MEDICATION ERROR:

MASALAH DAN
DAMPAKNYA
Oleh
Urip Harahap

PROGRAM PROFESI APOTEKER

MEDAN 2014

 Pharmacotherapy is a complex process and

involves interaction of the patient and the
healthcare professionals at various levels.
Prevention of medication errors is important
however, errors may occur even in a carefully
monitored healthcare setup.
The out comes of the errors may range from
mild inconvenience to the patient to even fatal
toxic reactions.
There are several predisposing factors for the
occurrence of errors starting from improper drug
J Pharm Sci. technique
selection to errors Pak
in administration
by the healthcare 2006;19(3):244-51.
providers' and patients

 The Institute of Medicine's 1999 report

suggested that medical errors accounted for
44,000-98,000 deaths each year.
These deaths exceed the eighth leading cause of
death in the United States.
It is estimated that the total cost of medical
errors is $17 billion-$29 billion annually.
Although the percentage of drug-related medical
errors in ambulatory settings is unknown, drugs
are the most common cause of medical errors in
hospitals, affecting 3.7% of patients.
Clearly, medication errors are a significant
component of medical errors in U.S. hospitals.
Pharmacotherapy.2001;21(9)

..\PROGRAM PROFESI APOTEKER\MEDICATION ERROR\TTM-1

INTRO TO MEDICATION ERRORS 2013.pdf

KASUS
1. Tuan S, a 63 tahun memiliki sejarah PUD, diterapi idengan
PPIs saja sebagai pasien luar terpaksa masuk ICU akibat
distres pernapasan. Diagnosis menyatakan pasien mengidap
pneumonia. Diagnosis lain menyatakan pasien mengalami
embolisme paru. Tritmen dengan antibiotik dan IV heparin
pun dilakukan. 24 jam kemudian, kondisi klinis pasien
membaik, dan dia pun dipindahkan unit pembelajaran medis.
Sebelum dipindahkan dari ICU, CT scan dada meastikan
bahwa pasien tidak ada embolisme paru.
2. Hari ke 4 setelah di unit pemulihan, berkembang
hematemesis (muntah darah), hipotensi, dan distres
pernapasan. Pasien terpaksa diintubasi, pasien kembali ke ICU
dan diberikan 8 unit darah. Endoscopy menunjukkan ada
perdarahan aktif peptik ulser. Heparin IV dihentikan. Protamin
kemudian diberikan, sebab tromboplastin time > 150 detik.
Dan PPI diresepkan.
3. Mengapa terjad ME?. Apa yang harus dilakukan untuk

A WOMEN DIED
FROM A MEDICATION ERROR
Seorang wanita masuk RS karena nyeri batu
ginjal dan diberi narkotik sebagai pain kllier.
Perawat ternyata mengabaikan instruksi
dokter dan waita itu diberinya depresant
SSP yang lain, sehingga SSP shutting down.
Dan akibatnya terjadi aspiksia (tubuh
kekurangan oksigen akibat gagal
pernapasan). Akhirnya pasien meninggal
dunia
6

MEDICATION ERROR CASES

That case involves a medication dispensing

error ata pharmacy in Xenia, Ohio, in which
the customer was prescribed methimazole and
was dispensed metalozone).

The National Coordinating Council for Medication Error

8
Reporting and Prevention

THE RELATIONSHIP AMONG ME, ADES,

& ADRS
Suatu yang tidak diharapkan,
DRP
Kejadia yang
tidak diinginkan, atau
sesungguhnya bisa
dicegah yang
berpotensi
menyebabkan
penggunaan obat
yang tidak tepat
atau membahaykan
pasien akibat
persepan,
transkripis,
dispensing,
administrasi,
ketidakpatuhan
atau monitoring
obat.

respons obat berlebihan dgn

atau tanpa iinjury
Bahaya secara langsung
akibat penggunaan dan
pemberian dosis yang normal

Medicatio
n Errors

ADEs
ADRs

ME yang dihentikan
Suatu Injuri yang diakibatkan obat atau kurangnya
sebelum terjadi
obat dimaskudkan
bahaya kadang Adverse drug reactions & overdoses
kadang disebut
Dose reductions & discontinuations of drug
near misses atau
Nebecker et al. Ann Intern Med 2004;140: 795-801, J Gen Med therapy
lebih formal
10:199-205,1995.

ME is A Problem

MEDICATION ERROR DEATHS

INCREASING
Deaths from Medication
Errors

1983
Phillips DP. Annu Rev Public Health. 2002;23:13550.

1998

NCC MERP Index for Categorizing Errors

THE MEDICATION USE

SYSTEM
HIGH-LEVEL PORTRAYAL OF A MEDICATION USE
SYSTEM

Selectio
n&
Procurin
g
Establish
formulary

Clinician &
administrat
ors

Prescribing
Assess
patient;
determine
need for
drug
therapy;
select &
order drug

Physicia
n/
prescrib
Joint Commission.
1998
er

Preparing
&
Dispensing
Purchase &
store drug;
review &
confirm
order;
distribute to
patient
location

Pharmaci
st

Administer
ing
Review
dispensed
drug order;
assess
patient &
administer

Monitorin
g
Assess
patient
response
to drug;
report
reactions &
errors

All
Nurse/other
practitioners,
health
plus patient
professionals
&/or family

MAJOR AREAS FOR MEDICATION

ERROR

39%

38
%
12%

Medication Errors Reporting

Program US

11
%

Gambar 1: Hubungan berbbagai

definisi terkait dengan DRP

CLASSIFICATION OF INTRINSIC
TOXICITY

CLASSIFICATION OF EXTRINSIC
TOXICITY
ME can be divided into five main
classes: prescribing, transcription,
dispensing, administration (including
non-compliance) and across settings
(errors occurring on the interface
between different healthcare settings
for example, between hospital and
ambulatory care)

Where do medication errors occur?

Prescribing

39%

Transcribing

Dispensing

12%

11%

Administering

38%

JAMA 1995 Jul 5,274(1):2

ERROS IN MEDICATION
CYCLE
MDICATION
MANGEMENT
PROCESSES

E
R
R
O
R
S

ORDERI
NG
Wrong Dose
Wrong Drug
Wrong
Route/Form
Allergy, Drug
Interaction

TRANCRIBIN
G

Wrong
Wrong
Wrong
Wrong
Wrong

Dose
Route
Patient
Time
Drug

DISPENSIN
G

Wrong Dose
Wrong Route
Wrong Patient
Wrong Time
Incorrect
Labelling
Primary catch
allergy, Drug
Interaction

ADMINSTERIN
G

Wrong Patient
Wrong Dose
Wrong Drug
Wrong
Time/Omitted
Wrong Route
Frequently
Involves
Infusion
Pump

Lucean, Leape, et al., JAMA, 1995

DEATHS FROM MEDICINES IN THE UK

1999 - 2000 (ICD9 & 10 DATA)

A spoonful of sugar - Audit Commission (2001)21

Ratio of death to 1979

levels

DEATHS FROM MEDICATION

ACCIDENTS
Phillips DP, Breder CC,
Annu. Rev. Public Health
2002; 23: 135-50

Prescription
Medicne

Railwa
Motor Vehicle
y
Water
transport
Air transport

Year of
death

22

KLASIFIKASI ME

23

KLASIFIKASI ME

FIVE RIGHTS MEDICATIONS

1. Right Patient
2. Right Drug
3. Right Dose
4. Right Route
5. Right Frequency
Waspada Efek
samping
25

They just count a few tablets

26

Department of
Pharmacy
Hospital UKM
Cheras KLMalaysia

27

Principles
We all make errors
All human beings without exception
whatsoever, make errors.. And
such errors are a completely normal
part of human cognitive function
Allnutt M.F. Human factors in accidents. Br. J
Anaesth. Jul 59(7):856-64, 1987.

The health-care system is making

errors
28

Human Error
(Mistakes, Slips, Lapses)
Eror tak bisa dielakkan karena kita punya
ketebartasan :
- limited memory capacity
- limited mental processing capacity
- negative effects of fatigue other stressors

Semua kita bisa saja melakukan kesalahan kapan

saja
Umumnya terjadi karena kekurangcermatan kita
Sebenarnya kejadian efek buruk yang dialami
pasien jauh lebih banyak ketimbang yang kita
perkirakan
Eror selalunya tak segera dapat diketahui (diamati)
29

They just weigh and measure thing

30

PRINSIPIL
Kesalahan bisa saja terjadi pada:
Prescribing, Transcribing, Dispensing,
documenting dan administering
Diperkirakan: :
140,000 masuk RS per tahun terkait
dengan medication problems
20% lebih Medication Errors (ME) berupa
adverse events pada sistem pelayanan
kesehatan di Australia
Cost ME: $380 juta per tahun pada
sistem kesmas di Australia
Australian Council for Safety & Quality in Health Care, Second
31
National Report on Medication Safety, 2002, Commonwealth
Dept of Health, Canberra

 The health-care system is making errors

32

Prinsipil
Kita perlu merancang sistem yang bisa
mengurangi potensi error
Manusia melakukan kesalahan
disebabkan kesalahan sistem , tugas dan
proses yang dikerjakan dirancang dengan
tidak baik
Prof. LucianLeape, Harvard School of Public Health

Mayortitas medical errors sesungguhnya

bukan karena kesembronoan individu atau
tindakan sekelompok orang , tetapi karena
sistem, meski pun tidak menapikan manusia
juga membuat kesalahan
33

 Keselahan lebih umum adalah disebabkan oleh

kesalahan sistem (faulty systems), proses dan
kondisi yang mendorong orang untuk
membuat kesalahan atau sistem itu gagal
untuk mencegah mereka dari kesalahan itu

To Err Is Human: Building A Safer Health System. IOM,

2000.
34

Medical/medication errors in the

UK
10% yang masuk ke RS 10% mengalami
ROM
Diperkirakan 850,000 ADE/thn, dgn cost
2 milar /thn
Sekitar 400 juta karena kelalaian dalam
seting kilins
Dari kejaian itu sepremepatnya
membahayakan hidup pasien
The Chief Medical Officer An Organisation with a Memory
Department of Health (2000)

35

Sources of Error
Prescribing error - selecting the wrong or
inappropriate drug/dose/formulation/duration
etc
Communicating those instructions
Supply error - timely; wrong drug, dose,
route; expired medicines, labelling.
Administration error - timing; wrong route;
wrong rate/technique.
Lack of user education - actions to take.
36

Point of Error

37

Tell me how and when to use the

Medicine

38

Counter-prescribing

39

Not really health care practitioner

businessmen

40

Do you need a degree to be a pharm

41

PRESCRIPTION
ERROR

PRESCRIBIN
Resep didefinisikan
sebagai
G
pesanan/permintaan tertulis dari
seorang dokter kepada apoteker untuk
membuat atau menyerahkan obat
kepada pasien
Agar proses pengobatan berhasil maka
penulisan resep harus baik dan benar
(rasional).

Medication Prescribing Process

Components: Communication
Written Prescription Orders
Medication Ordering Systems
Electronic Order Transmission
Dosage Calculations
Verbal Orders

Cohen MR. Medication Errors. Causes, Prevention, and Risk Management; 8.1-8.23.

Specific Factors Related to Errors

in Medication Prescribing
Decline in renal or hepatic function
13.9%
History of medication allergy 12.1%
Use of abbreviations 11.4%
Incorrect dose calculation
Lesar10.8%
et al. JAMA,
1997

PRESCRIPTION ERROR
7000 Annual deaths in USA are due to
prescription error.
Second largest cause of malpractice
suits in USA.

46

Written Medication Orders: Illegible

Handwriting
16% of physicians have illegible
handwriting
Common cause of prescribing errors
Delays medication administration
Interrupts workflow
Prevalent and expensive claim in
malpractice cases
Anonymous. JAMA 1979; 242: 2429-30; 2. Brodell RT. Arch Fam Med 1997; 6: 296-8; 3.
Cabral JDT. JAMA 1997; 278: 1116-7; 4. ASHP. Am J Hosp Pharm 1993; 50: 305-14;
5. Cohen MR. Medication Errors. Causes, Prevention, and Risk Management; 8.18.23.

Where Do Errors occure?

48

Where do medication errors occur?

Prescribing

39%

Transcribing

Dispensing

12%

11%

Administering

38%

JAMA 1995 Jul 5,274(1):2

ERROS IN MEDICATION
CYCLE
MDICATION
MANGEMENT
PROCESSES

E
R
R
O
R
S

ORDERING

Wrong Dose
Wrong Drug
Wrong
Route/Form
Allergy, Drug
Interaction

TRANCRIBIN
G

Wrong
Wrong
Wrong
Wrong
Wrong

Dose
Route
Patient
Time
Drug

DISPENSIN
G

Wrong Dose
Wrong Route
Wrong Patient
Wrong Time
Incorrect
Labelling
Primary catch
allergy, Drug
Interaction

ADMINSTERIN
G

Wrong Patient
Wrong Dose
Wrong Drug
Wrong
Time/Omitted
Wrong Route
Frequently
Involves
Infusion
Pump

Lucean, Leape, et al., JAMA, 1995

50

Paper Kills

The Challenge of Prescription Ha

Illegible Handwriting
Unclear Abbreviations and Doses
Verbal Communication Among
Physicians, Patients and Pharmac

Source: The Institute of Medicine of the National

Academies of Science (IOM).

ERRORS IN ORDER WRITING

ARE EXTREMELY COMMON
Bates, et al. (1995)
Prospective, randomized examination of
4031 admissions to 11 care units at 2
hospitals:
Adverse drug event rate of 6.5 per 100
admissions 56% were errors in drug ordering
Bates DW, et al. Incidence of Adverse Drug Events and
Potential Adverse Drug Events: Implications for
Prevention. JAMA. 1995; 274: 29-34

CPOE the rationale

52

ERRORS IN ORDER WRITING ARE

EXTREMELY COMMON
770,000 injuries and deaths from adverse
drug events annually
28% are preventable medication errors
56% are professional errors at the time
of ordering
Classen DC, et al. Adverse drug events in hospitalized patients: excess length of
stay, extra costs, and attributable mortality.JAMA. 1997; 277: 301-306
Cullen DJ, et al. Preventable adverse druge events in hospitalized patients: a
comparative study of intensive care units and general care units. Crit Care Med.
1997; 25: 1289-1297

CPOE the rationale

53

A Public Health Crisis

7,000 Americans Die Annually
From Preventable Medication Errors

1.5 Million Americans Injured Annually

by Preventable Medication Errors
Source: The Institute of Medicine
54 of
the National Academies of Science
(IOM).

75% of drug-allergy alerts ignored

In ambulatory world, of
3481 consecutive alerts,
91% of drug-allergy and
89% of high-severity drug
interaction alerts ignored

Weingart, S., et. Al., Arch Int Med,

2003; 163(21):2625
55

PRESCRIBING ERRORS BY
MEDICATION CATEGORY
Antimicrobials 40%
Cardiovascular 18%
Lesar et al. JAMA,
Gastrointestinal 7% 1997
Narcotic analgesics 7%

Antibiotics 34%
Cardiovascular 16%
Gastro-intestinal 7%
Narcotics 6%
Analgesics 5%
Hormonal 4%
All others 38%

McWhorter School of
Pharmacy Faculty
Roger Lander, Pharm.D.
56

Specific Factors Related to Errors

in Medication Prescribing

Decline in renal or hepatic function 13.9%

History of medication allergy 12.1%
Use of abbreviations 11.4%
Incorrect dose calculation 10.8%
Lesar et al. JAMA, 1997

Lesar et al. JAMA, 1997

57

ERRORS -SOLUTIONS
Important to take a systems focus
Humans are error-prone
Punishing the individuals doesnt work

Culture of safety, not of blame

Airline and nuclear power industries

Fix the entire medication process
cPOE with CDS can reduce preventable
ADEs by 83%
Bates, et. al., J Am Med
Informatics Assn, July 1999
58

IT IS HARD TO CRASH AN AIRBUS

340
Jangan melebih laju
yang ditentukan
Jangan tiba-tiba
memutar ketika
menukik
Jangan terlalu cepat
menukik
Jangan tiba-tiba
menarik tuas
Jangan landing tiba-tiba
Jangan tubrukan
dengan sesuatu (misal:
How
banguna
n) hard is it

to crash your
patient?

59

Part of the Cockpit airplane

60

61

62

Many health care professionals may wonder why

doctors need to include purpose on prescriptions.
See Figure 1 for an example of why this guideline is
important. The prescriber in this case confused
hydralazine with hydroxyzine. Because the
purpose of the prescription was included, the
pharmacist
immediately recognized the error and had the order
changed to hydroxyzine.

63

 PREVETION RELATED PRESCRIBING

ERROR.ppt
UPAYA PREVENSI ME PADA DISPENSING.ppt
PREVENTING ME RELATED TO
ADMINISTRATION TTM.ppt
MEDICATION ERRORS RELATED TO
MONITORING.ppt
THE ROLE OF DRUG
VIDEO PREVENTION ME\Preventing
Medication Errors pt 1 of 3.flv
VIDEO PREVENTION ME\Preventing
Medication Errors pt 2 of 3.flv
VIDEO PREVENTION ME\Preventing

65

DAMPAK ME
Medication Error adalah jenis Medical
Error yang paling umum terjadi di
berbagai RS
Diperkirakan 7000 orang meninggal
/tahun (The Business Case for Medication
Safety, February 2003)
Mediaction Error terjadi dengan
regulariats yang sukar dipercaya
Studi di 36 RS (dipublikasi 2002)
ditemukan pada setiap kemungkinan
terjadi 2 ME setiap hari.
66

DAMPAK ME.
Kesalahan pengobatan fatal bukan hal yang
baru. Hasil studi yang dipublikasi pada tahun
1983, melaporkan bahwa kesalahan label
(labeling error) telah terjadi karena tertukarnya
label antara vincristine dan methotrexate
sehingga terjadi kesalahan rute pemberian
vincristine diberi secara intratekal yang berakibat
fatal.
Pada artikel lain (dipublikasi 1970-an dan 1980an)
terjadi kematian ganda akibat kesalahan satu
mediaksi atau lebih
Di awal tahun 1966 University Arkansas
menerbitkan hasil penelitiannnya 66.1% dari 654
terjadi kesalahan pengobatan serius (tidak
67
termasuk wrong time errors)

MEDICAL ERRORS
Diagnostic

Treatment

Preventive

Other

Not doing test

Misreading test
Wrong test
Not acting on
results

Wrong drug,
dose,
route, time
Inappropriate
drug

Failure to
provide
drug or test

Equipment
failure
Communication
failure
Surgery Mixups

Medication
Error
To Err Is Human: Building A Safer Health System. IOM, 2000.
Qual Rev Bull. 19(5):144149, 1993.
68

MEDICATION MANAGEMENT
PROCESS
WHERE ADE AsORIGINATE
Published in Computerized Physician
Order Entry: Costs, Benefits and
Challenges, Feb 2003, AHA

69

Errors in ICU Medication

Administration
Med Administration Errors (3.3%)
Vasoactive Drugs (33%)
Sedative / Analgesics (26%)
Wrong Infusion Rate (40%)
Pharmacist Involvement cited in low rate

Calabrese et al. Intensive Care Med,

2001; 27:1592-1598.
70

MEDICATION ERROR DEATHS

FDA Adverse Events Reporting System
1993-98:
Error Type %
Wrong dose 41
Wrong drug 16
Wrong route 9.5
Phillips J, Meam S, Brinker A, et al. Retrospective
analysis of mortalities associated with medication
errors. Am J Health-sys Pharm, 2001; 58:1835-41.

71

PERAN FARMASI KLINIS MENGURANGI

RESIKO
Admission medication history

Formulary
Prescribing protocols
Allergy check
Prospective review
Administration instruction
Clinical pharmacy
Drug distribution
system

Opportunity
For Error
72

APA YANG TERJADI JIKA KITA TIDAK MELAKUKAN

SEMUA ITU?

Admission medication history

Formulary
Prescribing protocols
Allergy check
Prospective review
Administration instructions
Clinical pharmacy
Drug distribution
system

Opportunity
For Error
Adapted by P.Thornton from J. Reason, 9/01

73

Sources of Errors and Elements

of Defense Against Them

74

The Accident Causation

Model
(Adopted from Reason & Dean)

Latent
Conditions

Acciden

Defences
75

THE MEDICINES MANAGEMENT

CYCLE
DOCTOR

Decision to
prescribe

Transfer
information
Monitor
response

Order entry
Patient

Administer
Distribute

Nurses

Review order
Supply medicine

Supply
information

Pharmacy

76

From Bates et al 19

Drug therapy assessment

Six types of problems which may
result in treatment failure
:
1. Inappropriate selection of medication
2. Inappropriate formulation of medication
3. Inappropriate administration of drug
therapy
4. Inappropriate medication-taking
behaviour
5. Inappropriate monitoring of drug
therapy

77

Proximal Causes of
MedicationErrors*

* Adapted from Leape LL, et al. Systems analysis of adverse drug events.
JAMA 1995;274:35-43
78

IOM Report:
Preventing Medication Errors
IOM study estimated 1.5 million preventable
adverse medication events per year
One medication error per patient per day

Committee on Identifying and Preventing

Medication Errors,
Philip Aspden, Julie Wolcott, J. Lyle Bootman,
Linda R. Cronenwett, Editors.
Washington DC; National Academies Press;
79
2007.

So drugs are safe ..

Photosensitivity from
Amiodarone

Severe extravasation
of amiodarone
infusion
80

NSAID or COX-2 induced peptic ulcer

81

Goitre
Hypothyroidism
Secondary to
Amiodarone

Bleeding due to
anticoagulation
82

Erythemal rash from penicillin in patient with a prev

Known allergy/ adverse drug reaction
83

84
Necrotising fascititis secondary to infection at site of
IV i

Acute Liver failure from Black Cohosh - herbal medic

85

PATIENT CONCERN

ASHP Survey: May 1 and 5, 2

86

IOM Report:
Preventing Medication Errors
IOM study estimated 1.5 million
preventable adverse medication events
per year
One medication error per patient per day
Committee on Identifying and Preventing Medication Errors,
Philip Aspden, Julie Wolcott, J. Lyle Bootman, Linda R.
Cronenwett, Editors.
Washington DC; National Academies Press; 2007.
87

Drug Related Morbidity and

Mortality Costs

Ernst, J Am Pharm Assn.

2001; 41:192-9 (Mar 2001)

88

Safeguard Against Errors in HighRisk Drugs

89

Reducing the risk of adverse events

Always
include a detailed drug history in the consultation

Only
use drug treatment when there is a clear indication

Stop
drugs that are no longer necessary

Check
dose and response, especially in the young, elderly
and those with renal, hepatic or cardiac disease
90

ADHERENCE vs
COMPLIANCE

Adherensi
Tindakan atau kualitas pasien mengikuti
anjuran klinis dari dokter yang mengobatinya
(Kaplan dkk., 1997). Menurut Sacket dalam
Niven (2000) menyatakan kepatuhan adalah
sejauh mana perilaku pasien sesuai dengan
ketentuan yang diberikan oleh profesional
kesehatan.

Compliance: Tindakan atau kerelaan

untuk mencapai hasil yang diinginkan

Variabel yang mempengaruhi Tingkat

adherensi (Bruner 2002
Demogr Penyakit
af

Program
Terapeutik

Psikososial

Usia
keparahan Kompleksitas Intelegensia
Jenis
sikap
penyakit
program
kelamin, hilangnya Efek samping terhadap
Suku
gejala
yang tidak
tenaga
bangsa,
akibat
menyenangk
kesehatan
Status
penerimaan,
terapi.
an.
sosio
atau
ekonomi
penyangkalan
Pendidika
terhadap
n.
penyakit
keyakinan
agama atau
budaya

Faktor yang penyebab Ketidakpatuhan (Niven,

2002)
Pemahaman
tentang
intruksi

Seorang tidak
mematuhi
intruksi jika
pasien salah
memahami
yang
diinstruksikan
oleh profesional
kesehatan

Kualitas
Interaksi

Tingkat
kepatuhan juga
sangat
ditentukan oleh
kualitas interaksi
antara
profesional
kesehatan dan
pasien

Isolasi sosial
dan keluarga

Keluarga
ternyata
merupakan i
faktor penting
menentukan
keyakinan dan
nilai kesehatan
individu, selain
menentukan
keberhasilan
tritmen atau
program
pengobatan
yang diterima
pasien

Keyakinan,
sikap dan
kepribadian

Becker et al
(1979) dalam
Niven (2002)
telah
mengusulkan
bahwa model
keyakinan
kesehatan
berguna untuk
memperkirakan
ketidakpatuhan
terhadap
rencana
pengobatan

Strategi meningkatkan Kepatuhan

(Smet, 1994)

Dukungan
profesional

Dukungan
sosial

Sangat
Ditujukan
diperlukan untuk
pada
meningkatkan
Keluarga
Jika
kepatuhan.
contoh, dengan
profesional
teknik
kesehatan
komunikasi yang
dapat
baik oleh
meyakinkan
profesional
keluarga
kesehatan
pasien akan
(dokter,
meningkatka
farmasisi atau
n kepatuhan
perawat) akan
pasien
menodorong
ketaatan pasien.

Perilaku Sehat

Pemberian
informasi

Modifikasi
Pemberian
perilaku sehat
informasi yang
sangat
jelas pada
diperlukan.
pasien dan
Untuk pasien
keluarga
hipertensi,
mengenai
misal
penyakit yang
bagaimana
dideritanya
cara
serta cara
menghindari
pengobatanny
komplikasi
a sangat
adalah dengan
penting
mengubah
gaya hidup
dan kontrol
secara teratur
atau minum
obat
Ghana Syakira, 2009
antihipertensi

KONSEKUENSI KETIDAKPATUHAN
Untuk invidu:
Pengobatan gagal: misal virus tak ditekan secara
maksimal, menyebabkan desktruksi sistem imun,
progresi penyakit meningkat
Resistensi : Emergensi strain virus resisten
Membatasi opsi tritmen di masa datang : Tritmen
semakian kompleks, lebih toksik, uncertain prognosis

Dari persepektif Kesehatan Masyarakat:

Transmisi virus resisten (potensi gagal pengobatan
tinggi)

Dari perspektif Ekonomi Kesehatan:

Dampak negatif pada penentuan cost-benefit penyakit
Menyebabkan tinggi biaya pasien secara individu dan program

Adherence: Why do Patients Miss Doses? (Barriers to

adherence 1)
FAMILY SAID
NO TO
MEDICATION

AWAY
FROM
HOME

TAKING
PILL
HOLIDAY
S

UNABLE
TO
CARE
FOR
SELF

RAN
OUT
OF
PILLS
DID NOT
WANT
OTHERS
TO SEE

FORGO
T/
BUSY

DID NOT
UNDERSTAND
INSTRUCTIONS

SLEPT
IN

FEAR
SIDE
EFFECTS
FELT
ILL

PILLS
DO NOT
HELP

FELT
BETTER

Lets find together a solution for

your problem
I am listening
You can trust me
I understand
I suggest
What do you think?
Ill explain to you how to take
these medicines

MIS
DO

BARIER LAIN TERKAIT

ADREHERENSI

Sulit berkomunikasi

Tingkat kemampuan

Kurang pengetahauan
tentang penyakit

Pemahaman yang
rendah terhadap
efektivitas obat

Kurang dukungan sosial

Merasa tidak nyaman

karena penyakitnya
terungkap

Kondisi kehidupan yang

sulit

Penggunaan alkohol
dan Narkoba

Depresi dan masalah

psikitarik

Sistem barier

Adherence Multi-disciplinary Roles

Same message from all!

Doctors

Pharmacist

Adherence
Message for
the patient
Family/
Friends

Adherence
Nurse
Counselor
Social
Worker

Adherence to Antiretroviral Therapy in Adults: A guide

for Trainers. Horizon/Population Council

Strategies and Tools to Enhance

Adherence (1)
Pre-treatment strategies
Identifikasi potensial non-adherent dan
pastikan barier adherensi sebelum
obat diresepkan
Identifikasi patner/teman baik
adherensi (Peer, friend, family)
Identifikasi pengingat (reminders)/alat
yang bisa membantu mengingat
menggunakan obat

Strategies and Tools to Enhance

Adherence (2)
Treatment adherence-support
strategies
Tinjau setiap hari dengan cermat apakah semua
pasien telah menggunakan obat
Perawat harus betul-betul melakukan pemantauan
berdasarkan pedoman kerja yang ditentukan
Bar Code Medication Administration_2.mp4
Barcode Medication Administration
Demonstration.mp4