DRUG THERAPY ASSESSMENT WORKSHEET (DTAW)
Type of problem Assessment
Are there drug without a
medical indication ?
Are any medication unidentified
(are any unlabeled or are any-
Correlation between
prior to admission clinic visit-
Drug Therapy and
unknown) ?
Medical Problem
Are there untreated medical
conditions ?
Do they require drug therapy ?
What is the comparative efficacy
of the chosen medication(s) ?
Appropriate Drug
Selection
What is the relative safety of the
chosen medication(s) ?
Has the therapy been toilered to
this individual patient ?
Presence of Drug-Related Problem
1. A problem exists.
2. More information is needed for a
determination.
3. No problem exists or an
intervention is not needed.
1. A problem exists.
2. More information is needed for a
determination.
3. No problem exists or an intervention
is not needed.
Comments/Notes
Berdasarkan hasil laboratorium tanggal 22/02
pasien mengalami hipokalemia dengan nilai K =
3,3 (<3,5) namun pasien tidak menerima terapi
KSR untuk koreksi kalium.
Berdasarkan hasil laboratorium tanggal 25/02
pasien mengalami anemia dengan nilai Hb = 9,2
(<12) namun pasien tidak menerima terapi
untuk anemia baik itu suplemen besi, suplemen
vitamin B12, suplemen asam folat untuk
meningkatkan nilai Hb.
Pemberian metoklopramid 10 mg saat pasien
operasi ditujukan untuk mengurangi
mual/muntah pasca operasi (postoperative
nausea and vomiting) namun metoklopramid
merupakan antiemetik lemah dan pada dosis 10
mg metoklopramid tidak efektif dalam
mengurangi terjadinya PONV. Dosis
metoklopramid yang efektif untuk mengurangi
terjadinya PONV yaitu >20 mg (Glass et al.,
2014).
 Are the prescribed dose and Laxadine merupakan laksatif dengan kombinasi
dosing frequency appropriate- Phenolphthalein, liqd paraffin dan glycerin.
within the usual therapeutic range Penggunaan laxadine pada dewasa seharusnya
and/or modified for patient sekali sehari menjelang tidur sebanyak 15-
factors ? 30mL (MIMS, 2017). Sementara pada pasien
regimen dosis yang diterima adalah 3 x 30 ml.
1. A problem exists.
Is the route/dosage form/mode of
administration appropriate,
2. More information is needed for a
considering efficacy, safety,
Drug regimen determination.
convenience, patient
limitation, and cost ?
3. No problem exists or an intervention
is not needed.
Are doses scheduled to maximize
therapeutic effect and compliance
and to minimize adverse effect,
drug interactions, and regimen
complexity ?

Is the length or course of therapy

appropriate ?
1. A problem exists.

2. More information is needed

Are there any therapeutic
Therapeutic for a determination. Tidak terdapat duplikasi obat pada terapi yang
duplications ?
duplication diterima pasien.
3. No problem exists or an
intervention is not needed.

Drug allergy Is the patient allergic to or 1. A problem exists. Pasien tidak memiliki riwayat alergi obat.
Intolerance intolerant of any medicines (or
chemically related medications) 2. More information is needed for a
 currently being taken ?
determination.
Is the patient using any method to
alert health care providers of the 3. No problem exists or an
allergy/intolerance (or serious intervention is not needed.
medical problem) ?
1. A problem exists 1. Pemberian Brainact Inj mempunyai efek
Are there symptoms or medical
samping aktual gangguan epigastrum
problems that may be drug
2. More information is needed for (MIMS).
Adverse Drug induced ?
a determination. 2. Pemberian lorazepam mempunyai efek
Events
samping gelisah, cemas dan tidak nyaman.
What is the likelihood that the
3. No problem exists or an
problem is drug related ?
intervention is not needed.
Are there drug-drug interactions ?
Are they clinically significant ? 1. A problem exists.
Are any medications
contraindicated(relatively or 2. More information is needed
Interactions : absolutely) given patient for a determination.
Drug-drug, characteristic and current/pass
Drug-Disease disease states ? 3. No problem exists or an Penggunaan laxadin sirup secara terus menerus
Drug-nutrient, and intervention is not needed. dapat menurunkan kadar elektrolit dalam tubuh
Drug-Laboratory Are there drug-nutrient (MIMS)
Test interactions ?
Are they clinically significant ?

Are there drug-laboratory test

interactions ?
Are they clinically significant ?
Social or Is the patients current use of 1. A problem exists. Perlu menggali informasi lebih lanjut kepada
Recreational social drugs problematic ? pasien maupun keluarga pasien, apakah pasien
Drug Use 2. More information is needed mengkonsumsi obat, suplemen atau vitamin
 Could the sudden decrease or
discontinuation of social drugs be
related to patient symptoms (e.g.,
withdrawal) ?
Has the patient failed to receive
medication due to system error or
noncompliance?
Failure to Receive
Therapy
Are there factors hindering the
achievement of therapheutic
efficacy?
Financial Impact Is the chosen medication(s) cost
effective?
Does the cost of drug therapy
represent a financial hardship for
the patient?
Patient Does the patient understand the
Knowledge of purpose of his or her
Drug Therapy medication(s), how to take it and
the potential side effect of
therapy?
Would the patient benefit from
educationtool (e.g., writen patient
education sheets, wallet cards and
reminder packaging)?
for a determination
yang dapat mempengaruhi gaya hidup
3. No problem exists or an
intervention is not needed.
1. A problem exists.
2. More information is needed for
a determination
3. No problem exists or an
intervention is not needed.
1. A problem exists.
2. More information is needed for
a determination
3. No problem exists or an
intervention is not needed.
1. A problem exists.
2. More information is needed
1. Pasien mendapatkan terapi parasetamol.
for a determination
Memberikan edukasi kepada pasien bahwa
parasetamol dikonsumsi jika pasien mengalami
3. No problem exists or an
nyeri. Jika nyeri tidak terasa maka penggunaan
intervention is not needed.
parasetamol dapat dihentikan.
 DAFTAR PUSTAKA

Glass, P. S. A., et al., 2014. Consensus Guidelines for the Management ofPostoperative
Nausea and Vomiting. Anesthesia and Analgesia Volume 118 Number 1.
MIMS, 2017
Diakses dari http://www.mims.com, pada Maret 2017