: (021) :

Tempat/Tgl Lahir Alamat rumah Alamat Kantor Telp. Rumah Telp. Kantor Fax Hp Email

: Jakarta, 27 Mei 1954 : Jl. Jati Sari II / 22, Jati Padang – Pasar Minggu Jakarta Selatan : RS Premier Bintaro Jl. MH. Thamrin No. 1 sektor VII Bintaro Jaya : (021) 780.3556 : (021) 745.5500 ext. 2000 : (021) 745.5800 : 0816.824.109 : [email protected]

PENDIDIKAN UMUM: Dokter FK-UI Dokter Spesialis Anestesiologi FK-UI Konsultan Intensive Care

periode 1973 – 1979 periode 1986 – 1989 periode 1996

PENGALAMAN BEKERJA : -Dokter POLTABES – Medan -Dokter RS POLDASU – Medan KASUBSI KESJAS POLDA SUMUT PANIT GAWAT DARURAT RS POLPUS -Dokter Anestesiologi RS POLRI Pusat -KA.NIT anestesiologi & ICU RS POLPUS -Ketua Panitia AKREDITASI RS POLPUS

1981 - 1985 1983 - 1985 1985 - 1986 1991 - 1995 1990 – 2000 1995 - 2000 1998

ORGANISASI : Ketua IDSAI cabang JAKARTA Sekjen PP IDSAI Ketua Umum PP IDSAI Anggota ex officio P2KB IDI Ketua Umum PP PERDATIN Anggota Makersi IRSJAM Anggota MPPK IDI Ketua Komite Medis RSPB

periode 2001 – 2004 periode 2004 – 2007 periode 2007 – 2010 periode 2006 – 2009 periode 2010 – 2013 periode 2010 – sekarang periode 2009 – 2012 periode 2009 - sekarang

KIAT PROFESI ANESTESIA Dalam Mencegah KTD Dr BAMBANG TUTUKO SpAn KIC PERHIMPUNAN DOKTER SPESIALIS ANESTESIOLOGI dan TERAPI INTENSIF INDONESIA

Kongres XII PERSI dan Seminar Tahunan VI Patient Safety 2012

Kita menghadapi peralatan dg teknologi canggih

Kompleksitas = peningkatan kemungkinan terjadinya KTD !

1 medication error in every 133 anesthetics

(Glavin RJ. Br J Anaesth 2010;105:762010;105:76 829)

1 million anesthetic medication errors in one year

• • •

Medication Errors in Anesthesia 2266 members Canadian Society Anesthesiologists: 30% admitted to at least > 1 error in their lifetime (Orser et al., 2001) Japanese Society Anaesthesiologists: 27454 anaesthetics over 8 years. 233 medication errors: overdose 25%, substitution 23%, omission 21% (Yamamoto et al., 2008) New Zealand: 89% anesthesiologists admitted drug administration error during career, 12,5% reported having harmed patients by drug administration error (Merry et al., 1995)

Medication Errors in Anesthesia

• drug errors among top 5 reported

patient safety incidents occuring during anesthesia

• reported incidence in literature varies

widely: ranging from 1:131 to 1:5,475 anaesthetics (UK, NPSA 2010)

• Literature indicates these errors remain a cause of serious harm to patients

“The The error of one moment becomes the sorrow of whole life”

• A Chinese Proverb

• • • • •

disebut juga sbg ergonomics telah lama dikenal dalam bidang penerbangan dan pembangkit tenaga nuklir baru akhir2 ini diakui sbg bagian yg utama dari patient safety kontributor utama pada KTD dalam pelayanan kesehatan seluruh personil layanan kesehatan harus mempunyai pengetahuan dasar tentang

KIAT PROFESI ANESTESI Dasar Pemikiran hak pasien atas patient safety

dokter pada dasarnya tidak punya niat mencelakakan pasien

concern perhimpunan untuk kesejahteraan anggotanya dan patient safety

Perhimpunan

• • • • • •

membentuk Dewan Pembina mengusahakan back up asuransi profesi melaksanakan P2KB yg terarah menerbitkan buku2 pedoman / panduan praktik mengusahakan update kurikulum agar sesuai kebutuhan lapangan menjalin hubungan dg institusi terkait

• suatu badan dibawah Ketua • tujuan membina anggota (positive thinking)

• bersifat PROAKTIF, tidak menunggu aduan, membimbing anggota yg mendapat kasus

• tdd para pakar DSpAn tidak hanya di

bidang ilmu, tetapi juga manajemen RS dan organisasi, bila perlu bisa

Person Approach

• •

see an errors as the product of carelessness remedial measures directed primarily at the error-maker

• • • •

naming blaming shaming retraining

• mengharuskan anggota memiliki

asuransi profesi sebelum diberikan rekomendasi ijin praktek

• negosiasi dg pihak asuransi profesi

untuk penyelesaian diluar pengadilan (agar tidak mengganggu pelayanan)

Kedokteran Berkelanjutan (P2KB) • materi2 P2KB disesuaikan dg: • perkembangan ilmu dan tren lapangan / dunia • patient safety, high risk surgical dll. • jenis2 kasus yang ditangani Dewan Pembina • kompetensi di bidang airway, anestesi regional, pain

• •

penyusunan struktur materi / modul / workshop oleh tim P2KB Pusat pelaksanaan modul / workshop di cabang2 oleh instruktur cabang yg sudah di ToT.

• • • • • • •

Panduan Praktik

Buku: Standard dan Pedoman Pelayanan Anestesiologi Indonesia Buku: Panduan Tatalaksana Nyeri Perioperatif Buku: Pedoman Terapi Cairan Perioperatif Buku: Pedoman TCI (Target Control Infusion) dan TIVA (Total Intra Venous Anesthesia) Buku: Pedoman Anestesi Inhalasi

Cetak ulang buku saku: Kode Etik Kedokteran Indonesia dan Pedoman Etik Spesialis Anestesiologi dan Reanimasi Indonesia Buku: Pedoman Penjabaran Kewenangan Klinis

•Anaesthesia. 2004 May;59(5):493-504.

•Evidence-based based strategies for preventing drug administration errors during anaesthesia. •Jensen LS, Merry AF, Webster CS, Weller J, Larsson L. •Source •Aarhus University, Aarhus, Denmark.

•Abstract •We developed evidence-based based recommendations for the minimisation of errors in intravenous drug administration in anaesthesia from a systematic review of the literature that identified 98 relevant references (14 with experimental designs or incident reports and 19 with reports of cases or case series). We validated the recommendations using reports of drug errors collected in a previous study. One general and five specific strong recommendations were generated: systematic countermeasures should be used to decrease the number of drug administration errors in anaesthesia; the label on any drug ampoule or syringe should be read carefully before a drug is drawn up or injected; the legibility and contents of label on ampoules and syringes should be optimised according to agreed standards; syringes should (almost) always be labelled; formal organisation of drug drawers and workspaces should be used; labels should be checked with a second person or a device before a drug is drawn up or administered.

• • • •

One general and five specific strong recommendations were generated: systematic counter measures should be used to decrease the number of drug administration errors in anaesthesia;

the label on any drug ampoule or syringe should be read carefully before a drug is drawn up or injected; the legibility and contents of labels on ampoules and syringes should be optimised according to agreed standards;

•

syringes should (almost) always be labelled;

•

formal organisation of drug drawers and workspaces should be used;

•

labels should be checked with a second person or a device before a drug is drawn up or administered.

Update Kurikulum

• memberi input ke KOLEGIUM

kompetensi apa saja yg perlu diperkuat dan perlu ditambahkan, seperti:

• perkembangan difficult airway devices • pain as 5th vital sign, penanganan / manajemen nyeri

• dll

Kerja sama dg institusi terkait

• • • • •

pihak RS , karena KTD menyangkut sistim dg Kemkes, untuk penerbitan peraturan2 yg menunjang praktik yg patient safety, seperti pedoman peralatan anestesia sesuai jenjang RS, pedoman2 praktik anestesia, PMK 519 thn 2011 dg PERSI , sosialisasi ttg PAB dari Akreditasi RS KARS 2012, pelaksanaan PMK 755 dg menerbitkan buku pedoman kewenangan klinik , pelatihan patient safety bidang anestesia, dll.

Sosialisasi SPM, Lifebox, Surgical Safety Checklist stakeholder lain.

perioperative care approach by Anesthesiologists focus on a systems approach to high-risk high surgery, rather than clinging to the fragmented traditional disease-oriented oriented approach. The modern hospital should be able: • to identify patients with a substantially increased risk of peri- and postoperative morbidity, • design care paths that include specific interventions to reduce these complications.

TANTANGAN KEDEPAN

n estimation of the global volume of surgery: odelling strategy based on available data

s G Weiser, Scott E Regenbogen, Katherine D Thompson, Alex B Haynes, Stuart R Lipsitz, William R Berry, Atul A Gawande

w.thelancet.com Published online June 25, 2008 DOI:10.1016 S0140-6736(08)60878-8

rgical data from (29%) of 192 WHO member states

Global Volume of Surgery Jumlah pembedahan di seluruh dunia banyak Dg memperhatikan tingginya angka kematian dan komplikasi dari tindakan bedah mayor, saat ini keamanan pembedahan (surgical safety) harus sudah menjadi substansi public health dunia

Upaya2 public-health health dan surveilansnya harus mulai dilaksanakan

PRACTICE of PERIOPERATIVE MEDICINE

• evolved over time and is expected to present new challenges and opportunities.

• Standardization of medical practice aims to reduce healthcare co while improving outcomes.

• Standardization in perioperative medicine may be accomplished b introducing clinical pathways that encompass the entire perioperative period from the preoperative evaluation to the postdischarge disposition.

• Despite published evidence that clinical pathways improve outcome, they are widely underutililized in perioperative medicine

perioperative care approach by Anesthesiologists focus on a systems approach to high-risk high surgery, rather than clinging to the fragmented traditional disease-oriented oriented approach. The modern hospital should be able: • to identify patients with a substantially increased risk of peri- and postoperative morbidity, • design care paths that include specific interventions to reduce these complications.

The development of clinical pathways in perioperative medicine will only succeed in tight collaboration with all specialties involved, but thei implementation will critically depend on the leadership of the anesthesia team of the future long-term term effects of both surgery and innovative research efforts to develop effective strategies that secure long-term term benefits

PROCESS IN THE PERI-OPERATIVE PERI PERIOD

Anesthesia Patient Safety Foundation, 1985

an independent nonprofit corporation

vision ‘that that no patient shall be harmed by anesthesia’ anesthesia

Recent initiatives of the APSF: • improved medication safety • audible physiologic alarms

• standardization of Anesthesia Information Management Systems (AIMSs

the consideration of long-term term outcomes

strive to further improve care, the anesthesia team of the future have to rely

• untuk mengurangi terjadinya KTD pada tindakan anestesia, kita harus mampu memberikan pelayanan yang lebih aman yi dg kiat2 PATIENT SAFETY

• untuk melakukan patient safety, kita

harus paham dan mengEDUKASI diri sendiri tentang patient safety