ANALISIS SELF REPORTED ASUHAN PERSALINAN DAN MEDICAL ERROR OLEH LULUSAN DIII KEBIDANAN DI KABUPATEN BANTUL

ISTRI BARTINI, dr. Ova Emilia, M. Med, Ph.D, SpOG(K)

2012 | Tesis | D4 BIDAN PENDIDIK

Latar belakang: Peningkatan cakupan persalinan oleh tenaga kesehatan di Indonesia (82,3%) belum bersinergi dengan penurunan AKI (228/100.000 kelahiran hidup). Rendahnya kualitas pelayanan pada tingkat primer menjadi faktor penyebab utama lambatnya pencapaian MDGs. Bidan sebagai provider di tingkat pelayanan primer menjadi ujung tombak dalam pertolongan persalinan. Persepsi masyarakat tentang kualitas lulusan DIII kebidanan yang masih kurang, menjadi suatu kekhawatiran terhadap terjadinya medical error oleh bidan lulusan DIII kebidanan. Kompetensi asuhan persalinan merupakan salah satu kompetensi bidan yang berisiko terjadinya medical error. Di Kabupaten Bantul, jumlah kematian ibu pada tahun 2010 sebanyak 18 kasus yang sebagian besar kematian terjadi pada masa persalinan Tujuan: Untuk mendeskripsikan kepatuhan terhadap asuhan persalinan normal dan medical error yang terjadi dalam asuhan persalinan yang dilaksanakan oleh lulusan DIII kebidanan. Metode: Studi kuantitatif dengan rancangan cros sectional terhadap terjadinya medical error dalam asuhan persalinan oleh bidan lulusan DIII kebidanan di Kabupaten Bantul. Data dikumpulkan dengan kuesioner (self reported) dan dianalisis secara univariat, bivariat dan multivariat. Hasil : Hasil analisis diketahui 41,51% terjadi medical error dalam asuhan persalinan, 24,53% asuhan persalinan oleh bidan lulusan DIII kebidanan dikategorikan sebagai asuhan persalinan yang tidak baik (n=53). Self reported tentang medical error pada 4 aspek yang diteliti, 14 responden menyatakan pernah terjadi medical error terjadi pada aspek tindakan pertolongan persalinan (26.42%), 10 responden menyatakan terjadi medical error pada upaya pencegahan infeksi (18.87%), 8 responden (15.09%) menyatakan terjadi medical error pada saat pemberian obat dan hanya 3 responden yang menyatakan terjadi medical error (5.66%) pada saat penentuan diagnosa. Asuhan persalinan yang tidak baik significant terhadap terjadinya medical error (p=0,000),dan 3,8 menyebabkan medical error setelah dikontrol oleh variabel luar (fasilitas & SOP) dengan nilai R² 0,16. Kesimpulan: Asuhan persalinan oleh bidan lulusan DIII kebidanan di Kabupaten Bantul 75,5% dikategorikan baik, dan kejadian medical error dalam asuhan persalinan sebanyak 41,5%. Prevalensi asuhan persalinan yang tidak baik meningkatkan kejadian medical error dibandingkan dengan asuhan persalinan persalinan yang baik. Medical error dalam asuhan persalinan yang diungkapkan melalui self reported dalam penelitian ini terjadi dipengaruhi pula oleh kelengkapan alat dan standart operasional prosedur yang ada di fasiltas pelayanan kebidanan.

Background: Increased coverage of deliveries by health personnel in Indonesia (82.3%) does not synergize with decreased MMR (228/100.000 live births). The low quality of care at the primary level becomes the main causal factor for the slow achievement of the MDGs. Midwives as providers in the primary care level become the front liners in delivery assistance. Public perception of the low quality of DIII midwifery graduates becomes a concern to the occurrence of medical errors by DIII midwifery graduates. Competence of delivery care is one of midwives’ competences at risk of medical error. In Bantul District, the number of maternal deaths in 2010 was 18 cases with a majority of deaths occurring during childbirth. Objective: To describe compliance to normal delivery care and medical errors that occurred in the delivery care conducted by DIII midwifery graduates. Methods: A quantitative study with a cross-sectional design to the occurrence of medical errors in delivery care by DIII midwifery graduates in Bantul District. Data were collected by questionnaire (self reported) and analyzed by univariate, bivariate and multivariate. Results: The results of the analysis suggested that 41.51% medical error occurred in the delivery care and 24.53% of delivery care by D III midwifery graduates were categorized as not good (n = 53). Self reported about medical errors in the four aspects being studied showed that 14 respondents (26.42%) said that medical error ever occurred in the action aspect of delivery assistance, 10 respondents (18.87%) said that medical errors occurred in the prevention of infection, 8 respondents (15.09%) stated that medical error occurred during the administration of drugs and only 3 respondents (5.66%) said that medical errors occurred at the time of diagnosis establishment. Not good delivery care was significant to the occurrence of medical errors (p = 0.000), and 3.8 times causing a medical error after being controlled by extraneous variables (facilities & SOP) with R² value of 0.16. Conclusion: Delivery care by DIII midwifery graduates in Bantul District 75,5% was categorized good, and 41.51% medical error occurred in the delivery care.The prevalence of not good delivery care increased the incidence of medical errors than that of good delivery care. Medical errors in delivery care expressed through self-reported in this study showed that they were also influenced by the completeness of equipment and standard operating procedures in obstetric care facility.

Kata Kunci : Medical error, lulusan DIII Kebidanan, asuhan persalinan