Rina Mutiara, Pharmacy Department, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia

 The Cipto Mangunkusumo Hospital (CMH) is the principal teaching and referral hospital in Indonesia. It has more than 1000 bed hospital located in central Jakarta. Each day many patients attend CMH from Jakarta and other regions of Indonesia. As the main referral hospital in Indonesia, CMH can provide a role model for the practice of oncology in Indonesia. The hospital has 45 pharmacists. We only have 2 oncology pharmacists that give oncology service for inpatient and outpatient including pediatric and adult patients. The oncology pharmacy should be provided with sufficient staffing to run the service. Pharmacy department has the commitment to ”Help, give the best”. The oncology pharmacy does cytotoxic handling service for 80 patients per day including 30 pediatrics and 10 adult patients in the outpatient setting. For inpatients there are an estimated 10 pediatrics and 30 adult patients per day. The cytotoxic handling service is available six days a week starting from 8 am to 4 pm. 

 The first time we opened our cytotoxic service needed a big effort to realize this service. We faced many barriers including human resources, facilities, availability of personal protective equipment (PPE). At the beginning, the preparation and administration of cytotoxic drugs at CMH did not include safety precautions for staff. These drugs were handled by nurses in ward areas without adequate protection. As a referral hospital we needed a cytotoxic service and it should be a pharmacy responsibility. The Pharmacy Department planned to improve the handling of cytotoxic drugs but we have limited human resources and experience in this area. Therefore, we requested assistance from an Australian hospital to provide the training for our pharmacy staff and technicians. As a result we began the service in 2003. Some modifications were required to meet the hospital’s limited budget.  The oncology pharmacists should actively participate in all clinical activities such as ward rounds, case presentations and also review all patients medications. The oncology pharmacist must be familiar with all clinical aspects of trials that involve patients with cancer.  They are involved in clinical trials to facilitate the running of the studies and to ensure adherence to study protocols. To facilitate this requirement they must possess knowledge in oncology literature, study design, methodology, regulatory ethical issues related to research in patients with cancer and the entire oncology drug development process.  We also need to make networking with other hospitals a priority to learn more information related to cytotoxic drugs and the development of oncology pharmacy services, that’s why I applied to become a member of ISOPP. Some of the benefits of this membership are to get updated information related to oncology pharmacy, and the ability to discuss with other pharmacy colleagues in the world ideas for improvement to oncology pharmacy services. There are many challenges to implementing oncology pharmacy services.

Thank you for ISOPP for giving so many good chances to develop my knowledge and skill in the field of oncology pharmacy. 

Training of Cytotoxic Drug Handling	How to use PPE