Professional Documents
Culture Documents
Date
RR
HR
Temp
BP
Hb
Leko
Tromb
PCV
Past Medical
History/Surgery : GDA
PH
pCO2
pO2
Family and Social History : HCO3
BE
K
Na
Cl
Eo
Baso
Lifestyle: Batang
Seg
Limf
Mono
Bl.Dir
Indir
TTT
SGOT
SGPT
BUN
SCr
Sesak
Batuk
Acute and Chronic Medical Data Serum Concentration
Problems :
Medication PTA
Time Line: Circle actual administration times and record appropriate medications and meals
below.
6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5
Notes:
Patient : Tn. SH
Location/Room : Bedah/Gladiol
Pharmacist : Kelompok 5
Date :
Is the patient allergic to or intolerant 1. A problem exists. Pasien tidak menunjukkan riwayat alergi
of any medicines (or chemically pada penggunaan obatnya
related medications) 2. More information is needed
currently being taken ? for a determination.
Drug allergy
Intolerance
Is the patient using any method to 3. No problem exists or an
alert health care providers of the intervention is not needed.
allergy/intolerance (or serious
medical problem) ?
Are there symptoms or medical 1. A problem exists a. Tidak mengalami efek samping
problems that may be drug induced ? b. Efek samping potensial :
Adverse Drug Events
2. More information is needed for - Ceftriaxone :
What is the likelihood that the a determination. Trombositopenia dan leukopenia (
problem is drug related ? ≥ 10%) (Aronson, 2005)
3. No problem exists or an - Ketorolac : Pusing, dyspepsia,
intervention is not needed. mengantuk, nyeri GI, mual ( ≥
10%) (Aronson, 2005)
- Metoklorpramid : Ekstrapiramidal,
gelisah, lelah ( ≥ 10%) (Aronson,
2005)
a. Tidak terjadi interaksi antara obat-
Are there drug-drug interactions ? 1. A problem exists. obatan yang digunakan pada pasien.
Are they clinically significant ? b. Tidak ada obat-obat yang
Are any medications 2. More information is needed for a kontraindikasi pada kondisi pasien.
contraindicated(relatively or determination.
Interactions :
absolutely) given patient
Drug-drug,
characteristic and 3. No problem exists or an
Drug-Disease
current/pass disease states ? intervention is not needed.
Drug-nutrient, and
Drug-Laboratory Test
Are there drug-nutrient interactions ?
Are they clinically significant ?
1. A problem exists.
Is the chosen medication(s) cost
effective? 2. More information is needed for a
Financial Impact determination
Does the cost of drug therapy
represent a financial hardship for the 3. No problem exists or an
patient ? intervention is not needed.
Does the patient understand the 1. A problem exists. Perlu adanya pemberian informasi ke
purpose of his or her medication(s), pasien ataupun keluarga pasien mengenai
how to take it and the potential side 2. More information is needed for a tujuan pengobatan dan bagaimana agar
Patient Knowledge effect of therapy ? determination pengobatan yang dilakukan dapat
of Drug Therapy mencapai hasil yang maksimal
would the patient benefit from 3. No problem exists or an
education intervention is not needed.
tool (e.g., writen patient education
sheets, wallet cards and reminder
packaging) ?