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All Journal MMJ (Mahakam Midwifery Journal) Jurnal Pengabdian kepada Masyarakat Jurnal Ilmu Kebidanan dan Kesehatan JURNAL SABHANGA Termometer: Jurnal Ilmiah Ilmu Kesehatan Dan Kedokteran International Journal of Scientific Multidisciplinary Research (IJSMR)
Endah Wijayanti
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Agriculture, Biological Sciences & Forestry Humanities Decision Sciences, Operations Research & Management Dentistry Economics, Econometrics & Finance Education Environmental Science Health Professions Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Mechanical Engineering Medicine & Pharmacology Nursing Public Health Social Sciences Veterinary Other

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Journal : Termometer: Jurnal Ilmiah Ilmu Kesehatan Dan Kedokteran

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Analisis Dokumentasi Kunjungan Masa Nifas Berdasarkan Data EMR di Puskesmas Nalumsari I Evita Aurilia Nardina; Ratih Kumala Dewi; Endah Wijayanti
Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran Vol. 3 No. 3 (2025): Juli : Termometer: Jurnal Ilmiah Ilmu Kesehatan dan Kedokteran
Publisher : Pusat Riset dan Inovasi Nasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/termometer.v3i3.5390

Abstract

Postpartum visit documentation is a vital component of midwifery care, serving not only as a clinical record but also as an indicator of service quality. The use of Electronic Medical Records (EMR) in primary healthcare settings is expected to improve the accuracy and completeness of postpartum care documentation. This study aimed to analyze the completeness of postpartum visit documentation based on EMR data at Nalumsari I Public Health Center, Jepara Regency. A descriptive quantitative design with a retrospective approach was used to assess 120 postpartum medical records from 2023. The findings showed that the most consistently documented components were blood pressure (98.3%) and uterine involution (95.8%), while psychological status and health education were less frequently recorded (65% and 58.3%, respectively). The Chi-Square test revealed a significant relationship between the number of postpartum visits and the completeness of documentation (p = 0.001). These results indicate that more frequent visits are associated with more complete and higher-quality documentation. This study implies the need to strengthen health workers' capacity in EMR-based documentation, especially in recording non-clinical aspects such as emotional support and postpartum health education.
Co-Authors Andi Heriyah Andraini, Rus Dini Indo Virawati Evita Aurilia Nardina Ganda Ardiansyah Genevieva Esmeraldine Tanihatu Grace Carol Sipasulta Ni Nyoman Murti Norhayati Nur Fitriah Ratih Kumala Dewi sri wulan Supriadi Supriadi Supriadi