Implementation of Patient Safety Management in Efforts to Improve

the Quality of Hospital Services

Sontina Saragih

Abstract
Patient safety is a priority and the main responsibility for all hospital staff, because
prioritizing patient safety can influence the level of hospital quality. The hospital is a place
for patient health and safety. The aim of this research is to find out an overview of the
implementation of patient safety in hospitals based on 6 patient safety targets. This
research uses literature review and analysis methods, namely by collecting, reading,
recording and processing data related to efforts to implement patient safety in efforts to
improve the quality of hospital services. The results of this research from the literature
review were obtained from
6 indicatorsof patient safety targets from accuracy of identification. patients, increasing
effective communication, increasing the use of drugs that need to be monitored, ensuring
the right location, correct procedure and correct operation, reducing the risk of infection
related to health services, reducing the risk of patient falls. Many hospitals, especially
health workers, have fulfilled these target indicators. It is recommended that health
workers must strictly comply with SOPs in accordance with applicable regulations, this is
useful as an indicator of achieving 100% patient safety targets.
Keywords: Hospital, Patient Safety,6 Patient Safety

Introduction
Hospitals are health service institutions that have direct contactwith patients,
they must prioritize safe, high-quality, anti-discriminatory and effective health
services by prioritizing the interests of patients in accordance with established
hospital service standards. Based on the Law on Health and Hospitals No. 44 of
2009, patients as users of health services have the right to obtain security and
safety while undergoing treatment in hospital. So, the hospital is the place to get
health facilities and the place to get patient safety, but the health service place will
not be free from the risk of undesirable things happening at work and accidents in
patient care.
World Health Organization (2022) Patient safety is a care action that aims to
prevent and reduce risks, errors and losses that occur to patients during the provision
of health services. Ballard 2003 (in Tri, 2023) Patient safety is the responsibility of all
parties related to health service providers. Stakeholders have responsibility to ensure
Nothere are actions that endanger the patient. The public, patients, doctors, nurses,
health workers, researchers, professionals, hospital accreditation institutions and
the government have a shared responsibility for patient safety efforts. Choudhury
& Asan (2020) Patient safety goals when implemented correctly, can help
improve patient safety through improving error detection, patient stratification,
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and medication management.

RI Minister of Health Regulation No. 11 of 2017 concerning Patient Safety, with
the aim of improving the quality of health service facilities through implementing risk
management in all aspects of services provided by health service facilities. According
to the World Health Organization (2022), patient safety is a care action that aims to
prevent and reduce risks, errors and losses that occur to patients during the provision
of health services. Choudhury & Asan (2020) patient safety targets if implemented
correctly, can help improvepatient safety through improving error detection, patient
stratification, and medication management. It is estimated that according to the
World Health Organization (2022) there are 4 out of 10 patients harmed in
primary and outpatient health care. Up to 80% of harm can be prevented, but the
most detrimental errors relate to prescribing, administering medication and wrong
diagnoses.
Patient Safety is a concept that patients who are in health services can
achieve the expected impact. In terms of injury, patient safety is defined as being
free from accidental injury by ensuring patient safety through establishing
operational systems, minimizing the possibility of errors, and increasing
prevention so that accidents do not occur in the service process. Patient safety
regulations aim to improve the quality of health service facilities through the
implementation of risk management in all aspects of services provided by health
service facilities. To prevent injuries caused by errors resulting from carrying out
an action or not taking action that should be taken. The quality of a hospital's
services can be seen in terms of the following aspects: clinical aspects (services of
doctors, nurses and related medical techniques), aspects of service efficiency and
effectiveness, patient safety and patient satisfaction (Donabedian 1988, in
Cahyono, 2021).
Sumarni (2017) Revealing the occurrence of patient safety incidents in an
areahospitals will have an impactwhich is detrimental to the hospital, staff and
patients as recipients of services, the opinion is that the bad thing that results is a
decrease in the level of patient trust and security in health services. Meanwhile,
Solha Elrifda (2021) revealed various cases that were risky or detrimental to
patient safety that had occurred in patients who were being treated or treated in
hospital, including decubitus ulcers, nosocomial infections, side effects of blood
transfusions, misdiagnosis, as well as the risks and effects of allergies. medication
or anaphylactic shock. However, there has been no official recording and
reporting.
According to Ardi Haris Saputra et al (2022), it proves that the implementation
of patientsafety is still not working effectively.Because if these patient safety
indicators are not implemented properly, it could have an impact on the survival
of the hospital, the environment and the quality of the hospital. Lusiana (2022)
stated that in Indonesia a law has been issued regarding patient safety which must
be obeyed by all hospitals, but there are still many hospitals that fail to realize that
all members of the health workforce, including nurses, doctors and other health
workers, can Prioritizes all patient safety if an undesirable incident occurs. The
completeness of filling out medical record files and patient safety in hospitals is
also a factor in the hospital's efforts to provide good service for patients.
According to Erwin et al (2023), the importance of medical records for
doctors and dentists is related to patient safety as recipients of medical services.
Quality measurement of service indicator values refers to minimum service
standards No. 129/Menkes/SK/II/2021 which should be 100%. From the research
data in the article above, many hospitals show figures that are less than the
specified standards. The aim of this research is to determine the implementation of
patient safety in an effort to improve the quality of services in hospitals based on
the Republic of Indonesia Health Ministerial Decree number 1691 of 2021
concerning hospital patient safety. There are 6 patient safety targets, namely:
accurate patient identification, increasing effective communication, increasing the
use of appropriate drugs. It is necessary to be aware of ensuring the right location,
the right procedure and the right operation, reducing the risk of infection related to
health services, reducing the risk of patient falls.
Research methods
This research aims to determine the implementation of patient safety in an
effort to improve the quality of services in hospitals based on the Republic of
Indonesia Minister of Health Regulation number 1691 of 2021 concerning hospital
patient safety, there are 6 targets. patient safety. StudyThis method uses a literature
review and analysis study approach, namely by collecting, reading, recording and
processing data related to efforts to implement patient safety in an effort to
improve the quality of hospital services. This research data collection method uses
searches from Google Scholar and also several internet sources. The literature
search focused on the implementation of 6 patient safety targets in hospitals
according to the Republic of Indonesia Minister of Health Regulation number
1691 of 2021 concerning hospital patient safety.
Research Results and Discussion
Implementing patient safety in improving the quality of services in
hospitals is a very important thing for a hospital to implement, because this
concerns the lives of patients in the hospital. as a measuring tool to see whether
the quality of patient safety services in hospitals is running well, it can be seen
through 6 patient safety targets, namely: accurate identification of patients,
increasing effective communication, increasing the use of drugs that need to be
watched out for, ensuring the exact location of the right procedure and the right
operation, reducing the risk of health care-associated infections, reducing the risk
of patient falls.
Accuracy of Patient Identification
Patient identification and matching patients with treatment are activities that
are carried out routinely in all care settings (Australian commission on safety and
quality in health care, 2017). Patient identification is very important in the context of
health care to ensure that information related to a particular patient can be managed
properly and correctly before a medical action is carried out. In research (Neri, Lestari
and Yetti, 2018) it was found that based on 6 patient safety targets, it was found that
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the target component had low accuracy in identifying patients correctly, this was
because the stock of patient ID bracelets had run out so many patients did not wear
them.identity bracelet. This will be very risky for patient identification.
According to Hadi (2022) patients are identified using two patient identities
(namepatient, medical record number, date & year of birth, patient identification
bracelet using a barcode) are not permitted to use the room number or location of
the patient when being treated. Ade's research (2017) also stated that of the 5
target elements, the accuracy of patient identification in the 2012 version of
hospital accreditation for the main element to element four was not in accordance
with the provisions that had been set. Accuracy in identifying patients is an effort
to reduce errors in carrying out actions on patients (WHO, 2017). Low targets in
efforts to identify patients properly and correctly can also have an impact on the
quality of hospital services, because according to Ismainar (2015) in the book
Patient Safety in Hospitals, one of the quality aspects is patient safety, namely
efforts to protect patients in I'm sick.
Accurate patient identification is very important for the safety of every patient
in the hospital, because patient identification will determine the patient's identity and
helphealth workers can identify patients using colored bracelets, this patient
identification can also see data on the patient's medical history and reduce errors
in patient identification before treatment is given.
EnhancementEffective Communication
Increasing effective communication using the SBAR technique (situation,
background, assessment, recommendation), according to (Tiara, 2020)
participation perceptions regarding nurses' knowledge regarding effective
communication using the SBAR technique is communication that minimizes
errors by doctors, nurses and other health workers when communicating in
completing problems and conveying problems by communicating via telephone or
directly using this technique. In research (Nursery and Champaca, 2018) for the
target of effective communication, it was discovered that nurses had not received
clear SOP socialization regarding giving doctor's orders by telephone, so that
when nurses wanted to carry out verification it was quite difficult.
Furthermore, in Iskandar's (2017) research, it was discovered that the effective
communication component was low because the duty doctor or nurse sometimes still
had not confirmed it back to the DPJP doctor, where the duty doctor or nurse, after
receiving instructions, immediately gave a TBaK stamp. According to (Hadi, 2022)
inThe Patient Safety Management Textbook states that the elements in this goal,
namely complete verbal and telephone orders or examination results, are read
back in full by the recipient of the order. Then the order or inspection results are
confirmed again by the person giving the order or delivering the inspection
results. In this case, it is also supported by the theory in the book Patient Safety in
Hospitals (Ismainar, 2015) that one of the 7 patient safety standards states that
communication is the key for staff to achieve patient safety. The standard of this
communication is that the hospital plans and designs the patient safety
information management process to meet information needs.
 Efforts to increase effective patient communication must be in accordance with
the SOPclear, techniqueused by officers to communicate is using the situation,
background, assessment and recommendation (SBAR) technique, this technique
allows communication to be well organized and avoids miss communication
between DPJP doctors, duty doctors and nursing staff. Miss communication
between DPJP doctors, duty doctors and nursing staff will have an impact on
patient safety and reduce the quality of service in hospitals.
Increased use of drugs that need to be watched out for
With the goal of improving the safety of cautionary medicines, health
service providers must ensure safe administration of medicines, including
verifying patient identity, writing clear prescriptions, correct use of medicines,
and monitoring side effects of medicines. It is known that for policy there is
already an SOP policy, but the socialization has not been implemented properly
(Alfiah, 2022). The medication you need to be careful about is placed in a separate
place and not in the patient care unit. In research (Nursery and Champaca, 2018) it
is known that there is no labeling of certain types of drugs such as diazepam and
drugs that look similar and sound the same.
Furthermore, Alfiah's (2022) research is in accordance with the theory of
elementsThis target assessment concerns the placement of drugs that must be
watched out for, but the implementation of the SOP policy is not yet in
accordance with the assessment elements because it has not been implemented
properly. In the Patient Safety Management Textbook, it is stated that
concentrated electrolytes are not in patient care units unless clinically necessary
and the policy must be implemented (Hadi, 2022). For research (Nursery and
Champaca, 2018) it is not in accordance with the theory in the Patient Safety
Management Textbook which states that stored high alert drugs or concentrated
electrolytes must be clearly labeled, and stored in strictly restricted areas (Hadi,
2022).
The target indicators for providing drug safety to patients in a hospital are
things that officers need to pay attention to. Use of labels for each type of drugWhat is
used must be appropriate and clear. The use of clear SOPs including verifying
patient identity, writing clear prescriptions, using appropriate medications, and
monitoring side effects of medications will minimize errors in administering
patient medication.
Certainty of the Right Location, Right Procedure and Right Operation
In research (Nursery and Champaca, 2018) the target of ensuring the
location of surgery, the correct procedure, surgery on the correct patient was
found to be a low percentage of 59.8%. In this research (Nursery and Champaca,
2018) it was found that not much was done by implementing nurses in determine
the exact location, procedure and patient because this is mostly done in the
operating room. Nurses also assist doctors in recording or filling out informed
consent and examination procedures according to the doctor's advice before the
operation begins. In this case, it is in accordance with the patient safety target
assessment theory contained in the Patient Safety Management Textbook, which
 6

states that the operating team implements and records procedures before the start
of a surgical procedure (Hadi, 2022).
In serviceIn hospitals, ensuring the right location, right procedure and right
operation is very important for patient safety in a hospital, this concerns the
actions that will be taken by health workers and the actions of specialist doctors in
the process of providing care to their patients. Before any action is given to
someone, the patient needs proper assurance, because this concerns the patient's
life. These target indicators will definitely have an impact on the quality of service
and service quality of a hospital.
Reducing the Risk of Health Care-Associated Infections
Health service providers must implement infection prevention measures,
including sterilization of medical equipment, management of medical waste, control of
nosocominal infections and finally hand hygiene of health service providers. The
target of reducing the risk of infection related to health services was found to be the
lowest percentage of 50.5% in research (Nursery and Champaca, 2018). For this
target, it was found that when installing an IV, nurses sometimes continued to apply
disinfectant repeatedly to the patient's skin. It is also known that the nurse installed a
down catheterSometimes they still use medical gloves/gloves that are not sterile,
but their implementation in the field is still not in accordance with the theory of
patient safety target elements. In the Patient Safety Management Textbook, it is
stated that hospitals must have policies that can lead to a sustainable reduction in
the risk of infections associated with health services. According to (Hadi, 2022),
efforts to overcome the risk of this infection include avoiding risks by deciding
not to continue activities that pose risks and reducing the possibility of risks
occurring.
Hand hygiene and sterilization of medical equipment are the main keys that
must be implemented by officers, in order to prevent infection in the patient's body
parts after surgery.actions or operations carried out by health workers. The use of
disinfectants and sterile medical gloves is a good step to fulfill the theory of
patient safety service goals.

Reducing the Risk of Patient Falls

Reducing patient falls is an important priority in world health. In the target of
reducing the risk of patient injury due to falls, the lowest percentage was found to be
61.7% in research (Nursery and Champaca, 2018). For this target, it was found that
nurses had carried out identification of fallen patients by giving signsrisk of falling or
by hanging a sign, it was also found that nurses were still confused about the
changing risk assessment format for falling patients. In terms of target
implementation, it has gone well, but there is a risk assessment format that
sometimes still changes. The implementation of this target in this research
(Nursery and Champaca, 2018) is in accordance with the theory in the Patient
Safety Management Textbook, which states that there is a process of initial
assessment of patients regarding the risk of falls and re-assessing the patient if a
change in condition is indicated (Hadi, 2022) . According to (Ismainar, 2015),
reducing the risk of patient injury due to falls is included in the quality aspect of
hospital services, so that if this target percentage is low it can have an impact on
hospital quality. In this target indicator for the risk of falling patients, identifying
patients and marking patients who are at risk of falling has been well implemented
from the research above. It is also found in the research above that many nurses
are confused about the format for assessing the risk of falling patients because it is
always changing.
Conclusion
The influence of the quality of hospital services on the implementation of
patient safety cannot be separated from the indicators that must be met in accordance
with the Republic of Indonesia Minister of Health Regulation number 1691 of 2021
concerning hospital patient safety, there are 6 safety targetspatients, namely: accurate
identification of patients, increasing effective communication, increasing the use
of drugs that require attention to ensuring the right location, right procedure and
right operation, reducing the risk of infection related to health services, reducing
the risk of patient falls. The level of service of a hospital cannot be separated from
its responsibility for the safety of its patients. The higher the level of patient
safety, the higher the public's trust in the hospital.

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