AUDIT PENATALAKSANAAN MENINGITIS BAKTERIALIS PADA ANAK DI RSUP DR. SARDJITO

I Putu Ardika Yuda, Prof. dr. Sunartini Hapsara, Ph.D, Sp.A(K)

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

: LatarBelakang Angka kematian dan disabilitas pada pasien meningitis bakterialis masih cukup tinggi serta berhubungan dengan kualitas pelayanan. Audit medis perlu dilakukan sebagai salah satu upaya meningkatkan patient safety pada pasien meningitis bakterialis. : Tujuan Untuk mengetahui kesesuaian antara praktik penatalaksaan meningitis bakterialis pada anak yang dirawat di bangsal anak RSUP Dr. Sardjito dengan pedoman pelayanan medis berdasarkan Standar pelayanan medis (SPM) RSUP Dr. Sardjito 2005 dan (PedomanPelayananMedis) PPM IDAI 2010. :A Metode udit retrospektif dengan menggunakan pedoman audit berdasarkan SPM RSUP Dr. Sardjitotahun 2005 dan PPM IDAI tahun 2010. Subjek penelitian adalah anak usia 1 bulan-18 tahun dengan diagnosis meningitis bakterialis yang dirawat di bangsal anak RSUP Dr. Sardjito pada 1 Januari 2011 sampai dengan 31 Mei 2013. Terdapat 114 anak dengan diagnosis meningitis bakterialis Hasil: . Rata-rata lama waktu penanganan di UGD adalah 89 menit dengan median 78 menit. Median lama waktu dilakukannya pungsi lumbal sejak pasien masuk adalah 4,5 jam (rentang interkuartil 2,3 – 18,2 jam). Hanya 62/114 (54,4%) pasien mendapatkan antibiotik dosis intrakranial dalam waktu 6 jam sejak pasien masuk. Tapi defisiensi ini tidak terbukti mempengaruhi outcome kematian (OR [odds ratio]: 0,7; 95%CI:0,18-3,0; p=0,480) maupun terjadinya sekuel (OR: 1,1; 95%CI:0,4-2,5; p=0,839). Pemeriksaan tes pendengaran dengan brainstem evoked respons audiometri (BERA) hanya dilakukan pada 26/63 (41,3%) pasien. Belum Simpulan: semua kasus penatalaksanaan meningitis bakterialis memenuhi standar mutu sesuai pedoman. Perlu diadakan pelatihan atau workshop tatalaksana meningitis bakterialis pada anak di RSUP Dr. Sardjito.

Background: Mortality and disability in children caused by bacterial meningitis is still quite high and is associated with quality of care. So that medical audit should be done as an effort to improve patient safety. To Objectives: determine compatibility the practice management of bacterial meningitis in children with medical care guidelines based on Dr.Sardjito Hospital standard of medical service (SMS) 2005 and IDAI SMS 2010 and then determines the factors that cause deficiency. audit Methods: Retrospective was performed using audit criterion and standards based on Dr.Sardjito Hospital SMS 2005 and IDAI SMS 2010. Subjects were children 1 month-18 years of age, hospitalized with a diagnosis ofbacterial meningitis or bacterial meningoencephalitis in the pediatric ward during period of 2 years between January 1, 2011 until May 31, 2012. Result: There were 114 children with a diagnosis of bacterial meningitis during the audit period. The average length of time in the emergency room treatment is 89 minutes with a median of 78 minutes. Lumbal puncture were performed with median time 4.5 hours (interquatil range 2.3 to18.2 hours) since patient admitted. Only 62 (54.4%) patients were received a dose of intracranial antibiotics within 6 hours since admission, but this deficiency is not proven to affect the outcome of death (Odds Ratio [OR]: 0.7; 95% CI:0.18-3.0; p = 0.480) and the sequel (OR: 1.1 ; 95% CI :0.4- 2.5; p = 0.839). Examination hearing test is only done on 26/63 (41.3%) patients. Not Conclusion: all cases of bacterial meningitis management meet standard of medical service. Workshop on the management of bacterial meningitis in children need to be held.

Kata Kunci : meningitis bakterialis audit medis-defisiensi