UPAYA MENCEGAH MALPRAKTEK DALAM BIDANG FETOMATERNAL

Judi Januadi Endjun

Sanny Santana Novi Resistantie Febriansyah Darus

Divisi Fetomaternal Departemen Obstetri dan Ginekologi RSPAD Gatot Soebroto Jakarta 2005

AGENDA BAHASAN
PENDAHULUAN REDUCING LITIGATION RISKS IN O&G STANDAR PROFESI MATERI AJAR JENJANG PENDIDIKAN LANJUTAN KESIMPULAN

JJE/RSPAD/2005

PENDAHULUAN

Krisis ekonomi multidimensi, terutama akhlak, keimanan, kejujuran Pendidikan ?? Tuhan menyuruh kita JUJUR, Tuhan yang memberi kita rejeki, mengapa kita harus tidak JUJUR Bekerja secara TIM (kesetaraan) Masalah medikolegal terbanyak : OBGIN
JJE/RSPAD/2005

PENDAHULUAN

O&G by the nature of their work are more often than most practitioners in other fields, liable to face litigation in respect of mal-practice Cases are highlighted in the press and sometimes on TV The general public has grown to expect high standards and expectations of their specialists

PENDAHULUAN

Health and safety the mother and child Child birth is the period of time when accidents both avoidable and unavoidable tend to happen The most hazardous journey anyone ever makes in ones life is the passage through the 10 cm of the birth canal

REDUCING LITIGATION RISKS IN O&G

Medical Protection Society (MPS) Clinical Guidelines Communication Medical Records Medical Problems Avoiding litigation in O&G

Dermot Mac Donald,2005

Medical Protection Society

Medico-Legal Claims in O&G The Medical Defense Union The Institute of O&G The College of O&G Society (ISOG, etc) Medical Faculty The Lawyer

Dermot Mac Donald,2005

Clinical Guidelines

Systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions Practice of good medicine

Avoid medico-legal challenge

Dermot Mac Donald,2005

Epidemic of legal challenge facing the practitioner of O&G in day to day practice

Defensive medicine has become the norm

Dermot Mac Donald,2005

Communication

The teaching and learning of communication skills have become a significant part of the medical undergraduate curriculum The patient who eventually makes the decision in regard to their management may lighten the doctors responsibility Lack of informed consent is a constant plea by Plaintiffs The amount of detail to give the patient about possible risks and complications is always a difficult decision
Dermot Mac Donald,2005

Communication

In the event of serious complication or mishap :

The consultant in charge should speak to the patient and / or family as soon as possible

The patient should be given a factual account in simple language together with an apology if indicated
Saying sorry does not constitute an admission of legal liability The doctor should over-elaborate on the event nor give an over-optimistic prognosis
The MDU, 1991

Communication
It is most important not to apportion blame at least not until a thorough investigation of all the relevant facts has taken place The patient and family should be given time to consider what happened and the consultant should offer to meet them a second time Case conference with all involved the patient and relatives do not hear inaccurate or different accounts from various members of staff
The MDU, 1991

Medical Records
Partograms are recommended, and careful maternal and fetal records should be entered on these. Legibility and Signing Timing Alteration Detail Storage

Dermot Mac Donald,2005

Legibility and Signing

The notes should be legible, clearly dated and timed with a identifiable signature A stamp of the doctors name beside the signature may diminish problems of identification years later as the defence is prepared

Timing

Very important to write the exact time of the event (CS, forceps, delivery, etc) and
Also the time at which the notes are actually written. For instance : 14.00 Fetal bradycardia of 80 bpm; 14.05 Decision to perform CS.; 14.50 C.S commenced. 14.55 Baby delivered. 15.20 Clinical notes written and completed after 20 minutes Accompanied by an exact note of the detail. Such as FHR 180, 170 to 180

The notes should indicate some explanation for the delay and documented

Timing

EFM records : comments should be written (and signed) on actual trace : interpretations, decision, plans, etc should be explicitly written when fetal heart trace (or IA) suggests abnormality

Alteration

Notes must not be altered.

If alteration are necessary, such alteration must be made by drawing a single line through the original (so that it can still be read.

The time, date etc and reason for making the alteration clearly stated and again, clearly signed

Detail

The more explicit the information recorded, the more helpful it will be in defence.
Failure to progress by actual detail of cervix 5 cms dilated with no progress for 3 hours despite oxytocin and membrane rupture Doctors are trained to help patients and treat their ailments. Writing notes and keeping records of the treatments may become more important than the actual treatments

Storage

All records must be carefully stored last they are required in consultation in future years The EFM should be carefully stored in the patients record file

Medical Problems

Intra partum fetal hypoxia : cerebral palsy Trauma fetal Trauma maternal Retained swabs Perineal tears & Episiotomies Complications of CS Vaginal repair

Retained placental tissue Rhesus disease Incompetent cervix/cervical cerclage Abdominal hysterectomy Ureteric & Bladder injury Bowel injury Retention of foreign body Diathermy burns, etc

STANDAR PROFESI

Kumpulan standar yang ditetapkan oleh organisasi profesi, yang bersifat mengikat pada anggotanya, terdiri dari standar kompetensi, standar etika, dan standar pelayanan medis Standar bersifat dinamis
Draft Standar Profesi POGI,2005

STANDAR ETIKA

Sesuai dengan Pedoman Etik O&G dan KODEKI Altruisme : kepentingan klien diutamakan Integritas : berilmu & profesional Menjunjung tinggi harkat & martabat profesi Kesejawatan : sumpah dokter & profesional Akuntabilitas : dapat dipertanggungjawabkan Memberikan pelayanan terbaik Siap sedia menjalankan profesinya Mampu berkomunikasi secara profesional dengan prinsip saling asah, asih, dan asuh Kepemimpinan yang baik dan profesional
Draft Standar Profesi POGI, 2005

STANDAR KOMPETENSI

Pencapaian kompetensi minimal Harus terus dikembangkan (Continuing Professional Development) dan Continuing Medical Education

Panduan Pendidikan Dokter Indonesia

JJE/RSPAD/2005

STANDAR PELAYANAN MEDIK

SOP
SPM Tempat Praktek

Catatan Medik dibuat berdasarkan CMBM : evaluasi lanjutan memakai sistim SOAP
JJE/RSPAD/2005

MATERI RUJUKAN

ABOG, RCOG, ACOG, etc : Guidelines Clinical Conference Scientific meeting, Courses, etc Textbooks : Fetal-medicine, Ultrasound, Neonatology, Genetics, etc Journals : Placenta, White Journals (ISUOG), etc
JJE/RSPAD/2005

JENJANG PENDIDIKAN LANJUTAN

Spesialisasi (Klinikus)
Pendidik (S1 S2 S3 Guru Besar) Non Medis Tidak berpraktek
JJE/RSPAD/2005

AVOIDING LITIGATION IN O&G

1. 2. 3. 4. 5. 6.

Ensure the competency of your support staff Admit if you are wrong Keep a rein on your lawyers Release medical reports and record promptly Generally to avoid litigation General advice
R.K. Nathan, 2005

Generally to avoid litigation

Listen carefully to the patients complaints Examine the patient Explain her problems and the treatment you would recommend Record all of the above Recommend to a specialist whenever you think it necessary Update your knowledge of medicine

Give due concern to slow progress of labour or failure of the fetal head to descend Avoid allowing inexperienced or unqualified staff to be in attendance & the failure of the specialist to attend Ensure an adequately equipped delivery room Keep the patient briefed of her progress

KESIMPULAN

Krisis multidimensi berdampak buruk terhadap dunia pendidikan (kualitas luaran anak didik), penelitian, dan pelayanan kesehatan Kejujuran, Kemauan memperbaiki diri, Komunikasi, dan Kesejawatan merupakan pilar dasar yang harus tetap dijaga

Apa yang dapat kita berikan agar pendidikan, penelitian, dan pelayanan dokter di Indonesia tidak semakin terpuruk ??
JJE/RSPAD/2005

THANK YOU