5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR KLINIS TERAPI ASPILET

POST AV SHUNT
BULAN : ............................................................................................

N  Tangg Nama Pasien No RM Diberi Aspilet !eterangan

o al (ya /tidak

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR KLINIS KEJADIAN MEDICAL

ERROR
BULAN : .....................................................................................

No Tangg Nama Pasien No RM "enis !e#adian  Tertanga !riteria

al Medi$al error ni &nsiden
(%a/Tida
k

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR KLINIS TINGKAT INSIDEN TERKAIT

SEDASI ANESTESI DI KAMAR OPERASI

BULAN : .....................................................................................................
No Tangg Nama Pasien No RM "enis &nsiden !eterangan
al

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR KLINIS PEMBERIAN

PRODUK DARAH
BULAN : .....................................................................................................

No Tangg Nama Pasien No RM &n'ormed eklist &nsiden

al onsent Monitoring (%a/Tida
(%a/Tidak Pemberian k
Prod)k Dara*
(%a/Tidak

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR KLINIS KELENGKAPAN

REKAM MEDIK 
BULAN : .....................................................................................................

No Tangg Nama Pasien No RM !elengkapa Lengkap + ,-, !eteranga

al n  "am setela* n
(%a/Tidak pasien p)lang
(%a/Tidak

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR KLINIS KEJADIAN

PHLEBITIS DI RAWAT INAP
BULAN : .....................................................................................................

No Tangg Nama Pasien No RM !eterangan

al

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR MANAJEMEN

KETERSEDIAAN OBAT DAN ALAT KESEHATAN
BULAN : .............................................................................................................
..........
No Tanggal  "enis Permintaan ")mla akt) !eses)aia !eterang
Permintaa * Pengada n an
n an Pengadaa
n
(%a/Tidak

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

M0N&T0R&N1 &ND&!AT0R MANA"2M2N LAP0RAN !&N2R"A R3

Periode : ...................................................................................

N0 Nama  "enis Laporan akt) Lengkap !eses)aian !et

&nstalasi / Penyera*an (%a/Tidak (%a/Tidak
3at)an !er#a Laporan

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR MANAJEMEN PENGGUNAAN

SUMBER DAYA AIR

BULAN : .....................................................................................................

 Tangg  "enis Masala* akt) Penyebab Tertanga !eteranga

al !e#adian ni n
(%a/Tidak


RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR MANAJEMEN PENGGUNAAN

SUMBER DAYA LISTRIK 

BULAN : .....................................................................................................

 Tangg  "enis Masala* akt) Penyebab Tertanga !eteranga

al !e#adian ni n
(%a/Tidak


RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR MANAJEMEN PETUGAS

MEDIS TERTUSUK JARUM DI RAWAT INAP
B)lan : ...............................................................................................................
..

No Tanggal  "enis Pro'esi Dilak)kan !eterangan

!e#adian  Tindakan
penangg)langa
n
(%a/ Tidak

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR KLINIS DERAJAT NYERI POST

HEMORRHOIDEKTOMI

B)lan : ...............................................................................................................
..

No Tangg Nama Pasien No RM Post Nilai !eterang

al 4emorr*oidektomi 5as+ an
yang diberi (%a/
analgetik  Tidak
(%a/ Tidak

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

MONITORING INDIKATOR KLINIS PEMBERIAN ANTIBIOTIK 

PROFILAKSIS

PADA PASIEN OPEN FRAKTUR FEMUR

B)lan : ...............................................................................................................
..
No Tangg Nama Pasien No RM Pro 0perasi 0R&6 Pemberia !eterang
al 6em)r e$ 6akt)r n an
6em)r Terb)ka Pro7laksis
(%a/ Tidak Antibiotik
+8 #am
(%a/Tidak

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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5/20/2018 Da f ta r Pmkp Indika tor 97 - slide pdf.c om

RS. KHUSUS BEDAH

“RINGROAD SELATAN”

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