Supervisi Meningkatkan Pelaksanaan Serah Terima di Rumah Sakit X di Jakarta: Fishbone Analysis
Authors: Gunawan Deny , Hariyati Rr Tutik Sri , Fitri Desnita 
Published: March 2020

Hospitals are the health care facilities which are required to provide the safe, effective and efficient services that provide the effective communication as one of the patient's safety goals. The handover between nursing shifts is part of the effective communication. If it is not properly implemented, the patient's safety is threatened. The supervision is needed in order to make the handover becomes effective and efficient. The purpose of this study was to identify the problem of applying the handover between the nursing shifts and developing the problem-solving solutions. The method used was a pilot study. The implementation process starts from identifying the problem, analyzing the problem, determining the priority of the problem, developing an action plan, implementation, and evaluation. The root problem analysis was carried out by using fishbone. The sample was 1 emergency department (ED) which involves the 32 staff nurses and 2 head nurses. The result indicates that there are some problems in the application of handover between nursing shifts that was not optimal in nursing supervision. The implementation and evaluation were carried out on 5 shifts of nurse shifts which involves the 32 staff nurses. The evaluation results also showed that there were the increasing number of the handover method among the nursing shifts, the pre-conference and post-conference, the head nurses supervision and team leader, the patient involvement, the supervision format, the documentation of head nurses and team leader, the bedside handover, and the documentation of nursing care. The conclusion in this study showed that the important of graded supervision in order to optimize the application of handover between nursing shifts in accordance with the objectives that must be achieved.
Keywords: emergency department; handover; head nurse; supervision; team leader

ABSTRAK

Rumah sakit merupakan fasilitas pelayanan kesehatan yang wajib memberikan pelayanan yang aman, efektif, dan efisien yang melingkupi komunikasi efektif sebagai salah satu dari sasaran keselamatan pasien. Serah terima antar shift keperawatan merupakan bagian dari komunikasi efektif tersebut. Apabila tidak dijalankan dengan benar, maka keselamatan pasien terancam. Supervisi diperlukan agar serah terima berjalan dengan efektif dan efisien. Tujuan studi ini adalah mengidentifikasi masalah dalam penerapan serah terima antar shift keperawatan serta mengembangkan solusi pemecahan masalah. Metode yang digunakan adalah pilot study. Proses pelaksanaan dimulai dari identifikasi masalah, analisis masalah, penetapan prioritas masalah, penyusunan plan of action, implementasi, serta evaluasi. Analisis akar masalah dilakukan dengan menggunakan metode fishbone. Sampel dalam studi ini adalah 1 instalasi gawat darurat (IGD) yang meliputi 32 perawat pelaksana dan 2 kepala ruangan. Hasil identifikasi menunjukkan ada adanya masalah dalam penerapan serah terima antar shift keperawatan yakni dalam supervisi keperawatan yang belum optimal. Implementasi dan evaluasi dilakukan pada 5 pergantian shift perawat yang melibatkan 32 perawat pelaksana. Hasil evaluasi menunjukkan adanya peningkatan angka penerapan metode serah terima antar shift keperawatan, peningkatan pre conference dan post conference, peningkatan supervisi kepala ruangan dan ketua tim, peningkatan pelibatan pasien, peningkatan format supervisi, peningkatan pendokumentasian kepala ruangan dan ketua tim, peningkatan bedside handover, dan peningkatan pendokumentasian asuhan keperawatan. Kesimpulan dalam studi ini mengungkapkan pentingnya supervisi secara berjenjang untuk mengoptimalkan penerapan serah terima antar shift keperawatan sesuai dengan tujuan yang ingin dicapai.
Kata kunci: gawat darurat; kepala ruangan; ketua tim; serah terima; supervisi