Soal 1

Incidence in hospital is currently still a lot happening, management always minimizes the
incident. Please explain the efforts made by quality management to reduce incidence in
hospital.

Answer :

Efforts made by quality management to reduce incidents in hospitals include:

1. The leadership and management are committed to patient safety
2. The hospital has a patient safety programme, and management has an information
management system to support safe practices for all departments.
3. Management has open and fair leadership and builds commitment and focus on
patient safety to reduce incidents, as well as being a leader who supports staff in
patient safety efforts.
4. Management has open and fair leadership and builds commitment and focus on
patient safety to reduce incidents, as well as being a leader who supports staff in
patient safety efforts.
5. The leadership provides resources, including an annual budget for patient safety
activities based on a detailed action plan.
6. Management promotes a culture of patient safety and identifies and takes action
security problems by running the following program :
 Increasing patient safety efforts by implementing 6 patient safety targets in
hospitals (Accuracy of patient identification, increased effective
communication, increased drug safety that needs to be watched out for (high-
alert) certainty of right-location, right-procedure, right-patient surgery,reducing
the risk of health care-associated infections, reducing the risk of patient falls
 Recognize and identify and manage risks that can cause incidents in hospitals
 Incident reporting and analysis of incidens
 Implementation of solutions to minimize risk.ability to learn from incidents and
follow-up, implementation of solutions to minimize the emergence of risks
 following up an incident to minimize the occurrence of risks and implementing
solutions to minimize the occurrence of risks and prevent injury due to mistakes
in carrying out an action or not taking an action that should be taken.
Some of the things above are a system that can be implemented by management to become an
effective way to prevent injuries or incidents to patients caused by wrong actions.
Patient safety is very, very closely related to the recognition of types and prevention of
patient safety incidents. Patient safety incidents can be prevented or minimized by increasing
the knowledge of all staff, implementing a safety culture for patients, such as reporting and
learning from any incidents that occur. Therefore, health workers need awareness to learn
from mistakes and report when incidents occur. The leadership ensures the provision
of competent staff, including independent practitioners and volunteers, to deliver safe care at
all times.

Soal 2
Sentinel is a fatal incident in patient safety in a hospital. Explain the reasons why sentinel
cases need to be investigated.

Answer :

Sentinel cases need to be investigated to monitor efforts to prevent errors from occurring so
that it is hoped that this can encourage further investigations, reporting will be the start of a
learning process to prevent the same incident from happening again. Incident reporting
systems in hospitals include policies, reporting flow, reporting forms and reporting
procedures that must be socialized to all employees. Reported incidents are events that have
occurred, have the potential to occur or have nearly occurred.
by carrying out a simple investigation, the investigation results report and incident report are
reported to the KP Team at the Hospital, after carrying out a simple investigation, the
investigation results report and incident report are reported to the KP Team at the Hospital.
After conducting the analysis, the team will provide recommendations for improvement and
learning to the work unit and then socialize it to other units in the hospital so that it doesn't
happen again and report to the board of directors

Apart from that, it is important to carry out sentinel investigations so that sentinel incident
reports have a broad impact. Preventing sentinel events from spreading is done at least by
limiting/localizing activities and reducing the impact of sentinel events. Saving evidence
includes at least the act of identifying it, ensuring the safety and integrity of the evidence, and
making an official report. Controlling the situation involves at least actively securing the
incident location, controlling information and mass media, and calming patients, family
visitors and health workers.

patient safety incident investigation, hereinafter referred to as incident reporting, is a system

for documenting patient safety incident reports, analysis and solutions for learning. Reporting
patient safety incidents in hospitals is very helpful for implementing patient safety incident
reporting and with socialization it can also improve the ability of health human resources in
analyzing, handling and reporting patient safety incidents, providing rewards to health human
resources who are able to analyze, handle and report patient safety incidents. well and protect
the reporter by not including the name and personal data of the reporter. This will be a
motivation to report all patient safety incidents in the hospital. so that it can continuously
improve the quality of health services and become a learning process for improving services
that are oriented towards patient safety

soal 3
About 70 % of medical error are related to interpersonal interaction issues; and ineffective
communication is root cause for nearly 66 % of all sentinel events reported. Please tell that
interpersonal interaction issues and give some example cases.

Answer
One step to improve patient safety is to implement good and effective communication in
services. he professional behavior of care givers who lack communication, attention,
carelessness, carelessness, and lack of care in maintaining patient safety causes errors that
result in injury to patients, in the form of Near Misses (Nearly Injury Events/KNC) or
Adverse Events (Not Excellent Events/KTD )
Communication is one of the root causes of medical misadministration in sentinel events, n
the event that an incident has occurred, either as a result of an act or omission or as a result of
an accident that was not previously predicted, then the most important attitude is to reduce
the magnitude of the risk by taking appropriate steps in managing the incident, usually a
quick and appropriate response to every interest and based on effective communication.
Hospitals need to create open communication standards during the care process regarding
incidents with patients and their families, meaning that patients and families receive clear
information about what they are experiencing, so that incidents and complaints from the
patient's family do not occur, because errors in communication can result in conflict between
patients and officer.

The following are some examples of communication problems that result in medical errors:

1. the room doctor on duty received advice from the specialist doctor in charge of the
patient regarding therapy for a child patient who was having a high fever, because it
was raining the doctor had difficulty hearing the advice, the doctor gave advise in the
form of 300 mg intravenous paracetamol infusion, the room doctor wrote 500 mg
paracetamol tablets.therapy given to patients, but there were no complaints or
problems after administering the drug. This is a medical error but is classified as a
non-injury event (KTC). This happens because the room doctor does not
communicate effectively, namely repeating the advice given or reconfirming the
therapy
2. Mrs S, who had just given birth, was in a coma for two days, after an examination it
turned out that the patient had taken the wrong medicine. The patient should receive
the drug methylergotamine, one of the functions of which is to control bleeding
during labor or delivery and speed up the return of the uterus (uterus) to a normal
state, while the drug given by the pharmacy is a drug containing glibenclamide as an
anti-dibetic, namely lowering blood sugar levels which should be given to another
Mrs. S who has almost the same name. The patient fell into a coma because the
patient's body could not cope by releasing hormones that increase blood sugar
because the patient was not a diabetic. This incident is an unexpected event (KTD)
where the nurse when providing therapy cannot communicate effectively, namely re-
confirming the patient's identity name before giving the medicine (Exact patient) thus
causing an unexpected event.
Soal 4
Patient Centered Care merupakan paradigma baru dalam menjalankan program
keselamatan pasien di rumah sakit. Perubahan ini akan memberikan pengaruh jika
manajemen maupun staf medis tidak dapat mengikutinya.

Jelaskan hambatan yang dialami oleh pihak manajemen dalam mempersiapkan program
Patient Centered Care.

Jawaban :
Hambatan yang dialami oleh pihak managemen dalam mempersiapkan program patien
centered care adalalah :
1. Kendala Financial ( anggaran )
Di era JKN tentunya rumah sakit perlu mengatur dengan baik anggaran dengan
adanya system klaim JKN tentunya tidak mudah menjalankan program PCC dimana
banyak hal yang harus di porsikan dalam anggaran rumah sakit untuk mendukung
program ini di antaranya menyediakan anggaran untuk meningkatkan lingkungan fisik
yang aman dan nyaman untuk pasien , Salah satu faktor terpenting yang berkontribusi
pada PCC (Patient Centered Care) adalah kualitas lingkungan fisik dimana perawatan
disediakan. contoh memperbaiki gedung /ruangan yang sudah rusak , mengganti AC
di ruangan yang tidak dingin agar pasien nyaman , dan sebagainya. Selain ini perlu di
persiapkan anggaran untuk perekrutan SDM sehingga jumlah SDM cukup sesuai
dengan stadar rumah sakit termasuk anggaran untuk pelatihan /diklit dan lainnya guna
meningkatkan kompetensi dan kualitas dari SDM yang tentunya berpengaruh
langsung dalam proses layanan dalam program PCC. Anggaran lain yang perlu di
porsikan adalah faktor pembiayaan dan pengawasan yaitu perlu adanya anggaran yang
memadai untuk pengolahan data rekam medis perlu adanya pengawasan yang
dilakukan secara berkesinambungan dan bertanggungjawab.
Rumah sakit juga harus menyiapkan anggaran untuk turut mengembangkan fasilitasi
dengan mengikuti teknologi dan memperbaharui system informasi terbaru dalam
memenuhi akses layanan sehingga membutuhkan anggaran ekstra untuk menyiapkan
program ini agar bisa menjalankan program PCC dengan baik. Faktor yang
berkontribusi akhir menyerap hampir semua elemen di atas adalah dukungan
 teknologi, khususnya teknologi informasi kesehatan yang melibatkan pasien dan
keluarga secara langsung dalam proses perawatan dengan memfasilitasi komunikasi
dengan pemberi asuhan dan menyediakan akses yang memadai terhadap informasi
yang dibutuhkan.

2. Peran Pimpinan dan managemen di Rumah sakit

Transformasi organisasi yang dibutuhkan untuk mencapai asuhan berkelanjutan dalam
PCC (Patient Centered Care) tidak akan terjadi tanpa dukungan dan partisipasi dari
pimpinan.
Pimpinan dan managemen yang kurang terlibat aktif dan kurang peduli, tidak
komunikatif dan kolaboratif akan menghambat progam PCC di rumah sakit. Sebagai
Pimpinan perlu berkomiten dalam menjalankan program ini, menjalin komunikasi dan
koordinasi yang baik dengan komite-komite, membuat kebijakan yang mendukung
program, termasuk melakukan evaluasi berkala terhadap program PCC dan merangkul
semua SDM yang terlibat dan mendukung penuh kebutuhan layanan yang
berkontribusi terhadap jalannya program PCC. Managemen sesuai dengan unit kerja
nya juga menyusun program kerja yang berhubungan dengan layanan yang bersifat
PCC. Contoh bagian HRD/ SDM pentingnya perekrutan, pelatihan, evaluasi,
kompensasi dan mendukung staf berkomitmen untuk menerapkan PCC (Patient
Centered Care).

3. SDM
Peran SDM terutama para profesional pemberi asuhan yang bersentuhan dengan
layanan pasien yang kurang maksimal baik dalam hal kuantitas atau jumlah sangat
mempengaruhi program ini. Sumber daya manusia mencakup jumlah petugas medis
pada bagian tertentu yang sedikit sedangkan pasien banyak sehingga sulit memadukan
waktu untuk berkolaborasi secara langsung, contoh Petugas medis yang jumlahnya
sedikit adalah ahli gizi, sedangkan pelaksanaan Patient Centered Care harus semua
profesi terlibat didalamnya. Kesulitan dalam merekrut dan mempertahankan dokter
juga memberi porsi dalam hamabatan program ini sedangkan dokter sebagai leader
dalam program PCC. Hambatan lain yang di hadapi managemen adalah bagaimana
mendorong dan mengatur agar tim PCC dalam bertugas dalam menyelesaikan
pekerjaan tim kesehatan mampu melakukan kerjasama dan saling membantu dalam
bagian sehingga hal ini dapat meningkatkan kinerja unit masing-masing. Kerjasama
 intrabagian yang baik diharapkan dapat membangun kerjasama yang dilakukan antar
bagian/unit kerja karena mereka akan terbiasa saling berkoordinasi satu sama lain tim
medis dalam memberikan pelayanan kesehatan.Selain itu kurang nya profesionalitas
tim PCC dalam layanan membuat management kesulitan dalam menyempurnakan
program ini. Sikap profesional yaitu mengedepankan kepentingan pasien, jujur,
ikhlas, bekerja sesuai protap dan kompetensi masing-masing, sehingga dapat
disimpulkan sikap profesional dalam bekerja sehingga selama ini tidak ada masalah
antar profesi. Hanya saling menghormati dalam menjalankan Patient Centered Care
dengan mendengarkan masukan ataupun memberikan masukan dari berbagai profesi
belum terlihat adanya pertemuan-pertemuan yang konkrit membahas masalah pasien.
Patient Centered Care memberikan indicator bahwa team dalam pemberian asuhkan
dapat berkomunikasi dengan intensif dalam memberikan asuhan pada pasien yang
dikelola. Termasuk di dalam nya kurang nya peran dari komite –komite dalam
menjalankan program kerja nya mendukung layanan PCC baik itu komunikasi dan
kerjasama yang baik dari komite.

4. Integrasi rekam medis

Program PCC melibatkan berbagai professional pemberi asuhan yang berfokus pada
pasien dan hasil layanan di integrasikan dalam rekam medis. Kendala yang di hadapi
tidak lengkapnya rekam medis terutama catatan perkembangan pasien teritegrasi oleh
para PPA dalam menjalankan program PCC. Kendala yang mempengaruhi lengkap atau
tidaknya pengisisan rekam medis adalah jumlah pasien. Jumlah pasien yang banyak
menyebabkan keterbatasan waktu pengisisan sehingga dokter dengan jumlah pasien yang
banyak cenderung mangabaikan pengisian rekam medis dengan alasan semua pelayanan telah
tercatat di buku visite, form CPPT yang yang tidak kompleksitas, dan sumber daya manusia
yang perbandingannya tidak terlalu jauh dengan jumlah pasien. Selanjutnya dari aspek
petugas medis sangat dibutuhkan kesadaran yang tinggi untuk melaksanakan kewajiban
mengisi rekam medis seseuai SOAP, kerja sama yang baik antar profesi, dan tanggung jawab.
Hal ini dilakukan untuk mendukung peningkatan mutu dan kualitas pelayanan Rumah Sakit.

Soal 5

Melanjuti soal nomor 4, jelaskan upaya yang dilakukan pihak manajemen untuk
mengatasi hambatan dalam penerapan PCC di rumah sakit.