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Step by Step of QAP 2

Step by Step of QAP 2

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Dipublikasikan oleh Suhazeli Abdullah

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Published by: Suhazeli Abdullah on Aug 21, 2010
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07/30/2013

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MODEL OF GOOD CARE

By: Dr. Suhazeli bin Abdullah, Family Medicine Specialist, Klinik Kesihatan Permaisuri
Bengkel QAP PKDS 1

What is MOGC?
Variation in healthcare delivery € To follow the best practice available € Element of Evidence-Based Medicine € Provision of protocols & guidelines.
€

Management Protocol y CPG y SOP
y

Bengkel QAP PKDS

2

Recap«.

ABNA concept
Ideal
100

With unlimited resource
y ideal level of care

Optimum

75

50

} ABNA
Actual

Optimal Achievable Level - targeted level within means

ABNA:
y difference between OA

25

0

& achieved level y QA aims at narrowing or eliminating this gap

Bengkel QAP PKDS

3

€

To reduce magnitude of ABNA
y Eliminate or minimized

Error of omission Error of commission

Bengkel QAP PKDS

4

Process of Care

MoGC

Bengkel QAP PKDS

5

PROCESS OF CARE
€

Processes is the steps in healthcare activities the workers
y - should undertake y - get information about y - should record y - do when diagnose, treating, follow-up

€

The steps is adopted from professionally accepted standard of norm, SOP, guidelines, circulars, CPG & ««.
Bengkel QAP PKDS 6

FLOW CHART SYMBOLS
€

OVAL / CIRCLE INDICATES THE FIRST & LAST DIAMOND SHAPE REPRESENTS A DECISIONPOINT RECTANGLE REPRESENTS A PROCESSING STEP
7

€

€

Bengkel QAP PKDS

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

Bermasaalah

Pemeriksaan ibu dan janin di Pusat Bersalin

Tidak bermasaalah

Di masukan ke Dewan Bersalin DISCAJ

Bersalin di PBBR Penjagaan ibu dan bayi di postnatal
8

Bengkel QAP PKDS

MODEL OF GOOD CA E
STEP NO PROCESS OF CARE CRITERIA STANDARD

A B C C1 C2 C3 D

Bengkel QAP PKDS

9

CONTOH: Proses kerja MOGC bagi
mendapatkan laporan perubatan
€ € € € € € €

PROSES Buat permohonan + bayar Trace BHT Beri Dr untuk deraf report Deraf } Taip } Tandatangan } Beri kepada pemohon

MASA SEPATUT DIAMBIL 1 hari 1 hari 3 hari ] JUMLAH MASA
] YANG ] DIPERLUKAN ] < 1 minggu

2 hari

] ]

Bengkel QAP PKDS

10

Proses mendapatkan laporan perubatan sebenar
MASA TELAH DI AMBIL

€ € € € € € €

Buat permohonan + 1 hari bayar Trace BHT 5 hari Beri Dr untuk deraf report 5 hari Deraf ] Taip ] Tandatangan ] 8 hari Beri kepada pemohon
2 hari
Bengkel QAP PKDS

} } } } } } } }

JUMLAH MASA YANG DIPERLUKAN > 3 minggu

11

No. 1.

Process Registration y Address y Time of registration y Educational status History Taking y LMP y Age y Parity y Family History y Past Obstetric History y History  Conduct / TBA  PE  IUGR  LSCS y Past gynae history y Past medical history y Symptoms of eclampsia

Criteria < 12 / 52

Standard 90 %

*2.

1 x / pregnancy (During booking)

100 %

Every ANC visit Every Home visit

Bengkel QAP PKDS

12

*3.

Physical Examination y Height y Weight y BP y Pallor y Thyroid y Fundus y Abdomen Lab Investigation y Urine : Sugar , Albumin y Blood group + Rh Management a. Mild PE Refer M&HO (Rx protocol) b. Severe PE Refer hospital Follow-up a. Antenatal clinic b. Home visit Health education y Advice
Bengkel QAP PKDS

1 x / pregnancy Every visit

100 %

*4.

Every visit 100 %

*5.

All cases All cases

100 %

*6.

Weekly 2x / week

90 %

7.

100 %

13

MODEL OF GOOD CARE
No. 1. Process Admission Room
Registration & Clerking Identification of risk factor for low A/S CTG Case should be attended within 30 minutes Risk factors identified Prompt CTG for high risk cases 100 % 100 %

Criteria

Standard

100 %

Bengkel QAP PKDS

14

No.

Process

Criteria

Standard

2.

Antenatal Ward

1.

CTG for all high risk cases FKC for all cases

100 % 100 %

2. Fetal well being 3. 4. Maternal monitoring

100 % FH monitoring for all cases U/S for high risk cases 100 %

100 %
1.

V/S for all cases 100 % Education for all cases
Bengkel QAP PKDS 15

2.

No. 3.

Process

Criteria

Standard

Labour room

Identify risk factor for Reassessmen low A/S t of risk factor Effective use of partogram Partogram External CTG for all patient at least once Internal CTG for all high risk cases
Bengkel QAP PKDS

100 %

100 %

100% 100 %
16

CTG

MODEL OF GOOD CARE
Proses kerja
1. Pendaftaran ke PBBR,HTAA

Kriteria
Mengikut garispanduan dan checklist ABC KKM

Standard T/jawab

100%

J/M

2.

Pemeriksaan pesakit

1.

2.

Mengambil riwayat pesakit Pemeriksaan fizikal / vagina Pathogram setiap 4 jam Pemeriksaan kontraksi ibu dan denyutan janin

100%

J/M

3.

Intrapartum

1.

100%

J/T atau J/M

2.

Bengkel QAP PKDS

17

4.

Kelahiran normal

1. 2. 3. 4. 5. 6.

7.

Ibu di beri suntikan syntometrine Placenta di keluarkan mengikut CCT Darah cord di ambil untuk G6PD Bayi di bersihkan secara top & tail Bayi di beri tag yg sama degan ibu Pemeriksaan fizikal bayi dibuat mengikut checklist Bayi di beri kepada ibu dalam tempoh < 30 minit Pemeriksan fizikal ibu dan bayi Kaunseling penyusuan bayi, perancantg keluarga,pemakanan sihat dan penjgaan postnatal Penyediaan bil Temujanji di Pusat Kesihatan yang berdekatan

100%

J/T atau J/M

5.

Postpartum

1. 2.

90%

J/T atau J/M

6.

Discaj

1. 2.

100%

J/T atau J/M

Bengkel QAP PKDS

18

Bengkel QAP PKDS

19

indicator
€ An

INDICATOR is a measurable variable (data) relating to structure, process or outcome

Bengkel QAP PKDS

20

GENERAL indicator

Bengkel QAP PKDS

21

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.

€

Bengkel QAP PKDS

22

choosing indicator
€ € €

Nosocomial Infection Rate BOR as an indicator of bed utilization Kelewatan menghantar kes-kes rujukan kecemasan. Kadar pembatalan temujanji pesakit luar

€

Bengkel QAP PKDS

23

choosing indicator
€

Peratusan Ibu Hamil Mendapat Rawatan Pergigian Kadar ³Reject´ Filem X-Ray Kadar Penggunaan Botol Spesimen Yang tidak Betul Kadar Kehadiran Tindak Susul Selepas program Saringan CVD.
Bengkel QAP PKDS 24

€ €

€

Bengkel QAP PKDS

25

standards setting
1. 2. 3. 4. Literature Other studies Consensus Arbitrary
Bengkel QAP PKDS 26

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 low, that¶s acceptable Use literature and other studies to determine the appropriate standard in YOUR setup
Bengkel QAP PKDS 27

€

€

standards setting
€

Or set standards after knowing current level of care
y

Only useful data

€

When human factors are involved usually the standard should not be 100%
y

(It can be absolute if the factor or problem is seen to be very important)

Bengkel QAP PKDS

28

€

Indikator
y Bil. Ibu Hamil Anemia

X 100

Jumlah ibu Hamil pada 35 ± 36 minggu

€

Standard
y standard yang akan dicapai bagi tahun

2004 adalah 25%

Bengkel QAP PKDS

29

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

Bengkel QAP PKDS

31

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
€

Bengkel QAP PKDS

32

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
€

Bengkel QAP PKDS

33

exclusion criteria
€ € € €

Subjects to be excluded from study Limits sample size to relevant subjects Smaller number to study Data collection easier and manageable

Bengkel QAP PKDS

34

criteria
€

MENINGKATKAN KEHADIRAN IBU HAMIL MEMDAPATKAN RAWATAN PERGIGIAN.
1.

Kehadiran Ibu Hamil bermaksud ibu mengandung yang menghadiri Klinik Antenatal datang mendapatkan rawatan pergigian.(kriteria) Kehadiran bermaksud datang untuk mendapatkan rawatan pergigian (definasi) Kehadiran ibu hamil untuk mendapatkan rawatan pergigian apabila dirujuk oleh kakitangan KKIK. (Inclusion criteria)

2.

3.

Bengkel QAP PKDS

35

Pengurangan Peratus Anemia Dikalangan Ibu Hamil Pada Usia Kandungan 36 Minggu Di Daerah Setiu
€

Inclusion Criteria
y 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)
y Semua ibu hamil yang disahkan mengalami penyakit perubatan y y y y

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 ³booking´ akibat dari kes luar yang mahu bersalin di kampung halaman. Kes yang mungkir temujanji melebihi dua (2) kali berturut-turut.

Bengkel QAP PKDS

36

Bengkel QAP PKDS

37

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