Medical Superintendent's Checklist for District & Tehsil Hospitals

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



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

Paramedics
Sweeper/Cleaner
Other (specify)

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