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The National
Early
Warning
Score
! National Early Warning Score adalah sistem
penilaian kumulatif yang menstandarkan
penil...
NEWS Validation for Medical & Surgical Patients
using ViEWS Parameters
1. Bleyer A.J. et al. (2011). Longitudinal analysis...
Important Points
Skor	Dini	Peringatan	Dini	
tidak	menggantikan	
penilaian	klinis	yang	
kompeten
Ketika	staf	khawatir	
tent...
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Overall COMPASS© / NEWS Education Programme
incorporates:
• Categorisation of patients’
SEVERITY of illness for EARLY
dete...
Jika	terjadi	arrest jantung	atau	pernafasan,	
aktifkan	sistem	serangan	jantung
Beberapa	pasien	
mungkin	memerlukan	
pemeri...
Mengapa	kita	memerlukan	National	Early	
Warning	Score	dan	Program	Workshop	ini?
Cardiac Arrest Calls in a
General Hospital
Gallagher, J. Groarke, J.D. & Courtney, G. (2006)
IMJ. 99(6),114-116.
• Retrosp...
RASIONAL	DARI	
INDIKATOR	NEWS
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Jalan napas yang memadai dan kemampuan
untuk melindungi jalan nafas
DO2 tergantung pada:
DO2 tergantung pada:
Effective lung mechanics – neurological and muscular
DO2 tergantung pada:
Berfungsinya jaringan paru-paru
Pasokan darah pulmonal yang cukup
DO2 tergantung pada:
Chain of Oxygen Delivery
DO2 = (SVxHR) x (Hb) x SaO2 x 1.39)+PaO2 x 0.003
Haemoglobin-
Normal Adult range / Concentration
...
Chain of Oxygen Delivery
DO2 = (SVxHR) x (HB) x SaO2 x 1.39)+PaO2 x 0.003
(SVxHR) = Cardiac output (CO)
Tergantung pada:
–...
Airway & Breathing
Decreased oxygen delivery at the tissue level
Anaerobic metabolism
Lactate production
Acidosis
Stimulat...
C$*L"+ M(N*0"#@$&-
! Points to Note-
• Some patients with Chronic Obstructive Pulmonary Disease
(COPD) are “CO2 retainers”...
Airway &	Breathing
• Peningkatan laju pernafasan dapat
terjadi dengan SaO2	normal
• Pasien meninggal karena hipoksia
lebih...
Circulation
O$*/<'"#$%&
• Penurunan TD (Hipotensi) didefinisikan sebagai
penurunan lebih dari 20% dari tekanan darah biasa
atau tekana...
Circulation
•Penurunan TD	bisa jadi akibat dari:
•Penurunan volume	darah intravaskular
•Penurunan resistansi pembuluh dara...
Circulation
Penurunan volume darah intravaskular
◦Curah jantung turun dari volume stroke rendah
◦Volume stroke jatuh menye...
Circulation
•Penurunan resistensi vaskular perifer
•Vasodilatasi menyebabkan TD	rendah
•Vasodilatasi menyebabkan venous	re...
Circulation
•Berkurangnya kontraktilitas jantung
•Curah	jantung turun dari volume	stroke	rendah
•Volume	stroke	jatuh menye...
The Hypotensive Patient
•Reduksi di preload (volume loss)
• (e.g. haemorrhage, sepsis, vomiting)
•Reduksi di cardiac contr...
Hypotension &	Organ Perfusion
Cerebral	hypoxia	
à agitation,	
confusion
Renal	impairment	
à reduced	urine	
output	
Myocard...
The Hypotensive Patient
Ø Heart rate and rhythm
Ø Peripheral pulses
Ø Capillary refill
Ø Limb temperature
Ø Central pulses...
Pasien dengan Gangguan Tingkat
Kesadaran
Airway, Breathing, Circulation
Don’t forget the Glucose
• AVPU
• Pupils
• Blood G...
Pasien dengan Gangguan Tingkat
Kesadaran
Glasgow Coma Scale
Patients best response to stimuli out of 15
3 components
• Eye...
Pasien dengan Gangguan Tingkat
Kesadaran
Glasgow Coma Scale
ü Kaji setelah resusitasi selesai
ü Pantau GCS secara teratur
...
Hypothermia (Temperature 350C)
Kemungkinan Penyebab
• Sepsis
• Hypoadrenalism,
hypopituatism, hypothyroidism
• Aggressive ...
Urine Output
• Keluaran urin harus lebih besar dari
0.5ml	/	kg	/	jam
• Pencegahan gagal ginjal akut penting
• Jangan berik...
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Respiratory section
Version 6
Blood Pressure section
Version 6
Heart Rate section
Level of Consciousness section
Version 6
Temperature section
APA	YANG	HARUS	
KITA	LAKUKAN??
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LATIHAN	DENGAN	FORMULIR	
NEWS	VERSI	ORIGINAL	
EDIT	BAHASA	INDONESIA
Latihan dengan NEWS & Obs chart
• T - 370C,
• Nadi - 65,
• RR - 22,
• SaO2 - 96%
• BP 130/60
• patient is alert.
Latihan dengan NEWS & Observation
Chart
• T	- 370C,	
• Nadi - 65,	
• RR	- 22,
• SaO2	- 96%,	
• BP	130/60	
• patient	is	ale...
Latihan dengan NEWS &	Observation Chart
• T – 370C,
• Nadi - 65,
• RR - 22,
• SaO2 – 96%,
• BP 130/60,
• patient is alert....
Responsibilities
Beritahu	Clinical	Nurse	
Manager/Nurse	in	Charge	
dan/atau	tenaga	medis	yang	
sesuai.
Tingkatkan	frekuens...
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KOMUNIKASI DENGANKOMUNIKASI DENGAN
(I)SBAR
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PERSIAPAN SEBELUM
MELAKUKAN KOMUNIKASI
Sebutkan nama dan bangsal anda
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Saya menelepon tentang pasien
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Pasien tadi mengalami
! penurunan kesadaran
! Nafas cepat dan dangkal
! Saturasinya mulai menurun
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Saya rasa pasien saat ini
mengalami
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ADA	PERTANYAAN??
REFERENSI
De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P. (2013). SBAR
improves nurse–physician communica...
REFERENSI
Beyea, S. C. (1999). Standardized language—Making nursing practice count. AORN journal,
70(5), 831-838.
Jenerett...
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
Early Warning Score HIPERCCI 2017
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Early Warning Score HIPERCCI 2017

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Materi National Early Warning Score System HIPERCCI 2017

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Early Warning Score HIPERCCI 2017

  1. 1. !"#$%&"'()"*'+(,"*&$&- ./%*0 .+1#02( 3!),..4 !"#$%&'(&"$)*+,&-$./0/1$0/234/1$56/1$7/5/08/9:/;< =&'&"6>1$0/234/1$56
  2. 2. !"# %&'(&" )*+,&- ./0/1$0/234/1$56/1$7/5/08/9:/;< ! ??@A !.B#C&"1$DE$F&'(&"# EGHI ! J383'C$K>6#C#>'A !.&6#8$&'-$!,3"L3'8M$5("6#'L$0C&NN1$08+>>B$>N$5("6#'L1$ O'#P3"6#C&6 Q&-R&+ 7&-& ! !-(8&C#>'$S#6C>"MA !08+>>B$>N$5("6#'L1$T&8(BCM$>N$73-#8#'31$O'#P3"6#C&6 Q&-R&+ 7&-& !7&6C3"$>N$5("6#'L$08#3'83$9:'C3'6#P3$;&"3<$?+3$O'#P3"6#CM$ >N$)-3B&#-3$)(6C"&B#& ! !,&#BA !3"#UM&'(&"VWWXYM&+>>/8>,
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  4. 4. The National Early Warning Score ! National Early Warning Score adalah sistem penilaian kumulatif yang menstandarkan penilaian tingkat keparahan penyakit akut ! Alat sederhana ! Sistem Peringatan & Pemicu Warning Sistem ! Digunakan di semua rumah sakit di Irlandia ! Menunjukkan tanda-tanda awal pemburukan ! Skor dihitung dengan menggunakan tanda vital pasien ! Parameter penilaian didasarkan pada parameter ViEWS yang divalidasi untuk pasien medis dan bedah
  5. 5. NEWS Validation for Medical & Surgical Patients using ViEWS Parameters 1. Bleyer A.J. et al. (2011). Longitudinal analysis of one million vital signs in patients in academic medical centre. Resuscitation doi:10.1016/j. Resuscitation, 2011.06.033 2. Kellett J & Kim A. (2011). Validation of an abbreviated VitalpacTM Early Warning Score (ViEWS) in 75,419 consecutive admissions to a Canadian Regional Hospital Resuscitation. doi:10.1016/j.resuscitation.2011.08.022 3. Prytherch D, Smith G, Schmidt P, Featherstone P. (2010). ViEWS – Towards a national early warning score for detecting adult inpatient deterioration. Resuscitation. 81(8), 932-7. 4. Mitchell I., McKay H., Van Leuvan C., Berry R., McCutcheon C., Avard B., Slater N., Neeman T. and Lamberth P. (2010). A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients. Resuscitation. 81, 658–666. 5. National Institute for Health and Clinical Excellence (NICE), (2010). Acutely ill patients in hospital. Available at: http://www.nice.org.uk/guidance/index
  6. 6. Important Points Skor Dini Peringatan Dini tidak menggantikan penilaian klinis yang kompeten Ketika staf khawatir tentang perawatan pasien harus ditingkatkan dapat ditingkatkan terlepas dari skor NEWS dilanjutkan skrining untuk Sepsis saat ada NEWS dari ≥ 4 (atau 5 jika pasien menggunakan oksigen tambahan) Dalam persentase kecil pasien, NEWS tidak mengidentifikasi kemerosotan dalam kondisi pasien
  7. 7. @3&"'#'L _(C8>,36 ! 03C3B&+ ,3'M3B36&#*&' [>"*6+>4$#'# 4363"C& +&"(6 -&4&CA ! 73,&+&,# 43'C#'L'M& -&' "3B3P&'6# 43'L&,&C&' -&' N#6#>B>L# M&'L$ ,3'-&6&"#'M& ! 73'L3'&B# -&' ,3'L#'C3"4"3C&6#*&' 43'L&,&C&' &^'>",&B ! .3"*>,('#*&6# 638&"& 3N3*C#N -3'L&' >"&'L$M&'L$C34&C -&' 4&-& 6&&C M&'L$ C34&C ! 73'L3'&B# -&' ,3'L3B>B& 4&6#3' M&'L$ ,3,^("(* ! 73,N&6#B#C&6# *3"R& C#, -&B&, C#, ,(BC#$ -#6#4B#' -&' ,3'L3,^&'L*&' "3'8&'& ,&'&R3,3'
  8. 8. Overall COMPASS© / NEWS Education Programme incorporates: • Categorisation of patients’ SEVERITY of illness for EARLY detection of clinical deterioration • A TRACKING system using the NEWS based on the patient’s vital signs • A definitive plan to ESCALATE care • TRIGGERING a swift response i.e. activation of an early response appropriate to the level of the score • The use of a structured COMMUNICATION tool (ISBAR), (more information on this later)
  9. 9. Jika terjadi arrest jantung atau pernafasan, aktifkan sistem serangan jantung Beberapa pasien mungkin memerlukan pemeriksaan medis segera namun tidak akan memicu skor tinggi. Protokol ini diaktifkan dengan skor 3 dalam satu parameter atau total skor 3.
  10. 10. Mengapa kita memerlukan National Early Warning Score dan Program Workshop ini?
  11. 11. Cardiac Arrest Calls in a General Hospital Gallagher, J. Groarke, J.D. & Courtney, G. (2006) IMJ. 99(6),114-116. • Retrospective study of cardiac arrest over 24 month period (2002-2004) • Subgroup of 20 patients progress in preceding 24 hours- • Decline in patients condition evident in 45- 75% • Respiratory rate infrequently recorded
  12. 12. RASIONAL DARI INDIKATOR NEWS
  13. 13. !"#$%& %'( )#*%+,"'-
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  15. 15. Jalan napas yang memadai dan kemampuan untuk melindungi jalan nafas DO2 tergantung pada:
  16. 16. DO2 tergantung pada: Effective lung mechanics – neurological and muscular
  17. 17. DO2 tergantung pada: Berfungsinya jaringan paru-paru
  18. 18. Pasokan darah pulmonal yang cukup DO2 tergantung pada:
  19. 19. Chain of Oxygen Delivery DO2 = (SVxHR) x (Hb) x SaO2 x 1.39)+PaO2 x 0.003 Haemoglobin- Normal Adult range / Concentration (anaemia: causes)
  20. 20. Chain of Oxygen Delivery DO2 = (SVxHR) x (HB) x SaO2 x 1.39)+PaO2 x 0.003 (SVxHR) = Cardiac output (CO) Tergantung pada: – Kontraktilitas otot jantung – Pre-load (venous return ke jantung) – After-load (resistansi dari ejeksi ventrikel) – Heart rate
  21. 21. Airway & Breathing Decreased oxygen delivery at the tissue level Anaerobic metabolism Lactate production Acidosis Stimulates respiratory drive Increases the respiratory rate
  22. 22. C$*L"+ M(N*0"#@$&- ! Points to Note- • Some patients with Chronic Obstructive Pulmonary Disease (COPD) are “CO2 retainers”, i.e. they do not respond to raised CO2 but do respond to low O2 - high concentrations of O2 may suppress their hypoxic drive. • NB – these patients will also suffer end-organ damage or cardiac arrest if their blood O2 levels fall too low. • In COPD if PCO2 " 8kPa but hypoxic (PO2 # 8kPa) – DO NOT TURN O2 DOWN • Don’t rely on machines! • Stay with the patient – aim to achieve a PaO2 of 8kPa, or SaO2 of 90%.
  23. 23. Airway & Breathing • Peningkatan laju pernafasan dapat terjadi dengan SaO2 normal • Pasien meninggal karena hipoksia lebih cepat dari pada CO2 tinggi • Jika pasien memburuk jangan menghentikan oksigen tambahan saat mengambil AGD
  24. 24. Circulation
  25. 25. O$*/<'"#$%& • Penurunan TD (Hipotensi) didefinisikan sebagai penurunan lebih dari 20% dari tekanan darah biasa atau tekanan darah sistolik kurang dari 100 mmHg. • Hipotensi dapat mencerminkan penurunan curah jantung yang dapat menyebabkan penurunan jumlah oksigen yang sampai ke jaringan
  26. 26. Circulation •Penurunan TD bisa jadi akibat dari: •Penurunan volume darah intravaskular •Penurunan resistansi pembuluh darah perifer •Berkurangnya kontraktilitas jantung
  27. 27. Circulation Penurunan volume darah intravaskular ◦Curah jantung turun dari volume stroke rendah ◦Volume stroke jatuh menyebabkan takikardia ◦Untuk mempertahankan TD à resistensi perifer meningkat Hipotensi, tangan dingin & tidak ada gagal jantung - cairan infus
  28. 28. Circulation •Penurunan resistensi vaskular perifer •Vasodilatasi menyebabkan TD rendah •Vasodilatasi menyebabkan venous return rendah •Venous return rendah menyebabkan stroke volume rendah •Hipotensi, tangan hangat: cairan IV
  29. 29. Circulation •Berkurangnya kontraktilitas jantung •Curah jantung turun dari volume stroke rendah •Volume stroke jatuh menyebabkan takikardia •Untuk mempertahankan BP, resistensi perifer meningkat •Hipotensi, tangan dingin & tanda gagal jantung •Hentikan cairan •Konsultasi ICU / CCU
  30. 30. The Hypotensive Patient •Reduksi di preload (volume loss) • (e.g. haemorrhage, sepsis, vomiting) •Reduksi di cardiac contractility (pump failure) • (e.g. MI, heart failure) •Reduksi di afterload (vasodilation) • (e.g. sepsis, overdose)
  31. 31. Hypotension & Organ Perfusion Cerebral hypoxia à agitation, confusion Renal impairment à reduced urine output Myocardial ischaemia à angina, MI Gut ischaemia à abdominal pain, nausea Peripheral ischaemia àakral dingin
  32. 32. The Hypotensive Patient Ø Heart rate and rhythm Ø Peripheral pulses Ø Capillary refill Ø Limb temperature Ø Central pulses Ø TD Ø Urine output Ø Oxygen saturations Ø Colour Ø Chest Auscultation Ø JVP Bagaimana Anda menilai efek bolus cairan? - Perhatian untuk pasien dengan disangka / terdiagnosis penyakit jantung
  33. 33. Pasien dengan Gangguan Tingkat Kesadaran Airway, Breathing, Circulation Don’t forget the Glucose • AVPU • Pupils • Blood Glucose
  34. 34. Pasien dengan Gangguan Tingkat Kesadaran Glasgow Coma Scale Patients best response to stimuli out of 15 3 components • Eye opening • Best motor response • Best verbal response Range 1-4 Range 1-6 Range 1-5
  35. 35. Pasien dengan Gangguan Tingkat Kesadaran Glasgow Coma Scale ü Kaji setelah resusitasi selesai ü Pantau GCS secara teratur ü Jika GCS turun> 2 poin, hubungi staf medis ü Jika GCS berada di bawah 9, hubungi ICU atau staf anestesi karena intubasi mungkin diperlukan
  36. 36. Hypothermia (Temperature 350C) Kemungkinan Penyebab • Sepsis • Hypoadrenalism, hypopituatism, hypothyroidism • Aggressive fluid resuscitation • Exposure to low temperatures (Intra-operatively) • Neurological (stroke, trauma, tumour) • Skin disease (burns, dermatitis) • Drug induced (sedatives) • Neuromuscular in-sufficiency Signs and Symptoms • HR, RR & metabolic rate decreases • Confusion • Arrhythmias • Cardiac Arrest
  37. 37. Urine Output • Keluaran urin harus lebih besar dari 0.5ml / kg / jam • Pencegahan gagal ginjal akut penting • Jangan berikan Forusemide untuk keluaran urin rendah kecuali penyebab lain sudah ditemukan dikesampingkan & pasien kelebihan cairan secara klinis
  38. 38. !"#$%&'(#$ )*'&+#*,-.*/,0-1*/#&#$- 23+/"-4"#$*# 5"#$$(#*6*# 7&*$/*5- 89:"/;*:& <(#'(6 =*:&"# 4">*:* 0*#$-'&4*6 %*5&,? @%"-)*'&+#*,-A*'&"#'-89:"/;*'&+#-B%*/'-(:":-'%"-C&/>*0D-E/"*'%&#$D-B&/3(,*'&+#D- 7&:*9&,&'0D-.F=+:(/"-<CEB7.?-*::"::5"#'-*==/+*3%
  39. 39. Respiratory section
  40. 40. Version 6 Blood Pressure section
  41. 41. Version 6 Heart Rate section
  42. 42. Level of Consciousness section
  43. 43. Version 6 Temperature section
  44. 44. APA YANG HARUS KITA LAKUKAN??
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  47. 47. LATIHAN DENGAN FORMULIR NEWS VERSI ORIGINAL EDIT BAHASA INDONESIA
  48. 48. Latihan dengan NEWS & Obs chart • T - 370C, • Nadi - 65, • RR - 22, • SaO2 - 96% • BP 130/60 • patient is alert.
  49. 49. Latihan dengan NEWS & Observation Chart • T - 370C, • Nadi - 65, • RR - 22, • SaO2 - 96%, • BP 130/60 • patient is alert. • T - 380C , • Nadi - 86, • RR - 30, • SaO2 - 92%, • BP 110/60, • patient is alert.
  50. 50. Latihan dengan NEWS & Observation Chart • T – 370C, • Nadi - 65, • RR - 22, • SaO2 – 96%, • BP 130/60, • patient is alert. • T – 380C, • Nadi - 86, • RR - 30, • SaO2 - 92%, • BP 110/60, • patient is alert. • T – 380C, • Nadi - 112, • RR – 32, • SaO2 – 92% • BP 100/60, • patient is alert.
  51. 51. Responsibilities Beritahu Clinical Nurse Manager/Nurse in Charge dan/atau tenaga medis yang sesuai. Tingkatkan frekuensi observasi sebagaimana diidentifikasi dalam protokol eskalasi. Protokol Eskalasi dapat diturunkan jika sesuai dan didokumentasikan dalam rencana pengelolaan. Jika Anda khawatir, perawatan pasien dapat ditingkatkan tanpa memperhatikanEarly Warning Score. Jika respon tidak sesuai dengan protokol eskalasi, Perawat yang Sedang bertugas harus menghubungi Konsultan/Dokter.
  52. 52. J364>'6#^#B#C#36 ! K3"C#,^&'L*&' *3^(C(+&' ('C(* *3B(&" -&"# ^&'L6&B ! K3"C#,^&'L*&' *3&+B#&' 43"6>'#B b$43"&B&C&' M&'L$-#^(C(+*&' ('C(* C"&'64>"C&6# M&'L$&,&'
  53. 53. Communication, Management Plans & Teamwork
  54. 54. KOMUNIKASI DENGANKOMUNIKASI DENGAN (I)SBAR
  55. 55. 2!5)K)$S)JO0$9:<0.)J
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  60. 60. .3"*>'C"#^(6#$('C(*$36*&B&6#$,&'&R3,3'$M&'L$3N3*C#N$-&'$ ,3'#'L*&C*&'$4&6#3'$6&N3CM$-&'$-#"3*>,3'-&6#*&'$>B3+$ >"B-$S3&BC+$_"L&'#h&C#>'$9S_<$-&'$C+3$O2$5&C#>'&B$S3&BC+$ 03"P#83 0.)J$90#C(&C#>'1$.&8*L">('-1$ )66366,3'C$&'-$J38>,,3'-&C#>'<$ &-&B&+ ,3C>-3 C3"6C"(*C(" ('C(* ,3'L*>,('#*&6#*&' #'N>",&6# M&'L$ ,3,3"B(*&' 43"+&C#&' -&' C#'-&*&' 63L3"&/
  61. 61. PERSIAPAN SEBELUM MELAKUKAN KOMUNIKASI
  62. 62. Sebutkan nama dan bangsal anda 0&M& 43"&[&C !"# %&'(&" -&"# .&'L6&B i Saya menelepon tentang pasien 5&,&$4&6#3' 9.3R><$-3'L&' -#&L'>6& 4>6C$43"-&"&+&' &^->,3' 0&&C #'# 4&6#3' ,3'L&C&*&' 'M3"# -&-&$^3"&C -#$-&-&$*#"# -&' 63,&*#' ^3"&C Pasien saat ini: (R-A-B-C-D-E) R = Kesadaran Somnolen, A = Airway spontan, B =Nafas spontan, RR 24x/menit, SpO2 92%, C = Nadi 110 x/menit, TD 100/65 mmHg, RR 24 x/menit, Suhu 36.5 C, D = GCS 10 Nyeri skala 8,
  63. 63. Pasien tadi mengalami ! penurunan kesadaran ! Nafas cepat dan dangkal ! Saturasinya mulai menurun ! Tekanan darah mulai menurun ! Nilai NEWS ada yang 3
  64. 64. Saya rasa pasien saat ini mengalami 5M3"#$-&-&$*&"3'&$R&'C('L Masalah pasien saat ini adalah Q&'LL(&'$4&-&$R&'C('L'M& Saya tidak yakin namun pasien sedang ke arah perburukan, kita harus melakukan sesuatu
  65. 65. Saya rasa kita harus J3*&,$!2Q$EV$@3&- 2>'6(B$:;;O ;3*$@&^$('C(*$43'#'L*&C&'$ 3'h#,$R&'C('L Apakah ada pengobatan yang akan diberikan? Setelah terapi diberikan/tindakan dilakukan )4&*&+$6&M&$B&4>"$B&L#$*3$&'-&j .3"&4&$R&,$B&L#$6&M&$+&"(6$B&4>"j
  66. 66. 0.)J$*#'# C3B&+ -#&-&4C&6# >B3+ ^&'M&* >"L&'#6&6# 63^&L&# *3"&'L*& *3"R& ('C(* 83*B#6C *343"&[&C&' ('C(* ,3,(-&+*&' 43'L&B#+&' C&'LL('L R&[&^ 4&6#3' -&"# 43"&[&C M&'L$*3B(&" 6+#NC$*3 M&'L$,&6(* 6+#NC/
  67. 67. @&4>"&' -&' 43'LL('&&' *>,('#*&6# 6C&'-&" 6343"C# 0.)J$,3,3'(+# ^&'M&* ?(R(&' 2363B&,&C&' K&6#3'1$^3",&'N&&C ^&L# 4&6#3' -&' *3B(&"L&1$-&' ,3'LL('&*&' 6(,^3" -&M& ,#'#,&B$('C(* ,3'3"&4*&' 43"(^&+&' C3"63^(C/
  68. 68. ADA PERTANYAAN??
  69. 69. REFERENSI De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P. (2013). SBAR improves nurse–physician communication and reduces unexpected death: a pre and post intervention study. Resuscitation, 84(9), 1192-1196. Doyle, M. (2006). Promoting standardized nursing language using an electronic medical record system. AORN journal, 83(6), 1335-1342. Novak, K., & Fairchild, R. (2012). Bedside reporting and SBAR: Improving patient communication and satisfaction. Journal of pediatric nursing, 27(6), 760-762. Ramasubbu, B., Stewart, E., & Spiritoso, R. (2016). Introduction of the identification, situation, background, assessment, recommendations tool to improve the quality of information transfer during medical handover in intensive care. Journal of the Intensive Care Society, 1751143716660982. Raymond, M., & Harrison, M. C. (2014). The structured communication tool SBAR (Situation, Background, Assessment and Recommendation) improves communication in neonatology. SAMJ: South African Medical Journal, 104(12), 850-852. Woodhall, L. J., Vertacnik, L., & McLaughlin, M. (2008). Implementation of the SBAR communication technique in a tertiary center. Journal of Emergency Nursing, 34(4), 314-317.
  70. 70. REFERENSI Beyea, S. C. (1999). Standardized language—Making nursing practice count. AORN journal, 70(5), 831-838. Jenerette, C., & Brewer, C. (2011). Situation, background, assessment, and recommendation (SBAR) may benefit individuals who frequent emergency departments: Adults with sickle cell disease. Journal of Emergency Nursing, 37(6), 559-561. Lisbeth Blom MSc, R., Pia Petersson PhD, R. N., Peter Hagell PhD, R. N., & Albert Westergren PhD, R. N. (2015). The Situation, Background, Assessment and Recommendation (SBAR) Model for Communication between Health Care Professionals: A Clinical Intervention Pilot Study. International Journal of Caring Sciences, 8(3), 530. McCormick, K. A., Lang, N., Zielstorff, R., Milholland, D. K., Saba, V., & Jacox, A. (1994). Toward standard classification schemes for nursing language: recommendations of the American Nurses Association Steering Committee on Databases to Support Clinical Nursing Practice. Journal of the American Medical Informatics Association, 1(6), 421-427. Martin, H. A., & Ciurzynski, S. M. (2015). Situation, Background, Assessment, and Recommendation–Guided Huddles Improve Communication and Teamwork in the Emergency Department. Journal of Emergency Nursing, 41(6), 484-488. Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice. OJIN: The Online Journal of Issues in Nursing, 13(1), 243-50. Tews, M. C., Liu, J. M., & Treat, R. (2012). Situation-background-assessment-recommendation (SBAR) and emergency medicine residents' learning of case presentation skills. Journal of graduate medical education, 4(3), 370-373.

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