EVIDENCE BASED

NURSING CARE
Dr.dr.Akrom, M.Kes.
IMANI PROKAMI DIY
AHMAD DAHLAN DRUG INFORMATION
AND CRISSIS CENTER (ADDICT)

TUJUAN

EVIDENCE?
APAKAH EVIDENCE BASED PRACTICE?
MENGAPA EBP?
RESOURCES OF EVIDENCE, SEARCH OF
EVIDENCE DAN LEVEL OF EVIDENCE
BAGAIMANA LANGKAH-LANGKAH
MEMPRAKTEKKAN EB-NURSING CARE?
EBP NURSING IN PRACTICE; CHRONIC
PATIENTS; SEPSIS; HOSPITAL-ASSOCIATED
INFECTION; NOSOKOMIAL DAN RESISTENSI
ANTIBIOTIK

APAKAH HARAPANKU
SEBAGAI PERAWAT?

RUANGAN
RUANGAN
RUANGAN
RUANGAN

RAMAH PASIEN?
ZERO ERROR?
SAYANG IBU/PASIEN?
PELAYANAN PRIMA?

ASUHAN KEPERAWATAN

MANAJERIAL-ORGANISASI

PELAYANAN-KLINIS

Keputusan
klinis

Keputusan
manajerial
KEPUASAN PASIEN
KESELAMATAN PASIEN
KUALITAS HIDUP PASIEN

BAGAIMANA KITA BELAJAR

TENTANG NURSING?

Tradition
Authority
Borrowing
Trial and error
Personal experience
Role modeling and
mentorship
Intuition and reasoning
Nursing research

BAGAIMANA KITA MENGEMBANGKAN

KUALITAS DIRI DAN KUALITAS PELAYANAN
DALAM KEPERAWATAN SEKARANG?

Saya tiap hari minimal 1 jam membaca buku teks untuk

meningkatkan pengetahuan keperawatan (B/S)
Saya minimal 1x/bulan mengikuti kegiatan seminar atau workshop
untuk meningkatkan
kompetensi. (B/S)
Saya tiap hari minimal 1 jurnal ilmiah keperawatan saya baca
(B/S)
Saya selalu mengutamakan keselamatan dan kualitas hidup pasien
yang saya rawat (B/S)
Saya selalu berusaha meng-up date pengetahuan dan ketrampilan
keperawatan saya (B/S
Saya sudah berusaha untuk menerapkan evidence based-nursing
practice pada setiap Kegiatan profesional keperawatan (B/S)

APAKAH INI EVIDENCE?

MANAKAH
EVIDENCE?

www.bmj.com

www.nejm.org

A. Research Evidence

Randomized controlled trials

Laboratory experiments
Clinical trials
Epidemiological research
Outcomes research
Qualitative research
Expert practice knowledge,
inductive reasoning

B. Clinical Expertise
Knowledge gained
from practice over
time
Inductive reasoning

C. Patient Values,
Circumstances

Unique preferences
Concerns
Expectations
Financial resources
Social supports

APAKAH EBP?
EBP=evidence based
practice=praktek
profesi berbasis bukti
ilmiah adalah praktek
profesional dengan
mengintegrasikan
antara pengalaman
klinik/profesi, buktibukti ilmiah hasil
penelitian dengan
nilai-nilai spesifik
indifidual pasien

EBP is

Integration of best research evidence,

clinical expertise, and patient values in
making decisions about the care of
individual patients (Institute of Medicine, 2001).

Evidence-Based Practice
is knowing that what we
do is the best practice

Bagaimana EBM di negara

lain

EBP

MENGAPAKAH PRAKTIK
KEPERAWATAN HARUS EBP?
1. KLINIS-EFIKASI
2. KLINIS-SAFTY MENGHINDARI
RISIKO HARM/HAZARD
3. KLINIS-EKONOMI
4. ETIKOLEGAL-HUKUM: MALPRAKTIK
KESALAHAN MEDIKASI
5. KLINIS-PRAKTIS-TEAM WORK

Mengapa EBP penting ?

The 2003 report by the Institute of Medicine
(Health Professions Education: A Bridge to
Quality) recommends that all health care
professionals possess certain skills and
competencies in order to enhance patient
care quality and safety.
All health professionals should be educated to deliver
patient-centered care as members of an interdisciplinary
team, emphasizing evidence-based practice, quality
improvement approaches, and informatics.
(Institute of Medicine, 2003)

EBP meningkatkan kualitas pelayan

 Evidence-based practice (EBP) as one of

five core competencies all health
professionals should possess regardless
of their title or discipline (Institute of
Medicine, 2003) for crossing the quality
chasm.

Long life
learner

Enhance
Communication
skill

Managerial
skills: decision
maker & smart

SUMBER PUSTAKA
ILMIAH/EVIDENCE SERTA
ALAMATNYA

SUMBER EVIDENCE/PUSTAKA ILMIAH TERSEDIA

MELIMPAH DI INTERNET.
ADA YANG BEBAS AMBIL/GRATIS TAPI BANYAK
JUGA YANG BERBAYAR
ADA YANG BERUPA JURNAL TUNGGAL/KUMPULAN
JURNAL TETAPI BANYAK JUGA YANG BERUPA
PERPUSTAKAAN MAYA
CONTOH JURNAL TUNGGAL/KUMPULAN:
WWW.NEJM.ORG; WWW.BMJ.COM ;
WWW.BIOMED.ORG DLL
CONTOH PERPUSTAKAAN MAYA:
WWW.PUBMED.COM

APAKAH EVIDENCE ?
BAGAIMANAKAH LEVEL OF
EVIDENCE?

EVIDENCE=SCIENTIFIC EVIDENCE--INFORMASI/DATA HASIL DARI PENELITIAN

KLINIS --- DILAPORKAN DALAM BENTUK
PUBLIKASI ILMIAH ATAU JURNAL=PUSTAKA
ILMIAH
KEMAMPUAN PUSTAKA ILMIAH SEBAGAI
EVIDENCE BERVARIASI
PEMERINGKATAN EVIDENCE SESUAI DENGAN
VALIDITAS HASIL CRITICAL APPRAISAL/HASIL
KAJIAN KRITIS
EVIDENCE BERTINGKAT: 1-5/6/7
PERINGKAT I:REVIEW SISTEMATIK, RCT
MCS/SAMPEL BESAR DST

LE
VE
L
OF
EV
ID
E

NC
E

Level evidence sebagai dasar

penyusunan rekomendasi
The guidelines use the Grades of
Recommendation, Assessment,
development, and Evaluation (GRAdE)
system to establish the quality of evidence
from high (A) to very low (d) and to
determine the strength of recommendations
as strong (1) or weak (2).

TAHAPAN PROSES EBP

5 TAHAPAN:
1. Formulasi
permasalahan
2. Mengumpulkan
bukti ilmiah
3. Melakukan
critical
appraisal
4. Menerapkan
hasil kajian
5. evaluasi

TAHAP 1: FORMULASI
PERMASALAHAN
Diringkas dalam susunan yang disingkat
dengan PICO.
P=PROBLEM OR PASIEN
I=INTERVENTION
C=COMPARISON
O=OUTCOME
PICO berfungsi sebagai Pedoman
pencarian pustaka/literature/jurnal
sebagai evidence

CONTOH PENGGUNAAN PICO

In caring for disabled adults,

does the use of level-access
showers improve patient
hygiene more than bed
bathing???

P DISABLED ADULT CARING

I USE OF LEVEL-ACCESS SHOWER
C BED BATHING
O PATIENTS HYGIENE

TAHAP II: PENCARIAN

PUSTAKA/JURNAL SEBAGAI
EVIDENCE

Alamat jurnal tunggal: jurnal jurnal

ilmiah keperawatan dan klinik, contoh:
www.nejm.org; www.hindawi.com;
www.biomed.com; www.bmj.com;
Alamat perpustakaan:
www.pubmed.com
Alamat guide line: www.sign.gov;
www.nice.gov; www.clearinghouse.com

www.nejm.org

www.pubmed.gov

Contoh evidence ttg medication

Error dan model intervention

www.guideline.gov

TAHAP III:
ANALISIS KRITIS/KAJIAN JURNAL
TUJUAN:
1. MENENTUKAN VALIDITAS JURNAL
2. MENENTUKAN TINGKAT
KEPENTINGAN: LEVEL OF EVIDENCE
3. MENENTUKAN KEMANFAATAN DAN
PENERAPANNYA

PERTIMBANGAN DALAM
ANALISIS KRITIS
KENALI BENTUK JURNAL: PRIMER,
SEKUNDER, TERSIER
TENTUKAN VALIDITAS DAN LEVEL OF
EVIDENCE
JURNAL LEVEL I> JURNAL LEVEL II
DST

SYSTEMATIC REVIEW> RCT

TUNGGAL

JURNAL TUNGGAL

CLINICAL PRACTICE GUIDELINE:

TAHAP IV: APLIKASI

Menerapkan hasil kajian jurnal sebagai
evidence untuk penentuan tindakan atau
kebijakan.
BENTUK INTERVENSI ATAU TINDAKAN
YANG DISAJIKAN DALAM JURNAL ATAU CPG
DENGAN EVIDENCE TERTINGGI DAN
SESUAI DENGAN KONDISI TEMPAT KERJA
DIPILIH UNTUK DITERAPKAN.
Susun sebagai SOP
PELATIHAN SOP
APLIKASI, MONITORING DAN PROBLEM
SOLVING pada unit yang paling sesuai
dengan karakteristik sampel di jurnal

TAHAP V:
EVALUASI DAN TINDAK LANJUT
Tujuan: menentukan efektifitas dengan
melakukan penilaian antara output yang
dihasilkan dengan target yang telah
ditetapkan.
1. hasil sesuai dengan tujuan dan target
yang telah ditetapkan maka dilanjutkan
dan diperluas
2. Hasil belum sesuai dengan tujuan dan
target --- perlu pengkajian lebih lanjut dan
apabila diperlukan ----searching evidence
terbaru

PENINGKATAN
KUALITAS DIRI
MANAJERIALORGANISAS

PENINGKATAN KUALITAS
PELAYANAN

Patients
safety
Pencegahan
Kesalahan medikasi

PENGEMBANGAN
STAF

PPI
Peningkatan Kualitas pelayanan &
Keberhasilan terapi

TAHAPAN

PANDUAN

CONTOH

Formulasi
permasalahan

Lakukan penilaian
praktik lama, apa yg
belum berjalan dan
apa harapan.
Formulasikan hasil
kajian dalam PICO

Selama ini pasien rawat inap dilap

dengan air dan sabun untuk mandi,
apakah penggunaan antiseptik
dapat menurunkan kejadian infeksi
terkait perawatan di RS?.
P=infeksi-terkait yankes RS,
I/C=antiseptik v.s. usual,
O=insidensi infeksi terkait yankes
RS turun

Searching
evidence

Cari evidence dengan

menggunakan kata
kunci dari PICO, dapat
jurnal sesuai lakukan
kajian kritis

www.nejm.org. dapat jurnal dengan

judul:

Rencanakan
perubahan

Susun perencanaan
untuk melakukan
perubahan:
sosialisasi, pelatihan
dan kebijakan-SOPprotokol

Dipilih pasien ruang isolasi atau

ruang infeksi ok insidensi mdr
paling banyak dst

Implentasikan

Implementasi
protokol- penetapan

Lakukan protokol. Monitor kondisi

selama pelaksanaan program

Daftar error event

EBP-PATIENTS SAFETY
Apakah jenis interfensi untuk
menurunkan kesalahan (error) dalam
operasi? P=SURGERY
TAHAP 1

TAHAP 2

I= TIME OUT PROSEDURE

C=PLASEBO
O=ERROR OPERATION

Alamat searching:
-www.pubmed.com
-www.nejm.org

 Surgical checklist application and its impact

on patient safety in pediatric surgery
Background: Surgical care is an essential component of health care of children worldwide. Incidences of
congenital anomalies, trauma, cancers and acquired diseases continue to rise and along
with that the impact of surgical intervention on public health system also increases. It then becomes
essential that the surgical teams make the procedures safe and error proof. The World Health
Organization (WHO) has instituted the surgical checklist as a global initiative to improve
surgical safety. Aims: To assess the acceptance, application and adherence to the WHO Safe Surgery
Checklist in Pediatric Surgery Practice at a university teaching hospital. Materials and Methods:
In a prospective study, spanning 2 years, the checklist was implemented for all patients who underwent
operative procedures under general anesthesia. The checklist identified three phases of an operation,
each corresponding to a specific period in the normal flow of work: Before the induction of anesthesia
("sign in"), before the skin incision ("time out") and before the patient leaves the
operating room ("sign out"). In each phase, an anesthesiologist ,-"checklist coordinator," confirmed that
the anesthesia, surgery and nursing teams have completed the listed tasks before proceeding with the
operation and exit. The checklist was used for 3000 consecutive patients. Results:
No major perioperative errors were noted. In 54 (1.8%) patients, children had the same names and
identical surgical procedure posted on the same operation list. The patient identification tag was missing
in four (0.1%) patients. Mention of the side of procedures was missing in 108 (3.6%) cases. In 0.1% (3)
of patients there was mix up of the mention of side of operation in the case papers and consent forms. In
78 (2.6%) patients, the consent form was not signed by parents/guardians or the side of the
procedure was not quoted. Antibiotic orders were missing in five (0.2%) patients. In 12 (0.4%) cases,
immobilization of the patients was suboptimal, which led to displacement of diathermy grounding pad. In
54 (1.8%) patients, the checklist was not used at all. In 76 (2.5%) patients the checklist was found to be
incompletely filled. Conclusions: Our study supports the use of the checklist as an essential safety tool
and reinforcement of the same. T he checklist may act as a valuable prompt to focus the team, to ensure
that even the simple things have been cared for

MEDICATION ERROR AND

EBP
Medication error: kesalahan medikasi
Jenis kejadian ME berdasarkan proses:
1. prescribing
2. dispensing
3. distribution
4. drug administraton & administration

What is a Medication Error

"A medication error 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 labeling,
packaging, and nomenclature; compounding; dispensing;
distribution; administration; education; monitoring; and
use."
- National Coordinating Council for Medication Error
Reporting and Prevention

Tulisan
Sulit di baca

Kesalahan
Administrasi
obat

Kesalahan
etiket

Patient Safety and Medical Errors

Become a National Concern

November 29, 1999

57

58

IOM Report: Preventing Medication

Errors
One medication error per day per
inpatient
Variation across institutions

At least 25% of injuries from medications

are preventable
Annual preventable injuries from
medications
380,000-450,000 in hospitals for $3.5 billion
800,000 in long-term care
530,000 in Medicare ambulatory patients for
$887 million
59

Preventing Medication Errors:

Recommendations
Patients rights and enhancing consumer
information
Utilizing HIT
Prescribing and transmission of all
prescriptions electronically by 2010
Appropriate clinical decision support
Adopt other appropriate technology
(eMAR, bar coding, smart iv pumps)
Monitor for medication errors
Standards for HIT
More research
60
Pediatrics a prime focus area

Overview
Why medication errors occur in children
Pediatric medication error epidemiology
Inpatient
Outpatient
Prevention strategies
HIT
Safety and quality
Financial
61

Why medication errors occur

in children

Weight based dosing

Stock medicine dilution
Ten fold errors
Decreased communication abilities
Inability to self-administer medications
Increased vulnerability of young,
critically ill children
Immature renal and hepatic systems
62

Comparisons of Adult and Pediatric

Inpatients
Pediatrics

Adults**

Orders reviewed
10,778
10,070
Medication errors
616 (5.7%)
530
(5.3%)
Near Misses
115 (1.1%)
35 (0.35%)
*
ADEs
26 (0.24%)
25 (0.25%)
Preventable ADEs
5 (0.05%)
5
(0.05%)
*p value <0.05
Kaushal et al, JAMA 2001
**Study performed at Brigham and Womens Hospital in 1992 using
63
similar methods

Error Stage for Medication

Errors

64

Near Misses in the NICU per 100

orders

*
*
*

JAMA 2001;285;2114-20

* P<0.001

65

Ambulatory Setting:
Medication Errors
2952 medication
errors
1.6 errors per
patient
1.3 errors per
prescription
521 (12%) rx
inappropriate
abbreviation
1389 (64%) rx
partially illegible
66

Preliminary Results For Six Office Practices

Rate

95% CI

3%

57

3-4

Non-preventable ADEs 13%

226

11-15

Ameliorable ADEs

9%

152

7-10

Non-intercepted Near
Misses

25%

455

22-29

Preventable ADEs

67

Stages
Preventable ADEs

Near Misses

68

Why Do Errors Occur?

Physician writes an order
Nursing, pharmacist, and clerical staff
mechanisms are in place to carry out
orders
What occurs in reality?

69

We deliver medications in hospitals in a

manner that essentially hasnt changed in 60
years.
physician writes order

pharmacist checks
order/allergies

nurse checks patient,

drug, dose, route, time

secretary transcribes

pharmacist checks
drug interactions

nurse administers
drug

nurse double checks

pharmacy tech loads

drawer

Is a double check
necessary?

secretary faxes

pharmacy tech places

drawer in delivery system

Is drug administered
via pump

pharmacist receives
fax

nurse obtains drug

from delivery system

pharmacist enter
order

nurse checks drug

against med sheets

If order incorrect:
multiple other steps
70

We deliver medications in hospitals in a

manner that essentially hasnt changed in
60 years.
pharmacist checks
nurse checks patient,
C
order/allergies
ons
drug, dose, route, time
of t ider:
hes
W pharmacist checks
nurse administers
secretary transcribes
e s hatdrug
drug
s thinteractions
tep
see
5% techrloads
ror
Is a double check
pharm.
,drawer
nurse double checks
r
1%
, 0. ate in necessary?
1%
ea c
,
pharm. tech places
Is
drug
administered
ho
0 .0
secretary faxes
ne
1
drawer in meditrol
%via pump

physician writes order

pharmacist receives
fax

nurse obtains drug

from meditrol

pharmacist enter
order

nurse checks drug

against med sheets

If order incorrect:
multiple other steps
71

ISMPs ten key elements of the

medication-use system

Patient information: Failure to obtain the patients pertinent demographic

(age, weight) and clinical (allergies, lab results) information
Drug information: Failure to provide accurate and usable drug information
Communication of drug information: Miscommunication between MD,
R.Ph. and RN
Drug labeling, packaging and nomenclature: Drug names that lookalike or sound-alike, as well as products that have confusing drug labeling
and non-distinct drug packaging
Drug storage, stock, standardization, and distribution: Lack of
Standard drug administration times, drug concentrations
Drug device acquisition, use and monitoring: Lack of safety
assessment of drug delivery devices and/or a system of independent
double-checks
Environmental factors: Environmental factors that often contribute to
medications errors include poor lighting, noise, interruptions and a
significant workload.
Staff competency and education: Staff education should focus on
priority topics, such as: new medications being used in the hospital, highalert medications, medication errors that have occurred both internally and
externally, protocols, policies and procedures related to medication use.
Patient education: Patients must receive ongoing education
Quality processes and risk management: The way to prevent errors is
to redesign the systems and processes that lead to errors rather than focus
on correcting the individuals who make errors.

MENUJU PERBAIKAN
Apakah rencana Saudara untuk
mengurangi kejadian kesalahan medikasi
di tempat Saudara kerja?
Berdasarkan evidence yang ada silakan
susun EBP guideline sekecil apapun
untuk pengurangan kejadian medication
error di tempat Saudara

IPCN

IPCLN

IPCO

MENURUNKAN/CEGAH

Surgical
Site infection
(INFEKSI
LUKA OPERASI=
ILO)

IInfeksi Aliran Darah

MDRPrimer
(BSI / Bloodstream Infection)

Ventilator
Associated
Pneumonia

HAI PREVALENCE

KASUS:
Kejadian HAI masih tinggi. Sebagai kepala
ruang Saudara bermaksud menurunkan kejadian HAI di RS Saudara.
Salah satu masukan tentang bentuk interfensi untuk menurunkan kejad
di ruangan adalah dengan membersihkan/ memandikan pasien dengan
Antiseptik. Sebelum masukan tersebut dilaksanakan bermaksud menca
Tingkat keberhasilan penggunaan antiseptik dalam menurunkan kejadi
Bagaimana langkah Saudara untuk mendapatkan evidence tsb?

Bagaimana langkah
Saudara untuk
menerapkan EBP
dalam menurunkan
HAI di RS Saudara?

New evidence

Efektif menurunkan kejadian HAI.

SSI-ILO
ILO (Infeksi Luka Operasi)
sangat berbahaya
Perlu diwaspadai dan dicegah
Caranya??
Antibiotik
profilaksis

NON FARMAKOLOGIS

SSI (ILO)

Bagaimana new atau current evidence?

Bagaimana menerapkan EBP?

TAHAPAN

PANDUAN

CONTOH

Formulasi
permasalahan

Lakukan penilaian
praktik lama, apa yg
belum berjalan dan
apa harapan.
Formulasikan hasil
kajian dalam PICO

Selama ini pasien sebelum operasi

dibersihkan/dimandikan sebelum
operasi apakah menggunakan
sabun, antiseptik, ataukah tanpa
dibersihkan yang efektif
menurunkan kejadian ILO?.
P=ILO, I/C=antiseptik/soap/plasebo,
O=insidensi ILO turun

Searching
evidence

Cari evidence dengan

menggunakan kata
kunci dari PICO, dapat
jurnal sesuai lakukan
kajian kritis

www.nejm.org. atau
www.guideline.gov; www.nice.org;
www.sign.com; www.pubmed.com.

Rencanakan
perubahan

Susun perencanaan
untuk melakukan
perubahan:
sosialisasi, pelatihan
dan kebijakan-SOPprotokol SSI

Susun SOP-protokol penanganan

SSI yang evidence based.
Susun kebijakan dan rencanakan
teamwork, scheduling dan metode
pelatihan SOP baru

Implentasikan

Implementasi
protokol- penetapan
kondisi mula-dan

Laksanakan SOP
Lakukan monitoring dan kontrol
pelaksanaannya dengan baik.

SURGICAL SITE INFECTION

NGC-USA

FIRST EDITION=2008

APA YANG BARU

BAGAIMANA NEW EVIDENCE PREOPERATIVE

SHOWERING?

BAGAIMANA NEW EVIDENCE

sabun biasa, antiseptik atau tidak
dibersihkan?

Mandi pakai sabun atau pakai antiseptik

Pada hari akan operasi maupun sebelumny
Tidak terbukti menurunkan SSI

Antibiotik Profilaksis
antibiotik yang diberikan pada penderita
yang menjalani pembedahan sebelum
adanya infeksi, yang tujuannya ialah
untuk mencegah terjadinya infeksi
akibat tindakan pembedahan
- Antibiotik profilaksis juga diberikan
untuk memperlama fase Golden Period
yaitu fase pertahanan tubuh terhadap
infeksi.

Tujuan terapi
Antibiotik Profilaksis
Mereduksi timbulnya infeksi yang terjadi pada pembedahan
Penggunaan antibiotik sebagai pendukung penanganan
kejadian yang efektif
Meminimalkan efek antibiotik pada flora normal bakteri
pasien
Meminimalkan efek samping
Menurunkan mortalitas dan morbiditas pasca operasi
Mengurangi lama waktu pasien harus menjalani rawat inap
pasca operasi
Meminimalkan perubahan-perubahan pada pasien yang
terkait dengan sistem pertahanan tubuh

Algoritma Terapi Antibiotik

Profilaksis Pembedahan

TERAPI
Terapi non-farmakologi
-

menjaga suhu tubuh (normothermia)

pemberian oksigen tambahan selama operasi
mengontrol kadar glukosa selama operasi
Melakukan tindakan pencegahan seperti :
menghilangkan rambut pada bagian tubuh
yang akan dibedah, perawatan luka pasca
bedah dan menggunakan perlengkapan
bedah dan ruangan bedah yang steril

 Terapi Farmakologi
Dengan Anbibiotik Profilaksis
Prinsip penggunaan antibiotik profilaksis :
- Tepat indikasi
Untuk bedah bersih kontaminasi, bersih yang memasang
bahan prostesis, operasi bersih yang jika sampai terjadi
infeksi akan menimbulkan dampak yang serius seperti
operasi bedah syaraf, bedah jantung, dan mata.
- Tepat obat
Dengan mempertimbangkan spektrum antibiotik dan
potensi bakteri.
- Tepat dosis
Untuk tujuan profilaksis diperlukan antibiotika dosis
tinggi, agar didalam sirkulasi dan didalam jaringan tubuh
dicapai kadar diatas MIC. Dosis yang kurang adekuat,
tidak hanya tidak mampu menghambat pertumbuhan
bakteri, tetapi justru merangsang terjadinya resistensi
bakteri

- Tepat rute pemberian

Agar antibiotik dapat segera didistribusikan ke jaringan
maka pemberiannya dilakukan secara intravena
- Tepat waktu pemberian

Pemberian antibiotik umumnya 30-60 menit sebelum

pembedahan
Waktu pemberian
Pemberian dini (early), 2 24 jam sebelum
operasi

Angka kejadian
infeksi (%)
3,8

Pre-operative, 0 2 jam sebelum operasi

0,6
Peri-operative, 0 3 setelah operasi
Poat-operative, 3 24 jam setelah operasi

1,4

(Classen
DC, 1992)
3,3

- Tepat lama pemberian

Mempertimbangkan proses pembedahan, jika lama
dapat diberikan dosis tambahan dapat diberikan setiap
2 jam untuk sefoksitin atau setiap 4 jam untuk sefazolin

Contoh penggunaan antibiotik profilaksis

Jenis pembedahan

Kuman patogen

Antibiotik pilihan

Pemasangan prostese katub jantung

Pemasangan prostese sendi

Staphylococci

Sefalotin
iv
Sefazolin iv

Instrumentasi traktus urinarius bawah

Bakteri enterik Gram negatif Gentamisin iv

Bedah kolorektal

Bakteri enterik Gram negatif Metronidazol iv +

Enterococci anaerob
Sefalotin iv /
Sefazolin iv /
Gentamisisn iv

Bedah traktus respiratorius atas

Aerobik dan mikroaerofilik

Stertococcus, anaerob

Sefalotin iv/
Sefazolin iv

POLA KUMAN ICU RSU DR

KARYADI

POLA SEBARAN KUMAN DI RS

FATMAWATI JAKARTA

POLA RESISTENSI KUMAN DI RS

FATMAWATI (2001-2002)

KESIMPULAN
Perawat memegang peran vital di RS dalam
PPI
Penguasaan prinsip EBP sangat diperlukan
oleh perawat.
Penanganan PPI dengan prinsip EBP lebih
menjamin kualitas outcome

SEPSIS
At least 2 sets of blood samples
(aerobic and anaerobic) should be
Prognosis should be discussed with
cultured
patients and their families within 72
before antibiotic therapy is started.
hours of admission to the intensive
Crystalloids should be the initial
care unit.
choice in resuscitation of patients
with severe sepsis and septic shock
Nurse-directed weaning off of
mechanical ventilation is effective
in reducing duration of mechanical
ventilation.
Insulin dosing should begin when 2
consecutive blood glucose levels
exceed 180 mg/dL.
Low-dose feeding in the first week
(up to 500 kcal per day) is suggested