17,safety devices - dr samhari.pdf
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Safety Instruments/Devices
Keselamatan Pasien
Dr. A. Samhari Baswedan MPAWorkshopWorkshop KeselamatanKeselamatan PasienPasien dandan ManajemenManajemen RisikoRisiko KlinisKlinis didi RumahRumah SakitSakit
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Dr. Ahmad Samhari Baswedan MPA Dr. Ahmad Samhari Baswedan MPA
•• MulaiMulai di Yogyakarta, 7 Pebruari 1954; SekarangSekarang di Taman Rasuna Apartment, Tower 18N, Unit 20I, Jln HR Rasuna Said, Kuningan Jakarta,12930; HandPhoneHandPhone : 0811 80 70 30; ee--mailmail : [email protected]
•• MenerimaMenerima Masters in Public Administration, Harvard University, USA,
1998. LulusLulus Medical Doctor, Gadjahmada University, Yogyakarta, 1981
• Sekarang,Sekarang, Anggota Komite Keselamatan Pasien PERSI dandan ProgramManager PR-TB Global Fund ‘Asiyiyah dan Konsultan ManajemenRumah Sakit & Kinerja Organisasi
• Sebelumnya,ebelumnya, Management Consultant (Organisasi & SDM) & GuestLecture Program Magister Kesehatan FK-UGM. 2001 – 2006; HealthCoordinator, UNICEF East Timor 2000-2001; Health & NutritionCoordinator, UNICEF Indonesia 1988-2000; Nutrition & Health Officer,UNICEF Indonesia 1983-1988 ; Teaching Staff, Medical SchoolGadjahmada University 1981-1983 2
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HARUS SAFETY DEVICE
Empiris – Teoritis - Praktis
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Safety Devices dalam Pelayanan Kesehatan
Fisik SpecimenData & Images
DIAGNOSTIK
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osakit SEHAT
Medikasi(MedicineDelivery)
Farmasi NursingTindakan
(Inter-vention)
TERAPI
Adapted from Safety Framework, RS Persahabatan Jakarta, November 2007
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Refraktometer, Non Contact Tonometer, Biometri,
Ultrasonografi Mata, Topografi Kornea, Nd.Yag
Laser, Argon laser, LASIK, Foto Fundus,, OpticalOptical
CoherenceCoherence Tomography/OCT,Tomography/OCT, FundusFundus FluoresceinFluorescein
Angiography/FFA, Angiography/FFA, NonNon ContactContact TonometriTonometri// NCT,NCT,
ElectroretinographyElectroretinography/ERG,/ERG, Perimeter Perimeter Humphrey,Humphrey,
Octopus,Octopus, GoldmanGoldman Laser Laser NdNd--YagYag,, Laser Laser Argon, Argon,
HEPAHEPA Filter Filter, Mikroskop Operasi dengan CCTV,
Alat bedah katarak Fakoemilsifikasi, Bedah
Vitreretina, Koreksi Glaukoma, Okuloplasti, Revisi
Strabismus……
IniIni barubaru daftar daftar daridari bagianbagian KesehatanKesehatan Mata……Mata……
ASB ASB--2610201026102010
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Situasi Nyata di Lapangan?
Absence of Equipment Maintenance :
India : Moderate
Bangladesh : Moderate
Srilangka : Moderate –Low
Indonesia : High(IAPB Workshop Report, 2008)
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Safety Device dan Multi-Causal Theory
“Swiss Cheese” Diagram (Reason, 1991)
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KTDKNC
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HAIs: Masalah Pelayanan Kesehatan Dunia
MORBIDITAS• 32 % = Urinary Tract Infections
• 22 % = Surgical Site Infections
• 15 % = Pneumonia/Lung Infections
• 14 % = Blood-Stream Infections
MORTALITAS• 11,1 %
• 8,2 %
• 36,3 %
• 30 9 %
HAI : “Hospital Acquired Infection” / BSI : Blood stream Infection / CRBSI : Catheter-Related BSI
DIMANA?• 1,96 % = High Risk Nurseries (PICU/NICU)
• 1,12 % = Well-Baby Nurseries• 24,55 % = ICU (semua pasien)
• 74,55 % = Di luar ICU (semua pasien)
USA : Klevens, Edwards, Richards, et al. Pub Health Rep 2007;122:160-6
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Global Distribution of HIV
Infections 1984-1997
Global Distribution of
HIV/AIDS 1999
Source: UNAIDS/WHO Source: Ippolito, et.al.
North America/
Western Europe
KTD Luka Tusuk/NSI & ANCAMAN AIDS
Sub-Saharan
Africa
Others
North America/ Western Europe
-
Africa 90%70%
26%6%
4%
4%
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INDONESIA? # 1 TER- “CEPAT” DI ASIA
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Contoh Analisa “ Total Cost of Care”
Penggunaan IV Cath Convensional:• Rp 4,500 (3 kali dalam 2 hari) = 13,500
• Thrombophob Rp. 13,500 (3 tube) = 55,500
• Dressing Rp 4,750 (3 kali) = 13,250
• Cost/Biaya pasang IV Cath (3 kali) = 3X
• Cost/Biaya Keluhan pasien = 3Y
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TOTAL Cost of Care = ( 81,250 + 3X + 3Y )
Penggunaan IV Cath “Biomaterial” (Setengah Safety)• Rp 4,500 (1 kali, pada hari 1) = 4,500
• Rp. 14,500 (1 kali dalam 2 hari) = 14,500• Thrombophob Rp.13,500 (1 tube) = 13,500
• Dressing Rp 4,750 (2 kali) = 9,500
• Cost/Biaya pasang IV Cath (2 kali) = 2X
• Cost keluhan pasien = 2Y
TOTAL Cost of Care = ( 52,000 + 2X + 2Y)
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Kondisi Kita Sekarang:
Dalam Lingkaran Setan Non-SafetyBanyak RS
ingin Al-Kes
yang
MURAH
BanyakVendor Jual
Al-Kes
MURAH
BanyakVendor Jual
Al-Kes
Non-Safety
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Banyak RS
Pakai Al-Kes
Non-Safety
anya
RUGI AKIBAT
kasus
Non-Safety
Al-Kes
Safety
Jadi MAHAL
Total Value
TURUN
Total Cost of
Care NAIK
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Tujuan Kita:
Lingkaran Aman Safety
Banyak RS
ingin Al-Kes
SAFETY
Banyak
Vendor Jual
Al-Kes
SAFETY
Al-Kes
Safety
MENJADI
MURAH
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Banyak RS
MEMAKAI
Al-Kes
Safety
Banyak RS
TERHINDAR
kasus
Non-Safety
Total Value
NAIK
Total Costof Care
TURUN
INGAT : SAFETY BEYOND QUALITY
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Hasil Klinis Terbaik Yang Dapat Dicapai
+
Total VALUE = Hasil Pelayanan
epuasan e anggan as en e uarga
+
Keuangan RS tetap “Sehat”
VALUE : Kriteria UTAMA Safety Device
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ASB ASB--270208270208
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SAFETY DEVICE
ALAT KESEHATAN dengan RISIKO TERKECIL berakibatKTD (“ Adverse Events”/“Unintended Negative Outcomes”)
Error Margin : 3% - 5%
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Taxonomi
Safety DevicesMedication
Delivery
Diagnostic
Medical
Syringes
NonSyringes
Specimen Capture
ADS
RUPS
IV
Catheter
Non-IV
Catheter
Blood
Non-Blood
Therapy
Intervention Safety Tools
VacuumTUBEs
“
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Data/Image
Capture
System”
Other TUBEs
or Devices
Care Related
Non-Care Related
Non-Medical
Waste
Mngmnt.
Food, Linen, Gas, Ambulance etc.
Building
Others
Medical/Bio
Waste
“Sharps”
Waste
Safety
Devices
ECG, USG,
MRI, CT-Scan
ICU Monitor
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ALAT yang BANYAK dipakai DI RS
Alcohol Swab
Alat SuntikSarung Tangan
IV Catheter
“Dressing”
Botol Infus / Infusion Set
Catheter / NGT
ASB ASB--270208270208
Tempat Tidur
Termometer
Tensimeter
ECG Ambulans
USG / Rontgen / CT-Scan / MRI dll…
SUDAHKAH Mereka MEMENUHI Kriteria SAFETY?
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PRINSIP SAFETY DEVICE
1
• The RIGHT DEVICE for
• The RIGHT PROCEDURE for • The RIGHT PATIENT
2
Safety in
• Procuring, Using, Maintainingasb0108
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KRITERIA SAFETY DEVICE
SAFETY BAHAN TEKNO
LOGI
PROSES
Untuk PASIEN
Untuk PETUGAS TEKNIS
ASB ASB--270509270509
Untuk
ANGGARAN
KONSEPTUAL / Strategis
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KRITERIA KONSEPTUAL
Safet
untuk
Pasien
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AMANuntuk
Petugas
untuk
Kelangsungan
Bisnis
Beyond Quality…
Safety
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#1:AMAN unt uk PASIEN
RISIKO TERKECIL untuk KTD & KNC
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Beyond QualitySafety
(HAI/BSI, Drug Reactions, and
IATROGENIC DAMAGE dan terutama,
MIS-DIAGNOSIS )
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#2: AMAN unt uk PETUGAS
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Beyond Quality
Safety
RI SI KO TERKECI L
untuk NSI & Blood Splatter, TI DAK memudahkan ERROR saat DI PAKAI
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#3: AMAN unt uk ANGGARAN
(Kelangsungan Bisnis)
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Beyond Quality
Safety
,
Menurunkan TOTAL COST of CARE
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• BAHAN
KRITERIA TEKNIS
SAFETY DEVICES
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•
• PROSES
BAHAN : Medical / Surgical GradeTEKNOLOGI : Mutakhir dg Error Margin 3% - 5%PROSES : Fokus pada Fungsi BUKAN Penampilan
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asb0108
asb26102010
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Basics Of…?
asb26102010
Do We know?
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Basics f or Hypoderm ic Syr inge
TaperedPlunger
Marka Jelas
Positive Stop “retaining ring”
BarrelBENING
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“SerratedThumbPress” Sayap
lebar “Flanges”
Luer TipLatex - Free
Stopper
Kri teria Standar
BAHANPolyprophyleneMedical Grade
MINIMUM “Reflux” dan “Sticktion”
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Kriteria ALAT SUNTIK yang baik:
Bahan po l y p r ophy l ene m ed i ca l g r ade
Jarum st a in less st eel su r g ica l g r ad e & double bevel
Barrel bening (transparan)
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Mark a jelas (“bo ld sca le m ar k ing ”)
Plunger sul it lepas saat aspi rasi (“p os i t iv e st op ”)
Plunger ada lekukan (“t a pe r ed p lu ng er r od”)
Pangkal Bar rel “ bersayap lebar” (“w ide f l ange”)
Pangkal Plunger “kasar ” (“serr ated t hum b p ress”)
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Bebas “l ateks/ karet alam” (“Latex f ree” )
Bebas “r ef lux” (“alir an balik darah”)
Kriteria ALAT SUNTIK yang baik:
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e as s c on a ran o a ersen a -sen a
Jarum Aman dari r isik o Luk a Tusuk
Barrel r usak sesudah dipakai.
Lim bah Metal dan plast ik dapat d ip isah
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Bahan kateter : “Biomaterial”
Bahan bagian yang lain : polypropylene medical
grade dan stain less steel
“Mandrin” aman dar i l uka tusuk dan Blood Splat ter
Basics f or IV Catheter
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• Phlebit is = Kompl ikas i IV Cat heter yg pal ing ser ing
• Bahan k ate ter m er upakan penyebab utam a thr omb oph leb i t i s
• Bah an “Biom at er ial” m engur ang i ph leb i t i s s/ d 46%
• Baha n Biom at er ia l m engurang i ker usakan u jung ka teter s/ d 50%
SOURCE : Gaukroger, P.B. et al, Infusion Thrombophlebitis: A prospective comparison, Anaesth Intens care(1988), 16, 265-271
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Bahan : “Ful l Cot ton”
Packing : “Full alum inum foi l” dg “heat -resistant
l ining” di bagian luar dan d iproses secara vakum
Bahan ak t if : Isopropyl alcohol / Acohol + Iodine /
Alcohol + Chlor hexidine
Basics for Alcohol Swabs
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Basics f or “Elect ron ic Diagnost ics”
Industr ial Com ponent NOT General OR Household
Micro-vol tage & “Ful l Insulat ion ”
Clear d irect ion for main tenance & calib rat ions
50,000 hour s LCD
Margin of Err or m aximum 3%
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RISIKO TINGGI(1) Infeksi , (2) Image,
(3) Tuntutan
DIMANA & KAPAN?
DV A HARUS mendahulukan Safety Pasien & Petugas
TINGGI dalam(1) Pemakaian Alat,
(2) Beban Kerja,(3) Capital Investment.
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DIMANA & KAPAN Safety Device?
HARUS (“Segera”) :1. UGD 2. ICU 3. OK
4. Laboratorium (Klinik/Mikro/Rad.) 5. Poliklinik
. .
Sebaiknya juga segera…1. VIP Unit* 2. Bagian Gizi
Baru kemudian….Semua Bangsal/Unit Pelayanan
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MEMILAH dan MEMILIH?Tindak Lanjut?
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LAKUKAN DVA : Device V alue Audit!
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Langkah Langkah Device Value Audit
ApakahKTD Terkaitdg Peralatan?
(RCA)
PeralatanSUDAHSafety?
YA!
TIDAK
MONITOR (HAI/BSI/NSI)
andREVIEW
YA!
BELUM FOKUS PADA Unit:
KTD krn Alat?
KTD krnCara Pakai?
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Teruskan RCA utk mencariPenyebab
MendasarKTD!
SEGERALAKUKAN
D V A!
HIGH RISKS forInfections,
Image, Legal
HIGH inUsage/Consumables,
Production Pressure,Capital Investment.
LAKUKAN Laporan KTD/NSI,RCA, FMEA, Risk Grading dll
Pemakaian Safety Device mencegah KTD dan mengurangi biaya total RS dengan
mencegah risiko pemborosan biaya pelayanan/pengobatan dan biaya akibat KTD!
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Medical Device Recalls List
ource:www.fda.gov/MedicalDevices/Safety/
RecallsCorrectionsRemovals/default.htm
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Semoga bermanfaat,
terimakasih,and
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oo
0811 80 70 30