MODEL OF GOOD CARE
By:
Dr. Suhazeli bin Abdullah,
Family Medicine Specialist,
Klinik Kesihatan Permaisuri
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What is MOGC?
Variation in healthcare delivery
To follow the best practice available
Element of Evidence-Based Medicine
Provision of protocols & guidelines.
Management Protocol
CPG
SOP
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Recap….
ABNA concept
Ideal With unlimited resource
ideal level of care
100
Optimum Optimal Achievable Level
75
50
} ABNA Actual
- targeted level within
means
25
ABNA:
difference between OA
0 & achieved level
QA aims at narrowing or
eliminating this gap
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To reduce magnitude of ABNA
Eliminate or minimized
○ Error of omission
○ Error of commission
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Process of Care MoGC
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PROCESS OF CARE
Processes is the steps in healthcare
activities the workers
- should undertake
- get information about
- should record
- do when diagnose, treating, follow-up
The steps is adopted from professionally
accepted standard of norm, SOP,
guidelines, circulars, CPG & …….
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FLOW CHART SYMBOLS
OVAL / CIRCLE
INDICATES THE
FIRST & LAST
DIAMOND SHAPE
REPRESENTS A
DECISIONPOINT
RECTANGLE
REPRESENTS A
PROCESSING STEP
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CARTA ALIRAN ASAL PENGENDALIAN KES
IBU BERSALIN DI PBBR, HTAA
Pendaftaran masuk di PAC
Saringan di buat oleh
Jururawat y/m mengikut
checklist
Risiko Tinggi Risko Rendah
Pemeriksaan ibu
Tidak
Bermasaalah dan janin di Pusat
bermasaalah
Bersalin
Di masukan Bersalin di
ke Dewan PBBR
Bersalin
Penjagaan ibu
DISCAJ dan bayi di
postnatal
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MODEL OF GOOD CARE
STEP NO PROCESS OF CARE CRITERIA STANDARD
A
B
C
C1
C2
C3
D
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CONTOH: Proses kerja MOGC bagi
mendapatkan laporan perubatan
PROSES MASA SEPATUT
Buat permohonan DIAMBIL
+ bayar
1 hari
Trace BHT
] JUMLAH
Beri Dr untuk 1 hari MASA ] YANG
deraf report ] DIPERLUKAN
Deraf } 3 hari ] < 1 minggu
Taip } ]
]
Tandatangan } 2 hari
Beri kepada
pemohon
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Proses mendapatkan laporan perubatan
sebenar
MASA TELAH DI AMBIL
Buat permohonan + 1 hari
bayar
Trace BHT JUMLAH MASA
5 hari } YANG
Beri Dr untuk deraf } DIPERLUKAN
report 5 hari }
Deraf ] } > 3 minggu
Taip ] }
Tandatangan ] 8 hari }
Beri kepada }
pemohon 2 hari }
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No. Process Criteria Standard
1.
Registration
< 12 / 52 90 %
Address
Time of registration
Educational status
*2.
History Taking
1 x / pregnancy 100 %
LMP
(During booking)
Age
Parity
Family History
Past Obstetric History
History
Conduct / TBA
PE
IUGR
LSCS
Past gynae history
Past medical history
Symptoms of eclampsia Every ANC visit
Every Home visit
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*3.
Physical Examination
1 x / pregnancy 100 %
Height
Every visit
Weight
BP
Pallor
Thyroid
Fundus
Abdomen
*4. Every visit
Lab Investigation
100 %
Urine : Sugar , Albumin
Blood group + Rh
*5.
Management
All cases 100 %
a. Mild PE Refer M&HO (Rx
All cases
protocol)
b. Severe PE Refer hospital
*6.
Follow-up
Weekly 90 %
a. Antenatal clinic
2x / week
b. Home visit
7.
Health education
100 %
Advice
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MODEL OF GOOD CARE
No. Process Criteria Standard
1. Admission Room
Registration & Case should be 100 %
Clerking attended within 30
minutes
Identification of risk 100 %
factor for low A/S Risk factors identified
CTG Prompt CTG for high 100 %
risk cases
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No. Process Criteria Standard
2. Antenatal Ward 1. CTG for all high risk 100 %
cases
100 %
2. FKC for all cases
Fetal well being 100 %
3. FH monitoring for all
cases 100 %
4. U/S for high risk cases
Maternal monitoring
100 %
1. V/S for all cases
100 %
2. Education for all cases
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No. Process Criteria Standard
3. Labour
room Identify risk factor for 100 %
Reassessmen low A/S
t of risk factor
Effective use of 100 %
Partogram partogram
External CTG for all 100%
patient at least once
CTG
Internal CTG for all
100 %
high risk cases
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MODEL OF GOOD CARE
Proses kerja Kriteria Standard T/jawab
1. Pendaftaran ke Mengikut garispanduan dan
PBBR,HTAA checklist ABC KKM 100% J/M
2. Pemeriksaan pesakit 1. Mengambil riwayat
pesakit 100% J/M
2. Pemeriksaan fizikal /
vagina
3. Intrapartum 1. Pathogram setiap 4
jam 100% J/T atau J/M
2. Pemeriksaan
kontraksi ibu dan
denyutan janin
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4. Kelahiran normal 1. Ibu di beri suntikan syntometrine
2. Placenta di keluarkan mengikut CCT 100% J/T atau J/M
3. Darah cord di ambil untuk G6PD
4. Bayi di bersihkan secara top & tail
5. Bayi di beri tag yg sama degan ibu
6. Pemeriksaan fizikal bayi dibuat
mengikut checklist
7. Bayi di beri kepada ibu dalam tempoh
< 30 minit
5. Postpartum 1. Pemeriksan fizikal ibu dan bayi
2. Kaunseling penyusuan bayi, 90% J/T atau J/M
perancantg keluarga,pemakanan sihat
dan penjgaan postnatal
6. Discaj 1. Penyediaan bil
2. Temujanji di Pusat Kesihatan yang 100% J/T atau J/M
berdekatan
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INDICATOR
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indicator
An INDICATOR is a measurable
variable (data) relating to
structure, process or outcome
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GENERAL indicator
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clinical indicator
an instrument (DATA) used to assess a
measurable aspect of patient care
acts as a guide to assessing the
performance of a hospital, department
or individuals within it.
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choosing indicator
Nosocomial Infection Rate
BOR as an indicator of bed utilization
Kelewatan menghantar kes-kes rujukan
kecemasan.
Kadar pembatalan temujanji pesakit luar
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choosing indicator
Peratusan Ibu Hamil Mendapat Rawatan
Pergigian
Kadar “Reject” Filem X-Ray
Kadar Penggunaan Botol Spesimen Yang
tidak Betul
Kadar Kehadiran Tindak Susul Selepas
program Saringan CVD.
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STANDARDS
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standards setting
1.Literature
2.Other studies
3.Consensus
4.Arbitrary
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Standards Setting
Setting too high a standard may make the problem
unsolvable and the target unreachable
If its too low, it may not reflect quality level of care
that’s acceptable
Use literature and other studies to determine the
appropriate standard in YOUR setup
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standards setting
Or set standards after knowing current level of
care
Only useful data
When human factors are involved usually the
standard should not be 100%
(It can be absolute if the factor or problem is seen to be very
important)
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Indikator
Bil. Ibu Hamil Anemia X 100 Jumlah ibu
Hamil pada 35 – 36 minggu
Standard
standard yang akan dicapai bagi tahun
2004 adalah 25%
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INDIKATOR & STANDARD
INDIKATOR : adalah peratusan jumlah kes berisiko
rendah bersalin di PBBR mengikut garispanduan iaitu
Jumlah kes berisiko rendah bersalin
Jumlah kelahiran di HTAA 100 %
STANDARD : Peratusan yang bersalin di Pusat
bersalin adalah tidak kurang daripada
12 % JUMLAH KESELURUHAN
KELAHIRAN DI HTAA
CRITERIA
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Criteria
Conditions to fulfill or to define an
indicator or a variable/sample
In simple words are DEFINITIONS or
PREREQUISITES of a term
May be tied to a STANDARD
Can be used to define the sample limits
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Inclusion Criteria
Criteria of study subjects that is to be
included in data (sample to be collected)
not clearly defined by indicator or title
List should not be too long
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exclusion criteria
Subjects to be excluded from study
Limits sample size to relevant subjects
Smaller number to study
Data collection easier and manageable
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criteria
MENINGKATKAN KEHADIRAN IBU HAMIL
MEMDAPATKAN RAWATAN PERGIGIAN.
1. Kehadiran Ibu Hamil bermaksud ibu mengandung yang
menghadiri Klinik Antenatal datang mendapatkan rawatan
pergigian.(kriteria)
2. Kehadiran bermaksud datang untuk mendapatkan rawatan
pergigian (definasi)
3. Kehadiran ibu hamil untuk mendapatkan rawatan pergigian
apabila dirujuk oleh kakitangan KKIK. (Inclusion criteria)
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Pengurangan Peratus Anemia Dikalangan Ibu
Hamil Pada Usia Kandungan 36 Minggu Di Daerah
Setiu
Inclusion Criteria
Semua ibu hamil yang datang ke Klinik ibu dan anak semasa tempoh kajian.
Mereka yang mengalami anemia di Daerah Setiu selain dari kriteria tertentu
yang disisihkan seperti dibawah.
Exclusion (Kriteria yang yang disisih)
Semua ibu hamil yang disahkan mengalami penyakit perubatan yang seperti
Thalasemia, Luekemia dan Haemophilia.
Pesakit yang memerlukan perawatan segera ke hospital seperti anemia
yang teruk dan memerlukan pemindahan darah.
Pesakit yang mengalami komplikasi dari perdarahan, eklampsia dan kencing
manis yang teruk
Kes lewat “booking” akibat dari kes luar yang mahu bersalin di kampung
halaman.
Kes yang mungkir temujanji melebihi dua (2) kali berturut-turut.
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BENGKEL 3
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