Kiat Profesi Anestesia dalam Mencegah KTD - Manajemen Rumah ...

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Kiat Profesi Anestesia dalam Mencegah KTD - Manajemen Rumah ...

Tempat/Tgl Lahir : Jakarta, 27 Mei 1954Alamat rumah : Jl. Jati Sari II / 22, Jati Padang – Pasar MingguJakarta SelatanAlamat Kantor: RS Premier BintaroJl. MH. Thamrin No. 1 sektor VII Bintaro JayaTelp. Rumah : (021) 780.3556Telp. Kantor : (021) 745.5500 ext. 2000FaxHp: (021) 745.5800: 0816.824.109Email: bambang.tutuko@gmail.comPENDIDIKAN UMUM:Dokter FK-UI periode 1973 – 1979Dokter Spesialis Anestesiologi FK-UI periode 1986 – 1989Konsultan Intensive Careperiode 1996PENGALAMAN BEKERJA :-Dokter POLTABES – Medan 1981 - 1985-Dokter RS POLDASU – MedanKASUBSI KESJAS POLDA SUMUT1983 - 19851985 - 1986PANIT GAWAT DARURAT RS POLPUS 1991 - 1995-Dokter Anestesiologi RS POLRI Pusat-KA.NIT anestesiologi & ICU RS POLPUS1990 – 20001995 - 2000-Ketua Panitia AKREDITASI RS POLPUS1998ORGANISASI :Ketua IDSAI cabang JAKARTAperiode 2001 – 2004Sekjen PP IDSAIperiode 2004 – 2007Ketua Umum PP IDSAI periode 2007 – 2010Anggota ex officio P2KB IDI periode 2006 – 2009Ketua Umum PP PERDATIN periode 2010 – 2013Anggota Makersi IRSJAMperiode 2010 – sekarangAnggota MPPK IDIperiode 2009 – 2012Ketua Komite Medis RSPB periode 2009 - sekarang


KIAT PROFESI ANESTESIADalam MencegahKTDDr BAMBANG TUTUKO SpAn KICPERHIMPUNAN DOKTER SPESIALIS ANESTESIOLOGI dan TERAPI INTENSIFINDONESIAKongres XII PERSI dan Seminar Tahunan VI Patient Safety2012


Kita menghadapi peralatan dgteknologi canggih


Kompleksitas =eningkatan kemungkinanterjadinya KTD !


medication error in every 133nestheticsGlavin RJ. Br J Anaesth 2010;105:76-829)1 million anesthetic medicationerrors in one year


Medication Errors inAnesthesia• 2266 members Canadian SocietyAnesthesiologists: 30% admitted to at least > 1error in their lifetime (Orser et al., 2001)• Japanese Society Anaesthesiologists: 27454anaesthetics over 8 years. 233 medication errors:overdose 25%, substitution 23%, omission 21%(Yamamoto et al., 2008)• New Zealand: 89% anesthesiologists admitteddrug administration error during career, 12,5%reported having harmed patients by drugadministration error (Merry et al., 1995)


Medication Errors inAnesthesia• drug errors among top 5 reportedpatient safety incidents occuring duringanesthesia• reported incidence in literature varieswidely: ranging from 1:131 to 1:5,475anaesthetics (UK, NPSA 2010)• Literature indicates these errors remaina cause of serious harm to patients


The error of one momentbecomes the sorrow ofwhole life• A Chinese Proverb


• disebut juga sbg ergonomics• telah lama dikenal dalam bidangpenerbangan dan pembangkit tenaga nuklir• baru akhir2 ini diakui sbg bagian yg utamadari patient safety• kontributor utama pada KTD dalampelayanan kesehatan• seluruh personil layanan kesehatan harusmempunyai pengetahuan dasar tentang


KIAT PROFESI ANESTESIDasar Pemikiranhak pasien atas patient safetydokter pada dasarnya tidak punya niatmencelakakan pasienconcern perhimpunan untukkesejahteraan anggotanya dan patientsafety


Perhimpunan• membentuk Dewan Pembina• mengusahakan back up asuransi profesi• melaksanakan P2KB yg terarah• menerbitkan buku2 pedoman / panduanpraktik• mengusahakan update kurikulum agarsesuai kebutuhan lapangan• menjalin hubungan dg institusi terkait


• suatu badan dibawah Ketua• tujuan membina anggota (positivethinking)• bersifat PROAKTIF, tidak menungguaduan, membimbing anggota ygmendapat kasus• tdd para pakar DSpAn tidak hanya dibidang ilmu, tetapi juga manajemen RSdan organisasi, bila perlu bisa


Person Approach• see an errors as the product of carelessness• remedial measures directed primarily at theerror-maker• naming• blaming• shaming• retraining


• mengharuskan anggota memilikiasuransi profesi sebelum diberikanrekomendasi ijin praktek• negosiasi dg pihak asuransi profesiuntuk penyelesaian diluar pengadilan(agar tidak mengganggu pelayanan)


Kedokteran Berkelanjutan (P2KB)• materi2 P2KB disesuaikan dg:• perkembangan ilmu dan tren lapangan / dunia• patient safety, high risk surgical dll.• jenis2 kasus yang ditangani Dewan Pembina• kompetensi di bidang airway, anestesi regional,pain• penyusunan struktur materi / modul / workshop oleh timP2KB Pusat• pelaksanaan modul / workshop di cabang2 olehinstruktur cabang yg sudah di ToT.


• Buku: Pedoman Penjabaran Kewenangan KlinisPanduan Praktik• Buku: Standard dan Pedoman Pelayanan AnestesiologiIndonesia• Buku: Panduan Tatalaksana Nyeri Perioperatif• Buku: Pedoman Terapi Cairan Perioperatif• Buku: Pedoman TCI (Target Control Infusion) dan TIVA(Total Intra Venous Anesthesia)• Buku: Pedoman Anestesi Inhalasi• Cetak ulang buku saku: Kode Etik Kedokteran Indonesiadan Pedoman Etik Spesialis Anestesiologi danReanimasi Indonesia


•Anaesthesia. 2004 May;59(5):493-504.•Evidence-based strategies for preventing drugadministration errors during anaesthesia.•Jensen LS, Merry AF, Webster CS, Weller J, Larsson L.•Source•Aarhus University, Aarhus, Denmark.•Abstract•We developed evidence-based recommendations for the minimisation of errorsin intravenous drug administration in anaesthesia from a systematic review of theliterature that identified 98 relevant references (14 with experimental designs orincident reports and 19 with reports of cases or case series). We validated therecommendations using reports of drug errors collected in a previous study. Onegeneral and five specific strong recommendations were generated: systematiccountermeasures should be used to decrease the number of drug administrationerrors in anaesthesia; the label on any drug ampoule or syringe should be readcarefully before a drug is drawn up or injected; the legibility and contents of labelon ampoules and syringes should be optimised according to agreed standards;syringes should (almost) always be labelled; formal organisation of drug drawersand workspaces should be used; labels should be checked with a second personor a device before a drug is drawn up or administered.


• One general and five specific strong recommendations were generated:• systematic counter measures should be used to decrease the number of drugadministration errors in anaesthesia;• the label on any drug ampoule or syringe should be read carefully before a drugis drawn up or injected;• the legibility and contents of labels on ampoules and syringes should beoptimised according to agreed standards;• syringes should (almost) always be labelled;• formal organisation of drug drawers and workspaces should be used;• labels should be checked with a second person or a device before a drug isdrawn up or administered.


Update Kurikulum• memberi input ke KOLEGIUMkompetensi apa saja yg perlu diperkuatdan perlu ditambahkan, seperti:• perkembangan difficult airway devices• pain as 5th vital sign, penanganan /manajemen nyeri• dll


Kerja sama dg institusi terkait• pihak RS , karena KTD menyangkut sistim• dg Kemkes, untuk penerbitan peraturan2 ygmenunjang praktik yg patient safety, sepertipedoman peralatan anestesia sesuai jenjang RS,pedoman2 praktik anestesia, PMK 519 thn 2011• dg PERSI , sosialisasi ttg PAB dari Akreditasi RSKARS 2012, pelaksanaan PMK 755 dgmenerbitkan buku pedoman kewenangan klinik ,pelatihan patient safety bidang anestesia, dll.• Sosialisasi SPM, Lifebox, Surgical Safety Checklist• stakeholder lain.


perioperative care approachby Anesthesiologistsfocus on a systems approach to high-risk surgery,rather than clinging to the fragmented traditionaldisease-oriented approach.The modern hospital should be able:• to identify patients with a substantially increasedrisk of peri- and postoperative morbidity,• design care paths that include specificinterventions to reduce these complications.


TANTANGAN KEDEPAN


estimation of the global volume of surgery:delling strategy based on available dataG Weiser, Scott E Regenbogen, Katherine D Thompson, Alex B Haynes, Stuart R Lipsitz, William R Berry, Atul A Gawande.thelancet.com Published online June 25, 2008 DOI:10.1016 S0140-6736(08)60878-8gical data from (29%) of 192 WHO member states


lobal Volume of SurgeryJumlah pembedahan di seluruh dunia banyakDg memperhatikan tingginya angka kematiandan komplikasi dari tindakan bedah mayor,saat ini keamanan pembedahan (surgicalsafety) harus sudah menjadi substansi publichealth duniaUpaya2 public-health dan surveilansnya harusmulai dilaksanakan


PRACTICE ofERIOPERATIVE MEDICINE• evolved over time and is expected to present new challenges andopportunities.• Standardization of medical practice aims to reduce healthcare cowhile improving outcomes.• Standardization in perioperative medicine may be accomplished bintroducing clinical pathways that encompass the entireperioperative period from the preoperative evaluation to thepostdischarge disposition.• Despite published evidence that clinical pathways improveoutcome, they are widely underutililized in perioperative medicine


perioperative care approachby Anesthesiologistsfocus on a systems approach to high-risk surgery,rather than clinging to the fragmented traditionaldisease-oriented approach.The modern hospital should be able:• to identify patients with a substantially increasedrisk of peri- and postoperative morbidity,• design care paths that include specificinterventions to reduce these complications.


The development of clinical pathways inperioperative medicine will only succeed in tightcollaboration with all specialties involved, but theiimplementation will critically depend on theleadership of the anesthesia team of the futurelong-term effects of both surgery and innovativeresearch efforts to develop effective strategiesthat secure long-term benefits


PROCESS IN THE PERI-OPERATIVE PERIOD


trive to further improve care, the anesthesia team of the future have to relyAnesthesia Patient Safety Foundation, 1985n independent nonprofit corporationision ‘that no patient shall be harmed by anesthesia’ecent initiatives of the APSF:• improved medication safety• audible physiologic alarms• standardization of Anesthesia Information Management Systems (AIMSshe consideration of long-term outcomes


• untuk mengurangi terjadinya KTD padatindakan anestesia, kita harus mampumemberikan pelayanan yang lebihaman yi dg kiat2 PATIENT SAFETY• untuk melakukan patient safety, kitaharus paham dan mengEDUKASI dirisendiri tentang patient safety

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