Optimalisasi Peran

Apoteker dalam
Pelayanan Klinis
dan
Sistem Bisnis di Rumah
Sakit
SEMINAR DAN RAKERCAB IKATAN
APOTEKER INDONESIA PENGURUS CABANG
BANYUWANGI 2021 -2022

Apt. L. ENDANG BUDIARTI

2. Kontribusi Instalasi Farmasi RS dalam menjaga proses bisnis RS dengan pandemi yang
berkepanjangan.

3. Praktik klinis : kesempatan percepatan dan perkembangan di era pandemi Covid-19

4. Menjaga keseimbangan antara keamanan petugas dan kualitas pelayanan kefarmasian di

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Your best quote that reflects your
approach… “It’s one small step for
man, one giant leap for mankind.”

- NEIL ARMSTRONG

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 Dampak pandemi dalam pelayanan
kefarmasian di Rumah Sakit

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 Pasien takut ke
rumah sakit
R/ turun
Pasien covid-19
DOMINAN Antiviral,
disenfektan
Obat, vaccine meningkat
EUA
Ketersediaan
Distribusi sediaan obat terganggu
farmasi global Pengetahuan,
pemeriksaan dan Biaya diagnostic
terganggu pengobatan meningkat Obat ED
selalu berubah meningkat
Karyawan takut
melayani Kebijakan
Kebutuhan APD pemerintah
Penghasilan
meningkat dinamis turun

Biaya operasional
tinggi (APD)

Mental distress

SDM terbatas
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 Kontribusi Instalasi Farmasi RS
dalam menjaga proses bisnis RS
dengan pandemi yang
berkepanjangan

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 SEDIAAN FARMASI, REAGEN, APD, DISENFEKTAN

SUASANA AMAN
KUALITAS,
KECUKUPAN DAN
KONTINYUITAS
MINIMAL WASTE
PERSEDIAAN PENGOBATAN

SUPPLY PRAKTIK
CHAIN MANAGEMENT FARMASI KLINIK

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The challenge for companies will be to make their supply chains more resilient without weakening their
competitiveness.

To meet that challenge, managers should first understand their vulnerabilities and then consider a number
of steps—some of which they should have taken long before the pandemic struck.

Identify your vulnerabilities → mapping your full supply chain

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MAPPING VULNERABILITIES SUPPLIERS
RISK LOW MEDIUM HIGH

IMPACT ON
REVENUE
TIME TO RECOVER
DISTIVE
ALTERNATIVE
RESOURCE

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Supply Chain Management
safety stock, like any inventory, carries with it the risk of obsolescence and also ties up cash. It runs
counter to the popular practice of just-in-time replenishment and lean inventories. But the savings
from those practices have to be weighed against all the costs of a disruption, including lost revenues,
the higher prices that would have to be paid for materials that are suddenly in short supply, and the
time and effort that would be required to secure them.

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Diversify your supply base
“China plus one”
strategy of spreading production between China and a Southeast Asian country such as Vietnam,
Indonesia, or Thailand

So, we leveraged a lot of the relationships that we had with the various different pharmaceutical
companies and set up contracts and relationships bypassing the wholesalers, who we were basically on
allocation with, and getting direct shipments from the pharmaceutical companies directly into the
organization
(Onisis Stefas, PharmD, vice president and chief pharmacy officer at New Hyde Park, N.Y.-based Northwell Health)
How 3 pharmacy leaders are using lessons learned from COVID-19 to prepare for future pandemics
(beckershospitalreview.com)

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Sistem distribusi VS SURGE CAPACITY, SPREADING
Individual Floor stock Centralisasi Unit Dose
Prescription Dispensing

ZONA H CM H C
(Merah/Hijau/Crit
ical)
Waktu ++ + + +++
pengerjaan
Biaya pasien +++ ++ +++ +

Risiko Errors +++ ++++ ++ +

Rejimentasi ++ + + +++
SYSTEM – PASIEN TAKUT KE
RUMAH SAKIT

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TELEPHARMACY
The implementation of telepharmacy services in a multihospital
health system expanded hours of service, improved the speed of
processing of physician medication orders, and increased clinical
pharmacy, services and cost avoidance.

Impact of telepharmacy in a multihospital health system, 2010, (Garrelts, Gagnon, et all)

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 LEAN MANAGEMENT
It’s time to adopt a new vision suitable to the
realities of the new era

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PERAN PENTING STAKEHOLDER :
KPPI – KFT – TIM KLINIS

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Praktik apoteker klinis :
kesempatan percepatan dan
perkembangan di era pandemi Covid-19

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 Patient safety : freedom from accidental or
preventable injuries produced by medical care

Medication safety : freedom from preventable harm

DAMPAK
RINGAN
→ FATAL (KOMORBID)
22
EFEKTIFITAS

23
 Penatalaksanaan
KASUS BERAT
farmakologi
KASUS SEDANG
✓ Klorokuin fosfat, 500 mg/12 jam/oral (hari ke 1-3) dilanjutkan 250 mg/12 jam/oral (hari ke 4-10)
✓ Vitamin C 200 –ATAU
400Hidroksiklorokuin
mg/8 jam dalamdosis 400
100 cc mg0,9%
NaCl /24 jam/oral (untuk
habis dalam 5 hari),
1 jam setiapsecara
diberikan 3 hari drips
kontrol EKG
Intravena (IV)
selama perawatan
✓ Azitromisin 500 mg/24 jam (untuk 5 hari)
✓ Klorokuin fosfatatau
500levofloxacin
mg/12 jam750oral mg/24
(5-7 hari)
jam/intravena (5 hari)
ATAU Hidroksiklorokuin (sediaan
✓ Bila terdapat yg adasepsis
kondisi 200 mg) hari ko-infeksi
karena pertama 400 mg/12
bakteri, jam/oral,
pemilihan selanjutnya
antibiotik 400 mg/24
disesuaikan dengan kondisi
jam/oral ( 5-7 hari) klinis,
✓ Azitromisin 500 mg/24
fokus jam perdan
infeksi iv atau perrisiko
faktor oral (untuk 5- 7pada
yang ada hari)pasien.
dengan
alternatif Levofloxacin 750 mg/24
Pemeriksaan jam
kultur per ivharus
darah ataudikerjakan
per oral (untuk 5-7 hari)
✓ Pengobatan simtomatis (Parasetamol
Pemeriksaan dan lain-lain).
kultur sputum (dengan kehati-hatian khusus) patut dipertimbangkan.
✓ Antivirus : ✓ Antivirus : Oseltamivir 75 mg/12 jam oral ATAU Favipiravir (Avigan sediaan 200 mg) loading dose 1600

KEAMANAN
mg/12jam
Oseltamivir 75 mg/12 jam/oral
oral hari ke-1 dan selanjutnya 2 x 600 mg (hari ke 2-5)
Vitaminsediaan
✓ (Avigan
ATAU Favipiravir C 200 – 400
200 mg/8
mg) jam dalam
loading 100 ccmg/12
dose 1600 NaCl 0,9% habis
jam/oral dalam
hari ke-11dan
jamselanjutnya
diberikan secara
2 x 600drips
mg (hari ke 2-5) Intravena (IV) selama perawatan
✓ Vitamin B1 1 ampul/24 jam/intravena
PROTOKOL PENATALAKSANAAN COVID-19
✓ Hydroxycortison 100 mg/24 jam/ intravena (3 hari pertama)
24
Crisis = fast tract, opens up doors for
innovation and doing things differently
this crisis actually helped fast track or solidify some of the shared services needs around gathering of information.

ID pharmacists, system critical care pharmacists, essentially created the guidelines

When we had our system and pharmacy therapeutics committee, we were able to make quick changes and
disseminate that information quickly to all of our providers or nurses and pharmacies.

(Adrian Gonzales, PharmD, system director of central pharmacy services at Roseville, Calif.-based Adventist Health, )

How 3 pharmacy leaders are using lessons learned from COVID-19 to prepare for future pandemics
(beckershospitalreview.com)

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Pharmacy response to COVID-19:
lessons learnt from Canada
Ali Elbeddini1* , Amy Botross2 , Rachel Gerochi2 , Mohamed Gazarin1 and Ahmed Elshahawi3

Pharmacists’ key responsibilities during COVID-19 shifted dramatically, in such a short period of
time, to include delivery of pharmacists’ services through telehealth and telemedicine. As COVID-
19 impacted direct patient care, telemedicine provided an opportunity to optimize medication
management for the high-risk immunocompromised population and for people who were self-
isolating [4].
Pharmacists also became increasingly involved in managing and renewing chronic medications,
providing minor ailment consultations, clarifying misconceptions and screening patients for
COVID-19 symptoms [5].
Moreover, pharmacists spend a signifcant amount of time communicating and connecting with
other HCPs, on behalf of their patients, to clarify drug orders and offer recommendations and
pharmaceutical opinions to enhance medication management

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 Keraguan
PAN
DEM
IC

Signifikan
Apoteker
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OBAT DENGAN PENANGAN
KHUSUS

REMDESIVIR • REKONSTITUSI DAN DILUSI

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 PRAKTIK APOTEKER KLINIK
SEMAKIN BERKEMBANG
DALAM KOLABORASI
PIO

KOLABORASI
REKONSILIASI KONSELING

DIGITAL
PRAKTIK’
APOTEKER KLINIK

PTO MESO

IV-ADMIXTURE

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 Menjaga keseimbangan :

keamanan petugas
dan
kualitas pelayanan kefarmasian di
rumah sakit

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Health systems’ top concerns, both
personally and professionally, during the
COVID-19 pandemic
Health systems have also been challenged to determine which staff members need to be on-
site versus who can work remotely.

Pharmacies are finding that not every role needs to be there in person seven days a week.
Clinical pharmacists, for example, can be remote for a good portion of their position as they
can do counseling and medication management via the phone or computer.

But pharmacy technicians are the ones who need to be on site, as they are mixing and
delivering the medications.

How health system pharmacies are navigating the ‘new normal’: Lessons learned from the COVID-19 pandemic
(beckershospitalreview.com)

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Staf terpapar vs surge capacity
Not only did we have our own staff that was impacted by COVID, we also had a surge in
volume, and with that surge in volume, we needed additional resources.

partnered, but this time, with the

(Dr. Onisis Stefas)

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 1. Visoner 2.
Optimistis,tdk
gampang
menyerah

9. Karakter 3. Tantangan
AGILE dijadikan
(tangkas/lincah) peluang 4.
inovator

Leadership

7. Problem solver
5. Kemampuan
8. Risk
hard skills dalam
management
manjemen
ability

6. Kemapuan
soft skills
(komunikasi,neg
osiasi, conlict
resolution)

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Take home messages
❖PANDEMIK BERMASALAH PADA SUPPLY CHAIN PERBEKALAN KESEHATAN

❖PANDEMIK MEMERLUKAN GUIDANCE DALAM MANAJEMEN KLINIS

❖PANDEMIK PINTU KOLABORASI TIM KLINIK

❖KETERBUKAAN, INOVASI, NETWORKING, TEKNOLOGI MENDUKUNG KEBERLANGSUNGAN BISNIS

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TERIMA KASIH – MATUR NUWUN

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