Download - LBM 2 4.2
Struktur organisasi berdasarkan peraturan menteri kesehatan republik indonesia nomor
1045/Menkes/PER/XI/2006 tentang pedoman organisasi rumah sakit di lingkungan
departemen kesehatan
RSU Kelas A dipimpin oleh seorang Kepala disebut Direktur Utama.
(2) Direktur Utama membawahi paling banyak 4 (empat) Direktorat.
(3) Masing-masing Direktorat terdiri dari paling banyak 3 (tiga) Bidang atau 3 (tiga) Bagian.
(4) Masing-masing Bidang terdiri dari paling banyak 3 (tiga) Seksi.
(5) Masing-masing Bagian terdiri dari paling banyak 3 (tiga) Subbagian.
dasar hukum tindakan perawat Sumber: PPNI
- UU nomor 23 tahun 1992, tentang kesehatan yang menyebutkan bahwa UU No. 23
Tahun 1992 tentang Kesehatan Pasal 32 ayat (4) menyebutkan bahwa; Pelaksanaan
pengobatan dan atau perawatan berdasarkan ilmu kedokteran dan atau ilmu
DIREKTURUTAMA
DIREKTORAT KOMITE DIREKTORAT DIREKTORAT DIREKTORAT
BAGIANBAGIAN BAGIANBAGIANBAGIAN BAGIANBIDANGBIDANG BAGIANBAGIAN BAGIAN
SUB
BAG
SMF
SUB
BAG
SUB
BAG
SUB
BAG
SUB
BAG
SUB
BAG
SUB
BAG
SUB
BAG
SUB
BAG
SUBBAG
SUBBAG
SUBBAGS
UBBAG
SUBBAG
SUBBAGS
UBBAG
SUBBAG
SUBBAGS
UBBAG
SUBBAG
SUBBAGS
UBBAG
SUBBAG
SUBBAGS
UBBAG
SUBBAG
SUBBAGs
eksi
seksi
seksi
seksi
seksi
seksi
SPI
BIDANG
seksi
seksi
seksi
KOMITE
INSTALASI
U P F
KJF
KJF
INSTALASI
KJF
INSTALASI
KJF
STRUKTUR ORGANISASI RUMAH SAKIT UMUM KELAS A
INSTALASI
keperawatan, hanya dapat dilaksanakan oleh tenaga kesehatan yang mempunyai
keahlian dan kewenangan untuk itu
- UU no 36 Tahun 2009 tentang kesehatan pasal 63 ayat 3 yang menyebutkan
pengendalian, pengobatan, dan/atau perwatan dapat dilakukan berdasarkan ilmu
kedokteran dan ilmu keperawatan atau cara lain yang dapat dipertanggungjawabkan
kemanfaatan dan keamanannya
- UU no 36 Tahun 2009 tentang kesehatan pasal 63 ayat 4 yang menyebutkan
pelaksanaan pengobatan dan/atau perawatan berdasarkan ilmu kedokteran atau ilmu
keperawatan hanya dapat dilakukan oleh tenaga kesehatan yang mempunyai keahlian
dan kewenangan untuk itu
- Pasal 53, ayat (1) juga menyebutkan bahwa tenaga kesehatan berhak memperoleh
perlindungan hukum dalam melaksanakan tugas sesuai dengan profesinya. Pasal 53,
ayat (2) menyebutkan bahwa tenaga kesehatan dalam melakukan tugasnya
berkewajiban untuk mematuhi standar profesi dan menghormati hak pasien.
- Keputusan menteri nomor 1239/Menkes/SK/XI/2001 tentang registrasi dan praktik
perawat tertuang pada Pasal 20 yaitu disebutkan bahwa (1) Dalam keadaan darurat
yang mengancam jiwa seseorang/pasien, perawat berwenang untuk melakukan
pelayanan kesehatan diluar kewenangan sebagaimana dimaksud dalam Pasal 15. (2)
Pelayanan dalam keadaan darurat sebagaimana dimaksud pada ayat (1) ditujukan
untuk penyelamatan jiwa. Isi Pasal 15 yaitu Perawat dalam melaksanakan praktik
keperawatan berwenang untuk :
a. melaksanakan asuhan keperawatan yang meliputi pengkajian, penetapan
diagnosa keperawatan, perencanaan, melaksanakan tindakan keperawatan dan
evaluasi keperawatan;
b. tindakan keperawatan sebagaimana dimaksud pada butir a meliputi : intervensi
keperawatan, observasi keperawatan, pendidikan dan konseling kesehatan;
c. dalam melaksanakan asuhan keperawatan sebagaimana dimaksud huruf a dan b
harus sesuai dengan standar asuhan keperawatan yang ditetapkan oleh organisasi
profesi;
d. pelayanan tindakan medik hanya dapat dilakukan berdasarkan permintaan
tertulis dari dokter.
- PERMENKES RI no. Hk.02.02/Menkes/148/2010 tentang Praktik Keperawatan
“Dalam keadaan darurat untuk penyelamatan nyawa seseorang/pasien dan tidak
ada di tempat kejadian, perawat dapat melakukan pelayanan kesehatan diluar
kewenangan sebagaiman dimaksud dalam pasal 8
- UU no 36 tahun 2009 pasal 83
(1) Setiap orang yang memberikan pelayanan kesehatan pada bencana harus ditujukan
untuk penyelamatan nyawa, pencegahan kecacatan lebih lanjut, dan kepentingan
terbaik bagi pasien
(2) Pemerintah menjamin perlindungan hukum bagi setiap orang sebagaiman
dimaksud pada ayat (1) sesuai dengan kemampuan yang dimiliki
Tindakan Keperawatan menurut Permenkes No. Hk.02.02/Menkes/148/2010 pasal 8
1) Memenuhi kebutuhan oksigen
2) Memenuhi kebutuhan nutrisi
3) Memenuhi kebutuhan integritas jaringan
4) Memenuhu kebutuhan cairan dan elektrolit
5) Memenuhi kebutuhan eliminasi
6) Memenuhi kebutuhan kebersihan diri dan lingkungan
7) Memenuhi kebutuhan istirahat dan tidur
8) Memenuhi kebutuhan obat-obatan
9) Memenuhi kebutuhan sirkulasi
10) Memenuhi kebutuhan rasa nyaman, aman dan keselamatan
11) Memenuhi kebutuhan manajemen nyeri
Dll
Sumber: THE UNIVERSITY OF CONNECTICUT HEALTH CENTER 1
JOHN DEMPSEY HOSPITAL-DEPARTMENT OF NURSING
STRUCTURE STANDARDS - EMERGENCY DEPARTMENT
NURSING PROCESS
1. Assessment
An initial triage assessment will be performed on each patient either by
the triage nurse, charge nurse or nurse admitting the patient to a
patient care area. Initial vital signs will be done during triage.
All pediatric patients will have a temperature, pulse, respiration and
weight taken (when indicated). All patients older than 8 years will
also have a blood pressure taken.
If vital signs are not done, reason for deferral must be documented on
the patient's chart.
All patients who are hypertensive need to have a blood pressure repeated
at least once prior to discharge or admission to the hospital. Refer to
ED Protocol: Blood Pressure Screening for the Adult Patient.
Patients who are classified as Level 4 or Level 5 shall have vital signs
repeated prior to disposition if initial vital signs were abnormal.
THE UNIVERSITY OF CONNECTICUT HEALTH CENTER 19
JOHN DEMPSEY HOSPITAL-DEPARTMENT OF NURSING
STRUCTURE STANDARDS - EMERGENCY DEPARTMENT
Rev. 5/06, 12/06, 9/08, 7/09, 11/09, 10/12
Patients who are classified as Level 3 shall have vital signs repeated
at least once or more frequently as warranted by the Nursing/MD staff.
Patients who are classified as Level 1 or Level 2 shall have vital signs
repeated frequently as warranted by the nursing/MD staff.
2. Planning
Refer to Department of Nursing Structure Standards.
3. Nursing Interventions
Refer to Department of Nursing Structure Standards.
4. Evaluation
Refer to Department of Nursing Structure Standards.
5. Documentation/Retention of Records
All patients in the ED have a triage assessment documented upon arrival,
and reassessment, interventions, procedures, completion of orders will
be documented in the electronic record. Documentation in the ED
includes the ED electronic record and additional forms as indicated,
i.e. ambulance run forms, consults, PEC. All documentation is signed
electronically. Paper documentation sent to HIM to be scanned into the
patient’s record.
B. NURSING RESPONSIBILITIES
The role of the professional nurse at JDH is consistent with the scope of
practice outlined in the State of Connecticut Nurse Practice Act (1975).
Nursing practice is directed by the Department of Nursing Manual, Lippincott
Nursing Practice Manual, Unit-specific practice Manuals, the Hospital
Administrative Manual, and in collaboration with other disciplines. Practice
is evaluated by competencies: orientation and annual.
The specialized, tertiary care setting demands assessment of specific
nursing responsibilities in each clinical area. Therefore, Unit Structure
Standards and Practice Manuals further define the professional nurse role in
each area of nursing practice.
1. Emergency equipment is checked daily by an RN.
2. ED nursing staff may perform the following bedside testing:
a. blood glucose
b. urine chemstrip
c. Hemocult slides, Gastroccult slides
d. I-STAT
e. urine pregnancy (Quick Vue)
f. pH check
g. rapid strep
THE UNIVERSITY OF CONNECTICUT HEALTH CENTER 20
JOHN DEMPSEY HOSPITAL-DEPARTMENT OF NURSING
STRUCTURE STANDARDS - EMERGENCY DEPARTMENT
Rev. 5/06, 12/06, 9/08, 7/09, 11/09, 10/12
3. Nursing staff at the change of each shift should perform room checks on
their assigned area.
4. All treatments and/or medications ordered in the ED must be signed by
the LIP.
A verbal order is generally not given, however, in an emergency
situation a verbal order is taken by nursing and the order shall be
entered into the electronic record by the nurse. When the order is
completed, the order shall be signed off by the nurse and co-signed by
the LIP.
It is the philosophy of the ED staff that we do not provide telephone
advice. Callers are advised to call their PMD, or seek medical
attention at a medical facility or ED.
The ED is equipped and supplied so that most standard procedures can be
performed when necessary to determine patient status. However, certain
procedures should be performed where optimal conditions exist for the
patient. Refer to Administrative Protocol: Procedures Not Performed in
the ED.
Refer to Department of Nursing Structure Standards.
Evaluasi dan pengendalian mutu
Kriteria:
1. Ada data dan informasi mengenai:
Jumlah kunjungan
Kecepatan pelayanan (respon time)
Pola penyakit/kecelakaan (10 terbanyak)
Angka kematian
2. Instalansi/unit gawat darurat harus menyelenggarakan evaluasi terhadap
pelayanan kasus gawat darurat sedikitnya satu tahun sekali dalam setahun
Goal-Directed Measures of Success, sumber: The Emergency Department as a Complex
System
Mark Smith, MD
Chair, Department of Emergency Medicine
Washington Hospital Center
Clinical Professor of Emergency Medicine
The George Washington University School
of Medicine and Health Sciences
Washington, DC
The processes of ED care can be tracked and measured and the quality of their
outcomes can be judged. Many different quantitative metrics are used to assess
how well the Emergency Department is performing as a system that should be
optimized tor provide patient care. . For some of the measures, the goal is to score
high: patient satisfaction, clinical outcomes, medical staff satisfaction, managed
care organization
satisfaction, ED patient volume, revenue, hospital admissions (assuming the
hospital is still being paid on a modified fee for service basis), payor mix, and
community reputation. For other measures, the goal is to score low: patient
throughput or turnaround time, complaints, ambulance reroute/diversion time,
costs, malpractice cases and losses, and regulatory agency violations. These
measures are relatively precise, most
of the data are easily obtained, and the majority of these measures are considered
standard metrics that lend themselves to cross-ED comparison on a national scale
The existence of these measures means that the outcomes and consequences . both
intended and unintended-- of a given intervention that is designed to change and
improve a specific ED process can be assessed with reasonable precision..
*) Dokumentasi kolaborasi
Sumber: PENERAPAN INTEGRATED CARE PATHWAYS (ICP) SEBAGAI
BAGIAN SISTEM INFORMASI MANAJEMEN KEPERAWATAN
DI RUMAH SAKIT dari FIK UI
ICP (Integrated Care Pathway) merupakan format dokumentasi multidisiplin. Format
ini dikembangkan untuk
pengembangan multidisiplin (dokter, perawat, rehabilitasi, gizi, dan tenaga kesehatan lain)
yang diciptakan tidak terlalu rumit dan panjang. Pada format pengkajian multidisiplin
menunjukkan format pengkajian awal yang memungkinkan diisi oleh berbagai disiplin ilmu.
Pengisian ini terdiri dari data riwayat pasien, pemeriksaan fisik dan pengkajian skrining
lainnya yang diisi oleh multidisiplin sesuai kesepakatan.
Sasaran dari ICP adalah benar orang (the right people), benar instruksi (the righat
order), benar tempat (in the right place), melakukan hal yang benar (doing the right thing),
pada waktu yang tepat (in the right time), dengan hasil yang benar (with the right outcomes),
dan semua berfokus pada pengalaman pasien (all with attention to the patient experience)
Tujuan utama implementasi ICP menurut Depkes RI (2010) adalah untuk:
1. Memilih “best practice” pada saat pola praktek diketahui berbeda secara bermakna.
2. Menetapkan standar yang diharapkan mengenai lama perawatan dan penggunaan
pemeriksaan klinik serta prosedur klinik lainnya.
3. Menilai hubungan antara berbagai tahap dan kondisi yang berbeda dalam suatu proses
serta menyusun strategi untuk mengkoordinasikan agar dapat menghasilkan pelayanan
yang lebih cepat dengan tahapan yang lebih sedikit.
4. Memberikan peran kepada seluruh staf yang terlibat dalam pelayanan serta peran
mereka dalam proses tersebut.
5. Menyediakan kerangka kerja untuk mengumpulkan dan menganalisa data proses
pelayanan sehingga provider dapat mengetahui seberapa sering dan mengapa seorang
pasien tidak mendapatkan pelayanan sesuai standar.
6. Mengurangi beban dokumentasi klinik.
7. Meningkatkan kepuasan pasien melalui peningkatan edukasi kepada pasien, misalnya
dengan menyediakan informasi yang lebih tepat tentang rencana pelayanan.
Prasarana kolaborasi multidisiplin
Sumber: Three ways collaborative communications can revolutionize patient care
(www.avaya.com)
Programmable Internet Protocol (IP) phones, PDAs and touch-screen tablet devices
— powered by the latest generation of Session Initiation Protocol (SIP)-enabled
unified communications — can be used to keep clinical, administrative and operations
staff connected, whether by voice, video, instant message, e-mail or paging. These
devices can be programmed for voice-activated number lookup and dialing. Doctors
and other clinical staff can be located and communicated with via instant message
and“presence” capabilities. The latest video collaboration tools enable staff to
instantly set up voice conference calls and high-definition videoconferences,
removing and adding participants by simply touching a screen. Even equipment can
be easily located throughout the hospital with a simple click.
Sarana Kolaborasi
Sumber:
Chapter 33. Professional Communication and Team Collaboration
Michelle O’Daniel, Alan H. Rosenstein
The literature reviewed shows that effective teams are characterized by common
purpose and intent, trust, respect, and collaboration. Team members value familiarity
over formality and watch out for each other to make sure mistakes are not made.
Health care teams that do not trust, respect, and collaborate with one another are more
likely to make a mistake that could negatively impact the safety of patients.
One of the first crucial steps is organizational commitment and willingness to address
the situation. Commitment needs to come from the top down and bottom up, making a
statement about the way the organization does business. The rallying point should be
around behavioral standards and their relationship to patient safety. It’s ironic that
ever since the publication of the original IOM report, To Err Is Human, organizations
have spent the bulk of their time and efforts in improving patient systems rather than
addressing the human factor issues highlighted in the original report.2 Several recent
reports have suggested that while we have made progress in the patient safety
movement, we have a long way to go in meeting the IOM recommendations.62
Addressing defects in communication that affect collaboration, information exchange,
appreciation of roles and responsibilities, and direct accountability for patient care are
key components of any patient safety program. Clinical and administrative leaders
must set the tone by establishing and adhering to behavioral standards that support
agreed-upon code of conduct practices backed by a nonpunitive culture and zero-
tolerance policy.
The next step in the process is recognition and self-awareness. Organizations must be
able to assess the prevalence, context, and impact of behaviors to identify potential
opportunities for improvement. Doing an internal assessment will help pinpoint the
seriousness of the situation and provide clues to areas that need to be addressed.
Assessment information can be gained from formal methods such as incident reports,
survey tools, focus groups, department meetings, task forces or committees, direct
observation, suggestion boxes, and hot lines. Informal methods such as casual
meetings and gossip can also provide valuable surface information and should be
evaluated more deeply as to the source, relevance, and significance of the events to
determine next steps. In many organizations there are still remnants of reluctance to
address the issue head on for fear of antagonizing a prominent surgeon or staff
member. With growing concerns about workforce shortages, staff satisfaction and
retention, hospital reputation, liability and patient safety, and the need for compliance
to the latest Joint Commission proposed standards addressing disruptive behaviors,
organizations can no longer afford to take a passive approach to the situation.63–66
Creating opportunities for different groups to just get together is a highly effective
strategy for enhancing collaboration and communication. These group interactions
can be either formal or informal. Encouraging open dialogue, collaborative rounds,
implementing preop and postop team briefings, and creating interdisciplinary
committees or task forces that discuss problem areas frequently provides an upfront
solution that reduces the likelihood of disruptive events. When a disruptive event does
occur, some organizations have implemented a time-out, code
9 Patient Safety and Quality: An Evidence-Based Handbook for Nurses
white, or red light policy that addresses the issue in real time to prevent any further
serious consequences.59
Developing and implementing a standard set of behavior policies and procedures is
vital. These policies need to be consistent and universally applied. There should not
be a separate policy for any one particular discipline or service. For the medical staff,
the policies should become part of the medical staff bylaws with signed agreements to
abide by these policies at the time of appointment and recredentialing. Included in the
policies should be a standardized protocol outlining expected standards and the
process for addressing disruptive behavior issues, recommendations, followup plans,
and actions to be taken in the face of individual resistance or refusal to comply. Prior
to implementation, make sure all employees are familiar with the existence, purpose,
and intent of the policies and procedures.
For the process to unfold, the organization needs to encourage its employees to report
disruptive behaviors. The organization needs to address issues related to
confidentiality, fear of retaliation, and the common feelings that there is a double
standard and that nothing ever gets done. Reporting mechanisms should be made easy
and must be supported by the presence of a nonpunitive environment. The ideal
vehicle for reporting is to address the situation in real time, but concerns about
position, appropriateness, receptiveness, fear, hostility, and retaliation are significant
impediments.67 Appropriate vehicles for reporting may include reporting of the
incident to a superior, filing an incident report, using a complaint or suggestion box,
or reporting directly to a task force or interdisciplinary committee with assigned
responsibilities for addressing these issues.59 Besides maintaining confidentiality and
reducing risks of retaliation, one of the most crucial aspects of the reporting system is
to give recognition and assurance that the complaints will be addressed and actions
will be taken. Responses should be timely, appropriate, consistent, and provide
necessary feedback and followup.
Taking action though appropriate intervention strategies is next. On one level, generic
educational programs can do a lot to spread the message and teach basic skills
necessary to promote effective communication. Appropriate topics should include
sessions on team dynamics, communication skills, phone etiquette, assertiveness
training, diversity training, conflict management, stress management, and any other
courses necessary to foster more effective team functioning and communication flow.
Courses should be offered to all staff and employees at the organization: physicians,
physicians in training, nurses, nursing students, and all other staff who have patient
contact or play a role in the delivery of patient care. For individuals who have
consistently exhibited disruptive behavior, education may need to be supported by
more focused sessions and specific counseling. Another important strategy is to
promote and assure competency training at all levels of the health care team. This is a
key factor affecting trust and respect, which have such a strong influence on team
collaboration.
Focused team training programs have been of particular value. One of the newer
approaches to improving team collaboration and patient safety is through the
principles learned from the aviation industry. Fostering an environment of trust and
respect, accountability, situational awareness, open communication, assertiveness,
shared decisionmaking, feedback, and education, interdisciplinary CRM training has
brought significant improvements to communication flow in the perioperative
setting.52, 53
Having a clinical champion or early adopter who actively promotes the importance of
appropriate behavior, communication, and team collaboration can be an extremely
valuable asset. Champions can come from the executive ranks or through the
voluntary interest and enthusiasm of other staff members. Co-champions may be even
more effective. Some
10 Communication & Teamwork
organizations have reported that having a nurse and physician (or other health care
professional) go through a joint training program will help foster mutual cooperation
and collaboration between the different disciplines.59 Followup and feedback bring
closure to the process. It is important to let people know that their input is welcomed,
followup actions will be taken, and appropriate feedback will be provided.