Tujuan : Untuk mengetahui apakah trombosit dan kovariat lainnya yaitu jenis kelamin, usia, lama saklt, perdarahan, status gizi, hepatomegali, hematokrit, dan leukosit merupakan prediktor terjadinya renjatan pada pasien demam berdarah dengue (DBD) anak. Desain : kohort retrospektif dcngan analisis survival di dua rumah sakit di Jakarta. Penentuan tilik potong untuk trombosit, leukosit, dan hematokrit berdasarkan lama sakit menggunakan metode receiver operating characleristic (ROC). Nilai diskriminasi model prediksi menggunakun parameter area under curve (AUC). Subyek : Pasien suspek DBD, derajat I-Il, tanpa penyakit penyerta, lama sakit 3-5 hari. Keluaran utama: I-lubungan antara trombosit dengan renjatan dan model prcdiksi renjatan DBD pada awal perawatan dan 24jam perawatan. Hasil : Telah direkrut sebanyak 525 subyek dari catatan medis rumah sakit. Insidens renjatan sebesar 6,l%. Titik potong trombosit awal perawatan dengan lama sakit 3, 4 dan 5 hari musing-masing adalah 81.500/ul, 59.500/ul dan 53.500/ul. Titik potong trombosit 24 jam perawatan dengan lama sakit 4, 5 dan 6 hari masing-masing adalah 59.500/ul, 53.500/ul, dan 45.000/ul. Baik trombosit awal perawatan maupun 24 jam perawatan berhubungan dengan teijadinya renjatan dengan hazard ratio masing-masing sebesar 3,5 (lK95% 1,5-8,4) dan 3,3 (lK95% 1,4-7,5). Nilai diskriminasi trombosit awal perawatan dan 24 jam perawatan musing-masing sebesar 72,3% (IK 95% 63,1-8l,6) dan 67,'7% (IK 95% 58,2-‘77,3). Trombosit bersama-sama dengan karakteristik klinis rumah sakit, perdarahan, status gizi, interaksi lama sakit dengan hematokrit, dan interaksi lama sakit dengan hepatomegali baik pada awal perawatan maupun 24 jam perawatan merupakan prediktor lerjadinya renjatan. Model prediksi pada awal pcrawatan dan 24 jam perawatan mempunyai nilai kalibrasi yang baik dan nilai diskriminasi yang baik dengan AUC sebesar 84,l%; lK95% 77,9-90,3 untuk awal perawatan dan 80,4% (IK 95% 72,4-88,4) untuk 24 jam perawatan. Nilai diskriminasi model prcdiksi ini lebih baik daripada nilai diskriminasi trombosit awal perawatan maupun 24jam perawatan. Kesimpulan dan saran: Trombosit merupakan prediktor terjadinya renjatan pada DBD anak akan letapi penggunaan trombosit sebagai prediktor renjatan akan lebih balk jika digunakan bcrsama-sama dengan parameter Iainnya yaitu perdarahan, status gizi, hepatomegali, dan hematokrit. Saran: Perlu dilakukan penelitian lanjutan untuk mengetahui reproducibilizjv dan rransporrability model prediksi renjatan yang diperoleh dalam penelitian ini.

Purpose: to investigate whether thrombocyte and other covariate such as sex, age, time before admission, bleeding, nutritional status, hepatomegali, haematocrit, and leukocyte, can be used to predict shock at children with dengue hemorrhagic fever (Di-IF). Design: Retrospective cohort with survival analysis. Cit off point for thrombocyte, leukocyte. and haematocrit according to day of sick were determined by receiver operating characteristic (ROC) curve. Magnitude of discrimination was assessed by area under curve (AUC). Subject: Children suspected with DH F, grade l and II at admission. Main outcome: to know association between thrombocyte with shock and to know prediction model to predict shock at admission and 24 hours after admission. Result: There were 525 subjects. Incident of shock was 6.l%. Cut off point for thrombocyte according to long of sick at 3, 4 and 5 day were 81.500/ul, 59.500/ul and 53,500/ul respectively. Cut olT point for thrombocyle at 24 hours aller admission ut 4, S, and 6 day were 59.500/ul, 53,500/ul, and 45,000/ul respectively. Both thrombocyte at admission and 24 hours after admission had association with shock with hazard ratio 3.5 (95%Cl l.5-8.4) and 3.3 (95Cl% i.4-7.5) respectively with magnitude of discrimination were 72.3% (95Cl% 63.1-8l.6) and 67.7% (95%Cl 58.2-77.3) respectively. Thrombocyte together with clinical characteristic of hospital, bleeding, nutritional status,interaction between time before admission and hepatomegali, interaction between time before admission and haematocrit were significant variables to include in to the prediction model for shock both for admission and 24 hours after. These models had good calibration and discrimination with magnitude of discrimination were 84.l%; lK95% 77.9-90.3 and 80.4% (95%Cl 72.4-88.4) respectively. Discrimination of tlicse models was higher than discrimination of thrombocyte alone. Conclusion: Thrombocyte is a predictor of shock but using prediction models consist of thrombocyte and other variables such as bleeding, nutritional status, hepatomegali, haematocrit is better to predict shock than thrombocyte alone. Suggestion: To conduct further research to investigate reproducibility and transportability of these prediction models.

Latar belakang Pelayanan kesehatan yang bermutu mempakan salah satu kcbutuhan dasar bagi semua masyarakal. Masyarakat menuntut layanan yang lcbih baik, yaitu suatu layanan yang tidak hanya semala mendapatkan pemeriksaan fisik, tetapi juga suatu Iayanan yang ramah, berkesinambungan dapat diterima dan wajar Serta bermulu. Pengukuran mutu layanan dapat di lakukan secara subyektif mnupun secara obyektiti Pengukuran secara obyektif adalah pengukuran terhadap profesionalisme pelayanan seperti Standard Operating Procedurs. Standard Operating Procedurs adalah Suatu perangkat inslruksil langkah-langkah yang di bakukan untuk menyelesaikan suatu proses kerja rutin tertenlu. Kasus diare merupakan kasus yang paling sering di jumpai di rumah sakit. Penatalaksanaan kasus diare pada anak sangat panting, karena kesalahan pada penanganan, dimana konsentrasi terhadap kebutuhan keseimbangan cairan dan elektrolit dapat berakibat fatal yaitu kemalian. Dalam pengawasan pasien ini perawat dalam menjalankan tugasnya dituntut mtuk dapat menjalankan SOP yang telah di buat dan ditetapkan oleh mmah sakit pcnyedia jasa Iayanan kesehatan. Tujuan: Penelitian yang penulis lakukan bemgjuan untuk menjawab pertanyaan mengenai bagaimana gambaran serta apakah ada monitoring dan evaluasi pelaksanaan SOP wuhan keperawatan anak dengan diana oleh perawat di ruang rawat Rumah Sakit Rawa Lumbu. Metode penelitian: Rancangan penelitian ini adalah kualitatif dan kuantitatif dengan menganalisa data secara retrospektif dan dengan melakukan metode wawancara serta Focus Group Discussion terhadap perawat pclaksana, kepala unit ruangan, kepala bidang pcrawat dan dokter spesialis anak Rumah Sakit Rawa Lumbu. Hasil penelitian: Semua responden mengetahu adanya SOP diare pada anak dan mereka mengemhui bahwa sebagian perawat tidak menjalankan SOP tesebut, hal tersebut tenjadi di karenakan perbandingan jumlah perawat dan jumlah tempat tidur tidak seimbang Sementara itu monitoring dan evaluasi terhadap SOP belum pemah dilakukan. Kesimpulan: SOP muhan keperawatan diare pada anak saat ini sudah baik, tetapi pefawat ada sebagian yang belum memahami SOP tersebut dan belum secara lengkap menempkan SOP asuhan keperawatan diare pada anak di karenakan beban kerja perawai yang tinggi. Hal tersebut disebabkan antara Iain adalah tidak tersedianya alat penunjang kcgiatan pelaksanaan SOP juga tidak seimbangnya perbandingan jumlah perawai dan jumlah tcmpax tidur

Background: High quality health services were one of the basic needs in all communities. Community was urging for better services, services which do not only comprising of physical diagnosis, but also kind, continual, acceptable, appropriate and high quality services. Assessment of services quality could be done by either subjective or objective ways. Objective assessment was assessment of services professionalism such as Standard Operating Procedures (SOP). SOP is an instruction or steps protocol that has to be standardized in order to finish some routine work process. Diarrhea cases were ease which very probable to found in hospital. Management of diarrhea cases in children is very important, because of error in handling, such as in the concentration of electrolyte and fluid balance needs, could causing final consequences, in the end was death. When watching these patients, nurses who doing these jobs were urged to do SOP that have been made and signed by the hospital which supplying health services. Aim: Study which writer done was aimed to answer quwtions about how is the description and is there any monitoring and evaluation of children with diarrhea nursing care SOP implementation by nurses in Rawa Lumbu Hospital treatment room. Researching method: this study was designed using qualitative and quantitative method by analyzing data retrospectively and by doing interview method and Focus Group Discussion with practitioner nurses, head of the room unit, and podiatrist ofllawa Lumbu Hospital. Result of the study: All respondents knew the existence of diarrhea in children SOP and they knew that some nurses were not implementing the SOP caused by comparison of nurses and beds amount was unbalanced. ln the other hand, monitoring and evaluation of SOP were never being done before. Conclusion: Diarrhea in children nursing care SOP were good these time, but there were some nurses who have not understand these SOP and have not completely implementing the Diarrhea in children nursing care SOP because of nurse’s high workloads. This could be caused by such thing as instrument of the SOP implementation were not provided and the unbalanced number of comparison between nurses and beds amount.