COM-SPMS FORM NO. 3 ( IPCR)CITY OF MANILA -STRATEGIC PERFORMANCE MANAGEMENT SYSTEM (COM-SPMS) TEMPLATE

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW IPCR)

I, _________________________________________ (Name,) STAFF NURSE ( NURSE I, II , III ) (Position/Designation), NURSING SERVICE , (Division) _______________________________________________( Department), commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the period ______________________________to ___________________________, 20____.

SignatureDate of Signing (Beginning of the Rating Period): ________________________

REVIEWED BY APPROVED BY:

Immediate Supervisor Department HeadDate Date

RATING SCALE LEGEND5 - Outstanding Q- Quality4- Very Satisfactory E- Efficiency3 - Satisfactory T-Timeliness2 -Unsatisfactory A- Average1- Poor

Major Final Output( MFO) Success Indicators Actual AccomplishmentsRATING

REMARKSQ E T A( please add rows if necessary) (Targets + Measures)

MFO 1.Basic and Specialized Medical Services

Patient Care Management 100% of patients within:

For minimal to moderately ill: 15 to 30 minutesFor critically ill: 1 to 2 hours

100% of patients given quality nursing care withinthe shift

100% of patient’s health condition and nursing caredocumented within the shift

100% of patient’s referral coordinated within the shift

100% health teachings to patients provided within the shift

MFO 2.Regulatory Services for Health Products,Devices, Equipment and Facilities

100% of medical equipment and facilities handledand maintained daily

100% of medicines administered to patients withprescription and recorded to patient’s chart per shift

100% of medicines and supplies used to patients reflected in the availment form per shift

conducted daily inventory of medicines, suppliesand equipment.

MFO 3.General Administrative Support Services(GASS)

Record Management

Admitting & Discharge

Dietary Services

Philhealth Services

Housekeepig

100% completeness of patient’s chart ensured pershift

100% of admitted and discharged patients properlyrecorded in the logbooks per shift

100% of patient’s diet list submitted daily 100% of newly admitted patient’s diet and changes

in patient’s diet informed per shift 100% of patient’s classification facilitated per shift

100% of clinical area cleaned and maintained pershift

Conduct concurrent and terminal disinfection per shift

MFO 4.Support to Operations

100% of assistance provide to departmentsunder the City Government of Manila and otheragencies

Health Activities of the City Socio-cultural Activities Disaster management Medical Mission Working Committees of the Hospital

Management

FINAL AVERAGE RATING

ADJECTIVAL RATING

DISCUSSED WITH : ASSESSED BY : FINAL RATING BY:Immediate Supervisor Department Head

I certify that I discussed my assessment of the performance with the employee .

Name & Signature of Ratee Name & Signature of Rater Name & Signature of Department HeadPosition : Position : Position :Date : Date : Date :