Dr. Yusi Anggriani, M.

Kes, Apt
 Sekilas tentang Saya
Dr. Yusi Anggriani, M.Kes, Apt.
Riwayat Pendidikan:
• S3 Social Pharmacy & Administrative, University Sain Malaysia, 2014
• S2 Magister Manajemen & Kebijakan Obat, Fak Kedokteran UGM, 2002
• Apoteker Farmasi UGM, 2000
• S1 Farmasi UGM, 1999

Pengalaman:
• Dosen Fakultas Farmasi Universitas Pancasila (2004- sekarang)
• Komite Nasional Penilai Obat Jadi BPOM RI (2002- sekarang)
• Komite Nasional Informatorium Obat Nasional Indonesia BPOM (2011-sekarang)
• Tim Nasional Percepatan Penanggulangan Kemiskinan Kementrian Sekretariat Negara, Pokja Kesehatan
(2014-2016)
• Tim penyusun Pedoman Farmakoekonomi Kementerian Kesehatan RI (2011 dan 2016)
• Tenaga ahli/konsultan berbagai studi terkait akses obat dan kebijakan kefarmasian
• Dosen Manajemen penggunaan obat, MM Kebijakan Obat UGM (2003-2004)
• Apoteker pengelola Apotek di Yogya (2000-2004)
• Staff peneliti Pusat Studi dan Kebijakan Obat UGM (2001-2003)

RAKERNAS DAN PIT IAI, 6-8

SEPTEMBER 2017
Contents

Definition Pharmaceutical Care Plan Process

1
Pharmaceutical Care Plan Process di Rumah Sakit
2

3 Pharmaceutical Care Plan Process

4
Pharmaceutical Care Plan

Pharmaceutical Care Plan is the process in which

pharmacist cooperates with the patient and health care
provider in:

Designing Implementing Monitoring

Pharmaceutical Care Plan

 It describes specific services

activities through which an
individual pharmacist
cooperates with patients and
other health care
professionals in designing,
implementing & monitoring a
therapeutic plan that will
produce specific outcomes for
the patient
PROFIL PENGOBATAN PASIEN
DI
RUMAH SAKIT
CKD stage V dengan anemia,asidosis metabolik, CHF Fc II, CAD, Hipertensi
 BIODATA PASIEN
 Nama : Tn. I
 Alamat : Kp. Bulak,klender
 Umur : 65 tahun
 BB : 50 Kg
 Diagnosa : CKD stage V dengan
anemia,asidosis metabolik, CHF Fc II,
CAD, Hipertensi
 Alasan MRS : - Sesak nafas
- Batuk
 Tanggal MRS : 28-11-2013
 Pulang : 06-12-2013
Wawancara dengan keluarga pasien
 KELUHAN UTAMA

 Sesak sejak 5 hari SMRS

 Sesak disertai batuk

 Pasien tidur dengan 2 bantal (sesak bila tidur dengan 1 bantal)

 Bengkak pada kaki

 Turun berat badan ± 20 kg (jangka 1 tahun)

 RIWAYAT PENYAKIT DAN
PENGOBATAN
RIWAYAT PENYAKIT/Sosial RIWAYAT PENGOBATAN
 Hipertensi sejak 7 tahun yang lalu  Obat hipertensi (amlodipin dan ....... )
 DATA PERKEMBANGAN KLINIS PASIEN
TANGGAL PERKEMBANGAN KLINIS
28-11-2013  Sesak (+)
 TD : 210/110
HR = 97 x/menit
 RR = 20 x /menit
 Suhu = 37 0 C
29-11-2013 Sesak (+)
 TD : 150/90
HR = 97 x/menit
 RR = 20 x /menit
Suhu = 37 0 C
02-12-2013  Keluhan sesak berkurang
TD : 155/80
HR = 80 x/menit
 RR = 20 x /menit
 Suhu = 36,5 0 C
 DATA PERKEMBANGAN KLINIS PASIEN
TANGGAL PERKEMBANGAN KLINIS
03-12-2013  Tidak ada keluhan
 TD : 155/90
HR = 80 x/menit
 RR = 20 x /menit
Suhu = 36,5 0 C
04-12-2013  Tidak ada keluhan
 TD : 135/75
HR = 80 x/menit
 RR = 20 x /menit
 Suhu = 37 0 C
06-12-2013 Keluhan sesak (-)
 TD : 135/80
 HR =80 x/menit
 RR = 20 x /menit
Suhu = 36 0 C
 Hasil lab.
Normal 27/11 29/11 29/11 01/12 06/12
(09.32) (18.05)
8,24 8,40
LEKOSIT 5 - 10 ribu/mm3
2,09 2,27
Eritrosit 4,5 – 6,5 juta/ul
6,4 6,7
HB 12,0 - 16,0 g/dl
18 20
HT 35 - 47 %
16,2 15,6
RDW-CV 11,5 – 14,5 %
139,2 136,2 144
Na 135-145 mmol/l
5,80 3,65 3.73 5,70
K 3,5 – 5,5 mmol/L
118 100 100 101
CL 98-109 mmol/l
8,20
Ca 8,4 – 10,2 mg/dl
Kolesterol 130-159 (batas 130,4
LDL tinggi)
 Normal 27/11 29/11 29/11 01/12 06/12
(09.32) (18.05)
Phospor 8,2
anorganik 2,7 – 4,5 mg/dl
Mg 1,7 – 2,7 mg/dl 2,80
173 111 180 73
Ureum 20 -40 mg/dl
11,3 5,6 9,9 4,2
GFR: 4,61 GFR : 9,30 GFR : 5,26 GFR : 12,40
Creatinin 0,8 – 1,5 mg/dl ml/min ml/min ml/min ml/min
Kejernihan Agak keruh
urin Jernih
1,025
BJ urin 1,005 – 1,030
6,0
PH urine 5,5 – 8
Positif
Protein urin Negatif
7,248 7,353 7,514 7,34
PH 7,34 – 7,44
11,3 22,3 23,4 36,1
PCO2 35 – 45 mmHg
104 110,4 182,3 88,9
PO2 85-95 mmHg
22-26 4,8 12,1 18,4 19,0
HCO3 mmol/L
23-27 5,1 12,8 19,1 20,1
TCO2 mmol/L
 Tindakan/Konsul
Tanggal Jenis Hasil
28-11-2013 Konsul Jantung CHF Fc II, CAD

29-11-2013 Hemodialisa ke 1

30-11-2013 Transfusi darah

04-12-2013 Hemodialisa ke -2
Profil Pengobatan Pasien
Instalasi Farmasi RSUP Persahabatan
Tgl DRP Problem Assesment/action Monitoring
29/11 Gagal Pasien datang ke rumah sakit dengan -Menyarankan dokter Dokter tidak
menerima keluhan batuk (tidak berdahak) tetapi memberikan obat memberikan karena
obat pasien tidak mendapatkan terapi obat batuk pasien tidak mengeluh
batuk - cek pasien apakah batuk lagi
masih ada keluhan
batuk/tidak
30/11 Gagal Pasien tidak mendapatkan obat Tanyakan ke pegawai Amlodipin di hari
menerima amlodipine karena persediaan difarmasi depo farmasi rawat tersebut kosong tetapi
obat kosong inap di R.Cempaka persediaan diesok
harinya sudah ada
02/12 – Interaksi ISDN + AMLODIPINE - Pantau Tekanan -Tekanan darah pasien
05/12 obat Meningkatkan resiko hipotensi Darah pasien masih tinggi
(Drug Interaction facts)

30/11- Dosis Dosis lazim ranitidin (i.v) Saran kepada Dokter belum
05/12 obat Pengobatan : 50 mg tiap 6-8 jam dokter untuk meningkatkan dosis
rendah Profilaksis : 50 mg tiap 8 jam meningkatkan dosis ranitidin
(BNF, IONI) ranitidin
Dokter memberikan 2x50 mg
Tgl DRP Problem Assesment/action Monitoring

30/11- Dosis  Dosis valsartan (hipertensi) - Saran kepada - Dokter belum

05/12 obat untuk GFR < 25 ml/min = dimulai dokter untuk menurunkan dosis
tinggi dari dosis rendah 40 mg sekali menurunkan dosis valsartan
sehari valsartan 40 mg
(Handbook of Medication Dosing per hari
in Renal Failure for Healthcare
Professionals)

 Dokter memberikan terapi

valsartan 1 x 80 mg
OBAT PULANG PASIEN
Nama Obat Jumlah Obat Dosis

ISDN 15 3 x 15 mg
Ascardia 5 1 x 80 mg
Asam Folat 15 1 x 3 tab (15 mg)
Vit B12 15 3 x 1 tab
CaCO3 15 3 x 1 tab
Amlodipine 5 1 x 10 mg
Valsartan 5 1 x 160 mg
Kalitake 15 3x1
Ranitidin 10 2x1
The Pharmaceutical Care Cycle

Why do anything?
(identify the problem)

How will you know What do you want

you did it? to do?
(monitor and follow-up) (set goal)

How will you do it?

(develop a care plan)

Source: Rovers J. Des Moines, IA: Drake University College of Pharmacy.

22
How to implement Pharmaceutical Care
Plan?

 Not all patients require a written PCP.

 Pharmacists must assess their own patients and
identify specific areas on which to focus.
 The pharmacist identify patients with specific diseases
(e.g., asthma, hypertension, diabetes mellitus, or
hypercholesterolemia).
The development of a PCP

Five step process involving the SOAP format

(Subjective data, Objective data, Assessment, and Plan
of care).

Step 5 Evaluation the

achievement

Step 4
Developing Plan

Step 3
Assesing Problem

Step 2
Identifying Problem

Step 1
Gathering Information
 Essential Components of
Pharmaceutical Care Plan
1. Patient’s demographic date: age, sex, race etc.
2. Pertinent medical information
3. Medical history (current & past)
4. Family history
5. Dietary history
6. Medication history (prescription, OTC, social drugs,
allergies)
7. Physical findings (weight, height, B.P)
8. Lab results (serum drug levels, potassium levels,
serum creatinine levels relevant to drug therapy)
9. Patient complaints, symptoms & signs
Step 1. Gathering Information
Step 2. Identifying Problems

Example
 From the patient's medication profile in, one problem
is evident: diagnosis of asthma.
Step 2. Identifying Problems
Step 3. Assessing Problems
Step 3. Assessing Problems
For example, in the asthma case,
 The pharmacist may first investigate the etiology of
the factors that exacerbated the asthma.
 The pharmacist does not have to be involved in skin
testing, nor does the pharmacist have to conduct a
detailed, extensive history of all of the factors that
may have precipitated the asthma.
Step 3. Assessing Problems
Step 4. Developing the Plan

The pharmacist establishes:

1. goals linked to each of the patient's problems
2. specifies a course of action aimed at meeting each
goal.

Goal (i.e., desired improvement) should be stated in

terms of measurable outcomes that indicate problem
has been resolved.
Step 5. Evaluating the Achievement of
Outcomes
Step 5. Evaluating the Achievement of
Outcomes
The outcomes listed for asthma, e.g:
 Lower frequency and severity of acute exacerbations
 Fewer physician office visits
 Elimination of side effects
 Fewer emergency department visits
Documentation
“if we didn’t document it, we didn’t do it”

Documenting the patient care provided during the

pharmaceutical care encounter is CRITICAL STEP in
Pharmaceutical care process
The Value of Documentation
 Provided a permanent record of patient information that
the pharmacist has collected.
 Efficiently communicates key information to colleagues at
the practice site or to other health care professional
 Provides evidence of the pharmacist action and successes
in patient care
 Serves as legal record of care provided
CONCLUSION: Requirements to conduct
pharmaceutical care

38
 1 Kemampuan Komunikasi 4.69
2 Kejujuran/Integritas 4.59
Kualitas Lulusan
3 Kemampuan Bekerja Sama 4.54 Perguruan Tinggi
4 Kemampuan Interpersonal 4.5
5 Beretika 4.46 yang Diharapkan
6
7
Motivasi/Inisiatif
Kemampuan Beradaptasi
4.42
4.41
Dunia Kerja
(Skala 1 – 5)
8 Daya Analitik 4.36
9 Kemampuan Komputer 4.21
Diterbitkan oleh National Association
10 Kemampuan Berorganisasi 4.05
of Colleges and Employers, USA, 2002
11 Berorientasi pada Detail 4
(disurvei dari 457 pimpinan)
12 Kepemimpinan 3.97
13 Kepercayaan Diri 3.95
14 Ramah 3.85
SUKSES TIDAK HANYA
15 Sopan 3.82
16 Bijaksana 3.75
IPK, TAPI SOFT SKILL
17 Indeks Prestasi (>=3.0) 3.68
DAN ATTITUDE YANG
18 Kreatif 3.59 BAIK LEBIH
19 Humoris 3.25 DIHARAPKAN
20 Kemampuan Berwirausaha 3.23
Setiap Kelas Dibagi menjadi Kelompok
•Kelompok 1 : Pengertian DRP menurut rovers
•Kelompok 2 : Pengertian DRP menurut PCNE
•Kelompok 3 :Patient data collection
•Kelompok 4: Patient data evaluation
•Kelompok 5 : Patient Care Plan Development
•Kelompok 6: Drug Information skill for PC