NICU Care, Sense of Emergency NICU Care, Sense of Emergency and Doctor’s responsibility and Doctor’s responsibility

M.Sholeh Kosim M.Sholeh Kosim NICU SupervisorNICU Supervisor

Director of Human Resource and Education Director of Human Resource and Education Dr.Kariadi General Hospital Dr.Kariadi General Hospital

Semarang Semarang

Level of Perinatology care Level of Perinatology care

Level I : Rooming in system : Level I : Rooming in system : Low risk baby / normal baby Low risk baby / normal baby 24 hours mother – baby bounding 24 hours mother – baby bounding

Level II : Live support treatment Level II : Live support treatment Medium risk baby Medium risk baby Monitor Monitor

Level III : Life saving treatment Level III : Life saving treatment High risk baby High risk baby NICU care / treatment NICU care / treatment

NICU Care NICU Care

Complicated care Complicated care Many treatmentMany treatment Invasive treatment Invasive treatment

High cost High cost “ “ Not convenience “ environment Not convenience “ environment “ “ Dangerous “ if mismanagement Dangerous “ if mismanagement Psychological tension for parents Psychological tension for parents Moral hazard and unexpected event is nearly Moral hazard and unexpected event is nearly

happened happened

Indications for NICU Care Indications for NICU Care

Acute Acute Critically ill Critically ill Recoverable Recoverable

PrecautionPrecaution

Multiple congenital anomaly Multiple congenital anomaly Chronic disease Chronic disease Severe septic condition Severe septic condition Long term of unconsciousness / comatose Long term of unconsciousness / comatose

Kind of IllnessesKind of Illnesses

Respiratory failure Respiratory failure Haemodynamic failure : Shock Haemodynamic failure : Shock CNS disorders CNS disorders Severe septic condition Severe septic condition Multi organs failure Multi organs failure

Preconditions Preconditions

Informed consent Informed consent LBW : LBW : ≥ 1000 grams≥ 1000 grams Assurance of budget : Assurance of budget :

Covered by insurance : ASKES – KIN, etc Covered by insurance : ASKES – KIN, etc Out of pocket : parent’s approval Out of pocket : parent’s approval

Dangerous sign or Emergency condition Dangerous sign or Emergency condition

Respiratory failure Respiratory failure Convulsion Convulsion Shock Shock Hypothermic Hypothermic Severe dehydration Severe dehydration Deep comatose Deep comatose

Doctor in charge in NICU Doctor in charge in NICU

Competence Competence Dedicated Dedicated Care Care Sense of emergency Sense of emergency Moral Responsibility Moral Responsibility

Sense of Emergency Sense of Emergency

Matter of : Matter of : Knowledge Knowledge Skill Skill Attitude Attitude

Something to be learned , trained and shaped Something to be learned , trained and shaped Related to competence and knowledge Related to competence and knowledge Risk to moral hazard Risk to moral hazard

Doctor’s responsibilityDoctor’s responsibility Ethical Ethical Moral Moral Hippocrates and KODEKI Hippocrates and KODEKI Professional Professional

PATIENT’S SAFETY

Doctor in charge in Pediatric Department Doctor in charge in Pediatric Department

Access hour responsibility Access hour responsibility On behalf of Head of Department and On behalf of Head of Department and

Specialist Specialist Keep the system and service working Keep the system and service working “ “ Team work “ approachedTeam work “ approached Direct consultation to upper ordinate Direct consultation to upper ordinate

Hierarchy of Doctor in charge Hierarchy of Doctor in charge in Pediatric Department in Pediatric Department

Doctor in Charge I Doctor in Charge I Doctor in Charge in PICU & NICU Doctor in Charge in PICU & NICU

Doctor in Charge in Special care Doctor in Charge in Special care Doctor in charge in EMU ( “ UGD “) Doctor in charge in EMU ( “ UGD “) Doctor in charge III ( H N D ) Doctor in charge III ( H N D ) Doctor in Charge IV Doctor in Charge IV Doctor in Charge V Doctor in Charge V

Doctor in Charge I Doctor in Charge I

Team Leader Team Leader Aware and take care all patientsAware and take care all patients “ “ Top consultant “ among doctors in charge Top consultant “ among doctors in charge Authority to decide : Authority to decide :

Patient’s placing Patient’s placing Mobilization of doctors Mobilization of doctors

Delivery support for Caesarian section in theatre Delivery support for Caesarian section in theatre

Doctor in Charge in PICU & NICU Doctor in Charge in PICU & NICU

Responsible for : Responsible for : PICU & NICU admission PICU & NICU admission

From HND From HND From EMU ( UGD) From EMU ( UGD) Theatre ( IBS) Theatre ( IBS) Other wards Other wards

Forward consultationForward consultation Receive expertise Receive expertise

Replacing the role of Doctor in charge I Replacing the role of Doctor in charge I

Doctor in Charge in Special Care Doctor in Charge in Special Care

Responsible for : Responsible for : Special Care admission Special Care admission Delivery support for high risk baby in delivery Delivery support for high risk baby in delivery

room room Helping Doctor in Charge I for Caesarian Helping Doctor in Charge I for Caesarian

SectionSection Helping Doctor in Charge in HNDHelping Doctor in Charge in HND

Doctor in charge II in EMU( UGD)Doctor in charge II in EMU( UGD)

Responsible for : Responsible for : Emergency service Emergency service Life support and life saving Life support and life saving Initial treatment for emergency cases Initial treatment for emergency cases Preparation for deliver patient to : Preparation for deliver patient to :

PICU or NICU PICU or NICU HND HND Other wards Other wards

Doctor in Charge III ( HND) Doctor in Charge III ( HND)

Responsible for :Responsible for : HND care HND care Emergency care Emergency care Consultation to PICU & NICU Consultation to PICU & NICU Receive patient from PICU NICU Receive patient from PICU NICU Receive patient from EMU ( UGD ) Receive patient from EMU ( UGD )

Doctor in Charge IV & VDoctor in Charge IV & V

“ “ New comer “New comer “ Starting to learn Starting to learn Fully responsible to new patients Fully responsible to new patients Consultation to Doctor in Charge III or Consultation to Doctor in Charge III or

even Doctor in Charge I even Doctor in Charge I

ETHICAL HAZARDS ETHICAL HAZARDS

Consequent to be sued or sanction : Consequent to be sued or sanction : Change or erase Medical records Change or erase Medical records Postpone the patient’s treatment Postpone the patient’s treatment Postpone the patient’s admission Postpone the patient’s admission Lying or un honest Lying or un honest

Lesson learned Lesson learned

Patient safety Patient safety Patient neglected Patient neglected Un honest Un honest Miscommunication Miscommunication Miscoordination Miscoordination

Ethical & Moral hazard