Penerapan medication safety practices melalui pelaporan drug related problems (DRPs) di Rumah Sakit Bethesda Yogyakarta

DEWI, Luh Komang Mela, Prof. Dr. Iwan Dwiprahasto, M.Med.Sc., Ph.D

2010 | Tesis | S2 Ilmu Farmasi

Identifikasi masalah obat serta tindak lanjut berupa tindakan koreksi,penanganan dan pencegahan terulangnya masalah merupakan serangkaian tindakan untuk menjamin keamanan penggunaan suatu obat. Sistem pelaporan insiden medication errors (MEs) serta pemberian rekomendasi oleh apoteker kepada dokter merupakan penerapan medication safety practices dalam sistem pelayanan kesehatan.Penelitian ini merupakan penelitian quasi experimental dengan rancangan Posttest Only Design with Nonequivalent Control Group. Penelitian dilakukan selama satu bulan di dua ruang rawat inap bedah Rumah Sakit Bethesda Yogyakarta. Apoteker klinik melakukan identifikasi, koreksi, serta pelaporan insiden MEs di kedua ruang rawat inap. Masalah obat yang secara aktual maupun potensial mempengaruhi outcome farmakoterapi pasien dikategorikan sebagai Drug Related Problems (DRPs) dan diselesaikan melalui kerja sama dengan tenaga kesehatan lain.Apoteker klinik mengidentifikasi 283 masalah obat di Ruang I dan 39 masalah obat di Ruang II. Sebanyak 47% dan 25,6% masalah obat di Ruang I dan Ruang II merupakan insiden MEs, sedangkan 53% dan 74,4% merupakan DRPs.Seluruh insiden MEs di Ruang II dan 13,5% insiden MEs di Ruang I dilaporkan pada sistem pelaporan IFRS. Sembilan belas DRPs di Ruang I dan 13 DRPs di Ruang II diselesaikan melalui komunikasi dan pemberian rekomendasi kepada dokter. Metode pemberian rekomendasi tertulis menunjukkan acceptance rate sebesar 26,3%, sedangkan acceptance rate untuk metode pemberian rekomendasi verbal adalah 84,6% (p=0,02). Seluruh DRPs dapat diselesaikan dengan pemberian rekomendasi verbal, sedangkan DRPs yang dapat diselesaikan dengan rekomendasi tertulis adalah sebesar 33,3%.

Identification of problems caused by the use of drugs, followed by corrective actions, treatment, and prevention are essential to ensure safety. Implementation of medication error reporting systems as well as providing recommendations by pharmacists are strategies to improve medication safety practices in the health care system. This study is a quasi experimental study with Posttest Only Design with Nonequivalent Control Group. The study was conducted during one month period in two surgical wards in Yogyakarta Bethesda Hospital. Clinical pharmacist did the identification, corrective actions, as well as reporting of the medication errors incidences (MEs) in both wards. Drug problems which actually and potentially affect the patient’s outcome categorized as Drug Related problems (DRPs) and were resolved through collaboration with other health professionals.A total of 283 drug problems at Ward I and 39 drug problems at Ward II were identified by clinical pharmacists; 47% of those at Ward I and 25,6% of those at Ward II were considered as MEs. All of ME incidents identified at Ward II and 13,5 of those at Ward II were reported through pharmacy’s reporting system. Clinical pharmacist categorized 53% problems identified at Ward I and 74,4% of those at Ward II as DRPs. Nineteen DRPs in Ward I and 13 of those at Ward II were resolved through communication and delivering recommendations to physicians. A total of 26,3% of written recommendations were accepted compared with 84,6% of verbal recommendations (p = 0,02). All of the DRPs resolved and completed by verbal communication, whereas only 33,3% of those resolved by the use of written communication.

Kata Kunci : Medication afety practices,Medication errors,Drug related problems,Pelaporan,Rekomendasi