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    Putripa Rizki Hasibuan
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    This document appears to be an observation form for monitoring hand hygiene compliance at a health center. It records data from observations of 7 healthcare workers/staff. For each observation, it notes whether the staff performed hand hygiene before and after interacting with patients and touched the surrounding area. The form indicates that for most observations, hand hygiene was missed and gloves were not used.

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    KKT ANC

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    This document appears to be an observation form for monitoring hand hygiene compliance at a health center. It records data from observations of 7 healthcare workers/staff. For each observation, it notes whether the staff performed hand hygiene before and after interacting with patients and touched the surrounding area. The form indicates that for most observations, hand hygiene was missed and gloves were not used.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    3 views3 pages

    KKT Anc

    Uploaded by

    Putripa Rizki Hasibuan
    This document appears to be an observation form for monitoring hand hygiene compliance at a health center. It records data from observations of 7 healthcare workers/staff. For each observation, it notes whether the staff performed hand hygiene before and after interacting with patients and touched the surrounding area. The form indicates that for most observations, hand hygiene was missed and gloves were not used.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    Formulir Observasi Kepatuhan Kebersihan

    Tangan UPTD Puskesmas Andam Dewi Bulan

    Nama Petugas : Nama Petugas : Nama Petugas : Nama Petugas :


    Ruangan : Ruangan : Ruangan : Ruangan :
    Tanggal : Tanggal : Tanggal : Tanggal :
    Observer : Observer : Observer : Observer :
    Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action Opp. Indication HH Action

    1 bef-pat. 1 bef-pat. 1 bef-pat. 1 bef-pat.


    HR HR HR HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
     gloves  gloves  gloves  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    2 bef-pat. 2 bef-pat. 2 bef-pat. 2 bef-pat.


    HR HR HR HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
     gloves  gloves  gloves  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    3 bef-pat. 3 bef-pat. 3 bef-pat. 3 bef-pat.


    HR HR HR HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
     gloves  gloves  gloves  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    4 bef-pat. 4 bef-pat. 4 bef-pat. 4 bef-pat.


    HR HR HR HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
     gloves  gloves  gloves  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    5 bef-pat. 5 bef-pat. 5 bef-pat. 5 bef-pat.


    HR HR HR HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
     gloves  gloves  gloves  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    6 bef-pat. 6 bef-pat. 6 bef-pat. 6 bef-pat.


    HR HR HR HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
     gloves  gloves  gloves  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.

    7 bef-pat. 7 bef-pat. 7 bef-pat. 7 bef-pat.


    HR HR HR HR
    bef-asept. bef-asept. bef-asept. bef-asept.
    HW HW HW HW
    aft-b.f. aft-b.f. aft-b.f. aft-b.f.
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
    aft-pat.
     missed
     gloves  gloves  gloves  gloves
    aft.p.surr. aft.p.surr. aft.p.surr. aft.p.surr.
    Formulir Pelayanan Anc Sesuai Standart
    UPTD Puskesmas Andam Dewi Bulan

    Nomor Kohort :
    Nama Pasien :
    Tanggal Lahir :
    NIK :
    Tanngal Pengumpulan Data :
    Tangal Bersalin :

    Nom Kontak K1 K2 K3 K4 K5 K6
    or Ke

    Usia 0-12 Minggu >12-24 Minggu >24 Minggu sampai kelahiran


    Minggu

    ANC
    Sesuai
    Standar

    Sumber

    1 Pemeriksa
    an Dokter

    2 Tekanan
    darah

    3 Timbang
    berat
    badan

    4 Tinggi
    badan

    5 Nilai
    status gizi
    (ukur
    LILA)

    6 Ukur
    tinggi
    fundus
    uteri

    7 Tentukan
    presentasi
    janin dan
    denyut
    jantung
    janin

    8 Skrining
    status
    imunisasi
    dan
    berikan
    suntikan
    tetanus
    toksoid
    (TT) bila
    diperluka
    n.

    9 Beri tablet
    tambah
    darah

    10 Pemeriksa
    an
    laboratori
    um
    meliputi:

    1
    Golongan
    darah

    2 Kadar
    Hemoglo
    bin

    3 Gluko-
    Protein
    urin

    4
    termasuk
    pemeriksa
    an HIV

    12 Tata
    laksana

    13 Temu
    wicara/
    konseling

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