Standard 3.10 Provision of pharmaceutical services.

Standard 3.10 Provision of pharmaceutical services.

The provision of pharmaceutical services is carried out in accordance with the provisions of statutory regulations.

Pharmaceutical services are carried out in accordance with established policies and procedures.

a. Criterion 3.10.1

Pharmaceutical services are managed in accordance with established policies and procedures.

1) Main Thoughts:

a) Pharmaceutical services must be available at the Community Health Center. Therefore, the type and quantity of drugs and consumable medical materials (BMHP) must be available according to service needs.

b) Management of pharmaceutical preparations and consumable medical materials consists of:

(1) needs planning;

(2) request;

(3) acceptance;

(4) storage (5) distribution;

(6) control;

(7) recording, reporting and archiving; And

(8) management monitoring and evaluation

c) Pharmaceutical services at the Community Health Center consist of:

(1) reviewing prescriptions and dispensing drugs;

(2) providing drug information (PIO);

(3) counseling;

(4) patient visits (specifically inpatient health centers); (5) medication reconciliation;

(6) drug therapy monitoring (PTO); And

(7) evaluation of drug use

d) Withdrawal of expired, damaged or substitute drugs from circulation is managed in accordance with policies and procedures.

e) A drug formulary, which is a list of selected drugs that are needed and must be available at the Community Health Center, needs to be prepared as a reference in providing services to patients by referring to the national formulary; The selection of the type of drug is carried out through a collaborative process between care providers by considering patient needs, safety and efficiency.

f) If a drug runs out due to late delivery, lack of national stock, or other reasons that cannot be anticipated in normal inventory control, a process needs to be set up to alert doctors/dentists about the shortage of the drug and suggestions for a replacement.

g) The authenticity and safety of the medicines provided must be guaranteed. Therefore, it is necessary to manage the drug procurement chain. Drug procurement chain management is a series of activities that include the planning and selection process, procurement, receipt, storage, distribution and use of drugs.

h) Prescription is carried out by medical personnel. In prescription services, pharmaceutical officers are required to carry out prescription reviews/examinations which include fulfilling administrative requirements, pharmaceutical requirements and clinical requirements in accordance with statutory regulations, including, among others,

(a) accuracy of patient identity, medication, dosage, frequency, rules for taking/eating medication, and time of administration;

(b) duplication of treatment;

(c) potential allergies or sensitivities;

(D) interactions between the drug and other drugs or with food;

(e) variations in use Criteria;

(f) patient weight and/or other physiological information; And

(g) contraindications.

i) When administering medicines, a proper study must also be carried out which includes the accuracy of the patient's identity, the accuracy of the drug, the accuracy of the dose, the accuracy of the route of administration, and the accuracy of the time of administration.

j) For inpatient health centers, the patient's use of medication/self-medication, whether brought to the health center, prescribed, or ordered at the health center, is known and recorded in the medical record. Monitoring of drug use, especially psychotropic drugs, must be carried out in accordance with statutory provisions.

k) Drugs that need to be wary of are drugs that carry increased risks if used incorrectly and can cause major harm to patients.

l) Drugs that need to be watched out for (high alert) consist of:

(1) high risk drugs, namely drugs that if an error occurs can cause death or disability, such as insulin, heparin, or chemotherapy; And

(2) drugs whose names, packaging, labels, clinical use look the same (look alike), and sound alike, such as .

m) In order for medicines to be suitable for consumption by patients, cleanliness and safety of available medicines must be carried out starting from procurement, storage, distribution and delivery of medicines to patients as well as management of expired (out of date), damaged or substitute medicines.

n) The Community Health Center establishes policies and procedures for delivering medicines to patients so that patients understand the indications, dosage, how to use the medicine, and possible side effects.

o) Patients, their doctors, nurses and other health workers work together to monitor patients who receive medication. The purpose of monitoring is to evaluate the effect of treatment on the patient's symptoms or disease and to evaluate the patient for the occurrence of drug side effects.

p) Based on monitoring, the dose or type of drug, if necessary, can be adjusted by paying attention to rational drug administration. Monitoring is intended to identify anticipated therapeutic responses or unanticipated allergic reactions and drug interactions and to prevent risks to patients. Monitoring the effects of drugs in this case includes observing and documenting any medication errors.

q) If a patient emergency occurs, quick access to appropriate emergency medicine is very important. It is necessary to determine the storage location for emergency medicines at the service location and the emergency medicines that must be supplied to that location.

r) To ensure access to emergency medicines when needed, procedures are provided to prevent misuse, theft or loss of the medicines in question. This procedure ensures that medications are replaced when they are used, damaged, or expired. A balance between access, readiness and security of emergency medicine storage areas needs to be met.

s) Medication reconciliation is the process of comparing treatment instructions with the medication the patient has received. Reconciliation is carried out to prevent medication errors, such as medication not being given, duplication, dosage errors, or drug interactions.

t) The purpose of medication reconciliation is:

(1) ensure accurate information about the medications the patient is taking;

(2) identify discrepancies resulting from undocumented doctor's instructions; And

(3) identifying discrepancies resulting from not reading the doctor's instructions.

u) The stages of the medication reconciliation process are as follows.

(1) Data collection. This stage is carried out by recording data and verifying the medicines that the patient is and will be using, including the name of the medicine, dose, frequency, route, the medicine started, the medicine replaced, the medicine continued, the medicine stopped, the patient's allergy history, as well as any side effects of the medicine that have occurred. . Specifically for data on allergies and drug side effects, the date of the event, the drug that caused the allergic reaction and side effect, the effect that occurred, and the level of severity were recorded. Data on drug use history was obtained from the patient, the patient's family, the patient's medication list, the patient's existing medications, and medical records (medication charts). Data on drugs that can be used is no more than three months earlier. For all medicines used by patients, both prescription and over-the-counter medicines including herbal medicines, a reconciliation process must be carried out.

(2) Comparison. Health workers compare data on drugs that have been, are being used, and will be used. Discrepancy is when a discrepancy/difference is found between the data. Incompatibility can also occur if a medication is missing, different, added, or replaced without an explanation documented in the patient's medical record. This discrepancy can be intentional (intentional) by the doctor when writing the prescription or unintentional (unintentional) when the doctor does not know there is a difference when writing the prescription.

(3) The pharmacist confirms with the doctor if he finds documentation discrepancies. If there is a discrepancy, a doctor should be contacted within 24 hours. Other things that pharmacists must do are:

(a) determine whether the existence of the difference is intentional or unintentional;

(b) document the reasons for termination, suspension, or replacement; And

(c) provide signature, date and time of medication reconciliation.

(4) Communication. Communication is carried out with the patient and/or patient's family or nurse regarding changes in therapy that occur. Pharmacists are responsible for the drug information provided.

2) Assessment Elements:

a) A list of puskesmas drug formularies is available (D).

b) Pharmaceutical preparations and consumable medical materials are managed by pharmaceutical personnel in accordance with established guidelines and procedures (R,D,O,W).

c) Reconciliation of drugs and clinical pharmacy services is carried out by pharmacy staff in accordance with established procedures (R,D,O,W).

d) Review of prescriptions and correct drug administration at each drug administration service (R, D, O, W)

e) Educate each patient about the indications and how to use the drug (R, D, O, W).

f) Emergency medicines are available in the necessary units and can be accessed to meet emergency needs, then monitored and replaced in a timely manner after use or if they expire (R, D, O, W).

g) Evaluation and follow-up are carried out on drug availability and compliance of prescriptions with the formulary (D, W).