3/30/2019

POIN MFK
MENEJEMEN FASILITAS KESELAMATAN

Pelayanan

MFK 2
RENCANA KERJA
1. Keselamatan dan keamanan
sejauh mana banguna ,area,peralatan rumah sakit
tidak menimbulkan bahaya bagi px, staf,pengunjung
2. Penangan B3
Penangan, penyimpanan limbah, pengunaan bahan
radio aktif
3. Disaster
respon pada wabah, bencana

4. Proteksi kebakaran
Properti dan penghuni dilindungidari bahaya
kebakaran dan asap
5. Peralatan medis
pemilihan, pemiliharaan, penggunaan tehnology
dengan cara yang aman untuk mengurangi resiko
6. Sistem penunjang
Pemeliharaan sistem listrik, air dan sistem
penunjang lain nya dengan tujuan mengurangi
resiko kegagalan operasional

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MFK 3
ORANG YANG BERTANGGUN JAWAB  Merencanakan Program
1. Tetapkan petugas, buatkan tugas, tanggung  Melaksanakan Program
jawab dan wewenang pengawasan ,  Mendidik Staf
pengendalian  Monitoring
2. Kualifikasi jabatan (Bukti kinerja)  Evaluasi dan Revisi Program
3. Pengawasan ( buat program pengawasan )  Laporan Kepada Pimpinan
 Pengorganisasian dan Pengelolaan
Berkesinambungan

MFK 4
KESELAMATAAN DAN KEAMANAN
 Identifikasi Staf – Vendor – Pengunjung – Penyewa
 Kartu pengunjung
1. Panduan Keselamtan dan Keamanan Rs  Cheklist Pemasangan CCTV
 Program Pencegahan Cidera
2. Program Kerja Keselamatan Kerja dan
 Pelaporan Insiden
Keamanan
 Program Kerja
 Penyewa Harus Mematuhi Program di Atas

MFK 5
BAHAN BERBAHAYA B3
3. Buat Laporan Pemeriksaan Faselitas Fisi 1. Program pengelolaan B3
4. Tindak Lanjud • Iventarisasi
5. Laporan KTD • Penanganan
6. Anggaran Masing - Masing Unit • Penyimpanan
7. Perencanaan Pegantia Sistem • Penggunaan Bahan Berbahaya
• Pengendalian dan pembuangan B3
• Daftar Jenis, Jumlah, Tempat Penyimpanan B3
• Penanggung Jawab

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2. Panduan Tata Kelola B3
• Ketentuan Penanganan B3
• Ketentuan Pembuangan B3
• MSDS ( Material Safety Data Sheet)
Lembar Data Keamanan Bahan
• APD
• UU Menyangkut B3
• Izin IPAL (Izin Pembungan Air Limbah)
• Ketentuan Pemasangan Lebel
3. sosialissasi Program K3 Kepada Vendor
MFK 7
PROTEKSI KEBAKARAN (FIRE SAFETY)
1. Program Bahaya Kebakaran
2. Panduan Bahaya Kebakaran
3. Simulasi Kebakaran
4. Program Penanggulangan Kebakaran
5. SK Larangan Merokok
6. SK Untuk Semua Orang
7. Poster Di Tempat Strategis
3/30/2019
MFK 6
RENCANA BENCANA
1. Bentuk Tim Tanggan Darurat (SK)
2. Program Tim Tangap Darurat
3. Panduan Tim Tanggap Darurat
4. Uraian Tugas Tim Tanggap Darurat
5. SOP => Code Kecuali Code Red
6. Simulasi 1 Tahun Sekali (Briefing)
• Labeling di area rawan kebakaran
• Mengidentifikasi masalah resiko pada renovasi
• Pemetaan peralatan diteksi dini
• Jalur evakuasi, titik kumpul, rambu-rambu
• Laporan inspeksi peralatan
• Uji coba evakuasi pasien
• Dokumentasi pemeliharaan dan uji coba peralatan
MFK 8
PELARATAN MEDIS
1. PROGRAM PERENCANANA MEDIS
2. Panduan pengelolaan peralatan medis
• Daftar iventaris peralatan medis –
jumlah,loksai,kondisi,tahun pembelian
• Uji coba alat baru
• SOP pemelihraan
• Dokumentasi pelaksaan => rencana
pembelian/peganntian
• Tata cara penarikan alat medis
• Laporan penarikan alat medis
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MFK 9 MFK 10
MONITORING PROGRAM MANAJEMEN
SISTEM PENUNJANG FASILITAS DAN KESELAMATAN
1. PANDUAN TATA KELOLA (24 JAM) 1. Panduan pengawasan dan pengendalian
o Pemeriksaan berkala ( bukti)
2. SOP
o Uji coba (bukti )
3. Pemetaan area peoritas o Pemeliharaan ( bukti ) => tindak lanjud peningkatan
4. Ketentuan rencana cadangan 2. Cek air mutu , Air rumah sakit
5. Ujii coba kegagalan 3. Cek air RO ( dokumen)
6. dokumentsi 4. Monitoring di atas di kumpulkan
5. Buat perencanaan dan peningktan

MFK 11
PENDIDIKAN STAF
IN HAUSE TRANING
semua staf harus bisa demo apar
semua staf tau prosedur code-code
semua staf tau bahan berbahaya
Semua staf terlatih menggunakan alkes masing2 unit
Ada buktipengetesan

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CODE BLUE TEAM

 Pasien yang memerlukan tindakan
CODE BLUE resusitasi
 Serangan jantung
PROCEDURES  Gangguan pernafasan
 Pasien tidak sadar

 Train providers:
 Doctor
 Nurse
 Support Personnel

CODE BLUE ACTIVATION Sistem respon terbagi dalam 2

 Semua orang harus di didik bagaimana cara tahap, yaitu:
mengh aktifkan code blue dan kapan code  Respon awal (responder pertama) berasal
blue di aktifkan ? dari petugas rumah sakit baik medis
 Cardiac arrest
ataupun non medis yang berada di sekitar
 Respiratory arrest
korban (perawat primer/penolong
 Pasien tidak sadar
pertama)
 Activate Code Blue Response by
 CallingHospital Emergency Operator  Respon kedua (responder kedua) berasal
 Provide Information: Patient location, Adult/Pediatric dari tim code blue.
 Tekan tombol code blue yang ada di ruangan (king,
admisi/pendafataran, poli, multazam, gizi, ibnu sina)

CODE BLUE MEMBERS ROLE OF THE TEAM MEMBERS

 Physician: Emergency Department
EMERGENCY PHYSICIAN
 Team Leader: direct overall patient care
 Physician: Internal Medicine
 Manage the Code
 Physician: general Surgery
 Medication
 General Physician  Defibrillation

 Intensive Care Unit/Emergency Nurse  Other procedures: Intubation, compressions

 EKG (Electrocardiogram) Technician  Evaluate Code Blue procedures

 Effectiveness of
Chest Compression
 Nursing Supervisor
 Effectiveness of
assisted respirations
 Rhythm/pulse check

 Document in the medical record

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ROLE OF THE TEAM MEMBERS ROLE OF THE TEAM MEMBERS

EMERGENCY NURSE
 Maintains airway/oxygenation/ventilation
 Applies monitor leads/defibrillator pads
 Starts Intravenous access
 Administer medications
 Administers Electrical Shock (ACLS trained)
 Assist with intubation procedures
 Completes CPR record
PRIMARY NURSE
 Activate code blue team
 Bring Emergency Resuscitation
 Place backboard under patient
 Initiate 2 man Cardio Pulmonary Resuscitation
 Administer ventilations with 100% O2 with Bag/valve/mask
 Attach Electro cardiogram leads
 Attach “hands off” defibrillator pads
 Ensure patient Intra Venous access
 Prepare suction
 Obtain supplies from CPR Cart/Ward Stock
 Record events on CPR record

CODE BLUE ROLE OF THE TEAM MEMBERS

NURSING SKILLS SUPPORT PERSONNEL
 Identify respiratory/cardiac arrest
 Respiratory Therapist
 Activate Code Blue
 Maintains airway and oxygenation/ventilation
 Oxygen administration: Nasal cannula, mask  Assist with intubation procedures
 Bag-Valve-Mask resuscitation with 100% O2
 EKG Technician: Performs 12-lead EKG
 Cardiac Monitor/defibrillator pads Application
 Pharmacist: Prepares medications
 Intra Venous access
 Medication Administration
 Defibrillation (ACLS trained)
 CPR documentation

Simplified adult BLS algorithm.

BASIC LIFE SUPPORT

SURVEY
1- Establish Unresponsiveness
2- Activate Emergency Response System
3- Circulation
4- Defibrillation

Berg R A et al. Circulation 2010;122:S685-S705

Copyright © American Heart Association

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ESTABLISH ACTIVATE THE EMERGENCY

UNRESPONSIVENESS RESPONSE SYSTEM
 Tap and Shout “are you all right”  Call for help or send someone for help
 Yell for help
 Check for absent/abnormal breathing
 Code Blue protocol
by scanning the chest for movement
 Get the Automatic External Defibrillator

CIRCULATION DEFIBRILLATION
 Check corotid pulse for 5-10 seconds
 If no pulse Begin Cardio Pulmonary Resuscitation
 Compress center of chest (lower ½ of sternum)  Ifno pulse check for shockable
 Ratio: 30:2 compressions to breaths
 Depth: at least 2 inches (4-6 cm)
rhythm as soon as AED arrives
 Rate: at least 100/120 compressions per minute  Provide shocks as indicated
 Allow complete chest recoil
 Minimize interruptions  Follow each shock immediately with
 Switch providers every 2 minutes CPR compressions
 Avoid excessive ventilation
 If pulse present start rescue breathing
 1breath every 5-6 seconds (10-12 breaths per min.)
 Check pulse every 2 minutes

Advance Cardiac AIRWAY

Life Support Survey  Maintain patent airway in unconscious Pt’s
 Head tilt chin lift
 Simple airway adjuncts:
 Airway  Use advance airway if needed:
 Confirm proper placement
 Breathing  Physical exam
 Circulation  Quantitative waveform Capnography

 Secure Device to prevent dislodgement

 Differential Diagnosis  Monitor airway placement with continuous
quantitative waveform Capnography

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BREATHING CIRCULATION
 Supplemental O2 when indicated
 Titrate
O2 to oxygen sat ≥ 94% non arrest Pt’s  Monitor CPR quality
 100% O2 for Pt’s in cardiac arrest  Attach monitor/Defibrillator
 Monitor adequacy of ventilation and  Monitor for arrhythmias or arrest rhythms
oxygenation  Provide defibrillation/Cardioversion
 Clinical
criteria: chest rise and cyanosis
 Obtain IV/IO access
 Quantitativewaveform capnography
 Give appropriate drugs
 Oxygen saturation
 Give fluids if needed
 Avoid excessive ventilation

DIFFERENTIAL DIAGNOSIS ACLS

search for and treat reversible causes Cardiac
Arrest
H’s AND T’s Algorithm .
 Hypoxia  Tension pneumothorax
 Hypovolemia  Tamponade cardiac
 Hydrogen ion (acidosis)  Toxins
 Hypo/hyper kalemia  Thrombosis Pulmonary
 Hypothermia  Thrombosis Coronary

Copyright © American Heart Association

ACLS Cardiac Arrest Circular Algorithm. Bradycardia Algorithm.

Neumar R W et al. Circulation 2010;122:S729-S767 Neumar R W et al. Circulation 2010;122:S729-S767

Copyright © American Heart Association Copyright © American Heart Association

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Tachycardia Algorithm.
Neumar R W et al. Circulation 2010;122:S729-S767
Copyright © American Heart Association
3/30/2019
NSR with Ectopy > VT>VF>NSR
• A 48 year old iron worker is brought to the
Emergency Department by co-workers following an
onset of sudden sever “pressure-type” chest pain
radiating to his neck, jaw and left arm.
• He is pale slightly diaphoretic, and very anxious.
Wide-complex tachycardia >VF>NSR
• A 63-Year-old woman alcoholic with a history of
CHF is brought to the hospital by her daughters
becouse of worsening symptoms of dyspnea, cough
and wheezing.
• She looks moderately ill but denies chest pain.