Strategi Untuk Menerapkan Clinical Care Pathway

8/18/2019 Strategi Untuk Menerapkan Clinical Care Pathway

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StrategiStrategi untukuntuk menerapkanmenerapkanclinical care pathwayclinical care pathway


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TujuanTujuan pembelajaranpembelajaran

MampuMampu menyusunmenyusun langkahlangkah untukuntuk

implementasiimplementasi CCPCCPMengenalMengenal caracara monitoringmonitoring dandan evaluasievaluasi

penerapanpenerapan CCPCCPMampuMampu menyusunmenyusun indikator indikator untukuntuk evaluasievaluasiCCPCCPMampuMampu menyusunmenyusun strategistrategi dalamdalampengembanganpengembangan dandan penerapanpenerapan CCPCCP


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LangkahLangkah setelahsetelah pathwaypathway tersusuntersusun

SusunSusun indikator indikator pengukuranpengukuran dandan rencanarencana pengumpulanpengumpulandata:data: – – ProsesProses ::

ContohContoh ukuranukuran --ukuranukuran prosesproses :: – – PengukuranPengukuran fungsifungsi tubuhtubuh dandan mobilitasmobilitas – – TingkatTingkat kesadarankesadaran – – Temperatur Temperatur

– – TekananTekanan darahdarah – – FungsiFungsi paruparu – – SkalaSkala kesehatankesehatan pasienpasien (wellness indicator)(wellness indicator)

– – Clinical OutcomeClinical Outcome

SusunSusun paketpaket pelatihanpelatihan CCPCCPLaksanakanLaksanakan pelatihanpelatihanSosialisasiSosialisasi dandan implementasiimplementasi

MonitoringMonitoring dandan evaluasievaluasi ,, tindaktindak lanjutlanjut hasilhasil monitoringmonitoringdandan evaluasievaluasi


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UjicobaUjicoba pathway:pathway: – – PrePre --implementation education sessionsimplementation education sessions – – ImplementasiImplementasi dandan monitoringmonitoring pelaksanaanpelaksanaan ::

TingkatTingkat kepatuhankepatuhan thdthd pathwaypathwayHambatanHambatan dalamdalam penerapanpenerapan pathwaypathway

Faktor Faktor pendukungpendukung thdthd penerapanpenerapan pathwaypathwayVariansVarians yangyang terjaditerjadiOutcomeOutcome klinisklinis

– – PostPost --implementation review:implementation review:KlarifikasiKlarifikasi permasalahanpermasalahan yangyang terjaditerjadi selamaselama implementasiimplementasiReviewReview variansvariansReviesRevies dandan revisirevisi pathwaypathwayMengulangMengulang monitoringmonitoring dengandengan intervalinterval tertentutertentu


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MonitoringMonitoring dandan pengukuranpengukuran

MonitoringMonitoring dandan pengukuranpengukuran outcomeoutcome

pelayananpelayanan :: – – IsuIsu --isuisu yangyang timbultimbul selamaselama implementasiimplementasi

– – ReviewReview terhadapterhadap pathwaypathway dandan pelaksanaanpelaksanaanpathwaypathway – – ReviewReview terhadapterhadap variansvarians

– – ReviewReview terhadapterhadap outcomeoutcome klinisklinis – – SusunSusun rencanarencana koreksikoreksi dandan tindaktindak lanjutlanjut

– – LakukanLakukan monitoringmonitoring secarasecara reguler reguler berdasar berdasar kesepakatankesepakatan


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EvaluasiEvaluasi thdthd pathwaypathway


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SasaranSasaran evaluasievaluasi

Hospital wide evaluation:Hospital wide evaluation:

– – Apakah Apakah goalsgoals penerapanpenerapan CCPCCP untukuntukorganisasiorganisasi tercapaitercapai


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ContohContoh goalsgoals daridari John HunterJohn Hunter

HospitalHospitalGoalGoal Indicator Indicator EvaluationEvaluation

methodmethod1. Improved1. Improvedmultidisciplinary teammultidisciplinary team

Number of staff involvedNumber of staff involvedin development ICPin development ICPImproved communicationImproved communication

between team membersbetween team membersImproved communicationImproved communicationabout patient careabout patient care

Report from ICP subReport from ICP subgroupsgroupsSurveySurvey

CasemixCasemix datadata

2. Increased involvement2. Increased involvementof patient in theof patient in themanagement of his/hermanagement of his/herconditioncondition

Improved complianceImproved compliancewith treatmentwith treatmentImproved patientImproved patientsatisfactionsatisfaction

Patient surveyPatient survey

3. Streamline3. Streamlinedocumentation anddocumentation andimprove completion ratesimprove completion rates

Rationalization ofRationalization ofpaperwork associatedpaperwork associatedwith medical recordwith medical record

Audit Audit


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Evaluation of individual pathways:Evaluation of individual pathways:

– – Process evaluation:Process evaluation:How the pathway was usedHow the pathway was used

– – Outcome evaluation:Outcome evaluation:Whether the established goals were achievedWhether the established goals were achievedthrough the introduction of the pathwaythrough the introduction of the pathway


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Method for evaluationMethod for evaluationThe dataThe data collenctioncollenction method can be:method can be: – – QuantitativeQuantitative

– – QualitativeQualitativeUses of clinical indicators:Uses of clinical indicators: – – LOSLOS

Readmission rateReadmission rate – – NosocomialNosocomial incident rateincident rate – – Return to operating roomReturn to operating room

Aggregate variance analysis: Aggregate variance analysis: – – Collect dataCollect data – – Identify trendIdentify trend

– – Analysis cause of variance Analysis cause of variance – – Review and revised the pathwayReview and revised the pathwayFile Review, auditFile Review, auditCustomer feedback:Customer feedback:

– – Staff feedbackStaff feedback – – Patient feedbackPatient feedback – – Community agencies feedbackCommunity agencies feedback


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RencanaRencana TindakTindak LanjutLanjut


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PerluPerlu adaada pemahamanpemahaman yangyangsamasama ttgttg clinical care pathwayclinical care pathwayManfaatManfaat clinical care pathwayclinical care pathway

bagibagi praktisipraktisi klinisklinis dandanmanajemenmanajemen


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DukunganDukungan yangyang dibutuhkandibutuhkan

ManajerialManajerial ::

– – KomitmenKomitmen – – KebijakanKebijakan

KomiteKomite MedikMedikKomiteKomite KeperawatanKeperawatan

PraktisiPraktisi KlinisKlinis


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TidakTidak semuasemua penyakitpenyakitdisusundisusun care pathwaycare pathway


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PrasyaratPrasyarat

Awareness: problems of continuity of care, Awareness: problems of continuity of care,

coordination of care, inefficiencycoordination of care, inefficiencyLeadership commitmentLeadership commitment

Culture for implementing best practiceCulture for implementing best practice Availability of clinical guideline Availability of clinical guideline

LongLong --term clinical staff commitmentterm clinical staff commitmentManagerial supportManagerial support


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Key issuesKey issuesCommitment to provide best clinical practices,Commitment to provide best clinical practices,Management/owner Management/owner ’’s commitment, support, and policys commitment, support, and policyDevelopment of clinical guideline (if possible based on evidenceDevelopment of clinical guideline (if possible based on evidence ))Develop a framework for implementation (see the steps of developDevelop a framework for implementation (see the steps of develop ing ICP)ing ICP) – – Clear goals and objectives for implementing ICPClear goals and objectives for implementing ICP – – Expected benefits of implementationExpected benefits of implementation – – Identify barriers for implementationIdentify barriers for implementation

– – Start simple: selecting area of practiceStart simple: selecting area of practice – – Plan and manage a project: steps for development, implementationPlan and manage a project: steps for development, implementation , and, andevaluation ICPevaluation ICP

Long term clinical staff commitment, involvement of key players,Long term clinical staff commitment, involvement of key players,““Professional contractProfessional contract ””

Develop an ICP team consisting innovative team membersDevelop an ICP team consisting innovative team membersCommunication, dissemination and trainingCommunication, dissemination and trainingTimeTimeClear evaluation method, clear indicators for evaluation, varianClear evaluation method, clear indicators for evaluation, varian ce tracking,ce tracking,analysis and feedbackanalysis and feedback


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DiskusiDiskusi

Apa Apa key issueskey issues untukuntuk penerapanpenerapan ICPICP

Adakah Adakah permasalahanpermasalahan untukuntuk tiaptiap keykeyissuesissues

BagaimanaBagaimana strategistrategi organisasiorganisasi untukuntukmengatasimengatasi permasalahanpermasalahan tsbtsb

SusunSusun

rencanarencana

tindaktindak

lanjutlanjut

Documents

Strategi Untuk Menerapkan Clinical Care Pathway