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Keselamatan pasien (patient safety) rumah sakit adalah suatu sistem dimana rumah sakit membuat asuhan pasien lebih aman. Sistem tersebut meliputi: assesmen resiko, identifikasi dan pengelolaan hal yang berhubungan dengan risiko pasien, dan seterusnya. Sejak dideklarasikannya pelaksanaan Patient Safety di Rumah Sakit X pada tahun 2009 hingga tahun 2011, tercatat Insiden Keselamatan Pasien (IKP) sebanyak 171 kasus, dimana IKP paling banyak yaitu sekitar 60% terjadi di pelayanan rawat inap. Melalui penelitian ini, dianalisis penyebab terjadinya IKP di ruang perawatan Rumah Sakit X. Studi dilakukan terhadap 100 perawat pelaksana dengan menggunakan desain cross sectional untuk melihat bentuk hubungan antara variabel individu, kompleksitas pengobatan, kerjama, gangguan/ interupsi, komunikasi, Standar Prosedur Operasional, dan kenyamanan tempat kerja terhadap kejadian IKP.
Hasil penelitian menunjukkan variabel karakteristik individu, yang terdiri dari usia, masa kerja, dan kompetensi; dan variabel kerja sama yang memiliki hubungan yang signifikan terhadap kejadian IKP dengan nilai P value masing-masing sebesar 0.028, 0.010, 0.028, dan 0.012. Dengan kata lain variabel yang paling berpengaruh terhadap kejadian IKP adalah variabel karakteristik individu sehingga hasil studi ini bisa menjadi pertimbangan bagi Bagian SDM, Komite Keperawatan dan Bagian Keperawatan Rumah Sakit X dalam melakukan seleksi dan pengembangan SDM Keperawatan dalam upaya meningkatkan keselamatan pasien.
Patient safety is a system to make patient care become safer. The systems include risk assessment, identifying and managing the risks associated with patient, and so on. Since the patient safety program has been declared in "X" Hospital in 2009 until 2011, there are 171 cases recorded as a number of the patient safety incident (PSI), most cases about 60% occur in inpatient unit. Through this study, determinants of PSI in inpatient unit X Hospital are analyzed. Study is applied to 100 nursing staffs by cross sectional study design in order to observe the correlation between variable of individual characteristic, medication complexity, teamwork, interruption, communication, standard of procedure operational, and work place comfortable to PSI.
Result shows that there is a significant correlation between variable of individual characteristic (include age, working time, and levels of competence) and teamwork to PSI, with the P value: 0.028, 0.010, 0.028, and 0.012. In other word, the most significant variable to PSI is individual characteristic variable so it could be a consideration to recruit and do improvement based on patient safety by Human Resources, Nursing Committee and Nursing Unit of X Hospital.
The initial step to build patient safety is assessing patient safety culture in whichas a guide in implementing patient safety. The research was done in RSIA KurniaCilegon with a sample of medical personnel 79 respondents consisting of generalpractitioners, dentists, specialists, midwives and nurses with quantitative methodscross-sectional by using instrument AHRQ measure perceptions of patient safetyculture continued qualitative method aims to find out factors inhibiting andsupporting factors and knowing the steps efforts to improve patient safety culturein RSIA Kurnia results of this study, it was shown in patient safety culture is beingRSIA Kurnia 2015 with Tim advice KPRS socialize patient safety, reward andalways socialize a non-punitive response to faults, do Inhouse Training patientsafety, scheduling regular monthly meetings, and conduct an investigation in eachroom to do patient safety rounds regularly to improve the reporting of patientsafety incidents and improve safety culture at RSIA Kurnia.Keywords: patient safety cultur;AHRQ instrument;, medical personnel perception.
Abstrak
Keselamatan pasien menjadi penting karena masih tingginya angka KTD di rumah sakit secara global maupun nasional. Di RSUD Sele Be Solu pada tahun 2011,dari 1.560 pasien rawat inap penyakit dalam yang dilakukan pemasangan infus sebanyak 1,9% mengalami phlebitis. Di ruang rawat inap anak RSUD Sele Be solu, kejadian phlebitis setelah pemasangan infus kurang dari 3 hari ditemukan sebanyak 8 pasien (20%) dari 40 pasien anak dan ada 11 pasien (61,1%) dari 18 pasien anak setelah lebih dari 3 hari pemasangan infus. Selama ini belum pernah dilakukan penilaian budaya keselamatan pasien di Rumah sakit Sele Be Solu. Tujuan penelitian ini adalah untuk mengetahui hubungan frekuensi pelaporan KTD dengan budaya keselamatan pasien oleh perawat di RSUD Sele Be Solu. Metode kuantitatif dengan pendekatan cross sectional, populasi adalah seluruh perawat di instalasi rawat inap sebanyak 110 orang. Pengumpulan data dengan menyebarkan kuesioner.
Hasil penelitian ada hubungan antara frekuensi pelaporan KTD dengan feedback dan komunikasi terhadap kesalahan, (p value = 0,018) besarnya hubungan dua kali lebih besar dibandingkan dengan kerjasaman dalam unit. Kesimpulan dari penelitian ini adalah masih rendahnya tingkat pelaporan KTD di RSUD Sele Be Solu Kota Sorong. Saran kepada pihak manajemen agar segera membentuk komite keselamatan pasien di rumah sakit dan menerapkan standar keselamatan pasien sesegera mungkin/
Patient safety become an important issue because adverse events are still in a high level at hospital globally and nationally. In 2011, at Interna ward of Sele Be Solu Sorong hospital, from 1.560 patients which had i.v line attached by nurses, 1,9% patients were had phlebitis. While at the pediatric ward, phlebitis events after i.v line was attached less than three days, 8 patients was found (20%) from 40 patients, and there were 11 patients (61,1%) from 18 children after 3 days of i.v line was attached. The patient safety culture in Sele Be Solu hospital was never been assessed. The purpose is to discover the relationship between adverse events frequency report and patient safety culture by nurses at Sele Be Solu hospital. Quantitative method was used in this study with cross sectional approached, population were all nurses at inward installation, which are 110 people. Data was gathered with questionnaire which had filled by nurses.
The result is there are relationship between adverse events report frequency activity with feedback and communication to the false (p value=0,018) and the relationship are double amounts higher than teamwork in the unit. Conclusion is the report activity of adverse event at Sele Be Solu hospital Sorong is low. Suggest to the hospital management is to form patient safety committee at hospital and set the patient safety standard procedure immediately.
Latar belakang: Pelaporan Insiden Keselamatan Pasien (IKP) penting untuk memahami penyebab insiden dan meningkatkan keselamatan pasien. Tingkat pelaporan IKP oleh perawat di RSJPDHK tahun 2023 hanya 15,9%, menunjukkan masih banyak insiden yang tidak dilaporkan dan akan melemahkan kapasitas sistem pelaporan untuk mendorong pembelajaran. Penelitian terdahulu (2014-2023) mengidentifikasi bahwa faktor individu, psikologis, dan organisasi sebagai determinan penerapan pelaporan IKP.
Tujuan: Mengetahui determinan individu, psikologis, dan organisasi yang berkaitan dengan penerapan pelaporan IKP oleh perawat di RSJPDHK tahun 2024.
Metode: Penelitian kualitatif dengan desain studi kasus dilakukan pada bulan Juli – Oktober 2024. Penelitian ini melibatkan lima orang kepala unit kerja dan dua orang dari Komite Mutu melalui wawancara mendalam dan telaah dokumen.
Hasil: Penerapan pelaporan IKP meningkat pada tahun 2022-2024, namun belum merata di seluruh unit kerja. Perawat yang rutin melaporkan IKP menunjukkan pengetahuan yang lebih baik dan motivasi yang lebih tinggi. Hambatan psikologis lebih sedikit dirasakan pada perawat yang aktif melapor. Determinan organisasi yang paling banyak mendapat respon negatif meliputi supervisi kepala unit, pelatihan, dan dukungan manajemen berupa champion keselamatan pasien.
Kesimpulan: Akar permasalahan belum meratanya penerapan pelaporan IKP di RSJPDHK yaitu pelatihan yang belum efektif dan ketiadaan instrumen yang merinci pelaksanaan supervisi kepala unit dan uraian aktivitas champion keselamatan pasien.
Background: Patient Safety Incident (PSI) reporting is crucial for understanding the causes of incidents, which serve as a basis for improving patient safety. The PSI reporting rate by nurses at National Cardiovascular Center Harapan Kita (NCCHK) in 2023 was 15,9%, indicating that many incidents remain unreported, which weakens the reporting system’s capacity to drive learning. Previous research (2014-2023) identified individual, psychological, and organizational factors as determinants of PSI reporting implementation. Objective: To identify individual, psychological, and organizational determinants related to the implementation of PSI reporting by nurses at NCCHK in 2024. Method: A qualitative study with a case study design was conducted from July-October 2024. The study involved five units head and two members from the Quality Committee through in-depth interviews and document reviews. Results: The implementation of PSI reporting increased from 2022-2024 but remains inconsistent across all units. Nurses who regularly report PSI demonstrated better knowledge and higher motivation. Psychological barriers were less prominent among nurses who actively reported incidents. Organizational determinants receiving the most negative responses included unit head supervision, training, and patient safety champions. Conclusion: The root causes are ineffective training, the absence of detailed instruments outlining unit head supervision and specific activities for patient safety champions.
Building a culture of patient safety is the first step in the developmentof patient safety. Culture of patient safety in hospitals is part of the cultureof the organization, so that the assessment of organizational culture neededto be a guide in developing patient safety. This study aims to determine thepatient safety culture among providers in dr. H. Abdul Moeloek Lampungand identify organizational culture profile in the ranks of leadership.Descriptive study with qualitative interpretation and analysis of thestudy subjects took care providers and hospital management board, bydistributing questionnaires and implement the Consensus Decision MakingGroup (CDMG). The research instrument used questionnaires AHRQ(Agency for Heath Research and Quality) dividing the patient safety cultureto 1.) Cultural Openness, 2.) Cultural Justice, 3) Cultural Reporting, 4.)Cultural Learning, 5.) Cultural Information. While questionnairesOrganization Culture Assessment Instrument (OCAI) assesses six culturalcriteria, namely 1.) Dominant character, 2) Organizational Leadership, 3)Employee Management, 4.) Adhesive Organization, 5.) Strategic Emphasis,6.) Success Criteria. Organizational culture is divided into Type Clan,Adhocrazy, Market and Hierarchy.Results of the study found that a culture of openness, especiallycooperation in the unit are the dimensions of patient safety culture isstrongest and dominant. While the non-punitive responses and recording theweakest dimension. Type Hierarki culture obtained as the dominant type oforganizational culture as well strong for the current and expected. It servesas a guide to select a quality improvement strategy through CompetingValue Framework in order to develop and increase patient safety. Follow-upplan prepared and agreed in the Consensus Decision Making Group(CDMG) to ground elements of patient safety in the vision and mission ofthe organization and strengthening a culture of safety through patient safetytraining for all staff. Blamming culture must gradually and significantlysoon be eliminated in all forms of service in hospitals.Keywords: Organizational Culture, Patient Safety Culture, Patient safety,Cultural Hierarchy, RSUD dr. H. Abdul Moeloek