Nilai
25
0
15
0
30
15
0
20
0
20
10
0
15
0
TOTAL SCORE
Resiko Tinggi
......
0-24
Hijau
Licin
Tidak Licin
Lantai Kamar Mandi
Licin
Tidak Licin
Kondisi Bed
Baik
Tidak Baik
Pencahayaan
Baik
Cukup
Kurang
Bel ruangan
Berfungsi
Rusak
Pendingin Ruangan
Berfungsi
Rusak
Pintu Kamar Mandi
Berfungsi
Rusak
INDAK LANJUT PASIEN RESIKO JATUH SCORE TINGGI
1. Pasang gelang .................................................................................................sudah/ belum
2. Informasi kepada pasien/keluarga..................................................................sudah/ belum
3. Fasilitasi bila memerlukan pergerakan/perpindahan......................................ya/tidak
4. Lain-lain sebutkan ...............................................................................................................
..............................................................................................................................................
C. KONSULTASI/ LAPOR DOKTER ( waktu,dr siapa,hasil/advis)
...................................................................................................................................................
...................................................................................................................................................
KONDISI RUANGAN
Lantai Kamar
B.
T