Indikator Mutu Hd.docx
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LAPORAN INDIKATOR MUTU UNIT PELAYANAN (IMUP) IMUP 1 HD : KEPATUHAN PERAWAT DALAM MELAKSANAKAN KOMUNIKASI EFEKTIF DENGAN S-BAR RUANG/INSTALASI
: ...................................................................................
BULAN
: ..................................................................................
No
Tanggal
No. RM
Konsultasi Perawat kepada dokter dengan metode S-BAR Ya Tidak
Penanggung Jawab Data : . ................................................................................................
LAPORAN INDIKATOR MUTU UNIT PELAYANAN (IMUP) IMUP 2 HD : TIDAK ADANYA KEJADIAN PASIEN JATUH YANG BERAKIBAT KECACATAN/ KEMATIAN RUANG/INSTALASI
: ...................................................................................
BULAN
: ..................................................................................
No
Tanggal
No. RM
Identitas Pasien (nama,umur,jenis kelamin)
Diagnosa
Alasan pasien jatuh
Penanggung Jawab Data :....................................................................................................
Akibat
LAPORAN INDIKATOR MUTU UNIT PELAYANAN (IMUP) IMUP 4 HD : INSIDEN KESALAHAN TRANSFUSI RUANG/INSTALASI
: ...................................................................................
BULAN
: ..................................................................................
No
Tanggal
No. RM
Identitas Pasien (nama,umur,jenis kelamin)
Diagnosa
Gol Darah
Jenis Darah yang dibutuhkan
Penanggung Jawab Data : ..................................................................................................
Efek
LAPORAN INDIKATOR MUTU UNIT PELAYANAN (IMUP) IMUP 5 HD : KEPUASAN PELANGGAN RUANG HD RUANG/INSTALASI BULAN NO
TGL
: ................................................................................... : .................................................................................. Kode Resep
Area
Nilai indeks kepuasan
Penanggung Jawab Data :....................................................................................................
Ket (puas/tidak)
LAPORAN INDIKATOR MUTU UNIT PELAYANAN (IMUP) IMUP 8 HD : RESIKO TERTUSUK JARUM RUANG/INSTALASI
: ...................................................................................
BULAN
: ..................................................................................
No
Tgl/Jam Insiden
Nama Pegawai/ Umur
Profesi
Lokasi
Klasifikasi Perlukaan
Penanggung Jawab Data :.……………………………………………………………….
Tindak Lanjut
Pelaporan Insiden Ke Igd (Ya/Tidak)
Ket
: ...................................................................................
BULAN
: ..................................................................................
No
Tanggal
No. RM
Konsultasi Perawat kepada dokter dengan metode S-BAR Ya Tidak
Penanggung Jawab Data : . ................................................................................................
LAPORAN INDIKATOR MUTU UNIT PELAYANAN (IMUP) IMUP 2 HD : TIDAK ADANYA KEJADIAN PASIEN JATUH YANG BERAKIBAT KECACATAN/ KEMATIAN RUANG/INSTALASI
: ...................................................................................
BULAN
: ..................................................................................
No
Tanggal
No. RM
Identitas Pasien (nama,umur,jenis kelamin)
Diagnosa
Alasan pasien jatuh
Penanggung Jawab Data :....................................................................................................
Akibat
LAPORAN INDIKATOR MUTU UNIT PELAYANAN (IMUP) IMUP 4 HD : INSIDEN KESALAHAN TRANSFUSI RUANG/INSTALASI
: ...................................................................................
BULAN
: ..................................................................................
No
Tanggal
No. RM
Identitas Pasien (nama,umur,jenis kelamin)
Diagnosa
Gol Darah
Jenis Darah yang dibutuhkan
Penanggung Jawab Data : ..................................................................................................
Efek
LAPORAN INDIKATOR MUTU UNIT PELAYANAN (IMUP) IMUP 5 HD : KEPUASAN PELANGGAN RUANG HD RUANG/INSTALASI BULAN NO
TGL
: ................................................................................... : .................................................................................. Kode Resep
Area
Nilai indeks kepuasan
Penanggung Jawab Data :....................................................................................................
Ket (puas/tidak)
LAPORAN INDIKATOR MUTU UNIT PELAYANAN (IMUP) IMUP 8 HD : RESIKO TERTUSUK JARUM RUANG/INSTALASI
: ...................................................................................
BULAN
: ..................................................................................
No
Tgl/Jam Insiden
Nama Pegawai/ Umur
Profesi
Lokasi
Klasifikasi Perlukaan
Penanggung Jawab Data :.……………………………………………………………….
Tindak Lanjut
Pelaporan Insiden Ke Igd (Ya/Tidak)
Ket
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