Case Examples Hfmeca (Amkdp)

8/10/2019 Case Examples Hfmeca (Amkdp)

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LANGKAH ANALISIS MODUS KEGAGALAN, DAMPAK &

PENYEBAB

(AMKDP)/

HEALTHCARE FAILURE MODE EFFECT & CAUSES ANALYSYS

(HFMECA)

1. Pilih Proses yang berisiko tinggi dan Bentuk Tim

2. Gambarkan Alur Proses

3. Diskusikan & Prioritaskan Modus Kegagalan

4. Brainstorming Dampak Modus Kegagalan

5. Identifikasi Penyebab Modus Kegagalan

6. Hitung Total NPR (Nilai Prioritas Risiko)

7. Disain ulang proses / Re-disain Proses8. Analisa & uji Proses baru

9. Implementasi & Monitor Proses baru

HFMECA : Healthcare Failure Mode Effect , Causes and Analysis


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LANGKAH 1 : PILIH PROSES YANG BERISIKO TINGGI

Pilih Proses berisiko tinggi yang akan dianalisa.

Judul Proses :

BENTUK TIM

Ketua : ____________________________________________________________

Anggota 1. _______________ 4. ________________________________________2. _______________ 5. ________________________________________

3. _______________ 6. ________________________________________

Notulen _________________________________________

Apakah semua Unit yang terkait dalam Proses sudah terwakili ? YA / TIDAK

Tanggal dimulai ____________________ Tanggal selesai ______________________________


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LANGKAH 2A DIAGRAM PROSES

LANGKAH PROSES :

Gambarkan proses secara grafis,sesuai kebijakan & prosedur untuk setiap tindakan dan nomor dibawah ini.

Jika proses terlalu kompleks,anda memilih satu langkah proses atau sub proses untuk ditindak lanjuti

Cantumkan beberapa sub proses untuk setiap tahapan prosesTahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses

A. ----------------------- A. ----------------------- A. ----------------------- A. ----------------------- A. ----------------------- A. -----------------------

B. ----------------------- B. ----------------------- B. ----------------------- B. ----------------------- B. ----------------------- B. -----------------------

C. ----------------------- C. ----------------------- C. ----------------------- C. ----------------------- C. ----------------------- C. -----------------------

D. ----------------------- D. ----------------------- D. ----------------------- D. ----------------------- D. ----------------------- D. -----------------------

E. ----------------------- E. ----------------------- E. ----------------------- E. ----------------------- E. ----------------------- E. -----------------------

Pengadaan

TGM

Penerimaan &

Pengecekan TGM

dari Supplier

Penyimpanan

TGM di Instalasi

Gas Central

Pengecekan Ulang

Di Unit Penerima

Perencanaan

Ketersediaan

TGM

Pendistribusian

TGM ke

Unit2


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LANGKAH 2A DIAGRAM PROSES

LANGKAH PROSES :

Gambarkan proses secara grafis,sesuai kebijakan & prosedur untuk setiap tindakan dan nomor dibawah ini.

Jika proses terlalu kompleks,anda memilih satu langkah proses atau sub proses untuk ditindak lanjuti

Cantumkan beberapa sub proses untuk setiap tahapan prosesTahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses Tahapan Sub Proses

A. ----------------------- A. ----------------------- A. ----------------------- A. ----------------------- A. ----------------------- A. -----------------------

B. ----------------------- B. ----------------------- B. ----------------------- B. ----------------------- B. ----------------------- B. -----------------------

C. ----------------------- C. ----------------------- C. ----------------------- C. ----------------------- C. ----------------------- C. -----------------------

D. ----------------------- D. ----------------------- D. ----------------------- D. ----------------------- D. ----------------------- D. -----------------------

E. ----------------------- E. ----------------------- E. ----------------------- E. ----------------------- E. ----------------------- E. -----------------------


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LANGKAH 2B DIAGRAM SUB PROSES

LANGKAH SUB PROSES :

Gambarkan Subproses secara grafis,sesuai kebijakan & prosedur untuk setiap tindakan dan nomor dibawah ini.

Jika proses terlalu kompleks,anda memilih satu langkah Subproses untuk ditindak lanjuti

Catat Modus Kegagalan untuk setiap langkah Sub proses

Modus Kegagalan Modus Kegagalan Modus Kegagalan Modus Kegagalan Modus Kegagalan

----------------------- ------------------------ --------------------------- ---------------------------- -------------------------------

------------------------ ------------------------- --------------------------- --------------------------- -------------------------------

------------------------ ------------------------- --------------------------- --------------------------- -------------------------------

------------------------ ------------------------ --------------------------- --------------------------- -------------------------------

------------------------ ------------------------ --------------------------- --------------------------- -------------------------------

------------------------ ------------------------ -------------------------- --------------------------- -------------------------------

------------------------ ------------------------ -------------------------- --------------------------- -------------------------------


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LANGKAH 3

BRAINSTORMING POTENSIAL MODUS KEGAGALAN & BUAT

PRIORITAS MODUS KEGAGALAN

Proses Modus Kegagalan Bahaya Probabilitas Skor

Risi

ko

(3X

4)

Bands Kontrol Deteksi NPR

(5X7

X8

Ranking

Modus

Kegagalan

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 1 2 3 4 5 1-25 L M H E 1 2 3 4 1 2 3 4 5


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Modus Kegagalan Dampak Bahaya Probabilitas Skor

Risiko

(3X4)

Bands Kontrol Deteksi NPR(5X7X8)

1 2 3 4 5 6 7 8 9

1 2 3 4 5 1 2 3 4 5 1-25 L M H E 1 2 3 4 1 2 3 4 5

LANGKAH 4

BRAINSTORMING DAMPAK MODUS KEGAGALAN


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Modus

Kegagalan

Dampak Penyebab Bahaya Probabilitas SkorRisiko

(4X5)

Bands Kontrol Deteksi NPR

(6X8X9)

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 1 2 3 4 5 1-25 L M H E 1 2 3 4 1 2 3 4 5

LANGKAH 5

IDENTIFIKASI PENYEBAB MODUS KEGAGALAN


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LANGKAH 6

HITUNG TOTAL NPR

No Modus

Kegagalan

NPR

Modus

Kegagalan

Dampak NPR

Dampak

Penyebab NPR

Penyebab

Total NPR Ranking

1 2 3 4 5 6 7 8 9


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LANGKAH 7

PROSES DISAIN ULANG

1 2 3 4 5 6 7 8 9

Proses Modus

Kegagalan

Dampak Penyebab Rekomendasi

Redisain

Proses

Penanggung

jawab

Tanggal

Diselesaikan

Tanggal Dilaksanakan

Proses Baru

Ukuran

Outcome /

Pengawasan

Kinerja


11/15

No injuryFirst aid

treatmentonly with no

lost time, norrestricted

duty injuries

nor illnesses

Medical expenses,

lost time orrestricted duty

injuries orillness for 1 or

2 staff

Hospitalization

of 1 or 2 staff or3 or more staff

experiencing losttime or restricted

duty

injuries or

illnesses

Death or

hospitalizationof 3 or more

staff

Staff

Outcome

Evaluated &

First aid

treatment

No injury but

increased

LOS tomonitor

effects

MINOR

2

No injuryInjury with no

permanent loss of

function or

Evaluation &

treatment for1 or 2 visitors

(less than

hospitalizatin )

Injury with

permanent loss of

function

Or Hospitalization

of 1 or 2visitors

Death,

hospitalization

of 3 or more

Visitor

Outcome

No injuryInjury with no

permanent loss of

function

Injury with

permanent

loss offunction

DeathPatient

Outcome

INSIGNICANT

1

MODERATE

3

MAJOR

4

CATASTROPHIC

5

SEVERITY RATINGSEVERITY RATING(Modified by IMRK)(Modified by IMRK)


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PROBABILITY

(Modified by IMRK)

Very likely to occur every monthAlmost certain5

Likely to occur immediately or within a short period

(may happen several times in one year )

Likely4

Possible will occur

(may happen several times in 1 to 2 years)

Possible3

Unlikely to occur

(may happen sometimes in 2 to 5 years)

Unlikely2

Very Unlikely to occur

(may happen sometime in 5 to 30 years)

Rare1

DefinitionDescriptionRating


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RISK GRADING MATRIX

ExtremeHighModerateLowLowRare

1

ExtremeHighModerateLowLowUnlikely2

ExtremeExtremeHighModerateLowPossible3

ExtremeExtremeHighModerateModerateLikely4

ExtremeExtremeHighModerateModerateAlmost certain5

Catastrophic

5

Major

4

Moderate

3

Minor

2

Insignificant

1

Potenci al Concequences

Probability/Likelihood


14/15

Sample Detectability Scale

(Modified by IMRK)

0 out of 10

2 out 0f 10

5 out of 10

7 out of 10

10 out to 10

Probability of

Detection

Detection not possible at any pointAlmost certain

not to detect5

Unlikely to be detectedLow likelihood4

Moderate likelihood of detectionModeratelikelihood3

Likely to be detectedHigh likelihood2

Almost always detected immediatelyCertain to detect1

DefinitionDescriptionRating


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CONTROLLABILITY

Controls and Status are unknown or Residual riskDifficult4

Controls are either not practically in place not effective, not

communicated and or not complied with no reviews undertaken or

Controls can be introduced to reduce risk to an acceptable level butwill take longer than 1 year or entail significant effort or exp ensive

Moderate

difficult

3

Sufficient effective controls procedures are substantially in place

for specific circumstances, communicated & are complied with

periodic reviews are conducted or

Controls can be introduced to reduce risk to an acceptable level

within 1 year or at cost

Moderate

easy

2

Comprehensive effective controls fully in place, communicated,

complied with, maintained, monitored, reviewed & tested

regularly. All that is practicable to be done is being done orRisk can be introduced 1 month / or low cost or

Easy1

DefinitionDesriptionRating

Case Examples Hfmeca (Amkdp)

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