Embed Size (px)
Citation preview
EARLY DESIMINATION
Inpatient 3rd floor ward RSUA
M1 = ManNurse workforce analysis includes the number of nursing and
non-nursing personnel, Inpatient 3rd Floor ward RSUA nurses
have 17 people with bachelor degree of nursing and 1 people
with magister of nursing background and several nursing
personnel who have been trained.
The number of nurses is on the Inpatient 3rd Floor
RSUA are 15 people plus 2 people in structural (Unit
Coordinator and Vice Unit Coordinator)
Primary Nurse 2Alwan Reval S.Kep.,Ns
Unit Coordinator 3rd Floor WardRahmatul Fitriyah, S.Kep.,Ns
Vice Unit Coordinator 3rd Floor WardZaenal Abidin, S.Kep.,Ns
Primary Nurse 1Widyawati, S.Kep.,Ns
Primary Nurse 3Aulya Afifatur Rochmah, S.Kep.,Ns
Associate Nurse1. Nurul K, S.Kep., Ns2. Dwi C. M, S.Kep., Ns3. Eni P. L, S.Kep., Ns4. Samsul H, S.Kep., Ns, M.Kep
Associate Nurse1. Fauziah F, S.Kep., Ns2. Nurya, S.Kep., Ns3. Siti Nur I, S.Kep., Ns4. Masfin M, S.Kep., Ns
Associate Nurse1. Ahmad F, S.Kep., Ns2. Pamela R. A, S.Kep., Ns3. Shahtya D, S.Kep., Ns4. Rio Yanuar, S.Kep., Ns
Structural Organization
No Qualification Total Type
1234
NutrisionistCleaning ServiceHeatlh Care AssistantAdministrationJumlah
1 peoples3 peoples1 peoples1 peoples6 peoples
CentralCentral
Honorer RSUAHonorer RSUA
No Qualificatiion Total12
Specialist DoctorNurses
33 peoples17 peoples
Medical and Nursing Staffs
Non Medical Staffs
No
DeseaseMonth
Total PrecentageAugust September Oktober
1.2.3.4.5.6.7.8.9.10
DMCKDTBCVASHHIV/AIDSGEAHepatitisPneumoniaEfusi Pleura
74
105256476
181397843322
161757622310
413424191611111098
23,0319,1013,4810,678,996,186,185,465,064,49
10 main cases of disease per August-Oktober 2014 in inpatient instalation 3rd floor ward RSUA
Nursing staff recruitment based on Douglas method
Nursing staff recruitment based on Gillies method
Clasification TotalNursing staff needed
Morning shift Afternoon shift Night shiftMinimal care 0
0 x 0.17 = 0 0 x 0.14 = 0 0 x 0,10 = 0
Partial care 10 10 x 0,27 = 2,7 10 x 0,15 = 1,5 10 x 0,07 = 0,7Total care 4 4 x 0,36 = 1,44 4 x 0,30 = 1,2 4 x 0,20 = 0,8Total 18 4,14 2,7 1,5
4 3 2
Suggest nursing staff per day : 9 peoples
Suggest nursing staff per day : 13 peoples
The Need Of Nursing Staff Based On Dependence Patient And Nurse Recruitment On November 10th 2014
Nursing staff recruitment based on Health Ministry methodNo Category Average patient
per dayAverage
treatments hours per pasien per day
the number of treatments per
day
1 Internal patient 13 3,5 45,5
2 Surgery patient 1 4 43 Emergency patient 0 10 04 Pediatric patient 0 4,5 05 Obstetric patient 0 2,5 0
Total 14 24,5 49,5
Formula :
( total number of nurses + loss day) x 25%(7 + 2) x 25 % = 2,25 = 2 nursesNumber of nurses = personnel available + Loss day + non nursing job
= 7 + 2+ 2= 11 nurses
Date Shift WorkProduktif Non-Produktif
11-13 November 2014Morning Shift 95,9% 11,1%
Afternoon Shift 92,5% 15,9%Night shift 64,3% 49,2%
Average per day 84,2% 25,4%
Nurses Work Load in 3rd floor ward RSUA per November 11th-12rd 2014
the average productive workload of nurses per day in high criteria (84.2%)
Nursing satisfaction workingSTP TP CP P SP
Salary 0% 25% 56,8% 18,2% 0%Facility 3,6% 24,3% 38,2% 30,9% 0%
Employment Relationship 0% 0% 24,2% 60,6% 15,2%
Suitability Of Work 0% 9,0% 45,5% 45,5% 0%Supervision 0% 15,2% 48,4% 27,3% 9,1%
Promotion 0% 30,3% 48,5% 21,2% 0%
1. 56,8% said they felt quite satisfied for the salaries of nurses2. 38,2% said they felt quite satisfied for the facilities available in the
hospital3. 60,6% say they are satisfied for labor relations4. 45,5% say they are quite satisfied and satisfied as to the suitability of
work5. 48,4% said they felt quite satisfied for supervision in the workplace6. 48,5% said they felt quite satisfied for promotion.
Percentage of work satisfaction of nurses
Data Problem Etiologi
W: Nurses 3rd floor ward RSUA say MAKP has
not been trained.
O: From the observations were carried out on
11/12/2014 found that MAKP is not training.
D: There is no documentation of MAKP training
certificates
MAKP has been no training for nurses 3rd floor ward RSUA
There are no
planned training
MAKP from the
3rd floor ward
RSUA.
M1 Problem identification
Problem Purpose Plan Goal Indicator Time CoordinatorM1 – MANNurse 3rd floor ward RSUA not follow MAKP training
Improving the quality of human resources in nursing care services
1. Encourage MAKP training at all nurses in 3rd floor ward RSUA.
2. Support refresher nursing by competent personnel periodically.
1. The basic needs of patients are met
2. The nurse said they were satisfied with the work
Week3-5
Diah Susmiarti
Fawas Murtadho Santoso
M1 Plan of Action
M2 = Materials FacilitiesBased on the results of the questionnaire infrastructure100% of the nurses can use equipment63% of nurses expressed need additional equipment,45% of nurses stated inadequate administrative support.
Identify The ProblemProblem1. Lack of support facilities and infrastructure such as kitchen, bell patients
who have not functioned and no kitchen on the 3rd floor RSUA.Cause
2. There has been no opportunity to install and maximize the functionality of equipment functions as a high workload and development planning should be gradual.
Lack of support facilities and infrastructure such as kitchens, bell patients who have not functioned and no kitchen on the 3rd floor RSUA.
In order for the room infrastructure Inpatient 3rd floor can be maximized its use to those who have used, plus for the less, and which has not been inventoried
1. Observe the availability of facilities and infrastructure IRNA Level 3 and adjust the MOH standards
2. Make a report on unused tool and not available to the officer in charge
3. Preparation of a regular schedule of activities room inventory of facilities and infrastructure
4. Checking back post Inventory of goods and equipment
1.For a comparison between the availability of infrastructures with a reference standard in hospital accreditation manuals
2.The person in charge of the inventory of infrastructure
3.The absence of any inventory process
MingguI–V
Petrus Kanisius Siga Tage, S.Kep
Problem Purpose Plan Goal Indicators time coordinator
M2 Plan of Action
M3 = Methods MAKP
W: Nurses 3rd floor: 100% primary MAKP is applied 82% managed of job description were clear, but in the working 45% isn’t suitable with MAKP model. Cord. Unit & O: MAKP has been applied,special condition like PN helping AN in the nursing implemetation was happened when the patient exceeds the capacity. D: distribution of patients managed , NP and AN in charge already written.
PROBLEM: Implementation of the primary MAKP has been already done, but if the number of patients exceeds the capacity occurs, PN helping AN in the nursing implemetation
CAUSE: High workload
ACCEPTED NEW PATIENTSW: Nurses 3rd floor: 82% nurses have been doing introduction, explaining the rules and disease, and do documented. 73% no leaflets or brochures about diseaseCoord. Unit &O :Acceptance of new patients already well done, only if the patient exceeds the capacity, a description of the disease is not always given directly. no visitor cards and schedules visit cardD: all formats acceptance of new patients has been completed and signed by the nurse and the patient or family
PROBLEM: description of the disease and regulations have been implemented, but not optimal yet
CAUSE: No leaflets and brochures about disease, there aren’t visiting cards which given to the family.
DISCHARGE PLANNING
W:
Nurses 3rd floor: 82% do discharge planning when patients out from the hospital
and no distribution of leaflets in all patients.
Coord unit & O, D:
discharge planning doing good when patient out from hospital but in caring
process no documentation yet after educated, and no leaflets
PROBLEM: Health education were given to every patient and family when out from hospital, but no leaflets / brochures given.
CAUSE: Unavailable of leaflets or brochures by the hospital and there is no planning for maintenance dischare format
DRUG CENTRALIZATION
W:
45% said there isn’t inform consent of drug centralization to patient /
family, 73% stated that centralization of existing drugs in the room already
implemented optimally
Coord. Unit, O, D:
centralization has been done for every drug, except syrup, medication
chart has documented well but no consent form drug centralization of patient /
familyPROBLEM: There is no specific format for the centralized drug approval, the type
of drug has not been centralized syrup.
CAUSE: There isn’t inform consent of drug centralization to patient / family
NURSING ROUND
W:
82% of nurses said the implementation of nursing rounds is not optimal yet,.
Coord. Unit, O, D:
Nursing round has been done by profesion student and during this time for
prolong case, case study already done by medic ¶medic team,
documentation of case study already done.
PROBLEM: Nursing rounds have been implemented but the implementation is not maximized.
CAUSE: Limitless of nurse personnel make workload increase, so nurse have more time use for caring.
DOCUMENTATION
W:
55% of nurses stated the documentation is not implemented on time (not
immediately after performing the action). 73% of nurses stated that the model
is time-consuming documentation nurses.
Coord Unit, O, D :
nursing documentation already well done but very time-consuming so that all
implementation that have been done are not immediately documented. Every
documentation writing in SBAR’s system.
PROBLEM: Filling of medical records do not immediately after nursing implementation allowing forget to fill.
CAUSE: The increase in workload because of the limitations of nursing.
HAND OVER
W:
100% stated hand over done for 3 times, 18% hand over does’nt start on time.
Coord Unit, O, D:
Sometimes hand over not on time, some of nurse write the documentation
when hand over starting. the documentation hand over already well done.
PROBLEM: some of nurses are still completing documentation when hand over starting, and sometimes hand over not on time
CAUSE: Time management isn’t appropriate, and increase in workload.
SUPERVISIONW: Nurses 3rd floor 36% nurses said there isn’t form for supervision of implementations, 55% there isn’t feed back from supervisor, 64% want to change for every implementation suitable like result.Coord Unit, O: supervision done any time and verbal feedback give direcly, supervision has not been scheduled in assesment 10-14 November 2014D: There is no documentation result of implementation supervision
PROBLEM: supervision has not been scheduled, the documentation of supervision result just give by verbal
CAUSE: Supervision has not been scheduled
Problem Purpose Plan Indicator Time Coordinator
M3 – MethodeMAKPImplementation of the primary MAKP has been running well, but if the number of patients exceeds the capacity occurs penanambahan PP task concurrently PA
Expected after management practices by students FKP in Space Inpatient Level 3 is able to apply MAKP primary nursing well.
1. Applying the model MAKP planned in providing nursing care of patients under management.
2. Evaluate the implementation model of MAKP has been done in providing nursing care of patients under management.
MAKP is applied either primary nursing
Minggu 3-4
Evelin P, S.Kep
M3 Plan of Action
M4 = Money
1. Room financing and training: APBN and RKAT unair
2. Salary sorces:• PNS: APBN• Honorer: RKAT rektorat• contract: Airlangga university hospital
3.Patient Financing: general patients, personally, BPJS and jamkesmas non-quota.
Sources
24
4. Based on the interview on September 11th 2014, to 3rd floor nurses: • There were 5 respondents (83.3%) who are contract workers and honorary
said that the payments made under the regional minimum wage of Surabaya.• All respondents (100%) said no remuneration.• There are three respondents (27.3%) did not receive additional income such
as fees, transport and food allowances5. Result of interview to clarify the results of the questionnaire under the
responsibility of the Remuneration found that the income from the billing is divided into 40% for income together (all employees), 55% returned to their respective units and 5% to cash in nursing. Remuneration is divided every 3-4 months with rapel system. Remuneration granted to civil servants and non-civil servants (contract and honorary), this remuneration for the distribution by level of education, responsibility (coordinator, the chief unit, PN and AN), workload, tenure and employment status (as a civil servants and non-civil cervants).
6. Based on interviews with officers BPJS: AUH is not cooperate with major insurance companies and the lack of public patients. AUH parties cooperate with BPJS and a few insurance companies such as Bangun Arti Insurance and Cipta Dimensi Insurance.
7. According to the results of interviews with the patient's family, there were 17 patients BPJS (100%) said they had no difficulty in taking care of BPJS services, because they had been given information by nurses and administration.
Problem Purpose Plan Goal Indicator
The lack of a common number of general patients and the patients with insurance from major insurance companies.
To increase the number of general or private patients who using large insurance companies.
Recommend to collaborate with major insurance companies such as Prudential, Alians and AXA insurance company.
1. There is an enhancement in the number of general patients.
2. There’s an enhancement of the number of patients who use the health insurance from major insurance companies
M4 Plan of Action
Main Point
1. Improved quality (assessment risk of falls, anxiety, self-care, pain, plebitis, decubitus, UTI, SSI, and pneumonia)
2. Patient Safety1) Patient identification correcly
2) Effective Communication 3) Drug Safety 4) Right Surgery (location, patient and procedure) 5) Reduction of risk Infection
6) Reduction of Patient Fall
3. ALOS (Average Length of Stay), BTO (Bed Turn Over)
M5 = Marketing
Improved quality
• assessment of risk falls
No. Risk of Fall Morning Shift Afternoon Shift Evening Shift1.2.3
No riskModerate RiskHigh Risk
447
367
19 7
Total 15 Patient 18 Patient 17 Patient
Assesment risk fall using Morse Fall Scale on 11th November 2014, Patients at high risk of fall in IRNA 3rd floor RSUA are elderly patients and patients with loss awareness
Patient SatisfactionNo. Level of Satisfaction Total percentage1.2.3.4.
very satisfiedsatisfiednot satisfiedvery dissatisfied
113--
7,15%92,85%
0%0%
Total 14 100%
Assessment of patient satisfaction using satisfaction questionnaire on 11th November 2014 about 92.85% of patients satisfied with giving care of nurses
Patient Anxiety
No. Level of Anxiety Total Patient Percentage1.2.3.4.
NormalLowModerateHigh
111--
91,64%8,33%
0%0%
Total 12 100%
Anxiety assesment using Zung Self Rating Anxiety Scale (SAS/SRAS) on 11th November 2015 about 8,33% (1 patient) has a Low Anxiety
SELF CARE
Self Care assesment using KATZ index on 11-12th November 2014 about 4 patients with G index because low awareness and cannot do activity such as incontinent urine/alvi, toileting, eating, etc
Restrain
Patient in IRNA 3rd Floor RSUA on 11th November 2014, there was 1 patient with restrain because low awareness.
Decubitus assesment using Norton Scale on 10-12th November 2014, 4 patients have decubitus, but decubitus were gotten before nursing care in 3rd Floor RSUA.
Decubitus
PhlebitisNo. Phlebitis 10/11/1
411/11/1
412/11/1
413/11/1
414/11/1
415/11/1
41.2.
YesNo
215
315
116
314
114
011
Total 17 18 17 17 15 11
Phlebitis Assessment using Visual Infussion Score (VIS) on 10-15th November 2014 for patient with IV line, percentage phlebitis about 9,37% majority by elderly patient because many factors.
UTI, SSI, Pneumonia• Using UTI assesment, Southampton Scoring System ,
and Clinical Pulmonary Infection Score (CPIS)• No patient in 3rd floor RSUA suffer UTI, SSI, and
Pneumonia
Patient Safety
1. Patient identification correcly
1) Using pink or blue bracelet
2) Include name, age, address, birth date, and medic record number
3) Assesment on November11th 2014, about 53,3% (8 patient from15 patients) do not clearly about purpose to put identification bracelet
Effective communication• Using SBAR method (Situation, Background,
Assesment, Recommendation)
Drug SafetyLabeling and double crosscheck for high alert drug is
availableNo incident medication error
Right Surgery (location, patient and procedure)
• include Correct-Site, Correct-Procedure,Correct-Patient Surgery, time in and time out system
Reduction of risk Infection• has special team for infection control • Socialiszation about hand hygiene has not optimal
from the nurses yet• 10 patient or family (66,67%) do not know about
hand hygiene in 6 steps correcly
Reduction of Patient Fall Reduce of patient fall with close side rail There is form for risk fall assesment No sign risk fall or yellow bracelet
ALOS (Average Length of Stay)
• From ALOS formula , on Agust – October 2014 average value is 4,11 day
Problem purpose plan goal time coordinatorM5-Marketing
Effort to improve the quality of service
Propose explanation of health education for main purpose use identity bracelet to the patient and family.
Every patient using identity bracelet and know the purpose of identity bracelet
2nd week
Kusmanto,S.Kep
Propose to sign risk of fall for IRNA 3rd Floor RSUA
IRNA 3rd floor has a sign the risk of fall is used according to its function.
Eveline Paskalia Mea Mau, S.Kep
Propose to conduce health education about hand hygiene to patient and family.
3. All patients and families know how to wash hands correctly and know the benefits of using handrub.
Mardhiyah Hayati, S.Kep
M5 Plan of Action
Problem PriorityNo. Identification Persystem
(M1-M5)Problem
1. M5-MutuPasien Safety
Socialization installation idenification bracelet
2. M3Discharge Planning
Unavailability of leaflets related to the patient's illness
3. M3 Drug Centralization
There is no specific formafor the centralized drug approval.
4. M5-MutuPasien Safety
Installation Risk fall to the risk patients is not optimal
5. M3 Accepted new patient
A description of the disease and regulations have been implemented but not optimal
6. M1-ManMAKP
No training MAKP
7. M2 – MATERIALinfrastructur
Lack of support facilities and infrastructure (kitchen, bell patients who have not functioned, and inventory numbering).
8. M3 Supervision
There is no written documentation about the results of supervision and scheduling regular supervision
9. M5-MutuPasien Safety
Socialization of Hand Hygine to family or patient is not optimal
Diagram
0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0.1
- 0.1- 0.2- 0.3- 0.4- 0.5- 0.6- 0.7- 0.8- 0.9- 1.0- 0.1
- 0.2
- 0.3
- 0.4
- 0.5
- 0.6
M1(0.4, -0.2)
M2(0,7, 1.5)
M3
(0.3, -0.6)
DK
(0.2, -0.4)
RK
(0,-0,6)
SO(1.0, 0.5)
TT(0.4, 1.5)
DP(-1, -0.7)
SV(0.4, -0.3)
w
T
S
O
- 0.7
-0.8
-0.9
-1.0
1.0
M4(-0.7,0)
M5(1,1)
MAKP(0.3,0.7)
PB
(0.1,-0.3)
