17,safety devices - dr samhari.pdf

8/16/2019 17,Safety Devices - Dr Samhari.pdf

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Safety Instruments/Devices

Keselamatan Pasien

Dr. A. Samhari Baswedan MPAWorkshopWorkshop KeselamatanKeselamatan PasienPasien dandan ManajemenManajemen RisikoRisiko KlinisKlinis didi RumahRumah SakitSakit



Dr. Ahmad Samhari Baswedan MPA Dr. Ahmad Samhari Baswedan MPA

•• MulaiMulai di Yogyakarta, 7 Pebruari 1954; SekarangSekarang di Taman Rasuna Apartment, Tower 18N, Unit 20I, Jln HR Rasuna Said, Kuningan Jakarta,12930; HandPhoneHandPhone : 0811 80 70 30; ee--mailmail : [email protected]

•• MenerimaMenerima Masters in Public Administration, Harvard University, USA,

1998. LulusLulus Medical Doctor, Gadjahmada University, Yogyakarta, 1981

• Sekarang,Sekarang, Anggota Komite Keselamatan Pasien PERSI dandan ProgramManager PR-TB Global Fund ‘Asiyiyah dan Konsultan ManajemenRumah Sakit & Kinerja Organisasi

• Sebelumnya,ebelumnya, Management Consultant (Organisasi & SDM) & GuestLecture Program Magister Kesehatan FK-UGM. 2001 – 2006; HealthCoordinator, UNICEF East Timor 2000-2001; Health & NutritionCoordinator, UNICEF Indonesia 1988-2000; Nutrition & Health Officer,UNICEF Indonesia 1983-1988 ; Teaching Staff, Medical SchoolGadjahmada University 1981-1983 2



HARUS SAFETY DEVICE

Empiris – Teoritis - Praktis



Safety Devices dalam Pelayanan Kesehatan

Fisik SpecimenData & Images

DIAGNOSTIK

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osakit SEHAT

Medikasi(MedicineDelivery)

Farmasi NursingTindakan

(Inter-vention)

TERAPI

Adapted from Safety Framework, RS Persahabatan Jakarta, November 2007



Refraktometer, Non Contact Tonometer, Biometri,

Ultrasonografi Mata, Topografi Kornea, Nd.Yag

Laser, Argon laser, LASIK, Foto Fundus,, OpticalOptical

CoherenceCoherence Tomography/OCT,Tomography/OCT, FundusFundus FluoresceinFluorescein

Angiography/FFA, Angiography/FFA, NonNon ContactContact TonometriTonometri// NCT,NCT,

ElectroretinographyElectroretinography/ERG,/ERG, Perimeter Perimeter Humphrey,Humphrey,

Octopus,Octopus, GoldmanGoldman Laser Laser NdNd--YagYag,, Laser Laser Argon, Argon,

HEPAHEPA Filter Filter, Mikroskop Operasi dengan CCTV,

Alat bedah katarak Fakoemilsifikasi, Bedah

Vitreretina, Koreksi Glaukoma, Okuloplasti, Revisi

Strabismus……

IniIni barubaru daftar daftar daridari bagianbagian KesehatanKesehatan Mata……Mata……

ASB ASB--2610201026102010



Situasi Nyata di Lapangan?

Absence of Equipment Maintenance :

India : Moderate

Bangladesh : Moderate

Srilangka : Moderate –Low

Indonesia : High(IAPB Workshop Report, 2008)



Safety Device dan Multi-Causal Theory

“Swiss Cheese” Diagram (Reason, 1991)

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KTDKNC



HAIs: Masalah Pelayanan Kesehatan Dunia

MORBIDITAS• 32 % = Urinary Tract Infections

• 22 % = Surgical Site Infections

• 15 % = Pneumonia/Lung Infections

• 14 % = Blood-Stream Infections

MORTALITAS• 11,1 %

• 8,2 %

• 36,3 %

• 30 9 %

HAI : “Hospital Acquired Infection” / BSI : Blood stream Infection / CRBSI : Catheter-Related BSI

DIMANA?• 1,96 % = High Risk Nurseries (PICU/NICU)

• 1,12 % = Well-Baby Nurseries• 24,55 % = ICU (semua pasien)

• 74,55 % = Di luar ICU (semua pasien)

USA : Klevens, Edwards, Richards, et al. Pub Health Rep 2007;122:160-6



Global Distribution of HIV

Infections 1984-1997

Global Distribution of

HIV/AIDS 1999

Source: UNAIDS/WHO Source: Ippolito, et.al.

North America/

Western Europe

KTD Luka Tusuk/NSI & ANCAMAN AIDS

Sub-Saharan

Africa

Others

North America/ Western Europe

-

Africa 90%70%

26%6%

4%

4%

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INDONESIA? # 1 TER- “CEPAT” DI ASIA



Contoh Analisa “ Total Cost of Care”

Penggunaan IV Cath Convensional:• Rp 4,500 (3 kali dalam 2 hari) = 13,500

• Thrombophob Rp. 13,500 (3 tube) = 55,500

• Dressing Rp 4,750 (3 kali) = 13,250

• Cost/Biaya pasang IV Cath (3 kali) = 3X

• Cost/Biaya Keluhan pasien = 3Y

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TOTAL Cost of Care = ( 81,250 + 3X + 3Y )

Penggunaan IV Cath “Biomaterial” (Setengah Safety)• Rp 4,500 (1 kali, pada hari 1) = 4,500

• Rp. 14,500 (1 kali dalam 2 hari) = 14,500• Thrombophob Rp.13,500 (1 tube) = 13,500

• Dressing Rp 4,750 (2 kali) = 9,500

• Cost/Biaya pasang IV Cath (2 kali) = 2X

• Cost keluhan pasien = 2Y

TOTAL Cost of Care = ( 52,000 + 2X + 2Y)



Kondisi Kita Sekarang:

Dalam Lingkaran Setan Non-SafetyBanyak RS

ingin Al-Kes

yang

MURAH

BanyakVendor Jual

Al-Kes

MURAH

BanyakVendor Jual

Al-Kes

Non-Safety

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Banyak RS

Pakai Al-Kes

Non-Safety

anya

RUGI AKIBAT

kasus

Non-Safety

Al-Kes

Safety

Jadi MAHAL

Total Value

TURUN

Total Cost of

Care NAIK



Tujuan Kita:

Lingkaran Aman Safety

Banyak RS

ingin Al-Kes

SAFETY

Banyak

Vendor Jual

Al-Kes

SAFETY

Al-Kes

Safety

MENJADI

MURAH

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Banyak RS

MEMAKAI

Al-Kes

Safety

Banyak RS

TERHINDAR

kasus

Non-Safety

Total Value

NAIK

Total Costof Care

TURUN

INGAT : SAFETY BEYOND QUALITY



Hasil Klinis Terbaik Yang Dapat Dicapai

+

Total VALUE = Hasil Pelayanan

epuasan e anggan as en e uarga

+

Keuangan RS tetap “Sehat”

VALUE : Kriteria UTAMA Safety Device



ASB ASB--270208270208



SAFETY DEVICE

ALAT KESEHATAN dengan RISIKO TERKECIL berakibatKTD (“ Adverse Events”/“Unintended Negative Outcomes”)

Error Margin : 3% - 5%



Taxonomi

Safety DevicesMedication

Delivery

Diagnostic

Medical

Syringes

NonSyringes

Specimen Capture

ADS

RUPS

IV

Catheter

Non-IV

Catheter

Blood

Non-Blood

Therapy

Intervention Safety Tools

VacuumTUBEs

“

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Data/Image

Capture

System”

Other TUBEs

or Devices

Care Related

Non-Care Related

Non-Medical

Waste

Mngmnt.

Food, Linen, Gas, Ambulance etc.

Building

Others

Medical/Bio

Waste

“Sharps”

Waste

Safety

Devices

ECG, USG,

MRI, CT-Scan

ICU Monitor



ALAT yang BANYAK dipakai DI RS

Alcohol Swab

Alat SuntikSarung Tangan

IV Catheter

“Dressing”

Botol Infus / Infusion Set

Catheter / NGT

ASB ASB--270208270208

Tempat Tidur

Termometer

Tensimeter

ECG Ambulans

USG / Rontgen / CT-Scan / MRI dll…

SUDAHKAH Mereka MEMENUHI Kriteria SAFETY?



PRINSIP SAFETY DEVICE

1

• The RIGHT DEVICE for

• The RIGHT PROCEDURE for • The RIGHT PATIENT

2

Safety in

• Procuring, Using, Maintainingasb0108



KRITERIA SAFETY DEVICE

SAFETY BAHAN TEKNO

LOGI

PROSES

Untuk PASIEN

Untuk PETUGAS TEKNIS

ASB ASB--270509270509

Untuk

ANGGARAN

KONSEPTUAL / Strategis



KRITERIA KONSEPTUAL

Safet

untuk

Pasien

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AMANuntuk

Petugas

untuk

Kelangsungan

Bisnis

Beyond Quality…

Safety



#1:AMAN unt uk PASIEN

RISIKO TERKECIL untuk KTD & KNC

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Beyond QualitySafety

(HAI/BSI, Drug Reactions, and

IATROGENIC DAMAGE dan terutama,

MIS-DIAGNOSIS )



#2: AMAN unt uk PETUGAS

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Beyond Quality

Safety

RI SI KO TERKECI L

untuk NSI & Blood Splatter, TI DAK memudahkan ERROR saat DI PAKAI



#3: AMAN unt uk ANGGARAN

(Kelangsungan Bisnis)

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Beyond Quality

Safety

,

Menurunkan TOTAL COST of CARE



• BAHAN

KRITERIA TEKNIS

SAFETY DEVICES

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•

• PROSES

BAHAN : Medical / Surgical GradeTEKNOLOGI : Mutakhir dg Error Margin 3% - 5%PROSES : Fokus pada Fungsi BUKAN Penampilan



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asb26102010



Basics Of…?

asb26102010

Do We know?



Basics f or Hypoderm ic Syr inge

TaperedPlunger

Marka Jelas

Positive Stop “retaining ring”

BarrelBENING

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“SerratedThumbPress” Sayap

lebar “Flanges”

Luer TipLatex - Free

Stopper

Kri teria Standar

BAHANPolyprophyleneMedical Grade

MINIMUM “Reflux” dan “Sticktion”



Kriteria ALAT SUNTIK yang baik:

Bahan po l y p r ophy l ene m ed i ca l g r ade

Jarum st a in less st eel su r g ica l g r ad e & double bevel

Barrel bening (transparan)

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Mark a jelas (“bo ld sca le m ar k ing ”)

Plunger sul it lepas saat aspi rasi (“p os i t iv e st op ”)

Plunger ada lekukan (“t a pe r ed p lu ng er r od”)

Pangkal Bar rel “ bersayap lebar” (“w ide f l ange”)

Pangkal Plunger “kasar ” (“serr ated t hum b p ress”)



Bebas “l ateks/ karet alam” (“Latex f ree” )

Bebas “r ef lux” (“alir an balik darah”)

Kriteria ALAT SUNTIK yang baik:

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e as s c on a ran o a ersen a -sen a

Jarum Aman dari r isik o Luk a Tusuk

Barrel r usak sesudah dipakai.

Lim bah Metal dan plast ik dapat d ip isah



Bahan kateter : “Biomaterial”

Bahan bagian yang lain : polypropylene medical

grade dan stain less steel

“Mandrin” aman dar i l uka tusuk dan Blood Splat ter

Basics f or IV Catheter

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• Phlebit is = Kompl ikas i IV Cat heter yg pal ing ser ing

• Bahan k ate ter m er upakan penyebab utam a thr omb oph leb i t i s

• Bah an “Biom at er ial” m engur ang i ph leb i t i s s/ d 46%

• Baha n Biom at er ia l m engurang i ker usakan u jung ka teter s/ d 50%

SOURCE : Gaukroger, P.B. et al, Infusion Thrombophlebitis: A prospective comparison, Anaesth Intens care(1988), 16, 265-271



Bahan : “Ful l Cot ton”

Packing : “Full alum inum foi l” dg “heat -resistant

l ining” di bagian luar dan d iproses secara vakum

Bahan ak t if : Isopropyl alcohol / Acohol + Iodine /

Alcohol + Chlor hexidine

Basics for Alcohol Swabs

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Basics f or “Elect ron ic Diagnost ics”

Industr ial Com ponent NOT General OR Household

Micro-vol tage & “Ful l Insulat ion ”

Clear d irect ion for main tenance & calib rat ions

50,000 hour s LCD

Margin of Err or m aximum 3%



RISIKO TINGGI(1) Infeksi , (2) Image,

(3) Tuntutan

DIMANA & KAPAN?

DV A HARUS mendahulukan Safety Pasien & Petugas

TINGGI dalam(1) Pemakaian Alat,

(2) Beban Kerja,(3) Capital Investment.



DIMANA & KAPAN Safety Device?

HARUS (“Segera”) :1. UGD 2. ICU 3. OK

4. Laboratorium (Klinik/Mikro/Rad.) 5. Poliklinik

. .

Sebaiknya juga segera…1. VIP Unit* 2. Bagian Gizi

Baru kemudian….Semua Bangsal/Unit Pelayanan



MEMILAH dan MEMILIH?Tindak Lanjut?

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LAKUKAN DVA : Device V alue Audit!



Langkah Langkah Device Value Audit

ApakahKTD Terkaitdg Peralatan?

(RCA)

PeralatanSUDAHSafety?

YA!

TIDAK

MONITOR (HAI/BSI/NSI)

andREVIEW

YA!

BELUM FOKUS PADA Unit:

KTD krn Alat?

KTD krnCara Pakai?

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Teruskan RCA utk mencariPenyebab

MendasarKTD!

SEGERALAKUKAN

D V A!

HIGH RISKS forInfections,

Image, Legal

HIGH inUsage/Consumables,

Production Pressure,Capital Investment.

LAKUKAN Laporan KTD/NSI,RCA, FMEA, Risk Grading dll

Pemakaian Safety Device mencegah KTD dan mengurangi biaya total RS dengan

mencegah risiko pemborosan biaya pelayanan/pengobatan dan biaya akibat KTD!



Medical Device Recalls List

ource:www.fda.gov/MedicalDevices/Safety/

RecallsCorrectionsRemovals/default.htm



Semoga bermanfaat,

terimakasih,and

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oo

[email protected]

0811 80 70 30

17,safety devices - dr samhari.pdf

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