03 manajemen risiko klinik (mrk)

Praktek Bermutu dan Manajemen Risiko

Kematian BAYI Ibu X, ketuban pecah, hamil aterm Induksi partus, janin hidup Jam 22.00 dokter : hentikan induksi Jam 7.00 seksio sesarea Lahir bayi menangis  sesak Meninggal 2 jam kemudian Pasien tak puas

Kredensial SIKAP Akreditasi Standar Profesi AD/Statuta RS Komite Medik Ijin Praktek

MASALAH-TUNTUTAN Kematian ibu –bayi Asfiksia – kelumpuhan otak Kecacatan permanen Trauma Kelainan bawaan

Kenapa ada tuntutan ? PENYIMPANGAN PRAKTEK-KLINIK OR =5.76 290 kasus malpraktek vs 262 kontrol (1988-1998) Reduced medicolegal risk by compliance with obstetric clinical pathways : a case –control study Ransom et al – Obstet Gynecol 2003;101:751

Seksio sesarea Risiko besar pada ibu : perdarahan, infeksi, anestesi Risiko bayi : RDS, preterm, tersayat Persalinan pada bekas SS Peran : bidan, perawat, dr. Anak , Anestetist

Definisi Kecelakaan ( incident ): kejadian kesakitan/efek samping akibat tidak sesuai dengan pelayanan RS. Nama baik RS !!

LAPORAN KEJADIAN Obyektif Kerahasiaan Segera -24 jam, bila gawat per-telepon

MUTU >< RISIKO Manajemen mutu Semakin baik  semakin kecil risiko KOMUNIKASI !! Hargai hak pasien – tunjukkan sikap menolong – kunjungan > 1 kali /hari INFORMED CONSENT

Komite Medik Memegang teguh AD-Statuta RS Terdiri multidisiplin Menelaah Kredensial calon pegawai Menilai luaran pelayanan Proaktif – thd keluhan pasien/keluarga Membina informasi dari unit pelayanan-keluhan- KESEDIHAN pasien dan efek samping

PENERIMAAN DOKTER Sesuai dengan kebutuhan RS – kemampuan dokter ? Dokter patuh dengan AD-Statuta Rincian tugas Dokter Ob-Gin – kompetensi ?? Rekomendasi dari POGI Ijin praktek dari DepKes

Akreditasi Kompetensi Sikap  buku LOG : isi : luaran, jumlah tindakan ALARM (advances in labor and risk management) Kredit CME Kemampuan : pendidikan dan penelitian

Standar pelayanan Ada dokter konsultan Fetomaternal Multidisiplin : dr-OB, anestesi-OB, bidan-kompeten – OB+kompl, dsb Purna waktu FASILITAS : Km. Bersalin – 02, peghisap, oksimeter, tensi, alat resusitasi 1 Km Operasi – 3000 partus Monitor CTG, AGD, Mikroskop +LAB , Transfusi

Manajemen Risiko Prinsip : mengurangi Manajer Program  STANDAR - protap SIKAP – profesional Persyaratan : Ijin praktek Kompetensi: pelatihan Audit

Manajemen Risiko Klinik Struktur : dokter, bidan, perawat dll Tujuan : memperbaiki mutu, menghindari kecelakaan Langkah : Identifikasi masalah Analisa masalah Lokalisasi masalah  perbaiki Pendanaan – bila terjadi tuntutan Pertemuan dilakukan 1x/minggu.

Maternity clinical incident report Events that could result in important short- or long-term adverse effects for the mother or baby should be based on local consensus but would probably include: Maternal/delivery incident loss >1500 ml Cord accident Deep venous thrombosis Duration 2nd stage >3hrs (prim) Duration 2nd stage >1hr (parous) Duration established labour >18 hrs Eclampsia Hb <8g/dl postpartum Hysterectomy/laparotomy Fetal/neonatal incident APGAR <7 at 5 minutes Birth trauma Cord pH <7.2 Neonatal death Neonatal seizures Stillbirth >500g Shoulder dystocia Small for gestational age Term baby admitted to paediatric unit Unsuspected fetal anomaly Organisational incident Blood-Anaesthetic complications ITU admission Maternal death Pulmonary embolism Third degree tear Unsuccessful forceps/ventouse Uterine rupture Delay >30mins for emergency CS Delay following call for assistance Delivery outwith labour suite Faulty equipment Interpersonal conflict over case management Potential service user complaint Prescribing/administration error Retained swab/instrument Violation of local protocol/guideline

Kompetensi Analisa , contoh : Memakai Partogram Pengawasan janin – EFM- CTG Bekerja sesuai standar + etika profesi Membuat rekam medik lengkap

Program Pendidikan berkelanjutan bagi : dokter dan perawat/bidan Evidence based medicine – practice Menerapkan manajemen risiko Perbaikan protokol- protap Perbaikan rekam medik Telaah unit perawatan intensif- gawat darurat Perhatian pada allergi-efek samping Komunikasi dokter-pasien >>>>

Perbaikan pelayanan ? 60% Ob-Gyn di Australia pernah mengalami tuntutan dlm Obstetrik Uang ganti A$ 35.515 (median) 44% akan berhenti praktek obstetri dalam 5 tahun mendatang MacLennan AH, Spencer MK. Projections of Australian obstetricians ceasing practice and the reasons. Med J Aust 2002;176:425 .

Kredensial SIKAP Akreditasi Buku LOG ALARM Pelatihan Standar Profesi AD/Statuta RS Komite Medik Ijin Praktek POGI Panduan Etik

A Working Definition It is a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

Why do we need Clinical Governance? to give coherence to local quality improvement activities to promote the importance of clinical quality to restore public confidence in quality of clinical care to ensure public confidence in professional self-regulation

all professions and NHS managers provides framework for local professional self - regulation underpinned by continuing professional development Partnership for quality

Accountability for quality statutory responsibility for quality Chief Executive ultimately responsible for assuring quality of services (through the Board) formal local arrangements to assure clinical quality (i.e., Board sub-committee)

gives clinical quality equal status to financial management gives Boards responsibilities for clinical governance clear standards and quality systems openness and accountability Echoes Principles of Corporate Governance

To whom does it apply? principles of good clinical governance will apply to all NHS organisations and those engaged in NHS clinical practice arrangements must be proportionate to the size of the organisation

senior clinician responsible for clinical governance regular reports to the Board annual report on clinical governance Accountability locally

Coherent programme for quality improvement integrated quality improvement processes i.e., clinical audit evidence based practice innovations and good practice systematically disseminated adverse events openly investigated and lessons applied

What should it mean for patients? clearer accountability for quality increased confidence in quality of clinical services

by helping redress the balance between financial performance and quality by harnessing the commitment of clinicians and managers to the delivery of quality patient services by providing a coherent framework for disparate local quality improvement by reducing clinical risk and disseminating good practice. How can Clinical Governance help you?

NHSE Clinical Governance Key Steps Year 1 establish leadership, accountability and working arrangements carry out a baseline assessment of capacity and capability formulate and agree a development plan in light of the assessment clarify reporting arrangements for Clinical Governance within board and annual reports

Baseline Assessment of Capability and Capacity (1) a searching and honest analysis of organisations’ strengths and weaknesses in relation to current performance on quality. the identification of any particularly problematic services drawing where possible on objective data or feedback from users of services or referring agencies). an assessment of the extent to which data is in place for quality surveillance.

Baseline Assessment of Capability and Capacity (2) establishing whether there are any deficits in key mechanisms (eg for risk management etc) making sure that there is integration of quality activities and systems establishing explicit links to HiMPs NSF and PCG/PCTs

6. Gynaecology clinical incident report Events that could result in important short- or long-term adverse effects for the woman should again be based on local consensus but would probably include: Clinical incidents Damage to structures (e.g. ureter, bowel, vessel) Delayed or missed diagnosis (e.g. ectopic) Deep venous thrombosis Failed procedures (e.g. abortion, sterilisation, laparoscopy) ITU admission Omission of planned procedures (removal of IUCD at sterilisation, sterilisation at abortion) Operative blood loss >500ml Ovarian hyperstimulation (assisted conception) Performance of unplanned, unconsented procedures (e.g. removal of ovaries at hysterectomy) Pulmonary embolism Unplanned return to theatre

Organisational incidents Complications of anaesthesia Delay following call for assistance Faulty equipment Interpersonal conflict over case management Potential service user complaint Prescribing/administration error Retained swab/instrument Violation of local protocol/guideline

Organisasi POGI POGI JAYA Tim Manajemen Risiko Dokter Bidan/Paramedik Rumah Sakit AD Audit M - P Dewan Pertimbangan Cabang Ko-POGI Sikap dan kinerja Buku LOG Rekam Medik

03 manajemen risiko klinik (mrk)

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03 manajemen risiko klinik (mrk)