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PERKHIDMATAN FARMASI PESAKIT DALAM

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Page 1: Farmasi pesakit dalam3

PERKHIDMATAN FARMASI PESAKIT DALAM

Page 2: Farmasi pesakit dalam3

Farmasi Pesakit Dalam

The Inpatient Pharmacy is responsible

for the supply and dispensing of all

medicines to inpatients and for the

supply of medicines on discharge.

Page 3: Farmasi pesakit dalam3

Objektif

To dispense medications to inpatients and

discharge patients via the prescription or

imprest system

To provide pharmaceutical care via patient

counseling

Page 4: Farmasi pesakit dalam3

Skop Tugas

Dispensing

Medication counseling

Stock management

Page 5: Farmasi pesakit dalam3

IN-PATIENT PHARMACY

Services both in-patients & discharge patients.

Provide bedside dispensing and counseling service for

discharge patients.

Supply medications to in-patients in wards and units

through:

I) Modified Unit Dose System/Unit Of use

- Each Dose is packed and labelled & kept in trolley bins.

- II) Floor Stock System

- Commonly used drugs are stocked in the wards for after

office hours use.

- Minimum & maximum stock level constantly

monitored & replenished by pharmacy staff.

III) Supply Of Dangerous Drug (DD)

IV) Discharge Medication

IV) Counselling And Bedside Dispensing

Page 6: Farmasi pesakit dalam3

Garispanduan

Berdasarkan Formulari Ubat KKM A* = Consultant for specific indication

A = Consultant or specialist

B = Medical Officer

C = paramedical staff

* Item tiada dalam Formulari – perlu dapat kelulusan KPK

Page 7: Farmasi pesakit dalam3

Ubat-ubatan Untuk

Pesakit Dalam Wad

(Inpatient)

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Rx For Refilling

According to

Wards

Trolley Rx Filling

Based on Rx Data

of Individual

Patient

New Prescription

by Doctors

SCREENING

By Pharmacist

Further Clarifications

Contact Prescribers

Problems Rectified

Counter

Checking

Supply To Ward Staffs

Patients In Wards

Proses Kerja

Page 9: Farmasi pesakit dalam3

Screening (Penyaringan)

1. Preskripsi adalah lengkap

Nama pesakit dan MRN

Drug regimen adalah betul (Dose, frekuensi, cara

administrasi dan j/masa

T/tangan dan nama prescriber

Age dan berat untuk pesakit paediatrik (Prefer)

Bertarikh

2. Polifarmasi

3. Interaksi ubat

*Hubungi doktor jika terdapat sebarang permasalahan pada preskripsi dan buat dan buat pembetulan yang sepatutnya.

Page 10: Farmasi pesakit dalam3

Screening

2. Polifarmasi

3. Interaksi ubat

*Hubungi doktor jika terdapat sebarang

permasalahan pada preskripsi dan buat dan buat

pembetulan yang sepatutnya.

4. Sah

5. T/tangan pakar utk ubat khas

Page 11: Farmasi pesakit dalam3

Preskripsi Bermasalah

Hantar Balik

Sticker Kuning

•Masalah Dos

•Kekerapan

• Jangkamasa

Cop Kosign

Pakar

Page 12: Farmasi pesakit dalam3

Pembekalan Proses bekalan:

Melabel,

mengisi

menyediakan persediaan ekstemporaneus,

merekod,

menyemak balas,

Pembekalan melalui: Unit Dos

Unit Of Use

Imprest stock/ward stock

Semaksilang

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In-patients by implementing the Unit-of-Use/Unit Dose System.

Advantage of providing personalised and continuous supply of medication to patients, with better compliance and reduced wastage as compared to the traditional system where the wards order drugs in large quantities, which have led to overstocking and wastage.

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2.4 Melakukan “Bedside Dispensing” untuk pesakit Discaj dan Kaunseling

2.5 Memesan, menerima, menyemak dan mengeluarkan stok ubat 2.6 Membekalkan Dadah Berbahaya dan Item Psikotropik ke wad 2.7 Menyediakan Laporan QAP dan kompilasi statistik Membekalkan larutan intravena dan disinfektan yang baru

disediakan kepada semua wad/unit.

Mengawal secara berpusat pembekalan ubat-ubatan dengan mempunyai stor yang boleh menyimpan stok drug yang mencukupi untuk dibekalkan ke Farmasi Bekalan Wad dan Farmasi Satelit.

Page 15: Farmasi pesakit dalam3

IN-PATIENT PHARMACY

Services both in-patients & discharge patients.

Provide bedside dispensing and counseling service for

discharge patients.

Supply medications to in-patients in wards and units

through:

I) Modified Unit Dose System

- Each Dose is packed individually & kept in trolley bins.

- Supply is on everyday basis.

- II) Floor Stock System

- Commonly used drugs are stocked in the wards for after

office hours use.

- Minimum & maximum stock level constantly

monitored & replenished by pharmacy staff.

III) Supply Of Dangerous Drug (DD)

IV) Discharge Medication

IV) Counselling And Bedside Dispensing

Page 16: Farmasi pesakit dalam3

Unit Dose

The unit dose system may differ in form, depending on the specific needs of the organization.

Basic unit dose systems:

medications are contained in single unit packages; they are dispensed

in as ready-to-administer form as possible; and for most medications,

not more than a 24-hour supply of doses is delivered

to or available at the patient-care area at any time.

Numerous studies concerning unit dose drug distribution

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Floor Stock/Ward Stock

Ward Stock

• The floor stock system is used in small hospitals where pharmacists are not available to dispense individual doses for patients.

Floor Stock

It consists of a predetermined list of medications that are available in the patient care area of the hospital

Usually these items are inexpensive that have common use

(Example: alcohol, lotion, water for injection, normal saline, etc)

Certain medications for Example: emergency/Operation room medications that are required to be used almost immediately after the physician prescribes them, and it isn't practical to wait until the nurse dispenses them from

Page 18: Farmasi pesakit dalam3

Inpatient drug distribution

Supplying medications

to ward patients in

individualised bins

Preparing medication

from discharge scripts

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Bedside Dispensing

perkhidmatan terus ke

katil pesakit.

Khidmat ini dilakukan

oleh Pegawai Farmasi

yang bertugas dengan

menghantar ubat terus

kepada pesakit

yang "discharge"

(dibenarkan pulang) oleh

Doktor dan seterusnya

memberi kaunseling ubat-

ubatan.

Page 20: Farmasi pesakit dalam3

Dadah Berbahaya (DD)

Menurut Dangerous Drugs (Hospital, Etc) (General Exemption) Order 1952, Schedule B, 2:

All supplies of such drugs and preparations will be received by the Matron, Acting Matron, Senior Hospital Assistant or Senior Nurse of the hospital and shall be kept by her in a locked cupboard of which she alone shall have the key.

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Dangerous Drugs (DD)/

PsikotropikUbat yang dikawal oleh

Akta Dadah Merbahaya (DDA) 1952

Semua Inden dan Penghantaran

DD/Psikotropik hanya boleh

dikendalikan oleh

Matron/ Sister/ Staff Nurse

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Senarai DD/ Psikotropik

Clonazepam Tab

Diazepam Inj/ Tab/ Supp

Dihidrocodeine DF118

Fentanyl Inj/ Patch

Ketamin Inj

Lorazepam Tab

Methadone Syrup

Midazolam Inj/ Tab

Morfin Injeksi/ Tab/ Sirap

Oxycodone Tab

Phenobarbitone Tab/ Syrup

Pethidine Injeksi

Zolpidem Tab

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Pemeriksaan Wad

Pemeriksaan wad akan dijalankan oleh Staf Farmasi setiap 3

bulan (mengikut Jadual yang telah ditetapkan)

Tujuan pemeriksaan adalah untuk memastikan:

* Tiada ubat yang luput

* Tidak overstocking

* kaedah penyimpanan adalah betul

Laporan pemeriksaan akan dikeluarkan dan pihak wad

bertanggungjawab untuk membuat tindakan susulan

Page 24: Farmasi pesakit dalam3

Cold chain

Item- item ini perlu disimpan bawah suhu 2 - 8ºC untuk mengelakkan kerosakan ubat

Perlu membawa bersama Ice Box dengan pek ais di dalam.

Kebanyakan Fridge Item adalah ubat yang mahal, maka ubat tidak akan dibekalkan tanpa ice box.

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Permonitoran Stok

Memastikan stok sentiasa ada dan mencukupi

Mengelakkan ubat luput

Mengelakkan overstocking

Mengurangkan slow moving item

Page 26: Farmasi pesakit dalam3

High Alert Medication

What is High Alert Medication?

High-Alert Medication – Medications that have a heightened risk of causing significant patient harm when used in error.

The following medications which are currently listed in the have been classified as High Alert Medication.

amiodarone, IV

heparin, low molecular weight, injection

heparin, unfractionated, IV

insulin, subcutaneous and IV

magnesium sulfate injection

cyclophosphamide, oral

methotrexate, oral

nitroprusside sodium for injection

potassium chloride for injection, concentrated

potassium phosphates injection, concentrated

sodium chloride injection, hypertonic (more than 0.9% concentration)

warfarin

.

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Pembekalan Ubat HAM

Semua Ubat disemak silang sebelum dibekal

Ubat-ubat dilabel dengan “HIGH ALERT MEDICATION”

Membekalkan ubat dalam bentuk pek unit dos

Menghadkan penggunaan secara intrathecal, epidural analgesic, oleh staff terlatih sahaja

Page 28: Farmasi pesakit dalam3

Storage

DO NOT keep look alike or different strength drug side by side.

Limit the strength and quantity available in ward floor stock. Use smaller package, concentration, dose, and number of vials for floor stock.

Designated area or different label receptacle

Higher strength drugs to be keep in emergency trolley and lower strength to keep as floor stock

(storage container for HAM should be labeled by ward staff –eg. Insulin, heparin)

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THANK YOU