1 2
2.1.UKM ESSENSIAL
2.1.1.Upaya Promosi Kesehatan
2.1.1.1.Tatanan Sehat
1.Rumah Tangga
Sehat yang
memenuhi 10
indikator PHBS
2. Institusi
Pendidikan yang
memenuhi 7-8
indikator PHBS
(klasifikasi IV)
3.Institusi Kesehatan
yang memenuhi 6
indikator PHBS
(klasifikasi IV)
4. TTU yang
memenuhi 6
indikator PHBS
(klasifikasi IV)
2.1.1.2.Intervensi/ Penyuluhan
1.Kegiatan intervensi
pada Kelompok
Rumah Tangga
2. Kegiatan
intervensi pada
Institusi Pendidikan
3. Kegiatan
intervensi pada
Institusi Kesehatan
4. Kegiatan
intervensi pada TTU
5. Kegiatan
intervensi pada
Tempat Kerja
6.Kegiatan intervensi
pada Pondok
Pesantren
2.1.1.3.Pengembangan UKBM
1. Posyandu PURI
( Purnama Mandiri )
2.Poskesdes
beroperasi dengan
strata Madya,
Purnama dan
Mandiri
2.1.1.4. Penyuluhan NAPZA ( Narkotika Psikotropika dan Zat Adiktif)
1. Penyuluhan Napza
1.Pembinaan Tempat
Pengelolaan
Makanan ( TPM )
2.TPM yang
memenuhi syarat
kesehatan
2.1.2.3.Penyehatan Perumahan dan Sanitasi Dasar
1..Pembinaan
sanitasi perumahan
2.Rumah yang
memenuhi syarat
kesehatan
1.Konseling Sanitasi
2. Inspeksi Sanitasi
PBL
3.Intervensi terhadap
pasien PBL yang di
IS
1.Pelayanan
Kesehatan neonatus
pertama ( KN1)
2.Pelayanan
Kesehatan Neonatus
0 - 28 hari (KN
lengkap)
3.Penanganan
komplikasi neonatus
4.Pelayanan
kesehatan bayi 29
hari - 11 bulan
2. Pelayanan
kesehatan balita (0 -
59 bulan)
3.Pelayanan
kesehatan Anak pra
sekolah (60 - 72
bulan)
8.. Pelayanan
kesehatan remaja
2.1.3.5. 1.KB
Pelayanan
aktif Keluarga Berencana (KB)
(Contraceptive
Prevalence Rate/
CPR)
2. Peserta KB baru
3. Akseptor KB Drop
Out
4. Peserta KB
mengalami
komplikasi
5. Peserta KB
mengalami efek
samping
6. PUS dengan 4 T
ber KB
7. KB pasca persalinan
8. Ibu hamil yang
diperiksa HIV
3. Penggunaan Zinc
pada balita diare
4. Pelaksanaan
kegiatan Layanan
Rehidrasi Oral Aktif
2.1.5.2. (LROA)
ISPA ( Infeksi Saluran Pernapasan Atas)
Pemuan penderita
Pneumonia balita
2.1.5.3.Kusta
1. Pemeriksaan
kontak dari kasus
2. Kasus
Kusta Kusta yang
baru
dilakukan PFS secara
rutin
3. RFT penderita
Kusta
4. Penderita baru
pasca pengobatan
dengan score
kecacatannya tidak
bertambah atau tetap
5. Kasus defaulter
Kusta
6. Proporsi tenaga
kesehatan Kusta
tersosialisasi
7. Kader kesehatan
Kusta tersosialisasi
8. SD/ MI telah
dilakukan screening
Kusta
2.1.5.7. Malaria
1.Penderita Malaria
yang dilakukan
pemeriksaan SD
2.Penderita positif
Malaria yang diobati
sesuai standar
3.Penderita (ACT)
positif
Malaria yang di
follow up
2.1.5.8. Pencegahan dan Penanggulangan Rabies
1.Cuci luka terhadap
kasus gigitan HPR
2.Vaksinasi terhadap
kasus gigitan HPR
yang berindikasi
2.1.5.9. Pelayanan Imunisasi
1.IDL (Imunisasi
Dasar Lengkap)
2. UCI desa
3.Imunisasi Lanjutan
Baduta ( usia 18 sd
24 bulan)
4. Imunisasi DT pada
anak kelas 1 SD
5. Imunisasi Campak
pada anak kelas 1 SD
6. Imunisasi TT pada
anak SD kelas 2 dan
3
7. Imunisasi TT5
pada WUS (15-49
th)
8.Imunisasi TT2 plus
bumil (15-49 th)
9. Pemantauan suhu
lemari es vaksin
10..Ketersediaan
catatan stok vaksin
11. Laporan KIPI
Zero reporting / KIPI
Non serius
3. Setiap warga
negara Indonesia
usia 15 - 59 tahun
mendapatkan
skrining kesehatan
sesuai standar
Target
Tahun
2021 (T)
dalam %
3
59%
69%
100%
64%
49%
29%
100%
100%
100%
100%
100%
100%
72%
97%
a dan Zat Adiktif)
24%
97%
13%
100%
100%
100%
95%
29%
95%
95%
15%
83%
85%
55%
40%
87.50%
61%
87%
59%
10%
40%
40%
= Pemberdayaan Masyarakat
85%
60%
65%
75%
Berencana
100%
100%
100%
100%
97%
80%
100%
100%
80%
97%
85%
100%
81%
100%
100%
92.50%
100%
100%
100%
92.50%
68%
70%
10%
<3.5 %
< 3.5 %
< 12.50%
80%
60%
95%
Jumlah bayi umur 6-11 bulan mendapat kapsul Vitamin A biru (100.000
91%
IU) dibagi jumlah bayi umur 6-11 bulan yang ada dikali 100%
Jumlah anak balita umur 12-59 bulan mendapat kapsul vitamin A 2 (dua)
kali per tahun dibagi jumlah anak balita umur 12-59 bulan yang ada di 91%
wilayah kerja Puskesmas dikali 100%
Jumlah ibu hamil dapat 90 (sembilan puluh) tablet Besi kumulatif dibagi
jumlah sasaran bumil yang ada di wilayah kerja Puskesmas kerja dikali 92.5%
100%
Jumlah remaja putri yang mendapat 1 (satu) tablet tambah darah per
minggu dibagi jumlah remaja putri PROGRAM KESEHATAN
REMAJA (KRR/DAPODIK) di suatu wilayah kerja Puskesmas dikali
100%
40%
Jumlah balita kurus BARU yang ditemukan TIAP BULAN NYA dan
mendapat PMT pemulihan dibagi jumlah balita kurus yang ditemukan di 85%
wilayah kerja Puskesmas pada kurun waktu tertentu dikali 100%
Jumlah bumil KEK yang mendapat PMT pemulihan dibagi jumlah bumil
KEK yang ditemukan di wilayah kerja Puskesmas pada kurun waktu 90%
tertentu dikali 100%
Jumlah balita gizi buruk yang mendapat perawatan sesuai standar
tatalaksana gizi buruk dibagi jumlah balita gizi buruk yang ditemukan
dikali 100%
100%
Jumlah balita yang ditimbang berat badannya (D) dibagi jumlah balita 60%
yang ada ( S) dikali 100%
Jumlah balita yang naik berat badannya sesuai dengan standar (N) dibagi 62.5%
jumlah balita yang ditimbang berat badannya (D) di wilayah kerja
Puskesmas pada kurun waktu tertentu dikali 100%
Jumlah balita yang grafik pertumbuhannya berada di bawah garis merah 100
pada KMS dibagi jumlah balita yang ditimbang (D) di wilayah kerja
Puskesmas pada kurun waktu tertentu dikali 100%
Catatan untuk kinerja Puskesmas: <1.8
% = 100%; 1.81 - 2 % = 75%; >2.01-
2.25 % = 50%; >2,26 - 2,5 % = 25% > 2,5 %
= 0%
Jumlah rumah tangga yang mengkonsumsi garam beryodium CUKUP 90%
dibagi jumlah rumah tangga yang disurvei di wilayah kerja Puskesmas
pada kurun waktu tertentu dikali 100%
Jumlah ibu hamil dengan LiLA kurang dari 23,5 cm dibagi jumlah ibu 100
hamil diukur LiLA dikali 100% Catatan untuk
kinerja Puskesmas: < 12 = 100%
12.01-14%= 75% > 14.01-16%= 50%
> 16.01-20%= 25% > 20% = 0%
Jumlah bayi usia 6 bln mendapat ASI Eksklusif di suatu wilayah pada 69
periode tertentu di bagi jumlah bayi 6 (enam) bulan yang di periksa
dikali 100%
Jumlah bayi baru lahir yang mendapat IMD di satu wilayah pada periode 50
tertentu di bagi jumlah seluruh bayi baru lahir di suatu wilayah pada
periode tertentu di kali 100 %
Jumlah balita stunting di bagi dengan jumlah balita yang di periksa dikali 100
100 % Catatan kinerja
Puskesmas: <21 =
100% 21.01-27 = 75% 27.01-32 =
50% 32.01-37 = 25% >37 = 0%
100%
100%
100%
100%
85%
lebih dari
80%
lebih dari
95%
lebih dari
90%
lebih dari
97%
Kurang
dari 5%
lebih dari
95%
lebih dari
95%
100%
100%
100%
90%
IV/AIDS
100%
100%
lebih dari
95%
100%
100%
100%
100%
100%
100%
100%
95%
95%
80%
98%
98%
98%
85%
85%
100%
100%
90%
>80%
> 90%
>80%
> 90%
>80%
> 90%
100%
100%
k Menular
30%
30%
30%
> 91%
81 - 90 %
< 80%
Target
Tahun
2018 (T)
dalam
3 %
anan kesehatan yang dilakukan di Puskesmas UKM esensial, UKM pengembangan, UKP
sehatan, misalnya UKM esensial terdiri dari 5 Program ( Promosi Kesehatan, Kesehatan Lingkungan, KIA-
iabel Promosi Kesehatan adalah tatanan sehat, intervensi/penyuluhan, pengembangan UKBM dll
subvariabel Tatanan sehat adalah rumah tangga sehat yang memenuhi 10 indikator PHBS, Institusi Pendidi
an, misal orang, balita, rumah tangga dll
ikali kolom 5 (total sasaran)
m satuan sasaran
i tiap program, dihitung dengan cara kolom 7 ( pencapaian) dibagi kolom 5 ( total sasaran) dikali 100%
esmas adalah pencapaian kinerja puskesmas ( kolom 7) dibandingkan target sasaran ( kolom 6) diksli 100%
an % kinerja subvariabel dibagi sejumlah variabel
bvariabel, maka bisa langsung mengisi % kinerja variabel dan % kinerja rata- rata program
il penjumlahan variabel dibagi sejumlah variabel
arget tahun 2018 ( kolom 3) dengan % capaian riil ( kolom 8)
INERJA PUSKESMAS TAHUN 2021
LB3-Gizi
LB3-Gizi
LB3-Gizi
LB3-Gizi
LB3-Gizi
LB3-Gizi
LB3-Gizi
LB3-Gizi
Survei
LB3-Gizi
LB3-Gizi
LB3-Gizi
LB3-Gizi
dan bulan
timbang
n Lingkungan, KIA-KB dll)
UKBM dll
BS, Institusi Pendidikan yang memenuhi 7-8 indikator PHBS dst
1. Puskesmas Jelakombo
Target
Upaya Pelayanan Kesehatan/
Tahun Analisa akar
No Program/Variabel/Sub %Cakupan Rencana
2018 (T) Riil
penyebab
Tindak Lanjut
Variabel Program masalah
dalam %
1 2 3 4 5 6
4.Kunjungan rumah
30%
pasien jiwa
5.Setiap Orang
Dengan Gangguan
Jiwa ( ODGJ) ringan
atau Ganguan
Mental Emosional
(GME) mendapat
100%
pelayanan kesehatan
sesuai standar
2.2.4.Pelayanan Kesehatan
Tradisional
1.Penyehat 10%
Tradisional Ramuan
yang memiliki STPT
2.Penyehat 10%
Tradisional
Keterampilan yang
memiliki STPT
6.Pembinaan ke 35%
Penyehat Tradisional
2.2.4.Pelayanan Kesehatan
Olahraga
1.Kelompok /klub
30%
olahraga yang dibina
2.Pengukuran
Kebugaran Calon 70%
Jamaah Haji
3.Pengukuran
Kebugaran jasmani 25%
pada anak sekolah
1.Hasil pemeriksaan
kesehatan jamaah
75%
haji 3 bulan sebelum
operasional terdata.
2.Terbentuknya Tim
TRC [Tim Reaksi 100%
Cepat]
Target
Upaya Pelayanan Kesehatan/
Tahun
No Program/Variabel/Sub
2018 (T)
Variabel Program
1 2 dalam
3 %
Kolom Keterangan:
ke
2 Upaya Pelayanan Kesehatan adalah Upaya Pelayanan kesehatan yang dilakukan di
2 Program adalah bagian dari Upaya Pelayanan Kesehatan, misalnya UKM esensial t
2 Variabel adalah bagian dari Program , contoh: variabel Pelayanan Kesehatan Indera
2 Subvariabel adalah bagian dari variabel, contoh: subvariabel Mata adalah penemua
4 Satuan sasaran adalah satuan dari sasaran, misal orang, balita, rumah tangga dll
6 Target Sasaran = kolom 3 ( Target tahun 2018) dikali kolom 5 (total sasaran)
7 Pencapaian adalah hasil kegiatan Puskesmas dalam satuan sasaran
8 % cakupan riil adalah cakupan sesungguhnya dari tiap program, dihitung dengan ca
9 % Kinerja Sub Variabel/Variabel/Program Puskesmas adalah pencapaian kinerja p
10 Rata -rata variabel adalah penjumlahan % kinerja subvariabel ( kolom 9) dibagi sej
Catatan: Bagi program yang tidak mempunyai subvariabel, maka bisa langsung me
11 % kinerja rata2 program adalah hasil penjumlahan variabel ( kolom 10) dibagi seju
12 Analisa yang dimaksud untuk membandingkan target tahun 2018 ( kolom 3) denga
N KINERJA PUSKESMAS TAHUN 2018
4 5 6 4 5 6 4
Cukup
Tercapai
%Cakupan
Analisa
Riil
8 12
am, dihitung dengan cara kolom 7 ( pencapaian) dibagi kolom 5 ( total sasaran) dikali 100%
ah pencapaian kinerja puskesmas ( kolom 7) dibandingkan target sasaran ( kolom 6) diksli 100%
el ( kolom 9) dibagi sejumlah variabel
maka bisa langsung mengisi % kinerja variabel dan % kinerja rata- rata program
( kolom 10) dibagi sejumlah variabel
2018 ( kolom 3) dengan % capaian riil ( kolom 8)
4. Puskesmas Jabon 5. Puskesmas Tembelang 6 7
5 6 4 5 6 4 5 6 4 5
ngan, KIA-KB dll)
diksli 100%
7 8 9 10
6 4 5 6 4 5 6 4 5 6
11 12 13 14
4 5 6 4 5 6 4 5 6 4
14 15 16 17
5 6 4 5 6 4 5 6 4 5
17 18 19 20
6 4 5 6 4 5 6 4 5 6
21 22 23 24
4 5 6 4 5 6 4 5 6 4
24 25 26 27
5 6 4 5 6 4 5 6 4 5
27 28 29 30
6 4 5 6 4 5 6 4 5 6
31 32 33 34
4 5 6 4 5 6 4 5 6 4
34
Analisa
Rencana
akar
Tindak
penyebab
Lanjut
masalah
5 6
Upaya Pelayanan Kesehatan/
No Program/Variabel/Sub Variabel
Program
1 2
2.3.Upaya Kesehatan Perseorangan (UKP)
2.3.1. Pelayanan Non Rawat Inap
1. Angka Kontak
2.Rasio Rujukan Rawat Jalan
Non Spesialistik
3.Kelengkapan pengisian
informed consent dalam 24
jam setelah selesai pelayanan
2.3.4.Pelayanan laboratorium
1.Kesesuaian jenis pelayanan
laboratorium dengan standar
2.Kelengkapan pengisian
rekam medik rawat inap
dalam 24 jam
Keterangan:
Kolom ke
2 Upaya Pelayanan Kesehatan adalah Upaya Pelayanan kesehatan yang dilakukan di Puskesmas UK
2 Program adalah bagian dari Upaya Pelayanan Kesehatan, misalnya UKM esensial terdiri dari 5 P
2 Variabel adalah bagian dari Program , contoh variabel Promosi Kesehatan adalah tatanan sehat, in
2 Subvariabel adalah bagian dari variabel, contoh: subvariabel Tatanan sehat adalah rumah tangga
4 Satuan sasaran adalah satuan dari sasaran, misal orang, balita, rumah tangga dll
6 Target Sasaran = kolom 3 ( Target tahun 2018) dikali kolom 5 (total sasaran)
7 Pencapaian adalah hasil kegiatan Puskesmas dalam satuan sasaran
8 % cakupan riil adalah cakupan sesungguhnya dari tiap program, dihitung dengan cara kolom 7 (
9 % Kinerja Sub Variabel/Variabel/Program Puskesmas adalah pencapaian ( kolom 7) dibandingk
10 Rata -rata variabel adalah penjumlahan % kinerja subvariabel ( kolom 9) dibagi sejumlah variabe
Catatan: Bagi program yang tidak mempunyai subvariabel, maka bisa langsung mengisi % kinerj
11 % kinerja rata2 program adalah hasil penjumlahan variabel ( kolom 10) dibagi sejumlah variabel
12 Analisa yang dimaksud untuk membandingkan target tahun 2018 ( kolom 3) dengan % capaian riil ( kolom
Target Tahun 1. Puskesmas Jelakombo 2. Puskesmas Tambakrejo
2021 (T) Analisa akar Analisa akar
%Cakupan Rencana %Cakupan
dalam % penyebab penyebab
Riil Tindak Lanjut Riil
masalah masalah
3 4 5 6 4 5
< 5%
50%
100%
100%
100%
100%
100%
100%
100%
100%
80%
100%
90%
85%
68%
60%
100%
100%
100%
20%
10% - 40%
100%
> 91%
81 - 90 %
< 80%
Target Tahun
2018 (T)
dalam %
3
an)
engan cara kolom 7 ( pencapaian) dibagi kolom 5 ( total sasaran) dikali 100%
( kolom 7) dibandingkan target sasaran ( kolom 6) diksli 100%
ibagi sejumlah variabel
sung mengisi % kinerja variabel dan % kinerja rata- rata program
bagi sejumlah variabel
gan % capaian riil ( kolom 8)
smas Tambakrejo 3. Puskesmas Pulolor 4. Puskesmas Jabon
Analisa akar Analisa akar
Rencana %Cakupan Rencana %Cakupan Rencana
penyebab penyebab
Tindak Lanjut Riil Tindak Lanjut Riil Tindak Lanjut
masalah masalah
6 4 5 6 4 5 6
nuhi 7-8 indikator PHBS dst
4. PENGHITUNGAN PENILAIAN KINERJA PUSKE
5. Puskesmas Tembelang 6. Puskesmas Jatiwates 7. Puskesmas Megaluh
Analisa akar Analisa akar
%Cakupan Rencana %Cakupan Rencana %Cakupan
penyebab penyebab
Riil Tindak Lanjut Riil Tindak Lanjut Riil
masalah masalah
4 5 6 4 5 6 4
LAIAN KINERJA PUSKESMAS TAHUN 2021
7. Puskesmas Megaluh 8. Puskesmas Cukir 9. Puskesmas Brambang
Analisa akar Analisa akar Analisa akar
Rencana %Cakupan Rencana %Cakupan
penyebab penyebab penyebab
Tindak Lanjut Riil Tindak Lanjut Riil
masalah masalah masalah
5 6 4 5 6 4 5
esmas Brambang 10. Puskesmas Bl. Gudo 11. Puskesmas Pl. Gambang
Analisa akar Analisa akar
Rencana %Cakupan Rencana %Cakupan Rencana
penyebab penyebab
Tindak Lanjut Riil Tindak Lanjut Riil Tindak Lanjut
masalah masalah
6 4 5 6 4 5 6
12. Puskesmas Perak 13. Puskesmas Bandar KM 14. Puskesmas Bw. Plo
Analisa akar Analisa akar
%Cakupan Rencana %Cakupan Rencana %Cakupan
penyebab penyebab
Riil Tindak Lanjut Riil Tindak Lanjut Riil
masalah masalah
4 5 6 4 5 6 4
14. Puskesmas Bw. Ploso 15. Puskesmas Plandaan 16. Puskesmas
Analisa Kabuh
Analisa akar Analisa akar Rencana
Rencana %Cakupan Rencana %Cakup akar
penyebab penyebab Tindak
Tindak Lanjut Riil Tindak Lanjut an Riil penyebab
masalah masalah Lanjut
5 6 4 5 6 4 masalah
5 6
Rencana
%Cakup
Analisa Tindak
an Riil
Lanjut
8 12 14
17. Puskesmas Tapen 18. Puskesmas Keboan 19. Puskesmas Mojoagung
Analisa akar Rencana Analisa akar Rencana Analisa akar
%Cakupan %Cakupan %Cakupan
penyebab Tindak penyebab Tindak penyebab
Riil Riil Riil
masalah Lanjut masalah Lanjut masalah
4 5 6 4 5 6 4 5
kesmas Mojoagung 20. Puskesmas Gambiran 21. Puskesmas Sumobito 22. Puskesmas Jogoloyo
Rencana Analisa akar Rencana Analisa akar Rencana
%Cakupan %Cakupan %Cakupan
Tindak penyebab Tindak penyebab Tindak
Riil Riil Riil
Lanjut masalah Lanjut masalah Lanjut
6 4 5 6 4 5 6 4
22. Puskesmas Jogoloyo 23. Puskesmas Kesamben 24. Puskesmas Bl. Kesamben
Analisa akar Rencana Analisa akar Rencana Analisa akar Rencana
%Cakupan %Cakupan
penyebab Tindak penyebab Tindak penyebab Tindak
Riil Riil
masalah Lanjut masalah Lanjut masalah Lanjut
5 6 4 5 6 4 5 6
25. Puskesmas Peterongan 26. Puskesmas Dkh Klopo 27. Puskesmas Mayangan
Analisa akar Rencana Analisa akar Rencana Analisa akar
%Cakupan %Cakupan %Cakupan
penyebab Tindak penyebab Tindak penyebab
Riil Riil Riil
masalah Lanjut masalah Lanjut masalah
4 5 6 4 5 6 4 5
kesmas Mayangan 28. Puskesmas Jarak Kulon 29. Puskesmas Pulorejo 30. Puskesmas Kes. Ngor
Rencana Analisa akar Rencana Analisa akar Rencana
%Cakupan %Cakupan %Cakupan
Tindak penyebab Tindak penyebab Tindak
Riil Riil Riil
Lanjut masalah Lanjut masalah Lanjut
6 4 5 6 4 5 6 4
30. Puskesmas Kes. Ngoro 31. Puskesmas Bareng 32. Puskesmas Mojowarno
Analisa akar Rencana Analisa akar Rencana Analisa akar Rencana
%Cakupan %Cakupan
penyebab Tindak penyebab Tindak penyebab Tindak
Riil Riil
masalah Lanjut masalah Lanjut masalah Lanjut
5 6 4 5 6 4 5 6
33. Puskesmas
AnalisaJapanan 34. Puskesmas Wonosalam
Analisa
Rencana Rencana
%Cakupa akar %Cakupa akar
Tindak Tindak
n Riil penyebab n Riil penyebab
Lanjut Lanjut
4 masalah
5 6 4 masalah
5 6
PUSKESMAS :
KAB//KOTA :
1. Puskesmas Jelakombo
Target nilai Analisa
No Jenis Variabel Definisi Operasional Capaian akar
kinerja
Target penyebab
masalah
(1) (2) (3) (4) (5) (6)
2.4.1.Manajemen Umum
1.Rencana 5 Rencana sesuai visi, 10 ``````
(lima) tahunan misi, tugas pokok dan
fungsi Puskesmas
bedasarkan pada analisis
kebutuhan masyarakat
akan pelayanan
kesehatan sebagai upaya
untuk meningkatkan
derajat kesehatan
masyarakat secara
optimal
2. RUK Tahun RUK (Rencana Usulan 10 ``````
(n+1) Kegiatan) Puskesmas
untuk tahun yad ( N+1)
dibuat berdasarkan
analisa situasi,
kebutuhan dan harapan
masyarakat dan hasil
capaian kinerja, prioritas
serta data 2 ( dua) tahun
yang lalu dan data
survei, disahkan oleh
Kepala Puskesmas
2.4.3.Manajemen Peralatan
1.Data Inventarisasi peralatan 10 ``````
peralatan medis dan non medis
,analisa, rencana dan non kesehatan, data
tindak lanjut, kalibrasi alat, KIR dan
tindak lanjut dan laporan seluruh
evaluasi inventaris alat
kesehatan. Analisa
pemenuhan standar
peralatan, kondisi alat,
kecukupan jumlah alat
di Puskesmas dan
rencana tindak lanjut,
2.Rencana tindak lanjut
Rencana dan
Perbaikan. 10 ``````
Perbaikan, evaluasinya
kalibrasi dan
kalibrasi dan pemeliharaan alat,
pemeliharaan termasuk tindak lanjut
alat dan evaluasi
#DIV/0!
Jumlah Nilai Kinerja Manajemen Sumber Daya Manusia ( VI)
3.Kelembaban dan
temperatur ruangan
memenuhi syarat (25-
28ᵒC)
4.Ruangan bersih dan
bebas hama
5. ruangan
terkunci dan
berpengaman teralist
serta korden
3.Tempat penyimpanan
obat khusus sesuai
dengan perundang-
undangan [narkotika,
psikotropika, prekursor,
OOT dan obat yang
disimpan pada suhu
rendah (vaksin, dll)]
4.
Tersedia AC
5.Tersedia
thermohigrometer
6. Tersedia
kartu pengontrol suhu
dan kelembaban
6.Perencanaan Persyaratan perencanaan 10 ``````
obat:1. Ada SOP 2.Ada
perencanaan tahunan
3. Ada sistem dalam
perencanaan
4. Perencanaan dikirim
ke dinkes Kab/Kota 5.
ada evaluasi prosentase
kesesuaian perencanaan
obat yang dihitung
dengan rumus:
kesesuaian perencanaan
= jumlah obat yang
direncanakan/(pengguna
an obat + sisa
persediaan) dikalikan
100%, jika diperoleh
prosen kesesuaian rata-
rata =(100-80)% diberi
nilai 10, (60-79)% diberi
nilai 7, (40-69)% diberi
nilai 4, kurang dari 39%
diberi nilai 0
2.Ada jadwal
permintaan/pengadaan
obat
3.Ada sistem dalam
membuat
permintaan/pengadaan
4. Permintaan
/pengadaan
terdokumentasi
8.Penerimaan Persyaratan:1. Ada SOP 10
Penerimaan
2.Penerimaan dilakukan
oleh tenaga kefarmasian
3. Dilakukan
pengecekan kesesuaian
jenis dan jumlah barang
yang diterima dengan
permintaan 4.Dilakukan
pengecekan dan
pencatatan tanggal
kadaluarsa dan nomor
batch barang yang
diterima 5.Dilakukan
pengecekan kondisi
barang yang diterima
(misal : kemasan rusak)
1.Ada SOP
Pengendalian obat dan
BMHP
2.Dilakukan
pengendalian persedian
obat dan BMHP
3. Dilakukan
pengendalian
12.Pencatatan, penggunaan
Persyaratan: obat dan 10 ``````
Pelaporan dan BMHP 1. Ada
Pengarsipan catatan penerimaan obat
4. Ada catatan dan
yang rusak dan
pengeluaran obat
kadaluwarsa
2. Ada catatan mutasi
obat dan BMHP.
3.
Ada catatan penggunaan
obat dan BMHP.
4.Semua
penggunaan obat
dilaporkan secara rutin
dan tepat waktu
2.Dilakukan pemantauan
obat dan BMHP di sub
unit pelayanan
3.Ada evaluasi
hasil pemantauan
4.Hasil evaluasi
dilaporkan
2.Dilakukan pengkajian
persyaratan administratif
3.Dilakukan pengkajian
persyaratan Farmasetik
15. Peracikan Persyaratan:
resep. 1.Ada SOP 10 ``````
dan Pengemasan peracikan dan4.Dilakukan
pengemasan.
pengkajian 2.Semua
persyaratan
obat
Klinisyang dilayani
resep
sesuai dengan resep.
3.Semua obat masing-
masingdiberi etiket
sesuai dengan ketentuan.
4.
Dilakukan pengecekan
ulang sebelum obat
diserahkan.
16.Penyerahan Persyaratan: 10 ``````
dan Pemberian 1.Ada SOP
Informasi Obat Penyerahan obat.
2.Obat diserahkan
dengan disertai
pemberian informasi
obat yang
terdokumentasi
3.Informasi obat yang
diberikan sesuai dengan
ketentuan
.4.Obat dapat
dipastikan sudah
diberikan pada pasien
yang tepat
2.Dilakukan visite
mandiri.
3.Dilakukan visite
bersama dokter.
4.Ada catatan
20.Pemantauan Persyaratan: 10 ``````
hasil visite
dan Pelaporan 1.Ada SOP
.5.Ada evaluasi hasil
Efek Samping pemantauan dan
visite
Obat pelaporan efek samping
obat.
2.Terdapat dokumen
pencatatan efek samping
obat pasien..
3.Ada
pelaporan efek samping
21.Pemantauan obat pada dinas
Persyaratan: 10 ``````
terapi obat kesehatan.1.Ada SOP
(PTO) pemantauan terapi Obat.
2.Dilakukan PTO
baik rawat inap maupun
rawat jalan
.3.Ada dokumen
pencatatan PTO.
22.Evaluasi Persyaratan: 10 ``````
penggunaan obat 1.Ada SOP
(EPO) Evaluasi Penggunaan
Obat.
2`Ada SOP
Evaluasi Penggunaan
Obat.
3. Evaluasi
dilakukan secara
berkala.
Administrasi obat
23.Pengelolaan Persyaratan:4. Ada
1.Resep 10 ``````
resep dokumen pencatatan
disimpan minimal 5
EPO.
tahun. 2. Arsip resep
disimpan sesuai dengan
urutan tanggal. 3.Resep
narkotika dan
psikotropika
disendirikan.
4. Resep yang sudah
tersimpan > 5 tahun
dapat dimusnahkan
dengan disertai
dokumentasi dan berita
acara pemusnahan resep.
24.Kartu stok Persyaratan: 10 ``````
1.Tersedia
kartu stock untuk obat
yang disimpan di
gudang obat, ruang
farmasi,ruang
pelayanan, pustu dan
polindes .
2. Pencatatan kartu
stock dilakukan setiap
kali transaksi
(pemasukan maupun
pengeluaran).
3. Sisa
stok sesuai dengan fisik.
4.
Kartu stok diletakan
didekat masing-masing
barang
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Capaian Target penyebab RTL Capaian Target penyebab
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masalah masalah
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34
RTL
(7)
PENGHITUNGAN PENILAIAN KINERJA MUTU PUSKESM
1. Puskesmas Jelakombo
Target Tahun
Upaya Pelayanan Kesehatan/ Analisa akar
No 2018 (T) %Cakupan Rencana
Program/Variabel/Sub Variabel Program penyebab
dalam % Riil Tindak Lanjut
masalah
1 2 3 4 5 6
2.5. MUTU
Indeks Kepuasan Masyarakat
2.5.1 (IKM) 100%
Target Tahun
Upaya Pelayanan Kesehatan/
No 2018 (T)
Program/Variabel/Sub Variabel Program
dalam %
1 2 3
Kolom Keterangan:
ke
2 Upaya Pelayanan Kesehatan adalah Upaya Pelayanan kesehatan yang dilakukan di Puskesmas UK
2 Program adalah bagian dari Upaya Pelayanan Kesehatan, misalnya UKM esensial terdiri dari 5 P
2 Variabel adalah bagian dari Program , contoh variabel Promosi Kesehatan adalah tatanan sehat, in
2 Subvariabel adalah bagian dari variabel, contoh: subvariabel Tatanan sehat adalah rumah tangga
yang memenuhi 7-8 indikator PHBS dst
4 Satuan sasaran adalah satuan dari sasaran, misal orang, balita, rumah tangga dll
6 Target Sasaran = kolom 3 ( Target tahun 2018) dikali kolom 5(total sasaran)
7 Pencapaian adalah hasil kegiatan Puskesmas dalam satuan sasaran
8 % cakupan riil adalah cakupan sesungguhnya dari tiap program, dihitung dengan cara kolom 7 (
9 % Kinerja Sub Variabel/Variabel/Program Puskesmas adalah pencapaian ( kolom 7) dibandingk
10 Rata -rata variabel adalah penjumlahan % kinerja subvariabel ( kolom 9) dibagi sejumlah variabe
Catatan: Bagi program yang tidak mempunyai subvariabel, maka bisa langsung mengisi % kinerj
11 % kinerja rata2 program adalah hasil penjumlahan variabel ( kolom 10) dibagi sejumlah variabel
12 Analisa yang dimaksud untuk membandingkan target tahun 2018 ( kolom 3) dengan % capaian riil ( ko
A MUTU PUSKESMAS TAHUN 2018
Analisa Analisa
Analisa akar
%Cakupan Rencana %Cakupan akar Rencana %Cakupa akar
penyebab
Riil Tindak Lanjut Riil penyebab Tindak Lanjut n Riil penyebab
masalah
masalah masalah
4 5 6 4 5 6 4 5
%Cakupan Hambatan/Per
Analisa
Riil masalahan
8 12 13
Keterangan:
ukan di Puskesmas UKM esensial, UKM pengembangan, UKP
sensial terdiri dari 5 Program ( Promosi Kesehatan, Kesehatan Lingkungan, KIA-KB dll)
adalah tatanan sehat, intervensi/penyuluhan, pengembangan UKBM dll
adalah rumah tangga sehat yang memenuhi 10 indikator PHBS, Institusi Pendidikan
a dll
n)
engan cara kolom 7 ( pencapaian) dibagi kolom 5 ( total sasaran) dikali 100%
( kolom 7) dibandingkan target sasaran ( kolom 6) diksli 100%
bagi sejumlah variabel
sung mengisi % kinerja variabel dan % kinerja rata- rata program
bagi sejumlah variabel
ngan % capaian riil ( kolom 8)
uskesmas Jabon 5. Puskesmas Tembelang 6 7
6 4 5 6 4 5 6 4 5 6
8 9 10 11
4 5 6 4 5 6 4 5 6 4
11 12 13 14
5 6 4 5 6 4 5 6 4 5
14 15 16 17
6 4 5 6 4 5 6 4 5 6
18 19 20 21
4 5 6 4 5 6 4 5 6 4
21 22 23 24
5 6 4 5 6 4 5 6 4 5
24 25 26 27
6 4 5 6 4 5 6 4 5 6
28 29 30 31
4 5 6 4 5 6 4 5 6 4
31 32 33 34
5 6 4 5 6 4 5 6 4 5
34
Rencana
Tindak
Lanjut