90% of prescriber-patient

relationship results in a
prescription.

Medications are the most

prevalent health therapy in
Australia
Adverse medicines events
associated with:2
38% of readmissions to
hospital
33% ED attendances

Primum, non
nocere
(Above all, do no
harm)

ARTINYA :
GUNAKAN OBAT SECARA
RASIONAL.

The rational use of drugs requires that

patients receive medicines appropriate to
their clinical needs, in doses that meet their
own individual requirements, for an adequate
period of time, and at the lowest cost to them
and the community.
(WHO 1988)
Appropriate indication
Appropriate drug
Appropriate administration, dosage, and duration
Appropriate patient
Appropriate patient information
Appropriate evaluation

Tepat diagnosis, indikasi

Tepat pemilihan obat
Tepat cara pemberian
Tepat dosis, interval waktu, lama pemberian
Waspada ES
Tepat penilaian kondisi pasien
Obat efektif, aman, bermutu, tersedia,
terjangkau
Tepat informasi
Tepat tindak lanjut
Tepat dispensing
Pasien patuh

10

Problems of Irrational Drug

Use

11

Drug
DrugRegulation
Regulation

Patients
Patients
drug
misinformation
misleading
beliefs
inability to
communicate
problems

Prescribers
Prescribers

Industry
Industry

lack of education
and training
lack of drug
information
heavy patient load
pressure to
prescribe
generalization of
limited beliefs
misleading beliefs
about efficacy

Problems of Irrational Drug

Use

promotion
misleading
claims

Drug
DrugSupply
Supply
inefficient
management
non-availability
of required
drugs
etc
12

availability of
unsafe drugs
informal
prescribers
etc.

Salah menginterpretasikan resep (atau diagnosis)

Mengambil obat yg salah dari stock

Salah menghitung jml obat/Dosis salah

Etiket/Label/kemasan rusak

Salah dlm peracikan/compounding

Etiket tidak memadai

Tdk ada pengetahuan cukup ttg drug compliance

Pengetahuan ttg disease process yg tdk cukup

Tdk cukup waktu berbicara dg pasien ttg obatnya

Tdk mampu berkomunikasi ttg terapi pasien

13

Died December, 1994

after receiving an
accidental four-fold
overdose of
chemotherapy.
Boston Globe, May 23, 1994

Kesalahan Membaca Resep

Appeared in DRUG ADS:

. metronidazole has been given with no apparent
adverse effects during all stages of pregnancy ..
(Gilman et al., 1990) .

In Gilman et al., 1990:

While metronidazole has been given with no
apparent adverse effects during all stages of
pregnancy, its use during the first trimester is not
recommended

Malaria
choroquine resistance in 81/92 countries
Tuberculosis
2 - 40 % primary multi-drug resistance
Gonorrhoea
5 - 98 % penicillin resistance in N. gonorrhoeae
Pneumonia and bacterial meningitis
12 - 55 % penicillin resistance in S.
pneumoniae
Diarrhoea: shigellosis
10-90+ % amp, 5-95% TMP/SMZ resistance
WHO, Dept. Essential Drugs and
Medicines
Source: DAP,
EMC,Policy
GTB, CHD (1997)

20

MDR

ESBL

MRSA

PAN DRUG RESISTANCE

Policy, Legal and

Regulatory framework

Prescriber,
Dispenser &
their
workplaces

Rational
Drug Use

Drug Supply
System

Patient &
community

Educational programmes
STGs
DUE
clinical pharmacy programmes
Drug bulletins ???
Structured order forms, automatic stop orders
Prescribing restrictions
Dispensing restrictions
Clinical Microbiologist programs
PPRA, etc.

32