HOSPITAL SAFETY

dr. Joko Murdiyanto, Sp.An.

Background
‡ Sekitar 98,000 kematian di RS tjd karena medical error. ‡ Kesalahan ini meningkatkan sekitar $37.6 miliar biaya tambahan, termasuk $17 miliar terkait dengan kesalahan yang bisa dicegah.

Background«
‡ Fokus yg lebih besar pd hospital safety akan menciptakan RS yg lebih aman, demi kepentingan pasien, staf, dan pengunjung. ‡ Penekanan lbh besar pd hospital safety menyebabkan pasien, staf dan pengunjung lebih sehat dan nyaman.

(Gershon et al, 2000)

MEDICAL ERROR
Kegagalan memberikan pelayanan yang seharusnya atau memberikan pelayanan yang keliru dari seharusnya (IOM, 1999).

ADVERSE EVENT
Suatu kejadian yang mengakibatkan cedera yang tidak diharapkan pada pasien karena suatu tindakan (commission) atau karena tidak bertindak (ommission), dan bukan karena ´underlying diseaseµ atau kondisi pasien (KKP-RS)

Sumber: Dwiprahasto, Iwan. Patient Safety sebagai Fokus Pelayanan Kesehatan yang Bermutu. .

CAUSES OF HEALTH CARE ERROR
‡ Faktor Manusia (ex: kelelahan, depresi, pasien yg beragam, setting yg tdk familiar, tekanan waktu) ‡ Kompleksitas Medis (ex: teknologi yg rumit, perawatan intensif, hospital stay yg memanjang) ‡ Kegagalan Sistem (ex: komunikasi yg buruk, otoritas dokter, perawat dan tenaga kesehatan lain yang tidak jelas, nama obat yang mirip)

What is patient safety?
‡ Suatu disiplin ilmu kesehatan baru yg menekankan pada pelaporan, analisis, dan pencegahan kejadian medical eror yang seringkali mengakibatkan kejadian yg merugikan kesehatan (malpraktek) (www.wikipedia.org)

Indikator Patient Safety
‡ Indikator tingkat RS (hospital level indicator) >> mengukur potensi komplikasi yang sebenarnya dapat dicegah saat pasien mendapat berbagai tindakan medis di RS. ‡ Indikator tingkat area >> mencakup semua risiko komplikasi akibat tindakan medik yang didokumentasikan di tingkat yankes setempat (kab/kota)

Keselamatan pasien rumah sakit
Terdiri dari: ‡ Assesment risiko ‡ Identifikasi dan manajemen risiko terhadap pasien ‡ Pelaporan dan analisis insiden ‡ Kemampuan belajar dan menindaklanjuti insiden ‡ Menerapkan solusi untuk mengurangi serta meminimalisir risiko

Kebijakan patient safety di RS
‡ RS wajib melaksanakan sistem keselamatan pasien ‡ RS wajib melaksanakan 7 langkah menuju keselamatan pasien ‡ RS wajib menerapkan standar keselamatan pasien RS ‡ Evaluasi pelaksanaan keselamatan pasien RS akan dilakukan melalui program akreditasi RS. Instrumen akreditasi RS akan ditambah dg standar patient safety sehingga instrumen akreditasi RS menjadi 17 pelayanan.

Sistem Keselamatan Pasien RS
Terdiri dari: ‡ Pelaporan insiden, laporan bersifat anonim & rahasia ‡ Analisis, belajar, riset masalah, pengembangan taxonomy ‡ Pengembangan & penerapan solusi serta monitoring/evaluasi ‡ Penetapan panduan, pedoman, SOP, standar, indikator keselamatan pasien berdasarkan pengetahuan dan riset. ‡ Keterlibatan & pemberdayaan pasien & keluarganya

Langkah menuju keselamatan pasien RS

1. Membangun kesadaran akan nilai keselamatan pasien. 2. Membangun komitmen dan fokus yang jelas tentang keselamatan pasien. 3. Membangun sistem & proses manajemen risiko, serta melakukan identifikasi & assesment terhadap potensial masalah. 4. Membangun sistem pelaporan.

Lanjutan«
5. Melibatkan & berkomunikasi dengan pasien. 6. Belajar & berbagi pengalaman tentang keselamatan pasien dengan melakukan analisis akar masalah. 7. Mencegah cedera melalui implementasi sistem keselamatan pasien dengan menggunakan informasi yang ada.

Standar Keselamatan Pasien RS
1. Pasien dan keluarganya mempunyai hak mendapat informasi tentang hasil pelayanan termasuk hasil yang tidak diharapkan. 2. Mendidik pasien & keluarganya tentang kewajiban & tanggung jawab pasien dalam asuhan pasien. 3. RS menjamin terselenggaranya pelayanan yang berkesinambungan & terkoordinasi. 4. RS terus meningkatkan kinerja dan keslematan pasien.

Lanjutan«. 5. Peran kepemimpinan dalam meningkatkan keselamatan pasien: ‡ Menjamin implementasi program keselamatan pasien secara terintegrasi ‡ Menjamin kesinambungan program dengan mengidentifikasi risiko keselamatan pasien dan pengurangan resiko ‡ Merencanakan peningkatan kinerja dan penyesuaian prioritas ‡ Mendorong dan menumbuhkan komunikasi dan koordinasi

Lanjutan« 6. Mendidik staf untuk keselamatan pasien 7. Meningkatkan komunikasi untuk keselamatan pasien antara lain: ‡ Memenuhi kebutuhan informasi internal dan eksternal ‡ Transmisi data dan informasi harus tepat waktu dan akurat ‡ Rekam medis berisi informasi yang memadai ‡ Membuat data dan informasi

Safety systems in health care organizations

Definition: ‡ Berusaha utk mencegah kerugian bagi pasien, keluarga dan teman2 mereka, tenaga kesehatan profesional, pekerja pelayanan, relawan, dan individu2 lainnya yg aktivitasnya tidak lepas dari setting pelayanan kesehatan. ‡ Tidak hanya menghindari kerugian yg dapat dicegah, tetapi juga menyediakan perawatan yg tepat
(Kohn et.al, 2000)

PATIENT SAFETY PROGRAMS SHOULD:
(1) provide strong, clear, and visible attention to safety; implement nonpunitive systems for reporting and analyzing errors within their organizations; (2) incorporate well-understood safety principles, such as, standardizing and simplifying equipment, supplies, and processes; (3) establish interdisciplinary team training programs, such as simulation, that incorporate proven methods of team management.

Reccomendationá
‡ Health care organizations and the professionals affiliated with them should make continually improved patient safety a declared and serious aim by establishing patient safety programs with a defined executive responsibility. ‡ Health care organizations should implement proven medication safety practices.

KEY SAFETY DESIGN CONCEPTS
‡ Designing safe systems requires an understanding of the sources of errors and how to use safety design concepts to minimize these errors or allow detection before harm occurs.

PRINCIPLES FOR THE DESIGN OF SAFETY SYSTEMS IN HEALTH CARE ORGANIZATIONS

Principle 1. Provide Leadership
‡ Make patient safety a priority corporate objective. ‡ Make patient safety everyone·s responsibility. ‡ Make clear assignments for and expectation of safety oversight. ‡ Provide human and financial resources for error analysis and systems redesign. ‡ Develop effective mechanisms for identifying and dealing with unsafe practitioners.

Principle 2. Respect Human Limits in Process Design
‡ ‡ ‡ ‡ ‡ ‡ Design jobs for safety. Avoid reliance on memory. Use constraints and forcing functions. Avoid reliance on vigilance. Simplify key processes. Standardize work processes.

Principle 3. Promote Effective Team Functioning ‡ Train in teams those who are expected to work in teams. ‡ Include the patient in safety design and the process of care. Principle 4. Anticipate the Unexpected ‡ Adopt a proactive approach: examine processes of care for threats to safety and redesign them before accidents occur. ‡ Design for recovery. ‡ Improve access to accurate, timely information.

Principle 5. Create a Learning Environment
‡ Use simulations whenever possible. ‡ Encourage reporting of errors and hazardous conditions. ‡ Ensure no reprisals for reporting of errors. ‡ Develop a working culture in which communication flows freely regardless of authority gradient. ‡ Implement mechanisms of feedback and learning from error.

MEDICATION SAFETY
Selected Strategies to Improve Medication Safety
‡ Adopt a system-oriented approach to medication error reduction. ‡ Implement standard processes for medication doses, dose timing, and dose scales in a given patient care unit. ‡ Standardize prescription writing and prescribing rules. ‡ Limit the number of different kinds of common equipment. ‡ Implement physician order entry.

Cont¶« ‡ Use pharmaceutical software. ‡ Implement unit dosing. ‡ Have the central pharmacy supply high-risk intravenous medications. ‡ Use special procedures and written protocols for the use of high-risk medications.

Cont¶«
‡ Do not store concentrated solutions of hazardous medications on patient care units. ‡ Ensure the availability of pharmaceutical decision support. ‡ Include a pharmacist during rounds of patient care units. ‡ Make relevant patient information available at the point of patient care. ‡ Improve patients· knowledge about their treatment.

SAFETY ACTIVITIES IN HEALTH CARE ORGANIZATIONS
1. LIFE SAFETY
‡ refers to a set of standards for the construction and operation of buildings and the protection of patients from fire and smoke.

2. INFECTIOUS DISEASE SURVEILLANCE, PREVENTION, AND CONTROL ‡ It requires epidemiological expertise and includes attention to medical devices (e.g., intravascular and alimentation devices, ventilators, equipment used for examination); the physical environment (e.g., air ducts, surfaces); surgical wound management; and carriage by employees and other health professionals.

3. MORBIDITY AND MORTALITY CONFERENCES ‡ As a standardized case report system to investigate the reasons and responsibility for adverse outcomes of care. 4. AUTOPSY ‡ Unexpected findings at autopsy are an excellent way to refine clinical judgment and identify misdiagnosis. 5. RISK MANAGEMENT PROGRAMS

‡ Risk management includes identification of risk and education of staff, identifying and containing risk after an event,

HOSPITAL SAFETY CLIMATE (Gershon, et. al, 2000)
(1) senior management support for safety programs, (2) absence of workplace barriers to safe work practices, (3) cleanliness and orderliness of the work site, (4) minimal conflict and good communication among staff members, (5) frequent safety-related feedback/training by supervisors, (6) availability of personal protective equipment and engineering controls.

www.safetyandquality.org

TARGETED INTERVENTIONAL STRATEGIES FOR SAFETY CLIMATE IMPROVEMENTS

1. Management support ‡ High-level senior management serving on infection control and safety committees. ‡ Well-qualified safety and infection control professionals. ‡ Continuing educational support for safety and infection control professionals. ‡ Selection of membership to infection control and safety committees based on expertise, interest, enthusiasm, in addition to other requirements. ‡ Etc.

2. Job hindrances/facilitators

‡ Redesigning tasks to ensure that all workers have the ability to protect themselves when necessary. ‡ Transmitting information to employees regarding the need to protect themselves and still provide optimal patient care.

3. Personal protective equipment (PPE)
‡ Ensure that front line workers are in the decision making process regarding safety devices (ie, they should serve on product evaluation committees or on purchasing teams). ‡ Revisit PPE periodically to ensure that new technologies are examined for their potential application in your institution. ‡ Set up PPE Total Quality circles to identify novel solutions to problem areas (eg, eye protection usage).

4. Conflict/communication
‡ Train managers/supervisors on conflict resolution and communication skills, and retrain periodically. ‡ Rotate staff through a safety liaison position on each unit. They could attend infection control and safety meetings and report back to their home departments during regularly scheduled department meetings. ‡ Periodically evaluate supervisors on their leadership abilities (ie, they should have annual evaluations).

5. Feedback/training
‡ Add compliance practices to both manager and staff performance appraisals. ‡ Evaluate all safety training (especially on new safety devices) to ensure that it is truly effective. ‡ If self-study packets must be used, update and revise them annually. When feasible, add simulation exercises to the safety curriculum. ‡ Put simplified short versions of safety policies online in the hospital network system. ‡ Etc.

6. Cleanliness/orderliness
‡ Conduct frequent rounds to spot problems as they occur. ‡ Periodically reduce clutter in all departments (hold ´spring cleaningµ days). ‡ Involve employees on walk-through teams.

Wassalamualaikum WW

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