IMPLEMENTASI DENTAL SAFETY PROCEDURE BUNDLE DAN INSIDEN KESELAMATAN PASIEN PADA ODONTEKTOMI GIGI MOLAR KETIGA RAHANG BAWAH IMPAKSI DI RUMAH SAKIT GIGI DAN MULUT DI YOGYAKARTA

PIPIET OKTI K, Prof. dr. Adi Utarini, MSc, MPH, PhD; Dr. drg. Julita Hendrartini. M.Kes

2021 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar Belakang: Implementasi intervensi keselamatan pasien secara bersamaan (bundle) pada pelayanan kesehatan umum telah terbukti meningkatkan keselamatan pasien. Odontektomi gigi molar ketiga rahang bawah impaksi merupakan tindakan yang high volume, high cost, dan high risk. Rumah sakit gigi dan mulut di Yogyakarta perlu untuk memastikan keselamatan pasien, khususnya pada odontektomi. Tujuan: Penelitian ini bertujuan untuk menilai efektifitas implementasi DSPB dalam mengurangi insiden keselamatan pasien odontektomi gigi molar tiga rahang bawah impaksi di Rumah Sakit Gigi dan Mulut di Yogyakarta. Metode: Jenis penelitian ini adalah mixed method, desain embedded: model embedded experimental. Jenis penelitian kuantitatif adalah eksperimental semu (pretest and posttest without control group design) melibatkan 140 pasien yang dipilih dengan consecutive sampling. Insiden keselamatan pasien diukur 3 kali, selama odontektomi, 3 hari, dan 7 hari pascaodontektomi. Analisis data menggunakan regresi logistik ganda dan uji generalized estimating equations, dengan signifikansi 5%. Jenis penelitian kualitatif adalah fenomenologi. Observasi dan wawancara dilakukan tiga kali, sebelum implementasi, selama implementasi, dan setelah implementasi. Hasil: Insiden keselamatan pasien praimplementasi selama odontektomi sebesar 82,86%, pada hari ketiga sebesar 75,71% dan pada hari ketujuh sebesar 21,43%. Sebelum implementasi, kepatuhan dan pengetahuan tenaga kesehatan mengenai prosedur keselamatan pasien masih perlu ditingkatkan. Pada awalnya, implementasi DSPB di RSGM di Yogyakarta mengalami beberapa kendala, namun dengan beberapa jalan keluar yang dilakukan, DSPB dapat berjalan dengan baik. Insiden keselamatan pasien selama odontektomi adalah sebesar 65,75%, pada hari ketiga sebesar 60% dan pada hari ketujuh sebesar 10%. Hasil analisis statistik menunjukkan perbedaan bermakna insiden keselamatan pasien sebelum dan sesudah implementasi selama odontektomi (p = 0,02) dan pada hari ketiga (p = 0,04), namun tidak terdapat perbedaan bermakna pada hari ketujuh (p = 0,063). Setelah implementasi, tenaga kesehatan yang terlibat dalam penelitian memberikan masukan untuk melengkapi clinical reminder dan mengkombinasikan surgical safety checklist pada rekam medis elektronik. Kesimpulan: Implementasi Dental Safety Procedure Bundle terbukti dapat secara bermakna menurunkan insiden keselamatan pasien odontekomi gigi molar ketiga rahang bawah impaksi di RSGM selama odontektomi dan pada hari ketiga pascaodontektomi. Penurunan secara klinis juga terdapat pada hari ketujuh pascaodontektomi. Kata kunci: dental safety procedure bundle (DSPB), insiden keselamatan pasien, odontektomi, rumah sakit gigi dan mulut pendidikan, keselamatan pasien.

ABSTRACT THE IMPLEMENTATION OF DENTAL SAFETY PROCEDURE BUNDLE AND PATIENT SAFETY INCIDENTS OF IMPACTED LOWER THIRD MOLAR ODONTECTOMY IN DENTAL HOSPITAL IN YOGYAKARTA Kusumastiwi., P.O.,1 Dwiprahasto., I,1 Utarini, A.,1 Hendrartini, J.1 Background: Implementation of patient safety interventions (bundle) in medical services has been shown improve patient safety. Odontectomy of impacted lower third molars is a high volume, high cost, and high risk treatments. Dental teaching hospitals in Yogyakarta need to ensure patient safety, especially for odontectomy. Objective: The objective was to assess the effectiveness of implementation of Dental Safety Procedure Bundle (DSPB) in reducing patient safety incident of impacted lower third molar odontectomy in dental hospitals in Yogyakarta. Methods: This is a mixed method research with embedded design: embedded experimental model. The type of quantitative research is quasi-experimental with a pretest and posttest design without control group design, and involve one hundred and fourty subjects were recurited by consecutive sampling. Patient safety incident was measured three time, during odontectomy, 3 day and 7 day after odontectomy. Data were analyzed using multiple logistic regression and a generalized estimating equations tests, with a 5% significance level. Phenomenology is the type of qualitative research, through by observation and interviews, conducted three times, before implementation, during implementation, and after implementation Result: The incidence of pre-implementation patient safety during odontectomy was 82.86%, on the third day was 75.71% and on the seventh day was 21.43%. Before implementation, compliance and knowledge of health workers regarding patient safety procedures need to be improved. Initially, the implementation of the DSPB at the RSGM in Yogyakarta encountered several obstacles, but with several solutions, the DSPB was able to run well. The patient safety incident during odontectomy was 65.75%, on the third day, it was 60% and on the seventh day, it was 10%. The statistical analysis results showed a significant difference in the incidence of patient safety before and after implementation during odontectomy (p = 0.02) and on the third day (p = 0.04), but there was no significant difference on the seventh day (p = 0.063). After implementation, the health workers involved in the research provided input to complete the clinical reminder and combine the surgical safety checklist in the electronic medical record. Conclusion: The implementation of the Dental Safety Procedure Bundle (DSPB) was significantly reduce patient safety incident during odontectomy and third day postodontectomy. Clinically decrease also found on seventh day postodontectomy. 1Faculty of medicine, public health and nursing, Universitas Gadjah Mada

Kata Kunci : dental safety procedure bundle (DSPB), patient safety incident, odontectomy, teaching dental hospital, patient safety