AMINO IMSTC 2017

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AMINO Scientific Paper Scientific Poster Public Poster Videography Photography

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FOREWORD

AMINO is a program of AMSAIndonesia’s 2015/2016 tenure which is improvises previous publication: Bundle Regular of AMSA-Indonesia National Competition (BRAINs). AMINO is a place for archive all works from AMSA member who have participated national competition was held by AMSAIndonesia. With additional audio recording, it is expected that the readers would be to learn more regarding the works published in AMINO and to make AMINO more interactive.

As a closing, i would like to say thank you to Valdi Ven as a A-Team member, as the person in charge in AMINO project. I would like to say thank you to Ananta Siddhi Prawara as Regional Chairperson AMSA-Indonesia 2016/2017 and all E xe c u t i ve B o a r d A M S A- I n d o n e s i a 2016/2017 who always help me until AMINO finished. I hope this AMINO will give an inspiration for all AMSA member.

Thank You
 Best Regards

Edwin Setyawan
 Secretary of Academic AMSA-Indonesia 2016/2017
 Faculty of Medicine 2014
 Maranatha Christian University, Indonesia

AMINO will also published three times (PCC EAMSC, PCC AMSC, and IMSTC). AMINO will archive all works (i.e. scientific paper, scientific poster, public poster, photography, and videography) and I hope AMINO can make all AMSA member participate more in all competition that held by AMSA-Indonesia.

Official Email: academicandresearch@amsaindonesia.co m
 Phone: +6287823988766

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CONTENT

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All the works publicized here are the works of AMSA-Indonesia’s members who participated in Indonesian Medical Students’ Training and Competition (IMTSC) 2017 in Jakarta. In each section, the first works are acquired the first p l a ce i n I M STC 2 0 1 7 consecutively up to the third. H e re l i ste d b e l ow a re details of the winners.

Sections: Scientific Paper 1 s t by S a l l i e N a o m i , Q u i n t a Febryani, Robert 2nd by Angga Wiratama Lokeswara, Alice Tamara, Valdi Ven Japranata 3rd by Alfyran Janardhana, Savannah Quila Thirza, M Naufal Bachtiar

Videography 1st by M Taufan Wirya K u s u m a , D e v i n t a Akhlinianti, Siti Lukamanah 2nd by Elvira Lesmana, Arini Ayatika Sadariskar, Valdi Ven Japranata 3rd by Fauziyyah Djaafara, I Putu Ardi Wiraprasidi, Arondino Darmawan

Scientific Poster 1st by Angela Kimberly Tjahjadi, Joanna Erin Hanrahan, Clara Menna 2nd by Esmeralda P, Devina J, Josephine E 3rd Nadya Johanna, Almira Ramadhania, Harits Adi Putra

Photography 1st by Della Anastasia Candra, Ivan Angelo Allbright, Kevin Luke 2nd by Gerry Nathan R, Nicholas Abraham 3rb by Sekar Ratna Arnovita

Public Poster 1st by Elke Feliciana, Damarini Dida Pratiwi 2nd by M Rizal Shidiq, Savannah Quila Thirza, M Naufal Bachtiar 3rd by Maria Vannessa, Olivia Bernadi, Danny Aguswahyudy Jeremy

4 AMSA-Indonesia Competition Archive for Indonesian Medical Students’ Training and Competition 2017




SCIENTIFIC PAPER

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The Use of Isolation Chip to Treat Antibiotic Resistance in Community Sallie Naomi; Quinta Febryani; Robert Atma Jaya Catholic University of Indonesia Aim The aims of the study are: (1) Finding new way (antibiotics) to prevent, avoid, and solve antibiotic resistance in community. (2) Using technology to design a new antibiotic and understand how a powerful antibiotic substance is made in nature. (3) Providing new way to tap into secondary metabolites (microbial dark matter) from bacteria that won’t grow under standard laboratory conditions. Background Antibiotic resistance becomes a worldwide issue. Antibiotics are called "societal drugs," since resistant bacterial infections can pass from person to person. Thus, antibiotic use and antibiotic resistance can affect an entire community. Medical errors such as irrational use of antibiotics bring us to the crisis state of multidrugresistance. WHO released a policy to Combat Drug Resistance, which include nurturing of innovation and political commitment. In Indonesia, antibiotic resistance rates show high numbers, for ampicillin (66%), cotrimoxazole (52%), and chloramphenicol (39%). Material and Methods A systematic literature study search was conducted with 4 databases for articles published between 20011 until 2016. We used the following terms in the search field: Teixobactin AND [Antibiotic Resistance] and Antibiotic resistance AND [Public Health], Biotechnology AND [Teixobactin]. Results were compared and reevaluated in group sessions until consensus was obtained between reviewers. The final analysis included 25 articles, which met the criteria for the present literature study. Result Technology invented to solve antibiotic resistance is isolation chip (iChip). It’s a multichannel device that is able to culture microorganisms (in isolation from another) from soil that had not been able to be cultured in vitro previously to yield a higher number of novel microorganisms compared to traditional petri-dish methods to be developed into antibiotics. This iChip device resulted in isolation of teixobactin (previously uncultured) from a soil microorganism that unable grow in test tube. Teixobactin had excellent activity against Gram-positive pathogens, including drug-resistant strains. It has potency against most species, including difficult-totreat enterococci and M. tuberculosis and has promising in vivo activity, resulting in a substantial reduction in bacterial burden in mice infected with methicillin-resistant S. aureus or Streptococcus pneumonia.

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Conclusion Developing potential anti-microbes molecule using “iChip” is proven beneficial. iChip as a new way for discovering new natural antibiotics from isolation of soilmicroorganism’s compounds, such as teixobactin. The properties of teixobactin suggest that it evolved to minimize resistance development by target microorganisms. Teixobactin had excellent bactericidal activity and retained bactericidal activity against drug resistance gram-positive strains including M.tuberculosis. Keywords: Antibiotics Resistance, Isolation Chip, Teixobactin

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The Use of Isolation Chip to Treat Antibiotic Resistance in Community

Created by: Sallie Naomi Quinta Febryani Robert

FAKULTAS KEDOKTERAN
 UNIVERSITAS KATOLIK INDONESIA ATMA JAYA
 JAKARTA
 2014

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I. Introduction Antibiotic resistance becomes a worldwide issue. Antibiotics are called "societal drugs," since antibiotic resistance can pass from bacterium to bacterium and resistant bacterial infections can pass from person to person. Thus, antibiotic use and antibiotic resistance can eventually affect an entire community. Medical errors such as irrational use of antibiotics nowadays bringing us to the crisis state of multidrugresistance. This circumstance similar to the pre-antibiotic era, which many of infection growing tend to lethal and no antibiotic developed withstand it. (1–3) In 2013, over 480.000 new cases of MDR-TB (Multidrug-resistant Tuberculosis) were reported worldwide. (4) To prevent and raise the awareness against antibiotic resistance, WHO released a policy of Combat Drug Resistance, which is include monitoring of antimicrobial resistance and use, the rational use and regulation of antimicrobials, antimicrobial use in animal husbandry, infection prevention and control, and the nurturing of innovation and political commitment. (5,6) Antibiotic resistance itself is a change in the ability of bacteria to become resistant to antibiotics. Antibiotic resistance caused by irrational or waywardness use of antibiotic drugs, easy access and misunderstanding of antibiotic use, poor hygiene and sanitation of healthcare, and false use of antibiotic exceeds the maximum allowed doses as growth promotor in animal food and livestock sector. (7) Prevalence of antibiotic resistance increasing year to year. Based on CDC (Centers for Disease Control and Prevention) survey in USA, 2 million of people were infected by bacteria that resistance to one or more antibiotic and 23.000 of people death by resistant bacteria infection every year (2013). In Indonesia, antibiotic resistance rates show high numbers in inpatients against ampicillin (49%), cotrimoxazole (43%), and chloramphenicol (30%). While in outpatients show higher numbers against ampicillin (66%), cotrimoxazole (52%), methicillin (46%) and chloramphenicol (39%) (Kemenkes, 2005). The World Health Organization has also classified antimicrobial resistance as a serious threat’ to every region of the world which ‘has the potential to affect anyone, of any age, in any country. (8) Remembering no new classes of antibiotic was approved since 1980. Many of the world’s most important antibiotics (ex: streptomycin and tetracycline) were discovered in soil/other natural environments and easily cultured, but the same types of compounds finded over and over again because 99 percent of won’t grow under normal (standard) laboratory condition. (2,3) Beside the traditional bacterial culture, synthtetic biology based on genomics also has failed so far to come up with efficient strategies to developing molecules for specific bacterial target molecules. (9)

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The use of computer technology to creating a suitable natural condition for soil-bacteria culture has been developed by Northeastern University-Boston by the invention of iChip. It was a step forward to developing new antibiotic drugs against resistance. Teixobactin was one of 25 molecules that successfully developed and pass a validation. (3,10) Teixobactin has been found to treat many common bacterial infections and the scientists believe that bacteria will not become resistant to Teixobactin for at least 30 years because of its multiple methods of attack. This new discovery offers hope that many new antibiotics could be found to fight bacterial infections. (8) Objectives 1.

Finding a new way (antibiotics) to prevent, avoid, and solve antibiotic

resistance in community. 2.

Using technology to design a new antibiotics and understand how a powerful

antibiotic substance is made in nature 3.

Providing new way to tap into secondary metabolites (microbial dark matter)

from bacteria that won’t grow under standard laboratory conditions. II. Methods Search strategy and criteria for selecting articles A systematic literature study search was conducted with databases in Proquest, Medline, Google Scholar and EBSCO for articles published between 20011 until 2016. We used the following terms in the search field: Teixobactin AND [Antibiotic Resistance] and Antibiotic resistance AND [Public Health], Biotechnology AND [Teixobactin]. The search results were downloaded into a personal database. The results from all four databases were then combined, and duplicate publications were eliminated. Inclusion criteria The inclusion criteria used in this literature study were the following: (1) study representing antibiotics resistance as a public health issue and the most current technology / biotechnology developed to solve the antibiotic resistance issue and (2) the use and benefit of teixobactin (3) the synthesis and chemical structure of teixobactin, (4) and current research about the future implication and future use of teixobactin. The results from the literature study search were first reviewed by reading the titles and abstracts by an independent reviewer. The relevant studies were further checked by reading the full texts and assessed for inclusion.

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Review methodology The review team was recruited from the AMSA UAJ. Citations were included if they met criteria listed above resulting in a preliminary set of 25 potentially relevant publications. The full text articles were electronically distributed to the review team along to be summarized. Three reviewers extracted information independently related to study design, study population, interventions, outcome measures, methods, results, and conclusions for each article. Results were compared and reevaluated in group sessions until consensus was obtained between reviewers. The final analysis included 25 articles, which met the criteria for the present literature study. Primary outcomes and data extraction The primary outcome used in this literature study was the technology used to solve the current antibiotic resistance issue, the discovery and origin of teixobactin, teixobactin chemical structure, in-vitro and in-vivo study of teixobactin, the future use of teixobactin in humans. The data were extracted from the included studies; the main information included first author’s name, publication year, methods of research, research and study result, and overall conclusion about teixobactin. III. Result Technology Invented to Find a Solution for Antibiotic Resistance Isolation chip or commonly known as iChip is a multichannel device, that is used to simultaneously isolate and grow uncultured bacteria. (11–13) The iChip utilizes a system of hundreds of miniature diffusion chambers, each loaded with a single cell. It is made of a central hydrophobic plastic poloxymethylene (POM) plate with an array of holes 1mm in diameter. The POM can handle temperatures up to 170°C and can be autoclaved for sterilization. The thermoplastic structure has low water absorption and is resistant to mechanical abrasion. (2) Moreover, the assembly and disassembly of an iChip takes under 5 minutes making it usable for massive in situ cultivation of environmental microorganisms. In addition, it is able to culture microorganisms (in isolation from another) from soil that had not been able to be cultured in vitro previously. (14,15) (Figure 1) The myriad tiny agar-filled chambers of the iChip were first seeded with dilutions of soil containing approximately one bacterium per chamber and were then covered with a semipermeable membrane and placed back into the soil, permitting nutrients and waste products to diffuse into and out the chambers. The semipermeable membranes are polycarbonate membranes (pore size of 0.03μm), which are applied to both sides of the central plate to prevent cell migration. (16)

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Diffusion of nutrients and growth factors through the chambers enables growth of uncultured bacteria in their natural environment. Once a colony is produced, a substantial number of uncultured isolates are able to grow in vitro.14. Extracts from 10,000 isolates obtained by growth in iChips were screened for antimicrobial activity on plates overlaid with Staphylococcus aureus. (17) The diffusion system allows the cells on the iChip interact with naturally occurring nutrients and environmental factors. This technique has been demonstrated to yield a higher number of novel microorganisms compared to traditional petri-dish methods (50% vs. 1%). (11–13)This iChip device resulted in isolation of teixobactin (previously uncultured) from a soil microorganism that unable grow in test tube.(2,10) Discovery and Origin of Teixobactin As up to 99% of environmental bacteria are uncultured and are potentially untapped reservoir of novel compounds. By using iChip device, bacteria can then be grown in situ as they have access to the nutrients and growth factors present in their natural environment. (18) With the device, the researchers then found a new species of the Gram-negative beta-proteobacteria, named Eleftheria terrae that showed promising inhibitory activity against the Gram-positive pathogen Staphylococcus aureus. (19,20) By using DNA fingerprinting, this organism was identified belong to a new genus related to Aquabacteria. This group of Gram-negative organisms is not known to produce antibiotics. Determined by mass spectrometry, a partially purified active fraction contained a compound with a molecular mass of 1,242 Da, which was not reported in available databases. The compound was isolated and undergoes a complete stereo-chemical assignment. The molecule was called teixobactin, an 11-amino acid peptide antibiotic coded by nonribosomal peptide synthetases Txo1 and Txo2. Teixobactin was proved that it has potent bactericidal activity against Gram- positive pathogens including multidrug-resistant strains (MDR) and also highly effective against Mycobacterium tuberculosis. (3,13,17) Teixobactin Chemical Structure Teixobactin is a depsipeptide, which contains enduracididine, methylphenylalanine, and four D-amino acids. (Figure 2) Enduracididine (Figure 3) is a rare component of amino acid in teixobactin leading to synthetic approaches to developing new drug by cyclic guanidine synthetic routes. L-allo-enduracididine (analogue of teixobactin) residue was find important for potent antibacterial activity, because when substituted for L-arginine, it has 10-fold reduction in activity. It consists of two large non-ribosomal peptide synthetase (NRPS)coding genes, which named txo1 and txo2. Teixobactin strongly inhibited synthesis of peptidoglycan, but had essentially no effect on label incorporation into DNA. (14,21–23)

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In - vivo and In - Vitro Study of Teixobactin In in-vitro studies, it were unable to obtain mutants of S. aureus or M. tuberculosis resistant to teixobactin even when plating on media with a low dose of the compound. Serial passage of S. aureus in the presence of sub-minimum inhibitory concentration (MIC) levels of teixobactin over a period of 27 days failed to produce resistant mutants as well. (23) Also, no teixobactin-resistant S. aureus or M. tuberculosis was isolated at four times the MIC. Resistance that has not been developed to this compound shows that the target is not a protein. (Figure 4) Teixobactin specifically interacts with the peptidoglycan precursor, rather than interfering with the activity of enzymes. Teixobactin was found active against vancomycinresistant enterococci that have modified lipid II (lipid II-D-Ala-D-Lac or lipid II-D- Ala-D-Ser instead of lipid II-D-Ala-D-Ala). (4,13) This suggested that, unlike vancomycin, teixobactin is able to bind to these modified forms of lipid II. Lipid II is a peptidoglycan precursor molecule contained by almost all bacteria, important in organizing cytoskeletal proteins and peptidoglycan synthesis machineries. There is 4 classes of compounds target Lipid II: (i) glycopeptides (ex: vancomycin), (ii) unmodified peptides (ex: defensins); (iii) lantibiotics (ex: nisins); (iv) depsipeptides (ex: teixobactin). Teixobactin was discovered very stable, low toxicity, and most promising antibacterial compounds compared among them in the last three decades. (11,14–16,24) Moreover, teixobactin efficiently bound to the wall teichoic acid (WTA) precursor undecaprenyl-PP-GlcNAc (lipid III). Although WTA is not essential, inhibition of late membrane-bound WTA biosynthesis steps is lethal due to accumulation of toxic intermediates. Furthermore, teichoic acids anchor autolysins, preventing uncontrolled hydrolysis of peptidoglycan. Co-inhibition of lipid II and lipid III by 
 teixobactin causes a pronounced weakening of the cell wall compared to lipid II inhibition alone. This results in increased delocalization of autolysins leading to cell lysis and death. (4,23,24) Teixobactin simultaneously inhibit peptidoglycan and teichoic acid biosynthesis triggers synergistic effects, resulting in increased cell wall damage, delocalization of autolysins, and subsequent lysis and cell death. (19) Inhibition of teichoic acid synthesis by teixobactin would help liberate autolysins, contributing to the excellent lytic and killing activity of this antibiotic. Teixobactin is also likely to bind to prenyl-PP-sugar intermediates of capsular polysaccharide biosynthesis, which is important for virulence in staphylococci. For teixobactin and M. tuberculosis, it probably binds to decaprenyl-coupled lipid intermediates of peptidoglycan and arabinogalactan. (17) Teixobactin showed potent bactericidal activity against gram-positive pathogens, with minimal inhibitory concentrations of 0,5 ug per milliliter. (11,14,16) Teixobactin produce no resistance against target pathogens, because its mechanism of binding to less mutable fatty

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molecule of bacterial cell (Unusual antibiotic mechanism; usually binds to relatively mutable proteins in bacterial cell). Teixobactin molecule has a strong activity against Gram-positive bacteria (S. aureus, M.tuberculosis, Enterococci, C.difficile, B.anthracis, S.pneumonia, MRSA, Vancomycin Intermediate S. aureus (VISA), Vancomycin – resistant enterococci (VRE)) but didn’t effective against Gram-negative bacteria. Teixobactin does not bind mature peptidoglycan and hence it is capable of effectively targeting vancomycin intermediate resistant (VISA) strains that have increased cell wall density. (2,3,23) Teixobactin induced lysis is dependent on the Atl autolysin Teixobactin has been shown to have excellent bactericidal activity against S. aureus. The effect on cell morphology, of teixobactin and vancomycin after 4 hours exposure at 10 x MIC by electron microscopy. Exposure to teixobactin results in collapse of the cell wall while 
 vancomycin damage to the cell wall was less severe. (19) (Figure 5) Teixobactin was in vitro tested to had no toxicity against mammalian NIH/3T3 and HepG2 cells at 100 mg/ml 21 (the highest dose tested). The compound showed no hemolytic activity and did not bind to DNA, RNA, and protein. The compound retained its potency in the presence of serum, was stable, and had good microsomal stability and low toxicity. (13) The pharmacokinetic parameters determined after i.v. injection of a single 20 mg per kg dose in mice were favorable, as the level of compound in serum was maintained above the MIC for 4 h and showed good efficacy as well. Another animal efficacy study was also performed in a mouse septicemia model infected intra-peritoneally with methicillin-resistant S. aureus (MRSA) at a dose that leads to 90% death. One hour post-infection, teixobactin was introduced through IV administration at variable single doses (1- 20 mg/kg). The results of the septicemia model were very encouraging with a PD50 (protective dose at which half of the animals survive) of 0.2 mg/kg compared to the 2.75 mg/kg PD50 of vancomycin. (13,17) (Figure 6) Future use of Teixobactin Teixobactin had excellent activity against Gram-positive pathogens, including drug-resistant strains. Potency against most species, including difficult-to-treat enterococci and M. tuberculosis was below 1 mg/ml. Teixobactin was exceptionally active against Clostridium difficile and Bacillus anthracis (minimal inhibitory concentration (MIC) of 5 and 20 ng/ml, respectively). Teixobactin had excellent bactericidal activity against S. aureus and was superior to vancomycin and retained bactericidal activity against intermediate resistance S. aureus (VISA). Although, teixobactin was ineffective against most Gram-negative bacteria. (17)

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Teixobactin showed promising in vivo activity, resulting in a substantial reduction in bacterial burden in mice infected with methicillin-resistant S. aureus or Streptococcus pneumonia. (18) In vitro studies above revealed that the antibiotic inhibits peptidoglycan synthesis by targeting the peptidoglycan precursor lipid II and the cell wall teichoic acid precursor lipid III. This explains why teixobactin is ineffective against Gram-negative bacteria, as they lack teichoic acids and have an outer membrane that shields peptidoglycan. Result from the teixobactin discovery above that it was extracted from a type of Gram-negative bacterium (E. terrae) so the antibiotic cannot, naturally, be effective against Gram-negative microorganisms. (14) The targeting of lipids rather than proteins is less likely to select for resistance as protein-encoding genes can evolve mutations that block the binding of antibiotics more readily. The absence of resistant mutants of Staphylococcus aureus and M. tuberculosis after prolonged exposure of teixobactin in sub-lethal concentration, have generated immense interest on its development and introduction for clinical use. (18,23) It has been found effective in sepsis, pneumonia and soft tissue infection in animal model with a very low PD50 (50% protective dose) for MRSA in comparison to Vancomycin. Since it has no deleterious action against mammalian cells due to lack of target sites and not been found to cause serious toxicity, hemolysis or DNA damage, it is likely to have wide therapeutic window. (23) IV. Discussion Due to the unregulated use of antibiotics in agriculture, overuse in medicine, and abundance in everyday products, we expose microorganisms in the environment to a variety of antibiotics. And all of these exposures lead to high number of cases of antibiotic resistance. Many forms of resistance are dependent on enzyme action; those microbes with resistance pass the genes encoding for the enzymes to the next generation, and so forth. Resistance development limits the useful lifespan of antibiotics and results in the requirement for a constant introduction of new compounds. However, antimicrobial drug discovery is uniquely difficult. One of the current solutions for this continued medical success despite the growth of resistance has been the continuous development of new classes of antibiotics, which have different mechanisms of action. Bacterial infections that have developed resistance to one or multiple classes of antibiotics can still be treated by using antibiotics with a different mechanism of action, either alone or in combination with other antibiotics.

The new strategy had a major focus of measuring outcomes

alongside an innovative combination of policy approaches to stimulate research and development, improve surveillance, prevent and control infection, optimize antimicrobial use and relay key antibiotic resistance messages to public and professional audiences.

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The scientific case was apparent: the burden of drug-resistant infections was increasing with no new antibiotics in the pipeline. (25) The lack of novel compounds, coupled with the emergence and spread of antibiotic resistance has resulted in an increasingly dangerous situation. One approach to discover novel antibiotics is to improve our ability to cultivate microorganisms that produce them. Traditional culturing methods allow access to an estimated 1% of the biodiversity in soil. A novel cultivation technique, using an iChip, provides access to an untapped reservoir of natural product antibiotics. One of the result from this device is a new cell wall inhibitor, teixobactin, discovered from a screen of uncultured bacteria grown in diffusion chambers in situ. (17,19) This literature study suggests that new organisms such as uncultured bacteria are likely to harbor new antimicrobials. Teixobactin is a promising therapeutic candidate. Teixobactin is the first member of a new class of lipid II binding antibiotics, structurally distinct from glycopeptides, lantibiotics and defensins. The properties of teixobactin suggest that it evolved to minimize resistance development by target microorganisms. It is effective against drug-resistant pathogens in an animal model of infection. Binding of teixobactin to WTA precursor contributes to efficient lysis and killing, due to digestion of the cell wall by liberated autolysins. Polyprenyl-coupled cell envelope precursors, such as lipid II, are readily accessible on the outside of gram-positive bacteria and represent an ‘Achilles heel’ for antibiotic attack. (14,17) Although the discovery of teixobactin shows a new hope for antibiotic resistance, teixobactin still a long way from the clinic and has to undergo a series of rigorous human clinical trials before reaching the pharmacy shelves (years). Recently, teixobactin only on two years of human trial (in 2015), needs confirmation over 5-6 years, but shows potent killing against bacterial pathogen including MRSA and VRE (vancomycin resistant enterococci. (3,14) Teixobactin resistance difficult to manufacture in lab, but could possibly happen in the same pattern as resistance of Vancomycin; it is self-resistance vector from vancomycin drug captured by pathogenic bacteria through horizontal gene transfer. But E.terrae doesn’t carry genes for resistance like vancomycin producing bacteria. (3) V. Conclusion Developing potential anti-microbes molecule using “iChip”, a multichannel device that could create a suitable original environment for soil-bacteria culture is proven beneficial. iChip as a new way for discovering new natural antibiotics from isolation of soilmicroorganism’s compounds, such as teixobactin. Teixobactin is the first member of a new class of lipid II binding antibiotics, structurally distinct from glycopeptides, lantibiotics, and defensins. The properties of teixobactin suggest that it evolved to minimize resistance development by target microorganisms. It is likely that additional natural compounds with similarly low susceptibility to resistance are present in nature and are waiting to be discovered.

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Although, for teixobactin to become a drug to treat infections in people, clinical trials will need to be carried out to make sure that the drug is safe, well tolerated and efficacious. To do this, teixobactin will need to be formulated so that the antibiotic remains active in vivo at clinically relevant sites of infection. Full toxicology tests will also need to be carried out to ensure that there are no adverse reactions or drug – drug interactions following administration of teixobactin. Teixobactin had excellent bactericidal activity against S. aureus, was superior to vancomycin and retained bactericidal activity against vancomycin intermediate S. aureus (VISA). Moreover, as teixobactin is active against M. tuberculosis, it could offer the opportunity for a new treatment for patients with TB. References 1.

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Tables and Figures Figure   1. Models and Diagram of Isolation Chip or iChip

Figure 2. Chemical Structure of Teixobactin

Figure 3. Structure of the Enduracididine Family of Amino Acid

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Figure 4. Teixobactin In-Vitro Studies

 

(a) and (b) Time dependent killing of pathogens by teixobactin compared to other antibiotics (c) Teixobactin treatment resulted in lysis (d) Resistance acquisition during serial passaging in the presence of sub-MIC level of antimicrobials. The y axis is the highest concentration of the cells grew in during passanging. For ofloxacin, 256 x MIC was the highest concentration tested.

Figure 5 Electron Scanning Result for Teixobactin Activity Compared to Others

Figure 6 Mice Model in Vivo Studies of Teixobactin

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Indonesian Medical Students’ Training & Competition (IMSTC) 2017 Expanding the Implementation of Safety Checklist to Reduce Medical Errors and its Further Application in Indonesia  

Angga Wiratama LokeswaraI, Alice TamaraI, Valdi Ven JapranataI IFaculty

of Medicine, University of Indonesia Abstract

In 2013, medical error was the third leading cause of death and accounted for 251,454 deaths in United States alone. Nevertheless, medical errors are the common problem occurring in healthcare services globally. The review has set out 3 main objectives: (1) To review the effectiveness of WHO Surgical Safety Checklist and WHO Safe Childbirth Checklist; (2) To identify the principle characteristics of safety checklist in reducing medical errors; and (3) To analyze the further application of the safety checklist for Indonesian healthcare. We performed the search through PubMed, EBSCO, Clinical Key, and Science Direct, and reviewed 8 studies on the effectiveness of the current WHO Checklists, and 23 other literatures to explore safety checklist for expansion and further application in Indonesia. Out of 8 studies reviewed, 6 of them shows reduce rates of mortality and morbidity due to complication of medical intervention in WHO Surgical Safety Checklist (mortality rate reduce to 0.8% <P=0.003>, complication reduces to 7.0% <P<0.001>) and Safety Childbirth Checklist (decrease the mortality and morbidity rates up to 15.3% <80% power and alpha value: 0.05>). This shows that safety checklists can reduce possible medical errors. There are also 7 identified principle characteristics of safety checklist which help in reducing medical errors. Amongst them are the provision of time for briefings and debriefings, safety standardization, verbal confirmation, alteration of both the system and the physician in managing care, cost-efficiency and time-efficiency, opportunities for better communication, and brevity for modification. These principles will be important when expanding safety checklists for various medical services in the future. Despite the limited data on the effectivity of the checklists in Indonesian settings, studies on countries of similar characteristics support their application in Indonesia. Implementation of surgical safety checklist has been going on through Health Minister Decree No. 1691 on Hospital Patient Safety. However, the real challenge will be to ensure nation-wide adherence, including in its rural places. The WHO Safe Childbirth Checklists will also be particularly useful for Indonesia to help lessen the high childbirth-related maternal and neonatal mortality. By overcoming the current limitations and expanding new checklists for various medical services, the implementation of safety checklist can significantly improve the quality of healthcare services by minimizing avoidable medical errors, to hopefully save millions of patients and their families from unfortunate harm.

22

Indonesian Medical Students’ Training & Competition (IMSTC) 2017 Expanding the Implementation of Safety Checklist to Reduce Medical Errors and its Further Application in Indonesia Angga Wiratama LokeswaraI, Alice TamaraI, Valdi Ven JapranataI IFaculty

of Medicine, University of Indonesia

I.Introduction Medical errors are the common problem occurring in healthcare services globally. These errors incur high costs in terms of resources, and pose increasing risks to patient safety, many of which result in complications, hospitalization, disability, and death. In 2013, medical error was the third leading cause of death and accounted for 251,454 deaths in United States.1 It is also known that medical errors are estimated to cost about US$17-billion until US$29-billion per year due to lost household production, lost income, and additional health care costs.2 In developing countries, 5-15% of hospital admissions were caused by medical errors.3 Medical errors are believed to stem from several factors including lack of patient engagement in the process of care, neglected medication safety, ineffective communication among healthcare workers and in the healthcare worker-patient relationship, and unassured up-to-date standard operating procedures and training.3 Among these factors, lack of proper guidelines and training is probably the major cause of medical errors in Southeast Asian countries. A study on Southeast Asian healthcare also points out that amongst others, misinterpretation of medication/ prescription chart and heavy workload are considered to be contributing factors of medical errors.4 As medical errors are primarily caused by behavior of the healthcare workers, it is to be noted that many of them are actually preventable. Healthcare institutions should optimize their efforts to curtail avoidable medical errors. Currently, in Indonesia, efforts are being done to reduce medical errors by promoting a policy of “patient comes first”. However, this is hurdled by many obstacles such as inadequacy of health specialist and multiple responsibilities taken up by Indonesian medical practitioners.5 Therefore, other means to limit medical errors to achieve high quality of healthcare service is imperative. Furthermore, In Indonesia, one indicator of the poor healthcare quality is the high rate of childbirth-related maternal and neonatal mortality, in which medical errors may have some contribution in it. the latest data have shown that the childbirth-related maternal death in 2012 was 359 per 100,000 births, and neonatal death in the same year was at 19 per 1000 births.6

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With regards to these problems, early detection and prevention of potential error by
 utilization of safety checklist may offer significant benefit to prevent medical errors in procedures like surgery and childbirth. In 2008, World Health Organization released its first Surgical Safety Checklist.7 Since then, safety checklist in various other forms have emerged, such as the more recently published WHO Safe Childbirth Checklist (pilot edition).8 These safety checklists prove to be helpful in ensuring that all safety checks have been performed before proceeding to the next step of any medical procedures which may impose potential harm to the patients, such as surgery and childbirth procedure.9 In Indonesia, in particular, WHO Surgical Safety Checklist have been implemented in some hospitals, although its compliance and widespread distribution are still questionable. The WHO Safe Childbirth Checklist also has a great potential to be implemented in Indonesia to help lessen the burden of maternal and neonatal mortality.10 Therefore, this review has 3 main objectives: (1) To review the success of the implementation of WHO Surgical Safety Checklist and WHO Safe Childbirth Checklist in different countries and different settings; (2) To identify the principle characteristics of safety checklist and hence its potential for wider application in medical services; (3) To analyze the further utilization of the safety checklist for Indonesian healthcare. II.

Methods

We explored the implementation of safety checklist by searching through PubMed, EBSCO, Clinical Key, Science Direct, restricting the studies published in the years of no later than 2007 with focus on studies published after 2012. Our major references include materials published by World Health Organization which focus on the WHO Surgical Safety Checklist (First Edition) and its implementation guideline, as well as WHO Safe Childbirth Checklist (pilot edition) along with its implementation guideline. Our search terms include “medical errors”, “safety checklist”, “WHO Surgical Safety Checklist”, “WHO Safety Childbirth Checklist”, cross-referenced with terms such as “effectiveness”, “reduce mortality”, “patient safety”, which eventually lead us to 31 references, five studies of which reviewed in detail to evaluate the effectiveness of WHO Surgical Safety Checklist, three studies of which reviewed in detail to evaluate the effectiveness of WHO Safe Childbirth Checklist, and others were used to review their potential expansion and further application, specifically in Indonesia. A systematic diagram of our method can be found in Figure 1.

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Figure 1 Systematic diagram showing the methods involved in reviewing the literatures.

III.Results and Discussion 1)The success of the implementation of WHO Surgical Safety Checklist In 2008, World Health Organization released its first Surgical Safety Checklist with two main objectives: (1) ensuring consistency in patient safety; (2) introducing (or maintaining) a culture that values achieving it. The checklist introduces 3 checkpoints, each corresponds to a specific period of time in each surgical procedure, in which the team has to pause and verbally confirm that the items in the checklist before proceeding to the next step. The three points are Sign In (before induction of anesthesia), Time Out (before the first surgical incision, and Sign Out (during or immediately after wound closure, but before removal of patient from the operating room). The checklist has been constructed based on existing evidence and expert opinions, representing the steps whose omission can potentially cause significant but preventable surgical errors, without imposing high cost. It is hoped that that the checklist can minimize common medical mistakes which can be easily avoided, hence ensuring patient safety and ultimately improving quality of healthcare. 11

The WHO Surgical Safety Checklist can be found in Annex 1.

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  We reviewed 5 recent studies in detail and these studies conducted to evaluate the effectiveness of Surgical Safety Checklist have shown satisfactions regarding the decreased level of mortality and morbidity rate, suggesting that it is a fairly simple and cost-efficient method of ensuring safety.9,12,14-16 The detailed review can be found in Table 1. Haynes et al. (2009) stated the use of this checklist in clinical settings can reduce the rate of postoperative complication by 36% and surgical-site infection by 33-38%.9 This fact correlates with the increased reliability of routine interventions such as antibiotic prophylaxis12 and thromboembolic prophylaxis.13 Furthermore, several studies also point out the importance of the checklist as a means of enhancing the awareness of surgical teams regarding patient-related issues, procedure, and expected risks. 2)The success of the implementation of WHO Safe Childbirth Checklist In line with WHO’s efforts to improve maternal and child health, WHO has also implemented checklist-based safety improvement into childbirth and released WHO Safe Childbirth Checklist (pilot edition) in 2015. The checklist has 4 checkpoints, which are On Admission, Just Before Pushing, Soon After Birth, and Before Discharge.17 This checklist has a great potential to help many healthcare workers, especially in developing countries which may still be struggling to reduce maternal and neonatal mortality and morbidity. The WHO Safe Childbirth Checklist can be found in Annex 2. We reviewed 3 recent studies evaluating the use of the WHO Safety Childbirth Checklist.18-20 The detailed review can be found in Table 2. In general, they show that the checklist can reduce the rate of stillbirth20 and decrease incidence and mortality caused by complications for both mothers and newborns.19 These accomplishments can be achieved as the checklist provide better quality assessments required for complication detections which can avoid referral delay.19,20 Nevertheless, team leaders’ active participation and clear individual understanding are also needed to maintain the quality of SCC use in clinical settings. Thus, increasing the such factors influencing the implementation effectiveness as provider competency and motivation.18,19 Furthermore, Kumar et al. (2016)19 also stated that adequate human resource are required for such supportive service aspects as Family Planning in the checklist; making motivation, competency, and availability of essential commodities (e.g. human resource and equipment) essential for the effectiveness of checklist implementation.

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Table 1 Detailed review on the effectiveness of WHO Surgical Safety Checklist

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Table 2 Detailed review on the effectiveness of WHO Safe Childbirth Checklist

3) The principle characteristics of safety checklist in reducing medical errors Although the numbers and statistics of various studies have shown promising results in reduction of surgical complication, the exact mechanism of the reduction is not clear. There are, however, principle characteristics of the checklist which can fairly support the findings: 1.

By using the checklist, the surgical team has to introduce pauses, before and

after the surgery to ensure that safety measures are not overlooked. This will help to avert preventable errors that can possibly occur during the surgery. The pauses also allow some time for briefings and debriefings, which constitute team practices associated with enhanced safety and reduced complications of up to 80%.9 2.

The checklist also helps to standardize safety in patient care. This also means

that the health workers rely less on memory, hence preventing errors of omission. This is especially important as the medical procedures are often complex and often timelimited.21 3.

With the checklist, the team also performs verbal confirmation of the key steps

and procedures, instead of assuming that other member of the team has completed their every responsibility. Therefore, oral confirmation can increase adherence rate, and this alone has been proven to lower surgical-site infection rate.9

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  4.

The implementation of checklist does not only alter the behavior of the

medical personnel, but also the system of the healthcare services for the betterment of patient’s safety.9 This intervention is an example of improving quality of care through managing the delivery of healthcare and engaging clinicians in the process, instead of solely expecting physicians to be flawless and accurate without intervention in the process of care. 5.

The checklist also proves to be a cost-efficient and time-efficient measure in

reducing complications and ensuring safety. It is a readily available, one-page checklist which has been made briefly. This increases the feasibility of widespread implementation, hence broadening the potential impact of this fairly simple intervention.9,12 6.

The pauses made also provide opportunities for better communication

between the team. A doctor may be essential to the team, but is not the only one responsible for patient care. Therefore, en effective communication must be established between members of the team, so that the procedure can run smoothly. Poor communication among team members has been identified as one of the common problem during surgery. The checklist creates an environment where communication is encouraged, allowing teamwork to be performed effectively.9 7.

The brevity of the checklist also allows for modification to the preexisting

local practice and to the procedures routinely performed in specific setting. This increases the flexibility of the checklist for usage in various settings.22 Tailoring of the checklist by clinicians has also been known to enable greater ownership and participation, hence encouraging successful implementation.23 We believe that these are the essential aspects of the checklist, which can be retained although implemented in various, non-surgical conditions. One example is the WHO Safe Childbirth Checklist which has been published and implemented in a few countries. Other studies have also explored into using Ward Round Safety Checklist24 and Surgical Patient Safety System (SURPASS) which looks into surgical patient safety from admission to discharge25, safety checklists for cataract surgery, Caesarean section and endoscopy.26,27 It seems that the use of safety checklist has the real potential to be cost-efficient and effective method to further ensure patient’s safety in various medical services. This potential is worth exploring and investigating in the future.

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  Further application of safety checklist in Indonesian Healthcare 4) Even though there is lack of studies evaluating the effectiveness of the checklist, these results can still support their application in Indonesia as countries of similar characteristics like Filipina and India are included in the studies. However, its implementation must be cautioned with recommendations made by the previous studies. Gillespie and Marshall23 stated that the implementation of surgical safety checklist can be done by these mechanisms: active leadership, support strategies, simplification process, and checklist reflection. Similarly, WHO Safety Childbirth Checklist can also be implemented by the same mechanisms as the WHO Surgical Safety Checklist as both of them are safety checklist with similar factors affecting them. In fact, the Indonesian government has also encouraged the use of the surgical safety checklist through Health Minister Decree No. 1691 on Hospital Patient Safety.28 Nevertheless, as the study published by Sandrawati, et al. suggests, compliance rate to the Surgical Safety Checklist is still low.10 Despite the nation-wide legal enforcement, what remains a big challenge for Indonesia is ensuring that these checklists are implemented in hospitals and other healthcare facilities throughout the country, not only in well-known hospitals in big cities which are more likely to hire more experienced physicians, with better equipment. Concerns should be put to healthcare facilities in rural areas of Indonesia where surgical procedures become riskier. While very limited data are available on the number of medical errors in Indonesia (which in itself a problem to be addressed), it is still worthwhile to work towards country-wide application of these checklists. The more relevant checklist, in this case, will be the WHO Safe Childbirth Checklist. This is considering the existing high maternal and neonatal mortality rate in Indonesia. The latest data shows that the childbirth-related maternal death in 2012 was 359 per 100,000 births, and neonatal death in the same year was at 19 per 1000 births.6 In rural places, where healthcare facilities are limited, most of childbirth are handled by local midwives with some of them not medically trained. Only 88.7% births are handled by medical personnel and in the most rural place the number can reach 44.7%.6 The checklist, if implemented appropriately, has the potential to help mothers having childbirth in non-ideal conditions, to be have a safe delivery. However, apt translation and modifications have to be made, and education needs to be widely performed. Legal enforcement and local hospital regulations should also be firmly established to show that these measures are supported by stakeholders, hoping to increase its adherence rate.

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5) Challenges of the safety checklist Nevertheless, there are some limitations to the studies who have found success in   implementation of the checklist. There may be Hawthorne effects, which are the the consequences of the awareness of being observed.29 These effects are hardly avoidable in these circumstances, as the checklist coordinator has to read out loud the safety checks in the process. In practice, there are also challenges in the implementations. In the UK for instance, some clinicians resist the introduction to the checklist due to cultural and professional hierarchies, also some denial that some steps might be forgotten in routine procedures.26 In other places, some practitioners felt that the checklist is timeconsuming, although there is little evidence to support this claim.30 Although some may value the brevity and flexibility of the checklist, others complained of the lack of details and comprehensiveness.31 There has also been concerns that the list may give a false sense of security that all problems have been avoided.31 6) Future Studies Regarding the current checklists, studies must be done on how to minimize the current barriers which may limit the performance of the checklist. More studies should also be performed on the effectiveness of checklist implementation compared to the time spent in different settings, especially in urgent cases. Looking at the success of the current WHO checklists, the use of safety checklist should be expanded to varying clinical settings by constructing more safety checklists for various medical procedures or services. As for its further application in Indonesia, the first step will be to improve data consolidation as there is now very limited data regarding medical errors despite its importance to become a major indicator of quality of healthcare. Indonesia also needs to broaden the implementation of safety checklists even to the most rural places of Indonesia. WHO Safe Childbirth Checklist will be especially useful for many birthing places in Indonesia. Lastly, Indonesian clinicians should be more proactive in designing safety checklists for their practices and ensuring its adherence. IV. Conclusion With the currently high number of avoidable medical errors with their significant potential harm, the review has set out 3 main objectives: (1) To review the effectiveness of WHO Surgical Safety Checklist and WHO Safe Childbirth Checklist; (2) To identify the principle characteristics of safety checklist in reducing medical errors; and (3) To analyze the further application of the safety checklist for Indonesian healthcare. We have therefore come up with a framework of idea as can be seen in Figure 2.

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Figure 2 Framework of idea as conclusion to the review

In reviewing the effectiveness of WHO Surgical Safety Checklist and WHO Safe Childbirth Checklist, we find that these safety checklists have been proven to reduce mortality and morbidity rates due to complication of medical intervention, such as surgery, antibiotic prophylaxis, and newborn delivery. Out of 8 studies reviewed, 6 of them shows reduced rates of mortality and morbidity due to complication of medical intervention in WHO Surgical Safety Checklist (mortality rate reduces to 0.8% <P=0.003>, complication reduces to 7.0% <P<0.001>) and Safety Childbirth Checklist (decreasing the mortality and morbidity rates up to 15.3% <80% power and alpha value: 0.05>). Thus, compliance and implementation of safety checklists enhance the health service by reducing possible medical errors in clinical practices. There are 7 identified principle characteristics of safety checklist which help in reducing medical errors. These include: (1) introduction of pause which give time for briefings and debriefings; (2) standardization of safety by preventing errors of omission; (3) verbal confirmation which increases adherence rate; (4) alteration of both the system and the physician in managing quality of care; (5) cost-efficiency and time-efficiency hence increasing feasibility for widespread use; (6) opportunities for better communication to enhance teamwork; and (7) brevity of the checklist which allows room for modification and tailoring. We believe that these are the principles which needs to be retained in constructing other safety checklists for various medical services in the future

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  As for its further application in Indonesia, despite the limited data on the effectivity of the checklists in Indonesian settings, studies on countries of similar characteristics support the idea of their application in Indonesia. In fact, the Indonesian government has encouraged the use of the surgical safety checklist through Health Minister Decree No. 1691 on Hospital Patient Safety. However, the real challenge will be in ensuring its adherence throughout the whole country, including in its rural places. Escalated efforts need to be put in for education, training and monitoring in these places. We also believe that the recently published WHO Safe Childbirth Checklists will be particularly useful for Indonesia to help lessen the high childbirth-related maternal and neonatal mortality. In order to improve its application in Indonesia, data collection and further modification and tailoring are imperative. By overcoming the current barriers and expanding new checklists for various medical services, we believe that the implementation of safety checklist can significantly improve the quality of healthcare services in many different settings by minimizing avoidable medical errors. It is hoped that the safety checklist can pronouncedly save millions of patients and their families from unfortunate harm.

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Ava i l a b l e f ro m : h t t p : //www.w h o. i n t /p a t i e n t s a fe t y/s a fe s u rg e r y/to o l s _ re s o u rce s / SSSL_Checklist_finalJun08.pdf 8.

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safety checklist to reduce morbidity and mortality in a global population. N Engl J Med.; 360(5): 491-9. 10.

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implementation compliance of surgical safety checklist in surgery rooms. Buletin Penelitian Sistem Kesehatan [Internet]. 2013 [cited 5 January 2017]; 17(1): 71-9. Available from: ejournal.litbang.depkes.go.id/index.php/hsr/article/view/3577/3534 11.

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Edition). 2008. Available from: http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Manual_finalJun08.pdf 12.

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antibiotics for knee arthroplasties: Improving the routines in Sweden. Patient Saf Surg [Internet]. 2011;5(1):22. Available from: http://www.pssjournal.com/content/5/1/22 13.

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debriefing and multidisciplinary feedback improves venous thromboembolism prophylaxis in thoracic surgery: A prospective audit. Eur J Cardio-thoracic Surg. 2012;41(6):1326–9.

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item surgical safety checklist during urgent operations in a global patient population. Ann Surg [Internet]. 2010;251(5):976–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/ 20395848 16.

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study of the implementation of WHO Surgical Checklist in Finland: Improvements in activities and communication. Acta Anaesthesiol Scand. 2011;55(10):1206–14. 17.

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2015.

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10665/199177/1/9789241549455_eng.pdf 18.

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Effectiveness of the WHO Safe Childbirth Checklist program in reducing severe maternal , fetal , and newborn harm in Uttar Pradesh , India$ : study protocol for a controlled trial. Trials [Internet]. 2016;1–10. Available from: http://dx.doi.org/10.1186/s13063-016-1673-x 19.

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on improving adherence to essential practices during childbirth, in resource constrained settings. 2016;1–12. 20.

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quality of care for maternal and newborn health: prospective pilot study of the WHO safe childbirth checklist program. 2012;7(5). 21.

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Lancet. 2009; 374: 444 – 5 22.

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checklist implementation: key lessons for practicioners and partners. University of Leicester. 2015. 23.

Gillespie BM, Marshall A. Implementation of safety checklists in surgery: a realist

synthesis of evidence. Implement Sci [Internet]. Implementation Science. 2015;1–14. Available from: http://dx.doi.org/10.1186/s13012-015-0319-9 24.

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2015:2015-8. 25.

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patient outcomes. N Engl J Med. 2010; 363: 1928 – 37. 26.

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outcomes? BJA. 2012;1–8. 27.

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tentang Keselamatan Pasien Rumah Sakit. 
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  HEALTH DIGITAL MAP: A Breakthrough to Raise Priority and Awareness to Promote

and Prevent Communicable Diseases in Indonesia Alfryan Janardhana*, Savannah Quila Thirza**, M. Naufal Bachtiar*** *Third Year Medical Student, University of Brawijaya, ..... **Third Year Medical Student, University of Brawijaya, (savannahquila1705@gmail.com) ***Third Year Medical Student, University of Brawijaya, (naufalbachtiar@gmail.com)

Abstract Communicable diseases, also known as infectious diseases; are illnesses which result from infection, or presence and growth of pathogenic (capable of causing disease) biologic agents in an individual human or other animal host. Infections may range in severity from asymptomatic (without symptoms) to severe and fatal. The term infection does not have the same meaning as infectious disease because some infections do not cause illness in a host. In Indonesia, based on the current status quo, there are a large increasing numbers of diseases incidences in specific areas, especially rural areas, and those diseases are categorized as communicable diseases. Looking at our healthcare services aspect, we are lacking in some ways especially in promotive and preventive efforts for these diseases. Therefore, we are proposing a system to support our effort in promoting and preventing the diseases outspread, and by preventing the outspread we may also decrease the number of incidences. In this research we propose a making of a web based system to show the public and the health providers of a Health Digital Map, this livemap will help the government to realize their principles of action to measure the problems in our country, and to help the medical workforces, especially general practicioners, to evaluate the action to enhance the promotion and prevention of the diseases related in the endemic area as well as to raise the local public awareness. The map is useful as a livemap of updates on communicable diseases all around Indonesia, showing the exact area/ provinces suffering with the endemic. Keyword: Communicable diseases, Health Digital Map

37

HEALTH DIGITAL MAP: A Breakthrough to Raise Priority and Awareness to Promote and Prevent Communicable Diseases in Indonesia  

Alfryan Janardhana*, Savannah Quila Thirza**, M. Naufal Bachtiar*** *Third Year Medical Student, University of Brawijaya, ..... **Third Year Medical Student, University of Brawijaya, (savannahquila1705@gmail.com) ***Third Year Medical Student, University of Brawijaya, (naufalbachtiar@gmail.com) Abstract Communicable diseases, also known as infectious diseases; are illnesses which result from infection, or presence and growth of pathogenic (capable of causing disease) biologic agents in an individual human or other animal host. Infections may range in severity from asymptomatic (without symptoms) to severe and fatal. The term infection does not have the same meaning as infectious disease because some infections do not cause illness in a host. In Indonesia, based on the current status quo, there are a large increasing numbers of diseases incidences in specific areas, especially rural areas, and those diseases are categorized as communicable diseases. Looking at our healthcare services aspect, we are lacking in some ways especially in promotive and preventive efforts for these diseases. Therefore, we are proposing a system to support our effort in promoting and preventing the diseases outspread, and by preventing the outspread we may also decrease the number of incidences. In this research we propose a making of a web based system to show the public and the health providers of a Health Digital Map, this livemap will help the government to realize their principles of action to measure the problems in our country, and to help the medical workforces, especially general practicioners, to evaluate the action to enhance the promotion and prevention of the diseases related in the endemic area as well as to raise the local public awareness. The map is useful as a livemap of updates on communicable diseases all around Indonesia, showing the exact area/ provinces suffering with the endemic. Keyword: Communicable diseases, Health Digital Map Introduction Communicable diseases, also known as infectious diseases; are illnesses which result from infection, or presence and growth of pathogenic (capable of causing disease) biologic agents in an individual human or other animal host. Infections may range in severity from asymptomatic (without symptoms) to severe and fatal. The term infection does not have the same meaning as infectious disease because some infections do not cause illness in a host. According to WHO Country Health Profiles 2012: Indonesia, Lower Respiratory Infections ranked 4th among top 10 causes of death in Indonesia1. According to research conducted by Global Burden and Disease 2010 in Indonesia, Tuberculosis (TB) ranks third among top 40 diseases which quantify premature mortality by weighting younger deaths more than older deaths and other

38

communicable diseases such as Malaria and HIV/AIDS are also among the top 40 in Indonesia2.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. The 
 transmission of this disease is through droplets of people infected with the bacteria. According to Riskesdas 2013, the prevalence of Tb based on diagnosis is 0.4% of the population. Per 100.000 populations in Indonesia, there are 400 cases of diagnosed tuberculosis. Provinces with the highest prevalence of pulmonary tuberculosis are West Java at 0.7%, Jakarta and Papua which was 0.6% respectively2. Meanwhile, HIV/AIDS is an infectious disease caused by the human immunodeficiency virus that attacks the hosts’ immune system. The infection causes the host to be easily infected by a wide range of other diseases. According to Disease Control and Environmental Health, Ministry of Health Republic of Indonesia, 2014, mapping the HIV epidemic in Indonesia, the number of cases of HIV positive in 2013 have increased significantly 35% more compared to when in 2012. Provinces with the highest prevalence of HIV/AIDS are Papua, Java, and Bali, as well as some provinces in Sumatra, Kalimantan, and Sulawesi. Malaria is also an infectious disease caused by the parasite Plasmodium. The transmission of this disease is by the female mosquitoes ( Anopheles ). Based on Disease Control and Environmental Health, Ministry of Health Republic of Indonesia, 2014, their overview shows that in contrast, the percentage of endemicity in highly endemic areas have decreased from 18% in 2011, then became 16% in 2012, and finally 14% in 20132. Although the data conclude an increasing number of cases and mortality of TB and few decreasing cases of other communicable diseases such as HIV/AIDS, and Malaria, there are efforts and planning made by the government to enhance more efforts in promoting and preventing healthcare in area with communicable diseases endemic. Nowadays, realtime data demands are urgently needed by our people, starting from each individual, group, even government. In our latest JKN era, primary health care and general practicioners as the healthcare providers are expected to provide promotive and preventive effort well, therefore the efforts in curative and rehabilitative efforts may decrease as also the number of patients suffering the endemy will also decrease. Doing this innovation, must need accurate datas and realtime so that it may succeed and we can reach our target and goals. Meanwhile, for Indonesian people, the need of informations of what is actually happening in some areas regarding risk factors, number of incidences, are also highly needed. It is to make the people realize and alert about the fact that there are preventive and awareness needed. Which is why, we think that realtime disease mapping not also be available to be seen by health care providers but also the public. In Indonesia, the effort of promotion and prevention of diseases are still low, therefore it affects the awareness of locals suffering from the unknown diseases and also affect the increase of the diseases' outspread. Therefore, we propose the invention of a Health Disease Livemapping. This livemap’s features will be a livemap update of all areas, provinces, cities in Indonesia showing exactly what is happening within each specific territories

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This livemap will help the government to realize their principles of action to measure the problems in our country, and to help the medical workforces, especially general   practicioners, to evaluate the action to enhance the promotion and prevention of the diseases related in the endemic area as well as to raise the local public awareness. The map is useful as a livemap of updates on communicable diseases all around Indonesia, showing the exact area/provinces suffering with the endemic. Methods This scientific paper is based on literature review through analytic study on the effortof the progress to enhance health promotion and prevention of communicable diseases in Indonesia. Some methods and program were carefully evaluated in order to find the right method to create innovative pathway for health warranty of the people in the endemy area. Socioeconomic and characteristic of mentioned region were considered in order to meet the right methods for the system proposed. Data collection methods in this study are conducted by the method of literature (literature review) based on issues, both through digital and non-digital information from literature such as journals and reports. The method of data analysis literature conducted through two approaches, namely: 1. Method of Exposition, that the presented data and facts that may ultimately sought correlations between these datas. 2. Analytic methods, namely through the analysis of data or information by giving the argument through logical thinking and were then taken to a conclusion. Results The proposed system is a digital web based Livemap of all the entire areas in Indonesia. The map will use the GIS (Geographic Information System) website base. One of the GIS method towards the mapping of the diseases outspread is using the google map API (Application-Programming-Interface) based on website. The functions of API are as the programming system which is provided by Google thus Google Maps can be integrated into a website which is in the making, in this case it’s the communicable disease mapping. This system is open for everyone who are willing to know about communicable diseases in Indonesia by showing exactly what is happening within each specific territories. In particular, geographical analyses of the distribution of risk factors can be useful in prioritizing preventive measures3. This digital livemapping will be very useful for health service provision and targeting interventions if avoidable risk factors are known. Geographical studies of disease and environmental exposures may in some cases be sufficient by themselves to justify action, for example if the exposure-disease association is specific, the latency is short and the exposure is spatially defined.

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The web server is from the Ministry of Health Republic of Indonesia. In the BPJS era,

diagnosis data input of one’s disease is a very important thing, because the health funding can only be claimed from there. This data input is done by the healthworkers in primary health care center and secondary health care center, if the diagnosed illnesses are included in communicable diseases category, then the healthworkers in charge of data input must fill the database to be uploaded to the diseases mapping website. The website will be updated frequently every once in a week based on the collected data. If the number of the disease incidences rises high enough in one area, there will be a color-notification, which color represents the grade of the diseases. The technical support that will be done are : 1. Analysis of data of the diseases, areas, and health instances. In this first phase, there will be a disease analysis done and it will be brought into the system. The diseases we will be researching is the communicable diseases. 2. Do the planning of the data basis, it’s a phase to plan and design the graphics, captions, and the descriptions based on the data that will be used in this system. 3. Do the design of the user interface geographic information, it is to describe and design the functions and the commands that will be used in this web system. Such as, the function to show diseases data in the map and also coloring features in the web. 4. To do a fit and proper test to find out if the web system is already going well or not. 5. Do a countrywide workshop with few health care providers in the primary health care facility and secondary, to input the data and do a publication to the entire country. 6. Do a monitoring and evaluation frequently regarding this system. All diseases which concluded in the category of communicable diseases will be input into the map and there will be a monitoring and surveillance of the digital map conducted every month or every week, to help identify which specific area in Indonesia with the number of cases needed to receive the actions and evaluation from the government and the medical workforce. This system propose a complex but creative way to help medical workforce, together with the government, to identify and help decrease the high prevalence of communicable diseases in Indonesia

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Fig 1. The Digital updates communicable disease map scheme

Fig 2. The GIS Communicable Disease Mapping Scheme

Discussions Digital Live Updates communicable disease map system Based on the 10 essential public health services , the digital live updates communicables diseases map with GIS method may bring several advantages which are already analyzed by the CDC. For example4:

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In health monitoring, the function of disease livemapping updates can be used to map almost all groups of people from each specific areas with the communicable diseases endemy based on specific health status. . In order to inform and empower the policies, the function of this live map is used to provide informations about each group of people in Indonesia who are still unknown to the knowledge and informations about health and diseases informations in Indonesia in each specific areas. Also, there can be made a planning and making of a right time to do promotion to some groups of people that need to be updated about this informations. Other than that, it is also able to be used to enhance the people’ knowledge individually, which is why we highly need this updates. To ensure the competency of the workforces, the function of live updates map cam ne useful regarding the distribution of healthcare worekrs all around Indonesia, so it can be seen easily by them if there are increases or decreasis in specific territories or to notify them about the decreasing number of workforces to supply health care services. Furthermore, the usage of this system can be used as the basic of planning to provide healthcare workers for long term in the future in each specific areas in accordance to Ministry of Health of the Republic of Indonesia and Ministry of Home Affairs of the Republic of Indonesia Number 61 year 2014 about planning and equal distribution of health care workers in public health facilities.

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Feabilities of Digital live update communicable disease map system  

The increase in worldwide internet availability and use over the past 10 years, combined with these changes in health-seeking behaviour, has created new possibilities for the development of innovative surveillance systems5.

The digital live update of the communicable disease map may help to optimize our health service quality. This system may work to complement the existing program, which is JKN program (Jaminan Kesehatan Nasional). When healthcare providers have to fill diagnosis of the patient to be claimed later, can also at the same time, input the data in the database if the diagnosis is one of the communicable diseases. There are already researches about diseasemapping using GIS method for communicable diseases, which is in Nigeria. Nigeria ranked 4th between the entire countries in the world with the highest number of TB patients. Based on the research, it is said that using GIS method may ease the workups and controls of TB needed to identify which specific area is suffering with increasing number of TB transmission6. One of the researches which were done in Indonesia is the research in RSUD Dr. Soetomo which is one of the largest hospital in East Java. In this research, it is said that GIS is able to process the database in the hospital to become analytic informations to help the hospital in making decisions. The result is in form of disease outspread mapping with Kriging method, patients’ survival graphs using survival analysis method, and also several graphs useful to observe the data characteristic of the patients7. This system is relevant if it is used more widely, maybe nationwide to able to observe and identify the outspread of communicable diseases in Indonesia.

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  Benefits of Digital live update communicable disease map system In JKN era, there are changes in the financial system in primary health care center. Before there was JKN, the source of the funding in promotive and preventive services, either in healthcare efforts for the people or individual, is by BOK (Biaya Operasional Kesehatan). From JKN, government will be the one held responsible to fulfill the efforts to enhance the innovations and movements to fulfill the healthcare services of the people, while BPJS will support the capitation funding and individual healthservices. Primary Health Care Center has to be ready and able to operate and manage the funding to fulfill the JKN8. If this digital livemap can work along perfectly, the informations we get will be used mainly by primary health care center to do the preventive and promotive effort according to the initial planning. Promotive and preventive services are supposed to be more observed, mainly because there is JKN now. No matter how much the customers of JKN have paid or spent if there are no reliable efforts supporting the on hand facilities, then it will go to waste9 . Conclusion We believe that this system is able to enhance and optimize our effort in preventing and promoting the awareness of communicable diseases in Indonesia.We propose this system by carefully observing the urgencies and the current status of health care services in Indonesia. This system may become a big help for us to be able to raise the awareness of our people and try to make the first step in doing a healthcare movements specifically in communicable diseases category. This disease livemap is highly recommended in our country. On a final note, implementation of this system need to take place on a urgent basis.

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References : 1. CDC. (2016). CDC in Indonesia 2. Badan Pusat Statistik. 2014. Statistik Indonesia 2014. BPS, Jakarta. 3. Ramadona, A.L. & Kusnanto, H. (2011). Open Source GIS : Aplikasi Quantum GIS Untuk Sistem Informasi Lingkungan. BPFE. Yogyakarta 4. Krisna, K. P. A., Piarsa, I. N., Buana, P. W. (2014). Sistem Informasi Geografis Pemetaan Penyebaran Penyakit Berbasis Web, 2(3), 271–279. 5. Leung L. Internet embeddedness: links with online health information seeking, expectancy value/quality of health information websites, and internet usage patterns. Cyberpsychol Behav 2008; 11: 565–69. 6. Oloyede. (2013). Geospatial Information In Public health : using geographical information system to model the spread of tuberculosis.FIG working week. Abuja, Nigeria. 7. Rostianingsih, S., Kusuma, Y. R., Halim. s., Yuliana, O. Y., Budhi, G. S. (2015). Pemetaan Penyebaran Penyakit dengan Metode Kriging, (1), 121–131. 8. Kementerian Kesehatan RI. 2013. Riset Kesehatan Dasar, Riskesdas 2013. Kementerian Kesehatan RI, Jakarta. 9. Rustianto, (2013) Pelayanan Promotif dan Preventif Dalam Era JKN. Jurnal Fakultas Kesehatan Maasyarakat Universitas Diponegoro. Semarang.

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Comparison Effectiveness of Male Circumcision’s Technique According to Each

Complication for Preventing Medical Error Intan Karnina Putri*, Ghozi Fadlul Ramadhan** and Khusna Wahyuni*** *Third Year Medical Student, University of Jambi, (intankarninaputri@gmail.com) ** Second Year Medical Student , University of Jambi *** Second Year Medical Student, University of Jambi Abstract Introduction: Circumcision is the most common surgical procedure in boys. Although not difficult technically, it can result in complications ranging from mild to severe. We aimed to evaluate the complications of circumcision according to each technic.So, we can get a comparison which is the most effectiveness technique that can use for male’s circumcision with minimal complication but effective cost, effective procedure, and great satisfied. Methods: A literature review was conducted to find a new solution for the underlying problem. Literatures were obtained from various search engines such as PubMed, Journal, and Google Scholar. Results: The majority of circumcision are performed by doctors and by non doctor. Circumcision there are complications on

9,4% Bleeding is the most common

complication. Complications occurred in 17.5% circumcision with electrocautery techniques, 11.8% with clamp/ring, and the (1.5%) with conventional surgery techniques. Conclusion: The effectiveness of circumcision technique depends to the clinical target that want receive. Each technique of circumcision has advantage with different clinical achievement. In Indonesia it is more effective to use conventional techniques due to the amount of a tool that has not been adequate as well as limitations of the facilities and professionals. Technique of circumcision is related to complication and satisfaction outcome. Conventional technique is safer than nonconventional technique. Circumcision should be performed by skilled operators who can evaluate the patient preoperatively and identify contraindications, manage possible complications, and evaluate patient postoperatively. Keyword: circumcision, male, children, complication, technique.

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Comparison Effectiveness of Male Circumcision’s Technique According to Each

Complication for Preventing Medical Error Intan Karnina Putri*, Ghozi Fadlul Ramadhan** and Khusna Wahyuni***

*Third Year Medical Student, University of Jambi, (intankarninaputri@gmail.com) ** Second Year Medical Student , University of Jambi *** Second Year Medical Student, University of Jambi Introduction Circumcision is one of the most frequently surgical procedures in boy's performed around the world. In Australia, an estimated 70% of boys and adult men have undergone Circumcision.

1

while in Turkey which is a country with a majority Muslim

population such as in Indonesia, the prevalence of circumcision reaches 99%.

2

Circumcision performed with medical reasons and non medical. Non medical reasons include religion and rituals. Circumcision ritual is often done by the religions of Islam and the Jews, as well as in areas of sub-Saharan Africa

1

Medical reasons to circumcision

namely fimosis and balanitis. There is a wide controversy regarding the benefits and risks of action Circumcision. Circumcision said may reduce the risk of Carcinoma of the penis, cervical carcinoma, urinary tract infections, and sexually transmitted disease.

3

Circumcision though not technically difficult, this action can result in various complications mild to heavy 1. Various complications that have been reported include bleeding, infection and sepsis, meatal stenosis, laceration of penis, fistula urethral, and limfedema.

3

Circumcision mostly performed without resulting in complications. The

overall prevalence of complications is still not yet known for certain and range between 0.1-35% or 1-15 4-6%. By the end of 2014, an estimated cumulative total of 8.9 million male circumcisions had been performed, over 95% using the forceps-guided or dorsal slit surgical procedures. Innovative methods using circumcision device are being developed, evaluated and rolled out. They have the potential to simplify the procedure and to increase the acceptability of circumcision.4 Currently there is research on complications of boy’s circumcision in Indonesia. This research aims to find out what are the comparison arising from each technic of circumcision in children and the factors that affected it, so we can effort to reducing even preventing the medical error or other factors which affected the circumcision.

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Objectives General Objective: To enhance the quality of existing health care system in Indonesia to be the world standard throughout fixing a common medical surgical procedure by encourage the training of worker’s whom has responsibility for do circumcision and education to community especially in rural areas to have better choose for the people who will do a circumcision. Specific Objectives:

• To decrease the number of patients suffering from diseases, especially for common surgical procedure like cirsumcision

• To improve Indonesia health Care System to building and create patient safety thoroughly

• To increase productivity and life expectancy of every Indonesian citizens. • Empowering the nation to live their life as healthiest as possible. Methods The writers review systematically from literature, journals, books, and other reliable sources. Literatures and journals are obtained from reliable search engine like PubMed, application Read QxMD,and Google Scholar. After collecting all the new information from variable of sources, the writers carry out analysis of all the elements and think reasonably and logically for a new innovative solution to solve the problem stated in the scientific paper. Result A Survey study in Indonesia by Urology Division Universitas Indonesia with 210 samples of boy’s that had finished circumcision, the majority of circumcision are performed by doctors (10.7%), and in present day and 10,7% circumcision performed by non doctor. Circumcision there are complications on 15/159 childs (9,4%) (Figure 1). Bleeding is the most common complication. Complications occurred in 11/63 (17.5%) circumcision with electrocautery techniques, 2/17 (11.8%) with clamp/ring, and the 1/67 (1.5%) with conventional surgery techniques.5

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Figure 1. Table showing the various kind of complication that happened after circumcision in a survey of boy’s circumcision

In Figure 2, it can be seen that there is a relationship between the technique and the people doing the circumcision with the onset of complications. In this survey, not found the relationship between the age when circumcision (< 6 years with > 6 years) and complications (p = 0.094). Complications occurred in 11/142 (7.7%) circumcision conducted by doctors and 4/17 (23.5%) circumcision performed by non doctors.5

Figure 2. Table showing factors between technique and the people doing the circumcision.

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  Discussions Circumcision is the most common surgery performed on boys with different reasons such as religion, culture, as well as medical. So, in this era circumcision become a common surgery that always developing its technique. Some different advantages form each circumcision’s technique was explained by a meta-analysis, male circumcision may using disposable devices; this may lower the surgical skill required and accelerate the pace of delivery of voluntary medical Male circumcision while maintaining the safety of procedure. Devices were classified into one of two categories: ISD (In-situ Devices) and CDD (Circular Disposable Devices), according to their operation principles. An ISD consists of an inner and an outer ring. The inner ring is a frame that the outer ring can lock onto to clamp the foreskin. Excess foreskin is removed immediately after the rings are locked firmly or at the time when the rings are removed. Rings are removed according to surgeon’s assesement of whether ischemic foreskin has necrosed and the wound has healed. Without a ring in situ, CDD has a circular glans pedestal in which the excess foreskin can be incised smoothly and a fastening part to fix the reversed foreskin to prevent shifting. The wound is stapled simultaneously when incising the foreskin or glued with some type of biogel. The staples will theoretically fall off when the wound has healed. ISD was easier to perform, had higher surgical success rates, lower total procedure times, eliminated the need for suturing, possibly had fewer complications, caused less bleeding, gave better cosmetic result, may potentially reduce the time taken for recovery after surgery, and eliminated the need for routine injectable anesthesia compared with other methods. ISD was found to have less intraoperative blood loss, a lower incidence of wound bleeding than conventional circumcision (CC). ISD just showed a lower incidence of wound bleeding but needed more wound healing time than CDD. CDD was found to have lesser intraoperative blood loss and lower operative time than conventional circumcision (CC). CDD tended to be the treatment with the best wound healing condition and the least pain experience. However, it may be the most expensive device with the highest incidence of wound bleeding after surgery; among all techniques, the ISD circumcision tended to have the lowest operative time and bleeding volume intraoperatively and the lowest incidence of bleeding postoperativelky. Furthermore, ISD had the highest satisfaction rate despite requiring the longest wound healing time relative to the other techniques. CC showes no advantages other than a minor trend to be the cheapest male circumcision method.6

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In Indonesia, most circumcision are done with the excuse of religion, namely Islam. As with any other surgery, circumcision action may result in the occurrence of mild to severe complications. It is generally mild and circumcision complications can get therapy.

7.8

The level of complications of post circumcision is not yet known for

certain and estimated at 0.1-35%, but Williams and Kapila Friday expressed a more realistic complication rate that is 2-10%.8,9 Mild complicatication such as pain, infection, bleeding, wound healing is not perfect, trouble urinating, no adequate prepusium excision, and unsatisfactory cosmetic form.

10, 11

Severe Complications

can be found in the form of the glans penis amputation and death.

12-14

Weiss et al.,

report the median frequency of occurrence of complications of post circumcision of 1.5% (range 0-16%), and median frequency of severe complications of 0% (range 0-2%). The survey results shows post-circumcision most often complications are hemorrhage (6/159, 3.8%) and not heavy complications are obtained. Libraries reported that bleeding on the circumcision estimated at 1.6%.12 Light Bleeding can be addressed with an emphasis, while heavy bleeding often requires tailoring with hemostasis. Boys in Muslim countries usually undergo circumcision at the age of 1 year and over, for example 3-13 years in Turkey, 5-7 years in Morocco, and 2-12 years in the tribe of Bedouin. South Korea Research 16,17 at 1306 men who have undergone circumcision 55.2% done showed that at the age of 10-15 years, 15% at the age of 15 years, > 7.8% aged 1-10 years, and only 1% at age 18 infants. This contrasts with research in Israel that is generally circumcision done at the age of 8 days in accordance with Jewish belief.

10

The occurrence of complications is not

affected by the age when circumcision. It is similar to a study by Akyol et al. 19 at 415. But a study by Weiss et al.

3

demonstrated that circumcision by medical

personnel who performed at the age of children had greater complications (median 6%, range 2-14%) than in the age of neonates and infants. The frequency of lower complications at age neonates caused by a procedure that is easier and faster healing abilities at this age 16 factors that affect the occurrence of complications among other things people are doing circumcision. Circumcision in infants and children is conducted by medical personnel as well as non medical on a variety of conditions. The selection depends on the culture, cost, location, and socioeconomic status of the parents. In some countries, including Indonesia and rural areas in Turkey and Egypt, circumcision in a child is often done by non medical worker who don't get training and only learned from observation and experience. 15-17

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On Muslims in Nigeria to the North, around 70% of parents prefer to bring his son to the place of the traditional circumcision because more parents trust the power nonmedis and the location more accessible compared to the hospital 16 survey results differ with the study that is mostly done by the circumcision doctor (in present day%) , and 10.7% circumcision performed by non doctors. It is caused because the survey was conducted in Jakarta which is a big city in Indonesia, currently there is a tendency in the population in the urban area with a higher education level and socioeconomic status is that it is better to choose the medically circumcision with local anesthetic for their children.

10, 18, 19

On this research,

complications occurred in 11/142 (7.7%) circumcision conducted by doctors and 4/17 (23.5%) circumcision performed by non doctors. Conclusions The effectiveness of circumcision technique depends to the clinical target that want receive. Each technique of circumcision has advantage with different clinical achievement. In Indonesia it is more effective to use conventional techniques due to the amount of a tool that has not been adequate as well as limitations of the facilities and professionals. Technique of circumcision is related to complication and satisfaction outcome. Conventional technique is safer than nonconventional technique. Circumcision should be performed by skilled operators who can evaluate the patient preoperatively and identify contraindications, manage possible complications, and evaluate patient postoperatively.

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Reference 1. Hirji H, Charlton R, Sarmah S. Male circumcision: a review of the evidence. J Men’s Health   2005;2:21-30. Gend. 2. Ozdemir E. Significantly increased complication risks with mass circumcisions. Br J Urol. 1997;80:136-9. 3. Latifoglu O, Yavuzer R, Unal S, Sari A, Cenetoglu S, Baran NK. Complications of circumcision. Eur J Plast Surg. 1999;22:85 8. 4. WHO/UNAIDS. New Data on Male Ciecuncision and HIV Prevention: Policy and Proggrame Implications. Geneva, switzerland: World Hesalth Organization and Joint United Nation Programme on HIV/AIDS; 2007 5. Seno Hami Doddy, Nugroho Dimas, Wahyudi Irfan, Rodjani Arry. Faktor-faktor yang berhubungan dengan keluaran dan komplikasi sirkumsisi. J Indon Med Assoc. 2012;62;22-26 6. Yu fan, dehong cao, qiang wei, zhuang tang, ping tan, lu yang, et al. The characteristics of circular disposable devices and in situ devices for optimizing male circumcision: a network meta-analysis. Sci. Rep. 2016;6 7. Lerman SE, Liao JC. Neonatal circumcision. Pediatr Clin North Am. 2001;48:1539-57. 8. Williams N, Kapila L. Complications of circumcision. Br J Surg. 1993;80:1231-6. 9. Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited. Can Med Assoc J. 1996;154:769- 80. 10. Ben Chaim J, Livne PM, Binyamini J, Hardak B, Ben-Meir D, Mor Y. Complications of circumcision in Israel. Isr Med Assoc J. 2005;7:368-70. 11. Okeke LI, Asinobi AA, Ikuerowo OS. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol.2006;6:21-9. 12. Ahmed A, Mbibi NH, Dawam D, Kalayi GD. Complications of traditional male circumcision. Ann Trop Paediatr. 1999;19:113- 7. 13. Gluckman GR, Stoller ML, Jacobs MM, Kogan BA. Newborn penile glans amputation during circumcision and successful reattachment. J Urol. 1995;153:778-9. 14. Strimling BS. Partial amputation of glans penis during Mogen clamp circumcision. Pediatrics. 1996;97:906-7. 15. Hull TH, Budiharsana M. Male circumcision and penis enhancement in Southeast Asia: matters of pain and pleasure. Reprod Health Matters. 2001;9:60-7. 16. Ozdemir E. Significantly increased complication risks with mass circumcisions. Br J Urol. 1997;80:136-9. 17. Rizvi SA, Naqvi SA, Hussain M, Hasan AS. Religious circumcision: a Muslim view. BJU Int. 1999;83 Suppl 1:13-6. 18. Joint United Nations Programme on HIV/AIDS (UNAIDS). Neonatal and child male circumcision: a global review. 2010. Switzerland, UNAIDS. 19. Sahin F, Beyazova U, Akturk A. Attitudes and practices regarding circumcision in Turkey. Child Care Health Dev.2003;29:275-80.

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National Healthcare Associated Infection (HAI) Surveillance Strategies to Decrease the Rate of HAI Incidence in Indonesia Kevin Gracia Pratama, Maria Angelia AMSA-UAJ Introduction: Healthcare associated Infection (HAI) or similarly known as nosocomial infection is an infection that occurs in a hospital or during the process of care in any other healthcare facilities that is previously not present during entry. It results in many negative impacts such as prolonged hospital stay, development of drug-resistance bacteria additional high cost and many more. One way that several countries had been using to reduce HAI is by using public health surveillance. Public health surveillance is defined as the continuous, systematic collection analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice. The use of public health surveillance in Indonesia is very minimal or barely exists. Objective: The purpose of this paper is to review existing HAI surveillance in the world and suggests why public health surveillance is needed to reduce HAI cases in Indonesia. Material and methods: A literature review was done to identify new solutions to the existing problem. Literatures were obtained from Google Scholar, Proquest, and Pubmed. Official governments reports are also used. Results: Literatures and studies have shown that the use of HAI surveillance reduces the number of HAI incidence in some countries. HAI surveillance become effective when it is followed by the right intervention and new policy. Conclusion: The establishment of a national scale HAI surveillance is essential not only to decrease HAI cases, but also to know the current condition of HAI in Indonesia. There will be a difficult challenge to start a national surveillance and may takes up a long time before it is fully established. Nevertheless, the use of surveillance will be pointless without giving out the right interventions and policies.

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National Healthcare Associated Infection (HAI) Surveillance Strategies to Decrease the Rate of HAI Incidence in Indonesia Kevin Gracia Pratama, Maria Angelia AMSA-UAJ

Introduction Healthcare Associated Infection (HAI) is an infection that occurs in a hospital or during the process of care in any other healthcare facilities that is previously not present during entry(1). HAI is also known previously as nosocomial infection, which means hospital acquired infection. Since today's health care is not always located in a hospital, the term HAI is more appropriately used(2). HAI may attack anyone including patients who have been discharged to healthcare providers. It is a major threat to patient's safety yet it is preventable with the right intervention(3). HAI may results in prolonged hospital stay, disability, generation of antimicrobial-resistant bacteria, addition high cost and even death(1). Some example of HAI are surgical site infection, bloodstream infection from intravenous device, catheter associated infections, Gram-negative bacterial infection, etc. In a survey funded by the WHO, results shows that surgical site infection (SSI) is the leading cause of HAI followed by ventilator pneumonia (4). According to Departemen Kesehatan RI, from 10 Indonesia’s teaching hospitals (RSU Pendidikan) on 2010, It is reported that HAI contributed to 6-16% with the average of 9.8% patients. The most common nosocomial infections there are surgical site infection (SSI) (5). Public health surveillance is defined as the continuous, systematic collection analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice(6). Surveillance is an important part of healthcare because it could track the impact of certain interventions and evaluate for future strategies(6). In other words, surveillance could be used to monitor and act as an alert system in healthcare(2). HAI surveillance is an important aspect to reduce HAI incidence. An effective surveillance may inform key stake holders such as the Minister of Health to make a new policy or intervention(2). Collecting data alone is not enough to reduce HAI, instead it must drives action and change to eventually improve the current HAI condition(2).

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Currently there is no national HAI surveillance that has been done. Instead there are only   several surveillances done in a few hospitals that may represent the whole country. The purpose of this paper is to review existing HAI surveillance in the world and suggests why it is needed in Indonesia to reduce HAI cases. This paper focuses on identifying the importance of a well-established surveillance that could lead to a reduction of unnecessary HAI. Methods This scientific paper was based on literature review through analytic study on optimizing surveillance of nosocomial infection in order to reduce the number of nosocomial infection cases. Literatures and journals were obtained from various reliable search engines, such as Google Scholar, Proquest, and Pubmed. Beside journals and literatures, we also used official articles from government and CDC. After we collected all data we need, we analyzed the data. The method of data analysis literature conducted through two approaches, namely: 1. Method of exposition, that the presented data and facts that may ultimately sought correlations between these data. 2.Analytic methods, namely through the analysis of data or information by giving the argument through logical thinking and were then taken to a conclusion. Results Multistate Point-Prevalence Survey of HAI A 1-day survey conducted by 10 state health department and academic partners was done to determine the prevalence of HAI in acute care hospitals and generate updated estimates of the national burden of such infections. The survey was conducted in collaboration with the Emerging Infections Program (EIP) network. Demographic and clinical data were collected including medical records to identify active HAI at the time of the survey. A total of 183 hospitals and 11,282 patients were involved in the survey(7). Results shows that 452 patients had 1 or more HAI and the most common types of infections were pneumonia (21.8%), surgical-site infection (21.8%), followed by gastrointestinal infections (17.1%). Device associated infections which includes centralcatheter associated infection, catheter-associated urinary tract infection and ventilator associated pneumonia, accounts for 25.6% of the total HAI. Device associated infections has been the main focus of prevention in the past decades. On the other hand, infections not associated with devices or operative procedures (Clostridium difficile infections, nonventilator associated pneumonia, etc.) accounts for approximately half of the HAI in this survey(7).

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The result from this surveillance survey suggests that public health prevention   and surveillance should expand their focus not just within the device associated infections but also to include other types of infections. A successful prevention of HAI can be obtained by a better understanding of the epidemiology through repeated prevalence surveys (7). Surveillance system in Japan Japan Nosocomial Infection Surveillance (JANIS) system was established by the Japanese Ministry of Health, Labour, and Welfare back in July 2000. Participating hospitals routinely collect their infection surveillance data into the national database. Specifically, the ICU component consists of 30 ICUs spread all over japan with over 200 beds. All of the patients admitted to the ICUs were automatically taken into the survey. The data collected are sex, age, underlying disease, severity-of-illness, ICU admission and discharge, operation, device use, infection, and hospital discharge. The data were sent to management office via internet on a monthly basis(8). The main focus of the JANIS system is collecting date on nosocomial infection by multidrug resistant organisms (MDROs) such as MRSA(9). JANIS database has become an important source of information on the epidemiology of nosocomial infection in Japan. However, a study which was done to asses the current surveillance system suggest that the JANIS system provide an inadequate feedback. One of the main factor is that there is a wide distribution of risk factors among different hospital. Thus adjustment is needed to create a valid conclusion. In addition, benchmarking is also important to asses nosocomial infections(8). Nevertheless, JANIS data provide a helpful information to contribute to the development of infection control programs. The aim of surveillance itself is to generate effective interventions to reduce the rate of nosocomial infection. Therefore, the data itself need to be reported back to healthcare personnel and analyze to create successful interventions strategies(8). Japanese Nosocomial Infection Surveillance (JNIS) was an earlier system that was developed in 1998which is based on the US National Nosocomial Infection Surveillance (NNIS). It was renamed JHAIS (Japanese Healthcare-Associated Infection) in 2008. Currently it has approximately 50 hospitals participating each year (9). National Nosocomial Infections Surveillance (NNIS). According to Institute of Medicine (IOM), medical errors and HAIs have caused more than 50.000 deaths per year and cost more than $17 billion. They recommended to immediately reporting of medical error. They suggest that monitoring leads to reduction of case. This monitoring system is more known as surveillance system(10).

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Surveillance system emphasizes changes at the system rather than individual level. This scientific value of surveillance as part of a hospital infection-control program was   demonstrated strongly in the landmark Study of the Efficacy of Nosocomial Infection Control (SENIC). In that study, highly trained data collector evaluated more than 338,000 patient records from probability sample of U.S. hospitals to calculate infection rates. They found that hospitals with the lowest nosocomial infection rates had strong surveillance and prevention programs(10). During the last two decades, hospitals have established internal systematic monitoring of HAI rates. Every hospital has their own system using their own definitions, methods, and monitoring protocols(10). Although hospitals may have their own way, a monitoring system (surveillance) must satisfy three requirements: it must have a very clear purpose; it must use standard definitions, data fields, and protocols; and it must form an institution to standardize definitions and protocols, receive the data, assess them for quality, standardize the approach to risk-adjusting the benchmarks, and interpret and disseminate the data. (10) For the last 30 years, The Centers for Disease Control and Prevention (CDC’s) system named National Nosocomial Infections Surveillance has been serving as an institution that monitoring the nosocomial infections rate. This NNIS system is a hospital based system to monitor HAI and guide preventions effort of HAI(10). CDC definitions of nosocomial infections include clinical and laboratory information that require training, counseling, and updating tasks that are largely the responsibility of the institution. Thus, Infection Control Practitioners (ICPs) are practitioners that are trained to do surveillance. ICPs are positioned uniquely among hospital employees to determine whether a patient has a nosocomial infection or not(10,11). An institution has to asses the quality of data; to make it possible, a meaningful surveillance definitions of HAI itself must be available. These definitions do not define clinical illness; rather, the definitions themselves must be credible, consistent application across institution. There must be an external benchmark to be compared with the collected data. Standard definitions of nosocomial infections must be used so that consistency in data collection is maintained. This process should be combined with clinical findings and laboratory tests. But, there isn’t precise information that allows an ICP to accurately identify HAI itself without mix other causes(10). The surveillance data shown, that nosocomial infection is an endemic disease. Less than 10% all nosocomial infections become an outbreak. If it happens, it is often because one prevention strategy failed for a short period. The endemic-disease rate provides practitioner knowledge of the ongoing infection risks of hospitalized patients when there is no outbreaks are occurring(10).

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From 1990 until 1999, the nosocomial infection cases in the participating NNIS hospitals were decreasing. The reasons of those decreases are not fully known, but several explanations are possible. First, the improvements seen in NNIS hospitals also reflect other   national efforts to prevent infections. Second, the U.S. health-care system has shifted away from hospital-based care. By all reports, patient-care personnel began to perceive value in the data, relied on them for decisions, and altered their behaviors in many ways that could reduced the incidence of nosocomial infections in NNIS hospitals. The NNIS approach to surveillance of nosocomial infections may have actually improved the quality of patient care(10). The NNIS elements for successful reductions in nosocomial infection rates included : (1) voluntary participation and confidentiality (2) standard definitions and protocols (3) defined populations at high risk (e.g. ICU patients, surgical patients) (4) site specific, risk-adjusted infection rated comparable across institutions (5) adequate numbers of trained ICP (6) dissemination of data to health-care providers (7) a link between monitored rates and prevention efforts, where patient-care personnel relied on the data to alter their behavior in ways that may have reduced the incidence of nosocomial infections. Although NNIS has made methods for the surveillance, this method could change at any time in the future. Surveillance must be dynamic and keep improves to keep pace with the changing environment(10). Discussion Infection disease is the major caused of death around the world. One of them is health (care) associated infection (HAI). Estimates indicate that hundreds of millions of patients suffer from itself. The most common HCAI are urinary tract, surgical site, lower respiratory tract and bloodstream infections(12). How to prevent and control HAI? Study of the Efficacy of Nosocomial Infection Control (SENIC) has proved surveillance program leads to descent of HAI cases. How could a method of collecting and analyzing data leads to such huge impact? The keyword to solve the problem is behavior of caregivers. Caregivers must be aware of hygiene when contact with the patients such as hand hygiene or medical device such as catheter or ventilator. When the data is neglected, the program will be meaningless. Therefore, some countries have been developing a program to collect and analyzing data about HAI in hospital called surveillance program. For the example, Japan’s program called Japan Nosocomial Infection Surveillance (JANIS)(9). Despite all flaws in the program, this surveillance program surprisingly decreases the number of the HAI in the hospital. How about Indonesia? Indonesia has a program called Pencegahan dan Pengendalian Infeksi Nosokomial (PPI). The major issues of PPI are the safety of the patients, medical workers, the institution, the business, and the hospital environment. One of the strategies is establishing a polish that every hospital must runs PPI and forms a committee to monitoring the program.

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A national surveillance program is needed in Indonesia to control and prevent HAI.   Indonesia itself currently has limited surveillance data on HAI. A well established national surveillance data is needed in order to monitor whether a certain intervention on controlling HAI has a positive impact. Without it, it is highly unlikely for policy makers in the healthcare departments to identify the problem itself. Benchmarking is also an important part of a surveillance; It is important to know whether a certain number is on normal levels or above normal. It is pointless to keep giving interventions to control HAI and making new policy without actually evaluating on the effect of the interventions. This is why a comprehensive surveillance is needed. It will also provide interpretation and analysis of data that could lead to unusual findings. These findings will eventually be investigated and shared in order for policy makers to give out the right interventions(2). The ultimate goal of the surveillance program is to benefit patients with better healthcare. By understanding the problem through surveillance, healthcare policy makers could make the right interventions. A more focus intervention on certain type of HAI can also be done in order to reduce the rate of such infections. It will also improve efficiency on data collection by healthcare workers and in the end provides a comprehensive data all across the country(2). There is a lot to be done in order to established a national surveillance system. The first step towards establishing a surveillance on such scale is to identify what resources and type of surveillance that currently exists in Indonesia. There is clearly a wide variation between hospitals throughout the country and adjustments are needed to compare between one region with another. It is also important to find the right resources, skill level and experience to perform this type of surveillance. Finally, learning from other successful program from other countries is essential in order to identify the right component to be implemented in Indonesia(2). Conclusions Hospital Acquired Infection (HAI) is still a problem in the world. Many countries have been developing a program to monitor the statistic of HAI cases on their hospitals. This program is known as the surveillance program. This program consists of collecting and gives an interpretation to the data of HAI. Without surveillance, it is highly unlikely for markers in medical department to identify the problem itself. The important thing, surveillance program itself will not work if there is no action followed afterwards. This surveillance data should change the behavior of the caregiver toward the patients, they should be more aware of the hygiene of patient and everything that contacts with the patient. In this way, the program will bring impact and reduce the number of HAI cases.

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In Indonesia itself, there is a program called Pengendalian dan Pencegahan Infeksi

(PPI) that basically has a similar mechanism with other country’s surveillance program. But Indonesia should give more attention to the caregivers and medical workers’ behavior. Because surveillance program alone will not show any impact without the right actions. Lastly, the main importance of establishing a surveillance system in Indonesia is to provide information to healthcare policy maker to make the right decision. Surveillance system itself also acts as a monitoring mechanism to evaluate whether an intervention is done right or not.

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References 1.

Pittet D, Allegranzi B, Sax H, Bertinato L, Concia E, Cookson B, et al.

Considerations for a WHO European strategy on health-care-associated infection, surveillance, and control. Lancet Infect Dis. 2005 Apr;5(4):242–50. 2.

Russo PL BN, MClinEpid, PhD, Cheng AC MBBS, FRACP, MPH, PhD, Richards

M MBBS, FRACP, MD, Graves N PhD, Hall L BTech(BiomedSci), PhD. Healthcareassociated infections in Australia: time for national surveillance. Aust Health Rev. 2015;39(1):37–43. 3.

Scott RD II, Sinkowitz-Cochran R, Wise ME, Baggs J, Goates S, Solomon SL,

et al. CDC Central-Line Bloodstream Infection Prevention Efforts Produced Net Benefits Of At Least $640 Million During 1990-2008. Health Aff (Millwood). 2014 Jun;33(6):1040–7. 4.

Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L,

et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet. 2011 Jan 15;377(9761):228–41. 5.

Nugraheni R, Tono S, Winarni S. Infeksi Nosokomial di RSUD Setjonegoro

Kabupaten Wonosobo. MEDIA Kesehat Masy Indones. 2012;11(1):94–100. 6.

WHO | Public health surveillance [Internet]. WHO. [cited 2016 Dec 12].

Available from: http://www.who.int/topics/public_health_surveillance/en/ 7.

Magill SS MD, PhD, Edwards JR MStat, Bamberg W MD, Beldavs ZG MS,

Dumyati G MD, Kainer MA MB, BS, MPH, et al. Multistate Point-Prevalence Survey of Health Care-Associated Infections. N Engl J Med. 2014 Mar 27;370(13):1198–208. 8.

Suka M, Yoshida K, Takezawa J. Epidemiological approach to nosocomial

infection surveillance data: the Japanese Nosocomial Infection Surveillance System. Environ Health Prev Med. 2008 Jan;13(1):30–5. 9.

Morikane K. Infection Control in Healthcare Settings in Japan. J Epidemiol.

2012;22(2):86–90. 10.

Gaynes R, Richards C, Edwards J, Emori TG, Horan T, Alonso-Echanove J, et

al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis. 2001;7(2):295–8. 11.

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for quality. Infect Control Hosp Epidemiol. 1997 Jul;18(7):475–8. 12.

Mathai E, Allegranzi B, Kilpatrick C, Pittet D. Prevention and control of health

care-associated infections through improved hand hygiene. Indian J Med Microbiol. 2010 Apr;28(2):100–6.

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Knowledge and Attitudes Students of the Medical Faculty of the Christian University of Indonesian First Year Against Spread of Hepatitis B Among Health Workers

Joue Abraham*, Irma Lumbantoruan**, Syauqi Mirza*** *Universitas Kristen Indonesia – (+62) 81574924922, joueabraham@gmail.com **Universitas Kristen Indonesia – (+62) 81240292065 irmarebina@gmail.com ***Universitas Kristen Indonesia – (+62) 897889464035 saukimirza@gmail.com Abstrak Aim

: To identify the problem of service quality in healthcare department in

Indonesia and how to solve it. Background : Needlestick injuries is threatening danger for health professionals. Many diseases can be caused by this incident, such as Hepatitis B, Hepatitis C, even the most severe HIV / AIDS. Syphilis, Malaria and Herpes can also be transmitted through the incidence of needlestick injuries. A study showed that this happens due to the understanding of health workers on how to prevent the incidence of needlestick injuries. Understanding of diseases that can be transmitted through blood is also lacking. Their behavior in avoid needlestick injuries is also lacking, such as by closing the syringe. Medical students as a doctor at the future hold a big role to solve this problem. This medical error will give a bad impact to the quality of health service. Material and Methods: The research design is cross sectional. The criteria inclusion for sample is all Christian University of Indonesia medical students batch 2016. The criteria exclusion for sample is all Christian University of Indonesia which is have studied medical at another University before they studied at this university. Sampling was done by calculating 25% of the total population. The population was 172 persons, then the sample was 42 persons. .The research team used the google form in collecting the questionnaires because when this study was conducted to coincide with the holiday weekend. The data was processed with SPSS applications. Research team use google scholar, pubmed, healthline, and Medscape as search engine.

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  Results: Research team got 42 respondents. Based on research results, knowledge of respondents about the spread of hepatitis B virus among health workers overall is good with a percentage of 86.5% of 42 people. Respondents with poor knowledge got 13.5%. The attitude of the respondents about the spread of hepatitis B virus among health workers overall is good with a percentage of 87.4% of 42 people. Respondents with poor knowledge got 12.5%. Conclusion: The knowledge of medical students of Christian University of Indonesia in the first year about the spread of hepatitis B virus among health workers is good.

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Introduction Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with the blood or other body fluids of an infected person. An estimated 240 million people are chronically infected with hepatitis B (defined as hepatitis B surface antigen positive for at least 6 months). More than 686 000 people die every year due to complications of hepatitis B, including cirrhosis and liver cancer 1. Hepatitis B is an important occupational hazard for health workers. However, it can be prevented by currently available safe and effective vaccine. Hepatitis B among health workers is a public health concern, because it is associated with the quality of health service. Hepatitis B prevalence is highest in sub-Saharan Africa and East Asia, where between 5–10% of the adult population is chronically infected. High rates of chronic infections are also found in the Amazon and the southern parts of eastern and central Europe. In the Middle East and the Indian subcontinent, an estimated 2–5% of the general population is chronically infected. Less than 1% of the population of Western Europe and North America is chronically infected. Throughout the world, millions of healthcare professionals work in health institutions and it is estimated that 600,000 to 800,000 cut and puncture injuries occur among them per year, of which approximately 50% are not registered. In hospitals it is estimated that approximately 30 injuries occur per 100 beds per year. Hepatitis B virus (HBV) is the greatest threat of infection for healthcare workers (HCW). The risk of contracting hepatitis B by healthcare personnel is four times greater than that of the general adult population, among those who do not work in healthcare institutions. One of the most common modes of HBV transmission in the health care setting is an unintentional injury of an HCW from a needle contaminated with HBsAg-positive blood from an infected patient. Level of education, age of health care workers, knowledge about hepatitis B vaccinations, and working hours also have a contribute to incidence of needlestick injuries. This medical error have

a strong correlation with

quality of health service. A study showed that this happens due to the understanding of health workers on how to prevent the incidence of needlestick injuries. The understanding of diseases that can be transmitted through blood is also lacking. Their behavior in avoid needlestick injuries is also lacking, such as the right way to close the syringe.

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Methods The research design is cross sectional. The criteria inclusion for sample is all Christian   University of Indonesia medical students batch 2016. The criteria exclusion for sample is all Christian University of Indonesia which is have studied medical at another University before they studied at this university. Sampling was done by calculating 25% of the total population. The population was 172 persons, then the sample was 42 persons.The research team used the google form in collecting the questionnaires because when this study was conducted to coincide with the holiday weekend. The data was processed with SPSS applications. Results and Discussion The research took place in the faculty of medicine of the Indonesian Christian University obtained the respondents as many as 42 people. The questionnaire consists of two parts, namely knowledge and attitudes. Each - each section consists of 10 questions. In this study data will be presented in two parts. The first part is the knowledge and the second part is the attitude. Based on the results of data collection and processing has been done, then the results can be presented as follows:

Table 1. Knowledge of Health Workers Can Hepatitis B Virus Infected needles Through Thrift

Table 2. Knowledge Workers Mandatory Health Vaccinated Hepatitis B

Table 3. Knowledge When A Health Workers Not On Hepatitis B Vaccine

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  Based on Table 1, Table 2 and Table 3 the average knowledge of respondents overall was good with a percentage of 86.5% of 42 people. Respondents with poor knowledge was 13.5%. The knowledge of new students about the spread of hepatitis B virus among health workers is still good. Although there are some respondents who have less knowledge, but it is dominated by the respondents who have a good knowledge. This is because the respondents have had a lecture on hepatitis B virus from the microbiology.

Table 4. As future health professionals I should get vaccinated for Hepatitis B before entering the clinic

Table 5. As candidates for my health at risk for needle stick Used

Table 6. As a prospective health workers who will assist the delivery process, I at risk for blood that is not necessarily free of hepatitis B virus

Table 7. I Closes needles With One Hand, Not With Two Hands

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  Based on Table 4, Table 5, Table 6 and Table 7 the average knowledge of respondents overall was good with a percentage of 87.4% of 42 people. Respondents with poor knowledge was 12.5%. Although the respondents were new, they have a good attitude towards the spread of hepatitis B virus among health workers. Respondents who had a poor knowledge due not received instruction on how to take blood with a syringe. Also yet to get a lecture about universal precaution, but it is never mentioned in classes with other materials. Conclusion Based on existing research results can be concluded that the knowledge of first year student at the faculty of medicine of the Indonesian Christian University is good.

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Reference 1. Mueller A, Stoetter L, Kalluvya S, Stich A, Majinge C, et al. Prevalence of hepatitis B virus infection among health care workers in a tertiary hospital in Tanzania. Research Article. BMC Infectious Diseases (2015) 15:386. 2. Luiz A.S. Ciorlia, Dirce M.T. Zanetta. Hepatitis B in Healthcare Workers: Prevalence, Vaccination and Relation to Occupational Factors. Published literature. BJID 2005; 9 (October) 3. Zulfikar A Gorar, Zahid A Butt, Imrana Aziz. Risk factors for bloodborne viral hepatitis in healthcare workers of Pakistan: a population based case–control study. Downloaded from http://bmjopen.bmj.com/ on December 27, 2016 4. Elise M Beltrami, Ian T. Williams, Craig N Shapiro, Mary E Chamberland. Risk and Management of Blood-Borne Infections in Health Care Workers. Clinical Microbiolgy Reviews, July 2000, p. 385–407. Vol. 13, No. 3 5. Ann E. Rogers, Wei-Ting Hwang, Linda D. Scott, Linda H. Aiken, David F. Dinges. The Working Hours Of Hospital Staff Nurses And Patient Safety. Published literature. Health Affairs 23, no.4 (2004):202-212. 6. M Estryn-Behar, M Kaminski, E Peigne, N Bonnet, E Vaichere, C Gozlan, et al. Stress at work and mental health status among female hospital workers. British Journal of Industrial Medicine 1990;47:20-28. 7. Yoshihiko Y, Takako U, Maria I.L, Yoshitake H. Hepatitis B virus infection in Indonesia. World J Gastroenterol 2015 October 14; 21(38): 10714-10720. 8. Tanto C, Liwang F, Hanifati S, Pradipta EA. Hepatitis B. Kapita Selekta jilid II. 2014 9. Soemohardjo S, Gunawan S. Hepatitis B Kronik. Buku Dalam jilid II. 2014

Ajar Ilmu Penyakit

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Optimizing proper health workers quality towards healthcare service  

accessibility in remote and rural areas of Indonesia Ivany Lestari Goutama Faculty of Medicine, Universitas Tarumanagara, Jakarta, Indonesia

Abstract Aim: The aim of this study was to embrace medical students and healthworkers to be aware of current dimensions of health service failure occuring in remote and rural areas and identify the answer key to the problems by improving own retention. Background The remote and rural settlements often have to experience barriers to healthcare that limit their ability to get the care they need, such as distance, difficulties to attract proper health workers and need for an interpreter. Approximately one half of the global population lives in rural areas by only with 38% of the total nursing workforce and by less than a quarter of the total physician workforce. In 2006, World Health Organization (WHO) reported that Indonesia was among 57 countries suffering a critical shortage of health workers, with a health workforce ratio of less than 2.5 per 1000 population. In March 2016, Ministry Of Health (MOH) also mentioned that to achieve the availability of health care facilities, accessibility and quality of health services, requires not only from the government but also the strengthening of the health services and society in all parts of Indonesia. Material and Methods The study was conducted in Bengkulu province, Sumatra, Indonesia. A technique of convenient sampling was employed since a sampling frame of hospital patients could not be accessed by researchers. Three hundreds selfadministrated questionnaires were distributed to hospital patients and 300 questionnaires were returned and analyzed for the study. The variances in the full set of the 20 service failure variables are displayed in Table 1 that attribute to the six-factor solution, which is medical reliability (F1), physical evidence failure (F2), poor information (F3), medical treatment errors (F4), costly services (F5), complaint handling (F6). The cumulative value of total variance was 63.26%.

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Results   The result of the study clearly indicates that there are the underlying dimensions of

service failures in the healthcare services in Indonesia. It is important to study patient complaint behavior and conduct its recovery strategy to match the need of patients. Further analysis should be conducted. Further analysis should be conducted. Conclusion: To achieve the proper health service towards the rural and remote settlements, all parts of society (government, health services, patients) must collaborate in eliminating the service failures to achieve the optimal health care service, not only for the urban societies, but also for all. Conclusion To achieve the proper health service towards the rural and remote settlements, all parts of society (government, health services, patients) must collaborate in eliminating the service failures to achieve the optimal health care service, not only for the urban societies, but also for all.

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Optimizing proper health workers quality towards healthcare service accessibility in remote and rural areas of Indonesia Ivany Lestari Goutama Faculty of Medicine, Universitas Tarumanagara, Jakarta, Indonesia Introduction Access to healthcare service is critical for remote and rural residents in Indonesia.1,2,3 As health may become one of the main priority in life, patients are reluctant to take a risky decision, that even some of them are willing to pay high prices to get a quality service of healthcares.2 A wide range of health services exist in most of the urban and regional center, however they are not necessarily accessible. For the remote and rural settlements, they often have to experience barriers to healthcare that limit their ability to get the care they need such as physical distance from a health service, the difficulties in attracting proper health workers (doctors and nurses) to remote work locations and sometimes the need for an interpreter.3 Almost all countries get affected by this global problem. Approximately one half of the global population lives in rural areas by only with 38% of the total nursing workforce and by less than a quarter of the total physician workforce.2 In Bangladesh, for example, 30% of nurses are located in four metropolitan districts where only 15% of the population lives.2 Meanwhile, in South Africa, 46% of the population lives in rural areas, but only 12% of doctors and 19% of nurses are working there. In 2006, World Health Organization (WHO) reported that Indonesia was among 57 countries suffering a critical shortage of health workers with a health workforce ratio of less than 2.5 per 1000 population2. A study conducted by Indonesia’s Ministry of Health (MOH) in 2006 found that more than 50% of community health centers in remote areas were without medical doctors, compared with approximately 10% in non-remote areas.3 By improving four aspects of education, regulation, financial incentives, until personal and professional support,WHO states that these interventions may potentially be the answer of the problem for health services in remote and rural areas.2 MOH (March, 2016) also mentioned that the major concern of health priority programs and the implementation of Healthy Living Society Movement (GERMAS) to achieve the availability of health care facilities, accessibility and quality of health services, requires not only from the government but also the strengthening of the health services and embracing society from all parts of Indonesia.3

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Material and Methods   Comprehensive literature review for this research was undertaken. The origin of the 20 service failure 3 variables was adopted from the works of Bitner, Booms, and Tetreault (1990), Sargeant and Kaehler (1997), and Lewis and Spyrakopoulos (2001).4 The primary study was conducted in four cities in Bengkulu province, Southwest Sumatra, Indonesia.4 The province has a population of 1.9 millions and can be considered representative of the social strata existing in the wider Indonesian society. A technique of convenient sampling was employed since a sampling frame of hospital patients could not be accessed by researchers. Three hundreds self-administrated questionnaires were distributed to hospital patients and 300 questionnaires were returned and analyzed for the study. Patients or patient families were approached in the state hospitals in Bengkulu province. The researchers were interested to see whether patient perceptions of hospital service failures could be reduced and grouped into a smaller number of underlying factors.4 Prior to the extraction of factors, Bartlett test of Sphericity and the KMO measure of sampling adequacy confirmed that there was sufficient correlation among the variables to warrant the application of factor analysis. The next step in a factor analysis was to determine the number of factors to extract from the dataset. It was decided to follow the convention in selecting factors that account for variances (eigenvalue) greater than one. Factors with a variance less than one are no better than a single variable, since each variable has a variance of one (Hair et al., 1995). The eigenvalues are displayed in the penultimate row of Table 1. The eigenvalue suggests a six-factor solution. The last row of Table 1 shows the percentage of variance in the full set of the 20 service failure variables that can be attributed to the six factors. The cumulative value of total variance explained by the six-factor solution was 63.26%. Thus, a model with six factors was considered to be adequate to represent the data. The significant correlations between factors and statement variables are displayed in Table 1. A cut-off value of .50 (for correlation coefficients to be regarded as significant and to be included in the table) was applied. The cutoff value of .50 was considered to be sufficient since the sample size of the survey is bigger than 300 (Hair et al., 1995). Of the 20 service failure variables employed, one variable was excluded from the table because of its low correlation coefficient. The variable excluded was unfriendliness of doctors and paramedics in dealing with patients.

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Table 1: Rotated Component Matrix for Service Failure Variables

Factor 1: Medical reliability failure This factor exhibits the largest number of significant correlation coefficients. Factor 1 has heavy loadings for five variables mainly relating to incompetence of doctors and paramedics in dealing with patients. Four of the five variables in the factor reflect service failure in hospital related to doctor’s failures in dealing with patients. Inadequate skills of doctors, doctor mistake in medical treatment, doctor is in a rush in dealing with patients, and doctor is slow are service failure variable that count for this dimension. The result of the study suggests that hospitals in the country fail to maintain reliability aspect in providing services to patients. Factor 2: Physical evidence failure Factor 2 has heavy loadings for four variables pertaining to the physical evidences of services in hospital industry. The service failure variables that have a high correlation with this factor are limited number of doctors and paramedics, lack of medical facilities, and untidiness of the hospital. Therefore, the factor was name accordingly.

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  Factor 3: Poor information Factor 3 is characterized by two variables that reflect patient difficulties in finding information regarding medical treatment and patient difficulties in getting prescribed medication in the hospital drugstore. Factor 4: Medical treatment errors Factor 4 has heavy loadings on three variables that reflect medical treatment errors in the hospital service delivery. Individual scoring highly on this factor would tend to be concerned with diagnose errors conducted by doctors. They would also be concerned with the slow serviced provided by the medical staff. They felt that they did not have significant improvement after treatment and medication. The factor has thus been labelled “medical treatment errors�. All variables pertinent to this factor reflect service process failures. It is quite understandable since technical outcome of hospital services is difficult to be evaluated in a short period. Therefore, patients tend to judge the process of services provided by doctors and paramedics. Factor 5: Costly services The factor has been named accordingly since the three variables were related to extra cost associated with the services provided and the non-monetary cost related to the service. Patients perceived that administrative process is time consuming and they did not appreciate extra cost associated with the services provided by the hospital. Factor 6: Complaint handling failure Factor six relates to the hospital failure in handling patient complaints. Most patients perceived that hospitals are slow in handling their complaints. Patients also believed that hospital do not provide a value-for money service. They believed that cost of hospital is to expensive relative to the service provided.

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  Result

Table 2. Final Cluster Centres of Service Failures

Cluster 1: Demanding Segment (40.14% of the sample) Members of this cluster perceived that hospitals fail to deliver quality services for medical reliability, access to medical information, costly service, and the way the hospital handle patient complaints. Patients have negative opinions about the quality of services related to the four dimensions of hospital service quality. On the other hand, members of this cluster perceived that physical evidence and medical treatment were relatively fine. Cluster 2: Complainer (25.51% of the sample) Members of the segment have negative opinions on almost all dimensions of service quality delivered by the hospital. Of the six dimensions of the hospital services provided, only the dimensions of complaint handling was perceived positively by members of the segment. In other words, members of the segment perceived the quality of services provided by hospitals was below their expectations. Cluster 3: Salient patient (34.35% of sample) Patients in this group have positive opinions on four dimensions of hospital service delivery of medical reliability, information, costly service, and complaint handling approach. However, individuals who belong to the segment have negative perceptions of the quality of medical treatment conducted by doctors or paramedics. The result of the study clearly indicates that there are the underlying dimensions of service failures in the healthcare services in Indonesia’s remote and rural areas. It would be appealing to attempt an improvement of the service process and service delivery in the health services. It is also important for the health care service to study patient complaint behaviour and conduct its recovery strategy to match the need of patients. Further analysis should be conducted to profile segments found based on other variables such as demographics and patient behavior.

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Discussion   Indonesia's rural and remote areas present a tremendous challenge concerned with health service delivery. For instance, it is difficult to place doctors on remote islands or in mountainous or forest locations, and rural and remote areas suffer from a shortage of all essential health workers. Of those health workers willing to serve in such areas, generally their period of service is very short term. The reasons for this include communication difficulties, lack of basic and social facilities, low salary, low or no compensation, high living costs, lack of security and unclear career options. Therefore, interventions are needed in order to overcome the problem. However, the problems itself are yet to be solved unless there is a mutually cooperation of all healthcare services, government and society in attempt to make all work out. WHO suggests four main categories concerned to be the preventive and promotive effort towards the challenges, which are implementing on the education starts from the medical undergraduates and graduates by demonstrating the current situation in studies to start increasing the awareness until the health professionals by inviting them to involve, evaluating the regulatory system, optimizing the financial incentives, and embracing professional and personal support.

Table 3. Categories of interventions used to improve attraction, recruitment and retention of health workers in remote and rural areas2

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  Conclusion To achieve the proper health service towards the rural and remote settlements, all parts of society (government, health services, patients) must collaborate in eliminating the service failures to achieve the optimal health care service, not only for the urban societies, but also for all. By improving four aspects of education, regulation, financial incentives, until personal and professional support,WHO states that these interventions may potentially be the answer of the problem for health services in remote and rural areas.

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Recovery,Cranfield School of Management, Cranfield. 1995 2.

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Kesehatan Jadi Perhatian. 2016. Available from http://www.depkes.go.id/article/print/ 16040400004/menkes-penguatan-layanan-kesehatan-jadi-perhatian.html. 4.

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Implementation of Computerized Physician Order Entry (CPOE) System in

Reducing Medication Errors Authors: Andre Thadeo Abraham, Aulia Budi Agustin, Yosefina Sonia Christya Kartika Universitas Sebelas Maret, Surakarta Aim: The aim of this study is to explain benefits of CPOE system in improving health care service by reducing medication errors. Background: Medication errors can be caused by many factors, such as staff shortages which leads to heavy workload, doctor/nurse distraction, and misinterpretation of the prescription or medication chart. Therefore, it might be expected that the larger the amount of prescriptions, and the more steps in the prescribing procedure, the higher the risk of error. Computerized physician order entry (CPOE), an application of Health Information Technology (HIT) system, is any system in which clinicians enter order for medications, laboratory tests, consultation, or procedures into an electronic system. The order is then transmitted directly to the recipient responsible for carrying out the order, e.g. the pharmacy, laboratory, or radiology department. CPOE is an electronic form of physician’s order, therefore the system is expected to minimize human errors in delivering health service, including medication errors. Because the implementation of CPOE in Indonesia is very rare, the existing data regarding adoption of this system is very little. This is caused by some obstacles, which are ranging from system interoperability between the units or between the departments in the health care sector or hospitals, to regulatory issues. Material and Methods: The literatures relating to CPOE in reducing medication errors were reviewed in December 2016-January 2017 by using PubMed and Cochrane database. The keywords used were “CPOE” OR “Computerized Physician Order Entry” AND “Medication Errors”. Inclusion criteria for this review were articles published from 2011-2016 and articles that written in English. Reviews were excluded from this literature review. 82

  Results:

12 articles from 129 articles from PubMed and 2 articles from 15 articles from Cochrane met the inclusion criteria for this review. Literatures included in this literature review show that CPOE can reduce medication errors significantly. Implementation of CPOE in some literatures also shows increased time- and costefficiency in health care services. Conclusion: CPOE system has shown the potentials to reduce medication errors.

Reduced

medication errors will generate more effective medication thus improving health services. Adoption of CPOE system has been recommended as comprehensive process to provide patient safety. Implementation of CPOE system can be integrated with other systems to improve the quality of treatment.

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  Implementation of Computerized Physician Order Entry (CPOE) System in

Reducing Medication Errors Authors: Andre Thadeo Abraham, Aulia Budi Agustin, Yosefina Sonia Christya Kartika Universitas Sebelas Maret, Surakarta Introduction Medication error according to National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) is "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labelling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use".(1) It can occur in every step of medication process.(2) These medication errors can be caused by many factors, such as staff shortages which leads to heavy workload, doctor/nurse distraction, and misinterpretation of the prescription or medication chart.(3) Therefore, it might

be expected that the larger the amount of

prescriptions, and the more steps in the prescribing procedure, the higher the risk of error.(4) Medication error is a worldwide issue, but most studies on medication error have been undertaken in developed countries and very little is known about medication error in Southeast Asian countries.(3) Medication errors, in United States of America, are estimated to influence more than 7 million patients, causing up to 7000 death, and cost more than U$20 billion annually.(5) A study in a geriatric ward in public hospital in Bali, reported that medication error occurs in 20.4% of medication process.(6) According to the theories of human error, errors in prescribing, as in any other complex and high-risk procedure, are occasioned by and depend on failure of individuals, but are generated, or at least facilitated, by failures in systems.(4) Therefore, preventing medication error by targeting system is more effective compared to individuals.(7) Health information technology (HIT) systems are key aspect of medical technology. These systems are meant to enable greater cost savings, efficiency, and eventually improved patient outcomes.(8) Computerized Physician Order Entry (CPOE), an application of HIT system, is any system in which clinicians enter order for medications, laboratory tests, consultation, or procedures into an electronic system. The order is then transmitted directly to the recipient responsible for carrying out the order, e.g. the pharmacy, laboratory, or radiology department.(9,10) CPOE is an electronic form of physician’s order, therefore the system is expected to minimize human errors in delivering health service, including medication errors.(2)

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Implementation of CPOE in Indonesia is very rare, the existing data regarding adoption of this system is very little. This is caused by some obstacles, which are ranging from system 
 interoperability between the units or between the departments in the health care sector or hospitals, to regulatory issues.(9) The aim of this study is to explain benefits of CPOE system in improving health care service by reducing medication errors. Method The literatures relating to CPOE in reducing medication errors were reviewed in December 2016-January 2017 by using PubMed and Cochrane database. The keywords used were “CPOE” OR “Computerized Physician Order Entry” AND “Medication Errors”. Inclusion criteria for this review were articles published from 2011-2016 and articles that written in English. Reviews were excluded from this literature review. Result 12 articles from 129 articles from PubMed and 2 articles from 15 articles from Cochrane met the inclusion criteria for this review. Literatures included in this review show that CPOE can reduce medication errors significantly. Implementation of CPOE in some literatures also shows increased time- and cost- efficiency in health care services. CPOE in Reducing Errors and Increasing Patient Safety Medication error can be classified into administration error, prescribing error, preparation error, transcribing error, and dispensing error.(3) There are 7 of 12 literatures showing reduced medication errors using CPOE. Groups of errors showing be reduced by using CPOE are administration error and prescribing error. Prescribing error is any error in the prescribing process that can harm the patient safety.(11) The most common reduced medication errors are prescribing error, ranging from 36.2% to 94%. Inappropriate dose, inappropriate route and unclear prescription are the most frequent error in prescribing process.(12) Dosage errors commonly caused by omitted data, omitted dose of figures and omitted unit measurement.(13) In pediatric institution, CPOE performed best when identifying drug-allergy interactions, with over 99% errors prescription detected.(14) Compared to paper-based order entry, CPOE gives better result, a study showed increasing order with zero opportunities of error by 56%.(15) There is only one study examining effect of CPOE to administration errors. The study reported 17.5% reduced errors at administration stage. Significant result of CPOE intervention is shown at reducing errors related to unordered drug, incorrect dosage, and reaching wrong patient. (12)

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The CPOE system could eliminate almost majority of medication error.(16) Integrating CPOE with basic Clinical Decision Support System (CDSS) will give better performance, especially   in medication with special condition such as renal insufficiency.(14,17) Alerts system in CDSS increased formulary adherence to therapeutic protocols thus increased efficiency and improve medication safety.(18) Eventhough implementation of CPOE was associated with reduced medication error, there were some minor errors caused by CPOE, such as duplicated therapies.(12) CPOE also develop new types of errors that never present in paper-based prescribing, for example are typographical errors and menu selection errors.(15) However, new types of errors will not be generated when physicians become accustomed with the new systems.(16) CPOE in Providing Time-Efficient Medication Implementation of CPOE increases time efficiency in processing prescription and duration for treatment.(19,20) A study by Han et al. (19) showed medication orders made without CPOE required pharmacist intervention were 8 times greater, thus turn over time for orders made with CPOE are decreased by 58.8 minutes. Use of CPOE in Medical Intensive Care Unit (MICU) resulted in decreased patients’ length of stay (LOS) from 4.03 days to 3.26 days. (20) Increased time efficiency is caused by elimination of medication errors related to wrong dosage forms and formulary issue.(19) CPOE in Providing More Cost-Effective Medication Adoption of CPOE in the ambulatory setting of midsize group practices is a cost-effective strategy to improve medication safety. In a study held on the Everett Clinic to estimate the cost-effectiveness of CPOE in the ambulatory setting from the year 2011 to 2014, the CPOE strategy cost $18 million less than paper-based prescribing and is associated with 1.5 million fewer errors and 14,500 fewer Adverse Drug Events (ADEs).(21) Not only by avoiding errors and ADEs, but the dominance of CPOE system is also maintained by modeling medical groups with small numbers of providers. The number of primary care providers is a large driver of costs; so is their salary, the number of prescriptions per year, and, again, the number of chart pulls.(21) The cost-utility analysis reported in an article by Nuckols et. al. (22) estimated, for acute care hospitals with at least 25 beds, the probability that implementing CPOE as a component of an EHR (Electronic Health Record) system would be cost saving or costeffective, relative to using paper ordering systems. Across a range of reported estimates of CPOE implementation costs, the probability that CPOE would generate savings in addition to improving health outcomes exceeds 70% to 99%. Implementing CPOE could generate an average of $11.6 million to $170 million and 20 to 249 QALYs (quality-adjusted life-years) per hospital, depending on hospital size.

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  Further Development of CPOE For preformance improvement, CPOE can be integrated with CDSS. This sytem provide more beneficial impact such

as an advisor to provide guidance on initial dosing and

monitoring included drug-allergy interactions, dosing limits (both daily and cumulative), and inappropriate routes of administration.(14,23) The most common type of CDSS tool used to prevent prescribing errors is alerting that directed to all stages of the medication process, including prescribing, ordering, dispensing, and administration.(24) CPOE associated with CDSS will be more effective with some training for users to prevent another kind of errors that could occurs from insufficient skills level of technology.(25) Discussion Medication errors are shown to be a crucial issue in health services. Any errors regarding medication can cause harm not only to patients, but also to the health care providers who would take the responsibility. It is an important thing to implement CPOE in hospital so that it can minimize preventable medication errors, serving safer and more effective medication. Other systems, such as Clinical Decision Support System (CDSS), should be integrated with CPOE to generate even more successful system. Integration with CDSS gives CPOE system a better performance. A study using CDSS for evaluating and monitoring antibiotic treatment shows the system could detect antibiotic overdose, reducing ADEs. The CPOE system implementation progress in Indonesia has not shown a significant improvement, eventhough the users of CPOE system had had perception of its benefits.(9) It proves that CPOE system adoption will take process. Further studies should be conducted to find how to provide the most effective way of CPOE system implementation in Indonesia. Conclusion CPOE system has shown the potentials to reduce medication errors. Reduced medication errors will generate more effective medication thus improving health services. Adoption of CPOE system has been recommended as comprehensive process to provide patient safety. Implementation of CPOE system can be integrated with other systems to improve the quality of treatment. Conclusion CPOE system has shown the potentials to reduce medication errors.

Reduced medication

errors will generate more effective medication thus improving health services. Adoption of CPOE system has been recommended as comprehensive process to provide patient safety. Implementation of CPOE system can be integrated with other systems to improve the quality of treatment.

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Opportunity. Compact action Br A Roadmap increasing Value Heath Care [Internet]. 2010;(December). Available from: http://www.nehi.net/bendthecurve/sup/documents/ Medication_Errors_ Brief.pdf 6.

Ernawati DK, Lee YP, Hughes JD. Nature and frequency of medication errors in a

geriatric ward: An Indonesian experience. Ther Clin Risk Manag. 2014;10(1):413–21. 7.

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decade of progress in patient safety. J Clin Anesth. 2000;12(0):600–14. 8.

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Health Inform [Internet]. 2012;4(3). Available from: http://www.pubmedcentral.nih.gov/ articlerender.fcgi?artid= 3615836&tool=pmcentrez&rendertype=abstract 9.

Asyary A, Kusnanto H, Fuad A, Kesehatan F, Universitas M, Sistem J, et al. Sistem

Peresapan Elektronik pada Keselamatan Pengobatan Pasien Computerized Physician Order Entry on Patient Medication Safety. Kesehat Masy Nas. 2013;8 N0.23:125–32. 10.

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Making health care safer II: an updated critical analysis of the evidence for patient safety practices. Evid Rep Technol Assess (Full Rep) [Internet]. 2013;(211):1–945. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24423049 11.

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Computerized physician order entry in the cardiac intensive care unit: Effects on prescription errors and workflow conditions. J Crit Care. 2014;29(2):188–93. 14.

Chaparro JD, Classen DC, Danforth M, Stockwell DC, Longhurst CA. National trends

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Empowerment for Breast Cancer Patient with Online Cancer Support Group Mokhamad Fahmi Rizki S1, Fransisca Dela Verna2, Nadia Annizar3

University of Brawijaya

Aim: Influence empowerment breast cancer patient using the online cancer support group to psychological patients. Background: Breast cancer is the most common cancer in women both in the developed and less developed countries. Diagnosed with breast cancer and getting treatment is a very traumatic experience with the physical and psychological impact which often led to depression, changes in physical appearance, and decreased quality of life. Method: We conducted a systematic review and Inclusion and Exclusion Criteria to identify existing online cancer group potential to support patient empowerment in breast cancer patient. we using three main search engines, NCBI and Sciendirect, Pubchem. The combinations of terms used for the search included “Empowerment”, “Breast cancer”, “Online” ,”Support”. Limits were applied and only studies published in the last 15 years (2001-2016), and written in English were included. Studies outside of the ten year range were excluded to avoid subjectivity and bias in conducting this review. Result: We can divide the empowerment program into 3 categories, which are, information, beliefs, and skills. Online cancer support groups have an important role in empowering patients by educating service and patient to patient service about breast cancer. Patients can obtain information about breast cancer, treatment and possible effects of long term and short term. In the online cancer support group of breast cancer, patients receiving the emotional support is more likely to keep participating, while patients who received the support of information are more likely to drop out. Conlcusion: Social support can reduce the level of loneliness, stress and anxiety. Internet-based education programs are also useful to meet the information needs of patients. The use of internet and communications technology increases, it can be beneficial to health services. The Internet can be a tool to educate and empower breast cancer patients. Peer to peer support groups can help breast cancer patients to exchange information and emotional support. In the online cancer support group of breast cancer, patients receiving the emotional support is more likely to keep participating, while patients receiving information support are more likely to drop out. Further efforts to identify breast cancer survivors who need pyschosocial support is needed. The development of Internet-based education and support is important to improve breast cancer patients.

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Key  word: Breast cancer, Empowerment, online support group Author : 1Mokhamad

Fahmi Rizki S

087856844298 mokhamadfahmi@yaoo.com 2Fransisca

Dela Verna

081617132866 delaverna@gmail.com 3Nadia

Annizar

085741066582 annizarnadia@gmail.com

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Empowerment for Breast Cancer Patient with Online Cancer Support Group

by: Mokhamad Fahmi Rizki S. batch 2015 Fransisca Dela Verna batch 2015 Nadia Annizar batch 2015

FACULTY OF MEDICINE BRAWIJAYA UNIVERSITY MALANG 2016

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Introduction Cancer is the leading cause of morbidity and mortality due to malignancy worldwide. Based on data from the World health Organization (WHO) in 2012 there were 14 million new cases and 8.2 million people died of cancer. Cancer is a chronic disease caused by abnormalities in the process of uncontrolled cell division. Breast cancer is the most common cancer in women both in the developed and less developed countries. It is estimated that over 508.00 women worldwide died in 2011 due to breast cancer (Global Health Estimates, WHO 2013). Although breast cancer is thought to be a disease of the developed countries, almost 50% of breast cancer case and 58% of deaths occur in less developed countries. Usually patients with cancer felt shocked and tremendous concern after being diagnosed with cancer. At the beginning most would feel difficult to accept that she was suffering from cancer so they do not have spirit to live. Patients with cancer need strong support so they can keep the spirit to live. Empowerment has Important Role to support and educate cancer patients. Empowering interventions providing face-to-face support to patients require substantial resources and effort. A promising approach is the use of information technology (IT), which enables the provision of easily accessible, up-to-date, tailored information and automated feedback to patients. Many empowering Web-based interventions have been developed in the field of chronic diseases (eg, diabetes, heart failure, and chronic obstructive pulmonary disease), but relatively few seem to have been developed for, and rigorously tested in, cancer survivors (Kuijpers et all., 2013). Support can play a critical role in a cancer patient’s well-being and medical outcome (Klemm, et al., 2003). Research also indicates that social support can reduce psychological distress in cancer patients and increase the prospects of recovery (Taylor, et al., 1986). One study found that subjects who experienced weekly support groups reported less stress, tension, fatigue, fewer maladjusted coping responses, fewer phobias, and more vigor (Taylor, et al., 1986, pg. 608). Some researchers conceptualize illness as a social experience, suggesting that the suffering cancer patients experience “elicits intense emotions and the desire to talk to others� (Davison, Pennebaker, & Dickerson, 2000, pg. 205). As more people are diagnosed with various types of cancer and are turning to the internet for support, the demands of online support communities are increasing quickly (Blank & Adams-Blodnieks, 2007). As a result of empowering support cancer patient can achieve a better quality of life. The positive result can be seen as patients have less anxiety and have control over their situation in life in spite of illness (treacy et all., 2000). For instance, a breast cancer patient can be more empowered, has spirit to live and has a better quality of life if she can learn how to manage with side effects of her condition.

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This study is to explore the contribution of existing online cancer group to promote Reviews their empowerment in breast cancer patient. This can guide the development of innovative and sustainable eHealth services that may improve empowerment in breast cancer patient care. Research Methodology 2.1 Search Strategies A Systematical literature search to existing online cancer group potential to support patient empowerment in breast cancer patient. It was searched in Desember 2016 using three main search engines, NCBI and Sciendirect, Pubchem. The combinations of terms used for the search included “Empowerment”, “Patient”, “Breast cancer ” , “Online” ,”Support”. Limits were applied and only studies published in the last 10 years (2001-2016), and written in English were included. Studies outside of the ten year range were excluded to avoid subjectivity and bias in conducting this review. 2.2 Inclusion and Exclusion Criteria Inclusion Criteria: • Empowerment breast cancer • Online support breast cancer • Studies published in the last 15 years • Literature written in English Exclusion Criteria: • Not online support • Other Languange than English Result and Discussion 3.1 Research Findings The initial search that was conducted yielded a total of 78 trials. After reading the titles, 68 results were excluded as they did not fulfill the inclusion criteria, and a further 2 trials were excluded after reading the abstract. From the resulting 8 texts, 3 did not have a full available article. Thus, a total of 5 resulting trials were used. This information can be seen in the flow chart below:

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Tabel 1. Experimental studies of online peer support groups

Some studies show that cancer online support has a positive impact to psychologic patients. The results of some of the literature review indicates that online cancer support can decrease depression and improve the quality of life of patients.

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  Component empowerment process

Figure 1. learning component of the empowerment process (Stang, et all, 2009).

Empowerment processes connected to learning consciousness raising, acquisition of objective knowledge, learning from others’ experiencesand, discovery of new perspectives about life and aboutself. Learning as an empowerment process is depicted in Fig. 1. Even if the steps may appear as a simple process in the diagram, the learning component of empowerment in these self-help groups was experienced as an integrated, inter-twined and cyclical process. In the presentation below all names are fictitious. Empowerment need breast cancer patient

Figure 2. Categories and Sub-Categories of Empowerment Needs Breast Cancer patient (Salzer

al. (2010)

et

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  Education and empowerment program divide into 3 categories, which are, information, beliefs, and skills. Empowerment seems to be a sort of new concept for the breast cancer patient. Breast cancer is no longer a regarded as a deadly disease. Breast cancer survivors require support and care even after the treatment has finished. The are information such as complications treatment choices, how to prevent and reduce such complications, exercises choices, and diet information, breast reconstruction, sexual counseling information, and breast cancer peer group information. Information as an initial educative and empowerment program need to be comprehensive, easy to assess, continuous, and coordinated. The second category, beliefs also play the important role for the empowerment of breast cancer patients. Faith in God gives patients a special power and motivation to live. Faith in medical team and oneself is also important to keep the patient alive. The third category, skills is important for the breast cancer patient to express feelings, and questions, and use the internet. Patient who were able to get information and answers from the Internet, felt more empowered. Topics of post breast cancer patient

Fig 3. Frequencies of topics of posts, stratified by breast cancer stages of authors (Zhang et al, 2016)

Website early stage users more frequently focus on topics of posts about cancer diagnosis and health systems. While stage IV users more frequently focus on personal life discussion. Although different cancer stages website users have different focus of topics, they are becoming more interested in personal life discussions as they participate. The stage IV website users make the most of the forum for exchange emotional support.

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Empowerment need breast cancer patient

Owen et, all (2005) shown that greater expression of sadness is associated with improvements in overall quality of life (r = .49, p = .023). Greater expressions of anxiety, sadness, and overall negative affect are associated with emotional well-being improvement (rs =.50–.61, ps = .005–.02). Greater expression of anxiety and sadness, but not anger or overall negative effect, is associated with reductions in intrusive cancer-related thoughts (rs = .47–.60, ps = .004–.02). Role of empowerment online cancer support Educational services Online cancer support groups have an important role in empowering patients by educating patients about breast cancer. Patients can obtain information about breast cancer, treatment and possible effects of long term and short term. Thus, patients may prevent side effects and long term effects in healthy lifestyle behaviors than other breast cancer patients experience. Of course, the role of health care providers can not be separated to educate breast cancer patients. the beneficial effects of a cancer support group online services relating to the empowerment of patient education include increasing the level of knowledge, skills development through better decision making, increase the level of satisfaction, and quality of life better. However, a number of high-quality studies that support is still limited studies (Groen, et all, 2015).

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  Patient-to-patient services Patients services such as online support groups where pasine can exchange experiences with fellow patients and inquired about the most disturbing issues reviewed them. The service is quite structured and quality of feedback may be limited As a fellow patient may not have the proper medical knowledge. service patients may Contributing empowerment through increasing autonomy, because patients can ask questions about the issues that most bother reviewed them, and through increasing knowledge of the disease to other patients who are already suffering from the disease. In addition, it can improve the perception of support from the community, in this case a fellow patient because they do not feel alone suffer from the disease. For the moment there are some studies claiming effectiveness with regard to the empowerment of patients using an online support group. The results of controlled studies range from a positive effect on depression, trauma and perceived stress. Even some literature also have positive results on the quality of life of patients. However, some literature also says there is no effect, and even have a negative effect on psychosocial stress and quality of life (Groen, et all, 2015). Health benefits in online support groups for breast cancer Patients Diagnosed with breast cancer and getting treatment is a very traumatic experience with the physical and psychological impact which often led to depression, changes in physical appearance, and decreased quality of life (Ganz, 2000). These symptoms can cause intense emotions in breast cancer patients. facilitate their desire to talk with others experiencing similar problems is important. Online support groups, as well as face-to-face groups of traditional, widely used among women with breast cancer (Fogel et al., 2002). Breast cancer has the highest ratings in the frequency of posting grouped online (Davison, Pennebaker, and Dickerson, 2000). Several studies have assessed the effects of participation in online support groups for breast cancer patients and found that it can improve mental health and quality of life. These benefits are understood as coming from the exchange of supportive communication between patients. To better understand these benefits. Online support groups may be an open context in which to express one's thoughts and feelings, especially breast cancer patients.

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Conclusion The research objective of this review is to look at the use of the Internet to educate and empower breast cancer patients. It is clear that from the research review that the use of the Internet for breast cancer patients associated with social support. Social support can reduce the level of loneliness, stress and anxiety. Internet-based education programs are also useful to meet the information needs of patients. The use of internet and communications technology increases, it can be beneficial to health services. The Internet can be a tool to educate and empower breast cancer patients. Peer to peer support groups can help breast cancer patients to exchange information and emotional support. According to (Wang et all), in the forum of breast cancer patients, patients receiving the emotional support is more likely to keep participating, while patients receiving information support are more likely to drop out. Primary health care has not made a peer to peer group letting patients share their own experiences to other breast cancer. Through this review, we conclude that the main challenge in this case based on the education and empowerment of the Internet is the need of innovation. For further research, researchers need to be identified source of support and the patient's needs by knowing the characteristics of the patient. Through this review, we have revealed the need to develop more research on breast cancer patient education and empowerment-based internet. Further efforts to identify breast cancer survivors who need pyschosocial support is needed. The development of Internetbased education and support is important to improve breast cancer patients.

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REFERENCES 1.

Ana Porroche-Escudero. Perilous equations? Empowerment and the pedagogy of fear in breast cancer awareness campaigns. Women's Studies International Forum, Volume 47, Part A, November–December 2014, Pages 77-92

2. Anne M. Ryhänen, Sirkku Rankinen, Mervi Siekkinen, Maiju Saarinen, Heikki Korvenranta, Helena Leino-Kilpi. The impact of an empowering Internet-based Breast Cancer Patient Pathway programme on breast cancer patients’ knowledge: A randomised control trial. Patient Education and Counseling, Volume 88, Issue 2, August 2012, Pages 224-231 3. C.S. Bond, M. Merolli, O.H. Ahmed. Patient Empowerment Through Social Media. Participatory Health Through Social Media, 2016, Pages 10-26 4. Ellen L. Rubenstein. Rituals of introduction and revolving roles: Socialization in an online breast cancer community. Library & Information Science Research, Volume 37, Issue 4, October 2015, Pages 353-362 5. Grietje Bouma, Jolien M. Admiraal, Elisabeth G.E. de Vries, Carolien Annemiek M.E. Walenkamp, Anna K.L. Reyners. Internet-based support alleviate psychosocial and physical symptoms in cancer patients: analysis. Critical Reviews in Oncology/Hematology, Volume 95, Issue Pages 26-37

P. Schröder, programs to A literature 1, July 2015,

6. H.Sharon Campbell, Marie Rose Phaneuf, Karen Deane. Cancer peer support programs—do they work?. Patient Education and Counseling, Volume 55, Issue 1, October 2004, Pages 3-15 7. Jiyon Lee, Lara A. Hardesty, Nathan M. Kunzler, Andrew B. Rosenkrantz. Direct Interactive Public Education by Breast Radiologists About Screening Mammography: Impact on Anxiety and Empowerment. Journal of the American College of Radiology, Volume 13, Issue 1, January 2016, Pages 12-20 8. Myung Kyung Lee, Young Ho Yun, Hyeoun-Ae Park, Eun Sook Lee, Kyung Hae Jung, Dong-Young Noh. A Web-based self-management exercise and diet intervention for breast cancer survivors: Pilot randomized controlled trial. International Journal of Nursing Studies, Volume 51, Issue 12, December 2014, Pages 1557-1567 9. Richard L. Street Jr., Gregory Makoul, Neeraj K. Arora, Ronald M. Epstein. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Education and Counseling, Volume 74, Issue 3, March 2009, Pages 295-301 10. Yvonne Kiera Bartlett, Neil S. Coulson. An investigation into the empowerment effects of using online support groups and how this affects health professional/ patientcommunication. Patient Education and Counseling, Volume 83, Issue 1, April 2011, Pages 113-119 11. https://www.ncbi.nlm.nih.gov/books/NBK215943/ Institute of Medicine (US) and National Research Council (US) National Cancer Policy Board. 2004. Meeting Psychosocial Needs of Women with Breast Cancer. Washington DC. National Academies Press (US). 12. https://www.ncbi.nlm.nih.gov/books/NBK196214/ 13. Zhang, Shaodian, et al. "Longitudinal Analysis of Discussion Topics in an Online Breast Cancer Community using Convolutional Neural Networks." arXiv preprint arXiv:1603.08458 (2016). 102

Optimizing Residents’ Work Hour to Decrease Medical Error Incident in Hospital Putu Ijiya Danta Awatara1, Hasna Okta Asyrofi2 and Gabriela Nativity3 1Third Year Medical Student, University of Brawijaya (ijiyadanta19@gmail.com) 2Third Year Medical Student, University of Brawijaya (hasnaokta@gmail.com) 3Second Year Medical Student, University of Brawijaya (gabrielanativity98@gmail.com) Abstract Resident (undergraduate specialist doctor) working in industrialized countries have traditionally worked for long hours, particularly during the early stages of their career. Excessive working hours results in resident doctor fatigue which will lead to some incident of medical error in Indonesia’s health care system and yet, there is uncertain policy for the limit of working hours for residents itself. Therefore, we propose a system for optimizing the resident working hours in order to decrease medical errors in Indonesia. The method used in this paper is literature review, and the materials are relevant scientific journals or reports. The system is made into a guideline by setting 72 hours maximum working week because resident still needs an experience of firsthand exposure to a wide variety of patient cases through a patient care and education studies which include in working hour in the healthcare facilities (Jagsi et al., 2005). For on call duty, resident must take only maximum 24 hours duty. Resident must take a resting or meal time 30 minutes every six hours worked or 10 hours between duty in a week. Breaks within the working period provide for refreshment and restore physical capabilities and alertness. Resident should take a day off in a week from patient care and education duties. Shift working is commonly associated with a disruption of life outside work. Resident must not take all duties more than once every three nights. On average, shift workers lose 1–1.5 hours of sleep for each 24-hour period. Working more than three or four night shifts in a row may cause a significant sleep debt, with serious consequences for safety. This system is able to decrease medical error by emphasizing working hour system of resident while promoting high-quality education and safe patient care in Indonesia. Keyword : Resident , Medical Error, Working Hour System

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OPTIMIZING RESIDENTS’ WORK HOUR TO DECREASE MEDICAL ERROR INCIDENT IN HOSPITAL

by:

Putu Ijiya Danta Awatara batch 2014 Hasna Okta Asyrofi batch 2015 Gabriela Nativity batch 2015

FACULTY OF MEDICINE BRAWIJAYA UNIVERSITY

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MALANG 2017 INTRODUCTION Resident (undergraduate specialist doctor) working in industrialized countries have traditionally worked long hours, particularly during the early stages of their career, with 24hour on-call shifts and 100-hour working weeks commonly reported. Moreover, their schedules often featured frequent overnight and on-call duties. Historically, such schedules have been seen as an essential feature of junior doctor training, underpinned by the need to experience firsthand exposure to a wide variety of patient cases. This condition ensures that trainees develop the ability to recognize the impact of their interventions over time and obtain practice in independent decision-making. (Jagsi et al., 2005). A large body of literature has demonstrated that extended-work duration results in residents fatigue. Fatigue-related cognitive impairment has been linked to adverse events and errors for patients and for the residents itself. Olds and Clarke (2010) suggest, working more than 40 hours per week and working voluntary paid overtime are both significantly related to adverse events and errors in patients and their environment such as nosocomial infections and work injuries. Furthermore, at least one needle stick injury in the past year had the strongest and most consistent relationships with the work hour and voluntary paid overtime variables. (Olds and Clarke, 2010) The issue of working hours of resident has been conspicuous enough. In 2003, the Accreditation Council for Graduate Medical Education instituted limits on resident duty hours as an approach to improve patient safety and quality of training The standards include an 80-hour weekly limit on duty-hours averaged over four weeks, 10 hours of rest between duty periods, and a 24-hour limit on continuous duty with a possible 6 additional hours added for continuity of care and education, for a total of 30 hours of continuous duty (Rice & Leach, 2003). In UK, The Working Time Regulations (WTR) were the implementation of the 1993 European Working Time Directive, which regulate the average number of hours worked to 48 per week, across a reference period of 26 weeks for doctors in training. (Morrow et.al, 2012) In Indonesia, there is a law for limit hour of workers. Stated in Undang-Undang No. 13, every worker in Indonesia has 8 hours a day or 40 hours a week to do their job in the office. If the office wants to extend the working hours of the employee, they should get a permission from the office headmaster with a legal written permission and it includes in overtime work payment (Undang-Undang No 13 Tahun 2003 Pasal 77). But, the law above can’t be used for some job which need continuity in work like on-call or emergency duty, such as in healthcare sector (Kepmenakertrans No. 233 ayat 3). It makes the policy of resident working hours is uncertain about its limitation. Whereas, it has important role to anticipate such medical error cases in Indonesia.

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There are still many improper systems for resident in Indonesia. They may even get an extended working hour if they have on-duty shift. Based on data from RSUPM Cipto Mangunkusumo Jakarta, anesthesiology resident has 9-10 hours to work every day and if they   have on-call duties in ED in the same day, they should extend the hour for 32 hours ahead without sleep it is more than assigned rule in Indonesia. (Syahrul, 2014) Excessive working hours results in resident doctor fatigue which will lead to some incident of medical errors in Indonesia’s health care system and yet, there’s no certain policy for the limit of resident working hours itself. That is why it is an important thing to improve the system of resident limit hours in Indonesia, because it can potentially decrease case of medical errors in Indonesia by reducing fatigue case that will be a major factor that cause medical errors. Therefore, we propose a system for optimizing resident working hours in order to decrease medical errors in Indonesia. METHODS This scientific paper was based on literature review through analytic study on the effort of optimizing the working hour system of resident in order to decrease medical error in Healthcare facilities. Some methods and program were carefully examined in order to find the right method for the resident working hour optimization. Socioeconomic and characteristic of mentioned region were considered in order to meet the right methods for the system proposed. Data collection method in this study conducted by the method of literature (literature review) based on issues, both through digital and non-digital information from literature such as journals and reports. The method of data analysis literature conducted through two approaches, namely: 1. Method of exposition, that the presented data and facts that may ultimately sought correlations between these data. 2. Analytic methods, namely through the analysis of data or information by giving the argument through logical thinking and were then taken to a conclusion. RESULT The proposed system is working hour system of resident which including maximum working week, minimum resting time, on call duty limit, and day off in a week. We consider to propose resident working hour system to emphasize its which has not been stated yet in health provider policy in Indonesia, and to promote high-quality education and safe patient care. We propose to set 72 hours maximum working week which is more than stated in UU no. 13 in 2013 about Indonesian Labor Regulation because resident still need an experience firsthand exposure to a wide variety of patient cases through a patient care and education studies which include in work hour in the healthcare facilities (Jagsi et al., 2005). Weekly schedule (such as room visit, policlinic duties, patient care, and educational obligation) and on call duties in emergency room are included.

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For on call duty, resident must take only maximum 24 hours (with up to 6 hours addition) duty because the intelligent, motivated, highly-educated graduates that our medical schools produce are reduced by an overnight, 24-hour shift to a fraction of their intellectual selves. As Barger et al 
 demonstrated, patients, resident’s themselves and the general public are endangered; residents driving home after shifts of >24 hours have twice the odds of crashing their cars. (Landrigan, 2005). Resident must take a resting or meal time 30 minutes every six hours worked or 10 hours between duty in a week. Breaks within the working period provide for refreshment and restore physical capabilities and alertness. There is evidence to suggest that rest breaks in addition to the traditional breaks (two 15-minute breaks, and one 30-minute meal break) can improve overall productivity. Breaks can be used to attend to physical needs (eating, drinking, going to the toilet), recover from physical effort, relieve the effects of static postures, relieve the effects of repetitive physical actions, relieve the effects of concentrated mental work recover from unusually hot or cold conditions, take a nap. (Managing shift work to minimize workplace fatigue Department of Labor Wellington, 2007). Resident should take a day off in a week from patient care and education duties. Shift working is commonly associated with a disruption of life outside work. In a review, Wilson (2002) reported that shift workers in health care settings often felt isolated from their family and social commitments, and that they were unable to fulfill domestic roles, resulting in low self-esteem and increased anxiety. So they need to spend a time out from work routines for social activities and their family to fulfill their social needs and to prevent not only biological health but also mental health (Tucker et.al, 2013) Resident must not take all duties more than once every three night. On average, shift workers lose 1–1.5 hours of sleep for each 24-hour period. This builds up a sleep debt of 6 hours after 4 nights. Working more than three or four night shifts in a row is likely to cause a significant sleep debt, with serious consequences for safety. (Managing shift work to minimize workplace fatigue Department of Labor Wellington, 2007). Resident Working Hour System Guideline: •

A 72 hour maximum working week (including weekly schedule and on call duty)

•

Minimum 30 minutes resting time after six hours worked or 10 hours of rest between duty

periods in a week; •

A 24-hour limit on continuous duty, and up to six added hours for continuity of care and

education; •

One day in a week free from patient care and education duties

•

On call duties no more than once every three nights

•

Doctor must not work

o > 72 Hours in 72 consecutive days o > 138 Hours in 138 consecutive days o > 276 Hours in 276 consecutive days

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  Unless resident gives written permission to waive this system for medical emergency or disaster situation 4. DISCUSSION 4.1. Resident Working Hour System and Medical Error in Healthcare Facilities Medication error (ME) is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use (US Food and Drug Administration. Medication Errors; US Department of Health and Human Services. 21 May 2015). In US hospitals, 50.000 to 100.000 patients die annually from medical errors, and inadequate sleep among physicians may be a factor. Barger and colleagues showed that interns committed significantly more fatigue-related medical errors resulting in adverse patient outcomes during months with five or more overnight call shifts, compared with months with no extended shifts (OR 7.0) (Comondore, 2008). In Indonesia, Risidana et.al, have conducted a research of medication error at a Private Hospital Yogyakarta. Based on the results of this study, it can be concluded that medication error events, both potential and factual, occurred in a private hospital in Yogyakarta (Risdiana et.al, 2015). The Result are show in table below.

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The most common factor contributing to MEs is staff shortage/high workload;, however, that MEs usually arise from poorly designed work environments and systems rather than the individual performance of a single practitioner. (Salmasi et.al, 2015). Extended working hours negatively impact patients by contributing to worker fatigue. Fatigue is a physical and/or mental state caused by overexertion. It reduces a person’s capabilities to an extent that may impair their strength, speed, reaction time, coordination, decision making, or balance. Thus, reforming the duration of resident work hours is needed to reduce medical error in Hospital. A survey of indicators in the North West of England found that several indicators of patient outcomes (hospital standardized mortality ratio, average length of stay and standardized readmission rate) continued to follow the same trends of improvement following the introduction of the 2009 WTR as they had in the preceding year (Collum et al. 2010). Objective data were gathered in a study by Cappuccio et al. (2009) in order to examine the effects of the 48-hour work week on patient safety, and on doctors’ work-sleep patterns. This study indicated that a 48-hour week along with targeted efforts to improve sleep hygiene improves patient safety. Feasibility of Resident Working Hour System in Indonesia Resident Working Hour System is a highly applicable system. Some developed countries in Europe such as UK, Germany, Sweden even US, Australia, and New Zealand have applied the system. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) developed work-hour guidelines in 2002, revising them in 2011, which limit resident work hours to 80 h per week (further limiting first-year residents to ≤ 16 continuous hours)]. In the UK, the European Working Time Directive (EWTD) was incorporated into British law in 1998 and a restriction on doctors’ working hours was implemented in 2009, mandating reduction to 48 h per week. The Australian Medical Association (AMA) launched its Safe Working Hours campaign in 1995. This included the commissioning and reviewing of research in topic areas that included the actual working hours of junior doctors, systems of work, and the effect of fatigue on learning and performance. These efforts culminated in the development of a national code of practice around working hours, shift work, and rostering for hospital doctors (Glasgow et.al, 2011). This system should be applied in Indonesia because it is stated in Permenkes No 1199 tahun 2004 and Undang-Undang No 13 tahun 2003 that resident had time to rest in accordance with a predetermined time, but without writing specific time rules. Moreover, most hospitals in Indonesia still have an uncertain policy about duration of work and rest for resident. So it needs to be clarified by running this system (Syahrul, 2014).

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Benefit of Resident Working Hours System The limitation of resident working hour brings many positive impacts such as improvements in resident lifestyle (42%) and patient safety (34%). When residents don’t do their job in under pressure condition because of too many working time at hospital, the resident will have a greater quality of life because the residents can handle their house life (if any) and arranging their life better. So, they can keep their look and attire as a doctor who brings an impact in suggesting patient. Residents also can live healthier because they have some rest time. So, they have more motivation to work (Hutter, 2006). A study about working hour limitation in resident also decreases amount of resident who fall asleep when they work, while driving from work, or when they attend a conference. (Cull, 2015). The previous study shows, by limiting working hour, there are some improvement in knowledge of the residents because they spend more time for reading or attending symposium (Hutter, 2006). Looking from the patient’s point of view, we found that with policy of duty hour limitation in resident, it also makes an improvement in patient care. Because, the residents can minimalize the probability of medical error that can lead the patient into a danger and emergency condition or even death. Besides, if the residents work in a greater condition after having enough time for resting, the medical error to the patient could be minimized so that the patient doesn’t need to extend their time in hospital. It also can compensate the hospital cost. (Cull, 2015) CONCLUSION This system is able to decrease medical error by optimizing working hour system of resident which including maximum working week, minimum resting time, on call duty limit, and day off in a week. We consider to propose resident working hour system to emphasize the working time for resident which has not been stated yet in health provider policy in Indonesia, to make an improvement in resident lifestyle, and to promote high-quality education and safe patient care. This system should be applied in Indonesia because in fact, most hospitals still have an uncertain policy about duration of work and rest for resident. Hence, it needs to be clarified by running the system. On a final note, upon consideration the issue of implementation of this system is quite significant.

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REFERENCES : 1. Accreditation Council for Graduate Medical Education. (2006). The ACGME’s approach to limit resident duty hours 12 months after implementation: a summary of achievements, 2004. 2. Ariadi, A. (2015). Perubahan Fungsi Kognitif dan Psikomotor Peserta PPDS Anestesiologi dan Terapi Intensif FKUI pada Pelayanan Anestesia Elektif Setelah 12 Jam Kerja= The Cognitive Functions and Psychomotor Functions Changes in Anesthesiology and Intensive Care Residents FMUI after 12 Working Hours in Elective Anesthesia Services. 3. Barger LK, Ayas NT, Cade BE, Cronin JW, Rosner B, Speizer FE, et al. Impact of extendedduration shifts on medical errors, adverse events, and attentional failures. PloS Medicine. 2006; 3:e487. [PubMed: 17194188] 4. Caruso, C. C. (2014). Negative impacts of shiftwork and long work hours. Rehabilitation Nursing, 39(1), 16-25. 5. Comondore, V. R., Wenner, J. B., & Ayas, N. T. The impact of sleep deprivation in resident physicians on physician and patient safety: Is it time for a wake-up call?. Mental health, 1(1.78), 15. 6. Costa, G. (2010). Shift work and health: current problems and preventive actions. Safety and health at Work, 1(2), 112-123. 7. Cull, WL., Mulvey, HJ., Jewett, EA., et all. (2006). Pediatric Residency Duty Hours Before and After Limitations, 118(6),1807-1810 8. Glasgow, N. J., Bonning, M., & Mitchell, R. (2014). Perspectives on the working hours of Australian junior doctors. BMC medical education, 14(1), 1. 9. Harrington, J. M. (2001). Health effects of shift work and extended hours of work. Occupational and Environmental medicine, 58(1), 68-72. 10. Hutter, MM., Kellogg, KC., Ferguson, CM., Abbott, WM., & Warshaw, AL. (2006). The Impact of the 80-Hour Resident Workweek on Surgical Residents and Attending Surgeons, 243, 868-869 11. Keputusan Menteri Tenaga Kerja Dan Transmigrasi No.233 Ayat 3 Tahun 2003 Tentang Jenis Dan Sifat Pekerjaan Yang Dijalankan Secara Terus Menerus 12. Landrigan, CP., Rothschild, JM., Cronin, JW., Kaushal, R., Burdick, E., Katz, JT., et al. (2004). Effect of Reducing Interns’ Work Hours on Serious Medical Errors in Intensive Care Units, 351 (18), 1838 13. Landrigan, C. P. (2005). Sliding down the bell curve: effects of 24-hour work shifts on physicians' cognition and performance. SLEEP-NEW YORK THEN WESTCHESTER-, 28(11), 1351. 14. Lee, S., McCann, D., & Messenger, J. C. (2007). Working time around the world. Geneva: ILO. 15. Morrow, G., Burford, B., Carter, M., & Illing, J. (2012). The impact of the Working Time Regulations on medical education and training: Literature review. Report for the General Medical Council.

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16. Nishigori, H., Deshpande, G. A., Obara, H., Takahashi, O., Busari, J., & Dornan, T. (2015). Beyond work-hour restrictions: a qualitative study of residents’ subjective workload. Perspectives on medical education, 4(4), 176-180. 17. Olds, D. M., & Clarke, S. P. (2010). The effect of work hours on adverse events and errors in health care. Journal of safety research, 41(2), 153-162. 18. Peraturan Menteri Kesehatan Republik Indonesia Nomor 1199/MENKES/ PER/ X/ 2004 tanggal 19 Oktober 2004 tentang Pedoman Pengadaan Tenaga Kesehatan Dengan Perjanjian Kerja Di Sarana Kesehatan Milik Pemerintah 19. Risdiana, I., Kristin, E., & Utarini, A. Identification of Medication Error Indicators at a Private Hospital in Yogyakarta, Indonesia. 20. Rosta, J., & Aasland, O. G. (2011). Work hours and self rated health of hospital doctors in Norway and Germany. A comparative study on national samples. BMC health services research, 11(1), 1. 21. Salmasi, S., Khan, T. M., Hong, Y. H., Ming, L. C., & Wong, T. W. (2015). Medication errors in the Southeast Asian countries: a systematic review. PloS one, 10(9), e0136545. 22. Terpstra, O. T., & Stegeman, J. H. (2011). Effects of the restriction of working time for residents: a Dutch perspective. Journal of graduate medical education, 3(4), 462-464. 23. The Department of Labor Wellington (2007). Managing shift work to minimise workplace fatigue A guide for employers. 24. Tucker, P., Bejerot, E., Kecklund, G., Aronsson, G., & Åkerstedt, T. (2013). Doctors' Work Hours in Sweden: Their Impact on Sleep, Health, Work-family Balance, Patient Care and Thoughts about Work. Stressforskningsinstitutet. 25. Undang - Undang Republik Indonesia No 13 tahun 2013 Tentang Ketenagakerjaan.

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QUECK, Helping You to Get Healthy By, Z.F.K., Dicky, A.H. Leny, and H. Annisa University of Hang Tuah Surabaya ABSTRACT Aim: The objective of this paper is to analyze literatures and provide an alternative solution to reduce waiting time that may improve the healthcare quality, especially in primary care. Background: Patients' waiting time has been defined as the length of time from when the patient entered the outpatient clinic to the time the patient actually leaves the outpatient department (OPD). It compromises health because prolong waiting time increase patient dissatisfaction, less frequent outpatient visits and delays in diagnosis and treatment. Some efforts has been put to manage waiting time in healthcare institutions. One of some alternative solutions to reduce waiting time is by using a modern technology. Material and Methods: Participants consisted of 33 health service users who were randomly selected from 3 primary health centers in Surabaya and surrounding areas. Participants were given a questionnaire consist of 22 questions about customer satisfaction on queuing system in the public health centers. As an addition, secondary data from this study were obtained through literature study and internet. Literature sources used in this study were taken from international journals and statistical data of Directorate General of Resources and Equipment of Post and Information Technology. Results: According to a survey conducted on 33 respondents from some of the primary health centers, the data found that 2.9% of the population is still not that satisfied with registration speed in the primary health centers and 8.6% felt that the length of waiting time for the examination in the primary health centers is still too long. On the other hand, as quoted by the Director General of Resources and Equipment of Post and Information Technology, according to the survey agency We Are Social in 2016, the number of mobile phone users also increased significantly, becoming 323.6 million, an increase of 2% on the year 2015.This opportunity is very good to be used to facilitate the service queue so as to improve the quality of health services in Indonesia. Conclusion: As researchers, we expect that this system can be realized and applied in primary health centers throughout Indonesia. We really hope that this system can be implemented to help Indonesian health service become better in the future. 113

QUECK, Helping You to Get Healthy By Z.F.K., Dicky, A.H. Leny, and H. Annisa University of Hang Tuah Surabaya Introduction Patients' waiting time has been defined as the length of time from when the patient entered the outpatient clinic to the time the patient actually leaves the outpatient department (OPD) [5].

Whether it is a time used for registration of patient, routine doctor's appointment,

emergency room treatment, laboratory/diagnostic test, procedures, receiving the results of various tests, waiting happens to just about everyone seeking medical care. It is often one of the most frustrating parts about healthcare delivery system[5]. Waiting time is one of some key concerns in the healthcare quality issues in many countries due to its consequences both to the healthcare institutions and consumers. It compromises health because prolong waiting time increase patient dissatisfaction[4], less frequent outpatient visits and delays in diagnosis and treatment[9]. Delayed diagnosis and treatment can be devastating for individuals, their families, their employers, and those who rely on them. Disease might advance, potentially affecting treatment and outcomes, sometimes to the extent that, in some cases, elective treatment is impossible. That deterioration can also lead to complications, putting patients’ lives and well-being in jeopardy[6,7]. In emergency care, prolong waiting time may increase mortality rates[2]. Waiting for health care often involves significant personal costs and, even if short, entails some measure of pain and suffering, mental anguish, lost productivity at work and leisure, and strained personal relationships. A similar toll may be placed on family and friends. An individual’s inability to provide for themselves and their dependents may add a significant personal burden[6,7]. One of the biggest factors in the rising costs of health care is chronic illness. Delayed care often transforms an acute and potentially reversible illness or injury into a chronic, irreversible condition that involves permanent disability[6,7]. The findings indicate that on average, patients wait for more than two hours from registration to getting the prescription slip, while the contact time with medical personnel is only on average 15 minutes. Employee surveys on factors contributing to the lengthy waiting time indicate employee attitude and work process, heavy workload, management and supervision problems, and inadequate facilities to be among the contributory factors to the waiting time problem[1]. Regardless of waiting time, a study concluded that providing information, projecting expressive quality, and managing waiting time perceptions and expectations may be a more effective strategy to achieve improved patient satisfaction in the emergency department than decreasing actual waiting time[12]. However, it has to be underlined that those efforts cannot reduce the consequences of prolong waiting time.

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Some efforts has been put to manage waiting time in healthcare institutions. Some studies suggested with a dominant demand-side effect to provide patients an option, and some incentive, to opt out of the public health system, shifting the demand from the public health system to the private care market, however these suggestions may lead to decrease patients visits and revenue of public healthcare institutions[3]. One of some alternative solutions to reduce waiting time is by using a modern technology. For more than two decades, modern technology has been changing the developing world. Despite its potential negative effect on morality, the number of mobile phone escalate rapidly in Indonesia. The number of mobile phone user in Indonesia in 2016 has reached the amount of 326,3 million users, an increase of 2% from 2015. This value includes 126,13% of total population in Indonesia, which is 258,7 million. This is a great potention in the development of public services especially in the aspect of information and technology, including health services especially for Indonesian people who can not operating application via internet, like e-health. Objective: The objective of this paper is to analyze literatures and provide an alternative solution to reduce waiting time that may improve the healthcare quality, especially in primary care. Methods We use literature review and survey methods. Participant Participants consisted of 33 health service users who were randomly selected from 3 primary health centers in Surabaya and surrounding areas. As sign of gratitude, participant were given snacks. Procedure Participants were given a questionnaire consist of 22 questions about customer satisfaction on queuing system in the public health centers. As an addition, secondary data from this study were obtained through literature study and internet. The method used in this research are case study and literature review. The case study is one of the research methods in the social sciences. In research using this method, the longitudinal depth examination to a situation or event is referred to as a case by using the method - a systematic way of doing observation, data collection, information analysis, and reporting the results. The data used were collected from a survey of 33 respondents from primary health centers in Surabaya.

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The second research method through the study of literature. The literature study aims to find the variables to be studied, distinguishing things that are already done and determine what needs to be done, synthesize and gain a new perspective, as well as determine the meaning of relation between variables. Literature sources used in this study were taken from international journals and statistical data of Directorate General of Resources and Equipment of Post and Information Technology. From the obtained literature, it was found out that the potential for the development of health care facilities in Indonesia in the field of information technology is fairly large. Results According to data from Surabaya City Health Department, the number of the primary health centers located in Surabaya are 63 units. From all these primary health centers, almost entirely have e-Health services that can be used publicly. However, according to a survey conducted on 33 respondents from some of the primary health centers, the data found that 2.9% of the population is still not that satisfied with registration speed in the primary health centers and 8.6% felt that the length of waiting time for the examination in the primary health centers is still too long.

 

Table 1. The Level of Customer Satisfaction toward The Registration Waiting Time

Table 2. The Level of Customer Satisfaction toward The Appointment Waiting Time

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Reported also in International Journal for Equity in Health, long waiting times for an   appointment and preferential treatment for private patients are often cited by members of the statutory health insurance system as reasons for their dissatisfaction with the ambulatory sector. Moreover, health service decision-makers are apprehensive that long waiting times may not only provoke discontent but also have an influence on patients treatment outcomes if, as a result of the longer waiting times, they consult their doctors less frequently or their illnesses are diagnosed at a later stage[11]. On the other hand, as quoted by the Director General of Resources and Equipment of Post and Information Technology, according to the survey agency We Are Social in 2016, the number of mobile phone users also increased significantly, becoming 323.6 million, an increase of 2% on the year 2015[8].

Graph 1. Key Indicators to Digital statistics in Indonesia (In Million)

In Canada, the governments have attempted to reduce wait times primarily by increasing funding of provincial health care systems and through bureaucratic management approaches. An alternative approach that has been periodically debated in the public policy forum is to allow a larger role for privately funded medical care in Canada. The most prominent objection to allowing an expanded role for private insurance in the financing of basic health care in Canada is that it will contribute to inequalities in the distribution of health care. Specifically, those who are sufficiently wealthy, or who are in occupations where employers are willing and able to contribute financially to their employees’ private insurance plans, will receive more timely and, possibly, better health care than those who rely strictly upon the public insurance program[6,7].

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From the search results about e-health applications in the form of websites in general health services, it is known that some hospitals both public and private have already used the application. Five major hospitals have launched the government health services through the website, including application registration services, consultation, health education, information services, and internal coordination online. However, the management of the site is still not good, and still at the one direction stage in the form of health information. As for the 13 private hospitals searched, health services provided online is also still at the stage of health information. Even so, conditions are better provided by local health services such as Sragen District Hospital, Sepinggang primary health center, and the Surabaya Health Departement. Registration service has been going online, even though the management of the updating process has not gone well. The launched site still unable to fully accommodate the needs of the medical activities of the public yet, especially patients. Based on the SWOT analysis, it is known e-health application is very likely to be applied in Indonesia. The strength lies in health infrastructure and communication networks, which are sufficient to build the application to the deeper region in the form of hospitals, health centers, and IHC. However, ICT penetration has not been evenly distributed with the capability and awareness of human resources that have not been moved from the old character as well as the illegal practice of data security can be a debilitating and challenges in the implementation of telemedicine[13]. From the efforts above, it can be seen that those methods still have many weaknesses. The use of policy in Canada that engage the private insurances have a weakness in terms of the emergence of economic injustice. This injustice arises where the wealthiest people were able to get a better facility than they who must fully rely on public insurance. In Indonesia alone who already used e-health application in the health care system still has flaws. Although the health infrastructure and communications networks are adequate, but uneven penetration of ICT capabilities and awareness of human resources that have not been moved from the old character of the security and illegal practices be a tough challenge. Therefore, the use of SMS (Short Message Service) in facilitating the queue service to health care has a pretty good chance to cover the weaknesses contained in the e-health application. Mobile phone users in Indonesia amounted to very much, which almost entirely capable of using the SMS facility. This opportunity is very good to be used to facilitate the service queue so as to improve the quality of health services in Indonesia. The system used in the queue in the SMS is quite easy. First the sender must send a message that contains specific commands to the number of the service provider. This message will be passed through the Wireless Carrier to the Bulk SMS Service Provider. By SMS Service Provider, this message is forwarded to the server located in the Primary Health Center in accordance with the objectives stated in the message. The contents of the message will then be processed by the SMS queue application into order desired by the sender. Furthermore, the server will send feedback to the sender in the form of queue details received by user.

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*Code of Primary health center: Primary Health Center A = 01 Primary Health Center B = 02 **Type of health service: -General Practitioner (GP) -Dentistry (D) -Mother and Child Community (MCC) -Nutrition

(N)

-Laboratory (L)

For Example: “0001110610877 A GP” , Send this message to 505 and wait for the reply. The format reply you will receive : “Your queue number is 20. You can come at 12.30 in Primary Health Center A. Thank you.” After that, you can come to the primary health care.

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Discussion T h e n u m b e r o f m o b i l e p h o n e u s e r s i n I n d o n e s i a s h o w t h e r a p i d i t y o f technological development. In addition, the high of

public demand for good health

services are also increasing. Many attempts have been made to improve the quality of health services, especially in terms of queues, such as e – health application that has been used in Surabaya in several months. However, there are some wenesses arising from that solution. One of them is many Indonesian people still can not use internet. The ways of working of e - health is to enroll through application or by coming directly to the primarry health center which is asassisted by the employee. However, it is not embraced the whole society. For example, the elderly people who can not use the internet and can not come to the primary health center to register because of several factors, could be one of the weakness of e-health application. Thus, the use of systems that can resolve these weekness is through SMS queue system. An SMS queue system that is easy to use and can make someone easier to get a good health care. According to a survey conducted on 33 respondents from some of the primary health centers, the data found that 2.9% of the population is still not that satisfied with registration speed in the primary health centers and 8.6% felt that the length of waiting time for the examination in the primary health centers is still too long. It shows that there are a lot of people that are not satisfied about the waiting tmes system that are too long and difficult. Conclusion Based on the data obtained from the questionnaire, about 2.9% of respondents are not satisfied with the registration speed of health care and 3.8% of them felt that the length of the waiting time for the examination in the primary health centers is still too long, in which become the reason why we as researchers made the QUECK. We made this innovation because, first, this system can be easily done by primary health centers employee. Second, it works in the same way as

if we send a regular message. Third, the cost is relatively

inexpensive. Fourth, to facilitate elderly patients to get health care. As researchers, we expect that this system can be realized and applied in primary health centers throughout Indonesia. We really hope that this system can be implemented to help Indonesian health service become better in the future.

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Barua, B., Esmail, N., & Jackson, T. (2014). The effect of wait times in mortality in

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reduce public waiting time? Theory and empirical evidence from Canadian joint replacement surgery data. Production and Operations Management, 24(4), 605–618. https://doi.org/10.1111/ poms.12260 4.

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Noseworthy, T. W. (2011). The importance of patient expectations as a determinant of satisfaction with waiting times for hip and knee replacement surgery. Health Policy, 101(3), 245–252. https://doi.org/10.1016/j.healthpol.2011.05.011 5.

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OUTPATIENT SERVICES OF LARGE UNIVERSITY TEACHING HOSPITAL - A SIX SIGMA APPROACH. Management in Health, 17(1). https://doi.org/10.5233/mih.v17i1.259 6.

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from theory and international experience. 7.

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Medical Ethical-legal Review on Online Doctor Consulting Platform Phenomenon in Indonesia To Prevent legal Mal-adaption and Patient Harm Potential Although Its’ Multi Beneficial Mission By J.H., Enrico, P.D.S., Ika, A.T., Belinda Universitas Hang Tuah Surabaya ABSTRACT BACKGROUND Mobile app users enchancement lead to the global shift among many real sector converted to mobile app form including health services sector. Online Doctor consulting is great invention to make public health services more effective, faster, low cost and give much more accesible health services. This phenomenon happens almost in everywhere but there is a still lot of aspect before adapt it in Indonesia through Legal system, Medical Ethic and safety of Harm potential to the users or patient. METHOD Using a literature review and legal reasoning approach. RESULTS & DISCUSSION By administrative health regulation, this health service mobile platform is judged cant be considered as clinic. Other side the doctor that provided by the platform might have no STR and SIP (health practice certificate) and tend to overpromoting without MKEK recomend that causing possibilities of againts UU ITE. In other case doctor consulting through mobile app cant be equated with conventional standarized health services. CONCLUSION This mobile app based doctor consulting need a lot of multisectorial reviews befored deciding to be adapted in Indonesia hope is going to accepted by the legal system, medical ethic and profession standard and can supress any harmful potential for the users.

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  Medical Ethical-legal Review on Online Doctor Consulting Platform Phenomenon in Indonesia To Prevent legal Mal-adaption and Patient Harm Potential Although Its’ Multi Beneficial Mission By J.H., Enrico, P.D.S., Ika, A.T., Belinda Universitas Hang Tuah Surabaya ABSTRACT BACKGROUND Mobile app users enchancement lead to the global shift among many real sector converted to mobile app form including health services sector. Online Doctor consulting is great invention to make public health services more effective, faster, low cost and give much more accesible health services. This phenomenon happens almost in everywhere but there is a still lot of aspect before adapt it in Indonesia through Legal system, Medical Ethic and safety of Harm potential to the users or patient. METHOD Using a literature review and legal reasoning approach. RESULTS & DISCUSSION By administrative health regulation, this health service mobile platform is judged cant be considered as clinic. Other side the doctor that provided by the platform might have no STR and SIP (health practice certificate) and tend to overpromoting without MKEK recomend that causing possibilities of againts UU ITE. In other case doctor consulting through mobile app cant be equated with conventional standarized health services. CONCLUSION This mobile app based doctor consulting need a lot of multisectorial reviews befored deciding to be adapted in Indonesia hope is going to accepted by the legal system, medical ethic and profession standard and can supress any harmful potential for the users.

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Introduction Trends shows that health sector is going to digitalized and developed in mobile application platform systems. Medical mobile app start up is going to become most popular mobile app start up theme through many research that already done. By mobile app converted medical service, future medical service becoming much more effective, low cost, and accessible through this wide nation. Data shows in Indonesia there is a mobile app users enhancement through Android or IOs platform. Android smartphone increasing in sales from 220 million units in 2011 and become respectively 1.2 billion in this 2015. That will be a great potential for mobile app developer to develop mobile app approach in this health sector beside the population itself want it happened. Let’s take a look in several countries, in the US, a 2006 study found that searching for information on prescription or over-the-counter drugs was the fifth most popular search topic, and a 2004 study found that 4% of Americans had purchased prescription medications online. A 2009 survey conducted by Geneva-based Health On the Net Foundation. Found one-in-ten Europeans buys medicines from websites and one-third claim to use online consultation. In Germany, approximately seven million people buy from mail-order pharmacies, and mail-order sales account for approximately 8–10% of total pharmaceutical sales. In 2008, the Royal Pharmaceutical Society of Great Britain reported that approximately two million people in Great Britain were regularly purchasing pharmaceuticals online (both with a prescription from registered online UK doctors and without prescriptions from other websites). Other hands, in more conventional ways, the search engines web shows Health advice is now the second-most popular topic, after pornography, that people search for on the internet.With the advent of broadband and videoconferencing, many individuals have turned to online doctors to receive online consultations and purchase prescription drugs. Use of this technology has many advantages for both the doctor and the patient, including cost savings, convenience,accessibility, and improved privacy and communication. In google play store, the biggest Android Application provider platform validated by 132 million users across Indonesia we can find a lot medical app platform that downloadable.

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In google its self there are 2 most visited medical consultation site, http:// www.cyne##ycare.com and www.owe##xa.com. But we believe it is not only doctorpatient consultation medical service form application that already available, there is lot several systems and form of improving medical services by using mobile app that available worldwide. This need more consideration and depth study to help our people and legal system to adapt with this great innovation. Here several electronic medical services that available : • Computerized physician order entry (a means of requesting diagnostic tests and treatments electronically and receiving the results) • ePrescribing (access to prescribing options, printing prescriptions to patients and sometimes electronic transmission of prescriptions from doctors to pharmacists) • Clinical decision support system (providing information electronically about protocols and standards for healthcare professionals to use in diagnosing and treating patients) • Telemedicine (physical and psychological diagnosis and treatments at a distance, including telemonitoring of patients functions) • Consumer health informatics (use of electronic resources on medical topics by healthy individuals or patients) • Health knowledge management • Virtual healthcare teams (consisting of healthcare professionals who collaborate and share information on patients through digital equipment) • mHealth or m-Health • Medical research using grids: powerful computing and data management capabilities to handle large amounts of heterogeneous data. • Health informatics / healthcare information systems: also often refer to software solutions for appointment scheduling, patient data management, work schedule management and other administrative tasks surrounding health. So that’s all available using technologies-medical app system form that already used by several countries. That was countable but its always can be improved and modified by time. But we know, there is no something that sure all of that form can be adapted in Indonesia. It is be caused our multi legal system and lot of respected norms. Beside as medical student that experienced in medical life year by year, we need evaluate more for the harm effect potential through the patients safety reasons.

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Discussion The main thing that may come into our mind is the appearance of questions regarding this   that is whether it is sufficient enough or not to make a medical practitioner to be able topic, to diagnose, to give advices and to give medical prescription as what other countries have done so far. There will always be some constraints during the process of checking up that happens between doctor and patient, that is the lack of indirect communication. In the case of checking up using medical devices such as stethoscope, it should be done face to face. However, in mobile chatting, this kind of check up cannot be done because when a patient states his condition, the doctor has to make the presciption without making direct and physical check up toward his patient. This action, anyhow, does not obey the integrity of a public service personnel. In spite of that, it is a definite diagnose in the early stages examination of the patient. In the end, it needs a speciality in terms of cognitation and expertise which needs certain capacity that has been examined and certified. Certification of Doctors This profession is only done by certified doctor, that is doctors who have obtained license practice (Surat Ijin Praktek, SIP). This license is also should be questioned in choosing a platform or some specific sites that can provide online-based health services. This includes whether the doctors on duty and on providing public health service, including giving consultation, diagnose and prescription, are standardise and certified or not. To obtain a doctor’s degree, a medical student has to undergo a series of processes and procedure that have been strictly regulated through multiple and complex rules based on Indonesian rules so far. First, a recruit of medical student, must be educated through undergraduate program, is named as strata-I in Indonesia, to obtain a medical degree, is named as S.ked in Indonesia, for three years and a half. This process is done. After this process, a recruit of medical student must follow the physician profession education conducted in a teaching hospital for a year and a half. This phase is the phase where a recruit applies his knowledge about medical so far as long as his edication degree to his patients. After passing his physician profesion education, a young doctor is going through a period of legitimate gratuated as a sign to get his doctor’s degree, is named dr. in Indonesia. However, even after taking his degree, a young doctor cannot freely work in medical field. He has to pass a series of procedure called UKDI (Uji Kompetensi Dokter Indonesia) or Indonesian doctors competency test. Once he passed this competency test, he then is allowed to make STR (Surat Tanda Registrasi) or registration letter as a legitimate letter to work in medical field such as working as pratitioner in clinics in Indonesia for a doctor. But this is not the end, to open his own clinic legally, he has to pass an internship program, that is pre-registration professiona training competency-based primary care to have a competence in qualification as a doctor who has passed the basic edication as doctor.

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This internship is a compulsary program and takes a year to pass. Then, the question about online-based health services may rise again. The should be clear cut and clarity whether the 
 doctors who take care of the online-based sevice have passed the process above and are certified, including having SIP and STR, or not. As stated in Article 29, paragraph 1 of Law No.29 of 2004 on registration of doctors and dentists. It states that each of the doctors and dentists who take a practice of medicine in Indonesia are required to have a doctor registration letter, as well as dentist registration letter. As well as in Article 44, paragraph 1 of Law No.36 of 2009 on technology and the product of it that says in the development of technology within the meaning of Artile 42 can be technological tested and products’ tested for humans or animals. As well as Articles 36 and 46 of Law No.36 of 2014 on the requirement to hold a licence before practicing in medical field. This, however, makes us feel a bit tricky in finding platforms or sites that are fairly transparent in showing their license, both SIP and STR, and the feasibility of the doctors. But the worst thing is we do not know whether the sites and platforms are approved by rules and law. If the sites are not yet approved, the topics of SIP and STR, and the feasibility of the doctors are no more necessary to be discussed further. Moreover when those sites and platforms are only using Artificial Intelegence to subtitute the real doctor as decision makers by using algorithm technology to do treatment and therapy for patients. Platform As a Clinic Based on rules of Health Minister number 9 in 2014 on clinic, health facilities that organize personal health services are those who provide basic medical services and specialists. There are two types of clinics’ maintenance, pratama clinic and main clinic or klinik utama. Pratama Clinic is a clinic that adminster basic medical services both in specific and/or general. On the other hand, Main Clinic is a clinic that provide specialist medical services or basic and specialist medica services. A clinic can specifies its services on a certain field based on the diciplines or organ system. Organizing a clinic must consider several requierements, such as the condition of the location, building requirements, infrastructure, employment, pharmacy, and laboratory existence. Other than buildings, elements of infrastructure and facilities, including the existing equipment in the clinic, we also need to pay attention and prepare some other things like santation, electrical installation, fire prevention and suppression, and ambulances. Special for organizing inpatient clinic, it is ncessary to have medical gas systems, HVAC systems, lighting systems, and other infrastructures as needed. Plus, facilities and infrastructure of the clinic should be always well-maintained and functioning properly. In addition, clinic’s equipment should be complete including both medical and non-medical equipment in order to support the best services. Both medical and non-medical equipment should pass the standartds of qualification, security and safety. Last, medical equipment should also have marketing authorization.

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The requirements of employment in clinics should be in accordance with the type of service   hosted by the clinics. The employee should only be the person in charge of technical terms in a clinic. This person in charge of technical terms must hold a licence practice of that certain clinic, as well as being the caregiver of that certain clinic. There are, at least, two doctors and/or dentists as a medical personnel in a pratama clinic. There is, at least, aa specialist and a doctor as medical personnel is main clinic. While in main clinic that provides dentistry services, there should stay, at least a specialist dentist and a dentist as a medical personnel. A clinic may not hire health personnel of foreign nationals. The operation of a clinic cannot be done if those requirement above are not fulfilled because in order to organize a clinic, an operational licence is a obligation. In the end, online-based health applications (including platforms and sites) are only umbrellas to give consultations only and are not able to pass the requirements explained above. These kind of sites, in short, are not categorized as clinics. Professionalism Ethics With this course, to determine whether the platform is competent and so it is a need to make an advertisement that entice users to use the platform service.Whereas in accordance KODEKI in clause 4 is about self-praise that every doctor must avoid actions that are self-praise. In this clause every doctor is required to maintain the quality of professionalism in informing the competence and authority of doctors to other health professionals or the public. So, it is not allowed in showing greatness through public media such meetings to the public, mass media, electronic media, and other high-tech communication media. Prohibited act because it is self-praise among others include: 1) Using the title although not qualified or disobeying the law. 2) Including title of professor or academic degree of

membership are not associated with

medical services on board practices, the paper prescription, attributes other practices and public media. 3) Advertising themselves, peers, almamater or services health facilities associated with the provision of legal / discipline, such as: the fact inaccurate, unfair, unbalanced, siding, bad criticism, false, deceptive, incite and mislead, confuse fact and opinion personally, accentuating the violence, contrasting ethnic, religious, racial and groups, as well as making false news, defamation, sadistic and obscene. Advertise ability/exaggerating owned, whether spoken or written that may lead to debasement profession because it implies the meaning of excellence, uniqueness or sophistication of services tend to be misleading, showing off the bad taste and these are not necessarily recommended by MKEK IDI center.

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Then in clause 6 KODEKI about wise in new discoveries. This article describes each physician   be cautious in announcing any discovery or apply a technique or a new treatment that always has not been substantiated and that can cause public restlessness. Just as doctors are prohibited from announcing, advocate, the application of goods / products and health services / health related marketed multi-level marketing (MLM). Here the necessary role of government, judicial commission and the legislature to create a law that gives certainty to the community to this phenomenon. Judging from the basic principles of bioethics in the value of non-maleficience, who did worsen the patient's condition on the online consultation, which is not necessarily the correct diagnosis so that it can lead the negligent actions. In terms of non-maleficence, which non maleficence is not to do anything that aggravates the patients and choose a treatment that the smallest risk for the patient's own. However, if a consultation is done through online-based sites makes the doctor can not perform optimally examination because of the limitations of time and place. Thus, it may make a greater risk of error diagnosis. When it is viewed in terms of beneficence that have followed the principle that a doctor doing good, respect for human dignity, the doctor also must ensure that patients cared for in a healthy state. Of all of the requirements that online consultations can still accomplish although limited by distance. Meanwhile, if viewed in terms of justice, that is the principle that a doctor treated equally and fairly to the happiness and comfort of the patient. Differences in levels of economic, political views, religion, nationality, differences in social status, nationality and citizenship not be a differentiator among patients. So it does not become a barrier to physicians in providing care via online sites. If it is viewed in terms of autonomy which has the principle that a physician shall respect human dignity, every individual should be treated as human beings who have the right to selfdetermination. If it is applied in an online physician consultation, it will depend on the features provided by the application. If a given feature complete as a complete list of medical specialists,

laboratory tests and other investigations, it can facilitate the patient to take a

decision in according to his wishes. Service Standard Service standards in treating patients is providing health services. Physicians have obligation to be done in the practice of

health care professions, those are profession

obligations and law obligation. Profession obligation means that doctors have the standards which are already set in the science-based or text-books. Health services performed on patients are anamnesis, physical examination, laboratory tests, etc.

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Anamnesis is a technical examination which is conducted by a conversation between a doctor with a patient directly or with other people who know about the condition of the   patient, to get complete data. although anamnesis already supports for about 70% in determining the diagnosis, but there are not lege artis. Thus, it cannot be done via online. Physical examination is one of the important elements of the process of diagnozing a disease. Diagnosis is performed to determine the patient's disease, in order to deliver the appropriate therapy in these patients. Physical examination is aobjective component of the health assessment which is done by doing checks on the patient's like inspections, percussion, knocking a system or organ to be examined (palpation), and listen to using a stethoscope (auscultation). So, from a physical examination is not possible to undertake an examination of the patient online. Supporting examinations consist of laboratory studies, anatomic pathology, radiology, and so on. So it is not possible to do those via online. Besides, obligations under international law are the administration standard and therapy treatment standard. Administrative standards will be discussed in the next chapter, while the therapy standard in Permenkes No. 4 of 2014 on service standards of the profession of primary care for general doctors while for specialist health services according to the consensus held by each associations. So if, it is not suitable to the standards then it does not fulfill the contract that occurs between patients and doctors as health care providers can be called tort in civil law. And, if it could lead to losses so-called dolus in criminal law. Responsibility This platform has a lot of law responbilities through Peraturan Pemerintah no 82 of 2012 about ITE for using electronic system to run some this health service provider form. Beside there is a lot others regulation that control and managing a health providing system such as UU no 36 of 2009 about medical, UU no 29 of 2004 about medical practice and others spesific profession regulations. And from the lawsuit aspect, private law , public law and administrative law, all of this legal aspect can be used to control this practice. From the private law view that supported with UU ITE, UU consumen protect, this going to be manage the contract or relationship between the patient as user with the platform itself from private law views, that regulate the relationship between patient in this case as users, and the health services provider, in this case this online doctor platform through therapeutical contract that used to be used to evaluate patientdoctor relationship. But the real question is, is that this online relationship between patient and their health care provider is could be interconnected with the regular therapeutical contract form. In some contract, there some rights and obligations to all side. In this case still a lot some doctor’s obligation that haven not been fulfiled like any conventional medical services we used to know. platform .

This is really depend on the features that provided by the

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Any form of frauds can be penetrated by using both public or private law. UU ITE can be used   too. because this new medical/health service provider approach has really lot of harm potential if we as patient or user malusing this platform or other side, the developer can advantages this medical advice by online seeking trends to develop their mobile app. without a very prudence and regulation concern it will be really harmfull to provide a very respectful health services. Summary Clinical health application can be improved even further and expected to be alternate solution curent medical treatment. This application could solve limitation of the conventional method and give better medical service by giving patient better health information access directly from doctors. But in present condition there are many reasons that makes it not possible to consult with doctor via online. Online consultation with the doctor it self should be limited by the government so the case that can be solved by doing online consultation only minor disease or not life threatening one. And by limiting online doctors consultation, health providers can minimize the risk from information that can do harm. References 1.

Shannon, Thomas A. 1987. Pengantar Bioetika. Terjemahan Bertens, K. 1995. Jakarta. PT

Gramesia Pustaka Utama 2.

House call - No appointments, no waiting, speedy diagnosis and prescription - online

doctors are flourishing. But are they safe?, The Guardian, 4 June 2000 3.

Bakardjieva, M. (2005). Internet society: the Internet in everyday life. London: Sage

Publications. 4.

Hardey, M. (2001). 'E-health': the internet and the transformation of patients into

consumers and producers of health knowledge. Information, Communication & Society, 4(3), 388-405. 5.

Rice, R. E., & Katz, J. E. (2006). Internet use in physician practice and patient

interaction. In M. Murero & R. E. 6.

Rice (Eds.), The Internet and health care. Theory, research, and practice. Mahwah, NJ:

Lawrence Erlbaum Associates. 7.

Rice (Eds.), The Internet and health care. Theory, research, and practice. Mahwah, NJ:

Lawrence Erlbaum Associates. 8.

Klassen, K. J., T. R. Rohleder. 2004. Outpatient appointment scheduling with urgent

clients in a dynamic, multi-period environment. Internat. J. Service Indust. Management 15(2) 167–186.

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INFORMATION TECHNOLOGY USE AND IMPLEMENTATION OF POLICIES TO OVERCOME NUTRITION CARE SERVICES PROBLEMS Muhammad Nurjayadin*, Nur Syifa Rahmatika*, Thiufatin Terezky Brilyanti* *Medical

Faculty, Halu Oleo University, Kendari

ABSTRACT Aim This paper aimed to give advice how to improve the quality of nutrition care in term of compose diet menu for certain patient and how to manage availability of nutritionists. Background The most important value in hospital accrediation is providing proper healthcare, specially in nutrition care to ensure the quality productive hospital services. Professional management in nutrition care is needed to improve quality care service for hospitalized patient. This quality services is supported by availability of nutritionists. Material and Methods : This paper using literature review to collect relevant informations associated problems. Informations available from the journals, articles, researches reports and some approved website. Results According to JIC standard in healthcare, Indonesia having 24 accredited hospital among 2.087 that spread all over region in Indonesia. This mean, most of hospital are low quality in healthcare service including nutrition care. As an example, General Hospital of Mamuju, West Celebes having two problems in providing nutrition care. First, inappropiate standard in processing foodstuff cause food delivering not according condition and disease of the patients, e.g patient with coronary heart disease (CHD) have some dietary requirements in fulfill the diet. Second, available nutritionists as much as 5 in Mamuju Hospital. Meanwhile, according to Kepmenkes No.81/Menkes/SK/I/2004, estimation of lack nutritionists is about 929. These problems may be overcome by using information technology e.g. Nutrisurvey in composing patient menu according to the condition and associated disease for food delivering problems, whereas availability nutritionists problem may overcome by giving incentives including material and nonmaterial thing, education support, health improvement and workplace safety where at having more risk of accidents. Conclusions These problem may be solved or suppored by using information technology and some policies to overcome composing menu diet problems and availability nutritionists problems.

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INFORMATION TECHNOLOGY USE AND IMPLEMENTATION OF POLICIES TO OVERCOME NUTRITION CARE SERVICES PROBLEMS  

Muhammad Nurjayadin*, Nur Syifa Rahmatika*, Thiufatin Terezky Brilyanti* *Medical

Faculty, Halu Oleo University, Kendari

INTRODUCTION According to the Ministry of Health of the Republic of Indonesia in 2009, health care is an efforts that generate individual or together in an organization to maintain and improve health, prevent and cure diseases, and restore the health of individual, families, groups and or society. Therefore, the quality of health services in Indonesia needs to be improved in order to increase the quality of health in a variety of health care levels.(1) Referring to The Joint Commission International (JIC) for Hospital Accreditation, one of the hospital facilities supports in the assessment of accreditation standards to ensure patient safety is good nutrition care. If we have good nutrition care, we will have good accreditation. In Indonesia, the professionalism of nutrition in providing nutrition services is set in Permenkes No. 26 in 2013, on the Implementation of Employment and Labor Practice Nutrition. To optimize nutrition services at the hospital, the needed nutritional standard power requirements in more detail. Based on the results of Health Research (Riskesdas) in 2007 and the Household Health Survey (SKRT) in 1995 and 2001, in Indonesia occurred epidemiological transition from deaths because of non-communicable diseases is increasing while deaths attributable to communicable diseases. It is predicted to increase.(2) 36 million people die because of non-communicable diseases each year. More than 9 million deaths occur before 60 years old and things are going in poor and development country. In general, non-communicable diseases that can be cause of death is cardiovascular disease. In 2008 the estimated 17.3 million deaths due to cardiovascular disease. More than 3 million deaths because of cardiovascular diseases occur before the 60 years old.(3) Complications of hypertension will causes approximately 9.4 million deaths of worldwide each year. Hypertension causes 45% of deaths due to heart disease and 51% of deaths due to stroke. Deaths due to cardiovascular disease is expected to increase to reach 23.3 million in 2030.(3) Based on changes in epidemiology (Chart 1), health care that should be available in hospital is nutrition care. Health workers who play a role in nutrition services include nutrition specialist doctors, nutritionists, and nurses. But unfortunately, the deployment of nutrition service is not spread evenly. This make the nutrition problem in many hospital inadequate. Therefore, we need efforts to improve the primary health care in nutrition care and diets of patients so that can be solved optimally(2)

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Besides health care workers and the health labor, the modernization of the hospital is very important too. The development of technology impact the development of knowledge. Such as, the use of information technology to support health information management that has the   capability of processing more quickly with a variety of the latest innovative applications. In addition to simplify the management, the benefits of use medical records is also beneficial for patients because it can increase the effectiveness and efficiency in the health care process. In addition, simplify the health workers provide health services and assist in clinical decisionmaking such as the enforcement of diagnosis, therapy, avoid allergic reactions and drug duplication.(4) METHODS Method used in this paper is literature review. Literature review is to find relevance references according to the cases or problems by searching sources that have been made previously. These references may include journals, articles, research reports and approved website on internet. The procedure of this literature review started by criticize, compare, summarize and synthesize the sources. The goal is to strengthen the problem and the theoretical foundations in the review. RESULTS Problems NutritionCare in Indonesia Good hospital is a hospital has performance good nutrition. But unfortunately in Indonesia, nutrition care at the hospital unsatisfied. One of the example is in the general hospital of Mamuju, West Celebes. The amount of labor in the nutrition installation in Mamuju Hospital now as much as 22 people including 5 nutritionist and 17 chef/workers.(5) Planning the menu is a composing event will be processed to satisfied flavor consumer or patient and the nutritional needs balanced nutrition principles. Food materials processing includes diet and non-diet do the same time. Diet taken more harder processing. The results of interview in processing section foodstuffs, stated that

food materials such as fish and meat

must be measure. For a review of industrial tofu / tempeh only calculated per piece, so that the weight of industrial tofu / tempeh inappropriate to standard servings per class. Also standard servings of the food is role in food which associated with food nutritional value.

When the

portion less, automatic nutritional value is reduced, causing quality of food become is not good enough.(5) The menu on 10 days in the hospital show that the nutritional value foods served still very low if compared with presented RS.dr.Wahidin Sudirohusudo (one of accredited by JIC), primarily on food good research first day of class I, II, and III. It caused because 1) No standard guide nutritional needs per class patient care made, 2) Officers in section processing and distribution food is no attention to the standard portion which has set out to review every class care, 3). Lack of supervision on the part so that the nutritional value food processing for patients not sufficient review.(5)

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To achieve the quality of service and food at a local hospital, the need for supervision and quality control services. Monitoring is one of the management functions that try to get a job 
 or activity carried out in accordance with plans, guidelines, standards, regulations and the results are predetermined in order to achieve the expected goals.(5) Problems of Nutrition Deployment in Indonesia Based on data collection in 2010 about health labor, availability of labor workers in government-owned hospitals have provided 2,703 nutritionist. However, based on standards applicable of labor, in 2010, there is still a shortage of nutrients in the hospital number 194 nutritionist. In the clinic number of nutritionist in 2010, namely 7,547 labor in health centers nutrition while remote, border and island nutritional number of labor is 67 people. Based on the applicable standard of workforce health center nutritionist shortages in health centers is 303 people, while in remote, border and island were 34 power nutrition.(6) In accordance with Kepmenkes No. 81 / Menkes / SK / I / 2004 Guideline of Planning of Health Human Resources at Provincial, District / Municipal and Hospital, then set the following strategic objectives: •

In 2014 the expected availability of nutritionist 24 per 100,000 population

•

In 2019 the expected availability of nutritionist 48 per 100,000 population

•

In 2025 the expected availability of nutritionist 56 per 100,000 population(6)

Shortage of health workers is calculated by taking into account the needs and availability of health workers as well as reductions. Increased and equitable distribution of health labor, need to pay attention to a shortage of health workers in public hospitals belonging to the Ministry of Health and Local Government, the military and police as well as health centers. Nutritional needs of workers at the General Hospital of the Ministry of Health and local government in 2014 that is 978 people, while shortcomings there, in the year 2019 is predicted to need 1,785 people with a shortage of 929 people and in 2025 is predicted to have the needs of 2,524 people, while 1,007 people shortcomings (Table 1). At the military hospital, the nutritional needs of labor in 2014 was 120 people and hospitalized INP as many as 45 people, but lacking in army hospital as many as 60 people, while in the hospital Police have not met. In 2019, the predicted energy needs of nutrition in hospitals as many as 130 people TNI and Police hospitals as many as 48 people, while shortcomings in the army hospital as many as 50 people and hospitals Police are not met. Predictions 2025, 125 army hospital labor need nutritional deficiencies and hospitals 51 51 Police need nutritional power (Table 2). Nutritional energy needs in the health center in 2014 that 9,005 people with a shortage of 2,197 people, had predicted in 2019 that the nutritional needs of labor 8558 people with 679 people and a shortage of predictions that 2025 needs 8,111 people with a shortage of 837 people (Table 3). (6)

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According to the health service standards by the JIC (Joint Commission International), there are only 24 hospitals that have been accredited and appropriate the standards 
 JIC. Based on total number of hospitals in Indonesia that is numbered 2087, it mean that most hospitals do not appropriate the standards of health care, particularly in nutritional patient care services. DISCUSSION Management Diet for Cardiovascular Disease Fruits and vegetables – preference consume about up to six serving may give most benefit to decrease the risk of cardiovascular disease including coronary heart disease (CHD). Fibre – the recommended amount of dietary fibre is about 20-35 g per day. Fish – recommended consumption for meal fish at least twice per week, fish meal contain most long-chain omega-3 polyunsaturated fatty acids EPA and DHA. Recommendation for eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) is 1 gr, while alpha linolenic acid (ALA) is < 2 gr per day(7)Omega-3 fatty acid may reduce of CHD by preventing cardiac arrhythmia, lowering serum triglyceride levels, decreasing thrombotic tendency, and improving endothelial dysfunction.(8) Fat – nowadays, risk factor for coronary heart disease is associated to blood cholesterol level, more higher blood cholesterol level more increase risk factor for CHD. Limitation for lipid intake of saturated fat is less than 7% of energy, trans fat to less than 1% and cholesterol to less than 300mg per day. Sugar – limitation for added sugar of food or beverages is needed to reduce risk factor for CHD. Salt – achievable recommendation for salt (sodium) is about 2-3g per day. Limitation salt intake to ≤ 4 g/day (1550 mg sodium)(7). Alcohol – moderate alcohol intake is associated in reduce heart disease but it is not clear what amount that recommended is best. Preference alcohol intake is no more than one drink per day for women and no more up to two drinks a day for men.Fluids – divide fluid allowance throughout the day and avoiding drinking sugary fluid as well as control the amount of drink that consume (e.g. water, tea, coffee, soup, fruit juice, etc.). Weight – monitoring your weight periodically to evaluating risk factor of CHD.

(9)

Eat More Fruits and vegetables – five portions per day, such as apples, pears, bananas, oranges, pumpkin, spinach, tomatoes, cabbage, carrots, green beans. For vegetables, ½ cup cutup raw or cooked vegetables or 1 cup leafy veg/salad. Meanwhile fruits, allowed serving size is about 1 medium fruit or ½ cup fruit salad or ½ cup fruit juice. Wholegrain starches and high-fibre foods – oats, samp & beans, brown rice, brown or whole wheat bread, lentils, dried beans, split peas, etc. Recommendation serving size is 6-8 portion per day.

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Fish – grilled or steamed, especially sardines and pilchards (in tomato sauce). Serving size is
 about 30-40g or about 4-5 servings per day. Dairy – low fat milk, yoghurt, cheese. Serving size is about 1 cup milk or yoghurt or 30g cheese and 2-3 servings per day.In moderation: monounsaturated fats and oils – sunflower oil and soft tub margarine. Allowed serving size is about 1 teaspoon soft margarine, 1 tablespoon mayonnaise, 2 tablespoons salad dressing, 1 teaspoon vegetable oil or about 2-3 servings per day. Drink water – at least on or two liters a day.(9) Eat Less Fried food- deep-fried potato chips, chicken, pizza, hamburgers, pies. Processed food – sausages, Russians, colony, viennas, bacon. Salted snack – potato crisps, salted peanuts, savory biscuits, biltong, avoiding add extra salt to food after food has been cooked. Avoid – sweetened drink and alcohol use. For sweetened or added sugar, portion of serving size is 5 or fewer serving per week or 1 tablespoon sugar, 1 tablespoon jelly or jam, ½ cup sorbet and ices, 1 cup lemonade(9) Nutri survey Software Improving Healthcare Service Application in Information Technology managing system expecting good benefit to health field information service in hospital. Use of various tools of information technology may help service health, such as managing patients data, nurses and doctors, medicines, hospitalized or home care service, health insurance, medical tools, and utilization laboratories. In term of nutrition care, application of information technology is need to make preparing food for patient be adapted to the patient need. With this presence of information technology, may every nutrition fulfillment problem in hospital will be solved and more easier in do the care. (9) One of information technology that may use to facilitate nutrition care in planning menu for patient is “Nutri survey”. Nutri survey is a mathematical programming tool which can give clear answer to very practical very practical questions faced in the field by nutritionists working in developing countries. Many features provide by this software that helpful to support nutritionist to managing patient’s diet. These features include : (1) it is possible to calculate of the “Energy Requirement” based on each personal data, e.g. age, sex, height, weight, physical activity), the total energy requirement is calculated as sum of basal and additional energy expenditure and provide “Weight Gain-Reduction Diagram too that may help to determine the time which is necessary to reduce or increase body weight; (2) provide “Food Record”, after input food list and its amount that consume in a day, which has been matching with the chosen requirements of the references group e.g. men 19-24 years, we may compare the result with the recommended nutrient supply; (3) “Diagram”, a graphichal comparison of calculated and recommended nutrient supply; (4) “Food for Deficit

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Supply”, it possible to know how to compensate if intake in the current food record is 
 inadequate than the recommendation; (5) “Dietary History”, attempts to estimate the usual food intakes of individual over a long period of time (several months) and deliver general information on the types of foods consumed at mealtimes and between meals, their frequency of consumption and usual portion sizes. This information can be used to calculate mean daily supplies of nutrients. Therefore, the dietary history may useful for scientific studies or nutritionist to serve as a basis for nutritional counseling; (6) “Food Frequency”, a feature that possible to quantify the average nutrient intake of a person. A standard list of foods is presented and the frequency and number of the standard portion sizes can be entered;

(7)

“Individual

Anthropometric Assessment”, this feature may support to compare the anthropometric development of a child in comparison to an International references. After entering of birthdate, sex, date of visit, weight and height the program calculates the values for the percentiles, the % of the Median and the z-score for weight for age, height for age and weight for height.(9) With these provided features, nutritionist will be easier in preparing patient menu according to patient health status and associated disease. Furthermore, the period in preparing food will faster than the conventional method. However, this software only as a guidance and a comparison because it just provided approximated values based on personal data of the patient.

(9)

For example, throughout this software, nutritionist easily composing the menu for patient with cardiovascular disease e.g coronary heart disease (CHD). According to Ministry of Health of the Republic of Indonesia, some requirement of menu for CHD patient are adequate energy to maintain normal body weight, protein intake 0,8/kg ideal bodyweight/day, fat intake about 25-30% of daily expenditure energy consist of 7% for saturated fatty acid and 10-15% unsaturated fatty acid, low in cholesterol if dyslipidemia is exist, adequate vitamin and mineral, low-salt diet (allowance serve is 3-5gr/day if hypertension and edema is exist), easily digested food and not produce gas, and enough in fibre to avoid constipation.

(8)Through

features in this software,

nutritionist may easily determine the recipe of diet for patient and help to choose food materials that allowed and according to available data. The nutritionists still need to monitoring and evaluate the foods before serve them. The aim of evaluate food menu is give an appropriate composition nutrients according disease, bioavailability, and acceptance each patient.

(9)Besides,

it has to

note variation, behavioral meal, socio-cultural, climate, market condition, labors, tools, available funds, techniques and methods in modification fibre menu(7)

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Analysis of Dissemination of NutritionalSolutions in Indonesia   Labor is a supporter of the health of a country. To advance health of country needed a quality workforce. Most workers in Indonesia have low education with the skills and expertise are inadequate (minimal), so it doesn’t have the skills and experience as well as a maximum to enter the workforce. Because of that, the quality of the workforce in Indonesia is very low. The quality of low labor resulted in employment opportunities is getting smaller and limited. Because the majority of hospitals or other employment prefer a good quality workforce. Labor so rarely get a chance to work. Limited skills and education will limit the variety and number of jobs. Low levels of education will make Indonesian workers will be lack of mastery and development of science and technology. (1)

One important aspect of health development in Indonesia is the availability of human resources (HR) personnel health. Problem of health human resources, especially doctors, midwives and nurses in Indonesia at this time is inadequate and uneven distribution. This has an impact on the quality and accessibility of health services provided to citizens. Utilization of health labor to improve the equalization can be implemented by mobilizing health labor among the region as can be coordinated. In this case the increase in equity and labor utilization is still lacking, so we need for special attention from government to health workers in public hospitals, military, police as well as in health centers. Can be done this way: (1) 1.

The appointment of civil servants, Army personnel, civil servants at the Ministry of

Defense and Civil Affairs Police To appropriate the health labor in disadvantaged areas, border and island (DTPK) so as to continue education with the help of financing from the government, with an obligation after which it can return to the original task. 2.

Temporary staff (PTT)

Especially for health professionals such as doctors who are internship, can replace the rank of doctor as PTT. 3.

Special Assignment

To appropriate the needs of health professionals can be done by means of a special assignment to seek the reward system both material and non-material adequate in according to local conditions. 4.

There is more efficient use of Innovation

In this case can be constructed as Mobile Team, Flying Doctors, team medical labor in the field hospital, health and labor contracts on the basis of specific performance or output to serve in mountainous areas and islands which are difficult to reach and citizens spread.(1)

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  Then, to ensure the continuity of the main health service area left behind can also be done this way intentive administration, education aid, granting additional authority is limited to health workers, improving the health and safety of the working environment.(1) Giving intentive can include both material and non-material. To provide accountability and encouragement to the work force. Giving intentive material include the amount is adequate, equitable and fair. Intentive magnitude can be determined by the level difficulty of the assignment location, performance, or outside the targeted jobs. While non-material can be given the award as an exemplary amid health and achievement.(1) Educational assistance given to increase in the number of health labor, the quality and type as well as the provision of non-material intentive. And to do improving the health and safety of the working environment such as accident insurance in charge of workplace risk.(1) CONCLUSION Nutrition care problems for coronary heart disease (CHD) in Indonesia caused by food delivery for patient incorrect due to disease and unequalify in distribution of nutritionists in some area in Indonesia. For example, General Hospital of Mamuju, West Celebes having nutrition care in low standaridized caused in serving meal for patient and due to lack of available nutritionists. These problem may overcome by organizing diet menu according to patient’s status and disease, specially for CHD patients. To facilitate nutritionists to setting menu diet and following modernization era in provide health care, an information technology program is need to be used, such as software named Nutrisurvey. Furthermore, quality of health care is supported by availability of nutritionists, specially in term of ditribution of each region. To solve this problem, may overcome by giving incentives including material and nonmaterial thing, education support, health improvement and workplace safety where at having more risk of accidents.

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Journal of Nursing), Volume 2, No.1, Maret 2007. Prevention [Internet]. 2007;2(1):17–23. Available from: http://jks.fikes.unsoed.ac.id/index.php/jks/article/view/185/86gmbran 4.

Awan BK, Atma U, Makassar J, Tanjung J, No A. Penyusunan Sistem Evaluasi

Kinerja Layanan Dalam Membangun Tata Kelola TI Berbasis Komputasi Awan 1,2. 2016;2(2):75–86. 5.

Mustafa E, Hadju V, Jafar N. INPATIENT SATISFACTION LEVEL SERVICES

GENERAL SULAWESI PROVINCE. 6.

Kementerian Kesehatan RI. Pedoman Pelayanan Gizi Rumah Sakit (PGRS). 2013.

7.

Studi P, Masyarakat G, Sumberdaya DAN, Pertanian F. Energi-Protein Pasien

Rawat Inap Penderita. 2008; 8.

Tim N. Diet. 2011;

9.

Pretorius S, Dietician R, Mpe M. Nutrition Therapy in Prevention and Treatment

of Heart Failure. Circulation.

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  Tables and Figure

(Table 1) General Hospital of the Ministry of Health and local government!

(Table 2) Hospital of the Army and INP!

(Table 3) Clinical Health Labor

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(Chart 1) Prevalance of Communicable and Non-Communicable Disesase

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The current situation and outlooks for hypertension as non communicable disease in 
 Indonesia A. Muh. Yasser Mukti* ,Dzulfachri Kurniawan**, Elsa Shafira Prasetyati*** * First Year Medical Student, Muslim University Of Indonesia (andimuh_yassermukti@dr.com) ** First Year Medical Student, Muslim University Of Indonesia (fachri.spensix3@gmail.com) *** First Year Medical Student, Muslim University Of Indonesia (elsaprasetyati@gmail.com) Abstract Non-communicable diseases (NCDs) – including cardiovascular disease, diabetes, asthma, and chronic respiratory infections, and cancers – are the leading cause of death worldwide. In this context, hypertension is one of the major cause that can cause non-communicable disease, primarily cardiovascular disease (Galambos, Louis and Sturchio, Jeffrey L. Noncommunicable Diseases in the Developing World: Addressing Gaps in Global Policy and Research). Hypertension is an increase abnormal blood pressure, both systolic blood pressure and diastolic blood pressure, in general someone said to suffer from hypertension if systolic blood pressure / diastolic> 140/90 mmHg (Normally 120/80 mmHg). Health Research (Riskesdas) in 2007 showed that the majority of cases of hypertension in the community have not been diagnosed. This is evident from the results of measurements of blood pressure at age 18 years and over prevalence of hypertension in Indonesia amounted to 31.7%, of which only 7.2% of the population who already know have hypertension and only 0.4% of cases were taking medication hypertension.This problem is caused by the lack of early detection of hypertension actively, access to services and treatment. This brief review summarizes the present situation and problems of hypertension in department healthcare of Indonesia. Epidemiological data if the disease were obtained from several sources. (Suyono, Slamet.,2001) Keywords Non-communicable disease, Hypertension

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The current situation and outlooks for hypertension as non communicable disease in Indonesia A. Muh. Yasser Mukti* ,Dzulfachri Kurniawan**, Elsa Shafira Prasetyati*** * First Year Medical Student, Muslim University Of Indonesia (andimuh_yassermukti@dr.com) ** First Year Medical Student, Muslim University Of Indonesia (fachri.spensix3@gmail.com) *** First Year Medical Student, Muslim University Of Indonesia Introduction Non-communicable diseases (NCDs) – including cardiovascular disease, diabetes, asthma, and chronic respiratory infections, and cancers – are the leading cause of death worldwide. In this context, hypertension is one of the major cause that can cause non-communicable disease, primarily cardiovascular disease. An estimated 36 million people die from such disease each year, roughly two out of three deaths globally; 80% of these fatalities occur in low- and middle-income countries (LMICs). The statistics are stark, yet they hide the human toll of such disease burdens. The global health community has become increasingly aware of NCDs as primary threats to individuals, communities, health system infrastructures, and economic development. It is now acknowledged that NCDs contribute greatly to rising healthcare costs and the loss of economic productivity. (Galambos, Louis and Sturchio, Jeffrey L.,2014) Hypertension is an increase abnormal blood pressure, both systolic blood pressure and diastolic blood pressure, in general someone said to suffer from hypertension if systolic blood pressure / diastolic> 140/90 mmHg (Normally 120/80 mmHg). Hypertension in Indonesia will continue to increase in incidents and the prevalence, associated with changes lifestyle, foods high in fatty, cholesterol, decreased physical activity, the rise events and other stress-another. (Prof. Tjandra Yoga.2015) Hypertension remains a major challenge in Indonesia.

hypertension is a condition that is

often found in health care primary healthcare. It is a health problem with a prevalence high, at 25.8%, according to the data Riskesdas 2013. In addition, controlling hypertension has not been adequate though effective medicines many available. This is evident from the results of measurements of blood pressure at age 18 years and over prevalence of hypertension in Indonesia amounted to 31.7%, of which only 7.2% of the population who already know have hypertension and only 0.4% of cases were taking medication hypertension (Ministry of145 Health Republic of Indonesia,. 2012).

  Situation and Problems Of Hypertension in Indonesia Based on the results of blood pressure measurement, the prevalence of hypertension in the population aged 18 years and over in 2007 in Indonesia is 31.7%. According to province, the highest prevalence of hypertension in South Kalimantan (39.6%) and lowest in West Papua (20.1%). Meanwhile, if compared with the year 2013 decreased by 5.9% (from 31.7% to 25.8%). This decline can occur to various factors, such as tool tension gauges are different, people who have started to realize the dangers hypertension. The highest prevalence in Bangka Belitung (30.9%), and Papua had the lowest (16.8)%. The prevalence of hypertension in Indonesia obtained through questionnaire undiagnosed health workers by 9.4 percent, which was diagnosed force health or currently taking medication at 9.5 percent (Riskesdas,.2013). So, there was a 0.1 percent taking medication alone.

Table 1: Classification JNC* VII, 2003 JNC ~ Joint National Committee on the prevention, detection, evaluation and treatment of high blood pressure, central in Amerika

The next in the year 2013 by using individual analysis unit shows that nationally 25.8% of Indonesia's population suffering from the disease hypertension. If the current of Indonesia's population of 252.124.458 inhabitants there exists 65.04811 million souls who suffer from hypertension. A condition that is quite surprising. There are 13 provinces that percentage exceeds the national average, with highs in Bangka Belitung (30.9%) or in absolute terms at 30.9% x 1.380.762 inhabitants = 426 655 inhabitants. In absolute terms the number of people with hypertension in five provinces with a prevalence of hypertension.

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The highest popularity Riskesdas 2013 were as follows:  

Table 2 : 5 provinces with prevalence of high hypertension in absoulut kuantity (people)

Table 3 : 5 provinces with prevalence of low hypertension in absolute quantity (people)

Table 4 : Prevalence Hypertension by Gender in Indonesia

Based on the above table hypertension prevalence by gender in 2007 and in 2013 the prevalence of women is higher than men. The complications of hypertensive disease is coronary heart disease (CHD) kidney failed and Stroke.

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Prevention of Hypertension in Indonesia Hypertension is one of non-communicable diseases is quite high at the moment. For that we need look back especially on medical personnel. In this context, there is a need to develop an alternative workforce that is structured around the community and consumer needs (Beaglehole, R and Yach, D,.2003). Task-shifting describes a situation where a task normally performed by a physician is transferred to a health professional with a different or lower level of education and training, or to a person specifically trained to perform a limited task only, without having formal health education. Task-shifting may be facilitated by medical technology, which standardizes the performance and interpretation of certain tasks, therefore allowing them to be performed by nonphysicians or technical assistants instead of physicians. This has typically been done in close collaboration with the medical profession. Task-shifting can potentially result in cost and physician time savings without compromising the quality of care or health outcomes for patients. A study from Uganda reporting the potential impact of task-shifting on the costs of antiretroviral therapy and physician supply found that the estimated annual mean costs of follow-up per patient were US$31.68 for physician follow-up, US$24.58 for nurse follow-up and US$10.50 for pharmacist follow-up. It is also potentially an efficient way of reorganizing the workforce by ensuring better specialization of tasks, allowing physicians to focus on the jobs that cannot be otherwise delegated. A study from Rwanda showed that task-shifting from a physician-centered to a nurse-centered model for antiretroviral therapy reduced the demand on physician time by 76% (Department of Health.2016). As a mediator of these task-shifting, the department of health have provided various methods to alert the society regarding danger of non-communicable disease and how to prevent them. The Department of Health (DH) is an institution whose main goal is to provide help for others in need of medical assistance, hence prolonging their lives. One of their jobs is creating national policies and legislation. They set the strategy and direction, creates and updates the policy and legislative frameworks within which services operate and ensures a robust system of regulation is in place for the professions and allied industries. People’s care is in the hands of the professionals who look after them. This arrangement works well and the Department’s role should rarely be visible to healthcare professionals, patients and service users. However, that role is vital in securing high quality, efficient and fair services now and sustaining them in the future (Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, et al,.2014) The Department is responsible for sponsoring individual national bodies by supporting them and holding them to account for carrying out their responsibilities. They fund and assure the delivery and continuity of healthcare services while considering the multiple stakeholder in account. This sponsorship is also used to fund researches and technologies to seek improvements in the coming future. The Department of Health works together with partner organizations with similar goals, and hand in hand try to achieve their purpose.

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In the last century, the Department of Health from across the globe and many other scientists have put a lot of effort in researching the cure for various diseases, especially infectious disease. There used to be countless pandemic diseases throughout the globe, such as influenza and hepatitis. For that reason, researchers have developed vaccines to prevent further infection of these lethal diseases (Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, et al,.2014). However, although it is important to get vaccinated, the cause of disease doesn’t only on infectious ones. The neglect of non-communicable disease has cause the society to disregard its fatality and it is now becoming one of the major causes of death. CONCLUSION Hypertension remains a major challenge in Indonesia, it is a health problem with a high prevalence. Prevention of hypertension is very remained especially for department healthcare workers. Prevention can be done by giving information on the danger of the disease to herself. Task-shifting may be facilitated by medical technology, which standardizes the performance and interpretation of certain tasks, therefore allowing them to be performed by non-physicians or technical assistants instead of physicians. This has typically been done in close collaboration with the medical profession. Task-shifting can potentially result in cost and physician time savings without compromising the quality of care or health outcomes for patients.

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REFERENTION 1.

Ministry of Health Republic of Indonesia. 2012. Problem Hypertension In Indonesia .

Jakarta 2.

Central data and information of Health Republic Indonesia. Hypertension

3.

Suyono, Slamet. Buku Ajar IlmuPenyakit Dalam, Jilid 2, Edisi Balai Penerbit FKUI,

Jakarta ;2001 4.

Yundini, Faktor Risiko Hipertensi. Jakarta: Warta Pengendalian Penyakit Tidak

Menular ;2006. 5.

Central data and information of Health Republic Indonesia. Hypertension

6.

Statitical Fact sheet 2013 Update. American Heart Association, Inc. All rights reserved.

Unauthorized use prohibited 7.

Central data and information of Health Republic Indonesia. Hypertension

8.

Galambos, Louis and Sturchio, Jeffrey L. Noncommunicable Diseases in the

Developing World: Addressing Gaps in Global Policy and Research. Baltimore:John Hopkins University Press. 2014 9.

Beaglehole, R and Yach, D. Globalisation and the prevention and control of non-

communicable disease: the neglected chronic diseases of adults. Vol.362. 2003 10.

Department of Health. Annual Report and Accounts 2015-16. UK: Crown. 2016. Pg.2-3

11.

Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, et al. (2014) Task Shifting for

Non-Communicable Disease Management in Low and Middle Income Countries – A Systematic Review. PLoS ONE 9(8): e103754.Â

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SCIENTIFIC POSTER




Limiting Residents’ Extended Working Hours to Reduce Medical Errors by NEWS-Technology Angela Kimberly Tjahjadi, Joanna Erin Hanrahan, Clara Menna AMSA-Universitas Indonesia Background of the Study. Healthcare workers, especially residents are well-known for their long working hours due to the excessively long shifts. A study confirmed that after 17 hours of wakefulness, one’s psychomotor abilities has been deteriorated as low as intoxicated alcoholic person by 0.05%. After 24 hours of sustained wakefulness, the performance deficit is the same as 0.1% alcoholic consumption. This data suggests the inadequacies medical workers to perform procedures in the state of fatigue. An innovation of new technology called NEWS (non-extended working shifts) is designed to help increase the health care service quality by limiting extended night shifts in residents according to The Accreditation Council for Graduate Medical Education’s 2011 (ACGME 2011) regulation. NEWS is designed to count the number of working shifts thus protecting the residents from experiencing fatigue and further possible damage to the patient. Material & Methods. The review is conducted by literature searching in PubMed and ScienceDirect from 2007-2016. Ninety one journals from PubMed and 34 journals from Science Direct are found with keywords (residents fatigue) AND (medical error). We proceeded to put some criterions and analyze the title and abstract of papers collected and concluded to read full text of 10 journals in total for this scientific poster. Results. There is a 10-15% increasing medical errors committed by residents who extended their night shift working hours. Assessing this issue, we propose an innovation in implementing ACGME 2011 Regulation. Non-extended Working Shifts (NEWS) is designed as a multifunctional barcoded badge which serves both as ID card and daily attendance tap card. In every department and ICU, there will be machine where the residents tap the card. One attendance will be recorded if residents tap in and out after conducting their shifts. This machine will be set with certain time regulation according to 2011 ACGME Regulation to limit residents' working hours effectively. If the time limit is reached, it will be noted as a violation and personnel involved will be given a warning not to do the shift. Every data collected will be given to every department to be evaluated monthly. Conclusion. Extended working shift as the causal root of defective health care service quality. NEWS technology is a solution to reduce the number of medical errors and increase the quality of healthcare services by controlling the working shift hours of residents.




The Effectiveness in Reducing Medication Error and Adverse Drug Events (ADE) Through Implementation of CPOE in Pediatrics

Esmeralda P. S., Devina J., Josephine E. S. Faculty of Medicine, UNIKA Atma Jaya

ABSTRACT BACKGROUND : In the pediatric department, medication errors and Adverse Drug Events (ADEs) are reported to occur in 5.7% of orders and in six of every 100 patient admissions. Computerized Clinical Decision Support System (CDSSs) within Computerized Provider Order Entry (CPOE) has proven to reduce medication errors in adults population but lack of analysis on the effect on pediatrics population. Considering dynamic anatomy and physiology changes in the growth and development years of pediatrics population result in pharmacotherapy differences. The purpose of this review was to analyze the effectiveness of using CPOE as an advanced method to reduce medication error and ADEs in the field of pediatrics. MATERIAL AND METHODS : To examine the benefits and barriers to CPOE adoption, we do a literature review . We identify the literature, collect the data, and analyze it to obtain the result. RESULTS : Utilization of CPOE reduce medication error as this system will allow an organized and clear order from physicians to other sections of healthcare, a reduction in misconception and call backs from pharmacy due to vague or unclear information. Switching from paper charts to CPOE ease the access to patient’s medical records and reduction in medication error. This also will result in time saving due to better coordination of healthcare team. Adoption of CPOE will save the cost of health care . With CDSS, it offers suggestions or default values of drug doses, routes, frequencies, interactions, allergy checks, reminders, and guidelines. In other words, assisting the physicians in choosing the appropriate medications as well as comparing and contrasting that with the patient’s medical history. CPOE application in pediatrics simplify pediatric dosing calculations. CONCLUSION : The adoption of CPOE proved to be an effective solution for limiting medication error. CPOE favors numerous benefits for patients, physicians, and the government. It allows doctors to access patient’s medical record at ease. The burden of the cost of health care can also be cut down. CDSSs within CPOE will further reduce medication error due to the thorough checking of drug doses, interactions, and allergies. CPOE will provide a safer service in pediatrics due to advanced dosing calculation automatically adjusted to child’s chronological, gestational age, and weight. The success of implementation of CPOE surely require significant role from the government. Nevertheless, CPOE offers complete and accurate information, ensuring better quality of care especially in the pediatric department, while also effectively minimize medication error.




Assessment of Hand Hygiene Interventions to Improve Hand Hygiene Compliance   among Health Care Workers and Nosocomial MRSA Infection Level Reduction: A Systematic Review Nadya Johanna, Almira Ramadhania, Harits Adi Putra AMSA-Universitas Indonesia Abstract Background of the Study Hand hygiene is the single most important element of infection control. However, the adherence to hand hygiene remains low among the health workers. The low hand hygiene compliance can ease the transmission of nosocomial infection, such as MRSA (methicillin-resistant Staphylococcus aureus) as the most common health careassociated infections (HAI) in the acute care setting. Several methods have been applied to reduce MRSA transmission, such as hand hygiene. Therefore, improving hand hygiene compliance would be a simple, cost-effective, and impactful method to reduce MRSA infection. We propose this systematic review to compare the efficacy of some intervention models in improving health workers’ hand hygiene compliance to reduce MRSA nosocomial infection in healthcare setting. Material and Methods We performed searches of the literature in PubMed, PubMed Central, Science Direct, and Proquest of material published prior to January 5, 2016. Included studies were randomised controlled trials (RCT), non-RCT (NRCT), controlled before-after trials (CBA), and interrupted time series studies (ITS) implementing intervention(s) to improve compliance with hand hygiene among healthcare workers in hospital settings and measuring compliance or appropriate proxies in order to reduce MRSA infection. All papers are written in english. Screening was conducted independently by two reviewers and a third reviewer was consulted to resolve discordance. This study also use suggested risk of bias criteria for Cochrane EPOC reviews. Results Out of 2.214 papers screened, we included 8 studies that met the inclusion criteria. The majority of intervention applied is multifaceted and multimodal (87,5%). Six studies analyzes the intervention effect to the hand hygiene compliance rate and MRSA incidence or positive culture. A higher compliance rate and a greater reduction rate of MRSA incidence were reported when a multifaceted intervention was used, except in one study which was possibly due to the low baseline incidence rate and short monitoring periods.

Conclusion A multimodal and multifaceted strategy was proven to be necessary to improve the compliance rates of hand hygiene. Improvement in hand hygiene compliance significantly reduced the MRSA infection incidence. We recommend that when a multifaceted and multimodal intervention is implemented, practices should be monitored, and feedback loops should be implemented. Keywords : Hand Hygiene, Health Care Associated Infection, Methicillin-Resistant Staphylococcus aureus, Protocol Compliance




 

I-PASS Implementation for the Reduction of Medical Error in Hospital Handoffs Hanjaya Basuki, Andy Andrean, Tungki Pratama Umar Faculty of Medicine, Sriwijaya University

Background Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome. One way to decrease the number of the mistake is to upgrade our patient handoff system. Though there are handoff procedures in indonesia, such procedure did not have a high perception to the overall patient safety culture, as shown in the table below. Hospital handoff and transitions only have a bit more than fifty percent positive perception.Other thing that factor a handoff procedure error is communication failures (Starmer,2014). For this case, we take a look at I-PASS, a mnemonic developed by Rosenbluth and West to identify medical error that is used by Accreditation Council for Graduate Medical Education (ACGME) of North America. Material and Methods We systematically, reviewed journals from database such as NCBI, BMJ, JAMA, NEJM as well as government documents. Result According to Starmer (2014), from 10,740 patient admissions the number of preventable adverse events were dropped by 30% from the preintervention to the postintervention period (4.7 vs. 3.3 events per 100 admissions, P<0.001. The rate of nonpreventable adverse events did not change significantly (3.0 and 2.8 events per 100 admissions, P = 0.79). In the other hand, rate of non-harmful medical errors were reduced by 21% following implementation of I-PASS. Overall reduction of medical error were reported dropped by 23% from the preintervention to the postintervention period (24.5 vs. 18.8 per 100 admissions, P<0.001) Conclusion I-PASS Handoff Bundle implementation was associated with, reduction in overall error rates and preventable adverse events, improvements in verbal and written handoff communications, and it is not recommended for patient who require broader information and context. I-PASS is better used in condition where is time is limited. Keywords I-PASS, Medical Error, Hospital Handoffs

Author: 1. Hanjaya Basuki Email : hanjaya.basuki97@gmail.com Phone : +6282362894684 2. Andy Andrean Email : andreanandy12@gmail.com Phone : +6281239652335 3. Tungki Pratama Umar Email : tungkipratamaumar@gmail.com Phone : +6285368708668




 

Reducing and Preventing Medication Error: Appropriate Strategies for a Preventable Harm Rizki Fadillah, Shagnez Dwi Putri, Shafira Irmayati Faculty of Medicine Sriwijaya University

Background Medication errors are world issue that requires serious attention because it can harm patient health and lead to death. Medication error is actually really preventable, yet it became one of the most costly and common sources of preventable harm. Given the above circumstances, the study aimed to identify the appropriate strategies to prevent and reduce the incidence of the medication error in Indonesia. Methodology Study method is literature review. Data were obtained from analyzed and summarized the resources such as journal and article. Result and Discussion This study suggested necessary strategy to prevent and reduce medication error. Some of the these strategies include Computerize Provider Order-Entry System (CPOE), Bar code System, Medication reconciliation, Standardizing medication-use process and Education for The medical professional and patient. The following strategies has been shown to decrease the incidence of medication error especially in administration error. Conclusion In order to reduce medication error, the implementing of particular system mentioned is very important as well as to keep the relationship between patient and Medical Professional also important to prevent adverse drug event by giving the medication guidance.

Minimizing the Possibility of Medical Errors  

Cheryl Livia, Jessica Lauryn, Aristo Constantine Abstract In developing countries, especially Indonesia there is still many cases of medical errors. Such medical errors can be classified as two types which are active and latent errors. Active errors cases were caused by healthcare workers, not only doctors but also nurses and assistant nurses. Firstly, they don’t have sufficient knowledge about infection control and standard precautions.

Second, they have bad habits because

their behaviors have been up to low standard. In the other hand, latent errors cases were caused by the lack of facilities in the hospital. The worst effect that could happen from medical errors is disability. With errors from anamnesis and diagnostic procedures, it could lead to mistakes in treatment procedures. The disability could also lead to depression. Besides from disability and depression, it can also inflict great financial loss. So with the major losses that could be caused by such medical errors, this poster has been made to bring insight into Indonesian health workers. To help with this cause, some of the solutions are improving education and training for health workers, establish policies that creates a safer environment for patients and workers, improving communications and teamwork between workers, and simplifying procedures and policies to reduce misunderstandings. Materials & Methods Reducing and preventing medical errors with literary study. Result Classifications, effects, and probable solutions of medical errors. Conclusion To conclude this poster, medical errors are things that are classified as active and latent errors. These errors can bring many harm to the patients , however there are many solutions available for the healthcare workers and their administrator.

REFERENCES 1.

Zikhani R, M.D. Seven-Step pathway for preventing errors in healthcare. Journal

of Healthcare Management 2016;61:271-281. 2.

Technical Series on Safer Primary Care. 1st ed. World Health Organization; 2016.

3.

Duerink DO, Hadi U, Lestari ES, Roeshadi D, Wahyono H, Nagelkerke NJD, et al.

A tool to assess knowledge, attitude and behaviour of Indonesian health care workers regarding infection control. Acta Medica Indonesiana-The Indonesian Journal of Internal Medicine 2013;45. 4.

Charlton B, Kassirer JP, Ramsey M, Ioannidis JPA. Inadequacies of physical

examination as a cause of medical errors and adverse events: A collection of vignettes. The American Journal of Medicine 2015;128:1322–1324. 5.

Aronson JK. Medication errors: what they are, how they happen, and how to

avoid them. The Association of Physicians 2009;102:513-521.

 

Why and How to Prevent Medication Error Ignatius Ivan, Harvey Sidharta, Dylan Putra Wijaya Faculty of Medicine, Atmajaya University

 

Why and How to Prevent Medication Error Ignatius Ivan, Harvey Sidharta, Dylan Putra Wijaya Faculty of Medicine, Atmajaya University

ABSTRACT Patient safety is vital in patient care. There is a lack of studies on medical errors in the past, mainly on primary care settings. The aim of this study is to inform more people about errors that might happen during medication and how to prevent these errors from occuring, because healthcare workers are humans too and humans make mistakes. The issue is not how to hide or ignore these mistakes but how to report, study, and prevent them from happening in the future. Our method is using literature review from medical journals about general medication errors that occur in hospitals. A review of 11 studies conducted in primary care set-tings found that the rates of medical errors ranged between 5 and 80 errors per 100,000 visits. The most common errors were those related to delayed or missed diagnoses, followed by treatment errors. These errors occur because lots of factors such as bad education and medical reporting system, healthcare workers quality of life, technologies, etc. And a review of 4 journals which stated in average of 0,89% death from medication error where 69% of these errors can be prevented. As healthcare workers are humans too and humans make mistakes, the issue is not how to hide or ignore these mistakes but how to report, study, and prevent them happening in the future. There are several ways that could help us understanding these errors, such as : changing the education system, implementing a culture of safety, changing the reporting system, improving the technology, Setting a performance standard, and reducing healthcare workers work time for optimal performance.

The Use of Isolation Chip to Treat Antibiotic Resistance in Community Quinta Febryani; Sallie Naomi; Robert 
 Background Antibiotic resistance becomes a worldwide issue. Antibiotics are called "societal drugs," since resistant bacterial infections can pass from person to person. Thus, antibiotic use and antibiotic resistance can affect an entire community. Medical errors such as irrational use of antibiotics bring us to the crisis state of multidrug-resistance. WHO released a policy to Combat Drug Resistance, which include nurturing of innovation and political commitment. In Indonesia, antibiotic resistance rates show high numbers, for ampicillin (66%), cotrimoxazole (52%), and chloramphenicol (39%). Material and Methods A systematic literature study search was conducted with 4 databases for articles published between 20011 until 2016. We used the following terms in the search field: Teixobactin AND [Antibiotic Resistance] and Antibiotic resistance AND [Public Health], Biotechnology AND [Teixobactin]. Results were compared and reevaluated in group sessions until consensus was obtained between reviewers. The final analysis included 25 articles, which met the criteria for the present literature study. Result Technology invented to solve antibiotic resistance is isolation chip (iChip). It’s a multichannel device that is able to culture microorganisms (in isolation from another) from soil that had not been able to be cultured in vitro previously to yield a higher number of novel microorganisms compared to traditional petri-dish methods to be developed into antibiotics. This iChip device resulted in isolation of teixobactin (previously uncultured) from a soil microorganism that unable grow in test tube. Teixobactin had excellent activity against Grampositive pathogens, including drug-resistant strains. It has potency against most species, including difficult-to-treat enterococci and M. tuberculosis and has promising in vivo activity, resulting in a substantial reduction in bacterial burden in mice infected with methicillinresistant S. aureus or Streptococcus pneumonia. Conclusion Developing potential anti-microbes molecule using “iChip” is proven beneficial. iChip as a new way for discovering new natural antibiotics from isolation of soil-microorganism’s compounds, such as teixobactin. The properties of teixobactin suggest that it evolved to minimize resistance development by target microorganisms. Teixobactin had excellent bactericidal activity and retained bactericidal activity against drug resistance gram-positive strains including M.tuberculosis. Keywords: Antibiotics Resistance, Isolation Chip, Teixobactin




 

Computerized Physician Order Entry (CPOE): A Modern Innovation towards a Better Health Care Quality Service in Indonesia Lydia Rosalina Widjaja, Stella Clarissa, Vionita Jessica Faculty of Medicine, Atma Jaya Catholic University of Indonesia

Abstract Background of the Study: Medication error is the most frequent mistake that occurs in hospitals, resulting in 7000 patients die every year and 2 medication errors occur everyday. In Indonesia, 96% medication errors occurred in Intensive Care Units (ICU) and 80% in Community Health Centers (CHC). Computerized Provider Order Entry (CPOE) is an application that allows health care providers to directly enter medical orders through a computer, replacing the more traditional order methods of paper, verbal, and others. Medication, radiology, referral, admission, laboratory, and procedure orders can be entered directly through CPOE. Specifically, CPOE is integrated with Clinical Decision Support Systems (CDSS) that gives suggestions of drug doses and drug safety features. Furthermore, CPOE-CDSS recommends alternative tests or treatments that may be safer or lower cost. Besides CDSS, CPOE is integrated with Electronic Medical Record (EMR) and Adverse Drug Event (ADE) reporting systems. CPOE averts problems with poor handwriting and drug prescribing errors. Material and Methods: The method we use in this scientific poster is literature review from scholarly journals. The literature searching was conducted systematically in 2 databases: ProQuest and Google Scholar. Results: CPOE system has proven to be effective in reducing and preventing medical errors. CPOE-CDSS provides clinicians with reminders in order to optimize the safety and quality of clinical decisions. CDSS offers default values for doses, routes of administration, frequency of commonly used drugs, and more sophisticated drug safety features. CPOE is also able to reduce the time required to complete clinical task, coordinating medical team and reducing the time for nurse on reviewing, verifying, and correcting clinical instructions. Conclusion: CPOE has been shown to potentially become a solution to reduce and prevent medical errors. Furthermore, CPOE can also be cost-effective for hospital and also limit ADE incidence. However, CPOE is not widely used in hospitals in Indonesia because the implementation of a new clinical information system takes a lot of time and money. But we believe, with the proper training and optimization, CPOE is likely to be a reliable way to transfer physician's orders that tend to increase the efficacy of health quality services in Indonesia. Keywords: CPOE, CDSS, medical errors, hospital acquired infection




 

Reducing Maternal and Neonatal Mortality in Rural Indonesia by Implementing Self-Help Groups in Communities Edwin Ti Ramadan1, Alessa Fahira1, Stefanus Sutopo1 1Faculty

of Medicine, Universitas Indonesia, Indonesia

Background: Maternal mortality rate (MMR) in Indonesia is one of the highest compared to the countries in the south-east region of Asia, where in 2012 it is estimated there are 359 maternal deaths per 100,000 live births. Causes of which are related to the limited number of health care professionals and the delay to deliver babies in health care institutions which are determined by social, geographic and infrastructural factors. Hence, initiatives to improve maternal and neonatal health outcomes are needed. In this review, we consider Self-Help groups to be one of reliable and cost-effective implementations that may reduce MMR in rural areas of Indonesia. Methods: Method used to finish this literature review is by systematically reviewing journals from PubMed, WHO, BMC, and other reliable medical journals. The keywords that are used to find the journals are: rural, maternal, mortality, and health care. Exclusions are used to selects several of journals, which includes keywords mentioned above, that are not related towards the literature review title. Results: SHGs are small groups of predominantly rural women with similar economic affinity, of about 10-20 members each, that are well-established in the country in which they provide mutual assistance toward a common handicap or problem, material assistance, and emotional support. SHGs have been shown to improve maternal and child health knowledge and practice based on a quantitative study performed in India. SHGs provide a simple, sustainable and cost-effective approach towards the improvement of maternal and neonatal health care in Indonesia. Conclusion: We suggest a solution in the form of self-help groups, where these groups will help soon-tobe mothers and experienced mothers in the region support each other financially, psychologically and with sharing of knowledge. By the supervision of health professionals, health programs can also be formed in SHGs. Health professionals involved in the group can also learn about the hardships of pregnant mothers in an assigned rural area. Thus, they can serve these rural communities better, even in a wider part than to prevent maternal mortalities.

The Effect of Electronic Health Records on Hypertension Management: A Systematic Review Joseph Mikhael Husin, Gaviota Hartono, Andrew Pratama Kurniawan Universitas Indonesia

Background: Hypertension is a major burden and challenge yet to be solved in Indonesia because people tend to disregard their duty to regularly take the medicine or control their blood pressure regularly to physician. This problem may be solved with an integrated health management system for the physician and the patients. Electronic Health Records (EHR) can easily facilitate the physician and patient for chronic management especially hypertension. So this review aims to evaluate the use of EHR effectiveness to manage hypertension patient. Material and Methods: We used Pubmed and EBSCOhost (consisting of Academic Search Complete; CINAHL Plus with Full Text; Library, Information Science and Technology Abstracts; and Medline with Full Text) to search literatures until 2016. Terms used are “electronic health records” and “hypertension”. Screening was conducted by two independent reviewers and a third reviewer was consulted to resolve discordance. Results: Of 2404 articles identified in search, we reviewed 8 studies that compare the use of EHR and non-EHR to manage hypertension. There are 3 types of EHR included in the studies: EHR that acts as a database of medical record, accessible by patients and clinicians (type A); EHR that also allowed patients to use e-messaging system with their caregiver(s) (type B); and EHR that gives physicians alert or other decision-making support (type C). Out of those 3 types, EHR with clinical decision support is the most beneficial while EHR only as a database gave no significant benefit at all. Conclusion: EHR that gives a clinical decision support for the physician (type C), may improve the result of blood pressure therapy




PREVENTING THE INCIDENCE OF CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) Vania Elvira; Hana Maria Christian University of Indonesia!

Background of the Study Urinary catheter placement is an extremely common medical intervention. It can be used either temporarily, for example to drain a full bladder, to monitor urine output or it can be indwelling for long term drainage. While urinary catheters are a safe medical practice, complications can and do arise from their use and can be a source of morbidity for hospital or nursing home residents. There are tree points that base our background of Study. The impact of the happening of Catheter-Associated Urinary Tract Infection, the evidence-based risk, and the pathogenesis of how CAUTI occurs. Materials and Methods The method used in writing this literature review is to search methods in the literature review database such as Google, Google Scholar, PubMed, HealthLine, and Medscape and other medical journals such as CDC and AJIC with the time span 2005 – 2016. The key words that are used are CAUTI (Catheter-Associated Urinary Tract Infection), Urinary Catheter, HAI (Hospital Associated Infections). Results There are two cathegories of preventing CAUTI. Core and Supplemental. Core prevention. Core preventions are based on high levels of scientific evidence and demonstrated feasibility. And supplemental strategies are based on some scientific evidence and variable levels of feasibility. Conclusion CAUTI is the most frequently occurring healthcare-acquired infection and is associated with increased length of stay, morbidity, mortality, and overuse of antibiotics. Healthcare providers play an important role in preventing these infections. It is important to understand that in the course of everyday work, decisions about care of urinary catheters arise and we will be challenged to make the best decision consistent with evidence prevention practices.




Optimizing proper health workers quality towards healthcare service accessibility in remote and rural areas of Indonesia Ivany Lestari Goutama Faculty of Medicine, Universitas Tarumanagara, Jakarta, Indonesia Abstract Aim: The aim of this study was to embrace medical students and healthworkers to be aware of current dimensions of health service failure occuring in remote and rural areas and identify the answer key to the problems by improving own retention. Background: The remote and rural settlements often have to experience barriers to healthcare that limit their ability to get the care they need, such as distance, difficulties to attract proper health workers and need for an interpreter.1 Approximately one half of the global population lives in rural areas by only with 38% of the total nursing workforce and by less than a quarter of the total physician workforce.2 In 2006, World Health Organization (WHO) reported that Indonesia was among 57 countries suffering a critical shortage of health workers, with a health workforce ratio of less than 2.5 per 1000 population.2 In March 2016, Ministry Of Health (MOH) also mentioned that to achieve the availability of health care facilities, accessibility and quality of health services, requires not only from the government but also the strengthening of the health services and society in all parts of Indonesia.3 Material and Methods: Comprehensive literature review was conducted for this research. The study taken was conducted in Bengkulu province, Sumatra, Indonesia. A technique of convenient sampling was employed since a sampling frame of hospital patients could not be accessed by researchers. Three hundreds self-administrated questionnaires were distributed to hospital patients and 300 questionnaires were returned and analyzed for the study. The variances in the full set of the 20 service failure variables are displayed in Table 1 that attribute to the six-factor solution, which is medical reliability (F1), physical evidence failure (F2), poor information (F3), medical treatment errors (F4), costly services (F5), complaint handling (F6).4 The cumulative value of total variance was 63.26%. Results: The result of the study clearly indicates that there are the underlying dimensions of service failures in the healthcare services in Indonesia. It is important to study patient complaint behaviour and conduct its recovery strategy to match the need of patients. Further analysis should be conducted. Conclusion: To achieve the proper health service towards the rural and remote settlements, all parts of society (government, health services, patients) must collaborate in eliminating the service failures to achieve the optimal health care service, not only for the urban societies, but also for all.




Empowering Health Care System in Papua through Mobile Clinic Program: An Evaluation I Putu Febrian Andira Putra, Melissa Stephanie Kartjito, Syarifah Zaharatul Aini AMSA Universitas Gadjah Mada Background of the Study Papua is considered Indonesia’s most underdeveloped region in all sectors, even though its GDRP per capita was more than twice of its neighbor Papua New Guinea (PNG). However, many indicators (including health) show that indigenous Papuan people suffer a lower standard of living than their counterparts in PNG and that Papuans also comprise the poorest sector of Indonesian society. A comparison of a basic health statistic, such as Infant Mortality Rate between Melanesians living in PNG and those in Indonesian-controlled West Papua, shows a very stark difference. Indonesian government has continually aims to enhance Papua’s public health quality, for instance through government projects such as Mobile Clinic Program as an implementation of Program Percepatan Pembangunan Kesehatan Tanah Papua (P2KTP). Mobile Clinic is a comprehensive and integrated health care service through visitations to reach the reluctant community, focusing on early diagnosis and prompt treatment of nutritional problems, HIV/ AIDS, TB, Malaria, Filariasis and health promotion as well as cader training. This program is aimed to empower existing health care service and regarded by the Integrated Health Post (Posyandu) as a routine health care service. Evaluations of the Mobile Clinic program held in 2013 recommend this program to be conducted again without forgetting to overcome its weaknesses. Material and Methods For this scientific poster, we use literature searching from journals, data from Statistic Indonesia and Ministry of Health to find the weaknesses of mobile clinic program that can be evaluated for the next conduction. Results So far, the Mobile Clinic Program has showed positive progress in its aim to enhance Papua’s health quality, but there are areas to be improved, such as the medicine distribution, as there is no Standard Operating Procedure (SOP) and medicine distribution hasn't fully implementing the one-door policy; the team personnel area, where the Coordination Team of Mobile Clinic which guarantees medicine quality in distribution still needs to be improved, and there is no pharmacist in the team; and lastly the local people itself, as we see the need to educate local inhabitant about basic knowledge of medicine. Conclusions With a proper improvement considering what have been described above, this program should run smoothly. Aside from those, difficulties to reach the location and the amount of costs did not obstruct mobile clinic program performance because this program is supported by an adequate expense from the government




Is My Hospital Truly Safe? Vincentius DP, Yohanes SB, Gillbert RK Faculty of Medicine, University Gadjah Mada Indonesia

Background Indonesia, which has more than 250 million citizen, could not expect to escape from problems in her health. Our hospitals are leaky, for example people in hospital sneeze or cough without covering their mouth. It wouldn’t be surprising to find nosocomial infection of antibiotic-resistant bacteria in Indonesia. In addition hospitals are fewer than the total people. That reason permits the hospital to put many patients in one room, which augment the nosocomial infection. We thought, how could hospital help people, when it was overburdened and weak from inside? What are the crucial factors? Is there a way to stop it ? Materials and Method We use systematical review of many journals and including government reports. We define the question that would lead us to the conclusion, based on the information we extracted. Result The rate of nosocomial infection in Indonesia is 9,8%. However not every hospital have high rate of nosocomial, even though the rate’s still increasing to this day. The result contradicts the standard, KMK No.19 tahun 2008, which stated that the rate of nosocomial infection in the hospital should be below 1,5%. Why there are many nosocomial infection ? Because of he imbalance between demand and supply, Economic condition in Indonesia limits the growth of health care provision, Lack of knowledge for patient and health worker and weak Supervision. The government could improve the facilities of Community Health Centre, thus increasing its capabilities, thus decreasing the workload of the hospital. Also, Government could increase the subsidy to the universities so that future health worker could be smarter. With better knowledge, the student could be a better health worker. The hospital that committed high rate of nosocomial infection should be warned with heavy consequences. This would encourage the hospital to prevent the nosocomial infection. Conclusion Factors that increase the prevalence of nosocomial infection are Imbalance between demand and supply, poor economic condition, lack of knowledge, and weak supervision. Thus approaching these 4 factors could decrease nosocomial infection.

Referensi 1. Wikansari N, Hestiningsih R, Raharjo B. Pemeriksaan Total Kuman Udara dan Staphylococcus aureus di Ruang Rawat Inap Rumah Sakit X Kota Semarang. Jurnal Kesehatan Masyarakat. 2012;1(2):384 - 392. 2. Fitri Yanti L. Faktor-Faktor yang Mempengaruhi Perilaku Perawat Terhadap Pencegahan Infeksi Nosokomial di Ruang Rawat Inap Kelas II dan III RSAU dr. Jurnal Ilmiah Kesehatan. 2014;6(1):33 - 35. 3. Lelonowati D, Koeswo M, Rokhmad K. Penyebab Kurangnya kinerja Surveilans Infeksi Nosokomial di RSUD dr. Iskak Tulungagung. Jurnal Kedokteran Brawijaya. 2015;28(2):186 - 194. 4. Nugraheni RWinarni S. Infeksi Nosokomial RSUD Setjonegoro Kabupaten Wonosobo. Media Kesehatan Masyarakat Indonesia. 2012;11(1):94-100. 5. RM EKholik S. Hubungan Pengetahuan Tentang Infeksi Nosokomial dengan Sikap Mencegah Infeksi Nosokomial pada Keluarga Pasien di Ruang Penyakit Dalam RSUD Ratu Zalecha Martapura. Jurnal Skala Kesehatan. 2015;6(2):26- 33. 6. Veloo A, Komuji M, Khalid R. The Effects of Clinical Supervision on the Teaching Performance of Secondary School Teachers. Procedia - Social and Behavioral Sciences. 2013;93:35-39. 7. Farnan J, Petty L, Georgitis E, Martin S, Chiu E, Prochaska M et al. A Systematic Review. Academic Medicine. 2012;87(4):428-442. 8.. Kemenkes Indonesia. Profil Kesehatan Indonesia 2014. 1st ed. Jakarta: Kementerian Kesehatan Republik Indonesia; 2014.




Robotic Assisted Colorectal Surgery: An Advanced Innovation to Improve Medical Healthcare Authors: Jesslyn Valentina, Rafael Bagus Yudhistira, Patricia Arindita Eka Pradipta Asian Medical Students’ Association Universitas Sebelas Maret Faculty of Medicine, Universitas Sebelas Maret

Abstract Background During the past 50 years, the number of deaths from colorectal cancer has increased approximately tenfold. In Indonesia, colorectal cancer is the third most types of cancer. Considering this situation, it is important to find an effective treatment which can cure with less complication and medical errors. Laparoscopic surgery has been shown to be effective and has certain benefits over traditional open surgery. However, there are many limitations and medical errors due to the performance of laparoscopic surgery. To overcome these technical drawbacks, robotic laparoscopic colorectal surgery was introduced as an innovation of minimally invasive surgical methods. Material and Methods This literature review were identified by three search engines, Scopus, Pubmed and Google Scholar which reported the colorectal cancer, colorectal surgery, medical error, and robotic surgery, during January 2007 through January 2017. A total of 47 relevant articles were identified and 8 articles which met the eligible criteria were included in this review. Results Robotic laparoscopic surgery is feasible, produces similar perioperative outcomes and is oncologically safe. It may result in shorter hospital stays, reduced blood losses and lower conversion rates, but it also may require increased operation time costs. Conclusion With the enormous of potential advantages’, the development of robot assisted colorectal surgery opens the door to further researches and new approaches. However, the current progress is impeded by high costs and limited technology. Keyword: colorectal cancer, colorectal surgery, medical error, robotic surgery

Medical Error and How to Handle Them Yeniar Fitrianingrum, Auliya Y Yasyfin, Hillarine

Background Medical staffs have such a high burden of workloads. With doctor-patient ratio of 1 doctor for every 2 500 patients and keep rising in the number of hospital admissions. There seems to be an increase in workload of doctors and it is making medical error as the eighth most common cause of death.[1] There also a likelihood of clinical incidents to happen during nights shifts and it is thought that the distrubution of doctors needs to be put into consideration.[2] Furthermore, the trend of medical staffs to deny of stress and its effects on their performance might increase the likelihood of medical error. Material and Methods: Literature review using analytical descriptive. Utilizing a number of articles and doing cross-sectional review about how each articles describes the factors that might lead to medical errors. Results: - Although the total numbers of doctors seemed adequated throughout the day, there has been found a significant disparity in doctor-patient ratio among different shifts. It is measured by the average time that is needed to assess patients.[2] - It is also showed that during night shifts the number of doctors seemed to be lower compared to the patients needs, respectively.[2] - The way medical staffs openly recognise the effects of stress on their performance is thought to be low. Only a minority agreed that personal problems could hamper their decision-making ability.[1] - Medical staffs’ attitudes towards teamworks also put

contributions how well error is

handled in a hospital. The steep hierarchy in a teamwork mostly will cause junior staffs to less participate in decision making and that could further aggravate the situations.[1] - Different perspective on perceiving teamworks also increases the chance of medical error. Since different perspective even if it’s only from one member of the team might influence the whole team balance.[1] - The steep hierarchy also contributes to how medical staffs acknowledge errors. Barriers to discussing error seemed to be caused by a few reasons including personal reputations, the threat of malpractice suits, high expectations of patients’ family or society, possible disciplinary actions, threat to job security, and expectations of other team members.[1]

Conclusion -

Most medical staffs have the difficulty to acknowledge an error and it is said that

error is not handled aprropriately. -

The trend to deny the effects of stress and fatigue among medical staffs may

increase the likelihood of error. -

Redistribution of doctors to increase their number during night shifts needs to be

done. This way, we can reduse the individual workload of medical staffs to ensure a complete performance. References 1.

Sexton JB, Thomas EJ, Helmreich RL. Error, Stress, and Teamwork in Medicine and

Aviation: Cross Sectional Surveys. Journal of Human Performance in Extreme Environments. 2001Jan;6(1). 2.

Chacko S, Prabhavalkar S. Doctor-Patient Ratios and Acute Medical Admissions: A

Simple Solution for an Important Problem! Ulster Medical Journal [Internet]. 2014Jan [cited 2017Jan]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3992100/




Optimizing Residents’ Work Hour to Decrease Medical Error Incident in Hospital Donni Santoso1, Ajeng Maharani Putri2 and Devina Teresa3 1Second

Year Medical Student, University of Brawijaya (donni.san97@gmail.com)

2Second

Year Medical Student, University of Brawijaya (ajengmputri@yahoo.com)

3Second

Year Medical Student, University of Brawijaya (devinateresa@gmail.com)

Abstract Resident (undergraduate specialist doctor) working in industrialized countries have traditionally worked for long hours, particularly during the early stages of their career. Excessive working hours results in resident doctor fatigue which will lead to some incident of medical error in Indonesia’s health care system and yet, there is uncertain policy for the limit of working hours for residents itself. Therefore, we propose a system for optimizing the resident working hours in order to decrease medical errors in Indonesia. The method used in this paper is literature review, and the materials are relevant scientific journals or reports. The system is made into a guideline by setting 72 hours maximum working week because resident still needs an experience of firsthand exposure to a wide variety of patient cases through a patient care and education studies which include in working hour in the healthcare facilities (Jagsi et al., 2005). For on call duty, resident must take only maximum 24 hours duty. Resident must take a resting or meal time 30 minutes every six hours worked or 10 hours between duty in a week. Breaks within the working period provide for refreshment and restore physical capabilities and alertness. Resident should take a day off in a week from patient care and education duties. Shift working is commonly associated with a disruption of life outside work. Resident must not take all duties more than once every three nights. On average, shift workers lose 1–1.5 hours of sleep for each 24-hour period. Working more than three or four night shifts in a row may cause a significant sleep debt, with serious consequences for safety. This system is able to decrease medical error by emphasizing working hour system of resident while promoting high-quality education and safe patient care in Indonesia. Keyword : Resident , Medical Error, Working Hour System




Empowement for Breast Cancer patient with Online Cancer Support Group Fransisca Dela Verna1, Mokhamad Fahmi Rizki S2,Nadia Annizar3 University of Brawijaya

Background: Breast cancer is the most common cancer in women both in the developed and less developed countries. Diagnosed with breast cancer and getting treatment is a very traumatic experience with the physical and psychological impact which often led to depression, changes in physical appearance, and decreased quality of life. Metod: We conducted a systematic review and Inclusion and Exclusion Criteria to identify existing online cancer group potential to support patient empowerment in breast cancer patient. we using three main search engines,

NCBI and Sciendirect, Pubchem. The

combinations of terms used for the search included “Empowerment”, “Breast” cancer” , “Online” ,”Support”.

Limits were applied and only studies published in the last 15 years

(2001-2016), and written in English were included. Studies outside of the ten year range were excluded to avoid subjectivity and bias in conducting this review. Result: We can divide the empowerment program into 3 categories, which are, information, beliefs, and skills. Online cancer support groups have an important role in empowering patients by educating service and patient to patient service about breast cancer. Patients can obtain information about breast cancer, treatment and possible effects of long term and short term. In the online cancer support group of breast cancer, patients receiving the emotional support is more likely to keep participating, while patients who received the support of information are more likely to drop out. Conclusion Social support can reduce the level of loneliness, stress and anxiety. Internet-based education programs are also useful to meet the information needs of patients. The use of internet and communications technology increases, it can be beneficial to health services. The Internet can be a tool to educate and empower breast cancer patients. Peer to peer support groups can help breast cancer patients to exchange information and emotional support. In the online cancer support group of breast cancer, patients receiving the emotional support is more likely to keep participating, while patients receiving information support are more likely to drop out. Further efforts to identify breast cancer survivors who need pyschosocial support is needed. The development of Internet-based education and support is important to improve breast cancer patients. Keyword: Breast cancer, Empowerment, online support group

Author : 1Frasisca

Dela Verna

081617132866 delaverna@gmail.com 2Mokhamad

Fahmi Rizki S

087856844298 mokhamadfahmi@yaoo.com 3Nadia

Annizar

085741066582 annizarnadia@gmail.com




HEALTH DIGITAL MAP: A Breakthrough to Raise Priority and Awareness to Promote and Prevent Communicable Diseases in Indonesia Alfryan Janardhana*, Savannah Quila Thirza**, M. Naufal Bachtiar*** *Third

Year Medical Student, University of Brawijaya, .....

**Third

Year Medical Student, University of Brawijaya, (savannahquila1705@gmail.com)

***Third

Year Medical Student, University of Brawijaya, (naufalbachtiar@gmail.com)

Abstract Communicable diseases, also known as infectious diseases; are illnesses which result from infection, or presence and growth of pathogenic (capable of causing disease) biologic agents in an individual human or other animal host. Infections may range in severity from asymptomatic (without symptoms) to severe and fatal. The term infection does not have the same meaning as infectious disease because some infections do not cause illness in a host. In Indonesia, based on the current status quo, there are a large increasing numbers of diseases incidences in specific areas, especially rural areas, and those diseases are categorized as communicable diseases. Looking at our healthcare services aspect, we are lacking in some ways especially in promotive and preventive efforts for these diseases. Therefore, we are proposing a system to support our effort in promoting and preventing the diseases outspread, and by preventing the outspread we may also decrease the number of incidences. In this research we propose a making of a web based system to show the public and the health providers of a Health Digital Map, this live map will help the government to realize their principles of action to measure the problems in our country, and to help the medical workforces, especially general practitioners, to evaluate the action to enhance the promotion and prevention of the diseases related in the endemic area as well as to raise the local public awareness. The map is useful as a live map of updates on communicable diseases all around Indonesia, showing the exact area/ provinces suffering with the endemic. Keyword: Communicable diseases, Health Digital Map




ABSTRACT A REGULAR SCREENING TEST IS WORTH FOR HEALTH PROFESSIONAL Nuruddin Dzulkarnain, Afdini Safitri Dwi Mayang Sari, Denny Arvi M

Health workers dealing with various areas of health epidemiology, entomology, microbiology, counseling, administrator and sanitation (Government Regulation No. 32 of 1992 on Health Workers), so that health workers should also be able to maintain health and prevent disease outbreaks. It is set in Permenkes No.28 of 2014 on guidelines for the implementation of the JKN program which carry out a routine screening test. The purpose of the screening test is used for early detection and diagnosis. In order to increase the quality of medical personel, health workers should maintain their condition. . The advancement of the facilities including an equipment and manpower that can support the implementation of a screening program test. Screening test proposed include complete blood count, simple urine test, fecal test and blood sugar testing simple. The screening tests is a preventive programs for medical personnel to early detection and diagnosis. Health medical personnel can be maintained so as to optimize the quality of service. And indirectly affect the increase in the level of public health in Indonesia.




“QUECK, Helping You to Get Healthy� By, Z.F.K., Dicky, A.H. Leny, and H. Annisa University of Hang Tuah Surabaya

ABSTRACT Aim The objective of this paper is to analyze literatures and provide an alternative solution to reduce waiting time that may improve the healthcare quality, especially in primary care. Background: Patients' waiting time has been defined as the length of time from when the patient entered the outpatient clinic to the time the patient actually leaves the outpatient department (OPD). It compromises health because prolong waiting time increase patient dissatisfaction, less frequent outpatient visits and delays in diagnosis and treatment. Some efforts has been put to manage waiting time in healthcare institutions. One of some alternative solutions to reduce waiting time is by using a modern technology. Material and Methods Participants consisted of 33 health service users who were randomly selected from 3 primary health centers in Surabaya and surrounding areas. Participants were given a questionnaire consist of 22 questions about customer satisfaction on queuing system in the public health centers. As an addition, secondary data from this study were obtained through literature study and internet. Literature sources used in this study were taken from international journals and statistical data of Directorate General of Resources and Equipment of Post and Information Technology. Results According to a survey conducted on 33 respondents from some of the primary health centers, the data found that 2.9% of the population is still not that satisfied with registration speed in the primary health centers and 8.6% felt that the length of waiting time for the examination in the primary health centers is still too long. On the other hand, as quoted by the Director General of Resources and Equipment of Post and Information Technology, according to the survey agency We Are Social in 2016, the number of mobile phone users also increased significantly, becoming 323.6 million, an increase of 2% on the year 2015.This opportunity is very good to be used to facilitate the service queue so as to improve the quality of health services in Indonesia. Conclusion As researchers, we expect that this system can be realized and applied in primary health centers throughout Indonesia. We really hope that this system can be implemented to help Indonesian health service become better in the future.




HOOSPITAL : A PLATFORM TO CONNECT PATIENT AND HEALTH PROVIDER Enrico J Hartono , Ika Puji Dana Savitri, M. Mega Airlangga

Background Patients should know about their disease and all alternatives of therapy option before they decide it. Simple things from The Right of Patient that often mentioned from 1981 on Lisbon Declaration, and our own legal constitutions by UU no. 36 tahun 2009, UU no. 29 tahun 2004, and by medical ethics code (KODEKI). However, it seems to be pretty hard to provide health services that can always understand the patient’s right including knowing their disease and deciding which therapies that they will take. Aim With this mobile app that we create, we want to bring the patients closer to the health provider through real time communication and medication re-checked list to prevent therapeutic error by medical provider side. Material and Methods: We use literature and internet review. The rest of the methods were constructed from our own team discussion. Result and Conclusion Informed consent is conceptually believed as some process. To protect this process for keep providing patient based health services we develop day by day application to connect the patient and the health care provider. This application will divide it’s first activity by deciding whether the user is the patient or the health provider. In the interface of the medical provider’s side, it will be possible for the users to edit the necessary information for the patient’s users. Vice versa, the patients will get information about their disease from the medical provider users. Patient’s users also able to make some chat or get any emergency help using some features in this app.




PUBLIC POSTER







ERROR 404: PRESCRIPTION NOT FOUND

By Elke Feliciana & Damarini Dida Pratiwi AMSA-Universitas Padjadjaran

Potent drugs aren’t supposed to be bought freely from pharmacies without a doctor’s prescription. However, there are lots of potent drugs being freely sold. The store clerk does not ask for prescriptions, as long as the buyer stated what drugs they are looking for. Types of antibiotics, analgesics, and even hormone pills that are markedly potent are given easily to buyers. People bought antibiotics out of habit, without prescription, and even without knowing whether they need it or not. Ironically, more often than not, they don’t need it. This practice needs to be put at stop. People should know which drugs can’t be bought freely and the reason why. Doctors, pharmacist, nurse, and other health service worker should explain well to the patients about these drugs. The public should be made aware of the danger of consuming potent drugs without prescription. Our poster illustrates someone trying to buy medicine without having a prescription, and then they were rejected for not having the needed prescription. There is also a table with information about drugs that can be bought freely and drugs that can’t, and a brief explanation why.




MEDI-TOOL : MANAGE YOUR MEDICATION, MANAGE YOUR HEALTH

M. Rizal Shidiq*, Savannah Quila Thirza**, M. Naufal Bachtiar*** *Second **Third

Year Medical Student, University of Brawijaya, (rizalshidiq442@gmail.com)

Year Medical Student, University of Brawijaya, (savannahquila1705@gmail.com)

***Third

Year Medical Student, University of Brawijaya, (naufalbachtiar@gmail.com)

Abstract Background Every patients who have complaints and come to the doctors to seek for treatment, will be treated from the anamnesis to the prescription of the medication. The doctors will give a detailed prescription of what drugs to take, and

how many dosages, and what time

should the drugs be taken. The curative treatment from this medication will only work optimally if it’s taken strictly according to the rules given by the doctor. For example: the specific drugs should be taken every 4 hours, and if you missed 1-2 hours, it might affect the effect of the drug. Patients are highly recommended to take their medications on time and strictly according to the prescription. For some cases, some diseases, forgetting or missing the correct time to take the meds may affect greatly on the patients’ health. Mainly, for geriatric patients, where if the patients do not have someone close enough like family members to help them remember, they might tend to forget things easily and might need assistance. Objectives Because of the problems we haves stated above, we tried to come up and innovate with this new idea regarding the time to take the medications. We want to propose an idea of creating an application for a smartphone. In this application, to make it easier for people from any ages group to participate and use it, we will provide this application with only 3 simple steps, and voila, you will never forget to take your medication again. It is PIE, Plan, Input, Execute. Conclusion These plans and options only need the patients to input the prescription data and set the time and alarm, and they will be reminded often until the time the drugs and medications are finished. This application works wonderfully as an alarm and it vibrates so it will be easier to remind the user.




Help Others to Stay Healthy by Being Healthy  

by Maria Vanessa, Olivia Bernadi, Danny Aguswahyudy Jeremy

Hospitals have been one of the places where diseases may spread as infected people may come to get treated by the physicians. Others who come may also be the healthy ones who are coming along with the patients.1 It is something that can be avoided and it’s infection rate can be lowered. Nosocomial infection may happen where medical treatment activities are done, including hospitals. Both medical practitioners and patients can be the source of the diseases. Attention to simple preventive strategies may significantly reduce disease transmission rates. Thus, encouragement must be given to the physicians and education towards the patients will help to give an impact towards the health numbers. This poster aims to remind physicians the importance of their health and by following some blotted out aspects lined out on this poster, health professionals may prevent much unnecessary medical and financial distress to their patients and themselves. To highlight, having a frequent hand wash remains the most important intervention in infection control.2 Maintain a healthy body by eating a healthy diet but can also prevent infection. A study showed that eating more fruits and vegetables improved their ability to fight illness. Foods especially high in immune-boosting phytochemical are berries, kale, beets, broccoli, onions, garlic, shiitake mushroom and red bell peppers.3 Certain vitamin supplements may help address nutritional deficiencies, facilitate sleep and reduce your risk of developing chronic illnesses associated with health practitioners and some night shift workers are at risk for sleep disorders and nutritional deficiencies as well as gastrointestinal problems and impaired organ functioning.4 Therefore, there are many factors in which the disease may spread and there are many ways to reduce them. It would be better if the healthcare workers can start by being healthy themselves while giving hands to treat the ills.

References: 1. Hauck K, Zhao X. How dangerous is a day in hospital? A model of adverse events and length of stay for medical inpatients. Med Care [online journals]. December 2011 [cited 4 January 2017]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/ 21945976 2. H Saloojee, A Steenhoff. The health professional's role in preventing nosocomial infections. Postgrad Med J [online journals]. May 2000 [cited 4 January 2017]. Available from: http://pmj.bmj.com/content/77/903/16.full 3. Roizen Michael. Protect your health [online article]. 2014 [cited 4 January 2017]. Av a i l a b l e f r o m : h t t p : // w w w. c b n . c o m /s p e c i a l / P r o t e c t Yo u r H e a l t h / ProtectYourHealth_02_Diet.pdf 4. Lowden A, Moreno C, Holmbäck U, Lennernäs M, Tucker P. Eating and shift work effects on habits, metabolism, and performance. Scand J Work Environ Health [online journals]. 2010 [cited 4 January 2017]. Available from: https:// w w w . r e s e a r c h g a t e . n e t / p r o fi l e / U l f _ H o l m b a e c k / p u b l i c a t i o n / 4 1 4 1 7 3 7 2 _ E a t i n g _ a n d _ s h i f t _ w o r k _ _ E ff e c t s _ o n _ h a b i t s _ m e t a b o l i s m _ a n d _ p e r f o r m a n c e / l i n k s / 0fcfd50e049b407a38000000.pdf




THE SEVEN RIGHTS MEDICATION

Muhamad Rifa’i Khalida Khairunnisa Abstract In the globalization era if the health service providers can not be aware ,it’s potentially leading to medication error . A medication error is any preventable

incident

that

may

cause

or

lead

to

inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. In USA , two hospitals are 56 % and 34 % by medication error( bates, 1995 ).Based on the report by Peta Nasional Insiden Keselamatan Pasien (Konggres PERSI Sep 2007) the mistaken in of giving medication have position in the first ( 24.8 % ) of the top ten incident that reported. In Indonesia , prevention of medication error continue to be done in order to provide a safe treatment for patients. By increasing health comprehensive service program is expected public trust in health workers can increase. Ensure that the correct medicine is selected and matches the current valid prescription with the right patient .When clinical staff are sure that they have selected the correct medicine against the current medicine order and its medicine form. Where medicines are to be administered over an extended period of time, timed relative to other aspects of care or administered away from the health centre, it’s important that measures are in place to ensure accurate timing of administration. Ensure that each time a medicine is administered and is recorded in the event. All the information that should be known by the staff and the patient . The concept of ‘The Seven Rights’, provides an effective tool that should be applied whenever medicines are administered or issued, the right medicine must be administered to the right patient in the right dose at the right time via the right route, with the right documentation, and the client has the right information




 

Medical Error, is it Dangerous? Micheline, Ignatius Ivan, Stella Kallista

Medication error has become a widespread issue in almost every country nowadays. This problem happens due to the lack of information on medication error among the health professionals and patients. The lack of study on previous cases of medication errors in the past makes it even worse, The aim of this study is to inform people about errors that might occur during medication and ways to prevent it. We use literature review from several medical journals about medical errors that occurred in hospitals as our method in collecting the data. According to a research conducted in America between 2008 to 2011, there are more than 400.000 death cases due to medication error every year. The most common errors that might occur were delayed or incorrect diagnoses and treatments. The cause of these errors were mostly because of exhaustion, low quality of life and depression among health practitioners, etc. A study from 4 journals stated that 69% medication errors that happened in 0.89% death cases can actually be prevented. There are several ways that we can do to prevent it, such as: limit the shift duration, reduce the frequency of working overnight, regulate an appropriate time for break and conduct the 6 patient safety guidelines. Medication error is a preventable issue but it can be fatal if we don't put any effort in preventing it.




Primum non nocere  

Happy Hariani, Armitsi Anggia Arta, Aisyah Arifin AMSA-Unika Atma Jaya

One of the leading causes of preventable deaths in the world is medical error, including in Indonesia. The current healthcare service in Indonesia has not yet been effective and needs to be reviewed. Thus, the healthcare department in Indonesia must be strict to the healthcare workers in terms of preventing medical errors as it is a matter of life and death. Medical errors can be distinguished by two kinds of problem. First is the mistakes in planning actions which are caused by insufficient knowledge and by not following the correct safety regulation. Second is the error based on the incorrectly executed action which caused by memory-based errors (lapses) and action-based errors (slips) such as technical errors. Lack of safety culture in healthcare department, minimum facilities and many others can cause medical errors too. To prevent medical errors to increase in the future, there are lots of things that need to be done. The law and consequences have to be clear yet informative for the public. Other ways to prevent medical errors is by increasing the value of medical ethics by implanting the value written in Hippocratic Oath. Workshops can also be an option to educate the healthcare workers to improve their professionalism in practice. In conclusion, we should make sure that healthcare workers in Indonesia know the risk of medical errors. Medical errors can prevented by the law and punishment, the Hippocratic Oath and also workshops for healthcare workers. Let’s treat patients like the way you want yourself to be treated!

GEAR UP, CLEAN UP! Gabriella Anindyah AMSA-Universitas Indonesia

Hospitals are the leading lines of healthcare services in our country. The purposes of hospitals and healthcare workers who work there is to treat and cure the diseases of patients. However, it is sometimes neglected that hospitals, could create problems that no one expected. Most germs that cause serious infections in healthcare are spread by people’s actions. Every patient is at risk of getting an infection while they are being treated for another. Every healthcare worker are too at risk of getting an infection while they are treating patients. Preventing the spread of germs is very important to ensure the maximum efficacy of the healthcare system. This will prevent unnecessary diseases and infections, known as hospital-acquired infections. We need to remind doctors, medical students, and other healthcare professionals to still follow safety procedures in the midst of the hectic schedule. We also need to sensitize the public that they too, can play a part to prevent the spread of infections. According to WHO in their guide to preventing hospital-acquired infections, it is important that patients and doctors to disinfect and wash their hands to fulfill the optimal “hand hygiene” requirements. For medical practitioners, it is also important to wear the appropriate attire and gear. In conclusion, we must emphasize, that both doctors, and patients, play a part in preventing unnecessary diseases and infections in the hospital.




UNEVEN DISTRIBUTION OF MEDICAL WORKERS Bernadet Yulyanti, Grevaldo Austen, Steven Jonathan

One of the main healthcare issues in Indonesia is the uneven distribution of medical workers, especially the general practitioners. According to Indonesia’s Health Department, in 2015 the ratio of general practitioners Nusa Tenggara Barat on 13,20 was per 100.000 populations whilst the ratio on Jakarta was 25,99 per 100.000 populations. Nowadays, general practitioners tend to avoid working in rural areas for many reasons, such as staying far away from family, scarcity of transportation, insufficient facilities, and many more, despite the higher salary to compensate provided by government. This issue affects healthcare workers with heavy workload that serve in rural areas. Those with heavy workload or overtime are often too tired and therefore quite likely leads to commit mistakes. Some could be fatal for patients such as wrong diagnosis, improper dosage, and entry error. Preventing these errors and improving safety for patients require a systematical approach. Healthcare workers especially general practitioners need to raise their empathy and sympathy toward their colleagues by serving in rural areas that will contribute effectively to reduce human errors that caused by overwork. In addition, increasing the number of healthcare workers can also come to aid in improving public health. On the other hand healthcare workers also need to improve their experiences and knowledge about endemic cases.




Drugs : Use Smartly, Be Healthy Ferdy Bahasuan, Jonathan B Gilbert, Willis

There are lots of people that when they came to see the doctor, they were in the chronic or severe condition. In this case, seems like the cause is the doctors who didn’t play their role optimally. But actually, if we could see any further, it is because the patients. Patients usually self-medicating first by consuming drugs that they are not really know the indication. It couldn’t be anymore fatal if the patients using antibiotics as they self-medicating drugs without prescription and the directions from the doctor, which causing drugs resistance. By the national basic health research in 2013, there are 35,2% of the families in Indonesia storing drugs for self-medicating with the most composition of the drugs are 35,7% hard drugs and 27,8% antibiotics. 80% of the hard drugs and antibiotics consuming are without any prescription from doctor. And if it is going any further, the doctors couldn’t help optimally because the patients is already in a chronic condition and could be any possibilities of medical error.

That’s why, the purpose of our poster is to explain to the Indonesia’s citizen that consuming medication to heal their disease should be prescript and a precise indication from the doctor. We hope by making our posters, there is no more patients who come to see doctors with severe condition or any worse like drug resistance, which the doctors could be handling the patients optimally and reduce the number of medical error circumstances because of the early treatment they can get.




Smart MedTech Tablet : A Brilliant Way To Improve Quality of Life in Indonesia Raymond Wangsa Wijaya, Singgih, Niko Julian

Many death case have popped up in Indonesia that was caused by a small disease especially in Indonesia’s small island. Good treatment in that place is like a challenge to Indonesia’s medical service because of lack in the transportation, fund, knowledge, or healthcare professionals. According to UNICEF report in 2013, Indonesia is still experiencing a high average child mortality at 400 deaths per day that was caused by a small disease like pneumonia and diarrhea. The majority of this children come from poor families and the remote ones. This is where our innovation takes an action. With this smart tablet that contains many information about diseases and how to take care of it in the right way, healthcare of the people who live on that small island can be improved and people can stop worrying about their diseases. By just entering the symptoms, this machine will lead people for the right step to cure it and showed the dangerous level of the disease. Of course this plan can’t become a reality if government doesn’t take part in it. So, we need government to take action in supplying the tablet and train the person who can use it in every Indonesia’s island especially the small one. In conclusion, smart medtech tablet can improve quality of life in Indonesia by giving the knowledge of the disease and this program can be run if the government takes part of it too.

Stay Awake for Patient’s Sake Vina Cyrilla, Irvania Limarus, Ferdinand Gouwtama

Sleep deprivation gained notoriety in the medical field over the past three decades as research demonstrated time and again that long hours and lack of sleep could lead to medical errors. The Institute of Medicine reported in 1999 that medical errors were among the leading causes of mortality in the United States: 98,000 deaths per year. Many cite the case of Libby Zion—whose death in 1984 was attributed to the errors of overworked and under supervised residents—as the catalyst for duty hour reform. In 2004, the National Sleep Foundation conducted phone interviews of 1506 adults living in the United States in order to better understand sleep habits and related problems or disorders. That study showed that average Americans sleep 6.9 hours per night (less than the recommended 7-8 hours per night for adults). Seventy-five percent of respondents reported having sleep problems at least a few nights per week, and 24% stated that these problems affected their daily lives. Half of respondents reported feeling "tired, fatigued, or not up to par" at least 1 day a week. To put this 50% in perspective, look at other major public health threats: In the United States, 34.9% of the population is obese,17.8% of adults smoke,and 8% of babies are born at low birth weight.

Medical errors represent an important public health problem and pose a serious threat to patient safety in Indonesia too. Indonesia’s health care system make general practitioners must work harder and longer than other countries because Indonesia have “Night Duty” system. The Puskesmas GPs also reported that their workload had increased significantly, for example one GP (interviewee 8) served 70–100 patients per day after the introduction of the Jamkesmas and Jamkesda.

Contributing Comprehensively During the Anamnesis In Order to Prevent Medical Errors Jonathan Ariel, Rebecca Olivia Haryuni, Eric Vinson Wijaya Based on a Medical Malpractice Analysis book 2013, Medical errors can be caused by several things. In prior of the statement, 33% of malpractice ensue because of incorrect diagnosis with the percentage being the highest amongst other possibilities such as surgeries with only 24% and obstetrics with only 11%. One way to diagnose a patient is through anamnesis in which the consultation is undoubtedly vital in upholding a diagnosis inasmuch as anamnesis is a two ways communication. However, the lack of patients’ explanation, trust, respect, honesty and contribution towards their physician during the anamnesis could lead to a false diagnosis before finally ends in an erroneous medication granting. Furthermore, mistaken medications would do nothing but aggravate the patients’ health themselves, resulting in a worse healthcare, and in some worst case scenario, death is also possible.

This poster aims to increase public awareness that reducing medical errors is not solely the physicians’ responsibility. Patients can take part in reducing the errors conjunctly with their physician by increasing their participation during the anamnesis in which proactivity, openness and elucidation are included. Therefore, anamnesis would be improved before eventually results in a more accurate diagnosis as well as treatment. In conclusion, we believe that there are ways to minimize medical errors. One of the ways can be done by educating the patients on what they can do to prevent medical errors. They can start by providing comprehensive explanations as much as possible towards their physician during the anamnesis, in hope of indirectly assisting their physician in vindicating accurate diagnosis.

Where is the Balance in Our Healthcare System? Sheren Regina, Riky Pratama, Edwin Destra Background Health plays an important part in life and for that reason, societies keep track of their health well. But in this period, diseases are spreading quickly and people often get sick easily which can cause problems regarding the healthcare system. Several countries around the world, including Indonesia, implemented a national health insurance system. Jaminan Kesehatan Nasional (JKN) is an example of the government’s effort to increase Indonesia’s health quality. However, this system has yet to work smoothly and often encounter problems. Indonesia’s population, based on the 2010 census, is nearly 240 million and the numbers of doctors in Indonesia, according to Konsil Kedokteran Indonesia (KKI) 2016 data, is around 180 thousand. From this, we can analyze that 1,300 people are treated by only one doctor. This unbalanced ratio results in medical errors, as well as lack of adequate service and quality. Moreover, the uneven distribution of doctors between urban and rural areas adds up the problem. On the other side, people who pay for their health insurance makes sure that they are using the benefit to its maximum. By going straight to the doctor and ask for medicines although the symptoms are mild and common is an example that can incur loss which creates another problem within the healthcare system. Objective of the poster We would like to inform the public about several causes of Indonesia’s healthcare system problems and how serious it is. Conclusion The problems of our healthcare system are caused by both the management and societies, how they work unbalanced. This create problems that has become a responsibility for all of us, as the government, doctors even society to fix therefore having a better system in the future that everyone can benefit from it.




Is it Money or Sacred Oath? Aprianisa Obsidiany Daisy Tarigan, Edwarn Edwin AMSA-Universitas Tarumanagara Background Healthcare service is not about the quality that is given by tools and medical technologies to the patients, but how we as a doctor serve people. The sacred oath that has been carried out through ages said that we as a doctor need to serve people without any circumstances. In the recent years, healthcare service or we can say it by “medical service” to the people or patients already has changed or transform into different meanings, as doctor nowadays do not serve people or patients because of their dedication, but money. Most hospitals in Indonesia more prioritize money compare to the patient's health. Today human life is determined by money, without money people can not live, without money people can not maintain their health. When is this thing can be stopped? Objectives We want to improve the healthcare services to its maximum by reminding the doctor their sacred oath and to increase the patient awareness of the existence of BPJS. Conclusion In conclusion, we found out that healthcare service nowadays, especially in Indonesia, only rely in money. In which we discovered solution to fix this kind of problem which is using the existing system, BPJS. Due to the existence of BPJS, our job is getting easier, because what we need to do is only to tell others that this system is important for them, especially for the “low-economic” people, and how we do it? It is easy by giving them a preachment.




STOP SURGICAL ERROR SYIFA NUR MAULIDA AMSA-Universitas Jenderal Achmad Yani Background It is often said that there is no such thing as “minor� surgery. Whether we are having an appendix removed, any surgical procedure is a serious matter and involve an element of risk. Therefore, surgical errors are some of the most common types of medical malpractice. Simply defines, a surgical error is an unpreventable mistake during surgery. No two surgeries are identical. Likewise, every surgical error has the potential to be unique. There are several common reasons for surgical errors such as incompetence surgeon, insufficient preoperative planning, poor communication between surgeon and operating assistant, or even fatigue surgeon. The types of surgical errors that can occur are wide ranging as well. Operating on the wrong body part, leaving a piece of surgical instruments and injuring the internal organs during surgery for instance. Objective Firstly we made this movie to identify the problem of service quality in healthcare department in Indonesia especially about surgical errors as the common problem in medical malpractice. Secondly, this movie content deliver our opinion or ideas how to solve this problem by involving medical professionals, medical student and stake holder. Conclusion Surgical error is one of the common problem of service quality healthcare department in Indonesia. Wrong site surgery, surgical instruments left in body, damage to internal organs are several types of surgical error that commonly occur. Our goals in this movie is to prevent and reduce surgical errors in Indonesia by paying attention the operating schedule, preoperative preparation,surgeon experience, and improving communication between surgeon and operating assistant.




HEALTH IS THE WORK OF MANY HANDS By Damarini Dida Pratiwi & Elke Feliciana AMSA-Universitas Padjadjaran For years, people had this thought that improving the health status is the doctor’s responsibility only. It is only doctor’s job to make sure everyone’s healthy, while in fact, it is not. Achieving good health status is not merely the doctor’s responsibility. It is our responsibility, it is everyone’s responsibility. Everyone should work hand in hand in achieving and maintaining a good health status, no matter who they are. Thus, in order to improve the health status, we have to improve each and every sector. This poster illustrated that by showing how a lot of people are working together on “building” health. We hope that this will deliver the messages well to public, reminding us all that we are all needed to work together to improve the nation’s health. If health is like a building, then each of us holds the needed material. We just have to work together in making one complete piece.




CALL ME MAYBE? By Talitha R. Ayuningtyas, Damarini Dida Pratiwi & Elke Feliciana

Every country must have their own emergency call number. Why is emergency call important? They allow the caller to contact emergency service for assistance (usually asking help for police, firefighter or medical help).What is the emergency number in the United States? 911. The three digit number is so widely known and is associated with emergency in so many countries. This made rescuing and getting emergency help a bit faster and more effective. What about Indonesians? What is our emergency number? We have asked our relatives and friends whether they know what is our country’s emergency call especially for ambulance, and 9 out of 10 people didn't know the emergency call number. A lot of Indonesian doesn’t know their own emergency number, which is 118 and 119. We believe that by spreading the information and making the public aware of our own emergency number, it will help to make it more effective when we are asking and giving help in emergency situations, thus shortening the waiting time for patients in dire need. Knowing our country emergency call has always have been underestimated and people tend to think that it is unnecessary to remember it. Since we are living in a high-tech era and every single information can be searched in the internet, it makes this emergency number to be overshadowed. But we should realize that in emergency situation, every single seconds is precious, and it may risk people’s life. By making it well known and effective, we hope that the response system and the rescue process will also be more efficient. The phrase “Call me maybe?” is catchy, famous, and familiar, thus we hope we could intrigue the public to take a look at our poster, where information about the emergency number is provided."




LET’S START WITH A GOOD CONVERSATION Alif Indiralarasati, Amelia Nur Khasanah. AMSA-Universitas Gadjah Mada Background There are so many health problems in Indonesia. These problems come from many aspects; the disease itself, people life style, health service and health worker. Communication is one of essential thing that can affect health problem. Medical error and patient complaint are two problem that caused by miscommunication. Medical error is the third leading cause of death in the world. In Indonesia, medical error is also one of the problem that cause complaint from the patient. Actually, the main cause of these complaint is not medical error, but miscommunication between health worker and patient. Based on data, from 135 complaint, 80% caused by miscommunication. Miscommunication between health worker also cause medical error up to 80%. It happened because some important information isn't transferred clearly. Objective By this poster, we want to inform health worker and public about the fact above. We have to solve miscommunication by building good communication between health worker and patient. Good communication between health worker can reduce medical error. To give a good quality service, health worker have to know about the patient condition. Patient need to be opened about their condition and trust the health worker. Then, informed consent should be done well. Understanding between health worker and patient make all of us feel comfortable and save more life together. Conclusion Miscommunication can be reduced by building a good communication. So that, information can be transferred clearly. So, let's start with a good communication to reduce our health problem. Reference Kern, Christine (2016) "Healthcare Miscommunication Costs 2,000 Lives And $1.7 Billion." Available at http://www.healthitoutcomes.com/doc/healthcare-miscommunication-costslives-and-billion-0001 (3rd Januari 2017) Kompas (2011) "Miskomunikasi Picu Persoalan Dokter dan Pasien." Available at http:// h e a l t h . k o m p a s . c o m / r e a d / 2 0 1 1 / 0 6 / 2 8 / 1 8 0 4 1 9 8 / miskomunikasi.picu.persoalan.dokter.dan.pasien (3rd Januari 2017)




IT’S TIME TO SAVE OUR NEW GENERAL PRACTITIONERS! Kriswahyu Yudo Wirawan, Verrell Christopher Amadeus, I Putu Aditio

To become a general practitioner, one must pass in Undergraduate Medical Education Program, which is famous for the cost that is very expensive when compared to other undergraduate study programs. In addition, there are professional education and internship to obtain the permission to practice that prolongs studying time. Doctors are also lifelong learners, they have to keep studying even after they have graduated to keep up to date about the world of medicine. Seeing from the education process, we can think that the income of a general practitioner should be feasible and appropriate. But what is the reality? Compared with other professions, the salary of new doctors is very little. The salary of a new general practitioner in Indonesia is only about Rp 2-3 million per month. Whereas in other countries, as a comparison in Malaysia, a general practitioner is paid Rp15.000.000,00 per month, not including commissions. Moreover, the ratio becomes more ironic if we compare it with developed countries such as the United States and the United Kingdom. Not quite up there, a general practitioner, who primarily work in hospitals, often have working hours in excess of what it should be, and that makes their workload very heavy. Not to mention, with the passing of new legislation, few mistakes made by doctors, can immediately take them to jail. Seeing this, we need to make people aware that the general practitioners need special attention in today's era. We must respect them, realizing that the profession is very important in people's lives. We must act and support the movement in the struggle for justice and the welfare of doctors, so doctors can work safely and peacefully, in order to reach an optimal performance, because it is unattainable to reach “Healthy Indonesia”, without any optimal role of general practitioners in it.




ACTIVE LISTENING IS WHAT MATTERS Pramana Adhityo, Ronny F. Setiadharma, P. David Subroto AMSA-Universitas Gadjah Mada Background Misdiagnosis is one of crucial problem in medical world that can lead to mistreatment which also can have fatal effects on patient. Based on a research about misdiagnosis in US by Singh et al. (2014), approximately 12 million adults which were treated by doctors in US received misdiagnosis and 160.000 people suffered from permanent damage or dead because of misdiagnosis annualy. From this data, we could understand that good diagnostic holds key to effective and accurate treatment and also this process also supported by process of active listening from the doctor itself. Objective In Indonesia itself, we can find some case of misdiagnosis from doctors that also caused by insufficient of information. This insufficiency of information for diagnostic caused by process of listening which went passively. Some doctors are lack of interest to search for further information of patient’s complaint. Lack of information can decrease the accuracy of diagnosis, increasing the chance of misdiagnosis. Misdiagnosis can lead to increasing chance of harming patient, mistreatment or wrong medication, decreasing life expentancy of patient, incomplete medical record, and harming reputation of medical institute and personnel. From these reasons, we created this poster to promote the benefits of active listening in diagnosis process to medical personnels. Conclusion Active listening doesn’t mean to only listen to the patient, but also searching for further information. Sufficient information will lead to accurate diagnosis and usually to accurate prognosis and medication too. Indirectly, it will also lead to proper treatment that rise the reputation of medical institute or personnel. References 1.

Singh, H., Meyer, A. N. D. and Thomas, E. J. (2014) ‘The frequency of diagnostic

errors in outpatient care: estimations from three large observational studies involving US adult populations.’, BMJ quality & safety, (May), pp. 1–5. doi: 10.1136/bmjqs-2013-002627. 2.

Khullar, D. and Jena, A. B. (2016) ‘Reducing prognostic errors: a new imperative in

quality healthcare.’, BMJ (Clinical research ed.), 352(Mar), p. i1417. doi: 10.1136/bmj.i1417.




EVERYONE SHOULD KNOW ABOUT BPJS By Kriswahyu Yudo Wirawan, Verrell Christopher Amadeus, Dicky Hertanto AMSA-Universitas Gadjah Mada With the rapid advancement of human civilization, there are more things to take care of those aspects of our lives. One of them, which may be the most basic, is health. Nowadays, many people are improving their lifestyles to become more healthy. In addition, the government have come to strive so that the health care may be perceived evenly by society as a whole. In accordance with UU No. 24 Th. 2011 and one of the Sustainable Development Goals (SDGs) that is "universal health coverage", the Indonesian government has established department that is Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan as an effort for the embodiment of the availability of health insurance for all Indonesian people in mutual cooperation. BPJS Kesehatan allows anyone to be able to obtain a guarantee of health. This is also one of the efforts to optimize the health services for the people of Indonesia, but in reality, there are still many problems that we encounter. BPJS membership is not yet optimal because many patients enroll themselves in BPJS after the occurrence of the disease. Other than that, factors such as unequal competence and the uneven distribution of medical personnel as well as the claims of some diseases those are still considered far from the standard of care also affect the usage of the membership. This of course is our common concern. Each party has a role in these efforts to succeed BPJS. All parties must recognize, know and implement the program correctly. Proactive society, professional medical practitioners, the care government, they will certainly be strong foundations in the implementation BPJS Kesehatan, for the sake of A better and optimal Indonesian health care. In order for the foundation to be built, everyone, young or old, medical personnel or not, should know and understand fully about BPJS.




HANDS FOR HEALTH Marwanida Haura, Cindy Elica Cipta, Yohanes Don Bosco Fernando Mario Marcelino AMSA-Universitas Gadjah Mada Background What people seek from healthcare services is health itself, but contrarily people sometimes get diseases from their interactions with healthcare services. This could happen in the presence of error somewhere in the process. One of the simplest yet significant things that could affect the result is hygiene. Not to be focused on complicated aseptic procedures, basic hand hygiene actually plays major part in healthcare services success. Objective According to World Health Organization (WHO), the prevalence of healthcare-associated infections in Indonesia is 7.1% in 2011. This occurrence could lead into the blaming towards health workers. Superficially, people agreed that health workers are responsible for the safety of patients, their relatives, and others who have interactions with healthcare services from unnecessary healthcare-associated infections. However, it can’t be denied that community also have role within. The reason is that causative agents of infections not only exist in patients, health workers, or the healthcare services, but they’re everywhere, even coming from visitors. Therefore we can encourage both health workers and community to contribute in preventing infections caused by poor hand hygiene. Conclusion The community as visitors must also follow ‘My 5 Moments for Hand Hygiene’ from WHO. It can be simplified into hand hygiene before interactions with patients and their surroundings to save them from outside infectious agents, and hand hygiene afterwards to keep themselves from any infectious agents that may exist in patients. Although simple, hand hygiene should be done properly based on trustable guidelines. By having both health workers and community aware of their role, there would be minimal healthcareassociated infections and the incidents of blaming others. References 1.

World Health Organization. Report on the Burden of Endemic Health Care-

Associated Infection Worldwide. Geneva: WHO Press; 2011. Available from: http:// apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf [Accessed 31 st December 2016]. 2.

World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: a

Summary. Geneva: WHO Press; 2009. Available from: http://www.who.int/gpsc/5may/ tools/who_guidelines-handhygiene_summary.pdf [Accessed 31st December 2016].

LIES END LIVES Cornelia Ancilla and Veronica Wulan W. AMSA-Universitas Gadjah Mada Background When we hear the word “communication”, we will not associate it with “death”, will we? However, according to The New England Journal Medicine (2014), miscommunication in health care can increase medical errors by 30%, and these errors can bring about 1.000 deaths a day (dr. Daniel West, 2014). This is a high percentage derived from a seemingly simple task: communication. In addition, one factor of miscommunication is lie, since according to a survey from digital health platform ZocDoc, 27% respondents say that they tell white lies or omit some health information during their appointment. As people who work at healthcare system, we have to also understand why patients lie. In some cases, patients do it because they think that doctors will judge them. They fear an aversion to being lectured, or because they wish to present themselves in a positive light. Objectives We create this poster to open people’s mind and engage public understanding that lying can cost their lives. Giving false or hiding important information can lead to wrong diagnosis which can lead to false treatment or medication, which then can lead to more severe injury and the worst, death. For example, a huge smoker with shortness of breath tells doctor that he doesn’t smoke. Finally, the patient dies because the doctor thinks that it’s only asthma and gives him inhaler instead. We also need to build public trust that doctors don’t judge their patients. Doctors know certain disease is caused by particular behaviour, so they will not humiliate patients who come to them with that symptoms. Conclusion We hope that our work can invite and persuade society to be honest to the doctors. We believe that if patients tell doctors the truth about their health status, habits, and medical history, there will be improvements in the world healthcare system. Bibliography dr. Daniel West, dr. Tejal Gandhi, Betsy Imholz . (2014). Miscommunication a Leading Cause of Medical Errors, Study Find. Amy J.Starmer, et al. (2014). Changes in Medical Errors after Implementation of a Handoff Program. The New England Journal of Medicine.




THE DIRTY SIDE OF YOUR WHITE COAT

White coats are usually worn to show one’s identity as a doctor, medical student, or nurse. For practical reasons, some medical student and doctor may wear their white coats outside the hospital. It’s a kind of pride for some people by wearing a white coat and showing them around. This could also happen because the hospital or college is lacking of changing room. White coats worn may transmit pathogenic bacteria, as white coats could be contaminated with bacterias. Because many faculty of medicine are usually close to academic hospital, it isn’t uncommon to see medical student wearing their white coat to canteen and campus even for non-clinical matters. In a study by Banu, Anand and Nagi, they found that some bacteria such as Staphylococcus aureus (68%) contaminate the white coat the most at the sides. From this study, it can be concluded that white coat may takes part in the nosocomial transmission of pathogenic bacteria. Several anticipation can be done, such as possessing two or more white coat to change regularly, scupulously washing oneself white coat and providing conducive changing area around the hospitals or campus (Banu et al., 2012). This is want we want to emphasize. So we need to sensitize doctors and medical student especially to introspect oneself. Several anticipation offered above can be easily applied with low cost and effective result. One should also be aware on where they are wearing their white coat so that unwanted pathogen transmission could be prevented. Eventually, nosomical transmission of pathogens to other patient, doctor, medical student and people around can be minimalized. Reference : Banu, A., Anand, M., Nagi, N., 2012. White Coats as a Vehicle for Bacterial Dissemination. J Clin Diagn Res 6, 1381–1384. doi:10.7860/JCDR/2012/4286.2364




Communication, The Simplest, The Most Crucial (2) Regina R Gunawan & Joshua Timoti AMSA-Universitas Gadjah Mada Background Since the beginning of medical world, lots of life have been taken away because of medical errors. Even though technologies and knowledge have improved drastically, medical errors are inevitable. Lucky for us, these medical errors can be reduced simply by improving the quality of healthcare department in Indonesia. Objectives Through this poster, we aim to prevent medical errors cause by bad communication. Bad communication can lead to misdiagnosis because the exchange of information between patient and doctors won't be done well enough to have prior information to create a diagnosis. This lead to wrong treatment because without the right information about the patients' condition and the right diagnosis, doctors may treat patient not accordingly to the patient's disease. As a result, the patient's disease will not be cured and some other complicated disease may occur that can cause the patient's death. With that in mind, the basic thing that needed to be improved is communication. Communication can be improved by following these basic principles. Communication should be two-way, either between doctors and their colleagues or doctors and patients. To create a two-way communication, both parties need to listen to each other, ask each other, clarify unfamiliar things and also give feedback to each other. Last but not least, a good communication should be conducted interpersonally. This means both parties to have empathy to understand each other, not to only obtain information but to have personal connection between each other. Conclusion In conclusion, by improving communication, medical errors can be prevented.

Wrong Anesthesia Dose is Dangerous Regina R Gunawan & Joshua Timoti AMSA-Universitas Gadjah Mada Background More and more death occurred because of medical errors. This fact is contrast to the medical world's principal that is the patient's safety as the highest priority. Furthermore, this cause of death is shown as one of the most leading causes of death in the world. However, medical errors are a cause of death that can be prevented by improving the quality of healthcare. Objectives This poster aims to increase awareness about wrong anesthesia dose that is dangerous. Anesthesia is needed every surgery, however it has a huge risk and a tiny margin of error. Both under dose and overdose anesthesia can lead to serious and complicated problems. Under dose anesthesia can lead to insomnia, depression and anxiety. On the other hand, overdose anesthesia can lead to hallucination, nausea and also brain damage. Sometimes wrong dose of anesthesia can even kill the patient. The world of medicine is a world where everybody will try to become perfect. Same as in anesthesia. Doctors need to pay attention and care about anesthesia during surgery. Also, doctors need to take note on how many anesthesia should be given to the patient before the surgery begin. In addition, the right anesthesia drugs need to be pick before surgery. Last, but not least, the injection itself need to be perfect not less and not more. Conclusion In conclusion, doctors need to give the right amount of anesthesia does because doing the opposite can lead to danger.




Your Insurance is Your Wings, No Worry About Your Billings Iesha Kinanti Adhuri, Salma Salsabila, Nur Syifa Fikri Background National Health Insurance is a program performed by the government that aims to provide a comprehensive guarantee of health for all Indonesian people to be able to live healthy, productive and prosperous. Up until March 2016, there are a total of

163.327.183 Indonesia’s

population that possesses National Health Insurance. Documents like identity card, family card, TIN card and photo are the only things needed to sign up for National Health Insurance. The sustainability of health insurance depends on the monthly fee of its members. And this becomes a problem as not everyone is aware to fulfill their obligations. The main reason why National Health Insurance is important is the fact that 150 million people each year suffer severe financial hardship and 100 million are pushed into poverty as a result. Objectives
 To raise people's awareness of the importance of national health insurance. The benefits of National Health Insurance are: 1. It is cheaper than private healthcare – because the only spending is the fee you pay every month 2. Assure your health for a whole lifetime – you pay according to your class, and national health insurance will cover your healthcare 3. There’s no exception – everyone can take a part in national health insurance, no matter their condition is 4. Almost all diseases can be covered – especially all of curative health care services 5. Taking part in national health insurance also means taking part in increasing national’s health status
 Conclusions The people’s awareness of National Health Insurance can stimulate people’s interest to register. This membership, in turn, will support the development of better health care system financed by the fee of the members. Sources; 1.

Indonesian Health Economic Association. 2015. Indonesian National Health Accounts

2012. InaHEA Congress. Jakarta, Indonesia. 2.

http://bpjs-kesehatan.go.id

3.

Departemen Kementerian Kesehatan. 2013. Profil Kesehatan Indonesia Tahun 2012.

Jakarta : Kementerian Kesehatan RI. 4.

World Health Organization. Health Financing on Global Health Observatory. Accessed

from www.who.int/gho/health_financing/en on 6 Januari 2017




CAUTION! Your Prescription Could Kill Your Patient Patricia Pradipta, Afifa Intifadha H, Aditia Nurmalita S Southeast Asia is a region of enormous cultural economic and social diversity. The total population of this region is approximately 600 milion with Indonesia being the region’s most populated country. Despite rapid developments, Indonesia still lag behind in medical field than the other countries of Southeast Asia such as Malaysia and Singapore. One of the huge problem in Indonesia is medication error. The National Coordinating Council Medication Error Reporting and Prevention (NCCMERP) defines Medication Error (ME) is any preventable event that may cause or lead to inappropiate medication use or patient harm while the medication is in the control of the health care professional. According to research by National Institute of Health Research and Development (Litbangkes) shows that there was high rate of medication error in Indonesia, such as 86%prescribers who did not write patients’ age, and 48.7% for weight, 34% no precaution about side effects of the medicines, 7.4% overdoses, 7.4% wrong dosages, 1,9% miscalculated the amount of medicines, and 1.8% drug interactions in the prescription. Actually we can avoid Medication Error by doing simple things such as completing our patient’s identitiy (age, weight) to get the right doses of medicine and assessing their conditions like allergies, pregnancies, and other disease. These simple things can make a big impact to our patient safety and health.

References: Aronson, J. K. (2009). Medication errors: definitions and classification. British Journal of Clinical Pharmacology, 67 (6), 559-604. http://doi.org/10.1111/j.1365-2125.2009.03415. Ernawati, D. K., Lee, Y. P., & Hughes, J. D. (2014). Nature and frequency of medication errors in a geriatric ward: an Indonesian experience. Therapeutics and Clinical Risk Management, 10. 413-421. http://doi.org/10.2147/TCRM.S61687 Nccmerp.org. (2017). National Coordinating Council Medication Error Reporting and Prevention. [online] Available at: www.nccmerp.org/about-medication-errors [Accessed January 5, 2017]. Purba, A., Soleha, M., Sari, I. (2012). Kesalahan Dalam Pelayanan Obat (Medication Error) dan Usaha Pencegahannya. Buletin Penelitian Sistem Kesehatan, 10 (1 Jan). [online] Available at http://ejournal.litbang.depkes.go.id/index.php/hsr/article/view/1769 [Accessed January 4, 2017] Salmasi, S., Khan, T. M., Hong, Y.H., Ming, L.C., & Wong, T. W. (2015). Medication Errors In the Southeast Asian Countries: A Systematic Review. PLoS ONE, 10 (9), e0136545. http://doi.org/ 10.1371/journal.pone.0136545.




PREVENTING INTRAVENOUS MEDICATION ERROR WITH SALINE Leonard Sarwono Atta Sammapanidhi, Adilla Shafryantyo Purnomo, Aninditya Verinda Putrinadia Background Most of hospitalized patients acquire intravenous therapy. It means all of medical personnel must have enough ability to provide those intravenous therapy. In Indonesia, there are many medical personnel who do not understand the guideline of providing intravenous therapy properly. It is shown by high case prevalence of morbidity and mortality caused by medication error in the administration of therapy. Therefore, it is important for medical personnel to know about SALINE. Smart action to prevent intravenous medication error. Objective To decrease mortality and morbidity cases caused by intravenous medication error. Conclusion SALINE which is consisted of sterilization, abbocath size, location of injection, identity of patient, and solution type is a small action to give a big effect.




Needlestick Injurires Alfred Tanjung*, Adolf Gideon** and Yoris Junanto*** *Second Year Medical Student, University of Brawijaya (alfredtanjung97@gmail.com) **Second Year Medical Student, University of Brawijaya (adolfgideon@yahoo.com) ***Second Year Medical Student, University of Brawijaya (yorisjunanto@gmail.com)

Abstract One of the many medical tools that medical staffs usually use is the needlestick. It is widely used whether in small-scale/local medical facilities or at large research hospitals. Needlestick has a very crucial role in medical care and treatment. Besides their functionality, needlesticks also carry risks that many medical professionals might not be aware of – the risk of being accidentally pierced by it. This condition is known as ‘needlestick injury’ and it is categorized as one of medical errors. Needlestick injury may put medical staffs at risk of being infected by disease – mainly carried by viruses such as HIV, HBV (Hepatitis-B Virus), and HCV (Hepatitis-C Virus) that is found in their patient’s blood. The lack of awareness of medical professionals regarding the possible infections that may harm them is one of the contributing factor of the high number of injuries happened worldwide. However, with correct handling and precautions, infection may be prevented. First aid methods such as keeping the wound clean using antiseptics and washing injured areas with soap and water may prevent infection, and furthermore, save lifes. The risk of needlestick injuries may be reduced further by raising awareness of the medical staff to prevent the pierceng to happen at the first place. Therefore, needlestick injuries are possible to be prevented and treated, if medical staffs aware of the risks and know how to treat the injury correctly. This poster is aimed to raise this awareness, thus the overall number of injuries may be reduced. Keyword : Needle Stick, Injury, Medical Error




CORRECT DIAGNOSES, SAVE LIVES Priscilla Christina, Lois Theodora AMSA-Universitas Brawijaya University

Misdiagnosis by physicians is a serious and common occurrence in the health industry. Misdiagnosis itself means an inaccurate assessment of a patient's condition which are often incredibly harmful to patients. This, in turn, can have physical, psychological, and financial consequences. Causes are include inadequate communication between physicians and patients, a health care system design that doesn’t support the diagnostic process, limited feedback to clinicians about diagnostic performance, and a health care culture that discourages transparency, so diagnostic mistakes are typically not reported/not learned from. Institute of Medicine (IOM) has built a new, yet equally concerning, report released in September 2015 that Americans experience about 12 million diagnostic errors a year. Considering of that, we have developed a list of 8 low-tech ways to get a correct diagnosis: 1. Listen carefully to the patient’s story without interrupting. 2. Find out what dreaded diagnosis the patient believes he has so the doctors can rule it in or out. 3. Don’t forget the patient’ past history. 4. Don’t skip the physical exam, do a focused and purposeful physical exam; even a negative exam. 5. Discuss the diagnosis and treatment plan with the patient. 6. Use differential diagnosis checklists. 7. Follow up and follow up, and do so in a timely manner. 8. Quickly reconsider the diagnosis and/or get a consultation if things are not going as expected (The Journal of Family Practice)




CORRECT PPE ORDER CAN SAVE LIVES Fakhriyah Iffatunnisa, Nadya Aninditha Permatasari AMSA-Universitas Brawijaya University

Infection in the OR has become one of the crucial problems in the hospital. The infection can cause Surgical Site Infections, which are the second most common complications of surgery. They can result in larger bills due to many other unintended problems, such as longer hospital stays, more doctor visits, more treatment, absence from work, etc. There are effective methods that can prevent surgical site infections. One such method is the correct sequence of putting on the Personal Protective Equipment, as well as the removals in the reverse sequence. The sequences are as follows: 1.

6 Steps of handwashing

2.

Medical gown

3.

Surgical face mask

4.

Goggles / eyes protection

5.

Gloves

For removals, follow the procedures in reverse order. The above mentioned method can greatly reduce Surgical Site Infections along with the patient problems.




Reducing and Preventing Medicals Error Frinny Sembiring, Maria Juliana Dorothy AMSA-Universitas Brawijaya University Objectives According to UUD 1945 article 34 paragraph 3 said that country is responsible to provide healthcare facility and public health care facility (Depkes RI,2007). But in the reality the health care services was far from that we expect. From the user of health care services in Sanglah Hospital, 84,96 % stated that his health has not been satisfied with the service as nurses were unfriendly and grumpy, treatment roomnot clean, schedule a doctor's visit is not timely, and parking facilities are not adequate. In health care alone many of the problems that lead to user dissatisfaction health services, especially on the part of the doctor himself as malpractice, drug administration errors, hospital-acquired infection, and many more. So that governments and professionals health care should be collaborate to solve this health care problem. One of them is to make the documentation (examination

results,

clinical records, recomendation, and consultation), and providing communication between the patient and provider each other, facilitating data entry, identification and evaluation of risk. And Also goverment can the make the program to improve the health care skills and knowledge about drugs adverse medical error and adverse effects of drugs as well as increasing Patients 'and their families' knowledge about medication administration. Also, documenting prescription be standardized using the full drug name and the route of drug entry into the body. Furthermore, a comprehensive, list of the benefits and role of impact of technologies on reducing medical errors and increasing patient safety to be Provided and the most effective ones to be localized as well as redesigning the workflows. Conclusion It is important to improve health care service quality. Good health care service of make the quality of life of patients to be better and improve the health of the people of Indonesia as high as possible.




Keep Germ Away Everyday Nadia Anizzar1, Astrid Lutfiana Jahmadi2, Mokhamad Fahmi Rizki Sya’ban3 AMSA-Universitas Brawijaya University Background Washing hands is an important step in disease prevention and transmission of pathogens. but nowadays most people only use water and do not use soap when washing hands. Though the soap has an important role in killing pathogens in hand. Objective The purpose of this poster is to remind and inform that hand washing only using water alone is not enough to kill pathogens have in hand. Conclusion Washing hands is a very important thing to decide transimisi disease. Proper hand washing is to use soap and water for 20-30 seconds or use hand sanitizers for 40-60 seconds.




Safe Your Future With SAFETY! Nuansa Firgie Paramitha1, Hasna Okta Asyrofi2 and Latania Naufa Arinugraha3 1Third

Year Medical Student, University of Brawijaya (nuansafirgieparamitha@gmail.com) 2Third

Year Medical Student, University of Brawijaya (hasnaokta@gmail.com)

3Second

Year Medical Student, University of Brawijaya (latania1997@gmail.com)

Background Raising number of medical error always shows in health workers in hospital and the environment. One of the most popular cases is needle stick injury. According to data from WHO (World Health Organization), they reports in the World Health Report 2002, that of the 35 million health-care workers, 2 million experience percutaneous exposure to infectious diseases each year. It further notes that 37.6% of Hepatitis B, 39% of Hepatitis C and 4.4% of HIV/AIDS in Health-Care Workers around the world are due to needlestick injuries. From Riskerdas (Riset Kesehatan Dasar) in Indonesia, the prevalence of Hepatitis B cause from needle stick injury is 9,4% that means in 10 person, there is 1 that brings Hepatitis B virus. Objectives From the bad impact above, should made an effort to prevent of needle stick injury among health workers that have the risk factors such as nurse, doctor and co-assistant (ungraduated medical student). So, the spreading of impact could be stopped. So, here we are trying to spread the information about how to prevent the needle stick injury among the health workers in the hospital. And it’s actually when a person knows how to prevent this case, it will spread into all the people all of the world. Conclusion To prevent this cases in the world, we show you an easy way to remember the way to prevent with SAFETY (SOP, APD, Full Energy, Emergency Call, Throw Unused Needle, and keep Your Hygiene well) Keywords Needle Stick Injury, HIV, Hepatitis B, Hepatitis C, Prevention




MAKE SURE YOU’RE NOT SICK Nuruddin Dzulkarnain, Afdini Safitri Dwi Mayang Sari, Denny Arvi M.

Health, according to WHO (1947) is the state of perfect physical, mental, and social free from disease or infirmity. Meanwhile, according to the Health Law No. 36 of 2009 Chapter 1 Article 1 that "Health is a state of healthy, both physically, mentally, spiritually and socially to enable more people to live socially and economically productive". Health cannot be separated from their health care providers. Efforts to utilize sports, medicine, physical activity, and exercise is the most basic needs to improve the health and fitness in daily life. WHO study on risk factors stated that Sedentary lifestyle is one out of ten (10) causes of death and disability in the world. In most countries around the world, between 60% - 85% of adults are not doing enough physical activity to maintain their physical ability. Doctors is one of the Medical workers that very instrumental and rarely do physical activity. To reach a healthy life, at least health workers needs to do a regular exercise. Without balanced physical activity, it can cause diseases due to lack of movement. Regular exercise is important for maintaining the health and fitness of the body, especially addressed to professional health workers to optimize their physical fitness first before taking care patients in order to give them satisfying health care.




ESI: Time Saving, Life Saving Belinda Anasthasya Tansy, Nabila Zain Permata, Putu Eka Dianti Putri

Approximately hundreds of people go to the emergency with different kind of complaint. Each complaint has its own management and treatment. In Indonesia, the management and the treatment are based on triage. The triage consists of P1 (emergency), P2 (urgency), and P3 (non-urgent). Although the triage has been divided into three groups, there are still many patients who aren't getting immediate management which leads to worse conditions. As a health provider, we need a new method to enhance the quality of our health service. An effective and efficient triage process in Indonesia will best manage the number of patients in the Emergency Department as well as treatment room. The method is called ESI (Emergency Severity Index). ESI is a principal role for a triage instrument of the emergency and is to facilitate the prioritization of patients based on the urgency of treatment for the patients' conditions. ESI itself could perform a brief and focused assessment for the patient, which leads to how long a patient could wait for medical examination and treatment. There is standardization of triage acuity scales (i.e., 1) resuscitation, 2) emergent, 3) urgent, 4) less urgent, 5) non-urgent). The classification of ESI is more specific, accurate, and could give a clinical decision based on clinical assessment so that that patient would receive an appropriate and immediate management, and also could improve the life expectancy in Indonesia. This method could also sort out which patient amongst other patients who should get a first aid. Thus, with this new method, we expect that it could improve our health service and our patients' satisfaction. Time saving, life saving.




SCREENING FOR EVERYONE Karlina, Raditya Sri Damar, Rani Waskita

This project aims to encourage people, especially Health Professional to do regular health exams. Many diseases can be asymptomatic and remain undetected for years, and by the time symptoms started manifesting, it would have been too late for recovery. Regular health exams can help find problems before they start. They can help find problems early, when your chances for treatment and recovery are better. A yearly health exam is also an opportunity to reevaluate someone's risk for various conditions. Family history, lifestyle, and other factors may change from year to year and affect their risk profile. By getting the right health services, screenings, and treatments, this will increase the chances for people to live a longer, healthier life. Everyone is at risk of various medical conditions that can be affected by many factors of their lives, and early detection will prevent the condition from worsening and help people to live a healthier life.




1 for 2: One Attention for Two Existences Authors: Antonius Galih P., Azizah Amimathul F., Katherine Fedora

Maternal death has become a very big and serious health problem in the world. In fact, the solution for that problem was still not been found until now. Global maternal mortality ratio is 200 deaths per 100,000 live births. In Indonesia, according to data SKDI 2012 an increase in maternal mortality that occurs today is about 359 per 100,000 live births. The figure is high than other countries. The cause of maternal death can be classified into direct and indirect causes. Direct causes of maternal mortality in Indonesia is dominated by hemorrhage, hypertension / eclampsia, and infection. There may be a lot of indirect causes that can cause maternal death such as the late recognition of danger signs, difficulties in making decision for urgencies, not going to health care facilities as soon as possible in urgency conditions, too old to get pregnant, too young to get pregnant, already have too many children, and pregnancy interval between the previous and current pregnancy that is too close. We assumed that many of the maternal mortality causes is basically associated with the lack of information by the mother herself. Therefore, to increase the knowledge of pregnant women in Indonesia, we as medical students of Airlangga University invites all the medical students in Indonesia to join us in assisting and educating pregnant women all over Indonesia. This program is implemented by accompanying one pregnant women by one medical student during her pregnancy, and child birth. The program aims for monitoring the state of the mother during pregnancy and give education about their pregnancy. With this program, we expect the early detection of problems during pregnancy, reduce maternal and child mortality rate, and improve the health of Indonesia. One attention from us can support the existences of two persons: the baby and the mother herself.







Electronic Health Record Henry Timothy, Fenska Seipalla AMSA-Universitas Airlangga




Keep Healthy Without Drugs Putu Gea Rini Dian Pratiwi Chorisma Permata Putri Nurazizah M. Hanun Mahyuddin Background In Indonesia, drugs (medicines) have always been the first choice as an alternative to fight the disease. Doctors almost always prescribe drugs to cure patients. This service is very common although there are times when doctors should not give drugs to patients, especially children so that it can be said that the doctors in Indonesia is still "easy" provide medicines. In addition, the mindset of Indonesian society is to consult a doctor with the main objective to get the medicine to treat his condition. On the other hand, the majority of Indonesian people pay less attention to healthy lifestyles. It is quite different in developed countries, such as in the Netherlands, the USA, UK, Singapore, and so on. There, doctors prefer to give the best solutions to their patients and to the extent possible not to give the drugs. Most people in developed countries choose to set up and maintain a healthy lifestyle such as, maintaining a healthy diet, drinking plenty of water, exercising regularly, maintaining the health of the environment, and adequate rest. Objectives This poster was created for Indonesian people to have a mindset of have a healthy life style to not get sick, do not always rely on medications that can harm health itself later on if consumed in long term. In addition, the health provider especially doctors should begin to minimize the provision of medicines for minor ailments and provide guidance to fight the disease and give some healthy living solutions. Conclusion Medication is sometimes able to cure a symptom of disease. However, in the long term negative effects that will be given much greater. So it's time to change the habits of drugs consumption and replace it with a healthy lifestyle such as exercising, drinking lots of water, and a healthy diet.




KNOW YOUR MEDICINE BEFORE YOU TAKE IT! Dian Indra Malik, Mujahidah Yunus, Sasqia Pratiwi Iqbal Universitas Halu Oleo

ABSTRACT Medical error means an act of omission or commission in planning or execution that contributes or could contribute to unintended result. A study has conducted in 2011 at private care in Daerah Istimewa Yogyakarta found that 82% cases ISPA patients has been administrated by the primary doctors with inappropriate medicine, and this number has no different between the primary doctors and specialist doctors. The impact of medical error is varied, from the simple and reversible cases to serious adverse events that caused serious impairments even death. Technically, medical error is divided into 2, (1) error of omission and (2) error of commission. Wrong in diagnose, delays in patients treatment, or not prescript medicine is part of error of omission while error of commission comprise wrong in deciding therapy, giving the wrong medicine, or the medicine is giving with the wrong indications, and these public posters refers to the wrong of commission case. The objectives are (1) to show society that medical error cases (wrong medicine that is given to the patients) are commonly happening around us and they need to be aware of it (2) to encourage society to always ask the medical professionals about the medicine in terms they can understand and helps prevent medical error problems especially in giving the wrong medicine (3) to urge the patients and their family that is important to be critical about the medicine that is prescript to the patients. With these public poster, we hope we could decrease the number of medical error cases to improve healthcare quality in Indonesia.




5 Mins Consult, Is It Enough? Afrilia Chaerunissa, Fahirany Noor, Muhammad Fuad Alamsyah AMSA–Universitas Muslim Indonesia

From data Medical error is the third leading cause of death in the World, behind heart disease and cancer, according to a recent study published by Drs. Makary and Daniel at Johns Hopkins University. It is estimated at least 251,454 people die due to medical errors every year. known is more increasing years by years ,The study goes on to say that The key element of medical errors in a patient-doctor relationships, there is reason to believe that it deserves more attention. Furthermore, with an increasing emphasis on value and efficiency in health care delivery, quality time between doctor and patient is an increasingly valuable resource. doctor spend time in face-to-face contact with patients gathering information, and developing a relationship is importantly but

nowadays a lot of

doctor out there underestimated it. So From this poster we hope the doctor spend more time with the patient to avoid medical errors and treat patients holistically.




Be Professional Or Not. Keep It, Keep It, Keep It Andi Muh Ariansyah N, Dian Hariati, Nabil Sangga Buana AMSA-Universitas Muslim Indonesia

Background The doctor's duty to maintain the confidentiality of patient information is a basic staple in medical ethics since the time of Hippocrates. Currently the ethics of professional of medicine has been widely influenced by developments in human rights. More than that, The quality of medical personnel is one of those doctors have experienced gaps at this time. inform the patient's confidentiality to anyone is violating the code of ethics of medicine. This is the location of faults. Doctors are easily persuaded to expose things that they should not to be delivered. This evidence suggests that the lack of ethical values that are obtained by doctor. Objectives: The purpose of this poster is to provide an overview as well as an understanding that this is how a doctor's role is to maintain the patient's secrets. Conclusion: Therefore it takes consciousness from doctor rather pay more attention to medical ethics rules so that the quality of the doctor stay awake. Be the one that is considered good for the patient to tell you many with complaints and did not reveal to anyone. The quality of the good conduct of a doctor can create quality health care that is safe, free, and secure.

"A doctor must maintain confidentiality in absolute terms about which he should know about their patients even after the patient's death"




The Deathly Hollows

Abstract Medical errors is a serious problem in health-care setting because it represent the act of threatening the patient’s safety, whether it worsen the disease or even causing death. Many aspect can cause medical errors, such as inadequate diagnostic, unprovided facilities, lack of knowledge, improper treatment, and lack of communication. Effective communication is key to patient safety. A review of root cause analyses suggest that in over 60% of error, poor communication was an important causal factor. The importance of efficient communication should be considered as a must in every medical practice. Communication in the health-care setting may be divided into two types: those between one health-care worker and another, and those between the patient (and / or family member) and a health-care worker. Each has different elements that can contribute to medical error. In this situation, each health workers should contribute to the success of the patient’s treatment. If the communication among health workers does not good enough, it could create the deathly hollows as the patient’s near to death. Therefore, the phenomenon of medical errors and harmful action performed by health-care worker can be reduced by performing an adept communication between all involved elements. This can be achieved when a health-care worker is well trained before performing any action.




A POINT TO REMEMBER: BE CAREFUL WITH SYRINGES Andi Muh. Firshan Makbul, Dhiya Muthiah Gaffari, Amila Saliha M. Faculty of Medicine, Hasanuddin University – Makassar, Indonesia

According to WHO, sharp injuries resulted in 16000 hepatitis C viruses, 66000 hepatitis B viruses and 1000 HIV infections in healthcare workers worldwide. Recapping, disassembly, and inappropriate disposal increase the risk of needle stick injury. This incidence is higher in developing countries for the higher rate of injection with previously used syringes. Developing countries where the prevalence of HIVinfected patients is very high, record the highest needle stick injury too. Needle stick injuries were also common occupational health hazard.
 
 In carrying out work activities, we cannot be free from the risk of accidents. Operating room, treatment room, and lab are areas where a lot sharps in particular needles, both syringes and suture needles are used. The incidence of needle stick injury in Hospital is an event that is always there in every hospital. The incidence of needle stick injury in Hospital is like an iceberg phenomenon. Meanwhile, in Indonesia many cases but not all are reported, only certain cases. This is due to the lack of awareness of victims who do not report what had happened. Prudence in action can reduce the risk of needle stick injury among them. But In case it happened, healthcare workers need sufficient knowledge in dealing with these injuries. The awareness of victims to report the experienced events are also necessary. Because the victim will receive further treatment related to whether or not they should be given medication or given counseling only. So, stay out of trouble by always remember to be careful with syringe. Contact details Andi Muh. Firshan Makbul makbulfirshan@gmail.com +6281242622535




Don’t nod, Ask! Richard Holman Matanta, Sausan Maulida

Indonesia is currently facing an issue of antibiotic resistance. This is causing a big trouble, because Indonesia is still fighting with infectious diseases. While mutation is natural occuring in infectious agents which leads to antibiotic resistance, many healthcare provider in Indonesia speeds up this process by prescribing unnecessary antibiotics. Many patients force doctors to prescribe antibiotic, due to their lack of understanding of pharcokynetic and pharcodynamic of antibiotics. Around 50% of people in Jakarta believe that any kind of fever should be treated by antibiotics. Not only that, 70% of people in Jakarta believe that antibiotic should be used for any kind of infection –including viral infections- But, doctors also plays a role. Some doctors are eager to prescribe antibiotics even when there is no proof of bacterial infection. Because of these, a good relationship between doctors and patients are necessary. Patients and doctors should cooporate in order to implement a rational antibiotic use. In order to give rise to the awareness of this issue, this poster supposed to give the public a sight that different infectious agents should be treated with the appropriate antibiotics. Patients should be given the whole knowledge of the antibiotics they are using, from how the drugs works, why they are precribed and how to consume them. These knowledge is going to be important for the patients A total rational use of antibiotics is a long way to run for Indonesia. Better infrastructure and diagnostic tools are necessary in order to achieve a total accuracy for antibiotic. But a difference could be done by patients and us. And this is simply by asking the healthcare workers about our drugs. It is obvious, that in fighting infections and other medical problem, education and knowledge is still the best weapon- both for patients and healthcare providers




IS YOUR JOB KILLING YOU Andi Muh. Firshan Makbul, Dhiya Muthiah Gaffari, Amila Saliha M. Faculty of Medicine, Hasanuddin University – Makassar, Indonesia

In providing health for their patients, medical workers always try to give everything they could to fulfill the demand, even if everything means putting their own health on risk. How? In a regular work day, it can be emotionally draining as they witness suffering, pain, hurt, even death. By dealing with increasing amount of patient care demands, constrained resources, mounting paperwork can also cause them to experience mental stress. Stress is both a physical and emotional syndrome. It occurs when the demands on someone are greater than their capacity to respond. A downward spiral is frequently set up, because performance drops when stress mounts. In the new review, researcher led by Dr. Douglas Mata a clinical fellow at Harvard Medical School, analyzed every study that had been published on the topic of residents and depression. The estimates of depression prevalence also varied widely, from 20% to 43%. But medical workers intrinsic personality traits often make it easy for them to ignore their own health needs and allow them to let work become their only priority. The fact that from the beginning they are already exposed to long hours and heavy workloads and the mindset that it's the only way to achieve success. Making them hesitate to consult, that they fear it would consider them as the weak ones and turn it to a bigger problem. The solutions are relatively simple which there needs to be a recognition and awareness of the contribution of medical residents toward their patients and themselves. Contact details Andi Muh. Firshan Makbul makbulfirshan@gmail.com +6281242622535




Medication Safety Remember: 3R Andi Muh. Firshan Makbul, Dhiya Muthiah Gaffari, Amila Saliha M. Faculty of Medicine, Hasanuddin University – Makassar, Indonesia

With the growing reliance on medication therapy as the primary intervention for most illnesses, patients receiving medication interventions are exposed to potential harm as well as benefits. Benefits are effective management of the illness/disease, slowed progression of the disease, and improved patient outcomes with few if any errors. Harm from medications can arise from unintended consequences as well as medication error (wrong medication, wrong time, wrong dose). Medication errors can cause serious adverse effect and potentially to evoke the fatal risk of the disease Monitoring the safety and efficacy of the drugs adequately can prevent the occurrence of adverse effect. An adverse drug event (ADE) is defined as harm experienced by a patient as a result of exposure to a medication, and ADEs account for nearly 700,000 emergency department visits and 100,000 hospitalizations each year. Medication errors have a huge impact on health care system, patient, etc. It compromises the confidence of patients on healthcare system. Preventing ADEs is a major priority for accrediting and regulatory agencies. Then, what role can medical health workers take? By following medication safety remember which are 3R that include Right Drugs, Right Patient, and Right Time. Right drugs, by giving patients the exact drug they need with the right dose and right route. Right patient, confirm patient’s identity. Make sure you don’t give the right drug to the wrong person. And last but not least, right time. Safety rules are there for us to follow. So, take care and we will see you tomorrow. Contact details Andi Muh. Firshan Makbul makbulfirshan@gmail.com +6281242622535




Protect Your Patients, Protect Yourself! Andi Muh. Firshan Makbul, Dhiya Muthiah Gaffari, Amila Saliha M. Faculty of Medicine, Hasanuddin University – Makassar, Indonesia

Through the process of providing health, healthcare workers often face hazardous working conditions with potential exposures to a variety of toxic and infectious agents. Given the high risks to the health problems in hospitals, it is necessary to do prevention against the disease incidence due to the potential exposures. Like shield and armor to knights, to protect themselves, healthcare workers have their own which are known as PPE. Personal Protective Equipment is specialized clothing or equipment used to prevent contact with hazardous substances. It protects healthcare workers from direct exposure to blood, body fluids, and other potentially infectious materials. Also, it reduces the transmission of communicable diseases when other measures such as engineering controls and work practices cannot completely eliminate the exposure. In terms of communicable disease, Nosocomial infections or are known as Healthcare-associated Infections (HAIs) is an infection that spread among patient and healthcare workers in hospitals that occur during treatment. Several studies in the year 1995-2010 show that HAIs’ prevalence in developing countries is higher than developed countries. Infection from officers definitely affect the quality of service which includes all activities of medical health workers who hold professional interaction with the patient. Above all this facts, adherence to PPE protocols is often quite low. Few studies have tested improvement to adherence rate which bring to several conclusions that all includes knowledge in it. Together, we can spread the issue and increase the awareness on PPE protocols. Considering us to not only protect ourselves but also protecting the patients.

Contact details Andi Muh. Firshan Makbul makbulfirshan@gmail.com +6281242622535




TIME to REST, to AIM for the BEST A.Nurul Azizah Maruddani, Khumaira, Budi Sutiono, Imam Amriadi AS Faculty of Medicine, Hasanuddin University – Makassar, Indonesia

Becoming a medical professional holds a true meaning of “saving lives”. As healthcare provider, one should put full attention to the well-being of the patients regardless the situation. Unfortunately, this premise often misleads to the condition where they ignore their own well-being as a human. Normal adults need approximately 7 hours of sleep each day, which means around 49 hours in a week. In contrary, a junior doctor in a hospital only get to sleep 3-4 hours in a day, not to mention several slepless nights have to be spent during heavy call rotations. Fatigue , or exhaustion is a feeling of tiredness, alleviated by periods of rest. Various studies find numerous adverse effects of fatigue, both on cognitive and psychomotor ability. It clearly demonstrates negative consequences on personal safety,such as the occurence of needlestick injury or even increased risk of accidents while driving after long-shifts. On top of it all,there is big potential consequences for patient safety, such as clinical errors and diagnostic mistake. This problem surely calls for drastic measures. In developed countries such as U.K. and U.S. , working time restriction is already introduced. Several studies found that these working time reduction for junior doctors found to bring positive impacts to the health-care quality.




Be the Front Liner of Healthiness Nurizki Meutiarani M. 1), Falensia Dwita Lestari 2), M. Shulfie Asadul J.3), Medical Faculty of Hasanuddin University, Makassar, Indonesia nurizkim@gmail.com 2)

Medical Faculty of Hasanuddin University, Makassar, Indonesia falensia.dwita@yahoo.com

3)

Medical Faculty of Hasanuddin University, Makassar, Indonesia asaduljailie25@gmail.com

Background: Doctors make an important contribution to the management and leadership of health services and the delivery of healthcare around the world as part of a multidisciplinary team. All doctors have some responsibilities for using resources; many will also lead teams or be involved in supervising colleagues. In order to improve the healthiness especially in Indonesia, we should not rely on doctor only to reach this goal. We should expand our mind that, healthiness, one of basic human right that need to be sustained, not only by doctor or other healthworkers but also by other proffesional jobs. And to achieve this, we need all professional jobs to work together side by side in each specific sector to reach this very important goal. Objective: We should now that every single job in this world give contribution to improve the healthiness in this country, through their little action but it is give meaningful impact to the society healthiness. For example the social services like teacher in the school that giving early education about how to keep your body fit and health; teacher teach us on how to clean our hand and our teeth properly, also how the school habituate us to exercise through sport class. Other examples are the farmer who provided fresh and healthy food, while cleaning services who keep our environment cleaned in order to create a proper system to live. Even it is not their main job to improve the healthiness, but somehow their action gave big impact to improve the healthiness indirectly. Even with the help of skillful doctors or proper medication, we can not to cure the disease without proper nutrition and clean environment. Conclusion: So, through this poster we want to send message for every people that whatever your job, you can be the front liner of healthiness. We can achieve better healthcare if all professional jobs work together, because together, we can do it!




HEAR YOUR DOCTOR, TAKE YOUR MEDICINE PROPERLY! “KNOW THE DOSAGE, THE TIME, AND THE SIDE EFFECT” M. Shulfie Asadul J.1), Nurizki Meutiarani M.2), Falensia Dwita Lestari3), 1)

Medical Faculty of Hasanuddin University, Makassar, Indonesia

2)

asaduljailie25@gmail.com 2)

Medical Faculty of Hasanuddin University, Makassar, Indonesia nurizkim@gmail.com

3)

Medical Faculty of Hasanuddin University, Makassar, Indonesia falensia.dwita@yahoo.com

Background: Medicine used by all the creatures on the inside and outside of the body to prevent, alleviate and cure the diseases. Until now, medicine is one of component that irreplaceable in the health service, therefore it is very important for patients to use medicine appropriately. The rational usage of medicine is when patients receive treatment according to their clinical needs, appropriate doses, and within adequate period of time. Irrational usage of medicine will cause the decreasing treatment quality, which increase the morbidity and mortality, the risk of side effects that trigger the occurrence of undesired reactions, bacterial resistance, and psychosocial impact that resulted in the dependence of drugs that are not needed. For example, a group of drugs that most widely used is antibiotic. Improper usage of antibiotics will cause a lot of side effects like bacterial resistant that would bring harm to the patient itself. In Indonesia, the sensitivity test of bacteria in patients with pneumonia showed that the Pseudomonas sp. resistant to amoxicillin, clavulanic acid, and ampicillin (87.5%). Objective: The purpose of this poster is to improve the quality of health services through health practitioners and the public as a patient. Doctors should explain the disease and educate patients to use their medicine properly. In addition, society as a patient should understand well the doctor explanation, especially in understanding the usage of medicine that has been prescribed. Conclusion: Well, through this poster, we hope every people should understand about their disease and how to use their medicine properly. Ask your doctor about the dose, when you should consume it, what is the function, and also the side effects that caused by the medicine. So you can choose your own medication with doctor’s help and the healing process will better with minimum side effect in the future.




SAVING THE MONEY FOR HEALTH INSURANCE Falensia Dwita Lestari 1), M. Shulfie Asadul J.2), Nurizki Meutiarani M. 3), 1)

Medical Faculty of Hasanuddin University, Makassar, Indonesia

2)

falensia.dwita@yahoo.com

3)

2)

Medical Faculty of Hasanuddin University, Makassar, Indonesia

4)

asaduljailie25@gmail.com

5)

3)

Medical Faculty of Hasanuddin University, Makassar, Indonesia

6)

nurizkim@gmail.com

Background: When people talk and then offered an insurance product, most people will avoid it. It is because the stereotypes of insurance agents in the past which is identical to the the person who seem less accommodating their customers and also the procedure was complicated. But nowadays, there are a lot of insurance companies that compete to offered their product with their best service and easier procedure, which is, give more benefit toward their customer.It has been said that nothing is more important than your health, and there is a lot of truth to that saying. Among other things, a loss of health can mean a loss of earnings if you are not able to work, and it can also mean medical bills that are extremely expensive. Objective: The importance of having health insurance should not be dismissed or underestimated. Health insurance can covers the unpredictable moments in life. It is the guarantee of being seen when ill and to have that medical treatment on a pay scale based on coverage. Rising medical costs can wipe out a lifetime of savings with just one major medical event. Even the most routine of surgeries can cost tens-of-thousands of dollars, and more sophisticated procedures can easily run into the hundreds-of-thousands of dollars. Health insurance can help pay those skyrocketing cost and help save you from financial ruin. It can also help individuals to lead more healthy lives by paying for preventive measures such as regular check ups and immunizations to name just two. Conclusion: We could imagine that when uninsured, we receive less medical care and less timely care and these seem to be the people that experience the worse health problems. So, saving your money for health insurance is the better option.




Just Ask Marselno Tatipikalawan

Background Several medical interventions have their own great risks for the patients. Thus, to know what your physician will do to yourself is extremely important. Informed consent is a agreement of patients or patients’ relatives about medical interventions done by their doctor after receiving detailed informations about the interventions. The content of informed consent is associated with patient’s disease, including the method, purpose, risks, and use of interventions and/or its alternative. In Indonesia, informed consent is regulated by Ministry of Health in No.290/MENKES/PER/III/2008. The purpose of informed consent is for the protection towards both patients and the doctors. The patients will receive protection from interventions done by doctors and the doctors will receive legal proctection towards medical error from the interventions with great risks. Thus, it is crucial for patient to ask many things about anything related to the interventions that shall be done to them so the patients can actually understand about the interventions and even their disease. Asking about informed consent, hopefully, may soon be helpful reducing medical errors and harm for the patients and loss for the doctors. Objectives To encourage people to ask many things related to interventions that shall be done to them by their doctors and to raise public awareness about how important the informed consent is to reduce medical error in Indonesia Conclucion Several interventions done by doctors towards their patients have their own great risks. Understanding the informed consent and asking many things related to it may be helpful for reducing medical error and harm towards the patients and loss towards the doctors.

Contributing Comprehensively During the Anamnesis In Order to Prevent Medical Errors Jonathan Ariel, Rebecca Olivia Haryuni, Eric Vinson Wijaya

Based on a Medical Malpractice Analysis book 2013, Medical errors can be caused by several things. In prior of the statement, 33% of malpractice ensue because of incorrect diagnosis with the percentage being the highest amongst other possibilities such as surgeries with only 24% and obstetrics with only 11%. One way to diagnose a patient is through anamnesis in which the consultation is undoubtedly vital in upholding a diagnosis inasmuch as anamnesis is a two ways communication. However, the lack of patients’ explanation, trust, respect, honesty and contribution towards their physician during the anamnesis could lead to a false diagnosis before finally ends in an erroneous medication granting. Furthermore, mistaken medications would do nothing but aggravate the patients’ health themselves, resulting in a worse healthcare, and in some worst case scenario, death is also possible. This poster aims to increase public awareness that reducing medical errors is not solely the physicians’ responsibility. Patients can take part in reducing the errors conjunctly with their physician by increasing their participation during the anamnesis in which proactivity, openness and elucidation are included. Therefore, anamnesis would be improved before eventually results in a more accurate diagnosis as well as treatment. In conclusion, we believe that there are ways to minimize medical errors. One of the ways can be done by educating the patients on what they can do to prevent medical errors. They can start by providing comprehensive explanations as much as possible towards their physician during the anamnesis, in hope of indirectly assisting their physician in vindicating accurate diagnosis.




VIDEOGRAPHY




LOW HEALTHCARE QUALITY IN INDONESIA PROVOKES INSIDERS HAVING THE TREATMENT OVERSEAS Alyauma Akmal Kalani, Intan Chaharunia Mulya, Meulueya Astrie Israr Abstract Indonesia is a fast growing country with the highest rising in healthcare cost over the past few years. Most Indonesians appear to look for medical service overseas which is lower in cost and higher in quality. However, this issue makes effect on private and public expenditure growth rate (%of GDP). According to World Bank estimates, in 2013, Indonesia spent a remarkably low 3.1% of GDP on total public and private healthcare compared to an ASEAN average of 4%. Indonesians prefer having medical checkup and treatment overseas to Indonesia after experiencing what Indonesia offers. Outdated technologies, late treatment, busy professionals, low communication skills and staggering bill are the sources of issue. Those ended up to the slackening of people trust toward Indonesia’s government and professionals. Banning foreign professional to practice in Indonesia is also one of the sources. Therefore, Indonesia has to manage its health care services and provide facilities to support diagnosis and bring back people trust toward Indonesian’s healthcare services. At the end, good trust will not only bring a healthier Indonesia but also a prosperous Indonesia.

Looking Through

Elvira Lesmana, Arini Ayatika Sadariskar , Valdi Ven Japranata Background of the Photo 
 Poor service quality is still believed to be a common issue among healthcare workers. Most people associate such problem with the system of care and how its redundance influences service performance. However, do they ever realize that the problem could possibly stem from behavior? The lack of empathy they give to the patients may have certain impacts to the overall patients’ health status and satisfaction. In a recent study, it was found that empathy implemented in physician-patient interaction positively correlates with patient adherence and satisfaction. It also leads to better diagnostic and clinical outcomes, lowering patient’s anxiety and distress, and enhancing 1 patient’s independency. 
 Objectives of the Photo 
 This 3-minute-video is aimed at healthcare workers in order to show that empathy may be the key to the betterment of health service quality. 
 Conclusion 
 In conclusion, if all healthcare workers express empathy in their relation to patients, it will surely improve the quality of healthcare service. 
 Reference: 
 1. Derksen J, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract [Internet]. 2013 Jan [cited 6 January 2017]; 63(606): e76-84. Available from: www.ncbi.nlm.nih.gov/pmc/ articles/PMC3529296/

Tired Health Workers, Patients Threatened!  

Muhamad Syauqi Mirza, Ni Kadek Nadia Dwi Rachmawaty, Joue Abraham Trixie Background of Movie In Indonesia, there’s no regulation that regulate the hours of duty for resident & a young doctor. In fact, no institute that confess hold a responsibility on things like that. A doctor & paramedic at the hospital avarage working hours between 7-8 hours/day or up to 5-6 days/week. While the young doctor and the resident can work up to 33 hours. This is due to the lack of health workers, so that one doctor must deal with patients beyond its capacity. Excessive working hours are closely linked to the pressure experienced by a doctor in the workplace. It also has a strong correlation with patient safety, which also impacted on the quality of a health service. A study showed that health workers are overworked tend to make mistakes, or socalled medical error. Working in over forty or fifty hours each week can significantly increase the incidence of medical error. Medical errors occur most often used needles pricked. Many diseases can be caused by this incident, such as Hepatitis B, Hepatitis C, even the most severe HIV / AIDS. Syphilis, Malaria & Herpes can also be transmitted through the incidence of needlestick injuries. Objective of the Movie To explain the current situation of service quality in healthcare department in Indonesia Conclusion A health worker's hours of work overload can have a negative effect for the patient, even the health workers themselves. Of course, has implications for the quality of health services in Indonesia.

MASQUERADE: Maximizing Quality, Minimizing Errors

Laksmita Dwana Trisakti University

The gap between the care patients should get and what they actually received likely contributes to thousands of preventable deaths each year, and health care systems worldwide continue to face the challenge of delivering quality care. The susceptibility in our respective country’s system towards healthcare quality demands a sustainable development as a solution for the betterment in the future, which will hand over through generations. Facing current medical affairs such as the increasing number of patients – from infectious to chronic diseases, an uneven distribution of medical professionals in certain areas, and a high rate of mortality shows a fault in healthcare departments management. To disenchant public’s awareness of the importance of healthcare service quality through a preferable standardized medical professionals, to optimize the healthcare management by refining a systematic management and strengthening health policy, and to establish a group discussion as a mediation forum of government and private sectors to achieve a better coordination between the stakeholders are the objectives of the proposed solutions. As a final accession, to attain an effective, safe, efficient, patient-centered, equitable performance of healthcare department are the millennium goals in order to maximizing healthcare service quality and minimizing medical and systematic errors.

Five Dimensions of Health Service

K. Marfian Maranatha Christian University, Bandung, West Java, Indonesia Background Health service is one aspect of the medicine sphere which interacts directly with the “health-seekers”. That’s why we have to pay our outmost attention and care to improve this country’s health service, which will serve greatly to our nation’s rise by providing its people the best health service possible, which will undeniably improve the people’s quality of life – if planned and executed properly and professionally. Objectives To show the weaknesses of current health service in various places in Indonesia and to propose some recommendations that are based on a theory from Zeithaml, Parasuraman, and Berry. Conclusion According to Zeithaml, Parasuraman, and Berry in The use of the quality model of Parasuraman, Zeithaml and Berry in health services (1985), there are five dimensions that have to be evaluated to assess the quality of health service: tangibility, reliability, responsiveness, assurance, and empathy – and all of them must be discussed with great concern by the people in the medicine sphere, which will actually lead to quality implementation and manifestation.

Improving Health-Care Services: Preventing Medication Errors

Afifa Intifadha Habibatullah, Aqiillah Hepyanti Damanik, Aditia Nurmalita Sari Medication errors according to the National Coordinating Council Medication Error Reporting and Prevention (NCCMERP) are defined as any preventable events that may cause inappropriate medication uses or harm to patients under the control of health care professionals, patients, or consumers. A surprising fact shows that the improvement of medical science is resulting in increased medical errors. A study published at British Medical Journal shows that medical errors in hospitals and other health-care facilities may now be the third-leading cause of death in the United States, claiming 251.000 lives a year. In Indonesia, the exact number of deaths by medical errors is unknown since most cases went unreported. But a study conducted in a hospital in Bali shows medication error rate of 20.4%. Considering a lot of medical errors happened in health-care facilities, effective methods are needed to prevent these errors from happening. Medication errors especially need some serious attention, since those are one of the most common medical errors. To prevent frequent medication errors, we propose these following methods: 1.

Using an integrated and computerized data collection system, instead of the

conventional paper-based one. 2.

Ascertain the identity of the patient before any medical treatment or drug

administration. 
 3.

Minimizing the use of patient’s own or ‘home’ medication to prevent “borrowing”

medications. 
 Improving the quality of health-care services is not only assessed by the sophisticated medical science but also the minimum rate of medical errors. Those methods that have been proposed are expected to lower the rate of medical errors. References: Ernawati, Desak Ketut, Ya Ping Lee, and Jeffery David Hughes. “Nature and Frequency of Medication Errors in a Geriatric Ward: An Indonesian Experience.” Therapeutics and Clinical Risk Management 10 (2014): 413–421. PMC. Web. 5 Jan. 2017. Makary Martin A, Daniel Michael. “Medical error—the third leading cause of death in the US.” BMJ. 2016; 353 :i2139 Purba A, Soleha M, Sari I. “Kesalahan dalam Pelayanan Obat (Medication Error) dan Usaha Pencegahannya. Buletin Penelitian Sistem Kesehatan.” Jakarta, 10, Nov. 2012. Available at: <http://ejournal.litbang.depkes.go.id/index.php/hsr/article/view/1769>. Date accessed: 05 Jan. 2017.

Preventing Prescribing Errors with CDE Kirana Pawitra Nareswari, Aulia Budi Agustin, Margareth Hildaria AMSA-Universitas Sebelas Maret

In medical world, the health care systems are challenged with medication errors. A patient harm while the medication is in the control of the health care professional, patient, and consumer. The contributing factors to medical errors are staff shortage or high workload, nurse or doctor distraction, incorrect interpretation of prescribing or medication chart, lack of knowledge and experience. One of the most happening cases of medical errors is prescribing error. There are “C-D-E” alternatives to prevent prescribing errors. First, “C” for computerized prescribing. This method could lessen the happening of incorrect prescriptions interpretation caused by bad handwriting of the doctors. Then, “D” for double-checking. By applying double-checking method in interpreting the prescriptions, it could decrease the probability of wrong interpretation of the first prescription reader. Last, “E” for education. It may be better to increase the quality of the healthcare educations to prevent the knowledge- lacking of the health care providers as one of the leading cause to medical errors. In conclusion, there are three ways to prevent prescription errors. “C” for computerized prescribing, “D” for double checking, and “E” for education.

1 for 2: One Attention for Two Existences  

Antonius Galih P., Azizah Amimathul F., Katherine Fedora

Maternal death has become a very big and serious health problem in the world. In fact, the solution for that problem was still not been found until now. Global maternal mortality ratio is 200 deaths per 100,000 live births. In Indonesia, according to data SKDI 2012 an increase in maternal mortality that occurs today is about 359 per 100,000 live births. The figure is high than other countries. The cause of maternal death can be classified into direct and indirect causes. Factors direct causes of maternal mortality in Indonesia are eclampsia, and infection. Indirect factor such as too late to recognize the danger signs and take a decision, late referred to health care facilities, too old to get pregnant and too many children. Therefore, to reduce maternal mortality, we create a program that is assistance to pregnant women. This program is implemented by accompanying one pregnant women by one medical student during her pregnancy, and child birth. The program aims for monitoring the state of the mother during pregnancy and give education about their pregnancy. With this program, we expect the early detection of problems during pregnancy, reduce maternal and child mortality rate, and improve the health of Indonesia.

 

Creating Competence and Caring Doctors: All Begins in the Medical School Ghaly Khaidar Ardli, Nurrochmah Ihayani I, Putu Eka Dianti P Faculty of Medicine, Hang Tuah University

Background: A 2011 survey of 800 recently hospitalized patients found that only 53 percent of them felt that their doctors were empathic and caring. In a study where doctorpatient encounters were videotaped, researchers found that doctors often overlooked or dismissed signs of distress communicated by patients, providing empathic responses only 22 percent of the time. Some researches also found a high prevalence of burnout among doctors. In fact, all patients want their doctors to be academically prepared. But equally important, they want their doctors to provide a caring care. According to recent studies, patients whose doctors listen to them and demonstrate an understanding of their concerns comply more with those doctors’ orders, are more satisfied with their treatment and enjoy better health. Objective: To discuss the roles of medical schools for improving the service quality in healthcare department Conclusion: Medical schools have an important role in preparing the future doctors. Empathy and honesty are fundamental characteristic of doctors that can be taught and should be learnt in medical schools. The healthcare professionals are the role models for medical students. Academic honesty will create an academically prepared doctor, while empathy will create a compassionate care doctor.

Treat Your Patient Better: Comply with the Standard Precautions, Please Muhammad Taufan Wirya Kusuma, Devinta Akhlinianti, Siti Lukmanah Faculty of Medicine, Hang Tuah University

Background: Healthcare-associated infections are a major, yet often preventable, threat to the safety of patients, healthcare workers and visitors. On any given day, about one in 25 hospital patients has at least one healthcare-associated infection. Moreover, in a meta-analysis conducted by Dioso et al. in 2014, it was revealed that doctor’s compliance with the standard precautions was between 30% to 50%. A total of less than 80% compliance was found among doctors and nurses from the studies. In fact, promotion of a safety climate is a cornerstone of prevention of transmission of pathogens in health care. Inadequate healthcare workers’ knowledge and the lack of protective materials and other equipments and utilities are crucial issues that need urgent attention. Objective: To identify the problem of service quality related to the standard precautions in healthcare department in Indonesia and how to solve it. Conclusion: Worldwide escalation of the use of standard precautions would reduce unnecessary risks associated with health care. Promotion of an institutional safety climate helps to improve conformity with recommended measures and thus subsequent risk reduction. Provision of adequate staff and supplies, together with leadership and education of health workers, patients, and visitors, is critical for an enhanced safety climate in health-care settings.

Be Prepared for Fast Response Muhammad Faklun Badrun AMSA-Universitas Halu Oleo

Background Health service is one aspect of the medicine sphere which interacts directly with the “health-seekers”. That’s why we have to pay our outmost attention and care to improve this country’s health service, which will serve greatly to our nation’s rise by providing its people the best health service possible, which will undeniably improve the people’s quality of life – if planned and executed properly and professionally. Objectives To show the weaknesses of current health service in various places in Indonesia and to propose some recommendations that are based on a theory from Zeithaml, Parasuraman, and Berry. Conclusion According to Zeithaml, Parasuraman, and Berry in The use of the quality model of Parasuraman, Zeithaml and Berry in health services (1985), there are five dimensions that have to be evaluated to assess the quality of health service: tangibility, reliability, responsiveness, assurance, and empathy – and all of them must be discussed with great concern by the people in the medicine sphere, which will actually lead to quality implementation and manifestation.

Kill Them with Hygiene

Leonardo Liesay , Noviyanter Siahaya, Jevangaline Tanasale AMSA-Universitas Pattimura

Background We made this movie because medical students nowadays seems doesn’t have high awareness on hygiene in their daily life. This maybe looks not important, because they thought when doing medical actions they will follow the procedure. But as a human, there is a medical error like nosocomial infection. When they are in pressure while facing an emergency patient, they might be confused on following the procedure, especially on hygiene procedures that can lead into spreading bacteria that can cause infection. On the movie, illustrated a co-assistant doctor that doesn’t follow the hygiene procedure and caused a nosocomial infection by methicillin resistant Staphylococcus aureus. To prevent that, we have to build and inculcate awareness of hygiene in ourselves, so whatever the conditions we always do the right hygiene procedures. Objectives Raise awareness of hygiene in medical students and all stake holders to prevent them from doing the wrong hygiene procedure when performing medical actions and optimizing healthcare workers’ quality.

Conclusion With showing what the causes of doing a wrong hygiene procedure, medical students and all the stake holders can understand the important of raising awareness of hygiene that can prevent them from doing a medical error and optimizing healthcare workers’ quality.

Closer to Disclosure

Fauziyyah Djaafara, I Putu Ardi Wiraprasidi, Arondino Darmawan Faculty of Medicine, University of Sam Ratulangi, Manado

Background In this modern era, healthcare departments in society are more motivated to create many innovations. Unfortunately, Pusat Kesehatan Masyarakat (Puskesmas) which is the frontline healthcare facility in the society often given less attention. This situation inspired us to promote Puskesmas through this video. Nowadays, Puskesmas already been improved and no longer has the ‘old’ face that we had known. One successful example is located in the rural area of North Sulawesi, in Kotamobagu, where great innovation using electronic card (e-card) was created and applied.

Objectives Through this video, we want to give clear description and change the paradigm of people that modern Puskesmas is way different from the past. We want to convince the viewers on how Puskesmas has evolved to provide more comprehensive service, by presenting a successful story of Puskesmas in rural area. Hopefully, viewers can be encouraged to obtain their healthcare from Puskesmas. Conclusion Puskesmas may not be the the highest level of healthcare department, but Puskesmas also has the optimal healthcare service, great innovations, and current technology. Through this video, we would like to engage the viewers to take a closer look and reveal the disclosure of inspirational illustration of the new face of Puskesmas.

Be The Change  

Peter Sylvanus,Valeska Harsen, Yosua Hady Putera AMSA-UPH

Background: The story and concept of the video is based on everyday lifes. In this video presents a worker at a construction site and being injured because he did not use any safety equipments. Workers especially in Indonesia, think that safety equipments such as helmet, gloves are mere tool and gives nothing to benefits them. We want to remind other people to not take something so lightly, because even in the smallest error, could reduce their health quality or even kill someone. We took this for our concept because it is simple and it will give more impact and reminds viewers to understand more about the qualities of workers right now, especially in Indonesia. Objectives: To show the viewers the health quality of workers in Indonesia, give some solutions to prevent it from happening, and also optimizing health quality workers especially in Indonesia by the goverment point of view and the workers point of views. Conclusion: In conclusion, workers in Indonesia have a low health quality and need to be optimize. This optimalization needed from both sides,

goverment and workers. Government

need to give more proper instruction and realization to BPJS, thus from workers need to be self concious for their own health quality.

HOME CARE, WHAT IS IT? By Syahrun Mubarak Aksar, Samsul Rahmat, Muhammad Surya Arma Arsyad Indonesia is one of five countries in the world which has the highest population density, which is about 255 million people spread from Sabang to Merauke. With a growing population, Indonesia is faced by several problems. One of them is a health issue. Indonesia with low level of health has several problems, espescially in the health services such as delayed an emergency act or first aid, distance and inability patients to go to health services, and lack of post-hospital rehabilitation. Because of that, Home Care is one of the best solution to increase our health services in Indonesia. There are three types of Home Care, they are 1. Home Care Followed Up Patient which is Home Care Team will follow up the patient who has been hospitalized and currently taking care at home and getting better. 
 2. Home Care for Visited Patients which is Home Care Team will go to the home of the society who has called them and told their addres clearly. 
 3. Home Care Emergency which is Home Care Team will also go to the home of the society who has called them and told their addres clearly but it is in an emergency situation.

Harmonize Information for Healthier Indonesia
 Authors: Ahmad Fahmi Nugraha, A. M. Akramullah Dendi J., Pricella Mutiari Medical errors are an under-recognized cause of death. Medical error is now the third leading cause of death in the U.S. Some 440,000 deaths a year are caused by hospital mistakes, How about in Indonesia? According to a study conducted in a private practice in DIY, it is found that 82% of antibiotics given in acute respiratory infection cases, turns out to be inappropriate, and this number did not differ between general practitioners and specialists. Hippocrates must be spinning in his grave. We have lost track of what should be the most important

dictum in medicine, his “First, do no harm.” Too many

doctors, too many tests, too many procedures, and no one keep track of all the information. It’s a prescription for disaster, and the disasters will keep happening if we don’t take action now.

dr. Juminten Saimin, Sp. OG (K) is our beloved

teacher and the dean of Medical Faculty of Halu Oleo University. Through our interview with her in this video, we hope the audience can learn about good quality-healthcare, the role of doctors and government in achieving that quality, the reality of healthcare in Indonesia, the most common medical error and the impact for patients, and a breakthrough that can reduce medical errors. Through our interview, we can conclude that the main cause of medical error is lack of communication between health workers, resulting in mismatched information of the patient. Therefore, we highly recommend the use of Electronic Health Record system to be implemented in Indonesia, especially in big hospitals.

Surgical Errors Regina Mega A.P.S, Saviera Salsabila S, Gantira Rizaldy Background It is often said that there is no such thing as “minor� surgery. Whether we are having an appendix removed, any surgical procedure is a serious matter and involve an element of risk. Therefore, surgical errors are some of the most common types of medical malpractice. Simply defines, a surgical error is an unpreventable mistake during surgery. No two surgeries are identical. Likewise, every surgical error has the potential to be unique. There are several common reasons for surgical errors such as incompetace surgeon, insufficient preoperative planning, poor communication between surgeon and operating assistant, or even fatigue surgeon. The types of surgical errors that can occur are wide ranging as well. Operating on the wrong body part, leaving a piece of surgical instruments and injuring the internal organs during surgery for instance. Objective Firstly we made this movie to identify the problem of service quality in healthcare department in Indonesia especially about surgical errors as the common problem in medical malpractice. Secondly, this movie content deliver our opinion or ideas how to solve this problem by involving medical professionals, medical student and stake holder.

 

Conclution Surgical error is one of the common problem of service quality healthcare department in Indonesia. Wrong site surgery, surgical instruments left in body, damage to internal organs are several types of surgical error that commonly occur. Our goals in this movie is to prevent and reduce surgical errors in Indonesia by paying attention the operating schedule, preoperative preparation,surgeon experience, and improving communication between surgeon and operating assistant.




PHOTOGRAPHY

Search: My Symptom Della Anastasia Candra, Ivan Angelo Albright & Kevin Luke

Abstract The abundance of information on the internet and convenience of accessing it, encourage people to diagnose themselves. According to Susannah Fox, in 2011 80% of internet users have looked online for information about any of fifteen health topics such as a specific disease or treatment. However, internet doesn’t always give reliable information and may give patients negative impacts, like over anxiety about their symptom. The photo is addressed to both patients and healthcare providers. Patients should be selective in absorbing information on internet and keep in mind that internet isn’t one hundred percent correct. On the other hand, healthcare providers should realize that nowadays patients are “smart” enough to diagnose themselves without knowing the information’s validity. As a healthcare provider, we have to concern more on this phenomena. Education to patients and society about medical information on internet isn’t one hundred percent reliable need to be conducted, at the same time, healthcare providers have to encourage patients to see a doctor if not feeling well. These will improve healthcare service by minimizing unnecessary anxiety and self-treatment. Source: http://www.pewinternet.org/2011/05/12/the-social-life-of-health-information-2011/




Healthcare : Providing Quality, Providing Happiness Gerry Nathan R

Background of this photo Indonesia’s Healthcare quality has been a point of attention for many years, concerning also on the quality of service and availability of facilities. In Indonesia according to Worldbank in 2012, there are only 0.2 doctors per 1,000 people and the satisfaction quality of healthcare is ranging from 57% to 67%, but the facts contradicts in this photo that was taken in Puskesmas Sleman, Yogyakarta. It reflects the perfect healthcare service, where joy, happiness, clarity and satisfaction from the patient come around as one. This should be the kind of service that all of the healthcare workers provides in Indonesia. Objectives of the photo Through this photo, the author hopes that the viewers can understand that, as the future and present healthcare workers, we need to improve the quality of healthcare by giving a sincere and satisfying service to patients. With the intention that our eort can impact the outcome of medical care. Conclusion The reflection of healthcare quality lies in the heart of the patients and it is through to us, the future healthcare workers, to not let them down.

Time Saving is Live Saving Sekar Ratna Arnovita Depicted above is a doctor hastily handling his patient who is wounded and needing immediate medical attention. Over time, among patient’s inquiries regarding clinic services are lack of discipline, lack of attention and understanding to patient, ineffective communication, and slow response. Vital to a doctor’s mental inventory is not only medical knowledge and dexterity, but also attitude. Trust between the patient and the doctor is built upon the foundation that is professional attitude, which is shown through the doctor’s behavior, methods of communication, and visual presentation. When trust has been attained, the patient may rest comfortably no matter the condition. Being a great doctor by doing perceptive aid and help with love, we can help the patient save life. Time saving is live saving.

THE IMPORTANT TO QUICK THE SERVICE Muhamad Rifa’i, Intan Karnina Putri, Hairon Dhiyaulhaq

Abstract From the subtheme about optimizing healthcare services management, we know that Indonesia has too many weakness about its healthcare management. This photo describe a geriatric patient who are waiting to have a further examination radiology which not accompanied by health workers who have the responsibility to provide the best service towards patients. From the Objectives, the importance of service quality in healthcare department is to improve the Nations health. The thing that still escapes the attention of security in the form of a room of specimens is high, still has the possibility to spread radiation to the outdoors. It also depends on the standard of the room Radiology owned every health service center. This patient might not know how condition installation Radiology are running because the patient is unable to see clearly again the sign lights above the door installation, moreover, standardized security standards are still very weak. Therefore very necessary healthcare’s workers to give instructions, supervises, and give guidance to improve the Nation’s health. Optimizing healthcare services management is indispensable with the way to form a working shift arrangements that are more effective, improving the quality of healthcare's work so that Patients get what they are supposed to get.

Executive Polyclinic for Aceh Sarach Meilia Aliyah

Abstract In this era, society need to choose the form and type of medical services. However, when it is not available in Aceh, the people will seek it out to the other province till other country but these medical service are not without problems. First, the society need much of funds because of the high cost. Second, we can not get rid of the medical problems unresolved. Third, the hospital also get a lot of cases problem gone worse after returning home. Because of that, the Regional General Hospital dr. Zainoel Abidin provide an excellent medical servise called Executive Polyclinic. RSUDZA provide international standard of professional service. And benefit from the service will later be returned to the hospital to quality improvement. But behind of that, many patients who say that quality provided by the hospital is not comparable as well as expected. But these problems has been resolved. In optimizing the service, improve human resource capacity is not only done on the medical sta, but in all part that relate directly to the hospital to running an integrated manner. In the end, main goal of Executive polyclinic programe is provided for the people as a new alternative medical services.

Do It with Heart Elvira Lesmana, Aya Sadariskar, Valdi Ven Japranata

Background of this photo Many medical procedures are in fact causing patient inconvenience. For instance, this photo shows a patient undergoing cervical traction procedure. It is a common physical therapy for patients suffering from broken neck or neck pain. By using traction device, muscles in neck region are stretched at different degrees depending on weight placed in the device. During the procedure, patient may experience discomfort feeling in the neck. It is generally known that patient safety and convenience are first priorities in healthcare services. Despite the unpleasant treatment performed on the patients, healthcare workers are actually able to serve patients in favorable manner, such as showing empathy and communicating with patients in friendly way. Such way will surely improve patient’s satisfaction and healthcare service quality.1 Objectives of the photo The objective of this photo is to show that cervical traction may cause inconvenience and to promote favorable service manner by healthcare workers. Conclusion To conclude, healthcare workers’ service manner is essential part to achieve best healthcare service quality, regardless how inconvenience the medical procedure is. Reference 1. Pollak KI, Alexander SC, Tulsky JA, Lyna P, Coffman CJ, Dolor RJ, et al. Physician empathy and listening: associations with patient satisfaction and autonomy. J Am Board Fam Med [Internet]. 2011 Nov [disitasi 21 Desember 2016]; 24(6): 665-72. Diunduh dari: www.ncbi.nlm.nih.gov/pmc/articles/PMC3363295/

Paradox Daniel Martin Simadibrata, Elvira Lesmana, Arini Ayatika Sadariskar

Abstract This ill looking child, Rino is only 9 years old and is being treated in the hospital for persistent diarrhea. He had grabbed a random paper nearby and inspected it, in order to take his mind off of the scorching heat of the room. Imagine yourself in his position: ailed and distressed, not only by the malady experienced, but also tortured by the heat. This is a serious issue that must be solved in our nation. Critically dehydrated patients due to diarrhea are in need of high-quality care, but often times, they are left to suffer in hot hospital rooms. A simple, yet crucial, requirement such as proper air conditioning is often neglected by health care facilities across Indonesia. Without proper air conditioning, patients will be burdened by drastic water loss, which will further aggravate the patient’s health condition. Simply said, a change needs to be proposed in order to better up the situation. As often said, “A picture is worth a thousand words.” This picture, captured in a hospital in Depok, aims to emphasize the importance of a proper healthcare environment in relation to the success of treating patients suffering from various ailments. This is a pervasive, and unfortunately overlooked, problem in Indonesia that must be attended to.

Something for Somebody Elvira Lesmana, Arini Ayatika Sadariskar & Valdi Ven Japranata

Background of the photo Medical instruments play a significant role in patient care and treatment. Most of such devices, such as hospital beds, wheelchairs, and stethoscopes, are commonly shared among patients. However, inadequate sanitation of shared medical instruments may pose a threat to patient safety. This could be a mode of transmission of infectious agents, such as bacteria and virus, to be spread from patient to patient. Therefore, a standard operating procedure regulating the safety of shared medical devices should be implemented. Medical instrument safety checklist may provide an advantage to such purpose. By utilization of safety checklist, one could avoid the potential harm that may emerged due to neglected instruments’ sanitation.1 Objectives of the photo This photo, which is taken at Kesdam Cijantung, Depok, aims to raise awareness that shared medical instruments could harm the patient safety if the sanitation of devices is not assured. Conclusion In conclusion, the threat of shared medical instrument utilization can be prevented by using safety checklist and thus improving overall healthcare quality. Reference 1. Medicine and Healthcare Products Regulatory Agency. Devices in practice: checklists for using medical devices [Internet]. 2014 June [cited 6 January 2017]. Available from: www.gov.uk/government/publications/devices-in-practice-checklists-for-using-medicaldevices

Double Check Triana Hardianti Gunardi

Background According to John-Hopkins medical analysis study, medical error is now the third leading cause of death in the United States. It has caused more than 250,000 deaths every year, with most errors linked to poorly coordinated care and underuse protocols.1 While in the European Union, WHO study has revealed that 50-70% medical errors can be prevented by thorough systematic approaches to patient safety; just as according to International Patient Safety Goals (IPSG) which ensure safe and effective delivery of health care services2 In this photo, two nurses are going to give blood transfusion to a thalassemic child. Any error of identification/package of blood/procedure might lead to fatal condition. Therefore, they are double checking to ensure the correct patient receive correct procedure–in this case is blood transfusion of pack-red-cells–at the correct point. Objective Maximizing service quality in healthcare department by minimizing medical error. Conclusion Double check to ensure: correct patient, correct procedure, and correct point. Reference 1.

Daniel M. Study suggests medical errors now third leading cause of death in the U.S. 2016 May 3[cited 2017 Jan 5]. Available from: http://www.hopkinsmedicine.org/news/ media/releases/ study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us

2. World Health Organization. Data and statistics Patient Safety. [cited 2017 Jan 5]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/patientsafety/data-and-statistics

Dangers that Lurk Health Workers Muhamad Syauqi Mirza, Joue Abraham Trixie, Halia Ignatia Hasibuan

Background of the photo Needlestick used a lurking danger for health professionals. Many diseases can be caused by this incident, such as Hepatitis B, Hepatitis C, even the most severe HIV / AIDS. Syphilis, Malaria and Herpes can also be transmitted through the incidence of needlestick injuries. A study showed that this happens due to the understanding of health workers on how to prevent the incidence of needlestick injuries. Understanding of diseases that can be transmitted through blood is also lacking. Their behavior in avoid needlestick injuries is also lacking, such as by closing the syringe. Objectives of the photo This photo aims to educate health professionals about the dangers that lurk. Also to give advice to the government to pay more attention to health professionals. When many health workers are exposed to infection from used needles and syringes, certainly there will be more funds will be issued. It also should require all health workers to get vaccination Hepatitis B and Hepatitis C. Conclusion Needlestick injuries among health workers, will decrease quality of health services in Indonesia. Government, health workers, even medical student must to pay attention to this phenomena.

“I've been keepin' busy all the time� – Jet Lag, Simple Plan Muhamad Syauqi Mirza, Joue Abraham Trixie, Halia Ignatia Hasibuan

Background of the photo Indonesia, there is no regulation governing hours of work and watch for resident and young doctors. In fact, there is no claim to the competent institution that takes care of things like that. Doctors and nurses in a hospital avarage working hours between seven and eight hours per day, five to six days per week. While the young doctor and a resident can work up to thirty-three hours. This is due to the lack of health workers, so that one doctor must deal with patients beyond its capacity. Citing data from the Konsil Kedokteran Indonesia (KKI) per October 22, 2016, the number of doctors in Indonesia reached 114 602 people, not including doctors and dentists. These data indicate that the ratio of doctors in Indonesia had enough by the standards of Jaminan Kesehatan Nasional, where one doctor serves a maximum of 2,500 residents. The problem is the accumulation of doctors in cities - big cities, such as Jakarta. Excessive working hours are closely linked to the pressure experienced by a doctor in the workplace. It also has a strong correlation with patient safety, which also impacted on the quality of a health service.A study showed that health workers are overworked tend to make mistakes, or so-called medical error. Working in over forty or fifty hours each week can significantly increase the incidence of medical error. Medication error is a mistake in the treatment process that is still under the supervision and responsibility of healthcare professionals, patients and consumers, and should be prevented (Cohen, 1991, Basse & Myers, 1998). In Surat Keputusan Menteri Kesehatan RI Nomor 1027/MENKES/SK/IX/2004 stated that the definition of medication errors is the occurrence of adverse patient, resulting from the use of drugs for the treatment of health personnel, which could otherwise be prevented. Objectives of the photo To explain the current situation of service quality in healthcare department in Indonesia.

Conclusion A health worker's hours of work overload can have a negative eect for the patient, even the health workers themselves. Of course, has implications for the quality of health services in Indonesia.

Sign of Concern Imelda

Abstract I took this photo at a hospital in Tarakan, North Borneo. A sign board is written "Rumah Sakit Ini Kawasan Bebas Asap Rokok" which is quite interesting to me. These boards are displayed quite large and indicates that anyone who was in the hospital neighborhood is forbidden to smoke. Which becomes the appeal itself is a sign of concern for hospitals to improve the quality of healthcare in the hospital. Not only for the patient themselves but also for all doctors, sta or anyone who was in the hospital neighborhood. This is just a simple sign but leave a tremendous eect Due to learn to exercise restraint, show concern about the patients or others who are in hospital and purely a decision whether we want to follow this sign or even break them. All depend on the decisions and our own consciousness. I took the title sign of concern because the view of the state of the hospital were simple but trying to maximize the quality of healthcare that is around it, this sign of concern that led to our consciousness.

Simple Act to Reduce Infections Anastasia Jessica Christi, Novia Lauren Sieto & Vika Damay

Background As medical personnel, patient contact is inevitable. Our immune system may have been strong enough to fight disease-causing germs, but what about the patients? With patients' unhealthy conditions, they surely will be more susceptible to nosocomial infections. Objective Hand washing is a simple thing but often forgotten. Through hand washing, healthcare workers can reduce the number of medical errors that would likely to happen in contact with patients. Conclusion This photo suggests that one small action can have a great impact ; Hand washing to reduce medical errors.

Protect Yourself, Protect Others Amanda Tanasia, Vincent Phoa, Novia L Sieto

Background Nosocomial infections is one of the leading causes of hospital deaths worldwide. Regarding Indonesia's tropical climate, hospitals have to be aware of the dangerous pathogens and how to prevent them. Every day, people lose their lives due to nosocomial infections, and some of them may be drug-resistant pathogens. Doctors and nurses not only risk their lives when they treat ill patients, but also risk lives of others if they forget one simple yet crucial procedure; cleaning their hands. Objective Patient safety is the top priority for all healthcare professionals. Most people however, are likely to forget that threats to patients may also come microscopically. Even though it has been issued that every wards in every hospitals should have alcohol handwashes, people tend to forget they are even there. Ironically, as the number of drug resistant pathogens rise, so does the number of people disregarding how important to wash their hands. Therefore it is imperative to protect yourself, as healthcare professionals, and the lives you treat just by washing your hands before and after treating ill patients. Conclusion Handwashing is a simple procedure, yet very crucial to prevent disease transmissions which may result in death of a patient. Even though it something that has been taught since childhood, many people disregard them. However, as healthcare professionals, cleanliness should be of top priority, so does patient health.

Simple Act to Reduce Infections Novia Lauren Sieto, Vika Damay & Anastasia Jessica Christi

Background As medical personnel, patient contact is inevitable. Our immune system may have been strong enough to fight disease-causing germs, but what about the patients? With patients' unhealthy conditions, they surely will be more susceptible to nosocomial infections. Objective Hand washing is a simple thing but often forgotten. Through hand washing, healthcare workers can reduce the number of medical errors that would likely to happen in contact with patients. Conclusion Therefore, like what is being drawn in this photo : to reduce the risk of medical errors , healthcare workers have to start caring by do check and follow up their patients frequently to provide a better prognosis for the patient.

Sharing Knowledge, Improving Each Other Novia Lauren Sieto, Vika Damay & Anastasia Jessica Christi

Background Medical profession is a noble job. Dealing with human lives is not easy. A wide variety of patients come to ask for help on the conditions they suffered. The fates of patients’ lives are in the hands of medical personnel. This could lead not only to positive things, but also towards the negatives. As healthcare workers, we would not let patients who entered hospital in the hope of recovering have even worse conditions due to the negligence of the medical staffs. Objective Frequently do check and follow-up increases the accuracy in providing diagnosis and treatment to patients. It is an essential habit that healthcare workers have to start to practice since the clinical phase of their education (co-ass). Conclusion Thereby we can create optimal healthcare service quality started from sharing our knowledge with our colleagues, in bringing each other's quality improvement like what this photo tells us about 'sharing knowledge to improve healthcare workers' quality'.

Occupational Risk Vincent Phoa, Amanda Tanasia & Novia L Sieto

Background There is no doubt that the hospital is a place teeming with pathogens. Some of those pathogens may be drug-resistant and can be found in simple places such as the trash can. Tissue papers, spoons, and water bottles may contain pathogens from a patient, and may infect others if they are not disposed properly and safely. Cleaning servicemen risk their lives every single day so that patients and healthcare practitioners can enjoy the luxury of a healthy and clean environment. Objective Sanitation and cleanliness are some of the determinants of a healthy life. A hospital should provide that example by making sure their establishment are free from dangerous pathogens and tidy. It is the duty of the cleaning servicemen to make sure that those factors are met, which, most of the time, are disregarded. Conclusion Cleanliness and tidiness are important factors to a healthy environment. But more than that, it is imperative to make sure dangerous pathogens not being spread through proper disposal of human wastes. This is made possible by none other, the cleaning servicemen.

Better Waiting Room for Better Prognosis for the Patients Pretika Prameswari, Donna Shandra , Nazamta I.

Background This Photo gives us exactly the current situation in the one of Govermental Hospital in Indonesia. This is a waiting room when many patients with many disese wait together in one place. We also can see the wall and the plafond with many fungi. The plafond is also leak a water from the out side every raining. In Indonesia Infectious Disease still had a high prevalence. About seven from ten patients comes with a weakened immune. The weakened immune means they can infect with many pathogen easily. When they are wait in the same room togheter for a long time, the can be infect with the others and their disease comes more severe. Many fungi that we found in the wall and plafond can also infect the patiens especialy when there is a wound in their body. The spora of that fungi can spread and fall everywhere. The leak of the plafond can also make the environment moist, the moist environment can support the fungi grows. Objective 1.

To explain the current situation of service quality in healthcare department in Indonesia and related disease.

2. To Identify the problem(s) of service quality in healthcare department in Indonesia and how to solve it. Conclusion We can reduce the infectious desease or the complication of infectious with the better waiting room in health facilities.

Crisis of Clean Water and Health Facility Immanuella Yosephine Sirait

Background of the photo Not having access to clean water is what this neighborhood is dealing with and when the people got sick from drinking dirty rain water they need to find a doctor for their illness they faced a 2 -hour walk to get to the nearest hospital. This case illustrates only one of the challenges for Indonesia in socio-infrastructure as it on it’s way to make health care accessible to the country’s entire population in 2019 by implying the current national health insurance (JKN) program. These people live in remote and poor west of this country. They wished they government improve the health service quality in their region, they may theoretically have access to Health care by JKN but there are not enough Hospital and Doctors to provide because there is a gap in developed and underdeveloped region in Indonesia caused by different in number of hospital and doctor growth also in infrastructure since 2014, where they only develop mainly in Java. The lack of hospital growth and doctor equity service has prevented these people to access Healthcare. The JKN program has started since 2014 but regional inequity in access to healthcare services has not drastically improve. Hospital and Healthcare seems to be distributed based on market demands and in region with good economic development. Objective 1. To discuss the role of healthcare professionals, government and together with other members that is associated to improve the service quality in healthcare 2. To understand how important service quality in healthcare department to improve nation’s health. Conclusion Indonesia still has a long way to reach Universal Healthcare Coverage. It can start by improving universal coverage policy on both socio-economy equity Geography equity and infrastructure equity. Clean water is just an example of infrastructure inequity which lead to health problem in Indonesia and the government couldn’t provide the service these people deserve.

Eroding Errors with Barcode Kevin Eliezer Ferdinandus

Background of the photo Medical error accounts for sizable amount of death; the third largest cause of death in the US with around 250,000 case per year. It is caused by many factors, ranging from complex health-care system, lack of competency & education, and human errors. One of the most common medical procedure in the world is blood test. Since this is a prevalent procedure, it is expected to be delivered with high precision. But reality is disagrees: wrong data inputs often happens around the field. This photo was taken in the Clinical Pathology Lab of RSUP H. Adam Malik Medan where technology is implemented to increase the lab’s productivity rate and to minimize human error in identifying samples and results by using barcodes. Objectives of the photo Through this photo, the author hopes viewers are getting insights on how technology can help in maximizing healthcare service quality, specifically in this case the barcodes can help reducing and preventing medical error by giving accurate results and delivering it to the right place. Conclusion Living in the age of technology, it is great if we can incorporate cutting-edge findings to help us in our daily life, in our case as medical students it is applying it on healthcare services.

Laboratory Diagnostics : Integrated, Fast, Efficient and Best than Ever Before Nicholas Abraham, Gerry Nathan R

Background of the photo In the 21st century, laboratory diagnostics has been one of the most reliable tool that healthcare clinician depends on. We also can agree that technology have been our best companion in improving the quality of healthcare facilities all around the world. Yet, the problem at hand is that this kind of technology drawbacks with the manpower itself. By means that our Healthcare Workers especially in Indonesia is not ready to embrace this new kind of sophisticated technology in the aspects of knowledge and skill. Objectives of the photo As the future healthcare clinician or doctors. Utilizing this type of technology that is in our grasp is very important. For the sake of our patients, and our jobs as well. By making the right diagnosis, planning of the treatment will be efficient, and moreover the outcome for our patients, which is the healing process will be faster, and satisfying. And finally for us, the doctors, will significantly reduce the rate of medical errors. Conclusion So, let’s be the generation of doctors that are willing to learn and improve the face of healthcare in Indonesia through technologies!

Territory Cadre: Portray the Cadre, help Promote the Importance of Health Adilla Shafryantyo Purnomo

Abstract Health is a right held by all people without exception. So that health promotion is needed in the current global era. Increasing number of people, the more people that must be considered. The ratio between the number of doctors and a population highly inversely so that when only relying on health personnel, the quality of health just rely on the competence of health professionals. WHO ratio covenants, there should be 40 doctors per 100 thousand inhabitants. Whereas today, in Indonesia only 33 doctors per 100 thousand inhabitants. Thus, can not simply rely on existing health workers. Preventive measures are the best way to maintain the stability of the health of the population. As one way of preventive measures is the health cadre, cadres held for the region's independence in maintaining the health of the region. Here can involve the womens of PKK contained in the region to continue to help monitor and maintain the health of the environment and territory. So as to optimize management services. The cadres can help socialize health activities in the region, and can promote health care. This photo shows a cadre that helps convey the importance of health care.

Our Patient is Our Priority Achmad Januar Er Putra, Bonfilio Neltio Ariobimo, Yohanes Krisnantyo Adi Pinandito

Photo details: Print size: 16R Location: Private Hospital in Surabaya, Indonesia Consent: oral consent only Abstract Background: At first day, when we are fully registered as a medical doctor, we have to loudly speak am Hippocratic Oath, which is one of the sentence is “The health of my patients will be my first consideration.” By then, we have to give our best to our patients, as we know because by becoming a health alliances, we have to fully understand with the wide scope of our patients, one of them is the medical error that might be happened to them. Medical error is different with the medical risk, which is the error can be prevented by the development of our skills. By this photo, we are hoping that we can promote the reduction of medical errors because at 2006-2012, the malpractice comprises 182 cases at Eastern Part of Indonesia (Tempo, 2012). Malpractice can be prevented. There are several ways to reduce the huge number of medical error, one of them is the application of identity brace system. At this brace, the doctor and other health alliances can write every important information from the patient, such as the identity and the medical conditions.

Then, if this patient is transferring to

another room, the other doctor and medical team who keep the patients will not doing the treatments contraindicated to the patient’s condition.

References 1.

Darmadipura, Sajid. 2012. Buku Pegangan Bioetik FK Unair. Cetakan Kedua. Surabaya: Airlangga University Press.

2. https://m.tempo.co/read/news/2013/03/25/058469172/sampai-akhir-2012-terjadi-182kasus-malpraktek 3. http://www.who.int/management/facility/hospital/en/index6.html

Note: Camera: Samsung Galaxy S7 Edge Size: 3.56 MB Resolution: 4023x3024 Orientation: 00

The Checklist Keeps the Patients Alive Achmad Januar Er Putra, Bonfilio Neltio Ariobimo, Yohanes Krisnantyo Adi Pinandito

Photo details: Camera: Samsung Galaxy S7 Edge Print size: 16R Location: Private Hospital in Surabaya, Indonesia Consent: oral consent only Description of the background This is a photograph of a doctor and medical team in a private hospital that using a surgical safety checklist on taking care of patients. This checklist is a new method that is applied in these hospital with the objective to do surgery procedure safely. Since 2006 to 2012 there were 182 cases of medical negligence in Indonesia. The existence of this checklist can reduce the risk of medical negligence endangering the patient such as error of procedure, inappropriate use of drugs, and failed of anesthesia, etc. Hopefully this method could be applied in every hospitals which done surgery so that the medical personnel could eliminate what is not necessary for the patient before and during the surgery, also prevent possibilities of medical error. References 1.

http://www.who.int/management/facility/hospital/en/index6.html

2. h t t p : // w w w . w h o . i n t / p a t i e n t s a f e t y / s a f e s u r g e r y / t o o l s _ r e s o u r c e s / SSSL_Manual_finalJun08.pdf 3. https://m.tempo.co/read/news/2013/03/25/058469172/sampai-akhir-2012-terjadi-182kasus-malpraktek

 

The Checklist Keeps the Patients Alive Bonfilio Neltio Ariobimo, Achmad Januar Er Putra, Yohanes Krisnantyo Adi Pinandito Photo details: Camera: Samsung Galaxy S7 Edge Print size: 16 R Location: Private hospital in Surabaya Consent: Oral consent only Description and Background: This is a photograph of a doctor and medical team in a private hospital that using a surgical safety checklist on taking care of patients. This checklist is a new method that is applied in these hospital with the objective to do surgery procedure safely. Since 2006 to 2012 there were 182 cases of medical negligence in Indonesia. The existence of this checklist can reduce the risk of medical negligence endangering the patient such as error of procedure, inappropriate use of drugs, and failed of anesthesia, etc. Hopefully this method could be applied in every hospitals which done surgery so that the medical personnel could eliminate what is not necessary for the patient before and during the surgery, also prevent possibilities of medical error. References: 1.

http://www.who.int/management/facility/hospital/en/index6.html

2.

http://www.who.int/patientsafety/safesurgery/tools_resources/

SSSL_Manual_finalJun08.pdf 3.

https://m.tempo.co/read/news/2013/03/25/058469172/sampai-

akhir-2012-terjadi-182-kasus-malpraktek

The Five Stars Superdoctor: A Dream Yet to Be Bonfilio Neltio Ariobimo, Yohanes Krisnantyo Adi Pinandito & Achmad Januar Er Putra

Photo details: Print size: 16R Location: Jl. Prof. Dr. Moestopo, Surabaya Consent: oral consent only Abstract Doctor is not only about profession, but it goes beyond. Doctor has to deal with a quaint decision, whether to save a person’s life or not. Doctor has to analyze the patient’s quality of life, not only cure and treat the illness. Common people see doctor as a magical hero, just like Superman. They do put their responsibility to keep the beat of this society rhythmically as what Superman did at the comic! Everyone who will to serve their life, can be a superdoctor (i.e. superman and doctor). But, of course it is not as easy as flipping our palm. World Health Organization (WHO) has launched a concept about the ideal profile of a doctor, known as “Five Stars Doctor”. This Five-Stars Doctor carries out a wide range of services in field of health setting that should be met with several criteria. It’s all about the requirements of relevance, quality, cost-effectiveness, and equity in health. Care provider, decision-maker, communicator, community leader, and manager are the values of it. We have to believe that by applying those values, we can be a superdoctor with the best standards of services! References 1.

http://www.who.int/hrh/en/HRDJ_1_1_02,pdf

2. http://www.globalfamilydoctor.com/member/awards/WONCAfive-stardoctors.aspx 3. Boelen, C. Frontline doctors of tomorrow. World Health Organization, 1994, 47:4-5.

Optimizing Health Service Quality in Indonesia Anastasia Patty & Kezia Warokka Putri

Background This photo shows that the good professionalism of doctor and adequate health facilities can increase patient satisfaction with the doctor, so willing to do a routine control. Objectives Things that can be done to improve health services in Indonesia are modernizing the medical equipment, facilities, and equalize the doctor’s distribution. Modernization of medical equipment can be much easier with the government cooperation to reduce import duty and sales tax. The authors also suggested that the puskesmas should be optimally empowered to make treatment, by providing pediatrician and internist at each puskesmas, due to the high public demand for such specialists. Therefore, the Indonesian government is expected to help raising the national health budget that is still below 5%. Due to the huge number of Indonesian population, medical personnel who have not been evenly distributed and insufficient will greatly affect the health service, e.g. doctor-patient communication are becoming ineffective due to the lack of time because the number of doctors are limited, but so many patients. Its required doctor self-sacrifice and devotion to the country, also government assistance by improving infrastructure services in the village. Conclusion Qualified medical facility and competent medical personnel can increase treatment efficiency and improve Indonesian health.

Serve With Heart Khen Mikhael, Fenska Seipalla, Airlangga Sihotang

Abstract A Patient is not an object to be treated, but a teacher for every physician in this world. The ratio of physician in Indonesia in 2015 is about 1:2400, but good communication with patient must be improved to fulfill the needs of the patient. However, if we think about it, some doctors in Indonesia often only give superficial information about patients’ disease and treatment without a look at their background or social status or education. This issue has become one of medical problems because physician-patient communication can affect patients’ physiological health. Notably, empathy is a part of communication for the physician to understand patients’ concerns, perspectives which can bring more accurate diagnoses and treatment. They should listen to patient side and taking care of their mind and body at the same time. For some patients, knowing that there is empathy can strengthen them to not having mental breakdown when hear about their diagnosed result. This matter should be taken care of by physician to realize how important it is to serve a patient with heart. Just as only using their skills would not bring the best outcomes for patients.

Learning for the Best Future Health Care System in Indonesia Primadita Esther Rosita, Elvin Nuzulistina & Gilda Hartecia

Background of the photo As a future doctor, we must help improving the health care system in this country from now on. Even we're still students, doesn't mean  that there's nothing to do. We study from the very simple question to the most complex research journal. We dedicate our teenage life to sleep with our textbooks in order to be the one who stand between our patients and their graves one day, not just to pass the exams. Objectives of the photo Medical student is practicing to do medical skill with her friend's nose. Conclusion The future of Indonesia's health care system is on the hands of future doctor itself.

Are We There Yet? Dewinsya Medisujiannisa MS Idris

Photo details: Image size: 3024 Ă— 4032 pixelsLocation : Flyover Jl. Urip Sumoharjo , Makassar - Indonesia Consent: As attached

Objectives of the photo (Persero) now BPJS Employment (Employment social security governing body) is a public program that provides protection for the workforce to cope with the risks of certain economic and social organization of his use of the social insurance mechanism. To June 30, 2016, the number of participants was recorded as much Employment BPJS 19.6 million people or about 89.6 percent of the 2016 target membership. While the company's active membership has reached 97.8 percent from the target for 2016. BPJS Employment exposes the Innovation Community fund raising (crowdfunding) for vulnerable workers in the framework of social protection at the Conference of the International Social Security Association (ISSA) Panama, Colombia. Will the management of the health service is successfully resolve health issues in Indonesia? Are we there yet? References 1.

http://bisnis.liputan6.com/read/2569218/68-juta-orang-keluar-dari-kepesertaan-bpjs-tk

2. http://bisnis.liputan6.com/read/2656412/bos-bpjs-ketenagakerjaan-pamer-terobosanke-dunia 3. http://www.ey.com/Publication/vwLUAssets/ey-the-new-mandatory-health-insurancescheme/$FILE/ey-the-new-mandatory-health-insurance-scheme.pdf 4. http://www.bpjsketenagakerjaan.go.id/page/profil/Sejarah.html

Work with Heart I Putu Ardi Wiraprasidi, Arondino Darmawan, Fauziyyah Djaafara,

Background of the photo This photo was taken in Posyandu of Puskesmas Gogagoman, Kotamobagu, North Sulawesi. It may looks simple, but there are a lot of meanings and stories in this photo. The first thing is, people always enthusiastic to come Posyandu. In fact, they always remember the regular date and the regular schedule of the Posyandu. There’s a deep trust for the medical workers in Posyandu. Even the facilities in Posyandu looks very simple, but the quality of service healthcare still maintained very well. Through the photo, we can see how the medical worker running her duty. She already worked as medical worker for many years. She faced a lot of many obstacles and challenges. In her duty, she has to combine the passion of working in public health, solving the problem and keep on updating her knowledge. Objectives of the photo Through this photo, we would like to show you how important it is for being a medical workers for society. Conclusion Best quality comes from the heart. The best service quality of healthcare is start from the trust of the patient and the performance of the medical workers.




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