Upaya Mencegah Malpraktek Dalam Bidang Fetomaternal

7/30/2019 Upaya Mencegah Malpraktek Dalam Bidang Fetomaternal

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UPAYA MENCEGAH

MALPRAKTEK DALAM BIDANG

FETOMATERNALJudi Januadi Endjun

Sanny Santana

Novi ResistantieFebriansyah Darus

Divisi Fetomaternal

Departemen Obstetri dan Ginekologi

RSPAD Gatot Soebroto

Jakarta

2005


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AGENDA BAHASAN

PENDAHULUAN

REDUCING LITIGATION RISKS IN O&G

STANDAR PROFESI MATERI AJAR

JENJANG PENDIDIKAN LANJUTAN

KESIMPULAN

JJE/RSPAD/2005


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PENDAHULUAN

Krisis ekonomi multidimensi, terutamaakhlak, keimanan, kejujuran Pendidikan ??

Tuhan menyuruh kita JUJUR, Tuhan yangmemberi kita rejeki, mengapa kita harus tidakJUJUR

Bekerja secara TIM (kesetaraan)

Masalah medikolegal terbanyak : OBGIN

JJE/RSPAD/2005


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PENDAHULUAN

O&G by the nature of their work are more oftenthan most practitioners in other fields, liable toface litigation in respect of mal-practice

Cases are highlighted in the press andsometimes on TV

The general public has grown to expect highstandards and expectations of their specialists


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PENDAHULUAN

Health and safety the mother and child

Child birth is the period of time when accidents

both avoidable and unavoidable tend to happen

The most hazardous journey anyone ever

makes in ones life is the passage through the10 cm of the birth canal


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REDUCING LITIGATION

RISKS IN O&G Medical Protection Society (MPS)

Clinical Guidelines

Communication Medical Records

Medical Problems

Avoiding litigation in O&G

Dermot Mac Donald,2005


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Medical Protection Society

Medico-Legal Claims in O&G

The Medical Defense Union

The Institute of O&G The College of O&G

Society (ISOG, etc)

Medical Faculty The Lawyer



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Clinical Guidelines

Systematically developed statementswhich assist clinicians and patients inmaking decisions about appropriate

treatment for specific conditions

Practice of good medicine

Avoid medico-legal challenge



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Epidemic of legal challengefacing the practitioner of O&G

in day to day practice

Defensive medicine hasbecome the norm



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Communication

The teaching and learning of communication skills have

become a significant part of the medical undergraduate

curriculum

The patient who eventually makes the decision in regard to

their management may lighten the doctors responsibility

Lack of informed consent is a constant plea by Plaintiffs

The amount of detail to give the patient about possible risks

and complications is always a difficult decision



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Communication

In the event of serious complication or mishap :

The consultant in charge should speak to the patient and / orfamily as soon as possible

The patient should be given a factual account in simplelanguage together with an apology if indicated

Saying sorry does not constitute an admission of legal liability

The doctor should over-elaborate on the event nor give anover-optimistic prognosis

The MDU, 1991


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Communication

It is most important not to apportion blame at leastnot until a thorough investigation of all the relevant

facts has taken place

The patient and family should be given time toconsider what happened and the consultant should

offer to meet them a second time

Case conference with all involved the patient andrelatives do not hear inaccurate or different

accounts from various members of staff

The MDU, 1991


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Medical Records

Partograms are recommended, andcareful maternal and fetal records shouldbe entered on these.

Legibility and Signing Timing

Alteration

Detail Storage



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Legibility and Signing

The notes should be legible, clearly datedand timed with a identifiable signature

A stamp of the doctors name beside thesignature may diminish problems ofidentification years later as the defence is

prepared


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Timing

Very important to write the exact time of the event (CS,forceps, delivery, etc) and

Also the time at which the notes are actually written.

For instance : 14.00 Fetal bradycardia of 80 bpm; 14.05Decision to perform CS.; 14.50 C.S commenced. 14.55Baby delivered. 15.20 Clinical notes written and completedafter 20 minutes

Accompanied by an exact note of the detail. Such as FHR180, 170 to 180

The notes should indicate some explanation for the delayand documented


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Timing

EFM records : comments should be

written (and signed) on actual trace :

interpretations, decision, plans, etc should

be expl ic i t lywritten when fetal heart trace(or IA) suggests abnormality


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Alteration

Notes must not be altered.

If alteration are necessary, such alteration mustbe made by drawing a sing le l ine through the

or ig inal(so that it can still be read.

The time, date etc and reason for making the

alteration clearly stated and again, clearly signed


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Detail

The more explicit the information recorded, themore helpful it will be in defence.

Failure to progress by actual detail of cervix 5cms dilated with no progress for 3 hours despiteoxytocin and membrane rupture

Doctors are trained to help patients and treat theirailments. Writing notes and keeping records of thetreatments may become more important than theactual treatments


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Storage

All records must be carefully stored last

they are required in consultation in future

years

The EFM should be carefully stored in the

patients record file


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Medical Problems

Intra partum fetal hypoxia :

cerebral palsy

Trauma fetal

Trauma maternal

Retained swabs

Perineal tears &

Episiotomies Complications of CS

Vaginal repair

Retained placental tissue

Rhesus disease

Incompetent cervix/cervicalcerclage

Abdominal hysterectomy

Ureteric & Bladder injury

Bowel injury Retention of foreign body

Diathermy burns, etc


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STANDAR PROFESI

Kumpulan standar yang ditetapkan oleh

organisasi profesi, yang bersifat mengikat

pada anggotanya, terdiri dari standar

kompetensi, standar etika, dan standarpelayanan medis

Standar bersifat dinamis

Draft Standar Profesi POGI,2005


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STANDAR ETIKA

Sesuai dengan Pedoman Etik O&G dan KODEKI Altruisme : kepentingan klien diutamakan

Integritas : berilmu & profesional

Menjunjung tinggi harkat & martabat profesi

Kesejawatan : sumpah dokter & profesional

Akuntabilitas : dapat dipertanggungjawabkan

Memberikan pelayanan terbaik

Siap sedia menjalankan profesinya

Mampu berkomunikasi secara profesional dengan prinsip

saling asah, asih, dan asuh

Kepemimpinan yang baik dan profesional

Draft Standar Profesi POGI, 2005


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STANDAR KOMPETENSI

Pencapaian kompetensi minimal

Harus terus dikembangkan (Cont inuingProfess ional Development) dan

Con t inuing Medical Educat ion

Panduan Pendidikan Dokter Indonesia

JJE/RSPAD/2005


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STANDAR PELAYANAN MEDIK

SOP

SPM

Tempat Praktek

Catatan Medik dibuat berdasarkan CMBM :evaluasi lanjutan memakai sistim SOAP

JJE/RSPAD/2005


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MATERI RUJUKAN

ABOG, RCOG, ACOG, etc : Guidelines

Clinical Conference

Scientific meeting, Courses, etc

Textbooks : Fetal-medicine, Ultrasound,

Neonatology, Genetics, etc

Journals : Placenta, White Journals (ISUOG), etc

JJE/RSPAD/2005


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JENJANG PENDIDIKAN

LANJUTAN

Spesialisasi (Klinikus)

Pendidik (S1 S2 S3 Guru Besar)

Non Medis

Tidak berpraktek

JJE/RSPAD/2005


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AVOIDING LITIGATION IN O&G

1. Ensure the competency of your supportstaff

2. Admit if you are wrong

3. Keep a rein on your lawyers

4. Release medical reports and recordpromptly

5. Generally to avoid litigation6. General advice

R.K. Nathan, 2005


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Generally to avoid litigation

Listen carefully to thepatients complaints

Examine the patient

Explain her problems andthe treatment you wouldrecommend

Record all of the above

Recommend to a specialist

whenever you think itnecessary

Update your knowledge ofmedicine

Give due concern to slowprogress of labour orfailure of the fetal head todescend

Avoid allowinginexperienced orunqualified staff to be inattendance & the failure ofthe specialist to attend

Ensure an adequatelyequipped delivery room

Keep the patient briefed ofher progress


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KESIMPULAN

Krisis multidimensi berdampak buruk terhadapdunia pendidikan (kualitas luaran anak didik),penelitian, dan pelayanan kesehatan

Kejujuran, Kemauan memperbaiki diri, Komunikasi,dan Kesejawatan merupakan pilar dasar yangharus tetap dijaga

Apa yang dapat kita berikan agar pendidikan,penelitian, dan pelayanan dokter di Indonesia tidaksemakin terpuruk ??

JJE/RSPAD/2005


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THANK YOU

Upaya Mencegah Malpraktek Dalam Bidang Fetomaternal

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