Dr. Ahmad Samhari Baswedan MPA
• Mulai di Yogyakarta, 1954; Sekarang di Kuningan, Jakarta. HandPhone : 0857-1923-8100; e-mail : [email protected] • Master in Public Administration, Harvard University, USA, 1998. • Medical Doctor, Gadjahmada University, Yogyakarta, 1981 • Sekarang, Anggota Komite Keselamatan Pasien PERSI dan Sekretaris Eksekutif, The Global Fund to Fight AIDS, TB and Malaria in Indonesia dan Konsultan Manajemen RS & Kinerja Organisasi • Sebelumnya: 2009-20015 Program Manager, The Global Fund for Indonesia Community TB Program; 2004-2007 Consultant Patient Safety SE Asia; 2001-2006 Management Consultant (HR & Organization) & Guest Lecture Magister Kesehatan FK-UGM; 2000-2001 Coordinator Health, UNICEF East Timor; 1988-2000 Health & Nutrition Coordinator, UNICEF Indonesia; 1983-1988 Health & Nutrition Officer, UNICEF Indonesia; 1981-1983 Teaching Staff, Medical School, Gadjahmada.
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APA? SAFETY DEVICE
ALAT KESEHATAN dengan RISIKO TERKECIL berakibat KTD (“Adverse Events”/“Unintended Negative Outcomes”)
Error Margin : 3% - 5%
ASB-270208
AL-KES yang BANYAK dipakai DI RS Alcohol Swab
Alat Suntik
Sarung Tangan, APD
Catheter IV / Cardio / Urethra
“Dressing”
Botol Infus / Infusion Set
NGT- Intubasi
Ventilator
Tempat Tidur
Termometer
Tensimeter
ECG
Ambulans
Generator / UPS
USG / Rontgen / CT-Scan / MRI dll…
SUDAHKAH Mereka MEMENUHI Kriteria SAFETY?
Safety Device Issues :
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TEKNIS STRATEGIS
Infeksi (HAI/BSI/CRBSI/Covid-19)
NSI
Mis-Dx & Mis-Tx
“Tuntutan” (Legal)
Image
“Sustainability”
Pasien & RS
Jadi Korban
“Total Cost of Care” NAIK
Total Value TURUN “Total Business Cost”
TINGGI
Hospital Acquired Infections: Masalah Kesehatan Dunia
HAI : “Hospital Acquired Infection” / BSI : Blood stream Infection / CRBSI : Catheter-Related BSI
MORBIDITAS
• 32 % = Urinary Tract Infections
• 22 % = Surgical Site Infections
• 15 % = Pneumonia/Lung Infections
• 14 % = Blood-Stream Infections
MORTALITAS
• 11,1 %
• 8,2 %
• 36,3 %
• 30,9 %
DIMANA?
• 1,96 % = High Risk Nurseries
• 1,12 % = Well-Baby Nurseries
• 24,55 % = ICUs (all patients)
• 74,55 % = Outside ICUs (all patients)
USA : Klevens, Edwards, Richards, et al. Pub Health Rep 2007;122:160-6
BAGAIMANA dengan
Covid-19?
ASB-270509
KONSEP SAFETY DEVICE
SAFETY
DEVICE
BAHAN
MATERIAL
TEKNO
LOGI
PROSES
Untuk PASIEN
Untuk PETUGAS
Untuk INSTITUSI
(Kelangsungan
Bisnis)
TEKNIS
STRATEGIS
1. AMAN untuk PASIEN
a. Bebas Infeksi
b. High Quality to “minimize” Error
c. Mis-Dx dan Mis-Tx karena
“SALAH” membaca hasil
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Beyond Quality
Safety
2. AMAN untuk PETUGAS
RISIKO TERKECIL
terkena Viral Infection, NSI,
Blood Splatter, dan TIDAK memudahkan ERROR saat DIPAKAI
A. Global Distribution of Documented Occupational HIV
Infections, 1984-1997
B. Global Distribution of People Living with HIV/AIDS, 1999 Source: UNAIDS/WHO Source: Ippolito, et.al.
North America/
Western Europe
Sub-Saharan
Africa
Others
North America /
Western Europe
Others Sub-Saharan
Africa 90% 70%
26% 6%
4%
4%
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AIDS? Indonesia # 1 TER-CEPAT Di Asia Covid-19? Indonesia #1 TER-TINGGI kematian NaKes
AIDS, Covid-19 & KTD Luka Tusuk/NSI
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Beyond Quality
Safety
3. AMAN untuk INSTITUSI.
Total VALUE Tinggi (Total COST-of-CARE RENDAH/SEDANG)
Every surgery must use pulse oximetry and the checklist
$25 $250 VALUE : 100
surgery
PRICE :
$275
PEMANFAATAN TEKNOLOGI
“Material Technology,
Process Technology,
Information Technology”
UNTUK SAFETY DEVICE
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Basics ALAT SUNTIK yang Aman:
Material : Barrel polyprophylene medical grade dan
“Latex free” obat tidak rusak & dosis tepat
Material : Jarum stainless steel surgical grade
Process & Technology: HARUS BEBAS dari
“Reflux” (“aliran balik darah”) dosis tepat
“Sticktion” (“aliran obat tersendat-sendat”) dosis
tepat & aman untuk
Technology : Safety Generasi >3 = minimum risk Luka
Tusuk & Blood Splatter Aman Bagi Petugas
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Material AND Process :
Barrel bening kaca (transparan)
Marka jelas (“bold scale marking”)
Plunger sulit lepas saat aspirasi (“positive stop”)
Plunger ada lekukan (“tapered plunger rod”)
Pangkal Barrel “bersayap lebar” (“wide flange”)
Pangkal Plunger “kasar” (“serrated thumb press”)
Barrel langsung rusak sesudah dipakai.
Limbah Metal dan plastik dapat dipisah
Basics ALAT SUNTIK yang baik:
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Bahan utama : “Biomaterial”
Bahan bagian yang lain : polypropylene medical
grade dan stainless steel surgical grade
“Mandrin” aman dari luka tusuk dan Blood Splatter
• Phlebitis adalah Komplikasi IV Catheter yg paling sering
• Bahan “Biomaterial” mengurangi phlebitis s/d 46%
• Bahan Biomaterial mengurangi kerusakan ujung kateter s/d 50%
SOURCE : Gaukroger, P.B. et al, Infusion Thrombophlebitis: A prospective comparison, Anaesth Intens care (1988), 16, 265-271
Basics for IV Catheter
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Bahan utama : “Full Cotton”
Technology : “Full aluminum foil” dg “heat-resistant
lining” di bagian luar dan diproses secara vakum
Bahan desinfektans : Isopropyl alcohol/Acohol +
Iodine / Alcohol + Chlorhexidine
Basics for Alcohol Swabs
Basics for “Electronic Diagnostics”
Material : Industrial NOT General OR Household
Micro-voltage & “Full Insulation” (techno)
Clear guide for maintenance & calibration
25,000 hours LCD ; Error Margin max 3% (techno)
Use ONLY Manufacturer’s Accessories (material)
Kamar Pasien Bebas Resiko Jatuh
USE of “Geo-textile” fabrics to help stop (Covid-19) Infection (material)
Reduces cross-contamination between health staff & patient
Use for : APD & Masker
(Surgical & Medical)
Use of disposable “drapes” for Patient & Health Worker safety (material)
Disposable Roll Periksa
OUTPATIENT
Disposable Bed Sheets and Pillow Cover
INPATIENT
SURGICAL
Disposable drapes for surgery
Use Information Technology to Reduce Error
(e-Medicine / e-Health)
• Computerized Physician Order
Entry (CPOE): very effective in
reducing errors.
• Medications & Diagnostic orders
entered DIRECTLY on to a Tablet
connected to a computer network,
NOT written or done verbally.
DIMANA & KAPAN Safety Device?
HARUS (“Segera”) : 1. UGD 2. ICU 3. OK
4. Poliklinik, 5. Laboratorium (Klinik/Mikro/Rad.)
6. Bangsal Bedah 7. Bangsal Paediatri
Sebaiknya juga segera… 1. VIP Unit* 2. Bagian Gizi
Baru kemudian…. Semua Bangsal/Unit Pelayanan
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• Fokus pada alat habis pakai/consumables
(Syringes, Alcohol Swabs, Gloves, APD, IV Catheter,
dll) dan alat dengan “High Capital Investment”
(Diagnostik, Transport, Infrastructure, dll)
• Fokus pada Unit kerja dengan “high work
pressure”, “high infection-risk” dan “high image-
&-legal-risk” (UGD, ICU, OK, Poli, Lab, Bangsal
Paediatri, Bedah dan VIP)
Segera LAKUKAN Device Value Audit (DVA)
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Langkah Langkah Device Value Audit
Apakah KTD Terkait dg Peralatan?
(RCA)
Peralatan SUDAH Safety?
Teruskan RCA utk mencari
Penyebab Mendasar
KTD!
SEGERA LAKUKAN
DVA!
YA!
TIDAK
MONITOR (HAI/BSI/NSI)
and REVIEW
YA!
BELUM FOKUS PADA Unit:
HIGH RISKS for: Infections,
Image, Legal
HIGH in: Usage/Consumables,
Work-Pressure, Capital Investment.
LAKUKAN Laporan KTD/NSI, RCA, FMEA, Risk Grading dll
KTD krn Alat?
KTD krn Cara Pakai?
Pemakaian Safety Device mencegah KTD dan mengurangi biaya total RS dengan mencegah risiko pemborosan biaya pelayanan/pengobatan dan biaya akibat KTD!
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Good Luck!
0857-1923-8100
Semoga bermanfaat,
terimakasih, and
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