1. PERKHIDMATAN FARMASI
PESAKIT DALAM

2. Farmasi Pesakit Dalam
The Inpatient Pharmacy is responsible
for the supply and dispensing of all
medicines to inpatients and for the
supply of medicines on discharge.

3. Objektif
To dispense medications to inpatients and
discharge patients via the prescription or
imprest system
To provide pharmaceutical care via patient
counseling

4. Skop Tugas
Dispensing
Medication counseling
Stock management

5. IN-PATIENT PHARMACY
 Services both in-patients & discharge patients.
 Provide bedside dispensing and counseling service for
discharge patients.
 Supply medications to in-patients in wards and units
through:
I) Modified Unit Dose System/Unit Of use
- Each Dose is packed and labelled & kept in trolley bins.
- II) Floor Stock System
- Commonly used drugs are stocked in the wards for after
office hours use.
- Minimum & maximum stock level constantly
monitored & replenished by pharmacy staff.
III) Supply Of Dangerous Drug (DD)
IV) Discharge Medication
IV) Counselling And Bedside Dispensing

6. Garispanduan
Berdasarkan Formulari Ubat KKM
 A* = Consultant for specific indication
 A = Consultant or specialist
 B = Medical Officer
 C = paramedical staff
* Item tiada dalam Formulari – perlu dapat kelulusan KPK

7. Ubat-ubatan Untuk
Pesakit Dalam Wad
(Inpatient)

8. Proses Kerja
New Prescription
by Doctors Further Clarifications
SCREENING Contact Prescribers
By Pharmacist
Problems Rectified
Trolley Rx Filling Counter
Rx For Refilling Checking
According to Based on Rx Data
Wards of Individual
Patient
Supply To Ward Staffs
Patients In Wards

9. Screening (Penyaringan)
 1. Preskripsi adalah lengkap
 Nama pesakit dan MRN
 Drug regimen adalah betul (Dose, frekuensi, cara
 administrasi dan j/masa
 T/tangan dan nama prescriber
 Age dan berat untuk pesakit paediatrik (Prefer)
 Bertarikh
2. Polifarmasi
3. Interaksi ubat
*Hubungi doktor jika terdapat sebarang permasalahan pada
preskripsi dan buat dan buat pembetulan yang sepatutnya.

10. Screening
 2. Polifarmasi
 3. Interaksi ubat
 *Hubungi doktor jika terdapat sebarang
permasalahan pada preskripsi dan buat dan buat
pembetulan yang sepatutnya.
 4. Sah
 5. T/tangan pakar utk ubat khas

11. Preskripsi Bermasalah
Hantar Balik
Sticker Kuning
•Masalah Dos
•Kekerapan
• Jangkamasa
Cop Kosign
Pakar

12. Pembekalan
 Proses bekalan:
 Melabel,
 mengisi
 menyediakan persediaan ekstemporaneus,
 merekod,
 menyemak balas,
 Pembekalan melalui:
 Unit Dos
 Unit Of Use
 Imprest stock/ward stock
 Semaksilang

13.  In-patients by implementing the Unit-of-Use/Unit
Dose System.
 Advantage of providing personalised and continuous
supply of medication to patients, with better
compliance and reduced wastage as compared to the
traditional system where the wards order drugs in
large quantities, which have led to overstocking and
wastage.

14.  2.4 Melakukan “Bedside Dispensing” untuk pesakit Discaj dan
Kaunseling
 2.5 Memesan, menerima, menyemak dan mengeluarkan stok ubat
 2.6 Membekalkan Dadah Berbahaya dan Item Psikotropik ke wad
 2.7 Menyediakan Laporan QAP dan kompilasi statistik
 Membekalkan larutan intravena dan disinfektan yang baru
disediakan kepada semua wad/unit.
 Mengawal secara berpusat pembekalan ubat-ubatan dengan
mempunyai stor yang boleh menyimpan stok drug yang mencukupi
untuk dibekalkan ke Farmasi Bekalan Wad dan Farmasi Satelit.

15. IN-PATIENT PHARMACY
 Services both in-patients & discharge patients.
 Provide bedside dispensing and counseling service for
discharge patients.
 Supply medications to in-patients in wards and units
through:
I) Modified Unit Dose System
- Each Dose is packed individually & kept in trolley bins.
- Supply is on everyday basis.
- II) Floor Stock System
- Commonly used drugs are stocked in the wards for after
office hours use.
- Minimum & maximum stock level constantly
monitored & replenished by pharmacy staff.
III) Supply Of Dangerous Drug (DD)
IV) Discharge Medication
IV) Counselling And Bedside Dispensing

16. Unit Dose
 The unit dose system may differ in form, depending
on the specific needs of the organization.
 Basic unit dose systems:
 medications are contained in single unit packages; they are
dispensed
 in as ready-to-administer form as possible; and for most
medications,
 not more than a 24-hour supply of doses is delivered
 to or available at the patient-care area at any time.
 Numerous studies concerning unit dose drug distribution

17. Floor Stock/Ward Stock
 Ward Stock
 • The floor stock system is used in small hospitals where pharmacists
are not available to dispense individual doses for patients.
 Floor Stock
 It consists of a predetermined list of medications that are available in the
patient care area of the hospital
 Usually these items are inexpensive that have common use
 (Example: alcohol, lotion, water for injection, normal saline, etc)
 Certain medications for Example: emergency/Operation room medications
that are required to be used almost immediately after the physician
prescribes them, and it isn't practical to wait until the nurse dispenses them
from

18. Inpatient drug distribution
 Supplying medications
to ward patients in
individualised bins
 Preparing medication
from discharge scripts

19. Bedside Dispensing
 perkhidmatan terus ke
katil pesakit.
 Khidmat ini dilakukan
oleh Pegawai Farmasi
yang bertugas dengan
menghantar ubat terus
kepada pesakit
yang "discharge"
(dibenarkan pulang) oleh
Doktor dan seterusnya
memberi kaunseling ubat-
ubatan.

20. Dadah Berbahaya (DD)
 Menurut Dangerous Drugs
(Hospital, Etc) (General
Exemption) Order 1952, Schedule
B, 2:
 All supplies of such drugs and
preparations will be received by
the Matron, Acting Matron,
Senior Hospital Assistant or
Senior Nurse of the hospital and
shall be kept by her in a locked
cupboard of which she alone shall
have the key.

21. Dangerous Drugs (DD)/
Psikotropik
Ubat yang dikawal oleh
Akta Dadah Merbahaya (DDA) 1952
Semua Inden dan Penghantaran
DD/Psikotropik hanya boleh
dikendalikan oleh
Matron/ Sister/ Staff Nurse

22. Senarai DD/ Psikotropik
Clonazepam Tab Methadone Syrup
Diazepam Inj/ Tab/ Supp Midazolam Inj/ Tab
Dihidrocodeine DF118 Morfin Injeksi/ Tab/ Sirap
Fentanyl Inj/ Patch Oxycodone Tab
Phenobarbitone Tab/
Ketamin Inj Syrup
Lorazepam Tab Pethidine Injeksi
Zolpidem Tab

23. Pemeriksaan Wad
 Pemeriksaan wad akan dijalankan oleh Staf Farmasi setiap 3
bulan (mengikut Jadual yang telah ditetapkan)
 Tujuan pemeriksaan adalah untuk memastikan:
 * Tiada ubat yang luput
 * Tidak overstocking
 * kaedah penyimpanan adalah betul
 Laporan pemeriksaan akan dikeluarkan dan pihak wad
bertanggungjawab untuk membuat tindakan susulan

24. Cold chain
 Item- item ini perlu disimpan bawah
suhu 2 - 8ºC untuk mengelakkan
kerosakan ubat
 Perlu membawa bersama Ice Box
dengan pek ais di dalam.
 Kebanyakan Fridge Item adalah ubat
yang mahal, maka ubat tidak akan
dibekalkan tanpa ice box.

25. Permonitoran Stok
 Memastikan stok sentiasa ada dan mencukupi
 Mengelakkan ubat luput
 Mengelakkan overstocking
 Mengurangkan slow moving item

26. High Alert Medication
What is High Alert Medication?
 High-Alert Medication – Medications that have a heightened risk of causing
significant patient harm when used in error.
 The following medications which are currently listed in the have been classified as
High Alert Medication.
 amiodarone, IV
 heparin, low molecular weight, injection
 heparin, unfractionated, IV
 insulin, subcutaneous and IV
 magnesium sulfate injection
 cyclophosphamide, oral
 methotrexate, oral
 nitroprusside sodium for injection
 potassium chloride for injection, concentrated
 potassium phosphates injection, concentrated
 sodium chloride injection, hypertonic (more than 0.9% concentration)
 warfarin
.

27. Pembekalan Ubat HAM
 Semua Ubat disemak silang sebelum
dibekal
 Ubat-ubat dilabel dengan “HIGH
ALERT MEDICATION”
 Membekalkan ubat dalam bentuk pek
unit dos
 Menghadkan penggunaan secara
intrathecal, epidural analgesic, oleh staff
terlatih sahaja

28. Storage
 DO NOT keep look alike or different strength drug side by side.
 Limit the strength and quantity available in ward floor stock. Use
smaller package, concentration, dose, and number of vials for floor
stock.
 Designated area or different label receptacle
 Higher strength drugs to be keep in emergency trolley and lower
strength to keep as floor stock
 (storage container for HAM should be labeled by ward staff –eg.
Insulin, heparin)

29. THANK YOU