FORMAT PENILAIAN PROSEDUR
TINDAKAN KEPERAWATAN
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Unit
Kompetensi : Scrub Tindakan Laparotomi Eksplorasi |
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Nama
Perawat : |
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NIP : |
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Tempat
Tugas : |
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No |
Tindakan |
Penilaian |
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Ya |
Tidak |
Skor |
Catatan |
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A |
PREOPERATIVE |
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1 |
Melakukan serah terima pasien |
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2 |
Melakukan prosedur Surgical
safety cheklist (Sign In) |
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3 |
Menyiapkan
Peralatan Medik |
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Surgical light/lampu operasi |
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Meja mayo, meja instrumen, meja operasi |
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Eletro Surgical Unit (ESU) &elektroda |
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Mesin suction+ botol |
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Oksigen sentral dan vacum sentral |
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Mesin anastesi dan obat-obatan |
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Pasien monitor |
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Standar infus |
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Tempat sampah infeksi dan non
infeksi |
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Box untuk benda tajam |
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4 |
Menyiapkan Alat Instrumen |
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Sponge holder
1 buah |
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Towel
clamp 4
buah |
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Nierbekken 1 buah |
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Kom 3
buah |
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Scalpel 1 buah |
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Arteri clamp 4 buah |
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Strong clamp 6 buah |
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Allis clamp 2 buah |
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Kocher clamp 4 buah |
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Klem usus 2
buah |
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Gunting jaringan
1 buah |
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Gunting benang
1 buah |
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Needle holder
2 buah |
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Pinset
chirurgis 2 buah |
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Pinset
anatomis 2 buah |
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Spatel abdomen |
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S.haak |
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Hak otomatis |
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Canule suction |
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5 |
Menyiapkan
Set Linen Steril |
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Jas operasi/gaun : 4
buah |
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Duk kecil : 4 buah |
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Duk besar : 2 buah |
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Duk lubang : 1buah |
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6 |
Menyiapkan Bahan Habis Pakai
(BHP) |
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Sarung tangan
steril |
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Kasa steril |
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Kasa besar |
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Benang absorbable (3/0,2/0,0,1,2) |
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Benang non
absorbable (silk 1 & nilon 3/0) |
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Blade |
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Spoit 50 cc |
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NGT (untuk
drain) |
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Underpad |
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Suction
conector |
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Couter pencil |
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Betadine |
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Alkohol |
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7 |
Mengatur
posisi pasien |
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8 |
Mengatur
tegangan dan memasang elektroda ESU |
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B |
INTRA OPERATIVE |
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9 |
Melakukan prosedur cuci tangan bedah |
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10 |
Gowning dan gloving sesuai prosedur |
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11 |
Menata alat instrumen di atas meja mayo |
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12 |
Melakukan asepsis daerah operasi |
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13 |
Melakukan prosedur drapping |
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14 |
Menyambung hand switch couter dan selang suction pada
ESU dan mesin suction |
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15 |
Melakukan prosedur Surgical
safety cheklist (Time Out) |
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16 |
Melaksanakan instrumentasi (scrub) sesuai prosedur
operasi |
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17 |
Menghitung kembali kasa, jarum dan alat instrumen yang
telah digunakan |
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18 |
Melakukan prosedur Surgical
safety cheklist (Sign Out) |
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C |
POST OPERATIVE |
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19 |
Melakukan dressing pada luka operasi |
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20 |
Memberi kemasan dan label pada spesimen jaringan (jika
ada) |
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21 |
Membersihkan/merapikan klien |
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22 |
Mengganti alat tenun |
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23 |
Merapikan alat dan mengembalikan ke tempat semula |
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24 |
Melakukan pemrosesan alat |
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25 |
Melakukan dokumentasi |
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Evaluasi
diri : |
(paraf
& nama) |
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Evaluasi
Kayan : |
(paraf
& nama) |
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Rekomendasi
(Kayan ) : |
Tanda tangan & Nama Jelas |
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