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Quality nutritional care services are fulfilled steps ranging from assessment, diagnosis, intervention, monitoring and evaluation. Quality measures are illustrated through the evaluation of the success of nutritional care and compliance of nutrition personnel carrying out PAGT. The results of nutrition care search in inpatients conducted Nutrition installation and Food Production (IGPM) at RSUPN Dr. Cipto Mangunkusumo in March 2021 against 40 inpatients obtained new results 43% medical records with documentation monitoring the evaluation of complete nutritional care, still found discrepancies in nutritional care documentation in inpatients. This study aims to analyze the quality of nutritional care in inpatients at RSUPN Dr. Cipto Mangunkusumo. This research was conducted in June-July 2021, with a type of mix methode research with explanatory research design on nutritional quality variables, motivation, teamwork and commitment. Samples in quantitative research, namely dietetic nutritionists conducted by 21 people and qualitative research on hr management variables, competency training education using 8 informants. The results showed that nutritional care in inpatients in RSCM was quite good, although there were still some discrepancies in documentation and foster care measures such as there was no monitoring and evaluation period plan on the documentation of 36.5%, and the nutritional assessment was not on time (>1x24 hours) of 21.6%, in terms of motivation, collaboration and commitment of officers in the application of nutritional care is quite good , HR management is managed very well ranging from energy planning, orientation and guidance of new employees, to the granting of authority is good enough, but for the newly formed career level system can not be applied. The education, training and competence of nutritionist-dietitian personnel is managed and very well planned by the Nutrition Installation and Food Production of RSUPN Dr. Cipto Mangunkusumo. A system is needed, to improve compliance in documentation such as form evaluations to facilitate and streamline the time of filling out foster documentation and equalization of Hospital Information System (HIS) in all wards
ABSTRAK
Sisa makanan merupakan salah satu indikator dalam pelayanan gizi khususnyapenyelenggaraan makanan. Dengan pelayanan makanan yang memuaskan selerapasien tanpa mengurangi nilai gizi merupakan terapi diet yang dibutuhkan dalampenyembuhan pasien. Penelitian ini merupakan penelitian quasi eksperimen,dengan membagi sampel menjadi kelompok control dengan mendapatkanmakanan dengan standar porsi diet rumah sakit 2300 kkal dan kelompokperlakuan mendapat standar porsi diet sesuai kebutuhan 1700 kkal. Penelitian inidilakukan pada 34 responden, 17 kelompok control dan 17 kelompok perlakuan.Penelitian dilakukan pada pasien bedah perempuan dengan diet makanan biasa,usia 18-59 tahun, di ruang perawatan RSCM . Pengumpulan data sisa makanandengan system food weighing selama 4 hari. Analisis bivarian menggunakan uji bedadua mean T test independendandependen.Terdapat rata – rata sisa makanan padakelompok control sebanyak 206,37 gram dan kelompok perlakuan sebanyak 117.59 gramper orang per hari. Sisa makanan terbesar disumbangkan dari makanan pokok sebesar41,52% dan sayur sebanyak 24.15% pada kontrol dan 32.87% untuk makanan pokok dan21.81% untuk sayuran pada kelompok perlakuan dari total sisa makanan. Sisa makanankelompok kontrol sebanyak 17.65% masuk dalam katagori banyak (>20%)..Penelitianserupa dapat dilakukan pada kelompok pasien yang mendapatkan makanan lunak danpada kelompok pasien yang tidak berdiet khusus.
ABSTRACT
In nutritional services, waste plate becoming one particular indicator, especiallyin the food provisions for the patient. Food provisions that can satisfy patientstaste without compromising the nutritional value is a dietary therapy required inthe treatment of the patients itself. This is a quasi-experimental study, by dividingthe sample into the control group who received 2300 kcal standard dietaryhospital food portion and the treatment group who received standard dietservings as needed 1700 kcal. This study conducted on 34 respondents, both forthe control group as well as for the treatment group consists of 17 patients. Thestudy was conducted to female surgical patients with normal diet, age 18-59years, at Dr. CiptoMangunkusumo General Hospitals treatment room. The wasteplatedata collection performed by using the food weighing systems for 4 days.Two different mean independent and dependent T-test is used as the bivariateanalysis for this study. There is an average of the waste plate per person per dayas much as 206,37 grams in the control group and 117,59 grams in the treatmentgroup. The biggest waste plate comes from the staple foods and vegetables,respectively 41.52% and 24.15% in controls group and the treatment group was32.87% and 21.81% from the the total of leftover food. Waste plate in the controlgroup as much as 17.65% are included in a lot category (> 20%). Similar studiescan be performed on a group of patients who received bland foods and in thegroup of patients who did not having specific diet.
HIV/AIDS impact to increased susceptibility to other diseases infections whichlead to death. The death of AIDS is also a problem, especially in Indonesia.According to UNAIDS, Indonesia is included in the list of countries where deathsfrom AIDS do not decline or rate of less than 25% of his descent. This research isobservational research, design with cross sectional. This research aims to know thedescription and the main factors which related to mortality of AIDS HIV/AIDS ininpatient unit RSUPN Dr Cipto Mangunkusumo in 2008-2012. The sample of thisresearch are 207 patients. Data collected by utilizing the patient's medical record datato see the independent variables consisted of gender, age, job, CD4 levels, risk factorsof transmission, the amount of illness suffered, nutritional status, history of centralnervous disorders, drug consumption history ARV consumption, and psychologicalconditions to be linked with the status of a patient's death related with HIV/AIDS.The data analysis done to multivariate analysis with prediction model. The resultsshowed that the AIDS death prevalence reach up to 28.5%. The results ofMultivariate analysis obtained 4 variables related to the death of AIDS, poornutritional status (OR=4,75) with 95% CI (2,278-9,917), central nervous disorderhistory (OR=1,82) with 95% CI (1,025-3,251), the number of illnesses suffered morethan 5 disease (OR=4,09) with 95% CI (1,854-9,043), and CD4 levels. CD4 levelsbecame the most influential factors towards AIDS deaths with a value of 5, 9 OR and95% CI (2,096-17,106). From the results can be recommended the efforts toincreased awareness toward control CD4 blood levels for HIV/AIDS patients andother supporting efforts to prevent deaths of AIDS such as improved quality ofnutrition AIDS patients, screening and early detection of central nervous disorders,and prevention of complications of the disease.Keywords: HIV/AIDS, Death, CD4 level, main determinant
The patient safety incident reporting system is a critical component in mitigating preventable risks within healthcare services. Dr. Cipto Mangunkusumo National General Hospital (RSCM) has implemented both manual and electronic (e-Report) methods for reporting incidents. However, its implementation remains suboptimal. This study aims to evaluate the implementation of the incident reporting system at RSCM using a qualitative approach, guided by the Donabedian framework (structure–process–outcome) and the Plan–Do–Study–Act (PDSA) improvement cycle. The findings reveal that the current e-Report system does not sufficiently meet user needs due to an unintuitive interface and the absence of key functionalities such as report tracking, automated notifications, and feedback mechanisms. Additionally, fragmented reporting channels, a predominance of manual submissions, and the perception of reporting as a bureaucratic burden have contributed to a weakened safety culture. The follow-up process is also perceived as lacking transparency and is rarely communicated back to reporters, further reducing trust in the system. These challenges form the basis for recommendations to develop a centralized, user-friendly, and integrated reporting system, supported by unit-based training and a single-channel reporting policy. The PDSA cycle is applied as a strategic framework to design a more responsive and sustainable system that enhances both service quality and patient safety at RSCM.
Pendahuluan. Artritis reumatoid (AR) adalah peradangan kronik autoimun yang terutama melibatkan persendian secara bilateral dan simetris. Walaupun memiliki prevalensi yang rendah namun jika tidak diterapi secara adekuat maka akan menimbulkan masalah persendian yang bersifat permanen, kecacatan dan gangguan fungsi sendi sehingga menimbulkan dampak secara ekonomi dan sosial pada individu yang mengalaminya. Penyakit AR ini tidak dapat disembuhkan namun penyakit ini harus tetap ditatalaksana untuk mencegah progresifitas dari penyakit itu sendiri dan saat ini prediksi kegagalan atau keberhasilan terapi MTX belum pernah dilakukan di Indonesia terutama pengembangan terhadap suatu sistem skoring yang aplikatif, hal ini menjadi landasan untuk melakukan analisis faktor-faktor yang memengaruhi kegagalan pengobatan metotreksat pada pasien AR dalam hal ini dalam skala rumah sakit yang menyesuaikan dengan kondisi di Indonesia dan melakukan pengembangan sistem skoring prediktor terhadap kegagalan monoterapi metotreksat. Metode. Penelitian menggunakan desain studi kohort retrospektif yang menggunakan data rekam medis elektronik (RME) pasien poli reumatologi penyakit dalam RSCM pada kurun waktu Oktober 2020 - September 2023. Dilakukan analisis deskriptif dan bivariat dengan menggunakan analisis chi-square yang dilanjutkan dengan analisis multivariat dengan analisis model Generalized Linear Model (GLM) dengan family Poisson untuk mendapatkan nilai koefisien, RR dengan interval kepercayaan 95% dari variabel independen terhadap kegagalan terapi monoterapi metotreksat yang dilanjutkan proses eliminasi variabel melalui metode backward. Hasil. Penelitian ini mendapatkan jumlah sampel sebanyak 215 subyek setelah melalui seleksi kriteria inklusi dan eksklusi, dan didapatkan hasil bahwa jumlah sendi nyeri ≥ 6 memiliki RR 1,52 (CI 95% 1,09-2,16), obesitas memiliki RR 1,41 (CI 95% 1,04-1,24), faktor peradangan LED memiliki RR 2,21 (CI 95%1,07-4,10) dan derajat aktifitas penyakit yang tinggi dengan RR 1,36 (CI 95% 1,03-1,79) adalah variabel yang memengaruhi kegagalan monoterapi metotreksat. Pada pembentukan skoring didapatkan skoring TOLD memiliki nilai kalibrasi dari Hosmer-Lemeshow goodness of fit sebesar 0,29 dan nilai diskriminasi area under curve (AUC) pada kurva receiver operating characteristics (ROC) sebesar 0,71 (CI 95% 0,65-0,78; p-value 0,03). Kesimpulan. Jumlah sendi nyeri ≥ 6, obesitas, faktor peradangan LED dan derajat aktifitas penyakit yang tinggi adalah variabel yang memengaruhi kegagalan monoterapi metotreksat dan pembentukan skoring prediksi TOLD memiliki nilai diskriminasi dan kalibrasi yang cukup baik
Introduction. Rheumatoid arthritis (RA) is a chronic autoimmune inflammation that mainly involves the joints bilaterally and symmetrically. Even though it has a low prevalence, if it is not treated adequately, it will cause permanent joint problems, disability and impaired joint function, causing economic and social impacts on the individuals who experience it. RA disease cannot be cured but this disease must still be managed to prevent progression of the disease itself and currently predictions of failure or success of MTX therapy have never been carried out in Indonesia, especially the development of an applicable scoring system, this is the basis for conducting analysis of factors that influence methotrexate treatment failure in RA patients, in this case on a hospital scale that adapts to conditions in Indonesia and develops a predictor scoring system for failure of methotrexate monotherapy. Methods. The study used a retrospective cohort study design using electronic medical record (RME) data from patients in the RSCM internal medicine rheumatology clinic in the period October 2020 - September 2023. Descriptive and bivariate analysis was carried out using chi-square analysis followed by multivariate analysis using Generalized model analysis. Linear Model (GLM) with the Poisson family to obtain coefficient values, RR with a 95% confidence interval of the independent variable for failure of methotrexate monotherapy therapy, followed by a variable elimination process using the backward method. Results. This study obtained a sample size of 215 subjects after going through selection criteria for inclusion and exclusion, and the results showed that the number of painful joints ≥ 6 had an RR of 1.52 (CI 95% 1.09-2.16), obesity had an RR of 1.41 (CI 95% 1.04-1.24), inflammatory factor ESR had RR 2.21 (CI 95% 1.07-4.10) and high degree of disease activity with RR 1.36 (CI 95% 1.03 -1.79) are variables that influences the failure of methotrexate monotherapy. In forming the scoring, it was found that TOLD scoring had a calibration value from the Hosmer-Lemeshow goodness of fit of 0.29 and an area under curve (AUC) discrimination value on the receiver operating characteristics (ROC) curve of 0.71 (CI 95% 0.65-0 .78; p-value 0.03). Conclusion. The number of painful joints ≥ 6, obesity, ESR inflammatory factors and a high degree of disease activity are variables that influence the failure of methotrexate monotherapy and the formation of TOLD prediction scoring has quite good discrimination and calibration values.