Chemotherapy in Dharmais Cancer Hospital

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Chemotherapy in Dharmais Cancer Hospital - Dharmais Cancer Hospital

Transcript of Chemotherapy in Dharmais Cancer Hospital

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MEDICATION ERROR IN INFUS THERAPYCAUSES OF MEDICATION ERRORTo address the causes and prevention of medication errors throughout the entire system of medication therapy is a daunting task. It has been estimated that, from the “tip of the pen to the tip of the tongue,” there are 65 steps in the process of medication administration.14Errors may occur at any step in this process, including:

Prescribing errorsCompounding errorsDispensing errorsAdmininstration errorsMonitoring errorsCommunication and management errors, including failures in

error reporting

••

• Although medication errors can occur through any route of administration, this online course willfocus on the prevention of medication errors in the dispensing and administration of intravenous(IV) medications.

• The administration of IV medications carries a relatively greater risk for error than other routes ofmedication administration, in part because of the complexity associated with their preparation andadministration. For example:

• IV medications are associated with 54% of potential ADEs.15

• 60 % of serious and life-threatening medication errors are associated with IV medications.16

• Infusion devices account for up to 35% of all medication errors that result in significant harm. Themost common error is incorrect manual programming of infusion parameters (eg, rate, drug, dose)into infusion devices. (Other errors include administering the wrong drug, administering the rightdrug to the wrong patient, and tampering with the recommended infusion parameters.)

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ResearchResearch•• In 1979, Falk et al reported an increased mutagenic In 1979, Falk et al reported an increased mutagenic

activity in the urine of nurses exposed to cytotoxics.activity in the urine of nurses exposed to cytotoxics.•• InIn 19831983,, SotaniemiSotaniemi etet alal reportedreported thatthat destructiondestruction inin 33

nursenurse liverliver thatthat workwork atat oncologyoncology wardward..•• InIn twotwo Hospital,Hospital, InIn Italy,Italy, hashas carriedcarried cyclophosphamidecyclophosphamide

andand iphosphamideiphosphamide inin nursenurse urineurine andand pharmacypharmacy staffstaff thatthatnotnot followfollow procedureprocedure ofof handlinghandling cytotoxiccytotoxic..

•• Taxis,KTaxis,K..,Barber,W,Barber,W..,,20032003,, reportedreported thatthat occuredoccured 249249mistakesmistakes byby nursesnurses fromfrom 430430 timestimes preparationpreparation intraintravenavena drugsdrugs (dispencing(dispencing andand administration)administration)..

•• LimLim..SS..,, 19981998,, PrincessPrincess MargarethMargareth Hospital,Hospital, reportedreported thatthatcostcost savingsaving forfor drugsdrugs aboutabout $$ 250250..000000/year/year andandefficiencyefficiency timetime ofof nursenurse isis 330330 hour/monthhour/month..

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Microbiology Data In Oncology ward ’Dharmais’ Hospital Microbiology Data In Oncology ward ’Dharmais’ Hospital 20002000

PreparatePreparate Coloni amountColoni amountWard third classWard third class 750 coloni750 coloniWard first classWard first class 550 coloni550 coloniWard VIP/VVIP classWard VIP/VVIP class 225 coloni225 coloniWard IsolateWard Isolate 40 coloni40 coloniSurgical RoomSurgical Room 65 coloni65 coloniICU RoomICU Room 240 coloni240 coloniIV Preparation in third class roomIV Preparation in third class room 50 coloni50 coloniIV Preparation in Second class roomIV Preparation in Second class room SterileSterileIV Preparation in VIP class roomIV Preparation in VIP class room SterileSterile

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Why Does PIVAS ImplementWhy Does PIVAS Implement ??1.1. For all intravena drug must sterile from For all intravena drug must sterile from

contamination (nosocomial infection)contamination (nosocomial infection)2.2. Especially for cytotoxic/neoplastic drugs, Especially for cytotoxic/neoplastic drugs,

we must protect the operator from we must protect the operator from exposure the cytotoxic drugs exposure the cytotoxic drugs (carcinogenic, mutagenic, oncogenic etc)(carcinogenic, mutagenic, oncogenic etc)

3.3. Pharmacists responsible to realisize both Pharmacists responsible to realisize both of them. Because they have knowledge of them. Because they have knowledge and skilland skill

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•• Tingginya tingkat infeksi nosokomialTingginya tingkat infeksi nosokomial•• Data pertumbuhan mikroba pada sediaan iv Data pertumbuhan mikroba pada sediaan iv

injection yang direkonstitusi di ruang injection yang direkonstitusi di ruang perawatan.perawatan.

•• Risiko infeksi pasien bertambah Risiko infeksi pasien bertambah →→ biaya biaya pengobatan pengobatan ↑↑

Tanggungjawab Farmasis akan pelayanan IV Admixture secara aseptis

Standar Pelayanan Farmasi RS Tahun 2004

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PHARMACY STRATEGY TO DO PIVASPHARMACY STRATEGY TO DO PIVAS11. Make Presentation in front of nurse and doctor (PTC/ . Make Presentation in front of nurse and doctor (PTC/

Pharmacy & Therapy Committee) that involve :Pharmacy & Therapy Committee) that involve :§§ Effect of CytotoxicEffect of Cytotoxic§§ Condition area in oncology wardsCondition area in oncology wards

2. Benchmark to another country had set up centralisation 2. Benchmark to another country had set up centralisation of handling cytotoxic. of handling cytotoxic. -- National University Hospital SingaporeNational University Hospital Singapore-- Royal North Shore Hospital Australia . Royal North Shore Hospital Australia .

3. Design and Set Up Clean Room3. Design and Set Up Clean Room4. Make Standard Procedure4. Make Standard Procedure5. Training the Pharmacy staff5. Training the Pharmacy staff6. Running Programme PIVAS6. Running Programme PIVAS7. Evaluation and Report7. Evaluation and Report

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Facility DesignFacility Design

Clean roomClean roomStorage AreaStorage AreaAdministrasi AreaAdministrasi AreaClean AreaClean AreaToilet AreaToilet AreaAnte RoomAnte RoomPass BoxPass BoxBiological Safety cabinet (BSC) Biological Safety cabinet (BSC)

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Biological Safety Cabinet (BSC) :Biological Safety Cabinet (BSC) :•• BSC Class II for Cytotoxic drugs (Cytogard)BSC Class II for Cytotoxic drugs (Cytogard)•• Fungsi : Memberikan proteksi kepada Fungsi : Memberikan proteksi kepada

petugas, materi yang dikerjakan, dan petugas, materi yang dikerjakan, dan lingkungan.lingkungan.

•• Prinsip kerja : Tekanan udara didalam Prinsip kerja : Tekanan udara didalam cytogard lebih negatif dari tekanan udara cytogard lebih negatif dari tekanan udara luar, sehingga aliran udara bergerak dari luar luar, sehingga aliran udara bergerak dari luar ke dalam BSC, Didalam BSC udara bergerak ke dalam BSC, Didalam BSC udara bergerak vertical membentuk barrier, sehingga jika ada vertical membentuk barrier, sehingga jika ada percikan obat kanker didalam BSC tidak percikan obat kanker didalam BSC tidak kembali kearah petugas.kembali kearah petugas.

•• Validasi alat : kalibrasi 6 bulan sekali Validasi alat : kalibrasi 6 bulan sekali

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Personal Protective EquipmentPersonal Protective Equipment1. Protective Gown

2. Head Cap

3. Chemotherapy Mask

4. Glove

5. Shoe and Boot

6. Emergency Kit :

- NaCl 0,9 % 500 ml

- Larutan Pencuci mata Steril

- Air Sabun 120 ml

- Lar. Chlorin 5 % 500 ml

- H2O2 3 % 500 ml

7. Formulir Laporan Kecelakaan

1

2

3

4

5

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PERSONALPERSONAL

•• PersonsPersons shouldshould getget trainingtraining aboutabout asepticaseptictechniquetechnique andand handlinghandling cytotoxiccytotoxic beforebeforeplacedplaced inin handlinghandling cytotoxiccytotoxic areaarea..

•• StaffStaff whowho pregnantpregnant oror planplan toto pregnanpregnan notnotrecommendedrecommended toto reconstitutionreconstitution..

•• WomenWomen breastfeedingbreastfeeding notnot recommendedrecommendedtootoo..

•• Every staff must check laboratorium at least Every staff must check laboratorium at least per 6 month. per 6 month.

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Contoh :

Obat Injeksi

Obat Kanker

TPN

PIVAS

Mutu :

•Produk steril

•Operator selamat

• Stabilitas ; suhu, waktu

Efisien :

•Unit dose

• Sisa obat utk pasien tdk mampu

E

F

E

K

T

I

F

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Workflow of Centralization PIVAS Workflow of Centralization PIVAS

- Inpatient Ward- One day care Ward

DEPARTMENT OF PHARMACY

Not CompleteDoctor/ nurse

Complete

completed

Desinfection

Clean Roomrekonstitution

Syringe/infuse

Labelling insideFinished

Pass box

Labeling outside

Delivery

Drug &Chemotherapy

order formChecklist Preparation :

- Data of Patient (MR, Name, Age, Weight, Height, Diagnose)

- Dosis & Exp.Date of Drugs

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CENTRALISATION HANDLING CYTOTOXIC

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TRANSPORTATION & WASTE HANDLINGTRANSPORTATION & WASTE HANDLING

•• WorkerWorker deliverydelivery thethe preparationpreparation withwithclosedclosed trolleytrolley..

•• HandlingHandling andand disposingdisposing ofof CytotoxicCytotoxic wastewasteinin separateseparate andand signedsigned container,container, forforsharpensharpen wastewaste likeslikes spuit,spuit, vialvial andand ampulampuldisposedispose inin sharpsharp containercontainer..

•• AllAll ofof wastewaste burnburn inin inceneratorincenerator

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Average :• Amount of Patien 525/ month • Amount of Preparation 1520 /month • Average Preparation 52/day

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EFFICIENCY OF PIVASEFFICIENCY OF PIVAS“Handling Cytotoxic On The 2009”“Handling Cytotoxic On The 2009”

No. No. BULANBULAN PENDAPATANPENDAPATAN PENGHEMATANPENGHEMATAN

1.1. JanuariJanuari Rp. 2,247,038,484.00Rp. 2,247,038,484.00 Rp. 113,500,500.00Rp. 113,500,500.00

2.2. FebruariFebruari Rp. 2,169,488,819.00Rp. 2,169,488,819.00 Rp. 90,800,400.00Rp. 90,800,400.00

3.3. MaretMaret Rp. 3,024,856,762.00Rp. 3,024,856,762.00 Rp. 121,067,200.00Rp. 121,067,200.00

4.4. AprilApril Rp. 3,488,656,873.00Rp. 3,488,656,873.00 Rp. 116,022,733.33Rp. 116,022,733.33

5.5. MeiMei Rp. 3,205,318,364.00Rp. 3,205,318,364.00 Rp. 119,806,083.33Rp. 119,806,083.33

6.6. JuniJuni Rp. 3,586,061,215.00Rp. 3,586,061,215.00 Rp. 123,589,433.33Rp. 123,589,433.33

7.7. JuliJuli Rp. 2,584,730,465.00Rp. 2,584,730,465.00 Rp. 127,372,783.33Rp. 127,372,783.33

8.8. AgustusAgustus RpRp. 2,657,100,514.00. 2,657,100,514.00 Rp. 131,156,133.33Rp. 131,156,133.33

TotalTotal RpRp. 22,923,251,496.00. 22,923,251,496.00 RpRp. 943,315,266.67. 943,315,266.67

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