BKJ-BOR-PPK-11 PIND.

2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
1 RIGHT HAND
2 LEFT LEG
3 LEFT HAND
4 LEFT HAND
5 LEFT HAND
6 LEFT HAND
7 LEFT LEG
8 RIGHT HAND
9 RIGHT HAND
10 RIGHT HAND
11 RIGHT HAND
12 LEFT HAND
13 LEFT HAND
14 LEFT HAND
15 LEFT HAND
16 LEFT LEG
17 LEFT HAND
18 LEFT HAND
19 RIGHT HAND
20 RIGHT HAND
JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018
 BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
Thrombo
Additive VIP Score

Conscious Patient ( √ )
Palpable Venous

Unconscious patient
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Medication
Canulation

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
21 RIGHT HAND
22 RIGHT HAND
23 RIGHT HAND
24 RIGHT HAND
25 RIGHT HAND
26 LEFT LEG
27 LEFT HAND
28 LEFT HAND
29 LEFT HAND
30 LEFT HAND
31 LEFT LEG
32 RIGHT HAND
33 RIGHT HAND
34 RIGHT HAND
35 LEFT LEG
36 LEFT HAND
37 LEFT HAND
38 LEFT HAND
39 LEFT HAND
40 LEFT LEG
JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
 KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
Thrombo
Additive VIP Score

Conscious Patient ( √ )
Palpable Venous

Unconscious patient
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Medication
Canulation

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
41 RIGHT HAND
42 LEFT LEG
43 LEFT HAND
44 LEFT HAND
45 LEFT HAND
46 LEFT HAND
47 LEFT LEG
48 RIGHT HAND
49 RIGHT HAND
50 RIGHT HAND
51 RIGHT HAND
52 LEFT HAND
53 LEFT HAND
54 LEFT HAND
55 LEFT HAND
56 LEFT LEG
57 LEFT HAND
58 LEFT HAND
59 RIGHT HAND
60 RIGHT HAND
JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
 CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
61 RIGHT HAND
62 RIGHT HAND
63 RIGHT HAND
64 RIGHT HAND
65 RIGHT HAND
66 LEFT LEG
67 LEFT HAND
68 LEFT HAND
69 LEFT HAND
70 LEFT HAND
71 LEFT LEG
72 RIGHT HAND
73 RIGHT HAND
74 RIGHT HAND
75 LEFT LEG
76 LEFT HAND
77 LEFT HAND
78 LEFT HAND
79 LEFT HAND
80 LEFT LEG
JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
 Ward : OGOS 2020
Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
81 RIGHT HAND
82 LEFT LEG
83 LEFT HAND
84 LEFT HAND
85 LEFT HAND
86 LEFT HAND
87 LEFT LEG
88 RIGHT HAND
89 RIGHT HAND
90 RIGHT HAND
91 RIGHT HAND
92 LEFT HAND
93 LEFT HAND
94 LEFT HAND
95 LEFT HAND
96 LEFT LEG
97 LEFT HAND
98 LEFT HAND
99 RIGHT HAND
100 RIGHT HAND
JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
 Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
101 RIGHT HAND
102 RIGHT HAND
103 RIGHT HAND
104 RIGHT HAND
105 RIGHT HAND
106 LEFT LEG
107 LEFT HAND
108 LEFT HAND
109 LEFT HAND
110 LEFT HAND
111 LEFT LEG
112 RIGHT HAND
113 RIGHT HAND
114 RIGHT HAND
115 LEFT LEG
116 LEFT HAND
117 LEFT HAND
118 LEFT HAND
119 LEFT HAND
120 LEFT LEG
JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
 Thrombo
Additive VIP Score

Conscious Patient ( √ )
Palpable Venous

Unconscious patient
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Medication
Canulation

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
121 RIGHT HAND
122 RIGHT HAND
123 RIGHT HAND
124 RIGHT HAND
125 RIGHT HAND
126 LEFT LEG
127 LEFT HAND
128 LEFT HAND
129 LEFT HAND
130 RIGHT HAND
131 LEFT LEG
132 LEFT HAND
133 LEFT HAND
134 LEFT HAND
135 LEFT HAND
136 LEFT LEG
137 RIGHT HAND
138 RIGHT HAND
139 RIGHT HAND
140 RIGHT HAND
JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
 Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
141 RIGHT HAND
142 LEFT LEG
143 LEFT HAND
144 LEFT HAND
145 LEFT HAND
146 LEFT HAND
147 LEFT LEG
148 RIGHT HAND
149 RIGHT HAND
150 RIGHT HAND
151 RIGHT HAND
152 LEFT HAND
153 LEFT HAND
154 LEFT HAND
155 LEFT HAND
156 LEFT LEG
157 LEFT HAND
158 LEFT HAND
159 RIGHT HAND
160 RIGHT HAND
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection
 BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
161 RIGHT HAND
162 LEFT LEG
163 LEFT HAND
164 LEFT HAND
165 LEFT HAND
166 LEFT HAND
167 LEFT LEG
168 RIGHT HAND
169 RIGHT HAND
170 RIGHT HAND
171 RIGHT HAND
172 LEFT HAND
173 LEFT HAND
174 LEFT HAND
175 LEFT HAND
176 LEFT LEG
177 LEFT HAND
178 LEFT HAND
179 RIGHT HAND
180 RIGHT HAND
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018
 BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
181 RIGHT HAND
182 LEFT LEG
183 LEFT HAND
184 LEFT HAND
185 LEFT HAND
186 LEFT HAND
187 LEFT LEG
188 RIGHT HAND
189 RIGHT HAND
190 RIGHT HAND
191 RIGHT HAND
192 LEFT HAND
193 LEFT HAND
194 LEFT HAND
195 LEFT HAND
196 LEFT LEG
197 LEFT HAND
198 LEFT HAND
199 RIGHT HAND
200 RIGHT HAND
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
 KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
201 RIGHT HAND
202 LEFT LEG
203 LEFT HAND
204 LEFT HAND
205 LEFT HAND
206 LEFT HAND
207 LEFT LEG
208 RIGHT HAND
209 RIGHT HAND
210 RIGHT HAND
211 RIGHT HAND
212 LEFT HAND
213 LEFT HAND
214 LEFT HAND
215 LEFT HAND
216 LEFT LEG
217 LEFT HAND
218 LEFT HAND
219 RIGHT HAND
220 RIGHT HAND
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
 CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
221 RIGHT HAND
222 LEFT LEG
223 LEFT HAND
224 LEFT HAND
225 LEFT HAND
226 LEFT HAND
227 LEFT LEG
228 RIGHT HAND
229 RIGHT HAND
230 RIGHT HAND
231 RIGHT HAND
232 LEFT HAND
233 LEFT HAND
234 RIGHT HAND
235 RIGHT HAND
236 RIGHT HAND
237 RIGHT HAND
238 LEFT HAND
239 LEFT HAND
240 RIGHT HAND
JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
 Ward : OGOS 2020
Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
241 RIGHT HAND
242 LEFT LEG
243 LEFT HAND
244 LEFT HAND
245 LEFT HAND
246 LEFT HAND
247 LEFT LEG
248 RIGHT HAND
249 RIGHT HAND
250 RIGHT HAND
251 RIGHT HAND
252 LEFT HAND
253 LEFT HAND
254 LEFT LEG
255 LEFT HAND
256 LEFT HAND
257 LEFT HAND
258 LEFT HAND
259 RIGHT HAND
260 RIGHT HAND
JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

BKJ-BOR-PPK-11 PIND.2/2018

BAHGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS
Ward : OGOS 2020
 Thrombo

Conscious Patient ( √ )
Additive VIP Score

Unconscious patient
Palpable Venous
Slight Redness
phlebitis

Plain IV drip

IV Branula
Total Site of IV

Redness

Swelling

Pyrexia

(Adult) ( √ )
Canulation

Medication

cord
Blood TX
NO. RN 0 1 2* 3* 4* 5* YES NO

Total no. Total no. Total no. Total no. Total no.
261 RIGHT HAND
262 LEFT LEG
263 LEFT HAND
264 LEFT HAND
265 LEFT HAND
267 LEFT HAND

JUMLAH
To be filled by Ward Sister U32/ KUP U32 reviewed in OGOS 2020

* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection