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Berita detiknews.com  hari ini (10 april 2010) memuat  : seorang mantri yang bertugas sebagai kepala puskesmas pembantu di pedalaman kalimantan dijatuhi pidana karena membuat resep obat daftar G.Pidana dijatuhkan karena  ybs bersalah melakukan praktik selayaknya dokter. Mantri tsb- Misran – mendapatkan “pembelaan” melalui berbagai pendapat dari sekretaris dinas kesehatan bersangkutan yang juga seorang dokter,sampai kriminolog dan pengamat kesehatan. Melalui tulisan ini saya ingin berbagi pendapat, dan minta tolong kepada mereka yang punya kapasitas untuk menterjemahkan UU kedalam peraturan pelaksanaannya : bahwa ada 3 jenis kewenangan,

1.  kewenangan  yang didapat karena keahlian (authority by expertise), 
2. kewenangan yang didapat karena posisi (authority by position),
3. kewenangan yang didapat karena situasi (authority by situation)

Pada kasus ini, pastilah jenis kewenangan yang pertama tidak berlaku bagi dirinya karena Pak Misran bukan dokter – dan untuk itu dia dipidanakan, tetapi ada dua jenis kewenangan yang lain yang menurut saya dapat diberlakukan dalam kasus ini yaitu kewenangan yang didapat karena posisi yang disandang, dalam konteks ini ybs sebagai kepala puskesmas pembantu yang memang harus mengambil alih tanggung jawab apabila dokter tidak ada di area/ditempat; dan jenis kewenangan ketiga yaitu kewenangan yang didapat karena situasi (authority by situation), dalam kasus ini yang bersangkutan bekerja dipedalaman kalimantan yang menurut sekretaris dinas kesehatan setempat memang ditempatkan disana sebagai ujung tombak pelayanan kesehatan karena ketiadaan dokter. Nah ini betul-betul situasional sehingga jenis kewenangan ketiga harus diberlakukan,apalagi pemda dan dinas kesehatan setempat menyatakan bahwa ini adalah kondisi yang dihadapi di daerah pedalaman. Satu hal yang saya ingin titipkan kepada sekretaris dinas kesehatan setempat,atau mungkin juga ditempat lain, dalam hal perawat diberi tugas diluar konteks bidang keahliannya mereka harus diberikan perlindungan untuk dapat menjalankan peran dengan kewenangan karena posisi yang disandang atau kewenangan situasional melalui SPO sebagai bekal. Karena kasus ini sedang kasasi, saya ingin minta tolong PPNI dengan kapasitasnya,untuk memberi informasi kepada para pengambil keputusan tentang  ketiga jenis kewenangan ini untuk menjadi pertimbangan.

ABSTRACT 

Background . Implementation of care path which is essentially an interdiscipline approach of patient care require cohesiveness among health care practitioners in excersizing their role and function. Care path was developed to bridge the role overlap and synergize the medical and nursing intervention in patient care so that patient’s need of care were delivered safely,integrated and continuously. The purpose of the study was to identify whether physicians and nurses work cohessively in the implementation of care path; and is there any significant relationship between cohesiveness  in the implementation of care path and incidence related to issues of patient safety in the interdisciplinary model of patient care of a teaching hospital.

Methodology. Descriptive correlational design was used to identify any significant relationship between the cohesiveness in care path implementation and the observed incidence related to issues of patient safety during patient care activities. Cohessiveness of care path implementation was measure through identification of mean score of expert culture and collective culture; the observed incidence related to indicator of patient safety was identified during the process of patient care. 39 phycisians and 31 nurses participated in this study, Spearman’r  was implemented at 0.05 level of significant.

Result & Discussion. Cohessiveness among physicians and nurses in the implementation of care path  supported by the findings of the study where  mean score of collective culture (87.69) greater than expert culture (77.61) at p 0.000. The finding also identify 301 observed incidence related to 17 indicators out of 30 indicators of patient safety. Spearman’r  on mean score of expert culture and patient safety was 0.173 ( p > 0.05); Spearman’r on mean score of collective culture and patient safety was  0.327* significant at 0.05.

Conclusion. There is a significant relationship between Cohessiveness in the implementation of care path and patient safety in interdisciplinary model of patient care.

Keywords: cohesiveness,care path,collective culture,patient safety

Conducted collaborativelly by Universitas Padjadjaran,Flinders University,STIK Immanuel,Chulalongkorn University,STIKES Unjani , STIKES St Borromeous,AUAP (Association of Universities of Asia and Pacific), Supported by INA (Indonesian Nurses Association)

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ABSTRACT 

Background.The study on indicators of patient safety related to nursing care was conducted to identify aspect and process of care that may lead to the unsafe nursing care practices. This identification is necessary to be done as a based to evaluate  the practice of care related to the issues of safety of patients,care provider,environment and hospital business.

Methodology. Qualitative research was conducted through the use of focus group discussion(FGD).12-18 of nurses from various background (staff nurse,head nurse,supervisors and educators) which involves in interdisciplinary model of care,and get informed of patient safety participates in this study. FGD was conducted  in three phases : 1) to identify patient safety issues related to nursing care practices for hospitalized patients, 2) to identify  indicators of adverse event based on 10 care path which was developed earlier, saturation  was achieved at the 6^th path.  3) classify the adverse event indicators related to the issues of safety of the patients and the care provider in terms of diagnostic error, treatment error, preventive error and others

Result. 30 indicators was identified through the series of FGD, 2 indicators related to (the process of) diagnostic error ; 13 indicators related to treatment error,13 indicators related to preventive error and 2 indicators of others.

Conclusion.The identified 30 indicators of patient safety related to nursing care practices is the accepted instrument to evaluate the practice of nursing care.

Keywords: patient safety,adverse events,nursing care,interdisciplinary model of care

^*F.Sri Susilaningsih,MN. (Department of Fundamental of Nursing,School of Nursing Padjadjaran University.Currently Doctorate Student of School of Medicine Gadjah Mada University)