home care pharmacy

7/28/2019 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.

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