LOGIC DESIGN OF HOSPITAL DRUG INTERACTION NOTIFICATION SYSTEM IN SYAMSUDIN, SH HOSPITAL SUKABUMI CITY
Deden Herlan Suangsa*1, Indang Trihandini2, [email protected]
1Postgraduate Student Specialization in Health Informatics, Faculty of Public Health, University of Indonesia
2 Biostatistics and Population Department, Faculty of Public Health, University of Indonesia
ABSTRACT
Background. As with the importance of medical services in hospitals, the Drug Information Service (PIO) which is a pharmaceutical service also has an important function to ensure patient safety. PIO functions to identify drugs that must be wary of (high-alert medication), and drugs that are at high risk of causing unwanted drug reactions (ROTD). The PIO function has been carried out manually so that it takes a long time and human errors often occur in the form of undetected risk of drug reaction. This research will build a model of automatic drug interaction notification system for pharmaceutical staff, so that they can immediately educate patients or families.
Methods. The initial research was carried out at R. Syamsudin Hospital, SH in Sukabumi City through a Focus Group Discussion (FGD) and in-depth interviews with pharmacists, pharmacist assistants, hospital health promotion staff, and hospital programmers. The system development approach uses prototyping method until the modeling stage.
Results. The search for drugs that interact with other drugs is still done manually and the education provided is still limited to the education of drug use in general. This has a patient safety risk associated with drug interactions. The logic design of the drug interaction notification system is needed which serves as a reminder to the pharmacy staff when inputting prescription drugs, so that the patient will be given more appropriate education. This system can provide easy access to information, time efficiency, save more data with small storage space.
Keywords: Drug Interaction, Notification System, Drugs
INTRODUCTION
As with the importance of medical services in hospitals, the Drug Information Service (PIO) which is a pharmaceutical service also has an important function to ensure patient safety. PIO functions to identify drugs that must be wary of (high-alert medication), and drugs that are at high risk of causing unwanted drug reactions (ROTD).
The PIO function has been carried out manually so that it takes a long time and human errors often occur in the form of undetected risk of drug reaction. This research will build a model of automatic drug interaction notification system for pharmaceutical staff, so that they can immediately educate patients or families.
Drug Information Services (PIO) is one of the services performed in hospitals or in pharmaceutical service units. The definition of PIO is any objective data or knowledge, scientifically described and documented covering pharmacology, toxicology, and pharmacotherapy. Drug information covers, but is not limited to knowledge such as chemical names,
structure and properties, identification, diagnostic indications or therapeutic indications, mechanism of action, start time and duration of work, dosage and schedule of administration, recommended dosages, absorption, detoxification metabolism , excretion, side effects and adverse reactions, contraindications, interactions, prices, benefits, signs, symptoms and treatment of toxicity, clinical efficacy, comparative data, clinical data, drug use data, and any other information useful in the diagnosis and treatment of patients.(Kementerian Kesehatan Republik Indonesia, 2014).
Drug Information Services (PIO) in hospitals must synergize with other pharmaceutical services.
The role of the PIO to support the development of drug management policies to improve safety, especially drugs that need to be watched for (high- alert medication). High-alert medication is a drug that must be wary of because it often causes serious errors (sentinel events) and high-risk drugs cause unwanted drug reactions (ROTD).(Kementerian Kesehatan Republik Indonesia, 2014).
Drug interactions can be interpreted as modifying the effect of a drug by other chemical compounds, whether in the form of drugs, food components, herbal components, or other compounds or other compounds that are simultaneously in the body or body surface. Effect modification can be in the form of enhancement, reduction or elimination of drug effects (Yulinah &
Kurniati, 2019).
Drug interactions and drug side effects really need to get attention. A study conducted in the United States shows that there are almost 100,000 people each year must be hospitalized or have to stay in hospital longer than they should, not infrequently until there are cases of death due to interactions and / or drug side effects. Patients who are treated in hospitals often receive therapy with polypharmacy (6-10 kinds of drugs) because patients are treated by more than one doctor, so it is very possible drug interactions, especially those affected by the severity of the disease or age (“http://medicafarma.blogspot.com/2010/11/intera ksi-obat.html,” 2010).
Drug interactions are clinically important if they result in increased toxicity and / or reduction in drug effectiveness. So it should be noted especially when it comes to drugs with narrow safety limits (low therapeutic index), such as cardiac glycosides, anticoagulants and cytostatic drugs. It also needs to be considered drugs that are commonly used together (Gitawati, 2012).
The average number of prescriptions per 2019 in Syamsudin, SH hospital is as many as 163,931 prescriptions, there are about 1,639 (1%) prescriptions that experience drug interactions with drugs. The prescription came from inpatient, outpatient and emergency department.
Patient education is a series of information services that provide understanding to patients, especially related to patient compliance in using drugs so that patients will get education on effective and safe use of drugs. maximize the therapeutic effect and minimize side effects. The correct drug, both dosage and type, may increase or decrease the effect due to interactions with other drugs or food.
It could be that the drug is no longer effective because of improper storage methods, and so on (Kementerian Kesehatan Republik Indonesia, 2014).
METHOD
Initial research was carried out at the R.
Syamsudin General Hospital, Sukabumi City
depth interviews with pharmacists, pharmacist assistants, hospital health promotion staff, and hospital programmers. The system development approach uses prototyping method until the modeling stage (Sarosa, 2019).
RESULT
1. Analysis of the running system Prescription service at R. Syamsudin, SH hospital has used the prescription service application in order to facilitate the service, but in finding prescription drugs that interact with other drugs are still done manually by using a separate MedScape application so it requires more time. By adding a notification system to an existing system, it can accelerate the discovery of drugs that interact with each other so that the drug delivery education is more effective.
2. System Design a. Context Diagram
Context diagram is a diagram that shows system boundaries, the interaction of all external entities with the system and information that generally flows between entities and systems (Sulianta, 2017). Context diagram is the highest level of DFD that describes all the input to the system or the output of the system. He will give an overview of the whole system. Limitation of Hospital Drug Interaction Notification System (SENIORS) can be seen in the picture. The input entities of the Hospital Drug Interaction Notification System (SENIORS) are patients while the output entities are Healt Promoting Hospital, the Head of Pharmacy Installation and Pharmacists.
b. Entity Relationship Diagram
Entity Relationship Diagram (ERD) is a diagram used to design tables that will be implemented in a database. ERD is formed based on three elements namely entities, attributes and relations. Next, ERD Seniors starts with patients, admins and pharmacists and other supporting entities.
c. Attributes
Attributes are often also referred to as properties, are information related to an entity that needs to be stored as a database. Attributes function as an explanatory entity for describing attributes (“http://mfikri.com/artikel/kupas- tuntas-konsep-model-data-entity-relationship- diagram-atau-erd.html,” n.d.). Attributes are
information related to an entity that needs to be stored as a database. Attributes function as an explanatory entity for describing attributes
(Sulianta, 2017). Seniors attribute as seen in picture 3.
d. Table Relationship Diagram
Table Relationship Diagram is made to illustrate the relationship between entities, the following entity relationships Seniors as in picture 4.
d. Flow Chart
Flow charts use symbols to describe the sequence of processes, including data processing. Flow charts are often used to describe the algorithm of an application, the sequence of processes, procedures and work flow (Sarosa, 2019). Picture 5 shows the Seniors process and workflow.
f. Interface Design
The design of the interface is made to facilitate the user in understanding the application concept to be built
Picture 6. Login Page Seniors
Picture 7. Homepage Seniors
Picture 8. Patient Data Page Seniors
Picture 9. Prescription Input Page Seniors
Picture 10. Warning Interaction Page Seniors
Picture 11. No Interaction Page Seniors
CONCLUSION
Pharmacists and pharmacist assistants have limitations in memorizing hundreds of drug interactions with drugs, and it takes a long time to search for drug interactions done manually using applications that are not integrated with the Hospital Drug Interaction Notification System (Seniors) will greatly help speed up drug discovery drugs that interact with each other so that education is more effective drug delivery and for cases of heavy interactions will help pharmacists to recommend drug replacement to the doctor in charge. This system can provide easy access to information, time efficiency, save more data with small storage space.
REFERENCE
Gitawati, R. (2012). Interaksi Obat Dan Beberapa Implikasinya. Media of Health Research and Development, 18(4 Des), 175–184.
https://doi.org/10.22435/mpk.v18i4Des.1086.
http://medicafarma.blogspot.com/2010/11/interaksi -obat.html. (2010).
http://mfikri.com/artikel/kupas-tuntas-konsep- model-data-entity-relationship-diagram-atau- erd.html. (n.d.).
https://gomockingbird.com. (n.d.).
https://www.lucidchart.com. (n.d.).
Kementerian Kesehatan Republik Indonesia.
Peraturan Menteri Kesehatan Republik Indonesia Nomor 58 Tahun 2014 tentang Standar Pelayanan Kefarmasian di Rumah Sakit. , (2014).
Sarosa, S. (2019). Metodologi Pengembangan Sistem Informasi. Indeks.
Sulianta, F. (2017). Teknik Perancangan Arsitektur Sistem Informasi. Penerbit Andi.
Yulinah, E., & Kurniati, F. (2019). Dasar-dasar Interaksi Obat. Isfi Penerbitan.
