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Penggunaan Daftar Tilik (Checklist) sebagai Panduan Read-Back Mengurangi Potensi Risiko Medication Error Maharjana, Ida Bagus N.; Kuswardhani, Tuty; Purwaningsih, Cok I. I.
Indonesian Journal of Clinical Pharmacy Vol 3, No 2 (2014)
Publisher : Indonesian Journal of Clinical Pharmacy

Rumah sakit sebagai lini terakhir pelayanan kesehatan berkewajiban memberikan pelayanan berkualitas dan beorientasi pada keselamatan pasien, salah satunya tanggung jawab dalam mencegah medication error. Kolaborasi dan komunikasi yang efektif antar profesi dibutuhkan demi tercapainya keselamatan pasien. Read-back merupakan salah satu cara dalam melakukan komunikasi efektif. Before-after study dengan pendekatan TQM PDCA. Sampel adalah catatan obat pada rekam medik pasien rawat inap RSUP Sanglah pada minggu ke-3 bulan Mei (before) dan minggu ke-3 bulan Juli (after) 2013. Perlakuan dengan menggunakan checklist, meminta waktu 2 menit untuk read-back oleh dokter dan perawat seusaivisite bersama. Didapatkan 57 sampel (before) dan 64 sampel (after). Before 45,54% ketidaklengkapan pengisian catatan obat pada rekam medik pasien yang berpotensi risiko medication error menjadi 10,17% setelah perlakuan read-back dengan checklist selama 10 minggu, dengan pencapaian 77,78% berdasarkan pendekatan TQM PDCA. Panduan read-back menggunaan daftar tilik (checklist) sebagai komunikasi efektif dapat menurunkan ketidaklengkapan pengisian catatan obat pada rekam medik yang berpotensi risiko medication error, 45,54% menjadi 10,17%.Kata kunci: Checklist, medication error, read-backChecklist Usage as a Guidance on Read-Back Reducing the Potential Risk of Medication ErrorHospital as a last line of health services shall provide quality service and oriented on patient safety, one responsibility in preventing medication errors. Effective collaboration and communication between the profession needed to achieve patient safety. Read-back is one way of doing effective communication. Before-after study with PDCA TQM approach. The samples were on the medication chart patient medical records in the 3rd week of May (before) and the 3rd week in July (after) 2013. Treatment using the check list, asked for time 2 minutes to read-back by the doctors and nurses after the visit together. Obtained 57 samples (before) and 64 samples (after). Before charging 45.54% incomplete medication chart on patient medical records that have the potential risk of medication error to 10.17% after treatment with a read back check list for 10 weeks, with 77.78% based on the achievement of the PDCA TQM approach. Checklistusage as a guidance on Read-back as an effective communication can reduce charging incompletenessdrug records on medical records that have the potential risk of medication errors, 45.54% to 10.17%.Key words: Checklist, medication error, read-back

Penggunaan Daftar Tilik (Checklist) sebagai Panduan Read-Back Mengurangi Potensi Risiko Medication Error Ida Bagus N. Maharjana; Tuty Kuswardhani; Cok I. I. Purwaningsih
Indonesian Journal of Clinical Pharmacy Vol 3, No 2 (2014)
Publisher : Universitas Padjadjaran

Rumah sakit sebagai lini terakhir pelayanan kesehatan berkewajiban memberikan pelayanan berkualitas dan beorientasi pada keselamatan pasien, salah satunya tanggung jawab dalam mencegah medication error. Kolaborasi dan komunikasi yang efektif antar profesi dibutuhkan demi tercapainya keselamatan pasien. Read-back merupakan salah satu cara dalam melakukan komunikasi efektif. Before-after study dengan pendekatan TQM PDCA. Sampel adalah catatan obat pada rekam medik pasien rawat inap RSUP Sanglah pada minggu ke-3 bulan Mei (before) dan minggu ke-3 bulan Juli (after) 2013. Perlakuan dengan menggunakan checklist, meminta waktu 2 menit untuk read-back oleh dokter dan perawat seusaivisite bersama. Didapatkan 57 sampel (before) dan 64 sampel (after). Before 45,54% ketidaklengkapan pengisian catatan obat pada rekam medik pasien yang berpotensi risiko medication error menjadi 10,17% setelah perlakuan read-back dengan checklist selama 10 minggu, dengan pencapaian 77,78% berdasarkan pendekatan TQM PDCA. Panduan read-back menggunaan daftar tilik (checklist) sebagai komunikasi efektif dapat menurunkan ketidaklengkapan pengisian catatan obat pada rekam medik yang berpotensi risiko medication error, 45,54% menjadi 10,17%.Kata kunci: Checklist, medication error, read-backChecklist Usage as a Guidance on Read-Back Reducing the Potential Risk of Medication ErrorHospital as a last line of health services shall provide quality service and oriented on patient safety, one responsibility in preventing medication errors. Effective collaboration and communication between the profession needed to achieve patient safety. Read-back is one way of doing effective communication. Before-after study with PDCA TQM approach. The samples were on the medication chart patient medical records in the 3rd week of May (before) and the 3rd week in July (after) 2013. Treatment using the check list, asked for time 2 minutes to read-back by the doctors and nurses after the visit together. Obtained 57 samples (before) and 64 samples (after). Before charging 45.54% incomplete medication chart on patient medical records that have the potential risk of medication error to 10.17% after treatment with a read back check list for 10 weeks, with 77.78% based on the achievement of the PDCA TQM approach. Checklistusage as a guidance on Read-back as an effective communication can reduce charging incompletenessdrug records on medical records that have the potential risk of medication errors, 45.54% to 10.17%.Key words: Checklist, medication error, read-back

ANTIMICROBIAL STEWARDSHIP STRATEGY TO REDUCE LENGTH OF STAY AND COST OF ANTIBIOTIC CONSUMPTION: A SYSTEMATIC REVIEW Damayan, Anak Agung Istri Agung Sri Stuti; Maharjana, Ida Bagus Nyoman; Nurwahyuni, Atik
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (565.803 KB)

Background: Reducing the cost of care and length of stay for patient in hospital are important to monitor the benefits of implementing an antimicrobial management program. An antimicrobial management program is a strategy to decrease Antimicrobial Resistance (AMR) that affect to the treatment of the patient. One of the antimicrobial management programs is Antimicrobial Stewardship Programs (ASP). This study aims to determine the appropriate strategies in the application of Antimicrobial Stewardship Programs (ASP) that can reduce the length of stay and cost of antibiotic consumption for patient in hospital.Methods: This study was a systematic review that used PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Data obtained from Electronic databases ProQuest and Medline (PubMed) that published five years times span. By using keywords such as antimicrobial stewardship, antimicrobial resistance, length of stay, length of the hospital and patient cost to find the relevant journal. Results: The search found 3,541 studies, of which 26 studies were included in the systematic review. After excluded the article review, there were 9 studies that used quasi-experimental, observational cohort studies and Randomized Control Trial (RCT). These studies conducted majority in Europe and USA, only 1 study that conducted in Asia. Analysis of the studies found out that 6 of 9 studies mentioned if ASP can reduce the length of stay of the patient in hospital. Only 3 of 9 studies that examined the effect of ASP in cost of care and these 3 studies mentioned ASP can reduce the cost of care. Conclusion: This study showed that implementing ASP can reduced the length of stay and antibiotics consumption among patient in hospital by manage the antimicrobial use, conduct audits and feedback in an appropriate step, and intravenous to oral switch program.

FACTORS RELATED TO THE REDUCTION OF MEDICATION DISCREPANCIES AT TRANSITION OF CARE: A SYSTEMATIC REVIEW Maharjana, Ida Bagus Nyoman; Wibowo, Adik
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (682.918 KB)

Background: Adverse drug events (ADE) are a leading cause of injury and death within health care systems around the world. Up to 67% of patients? prescription medication histories recorded on admission to hospital have one or more errors and 30 ? 80% of patients have a discrepancy between the medicines ordered in hospital and those they were taking at home. This study aims to systematically evaluate the available literature on the medication history records as a quality improvement in reducing medication discrepancies during the transition of care. Methods: This study was used systematic review which performed according to the PRISMA method. The search included articles were obtained through databases: MEDLINE (1946), EMBASE (1966), CINAHL (1937) and PubMed (1946). Some of the key words or Medical Subject Heading (MeSH) terms used in the search were: ?transition of care,? ?medication discrepancies,? ?medication errors,? ?patient safety,? ?medication history,? ?patient admission,? ?patient discharge,? ?patient transfer,? and ?hospital?. Only studies published in English were included. Exploring literature was focused on the articles published from 2009 to 2019. Results: Initially, a total of 162 potentially relevant articles were obtained. After screening tittle and reviewing abstracts, 14 full text were assessed for eligibility. Of the 10 articles met all inclusion criteria, 5 studies were randomized controlled trials, 2 quasi-experimental studies, 1 cohort study, and 2 qualitative studies with quantitative approaches. All studies found that involving best possible medication history in identifying medication discrepancies and communicating this information affected medication discrepancies in the medical record. Conclusions: The available literature such as lack of well-designed studies precluded us from concluding that no effect exists. Medication reconciliation supported by information technology was an important tool for minimizing the percentage of medications with unintentional discrepancies

PREVENTION AND MANAGEMENT FOR THE COMPLICATION OF THIRD MOLAR SURGERY : A SYSTEMATIC REVIEW Wirastuti, Ida Ayu; Maharjana, Ida Bagus Nyoman; Soewondo, Prastuti
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: Impacted third molar surgery is one of the most common procedures performed by maxillofacial surgeons and it is often attended by complications. Although clinical conditions associated with retained third molars are well understood, little is known about the impact of those conditions on the quality of life among affected patients. There is growing recognition that the impact of oral conditions on quality of life is an important outcome that can be quite useful in making treatment decisions. All the information in this review could be useful for the clinicians in order to show the surgical and pharmacologic parameters that may influence the postoperative discomfort in the third molar surgeries. Methods: This systematic review followed the recommendations in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Some of the key words or Medical Subject Heading (MeSH) terms used in in the two data bases (Proquest and Google Scholar) were: (1) Third Molar Surgery, (2) Complication, (3) Prevention. The articles were published in English from 2009 to 2019. Results: Studies were eligible if they evaluated prevention and management for the complication of third molar surgery, and eight studies for qualitative synthesis. Of the eight articles, all studies were selected with Randomized Control Trial. Eight studies were included because they discussed the prevention and management of third molar surgery complication. Almost all of the practices of prevention and management of third molar surgery complication described that analgetic ibuprofen and paracetamol were used for decreasing the pain, and also amoxicillin tablet was used as an antibiotic for preventing high risk complication. According to studies, prophylactic use of chlorhexidine mouth rinse in third molar surgery are equally effective in keeping post operative infection to a minimum level in medically competent patient. Conclusions: All studies revealed that the most common complications of third molar surgery were pain, trismus, swelling, alveolar osteitis, and dry socket. Those studies discussed the prevention and management third molar surgery complication. Ibuprofen and paracetamol were used to decrease the pain, amoxicillin (1g) and amoxicillin/clavulanate (875/125mg) had similar efficacious in preventing infection after retained third molar extraction, but amoxicillin and clavunate (875/125mg) produced more gastrointestinal discomfort. Prophylactic use of chlorhexidine mouth rinse and gel in third molar surgery were equally effective in keeping post operative infection. Corticosteroid had a significant and sustained anti- inflammatory effects.

PREVENTION AND MANAGEMENT FOR THE COMPLICATION OF THIRD MOLAR SURGERY : A SYSTEMATIC REVIEW Ida Ayu Wirastuti; Ida Bagus Nyoman Maharjana; Prastuti Soewondo
Proceedings of the International Conference on Applied Science and Health No. 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: Impacted third molar surgery is one of the most common procedures performed by maxillofacial surgeons and it is often attended by complications. Although clinical conditions associated with retained third molars are well understood, little is known about the impact of those conditions on the quality of life among affected patients. There is growing recognition that the impact of oral conditions on quality of life is an important outcome that can be quite useful in making treatment decisions. All the information in this review could be useful for the clinicians in order to show the surgical and pharmacologic parameters that may influence the postoperative discomfort in the third molar surgeries. Methods: This systematic review followed the recommendations in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Some of the key words or Medical Subject Heading (MeSH) terms used in in the two data bases (Proquest and Google Scholar) were: (1) Third Molar Surgery, (2) Complication, (3) Prevention. The articles were published in English from 2009 to 2019. Results: Studies were eligible if they evaluated prevention and management for the complication of third molar surgery, and eight studies for qualitative synthesis. Of the eight articles, all studies were selected with Randomized Control Trial. Eight studies were included because they discussed the prevention and management of third molar surgery complication. Almost all of the practices of prevention and management of third molar surgery complication described that analgetic ibuprofen and paracetamol were used for decreasing the pain, and also amoxicillin tablet was used as an antibiotic for preventing high risk complication. According to studies, prophylactic use of chlorhexidine mouth rinse in third molar surgery are equally effective in keeping post operative infection to a minimum level in medically competent patient. Conclusions: All studies revealed that the most common complications of third molar surgery were pain, trismus, swelling, alveolar osteitis, and dry socket. Those studies discussed the prevention and management third molar surgery complication. Ibuprofen and paracetamol were used to decrease the pain, amoxicillin (1g) and amoxicillin/clavulanate (875/125mg) had similar efficacious in preventing infection after retained third molar extraction, but amoxicillin and clavunate (875/125mg) produced more gastrointestinal discomfort. Prophylactic use of chlorhexidine mouth rinse and gel in third molar surgery were equally effective in keeping post operative infection. Corticosteroid had a significant and sustained anti- inflammatory effects.

ANTIMICROBIAL STEWARDSHIP STRATEGY TO REDUCE LENGTH OF STAY AND COST OF ANTIBIOTIC CONSUMPTION: A SYSTEMATIC REVIEW Anak Agung Istri Agung Sri Stuti Damayan; Ida Bagus Nyoman Maharjana; Atik Nurwahyuni
Proceedings of the International Conference on Applied Science and Health No. 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: Reducing the cost of care and length of stay for patient in hospital are important to monitor the benefits of implementing an antimicrobial management program. An antimicrobial management program is a strategy to decrease Antimicrobial Resistance (AMR) that affect to the treatment of the patient. One of the antimicrobial management programs is Antimicrobial Stewardship Programs (ASP). This study aims to determine the appropriate strategies in the application of Antimicrobial Stewardship Programs (ASP) that can reduce the length of stay and cost of antibiotic consumption for patient in hospital.Methods: This study was a systematic review that used PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Data obtained from Electronic databases ProQuest and Medline (PubMed) that published five years times span. By using keywords such as antimicrobial stewardship, antimicrobial resistance, length of stay, length of the hospital and patient cost to find the relevant journal. Results: The search found 3,541 studies, of which 26 studies were included in the systematic review. After excluded the article review, there were 9 studies that used quasi-experimental, observational cohort studies and Randomized Control Trial (RCT). These studies conducted majority in Europe and USA, only 1 study that conducted in Asia. Analysis of the studies found out that 6 of 9 studies mentioned if ASP can reduce the length of stay of the patient in hospital. Only 3 of 9 studies that examined the effect of ASP in cost of care and these 3 studies mentioned ASP can reduce the cost of care. Conclusion: This study showed that implementing ASP can reduced the length of stay and antibiotics consumption among patient in hospital by manage the antimicrobial use, conduct audits and feedback in an appropriate step, and intravenous to oral switch program.

Hubungan Dukungan Keluarga dan Peran Tenaga Kefarmasian terhadap Kepatuhan Minum Obat Antihipertensi Apsari, Dewi Puspita; Putra, I Gusti Ngurah Manik Satria Wibawa; Maharjana, Ida Bagus N
Jurnal Ilmiah Medicamento Vol 7 No 1 (2021): Jurnal Ilmiah Medicamento
Publisher : Fakultas Farmasi Universitas Mahasaraswati Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36733/medicamento.v7i1.1499

Hipertensi yang tidak terkontrol dapat mengakibatkan berbagai macam komplikasi. Ketidakpatuhan terhadap pengobatan adalah salah satu penyebab hipertensi tidak terkontrol. Dukungan keluarga dan peran tenaga kefarmasian yang tinggi merupakan faktor yang dapat mempengaruhi kepatuhan pasien dalam menjalankan terapi hipertensi. Penelitian ini bertujuan mengetahui hubungan dukungan keluarga dan peran tenaga kefarmasian terhadap kepatuhan minum obat antihipertensi di Puskesmas. Desain penelitian yang digunakan adalah analitik dengan pendekatan cross sectional study. Penelitian dilaksanakan pada bulan Maret-Mei tahun 2020 dan populasi pada penelitian ini adalah 100 pasien hipertensi lansia yang melakukan pengobatan rawat jalan di Puskesmas Mengwi I. Analisis data dilakukan dengan cara univariat dan bivariat dengan menggunakan uji Rank Spearman. Hasil uji statistik yang dilakukan didapatkan hubungan yang signifikan (p=0,00) dan kuat (r=0,558) antara skor total dukungan keluarga terhadap kepatuhan minum obat antihipertensi pada 73 (73 %) responden. Selain itu juga pada peran tenaga kefarmasian, terlihat hubungan yang signifikan (p=0,00) antara penyediaan informasi, konseling pengobatan dan gaya komunikasi tenaga farmasi terhadap kepatuhan minum obat antihipertensi. Dari hasil penelitian dapat disimpulkan bahwa dukungan keluarga dan peran tenaga kefarmasian berpengaruh signifkan terhadap kepatuhan minum obat antihipertensi di Puskesmas Mengwi I.

FACTORS RELATED TO THE REDUCTION OF MEDICATION DISCREPANCIES AT TRANSITION OF CARE: A SYSTEMATIC REVIEW Ida Bagus Nyoman Maharjana; Adik Wibowo
Proceedings of the International Conference on Applied Science and Health No. 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: Adverse drug events (ADE) are a leading cause of injury and death within health care systems around the world. Up to 67% of patients’ prescription medication histories recorded on admission to hospital have one or more errors and 30 – 80% of patients have a discrepancy between the medicines ordered in hospital and those they were taking at home. This study aims to systematically evaluate the available literature on the medication history records as a quality improvement in reducing medication discrepancies during the transition of care. Methods: This study was used systematic review which performed according to the PRISMA method. The search included articles were obtained through databases: MEDLINE (1946), EMBASE (1966), CINAHL (1937) and PubMed (1946). Some of the key words or Medical Subject Heading (MeSH) terms used in the search were: “transition of care,” “medication discrepancies,” “medication errors,” “patient safety,” “medication history,” “patient admission,” “patient discharge,” “patient transfer,” and “hospital”. Only studies published in English were included. Exploring literature was focused on the articles published from 2009 to 2019. Results: Initially, a total of 162 potentially relevant articles were obtained. After screening tittle and reviewing abstracts, 14 full text were assessed for eligibility. Of the 10 articles met all inclusion criteria, 5 studies were randomized controlled trials, 2 quasi-experimental studies, 1 cohort study, and 2 qualitative studies with quantitative approaches. All studies found that involving best possible medication history in identifying medication discrepancies and communicating this information affected medication discrepancies in the medical record. Conclusions: The available literature such as lack of well-designed studies precluded us from concluding that no effect exists. Medication reconciliation supported by information technology was an important tool for minimizing the percentage of medications with unintentional discrepancies

TERAPI SULIH (SWITCH THERAPY) ANTIBIOTIK PADA PASIEN PNEUMONIA KOMUNITI DI RSUD WANGAYA KOTA DENPASAR Dewi Puspita Apsari; Ni Made Krisna Dwiyanti; I.B.N. Maharjana
Jurnal Insan Farmasi Indonesia Vol 4 No 1 (2021): Jurnal Insan Farmasi Indonesia
Publisher : Sekolah Tinggi Ilmu Kesehatan ISFI Banjarmasin

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36387/jifi.v4i1.662

Hospitalized community-acquired pneumonia (CAP) patients are always prescribed intravenous (IV) antibiotics. Inappropriate and unnecessary IV antibiotics usage leads to an increase in healthcare costs and bacterial resistance. IV to per oral (PO) conversion therapy can overcome these problems. The aim of the study was to evaluate the practice of switching from intravenous to oral antibiotics of inpatients with community-acquired pneumonia (CAP). This retrospective observational study was conducted by taking patient medical record from january until december 2019. Outcomes of the study are patient characteristics, pattern use, antibiotic and type conversion therapy. Adult inpatients on conversion therapy were eligible for study enrollment. Data were analyzed descriptively using SPSS 17.0. The study showed that among 78 patients who were eligible for conversion therapy. Most of the patient has mean duration conversion therapy 48-72 hours as much as 55 (70,5%). Beta-lactams were the most commonly converted antibiotics. However, the step-down therapy was the major type of conversion practiced in this study as much as 48 (61,5) followed by sequential and switch over with numbers 21 (27%) and 9 (11,5%) respectively. Based on the study findings wangaya hospital should improve the practice of sequential therapy in order to reduce the burden of CAP.

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