EWS in HOSPITAL

Dr. Aurick Yudha Nagara, Sp.Em

 I. KELOMPOK STANDAR (ARK,HPK,AP,

PELAYANAN BERFOKUS PAP,

PAB,PKPO
PADA PASIEN MKE)

(7 BAB)

II. KELOMPOK
STANDAR
STANDAR (PMKP,PPI,TKRS,
NASIONAL MANAJEMEN RS
MFK, KKS, MIRM)
(6 BAB)
AKREDITASI
RUMAH SAKIT III. SASARAN
ED 1 KESELAMATAN PASIEN SKP

PONEK
IV. PROGRAM HIV/AIDS
TB
NASIONAL
PPRA
GERIATRI

V. INTEGRASI
PENDIDIKAN KESEHATAN IPKP
DALAM PELAYANAN
 1.PEMBERIAN
PELAYANAN UNTUK
SEMUA PASIEN
2.PELAYANAN
PASIEN RISIKO
10.PELAYANAN
TINGGI DAN
PASIEN POPULASI
PENYEDIAAN
KHUSUS
PELAYANAN RISIKO
TINGGI

3.DETEKSI
9.PELAYANAN (MENGENALI)
PASIEN RESTRAIN PERUBAHAN KONDISI
PASIEN
BAB
PELAYANAN
& ASESMEN
PASIEN

8.PELAYANAN 4.PELAYANAN
PASIEN DIALISIS RESUSITASI

7.PELAYANAN
PASIEN DENGAN
PENYAKIT
MENULAR DAN 5.PELAYANAN
MEREKA YANG DARAH
DAYA TAHANNYA
DITURUNKAN 6.PELAYANAN
(IMMUNO-SUPPRESSED) PASIEN KOMA DAN
YANG
MENGGUNAKAN
VENTILATOR
PAP 3.1 EARLY WARNING SYSTEM (EWS)

Banyak pasien diluar daerah pelayanan kritis mengalami keadaan

kritis selama dalam perawatan

Seringkali, pasien memperlihatkan TANDA BAHAYA DINI

(tanda tanda vital yang memburuk, perubahan kecil st
neurologisnya) sebelum mengalami penurunan kondisi klinis yg
meluas shg sampai mengalami kejadian kritis/yg tidak diharapkan

Sebagian besar pasien yg mengalami gagal jantung/gagal paru

sebelumnya memperlihatkan tanda2 fisiologis diluar kisaran normal,
yg merupakan indikasi keadaan pasien memburuk
PAP 3.1 EARLY WARNING SYSTEM (EWS)

Ada KRITERIA FISIOLOGIS yg dapat membantu staf

utk mengenali sedini mungkin pasien yg kondisinya
memburuk

Penerapan EWS membuat staf mampu mengidentifikasi

keadaan pasien memburuk sedini mungkin dan bila
perlu MENCARI BANTUAN STAF YG KOMPETEN

Diharapkan, hasil asuhan akan lebih baik.

 Elemen Penilaian PAP 3.1.

No Elemen Penilaian Penialain yg Bukti yg disiapkan RS

diminta

1 Ada regulasi ttg pelaksanaan early R (Regulasi) -SK Direktur EWS

-Panduan/Pedoman EWS
warning system (EWS) -SPO EWS

2 Ada bukti staf klinis dilatih -Sertifikat EWS Staf  In House

D, W Trainning  Dokumen bukti pelatihan
menggunakan EWS (Dokumen, -wawancara Staf
wawancara)
3 Ada bukti staf klinis mampu -Sertifikat EWS Staf
D, W, S -wawancara
melaksanakan EWS (Dokumen, -Simulasi Staf EWS (sesuai dg SPO)
Wawancara,
Simulasi)
4 Tersedia pencatatan hasil EWS -Dokumen rekam medis (lembar
D, W EWS?CPPT?)
(Dokumen, -wawancara staf
wawancara)
PAP 3.1 EARLY WARNING SYSTEM (EWS)

BAHAYA DINI
(perubahan
fisiologis)
Tools  EWS Patient
safety

• INDIVIDU
• TEAM
WORK
• REGULASI
EARLY WARNING SYSTEM (EWS)
serangkaian sistem yang berfungsi untuk
memberitahukan akan terjadinya “kejadian”
 EARLY WARNING SYSTEM (EWS)

A specific procedure for the early

detection of any departure from normal
frequencies of clinical cases or serological
reactors of specific diseases by monitoring
a sample of the population at risk

Georgaka D, Mparmparousi M, Vitos M. Early Warning Systems. HOSPITAL CHRONICLE.

2012.Vol 7;1:37–43.
 EARLY WARNING SYSTEM (EWS)
• EWS merupakan cara untuk mengidentifikasi
perburukan klinis yang terjadi pada pasien
yang sudah mempunyai beberapa kebutuhan
medis.
• TRIASE ???
 2010 NOW
2007
•importance of EWS by including them:
• In the guidelines for resuscitation
• First link in the chain of survival
2003
*MODIFIED EWS/MEWS
* Standardized Early Warning System (SEWS)
•Multiple-parameter or – Aggregate weighted scoring
systems
1997
•NICE paramater
•Heart rate
•Respiratory rate
*first to develop
•Systolic blood pressure
•Level system
* track and trigger to identify early signs of deterioration  physiological parameters
of consciousness
•Oxygen saturation
*predict outcome
 NOW
STANDAR
NASIONAL
AKREDITASI
RUMAH SAKIT
ED 1
 EARLY
WARNING
SCORE
IS
IMPORTANT ?

Georgaka D, Mparmparousi M, Vitos M. Early Warning Systems. HOSPITAL CHRONICLE. 2012.Vol

7;1:37–43.
Early Warning Score in Hospital

Meningkatkan hasil pelayanan pada pasien 

PATIENT SAFETY

Mencegah pasien jatuh pada kondisi kritis/perburukan

kondisi/kematian

Komunikasi antar staf

• transfer intra hospital
• Pasien butuh “perhatian” khusus

Georgaka D, Mparmparousi M, Vitos M. Early Warning Systems. HOSPITAL CHRONICLE. 2012.Vol 7;1:37–43.
 SYSTEM

1 3 5

2 4
 High quality EWSystem
Timeliness (TEPAT WAKTU)
• Pengumpulan tanda vital pasien yg tepat waktu

Accuracy (KETEPATAN)
• Ketepatan skoring/interpretasi dari pengumpulan data tanda vital pasien

Consistency (KONSISTEN)
• Pemakain tools/score yg konsisten dalam menilai data berupa tanda vital
pasien

Completeness (KELENGKAPAN)
• mengacu pada semua parameter tanda vital yang harus dikumpulkan
Georgaka D, Mparmparousi M, Vitos M. Early Warning Systems. HOSPITAL CHRONICLE. 2012.Vol 7;1:37–43.
 Failure of
organization

Lack of
knowledge
Providing
suboptimal Failure to
appreciate
care urgency

Non-
availability
of
equipment
Early Warning Score in Hospital

• National Early warning Score

NEWS
• Triage Early Warning Score
TEWS
• Modified Early Obstetric Warning Score
MEOWS
• Paediatric EWS
PEWS
• Modified Early Warning Score
MEWS
NATIONAL Early Warning Score
(NEWS)
NATIONAL Early Warning Score
(NEWS)
NATIONAL Early Warning Score
(NEWS)
• USED IN:
1. In Emergency
2. In ICU
3. In PICU
4. In NICU
5. In maternity room
6. In ward room
NATIONAL Early Warning Score
(NEWS)
• PARAMETER FISIOLOGIS:
1. Respiratory Rate (RR)
2. Saturasi Oksigen (SaO2)
3. Bantuan Oksigen (Nasal canule,
NRBM, dll)
4. Temperature
5. Sistole Blood Presure
6. Heart Rate
7. Kesadaran (AVPU)
NATIONAL Early Warning Score
(NEWS)
 NATIONAL Early Warning Score (NEWS)
RESPON KLINIS FREKUENSI
MONITORING

Lanjutkan pemantauan EWS rutin Minimal 12 jam

• Informasikan hasil penilaian keada Minimal 4 s/d 6 jam

Perawat PJ
• Perawat PJ memutuskan untuk
ekskalasi/tidak frekwensi
pemantauan

• Perawat PJ melapor kepada DPJP Meningkatkan

• Pengkajian ulang oleh pemantauan
dokter/DPJP minimal tiap 1 jam

• Perawat PJ melapor kepada DPJP Pemantauan terus

• Pengkajian ulang oleh menerus/kontinyu
dokter/DPJP
• Rencana pindah ICU
NATIONAL Early
Warning Score
(NEWS)
NATIONAL Early Warning Score
(NEWS)
• MEWS should be used to monitor all adult inpatients in the Trust.
• This includes patients undergoing invasive procedures such as
radiological procedures and endoscopy.
• The Observation Chart should accompany the patient to the
department where the procedure is being carried out for continued
use / monitoring of the patient
• All patients should have a full set of observations carried out prior
to transfer, either to a different area of care, or to undergo any
diagnostic investigations or invasive procedures
• These observations should be used as a guide in conjunction with
the intra-hospital Transfer Risk Assessment Tool prior to transfer.
 TRIAGE Early Warning Score
(TEWS)

• Triage Early Warning Score (TEWS) is • Infant

a useful tool used to identify patients • Children
in emergency departments who • Adult
are at risk of deterioration and
who may require admission

An evaluation of the Triage Early Warning Score in an urban accident and emergency
department (Submitted: 2013-12-03. Accepted: 2013-02-17)
PEDIATRIC Early Warning Score
(PEWS)
• The Paediatric Early Warning Score
(PEWS) is a specialised tool that
measures the infant/ child’s clinical
status and recommends an appropriate
response
• The tool is designed to identify children
who are at risk of deterioration
PEDIATRIC Early Warning Score
(PEWS)

PERNA
PASAN

KARDI
OVASK
ULAR
PERILAKU
PEDIATRIC Early Warning Score
(PEWS)
PEDIATRIC Early Warning Score
(PEWS)
PEDIATRIC Early Warning Score
(PEWS)
 Modified Early Obstetric Warning
Score (MEOWS)

• a modified early obstetric warning system (MEOWS)

chart is used from 20 weeks gestation when the
woman is admitted to maternity wards
• The MEOWS chart is used in the postnatal period up
to the 6th week following childbirth
British Journal of Midwifery.Downloaded from magonlinelibrary.com by 195.195.094.179 on December 2, 2014.
 Modified Early Obstetric Warning
Score (MEOWS)
PARAMETER PARAMETER SPESIFIK
FISIOLOGIS MATERNAL
• respiratory rate • diastolic blood
• oxygen saturation pressure
• temperature • severity of pain
• systolic blood • antenatal discharge
pressure and/or postnatal
• heart rate lochia
• conscious level • proteinurea
Modified Early Obstetric Warning
Score (MEOWS)
Modified Early Obstetric Warning
Score (MEOWS)
Modified Early Obstetric Warning
Score (MEOWS)
TERIMAKASIH