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DINAS KESEHATAN KORPS MARINIR KLINIK PRATAMA CILANDAK

HASIL MONITORING SASARAN KESELAMATAN PASIEN UNIT YANG DINILAI :………………………. Bulan :

Tahun :

INDIKATOR

TARGE

NO

KESELAMATAN PASIEN

T

1.

Ketepatan identifikasi pasien

100%

2.

Ketepatan Pemberian Obat

100%

Kepada Pasien 3.

Ketepatan Prosedur

≥80%

Tindakan Medis dan Keperawatan 4.

Pengurangan terjadinya Risiko Infeksi di Klinik Pratama

≥90%

HASIL PENGUKURAN Mgg I

Mgg II Mgg III

Mgg IV

KESIMPULAN

BUKTI PELAKSANAAN MONITORING INDIKATOR MUTU LAYANAN KLINIS

NO

TANGGAL

PETUGAS

HASIL MONITORING

KET

YANG DIMONITORING

IDENTIFIKASI MASALAH, ANALISA DAN RENCANA TINDAK LANJUT

NO

MASALAH

ANALISA

RTL

KET

TINDAK LANJUT DAN EVALUASI

NO

TINDAK LANJUT

EVALUASI

KET

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