Nicu care, sense of emergency

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Nicu care, sense of emergency

  1. 1. NICU Care, Sense of Emergency and Doctor’s responsibility M.Sholeh Kosim NICU Supervisor Director of Human Resource and Education Dr.Kariadi General Hospital Semarang
  2. 2. Level of Perinatology care <ul><li>Level I : Rooming in system : </li></ul><ul><ul><li>Low risk baby / normal baby </li></ul></ul><ul><ul><li>24 hours mother – baby bounding </li></ul></ul><ul><li>Level II : Live support treatment </li></ul><ul><ul><li>Medium risk baby </li></ul></ul><ul><ul><li>Monitor </li></ul></ul><ul><li>Level III : Life saving treatment </li></ul><ul><ul><li>High risk baby </li></ul></ul><ul><ul><li>NICU care / treatment </li></ul></ul>
  3. 3. NICU Care <ul><li>Complicated care </li></ul><ul><ul><li>Many treatment </li></ul></ul><ul><ul><li>Invasive treatment </li></ul></ul><ul><li>High cost </li></ul><ul><li>“ Not convenience “ environment </li></ul><ul><li>“ Dangerous “ if mismanagement </li></ul><ul><li>Psychological tension for parents </li></ul><ul><li>Moral hazard and unexpected event is nearly happened </li></ul>
  4. 4. Indications for NICU Care <ul><li>Acute </li></ul><ul><li>Critically ill </li></ul><ul><li>Recoverable </li></ul>
  5. 5. Precaution <ul><li>Multiple congenital anomaly </li></ul><ul><li>Chronic disease </li></ul><ul><li>Severe septic condition </li></ul><ul><li>Long term of unconsciousness / comatose </li></ul>
  6. 6. Kind of Illnesses <ul><li>Respiratory failure </li></ul><ul><li>Haemodynamic failure : Shock </li></ul><ul><li>CNS disorders </li></ul><ul><li>Severe septic condition </li></ul><ul><li>Multi organs failure </li></ul>
  7. 7. Preconditions <ul><li>Informed consent </li></ul><ul><li>LBW : ≥ 1000 grams </li></ul><ul><li>Assurance of budget : </li></ul><ul><ul><li>Covered by insurance : ASKES – KIN, etc </li></ul></ul><ul><ul><li>Out of pocket : parent’s approval </li></ul></ul>
  8. 8. Dangerous sign or Emergency condition <ul><li>Respiratory failure </li></ul><ul><li>Convulsion </li></ul><ul><li>Shock </li></ul><ul><li>Hypothermic </li></ul><ul><li>Severe dehydration </li></ul><ul><li>Deep comatose </li></ul>
  9. 9. Doctor in charge in NICU <ul><li>Competence </li></ul><ul><li>Dedicated </li></ul><ul><li>Care </li></ul><ul><li>Sense of emergency </li></ul><ul><li>Moral Responsibility </li></ul>
  10. 10. Sense of Emergency <ul><li>Matter of : </li></ul><ul><ul><li>Knowledge </li></ul></ul><ul><ul><li>Skill </li></ul></ul><ul><ul><li>Attitude </li></ul></ul><ul><li>Something to be learned , trained and shaped </li></ul><ul><li>Related to competence and knowledge </li></ul><ul><li>Risk to moral hazard </li></ul>
  11. 11. Doctor’s responsibility <ul><li>Ethical </li></ul><ul><li>Moral </li></ul><ul><li>Hippocrates and KODEKI </li></ul><ul><li>Professional </li></ul>PATIENT’S SAFETY
  12. 12. Doctor in charge in Pediatric Department <ul><li>Access hour responsibility </li></ul><ul><li>On behalf of Head of Department and Specialist </li></ul><ul><li>Keep the system and service working </li></ul><ul><li>“ Team work “ approached </li></ul><ul><li>Direct consultation to upper ordinate </li></ul>
  13. 13. Hierarchy of Doctor in charge in Pediatric Department <ul><li>Doctor in Charge I </li></ul><ul><li>Doctor in Charge in PICU & NICU Doctor in Charge in Special care </li></ul><ul><li>Doctor in charge in EMU ( “ UGD “) </li></ul><ul><li>Doctor in charge III ( H N D ) </li></ul><ul><li>Doctor in Charge IV </li></ul><ul><li>Doctor in Charge V </li></ul>
  14. 14. Doctor in Charge I <ul><li>Team Leader </li></ul><ul><li>Aware and take care all patients </li></ul><ul><li>“ Top consultant “ among doctors in charge </li></ul><ul><li>Authority to decide : </li></ul><ul><ul><li>Patient’s placing </li></ul></ul><ul><ul><li>Mobilization of doctors </li></ul></ul><ul><li>Delivery support for Caesarian section in theatre </li></ul>
  15. 15. Doctor in Charge in PICU & NICU <ul><li>Responsible for : </li></ul><ul><ul><li>PICU & NICU admission </li></ul></ul><ul><ul><ul><li>From HND </li></ul></ul></ul><ul><ul><ul><li>From EMU ( UGD) </li></ul></ul></ul><ul><ul><ul><li>Theatre ( IBS) </li></ul></ul></ul><ul><ul><ul><li>Other wards </li></ul></ul></ul><ul><ul><li>Forward consultation </li></ul></ul><ul><ul><li>Receive expertise </li></ul></ul><ul><li>Replacing the role of Doctor in charge I </li></ul>
  16. 16. Doctor in Charge in Special Care <ul><li>Responsible for : </li></ul><ul><ul><li>Special Care admission </li></ul></ul><ul><ul><li>Delivery support for high risk baby in delivery room </li></ul></ul><ul><ul><li>Helping Doctor in Charge I for Caesarian Section </li></ul></ul><ul><ul><li>Helping Doctor in Charge in HND </li></ul></ul>
  17. 17. Doctor in charge II in EMU( UGD) <ul><li>Responsible for : </li></ul><ul><ul><li>Emergency service </li></ul></ul><ul><ul><li>Life support and life saving </li></ul></ul><ul><ul><li>Initial treatment for emergency cases </li></ul></ul><ul><ul><li>Preparation for deliver patient to : </li></ul></ul><ul><ul><ul><li>PICU or NICU </li></ul></ul></ul><ul><ul><ul><li>HND </li></ul></ul></ul><ul><ul><ul><li>Other wards </li></ul></ul></ul>
  18. 18. Doctor in Charge III ( HND) <ul><li>Responsible for : </li></ul><ul><ul><li>HND care </li></ul></ul><ul><ul><li>Emergency care </li></ul></ul><ul><ul><li>Consultation to PICU & NICU </li></ul></ul><ul><ul><li>Receive patient from PICU NICU </li></ul></ul><ul><ul><li>Receive patient from EMU ( UGD ) </li></ul></ul>
  19. 19. Doctor in Charge IV & V <ul><li>“ New comer “ </li></ul><ul><li>Starting to learn </li></ul><ul><li>Fully responsible to new patients </li></ul><ul><li>Consultation to Doctor in Charge III or even Doctor in Charge I </li></ul>
  20. 20. ETHICAL HAZARDS <ul><li>Consequent to be sued or sanction : </li></ul><ul><ul><ul><li>Change or erase Medical records </li></ul></ul></ul><ul><ul><ul><li>Postpone the patient’s treatment </li></ul></ul></ul><ul><ul><ul><li>Postpone the patient’s admission </li></ul></ul></ul><ul><ul><ul><li>Lying or un honest </li></ul></ul></ul>
  21. 21. Lesson learned <ul><li>Patient safety </li></ul><ul><li>Patient neglected </li></ul><ul><li>Un honest </li></ul><ul><li>Miscommunication </li></ul><ul><li>Miscoordination </li></ul>Ethical & Moral hazard
  22. 22. Terimakasih

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