Materi Prof Nursalam
Materi Prof Nursalam
Materi Prof Nursalam
By:
Prof. Dr. Nursalam, M.Nurs (Hons)
Professor in Nursing, Airlangga University & Hospital
nursalam-2014
CURRICULUM VITAE
Quality of Care:
The degree to which health services for individuals
and populations increase the likelihood of desired
health outcomes and are consistent with current
professional knowledge.
Patient Safety:
is defined as: the prevention of harm to patients.
ISSUES .. Quality - Safety
STEEEP
Safe: avoiding injuries to patients from the care that is intended to help them
Timely: reducing waits and sometimes harmful delays for both those who
receive and those who give care
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)
Efficient: avoiding waste, in particular waste of equipment, supplies, ideas,
and energy
Equitable: FAIR, providing care that does not vary in quality because of
personal characteristics such as gender, ethnicity, geographic location, and
socioeconomic status
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
nursalam-2014
STEEEP Framework outlined by the Institute of Medicine (IOM)
Meeting clients needs now
and in the future
SUSTAIN
Making good contributions QUALITY AND
to Patient safety PRODUCTIVITY
(REMEMBER
A-P-I)
mtrla/13072010 14
2
MODEL OF QUALITY & PATIENT
SAFETY IMPROVEMENT
Nursalam-07
QUALITY IMPROVEMENT & PATIENT
SAFETY (PMKP)
KARS (2015)
MODEL Q & PS IMPROVEMENT (KOPELMEN)
1. INPUT:
2. PROCESS POAC /
M1,M2,M3
P-D-S-A ...... MAKP 3. OUTPUT
,M4,M5
- ORGANIZATION
Reward system
1.PLANNING -JCI
Goal setting and MBO * harian, bulanan, Triwulan/Semester dan
1. PATIENT CENTER CARE
Selection tahunan
Nursalam-07
STRATEGIC PLANNING
(1). INPUT - BSC
4. FINANCIAL
Customer
Value
Proposition
3.
CUSTOMER
Operation
Management
Processes
2. SERVICE:
Internal Business Innovation
Customer
Process Processes
Management
Processes
1. SDM:
Learning and
Growth ORGANIZATION CAPITAL
- Culture
HUMAN CAPITAL - Leadership
- A: Attitude - Alignment
- K: knowledge INFORMATION CAPITAL - Teamwork
- S: skill - System - Penataan Mindset
- I: insight - Database
- Information Technology
BSC-RSPHC
(2). PROCESS
INTI - MANAJEMEN
Love
Care
Professio Conscious
nalism ness
10 Cs
CARING
COMMUNICATION
COLLABORATION
CONSITENCE
CAREFULNESS
COMPASSION
COURTESY
COMPETENT
CONFIDENCE
COMMITMENT
11/15/2017 CARE 22
Caring
Nursing is described as a caring relationship, an
enabling condition of connection and concern. -Dr.
Benner
Caring is primary because caring sets up the
possibility of Giving and Receiving Help. -
KAYA (SUPAYA BISA MEMBERI)
Nursing is viewed as a caring practice whose science
is guided by the moral art and ethics of care and
responsibility.
Nursing practice as the care and study of the lived
experience of health, illness, and disease and the
relationships among the three elements (Dr. Benner)
nursalam-2014
1. Golden heart; 2. Kaya Ilmu;
3. Kaya beneran
Allah Maha Penyayang adalah Maha Kaya, Maha
Berterima Kasih dan Maha pembalas Kebaikan.
Dengan sedekah kita akan mendaptkan keuntungan
tidak terhingga. Keuntungan itu bisa berupa
ketentraman hati, dihindarkan dari bencana,
bertambahnya sahabat, berlipatgandanya aset bisnis,
bertambahnya tabungan atau khusnul khotimah.
Khusnul khotimah tidak bisa dijual dengan
miliaran rupiah, bahkan jika berhimpun
semua orang kaya di bumi tidak akan mampu
membelinya.
ASSERTIVENESS
International Nurses Day 2015
25
Nursing Responsibilities in Patient-
Centered Approaches (Faye Abdellah)
Effective communication between patient and
caregiver. Information is accurate, timely and
appropriate.
Do everything possible to
alleviate patients pain and make them
feel comfortable.
PATIENT-CENTRED
CARE & PATIENT SAFETY
(BILA PASIEN ITU SAYA / SAUDARA....)
PRINCIPLE OF CARING
nursalam-2014
SHIFTING THE CULTURE OF
CARING
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Build - T-E-A-M:
Together Everyone Accept & Achieve More
Well do this together
Replenish the soul of
experienced nurse
Learn not to eat the
young.
Experience (first hand)
generational issues.
Patients like it
Nursalam-preceptorship-2013 29
(3). OUTPUT
1. PATIENT SAFETY
2. SATISFACTION (R-A-T-E-R)
3. SELF CARE
4. ANXIETY
5. COMFORT
6. KNOWLEDGE
A. PATIENT SAFETY
SKP / IPSG
(International Patient
Safety Standar Goal)
21/5/2013 NURSALAM-MAKP-2013 31
The world is a dangerous place
to live; not because of the
people who are evil, but because
of the people who don't do
anything about it.
(Albert Einstein)
IPSG I :
IDENTIFY PATIENT CORRECTLY
1. PATIENTS NAME
2. BIRTH OR REG. NUMBER
MODEL: S-B-A-R
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b. Abbreviation c. Critical Result Value/
Singkatan baku yang nilai-nilai pemeriksaan
tidak boleh digunakan. yang kritis
nursalam-2014
A. READ BACK
PERSYARATAN DASAR KEBIJAKAN
Setiap order 1. Mengembangkan kebijakan dan
prosedur keakuratan
lisan/telepon /melaporkan
komunikasi lisan / Telepon.
hasil-hasil pemeriksaan 2. Orang menerima informasi /
dengan nilai yang kritis order, mencatat kelengkapan
orang yang memberikan order/ hasil pemeriksaan /
order harus memverifikasi menginput ke dalam komputer.
kelengkapan order 3. Orang menerima informasi /
order membacakan kembali atau
meminta pada penerima
read back secara lengkap.
order untuk membacakan 4. Orang memberikan order
kembali atau "read back" mengkonfirmasi kembali
kelengkapan order informasi /order tersebut
tersebut.
nursalam-2014
B. ABBREVIATION (SINGKATAN BAKU
YANG TIDAK BOLEH DIGUNAKAN
PERSYARATAN DASAR KEBIJAKAN
nursalam-2014
d. HAND OFF COMMUNICATIONS
( Serah terima informasi pasien antar
perawat dan/staf medis )
Hand-over
Delegation from doctor to
nurse
Delegation doctor on-call
Between ward to ward
nursalam-2014
SBAR
INTERGATED
NOTES
NURSALAM-2004
APA YANG DI BAHAS DALAM SBAR ?
1) Situasition meliputi :nama, umur, tanggal MRS, hari
perawatan, dokter yang merawat, nama perawat yang
bertanggungjawab, diagnosis medis dan masalah
keperawatan yang belum teratasi.
2) Background meliputi : kondisi pasien, riwayat alergi,
pembedahan, alat invasive, obat-obatan, pengetahuan
pasien dan keluarga tentang masalah kesehatan,
pemeriksaan diagnostik.
3) Assessment meliputi :hasil pengkajian terkini, tanda
vital, pain skore, tingkat kesadaran, status restrain, risiko
jatuh, status nutrisi, eliminasi, hal-hal yang kritis.
4) Recommedation meliputi :Intervensi asuhan
keperawatan yang perlu dilanjutkan, termasuk nursing care plan
dan discharge planning. Edukasipasien dan keluarganya. 42
SBAR Hand-off Communication Guidelines Document in Medical Record Report Received & Verified
Radiology - Document in the Medical Record - time patient returned to unit and how the patient tolerated procedure
Sbar 3.27.06
unit MED/SURG/TEL/PED LABOR POSTPARTUM NEONATE RADIOLOGY
ED/SURGICAL SERVICES
VS, pain scale VS, pain scale, labor VS, pain scale, stable/current VS, pain scale, Mode of Transportation
S stable/ current problem/ change
in condition
progression/, current problem/
change in condition
problem/change in condition
i.e. heavy lochia, breastfeeding
stable/current problem/change in
condition
IV
O2
Situation i.e. critical labs, unstable VS, i.e. obstetrical problem, pain difficult, psychosocial problem i.e. temp instability, feeding
pain, change in LOC, difficulty tolerance, fetal decelerations problem, irritability, bilirubin
breathing, GI bleeding check abnormal
Recent Nursing interventions Recent Nursing interventions Recent Nursing interventions Recent Nursing interventions
Medical interventions Medical interventions Medical interventions Medical interventions
Summary of Mental and Physical Summary of Mental and Physical Summary of Mental and Physical Summary of Mothers & Babys Pertinent Medical
B history
Diagnosis
history
Gravida Para
history
Gravida Para
Birth, Mental and Physical
history
History (i.e.
communication
Background Allergies Allergies Type of Delivery Gravida Para problems, seizure
Code Status Beta Strep Allergies Type of Delivery disorder)
Fall Risk Physician/Consults Beta Strep Allergies Allergies
Braden Scale Physician/Consults Beta Strep Code status
Isolation Physician/Consults Fall risk
Physician/Consults Isolation
Activity
Clinical/diagnostic labs/tests Clinical/diagnostic labs/tests Clinical/diagnostic labs/tests Clinical/diagnostic labs/tests
tests results tests results tests results tests results
Recommendations & Recommendations & Recommendations & Recommendations & Call RN if patient c/o
R interventions for treatment, level
of care
interventions for treatment, level
of care
interventions for treatment, level
of care
interventions for treatment, level
of care
increase pain,
intolerance of
Recommendation procedure, IV problems
INTEGRATED NOTES
IPSGs III :
IMPROVE THE SAFETY OF
HIGH-ALERT MEDICATIONS
21/5/2013 NURSALAM-MAKP-2013 46
LASA (LOOK ALIKE SOUND ALIKE)
NORUM ( NAMA OBAT RUPA MIRIP)
Look alike
21/5/2013 NURSALAM-MAKP-2013 47
Sound Alike
hidraALAzine hidrOXYzine
ceREBYx ceLEBRex
vinBLASTine vinCRIStine
chlorproPAMIDE chlorproMAZINE
glipiZIde glYBURIde
DAUNOrubicine dOXOrubicine
21/5/2013 NURSALAM-MAKP-2013 50
I II III
7 11
S
I
G
N
I
N
T
I
M
E
O
U
T
S
I
G
N
O
U
T
IPSGs V :
REDUCE THE RISK OF HEALTH
CAREASSOCIATED INFECTIONS
Phlebitis (VIP)
Peneumonia (HAP / VAP)
nursalam-METODOLOGI
PNEUMONIA - HAP
nursalam-METODOLOGI
DICUBITUS
nursalam-METODOLOGI
IPSG VI :
REDUCE THE RISK OF PATIENT HARM
RESULTING FROM FALLS
21/5/2013 NURSALAM-MAKP-2013 60
ADVERSE EVENT
Pasien Near Miss (NM)
tidak cidera
(KNC=Kejadian NYARIS CIDERA)
Proses of Care - Dpt obat c.i., tdk timbul (chance)
Error - Plan, diket, dibatalkan (prevention)
- Dpt obat c.i., diket, beri anti-nya
(mitigation)
-Kesalahan proses
-Dpt dicegah
-Pelaks Plan action Pasien
tdk komplit
cidera Adverse Event (AE)
- Plan action yg salah
-commission & omission (KTD=Kejadian Tdk Diharapkan)/
Sentinel
21/5/2013 NURSALAM-MAKP-2013 61
B
SATISFACTION
R-A-T-E-R
(Parasuraman)
21/5/2013 62
NURSALAM-MAKP-2013
DIMENSIONS OF SERVICE QUALITY
R-A-T-E-R
Reliability:
Perform promised service dependably and accurately.
Assurance:
Ability to convey trust and confidence.
Example: cleanliness.
Empathy:
Ability to be approachable, caring, understanding and relating with customer needs.
Example: being a good listener.
Responsiveness:
Willingness to help customers promptly.
Example: avoid keeping customers waiting for no apparent reason.
Quick recovery, if service failure occurs
PERCEIVED SERVICE QUALITY
6-64
C
SELF CARE
(INDEX KATZ)
21/5/2013 NURSALAM-MAKP-2013 65
D
COMFORT
(PAIN SCALE)
21/5/2013 NURSALAM-MAKP-2013 66
nursalam-METODOLOGI
nursalam-METODOLOGI
nursalam-METODOLOGI
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E
ANXIETY
Zung Self-Rating Anxiety Scale ( SAS / SRAS ) adalah penilaian kecemasan pada
pasien dewasa yang dirancang oleh William WK Zung, dikembangkan berdasar gejala
kecemasan dalam DSM-II (Diagnostic and Statistical Manual of Mental Disorders).
Terdapat 20 pertanyaan, dimana setiap pertanyaan dinilai 1 4 (1 : tidak pernah, 2:
kadang-kadang, 3: sebagian waktu, 4: hampir setiap waktu. Terdapat lima belas
pertanyaan ke arah peningkatkan kecemasan dan lima pertanyaan ke arah penurunan
kecemasan. ( Zung Self-Rating Anxiety Scale ( SAS / SRAS ) dalam Ian
mcdowell.(2006)
Rentang penilaian 20-80, dengan pengelompokan sbb:
Skor 20 - 44 normal/tidak cemas
Skor 45-59 Kecemasan ringan
Skor 60-74 Kecemasan sedang
Skor 75-80 kecemasan berat
21/5/2013 NURSALAM-MAKP-2013 71
F
KNOWLEDGE
(HBM , DP, PPB)
21/5/2013 NURSALAM-MAKP-2013 72
3
QUALITY
IMPLEMENTATION IN
NURSING CARE
AIRLANGGA HOSPITAL
NURSALAM-2004
EMERGENCY DEPARTEMENT
NURSALAM-2004
WARD DEPT
Phlebitis
decubitus
Patient fall
Medication error
Patient Satisfaction
Blood sampling
NURSALAM-2004
ICU
ABG (>3x)
Phlebitis
Decubitus
Patient fall
Medication error
Injury on restraint
Extubation
NURSALAM-2004
OPERATING ROOM
Patient Identification
Gass and other instruments
Schedule on operation
ME
Patient fall
Response time for emergency preparation (<60
menit)
NURSALAM-2004
OUT PATIENT DEPT
NURSALAM-2004
4
CONCLUSION
1. The important component of quality improvement is a
dynamic process that often employs more than one
quality improvement tool; input-process-output; and
apply five dimensions of service quality are R-A-T-E-R
by PCC (patient-center- care & Patient safety).
2. Quality improvement requires some essential elements
for success especially on hospital accreditation
3. The principles of patient safety is in the
implementation on IPSG standard
RECOMENDATION
A P I KUANTITAS)
A = AKTUALITAS
P = PRODUKTIFITAS
I = INOVATIF
NETWORKING & INTERCONNECTING
11/15/2017 87
SUCCES IS NOT ONLY AN OPTION.
It is the right of everyONE