PowerPoint Presentation
Dr. Nico A. Lumenta, K.Nefro, MM, MHKesKomisi Akreditasi Rumah
Sakit
Konsep Filosofis Asuhan PasienProfesional Pemberi Asuhan Tim
InterdisiplinInterprofessionality : Kolaborasi, Kompetensi
InterprofesionalAsuhan TerintegrasiPasien-Keluarga EngagementCase
ManagerBPISPatient Centered CareStandar Induk dalam Akreditasi
RSTrend global dalam Asuhan Pasien
CURRICULUM VITAENama: Dr. Nico A. Lumenta, K.Nefro, MM, MHKes
Lahir: Magelang, 5 Nov 1943 Alamat: Jl. Kayu Mas I/4, Pulo Mas,Jkt
TimurPendidikan: Dokter, 1970, FK.UKI, Jakarta Konsultan Nefrologi
(Ginjal-Hipertensi) 1982, Pernefri (Perhimpunan Nefrologi
Indonesia)Magister Manajemen, 1994, Sekolah Tinggi Manajemen PPM,
Jkt.Magister Hukum Kesehatan, 2013, Unika Soegijapranata,
SemarangJabatan RS : RS Mediros : Ketua Komite Medis, Koordinator
KSM PD.Ginjal-Hipertensi Organisasi:KARS Kepala Bidang Publikasi
& Pemasaran 2014 - 2018KARS (Komisi Akreditasi Rumah Sakit) Dep
Kes RI : Ketua Bidang Akreditasi 2011-2014, Surveior / Pembimbing
Akreditasi sejak 1995Member Advisory Council Asia Pacific, Joint
Commission International, sejak 2009
KARS Dr.Nico Lumenta2Ketua KKP-RS (Komite Keselamatan Pasien
Rumah Sakit)-PERSI 2005-2012Wakil Ketua Komite (Nasional)
Keselamatan Pasien RS 2012-2015Ketua IKPRS (Institut Keselamatan
Pasien Rumah Sakit) - PERSI 2012-2015Pengurus PERSI Pusat, Ketua
Kompartemen Akreditasi Nasional, 2012-2015PJ SubPokja Model
Akreditasi Baru, Pokja Penyempurnaan Akreditasi RS, DitJen Bina Yan
Med, 2010-2011Penghargaan: Kadarman Award 2007 (untuk Patient
Safety), Sekolah Tinggi Manajemen PPMLain-lain :Sekretaris Jendral
PERSI Pusat 19881990, 19901993, 19931996Direktur Ketua
RS.PGI.Cikini, Jakarta, 1983 1993Dekan Fakultas Kedokteran UKI,
1988 1991 Kepala Bagian Ilmu Penyakit Dalam FK-UKI, Jakarta, 1992 -
1995 Kepala Renal Unit (Unit Ginjal) RS.PGI Cikini, 1973 1981 KARS
Dr.Nico Lumenta3Tujuan utama pelayanan kesehatan Rumah Sakit adalah
Pelayanan/Asuhan pasien.Core Business RS = Patient Care(Standar
Pelayanan Pasien -PP/COP)Asuhan Pasien(Patient Care)Cure CareCARE =
Commitment Attention Respons Empathy KARS Dr.Nico Lumenta4Dalam
konteksAsuhan Pasien (Patient Care) PCC merupakan induk dari
Standar Akreditasi Rumah Sakit v. 2012KARS Dr.Nico Lumenta!56Bab 1.
APK Akses ke Pelayanan dan Kontinuitas PelayananBab 2. HPK Hak
Pasien dan KeluargaBab 3. AP Asesmen PasienBab 4. PP Pelayanan
PasienBab 5. PAB Pelayanan Anestesi dan BedahBab 6. MPO Manajemen
dan Penggunaan ObatBab 7. PPK Pendidikan Pasien dan
KeluargaPCCPFPKARS Dr.Nico LumentaPicker Institute and Harvard
Medical School researchers conducted thousands of interviews to
understand just what matters most to patients in the healthcare
experience. That research revealed the Eight Dimensions of
Patient-Centered Care National Research Corp.
www.nationalresearch.com. March, 2014
There is no one type of patient and no single way of treating
everyone.Moreover, every patient has a different view on the
quality of his meal or her environment.But there is a way to be
sure each patient gets the care needed in a nurturing environment
by providing care that consciously adopts the patients
perspective.7Sistem 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
DokumenImplementasiTataKelola RS & TataKelola Klinis dlm
perspektif Std Akred 2012UU 44/2009 ttg RS, Peraturan Per UU an
lainnyaPCC4 FondasiAsuhan pasienPelayananFokus Pasien(Patient
CenteredCare)ManajemenRisiko RS Risiko KlinisAsuhan MedisAsuhan
KeperawatanAsuhan GiziAsuhan ObatEvidence Based MedicineValue Based
Medicine(Nico A Lumenta & Adib A Yahya, 2012)Standar Pelayanan
Pasien : Tujuan utama pelayanan kes RS adalah pelayanan
pasien.Konsep FilosofisAsuhan pasien(Patient
care)EBMVBMEtikKebutuhanPasienMutuPatientSafetyPola24Safety is a
fundamental principle of patient care and a critical component of
Quality Management. (World Alliance for Patient Safety, Forward
Programme, WHO, 2004)KARS Dr.Nico Lumenta9Procedures 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.PATIENT
CENTERED CAREHarvey Picker( 1915 2008)He was the founder of the
Boston-based Picker Institute, whose goal is to promote
patient-centered healthcare.The term patient-centered care was
coined by Harvey Picker, 1988He believed that the American health
care system was technologically and scientifically outstanding, but
overall was not sensitive to patients' concerns and their comfortIn
The Year 1986, they founded the Picker Institute, dedicated to
developing a patient-centered approach to healthcare
Standar AkreditasibaruFokus PasienQuality & Safetyof Patient
CareISQuaPatientCentered CareKARS Dr.Nico Lumenta10KARS Dr.Nico
Lumenta
(McAdam, S : Transitioning to PCC to Improve Quality, HMA 2013,
Bangkok)1988:The term patient-centered care was coined by Harvey
Picker11Six aims for improvement health care systemInstitute of
Medicine : Crossing the Quality Chasm: A New Health System for the
21st Century, 2001Safe. Effective. Patient-centered. Timely.
Efficient.Equitable.Safe. Avoiding injuries to patients from the
care that is intended to help them.Effective. Providing services
based on scientific knowledge to all who could benefit and
refraining from providing services to those not likely to benefit
(avoiding underuse and overuse, respectively).Patient-centered.
Providing care that is respectful of and responsive to individual
patient preferences, needs, and values and ensuring that patient
values guide all clinical decisions.Timely. Reducing waits and
sometimes harmful delays for both those who receive and those who
give care.Efficient. Avoiding waste, including waste of equipment,
supplies, ideas, and energy.Equitable. Providing care that does not
vary in quality because of personal characteristics such as gender,
ethnicity, geographic location, & socioeconomic status.Enam
elemen ini dilahirkan oleh IHI Institute for Helathcare
ImprovementPublikasi pertama PCC oleh IOMWHO menjadikan 6 elemen
ini sbg definisi mutu pelayanan kesehatanKARS Dr.Nico
Lumenta12MANAJEMEN RISIKORUMAH SAKITKARS Dr.Nico
Lumenta13Procedures 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.Roberta Caroll, editor : Risk
Management Handbook for Health Care Organizations, 4th edition,
Jossey Bass, 2004HospitalRiskManagementPatient RisksClinical Risk
MgtPatient SafetyMedical Staff RisksFinancial RisksProperty
RisksOther RisksEmployee RisksHospital Risk Management Categories
of Risk KARS Dr.Nico LumentaKategori Risiko di Rumah Sakit(
Categories of Risk )Patient care-related risksMedical staff-related
risksEmployee-related risksProperty-related risksFinancial
risksOther risksRoberta Caroll, editor : Risk Management Handbook
for Health Care Organizations, 4th edition, Jossey Bass, 2004KARS
Dr.Nico LumentaHospitalSafetyofThePatientofTheHealth CareWorkerof
TheFacilitiesof TheEnvironmentofTheBusinessScope of Hospital Risk
Management (revised) :KARS Dr.Nico Lumenta16Five for Life Five is
Life S1 : Safety for The Patient (no injury, blood-borne diseases,
iatrogenic diseases, infections etc)S2 : Safety for The HCW
(needle-stick injury)S3 : Safety for The Institution (preventing
litigations)S4 : Safety for The Environment (green product/no
pollution)S5 : Safety for The Business (sustainability- happy
patient, happy HCW, happy shareholder)17Proses Manajemen
RisikoKOMUNIKASI DAN KONSULTASIMONITOR DAN REVIEWTEGAKKAN
KONTEKSIDENTIFIKASI RISIKOANALISA RISIKOEVALUASI RISIKOKELOLA
RISIKOASESMEN RISIKORISK REGISTERKARS Dr.Nico
Lumenta17PATIENT-CENTREDCARE(PELAYANAN Fokus PASIEN)BPISKARS
Dr.Nico Lumenta18Procedures 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.Patient-Centered CareIOM 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 klinisDefinisiKARS Dr.Nico LumentaPicker
Institute :Respect for patients values, preferences and expressed
needsCoordination and integration of careInformation communication
and educationPhysical comfortEmotional support and alleviation of
fear and anxietyInvolvement of family and friendsContinuity of care
and smooth transitionAccess to CareHormati nilai2, pilihan dan
kebutuhan yg diutarakan oleh pasienKoordinasi dan integrasi
asuhanInformasi, komunikasi dan edukasiKenyamanan fisikDukungan
emosional dan penurunan rasa takut & kecemasanKeterlibatan
keluarga & teman2Asuhan yg berkelanjutan dan transisi yg
lancarAkses thd pelayanan.KARS Dr.Nico LumentaAsuhan PasienModel
TraditionalAsuhan PasienModelPatient Centered CareKARS Dr.Nico
Lumenta21DokterPerawatApotekerFisioterapisAhliGiziLainnyaRadiograferPasienDokter
merupakan PUSAT / UNIT SENTRAL dalam Model Tradisional asuhan
pasien, tetapi..Patient safety tidak terjamin !!Dokter = Captain of
the ship Model Tradisional Asuhan
PasienAnalisBarrierDiseasecenteredcareKARS Dr.Nico Lumenta(Medical
paternalism)Pada model ini terkondisi adanya 2 Kubu, potensi
konflik lebih tinggi !!(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 Wake-up Call.bagi dunia
pelayanan kesehatan.Patient safetytidak terjamin !!KARS Dr.Nico
Lumenta23(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 safetytidak terjamin !!KARS Dr.Nico Lumenta (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 !!)!KARS Dr.Nico Lumenta
The risk of being killed in a hospital due to medical error is
around one in 300Hospitals 'more dangerous' than air travelIf you
feel safer in hospital than on a airplane, think again.in a
developed countrythe risk of dying in an air accident is one in 10
million, New York Times, July 04KARS Dr.Nico Lumenta26
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
WHOInsidenKeselamatan PasienKARS Dr.Nico Lumenta27As 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.Sistem
ManajemenSistem Pelayanan Klinis Asuhan Pasien / Patient Care
Quality & SafetyPASIENProfesi Pemberi Asuhan :Dokter, Perawat,
Staf Klinis lainnyaJajaran ManajemenLatent FailureActive
FailureUnsafe ActPemilikAsuhan PasienModel TraditionalAsuhan
PasienModelPatient Centered CareKARS Dr.Nico
Lumenta29Pasien,KeluargaPerawat/BidanApotekerAhliGiziDPJPModel
Patient Centered Care(Interdisciplinary Team Model
Interprofessional Collaboration)Lainnya1. Pasien adalah pusat
pelayanan, Pasien adalah bagian dari Tim2. Nakes PPA (Profesional
Pemberi Asuhan), merupakan Tim Interdisiplin, diposisikan di
sekitar pasien, tugas mandiri, delegatif, kolaboratif, kompetensi
memadai, sama penting / setara pd kontribusi profesinya3. DPJP :
sebagai Clinical Leader, melakukan Koordinasi, Review, Sintesis,
Interpretasi, Integrasi asuhan komprehensifClinical/Team
LeaderKoordinasiKolaborasiSintesisInterpretasiIntegrasi asuhan
komprehensifFisioterapisPsikologiKlinisPenataAnestesiPada model ini
terkondisi hanya 1 Kubu, potensi konflik rendahNakes
ProfesionalPemberi Asuhan Asesmen Pasien (Skrining, Periksa
Pasien)Informasi dikumpulkan : Anamnesa, pemeriksaan, pemeriksaan
lain / penunjang, dsbAnalisis informasi : dihasilkan Diagnosis /
PRoblem / Kondisi, identifikasi Kebutuhan Yan PasienRencana
Pelayanan/Care Plan : untuk memenuhi Kebutuhan Yan PasienProses
Asuhan PasienPatient CareImplementasi Rencana/Pemberian
PelayananMonitoringAsesmen UlangTugas Mandiri2 blok
kegiatan31SOAPIAR1. Asesmen Pasien IARInformasi DIKUMPULKAN :
anamnesa, pemeriksaan fisik, pemeriksaan lain / penunjang, dsbStd
AP 1
Analisis informasi : menghasilkan kesimpulan a.l. Masalah,
Kondisi, Diagnosis, untuk mengidentifikasi kebutuhan pelayanan
pasienStd APK 1, 1.1.1, 1.1.2, 3, 4, AP 1.3, 1.3.1, 1.2. EP 4, 1.9,
1.11, 4.1, PP 7.Rencana Pelayanan / Plan of Care, untuk memenuhi
kebutuhan pelayanan pasienStd PP 2 EP 1, PP 2.1, 5, Std AP 2, PAB
5, 7, 7.4.32Proses Asuhan Pasien2 blok proses, oleh masing2 PPA2.
ImplementasiMonitoringPemberian pelayanan/asuhan, pelaksanaan
rencana, beserta monitoringnyaStd PP 2, EP 2, PP 5 EP 2 & 3,
PAB 3 EP 5, 5.3, 6, 7.3, SOAPIARDignity 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.
What are the Core Concepts of Patient Centered 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 2008KARS Dr.Nico LumentaSisiPasienMartabat dan Respek.
Profesional Pemberi Asuhan mendengarkan, menghormati &
menghargai pandangan serta pilihan pasien & keluarga.
Pengetahuan, nilai-nilai, kepercayaan, latar belakang kultural
pasien & keluarga dimasukkan dlm perencanaan pelayanan dan
pemberian pelayanan kesehatanBerbagi informasi. Profesional Pemberi
Asuhan mengkomunikasikan dan berbagi informasi secara lengkap
pasien & keluarga. Pasien & keluarga menerima informasi
tepat waktu, lengkap, dan akuratAsesmen : metode, substansi /
kebutuhan edukasi, konfirmasi Partisipasi. Pasien & keluarga
didorong dan didukung utk berpartisipasi dlm asuhan dan pengambilan
keputusan / pilihan merekaKolaborasi / kerjasama. Pimpinan
pelayanan kesehatan bekerjasama dgn pasien & keluarga dalam
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 2008What are the Core Concepts of Patient
Centered Care?SisiPasienKARS Dr.Nico LumentaInterdisciplinary Team
Profesional Pemberi Asuhan diposisikan mengelilingi
pasienKompetensi yang memadai Berkontribusi setara dalam fungsi
profesinyaTugas mandiri, kolaboratif, delegatif, bekerja sebagai
satu kesatuan memberikan asuhan yang
terintegrasiInterprofessionalityInterprofessional
CollaborationInterprofessional EducationInterprofessional
Collaborative Practice CompetencyDPJP adalah Clinical Leader. DPJP
melakukan koordinasi, sintesis, review dan mengintegrasikan asuhan
pasienPersonalized Care & BPIS (Bila Pasien Itu Saya) Keputusan
klinis selalu diproses berdasarkan juga nilai-nilai pasienSetiap Dr
memperlakukan pasiennya sebagaimana ia sendiri ingin
diperlakukan(Sintesis berbagai refernsi, 2014)Core Concepts of
Patient Centered CareKARS Dr.Nico LumentaSisiProfesionalPemberi
AsuhanPatient- and family-centered care is a change in thinking
from serving patients and families to partnering with patients and
families. And thats a very big difference !!Senior Vice President,
Patient and Family Centered Care, MCG Health SystemKARS Dr.Nico
Lumenta(Strategies for Leadership, ADVANCING THE PRACTICE OF
Patient- and Family-Centered Care, A Resource Guide for Hospital S
enior Leaders, Medical Staff and Governing Boards. American
Hospital Association and Institute for Family Centered Care,
2004)36Interprofessional Collaboration (IPC)When multiple health
workers from different professional backgrounds work together with
patients, families, carers, and communities to deliver the highest
quality of care InterprofessionalityInterprofessional Education
(IPE)When students from two or more professions learn about, from
and with each other to enable effective collaboration and improve
health outcomesThe World Health Organization recognizes
interprofessional collaboration in education and practice as an
innovative strategy that will play an important role in mitigating
the global health crisis.We know that interprofessional
collaboration is key to providing the best in patient care.
(Framework for Action on Interprofessional Education &
Collaborative Practice, WHO, 2010)Sisi Prof. PemberiAsuhanKARS
Dr.Nico Lumenta37STANDAR KOMPETENSI DOKTER INDONESIAKonsil
Kedokteran Indonesia 2012
Area Kompetensi
Profesionalitas yang luhurMawas Diri dan Pengembangan
DiriKomunikasi EfektifPengelolaan InformasiLandasan Ilmiah Ilmu
KedokteranKetrampilan KlinisPengelolaan Masalah Kesehatan
KARS Dr.Nico LumentaSisi PemberiAsuhan : DrC. Penjabaran
KompetensiProfesionalitas yang Luhur Area Kompetensi1.1. Kompetensi
Inti1.2. Lulusan Dokter Mampu : 1. Berke-Tuhan-an (Yang Maha Esa/
Yang Maha Kuasa)2. Bermoral, beretika, dan berdisiplin3. Sadar dan
taat hukum4. Berwawasan sosial budaya5. Berperilaku
profesionalMenunjukkan karakter sebagai dokter yg
profesionalBersikap dan berbudaya menolongMengutamakan keselamatan
pasienMampu bekerja sama intra- dan inter- profesional dalam tim
pelayanan kesehatan demi keselamatan pasienMelaksanakan upaya
pelayanan kesehatan dalam kerangka sistem kesehatan nasional dan
global.STANDAR KOMPETENSI DOKTER INDONESIAKonsil Kedokteran
Indonesia 2012KARS Dr.Nico Lumenta39
(Framework for Action on Interprofessional Education &
Collaborative Practice, WHO, 2010)KARS Dr.Nico Lumenta
Interprofessional Education Collaborative Expert Panel. Core
competencies for interprofessional collaborative practice: Report
of an expert panel. Washington, D.C.: Interprofessional Education
Collaborative, (2011)KARS Dr.Nico Lumenta
(Framework for Action on Interprofessional Education &
Collaborative Practice, WHO, 2010)KARS Dr.Nico Lumenta
KARS Dr.Nico LumentaInterprofessional Education
Interprofessional Collaborative Practice Competency
DomainsInterprofessional Education Collaborative Expert Panel..
Core competencies for interprofessional collaborative practice:
Report of an expert panel. Washington, D.C.: Interprofessional
Education Collaborative, (2011)KARS Dr.Nico Lumenta44Kompetensi
dalam Kolaborasi InterprofesionalInterprofessional Education
Collaborative Expert Panel.. Core competencies for
interprofessional collaborative practice: Report of an expert
panel. Washington, D.C.: Interprofessional Education Collaborative,
(2011)Ranah Kompetensi 1:Values/Ethics for Interprofessional
PracticeBekerja bersama Nakes dari profesi lain untuk memelihara
iklim saling respek (menghormati) dan berbagi nilai2.Ranah
Kompetensi 2:Roles/ResponsibilitiesMenggunakan pengetahuan dari
peran masing2 guna memperoleh dan mengatasi kebutuhan layanan
kesehatan dari pasien dan populasi yang dilayani.Ranah Kompetensi
3:Interprofessional CommunicationBerkomunikasi dengan pasien,
keluarga, komunitas, dan profesional kesehatan lain dengan cara
yang responsif dan bertanggung jawab yang mendukung suatu
pendekatan tim dalam pemeliharaan kesehatan serta pengobatan
penyakit.Ranah Kompetensi 4:Teams and TeamworkMenerapkan nilai2
membangun-relasi dan prinsip2 dinamika tim untuk kinerja efektif
dalam tim dgn peran yang berbeda untuk merencanakan dan memberikan
asuhan berfokus pasien-/populasi yang aman, tepat waktu, efisien,
dan wajar.(10)(9)(8)(11)(38)45VE1. Tempatkan minat pasien /
populasi di pusat pemberian asuhan nakes yang interprofesional VE2.
Hormati martabat dan privasi para pasien sambil menjaga
konfidensialitas dalam pemberian asuhan berbasis tim. VE3.
Rangkullah keberagaman kultural dan perbedaan individual yang
menjadi ciri pasien / populasi, dan tim nakes.VE4. Hormati keunikan
budaya, nilai2, peran / tanggung jawab, dan expertise dari nakes
lain.VE5. Bekerjasamalah dengan mereka yang menerima asuhan, mereka
yang memberikan asuhan, dan orang2 lain yang berkontribusi untuk
dan mendukung pencegahan dan pelayanan kesehatan.Ranah Kompetensi
1: Nilai2 / Etika untuk Praktek Interprofesional(10)46Ranah
Kompetensi 2: Peran / Tanggung JawabRR1. Komunikasikan secara jelas
peran & tanggung jawab anda kepada pasien, keluarga, dan
profesional lain.RR2. Kenali keterbatasan anda dalam ketrampilan,
pengetahuan, dan kemampuan.RR3. Ajak berbagai tenaga profesional
kesehatan yang melengkapi expertise profesional anda, maupun
sumber2 yang terkait, untuk mengembangkan strategi dalam memenuhi
kebutuhan asuhan pasien yang spesifik.RR4. Jelaskan peran dan
tanggung jawab pemberi asuhan lain dan bagaimana tim bekerja sama
dalam memberikan asuhan.RR5. Gunakan sepenuhnya cakupan
pengetahuan, ketrampilan, dan kemampuan profesional kesehatan yang
tersedia maupun nakes dalam memberikan asuhan yang aman, tepat
waktu, efisien, efektif, dan wajar.(9)47Ranah Kompetensi 3:
Komunikasi InterprofesionalCC1. Pilih alat dan tehnik komunikasi
yang efektif, termasuk sistem informasi dan teknologi komunikasi,
untuk memfasilitasi diskusi dan interaksi yang meningkatkan fungsi
tim.CC2. Kelola dan komunikasikan informasi dengan pasien,
keluarga, dan anggota tim pelayanan kesehatan dalam bentuk yang
bisa dimengerti, sedapat mungkin menghindari istilah yang
spesifik.CC3. Nyatakan pengetahuan dan pendapat anda kepada anggota
tim yang terlibat dalam asuhan pasien, dengan percaya diri, jelas,
dan respek, dan bekerja untuk memastikan pengertian yang sama
terhadap informasi dan pengobatan serta keputusan pola asuhan yang
diambil.(8)48Ranah Kompetensi 4: Tim dan Kerjasama TimTT1. Jelaskan
proses pembentukan tim dan peran serta praktik dari tim yang
efektif.TT2. Kembangkan konsensus atas prinsip2 etis untuk memandu
semua aspek dari asuhan pasien dan kerjasama tim.TT3. Ajak
profesional kesehatan lain-yang tepat bagi situasi asuhan yang
spesifik dalam pemecahan masalah berfokus pasien.TT4. Integrasikan
pengetahuan dan pengalaman dari profesi lain yang tepat bagi
situasi asuhan yang spesifik untuk menginformasikan keputusan
asuhan, sambil menghormati nilai2 pasien / komunitas dan prioritas
/ preferensi asuhan. TT5. Terapkan praktek2 kepemimpinan yang
mendukung praktek kolaboratif dan efektivitas tim.(11)49Principles
of the interprofessional competenciesPatient/family centered
(hereafter termed patient centered)Community/population
orientedRelationship focusedProcess orientedLinked to learning
activities, educational strategies, and behavioral assessments that
are developmentally appropriate for the learnerAble to be
integrated across the learning continuumSensitive to the systems
context/applicable across practice settingsApplicable across
professionsStated in language common and meaningful across the
professionsOutcome drivenInterprofessional Education Collaborative
Expert Panel. Core competencies for interprofessional collaborative
practice: Report of an expert panel. Washington, D.C.:
Interprofessional Education Collaborative, (2011)KARS Dr.Nico
Lumenta50Professional CompetencyInterprofessional
CompetencyBehavioral demonstrations of an integrated set of
knowledge, skills, and attitudes that define the domains of work of
a specific health profession applied in specific care
contextsBehavioral demonstrations of an integrated set of
knowledge, skills and attitudes for working together across the
professions, with other health care workers, and with
patients/families / communities / populations to improve health
outcomes in specific care contextsKARS Dr.Nico Lumenta51
INSTITUTIONAL SUPPORT MECHANISMSWORKING
CULTUREMECHANISMSENVIRONMENTAL MECHANISMSFigure 8.Examples of
mechanisms that shape collaboration at the practice levelKARS
Dr.Nico Lumenta52Elements of collaborative practice
(Kasperski M. Implementation strategies: Collaboration in
primary care - family doctors and nurse practitioners delivering
shared care. Toronto, ON: Ontario College of Family Physicians,
2000)KARS Dr.Nico LumentaTanggung jawab - ResponsibilityAkuntabel -
AccountabilityKoordinasi - CoordinationKomunikasi -
CommunicationKerjasama - CooperationAsertif - AssertivenessOtonomi
- AutonomyPercaya & Respek- Mutual trust and respect
53Collaborative practice can decrease:total patient
complicationslength of hospital staytension and conflict among
caregiversstaff turnoverhospital admissionsclinical error
ratesmortality rates(Framework for Action on Interprofessional
Education & Collaborative Practice, WHO, 2010)
KARS Dr.Nico Lumenta54Patient- and family-centered care is a
change in thinking from serving patients and families to partnering
with patients and families. And thats a very big difference.(Senior
Vice President, Patient and Family Centered Care, MCG Health
System. Strategies for Leadership, ADVANCING THE PRACTICE OF
Patient- and Family-Centered Care, A Resource Guide for Hospital S
enior Leaders, Medical Staff and Governing Boards. American
Hospital Association and Institute for Family Centered Care,
2004)KARS Dr.Nico Lumenta
(Partnering with patients to drive shared decisions, better
value, and care improvement. INSTITUTE OF MEDICINE, 2014)Sisi
Pasien55KARS Dr.Nico Lumenta
Patient Activation Measurement
ActivatedPatientsPasienPasifPasrah56KARS Dr.Nico
LumentaPatient-Centered Care: Empowerment and Engagement
(Partnering with patients to drive shared decisions, better
value, and care improvement. INSTITUTE OF MEDICINE,
2014)57Pasien,KeluargaFisioterapisPerawatApotekerAhliGiziAnalisRadiograferDPJPManajer
Pelayanan PasienCase ManagerClinical/Team LeaderReview AsuhanSecara
kolaboratif melakukan sintesa & integrasi asuhan
pasienLainnyaKARS Dr.Nico
LumentaMPPCaseManagerDokterKeluargaYanKeuangan/BillingAsuransiPerusahaan/EmployerBPJSYan
Kes/ RS LainKARS Dr.Nico LumentaDunn,N : Practical Issues Around
Putting The Patient in Centre of Care, J R Soc Med.Jul
2003Bensberg, M :Patient Centred Care Literatur Review, Dandenong
District Division of General Practice, October 2007
59Barrier to Patient Centered Care :
Pasien Kurang percaya diri bertanyaTidak cukup pengetahuan utk
analisis informasiStatus social-ekonomiDokter/StafKurang waktu,
impracticalMotivationTidak terlatih menangkap ekspresi pasien ttg
nilai, ide, perasaanSulit diimplementasi, tidak jelas akan adanya
perbaikan outcomeKARS Dr.Nico LumentaDunn,N : Practical Issues
Around Putting The Patient in Centre of Care, J R Soc Med.Jul
2003Bensberg, M :Patient Centred Care Literatur Review, Dandenong
District Division of General Practice, October 200760
A large number of variables potentially influence a doctors
propensityto be patient centred. (Mead and Bower, 2000). Beberapa
elemen pokok untuk keberhasilan RS menerapkan / melaksanakan asuhan
berfokus pasien / PCC adalah :Komitmen kuat senior
leadershipKomunikasi yang jelas tentang visi
strategis,Keikutsertaan aktif dengan pasien dan keluarga di seluruh
RS,Fokus terhadap kepuasan staf,Penilaian dan umpan balik secara
aktif dalam pelaporan pengalaman pasien,Sumber yg adekuat untuk
redesain pemberian asuhan,Capacity building staf,Akuntabilitas dan
insentif Budaya yang kuat mendukung perubahan dan
pembelajaran.Promoting Patient-centered Care(Luxford,K.,
Safran,DG., Delbanco,T . Promoting patient-centered care: a
qualitative study of facilitators and barriers in healthcare
organizations with a reputation for improving the patient
experience. Journal for Quality in Health Care, vol 23, 2011)
Partnering with Patients and Families to Design a Patient and
Family-Centered Health Care System. Johnson, B et al. Institute for
Family-Centered Care 2008The MCG Health System in Augusta, Georgia.
Member University HealthSystem ConsortiumSetelah PCC diterapkan
secara penuhKARS Dr.Nico LumentaPasien = Pusat dalam proses asuhan
pasien (patient care) PCC Patient Centered CareKonsep inti PCC :
Sisi Pasien : Martabat & Respek, Informasi, Partisipasi,
KolaborasiSisi PPA : Tim Interdisiplin, Kolaborasi
Interprofesional, DPJP Clinical Leader, Personalised
care-BPISProfesional Pemberi Asuhan (PPA) diposisikan mengelilingi
Pasien, menghormati dan responsif terhadap pilihan, kebutuhan &
nilai-nilai pribadinyaPPA Tim Interdisiplin, dgn kompetensi
memadai, termasuk Interproffesional Competency, dgn Kolaborasi
Interprofesional (Interproffesional Collaboration), memberikan
kontribusi profesinya yg setara. Tugas mandiri, delegatif dan
kolaboratifKARS Dr.Nico LumentaRingkasan Ciri Pokok PCC64DPJP
adalah sbg Clinical/Team Leader : kerangka pokok asuhan pasien,
review-sintesa-integrasi asuhanPPA melakukan komunikasi-edukasi
lengkap & adekuat ke Pasien-Keluarga sehingga paham secara
komprehensif & adekuatPasien & keluarga adalah Mitra PPA
bagian dari tim : mereka ikut memilih alternatif ikut merasa
memiliki keputusan ikut bertanggungjawab Dalam konteks PCC, Manajer
Pelayanan Pasien / Case Manager (berbasis klien) menjaga
kontinuitas pelayanan serta kendali mutu biaya utk memenuhi
kebutuhan Ps dan keluargaKARS Dr.Nico LumentaRingkasan Ciri Pokok
PCC65Pada model asuhan pasien yang tradisional, Dokter merupakan
pusat dari asuhan pasien, sebagai Captain of the ship, namun
patient safety belum terjaminAsuhan pasien terdiri dari 4 pilar :
Etik, Kebutuhan Pasien, Mutu-Keselamatan Pasien, EBM-VBM, dpayungi
oleh Manajemen Risiko RS dan PCCPada model PCC, pasien adalah
pusat, profesional pemberi asuhan (PPA) diposisikan mengelilingi /
melayani pasien, & semua PPA tsb berkolaborasi dlm fungsi yg
setara, sehingga disebut Interdisciplinary team dgn Kolaborasi
Interprofesional. Dr adalah Team Leader / Coach. Pasien memperoleh
asuhan yg terbaik & bermanfaat bagi pasienPCC dalam pelaksanaan
asuhan pasien, masih belum dipahami sepenuhnya, belum sepenuhnya
dihargaiDengan PCC terjadi perubahan mendasar dlm cara Manajemen
RS. Saat ini PCC merupakan Mainstream model, sdh menjadi Trend
global pelayanan kesehatan di Rumah Sakit di duniaDisadari atau
tidak, akar masalah arus pasien keluar negeri adalah karena belum
sepenuhnya RS di Indonesia menerapkan PCCStandar Akreditasi RS
v.2012 mengharuskan & mengoptimalkan penerapan PCCTerapkan PCC
langkah demi langkah - one step at a timeKesimpulanKARS Dr.Nico
LumentaKepuasan PasienSistem ManajemenSistem Pelayanan Klinis
Asuhan Pasien / Patient Care Quality & SafetyPASIEN
ProfesionalPemberiAsuhanManajemenPasienPerawatApotekerFisioterapisAhliGiziRadiograferPasienDokterAnalisBPISEnthusiatic
PatientLainnyaKODEKI Pasal 18Setiap Dr memperlakukanteman
sejawatnyasebagaimana ia sendiri ingin diperlakukanPasien(BPISBila
Pasien Itu Saya)KARS Dr.Nico Lumenta
Dr. Nico A. Lumenta, K.Nefro, MM, MHKesKomisi Akreditasi Rumah
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