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"PendahuluanBerbagai studi menunjukkan obat off-label banyak diberikan pada pasien anak. Pemberian obat off-label dapat menimngkatkan risiko efek samping obat. Penelitian ini bertujuan mengevaluasi peresepan obat off-label pada pasien anak di Instalasi Gawat Darurat RSUPN dr. Cipto Mangunkusumo (IGD-RSCM) yang selama ini belum pernah diteliti.MetodeDesain penelitian ini potong lintnag. Sampel peresepan, diambil dari rekam medis pasien anak di IGD-RSCM secara consecutive sampling. Kriteria inklusi adalah peresepan untuk pasien anak usia 0-18 tahun di IGD RSCM pada periode Januari- Desember 2018. Kriteria eksklusi berupa data tidak terbaca atau tidak lengkap, peresepan elektrolit, suplemen, vitamin, dan obat luar. Data jenis kelamin, usia, dan jenis kelompok obat berdasarkan klasifikasi The Anatomical Therapeutic Chemical (ATC) dicatat. Status peresepan off-label ditentukan berdasarkan usia pasien saat obat diresepkan. Proporsi peresepan off-label pada kelompok gender dan usia anak dianalisis dengan uji Chi-Square.HasilDari 446 sampel peresepan yang diuji, 24,7% sampel merupakan peresepan off- label berdasarkan kategori usia.Berdasarkan kelompok ATC, kelompok obat yang paling sering diresepkan adalah obat sistem saraf dengan proposi off-label paling tinggi ditemukan pada kelompok agen antineoplastik dan imunomodulasi (88,2%). Tidak ada perbedaan proporsi peroff-label yang signifikan antara pasien anak laki- laki (21,9%) dan perempuan (27,4%) (p = 0,169, PR= 0,662 IK= 0,593 – 1,005). Tidak ada hubungan signfikan antara kelompok usia (bayi, anak, dan remaja) terhadap proporsi peresepan off-label (p = 0,086).KesimpulanProporsi peresepan obat off-label pasien anak di Instalasi Gawat Darurat RSCM adalah 24,7%. Jenis kelamin dan perbedaan kelompok usia antara bayi, anak, dan remaja tidak berhubungan dengan besar proporsi peresepan off-label.

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Introduction

Various studies showed that pediatric patients often received off-label drugs. Off- label drug administration can increase the risk of adverse drug reactions. This study aims to evaluate the off-label prescriptions in pediatric patients at the Emergency Department of dr. Cipto Mangunkusumo Hospital (IGD-RSCM) which has never been studied.

Methods

This is a cross sectional study. Prescription samples were taken from the medical records at IGD-RSCM by consecutive sampling. The inclusion criteria were prescriptions for children aged 0-18 years treated at IGD-RSCM during January- December 2018. The exclusion criteria were unreadable, incomplete prescribing data, electrolytes, supplements, vitamins, and external medications. Data of gender, age, and drug class based on The Anatomical Therapeutic Chemical (ATC) classification were recorded. Off-label prescribing status was determined based on the patient's age at the time of prescription. Proportions of Off-label prescriptions in each gender and pediatric age groups were analyzed using the Chi-Square test. Results

Of the 446 prescriptions analyzed , 24.7% were prescribed off-labelly by age category. Based on the ATC, nervous system drugs was the most frequently prescribed medication. The highest proportion of off-label drugs prescription was the antineoplastic and immunomodulating agent (88.2%). There was no significant difference in the off-label prescription proportion between boys (21.9%) and girls (27.4%) (p=0.169, PR=0.662 CI=0.593-1.005). There was no significant association between age groups (infants, children and adolescents) and the proportion of off-label prescriptions (p= 0.086).

Conclusion

The proportion of pediatric off-label prescription at the IGD-RSCM was 24.7%. Gender and pediatric age group differences were not associated with the level of off-label prescriptions proportions."

"Pendahuluan: Penelitian di beberapa negara menunjukkan tingkat penggunaan obat off-label yang tinggi pada pasien pediatrik. Penggunaan obat off-label sendiri berpotensi meningkatkan kejadian efek samping obat. Penelitian ini bertujuan untuk mengevaluasi penggunaan obat off-label kategori usia pada pasien bangsal anak RSUPN Dr. Cipto Mangunkusumo (RSCM) yang belum pernah diteliti sebelumnya. Metode: Desain penelitian adalah observasional analitik cross sectional. Sampel merupakan data sekunder dari rekam medis pasien pediatrik yang dirawat di Bangsal Anak RSCM yang dipilih secara consecutive sampling. Kriteria inklusi adalah rekam medik pasien anak 0-18 tahun yang dirawat di Bangsal Anak RSCM periode Januari – Desember 2018, dan kriteria eksklusi berupa data pengobatan yang sulit dibaca, tidak lengkap, serta peresepan elektrolit, suplemen, dan obat luar. Obat yang diberikan dicatat dan ditabulasi. Status peresepan off-label ditentukan berdasarkan usia ketika obat diresepkan dan dicocokkan dengan ketentuan yang tertera pada label atau referensi yang relevan. Beda proporsi penggunaan obat off-label antar kelompok dianalisis menggunakan uji Chi-Square. Hasil: Dari 456 sampel peresepan, 12,5% (CI95 = [9,46%; 15,54%]) di antaranya diberikan secara off-label kategori usia. Berdasarkan klasifikasi ATC, golongan obat terbanyak yang diberikan secara off-label adalah agen antineoplastik dan imunomodulasi (61,2%) dan sistem muskuloskeletal (20,0%). Tidak didapatkan hubungan bermakna antara jenis kelamin dengan penggunaan obat off-label (p = 0,571; PR= 1,19; CI95 = [0,732; 1,942]) serta antara kategori usia bayi, anak, dan remaja dengan penggunaan off-label (p = 0,392). Kesimpulan: Tingkat penggunaan obat off-label kategori usia di bangsal anak 12,5%. Dalam penelitian ini, jenis kelamin dan kelompok usia tidak berpengaruh terhadap prevalensi penggunaan obat off-label.

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Introduction: Various studies conducted in many countries showed high level of off-label drug use in pediatric patients. Off-label drug use may increase the occurrence of adverse drug reactions. This study aims to evaluate off-label drug use in Dr. Cipto Mangunkusumo National Central General Hospital (RSCM) which has never been conducted. Methods: Samples were secondary data from medical records of pediatric patients admitted to RSCM Pediatric Ward and collected using consecutive sampling method. Inclusion criteria were medical records of patient of 0-18 years old admitted in the period of January-December 2018, and exclusion criteria were unreadable or incomplete medication record, and electrolyte, supplement, or external medicine. Collected data were recorded and tabulated. Off-label status was determined based on patients’ age when the drug was prescribed and then was matched with the information on the label of the drug or relevant references. Results: Of 456 evaluated prescriptions, 12,5% (CI95 = [9,46%; 15,54%]) were administered off-label according to age category. Based on Anatomical Therapeutic Chemical (ATC) classification, the most frequent drugs prescribed off-label were anti-neoplastic and immunomodulating (61,2%) and musculoskeletal system drugs (20,0%). There was no association between gender and off-label drug use (p = 0,571; PR= 1,19; CI95 = [0.732; 1.942]), and also between infant, children, and adolescent age categories and off-label drug use (p = 0,392). Conclusion: The prevalence of off-label drug use according to age category in the pediatric ward was 12.5%. In this study, gender and also infant, children, and adolescent age categories had no effect on the prevalence of off-label drug use."

"PendahuluanPasien anak, termasuk di Pediatric Intensive Care Unit (PICU), tergolong rentan menerima peresepan obat off-label, yang berpotensi menimbulkan kejadian efek samping obat. Penelitian ini bertujuan mengevaluasi penggunaan obat off-label pada pasien anak di PICU RSCM, yang belum pernah diteliti.MetodeSampel merupakan peresepan yang diambil dari rekam medis secara consecutive sampling. Perhitungan jumlah sampel menggunakan proporsi tunggal dan beda dua proporsi. Kriteria inklusi adalah pasien anak <18 tahun yang dirawat di PICU RSCM tahun 2018. Kriteria eksklusi adalah pasien dengan data pengobatan yang sulit dibaca atau tidak lengkap, obat luar, elektrolit, dan suplemen. Data ditabulasi berdasarkan nama obat, jenis kelamin, usia, status off-label obat berdasarkan usia pasien, dan klasifikasi Anatomical Therapeutic Chemical (ATC). Uji Chi-Square dipakai untuk mengetahui beda proporsi penggunaan obat off-label antar kelompok.HasilDari 400 peresepan yang dievaluasi, 23,8% tergolong off-label kategori usia. Berdasarkan klasifikasi ATC, peresepan di PICU didominasi oleh obat kardiovaskular (25,25%). Obat muskuloskeletal paling sering diresepkan secara off-label (84,6%). Tidak ada perbedaan signifikan proporsi penggunaan obat off-label pada kelompok laki-laki (21%) dan perempuan (26,5%) (p = 0,196,). Proporsi off-label pada kelompok usia bayi (0-2 tahun) 33,8%, anak (2-12 tahun) 18,6%, dan remaja (12-18 tahun) 14,3%. Peresepan off-label pada bayi lebih tinggi secara signifikan dibandingkan anak (p = 0,002) dan remaja (p = 0,001)KesimpulanSebanyak 23,8% peresepan pada pasien PICU diberikan secara off-label berdasarkan usia, dan yang tersering adalah obat muskuloskeletal. Perbedaan proporsi obat off-label antar jenis kelamin tidak signifikan, sedangkan antar kelompok usia signifikan.

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Introduction

Pediatric patients, including Pediatric Intensive Care Unit (PICU) patients, are prone to off-label drug prescriptions, which potentially lead to adverse drug reactions. This study aimed to assess the use of off-label drugs on PICU patients at RSCM, which has never been studied before.

Methods

Samples were prescriptions taken from medical records connsecutively. Sample size were calculated using single proportion and difference between two proportions. The inclusion criteria were <18 years old PICU patients at RSCM admitted in 2018. The exclusion criteria were patients with unclear or incomplete data, external drugs, electrolytes, and supplements. Data were tabulated by drug name, sex, age, off-label drug status based on patient age, and Anatomical Therapeutic Chemical (ATC) classification. Difference in proportions between groups were tested using Chi-Square.

Results

Of the 400 prescriptions evaluated, 23.8% were off-label by age. Based on the ATC classification, PICU prescription was dominated by cardiovascular drugs (25.25%). Musculoskeletal drugs were most often prescribed off-label (84.6%). There was no significant difference in off-label prescription between males (21%) and females (26.5%) (p = 0.196). The proportion of off-label in the infant age group (0-2 years) was 33.8%, in children (2-12 years) 18.6%, and in adolescents (12-18 years) 14.3%. Infants were given off-label drugs significantly higher than children (p = 0.002) and adolescents (p = 0.001)

Conclusion

Off-label prescription in PICU patients is 23.8%. Musculoskeletal drugs are most often prescribed off-label. The difference in the proportion of off-label drugs between sexes was not significant, whereas between age groups was significant"

"ABSTRAKReaksi obat tidak dikehendaki (ROTD) adalah salah satu masalah kesehatan di masyarakat yang terjadi terutama pada populasi anak.  ROTD pada anak dapat memiliki efek yang relatif lebih parah bila dibandingkan dengan orang dewasa. Penggunaan obat off-label merupakan faktor risiko terjadinya ROTD pada anak. Penelitian tentang penggunaan obat off-label sudah dilakukan di beberapa tempat di Indonesia tetapi sebagian besar hanya sebatas persentase penggunaan obat off-label tetapi tidak diketahui lebih lanjut tentang pengaruhnya terhadap munculnya ROTD. Tujuan dari penelitian ini adalah mengevaluasi penggunaan obat off-label dan on-label sebagai faktor risiko terjadinya reaksi obat tidak dikehendaki pada pasien pediatri di ruang rawat Rumah Sakit Umum Pusat Fatmawati.  Penelitian ini merupakan penelitian studi kohor yang membandingkan reaksi obat tidak dikehendaki antara peresepan secara ­on-label  dan off-label selama masa rawat pasien. Studi ini meneliti 130 pasien dengan jumlah penggunaan obat sebanyak 549 obat selama 4 bulan masa penelitian. Sebanyak 141 obat digunakan secara off-label dan 408 obat digunakan secara on-label. Pemberian obat off-label memiliki risiko untuk terjadinya ROTD 5,787 (Relative Risk=5,787; 95% Confidence Interval 1,072- 31,256) atau 5 kali lebih besar dibandingkan dengan pemberian obat on label. Peneitian ini mengindikasikan bahwa pemberian obat off-label merupakan faktor risiko terjadinya reaksi obat tidak dikehendaki. Variabel perancu yang berhubungan bermakna dengan kejadian ROTD adalah variabel umur (p< 0,05).

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ABSTRACT

Adverse drug reaction (ADR) is  one of the health problems in the community that occurs mainly in the pediatric population. ADR in children can have a relatively more severe effect compared to adults. The use of off-label drugs is a risk factor for ADR in children. Research on off-label drug use has been carried out in several places in Indonesia, but most are only limited to the percentage of off-label drug use, but it is not known more about its effect on the emergence of ROTD. The purpose of this study was to evaluate the use of off-label and on-label drugs as risk factors for adverse drug reactions in pediatric patients in the ward room at the RSUP Fatmawati. This study is a cohort study that compares adverse drug reactions between on-label and off-label prescriptions during the patient's care period. The study examined 130 patients with a total drug use of 549 during the 4 months of the study, 141 drugs are used off-label and 408 drugs are used on-label. Patients who received an off-label drug has a risk for ADR 5,787 (Relative Risk = 5,787; 95% Confidence Interval 1,072-31,256) or 5 times higher than patients who received the drug on label. This research indicates that giving off-label drugs is a risk factor for adverse drug reactions. Confounding variables that are significantly related to the incidence of ADR are age variables (p <0.05).

 

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"[Obat Off-label merupakan obat yang diresepkan tidak sesuai dengan ketentuan izin edar termasuk indikasi, dosis, kontraindikasi, usia, dan rute pemberian. Penelitian ini dilakukan untuk mengevaluasi pola penggunaan obat off-label untuk pasien usia 0 sampai 2 tahun di Instalasi Rawat Jalan Rumah Sakit Umum Pusat Fatmawati periode Maret 2015. Penelitian ini menggunakan design studi cross-sectional dan data diambil dari resep dan rekam medis periode Maret 2015 dengan teknik total sampling. Sampel penelitian adalah data pasien usia 0 sampai 2 tahun yang menerima obat pada periode Maret 2015. Evaluasi dilakukan terhadap 156 terapi obat dari 25 jenis obat yang digunakan pada 64 pasien dari 113 pasien dengan pasien usia kurang dari 1 bulan (5%) dan pasien usia >1 bulan sampai 2 tahun (95%) terdiri atas laki-laki atau perempuan sebesar 50% serta diagnosis terbanyak adalah epilepsy (36%). Terdapat 8 jenis obat dengan 55 terapi obat. Proporsi kategori off-label dosis sebanyak 20 terapi obat (36%) dengan penggunaan tertinggi adalah sefiksim (50%) dan off-label usia sebanyak 35 terapi obat (64%) dengan penggunaan tertinggi adalah asam valproat (80%). Berdasarkan hasil penelitian, penggunaan obat off-label lebih tinggi pada pasien 1 bulan-2 tahun dan golongan obat yang paling banyak digunakan adalah obat golongan saluran pernapasan sebanyak 5 jenis obat (63%).;Off-label drug is a prescribed drug that unsuitable with official drug information, and patient age, drug indications, dosage, and route of administration that are not appropriate. This study aimed to evaluate of off-label drugs use in under 2-year-old patients in Fatmawati General Hospital on March 2015. Sample data was data of under recieving drug therapy on march 2015. Cross-sectional was used and data were collected by total sampling from prescriptions and medical records. Sample are data 2-year-old patients that recieve drug on March 2015. Sample were 156 drug therapy of 25 item drugs that were used in 64 patients from 113 patients that consist of patient under 1 month (5%) and after 1 month until 2 years (95%) with boys as big as girls (50%) and the highest diagnostic was epilepsy (36%).There were 8 items drugs with 55 off-label drug therapy that consist of 20 (36%) off-label doses with sefiksim was the highest used and 35 (64%) off-label age with valproic acid was the highest used. Based on the results, off-label drug use was higher (63%) in babies and respiratory system drug class was the most frequently used drug in those patients which is 5 item drugs that used., Off-label drug is a prescribed drug that unsuitable with official drug information, and patient age, drug indications, dosage, and route of administration that are not appropriate. This study aimed to evaluate of off-label drugs use in under 2-year-old patients in Fatmawati General Hospital on March 2015. Sample data was data of under recieving drug therapy on march 2015. Cross-sectional was used and data were collected by total sampling from prescriptions and medical records. Sample are data 2-year-old patients that recieve drug on March 2015. Sample were 156 drug therapy of 25 item drugs that were used in 64 patients from 113 patients that consist of patient under 1 month (5%) and after 1 month until 2 years (95%) with boys as big as girls (50%) and the highest diagnostic was epilepsy (36%).There were 8 items drugs with 55 off-label drug therapy that consist of 20 (36%) off-label doses with sefiksim was the highest used and 35 (64%) off-label age with valproic acid was the highest used. Based on the results, off-label drug use was higher (63%) in babies and respiratory system drug class was the most frequently used drug in those patients which is 5 item drugs that used.]"

"Tuberkulosis (TB) adalah suatu penyakit infeksi menular yang disebabkan oleh bakteri M. tuberculosis yang dapat menyerang berbagai organ, terutama paruparu. Lamanya pengobatan tuberkulosis yang berlangsung minimal 6 bulan serta efek samping yang ditimbulkan menyebabkan tidak patuhnya pasien menjalani pengobatan. Tujuan penelitian ini yaitu untuk mengevaluasi penggunaan obat antituberkulosis dan melihat hasil pengobatan dengan menggunakan obat antituberkulosis di Instalasi Rawat Jalan RSUPN dr. Cipto Mangunkusumo Jakarta periode Januari 2014 ? Oktober 2015. Metode penelitian ini dilakukan secara deskriptif analitik retrospektif dan mengevaluasi catatan rekam medis dari 223 pasien tuberkulosis paru dengan kasus baru. Analisis dilakukan pada 223 pasien dimana jumlah penderita perempuan lebih tinggi dari pada laki-laki yaitu sebesar 53% dan paling banyak diderita oleh pasien dengan umur produktif yaitu pasien dengan rentang umur 46-55 tahun dan pasien dengan rentang umur 26-35 tahun. Sesuai dengan Pedoman Nasional Pengobatan Tuberkulosis, jenis OAT (Obat Antituberkulosis) yang paling banyak digunakan adalah OAT-KDT sebanyak 99,1% dan hanya 0,9% yang menggunakan OAT-Lepasan karena pasien memiliki riwayat hepatotoksis. 49,8% pasien yang menjalani pengobatan selama ≥ 6 bulan dan 43% pasien mendapatkan pengobatan secara rasional. 95% pasien menjalani pengobatan ≥ 6 bulan mendapatkan pengobatan lengkap, dan 95% pasien menjalani pengobatan < 6 bulan merupakan pasien putus berobat.

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Tuberculosis (TB) is a contagious infectious disease caused by M. tuberculosis that can affect various organs, especially the lungs. The duration of treatment for tuberculosis at least 6 months. Side effects caused disobedience by patients undergoing treatment. The purpose of this study is to evaluate the use of antituberculosis medicines and see the results of treatment using anti-tuberculosis medicines in RSUPN dr. Cipto Mangunkusumo the period January 2014 - October 2015. This research method is a descriptive analytic retrospective and evaluate the medical record of 223 patients with new cases of pulmonary tuberculosis.

Analysis was conducted on 223 patients in which the number of female patients is higher than in men that is equal to 53% and most suffered by patients with productive age in which patients with a lifespan of 46-55 years and patients with a lifespan of 26-35 years. In accordance with the National Guidelines for Treatment of Tuberculosis, the most widely used the OAT-KDT as much as 99.1% and only 0.9% using OAT-Removable because the patient had a history of hepatotoxic. 49.8% of patients undergoing treatmen't 6 months and 43% of patients receiving treatment in a rational way. 95% of patients undergoing treatment ≥ 6 months get a complete treatment, and 95% patients undergoing treatment < 6 months patients defaulting treatment."

"Angka kejadian bedah caesar di seluruh dunia terus meningkat setiap tahun. Namun, angka risiko kematian pasca bedah caesar sangat tinggi akibat infeksi. Pemakaian suatu jenis antibiotik profilaksis pada sebagian kasus bedah caesar telah terbukti dapat mengurangi kejadian infeksi luka operasi. Tujuan penelitian ini untuk mengetahui pola penggunaan antibiotik profilaksis serta kerasionalan antibiotik profilaksis yang digunakan pada pasien bedah caesar di RSUPN Dr. Cipto Mangunkusumo tahun 2015. Penelitian dilakukan secara observasional dengan menggunakan metode deskriptif dan data diperoleh dari rekam medis pasien secara retrospektif. Pengambilan data dilakukan dengan teknik purposive sampling. Evaluasi kerasionalan penggunaan antibiotik profilaksis dinilai dari ketepatan pasien, tepat indikasi, tepat obat, tepat dosis, tepat waktu pemberian dan tanpa infeksi luka operasi. Pasien yang memenuhi kriteria sebagai subjek penelitian sebanyak 245 pasien. Data yang diperoleh menunjukkan bahwa jenis antibiotik profilaksis yang paling banyak digunakan adalah sefazolin (72,66%). Pada penelitian terdapat pasien bedah caesar yang menerima antibiotik profilaksis 100% tepat pasien, 100% tepat indikasi, 98,78% tepat obat, 98,37% tepat dosis dan 72,24% tepat waktu pemberian, serta 98,37% tanpa infeksi luka operasi. Penggunaan antibiotik profilaksis pada pasien bedah sesar terbukti 72,24% pasien menunjukkan kerasionalan. The number of caesarean section in all over the world continue to increase each year. But the rate of post caesarean section risk of death is very high due to infection. The use of a type of antibiotics prophylaxis in some cases of caesarean section has been proven to reduce the occurrence of surgical site infection. The purpose of this study was to know the image of antibiotic prophylaxis and the rationality of antibiotic prophylaxis on caesarean section patients in RSUPN Dr. Cipto Mangunkusumo in 2015. This study was conducted in observation using descriptive method and the data is acquired from medical record investigation retrospectively. Data were collected using purposive sampling technique. Rational use of antibiotics assessed evaluation of the appropriate patient, appropriate indication, appropriate drug, appropriate dose, appropriate time and without the provision of surgical site infection. Eligible patients as subjects of research were 245 patients. Data obtained showed that the most common kind of antibiotic prophylaxis that being used is cefazoline (72.66%). In this study were caesarean patients who received antibiotic prophylaxis showed 100% appropriate patient, 100% appropriate indication, 98.78% appropriate drug, 98.37% appropriate dose, 72.24% appropriate time and 98.37% no surgical site infection. The usage of antibiotic prophylaxis in patients with proven 72.24% caesarean section patients showed rationality."

"ABSTRAKLatar belakang: Penggunaan antibiotik profilaksis bedah bertujuan untuk mencegah infeksi daerah operasi pada pasien yang dianggap mempunyai risiko tinggi. Meskipun kebijakan penggunaan antibiotik profilaksis dalam operasi telah ditetapkan, masih terdapat penggunaan yang tidak sesuai yang dapat menyebabkan peningkatan risiko resistensi antibiotik dan peningkatan biaya perawatan di rumah sakit.Tujuan: Mengevaluasi ketepatan penggunaan antibiotik profilaksis serta efisiensi biaya penggunaan antibiotik profilaksis pada pasien bedah digestif di RSUPN-CMMetode: Penelitian ini merupakan studi retrospektif. Data sekunder diambil dari rekam medik pasien rawat inap Departemen Bedah RSUPN-CM selama periode Januari hingga Desember 2015. Pada penelitian ini 102 pasien yang mendapatkan antibiotik profilaksis dievaluasi berdasarkan panduan NHS Lanaskhire untuk ketepatan dosis dan waktu pemberian pada tindakan pembedahan dan panduan antibiotik profilaksis divisi bedah digestif RSUPN-CM untuk pemilihan antibiotik berdasarkan indikasi tindakan.Hasil: Dari 102 pasien penelitian 81,4 pasien mendapatkan antibiotik profilaksis dengan indikasi sesuai tindakan dan 90,8 pasien mendapatkan antibiotik profilaksis tepat dosis. Berdasarkan ketepatan waktu pemberian antibiotik profilaksis, sebanyak 52 pasien mendapatkan antibiotik profilaksis tepat waktu 30 menit . Sementara itu, pasien yang mendapatkan antibiotik profilaksis lebih dari satu dosis yang berarti bukan lagi profilaksis sebanyak 15,7 . Tambahan biaya obat akibat pemberian antibiotik profilaksis yang tidak sesuai pedoman sebesar Rp. 16.016.007,-.Kesimpulan: Hasil penelitian menunjukkan masih adanya penggunaan antibiotik profilaksis yang tidak sesuai pedoman pada pasien bedah digestif RSUPN-CM. Pemberian antibiotik profilaksis yang tidak sesuai pedoman dapat menyebabkan peningkatan biaya perawatan rumah sakit. Diperlukan upaya untuk meningkatkan kepatuhan terhadap pedoman yang digunakan.hr>b>ABSTRACT"Background Prophylactic antibiotic is used to prevent surgical wound infections in surgery patients who are considered to have high risk of contamination. Despite established guideline, some studies reported inappropriate use of prophylactic antibiotic which potentially increase the risk of antibiotic resistance and hospitalization cost.Aim To evaluate the appropriateness and cost of prophylactic antibiotic usage in digestive surgery patients at Cipto Mangunkusumo hospital.Methods This was a retrospective study conducted on digestive surgery patients. Secondary data were collected from medical records of hospitalized patients in Surgery Department of Cipto Mangunkusumo hospital during the periode January to Desember 2015. In this study, 102 patients receiving prophylactic antibiotics were evaluated based on NHS Lanaskhire guideline for dosage and timimg in accordance with surgical types and guideline of digestive surgery division Cipto Mangunkusumo hospital for antibiotic selection.Results In 102 patients 81,3 patients received prophylactic antibiotics with appropriate indications and 91,2 patients received prophylactic antibiotics with appropriate doses. While 52 patient received prophylactic antibiotic with appropriate timing of 30 minutes. Meanwhile, patients that received prophylactic antibiotics more than once, which means not prophylactic anymore, were accounted for 15,7 . The estimated extra cost due to of inappropriate use of prophylactic antibiotics was Rp. 16.016.007, .Conclusion The results showed that inappropriate use of antimicrobial prophylaxis was still found in digestive surgery Cipto Mangunkusumo hospital and it increased drug cost. The most frequent inappropriateness was the timing of administration followed by inappropriate indication and dose. More work is needed in order to increase the adherence to the guidelines. "

"Penggunaan obat yang tidak rasional menjadi salah satu tantangan bagi negara berkembang karena tingginya jumlah kasus yang terjadi jika dibandingkan negara maju. Hal ini dapat berdampak negatif pada aspek ekonomi maupun kesehatan bagi masyarakat. WHO telah merancang indikator pelayanan pasien untuk mengidentifikasi resep dan pelayanan oleh tenaga kesehatan melalui pengadaan nilai optimum sebagai upaya untuk menjaga kerasionalan penggunaan obat. Evaluasi pelayanan obat menggunakan indikator pelayanan pasien masih jarang dilakukan di rumah sakit wilayah Indonesia. Penelitian ini bertujuan untuk mengevaluasi pelayanan obat menggunakan indikator pelayanan pasien di Klinik Umum Rumah Sakit Universitas Indonesia. Penelitian ini dilakukan secara prospektif dengan metode observasi untuk waktu konsultasi medis dan penyiapan obat, pelabelan dan kesesuaian penyerahan obat serta melakukan wawancara untuk mengetahui pengetahuan pasien. Sampel diambil secara consecutive sampling yaitu 100 untuk waktu konsultasi medis dan 99 untuk aspek lainnya. Analisis data univariat menunjukkan hasil waktu konsultasi medis 12,44 ± 8,1 menit; waktu penyiapan obat 2738,79 ± 1729,3 detik;  kesesuaian penyerahan obat (96,25%); pelabelan obat memadai (100%); dan pengetahuan pasien (78,78%). Kemudian, dilakukan analisis bivariat terhadap pengetahuan pasien. Uji Korelasi Spearman menunjukkan nilai p=0,111, r=0,161 (usia); uji Mann-whitney U test nilai p=0,014 (tingkat pendidikan), nilai p=0,075 (jenis kelamin). Berdasarkan hasil tersebut, disimpulkan bahwa tidak semua aspek indikator memenuhi nilai optimum dan adanya hubungan antara tingkat pendidikan dengan pengetahuan pasien, maka dari itu pelayanan pasien di Rumah Sakit Universitas Indonesia masih perlu ditingkatkan.

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Irrational use of drugs is one of the challenges in developing countries because of the high number of cases that occur when compared to developed countries. It can have a negative impact on economic and public health aspects. WHO has designed patient care indicators to identify prescriptions and services by health workers through the provision of optimum values in an effort to maintain rational drug use. Evaluation of drug services using patient care indicators is slightly done in Indonesia, especially in hospitals. This research was conducted to evaluate drug services using patient care indicators in the general outpatient at The University of Indonesia Hospital. It was conducted prospectively with observation for consultation and dispensing time, adequately labeled, and drugs actually dispensed also using the interview to determine patient's knowledge. Samples were taken consecutively with 100 samples for consultation time and 99 samples for other aspects. The univariate data analysis shows results for consultation time is 12,44 ± 8,1 minutes; drugs dispensing time is 2738,79 ± 1729,3 seconds; drugs actually dispensed is (96,25%); adequately labeled (100%); and patient's knowledge is (78,78%). Then, conducted bivariate analysis of patient’s knowledge. Spearman Correlation test analysis showed p=0,111, r=0,161 (age); Mann-whitney U Test showed p=0,014 (educational), p=0,075 (gender). Based on the results, it is concluded that not all aspects of indicators meet the optimum values and there was a relationship between educational level with patient's knowledge, therefore patient care at The University of Indonesia Hospital still needs to be improved."

"Program Jaminan Kesehatan Nasional (JKN) merupakan jaminan perlindungan kesehatan yang dikembangkan di Indonesia, dimana peserta akan mendapatkan pelayanan kesehatan yang komperhensif (promotif, preventif, kuratif dan rehabilitatif) sesuai dengan indikasi medisnya. Dalam rangka mendukung pelaksanaan program tersebut, Kementerian Kesehatan berupaya untuk menjamin ketersediaan, keterjangkauan dan aksesibilitas obat dengan menyusun Formularium Nasional (Fornas). Sejak pertama kali diterbitkan pada tahun 2013, Fornas telah mengalami 4 kali revisi dan 7 kali perubahan (Adendum), baik dari segi jumlah item obat ataupun sediaan/kekuatannya. Rumah Sakit Umum Pusat Nasional (RSUPN) Dr. Cipto Mangunkusumo sebagai fasilitas kesehatan rujukan tingkat lanjutan yang menerapkan penggunaan Fornas pada pasien JKN juga perlu melakukan pembaruan data obat Fornas terhadap data obat Fornas terbaru. Laporan ini disusun bertujuan untuk memperbarui data terkait obat Fornas pada sistem EHR RSUPN Dr. Cipto Mangunkusumo terhadap Fornas edisi 2021 beserta adendumnya berdasarkan hasil tarikan dari sistem EHR pada 18 lokasi yang telah ditentukan, serta melakukan evaluasi terhadap penggunaan obat Fornas Periode Juli – Desember 2022 berdasarkan data obat Fornas yang telah diperbarui. Hasil dari pembaruan obat Fornas pada sistem EHR RSUPN Dr. Cipto Mangunkusumo diperoleh sebanyak 77 item obat kategori non Fornas yang sudah termasuk kedalam obat kategori Fornas dengan persentase pembaruan sebesar 4% dari total obat yang digunakan selama periode Juli – Desember 2022. Dengan adanya pembaruan terhadap obat Fornas ini diperoleh capaian rata-rata pelayanan resep obat Fornas pada periode Juli – Desember 2022 meningkat dari 96,07% menjadi 96,35%.

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The National Health Insurance Program (JKN) is a health protection insurance developed in Indonesia, where participants will receive comprehensive health services (promotive, preventive, curative and rehabilitative) according to their medical indications. In order to support the implementation of the program, the Ministry of Health seeks to ensure the availability, affordability and accessibility of drugs by compiling the National Formulary (Fornas). Since it was first published in 2013, Fornas has undergone 4 revisions and 7 amendments (addendum), both in terms of the number of drug items or their dosage/strength. Rumah Sakit Umum Pusat Nasional (RSUPN) Dr. Cipto Mangunkusumo as an advanced level referral health facility that applies Fornas to JKN patients also needs to update Fornas drug data against the latest Fornas drug data. This report was prepared with the aim of updating data related to Fornas drugs in the EHR system of RSUPN Cipto Mangunkusumo on the 2021 edition of Fornas and its addendum based on the results of withdrawals from the EHR system at 18 predetermined locations, as well as evaluating the use of Fornas drugs for the period July - December 2022 based on updated Fornas drug data. The results of the Fornas drug update on the EHR system of RSUPN Dr. Cipto Mangunkusumo obtained 77 items of non-Fornas category drugs which were included in the Fornas category of drugs with a renewal percentage of 4% of the total drugs used during the period July - December 2022. With the renewal of Fornas drugs, the average achievement of Fornas drug prescription services in the July – December 2022 period increased from 96.07% to 96.35%."