[22/05, 7:50 PM] Dr. Raja Nqa Pollachi: Food Safety
1)Raw materials- ingredients required for preparation -grocery items, vegetables,milk etc.
a)procurement
b)stock maintenance
c)safe storage - perishable items in refrigerator . Grocery items - stored above floor level . Prevention of pilferage. Measures against insects and rodents
d)External quality testing of supplies
e)MOU with contractor. Penalty clauses
f)Quality and quantity of vegetables received- register maintained by Kitchen staff
2)Preparation of food
a)Cook and helpers - tested for communicable diseases . Immunized- typhoid, HepatitisA Dewormed regularly
b)Personal hygiene - hair, nails, cap and mask , kitchen apron worn during cooking . Clean chappals .Social Hand wash . Washing feet after visiting restroom.
c)Clean vessels. Vessels washed and dried in sunlight. Vessels cleaned with boiling water before cooking .
d)Cutting of vegetables with knife on raised platform or table
e) Hygienic preparation , washing the ingredients well. Clean maintenance of Kitchen.
f)Using clean water for cooking - RO water tested every month
g)Storage of cooked food - separately. All items in clean containers with lids
h)Food sample sent for Internal quality - Duty MO . Storage of Sample food in refrigerator
3)Distribution of food
a)Food trolley - clean. Cleaned well after food distribution
b)Food items arranged in closed containers
c)PPE - worn during distribution
d)Diet supplied as per Diet order
e)Gas Stove used- clean
f)sop for food preparations
g)training of staff in infection prevention measures
h)Food distributed in clean trays .
4)Appropriate diet provided - as per condition of patient
a)Nutritional screening by treating doctor. Diet instruction written every day in case sheet . Nutritional assessment using format - for high risk cases by Dietician (where available)
b)Diet order- documentation in Diet sheet - type of diet- IOD, child, hypertensive, diabetic, postpartum diet, iron rich, protein rich, liquid etc.
c)Diet calculation by Kitchen staff - no. of diets of each type required
d) Calculation of raw materials for preparation - by Office staff
5)Kitchen surveillance using format by Kitchen staff and monitored by Kitchen MO
6)Supervision- NS, JAO, Kitchen MO, CMO.
7)Stock maintenance
8)Analysing Patient views in PSS.
9)Root Cause analysis of Food related complaints/ problems
10)Maintaining registers, sop, culture surveillance, external and internal quality testing reports, house keeping checklist
[22/05, 7:50 PM] Dr. Raja Nqa Pollachi: 11)Provision of safe Drinking water in the facility - tested every month.
12)Kitchen waste disposal - in compost .
[23/05, 8:00 AM] Dr. Raja Nqa Pollachi: Pareto analysis can be done for Indications for Primary LSCS (since LSCS audit is done)
Non compliance for Handwash ( from Hand hygiene audit data)
Prescription audit etc.
[24/05, 7:28 AM] Dr. Raja Nqa Pollachi: Good morning
It's better to arrange the documents in this order for ease of review by the External Assessors
[24/05, 9:39 AM] Dr. Raja Nqa Pollachi: In any new building constructed please make sure they have all these Nqas requirements .
1. Uniform signages.
2. Elbow taps in all patient care areas and labs .( except toilets )
3. IN ops and wards towel rings and hand wash stands .
3.one disabled friendly toilet .
4. All toilets with flush .
5. Wire mesh work for all windows
6. Provision for connection of pipes for fire extinguishing from above water tank .
7. Floor directing tiles for blind people .
8 . A common chamber for liquid waste management .
These are all to be provided by pwd civil people ,only if we mention
[24/05, 4:59 PM] Dr. Raja Nqa Pollachi: Radiology
1.Infrastructure- as per AERB guide lines, waiting area,Ventilator above 2m height in Xray room, registration room or place ,dress change room or cubicle, dark room,storage area for xray films, AC provision for digital units and CT, intercom facility, lead lining for door and windows
2)Displays- Trilingual caution signage, caution signage for pregnant women , Scope of services- available and non available, department layout, pregnant women or planning pregnancy to inform , timing for routine xrays and reporting, duty roster - 24 hours services , numbering of department, user charges, Cashless investigation for JSSK beneficiaries, Process Flow Chart- for taking xrays, developing film, patient flow from receiving registration shooting film and reporting, AERB registration certificate , policy to prioritize emergency cases, Quality policy, Quality Objectives
3)Training of staff in department - Radiation safety, Fire safety, BMW management, Hand hygiene , Procedure for handling MLC x-rays, Role in Disaster management , Process flow , register maintenance, Quality assurance and improvement, Buffer stock calculation , Quality indicators, SOP
4)Staff Competence testing - operating xray equipment, hand wash, fire safety
5)External Quality Assurance - TLD badges,exposed Xray films quality - technical aspects ,lead aprons for flouroscopy or CT
Internal quality- exposed Xray films- technical aspects
6)Equipment maintenance- preventive and breakdown, daily cleaning procedures , equipment log , breakdown register
7)Employee safety measures - TLD badge , Lead screen, Lead apron, Lead shields
8)Patient and environment safety- caution signage, warning red light during film exposure, xray room closed at the time of radiation exposure, female attender for women, attender for children and lead apron for escort, LMP to be recorded during registration for all women in child bearing age group, BMW as per guidelines , Handing over Taking over register for IP, Emergency tray for invasive procedures and dyes
9)AERB registration
10) Standard formats - i) Requisition- provisional diagnosis or indication to be written, type of x-ray and view and doctor's sign
ii)Reporting format - signed by Radiologist or competent specialist
11)Identification of patient and service provider- Registration- UHID, x-ray film - name of patient, side- left or right , sign of radiographer, report - sign of reporting person, sign of MO in requisition
12)Copy of SOP , AERB guidelines
[24/05, 4:59 PM] Dr. Raja Nqa Pollachi: 2)Display- Instructions for patient preparation
[24/05, 4:59 PM] Dr. Raja Nqa Pollachi: Ultrasound imaging
1)Display
I)Display of PNDT Act - 3 boards
ii)Scan license - all scan machines serial no. included .Form B.
iii)Training Certificate if Sonologist performing
iv))Scope of services- available and non available
v)Instructions for preparation of patient eg. full bladder for pelvic scan , for placenta previa
vi)Timings -routine and 24 hours availability of service vii)IEC for patients . One female attender allowed .
2)Format- i)Requisition form- include indication, type of scan ,sign of MO ii)Reporting format - or at least a seal. Sign of sinologist/radiologist iii)Form F iv)consent form in Tamil
3)Scan register- include date and time , impression, sign of performing doctor
4)Form F to be sent to JD office every month through the Office . Acknowledgment to be obtained and kept in file.
5)Machine maintenance- preventive and breakdown. Calibration . Equipment log. User manual
6)Training of all Obstetricians in pregnancy scanning
7)Copy of PNDT Act to be available
8)Infrastructure - separate scan room , toilet facility . Ultrasound is an important Critical machine which should be available in Obstetric Casualty in all CEmONC centres.
9)Waste management- green and yellow bins
10)Linen change policy
[28/05, 4:38 PM] Dr Raja Pollachi NQA: Department nodal officer and staff nurse must able to explain quality tools ,department SOP
[28/05, 4:39 PM] Dr Raja Pollachi NQA: Sathish when you are coming to mettupalayam ?
[28/05, 4:39 PM] Dr Raja Pollachi NQA: Complete remaining works and train them then and there
[28/05, 4:41 PM] NQAS Dr. Sathishkumar NHM: sir im in mettupalayam only sir, Ill train them hands on at their department sir
[30/05, 8:39 AM] Dr. Raja Nqa Pollachi: Bowi.deck and biological indicators daily has to be done or weekly once.
[30/05, 8:39 AM] Dr. Raja Nqa Pollachi: Physical and chemical indicators only daily doing .other two not supply
[30/05, 8:39 AM] Dr. Raja Nqa Pollachi: BowieDick and Microbiological tests needs special Indicator strips which have to be purchased . Bowie dick to be done daily during the first cycle to check air leakage. Microbiological test can be done once weekly. This is the most important foolproof method of sterilization validity testing. All the other tests indicate only some aspect - I) physical - for monitoring only - but very important - proper documentation is essential 2) Signaloc- chemical indicator - colour change just shows that the appropriate sterilization temperature has been reached.Affixing on the outside and inner aspect of lid and in autoclave register . Date of autoclaving, expiry date if not opened, autoclave no. and cycle no. and sign of staff nurse on the strip. This is important for Recall procedures in case of sterilization failure. 3)Bowie dick- colour change of indicator- shows that there is no air leak. So vacuum will be created and steam can penetrate the materials .If there is air leak, this will not happen,steam penetration will be inadequate and there will be moisture inside the containers. 4) Microbiological test- shows that the spores of organisms- bacillus stearothermophyllus are killed. This is the only indicator giving the assurance about the effectiveness of the autoclave in sterilizing materials ( an equipment for steam sterilization which kills both vegetative and spore forms of the organisms ) .
[30/05, 8:39 AM] Dr. Raja Nqa Pollachi: What is the meaning of zoning in OT .
[30/05, 8:39 AM] Dr. Raja Nqa Pollachi: OT has actually 4 zones - Protective zone - restricting entry of outside people , Green- restricting entry of staff and clean dress and chappals to be worn here , Yellow- restricting movement of theatre staff . Staff wearing theatre dress should not move beyond this zone , Red- sterile zone which has to be entered only during preparation procedures and during surgeries and to be kept closed at other times or even locked.
[30/05, 8:39 AM] Dr. Raja Nqa Pollachi: A board next to suggestion box ?
[30/05, 8:39 AM] Dr. Raja Nqa Pollachi: Suggestion boxes should be transparent at the lower part and there should be a display showing the policy of daily opening. The boxes have to be numbered . A person assigned for opening , enetering in a Register. All complaints and suggestions to be analysed and documented and action to be taken by the Hospital superintendent and the same entered in the register with sign by the authority.
[30/05, 8:39 AM] Dr. Raja Nqa Pollachi: Rounds has to be maintained in casuality also ?
[30/05, 8:40 AM] Dr. Raja Nqa Pollachi: Rounds are routine procedures done for Supervision by the Hospital superintendent , Nursing Supervisor and the Department in charge. These contain all observations made during the rounds, instructions given and any changes made . These are casual remarks and can be maintained as such in a diary and points noted down. These dont need long formal register.
[30/05, 8:40 AM] Dr. Raja Nqa Pollachi: The Rounds book should be maintained by each supervising person separately .Not in a common register.
[30/05, 9:21 AM] Dr. Seralathan Mettupalayam Nqa: Requesting all doctors to assemble at our blood bank today at 12 noon to discuss key issues about quality tools
[30/05, 10:20 AM] +91 99420 80350: Warning signages ought to be in red and white....
[30/05, 11:59 AM] Dr. Raja Nqa Pollachi: Red zone in OT - positive pressure maintained preventing entry of outside air in to the sterile area. For maintaining this positive pressure and temperature , there must be effective maintenance of the air handling units and regular cleaning of the filters and ducts. Otherwise the efficiency of the machines will be affected . Register to be maintained for this.
[31/05, 12:41 AM] Dr. Raja Nqa Pollachi: Since there's a glitch I am releasing 50k per hsp for gap closure by Monday.
And kayakalp commendation award money of 1 lakh by Wednesday
Pls bare with us, me and NHM are working out to support with additional gap closure funds.thanks
[31/05, 12:41 AM] Dr. Raja Nqa Pollachi: In order to support you,I need gap assessment, additional funds required for closure of gaps with justification by Tomorrow from all the hospital's.
[31/05, 12:41 AM] Dr. Raja Nqa Pollachi: Pls communicate to all the hospital's, thanks
[31/05, 10:05 AM] Dr. Raja Nqa Pollachi: PP unit
1) OP services
2) Ward services
3) OT services
1)OP
i)FP clinic - a)functioning during morning and evening OP, ie.at least 6 hours services.. b)Responsibility - PP MO and FW ANM . FP OP register to be maintained.
c)Display - IEC of all the available methods of FP ; display of list of FP services available - temporary and permanent including camps for laparoscopy and NSV ;dates of surgery- fixed days or all working days ;Display on the table ( cafeteria method)- samples of IUCD, condoms, pills etc. to help patients make their choice ; handbills if available about each method to be kept on the table ; display of Confidential Abortion services
Display of FP compensation amount, Indemnity scheme for failure cases , insurance scheme, incentive deposits for girl child . Banners on camp services may be put up outside.
Display of Reproductive Rights of women.
Display of MTP Act and PCPNDT Act.
A copy of the above 2 Acts to be available with PP MO. Also copies of Standards of male and female sterilization and Quality assurance in sterilization to be available with PP MO and FW ANM.
Training certificates of all those trained in surgeries, Iucd insertions to be available .
Stock register for all FP materials - maintained by ANM . There should be no Stock out situation. Follow-up register - maintained by ANM for all temporary methods , permanent methods,abortions separately. Checklist for communication details - Days of follow-up and warning signs and symptoms .
Selection criteria - age criteria ( legal age - 22 to 49 years )and medical criteria may be displayed- for each method - as reminders
ii)FP counseling services in the FP clinic - responsibility - FP counselor - register to be maintained with sign from patients. Group education may also be done and register maintained. Flip charts and models and booklets to be available with counselor.Privacy in counseling room . Counselor must have Training certificate.
iii)IUCD insertion room - register . Display the Steps of insertion and removal in this room. Keep sterile trays ready ( checklist for instruments and materials required may be maintained)- Autoclave register . BMW bins . Focus light. Privacy for patients. Display of warning signs and symptoms and follow-up days .Informed consent .
iv)ARSH- adolescent reproductive and sexual health services - separate register- Contraception services and. Abortion services . Linkage to be maintained with Adolescent friendly Health clinic register .
v) Confidential Abortion services - display MTP act and PNDT acts . Informed consent- Form C. IEC about Surgical method and Medical methods of abortion. Register for Comprehensive abortion services to be maintained with follow-up.
2)Ward services
i)Postpartum ward/ FW ward for FP surgeries and abortion services .Restricted area signage for the ward. Display in ward - IEC on available FP methods in IEC corner identified.Display of Reproductive Rights of women. Display -the list of FP services available , Compensation for FP services, compensation for FP Indemnity scheme, FP insurance scheme (ask DD FW about this), incentive for girl children . Display in nursing station ---checklist of Tests to be done for FP surgeries ;FP centre Approval certificate from JD .
Case sheets - confidentiality maintained for unmarried patients.
Informed Consent - for limiting method of FP ;for IUCD acceptors ; for MTP - Form C
Handing over Taking over register - from OT . Nursing handover .
Discharge summary with advice on follow-up and warning signs and symptoms.
Preoperative checklist..
ii)PPIUCD services in LR by LR staff . Display of PPIUCD services . PPIUCD register to be maintained by LR staff. Parturition register - all delivered mothers - FP method adopted to be entered - responsibility FW ANM
iii) Counseling services - 3 types - register maintained by counselor Preprocedure , Post procedure and Follow-up counseling for FP methods adopted and also for Abortion cases. Checklist may be maintained for all dyeing counseling .Privacy during counseling - either bedside screens or room
Counseling on - Optimal pregnancy spacing, options for family planning and merits and demerits of each, information that condoms prevent STI and HIV
3)OT services
i)Dates of FP surgeries display - on all working days ( on fixed days - but at least one day per week)
ii) Scope of services - display of FP procedures done . Tubectomy- PS and Interval , MTP, IUCD insertions - PP and interval , include laparoscopy done in camps and NSV
iii)Informed consent forms ( mentioned previously)
iv) Training certificates for doctors in Laparoscopy, NSV, staff nurse training
Staff competency - i) Counselors - on counseling services. Use a format with checklist for the 3 types of counseling.
ii)ANM - Selection criteria, maintenance of records , IUCD insertion and removal steps, Buffer stock maintenance for contraceptives, register for stock and expenditure.Indications and method of EC pills - register
OC pills - medical criteria for selection, about what advice to give for missed pills , Injectable conhormones contraceptive- centchroman.
Follow-up of post NSV cases - about temporary contraception and semen analysis
iii) Ward staff - selection criteria, lab tests, preparation of patients for surgery , post surgical monitoring of patients
iv)OT staff - preparation for surgery , steps, instrument checklist for the procedure ,processing of instruments . Chemical sterilization of MVA syringe .
(MTP - surgical method is only by MVA or SE ) .
Methods of abortion - protocols for -MMA- medical methods of abortion , MVA, 2nd trimester abortion. For each method - selection criteria regarding gestational age .
(All abortion cases - scan pre and post procedure check scans to documented. Form C informed consent. pndt Form F for scan . Scan machine license and Training certificate of sonologist. )
v)LR staff - in PPIUCD insertion, IUCD insertion kit checklist , register , MVA syringe processing and sterilization.
[31/05, 10:05 AM] Dr. Raja Nqa Pollachi: Copy of manuals - Sterilization standards for male and female, Quality assurance in sterilization, Comprehensive abortion services, Oral contraception and Injectable contraceptive, IUCD insertion - should be available.
Copy of MTP act, PCPNDT act - should be available
Procedure to be followed in case of Sterilization failure - should be known
[31/05, 11:59 AM] Dr. Raja Nqa Pollachi: Rejection register and Refusal register - to be maintained in PN ward.
[31/05, 11:59 AM] Dr. Raja Nqa Pollachi: Sorry for Spelling mistakes - non hormonal contraceptive Centchroman.
[31/05, 11:59 AM] Dr. Raja Nqa Pollachi: PP unit- continued . Preservation of documents-
i)the Retention period of case sheets of sterilization cases - for longer period ( case sheets may be needed in future in case of failure)
ii) Informed consent forms for sterilization -consent obtained. ( for same reason mentioned above)
iii) Sterilization register
[02/06, 9:04 AM] Dr. Raja Nqa Pollachi: PP unit
1) OP services
2) Ward services
3) OT services
1)OP
i)FP clinic - a)functioning during morning and evening OP, ie.at least 6 hours services.. b)Responsibility - PP MO and FW ANM . FP OP register to be maintained.
c)Display - IEC of all the available methods of FP ; display of list of FP services available - temporary and permanent including camps for laparoscopy and NSV ;dates of surgery- fixed days or all working days ;Display on the table ( cafeteria method)- samples of IUCD, condoms, pills etc. to help patients make their choice ; handbills if available about each method to be kept on the table ; display of Confidential Abortion services
Display of FP compensation amount, Indemnity scheme for failure cases , insurance scheme, incentive deposits for girl child . Banners on camp services may be put up outside.
Display of Reproductive Rights of women.
Display of MTP Act and PCPNDT Act.
A copy of the above 2 Acts to be available with PP MO. Also copies of Standards of male and female sterilization and Quality assurance in sterilization to be available with PP MO and FW ANM.
Training certificates of all those trained in surgeries, Iucd insertions to be available .
Stock register for all FP materials - maintained by ANM . There should be no Stock out situation. Follow-up register - maintained by ANM for all temporary methods , permanent methods,abortions separately. Checklist for communication details - Days of follow-up and warning signs and symptoms .
Selection criteria - age criteria ( legal age - 22 to 49 years )and medical criteria may be displayed- for each method - as reminders
ii)FP counseling services in the FP clinic - responsibility - FP counselor - register to be maintained with sign from patients. Group education may also be done and register maintained. Flip charts and models and booklets to be available with counselor.Privacy in counseling room . Counselor must have Training certificate.
iii)IUCD insertion room - register . Display the Steps of insertion and removal in this room. Keep sterile trays ready ( checklist for instruments and materials required may be maintained)- Autoclave register . BMW bins . Focus light. Privacy for patients. Display of warning signs and symptoms and follow-up days .Informed consent .
iv)ARSH- adolescent reproductive and sexual health services - separate register- Contraception services and. Abortion services . Linkage to be maintained with Adolescent friendly Health clinic register .
v) Confidential Abortion services - display MTP act and PNDT acts . Informed consent- Form C. IEC about Surgical method and Medical methods of abortion. Register for Comprehensive abortion services to be maintained with follow-up.
2)Ward services
i)Postpartum ward/ FW ward for FP surgeries and abortion services .Restricted area signage for the ward. Display in ward - IEC on available FP methods in IEC corner identified.Display of Reproductive Rights of women. Display -the list of FP services available , Compensation for FP services, compensation for FP Indemnity scheme, FP insurance scheme (ask DD FW about this), incentive for girl children . Display in nursing station ---checklist of Tests to be done for FP surgeries ;FP centre Approval certificate from JD .
Case sheets - confidentiality maintained for unmarried patients.
Informed Consent - for limiting method of FP ;for IUCD acceptors ; for MTP - Form C
Handing over Taking over register - from OT . Nursing handover .
Discharge summary with advice on follow-up and warning signs and symptoms.
Preoperative checklist..
ii)PPIUCD services in LR by LR staff . Display of PPIUCD services . PPIUCD register to be maintained by LR staff. Parturition register - all delivered mothers - FP method adopted to be entered - responsibility FW ANM
iii) Counseling services - 3 types - register maintained by counselor Preprocedure , Post procedure and Follow-up counseling for FP methods adopted and also for Abortion cases. Checklist may be maintained for all dyeing counseling .Privacy during counseling - either bedside screens or room
Counseling on - Optimal pregnancy spacing, options for family planning and merits and demerits of each, information that condoms prevent STI and HIV
3)OT services
i)Dates of FP surgeries display - on all working days ( on fixed days - but at least one day per week)
ii) Scope of services - display of FP procedures done . Tubectomy- PS and Interval , MTP, IUCD insertions - PP and interval , include laparoscopy done in camps and NSV
iii)Informed consent forms ( mentioned previously)
iv) Training certificates for doctors in Laparoscopy, NSV, staff nurse training
Staff competency - i) Counselors - on counseling services. Use a format with checklist for the 3 types of counseling.
ii)ANM - Selection criteria, maintenance of records , IUCD insertion and removal steps, Buffer stock maintenance for contraceptives, register for stock and expenditure.Indications and method of EC pills - register
OC pills - medical criteria for selection, about what advice to give for missed pills , Injectable conhormones contraceptive- centchroman.
Follow-up of post NSV cases - about temporary contraception and semen analysis
iii) Ward staff - selection criteria, lab tests, preparation of patients for surgery , post surgical monitoring of patients
iv)OT staff - preparation for surgery , steps, instrument checklist for the procedure ,processing of instruments . Chemical sterilization of MVA syringe .
(MTP - surgical method is only by MVA or SE ) .
Methods of abortion - protocols for -MMA- medical methods of abortion , MVA, 2nd trimester abortion. For each method - selection criteria regarding gestational age .
(All abortion cases - scan pre and post procedure check scans to documented. Form C informed consent. pndt Form F for scan . Scan machine license and Training certificate of sonologist. )
v)LR staff - in PPIUCD insertion, IUCD insertion kit checklist , register , MVA syringe processing and sterilization.
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 3)Display
a)Directional signage from entrance leading to LR
b)Scope of services - provided and not - near entrance
c)Restricted area signage
d)Lay out of Labour ward complex
e)Fire escape route plan and Fire exit signages
f)High Risk Obstetric cases
g)Duty MO and SN
h)Scan - PNDT act related 3 boards inside and outside in waiting area. Scan license. Scan training certificate.
i)Naming and numbering each room
j)Department signage and number
k)Referral linkages - referral in and referral out
l)Birth Companion allowed and advantages - at entrance
m)Clinical protocols (mentioned already)to be displayed in casualty and LR
n)IEC - in waiting area - in Tamil- BF, KMC, Family planning, Immunization
o)In Nursing station - Safe injection Practices, Blood spillage management, Trays to be kept- checklist, Sterilization of LR, Safe delivery practices
p) Above wash basins- Hand wash, 5 Moments of Hand hygiene
q)Entitlements - JSY, JSSK, FP , Muthulakshmi reddy- near entrance
r)Ambulance service - at entrance
s) CEmONC services - in cemonc centres. - at entrance
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: Labour Room
1)Infrastructure
a)Obstetric Casualty in cemonc centres and General casualty in non cemonc centres
i)Patient receiving, examination area, scan facility - 24 hours , all emergency equipment including crash cart, suction, oxygen,emergency drug tray, PPH tray, Eclampsia tray, Delivery tray, saline stand, IV fluids, Fetal Doppler etc. to be available .Display Management protocols of important conditions like Anaemia, GDM and emergency cases like APH, Abortions, PIH , septic cases etc.Also Rapid initial assessment and Obstetric Triaging ( see SOP sent)
b) Pre labor room - CTG, fetal Doppler, BP app, etc. to be available
c)Labor room - Clean with NBCC
Admission criteria - those in Active Labor and those requiring immediate care like abortions etc. Discharge criteria - after the specified period of observation ( varies in different cases) , patients vitals are stable,uterus contracted and no undue bleeding pv , BF initiated , patient feels comfortable
d) Labor room - Septic with NBCC.Criteria for admission - all patients with Communicable diseases who need isolation and specific care.
e)Post delivery Observation - if separate room not available , patient to be kept in Labor room itself for the required period of observation
f)Preparation room - sterile Bins with gauze, sterile towels and patient gown , availability of hair clippers or sterile bin with scissors . BMW bins- Yellow, Red. General waste- green bin. Sterile tray for urinary catheter insertion. Availability of Betadine , Surgical spirit, sterile gloves, Foley catheter, urobag etc. Display for Preparation( refer SOP sent) and Dos and Donts ( no routine enema, no shaving ) - see Lakshya guidelines book
g)Room for High Risk patients in SDH eg. Eclampsia room with ICU cot, emergency equipment, eclampsia tray,management protocol display.
In DH - HDU needed with all arrangements as in ICU , separate staff posted , handwash facility, protocols display, emergency equipment and supplies ready
h)Toilet- preferably western type with support or hold bars on the sides . Bathrooms for bathing - Chlorhexidine soap to be used by patients going for surgery ( Dettol soap may be used )
i) Dirty utility area - keep the mops , buckets, brushes, soiled linen bin , wash materials , wash sink for washing instruments , house keeping cart etc.
j)Patient dress
change room - if room not available - a screen in Preparation room for privacy
k) Hot water availability - for bathing and warm water for washing instruments
l) Safe drinking water provision
m) Nursing station
n) Attender waiting area or shed - seating facility, IEC display in Tamil
o) NBSU and OT should be close to the LR
2) Arrangements to be made
a) Casualty- as mentioned above . Height and Weight machine . At least 2 cots for Obstetric training - Low risk and High risk . Table and chair for patient consultation
b)Zoning - clean, semisterile ( corridor) and sterile area ( Labor theatre - clean labor room and septic labor room .
c) Labor room - i)The doors and windows should always be kept closed. Fumigation done with H2O2. Culture swab taken every month and displayed outside along with next due date )
ii)Adequate illumination to be available in the procedure area with focus lights . Labor area - 500 lux. Support area- 150 lux.
iii) Doors and windows should always be kept closed
iv)Screes for privacy , preferably plastic , which can be easily and washed daily and of light colour
v)Labor table - as per patient load. Adequate space around for patient care. (future plan for LDR type of LR) . At least one table with facility for Trendelenburg position .
vi) NBCC - adequate space for new born care ,at least 200 sq. ft. Radiant warmer with stabilizer , must be free on 3 sides for baby care. Sterile bin for baby towels, resuscitation equipment, supplies and medicines required for routine and emergency care - maintain checklist for this . Baby weighing machine .
vii) Sterile corner- a rack or bench or table where the sterile items are neatly arranged . Bins for gauze, perineal pads, perineal towels, roller gauze ( cotton balls not to be used) , sanitary pads
Trays- delivery, episiotomy, forceps, ventouse,IUCD, MVA
Sterile supplies - urinary catheter, urobag, IUCD etc.
viii) BMW corner . Also yellow buckets under each labor board for collection of blood and body fluid ( do not throw other materials in this )
ix) Injection corner - medicines and supplies for injection, sterile gloves . Display of Safe injection practices .
x) Emergency kits corner - Crash cart, Emergency drug tray, PPH tray, NASG garment, Eclampsia tray
xi)Bedside lab testing corner ( if space is not available - keep all the items on a table in nursing station) - urine albumin and sugar by dipstick method, glucometer , similar to this is Haemoglobinometer , pregnancy test , BT, CT, , RDT for hiv
xii) Trolleys- to keep trays during procedures ( these must be prepared just as in OT - they should be cleaned well with alcohol after every use)
xiii) Optimum temperature maintenance in LR - about 26 c . exhaust fan to be available if no ac.
xiv) clean dress for patients
xv) clean chappals, cap and mask, plastic aprons to be worn while entering LR ( just as in OT) with LR uniform for staff working in LR . Sterile gowns and gloves to be worn during procedures . PPE to be provided for Birth companion also.
xvi) The floor should have non slippery tiles. The wall tiles require frequent cleaning and hence, do not nail these and create breaches or stick posters which will gather dust and settle organisms .
xvii) Emergency protocols display on wall- AMTSL, APH, PPH, abortion, sepsis management . Routine NB care, NB resuscitation display near NBCC . IEC -. BF poster may be displayed in a place where the patient can see.
xviii) Wall clock
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 4)HR
a)Cemonc centres - should have 24 hour availability of Obstetrician, anaesthetist and paediatricians. Non cemonc hospitals - 24 hour availability of MO with specialist available on calls .
b)Staff Nurse - should be posted for all shifts . They must be SBA,NSSK, Infection control and PPIUCD trained
c)Security staff posted round the clock at entrance of LR
5)Maintenance of registers
a)Casualty- OP register with time and sign of MO, ref in, ref out, complicated cases
b)Nursing station - Case sheets, Nominal register, stock registers etc.Taking over Handing over register - to OT or PN ward , Verbal order register
c)Partogram- live partograph in LR for each patient in Active labour
d)Parturition register- in Parturition corner in the Yellow zone .
Labour Room register to be maintained for Lakshya.
e)Scan cases - scan register - seal or reporting format to be used , form F
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: Registers- Birth companion with sign and address, PPIUCD register- informed consent to be obtained
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 6)Forms to be available
a)Maternity case sheet
b) Partograph
c)Safe Childbirth checklist - in case sheet
d)Oxytocin monitoring chart of
e)PN monitoring - in case sheet
f)OT related forms - prep checklist, surgery consent, anaesthetic consent, preanaesthesia assessment, preinduction assessment, intraoperative monitoring, alderete score chart, Safe Surgery checklist , Procedure card
g) Form F and consent form for scan
h) Checklist - Crash cart, Emergency medicine tray, PPH kit, Eclampsia tray , other Trays in Labor room . In the checklist mention if a drugs are stored elsewhere eg. Oxytocin , carboprost in refrigerator . Also mention that sterile supplies are kept in sterile tray and others are kept outside . ie. Do not mix sterile and unsterile materials.
i)Blood spillage kit and checklist - keep in nursing station
j) list of lab tests - display
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 9)Identification - ID band for mother and baby, baby foot print and mother's left thumb impression in case sheet, for procedure identification- attach Procedure card to case sheets for surgery patients
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 7)General consent in case sheet - scope of general consent should include Conducting Delivery
8) Informed consent- For all procedures like vacuum, forceps, assisted breech, LSCS, Anaesthesia etc.
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 10)Drug storage - NDPS drugs - double lock system, refrigerator, trays . Keep checklist for these. Display about High alert drugs and maximum dose in Nursing station.
Buffer stock calculation to be known
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 11) Blood transfusion - register with indication and Hb , forms related to this. Management of BT reaction may be displayed in Nursing station
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 12)House keeping - Schedule, HK checklist ,
3 bucket system - separate mops and buckets for clean LR, septic LR, corridors
Processing of instruments - work instruction to be available in nursing station
Chlorine solution preparation from concentrated hypo - display in nursing station as reminder
Uni directional mopping and mopping in LR - first around labour boards and then to periphery and outside
Cleaning of Labour board after each delivery and shifting of patient - chart to be maintained for each numbered Labor board
Weekly fumigation with H2O2 . Mopping during each shift and whenever required if there is body fluid spillage .Daily washing floor with detergent . Monthly culture swabs and display of next due.
Disinfection of all equipment every day.
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 13)Maintenance of equipment - preventive, breakdown, equipment log , equipment checklist , breakdown register , manuals and work instruction for each equipment , central oxygen supply , oxygen cylinders - label as full or empty.
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: Awareness about SOPs
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 14)Temperature chart - refrigerator, LR ( optimum temperature to be maintained)
15)Staff competency - management protocols (OSCE scores- pre test and post test- for Lakshya), lab tests, fire safety management, partograph entries , operating equipment, NB care ( refer OSCE), usage of Safe childbirth checklist
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 16) Copy of SOP should be available with staff
17) Training records of staff - sop and clinical management, Respectful maternity care, infection control especially khandwa shing, PPE, instrument processing, safe delivery practices , safe injections, prevention of HAI, BMW, Sterilization of LR , fire safety, partograph, Safe childbirth checklist etc.
Training certificates - SBA, IMEP( infection control and BMW) , NSSK , scan training for doctors , Bemonc training for doctor where Obstetrician is not available
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 18)Wheelchair and Stretcher bay outside LR
19) UPS backup for LR
20) PAS - public announcement system and intercom .
Register may be maintained for announcement of deliveries with timings
21)CCTV
22)Sterile dress for CS patients
23)Chemical sterilization of MVA syringe
24) PPIUCD- No touch technique
25)Immunization of staff . Personal file. Medical check up. Trainings. Induction training. Privileging. Job functions and responsibilities.
26) Autoclave register
27)Preparation for surgery
28) No routine enema . No routine shaving - hair clipping if required.
29)BMW management - placenta, dead fetus , abortus
30)Department in charge and staff responsible for calculating indicators
31)LR Quality Circle formation and meeting register
32)Display of Quality policy and Policy Objectives
33) Quality tools.Knowledge about interpretation of charts or graphs and Process map and action plan taken for these. Use PDCA project format for improving procedures like administering oxytocin within 1 minute of delivery, Delayed cord clamping etc.
34) PPH drill . Mock drill for handwash. Wearing and removing gloves and PPE. Exercise for BMW management . Drill for eclampsia management. Fire safety drill.
35) Follow-up of referred cases
36) Audit - lscs, maternal death , infant death, referral audit, Hic audits especially hand hygiene and HAI prevalence and action plan
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: 37)NSI and PEP
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: PDCA - project report type can also be used to improve Partograph maintenance, childbirth checklist usage.
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: Staff should know the Stages of Labour, 6 cleans to be followed during delivery, standard precautions , emergency signs and symptoms and management.
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: Patients with communicable disease who need isolation
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: Good morning Madam.
who are all the patients to be kept in septic labour room.
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: Chickenpox,Hepatitis B, PT, AGE, Fever cases like Dengue, H1N1 etc. HIV - all patients are considered to be potentially infectious patients and may be in Window period also. That is why Standard precautions are followed.Moreover Patient confidentiality is required and these cases should not be openly identified as HIV. Prepare the Admission criteria for Septic LR. Maintain separate register. Maintain protocols for medical management and prevention of infection of NB , besides the Obstetric management for these cases.
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: HIV,HBsAg positive?
[03/06, 11:30 AM] Dr. Raja Nqa Pollachi: Patient confidentiality required for - HIV cases, unmarried pregnancy, rape cases, MTP cases
[03/06, 11:31 AM] Dr. Raja Nqa Pollachi: Labour room must have at least one Labour board with facility for prop up for failure cases and Trendelenburg in case of Shock
[03/06, 11:31 AM] Dr. Raja Nqa Pollachi: Scan machine is an important equipment required for Obstetric casualty - for ectopic, APH etc.
A portable machine needed in LR.
[03/06, 11:31 AM] Dr. Raja Nqa Pollachi: CTG - monitoring- strip to be attached to case record.
[03/06, 11:31 AM] Dr. Raja Nqa Pollachi: Madam.
If any slides available for CPR class - kindly post, Mam.
Thanks Mam.
[03/06, 11:31 AM] Dr. Raja Nqa Pollachi: In all death cases , CPR form to be attached to case record. CPR form to be placed in Crash Cart. A post event analysis will help to identify deficiencies and action to be taken ( training, equipment and supplies availability etc.) to improve future outcomes.
[04/06, 8:25 AM] Dr. Raja Nqa Pollachi: First write a Flow Chart - for CSSD procedure eg.
Receiving bins , processing - write the various steps and then issue of sterile bins.
Now study what exactly is happening during the various steps. These observations you put up in AS - IS map. Analyse the problems and then put up an Improved map
[04/06, 8:25 AM] Dr. Raja Nqa Pollachi: Mam, i need maternal death audit form
[04/06, 8:25 AM] Dr. Raja Nqa Pollachi: Neonatal death audit form , also mam
[04/06, 8:25 AM] Dr. Raja Nqa Pollachi: For Primary LSCS audit- use the format sent by Expert adviser
[04/06, 8:57 AM] Dr. Raja Nqa Pollachi: Quality Outcome Indicators
1)The indicators are grouped mainly in to 4 categories.
i) Productivity ii) Efficiency iii)Clinical care and Safety iv) Service quality indicators.
Equity indicators - patients below BPL - all our patients fall in this
2)Formula and Calculation.
3)Numerator and Denominator . Inclusion criteria and Exclusion criteria for these.
4)Data source- whether directly from existing registers or from a separate register capturing the data every day ( Data capture register)
5)Bench mark for each indicator - if given
6)A person designated to calculate the indicators . For each department - by the identified staff nurse. For KPI- by the NQAS assistant to nodal officer (SN)
7) Analysis of the indicators - by department in charge. For KPI- by NQAS nodal officer
8) Graph for each indicator - Line graph or Bar graph. Use Excel sheet
9) Comments about each Value - satisfactory, unsatisfactory, Bench mark reached, any deficiencies,RCA, action plan for improvement . Use the PDCA - Time bound action plan format.
10)Awareness - about outcome indicators - among all staff and doctors
11)Meeting - record . On discussion about the Outcome indicators - once in 3 months . Document in the register. Actually - there ought to be a Quality Circle for each department and they can meet when required and a register can be maintained. The meetings, Induction training in the department and the Outcome indicators discussion - can be recorded commonly in this register.
12)Presentation - PPT- a brief presentation not more than 5-10 minutes
a)Facility level - prepared by NQAS nodal officer
b)Department levei- prepared by the Department in charge
Include the Outcome indicators in this
[04/06, 9:50 AM] Dr. Raja Nqa Pollachi: Good morning mam, , In general admin checklist , IQAP-daily rounds schedule , format wanted mam
[04/06, 9:50 AM] Dr. Raja Nqa Pollachi: Rounds - is something where every thing is supervised . No specific format is required for this.This is part of administrative schedule and hence a diary may be maintained for evidence.
1) Cleanliness - of ward, toilets ,equipment , furniture etc.Arrangement and neatness of all articles.
2)Availability of all equipments and materials - equipment, furniture, registers etc.
3)Staff availability - dress code followed . Observe the process - clinical care, transport , storage and point out the deficiencies observed.
4)Civil and Electrical related problems - identified
5)Check records - stock register verification at random, checking case records etc.
6)Functioning of all other Quality improvement activities - infection control including BMW, 5S method adopted , safety measures adopted eg. Stretcher and wheelchair - strapping of patients
7)Patient interview- about the care given and their satisfaction level.
Whatever observations are made in the Rounds - are corrected then and there . The same can be recorded shortly in the book.
Rounds - is an important exercise done by 1) Facility in charge 2) Department in charge 3) Nursing Supervisor and is very important to improve and maintain quality. These 3 people make rounds at different times or together. The Rounds book is to be maintained separately and individually by them.
[04/06, 9:50 AM] Dr. Raja Nqa Pollachi: During the Rounds - staff may utilize the opportunity and communicate their problems and their requirements which can be noted down by the superviser and arrangements made immediately or later as needed .
[04/06, 9:52 AM] Dr. Raja Nqa Pollachi: Rounds
1)Fixed Time schedule - everyone is mentally prepared for it
2) Surprise checks - unscheduled.
Both are important and have its own advantages .
