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CHECKLIST IGD & AMBULANCE.xlsx

Mar 01, 2018

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Erma Safitri
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    CHECKLIST FASILITAS INS

    BULAN :

    NO NAMA FASILITAS FARMALKES IGD SATUAN JUM

    Tempat Penyimpanan Aat IGD1 Lemari Instrumen EA

    2 Lemari obat Injeksi EA

    3 Lemari obat Oral EA

    4 Lemari Cairan Infus EA

    5 Lemari Alkes EA

    6 Lemari Pendingin EA

    !rol" Emergen#" EA

    Aat !e"#!te$an

    1 !ensi $eter %&"gno EA

    2 !ensi $eter Air 'aksa $obile EA

    3 !ensi $eter Air 'aksa EA

    4 %tetos#o& Anak EA

    5 %tetos#o&e EA

    6 !ermometer a(ila EA

    !ermometer telinga EA

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    ) %enter EA

    * Otos#o&e EA

    1+ %urgi#al $inor %et EA

    11 ,auter %unnat EA

    12 $esin %u#tion EA

    13 -ag .al/e $ask 0easa EA

    14 -ag .al/e $ask Anak EA

    15 ebulier Anak EA

    16 ebulier 0easa EA

    1 $esin E, EA

    1) 0efibrilator Cardio EA

    1* Pulse O("meter EA

    2+ ula 0ara Cek EA

    21 armer EA

    22 %et Irigasi Lambung EA

    23 Laringoss#o&e %et 0easa 7 Anak EA

    24 !abung Oksigen EA

    25 !abung Oksigen Portable EA

    26 !iang Infus EA

    2 Pis&ot EA

    2) 8rinal EA

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    2* -askom %tainles EA

    3+ ater arm 9a#k EA

    31 %terilisator EA

    32

    33

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    Im#%ii&ati#n Set

    1 e#k Collar %ie %: $: L EA

    2 %&alk EA

    3 L%- ; Long %&ine -oard < EA

    4 %#oo& %tre#er EA

    5 ,endri#k e(tri#ation de/i#e ;,E0< EA

    6 %tre#er EA

    )

    O%at In'e!(i Eme$)en*y

    1 E&ine&rine A$P

    2 Atro&ine A$P

    3 Cordarone A$P

    4 Lasi( A$P

    5 0o&amin A$P

    6 0obutamin A$P

    Cedo#ard A$P

    ) Amino&"lin A$P

    * $e"lon = -i#nat >LA%?

    1+ ,CL >LA%?

    11 @"lo#ain A$P

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    12 Cortide( A$P

    13 !etagam A$P

    14

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    O%at O$a Eme$)en*y

    1 Cedo#ard 5 mg !A-

    2 Ca&to&ril 12:5 mg !A-

    3 Amlodi&in 5 mg !A-

    4 !romboAs&ilet !A-

    5 Cardio As&irin !A-

    6 Pla/i( !A-

    Cai$an In+,(

    1 'inger La#tat 5++ ## >LA%?

    2 Otsu % +:* 5++ ## >LA%?

    3 Otsu % +:* 1++ ## >LA%?

    4 Otsu % +:* 25 ## >LA%?

    5 0e(trose 5 5++ ## >LA%?

    6 0e(trose 5 1++ ## >LA%?

    0e(trose 4+ 25 ## >LA%?

    ) 0e(trose 1+ 5++ ## >LA%?

    * Asering 5++ ## >LA%?

    1+ ,aen 3 - 5++ ## >LA%?

    Pe$en)!apan In+,(

    1 Infus %et $akro EA

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    2 Infus %et $ikro EA

    3 Infus %et -lood EA

    4 I. Cat 14 EA

    5 I. Cat 1) EA

    6 I. Cat 2+ EA

    I. Cat 22 EA

    ) I. Cat 24 EA

    * I. Cat 26 EA

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    Aat Ke(e-atan Ha%i( Pa!ai

    1 %u#tion Cateter EA

    2 ! EA

    3 >ole" Cateter EA

    4 8rine -ag EA

    5 Oro&aringeal !ube EA

    6 aso&aringeal !ube EA

    orotra#eal tube = E!! EA

    ) #annule nasal adult EA

    * #annule nasal #ild EA

    1+ %im&le $ask Adult EA

    11 %im&le $ask Cild EA

    12 on 'ebreting $ask Adult EA

    13 on 'ebreting $ask Cild EA

    14 $asker ebulier Adult EA

    15 $asker ebulier Cild EA

    16 %"ringe 1 ##: 3 ##: 5 ##: 1+ ##: 2+ ##: 5+ ## EA

    1 -enang Bait ; %ilk: 0ermalon: Plain < EA

    1) EA

    Aat Pein",n) Di$i

    1 !utu& ,e&ala EA

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    2 ,a#a mata EA

    3 $asker -iasa EA

    4 $asker *5 EA

    5 aun EA

    6 Celemek EA

    lo/e %teril EA

    ) lo/e 0is&osible EA

    -

    Jumlah batas minimal di IGD

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    ASI GAWAT DARURAT

    TANGGALKET

    . / 0 1 2 3 4 5 6 .7 .. ./ .0 .1 .2 .3 .4 .5 .6 /7 /. // /0 /1 /2 /3 /4 /5 /6 07 0.

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    PE!8A%

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    CHECKLIST PERALATAN AMB

    BULAN: AMBUL

    NO NAMA FASILITAS FARMALKES AMBULANCE JUMLA

    Ta%,n) O8y)en 9 Pe$aatan

    1 !abung O("gen 1 EA

    2 Cannule asal 1 EA

    3 %im&le $ask 1 EA

    4 on 'ebreating $ask 1 EA

    O%at #%at Eme$)en*y

    1 E&ine&rin 2+ A$

    2 Atro&in 2+ A$

    Int$a;ena Set

    1 Cairan Infus 'L 2 EA

    2 I. Cat oD 2+: 22: 24 2 EA

    3 I. Line -lood %et 2 EA

    4 I. Line -iasa 2 EA

    S,*ti#n Set

    1 $esin %u#tion 1 EA

    2 Cateter %u#tion 1 EA

    0efibrillator 1 EA

    Pulse O(imetr" 1 EA

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    $inor %et Instrumen %urgi#al 1 %E!

    Intubasi %et 1 %E!

    ,antong $a"at 1 EA

    Pe$an)!at mm#%ii&ati#n

    1 %tre#er $anufa#ture 1 EA

    2 Long %&ine -oard 1 EA

    3 %#oo& %tre#er 1 EA

    4 ?ead Immobilitation 1 EA

    Aat Pein",n) Di$i

    1 $asker 0is&osible 1 ,O!A

    2 lo/e dis&osible sie $ 1 ,O!A

    3 aun 2 EA

    4 Celemek 2 EA

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    ANCE INSTALASI GAWAT DARURAT

    E :

    TANGGAL

    . / 0 1 2 3 4 5 6 .7 .. ./ .0 .1 .2 .3 .4 .5 .6 /7 /. // /0 /1 /2 /3 /4 /5 /6 07 0.

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    KETERANGAN

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    PETUGAS

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    BULA

    NO

    1

    2

    3

    4

    1

    2

    4

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    CHECKLIST PERAL

    :

    FARMALKES UGD

    O%at O$a

    !abung O("gen

    Cannule asal

    %im&le $ask

    on 'ebreating $ask

    E&ine&rin

    Atro&in

    Celemek

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    MBULANCE INSTALASI GAWAT DARURA

    JUMLAHTANGGAL

    . / 0 1 2 3 4 5 6 .7 .. ./ .0 .1 .2 .3 .4 .5 .6 /7 /. //

    1 EA

    1 EA

    1 EA

    1 EA

    2+ A$P

    2+ A$P

    2 EA

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    KETERANGAN

    /0 /1 /2 /3 /4 /5 /6 07 0.

    PETUGAS