Republic of the Philippines

Department of Health
DR. JOSE RIZAL MEMORIAL HOSPITAL
Dapitan City

Appendix K
Nursing Service Bi-Annual Report Form

NURSING SERVICE MONTHLY REPORT FORM

Region/Province:
Region IX

Name of Hospital:
Dr. Jose Rizal Memorial Hospital

Date Accomplished:
January 26, 2018

Address:
Lawaan, Dapitan City

Bed Capacity: Implementing Bed Capacity - 75 Bed Occupancy (%): 100%

Authorized Bed Capacity - 200

 NURSING PERSONNEL
CATEGORY AUTHORIZED ACTUAL
Chief Nurse 1
Asst. Chief Nurse 1
Supervisor 7
Senior Nurse 33
OR Nurse 9
Staff Nurse 51
Nursing Attendant 38
Ward Clerk x
Others, Specify x

TOTAL

 PERSONAL RECORD: (For last month)

o Attendance Number of Number of
1.1 Absence without leave - -
1.2 Vacation leave 701
1.3 Sick leave 636
1.4 Maternity leave 568
TOTAL 1,905

o Resignation and Hiring of Nurses

2.1 Number of Nurses who resigned last month 2
2.2 Number of Nurses who were hired last month 27

o Resignation and Hiring of Nursing Attendants

2.1 Number of Nursing Attendants who resigned last month -
2.2 Number of Nursing Attendants who were hired last month -
 o Number of Nursing Personnel who attended continuing education programs
(in-service or outside) 120

TOPICS DATE NO. OF HOURS

Training for Animal Bite Treatment Center July 4-6, 2017 24
for Managers
Anti-smoking Symposium July 27, 2017 8
Basic Life Support, First Aid and Rescue July 17-19, 2017 24
Training
Winning the War on Diabetes July 31, 2017 8
Annual Consultation Meeting for Disease August 8-11, 2017 32
Surveillance Coordinator in Zamboanga
Peninsula
Emergency Medical Technician and August 21-25, 2017 40
Training of Trainers (EMT-TOT)
Basic Life Support, First Aid and Rescue August 16-18, 2017 24
Training
Smoking Status Assessment and August 30, 2017 8
Counseling Seminar
Basic Training Course in Hospital Infection August 24-25, 2017 16
Control
VFD Advocacy for Disease Surveillance August 30-31, 2017 16
Coordinator
Regional Coordinating Committee Meeting August 23-24, 2017 16
Competency Development in Hemodialysis August 29-December
18, 2017
3rd Quarter Regional Coordinating September 14, 2017 8
Committee
Family Planning on Hospital Operational September 20-22, 24
Guide for Recording and Reporting 2017
Gender Sensitivity Training September 14-15, 16
2017
6-day Basic Course Training on Integrated September 19-24, 54
Management Childhood Illness (IMCI) 2017
5 day Training of Trainer on Integrated September 25-29, 45
Management Childhood Illness (IMCI) 2017
Public Health Surveillance Systems for the September 27-29, 24
New Disease Surveillance Coordinators in 2017
Region IX
Annual Newborn Screening Convention October 3-4, 2017 16
One-day Live-Out Area Based Updates on October 18, 2017 8
the Current Issuances on Regulations for
Hospitals
Consultative Meeting October 25, 2017 8
BLS-CPR and First Aid Training October 10, 2017 8
Wheelchair Service Training Package: Basic November 13-17, 40
Level Program 2018
Live-in Cascade on the Rules on November 13-15, 24
Administrative Cases in the Civil Service 2018
(RACCS)
5-Day Training on Trauma Nursing November 13-17, 40
2018
ZN TB Summit December 5 & 6, 16
2017
 Review and Update of the EMT-B Course December 8-16, 2017 72
Module and Instructor’s Meeting and
Emergency Medical Technician Basic (EMT-
B) Training Course
EMT-B Training (TOT) Course December 10-16, 63
2017
2017 Caring of Carers and Recognition of December 13-14, 16
Mobilized Health Emergency Response 2017
Teams with the “One Nation One
Response”

 EQUIPMENT AND SUPPLIES

1. Are there new equipment used by nursing personnel? YES NO

LIST OF MEDICAL EQUIPMENT

January to June 2017
Brand Name & Model Quantity Date of Purchase
1. Defibrillator (D-100) 1 October 6, 2017

Do they know how to operate these? Yes. The end users were provided with trainings with certificates
on the use/operation of the equipment conducted by the
respective suppliers before installation/turn-over of the
equipment.

2. Do you have adequate budget for the following supplies per month:
YES NO
Medical
Housekeeping
Office
Others, please specify N/A N/A

 REPORTS
1. What were the reports by the nurses last month?

Name of Report Who prepared the Report Frequency Submitted to

Medical/Surgical Supplies
Sheena Fae P. Adasa (CSR) Monthly Accounting Section
Monthly Consumption Report
Medical Oxygen Monthly
Sheena Fae P. Adasa (CSR) Monthly Accounting Section
Consumption Report
Monthly Minor and Major Health Information
Cases Operating Room Monthly Management
System
Monthly Delivery
Operating Room Monthly HIMS
Accomplishment Report
Total Number of Clients
OPD Monthly HIMS
Services Rendered at OPD
Total Number of Surgery Done
OPD Monthly HIMS
at OPD
Weekly Tsekap Report OPD Monthly HIMS
Animal Bite Treatment Center
OPD-ABTC Monthly HIMS
Report
  INCIDENT REPORTS (For the past 6 months, summarize the number and nature of
problems/incidents written about) and actions taken.

Incident Report Cause Action Taken

Station 2: Failure Failure of the nurse to 1 The Nursing Service Memorandum Order No.
to Follow Standard secure signature of the 012s.2017 was released.
Protocol on supervisor on duty for OR
Accomplishing OR notification.
Station 2: Failure Failure of the nurses who 1. The Nursing Service Memorandum Order No. 011
to Check Different received the laboratory s.2017 was released.
Blood Type Results results to compare the new
(Type “A”+ and and the previously inserted
Type AB Rh results in the chart.
positive) of
Patient with
Health Record No.
54555
OPD: Written Alleged misbehavior of a 1. The Nursing Service Memorandum Order No. 012
complaints of OPD nursing staff at OPD. s.2017 was released.
Patient Nicanora 2. The Nursing Service staff was reminded of their
Paglalunan last duties and responsibilities.
December 7, 2017
Delivery of patient ER nurse failed to properly 1. An emergency meeting was called.
Tinaco, Lorena at instruct the patient to stay 2. Personnel on duty submitted their Explanation
the out patient at ER while on the process Letter
department of admission
waiting area
IE done 12:20pm with 7cm
dilatation, after 10 minutes
the mother delivered the
baby

 ACCOMPLISHMENTS
A. Patient Care

B. Training/Continuing Education
Program/Activities
 Infection Prevention and Control Seminar-Workshop
 Integrated Management of Childhood Illnesses___________________________
 Focused Charting___________________________________________________
 Ethico-Legal Aspects of Nursing________________________________________
 Patient Safety______________________________________________________
 Advanced Cardiac Life Support________________________________________
 Basic Life Support and Standard First Aid Training_________________________
  Basic Fire Fighting___________________________________________________
 Bomb Threat Awareness_____________________________________________
 What to know about Diabetes?________________________________________

C. Research
N/A

D. Extension Services
N/A

E. Number of Students affiliating in the hospital (last month)

o Nursing N/A
o Midwifery N/A
o Nursing Aide N/A

Prepared By:

ADORA J. TAMBASEN, RN, MN

NURSE V