endang yuniarti medication distribution systems(1)
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LOGO
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MEDICATION
DISTRIBUTIONSYSTEMS
Endang Yuniarti, S.Si.,M.Kes,Apt
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Contents
Floor Stock Distr ibution System
Individual Prescription System
Unit Dose System
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Hospital Pharmacy
Selection
Procurement
Storage
Preparation for administration
Distribution to the patient/patient
care unit
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Hospital setting
The hospital pharmacist workingwith other professionalsaccepted responsibility topurchase, prepare and distributedrug products so they wereavailable to the nurse toadminister to the patient asprescribed by the physician
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The role of the pharmacist
Providing the patient with anappropriate medication in an
acceptable dosage form tofacilitate easy administration.
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DEFINISI
Distribusi Obat adalah suatu prosespenyerahan obat mulai dari sediaandisiapkan oleh IFRS sampai obat diserahkanoleh perawat, dokter, apoteker dan tenagakesehatan lain kepada pasien
Sistem Distribusi Obat adalah tatananjaringan sarana, personel, prosedur danjaminan mutu yang serasi, terpadu, danberorientasi pada pasien dalam kegiatanpenyampaian sediaan obat
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Sistem Distribusi Obat Yang Baik
Menjamin ketersediaan obat Mutu dan kondisi obat tetap stabil
dalam proses distribusi
Kesalahan obat minimal dan
keamanan maksimum pada pasien Kerusakan obat dan kadaluwarsa obat
minimal
Efisien dalam penggunaan sumberdaya, baik sarana maupun SDM
Pencurian dan kehilangan obatminimal
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IFRS memiliki akses dalam semua tahapproses distribusi untuk pengendalian,pemantauan dan penerapan farmasi klinik
Memungkinkan interaksi dokter-perawat-apoteker-pasien
Mencegah pemborosan danpenyalahgunaan obat
Harga terkendali Mampu meningkatkan penggunaan obat
yang rasional
Sistem Distribusi Obat Yang Baik
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SISTEM DISTRIBUSI OBAT DI RS
1. Floor stock system (sistempersediaan lengkap di ruangan)
2. Individual prescription order system(sistem resep perorangan)
3. Unit dose system (sistem dosis unit)
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Floor Stock System
A duplication of a small pharmacy(often called the drug room) on thenursing unit where drugs were
stored prior to the nurse preparingdrugs to administer to patients.
The pharmacist was responsible for
stocking the nursing unit (routinevisit to ward check expiry, stockrotation and storage; deliver & top
up to shelves)
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Floor Stock System
The nurse would read thephysician order, go into the drugroom to select the drug and
prepare it, and then administer itto the patient.
The pharmacist would likely never
see the physician order but wouldstock the medication on the floorsolely from the nursing request.
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Floor stock system - advantages
1
2
3
Elimination of drug returns
Reduction in number of drug ordertranscription for the pharmacy
Ready availabili ty of the required drugs
Reduction in the number of pharmacypersonnel required
4
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Increased drug inventory onthe pavilions
Floor stock system - disadvantage
Increased hazards associated
with drug deterioration
Greater opportunity for pilferage
Medication errors may increase
Require capital outlay toprovide proper storage facilitieson the ward
1
4
2
5
3
Greater inroads are madeupon the nurses time
6
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Floor stock system
After pharmacy office hours
Obat-obat yang biasanya didistribusikan dgn
sistem floor stock:
1. Obat-obat life saving dan emergency
2. Obat-obat yang banyak digunakan dengan
harga yang relatif murah (top up shelves)
3. Cairan infus dasar
4. Bahan dan alat medis habis pakai.
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Emergency kit
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Emergency kit
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Emergency trolley
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Life saving drugs storage
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Top up shelves
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Basic Solution
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Basic Solution
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After pharmacy office hours
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After pharmacy office hours
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INDIVIDUAL PRESCRIPTION SYSTEM
Merupakan sistem distribusi obat dimana dokter
menuliskan resep per individu pasien untukbeberapa hari (2-5 hari) dan obat disiapkan difarmasi
Dapat digunakan untuk pasien rawat inap dan rawatjalan
Alur Pelayanan :
Dokter menuliskan resep
Perawat membawa resep ke farmasi RS
Farmasi menyiapkan obat
Perawat mengambil obat yang telah disiapkan atauobat diserahkan kepada perawat di ruang perawatan
Perawat memberikan obat sesuai order/instruksidokter
Bila obat dihentikan, obat dikembalikan ke farmasi
dan tidak dibayar oleh pasien
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Individual prescription order system
Advantage:1. All medication orders are
directly reviewed by thepharmacist
2. Provides for theinteraction of pharmacist,doctor, nurse and
patient3. Provides closer control ofinventory
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Individual prescription order system
Disadvantage: The possible delay in
obtaining the required
medication and the increasein cost to the patient
Need personnel time ofnurse to divide medication
Medication error is stillpossible
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Individual prescription order system
Even though the pharmacist
had the opportunity to review
the patient order, thepharmacist would place only
limited judgment on whether
it was correct or appropriate
for the patient.
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Individual prescription order system
This system did not provide
sufficient information
necessary to devise a
medication profile. Thus, the
pharmacist did not have the
opportunity to effectively
monitor drug therapy and
influence optimal prescribing.
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Individual Prescription System
Dispensing
Supply
Administering
Divide
into unit
dose
Review
Prepare
and label
Evaluation
Adminis
ter to
patient
Pharma
cist
Nurse
Medication
Physician order
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Individual Prescription System
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Individual Prescription System
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DELIVERY BY PNEUMATIC TUBE
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Individual Prescription System
Review:
Appropriateness of drug, dose, route,
schedule.
Drug interaction (drug-drug, drug-disease,
drug-food).
Formulary adherence Availability
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Penyiapan obat
Lama penyiapan mempengaruhi terjadinya
medication error, semakin cepat proses
penyiapan semakin memperbesar peluang
terjadinya error
Tempat kerja dan fasilitas yang memadai
(automatic dispensing machine, barcode,
dll)
SPO (Standar Prosedur Operasional)
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Penulisan etiket/labeling
Cek ulang penulisan label, cek terhadap resep,cek terhadap obat (segitiga emas)
Label
Obat Resep
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Penulisan etiket/labeling
Automatic dan Electronic labeling lebih
menjamin px safety
Penggunaan gambar direkomendasikan
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Penyerahan obat (Supply)
Pastikan obat yang diserahkan baik jenis,jumlah maupun cara pakai sesuai dengan
resep (penggunaan bar code
direkomendasikan) Libatkan perawat untuk memastikan obat
yang diserahkan benar dan akan digunakan
pasien dengan tepat
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DIspensing Error
1. Jumlah obat kurang2. Jumlah obat berlebih
3. Obat salah karena sound alike
4. Obat salah karena package alike
5. Obat berbeda tapi masih dalam kelas terapi yang
sama
6. Obat berbeda dari kelas terapi yang berbeda
7. Obat berbeda tapi memiliki sifat farmakologi
yang sama
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Dispensing Error
8. Salah bentuk sediaan9. Salah dosis/kemasan tapi obat sama
10. Salah kantong/salah etiket (wrong bag/label)
11. Ada obat berbeda dalam kantong yang sama12. Obat salah karena letak obat yang terlalu
berdekatan
13. Obat dengan nama dagang yang berbeda (zat
aktif sama)
14. Lain-lain
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Contoh 1:
Distribusikan obat-obat berikut dengan sistem
individual prescription untuk pasien an Tn.
Rahmat (RM 123456), yang dirawat di
ruang/paviliun Zam-zam dengan no kamar 10:
- Glimepiride 2 mg, satu kali sehari, setiap pagi, jumlah10 tablet
- Metformin 500 mg, tiga kali sehari, jumlah 30 tablet.
- Simvastatin 10 mg, satu kali sehari, jumlah 10 tablet- Alprazolam 1 mg, bila perlu, jumlah 10 tablet
- Paracetamol 500 mg, bila perlu, jumlah 10 tablet
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Contoh 2
Px Ny. Anisah (RM 567890), 75 th, ruang rawatArofah, no bed 12
Aspilet 80 mg, satu kali sehari, 10 tablet
Captopril 25 mg, tiga kali sehari, 30 tablet Bisoprolol 2,5 mg, satu kali sehari, 10 tablet
Meloxicam 7,5 mg, dua kali sehari, 20 tablet
Omeprazole 20 mg, dua kali sehari, 10 tablet
Cedocard 5 mg, 1 tablet bila perlu, 10 tablet
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Individual prescription to Unit Dose
Beberapa penelitian menunjukkan sistem
distribusi floor stock dan resep individu,
rawan terjadinya medication error.
Perlu dikembangkan sistem distribusi yang
lebih aman dan melibatkan peran Apoteker
yang lebih luas dalam proses pengobatan
pasien Sistem distribusi obat dosis unit.
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Unit Dose Distribution System
The fundamental difference between the
unit dose system and older is the more
active role of pharmacist in the medication
cycle with the patient reaping the benefits
of a trained medication practitioner
responsible for the medication cycle and
the return of the nurse to patient careresponsibilities
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Unit Dose Distribution System
The UD System is defined as a pharmacy-coordinated method of dispensing and
controlling medications in health care
institutions. This system is characterized by medications
contained in unit dose packages, dispensed in
ready-to-administer form, and not more than24-hour supply being delivered or available on
the patient care unit at any time.
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Unit dose distribution system
Advantage:
1. A reduction in the incidence of medication errors.
2. A decrease in the total cost of medication-relatedactivities.
3. A more efficient usage of pharmacy and nursing personal.4. Improve overall drug control and drug use monitoring.
5. More accurate patient billing for drugs.
6. The elimination or minimization of drug credit.
7. Greater control by the pharmacist over pharmacyworkload pattern and staff scheduling.
8. A reduction in the size of drug inventories located inpatient care areas.
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Unit dose distribution system
DIsadvantage:
1. Memerlukan personel farmasi yang lebih
banyak (terutama Apoteker), atau
2. Teknologi yang lebih advance
High invest
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Semakin banyak RS di Amerika
yang menggunakan sistem
distribusi dosis unit
TT dengan UDs
1975 1978 1982 1987
17,5%
38,2%
61,1%
73,8%
Perkembangan UDs di AS
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Unit Dose Distribution System
Less expensive Safer
Placed the pharmacist in a better position to be
involved in patient care Increased role of the pharmacist to be able to
evaluate the px order helped propel clinical
pharmacy services impacting px drug therapy
The unit dose system requires the pharmacy to
have and maintain a patient medication profile.
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Unit Dose System
Dispensing
Delivery
to the
floor
Administering
Double
check
Review
Prepareinto unit
dose utk
@ px
Evaluation
Adminis
ter to
patient
Pharmacist
Nurse
Medication inunit dose
Physician order
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UDDS
Actively placing the pharmacist in the middleof the medication use process
Each medication is placed in a unit of use
package, as the correct dose for the patient ina ready-to-administer form, not requiring any
preparation or selection by the nurse.
The medication will have a label that bearsthe px name , the name of medication, the
corresponding strength, and the administering
time.
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UDDS
For a new medication order for a patient or adose request from the nurse, the pharmacist
provided the medication to the floor before the
next cart exchange, either through a courier or
pneumatic system.
Narcotics were usually stored in a locked cabinet
with limited access. Prior to giving the dose, the
nurse had to take an accurate inventory of themedication and document doses removed.
Pharmacy would reconcile it.
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UDDS
As needed (PRN) medications :- keep them in the pharmacy and dispense them
upon request, or
- using a limited floor stock system, especiallymedications that had a low potential for
misuse and patient harm (laxative, antacids,
antipiretik)
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Medication Delivery from Pharmacy
Medication Category Delivery Method
1. Stable scheduled medications 24-hr supply (UDs)
2. Unstable scheduled medications Delivery 1 hr before administration time
3. Scheduled IV/TPN Sol Delivery 1 hr before administration time
4. PRN Medications UDs in limited supply; limited floor stocksupply; delivered in response to request by PCU
5. Controlled medications UDs Limited and secured supply ,
limited floors tock supply
6. STAT Medications Delivered in response to request from PCU
7. Emergency medications Emergency kits in PCU; delivered inresponse to request from PCU
8. Investigational medications Per dispensing protocol
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Cases
Distribusikan kepada pasien rawat inap
dengan sistem Unit Dose utk contoh soal di
atas.
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