CLINICAL PHARMACY

Hansen N, S.Si., Apt., Sp.FRS

Its not the strongest species

that survives, nor the most
intelligent, but the ones most
responsive to change
(Charles Darwin)

Clinical
Pharmacy

Gaps

Trends

Future
Needs

UCSF
Story

Clinical Pharmacy Philosophy

Pharmacists are the most highly trained experts on

drugs and drug products
Best professional to:

Promote rational drug prescribing

Teach patients to use drugs appropriately
Identify and prevent medication problems
Silverman, M and Lee, PR:
Pills, Profits, and Politics
UC Press 1975

Clinical
Pharmacy

Gaps

Trends

Future
Needs

UCSFs
Story

Model Works Well in Hospitals

Dr. Donald Brodie, 1965 :

The ultimate goal of the
Services of Pharmacy
must be
the SAFE USE of DRUGS
by the Public

Historical Milestones in the

Clinical Pharmacy Movement
1944- Clinical Pharmacy as an
educational tool first used
University of Washington, Prof. L. Wait
Rising
Disapproved by AACP and ACPE in 1946

1969- the term Clinical Pharmacy

comes to be used to denote patientoriented pharmacy practice

Decentralized Pharmacy
Services:
The Satellite Pharmacy Concept
Brought pharmacist into the
patient care environment
Health care professionals could put
a face to a name
Pharmacist was easily accessible
to assist with drug-related
problems

Decentralized Pharmacies:
made it possible for the physician, if he
so wishes, to discuss drug usage with
the pharmacists at the time the decision
is being made
and

provided students with adequate experience

in applying scientific and professional
knowledge gained in the classroom to the
practical aspects of drug usage in
therapeutic situations
Day, RL, et al. DICP 1991;25:308-314

What is a Clinical
Pharmacist?
1981- All pharmacists are clinical
pharmacists (ASHP)
1981-American College of Clinical
Pharmacy counters with a
pharmacists duties define whether
he is a clinical pharmacist

Clinical Pharmacy
(in the early years):
is a concept or a philosophy
emphasized the safe and appropriate
use of drugs in patients
focused on patient and not product
placed responsibility for drugs
therapy on all health disciplines who
are in any way concerned with drugs

Clinical Pharmacists
Functions in the Drug Use
Process

Medication history taking

Drug therapy advisor
Drug therapy monitoring
Patient drug counseling
Drug usage review
Drug therapy management
McLeod, DC, Am J Hosp Pharm 1976;33:904-911

Clinical
Pharmacy

Gaps

Trends

Future
Needs

UCSFs
Story

Model Works Well in Hospitals

Therapeutic advisors
Patient education
Drug use review and policy
Formulary work
Medication safety

Hospital practice
admission
Pharmacists attend pre-admission
clinics for planned admissions
Assess patients needs for medicines to
be prescribed during their stay, write
their prescriptions, provide any advice on
what should be stopped before surgery

For unplanned admissions,

pharmacists take medication history,
may write prescription

Some pharmacists have trained to

prescribe

Dispensing in hospital
Clinical
Pharmacist

Doctor

electronic
prescription
Patient

Pharmacy
technician

Dispensary
Robot
dispensed
drug

Only large teaching hospitals

Hospital practice
during hospital stay

Pharmacists check prescriptions regularly

frequency depends on type of ward and
correct any errors by discussion with
prescribers
Pharmacists provide advice to prescribers
as required
Some nurses have trained to prescribe

Some pharmacists select drugs and doses

for patients and write prescriptions
Pharmacists monitor quality of prescribing

Hospital practice - discharge

Pharmacists check discharge prescription
to make sure it is correct and all items are
clinically indicated, may write discharge
prescription
Pharmacists assess patients ability to
administer their own medicines and
provide advice to patients prior to
discharge
Hospital pharmacists discuss patients with
community pharmacists before discharge if
required

Primary care practice

Pharmacists are based within medical
practices (like PCU) most are part-time
Pharmacist may provide services directly
to patients and prescribe for them
Warfarin management (INR testing)
COPD clinics (spirometry)
doctors and nurse
prescribers
Medication reviews

Pharmacists advise other prescribers

Primary care pharmacists discuss patients
with hospital pharmacists if required

Community pharmacy
Pharmacists must provide advice with all
prescriptions and purchased medicines
Pharmacists all keep patient medication
records
Many pharmacists provide medication
reviews need to complete training
Some also trained as prescribers, provide
specialist clinics
Some provide screening for diabetes,
hypertension, osteoporosis

Kurikulum S1 farmasi
inggris

Definisi Pharmaceutical care menurut

Federation International
Pharmaceutical
Ph care is the responsible provision of pharmacotherapy for the purpose of achieve definite
outcomes that improve or maintain a patients
quality of life. It is a collaborative process that
aims to prevent or identify and solve medicinal
product and health related problems. This is a
continous quality improvement process for the
use of medicinal products.

Pharmaceutical Care ?
Hepler and Strand (1990)
from: Am. J Hosp Pharmacy 47,533-543
Is the direct responsible provision of medication
related care for the purpose of achieving definit
outcomes that improve patients quality of life
Outcomes:

kesembuhan (cure of disease)

pengurangan gejala penyakit (elimination or

reduction of patients symptoms)

perlambatan proses terjadinya penyakit

(arresting or slowing of a disease process)

pencegahan penyakit atau gejala penyakit

(preventing a disease or symptoms)

Clinical Pharmacy Services

2. EDUCATION
TALKS TO DOCTORS AND NURSES

HUKM Pharmacy Counseling Week

Selama peresepan
Konseling
Pharmacist

Patient

Karakteristik praktek farmasi

klinik
Berorientasi kepada pasien
Terlibat langsung di ruang perawatan di rumah
sakit (bangsal)
Bersifat pasif, dg melakukan intervensi setelah
pengobatan dimulai atau memberikan informasi
kalau diperlukan
Bersifat aktif, dg memberi masukan kpd dokter
sebelum pengobatan dimulai atau menerbitkan
buletin2 informasi obat atau pengobatan
Bertanggungjawab terhadap setiap saran atau
tindakan yang dilakukan
Menjadi mitra dan pendamping dokter

Kendala
Kurangnya pengetahuan teknis
Kurangnya kemampuan berkomunikasi
Tekanan kelompok kerja/ketidaknyamanan
kerja
Kurangnya motivasi dan keinginan untuk
berubah
Kurang percaya diri
Kurang pelatihan dalam arus kerja yg sesuai
Peningkatan persepsi tentang tanggung
jawab
Kurangnya staf di Instalasi Farmasi

Bagaimana di Indonesia ??
Kegiatan manajerial merupakan kegiatan
utama merupakan sumber pemasukan
uang terbesar di RS
Kegiatan klinik masih relatif sangat sedikit
dilakukan banyak kendala (apa ?)
Farmasis belum banyak dilibatkan dalam
tim kesehatan tidak dianggap sebagai
tenaga kesehatan, tapi lebih sebagai
penunjang medis

 Faktor sejarah : farmasi termasuk ilmu MIPA padahal

farmasi adalah profesi pelayanan kesehatan

Farmasis kurang kompeten mengapa ? (dulu)
Pendidikan farmasi tidak fokus farmasis ada di manamana, tapi tidak terasa adanya
Farmasis belum bisa menunjukkan kemampuannya di
bidang klinis, tidak percaya diri, dan kurang bisa
menjalin kerjasama dgn tenaga kesehatan lain
Kebijakan direktur RS tidak mendukung : Jumlah
farmasis terbatas, disibukkan dengan kegiatan
manajerial
Belum ada reward yang sepadan dengan pekerjaan
But dont worry kebijakan yang diusulkan Bina
Farmasi Klinik dan Komunitas Depkes : 1 farmasis untuk
30 bed

KEP. MENKES 1197 TH. 2004

PELAYANAN FARMASI
RUMAH SAKIT
BERORIENTASI PADA :
PELAYANAN PASIEN
PELAYANAN FARMASI
KLINIK