buletin 5s bil2-2016

BULETIN
BIL2/2016
FARMASI.HSIJB
JUNE
ISSUE
Antibiotic FORM
SNAKE ANTIVENOM



PENGAMBILAN
UBAT
&
INSULIN
DI BULAN RAMADHAN


ANTIMICROBIAL
STEWARDSHIP
ADR : Diclofenac
ANNUAL
GRAND DINNER


WELCOME & farewell
Editorial Board Advisor :
Pn Hajah Rohayah Binti Abd Ghani
Chief Editors :
Pn Nur Hazalina Binti Md Salleh
Pn Tan Pei Li
Pn Sim Shi Jia
Pn Nurul Balqis Riza Binti Bakri
Cik Sharifaq Sadiqa Binti S.N Azman
2016
Editors :
Pn Salinda Binti Sopian
Cik Shangeeta A/P Pariteppan
Cik Ng Tzi Jia
Pn Malini A/P Kalimuthu
En Izzureen Bin Sumali
Antibiotics form is designed to encourage the clinician to review basic clinical and laboratory information and to
categorize antimicrobial use as prophylactic, empirical and therapeutic. An antimicrobial order tools may improve the
quality of prescriptions by increasing the awareness of clinicians of desired antimicrobial spectrum. By filling in the
antimicrobial order tools, the prescribers also provide themselves the data for drug utilization surveillance.
Antimicrobial order tools can be an effective measure to decrease antimicrobial consumption by implementing
automatic stop orders and/or requiring clinicians to justify antimicrobial use.
Here are the following steps on how to fill the antibiotics form:
1) Please refer to the color coding above:
Red : MUST be filled.
Green: MUST be filled if culture results are available.
Blue : Justification- MUST be filled if culture negative or results are still pending.
Yellow: Either one column MUST be filled and stamped.
(a)
(b)
(c)
(d)
3) The use of empirical broad‐spectrum antimicrobial treatment may increase the risk of antimicrobial resistance. The de‐escalation strategy has the potential to improve patient outcomes without compromising patient safety.
Review at 72 hours after antimicrobial initiation or; once a week review of a specific ward, unit,
and hospital is required.
Once the de‐escalation opportunities is identified by following criteria:
i. Were appropriate cultures taken initially?
ii. Has there been any growth from the cultures?
iii. If there is no growth, can the antimicrobial be stopped?
iv. If there is growth, can the antimicrobial be de‐escalated
72 hours antimicrobial review form
Steps :
(a) Fill in patient’s name, RN, ward, specialty, Age, Body weight and Serum creatinine, Diagnosis, Drug, dose & frequency of antibiotics required and Date started.
(b) Indication of antibiotic required for either prophylaxis, empirical or treatment is based on
cultures sent prior the initiation of antibiotics from blood / sputum / Urine / Tissue / Pus or
others
(c) If the culture & sensitivity is available, it must be filled even if culture negative or results are
still pending.
(d) Specialist signature & stamp is required during working hour. If after office hours, signature &
stamp of Medical officer can be accepted but spoken to Specialist.
72 hours Antibiotics Review form should be filled completely as below:
(a)
(b)
(c)
(d)
List of antibiotics that require antimicrobial form :
HISTORY
DID YOU KNOW
Snake venoms are
complex substances that
can vary among snakes
from the same species.
Monovalent antivenom
are effective against a
given species whereas
polyvalent are effective
against a range of
species.
Antivenoms (or antivenin) is
a biological product used
in the treatment of
venomous bites or stings.
Traditionally, horses are
used to create antibodies because they
thrive in many environments worldwide, have
a large body mass, get
along with each other
and are familiar with
human so they don’t
get easily scared by
needles.
METHODOLOGY
1
2
3
4
5
6
Venoms are
extracted and
diluted with
water or
buffer solution
before injecting into
animal.
The toxin in
the venom
trigger the
horse’s immune system
to produce
antibodies
that
neutralises the
venom.
A veterinarian
supervises the
process over
a long period
of time so that
the animal
remain in
healthy
condition.
A small
proportion of
blood is
removed and
the plasma is
extracted.
The plasma is
purified and
packaged as
a liquid or
freeze dried
powder.
The anti
venom is
Injected into
envenomed
human
patient which
in turn
neutrilises the
venom.
ASSALAMUALAIKUM SEMUA!
SAYA AKAN KONGSIKAN TIPS
PENGAMBILAN UBAT DI BULAN PUASA YA…
1 kali sehari
Sebelum makan = 1 jam sebelum sahur
Selepas makan = selepas berbuka /
bersahur
2 kali sehari
Sebelum makan = 1 jam sebelum sahur &
2 jam selepas berbuka
Selepas makan = sebelum berbuka &
selepas bersahur
Sudut agama
“Wahai orang-orang yang beriman! Kamu
diwajibkan berpuasa sebagaimana
diwajibkan atas orang–orang yang dahulu daripada kamu,
supaya kamu bertakwa”
Al-baqarah:183
3 kali sehari
Sebelum makan : 1 jam sebelum sahur & Selepas
berbuka (sebelum mengambil menu utama)
& Sebelum tidur
Selepas makan : Selepas bersahur , Selepas berbuka& Sebelum tidur
4 kali sehari
Bergantung kepada jenis penyakit
Dapatkan nasihat
Tidak berpuasa ATAU ubat alternatif
CARA PENGAMBILAN INSULIN PADA BULAN PUASA
Basal—1 kali sehari = Insulin disuntik sebelum tidur. Dos mungkin perlu
diubahsuai mengikut keperluan
Comb30—2 kali sehari = Dos pagi disuntik
pada waktu berbuka, dos petang disuntik
pada waktu sahur
Dos insulin pada waktu sahur
mungkin perlu dikurangkan
mengikut keperluan untuk
mengelakkan hipoglisemia
Rapid—3 kali sehari = Dos sahur diubahsuai mengikut
keperluan, Dos tengah hari TIDAK PERLU disuntik,
Dos waktu berbuka dikekalkan atau diubahsuai mengikut
keperluan.
Prosedur tampalan, cabutan
atau pembersihan gigi (dengan
syarat tidak menelan apa-apa
bahan semasa rawatan)
Menggunakan ubat titis
mata dan ubat titis telinga
(dengan syarat tidak sampai
ke gegendang telinga)
Prosedur bius
setempat
UBAT YANG
TIDAK
MEMBATALKAN PUASA
Ubat kumur
Suntikan (pada otot,
sendi, lapisan kulit dan
salur darah)
Hyperglisemia ataupun kurangnya gula
di dalam darah boleh disebabkan oleh
pelbagai faktor seperti:

Tidak mengambil makanan dengan betul

Pengambilan ubat yang berlebihan
Ubat titis hidung atau
semburan di hidung
tanpa disedut
Pil tablet nitroglycerin (GTN)
atau ubat lain yang diletakkan
dibawah
lidah tanpa ditelan (rawatan
jantung)
Ubat sapu seperti krim, losyen dan plaster tampalan kulit berubat
Pengambilan ubat diabetes secara tidak
terancang dan tidak mengikut dos yang
bersesuaian boleh menyebabkan hipoglisemia atau
hiperglisemia.
Berikut merupakan tanda dan factor
hipoglisemia dan hiperglisemia.
TANDA HIPERGLISEMIA
(BERLEBIHAN GULA
DALAM DARAH)
Faktor-faktor
penyebab
hiperglisemia pula
adalah:
Tidak mengambil suntikan insulin atau ubat
diabetes dengan betul
TANDA HIPOGLISEMIA
( KURANG GULA DALAM
DARAH)
Tidak mengikuti
pengambilan
makanan yang betul
Rujukan: Panduan Bepuasa Bagi Pesakit, JAKIM
By: Salinda Sopian
ADVERSE DRUG EVENTS
DICLOFENAC & PERIORBITAL OEDEMA
DICLOFENAC SODIUM


GLOBAL REPORT-
Meanwhile in Hospital Sultan Ismail Johor Bahru, there were 42 cases NSAIDs-related ADR
reported from 2012 until 2016. From there, (28 cases; 57%) of the cases attributed to diclofenac
while the rest are contributed by other NSAIDs (14 cases; 43%) such as aspirin and mefenemic
acid. The most commonly adverse events associated with diclofenac were periorbital edema,
shortness of breath and general urticaria. Patients may present with one or compilation of the
symptoms.
ADVICES
From year 2000 until June 2015, the National Centre for Adverse Drug Reactions Monitoring
received 2,106 adverse drug reaction (ADR) reports related to diclofenac, comprising 4,188 adverse events. The three most commonly reported System Organ Classes (SOC) were body as a
whole - general disorders (1,500 events; 35.8%), skin and appendages disorders (1,478; 35.3%),
and respiratory system disorders (467; 11.2%). The most commonly reported adverse events
were periorbital oedema (588; 14%), itching (505; 12%), shortness of breath (297; 7.1%), orbital oedema (263; 6.3%) and rash (236; 5.6%)
ADR IN HSIJB

A member of Non-steroidal anti-inflammatory
drugs (NSAIDs)
Relieve pain and inflammation such as in rheumatism and gout
Inhibit cyclooxygenase-1 (COX-1) and (COX2) enzyme thus stop production of prostaglandin which responsible for mediation of pain
and inflammation


Use the lowest effective dose for the shortest duration necessary to control symptoms.
Please report any adver se events suspected to be r elated to the use of diclofenac to the
NPCB, to ensure comprehensive data analysis for drug safety profiling
ANTIMICROBIAL STEWARDSHIP
To improve patient outcome
To optimize antimicrobial therapy
Judicious use
Optimizing antimicrobial selection
Dose
Route
Duration
To limit the unintended consequences
Emergence of antimicrobial resistance
ADR
OBJECTIVES
PASUKAN AMS HSIJB
Penaung :Dr. Hj. Arbain bin Lani
Penasihat: Dr Khursiah binti Daud
Penyelaras: Pn. Roslita bt Alivi
Members of AMS Team:Head of AMS : Dr. Azmin Huda
Clinician/ Physician : Dr. Asma’ Bt Md. Arif
Pharmacist: Cik Chong Yan Jing
Pn Renuka A/P Rahoo
Cik Syafawati Bt Ghazali
Microbiologist: Pn. Sitina Bt Omar
Infection Control Nurse : KJ Salawati Bt Sela-
WORKFLOW OF AMS ROUND HSIJB
Pharmacist will review for candidate for AMS round according to the criteria
decided, cases deemed justify will be excluded from AMS round
Message to all AMS team members a day before AMS round
Pharmacist clerk the case and pharmacist/ Dr in-charge of respective ward present during AMS
round (with at least the presence of the head of AMS team and a physician).
Pharmacist document suggestion during round in powerchart
Pharmacist inform suggestion made during round to the doctor-in-charge
Review after few days to check whether recommendation accepted.
In Nov 2014, team HSIJB, chaired by Pn Roslita had their first
meeting; brief introduction on the AMS program was given to
all members. 50 copies of the AMS protocols were distributed
to all departments. Infectious disease physician and clinical microbiologist were requested to form the HSIJB AMS team
In March 2015. Dr.Azmin Huda became the Head of AMS team
HSIJB. The workflow of AMS round was decided and the first
AMS round was started on the 13th May 2015 in the orthopaedic
wards.
PROGRESS
OF AMS
TEAM HSIJB
Subsequent meetings were held on the 1st June 2015, 29th June
2015, 9th November 2015 and 21st December 2015 to further
review the AMS round workflow. Rounds were increased from
once in 2 weeks to once a week, increasing the types of antibiotics reviewed, expanding the discipline reviewed to ICU and also
welcoming referral case from other discipline to increase the
number of patients reviewed.




To encourage the clinician to review basic clinical
& laboratory information
To categorize antimicrobial use as prophylactic,
empirical or therapeutic.
Data for drug utilisation surveillance.
Implements automatic stop orders & justification of
antimicrobial use.
Stop empiric therapy if lab testing
subsequently shows –ve infection
Recommendation of
suitable antimicrobials for
the specific clinical
setting
Use narrow‐spectrum agents when
+ve cultures & sensitivities
ANTIMICROBIAL
STREAMLINING
Stop dual antimicrobial therapy
if there is overlapping in spectrum of activity
(IV) TO (PO) ABX CONVERSION
High dosage can be de‐escalated to
a standard dosage for a susceptible
organism.
ANNUAL
GRAND
DINNER
Aloha! On 5th of May 2016, Pharmacy department of Hospital Sultan Ismail JB
(HSIJB) held an annual dinner at Hotel Silka, Plentong. With Hawaiian theme chosen,
around 70 attendees went to this event along with their family members and everyone wore
glamorous and flowery style! On that night, as usual there were some speeches delivered
by our boss, Puan Rohayah and other staffs who were transferred to other hospitals such as
Pn Fazilah (Hosp Permai) and Pn Syuhadah (USM).
Apart from that, the hightlight of the event was performances by our staffs from every unit. We’ll
never forget the dance by inpatient unit’s staffs lead by Mr. Ting Hing Shen as the cross dresser
leader was amazingly funny! Then, in between the performances we have lucky draws to spice up
the ambience.
In the end, the King and Queen of the Hawaiian
night were crowned to Mr. Areerizal and Mdm
Maysha for wearing such a flamboyant suit and
dress. Meanwhile, the best performance was
awarded to the enthusiastic staffs from Inpatient
Unit. Then we have photography sessions before
the event was adjourned.
PF U48 & U41
ESTHER
AMALEENA
JASMINE
SADIQA
PRP U41
IZZUREEN
HAFIZAH
THAI RU WAY
FARAH
TONG MIN
PPF U29-32
NUR ATIQAH
NURFAZILAH
ZAITON
NURLYDIA
AKMAL
SYUHADA