PERKHIDMATAN FARMASI PESAKIT DALAM
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.
Objektif
To dispense medications to inpatients and
discharge patients via the prescription or
imprest system
To provide pharmaceutical care via patient
counseling
Skop Tugas
Dispensing
Medication counseling
Stock management
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
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
Ubat-ubatan Untuk
Pesakit Dalam Wad
(Inpatient)
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
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.
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
Preskripsi Bermasalah
Hantar Balik
Sticker Kuning
•Masalah Dos
•Kekerapan
• Jangkamasa
Cop Kosign
Pakar
Pembekalan Proses bekalan:
Melabel,
mengisi
menyediakan persediaan ekstemporaneus,
merekod,
menyemak balas,
Pembekalan melalui: Unit Dos
Unit Of Use
Imprest stock/ward stock
Semaksilang
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.
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.
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
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
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
Inpatient drug distribution
Supplying medications
to ward patients in
individualised bins
Preparing medication
from discharge scripts
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.
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.
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
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
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
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.
Permonitoran Stok
Memastikan stok sentiasa ada dan mencukupi
Mengelakkan ubat luput
Mengelakkan overstocking
Mengurangkan slow moving item
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
.
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
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)
THANK YOU
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