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Fakultas Kedokteran Universitas Brawijaya Gedung Graha Medika Lt. 1, Ruang 104
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INDONESIA
Jurnal Kedokteran Brawijaya
Published by Universitas Brawijaya
ISSN : 02169347     EISSN : 23380772     DOI : http://dx.doi.org/10.21776/ub.jkb
Core Subject : Health,
Medicine & Pharmacology
JKB contains articles from research that focus on basic medicine, clinical medicine, epidemiology, and preventive medicine (social medicine).
Arjuna Subject : Kedokteran - Kedokteran (Lain-Lain)
Articles 14 Documents
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Search results for , issue "Article in Press 2" : 14 Documents clear
Development of Caesarean Section Clinical Pathway : a lesson learnt Sastrawan, I Gede
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Clinical pathway is a crucial clinical management strategy aimed to ensure quality and cost. However, the development of clinical pathway at the hospital was mainly for administrative purpose as it is required by accreditation standards leading to high variation. Study aims to develop clinical pathway for caesarean section and explore the problem during development and initial implementation (simulation). The selection of caesarean section is based on its high volume, risk, and cost. Using participatory action research, the researcher started the program by performing literature review and regulation to proposed the first revised version draft. A group of relevant expert in the hospitals than discuss and proposed review, considering the available resources, current practice and behavior. The main differences of the new clinical pathway are: 1) it was developed based on literature and current practice, 2) adding notification, explanation, inclusion and exclusion criteria, and references.  Before initial implementation (simulation), the hospital also develop a procedure operational standards for the implementation, resources, and monitoring.  The first simulation on two cases found differences in type of medication and documentation method, which than further discussed with all care providers involved to define the agreed solution. Professional engagement and openness culture that embrace along the process are the main important key lesson learnt in addition to the understanding that clinical pathway development and implementation is a continuous learning process. Therefore continuous monitoring and evaluation is of paramount important to reach quality and efficiency, the ultimate goals of clinical pathway.
Factors Affecting Patient's Length of Stay In The Era Of Covid-19 Pandemic In Emergency Room Persada Hospital Simanungkalit, Sylvia Kitty; Holipah, Holipah; Dewanto, Aryo; David, David
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Length of stay (LOS) of a patient in an Emergency Room (ER) is the interval between the time the patient arrives and the time the patient physically leaves the ER. Prolonged LOS has potential to cause crowding. Meanwhile, from a clinical point of view, the factor of LOS has an impact on service suspension, which can reduce patient safety, even to death. Covid-19 pandemic has made hospitals establish a strict patient screening system and has the potential to increase the LOS of patients in the ER. The purpose of this study was to identify the factors that contribute to the LOS of patients. This study is an observational study of 38 respondents who came to the Emergency. LOS was compared between before and during Covid-19 pandemic condition. Observations were carried out by the Time Motion Study method to determine the patient's average time at each stage of the ER. The results showed the average LOS for emergency room patients with inpatient plans was 2 hours 7 minutes, while the LOS during pandemic was 4 hours 46 minutes 52 seconds. There were 2 hours 39 minutes 52 seconds time extension. The time extension is due to several factors: results of laboratory tests SARS COV-2; approval process for the Covid-19 Screening Team; Emergency Room and Laboratory were located in separate buildings.
WHY VISITS OF EMERGENCY DEPARTMENT DECREASED DURING THE COVID-19 PANDEMIC? CASE STUDY IN X HOSPITALS, MALANG REGENCY Kusumawati, Anita Mardiana; widyaningrum, kurnia
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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The visits rate to the Emergency DepartmentofX Hospital in the period April to June 2020, on average, decreased by 45.11% compared to the January - March 2020 period. The study aimed to identify the factors causing the decrease in the number of the Emergency Departmentduring the Covid-19 pandemic at X hospital. This study used a qualitative descriptive approach with Focus Group Discussion (FGD) data collection techniques analyzed using Fishbone Diagram combined with 5 WHYs.The subjects were determined based on purposive sampling, namely 8 respondents consisting of Nurses, Doctors and CoordinatorofEmergency Department, Head of Public Relations and Marketing Unit, Coordinator of Security Guard and Coordinator of Patient Registration Office. The results showed that there were several root causes of the decrease in the number of the Emergency Departmentat Xhospital: Emergency departmentstaffs had difficulty in providing education about Covid-19 screening and isolation care to patients and their families, patients refused further treatment, and patients refused to go to the hospital. Thus the decrease in the number of inpatients of the Emergency Department during the Covid-19 pandemic were caused by various factors, especially the difficulty of Emergency Departmentstaffs in providing education on Covid-19 screening and its subsequent care.
Workload of The Inpatient Nurses: What Are The Affecting Factors? Asjanti, Lidia
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Tingginya beban kerja perawat dapat berdampak terhadap mutu pelayanan rumah sakit. Perawat merupakan ujung tombak pelayanan, sehingga harus mendapat perhatian dan dikelola secara profesional agar memberikan kontribusi yang positif bagi kemajuan rumah sakit. Studi ini dilakukan untuk menjelaskan faktor-faktor yang memengaruhi tingginya beban kerja perawat di Instalasi Rawat Inap Bedah dan Dalam B (IRNA BDB) RS. Baptis Batu. Metode studi kualitatif dan kuantitatif dengan pendekatan deskriptif eksploratif. Penentuan akar masalah menggunakan diagram fishbone. Faktor-faktor yang berpengaruh terhadap tingginya beban kerja perawat ruang rawat inap rumah sakit adalah jumlah perawat kurang memenuhi kebutuhan beban kerja, penempatan perawat yunior dan magang meningkatkan beban kerja perawat yang lebih senior, perawat melakukan tugas administrasi keuangan, sampling darah untuk pemeriksaan laboratorium dan dispensing sediaan steril, serta fasilitas nurse call dan kamar mandi pasien yang kurang mendukung. Kesimpulan penyebab tingginya beban kerja perawat adalah kurangnya jumlah perawat, kualitas perawat berbeda-beda, beban tugas non asuhan keperawatan serta fasilitas yang kurang mendukung.
Laboratory Service Process Checklist: Preventive Measures to Increase Blood Glucose Test Accuracy Setyawan, Yudi; Wardhani, Viera
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

The accuracy of the blood glucose test results is an important measure for hospital quality due to its effect on treatment plan, decision and outcome. This study aims to develop checklists model to improve the laboratory results accuracy. The development of the checklist was based on laboratory services process: pre-analytic, analytic, and post-analytic which further implemented for all requests for blood glucose tests during study period (65 examination) in the first week of October 2020. After the implementation, result showed no incidence of test in-accuracy when conformed with patient clinical information. Staff express that the checklist is fast and easy to complete (3-5 minutes), and beneficial. Problem occurs when the workload is high because of limited number of staff at night shift or high patient volume leading to delay in checklist completeness. Therefore, regular monitoring and evaluation was suggested to ensure compliance, in addition to dividing the checklist performed in 2 stages. The pre-analytic stage is carried out first for all patients followed by the analytical and post-analytic stages because these two activities were located in different floor. It can be concluded that the use of checklists is effective as preventive measure increase the conformity of laboratory examination results with patient clinical information.Keywords: Laboratory checklist, test accuracy, patient safety.
PRE-TRIAGE SYSTEM : A SOLUTION TO FACING SURGE OF PATIENT DURING OF COVID-19 PANDEMIC Yuvita, Emilda; Fitriasari, Nikma; Harjayanti, Nofita Dwi
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

It is difficult to predict the end of Covid-19 pandemic. The emergency department (ED) as the main access for health services in the hospital has the highest risk of infection and overwhelmed by surge of patients. Modification of the emergency service system by implementing a pre-triage system can be a solution to dealing with surge of patients. The results of the preliminary study succeeded in forming a pre-triage system model. The pre-triage system model was carried out by identifying patients with the risk of Covid-19 in ED and modification of the emergency service flow. The implementation of the pre-triage system requires the readiness of the emergency department’s team. The sample used was all staff of emergency department of X Hospital which total 30. The results showed that 23,3% of respondents had good category knowledge, 56,67 % respondents had sufficient category knowledge, and 20% had less knowledge. The level of readiness found that 90% of respondents are ready for implementation of the pre-triage system. The Chi-Square test result show that the level of knowledge of the pre-triage system is not related to readiness to implement the pre-triage system.
The Implementation of the Seven-Rights Procedure in Drug administration in a Hospital Inpatient Room: the Inhibiting Factors and Alternative Solutions Puspitasari, Shinta Dwi; Dewanto, Aryo; Holipah, Holipah Holipah; Muliawan, Arrasyid Indra
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Medication error becomes one of the main concerns in ensuring patient safety worldwide. In the first semester of 2020, Hospital X reported two incidents of medication error. Although the incidents were categorised as “adverse event” and “near miss”, it should have been prevented. One of the methods to prevent medication error is the application of the seven-rights procedures in drug administration. This study aims to identify the inhibiting factors in the implementation of the seven-rights procedure in X Hospital as well as to obtain alternative solutions to those inhibiting factors. This study used a cross-sectional design. The data was gathered from 20 nurses at Hospital X using a questionnaire to measure the knowledge, attitude, and behaviour of nurses on the seven-rights procedure. The data is also supported by observation on the actual implementation of the procedures. At the end of the data gathering process, interviews with nurses in inpatient room were conducted to obtain their opinion about the obstacles in applying the seven-rights procedures. The results show that the main problem of drug administration errors was the lack of standard operating procedures (SOP) and nurses’ non-compliance behaviour on the seven-rights procedure. This study also reveals that there is no relationship between the nurses’ knowledge and their behaviour in applying the seven-rights procedures. To prevent medication error, the hospital manager should revise the SOP, conduct a periodic internal refreshment-workshop about the procedure, and perform scheduled supervision to the nurses.
LOSS OF LINEN STOCK AT RSIA PURI BUNDA: WHAT IS AFFECTING? DRIE, IVAN -; Ratri, Devita Rahmani; Nuthea, Merry -
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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The number of linens is insufficient, the cleanliness of the linen is lacking, and the inaccuracy of the time in linen services will affect the quality of hospital services. In addition, it has an impact on inefficient financing for linen needs and decreased patient satisfaction with linen services. Based on the results of research conducted at RSIA Puri Bunda Malang, it was found that there were still 108 linen incidents from the initial stock of linen 792. This research is a descriptive study that aims to find the root of the problem about what factors influence the loss of linen at RSIA Puri Bunda. From the results of the research conducted, there were several root problems that affected the missing linen in the inpatient unit, namely the absence of a hospital policy that regulated complete linen management techniques, weak evaluation monitoring, and inadequate linen management planning. The problem of the factors that influence the loss of linen in the inpatient unit of RSIA Puri Bunda Malang is the hospital management repairing and completing the existing linen management system or guidelines with a missing management monitoring and control system to make it more effective and efficient as well as strengthening the monitoring and evaluation functions under general manager coordination.
How Do Hospital Staffs Cope with Covid-19 at Work? A Phenomenological Study Febrianto, Wahyu; Indriani, Wiwin; Dewanto, Aryo; -, Holipah
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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The first confirmed Corona Virus Disease 2019 (Covid-19) case in Indonesia was found in March 2020 and rapidly spread out across all provinces. Covid-19 hit unexpectedly that almost all hospitals around the world were unprepared for it. Several studies show that Covid-19 impacts negatively on hospital finance, the mental health of healthcare workers (HCWs), and the death of HCWs. Hasta Brata Hospital (HBH) is one of the hospitals in East Java affected by the pandemic. Therefore, this study aims to investigate the experience of HBH staff face the issues. This study was qualitative research with a phenomenological approach. The data were collected using in-depth interviews with two HBH’s staff. ACovid-19 pandemic causes problems to the hospital, especially the staff. They experienced deep emotional and physical pressure at work, such as fear of infection, repeated conflict with patient's visitor, having different mindsets among staff, and increasing workload. The situation in the community is also frustrating them as the Covid-19 cases keep rising, while people tend to disobey the Covid-19 prevention protocols. Fortunately, they have proper job resource, started from physical support such as the provision of personal protective equipment, nutritional enhancement, and periodic Covid-19 screening; cognitive support such as knowledge update about Covid-19 and its handling methods; to psychological support such as motivational and spiritual support from the HBH leader. Moreover, they also pose strong personal resources that help them to cope with stressful working situations. They could, then, bounce back, feel optimistic that they could fight against Covid-19, with the hope that the pandemic will have an end. Continuous spiritual support gives them another personal resource of tawakkal, an Islamic concept of giving entire resignation and reliance on God only after exerting maximum effort. It seems that job resources and personal resources have succeeded in reducing the highly demanding situation and transform it into positive outcomes. Given a challenging situation, the hospital staffs strive to perform well and bring themselves into their work when providing patient care. Covid-19 pandemic forced the hospital and staff to adapt to the condition quickly. The presence of job resources and the provision of strong personal resources have succeeded in moderating job demands and resulting in positive outcomes. Tawakkal becomes an adding point on staff's personal resources that made them realize that Covid-19 is inevitable, and they have to fight back before finally giving their full resignation to God.
WHY INPATIENT VISITS DECREASED DURING THE PANDEMIC? CASE STUDY IN HOSPITAL X, MALANG REGENCY Lukito, Anggun Agatha Cristy; Widyaningrum, Kurnia
Jurnal Kedokteran Brawijaya Article in Press 2
Publisher : Fakultas Kedokteran Universitas Brawijaya

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ABSTRACTCovid-19, designated as a National disaster in Indonesia, has an impact on reducing the number of non-Covid-19 inpatient visits in almost all hospitals. Hospital X also underwent a decrease in inpatient visits, resulting in a decrease in the Bed Occupancy Rate (BOR) by 35,5%. The study aimed to identify the factors causing the decrease in the number of inpatients at Hospital X from April to July. This study used a qualitative descriptive approach with Focus Group Discussion (FGD) data collection techniques analyzed using Fishbone Diagram combined with 5 WHYs. The subjects were determined based on purposive sampling, namely 8 respondents consisting of the head of the inpatient room, the coordinator of the inpatient room, the outpatient coordinator, head of public relations and marketing unit, and the coordinator of the patient registration office. Through the Fishbone Diagram, there found several root cause themes covering 4 aspects, namely the Human aspect, the Method aspect, the Mother Nature or the Environment aspect  and the Market aspect as the cause of the decrease in the number of hospitalized patients at  Hospital X during the Covid-19 pandemic. 

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