FINAL DISSEMINATION

BOBO II
(4th March – 30th March 2019)

Nursing Management, Faculty of Nursing

UNIVERSITAS AIRLANGGA
2019
M1 (MAN)
PROBLEM CAUSES PLANNING
Lack of nursing staff 1. The ratio of nurses Propose :
and rooms is not 1. Increased higher
balanced on 5-8 level of employee
March, with an education
average BOR of 100% 2. Increasing employee
+ 12.45% competency through
2. High nurse workload regular education
= 90% and training
3. Addition of nurses
M1 (MAN)
Implementation
1. Determine the number of ideal
nurses according to several
theories (Douglas, Gillies, and the
Indonesian Ministry of Health)
2. Discuss with the head of the room
about the ideal number of nurses
Obstacles and Solutions
Quota for nurses to get the
opportunity to continue their
education is quite limited
Solution:
Recommend the ideal number of
nurses as needed
M2 (Material)
PROBLEM CAUSES PLANNING
1. Limitations of 1. Some tools are 1. Identification of
medical devices that broken facilities and
are not yet available 2. The number of tools infrastructure needs
2. Calibration has not needed is still lacking 2. Follow-up facilities
been carried out on 3. Lack of that are lacking to the
several tools, for communication head of the room
example: tension between nurses and 3. Provides marker
meters, standing IPS staff about tools stickers on devices
scales, and diapers that need to be that need to be
scales calibrated calibrated
M2 (Material)
Implementation
1. Identify damaged and unavailable
facilities and infrastructure needs
such as: ambu bag, syringe pump,
stethoscope.
2. Follow-up facilities that are lacking
to the head of the room
3. Provides marker stickers on
devices that need to be calibrated
Obstacles and Solutions
Response that is not responsive given
by IPS after reporting
Solution:
Improve room communication and
collaboration and social studies
M3 (Method) : MAKP
PROBLEM CAUSES PLANNING
MAKP has not been Lack of nurses with S1 Propose :
implemented Primary educational backgrounds 1. Socialization
nursing so that they have not met information
the MAKP Primary dissemination
Nursing standard 2. Planning the needs of
nurses who are S1-
educated
3. Socialize the role of
nurses according to
MAKP Primary
nursing
4. Applying the MAKP
Primary nursing
model to
management
profession practice
M3 (Method) : MAKP
Implementation Obstacles and Solutions
1. Socialize the results of the final Human Resources with an
dissemination undergraduate education (S1)
2. Propose and discuss the needs of background are still lacking
nurses who are S1-educated
3. Socialize the role of nurses Solution:
according to MAKP Primary The addition of nurses with S1
nursing education
4. Applying the MAKP Primary
nursing model to management
profession practice
M3 (Method) :
Acceptance of new patients
PROBLEM CAUSES PLANNING
1. The use of the 1. There is no 1. Make a welcome
welcome book has regulation regarding book that can be used
not been used the use of the for new patient
optimally. welcome book. admissions
2. Explanation about 3P 2. Each health worker 2. Carry out roleplay
is not optimal made an introduction acceptance of new
(Introduction to not at one time patients
patients about other
health workers,
hospital regulations,
diseases and drug
centralization)
M3 (Method) :
Acceptance of new patients
Implementation
1. Make a welcome book that can be
used for new patient admissions
2. Carry out roleplay acceptance of
new patients
Obstacles and Solutions
Hospital regulations have not been
regulated regarding the provision of a
welcome book.
Solution:
Procure a welcome book and
arrangements for using the welcome
book
M3 (Method) : Drug Centralization
PROBLEM CAUSES PLANNING
Drug centralization has Hospital settings Conducting role play
been carried out by the centralization of drugs
pharmacy in accordance carried out by nurses
with hospital rules
M3 (Method) : Drug Centralization
Implementation Obstacles and Solutions
Conducting role play centralization of -
drugs carried out by nurses
M3 (Method) : Handover
PROBLEM CAUSES PLANNING
1. The handover flow is 1. The handover flow 1. Implement
not in accordance applied in the room is handovers for each
with the theory a bedside handover shift change
2. Reporting using that is considered according to the
SBAR is not in more effective theory
accordance with the 2. Reporting using 2. Documentation using
theory SBAR is adjusted to the SBAR method
hospital rules according to the
theory
3. Do roleplay handover
M3 (Method) : Handover
Implementation
1. Implement handovers for each
shift change according to the
theory
2. Documentation using the SBAR
method according to the theory
3. Do roleplay handover
Obstacles and Solutions
The workload of nurses in the room is
high enough to require nurses to use a
short time to weigh
Solution:
Discuss again with the head of the
space related to the weighing scale
that is right for use in the room
M3 (Method) : Nursing Round
PROBLEM CAUSES PLANNING
Nursing rounds have not Not yet established team 1. Form a team of
been carried out in the of nursing rounds nursing rounds
bobo room 2. Do roleplay nursing
rounds
M3 (Method) : Nursing Round
Implementation
1. Form a team of nursing rounds
2. Do roleplay nursing rounds
Obstacles and Solutions
1. The appointed team has not been
able to participate maximally
because of other tasks.
2. Not yet arranged post-round
evaluation plan
Solution:
1. forming team commitment and
reaffirming the main tasks and
functions of each profession
2. Prepare a post-round evaluation
plan
M3 (Method) : Supervision
PROBLEM CAUSES PLANNING
The indirect Supervision is still 1. Make a supervision
implementation of underway documentation
supervision format
(documentation and 2. Carry out roleplay
performance) has been
carried out properly but
direct supervision is still
in the process of being
implemented.
M3 (Method) : Supervision
Implementation Obstacles and Solutions
1. Creating a supervision -
documentation format in roleplay
supervision
2. Carry out roleplay
 M3 (Method) : Discharge Planning
PROBLEM CAUSES PLANNING
1. The discharge planning 1. Limited availability of 1. Make leaflets about the
implementation has leaflets about handling 10 most nursing
been carried out well, nursing problems that problems at Bobo 2
but there is no leaflet clients can do in the 2. Designing roleplay
handling nursing room to be distributed discharge planning
problems for (KIE) to patients and families
aimed at patients or 2. Strategic education
families regarding planning has not been
home care implemented in the
2. Discharge planning room
carried out in the room
is when early and KRS,
while intra-discharge
planning is rarely done
and documented
M3 (Method) : Discharge Planning
Implementation
1. Make leaflets about the 10 most
nursing problems at Bobo 2
2. Implement roleplay discharge
planning
Obstacles and Solutions
1. There is no legalization of leaflet
nursing issues
2. Education has been carried out on
discharge planning, but there is no
documentation
Solution:
1. Need for leaflet legality
2. Require documentation
M3 (Method) : Documentation
PROBLEM CAUSES PLANNING
1. 28.6% of nurses 1. Nurse assignments 1. Socialization of the
thought the between meeting the importance of
documentation patient's ADL, documentation
model used was time delegation 2. Dissemination of
consuming while assignments, and standard nursing
71.4% of nurses said filling in the RM language (SNL) based
otherwise consisting of many on SDKI, SLKI, and
2. 28.6% thought that forms and the SIKI
the documentation number of patients in
used added to the the room
workload, but 71.4%
said otherwise
M3 (Method) : Documentation
Implementation
1. socialize the importance of
documentation
2. socialize about the standard
nursing language (SNL) based on
the SDKI, SLKI and SIKI
Obstacles and Solutions
Socialization does not include all
nurses in the room
Solution:
Disseminate more than 1 x and
conduct evaluations after socializing
M5 (QUALITY)
PROBLEM CAUSES PLANNING
1. 9/34 found patients 1. Family / patients 1. Educate patients /
who have not used an object to using families about the
identity bracelet identity bracelets importance of using
2. Family compliance in 2. Family awareness in identity bracelets
carrying out 5 doing hand washing 2. Conduct PKRS
moments and 6 steps is still low regarding 6 SKP
of hand washing are 3. Patients are not used 3. Distributing leaflets
still low to doing hand
3. Patients at high risk washing using 6 steps
of falling have not
been given a special
marker
M5 (QUALITY)
Implementation
1. Educate patients / families about
the importance of using identity
bracelets
2. Conduct PKRS regarding 6 SKP
3. Distributing leaflets
Obstacles and Solutions
Family / patients are less cooperative
even though education has been done
Solution:
1. Periodically educate
2. Hold a joint handwashing program
by all officers, patients, and
families in the room
 Total BOR in BOBO II Room
RSUD Dr.Soetomo Surabaya
12 – 24 March 2019
No Date ∑ Managed ∑ College
patient student BOR (%)

1 12 Mar 2019 10 11 100%

2 13 Mar 2019 9 11 90%
3 14 Mar 2019 10 11 100%
4 15 Mar 2019 10 11 100%
5 16 Mar 2019 10 11 100%
6 17 Mar 2019 9 11 90%
7 18 Mar 2019 9 11 90%
8 19 Mar 2019 10 11 100%
9 20 Mar 2019 7 11 70%
10 21 Mar 2019 10 11 100%
11 22 Mar 2019 9 11 90%
12 23 Mar 2019 9 11 90%
13 24 Mar 2019 9 11 90%
Average 9,3 11 93,07%
 Indicator Value in BOBO II Room
RSUD Dr.Soetomo Surabaya
12 – 24 March 2019
No. Indicator Value
1. AvLOS (Average Length Stay) 3,44
2. Pain scale No pain 32 patients (94,1%)
Moderate pain 2 patients (5,9%)
3. Risk fall Low risk 13 patients (54,2%)
High risk 11 patients (48,8%)
4. Decubitus No decubitus (0)
5. Phlebitis No phlebitis (0)
6. Urinary tract infection (UTI) No UTI (0)
7. Satisfy of patient Quite satisfied 10 orang (29,4%)
Very satisfied 24 orang (70,6%)
The highest number of medical diagnoses in managed patients
in BOBO II Room RSUD Dr.Soetomo Surabaya
12 - 24 March 2019

No Diagnosa Medik 7 Syndrom Nefrotic Acute

1 Acute Limphoblastic
Leukemi 8 Cholestasis
2 Acute Myeloid Leukemi 9 Atresia Bilier
10 DHF
3 Limphoma Hodgkin 11 Demam Reumatik Akut
4 Talasemi
12 Lupus Nefeitis
5 Idiopatic Trombositopeni
13 SLE
Purpura
14 Pneumonia
6 Limphoma Non Hodgkin 15 DF
16 Henoch Schonlin Purpura
The highest number of nursing diagnoses in managed patients
in BOBO II Room RSUD Dr.Soetomo Surabaya
12 - 24 March 2019

No. Diagnosis Keperawatan

1. Risk of infection
2. Risk of allergies
3. Chronic pain
4. Hipertermia
5. Risk of bleeding
6. Ineffective airway clearence
7. Ineffective perifer perfussion
 Problem Priority
No. Problem
1. Hand over
2. M1 (Man)
3. MAKP
4. M2 (Material)
5. Nursing Round
6. Nursing documentation
7. Discharge Planning
8. Supervision
9. M5 (Market)
10. Increase effective communication: SBAR
11. Acceptance of new patient
12. Drug centralization
13. M4 (Money)
 Conclusion
All programs or plans are well implemented but
some are still not optimal because there are
obstacles and must be solved with a joint solution.
THANK YOU 