FORM B.

LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : PEMBERI PELAYANAN
Area : RAWAT INAP
Numerator : JUMLAH PEMBERI PELAYANAN YANG
TERSEDIA
Denumerator : JUMLAH KESELURUHAN PEMBERI
PELAYANAN
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

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Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2020
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)

FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : DPJP
Area : RAWAT INAP
Numerator : PASIEN YANG MEMILIKI DPJP
Denumerator : JUMLAH PASIEN
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

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.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2020
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)

FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : KETERSEDIAAN PELAYANAN RAWAT
INAP
Area : RAWAT INAP
Numerator : JUMLAH TEMPAT TIDUR YANG TERISI
Denumerator : JUMLAH TEMPAT TIDUR YANG
TERSEDIA
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
........................................................................................................................................................
SENDAWAR, ....................... 2020
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)
FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -
PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : JAM VISITE DIKTER SPESIALIS
Area : RAWAT INAP
Numerator : JUMLAH DOKTER SPESIALIS YANG
VISITE JAM 08.00-14.00
Denumerator : JUMLAH PASIEN
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2020
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)
FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -
PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : KEJADIAN INFEKSI PASCA OPERASI
Area : RAWAT INAP
Numerator : KEJADIAN INFEKSI PASCA OPERASI
Denumerator : JUMLAH PASIEN PASCA OPERASI
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2018
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)

FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : KEJADIAN INFEKSI NASOKOMIAL
Area : RAWAT INAP
Numerator : JUMLAH KEJADIAN INFEKSI
NASOKOMIAL
Denumerator : JUMLAH PASIEN RAWAT INAP
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2020
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)

FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : KEJADIAN PASIEN JATUH
Area : RAWAT INAP
Numerator : KEJADIAN PASIEN JATUH
Denumerator : JUMLAH PASIEN
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2018
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)

FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : KEMATIAN PASIEN >48 JAM
Area : RAWAT INAP
Numerator : ANGKA KEMATIAN >48 JAM
Denumerator : JUMLAH PASIEN
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2020
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)

FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : KEJADIAN PULANG PAKSA
Area : RAWAT INAP
Numerator : ANGKA KEJADIAN PULANG PAKSA
Denumerator : JUMLAH PASIEN KESELURUHAN
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2020
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)

FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : KEPUASAN PELANGGAN
Area : RAWAT INAP
Numerator : SURVEY KEPUASAN PELANGGAN
Denumerator : JUMLAH PASIEN KESELURUHAN
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2020
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)

FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : KEPATUHAN PELAKSANAAN ASESMEN
RESIKOJATUH PASIEN RAWAT INAP
Area : RAWAT INAP
Numerator : TABEL RESIKO JATUH
Denumerator : JUMLAH PASIEN KESELURUHAN
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2020
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
 (........................................................) (........................................................)

FORM B. LAPORAN BULANAN DARI UNIT (KABAG/ KASI/ KEPALA INSTALASI -

PENANGGUNG JAWAB UNIT TERKAIT) KE KOMITE MUTU

FORM B. LAPORAN BULANAN DARI UNIIT KE KOMITE MUTU

Nama Unit : BENGKIRAI

Indikator Sasaran Unit : WAKTU TUNGGU OPERASI ELEKTIF
Area : RAWAT INAP
Numerator : REGISTER KAMAR BEDAH
Denumerator : JUMLAH PASIEN OPERASI
Formula : Numerator / Denumerator X 100 %
Target : % satuan lainnya
Hasil Indikator Mutu Unit :
Kesimpulan : TERCAPAI / TIDAK TERCAPAI
Analisis Unit : (Tercapai / Tidak tercapai dan Usulan)

.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................

Rekomendasi :
.........................................................................................................................................................
.........................................................................................................................................................
.......................................................................................................................................
SENDAWAR, ....................... 2018
PENANGGUNG JAWAB INDIKATOR MUTU
KEPALA BAGIAN / KASI / KEPALA INSTALASI VERIFIKATOR KOMITE MUTU
PENANGGUNG JAWAB UNIT
(........................................................) (........................................................)