Strategi Untuk Menerapkan Clinical Care Pathway
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Transcript of Strategi Untuk Menerapkan Clinical Care Pathway
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StrategiStrategi untukuntuk menerapkanmenerapkanclinical care pathwayclinical care pathway
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TujuanTujuan pembelajaranpembelajaran
MampuMampu menyusunmenyusun langkahlangkah untukuntuk
implementasiimplementasi CCPCCPMengenalMengenal caracara monitoringmonitoring dandan evaluasievaluasi
penerapanpenerapan CCPCCPMampuMampu menyusunmenyusun indikator indikator untukuntuk evaluasievaluasiCCPCCPMampuMampu menyusunmenyusun strategistrategi dalamdalampengembanganpengembangan dandan penerapanpenerapan CCPCCP
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LangkahLangkah setelahsetelah pathwaypathway tersusuntersusun
SusunSusun indikator indikator pengukuranpengukuran dandan rencanarencana pengumpulanpengumpulandata:data: – – ProsesProses ::
ContohContoh ukuranukuran --ukuranukuran prosesproses :: – – PengukuranPengukuran fungsifungsi tubuhtubuh dandan mobilitasmobilitas – – TingkatTingkat kesadarankesadaran – – Temperatur Temperatur
– – TekananTekanan darahdarah – – FungsiFungsi paruparu – – SkalaSkala kesehatankesehatan pasienpasien (wellness indicator)(wellness indicator)
– – Clinical OutcomeClinical Outcome
SusunSusun paketpaket pelatihanpelatihan CCPCCPLaksanakanLaksanakan pelatihanpelatihanSosialisasiSosialisasi dandan implementasiimplementasi
MonitoringMonitoring dandan evaluasievaluasi ,, tindaktindak lanjutlanjut hasilhasil monitoringmonitoringdandan evaluasievaluasi
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UjicobaUjicoba pathway:pathway: – – PrePre --implementation education sessionsimplementation education sessions – – ImplementasiImplementasi dandan monitoringmonitoring pelaksanaanpelaksanaan ::
TingkatTingkat kepatuhankepatuhan thdthd pathwaypathwayHambatanHambatan dalamdalam penerapanpenerapan pathwaypathway
Faktor Faktor pendukungpendukung thdthd penerapanpenerapan pathwaypathwayVariansVarians yangyang terjaditerjadiOutcomeOutcome klinisklinis
– – PostPost --implementation review:implementation review:KlarifikasiKlarifikasi permasalahanpermasalahan yangyang terjaditerjadi selamaselama implementasiimplementasiReviewReview variansvariansReviesRevies dandan revisirevisi pathwaypathwayMengulangMengulang monitoringmonitoring dengandengan intervalinterval tertentutertentu
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MonitoringMonitoring dandan pengukuranpengukuran
MonitoringMonitoring dandan pengukuranpengukuran outcomeoutcome
pelayananpelayanan :: – – IsuIsu --isuisu yangyang timbultimbul selamaselama implementasiimplementasi
– – ReviewReview terhadapterhadap pathwaypathway dandan pelaksanaanpelaksanaanpathwaypathway – – ReviewReview terhadapterhadap variansvarians
– – ReviewReview terhadapterhadap outcomeoutcome klinisklinis – – SusunSusun rencanarencana koreksikoreksi dandan tindaktindak lanjutlanjut
– – LakukanLakukan monitoringmonitoring secarasecara reguler reguler berdasar berdasar kesepakatankesepakatan
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EvaluasiEvaluasi thdthd pathwaypathway
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SasaranSasaran evaluasievaluasi
Hospital wide evaluation:Hospital wide evaluation:
– – Apakah Apakah goalsgoals penerapanpenerapan CCPCCP untukuntukorganisasiorganisasi tercapaitercapai
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ContohContoh goalsgoals daridari John HunterJohn Hunter
HospitalHospitalGoalGoal Indicator Indicator EvaluationEvaluation
methodmethod1. Improved1. Improvedmultidisciplinary teammultidisciplinary team
Number of staff involvedNumber of staff involvedin development ICPin development ICPImproved communicationImproved communication
between team membersbetween team membersImproved communicationImproved communicationabout patient careabout patient care
Report from ICP subReport from ICP subgroupsgroupsSurveySurvey
CasemixCasemix datadata
2. Increased involvement2. Increased involvementof patient in theof patient in themanagement of his/hermanagement of his/herconditioncondition
Improved complianceImproved compliancewith treatmentwith treatmentImproved patientImproved patientsatisfactionsatisfaction
Patient surveyPatient survey
3. Streamline3. Streamlinedocumentation anddocumentation andimprove completion ratesimprove completion rates
Rationalization ofRationalization ofpaperwork associatedpaperwork associatedwith medical recordwith medical record
Audit Audit
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Evaluation of individual pathways:Evaluation of individual pathways:
– – Process evaluation:Process evaluation:How the pathway was usedHow the pathway was used
– – Outcome evaluation:Outcome evaluation:Whether the established goals were achievedWhether the established goals were achievedthrough the introduction of the pathwaythrough the introduction of the pathway
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Method for evaluationMethod for evaluationThe dataThe data collenctioncollenction method can be:method can be: – – QuantitativeQuantitative
– – QualitativeQualitativeUses of clinical indicators:Uses of clinical indicators: – – LOSLOS
Readmission rateReadmission rate – – NosocomialNosocomial incident rateincident rate – – Return to operating roomReturn to operating room
Aggregate variance analysis: Aggregate variance analysis: – – Collect dataCollect data – – Identify trendIdentify trend
– – Analysis cause of variance Analysis cause of variance – – Review and revised the pathwayReview and revised the pathwayFile Review, auditFile Review, auditCustomer feedback:Customer feedback:
– – Staff feedbackStaff feedback – – Patient feedbackPatient feedback – – Community agencies feedbackCommunity agencies feedback
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RencanaRencana TindakTindak LanjutLanjut
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PerluPerlu adaada pemahamanpemahaman yangyangsamasama ttgttg clinical care pathwayclinical care pathwayManfaatManfaat clinical care pathwayclinical care pathway
bagibagi praktisipraktisi klinisklinis dandanmanajemenmanajemen
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DukunganDukungan yangyang dibutuhkandibutuhkan
ManajerialManajerial ::
– – KomitmenKomitmen – – KebijakanKebijakan
KomiteKomite MedikMedikKomiteKomite KeperawatanKeperawatan
PraktisiPraktisi KlinisKlinis
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TidakTidak semuasemua penyakitpenyakitdisusundisusun care pathwaycare pathway
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PrasyaratPrasyarat
Awareness: problems of continuity of care, Awareness: problems of continuity of care,
coordination of care, inefficiencycoordination of care, inefficiencyLeadership commitmentLeadership commitment
Culture for implementing best practiceCulture for implementing best practice Availability of clinical guideline Availability of clinical guideline
LongLong --term clinical staff commitmentterm clinical staff commitmentManagerial supportManagerial support
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Key issuesKey issuesCommitment to provide best clinical practices,Commitment to provide best clinical practices,Management/owner Management/owner ’’s commitment, support, and policys commitment, support, and policyDevelopment of clinical guideline (if possible based on evidenceDevelopment of clinical guideline (if possible based on evidence ))Develop a framework for implementation (see the steps of developDevelop a framework for implementation (see the steps of develop ing ICP)ing ICP) – – Clear goals and objectives for implementing ICPClear goals and objectives for implementing ICP – – Expected benefits of implementationExpected benefits of implementation – – Identify barriers for implementationIdentify barriers for implementation
– – Start simple: selecting area of practiceStart simple: selecting area of practice – – Plan and manage a project: steps for development, implementationPlan and manage a project: steps for development, implementation , and, andevaluation ICPevaluation ICP
Long term clinical staff commitment, involvement of key players,Long term clinical staff commitment, involvement of key players,““Professional contractProfessional contract ””
Develop an ICP team consisting innovative team membersDevelop an ICP team consisting innovative team membersCommunication, dissemination and trainingCommunication, dissemination and trainingTimeTimeClear evaluation method, clear indicators for evaluation, varianClear evaluation method, clear indicators for evaluation, varian ce tracking,ce tracking,analysis and feedbackanalysis and feedback
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DiskusiDiskusi
Apa Apa key issueskey issues untukuntuk penerapanpenerapan ICPICP
Adakah Adakah permasalahanpermasalahan untukuntuk tiaptiap keykeyissuesissues
BagaimanaBagaimana strategistrategi organisasiorganisasi untukuntukmengatasimengatasi permasalahanpermasalahan tsbtsb
SusunSusun
rencanarencana
tindaktindak
lanjutlanjut