EWS in HOSPITAL Dr.. Aurick Dr Auric k Yudha Nagara, Sp.Em
I. KELOMPOK STANDAR PELAYANAN BERFOKUS PADA PASIEN
(ARK,HPK,AP,
PAP, PAB,PKPO MKE)
(7 BAB)
STANDAR NASIONAL AKREDITASI RUMAH SAKIT ED 1
II. KELOMPOK STANDAR MANAJEMEN RS III. SASARAN KESELAMATAN PASIEN
IV. PROGRAM NASIONAL
V. INTEGRASI PENDIDIKAN KESEHATAN DALAM PELAYANAN
(PMKP,PPI,TKRS,, (PMKP,PPI,TKRS MFK, KKS, MIRM)
(6 BAB)
SKP PONEK HIV/AIDS TB PPRA GERIATRI
IPKP
1.PEMBERIAN PELAYANAN UNTUK SEMUA PASIEN 10.PELAYANAN PASIEN POPULASI KHUSUS
2.PELAYANAN PASIEN RISIKO TINGGI DAN PENYEDIAAN PELAYANAN RISIKO TINGGI
3.DETEKSI (MENGENALI) PERUBAHAN KONDISI PASIEN
9.PELAYANAN PASIEN RESTRAIN
BAB PELAYANAN & ASESMEN PASIEN
8.PELAYANAN PASIEN DIALISIS
4.PELAYANAN RESUSITASI
7.PELAYANAN PASIEN DENGAN PENYAKIT MENULAR DAN MEREKA YANG DAYA TAHANNYA DITURUNKAN S (IMMUNO - -SUPPRESSED UPPRESSED )
5.PELAYANAN DARAH 6.PELAYANAN PASIEN KOMA DAN YANG MENGGUNAKAN VENTILATOR
PAP 3.1
EARLY EARL Y WARNI ARNING NG SYSTEM (EWS)
Banyak pasien diluar daerah pelayanan kritis mengalami keadaan kritis selama dalam perawatan
Seringkali, pasien memperlihatkan TANDA BAHAYA DINI (tanda tanda vital yang memburuk, perubahan kecil st neurologisnya) sebelum mengalami penurunan kondisi klinis yg meluas shg sampai mengalami kejadian kritis/yg tidak diharapkan Sebagian besar pasien yg mengalami gagal jantung/gagal paru sebelumnya memperlihatkan tanda2 fisiologis diluar kisaran normal , normal , yg merupakan indikasi keadaan pasien memburuk
PAP 3.1
EARLY EARL Y WARNI ARNING NG SYSTEM (EWS)
Ada KRITERIA FISIOLOGIS yg dapat membantu staf utk mengenali sedini mungkin pasien yg kondisinya memburuk Penerapan EWS EWS membuat membuat staf mampu mengidentifikasi keadaan pasien memburuk sedini mungkin dan bila perlu MENCARI BANTUAN B ANTUAN STAF STAF YG KOMPETEN
Diharapkan, hasil asuhan akan lebih baik.
Elemen Penilaian PAP 3.1.
No
Elemen Penilaian
Penialain yg diminta
Bukti yg disiapkan RS
1
Ada regulasi ttg pelaksanaan early warning system (EWS)
R (Regulasi)
-SK Direktur EWS
Ada bukti staf klinis dilatih menggunakan EWS
D, W
Ada bukti staf klinis mampu melaksanakan EWS
D, W, S
Tersedia pencatatan hasil EWS
D, W
2
3
4
-Panduan/Pedoman EWS -SPO EWS
(Dokumen, wawancara) (Dokumen, Wawancara, Simulasi) (Dokumen,
-Sertifikat EWS Staf In House Trainning Dokumen bukti pelatihan -wawancara Staf
-Sertifikat EWS Staf -wawancara -Simulasi Staf EWS (sesuai dg SPO)
-Dokumen rekam medis (lembar EWS?CPPT?) -wawancara staf
PAP 3.1
EARLY WARNING SYSTEM (EWS)
BAHAYA DINI (perubahan fisiologis)
Tools
EWS
• INDIVIDU • TEAM WORK • REGULASI
Patient safety
EARLY WARNING SYSTEM (EWS) serangkaian sistem yang berfungsi untuk memberitahukan akan terjadinya
kejadian
“
”
EARLY WARNING SYSTEM (EWS) A specific procedure for the early detection of any departure from normal frequencies of clinical cases or serological reactors of specific diseases by monitoring a sample of the population at risk Georgaka D, Mparmparousi M, Vitos M. Early Warning Systems. HOSPITAL CHRONICLE. 2012.Vol 7;1:37 –4 3.
EARLY WARNING SYSTEM (EWS) •
•
EWS merupakan cara untuk mengidentifikasi perburukan klinis yang terjadi pada pasien yang sudah mempunyai beberapa kebutuhan medis. TRIASE ???
2007
2010
NOW
importance of EWS by including them: In the guidelines for resuscitation First link in the chain of survival *MODIFIED EWS/MEWS •
•
2003 •
* Standardized Early Warning System (SEWS) Multiple-parameter or – Aggregate weighted scoring systems 1997 NICE paramater •
•
Heart rate Respiratory rate *first to develop Systolic blood pressure Levelsystem of consciousness * track and trigger to identify early signs of deterioration physiological parameters Oxygen saturation *predict outcome •
• • •
NOW STANDAR NASIONAL AKREDITASI RUMAH SAKIT ED 1
EARLY WARNING SCORE IS
IMPORTANT ?
Georgaka D, Mparmparousi M, Vitos M. Early Warning Systems. HOSPITAL CHRONICLE. 2012.Vol 7;1:37 –43.
Early Warning Score in Hospital
Meningkatkan hasil pelayanan pada pasien PATIENT SAFETY
Mencegah pasien jatuh pada kondisi kritis/perburukan kondisi/kematian
Komunikasi antar staf • transfer intra hospital • Pasien butuh “perhatian” khusus
SYSTEM
5
3
1 2
4
High quality EWSystem Timeliness (TEPAT WAKTU) • Pengumpulan tanda vital pasien yg tepat waktu
Accuracy (KETEPATAN) • Ketepatan skoring/interpretasi dari pengumpulan data tanda vital pasien
Consistency (KONSISTEN) • Pemakain tools/score yg konsisten dalam menilai data berupa tanda vital pasien
Completeness (KELENGKAPAN) • mengacu pada semua parameter tanda vital yang harus dikumpulkan Georgaka D, Mparmparousi M, Vitos M. Early Warning Systems. HOSPITAL CHRONICLE. 2012.Vol 7;1:37 – 43.
Failure of organization
Providing suboptimal care
Lack of knowledge
Failure to appreciate urgency Nonavailability of equipment
Early Warning Score in Hospital NEWS
• National Early warning Score
TEWS
• Triage Early Warning Score
MEOWS PEWS MEWS
• Modified Early Obstetric Warning Score
• Paediatric EWS
• Modified Early Warning Score
NATIONAL Early Warning Score (NEWS)
NATIONAL Early Warning Score (NEWS)
NATIONAL Early Warning Score (NEWS) •
USED IN: 1. In Emergency 2. In ICU 3. In PICU 4. In NICU 5. In maternity room 6. In ward room
NATIONAL Early Warning Score (NEWS) •
PARAMETER FISIOLOGIS: 1. Respiratory Rate (RR) 2. Saturasi Oksigen (SaO2) 3. Bantuan Oksigen (Nasal canule, NRBM, dll) 4. Temperature 5. Sistole Blood Presure 6. Heart Rate 7. Kesadaran (AVPU)
NATIONAL Early Warning Score (NEWS)
NATIONAL Early Warning Score (NEWS) RESPON KLINIS
Lanjutkan pemantauan EWS rutin
•
•
• •
• •
•
FREKUENSI MONITORING
Minimal 12 jam
Informasikan hasil penilaian keada Perawat PJ Perawat PJ memutuskan untuk ekskalasi/tidak frekwensi pemantauan
Minimal 4 s/d 6 jam
Perawat PJ melapor kepada DPJP Pengkajian ulang oleh dokter/DPJP
Meningkatkan pemantauan minimal tiap 1 jam
Perawat PJ melapor kepada DPJP Pengkajian ulang oleh dokter/DPJP Rencana pindah ICU
Pemantauan terus menerus/kontinyu
NATIONAL Early Warning Score (NEWS)
NATIONAL Early Warning Score (NEWS)
• •
•
•
•
MEWS should be used to monitor all adult inpatients in the Trust. This includes patients undergoing invasive procedures such as radiological procedures and endoscopy. The Observation Chart should accompany the patient to the department where the procedure is being carried out for continued use / monitoring of the patient All patients should have a full set of observations carried out prior to transfer, either to a different area of care, or to undergo any diagnostic investigations or invasive procedures These observations should be used as a guide in conjunction with the intra-hospital Transfer Risk Assessment Tool prior to transfer.
TRIAGE Early Warning Score (TEWS) •
Triage Early Warning Score (TEWS) is a useful tool used to identify patients in emergency departments who are at risk of deterioration and who may require admission
An evaluation of the Triage Early Warning Score in an urban accident and emergency department ( Submitted: 2013-12-03. Accepted: 2013-02-17)
•
Infant
•
Children
•
Adult
PEDIATRIC Early Warning Score (PEWS) •
•
The Paediatric Early Warning Score (PEWS) is a specialised tool that measures the infant/ child’s clinical status and recommends an appropriate response The tool is designed to identify children who are at risk of deterioration
PEDIATRIC Early Warning Score (PEWS) PERNA PASAN KARDI OVASK ULAR PERILAKU
PEDIATRIC Early Warning Score (PEWS)
PEDIATRIC Early Warning Score (PEWS)
PEDIATRIC Early Warning Score (PEWS)
Modified Early Obstetric Warning Score (MEOWS) •
•
a modified early obstetric warning system (MEOWS) chart is used from 20 weeks gestation when the woman is admitted to maternity wards The MEOWS chart is used in the postnatal period up
to the 6th week following childbirth British Journal of Midwifery.Downloaded from magonlinelibrary.com by 195.195.094.179 on December 2, 2014.
Modified Early Obstetric Warning Score (MEOWS) PARAMETER FISIOLOGIS respiratory rate oxygen saturation temperature systolic blood pressure • heart rate • conscious level • • • •
PARAMETER SPESIFIK MATERNAL • diastolic blood pressure • severity of pain • antenatal discharge and/or postnatal lochia • proteinurea
Modified Early Obstetric Warning Score (MEOWS)
Modified Early Obstetric Warning Score (MEOWS)
Modified Early Obstetric Warning Score (MEOWS)
