Dr. Ahmad Samhari Baswedan MPA

• Mulai di Yogyakarta, 1954; Sekarang di Kuningan, Jakarta. HandPhone : 0857-1923-8100; e-mail : samharib@yahoo.com • Master in Public Administration, Harvard University, USA, 1998. • Medical Doctor, Gadjahmada University, Yogyakarta, 1981 • Sekarang, Anggota Komite Keselamatan Pasien PERSI dan Sekretaris Eksekutif, The Global Fund to Fight AIDS, TB and Malaria in Indonesia dan Konsultan Manajemen RS & Kinerja Organisasi • Sebelumnya: 2009-20015 Program Manager, The Global Fund for Indonesia Community TB Program; 2004-2007 Consultant Patient Safety SE Asia; 2001-2006 Management Consultant (HR & Organization) & Guest Lecture Magister Kesehatan FK-UGM; 2000-2001 Coordinator Health, UNICEF East Timor; 1988-2000 Health & Nutrition Coordinator, UNICEF Indonesia; 1983-1988 Health & Nutrition Officer, UNICEF Indonesia; 1981-1983 Teaching Staff, Medical School, Gadjahmada.

2

APA? SAFETY DEVICE

ALAT KESEHATAN dengan RISIKO TERKECIL berakibat KTD (“Adverse Events”/“Unintended Negative Outcomes”)

Error Margin : 3% - 5%

ASB-270208

AL-KES yang BANYAK dipakai DI RS Alcohol Swab

Alat Suntik

Sarung Tangan, APD

Catheter IV / Cardio / Urethra

“Dressing”

Botol Infus / Infusion Set

NGT- Intubasi

Ventilator

Tempat Tidur

Termometer

Tensimeter

ECG

Ambulans

Generator / UPS

USG / Rontgen / CT-Scan / MRI dll…

SUDAHKAH Mereka MEMENUHI Kriteria SAFETY?

Safety Device Issues :

asb0108

TEKNIS STRATEGIS

Infeksi (HAI/BSI/CRBSI/Covid-19)

NSI

Mis-Dx & Mis-Tx

“Tuntutan” (Legal)

Image

“Sustainability”

Pasien & RS

Jadi Korban

“Total Cost of Care” NAIK

Total Value TURUN “Total Business Cost”

TINGGI

Hospital Acquired Infections: Masalah Kesehatan Dunia

HAI : “Hospital Acquired Infection” / BSI : Blood stream Infection / CRBSI : Catheter-Related BSI

MORBIDITAS

• 32 % = Urinary Tract Infections

• 22 % = Surgical Site Infections

• 15 % = Pneumonia/Lung Infections

• 14 % = Blood-Stream Infections

MORTALITAS

• 11,1 %

• 8,2 %

• 36,3 %

• 30,9 %

DIMANA?

• 1,96 % = High Risk Nurseries

• 1,12 % = Well-Baby Nurseries

• 24,55 % = ICUs (all patients)

• 74,55 % = Outside ICUs (all patients)

USA : Klevens, Edwards, Richards, et al. Pub Health Rep 2007;122:160-6

BAGAIMANA dengan

Covid-19?

ASB-270509

KONSEP SAFETY DEVICE

SAFETY

DEVICE

BAHAN

MATERIAL

TEKNO

LOGI

PROSES

Untuk PASIEN

Untuk PETUGAS

Untuk INSTITUSI

(Kelangsungan

Bisnis)

TEKNIS

STRATEGIS

1. AMAN untuk PASIEN

a. Bebas Infeksi

b. High Quality to “minimize” Error

c. Mis-Dx dan Mis-Tx karena

“SALAH” membaca hasil

asb0108

asb0108

Beyond Quality

Safety

2. AMAN untuk PETUGAS

RISIKO TERKECIL

terkena Viral Infection, NSI,

Blood Splatter, dan TIDAK memudahkan ERROR saat DIPAKAI

A. Global Distribution of Documented Occupational HIV

Infections, 1984-1997

B. Global Distribution of People Living with HIV/AIDS, 1999 Source: UNAIDS/WHO Source: Ippolito, et.al.

North America/

Western Europe

Sub-Saharan

Africa

Others

North America /

Western Europe

Others Sub-Saharan

Africa 90% 70%

26% 6%

4%

4%

asb0108

AIDS? Indonesia # 1 TER-CEPAT Di Asia Covid-19? Indonesia #1 TER-TINGGI kematian NaKes

AIDS, Covid-19 & KTD Luka Tusuk/NSI

asb0108

Beyond Quality

Safety

3. AMAN untuk INSTITUSI.

Total VALUE Tinggi (Total COST-of-CARE RENDAH/SEDANG)

Every surgery must use pulse oximetry and the checklist

$25 $250 VALUE : 100

surgery

PRICE :

$275

PEMANFAATAN TEKNOLOGI

“Material Technology,

Process Technology,

Information Technology”

UNTUK SAFETY DEVICE

asb0108

Basics ALAT SUNTIK yang Aman:

Material : Barrel polyprophylene medical grade dan

“Latex free” obat tidak rusak & dosis tepat

Material : Jarum stainless steel surgical grade

Process & Technology: HARUS BEBAS dari

“Reflux” (“aliran balik darah”) dosis tepat

“Sticktion” (“aliran obat tersendat-sendat”) dosis

tepat & aman untuk

Technology : Safety Generasi >3 = minimum risk Luka

Tusuk & Blood Splatter Aman Bagi Petugas

asb0108

Material AND Process :

Barrel bening kaca (transparan)

Marka jelas (“bold scale marking”)

Plunger sulit lepas saat aspirasi (“positive stop”)

Plunger ada lekukan (“tapered plunger rod”)

Pangkal Barrel “bersayap lebar” (“wide flange”)

Pangkal Plunger “kasar” (“serrated thumb press”)

Barrel langsung rusak sesudah dipakai.

Limbah Metal dan plastik dapat dipisah

Basics ALAT SUNTIK yang baik:

asb0108

Bahan utama : “Biomaterial”

Bahan bagian yang lain : polypropylene medical

grade dan stainless steel surgical grade

“Mandrin” aman dari luka tusuk dan Blood Splatter

• Phlebitis adalah Komplikasi IV Catheter yg paling sering

• Bahan “Biomaterial” mengurangi phlebitis s/d 46%

• Bahan Biomaterial mengurangi kerusakan ujung kateter s/d 50%

SOURCE : Gaukroger, P.B. et al, Infusion Thrombophlebitis: A prospective comparison, Anaesth Intens care (1988), 16, 265-271

Basics for IV Catheter

asb0108

Bahan utama : “Full Cotton”

Technology : “Full aluminum foil” dg “heat-resistant

lining” di bagian luar dan diproses secara vakum

Bahan desinfektans : Isopropyl alcohol/Acohol +

Iodine / Alcohol + Chlorhexidine

Basics for Alcohol Swabs

Basics for “Electronic Diagnostics”

Material : Industrial NOT General OR Household

Micro-voltage & “Full Insulation” (techno)

Clear guide for maintenance & calibration

25,000 hours LCD ; Error Margin max 3% (techno)

Use ONLY Manufacturer’s Accessories (material)

Kamar Pasien Bebas Resiko Jatuh

USE of “Geo-textile” fabrics to help stop (Covid-19) Infection (material)

Reduces cross-contamination between health staff & patient

Use for : APD & Masker

(Surgical & Medical)

Use of disposable “drapes” for Patient & Health Worker safety (material)

Disposable Roll Periksa

OUTPATIENT

Disposable Bed Sheets and Pillow Cover

INPATIENT

SURGICAL

Disposable drapes for surgery

Use Information Technology to Reduce Error

(e-Medicine / e-Health)

• Computerized Physician Order

Entry (CPOE): very effective in

reducing errors.

• Medications & Diagnostic orders

entered DIRECTLY on to a Tablet

connected to a computer network,

NOT written or done verbally.

DIMANA & KAPAN Safety Device?

HARUS (“Segera”) : 1. UGD 2. ICU 3. OK

4. Poliklinik, 5. Laboratorium (Klinik/Mikro/Rad.)

6. Bangsal Bedah 7. Bangsal Paediatri

Sebaiknya juga segera… 1. VIP Unit* 2. Bagian Gizi

Baru kemudian…. Semua Bangsal/Unit Pelayanan

asb0108

• Fokus pada alat habis pakai/consumables

(Syringes, Alcohol Swabs, Gloves, APD, IV Catheter,

dll) dan alat dengan “High Capital Investment”

(Diagnostik, Transport, Infrastructure, dll)

• Fokus pada Unit kerja dengan “high work

pressure”, “high infection-risk” dan “high image-

&-legal-risk” (UGD, ICU, OK, Poli, Lab, Bangsal

Paediatri, Bedah dan VIP)

Segera LAKUKAN Device Value Audit (DVA)

asb0108

Langkah Langkah Device Value Audit

Apakah KTD Terkait dg Peralatan?

(RCA)

Peralatan SUDAH Safety?

Teruskan RCA utk mencari

Penyebab Mendasar

KTD!

SEGERA LAKUKAN

DVA!

YA!

TIDAK

MONITOR (HAI/BSI/NSI)

and REVIEW

YA!

BELUM FOKUS PADA Unit:

HIGH RISKS for: Infections,

Image, Legal

HIGH in: Usage/Consumables,

Work-Pressure, Capital Investment.

LAKUKAN Laporan KTD/NSI, RCA, FMEA, Risk Grading dll

KTD krn Alat?

KTD krn Cara Pakai?

Pemakaian Safety Device mencegah KTD dan mengurangi biaya total RS dengan mencegah risiko pemborosan biaya pelayanan/pengobatan dan biaya akibat KTD!

asb0108

Good Luck!

samharib@yahoo.com

0857-1923-8100

Semoga bermanfaat,

terimakasih, and