DPCR Target
DPCR Target
DPCR Target
I, IMELDA L. BIYOYO, RN,Nurse II/Supervising Nurse of Malimono District Hospital, commits to deliver and agree to be rated on the attainment of the following target in
accordance with the indicated measures for the period July to December, 2017.
IMELDA L. BIYOYO, RN
Nurse II/Supervising Nurse
Date:
Reviewed by: Date: Approved By: Date:
5-Outstanding R
4-Very Satisfactory A
3-Satisfactory T
2-Unsatisfactory I
1-Poor N
G
Rating
DIVISION/
SUCCESS INDICATOR Alloted INDIVIDUAL Q1 E2 T3 A4
PPA/MFO /OUTPUTS ACTUAL ACCOMPLISHMENT Remarks
(MEASURES + TARGETS) Budget ACCOUNTABLE
PERSON
I. F.
Orias
Output 2 200 ambulatory patients treated during Php 500.00 I. L. Biyoyo
non office hours with complete data M. B.
Emergency Room Registration Book information including disposition and
(Non-Emergency Patient) intervention like minor operation assisted, Mula
dressing and etc. within the rating period. A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Output 3 10 attended/treated OB-Gyne patients Php 250.00 Orias
I. L. Biyoyo
with complete data informations including C. Q. M. B.
BEMONC interventions and treatment given based
Emergency Logbook on the Hospital Policies and Procedures Macaranas
Mula
within the rating period. C. O.
A. M. Datso
Botardo
L. A.
J. V. Lumancas
Ga E.
R. Senados
I. F.
MFO 2: OUTPATIENT DEPARTMENT SERVICES Orias
Output 1 800 filled up ITRs with complete Php 3,500.00 I.C.
L. Q.
Biyoyo
demographic and baseline data, including Macaranas M. B.
Individual Treatment nursing assessment based on the policies
Mula C. O.
Record and procedures done within the rating A. M. Datso
period. Botardo
L. J.
A.V.
Lumancas
Ga
E. R.
Senados
I. F. Orias
C. Q.
Macaranas
C. O.
Output 2 20 Patients given with Tetanus Prophylaxis Php 30.00 I. L. Biyoyo
Botardo
Tetanus Prophylaxis Registration per Doctor's order with complete data L. A.M.
GaB.
information based on Hospital Policies and Mula
Logbook Procedures A. S.
Boc A. M. Datso
V. P. Llamera
J. V. Lumancas
E.
R. Senados
Output 3 1000 ambulatory patients recorded in Php 1,000 J. V. Lumancas
OPD Registration Book (Pedia, the logbook according to their
classification within the rating period.
Medical, OB-Gyne, Surgical) Eye Care
Patients
Output 4 2 confirmed or suspected TB patients with Php 50.00 J. V. Lumancas
TB Case Registration Book complete and correct information referred
to RHU TB DOTS.
I. F.
Orias
C. Q.
Macaranas
Output 3 200 admitted patients duly recorded with Php I. L. Biyoyo
complete data in the Admission 1000.00 M. B.
Admission Registration Book based on the Hospital
Registration Book policies and procedures within rating Mula
period. A. M. Datso
J. V. Lumancas
E.
R. Senados
J. V. Lumancas
E.
R. Senados
I. F.
Output 2 20 of recorded mothers and newborn Orias
Php 60.00 I. L. Biyoyo
information after delivery which includes C. Q. M. B.
Parturation Form interventions provided based on Hospital
Policies and Procedures. Macaranas
Mula
C. O.
A. M. Datso
Botardo
L. A.
J. V. Lumancas
Output 3 20 of recorded newborn given with hepa-B Php 30.00 I.
GaL. Biyoyo E.
vaccine within 24 hours after birth based
Hepa-B on DOH memo. R. SenadosM. B.
Logbook Mula
A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Orias
C. Q.
Macaranas
Output 4 20 deliveries recorded with complete data Php 30.00 I. L. Biyoyo
based on the Nursing policies and M. B.
Delivery procedures within the rating period.
Logbook (Maternal Mula
and Newborn) A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Output 5 20 newborns taken with blood samples Php M. B. Mula
24-72hrs. for screening After birth in Orias
Newborn Screening Samples/Slips 11,000.00 V.
C.Lumancas
Q.
accordance to NBS Central policies and
Procedures within the rating period. MacaranasE. R.
Senados C. O.
Botardo
Output 6 20 NBS report submitted Free Mailing M. B. MulaL. A.
quarterly/annually with complete data
Newborn Screening Report information based on NBS Central Policies Ga
and Procedures within the rating period.
J. V. Lumancas
E.
R. Senados
I. F.
Orias
C. Q.
Macaranas
C. O.
Output 2 200 informed consent obtained from Php350.00 I. L. Biyoyo
Informed Consent patients prior to initiation of care. M. B.
Mula
A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Output 3 200 patients vital signs checked and Orias
Php 350.00 I. L. Biyoyo
recorded within the rating period. C. Q. M. B.
Vital Signs/Temperature Pulse
Respiration (TPR) Sheet Macaranas
Mula
C. O.
A. M. Datso
Botardo
L. A.
J. V. Lumancas
Ga E.
R. Senados
I. F.
Output 4 200 patient's fluid intake and output Php 350.00 I. L. Biyoyo
monitored within the rating period. Orias
Intake and Output Sheet C. Q. M. B.
Mula
Macaranas
A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados
I. F.
Output 5 30 referral forms duly filled-up within the Php 50.00 I. L. Biyoyo
rating period. Orias
Referral Forms C. Q. M. B.
Mula
Macaranas
A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados
I. F.
Orias
C. Q.
Output 6 200 discharge instruction sheet given to Php 50.00 I. L. Biyoyo
patients/watchers for proper M. B.
Discharge Instruction Sheet instruction/health teaching within the
rating period. Mula
A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Output 7 200 discharge slips prepared for outgoing Php 50.00 I. L. Biyoyo
patients within the rating period Orias
Discharge Slip C. Q. M. B.
Mula
Macaranas
A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados
I. F.
200 Kardexes of patients updated per shift Php 50.00 Orias
Output 8 I. L. Biyoyo
C. Q.
within the rating period M. B.
Kardex Macaranas
Mula
C. O.
A. M. Datso
Botardo
L. A.
J. V. Lumancas
Ga
E.
R. Senados
I. F.
Output 9 400 Diagnostic exams requested for Php 100.00 I. L. Biyoyo
patients submitted, and charged based on Orias
Diagnostic Tests Request C. Q. M. B.
the attending Physicians order within the
rating period. Mula
Macaranas
A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados
I. F.
Orias
Ouput 10 prescription/supply requisition Php I. L. Biyoyo
encoded, submitted, and charged M. B.
Medication and Supply requests/ prescriptions within the rating
Requisition/Prescription period Mula
A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
600 administered medications Orias
Output 11 I.C.
L. Q.
Biyoyo
intravenously or orally to admitted patients
Medication Administration prepared within the rating period Macaranas M. B.
Mula C. O.
A.
Botardo M. Datso
L. A.
J.
GaV. Lumancas
E.
R. Senados
Output 12 200 patient inserted with Intravenous Php 350.00 I. L. Biyoyo
Fluid and documented within the rating
Intravenous Fluid Sheet period I.M.
F. B.
Mula
Orias
A. M. Datso
C. Q.
Macaranas
J. V. Lumancas
Output 13 400 Nurse's Notes accomplished by the Php 800.00 I. L. Biyoyo E.
Nurses Notes actual number of patients per shift R. SenadosM. B.
within the rating period. Mula
A. M. Datso
J. V. Lumancas
E.
R. Senados
Output 14 400 Doctor's orders carried out and duly Php 800.00 I. L. Biyoyo
recorded within the rating period
Carried out Doctor's Order I.M.
F. B.
Mula
Orias
A. M. Datso
C. Q.
Macaranas
J. V. Lumancas
E.
R. Senados
I. F.
MFO 6: OTHER RECORDS/SUPPORTING DOCUMENTS
Output 1 600 recorded list of therapeutic/routine Php150.00 I. L. Biyoyo
Diet list diet patients as prescribed by the physician M. B.
facilatated to dietary sectionwithin the
rating period. Mula
A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Output 2 20 referral forms issued containing Php30.00 I. L. Biyoyo
Orias
Referral Forms accurate data of patients referred to higher M. B.
facility based on the instruction of the C. Q.
Attending Physician within the rating Mula
Macaranas
period. A. M. Datso
C. O.
Botardo
J. V. Lumancas
L. A.
Ga E.
R. Senados
I. F.
Output 3 Master 200 listed patients catered in the facility Php100.00 J. V.
Orias Lumancas
Patients Index (MPI) with complete profile data carefully
indexed per Hospital Policies. C. Q. I. L.
Biyoyo
Macaranas
M. B.C.Mula
O.
Botardo
A. M. Datso
L. A.
Ga E. R.
3 death (ER, WARD,DOA Cases) recorded Senados
Output 4 Php 100.00 J. V. Lumancas
Other in the Logbook with correct and complete I. L.
information based on Hospital Policies.
Logbooks (Death Registration Book) Biyoyo
M. B. Mula
Ouput 5 1 patients recorded with allergic reaction Php 50.00 J. V. Lumancas `
Drug Allergy Registration Book after taking prescribed meds by the
Physician on duty in the facility within the
rating period.
A. M. Datso
E. R.
Senados
MFO 7: SUPERVISORY SERVICES
Output 1 500 endorsement recorded in the Php500.00 I. L. Biyoyo
I. F. Orias
Nursing logbook, for continuity of supervision by M.C.B.
the next shift based on the Nursing
Endorsement Logbook policies and procedures within the rating Mula
Q. Macaranas
period. A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Output 2 1 Approved policy(s) by the Chief of Orias
I. L. Biyoyo
Nursing Policy and Standards Hospital for compliance of department's C. Q.
operation's flow acted and implemented Macaranas
(to include Policy per area) within the rating period. C. O.
Botardo
L. A. Ga
Output 3 50 rounds conducted to different areas Php500.00 I. L. Biyoyo
Daily Rounds Logbook and checked equal staffing, census, M. B.
cleanliness and attended the issues and
concern based on the Hospital standard Mula
requirement within the rating period. A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Orias
C. Q.
Output 4 1 manual accomplished submitted for Php30.00 I. L. Biyoyo
Macaranas
Nursing Work Instruction Manual corrections and revisions within the rating
period. C. O.
Botardo
L. A. Ga
MFO 8: TRAININGS/ORIENTATION AND SEMINARS
Output 1 5 certificates obtained/filed in every I. L. Biyoyo
employee who attended seminars and M. B.
Certificate of trainings per memo order of requesting
attendance/appearance of trainings agency. Mula
and seminars A. M. Datso
J. V. Lumancas
MFO 9: RECORDS/REPORTORIAL AND COMMUNICATION SERVICES E.
Output 1 8 announcements, scheduled activities Php50.00 R. L.
I. Senados
Biyoyo
received by the office, posted for M. B. Mula
information and attendance of the same
Documents/reports / announcements by the conduct of such activities within A. M.
posted the rating period. Datso
J. V.
Lumancas
Output 2 10 meetings attended instructed by the Php50.00 I. L. Biyoyo
Chief of Hospital within the rating period. M. B.
Attendance to
meetings Mula
A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Output 3 8 approved accomplishment report Php50.00 Orias
I. L. Biyoyo
submitted to the requesting office C. Q.J. V.
Validated concerned within seven (7) working days Macaranas
Lumancas M.
Accomplishment Report / Soft and upon receipt of the letter/memo sent by
hard copies of official documents the requesting office. B. MulaC. O.
Botardo
L. A. Ga
Output 4 200 listed philhealth and non-philhealth Php50.00 I. L. Biyoyo
patients admitted/discharged daily ended
Monthly Mandatory Report at midnight per philhealth memo.
J. V. Lumancas
E.
R. Senados
Output 2 20 approved birth certificates recorded Php100.00 I. L. Biyoyo
and released to requesting patients within
Birth Certificate logbook the rating period. I.M.
F. B.
Mula
Orias
A. M. Datso
C. Q.
Macaranas
J. V. Lumancas
E.
R. Senados
I. F.
Output 3 5 approved medico-legal certificates Php50.00 I. L. Biyoyo
recorded and released to requesting Orias
Medico-Legal Certificate logbook C. Q. M. B.
patients within the rating period.
Mula
Macaranas
A. M. Datso
J. V. Lumancas
E.
R. Senados
A. M. Datso
E. R.
Senados
T. P.
Output 2 300 patients charts filed and organized Php I. L. Biyoyo
Senados
chronologically according to hospital 10,000.00
Patients Admission Chart policies within the rating period. I. F. M. B.
Orias
Mula C.
A. M. Datso
Q. Macaranas
J. V. Lumancas
E.
R. Senados
I. F.
Orias
C. Q.
Macaranas
C. O.
Botardo
L. A.
Ga
Output 3 1,000 medication tickets prepared, made Php200.00 I. L. Biyoyo
ready for use and distributed accordingly M. B.
Medication within the rating period.
Tickets(different colors) Mula
A. M. Datso
J. V. Lumancas
E.
R. Senados
I. F.
Output 4 200 of times autoclaving of instruments Php500.00 Orias
C. O. Botardo
conducted and always ready for use within L.C.A.Q.
Ga
Autoclaved the rating period.
Instruments Macaranas
200 sterilized and packed intruments/sets, C. O.
Output 5 M. B. Mula
conducted and always available and ready Botardo
Sterilized Packs A. M.
for use within the rating period. L. A.
and Sets, and Repacked OS, IE gloves, Datso
Ga
cotton and cherry balls and many others J. V.
Lumancas
E. R.
Senados
I. F. Orias
MFO 4: PHARMACY SERVICES C.
300 prescriptions dispensed and recorded Php50.00 Q. Macaranas
Output 1 M. B. Mula
C.
to in- and out-patients within the rating A. M.
Prescription Logbook period. O. Botardo
Datso
L.
J. V.
A. Ga
Lumancas
E. R.
Senados
I. F. Orias
C.
Output 2 50 prescriptions recorded and filed based Php50.00 A.
on daily tally sheet within 2 hours per Q. M Datso
Macaranas
Daily Stock Card/Tally Sheet week within the rating period. C.
O. Botardo
L.
A. Ga
Output 4 1 of transactions in monitoring inventory Php50.00 A. M Datso
of drugs and medicines based on
Inventory Logbook Pharmacy policies within the rating period.
A. M. Datso
E. R.
Senados
C. O.
Botardo
I. F. Orias
C.
MFO 6: HUMAN RESOURCE MANAGEMENT SERVICES
Output 1 1 Approved Citizens Charter implemented Php I. L. Biyoyo
and posted in ER, WARD and OPD sections
in compliance to RA 9485, the Anti Red
Citizens Charter Prepared and Posted Tape Act of 2007 within the rating period.
J. V. Lumancas
E.
R. Senados
I. F.
Output 6 1 Completed/Updated the worksforce of Php100.00 I. L. Biyoyo
Orias
Office Organizaional Structure in M.C.B.Q.Mula
Nursing compliance to the Department of Health
Organizational Structure licensing requirements within the rating J. V. Lumancas
Macaranas
period. C. O.
Botardo
L. A. Ga
Output 7 1 Success indicators/Performance Php50.00 I. L. Biyoyo
measures prepared, based on the
Table CSC/PGSDN/SPMS standards and
of Success Indicators submitted to the PHRMDO for review
within the rating period.
J. V. Lumancas
E.
R. Senados
I. F.
Orias
MFO 7: RECORDS MANAGEMENT AND COMMUNICATION/REPORTORIAL SERVICES C. Q.
Output 1 200 clients Satisfactory Form given and Php. 400.00 Macaranas
I. L. Biyoyo
collected to patient/significant others C. O.M. B.
Consolidated Patient's Survey before discharge within the rating period Botardo
Mula
per hospital policies.
L. A.
A. Ga
M. Datso
J. V. Lumancas
E.
R. Senados
C. O.
Output 2 20 Birth Certificate encoded and verified Php Botardo
M. Mula, RN,
PHILCRIS (Birth Cert. System) for registration at LCR within the rating L. A.MAN
MSN, Ga
period I.F.Orias
C.Q.Macaranas
Output 3 Number patients diseases registered Php A. Datso, RN
Philhealth Claims Case Rates according to Philhealth case rates
withing the rating period.
Output 2 10 types of diseases coded based I. L. Biyoyo
Diseases Coded on rules/guidelines on ICD-10
coding of specific conditions within
the rating period.
J. V. Lumancas
E.
R. Senados
Output 5 20 conducted/facilitated ward lecture to Php300.00 I. L. Biyoyo
patients and watchers the effect of their
Ward lifestyle and the probable remedies that I. M.
F. B.
Audience Lecture Logbook could be used in their home treatment Mula
Orias
recorded within the rating period. A. M. Datso
C. Q.
Macaranas
J. V. Lumancas
E.
R. Senados
Final Average Rating
I. F.
Adjectival Rating Orias
C. Q.
Macaranas
Comments and Recommendation for Development Purposes
Assessed By:
Discussed with Date I certify that I Date Final Rating By: Date
assessed he targets of the
performance with the employee.