Manajemen Pelayanan & Manajemen Asuhan Keperawatan

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Manajemen Pelayanan &

Manajemen Asuhan Keperawatan

Dr. Ns Rita Sekarsari SKp., Sp KV., MHSM

*) Disampaikan dalam Pelatihan & Bench Marking Manajemen Keperawatan Kontribusi Manajer Keperawatan Dalam Meningkatkan Pelayanan Keperawatan, Mesukseskan Akreditasi Rumah Sakit Versi 2012 & JCI

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No Pendidikan

1 AKPER DEPKES RI 1985 2 S1 PSIK UI 1993

3 S2 Monas Uni Melbourne 2001 4 Pengakuan Ns Sp KV 2011

5 S3 FIK UI Doktor Keperawatan 2014

Rita Sekarsari

No Pekerjaan

1 Koordinator Program Diklat RSJPDHK 2012 -

2 Ketua Sub Komite Keperawatan RSJPDHK 2007 - 2012

3 Ketua Komite Keperawatan & Manajer Instalasi Rawat Inap GP II & Pav

Sukaman, RSJPDHK 2001- 2007 4 Ka Ru ICU RSJPDHK 1993 - 2001 5 Supervisor Keperawatan RSJPDHK

1993 - 2009

6 Koordinator DIKLAT POST BASIC 1993 - 2001

NO Organisasi saat ini

1 Ketua II PP PPNI 2010-2016 2 President INKAVIN 2012-2017

3 Ketua Kolegium Keperawatan Spesialis Kardiovaskular 2010 - 2016

4 Pengurus MTKI 2011- 2016

5 Pengurus ARSPI 2011 - 2016

6 Pembimbing Akreditasi & Surveyor

Akreditasi Rumah Sakit V.2012 KARS ( 2013 sd> …..)

Kontak :

ritaakbar@yahoo.com

Ph: 08151626004 ₂

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ICN Position Statement/ Sekarsari/2014

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Sistem

Manajemen

Sistem Pelayanan Klinis

Asuhan Pasien / Patient Care

Quality & Safety

PASIEN

 Standar Manajemen

PMKP, PPI, TKP, MFK,

KPS, MKI

 Sasaran KP

 Sasaran MDG’s

 Std Yan Fokus Pasien

APK, HPK, AP, PP, PAB, MPO

PPK

 Regulasi :

• Kebijakan

• Pedoman,

• Panduan

• SPO

• Program

 Indikator :

• Ind. Area Klinis

• Ind Klinis

• Ind SKP

• Ind Upaya Manajemen

 Dokumen Implementasi

Pengelolaan Rumah Sakit dlm Perspektif Standar Akreditasi v.2012

UU 44/2009 ttg RS, Peraturan

Per UU an lainnya

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Tujuan utama pelayanan kesehatan Rumah Sakit adalah pelayanan pasien.

“Core Business RS = Patient Care”

(Bab Pelayanan Pasien (PP/COP)

Asuhan Pasien

(Patient Care)

Cure Care

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Pasien

 PCC merupakan pendekatan yg lbh modern dan inovatif dlm pelayanan kes sekarang, diterapkan dgn cepat di banyak RS di seluruh dunia.

 Model ini telah menggeser semua PPA menjadi di SEKITAR PASIEN

 fokus pada pasien  Patient-centered Care

 Sbg tambahan, mereka semua sama pentingnya pada kontribusi profesi nya dalam asuhan pasien

 “Interdisciplinary team model”  kompetensi-kewenangan yang memadai

“Dokter = Team Leader”

Model Patient-centered Care

Kompetensi yg memadai

“Interdisciplinary Team

Model”

Dokter/

DPJP Fisio terapis

Perawat

Apoteker

Ahli Gizi

Lainnya Analis

Radio grafer

Asuhan Integrasi

Staf Klinis

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Pasien

“Dokter = Team Leader”

Model Patient-centered Care

Kompetensi yg memadai

“Interdisciplinary Team

Model”

Dokter/

DPJP Fisio terapis

Perawat

Apoteker

Ahli Gizi

Lainnya Analis

Radio grafer

Staf Klinis

Case Manager

Asuhan Integrasi

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Case Manager

di Rumah Sakit

• Pengertian :

o CM adalah profesional dalam RS yang bekerja secara

kolaboratif dgn PPA, memastikan bahwa pasien dirawat serta ditransisikan ke tingkat asuhan yang tepat, dalam

perencanaan asuhan yang efektif dan menerima pengobatan yang ditentukan, serta didukung pelayanan dan perencanaan yang dibutuhkan selama maupun sesudah perawatan RS.

o American Case Management Association : CM adalah professional yang secara kolaboratif melakukan proses

asesmen, perencanaan, fasilitasi, koordinasi asuhan, evaluasi, dan advokasi untuk opsi pelayanan dalam rangka memenuhi kebutuhan pasien & keluarga akan pelayanan kesehatan yang komprehensif, melalui komunikasi dan sumber daya yang ada untuk memperoleh hasil yang bermutu dan cost effective.

• Ciri : Manajemen, Komunikator,, Wawasan pelayanan klinis, Membantu pasien memenuhi kebutuhan pelayanan.

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Nurses Play Key Role Improving Quality of Patient Care

 Nurses today have many role. In addition to meeting the needs of patients and serving as part of the health care team, nurses also play a key and vital role in meeting the Joint

Commission’s International Patient Safety Goals in such areas as medication safety,

communication and patient safety. This role allows nurses to highly contribute to quality improvement by yielding desired patient

outcomes and reducing the probability of undesired outcomes.

Joint Commission International/Sekarsari/2014

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NURSES’ ROLE IN IMPLEMENTING JCI

PATIENT-CENTERED STANDARD

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The Role of Nurses in Implementing Access to Care

& Continuity of Care

Carries out processes to ensure appropriate

patient access & continuity of care services in the organization and coordinate among health care practitioners:

 Admission to the organization

 Continuity of care

 Discharge, referral & follow up

 Transfer of patients

 Transportation

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The Role of Nurses in Ensuring full Understanding of Patient & Family Rights

 Identify patient’s values & believes &

protect their rights

 Inform patients of their rights

 Include the patient and his/ her family, when appropriate , in decisions about the patient’s care

 Obtain informed consent

 Inform patients about the organization process of receiving and acting upon complaints

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The Role of Nurses in Implementing Care of Patients

 Planning & delivering nursing care to each patient

 Monitoring patient progress and recording it to communicate the progress, evaluate the effectiveness of nursing measures

taken and modifying the nursing care plan accordingly

 Completing the care

 Planning the follow up

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The Role of Nurses in Implementing Assessment of Patients

 Collecting information & data on the patient’s physical, psychological, social status and health history ( initial upon admission, through out the patient stay, upon discharge)

 Recording and analyzing the data and

information to identify the patient’s health care needs

 Developing a nursing care plan to meet the patient’s identified needs

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The Role of Nurses in Implementing Medication Management and Use

 Medications administered following the 7 rights. Report administration details as established in the organization process

 Medication effects on patients are

monitored & reported, including adverse effects

 Adverse effects are reported in the time frame required by policy

 Medication errors and near misses are reported in timely manner using en

established process

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The Role of Nurses in Implementing Patient and Family Education

 Nurses assess and record patient’s

educational needs & continuously educate patients from the moment of admission and till the discharge time

 Encourage patient to speak up

 Educate patient also by involving in their care

Example:

 Dressing change teaching

 Medication teaching

 Signs to report teaching

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NURSES’ ROLE IN IMPLEMENTING JCI

HCO MANAGEMENT STANDARDS

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The Role of Nurses in Implementing Quality Improvement & Patient Safety

Nurses contribute a lot to this quality

improvement trough this standards chapters by:

 Participating in data collection, analysis and recommendations when evaluating nursing clinical & managerial processes

 Designing new clinical & managerial processes well

 Implementing & sustaining nursing care changes that result in improvement

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The Role of Nurses in Implementing Management of Communication & Information

Nurses should actively participated in tecnology training to ensure that they are:

 Comfortable with and knowledgeable about any new medication management technology such as electronic medical records, smart

pumps, or bar-coding systems

 They should incorporate technology into daily practice and make suggestions for way to use it to reduce errors

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The Role of Nurses in Implementing Prevention and Control of Infections

 Nurses should represent and engaged in the activities with the infection prevention and control

professionals

 Minimize the risk of infection by ensuring proper cleansing, disinfection, and sterilization processes &

by wearing gloves and/or mask or eye protection as needed

 Continuously apply hand washing and hand disinfection procedures

 Educate patients and families and encourage them to participate in the implementation and use of infection prevention and control practices in the organization

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The Role of Nurses in Implementing Governance, Leadership and Direction

Nursing leaders, among other organization

leaders, have special responsibilities to parients and organization. They:

 Support good communication between nurses

 Jointly plan and develop policies together with other leaders to guide the delivery of clinical services

 Provide for the ethical practice of nursing profession

 Oversee the quality of patient care

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The Role of Nurses in Implementing Facility Management and Safety

 Hazardous waste is properly disposed

 Proper protective equipment and procedures are used during use, spill, or exposure of

contaminated or radioactive or any other harmful materials

 Spills, exposures, and other incidents are reported

 Nurses can describe and/or demonstrate

actions to eliminate, to minimize, or to report safety, security and other risks

 Oversee the quality of patient care

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Staff Qualification and Education

 Staff Recruitment, Planning

 Orientation & Education

 Clinical Privilleges

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Reporting and Investigating Event

 Organizations depend on staff, including nurse to report adverse events - whether they are sentinel

events or near misses- so that systems can be revised as necessary

 Nurses should actively lead participation in root cause analysis teams. Because nurses have the most direct, 24/7 contact with patients, they provide a unique

perspective on system issues that could lead to a near miss or sentinel event.

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Para Pemberi Asuhan (PPA)

I. Asesmen Pasien

(Skrining, “Periksa Pasien”)

1) Pengumpulan Informasi : Anamnesa, pemeriksaan, pemeriksaan lain /

penunjang, dsb

2) Analisis informasi : dihasilkan Diagnosis / Problem / Kondisi,  identifikasi

Kebutuhan Yan Pasien

3) Susun Rencana Pelayanan / Pengobatan : untuk memenuhi Kebutuhan Yan Pasien

II. Implementasi / Pelaksanaan

Rencana

Asuhan Pasien

Patient Care

Asesmen Ulang

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Catatan Perkembangan Pasien Terintegrasi (Integrated Note) Nama pasien

(Semua Pemberi Asuhan menulis ttg perkembangan pasien disini, dan “semua membaca semua”)

Tanggal Jam

(Tepi utk mulai menulis)

Dokter

(Tepi utk mulai menulis)

Staf Klinis lainnya

10/5/13 7.30

8.15

9.10

S O A P

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O ddd eeee …..

A ggggg hhhhh kkkkk …..

P nnnn pppppp qqqqq.

ttd, nama Perawat

S O A P

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Skrining

Asesmen awal

Rencana asuhan

Rencana pulang

Hak pasien

MKI PPI SKP

Registrasi

Transfer Rujuk

Terminal Asesmen

ulang

Ringkasan pulang Lab, Rad

Risiko tinggi Restraint Risiko

malnutrisi Asesmen

nyeri

Risiko jatuh

Analisis data ->

Dx Pengumpulan

data klinis

Implementasi Rencana

asuhan

Pelayanan fokus pasien: MULTI PROFESI - ASUHAN – EDUKASI

Implementasi Rencana

asuhan

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“Kepuasan Pasien”

Sistem

Manajemen Sistem

Pelayanan Klinis

Asuhan Pasien / Patient Care

Quality & Safety

PASIEN

Profesi Pemberi

Asuhan

Manajemen Pasien

Perawat

Apoteker Fisio

terapis

Ahli Gizi Radio

grafer

Pasien

Dokter

Analis

“BPIS”

“Enthusiatic Patient”

Lainnya

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Form Edukasi

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