How to acheive NABH Standards in PHC & CHC Part 4 4

How to achieve NABH “Output” Standards in PHCs

Dr J L MeenaState Quality Assurance Officer

Department of Health & Family welfare

Government of Gujarat

Email:- [email protected]

Web:- www.gujhealth.gov.in/quality-assurance-program.htm399

mailto:[email protected]

http://www.gujhealth.gov.in/quality-assurance-program.htm

SECTION – D:Outcome Standards

33. Utilization Indices of the Centre

Objective Elements• Centre to record all parameters as stated in the

monitoring section of the IPHS.• Utilization of OPD, IPD, X-ray (only for CHC),

Labor Room, Man Power, Laboratory services, Referral services (to & from the facility), ambulance services, MLC services to be analyzed and maintained for continuous quality improvement.

Centre to record all parameters as stated in the monitoring section of the IPHS

Sr.

No.

Procedure Monthly Progres

sive

1. Total new cases 1604 17747

Old cases 457 5030

Total OPD 2061 22777

Average OPD/Day 66 68

2. Total delivery 2 16

Total operation 0 0

Other IPD 60 398

Total IPD 62 414

Average IPD/Day 2 1.23

Total bed days 23 187

BOR 0.77 0.55

3. Details of operations

TL 0 0

N.S.V 0 0

MTP 0 0

Hydrocele 0 0

Other Operation 0 0

Total operation 0 0

Sr.

No.

Procedure Monthly Progre

ssive

4. Services of laboratory

Tested BS 2286 18324

Total No. of Sputum tested 44 543

Sickling test 0 0

Electrophoresis 0 0

Hb 63 674

Blood Group 14 265

Pregnancy test 37 292

No. of Urine test 25 391

Other 0 10

Total 2469 3499

5. Referral services

No. of patients referred from

PHC

5 31

No. of patients refer back to

PHC

0 0

How much patients got

Referral transport service

0 0

6 Other MLC 0 0

Total MLC 0 0

Centre to record all parameters as stated in the monitoring section “National Health Prorgamm” of the IPHS

1Medical Care

2Reproductive And Child Health

*Antenatal Care

* Intranatal Care

* Postnatal Care

* New born Care

*Care Of the Child

* Family Planning

* MTP

* RTI / STI

* Nutritional Services

*Adolescent Health Care

3Integrated Disease Surveillance Project

4collection And Reporting of Vital Events

5BCC And Health Education

6Revised National T.B Control Programme

7National Leprosy Eradication

Programme

8National Programme For Control Of Blindness

9National Vector Borne Disease Control

Programme

10Integrated Management Of Neonatal & Childhood

Illness

11National Aids Control Programme

12National Programme Of Prevention & Control Of

Deafness

13National Cancer Control Programme

14National Mental Health Programme

15National Programme On Prevention & Control Of

Diabetes cvd & stroke

16National Iodine Deficiency Disordar Control

Programme

17National Programme Of Prevention & Control Of

Fluorosis(In Endemic)

18National Tobacco Control Programme

19National Programme For Health care Of Elderly

20Oral Health

21Physical Medicin And Rehabilitation services

22Referal Services

23Training



ECG UTILIZATION IN PERCENTAGE

MonthECG Utilization in

%(in round figures)Total

January 11 10% 221

February 11 11% 231

March 11 10% 223

April 11 05% 113

May 11 07% 149

June 11 06% 121

August 11 06% 125

September 11 06% 138

October 11 08% 167

ECG Utilization

ECG Average Time = 10 mins / ECGECG machine in the hospital = 03 Per day =24 ECG/machine (if one machine is used for4 hrs) Per day = 72 ECG (Total no. of ECG thatcan be done in one day if all the 3 machineswork for 4 hrs)

Working note:-No. of ECG Machine = 03Working hrs in a day = 4 hrs which is 240 min /dayAverage time taken for 1 ECG = 10 mins.Hence total no. of ECG that can be done in:•one machine per day = 240/ 10= 24•3 machines per day = 24*3 = 72•one month = 72 * 30 = 2160Hence utilization rate for the month of January 11= 221 / 2160 * 100 = 10.23%

Utilization of OPD, IPD, X-ray (only for CHC), Labor Room, Man Power, Laboratory services, Referral services (to & from the facility), ambulance services, MLC services

to be analyzed and maintained for continuous quality improvement

OT UTILIZATION IN PERCENTAGE

OT Utilization

Operation Theatre = 01

Average time per case = 30 mins per

case

The OT functions for 4 hours per day

Working Note:-

If the OT works for 4 hours per day i.e. 240

mins, then at least 8 cases can be done.

Then per day 8 cases can be done (if OT

functions for 4 hours per day)

Therefore in one month = 8 * 26 = 208 cases

(The OT functions 6 days a week only)

Hence, the Utilization Rate for the month of

January 11 = 224 / 208 * 100 = 107.69%



Month

OT UTILIZATION

IN %(in round

figures)

TOTAL

OT(MINOR)

January 11 108% 224

February 11 63% 132

March 11 108% 225

April 11 65% 135

May 11 64% 133

June 11 80% 166

July 11 73% 151

August 1171%

148

September 1175%

156

October 1168%

142





LABORATORY UTILIZATION IN PERCENTAGE



LABOUR ROOM UTILIZATION IN PERCENTAGE

MonthTOTAL TEST

LABORATORY UTILIZATION %

Jan 11 689 111.83

Feb 11 528 93.93

Mar 11 665 117.7

Apr 11 705 119.6

May 11 1000 153.88

June 11 877 151.56

July 11 735 120.35

Aug 11 634 540.34

Sect 11 763 650

Oct 11 674 574.43

Nov 11 625 532.67

MonthTOTAL

DELIVERYLABOUR ROOMUTILIZATION(%)

Jan 11 7 2.91

Feb 11 10 4.03

Mar 11 21 8.75

Apr 11 22 8.87

May 11 13 5.24

June 11 17 6.85

July 11 7 2.91

Aug 11 19 7.91

Sect 11 18 7.25

Oct 11 21 8.46

Nov 11 12 5.35

LABORATORY TECHNICIAN UTILIZATION IN PERCENTAGE



Working Note:- Average time per test as follow

For blood for mp = 15 min.

For HB= 10min.

For blood group=5min.

For HIV= 20min.

Urine Alb, Sugar=5 min.

Urine Pregnancy test=5min.

Sputum AFB =30min.

LT works 8 hours per day .total 24 days in a month ( 4 sunday+1day meeting in Ahmedabad +1 day meeting at H.Q)

8 hours*5days= 40hours (Monday to Friday)

4 hours*1 = 4 (Saturday) i.e. 44 hours total in a week

44 * 4 = 176 hours = 10560 min.

If LT works for 10560 min in a month then it corresponds to 100%

E.g : in month of oct.09 LT has done 12710 min. work, utilization rate of LT = 12710/10560*100 = 120.35

34. Statistics

Objective Elements• Statistics in terms of OPD attendance, BOR,

ALOS, BTO, Birth Rate, Death Rate, Minor and Major Operations etc. to be documented and reported.

• A bulletin is published every quarterly stating the above details.

Statistics in terms of OPD attendance, BOR, ALOS, BTO, Birth Rate, Death Rate, Minor and Major Operations etc. to be documented and

reported

Name of Indicator Month

July Aug Sep Oct Nov Dec Jan-11 Feb-11

Bed occupancy rate 23.88 /

month

21.11

/month

18.33m

onth

19.44/

month

17.7 /

month

38.7 /

month

39.78 /

month

21.42 /

month

Average length Of

stay

1.3

/month

1.22/

month

1.14/

month

1.12/

month

1.23 /

month

1.2

/month

1.42 /

month

1.38

/month

% Of institutional Of

delivery

86%/

month

94%/

month

94%/

Month

94%/

month

96% /

month

95%/

month

95%

Month

92% /

month

Incidence Of hospital

associated infection

2 1 1 1 0 1 2 1

No Of needle Prick

injuries / Month

0 0 0 0 0 0 1 0

NO Of instances Of

medication error

0 0 0 0 0 0 0 0

No of sentinel /Near

miss events/ Month

0 0 0 0 0 0 0 0

A bulletin is published every quarterly stating the above details

35. Reporting of Birth, Death and Other Detail

Objective Elements• All the birth and the death in the centre and the

population to be reported to the concerned Gram Panchayats, Nagar Palikas, Municipal Authorities and other local authorities.

• Incidence and prevalence of diseases to be reported to the district authorities.

• Epidemics and communicable diseases to be reported to the authorities.

• Accidents and mishaps should also be reported to authorities as per decided timelines.

All the birth and the death in the centre and the population to be reported to the concerned Gram Panchayats, Nagar Palikas, Municipal Authorities and other local authorities

Village Wise Sex Ratio 2010

Sr.no. Village Male FemaleTotal Birth Sex Ratio

1 Jetalpur 88 79 167 897

2 Gamadi 16 14 30 875

3 Chosar 20 21 41 1005

4 Istolabad 17 19 36 1011

6 Giramatha 24 26 50 1008

7 Naz 32 36 68 1012

8 Bareja -1 67 42 109 626

9 Bareja -2 67 61 128 910

11 Bareja-3 67 64 131 955

13 Bareja-4 65 68 133 1046

S], 463 430 893 929

Incidence and prevalence of diseases to be reported to the district authorities “by IDSP”

Epidemics and communicable diseases to be reported to the authorities “by IDSP”

Accidents and mishaps should also be reported to authorities as per decided

timelines

36. Medical Records

Objective Elements• The contents of the medical records are pre defined.• An audit of the medical records is carried out every

quarter.• The records are kept at for pre defined duration as per

the policy.• There shall be provisions for storing and retrieval of

the records.• All entries by the doctors and nurses are legible and

complete.• All records must be computerized for accurate record

maintenance.

The contents of the medical records are pre defined




An audit of the medical records is carried out every quarter

65%

70%

75%

80%

85%

90%

76%

80%

90%

77%

90%

% of cases where initial assessment of indoor patients completed within time limits

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

52%

57%

80%

47%

88%

% of cases where in care plan is documented & signed by the Medical officer

An audit of the medical records is carried out every quarter

The records are kept at for pre defined duration as per the policy as per Government of Gujarat Guideline

The records are kept at for pre defined duration as per the policy as per Government of Gujarat Guideline

There shall be provisions for storing and retrieval of the records

All entries by the doctors and nurses are legible and complete

All records must be computerized for accurate record maintenance

37. Patient & Employee Satisfaction Survey

Objective Elements• On going mechanism of conducting patient satisfaction

through involvement of consumer forums, RKS and PRI members shall be present.

• On going mechanism of conducting employee satisfaction shall be present.

• Centre should have Grievance Redress Policy and mechanism.

• Centre should have in use feedback mechanism like use of feedback forms, suggestion forms to be dropped in suggestion / complaint boxes at identified places.

On going mechanism of conducting patient satisfaction through involvement of consumer forums, RKS and PRI members shall be present



0

10

20

30

40

50

60

70

80

90

100

82

86

81 80 8274 77 76

80 79

96 9489

82 81 82

9288

%

QUESTIONS

On going mechanism of conducting employee satisfaction shall be present

Centre should have Grievance Redress Policy and mechanism

Centre should have Grievance Redress Policy and mechanism

Centre should have Grievance Redress Policy and mechanism “ Remarks & suggestions in Visit book ”

Centre should have in use feedback mechanism like use of feedback forms, suggestion forms to be dropped in suggestion / complaint

boxes at identified places





38. Health Information System

Objective Elements• Community statistics like IMR, MMR, Birth Rate,

Death Rate etc. to be documented and reported.

• Reporting of all the details to be done through a web based health information system to the authorities on a daily, weekly, monthly and annual basis.

• Health Information System tools should be as per the state directives.

Community statistics like IMR, MMR, Birth Rate, Death Rate etc. to be documented and reported

Sr.

no.Indicators 2004 2005 2006 2007 2008 2009

1 Total Birth 814 778 820 763 736 802

2 Total Death 210 225 172 194 165 168

3Total infant

death25 21 27 21 17 22

4Total Maternal

death02 0 01 0 0 0

Reporting of all the details to be done through a web based health information system to the authorities on a daily, weekly, monthly and

annual basis

Health Information System tools should be as per the state directives

Health for All

Healthcare

How to acheive NABH Standards in PHC & CHC Part 4 4