AUDIT PELAYANAN RADIOTERAPI

Daksa Ganapati
Perhimpunan Dokter Spesialis Onkologi Radiasi Indonesia (PORI)
 Disclaimer
Bahan – bahan pada Presentasi ini berasal dari :
- International Atomic Energy Agency (IAEA)
- Perhimpunan Dokter Spesialis Onkologi Radiasi Indonesia (PORI)

DAKSA_GANAPATI
 SITUASI PENYAKIT KANKER
DI INDONESIA

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KANKER
 Adanya peningkatan angka KEJADIAN DAN
KEMATIAN akibat KANKER
 Sebanyak 8,2 JUTA orang meninggal akibat KANKER
(DATA GLOBOCAN 2012), dan 60% terjadi di negara
berkembang
 INDONESIA memiliki PREVALENSI 5 TAHUN
KANKER no 2 di ASIA, dengan 330-508 kasus per
100.000 penduduk.

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 KANKER di BALI,NTB,& NTT

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 PENANGANAN KANKER

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PENANGANAN KANKER

PREVENTIF DEFINITIF

PALIATIF

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PENANGANAN KANKER

PEMBEDAHAN

MULTI
DISIPLIN
KEMOTERAPI RADIASI

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 PERAN RADIOTERAPI

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 Roles of Radiotherapy

60 % PASIEN KANKER AKAN

MEMERLUKAN TINDAKAN
RADIASI

Slide Prof Soehartati G, Sp.Rad (K) Onk.Rad

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 Memberikan dosis maksimal
pada jaringan tumor, dan dosis
minimal pada jaringan sehat.

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 RADIOTERAPI DI INDONESIA

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PENANGANAN
• 52 – 60 % penderita kanker
memerlukan TERAPI
PEMBEDAHAN
RADIASI / RADIOTERAPI*
• IDEAL : 1 Mesin / Pesawat
RADIASI untuk 1 Juta
RADIASI
KEMOTERAPI RADIASI
PENDUDUK
• INDONESIA (saat ini) : 1
Mesin untuk 3.5 Juta
Penduduk

The role of radiotherapy in cancer treatment: estimating optimal utilization

from a review of evidence-based clinical guidelines.
Delaney G1, Jacob S, Featherstone C, Barton M

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 MEGAVOLTAGE PER MILLION POPULATION, 2017(Now)

North Sumatera
3 Centers East Kalimantan
4 Linacs 1 Centers
1 linac North Sulawesi
1 Centers
Riau 1 Cobalt
1 Centers
1 Linacs

West Sumatera
2 Centers
1 Linacs South Kalimantan
1 Cobalt 1 Centers
1 Cobalt
South Sumatera
1 Centers
1 Cobalt Jakarta South Sulawesi
9 Centers 2 Centers
15 Linacs 2 Linacs
1 Tomo Central Java
1 Cobalt 6 Centers
6 Linacs Bali
8 Cobalt 1 Centers
1 Cobalt
West Java
3 Centers
3 Linacs
2 Cobalt Summary :
14/34 Provinces has Radiotherapy Facilities
Yogyakarta East Java
5 Centers 37 Centres
Motivated 1 Centers
6 Linacs 61 RT Machines; 41 Linacs, 19 Cobalt,1 Tomo
2 Linacs
3 Cobalt

Slide Prof Soehartati G, Sp.Rad (K) Onk.Rad

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 RADIOTERAPI DI INDONESIA
KUANTITAS vs KUALITAS ???

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 AUDIT PELAYANAN

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DAKSA_GANAPATI
DAKSA_GANAPATI
 Radiotherapy
Is a complex
Radiotherapy Process
process Overview – safety ?
RO

RTT
RO
MEDICAL PHYSICS
RTT
NURSE

MP

Radiation
RTT Oncologist
GTV
CTV
PTV
RO-MP-RTT

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DAKSA_GANAPATI
 QUATRO
(Quality Assurance Team of Radiation Oncology)
 - Independen
 - Multidisiplin
 - Komprehensif
 - Penekanan pada STRUKTUR dan
PROSES,dengan hasil akhir peningkatan MUTU
BUKAN HASIL TERAPI

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QUATRO audits are NOT
 For regulatory purposes
Solely as an impartial source of advice
 For investigation of accidents or reportable medical events
(misadministration)
A more focused audit is needed
 To assess for entry into cooperative clinical research studies
A specific audit focused on adherence to specific protocol is needed.
•QUATRO
the process of RT is reviewed to
improve the practice
create the atmosphere of trust (!!),
NO BLAME POLICY
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 special expertise in the therapeutic
applications of ionizing radiation.

Radiotherapy
Is a complex process
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DAKSA_GANAPATI
 QUATRO
Comprehensive QA program

ACTPR

(Apakah Kita Melakukan Apa Yang Kita Katakan Kita Lakukan ??)
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STRUKTUR AUDIT
 Permintaan Audit :
 Sukarela
 Melengkapi formulir mengenai kondisi infrastruktur (Man, Material,
Method)
 Komposisi Tim Audit :
 Dokter Spesialis Onkologi Radiasi
 Fisikawan Medis Radioterapi
 Radioterapis (Radiotherapy Technician)
 Teknisi atau anggota yang memiliki kompetensi khusus

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 QUATRO
Comprehensive QA program

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An institution may request QUATRO audits
for.....
 Receiving assistance to improve clinical practice
 Strengthening their QA programme
 Receiving assistance to ensure that the requirements for
patient protection are met
 Documenting gaps in technology and practices in order
to solicit funding from national authorities or other
funding bodies, including the IAEA
 Serving as guidance for further departmental
development
 Support in an application to become an accredited
training centre for a region
 Seeking recognition as a centre of competence

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STRUKTUR AUDIT
 Persiapan Audit
 Departemen/Instalasi (Mempersiapkan Tujuan
Instalasi, Dokumen, Materi Dosimetri, Informasi,
Rekam Medis)
 Peran Auditor
 Peran Regulator (Kementerian, Organisasi Profesi)

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STRUKTUR wawancara, peninjauan,
AUDIT (Prinsip Pembukaan kajian prosedur &
dokumen, kesuaian SOP,
dan Prosedur observasi
Audit Penilaian
Penutupan
Kesimpulan
Tujuan, Kegiatan Audit, - Masalah
Fasilitas, Temuan,
Laporan Internal
Benchmarking, - Masalah
Kesimpulan, Eksternal
Rekomendasi, Lampiran

Distribusi Laporan

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INFRASTRUKTUR
 Aspek Departemen/Instalasi (Tujuan,Target,
Demografi pasien)
 Struktur Departemen/Instalasi

 Alur Komunikasi

 Sistem Manajemen Mutu

 Proteksi Radiasi (pasien, staf, dan masyarakat)

 Beban Kerja

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 Way for success of audit ………..
Provide material
requested for any
dosimetry audit
Prepare data and
Formulate
relevant
the
documentations
objectives of
the audit
Provide the
treatment records ROLE OF THE
requested by the
audit team* INSTITUTION
Provide any clinical records
Inform the entire
from outside the
department and Identify and ensure department deemed
hospital management participation of the relevant to the cases
of the audit and its time individuals needed for the reviewed*
frame audit*

* Note: The audit team may request evaluation of other records/staffs as necessary
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 Prosedur Terkait Pasien
 Identifikasi Pasien
 Diagnosis dan Stadium
 Indikasi dan Keputusan Terapi
 Informed Consent
 Persiapan Pelaksanaan Radiasi
 Preskripsi dan Perencanaan Radiasi
 Pemberian radiasi
 Penyimpangan dalam pemberian radiasi
 Resume
 Follow up

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DAKSA_GANAPATI
Peralatan
 Aspek terkait Fisika Medis

 Aspek terkait Radioterapis

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DAKSA_GANAPATI
DAKSA_GANAPATI
Pelatihan
 Akademik

 Klinis

 Penelitian

 Akreditasi Profesional

 Pendidikan Profesional Berkelanjutan

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Standardized Reporting
Form

 CONTACT INFORMATION
 PATIENT DEMOGRAPHIC
 DEPARTMENT STRUCTURE
 WORK LOAD
 HOSPITAL SUMMARY

DAKSA_GANAPATI
 The Way for successful audit ………..

AUDIT STRUCTURE FOR QUATRO MISSION

 REQUEST
 AUDIT TEAM
 PREPARATION
 GUIDING AND PROCEDURES
 CONCLUSION
 REPORT
 DISSEMINATION OF THE REPORT

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 Radiotherapy center of competence
 RT center capable of delivering sustainable
radiotherapy service to a good standard, achievable
in economic environment.
 RT center that can serve as a model for other
radiotherapy centers.
 A training center for professional training of staff
working in radiotherapy.

DAKSA_GANAPATI
QUATRO audits are NOT
 For regulatory purposes
Solely as an impartial source of advice
 For investigation of accidents or reportable medical events
(misadministration)
A more focused audit is needed
 To assess for entry into cooperative clinical research studies
A specific audit focused on adherence to specific protocol is needed.
•QUATRO
the process of RT is reviewed to
improve the practice
create the atmosphere of trust (!!),
NO BLAME POLICY
DAKSA_GANAPATI
Tipe Departemen/Instalasi Radioterapi
a. Dasar
Memiliki peralatan dasar dan jumlah staf yang cukup untuk menterapi
tumor yang umum terjadi, dengan tujuan mencapai kontrol lokal dari
penyakit dengan ekstensi yang mungkin
b.Kompeten
Memastikan operasional jangka panjang, senter tersebut mampu
menyediakan pelatihan klinis bagi seluruh staf. Senter sejenis itu mampu
mendidik sendiri para Radioterapis secara lengkap dan mengatur
pendidikan spesialisasi onkologi radiasi serta fisika medis di tempat lain
c. Unggulan
Senter yang menyediakan kebutuhan pelatihan klinis dari senter-senter di
daerah tersebut dan terlibat dalam penelitian klinis yang bertujuan untuk
meningkatkan hasil dari terapi tumor dan stadium tertentu yang sering
dijumpai di daerah tersebut

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Rekomendasi
A. The institution is suitable to perform the functions that
comply with the IAEA criteria for a centre of
competence in radiotherapy
B. The audit team has identified areas for improvement,
resolvable by the institution
C. There are underlying major problems that cannot be
resolved by the institution or without significant
resources

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 AUDIT
(Sekilas QUATRO di Indonesia)

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 IAEA/ RCA Regional Training Course
Quality Audit in Radiation Oncology

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 IAEA/ RCA Regional Training Course
on Quality Audit in Radiation Oncology
 13 – 17 Oktober 2008
 Gedung A – Lantai 8, RSUPN Ciptomangunkusumo Hospital (1 / 8 senter RT di Asia yang
sudah diaudit)
 IAEA Officer :
 Eduardo Zubizaretta
 Reiko Imai
 Pembicara
 Mirriam Callaguas
 P. Scalliet
 Brendan Healy
 S. Gondhowiardjo
 Peserta (Pakistan, Thailand, Bangladesh, India, Singapore, Malaysia, China, Myanmar,
Vietnam, Philippines, Indonesia, Sri lanka, South Korea)
 RO : 16  INDONESIA  IAEA : 2. NON IAEA : 3 TOTAL 13
 MP: 17  INDONESIA  IAEA : 2 NON IAEA : 2 AUDITOR
 RTT: 14  INDONESIA  IAEA : 1 NON IAEA : 3 INDONESIA
TOTAL 47
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 TERIMA KASIH
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DAKSA_GANAPATI
DAKSA_GANAPATI
 The Way for successful audit ………..

AUDIT STRUCTURE FOR QUATRO MISSION

 REQUEST
 AUDIT TEAM
 PREPARATION
 GUIDING AND PROCEDURES
 CONCLUSION
 REPORT
 DISSEMINATION OF THE REPORT

DAKSA_GANAPATI
 The Way for successful audit ………..

AUDIT STRUCTURE FOR

QUATRO MISSION
 REQUEST
 AUDIT TEAM
 PREPARATION
 GUIDING AND PROCEDURES
 CONCLUSION
 REPORT
 DISSEMINATION OF THE REPORT

Role of Role of
IAEA Institution

Role of Auditor
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 The Way for successful audit ………..

IAEA – team, co-ordinate, brief auditors, inform institution of the audit methodology,
data needed, objectives, result dissemination

Audit team – prepare methodology, allocate responsibilities, analyse institution’s

data, report

Institution – objectives, prepare data and documentation, identify staff responsible

for interaction with auditors, inform management

DAKSA_GANAPATI
 The Way for successful audit ………..
AUDIT STRUCTURE FOR QUATRO MISSION
 REQUEST
 AUDIT TEAM
 PREPARATION
 GUIDING AND PROCEDURES
 CONCLUSION
 REPORT
 DISSEMINATION OF THE REPORT

DAKSA_GANAPATI
 The Way for successful audit ………..
AUDIT STRUCTURE FOR QUATRO MISSION
 REQUEST
 AUDIT TEAM
 PREPARATION
 GUIDING AND PROCEDURES
 CONCLUSION
 REPORT
 DISSEMINATION OF THE REPORT

DAKSA_GANAPATI
 The Way for successful audit ………..

AUDIT STRUCTURE FOR QUATRO MISSION

 REQUEST
 AUDIT TEAM
 PREPARATION
 GUIDING AND PROCEDURES
 CONCLUSION
 REPORT
 DISSEMINATION OF THE REPORT

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