CLINICAL PHARMACY

Hansen N, S.Si., Apt., Sp.FRS

Its not the strongest species that survives, nor the most intelligent, but the ones most responsive to change (Charles Darwin)

Clinical Pharmacy

Gaps

Trends

Future Needs

UCSF Story

Clinical Pharmacy Philosophy

Pharmacists are the most highly trained experts on drugs and drug products Best professional to:

Promote rational drug prescribing Teach patients to use drugs appropriately Identify and prevent medication problems
Silverman, M and Lee, PR: Pills, Profits, and Politics UC Press 1975

Clinical Pharmacy

Gaps

Trends

Future Needs

UCSFs Story

Model Works Well in Hospitals

Dr. Donald Brodie, 1965 :

The ultimate goal of the Services of Pharmacy must be the SAFE USE of DRUGS by the Public

Historical Milestones in the Clinical Pharmacy Movement

1944- Clinical Pharmacy as an educational tool first used
University of Washington, Prof. L. Wait Rising Disapproved by AACP and ACPE in 1946

1969- the term Clinical Pharmacy comes to be used to denote patient-oriented pharmacy practice

Decentralized Pharmacy Services:

The Satellite Pharmacy Concept
Brought pharmacist into the patient care environment Health care professionals could put a face to a name Pharmacist was easily accessible to assist with drug-related problems

Decentralized Pharmacies:
made it possible for the physician, if he so wishes, to discuss drug usage with the pharmacists at the time the decision is being made
and

provided students with adequate experience in applying scientific and professional knowledge gained in the classroom to the practical aspects of drug usage in therapeutic situations
Day, RL, et al. DICP 1991;25:308-314

What is a Clinical Pharmacist?

1981- All pharmacists are clinical pharmacists (ASHP) 1981-American College of Clinical Pharmacy counters with a pharmacists duties define whether he is a clinical pharmacist

Clinical Pharmacy (in the early years):

is a concept or a philosophy emphasized the safe and appropriate use of drugs in patients focused on patient and not product placed responsibility for drugs therapy on all health disciplines who are in any way concerned with drugs

Clinical Pharmacists Functions in the Drug Use Process

Medication history taking Drug therapy advisor Drug therapy monitoring Patient drug counseling Drug usage review Drug therapy management
McLeod, DC, Am J Hosp Pharm 1976;33:904-911

Clinical Pharmacy

Gaps

Trends

Future Needs

UCSFs Story

Model Works Well in Hospitals

Therapeutic advisors Patient education Drug use review and policy Formulary work Medication safety

Hospital practice admission

Pharmacists attend pre-admission clinics for planned admissions
Assess patients needs for medicines to be prescribed during their stay, write their prescriptions, provide any advice on what should be stopped before surgery

For unplanned admissions, pharmacists take medication history, may write prescription Some pharmacists have trained to
prescribe

Dispensing in hospital
Doctor Clinical Pharmacist electronic prescription Patient

Pharmacy technician

Dispensary Robot dispensed drug

Only large teaching hospitals

frequency depends on type of ward and correct any errors by discussion with prescribers Pharmacists provide advice to prescribers as required Some pharmacists select drugs and doses for patients and write prescriptions to prescribe Some nurses have trained Pharmacists monitor quality of prescribing

Hospital practice during hospitalregularly stay Pharmacists check prescriptions

Hospital practice - discharge

Pharmacists check discharge prescription to make sure it is correct and all items are clinically indicated, may write discharge prescription Pharmacists assess patients ability to administer their own medicines and provide advice to patients prior to discharge Hospital pharmacists discuss patients with community pharmacists before discharge if required

Primary care practice

Pharmacists are based within medical practices (like PCU) most are part-time Pharmacist may provide services directly to patients and prescribe for them
Warfarin management (INR testing) doctors and nurse COPD clinics (spirometry) prescribers Medication reviews

Pharmacists advise other prescribers Primary care pharmacists discuss patients with hospital pharmacists if required

Community pharmacy
Pharmacists must provide advice with all prescriptions and purchased medicines Pharmacists all keep patient medication records Many pharmacists provide medication reviews need to complete training Some also trained as prescribers, provide specialist clinics Some provide screening for diabetes, hypertension, osteoporosis

Kurikulum S1 farmasi inggris

Definisi Pharmaceutical care menurut Federation International Pharmaceutical

Ph care is the responsible provision of pharmaco-therapy for the purpose of achieve definite outcomes that improve or maintain a patients quality of life. It is a collaborative process that aims to prevent or identify and solve medicinal product and health related problems. This is a continous quality improvement process for the use of medicinal products.

Pharmaceutical Care ?
Hepler and Strand (1990) from: Am. J Hosp Pharmacy 47,533-543 Is the direct responsible provision of medication related care for the purpose of achieving definit outcomes that improve patients quality of life

Outcomes: kesembuhan (cure of disease) pengurangan gejala penyakit (elimination or reduction of patients symptoms) perlambatan proses terjadinya penyakit (arresting or slowing of a disease process) pencegahan penyakit atau gejala penyakit (preventing a disease or symptoms)

Clinical Pharmacy Services

2. EDUCATION
TALKS TO DOCTORS AND NURSES

HUKM Pharmacy Counseling Week

Selama peresepan
Konseling
Pharmacist

Patient

Karakteristik praktek farmasi klinik

Berorientasi kepada pasien Terlibat langsung di ruang perawatan di rumah sakit (bangsal) Bersifat pasif, dg melakukan intervensi setelah pengobatan dimulai atau memberikan informasi kalau diperlukan Bersifat aktif, dg memberi masukan kpd dokter sebelum pengobatan dimulai atau menerbitkan buletin2 informasi obat atau pengobatan Bertanggungjawab terhadap setiap saran atau tindakan yang dilakukan Menjadi mitra dan pendamping dokter

Kendala
Kurangnya pengetahuan teknis Kurangnya kemampuan berkomunikasi Tekanan kelompok kerja/ketidaknyamanan kerja Kurangnya motivasi dan keinginan untuk berubah Kurang percaya diri Kurang pelatihan dalam arus kerja yg sesuai Peningkatan persepsi tentang tanggung jawab Kurangnya staf di Instalasi Farmasi

Bagaimana di Indonesia ??
Kegiatan manajerial merupakan kegiatan utama merupakan sumber pemasukan uang terbesar di RS Kegiatan klinik masih relatif sangat sedikit dilakukan banyak kendala (apa ?) Farmasis belum banyak dilibatkan dalam tim kesehatan tidak dianggap sebagai tenaga kesehatan, tapi lebih sebagai penunjang medis

 Faktor sejarah : farmasi termasuk ilmu MIPA padahal farmasi adalah profesi pelayanan kesehatan Farmasis kurang kompeten mengapa ? (dulu) Pendidikan farmasi tidak fokus farmasis ada di manamana, tapi tidak terasa adanya Farmasis belum bisa menunjukkan kemampuannya di bidang klinis, tidak percaya diri, dan kurang bisa menjalin kerjasama dgn tenaga kesehatan lain Kebijakan direktur RS tidak mendukung : Jumlah farmasis terbatas, disibukkan dengan kegiatan manajerial Belum ada reward yang sepadan dengan pekerjaan But dont worry kebijakan yang diusulkan Bina Farmasi Klinik dan Komunitas Depkes : 1 farmasis untuk 30 bed

KEP. MENKES 1197 TH. 2004

PELAYANAN FARMASI RUMAH SAKIT BERORIENTASI PADA :
PELAYANAN PASIEN PELAYANAN FARMASI KLINIK