endang yuniarti medication distribution systems(1)

7/26/2019 Endang Yuniarti Medication Distribution Systems(1)

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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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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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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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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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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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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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DELIVERY BY PNEUMATIC TUBE


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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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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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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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endang yuniarti medication distribution systems(1)

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