9/16/20

9/15/20

Patient
Patient safety
safety
is
is aa key
key
component
component of of Risk
management
management

Dr
DrArjaty
ArjatyDaud
Daud MARS
MARS
Komite Nasional Keselamatan Pasien (KNKP)
Komite Nasional Keselamatan Pasien (KNKP)

CURICULUM VITAE

Nama : dr. Arjaty W. Daud, MARS

Alamat : Jl Kemang Timur XIV / 56 Jakarta Selatan
Tmpt / tgl. Lahir : Manado,17 Januari 1969
Status : Menikah
Email : arjatydaud19@gmail.com
Hp : 0812 1830 7169

PENDIDIKAN
S-1 Fakultas Kedokteran Universitas Sam Ratulangi - Manado , Lulus 1995
S-2 Fakultas Kesehatan Masyarakat, KARS Universitas Indonesia, Lulus 2005

PELATIHAN / SEMINAR
2017 : Update Acreditation Joint Commission International 6 th edition Amsterdam
2015 : Practicum Acreditation Joint Commission International 5 th edition Singapore
2011 : Practicum Acreditation Joint Commission Internationl 4 th edition Seoul
Patient Safety Course, Singapura
2010 : Safety in Healthcare, Kuala Lumpur
2009 : Hospital Management Asia, Vietnam
Course Risk Management PRMIA Jakarta
2007 : New Perspektif, Conferrence ASHRM, Chicago USA
Certified Profesional Healthcare Risk Management course, Chicago USA
Risk Management Base Training, Joint Commision Resources (JCR)
Patient Safety Up Date, Joint Commision International (JCI) Singapura
2005 : Lead Audior ISO 9001 – 2000, International Registered Certificated
Auditor (IRCA)

Arjaty/WPSD 2020 2
2
Arjaty/WPSD 2020

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Arjaty/WPSD 2020 3

AGENDA

1 Pendahuluan
2 Manajemen risiko dalam Akreditasi

3
Patient Safety is key component of Risk Management

3
4
Transformasi Manajemen risiko
Proses Manajemen risiko
5
Framework Strategi mitigasi risiko saat Pandemi
6
Covid 19

7 Keselamatan pasien saat Pandemi Covid 19

8 Manajemen risiko saat Pandemi Covid 19

2
 9/16/20

Pendahuluan
• Keselamatan Pasien adalah suatu sistem yang membuat asuhan pasien
lebih aman, meliputi asesmen risiko, identifikasi dan pengelolaan
risiko pasien, pelaporan dan analisis insiden, kemampuan belajar dari
insiden dan tindak lanjutnya, serta implementasi solusi untuk
meminimalkan timbulnya risiko dan mencegah terjadinya cedera
yang disebabkan oleh kesalahan akibat melaksanakan suatu tindakan
atau tidak mengambil tindakan yang seharusnya diambil. (PMK 11
Keselamatan Pasien 2017)

• Manajemen risiko adalah Kegiatan berupa identifikasi dan evaluasi

untuk mengurangi risiko cedera dan kerugian pada pasien, karyawan
rumah sakit, pengunjung dan organisasinya sendiri (JCAHO).

Arjaty/WPSD 2020 5

Manajemen Risiko dalam Akreditasi

PMKP 12 – Manajemen risiko

• Regulasi Manajemen risiko

• Program Manajemen risiko : Kategori risiko :
– Strategis, operasional, keuangan, kepatuhan, reputasi
• Framework manajemen risiko : Proses manajemen risiko untuk Strategi
Mitigasi risiko

MFK 2 Program manajemen risiko fasilitas & lingkungan di RS

Program MR fasilitas & lingkungan meliputi :

a.Keselamatan dan keamanan
b.B3 dan limbahnya
c.Penanggulangan bencana (emergensi)
d.Proteksi kebakaran (fire safety)
e.Peralatan medis
f.Sistem penunjang (utilitas)

MFK 3. Individu atau organisasi yang kompeten yang ditugasi untuk melakukan
pengawasan terhadap perencanaan dan pelaksanaan program MR fasilitas dan
lingkungan.

• Program pengawasan terhadap manajemen risiko

6

Arjaty/WPSD 2020

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Risk & Patient safety

Arjaty/WPSD 2020 7

PATIENT SAFETY IS KEY

COMPONENT OF RISK MANAGEMENT
Patient care
Related Medical Staff
Risks Related Risks
(Patient Safety)

Other Risk Employee

Risks Management Related
Risks

Property
Financial
Related
Risks
Risks

Roberta Caroll, editor : Risk Management Handbook for Health

8
Arjaty/WPSD 2020 Care Organizations, 4 th edition, Jossey Bass, 2004

4
 9/16/20

Patient Safety is Key

Component of Risk Management

Magnitude Incidence Medications

4 dari 10
134 juta KTD terjadi $42 juta setiap
pasien cedera
setiap tahun di RS tahun biaya yang
saat mendapat
*
yang menyebabkan dikeluarkan
perawatan di
2,6 juta kematian akibat Medication
tingkat primer
setiap tahunnya error
dan rawat
karena perawatan
jalan
yang tidak aman

Keselamatan pasien “fundamental issue” dalam pelayanan kesehatan :

Pasien bebas dari bahaya yang tidak seharusnya atau potensi bahaya
yang terkait dengan pelayanan kesehatan.
9
Arjaty/WPSD 2020

Burden of unsafe care

• Adverse event : Negara maju, 1 dari 10 pasien cedera ketika dirawat di

RS. (WHO)
• Medical error : USA : 44.000–98.000 kematian akibat kesalahan medis /
tahun (lebih tinggi drpd KLL di jalan raya, , kanker payudara, atau AIDS).
(USA)
• HAI : 1,4 juta orang di seluruh dunia, 50% dapat dicegah. (WHO)
• Medication error : 7000 kematian / tahun di RS (USA)
• Unsafe surgery : 7 juta komplikasi dan 1 juta kematian / tahun (WHO).
• Unsafe injections : 33% dari virus hepatitis B (HBV), 42% dari Hep C
(HCV) dan 2% infeksi HIV; > 70% suntikan di FKTP yang tidak perlu.
• Clinical handover : 15% clinical handovers : antara unit / tim / RS / –
menyebabkan KTD. (Australia)
• Medical device error : > 1 juta kerusakan alat kesehatan / tahun, dengan
rate 6,3 kejadian / 1000 hari rawat. (USA)
• Obat tradisional : tahun 2005, 2006 dan 2007, masing21 ,8%, 2,7% dan
12% orang yang diwawancarai melaporkan bahwa mereka mengalami
KTD karena obat tradisional . (Republik Korea)
10
Arjaty/WPSD 2020

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WORLD PATIENT DAY 2020 (WHO)

• Patient safety : a global health priority
• 3 technical report for Medication safety :
– Medication safety in transitions of care
– Medication safety in polypharmacy
– Medication safety in high risk situations
• Patient engagement tool for medication safety
(5 Moment Medication Safety)
• Global Patient safety Collaborative (GPSC) :
– Leadership
– Education and training
– Research
• Global campaign : Medication without harm

11
Arjaty/WPSD 2020

Arjaty/WPSD 2020 12

6
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TRANSFORMASI MANAJEMEN RISIKO

Risk Management has changed:

FROM REACTIVE TO PROACTIVE

Manajemen risiko berubah dari Program safety yang

menangani cedera dan kecelakaan ke Proses :
1. Identifikasi & menangani semua sumber risiko dan
kerugian
2. Menangani semua area fasilitas pelayanan termasuk
kepatuhan pada Peraturan Regulator
3. Memprioritaskan perlindungan di fasilitas pelayanan
pasien, pengunjung dan penyimpanan aset
4. Menghindari situasi potensial terjadinya kerusakan

Arjaty/WPSD 2020 13

TRANSFORMASI MANAJEMEN RISIKO

KRISIS MALPRAKTEK (1970)

Biaya klaim & premi asuransi meningkat

Risk Management program (ASHRM) (1980)

Moved from focused on medical profesional liability
issues to All risks associated with accidental loses
facing a health care organization

Traditionally Risk management to Concept ERM

Considering the myriad of complex legal, regulatory,
political, business & financial risks facing health care
organization
14
Arjaty/WPSD 2020

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Manajemen Risiko Perusahaan

(Enterprise Risk Management / ERM)
• Suatu Proses yang dilakukan oleh Dewan Entitas : Direksi,
Manajemen yang menerapkan strategi di seluruh area
perusahaan untuk mengidentifikasi kejadian potensial yang
dapat mempengaruhi Entitas dan mengelola risiko dalam risk
apetite untuk pencapaian tujuan institusi. COSO (2004).

• Perubahan Program MR berbasis insiden / reaktif, fokus

pada klinis ke Program MR multidisiplin Holistik berfokus
pada semua risiko organisasi disebut ERM

ERM MEMBANTU PENCAPAIAN TUJUAN ORGANISASI DAN

MENGHINDARI KERUGIAN

Arjaty/WPSD 2020 15

PROSES MANAJEMEN RISIKO

2. Pertimbangkan
1. Identifikasi &
potensial tehnik
Komplain Analisa
Laporan pasien risiko pengelolaan
Kronolo manajemen risiko
gis Audit
Medis
Rapat 5. Monitor &
Ronde / Kasus
Morning perbaikan
Report Program
SITUASI SAAT INI Manajemen
risiko
4. Implementasi 3. Pilih tehnik
tehnik pengelolaan
pengelolaan MR (CBA )
manajemen risiko
16

Arjaty/WPSD 2020

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 9/16/20

PROSES MANAJEMEN RISIKO

Identifikasi / Analisa Paparan Kelola Risiko melalui Tehnik MR

Identifikasi Analisa Risk Control Risk Financing

Risiko Risiko
Identifikasi Frequency Hindari Risiko
Kerugian kerugian
Transfer Retensi
(Risk Avoidance)
Seberapa sering
kerugian akan
Cegah kerugian Non Asuransi
terjadi”
(Loss Prevention) asuransi
+ Severity
(frekuensi) Kontrak,
Seberapa serius
perjanjian Pasif Aktif
dampak kerugian
terjadi? Reduksi
kerugian (Loss
Reduction )
Kerugian (Loss) (dampak)

Finansial Liabiity Personil Segregasi

Property

Kontrak transfer
(Non asuransi)
17
ASHRM
Arjaty/WPSD 2020

Identifikasi risiko
Adalah pemeriksaan apa yang ada di dalam organisasi, yang dapat
mengakibatkan cedera pada individu, sehingga bisa ditentukan apakah
organisasi sudah mengambil tindakan pencegahan (prevent), mitigate,
mendeteksi error yang dapat menyebabkan cedera (harm)

1. Daftar Potensi risiko yang menggambarkan proses risiko tinggi pada

pasien, staf, pengunjung atau pekerja kontrak.
Kriteria prioritas yang biasanya digunakan :
1. Probability or likelihood of occurrence (P)
Skor risiko :
2. Risk of harm (criticality) or impact (D)
DXPXK
3. System capacity or preparedness (K)
2. Daftar risiko :Rekapitulasi kejadian / insiden dalam waktu 1 tahun mencakup :
1.Insiden keselamatan pasien,
2. Insiden Staf medis
3.Insiden K3 (tenaga kesehatan & tenaga lainnya)
4.Hasil Inspeksi / Ronde fasilitas & lingkungan RS
5.Hasil asesmen PPI
6.Bisnis / keuangan (financial) RS Skor risiko :
7.Klaim litigasi DXP
18
8. Komplain, Arjaty/WPSD 2020
9.Investigasi eksternal & internal

9
 9/16/20

Analisa Risiko
Tools Risk Management :
1. Prioritize risk / Risk scoring / Risk grading matrix
2. Root Cause Analysis - RCA
3. Failure Mode Effect Analysis- FMEA
4. Hazard Vulnerability Analysis – HVA
5. Infection Control risk Assessment – ICRA
6. Pre Construction risk Assessment – PCRA
7. Hospital Safety Index - HSI

Tools Risk Management in Pandemic Covid 19 :

1. Rapid Hospital readiness Check list. (RHR Checklist)
2. Risk assessment and management of exposure of health care
workers in the context of COVID-19 (HCW Risk assessment)

19
Arjaty/WPSD 2020

HUBUNGAN MANAJEMEN RISIKO,

PERBAIKAN MUTU DAN KESELAMATAN PASIEN

Risk Patient
Management Safety

The organization will realize Benefits from this

collaboration such as :
ü improved communication among groups,
ü less duplication of effort,
ü better coordination of activities.

Arjaty/WPSD 2020 20

10
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Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework

to an incident that far exceeds the usual health and medical capacity and capabilities. Therefore, the same

FRAME WORK STRATEGI MITIGASI RISIKO

elements that come together to build any successful disaster response should also be used to develop robust
CSC plans and guide their implementation.
Figure 2-1 illustrates the systems framework that the committee believes should inform the develop-
ment and implementation of CSC plans. It is based on the five key elements of planning set forth in the

SAAT PANDEMI COVID 19 2009 letter report (see Table 1-1 in Chapter 1), which served as the starting point for the development of
the committee’s recommendations in that report and are foundational for all disaster response planning. The
Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework
figure depicts a strong foundation of underlying principles; steps needed to achieve the implementation of
disaster response; and the pillars of the disaster response system, each separate and yet together supporting
the jurisdictions—local, state, and federal governments—with the overarching authority for ensuring that
CSC planning and implementation occur.
CONTINUUM OF CARE CSC PLAN THE SURGE RESPONSE FRAMEWORK
BOX 2-5

SURGE CAPACITY Implementation of the Surge Response Framework:

Conventional, Contingency, and Crisis Response Cycle

Resource Resource
Shortage Triage
Threshold Threshold

CONVENSIONAL
Advise/Anticipate Adapt
Crisis
Response

Conventional Contingency

CONTIGENCY Response Response Allocate

CRISIS Assess Analyze

Awareness

Incident
1. SPACES,
2. STAFF, After an incident occurs, the first priority is to develop situational Awareness, and then
figurerelative
to Assess the situation to appear
to theinavailable
boxes 2-5 and 7-4.eps
resources. The incident commander,
3. SUPPLIES FIGURE 2-1
along with relevant technical experts and/or the clinical care committee (in a proactive
response/longer-term incident) Advises on strategies and Anticipates any resource
The foundation for CSC planning comprises ethical considerations and legal authority and environment, located on either side of the steps leading up deficits (and recommends obtaining necessary supplies, staffing, etc.). If a resource is
to the structure. The steps represent elements needed to implement disaster response; education and information sharing are the means for ensuring
that performance improvement processes drive the development of disaster response plans. The response functions are performed by each of the
scarce, Adaptive strategies (such as conservation, substitution, adaptation, and reuse)
should be implemented. In a crisis, a deliberate triage decision to Allocate/reallocate
HIRARKI KONTROL MITIGASI
five components of the emergency response system: hospitals and acute care, public health, out-of-hospital and alternate care systems, prehospital

4. CRISIS STRATEGIES FOR SCARCE

and emergency medical services, and emergency management/public safety. While these components are separate, they are interdependent in their
contribution to the structure; they support and are joined by the roof, representing the overarching authority of local, state, and federal governments.
resources may be necessary. In all cases, the response and any strategies should be
Analyzed at regular intervals as part of the disaster response planning cycle, and the

STANDARD RESOURCE SITUATIONS RISIKO PANDEMI COVID 19

elements repeated until the incident concludes. The terms in this figure can be further
described as follows:

OF CARE (CSC) 1-32 CRISIS STANDARDS OF CARE Awareness

• Incident commander recognizes current or anticipated resource shortfall(s) and

1.Copyright
Prepare
National Academy of Sciences. All rights reserved. assesses impact of current strategies.

2. Substitute
3. Conserve
1-48 CRISIS STANDARDS OF CARE
4. Re-use
Copyright National Academy of Sciences. All rights reserved.
5. Adopt
6. Re-allocate

Controlling exposures to occupational hazards is a fundamental way to protect personnel. Conventionally, a hierarchy
has been used to achieve feasible and effective controls. Multiple control strategies can be implemented concurrently
and or sequentially. This hierarchy can be represented as follows:

Elimination
Substitution
Engineering controls
Administrative controls
Personal protective equipment (PPE)

To prevent infectious disease transmission, elimination (physically removing the hazard) and substitution (replacing the
hazard) are not typically options for healthcare settings. However, exposures to transmissible respiratory pathogens in
healthcare facilities can often be reduced or possibly avoided through engineering and administrative controls and PPE.
Prompt detection and effective triage and isolation of potentially infectious patients are essential to prevent unnecessary
exposures among patients, healthcare personnel (HCP), and visitors at the facility.

N95 respirators are the PPE most often used to control exposures to infections transmitted via the airborne route,
though their effectiveness is highly dependent upon proper fit and use. The optimal way to prevent airborne
transmission is to use a combination of interventions from across the hierarchy of controls, not just PPE alone. Applying a
combination of controls can provide an additional degree of protection, even if one intervention fails or is not available.

Respirators, when required to protect HCP from airborne contaminants such as some infectious agents, must be used in

Continuum of care surge capacity

the context of a comprehensive, written respiratory protection program that meets the requirements of OSHA’s
Respiratory Protection standard ! . The program should include medical evaluations, training, and fit testing.

Surge capacity refers to the ability to manage a sudden, unexpected increase in patient volume that would otherwise
severely challenge or exceed the present capacity of a facility. While there are no commonly accepted measurements or
triggers to distinguish surge capacity from daily patient care capacity, surge capacity is a useful framework to approach a
decreased supply of N95 respirators during the COVID-19 response. Three general strata have been used to describe
surge capacity and can be used to prioritize measures to conserve N95 respirator supplies along the continuum of care.1

Conventional capacity: measures consist of providing patient care without any change in daily contemporary
practices. This set of measures, consisting of engineering, administrative, and PPE controls should already be

• Pelayanan konvensional adalah Fase stabil di

implemented in general infection prevention and control plans in healthcare settings.
Contingency capacity: measures may change daily standard practices but may not have any significant impact on the

mana pasien dirawat dengan standar

pelayanan biasa. Selama fase ini, RS memiliki
ruang perawatan yang memadai, staf yang
sesuai dan persediaan yang cukup. Konvensional

• Ketika sumber daya RS meningkat karena

pandemi COVID-19, RS pindah ke tingkat RS evaluasi
perubahan
Pelayanan kontingensi, di mana RS mengalami pelayanan (4 S) :
peningkatan rawat inap, permintaan staf serta 1. Space Kontigensi
persediaan. 2. Staff
3. Supplies
4. Standard of care
• Pada tahap ekstrim pandemi, RS perlu
menerapkan standar Pelayanan krisis, yang
Krisis
diperlukan ketika permintaan ruang,
persediaan, dan staf sangat tidak proporsional
dengan sumber daya yang tersedia sehingga Arjaty/webinarIM RK/covid19

RS dipaksa untuk menjatah pasokan dan

memodifikasi standar perawatannya.
Arjaty / WPSD 2020

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Crisis Standard of Care (CSC)

Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework

Definisi Standard Pelayanan saat Krisis (CSC) :

Perubahan
Where Do substansial
You Come In? dalam operasional perawatan kesehatan dan tingkat
pelayanan pada saat terjadi bencana (mis., Pandemi / bencana besar sprt Gempa
Community Conversations help policy makers:
bumi dll). Perubahan
Understand community concerns iniaboutdapat dibenarkan pada kondisi tertentu dan secara resmi
the use of limited

ditetapkan
medical resources during disasters
oleh Pemerintah, dengan menetapkan bahwa operasional pelayanan saat
Develop crisis standards of care guidelines that reflect
krisis akan berlaku dalam suatu periode waktu yang berkelanjutan. Deklarasi formal
community values and priorities

berlakunya Standar pelayanan saat krisis akan memberikan kekuatan hukum /

peraturan khusus dan perlindungan bagi Fasyankes dalam tugasnya untuk
mengalokasikan dan menggunakan sumber daya medis yang terbatas / langka dan
menerapkan alternatif operasional di fasilitas pelayanannya
When we need CSC ?

Scarce Medical
Resources
Extreme
Crisis PPE
Staff
Pandemi Ventilators
Covid 19 Drugs
Vaccines

Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework

CSC : salah satu aspek dalam Disaster Planning Arjaty / WPSD 2020
6-54 CRISIS STANDARDS OF CARE

Copyright National Academy of Sciences. All rights reserved.

to an incident that far exceeds the usual health and medical capacity and capabilities. Therefore, the same
elements that come together to build any successful disaster response should also be used to develop robust
CSC plans and guide their implementation.
Figure 2-1 illustrates the systems framework that the committee believes should inform the develop-
ment and implementation of CSC plans. It is based on the five key elements of planning set forth in the
2009 letter report (see Table 1-1 in Chapter 1), which served as the starting point for the development of
the committee’s recommendations in that report and are foundational for all disaster response planning. The
figure depicts a strong foundation of underlying principles; steps needed to achieve the implementation of
disaster response; and the pillars of the disaster response system, each separate and yet together supporting

Crisis standard of care (CSC) Plan

the jurisdictions—local, state, and federal governments—with the overarching authority for ensuring that
CSC planning and implementation occur.

2 2

FIGURE 2-1
Perlindungan Hukum untuk Praktisi dan Fasilitas Pelayanan Kesehatan yang
The foundation for CSC planning comprises ethical considerations and legal authority and environment, located on either side of the steps leading up

menerapkan Standar Perawatan Krisis

to the structure. The steps represent elements needed to implement disaster response; education and information sharing are the means for ensuring
that performance improvement processes drive the development of disaster response plans. The response functions are performed by each of the
five components of the emergency response system: hospitals and acute care, public health, out-of-hospital and alternate care systems, prehospital
Arjaty / WPSD 2020
and emergency medical services, and emergency management/public safety. While these components are separate, they are interdependent in their
contribution to the structure; they support and are joined by the roof, representing the overarching authority of local, state, and federal governments.

1-32 CRISIS STANDARDS OF CARE

Copyright National Academy of Sciences. All rights reserved.

12
 9/16/20

Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework

Implementation of the Surge Response Framework :

Conventional, Contigency and Crisis Response Cycle
BOX 2-5
• Setelah terjadi insiden, prioritas pertama Implementation of the Surge Response Framework:
adalah memiliki Kesadaran situasional Conventional, Contingency, and Crisis Response Cycle
(Awareness),
• Menilai (Assess) situasi sumber daya yang Resource Resource
tersedia. SKI bersama dengan para pakar Shortage Triage
Threshold Threshold
teknis terkait dan / atau komite medis
merespons proaktif / insiden jangka panjang Advise/Anticipate Adapt
• Memberikan saran (Advises) tentang strategi Crisis
dan mengantisipasi (Anticipates) defisit Response
sumber daya dan merekomendasikan
Conventional Contingency
pasokan / persediaan, staf, yang diperlukan). Response Response Allocate

• Jika sumber daya langka, strategi adaptif

(Adaptive) (mis. konservasi, substitusi,
adaptasi, dan reuse) harus diterapkan. Assess Analyze

• Dalam krisis, keputusan triase untuk

mengalokasikan (Allocate) / realokasi sumber
Awareness
daya perlu dilakukan.

• Dalam semua kasus, respons dan strategi apa

pun harus dianalisis (Analyzed) secara berkala
Incident
sebagai bagian dari siklus Rencana respons
bencana, dan elemen2 diulangi hingga insiden
berakhir. After an incident occurs, the first priority is to develop situational Awareness, and then
Arjaty
to Assess / WPSD
figure
the situation relative to the2020
to appear inavailable
boxes 2-5 and 7-4.eps
resources. The incident commander,
along with relevant technical experts and/or the clinical care committee (in a proactive
response/longer-term incident) Advises on strategies and Anticipates any resource
deficits (and recommends obtaining necessary supplies, staffing, etc.). If a resource is
scarce, Adaptive strategies (such as conservation, substitution, adaptation, and reuse)
should be implemented. In a crisis, a deliberate triage decision to Allocate/reallocate
resources may be necessary. In all cases, the response and any strategies should be
Analyzed at regular intervals as part of the disaster response planning cycle, and the
elements repeated until the incident concludes. The terms in this figure can be further
described as follows:

Awareness
Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response: Volume 1: Introduction and CSC Framework
• Incident commander recognizes current or anticipated resource shortfall(s) and

Allocation of specific resources along

assesses impact of current strategies.

the care capacity continuum.

1-48 CRISIS STANDARDS OF CARE
Incident demand/resource imbalance increases
Copyright National Academy of Sciences. All rights reserved.
Risk of morbidity/mortality to patient increases
Recovery
Conventional Contingency Crisis
Space Usual patient Patient care areas re-purposed (PACU, Facility damaged/unsafe or
care space fully monitored units for ICU-level care) non-patient care areas
utilized (classrooms, etc.) used for
patient care
Staff Usual staff Staff extension (brief deferrals of non- Trained staff unavailable or
called in and emergent service, supervision of broader unable to acequately care for
utilized group of patients, change in responsibilities, volume of patients even with
documentation, etc.) extension techniques
Supplies Cached and Conservation, adaptation, and substitution Critical supplies lacking,
usual supplies of supplies with occasional re-use of select possible re-allocation of life-
used supplies sustaining resources
Standard Usual care Functionally equivalent care Crisis standards of carea
of care
Normal operating Extreme operating
conditions conditions
Indicator: potential Trigger: crisis standards
for crisis standardsb of carec
Arjaty / WPSD 2020
FIGURE 2-2
Allocation of specific resources along the care capacity continuum.
NOTE: ICU = intensive care unit; PACU = postanesthesia care unit.
!a Unless temporary, requires state empowerment, clinical guidance, and protection for triage decisions and authorization for alternate care sites/
Figure 2-2.eps
techniques. Once situational awareness achieved, triage decisions should be as systematic and integrated into institutional process, review, and
documentation as possible.
!b Institutions consider impact on the community of resource use (consider “greatest good” versus individual patient needs—e.g., conserve resources

when possible), but patient-centered decision making is still the focus.

!c Institutions (and providers) must make triage decisions—balancing the availability of resources to others and the individual patient’s needs—shift to

community-centered decision making.

SOURCE: IOM, 2009, p. 53.

13
all can result in a crisis situation (Figure 2-4). Elimination of these delays requires practiced incident man-
agement, a common operating picture in place, recognition of indicators of the need for contingency and
crisis response, and establishment of CSC plans, all within the overarching construct of the disaster response
 9/16/20

Strategi untuk mencegah menipisnya sumber daya

saat kekurangan Ruang, Staf dan Persediaan

• BERSIAP (PREPARE) Tindakan sebelum terjadi kekurangan seperti menyimpan

peralatan penting dapat meminimalkan dampak kelangkaan sumber daya.
• PENGGANTI (SUBSTITUTE) Identifikasi obat-obatan, alat, atau staf yang setara
yang dapat digantikan ketika sumber daya biasa langka.
• BERADAPTASI (ADOPT) Gunakan obat, alat, atau staf yang akan memberikan
perawatan yang memadai ketika sumber daya tidak tersedia.
• PENGGUNAAN KEMBALI (REUSE). Gunakan kembali barang2 yang biasanya
dianggap sebagai penggunaan sekali pakai jika sterilisasi atau desinfeksi yang tepat
dimungkinkan.
• MENGHEMAT (CONSERVE) Gunakan lebih sedikit sumber daya dengan
menurunkan dosis atau mengubah praktik pemanfaatan. Konservasi masker wajah,
obat-obatan, atau persediaan lain, jika perlu, dapat memungkinkan RS untuk
mempertahankan tingkat sumber daya yang memadai.
• ALOKASIKAN KEMBALI (RE-ALLOCATE) Batasi penggunaan sumber daya untuk
pasien dengan kebutuhan yang lebih besar.
Arjaty / WPSD 2020

MECHANICAL VENTILATION / EXTERNAL OXYGENATION

STRATEGIES FOR SCARCE RESOURCE SITUATIONS

Arjaty / WPSD 2020

14
 9/16/20

OXYGEN –
STRATEGIES FOR SCARCE RESOURCE SITUATIONS

Arjaty / WPSD 2020

OXYGEN –
STRATEGIES FOR SCARCE RESOURCE SITUATIONS
OXYGEN - 03/29/2019 DRAFT REVISION
STRATEGIES FOR SCARCE RESOURCE SITUATIONS
Conventional Capacity – The spaces, staff, and supplies Contingency Capacity – The spaces, staff, and supplies used are Crisis Capacity – Adaptive spaces, staff, and supplies are not consistent
not consistent with daily practices, but provide care to a standard that with usual standards of care, but provide sufficiency of care in the setting of
used are consistent with daily practices within the institution.
is functionally equivalent to usual patient care practices. These spaces a catastrophic disaster (i.e., provide the best possible care to patients given
These spaces and practices are used during a major mass casualty
or practices may be used temporarily during a major mass casualty the circumstances and resources available). Crisis capacity activation
incident that triggers activation of the facility emergency
incident or on a more sustained basis during a disaster (when the constitutes a significant and adjustment to standards of care (Hick et al,
operations plan.
demands of the incident exceed community resources) 2009).

RECOMMENDATIONS Strategy Conventional Contingency Crisis

Inhaled Medications
• 1. Use compressed or room air for administration of nebulized medications when clinically appropriate.
• 2. Restrict the use of Small Volume Nebulizers when inhaler substitutes are available.
Substitute &
• 3. Restrict continuous nebulization therapy.
Conserve
• 4. Minimize frequency through medication substitution that results in fewer treatments (6h-12h instead of 4h-6h applications).
• 5. Change children from albuterol continuous nebulizers to Albuterol 8 puffs MDI Q2 hrs when they are ready to stop continuous
treatments. Only use albuterol nebulizers in continuous form for truly acute status asthmaticus.
High-Flow Applications
Conserve
• 6. Assure all resuscitation oxygen bags have shut off valves and are shut off when not in use.
• 7. Restrict the use of high-flow adult cannula systems as these can demand 12 to 40 LPM flows.
• 8. Restrict the use of simple and partial rebreathing masks to 10 LPM maximum.
Conserve
• 9. Consider intubation or non-invasive ventilation with a well-sealed mask over the use of high flow oxygen delivery systems for both
adult and pediatric patients during critical shortages.
Air-Oxygen Blenders
• 10. Eliminate the low-flow reference bleed occurring with any low-flow metered oxygen blender use. This can amount to an
additional 12 LPM. Reserve air-oxygen blender use for mechanical ventilators using high-flow non-metered outlets. (These do not Conserve
utilize reference bleeds).
• 11. Disconnect blenders when not in use.
Oxygen Conservation Devices
• 12. Use reservoir cannulas if available at 1/2 the flow setting of standard cannulas. Substitute &
• 13. Replace simple and partial rebreather mask use with reservoir cannulas or venti-masks at flow rates of 6-10 LPM Adapt
• 14. Use High Efficiency nebulizers and use air flow instead of oxygen when clinically possible.
Augment Oxygen Supply
• 15. Use hospital-based or independent home medical equipment supplier oxygen concentrators if available to provide low-flow
cannula oxygen for patients and preserve the primary oxygen supply for more critical applications. Substitute &
• 16. Consider other source of oxygen such as dental or veterinary offices.
Conserve
• 17. Obtain oxygen supply from industrial sources, such as supplied by welding companies and underwater diving operations.
• 18. Reduce hospital wide PSI from 50-40.
Arjaty / WPSD 2020
Conserve
Monitor Use and Revise Clinical Targets
• 19. Employ oxygen titration protocols to optimize flow or % to match targets for SPO2 or PaO2.
• 20. Discontinue oxygen at earliest possible time.

Conserve

©2020 Northwest Healthcare Response Network.

15
 9/16/20

PARTICULATE RESPIRATORS & GENERAL PPE (N95, Elastomeric,

PAPR, CAPR)
STRATEGIES FOR SCARCE RESOURCE SITUATIONS

Arjaty / WPSD 2020

PARTICULATE RESPIRATORS & GENERAL PPE

1 AND GENERAL PPE
PARTICULATE RESPIRATORS(N95, Elastomeric, PAPR, CAPR)
(N95, Elastomeric,STRATEGIES
PAPR, CAPR) FOR SCARCE RESOURCE SITUATIONS
STRATEGIES FOR SCARCE RESOURCE SITUATIONS
Contingency Capacity – The spaces, staff, and supplies used Crisis Capacity – Adaptive spaces, staff, and supplies are not
are not consistent with daily practices, but provide care to a
Conventional Capacity – The spaces, staff, and supplies used are consistent with usual standards of care, but provide sufficiency of care in
standard that is functionally equivalent to usual patient care
consistent with daily practices within the institution. These spaces and the setting of a catastrophic disaster (i.e., provide the best possible care
practices. These spaces or practices may be used temporarily during
practices are used during a major mass casualty incident that triggers to patients given the circumstances and resources available). Crisis
a major mass casualty incident or on a more sustained basis during a
activation of the facility emergency operations plan. capacity activation constitutes a significant and adjustment to standards
disaster (when the demands of the incident exceed community
of care (Hick et al, 2009).
resources)

RECOMMENDATIONS Strategy Conventional Contingency Crisis

General Infection Control Procedures
• 1. Screen all patients for symptoms specific to current situation and keep updated to any changing screening recommendations
• 2. At healthcare facilities where patients have scheduled appointments, consider screening prior to arrival to limit exposure and
resources
• 3. Establish procedures for managing visitors and ill healthcare personnel.
• 4. Establish triage procedures and separate areas for ill and well patients.
• 5. Assign dedicated staff to minimize exposure.
• 6. Require, when possible, or strongly encourage vaccination of primary personnel and first responders, according to vaccine
schedule as recommended for existing circumstances by the CDC and the Advisory Committee for Immunization Practices (ACIP).
• 7. Seriously consider creation of a registry to reflect the vaccination status of primary personnel and first responders to aid in
decisions regarding service assignments.
• 8. Educate and routinely train all staff regarding appropriate use and proper donning and doffing procedures of PPE and particulate
respirators.
• 9. Maintain good hand hygiene procedures including gloves, hand washing with soap and water and/or alcohol based hand sanitizers
depending on the current recommendations.
• 10. Maintain plan for N95 Fit Testing

Engineering Controls Prepare

• 11. When applicable to specific institution consider designing and installing engineering controls to reduce or eliminate exposure by
shielding healthcare providers and other patients from infection individuals. Examples of engineering controls include physical
barriers or partitions to guide patients through triage areas, curtains between patients in shared areas, closed suctioning systems for
airway suctioning for intubated patients, as well as appropriate air-handling systems (with appropriate directionality, filtration,
exchange rate, etc.) that are installed and properly maintained. Arjaty / WPSD 2020
Cache/ Increase Supply Levels
• 12. Clarify current CDC and OSHA guidelines for respirator and other PPE use; monitor for updates and recommendations.2
• 13. Cache additional supplies of PPE and respirators and their functional components (e.g. fit testing supplies, batteries, cartridges,
filters, hoods etc.).
• 14. Review vendor agreements, contingencies for delivery and production, including alternate vendors.
• 15. Consider other NIOSH approved respirators in times of short supply (e.g. These include N99, N100, P95, P99, P100, R95, R99, and
R100.)5
• 16. Review current supply of PPE and determine baseline and surge burn rates to better plan supply needs.
• 17. Maintain a reserve sufficient to meet estimated needs of PPE for all infectious diseases.
• 18. Review cached PPE on a regular basis for expirations dates and consider replacing/updating caches by rotating PPE into daily use
16
• 19. Obtain masks, cartridges and other PPE from alternate sources such as industrial suppliers and companies – welding, Substitute
manufacturing, etc. – as indicated.

©2020 Northwest Healthcare Response Network.

 9/16/20

PARTICULATE RESPIRATORS & GENERAL PPE

PARTICULATE RESPIRATORS1(N95, Elastomeric,

AND GENERAL PPE PAPR, CAPR)
(N95, Elastomeric,STRATEGIES
PAPR, CAPR) FOR SCARCE RESOURCE SITUATIONS
STRATEGIES FOR SCARCE RESOURCE SITUATIONS
Contingency Capacity – The spaces, staff, and supplies used Crisis Capacity – Adaptive spaces, staff, and supplies are not
are not consistent with daily practices, but provide care to a
Conventional Capacity – The spaces, staff, and supplies used are consistent with usual standards of care, but provide sufficiency of care in
standard that is functionally equivalent to usual patient care
consistent with daily practices within the institution. These spaces and the setting of a catastrophic disaster (i.e., provide the best possible care
practices. These spaces or practices may be used temporarily during
practices are used during a major mass casualty incident that triggers to patients given the circumstances and resources available). Crisis
a major mass casualty incident or on a more sustained basis during a
activation of the facility emergency operations plan. capacity activation constitutes a significant and adjustment to standards
disaster (when the demands of the incident exceed community
of care (Hick et al, 2009).
resources)

RECOMMENDATIONS Strategy Conventional Contingency Crisis

General Infection Control Procedures
• 1. Screen all patients for symptoms specific to current situation and keep updated to any changing screening recommendations
• 2. At healthcare facilities where patients have scheduled appointments, consider screening prior to arrival to limit exposure and
resources
• 3. Establish procedures for managing visitors and ill healthcare personnel.
• 4. Establish triage procedures and separate areas for ill and well patients.
• 5. Assign dedicated staff to minimize exposure.
• 6. Require, when possible, or strongly encourage vaccination of primary personnel and first responders, according to vaccine
schedule as recommended for existing circumstances by the CDC and the Advisory Committee for Immunization Practices (ACIP).
• 7. Seriously consider creation of a registry to reflect the vaccination status of primary personnel and first responders to aid in
decisions regarding service assignments.
• 8. Educate and routinely train all staff regarding appropriate use and proper donning and doffing procedures of PPE and particulate
respirators.
• 9. Maintain good hand hygiene procedures including gloves, hand washing with soap and water and/or alcohol based hand sanitizers
depending on the current recommendations.
• 10. Maintain plan for N95 Fit Testing

Engineering Controls Prepare

• 11. When applicable to specific institution consider designing and installing engineering controls to reduce or eliminate exposure by
shielding healthcare providers and other patients from infection individuals. Examples of engineering controls include physical
barriers or partitions to guide patients through triage areas, curtains between patients in shared areas, closed suctioning systems for
airway suctioning for intubated patients, as well as appropriate air-handling systems (with appropriate directionality, filtration,
exchange rate, etc.) that are installed and properly maintained.

Cache/ Increase Supply Levels

• 12. Clarify current CDC and OSHA guidelines for respirator and other PPE use; monitor for updates and recommendations.2
• 13. Cache additional supplies of PPE and respirators and their functional components (e.g. fit testing supplies, batteries, cartridges,
filters, hoods etc.).
• 14. Review vendor agreements, contingencies for delivery and production, including alternate vendors.
• 15. Consider other NIOSH approved respirators in times of short supply (e.g. These include N99, N100, P95, P99, P100, R95, R99, and
R100.)5
• 16. Review current supply of PPE and determine baseline and surge burn rates to better plan supply needs.
• 17. Maintain a reserve sufficient to meet estimated needs of PPE for all infectious diseases.
• 18. Review cached PPE on a regular basis for expirations dates and consider replacing/updating caches by rotating PPE into daily use
• 19. Obtain masks, cartridges and other PPE from alternate sources such as industrial suppliers and companies – welding, Substitute
manufacturing, etc. – as indicated.

©2020 Northwest Healthcare Response Network. Arjaty / WPSD 2020

PARTICULATE RESPIRATORS & GENERAL PPE

PARTICULATE RESPIRATORS1 AND GENERAL PPE

(N95, Elastomeric, PAPR, CAPR)
STRATEGIES
(N95, Elastomeric, PAPR, CAPR) FOR
STRATEGIES FOR SCARCE RESOURCE SITUATIONS
SCARCE RESOURCE SITUATIONS
Contingency Capacity – The spaces, staff, and supplies used Crisis Capacity – Adaptive spaces, staff, and supplies are not
are not consistent with daily practices, but provide care to a
Conventional Capacity – The spaces, staff, and supplies used are consistent with usual standards of care, but provide sufficiency of care in
standard that is functionally equivalent to usual patient care
consistent with daily practices within the institution. These spaces and the setting of a catastrophic disaster (i.e., provide the best possible care
practices. These spaces or practices may be used temporarily during
practices are used during a major mass casualty incident that triggers to patients given the circumstances and resources available). Crisis
a major mass casualty incident or on a more sustained basis during a
activation of the facility emergency operations plan. capacity activation constitutes a significant and adjustment to standards
disaster (when the demands of the incident exceed community
of care (Hick et al, 2009).
resources)

RECOMMENDATIONS Strategy Conventional Contingency Crisis

General Infection Control Procedures
• 1. Screen all patients for symptoms specific to current situation and keep updated to any changing screening recommendations
• 2. At healthcare facilities where patients have scheduled appointments, consider screening prior to arrival to limit exposure and
resources
• 3. Establish procedures for managing visitors and ill healthcare personnel.
• 4. Establish triage procedures and separate areas for ill and well patients.
• 5. Assign dedicated staff to minimize exposure.
• 6. Require, when possible, or strongly encourage vaccination of primary personnel and first responders, according to vaccine
schedule as recommended for existing circumstances by the CDC and the Advisory Committee for Immunization Practices (ACIP).
• 7. Seriously consider creation of a registry to reflect the vaccination status of primary personnel and first responders to aid in
decisions regarding service assignments.
• 8. Educate and routinely train all staff regarding appropriate use and proper donning and doffing procedures of PPE and particulate
respirators.
• 9. Maintain good hand hygiene procedures including gloves, hand washing with soap and water and/or alcohol based hand sanitizers
depending on the current recommendations.
• 10. Maintain plan for N95 Fit Testing

Engineering Controls Prepare

• 11. When applicable to specific institution consider designing and installing engineering controls to reduce or eliminate exposure by
shielding healthcare providers and other patients from infection individuals. Examples of engineering controls include physical
barriers or partitions to guide patients through triage areas, curtains between patients in shared areas, closed suctioning systems for
airway suctioning for intubated patients, as well as appropriate air-handling systems (with appropriate directionality, filtration,
exchange rate, etc.) that are installed and properly maintained.

Cache/ Increase Supply Levels

• 12. Clarify current CDC and OSHA guidelines for respirator and other PPE use; monitor for updates and recommendations.2
• 13. Cache additional supplies of PPE and respirators and their functional components (e.g. fit testing supplies, batteries, cartridges,
filters, hoods etc.).
• 14. Review vendor agreements, contingencies for delivery and production, including alternate vendors.
• 15. Consider other NIOSH approved respirators in times of short supply (e.g. These include N99, N100, P95, P99, P100, R95, R99, and
R100.)5
• 16. Review current supply of PPE and determine baseline and surge burn rates to better plan supply needs.
• 17. Maintain a reserve sufficient to meet estimated needs of PPE for all infectious diseases.
• 18. Review cached PPE on a regular basis for expirations dates and consider replacing/updating caches by rotating PPE into daily use
• 19. Obtain masks, cartridges and other PPE from alternate sources such as industrial suppliers and companies – welding, Substitute
manufacturing, etc. – as indicated.

©2020 Northwest Healthcare Response Network.

Arjaty / WPSD 2020

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 9/16/20

STAFFING
STRATEGIES FOR SCARCE RESOURCE SITUATIONS

Arjaty / WPSD 2020

STAFFING
STRATEGIES FOR SCARCE RESOURCE SITUATIONS
STAFFING
STRATEGIES FOR SCARCE RESOURCE SITUATIONS
Contingency Capacity – The spaces, staff, and supplies used Crisis Capacity – Adaptive spaces, staff, and supplies are not
are not consistent with daily practices, but provide care to a
Conventional Capacity – The spaces, staff, and supplies used are consistent with usual standards of care, but provide sufficiency of care in
standard that is functionally equivalent to usual patient care
consistent with daily practices within the institution. These spaces and the setting of a catastrophic disaster (i.e., provide the best possible care
practices. These spaces or practices may be used temporarily during
practices are used during a major mass casualty incident that triggers to patients given the circumstances and resources available). Crisis
a major mass casualty incident or on a more sustained basis during a
activation of the facility emergency operations plan. capacity activation constitutes a significant and adjustment to standards
disaster (when the demands of the incident exceed community
of care (Hick et al, 2009).
resources)
RECOMMENDATIONS Strategy Conventional Contingency Crisis
Staff and Supply Planning
• Assure facility has process and supporting policies for disaster credentialing and privileging - including degree of supervision required,
clinical scope of practice, mentoring and orientation, and verification of credentials.
• Encourage employee personal preparedness planning (ready.gov, redcross.org).
• Cache adequate personal protective equipment (PPE) and support supplies.
• Educate staff on facility disaster response and recommend regularly scheduled HICS training.
• Educate staff on community, regional and state disaster plans and resources. Prepare
• Develop facility plans addressing staff’s family / pets or staff shelter needs (such as daycare and unaccompanied minor needs) as well
as transportation plans for staff to get to and from the facility.
• Include a process of staff identification and verification. Recommend photos and hard-copy files.
• Create Job Cards for essential services and functions.
• Pre-identify critical positions and ensure redundant staffing for these.
• Recommend redundant staff communications and notification plans/procedures.
Focus Staff Time on Core Clinical Duties
• Minimize meetings and relieve administrative responsibilities not related to event. Conserve
• Cohort inpatients per OSHA/Public Health or CDC guidelines.
• Reduce documentation requirements. Adapt
Using Supplemental Staff
• Utilize administrative positions (e.g. nurse managers) as patient care extenders.
• Adjust personnel work schedules (longer but less frequent shifts, etc.) if this will not result in skill / PPE compliance deterioration. Substitute
• Voluntary call-back of staff
• Increase use of agency, per diem, travelers, float pools, locums staff
• Retain staff for extended hours (in accordance with labor contract and existing contracts/agreements when applicable)
Adapt
• Use family members/lay volunteers to provide basic patient hygiene and feeding – releasing staff for other duties.
• Postpone and reschedule out-patient non-acute and preventative care appointments to open more acute care out-patient
appointments during surge.
Focus Staff Expertise on Core Clinical Needs
• Personnel with specific critical skills (ventilator, burn management) should concentrate on those skills; specify job duties that can be
safely performed by other medical professionals.
Conserve
• Reduce availability of non-time sensitive laboratory, radiographic, and other studies.
• Postpone and reschedule elective procedures if it will improve staffing and space needs and does not result in undue patient
inconvenience
• Have specialty staff oversee larger numbers of differently specialized staff and patients (for example, medical/surgery nurses working
Substitute
in critical care are overseen by a critical care nurse).
Conserve
Use Alternative Personnel to Minimize Changes to Standards of Care
• Bring in equally trained staff (burn or critical care nurses, Disaster Medical Assistance Team [DMAT], other health system or Federal
sources). Adapt
• Cancel all non-acute/preventative care appointments, surgeries and procedures (e.g. endoscopies, etc. ) and divert staff to emergency
duties including in-hospital or assisting public health at external clinics/screening/dispensing sites.

©2020 Northwest Healthcare Response Network.

Arjaty / WPSD 2020

18
 9/16/20

KESELAMATAN PASIEN DI MASA PANDEMI COVID 19

Desain sistem kerja untuk Keselamatan pasien (Model SEIPS)

1. Assess the 2. Develop reliable 3. Measure the
work system pathways of care outcomes of care
a. Team and organisational culture and
communication a. Employee :
a. Care processes a. Job satisfaction
b. Environment
b. Professional work b. Employee safety & health
c. Tasks required and skills to complete
c. Collaborative b. Organizational outcome :
tasks Professional work and
d. Equipment for patient care and to a. Profitability
patient work c. Patient outcome :
protect staff
d. Patient work a. Patient safety
e. Person :
• The people needed to provide b. Quality of care
care
• The patients who will receive care

Arjaty / WPSD 2020

KESELAMATAN PASIEN DI MASA PANDEMI COVID 19

Care pathway
RAWAT
INAP
IGD ZONASI AREA

Suspected cases
TRIASE
TRIASE AREA NON PIE
SEKUNDER
SKRINING
PRIMER TRIASE
AREA PIE /COVID 19
SEKUNDER

Ya
Ruang ICU /
ISOLASI
Fasilitas Karantina Sakit Sakit
Ringan Berat
Tidak
Isolation/non-
RS dgn fasilitas
health facilities
pasien COVID?

Klinik
Karantina di rum ah
/Rawat
Jalan Rujuk ke RS dgn
fasilitgas perawatan
COVID
Strategy mitigasi risiko untuk memutus rantai penularan dengan
Identifikasi, Testing, Isolasi, clinical care, tracing, karantina
Arjaty / WPSD 2020

19
 9/16/20

KESELAMATAN PASIEN DI MASA PANDEMI COVID 19

RISIKO PADA PELAYANAN PASIEN

Akses point : Manajemen:
• Plan Disaster Pandemi -> SKI
Skrining, Triage • HVA
• HSI
• Indikator outcome
Asesmen Pasien • Komunikasi
• Bisnis Plan
Pemeriksaan • RBA / RKA
Fasilitas, Sar Pras :
• IT
Penunjang •
•
Zonasi : (MKH)
Ruang Isolasi
• Desain / Barrier
Perawatan pasien / • Lingkungan
Operasi / Tindakan SDM :
• Limbah
• Kuantitas
Transfer internal • Kualitas
• Pelatihan / Training Administrasi
• Drill / Simulasi • PPK
Discharge • CP
• Algoritme
• Checklist
Pemulasaran Supply chain : • SPO
• APD • Form2
jenazah • Obat
• Alat medis
Rujuk

Ambulance Arjaty / WPSD 2020

KESELAMATAN PASIEN DI MASA PANDEMI COVID 19

OUTCOME MEASURE
Monitoring keefektifan respons RS saat pandemi, termasuk kapasitas yang memadai untuk merawat
pasien dengan kondisi umum yang berat mis. serangan jantung, stroke, trauma, COPD dan
memastikan kesehatan masyarakat dilindungi semaksimal mungkin.
Indikator :
1. Hospitalisation rate for COVID-19 (indirect outcome measure of the territory).
2. In-hospital Mortality rate of patients hospitalized for COVID-19.
3. Average Length of Stay of COVID-19 patients.
4. Percentage of COVID-19 patients admitted to ICU.
5. In-hospital mortality rate of NO-COVID-19 patients hospitalised for AMI.
6. In-hospital mortality rate of NO-COVID-19 patients hospitalized for Stroke.
7. In-hospital mortality rate of NO-COVID-19 patients hospitalized for COPD.
8. Percentage of NO-COVID-19 hospitalized patients that acquired COVID during the hospitalisation.
9. COVID-19 infection rate among staff / Number of tests performed to hospital staff (as process
measure)
10.Survival rates

Bila memungkinkan, indikator 1-7 harus dikelompokkan berdasarkan kelompok umur.

Arjaty / WPSD 2020

20
 9/16/20

KESELAMATAN PASIEN DI MASA PANDEMI COVID 19

OUTCOME MEASURE Balancing measures

1.Staff infection rate
2.Staff mortality rate
Length of stay measures 3.Staff well being
1.Length of Stay 4.Illness and sickness rates
2.Average length of stay in ICU of infected 5.Mental illness
3.Average length of stay in hospital
Patient profiles to consider
§ Age
Process Measures (some examples) § Gender
1. Percentage of infected individuals admitted to § Ethnicity
ICU § Comorbidity § Region
2. Percentage of people with comorbidities § Contacts
3. Percentage of staff with and without correct
equipment
4. Number of patients not treated in appropriate
level of care
5. Percentage staff trained to use equipment
Arjaty / WPSD 2020

Manajaemen risiko saat

Pandemi Covid 19

• Keselamatan Pasien (KP)

• Pencegahan & Pengendalian
Infeksi (PPI)
Telemedicine
Cyber risk
• Manajemen Fasilitas &
Operasional Keamanan (MFK)
Technology
• Supply Chain
• Sumber daya

Finansial
Ketersediaan Anggaran
Legal /
Regulatory

Human
Human
Capital
Strategic capital • Kuantitas SDM
Strategic
• Kualitas SDM

• Bussiness Plan
• Master Plan

Arjaty / WPSD 2020

21
 9/16/20

Rapid Hospital Readiness

(RHR Check list)

Arjaty/WPSD 2020 43

Asesmen risiko
Petugas kesehatan yang terpapar Covid 19

• Asesmen ini digunakan di fasilitas pelayanan kesehatan dengan

pasien COVID 19.
• Formulir harus diisi semua petugas kesehatan yang telah
terpapar dengan pasien yang dikonfirmasi COVID-19.
• Asesmen ini membantu memberikan rekomendasi untuk tata
laksana petugas kesehatan yang terpapar Covid 19

Tujuan :
• Untuk menentukan kategorisasi risiko masing2 petugas kesehatan setelah
terpapar dengan pasien COVID-19
(Bagian 1: Formulir Asesmen risiko paparan virus COVID-19
untuk petugas kesehatan);
• Untuk menginformasikan Tata laksana petugas kesehatan yang terpapar
berdasarkan risiko Arjaty / IMRK / COVID 19 / 2020

(Bagian 2: Tata laksana petugas kesehatan yang terpapar virus. COVID-19).

Arjaty / WPSD 2020

22
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Pertanyaan dalam Asesmen risiko

Petugas kesehatan yang terpapar Covid 19
1. Informasi Pewawancara

2. Informasi Petugas Kesehatan

3. Interaksi petugas kesehatan dengan pasien COVID-19

4. Kegiatan petugas kesehatan yang dilakukan pada pasien COVID-19

di fasilitas pelayanan kesehatan

5. Kepatuhan pada prosedur PPI selama interaksi perawatan kesehatan

6. Ketaatan terhadap tindakan PPI saat melakukan prosedur penghasil

aerosol (mis. Intubasi trakea, pengobatan nebuliser, suction terbuka,
pengumpulan dahak, trakeotomi, bronkoskopi, resusitasi
kardiopulmoner (CPR), dll).
Arjaty / IMRK / COVID 19 / 2020

7. Accident dengan bahan biologis

Arjaty / WPSD 2020

Interpretasi
• Jawaban "Ya" untuk pertanyaan : 1 D - 1E dianggap paparan COVID-19 terjadi di
masyarakat . Petugas kesehatan harus dikelola sesuai prosedur Covid 19.
•
• Rekomendasi Tata laksana di Bagian 2: Tata laksana pada petugas kesehatan yan
g terpapar virus COVID-19 hanya berlaku untuk paparan di Fasyankes.

• Jika petugas kesehatan menjawab ‘Ya’ pada Pertanyaan 4A - 4D, petugas kesehat
an harus dianggap terkena virus COVID-19.

• Untuk pertanyaan 5 dan 6 : Kepatuhan pada prosedur PPI selama interaksi perawa
tan kesehatan, sesuai anjuran dan Ketaatan terhadap tindakan PPI saat melakuka
n prosedur penghasil aerosol (mis. Intubasi trakea, pengobatan nebuliser,
penyedotan jalan nafas terbuka, pengumpulan dahak, trakeotomi, bronkoskopi,
CPR, dll)

Pilihan jawaban :
• 'Selalu, sesuai anjuran' > 95%
• 'Sering' : 50% - < 95 %
• 'Kadang -kadang' : 20% - < 50% Arjaty / IMRK / COVID 19 / 2020

• 'Jarang' : < 20%.

Arjaty / WPSD 2020

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BERSAMA KITA BISA

MENGHADAPI COVID 19 MENUJU AKB

H ealth worker
E veryday
R escue
O ur live
Arjaty / WPSD 2020

a letter for
Health Hero
Jakarta, 2 Juli 2020
Dear,
Dokter, Perawat dan Petugas Kesehatan
Di - Fasilitas Pelayanan Kesehatan
Terima Kasih untuk semua pengorbanan, kesabaran dan keihlasan selama
merawat pasien Covid 19, meski dalam kecemasan dan kelelahan yang Engkau
rasakan. Engkau berjuang dan berdiri di garis depan melaksanakan tugas
muliamu ..
Kami bangga padamu ….. Engkaulah Pahlawan sesungguhnya….
Tetaplah tegar melaksanakan tugasmu ……
Doa kami akan selalu bersamamu.
“Semoga Allah SWT selalu memberikan Kesehatan, Kekuatan, dan Lelahmu
menjadi Berkah dalam Pengabdian yang tak berujung….
Ammiinn.. Arjaty

24
 9/16/20

Safe health worker ……

Safe patient…
Safety for All….

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