AN ANALYSIS ON THE POLICY IMPLEMENTATION OF ANTIBACTERIAL RESISTANCE CONTROL AT THE HOSPITAL

Abstract. In order to control Antibacterial Resistance at the hospital in Indonesia, the Government of Indonesia established an Antibiotics Resistance Control Committee and issued a Regulation from the Ministry of Health, regulation no 8/2015 on an antibiotics resistance control program at the hospital. This is an investigation on the Antibacterial Resistance Control Program (ARCP) at the Hospital, which compares its implementation at a government hospital and a private hospital, Persahabatan Central General Hospital (CGH) and Bogor Indonesian Red Cross Hospital (BIRCH). This was a descriptive study with a qualitative analysis obtained through indepth interviews and documentary research. We discovered that the ARCP was implemented better at Persahabatan CGH compared to BIRCH. Problems include ineffective communication, limited resources, lack of an antibiotic guideline (at BIRCH), lack of coordination between organizations, lack of supervision from the government, and the lack of motivation to implement the policy. These issues can be solved by intensifying the socialization of the policy, conducting more workshops and trainings for private and government hospitals that has not received any, providing an incentive for them to implement the program, such as including ARC into hospital accreditation indicators, and clarifying the benefits of the program to the stakeholders. Abstrak. Salah satu upaya pengendalian resistensi antibiotika di Indonesia adalah pembentukan pembentukan Komite Pengendalian Resisten Antibiotika (KPRA) dan diterbitkannya Permenkes no. 8 Tahun 2015 tentang program pengendalian resistensi antibiotika (PPRA) di rumah sakit (RS). Penelitian ini bertujuan untuk menggali lebih dalam terhadap implementasi kebijakan PPRA di RS dibandingkan antara RS pemerintah dengan RS swasta yaitu RS Persahabatan dan RS PMI. Metode penelitian merupakan studi deskriptif dengan analisis kualitatif melalui wawancara mendalam dan telaah dokumen. Hasil penelitian menyimpulkan bahwa pelaksanaan PPRA di RS Pemerintah lebih baik dari RS Swasta. Saran yang diajukan adalah mempercepat peningkatan kesadaran akan pentingnya PPRA, terutama bagi RS

Rancangan Pola Karir Perawat Klinik Di Rumah Sakit Tentara Jakarta

Clinical Nurse in an army hospital has unique career & development pattern. This study aimed at finding out description on an effective career pattern for clinical nurses at army hospital. This was a qualitative study conducted from March-April 2006 involving 25 informants. Primary data was collected by in-depth interview and secondary data was collected from documentations related to policy and regulation in career development of clinical nurse. The data source was from the hospital and its governing institutions; i.e. Regional Army Office & Ministry of Defense & Security. The results showed there was unclear development pattern for clinical nurses in army hospital. Different status of the nurse in the hospital has different characteristic of development. Almost all of training programs at the hospital are directed by the governing institutions with little involvement from the hospital management. Working experience, as part of career development, is mostly achieved due to experience in the organization, military rank (army), employment grade (government official), rotation and promotion programs, education and training, and military field duty. The policy and regulation on career development of clinical nurses depend on the policy & decision of the governing institutions. This research develops career development patterns for all clinical nurses based on their status, clinical duty, and structural assignment. The career pattern developed is appropriate with nurse's education, work experience, and its competence

Developing One Health surveillance systems

The health of humans, domestic and wild animals, plants, and the environment are inter-dependent. Global anthropogenic change is a key driver of disease emergence and spread and leads to biodiversity loss and ecosystem function degradation, which are themselves drivers of disease emergence. Pathogen spill-over events and subsequent disease outbreaks, including pandemics, in humans, animals and plants may arise when factors driving disease emergence and spread converge. One Health is an integrated approach that aims to sustainably balance and optimize human, animal and ecosystem health. Conventional disease surveillance has been siloed by sectors, with separate systems addressing the health of humans, domestic animals, cultivated plants, wildlife and the environment. One Health surveillance should include integrated surveillance for known and unknown pathogens, but combined with this more traditional disease-based surveillance, it also must include surveillance of drivers of disease emergence to improve prevention and mitigation of spill-over events. Here, we outline such an approach, including the characteristics and components required to overcome barriers and to optimize an integrated One Health surveillance system

Developing One Health surveillance systems

The health of humans, domestic and wild animals, plants, and the environment are inter-dependent. Global anthropogenic change is a key driver of disease emergence and spread and leads to biodiversity loss and ecosystem function degradation, which are themselves drivers of disease emergence. Pathogen spill-over events and subsequent disease outbreaks, including pandemics, in humans, animals and plants may arise when factors driving disease emergence and spread converge. One Health is an integrated approach that aims to sustainably balance and optimize human, animal and ecosystem health. Conventional disease surveillance has been siloed by sectors, with separate systems addressing the health of humans, domestic animals, cultivated plants, wildlife and the environment. One Health surveillance should include integrated surveillance for known and unknown pathogens, but combined with this more traditional disease-based surveillance, it also must include surveillance of drivers of disease emergence to improve prevention and mitigation of spill-over events. Here, we outline such an approach, including the characteristics and components required to overcome barriers and to optimize an integrated One Health surveillance system.</p

Health System Resource Gaps and Associated Mortality from Pandemic Influenza across Six Asian Territories

BACKGROUND: Southeast Asia has been the focus of considerable investment in pandemic influenza preparedness. Given the wide variation in socio-economic conditions, health system capacity across the region is likely to impact to varying degrees on pandemic mitigation operations. We aimed to estimate and compare the resource gaps, and potential mortalities associated with those gaps, for responding to pandemic influenza within and between six territories in Asia. METHODS AND FINDINGS: We collected health system resource data from Cambodia, Indonesia (Jakarta and Bali), Lao PDR, Taiwan, Thailand and Vietnam. We applied a mathematical transmission model to simulate a "mild-to-moderate" pandemic influenza scenario to estimate resource needs, gaps, and attributable mortalities at province level within each territory. The results show that wide variations exist in resource capacities between and within the six territories, with substantial mortalities predicted as a result of resource gaps (referred to here as "avoidable" mortalities), particularly in poorer areas. Severe nationwide shortages of mechanical ventilators were estimated to be a major cause of avoidable mortalities in all territories except Taiwan. Other resources (oseltamivir, hospital beds and human resources) are inequitably distributed within countries. Estimates of resource gaps and avoidable mortalities were highly sensitive to model parameters defining the transmissibility and clinical severity of the pandemic scenario. However, geographic patterns observed within and across territories remained similar for the range of parameter values explored. CONCLUSIONS: The findings have important implications for where (both geographically and in terms of which resource types) investment is most needed, and the potential impact of resource mobilization for mitigating the disease burden of an influenza pandemic. Effective mobilization of resources across administrative boundaries could go some way towards minimizing avoidable deaths

One Health : a new definition for a sustainable and healthy future

No abstract available.http://www.plospathogens.orgdm2022Medical Virolog

The Role of Electronic Medical Record in Enhancing Rational Antibiotics Prescription: A Systematic Review

Background: Antimicrobial resistance is a big problem in the world. Inappropriate use of antibiotics increases up to 36-54% in hospitals worldwide. One of the factors that trigger antimicrobial resistance is the prescription of irrational antibiotics. In the age of increasingly developing technology, a variety of medical equipment and support also developed, including electronic medical record (EMR). This study aimed to systema­ti­cally review the role of the electronic medical record in enhancing rational antibiotics pres­crip­tion. Subjects and Methods: This was a systematic review using articles obtained from 4 electronic databases, namely Proquest, EBSCO, PubMed, and Scopus. The keywords used in this study were “electronic medical record” OR “electronic health record” OR “electronic patient data” AND “hospital” AND “rational antibiotic prescribing” OR “ra­ti­onal antimicrobial prescribing” OR “improve antibiotic prescribing” OR “antibiotic re­sis­tance “OR “antimicrobial resistance”. The data were obtained from publication in 2014 to 2019, observational study, conducted in hospital, and related to EMR. The main outcome was the change in prescription from irrational to rational use of anti­bi­o­tics. The data were reviewed based on the PRISMA flow diagram. Results: Eight of 5549 articles met the inclusion criteria and were reviewed. Four of 8 articles discussed additional information technology (IT) tools that were technologica­l­ly linked to EMR. One article discussed government regulation. Two articles discussed hos­pital sys­tem. One articles discussed collaboration between EMR data and educa­tion­al promo­tion. EMR provided complete information about the patient’s condition, his­tory of the disease, the pattern of therapy administration, and the cost of treatment in the hospital. However, EMR itself was not enough. Program support, additional IT sys­tem, and re­gu­lation, were needed to change the behavior of rational antibiotic pres­cription. Conclusion: EMR can provide an overview of the medical record data, including pat­terns of antibiotics drug use. It helps the doctors to provide rational therapy easier by increase regulation, hospital system, or additional tools that support EMR in the case to reduce antimicrobial resistance. Keywords: electronic medical record, antimicrobial resistance, improve antibiotic prescribing, hospita

Role of e-Prescribing in the Reduction of Prescription Error Rate: A Systematic Review

Background: Prescription errors are a big problem in the world. The concept of medi­cation safety began to become a global concern since November 1999 after the Ins­ti­tute of Medication (IOM) reported an unexpected event of medication error in Ame­rica. Elec­­tronic Medical Record (EMR) has the potential to reduce instances of me­di­cation error and improve communication between pharmacist and prescriber. This study aimed to systematically review the role of e-prescribing in the reduction of pres­cription error rate. Subjects and Method: This was a systematic review using articles from 3 electronic databases, namely PubMed, Google Scholar, and Medline. The keywords used in the study were e-prescribing, electronic prescription, medication error, hospital formulary, and hospital. The articles under review were taken from observational studies conduc­ted in hos­pital invol­ving EMR (electronic prescription). These articles were published from 2015 to 2019. The main outcome was the incidence of prescription error. Steps in con­ducting syste­ma­tic review followed PRISMA flow diagram rule. Results: 6067 articles were obtained for systematic review based on pre-determined key­words. 9 articles met the inclusion criteria. 4 of 9 articles discussed EMR. 5 articles dis­cussed the use of e-prescribing with patient safety. In these articles, EMR could help reduce various errors, including difficulty in understanding the doctor’s writing. The e-prescribing through EMR did not run optimally, because it lacked support of pres­cription tools and compliance by doctors. Conclusion: The e-prescribing can reduce the number of prescription errors and main­­tain patient safety. The e-prescribing through electronic medical record helps doc­tors to prescribe according to the formulary and provides an overview of the hospi­tal with patterns of drug use. The efforts to maintain patient safety must continue so that patient safety is maintained. Keywords: electronic medical record, e-prescribing, medication error, patient safet

The Benefits of Interoperability to Prevent Medication Error in Hospital

Background: Healthcare Information and Management Systems Society (HIMSS) des­cribes interoperability as the extent to which systems and devices can exchange data, and interpret that shared data. Interoperability of health information systems can improve the accuracy of diagnosis, quality of care, and patient safety. One problem in patient safety is medication errors. Medication error defined as a failure in the treat­ment process that has the potential to lead to harm among patients. This study aimed to analyze the benefits of interoperability to prevent medication error in hos­pital. Subjects and Method: This was a systematic review study. The study were done by collecting related articles in English, published in 2014 to 2019. The databases used in this study were ProQuest, PubMed, and Sage Publication. The keywords used were interoperability, interoperable, electronic health records, data sharing, big data, health care information technology, hospitals, medication errors, medication without harm, unsafe medication, medication safety, prescribing errors, and prescription errors. Results: There were 10 articles that met the study criteria. From the articles it were found that interoperability prevents medication errors through (1) Providing quality inf­ormation with credibility; (2) Preventing the occurrence of making recipes; (3) In­creasing the effectiveness of information by direct transfer between systems; (4) Preventing data duplication, (5) Updating data in real time; (6) Data access in parallel by several users; (7) Prevention of data loss, differences in interpretation, and differen­ces in measurement unit; (8) Reconciliation of treatment between patient and hospital; (9) Evaluation of diagnoses and services to patients remotely; and (10) Prevention of medication errors at the administrative stage. Conclusion: Interoperability increases accuracy of diagnoses, quality of care, patient safety, by increasing credibility of information. The existence of reconciliation between users, both doctors, nurses, pharmacists, service units, and patients, can prevent admi­nistrative errors and prescription making, and help doctors make decisions. Keywords: interoperability, medication error, hospita