Evaluasi Penerapan Modified Early Obstetric Warning Score pada pasien maternal di RSUP Sardjito Tahun 2019-2020

Irmanda Terbelluh Sembiring D, dr. Detty S. Nurdiati, MPH, PhD, Sp.O.G. Subsp. K.FM; dr. Ahsanudin Attamimi, SpOG. Subsp. K.FM, M.Med.Ed

2023 | Tesis-Spesialis | S2 Ilmu Kebidanan dan Penyakit Kandungan

Latar Belakang:

Modified Early Obstetric Warning Score (MEOWS) digunakan untuk mengidentifikasi pasien obstetrik yang berisiko mengalami perburukan. MEOWS telah lama digunakan di bangsal maternal Rumah Sakit Umum Pusat dr. Sardjito. Penelitian di Rumah Sakit Tersier Nigeria menemukan bahwa kartu MEOWS tidak diisi secara lengkap, sehingga pada beberapa kasus, perburukan kondisi ibu tidak dapat diantisipasi sejak awal. Di RS tersier Brazil menemukan sebagian kartu MEOWS tidak ditindaklanjuti oleh paramedis dan dokter. Penelitian ini bertujuan untuk mengetahui kelengkapan pengisian kartu MEOWS dan kesesuaian intervensi yang dilakukan dengan petunjuk kartu MEOWS.

Metode:

Penelitian ini merupakan penelitian mixed method dengan pendekatan kuantitatif deskriptif dan kualitatif fenomonologi. Penelitian kuantitatif dilakukan dengan menelusuri rekam medis pasien yang dirawat di bangsal maternal RSUP dr. Sardjito selama tahun 2019 dan 2020. Penelitian kualitatif dilakukan dengan deep interview pada responden, kemudian dilakukan analisis kualitatif.

Hasil:

Sebagian besar kartu MEOWS (84,67%) telah diisi secara lengkap. Proporsi intervensi  saat terjadi aktivasi nilai MEOWS sudah dilakukan pada sebagian besar (89,51%) subyek penelitian. Proporsi intervensi yang sesuai dengan protocol MEOWS telah dilakukan pada sebagian besar kartu MEOWS teraktivasi (95,05%). Intervensi MEOWS dan kesesuaian intervensi tidak berhubungan dengan admisi HCU/ICU. Kesesuaian intervensi berhubungan dengan lama rawat inap ? 7 hari dengan nilai p 0,043, rasio prevalensi 0,456 (Interval Kepercayaan 95% 0,242-0,858). Alasan petugas tidak melengkapi kartu MEOWS, tidak melakukan intervensi dan tidak melakukan intervensi MEOWS yang sesuai adalah faktor manajemen, pengetahuan yang kurang, kepatuhan, kewaspadaan, pelatihan dan rekam medis.

Kesimpulan:

Sebagian besar kartu MEOWS telah terisi lengkap dan sebagian besar intervensi Kartu MEOWS teraktivasi telah dilakukan sesuai dengan petunjuk kartu MEOWS. Kesesuaian intervensi MEOWS kemungkinan dapat menurunkan prevalensi lama rawat inap  ? 7 hari. Kelengkapan dan intervensi MEOWS dipengaruhi oleh manajemen, pengetahuan, kewaspadaan dan kepatuhan petugas, yang mana dapat ditingkatkan dengan pelatihan dan penggunaan rekam medis yang praktis. 

Background:

Modified Early Obstetric Warning Score (MEOWS) is used to identify obstetric patients at risk of deterioration. MEOWS has long been used in the maternal ward of Dr. Sardjito Central General Hospital. Research in a Nigerian tertiary hospital found that the MEOWS card was not filled out completely, so in some cases, the deterioration of the mother's condition could not be anticipated early on. In a Brazilian tertiary hospital found that some MEOWS cards were not followed up by paramedics and doctors. This study aims to determine the completeness of MEOWS card filling and the suitability of interventions carried out with MEOWS card instructions.

Methods:

This research is a mixed method research with descriptive quantitative and qualitative phenomenology approaches. Quantitative research was conducted by tracing the medical records of patients admitted to the maternal ward of Dr. Sardjito Hospital during 2019 and 2020. Qualitative research was conducted with deep interviews with respondents, then qualitative analysis was carried out.

Results:

Most of the MEOWS cards (84.67%) were completed. The proportion of interventions during the activation of MEOWS was done in most (89.51%) of the study subjects. The proportion of interventions that were in accordance with the MEOWS protocol had been carried out on most of the activated MEOWS cards (95.05%). MEOWS interventions and appropriateness of interventions were not associated with HCU/ICU admissions. Intervention appropriateness was associated with length of stay ? 7 days with p value 0.043, prevalence ratio 0.456 (95% confidence interval 0.242-0.858). Reasons for staff not completing MEOWS cards, not performing interventions and not performing appropriate MEOWS interventions were management factors, lack of knowledge, compliance, vigilance, training and medical records. 

Conclusion:

Most of the MEOWS cards were completed and most of the activated MEOWS card interventions were performed according to the MEOWS card instructions. Appropriateness of MEOWS intervention is likely to reduce the prevalence of length of stay ? 7 days. MEOWS completion and interventions are influenced by staff management, knowledge, vigilance and compliance, which can be improved by training and practical use of medical records.

Kata Kunci : Modified Early Obstetric Warning Score chart, completeness of MEOWS card, suitability of MEOWS intervention