RUMAH SAKIT

Ery S Sasmito
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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 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.

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

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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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KOMUNIKASI DAN KONSULTASI TEGAKKAN KONTEKS

IDENTIFIKASI RISIKO

MONITOR DAN REVIEW

ANALISA RISIKO

ASESMEN RISIKO

EVALUASI RISIKO

KELOLA RISIKO

RISK REGISTER

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 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

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 Deskripsi

Temu

Kenal

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Proses 2

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 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

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 Reaktif, kegiatanidentifikasi 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

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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

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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 28
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
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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
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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

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Fire Issues
1. FIRE (inc. accidental)
1. FIRE ALARM FALSE
2. FIRE ARSON (MALICIOUS)
2. DEFECTIVE FIRE EQUIPMENT

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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

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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

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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

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K. Maternity

1. UNEXPECTED NEONATAL ADMISSION

TO SCBU
2. BIRTH TRAUMA (other)
3. UNDIAGNOSED CONGENITAL
ABNORMALITY

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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 38
 MOrganisation
 1ENVIRONMENTAL ISSUE
 PATIENT TRANSFERRED OR
DISCHARGED WITH
 1ENVIRONMENTAL ISSUE
 2Flooding
 3Oil Pollution
 4Effluent Pollution
 5Food Issue
 6SERVICE FAILURE
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 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
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 OService Users Issues
 1ALLERGIC REACTION
 2DEVELOPED PRESSURE SORES
 3Pressure ulcer developed within our
care
 4Pressure ulcer acquired elsewhere
5
 6CONCERN OVER A DO NOT
RESUSCITATE ORDER
 DELAY/FAILURE TO START CARDIO
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 PStaffing
Issues
 1INADEQUATE LEVELS
 2INADEQUATE SKILLS MIX
 3CONCERN OVER COMPETENCE
 4INADEQUATE SUPERVISION
 5ACTING BEYOND SCOPE OF PRACTICE
 6OTHER

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Q. Surgical / Theatre Issues
 1THEATRE LIST DETAILS INCORRECT
 2LATE AMENDMENTS TO LIST
3
 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 43
 RViolence Issues
 1FIREARMS/DANGEROUS WEAPONS
 2VERBAL (inc telephone)
 3by other
 4by patient
 5to staff by staff
 6PHYSICAL
 7by other
 8by patient

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