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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 Sakit