keselamatan pasien, urusan siapa?
DESCRIPTION
Keselamatan Pasien, Urusan Siapa? (dr.Purnamawati,SpA)Materi Presentasi PakarSimposium Gerakan Kesehatan Ibu dan Anak (GKIA), Balai Kartini Jakarta 19-20 Agustus 2015TRANSCRIPT
PATIENT SAFETY
PFPS – Patient for Patient safety; WHO PSP
1. WHAT & WHY?
2. STAKE HOLDERS?
3. HOW?
AGENDA
1. Patient & Patient safety
2. Patient & Sickness
3. Patient & RUM
1. PATIENT SAFETY 200 BC … 2005 …. 2013
PRIMUM NON NO CERE (Above all, DO NOT harm)
WHY IS IT A SERIOUS
GLOBAL HEALTH ISSUE?
SAFETY COST, RESOURCES
Patient safety is the absence of
preventable harm to a patient during
the process of health care.
WHAT & WHY
WHAT CAN BE WRONG?
• Diagnosis
• Treatment, Dosage (pediatric)
• Laboratory errors
• Patient identification
• Adverse event
• Infection control
• Surgery
Every point in the process of care-giving
contains inherent unsafety.
Today’s health-care context is highly complex.
Care is often delivered in a pressurized and fast-moving
environment, involving a vast array of technology and,
daily, many individual decisions and judgements by
health-care professional staff.
In such circumstances things can and do go wrong.
1. 1. SAFETY issues
To err is human… Institute of Medicine
If you think going to a hospital is safer than
travelling by plane … THINK again!!
Industries with a perceived higher risk (aviation,
nuclear plants) - much better safety record than
health care.
Aircraft accident 1: 10.000.000 chance
Patient harmed 1 : 300 chance
1.4 million people worldwide suffer from
infections acquired in hospitals.
Developed countries:
50% medical equipment
unusable/partly usable -
leads to substandard or
hazardous D/ or T/
health care-associated
infection: 20 x. Injections
given without sterilization is
70% causes 1.3 million
deaths
1 : 10 patients harmed.
Surgical safety: half of
the avoidable adverse
events results in
death or disability.
Developing countries:
1. 2. COST & RESOURCES
Additional hospitalization, litigation
costs, infections acquired in hospitals,
lost income, disability and medical
expenses have cost some countries
between US$ 6 - 29 billion a year.
The economic benefits of improving
patient safety are compelling.
HEALTH INDUSTRY 50% of Rx/ - unnecessary, ineffective
• Indonesia: increases
10-13% per year
• % causes e.g:
– Sophisticated exam
increased 65%
– Overtreatment - 56%
(50% Rx/ - ineffective)
MEDICAL ERROR - US:
Cause of death no 4-5
> $ 177.4 Billion (2000)
$847 million/yr - UK (2006)
2/3 pts – Rx/
10 drugs/pt, yr 2000, US
HARM?
0
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
300,000,000
350,000,000
Outpatient
Inpatient 31/1
340/6
109/8
SUPERBUGS (resistant to antibiotics)
HARM?
RESISTANT MICROBA
IN THE HOSPITAL
• CDC: ± 2 million/yr - USA additional infection 90,000 death
• Nosocomial infection = infection during hospitalization (“BONUS”)
Antibiotics =
societal
medicines HARM?
2. PATIENT as
STAKEHOLDER
• Symptoms and Signs
• DIAGNOSIS
• Management (Treatment)
RUM
SIGNS & SYMPTOMS
• PIECES OF PUZZLES that will lead doctors
to the DIAGNOSIS
• Be smart!
• Focus on:
– What is the problem?
Instead of on:
– how to suppress the
symptoms
EVIDENCE BASED MEDICINE (EBM)
↓
GUIDELINES
SICK
• Signs &
Symptoms
Fever, head-
ache, coughs,
mucous, etc
DIAGNOSIS
• URI/ISPA:
– Cold
– Influenza
GUIDELINE
Treatment
Advice
Non drug
Drug
2nd opinion
Combination
WHY DO WE NEED EBM? Save LIVES!
WHEN given a Rx/
• Do I really need medication?
• How many (count the lines)?
• 5 drug information – patient’s right
– Active ingredients?
– Indication?
– Risk of ADR?
– Contraindication?
– Dosage, duration, etc?
• The generics please?
• Support group
• Ambassador
Empower parents/consumers - HEPP
A thinking
community
Shared
responsibility
Promoting
Rational Use of Medicine
to the Community
• Client, Partner
• Learn
• Ask questions
Empower parents/consumers - HEPP • Courses
• (PESAT) – 6/12;
• Companies; Institutions
• Others: grandmother, baby sitters
• Mailing List [email protected]
• Breastfeeding support group (KLASI)
• Media
• Radio(s) ; Published materials
• Consultation corner (CBN (web server), Magazine
• Website: www.sehatgroup.web.id
• Model clinic
• Studies
SUA
Say NO to antibiotics for:
1.Common colds (coughs, coryza)
2.Acute diarrhea (non bloody diarrhea)
3. RATIONAL USE OF MEDICINE
(RUM)
Patients receive medications APPROPRIATE to their
clinical needs,
• in DOSES meet their individual requirements for
an
• ADEQUATE PERIOD of time,
• accurate INFORMATION, and
• at the LOWEST COST.
WHO conference of experts Nairobi 1985
Why
RUM?
• Better therapeutics
• Less side effects
• Saves money:
– Patient,
– Hospital,
– Country
• Ethics and Equity
Overtreatment
Undertreatment
Mistreatment
WHO:
1. Avoid mixing drugs
2. As few drugs as
possible
Irrational Use of Medicines:
Wasteful & Harmful
• Side effects of drugs → increased morbidity & mortality (and cost)
• Irrational use of antibiotics → resistant bugs → stronger & expensive antibiotics → prolong hospitalization, yet death rate increased
1. Polypharmacy
2. Overuse of Antibiotic, steroid
3. Non generics
4. High rate of injections
5. Supplement; off label use
”... Perlu segera dikoreks. Jika praktek-praktek
primitive itu tetap dipertahankan, keselamatan
pasien (patient safety) ... jadi taruhannya"
Prof Iwan Dwiprahasto
• "Menggeruskan tablet untuk dijadikan puyer, kapsul, bahkan sirup untuk sediaan anak, atau menggeruskan tablet atau kaplet untuk dijadikan saleb dan krim adalah bentuk off label use yang jamak ditemukan. Hal itu terjadi secara turun menurun, berlangsung puluhan tahun tanpa ada yang sanggup menghentikannya.”
• ”Melestarikan penyimpangan, menikmati kekeliruan, dan mengulang-ulang kesalahan tampaknya sudah menjadi hedonisme peresepan. Yang satu mengajarkan dan yang lain mengamini sambil menirukan. Itulah cara termudah untuk mendiseminasikan informasi yang tidak berbasis bukti."
Prof Rianto Setiabudi …
Permasalahan seputar puyer
• Kemungkinan kesalahan manusia
• Stabilitas obat tertentu dapat menurun
• Toksisitas obat dapat meningkat
• Waktu penyediaan obat lebih lama
• Efektivitas obat dapat berkurang
• pencemaran lingkungan
• tingkat higienis
• biaya lebih mahal
• Dokter tidak tahu obat mana …
• Potensial IRUM
Going to the Doctor?
1. Consultation 2. Second opinion
AIMS?
4. 1. Medical consultation
perundingan antara dokter dan pasien
untuk mencari sebab terjadinya penyakit
& untuk menentukan cara pengobatannya
AIMS?
Ask: the DIAGNOSIS in
medical term
4. 2. SECOND OPINION
• 20% second opinion
• 1 out of 3 : a new diagnosis
• Search in the credible web : appraise medical information
• Steps
– Choose the right doctor
– Prepare all the records
– Doctor-2 may agree or disagree
Some “don’ts” (for
agreed opinion):
• Don't assume that the doctor
who gives you better news is
the correct one. Just because
you like the answers better
doesn't mean she is right.
• Don't assume that Doctor-2 is
correct. If the second doctor's
opinion is always the correct
one, why did you go to a first?
• Don't assume that the "nicer"
doctor is right either. A doctor
with better bedside manner isn't
necessarily a better practitioner.
• If the doctors'
opinions are very
different, you'll want
to consider getting a
third opinion. The
third opinion will likely
be similar to either
Doctor-1 or Doctor-2,
and that will help you
make your treatment
decisions, too.
Some “do’s” (for
differing opinion):
Ask Doctor 3Qs:
What should
Be done?
Problems?
Cause?
Physical exam When - worry?
Diagnosis Treatment Plan
Emergency signs
Nowadays, most patient-physician interactions
end with a prescription
Tidak semua
obat
bermanfaat
Jika bermanfaat,
tidak untuk semua
Tidak semua
obat aman
Jika aman, tidak
untuk semua
Physicians should adopt the best guidelines
because they represent the best practice and
are best for the patient
Evidence
ACTION Factors influencing
the use of research
evidence
”TRANSLATING”
COMPLY to GUIDELINES
E2 = Evidence x Experience
GUIDELINES (CPG)
are systematically developed
statements that aim to help
physicians and patients reach
the best health care decisions.
A doctor will be able to
cure some of the time,
relieve most of the time
but should
comfort all the time.
• preventing medical error
• http://www.ahrq.gov/consumer/safety.html
The World Alliance for Patient Safety is working with
40 champions – who have in the past suffered
due to lack of patient safety measures –
to help make health care safer worldwide.