Optimalisasi Clinical Pathway “Penggunaan Antibiotik” dalam Praktik Kolaborasi Interprofesional Manajemen Perawatan Pasien Bedah Ortopedi di Surabaya

Praktik kolaborasi antar profesi kesehatan (interprofessional collaborative practice, IPC) dari berbagai latar belakang profesi yang berbeda menggunakan clinical pathway (CP) atau alur klinis disepakati oleh Profesional Pemberi Asuhan (PPA) sangat diperlukan untuk memberikan kualitas pelayanan yang terbaik. Penerapan CP penggunaan antibiotik pada pasien bedah dapat menjadi model, mengingat penggunaan antibiotik profilaksis bedah yang tidak tepat dapat meningkatkan risiko terjadinya Infeksi Luka Operasi (ILO) dan resistensi obat. Telah dilakukan penelitian yang bertujuan untuk mengetahui persepsi tenaga kesehatan dalam praktik kolaborasi interprofesional manajemen perawatan pasien bedah ortopedi sebelum dan sesudah intervensi CP terintegrasi, dan profil penggunaan antibiotik. Penelitian ini merupakan penelitian eksperimen kuasi (quasi-experiment) dengan rancangan one group pretest-posttest design menggunakan kuesioner Collaborative Practice Assessment Tool (CPAT). Lima puluh dua kuesioner diberikan kepada semua tenaga kesehatan (dokter, perawat, dan apoteker) yang berinteraksi dalam pengisian CP (tidak ada data gugur). Nilai persepsi tenaga kesehatan tentang praktik kolaborasi sesudah intervensi (212,17) lebih tinggi daripada sebelum intervensi (173,63); sedangkan nilai DDD/100 bed-days pre-intervensi lebih rendah daripada pos-intervensi. Namun kedua perbedaan tersebut tidak bermakna secara statistik

Optimalisasi Clinical Pathway “Penggunaan Antibiotik” dalam Praktik Kolaborasi Interprofesional Manajemen Perawatan Pasien Bedah Ortopedi di Surabaya

Praktik kolaborasi antar profesi kesehatan (interprofessional collaborative practice, IPC) dari berbagai latar belakang profesi yang berbeda menggunakan clinical pathway (CP) atau alur klinis disepakati oleh Profesional Pemberi Asuhan (PPA) sangat diperlukan untuk memberikan kualitas pelayanan yang terbaik. Penerapan CP penggunaan antibiotik pada pasien bedah dapat menjadi model, mengingat penggunaan antibiotik profilaksis bedah yang tidak tepat dapat meningkatkan risiko terjadinya Infeksi Luka Operasi (ILO) dan resistensi obat. Telah dilakukan penelitian yang bertujuan untuk mengetahui persepsi tenaga kesehatan dalam praktik kolaborasi interprofesional manajemen perawatan pasien bedah ortopedi sebelum dan sesudah intervensi CP terintegrasi, dan profil penggunaan antibiotik. Penelitian ini merupakan penelitian eksperimen kuasi (quasi-experiment) dengan rancangan one group pretest-posttest design menggunakan kuesioner Collaborative Practice Assessment Tool (CPAT). Lima puluh dua kuesioner diberikan kepada semua tenaga kesehatan (dokter, perawat, dan apoteker) yang berinteraksi dalam pengisian CP (tidak ada data gugur). Nilai persepsi tenaga kesehatan tentang praktik kolaborasi sesudah intervensi (212,17) lebih tinggi daripada sebelum intervensi (173,63); sedangkan nilai DDD/100 bed-days pre-intervensi lebih rendah daripada pos-intervensi. Namun kedua perbedaan tersebut tidak bermakna secara statistik

Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia

Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare’ perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists’ leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria

Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia

Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare’ perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists’ leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria