Peningkatan mutu bedah sesar di Rumah Sakit Umum Daerah Tanjungpinang Provinsi Kepulauan Riau menggunakan audit medik

UMAR, Husein, Prof. dr. Iwan Dwiprahasto, M.Med.Sc.,Ph.D

2008 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang : Pelayanan kesehatan tidak seaman seperti yang diperkirakan orang. Error dapat saja terjadi sepanjang prosedur perawatan pasien mulai dari diagnosis, pengobatan, pencegahan dan lainnya. Salah satu upaya untuk meningkatkan pelayanan yang diberikan adalah dengan melakukan audit medik, sehingga dapat diketahui sejauhmana pelayanan yang diberikan sudah mengikuti standar yang berlaku. Tujuan : Penelitian ini bertujuan untuk mengidentifikasi mutu pelayanan bedah sesar melalui audit medik dan mengetahui trend perbaikan mutu pelayanan bedah sesar pascaaudit. Metode : Penelitian dilakukan dengan action research. Data diperoleh dari rekam medik, dengan menggunakan blanko checklist dan formulir audit. Audit 1 dilakukan pada bulan Februari 2008 (data rekam medik bulan Januari 2008), hasilnya didiskusikan dangan peer reviewer. Untuk melengkapi data yang diperoleh dilakukan wawancara grup fokus Evaluasi dilaksanakan pada bulan April 2008 (data rekam medik bulan Maret 2008). Hasilnya disajikan dengan membandingkan persentase kesesuaian terhadap standar yang sudah disepakati sebelumnya antara audit 1 dan 2. Hasil : Terdapat 39 rekam medis yang diaudit, 18 pada audit 1 dan 21 pada audit 2. Hasil audit menunjukkan perbaikan pada unsur pemberian antibiotika profilaksis dari 61,1% menjadi 100%, sedangkan keadaan pasien waktu pulang (tidak demam dan bisa jalan) 100% pada audit 1 dan 2, lamanya perawatan pascabedah juga 100% baik audit 1 maupun 2. Setelah dilakukan telaah lebih lanjut dari hasil peer reviewer, ditemukan defisiensi pada indikasi operasi 16,7% (audit 1) dan 23,8% (audit 2), lama pemberian antibiotika profilaksis 38,9% (audit 1) dan 81% (audit 2) serta persiapan operasi emergensi 90,9% (audit 1) dan 71 ,4% (audit 2). Kesimpulan : Audit medik dapat meningkatkan mutu pelayanan bedah sesar dalam unsur penggunaan antibiotika profilaksis dan kepatuhan mengisi lembar kelengkapan rekam medik di RSUD Tanjungpinang. Telaah lebih lanjut terhadap hasil audit dapat memberikan gambaran yang sebenarnya dari mutu pelayanan di RSUD Tanjungpinang Saran: Peningkatan fasilitas dan tenaga yang kompeten merupakan faktor yang tak terpisahkan untuk meningkatkan mutu pelayanan di rumah sakit. Standar pelayanan yang telah disepakati, tidak harus diturunkan apabila ditemukan penyimpangan dalam hasil audit, sehingga jelas standar mutu yang harus dicapai.

Background: Today's health service is not as safe as it is expected by many. Error may occur along with the procedures of a patient's treatment, starting from the diagnostic, therapy, prevention and others. An effort made to improve the service quality, is through conducting a medical audition. This will enable us to find out the intensity of the standard procedure applied. Objective: This study is intended to identify service quality of a caesarean section through a medical audit and the trend on it's improvement after an audition Method: Study is done through action research. The data is obtained from the medical record, using checklist form and an audit form. The first audit was done in February 2008 (medical record January 2008), the results were discussed by peer reviewer. In order to compile necessary information a group focus discussion was conducted. Evaluation was performed in April 2008 (medical record March 2008). The result were presented by comparing the percentage according to the standards approved previously on the 1st and 2nd audition Result: This study contains 39 medical records, 18 of are conducted on the 1st audition and 21 conducted on the 2nd audition. Results show an improvement on aspects of preventive antibiotic from points 61 ,1% to 100%, the incoming patient on recovery (without fever and able to walk) from points 100% on 1st audition to 100% on 2nd audition. The duration of post operative treatment was 100% at the 1st and also at 2nd auditions. By a furthermore study to result of peer reviewer, found deficiency of operative indication about 16,7% on 1st audition and 23,8% on 2nd audition, the duration of preventive antibiotic 38,9% on 1st audition and 81,1% on 2nd audition. and preparation to emergency operation 90,9% on 1st audition and 71,4% on 2nd audition. Conclusion: A medical audit can improve the caesarean section service on aspect usage of preventive antibiotic and increase the obligations required in order to fulfill the medical record sheet at the Tanjungpinang General Hospital. Furthermore study to audit result can give the real situation from service quality in Tanjungpinang General Hospital. Suggestion: Developing human resource competency and upgrading facilities are two inseparable aspects absolutely needed to improve the service quality of a hospital. Service standard which have been agreed on, not have to be degraded by if found deviation in result make an audit, so that clear target forwards quality standard which must be reached.

Kata Kunci : Audit medik,Bedah sesar,Standar,Action research,Mutu