10/26/19

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Dr. Erwin Astha Triyono,dr.,SpPD-KPTI,FINASIM

• Wakil Ketua KPRA RSUD Dr.Soetomo

• Kepala Bidang DIKLAT RSUD Dr.Soetomo
• Wk.Ketua III panel ahli POKJA HIV&AIDS
Kemenkes R.I
• Tim Penyusun DOEN dan FORNAS Kemenkes R.I
• Sekretaris PAPDI Surabaya

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

ANTIBIOTIC STEWARDSHIP
PROGRAM
(Program Penatagunaan Antibiotik)

Erwin Astha Triyono/ Hari Paraton

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA
RSUD. DR. SOETOMO SURABAYA

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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Apa kata pakar tentang ASP ?

• Its about prescriber • Efektif menurunkan

behavior penggunaan antibiotik di
RS
• Seminar, workshop
sometime work, but • Cara terbaik untuk
penggunaan antibiotik
mostly no impact for secara optimal
convince them
• Meningkatkan outcome
• Patient misperception pasien
• Menurunkan prevalensi
resistensi

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

PENATAGUNAAN ANTIBIOTIK
(ASP)
Program/ intervensi/
strategi optimalisasi
penetapan jenis antibiotik,
dosis, lama terapi
dengan indikasi yang
tepat terkait sistem
informasi, data, SDM dan
prosedur yang tepat

Ohl CA. Seminar Infect Control 2001;1:210-21.

Ohl CA, Luther VP. J. Hosp. Med. 2011;6:S4
Dellit TH, et. al. Clin Infect Dis. 2007;44:159-177 4

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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

PENATAGUNAAN ANTIBIOTIK
• Upaya peningkatan outcome
pasien
• melalui kegiatan terkoordinasi
perbaikan penggunaan
antibiotik
• meliputi penentuan jenis,
dosis, durasi, rute, de-eskalasi
dan penghentian.

IDSA , 2015

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Standard MMU.1.1:
The hospital develops and
implements a program for the
prudent use of antibiotics based
on the principle of antibiotic
stewardship.

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JCI edisi 6 - 2017

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

1. turunnya kuantitas AB
2. Peningkatan kualitas AB
3. Perbaikan outcome pasien
4. Ketaatan terhadap PPK- AB
5. turunnya prevalensi AMR
ESBL, MRSA, CRE, NDM-1
6. Turunnya cost pasien
Tamma PD, Cosgrove SE. Infect Dis Clin North Am. 2011 25:245 Ohl CA, Luther VP. J. Hosp. Med. 2011;6:S4
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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

• Lakukan yang terbaik

• Jangan berbuat salah

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

AKTIVITAS
1. Audit dan Feed Back.
2. Restriksi dan Pre-
authorization
3. Implementasi PGA:
• Pelatihan
• PPK and Clinical Pathways
• Persetujuan AB
• Streamlining and de-escalation
• Optimalisasi dosis dan durasi

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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

PENDUKUNG PGA

• Implementation of Computerized
Decision Support System (CDSS)
• Mikrobiologi klinik
• Farmasi klinik
• Pengendalian dan Pencegahan
Iinfeksi
• Monitoring dan Evaluasi

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Computerized Decision Support

System - CDSS
• Mandatory use is triggered when a
targeted broad spectrum antimicrobial
is prescribed
• Prescribers are encouraged to use CDSS
for prescription of antimicrobials à
increases compliance to hospitals
guidelines
• Physicians selection of CDSS should
accurately reflect the severity &
infective condition of patients

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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Point-of-care interventions are

a valuable component of
antimicrobial stewardship.

• Monitoring dan Feedback langsung

kepada dokter
• Membimbing pemberian antibiotik
bijak.

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Point-of-care interventions are a valuable component of

antimicrobial stewardship.

• diagnosis yang tepat

• review pilihan antibiotik
• Pilihan antibiotik definitif berdasarkan hasil
kultur
• penetapan dosis yang sesuai kebutuhan
pasien
• de-eskalasi
• monitoring terapi
• automatic stop orders.

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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

ELEMEN PENTING PGA

• Strong Leadership
• Dukungan
• managemen
• sarana rapid diagnostik
• IT / CDSS
• ahli infeksi dan antibiotik
• Panduan/PPK spesifik
• Tim PGA
• Pre-autorisasi

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Selection of patients Primary review by clinical pharmacists
Identification of patients prescribed Collection of relevant information from STAGE I
audited antibiotic via IT system ? case notes and electronic record using Prospective review
standardized data collection form

Intervention No
Memo addressed Second review and evaluation of cases
Discussion and evaluation of case with STAGE II
to prescribing
doctor inserted physician and ASP team Mid-day Meeting
into case notes on
the same day
AIM:
OPTIMIZE ANTIMICROBIAL USAGE
Appropriate Appropiate Appropiate Appropiate
CHOICE DURATION DOSAGE ROUTE
Concurrent
Immediate
Feedback

APPROPRIATE.. ? Yes
Database Entry and Data Analysis
Pre-defined measures collated in database
Monthly review of data and departmental update

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Aktivitas Tim PGA
Diagnosis Prescription Selection Feed back
Disscusion - Desicion
Dr. Djovi. SpPD
RS. Super husada

R/ Meropenem
1 g no X
/ imm.

Ny. Rindu DPJP

Discussion:
Ms. Rindu. 46 yrs Delivery
BP110/70, TEMP: Meronem à
38.5, Leucosit:
14.000.
ASP Levofloxacin
750 mg
X-Ray Thorax:
Pneumonia (+)
Team
Diagnose: CAP

KPRA RSUD Dr.SOETOMO 17

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Kebijakan RSUD Dr.Soetomo tentang Pengendalian Penggunaan Antibiotik

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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

ALUR MONITORING DAN REVIEW PGA

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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

INFECTIOUS DISEASE INTEGRATED SERVICE TEAM

(Forum Kajian Kasus Infeksi Terintegrasi)

KLINISI PERAWAT/BIDAN

Komite PPI
KFT

FARMASI MIKROBIOLOGI
Mariyatul Qibtiyah - KPRA Klinik Klinik

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

ASP team Dr. Soetomo
Forum kajian General Academic Hospital
kasus infeksi terintegrasi dan visite Tim ASP – KPRA RSDS

Mariyatul Qibtiyah - KPRA

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ASP team Singapore General Hospital

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

Mariyatul Qibtiyah - KPRA

KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

CONTOH REKOMENDASI INTERVENSI ASP TEAM by IT

KPRA RSUD Dr.SOETOMO 24

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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

DATA EVALUASI PERESEPAN APPROPRIATE ATAU TIDAK PADA SETIAP DOKTER

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KOMITE PENGENDALIAN RESISTENSI ANTIMIKROBA

WORKING
TOGETHER
FOR
BETTER
OUTCOME

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