Peran Komite Medikdalam

PelaksanaanProgram Pengendalian Resistensi Antimikroba

Dr. Dody Firmanda, Sp.A, MAKetua Komite Medik

RSUP Fatmawati, Jakarta

http://www.esnips.com/web/komitemedik

Disampaikan pada pertemuan Amrin (Antimicrobial Resistance of Indonesia)Diselenggarakan oleh Direktorat Bina Medik Spesialistik Depkes RI di HotelHorison Bekasi 6 – 8 November 2008.

Gambar 1. Konsep dan Filosofi Komite Medik RS: Etika, Mutu dan Evidence-basedMedicine (EBM)

ClinicalLeadership

(untuk RS pendidikan)

KOMITE MEDIK: SISTEM CLINICAL GOVERNANCE, PATIENT SAFETY & CP

/ Adverse Events

SurveilansInfeksi

Nosokomial

High ImpactInterventions

Process:Implementation

of Patient Safety

1

2

3

4

5

Peran Komite Medik:Menegakkan Etik dan Mutu Profesi

Program Pengendalian Resistensi Antimikroba

1. Audit Medis2. Clinical Risks

Management3. Safety

1. DaftarFormularium RS

2. SPM/SPO3. CP: Penyakit

Infeksi & Tropis4. Surveilans

InfeksiNosokomial

5. High ImpactInterventions

1. Seleksi Antibiotik2. Penggunaan Antibiotik3. Penyebaran Mikroba

SurveilansInfeksi

Nosokomial

High ImpactInterventions

Program Pengendalian Resistensi Antimikroba1. Seleksi2. Penggunaaan3. Penyebaran

1. Daftar Formularium2. SPM/SPO

1. Surveilans2. High Impact Interventions1. Audit Medis

2. Clinical RisksManagement

3. PatientSafety

Clinical Pathways:Penyakit Infeksi dan Tropis

Terintegrasi secara ko-ordinasi dan ko-operasi

“span& spin ofcontrol ”

“Patched-in”“Patched-in”

MILIK KOMITE MEDIK RSUP FATMAWATI

2005 -2008

Pola Kuman 2005

Jenis Kuman Menurut Bahan RSUP Fatmawati JakartaJanuari - Desember 2005

Jenis Kuman Menurut RuangRSUP Fatmawati JakartaJanuari - Desember 2005

Gram negatif80.8%

Gram positif19.2%

Pseudo mo nas sp.21.2%

P.mirabilis3.6%

S.liquifaciens2.9%

P.aeruginosa2.4%

E.gregov iae2.1%

K.ozaenae1.8%

A.hinshawii1.0%S.enteritidis

1.1%

S.typhi1.3%

S.rubidiae1.0%

0.8%

C.amalunatycus0.2%

P.stuart ii0.2%

E.co li21.4%

E.aerogenes19.9%

K.pneumoniae9.5%

S.marcesens9.2%

S.aureus

17.0%

S.epidermidis

55.1%

β-haemolyt icus

23.4%

S.saprophyt icus

3.4%

Pola Kuman 2006

Jenis Kuman Menurut Bahan RSUP Fatmawati JakartaJanuari - Desember 2006

Jenis Kuman Menurut Ruang RSUP Fatmawati JakartaJanuari - Desember 2006

Pola Kuman 2007

GRAM NEGATIF

E .aer ogenes

19.5%

S. l i qui f ac i ens

7. 3%P.mi r abi l i s

4.6%

S.mar cesens

4. 1%

K .ozaenae

3.6%

P.aer ugi nosa

2. 6%

E.cl oac ae

1. 5%

E.gr egov i ae

0.9%

S.typhi

1. 2%

S. r ubi di ae

0.2%

S.ent er i t i di s

0.2%

P.stuar t i i

0. 2%

P.r et tger i

0. 2%

K.pneumoni ae

11. 3%

Pseudomonas sp.

17.4%

E.sakazaki i

0.2%

K.oxytoca

0. 2%

C.di ver sus

0.2%

P.vul gar i s

0.3%

M .mor gani i

0.3%

C.f r eundi i

0.7%

E.col i

23.5%

Gram positif25.63%

Gram negatif74.37%

GRAM POSITIF

S.epidermidis29%

S.aureus9%

S.β-haemolyticus

40%

Staphyloco ccus sp0%S.saprophyticu

s22%

Jenis Kuman Menurut Ruang RSUP Fatmawati JakartaJanuari - Desember 2007

Pola Kuman Januari – Juni 2008

Gram pos itif23%

Gram negatif77%

GRAM NEGATIF

E.aer ogenes16.6%

K. pneumoniae13.3%

P. aeruginosa10.9%

Pseudomonassp.8.7%

Alcaligenessp.0.1%

E. sakazakii

0.3%Prot eusvulgar is

0.3%

E.coli, ent eropat hogenic

0.3%

S. Typhi0.4%

E. agglomer ans0.4%

S. marcescens

7.5%

E.coli

21.4%

P. mirabilis

4.0%

S. liquef aciens

3.8%

E. gergoviae2.8%

E. cloacae

2.6%S. rubidaea

2.6%

K. ozaenae

1.3%

P. Alcalif ac iens0.6%

C. f reundi i

1.0%

C. diversus

0.6%

P. f luorescens

0.4%

GRAM POSITIF

S. epi der mi di s

43%

S. aur eus

6%

S. beta-haem. Gr oup A

0%

S. non-haemol yt i c (gamma)

3%

S. beta-haemol yt i c

28%

S. sapr ophyt i cus

20%

Jenis Kuman Menurut Bahan RSUP Fatmawati JakartaJanuari - Desember 2008

Jenis Kuman Menurut Ruang RSUP Fatmawati JakartaJanuari - Desember 2008

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)IADP : 6%

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)Phlebitis : 5%

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)ISK : 25%

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)ILO : 12 %

INDIKATOR Hospital Epidemiology Infection Control 2nd ed. (Mayhall. 2001)VAP : 50%

3003SefalosporinCeftum

1001SefalosporinLacedim

224018SefalosporinCeftazidin

6 Guns

280028SefalusponinMeiact

134284066KuinolonCiprofloxacin

440440SefalosporinCefotaxim

224736487SefalosporinCertriaxone

JumlahLantai 6Lantai 5Lantai 4Golongan

Sistem satu pintu obat,Penggunaan seleksi obat

antibiotika dan biaya obat

Form:ClinicalPathwaysofPneumonia

Variances

ANTIBIOTIC DRUGS

70 %

Cephalosporin 16%Amoxycillin 14%

Peningkatan SDMSub Komite Pengendalian InfeksiKomite Medik RSUP Fatmawati

6 orangCertificate of Achievement dari Asia Pacific Society of Infection Control

1. Dr. Pratiwi Andayani, Sp.A2. Dr. Sjafruddin, Sp.THT3. Dra. DebbieDaniel, Apt, M.Epid.4. Zr. Salfitriawati Arwan, SKep5. Zr. Minarni, AMK6. Zr. Ni Nyoman Sriadi

Langkah BerikutnyaKomite Medik

RSUP Fatmawati

PENGEMBANGANWORLD CLASS HOSPITALS

Dr. Dody Firmanda, Sp.A, MAKetua Komite Medik

RSUP FatmawatiJakarta

world-classadj. (of a person, thing, or activity) of or among the best in theworld.

hos·pi·taln. 1. an institution providing medical and surgical treatment and

nursing care for sick or injured people.2. hist. a hospice, esp. one run by the Knights Hospitallers.

© The Oxford Pocket Dictionary of Current English 2008, originallypublished by Oxford University Press 2008

WORLD CLASS HOSPITALS

DEFINITION(S)

WHO Europe : Performance Assessment Tools for Hospitals

(PATH)

Model Komite Medik RSUP Fatmawati

ClinicalPathways

dengan

PATH

Semoga Bermanfaat

Jakarta, 7 November 2008dodyfirmanda