KEJADIAN PRESCRIBING ERROR DI INSTALASI FARMASI RSUD LIWA LAMPUNG BARAT

Wiwit Yuli Nana Sari, Dr. Dra. Erna Kristin, M.Si, Apt;

2011 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Masalah medical error dalam beberapa tahun terakhir ini. Berdasarkan Laporan PERSI, 2007, kesalahan pemberian obat menduduki peringkat pertama (24.8%) dari 10 besar insiden yang dilaporkan. Kejadian prescribing, transcribing, dispensing dan administering, proses dispensing menduduki peringkat pertama dalam medication error. Institute of Medicine (IOM) menyebutkan insiden yang berhubungan dengan pengobatan menempati urutan pertama penyebab adverse event yang dialami pasien. RSUD Liwa pelayanan bidang farmasi sudah berjalan akan tetapi belum maksimal, dengan banyaknya komplain dari pelanggan internal (dokter) maupun pelanggan eksternal (pasien). Yang sangat berpengaruh terhadap kemungkinan-kemungkinan adanya terjadinya medication error di unit farmasi. Tujuan : Mengukur dan mengidentifikasi jenis kejadian prescribing error (too low dose, too high dose, interaksi obat, antibiotik kombinasi dan proporsi resep yang tidak terbaca) di Instalasi Farmasi RSUD Liwa. Metode: Penelitian ini merupakan penelitian deskriptif observasional dengan rancangan cross sectional melalui penelusuran data (resep) secara retrospektif (Januari-Juni 2010) terhadap resep yang dilayani Instalasi Farmasi RSUD Liwa Lampung Barat yang berasal dari resep rawat jalan dan rawat inap. Analisis data menggunakan distribusi frekuensi berdasarkan prescribing error (too low dose, too high dose, interaksi obat, antibiotik kombinasi dan proporsi resep yang tidak terbaca). Hasil: Ditemukan wrong dose 52 resep, proporsi di instalasi rawat inap too low dose 13 resep (2.7%) dan too high dose 39 resep (8.1%). Instalasi rawat jalan 2 resep (0.51%) too low dose dan 63 resep (16%) too high dose. Interaksi obat ditemukan di instalasi rawat jalan sebanyak 380 kali (31.9%) proporsi interaksi minor 248 kali (65.3%), moderate 101 kali (26.6%) dan mayor 31 kali (8.1%). Di instalasi rawat inap ditemukan 808 kali interaksi (68.1%) proporsi interaksi minor 437 kali (54.1%), moderate 283 kali (35%) dan mayor 88 kali (10.9%) dengan item obat terbesar KSR vs Spironolacton 22 kali (35.5%). Antibiotika kombinasi ditemukan 58 resep. Proporsi di intalasi rawat jalan sebanyak 44 resep (75.9%) dan instalasi rawat inap 14 resep (24.1%) dengan item antibiotik yang paling banyak terjadi kombinasi Co amoxiclav vs Metronidazole. Pada penelitian ini tidak ditemukan adanya prescribing error dengan indikator resep yang tidak terbaca. Diharapkan penelitian ini dapat mencegah dan mengurangi terjadinya medical error, dan memberikan sumbangan terhadap standar pengobatan, peningkatan medication safety di RSUD Liwa.

Background: Medical error problem in recent few years based on 2007 PERSI Report, prescribing error ranked in first position (24.8%) from 10 reported major incident. In the event of prescribing, transcribing, dispensing and administering, proses dispensing ranked in first position in medication error. Institute of Medicine (IOM) cited that, incident which correlated to medication ranked on first position that caused adverse event experienced by the patient. The pharmacy service of LIwa Regional General Hospital had been being implemented but not optimal yet, with many complaint from internal customer (physician) and external customer (patient) which had severe influenced to the possibility of medical error event in pharmacy unit. Objective : To measured and identified the sort of prescribing error event (too low dose, too high dose, drug interaction, antibiotic combination and the proportion of unreaded prescribing) in pharmacy unit of Liwa Regional General Hospital. Metode: The research was observational descriptive research with cross sectional design by data tracking (prescribing) retrospectively (January-June 2010) to the prescribing which get service by Pharmacy Unit of LIwa Regional General Hospital, West Lampung, which origin from outpatient and inpatient prescribing. Data analysis was done by frequency distribution based on prescribing error (too low dose, too high dose, drug interaction, antibiotic combination and the proportion of unreaded prescription). Result: It was founded, there was wrong dose 52 prescription, the proportion of too low dose in inpatient installation was 13 prescription (2.7%) and too high dose was 39 prescription (8.1%), in inpatient installation was 2 prescription (0.51%), too low dose was and too high dose was 63 prescription (16%). The drug interaction was founded in outpatient installation at 380 event (31,9%), proportion of minor interaction at 248 event (65,3%), moderate at 101 event (31,9%), proportion of mayor 31 event (8,1%). In inpatient installation it was founded 808 interaction event (68.1%), proportion of minor interaction was 437 event (54.1%), moderate was 283 event (35%) and mayor was 88 event (10.9%), with greatest drug item were potassium chloride versus Spironolacton was 22 event (35.5%). Antibiotic combination was founded 58 prescription. The proportion in outpatient installation was 44 prescription (75.9%) and in inpatient installation was 14 prescription (24.1%) with antibiotic item, most frequent occurs in combination of Co amoxiclav vs Metronidazole. In the research, there was founded no prescribing error with indicator of unreaded prescription. Its expected that the research could prevent and reduce the event of medical error, and provide contribution to prescription standard, medication safety enhancement in Liwa Regional General Hospital.

Kata Kunci : Prescribing Error, Deskriptif observasi, RSUD Liwa