Pemantauan Terapi Obat (PTO) merupakan salah satu bentuk pelayanan farmasi klinik yang diberikan oleh apoteker di rumah sakit, dilakukan untuk memastikan bahwa pasien mendapatkan terapi yang aman, efektif, dan rasional. Kegiatan PTO meliputi pengkajian resep dan pilihan obat, pengkajian dosis, cara pemberian obat, respons terapi, reaksi obat yang tidak dikehendaki (ROTD), dan rekomendasi perubahan atau alternatif terapi. Pada tugas khusus ini, dilakukan PTO secara berkesinambungan dan dievaluasi secara berkala pada pasien ulkus dekubitus grade 3 regio sacral dan syok sepsis dengan riwayat penyakit diabetes melitus tipe II, neglected femur fracture, hipoalbuminemia, dan hipokalemia di ruang rawat inap Teratai RSUP Fatmawati. Selain itu, dilakukan pula analisis kerasionalan terapi, analisis Drug Related Problem (DRP) menggunakan tools PCNE Versi 9.0, dan evaluasi penggunaan antibiotik secara kualitatif dengan metode Gyssens. PTO dilakukan selama satu bulan dengan metode retrospektif dan prospektif dengan melihat data sekunder melalui rekam medik, Catatan Perkembangan Pasien Terintegrasi (CPPT), dan profil penggunaan obat pasien, baik yang tertulis secara fisik maupun elektronik di website RSUP Fatmawati (SIMRS GOS). Hasil PTO menunjukkan bahwa terapi yang diterima oleh pasien sudah sesuai dengan indikasi dan Panduan Praktik Klinik (PPK) yang dikeluarkan oleh RSUP Fatmawati, tetapi ada satu obat yang diberikan dengan tidak adanya indikasi langsung dari obat tersebut. Berdasarkan analisis DRP menggunakan tools PCNE Versi 9.0, terdapat beberapa permasalahan terkait obat dan sebagian dari masalah masih belum terselesaikan saat pasien dirawat. Pada analisis penggunaan antibiotik secara kualitatif dengan metode Gyssens, didapatkan hasil bahwa penggunaan antibiotik Meropenem termasuk ke dalam golongan IIIA karena pemberian obat terlalu lama.

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Therapeutic Drug Monitoring (TDM) is a form of clinical pharmacy service provided by pharmacists in hospitals, to ensure that patients receive an effective, save, and rational therapy. TDM activities include: reviewing prescriptions and drug choices; assessing doses, methods of drug administration, therapeutic response, adverse drug reactions (ROTD); and giving recommendations for changes or alternative therapies. In this article, TDM was carried out continuously and evaluated periodically in patients with grade 3 decubitus ulcers in the sacral region and septic shock with a history of type II diabetes mellitus, neglected femur fracture, hypoalbuminemia, and hypokalaemia in the Teratai room at RSUP Fatmawati. In addition, rational therapy analysis, Drug Related Problem (DRP) analysis using PCNE Version 9.0 tools, and qualitative evaluation of antibiotic prescriptions using the Gyssens method were also carried out. TDM is carried out for one month with retrospective and prospective methods by looking at secondary data through medical records, integrated patient records, and profiles of patient drug use that is both written physically and electronically on the RSUP Fatmawati website (SIMRS GOS). The results of TDM showed that the therapy received by the patient was in accordance with the indications and clinical practice guidelines issued by RSUP Fatmawati, but there was one drug given with no direct indication of the drug. Based on the DRP analysis using PCNE Version 9.0 tools, there were several drug-related problems and some of the problems were still unresolved when the patient was treated. In a qualitative analysis of the use of antibiotics using the Gyssens method, it was found that the use of the antibiotic Meropenem was included in class IIIA because the administration of the drug was too long.