AUDIT KLINIS TATALAKSANA ANAK DENGAN THALASSEMIA DI RSUP DR. SARDJITO

HANIN NAJAHAH, DR. dr. Sri Mulatsih, SpA(K); dr. Amalia Setyati, SpA(K)

2014 | Tesis | S2 KEDOKTERAN KLINIK/MS-PPDS

Latar belakang: Thalassemia merupakan penyakit dengan high cost, high risk, dan high volume. Audit klinis dilakukan sebagai salah satu upaya meningkatkan mutu pelayanan dan patient safety pasien thalassemia. Tujuan: Mengevaluasi tatalaksana anak dengan thalassemia yang dirawat di RSUP Dr. Sardjito berdasarkan pedoman pelayanan medis (PPM) IDAI 2011 dan PHTDI 2013. Metode: Penelitian deskriptif dengan pengumpulan data retrospektif. Data diperoleh dari rekam medis anak thalassemia yang di rawat inap atau one day care di RSUP Dr. Sardjito dari 1 Januari 2012 sampai 31 Desember 2013. Audit klinik dilakukan berdasarkan PPM IDAI 2011 dan PHTDI 2013. Hasil: Terdapat 41 rekam medis yang diaudit. Berdasarkan PHTDI, dari 22 kriteria, 3 kriteria mempunyai tingkat kepatuhan tinggi, yaitu pemberian kelasi besi (100%), tepat dosis deferipron (93,5%) dan deferasirok (100%). Deviasi 100% terdapat pada 4 kriteria yaitu pemberian vitamin C, tepat dosis deferoksamin, pemeriksaan visual, dan pendengaran. Deviasi 82,9% terdapat pada 5 kriteria yaitu pemeriksaan elektrolit, jantung, endokrin, radiologi dan paru. Defisiensi terjadi pada 10 kriteria yaitu kadar Hb pretransfusi (75,1%), pemberian asam folat (100%), vitamin E (100%), terapi kombinasi (100%), pemantauan ferritin (65,9%), fungsi hati (100%), fungsi ginjal (95,1%), tumbuh kembang (100%), laktat dehidrogenase (100%), dan serologi virus (100%). Berdasarkan IDAI, dari 18 kriteria, terdapat 2 kriteria terpenuhi yaitu pemberian kelasi besi dan tepat dosis deferasirok. Deviasi terdapat pada 2 kriteria yaitu pemberian vitamin C dan tepat dosis deferoksamin. Defisiensi terdapat pada 14 kriteria lainnya. Simpulan: Tatalaksana anak dengan thalassemia yang dirawat di RSUP dr. Sardjito belum memenuhi standar PPM IDAI 2011 dan PHTDI 2013.

Background: Thalassemia is a disease with high cost, high risk, and high volume. Clinical audit needs to be done as an effort to improve the quality of care and patient safety. Objective: to evaluate the management of thalassemia in children treated at Dr Sardjito Hospital according to guidelines of IDAI 2011 and PHTDI 2013. Methods: This was a descriptive study with retrospective data collection. Data were obtained from medical records of thalassemia children in inpatient or one day care at Dr. Sardjito Hospital on January 1, 2012 to December 31, 2013. The clinical audit was performed using guidelines of IDAI and PHTDI. Results: Forty one medical records was audited. According to PHTDI, of 22 criteria, 3 criteria had high compliance: administration of iron chelation (100%), right deferiprone dose (93.5%) and deferasirox (100%). Deviation of 100% was on 4 criteria: administration of vitamin C, right dose deferoxamine, monitoring visual and audio. Deviation 82.9% was in 5 criteria: examination of electrolytes, heart, endocrine, radiological and pulmonary function. Deficiency occurs on 10 criteria: pre-transfusion hemoglobin level (75.1%), administration of folic acid (100%), vitamin E (100%), combined therapy (100%), monitoring ferritin (65.9%), liver function (100%), renal function (95.1%), growth and development (100%), lactate dehidrogenase (LDH) (100%), and viral serology (100%). According to PPM IDAI, of 18 criteria, two criteria had high compliance. Deviation found in 2 criteria and deficiencies found in 14 criteria. Conclusion: Management of children with thalassemia treated at Dr. Sardjito Hospital was not accordance with guidelines of IDAI and PHTDI.

Kata Kunci : Thalassemia, audit klinis, pedoman pelayanan medis