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"Pendahuluan: Berbagai studi menyatakan bahwa pencapaian kadar terapeutik vankomisin pada pasien sakit kritis sangat rendah. Hal ini terjadi karena perubahan farmakokinetik pada pasien kritis akibat proses penyakit dan berbagai intervensi medis. Vankomisin mempunyai indeks terapeutik yang sempit, oleh karena itu pencapaian target kadar terapeutik sangat penting dievaluasi. Saat ini, pemberian vankomisin pada pasien sakit kritis di Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia berdasarkan pedoman penggunaan antibiotik tahun 2022. Namun, evaluasi pencapaian target kadar terapeutik vankomisin pada pasien kritis belum pernah dilakukan. Evaluasi pencapaian target kadar terapeutik vankomisin ini dapat menjadi bahan pertimbangan untuk membuat pedoman pemberian dosis vankomisin yang lebih adekuat. Penelitian ini bertujuan untuk mengetahui gambaran pencapaian kadar terapeutik vankomisin pada pasien sakit kritis. Metode: Penelitian ini merupakan studi pendahuluan dengan desain potong lintang. Rekrutmen subjek penelitian dilakukan dengan metode consecutive sampling. Subjek penelitian adalah pasien sakit kritis yang menggunakan vankomisin. Pemeriksaan kadar vankomisin dilakukan dengan metode ELISA pada sampel darah subjek yang diambil saat trough concentration. Data-data klinis dan laboratorium lain didapatkan dari rekam medis subjek. Hasil: Jumlah subjek penelitian ini adalah 20 orang. Target kadar terapeutik vankomisin tercapai pada 45% subyek penelitian. Median kadar vankomisin pada penelitian ini adalah 17,43 mg/L (3,07 – 25,11 mg/L). Kadar terapeutik vankomisin lebih banyak tercapai pada subyek yang tidak mengalami overload cairan (61,5%) dan yang mendapat vankomisin dengan cara infus yang diperpanjang (64,3%). Pada penelitian didapatkan 3 (15,8%) subyek mengalami cidera ginjal akut setelah penggunaan vankomisin, dengan kadar vankomisin 17,37 mg/L, 11,16 mg/L, dan 13,64 mg/L. Kesimpulan: Capaian target kadar terapeutik vankomisin terjadi hanya pada sebagian pasien sakit kritis. Keadaan subyek yang tidak overload cairan dan pemberian infus vankomisin yang diperpanjang menjadi faktor yang mungkin mempengaruhi tercapainya target kadar terapeutik vankomisin. Kata kunci: trough concentration, vankomisin, pasien sakit kritis, farmakokinetik, kadar terapeutik

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Introduction: Various studies have stated that the achievement of vancomycin therapeutic levels in critically ill patients is very low. This condition occurs because of pharmacokinetic changes in critically ill patients due to the disease process and various medical interventions. Vancomycin has a narrow therapeutic index, therefore it is important to evaluate the drug concentration. Currently, the administration of vancomycin in critically ill patients at Cipto Mangunkusumo Hospital, Jakarta, Indonesia is based on local antibiotic guidelines 2022. However, an evaluation of vancomycin concentration in critically ill patients has never been carried out. Evaluation of vancomycin concentration can be considered as a basis for making adequate vancomycin dosing guidelines. Aim of this study was to describe the vancomycin concentration in critically ill patients. Methods: This research is a preliminary study with a cross-sectional design. Subjects recruitment was done by consecutive sampling method. Subjects were critically ill patients who taking vancomycin. Examination of vancomycin concentration was conducted using ELISA method on subjects' blood samples taken during trough concentration. Other clinical and laboratory data were obtained from the subject's medical record. Result: Sample size of this study was 20 subjects. The target therapeutic level of vancomycin was achieved in 45% of the study subjects. The median of vancomycin concentration on this study was 17.43 mg/L (3.07 – 25.11 mg/L). Therapeutic levels of vancomycin were achieved more in subjects who did not experience fluid overload (61.5%) and received vancomycin by extended infusion method (64.3%). There were 3 subjects (15.8%) experienced acute kidney injury after using vancomycin, with vancomycin concentration of 17.37 mg/L, 11.16 mg/L, and 13.64 mg/L. Conclusion: Achievement of target therapeutic levels of vancomycin occurs in only a minority of critically ill patients. The condition of the subjects who are not fluid overload and the prolonged administration of vancomycin infusion are factors that may affect the achievement of the target therapeutic level of vancomycin. Keywords: trough concentration, vancomycin, critically ill patients, pharmacokinetics, therapeutic concentration"

"Abstract:Suitable for practicing nurses and nursing students preparing for clinicals, this title offers learning tools such as Patient Safety Alerts, Evidence-Based Practice boxes, NIC interventions, case studies, Pharmacologic Management boxes which give you a better understanding of clinical practice and help you refer information quickly and easily"

"Salah satu upaya pelayanan kesehatan dasar yang dilakukan di Puskesmas adalah upaya promotif, preventif dan kurdtif yang dilakukan terhadap bayi dan balita, dimana sejak tahun 1996 Departemen Kesehatan bekerjasama dengan WHO, telah mengembangkan suatu pendekatan baru dalam mengklasifikasi dan mengobatl bayi dan balita saki!, yaitu dengan pendekatan Manajemen Terpadu Balita Saki!(MTBS).Manajemen Terpadu Bolita Saki!(MTBS) dilaksanakan untuk memperbaiki dan meningkatkan kualitas manajemen program maupun manajernen kasus yang mengacu pada kualh.as tatalaksana kasus sehingga angka kematian bayi dan balita dapat diturunkan.Tujuan penelitian ini adalah untuk mempero1eb gambaran tingkat kepatuhan petugas terhadap SOP pendekatan MTBS dan faktor-faktor yang mempengarohinya di Kabupaten Majalengka. Penelitian ini menggunakan desain cross sectional dengan pendekatan kuantitatif dengan jumlab sampel 58 petugas pe1aksana MTBS dengan 174 pengama!an. Pengumpulan data dilakukan dengan pengama!an secara langsung pada saat petugas memeriksa balita sakit dengan menggunakan daftar tilik dan waw!lncara dengan petugas MTBS.Hasil penelitian memperlihatkan babwa pada tingkat kepatuhan petugas dengan menggunak.an cut off point 90% dalam nilai kepatuhan tertinggi 96,74% dan terendah 37,52%, dengan rata rata masalah telinga (80,5%) dan terendab pada konseling (17,8%). Dari hasil uji bivariat didapatkan faktor yang berhubungan seca:ra statistik adalah kua1ifikasi tenaga, pengetahuan, motlvasi dan komitmen pimpinan. Hasil ujl statistik secara multivariat didapatkan faktor yang paling dominan berhubungan Oengan kepai.uhan petugas terhadap SOP pendekstan MTBS adalab komitmen pimpinan.Bagi Dinas Kesehatan dan Puskesmas di Kabupaten Majaiengka perlu kiranya mencoba mengadopsi suatu pendekatan bam daiam mengelola program MTBS yaitu dengan menggunakan manajemen mutu terpadu (Iota/ quality manajemen). Pendekatan tersebut lebih mengedepankan terhadap kepuasan pelanggan baik internal maupun ekstemaldan pendekatan budaya organisasi daJam melakukan perbaikan kepatuhan petugasnya. Melibatkan pegawai dalam pengambilan keputusan dan memberikan wewenang yang penuh terhadap stafnya dalam melaksanakan tugas dalam pengambHan keputusan. Lakukan perbaikar. kinelja dan kepatuhan petugas MTBS secara tents menerus: dengan meflggunakan siklus: PDCA (Plan-Do-Check-Act).

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The set of primary health care effort conducted in health center (puskesmas) are promotive, preventive and curative efforts for babies and children under five years (balita). MoH in collaboration with WHO. have developed a new approach in classification and treatment for balita through IMCL lMCl, known as MTBS, was conducted for improving and promoting the quality of program management and also case management which refer quality of operational procedures and so the mortality rate ofbaJita could be reduced.The objective of the study was to have description of the compliance level regarding the SOP of IMCI approach and its influencing factors in Majalengka District. The design of the study was Cross Sectional utilized quantitative approach, the sample size was 58 officials and involved J 74 observations. Data collection was conducted in direct observation while the officials examined the: sick balita by using checklist and also interviewing the officials.The result of the study showed the compliance level of the officials, with cut off point 90%, the highest level was 96?74% and the lowest level was 37,52%, the average level was 76,90%. The highest level of compliance was in eac examination (80,5%)the lowest level was in counseling (17,8%). According to bivariate testing, it showed the corresponding factors statistically in educational level, knowledge, motivation and managerial commitment. In multivariate testing. the dominant factor which was correspond to the compliance level ofthe officials was managerial commitment.Majalengka District Health Office (DHO) WllS proposed to implement the new approach above in IMCI management by using Total Quality Management (TQM). This approach prioritize the internal and external customer satisfaction. perform the organizational culture in improving compliance level of officials, also staff participation in decision making process and fully delegation to the staff in performing the assignment. Continuous improvement of the performance and compliance level of the IMCI officials will he gained by using PDCA (Plan Do Check Action) cycle."

"Penelitian ini bertujuan untuk menilai efektivitas early warning score terhadap kejadian henti jantung pasien di instalasi rawat inap rumah sakit tingkat IV TNI AD dr.Bratanata Jambi Tahun 2019. Penelitian dilaksanakan di bulan Desember 2018 sampai April 2019 di instalasi rawat inap dengan pendekatan kualitatif dengan metode studi kasus. Teknik untuk memperoleh data adalah dengan wawancara mendalam, telaah dokumen, dan observasi langsung. Hasil penelitian menunjukkan adanya kejadian yang tidak diharapkan berupa kejadian henti jantung mengarahkan kepada penerapan early warning score yang belum optimal. Ketidakpatuhan terhadap pengisian, pengkajian, dan pengaktifan protokol early warning score di lapangan antara lain dipengaruhi oleh maldistribusi perawat, beban kerja perawat yang tidak sesuai dengan kompetesinya, pengetahuan perawat, dan komunikasi antara perawat dengan dokter. Hambatan penerapan EWS di lapangan antara lain ketidaksesuaian jumlah perawat berbanding dengan pasien, beban kerja perawat di luar pelayanan kesehatan, dan kurangnya pengetahuan dari staf mengenai penurunan kondisi klinis pasien. Hal ini bermuara kepada standar operasional prosedur yang belum lengkap dan penyusunan pola ketenagaan yang masih belum efektif dan efisien, juga monitoring-evaluasi dan pelatihan berkesinambungan yang belum berjalan dengan baik sehingga implementasi early warning score tidak optimal. Rekruitmen pegawai sesuai dengan kompetensi dan profesionalitas, pembuatan kebijakan yang menggabungkan pola kebijakan top-down dan bottom-up, pengaturan ulang penempatan sumber daya perawat, pendidikan dan pelatihan berkelanjutan merupakan upaya yang dapat meningkatkan keberhasilan implementasi early warning score.

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This study aims to assess the effectiveness of the application of early warning score on patients cardiac arrest events in the inpatient at installation level IV Army Hospital Dr.Bratanata Jambi in 2019. The study was conducted in December 2018 to April 2019 in inpatient installations with a qualitative approach with a case study method. The technique for obtaining data is through in-depth interviews, document review, and direct observation. The results of the study show that the occurrence of adverse events such as cardiac arrests lead to an unoptimal implementation of an early warning score. Nurses noncompliance in filling, assessing and activating early warning score protocol in the field is influenced by nurses maldistribution, nurses workloads that are not in accordance with their competencies, nurses knowledge, and communication between nurses and doctors. Barriers to the application of EWS in the field include the mismatch of the number of nurses compared to patients, the workload of nurses outside of health services, and the lack of knowledge from staff regarding the decline in the patients clinical condition. This leads to incomplete operational standard procedures and the formulation of work patterns that are still ineffective and inefficient, as well as ongoing evaluations and training that have not run well so that the implementation of an early warning score is not optimal. Employee recruitment in accordance with competence and professionalism, policy making that combines topdown and bottom-up policy patterns, rearranging the placement of nurse resources, continuing education and training is an effort that can increase the success of the implementation of an early warning score."

"Pasien yang dirawat diruang perawatan intensif banyak terpasang alat-alat invasif yang dapat membuat pasien merasa tidak nyaman, nyeri dan kadang gelisah. Kolaborasi pemberian sedasi merupakan salah satu intervensi yang dapat memberikan rasa nyaman. Perawat berperan penting dalam pemantauan sedasi sehingga perlu paham terkait manajemen sedasi di ruang rawat intensif. Penelitian ini bertujuan untuk mengetahui hubungan pengetahuan perawat dengan praktik pemberian sedasi di ruang intensif di salah satu rumah sakit rumah sakit tipe A di Jakarta. Metode yang digunakan adalah cross sectional study dengan 80 responden, alat ukur yang digunakan adalah Nurses Knowledge of Sedatives, Sedation Assessment and Management Questionnaire dan Nurses Sedation Practice Scale Questionnaire. Hasil analisis one way anova menunjukkan bahwa terdapat perbedaan yang signifikan pada rata-rata praktik pemberian sedasi oleh perawat menurut tingkat pengetahuan perawat dengan p Value = 0,000. Penelitian ini merekomendasikan bahwa peningkatan pengetahuan perawat dapat dilakukan melalui program pendidikan dan pelatihan yang bertujuan untuk meningkatkan pengetahuan terkait pengkajian dan manajemen sedasi.

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Patients who are treated in intensive care unit are predominantly equipped by invasive devices which initiate discomfort, pain and restlessness to the patients. Collaboration in offering sedation is one of the intervention that can provide a feeling of comfort. Nurses play an important role in monitoring sedation hence they need to understand the sedation management in the intensive care unit. This study aimed to determine the correlation of nurses' knowledge with the practice of providing sedation in the intensive care unit in a type A hospital in Jakarta. The research methodology used a cross sectional study with 80 respondents and used the Nurses Knowledge of Sedatives, Sedation Assessment and Management Questionnaire and Nurses Sedation Practice Scale Questionnaire. The results of the one way anova analysis showed that there was a significant difference in the average sedation practice by nurses according to the level of knowledge of nurses with p Value = 0.000. This study recommends that increasing the knowledge of nurses can be done through education and training programs that aims to increase the knowledge related to sedation assessments and managements."