MANAJEMEN DAN PENGGUNAAN OBAT

(AKREDITASI 2012)

MULYADI MUCHTIAR
MPO
 MANAJEMEN DAN PENGGUNAAN OBAT (MPO)

• ORGANISASI DAN MANAJEMEN

• SELEKSI DAN PENGADAAN
• PENYIMPANAN
• PEMESANAN DAN PENCATATAN (ordering &
transcribing)
• PERSIAPAN DAN PENYALURAN (dispensing)
• PEMBERIAN (Administration)
• PEMANTAUAN (Monitoring)
ORGANISASI, SELEKSI DAN PENGADAAN , PENYIMPANAN
Pencampuran

RESEP

5 tepat

Sutoto.KARS 9
 Safety in our System:
High Alert Medications
 Case Study

• Physician ordered Norcuron (Vercuronium) for

a patient via Computerized Physician Order
Entry (CPOE)
• Ordered via remote location- not at the
bedside
• Accidentally prescribed for a patient on a
medical unit, meant for a patient in the ICU
 Case Study
• Pharmacist processed and prepared the
infusion, failing to recognize that a
neuromuscular blocking agent should never be
sent to a medical unit
• Auxiliary labels placed on bag
– High Alert medication
– Paralyzing agent
• Pharmacy technician delivered to medical unit
and didn’t question why not an ICU
 Case Study
• Independent double check performed by the
nurses to verify
– Drug
– Pump settings
– Patient
• Infusion started and patient walked to the
bathroom
• Patient fell to the floor once paralysis began to
set in
 Case Study
• Patient called for help
• Rapid response team responded
• Nurse questioned if new drug hung could have
done this
• Physician immediately stopped the infusion
• Patient treated and no long-term effects

ISMP Medication Safety Alert! May 31, 2007 Volume 12 Issue 11

 What Happened?
• Entered on wrong patient in CPOE
• No confirmation of correct patient or hardstop in CPOE
for NMB outside of the ICU
• Unfamiliarity with the medication
• Didn’t ask for clarification or information about the
medication
• Auxiliary labels not read
• Multiple providers involved
• 6 Rights
– Patient, drug, dose, route, time, response
• Others?
ORGANISASI, SELEKSI DAN PENGADAAN , PENYIMPANAN
Pencampuran

RESEP

5 tepat

Sutoto.KARS 17
How Do Errors Occur?
The Swiss Cheese Model
 IHI 5 Million Lives Campaign

Reducing Harm from High-Alert Medications

• The Goal:
– Reduce harm from high-alert medications by 50%
by December 2008
 IHI 5 Million Lives Focus

• Anticoagulants
– Heparin and Warfarin
• Narcotics/Opiates
– Patient-Controlled Analgesia
• Insulin
• Sedatives
– e.g., Midazolam
 IHI Recommended Measures
• ADEs:
– Related to Anticoagulant per 100 Admissions with Anticoagulant Administered
– Related to Insulin per 100 Admissions with Insulin Administered
– Related to Narcotic per 100 Admissions with Narcotic Administered
– Related to Sedative per 100 Admissions with Sedative Administered

• Percent of Patients Receiving:

– Anticoagulant with Treatment Appropriately Managed According to Protocol
– Heparin with aPPT Outside Protocol Limits
– Insulin with Blood Glucose Level Outside Protocol Limits
– Insulin with Treatment Appropriately Managed According to Protocol
– Narcotic Who Receive Subsequent Treatment with Naloxone
– Narcotic with Treatment Appropriately Managed According to Protocol
– Sedative Who Receive Subsequent Treatment with Flumazenil
– Sedative with Treatment Appropriately Managed According to Protocol
– Warfarin with INR Outside Protocol Limits
 Acreditation Approach
• Identify High Alert Medications
• Understand what causes harm at DUH
– Data analysis
• Decrease variation and standardize
• Develop long lasting solutions
• Involvement with front line staff up to senior
leadership
• Demonstrate improvement with data
 Eg. High Alert Medications
– Direct Thrombin Inhibitors – Potassium IV
– Neuromuscular Blocking – Heparin IV
Agents – Opiates
– IT administered medications – Chemotherapy IV and IT
– Total Parenteral Nutrition – Benzodiazepines
(TPN)
– Warfarin
– Antiarrhythmics (amiodarone
– Insulin IV
IV, lidocaine IV, dofetilide)
– Vasopressors (dopamine,
dobutamine, epinephrine,
norepinephrine,
phenylephrine)
 Selection of High Alert Medications
• Based on:
– Previous medication errors
– Sentinel Events
– ISMP, USP and other national data
• Increased risk of causing significant patient harm
when they are involved in medication errors.
• Although mistakes may or may not be more common
with these drugs, the consequences of an error are
potentially more devastating to patients.
 IHI Measure Examples
• The number of adverse drug events (ADEs)
associated with an anticoagulant per 100 admissions
in which the patient was administered at least one
dose of an anticoagulant, as detected using the IHI
Global Trigger Tool (using only the Medication
Module and Care Module triggers).

• The percentage of patients receiving insulin with

blood glucose levels outside the safety limits set by
the hospital’s insulin protocol during insulin
administration
Pharmacist is responsible for the quality,
quantity, and source of all medications,
chemical, biological and pharmaceutical
preparations used in diagnosis and treatment of
patients.
 Operational Definitions
Medication System Categorization Schema

 Procurement
 Storage
 Prescribing
 Preparation and Dispensing
 Administration

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 Medication Management
High Level Flow Chart

Monitoring

Storage Prescribing Preparation

Procurement Administration
Dispensing

Medication Errors
Electronic ordering system

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 MANAJEMEN DAN PENGGUNAAN OBAT (MPO)

• ORGANISASI DAN MANAJEMEN Organisasi, seleksi

adalah system yg
• SELEKSI DAN PENGADAAN akan diterapkan

• PENYIMPANAN
Penyimpanan,
• PEMESANAN DAN PENCATATAN (ordering & persiapan, dan
penyaluran
transcribing) adalah
environtment
• PERSIAPAN DAN PENYALURAN (dispensing) system
• PEMBERIAN (Administration)
Pemberian : system yg
• PEMANTAUAN (Monitoring) dilaksanakan oleh SDM
yg kompeten
 SEKIAN
TERIMA KASIH

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