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Paradigma BaruAsuhan Pasien(Patient Care)dalamStandar Akreditasi RS v.2012Dr. Nico A. LumentaKARSJuni 2013Patient Centered CareAsuhan Pasien TerintegrasiCase ManagerSistem ManajemenSistem Pelayanan Klinis Asuhan Pasien / Patient Care Quality & SafetyPASIENStandar ManajemenPMKP, PPI,TKP, MFK,KPS, MKISasaran KPSasaran MDGsStd Yan Fokus PasienAPK, HPK,AP, PP,PAB, MPOPPKRegulasi :KebijakanPedoman,PanduanSPOProgramIndikator :Ind. Area KlinisInd KlinisInd SKPInd Upaya Manajemen

DokumenImplementasiPengelolaan Rumah Sakit dlm Perspektif Standar Akreditasi v.2012UU 44/2009 ttg RS, Peraturan Per UU an lainnyaTujuan utama pelayanan kesehatan Rumah Sakit adalah pelayanan pasien.Core Business RS = Patient Care(Bab Pelayanan Pasien (PP/COP)Asuhan Pasien(Patient Care)Cure Care(Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: buildinga safer health system. Washington, D.C.: National Academy Press, 2000.)LaporanInstitute of Medicine IOMTO ERR IS HUMANBuilding a Safer Health System (Th 2000) Wake-up Call.bagi dunia pelayanan kesehatan.4(Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: buildinga safer health system. Washington, D.C.: National Academy Press, 2000.)RS - RS AE(>50% krn ME)MatiPasien RS di US: Admisi/yearPasien tsb:Mati sb AE(Extrapolasi)Mati sb lainDi Colorado & Utah(1992)2.9 %6.6 %33.6 juta44,000-98,000!!!Estimasi biaya: $17 - $50 milyar- KLL :43,458Cancer :42,297AIDS :16,516Di New York(1984)3.7 %13.6 %TO ERR IS HUMANBuilding a Safer Health System LaporanInstitute of Medicine - IOM Patient Safety

IRELAND:Failure to detect an excessivelyhigh blood calcium levelUSA:Failure to communicate diagnosis of spinal cancer leading to delay treatmentMEXICO:Fetal distress & untreated neonatal jaundice causing brain damageUK:A chemotherapy drug (Vincristine) incorrectly administered into his spine instead of veinUK:Leg operationMRSA.4 years remain ill amputation thru kneeSlide WHOPatient Safety6As Sir Liam mentioned in his comments, a growing body of research evidence internationally highlights the fact that patient safety know no geographical boundaries.

Behind the research statistics lies the stories of patients who have been harmed and sometime die as a result of patient safety problems. This slides shows some banners which we used at the recent World Health Assembly which tell the stories of six people

Kevin Murphy, from Ireland who died at 21 years of age following the failure to detect an excessively high blood calcium level over a period of some years;Pat Sheridan, from the United States who died at 45 years following the failure to communicate a diagnosis of spinal cancer. His son Cal, is brain damaged as a result of untreated neonatal jaundice. Pats widow, Sue Sheridan is leading our international work on patients for patient safety.Ian Kelly, from the United Kingdom, who had his leg amputated at 41 years after he contracted MRSA.Uriel Gonzales Vazquez fetal distress and untreated neonatal jaundice leading to brain damageSorrel King, from the United States, dies aged 18 months due to sever dehydration during a hospital stay.Wayne Jowett, from the United Kingdom died at 18 years as a result of a chemotherapy drug (Vincristine) adminstered into his spine instead of a vein. (98.000 pasien mati / tahun)JUMBO JET UNITSD A L A M 1 TAHUN S E T I A P H A R I 1 PESAWAT JUMBO JET BERPENUMPANG 268 ORANG J A T U H !!!(.....and die .....!!)(Pasien !!)!4 FondasiAsuhan pasienPelayananFokus Pasien(Patient CenteredCare)ManajemenRisiko RS Risiko KlinisAsuhan MedisAsuhan KeperawatanAsuhan GiziAsuhan ObatEvidence Based MedicineValue Based MedicineSafety is a fundamental principle of patient care and a critical component of Quality Management. (World Alliance for Patient Safety, Forward Programme, WHO, 2004)(Nico A Lumenta & Adib A Yahya, 2012)Tujuan utama pelayanan kesehatan RS adalah Pelayanan PasienKonsep FilosofisAsuhan pasien(Patient care)EBMVBMEtikKebutuhanPasienMutuPatientSafetyPola248Procedures were laid down for documenting hospitalisation for other illnesses whether cardiac or non-cardiac, and for events requiring the stopping of trial medication. Procedures were also defined for cases of worsening heart failure or renal function. For the former, sequential options included increasing the dose of diuretics, decreasing or discontinuing calcium channel blockers, adjustment of the digoxin dose, increasing the dose of other non-ACE inhibitor vasodilators and increasing the background lisinopril dose from 2.5 to 5 mg. For the latter, decreasing or discontinuing diuretics or calcium channel blockers or non-ACE inhibitor vasodilators was considered together with a decrease in background lisinopril therapy.Detailed procedures also existed for the starting and stopping of trial medication following an acute myocardial infarction. A listing of allowed and disallowed concomitant medication was provided and the procedure for recording serious adverse events was detailed.Pelayanan Fokus Pasien(Patient Centered Care)BPISIOM Institute of MedicinePatient-centered care as care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.Patient-centered care sebagai asuhan yang menghormati dan responsif terhadap pilihan, kebutuhan dan nilai-nilai pribadi pasien. Serta memastikan bahwa nilai-nilai pasien menjadi panduan bagi semua keputusan klinisWhat are the Core Concepts of Patient-centered Care?Dignity and Respect. Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.Information Sharing. Health care practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision-making.Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.Collaboration. Patients and families are also included on an institution-wide basis. Health care leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in health care facility design; and in professional education, as well as in the delivery of care.

Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System.Johnson, B et al. Institute for Family-Centered Care 2008What are the Core Concepts of Patient-centered Care?Martabat dan Rasa hormat. Pemberi pelayanan kesehatan mendengarkan & menghormati pandangan dan pilihan pasien & keluarga. Pengetahuan, nilai-nilai, kepercayaan, latar belakang kultural pasien & keluarga dimasukkan dlm perencanaan dan pemberian pelayanan kesehatanBerbagi informasi. Pemberi pelayanan kesehatan mengkomunikasikan dan berbagi informasi secara lengkap pasien & keluarga. Pasien & keluarga menerima informasi tepat waktu, lengkap, dan akurat Partisipasi. Pasien & keluarga didorong dan didukung utk berpartisipasi dlm asuhan dan pengambilan keputusan / pilihan merekaKolaborasi / kerjasama. Pimpinan pelayanan kes bekerjasama dgn pasien & keluarga dlm pengembangan, implementasi dan evaluasi kebijakan dan program; Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System.Johnson, B et al. Institute for Family-Centered Care 2008Patient-Centered Care on Medical/Surgical UnitsTruly patient-centered care on medical and surgical units honors the whole person and family, respects individual values and choices, and ensures continuity of care. Patients will say, "They give me exactly the help I want (and need) exactly when I want (and need) it.Care that is truly patient-centered considers patients cultural traditions, their personal preferences and values, their family situations, and their lifestyles. It makes the patient & family an integral part of the care team who collaborate with health care professionals in making clinical decisions. (Institute for Healthcare Improvement, 2012)

Patient-centered care puts responsibility for important aspects of self-care and monitoring in patients hands along with the tools and support they need to carry out that responsibility. Patient-centered care ensures that transitions between providers, departments, and health care settings are respectful, coordinated, and efficient. When care is patient-centered on medical-surgical units, unneeded and unwanted services can be reduced.(Institute for Healthcare Improvement, 2012)

15Dokter(DPJP)PerawatApotekerFisioterapiAhliGiziLainnyaRadiograferPasienPada Model tradisional pelayanan kesehatan, Dokter merupakan unit sentral / pusat dalam model pelayanan kesehatan, tetapi..Patient safety tidak terjamin !!Dokter = Captain of the ship Model Tradisional Pelayanan KesehatanAnalisPasienPCC merupakan pendekatan yg lbh modern dan inovatif dlm pelayanan kes sekarang, diterapkan dgn cepat di banyak RS di seluruh dunia.Model ini telah menggeser semua PPA menjadi di sekitar Pasien fokus pada pasien Patient-centered CareSbg tambahan, mereka semua sama pentingnya pada kontribusi profesi nya dalam asuhan pasienInterdisciplinary team model kompetensi-kewenangan yang memadaiDokter = Team LeaderModel Patient-centered CareKompetensiyg memadaiInterdisciplinaryTeamModelDokter/DPJPFisioterapisPerawatApotekerAhliGiziLainnyaAnalisRadiografer>>AsuhanIntegrasiStaf KlinisPasienDokter = Team LeaderModel Patient-centered CareKompetensiyg memadaiInterdisciplinaryTeamModelDokter/DPJPFisioterapisPerawatApotekerAhliGiziLainnyaAnalisRadiografer>>Staf KlinisCaseManagerAsuhanIntegrasiPara Pemberi Asuhan(PPA)Asesmen Pasien (Skrining, Periksa Pasien)Pengumpulan Informasi : Anamnesa, pemeriksaan, pemeriksaan lain / penunjang, dsbAnalisis informasi : dihasilkan Diagnosis / Problem / Kondisi, identifikasi Kebutuhan Yan PasienSusun Rencana Pelayanan / Pengobatan : untuk memenuhi Kebutuhan Yan PasienImplementasi / Pelaksanaan Rencana

Asuhan PasienPatient Care2 blok kegiatanCatatan Perkembangan Pasien TerintegrasiNama pasien

TanggalJam(Tepi utk)Dokter(Tepi utk)Staf Klinis lainnya10/5/137.30

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Case Managerdi Rumah SakitPengertian : CM adalah profesional dalam RS yang bekerja secara kolaboratif dgn PPA, memastikan bahwa pasien dirawat serta ditransisikan ke tingkat asuhan yang tepat, dalam perencanaan asuhan yang efektif dan menerima pengobatan yang ditentukan, serta didukung pelayanan dan perencanaan yang dibutuhkan selama maupun sesudah perawatan RS.American Case Management Association : CM adalah professional yang secara kolaboratif melakukan proses asesmen, perencanaan, fasilitasi, koordinasi asuhan, evaluasi, dan advokasi untuk opsi pelayanan dalam rangka memenuhi kebutuhan pasien & keluarga akan pelayanan kesehatan yang komprehensif, melalui komunikasi dan sumber daya yang ada untuk memperoleh hasil yang bermutu dan cost effective.CM selain di RS, juga dapat di Perusahaan Asuransi, di Perusahaan (besar) Ciri : Manajemen, Komunikator,, Wawasan pelayanan klinis, Membantu pasien memenuhi kebutuhan pelayanan.Peran : CM bekerja sama dengan DPJP dan PPA lainnya. CM bersama-sama merencanakan transisi serta kontinuitas asuhan, pemulangan dan juga follow up setelah pasien pulang rawat. CM berkoordinasi / berkomunikasi dengan pasien dan keluarga, sumber dana (mis. Asuransi, Perusahan), dan sarana komunitas yang dapat memberikan pelayanan yang dibutuhkan pasien, seperti fasilitas rehabilitasi atau penyedia peralatan medis. Dengan koordinasi ini, tujuan para CM adalah untuk memastikan hasil yang optimal baik bagi pasien maupun RS termasuk mutu asuhan, utulisasi sumber daya secara efisien dan penggantian biaya (reimbursement) perawatan. CM melayani bayi sampai dengan geriatrik, untuk pelayanan yang komprehensif, termasuk pelayanan rawat inap, pemeriksaan pre-admisi, day surgery, kemoterapi rawat jalan, pelayanan gawat darurat, perencanaan & pemulangannya, dsbKualifikasi : Perawat, Dokter, (Pekerja Sosial). CCM Certified Case ManagerFungsi penting ..

Fungsi penting :Koordinasi, penerapan Patient Centered Care, menjaga kontinuitas pelayananKoordinasi : Discharge Planning, Follow-up, Pelayanan pasca rawat, Home care, Sarana komunitasKoordinasi Rujukan, TransferMonev utilisasi sumber daya (utilization review) : kelayakan / kepantasan / prioritas dari pemeriksaan pelayanan, kendali mutu dan biaya Komunikasi dengan : Asuransi (Verifikasi Benefit/Manfaat), Perusahaan / employer, Rujukan konseling finansial Edukasi, Advokasi, Konseling pasien dan keluargaAsesmen psikososial dan lingkungannya, Hambatan pelayanan, Support Groups - pendampingan untuk motivasi, spiritualIntervensi konsultasi krisis dengan tim PPAMasalah-masalah legal dan etik

Sumber berbagai referensi)