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"Diagnosis dan tindakan pengobatan lanjutan pasien 70% ditentukan berdasarkan hasil laboratorium. Berbagai penelitian menunjukan bahwa tingkat kesalahan di laboratorium masih lebih rendah dibandingkan unit pelayanan lain di rumah sakit, namun keselamatan pasien harus tetap diutamakan sebagai tujuan layanan laboratorium. HFMEA merupakan metode proaktif untuk mengidentifikasi, evaluasi, dan rekam mode kegagalan penyebab masalah serta dampak yang akan timbul dalam upaya pencegahan potensi risiko. Tulisan ini bertujuan untuk mendapatkan gambaran faktor yang mempengaruhi keselamatan pasien di laboratorium, serta proses identifikasi risiko menggunakan HFMEA hingga merancang desain HFMEA yang dapat digunakan laboratorium rumah sakit. Penelitian ini menggunakan metode literature review dengan pangkalan data PubMed, Scopus, dan Google Scholar. Hasil pencarian didapat sebanyak 9 literatur berasal dari USA, China, Taiwan, India, Turki, Ghana, American Journal of Clinical Pathology, dan Europe Society of Pathology yang telah melakukan penelitian identifikasi risiko keselamatan pasien di laboratorium baik menggunakan metode HFMEA maupun metode lain. Hasil telaah literatur menunjukan tingkat eror tertinggi pada fase pre-analitik berkisar 49,2%– 84,5%. Kesalahan yang umum terjadi pada fase pre-analitik berupa clotting, dan inadekuat volume spesimen yang mengakibatkan terjadinya penolakan spesimen. Adapun faktor yang mempengaruhi keselamatan pasien laboratorium berupa, faktor kondisi pasien; faktor petugas laboratorium meliputi pelatihan petugas, kelalaian petugas, dan burnout petugas laboratorium; faktor fasilitas; dan faktor akreditasi. Penulis merancang desain HFMEA yang dapat digunakan pada laboratorium rumah sakit, namun perlu dilakukan penelitian lanjutan menggunakan data Indonesia, agar lebih representatif dan dapat digunakan di laboratorium rumah sakit Indonesia.

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Most of 70% patients are diagnosed and treatment based on laboratory results. Many studies have shown that error rates in laboratory is still lower than other units in hospital, but patient safety must be prioritized as the goal of laboratory services. HFMEA is a proactive method for identifying, evaluating, and recording failure modes that cause problems and impacts to prevent potential risks. This study aims to get an overview of the factors that influence patient safety in hospital laboratories, seeing the process of HFMEA and design a draft that can be used in hospital laboratories. This study used literature review method with databases from PubMed, Scopus and Google Scholar. The results obtained 9 literatures from USA, China, Taiwan, India, Turkey, Ghana, American Journal of Clinical Pathology, and Europe Society of Pathology who have conducted research to identify patient safety risks in the laboratory using HFMEA or other methods. The result showed the highest error rate is in pre-analytic phase ranged from 49.2%–84.5%. Errors in this phase are clotted, and inadequate specimen volume, that can cause specimen rejection. The factors that influence patient safety in laboratories are patient condition; laboratory staff factors include staff training, staff negligence, and burnout on laboratory personnel; facility factor; and accreditation factor. In this study, author designed a HFMEA draft that can be used in hospital laboratories, but needs further research using data in Indonesia, for more representative and applicable in hospital laboratories."

"Latar belakang: BPJS sejak berdiri tahun 2014 sampai saat ini berusaha menerapkan pelayanan yang setara. Kesenjangan pelayanan dalam segi fasilitas kesehatan di seluruh Rumah Sakit di Indonesa menjadi permasalahan yang tak kunjung usai sehingga terbitlah peraturan pemerintah No 47 tahun 2021 tentang KRIS-JKN. Hadir dengan 12 kriterianya untuk menjawab tantangan ketidaksetaraan pada fasilitas salah satunya RS Yarsi. Dilakukan uji coba penerapan tahun 2022 oleh DJSN didapati bahwa 79% RS membutuhkan perbaikan infrastruktur dalam skala kecil, 18% RS perlu perbaikan skala besar, dan 3% RS dinyatakan sudah siap. Peraturan Presiden No 59 tahun 2024 mewajibkan seluruh rumah sakit siap menerapkan KRIS-JKN paling lambat 30 Juni 2025.Tujuan penelitian: Mengetahui kesiapan penerapan dan mengusulkan strategi penyiapan KRIS-JKN di RS Yarsi.Metodologi penelitian: Menggunakan pendekatan kualitatif dengan desain action research menggunakan data primer temuan di lapangan dan data sekunder (file-file di rumah sakit) dan hasil wawancara. Penelitian ini dilaksanakan dari bulan April hingga Mei 2024.Hasil penelitian: Didapatkan hasil bahwa RS Yarsi sudah 80 % siap untuk menerapkan KRIS-JKN. Beberapa hal yang menjadi faktor internal dan faktor eksternal setelah melewati diskusi dengan tim CDMG kemudian dimasukan ke  matrix IE, penerapan KRIS-JKN di RS Yarsi berada di posisi sel 1, build and grow. Di matrix TOWS strategi yang diusulkan, yaitu Product Development dan Market Development. Pada tahapan penyusunan strategi pada matrix TOWS didapati prioritas pertama adalah pengembangan sarana dan prasarana, yaitu Pengganggaran revitalisasi sarana dan prasarana, optimalisasi SIMRS, penyesuaian kebutuhan sarana sesuai kriteria KRIS-JKN. Prioritas kedua pengembangan kompetensi SDM, yaitu dengan recruitement SDM yang kompeten dan kepala instalansi rawat inap, melakukan refreshement dan bounding antar pegawai. Prioritas ketiga pengembangan segmen pasar, yaitu melalui promosi layanan unggulan dan penguatan kerjasama lintas sektor, perbaikan manajemen tempat tidur RS, Customer Relationship Management (CRM), dan peningkatan enggangement dengan pelanggan dan mitra.Kesimpulan: RS Yarsi 80 % siap dalam menerapkan KRIS-JKN dengan strategi penyiapan yang diusulkan adalah Product Development dan Market Development dengan prioritas strategi pertama yaiitu pengembangan saran dan prasarana, kedua pengembangan kompetensi SDM, dan ketiga pengembangan segmen pasar.

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Background:  BPJS since its establishment in 2014 until now has tried to implement equal services. The gap in services in terms of health facilities in all hospitals in Indonesia has become a never-ending problem so that government regulation No. 47 of 2021 concerning KRIS-JKN was issued. It comes with 12 criteria to answer the challenge of inequality in facilities, one of which is Yarsi Hospital. A trial implementation in 2022 by DJSN found that 79% of hospitals needed small-scale infrastructure improvements, 18% of hospitals needed large-scale repairs, and 3% of hospitals were declared ready. Presidential Regulation No. 59 of 2024 requires all hospitals to be ready to implement KRIS-JKN no later than June 30, 2025.

Objective: Knowing the readiness of implementation and proposing a strategy for the preparation of KRIS-JKN at Yarsi Hospital.

Methode: Using a qualitative approach with an action research design using primary data from findings in the field and secondary data (files in hospitals) and interview results. This research was carried out from April to May 2024.

Results: The results were obtained that Yarsi Hospital is 80% ready to implement KRIS-JKN. Several things that became internal factors and external factors after going through discussions with the CDMG team were then included in the IE matrix, the implementation of KRIS-JKN at Yarsi Hospital was in the position of cell 1, build and grow. In the TOWS matrix, the proposed strategies are Product and Market Development. At the stage of strategy preparation in the TOWS matrix, it was found that the first priority was the development of facilities and infrastructure, namely the revitalization of facilities and infrastructure, optimization of SIMRS, adjustment of facility needs according to KRIS-JKN criteria. The second priority is the development of human resource competencies, namely by recruiting competent human resources and heads of inpatient installations, conducting refreshements and bounding between employees. The third priority for market segment development is through the promotion of superior services and strengthening cross-sector cooperation, improving hospital bed management, Customer Relationship Management (CRM), and improving engagement with customers and partners.

Conclusion: RS Yarsi is 80% ready to implement KRIS-JKN with the proposed preparation strategy of Product Development and Market Development with the first strategic priority, namely the development of advice and infrastructure, the second is the development of human resource competencies, and the third is the development of market segments."

"Sindrom koroner akut (SKA) merupakan masalah kesehatan nasional karena tingginya angka morbiditas dan mortalitas serta beban biaya yang dibutuhkan. Intervensi koroner perkutan (IKP) dan terapi antiplatelet seperti klopidogrel merupakan tata laksana yang direkomendasikan oleh organisasi kardiologi internasional. Meskipun demikian, pasien SKA masih dapat mengalami kejadian kardiovaskular mayor (KKM). Kemungkinan, resistensi klopidogrel berperan pada KKM sedangkan resistensi klopidogrel mungkin dipengaruhi oleh faktor genetik dan epigenetik. Penelitian ini bertujuan untuk mengetahui hubungan faktor genetik yaitu polimorfisme gen CYP2C19 dan P2Y12, serta epigenetik yaitu metilasi DNA gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dengan resistensi klopidogrel dan pengaruhnya terhadap KKM pada pasien SKA pasca IKP.Untuk menganalisis hubungan faktor genetik dan epigenetik dengan resistensi klopidogrel, penelitian dilakukan dengan desain potong lintang, sedangkan untuk analisis hubungan faktor genetik dan epigenetik dengan KKM dilakukan dengan desain kohort prospektif. Subjek penelitian meliputi 201 pasien SKA pasca IKP dan mendapat terapi klopidogrel di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dari bulan September 2018 sampai dengan Juni 2020. Resistensi klopidogrel ditentukan dengan pemeriksaan light transmission aggregometry (LTA) apabila hasilnya lebih besar dari 59% dengan agonis ADP 20 mM. Deteksi polimorfisme gen CYP2C19 dan P2Y12 serta ekspresi miRNA-26a dilakukan dengan metode qRT-PCR, sedangkan metilasi DNA gen CYP2C19 dan P2Y12 dikerjakan dengan metode konversi bisulfit. Pasien diobservasi selama satu tahun dan jika ada angina pektoris, infark miokard akut (IMA) rekuren, stroke, atau kematian, dicatat sebagai KKM.Dari 201 subjek, terdapat 45,8% carrier mutant polimorfisme *2 dan *3 gen CYP2C19, 36,8% carrier mutant polimorfisme rs3679479 gen P2Y12, 10% hipometilasi DNA gen P2Y12, 80,1% hipometilasi DNA gen CYP2C19, dan 66,2% ekspresi miRNA-26a up regulated. Proporsi resisten klopidogrel adalah 49,8% dan proporsi KKM adalah 14,9% (kematian 7,5%). Terdapat hubungan antara merokok (p = 0,001; OR 0,37 [IK 95%; 0,20–0,68]), hipometilasi DNA gen CYP2C19 (p = 0,037; OR 2,13 [IK 95%; 1,04–4,37]), dan ekspresi miRNA-26a up regulated (p = 0,020; OR 2,03 [IK 95%; 1,12–3,68]) dengan resistensi klopidogrel. Terdapat hubungan antara jenis kelamin perempuan (p = 0,040; HR 2,73 [IK 95%; 1,05–7,14]), usia ≥ 60 tahun (p = 0,035; HR 2,17 [IK 95%; 1,06–4,48]), eGFR rendah (p = 0,001; HR 3,29 [IK 95%; 1,59–6,84]), dan polimorfisme *2 dan *3 gen CYP2C19 (p = 0,047; HR 2,12 [IK 95%; 1,01–4,46]) dengan KKM dalam satu tahun.Hanya faktor epigenetik berupa metilasi DNA gen CYP2C19 dan ekspresi miRNA-26a yang berhubungan dengan resistensi klopidogrel. Walaupun resistensi klopidogrel tidak berhubungan dengan KKM, terdapat hubungan antara faktor genetik polimorfisme *2 dan *3 gen CYP2C19 dengan KKM.

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Acute coronary syndrome (ACS) is a national health problem due to high morbidity and mortality, and cost burden as well. Percutaneous coronary intervention (PCI) and antiplatelet therapy such as clopidogrel are recommended. However, ACS patients could still experience major adverse cardiovascular events (MACE). Clopidogrel resistance possibly plays a role in MACE whereas it may be affected by genetic and epigenetic factors. Therefore, the objective of this study was to determine the relationship between genetic factors which are CYP2C19 and P2Y12 polymorphisms, as well as epigenetic factors which are DNA methylation of CYP2C19 and P2Y12, and miRNA-26a expression and their effects on MACE in post-PCI patients.

To analyze the association between genetic and epigenetic factors and clopidogrel resistance, the study design was cross-sectional, while the study design of relationship between genetic and epigenetic factors and MACE was prospective cohort. The subjects were 201 post-PCI ACS patients who received clopidogrel therapy at Harapan Kita Hospital from September 2018 to June 2020. Clopidogrel resistance was determined by light transmission aggregometry (LTA) if the result was greater than 59% with agonist ADP 20 µM. The detection of CYP2C19 and P2Y12 gene polymorphisms and miRNA-26a expression were carried out by qRT-PCR method, while the DNA methylation of the CYP2C19 and P2Y12 genes were carried out by bisulfite conversion method. Patients were observed for one year and angina pectoris, recurrent acute myocardial infarction (AMI), stroke, or death, were recorded as MACE.

From 201 subjects, 45.8% were CYP2C19*2 and CYP2C19*3 polymorphism mutant carrier, 36.8% were rs3679479 P2Y12 polymorphism mutant carrier, 10% were hypomethylated of P2Y12, 80.1% were hypomethylated of CYP2C19, and 66.2% were up regulated in miRNA-26a expression. 49.8% of subjects were clopidogrel resistant and 14.9% of subjects experienced MACE (death was 7.5%). Smoking (p = 0.001; OR 0.37 [CI 95%; 0.20–0.68]), hypomethylated of CYP2C19 (p = 0.037; OR 2.13 [CI 95%; 1.04–4.37]), and up regulated miRNA-26a expression (p = 0.020; OR 2.03 [CI 95%; 1.12–3.68]) were associated with clopidogrel resistance. Female gender (p = 0.040; HR 2.73 [CI 95%; 1.05–7.14]), age over 60 years old (p = 0.035; HR 2.17 [CI 95%; 1.06–4.48]), low eGFR (p = 0.001; HR 3.29 [CI 95%; 1.59–6.84]), and CYP2C19*2 and CYP2C19*3 polymorphisms (p = 0.047; HR 2.12 [CI 95%; 1.01–4.46]) were associated with MACE in one year.

Only DNA methylation of CYP2C19 and miRNA-26a expression were associated with clopidogrel resistance. Although clopidogrel resistance was not associated with MACE, there was association between CYP2C19*2 and CYP2C19*3 polymorphisms and MACE."