PATIENT SAFETY IS A KEY COMPONENT OF

RISK MANAGEMENT

Dr. ADIB A YAHYA, MARS

PRESIDENT
ASIAN HOSPITAL FEDERATION
( AHF )

WORKSHOP KESELAMATAN PASIEN DAN MANAJEMEN RISIKO KLINIS

DI RUMAH SAKIT
1. What?

3. How?

2. Why?

4
What ?

5
 DEFINISI RISIKO

RISIKO ADALAH :

POTENSI TERJADINYA KERUGIAN

YANG DAPAT TIMBUL DARI PROSES
KEGIATAN SAAT SEKARANG ATAU
KEJADIAN DIMASA DATANG.

ERM, Risk Management Handbook for Health Care Organization 6

 Risiko di Rumah Sakit
RISIKO KLINIS :
SEMUA ISU YANG DAPAT BERDAMPAK
TERHADAP PENCAPAIAN PELAYANAN PASIEN
YANG BERMUTU TINGGI,AMAN DAN EFEKTIF.

RISIKO NONKLINIS/ Corporate Risk :

SEMUA ISSU YANG DAPAT BERDAMPAK
TERHADAP TERCAPAINYA TUGAS POKOK
DAN KEWAJIBAN HUKUM DARI RUMAH SAKIT
SEBAGAI KORPORASI.
7
KATEGORI RISIKO DI RUMAH SAKIT :
( Categories of Risk )

Patient care-related risks

Medical staff-related risks
Employee-related risks
Property-related risks
Financial risks
Other risks

8
Risiko yang berhubungan dengan perawatan pasien
(Patient care related risks)

Direct association with patient care

Consequences of inappropriate or incorrectly performed
medical treatments
Confidentiality and appropriate release of information
Protection from abuse, neglect and assault
Was patient informed of risks?
Nondiscriminatory treatment
Appropriate triage and transfer of patients from ER
Patient participation in research studies and use of experimental
drugs - was consent obtained?
Was patient discharged appropriately?

9
Risiko yang berhubungan dengan tenaga medis
(Medical staff - related risks)

- Credential terhadap staf medis ?

- Tindakan medis sesuai kompetensi dan prosedur baku ?

- Was patient properly managed ?

- Do we have adequately trained staff ?

10
 Risiko yang berhubungan dengan karyawan
(Employee related risks)

- Risiko keselamatan dan kecelakaan kerja

- Maintaining a safe environment - Employee Health Policy :
. reducing risk of occupational illness and injury
. providing for the treatment and compensation of
workers for work-related illnesses or injuries

11
Risiko yang berhubungan dengan property
(Property related risks)

Protect assets from losses due to fires, floods, etc

Paper and/or electronic records - patient, business
and financial - protected from damage or
destruction
Procedures for handling cash and safeguarding
valuables
Bonding and insurance to protect facility from
losses

12
 Risiko keuangan
(Financial risks)

Bad Debt

Meningkatnya suku bunga

Global Financial tsunami

13
 Risiko lain
(Other risks)

- Hazardous material management :

chemical, radioactive, infectious biological
waste management
- Legal & regulatory risks

14
WHY ?

15
 HOSPITAL

System made up of thousands of

inter-linked processes..

things can go wrong

16
Errors are inevitable

.but most are preventable

17
HOW ?

18
 DIDALAM SISTEM KITA YANG SANGAT KOMPEKS INI ..
BAGAIMANA KITA AKAN MENDARAT DENGAN SELAMAT ?
BAHAYA / HAZARD / RISIKO YANG MANA
YANG HARUS KITA TANGANI TERLEBIH DAHULU ?

19
 MANJEMEN RISIKO

. . . ADALAH PENDEKATAN PROAKTIF

UNTUK MENGIDENTIFIKASI,MENILAI
DAN MENYUSUN PRIORITAS RISIKO,
DENGAN TUJUAN UNTUK
MENGHILANGKAN ATAU
MEMINIMALKAN DAMPAKNYA.

20
RISK MANAGEMENT PROCESS

21
 PROSES MANAJEMEN RISIKO

KOMUNIKASI DAN KONSULTASI TEGAKKAN KONTEKS

IDENTIFIKASI RISIKO

MONITOR DAN REVIEW

ANALISA RISIKO

ASESMEN RISIKO

EVALUASI RISIKO

KELOLA RISIKO

RISK REGISTER

22
RISK MANAGEMENT TECHNIQUES/TREATMENTS

RISK CONTROL :

- EXPOSURE AVOIDANCE
- LOSS PREVENTION
- LOSS REDUCTION
- SEGREGATION (SEPARATION OR DUPLICATION)
- CONTRACTUAL TRANSFER FOR RISK CONTROL

RISK FINANCING :

- RISK RETENTION
- RISK TRANSFER
23
 IMPLEMENTASI
MANAJEMEN RISIKO KLINIK
DI RUMAH SAKIT

24
PRIMUM, NON NOCERE
FIRST, DO NO HARM

HIPPOCRATESS TENET
(460-335 BC)
Risiko SELALU MELEKAT dengan
proses pengobatan kepada
pasien itu sendiri

26
 RISIKO MENYATU DENGAN SEMUA ASPEK
PELAYANAN KESEHATAN,TERMASUK :

pengobatan dan perawatan kepada pasien;

menentukan prioritas pelayanan ;
pengembangan proyek dan pelayanan ;
pembelian obat dan produk kesehatan lain;
instruksi dan follow up kepada pasien.

27
CRITICAL POINTS IN CLINICAL RISK MANAGEMENT

PROVIDING CARE IN THE EMERGENCY ROOM

MAKING A DIAGNOSIS
ORDERING INVESTIGATIONS AND INTERPRETING
THE RESULTS
UNDERTAKING INVASIVE PROCEDURES
DRUG TREATMENT
WARD MANAGEMENT

28
 RISK MANAGEMENT IN ER
POTENTIAL ERRORS
Assessment of emergencies
by insufficiently experienced
junior staff
Inadequate use of specialist
opinion
Inadequate reading of simple
radiographs
Poor management of standard
situation
Inadequate assessment before
discharge
REDUCING/MINIMISING RISKS
Experienced clinicians available
full-time
Involvement of specialist in the
training of staff
Training of staff
on call radiologist
Use protocols with sensitivity
Senior staff to take responsibility
for discharges
29
 REDUCING DIAGNOSTIC ERROR

POTENTIAL ERRORS REDUCING/MINIMISING RISKS

Failure to take a well-focused

Concentrate on key elements
case history
Better training

Failure to assess the Write down conclusions before

evidence & make a DD making a plan

Inappropriate use of tests

Define spesific quuestios to be
answered by chosen tests

Leaving the problem

unexplained Get a second opinion
30
 REDUCING THE RISKS OF INVESTIGATION

POTENTIAL ERRORS REDUCING/MINIMISING RISKS

Clinician misreads visual Fully trained staff to interpret and

evidence e.g. x ray; ECG report on tests

Clinician not aware of lab results Clinically important results to be

relayed to clinician urgently
Clinician not aware of ward Ward tests to be supervised and
observation results discussed with clinicians

Clinician fails to understand test Aware of the limits of their

result competence
Senior staff to check repeatedly

Inappropriate use of tests Careful supervision

31
Reducing the risks of invasive procedures

Consider The risk : benefit ratio

Discuss the procedure with the patient
Carrying out the procedure including coping with
potential difficulties
Ensure that the equipment is in good working order
and that back up equipment is available
If the procedure is not going well obtain help / be
prepared to give up
Ensure that the operator has sufficient skill

32
Reducing the risks of invasive procedures

Consider The risk : benefit ratio

Discuss the procedure with the patient
Carrying out the procedure including coping with
potential difficulties
Ensure that the equipment is in good working order
and that back up equipment is available
If the procedure is not going well obtain help / be
prepared to give up
Ensure that the operator has sufficient skill

33
COMMON SPECIFIC FACTORS ASSOCIATED WITH
DRUG ADVERSE EVENTS

FAILURE TO TAKE ACCOUNT OF DECLINING

RENAL / HEPATIC FUNCTION

FAILURE TO CHECK FOR POSSIBLE ALLERGIC

RESPONSES

USING THE WRONG DRUG NAME OR MEANS OF

ADMINISTRATION

MISCALCULATION OF DOSAGE

34
 REDUCING THE RISKS OF ONGOING WARD CARE

POTENTIAL ERRORS REDUCING.MINIMISING RISKS

Failure to monitor clinical Joint education regarding

progress appropriate monitoring

Failure to recognise that a Regular supervision

patient is not making
satisfactory progress

Failure to provide appropriate Use spesialist staff clinician

treatment from appropriate unit, nurse
spesialist, physiotherapist

Shift working Briefing & de-briefing

SBAR

35
PATIENT SAFETY,QUALITY OF CARE

AND RISK MANAGEMENT

36
 The basic principles for safety
and quality of care
The basic principles for patient safety are
the principles for quality of care:
- to do the right thing
for the right patient
using the right method and
at the right time, and

- to communicate well with the patient

and the rest of the clinical team
37
 PRINSIP DASAR UNTUK ASUHAN YANG
AMAN DAN BERMUTU

Prinsip prinsip dasar untuk keselamatan pasien adalah

prinsip prinsip asuhan yang bermutu dengan
pengelolaan risiko secara benar melalui langkah langkah
:
- melaksanakan tindakan yang benar
pada pasien yang benar
menggunakan cara yang benar, dan
dalam waktu yang benar, serta

- berkomunikasi dengan baik dengan

pasien/keluarganya dan dengan anggota tim .

38
 Its easy gettin good players.
The hard part is gettin them to play
with each other

(Casey Stengel)

(Casey

39
Communicating Team ???

40
 MUTU DALAM PELAYANAN KESEHATAN

. dimulai dengan menjamin keselamatan

pasien

41
 Quality in Healthcare

. begins with ensuring patient safety

42
 alasan

Pasien yang paling berisiko mengalami

kerugian
Batas error untuk tindakan medis sangat
kecil
Ilmu kedokteran penuh dengan ketidak
pastian

43
 Key reasons

Patients are more at risk than non-patients

Medical interventions are, by their nature,
high-risk procedures - small error margins
Medicine remains an inexact, hands-on
endeavour

44
 Patient safety in context

Patient safety is an important component of

risk management, clinical governance, and
quality improvement.

45
 Konteks keselamatan pasien

Keselamatan pasien merupakan komponen

penting dari
manajemen risiko, tata kelola klinis dan
peningkatan mutu.

46
47
 kesimpulan
I. Manajemen risiko bukan hanya tentang menghindari
tuntutan pasien, tetapi merupan alat untuk
meningkatkan mutu pelayanan
II. Manajemen risiko harus dilakukan dengan cara
proaktif.
III. Manajemen risiko menjadi
urusan semua pemangku kepentingan
dalam rumah sakit baik klinisi dan nonklinisi

IV. Fokus utama manajemen risiko adalah

keselamatan pasien.

48
 CONCLUSIONS
I. Risk management is not primarily about avoiding or
mitigating claims; rather, it is a tool for
improving the quality of care.
II. Incident reporting is only one aspect of the identification of
risk. Incident reporting is on the reactive side of risk
management. More emphasis needs to be placed on
the proactive side.
III. Risk management is actually
the business of all stakeholders in the
organisation, clinicians and nonclinicians.

IV. The primary focus of risk management should now be

clinical governance and patient safety. 49
 FINAL WORD

Safe care is not an option.

It is the right of every patient
who entrusts their care to our Healthcare systems
Sir Liam Donaldson,
Chair, WHO World Alliance for Patient Safety,
Forward Programme, 20062007
50
PENGALAMAN JABATAN
Komandan Detasemen Kesehatan Pasukan Pengamanan Presiden (DanDenkes
Paspampres), 1987-1991
Kepala Rumah Sakit Muhammad Ridwan Meuraksa, Jakarta, 1992
Kepala Kesehatan Daerah Militer (Kakesdam) Jaya, Jakarta, 1993
Komandan Pusat Pendidikan Kesehatan TNI AD,1995 1999
Wakil Kepala Pusat Kesehatan TNI, 1999 2000
Kepala RSPAD Gatot Soebroto, 2000 2002
Dekan Fakultas Kedokteran UPN, Jakarta, 2000 2002
Wakil Ketua Tim Dokter Kepresidenan RI, 2000 2002
Direktur Kesehatan TNI Angkatan Darat (Dirkesad), 2002-2004
Wakil Ketua Tim Pemeriksaan kesehatan untuk calon Presiden dan calon Wakil
Presiden RI Th.2004
DOSEN Pasca Sarjana FKM UI, Kajian Administrasi Rumah Sakit (KARS)
DIREKTUR UTAMA RUMAH SAKIT MMC

ORGANISASI
Ketua Ikatan Rumah Sakit Jakarta Metropolitan (IRSJAM), 2000-2003
Ketua Umum Perhimpunan Rumah Sakit Seluruh Indonesia ( PERSI), 2003-2009
Anggota Komnas FBPI.
Ketua Komtap Bidang Kebijakan Kesehatan KADIN Indonesia
Angggota TNP2K.
Ketua Divisi Kemahkamahan Majelis Kehormatan Etik Kedokteran (MKEK) IDI Pusat
Tim Konsultan Institut Manajemen Risiko Klinis ( IMRK )
Koordinator Bidang 1 : KAJIAN KESELAMATAN PASIEN, KKPRS
Instruktur HOPE ( Hospital Preparedness for Emergencies and Disasters} 51
PRESIDENT OF ASIAN HOSPITAL FEDERATION ( AHF ) 2009 2011
 KESELAMATAN PASIEN
SEBAGAI KOMPONEN INTI
DARI MANAJEMEN RISIKO

Dr. ADIB A YAHYA, MARS

DIREKTUR UTAMA RS MMC

Workshop Nasional
Keselamatan Pasien dan Pencegahan Pengendalian Infeksi
Jakarta, 7 Juni 2012
 IMPLEMENTASI
MANAJEMEN RISIKO KLINIK
DI RUMAH SAKIT

53
PRIMUM, NON NOCERE
FIRST, DO NO HARM

HIPPOCRATESS TENET
(460-335 BC)
Risiko SELALU MELEKAT dengan
proses pengobatan kepada
pasien itu sendiri

55
 RISIKO MENYATU DENGAN SEMUA ASPEK
PELAYANAN KESEHATAN,TERMASUK :

pengobatan dan perawatan kepada pasien;

menentukan prioritas pelayanan ;
pengembangan proyek dan pelayanan ;
pembelian obat dan produk kesehatan lain;
instruksi dan follow up kepada pasien.

56
 TITIK TITIK KRITIS
DALAM MANAJEMEN RISIKO KLINIS DI RUMAH SAKIT

ASUHAN PASIEN DI INSTALASI GAWAT DARURAT

PENEGAKAN DIAGNOSA
PEMILIHAN PEMERIKSAAN DAN INTERPRETASI
HASIL
PROSEDUR INVASIV
PEMBERIAN OBAT OBATAN
MANAJEMEN RUANG PERAWATAN

57
 RISIKO DI IGD

POTENSI ERROR MENGURANGI RISIKO

ASESMEN PASIEN GADAR DR YG KOMPETEN TERSEDIA

OLEH DR YUNIOR SETIAP SAAT
PEMANFAATAN RUJUKAN
SPESIALIS YG KURANG PELIBATAN SPESIALIS DALAM
MEMADAI PELATIHAN
PEMBACAAN HASIL RO PELATIHAN
YANG KURANG MEMADAI Radiologist on call

MANAJEMEN YG JELEK PENGGUNAAN SPO SECARA

PADA SITUASI GADAR TEPAT
ASESMEN YG KURANG
MAMADAI PADA SAAT
PASIEN PULANG TANGGUNG JAWAB DR
SENIOR
58
 MENGURANGI EROR PADA DIAGNOSTIK

POTENSI ERROR MENGURANGI RISIKO

KONSENTRASI PADA ELEMEN2

ANAMNESA KURANG TAJAM KUNCI
PELATIHAN

GAGAL MENEGAKKAN DD TULISKAN KESIMPULAN SEBELUM

MEMBUAT PERENCANAAN

PENGGUNAAN TES YANG KURANG

TEPAT GUNAKAN PERTANYAAN SPESIFIK
TES 2 TERTENTUUNTUK

MEMBIARKAN PERMASALAHAN
TANPA PENJELASAN second opinion
59
 RISIKO DI RUANG RAWAT

POTENSI ERROR MENGURANGI RISIKO

KEGAGALAN MEMANTAU PENDIDIKAN TERPADU

KEMAJUAN KLINIS

GAGAL MENDETEKSI BAHWA

PASIEN TIDAK MENUNJUKKAN SUPERVISI TERATUR
KEMAJUAN

Briefing & de-briefing

PERGANTIAN JAGA
SBAR

60
 FINAL WORD

Safe care is not an option.

It is the right of every patient
who entrusts their care to our Healthcare systems
Sir Liam Donaldson,
Chair, WHO World Alliance for Patient Safety,
Forward Programme, 20062007
61
TERIMAKASIH 62