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Jurnal Manajemen Pelayanan Kesehatan
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NURSE-PHYSICIAN COLLABORATIVE PRACTICE IN INTERDISCIPLINARY MODEL OF PATIENT CARE Susilaningsih, Francisca Sri
Jurnal Manajemen Pelayanan Kesehatan Vol 14, No 02 (2011)
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Latar belakang: Penelitian tentang kolaborasi antara dokterdan perawat dalam asuhan pasien pada model pelayananrawat inap terpadu (MPRIT) merupakan bagian dari actionresearch yang bertujuan untuk mengembangkan model asuhanpasien sebagai basis integrasi antar profesi dalam pelayanankesehatan di rumah sakit pendidikan Hasan Sadikin. Modelpelayanan rawat inap terpadu (MPRIT) dikembangkan untukmeningkatkan tata kelola pelayanan pasien di tatanan rawatinap guna mengatasi fragmentasi pelayanan karena tumpangtindihnya peran dan fungsi care provider dengan latar belakangprofesi yang berbeda. Diharapkan potensi kerawanan terhadapberbagai kesalahan dapat diantisipasi dan diminimalisasi, sertakeutuhan dan kesinambungan pelayanan pasien dapatdiwujudkan. Tujuan penelitian ini adalah untuk mengidentifikasikerjasama dokter dan perawat secara kohesif dalam empatkomponen model yaitu alur proses pengelolaan pasien,pengelolaan pasien secara tim, dokumentasi asuhan pasiensecara terpadu dan pemecahan masalah secara interdisiplin.Metode: Penelitian ini menggunakan studi deskriptif untukmengidentifikasi perilaku afiliasi dan perilaku individu padakelompok dokter dan perawat yang menjalani proses kolaborasidalam pelayanan pasien di unit dengan MPRIT. Sejumlah 39dokter dan 32 perawat berpartisipasi dalam penelitian ini.Instrumen untuk mengukur perilaku afiliatif dan perilaku individudikembangkan berdasarkan konsep pelayanan interdisiplin dariSullivan. Kohesivitas dokter dan perawat dalam kolaborasiasuhan diukur dengan uji beda rerata skor perilaku afiliasi danperilaku individu pada keempat komponen model.Hasil: Rerata skor perilaku afiliatif secara signifikan lebih besardari perilaku individu pada tiga komponen model yaitu alur prosespengelolaan pasien, pengelolaan pasien secara tim, danpenyelesaian masalah secara interdisiplin. Temuan inimengindikasikan bahwa dalam proses kolaborasi, dokter danperawat cenderung menggunakan pendekatan share expertisedaripada personal autonomy. Hal ini merupakan ciri kohesivitaskelompok. Baik pada kelompok dokter maupun perawat, rerataskor perilaku afiliasi lebih besar dari perilaku individu. Pada ujibeda rerata skor perilaku individu antara dokter dan perawat,tidak ada perbedaan yang bermakna pada alur prosespengelolaan pasien dan dokumentasi asuhan terpadu. Adapunpada pengelolaan pasien secara tim dan penyelesaian masalahsecara interdisiplin, rerata skor perilaku individu dokter secarabermakna lebih besar dari perawat. Pada uji beda rerata skorperilaku afiliasi antara kelompok dokter dan perawat, tidak adaperbedaan yang signifikan di alur proses pengelolaan pasiendan pengelolaan pasien secara tim. Adapun untuk dokumentasiasuhan terpadu dan penyelesaian masalah secara interdisiplin,secara signifikan rerata skor perilaku afiliasi dokter lebih besardari perawat.Kesimpulan: Share expertise merupakan ciri penting perilakuafiliasi yang diperlukan untuk mewujudkan kerja sama yangkohesif antar pelaku pelayanan kesehatan. Penelitian inimenyimpulkan bahwa dokter dan perawat bekerjasama secarakohesif pada alur proses pengelolaan pasien dan pengelolaanpasien secara tim.Kata kunci: kolaborasi, dokter-perawat, interdisiplin, perilakuafiliasi, perilaku individu
MEMPERBAIKI PENCAPAIAN PRESTASI KESEHATAN DAN KESELAMATAN KERJA MELALUI PENDEKATAN PERILAKU TENAGA KERJA M. Ramdan, Iwan
Jurnal Manajemen Pelayanan Kesehatan Vol 14, No 02 (2011)
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So far, the approach used to assess the company’s achievementof occupational health and safety (OHS) performance are moreretrosfective and based on statistics of occupational accidentand work related disease in the past, though this approachcontains a lot of weaknesses. Likewise, prevention and reductionof occupational injuries and work related disease was not basedon behavioral approaches, whereas the main causes ofoccupational injuries and work related disease is a behavioralfactor of labor. In fact, until now the performance of IndonesianOHS has not been prideful yet.The research proves that the determinant of laborbehavior (self-efficacy and perceptions of OHS) has beensignificantly positively related to achievement of OHSperformance, and as a strong predictor for predictingachievement of OHS performance. To improve achievement ofOHS performance in the future, the results of this study isrecommended for use because it has several advantages overretrosfective approaches. This research also has mademeasuring tool that has proven valid, reliable and fit to assessself efficacy and perception of labor specific to the field ofOHS. This instrument can be used as additional tests inthe recruitment of new workers or for work rotation at thecompany.Keywords: achievement of OHS performance,proactive approach, self-efficacy questioner and OHSperceptions questione
STUDI PENGGUNAAN OBAT ANTI TUBERKULOSIS PADA PASIEN TB-HIV/AIDS DI RSUP SANGLAH DENPASAR TAHUN 2009 Lisiana, Novi
Jurnal Manajemen Pelayanan Kesehatan Vol 14, No 02 (2011)
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Background and Objective: A retrospective descriptive studyof anti-tuberculosis drugs in patients with TB - HIV/AIDS whowere hospitalized Nusa Indah Sanglah Hospital 2009 aims todetermine suitability of the use of anti-tuberculosis (OAT) tothe National Treatment Guidelines 2008 which consists of typesof drugs, combination drug and dosage, also to identify druginteractions that do occur based on the level of significance.Results and Conclusions: The results showed that the useof OAT category 1 has the largest percentage of 61.7% andthen use of a combination of streptomycin with ethambutolwhich is 12%, then use of isoniasid and rifampin which has apercentage of 6%. The percentage of the correct dose 60.9%,8.7% is not appropriate, and not identified was 30.4%. Usageof the appropriate OAT that is equal to 74% and 26% did notdeserve. Drug interactions occurred in 23 patients with asignificant percentage of drugs that interact with a percentageof 11.1%, the importance of 2 namely 33.3%, the importanceof 3 namely 0%, significance 4 namely 16.7%, and thesignificance was 5 of 55, 6%.Keywords: tuberculosis, TB-HIV/AIDS, suitability
REDESIGN PELAYANAN FARMASI DENGAN METODE FAILURE MODE AND EFFECT ANALYSIS Supriyanti, Eri
Jurnal Manajemen Pelayanan Kesehatan Vol 14, No 02 (2011)
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Background: Pharmacy service is a high risk area in thesupport of health service quality. PKU Muhammadiyah Hospitalis a hospital that respons to systematic movement in servicesthat focus on patient safety such as minimizing the incidenceof medication error that often happens. This condition requiresnew design that can minimize risk for the incidence of medicationerrorr by implementing Failure Mode and Effect Analysis (FMEA)method as a systematic and proactive method that improvesquality of hospital service.Objective: To design new service quality at PKUMuhammadiyah Hospital Yogyakarta by identifying risk formedication error in the process of drug use, factors that caninduce the incidence of medication error in the process druguse and make new design that can minimize risk for medicationerror of PKU Muhammadiyah Hospital Yogyakarta.Method: This study used action research. This design waschosen to involve subject of the study more actively in doing theredesign of pharmacy service using FMEA method to minimizerisk for the incidence of medication error. Subject of the studywere all incidents of medication error in the process of drug useincluding related health staff involved in the process of druguse. Primary were data obtained from indepth interview, groupdiscussion, focuses group discussion, and workshop.Result: Failure Mode and Effect Analysis (FMEA) method wasexpected to minimize errors in drug use system at outpatientpharmacy service at PKU Muhammadiyah Hospital Yogyakarta.Through FMEA method it was identified that the highest RiskPriority Number (RPN) was failure in confirmation with doctors(294), failure in identifying drug name (216). In this study newdesigns proposed as pilot project were change of layout ofdrug identification color sticker according to therapy class; thedetermination of standard operating procedure ofcommunication with doctors giving prescription, confirmationwith doctors for non cito prescription and procedure ofimplementation of outpatient pharmacy service supervision.Trial of layout of drug identification color sticker was carriedbecause it did not need high cost and was relatively easy tosocialize and do. The result of evaluation after new designintervention was declining value of RPN for failure incommunication with doctors (from 294 to 196) and failure inidentifying drug name (from 216 to 144).Conclusion: The new design implemented was relativelyeffective in minimizing errors in identifying drug name andminimizing failure in communication with doctors.Keywords: medication error, failure mode and effect analysis,redesign
ANALISIS NILAI PELANGGAN PADA PASIEN POLI ONKOLOGI RS KANKER X DAN PELAYANAN PENYAKIT KANKER TERPADU RSUP Y TAHUN 2010 Ayuningtyas, Dumilah
Jurnal Manajemen Pelayanan Kesehatan Vol 14, No 02 (2011)
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Background: It is crucial for hospitals to concentrate on whatis needed by service users, rather than what is provided atthe hospital. Customers will choose the health care providerthat offers maximum value. Creation and delivery of value tocustomers is an effective marketing strategy for hospitals. Sothat, hospitals need to know the position of its value in theeyes of customers and compared with competitors.Objective: To understand the overview of Customer Value inPoly Oncology Dharmais Cancer Hospital compared with PolyPPKT Y Hospital in 2010.Methods: This study uses quantitative research methods byinterviewing 100 respondents in Poly Oncology DharmaisCancer Hospital and Poly PPKT Y Hospital to obtain primarydata.Results: Results showed that customer value in PolyOncology lower than customer value in PPKT. However, in thevalue map, customer value in Poly Oncology is in quadrantexpensive, which means having the opportunity to gain marketshare greater than PPKT which value is in quadrant discount.Conclusion: Attributes of service at Poli Oncology and PPKTstill needs to be improved by conduct training for nurses aboutcustomer service, increase social activities in society, andgive more attention to health facilities.Keywords: customer value, benefits, costs
KAJIAN PENGEMBANGAN DESA SIAGA DI KABUPATEN OGAN ILIR Misnaniarti, Misnaniarti
Jurnal Manajemen Pelayanan Kesehatan Vol 14, No 02 (2011)
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Background: One strategy to achieve Healthy Indonesia isalert village program as stipulated in Decree of the Minister ofHealth number 564/Menkes/SK/VIII/2006. The observationthrough document review of Ogan Ilir health profile in year2007, environment-based morbidity is still high at 7.011 casesof diarrhea, 30 cases of dengue fever, 68 cases of clinicalmalaria and 11.637 cases of upper respiratory infections and295 cases of pulmonary tuberculosis. It showed that thererestill health problems that need to be handled by both governmentand society.Objective: Objective of this research was to developrecommendations of alert village development based on localresources in Ogan Ilir district.Methods: This was an observational study with quantitativeand qualitative approaches. The data was collected in OganIlir Health Office, all Health Centers in the working area ofOgan Ilir, and 40 villages that have become the pilot of alertvillage program in Ogan Ilir.Results: Development of alert villages in Ogan Ilir still topdown, and the establishment of alert villages have not beenfully utilizing the potency of various community based healthactivities.Conclusion: The community empowerment still needs to beimproved so that local community can dig their own potentialresources. The local government and health centers only asfacilitators.Keywords: alert village, community based health activities,community empowerment.
GURU SEKOLAH DASAR SEBAGAI AGEN PENGUBAH UNTUK PREVENSI TERHADAP KEKERASAN SEKSUAL PADA ANAK-ANAK Paramastri, Ira
Jurnal Manajemen Pelayanan Kesehatan Vol 14, No 02 (2011)
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Background: The Child Sexual Abuse (CSA) is sexual activityconducted by adult, elder people or a child to their peer. Theimpact of sexual abuse could be of physical, psychological aswell as social traumas. The CSA data varies based on itsresources. The phenomenon was not always be reported, asthe child was lacking of courage/will to report, lacking of familysupport to be brave to provide the reports to the police orlacking of various parties for the child protection. To protectchild, it needs a prevention strategy to reduce the rate of thecases. The teachers so far are seen as capable figures to bethe agent of change for their students.Objectives: The objective of the research was to test theappropriateness of the Elementary School Teachers as theagent of change for the CSA prevention.Method: The research used a quasi experiment with pretestposttestcontrol group design. The subject of the researchwere the teachers of “NC elementary school” and “LP 1elementary school” whom purposively taken and the chosenof “NC elementary school” as the control group and the “LP1elementary school” as the experiment group on random basis.Each elementary school teacher was evaluated of their CSAknowledge on pre and post intervention basis. The programintervention was conducted by research team.Results: The result shows that before the experiment wasconducted, the knowledge of the two groups on an equalposition therefore the precondition of an experiment wasfulfilled and the experiment was able to be conducted (p>0,05).There were a raise of knowledge from = 29,32 to become= 32,18, although this result was not statistically significant.Unlike the experiment group, the control group showed aknowledge differentiation on pre and post of the intervention(p<0,05), It shows by = 28,29 to be = 29,52. Before theintervention there were no differentiation between the twogroups (p>0,05), nevertheless the mean of the control groupis = 28,29 or lower than the mean of the experiment groupof = 29,32. As well as after the intervention, the two groupsdid not show differentiation (p>0,05), however the mean ofcontrol group is = 29,52 or lower than the experiment groupof = 32,18. The response of the teachers from the twoelementary schools toward the program was very good andthey committed to support and willing to widely share it to theirstudents. Furthermore, the teachers from the control groupsuggested share it to the local district level.Conclusion: Although statistically it did not show anydifferentiation, but practically, the teachers could become theagent of change for CSA prevention.Keywords: teacher, agent of change, prevention, CSA
Tenaga Kerja Kesehatan dalam Usaha Penurunan MDG4 dan MDG5: Sebuah Potret dan Harapan Aksi Segera Trisnantoro, Laksono
Jurnal Manajemen Pelayanan Kesehatan Vol 14, No 02 (2011)
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Di berbagai provinsi di Jawa dilaporkan angkakematian ibu stagnan bahkan ada yang memburukdalam waktu empat tahun terakhir ini. Di provinsiIndonesia timur, kematian bayi dilaporkan memburuksejak tahun 2000 ketika desentralisasi kesehatandijalankan. Mengapa hal ini terjadi? Apa saja faktorfaktoryang mempengaruhinya?Dalam tajuk ini, secara khusus dibahasmengenai peranan tenaga kesehatan saat ini untukusaha penurunan MDG4 dan MDG5. Potret situasitenaga kesehatan saat ini adalah jumlah kurang,distribusi tidak merata, kerja sama antar profesikurang, dan kompensasi yang tidak sesuaiharapan. Kekurangan tenaga kesehatan terjadi didaerah maju seperti Jawa dan tentunya di daerahsulit seperti Papua ataupun Nusa Tenggara Timur(NTT). Di Jawa masih terjadi kekurangan dokterspesialis obsgin, anastesi, serta anak di berbagaikabupaten. Di daerah sulit seperti NTT dan Papuaterjadi kekurangan dokter spesialis, dokter, bidan,dan perawat yang sangat besar. KesenjanganSumber Daya Manusia (SDM) Kesehatan di 32Kabupaten/Kota sangat mencolok. Di DKI Jakartaada sekitar 450-an dokter anak sementara diBengkulu kurang dari 10. Di Jakarta lebih dari 150tenaga spesialis anastesi bekerja, sementara di NTTtidak ada satupun spesialis yang bekerja penuhwaktu.Dalam pelayanan kesehatan ibu dan anak,terlihat bahwa kerja sama antar profesi kurang.Kesehatan ibu dan anak seolah identik dengan bidandan dokter spesialis. Peranan dokter umum mengecildalam dekade ini. Dokter umum menjadi profesiyang kurang terlatih dalam pelayanan kesehatan ibudan anak. Kurikulum pendidikan dokter cenderungmenempatkan dokter umum sebagai penonton dalamemergensi kebidanan. Sementara itu, jumlahspesialis obsgin sangat kurang. Sayangnyaperhimpunan spesialis dan kolegiumnya terkesantidak bersedia memberikan keahliannya ke dokterumum di daerah yang tidak ada atau kekuranganspesialis obsgin. Keadaan SDM ini diperparahdengan sistem kompensasi yang tidak menarik untukmelakukan pelayanan kesehatan ibu dan anakkhususnya yang melalui program jaminankesehatan.Mengingat momen pencapaian target MDG4 danMDG5 di tahun 2015 sudah dekat, walaupun sudahagak terlambat, faktor SDM perlu diangkat sebagaiisu strategis. Tanpa SDM yang baik maka upayamengurangi kematian ibu dan anak tidak akantercapai di tahun 2015, termasuk upaya mengurangigap antara provinsi timur dan barat.Dalam hal SDM, ada beberapa isu stretegis yangperlu dibahas. Isu strategis pertama adalah perlunyatenaga kerja kesehatan bekerja bersamamenggunakan prinsip pencegahan primer sampaisekunder/tertier dengan menggunakan pendekatanperjalanan alamiah penyakit. Analisis kebijakanmenunjukkan bahwa kebijakan nasional tentangkesehatan ibu dan anak banyak berada di masyarakatdan puskesmas. Seiring dengan situasi ini, kebijakannasional tentang tenaga kerja di MDG 4 dan MDG 5banyak membahas bidan, jarang untuk dokter danspesialis. Di samping itu, ada kecenderungankebijakan kesehatan ibu dan anak tidak membahaspelayanan kuratif. Dalam penyusunan danpelaksanaan kebijakan terlihat ada pemisahankegiatan antara pelayanan primer dengan sekunderdan tertier. Akibatnya rumah sakit dan tenaga kerjanyadalam kondisi terabaikan dalam MDG4 dan MDG5,padahal saat ini di Jawa kematian ibu banyak terjadidi rumah sakit. Aksi strategis yang diperlukan dalamisu ini adalah: (1) Meningkatkan pemahaman tentangperlunya kerja sama pelayanan primer sampaisekunder-tertier; dan (2) Meningkatkan jumlah dankerja sama antar profesi dalam MDG4 dan MDG5.Dalam konteks aksi strategis ini patut dicatatbahwa Kemenkes melakukan penggabunganpembinaan pelayanan kesehatan primer dansekunder-tertier. Ada dua Ditjen dengan nama dantugas baru yaitu Ditjen Bina Upaya Kesehatan danDitjen Bina Gizi dan KIA. Bersama dua Ditjen baruini diharapkan koordinasi pelayanan primer dengansekunder/tertier menjadi lebih baik di pelayanankesehatan ibu dan anak.Isu strategis kedua adalah perlunya inovasidalam menambah jumlah dokter spesialis dankemampuan tenaga kesehatan di berbagai tempat.Sebagai gambaran saat ini mutu sistem rujukanmasih buruk. Di daerah sulit, PONED dan PONEK24 jam sulit berjalan karena kekurangan SDM.Di banyak kabupaten di Jawa, pelaksanaanPONEK sulit 24 jam karena terbatasnya jumlah SDMdan sistem manajemen tidak memungkinkan. Apainnovasi strategisnya? (1) perlu dilakukan inovasimenambah jumlah tenaga melalui sistem kontrakseperti yang dilakukan Program Sister Hospital NTT;(2) perlu mendayagunakan residen. Residen saat inidapat dikembangkan sebagai tenaga yang tidakhanya belajar tetapi juga bekerja. Residen dalamproses pendidikannya ditempatkan di RS yangkekurangan tenaga dan dibayar sesuaikompetensinya; (3) perlu melakukan Task-Shifting.Definisi Task-Shifting menurut WHO adalah: Taskshifting involves the rational redistribution of tasksamong health workforce teams. Specific tasks aremoved, where appropriate, from highly qualifiedhealth workers to health workers with shorter trainingand fewer qualifications in order to make moreefficient use of the available human resources forhealth. Melalui adanya Task-Shifting ini kebutuhantenaga kesehatan secara sementara dapat diatasi,namun perlu pendidikan tenaga kesehatan yangsebenarnya; (4) perlu melakukan kontrak tenaga dipelayanan kesehatan primer. Saat ini memang sudahada kontrak tenaga (dokter, bidan), namun kontrakbersifat perorangan yang kurang efektif. Di daerahsulit tenaga kontrak perorangan cenderungberkumpul di kota kabupaten. Kontrak perludilakukan secara kelompok dan menjamin aspekkeamanan serta logistik. Inovasi ini membutuhkankemitraan antara pemerintah dan swasta. LembagaSwadaya Masyakarat sebaiknya ada yang bisamenjadi kontraktor untuk menyediakan tenagasecara kelompok (dokter, bidan, perawat,epidemiolog, dan lain-lain).Isu strategis ketiga adalah memperhatikaninsentif bagi tenaga kesehatan. Sebagaimanadiketahui tenaga kesehatan sebagai makhlukekonomi mempunyai kepuasan hidup yang diukurdengan: (1) tingkat pendapatan yang terdiri dari: gajidan insentif dari praktik; serta (2) waktu yang dapatdipakai untuk rekreasi. Saat ini penetapan insentiftenaga kesehatan masih berdasarkan asumsi.Pemerintah belum pernah melakukan negosiasidengan ikatan profesi. Sementara itu, ikatan profesimasih belum mempunyai standar pendapatan daninsentif bagi anggotanya yang wajar. Sebagaigambaran penetapan insentif dalam Jampersal,ditolak oleh sebagian bidan karena tidak sesuaidengan harapan. Insentif dokter dalam sistemkapitasi puskesmas juga dirasakan sangat kurangoleh para dokter.Sebagai penutup dapat ditegaskan bahwa targetMDG 4 dan MDG 5 di tahun 2015 sulit tercapai tanpainovasi dalam kebijakan tenaga kerja kesehatan.Dalam hal ini perlu ada keberanian untuk melakukanaksi yang bertujuan mengurangi kematian ibu dananak dengan memperhatikan isu-isu strategis.Laksono Trisnantoro (trisnantoro@ yahoo.com)
REDESIGN PELAYANAN FARMASI DENGAN METODE FAILURE MODE AND EFFECT ANALYSIS Supriyanti, Eri; Kristin, Erna; Djasri, Hanevi
Jurnal Manajemen Pelayanan Kesehatan Vol 14, No 02 (2011)
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Background: Pharmacy service is a high risk area in thesupport of health service quality. PKU Muhammadiyah Hospitalis a hospital that respons to systematic movement in servicesthat focus on patient safety such as minimizing the incidenceof medication error that often happens. This condition requiresnew design that can minimize risk for the incidence of medicationerrorr by implementing Failure Mode and Effect Analysis (FMEA)method as a systematic and proactive method that improvesquality of hospital service.Objective: To design new service quality at PKUMuhammadiyah Hospital Yogyakarta by identifying risk formedication error in the process of drug use, factors that caninduce the incidence of medication error in the process druguse and make new design that can minimize risk for medicationerror of PKU Muhammadiyah Hospital Yogyakarta.Method: This study used action research. This design waschosen to involve subject of the study more actively in doing theredesign of pharmacy service using FMEA method to minimizerisk for the incidence of medication error. Subject of the studywere all incidents of medication error in the process of drug useincluding related health staff involved in the process of druguse. Primary were data obtained from indepth interview, groupdiscussion, focuses group discussion, and workshop.Result: Failure Mode and Effect Analysis (FMEA) method wasexpected to minimize errors in drug use system at outpatientpharmacy service at PKU Muhammadiyah Hospital Yogyakarta.Through FMEA method it was identified that the highest RiskPriority Number (RPN) was failure in confirmation with doctors(294), failure in identifying drug name (216). In this study newdesigns proposed as pilot project were change of layout ofdrug identification color sticker according to therapy class; thedetermination of standard operating procedure ofcommunication with doctors giving prescription, confirmationwith doctors for non cito prescription and procedure ofimplementation of outpatient pharmacy service supervision.Trial of layout of drug identification color sticker was carriedbecause it did not need high cost and was relatively easy tosocialize and do. The result of evaluation after new designintervention was declining value of RPN for failure incommunication with doctors (from 294 to 196) and failure inidentifying drug name (from 216 to 144).Conclusion: The new design implemented was relativelyeffective in minimizing errors in identifying drug name andminimizing failure in communication with doctors.Keywords: medication error, failure mode and effect analysis,redesign

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