FORMAT PEMANTAUAN INDIKATOR MUTU

AREA STANDAR PELAYANAN MINIMAL (SPM)

UNIT PENJAMIN MUTU RUMAH SAKIT PRIMA PEKANBARU

Standar
Judul Indikator SKP.1 Jumlah Pasien Rawat Inap Terpasang Gelang 100%
Ruangan IPI
Bulan Sep-17
Nama Pasien Gelang Identitas
No Tanggal Diagnosa Ket
Baru Ya Tidak
1 9/1/2017 NN. NISMA cks + uedem cerebri+# maxilla
2 9/2/2017 TN.IRWANDI sh +ich
3 9/2/2017 AN. GHALBI dss+ syok hipolemik +epitaksis
4 9/6/2017 TN. MAHADI contusio gr3- 80% tentaman suicite
5 9/6/2017 NY. SISRIKAWATI peritonitis ec KET+syok hipo glikemic+sepsis
6 9/7/2017 NY.WIWIK TRI WAHYUNI obs. Penurunan kesadarn
7 9/7/2017 AN ADITIA meningo enchepalopati
8 9/7/2017 TN MUHTAR chest pain+ pneumonia
9 9/8/2017 NY.RUBINI serosis hepatis
10 9/8/2017 NY.NG AI LAN Syok sepsis,pneumoniacckd stage v
11 9/8/2017 TN. SAMIUN anemia berat ec melena
12 9/8/2017 NY ZAIMARNI dipsnue ec pneumoni
13 9/8/2017 TN RINALDI post craniotomi
14 9/11/2017 NY. RATNA post laparatomy
15 9/12/2017 TN.SARKAWI dispnue+ HT+dm tipe 2
16 9/13/2017 TN.ZAINUDIN SH+IVH
17 9/13/2017 AN.M HARIS cks + edh
18 9/14/2017 NY. WIWIK TRI WAHYUNI obs. penurunan kesadaran
19 9/18/2017 TN. SWARTO pneumonia
20 9/19/2017 TN. RIFANDI penkes + tumor mediastina
21 9/20/2017 TN .SUWERI spinal cort injuri
22 9/21/2017 TN SUWANTO pneumothorax
23 9/16/2017 NY SUPIYEM hipoglikemi +ulkus diabetikum
24 9/18/2017 TN. SUWAJI penurunan kesadaran ec. Stroke infark
25 9/18/2017 TN JEFRIYANTO cks +contusio cerebri +temporal dextra
26 9/18/2017 TN. TUALI cksb+ich+bifrontal+ sah+sdh
27 9/19/2017 TN. JHONI susp tb paru
28 9/21/2017 TN ERWAN TAPA cks
29 9/24/2017 TN. AGUS TRIONO cks +sdh temporal
30 9/26/2017 NY. KASMAWATI dyspneu+efusi pleura+ckd stage v
31 9/26/2017 NY. NOVA PERMATA SARI syok hipopolemik ec retensio plasenta
32 10/28/2017 NY YUNIDAR vomitus+ dehidrasi sedang +dm tipe 2
33 10/29/2017 NY RATNA WATI penkes ec sepsis +asidosis
34 10/30/2017 TN ZAMRAN penurunan kes ec stroke
35 10/30/2017 TN BAINUR stroke emboli +ht gr 2
36 10/30/2017 TN SYAFRIL post fisiotomy orif +debridement
37 10/30/2017 TN. SAUT gagal nafas +ppok
Numerator X 100 =....................% X100=.............%
Total Pasien Terpasang Gelang
Denumerator Total
Pasien

Dilaporkan Oleh

(..................................................)
Kepala Ruangan
 FORMAT PEMANTAUAN INDIKATOR MUTU
AREA STANDAR PELAYANAN MINIMAL (SPM)
UNIT PENJAMIN MUTU RUMAH SAKIT PRIMA PEKANBARU

Standar
Judul Indikator SKP.1 Jumlah Pasien Rawat Inap Terpasang Gelang 100%
Ruangan IPI
Bulan Oct-17
Nama Pasien Gelang Identitas
No Tanggal Diagnosa Ket
Baru Ya Tidak
1 10/2/2017 TN. SAUT gagal nafas tipe1 +ppok
2 10/2/2017 NY. HJ. DARJUNITA Imbalan electrolit ec gea
3 10/3/2017 NN.PUTRI YANI ckr+spinal crt injury
4 10/3/2017 TN.SYAHRIL post orif
5 10/4/2017 TN.SUPRAPTO multiple #contusio paru
6 10/7/2017 NY.MAHDALENA sh
7 10/8/2017 TN.IBNU RIUSADI cks+ sdh ocsipital
8 10/8/2017 TN.AHMAD SOLEH pneumotorax
9 10/8/2017 NY.YULIA RISKA post op histerectomi +ruptur urteri
10 10/10/2017 TN.LIBER AMBARITA pnemotorax
11 10/11/2017 NY.HERLINA post sc+histerectomi
12 10/12/2017 NY.ANG PO TJU penurunan kesadaran ec stroke
13 10/13/2017 TN.KURNIAWAN cks+sdh
14 10/13/2017 NN.UNY FANNY LINTA intoksikasi gramaxsone
15 10/13/2017 NY. ANYIU dm tipe2
16 10/13/2017 NY.PBR ARUAN chf+ af+n stemi
17 10/14/2017 AN.SIDDIK BIN LAMHOT ckr+trauma tumpul abdomen
18 10/15/2017 M.DESAH sh+ich+ivh+post evd
19 10/16/2017 TN. MALIAN post op vp shunt
20 10/16/2017 NY.ROSDIANA post craiotomy
21 10/17/2017 NY.SUTRIANA penuruna kesadarn ec metabolik
22 10/17/2017 NY.DIAN osteomelitus
23 10/17/2017 TN EMANUEL GEA cks +oedem cerebri
24 10/17/2017 AN AMMER SAID tetanus
25 10/18/2017 TN.M RUSDIN sepsis+dic+cap+aki
26 10/19/2017 TN. RUDIMAN metabolik inbalance
27 10/21/2017 NY.IDA DAHYUNI post histerectomi
28 10/22/2017 TN.SUDIMAN ckb+contusio cereberi
29 10/23/2017 TN.BASRI penurunan kesadran+ggal nafas tipe2
30 10/23/2017 TN SALIM sh+ich
31 10/23/2017 TN.HERDIANTO snake bite gr1
32 10/23/2017 NY.NUR AZIMA meningtis +dm tipe 2
33 10/26/2017 AN RISKIKA AULIA cks+edema paltebra+uedem cerebri
34 10/26/2017 TN YUSMAR ckd +inbalace electrolit
35 10/28/2017 NY. TJO KING stroke ec troke infasif
36 10/26/2017 NY. AGUS TRISNAWATIU post laparatomi
37 10/27/2017 AN. NABILA pneumonia
38 10/29/2017 AN. RAVINZAN ckr+edh
Numerator X 100 =....................% X100=.............%
Total Pasien Terpasang Gelang
Denumerator Total
Pasien

Dilaporkan Oleh
(..................................................)
Kepala Ruangan
 FORMAT PEMANTAUAN INDIKATOR MUTU
AREA STANDAR PELAYANAN MINIMAL (SPM)
UNIT PENJAMIN MUTU RUMAH SAKIT PRIMA PEKANBARU

Standar
Judul Indikator SKP.1 Jumlah Pasien Rawat Inap Terpasang Gelang 100%
Ruangan IPI
Bulan november2017
Nama Pasien Gelang Identitas
No Tanggal Diagnosa Ket
Baru Ya Tidak
1 11/1/2017 Tn.rusman sirait stoke infark
2 11/2/2017 Tn. Sulaji post laparatomi a/I peritonitis
3 11/3/2017 ny.sarah post sc+peb
4 11/3/2017 an. Athaya hidrocepalus
5 11/4/2017 tn.sudi post orif clavicula
6 11/5/2017 tn.syaiful ckr+sdh ftontal
7 11/5/2017 an.dzaky ckb +sdh
8 11/5/2017 ny.ti rohani penurunan kesadran ec KAD
9 11/11/2017 ny.lismawati dm tipe 2 +efusi pleura
10 11/10/2017 tn. Lianhock post cystostoy
11 11/11/2017 tn. Marsudi peuruna kesadaran ec hipoglikemi
12 11/13/2017 an. Candra alfami open #depres+ich
13 11/13/2017 tn.ismail post craniectomi
14 11/14/2017 tn. Lianhock ppok+post cystosoy
15 11/15/2017 tn.hendrik dm tipe 2+susp tb paru relap
16 11/16/2017 tn. Irwan yusuf ckr+sdh ftontal
17 11/17/2017 ny.jarmi ckr+oedem cerebri
18 11/18/2017 tn. Rusadi ppok ea+af
19 11/18/2017 tn. Kusmanto open #femur +pelvis
20 11/19/2017 tn. Imam muhadi cks+ich+sah
21 11/19/2017 ny.ng njuk penurunakesadara +snh
22 11/19/2017 tn. Hermanto ckr
23 11/20/2017 an. Ajril syok hipovolemik
24 11/21/2017 tn.soleha post evd
25 11/21/2017 ny.irma gagal nafas tipe 1+alo
26 11/23/2017 ny. Izza saklinah g1p0a0h0 prematur kontraksi +anemis
27 11/23/2017 tn.eko widodo ckb
28 11/24/2017 an.seril ikhwan pratama ckb +sdh
29 11/25/2017 ny.vera irawan post laparatomi
30 11/25/2017 ny.dwi nursantiu post sc a/I exlamsi
31 11/28/2017 ny. Hidayati snh+g4p2a1h1 gr 16-17mgg
32 11/30/2017 tn.syahril penurunan kesadran ec stroke infak
Numerator X 100 =....................% X100=.............%
Denumerator Total
Pasien

Dilaporkan Oleh

(..................................................)
Kepala Ruangan
 FORMAT PEMANTAUAN INDIKATOR MUTU
AREA STANDAR PELAYANAN MINIMAL (SPM)
UNIT PENJAMIN MUTU RUMAH SAKIT PRIMA PEKANBARU

Standar
Judul Indikator SKP.1 Jumlah Pasien Rawat Inap Terpasang Gelang 100%
Ruangan IPI
Bulan Jan-18
Nama Pasien Gelang Identitas
No Tanggal Diagnosa Ket
Baru Ya Tidak
1 12/2/2017 TN. M RASUL √ resent Mci
2 12/2/2017 NY.HIDAYATI √ gagal nafas +susp SLE
3 12/2/2017 NY WARSINI √ KAD
4 12/2/2017 TN EFENDI SILABAN √ rosc+gaal nafas+dm tipe2+retensi sputum
5 12/3/2017 AN.NUR VATIKA √ electric burn grade 2-3
6 11/6/2017 TN .RIVA'i √ uap dd stemi old mci
7 12/7/2017 tn jamin √ ckd dd aki
8 12/8/2017 tn .lias √ stroke non hemoragik
9 12/8/2017 an. Arkan nadri √ gea dd dehidrasi berat
10 12/8/2012 ny.lianty √ ckd on hd
11 12/8/2012 an.alif √ penurunan kesadaran sus sol
12 12/8/2012 tn.nurhadi √ STROKE INFARK
13 12/9/2017 tn .boksen √ sh+sah+ivh
14 12/10/2017 tn.hermanto √ cks+sdh+#clavikula+#femur
15 12/14/2017 ny.susi indrawati √ post debulding
16 12/16/2017 tn.bambang √ dyspneu +chf+sepsis
17 12/16/2017 ny.tusimi √ snh+ivh
18 12/18/2017 tn.nurmansyah √ obs compulsi ec stroke infark
19 12/19/2017 tn.samsul √ post LE a/i trauma tumpul abdomen
20 12/19/2017 tn.jumawan √ spinal cord injury
21 12/20/2017 tn. Jubel √ post orif
22 12/21/2017 tn.johanes √ ht emergency
23 12/21/2017 tn.efendi √ post cardiac arest +efusi pleura+tb paru
24 12/23/2017 an.ridho √ dss
25 12/23/2017 an.puja √ ckr+#mandibula
26 12/27/2012 an. Abdur rahman √ urosepsis
27 12/29/2012 ny.waliyah √ dm tipe2 +ht
28 12/30/2012 tn. Bainal ardi √ cks +chf
29 12/30/2012 tn. Selamat adi santoso √ cks gcs 10 +#parietal

Numerator X 100 =....................% Total Pasien Terpasang Gelang

X100=.............%
Denumerator Total
Pasien
 Dilaporkan Oleh

(..................................................)
Kepala Ruangan
 FORMAT PEMANTAUAN INDIKATOR MUTU
AREA STANDAR PELAYANAN MINIMAL (SPM)
UNIT PENJAMIN MUTU RUMAH SAKIT PRIMA PEKANBARU

Standar
Judul Indikator SKP.1 Jumlah Pasien Rawat Inap Terpasang Gelang 100%
Ruangan IPI
Bulan Jan-18
Nama Pasien Gelang Identitas
No Tanggal
Baru Ya Tidak
1 1/1/2018 tn .boksen √
2 1/2/2017 MISDARYANTI NOVERINA, Ny √
3 1/3/2018 MARTIN SITINJAK,TN √
4 1/3/2018 ROHANI, Ny √
5 1/5/2018 SYUKUR RAMBE,TN √
6 1/6/2018 Dwi Yori, Tn √
7 1/7/2018 NADRAH. NY √
8 1/7/2018 NG KOK ALIAS RUDI. TN √
9 1/8/2018 HASNAH, Ny. √
10 1/8/2018 AMIRHAM BIN RUSMAN. TN √
11 1/10/2018 EFENDI MARPAUNG, Tn √
12 1/12/2018 SUPRIANTO,Tn √
13 1/13/2018 AMIT SARAGIH. TN √
14 1/16/2018 SAMA NAINGGOLAN. TN √
15 1/18/2018 Indra Saputra ,Tn √
16 1/19/2018 MASri,NY √
17 1/20/2018 HASANUDDIN RAMBE, Tn √
18 1/19/2018 MASri,NY √
19 1/21/2018 Resdi, Tn √
20 1/26/2018 ROSNA, Ny √
21 1/28/2018 RUSDI BIN SUK TJOK YOU, TN √
22 1/29/2018 RASIMAN BIN RUSMAN. TN √
23 1/31/2018 ENY RAHAYU. NY √
24
25
26
27
28
29

Numerator X 100 =....................% Total Pasien Terpasang Gelang

Denumerator Total
Pasien
 Dilaporkan Oleh

(..................................................)
Kepala Ruangan
MAT PEMANTAUAN INDIKATOR MUTU
STANDAR PELAYANAN MINIMAL (SPM)
MIN MUTU RUMAH SAKIT PRIMA PEKANBARU

ang Gelang 100%

Diagnosa Ket

penurunan kesadaaran +sh+sah+ivh post evd

DM Tipe 2 Stuke Infark akut+ HT +CAD susp.TB
Craniextomi a/i CKB SDH Sah adema cerebri
CKD Stage 5 on HD +DM efusi pleura
Syok Tepsis
Elektrolit Imbalance
post sc
CKS +SDH + EDH +Closed # 1/3 Distal Femur
syock septis.DM tipe 2 ilo
CKS edema Celebri +TTA ac Trauma Hepar gr V + open # 1/3 Distal Tibia
stroke frambosin
Post ACDT a/i spinal cort injuri C3, C4
ICH POND
Penkes Hipo Glikemia lama elektrolit In Balance
Penurunan Kesadaran ec. SH +ICH+NH+DM TIPE II
Stroke Infark
Dipsneu ec CHF inbalance elektrolit sup hipaksi
Stroke Infark
Syok sepsis +syok hiponatremi +anemia berat +elektrolit Imbalance
Dm post Stroke + anemia
Syok sepsis +syok hiponatiani +nanis berat +elektrolit Imbalance
CKD sepsis malena +Anemia
Syok sepsis+Dm tipe 2+ Pneumonia

X100=.............%
 Dilaporkan Oleh

(..................................................)
Kepala Ruangan
 FORMAT PEMANTAUAN INDIKATOR MUTU
AREA STANDAR PELAYANAN MINIMAL (SPM)
UNIT PENJAMIN MUTU RUMAH SAKIT PRIMA PEKANBARU

Standar
Judul Indikator SKP.1 Jumlah Pasien Rawat Inap Terpasang Gelang 100%
Ruangan
Bulan
Nama Pasien Gelang Identitas
No Tanggal Diagnosa Ket
Baru Ya Tidak
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

Numerator X 100 =....................% X100=.............%

Total Pasien Terpasang Gelang
Denumerator Total
Pasien

Dilaporkan Oleh

(..................................................)
Kepala Ruangan