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Patient Safety Sar2
Patient Safety Sar2
06 Januari 2016
SOP OPERAN PASIEN DARI IGD DAN POLI KE RUANG INAP VIA
TELEPON
"PUNTEN .."
UTARAKAN TUJUAN "MAU MENGIRIMKAN PASIEN BARU UNTUK DI RUANG (NAMA RUANGAN) "
MENELEPON
2 ISI
JELASKAN IDENTITAS " TN./NY./AN. (NAMA) USIA
PASIEN
"PUNTEN .."
UTARAKAN TUJUAN "MAU MENGIRIMKAN PASIEN BARU UNTUK DI RUANG (NAMA RUANGAN) "
MENELEPON
2 ISI
JELASKAN IDENTITAS " TN./NY./AN. (NAMA) USIA
PASIEN
ASESSMENT DIAGNOSA
DIAGNOSA BANDING
SALAM "WASSALAAMUALAIKUM.."
"SELAMAT PAGI/SIANG/MALAM.."
STEP BY STEP
MELAPORKAN HASIL LAB PASIEN RUANGAN KEPADA DOKTER KONSULEN
VIA TELEPON
No JENIS LANGKAH URAIAN
1 PROLOG
SALAM "ASSALAAMUALAIKUM..DOKTER"
"ASSALAAMUALAIKUM.."
"SELAMAT PAGI/SIANG/MALAM DOKTER.."
UTARAKAN TUJUAN "MAU MELAPORKAN HASIL LAB PASIEN DI RUANG (NAMA RUANG)"
MENELEPON
2 ISI
JELASKAN IDENTITAS " TN./NY./AN. (NAMA) USIA
PASIEN
SALAM "WASSALAAMUALAIKUM.."
"SELAMAT PAGI/SIANG/MALAM.."
SOP TATALAKSANA MENANGANI HASIL LABORATORIUM YANG
TERMASUK KATEGORI KRITIS / CRITICAL VALUES
06 Januari 2016
Chemistry
Test Value Comments
Bicarbonate (Total CO2) <10 or >40 mmol/L
Bilirubin, Total >15 mg/dL
Calcium, Ionized <0.78 or >1.58 mmol/L
Calcium, Total <6.0 or >13.0 mg/dL
Glucose <40 or >450 mg/dL
Iron >500 ug/dL
Glucose, WB POC <60 or >450 mg/dL
Glucose, WB, neonatal POC <40 or >200 mg/dL
Magnesium <1.0 or >9.0 mg/dL
Phosphorus <1.0 or >9.0 mg/dL
Potassium / Kalium <3.0 or >6.1 mmol/L
Sodium / Natrium <120 or >160 mmol/L
Coagulation
Test Value Comments
When ordered as part of a panel
Prothrombin Time >44.7 seconds other criteria apply.
INR ?5.0
When ordered as part of a panel
PTT >85 seconds other criteria apply.
Fibrinogen <100 mg/dL
When ordered as part of a panel
Factors 2, 5, 8, 9, 11 ≤ 5%
other criteria apply.
Factor 7 ≤ 6%
Factor 10 ≤ 7%
Factor 13, Activity ≤ 5%
Infectious Disease
Test Value Comments
Detection of any infectious By:
agent:
Blood Positive Culture , Smear or Rapid AFB, bacterial, fungal, parasitic
Antigen
Bone Marrow Positive Culture or Smear AFB, bacterial, fungal, viral,
parasitic
Infectious Disease
Test Value Comments
Body Fluid Positive Culture or Smear AFB, bacterial, fungal, viral,
(Except gastrointestinal fluid or parasitic
urine sources)
CSF or other Central Nervous Positive Culture, Smear, or AFB, bacterial, fungal, viral
System specimen Antigen detection (except Enterovirus), parasitic
CSF or other Central Nervous Nucleic Acid Testing (NAT) All pathogens except Enterovirus,
System specimen EBV, HIV, JC virus, and
Parvovirus.
Eye / Ocular Positive Culture, Smear, or NAT AFB, bacterial, fungal, viral,
parasitic
Tissue Positive Culture or Smear AFB, bacterial, fungal, viral,
parasitic
Detection of specific By In
infectious agent
Mycobacterium sp., Acid Fast Positive stain, culture, NAT,
Bacillus (AFB) (M. and/or resistance to primary
tuberculosis) antituberculosis agents
Zygomycete Positive Culture Nasal, Sinus
Select Agents and other highly Positive Culture and/or positive
pathogenic organisms (Bacillus probe for C. immitis
anthracis, Brucellaspp.,
Burkholderia mallei,
Burkholderia pseudomallei,
Coccidiodes immitis,
Francisella tularensis, Yersinia
pestis, and C. diphtheriae,
Salmonella typhi, Vibrio
cholera)
5- fluorocytosine 100 µg/mL
Toxicology
Test Value Comments
Acetone >100 mg/dL
>150 g/mL @ 4 hours post ingestion
Acetaminophen @12 hours post ingestion
>40 g/mL
Amiodarone >3 g/mL
>30 g/mL Peak - draw 30 min post infusion.
Amikacin Trough - draw 30 min before
>8 g/mL infusion
Toxicology
Test Value Comments
Amitriptyline+Nortriptyline >500 ng/mL
Bupropion >400 ng/mL
Caffeine (Neonate) >40 g/mL
Carbamazepine Epoxide >15 g/mL
Carbamazepine, Total >20 g/mL Trough
Carbamazepine, Free >3.8 g/mL
Choramphenicol >25 g/mL
Chlorpromazine (12 and older) >750 ng/mL
Chlorpromazine (0-12 years) >200 ng/mL
Clomipramine+Norclomipramine >900 ng/mL
Clozapine >2000 ng/mL
Cyanide >100 g/mL
Desipramine >500 ng/mL
Cyclosporine A >700 ng/mL
Digitoxin >35 ng/mL
Trough - draw 8-12 hr. post dose.
Digoxin >2.4 ng/mL
Minimum post dose 6 hours
Disopyramide >7 g/mL
Doxepin+Nordoxepin >500 ng/mL
Ethanol >250 mg/dL
Ethosuximide >150 µg/mL
Ethylene Glycol >20 mg/dL
Everolimus >15 ng/mL
Felbamate >200 g/mL
>12 g/mL Peak - draw 30 min. post infusion.
Gentamicin Trough - draw 30 min. before
>2 g/mL infusion.
Flecainide >1.5 g/mL
Imipramine+Desipramine >500 ng/mL
Isopropanol >50 mg/dL
Methanol >20 mg/dL
> 30 min. post IV dose after
Lidocaine >9 g/mL steady state (5-10 hours)
Lithium 1.6 mmol/L Trough
Toxicology
Test Value Comments
Mexiletine >2 g/mL
Mycophenolic Acid (MPA) >25 g/mL
Nortriptyline >500 ng/mL
Pentobarbital >10 g/mL
Phenytoin, Total >30 g/mL Trough, 3 months – adult
>14 g/mL Trough, 0 - 3 months
>50 g/mL Trough, 3 months – adult
Phenobarbital
>40 g/mL Trough, 0 -3 months
Phenytoin, Free >3.0 g/mL
Primidone > 15 g/mL
Propafenone >2 g/mL
Protriptyline >400 ng/mL
Hematology
Test Value Comments
Hematocrit 21% or 65%
Hemoglobin ≤7 or >21.0 g/dL
Platelet Count 20 or 1000 x 103/µL
White Blood Cell Count 2.0 or 40 x 103/µL
Immunology
Test Alert Value
California Encephalitis Antibody, IgM, serum > 1:16
California Encephalitis Antibody, IgM, CSF > 1:1
Coxiella burnetii Antibody, IgM, CSF > 1:128
Dengue Fever Virus Antibody, IgM > 2.85 IV
Eastern Equine Encephalitis Antibody, IgM, serum > 1:16
Eastern Equine Encephalitis Antibody, IgM, CSF > 1:1
Ehrlichia chaffeensis Antibody, IgG > 1:256
Ehrlichia chaffeensis Antibody, IgM > 1:6
Glomerular Basement Membrane Ab, IgG by Multiplex Bead
> 26 AU/mL
Assay
Hepatitis A Virus Antibody, IgM Positive
< 200 mg/dL 0-1 months
< 150 mg/dL 2-5 months
Immunoglobulin IgG < 200 mg/dL 6-11 months
< 250 mg/dL > 1 year
Measles (Rubeola) Antibody, IgM, serum or CSF > 1.21 AU
Mumps Virus Antibody, IgM serum or CSF > 1.21 IV
Rickettsia rickettsia Antibody, IgM > 1:64
St. Louis Encephalitis Antibody, IgM, serum > 1:16
St. Louis Encephalitis Antibody, IgM, CSF > 1:1
Western Equine Encephalitis Antibody, IgM, serum > 1:16
Western Equine Encephalitis Antibody, IgM, CSF > 1:1
West Nile Virus Antibody, IgM, serum or CSF > 1.11 IV
Infectious Disease
Detection of specific infectious agent By In
Antimicrobial Resistance markers of: Primary cultures
• KPC Susceptibility test methods (Not referred
• Vanco I or R in S. aureus isolates)
Positive Stain, Culture or Nucleic
Bordetella pertussis
Acid Test
E. coli O157 or Shiga Like Toxin Positive culture (Preliminary) or
producing Enzyme Immunoassay
Legionella (all species) Positive Culture
Positive Stain, Antigen detection or
Legionella pneumophila
Nucleic Acid Test
Measles Positive Culture
Mumps Positive Culture
Infectious Disease
Detection of specific infectious agent By In
Polio Positive Culture
Positive Stain or Nucleic Acid Test
Pneumocysitis
Streptococcus, Group A Positive culture
Positive Culture or Nucleic Acid Neonate < 3 months
Ureaplasma or Mycoplasma hominis
Test of age
Virus Detection – other sources except Neonate < 3 months
Positive Culture or Smear
urine of age
Respiratory Viruses (influenza, Local clients only
Positive Culture, Smear, or Nucleic
parainfluenza, adenovirus, RSV, (BMT UUHCS
HMPV) Acid Test In patients only)
SOP TENTANG KONDISI PASIEN KATEGORI KRITIS
/ CRITICAL CONDITION
06 Januari 2016
Pemeriksaan GCS
Eye (respon membuka mata) :
(4) : spontan
(3) : dengan rangsang suara (suruh pasien membuka mata).
(2) : dengan rangsang nyeri (berikan rangsangan nyeri, misalnya
menekan kuku jari)
(1) : tidak ada respon
KATEGORI KRITIS
1. Apatis sampai coma
2. GCS 3 sampai 13
3. Cedera Kepala Sedang
l. Dengar bunyi pertama kali muncul dan lihat pada angka berapa
bunyi nadi terdengar
s. Cuci tangan
KATEGORI KRITIS
1. Tekanan darah <90 mmHg sistolik
2. Tekanan darah >180 mmhg sistolik
3. MAP < 70
4. MAP > 100
TANPA STETOSKOP
1. Raba lokasi arteri menggunakan jari telunjuk dan jari tengah
Arteri radialis di pergelangan tangan
Arteri carotis di leher, di bawah angulus mandibular
Arteri brachialis di fossa cubiti
Arteri femoralis di inguinal
Ateri dorsalis pedis di dorsum pedis
2. Hitung jumlah pulse per 60 detik atau per 15 detik
3. Tentukan heart rate / pulse rate
4. Tentukan apakah reguler atau ireguler
5. Tentukan apakah teraba kuat atau lemah
KATEGORI KRITIS
1. Heart/pulse rate < 60
2. Heart/pulse rate >150
3. Ireguler
4. Teraba lemah
KATEGORI KRITIS
1. Respiration rate <16 dan > 25 per menit
2. Ada retraksi otot sekunder
3. Ekspirasi memanjang
4. Orthopnoe, sesak bila berbaring
5. Pasien mengeluh sesak nafas
KATEGORI KRITIS
1. Bila temperature tubuh diatas 37,5oC
2. Bila temperature tubuh dibawah 36oC
MENENTUKAN SATURASI O2
1. Siapkan alat, berupa pulse oxymeter , bisa yang portable, bisa
yang tergabung dengan vital sign monitor
2. Pasangkan sensor pada salah satu ujung jari tangan pasien
3. Lihat angka saturasi yang keluar pada alat tersebut
4. Tentukan nilai saturasi Oksigen berdasarkan angka yang keluar
tersebut
5. Apabila pasien memerlukan bantuan oksigen, tentukan saturasi
oksigen sebelum dan sesudah pemberian bantuan oksigen
KATEGORI KRITIS
1. Apabila saturasi < 92%
KATEGORI KRITIS
1. Acral teraba Dingin
2. Perubahan warna kembali ke merah memerlukan waktu > 2
detik
IGD
RUANG RAWAT INAP
OK
VK
Unit pemeriksaan penunjang
06 Januari 2016
1 Pneumothorax
2 Hidropneumothorax
3 Effusi pleura
4 Edema paru
5 Fraktur costae
6 Pneumoperitoneum
7 Ileus Obstruksi maupun paralitik
8 Invaginasi
9 Ascites
10 Fraktur tulang belakang yang tidak stabilSpine Trauma Spine fracture
11 Corpus Alienum Trachea dan Esofagus
12 Cerebral Hemorrhage/Hematoma
13 Acute Stroke
14 Depreese skull fracture
15 Brain tumor ( mass effect )
16 Spinal cord, compression HNP
17 Tumor Abdomen
18 Trauma Abdomen
19 Tumor Abdomen
20 Frakture ekstremitas
21 Dislokasi sendi
22 TB Paru
23 Tumor Paru
24 Pneumomediastinum
25 Appendicitis
26 Volvulus
27 Perdarahan Retroperitonea
28 Kehamilan Ektopik
29 Placenta Previa
30 Torsio Testis
31 Torsio Ovarium
32 Kematian Fetus
SOP TATALAKSANA MENANGANI HASIL EKG YANG TERMASUK
KATEGORI KRITIS / CRITICAL VALUES
06 Januari 2016
PROSEDUR
1. Petugas unit pelayanan mendapatkan hasil pemeriksaan
setelah melakukan test EKG sesuai sop.
2. Petugas mencocokkan hasil tersebut dengan daftar critical
values yang tersedia
3. Apabila hasil pemeriksaan tersebut sesuai/termasuk kategori
kritis, maka segera dilaporkan kepada dokter penanggung
jawab Ruangan atau Pelayanan. Dokter penanggung jawab
segera memberikan instruksi.
4. Apabila dokter penanggung jawab Pelayanan tidak dapat
dihubungi, maka petugas segera melaporkan hasil rongent
kepada dokter penanggung jawab Ruangan.
5. Semua pelaporan dilakukan sesuai SOP
9. Pelaporan hasil lab dengan kategori kritis dicatat dalam buku
berita acara peleporan critical values