INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, GEMMALOU C. GUTIERREZ , of the OB-OR COMPLEX commit to deliver and agree to be rated on the attainment of the following targets in accordance with the indicated measures for the

period JULY TO DECEMBER 2015.

GEMMALOU C. GUTIERREZ Ratee

Date: ________________________

Received by:MARIQUITA E. UYVICO, RN

Date Approved by: Date

Immediate Supervisor Head of Office

MAJOR FINAL

OUTPUT

OUTPUT SUCCESS INDICATOR(TARGET + MEASURES)

ACTUAL ACCOMPLISHMENT RATING REMARKS

QUANTITY EFFICIENCY TIMELINESS QUANTITY EFFICIENCY TIMELINESS Q E T ACORE FUNCTIONMFO 1: QUALITY TERTIARY HEALTH SERVICES

1. Receives and endorsed patients 2 patients per shift Error free 5 mins per patient per shift

3 patients per shift

Error free 5 mins per patient per shift

2. Receives OR notification for emergency and elective cases

2 notifications per shift

1 minor error

3 mins per notification per shift

3 notifications per shift

Error free 2 mins per notification per shift

3. Prepares patient for surgical procedure

2 patients per shift Error free 15 mins per patient per shift

3 patients per shift

Error free 10 mins per patient per shift

4. Fills up forms (livebirth certificate, fetal death dertificate)

2 forms per shift 1 minor error

5 mins per form per shift

2 forms per shift

Error free 5 mins per forms per shift

5. Prepares sterile surgical packs, supplies and instruments.

2 times per shift Error free 30 mins per procedure per shift

3 times per shift Error free 10 mins per procedure per shift.

6. Transport and endorses well babies to PACU and pathologic babies to NICU

2 times per shift Error free 15 mins per baby per shift

3 times per shift Error free 10 mins per baby per shift

7. Soaks infectious and non infectious instrumetns

2 times per shift Error free 30 mins for non infectious 24 hour for infectious

3 times per shift Thoroughly done

30 mins for non infectious24 hour for infectious

8. Makes and submits 24-hour census Once per day 1 minor error

30 mins per day Once per day Error free 20 mins per day

9. Analyzes and determines staffing needs in the unit.

Twice a month Error free 1 hour per month Twice a month Error free 45 mins per month

10. Forwards prescriptions/RIS of drugs to the pharmacy

Twice a week Error free 45 mins per week Twice a week Error free 30 mins per week

11. Coordinates between nurses, patients, members of the health team and other unit.

1 patient and 5 members of the health team per procedure

Thoroughly done

1 hour per patient and 6 members of the health team per procedure

1 patient and 6 members of the health team per procedure

Thoroughly done

1 hour and 30 mins per patient and 6 members of the health team per procedure per shift

12. Ensures that the area is maintained clean and orderly.

Twice per shift Thoroughly done

1 hour shift Three times per shift

Thoroughly done

1 hour and 30 mins per shift

13. Evaluates the performance of personnel, job order in the unit.

Twice per month for 2 staff, 8 Job order, 3 nursing attendants, 1 midwife

Error free 15 mins per personnel per session

Twice a month for 2 staff, 8 job order, 3 nurisng attendant, 1 midwife

Error free 10 mins per personnel per session

14. Prepares and submits monthly report.

1 assigned report per month

Error free 45 mins per month 6 assigned report per 6 months

Error free 30 mins per month

15. Monitors the inventory and maintenance of supplies, equipment and facilities.

Once per month Error free 1 hour per inventory Twice a month Error free 45 mins per inventory

16. Delegates to subordinates and gives assignment.

2 staff, 8 job order, 3 nursing attendants, 1 midwife

Delegated cleanly and fairly

15 mins per task 2 staff, 8 job order, 3 nursing attendants, 1 midwife

Delegated cleanly and fairly

10 mins per task

17.Attends monthly unit meetings, conferences, seminars, social functions organized by the hospital.

Once per month Attentively attended

2 hours per meeting8 hours per seminar or functions

6 unit meetings and 2 seminars in 6 months

Well participated

3 hours per meeting24 hours in 2 seminars with extension

FINAL AVERAGE RATINGComments and Recommendations for Development Purposes

Discussed with Assessed by Final Rating by Date

____________________________ _____________________ Employee Date

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

_________________________________________Supervisor

_______________________Division Head

Legend: 1- Quantity 2- Efficiency 3- Timeliness 4- Average