IDENTIFIKASI

RISIKO
{
RUMAH SAKIT

Ery S Sasmito
 ??
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 DEFINISI RISIKO

RISIKO ADALAH :
POTENSI TERJADINYA KERUGIAN
YANG DAPAT TIMBUL DARI PROSES
KEGIATAN SAAT SEKARANG ATAU
KEJADIAN DIMASA DATANG.

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 WHY ?

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Risiko SELALU MELEKAT dengan
proses pengobatan kepada
pasien itu sendiri

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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.

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 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
8 KORPORASI.
 Patient care-related risks

Medical staff-related risks

Employee-related risks

Property-related risks

Financial risks
KATEGORI RISIKO DI RUMAH
Other risks
SAKIT :
( Categories of Risk )
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 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?
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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 ?

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 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

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 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
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 Risiko keuangan
(Financial risks)

Bad Debt

Meningkatnya suku bunga

Global Financial tsunami

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 Risiko lain
(Other risks)

- Hazardous material management :

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

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 HOW ?

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 MANJEMEN RISIKO

ADALAH PENDEKATAN PROAKTIF

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

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 RISK MANAGEMENT PROCESS

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PROSES MANAJEMEN RISIKO

KOMUNIKASI DAN KONSULTASI TEGAKKAN KONTEKS

IDENTIFIKASI RISIKO

MONITOR DAN REVIEW

ANALISA RISIKO

ASESMEN RISIKO

EVALUASI RISIKO

KELOLA RISIKO
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RISK REGISTER
 Adalah proses mengenal, menemukan
dan mendeskripsikan risiko
Hal pertama yang dilakukan untuk
mengenal risiko adalah dengan
mengidentifikasinya
Jika kita tidak dapat mengenal,
menemukan dan mengetahui risiko
tentunya tidak dapat berbuat apapun
terhadapnya

Identifikasi Risiko
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 Deskripsi

Temu

Kenal

Proses 1
Proses 2
 Proaktif, dengan cara mencari risiko yang akan
muncul dan potensial akan menimbulkan
kerugian bagi rumah sakit.
Metodenya berupa Audit, inspeksi,
brainstorming, pendapat ahli, belajar
pengalaman rs lain, FMEA, SWOT, survey dll

Pendekatan Identifikasi
Risiko
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 Reaktif, kegiatan identifikasi yang dilakukan
setelah terjadi risiko muncul dalam bentuk
manifestasi berupa insiden / gangguan
Metoda yang dipakai mempelajari berdasarkan
Laporan Kejadian

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 Secara terstruktur harus dilakukan di RS
Setiap Unit kerja lakukan Identifikasi Risiko
yang ada di Unit
Kumpulkan Data
Identifikasi Risiko Rumah Sakit

JADI ?
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A . Access
1. Pemulangan Pasien : tertunda/salah/tidak
sesuai/penolakan/APS/tidak sesuai rencana/keputusan
tertunda
2. FAILURE TO FOLLOW-UP, MISSED APPOINTMENT
FAILURE TO REFER
3. TRANSFER - DELAY/FAILURE, TRANSPORT
INAPPROPRIATE, TRANSPORT - DELAY/FAILURE
4. DLL

Identifikasi Risiko
(contoh)
Accident

1. CONTACT WITH ELECTRICITY

2. EXPOSURE TO HARMFUL SUBSTANCE
Exposure to Radiation, to Asbestos
3. MOVING AND HANDLING
1. Patient/Positioning
2. Non-patient
4. STRUCK BY FALLING OBJECT
5. CONTACT WITH HOT / COLD
6. STRUCK BY MOVING VEHICLE
7. SLIP/TRIP/FALL
1. Slip/Trip/Fall on same level
2. Slip/Trip/Fall from Height
C . MASALAH BANGUNAN DAN FASILITAS

1. Kerusakan Dinding / Lantai

2. PIPA AIR atau GAS BOCOR
3. SEWAGE SMELL (bau Pembuangan)
4. PINTU TERKUNCI / TIDAK BERFUNGSI / PINTU RUSAK
5. PERALATAN PECAH
6. BLEEP SYSTEM FAILURE
7. FAILURE OF DEVICE/EQUIPMENT
8. DELAY/FAILURE TO PROVIDE EQUIPMENT TO USER
9. IT/TELECOMMUNICATIONS FAILURE
10. LACK/UNAVAILABILITY OF DEVICE/EQUIPMENT
11. USER ERROR OF DEVICE/EQUIPMENT
12. WRONG DEVICE OR EQUIPMENT USED
13. INADEQUATE CHECK ON EQUIPMENT/SUPPLIES
14. FAILURE/DELAY IN COLLECTION/DELIVERY SYSTEMS
15. DEFECTIVE PRODUCT / SUPPLIES
16. FALLING OBJECT
D . Clinical Assessment and Treatment

1. DELAY/DIFFICULTY IN OBTAINING CLINICAL ASSISTANCE

2. DIAGNOSIS WRONG
3. TREATMENT - DELAY/FAILURE TO MONITOR
1. TREATMENT - FAILURE/INCORRECT
2. DELAY OBTAINING BLEEP HOLDER OR ON-CALL STAFF
3. TREATMENT - DELAY/FAILURE IN RECOGNISING
4. TREATMENT - FAILURE TO DISCONTINUE
4. PATIENT INCORRECTLY IDENTIFIED
1. BLOOD TRANSFUSION REACTION / BLOOD COMPONENT TRANSFUSION ERROR / Incorrect Dispensing /
Delay/Problem Obtaining Blood
5. SCANS/X-RAYS/SPECIMENS WRONG/ Missing / Not Read
6. TEST REQUEST FORM - NONE/INCOMPLETE
1. TEST - FAILURE/DELAY TO UNDERTAKE
2. TEST RESULTS/REPORT INCORRECT/REPORT FAILURE /DELAY TO RECEIVE /REPORT MISSING
MISLABELLED
7. DIETARY ERROR / Food Hazard /Delay
8. DOCTOR'S INDUCED TREATMENT / NOT REFERRED TO SPECIFIC DOCTOR
9. CODE BLUE / SCISSORS LEFT IN DIAPERS
E. Community
1. DOG/RAT/Ant/kecoak/HOUSEHOLD PETS/OTHERS
2. STAFF LOCATION UNKNOWN
3. CAR BREAKDOWN
4. UNHYGIENIC ENVIRONMENT
5. UNSAFE ENVIRONMENT
6. INADEQUATE SUPPORT
7. OTHER
8. DELAY/FAILURE TO PROVIDE SOCIAL CARE
9. DELAY/FAILURE OF CARE AGENCY TO PROVIDE
CARE
Financial Issues

1. WRONG COST ESTIMATION

2. DOUBLE CHARGED
3. TARIFF DIFFER BETWEEN THE BOOK AND IN THE
SYSTEM
4. WRONG INPUT IN CHARGE SLIP
5. TRANSACTION NOT INPUTED
6. OTHER
Fire Issues

1. FIRE (inc. accidental)

1. FIRE ALARM FALSE
2. FIRE ARSON (MALICIOUS)
2. DEFECTIVE FIRE EQUIPMENT
H. Infection Control

1. FAILURE TO DECONTAMINATE EQUIPMENT

1. INFECTION - CROSS/HEALTHCARE ACQUIRED
2. INFECTION WOUND
2. UNSAFE/INAPPROPRIATE CLINICAL ENVIRONMENT
1. UNSAFE/INAPPROPRIATE CLINICAL WASTE ISSUE
3. EXPOSURE TO BODILY FLUIDS
4. NEEDLESTICK INJURY
1. Dirty Needlestick Injury
2. Clean Needlestick Injury
5. FAILURE OF STERILISATION OR CONTAMINATION OF
1. CUT BY SHARP OBJECT - NOT NEEDLESTICK
2. NOTIFIABLE DISEASE
I . Information

1. FAILURE TO OBTAIN CONSENT

2. NO ACCESS TO MEDICAL DOCUMENTATION
3. CONFIDENTIALITY BREACH
4. INCORRECT MENTAL HEALTH ACT RECORDS
1. HEALTHCARE RECORD - DELAY IN OBTAINING
2. HEALTHCARE RECORD MISLABELLED
3. HEALTHCARE RECORD - WRONG DELIVERY
4. REFERRAL - MISSING/INADEQUATE/ILLEGIBLE
5. APPOINTMENT RECORDING ERROR
6. DOCUMENTATION MISFILED
7. HEALTHCARE RECORD - NOT SIGNED/DATED BY STAFF
J. IT Security

1. VIRUS ATTACK
2. ILLEGAL SOFTWARE
3. PASSWORD COMPROMISED
4. LOSS OF DATA
5. LOSS/THEFT OF IT EQUIPMENT
6. E-MAIL CONFIDENTIALITY BREACHED
7. INTERNET MISUSE
8. ANTI VIRUS EXPIRED
K. Maternity

1. UNEXPECTED NEONATAL ADMISSION TO SCBU

2. BIRTH TRAUMA (other)
3. UNDIAGNOSED CONGENITAL ABNORMALITY
L. Medication
1. Prescribing
1. ILLEGIBLE PRESCRIPTION
2. INCORRECT OR INAPPROPRIATE PRESCRIPTION
3. NO SIGNATURE
4. ALLERGY NOT RECORDED
2. Dispensing
1. LABEL ERROR
2. WRONG MEDICINE/STRENGTH
3. WRONG QUANTITY
4. DELAY/PROBLEM OBTAINING MEDICATION
5. EXPIRED / DAMAGED MEDICINE
3. Administration
1. WRONG PATIENT
2. DELAY IN PAEDIATRICIAN ARRIVING WITHIN 15 MINS OF
3. WRONG PATIENT
4. WRONG MEDICINE, Wrong dose, WRONG FORMULATION, WRONG FREQUENCY/RATE/TIME
4. MEDICINE OMITTED
1. EXPIRED MEDICINE
2. ALLERGY RECORDED BUT TREATMENT GIVEN

3. NO RECORD OF ADMINISTRATION
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6. Monitoring and Advice
7. 24ADVERSE DRUG REACTION
8. 25WRONG/OMITTED VERBAL OR WRITTEN ADVICE
9. 26FAILURE TO MONITOR SIDE EFFECTS/THERAPY
10. 27FAILURE PATIENT TO FOLLOW DIRECTIONS
11. 28Medicine Security
12. 29MEDICINES OBTAINED BY THEFT OR DECEPTION
13. 30CONTROLLED DRUG ISSUE
14. 31DELIVERY/TRANSPORT MEDICATION ISSUE
15. 32INCORRECT STORAGE
16. 33MEDICINES MISSING/UNACCOUNTED FOR
17. 34MEDICINES FOUND LOOSE/NOT GIVEN
18. 35MEDICINE KEY ISSUES
19. 36LEFT UNATTENDED
20. 37Other
21. 38
22. 39MAR CHART OR MDS (E.G. DOSSETT) BOX ISSUE
23. 40INCORRECTLY IDENTIFIED
24. 41
25. 42OTHER
 MOrganisation
1ENVIRONMENTAL ISSUE
PATIENT TRANSFERRED OR DISCHARGED WITH
1ENVIRONMENTAL ISSUE
2Flooding
3Oil Pollution
4Effluent Pollution
5Food Issue
6SERVICE FAILURE (Lighting/Power/Heating etc.)
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ON CALL SYSTEMS FAILURE
8OTHER
 NSecurity Issues
1INTRUDER
2THEFT
3Theft of Staff Property
4Theft of Trust Property
5Theft of Patient Property
6Theft from/of Staff Vehicle
7Theft from/of Trust (loan) Vehicle
8ABSCONDER/MISSING PERSON
9VANDALISM
10UNSAFE ENVIRONMENT - (inc PERSONAL SAFETY)
11LOST OR MISPLACED PROPERTY
12BOGUS STAFF MEMBER
13ACCIDENTAL DAMAGE
14FRAUD OR DECEPTION
15FORCED ENTRY
16OTHER
17SECURITY FALSE ALARM
 OService Users Issues
1ALLERGIC REACTION
2DEVELOPED PRESSURE SORES
3Pressure ulcer developed within our care
4Pressure ulcer acquired elsewhere
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6CONCERN OVER A DO NOT RESUSCITATE ORDER
DELAY/FAILURE TO START CARDIO PULMONARY
6CONCERN OVER A DO NOT RESUSCITATE ORDER
7UNEXPECTED OR SUSPICIOUS DEATH
8ISSUE CONCERNING PATIENT DIGNITY
9ALCOHOL AND ILLEGAL DRUGS USED
10TOURNIQUET PROBLEM
11CHAPERONE ISSUES
12PATIENT SELF HARM
13SUICIDE
14SUICIDE ATTEMPTED
15SUDDEN ONSET OF ILLNESS
16INFUSION SITE
17Swollen
18Haematoma
19OTHER
 PStaffing Issues
1INADEQUATE LEVELS
2INADEQUATE SKILLS MIX
3CONCERN OVER COMPETENCE
4INADEQUATE SUPERVISION
5ACTING BEYOND SCOPE OF PRACTICE
6OTHER
Q. Surgical / Theatre Issues
1THEATRE LIST DETAILS INCORRECT

2LATE AMENDMENTS TO LIST

4DIATHERMY BURN
5TOURNIQUET PROBLEM

6OPERATION SITE WRONGLY MARKED

7WRONG OPERATION PERFORMED

8INCORRECT SWAB OR INSTRUMENT COUNT

9DEEP VEIN THROMBOSIS NO PROPHYLAXIS

10UNPLANNED RETURN TO THEATRE

11UNEXPECTED ACUTE ADMISSION

INCOMPLETE PRE-OPERATIVE PREPARATION OF

11UNEXPECTED ACUTE ADMISSION

12INCOMPLETE POST-OPERATIVE PREPARATION OF PATIENT

13CARDIAC ARREST IN OT

14DISCREPANCIES BETWEEN PREOPERATIVE AND POSTOPERATIVE DIAGNOSES

15ADVERSE EVENTS DURING DEEP SEDATION OR ANESTHESIA

16OTHER
 RViolence Issues
1FIREARMS/DANGEROUS WEAPONS
2VERBAL (inc telephone)
3by other
4by patient
5to staff by staff
6PHYSICAL
7by other
8by patient
Communicating Team ???

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