Perbedaan terjadinya Nursing Error pada shift jaga perawat

AULAWI, Khudazi, Prof.dr. Mochamad Anwar, M.Med.Sc.,Sp.OG(K)

2007 | Tesis | S2 Ilmu Kedokteran Klinik (Epidemiologi Klinis)

Perawat di rumah sakit melakukan asuhan keperawatan selama 24 jam terus menerus. Untuk menjaga kesinambungan asuhan keperawatan diperlukan pengaturan dengan shift. Nursing error baik disadari maupun tidak bisa terjadi pada saat melakukan asuhan keperawatan dengan sistem shift tersebut. Tujuan penelitian ini adalah mengetahui angka kejadian nursing error dan perbedaan kejadian nursing error antara shift kerja perawat (pagi, siang, malam). Penelitian ini menggunakan disain potong lintang (cross sectional study). Ada 7 kriteria yang disebut nursing error pada penelitian ini, yaitu 1). Kesalahan memberikan obat, atau menghitung dosis, atau pasien, atau waktu dan atau cara pemberian. 2). Pasien jatuh 3). Cairan infus kehabisan. 4). Salah mempersiapkan pasien untuk suatu tindakan. 5). Tidak melakukan suatu pengobatan/tindakan sesuai yang direncanakan. 6). Mengambil sampel pemeriksaan salah pasien. 7). Melakukan pengobatan/tindakan salah pasien. Pengukuran nursing error dilakukan dengan dua cara; pertama dari laporan perawat melalui lembar kuesioner, kedua melalui observasi. Observasi hanya untuk menilai nursing error pada pemberian obat injeksi. Teridentifikasi sebanyak 29 nursing error dari laporan perawat atau 10,3 kejadian per 1000 nursing-hour worked dan 51 nursing error pada pemberian obat injeksi (hasil observasi), atau 18 kejadian per 1000 nursing-hour worked. Ada perbedaan antara shift pagi, siang dan malam baik yang dilaporkan perawat (p=0,02), maupun hasil observasi (p< 0,001). Perbedaan yang paling bermakna terjadi antara shift pagi dengan shift malam(p=0,02). Disimpulkan ada perbedaan kejadian nursing error antar shift jaga perawat, dan perbedaan yang paling bermakna pada shift pagi dengan malam.

In daily activity nurses are 24 hours companions’ patient in care well-being. Therefore, in hospital, shift system is become a part of everyday nursing practice, and this shift system could impact upon nurse performance and leads to the error. Objectives of the study are: 1) to determine incidence of nursing errors at the hospital and 2) to know whether there is a difference on incidence of nursing error between the morning, afternoon and night shifts. The design of this study is cross-sectional. There are 7 criteria’s nursing errors which are included in this study, they are among others: (1) error on drug administration, drug dosage calculation, time and route of administration (2) patient fall, (3) forget to change infusion when its finish, (4) error on preparing patient preprocedure, (5) do not adhere the treatment/procedure guideline,(6) taken blood sample to wrong patient, and (7) given the treatment to wrong patient. The data were prospectively collected during 36 shift works. Nursing errors were measured using two approaches; nursing daily report and direct observation. The last measurement was only to know error on parenteral drug administration. Twenty nine nursing errors were found from the nurse-daily-report (the incidence rate is 10.3 per 1000 nursing-hours worked) and 51 errors on parenteral drug administration were identified during the direct observational in the ward (incidence rate is 18.0 per 1000 nursing-hours worked). There are significantly difference on incidence of nursing error between morning, afternoon and night shifts, both from nursing report (p=0.02) or from the direct observational (p<0.001). This study found that these errors were significantly higher in night shift compare to other shifts (p=0.02). The incidence of nursing error is 10.3 and 18.0 per 1000 nursinghours worked which are identified from the nursing report and direct observational, respectively. There is a difference on incidence of nursing error on shift-system, in particularly on night shift.

Kata Kunci : Perawat,Asuhan Keperawatan,Nursing Error,Shift, Nursing error, nursing-hour worked, patient fall, Shift