6. MNJM RESIKO 2015.pptx
-
Upload
adelina-kristanti -
Category
Documents
-
view
222 -
download
0
Transcript of 6. MNJM RESIKO 2015.pptx
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 1/48
MANAJEMEN RESIKODALAM PRAKTEK
KEDOKTERANBudi Mulyono,
Bag. Patologi Klinik FKUGM/
SMF Patologi Klinik & Ked Laboratorium
RSUP DR Sardito
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 2/48
HIDUP PENUH RESIKORESIKO “INHERENT”
KEGIATANRESIKO TERSEMBUNYI >>>
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 3/48
Resikoterka!"#
tata#a$
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 4/48
Resiko adala!" Kemungkinan teradinya #e#uatu
atau $eri#ti%a yang memba%aakibat yang tidak diinginkan ata#tuuan, #trategi, #a#aran, target dariorgani#a#i atau indiidu
Se#uatu yang da$at menggangguata# $en'a$aian !a#il kera dili!atdari a#$ek
( )t"*+ tuu, mutu, %aktu, 'atu dan
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 5/48
, Ti-e Resiko !ariKe.e-ata Kesa!ara /
Pe'a0a'a+
*+ Re#iko #egera dira#akan " memanat
$o!on, berkendara #e$eda, motor, mobil+-+ Re#iko di$a!ami #etela! melalui ilmu
$engeta!uan & teknologi " diare karenabakteri diketa!ui melalui ui laboratorium
+ Re#iko (irtual), di#adari teta$i ma#i!kontroer#ial, ilmu%an ma#i!mem$erdebatkan " $emana#an global,
$erokok $a#i0
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 6/48
1 K"a!ra Resiko Bisis
Operational risk:
Mis.o!".t
Sa&a0 i2or'asi3otra.tio
Financial risk:
3ost o2 .a-ita&Pe#e'4a#a "sa0a
Resiko -asar
Strategic risk:
3"sto'er .0a#eBra!i#
3o'-etitio
Hazard risk:
Ke.e&akaa ker%aBe.aa a&a'
A.a'a -i0ak ke ,
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 7/48
Resiko S-esia&is !a&a'
-raktek Ke!oktera +
*. Re#iko ke-ro2esia"
1 kemauan dlm teknologi Kedokteran1 $ro0e#i lain yg (over-lapping)
-. Re#iko -e&a5aa"
1 manaemen " aturan RS1 medikolegal " undang1undang, $eraturan
$emerinta!
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 8/48
• Keluhan/ komplain:87,000 per tahun, peningkatan 20-25% daridekade lalu.
• Efek merugikan teradi pada !,7% pa"ien ra#atinap : 28% teradi karena kelalaian dan $%menim&ulkan kematian, 'ang "e&enarn'a dapatdi(egah.
• )enelitian Kent *$++$: 70% tuntutan hukumdapat di(egah dengan permohonan maaf danpenela"an.
Masalah Resiko Klinik
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 9/48
Apa yang paling ditakutkan ?
• Pemberian obat yangsalah (61%)
• Pemberian 2 obat
yang salingberinteraksi negati(!"%)
• Komplikasi prosedurmedis (!#%)
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 10/48
Me#a-a Kese&a'ata Pasie
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 11/48
Mengapa Patient Safety
Process of care OutcomeStructure : AE
“Blaming”-)engaduan, untutan-uduhan alpraktek*)id/)erd
-)ro"e" 1ukum:)oli"i,)engadilan
-lo#-up a"" edia, +0%
)u&lika"i-opini negatif -)ertahanan 34 :
- )enga(ara- 34/r : 6"uran"i- untutan &alik
- "&
Patient Safety
-ulture
-3eporting
-earning /Analysis/Research
-K93-&a"ed 4tandard-uideline
-;mplementa"i,onitor -)atient ;n<ol<ement
Costly
Kecurigaan meningkat
Kepercayaan meningkat
Cost: n!esment
"uality "uality "uality
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 12/48
atient Safety di berbagai negara
#$ Ameri%a : A&R" 'Agency for &ealthcare Research an(
"uality)* +,,#
+$ Australia : Australian Council for Safety an( "uality in
&ealth Care* +,,,-$ nggris : .PSA '.ational Patient Safety Agency)* +,,#
$ Cana(a : .SCPS '.ational Steering Committee on
Patient Safety)* CPS 'Cana(ian Patient Safety
nstitute)* +,,-0$ Malaysia : Patient Safety Council* +,,
1$ 2enmar% : 33 Patient Safety* +,,-
4$ n(onesia : 55P6RS* +,,0
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 13/48
“Acci(ent Mo(el”
Management2ecisions/
Organisational
Processes
Bac%groun(
7actors:
8or%loa(super!ision
e9uipment
%no8le(ge
training
3nsafe Acts:
mista%es
omissions
!iolations
Latent Failures Work
Conditions
Active Failures
Defences
Near Miss
MISS!!
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 14/48
*-/-/*3 *4
Multi-Causal Theory “Swiss
Cheese” diagram (Reason, 11!
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 15/48
Re#iko !aru# di!ada$i, dianti#i$a#idan dikelola M56578M86 R8S9K:
;idak bole!
bingung ;idak
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 16/48
Maa%e'e Resiko" identi<ka#i,$engukuran dan $rioriti#a#i re#iko, #ertakoordina#i #umber daya utk mengendalikan
dam$ak keadian yang tidakmenguntungkan
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 17/48
R9SK M565G8M86; #!ouldbe"
• ;ake into a''ount !uman0a'tor#
• ;ailorable• Dynami', iteratie, re#$on#ie
to '!ange
• =a$able o0 'ontinualim$roement and en!an'ement
• Sy#temati' and #tru'tured
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 18/48
La#ka0
-erta'a" adanya$eren'anaan re#ikodlm #etia$ kegiatan
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 19/48
Ri#k Management Plan a# a tool to
redu'e error#"
*. Po##ible a$$li'ation"
1 $atient identi<'ation
1 $roi#ion o0 ne% treatment# and #eri'e#
-. S!ould be alerted" 1 !ig! olume a'tiitie#
1 immedia'y o0 treatment
1 'riti'al area#" blood banking, in0e'tion ,
mole'ular t>
1 in#u?'ient 'om$eten'y lo% olume
$ro'edure#+
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 20/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 21/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 22/48
Pemantauan dan reie%
dilakukan untuk mengukure0ektiita# $eren'anaan
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 23/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 24/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 25/48
Dengan kemauan teknologi ke#ala!an $ada ta!a$PR5 & P5S=5 @@@ 96;R5 5nalitik
PR5
5651L9;9K
96;R5
5651L9;9K
P5S=5
5651L9;9K
;a!a$1ta!a$ Pelayanan
Klinik
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 26/48
Kontributor ta!a$ $ra1
analitik"
P86G5B5956 P5D5"
• Langka!1langka! / $ro#e# yangber$engaru! t!d kualita# !a#il"$er#ia$an $a#ien, eduka#i
• Kondi#i (ideal) untuk $er#ia$an dari$embuat alat
• 9n#truk#i1in#truk#i yang adekuat bagi$a#ien & (front-liner )
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 27/48
Kontributor ta!a$ intra1
analitik"• ;idak 'uku$ $ema!aman teori dan
a$lika#i A=
• ;idak ada alida#i metodik /teknik$ada $a#ien tertentu
• (Turnover ) #ta0 yg terlalu 'e$at
tan$a di#ertai training yg 'uku$
• Kurangnya komunika#i tekni# antar$elak#ana
• ;idak dila$orkannya (interfering
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 28/48
Kontributor ta!a$ $a#'a1
analitik"• ;idak diadakan alida#i !a#il
$engobatan
• ;eknologi in0orma#i belum ditera$kan
• ;idak dilakukan anali#i# retro#$ekti0A=
• ;idak dilakukan review & verifydelayed side eect
• Using dierent instruments/methodswithout accountin for dierences
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 29/48
Standard o0 9S:"
• 9S: *3*C $arti'ular reuirement# 0orAuality and =om$eten'e in medi'al laboratory
• 9S: --E t!e u#e o0 ri#k redu'tion met!od#
in !ealt! 'are" R=5, FM85• 9S: *4C* a$$li'ation o0 ri#k management
to medi'al dei'e#" R=5, FM85
• 9S:/;S *EC4C ri#k treatment $lan, FM85
;!o#e #tandard do not $roide detailedguidan'e on ri#k management t!at %ould!el$ a medi'al #eri'e# to #et u$ a ri#kmanagement $rogram
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 30/48
;!e 7=9 7oint =ommi##ion9nternational+ Standard
#uda! diada$ta#i Komi#i5kredita#i RS+
• Ri#k management te'!niue to identi0y and
'ontrol medi'al error #our'e
• De#'ribe# !o% to u#e t%o tool#"
*. FM85 in order to redu'e and $reent
$otentialerror#
-. R=5 in order to $reent t!e
re'urren'e o0 ob#ered error#
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 31/48
6MEA+ 0ailure mode and ee't analy#i#anali#i# $engaru! dan 'ara kegagalan+6RA3AS" 0ailure, re$orting, analy#i#,
'orre'tie a'tion #y#tem+
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 32/48
6MEA
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 33/48
6MEA
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 34/48
6MEA
=antumkan dalam lembar kera FM85
%ork#!eet+
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 35/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 36/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 37/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 38/48
& i
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 39/48
Root 3a"se Aa&5sisR=5+"
• Men'ari akar $erma#ala!an untuk dibuat$enyele#aiannya
• Berbeda dgn FM85 yg di$akai #bg
$er!itungan kede$an , maka R=5 #angatberman0aat $ada keadian yang #uda!teradi
•Fi#! bone diagram, mela'ak ke Man,Met!od, Material, Ma'!ine, Money
• Ber#ama dg FM85 & FR5=5S utk 0ormula#i9ntegrated Ri#k Management
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 40/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 41/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 42/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 43/48
Auality & Sa0ety
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 44/48
4 S;R5;8G9 M86G86D5L9K56
R8S9K:"
1. Avoidance" meng!indari re#iko denganmeruba! #e'ara total kegiatan
2. Transference" $eminda!an re#iko ke$ada
$i!ak ketiga yg ka$abel eg." a#uran#i+3. Mitigation (ed!ction"" melakukan
langka!1langka! intermedia#i untukmengurangi dam$ak buruk re#iko ak#i
a%al, $emantauan ketat #. Acceptance (etention": menerima
re#iko dg $er#ia$an akibat $ada Cost-Schedule-Scope-uality
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 45/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 46/48
R9SK M565G8M86; 9MPR:H96GAU5L9;I & P5;986; S5F8;I
=:S; 8FF9=986=I
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 47/48
7/23/2019 6. MNJM RESIKO 2015.pptx
http://slidepdf.com/reader/full/6-mnjm-resiko-2015pptx 48/48
RESUME+
• Re#iko #elalu ada dan !aru# di$er!itungkan$ada #etia$ kegiatan $elayanan,M56578M86 R8S9K: meru$akan alat untuk
mengendalikan• Pro0e#i S$e#iali# Klinik #eyogyanya
mema!ami a$lika#i M56578M86 R8S9K:,terutama dalam a#$ek U!"#T$
#%'()*%*+T & !T#*+T S!,*T$ • uman factor meru$akan !al utama dan
FM85 dan R=5 meru$akan langka! $okokdalam 'isk !nalysis