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    Self Assesment Perawat

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    Salahuddin Ageng Natanegara
    This document appears to be a self-assessment form for a hospital to evaluate its compliance with nursing standards. It contains several sections that assess areas like patient and family rights, education of patients and families, management of communication and information, and infection prevention and control. Each section includes multiple elements to evaluate using criteria like completeness of documentation and reference documents. Scores and compliance levels are included for each element. The form allows the hospital to systematically review its practices and documentation against established nursing standards.

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    Self Assesment Perawat

    Uploaded by

    Salahuddin Ageng Natanegara
    32 views183 pages
    This document appears to be a self-assessment form for a hospital to evaluate its compliance with nursing standards. It contains several sections that assess areas like patient and family rights, education of patients and families, management of communication and information, and infection prevention and control. Each section includes multiple elements to evaluate using criteria like completeness of documentation and reference documents. Scores and compliance levels are included for each element. The form allows the hospital to systematically review its practices and documentation against established nursing standards.

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    SA

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    This document appears to be a self-assessment form for a hospital to evaluate its compliance with nursing standards. It contains several sections that assess areas like patient and family rights, education of patients and families, management of communication and information, and infection prevention and control. Each section includes multiple elements to evaluate using criteria like completeness of documentation and reference documents. Scores and compliance levels are included for each element. The form allows the hospital to systematically review its practices and documentation against established nursing standards.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    32 views183 pages

    Self Assesment Perawat

    Uploaded by

    Salahuddin Ageng Natanegara
    This document appears to be a self-assessment form for a hospital to evaluate its compliance with nursing standards. It contains several sections that assess areas like patient and family rights, education of patients and families, management of communication and information, and infection prevention and control. Each section includes multiple elements to evaluate using criteria like completeness of documentation and reference documents. Scores and compliance levels are included for each element. The form allows the hospital to systematically review its practices and documentation against established nursing standards.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 183

    SELF ASSESSMENT STA

    TANGGAL :

    No Elemen Penilaiaan

    I Hak Pasien dan Keluarga

    HPK .1

    HPK 1.1

    2
    HPK 1.1.1

    HPK 1.2

    HPK 1.3

    HPK 1.4

    2
    3

    HPK 1.5

    HPK 1.6

    HPK.2

    1
    2

    HPK 2.1

    HPK 2.1.1

    HPK 2.2

    1
    2

    HPK 2.3

    HPK 2.4

    HPK 2.5

    2
    HPK.3

    HPK.4

    HPK.5

    2
    3

    HPK.6

    HPK.6.1

    HPK.6.2

    2
    3

    HPK.6.3

    HPK.6.4

    6
    HPK.6.4.1

    HPK.7

    7
    HPK.7.1

    HPK.8

    HPK.9

    1
    2

    HPK.10

    HPK.11

    4
    5

    6
    SELF ASSESSMENT STANDAR KEPERAWATAN

    Kelengkapan Berkas Kelengkapan Dokumen Acuan


    Skor Keterangan
    SELF ASSESSMENT STANDAR K
    TANGGAL :

    No Elemen Penilaiaan Kelengkapan Berkas

    II Millenium Development Goal's

    MDG'S.1

    MDG'S.2

    1
    2

    MDG'S.3

    3
    4

    6
    NT STANDAR KEPERAWATAN

    Kelengkapan Dokumen Acuan Skor Keterangan


    SELF ASSESSMENT STA
    TANGGAL :

    No Elemen Penilaiaan

    III Kualifikasi dan Pendidikan Staf

    KPS.1

    KPS.1.1

    3
    KPS.2

    KPS.3

    3
    4

    KPS.4

    KPS.5

    1
    2

    KPS.6

    3
    4

    KPS.6.1

    KPS.7

    4
    KPS.8

    KPS.8.1

    KPS.8.2
    1

    KPS.8.3

    KPS.8.4

    1
    2

    KPS.9

    4
    5

    KPS.9.1

    KPS.10

    KPS.11
    1

    KPS.12

    4
    5

    KPS.13

    KPS.14

    KPS.15

    1
    2

    KPS.16

    KPS.17

    1
    2

    3
    SELF ASSESSMENT STANDAR KEPERAWATAN

    Kelengkapan Berkas

    Uraian Tugas Staf


    SPO Penerimaan Staf

    SPO Evaluasi Kualifikasi Staf Baru

    SPO Penetapan Staf

    Proses Kredensial Staf Klinis


    NDAR KEPERAWATAN

    Skor
    Kelengkapan Dokumen Acuan Keterangan

    KMK 81/2004 ttg Pedoman Penyusunan Perencanaa

    KMK ttg Standar Profesi Tenaga Kesehatan

    0

    5

    SK Pengangkatan Staf

    Medical Staf Bylaws


    Hasil Kredansial
    SPO Penerimaan Staf Non Klinis

    SPO Evaluasi Staf Non Klinis


    SELF ASSESSMENT STANDA
    TANGGAL :

    No Elemen Penilaiaan Kelengkapan Berkas

    PPI Pencegahan dan Pengendalian Infeksi

    EP 1

    EP 1

    3
    4

    EP 1

    4
    EP 1

    EP 1

    5
    6

    5.1

    EP 1

    EP 1

    2
    3

    EP 1

    7.1

    EP 1

    3
    4

    7.1.1

    EP 1

    7.2

    EP 1

    2
    3

    7.3

    EP 1

    7.4

    EP 1

    7.5

    EP 1
    2

    EP 1

    9
    EP 1

    10

    EP 1

    10.1

    EP 1
    2

    PPI.10.2

    PPI.10.3

    PPI.10.4

    1
    2

    PPI.10.5

    PPI.10.6

    PPI.11

    1
    2

    6
    ENT STANDAR KEPERAWATAN

    Kelengkapan Dokumen Acuan Skor


    Keterangan
    SELF ASSESSMENT STAND
    TANGGAL :

    No Elemen Penilaiaan

    VI Pendidikan Pasien dan Keluarga

    PPK.1

    PPK.2

    3
    4

    PPK.2.1

    PPK.3
    1

    PPK.4

    5
    PPK.5

    PPK.6

    4
    SELF ASSESSMENT STANDAR KEPERAWATAN

    Kelengkapan Berkas Kelengkapan Dokumen Acuan Skor


    Keterangan
    SELF ASSESSMENT S
    TANGGAL :

    No Elemen Penilaiaan

    VI Manajemen Komunikasi dan Informasi

    MKI.1

    MKI.2

    2
    3

    MKI.3

    MKI.4

    4
    5

    MKI.5

    MKI.6

    4
    MKI.7

    MKI.8

    6
    7

    MKI.9

    MKI.10

    3
    4

    MKI.11

    MKI.12

    2
    3

    MKI.13

    MKI.14

    3
    4

    MKI.15

    MKI.16

    MKI.17

    3
    MKI.18

    MKI.19

    MKI.19.1

    2
    3

    MKI.19.1.1

    MKI.19.2

    1
    2

    MKI.19.3

    MKI.19.4
    1

    MKI.20

    2
    3

    MKI.20.1

    MKI.20.2

    MKI.21

    1
    2

    5
    SELF ASSESSMENT STANDAR KEPERAWATAN

    Kelengkapan Berkas

    Data Populasi Pasien


    Ketentuan Tentang Pengaturan Data dan Informasi
    Pelaksanaan Pencatatan dalam RM

    Sistem Penyimpanan dan Pengambilan Berkas

    Sistem Pencatatan RM

    Hasil Pemeriksaan Untuk Menetapkan Diagnosis


    RM Gawat Darurat

    Kesimpulan Setelah Penanganan/Pengobatan Selesai

    Kondisi Pasien yang dipulangkan

    Instruksi Tindak Lanjut Pelayanan


    AR KEPERAWATAN

    Skor
    Kelengkapan Dokumen Acuan Keterangan

    UU No 36/2009 ttg Kesehatan


    UU No.29/2004 Tentang Praktek Kedokteran

    UU No.44/2009 Tentang Rumah Sakit


    PMK 269/Menkes/Per/III/2008
    10

    SOP

    Identitas Pasien
    10

    Dokumen RM
    10
    10

    Jam Kedatangan
    10

    Dokumen RM
    10

    Instruksi tindak lanjut pelayanan


    10
    SELF ASSESSMENT STANDAR KEPERAWA
    TANGGAL :

    No Elemen Penilaiaan

    SKP 1

    EP 1

    EP 2

    5
    SKP.2

    SKP.3

    4
    SKP.4

    SKP.5

    3
    SKP.6

    4
    SELF ASSESSMENT STANDAR KEPERAWATAN

    Kelengkapan Dokumen Acuan Ya/Tidak

    PMK 1691/2011 Tentang Keselamatan pasien RS YA

    SK Identifikasi Pasien YA

    Panduan identifikasi pasien YA

    Form Persetujuan tindakan/prosedur YA

    SPO pelaksanaan identifikasi pasien YA

    SPO pemasangan gelang YA

    Bukti sosialisasi identifikasi gelang

    SK komunikasi pemberian informasi/edukasi efektif

    Panduan komunikasi pemberian informasi/edukasi

    SPO Komunikasi via phone/Lisan tehnik SBAR

    SPO Verifikasi Via Phone/ Lisan

    Bukti sosialisasi SBAR


    AN

    Keterangan

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