Form Bundle Iad, Isk, Ido, Vap Checklist

AUDIT IAD BUNDLE CHECKLIST Rangan!

RSU dr. G.L TOBING

Ta n ng gg al al

No

N am am a Pasien/ No Bed

  hand hygiene

Blan " Ta#n!

Menggunakan

Pembersihan

Lokasi

APD

kulit dengan

 pemasangan

chlorhexidine

sesuai

Slang infuse diganti Sesuai

Swab alcohol Setiap injeksi

Spuit yang

Penutup

Perawatan

Menggunakan

digunakan

insersi

lokasi insersi

stopper needles

disposable

standar 

dengan

setiap 4 hari

transparan

dan jika kotor 

dressing

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TOTAL Ke$erangan! % &a % $ida'  Peng#i$ngan!

Ʃ &a

( )**+ Ʃ&a

" $ida'  AUDIT ISK BUNDLE CHECKLIST Rangan! Blan " Ta#n!

Tanggal

No

Nama Pasien

Pemasangan APD sesuai  tepat indikasi

Pemasangan menggunakan alat steril

and ygiene

Segera

Pengisian

dilepas

 balon sesuai

 jika tidak

! "# ml$

%iksasi kateter  dengan  plester 

&rine bag menggantung

indikasi 

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TOTAL Ke$erangan! % &a % $ida'  Peng#i$ngan!

Ʃ &a

( )**+ Ʃ&a

" $ida'  AUDIT IDO BUNDLE CHECKLIST Rangan! Blan " Ta#n!

Tanggal

No

Nama Pasien

'ukur  Dengan e( clipper 

)aktu cukur  ! * + jam$ sebelum operasi

Mandi cholrhexidine

Antibiotic , jam sebelum insisi

Pasien tidak  sedang infeksi

-ula darah .erkontrol

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TOTAL Ke$erangan! % &a % $ida'  Peng#i$ngan!

Ʃ &a

( )**+ Ʃ&a

" $ida'  AUDIT ,ENTILATOR BUNDLE CHECKLIST /uangan0 1ulan2 .ahun0

Tanggal

No

Nama Pasien/ No Bed

HOB -**01*

Peng'a2ian se$ia3 #ari $er#ada3 sedasi dan e($4asi

Hand #&giene

Oral H&giene 0 5 6 2am

Pen&i'a$an gigi se$ia3  )7 2am

S8$ion / mana2emen se'resi

Pro9ila'sis 3e3$i8 l8er

D,T Pro9ila'sis

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TOTAL Ke$erangan! % &a % $ida'  Peng#i$ngan!

Ʃ &a

( )**+

Ʃ&a

" $ida'