Home Care Pharmacy
Transcript of Home Care Pharmacy
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PERILAKU PELAYANAN KEFARMASIAN
Ratna Kurnia Illahi, M. Pharm., Apt.
25 Mei 2012
Department of Pharmacy, Faculty of Health ScienceUniversity of Muhammadiyah Malang
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Ambulatory care
- Definition
- Examples of ambulatory care and role of
pharmacist1. Residential care
2. HPN (Home Parenteral Nutrition) and Home
Dialysis
- Pharmacists fee in ambulatory care?
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What is ambulatory care?
Health services provided on an outpatient
basis to those who visit a hospital or another
health care facility and depart aftertreatment on the same day.
(Mosby's Medical Dictionary, 8th edition.2009,
Elsevier)
Pelayanan kesehatan kepada pasienrawat jalan.
Siapa saja?
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Residential care
Three types of residential, depend on the
clientele:
- independent residents- elderly residents
- people with specific medical
requirements
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Medicine administration in homesPatient have complete control of all their
medicine, both prescribed and OTC (esp.
independent)
Pharmacists role1. Preparing the medicines
2. Documentation and recording
3. Storage and control of medicines
4. Assistance in maintaining compliance
5. Ordering and delivery of medicines
6. Disposal of unwanted medicines
7. Regular visits
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Can be prepared for 1-month supply.
Stages:
1. Check the identity of the patient.
2. Check the residents medication record,
noting any changes made by the doctor.3. Identify the medicine and check that the
label has the residents name and
corresponds with the medication record.
4. Administer the medicine.5. Endorse the medication record
immediately
6. Record if there any reason why a dose is
not taken
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At least three type of records should be used:
1. A medicines record, which is used as a
central record of ordering and receiving
medicines effective stock control.
2. The medication profile for each patient
(PMR); will include information such as
allergy and current and past medicines.
3. The administration record, should be in the
same sheet with medication profile.
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Independent patient responsible for the
storage of their medicines, however in a
resident like nursing homes there must be a
place (medicine cupboard) that can be used
to store the medicines centrally.
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Pharmacist must understand the reason for
non-compliance and helped to solve the
problems.
Understanding about the medicines, most of
times is a keyword for improving patientscompliance.
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Agreement on minimum stock level must be
made, to allow adequate time for
prescription preparation, collection,
dispensing and delivery.
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Medicines that are no longer used because
treatment has been discontinued or
completed should be destroyed, and the
overall responsibilty is lies with the
pharmacist with the help of the carer.
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The pharmacist should check the medication
records in a regular basis, expiry date
checks, and add a more clinical role by
reviewing the medications profile of the
patients; help to identify problems arising
with combination of medicines, dosage form
or selection of drug.
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Parenteral nutrition frequently given topatients, especially post-op patients, who
potentially suffer from nutritional
defficiencies.
Short-term IV of 5% D5NS may be sufficientfor post-op patients (provide 500 cal/day
without any proteins, vitamins or minerals),
but longer-term patients may need total
parenteral nutrition (TPN). If it is supplied topatients at home, it is known as home
parenteral nutrition (HPN)
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Indications for TPN:
- GIT disease including Crohns disease and
malabsorption syndrome
- Major trauma including severe burns,
intensive care patients, and acute renal
failure
- Major abdominal surgery
- Malignancy of the small bowel
- High dose chemotherapy, radiotherapy,
and bone marrow transplantation.
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TPN formulation
Made in hospital under strict aseptic
conditions, or readily available from
pharmaceutical companies.
Component:
- Water- Protein source
- Energy source carbohydrate and possibly fat
- Electrolytes
- Trace elements
- Vitamins and minerals.
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HPN
- Becoming popular for long-term TPN
patients because does not require
hospitalisation.
- Given to patients via central vein or
peripheral vein.
- Suitable candidates for HPN initially
provided with TPN until their medical
condition is stabilized undergo training for
administration TPN at home.
- Require regular check-up to hospital
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Potential problems for HPN patients:
- Mechanical problems- Metabolic problems
- Catheter-related problems
- Psychological and social problems
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Pharmacists role in TPN/HPN
- Give training on aseptic technique forhandling and setting up TPN bags
- Formulation requirements
- Potential complications or stability
problem- Give information on storage conditions
required.
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An artificial method used to substitute theact and function of kidney (ultrafiltration) in
patients with impaired renal condition.
Not completely replace renal function, but
can be used as a way of removing toxicmetabolites, correcting acid-base balance
and avoiding fluid overload.
Main types:
- Haemodalysis (HD)
- Peritoneal dialysis (PD)
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Haemodialysis (HD)
- In HD blood is removed from the patients
body and filtered by passing it over an
artificial semipermeabel membrane known
as a dialyser before being return to the
patients body again.
- Much more efficient in treating renal
failure than peritoneal dialysis and can
correct the fluid overload and electrolyte
imbalance more rapidly, however it is a
much more complicated procedure forhome patients.
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Haemodialysis
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Peritoneal Dialysis (PD)
- In PD the dialysis fluid is passed directly
into the patients body (peritoneum-
lined abdominal cavity) and no blood
removal occurs.
- Peritoneal membrane acts as a
semipermeabel membrane allowing
exchange between the blood and the
dialysis solution.
- Continuous ambulatory peritoneal dialysis
(CAPD) is the most widely used for home
dialysis.
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Advantages:
- Less disruption to the bodys electrolyte
balance
- Blood loss is avoided
- Simple process, easy to teach patients
- Useful technique for children- Blood sugar level can be controlled by
adding insulin to dialysis fluids, if
required.
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Disadvantages:
- Not as efficient as haemodialysis
- Obesity can be a problem for some
patients
- Contraindicated in patients who have
recently undergo abdominal surgery- Potential develop of peritonitis.
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Peritoneal dialysis
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Pharmacists role in dialysis
- Give training on aseptic technique andcatheter care
- Clinical assesment of patients
- Provision of drug information
(bioavailability of renally excreted drugs)- Ordering and supplying dialysis fluid and
ancillaries to home dialysis patients.
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Pharmacists fee in ambulatory care?
- Pharmacist-directed patient care services,such as patient education, patient
counselling, product use demontration,
therapy monitoring, utilization review,
disease management and wellness
management, traditionally have not been
paid for by private-pay patients or
included as benefits in healtcare plans.
- Still debatable
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Winfield AJ, Richards RME, eds. Pharmaceutical
Practice. 3rd ed. Churchill Livingstone:2004.
Bradberry JC, Srnka Q. Pharmacist compensation
for ambulatory patient care services.Am J Man
Care.1998; 4(12):1727-38.