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EVIDENCE BASED –NURSING

PRACTICE DAN MEDICATION ERROR

Dr.dr.Akrom, M.!".

IMANI – PR#AMI DI$

A%MAD DA%&AN DRUG IN'#RMATI#N AND

CRISSIS CENTER (ADDICT)

TU*UAN

• EVIDENCE+

• APAA% EBP+

• MENGAPA EBP+

• RES#URCES #' EVIDENCE, SEARC% #' EVIDENCE

DAN &EVE& #' EVIDENCE

• BAGAIMANA &ANGA%&ANGA%

MEMPRATEAN EBP NURSING+• EBP NURSING IN PRACTICE- C%R#NIC PATIENTS-

SEPSIS- %#SPITA&ASS#CIATED IN'ECTI#N-

N#S##MIA& DAN RESISTENSI ANTIBI#TI

BAGAIMANA ITA MENGETA%UI DAN

BE&A*AR TENTANG NURSING+

• Trdo

• A3or

• Borro56

• Tr7 d !rror

• P!r"o7 !!r!:!

• Ro7! mod!76 d m!or"3

• Io d r!"o6

• Nr"6 r!"!r:3

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BAGAIMANA ITA

MENGEMBANGAN UA&ITAS DIRI

DAN UA&ITAS PE&A$ANAN DA&AM

EPERA;ATAN SEARANG+

S 3rmm7 1

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@

555.=m! r!"!r:3

•

E!r r::! ko57!d6!,d:>! r!"o6

B. Clinical Expertise• o57!d6! 6!d ?rom

r::! o>!r m!

• Id:>! r!"o6

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C. Patient Values Circu!stances

• U! r!?!r!:!"

• Co:!r"

• E!:o"

• ':7 r!"or:!"

• So:7 "or"

APAA% EBP+

• EBPevidence based practicerk!kro?!"=!r="" =k 7m3d73 rk!k ro?!"o7d!6 m!6!6r"kr pen"ala!an#lini#$pr%&esi, 'u#ti('u#tiil!iahhasil penelitiand!6 77 "!"?k

d?d7 "!

EBP is)

• I!6ro o? =!" r!"!r:3 !>d!:!, :7:7

!!r"!, d ! >7!" mk6

d!:"o" =o 3! :r! o? d>d7 !"(I"! o? M!d:!, 2001).

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Evidence(Based Practice

is #n%*in" that *hat *e d% is the

'est practice

EBP

MENGAPAA% PRATI

EPERA;ATAN %ARUS EBP+

• 1. &INISE'IASI

• 2. &INISSA'T$ – MENG%INDARI RISI#%ARM/%AFARD

• @. &INISE#N#MI

• 4. ETI#&EGA&%UUM MA&PRATI –ESA&A%AN MEDIASI

• . &INISPRATISTEAM ;#R

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H

Men"apa EBP pentin" ?

• T3! 200@ r!or = 3! I"! o? M!d:!(Health Professions Education: A rid!e to "ualit# )

r!:omm!d" 3 77 3!73 :r! ro?!""o7"o""!"" :!r "k77" d :om!!:!" ord!r o

!3:! ! :r! 7 d "?!. –   All health professionals should be educated to deliver patient$

centered care as %e%bers of an interdisciplinar# tea%&e%phasi'in! evidence$based practice& (ualit# i%prove%entapproaches& and infor%atics)

*Institute of Medicine& +,,-.

EBP m!6kk k7" !7

• E>d!:!="!d r::! (EBP) " o! o? ?>!

:or! :om!!:!" all health pr%&essi%nals

"3o7d o""!"" r!6rd7!"" o? 3!r 7! or

d":7! (I"! o? M!d:!, 200@) ?or

:ro""6 3! 7 :3"m.

&o6 7?!

7!r!r

E3:!

Comm:o

"k77

M6!r7

"k77" d!:"o

mk!r "mr

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SUMBER PUSTAA I&MIA%/EVIDENCE

SERTA A&AMATN$A

• SUMBER EVIDENCE/PUSTAA I&MIA% TERSEDIAME&IMPA% DI INTERNET.

• ADA $ANG BEBAS AMBI&/GRATIS TAPI BAN$A *UGA$ANG BERBA$AR

• ADA $ANG BERUPA *URNA& TUNGGA&/UMPU&AN*URNA& TETAPI BAN$A *UGA $ANG BERUPAPERPUSTAAAN MA$A

• C#NT#% *URNA& TUNGGA&/UMPU&AN;;;.NE*M.#RG- ;;;.BM*.C#M -;;;.BI#MED.#RG D&&

• C#NT#% PERPUSTAAAN MA$A ;;;.PUBMED.C#M

APAA% EVIDENCE + BAGAIMANAA%

&EVE& #' EVIDENCE+• EVIDENCESCIENTI'IC EVIDENCEIN'#RMASI/DATA %ASI&

DARI PENE&ITIAN &INIS DI&AP#RAN DA&AM BENTUPUB&IASI I&MIA% ATAU *URNA&PUSTAA I&MIA%

• EMAMPUAN PUSTAA I&MIA% SEBAGAI EVIDENCEBERVARIASI

• ADA PEMERINGATAN PUSTAA I&MIA% BERDASAANEMAMPUANN$A SEBAGAI EVIDENCE

• PEMERINGATAN EVIDENCE SESUAI DENGAN VA&IDITAS%ASI& CRITICA& APPRAISA&/%ASI& A*IAN RITIS

• EVIDENCE BERTINGAT 1/H/J

• PERINGAT IREVIE; SISTEMATI, RCT MCS/SAMPE& BESARDST

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D!"6 d T3! E>d!:! Prmd

Am7 r!"!r:3

I >ro (!" =!) r!"!r:3

C"! "!r!"/R!or"

Id!", Edor7", #o"

C"! Coro7 Sd!"

Co3or "d!"

Rdom!d Coro77!d

Sd!"

Rdom!d Coro77!d

Do=7! B7d Sd!"  M e t   a( a n

 a l   + s  i   s 

&!>!7 !>d!:! "!=6 d"r

!" r!kom!d"

• T3! 6d!7!" "! 3! Grd!" o?

R!:omm!do, A""!""m!, d!>!7om!,

d E>7o (GRAdE) ""!m o !"=7"3

3! 7 o? !>d!:! ?rom 363 (A) o >!r

7o5 (d) d o d!!rm! 3! "r!63 o?

r!:omm!do" " "ro6 (1) or 5!k (2).

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,AHAPAN PR-E EBP

TA%APAN

1. 'orm7"!rm"73

2. M!6m7k=k 7m3

@. M!7kk:r:7 r"7

4. M!!rk3"7 k7"

EBP Pr%cess

1. A""!"" r::! (?orm7! !"o)/hat isn0t 1or2in!3

/hat do #ou 1ant to 2no1 about3 

2. D!:d! (!>d!:! r!>!5)/hat resources are available and are the# an# !ood3

/hat has 1or2ed in other places3

Ho1 can #ou chan!e #our practice3 

@. P7 (d!>!7o 7 ="!d o ?d6")Ma2e a plan to chan!e care based on relevant& applicable infor%ation)

4et others help)

4. I!r>!! (k! :o o r!>!5 ro:!"" or :36!)I%ple%ent revised care!ivin! protocol in clinical unit)

. E>7! (:r! mro>!d or mod? d 6 !r>!!)Ho1 1ell is that 1or2in! for #ou3 

T3! EBP Pro:!"" S!" r!

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TA%AP 1 '#RMU&ASI PERMASA&A%AN

• Dr6k" d7m "" 6 d"6kd!6 PIC#.

• PPR#B&EM #R PASIEN

• IINTERVENTI#N

• CC#MPARIS#N

• ##UTC#ME

• PIC# =!r?6" "!=6 P!dom !:r

"k/7!rr!/

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555.!

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Coo3!>d!:! 6m!d:o

Error d mod!7 !r>!o

555.6d!7!.6o>

TA%AP III

ANA&ISIS RITIS/A*IAN *URNA&

• TU*UAN

• 1. MENENTUAN VA&IDITAS *URNA&

• 2. MENENTUAN TINGAT EPENTINGAN

&EVE& #' EVIDENCE

• @. MENENTUAN EMAN'AATAN ATAU

PENERAPAN

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PERTIMBANGAN DA&AM ANA&ISIS

RITIS

• ENA&I BENTU *URNA& PRIMER, SEUNDER,TERSIER

• TENTUAN VA&IDITAS DAN &EVE& #'

EVIDENCE

• *URNA& &EVE& IK *URNA& &EVE& II DST

S$STEMATIC REVIE;K RCT TUNGGA&

*URNA& TUNGGA&

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C&INICA& PRACTICE GUIDE&INE

TA%AP IV AP&IASI• M!!rk 3"7 k

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C#NT#% M#DE& AP&IASI EBP

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PENINGATAN

UA&ITAS DIRI

PENINGATAN UA&ITAS

PE&A$ANAN

PENGEMBANGAN

STA'

P!:!63

!"73 m!dk"

P!6k

!=!r3"7!r

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1J

IPCN IPC&N IPC#

Sr6:7

S! ?!:o

(IN'ESI

&UA #PERASI

I)

MENURUNAN/CEGA%

II?!k"A7rDr3

Prm!r

(5I 6 loodstrea% Infection.

MDR 7entilator 

 Associated

Pneu%onia

%AI PREVA&ENCE

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ASUS

!.". "7, #"d!" ?!k" – !rk

k!"RS r

S!r:36 !>d!:! Cr !>d!:! d!6

m!66k k k:

drPIC#, d

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SSII

I (I?!k" &k #!r")

"6 =!r=3

P!r7 d5"d d d:!63

Cr++

Anti'i%ti#

pr%&ila#sis N#N 'ARMA#GIS

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SSI (I)

B6m !5 current evidence+

B6m m!!rk EBP+

,AHAPAN PAND/AN C-N,-H

'orm7"

!rm"73

&kk!7rkk

7m, 6 =!7m

=!r

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NGCUSA

'IRST EDITI#N2008

APA $ANG BARU

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BAGAIMANA NE; EVIDENCE PRE#PERATIVE

S%#;ERING+

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2@

BAGAIMANA NE; EVIDENCE

"= =", "!k dk d=!r"3k+

Md k "= k "!k

Pd 3rk o!r" m "!=!7m

Tdk !r=k m!rk SSI

A=ok Pro?7k""

=ok 6 d=!rk d !d!r 6

m!

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Al"%rit!a ,erapi Anti'i%ti# Pr%&ila#sis

Pe!'edahan

TERAPI• ,erapi n%n(&ar!a#%l%"i

m!

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( ,epat rute pe!'erian

A6r =ok d "!6!r dd"r="k k!

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2H

P#&A UMAN ICU RSU DR AR$ADI

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2J

P#&A SEBARAN UMAN DI RS

'ATMA;ATI *AARTA

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'ATMA;ATI (20012002)

ESIMPU&AN

P!r5 m!m!66 !r >7 d RS d7m PPI

P!6" r" EBP "6 d!r7k o7!3 !r5.

P!6 PPI d!6 r" EBP 7!=3 m!!r! "!"" d "!: "3o:k

Nr"!dr!:!d 5!6 o?? o? 

m!:3:7 >!7o " !??!:>!

r!d:6 dro o? m!:3:7 >!7o.

I"7 do"6 "3o7d =!6 53! 2

:o"!:>! =7ood 67:o"! 7!>!7" !:!!d 180

m6/d&.

&o5do"! ?!!d6 3! ?r" 5!!k

( o 00 k:7 !r d) " "66!"!d

Pro6o"" "3o7d =! d":""!d 53

!" d 3!r ?m7!" 53 J2

3or" o? dm""o o 3! !">! :r! .

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