FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : JANUARI

TERPASANG KANCING JUMLAH PASIEN

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH
PASIEN (NOMERATOR) (DENOMINATOR)
1 1/2/2017 SUKENDAR BIN WASDIYA, TN A011700127 1 1
2 1/2/2017 ABDUL RIFQI A011700125 1 1
3 1/2/2017 PETRUS NAKARO WYAKTO SAMBODO A011700119 1 1
4 1/2/2017 RAMIAH BT ADIYA, NY A011700128 1 1
5 1/2/2017 NANA SABARTINI, NY A011700124 1 1
6 1/2/2017 ZIDNI UWAIS QORNI A011700131 1 1
7 1/2/2017 NIA HIDAYANA, NY A011700133 1
GRAFIK
1 PENCAT
8 1/2/2017 IKE PALUPI KRISTIANI, NY ~ A011700123 1 1
9 1/2/2017 ANNIDA WULAN RAMADHANI A011700122 1 1
10 1/2/2017 MUNIKAH BT RABIDIN, NY A011700138 1 100 1
11 1/2/2017 ZIYAD FAWWAZ S A011700139 1 90 1
12 1/2/2017 PURWANTO BIN KARSAN SOERODIRDJO, TN A011700140 1 80 1
13 70
1/2/2017 AGNY BRAJA DENTA A011700142 1 1
60
14 1/2/2017 ELVINA EDYSTI A011700143 1 1
50
15 1/2/2017 ROCHAENI BT CASNA, NY A011700144 1 40 1
16 1/2/2017 MUHAMAD KEVIN A091600158 1 30 1
17 1/2/2017 RAYHAN AL FAHRI A091600129 1 20 1
10
0
PENCAPAIAN (%)
RESIKO PASIEN JATUH

FORMULA /
PENCAPAIAN
(%)

GRAFIK PENCATATAN RESIKO PASIEN JATUH

100
90
80
70
60
50
40
30
20
10
0
PENCAPAIAN (%) TARGET (%)
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : JANUARI

TERPASANG KANCING
NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG
PASIEN (NOMERATOR)
1 MUHAMMAD ARRAFI MANAF A021701935 1
2 SITI MUNDIROH, NY A021701980 1
3 SANIMA BT R. MUHAMMAD H, NY A021702023 1
4 ROSNI BT BAHRUM, NY (HC BALONGAN) A021702005 1
5 RUDIYANTO BIN M. E HAEYADI, TN A021702109 1
6 YASMIN FADHILAH A021702121 1
7 DARWIJA BIN BUNARWI, TN A021702128 1
8 DARSIWEN BT WARDIYAH, HJ, NY A021702129 1
9 MUHAMMAD FATIH RIZQI MUBAROK A021702183 1
10 JANE IVANA SINAGA A021702189 1
11 RAMADHAN ILHAM NASRALLAH A021702194 1
12 VALLE VADILLAH VIRMANSYAH A021702198 1
13 ALTAMIS AQLAN A021702197 1
14 RIHADATUL AISY NUR ZAKKIYAH A021702199 1
15 AL BIAN IBNU HAKIM HARAHAP A021702203 1
16 FAHMI GINANJAR SAEFUDIN, TN A021703353 1
17 KANIA RISCA. D ~ A021703355 1
18 ANIS PUSPITASARI, NY A021703364 1
19 ASIH ARWINI, HJ, NY A021703481 1
20 RHEZA ZULMI FAHLEVI A021703548 1
21 ABDUL WAKID, TN A021703542 1
22 RIZKY MIFTAHUL AKBAR A021703604 1
23 SUPRANA BIN M. SOEBANA, TN A021703637 1
24 KATINA BIN NADOL, TN A021703647 1
25 ENDARINI TRIFINDA A021703671 1
26 WIDIANINGSIH BT ILYAS SURYADI, SE, NY A021703672 1
27 ALOYSIUS DANYEL P.P.HUTUBESSY.TN A011700505 1
28 SAEFUDIN ANWAR A021703679 1
29 SAPARI BIN KUWAT, TN A021703680 1
30 HARTOYO BIN SUKIYAT, TN A021703681 1
31 SARINI BT ASRADI, HJ, NY A021703683 1
32 MUJIWATI BT ABD SANUSI, NY A021703691 1
33 AGUSTINUS SIDI, TN A021703692 1
34 YAZID MUHARRAM A021703693 1
35 MAWAR ALIYAH ABDANI A021703698 1
36 SOFWANUDDIN BIN MUHAMMAD SAFIUDDIN, TNA021703699 1
37 SALAMAH BT MAKMUR, NY A021703701 1
38 HADI MURNADI, TN A021703702 1
39 IKA SILVIANA SORAYA, NY ~ A021703705 1
40 NURZAEN MISBACH, TN A021703710 1
41 JULIA HANDAYANI, HJ, NY A021703711 1
42 ELMIRA DATIN RAMADHANI A021703712 1
43 NAURA ANDIENA PUTRI A021703713 1
44 SITI NURAENI A021703714 1
45 F.X. SUPOYO, TN A021703715 1
46 IKA PRAMESTI, NY A021703709 1
47 TOTO WALUYO, TN A021703722 1
48 ALDEN SEIF ZYENO LATUTUAPARAYA A021703719 1
49 SRI HARTUTI, NY A021703721 1
50 DADAN HAMDANI A021703725 1
51 IIN MARIFAH, NY A021704244 1
52 MUHAMMAD RAFFAN AL-ASHRAF A021704717 1
53 LILIAN ELVIRA CHANDRA A021704718 1
54 KOSIM, TN ~ A021704719 1
55 TIMAN BIN NURSALIM, TN A021704720 1
56 DARYANI BT DAHLAN, NY A021704721 1
57 EDFAN GUSTIAFAN, TN A021704723 1
58 ISLAKHUDDIN,TN A021704724 1
59 AHMAD RAMADHAN YUSFIANDA A021704725 1
60 NAYLA AZZAHRA YUSFIANA A021704726 1
61 BISMA ARKAN PERMANA A021704730 1
62 YENI YUNIAR ANDRIYANI, NY A021704732 1
63 META DWI AMELIA, NY A021704733 1
64 TANIMAH,NY A021704736 1
65 ADHYASTHA AMZAR RAIHAN A021704737 1
66 SRI TANJUNG, NN A021704740 1
67 LUCY ANITA WINANT, DR, HJ, NY*** A021704742 1
68 ABDUL FATAH AGUS WACHYONO, TN A021704743 1
69 SUMAERIH BT TARMIDI, NY A021704744 1
70 NAURA KHANZA PUTRI AMANTA A021704745 1
71 RITA SYAIFUL, NY A021704746 1
72 MANSUR BIN YANA,H,TN A021704747 1
73 IPAH SURIPAH, NY A021704751 1
74 CARINNA NURUNNISA A A021704752 1
75 SITI DJUBAEDAH, NY A021704753 1
76 NOVA SILVA HENDRIYANI, NY A021704754 1
77 SUCI HARIYANI, NY A021704755 1
78 YAN DEMSI, TN~ A021704759 1
79 ESTERIA A SIMANJUNTAK,NY A021704760 1
80 SUPRANA BIN M. SOEBANA, TN A021704761 1
81 KHODIJAH BT USMAN, HJ. NY A021704762 1
82 RULLY DANIATIE, NY A021704763 1
83 YOZA LUCMAN HARTANTO A021704764 1
84 BUDIARTI BT LIE ANG KWIE, NY A021704765 1
85 RAFLI ARIFUDIN GUSTIAN A021704766 1
86 SRI SULAKSANAH, IR, NY A021704767 1
87 IKE PALUPI KRISTIANI, NY A021704768 1
88 ADE SUTIKNO, TN A021704770 1
89 PIRATA QUON SAVA RUOBAI TAQI A021704771 1
90 RIZKY ZULKARNAEN A021704772 1
91 SAHARA YUNING R.D, NY A021704773 1
92 M. REIHAN ALEYZA SIFA~ A021704775 1
93 KOSIM BIN RUSDI, TN ~ A021704778 1
94 SUKEMI BIN KASRAN, TN A021704779 1
95 RATU NURSITI, NY A021704780 1
96 R RONNY JULIANY S, TN A021704781 1
97 HABIBURRAHMAN AL-WAFI A021704782 1
98 ABDIRRAHMAN NAWWAF A021704783 1
99 ABDUL MUTHOLIB, TN A021704784 1
100 RIKI HENDARSYAH, TN A021706104 1
101 AGAM AFDILAH A021706161 1
102 JAVIER AKTAM KHAIRULLAH A021706195 1
103 WASIAH BINTI NAWI, NY A021706204 1
104 DENI IMAN SAPUTRO A021706267 1
105 RIFQY MAULANA HARTONO A021706288 1
106 RAPINGI BIN KALIL, TN A021706290 1
107 IDA SUGIARTI, NY A021706292 1
108 STEFHANIE NUR HIDAYANTI A021706295 1
109 PIETER JOHN L, DRS,TN A021706294 1
110 JAJAT SUDRAJAT A021706298 1
111 SHEILA PARCIA KAPITALIANA A021706296 1
112 RAKILO BIN KARPO, H, TN A021706301 1
113 YATI ROHAYATI, NY A021706302 1
114 SYAHNAZ AZZAHRA MAULINA A021706308 1
115 MUSLIH ALI HASAN, TN A021706313 1
116 HENI MULYANI, NY A021706315 1
117 BINTANG SHALVARISMA, NY A021706319 1
118 ABDIL ARIQINO HISYAM A021706320 1
119 RUSYATI BT TARGI, NY A021706559 1
120 DASITI BT RAKIYA, HJ, NY A021706523 1
121 DAUD BIN ABDUR ROZAK, TN A021706541 1
122 DIVA ANDINA PUTRI A021706544 1
123 RUSYATI BT TARGI, NY A021706559 1
124 ATHADHEFINO ZHAFRAN A021706569 1
125 AMIR HUSAEN, TN A021706574 1
126 RAMADITO FERDIAN ASSA A021706591 1
127 PATONI BIN SARTAMAN, TN A021706619 1
128 MUHAMMAD HAFIDZ DZIKRI OKTOVIANO A021702184 1
128

KET : TERPASANG = 1
TIDAK TERPASANG = 0

Mengetahui
Ka IGD

dr. Agus Kusnandang, Sp.S

JUMLAH PASIEN FORMULA /
RESIKO JATUH PENCAPAIAN
(DENOMINATOR) (%)
1 JANUARI
1 PENCAPAIAN (%) 100
1 TARGET (%) 100
1
1
1 GRAFIK PENCATATAN RESIKO PASIEN JATUHJATUH
1
GRAFIK PENCATATAN RESIKO PASIEN
1
1
1 100
100
1 90 90
80
1 80
70 70
1
60 60
1
50 50
1 40 40
1 30 30
1 20 20
1 10 10
0 0
1 PENCAPAIAN
PENCAPAIAN (%) (%) TARGET TARGET
(%) (%)
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 1
1
1
1
1
1
128 100

Cirebon, .......................
Pengumpul data

………………………………………….
ASIEN JATUHJATUH
IKO PASIEN

ET TARGET
(%) (%)
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : JANUARI

TERPASANG KANCING JUMLAH PASIEN

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH
PASIEN (NOMERATOR) (DENOMINATOR)
1 Ny. Siti Aisyah A016100034 1 1
2 Tn. Dr. Sunardjo A00100083 1 1
3 Ny. Sutinah A17030014 1 1
4 Ny. St. Juroh A13030176 1 1
5 Tn. Narita A17030022 1 1
6 An. Kenzie A17020625 1 1
7 Tn. Kanot A13120023 1 1
8 Ny. Entur A17030028 1 1
9 An. Bayu A15030111 1 1
10 Tn. Hadi A16110984 1 1
11 Ny. Sanisih A17020759 1 1
12 Sdr. Dwiyan A17030051 1 1
13 Ny. Utiyah A17030053 1 1
14 Tn. Ismail A17030054 1 1
15 Ny. Endang A17030080 1 1
16 Tn. Arie A17020769 1 1
17 Tn. Warma A11121023 1 1
18 Tn. Zakaria A15070207 1 1
19 Ny. Emi Sukemi A17030088 1 1
20 Ny. Syarifah A00110477 1 1
21 Ny. Aty A15080392 1 1
22 Ny. Sutiani A14010042 1 1
23 An. Aurin A17030099 1 1
24 NY. Prisola A1739339 1 1
25 Tn. Dian A17030104 1 1
26 Ny. Muktiasih A17030111 1 1
27 Tn. Jc. Malau A05090109 1 1
28 An. Haizar A17020447 1 1
29 Tn. Ismail A17030054 1 1
30 Ny. Sawiti A16100449 1 1
31 Ny. Rasiyem A17030125 1 1
32 Ny. Kotiah A17030126 1 1
33 Tn. Apandi A15040752 1 1
34 An. Daud A07100008 1 1
35 Ny. Rini A17011753 1 1
36 Ny. Masni A16110088 1 1
37 AN. Sandi A13060219 1 1
38 Ny. Hastin A07010720 1 1
39 Ny. Tarsini A17030160 1 1
40 Ny. Sukipah A17030167 1 1
41 Tn. Hasan Basri A1703075 1 1
42 An. Kayla A17030180 1 1
43 Ny. Yuli A17030183 1 1
44 Ny. Sri A17030184 1 1
45 Tn. Dedi A17030199 1 1
46 An. M. Rifqi A17020103 1 1
47 Tn. Tumino A17030212 1 1
48 Ny. Wartini A17030223 1 1
49 Tn. Asep A17030224 1 1
50 Ny. Siti A17030250 1 1
51 An. Syifa A17030254 1 1
52 Tn. Sumarno A17030267 1 1
53 Ny. Yuliyani A17030267 1 1
54 Ny. Lelasari A17030257 1 1
55 Tn. Rochyadi A17030276 1 1
56 Sdr. Rizal A17030282 1 1
57 Tn. Aman A17030285 1 1
58 Tn. Abdul A17030286 1 1
59 An. Jihan A17030288 1 1
60 Ny. Kurniah A17030292 1 1
61 Ny. Romlah A17030295 1 1
62 An. Nayla A17030297 1 1
63 Sdr. Aditya A17030299 1 1
64 An. Javier A17030301 1 1
65 Ny. Sri.W A17030303 1 1
66 An. Malika A17030302 1 1
67 Ny. Riyah A17030306 1 1
68 Ny. Raminah A17030308 1 1
69 An. M. Rizal A17030312 1 1
70 Tn. Sunadi A17030313 1 1
71 Tn. Iwan A17030323 1 1
72 Tn. Kusyanto A17030331 1 1
73 Tn. Slamet A17030351 1 1
74 Tn. Ruyanto A17030354 1 1
75 An. Arganto A17030357 1 1
76 Tn.Marica A17030370 1 1
77 Ny. Eti A17030374 1 1
78 An. Nabila A17030432 1 1
79 Ny. Susnida A17030433 1 1
80 Tn. Agus A17030436 1 1
81 Tn. Djoni A04021377 1 1
82 Tn. Sutrisno A09050397 1 1
83 Ny. Munari A07050197 1 1
84 Ny. Rochmawati A04011750 1 1
85 Ny. Tintin A17030471 1 1
86 Tn. Tama A04011351 1 1
87 Ny. Sunaeni A17030473 1 1
88 An. Indri hapsari A05100449 1 1
89 Tn. Balok A17030489 1 1
90 Tn. Nana A04010572 1 1
91 Tn. Sukirman A17030504 1 1
92 Ny. Sarimah A04011988 1 1
93 An. Sabila Anin A16041177 1 1
94 Ny. Go Njoek A17020773 1 1
95 Ny. Turairah A01030046 1 1
96 Ny. Uun Kurniah A13080592 1 1
97 Tn. Sutedja A17030535 1 1
98 Ny. Kunaeni A15070346 1 1
99 Tn. Yudika A16080310 1 1
100 Ny. Aan A16080837 1 1
101 Tn. Johanes A04011153 1 1
102 Ny. Indri kusumawati A08120135 1 1
103 Ny. Feliana A17030558 1 1
104 An. Syakilah A17030564 1 1
105 An. Sahana A17030365 1 1
106 NY. Patimah A17030542 1 1
107 Ny. Dewi A17030567 1 1
108 An. Gabriel A16110341 1 1
109 Tn. Baginda A11110744 1 1
110 Ny. Eliyanah A17030136 1 1
111 Ny. Sri eni A03040615 1 1
112 Ny. Mulyati A17030563 1 1
113 Nn. Retna A04011304 1 1
114 Ny. Manggi A17030631 1 1
115 Nn. Sri agustina A17030647 1 1
116 Nn. Laras A17030658 1 1
117 Tn. Maulana A04010204 1 1
118 Ny. Norma A14060785 1 1
119 Tn. H. Wartam A14010508 1 1
120 An. Haikal A03080298 1 1
121 Tn. Umar A13110182 1 1
122 An. Keyla A19011960 1 1
123 Tn. Sarly A17030746 1 1
124 Tn. Almo A16050220 1 1
125 Ny. Tri Setio A17030794 1 1
126 Ny. Katirah A14060243 1 1
127 Ny. Kusna A17030810 1 1
128 Ny. Siska A17030875 1 1
128 128

KET : TERPASANG = 1
TIDAK TERPASANG = 0

Mengetahui Cirebon, .......................

Ka IGD Pengumpul data

dr. Agus Kusnandang, Sp.S ………………………………………….

 FORMULA /
PENCAPAIAN
(%)
JANUARI
PENCAPAIAN (%) 100
TARGET (%) 100

GRAFIK PENCATATAN RESIKO PASIEN JATUH

GRAFIK PENCATATAN RESIKO PASIEN JATUH

100
90 100
80 90
70 80
60 70
50 60
40 50
30 40
20 30
10 20
0 10
PENCAPAIAN (%) TARGET (%)
0
PENCAPAIAN (%) TARGET (%)
 100

on, .......................

………………………………….
H
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : JANUARI

TERPASANG KANCING JUMLAH PASIEN

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH
PASIEN (NOMERATOR) (DENOMINATOR)
1 An. Nahda A14110526 1 1
2 Tn. M. Ali kahf A15110583 1 1
3 Tn. Suparno A17040008 1 1
4 Ny. Irnawati A17012293 1 1
5 Tn. David A17040015 1 1
6 Tn. Endang A13020558 1 1
7 Tn. Daspin A17040021 1 1
8 An. Khaziyah A13070242 1 1
9 Tn. Danuri A14090730 1 1
10 Tn. Rangga A17040033 1 1
11 NY. Dini anggraeni A17040034 1 1
12 NY. Mariah A17040039 1 1
13 NY. Suciyati A10100634 1 1
14 Tn. Sunarto A03010632 1 1
15 Ny. Sangidah A17030885 1 1
16 An. M. Faiz A07090844 1 1
17 An. Abdilah A17040091 1 1
18 Ny. Suripah A17040120 1 1
19 Sdr. Yuda A17040122 1 1
20 Tn. Yucis A16020595 1 1
21 An. Asraf kamal A14080245 1 1
22 Tn. Bijri susilo A17040140 1 1
23 NN. Halimatul A17540152 1 1
24 Tn. Caspin A16070120 1 1
25 Ny. Diana natalia A12060068 1 1
26 An. Albert A17040165 1 1
27 Ny. Darsini A06080465 1 1
28 Ny. Caroline A07010661 1 1
29 An. Moh haris A17040194 1 1
30 An. Ratu talita A15060163 1 1
31 An. Devi A16070265 1 1
32 Tn. Edi gunadi A10070406 1 1
33 Ny. Ratna Dewi A17040228 1 1
34 Ny. Kasfah A17020363 1 1
35 Tn. Mashud A08100064 1 1
36 An. Subhi brian A17040243 1 1
37 Ny. Casini A17040247 1 1
38 Ny. Irnawati A17012293 1 1
39 Ny. Siti rosita A17040253 1 1
40 Tn. Madriah A17040258 1 1
41 An. Faizal A17040260 1 1
42 Tn. Deni Hermanto A17040262 1 1
43 Ny. Dina kartika A09100486 1 1
44 An. Adam A15120324 1 1
45 Ny. Yossy. D A17040267 1 1
46 An.Rahma A17040272 1 1
47 Tn. Supardi A11030057 1 1
48 Tn. Suhanto A08031039 1 1
49 M. Royhan A17020043 1 1
50 Ny. Mahmuda A17040297 1 1
51 Ny. Ratna A11100326 1 1
52 sdr, Gilbert A07030083 1 1
53 An. Jovan A17040373 1 1
54 Tn. Sukid A17040375 1 1
55 Ny. Tjasri A17040379 1 1
56 Tn. Hari A06110302 1 1
57 Tn. Rayanto A17040395 1 1
58 An. Nayla A17040409 1 1
59 An. Alfath A10030012 1 1
60 Tn. Aliman A17040423 1 1
61 Ny. Taswih A17040429 1 1
62 Ny. Opi A13070643 1 1
63 Sdr. Habibi A16110392 1 1
64 An. Ihlasiyah A15020080 1 1
65 An. Aldo A17040460 1 1
66 Aj. Aisya A17040464 1 1
67 Tn. Syarif A15020579 1 1
68 Nn. Hana Tiara A01050336 1 1
69 Nn. Diana A17040477 1 1
70 Tn. Maksum A17040481 1 1
71 An. Nadiva A17040482 1 1
72 Tn. Riyanto A03020403 1 1
73 Nn. Mutiara A04120721 1 1
74 Ny. Titin A14040754 1 1
75 An. Azhar A16090418 1 1
76 Ny. Turiah A17040497 1 1
77 An. Abraham A17010931 1 1
78 An. Syakirah A13060938 1 1
79 Ny. Saham A02070404 1 1
80 An. Ahmad alif A16080737 1 1
81 Tn. Wardi A17040309 1 1
82 An. Euzel A17040510 1 1
83 An. Naureen A17040524 1 1
84 An. M. Atha A17040521 1 1
85 Ny. Nurhayati A16050288 1 1
86 An. Naura A17040550 1 1
87 Tn. Sakaji A17040555 1 1
88 An. M. Daffa A12100718 1 1
89 An. Hani Rahmawati A13090473 1 1
90 Tn. Tofq A17040582 1 1
91 Ny. Sri hartini A17040586 1 1
92 An. Tommi A17040598 1 1
93 Tn. Sobari A17040606 1 1
94 Ny. Emi sukemi A17030088 1 1
95 Ny. Sari Bt bandi A17040616 1 1
96 Nn. Cut mutia A16020906 1 1
97 An. M. Arya A15030563 1 1
98 Ny. Artutini A09032850 1 1
99 Tn. Danuri A14090730 1 1
100 Tn. Tono A170115177 1 1
101 Nn. Lulu A17011605 1 1
102 Ny. Rofah A17040667 1 1
103 Ny. Atimah A17040668 1 1
104 Ny. Abdila A17040675 1 1
105 Ny. Lina A08010563 1 1
106 Tn. Lutfiansyah A15110691 1 1
107 An. Nindia A17040677 1 1
108 NY. Melly A17040650 1 1
109 AN. Ghusan A07060123 1 1
110 Tn. Een A08010079 1 1
111 NY. Tati A17030684 1 1
112 Ny. Sanati A01700684 1 1
113 NY. Halimah A17040690 1 1
114 Ny. Wartini A17040693 1 1
115 Tn. Dedi A17040695 1 1
116 Tn. Sudarmo A17040834 1 1
117 An. Falah A16050804 1 1
118 Ny. Elis A17040840 1 1
119 An. Ananda A17020434 1 1
120 Ny. Julia A17040845 1 1
121 An. Kevin A17040846 1 1
122 Ny. Suratmi A1704040850 1 1
123 Ny. Mawadah A17040851 1 1
124 Ny. Dasmen A17040887 1 1
125 Ny. Turkinih A17040891 1 1
126 An. M. Imam A17040923 1 1
127 Tn. Agus A16041070 1 1
128 Nn. Daenah A17040927 1 1
128 128

KET : TERPASANG = 1
TIDAK TERPASANG = 0

Mengetahui Cirebon, .......................

Ka IGD Pengumpul data

dr. Agus Kusnandang, Sp.S ………………………………………….

 FORMULA /
PENCAPAIAN
(%)
JANUARI
PENCAPAIAN (%) 100
TARGET (%) 100

GRAFIK PENCATATAN RESIKO PASIEN JATUH

GRAFIK PENCATATAN RESIKO PASIEN JATUH

100
90 100
80 90
70 80
60 70
50 60
40 50
30 40
20 30
10 20
0 10 PENCAPAIAN (%) TARGET (%)
0
PENCAPAIAN (%) TARGET (%)
 100

on, .......................

………………………………….
H
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGDIGD

Periode : MEI
TERPASANG
KANCING
JUMLAH PASIEN
KUNING PADA FORMULA /
NO NAMA PASIEN RM RESIKO JATUH
GELANG PENCAPAIAN (%)
(DENOMINATOR)
PASIEN
1 NY. TARINIH A17050002 1
(NOMERATOR) 1
2 TN. AHMADI A17050001 1 1
3 Tn. Maskary A17011484 1 1
4 Tn. Mas Abdul A07060271 1 1
5 Ny. Fitria A17040197 1 1
6 Tn. Rohman A17050009 1 1
7 Tn. Gunawan A10030790 1 1
8 Ny. Sari A17050012 1 1
9 Tn. Suryadi A17050034 1 1
10 Tn. Ono A14080341 1 1
11 Tn. Eka sapta A17050072 1 1
12 Riya juwita A17050076 1 1
13 An. Yosi A17050081 1 1
14 Tn. Sohibi A14120279 1 1
15 Nn. Maya A15090091 1 1
16 An. M. Dhivo A16010462 1 1
17 Tn. Adi vivid A17050115 1 1
18 Tn. Marguna A17050120 1 1
19 NY. Dewi wulandari A17050124 1 1
20 Tn. Hasan A14090222 1 1
21 An. Aschabus A17050138 1 1
22 Tn. Rudi wahyudi A13060710 1 1
23 Tn. Diki A07030313 1 1
24 NY. JAHRO A17050190 1 1
25 SYAHNAZ A13020112 1 1
26 NY. PARITUM A17030550 1 1
27 TN. SUNARYADI A03100370 1 1
28 AN. MARYAM A17050194 1 1
29 AN. ELL WILLI A17050193 1 1
30 NY. TARMINI A17050198 1 1
31 AN. MALIKI A16051236 1 1
32 TN. UNO A17050204 1 1
33 NY. WARSITI A17050205 1 1
34 TN.M.YUSUF A04021705 1 1
35 NY. KUSNAENI A17050277 1 1
36 AN. HISYAM A17050278 1 1
37 NY. ARIANA A16110721 1 1
38 TN. RAWILAH A15090411 1 1
39 AN. ADHYASTA A16100385 1 1
40 NY. NURAEDAH A17050363 1 1
41 TN. SOEDIRDJO A15020635 1 1
42 NY. NANIH A01100025 1 1
43 TN. ZAENUDIN A396239 1 1
44 TN. IDING A04020528 1 1
45 NY. RASMINIH A17050392 1 1
46 AN. AMMAR A17050393 1 1
47 TN. ERO A03080371 1 1
48 TN. ANDREAS A17050395 1 1
49 NY. OEY A17050513 1 1
50 NY. SALAMAH A00082311 1 1
51 NY. IDA A04012017 1 1
52 NY. RUKIYAH A17050547 1 1
53 AN. RIKO A17050552 1 1
54 NY. TITI A17050553 1 1
55 AN. M.DIKRI A17050561 1 1
56 NY. TAMAR A1705289 1 1
57 TN. CANITO A17050570 1 1
58 AN. AQILA A17050537 1 1
59 AN. VEGA A16100132 1 1
60 TN. SUDARNO A17050579 1 1
61 AN. ATIKA A17050582 1 1
62 TN. HADI A941724 1 1
63 NY. RR.ENDANG A366317 1 1
64 NY. SURATMI A17050642 1 1
65 AN. DIAZ A17050641 1 1
66 AN. M. AYMAN A17050640 1 1
67 NY. SYARIFAH A321604 1 1
68 NY. ROHMA A17050644 1 1
69 NY. NURHAYATI A12110635 1 1
70 NY. SAENAH A17050645 1 1
71 NY. KARISEM A17050646 1 1
72 TN. CIPTADI A17050648 1 1
73 AN. MUHAMAD FARID A170606511 1 1
74 NY. LASMI A03060480 1 1
75 TN. CHOLIK A0812017 1 1
76 TN. BAHTIAR A05050141 1 1
77 NY. RAINAH A17050268 1 1
78 TN. R. MUGIONO A04021684 1 1
79 AN. ALFI A12120452 1 1
80 NY. ENENG A04011369 1 1
81 TN. JANA A17050691 1 1
82 TN. UMAR A13090691 1 1
83 NY. MAESAROH A17050695 1 1
84 AN. BILQIS A17050699 1 1
85 NY. SARWI A13050435 1 1
86 NY. SANI A16100398 1 1
87 AN. KAMIL A003065 1 1
88 NY. OEY A17050517 1 1
89 NY. SAMI A17050725 1 1
90 NY. EUIS A17040689 1 1
91 AN. FADIL A17010954 1 1
 92 TN. AGENG A17050227 1 1
93 TN. MARYONO A14100112 1 1
94 NY. NURHAYATI A12110635 1 1
95 AN. DWI RAJA A17050728 1 1
96 AN. SAMUEL A002665 1 1
97 NY. ASMINAH A17050758 1 1
98 TN. RUSDI A04011470 1 1
99 NY. WARNIAH A14100672 1 1
100 AN. MAHIRA A001676 1 1
101 AN. GREAT RATU A17030435 1 1
102 AN. AZIRA A14090666 1 1
103 AN. M. RIZKI A17050763 1 1
104 AN. ARIMBI A16020516 1 1
105 AN. SYAILENDRA A15010595 1 1
106 NY. NARWITI A1750767 1 1
107 TN. WASTULA A17050766 1 1
108 NY. TRI A00082599 1 1
109 AN. APRIANSYAH A17018840 1 1
110 AN. NAIDA A11060463 1 1
111 AN. M. HAFIZ A14090535 1 1
112 AN. AZAHRA A14100227 1 1
113 TN. MA NURCHOLIS A04010700 1 1
114 TN. DASILAN A17050787 1 1
115 NY. TITI A11100423 1 1
116 AN. ANIN A17050800 1 1
117 AN. ABIDZAR A15010041 1 1
118 TN. BAHTIAR A05050141 1 1
119 TN. SIJAMADI A00091102 1 1
120 NY. AMINAH A16040304 1 1
121 NY. TITIN A00081004 1 1
RESIKO PASIEN JATUH

PENCAPAIAN (%)
TARGET (%)

GRAFIK PENCATATAN RESIKO PASIEN JATU

100
90
80
70
60
50
40
30
20
10
0
PENCAPAIAN (%) TARGET (%)
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : JUNI

TERPASANG KANCING JUMLAH PASIEN FORMULA /

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH PENCAPAIAN
PASIEN (NOMERATOR) (DENOMINATOR) (%)
1
2
3
4
5
6 GRAFIK PENCATATA
7
8
9
10
100
11
90
12 80
13 70
14 60
15 50
16 40
17 30
18 20
19 10
20 0
PENCAPAIAN (%)
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : JULI

TERPASANG KANCING JUMLAH PASIEN FORMULA /

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH PENCAPAIAN
PASIEN (NOMERATOR) (DENOMINATOR) (%)
1
2
3
4
5
6
7 GRAFIK PENCATA
8
9
10
11 100
12 90
80
13
70
14 60
15 50
40
16 30
17 20
10
18
0
19 PENCAPAIAN (%)

20
21
22
23
24
25
26
27
28
29
30
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : AGUSTUS

TERPASANG KANCING JUMLAH PASIEN FORMULA /

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH PENCAPAIAN
PASIEN (NOMERATOR) (DENOMINATOR) (%)
1
2
3
4
5
6
7 GRAFIK PENCATAT
8
9
10
11 100
90
12 80
13 70
60
14
50
15 40
16 30
20
17
10
18 0
PENCAPAIAN (%)
19
20
21
22
23
24
25
26
27
28
29
30
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : SEPTEMBER

TERPASANG KANCING JUMLAH PASIEN FORMULA /

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH PENCAPAIAN
PASIEN (NOMERATOR) (DENOMINATOR) (%)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : OKTOBER

TERPASANG KANCING JUMLAH PASIEN FORMULA /

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH PENCAPAIAN
PASIEN (NOMERATOR) (DENOMINATOR) (%)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
0 0 #DIV/0!

KET : TERPASANG = 1
TIDAK TERPASANG = 0

Mengetahui Cirebon, .......................

Ka IGD Pengumpul data

dr. Agus Kusnandang, Sp.S ………………………………………….

 OKTOBER
PENCAPAIAN (%) #DIV/0!
TARGET (%) 100

GRAFIK PENCATATAN RESIKO PASIEN JATUH

100
90
80
70
60
50
40
30
20
10
0
PENCAPAIAN (%) TARGET (%)
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : NOPEMBER

TERPASANG KANCING JUMLAH PASIEN FORMULA /

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH PENCAPAIAN
PASIEN (NOMERATOR) (DENOMINATOR) (%)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
0 0 #DIV/0!

KET : TERPASANG = 1
TIDAK TERPASANG = 0

Mengetahui Cirebon, .......................

Ka IGD Pengumpul data

dr. Agus Kusnandang, Sp.S ………………………………………….

 NOPEMBER
PENCAPAIAN (%) #DIV/0!
TARGET (%) 100

NOPEMBER

100
90
80
70
60
50
40
30
20
10
0
PENCAPAIAN (%) TARGET (%)
 FORMAT PENCATATAN RESIKO PASIEN JATUH

Nama Unit/ Instalasi : IGD

Periode : DESEMBER

TERPASANG KANCING JUMLAH PASIEN FORMULA /

NO TGL. MRS NAMA PASIEN RM KUNING PADA GELANG RESIKO JATUH PENCAPAIAN
PASIEN (NOMERATOR) (DENOMINATOR) (%)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
0 0 #DIV/0!

KET : TERPASANG = 1
TIDAK TERPASANG = 0

Mengetahui Cirebon, .......................

Ka IGD Pengumpul data

dr. Agus Kusnandang, Sp.S ………………………………………….

 DESEMBER
PENCAPAIAN (%) #DIV/0!
TARGET (%) 100

GRAFIK PENCATATAN RESIKO PASIEN JATUH

100
90
80
70
60
50
40
30
20
10
0
PENCAPAIAN (%) TARGET (%)
 PENCATATAN RESIKO PASIEN JATUH IGD

SKP 6 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
NUMERATOR 128 128 128 128 128 0 0 0 0 0
DENOMINATOR 128 128 128 128 128 0 0 0 0 0
PENCAPAIAN (%) 100 100 100 100 100 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
TARGET (%) 100 100 100 100 100 100 100 100 100 100

Mengetahui Cirebon, .......................

Ka IGD Pengumpul data

dr. Agus Kusnandang, Sp.S ………………………………………….