Clinical Pathways # Dr. Dody Firmanda, Sp.A, MA Ketua Komite Medik RSUP Fatmawati, Jakarta. Pendahuluan Dengan terbitnya Undang Undang Republik Indonesia Nomor 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial (BJPS)1. Sesuai Sesuai dengan dengan amanat amanat perund perundang angan an terseb tersebut ut - peratu peraturan ran mengen mengenai ai pelaksa pelaksanaan naan BPJS BPJS Keseha Kesehatan tan haru haruss tela telah h ada ada pali paling ng lama lama tang tangga gall 25 Nove Novemb mbe er 2012 2012 (1 tahu tahunn dari dari 2 diundangkannya) dan sudah harus mulai beroperasi pada tanggal 1 Januari 20143 sert sertaa untu untukk BPJS BPJS Kese Keseha hata tann4 tida tidakk disel diselen engg ggara araka kann lagi lagi oleh oleh 5 Kementeri Kementerian an Kesehatan Kesehatan . Perta Pertanyaa nyaann yang timbul timbul adalah adalah bagaim bagaimana ana sistem sistem BPJS Kesehatan tersebut? Dalam Undang Undang RI Nomor 29 Tahun 2004 tentang Praktik Kedokteran pada pasal 45 mener menerangk angkan an tentang tentang kewajib kewajiban an menye menyeleng lenggar garaka akann kendali kendali mutu mutu dan ke kenda ndali li biaya. biaya.6 Pada Pada Unda Undang ng Undang Undang RI Nomo Nomorr 44 Tahu Tahunn 2010 2010 tent tentan angg Ruma Rumah h Saki Sakitt pada pada pasa pasall 33 mene menera rang ngka kann tent tentan angg org organis anisas asii 7 rumah rumah sakit sakit yang yang efekti efektif, f, efisie efisien, n, dan akuntab akuntabel. el. Peraturan Peraturan Pemerintah Pemerintah Nomor 23 Tahun 2005 tentang Pengelolaan Keuangan Badan Layanan Umum dan dan Pera Peratu tura rann Ment Menter erii Dala Dalam m Nege Negeri ri Nomo Nomorr 61 Tahu Tahunn 2007 2007 tenta entang ng Pedom Pedoman an Tek Teknis nis Penge Pengelola lolaan an Keuanga Keuangann Badan Badan Layanan Layanan Umum Umum Daerah Daerah pada pada pasal 1 ayat 1 menyebutkan untuk memberikan pelayanan kepada masyarakat berupa berupa penyedi penyediaan aan barang barang dan/atau dan/atau jasa jasa yang yang dijual dijual tanpa tanpa mengut mengutamak amakan an menc mencar arii ke keun untu tunga ngann dan dalam dalam melak melakuk ukan an ke kegi giat atann annya ya didasa didasark rkan an pada pada 8,9 prinsip efisiensi dan produktivitas. #
Disampaikan pada Acara Pelatihan Penyusunan Clinical Pathways RSUD Kanujoso Djatiwibowo
Balikpapan, Kalimantan Timur 7-8 Juli 2012. 1
Undang Undang RI Nomor 24 Tahun 2011 tentang Badan Penyelenggara Jaminan Sosial Undang Undang RI No.24 Tahun 2011 Pasal 70 ayat a. 3 Undang Undang RI No.24 Tahun 2011 Pasal 60 ayat (1). 4 Undang Undang RI No.24 Tahun 2011 Pasal 5 ayat (2)a. 5 Undang Undang RI No.24 Tahun 2011 Pasal 60 ayat (2)a. 6 Undang Undang RI Nomor 29 Tahun 2004 tentang Praktik Kedokteran 7 Undang Undang RI Nomor 44 Tahun 2010 tentang Rumah Sakit 8 Peraturan Pemerintah RI Nomor 23 Tahun 2005 tentang Pengelolaan Keuangan Badan Layanan Umum 9 Peraturan Menteri Dalam Negeri Nomor 61 Tahun 2007 tentang Pedoman Teknis Teknis Pengelolaan Keuangan Badan Layanan Umum Daerah 2
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Dala Dalam m mela melaku kukkan evalua aluassi kebij bijakan akan dan dan siste istem m laya layana nann keseha sehata tann (health ada 3 krite riteri riaa kunc kuncii yak yakni healthcar caree system system and polici policies es evaluat evaluation ion) ) ada krit kriter eria ia efek efekti tifi fita tas, s, efis efisie iens nsi, i, dan ke kebe bera radi dilan lan/e /eku kuit itii (effectiveness, 10 efficiency efficiency and equity) equity) yang merupakan suatu rangkaian sistematik dalam suatu sistem. Melakukan suatu analisis ekonomi dalam pelayanan kedokteran pro profesi adalah lah tidak mud mudah, mengi ngingat bany anyak fakto aktorr yang harus rus dipertimbangkan dari berbagai dimensi termasuk cara pendekatan dari jenis analisis ekonomi yang akan digunakan, batasan terminologi ekonomi itu sendiri mengenai utilization utilization,, productivi productivity, ty, benefit, benefit, efficiency, efficiency, effective effectiveness, ness, value kebi bija jaka kann fisk fiskal al dan dan ting tingka katt inflati yang seri sering ng kali kali for for mone money y , ke inflation on rate rate yang berubah. Disamping keterbatasan sumber daya dan kebijakan ekonomi yang dipengaruhi politis, sehingga tidak jarang 'resources' tersebut telah dipagu menjadi 'fixed' .11 Sedangkan di sisi dimensi lain profesi itu sendiri dituntut untuk meningkatkan mutu pelayanannya dan keprofesiannya dalam koridor etik-sosio-budaya serta berbagai peraturan dan perundangan hukum. 7 Seda Sedangk ngkan an isti istilah lah,, de defi finis nisii dan dan dime dimens nsii akan akan efisiensi juga juga belu belum m ada ada kesepakatan yang jelas dan eksplisit – tergantung dari berbagai perspektif. Efisie Efisiensi nsi dapat dapat digolong digolongkan kan kep kepada ada efisie efisiensi nsi tehnik tehnik (technical (technical efficiency) efficiency) , efisiensi efisiensi produksi/hasi produksi/hasill (productiv dan efis efisie iens nsii aloka alokatif tif (productivee efficiency efficiency) ) dan termasuk suk didalam didalamnya nya bidang bidang market dan (allocative (allocative/socie /societal tal efficiency) efficiency) terma kesehatan.6,12 (Tabel 1)
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Aday LA, Begley CE, Lairson DR. Evaluating the healthcare system: effectiveness, efficiency and rd equity equity.. 3 ed. Washington DC: Health Administration Press, 2004. 11 Firmanda D. Aplikasi integrasi sinergis antara Evidenve-based Medicine, Evidence-based Healthcare dan Evidence-based Policy dalam satu sistem peningkatan mutu pelayanan kesehatan dan kedokteran (Clinical Governance): suatu tantangan profesi IDAI di masa mendatang.II. Cost Effectiveness Analyses (CEA) Standar Pelayanan Medis (SPM) Kesehatan Anak IDAI Disampaikan pada Acara Pertemuan Perhimpunan Organisasi Profesi dengan Ditjen Yan Medik Depkes RI di Bogor September 2005. http://www.scribd.com/doc/12827936/Dody-Firmanda-2005-042-Aplikasi-integrasi-sinergisEvidenvebased-Medicine-Evidencebased-Healthcare-dan-Evidencebased-Policy-dalam-Clinical-Gove 12 Firmanda Firmanda D. Pengen Pengendal dalian ian mutu dan efisien efisiensi si pembiay pembiayaan aan layana layanan n keseha kesehatan. tan. Disampai Disampaikan kan dalam rangka evaluasi Program Pelayanan Askes Terpadu Rumah Sakit (PPATRS) diselenggarakan oleh Kantor
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Tabel 1. Berbagai definisi dam dimensi tingkat analisis tentang efektifitas, efiensi dan keberadilan/ekuiti. 12
Evolusi sistem layanan kesehatan di sarana kesehatan (rumah sakit) secara prinsi prinsipnya pnya mulai mulai dari dari yang bercir bercirika ikann ’doing dalam hal hal ini ini ’doing things things cheape cheaper’ r’ dalam efficiency pada tahun 1970an pada waktu krisis keuangan dan gejolak OPEC, kemudian ekonomi mulai pulih dan masyarakat menuntut layanan kesehatan bercirikan ’doing things better’ dalam hal ini quality improvement . Selama dua dekade tersebut manajemen bercorak ’doing things right’ (dikenal sebagai merupakan kombinasi kombinasi ’doing things cheaper’ increasing effectiveness) yang merupakan dan ’doing things better’. Ternyata prinsip ’doing things right’ tidak memadai mengik mengikuti uti perke perkemba mbangan ngan kemaju kemajuan an teknolo teknologi gi maupun maupun tuntut tuntutan an masyar masyaraka akatt yang semakin kritis; dan prinsip manajemen ‘doing things right’ tersebut telah
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Pada abad 21 ini masa era globalisasi dibutuhkan tidak hanya ’doing things right’, akan tetapi juga diperlukan prinsip manajemen ‘doing the right things’ sehingg sehinggaa kombin kombinasi asi ked keduan uanya ya disebu disebutt sebaga sebagaii prinsip prinsip manajem manajemen en layanan layanan 13 modern ‘doing the right things right’ . Manfaat Clinic Clinical al Pathwa Pathways ys dala dalam m Efis Efisie iens nsii Pemb Pembia iaya yaan an,, Efek Efekti tifi fita tass Pelayanan dan Keberadilan/Ekuiti Clinical Clinical Pathways Pathways (CP) adalah suatu konsep perencanaan pelayanan terpadu yang merangkum setiap langkah yang diberikan kepada pasien berdasarkan standar pelayanan medis dan asuhan keperawatan yang berbasis bukti dengan hasi hasill yang yang teru teruku kurr dan dan dala dalam m jang jangkka wakt waktuu tert terten entu tu sela selama ma di ruma rumah h 14,15,16 sakit. Berikut Berikut hasil penelitian penelitian penerapan penerapan Clinical Clinical Pathways Pathways Pneumonia (Gambar 1 dan 2) yang yang dilak dilakuk ukan an dalam dalam rangk rangkaa memb membuk uktik tikan an adany adanyaa efis efisie iensi nsi biay biaya, a, efek efekti tifi fita tass laya layana nann dan dan ke kebe bera radi dila lan/ n/ek ekui uiti ti bagi bagi semu semuaa pasi pasien en tanp tanpaa mema memanda ndang ng latar latar belak belakang ang ke keada adaan an sosi sosial al ek ekono onomi mi,, pe pend ndidi idika kann maupu maupunn gender gender.. Dari Dari Gambar 1 dan 2 di bawa bawah h untu untukk kasus asus pneu pneumo moni niaa biay biayaa perawatan sampai sembuh (dengan tarif rumah sakit) mempergunakan Clinical Pathways Pneumonia adalah sekitar Rp 495 000,- untuk kelas III, Rp 1 120 000,- untuk kelas II, Rp 1 480 000,- untuk kelas I dan Rp 2 150 000,- untuk kelas VIP. Sedangkan bila dihitung berdasarkan klaim Jamkesmas untuk kasus yang sama adalah Rp 2 707 663,-. Maka secara matematik dengan mempergunakan Clini ntuk kasus asus pneu pneumo moni niaa ters terse ebut but Clinica call Pathw Pathways ays untu meng menghe hema matt (2 707 707 663 663 – 495 495 000 000 = Rp 2 212 212 663, 663,-) -).. De Deng ngan an demik demikia iann 13
Firmanda D. Peran Efektifitas Klinis dalam rangka mewujudkan keselamatan/keamanan (safety) dan berorientasi kepada pasien (patient centredness).Disampaikan pada Hospital Management 3 yang diselenggarakan oleh Pusat Kajian Administrasi dan Kebijakan Kesehatan FKM UI di Grand Angkasa Hotel International, Medan 11 Agustus 2008. http://www.scribd.com/doc/9813111/Dody-Firmanda-2008Peran-Efektivitas-Klinis-Dalam-PATH
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Firmanda D. Pedoman Penyusunan Clinical Pathways dalam rangka implementasi Sistem DRGs Casemix di rumah sakit. Disampaikan dalam Sidang Pleno Komite Medik RS Fatmawati, Jakarta 7 Oktober 2005. 15 Firmanda D. Clinical Pathways: Peran profesi medis medis dalam rangka menyusun Sistem DRGs Casemix di rumah sakit. Disampakan pada kunjungan kunjungan lapangan ke RSUP Adam Malik Medan 22 Desember 2005, RSUP Hasan Sadikin Bandung 23 Desember 2005 dan Evaluasi Penyusunan Clinical Pathways dalam rangka penyempurnaan Pedoman DRGs Casemix Depkes RI, Hotel Grand Cempaka Jakarta 29 Desember 2005.
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terliha terlihatt jelas jelas dari dari segi segi ekonom ekonomi/pe i/pembi mbiaya ayaan an rumah rumah sakit sakit terse tersebut but sangat sangat efisien dan menguntungkan bila menggunakan Clinical Pathways . Dengan mempergunaka mempergunakann Clinical menghitung Cos Clinical Pathways Pathways dapat menghitung Costt Weight Weight seti setiap ap ke kelo lomp mpok ok kasu kasus, s, cont contoh oh untu untukk kasus asus pneu pneumo moni niaa di atas atas rera rerata ta sumberdaya (resources) rumah sakit (obat obatan, bahan dan alat dll) yang terpakai adalah Rp 250 000,- maka Cost-Weight nya adalah (450 000/250 000 = 1.8). 1.8).
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Gambar 1. Contoh hasil penelitian implementasi salah satu Clinical Pathways untuk kasus pneumonia
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Tentang cara langkah langkah perhitungan cost weight, casemix index, base rate rumah sakit dan alokasi alokasi anggaran dapat dilihat dalam Gambar 3 berikut. berikut.
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Agar Agar tidak tidak tump tumpang ang tind tindih ih sert sertaa sine sinerg rgis is de deng ngan an ke keny nyat ataan aan di lapan lapanga gann (rumah sakit), maka implementasi Clinical Pathways sebaiknya terpadu dengan tatakelola manajamen (corporate governance) dan tatakelola klinis (clinical ang tela telah h berl berlak akuu sesu sesuai ai misi isi rum rumah sak sakit dala dalam m bida bidang ng governance ) yang pelayanan, pendidikan dan penelitian. Dengan terbitnya Peraturan Menteri Kesehatan RI Nomor 1348 1348/M /MEN ENKES KES/PE /PER/ R/IX IX/2 /201 010 0 – yang yang diguna digunaka kann adalah adalah istil istilah ah Stan Standa darr Pelaya Pelayanan nan Kedokt Kedokter eran an (SPK) (SPK) yang yang terdir terdirii dari dari Pedom Pedoman an Nasion Nasional al Pelayan Pelayanan an Kedokteran (PNPK) dan Standar Prosedur Operasional (SPO). PNPK dibuat oleh organisasi profesi dan disahkan oleh Menteri Kesehatan RI, sedangkan SPO dibuat di tingkat rumah sakit oleh profesi medis dengan koordinator Komite Medis dan ditetapkan penggunaannya di rumah sakit tersebut oleh pimpinan (direktur). Standar Standar Prosedur Prosedur Operasio Operasional nal untuk profesi profesi medis medis di rumah rumah sakit sakit dalam 17 bentuk Panduan Praktik Klinis - pada umumnya dapat diadopsi dari Panduan Nasion Nasional al Pelayan Pelayanan an Kedok Kedokter teran an (PNPK) (PNPK) yang telah telah dibuat dibuat ole oleh h organis organisasi asi profes profesii masing masing masing, masing, tinggal tinggal dicocokk dicocokkan an dan disesu disesuaik aikan an dengan dengan kondis kondisii sarana dan kompetens kompetensii yang ada di rumah sakit. Bila PNPK PNPK yang telah telah dibuat oleh organisasi profesi tersebut dan telah disahkan oleh Menteri Kesehatan RI serta sesuai dengan kondisi rumah sakit – maka tinggal disepakati oleh anggo anggota ta prof profes esii (SMF) (SMF) terk terkait ait sebag sebagai ai Pandu Panduan an Prak Prakti tikk Klin Klinis is (PPK) (PPK) dan disahkan penggunaannya di rumah sakit oleh direktur rumah sakit tersebut. Namun Namun bila bila PNPK PNPK terseb tersebut ut belu belum m ada ada atau atau tida tidakk sesu sesuai ai dengan kondisi kondisi rumah sakit atau dalam PNPK belum mencantumkan jenis penyakit yang sesuai dengan keadaan penyakit it di daerah daerah/rum /rumah ah sakit sakit terse tersebut but – keadaan epidemio epidemiologi logi penyak maka profesi di rumah sakit tersebut wajib membuat Panduan Praktik Klinis
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Gambar 4. Ringkasan Peraturan Menteri Kesehatan RI Nomor 1348/MENKES/PER/IX/2010 tentang Standar Pelayanan Kedokteran – PNPK, SPO dan PPK. Pro
sela
elah elah
Pand
Prakt Praktik ik Klin
(PPK) (PPK) Rumah Rumah
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Sist Sistem em Case Casemi mix x adala adalah h suat suatuu cara cara menge mengelo lola la sumb sumber er daya daya ruma rumah h saki sakitt seefek see fektif tif mungk mungkin in dalam dalam member memberikan ikan layanan layanan ke keseh sehatan atan yang yang terjang terjangkau kau kepa ke pada da masya masyarak rakat at berd berdas asark arkan an pe penge ngelo lompo mpokk kkan an spek spektru trum m diagn diagnos osis is peny pe nyak akit it yang yang homo homoge genn dan dan prose prosedu durr tinda tindaka kann yang yang dibe diberi rika kann - secar secaraa ringkasnya terdiri dari 3 komponen utama – yakni kodefikasi diagnosis (ICD 10) 10) dan dan pros prosed edur ur tindak tindakan an (ICD 9 CM), CM), pe pemb mbia iaya yaan an (costing ) yang dapat berupa topatau komb kombin inasi asi top-do down wn appro approac ach, h, acti activi vity ty base based d cost costing ing dan atau keduanya, dan melalui Clinical Pathways .18,19,20,21,22 INA-D INA-DRG RG adalah adalah variasi variasi sistem sistem casemi casemix x versi versi Kement Kementeri erian an Keseha Kesehatan tan RI untuk Indonesia yang disusun berdasarkan data dari 15 rumah sakit vertikal, memp memper ergu guna nakkan ICD 10 untu untukk diag diagno nosi siss dan dan ICD ICD 9 CM untu untukk pros prose edur dur tindakan serta biaya berdasarkan tarif yang berlaku pada waktu tersebut. Upaya tersebut memang belum sempurna dan belum mencerminkan realitas keadaan seluruh pelosok tanah air – namun sebagai titik tonggak awal, hal ters terse ebut but meru merupa paka kann suat suatuu ke kebe berh rhas asil ilan an dala dalam m memb membuuat suat suatuu sist sistem em pembiayaan layanan kesehatan rumah sakit dan usaha baik menuju kepastian dan dapat dapat diperba diperbaiki iki serta serta ditingk ditingkatk atkan an kualit kualitas as maupun maupun validi validitas tas datanya datanya yang representatif untuk Indonesia. Sebagai sistem yang baru lahir INADRG akan akan terus terus bergul bergulir ir dan berkem berkemban bangg sesuai sesuai tuntut tuntutan an perkem perkembang bangan an layanan kesehatan kesehatan baik nasional maupun regional. regional.23 Dengan berakhirnya lisensi grouper INA-DRG terhitung tanggal 30 September 2010, maka nama sitem Casemix INA-DRG berubah menjadi INA-CBG 24.
18
Goldman L. Cost-Effectivene Cost-Effectiveness ss in a flat world — Can ICDs help the United States get rhythm? N Engl J Med 2005;353(14 ):1513-5. 19 Dana B Mukame DB, Zwanziger J, Bamezai A. Hospital competition, resource allocation and quality
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P2JK P2JK Keme Kement nter erian ian Kese Keseha hatan tan RI telah telah menga mengadak dakan an pe pert rtem emua uann de deng ngan an seluruh perhimpunan profesi dan kolegium di Denpasar Bali pada tanggal 23 November 2009 dan menghasilkan keputusan sebagai berikut: 1. Kesepa Kesepakat katan an dan komit komitme menn bersam bersamaa seluruh seluruh perhimpun perhimpunan an profes profesii dan Kolegium Kolegium – setiap setiap perhimpunan perhimpunan profesi membuat 10 penyakit penyakit terbanyak terbanyak Stan Standa dar/P r/Ped edom oman an Pelay Pelayan anan an Medis Medis (S/PP (S/PPM) M) dan Clini Clinica call Pathw Pathway ayss untuk melengkapi INA-DRG dalam Program Jaminan Kesehatan. 2. Pertem Pertemuan uan selanj selanjutn utnya ya tanggal tanggal 22 Januar Januarii 2010 2010 disele diselengg nggarak arakan an ole oleh h Pusat Pembiayaan dan Jaminan Kesehatan (P2JK) Sekretariat Jenderal Depkes RI – membahas seluruh SPM dan CP. Rencana pertemuan lanjutan tanggal 22 Januari 2010 diundur dan terealisasi pada tanggal 7-9 April 2010 di Batam dengan pembahasan kembali mengenai Standar Standar Pelayanan Pelayanan Kedokteran Kedokteran setiap perhimpunan perhimpunan profesi. profesi. Namun setelah itu tidak ada tindak lanjut seterusnya. Terlepas dari kendala penggunaan Clinical Clinical Pathways Pathways sebagai pelengkap INACBG; implementasi Clinical Pathways sangat bermanfaat bagi profesi dalam memberikan pelay rumah sak sakit pelayana anan, n, pendidi pendidika kann maupun maupun pene peneliti litian an di rum sebagaimana dapat dilihat dalam gambar 5 sampai 7 berikut.
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Konsep. konstruksi maupun model implementasi Clinical Pathways secara tidak langsung sebagaimana diutarakan diatas bahwa: sebaga gaii instr instrume umenn pe pelay layana anann berf berfok okus us ke kepa pada da pasie pasienn Clinic Clinical al Pathway Pathways s seba terinteg tegras rasi, i, berke berkesina sinambu mbunga ngann dari dari pasien pasien masuk masuk (patient-fo (patient-focused cused care) care) , terin dirawat sampai pulang sembuh (continuous (continuous care), care), jelas akan dokter/perawat penangg penanggung ung jawab jawab pasien pasien (duty utilitas as pemer pemeriks iksaan aan penunjan penunjang, g, (duty of care care) ) , utilit penggun penggunaan aan obat obat obatan obatan termas termasuk uk antibi antibioti otika, ka, prosed prosedur ur tindaka tindakann operasi operasi,, antisipasi antisipasi kemungkinan kemungkinan terjadinya terjadinya medical (latenn dan dan akti aktif, f, nyari nyariss medical errors errors (late terjadi terjadi maupun kejadian tidak diharapkan/KTD diharapkan/KTD)) dan pencegahan pencegahan kemungkinan kemungkinan cedera (harms) serta serta infeks infeksii nosoko nosokomia miall dalam dalam rangka rangka ke kesela selamat matan an pasien pasien (patient safety) , mendeteksi dini titik titik potensial berisiko selama proses layanan perawatan perawatan pasien (tracers dalam rangka rangka manaje manajemen men (tracers methodology methodology) ) dalam risiko (risks management), rencana pemulangan pasien (patient discharge) , upay upayaa pe penin ningk gkat atan an mutu mutu layan layanan an berk berkes esin inam ambu bung ngan an (conti (continuo nuous us quality quality improvement) baik dengan pendekatan tehnik TOC (Theory of Constraints) untuk untuk sistem sistem maupun maupun indivi individu du profes profesi, i, penulus penulusura urann kiner kinerja ja (performance) individu profesi maupun kelompok (team-work). Meru Merupa pakkan suat suatuu rang rangka kaia iann sist siste em yang yang dapa dapatt dipe diperg rgun unak akan an seba sebaggai instru instrume menn untuk untuk memenu memenuhi hi persy persyarat aratan an penilai penilaian an Akreditasi dari dari Komite Komite Akreditasi Rumah Sakit (KARS) versi baru maupun dari Joint Commissio Commissio
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Prinsip prinsip dalam menyusun Clinical Pathways Clinical Clinical Pathways Pathways (CP) adalah suatu konsep perencanaan pelayanan terpadu yang merangkum setiap langkah yang diberikan kepada pasien berdasarkan standar pelayanan medis dan asuhan keperawatan yang berbasis bukti dengan hasi hasill yang yang teru teruku kurr dan dan dala dalam m jang jangkka wakt waktuu tert terten entu tu sela selama ma di ruma rumah h 25,26,27 sakit. Dalam Dalam membuat membuat Clinical penan nanga gana nann kasus kasus pasie pasienn rawa rawatt inap inap di Clinical Pathways Pathways pe rumah sakit harus bersifat: a. Selur luruh kegiatan pelaya ayanan yang diberikan harus secara terpad terpadu/i u/inte ntegr grasi asi dan berori berorient entasi asi fokus fokus terhadap terhadap pasien pasien (Patient Focused Care) serta berkesinambungan (continuous of care)
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terse ebut but dapa dapatt meru merupa paka kann suat suatuu Stan Standa darr Pros Prosed edur ur Clinic Clinical al Pathway Pathways s ters Operasional yang merangkum: a. Profe Profesi si medis medis:: Standar Standar Pelayanan Pelayanan Medis dari dari setia setiapp Kelomp Kelompok ok Staf Staf Medis/Staf Medis Fungsional (SMF) klinis dan penunjang. b. Profesi Profesi keperawatan keperawatan:: Asuhan Keperawat Keperawatan an c. Profesi farmasi: Unit Dose Daily dan Stop Ordering d. Alur Alur Pelaya Pelayanan nan Pasien Pasien Rawat Rawat Inap dan Operas Operasii dari dari Sistem Sistem Kelompok Kelompok Staf Staf Medi Medis/ s/St Staf af Medi Mediss Fung Fungsi sion onal al (SMF (SMF), ), Inst Instal alas asii dan dan Sist Siste em Manajemen Rumah Sakit. Langkah langkah penyusunan Clinical Pathways Langk Langkah ah langk langkah ah dalam dalam menyu menyusu sunn Form Format at Clinic yang harus harus Clinical al Pathway Pathways s yang diperhatikan:
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Persiapan dalam penyusunan Clinical Pathways Agar dalam menyusun Clinical Clinical Pathways Pathways terarah dan mencapai sasaran serta efisie efisienn waktu, waktu, maka maka diperl diperluka ukann ke kerjas rjasama ama dan koord koordinas inasii antar antar profes profesii di SMF, Instalasi Rawat Inap (mulai dari gawat darurat, ruangan rawat inap, ruangan ruangan tindakan, instalasi instalasi bedah, bedah, ICU/PICU/NIC ICU/PICU/NICU) U) dan sarana penunjang penunjang
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diperlukan, menggunakan obat obataan (terutama antibiotik) sesuai evidence- sehingga ga pel pelaya ayanan nan efektif disam disampin pingg tidak tidak memb membed edak akan an latar latar based; sehing belakang pasien karena fokus kepada pasien dan penyakitnya dan seka sekali ligu guss meme memenu nuhi hi selu seluru ruh h tiga (keberadilan/ekuiti) dan tiga tuju tujuan an dari dari Unda Undang ng Unda Undang ng RI No Nomo morr 29 Tahu Tahunn 2004 2004 dan dan empa empatt tuju tujuan an Unda Undang ng Undang RI Nomor 44 Tahun 2009. 009. Bahkan Bahkan bila bila dilaksa dilaksanak nakan an Clinical
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LAMPIRAN:
Panduan Praktik Klinis SMF………………………………………………………… RSUD KANUJOSO JATIWIBOWO BALIKPAPAN
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8. Te Tera rapi pi
1. 2. 3. 4. 5.
……………… ……………………… ……………… ……………… ……………… ……………… ……………… ……………… ……………… …………… …… ……………… ……………………… ……………… ……………… ……………… ……………… ……………… ……………… ……………… …………… …… ……………… ……………………… ……………… ……………… ……………… ……………… ……………… ……………… ……………… …………… …… ……………… ……………………… ……………… ……………… ……………… ……………… ……………… ……………… ……………… …………… …… ……………… ……………………… ……………… ……………… ……………… ……………… ……………… ……………… ……………. ……...... .........
9. Edukas Edukasii
1.
……………… ……………………… ……………… ……………… ……………… ……………… ……………… ……………… ……………… …………… ……
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CLINICAL PATHWAYS PATHWAYS
RUMAH SAKIT UMUM DAERAH KANUJOSO DJATIWIBOWO BALIKPAPAN
Nama Pasien: …………………………………………………… Diagno Diagnosi siss Awal: Awal: ……… ……………… ……………… ……………… ………..
R. Rawat
…………………………………………………………….. Umur: Berat Badan: Tinggi Badan: Nomor Rekam Medis: ……………… ……………..kg …………..cm ……………………………. Kode Kode ICD 10 : …………………… Rencana rawat : …… hari Tgl/Jam masuk: Tgl/Jam keluar: Lama Rwt Kelas: Tarif/hr (Rp): Biaya (Rp)
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