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CURRICULUM VITAE

DATA PRIBADI
Nama : dr.ADIB ABDULLAH YAHYA,MARS
Pangkat : Brigjen TNI (Purn)
Tempat/tanggal lahir : Magelang,16 Februari 1949
Jabatan : DIREKTUR UTAMA RUMAH SAKIT MMC
Agama : Islam
ALAMAT : Jl. Punai H-24,Kel.Tengah,Jakarta Timur - 13540
Telp : (021)8404580
Fax : (021) 8408047
HP : 08161803497
E-MAIL : adibabdullahyahya@yahoo.com

PENDIDIKAN UMUM
SMA Negeri Magelang 1966
S1 : Fakultas Kedokteran Universitas Gajah Mada (UGM),
Yogyakarta, 1973
S2 : Fakultas Kesehatan Masyarakat, Universitas Indonesia (UI), Jakarta,
Program Kajian Administrasi Rumah Sakit ( KARS )

PENDIDIKAN MILITER
Sekolah Staf dan Komando TNI Angkatan Darat (SESKOAD), 1987/1988

PELATIHAN
Combined Humanitarian Assistance Response Training, oleh Singapore Armed Forces (SAF), Singapura, 2000
Health as a Bridge for Peace Workshop, oleh World Health Organization (WHO), Yogyakarta, 2000

1
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} 2
PRESIDENT OF ASIAN HOSPITAL FEDERATION ( AHF ) 2009 - 2011
PERMASALAHAN PATIENT SAFETY
DI KAMAR BEDAH

dr. ADIB A YAHYA, MARS


DIREKTUR UTAMA RS MMC
PELATIHAN BEDAH DASAR BAGI PERAWAT BEDAH
PENCAPAIAN KOMPETENSI BAGI PERAWAT BEDAH
PD HIPKABI DKI, JAKARTA 18 OKTOBER 2012
PEMBAHASAN

STATE-OF-THE-ART PATIENT SAFETY


NURSES ROLE IN PATIENT SAFETY
PATIENT SAFETY DI KAMAR BEDAH
STATE-OF-THE-ART
PATIENT SAFETY
To Err is Human:
Building a Safer Health System
(1999/2000)

IOM Study of Medical Errors


1984 New York -2.9% of admissions suffered an adverse event, 58% of


which were preventable

1992 Colorado and Utah - 3.7% of admissions suffered an adverse event,


53% of which were avoidable

Over 33.6Mn US hospital admissions pa between 44,000 and 98,000


avoidable deaths occur
8th most frequent cause of death
ahead of AIDS (16,516 deaths pa),
breast cancer (42,297 deaths pa) and
motor car accidents (43,458 deaths pa)

Total cost to the US economy of avoidable deaths due to


healthcare error $17 - $29 Bn pa

HRRI.Healthcare Risk Resources International


Sejak 2006 : Workshop
Keselamatan Pasien & UU.N0.44 TH.2009
Manajemen Risiko Tentang Rumah
Klinis, telah diikuti Sakit :
hampir 1900 Staf RS Keselamatan Pasien
To Err is Human: (Dr, Perawat, dll) dari + wajib dilaksanakan
Building a Safer Health 250 Rumah Sakit oleh Rumah Sakit
System seluruh Indonesia
(1999/2000)

WHO SEAR Patient Safety


Workshop on

Patients for Patient Safety


Jakarta Declaration
1 Juni 2005, PERSI
membentuk badan Jakarta, Hotel Four Seasons, 19
nasional : KKPRS July 2007

2000 2004 2005 2006 2007 2008 2009

21 Agustus 2005 Pencanangan

Gerakan Keselamatan Pasien 2008 :

oleh Menteri Kesehatan RI, Keselamatan Pasien RS telah

2004, 27 Oktober : mulai di Akreditasi oleh KARS


di Jakarta
WHO memimpin
gerakan keselamatan
pasien dengan
membentuk : World 2006, KKI : Standar
Alliance for Patient Kompetensi Dokter :
Safety, sekarang
WHO Patient Safety Keselamatan Pasien
Pencanangan
Gerakan Keselamatan Pasien
Rumah Sakit
Oleh
Menteri Kesehatan

Seminar Nasional Persi


21 Agustus 2005
JCC
Key Concepts

Human fallibility / to err is human


Anatomy of error / incident types
System approach
Just Culture / no blaming culture
Organizational Learning by reporting

10
Complex health environments can cause harm
?
NURSES ROLE
IN PATIENT SAFETY
Nursing Role In Patient Safety:

54 percent of all healthcare providers


Surveillance and rescue of patient
status
Coordination and integration of care
Therapeutics, support, and education
Intercepting errors
Commission of errors
Vigilance :
The Essence of Nursing

Vigilance has been defined as

"a state of watchful attention, of


maximal physiological and
psychological readiness to act and of
having the ability to
detect and react to danger"
Nightingale (1860/1969) recognized the
importance of vigilance in nursing

In Notes on Nursing, she wrote:

The most important practical lesson that


can be given to nurses is to teach them

- what to observe, how to observe -


what symptoms indicate improvement,
what the reverse
- which are of importance, which are of
none
-which are evidence of neglect, and of
what kind of neglect.
Through their vigilance, nurses act to keep
patients safe, identify areas of risk and
recognize situations
in need of improvement.

17
a.
Florence Nightingale

The first to measure nursing outcomes


- Wherever nurses were,
far fewer patients died. -
Wherever nurses were not,
far more patients died.
CHALLENGES TO SAFE NURSING CARE

NURSING PRACTICE ENVIRONMENT AND


WORKFORCE ISSUES
NURSING PERSPECTIVE ON PATIENT SAFETY
TECHNOLOGY
CULTURE OF BLAME
TEAMWORK AND COMMUNICATION
Team Work & Communication . ???
PATIENT SAFETY
DI
KAMAR BEDAH
IMPLEMENTASI KESELAMATAN PASIEN

Patient Safety Goals

1. Identifikasi pasien dengan benar


2. Tingkatkan komunikasi efektif
3. Tingkatkan keamanan untuk pemberian obat yang
berisiko tinggi
4. Eliminasi salah sisi, salah pasien, salah prosedur
operasi
5. Reduksi risiko infeksi nosokomial
6. Reduksi risiko pasien cedera dari jatuh
JCAHO

(Joint Comm. On Accreditation for Healthcare


organization)

- Setiap tahun menetapkan National Patient


Safety Goals(sejak 2002)

- Juli 2003 : Pedoman The Universal Protocol for

Preventing Wrong Site,


Wrong Procedure,
Wrong Person Surgery
Potentially catastrophic events
in the Operating Room
Problems of anaesthesia
Wrong-site/wrong-side surgeries,
Wrong person surgery
Retained foreign bodies after surgery
Unchecked blood transfusions,
Mismatched organ transplants and
Overlooked allergies
Medication error
Safety in the operating room
Observed staff performing surgeries in the ORs
to ensure that:

A. The correct surgery (right patient, procedure, and


side) was performed.

B. Surgical counts (of sponges, sharps, and


instruments) were conducted according to standards.

C. Operating suite areas were environmentally clean


and free of potential hazards (such as biological or
pathological).
A. Ensuring Correct Surgery

Step 1 - Informed Consent


Step 2 - Marking the Site
Step 3 - Patient Identification
Step 4 - Time-Out Briefing
Step 5 - Imaging Data
A Ielping Hand to Ensure Correct Procedures

. making things safer for our patients


Ensuring Correct Surger`- in the Veterans Health Administration
Days to hours before surgery Just before entering OR Immediately prior to surgery
JANUAIfl
I , 1 4 s
6 7 K `i 011 12
13 i i 1 l 1 19
2,7 ?6
27 2K 29 30 31

0 Step 1: Consent Form Step 3: Patient Step 4: Time Out"


Identification
The consent form must include: Within the OR when the patient is present
patient's full name OR staff shall ask the patient and prior to beginning the procedure. OR staff
procedure site and to state (NOT confirm): must verbally confirm through a "time out":
side their full name presence of the correct patient
name of procedure full SSN or date of birth *patient property positioned*
reason for procedure a site for the procedure marking of the correct site and side
procedure to be performed
availability of the correct Implant
Z Step 2: Mark Site

The operative site must Step 5: Imaging Data


be marked by a physician
or other privileged 7::k data is
If rnllging

provider who is a rnen,ber used to confirm the


of the operating team surgical site, two
Moh ZIL members of the O
Check responses
team must confirm
against the marked site,
the images are
Do fjQI mark non-operative sites ID band. consent form
correct and properly Ail 'Voi

I L and other documents


labeled

I oi no-r: ml -nn.dlni o.: the Vcl, r.In> IkiIIhAdtntnisttnrre Directs' .. H.I4_;.2 ,Intl v.lur I 'x . l NA.,
r /.,; AUC...F(W
lnJjc.rrta vcw, jrm :OpJ O_,V,lrrrr. h $. '6 lirnhdJC11 1, C'' iC r.\'n r,Ai..1' iJ I rlr.f'; /k!r,4aaJRCi!.P'i. ,s C .v r:ai.\N y1 , Jv,
11,

Before induction of anaesthesia Before skin incision

PATIENT HAS CONFIRMED CONFIRM ALL TEAM MEMBERS HAVE NURSE VERBALLY CONFIRMS WITH THE
IDENTITY INTRODUCED THEMSELVES BY NAME AND TEAM:
SITE ROLE
PROCEDURE THE NAME OF THE PROCEDURE RECORD
CONSENT SURGEON, ANAESTHESIA PROFESSIONAL
AND NURSE VERBALLY CONFIRM THAT INSTRUMENTSPONGE AND NEEDLE,
SITE MARKED/NOT APPLICABLE PATIENT COUNTS ARE CORRECT (OR NOT
SITE APPLICABLE)
ANAESTHESIA SAFETY CHECK COMPLETED PROCEDURE
NOW THE SPECIMEN IS LABELLED
PULSE OXIMETER ON PATIENT AND FUNCTIONING ANTICIPATED CRITICAL EVENTS (INCLUDING PATIENT NAME)

DOES PATIENT HAVE A: SURGEON REVIEWS: WHAT ARE THE WHETHER THERE ARE ANY EQUIPMENT
CRITICAL OR UNEXPECTED STEPS, PROBLEMS TO BE ADDRESSED
KNOW N A LLERGY? OPERATIVE DURATION, ANTICIPATED
NO BLOOD LOSS? SURGEON, ANAESTHESIA PROFESSIONAL
YES AND NURSE REVIEW THE KEY CONCERN
ANAESTHESIA TEAM REVIEWS: ARE THERE FOR RECOVERY AND MANAGEMENT
DIFRCULTAIRWAY/ASPIRATION RISK? ANY PATIENT-SPECIFIC CONCERNS? OF THIS FATIENT
NO
YES, AND EQUIPMENT/ASSISTANCE AVAILABLE NURSING TEAM REVIEWS: HAS STERILITY
(INCLUDING INDICATOR RESULTS) BEEN
RISK OF >SOOML BLOOD LOSS CONFIRMED? ARE THERE EQUIPMENT
(7ML/KG IN CHILDREN)? ISSUES OR ANY CONCERNS?
NO
YES, AND ADEQUATE INTRAVENOUS ACCESS HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN
AND FLUIDS PLANNED WITHIN THE LAST 60 MINUTES?
YES
NOT APPLICABLE

IS ESSENTIAL IMAGING
DISPLAYED? YES
NOT APPLICABLE

THIS CHECKLIST IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FR LOCAL PRACTICE ARE ENCOURAGED.
B. Surgical Counts

Sponge and Sharps Counts


Counts should be taken:
- Before the procedure to establish a
baseline.
- Before closure of a cavity within a cavity.
- Before wound closure begins.
- At skin closure or end of the procedure.
- At the time of permanent relief of the
circulating nurse.
Instrument Counts
Counts should be taken:
- Before the procedure to establish a
baseline.
- Before wound closure begins. - At
the time of permanent relief of the
circulating nurse.
C. Environment of Care

Heating, Ventilation, and Air


Conditioning
Equipment Management
Anesthesia Medication Cart Security
Conclusions of Safety in the OR

1. A systems approach to patient safety - Modifying


the environment to reduce the chance of mistakes.

- Using checklists and standard procedures - Building in


opportunities for team members to recognize and correct
mistakes before they affect the patient. - Encouraging
every person on the team to feel responsible for patient
safety and to speak up if they see a problem. 2. If things go
wrong: Safety reporting and follow-up 3. Improving
communication is key

4. Patient safety is everyone's job


KESIMPULAN

1. LAKUKAN PENDEKATAN SISTEM TERHADAP KESELAMATAN PASIEN :


- MODIFIKASI LINGKUNGAN SEHINGGA MENGURANGI
KECENDERUNGAN TERJADINYA KESALAHAN
- GUNAKAN CHECKLIST DAN SPO
- BANGUN KEMAMPUAN ANGGOTA TIM UNTUK MENGENALI DAN
MELAKUKAN KOREKSI KESALAHAN YANG TERJADI SEBELUM
TERKENA PASIEN
- DORONG KEBERANIAN SETIAP ANGGOTA TIM UNTUK IKUT
BERTANGGUNG JAWAB TERHADAP KESELAMATAN PASIEN DAN
BERANI BICARA APABILA TIMBUL MASALAH

2. BILA TERJADI INSIDEN :


- LAPORKAN DAN DITINDAK LANJUTI

3. TINGKAT KAN KOMUNIKASI TIM

4. KESELAMATAN PASIEN ADALAH TANGGUNG JAWAB SETIAP ORANG


FINAL WORD

Kesembuhan pasien ada ditangan ALLAH, tetapi


KESELAMATAN PASIEN ADA DITANGAN KITA
Keselematan Pasien adalah AMANAH
yang harus kita pertanggung jawabkan
kepada ALLAH S.W.T

( ADIB AY )
TERIMAKASIH 3