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    1. The document is a monitoring form tracking patient information including name, age, diagnosis, number of medications, whether antibiotics or injections were given, generic vs brand names of medications, dosages, and whether treatment was in accordance with guidelines for 13 patients treated for upper respiratory infections from November 1-18, 2017 at a health center in South Halmahera, North Maluku Province, Indonesia. 2. Common medications prescribed included amoxicillin, paracetamol, cough syrup, dexamethasone, loratadine, and vitamins. Dosages and number of days of treatment varied depending on patient age and severity of symptoms. 3. Treatment for all patients was in accordance

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    1. The document is a monitoring form tracking patient information including name, age, diagnosis, number of medications, whether antibiotics or injections were given, generic vs brand names of medications, dosages, and whether treatment was in accordance with guidelines for 13 patients treated for upper respiratory infections from November 1-18, 2017 at a health center in South Halmahera, North Maluku Province, Indonesia. 2. Common medications prescribed included amoxicillin, paracetamol, cough syrup, dexamethasone, loratadine, and vitamins. Dosages and number of days of treatment varied depending on patient age and severity of symptoms. 3. Treatment for all patients was in accordance

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    1 views10 pages

    Monitoring Peresepa NOVEMBER 2017

    Uploaded by

    sitra anna
    1. The document is a monitoring form tracking patient information including name, age, diagnosis, number of medications, whether antibiotics or injections were given, generic vs brand names of medications, dosages, and whether treatment was in accordance with guidelines for 13 patients treated for upper respiratory infections from November 1-18, 2017 at a health center in South Halmahera, North Maluku Province, Indonesia. 2. Common medications prescribed included amoxicillin, paracetamol, cough syrup, dexamethasone, loratadine, and vitamins. Dosages and number of days of treatment varied depending on patient age and severity of symptoms. 3. Treatment for all patients was in accordance

    Copyright:

    © All Rights Reserved
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    of 10

    FORMULIR MONITORING INDIKATOR PERESEPAN

    Puskesmas : Babang
    Kabupaten : Halmahera Selatan
    Propinsi : Maluku Utara
    Antibiotik Injeksi Jumlah Sesuai
    Tgl No Nama Umur Diagnosis Jumlah R/ Generik Nama Obat Dosis Jumlah Pedoman
    1/0 1/0
    Ya / Tidak
    11/1/2017 1 Tn. Imbran 52 Thn ISPA 6 1 0 6 a. Ciprolaxacin 500 mg 2 x 1, dihabiskan 10
    b. Paracetamol 500 mg 3x1 10
    c. GG 3x1 10
    d. Dexa 0,5 mg 3x1 10
    e. Ctm 4 mg 3x1 10
    f. Vitamin C 2x1 10
    11/2/2017 2 An. Intan 7 Thn ISPA 5 1 0 5 a. Amoxicillin 500 mg 3 x 1/2 5
    b. GG 3 x 1/2 5
    c. Ctm 4 mg 3 x 1/2 5
    d. Dexa 0,5 mg 3 x 1/2 5
    e. Vitamin C 1x1 10
    11/3/2017 3 By. Alfino 2 Bln ISPA 5 1 0 5 a. Amoxicillin syr 3 x 1/2 cth,dihabiskan 1
    b. Paracetamol drop's 3 x 0,6 cc 1
    c. GG 3
    d. Ctm 4 mg m.f.Pulv.No.X 2
    e. Vitamin C 3 x 1 Bks 3
    11/4/2017 4 Tn. Fikri 24 Thn ISPA 5 1 0 5 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Paracetamol 500 mg 3x1 10
    c. GG 3x1 10
    d. Ctm 4 mg 3x1 10
    e. Vitamin C 2x1 10
    11/6/2017 5 Tn. Bachtiar 52 Thn ISPA 5 1 0 4 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Paracetamol 500 mg 3x1 10
    c. Dexa 0,5 mg 3x1 10
    d. Ctm 4 mg 3x1 10
    e. Caviplex 1x1 10
    11/7/2017 6 Nn. Dwi Ariyani 14 Thn ISPA 4 1 0 4 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Paracetamol 3x1 10
    c. GG 3x1 10
    d. Ctm 4 mg 3x1 10
    11/8/2017 7 An. Setiawan 6 Thn ISPA 6 1 0 6 a. Amoxicillin syr 3 x 1c,dihabiskan 1
    b. paracetamol syr 3x1c 1
    c. Dexa 0,5 mg 3 x 1/2 5
    d. Ctm 4 mg 3 x 1/2 5
    e. Vitamin C 1x1 10
    f. Vitamin B'comp 2x1 10
    11/9/2017 8 Ny. Iya 30 Thn ISPA 5 1 0 5 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Dexa 0,5 mg 3x1 10
    c. Ctm 4 mg 3x1 10
    d. Vitamin C 2x1 10
    e. Ambroxol 3x1 10
    11/10/2017 9 An. Riyana 8 Thn ISPA 5 1 0 5 a. Cefixim Syr 2x1c 1
    b. GG 3 x 1/2 5
    c. Dexa 0,5 mg 3 x 1/2 5
    d. Loratadin 2 x 1/2 5
    e. Vitamin C 1x1 10
    11/11/2017 10 Ny. Sartin 54 Thn ISPA 5 1 0 5 a. Ciprolaxacin 500 mg 2 x 1, dihabiskan 10
    b. Paracetamol 3x1 10
    c. GG 3x1 10
    d. Ctm 4 mg 3x1 10
    e. Vitamin C 2x1 10
    11/12/2017 11 Ny. Falentina 62 Thn ISPA 5 1 0 5 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. GG 3x1 10
    c. Loratadin 2x1 10
    d. Dexa 0,5 mg 3x1 10
    e. Paracetamol 3x1 10
    11/14/2017 12 Tn. Evanston 52 Thn ISPA 5 1 0 5 a. Ciprolaxacin 500 mg 2 x 1, dihabiskan 10
    b. Ambroxol 3x1 10
    c. Loratadin 2x1 10
    d. Dexa 0,5 mg 3x1 10
    e. Vitamin C 2x1 10
    11/15/2017 13 Ny. Yanti 29 Thn ISPA 6 1 0 6 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Paracetamol 3x1 10
    c. Ctm 4 mg 3x1 10
    d. Ambroxol 3x1 10
    e. GG 3x1 10
    f. Vitamin B'comp 3x1 10
    11/16/2017 14 Tn. Lukas 46 Thn ISPA 5 1 0 4 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Paracetamol 3x1 10
    c. Ambroxol 3x1 10
    d. Ctm 4 mg 3x1 10
    e. Caviplex 1x1 10
    11/18/2017 15 Ny. Siti 56 Thn ISPA 4 0 0 4 a. Ambroxol 3x1 10
    b. Ctm 4 mg 3x1 10
    c. Dexa 0,5 mg 3x1 10
    d. GG 3x1 10
    11/20/2017 16 Ny. Selfi 36 Thn ISPA 6 1 0 6 a. Ciprolaxacin 500 mg 2 x 1, dihabiskan 10
    b. GG 3x1 10
    c. Ambroxol 3x1 10
    d. Ctm 4 mg 3x1 10
    e. Dexa 0,5 mg 3x1 10
    f. Vitamin C 2x1 10
    11/21/2017 17 Tn. Sutno 29 Thn ISPA 4 1 0 4 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Ibrpfen 400 mg 2x1 10
    c. Paracetamol 3x1 10
    d. Vitamin C 2x1 10
    11/22/2017 18 Ny. Marie 42 Thn ISPA 5 1 0 5 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Paracetamol 3x1 10
    c. Ibuprofen 400 mg 2x1 10
    d. Ambroxol 3x1 10
    e. Ctm 4 mg 3x1 10
    11/23/2017 19 Ny. Yati 24 Thn ISPA 5 1 0 5 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Ibrpfen 400 mg 2x1 10
    c. Ambroxol 3x1 10
    d. Ctm 4 mg 3x1 10
    e. Dexa 0,5 mg 3x1 10
    11/24/2017 20 Ny. Kartati 33 Thn ISPA 4 1 0 4 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Ibrpfen 400 mg 2x1 10
    c. Ctm 4 mg 3x1 10
    d. Vitamin B'comp 2x1 10
    11/25/2017 21 An. Frdianus 2 Thn ISPA 2 1 0 2 a. Amoxicillin syr 3 x 1 c,dihabiskan 1
    b. paracetamol syr 3x1c 1
    11/27/2017 22 Tn. Rinto 37 Thn ISPA 5 1 0 5 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Ambroxol 3x1 10
    c. Dexa 0,5 mg 3x1 10
    d. Loratadin 2x1 10
    e. Vitamin C 2x1 10
    11/28/2017 23 An. Angelika 14 Thn ISPA 5 1 0 5 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Ambroxol 3x1 10
    c. Paracetamol 3x1 10
    d. Dexa 0,5 mg 3x1 10
    e. Ctm 4 mg 3x1 10
    11/29/2017 24 Ny. Suryani 24 Thn ISPA 5 1 0 4 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Ambroxol 3x1 10
    c. Paracetamol 3x1 10
    d. Ctm 4 mg 3x1 10
    e. Caviplex 1x1 10
    11/30/2017 25 Ny. Aisya 36 Thn ISPA 6 1 0 6 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. GG 3x1 10
    c. Dexa 0,5 mg 3x1 10
    d. Loratadin 2x1 10
    e. Paracetamol 3x1 10
    f. Antasida 3 x 1 ac 10
    25 TOTAL 1302 123 24 0 120 n = Jumlah pasien (sampel)
    RATA-RATA 1302 4,92 A = Jumlah item obat
    PERSENTASE 1302 0,96% 0% 0,97% B = Jumlah pasien yang mendapat antibiotik
    TOTAL 0102 A B C D C = Jumlah pasien yang mendapat injeksi
    n RATA-RATA 0102 E D = Jumlah generik
    PERSENTASE 0102 F% G% H% 1 = Jika diberikan antibiotik atau injeksi
    TOTAL 21 A B C D 0 = Jika tidak diberikan antibiotik atau injeksi
    n RATA-RATA 21 E E = A/n
    PERSENTASE 21 F% G% H% F = B/n x 100%
    G = C/n x 100%
    H = D/A x 100%
    1. ISPA nonpneumni
    2. Diare non speisfik
    3. Mialgia
    FORMULIR MONITORING INDIKATOR PERESEPAN

    Puskesmas : Babang
    Kabupaten : Halmahera Selatan
    Propinsi : Maluku Utara
    Antibiotik Injeksi Jumlah Sesuai
    Tgl No Nama Umur Diagnosis Jumlah R/ Generik Nama Obat Dosis Jumlah Pedoman
    1/0 1/0
    Ya / Tidak
    11/2/2017 1 By. Nurlisa 1,10 Thn Diare Akut 3 1 0 3 a. Cotry syr 2 x 1 cth, dihabiskan 1
    b. Oralit 1/2 Bks Tiap BAB 6
    c. Zink Dispersible 1 x 1 dihabiskan 10
    11/3/2017 2 By.Aika 11 Bln GEA 4 1 0 4 a. Cotry syr 2 x 1/2 cth,dihabiskan 1
    b. Oralit 1/2 Bks Tiap BAB 3
    c. Zink Dispersible 1 x 1 dihabiskan 10
    d. Paracetamol drops 3 x 0,6 cc 1
    11/7/2017 3 Tn Lukas 67 Thn DIARE 3 1 0 3 a. Cotry 480 mg 2 x 1, dihabiskan 10
    b. Oralit 1 Bks Tiap BAB 6
    c. Papaverin 3x1 10
    11/8/2017 4 An. Benjamin 1 Thn GEA 4 1 0 4 a. Cotry syr 2 x 1 cth, dihabiskan 1
    b. Oralit 1/2 Bks Tiap BAB 6
    c. Zink Dispersible 1 x 1 dihabiskan 10
    d. Paracetamol Syr 3 x 1 cth 1
    11/9/2017 5 By. Suci 3 Bln DIARE 2 0 0 2 a. Oralit 1/2 Bks Tiap BAB 3
    b. Zink Disperseble 1 x 1/2, dihabiskan 5
    11/11/2017 6 Tn. Hamid 87 Thn Diare Akut 4 1 0 4 a. Cotry 480 mg 2 x 1, dihabiskan 10
    b. Paracetamol 3x1 10
    c. Papaverin 3x1 10
    d. Antasida 3 x 1 ac 10
    11/22/2017 7 An. Rafael 1,6 Thn DIARE 2 1 0 2 a. Cotry syr 2 x 1 cth, dihabiskan 1
    b. Oralit 1 Bks Tiap BAB 6
    11/25/2017 8 An. Cucu eka 11 Thn Diare Akut 3 0 0 2 a. Loperamid 3x1 10
    b. Oralit 1 Bks Tiap BAB 6
    c. Vitamin B'comp 2x1 10
    11/27/2017 9 An. Andradies 1,7 Thn GEA 3 1 0 3 a. Cotry syr 2 x 1 cth, dihabiskan 1
    b. Oralit 1 Bks Tiap BAB 6
    c. Zink Dispersible 1 x 1, dihabiskan 10
    11/30/2017 10 Tn. Farid 29 Thn GEA 5 1 0 4 a. Cotry 480 mg 2 x 1, dihabiskan 10
    b. Loperamid 3x1 10
    c. Domperidon 3 x 1 ac,mual/muntah 10
    d. Papaverin 3x1 10
    10 TOTAL 1302 33 10 0 0,93 n = Jumlah pasien (sampel)
    RATA-RATA 1302 3,3 A = Jumlah item obat
    PERSENTASE 1302 1.00% 0% 0,91% B = Jumlah pasien yang mendapat antibiotik
    TOTAL 0102 A B C D C = Jumlah pasien yang mendapat injeksi
    n RATA-RATA 0102 E D = Jumlah generik
    PERSENTASE 0102 F% G% H% 1 = Jika diberikan antibiotik atau injeksi
    TOTAL 21 A B C D 0 = Jika tidak diberikan antibiotik atau injeksi
    n RATA-RATA 21 E E = A/n
    PERSENTASE 21 F% G% H% F = B/n x 100%
    G = C/n x 100%
    H = D/A x 100%
    1. ISPA nonpneumni
    2. Diare non speisfik
    3. Mialgia
    FORMULIR MONITORING INDIKATOR PERESEPAN

    Puskesmas : Babang
    Kabupaten : Halmahera Selatan
    Propinsi : Maluku Utara

    Antibiotik Injeksi Jumlah Sesuai


    Tgl No Nama Umur Diagnosis Jumlah R/ Generik Nama Obat Dosis Jumlah Pedoman
    1/0 1/0
    Ya / Tidak
    11/1/2017 1 Ny. Kuraisin 47 Thn MYALGIA 4 0 0 4 a. Piroxicam 2x1 10
    b. Methyelprednisolon 2x1 10
    c. Vitamin B'Comp 2x1 10
    11/6/2017 2 Tn. Lukas 46 Thn MYALGIA 2 0 0 1 a. Paracetamol 500 mg 3x1 10
    b. Caviplex 1x1 10
    11/9/2017 3 Ny. Adriyana 33 Thn MYALGIA 4 1 0 3 a. Amoxicillin 500 mg 3 x 1, dihabiskan 10
    b. Caviplex 1x1 10
    c. Vitamin B1 2x1 10
    d. Asam mefenamat 3x1 10
    11/10/2017 4 Tn. Beni 77 Thn MYALGIA 3 0 0 3 a. Ibuprfen 400 mg 2x1 10
    b. Methyelprednisolon 2x1 10
    c. Antasida 3 x 1 ac 10
    11/13/2017 5 Ny. Tumina 52 Thn MYALGIA 2 0 0 2 a. Ibuprfen 400 mg 2x1 10
    b. Vitamin B'comp 2x1 10
    11/18/2017 6 Ny. Suryati 39 thn MYALGIA 2 0 0 2 a. Ibuprfen 400 mg 2x1 10
    b. Vitamin B'comp 2x1 10
    11/20/2017 7 Ny. Antonia 30 Thn MYALGIA 3 0 0 3 a. Piroxicam 2x1 10
    b. Vitamin B'comp 2x1 10
    c. Dexa 0,5 mg 3x1 10
    11/21/2017 8 Ny. Hafifa 34 Thn MYALGIA 3 0 0 3 a. Ibuprfen 400 mg 2x1 10
    b. Vitamin B'comp 2x1 10
    c. Vitamin B12 2x1 10
    11/23/2017 9 An. Jhon 32 Thn MYALGIA 3 0 0 2 a. Piroxicam 2x1 10
    b. Metaneuron 3x1 10
    c. Vitamin B'Comp 2x1 10
    11/28/2017 10 Ny. Anila 36 Thn MYALGIA 3 0 0 3 a. Piroxicam 2x1 10
    b. Vitamin B'comp 2x1 10
    c. Dexa 0,5 mg 3x1 10
    11/29/2017 11 Ny. Dina 42 Thn MYALGIA 3 0 0 3 a. Paracetamol 500 mg 3x1 10
    b. Vitamin B'comp 2x1 10
    c. Dexa 0,5 mg 3x1 10
    11/30/2017 12 Tn. Herson 26 Thn MYALGIA 4 0 0 4 a. Natrium Diklofenak 2x1 10
    b. Vitamin B'comp 2x1 10
    c. Antasida 3 x 1 ac 10
    d. Dexa 0,5 mg 3x1 10
    12 TOTAL 1302 35 1 0 33 n = Jumlah pasien (sampel)
    RATA-RATA 1302 2,91 A = Jumlah item obat
    PERSENTASE 1302 0,08% 0% 0,94% B = Jumlah pasien yang mendapat antibiotik
    TOTAL 0102 A B C D C = Jumlah pasien yang mendapat injeksi
    n RATA-RATA 0102 E D = Jumlah generik
    PERSENTASE 0102 F% G% H% 1 = Jika diberikan antibiotik atau injeksi
    TOTAL 21 A B C D 0 = Jika tidak diberikan antibiotik atau injeksi
    n RATA-RATA 21 E E = A/n 1. ISPA nonpneumni
    PERSENTASE 21 F% G% H% F = B/n x 100% 2. Diare non speisfik
    G = C/n x 100% 3. Mialgia
    H = D/A x 100%

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