India Karnataka PHC Quality Assessment Web viewPrimary excision and care of burns. ... DDCs & Fever treatment depots established. ... Plan clear and followed but not covering all anganwadis

PART- 1

FORM 1: PHC QUALITY ASSESSMENT CHECKLIST

QUALITY ASSURANCE GROUP VISIT

IDENTIFICATION

State:__________________ District: ________________ Taluka: _________________

Block: ____________ Distance from District HQ (Kilometers) ________________________________________

Name & Address of Facility

PHC Staff respondents

Name Designation1 _____________________________ __________

2 ______________________________ __________

3 ______________________________ __________

4 ______________________________ __________

DQAG MembersName Designation

1. ____________________________ ____________

2. ____________________________ ____________ 3. ____________________________ ____________ 4. ____________________________ ____________

Date when last supervisory visit was made by DHO/CS/ADHO/THO to review QA ‘actions plan’ or to provide facilitative supervision on QA: ___________________________ Time started assessment: _________ Time ended assessment: ___________

Date of Assessment: __________ Signature of the Team Leader DQAG

1

GENERAL INFRASTRUCTURE MANAGEMENT

Q. No.

Sub-elements

Instructions: On day of visit. Ask MO I/C and/or other staff and fill

the following questions

Response

Score

(0)

Score

(1)

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(2)

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(4)

A B C D E

QA.1 Compound Wall / fencing including bio fencing

None Partial All around but without gate

Compound with gate

QA.2 Condition of plaster on walls and paint

No plaster / Not painted in the past

two years

Plaster coming off in places

Well plastered

Not painted in the past one year

Well plastered and painted in past one

year

QA.3 Condition of floor No proper flooring Flooring coming off in a places

Floor in good condition

QA.4 Cleanliness Dirty with un cleared garbage.

Cobwebs in building

Stains on wall and floor. Needs

thorough cleaning

Fair Good Excellent

QA.5 Is a garbage dump close to the PHC

Yes No

QA.6 Surrounding environment of PHC with its compound

Unclean with weeds Unlevelled ground, but clean

Clean with saplings planted

Greenary present but not maintained

properly

Well maintained garden

2

Q. No.

Sub-elements



Response

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A B C D E

QA.7 Is there prominent display boards regarding service availability

No Yes, but not in good condition

In good condition but not properly

displayed

Highly visible and impactive

QA.8 Are IEC posters displayed properly and aesthetically

No Poor Fair Good Excellent

QA.9 Location of pharmacy No pharmacy / In inconvenient corner

In a conspicuous place easily identified

B + well fabricated counter

C + IEC displayed

QA.10 Pharmacy for drug storage and dispensing (cleanliness, maintenance of records and bin cards, arrangement of drugs etc.,)

No BIN cards or illegible BIN cards.

Badly maintained. Mediocre with incomplete BIN

cards

Well maintained. Updated properly

displayed BIN cards

QA.11 Waiting space for patients and wards

No Waiting area with out adequate seating

facility

Waiting area with adequate seating

facility

Well arranged with seats and safe drinking water

provision.

D + IEC well displayed

3

Q. No.

Sub-elements



Response

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A B C D E

QA.12 Emergency / Casualty room No Yes but not well set with water supply. No MLC register

Well set with stomach wash area and water supply

but without emergency

medicines. MLC register not updated

for more than a week

Well equipped including

emergency medicines.

MLC register updated but not as

on date

Well equipped including

emergency medicines.

MLC register updated as on date

QA.13 Availability of easy, free access to condoms

No. Box is kept but no condoms inside

Supplied at pharmacy on

request

Box with condoms kept for easy access

QA.14 Dressing Room No separate room or designated place for

dressing

No separate room but a clean

designated place for dressing

A separate dressing room with all

essential consumables for dressing but not

properly organised

A well organised dressing room. Cap

of consumable containers not

closed

Well organised, cleanly maintained with water supply.

4

Q. No.

Sub-elements



Response

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A B C D E

QA.15 Labour room No labour room Poor physical state. No Uninterrupted power supply and

water supply

As per specification but without

uninterrupted power and water supply. Use of designated

footwear

As per specification with uninterrupted

power and hot water supply. Suction machine with

oxygen cylinder

In excellent condition. With attached toilet.

Clearly displayed PPH & Eclampsia protocol. APGAR

scoring

QA.16 Wards No clear demarcated ward

Only post labour ward

Post labour ward with attached toilet

well maintained

C+ general ward well maintained

All wards with clean and tidy beds and

linen

QA.17 Toilets / wash rooms Unclean, non functional

Functional but not always clean. No

water supply inside

Functional with water supply but not

always clean

Clean

QA.18 Laboratory No lab Lab has only uni-ocular microscope

Lab has binocular microscope but with inadequate supply of consumables

Lab has binocular microscope but with adequate supply of

consumables

Well equipped, neatly maintained

lab with datum charts

QA.19 Bio Medical Waste management

Nil Only pit Clear segregation, collection system

established. But not proper disposal

Clear segregation, collection, and disposal system

established.

Laison with CTF/local bodies for effective final

disposal

5

Q. No.

Sub-elements



Response

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A B C D E

QA.20 Mortuary No Without PM table, without water

supply & electricity

With PM table, with water supply &

electricity, but not properly

maintained

With PM table, with water supply & electricity, well

maintained

QA.21 Cold chain room No Only ILR present and functioning

without stabilizer directly plugged in

ILR & deep freezer present and

functioning without stabilizer

ILR & deep freezer present and

functioning with stabilizer

QA.22 Store Room No store toom, or articles just piled up

or stocked up

Improperly maintained store

room

Clean and well arranged without

proper documentation

Clean and well arranged with

proper documentation

QA.23 Optometrist room No Present without Snell’s chart

Present with Snell’s chart and colour

identification

Score Obtained (max-74) =

6

SERVICES:

OPD Management

Q. No.

Sub-elements

Instructions: On day of visit ask MO I/C and/or other staff and fill the

following questions

Response

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A B C D E

QA.1 Out patient registration No registration Slip is issued but not recorded

Record of OP maintained

Record of OP maintained +

patients are guided

D + OP book given

QA.2 Availability of Doctor No doctor Incharge doctor is available some days

in a week

A doctor is available on all days, but not

residing in HQ

Doctor resides in the village where PHC is located

Doctor resides in the PHC boundaries

giving service round the clock

QA.3 Availability of drugs Essential drugs not available

Essential drugs available. Vital

drugs not available

Essential and vital drugs available.

Desired drugs not available

All VED drugs available but not in dispensing counter

All VED drugs available in

dispensing counter

QA.4 Dressing room quality of maintenance and service

No dressing room Dressing room present. Unclean,

no water supply and outlet.

Dressing room has water supply and

outlet, but not clean and tidy.

Dressing room clean, but no water supply nor outlet.

Dressing room clean with water

supply and outlet. All dressing

materials and chemicals available

7

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.5 Are patients reaching PHC after OPD hours attended to.

Not attended to Yes attended to, but only by group D

Yes attended to, but only by group D and SN/JHAF

Yes attended to, by doctor only.

Yes attended to, by doctor, SN/JHAF,

and group D

QA.6 Primary wound care Only superficial wound dressing

done without application of

relevant antiseptics

Wounds dressings done with

application of antiseptics

Wounds dressing, suturing of wounds

done with only threads

Wounds dressing, suturing of wounds done with catguts

also

Wounds dressing, suturing of wounds done with catguts

also. Repair of earlobes

QA.7 . Primary care of injuries - orthopaedic

No orthopaedic support available

Slings, slabs and other supports are

only given

B + POP followup done

Closed reductions are done. No

inpatient admission. Referred out

Closed reductions done and admitted

QA.8 Minor Surgeries Only drainage of abscess done

Drainage of abscesses, excision of cysts (sebaceous)

etc.

Primary repair of incisional wounds

done

Excision of cysts on face and periorbital

area done

Bull gore and other animal inflicted

injuries attended to

QA.9 Management of burn injuries Not done Only application of antiseptic ointments and dressing done

Application of antiseptic ointments

dressing and correction of electrolyte

imbalance done

Primary excision and care of burns /

scald etc. done

Primary excision and care of burns.

Admission as inpatients and

adequate care given

8

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.10 Primary management of OP poisoning, insect bites,

Not attended to Stomach wash/primary care

B + Treated as inpatient


Maternal Care

Q. No.

Sub-elements

Instructions: On day of visit ASK MO I/C and/or other staff and fill the

following questions

Response

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A B C D E

QA.1 Pre Natal More than 40% of ANC registered are

in 3rd trimester

ANC registration in 3rd trimester

between 30% and 40%

ANC registration in 3rd trimester less

than 30%, with all primy gravidas

given 2 doses of TT. Min 3 ANC

checkups

C + all primy gravidas given 2

doses of TT + 100 tabs of IFA. High risk pregnancies

identified. IV iron sucrose. More than

3 ANC

C +D + Health education on pregnancy, lactation,

immunisation, nutrition and benefits of

institutional deliveries

9

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.2 Natal Deliveries conducted only in

day time

More than 30% of deliveries at night

10units of Oxytocin given. Usage of

partograph

B + Episiotomy given to all primy

gravidas Tab Misoprostol for

prevention of PPH. Complete

sterilisation of instruments

B + C + Child is breast fed within ½

hr of delivery

B + C + D + Usage of umbilical clip

QA.3 Post Natal No sanitary care or education given

Sanitary care and sanitary education

given

B + Clean post natal ward/room with facility for

warming food and milk

B + C + Madilu kit given ensuring 48 hrs stay. Education on immunization

and nutrition

B + C + D + food given to mother and

1 attendant

QA.4 child care No baby corner in labour room

Baby warmer with photo therapy

B + mucous suction apparatus used. Education on burping child

B + C + At birth dosage of BCG, OPV & Hep B

B + C + Clinical Child assessment


Immunisation10

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.1 Place of immunisation No clear designated place in the PHC

Clear designated room but also used for other purposes

on non immunisation days

Room exclusively for immunisation

C + excellent IEC with display of

universal immunisation programme

D + IEC on nutrition,breast

feeding etc.,

QA.2 Cold chain maintenance T series vaccine found in deep

freezer

Used vials kept in ILR

No temp chart

Vaccines stored as separated boxes in provided baskets in ILR with T series at

the bottom.

Any other drugs other than vaccine

Temp chart updated till last week. No power cut details.

C + Thermometer is optimally

functioning

D + 1 foot space all around ILR and

deep freezer. Stabilizer is clearly visible in proximity. No more than 1mm

frosting

QA.3 Vaccine stock Some or all vaccines stock out

Expired vaccine stored

Partially used vaccine vials

present

Vaccines present but no

corresponding solvents

Vaccines and solvents available but solvents not

stored at ILR temp.

Vaccines and solvents available

and solvents stored at ILR temp.

11

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.4 Usage of AD syringe Not available Use disposable other than AD

syringe

Use AD syringe

QA.5 IEC of immunisation None displayed Randomly displayed

Displayed in waiting room

Displayed in waiting room as

well as immunisation room

D + education sessions on

immunisation conducted

Trickler bag/box maintained

QA.6 Immunisation day No fixed day Planned days only Fixed day of the week (Thursday)

C + Out reach immunisation done under supervision

QA.7 Vaccine distribution Not done Supplied to SCs day before

immunisation

Supplied to SC on the day of

immunisation in 4 pack vaccine carrier

Total Score (max-22)=

12

Wound Management

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.1 Availability of consumables for dressing

Only povidone I2 or tincture iodine

available

A + spirit available B + antiseptic solutions/ointments available with clean

neat dressing materials

C + POP powder available

D + antiseptic tunnules available

QA.2 Orthopaedic management None Only sprains managed

Closed reduction of limbs done with immobilisation

Post immobilisation POP application

done

QA.3 Burn/Scald injury management Only primary management

A + antiseptic tunnules

In patient management of

burn/scald injuries present

QA.4 Dog/animal bite Only Primary wound care

A + only TT given B + ARV given appropriately

C + education on post exposure profile access

D + high risk pre exposure

vaccination education given

QA.5 Snake bite Only primary wound care

A + TT given B + ASV C + in patient care

13

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.6 Bee and other Insect bites Only primary wound care

A + TT given B + outpatient line of medical care

given

C + in patient care

QA.7 Eye injuries Preliminary primary care done

A + sterile bandaging done

Foreign bodies from congenctival sack

removed under local anaesthesia


In-patient Care

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.1 Bed occupancy during the assessment period

No occupancy in a month

No occupancy for any fortnight

Occupancy only for MCH care

C + MLC and RTA cases

D + chronic or acute medical and

surgical cases

14

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.2 Life saving emergency drugs No IV fluids available

Only IV fluids available

B + IV broncho dialators and

oxygen available and used

C + Local anaesthetics

available and used

D + Respiratory stimulants available

QA.3 Diet No diet given Only two times meal given

Breakfast and two meals given

C + Provision for warming food

QA.4 Availability of health care providers

Only Gp D on duty in the night

A + Staff nurse residing in campus

A + Staff nurse on duty

C + Doctor giving services on call in

night also

C + Doctor residing in campus and

giving services in night also

QA.5 Hygiene No water supply Limited period water supply

Round the clock water supply

B/C + hotwater supplied

QA.6 Linen No linen or unclean, torn/damaged

bedsheets/blankets/ screens/curtains

Bed sheets, blankets, screens

and curtains undamaged but

unclean

Bed sheets and blankets, clean and

undamaged, but screens and curtains

unclean

Bed sheets, blankets, screens and curtains clean and undamaged

D + In-patient clothing given to

patients

Score obtained (max-22) =

15

PREVENTIVE CARE (Communicable diseases)

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.1 Diligent monitoring Provisional diagnosis not

recorded in the OPD register (Only

Symptoms recorded)

Provisional diagnosis recorded with treatment, but

no record of address & no daily

abstract

Provisional diagnosis, treatment and address clearly

recorded, but no daily abstract put.

Provisional diagnosis, treatment and address clearly recorded, and daily

abstract put

IEC activities of possible public

health challenge of that period planned

and done

QA.2 Diligent preventive health care activity

Staff nurse/pharmacist/ HQ JHAF only

records the noticed trend but no

communication given to concerned

people

Directions on preventive health

care given to health education staff

The MO and Senior health assistants are

well aware of the situation and action

taken

Junior Health Assistants

implement the health care activity after the report of

outbreak

Junior Health Assistants

implement the preventive health

care activity in time before the outbreak

QA.3 Malaria - Filaria - NVBDCP No passive smears collected only active smears

collected and sent for examination

Active & Passive smears collected but smears are stained after >5 days of date of

collection

B but smears stained before 5 days of date of

collection

C+ smears examined after 7 days of date of

collection

C + smears examined within 7

days of date of collection

16

Q. No.

Sub-elements


following questions

Response

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A B C D E

QA.4 Malaria - Filaria - NVBDCP contd.. DDCs established DDCs & Fever treatment depots

established

Malaria clinics conducted

Regular planned spraying conducted

QA.5 Radical Treatment for malaria RT initiated after 10 days of

confirmation

RT initiated between 8-10 days

of confirmation

RT initiated between 5-7 days of

confirmation

RT initiated between 3-5 days of

confirmation

RT initiated between within 3

days of confirmation

QA.6 RNTCP (Tuberculosis) No sputums collected. Chest symptomatic are

referred to another institutions

Sputums from chest symptomatic

collected and sent for examination on

the same day of collection

Sputum smears are prepared (good

quality) and sent for examination

Sputum smears are prepared, stained and examined on

the same day

D+ categorisation done and treatment

initiated.

QA.7 DOTS None Cat-1 DOTS only given

Cat-1 & 2 DOTS given

C + Cards not updated

C + cards properly updated

QA.8 Leprosy None IEC on leprosy done, but no cases

identified

IEC done but only PB cases detected

and treatment initiated

C+ MB cases also detected and

treatment initiated

D + cards updated

Score obtained (max-32) =

17

PREVENTIVE CARE (Non Communicable diseases)

Q. No.

Sub-elements


following questions

Response

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(0)

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(1)

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(4)

A B C D E

QA.1 Blindness control No examinations of the eye done

Screening for cataract done only

in PHC on designated dates by

optometrist (PMOA)

B + Screening for cataract done by MO on all days

C + school health screening also done

D + screening done on planned days of

camps

QA.2 Anaemia Only Assessment of anaemia done

Only IFA tabs distributed

B + IEC displayed in PHC

C + IEC on local nutrition done. Hb % done (Sahli’s

method)

D + follow up of anaemia done and

recorded

QA.3 School Health Checkup No clear plan Plan clear but not followed

Plan clear and followed. Reporting

delayed

Timely reporting Followup of referred students

done

QA.4 Anganwadi Health Checkup No clear plan Plan clear but not followed

Plan clear and followed but not

covering all anganwadis during

each quarter

Plan clear and followed covering

all anganwadis during each quarter

C + adequate stock of ORS and

optimally utilised


18

FAMILY WELFARE PROGRAMME

Q. No.

Sub-elements


following questions

Response

Score

(0)

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(1)

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(2)

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(3)

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(4)

A B C D E

Temporary Methods

QA.1 Contraceptive Condoms No IEC on CC nor free CC dispensing

box

Box of CC present but empty. Few

posters of IEC on CC in non

conspicuous places

B + CC present in the box and IEC on

CC in clearly visible places

C + adequate stock stocked in the PHC

D + regular issual and recording of issual of CC to

health assistants. IEC on CC

exhibited on shandy days in shandy

QA.2 Oral Contraceptive Pills No IEC on OCP. No stock of OCP or

no distribution in the past month

IEC on OCP present in non-

conspicuous places. OCP dispensed to

health assistants but not dispensed in

PHC.

IEC on OCP in clearly visible places. OCP

dispensed during OPD regularly.

Relevant records maintained

C + Awareness on OCP given during

mahila arogya sangha meetings

D + IEC on OCP exhibited on shandy

days in shandy.

QA.3 Emergency Contraceptive Pills No IEC on ECP. No stock

IEC on ECP present in non-conspicuous

places. ECP dispensed to health assistants but not

dispensed in PHC.

IEC on ECP in clearly visible places. ECP

dispensed during OPD. Relevant

records not maintained

IEC on ECP in clearly visible places. ECP

dispensed during OPD. Relevant

records maintained

D + appropriate counselling given

19

Q. No.

Sub-elements


following questions

Response

Score

(0)

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(1)

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(2)

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(3)

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(4)

A B C D E

QA.4 Intra uterine contraceptive device No IEC on ECP. No stock

IEC on IUD present in non-conspicuous

places. IUD inserted only on designated days.

IEC on IUD in clearly visible places. IUD

insertions done as when required by the beneficiary.

Relevant records maintained

C + awareness and counselling done before and after insertion of IUD

D + awareness given on adverse

effects if occurs and also on where to

seek help

Permanent methods

QA.5 Mini-Lap tubectomy No IEC on Tubectomy.

IEC on tubectomy present in non-

conspicuous places. Tubectomy not

conducted

IEC on tubectomy in clearly visible

places. Tubectomy conducted. Relevant records maintained

C + arrangement for food done for

beneficiary and attendant.

D + incentives given during discharge.

QA.6 Laproscopic tubectomy No IEC on Tubectomy.

IEC on tubectomy present in non-

conspicuous places. Tubectomy not

conducted

IEC on tubectomy in clearly visible

places. Tubectomy conducted. Relevant records maintained

C + arrangement for food done for

beneficiary and attendant.

D + incentives given during discharge.

QA.7 No Scalpel Vasectomy No IEC on NSV. IEC on NSV present in non-

conspicuous places. NSV not conducted

IEC on NSV in clearly visible places. NSV

conducted. Relevant records maintained

C + awareness given to spread

message of NSV in community

D + incentives given immediately

after procedure

20

Q. No.

Sub-elements


following questions

Response

Score

(0)

Score

(1)

Score

(2)

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(3)

Score

(4)

A B C D E

QA.8 Achievements Only Laproscopic tubectomy services

given.

Laproscopic and Mini-lap tubectomy

services given

C + NSV services given

D + regular followup of

sterilisation cases done

QA.9 PC & PNDT No IEC IEC present in non-conspicuous places.

IEC in clearly visible places

Awareness and counselling on female child

importance in public

gathering/meetings


OTHER SERVICES

Q. No.

Sub-elements

Instructions: On day of visit ask MO I/C and/or other staff and fill


Response

Score

(0)

Score

(1)

Score

(2)

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(3)

Score

(4)

A B C D E

QA.1 Laboratory services Only blood smear examination for

malarial parasite done

A + urine for sugar & albumin done

B + blood grouping by Sahli’s method +

BT, CT

C + sputum smears examined

D + Pregnancy test done

21

Q. No.

Sub-elements

Instructions: On day of visit ask MO I/C and/or other staff and fill


Response

Score

(0)

Score

(1)

Score

(2)

Score

(3)

Score

(4)

A B C D E

QA.2 Medico Legal Cases None attended to. Only referred

Attended to. Documentation not

clear

Attended to. Documentation

clear

C + needed cases reported to legal authorities after a

week

C + needed cases reported to legal

authorities within a week

QA.3 Post mortem No post mortems done PMs done but no PM register

PMs done. PM register present. Documentation

delay

PMs done, PM register update. But

PM reports submission to legal authorities delayed

PMs done. PM Register update.

Reports submitted promptly.

QA.4 Medical examination for insurances

Not done or no records Done + Proper documentation

QA.5 Medical Termination of Pregnancies

Reported to have done but no records

maintained

Done. Documentation

improper

Done. Proper Documentation

D + in patient care given

QA.6 Arogya Raksha Samithi / RKS ARS non functional ARS meeting very rarely

ARS meeting only once a quarter

ARS meeting alternate months

ARS meeting every month


22

SUMMARY OBSERVATION SHEET

Sl No. Component Observations Directions for improvement

1 Infrastructure Management

2 OPD Management

3 Maternal Care

4 Immunisation

5 Wound Management

6 In-patient Management

7 Preventive Care (Communicable diseases)

8 Preventive Care (Non-Communicable diseases)

9 Other services

10 General Remarks

SUMMARY REPORT23

Infrastructure Management

OPD Management Maternal Care Immunisation Wound

managementIn-patient Service

Total Score applicable 74 38 16 22 23 22

Score obtained

Preventive Care

Communicable diseases

Preventive Care Non-

Communicable diseases

Family welfare Other Services Total

Service Quality Index (Score reduced to 10

pts total)(= 10x S / 300)

Total Score applicable 32 16 35 22 300 10

Score obtained

SQI Less than 4 4 to 4.9 5 to 6.9 7 to 8.9 9 to 10

Grading Needs Improvement Satisfactory Good Very Good Excellent

Grade E D C B A

Signature of Members of DQAG: 1. ……………………………………………………….. 2. …………………………………………………………………

3. ………………………………………………………… 4. …………………………………………………………………..

24

Documents

India Karnataka PHC Quality Assessment Web viewPrimary excision and care of burns. ... DDCs & Fever treatment depots established. ... Plan clear and followed but not covering all anganwadis