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Keselamatan pasien merupakan isu global yang mendorong pengembangan sistem pelaporan insiden di fasilitas kesehatan. Siloam Hospitals Kelapa Dua telah mengimplementasikan Sistem Informasi Manajemen Mutu (SIMM) berbasis web sejak Maret 2023 untuk mendukung pelaporan insiden keselamatan pasien. Penelitian ini bertujuan mengevaluasi implementasi SIMM dan faktor-faktor yang memengaruhi penggunaannya.
Penelitian menggunakan pendekatan studi kasus dengan metode campuran. Data kuantitatif diperoleh dari 774 laporan insiden yang teregister di SIMM selama Maret 2023–Desember 2024. Data kualitatif dikumpulkan melalui wawancara mendalam dengan 10 informan dari berbagai profesi.
Hasil menunjukkan bahwa perawat merupakan pelapor terbanyak. Pengetahuan staf tentang pelaporan cukup baik, namun pelatihan formal masih terbatas. Budaya keselamatan tergolong baik, ditandai dengan dukungan manajemen dan komunikasi terbuka, meskipun masih ada persepsi menyalahkan. SIMM dinilai cukup mudah digunakan, namun terdapat kendala teknis dan kompleksitas formulir. Fitur proteksi identitas pelapor sering digunakan secara tidak sengaja.
Rata-rata 35 laporan diterima setiap bulan oleh 17 pelapor aktif. Fitur analisis akar masalah (RCA) digunakan pada 76,0% laporan, namun hanya 60,0% yang diselesaikan tepat waktu. Dashboard SIMM dimanfaatkan untuk analisis tren. Ketepatan waktu pelaporan dalam 1×24 jam tercapai pada 62,8% laporan, dan 73,8% laporan diproses lengkap. Pelaporan berkontribusi pada perbaikan proses dan pembelajaran organisasi, meskipun tingkat pelaporan 22,03 per 1.000 hari pasien—masih di bawah tolok ukur.
SIMM memberikan kontribusi positif terhadap pelaporan insiden, namun optimalisasi sistem, pelatihan, dan budaya pelaporan masih perlu ditingkatkan.
Patient safety is a global concern that has driven the development of incident reporting systems in healthcare facilities. Siloam Hospitals Kelapa Dua implemented a web-based Quality Management Information System (QMIS) in March 2023 to support patient safety incident reporting. This study aims to evaluate the implementation of QMIS and the factors influencing its use. A case study with a mixed-methods approach was conducted. Quantitative data were obtained from 774 incident reports registered in QMIS between March 2023 and December 2024. Qualitative data were collected through in-depth interviews with 10 informants from various professional backgrounds. Findings show that nurses were the most frequent reporters. Staff demonstrated adequate knowledge of incident reporting, although formal training was limited. The hospital’s safety culture was generally strong, supported by management commitment and open communication, though some perceptions of blame remained. QMIS was considered user-friendly, despite technical issues and form complexity. The anonymous reporting feature was often used unintentionally, complicating follow-up. On average, 35 reports were submitted monthly by 17 active users. The root cause analysis (RCA) feature was used in 76.0% of reports, with only 60.0% completed on time. The QMIS dashboard was used for trend analysis. Timely reporting within 24 hours was achieved in 62.8% of cases, and 73.8% of reports were fully processed. Reporting contributed to process improvements and organizational learning, although the reporting rate remained at 22.03 per 1,000 patient days—below the benchmark. QMIS has positively supported incident reporting, but further improvements are needed in system optimization, training, and fostering a stronger reporting culture.
Patient safety incident reports have a very important role in the application of patient safety in the hospital to ensure incident recognition and fast follow-up so that more serious incidents do not occur. Reporting patient safety incidents at Matraman Hospital has not shown a good reporting culture. In the preliminary study, researchers found 19 incidents occurred and had to be reported, but not being reported. This is the background for researchers to analyze compliance with patient safety incident reporting by nurses at the Matraman Regional General Hospital. The purpose of this study was to obtain evidence and results of compliance analysis of patient safety incident reporting by nurses at Matraman Hospital in 2020 and the factors that influence it. The research was conducted through a cross-sectional approach with a crosssectional method, data collection using a questionnaire instrument that is completed online. The population and research sample were all nurses who worked at the Matraman Hospital (48 nurses) where in this study, 2 nurses stated that they were not willing to be research respondents (N = 46). The data were then analyzed using univariate and bivariate methods to look for relationships between variables. Of the 46 respondents who agreed to fill out the questionnaire, it was found that 18 out of 46 respondents (39.13%) reported the number of incidents they witnessed, and the rest reported lower number of incidents than what they actually witnessed. The Anova test results show that the variables that have a significant relationship with patient safety incident reporting are the perception of patient safety reporting (Sig. 0.002), compliance with organizational regulations (Sig. 0.001), and the application of reward and punishment (Sig. 0.033). Tests on other variables, namely the level of knowledge (Sig. 0.148), the role of management (Sig. 0.245) and the application of no blaming culture (Sig. 0.990) did not show a relationship with compliance with incident reporting
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.
