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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