garis panduan perkhidmatan perawatan domisiliari di kesihatan

BAB 4LAMPIRAN

Garis Panduan Perkhidmatan Perawatan Domisiliari Di Kesihatan Primer Edisi 1 Ms. 126 Mac 2014

LAMPIRAN IKEPERLUAN PERALATAN Beg Perawatan ( Satu Unit)

Bil. Jenis Barangan Kuantiti

1. Beg Perawatan 1

2. Dressing Set disposable 2

3. Dressing Scissor 12cm 2

4. Stetoskop 1

5. B/P set 1

6. Lignocaine Gel 1

7. Alcohol Handrub 1

8. Klinikal/Digital Thermometer 1

9. Glucometer 1

10. Gloves, Mask dan Apron Mengikut keperluan

11. Paper/hand towel Mengikut keperluan

12. Gluco strip Mengikut keperluan

13. Syringes Mengikut keperluan

14. Cotton/ Gauze (Tambahan) Mengikut keperluan

15. Plaster ( micropore) Mengikut keperluan

16. Cleansing lotion (e.g. – povidone, normal saline)

Mengikut keperluan

17. Disinfectant lotion (e.g. – hibitane, alcohol ) Mengikut keperluan

18. Condom catheter Mengikut keperluan

19. Foley’s catheter Mengikut keperluan

20. Ryles’s tube Mengikut keperluan

21. Water for injection Mengikut keperluan

22. Urine Bag & hanger Mengikut keperluan

23. Bandage Pelbagai saiz Mengikut keperluan


LAMPIRAN IIPPD 001/2014

BORANG RUJUKAN PERKHIDMATAN PERAWATAN DOMISILIARI (PPD)

Kepada Penyelaras Perkhidmatan Perawatan DomisiliariHospital ................................

Kepada Penyelaras Perkhidmatan Perawatan Domisiliari Klinik Kesihatan .....................................

(Ditentukan oleh Penyelaras Hospital)

A. PERIHAL PESAKIT [ Diisi oleh Jururawat ]

Bil Perkara Maklumat1. Nama2. No. Kad Pengenalan3. Jantina4. Alamat

5. No. Telefon6. Wad / Klinik7. Tarikh masuk wad8. Tarikh keluar wad9. Tarikh rujukan

A. PERIHAL PENJAGA [ Diisi oleh Jururawat ]

Bil Perkara Maklumat1. Nama penjaga2. No. Kad Pengenalan3. Alamat penjaga

4. No. Telefon penjaga rumah/pejabat/bimbit

5. Status persaudaraan

B. MAKLUMAT PERAWATAN [ Diisi oleh Pegawai Perubatan ]

Bil Perkara Maklumat1. Diagnosa2. Komplikasi3. Alahan Ubat

4. Rawatan / Ubatan


C. PERANCANGAN PERAWATAN [ Di isi oleh Pegawai Perubatan]

Bil AktivitiTanda mengikut keperluan

Catatan

1 Nursing care2 Ubatan / suntikan3 Cucian luka (dressing)4 Penukaran ryle’s tube5 Penukaran catether6 Fisioterapi7 Terapi carakerja8 Lain-lain

D. Modified Rankin Scale (mRS) : NYATAKAN SKOR PESAKIT

1 - No significant disability despite symptoms. Able to carry out all usual duties and activities.2 - Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance.3 - Moderate disability; requiring some help, but able to walk without assistance.4 - Moderately severe disability. Unable to walk without assistance and unable

to attend to own bodily needs without assistance.5 - Severe disability; bedridden, incontinent and requiring constant nursing care and attention

Nota: Hanya pesakit skor 4 atau 5 layak untuk Perkhidmatan Perawatan Domisiliari

E. Rawatan susulan yang di perlukan

................................................................................................................................................

................................................................................................................................................

................................................................................................................................................

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DI RUJUK OLEH:

Nama Pegawai Perubatan yang menjaga kes:.....................................................

Tandatangan : ..............................................................................................

Cop rasmi :...............................................................................................

Tarikh :...............................................................................................ARAHAN : Jururawat di Wad dikehendaki menghubungi awal Penyelaras PPD Hospital mengenai kes yang memerlukan Perkhidmatan Perawatan Domisiliari setelah di kenalpasti oleh Pakar


LAMPIRAN III

PPD 002/2014

SENARAI SEMAK KRITERIAPEMILIHAN KES UNTUK PPD DI KLINIK KESIHATAN

Nama kes :.....................................................................................................

No K.P :.....................................................................................................

Tarikh Rujukan :......................................................................................................

Ya Tidak

1. Adakah pesakit telah dinilai oleh Pegawai Perubatan.

2. Modified Rankin Scale (Skor 4 atau 5 )

3. Penjaga telah tandatangan memberi konsen bagi anggota PPD meneruskan perawatan di rumah.

4. Pesakit tinggal dalam kawasan operasi Klinik Kesihatan

yang ada perkhidmatan PPD .

5. Pesakit mempunyai penjaga tetap serta memenuhi kriteria:

Penjaga dewasa, waras dan berupaya.

Penjaga perlu ada bersama semasa perawatan di rumah.

Bersedia untuk belajar prosedur penjagaan pesakit.

Penjaga perlu memahami dan mematuhi polisi PPD .

Disahkan oleh :

Tandatangan : .................................................................................

Nama Penyelaras PPD Hospital: ............................................................

Jawatan : .................................................................................

No. Telefon Bimbit : .................................................................................


LAMPIRAN IV

PPD 003/2014

BORANG PERSETUJUAN PENJAGA BAGI PERKHIDMATAN PERAWATAN DOMISILIARI (PPD)

Saya.............................................................bersetuju / tidak bersetuju menjadi penjaga kepada …................……………................ untuk menerima perkhidmatan kesihatan domisiliari yang akan dijalankan oleh Pasukan Perkhidmatan PPD dari Klinik Kesihatan..........................

Saya berjanji akan mematuhi syarat-syarat yang disenaraikan;

i. Saya akan ada bersama semasa lawatan PPD di rumah.

ii. Saya bersedia untuk belajar prosedur penjagaan pesakit.

iii. Pesakit akan didiscaj dari penjagaan PPD dalam tempoh masa tidak lebih 3 bulan

atau lebih awal sekiranya pasukan PPD yakin saya dapat mengambil alih jagaan

pesakit.

iv. Pesakit tertakluk kepada Perintah Fi (Perubatan)1982-Akta Fi 1951 dan surat

pekeliling perbendaharaan KK/BP/WAI(S)/09/692/79Jld.5 sk.2/2013(1b) bertarikh 7

Jun 2013.(Lampiran X)

v. Membeli sendiri peralatan yang tidak dibekalkan.

Sekiranya saya gagal mematuhi syarat yang ditetapkan, pesakit akan digugurkan dari program PPD.

Tandatangan Penjaga : .......................................................................Nama : ................................................................................No K.P : ................................................................................Tarikh : ................................................................................

Tandatangan Saksi : ........................................................................... Nama : ................................................................................No K.P : ................................................................................Tarikh : ................................................................................

(Format ini diisi oleh Penyelaras PPD di Hospital/PPD Klinik Kesihatan)


LAMPIRAN V

Borang Penilaian Modified Barthel Index

NAMA :………………………………………………………… NO K/P:……………........................

DIAGNOSIS ……………………………………………………………………………

Activity CriteriaFIRST VISIT

SCORESCORE UPON DISCHARGE

Personal HygieneUnable to perform task (0)Substantial help required (1)Moderate help required (3)Minimal help required (4)Fully independent (5)

Bathing

ToiletUnable to perform task (0)Substantial help required (2)Moderate help required (5)Minimal help required (8)Fully independent (10)

Stair climbingFeedingDressingBowel controlBladder control

Chair/Bed transfers Unable to perform task (0)Substantial help required (3)Moderate help required (8)Minimal help required (12)Fully independent (15)

Ambulation

Or Wheelchair (Score only if patient is unable

to ambulate and is trained in wheelchair)

Unable to perform task (0)Substantial help required (1)Moderate help required (3)Minimal help required (4)Fully independent (5)

Activity TOTAL SCORE (105)

MBI TOTAL SCORE

DEPENDENCY LEVEL

0 – 24 Total25 – 49 Severe50 – 74 Moderate75 – 90 Mild91 - 99 Minimal

Anggota kesihatan:………………………………… Tandatangan :…………………………..

Sekiranya klien mencapai tahap total, severe dan moderate klien perlu dirujuk kepada Pegawai Pemulihan atau Jurupulih Perubatan Carakerja/Anggota


Borang Penilaian Modified Barthel Index (MBI)

NAMA :…………………………………………………… NO K/P …………………….

DIAGNOSA …………………………………………………………………………………………

Aktiviti KriteriaSKOR

LAWATAN PERTAMA

SKOR SEMASA DISCAJ

Kebersihan diri Perlu bantuan sepenuhnya (0)Perlu bantuan maksima (1)Perlu bantuan sederhana (3)Perlu bantuan minima (4)Berdikari sepenuhnya (5)Mandi

Kemahiran ke tandas (Toileting)Perlu bantuan sepenuhnya (0)Perlu bantuan maksima (2)Perlu bantuan sederhana (5)Perlu bantuan minima (8)Berdikari sepenuhnya (10)

Menaiki tanggaMemakai pakaianMakan & MinumKawalan pembuangan air kecilKawalan pembuangan air besar

Pemindahan ke kerusi/katil Perlu bantuan sepenuhnya (0)Perlu bantuan maksima (3)Perlu bantuan sederhana (8)Perlu bantuan minima (12)Berdikari sepenuhnya (15)Pergerakan

Penggunaan kerusi roda (skor hanya jika pesakit perlu bantuan sepenuhnya untuk bergerak dan telah dilatih berkerusi roda)

Perlu bantuan sepenuhnya (0)Perlu bantuan maksima(1)Perlu bantuan sederhana (3)Perlu bantuan minima (4)Berdikari sepenuhnya (5)

Aktiviti JUMLAH MARKAH (100)

MARKAH MBI TAHAP KEBERGANTUNGAN0 – 24 Sepenuhnya

25 – 49 Maksima50 – 74 Sederhana75 – 90 Ringan91 - 99 Minima

Anggota kesihatan:………………………………… Tandatangan :…………………………..

Sekiranya klien mencapai tahap total, severe dan moderate klien perlu dirujuk kepada Pegawai Pemulihan atau Jurupulih Perubatan (Carakerja/Anggota)


MODIFIED BARTHEL INDEX (SHAH VERSION) : SELF CARE ASSESSMENT(PENERANGAN LANJUT)

INDEX ITEM SCORE DESCRIPTIONCHAIR/BED TRANSFER 0 Unable to participatein a transfer. Two attendants

are required to transfer the patient with or without a mechanical device

3 Able to participate but maximum assistance of one other person is require in all aspects of the transfer

8 The transfer requires the assistance of one other person. Assistance may be required in any aspect of the transfer.

12 The presence of another person is required either as a confidence measure, or to provide supervision for safety.

15 The patient can safety approach the bed walking or in a wheelchair, lock brakes, lift footrests, or position walking aid, move safely to bed, lie down, come to a sitting position on the side of the bed, change the position of the wheelchair, transfer back into it safely and/or grasp aid and stand. The patient must be independent in all phases of this activity.

AMBULATION 0 Dependent in ambulation3 Constant presence of one or more assistant is

required during ambulation 8 Assistance is required with reaching aids and/or their

manipulation. One person is required to offer assistance

12 The patient is independent in ambulation but unable to walk 50 metres without help, or supervision is needed for confidence or safety in hazardous situations.

15 The patient must be able to waar braces if required, lock and unlock these braces assume standing position, sit down, and place the necessary aids into position for use. The patient must be able to crutches, canes, or a walkarette, and walk 50 metres without help or supervision.

AMBULATION WHEELCHAIR

0 Dependent in wheelchair ambulation.

1 Patient can propel self short distances on flat surface, but assistance is required for all other steps of wheelchair management

3 Presence of one person is necessary and constant assistance is required to manipulate chair to table, bet etc.

*(If unable to walk)

Only use this item if the patient is rated “0” for Ambulation, and then

4 The patient can propel self for a reasonable duration over regularly encountered terrain. Minimal assistance may still be required in “tight corners” or to negotiate a kerb 100 mm high.


INDEX ITEM SCORE DESCRIPTIONonly if the patient has been trained in wheelchair management.

5. To propel wheelchair independently, the patient must be able to go around corners, turn around, manoeuvre the chair to a table, bed, toilet, etc. The patient must be able to push a chair at least 50 metres and negotiate a kerb.

STAIR CLIMBING 0 The patient is unable to climb stairs.2 Assistance is required to all aspects of chair

climbing, including assistance with walking aids.5 The patient is able to ascend descend but is unable

to carry walking aids and needs supervision and assistance.

8. Generally no assistance is required. At times supervision is required for safety due to morning stiffness, shortness of breath etc.

10 The patient is able to go up and down a flight of stairs safely without help or supervision. The patient is able to use hand rails, cane or crutches when needed and is able to carry these devices as he/she ascends or descends.

T OILET TRANSFER 0 Fully dependent is toileting2 Assistance required in all aspects of toileting5 Assistance may be required with management of

clothing, transferring, or washing hands.8. Supervision may be required for safety with normal

toilet. A commode may be used at night but assistance is required for emptying and cleaning.

10 The patient is able to get on/off the toilet, fasten clothing and use toilet paper without help/ If necessary may use a bed pan or commode or urinal at night but must be able to empty it and clean it.

BOWEL CONTROL 0 The patient is bowel incontinent.2 The patient needs help to assume appropriate

position, and with bowel movemebt facilitatory techniques.

5 The patient can assume appropriate position, but cannot use facilitatory techniques or clean self without assistance and has frequent accidents. Assistance is required with incontinence aids such as pad, etc.

8 The patient may require supervision with the use of suppository or enema and has occasional accidents.

10 The patient can control bowels and has no accidents, can use suppository, or take an enema when necessary.


INDEX ITEM SCORE DESCRIPTIONBLADDER CONTROL 0 The patient is dependent in bladder management, is

incontinent, or has indwelling catheter2 The patient is incontinent but is able to assist with

the application of an internal or external device.5 The patient is generally dry by day, but not at night

and needs some assistance with the devices.8 The patient is generally dry by day and night, but

may have an occasional accident or need minimal assistance with internal or external devices.

10 The patient is able to control bladder day and night, and/or is independent with internal or external devices.

BATHING 0 Total dependance in bathing self1 Assistance is required in all aspects of bathing, but

patient is able to make some contribution3 Assistance is required with either transfer to

shower/bath or with washing or drying, including inability to complete a task because of condition or disease, etc.

4 Supervision is required for safety in adjusting the water temperature, or in the transfer.

5 The patient may use a bathtub, a shower, or take a complete sponge bath. The patient must be able to do all the steps of whichever method is employed without another person being present.

DRESSING 0 The patient is dependent in all aspects of dressing and is unable to participate in the activity

2 The patient is able to participate to some degree, but is dependent in all aspects of dressing.

5 Assistance is needed in putting on, and or removing any clothing.

8 Only minimal assistance is required with fastening clothing such as buttons, zips, bra, shoes, etc.

10 The patient is able to put on, remove corset, braces, as prescribed.

PERSONAL HYGIENE (Grooming)

0 The patient is unable to attend to personal hygiene and is dependent in all aspects

1 Assistance is required in all steps of personal hygiene, but patient able to make some contribution.

3 Some assistance is required in one or more steps of personal hygiene.

4 Patient is able to conduct his/her own personal hygiene but requires minimal assistance before and/or after the operation.

5 The patient can wash his/her hands and face, comb hair, clean teeth and shave. A male patient may use any kind of razor but must insert the blade, or plug in the razor without help, as well as retrieve i from the drawer or cabinet. A female patient must apply her own make-up , if used, but need not braid or style


INDEX ITEM SCORE DESCRIPTIONher hair.

FEEDING 0 Dependent in all aspects and needs to be fed, nasogastric needs to be administered.

2 Can manipulate an eating device, usually a spoon, but someone must provide active assistance during the meal

5 Able to feed self with supervision. Assistance is required with associate tasks such as putting milk/sugar into tea, salt, pepper, spreading butter, turning a plate or other “set up” activities.

8 Independence in feeding with prepared tray, exvept may need cut, milk cartoon opened or jar lid etc. The presence of another person is not required.

10 The patient can feed self from a tray or table when someone puts the food within reach. The patient must put on an assistive device if needed, cut food, and if desire use salt and pepper, spread butter, etc.


LAMPIRAN VI

BORANG SALINAN DASS (SOAL SELIDIK DASS)

Langkah 1 : Sila baca dan tuliskan skor yang bersesuaian dengan anda.

BAHAGIAN 1

Sila baca setiap kenyataan dan tuliskan skor mengikut skala yang mengambarkan keadaan anda SEMINGGU YANG LEPAS. Tidak ada jawapan betul dan salah. JANGAN guna terlalu banyak masa untuk mana-mana kenyataan.0 = Tidak pernah sama sekali 1 = Jarang 2 = Kerap 3= Sangat Kerap

S Tidak Pernah

Jarang Kerap SangatKerap

1. Saya rasa susah untuk bertenang

2. Saya sedar mulut saya rasa kering

3. Saya seolah-olah tidak dapat mengalami perasaan positif sama sekali

4. Saya mengalami kesukaran bernafas (contohnya, bernafas terlalu cepat, tercungap-cungap walaupun tidak melakukan ativiti fizikal

5. Saya rasa tidak bersemangat untuk memulakan sesuatu keadaan

6. Saya cenderung bertindak secara berlebihan kepada sesuatu keadaan

7. Saya pernah menggeletar (contoh tangan)

8. Saya rasa terlalu gelisah

9. Saya risau akan berlaku keadaan yang menyebabkan saya panik dan berkelakuan bodoh

10. Saya rasa tidak ada harapan (Putus harapan)

11. Saya dapati saya mudah resah

12. Saya berasa sukar untuk relaks

13. Saya rasa muram dan sedih

14. Saya tidak boleh menerima apa jua yang menghalangi saya daripada meneruskan apa yang saya sedang lakukan

15. Saya rasa hampir panik

16. Saya tidak bersemangat langsung

17. Saya rasa diri saya tidak berharga

18. Saya mudah tersinggung


19 Walaupun saya tidak melakukan aktiviti fizikal, saya sedar akan debaran jantung saya (contoh degupan jantung lebih cepat

20 Saya rasa takut tanpa sebab

21 Saya rasa hidup ini tidak bererti lagi

Langkah 2 : Masukkan skala markah jawapan ke dalam ruangan kosong di Bahagian 2, mengikut soalan (S) bagi setiap kategori (Stres, Anxieti dan Kemurungan).

BAHAGIAN 2

Panduan Mengira Skor :-Masukkan skala markah jawapan bagi soalan (S) bagi setiap kategori.

TEKANAN (STRESS)SOALAN S1 S6 S8 S11 S12 S14 S18 JUMLAHMARKAH

KEBIMBANGAN (ANXIETY)SOALAN S2 S4 S7 S9 S15 S19 S20 JUMLAHMARKAH

KEMURUNGAN (DEPRESSION)SOALAN S3 S5 S10 S13 S16 S17 21 JUMLAHMARKAH

Langkah 3 : Jumlahkan skala markah bagi setiap kategori bagi mengetahui tahap status kesihatan mental anda.

Rujuk petak skor saringan dan terjemahkan jumlah skor untuk mengetahui tahap status kesihatan mental anda.

SKOR SARINGANKEMURUNGAN(DEPRESSION)

KEBIMBANGAN(ANXIETY)

TEKANAN(STRES)

NORMAL 0 – 5 0 - 4 0 - 7RINGAN 6 - 7 5 - 6 8 - 9SEDERHANA 8 - 10 7 - 8 10 - 13TERUK 11 - 14 9 - 10 14 - 17SANGAT TERUK 15 + 11 + 18 +

Langkah 4 : Sila isikan keputusan dalam bahagian 3 dan isikan dalam borang Keputusan Saringan Minda Sihat


BAHAGIAN 3

Isikan tahap kesihatan mental ( normal, ringan, sederhana, teruk, atau sangat teruk)ke dalam jadual.

KEPUTUSAN UJIAN DASS

UJIAN TAHAPTEKANAN (STRESS)

KEBIMBANGAN (ANXIETY)KEMURUNGAN (DEPRESSION)

Interpretasi

Normal : Kehidupan yang selesa Ringan : sihatSederhana : Cari Pengetahuan mengenai pengurusan kesihatan mentalTeruk : (Berjumpa dan berbincang dengan kaunselor untuk mengurus

kesihatan mental dengan lebih positif)Sangat teruk : (Berjumpa dan berbincang dengan kaunselor dan merujuk kepada

psikiatris jika perlu)


LAMPIRAN VII

PPD 004(a)/2014

NO. PENDAFTARAN

MY KID NO./ NO. K/P:

REKOD PELANGGAN / PESAKIT PERAWATAN DOMISILIARI

NAMA PESAKIT

NO KAD PENGENALAN PESAKIT

NAMA PENJAGA

NO KAD PENGENALAN PENJAGA

NO TEL.1.Telefon Bimbit:

2.Rumah:

ALAMAT SEMASA MENJALANKAN RAWATAN


REKOD TAHAP KESIHATAN SEMASA PERAWATAN DI RUMAH (Simpanan Penjaga)

Tarikh B/P Nadi Suhu Kadar Pernafasan

RBS/FBS Masalah/Catatan Nama

anggotaTanda tangan

Tarikh Temujanji

17

LAMPIRAN VII

PPD 004(b)/2014

REKOD PENILAIAN KES PERHIDMATAN PERAWATAN DOMISILIARI

(SIMPANAN KLINIK KESIHATAN)

1. BIODATA PELANGGAN

NAMA :

………………………………………………………...

PENJAGA / WARIS(Potong yang tidak berkenaan)

Nama:

…………………………………………………Kad Pengenalan:

Pendidikan: Rendah Menengah Tinggi Pekerjaan: ………………………………………………….

Hubungan dengan pesakit : ..........................

Pendapatan Keluarga Sebulan: RM ….……

JANTINA : Lelaki Perempuan

Pekerjaan : ………………………………………….

KUMPULAN ETNIK Melayu China IndiaKadazan/Dusun

Murut Bajau

Melanau Iban BidayuhOrang Asli Lain -lain

kumpulan etnikLainPribumiSabah/ Sarawak

18

TARIKH LAHIR:

NO. MY KID/ NO. KAD PENGENALAN:

TARAF PERKAHWINAN:

Bujang Kahwin Janda Duda

No Telefon

Rumah:

Pejabat:

Tel. Bimbit:

Maklumat Tempat TinggalAlamat semasa rawatan:

……………………………………………………………………………………...

……………………………………………………………………………………...

Keadaan rumah dan persekitaran : sesuai kurang sesuai tidak sesuai

Jarak tempat tinggal ke Klinik Kesihatan : km

Jenis Pengangkutan : Sendiri Awam

Poskod

2. SEJARAH PERUBATAN

Bil. Diagnosa Tahun Diagnosa

Hari BulanB u l a n

TahunT a h u n

-

--

-

19

2.1. UBAT-UBATAN SEMASA :

2.2. SEJARAH ALAHAN KEPADA UBAT-UBAT :

3. PENILAIAN AWAL PESAKIT : Tandakan ( ) di ruangan yang berkenaan

3.1. Penilaian Fisikal Normal Tidak Normal Catatan

Tahap Kesedaran

20

Kesihatan Oral

Keadaan Kulit

Penglihatan

Pendengaran

Komunikasi(Cara-cara utama berkomunikasi dengan keluarga)

Tanda kotak yang

berkenaanCatatan

Pertuturan

Tulisan

Menggunakan Isyarat

Tidak berkomunikasi

Status Pemakanan Ya Tidak Catatan

Ada Selera makan

21

Kebolehan mengunyah

Kebolehan menelan

Tanda-tanda KZMJika ada, nyatakan ...............................

..............................................................

Penilaian Sosial & Psikologikal Catatan

Baik Tidak Baik

a) Hubungan dan sokongan keluarga

22

b) Masalah tingkahlaku Ya Tidak

Normal

Ganas (aggressive)

Pelupa (forgetful)

Keliru (confused)

Murung (depression)

Resah (restless)

Pemeriksaan Catatan

Tekanan darah

Nadi

Kadar Pernafasan

Suhu

FBS/RBS

Skor Penilaian Modified Barthel Index:(Rujuk Lampiran V)

Nama & Cop Paramedik yang membuat penilaian :

Tandatangan :

Tarikh :

23

4. SENARAI MASALAH DAN RANCANGAN PENGENDALIAN PELANGGAN (NURSING PROBLEMS)

Nama Pelanggan :................................................................

No K/P :................................................................

Bil. Tarikh Masalah Aktiviti Yang DirancangTarikh Diatasi Catatan

Nama & Tanda tangan

24

5. RANCANGAN PENGENDALIAN PELANGGAN (PERLAKSANAAN)

Nama Pelanggan :................................................................

No K/P :..............................................................

Tarikh Tanda Vital Penilaian Perlaksanaan Perawatan Tandatangan

B/P:PR:RR:Temp:RBS:Pain Score 0-10:

25

Tarikh discaj dari PPD :

Penilaian sebelum discaj :

Skor Penilaian Modified Barthel Index:( Rujuk Lampiran V)

Langkah-langkah / pengendalian yang perlu seterusnya :

Nama & Cop Paramedik : Tandatangan :

6. PELAN DISCAJ

26

LAMPIRAN IX

BORANG PERMOHONAN PENDAFTARAN ORANG KURANG UPAYA(RUJUK PDF)

27

LAMPIRAN IX

SURAT AKTA FI (Rujuk PDF)

28

LAMPIRAN X

SURAT AKTA FI (RUJUK PDF)

29

LAMPIRAN XI

BAHAGIAN PEMBANGUNAN KESIHATAN KELUARGAKEMENTERIAN KESIHATAN MALAYSIA

KURSUS PENJAGAAN PERAWATAN DOMISILIARI

BUKU LOG

NAMA STAF

JAWATAN

TEMPAT BERTUGAS

TEMPAT LATIH AMAL (HOSPITAL)

TARIKH MULA LATIHAN

30

TANGGUNGJAWAB STAF :Anda Harus

1. Merancang pengalaman klinikal anda sendiri untuk memperolehi kemahiran di hospital yang berdekatan

2. Melengkapkan catatan dengan kemas serta di tandatangani oleh Pegawai Penyelia

3. Merekodkan kes-kes yang diuruskan sahaja

SENARAI PENGALAMAN KLINIKAL

1. MEMASUKKAN RYLE’S TUBE KEPADA PESAKIT

Bil. Tarikh Nama No. K/P Penyelia

1 Nama TT

31


1. MENJALANKAN GASTROSTOMY FEEDING KEPADA PESAKIT


1 Nama TT


1. JAGAAN TRACHEOSTOMY WOUND


1 Nama TT

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garis panduan perkhidmatan perawatan domisiliari di kesihatan

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