Peran Komite Medik dalam Pelaksanaan Program Pengendalian Resistensi Antimikroba

Dr. Dody Firmanda, Sp.A, MA Ketua Komite Medik RSUP Fatmawati, Jakartahttp://www.esnips.com/web/komitemedikDisampaikan pada pertemuan Amrin (Antimicrobial Resistance of Indonesia) Diselenggarakan oleh Direktorat Bina Medik Spesialistik Depkes RI di Hotel Horison Bekasi 6 8 November 2008.

Clinical Leadership

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

(untuk RS pendidikan)

KOMITE MEDIK: SISTEM CLINICAL GOVERNANCE, PATIENT SAFETY & CP

/ Adverse Events

Surveilans Infeksi Nosokomial

High Impact Interventions

Process: Implementation of Patient Safety

1

5

2

3 4

Peran Komite Medik: Menegakkan Etik dan Mutu Profesi Program Pengendalian Resistensi Antimikroba1. Daftar Formularium RS 1. Audit Medis 2. SPM/SPO 2. Clinical Risks 3. CP: Penyakit Management Infeksi & Tropis 3. Safety 4. Surveilans Infeksi Nosokomial 5. High Impact Interventions 1. Seleksi Antibiotik 2. Penggunaan Antibiotik 3. Penyebaran Mikroba

Surveilans Infeksi Nosokomial

High Impact Interventions

Program Pengendalian Resistensi Antimikroba1. Daftar Formularium 2. SPM/SPO 1. Seleksi 2. Penggunaaan 3. Penyebaran

1. Audit Medis 2. Clinical Risks Management 3. Patient Safety

1. Surveilans 2. High Impact Interventions Clinical Pathways: Penyakit Infeksi dan Tropis

Terintegrasi secara ko-ordinasi dan ko-operasi

span& spin ofcontrol

Patched-in Patched-in

2005 -2008

MILIK KOMITE MEDIK RSUP FATMAWATI

Pola Kuman 2005

Jenis Kuman Menurut Bahan RSUP Fatmawati Jakarta Januari - Desember 2005

Jenis Kuman Menurut Ruang RSUP Fatmawati Jakarta Januari - Desember 2005

Pola Kuman 2006Gram positif 19.2%

Gram negatif 80.8%

0.8% S.typhi A S.rubidiae .hinshawii 1 S.enteritidis 11 .3% .0% .0% 1% .1 K.ozaenae E.gregov iae 1 .8% P.aeruginosa % 2.1 2.4% S.liquifaciens 2.9%

C.amalunat ycus 0.2%

P .stuart ii 0.2%

S.aureus 17.0%

S.saprophyticus 3.4%

P .mirabilis 3.6% S.marces ens 9.2% K.pneumo niae 9.5% E.aerogenes 19.9%

E.co li 21 .4%

-haemolyt icus 23.4% S.epidermidis 55.1%

Pseudo mo nas sp. 21 .2%

Jenis Kuman Menurut Bahan RSUP Fatmawati Jakarta Januari - Desember 2006

Jenis Kuman Menurut Ruang RSUP Fatmawati Jakarta Januari - Desember 2006

Pola Kuman 2007Gram negatif 74.37% Gram pos itif 25.63%

GRAM POSITIFK . pneumoni ae 11. 3% S. l i qui f ac i ens 7. 3% Pseudomonas sp. P.mi r abi l i s 4. 6%

GRAM NEGATIFS.mar cesens 4. 1% K .ozaenae 3.6%

S.sapro phyticu s 22%

S.aureus 9%

Staphylo co ccu s sp 0%

17.4%

P. aer ugi nos a 2. 6%

S. haemo lyticus 40%

E . cl oac ae 1. 5% S.typhi 1. 2% E . gr egov i ae 0.9% C.f r eundi i 0.7% M . mor gani i E .aer ogenes 19. 5% 0. 3% P.vul gar i s 0. 3%

S.epidermidis 29%E.col i 23.5% S. r ubi di ae 0. 2%

K.oxytoca 0. 2% E. sakazaki i 0.2%

S.ent er i t i di s 0. 2% P.stuar ti i 0. 2% P .r ettger i 0. 2%

C.di ver sus 0.2%

Jenis Kuman Menurut Ruang RSUP Fatmawati Jakarta Januari - Desember 2007

Pola Kuman Januari Juni 2008Gram ne gatif 77%

Gram pos itif 23%

GRAM POSITIF

GRAM NEGATIF

P. mirabilis 4.0% S. liquef aciens 3.8% E. ger goviae 2.8% E. cloacae 2.6% S. rubidaea 2.6% K. ozaenae 1.3% P. Al calif aciens 0.6% C. f reundii 1.0%

S. marcescensS. bet a-haemol yti c 28%

Pseudomonassp. 8.7% P. aer uginosa 10.9%

7.5%

S. epi der mi di s 43%

K. pneumoniae 13.3%

S. bet a-haem. Gr oup A 0% S. sapr ophyti cus 20% S. aur eus S. non-haemol yti c (gamma) 3% 6%

C. diver sus 0.6% P. f luor escens 0.4% E. aggl omer ans 0.4% S. Typhi 0.4% E.coli, ent er opat hogenic 0.3% E. sakazakii 0.3% Pr ot eusvulgar is 0.3%

E.aer ogenes 16.6% E.coli 21.4% Al caligenes sp. 0.1%

Jenis Kuman Menurut Bahan RSUP Fatmawati Jakarta Januari - Desember 2008

Jenis Kuman Menurut Ruang RSUP Fatmawati Jakarta Januari - 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%

Golongan Certriaxone Cefotaxim Ciprofloxacin Meiact 6 Guns Ceftazidin Lacedim Ceftum Sefalosporin Sefalosporin Sefalosporin Sefalosporin Sefalosporin Kuinolon Sefalusponin

Lantai 4 87 0 66 28

Lantai 5 64 44 40 0

Lantai 6 73 0 28 0

Jumlah 224 44 134 28

18 1 3

0 0 0

4 0 0

22 1 3

Sistem satu pintu obat, Penggunaan seleksi obat antibiotika dan biaya obat

Form: Clinical Pathwaysof Pneumonia

VariancesANTIBIOTIC DRUGS 70 %

Cephalosporin 16% Amoxycillin 14%

Peningkatan SDM Sub Komite Pengendalian Infeksi Komite Medik RSUP Fatmawati6 orang Certificate of Achievement dari Asia Pacific Society of Infection Control1. 2. 3. 4. 5. 6. Dr. Pratiwi Andayani, Sp.A Dr. Sjafruddin, Sp.THT Dra. DebbieDaniel, Apt, M.Epid. Zr. Salfitriawati Arwan, SKep Zr. Minarni, AMK Zr. Ni Nyoman Sriadi

Langkah Berikutnya Komite Medik RSUP Fatmawati

PENGEMBANGAN

WORLD CLASS HOSPITALS

Dr. Dody Firmanda, Sp.A, MA Ketua Komite Medik RSUP Fatmawati Jakarta

WORLD CLASS HOSPITALSDEFINITION(S) world-classadj. (of a person, thing, or activity) of or among the best in the world.

hospital

n. 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, originally published by Oxford University Press 2008

WHO Europe : Performance Assessment Tools for Hospitals

(PATH)

Model Komite Medik RSUP Fatmawati

PATH

dengan

ClinicalPathways

Semoga BermanfaatJakarta, 7 November 2008 dodyfirmanda