SCIENCE, HISTORY AND TECHNOLOGY: February 2024

a) The Community Health Center establishes policies regarding outbreak management in accordance with its authority to ensure protection for staff, visitors and the patient environment.

b) The criteria for an infection outbreak related to health services at the Community Health Center are as follows:

(1) There are incidents of infection that did not previously exist or have not appeared for a long time which are caused by health service activities which impact the risk of infection, both at the Puskesmas and in the Puskesmas working area.

(2) The incidence has doubled or more compared to the previous period.

(3) Incidence can increase widely over the same time period.

(4) The infection event is designated as an outbreak by the government.

c) In an outbreak situation, appropriate guidelines, health protocols and procedures are prepared and implemented to prevent the transmission of infectious diseases.

2) Assessment Elements:

a) Identification of the possibility of an infection outbreak occurring, both in the Puskesmas and in the Puskesmas working area (D, W).

b) If an infection outbreak occurs, countermeasures are carried out in accordance with the policies, guidelines, health protocols and procedures prepared and evaluation and follow-up are carried out on the implementation of countermeasures in accordance with the regulations prepared (D,W).

Criterion 5.5.5 PPI TRANSMISSION PRECAUTIONS

Criterion 5.5.5

Efforts are made to prevent the spread of infection by implementing transmission-based precautions in providing patient care which can be transmitted through transmission.

1) Main Thoughts:

a) The PPI program in isolation precautions consists of standard precautions and transmission-based precautions. Transmission-based precautions include awareness of transmission through contact, droplets and air borne.

b) Transmission of air-borne diseases, including transmission caused by procedures or actions that cause aerosolization, is one of the risks that needs to be watched out for and received special attention at the Community Health Center.

c) To reduce the risk of transmission of air borne disease, this is done by, among other things, using PPE, arranging examination rooms, placing patients, or transferring patients in accordance with PPI principles. Prevention efforts also need to be aimed at providing protection to staff, visitors and the patient environment. Proper room cleaning every day during the patient's stay at the Puskesmas and cleaning again after the patient goes home must be carried out in accordance with infection prevention and control standards or guidelines.

d) To prevent transmission of airborne disease, it is necessary to identify patients at risk by providing masks, placing patients in separate or cohorting areas, and teaching cough etiquette.

e) To prevent airborne transmission, patient management procedures and SOPs are established in accordance with regulations.

2) Assessment Elements:

a) Identification of infectious diseases transmitted through airborne transmission and procedures or actions served at the Community Health Center that cause aerosolization as well as efforts to prevent transmission of infection through airborne transmission by using PPE, arranging examination rooms, placing patients, or transferring patients in accordance with the regulations prepared ( R,O,W)

b) Evaluation and follow-up are carried out on the results of monitoring the implementation of examination room layout, use of PPE, patient placement and patient transfer to prevent transmission of infection (D,W).

Criterion 5.5.4 IPC HAND CLEANLINESS

Criterion 5.5.4

Puskesmas carries out hand hygiene efforts according to standards.

1) Main Thoughts:

a) Puskesmas carries out education and provides educational facilities for hand hygiene for visitors and puskesmas staff.

b) Community Health Centers are required to provide facilities and infrastructure for carrying out hand hygiene, including:

(1) hand washing facilities include running water, soap, hand drying tissue/disposable towels; and/or

(2) alcohol-based hand rubs whose availability must be guaranteed at the Community Health Center.

c) The person in charge of PPI periodically evaluates and follows up on the implementation of PPI at the Puskesmas in accordance with the stipulated provisions.

2) Assessment Elements:

a) Hand hygiene education is carried out for all Puskesmas employees, patients and patient families (D, W).

b) Facilities and infrastructure for hand hygiene are available at the service location (O).

c) Evaluation and follow-up are carried out on the implementation of periodic hand hygiene in accordance with the stipulated provisions (D,W).

Criterion 5.5.3 IPC IMPLEMENTATION

Criterion 5.5.3

Community health centers that reduce the risk of infection related to health services need to implement and implement PPI programs to reduce the risk of infection for patients, staff, patient families, the community and the environment.

1) Main Thoughts:

a) The infection prevention and control program at the Community Health Center is a program carried out to identify and reduce the risk of contracting and transmitting infections among patients, staff, families, communities and the environment through the implementation of isolation precautions consisting of standard precautions and transmission-based precautions, use of antimicrobials wisely, and bundles for healthcare-associated infections.

b) The implementation of the program needs to be monitored continuously to ensure consistent implementation.

c) Standard Precautions are implemented in accordance with the provisions of laws and regulations through the following:

(1) Hand hygiene

Hand hygiene is a very effective way to prevent infection that must be carried out by health workers, patients, visitors and the wider community. Implementation and education about hand hygiene needs to be carried out continuously so that it can be implemented consistently.

(2) Use personal protective equipment (PPE) correctly and according to indications

Personal protective equipment (PPE) is used correctly to prevent and control infections. The PPE in question includes headgear (hats), masks, goggles (face shields), gloves, protective gowns, protective shoes used appropriately and correctly by Puskesmas staff, and used according to indications in providing patient care.

(3) Coughing and sneezing etiquette

Coughing and sneezing etiquette is applied to everyone in cases of infection by droplet or airborne transmission. When coughing or sneezing, a person must cover their nose and mouth with a tissue or sleeve under their clothes, immediately throw the used tissue in the trash, then wash their hands using clean water and soap or alcohol-based hand sanitizer, and must wear a mask.

(4) Correct patient placement

Patients with infectious diseases should be placed separately from patients without infectious diseases. Patient placement must be adjusted to the infection transmission pattern and should be placed in a separate room. If a separate room is not available, cohorting can be done. The distance between one patient's bed and another is at least 1 meter.

(5) Safe injection

Safe injection procedures need to pay attention to the sterility of the equipment used and the injection procedure. The use of sterile syringes and needles must be single use and this also applies to the use of multidose vials to prevent microbial contamination when the drug is used on patients. Safe injections based on PPI principles include:

(a) apply aseptic techniques to prevent contamination of injection equipment;

(b) all syringes used must be single use for one patient and one procedure, even if the syringe is different;

(d) mixing of drugs is carried out in accordance with statutory regulations; And

(e) management of used sharps waste needs to be managed properly in accordance with statutory regulations.

(6) Properly decontaminate patient care equipment.

Reducing the risk of infection is carried out by decontamination activities through pre-cleaning, cleaning, disinfection and/or sterilization with reference to the Spaulding category which includes:

a) critical, relating to medical devices used on sterile tissue or blood vessel systems using sterilization techniques, such as surgical instruments and parturition sets.

b) semicritical, relating to equipment used on mucous membranes and small areas of abrasion skin using high-level disinfection (DTT), such as oropharyngeal airway (OPA)/Guedel, tongue depressors, and dental mirrors.

c) non-critical, relating to equipment used on body surfaces in contact with intact skin to carry out low-level disinfection, such as blood pressure monitors or thermometers.

The decontamination process includes the following actions.

(a) Initial cleaning is carried out by officers at the workplace using PPE by cleaning themselves of all dirt, blood and body fluids with running water and then transporting them to the cleaning, disinfection and sterilization site.

(b) Cleaning is a physical process of removing all dirt, blood, or other body fluids from the surface of equipment manually or mechanically by washing the equipment clean with detergent (disinfectant and chlorine group with composition in accordance with applicable standards) or enzymatic solution, and drained before disinfection or sterilization.

(c) High level disinfection is carried out for semicritical equipment to remove all microorganisms, except for some endospore bacteria by boiling, evaporating, or using chemical disinfectants.

(d) Sterilization is the process of removing all microorganisms, including endospores, using high pressure steam (autoclave), dry heat (oven), chemical sterilization, or other sterilization methods. Environmental decontamination is the cleaning of environmental surfaces around the patient from possible contamination of blood, blood products, or body fluids. Cleaning is carried out using a disinfectant liquid such as 0.05% chlorine for environmental surfaces and 0.5% for environments contaminated with blood and blood products. Apart from chlorine, other disinfectants can be used according to the provisions.

(7) Proper management of linen

Good and correct management of linen is one effort to reduce the risk of infection. Linen is divided into non-infectious dirty linen and infectious dirty linen. Infectiously dirty linen is linen that has blood or other body fluids on it. Handling linen that has been used must be done carefully. This precaution includes the use of PPE by officers who manage linen and hand hygiene in accordance with IPC principles, especially for infectious linen. Health facilities must create management regulations. Linen management includes managing linen in the room, transporting linen to the washing/laundry room, and managing linen in the washing/laundry room. The principle that must be considered in managing linen is to always separate clean linen, dirty linen and sterile linen. In other words, each group of linen must be placed separately.

(8) Waste management properly and in accordance with statutory regulations

Puskesmas produce waste every day, especially infectious waste, sharp objects and needles which, if disposal is carried out incorrectly, can pose a risk of infection. Infectious waste management includes the management of infectious body fluid waste, blood, laboratory samples, sharp objects (such as needles) in special storage (safety boxes), and B3 waste. Education process for employees regarding safe management, availability of special storage areas, and reporting exposure to infectious waste or needle sticks and sharp objects. Waste management includes the following waste:

(a) Infectious waste is waste contaminated with blood and body fluids, laboratory samples, blood products, etc. which are placed in yellow plastic bags and processed in accordance with statutory provisions.

(b) Sharps waste is all waste that has sharp surfaces which is placed in a special puncture-resistant and waterproof storage (safety box). Storage should not exceed ¾ of the contents of the storage box.

(d) Waste management includes identification, storage, transportation, temporary storage and final processing of waste.

In carrying out their service duties, health workers need to be protected from exposure to infection.

Officer protection is carried out through regular checks, vaccination and protection, as well as follow-up if exposure occurs.

(9) Protect personnel against infection

Health workers in carrying out their service duties need to be protected against exposure to infection. Officer protection is carried out through regular inspections, vaccination, and protection and follow-up if exposure occurs.

d) The implementation of standard precautions needs to be monitored by the PPI team or officers who are given responsibility so that they are carried out periodically in the implementation of Puskesmas service activities.

Assessment Elements:

a) There is evidence of implementation and monitoring of Standard precautionary principles in accordance with the Main Ideas in numbers (1) to (9) in accordance with established procedures (R,D,O,W).

b) If there is management in Principles number (6) to number (8) which is carried out by a third party, the Puskesmas must ensure that quality standards are implemented by the third party in accordance with the provisions of statutory regulations (D,W).

Criterion 5.5.2 IDENTIFICATION OF INFECTION RISK

Criterion 5.5.2

Various risks of infection are identified in the delivery of services as a basis for developing and implementing strategies to reduce these risks.

1) Main Thoughts:

a) Puskesmas carries out identification and assessment of the risk of infection, both in providing individual health services and public health efforts, which may or have occurred to patients, visitors, staff, families and the community. Implementation of identification and review of care delivery must be in accordance with PPI principles.

b) Based on this study, a strategy for infection prevention and control was developed through (a) isolation precautions consisting of two layers, namely standard precautions and transmission-based precautions, (b) wise use of antimicrobials, and (c) implementation of infection bundles related to services health, including primary bloodstream infections, surgical site infections, urinary tract infections due to catheter placement, and other infections that may occur as a result of health services.

c) To implement isolation precautions, it is necessary to ensure:

(1) availability of personal protective equipment (PPE), such as gloves, protective glasses, masks, shoes and protective gowns (according to exposure risk);

(2) availability of proper linen;

(3) availability of medical equipment in accordance with provisions;

(4) availability of safe injection equipment; And

(5) waste management through safe placement and disposal of clinical waste and waste that has the potential to transmit diseases that requires special disposal, such as sharp objects/needles and other disposable equipment that may come into contact with body fluids.

d) Renovation of buildings in the Puskesmas area can be a source of infection. Exposure to construction dust and dirt, noise, vibration, dirt, and other hazards may constitute potential hazards to lung function and the safety of employees and visitors. Therefore, Community Health Centers must establish risk criteria to deal with these impacts which are outlined in the form of regulations regarding risk assessment and infection control (infection control risk assessment/ICRA).

2) Assessment Elements:

a) Identification and assessment of the risk of infection related to the provision of services at the Community Health Center (D,W).

b) Develop and implement a strategy to minimize the risk of infection related to the provision of services at the Puskesmas and ensure the availability of (a) to (c) as stated in the Main Ideas (D,W) section.

Criterion 5.5.1 IPC PROGRAM

Standard 5.5 Infection prevention and control program.

Infection prevention and control programs are implemented to prevent and minimize the occurrence of infections related to health services.

Infection prevention and control, hereinafter abbreviated as PPI, is an effort to prevent and minimize the occurrence of infections in patients, staff, visitors and the community around health facilities.

a. Criterion 5.5.1

Regulations and infection prevention and control programs are implemented by all Puskesmas employees in a comprehensive manner to prevent and minimize the risk of infections related to health services.

1) Main Thoughts:

a) Infection prevention and control, hereinafter abbreviated to PPI, is an effort to prevent and minimize the occurrence of infections in patients, staff, visitors and the community around health facilities.

b) The aim of PPI is to improve the quality of services in health care facilities so as to protect health human resources, patients and the community from infectious diseases related to health services.

c) The risk of infections acquired and/or transmitted among patients, staff, students and visitors is identified and prevented or minimized through IPC activities.

d) Puskesmas need to develop a PPI program which includes (a) implementation of isolation precautions consisting of standard precautions and transmission-based precautions, (b) PPI education and training (can be in the form of training or workshops) for both staff and patients and families, as well as the community, (c) preparation and implementation of infection bundles related to health services, (D) monitoring the implementation of isolation precautions, (e) surveillance of infectious diseases related to health services, and (f) wise use of anti-microbials and reporting in accordance with statutory regulations.

e) The activities listed in the PPI program depend on the complexity of clinical activities and Puskesmas services, the size of the Puskesmas area, the level of risk and coverage of the population served, geography, number of patients and number of employees and are an integrated part of the Quality Improvement Program.

f) So that infection prevention and control can be implemented optimally, it is necessary to appoint trained staff to coordinate, monitor and assess the implementation of PPI principles and programs in services based on policies and guidelines that refer to statutory provisions.

g) To monitor and assess the implementation of the PPI program, indicators are prepared as evidence of the implementation of planned activities.

2) Assessment Elements:

a) The Puskesmas prepares a plan and implements a PPI program consisting of (R,D):

(1) implementation of isolation precautions consisting of standard precautions and transmission-based precautions,

(2) PPI education and training (can be in the form of training or workshops) for both staff, patients and families, as well as the community,

(3) preparation and implementation of infection bundles related to health services,

(4) monitoring the implementation of isolation precautions,

(5) surveillance of infectious diseases related to health services and,

(6) wise and comprehensive use of anti-microbials in providing services at Community Health Centers

b) Monitoring, evaluation, follow-up and reporting are carried out on the implementation of the PPI program using specified indicators (D,W).

Criterion 5.4.2 QUALITY AND SAFETY CULTURE

Criterion 5.4.2

Health care providers play an important role in improving behavior in providing services that reflects a culture of quality and safety culture.

1) Main Thoughts:

a) Efforts to improve the quality of clinical services and patient safety are the responsibility of all health workers who provide patient care. Puskesmas measures patient safety culture by conducting patient safety culture surveys every year. Patient safety culture is also known as a safe culture, namely an organizational culture that encourages each individual staff member (clinical or administrative) to report matters of concern about safety or quality of service without compensation from the Community Health Center.

b) Health personnel are medical personnel, nurses, midwives and other health personnel who are authorized and responsible for carrying out patient care.

c) Behavior related to safety culture in the form of

(1) provision of good services, including shared decision making;

(2) collaborate with patients;

(3) collaborate with other health workers;

(4) collaborating within the health care system;

(5) minimizing risks;

(6) maintaining professional performance;

(7) professional and ethical behavior;

(8) ensuring the implementation of standardized service processes; And

(9) quality and safety improvement efforts including involvement in incident reporting and follow-up.

d) Behavior that does not support a safety culture such as:

(1) inappropriate behavior, including the use of words or body language that demeans or offends fellow staff, for example swearing and cursing;

(2) disruptive behavior, including inappropriate behavior that is carried out repeatedly, forms of verbal or nonverbal actions that endanger or intimidate other staff, reckless comments in front of patients that have the effect of lowering the credibility of other clinical staff, for example by making negative comments the results of other staff's actions or treatment in front of the patient by saying, “This medicine is wrong. Where did he graduate?", prohibiting nurses from making incident reports, scolding other clinical staff in front of patients, or showing anger by throwing medical records in the ward;

(3) harassing behavior related to race, religion, ethnicity, including gender; And

(4) sexual harassment.

e) The quality of clinical services is not only determined by the existing service system, but also by behavior in providing services. Health workers need to evaluate behavior in providing services and make efforts to improve both the service system and service behavior, which reflects a culture of safety and a culture of continuous clinical service improvement.

2) Assessment Elements:

a) Patient safety culture is measured by conducting a patient safety culture survey which becomes a reference in the safety culture program (D,W).

b) The Community Health Center creates a system to identify and submit reports of behavior that does not support a safety culture or is "unacceptable" and efforts to improve it (D,W).

c) Education is carried out about clinical quality and patient safety for all health care workers (D, W).

Criterion 5.4.1 IKP REPORTING

Standard 5.4 Reporting patient safety incidents and developing a safety culture

The Community Health Center establishes a patient safety incident reporting system and develops a safety culture.

Reporting patient safety incidents is related to the safety culture at the Community Health Center and is necessary to prevent further or repeated incidents in the future which will have a greater detrimental impact on the Community Health Center.

a. Criterion 5.4.1

Reporting, documentation, root cause analysis and preparation of corrective actions are carried out as an effort to improve and prevent potential patient safety incidents.

1) Main Thoughts:

a) A patient safety incident is any unintentional event and condition that results in or has the potential to result in preventable injury to a patient.

b) Patient safety incidents consist of (1) significant potential injury conditions (KPCS), (2) near injury events (KNC), (3) non-injury events (KTC), (4) unexpected events (KTD), and ( 5) sentinel event (KS).

c) Patient safety measures are taken to prevent incidents from occurring. The incident type consists of the following incidents:

(1) Unexpected events (KTD) are incidents that result in injury to the patient. For example, a patient falls out of bed and injures his ankle.

(2) Non-injury events (KTC) are incidents that have affected/exposed the patient, but no injury occurred. For example, a nurse gives the wrong medicine to a patient, the medicine has been taken, but the patient is not injured.

(3) Potentially significant injury conditions (KPCS) are all situations or related conditions (other than disease processes) that have the potential to cause significant injury/sentinel events. For example, a damaged DC shock, although there are no patients yet, has the potential to cause significant injury.

(4) A near miss (KNC) is an incident that occurs, but has not affected/been exposed to the patient because it can be prevented. For example, when a nurse wants to give medicine to a patient, when checking, it turns out that the medicine given by the pharmacy is another patient's medicine with a similar name so the medicine is not given.

(5) Sentinel is an undesirable event that results in death or serious injury. Sentinel events can be:

(a) unexpected death, including but not limited to

1. death that is not related to the course of the disease or the patient's condition (for example: death due to late transfer process);

2. term infant death; And

3. suicide;

(b) permanent loss of function unrelated to the patient's disease or condition;

(d) kidnapping of children, including babies or children being sent to a house other than their parents' home; And

(e) rape, workplace cruelty such as assault (resulting in death or permanent loss of function) or murder (intentional) of patients, family members, staff, doctors, visitors, or vendors/third parties while within the Puskesmas environment.

d) Patient safety incident reporting, hereinafter referred to as incident reporting, is a system for documenting patient safety incident reports. Incident reporting consists of internal incident reports and external incident reports.

e) The reporting system is expected to encourage individuals within the Community Health Center to care about dangers or potential dangers that could occur to patients. Reporting is also important to monitor efforts to prevent errors so that it can encourage investigations. On the other hand, reporting will be the start of a learning process to prevent the same incident from happening again.

f) Community Health Centers need to carry out an analysis using a risk grading matrix which will determine the type of incident investigation carried out after an internal incident report. Investigations consist of simple investigations and investigations with Root Cause Analysis (RCA). Investigations using root cause analysis (RCA) consist of simple investigations (for green and blue risk grading) and comprehensive investigations (for red and yellow risk grading). In sentinel events there is no need to consider color grading.

g) Community health centers need to establish a community health center patient safety learning reporting system (SP2KPP) for incidents which includes policies, reporting flow, reporting forms, reporting procedures, incidents that must be reported internally, namely all types of incidents including sentinel events, unexpected events, near-miss incidents, non-injury events and significant potential injury events. Meanwhile, the external reports reported are IKP which includes the types of unforeseen accidents and sentinel incidents for which root cause analysis (RCA) and corrective action plans have been carried out. It is also determined who makes the report, the reporting deadline, investigation and follow-up.

h) Reporting of patient safety incidents is reported in accordance with statutory provisions.

2) Assessment Elements:

a) Reporting is carried out if an incident occurs in accordance with established policies and procedures to the patient safety team and head of the health center accompanied by analysis, incident investigation and follow-up on incidents (R,D,W).

b) Reporting to the National Patient Safety Committee (KNKP) regarding incidents, analysis and follow-up is carried out in accordance with the specified time frame (D, O, W).

Criterion 5.3.6 RISKS OF PATIENT FALLS

Criterion 5.3.6

Processes to reduce the risk of patient falls are developed and implemented.

1) Main Thoughts:

a) Injuries to patients can occur due to falls in health facilities. The risk of falls can occur in patients with a history of falls, drug use, drinking alcoholic beverages, balance disorders, visual disturbances, mental disorders, and other reasons.

b) Screening is carried out in accordance with policies and procedures prepared to minimize the risk of falls in outpatients and assessment of the risk of falls in emergency room patients and inpatients at the Community Health Center.

c) Fall risk screening is carried out on outpatient patients by taking into account

(1) patient condition: for example geriatric patients, dizziness, vertigo, balance disorders, visual disturbances, drug use, sedation, consciousness and/or mental status, and alcohol consumption;

(2) diagnosis: for example, patients with a diagnosis of Parkinson's disease;

(3) situations: for example, patients receiving sedation or patients with a history of prolonged bed rest who will be transferred for supporting examinations from an ambulance and changing positions will increase the risk of falls;

(4) location: for example, the results of identifying areas in the Community Health Center that are at risk of patient falls, including locations that have lighting problems or have other barriers, such as physiotherapy service areas and stairs.

d) Criteria for screening for possible fall risks must be established, both for inpatients and outpatients, and efforts must be made to prevent or minimize falls in health facilities.

e) Examples of tools for conducting assessments on inpatients are the Morse scale for adult patients and the Humpty Dumpty scale for children, while for outpatients this is done using the get up and go test or by asking three questions, namely

(1) have you ever fallen in the last 6 months;

(2) whether using medications that disrupt balance; And

(3) whether standing and/or walking requires the help of another person.

If the answer to one of these questions is yes, the patient is categorized as being at risk of falling.

2) Assessment Elements:

a) Screening of patients with a risk of falling in outpatient settings and assessment of the risk of falls in the ER and inpatient care is carried out in accordance with policies and procedures and efforts are made to reduce this risk (R,O,W,S).

b) Evaluation and follow-up are carried out to reduce the risk of situations and locations identified as being at risk of patient falls (D, W).

Criterion 5.3.5 HAND CLEANLINESS KP

Criterion 5.3.5

The hand hygiene process is implemented to reduce the risk of infection associated with health services.

1) Main Thoughts:

a) Community health centers must implement hand hygiene which has been proven to reduce the risk of infection occurring in health facilities.

b) Hand hygiene procedures need to be developed and socialized. Information regarding the procedure is posted in an easy-to-read place. Medical personnel, health workers and Puskesmas employees need to be educated about hand hygiene. Hand hygiene outreach also needs to be carried out among patients and their families.

c) Hand hygiene is the key to effective infection prevention and control, so Community Health Centers must establish policies and procedures regarding hand hygiene.

2) Assessment Elements:

a) Established hand hygiene standards that refer to WHO Standards (R).

b) Hand hygiene is carried out in accordance with established regulations (D, O, W).

Criterion 5.3.4 PROCEDURE COMPLIANCE

Criterion 5.3.4

Processes to ensure the right patient, right procedure, and right side for patients undergoing surgery/medical procedures are established and implemented.

1) Main Thoughts:

a) The occurrence of injuries and unexpected events can be caused by the wrong person, the wrong procedure, the wrong side of invasive procedures or actions on the patient.

b) The Community Health Center must determine operative procedures, invasive procedures and procedures which include all actions involving cuts/incisions or punctures, tissue extraction, tooth extraction, implant installation and other invasive actions or procedures that fall under the authority of the Community Health Center as a level health service facility. First.

c) Puskesmas must develop a system to ensure the correct patient, correct procedure, and correct side when carrying out actions by implementing a general protocol (universal protocol) which includes:

(1) verification process before action is taken; Marking of the side where the action/procedure will be carried out; And

(2) time out which is done immediately before the procedure begins.

d) The verification process before carrying out the action aims to verify the correct person, correct procedure, correct side, ensuring that all documents, approval of medical action, medical records, results of supporting examinations are available and labeled, ensuring that medicines, intravenous fluids, and if any are available The necessary blood products, medical devices or implants are available and ready for use.

e) Marking of the side that will receive the action/procedure is made by involving the patient if possible and is done with signs that are immediately recognizable and not confusing. Marking must be done uniformly and consistently. Marking is performed on all organs that have laterality (right versus left, such as one of two limbs, one of a pair of organs), multiple structures (such as fingers, toes, or lesions), or multiple levels (spine). For procedures at the dental clinic, such as tooth extraction, markings, if necessary, are carried out using dental x-rays or odontograms. Marking must be carried out by the operator/person who will carry out the procedure and the entire procedure and remain with the patient during the procedure.

f) Side marking can be performed at any time before the procedure begins as long as the patient is actively involved in side marking and marking. There are times when patients are in a situation where it is not possible to participate, for example in pediatric patients or when the patient is not competent to make decisions about health care.

g) A break (time out) is an opportunity to answer all unanswered questions or straighten out any confusion. The break is held at the location where the procedure will be performed, just before starting the procedure, and involves the entire team that will be performing the surgical or invasive procedure.

2) Assessment Elements:

a) Marking of the side of the operation/medical procedure is carried out consistently by the service provider who will carry out the action in accordance with the established policies and procedures (R,O,W,S).

b) Verification is carried out before surgery/medical procedures to ensure that the procedure has been carried out correctly (D, O, W).

c) There is a time out before surgery/medical procedures to ensure all questions have been answered or to straighten out any confusion (O,W).

Criterion 5.3.3 SAFETY OF MEDICINES

Criterion 5.3.3

Processes to improve the safety of cautionary medicines are established and implemented.

1) Main Thoughts:

a) Medication administration to patients needs to be managed well in an effort to ensure patient safety. Mistakes in using medication that need to be taken care of can cause injury to the patient.

b) High alert medications are drugs that have a risk of causing serious injury to patients if used incorrectly. High alert drugs include: 1) High risk drugs, namely drugs with active substances that can cause death or disability if an error occurs in their use (for example: insulin, heparin or cytostatics), 2) Drugs that look similar and sound similar ( Name of drug with similar appearance and pronunciation/NORUM, or Look Alike Sound Alike/LASA) 3) Concentrated electrolytes for example: potassium chloride with a concentration equal to or more than 1 mEq/ml, sodium chloride with a concentration of more than 0.9% and magnesium sulfate injection with a concentration equal to or more than 50%.

c) Medication errors can also occur due to the presence of drugs with similar names and looks (look alike sound alike).

d) Policies and procedures regarding the management of drugs that require caution are established and implemented which include storing, arranging, prescribing, labeling, preparing, using and evaluating the use of drugs that require caution, including psychotropic drugs, narcotics and drugs with similar names or appearance.

2) Assessment Elements:

a) A list of drugs that need to be wary of and drugs with similar names or looks is prepared and labeling and arrangement of drugs that need to be wary of and drugs with similar names or looks are carried out in accordance with the policies and procedures prepared (R,D,O,W).

b) Monitoring and controlling the use of psychotropic/narcotic drugs and other drugs that require high alert (D,O,W).

Criterion 5.3.2 EFFECTIVE COMMUNICATION

Criterion 5.3.2

Processes to increase the effectiveness of communication in the delivery of care are established and implemented.

1) Main Thoughts:

a) Errors in making clinical decisions, actions and treatment can occur due to ineffective communication in the patient care process.

b) Communication that is effective, timely, accurate, complete, clear and understandable to the recipient will reduce errors and result in improved patient safety.

c) Communication that is prone to causing errors, among others, occurs when (1) giving verbal orders, (2) giving verbal orders via telephone, (3) delivering critical results of diagnostic supporting examinations, (4) handing over between shifts. , and (5) transfer of patients from one unit to another unit.

d) Effective communication policies and procedures need to be developed and implemented in the delivery of verbal messages, verbal messages via telephone, delivery of critical values of examination results supporting diagnosis, patient handover on duty or handover from one unit to another, for example for supporting examinations and transfer of patients to another unit.

e) Reporting the patient's condition in verbal communication or by telephone, among other things, can be done using the SBAR technique (situation, background, assessment, recommendation). Meanwhile, when receiving instructions over the telephone, you can use the readback method (write down, read back and confirm).

f) The patient handover using the SBAR technique is carried out by paying attention to the opportunity to ask questions and provide explanations (readback, repeat back), using a standard form, and containing critical information that must be conveyed, including, among other things, about the patient's status/condition, treatment, plans care, follow-up that must be carried out, significant changes in the patient's status/condition, and limitations or risks that the patient may experience.

g) Implementation of effective verbal or telephone communication when receiving instructions written down in full (T), read again by the recipient of the order (B), and confirmed to the giver of the order (K), known as TBAK.

h) The critical value of the results of supporting examinations which is significantly outside the normal range of numbers must be determined and immediately reported by the health worker responsible for supporting services to the doctor responsible for the patient in accordance with the time conditions set by the Community Health Center using the readback method (write down, read back and confirm).

i) To increase competence in carrying out effective communication, it is necessary to provide education to employees. Education can be carried out in the form of training, workshops, on-the-job training, or other forms that are considered effective for transferring skills and knowledge to increasing employee competency in carrying out effective communication.

2) Assessment Elements:

a) Giving verbal orders over the telephone using the SBAR and TBAK techniques according to the Main Ideas (D,W).

b) Reporting of the patient's condition and reporting of critical values of laboratory examination results is carried out in accordance with procedures, namely written in full, re-read by the recipient of the message, and confirmed by the sender of the message, and recorded in the medical record, including identification of who the critical values of laboratory examination results are reported to ( D, W, S).

c) Effective communication is carried out during the patient handover process which contains critical matters which are carried out consistently in accordance with SBAR procedures and methods using standardized forms (R, D, W, S).

Criterion 5.3.1 PATIENT IDENTIFICATION

Standard 5.3 Patient safety objectives.

Patient safety goals are implemented in patient safety efforts.

Puskesmas develops and implements patient safety targets as an effort to improve service quality.

a. Criterion 5.3.1

The patient identification process is carried out correctly.

1) Main Thoughts:

a) Misidentification of patients can occur at the Community Health Center during service as a result of staff negligence, the patient's state of consciousness, bed changes, or other conditions that cause mistaken identity.

b) Patient identification policies and procedures need to be developed, including identification of patients in special conditions, for example patients who cannot identify themselves, have decreased consciousness, are in a coma, have mental disorders, come without clear identification, and there are two or more patients who have the same or similar names. .

c) Identification must be carried out using at least two relatively unchanged identification methods, namely full name, date of birth, medical record number, or population identification number.

d) Identification must not use the room number or location of the patient being treated.

e) The correct identification process must be carried out starting from screening, at the time of registration, and every time a diagnostic procedure, action procedure, medication administration and diet administration are carried out.

2) Assessment Elements:

a) Patient identification is carried out before diagnostic procedures, procedures, medication administration, immunization and diet administration are carried out in accordance with established policies and procedures (R,D,O,W).

b) Correct identification procedures are carried out if patients with special conditions are found as mentioned in the Main Ideas in accordance with established policies and procedures (R,D,O,W).

Criterion 5.2.2 RISK MANAGEMENT

Criterion 5.2.2

Puskesmas carries out risk management in accordance with applicable regulations.

1) Main Thoughts:

a) The risk management (MR) program contains strategies and activities to reduce or mitigate risks that are prepared annually, integrated in the Community Health Center planning, and based on identification and analysis of risks that have either resulted in events/incidents or those that have the potential to cause events/incidents to occur.

b) Risk management in the form of reduction, mitigation and monitoring strategies for implementation is carried out according to risk categories.

c) One tool/method of proactive analysis of critical and high-risk processes is failure mode effect analysis to analyze at least one selected critical or high-risk process every year.

d) To use this method/tool or other similar tools effectively, the Head of the Community Health Center must (1) know and study the approach, (2) agree on a list of processes that pose a high risk in terms of patient, service user and staff safety, then (3) apply the tool to analyze the process. Community Health Center leaders take action to redesign processes or take action to reduce risks at the analyzed process stages.

2) Assessment Elements:

a) A risk management plan is prepared which is integrated into the Community Health Center level planning as an effort to minimize and/or mitigate risks (D).

b) The Community Health Center Quality Team monitors the treatment plan (D,W).

c) Reporting is carried out to the Head of the Community Health Center and to the district/city regional health service as well as across related programs and sectors (D,W).

d) There is evidence that the Community Health Center has carried out and followed up on a failure mode effect analysis at least once a year on prioritized high risk processes (D,W).

Criterion 5.2.1 IDENTIFICATION OF RISK

Standard 5.2 Risk management program.

The risk management program is used to identify, analyze, evaluate, manage risks and monitor and review to reduce losses and injuries to patients, staff, visitors, health center institutions and UKM and community service targets.

Risk management efforts are carried out by preparing a risk management program every year which includes the risk management process, namely communication and consultation, establishing context, identification, analysis, evaluation, risk management, and monitoring and reviews carried out as well as risk management reporting.

a. Criterion 5.2.1

Risks in the implementation of various Community Health Center efforts towards service users, families, communities, staff and the environment are identified and analyzed.

1) Main Thoughts:

a) Implementation of every Puskesmas activity can pose a risk to service users, families, the community, staff and the environment. These risks need to be managed by the person responsible and implementing them to take steps to prevent and/or minimize risks so that they do not cause negative consequences or losses.

b) Management program Risk management is a proactive approach whose important components include:

(1) risk identification process;

(2) risk integration includes clinical risks related to patient safety and non-clinical risks including risks related to safety facility management (MFK), PPI risks that do not have an impact on patients, financial risks, compliance risks, reputational risks and strategic risks;

(3) risk management process reporting every six months; And

(4) management related to claims.

c) Identification of risks that may occur is documented in the risk register.

d) The risk category at the Community Health Center includes clinical risks related to patient safety and non-clinical risks including risks related to safety facility management (MFK), PPI risks that do not have an impact on patients, financial risks, compliance risks, reputational risks and strategic risks on KMP, UKM services, as well as UKP, laboratory and pharmaceutical services.

e) A risk register must be created as a basis for preparing risk management programs and to help Puskesmas officers recognize and be aware of possible risks and their consequences so that they can protect program targets, patients, families, communities, staff, the environment and health service facilities.

f) The Puskesmas prepares a risk profile and carries out risk management as a step after creating a risk register. Furthermore, monitoring is carried out and submission of risk management reports every six months to the Head of the Community Health Center.

2) Assessment Elements:

a) A risk management program is prepared to be determined by the Head of the Community Health Center (R,W).

b) The Community Health Center Quality Team guides risk management (D,W)

c) Identification, analysis and evaluation of risks that could occur at the Community Health Center are carried out which are documented in the risk list (D,W).

d) A risk profile is prepared which is a priority risk based on evaluation of the results of risk identification and analysis on the list of risks that require further treatment (D,W)

Criterion 5.1.4 IMPROVING PDSA QUALITY

Criterion 5.1.4

Quality Improvement is achieved and maintained.

1) Main Thoughts:

a) Information from analysis of quality indicator measurement data is used to identify problems and potential improvements.

b) Methods for improving and maintaining quality and patient/community safety include, among other things, using a quality improvement cycle with the stages of planning (plan), testing (do), studying/analyzing the results of improvement trials (study), and following up on the results analysis of improvement trials (action).

c) After planning, an improvement trial is carried out and the results are studied by collecting data during the trial activities, then an assessment is carried out again to prove that the changes made have actually resulted in an improvement in quality.

d) Effective changes that can be made include improving policies, improving service flow, improving standard operating procedures, staff education, timely availability of equipment, and various other forms of changes. If the change is deemed effective, it can be replicated to other work units.

e) The results of changes in letter d can maintain or improve the quality of services at the Community Health Center. The quality improvements carried out are communicated and socialized across programs and sectors and are documented.

f) The Puskesmas quality improvement program is reported to the district/city regional health office at least once a year.

2) Assessment Elements:

a) There is evidence that the Community Health Center has piloted a quality improvement plan based on Criteria 5.1.1 and 5.1.2 (D,W).

b) There is evidence that the Community Health Center has evaluated and followed up on the results of quality improvement trials (D,W).

c) The success of the quality improvement program at the Community Health Center is communicated and socialized to LP and LS and documentation of quality improvement program activities (D,W) is carried out.

d) The quality improvement program is reported to the district/city regional health office at least once a year (D,W).

Criterion 5.1.3 VALIDATION OF INDICATOR DATA

Criterion 5.1.3

Validation and analysis of the results of quality indicator data collection were carried out as consideration in making decisions to improve Puskesmas quality and performance.

1) Main Thoughts:

a) The benefits and success of quality improvement programs can only be demonstrated if supported by the availability of valid data. Therefore, it is very important to carry out valid measurements of the specified indicators.

b) To ensure that the data from each quality indicator collected is valid and can be used for decision making in improving quality and conveying information about the quality of Puskesmas services to the community, data validation needs to be carried out.

c) Data validation is carried out when:

(1) there is a new indicator used;

(2) data will be displayed to the public through information media determined by the Community Health Center;

(3) there is a change in the indicator profile, for example a change in data collection tools, a change in the numerator or denominator, a change in the collection method, a change in data source, a change in the subject of data collection, and a change in the operational definition of the indicator;

(4) there is a change in measurement data for unknown reasons; And

(5) the data source changes, for example if part of the patient record is changed to electronic format so that the data source becomes electronic and paper; or the subject of data collection changes, for example changes in average patient age, adoption of new practice guidelines, or adoption of new technologies and treatment methodologies.

d) Validation of data from quality indicator measurement results is carried out by officers who are given responsibility for carrying out validation. However, in the event that there are limited personnel, the officer responsible for data validation may be concurrently the officer responsible for the indicators.

e) In order to reach a conclusion and make a decision, data must be combined, analyzed and transformed into useful information.

f) Data analysis involves individuals on the quality team who understand information management, have skills in data collection methods, and know how to use various statistical tools. The results of data analysis must be reported to the Head of the Community Health Center by the person in charge of quality who is responsible for the process and results measured as a basis for carrying out corrective follow-up.

g) Statistical techniques can be useful in the data analysis process, especially in interpreting variations and deciding areas that most need improvement. Run charts, control charts, histograms, and Pareto diagrams are examples of statistical methods that are very useful for understanding patterns and variations in health service performance.

h) Determining the frequency of data collection and analysis must take into account the need to improve the quality of service activities as outlined in the established indicator profile.

i) Data analysis can be done by:

(1) achievements are compared serially over time. Comparing data at Community Health Centers from time to time to see trends, for example PIS PK data from month to month or from year to year;

(2) achievements compared with predetermined targets. Comparing achievement data with targets that have been set periodically;

(3) achievements compared with the achievements of similar health service facilities. Compare with other health centers if possible with similar health centers;

(4) achievements are compared with standards and references that are classified as best practice or clinical practice guidelines. Compare it with the desired practice which in the literature is classified as best practice, better practice, or clinical practice guidelines.

j) As a public body, Puskesmas is obliged to provide public information that is accurate, correct and factual. Information about the performance of the Community Health Center is public information that needs to be conveyed to the public/community. Submitting information about the performance of the Community Health Center can encourage community participation and active role in health development in the work area of the Community Health Center.

2) Assessment Elements:

a) Data validation is carried out on the results of indicator data collection as requested in the Main Thoughts (D,O,W).

b) Data analysis was carried out as stated in Main Ideas (D,W).

c) A follow-up plan is prepared based on the results of the analysis in the form of a quality improvement program. (R,D,W)

d) Follow-up and evaluation of the quality improvement program in letter c is carried out. (D,W)

e) Reporting of quality indicators is carried out to the head of the community health center and the district/city regional health service in accordance with established procedures (D, W).

Criterion 5.1.2 QUALITY INDICATORS

Criterion 5.1.2

The Head of the Community Health Center and the team or officers who are responsible for improving quality and patient safety are committed to cultivating a culture of continuous quality improvement through managing quality indicators.

1) Main Thoughts:

a) The Head of the Community Health Center is responsible for setting priorities for programs that need to be improved, taking into account processes that have high risk implications, involve a large population (high volume), require large costs if not managed well (high cost), achievement low performance (bad performance), or tends to cause problems (problem prone).

b) The success of quality improvement can be measured through measuring quality indicators.

c) Puskesmas measures quality indicators consisting of:

(1) National Quality Indicator (INM)

This indicator is an indicator that must be measured and reported by all Community Health Centers.

(2) Community Health Center Priority Quality Indicators (IMPP)

This indicator is formulated based on priority health problems in the Puskesmas work area whose improvement efforts must be supported by KMP, UKM and UKP, laboratory and pharmacy.

Example:

The problem at the Puskesmas level which is determined in accordance with health problems in the work area is the high prevalence of tuberculosis, so efforts are made to improve UKP activities related to the provision of clinical services to overcome the problem of tuberculosis, efforts are made to improve the performance of UKM services to reduce the prevalence of tuberculosis, and management support is needed to overcome the problem of tuberculosis.

(3) Service Priority Quality Indicator (IMPEL) This indicator is formulated based on priority health problems in each service unit.

d) Puskesmas improves knowledge and skills through training, workshops, comparative studies, on-the-job training or in-house training regarding quality improvement programs.

e) Quality indicators that have been achieved during the current year can be replaced with new quality indicators. Quality indicators that have not reached the target can remain a priority for the following year.

2) Assessment Elements:

a) There is a policy regarding Puskesmas quality indicators which is equipped with an indicator profile (R).

b) Quality indicators are measured according to the indicator profile (D, W).

c) Evaluation of efforts to improve the quality of the Community Health Center is carried out based on follow-up to the improvement plan (D, W).

Wednesday, February 7, 2024

Criterion 5.1.1 QUALITY IMPROVEMENT PROGRAM

CHAPTER V IMPROVING THE QUALITY OF PUSKESMAS (PMP)

1. Standard 5.1 Continuous quality improvement.

Quality improvement is carried out through continuous efforts consisting of quality improvement efforts, patient safety efforts, risk management efforts, and infection prevention and control efforts to improve service quality and minimize risks for patients, families, communities, staff and the environment.

a. Criterion 5.1.1

The Head of the Puskesmas determines the person responsible for quality, the quality team and the Puskesmas quality improvement program.

1) Main Thoughts:

a) The provision of services, whether management services, public health services, or individual health efforts, must be able to guarantee the quality and safety of patients, families, communities and the environment.

b) So that efforts to improve quality at the Puskesmas can be managed well and consistently with the vision, mission, goals and values, a Quality Responsible Person is appointed, who in carrying out his duties is assisted by the Puskesmas Quality Team, consisting of coordinators, such as the patient safety coordinator (KP ), Infectious Disease Control (PPI), Risk Management (MR), Occupational Safety and Health (K3), and so on, in accordance with what is described in the TKM Guidebook at Community Health Centers.

c) The appointment and competency requirements of the Person Responsible for Quality are determined by the Head of the Community Health Center. These competency requirements include, among others:

(a) have a minimum education of D-3 in Health,

(b) have a commitment to improving quality and patient safety, risk management, and PPI,

(D) and has attended workshops on Quality Management, Patient Safety, and PPI.

d) Members of the quality team or officers with related responsibilities, have the task of (a) preparing programs, (b) facilitating, coordinating, monitoring, (c) and cultivating activities for quality improvement, patient safety, risk management, and prevention and control infection. The team member or responsible officer must also ensure that the implementation of activities is carried out consistently and continuously.

e) Policies, guidelines/guidelines, procedures related to the Puskesmas quality improvement program are used as a reference for the Head of the Puskesmas, Person in Charge of Puskesmas Service Efforts and Coordinator, as well as implementers of Puskesmas activities, in implementing: (a) quality improvement, (b) patient safety, ( c) risk management, (D) and infection prevention and control.

f) The quality improvement program created must include at least objectives, targets, clear division of responsibilities and activities to be carried out. Quality improvement programs need to be updated regularly, and communicated to related programs and sectors.

g) The Head of the Community Health Center needs to facilitate, allocate and provide the resources needed for the quality improvement program in accordance with the needs and existing resources at the Community Health Center.

h) Quality improvement programs are prepared collaboratively with coordinators starting from planning, implementation, supervision, control, to assessment and follow-up.

i) The quality improvement program is prepared by taking into account, among other things: achievement of quality indicators, developments in community needs and expectations, statutory provisions, technological developments and applicable policies in the context of continuous quality improvement efforts.

j) Planning, implementation and achievements of quality improvement program services are documented, socialized and communicated to all health workers who provide services.

2) Assessment Elements:

a) The Head of the Community Health Center forms a quality team in accordance with the requirements, complete with job descriptions, and determines a quality improvement program (R,W).

b) The Community Health Center together with the quality team implements and evaluates the quality improvement program (D,W).

c) The Quality Team prepares a quality improvement program and carries out follow-up efforts to improve quality on an ongoing basis (D,W).

d) The quality improvement program is communicated to cross-programs and cross-sectors, and is reported periodically to the head of the Community Health Center and the district/city regional health service in accordance with established procedures (D,W).

Standard 4.5 Control of non-communicable diseases and their risk factors.

Control of non-communicable diseases and their risk factors is carried out in an effort to improve health services towards universal health coverage, especially strengthening primary health services by encouraging promotive and preventive efforts. The Community Health Center carries out control of the main non-communicable diseases which include hypertension, diabetes mellitus, breast and cervical cancer, Chronic Obstructive Pulmonary Disease (COPD), as well as the Refer-Back Program (PRB) for non-communicable diseases (NCD) and other catastrophic diseases in accordance with competency at the level primary, as well as handling NCD risk factors through integrated non-communicable disease services (Pandu PTM) in accordance with the Pandu algorithm.

a. Criterion 4.5.1

Non-communicable disease prevention and control programs and their risk factors are planned, implemented, monitored and followed up.

1) Main Thoughts:

a) Increases in risk factors and non-communicable diseases not only have an impact on increasing morbidity, mortality and disability rates, but also result in loss of productivity which has an impact on the economic burden at the individual, family and community levels.

b) Efforts to control non-communicable diseases are carried out through various promotive and preventive activities without neglecting curative and rehabilitative measures.

c) Early detection or screening needs to be carried out to prevent an increase in PTM cases.

d) Efforts to control risk factors for non-communicable diseases, such as unhealthy eating patterns, lack of physical activity, smoking and other risk factors, are carried out in an integrated manner through a family approach with PIS-PK and community movements.

e) Promotive and preventive activities are carried out through the following efforts:

(1) Promotional

This effort is carried out by providing the widest possible information and education to the public so that awareness grows to take responsibility for their own health and the environment, including, among other things, by:

(a) carry out health promotion/KIE regarding the prevention and control of non-communicable diseases to the community at least once a month, including, among other things, healthy food consumption patterns and balanced nutrition, obesity prevention, smoking cessation, physical activity, risk factors for cervical cancer and breast cancer , other NCD risk factors, use of information and communication technology and other NCD materials; And

(b) provide KIE PTM media in printed form, downloadable links, or in other forms of media.

(2) Preventive

(a) Implementation of UKBM through the PTM Integrated Development Post (Posbindu).

1. Implementation of UKBM through PTM posbindu is carried out periodically and regularly and in accordance with the number of targets in carrying out early detection of NCD risk factors carried out by trained posbindu cadres.

(a) Measure Body Weight (BB);

(b) Measure Body Height (TB);

(d) Current Blood Sugar (GDs);

(e) Body Mass Index (BMI) and Abdominal Circumference (LP); And

(f) Examination of visual acuity (tumbling or counting fingers) and hearing acuity using a modified whisper test;

(g) COPD screening with the PUMA (Prevalence Study and Regular Practice, Diagnosis and TreatMent, Among General Practitioners in Populations at Risk of COPD in Latin America) questionnaire. The PUMA instrument is used to detect COPD using seven questionnaires with a score of more than seven, the patient is directed to continue the examination with spiro to confirm the diagnosis. Carried out at FKTP and posbindu by cadres or health workers;

(h) Providing education is carried out according to needs.

2. The stages of posyandu activities consist of five stages, namely

(a) participant registration;

(b) FR interview;

(c) FR measurements consisting of weight measurements, height measurements, abdominal circumference measurements, BMI calculations, PUMA interviews, as well as visual acuity and hearing acuity checks;

(d) FR PTM examination which consists of measuring blood pressure and checking blood sugar levels; And

(e) FR PTM identification, education, and early follow-up.

3. Maintenance of PTM posbindu supporting facilities is carried out by calibrating digital measuring instruments.

(b) Providing smoking cessation (UBM) counseling services through trained personnel.

(c) Creation of Non-Smoking Areas (KTR) in the Puskesmas environment through collaboration with district/city regional health offices and related agencies to encourage and supervise the implementation of KTR in seven settings (health facilities, schools, workplaces, places of worship, public transportation, places children's play area, and other designated public places).

(d) Prevention at FKTP is carried out through early detection of breast cancer and cervical cancer with clinical breast examination (SADANIS) and visual inspection with acetic acid (IVA) in women aged 30-50 years who have had sexual contact.

f) Curative and rehabilitative activities are carried out, among other things, through efforts

(1) strengthening access to integrated PTM services at Community Health Centers by strengthening the skills of health workers in handling PTM and PTM risk factors in accordance with the authority and competence at FKTP;

(2) strengthening the referral system from UKBM to FKTP;

(3) following up on the PTM Referback Program (PRB);

(4) follow up on community-based palliative services in accordance with the Standards; And

(5) providing services in accordance with clinical practice guidelines for doctors at Community Health Centers and NCD disease algorithms, including services for hypertension, DM, and early detection of cervical cancer and breast cancer.

g) Implementation of PTM by Puskesmas is carried out through the following activities:

(1) utilize obesity charts at the Community Health Center and outside the Community Health Center;

(2) provide guidance to PTM posbindu at least twice per year;

(3) providing a prediction chart for NCD risk factors for Community Health Centers that have implemented PTM Pandu; And

(4) strengthening skills in handling NCD cases, especially among doctors and health workers, which is carried out to prevent complications by training/workshops/increasing technical skills in handling NCD cases.

h) Determining stunting performance indicators is integrated with determining Puskesmas performance indicators.

i) Puskesmas carries out measurements and analysis of predetermined performance indicators. Analysis of indicator achievements is carried out using analytical methods in accordance with applicable guidelines and guidance, for example by referring to the situation analysis method contained in the Community Health Center Management Guidebook.

j) Recording and reporting of non-communicable disease control services and risk factors, both manually and electronically, is carried out completely, accurately, on time and in accordance with procedures. Reporting to the head of the community health center and district/city regional health service and/or other parties refers to the provisions of statutory regulations. Reporting to the head of the community health center can be done in writing or delivered directly through meetings such as monthly mini workshops, management review meetings, and other forums.

k) Implementation of monitoring, evaluation and follow-up is carried out in an integrated manner across programs and across sectors.

l) The non-communicable disease management program plan and its risk factors are prepared by prioritizing promotive and preventive efforts based on the results of analysis of non-communicable disease problems in the Puskesmas work area with cross-program involvement that is integrated with the RUK and RPK of UKM services as well as UKP, laboratory and pharmacy.

2) Assessment Elements:

a) Performance indicators for controlling non-communicable diseases are determined, accompanied by achievements and analysis (R, D, W).

b) Established a Non-Communicable Disease control program including a plan to increase the capacity of personnel related to P2PTM (R,W).

c) Non-communicable disease control activities are coordinated and implemented in accordance with plans that have been prepared jointly across programs and across sectors in accordance with established policies, guidelines, procedures and terms of reference (R,D,W).

d) Stages of PTM activities and inspections are carried out at Posbindu in accordance with applicable regulations (R,D,O,W).

e) Integrated management of Non-Communicable Diseases is carried out starting from diagnosis, treatment, monitoring, evaluation and follow-up in accordance with clinical practice guidelines and NCD service algorithms by competent health personnel (D, O, W).

f) Monitoring, evaluation and follow-up are carried out on the implementation of non-communicable disease control programs (D,W).

g) Recording is carried out and reporting is carried out to the head of the community health center and the district/city regional health service in accordance with established procedures (R, D, W).

Standard 4.4 Tuberculosis control program.

The Tuberculosis (TBC) Control Program was held in an effort to improve health services towards universal health coverage, especially strengthening primary health services by encouraging promotive and preventive efforts.

Puskesmas provides services to TB service users starting from finding TB cases in people suspected of TB, establishing a diagnosis, determining the classification and type of TB service users, as well as case management consisting of treatment of service users along with monitoring and evaluation to break the chain of transmission in accordance with the provisions of the legislation.

a. Criterion 4.4.1

Community Health Centers provide services to TB patients starting from finding TB cases in people suspected of TB, establishing a diagnosis, determining the classification and type of TB service users, as well as case management consisting of patient treatment along with monitoring and evaluation.

1) Main Thoughts:

a) Tuberculosis control is all health efforts that prioritize promotive and preventive aspects without neglecting curative and rehabilitative aspects aimed at protecting public health, reducing morbidity, disability or death, ending transmission, preventing drug resistance, and reducing the negative impacts resulting from tuberculosis.

b) Tuberculosis is an infectious disease problem both globally and nationally. Efforts to control the transmission of tuberculosis are one of the national priority programs in the health sector

c) Tuberculosis control programs are planned, implemented, monitored and followed up in an effort to eliminate tuberculosis.

d) Determination of TB performance indicators is integrated with the determination of Puskesmas performance indicators

e) TB patient services are carried out through:

(1) services for Drug Sensitive TB (SO) cases which consist of

(a) active and passive TB case finding;

(b) diagnosis is carried out according to the Standards by rapid molecular, microscopic and culture tests;

(d) monitoring of TB patients is carried out through microscopic examination at the end of the 2nd month, the end of the 5th month, and at the end of treatment.

(2) services for Drug Resistant TB (RO) cases are carried out by:

(a) active and passive TB case finding;

(b) the ability of the Community Health Center to screen TB RO cases and refer suspects for diagnosis if necessary

(d) the ability of the Community Health Center to carry out laboratory examination referrals and follow-up for TB RO service users.

(3) providing TB preventive treatment to children and PLWHA;

(4) providing education about transmission, prevention of TB disease, and cough etiquette to patients and families;

(5) provision of services by the Community Health Center in monitoring drug swallowing (PMO) for TB SO and TB RO patients;

(6) obligation to report TB cases to the management of the National TB Control Program;

(7) participation in strengthening the quality of the TB microscopic laboratory in accordance with the provisions of the TB program; And

(8) strengthening the role of cross-programs, cross-sectors and communities in implementing public private mix (PPM), involving professional organizations, health facility associations, BPJS, etc.

f) Promotive and preventive efforts are carried out in the context of TB control programs in accordance with established guidelines.

g) Tuberculosis control programs need to be prepared and coordinated, both in preventive and curative efforts at Community Health Centers, through strategies or strategies for direct supervision of short-term treatment or DOTS (directly observed treatment short course). To carry out this strategy, the Community Health Center formed a DOTS team.

h) To achieve the targets of the National TB Control Program, provincial and district/city governments must set regional level TB control performance indicator targets based on national targets and pay attention to national strategies which are then used as the basis for Puskesmas in setting targets and performance indicators that are monitored annually.

i) The Community Health Center measures the performance indicators that have been determined and is accompanied by an analysis of achievements. Analysis of indicator achievements is carried out using analytical methods in accordance with applicable guidelines/guidelines, for example by referring to the situation analysis method contained in the Community Health Center Management Guidebook.

j) The tuberculosis control program plan is prepared by prioritizing promotive and preventive efforts based on the results of analysis of tuberculosis control problems in the Puskesmas work area with cross-program involvement that is integrated with the RUK and RPK of UKM services as well as UKP, laboratory and pharmacy.

k) Recording and reporting of tuberculosis control services, both manually and electronically, is carried out completely, accurately, on time and in accordance with procedures. Reporting to the head of the community health center and district/city regional health service and/or other parties refers to the provisions of statutory regulations. Reporting to the head of the community health center can be done in writing or delivered directly through meetings such as monthly mini workshops, management review meetings, and other forums.

2) Assessment Elements:

a) Determine performance indicators and targets for tuberculosis control accompanied by achievements and analysis. (R, D, W).

b) Establish a tuberculosis control program plan (R).

c) A TB DOTS team is established at the Community Health Center consisting of doctors, nurses, laboratory analysts and trained reporting recording officers (R).

d) Logistics are available, both OAT and non-OAT, according to program needs and managed in accordance with procedures (R,D,O,W).

e) Management of tuberculosis cases is carried out starting from diagnosis, treatment, monitoring, evaluation and follow-up in accordance with established policies, guidelines and procedures (R, D, O, W).

f) Coordinate and implement the tuberculosis control program in accordance with plans prepared jointly across programs and across sectors (R, D, W).

g) Monitoring and evaluation are carried out as well as follow-up efforts to improve the tuberculosis control program (D,W).

h) Recording is carried out and reporting is carried out to the head of the community health center, district/city regional health service in accordance with established procedures (R, D, W).

Standard 4.3 Increase coverage and quality of immunization.

Increasing the coverage and quality of immunization is carried out in an effort to improve health services towards universal health coverage, especially strengthening primary health services, by encouraging promotive and preventive efforts.

Puskesmas implements immunization programs in accordance with statutory provisions.

a. Criterion 4.3.1

Immunization programs are planned, implemented, monitored and evaluated in an effort to increase immunization coverage and quality.

1) Main Thoughts:

a) As an effort to protect the public from infectious diseases that can be prevented through immunization, Community Health Centers are required to carry out immunization activities as part of the national priority program.

b) Determining immunization performance indicators is integrated with determining Puskesmas performance indicators.

c) The implementation of the immunization program at the Community Health Center needs to be planned, implemented, monitored and evaluated in order to achieve optimal immunization coverage.

d) Detailed planning (micro planning) includes area mapping, identifying and determining the number of targets, human resource requirements, determining needs, immunization implementation schedules, as well as logistics distribution schedules and mechanisms, and operational costs are prepared to ensure the implementation of the immunization program runs well. Detailed planning is prepared involving cross-related programs.

e) Follow-up actions to improve the immunization program based on the results of monitoring and evaluation are carried out including promotive and preventive efforts in the context of reaching targets and increasing immunization coverage through:

(1) sweeping activities, drop out follow up (DOFU), SOS (sustainable outreach services) activities for difficult geographic areas, defaulter tracking, backlog fighting, crash programs, and catch up campaigns;

(2) efforts to improve the quality of immunization through administering vaccines in accordance with procedures, administering immunizations safely and in accordance with procedures, target data validation activities, self-assessment of data quality (data quality self-assessment/DQS), and rapid comfort assessment (rapid convenience assessment/RCA) to validate the results of immunization coverage and periodic supervision; as well as

(3) efforts to mobilize the community with outreach activities through various communication media, increasing involvement across programs and related sectors, and establishing a community communication forum that cares about immunization.

f) Puskesmas carries out cold chain vaccine management in accordance with established procedures.

g) The Community Health Center measures the performance indicators that have been determined and is accompanied by an analysis of achievements. Analysis of indicator achievements is carried out using analytical methods in accordance with applicable guidelines/guidelines, for example by referring to the situation analysis method contained in the Community Health Center Management Guidebook.

h) Recording and reporting of immunization services, both manually and electronically, is carried out completely, accurately, on time, and in accordance with procedures with a predetermined report format which includes coverage of immunization performance indicators, stock and use of vaccines and other logistics, as well as conditions vaccine chain equipment and AEFI. Reporting to the head of the community health center and district/city regional health service and/or other parties refers to the provisions of statutory regulations. Reporting to the head of the community health center can be done in writing or delivered directly through meetings such as monthly mini workshops, management review meetings, and other forums.

i) Monitoring and evaluation is carried out periodically, continuously and in stages, then analysis is carried out and follow-up plans are made to improve the immunization program.

j) Plans for programs to increase and cover the quality of immunization are prepared by prioritizing promotive and preventive efforts based on the results of analysis of immunization problems in the Puskesmas work area with cross-program involvement that is integrated with the RUK and RPK for UKM services as well as UKP, laboratory and pharmacy.

2) Assessment Elements:

a) Determine performance indicators and targets for the immunization program accompanied by achievements and analysis (R, D, W).

b) Establish an immunization program (R,W).

c) Vaccines and logistics are available according to the needs of the immunization program (R,D,O,W).

d) Vaccine management is carried out to ensure that the vaccine chain is managed in accordance with procedures (R,D,O,W).

e) Activities to increase immunization coverage and quality are coordinated and implemented in accordance with plans and procedures that have been jointly established across programs and across sectors in accordance with established policies, guidelines, procedures and terms of reference (R,D,W).

f) Monitoring and evaluation are carried out as well as follow-up efforts to improve the immunization program (D,W).

g) Recording is carried out and reporting is carried out to the head of the community health center and the district/city regional health service in accordance with established procedures (R, D, W).

Standard 4.2 Reducing the number of maternal deaths and the number of infant deaths.

The program to reduce the number of maternal deaths and the number of infant deaths was carried out in an effort to improve health services towards universal health coverage, especially strengthening primary health services, by encouraging promotive and preventive efforts. Puskesmas provides health services for pregnant women, childbirth health services, postnatal health services, as well as newborn health services along with monitoring and evaluation in accordance with statutory provisions.

a. Criterion 4.2.1

Puskesmas provides health services for pregnant women, health services for mothers giving birth, health services for the postnatal period, and health services for newborns.

1) Main Thoughts:

a) Pregnant women's health services are every activity and/or series of activities carried out from the conception period until delivery.

b) Health services for pregnant women, childbirth, the postnatal period and newborns are carried out in accordance with the standards in the applicable guidelines.

c) Health service efforts for pregnant women are implemented in an integrated manner with cross-programs in the context of reducing stunting.

d) Services during pregnancy include services in accordance with quantity standards and quality standards.

(1) The quantity standard is a minimum of six visits during the pregnancy period (K6) with the following conditions:

(a) once in the first trimester.

(b) twice in the second trimester.

(2) Quality Standards, namely antenatal services that meet the 10 Ts which include:

(a) measurement of body weight and height;

(b) blood pressure measurement;

(d) measurement of the height of the top of the uterus (fundus uterine);

(e) determination of fetal presentation and fetal heart rate (FHR);

(f) providing immunizations according to immunization status;

(g) administering blood supplement tablets of at least 90 tablets;

(h) laboratory tests;

(i) case management/handling; And

(j) conversation (counseling)

e) Determining stunting performance indicators is integrated with determining Puskesmas performance indicators.

f) Maternal health services, hereinafter referred to as delivery, are any activity and/or series of activities aimed at the mother from the start of labor until 6 hours after giving birth.

g) Services during childbirth according to standards include:

(1) normal delivery.

(2) labor with complications

h) The standard for normal delivery is Normal Childbirth Care (APN) according to the Standard, namely

(1) carried out in a health facility.

(2) a minimum of 3 helpers, consisting of:

(a) doctors, midwives and nurses; or

(b) doctor and 2 (two) midwives.

i) Standards for births with complications refer to the Maternal Health Services Pocket Book at FKTP and FKRTL.

j) Postnatal health services are any activities and/or series carried out aimed at the mother during postpartum (6 hours to 42 days after giving birth).

k) Postnatal health services are carried out at least four times, namely as follows.

(1) The first service is carried out 6 - 48 hours after delivery

(2) The second service is carried out 3 - 7 days after delivery

(3) The third service is carried out 8 - 28 days after delivery

(4) The fourth service is carried out 29 - 42 days after delivery.

Services are carried out with a scope that includes:

(1) examination and management using the postpartum management algorithm;

(2) identification of risks and complications;

(3) managing risks and complications;

(4) counseling; And

(5) recording in maternal and child health books, maternal cohorts and maternal cards/medical records;

l) Newborn health services are provided through essential neonatal health services in accordance with the Standards. Essential neonatal health services are provided when the baby is 0-28 days old.

m) Newborn baby services include services in accordance with quantity standards and quality standards.

(1) Standard service quantity is a minimum of three visits during the neonatal period with the following conditions:

(a) Neonatal Visit 1 (KN1) 6-48 hours

(b) Neonatal Visit 2 (KN2) 3-7 days

(2) The quality standards set are as follows:

(a) Essential Neonatal Services at Birth (0—6 hours).

Essential neonatal care at birth includes:

1. neonate care in the first 30 seconds;

2. keeping the baby warm;

3. cutting and caring for the umbilical cord;

4. early initiation of breastfeeding (IMD);

5. providing identity;

6. vitamin K1 injection;

7. administering antibiotic ointment/eye drops;

8. physical examination of the newborn;

9. determination of gestational age;

10. immunization (injection of hepatitis B0 vaccine);

11. monitoring danger signs; And

12. Referral of cases that cannot be treated in a stable condition in a timely manner to more capable health facilities.

(b) Essential Neonatal Services After Birth (6 hours - 28 days).

Essential neonatal care after birth includes:

1. keeping the baby warm;

2. counseling on newborn care and exclusive breastfeeding;

3. health examination using the Integrated Management Standards for Sick Toddlers (MTBS) and the KIA book;

4. giving vitamin K1 to those born not in a health facility or who have not received a vitamin K1 injection;

5. Hepatitis B immunization injection for babies less than 24 hours old who were born without assistance from health personnel;

6. care using the kangaroo method for low birth weight (LBW) babies; And

7. handling and referring cases of neonatal complications.

n) Community health centers that provide delivery services must carry out services and provide equipment, medicines and infrastructure for maternal and newborn health services, including standard maternal emergency equipment in accordance with their authority based on statutory provisions.

o) To ensure the success of implementing the program to reduce the number of maternal deaths and the number of infant deaths, promotive and preventive efforts are carried out with cross-program and cross-sector involvement as well as community empowerment. The form of involvement in this activity can be the formation of coordination within a team which aims to reduce the number of maternal deaths and the number of infant deaths at the sub-district level, namely by having the Desa Siaga program with a birth planning and complication prevention (P4K) program approach, Husband Standby, and empowerment activities. other.

p) The Community Health Center measures the performance indicators that have been determined and achieves an analysis. Analysis of indicator achievements is carried out using analytical methods in accordance with applicable guidelines/guidelines, for example by referring to the situation analysis method contained in the Community Health Center Management Guidebook.

q) Recording and reporting of health services for pregnant women, postpartum women, postpartum mothers, newborns and infants is carried out manually or electronically completely, accurately, on time, and in accordance with procedures covering the scope of the family health program, cohort recording, reporting of maternal deaths, stillbirths and neonatal deaths, post-natal infant deaths, as well as filling out and utilizing the KIA book. Reporting to the head of the community health center and district/city regional health service and/or other parties refers to the provisions of statutory regulations. Reporting to the head of the community health center can be done in writing or delivered directly through meetings such as monthly mini workshops, management review meetings, and other forums.

r) The program plan to reduce the number of maternal deaths and the number of infant deaths is prepared by prioritizing promotive and preventive efforts based on the results of an analysis of the problem of maternal mortality and infant mortality in the Puskesmas work area by involving cross-programs that are integrated with the RUK and RPK of UKM services as well as UKP, laboratories and pharmacy.

Assessment Elements:

a) Establishment of performance indicators and targets in order to reduce the number of maternal deaths and the number of infant deaths accompanied by achievements and analysis (R, D, W).

b) Establish a program to reduce the number of maternal deaths and the number of infant deaths (R,W).

c) Available tools, medicines, consumables and supporting infrastructure for maternal and newborn health services including standard maternal and neonatal emergency equipment in accordance with standards and managed in accordance with procedures (R, D, O, W).

d) Provide health services during pregnancy, delivery, postnatal period, and for newborns in accordance with established procedures; It is stipulated that it is mandatory to use a partograph during delivery assistance and pre-referral stabilization efforts in cases of complications, including services at Community Health Centers capable of PONED, in accordance with established policies, guidelines, procedures and terms of reference (R,D,W).

e) Coordinated and implemented programs to reduce the number of maternal deaths and the number of infant deaths in accordance with regulations and activity plans prepared jointly across programs and across sectors (R, D, W).

f) Monitoring, evaluation and follow-up are carried out on the implementation of the program to reduce the number of maternal deaths and the number of infant deaths, including health services during pregnancy, childbirth and for newborns at Community Health Centers (D, W).

g) Recording is carried out, then reporting is carried out to the head of the community health center and the district/city regional health service in accordance with established procedures (R, D, W).

SCIENCE, HISTORY AND TECHNOLOGY

Friday, February 9, 2024

accreditation of primary health facilities

CHAPTER 5 Improving the Quality of Community Health Centers.

CHAPTER 4 National Priority Programs

CHAPTER 3 Implementation of Individual Health Efforts,Laboratory, and Pharmacy;

CHAPTER 2 Implementation of Public Health Efforts Oriented to Promotive and Preventive Efforts;

CHAPTER 1 Leadership and Management of Community Health Centers;

Thursday, February 8, 2024

Criterion 5.5.6 INFECTION OUTBREAK

Criterion 5.5.5 PPI TRANSMISSION PRECAUTIONS

Criterion 5.5.4 IPC HAND CLEANLINESS

Criterion 5.5.3 IPC IMPLEMENTATION

Criterion 5.5.2 IDENTIFICATION OF INFECTION RISK

Criterion 5.5.1 IPC PROGRAM

Criterion 5.4.2 QUALITY AND SAFETY CULTURE

Criterion 5.4.1 IKP REPORTING

Criterion 5.3.6 RISKS OF PATIENT FALLS

Criterion 5.3.5 HAND CLEANLINESS KP

Criterion 5.3.4 PROCEDURE COMPLIANCE

Criterion 5.3.3 SAFETY OF MEDICINES

Criterion 5.3.2 EFFECTIVE COMMUNICATION

Criterion 5.3.1 PATIENT IDENTIFICATION

Criterion 5.2.2 RISK MANAGEMENT

Criterion 5.2.1 IDENTIFICATION OF RISK

Criterion 5.1.4 IMPROVING PDSA QUALITY

Criterion 5.1.3 VALIDATION OF INDICATOR DATA

Criterion 5.1.2 QUALITY INDICATORS

Wednesday, February 7, 2024

Criterion 5.1.1 QUALITY IMPROVEMENT PROGRAM

Standard 4.5 Control of non-communicable diseases and their risk factors.

Standard 4.4 Tuberculosis control program.

Standard 4.3 Increase coverage and quality of immunization.

Standard 4.2 Reducing the number of maternal deaths and the number of infant deaths.