Form Asesmen Resiko Pasien Jatuh

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RSIA PRIMA HUSADA

FORM

: ASESMEN RESIKO PASIEN JATUH & TINDAK LANUTNYA

A. IDEN IDENTI TIT TAS :  Nama Pasien : L/P,, Umur: L/P !/"#n, N$. RM : A#ama : Tan%%a# : Jam : Peu Peu%a %ass an% an% me#a me#a'u 'u'a 'ann ases asesme menn :  Nama : ............................... Dr/"i(an/)era*a/)eu%as #ain +............................................ +.......................................... .. ASESMEN RESIKO PASIEN JATUH menuru MORSE K$n(isi Pasien SKALA Ya Ri*aa Jau! Ti(a' Ya Dia%n$sa se'un(er  Ti(a' Pera#aan K!usus A#a 2anu Ja#an T$n%'a/ 4a#'er Kursi R$(a / Tan)a A#a 2anu Ya Pasien Di In5us Ti(a' Ter%an%%u 6ara 2er7a#an Lema!  N$rma# Keer"aasan Daa In%a/)en%aru! K$n(isi Mena# O"a 2ius  N$rma#

Ni#ai  0 1 0 30 1 0 0 0 0 10 0

TOTAL S6ORE

-

1 0

...... Score total, tingkat resiko dan Warna Gelang

Resi'$ Tin%%i

89

e#an% mera!

Se(an%

 ; 99

Kunin% Ren(a! 0;9 Hi7au

ASESMEN KONDISI RUANAN 2. KONDISI RUANAN SKALA T Lanai Kamar Li?in Ti(a' Li?in Lanai Kamar Man(i Li?in Ti(a' Li?in K$n(isi 2e( 2ai'  Ti(a' 2ai'  Pen?a!aaan 2ai' 6u'u) Kuran% 2e# ruan%an 2er5un%si Rusa' Pen(in%in Ruan%an 2er5un%si Rusa' Pinu Kamar Man(i 2er5un%si Rusa' INDAK LANJUT PASIEN RESIKO JATUH S6ORE TINI 1. Pasan% %e#an% ............. .................... .............. ............. ............. .............. .............. ............. ............. .............. .............. ............. ............. ..........su(a ...su(a!/ !/ "e#um . In5$rmasi In5$rmasi 'e)a(a )asien/'e#ua )asien/'e#uar%a... r%a......... ............. .............. .............. ............. ............. .............. ............. ............. ..........su(a! ...su(a!// "e#um 3. is a(>is ................................................................................................................................................... ...................................................................................................................................................