Tatakelola Pelayanan Medis Covid 19

Sharing from Siloam Hospitals

Sabtu, 12 Februari 2022

Wahyuni Dian Purwati

 1
Perkembangan Kasus COVID-19 di Indonesia*

*Tanggal Pembaruan Terakhir Data dari Kementerian Kesehatan: 10 Februari 2022

Sumber data: https://covid19.go.id/peta-risiko
Siloam Patient Dashboard Trends
Last Update: 12/02/2022
Hospitalized COVID Patients Monthly Trend
Total Patients 33,589 4,500 4,481
Last updated 12 Feb 2022
4,000

Total Admitted to SHG

Last updated 12 Feb 2022
285 3,500

3,106 3,068
3,000 2,911

2,500
2,172

2,000 1,868 1,920

1,514
1,500 1,355 1,389 1,412
1,235

1,000
928 994
709 689
524 554 573
475
500
157
60 102
-

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LEARNING FROM THE LAST 2 YEARS

Peningkatan kasus COVID

Tenaga Medis Alat bantu nafas &

Kamar Perawatan Alat Medis dan Obat
Oksigen

Pasokan oksigen kurang,

RS COVID Penuh Tenaga Medis dan Non Keterbatasan alat medis
kelangkaan tabung,
Antrian pasien di ED Medis terpapar covid dan obat anti virus
Kendala teknis vendor
 Tantangan TATA KELOLA COVID-19

TEHNOLOGI YANG MEMPERTAHANKAN

PENANGANAN MEDIS PENGALAMAN DAN
MENDUKUNG BUDAYA KERJA YANG
KESELAMATAN PASIEN
PELAYANAN MEDIS AMAN DAN SEHAT

Accountable dan
dapat di claim
Pengendalian Infeksi
Menerapkan Memahami Mempertahankan

Dasar-Dasar Pencegahan
Pengetahuan Dan Disiplin
Kepemimpinan

Perubahan kebijakan &

protokol
Prinsip Pengendalian Infeksi

1. Agar staf terlibat dalam perubahan, Tujuan yang jelas

mereka perlu memahami logika dan
Penyaringan & Pemantauan alasannya.
2. Pendidikan tentang prinsip-prinsip Perubahan perilaku
Physical Distancing pengendalian infeksi akan membantu membutuhkan waktu
Alat Pelindung Diri staf dalam menilai tingkat risiko yang ada
di lingkungan mereka.
3. Pemantauan kepatuhan secara teratur Pelatihan, pemantauan dan
Kebersihan & Disinfeksi audit
diperlukan untuk mempertahankan
tingkat kesadaran yang tinggi
 15
Covid Related Training
Transfer of Knowledge from The Expert
PENCEGAHAN INFEKSI DI RS : HOSPITAL ZONING
 14
PENCEGAHAN INFEKSI ENCEGAHAN INFEKSI DI RS
Area Transit
• Pengaturan jadwal dinas
• Alat Pelindung Diri sesuai standart
• Pemantauan Kesehatan berkala
• Penyediaan akomodasi
PENCEGAHAN INFEKSI DI RS
Kriteria Staf Kembali Bekerja Pasca Terkonfirmasi Covid-19
 6
Pelayanan Covid

Negative-pressured room
COVID beds

Hub and spoke

Hemodialysis room Operating Theatre

ICU

OPD
MySiloam App
 Respond
Confirm with appropriate care and treatment
SARS-CoV-2 infection

Assess Evaluate
symptoms, risk factors clinical response and recovery
and severity

The COVID-19 CARE pathway is aligned with the eighth version of the WHO
Therapeutics and COVID-19: living guideline published on the 14 January 2022
COVID-19 Clinical Care Pathway (who.int)
Provide early clinical assessment and evaluation to determine if the patient
has symptoms, emergency signs or risk factors that may warrant treatment, clinical referral or
admission to hospital care.
Developing Protocols with Subject Matter Experts

Pulmonologist
Anesthesiologist
Internist
ENT
Clinical Pathologist
Radiologist
Pediatrician
Obstetrician

• Pertemuan rutin dengan DPJP

• Diskusi dan update pedoman
dan protocol
 Pemetaan Fasilitas Oksigen
Oxygen Concentrator PGS / VGL
Description 6m3 Cylinders VIE
/ Generator

Oxygen Gas Gas Liquid Liquid Central O2 Concentrator

Type (Container returned (self produce) (Container returned (fixed container on 80 to 500 or more Liter/min
when empty) when empty) site, refill when
empty)
Source of Externally produced Self produced Externally produced Externally produced
Oxygen
Capacity Small Small – Large Medium From 1,000m3 to
3
(6m /cylinder) (100m3 to 700+ m3 120m3 /cylinder 10,000m3 /tank
/day)
Purity 90-99% 90-95% 99% 99%

Portable O2 Concentrator
5-10 LPM / 19
Monitoring Harian Kebutuhan O2

𝑩𝒖𝒇𝒇𝒆𝒓 𝑺𝒕𝒐𝒄𝒌
O2 Inventory Days = 𝑫𝒂𝒊𝒍𝒚 𝑪𝒐𝒏𝒔𝒖𝒎𝒑𝒕𝒊𝒐𝒏

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 CLEAN AND SAFE HOSPITAL: STAFF & PATIENT SAFETY
Pre Hospital Hospital Area Post Hospital

- Covid Task Force

- Standardized Covid
Protocols (V.20)
Hospital at Home
- Hospital Zoning
Drive Thru
- Upgrade Facilities (negative
Pharmacy Deliveries
pressure, external triage,
etc)
MySiloam – Patient Portal
- Covid Testing
- Digital Laboratorium Results
- Covid Vaccination
- Digital Radiology Results
- Covid related training
- Drug Records
- Appointment System
- Teleconsultation
 TATA KELOLA COVID 19

Pengendalian Ketersediaan
Infeksi alkes dan obat

Keamanan staff Tatalaksana medis

dan pasien sesuai protokol
• Risk factors:
> 60 years, hypertension, diabetes, cardiac disease, chronic lung disease,
cerebrovascular disease, dementia, mental disorders, chronic kidney disease,
immunosuppression (including HIV), obesity, cancer and unvaccinated against
COVID-19.
Risk factors in pregnant or recently pregnant women: advanced maternal age
(>=35 years), obesity, chronic medical conditions, and pregnancy specific
disorders (e.g. gestational diabetes and pre-eclampsia/eclampsia).

• Emergency signs are obstructed or absent breathing, severe

respiratory distress, cyanosis, shock, coma and/or convulsions.
Treatment selection is determined by severity of disease and risk
factors.

• For patients with COVID-19 presenting with mild or ​moderate

COVID-19 (non-severe symptoms) without ​risk factors for severe
disease the treatment care plan includes:​
• Symptom management and supportive care​
• Monitoring (at home, or in the community)​

• For patients with mild or moderate COVID-19​ (non-severe

symptoms) AND risk factors for severe disease​ consider
including in the treatment care plan:​
• Sotrovimab or casirivimab and imdevimab* ​(neutralizing
monoclonal antibodies)
• For patients presenting with severe or critical COVID-19 immediately ​assess
for emergency signs.
• For patients with severe or critical COVID-19, the treatment ​care plan includes:​
• Oxygen therapy AND​
• Corticosteroids AND ​
• Venous thromboembolism prophylaxis AND​
• Interleukin-6 receptor blocker (tocilizumab OR sarilumab) OR baricitinib
• For seronegative patients, consider including casirivimab and
imdevimab* ​(neutralizing monoclonal antibodies)​
• Symptom management and supportive care
• All patients receiving COVID-19 treatment require clinical monitoring and follow up by a
health care professional throughout their illness and recovery, including those who
develop post COVID-19 condition.
• If patients have emergency signs OR SpO2 <90%, seek ​urgent medical assistance. ​
• If patients have SpO2 between 90-94%, worsening symptoms, ​side-effects or
concerns, patient or caregiver should immediately seek advice from a health care
professional.
• It is important that all COVID-19 treatments are prescribed,
completed or stopped under guidance of a health care professional.
• Ensure reporting of any adverse events (AE) through local or national
reporting systems.