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"Penelitian tugas akhir program magister ini dilatarbelakangi oleh tingginya penggunaan antibiotika dalam terapi empiris di ruang perawatan intensive care unit (ICU) dalam penanganan infeksi, tanpa harus menunggu hasil kepekaan bakteri.Penelitian ini bertujuan mencari hubungan antara penggunaan antibiotika pada terapi empiris dengan kepekaan bakteri dengan menggunakan rancangan studi potong lintang (Cross Sectional), pengambilan data secara retrospektif terhadap rekam medik dan data dianalisis dengan uji regresi logistik.Hasil penelitian menunjukkan terdapat hubungan yang signifikan antara intensitas penggunaan antibiotika pada terapi empiris dengan kepekaan bakteri dengan nilai P = 0,000 (P lebih kecil dari α = 0,05), dengan hasil seftriakson merupakan antibiotika yang paling besar memberikan hubungan terhadap resistensi bakteri.Dalam penelitian ini disarankan agar dilakukan perputaran penggunaan antibiotika (antibiotic cycling) berdasarkan pada pola penggunaan antibiotika dan pola kepekaan bakteri.

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The Relationship Between the Use of Antibiotics on Empirical Therapy with a Sensitivity of Bacteria in Intensive Care Unit at Fatmawati Hospital Jakarta Period January 2009 - March 2010. The research was motivated by the high use of antibiotics in empirical therapy in intensive care unit (ICU) for treatment of infection, without having to wait for the results of bacterial sensitivity.This study aims to find the relationship between use of antibiotics in empirical therapy with a sensitivity of bacteria by using cross-sectional study design (cross sectional), retrospective data collection of medical records and data were analyzed with logistic regression.Results showed a significant correlation between the intensity of the use of antibiotics in empirical therapy with a sensitivity of bacteria with P = 0.000 (P less than α = 0.05), with the results of antibiotic ceftriaxone is the greatest give the relationship of bacterial resistance.In this research suggests the use of antibiotic cycling based on usage patterns of antibiotic and patterns of sensitivity bacteria."

"Seorang apoteker memiliki peran penting dalam praktek pelayanan kesehatan di rumah sakit dan apotek. Apoteker harus memenuhi standar kompetensi sebagai persyaratan untuk memasuki dunia kerja dan menjalani praktek keprofesiannya. Standar kompetensi apoteker di Indonesia terdiri dari sepuluh standar kompetensi sebagai kemampuan yang diharapkan oleh apoteker saat lulus dan masuk ke tempat praktek kerja profesi. Sebagai bekal dan pengalaman calon apoteker untuk dapat memahami peran apoteker dan meningkatkan kompetensi, maka dilaksanakan Praktik Kerja Profesi Apoteker (PKPA) di RSUP Fatmawati dan Apotek Dini selama periode bulan Februari-Juni 2020. Selama PKPA, calon apoteker diharapkan dapat memperluas wawasan, pemahaman, dan pengalaman untuk melakukan pekerjaan kefarmasian di tempat praktik kerja profesi.

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A pharmacist has an important role in health services in hospitals and pharmacies. Pharmacists must meet competency standards as a requirement to enter professional work practice and undergo professional practice. Pharmacist competency standards in Indonesia consist of ten competency standards as the skills expected by pharmacists when they graduate and enter professional work practices. As a provision and experience for prospective pharmacists to be able to understand the role of pharmacists and improve competence, an internship was carried out at RSUP Fatmawati and Apotek Dini during the period February-June 2020. During internship, prospective pharmacists are expected to broaden their horizons, understanding, and experience doing pharmaceutical work in a professional work practices."

"Penggunaan antimikroba yang tidak tepat di ruang ICU dapat meningkatkan terjadinya resistensi bakteri. Penelitian ini bertujuan untuk menganalisis rasionalitas/ketepatan penggunaan antimikroba dan faktor-faktor yang mempengaruhi rasionalitas/ketepatan penggunaan antimikroba tersebut di ruang ICU periode Januari ndash; Desember 2010 dengan menggunakan metode Gyssens.Penelitian dilakukan dengan desain potong lintang cross sectional, data retrospektif diambil dari kardeks obat dan data rekam medis pasien. Faktor-faktor yang paling dominan dalam mempengaruhi rasionalitas/ketepatan penggunaan antimikroba berdasarkan metode Gyssens dilakukan analisis multivariat dengan menggunakan regresi logistik ordinal.Penggunaan antimikroba di ruang ICU RSUP Fatmawati sebanyak 912 rejimen dari 410 pasien. Berdasarkan metode Gyssens, penggunaan antimikroba antimikroba empiris yang tidak tepat sebesar 596 rejimen 74,03 dan penggunaan antimikroba definitif yang tidak tepat sebesar 84 rejimen 78,51 . Rasionalitas/ketepatan penggunaan antimikroba empiris dipengaruhi oleh penyakit utama terkait infeksi, penyakit penyerta terkait infeksi dan dokter. Penggunaan antimikroba di ruang ICU RSUP Fatmawati tidak rasional/tidak tepat.

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Inappropriate use of antimicrobial in the intensive care unit can increase bacterial resistance. The aim of this research were to analyze the rationality of antimicrobial use and the factors that influenced the rationality of antimicrobial use in the Intensive Care Unit during the period of January to December 2010 based on the Gyssens's method.This research was a cross sectional study with retrospective datas taken from patient rsquo s medicine orders and medical records. The factors that most influenced the rationality of antimicrobial use based on the Gyssen rsquo s method were analyzed using ordinal regression logistic. There were 912 regimens of antimicrobial use from 410 patients in the Intensive Care Unit of Fatmawati hospital.Using the Gyssens rsquo s method, there were 596 inappropriate empiric antimicrobial regimens 74,03 and 84 inappropriate definitive regimens 78,51 . The rationality of empiric antimicrobial use was influenced by the infection as the main disease presentation, the infection as the supplementary factor to the disease presentation and clinician rsquo s choice.The use of antimicrobial in the Intensive Care Unit at Fatmawati hospital was inappropriate."

"Antibiotika golongan sefalsoporin merupakan salah satu antibiotika yang banyak digunakan oleh pasien ICU RSUP Fatmawati Jakarta. Tujuan dari penelitian ini adalah untuk mengetahui dan mengevalusi penggunaan antibiotika golongan sefalosporin pada pasien ICU. Penelitian ini dilakukan dengan metode survey yang bersifat deskriptif analitis retrospektif-prospektif. Data dikumpulkan dari Catatan Medis dan hasil pemeriksaan laboratorium (uji kultur dan sensitivitas) pasien ICU yang dirawat pada bulan Januari-September 2006.Hasil penelitian ini menunjukkan 323 pasien ICU (68,43%) menggunakan antibiotika golongan sefalosporin. Antibiotika golongan sefalosporin yang banyak digunakan adalah seftazidim 32,68%, seftriakson 29,05% dan sefpirom 14,50%. Pada evaluasi penggunaan antibiotika golongan sefalosporin terdapat 17,96% ketidaktepatan dosis.Hasil uji kultur dan sensitivitas menunjukkan bahwa antibiotika golongan sefalosporin telah mengalami resistensi yaitu sefaleksin (73,24%), sefotiam (71,83%), sefotaksim (63,38%), seftriakson (60,56%) dan sefpirom (60,34%). Data diuji dengan metode kai Kuadrat dan hasil yang diperoleh menunjukkan ada hubungan bermakna antara tingkat penggunaan antibiotika golongan sefalosporin dengan resistensi kuman terhadap antibiotika golongan sefalosporin di ICU RSUP Fatmawati.Cephalosporin is the most frequently antibiotics used at Intensive Care Unit, Fatmawati Hospital Jakarta. The objective of this study is to know the description and to evaluate the cephalosporin use at Intensive Care Unit. The study conducted with analytical descriptive retrospective-prospective method. The data collected from Medical Record and laboratory test result (Culture and Sensitivity Test) of ICU patient during January until September 2006.

The result of this study indicated that 323 patient (68,43%) used cephalosporin. The most frequently cephalosporin used by ICU patient was ceftazidime 32,68%, followed by ceftriaxone 29,05% and cefpirome 14,50%. Evaluation of cephalosporin used indicated 17,96 % an incorrect doses of cephalosporin.

The result of Culture and Sensitivity Test showed that cephalosporin has been resistance including cefotiam (71,83%), cefotaxime (63,38%), ceftriaxone (60,56%) and cefpirome (60,34%). The data from the study examined with Chi Square Test Method and the result show that there was a correlation between the level of cephalosporin use and the resistance of microbe to cephalosporin at Intensive Care Unit, Hospital Jakarta."

"Penggunaan antibiotik yang tinggi pada pasien sepsis dapat memicu penggunaan antibiotik yang tidak rasional. Upaya untuk memaksimalkan penggunaan antibiotik yang rasional merupakan salah satu tanggung jawab apoteker. Penelitian ini bertujuan untuk mengevaluasi kualitas dan kuantitas penggunaan antibiotik pada pasien sepsis di ruang rawat Intensive care unit (ICU) dengan metode Gyssens dan ATC/DDD dan mengevaluasi pengaruh intervensi apoteker dalam meningkatkan kualitas penggunaan antibiotik dan outcome terapi. Penelitian dilakukan secara prospektif selama periode Agustus-November 2018 dengan menggunakan rancangan studi pra eksperimen one grup pretest-posttest. Rekomendasi diberikan kepada penulis resep terhadap masalah ketidaktepatan penggunaan antibiotik yang ditemukan. Evaluasi kualitatif dengan metode Gyssens diperoleh hasil bahwa penggunaan antibiotik pada pasien sepsis yang rasional sebesar 85,09 % dan yang tidak rasional sebesar 14,91 %. Jenis antibiotik, jenis terapi antibiotik, jumlah antibiotik  dan lama penggunaan antibiotik berpengaruh terhadap kualitas penggunaan antibiotik. Intervensi meningkatkan ketepatan penggunaan antibiotik (0 % menjadi 64,71 %), menurunkan masalah pemilihan antibiotik (88,24 % menjadi 32,35 %), masalah lama pemberian antibiotik (5,88 % menjadi 0 %) dan masalah rute pemberian obat (5,88 % menjadi 0 %). Kualitas penggunaan antibiotik yang rasional dan yang tidak rasional berpengaruh terhadap hasil terapi. Kuantitas penggunaan antibiotik sebesar 63,84 DDD/patient-day dengan nilai terbesar pada antibiotik meropenem yaitu 32,91 DDD/patient-day.

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High use of antibiotics in sepsis patients can lead to irrational use of antibiotics. Pharmacist has responsibility to improve appropriate antibiotics usage. This study was proposed to evaluate quality and quantity of antibiotics usage in sepsis patients in the Intensive care unit (ICU) ward with the Gyssens and ATC/DDD methods and evaluate whether intervention of pharmacy can improve quality of antibiotics usage and therapy outcome. The study was conducted prospectively during the period August - November 2018 using pre experiment one grup pretest-posttest design. Recommendations were given to prescribers to solve the problems of inappropriate antibiotics usage. Qualitative evaluation using that about 85.09 % antibiotic prescriptions were appropriate, and 14.91 % were inappropriate. Type of antibiotics, type of antibiotic therapy, total and duration antibiotics used by patients have effect on quality and quantity antibiotics usage. Intervention of pharmacist improve appropriateness of antibiotics (0% to 64.71 %), decrease drug choice problems (88.24 % to 32.35 %), duration problems (5.88 % to 0 %) and route of administration problems (5.88 % to 0 %). Appropriate used of antibiotics had significant different effect to outcome therapy compare with inappropriate used of antibiotics. The quantity of antibiotic use is 63.84 DDD/patient-day with the greatest value on meropenem antibiotics is 32.91 DDD/patient-day."

"Pemantauan Terapi Obat pada Neonatus Kurang Bulan, Bayi Berat Lahir Rendah, dan Sepsis di Ruang Neonatus Intensive Care Unit (NICU) RSUP Fatmawati Bulan September 2020.

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Neonates, especially preterm infants have weak physical defenses and immature immune function, making them susceptible to bacterial invasion. One of the efforts to achieve the Sustainable Development Goals (SDGs), which is to reduce the incidence of neonatal mortality to 12 per 1,000 live births, it is necessary to collaborate between health workers in treating patients. Pharmacists in hospitals need to carry out their roles, one of which is by monitoring the therapy given. Data were collected directly by looking at the cardex and patient's medical records with the following criteria: less-month neonatal patients, receiving polypharmacy, patients with antibiotic therapy, and length of stay in the hospital ≥5 days. The data obtained were analyzed using the SOAP method and identified problems related to drugs. From the Monitoring of Drug Therapy (PTO), it was found that drug-related problems that occurred were dose mismatches and frequency mismatches, and analysis of the evaluation of antibiotic administration (EPA) with the Gyssens method found that the use of antibiotics was found in category IIIa, namely giving meropenem too long and category IIa, which was not the right dosage."

"Perawat memiliki peran yang penting untuk mencegah pasien Intensive Care Unit yang terpasang ventilator agar tidak mengalami Ventilator Associated Pneumonia. Penelitian ini bertujuan untuk mengetahui gambaran tingkat pengetahuan perawat Intensive Care Unit terhadap pencegahan Ventilator Associated Pneumonia di RSUP Fatmawati Jakarta. Penelitian ini menggunakan metode cross sectional dengan analisis deskriptif pada 57 perawat Intensive Care Unit. Hasil dari penelitian ini menunjukkan bahwa tingkat pengetahuan perawat Intensive Care Unit RSUP Fatmawati berada dalam kategori sedang dengan persentase 74,04%. Penelitian ini menyarankan untuk perawat mengikuti pelatihan pencegahan Ventilator Associated Pneumonia sebagai upaya peningkatan pengetahuan dan penurunan angka kejadian Ventilator Associated Pneumonia di ruang Intensive Care Unit.

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Nurses have important role to prevent Ventilator Associated Pneumonia in the mechanically ventilated patients in the Intensive Care Unit. This study aimed to described the level of knowledge of Intensive Care Unit nurses in the prevention of Ventilator Associated Pneumonia at RSUP Fatmawati Jakarta. This study used a cross sectional method with analytic descriptive to 57 nurses. The results of this study showed that the level of knowledge of Intensive Care Unit nurses at RSUP Fatmawati Jakarta are in the average-level with a percentage of 74.04%. This study suggested to following nursing training about Ventilator Associated Pneumonia prevention in order to increasing the knowledge level of Ventilator Associated Pneumonia prevention and as well as reducing the number of Ventilator Assoiated Pneumonia in the Intensive Care Unit."

"ABSTRAKPasien yang terpasang ventilator mengalami kesulitan berbicara sehingga mengalami gangguan dalam berkomunikasi dan menggunakan suatu metode dalam berkomunikasi. Penelitian ini menggunakan desain crossectional dengan sampel 45 responden dan tekhnik pengumpulan data purposive sampling. Hasil penelitian menunjukkan metode komunikasi yang digunakan pasien yaitu menunjuk atau membuat isyarat dengan tangan yang digunakan 100% responden, menulis atau menggambar yang digunakan 40% responden, menggerakkan bibir atau mencoba untuk berbisik yang digunakan 91% responden, ekspresi wajah yang digunakan 84% responden, dan menggerakkan kepala, ya atau tidak yang digunakan 93% responden. Metode komunikasi lain yang digunakan adalah mengetuk tempat tidur. Perawat diharapkan mengetahui metode komunikasi yang digunakan pasien yang terpasang ventilator sehingga dapat memberikan penjelasan tentang pilihan metode komunikasi sesuai keadaan pasien serta menyediakan media sesuai metode komunikasi yang dipilih.

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ABSTRAKPatients who have difficulty speaking with mechanical ventilation so that impaired communication and uses a method of communicating. This study used crosssectional design with a sample of 45 respondents and data collection purposive sampling technique. The results showed that method of communication used by patients to refer or make a gesture with the hand were used 100% by the respondents, writing or drawing were used 40% by respondents, moving his lips or trying to whisper were used 91% by respondents, the facial expression were used 84% by respondents, and move his head, yes or not were used 93% by respondents. Another communication method which was used by the patient is knocking on the bed. Nurses are expected to know the method of communication used by patients with mechanical ventilation in order to provide an explanation of the preferred method of communication according to the situation of patients and provide appropriate media communication method selected."

"Upaya untuk memaksimalkan penggunaan antibiotik yang rasional merupakan salah satu tanggung jawab penting dari pelayanan farmasi. Penggunaan obat dikatakan rasional jika obat yang digunakan sesuai indikasi, kondisi pasien dan pemilihan obat yang tepat terkait jenis, sediaan, dosis, rute, waktu dan lama pemberian, mempertimbangkan manfaat dan resiko dari obat yang digunakan. Penggunaan antibiotik yang tidak tepat dapat menyebabkan pengobatan lebih mahal, efek samping lebih toksik, meluasnya resistensi dan timbulnya kejadian superinfeksi yang sulit diobati. Setelah melakukan pemantauan terapi obat pada pasien di ruang ICU RSUP Fatmawati, kesimpulan yang didapat: Pengobatan yang diterima oleh Nn. TRA sudah sesuai dengan indikasi penyakit, yaitu abses submandibularis, dengan frekuensi pengobatan dan dosis antibiotik juga dinilai sudah tepat. Pada Ny. AAH, didapatkan adanya obat yang tidak sesuai indikasi, yaitu tigecycline dan penggunaan meropenem serta levofloxacin juga tidak tepat dosis dan tidak tepat frekuensi pemakaian. Sepanjang penggunaan tigecycline, kondisi pasien justru memburuk hingga kemudian dinyatakan meninggal pada tanggal 11 April 2022 akibat gagal ventilasi dan sepsis pneumonia. Penggunaan tigecycline kemungkinan tidak efektif. Perhitungan DDD/100 patient-days, meropenem memiliki nilai DDD tertinggi,  kemudian disusul oleh amikasin, levofloxacin, metronidazole, dan tigecycline secara berurutan. Pada perhitungan DU 90 %, meropenem, amikacin, dan levofloxacin termasuk dalam segmen tersebut. Antibiotik yang memiliki nilai DDD/100 patient-days yang tinggi dan termasuk dalam segmen 90 % perlu diawasi penggunaannya dengan baik karena penggunaan yang tinggi dapat meningkatkan resiko terjadinya resisten antibiotik.

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Efforts to maximize the rational use of antibiotics is one of the important responsibilities of pharmaceutical services. The use of drugs is said to be rational if the drugs used are according to the indications, the patient's condition and the selection of the right drug regarding type, preparation, dose, route, time and duration of administration, considering the benefits and risks of the drug used. Inappropriate use of antibiotics can cause more expensive treatment, more toxic side effects, widespread resistance and the emergence of superinfections that are difficult to treat. After monitoring drug therapy on patients in the ICU at Fatmawati Hospital, the conclusion was obtained: The treatment received by Ms. TRA is in accordance with the indications of the disease, namely submandibular abscess, with the frequency of treatment and dosage of antibiotics also considered to be appropriate. To Mrs. AAH, it was found that there were drugs that were not according to indications, namely tigecycline and the use of meropenem and levofloxacin, which also included incorrect doses and incorrect frequency of use. Throughout the use of tigecycline, the patient's condition worsened until he was declared dead on April 11 2022 due to ventilation failure and pneumonia sepsis. The use of tigecycline may not be effective. Calculating DDD/100 patient-days, meropenem has the highest DDD value, followed by amikacin, levofloxacin, metronidazole, and tigecycline in sequence. In the 90% DU calculation, meropenem, amikacin, and levofloxacin are included in this segment. Antibiotics that have a high DDD/100 patient-days value and are included in the 90% segment need to be monitored carefully because high use can increase the risk of antibiotic resistance."