HOSPITAL

SAFETY

dr. Joko Murdiyanto, Sp.An.

 Background

• Sekitar 98,000 kematian di RS tjd

karena medical error. 
• Kesalahan ini meningkatkan sekitar
$37.6 miliar biaya tambahan, termasuk
$17 miliar terkait dengan kesalahan
yang bisa dicegah.
Background…

• Fokus yg lebih besar pd hospital

safety akan menciptakan RS yg lebih
aman, demi kepentingan pasien, staf,
dan pengunjung.
• Penekanan lbh besar pd hospital
safety menyebabkan pasien, staf dan
pengunjung lebih sehat dan nyaman.
(Gershon et al, 2000)
 MEDICAL ERROR

Kegagalan memberikan pelayanan

yang seharusnya atau memberikan
pelayanan yang keliru dari seharusnya
(IOM, 1999).
 ADVERSE EVENT

Suatu kejadian yang mengakibatkan

cedera yang tidak diharapkan pada pasien
karena suatu tindakan (commission) atau
karena tidak bertindak (ommission), dan
bukan karena “underlying disease” atau
kondisi pasien (KKP-RS)
Sumber: Dwiprahasto, Iwan. Patient Safety sebagai Fokus Pelayanan Kesehatan yang Bermutu. .
 CAUSES OF HEALTH CARE
ERROR

• Faktor Manusia (ex: kelelahan, depresi, pasien

yg beragam, setting yg tdk familiar, tekanan
waktu)
• Kompleksitas Medis (ex: teknologi yg rumit,
perawatan intensif, hospital stay yg
memanjang)
• Kegagalan Sistem (ex: komunikasi yg buruk,
otoritas dokter, perawat dan tenaga kesehatan
lain yang tidak jelas, nama obat yang mirip)

(www.wikipedia.org)
 What is patient safety?

• Suatu disiplin ilmu kesehatan baru yg

menekankan pada pelaporan, analisis, dan
pencegahan kejadian medical eror yang
seringkali mengakibatkan kejadian yg
merugikan kesehatan (malpraktek)

(www.wikipedia.org)
 Indikator Patient Safety

• Indikator tingkat RS (hospital level

indicator) >> mengukur potensi
komplikasi yang sebenarnya dapat
dicegah saat pasien mendapat berbagai
tindakan medis di RS.
• Indikator tingkat area >> mencakup
semua risiko komplikasi akibat tindakan
medik yang didokumentasikan di tingkat
yankes setempat (kab/kota)
 Keselamatan pasien rumah sakit

Terdiri dari:
• Assesment risiko
• Identifikasi dan manajemen risiko terhadap
pasien
• Pelaporan dan analisis insiden
• Kemampuan belajar dan menindaklanjuti
insiden
• Menerapkan solusi untuk mengurangi serta
meminimalisir risiko
 Kebijakan patient safety di RS

• RS wajib melaksanakan sistem keselamatan

pasien
• RS wajib melaksanakan 7 langkah menuju
keselamatan pasien
• RS wajib menerapkan standar keselamatan
pasien RS
• Evaluasi pelaksanaan keselamatan pasien RS
akan dilakukan melalui program akreditasi RS.
Instrumen akreditasi RS akan ditambah dg
standar patient safety sehingga instrumen
akreditasi RS menjadi 17 pelayanan.
 Sistem Keselamatan Pasien RS

Terdiri dari:
• Pelaporan insiden, laporan bersifat anonim &
rahasia
• Analisis, belajar, riset masalah, pengembangan
taxonomy
• Pengembangan & penerapan solusi serta
monitoring/evaluasi
• Penetapan panduan, pedoman, SOP, standar,
indikator keselamatan pasien berdasarkan
pengetahuan dan riset.
• Keterlibatan & pemberdayaan pasien &
keluarganya
 Langkah menuju keselamatan pasien RS

1. Membangun kesadaran akan nilai

keselamatan pasien.
2. Membangun komitmen dan fokus yang
jelas tentang keselamatan pasien.
3. Membangun sistem & proses manajemen
risiko, serta melakukan identifikasi &
assesment terhadap potensial masalah.
4. Membangun sistem pelaporan.
Lanjutan…

5. Melibatkan & berkomunikasi dengan

pasien.
6. Belajar & berbagi pengalaman tentang
keselamatan pasien dengan melakukan
analisis akar masalah.
7. Mencegah cedera melalui implementasi
sistem keselamatan pasien dengan
menggunakan informasi yang ada.
 Standar Keselamatan Pasien
RS
1. Pasien dan keluarganya mempunyai hak
mendapat informasi tentang hasil pelayanan
termasuk hasil yang tidak diharapkan.
2. Mendidik pasien & keluarganya tentang
kewajiban & tanggung jawab pasien dalam
asuhan pasien.
3. RS menjamin terselenggaranya pelayanan
yang berkesinambungan & terkoordinasi.
4. RS terus meningkatkan kinerja dan keslematan
pasien.
Lanjutan….

5. Peran kepemimpinan dalam meningkatkan

keselamatan pasien:
• Menjamin implementasi program keselamatan pasien
secara terintegrasi
• Menjamin kesinambungan program dengan
mengidentifikasi risiko keselamatan pasien dan
pengurangan resiko
• Merencanakan peningkatan kinerja dan penyesuaian
prioritas
• Mendorong dan menumbuhkan komunikasi dan
koordinasi
Lanjutan…

6. Mendidik staf untuk keselamatan pasien

7. Meningkatkan komunikasi untuk keselamatan pasien
antara lain:
• Memenuhi kebutuhan informasi internal dan
eksternal
• Transmisi data dan informasi harus tepat waktu dan
akurat
• Rekam medis berisi informasi yang memadai
• Membuat data dan informasi
 Safety systems in health care organizations

Definition:
• Berusaha utk mencegah kerugian bagi pasien,
keluarga dan teman2 mereka, tenaga kesehatan
profesional, pekerja pelayanan, relawan, dan
individu2 lainnya yg aktivitasnya tidak lepas
dari setting pelayanan kesehatan.
• Tidak hanya menghindari kerugian yg dapat
dicegah, tetapi juga menyediakan perawatan yg
tepat
(Kohn et.al, 2000)
 PATIENT SAFETY PROGRAMS
SHOULD:

(1) provide strong, clear, and visible attention to

safety; implement nonpunitive systems for
reporting and analyzing errors within their
organizations;
(2) incorporate well-understood safety principles,
such as, standardizing and simplifying equipment,
supplies, and processes;
(3) establish interdisciplinary team training
programs, such as simulation, that incorporate
proven methods of team management.
 Reccomendation…

• Health care organizations and the

professionals affiliated with them should
make continually improved patient safety
a declared and serious aim by establishing
patient safety programs with a defined
executive responsibility.
• Health care organizations should
implement proven medication safety
practices.
 KEY SAFETY DESIGN
CONCEPTS

• Designing safe systems requires an

understanding of the sources of
errors and how to use safety design
concepts to minimize these errors
or allow detection before harm
occurs.
 PRINCIPLES FOR THE DESIGN OF
SAFETY SYSTEMS IN HEALTH CARE
ORGANIZATIONS

Principle 1. Provide Leadership

• Make patient safety a priority corporate objective.
• Make patient safety everyone’s responsibility.
• Make clear assignments for and expectation of
safety oversight.
• Provide human and financial resources for error
analysis and systems redesign.
• Develop effective mechanisms for identifying and
dealing with unsafe practitioners.
 Principle 2. Respect Human Limits in
Process Design

• Design jobs for safety.

• Avoid reliance on memory.
• Use constraints and forcing functions.
• Avoid reliance on vigilance.
• Simplify key processes.
• Standardize work processes.
 Principle 3. Promote Effective Team
Functioning
• Train in teams those who are expected to work
in teams.
• Include the patient in safety design and the
process of care.

Principle 4. Anticipate the Unexpected

• Adopt a proactive approach: examine processes
of care for threats to safety and redesign them
before accidents occur.
• Design for recovery.
• Improve access to accurate, timely information.
Principle 5. Create a Learning Environment
• Use simulations whenever possible.
• Encourage reporting of errors and hazardous
conditions.
• Ensure no reprisals for reporting of errors.
• Develop a working culture in which
communication flows freely regardless of
authority gradient.
• Implement mechanisms of feedback and
learning from error.
 MEDICATION SAFETY
Selected Strategies to Improve
Medication Safety
• Adopt a system-oriented approach to
medication error reduction.
• Implement standard processes for
medication doses, dose timing, and dose
scales in a given patient care unit.
• Standardize prescription writing and
prescribing rules.
• Limit the number of different kinds of
common equipment.
• Implement physician order entry.
Cont’…

• Use pharmaceutical software.

• Implement unit dosing.
• Have the central pharmacy supply
high-risk intravenous medications.
• Use special procedures and written
protocols for the use of high-risk
medications.
Cont’…
• Do not store concentrated solutions of
hazardous medications on patient care units.
• Ensure the availability of pharmaceutical
decision support.
• Include a pharmacist during rounds of patient
care units.
• Make relevant patient information available at
the point of patient care.
• Improve patients’ knowledge about their
treatment.
 SAFETY ACTIVITIES IN
HEALTH CARE
ORGANIZATIONS
1. LIFE SAFETY

• refers to a set of standards for the

construction and operation of buildings
and the protection of patients from fire
and smoke.
 2. INFECTIOUS DISEASE
SURVEILLANCE, PREVENTION, AND
CONTROL

• It requires epidemiological expertise and

includes attention to medical devices (e.g.,
intravascular and alimentation devices,
ventilators, equipment used for examination);
the physical environment (e.g., air ducts,
surfaces); surgical wound management; and
carriage by employees and other health
professionals.
 3. MORBIDITY AND MORTALITY
CONFERENCES
• As a standardized case report system to investigate the
reasons and responsibility for adverse outcomes of care.

4. AUTOPSY
• Unexpected findings at autopsy are an excellent way to
refine clinical judgment and identify misdiagnosis.

5. RISK MANAGEMENT PROGRAMS

• Risk management includes identification of risk
and education of staff, identifying and
containing risk after an event, education of staff
and patients, and risk transfer.
 HOSPITAL SAFETY CLIMATE
(Gershon, et. al, 2000)

(1) senior management support for safety programs,

(2) absence of workplace barriers to safe work practices,
(3) cleanliness and orderliness of the work site,
(4) minimal conflict and good communication among
staff members,
(5) frequent safety-related feedback/training by
supervisors,
(6) availability of personal protective equipment and
engineering controls.
www.safetyandquality.org
TARGETED INTERVENTIONAL
STRATEGIES FOR
SAFETY CLIMATE
IMPROVEMENTS
 1. Management support

• High-level senior management serving on

infection control and safety committees.
• Well-qualified safety and infection control
professionals.
• Continuing educational support for safety and
infection control professionals.
• Selection of membership to infection control
and safety committees based on expertise,
interest, enthusiasm, in addition to other
requirements.
• Etc.
 2. Job hindrances/facilitators

• Redesigning tasks to ensure that all

workers have the ability to protect
themselves when necessary.
• Transmitting information to
employees regarding the need to
protect themselves and still provide
optimal patient care.
 3. Personal protective equipment (PPE)

• Ensure that front line workers are in the

decision making process regarding safety
devices (ie, they should serve on product
evaluation committees or on purchasing teams).
• Revisit PPE periodically to ensure that new
technologies are examined for their potential
application in your institution.
• Set up PPE Total Quality circles to identify
novel solutions to problem areas (eg, eye
protection usage).
 4. Conflict/communication

• Train managers/supervisors on conflict

resolution and communication skills, and
retrain periodically.
• Rotate staff through a safety liaison position
on each unit. They could attend infection
control and safety meetings and report back to
their home departments during regularly
scheduled department meetings.
• Periodically evaluate supervisors on their
leadership abilities (ie, they should have
annual evaluations).
 5. Feedback/training

• Add compliance practices to both manager

and staff performance appraisals.
• Evaluate all safety training (especially on new
safety devices) to ensure that it is truly
effective.
• If self-study packets must be used, update and
revise them annually. When feasible, add
simulation exercises to the safety curriculum.
• Put simplified short versions of safety policies
online in the hospital network system.
• Etc.
 6. Cleanliness/orderliness

• Conduct frequent rounds to spot problems as

they occur.
• Periodically reduce clutter in all
departments (hold “spring cleaning” days).
• Involve employees on walk-through teams.
Wassalamualaikum WW