Checklists for Monitoring of Various Sections OF DHQ and THQ Hospital
Checklists for the following areas are included here:
1. General condition of the Hospital
2. Adult ward
3. Paediatric ward
4. Gynae/Obs
5. Out-patient Department
6. Casualty
7. Theatre
8. Pharmaceutical services
9. BloodBank
10. Personnel
Date of visit……………….. Tick appropriate box √
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Comments
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SECTION 1:GENERAL
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Assessment
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Hospital premises clean
|
Y
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N
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Un interrupted Power supply available
|
Y
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N
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Un interrupted Water supply available
|
Y
|
N
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Waiting room facilities for attendants
|
Y
|
N
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Clean toilet facilities for attendants
|
Y
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N
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Functional system of waste disposal
|
Y
|
N
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Attendance register and physical presence of staff
|
Y
|
N
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New construction/progress of ADP schemes
|
Y
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N
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Funds for maintenance and repair available
|
Y
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N
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SECTION 2: ADULT WARD
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Protocols and patient care
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Assessment
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Adult CPR protocol visible
|
Y
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N
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1
Standard Treatment Guidelines (In-patient and outpatient) available
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Y
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N
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National/International Guidelines on Chronic Diseases treatment
|
Y
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N
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All new and critically ill patients seen at least once
a day including weekends by a senior doctor; Spot check of patient records, doctor’s notes |
Y
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N
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Doctor coverage available 24-hours; Doctors on call register/Duty Rota displayed
|
Y
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N
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Patient notes are recorded; check inpatient files
|
Y
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N
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Discharge summaries are made; check recent discharges
|
Y
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N
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Equipment
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|||||
Adult resuscitation trolley present
|
Y
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N
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Evidence that resuscitation trolley equipment was checked within last 24 h
|
Y
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N
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Available
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Working
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Defibrillator (accessible within 3 minutes)
|
Y
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N
|
Y
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N
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Oxygen supply
|
Y
|
N
|
Y
|
N
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Suction Machine
|
Y
|
N
|
Y
|
N
|
|
ECG
|
Y
|
N
|
Y
|
N
|
|
BP apparatus
|
Y
|
N
|
Y
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N
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Drug and Supplies
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|||||
Intravenous Solutions
|
Y
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N
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Medicines according to essential drug list (MCC
|
Y
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N
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2
List?)
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Patients receive their medication on time; do spot check of patients in ward
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Y
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N
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Anaphylaxis tray available
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Y
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N
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SECTION 3:PAEDIATRIC WARD
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Protocol and Patient Care
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Child and infant CPR protocol visibly displayed
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Y
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N
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Treatment guidelines available
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Y
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N
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Rehydration charts visibly displayed
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Y
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N
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Guide lines on nutrition available
|
Y
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N
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Health Messages (Breast Feeding, hand washing and vaccination) displayed.
|
Y
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N
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Equipment
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Paediatric resuscitation trolley present
|
Y
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N
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Evidence that resuscitation trolley equipment was checked within last 24h
|
Y
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N
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Accommodation available for mother
|
Y
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N
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Oral re-hydration therapy corner / area
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Y
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N
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Procedure room / area for lumber puncture, blood taking, etc.
|
Y
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N
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3
Isolation ward or room
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Y
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N
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Intravenous solutions for neonates and children
|
Y
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N
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Un interrupted Oxygen supply available
|
Y
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N
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Nebulizer and medicines for nebulization
|
Y
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N
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SECTION 4: GYNAE/OBS
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Protocols and patient care
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The following guide lines are available:
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Breast feeding guide lines/Breast Feeding Ordinance
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Y
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N
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Neonatal resuscitation guidelines
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Y
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N
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Contraception protocol
|
Y
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N
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STD/HIV protocol
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Y
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N
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Cervical cancer screening protocol
|
Y
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N
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Equipment
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Resuscitation trolley
|
Y
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N
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First stage room
|
Y
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N
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Delivery room
|
Y
|
N
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Fully equipped theatre accessible
|
Y
|
N
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Laboratory service for blood tests (routine and
rapid) |
Y
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N
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X-Ray facilities
|
Y
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N
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SECTION 5: CASUALTY
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Protocols and patient care
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CPR protocols visible
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Y
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N
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Glasgow coma scale measurement chart visible
|
Y
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N
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4
Doctor coverage available 24 hours (doctors duty register/duty roster displayed)
|
Y
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N
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Equipment
|
N
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Ambulance along with driver
|
Y
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N
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Emergency trolley present
|
Y
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N
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Evidence that emergency trolley equipment was checked within last 24hrs
|
Y
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N
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Oxygen masks available in full range of sizes
|
Y
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N
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Available
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Working
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BP apparatus
|
Y
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N
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Y
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N
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Defibrillator
|
Y
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N
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Y
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N
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Oxygen supply
|
Y
|
N
|
Y
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N
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Suction Machine
|
Y
|
N
|
Y
|
N
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Glucometer
|
Y
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N
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Y
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N
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Nebulizer and medicines for nebulisation
|
Y
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N
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ECG
|
Y
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N
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Drugs and Supplies
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Availability of the following:
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Resuscitation drugs
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Y
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N
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Gloves and aprons
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Y
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N
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Reliable oxygen supply
|
Y
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N
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I/V cannulae different sizes
|
Y
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N
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Gastric tubes different sizes
|
Y
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N
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Urinary catheter different sizes
|
Y
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N
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Emergency ultrasound and x-ray facilities available
|
Y
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N
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5
Facilities for cross match and supply of blood
|
Y
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N
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SECTION 6: OPERATION THEATRE
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Equipment/Facilities
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Available
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Working
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Operating theatre with dedicated uninterrupted power supply
|
Yes
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No
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Yes
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No
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Standby electricity generator
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Wash basins and tape water
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Over head lamps
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At least one fully functioning, regularly serviced anaesthetic machine
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Surgical instruments for range of operations
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Standby suction machine
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Diathermy machine
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Pulse oximeter
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Ventilator to support patients with delayed recovery
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Sterilized equipment
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Yes
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No
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Post-operative recovery area
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Y
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N
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Drugs & supplies
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Yes
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No
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Bandages, dressings
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Y
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N
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Full range of suture material
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Y
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N
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Anaesthetic gases (oxygen, nitrous oxide, compressed air) present
|
Y
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N
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Anaesthetic drugs (local and general)
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Y
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N
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Theatre sterilisation
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Y
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N
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Soap and surgical scrubs
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Y
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N
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SECTION 7: OPD
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6
Standard treatment guide line available
|
Y
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N
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Situation in the waiting room acceptable
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Y
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N
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Emergency resuscitation trolley available and recently checked
|
Y
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N
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Diagnostic set (ophthalmoscope and otoscope)
|
Y
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N
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A short stay area for observation of acute patients
|
Y
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N
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Dressings
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Y
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N
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Sufficient staff(doctors, Paramedics, Ward Boys, Dais and Sweeper etc.) available at all times
|
Y
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N
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Clinical support services: X-ray, Ultrasound and laboratory service available from 8 am to 2pm six days a week.
|
Y
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N
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Investigation results available in time: evidence
|
Y
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N
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SECTION 8: PHARMACEUTICAL SERVICES
|
Yes
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No
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Racks/shelves for storage of medicines present
|
Y
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N
|
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Adequate cold storage including thermometer for heat sensitive products
|
Y
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N
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Medicine according to EDL(MCC list for DHQ hospitals) all available
|
Y
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N
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Documented evidence that the cold chain is maintained at all times
|
Y
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N
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Accuracy in drug supply record-keeping and effectiveness of stock management
|
Y
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N
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7
Medicines stored in a specific order (alphabetic or according to diseases)
|
Y
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N
|
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LIFO(last in first out) FIFO (first in first out)
JIT (Just in time) or any other method used for distribution of medicines |
Y
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N
|
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Expired medicines found in racks
|
Y
|
N
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All medicines labeled
|
Y
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N
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MCC list available
|
Y
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N
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Pharmacist/trained personnel for pharmacy available
|
Y
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N
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SECTION 9: BLOOD BANK
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Availability of staff
|
Y
|
N
|
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Availability of blood
|
Y
|
N
|
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Availability of transfusion kits
|
Y
|
N
|
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Facility for screening blood for HIV/Hbs and HCV
|
Y
|
N
|
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Blood storage facilities
|
Y
|
N
|
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SECTION 10: PERSONNEL
|
Sanction position
|
Posted No
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Present No
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Specialist
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Medical Officers
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WMO
|
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Nurses
|
8
Paramedics
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Sweeper/Cleaner
|
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Other (specify)
|