Analisis Medication Error di Instalasi Farmasi Rawat Jalan RSPAD Gatot Soebroto Jakarta Pusat

https://doi.org/10.22146/jmpf.82186

Ayyoehan Tiara Annisa(1), Nanang Munif Yasin(2), Susi Ari Kristina(3*)

(1) Magister Manajemen Farmasi, Fakultas Farmasi, Universitas Gadjah Mada
(2) Departemen Farmakologi dan Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(3) Faculty of Pharmacy, Universitas Gadjah Mada
(*) Corresponding Author

Abstract


Medication errors (MEs) have an impact on drug service inaccuracies and endanger patients at risk through a variable number of accidents, so it is necessary to conduct different methods and definitions study. This study aimed to analyze MEs and causing factors in the Outpatient Pharmacy Installation of Gatot Soebroto Army Hospital. A mixed method study between quantitative and qualitative was conducted. A quantitative study was carried out by analyzing outpatient prescriptions to identify MEs with a checklist instrument and interviewing informants to find out some factors causing MEs. After the data generated from an interview, data were collected as a total of causing MEs, so the factors causing MEs could be determined. Data analysis was carried out descriptively. The results showed MEs in each Outpatient Pharmacy Installation of Gatot Soebroto Army Hospital. Errors at the BPJS Outpatient Pharmacy Installation consisted of prescribing errors (41,6%), transcribing errors (4,6%), and dispensing errors 15,7%). Errors at the Kartika Pavilion Outpatient Pharmacy Installation consisted of prescribing errors (12,4%), transcribing errors (2,4%), and dispensing errors (0,7%). BPJS Outpatient Pharmacy Installation has the highest medication errors (61,8%) in Gatot Soebroto Army Hospital compared to the Kartika Pavilion Outpatient Pharmacy Installation (15,5%) which was caused by the number of patients being larger and not comparable with the minimum number of staff. Other factors that cause ME include human factors such as the performance of staff and fatigue, system factors such as manual recipes and the absence of an e-prescription system, and environmental factors such as a busy work environment.


Keywords


Dispensing Error; Medication Error; Prescribing Error; Rumah Sakit; Transcribing Error.

Full Text:

PDF


References

  1. National Coordinating Council for Medication Error Reporting and Prevention. About Medication Errors | NCC MERP. NCC MERP: National Coordinating Council for Medication Error Reporting and Prevention. Published 2022. Accessed March 29, 2022. https://www.nccmerp.org/about-medication-errors
  2. Billstein-Leber M, Carrillo CJD, Cassano AT, Moline K, Robertson JJ. ASHP Guidelines on Preventing Medication Errors in Hospitals. American Journal of Health-System Pharmacy. 2018;75(19):1493-1517. doi:10.2146/ajhp170811
  3. Zauderer S. 29 Medication Errors Statistics & Facts (2023). Cross River Therapy. Published 2022. Accessed January 11, 2023. https://www.crossrivertherapy.com/medication-errors-statistics
  4. Elliott RA, Camacho E, Jankovic D, Sculpher MJ, Faria R. Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Qual Saf. 2021;30(2):96-105. doi:10.1136/bmjqs-2019-010206
  5. Dorothy A, Yadesa TM, Atukunda E. Prevalence of Medication Errors and the Associated Factors: A Prospective Observational Study Among Cancer Patients at Mbarara Regional Referral Hospital. CMAR. 2021;Volume 13:3739-3748. doi:10.2147/CMAR.S307001
  6. Kim JY, Moore MR, Culwick MD, Hannam JA, Webster CS, Merry AF. Analysis of medication errors during anaesthesia in the first 4000 incidents reported to webAIRS. Anaesth Intensive Care. 2022;50(3):204-219. doi:10.1177/0310057X211027578
  7. Shitu Z, Aung MMT, Tuan Kamauzaman TH, Ab Rahman AF. Prevalence and characteristics of medication errors at an emergency department of a teaching hospital in Malaysia. BMC Health Serv Res. 2020;20(1):56. doi:10.1186/s12913-020-4921-4
  8. Citraningtyas G, Angkoauw L, Maalangen T. Identifikasi Medication Error di Poli Interna Rumah Sakit X di Kota Manado. Jurnal MIPA Universitas Sam Ratulangi Indonesia. 2020;9(1):5.
  9. Salmasi S, Khan TM, Hong YH, Ming LC, Wong TW. Medication Errors in the Southeast Asian Countries: A Systematic Review. Plos ONE. Published online 2015. doi:10.1371/journal.pone.0136545
  10. Komite Keselamatan Pasien Rumah Sakit (KKPRS). Pedoman Pelaporan Insiden Keselamatan Pasien (IKP) (Patient Safety Incident Report). Komite Keselamatan Pasien Rumah Sakit (KKPRS). Published online 2015. Accessed June 9, 2022. http://rsjiwajambi.com/wp-content/uploads/2019/09/Pedoman_Pelaporan_IKP-2015-1.pdf
  11. Williams D. Medication Errors. J R Call Physicians Edinburgh. Published online 2007.
  12. RSPAD Gatot Soebroto. RSPAD Gatot Soebroto | Presidential Hospital. RSPAD Gatot Soebroto | Presidential Hospital: Where Nation Heals Its Heroes. Published 2019. Accessed January 11, 2023. http://rspadgs.mil.id/id
  13. Jas A. Perihal Resep & Dosis Serta Latihan Menulis Resep. USU Press; 2009.
  14. Cheung KC, Bouvy ML, De Smet PAGM. Medication errors: the importance of safe dispensing. British Journal of Clinical Pharmacology. 2009;67(6):676-680. doi:10.1111/j.1365-2125.2009.03428.x
  15. Cohen MR. Medication Errors 2nd Edition. American Pharmacists Association; 2007.
  16. Notoatmodjo S. Metodologi Penelitian Kesehatan. Rineka Cipta; 2010.
  17. Sugiyono. Metode Penelitian Kuantitatif, Kualitatif, dan R&D. Alfabeta; 2019.
  18. Creswell JW. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 4th ed. SAGE Publications; 2014.
  19. Shrestha R, Prajapati S. Assessment of prescription pattern and prescription error in outpatient Department at Tertiary Care District Hospital, Central Nepal. J of Pharm Policy and Pract. 2019;12(1):16. doi:10.1186/s40545-019-0177-y
  20. Maalangen T, Citraningtyas G, Wiyono WI. IDENTIFIKASI MEDICATION ERROR PADA RESEP PASIEN POLI INTERNA DI INSTALASI FARMASI RUMAH SAKIT BHAYANGKARA Tk. III MANADO. PHA. 2019;8(2):434. doi:10.35799/pha.8.2019.29310
  21. Almousa F, Alhaqbani H, lsagga R, Alshehri A, Alsarra I. Incomplete prescription and medication error in hospital practice: a Saudi local experience. IJMDC. Published online 2020:1031-1035. doi:10.24911/IJMDC.51-1540938203
  22. Bowen JF. Prescriptions and Medication Orders. Jones & Bartlett Learning Publish; 2016.
  23. New South Wales Health Government. Requirement for patient date of birth on prescriptions - Pharmaceutical services. Published 2022. Accessed October 21, 2022. https://www.health.nsw.gov.au/pharmaceutical/Pages/prescribers-dob-factsheet.aspx
  24. Lisni I, Gumilang NE, Kusumahati E. Potensi Medication error Pada Resep di Salah Satu Apotek di Kota Kadipaten: Potential Medication Error on Prescription at One Pharmacy in Kadipaten City. J Sains Kes. 2021;3(4):558-568. doi:10.25026/jsk.v3i4.564
  25. Worthen D, ed. Dictionary of Pharmacy. Taylor & Francis; 2017.
  26. Al-Worafi YM. Drug Safety in Developing Countries. Elsevier Health Sciences; 2020.
  27. Farghali A, Borycki EM, Macdonald S. Pharmacist’s perception of the impact of electronic prescribing on medication errors and productivity in community pharmacies. Knowledge Management & E-Learning: An International Journal. Published online December 30, 2021:536-558. doi:10.34105/j.kmel.2021.13.029
  28. Mahendra AD. THE NATURAL AND PREVALENCE OF MEDICATION ERRORS IN A TERTIARY HOSPITAL IN INDONESIA. Int J Curr Pharm Sci. Published online May 17, 2021:55-58. doi:10.22159/ijcpr.2021v13i3.42096
  29. Maharaj S, Brahim A, Brown H, et al. Identifying dispensing errors in pharmacies in a medical science school in Trinidad and Tobago. J of Pharm Policy and Pract. 2020;13(1):67. doi:10.1186/s40545-020-00263-x
  30. Chand S, Hiremath S, Shastry CS, Joel JJ, Krishna Bhat CH, Dikkatwar MS. Incidence and types of dispensing errors in the pharmacy of a tertiary care charitable hospital. Clinical Epidemiology and Global Health. 2022;18:101172. doi:10.1016/j.cegh.2022.101172
  31. Johnston DW, Allan JL, Powell DJH, et al. Why does work cause fatigue? A real-time investigation of fatigue, and determinants of fatigue in nurses working 12-hour shifts. Annals of Behavioral Medicine. 2019;53(6):551-562. doi:10.1093/abm/kay065
  32. Ahmed Z, Saada M, Jones AM, Al-Hamid AM. Medical errors: Healthcare professionals’ perspective at a tertiary hospital in Kuwait. Vaismoradi M, ed. PLoS ONE. 2019;14(5):e0217023. doi:10.1371/journal.pone.0217023
  33. Hinojosa-Amaya JM, Rodríguez-García FG, Yeverino-Castro SG, Sánchez-Cárdenas M, Villarreal-Alarcón MÁ, Galarza-Delgado DÁ. Medication errors: electronic vs. paper-based prescribing. Experience at a tertiary care university hospital: Errors in medication. J Eval Clin Pract. 2016;22(5):751-754. doi:10.1111/jep.12535
  34. Farzi S, Irajpour A, Saghaei M, Ravaghi H. Causes of medication errors in intensive care units from the perspective of healthcare professionals. J Res Pharm Pract. 2017;6(3):158. doi:10.4103/jrpp.JRPP_17_47



DOI: https://doi.org/10.22146/jmpf.82186

Article Metrics

Abstract views : 894 | views : 1414

Refbacks

  • There are currently no refbacks.


Copyright (c) 2023 JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

©Jurnal Manajemen dan Pelayanan Farmasi
Faculty of Pharmacy
Universitas Gadjah Mada
Creative Commons License
View My Stats