%), drug interaction (8,47%), untreated indications (5,93%), overdose drug (3,39%), dan drug without indications (1,70%). The most frequent drug class involved was erythropoietin (38,98%) and antihipertensive (38,98%). Clinical Outcome patient who have DRPs include chronic disease risk (53,39%), no effect (21,19%), and therapy failed (13,56%). A moderate significant correlation between number of drug taken by patient and the number of DRPs occurence was identified (α <,05).

Kata Kunci : Hemodialisis,Drug related problems,hemodialysis, drug related problems.