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Abstract
Background: The healthcare sector, specifically hospitals, is vulnerable to antimicrobial resistance due to diverse services and patient populations, alongside continuous intensive antimicrobial use. This resistance presents a significant national and global health threat. Therefore, implementing an antimicrobial stewardship program is crucial for reducing resistance development and spread in hospitals. Pharmacists, as healthcare professionals, have an essential role in upholding stewardship through pharmaceutical services in line with Standard Operating Procedure (SOP).
Objective: This study aimed to evaluate Restricted Antimicrobial Standard Operating Procedure (SOP-A) at Tabanan Regional General Hospital (RSUD Tabanan) to enhance the quality of pharmaceutical services.
Method: A qualitative method was used in SOP evaluation, comparing data from interviews with the Head of Pharmacy Installation at RSUD Tabanan and observations of implementation. The data were then contrasted with recent literature and regulations to identify discrepancies necessitating improvements. Moreover, data were analyzed using the descriptive method and presented in narrative, figure, and table formats.
Results: The results showed that based on interviews and observations of SOP-A implementation, several revisions were needed. These revisions include adding restricted antimicrobials from the reserve categories (cefepime, cefpirome, and carbapenems), establishing a protocol for eligible patients without waiting for culture results, outlining a process for obtaining approval from the Head of the Antimicrobial Resistance Control Program (PPRA) and Hospital Director, as well as incorporating antimicrobial usage history into the restricted antibiotic use application form.
Conclusion: SOP-A at RSUD Tabanan requires four key additions, namely a list of reserve category antimicrobials, a protocol for administering restricted antimicrobials to eligible patients without waiting for culture results, a process for obtaining approval from the Head of the PPRA and Hospital Director, as well as inclusion of antimicrobial usage history in the restricted antibiotic use application form.
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References
- Adil, A. S. & Kundarto, W. (2019). Evaluasi Penggunaan Antibiotik pada Pasien Geriatri Wanita Infeksi Saluran Kemih di Instalasi Rawat Inap RSUD Dr. Moewardi Surakarta Tahun 2017. Journal of Pharmaceutical Science and Clinical Research, 4(1), 1-15. https://doi.org/10.20961/jpscr.v4i1.22882
- Bankar, N. J., Ugemuge, S., Ambad R.S., Hawale D.V., & Timilsina, D.R. (2022). Implementation of Antimicrobial Stewardship in the Healthcare Setting. Cureus, 14(7), 1–7. https://doi.org/10.7759/cureus.26664
- Bardani, F. R., Andriani, Y. & Rahmadevi, R. (2021). Penggunaan Antibiotik Restriksi pada Pasien Sepsis di Ruang ICU RSUD H. Abdul Manap Kota Jambi Periode 2017-2019. Jurnal Sains dan Kesehatan, 3(2), 227–232.
- Basavaraju, M., Alladi, A. & Vepakomma, D. (2021). Outcome of Restricted Antibiotic Policy In A Tertiary-Level Paediatric Surgical Unit. African Journal of Paediatric Surgery, 18(1), 28–32. https://doi.org/10.4103/ajps.AJPS_127_20
- CDDEP. (2021). The State of the World’s Antibiotics 2021: A Global Analysis of Antimicrobial Resistance and Its Drivers. Washington (DC): The Center for Disease Dynamics, Economics & Policy (CDDEP).
- European Centre for Disease Prevention and Control (ECDC). (2022). Assessing The Health Burden of Infections With Antibiotic-Resistant Bacteria In The EU/EEA, 2016-2020. Stockholm: ECDC. 1–23.
- Habboush, Y. & Guzman, N. (2023). Antibiotic Resistance, In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK513277/.
- Herman, Rahman, & Asti, H. (2019). Prokalsitonin dan Kultur Darah Sebagai Penanda Sepsis di RSUP Dr Wahidin Sudirohusodo Makassar. Jurnal Media Analis Kesehatan, 10(2), 152–162. https://doi.org/10.32382/mak.v10i2.1316
- Jantarathaneewat, K., Camins, B. & Apisarnthanarak, A. (2022). The Role of The Clinical Pharmacist In Antimicrobial Stewardship In Asia: A Review. Antimicrobial Stewardship and Healthcare Epidemiology, 2(1), 1-9. https://doi.org/10.1017/ash.2022.310
- Kemenkes RI. (2015). Peraturan Menteri Kesehatan Republik Indonesia Nomor 8 Tahun 2015 Tentang Program Pengendalian Resistensi Antimikroba di Rumah Sakit. Jakarta: Kementerian Kesehatan Republik Indonesia.
- Kemenkes RI. (2016). Peraturan Menteri Kesehatan No. 72 tahun 2016 tentang Standar Pelayanan Kefarmasian di Rumah Sakit. Jakarta: Kementerian Kesehatan Republik Indonesia.
- Kemenkes RI. (2021). Peraturan Menteri Kesehatan Republik Indonesia Nomor 28 Tahun 2021 Tentang Pedoman Penggunaan Antibiotik, Kemenkes RI. Jakarta: Kementerian Kesehatan Republik Indonesia.
- Knobler SL, Lemon SM, Najafi M, et al., editors. (2003). The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for Containment: Workshop Summary. 5, Factors Contributing to the Emergence of Resistance. Washington (DC): National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK97126/
- Limato, R., Lazarus, G., Dernison, P., Mudia, M., Alamanda, M., Nelwan, E.J., Sinto, R., Karuniawati, A., Doorn, H.R.V., & Hamers, R.L. (2022). Optimizing Antibiotic Use In Indonesia: A Systematic Review and Evidence Synthesis To Inform Opportunities For Intervention. The Lancet Regional Health - Southeast Asia, 2(6). https://doi.org/10.1016/j.lansea.2022.05.002
- Natawidjaja, R., Manuaba, I. B. T. W. & Adiputra, P. A. T. (2019). Faktor Risiko Yang Mempengaruhi Length of Stay Pasien Kanker Solid Dengan Febrile Neutropenia Pasca Kemoterapi Neoadjuvant/Terapeutik Di Ruang Isolasi RSUP Sanglah Bali. Intisari Sains Medis, 10(1), 155–159. https//doi.org/10.15562/ism.v10i1.367
- Noviyani, R. & Purnamasari, G. A. P. P. (2023). Penyusunan Standard Operating Procedure ( SOP ) Evaluasi Perencanaan Perbekalan Kefarmasian di Rumah Sakit X. Indonesian Journal of Legal and Forensic Sciences, 13 (1), 30–45.
- Parathon, H., Kuntaman, Widiastoety, T.H., Muliawan, B.T., Karuniawati, A., Qibtiyah, M., Djanun, Z., Tawilah, J.F., Aditama, T., Thamlikitkul, V., & Vong, S. (2017). Progress Towards Antimicrobial Resistance Containment and Control In Indonesia, BMJ, 358 (3808), 31–35. https://doi.org/10.1136/bmj.j3808
- Pemerintah RI. (2009). Undang-Undang Republik Indonesia Nomor 36 Tahun 2009 tentang Kesehatan. Jakarta: Pemerintah Republik Indonesia.
- Pemerintah RI. (2018). Peraturan Pemerintah No. 34 Tahun 2018 tentang Sistem Standardisasi dan Penilaian Kesesuaian Nasional. Jakarta: Pemerintah Republik Indonesia.
- Pemerintah RI (2023) Undang-Undang Republik Indonesia Nomor 17 Tahun 2023 Tentang Kesehatan, Undang-Undang. Jakarta: Pemerintah Republik Indonesia.
- Pemerintah RI. (2024). Peraturan Pemerintah Republik Indonesia Nomor 28 Tahun 2024 Tentang Peraturan Pelaksanaan Undang-Undang Nomor 17 Tahun 2023 Tentang Kesehatan. Jakarta: Pemerintah Republik Indonesia.
- Pratiwi, M. (2022). Pengaruh Ketepatan Terhadap Efektivitas Antibiotik Pada Pasien Demam Neutropenia di
- RSUP Dr Kariadi Semarang. Jurnal Pusat Penelitian Farmasi Indonesia, 1(1), 1–7.
- Pulingam, T., Parumasivam, T., Gazzali, A.M., Sulaiman, A.M., Chee, J.Y., Lakshmanan, M., Chin C.F., & Sudesh, K.. (2022). Antimicrobial Resistance: Prevalence, Economic Burden, Mechanisms of Resistance and Strategies To Overcome. European Journal of Pharmaceutical Sciences, 170, 1-18. https://doi.org/10.1016/j.ejps.2021.106103
- Read, A. F. & Woods, R. J. (2014). Antibiotic Resistance Management. Evolution, Medicine and Public Health, 2014(1), 147. https://doi.org/10.1093/emph/eou024
- Rukmini, R., Siahaan, S. & Sari, I. D. (2019). Analisis Implementasi Kebijakan Program Pengendalian Resistensi Antimikroba (PPRA). Buletin Penelitian Sistem Kesehatan, 22(2), 106–116. https://doi.org/10.22435/hsr.v22i2.1038
- Saleem, Z., Hassali, M.A., Godman, B., Fatima, M., Ahmad Z., Sajid, A., Rehman, I.U., Nadeem, M.U., Javaid, Z., Malik, M., & Hussain, A. (2020). Sale of WHO AWaRe Groups Antibiotics Without A Prescription In Pakistan: A Simulated Client Study. Journal of Pharmaceutical Policy and Practice, 13(1), 1–8. https://doi.org/10.1186/s40545-020-00233-3
- Tambunan, R. M. (2013) Standard Operating Procedures (SOP). Jakarta: Maiestas.
- Taufiq, A. R. (2019). Penerapan Standar Operasional Prosedur (SOP) Dan Akuntabilitas Kinerja Rumah Sakit. Jurnal Profita, 12(1), 56. https://doi.org/10.22441/profita.2019.v12.01.005
- WHO. (2019). Antimicrobial Stewardship Programmes In Health-Care Facilities In Low- and Middle-Income Countries: A WHO Practical Toolkit. JAC-Antimicrobial Resistance. https://doi.org/10.1093/jacamr/dlz072
- WHO. (2023). Buku Antibiotik WHO AWaRe (Access, Watch, Reserve). http://apps.who.int/bookorders.
- Wiraya, M. & Haryati, T. S. (2022). Implementasi Sop Keperawatan Berbasis Elektronik Di Rumah Sakit. Journal of Innovation Research and Knowledge, 1(8), 623–625.
References
Adil, A. S. & Kundarto, W. (2019). Evaluasi Penggunaan Antibiotik pada Pasien Geriatri Wanita Infeksi Saluran Kemih di Instalasi Rawat Inap RSUD Dr. Moewardi Surakarta Tahun 2017. Journal of Pharmaceutical Science and Clinical Research, 4(1), 1-15. https://doi.org/10.20961/jpscr.v4i1.22882
Bankar, N. J., Ugemuge, S., Ambad R.S., Hawale D.V., & Timilsina, D.R. (2022). Implementation of Antimicrobial Stewardship in the Healthcare Setting. Cureus, 14(7), 1–7. https://doi.org/10.7759/cureus.26664
Bardani, F. R., Andriani, Y. & Rahmadevi, R. (2021). Penggunaan Antibiotik Restriksi pada Pasien Sepsis di Ruang ICU RSUD H. Abdul Manap Kota Jambi Periode 2017-2019. Jurnal Sains dan Kesehatan, 3(2), 227–232.
Basavaraju, M., Alladi, A. & Vepakomma, D. (2021). Outcome of Restricted Antibiotic Policy In A Tertiary-Level Paediatric Surgical Unit. African Journal of Paediatric Surgery, 18(1), 28–32. https://doi.org/10.4103/ajps.AJPS_127_20
CDDEP. (2021). The State of the World’s Antibiotics 2021: A Global Analysis of Antimicrobial Resistance and Its Drivers. Washington (DC): The Center for Disease Dynamics, Economics & Policy (CDDEP).
European Centre for Disease Prevention and Control (ECDC). (2022). Assessing The Health Burden of Infections With Antibiotic-Resistant Bacteria In The EU/EEA, 2016-2020. Stockholm: ECDC. 1–23.
Habboush, Y. & Guzman, N. (2023). Antibiotic Resistance, In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK513277/.
Herman, Rahman, & Asti, H. (2019). Prokalsitonin dan Kultur Darah Sebagai Penanda Sepsis di RSUP Dr Wahidin Sudirohusodo Makassar. Jurnal Media Analis Kesehatan, 10(2), 152–162. https://doi.org/10.32382/mak.v10i2.1316
Jantarathaneewat, K., Camins, B. & Apisarnthanarak, A. (2022). The Role of The Clinical Pharmacist In Antimicrobial Stewardship In Asia: A Review. Antimicrobial Stewardship and Healthcare Epidemiology, 2(1), 1-9. https://doi.org/10.1017/ash.2022.310
Kemenkes RI. (2015). Peraturan Menteri Kesehatan Republik Indonesia Nomor 8 Tahun 2015 Tentang Program Pengendalian Resistensi Antimikroba di Rumah Sakit. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kemenkes RI. (2016). Peraturan Menteri Kesehatan No. 72 tahun 2016 tentang Standar Pelayanan Kefarmasian di Rumah Sakit. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kemenkes RI. (2021). Peraturan Menteri Kesehatan Republik Indonesia Nomor 28 Tahun 2021 Tentang Pedoman Penggunaan Antibiotik, Kemenkes RI. Jakarta: Kementerian Kesehatan Republik Indonesia.
Knobler SL, Lemon SM, Najafi M, et al., editors. (2003). The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for Containment: Workshop Summary. 5, Factors Contributing to the Emergence of Resistance. Washington (DC): National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK97126/
Limato, R., Lazarus, G., Dernison, P., Mudia, M., Alamanda, M., Nelwan, E.J., Sinto, R., Karuniawati, A., Doorn, H.R.V., & Hamers, R.L. (2022). Optimizing Antibiotic Use In Indonesia: A Systematic Review and Evidence Synthesis To Inform Opportunities For Intervention. The Lancet Regional Health - Southeast Asia, 2(6). https://doi.org/10.1016/j.lansea.2022.05.002
Natawidjaja, R., Manuaba, I. B. T. W. & Adiputra, P. A. T. (2019). Faktor Risiko Yang Mempengaruhi Length of Stay Pasien Kanker Solid Dengan Febrile Neutropenia Pasca Kemoterapi Neoadjuvant/Terapeutik Di Ruang Isolasi RSUP Sanglah Bali. Intisari Sains Medis, 10(1), 155–159. https//doi.org/10.15562/ism.v10i1.367
Noviyani, R. & Purnamasari, G. A. P. P. (2023). Penyusunan Standard Operating Procedure ( SOP ) Evaluasi Perencanaan Perbekalan Kefarmasian di Rumah Sakit X. Indonesian Journal of Legal and Forensic Sciences, 13 (1), 30–45.
Parathon, H., Kuntaman, Widiastoety, T.H., Muliawan, B.T., Karuniawati, A., Qibtiyah, M., Djanun, Z., Tawilah, J.F., Aditama, T., Thamlikitkul, V., & Vong, S. (2017). Progress Towards Antimicrobial Resistance Containment and Control In Indonesia, BMJ, 358 (3808), 31–35. https://doi.org/10.1136/bmj.j3808
Pemerintah RI. (2009). Undang-Undang Republik Indonesia Nomor 36 Tahun 2009 tentang Kesehatan. Jakarta: Pemerintah Republik Indonesia.
Pemerintah RI. (2018). Peraturan Pemerintah No. 34 Tahun 2018 tentang Sistem Standardisasi dan Penilaian Kesesuaian Nasional. Jakarta: Pemerintah Republik Indonesia.
Pemerintah RI (2023) Undang-Undang Republik Indonesia Nomor 17 Tahun 2023 Tentang Kesehatan, Undang-Undang. Jakarta: Pemerintah Republik Indonesia.
Pemerintah RI. (2024). Peraturan Pemerintah Republik Indonesia Nomor 28 Tahun 2024 Tentang Peraturan Pelaksanaan Undang-Undang Nomor 17 Tahun 2023 Tentang Kesehatan. Jakarta: Pemerintah Republik Indonesia.
Pratiwi, M. (2022). Pengaruh Ketepatan Terhadap Efektivitas Antibiotik Pada Pasien Demam Neutropenia di
RSUP Dr Kariadi Semarang. Jurnal Pusat Penelitian Farmasi Indonesia, 1(1), 1–7.
Pulingam, T., Parumasivam, T., Gazzali, A.M., Sulaiman, A.M., Chee, J.Y., Lakshmanan, M., Chin C.F., & Sudesh, K.. (2022). Antimicrobial Resistance: Prevalence, Economic Burden, Mechanisms of Resistance and Strategies To Overcome. European Journal of Pharmaceutical Sciences, 170, 1-18. https://doi.org/10.1016/j.ejps.2021.106103
Read, A. F. & Woods, R. J. (2014). Antibiotic Resistance Management. Evolution, Medicine and Public Health, 2014(1), 147. https://doi.org/10.1093/emph/eou024
Rukmini, R., Siahaan, S. & Sari, I. D. (2019). Analisis Implementasi Kebijakan Program Pengendalian Resistensi Antimikroba (PPRA). Buletin Penelitian Sistem Kesehatan, 22(2), 106–116. https://doi.org/10.22435/hsr.v22i2.1038
Saleem, Z., Hassali, M.A., Godman, B., Fatima, M., Ahmad Z., Sajid, A., Rehman, I.U., Nadeem, M.U., Javaid, Z., Malik, M., & Hussain, A. (2020). Sale of WHO AWaRe Groups Antibiotics Without A Prescription In Pakistan: A Simulated Client Study. Journal of Pharmaceutical Policy and Practice, 13(1), 1–8. https://doi.org/10.1186/s40545-020-00233-3
Tambunan, R. M. (2013) Standard Operating Procedures (SOP). Jakarta: Maiestas.
Taufiq, A. R. (2019). Penerapan Standar Operasional Prosedur (SOP) Dan Akuntabilitas Kinerja Rumah Sakit. Jurnal Profita, 12(1), 56. https://doi.org/10.22441/profita.2019.v12.01.005
WHO. (2019). Antimicrobial Stewardship Programmes In Health-Care Facilities In Low- and Middle-Income Countries: A WHO Practical Toolkit. JAC-Antimicrobial Resistance. https://doi.org/10.1093/jacamr/dlz072
WHO. (2023). Buku Antibiotik WHO AWaRe (Access, Watch, Reserve). http://apps.who.int/bookorders.
Wiraya, M. & Haryati, T. S. (2022). Implementasi Sop Keperawatan Berbasis Elektronik Di Rumah Sakit. Journal of Innovation Research and Knowledge, 1(8), 623–625.