DRUG RELATED

PROBLEMS
Luh Putu Febryana Larasanty, M.Sc.,Apt.
 DEFINISI :
A Drug-Related Problem

an event or circumstance involving

drug therapy that actually or potentially
interferes with desired health
outcomes.
KLASIFIKASI DRP :

• DRP terkait
INTRINSIK obat tsb
• ADR

• DRP terkait
EKSTRINSIK
penganganan
obat
• ME
 KLASIFIKASI DRP :
• Strand et all (1990) : mengelompokan
DRP yang dapat merugikan pasien
menjadi 8 kriteria :
1.That requires drug therapy (a drug
indication), but the patient is not receiving
a drug for that indication
2.For which the wrong drug is being taken
3. For which too little of the correct drug is
being taken
4. For which too much of the correct drug is
being taken
5. Resulting from an adverse drug reaction
6. Resulting from a drug–drug, drug–food or
drug–laboratory interaction
7. That is the result of not receiving the
prescribed drug (non-adherence)
8. That is the result of taking a drug for
which there is no valid medical indication
 Disederhanakan menjadi 7
1. Unnecessary drug therapy
2. Wrong drug
3. Dose too low
4. Dose too high
5. Adverse drug reaction
6. Inappropriate adherence
7. Needs Additional Drug Therapy
 KLASIFIKASI DRP :
• Pharmaceutical Care Network Europe :
• Membangun skema mengenai masalah,
penyebab, intervensi serta luaran dari
intervensi
• Update terakhir tahun 2010
 PROBLEMA
• Kejadian yang diharapkan maupun tidak
diharapkan atau suatu keadaan yang
dapat atau mungkin saja salah pada
penggunaan terapi obat
• Domain : Treatment effectiveness
There is a (potential) problem with the
(lack of) effect of the pharmacotherapy
• Problema :
1.No effect of drug treatment/ therapy failure
2.Effect of drug treatment not optimal
3.Wrong effect of drug treatment
4.Untreated indication
• Domain : Adverse reactions
Patient suffers, or will possibly suffer, from
an adverse drug event
• Problema :
1.Adverse drug event (non-allergic)
2.Adverse drug event (allergic)
3.Toxic adverse drug-event
• Domain : Treatment costs
The drug treatment is more expensive
than necessary
• Problema :
1.Drug treatment more costly than
necessary
2.Unnecessary drug-treatment
• Domain : Others
• Problema :
1.Patient dissatisfied with therapy despite
optimal clinical and economic treatment
outcomes
2.Unclear problem/complaint.
 KAUSA
• Aksi (atau kurangnya aksi) yang memicu
munculnya problema potensial atau aktual
• Kausa biasanya merupakan suatu perilaku
yang mengakibatkan suatu masalah, dan
seringkali adalah medication error
• Setiap problema pasti memiliki kausa
• Satu jenis problema dapat disebabkan
oleh satu atau lebih kausa.
• Domain : Drug selection
The cause of the DRP is related to the
selection of the drug
• Kausa :
1.Inappropriate drug (incl. contra-indicated)
2.No indication for drug
3.Inappropriate combination of drugs, or
drugs and food
4.Inappropriate duplication of therapeutic
group or active ingredient
5. Indication for drug-treatment not noticed
6. Too many drugs prescribed for indication
7. More cost-effective drug available
8. Synergistic/preventive drug required and
not given
9. New indication for drug treatment
presented
• Domain : Drug form
The cause of the DRP is related to the
selection of the drug form
• Kausa :
1.Inappropriate drug form
• Domain : Dose selection
The cause of the DRP is related to the
selection of the dosage schedule
• Kausa :
1.Drug dose too low
2.Drug dose too high
3.Dosage regimen not frequent enough
4. Dosage regimen too frequent
5. No therapeutic drug monitoring
6. Pharmacokinetic problem requiring dose
adjustment
7. Deterioration/improvement of disease
state requiring dose adjustment
• Domain : Treatment duration
The cause of the DRP is related to the
duration of therapy
• Kausa :
1.Duration of treatment too short
2.Duration of treatment too long
• Domain : Drug use process
The cause of the DRP can be related to
the way the patient uses the drug, in spite
of proper dosage instructions (on the
label)
• Kausa :
1.Inappropriate timing of administration
and/or dosing intervals
2.Drug underused/ under-administered
(deliberately)
3. Drug overused/ over-administered
(deliberately)
4. Drug not taken/administered at all
5. Wrong drug taken/administered
6. Drug abused (unregulated overuse)
7. Patient unable to use drug/form as
directed
• Domain : Logistics
The cause of the DRP can be related to
the logistics of the prescribing and
dispensing process
• Kausa :
1.Prescribed drug not available
2.Prescribing error (necessary information
missing)
3.Dispensing error (wrong drug or dose
dispensed)
• Domain : Patient
The cause of the DRP can be related to
the personality or behaviour of the patient.
• Kausa :
1.Patient forgets to use/take drug
2.Patient uses unnecessary drug
3.Patient takes food that interacts
4.Patient stored drug inappropriately
• Domain : Other
• Kausa :
1.Other cause; specify
2.No obvious cause
 INTERVENSI
• The problem will usually lead to one or
more in interventions to correct the cause
of the problem.
• Domain : No intervention
• Intervensi :
1.No Intervention
• Domain : At prescriber level
• Intervensi :
1.Prescriber informed only
2.Prescriber asked for information
3.Intervention proposed, approved by
Prescriber
4.Intervention proposed, not approved by
Prescriber
5.Intervention proposed, outcome unknown
• Domain : At patient/carer level
• Intervensi :
1.Patient (medication) counselling
2.Written information provided only
3.Patient referred to prescriber
4.Spoken to family member/caregiver
• Domain : At drug level
• Intervensi :
1.Drug changed to ….
2.Dosage changed to ….
3.Formulation changed to …..
4.Instructions for use changed to …..
5.Drug stopped
6.New drug started
• Domain : Other intervention or activity
• Intervensi :
1.Other intervention (specify)
2.Side effect reported to authorities
 LUARAN INTERVENSI
• One problem (or the combination of
interventions) can only lead to one level of
solving the problem
• Domain : Not known
• Luaran Intervensi :
1.Outcome intervention not known
• Domain : Solved
• Luaran Intervensi :
1.Problem totally solved
• Domain : Partially solved
• Luaran Intervensi :
1.Problem partially solved
• Domain : Not solved
• Luaran Intervensi :
1.Problem not solved, lack of cooperation of
patient
2.Problem not solved, lack of cooperation of
prescriber
3.Problem not solved, intervention not
effective
4.No need or possibility to solve problem
 HOW TO MANAGE DRP?
• Form isian penanganan DRP oleh
farmasis : GENAP 2015-
2016\17_DRP_form_ext_V6-2.pdf
 STEP BY STEP
SUBJEKTIF OBJEKTIF TERAPI PROBLEM KAUSA INTERVENSI
Pasien Diagnosa : Na ADR -Pemilihan obat Tanya
mengeluh rematik diklofenak tidak tepat informasi
nyeri pada Predisone -Kombinasi pada dokter
sendi Riwayat obat Ajukan saran
terutama penyakit di meningkatkan terapi
pada pagi RM : ADR Penggantian
hari. dispepsia obat ke…
SUKSMA