Implementasi metode Global Trigger Tool IHI (Institute for Healthcare Improvement) untuk identifikasi kejadian tak diinginkan (KTD) di pelayanan kebidanan RSUD Pariaman Provinsi Sumatera Barat

Kesalahan yang terjadi dalam proses perawatan medis berpotensi dan dapat menyebabkan cedera pada pasien yang merupakan peristiwa buruk. Institute for Healthcare Improved Global Trigger Tool adalah salah satu metode analisis retrospektif yang menggunakan "pencetus" atau "pemicu" untuk mendeteksi kemungkinan peristiwa buruk. Pentingnya rumah sakit dalam memberikan layanan dan dalam rangka meningkatkan perawatan kebidanan, maka IHI dapat menjadi alternatif jawaban masalah yang ada. Tujuan: Untuk mendeskripsikan distribusi frekuensi efek samping pada perawatan kebidanan di Rumah Sakit Umum Daerah (RSUD) Pariaman berdasarkan metode IHI Global Trigger Tool. Metode: Penelitian ini merupakan studi kasus dengan desain penyelesaian masalah. Identifikasi instrumen insiden keselamatan pasien menggunakan alat Pemicu IHI digunakan untuk melakukan tinjauan rekam medis pasien sekunder data kebidanan RSUD Pariaman. Hasil: Ditemukan 41 (41,7%) pasien dengan pemicu (+) jumlah pemicu 92, rata-rata 2,04 pemicu per pasien. Ditemukan 9 (9,4%) pasien dengan efek samping 12, rata-rata 1:33 efek samping per pasien. Jumlah yang terluka adalah 12 dengan proporsi cedera parah sebanyak 16,7%. Karakteristik pasien yang paling banyak adalah 20-29 tahun (45,8%) dan umumnya terjadi dalam kasus rujukan darurat (70,8%). Simpulan: Tidak ada hubungan antara usia dan keberadaan pemicu sementara status rujukan secara signifikan terkait dengan pemicu. Unit layanan kamar kebidanan merupakan unit pemicu yang paling umum (43,9%), dan unit rawat inap adalah unit yang paling banyak terjadinya kejadian buruk (44,4%). Sedangkan unit perawatan intensif adalah unit di mana pemicunya berpotensi tertinggi untuk menjadi peristiwa buruk (100%). Hasil audit medis dalam rangka meningkatkan layanan dalam bentuk presentasi kasus salah satu pasien. Audit medis merupakan salah satu upaya untuk menemukan solusi perbaikan pelayanan kebidanan RSUD Pariaman

Intervensi pada perilaku bidan tentang pelaksanaan inisiasi menyusu dini dengan menggunakan layanan pesan singkat

Latar belakang: Angka kematian bayi dan angka kematian ibu dapat ditekan dengan memfasilitasi bayi baru lahir untuk menyusu sendiri 1 jam setelah persalinan, yang dikenal dengan istilah inisiasi menyusu dini. Namun, persentase menyusu dalam 1 jam di Provinsi Sumatera Selatan hanya mencapai 29,2% pada tahun 2010. Beberapa penelitian menemukan faktor penghambat meliputi kurangnya pemahaman dan persepsi tenaga penolong persalinan. Penelitian ini bertujuan melihat pengaruh pemberian pesan singkat terhadap perilaku inisiasi menyusu dini pada bidan.Metode: Jenis penelitian ini adalah quasi-experimental melalui before and after design dengan kelompok kontrol. Subjek penelitian berjumlah 64 bidan di Kota Palembang. Perlakuan yang diberikan berupa 18 topik pesan edukasi dalam bentuk pesan singkat melalui handphone. Data dianalisis melalui uji univariat, bivariat, dan regresi linear.Hasil: Pemberian perlakuan meningkatkan persepsi sebesar 7.3% (p value = 0.0308). Pengetahuan kelompok intervensi meningkat setelah perlakuan, walaupun perubahan rerata tidak bermakna dibandingkan dengan kelompok kontrol. Sebagian besar subjek kurang tepat dalam menjalankan tahapan inisiasi menyusu dini, antara lain tentang pemberian informasi saat layanan antenatal, durasi yang singkat, dan bayi masih diarahkan saat inisiasi menyusu dini.Kesimpulan: Pelaksanaan inisiasi menyusu dinibelum dijalankan secara maksimal oleh bidan. Tidak semua persalinan difasilitasi inisiasi menyusu dini karena keadaan ibu dan bayi yang tidak mendukung. Bidan sebaiknya dapat memberikan motivasi ibu bersalin, dimulai saat pemeriksaan kehamilan. Komitmen dan kepercayaan diri merupakan kunci dari keyakinan bidan untuk senantiasa memfasilitasi inisiasi menyusu dini pada setiap persalinan. Selain itu, hasil penelitian ini perlu dianalisis jangka panjang untuk dampak yang lebih signifikan.Intervention on midwife behavior about early initiation of breastfeeding practice using short message servicePurposeThis research examined the effects of an intervention by delivering short message service towards midwife behavior.MethodsThis research was a quasi-experimental study with pre and post test design using control group. A total of 64 midwives in Palembang participated until data extraction. About 18 themes of short messages were delivered through participants’ mobile phone. Data were analyzed by univariate, bivariate, and linear regression tests.ResultsResults showed that the intervention improved early breastfeeding perceptions by about 7.3% (p= 0.0308). Participants’ knowledge was increased after intervention although there was no significant mean difference between groups. Almost all participants (over 80%) practiced imperfect early breastfeeding, especially in giving information since antenatal care, short-duration, and directing baby for sucking mother’s nipple.ConclusionNot all of participants facilitated early breastfeeding in every birth because of other factors such as unsupported mother and infant’s condition. Early initiation of breastfeeding is not easily implemented by health staff. It is better that midwives could motivate mothers to breastfeed within 1 hour since antenatal care. The important keys are having high commitment and confidence which contribute to midwives’ belief for practicing every step in every birth. We concluded that this research should be continued for long-term-analysis to give more significant results

Persepsi masyarakat kota Bima terhadap inisiasi kawasan tanpa rokok di terminal Dara

Latar belakang: Kawasan tanpa rokok merupakan tempat yang dinyatakan terlarang untuk semua aktivitas yang berhubungan dengan rokok di fasilitas umum. Penerapan kawasan tanpa rokok di Kota Bima masih dalam proses sosialisasi sehingga banyak area yang belum menerapkan seperti Terminal Dara Kota Bima. Penelitian bertujuan untuk mengindentifikasi persepsi pengguna Terminal Dara Kota Bima terhadap upaya inisiasi kawasan tanpa rokok di Terminal Dara Kota Bima.Metode: Penelitian kualitatif ini menggunakan pendekatan fenomenologi. Responden penelitian berasal dari petugas, pengunjung dan penjual di terminal sejumlah 20 orang. Pengumpulan data melalui observasi dan wawancara mendalam. Data dianalisis dengan teknik content analysis.Hasil: Pengguna terminal mengetahui bahwa rokok menyebabkan kematian. Pengguna Terminal memberikan respon positif terhadap penerapan kawasan tanpa rokok. Hambatan yang ditemukan dalam proses inisiasi meliputi ketidakpedulian dari masyarakat dan keberadaan pedagang rokok. Kawasan tanpa rokok dapat terlaksana jika didukung dengan adanya sosialisasi peraturan.Kesimpulan: Inisiasi kawasan tanpa rokok di Terminal Dara Kota Bima dapat berjalan jika dituangkan dalam produk kebijakan dan diikuti dengan sosialisasi secara menyeluruh agar pengguna terminal dapat mengetahui dan mematuhi kebijakan kawasan tanpa rokok.Bima community perceptions on initiation of non-smoking area in Dara terminalPurposeThis study aimed to determine the passengers’ perceptions about the effort to authorize Dara terminal of Bima city as a non-smoking area.MethodsThis study was a qualitative research with a phenomenological approach. Data were collected by observation in August for 2 weeks and through in-depth interviews with 20 informants among terminal users. Data were analyzed using content analysis technique.ResultsTerminal users understand that: (1) smoking can cause serious illness and even can cause death, (2) the public are benefited from the terminal as a non-smoking area, because they can access the terminal without fear of the exposure, and (3) cooperation is needed with other parties to reduce the number of smokers in the terminal. Obstacles that may be present in this effort to authorize the non-smoking area are smoking habits in the terminal which are considered normal and traders who feel threatened because cigarette smoking is the goods that are often bought by smokers in the terminal. A non-smoking area is considered can be implemented if the regulation is realistic, well socialized to people, and the communities obey to the regulation.ConclusionsThe initiation of a non-smoking area in Dara terminal of Bima city can be accomplished if there is a policy of non-smoking areas, in cooperation with relevant parties and followed by a thorough socialization so that people who access the terminal can determine and adhere to the non-smoking area policies that will be formed

Contact Investigation of Children Exposed to Tuberculosis in South East Asia: A Systematic Review

Background. Screening of children who are household contacts of tuberculosis (TB) cases is universally recommended but rarely implemented in TB endemic setting. This paper aims to summarise published data of the prevalence of TB infection and disease among child contacts in South East Asia. Methods. Search strategies were developed to identify all published studies from South East Asia of household contact investigation that included children (0–15 years). Results. Eleven studies were eligible for review. There was heterogeneity across the studies. TB infection was common among child contacts under 15 years of age (24.4–69.2%) and was higher than the prevalence of TB disease, which varied from 3.3% to 5.5%. Conclusion. TB infection is common among children that are household contacts of TB cases in South East Asia. Novel approaches to child contact screening and management that improve implementation in South East Asia need to be further evaluated

High caseload of childhood tuberculosis in hospitals on Java Island, Indonesia: a cross sectional study

Background Childhood tuberculosis (TB) has been neglected in the fight against TB. Despite implementation of Directly Observed Treatment Shortcourse (DOTS) program in public and private hospitals in Indonesia since 2000, the burden of childhood TB in hospitals was largely unknown. The goals of this study were to document the caseload and types of childhood TB in the 0-4 and 5-14 year age groups diagnosed in DOTS hospitals on Java Island, Indonesia. Methods Cross-sectional study of TB cases recorded in inpatient and outpatient registers of 32 hospitals. Cases were analyzed by hospital characteristics, age groups, and types of TB. The number of cases reported in the outpatient unit was compared with that recorded in the TB register. Results Of 5,877 TB cases in the inpatient unit and 15,694 in the outpatient unit, 11% (648) and 27% (4,173) respectively were children. Most of the childhood TB cases were under five years old (56% and 53% in the inpatient and outpatient clinics respectively). The proportion of smear positive TB was twice as high in the inpatient compared to the outpatient units (15.6% vs 8.1%). Extra-pulmonary TB accounted for 15% and 6% of TB cases in inpatient and outpatient clinics respectively. Among children recorded in hospitals only 1.6% were reported to the National TB Program. Conclusion In response to the high caseload and gross under-reporting of childhood TB cases, the National TB Program should give higher priority for childhood TB case management in designated DOTS hospitals. In addition, an international guidance on childhood TB recording and reporting and improved diagnostics and standardized classification is require

Strengthening government’s response to COVID-19 in Indonesia: A modified Delphi study of medical and health academics

The Indonesian government has issued various policies to control COVID-19. However, COVID-19 new cases continued to increase, and there remain uncertainties as to the future trajectory. We aimed to investigate how medical and health academics view the Indonesian government’s handling of COVID-19 and which areas of health systems need to be prioritized to improve the government’s response to COVID-19. We conducted a modified Delphi study adapting the COVID-19 assessment scorecard (COVID-SCORE) as the measurement criteria. We invited medical and health academics from ten universities across Indonesia to take part in the two-round Delphi study. In the first round, participants were presented with 20 statements of COVID-SCORE and asked to rate their agreement with each statement using a five-point Likert scale. All participants who completed the first cycle were invited to participate in the second cycle. They had the opportunity to revise their answers based on the previous cycle’s results and ranked a list of actions to improve government response. We achieved a moderate consensus level for five statements, a low consensus level for 13 statements and no consensus for two statements. The prioritization suggested that top priorities for improving the government’s response to COVID-19 in Indonesia encompass: (1) strengthening capacity to ensure consistent, credible and targeted communication while adopting a more inclusive and empathic communication style to address public concerns; (2) ensuring universal access to reliable COVID-19 testing by expanding lab infrastructure, facilitating operational readiness, and scaling up implementation of proven alternative/complementary tests to RT-PCR; and (3) boosting contact tracing implementation capacity and facilitating contact tracing for all positive cases, involving key stakeholders in further development of the existing contact tracing system (i.e. PeduliLindungi) as well as its evaluation and quality assurance. Ultimately, our study highlights the importance of strengthening health system functions during the pandemic and improving health system resilience for dealing with future public health emergencies

Strengthening government's response to COVID-19 in Indonesia: A modified Delphi study of medical and health academics

The Indonesian government has issued various policies to control COVID-19. However, COVID-19 new cases continued to increase, and there remain uncertainties as to the future trajectory. We aimed to investigate how medical and health academics view the Indonesian government's handling of COVID-19 and which areas of health systems need to be prioritized to improve the government's response to COVID-19. We conducted a modified Delphi study adapting the COVID-19 assessment scorecard (COVID-SCORE) as the measurement criteria. We invited medical and health academics from ten universities across Indonesia to take part in the two-round Delphi study. In the first round, participants were presented with 20 statements of COVID-SCORE and asked to rate their agreement with each statement using a five-point Likert scale. All participants who completed the first cycle were invited to participate in the second cycle. They had the opportunity to revise their answers based on the previous cycle's results and ranked a list of actions to improve government response. We achieved a moderate consensus level for five statements, a low consensus level for 13 statements and no consensus for two statements. The prioritization suggested that top priorities for improving the government's response to COVID-19 in Indonesia encompass: (1) strengthening capacity to ensure consistent, credible and targeted communication while adopting a more inclusive and empathic communication style to address public concerns; (2) ensuring universal access to reliable COVID-19 testing by expanding lab infrastructure, facilitating operational readiness, and scaling up implementation of proven alternative/complementary tests to RT-PCR; and (3) boosting contact tracing implementation capacity and facilitating contact tracing for all positive cases, involving key stakeholders in further development of the existing contact tracing system (i.e. PeduliLindungi) as well as its evaluation and quality assurance. Ultimately, our study highlights the importance of strengthening health system functions during the pandemic and improving health system resilience for dealing with future public health emergencies. © 2022 Mahendradhata et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

LAMA WAKTU YANG DIHABISKAN PASIEN DI UGD RSPAU dr. S. HARDJOLUKITO DAERAH ISTIMEWA YOGYAKARTA

Latar Belakang: Salah satu keluhan pasien yang paling sering muncul adalah lama waktu yang dihabiskan pasien di unit gawat darurat setelah mereka mendapatkan penanganan pertama. Pasien harus menunggu sebelum mereka bisa pulang, atau dipindahkan ke bangsal perawatan, ke ICU atau menjalani operasi. RSPAU Dr Suhardi Hardjolukito adalah RS tipe B dengan kapasitas 215 tempat tidur. Tujuan: untuk mengukur lama waktu yang dihabiskan pasien di UGD dan menganalisis faktor-faktor yang mempengaruhi lama waktu tunggu tersebut. Metode: Ini adalah penelitian observasional dengan rancangan cross-sectional. Penelitian dilakukan di unit gawat darurat RSPAU Dr Suhardi Hardjolukito, yang memiliki kapasitas 15 tempat tidur, pada bulan November 2014. Observasi dilakukan selama 7 hari pada shift pagi, sore, dan malam. Sejumlah 305 pasien menjadi sampel penelitian dan diamati selama pasien berada di UGD. Hasil: Rata-rata waktu perawatan di UGD RSPAU dr.S.Hardjolukito masih sangat bervariasi, berkisar antara 8 s/d 270 menit (4.5 jam). Tahapan pelayanan yang memiliki waktu tunggu paling lama adalah pelayanan di laboratorium dan radiologi. Sementara karakteristik kunjungan yang paling besar pengaruhnya terhadap lama pelayanan di UGD adalah kunjungan pada hari kerja, jenis kelamin pasien perempuan, diagnosis emergency, dan waktu kunjungan pagi hari.  Kesimpulan dan Rekomendasi: Waktu yang dihabiskan pasien di UGD RSPAU dr.S.Hardjolukito sangat bervariasi. Banyak penyebab waktu tunggu tersebut sebenarnya tidak penting dan bisa dicegah. Rumah sakit harus mengurangi kepadatan UGD pada waktu-waktu sibuk dengan meningkatkan efisiensi RS, memperbaiki alur pasien, dan menggunakan metode maajemen operasional dan teknologi informasi