INTRUMEN SUPERVISI PROGRAN PMKP

KOMITE PENINGKATAN MUTU DAN KESELAMATAN PASIEN (PMKP)

RUMAH SAKIT IBU DAN ANAK RESPATI TASIKMALAYA

NAMA : ...............................................................
JABATAN : ...............................................................
TANGGAL : ...............................................................

BELUM SESUAI SESUAI

NO ASPEK YANG DIAMATI SESUAI SEBAGIAN SEMUA CATATAN
(1) (2) (3)
PENGUKURAN INDIKATOR MUTU
A.
UNIT DAN PRIORITAS
1. Pengumpulan Data
2. Pelaporan Data
3. Analisa Data
4. Validasi dan Publikasi Data
PELAPORAN DAN ANALISIS
B. INSIDEN KESELAMATAN PASIEN
(IKP)
5. Formulir IKP (Ketersediaan Form)
Jenis – jenis IKP yang dilaporkan
6.
(KPC,KNC,KTC,KTD,Sentinel)
7. Prosedur Pelaporan IKP
8. Batas Waktu Pelaporan
PENGUKURAB BUDAYA
C.
KESELAMATAN PASIEN
Dimensi harapan dan tindakan manajer
9.
mempromosikan patiet safety,
Dimensi organization learning (Perbaikan
10.
berkelanjutan),
11. Dimensi kerja sama dalam unit,
12. Dimensi komunikasi yang terbuka,
13. Dimensi umpan balik,
Dimensi respon ‘non-punitive’ terhadap
14.
kesalahan,
15. Dimensi staffing
Dimensi dukungan manajemen RS terhadap
16.
upaya keselamatan pasien,
17. Dimensi kerja sama antar unit rumah sakit,
Dimensi handsoff dan transisi antar unit
18
pelayanan,
Diemensi presepsi keseluruhan mengenai
19
keselamatan pasien
20 Dimensi frekuensi pelaporan kejadian
D. MANAJEMEN RISIKO
21 Manajemen Pengobatan
 22 Pengurangan Risiko jatuh
23 Pengendalian infeksi
24 Risiko peralatan
Resiko sebagai akibat kondisi yang sudah
25
lama berlabgsung

Kriteria Skor :
Sangat Baik : 65 s/d 70
Baik : 50 s/d 64
Kurang : <50

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Refleksi (Gambaran dari Kesimpulan):

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Rekomendasi :
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Penilai,

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NRK.