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84 views405 pages

Wa0003

Uploaded by

SK Fahim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Published by

Department of Health & Family Welfare


Government of West Bengal

Staff Interview
M A N U A L
R E A D Y R E F E R E N C E FOR S T A F F I N T E R V I E W
(SI) PREPARATION
NQAS LAQSHYA & MUSQAN

NQAS LaQshya & MusQan


INTRODUCTION
From the Desk of State Nodal Officer QA, West Bengal

This book is intended to be a guide for the Staff Interviews (SI) in the context of NQAS, LaQshya &
MusQan Quality certification as per the actual checklist given by NHSRC, MoHFW only. Assessor
might ask questions mentioned in checklists and not included in this book, but this book can be a
valuable tool for staff preparation and will help employees to understand the types of questions they
may face and the expected responses that demonstrate compliance with quality standards. This book
should not be considered as any G.O or guideline book under any circumstances.

The book serves only as a ready reference for Staff Interviews for NQAS, LaQshya & MusQan; it is
not meant to be used as a manual for obtaining certification or clinical guidelines. It is also not meant
to take the place of using the NQAS, LaQshya, or MusQan checklists in their entirety. Only those
who only follow the NQAS, LaQshya, or MusQan checklists will find this book helpful and without
following checklists this book will not help in any way. The answers given to the different questions
presented in this book are based on the guidelines in effect as of right now based on our knowledge,
which have been reviewed and approved by the relevant authorities. However, these may change at
any time in accordance with changes in policy. In accordance with State, National or International
policies and directives, all healthcare facilities should follow the most recent Clinical care and
Infection control guidelines. Although every effort has been made to ensure that the contents of this
book are as clear and accurate as possible, users are cautioned that they cannot hold the State Quality
Assurance Unit, NHM Govt. of West Bengal, or the Hospital Administration Branch Swasthya
Bhawan responsible for any clinical or nonclinical adverse consequences as a result of utilizing it.
This book should not be interpreted as a clinical care or infection control guideline in under any
circumstances; rather, it is intended solely to offer only guidance for Staff Interviews (SI) in
accordance with the NQAS, LaQshya, and MusQan Checklist.

Lastly, I am sincerely thankful to Dr. Arijit Banerjee, State Consultant of State QA Cell, West
Bengal, Hospital Administration Branch Swasthya Bhawan, for his humongous hard work, sincerity
and dedication to make this book possible.

The handbook is written in English and is intended to be printed in hard copy. Separate chapters offer
explanations of different areas per checklists. This book shouldn't be considered as an instruction
manual or guideline book or Government order for any clinical or non-clinical practice, because it is
solely focused on ‗Staff Interview (SI)‘ preparation as per NQAS, LaQshya, and MusQan checklists.

Dr. Nirmalya Roy


State Nodal Officer (QA), W.B
Swasthya Bhawan

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 1


CREDITS:

Prepared, Edited, Reviewed & Customized by:

Dr. NIRMALYA ROY


State Nodal Officer, State QA Cell Swasthya Bhawan, Hospital Administration Branch, W.B
NQAS National Assessor, State & National Mentor of NQAS, LaQshya & MusQan
PGDHQM TISS Mumbai

Dr. ARIJIT BANERJEE


State Consultant QA Cell, Swasthya Bhawan, Hospital Administration Branch, W.B
NQAS National Assessor, National ToT Infection Prevention & Practices MoHFW, GoI
State Mentor of NQAS, LaQshya & MusQan, PGDHQM TISS Mumbai

Special Thanks for Suggestions & Review with Recommendations to the:

1. Dr. Gobinda Chandra Das, Professor & HoD Pediatrics Dept. RG Kar MCH (SQAC member, WB )

2. Prof. Dr. Runa Bal, Obstetrics and Gynecology Department NRS MCH (SQAC member, WB)

3. Dr. Sishir Naskar, Superintendent M R Bangur DH, South 24 pgs (SQAC member, WB & NQAS GoI
External Assessor)

4. Dr. Jayanta Sarkar, Superintendent Krishnagar DH, Nadia ( NQAS GoI External Assessor)

5. Dr. Ananya Ghoshal Mukherjee, Dy CMOH IV, Paschim Bardhaman ( NQAS GoI External Assessor)

6. Smt. Tanusree Bakshi, Sister In charge & ICN, Serampore Walsh Super Specialty Hospital Hooghly.
(NQAS GoI External Assessor & , National ToT Infection Prevention & Practices MoHFW,GoI)

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 2


INDEX:

Sl. No Chapter Page No


i INTRODUCTION: From the State Nodal Officer‘s Desk 01
ii CREDITS 02
iii INDEX 03

A Department Specific
1 Accident & Emergency 04 - 28
2 OPD 29 - 37
3 Labor Room & Maternity Ward 38 - 54
4 Paediatrics Ward 55 - 69
5 SNCU 70 - 85
6 NRC 86 - 93
7 Operation Theatre & Mat – O.T 94 - 116
8 Post Partum Unit 117 - 131
9 Intensive Care Unit / Critical Care Unit 132 - 143
10 IPD 144 - 161
11 Blood Bank 162 - 171
12 Laboratory 172 - 181
13 Radiology 182 - 190
14 Pharmacy 191 - 203
15 Auxiliary Services 204 - 211
16 NBSU (CHC) 212 - 217
17 Blood Storage Unit (CHC) 218 - 222
18 General Clinic (UPHC) 223 - 225
19 Maternity Health (UPHC) 226 - 229
20 New Born & Child Health (UPHC) 230 - 235
21 Family Planning (UPHC) 236 - 242
22 Immunization (UPHC) 243 - 248
23 Communicable Disease (UPHC) 249 - 254
24 Non Communicable Disease (UPHC) 255 - 260
25 Outreach (UPHC) 261 - 265
26 National Health Programe (PHC) 266 - 273
27 Health & Wellness Centre -Sub Centre 274 - 317
B Inventory Management System 318 - 324
C Disaster Management System & Fire Safety 325 - 332
D Quality Management System 333 - 349
E Infection Prevention & Control 350 - 396
F Bibliography 397 - 398

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 3


Department:

Accident
& Emergency

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 4


What are the Patient Rights and Responsibilities?
Patient rights:

 Right to information
 Right to receive records and reports
 Right to Emergency Medical Care
 Right to informed consent
 Right to confidentiality human dignity and privacy
 Right for second opinion
 Right to transparency in care
 Right to non-discrimination
 Right to safety and quality care according to standards
 Right to choose alternative treatment options
 Right to choose source for obtaining medicines or tests
 Right to proper referral and transfer
 Right to protection for patients involved in clinical trials
 Right to protection of participants involved in health research
 Right to take discharge of patient, or receive body of deceased from hospital
 Right to Patient Education
 Right to be heard and seek redressal.

Patient Responsibilities:

 Patients should provide all required health related information to their doctor, in response
to the doctor‘s queries without concealing any relevant information, so that diagnosis and
treatment can be facilitated.
 Patients should cooperate with the doctor during examination, diagnostic tests and
treatment, and should follow doctor‘s advice, while keeping in view their right to
participate in decision making related to treatment.
 Patients should follow all instructions regarding appointment time, cooperate with
hospital staff and fellow patients, avoid creating disturbance to other patients, and
maintain cleanliness in the hospital.
 Patients should respect the dignity of the doctor and other hospital staff as human beings
and as professionals. Whatever the grievance may be, patient / caregivers should not
resort to violence in any form and damage or destroy any property of the hospital or the
service provider.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 5


 Respect privacy and dignity of other patients.

*Source: Charter of Patients’ Rights for adoption by NHRC –vide F.no: Z-28015/09/2018-MH-II

What is Triage and Mass Casualty Management?

Triage and mass casualty management are essential components of emergency medical services
(EMS) and disaster response. They involve systematic approaches to quickly and efficiently
evaluate and prioritize the medical care of a large number of injured or ill individuals when
resources are limited.

Triage:

Triage is the process of sorting and categorizing patients based on the severity of their injuries or
illnesses. The primary goal of triage is to identify and prioritize patients who require immediate
medical attention and resources, ensuring that those with life-threatening conditions receive
prompt care. Triage can occur in various settings, such as emergency departments, disaster
scenes, or mass casualty incidents.

During triage, trained medical personnel use a standardized system to assess patients rapidly.
This assessment is typically based on the severity of injuries, physiological parameters (such as
vital signs), and the patients' ability to tolerate treatment delays. The most common triage
systems use color codes or tags (e.g., red, yellow, green, black) to assign priorities and guide the
allocation of resources. Red denotes immediate or emergent care, yellow indicates delayed care,
green signifies minor or non-urgent care, and black represents patients who are either deceased
or unlikely to survive given the available resources. Triage systems typically use color-coded
tags or labels to categorize patients into different priority levels, such as:

 Immediate (red tag): These are patients with life-threatening injuries or conditions who
require immediate medical intervention to survive.
 Not Immediate (yellow tag): This category includes patients with serious injuries or
conditions that are not immediately life-threatening and can tolerate some delay in treatment.
 Minimal (green tag): Patients with minor injuries or non-urgent medical conditions fall into
this category and can wait for treatment.
 Expectant / brought dead (black tag): Unfortunately, this category is reserved for patients
whose injuries or conditions are so severe that they are unlikely to survive even with medical
intervention.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 6


The general triage protocol should be as per “WHO” Emergency Triage Assessment and
Treatment (ETAT) guideline and as per the hospital policy.

Mass Casualty Management, as defined by the World Health Organization (WHO), refers to the
organization and coordination of resources, services, and medical assistance to effectively respond to
a situation where the number of casualties exceeds the normal capacity of local health services to
manage. This can result from various events, including natural disasters, industrial accidents,
transportation incidents, or acts of terrorism.

Key principles and components of Mass Casualty Management, according to the WHO, include:

1. Early Warning and Preparedness: Establishing early warning systems to detect and
respond to potential mass casualty incidents. Conducting regular training and drills to ensure
preparedness among healthcare and emergency response teams.

2. Coordination: Establishing a coordinated response involving various stakeholders, including


healthcare providers, emergency services, public health agencies, and other relevant
organizations. Clearly defining roles and responsibilities of different agencies involved in the
response.

3. Triage: Implementing a systematic triage process to quickly assess and prioritize the medical
needs of casualties. Allocating resources based on the severity of injuries and the likelihood
of survival.

4. Treatment and Evacuation: Providing timely and appropriate medical care to those
affected..Coordinating the evacuation and transportation of patients to appropriate healthcare
facilities based on the level of care required.

5. Resource Management: Efficiently managing and allocating resources, including medical


supplies, personnel, and equipment. Mobilizing additional resources as needed from both
local and external sources.

6. Communication: Establishing effective communication channels among responders,


healthcare facilities, and other relevant authorities. Providing accurate and timely information
to the public to prevent panic and ensure their safety.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 7


7. Documentation and Information Management: Maintaining accurate records of casualties,
treatments provided, and resource utilization. Facilitating information sharing among
responding agencies for a comprehensive understanding of the situation.

8. Psychosocial Support: Recognizing and addressing the psychosocial needs of survivors, their
families, and responders. Integrating mental health support into the overall response.

9. Post-Event Evaluation: Conducting a thorough evaluation of the response to identify


strengths, weaknesses, and areas for improvement. Using lessons learned to enhance future
preparedness and response efforts.

Mass Casualty Management is a multidisciplinary and collaborative approach that involves the
cooperation of various sectors, including healthcare, emergency services, public health, and local
authorities. The goal is to minimize the impact of the incident on public health and safety through
a well-coordinated and effective response.

What is CPR?
CPR stands for Cardiopulmonary Resuscitation. It is an emergency life-saving procedure performed
on individuals who are experiencing cardiac arrest or a complete cessation of heart function. CPR is
intended to maintain blood flow and oxygenation to vital organs, particularly the brain, until
advanced medical care can be provided. It involves a combination of chest compressions and rescue
breaths to support the person's circulation and breathing.

Here are the key steps involved in performing CPR:

 Call for help: Call or help / someone nearby to call for medical assistance by experts.
Request an Automated External Defibrillator (AED) if available. But if not -

 Open the airway: Carefully tilt the person's head back using one hand on their forehead
and lift their chin with your other hand. This maneuver helps open the airway for
effective breathing.

 Perform chest compressions:


o Position the person on their back on a firm surface.
o Place the heel of one hand on the center of the person's chest, between the nipples.
o Place the other hand on top of the first hand, interlocking the fingers.
o Keep your elbows straight and position your shoulders directly above your hands.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 8


o Push hard and fast, compressing the chest at least 2 inches (5 centimeters) deep and
at a rate of 100-120 compressions per minute.
o Allow the chest to recoil completely between compressions.

 Provide rescue breaths: After 30 compressions, provide two rescue breaths. Maintain
the head tilt and chin lift position, Tilt the person's head back gently and lift the chin to
open the airway.
o Pinch the person's nose shut with your hand.
o Use ambo bag or Take a normal breath, cover the person's mouth with
yours, and create an airtight seal.
o Give two rescue breaths, each lasting about one second, while watching
for the chest to rise.
o Continue cycles of compressions and breaths: Perform 30 chest
compressions followed by two rescue breaths. Repeat the cycle without
interruptions until the person shows signs of life, trained medical
personnel take over. or if available an AED arrives, or you become too
exhausted to continue.
 Continue cycles of compressions and breaths: Repeat the cycle of 30 compressions
followed by two breaths. Maintain the proper ratio until the person shows signs of
recovery, professional help arrive.

 CPR without rescue breaths is called Hands only CPR

** Always check latest Clinical Guideline in this regard.

What is Medico Legal Cases and requirements of Medico Legal Cases?

Medico Legal Cases (MLCs) are cases that involve both medical and legal aspects. These cases
typically arise when a person seeks medical attention due to an injury, illness, or any medical
condition that may have legal implications. MLCs require medical professionals to provide
detailed documentation, examination, and expert opinions that may be used in legal proceedings.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 9


MLC should be informed to Police and need to be collected the MLC no. from them by Hospital
Staff.

The requirements for Medico Legal Cases can vary based on the jurisdiction and specific
circumstances, but generally, the following elements are involved:

o Detailed documentation: In MLCs, accurate and comprehensive documentation


is crucial. Medical professionals must record all relevant information, including
the patient's personal details, medical history, clinical findings, treatment
provided, and any other pertinent observations. This documentation helps
establish a clear timeline and a factual basis for the case. Copy of detail
documentations need to be preserved for 15 years as per order vide no. SBHI/2D-
4/2016/259/1(33) dated 31.08.2016 issued by Director, State Bureau of Health
Intelligence, Directorate of Health Services, Govt. of WB .

o Medico Legal Certificate: A Medico Legal Certificate is a formal document


issued by the medical professional involved in the case. It contains essential
details about the patient's condition, injuries, or illnesses, along with the
examination findings and medical opinion. This certificate serves as a crucial
piece of evidence in legal proceedings.

o Forensic evidence collection: In cases involving criminal activities or injuries


resulting from violence, including abuse, assault of type, medical professionals
may be required to collect forensic evidence. This can include collecting samples
(with proper labeling), such as blood, urine, or DNA swabs, documenting injuries
with photographs, or preserving any physical evidence that may help in the
investigation and subsequent legal proceedings.

o Expert opinions: Medical professionals may be called upon to provide expert


opinions in MLCs. These opinions are based on their specialized knowledge and
expertise in a particular field of medicine. Expert opinions help interpret medical
findings, explain the nature of injuries or illnesses, and assess the causation or
correlation between the medical evidence and the legal case.

** Always check latest Administrative and Clinical Guideline in this regard.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 10


What is Glasgow Comma Scale (GCS)?

The Glasgow Coma Scale (GCS) is a neurological assessment tool used to evaluate and quantify
the level of consciousness and neurological function in patients with traumatic brain injury (TBI)
or other conditions affecting the brain. It consists of three components: eye-opening response,
verbal response, and motor response. Each component is assessed and assigned a score, and the
total GCS score helps in assessing the severity of the brain injury and determining the
appropriate medical response.

Here's a breakdown of the components and scoring system of the Glasgow Coma Scale:

Eye-opening response (E):

o Spontaneous: 4 points
o To speech: 3 points
o To pain: 2 points
o No response: 1 point

Verbal response (V):

o Oriented and coherent: 5 points


o Confused conversation but able to answer questions: 4 points
o Inappropriate words: 3 points
o Incomprehensible sounds: 2 points
o No response: 1 point

Motor response (M):

o Obeys commands: 6 points


o Localizes pain: 5 points
o Withdraws from pain: 4 points
o Abnormal flexion (decerebrate response): 3 points
o Extensor response (decorticate response): 2 points
o No response: 1 point

The scores from each component are added together to obtain the total GCS score, which ranges
from 3 (indicating deep unconsciousness) to 15 (indicating a fully conscious and alert state).
After assessing each component, the scores are added together to determine the overall GCS

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 11


score. For example, a person who spontaneously opens their eyes (4 points), gives inappropriate
words (3 points), and withdraws from pain (4 points) would have a GCS score of 11 (4 + 3 + 4).

The scores for each component are summed up to give the overall GCS score, which can range
from 3 to 15. A higher score indicates a higher level of consciousness and better neurological
functioning.

The interpretation of GCS scores is as follows:

 Severe brain injury: GCS score of 3 to 8


 Moderate brain injury: GCS score of 9 to 12
 Mild brain injury: GCS score of 13 to 15

The Glasgow Coma Scale is a widely recognized and used tool in assessing and monitoring
patients with brain injuries. It helps healthcare professionals communicate the level of
consciousness, track changes over time, and guide treatment decisions and prognosis.
** Always check latest Clinical Guideline in this regard.

What are the standard criteria of assessment of Poly trauma?

Polytrauma refers to the occurrence of multiple severe injuries sustained by an individual, often as a
result of a single traumatic event. These injuries can affect various body systems and organs
simultaneously. Polytrauma patients typically experience a combination of injuries.

General Standard Criteria of Assessment:


When assessing a patient with polytrauma, which refers to the presence of multiple injuries in
different body systems, healthcare professionals follow a systematic approach to evaluate and
manage the patient's condition. The assessment involves considering both life-threatening
injuries and less severe injuries that may require attention. While the specific criteria may vary
based on clinical protocols and individual patient circumstances, the following are generally
considered in the assessment of polytrauma:

Primary Survey: The primary survey focuses on identifying and managing life-threatening
conditions that require immediate attention. It follows the ABCDE approach:

 Airway: Ensure the patient has a patent airway and provide interventions if needed.
 Breathing: Assess breathing, administer oxygen if necessary, and provide assistance or
intervention to maintain adequate ventilation.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 12


 Circulation: Evaluate the patient's circulation, control bleeding, and initiate resuscitation
if needed.
 Response: Assess the patient's level of consciousness, pupil response, and motor
function.
 Exposure/Environment: Undress the patient to assess for injuries and maintain a warm
environment.

Secondary Survey: The secondary survey is a more detailed assessment that focuses on
identifying injuries that may not be immediately life-threatening. It includes a head-to-toe
examination, taking into account the following aspects:

 Head and Neck: Assess for skull fractures, head injuries, and cervical spine injuries.
 Chest: Evaluate the chest for signs of trauma, such as rib fractures or pneumothorax.
 Abdomen: Examine the abdomen for signs of internal bleeding or organ injury.
 Pelvis and Genitourinary System: Assess for fractures, pelvic instability, or urogenital
injuries.
 Extremities and Musculoskeletal System: Evaluate for fractures, dislocations, or other
injuries.
 Neurological Assessment: Monitor neurological status, including Glasgow Coma Scale,
pupillary response, and motor function.

Radiological Imaging: If the doctor suggests appropriate imaging studies, such as X-rays, CT
scans, or ultrasounds, to further evaluate injuries may be done.

Ancillary Tests and Investigations: Depending on the specific injuries and clinical suspicion, if
the doctor suggests additional tests may be ordered, including laboratory tests (e.g., complete
blood count, blood gas analysis), imaging studies (e.g., CT scans, MRIs), or specialty
consultations (e.g., orthopedic surgeon, neurosurgeon) may be needed.

Reassessment: Regular reassessments are crucial to identify any deterioration or changes in the
patient's condition. Repeated assessments should be performed to ensure ongoing monitoring
and prompt intervention if necessary.

** Always check latest Clinical Guideline in this regard.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 13


What are the Standard Criteria of Assessment of Myocardial Infarction (MI) ?

Assessment of Myocardial Infarction (MI), involves various criteria to diagnose and evaluate the
extent of damage to the heart muscle. The assessment should be done by the Medical Officer and
typically based on a combination of clinical symptoms, electrocardiographic (ECG) findings,
laboratory tests, and imaging studies.

Here are the standard criteria used for the assessment of MI:

Clinical Symptoms: The patient's presentation and history of chest pain or discomfort are
essential for diagnosing MI. Typical symptoms include severe chest pain or pressure that may
radiate to the arm, jaw, or back, accompanied by shortness of breath, sweating, nausea, or
lightheadedness.

Electrocardiogram (ECG): The ECG is a vital tool for diagnosing MI and determining the
location and severity of the infarction. The following ECG findings are commonly assessed:

 ST-Segment Elevation: This is a hallmark finding of ST-segment elevation myocardial


infarction (STEMI), which suggests a complete blockage of a coronary artery. The
presence of ST-segment elevation in specific leads indicates an acute MI. The affected
leads depend on the coronary artery involved.
 Q Waves: Appearance of pathological Q waves in specific leads suggests a previous MI
or ongoing myocardial injury.
 T-Wave Changes: T-wave inversions or hyper acute T-waves can be indicative of an
acute MI.

Cardiac Biomarkers: Cardiac biomarkers are specific proteins released into the bloodstream
following myocardial cell damage. The most commonly assessed biomarkers are:

 Troponin: Troponin I or troponin T levels rise within a few hours after an MI and
remain elevated for several days. Serial measurements are typically taken to observe
changes over time.
 Creatine Kinase (CK) and CK-MB: CK and CK-MB levels increase within hours of an
MI, but they are less specific than troponin. They may still be used in specific situations
or if troponin is not available.

Imaging Studies: Additional imaging techniques may be employed to assess the extent of
myocardial damage and evaluate cardiac function. These may include:

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 14


 Echocardiography: This ultrasound-based test provides information about the size,
shape, and movement of the heart's chambers and valves.
 Coronary Angiography: This invasive procedure involves injecting contrast dye into
the coronary arteries to visualize any blockages or narrowing.
 Cardiac MRI or CT: These imaging modalities can provide detailed images of the
heart, allowing assessment of myocardial viability and scar tissue.
It's important to note that these criteria may vary based on the guidelines can be updated over
time. The assessment of MI should always be performed by qualified healthcare professionals
based on the latest clinical guidelines and individual patient characteristics.

** Always check latest Clinical Guideline in this regard.

What are the Standard Criteria of Assessment of Pain?

Pain assessment should be ongoing, individualized, and documented. Patients should be asked to
describe their pain in terms of the following characteristics: location, radiation, mode of onset,
character, temporal pattern, exacerbating and relieving factors, and intensity.
The standard criteria for the assessment of pain may vary depending on the setting and purpose
of the assessment. However, in general, the following are commonly used criteria to assess pain:

 Self-Report: The most reliable and common method of assessing pain is through self-
report, where the individual experiencing pain provides subjective information about
their pain intensity, location, quality, and any other relevant factors. This can be done
using verbal rating scales, numerical rating scales, visual analog scales, or descriptive
scales. Patients are asked to rate their pain intensity using scales such as numerical rating
scales (NRS), visual analog scales (VAS), or verbal rating scales (e.g., mild, moderate,
severe). They may also describe the quality and location of pain.

 Pain Intensity: Assessing the intensity of pain is crucial in understanding its severity.
Various scales, such as numeric rating scales (NRS) or visual analog scales (VAS), can
be used to quantify pain intensity on a scale from 0 to 10 or through other similar
metrics. These tools are designed to assess pain based on observational measures and are
often specific to certain populations; Examples include the Behavioral Pain Scale (BPS),
Critical-Care Pain Observation Tool (CPOT), and Pain Assessment in Advanced
Dementia (PAINAD).

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 15


 Location: Determining the specific location(s) of pain helps in diagnosing and treating
the underlying condition. Individuals may be asked to point to or describe the exact area
where they feel pain.

 Quality: Understanding the quality or nature of pain can provide insights into its
underlying cause. Pain can be described as sharp, dull, burning, throbbing, stabbing, or
shooting, among other descriptors. The individual's description helps healthcare
professionals to identify potential causes and appropriate treatment options.

 Onset and Duration: Evaluating when the pain started (onset) and how long it has been
present (duration) provides valuable information for diagnosis and treatment planning. It
helps distinguish acute pain from chronic pain and provides insights into the progression
of the condition.

 Aggravating and Alleviating Factors: Identifying factors that worsen or alleviate the
pain helps in understanding its triggers and designing appropriate pain management
strategies. Patients may be asked about activities, movements, positions, or interventions
that exacerbate or relieve their pain.

 Associated Symptoms: Assessing any accompanying symptoms, such as nausea,


dizziness, fatigue, or changes in sleep patterns, can aid in diagnosing and managing the
underlying condition causing the pain.

 Impact on Daily Life: Understanding how pain affects an individual's daily functioning,
activities, and quality of life is essential. Assessing the impact of pain on physical
functioning, emotional well-being, sleep, work, and social interactions helps determine
the overall burden of pain.

 Nonverbal Cues: In situations where self-report is not possible or reliable (e.g., infants,
cognitively impaired individuals), nonverbal cues such as facial expressions, body
movements, vocalizations, and physiological changes may be assessed to infer the
presence and intensity of pain. For patients who are unable to communicate verbally or
have difficulty expressing pain, healthcare professionals rely on non-verbal cues to
assess pain. These cues include facial expressions (grimacing, furrowed brow), body
movements (guarding, restlessness), vocalizations (moaning, crying out), and
physiological changes (increased heart rate, elevated blood pressure).

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 16


Types of Pain Rating Scales:

There are multiple pain assessment scales are present for Adults, few of them are:

– Visual Analog Scale (VAS)


– Numerical Rating Scale (NRS)
– Verbal Descriptor Scale(s) (VDS)
– Behavioral Pain Scale (BPS) etc

For Pediatrics age group:

– Neonatal Pain, Agitation, and Sedation Scale (N-PASS)


– Neonatal/Infant Pain Scale (NIPS)
– Neonatal Facial Coding System (NFCS)
– CRIES
The facility will use any one based on the instruction of the doctor & administrative guidelines.

** Always check latest Clinical Guideline in this regard.

What are the Standard Criteria of Assessment of Burn Patient?


A burn is an injury caused by thermal, chemical, electrical or radiation energy. A scald is a burn
caused by contact with a hot liquid or steam but the term 'burn' is often used to include scalds.

Standard Criteria of Assessment of burn patient

Assess airway, breathing, circulation, disability, exposure (prevent hypothermia) and the need for
fluid resuscitation. Also, assess severity of burns and conscious level.

Establish the cause: consider non-accidental injury.

Assess for associated injuries: associated injuries may be sustained while the victim attempts to
escape the fire. Explosions may throw the patient some distance and result in internal injuries or
fractures.

 It is essential that the time of the burn injury be established.


 Burns sustained within an enclosed space suggest possible inhalation injury.
 Pre-existing illnesses, drug therapy, allergies and drug sensitivities are also important.
 Establish the patient's tetanus immunization status.

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 Body surface area - Rule of Nines:
 The adult body is divided into anatomical regions that represent 9%, or multiples of
9%, of the total body surface. Therefore 9% each for the head and each upper limb; 18% each
for each lower limb, front of trunk and back of trunk.

 The palmar surface of the patient's hand, including the fingers, represents
approximately 1% of the patient's body surface.

 Body surface area differs considerably for children - the Lund and Browder chart takes
into account changes in body surface area with age and growth.

 If not available:
 For children <1 year: head = 18%, leg = 14%.

 For children >1 year: add 0.5% to leg, subtract 1% from head, for each
additional year until adult values are attained.

Depth of burn (previously described as first-degree, second-degree and third-degree burns):


Burn wounds are dynamic and need reassessment in the first 24-72 hours because depth can increase
as a result of inadequate treatment or superadded infection. Burns can be superficial in some areas but
deeper in other areas

 Epidermal (superficial partial-thickness): red, glistening, pain, absence of blisters


and brisk capillary refill. Not life-threatening and normally heal within a week, without
scarring.

 Superficial dermal: pale pink or mottled appearance with associated swelling and
small blisters. The surface may have a weeping, wet appearance and is extremely
hypersensitive. Brisk capillary refill. Heal in 2-3 weeks with minimal scarring and full
functional recovery.

 Deep dermal: blistering, dry, blotchy cherry red, doesn't blanch, no capillary refill
and reduced or absent sensation. 3-8 weeks to heal with scarring; may require surgical
treatment for best functional recovery.

 Full-thickness (third-degree): dry, white or black, no blisters, absent capillary refill


and absent sensation. Requires surgical repair and grafting.

 Fourth-degree: includes subcutaneous fat, muscle and perhaps bone. Requires


reconstruction and, often, amputation.

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Circumferential extremity burns: assess status of distal circulation, checking for cyanosis,
impaired capillary refilling or progressive neurological signs. Assessment of peripheral pulses in burn
patients is best performed with a Doppler ultrasound

** Always check latest Clinical Guideline in this regard.

What is High Alert Drugs and what are the cautious administration of high alert drugs?

High alert drugs are medications that have a heightened risk of causing significant harm to
patients if used in error. These drugs have a greater potential for adverse effects due to their
characteristics, dosage forms, or potential for medication errors..

To ensure that the right doses of high-alert drugs are administered, healthcare facilities follow
strict processes and protocols. These processes involve multiple layers of checks and
verifications to minimize the risk of errors.

Here is an outline of the typical steps involved in the process:

 Drug Formulary and Policies: Healthcare organizations should establish a drug


formulary that includes high-alert medications, or the facility should list the names of
High Alert Drugs with the existing medication available. This formulary or lists
outlines the approved drugs, their indications, dosing guidelines, and precautions as per
approved EDL. Policies and protocols must be developed to ensure the safe use of
high-alert drugs.

 Labeling: High Alert Medications will be prescribed, dispensed, and administered using
practices that are proven safe. High Alert Medications should have “HIGH ALERT
MEDICATION” labels on storage shelves, containers, product packages and loose
vials or ampoules. Any changes of brand / colour / preparation of High Alert
Medications must be informed as soon as possible.

Strategies to Reduce ERRORS due TO HIGH ALERT DRUGS:

1) List of High Alert Medications within the facility shall be identified.

2) High Alert Medications should have HIGH ALERT MEDICATION label on storage

shelves and or loose vials/ ampoules.

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3) High Alert Medications should be kept in secure places with an IEC of maximum

dosage of each drug.

4) High Alert Medications should Not be prescribed in abbreviation or in short forms, and

should be prescribed in generic names with proper dosage, route & patient name.

5) High Alert Medications must be double checked before they are prepared, dispensed

and administered to the patients.

6) All High Alert Medications issued from the pharmacy must be counterchecked and

verified by another pharmacy staff prior to dispensing for the purpose of medication safety

and accuracy. If the any prescription is not legible it should be verified by the doctor.

7) Verbal communications of medication order on high alert medication are Not

Recommended and in case of emergency it should be immediately rechecked via spelling

of the drug for verification and documented with signature of the doctor.

8) After administration of High Alert Medications proper medication record should be

maintained and patient need to be closely monitored for any adverse event.

9) After use stock of High Alert Medications should be properly updated and counter

signed by the authority.

What are LASA drugs?

LASA Stands for Look Alike and Sound Alike (LASA) Medicines:

Look Alike Sound Alike (LASA) medications are drugs that are visually similar in physical
appearance or packaging and/or names of medications that have spelling similarities or
similarity during pronunciation. Eg : Lora-zepam, Clona-zepam, Dopa-mine-Dobuta-mine

Strategies to avoid errors with LASA medications:

1) List of LASA drugs should be available at the facility

2) During Storage - Use Tall Man lettering to emphasize differences in medications with
sound-alike names. eg- DOPamine & DOBUTamine.

3) Use additional Warning labels for look-alike medicines.

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4) Store LASA medication separately from LASA pair with proper labeling.

5) Prescription should clearly specify generic name of medication, dosage and complete
direction for use.

6) During dispending or drug administration - Identify medicines based on its name and strength
and double check.

7) Ensure proper documentation.

What is Adverse Drug Reaction?

An adverse drug reaction (ADR), also known as an adverse drug event (ADE), refers to any
unwanted or harmful response to a medication. It occurs when a patient experiences a negative
reaction after taking a drug, whether it is prescribed, over-the-counter, or even herbal or
alternative remedies. Adverse drug reactions can range from mild and tolerable side effects to
severe and life-threatening complications.

Here are some key points about adverse drug reactions:

 Types of Adverse Drug Reactions: There are different types of adverse drug reactions,
including:
 Type A (Augmented) Reactions: These are predictable and dose-dependent reactions
that are an extension of the drug's known pharmacological effects. For example,
drowsiness caused by sedating antihistamines.
 Type B (Bizarre) Reactions: These are unpredictable reactions that are unrelated to the
known pharmacological action of the drug. They often occur in susceptible individuals
and can range from mild to severe. Examples include severe allergic reactions or
anaphylaxis.
 Type C (Chronic) Reactions: These reactions are associated with long-term use of a
drug and may develop gradually over time. An example is drug-induced osteoporosis
from long-term corticosteroid use.
 Type D (Delayed) Reactions: These reactions have a delayed onset, occurring days,
weeks, or even months after drug exposure. An example is drug-induced liver injury.
 Type E (End-of-Use) Reactions: These reactions occur when a drug is withdrawn,
resulting in a rebound or withdrawal response. An example is rebound hypertension after
sudden discontinuation of antihypertensive medication.

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 Type F (Failure) Reactions: These reactions occur when a drug fails to produce the
intended therapeutic effect. For example, a patient may not respond to an antibiotic due
to bacterial resistance.

 Symptoms and Severity: Adverse drug reactions can manifest in various ways, ranging from
mild to severe. Common symptoms include nausea, vomiting, rash, dizziness, headache,
diarrhea, and fatigue. In severe cases, adverse drug reactions can lead to organ damage,
anaphylaxis, cardiovascular events, or even death.
 Risk Factors: Certain factors increase the risk of experiencing an adverse drug reaction.
These include individual susceptibility, age (the very young and elderly are often more
vulnerable), concomitant use of multiple medications, underlying medical conditions, genetic
factors, and drug interactions.
 Reporting and Monitoring: Adverse drug reactions should be promptly reported to
healthcare providers and regulatory authorities in prescribed forms. Samples like vials, strips,
bottles may be send to authority with proper labeling and documentations. Reporting systems
help identify trends, improve drug safety, and inform regulatory decisions. Healthcare
professionals monitor patients closely for adverse drug reactions during treatment and adjust
medications as necessary. A separate register should be maintained.
 Prevention and Minimization: Adverse drug reactions can be minimized through proper
prescribing practices, patient education about potential side effects, accurate medication
reconciliation, regular monitoring, and reviewing the patient's medication history to identify
drug interactions or contraindications.
 Pharmacovigilance: Pharmacovigilance is the science and activities related to the detection,
assessment, understanding, and prevention of adverse drug reactions. It plays a crucial role in
ensuring drug safety and identifying any previously unrecognized risks associated with
medications. If a person suspects they are experiencing an adverse drug reaction, it is
important to seek medical attention promptly. Healthcare professionals can evaluate the
symptoms, discontinue or adjust the medication if necessary, and provide appropriate
treatment or management strategies.

Adverse Drug Reaction vs. Medication Error: It's important to distinguish between an ADR
and a medication error. An ADR refers to the patient's unwanted response to a drug, whether
prescribed and administered. On the other hand, a medication error refers to a mistake in the
medication process, such as prescribing, dispensing, or administering the wrong medication or
dose.

**Any kind of Drug Reaction or Medication Error if any should be recorded and reported.

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What is Blood Transfusion Reaction?

A blood transfusion reaction refers to an adverse reaction that occurs as a result of receiving a
blood transfusion. Although blood transfusions are generally considered safe, complications can
occur in rare instances. These reactions can vary in severity and may range from mild to life-
threatening. It's important to closely monitor patients during and after transfusions to promptly
identify and manage any adverse reactions.

Types of Transfusion Reactions:

 Immune reactions
 Non immune reactions
 Immediate
• During or within few hours of transfusion
 Delayed
• Days or weeks after the transfusion

Specific blood transfusion reactions include:

 Febrile Non-Hemolytic Reaction: This reaction is characterized by the development


of fever during or shortly after the transfusion. It is often accompanied by chills,
headache, and mild discomfort. It is typically caused by the recipient's antibodies
reacting to white blood cells in the donated blood.
 Allergic (Hypersensitivity) Reaction: Allergic reactions can occur due to sensitivity to
proteins or other substances in the transfused blood. Symptoms may include hives,
itching, flushing, wheezing, shortness of breath, and, in severe cases, anaphylaxis.
 Acute Hemolytic Transfusion Reaction (AHTR): Acute hemolytic reactions happen
within 24 hours of transfusion. This is a severe and potentially life-threatening reaction
caused by the recipient's immune system attacking and destroying the transfused red
blood cells. It can result from intravascular haemolysis, or ABO blood group
incompatibility or other red cell antibodies, or extravascular haemolysis or Rh minor
group incompatibility. Sign & Symptoms include fever, chills, back pain, chest pain,
Hypotension, Tachycardia, hemoglobinuria (red or brown urine), Dyspnoea and
disseminated intravascular coagulation (DIC).

 Delayed Hemolytic Reaction: This type of reaction can occur days to weeks after a
transfusion. This hemolytic reaction happen after 24 hours, usually occur two weeks after
but can go up to 30 days post transfusion. It is characterized by the recipient's immune

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 23


system mounting an immune response against the transfused red blood cells, resulting in
their destruction. Symptoms include gradual decline in hemoglobin levels, jaundice, and
sometimes fever.

 All type or any type of transfusion reaction should be recorded in a register with proper
details. A register with details documentation should be maintained. it should be
promptly reported to healthcare providers and authorities in prescribed forms. Samples
(Blood bag with residual blood) should be sending back to authority with proper labeling
and documentations.

** Always check latest Guidelines from NACO / National Blood Transfusion Council
(NBTC) in this regard.

What are the procedures for secure storage of Narcotic and Psychotropic drugs?

• All Narcotic and Psychotropic drugs available in the hospital must be listed as per EDL
and displayed.
• Drug substances like Narcotics, Psychotropic drugs and other potent drugs shall be stored
in their designated cupboard / drawer under double lock system with signages outside.
• One key for the same shall be with the Sister-In charge and the other with the on duty Staff
nurse / any other person (two different people).
• Narcotic drugs will be released only on the signed requisition of the Doctor/MO.
• List of availability must be updated after each use.

What are the procedures of patient Hand over, whenever staff duty change happens?
Patient handovers often referred to as "shift handovers" or "shift change reports," are crucial in
hospitals to ensure continuity of care and patient safety when there is a change in staff duty. Proper
handovers help convey important patient information accurately and comprehensively.

Whenever hand over is given it should be in bed side and as per SBAR method.
Providing patient handover using the SBAR (Situation, Background, Assessment, Recommendation)
format is an effective way to convey important patient information in a clear and structured manner.

Here's how to give a patient handover using SBAR:

1. Situation (S): Start the handover by providing a brief and concise overview of the patient's
current situation. Include the following information:

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o Patient's name and age.
o The primary reason for admission or the main concern.
o A brief statement of the patient's current condition, such as "The patient is stable" or
"The patient's condition is deteriorating."
2. Background (B): Provide the necessary background information about the patient. This
section should cover:
o Relevant medical history, including chronic conditions or recent surgeries.
o Allergies or sensitivities.
o Key vital signs and trends, such as blood pressure, heart rate, respiratory rate,
temperature, and oxygen saturation.
o Current medications, dosages, and administration routes.
o Any recent laboratory results, diagnostic tests, or imaging findings.
o Important events during the shift, such as interventions, responses to treatment, or
changes in the patient's status.
3. Assessment (A): Describe your assessment of the patient's current clinical status. This section
should include:
o The patient's signs and symptoms.
o Any concerns, potential complications, or changes in condition.
o Response to interventions or treatments.
o Pain level, if applicable.
4. Recommendation (R): Provide your recommendations for the patient's ongoing care and any
actions that should be taken. Include:
o Specific plans for treatment or management.
o Medication changes, dosage adjustments, or any new prescriptions.
o Upcoming procedures, tests, or consultations.
o Any special patient needs or concerns.
o Code status, advance directives, or other important preferences.

When giving a patient handover using SBAR, it's important to be clear and concise, focusing on the
most relevant information. Here are some additional tips:

 Use plain language and avoid medical jargon.


 Speak in a calm and organized manner.
 Encourage the receiving healthcare provider to ask questions for clarification.
 Be prepared to provide further details if requested.
 Document the handover information in the patient's medical record or handover report.

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 Ensure a smooth transition of care by confirming that the receiving healthcare provider
acknowledges the handover and is ready to assume responsibility for the patient.

SBAR is a valuable communication tool in healthcare settings, promoting effective and structured
information exchange. It helps ensure that all relevant patient information is conveyed accurately,
improving patient safety and continuity of care. Handover register should be properly maintained.

What are the procedures to check drug before administration/ dispensing?

Checking a drug before administration or dispensing is a critical step in ensuring patient safety. The
following are general procedures that healthcare professionals typically follow to verify and
administer medications safely:

1. Prescription Review: Verify the prescription or medication order. Ensure that it is legible
and complete. Confirm that the order includes the patient's name, the drug name, dosage,
route of administration, frequency, and any other relevant information.

2. Patient Identification: Confirm the patient's identity using at least two patient identifiers
(e.g., name and date of birth)

3. Patient Education: Provide the patient with information about the medication, including
route of administration, potential side effects, and any other relevant instructions.

4. Drug Storage: Ensure that the drug is stored appropriately, considering factors such as
temperature, light exposure, and expiration date.

5. Medication Label Check: Check the medication label against the medication order. Verify
the drug name, strength, dosage form, and concentration.

6. Expiration Date Check: Confirm that the medication has not expired.

7. Dosage Calculation: If the medication requires dosage calculations, double-check the


calculations to ensure accuracy.

8. Allergy Check: Confirm that the patient does not have any known allergies to the
medication.

9. Drug Interactions: Check for potential drug interactions with other medications the patient is
currently taking.

10. Documentation: Document the medication administration or dispensing, including the date,
time, dose, route, and any other relevant information.

11. Follow-Up Monitoring: Monitor the patient for any adverse reactions or side effects after
medication administration.

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** Always follow the specific guidelines and procedures established by your healthcare
institution.

What are the process for end of life care and death & Procedures for decent communication of death?

Facility should have a defined procedure for record of death of the admitted patient and
communication with the relatives. Hospital should have a defined procedure for record of death of the
admitted patient and communication with the relatives.

Clinical policy of care at the end of life and the professional practice it guides should:

 Be respectful to the dignity of both patient and caregivers;


 Be sensitive to and be respectful of the patient's and family's wishes;
 Should use the most appropriate measures that are consistent with patient‘s choices
 Should try to arrange for alleviation of pain and other physical symptoms;
 Should be able to access and manage psychological, social, and spiritual/religious problems;
 Should offer continuity (the patient should be able to continue to be cared for, if so desired,
by his/her primary care and specialist providers);
 Should provide access to any therapy which may realistically be expected to improve the
patient's quality of life, including alternative or nontraditional treatments;
 Should be respectful to the right to refuse treatment
 Should be respectful to the physician's professional responsibility to discontinue some
treatments when appropriate, with consideration for both patient and family preferences.

 Death of a patient is handled carefully with concern without complacency. Counselling of next of
kin with empathy is importance. All help in shifting the body from the hospital is extended to the
next of kin. The dead body is released as soon as possible after completion of all formalities.
 Acknowledgement for receipt of the body and the Death Certificate is obtained from next of
kin/legal representative and handing-over of the body to patient‘s relatives. It is ensured that
hospital staff takes due care and concern in this respect. Due arrangements are made if preserving
the body in the mortuary is found necessary.
 Security staffs of the hospital are to be present till the departure of the deceased and ensure
orderliness in handing over the body to the next of kin.

** It should be done as per the hospital policy, always check the latest G.O in this regard

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What is Basic life support (BLS) and Advance life support (ALS)?

Basic Life Support (BLS) and Advanced Life Support (ALS) are two levels of emergency
medical care provided to individuals experiencing life-threatening medical emergencies.

Basic Life Support (BLS):

 Definition: BLS refers to the fundamental level of medical care given to individuals in
life-threatening situations. It focuses on maintaining the basic vital functions of the body
until more advanced medical care can be administered.
 Key Components:
– Cardiopulmonary Resuscitation (CPR): BLS often involves chest compressions and
rescue breaths to maintain blood circulation and oxygenation in the absence of a pulse.
– Airway Management: Basic techniques for opening and maintaining an airway to ensure
proper breathing.
– Control of Bleeding: Basic methods to control external bleeding.
Advanced Life Support (ALS):

 Definition: ALS is a higher level of emergency medical care that involves more
advanced techniques and equipment beyond what is included in BLS.
 Key Components includes - Advanced Airway Management, Medications to manage
cardiac arrest, seizures & other complications, Intravenous (IV) Access, Advanced
monitoring and use of Defibrillators.

In an emergency situation, the level of care provided depends on the skills and training of the
individuals present. BLS is often the first response to emergencies, and ALS is called in when
more advanced medical interventions are needed. Both BLS and ALS play crucial roles in the
chain of survival for patients experiencing life-threatening events.

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Department:

OPD

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How to check VVM level of vaccine and how to identify discard point?
VVM stands for Vaccine Vial Monitor, and it's a small sticker-like device attached to vaccine
vials to help healthcare workers determine whether the vaccine has been exposed to temperature
conditions that might have compromised its effectiveness. The VVM changes its color over time
based on temperature exposure, providing an indication of the vaccine's viability.

To check the VVM level of a vaccine and identify the discard point, follow these steps:
 Locate the VVM: The VVM is usually located on the vaccine vial or packaging. It's a
small rectangular sticker with multiple circles or squares that change color.
 Observe the VVM Indicator: The VVM has different stages or levels represented by
color changes in the circles or squares. The stages are often labeled as "plus" (+) signs,
typically from "+2" to "+8." Each stage corresponds to a specific level of heat exposure.
 Check the Color: Each circle or square in the VVM will change color based on the
cumulative heat exposure the vaccine has received. The color change indicates the
vaccine's viability.
 Interpret the VVM Level: The level indicated by the VVM will guide you on whether
the vaccine is safe to use or needs to be discarded. The specific color and its meaning may
vary depending on the vaccine manufacturer, so refer to the accompanying instructions or
guidelines.
 Identify the Discard Point: The discard point is the stage at which the vaccine has been
exposed to temperatures that have compromised its effectiveness. If the VVM reaches the
designated discard point, the vaccine should not be used and should be appropriately
disposed of following proper medical waste disposal procedures.
 Follow Guidelines: It's crucial to follow the guidelines provided by the vaccine
manufacturer and latest guidelines of the Government Health Department. These
guidelines will give you clear instructions on how to interpret the VVM and what actions
to take based on the VVM level.
 Always prioritize patient safety and follow established protocols for vaccine handling,
storage, and administration. If you're unsure about how to interpret the VVM or how to
handle a vaccine with a specific VVM level, consult with a qualified healthcare
professional or your local health authority for guidance.

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What is the correct use Auto Disposable syringe?

Auto Disposable syringes, also known as auto-disable syringes or AD syringes, are designed to
prevent the reuse of syringes, reducing the risk of transmitting infections through contaminated
needles. These syringes typically have features that render them unusable after a single injection.
Here's how to correctly use an Auto Disposable syringe:

 Inspect the Syringe: Before use, visually inspect the syringe for any damage or defects.
Make sure the packaging is intact and the syringe looks clean and functional.
 Wash Hands: Wash your hands thoroughly with soap and water or use hand sanitizer to
maintain proper hygiene.
 Prepare the Vaccine or Medication: Draw the appropriate amount of vaccine or
medication into the syringe according to the dosage prescribed by a healthcare
professional / doctor.
 Expel Air Bubbles: Gently tap the syringe to move any air bubbles to the top, then push
the plunger slightly to expel the air bubbles. This ensures that you're injecting the correct
amount of the medication.
 Administer the Injection: Choose the appropriate injection site (e.g., upper arm, thigh).
Insert the needle at the correct angle and depth. Slowly push the plunger to administer
the medication.
 Dispose of the Syringe Safely: After the injection, the auto-disable feature of the syringe
will engage, making it impossible to reuse. Follow Bio medical waste disposal guidelines
to properly dispose of the used syringe.
 Wash Hands Again: After administering the injection and disposing of the syringe,
wash your hands again to ensure proper hygiene.

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 Ensure documentation: After completion of the infection ensure proper documentation
of the activity.

How to conduct Shake test for DPT, DT and TT?

The "shake test" is a common practice used to check the reconstitution of vaccines such as DPT
(Diphtheria, Pertussis, Tetanus), DT (Diphtheria, Tetanus), and TT (Tetanus Toxoid) vaccines
after reconstitution with a diluents. This ensures that the vaccine powder and the diluents have
mixed properly, and the vaccine is ready for administration.

The "shake test" of a vaccine is a quality control procedure used to verify the solution is uniform
and ready for safe and effective administration.

The process involves gently shaking the reconstituted vaccine vial to check for the following:

 Homogeneity: The solution should appear uniform and well-mixed without any visible
clumps, particles, or separation. Any signs of incomplete mixing could indicate that the
vaccine might not be effective or safe to administer.
 Absence of Sediment: There should be no sediment at the bottom of the vial, as this
could indicate that the vaccine components have not mixed properly.
 Consistency: The solution should have a consistent color and texture throughout,
without variations or color changes.
 Lack of Frothing or Foaming: Vigorous shaking could lead to frothing or foaming,
which could affect the vaccine's accuracy and dosage.

Tilt the vial to observe the solution's uniformity. It should appear homogeneous and well-mixed,
without any visible clumps or sediment. The shake test is an important step in ensuring the
quality and efficacy of vaccines. Improper reconstitution can lead to under dosing or overdosing,
which can impact the vaccine's effectiveness and safety. It's important to note that the specific
procedures for reconstitution and performing the shake test may vary based on the type of
vaccine and the manufacturer's instructions. Always follow the manufacturer's guidelines

** Always check latest Clinical Guideline in this regard.

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What is Anaphylaxis and AEFI?

Anaphylaxis and AEFI (Adverse Events Following Immunization) are both terms related to the
field of immunization and healthcare. They refer to different aspects of reactions that can occur
after receiving vaccines.

Anaphylaxis:
Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur shortly
after exposure to an allergen, including certain components of vaccines. Anaphylaxis involves
a rapid and severe immune response that can affect multiple body systems, leading to
symptoms such as difficulty breathing, swelling of the face and throat, a sudden drop in blood
pressure, and hives. Anaphylaxis requires immediate medical attention, as it can lead to shock
and even death if not treated promptly with medications like epinephrine (adrenaline). In the
context of vaccines, anaphylactic reactions are rare but are a recognized concern. Healthcare
providers are trained to identify and manage anaphylactic reactions during the administration
of vaccines. People with a history of severe allergic reactions to vaccine components or other
allergens should consult their healthcare provider before receiving vaccines.

AEFI (Adverse Events Following Immunization):


An adverse event following immunization (AEFI) is any untoward medical occurrence which
follows immunization and which does not necessarily have a causal relationship with the usage
of the vaccine. The adverse event may be any unfavorable or unintended sign (e.g. Abscess
following vaccination), abnormal laboratory finding (e.g. Thrombocytopenia following
measles vaccination) symptom or disease (e.g. Disseminated BCG infection following BCG
vaccination).
Types:
 Minor - Usually occur within a few hours of injection. Resolve after short period of
time and pose little danger.
 Severe - Can be disabling and, rarely life threatening. Most do not lead to long-term
problems. Must be reported
 Serious – Extreme condition may lead to death or persistent or significant disability.
Inpatient hospitalization is needed.

** All categories of AEFI are to be recorded in AEFI register

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WHO cause specific definition of AEFIs:

In summary, anaphylaxis is a severe reaction that can occur after exposure to allergens,
including vaccine components, while AEFI refers to any adverse medical event that follows
immunization. Healthcare providers and regulatory agencies play a critical role in monitoring
and managing these events to ensure the safety and effectiveness of vaccines.
** Always check latest Clinical & Departmental Guidelines in this regard.

What to do in case of Anaphylaxis?


Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur rapidly
and requires immediate medical attention.
Here are general steps to take in case of anaphylaxis:
1. Recognize the Symptoms,
2. Call for Emergency Medical Help / doctor if needed
3. Administer Adrinalin as per guideline
4. Maintain Airway and Breathing
5. Administer Additional Medications , if prescribed by the doctor

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6. Monitor Vital Signs
7. Do not leave the person alone
** Follow the instruction of Medical Officer & Operational guidelines in this regard.

What are the symptoms or signs and symptoms of Extra pulmonary Tuberculosis?
Organ specific symptoms and signs like swelling of lymph nodes, pain & swelling in joints,
neck stiffness, disorientation, etc or constitutional symptoms like weight loss, fever> 2 weeks
night sweat.

Who are the presumptive DRTB cases?

1. TB patients who have failed treatment with first‑lineanti‑tubercular drugs (ATD).


2. Paediatric TB non‑responde.
3. TB patients who are contacts of DRTB.
4. TB patients who are found positive on any follow‑up sputum smear examination
during treatment with first‑line ATD.
5. Previously treated TB cases
6. TB patients with HIV co‑infection

How the facility to ensure that there are no financial barrier to access and that there is financial
protection given from cost of care?
By following measures-
1. Free OPD Consultation / ANC Checkups- all consultations are free of cost for all, including
BPL.
2. Patient party will not spend anything on purchasing drugs or consumables or diagnostics from
outside. This is a strict Govt. policy and is to ensured fully
If any other expenditure occurred it is to be reimbursed from hospital either through different
government guidelines.

What are the procedure for referral / transfer to other hospital?


When a patient in OPD is referred to other higher centre for the purpose of investigation or
management the following points must be observed:
1. Referral should be done with the instruction of Medical Officer / Hospital Authority.

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2. Referral is to be clearly written in OPD ticket, & referral slip must be issued mentioning the
exact cause of referral along with relevant history, findings of the patient and name of the
referring Doctor
3. Referral linkage with higher tier centre is to be maintained
4. Referral register need to be updated and properly maintained with cause of referral
5. Information regarding referral is to be shared with the hospital in charge, if necessary,
depending on merit of the case
6. There should be system for follow up of referred patient & record to be maintained.
7. Similarly for referred-in patient from lower tier facilities, record is to be maintained
8. For ICTC lab tests, it should have functional linkages with ART and state referral labs

How to ensure safe and potent vaccines?


Before beginning your immunization session, and before giving each vaccine, follow these
steps to ensure that every dose that you are going to give is safe and effective:
 Check label: Make sure the label on the vaccine vial is attached and clear enough to read.
If you find that the label is not clear enough to read or has come off, discard the vial.
 Check vaccine: Check that the vaccine being given is the correct one.
 Check expiry: Look for the expiry date on the vial. If the expiry date has passed, do not
use the vial; Discard it.
 Check the vaccine vial monitor (VVM) on vials to make sure that the vaccine is in the
usable stage.

What is Open Vial Policy?


Open Vial Policy has been developed to minimise and prevent vaccine wastage under the
UIP. It permits the reuse of partially used multi dose vials of relevant vaccines under UIP in
succeeding sessions up to 28 days PROVIDED certain conditions are fulfilled. It is essential
that the policy is followed correctly, so as to minimize wastage, adverse effects following
immunization and ensuring that the vaccination is effective.

Open Vial Policy is valid for the following vaccines:


• DPT, Td & TT,
• Hepatitis B,
• Oral Polio Vaccine (OPV)
• PCV
• Haemophilus influenzae type B (Hib) containing Pentavalent vaccine and

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• Injectable Inactivated Poliovirus Vaccine (IPV).

Open Vial Policy does NOT apply to:


• Measles,
• BCG and
• Japanese Encephalitis (JE) vaccines.
• Rotavirus vaccine

Provided that certain conditions are upheld, a vial of the vaccine that has been opened
during a session can be utilized for multiple immunization sessions WITHIN a period of
28 DAYS.
• The expiry date has not passed.
• The vaccines are stored under appropriate cold chain conditions both during transportation
and storage in cold chain storage point.
• The vaccine vial septum has not been submerged in water or contaminated in any way.
• Aseptic technique has been used to withdraw vaccine doses. (That is needle/septum has not
been contaminated in anyway)
• The vaccine vial monitor (VVM), has not reached/crossed the discard point.

A vaccine vial should be DISCADED if any of the following conditions are met and the
Medical Officer or Supervisor should be informed:
o VVM reached/crossed discard point (for freeze dried vaccine, before
reconstitution only) or vaccine vials without VVM or disfigured VVM.
o No label/partially torn label and/or writing on label not legible.
o Any vial thought to be exposed to non-sterile procedure for withdrawal.
o Open vials that have been under water or vials removed from a vaccine carrier
that has water.
o If vaccine vial is frozen or contains floccules or any foreign body.
o If there is breakage in the continuity of the vials (crack/leaks).
o If there is any reported AEFI following use of any of the vaccine vial, do not
use it, and retain it safely.

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Department:

Labor Room &


Maternity Ward

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What do you mean by the term High Risk patients & Vulnerable Patients?

Vulnerable patients and high-risk patients are terms commonly used in the medical field to refer
to individuals who are more susceptible to experiencing negative health outcomes or
complications due to various factors. These factors can include pre-existing medical conditions,
weakened immune systems, age, and other relevant characteristics.

 High-Risk Patients:
High-risk patients are individuals who have a higher likelihood of experiencing complications or
adverse outcomes due to prognosis of the medical or disease condition if intervention is not
given properly.

High risk patients include those:

 Any patient who might have bad prognosis without proper intervention
 Unable to understand the care processes or participate in decision making
 All Medical & life threatening emergency cases
 Patients requiring resuscitative services
 Patients requiring blood and blood products
 Patients who are comatose or/& mechanically ventilated
 Patients who are immune-suppressed
 Hemodialysis patients
 Patients in restraints
 Patients undergoing moderate and deep sedation
 Immunocompromised patients,
 pregnant women with danger sings
 Any other patients with complicated clinical conditions

 Vulnerable Patients: Vulnerable patients are those who have an increased susceptibility to self-harm
or adverse outcomes knowingly or unknowingly due to various factors. These factors may include
socioeconomic status, age, disabilities, mental health conditions, and more. Healthcare providers
often need to take extra precautions and tailor their care approaches when dealing with vulnerable
patients to ensure their safety and well-being.
Vulnerable patients include but not limited to -

 Any patient who can cause self harm


 Infants
 Children

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 Physically challenged individuals
 Elderly and frail
 Patient with Mental disorders / disability
 Sexual victims
 Prisoners
 Other individuals less able to protect themselves

What is Partograph ?

A partograph is a graphical record used in obstetrics to monitor the progress of labor and the
well-being of both the mother and the fetus during childbirth. It is a tool that helps healthcare
providers track various parameters and make informed decisions regarding the management of
labor. The partograph consists of a chart where important information is recorded over time. It
usually includes the following components:

 Cervical Dilation: This refers to the opening of the cervix, which is measured in
centimeters to monitor the progress of labor.
 Fetal Heart Rate: The fetal heart rate is monitored to ensure the well-being of the baby.
Abnormalities in the heart rate might indicate fetal distress.
 Contractions: The frequency and strength of uterine contractions are recorded, as they
play a crucial role in the progression of labor.
 Membrane Rupture: The time of rupture of the amniotic membranes (when the "water
breaks") is noted, as it can impact the timeline of labor.
 Maternal Vital Signs: Maternal blood pressure, pulse, and temperature are tracked to
monitor the mother's overall health during labor.
The partograph allows healthcare providers to visually assess the progress of labor against a
predefined "action line" or "alert line." If the labor progression crosses certain thresholds or if
any of the monitored parameters deviate from the norm, medical interventions might be required
to ensure the safety of both the mother and the baby as per the doctor‘s advice.

What is LaQshya ?

LaQshya" is an initiative aimed at improving the quality of care in labor rooms and maternity
operation theaters in public health facilities. LaQshya stands for "Labour Room Quality
Improvement Initiative" and is part of the larger goal to reduce maternal and newborn mortality
rates in the country. The initiative focuses on ensuring that the delivery rooms and operation

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theaters in health facilities meet certain Quality standards, and intended for achieving
improvements in the intra-partum and immediate post-partum care. The Guideline book
published in 2017 by MoHFW.

What are the objectives of LaQshya?

There are 3 objectives of LaQshya –


o To reduce maternal and newborn mortality & morbidity due to APH, PPH,
retained placenta, newborn asphyxia, and sepsis, etc.
o To improve Quality of care during the delivery and immediate post-partum care,
stabilization of complications & ensure timely referrals.
o To enhance patient satisfaction and and provide Respectful Maternity Care
(RMC) to all pregnant women attending the hospital.

What is Quality circle? What are the functions of a Quality Circle?

Quality circles are informal groups of the staff in each department that works closely to
improve the Quality of Labour Room and Maternity OT.
Function:
o Ensuring Adherence to Protocols & Clinical guidelines
o Ensure evidence based practices and prevention of Infection
o Assessment of Labour room & Maternity OT using departmental check-lists.
o Action planning for closure of gaps as per guidelines
o Ensuring regular update of performance indicators and Outcome indicators

What is LDR concept?

Labor-Delivery-Recovery (LDR) room concept says that - a pregnant woman spends the duration of
labor, delivery, and 4 hours postpartum in the same bed.

Each standard LDR unit will have the following components— 4 labor table (partition In between),
one nursing station, one newborn care area, two toilets and two washing areas. [1 LDR unit = 4 LDR
Beds]

LDR concept is more client-centric and ensures better care, privacy, and comfort to the pregnant
woman during labor process. It also obviates the need for having additional waiting area or labor
area and associated services

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What is OSCE / Full form of OSCE ?

Objective Structured Clinical Examination (OSCE) is a clinical skills assessment method that is
based on objective testing to test clinical skill performance and competence in skills.

The assessment will consist of 4 OSCE stations. These will test the knowledge and skills of our
staffs:

- Active Management 3rd Stage Labour (AMTSL)

- Postpartum Haemorrhage (PPH) / Shock management

- Eclampsia Management

- Newborn Resuscitation

What is Respectful Maternity Care?

Respectful Maternity Care (RMC) is an approach to maternal health care that emphasizes the
importance of providing respectful and dignified care to women during pregnancy, childbirth, and the
postpartum period. It recognizes the rights of women to be treated with dignity, respect, and
kindness, regardless of their background or circumstances. The RMC framework seeks to ensure that
childbirth is a positive and empowering experience for women, fostering a supportive and respectful
environment.

Some important points of RMC are -

1. Confidentiality and privacy is protected

2. The woman is protected from physical harm or ill treatment.

3. The woman‘s right to information, informed consent, and choice/preferences is protected.

4. The woman is treated with dignity and respect.

5. The woman receives equitable care, free of discrimination.

6. The woman is never left without care.

7. The woman is never detained or confined against her will.

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What are the 10 don’ts in Labour Room ?

1. No routine enema

2. No routine shaving

3. No routine induction /augmentation of labour

4. No place for routine suctioning of the baby

5. No pulling of the baby.

6. No routine episiotomy

7. No fundal pressure

8. No immediate cord cutting

9. No immediate bathing of the newborn

10. No routine resuscitation on warmer

What are the Protocols for entry to the labor room?

1. Entry to the labor room should not be direct. Ideally a buffer zone needs to be created if
possible for changing of shoes, wearing of mask and cap before entering the labor room.
2. Entry to the labor room should be allowed only to the pregnant woman, her birth
companion, doctor, nurse/ANM on duty, and other support staff. Cleaning staff should be
allowed periodic entry as per the SOP and protocols of cleaning.
3. Before entering the labor room, hand washing, gown, slippers, cap and mask should be
worn by everyone including the birth companion.
4. Entry of male staff should be restricted only to those who are on duty or have been called
for any accessories and fittings. They should be polite and respectful to the dignity and
privacy of the women.

What are the 7 Trays to be kept in Labour room?

1. Delivery tray
2. Episiotomy tray
3. Baby tray
4. Medicine tray
5. Emergency drug tray
6. MVA/ EVA tray
7. PPIUCD tray

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How Management of Obstructed Labour done?

It should be done as per the clinical findings and guidelines by a doctor. On a general term
diagnoses obstructed labour usually based on data registered from the partograph, Re-hydrates
the patient to maintain normal plasma volume, check vitals, gives broad spectrum antibiotics,
perform bladder catheterization and takes blood for Hb & grouping, Decides on the mode of
delivery as per the condition of mother and the baby.

** Always check latest Clinical & Departmental Guidelines in this regard.

How to Identify PPH?


Assessment of bleeding (PPH if >500 ml or > 1 pad soaked in 5 Minutes or any bleeding
sufficient to cause signs of hypovolemia in patient, or any other condition diagnosed by the
doctor.

How to use of Oxytocin for Management of PPH ?

 Initial Dose: Infuse 20 IU in 1 L NS/RL at 60 drops per minute

 Continuing dose: Infuse 20 IU in 1 L NS/RL at 40 drops per minute

 Maximum Dose: Not more than 3 L of IV fluids containing oxytocin


**Always check for Doctors advice and latest Clinical guidelines in this regard

How Dangers signs are identified?


It should be assessed by a professional. Examining the perineum for inflammation, status of
episiotomy/tears, lochia for colour, amount, consistency and odour, Checks calf tenderness,
redness or swelling. Mother's danger sign: Bleeding, pain abdomen, severe headache, visual
disturbance, breathing diffculity, fever & chill, difficulty in empty bladder, foul smelling
discharge. Baby Danger Sign: Fast/difficult breathing, fever, unusual cold, refusal of feeding,
failure to thrive, less active than usual & yellow discoloration

What are the 'six cleans' are followed during delivery?

1. Clean Hands,
2. Clean Perineum
3. Clean Delivery Surface,
4. Clean Blade,
5. Clean Cord Tie,
6. Clean Towel & Cloth To Wrap

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What is High Alert Drugs and what are the cautious administration of high alert drugs?

High alert drugs are medications that have a heightened risk of causing significant harm to
patients if used in error. These drugs have a greater potential for adverse effects due to their
characteristics, dosage forms, or potential for medication errors..

To ensure that the right doses of high-alert drugs are administered, healthcare facilities follow
strict processes and protocols. These processes involve multiple layers of checks and
verifications to minimize the risk of errors.

Here is an outline of the typical steps involved in the process:

 Drug Formulary and Policies: Healthcare organizations should establish a drug


formulary that includes high-alert medications, or the facility should list the names of
High Alert Drugs with the existing medication available. This formulary or lists outlines
the approved drugs, their indications, dosing guidelines, and precautions as per approved
EDL. Policies and protocols must be developed to ensure the safe use of high-alert
drugs.

 Labeling: High Alert Medications will be prescribed, dispensed, and administered using
practices that are proven safe. High Alert Medications should have “HIGH ALERT
MEDICATION” labels on storage shelves, containers, product packages and loose vials
or ampoules. Any changes of brand /colour / preparation of High Alert Medications must
be informed as soon as possible.

Strategies To Reduce ERRORS due TO HIGH ALERT DRUGS:

1. List of High Alert Medications within the facility shall be identified.

2. High Alert Medications should have HIGH ALERT MEDICATION label on storage

shelves and or loose vials/ ampoules.

3. High Alert Medications should be kept in secure places with an IEC of maximum dosage

of each drug.

4. High Alert Medications should Not be prescribed in abbreviation or in short forms, and

should be prescribed in generic names with proper dosage, route & patient name.

5. High Alert Medications must be double checked before they are prepared, dispensed and

administered to the patients.

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6. All High Alert Medications issued from the pharmacy must be counterchecked and

verified by another pharmacy staff prior to dispensing for the purpose of medication

safety and accuracy. If the any prescription is not legible it should be verified by the

doctor.

7. Verbal communications of medication order on high alert medication are Not

Recommended and in case of emergency it should be immediately rechecked via spelling

of the drug for verification and documented with signature of the doctor.

8. After administration of High Alert Medications proper medication record should be

maintained and patient need to be closely monitored for any adverse event.

9. After use stock of High Alert Medications should be properly updated and counter signed

by the authority.

What do you mean by LASA drugs?

LASA Stands for Look Alike and Sound Alike (LASA) Medicines:

Look Alike Sound Alike (LASA) medications are drugs that are visually similar in physical
appearance or packaging and/or names of medications that have spelling similarities or
similarity during pronunciation. Eg : Lora-zepam, Clona-zepam, Dopa-mine-Dobuta-mine

Strategies to avoid errors with LASA medications:

1) List of LASA drugs should be available at the facility

2) During Storage - Use Tall Man lettering to emphasize differences in medications with
sound-alike names. eg- DOPamine & DOBUTamine.

3) Use additional Warning labels for look-alike medicines.

4) Store LASA medication separately from LASA pair with proper labeling.

5) Prescription should clearly specify generic name of medication, dosage and complete
direction for use.

6) During dispending or drug administration - Identify medicines based on its name and strength
and double check.

7) Ensure proper documentation.

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What is Adverse Drug Reaction?

An adverse drug reaction (ADR), also known as an adverse drug event (ADE), refers to any
unwanted or harmful response to a medication. It occurs when a patient experiences a negative
reaction after taking a drug, whether it is prescribed, over-the-counter, or even herbal or
alternative remedies. Adverse drug reactions can range from mild and tolerable side effects to
severe and life-threatening complications.

Here are some key points about adverse drug reactions:

 Types of Adverse Drug Reactions: There are different types of adverse drug reactions,
including:
 Type A (Augmented) Reactions: These are predictable and dose-dependent reactions
that are an extension of the drug's known pharmacological effects. For example,
drowsiness caused by sedating antihistamines.
 Type B (Bizarre) Reactions: These are unpredictable reactions that are unrelated to the
known pharmacological action of the drug. They often occur in susceptible individuals
and can range from mild to severe. Examples include severe allergic reactions or
anaphylaxis.
 Type C (Chronic) Reactions: These reactions are associated with long-term use of a
drug and may develop gradually over time. An example is drug-induced osteoporosis
from long-term corticosteroid use.
 Type D (Delayed) Reactions: These reactions have a delayed onset, occurring days,
weeks, or even months after drug exposure. An example is drug-induced liver injury.
 Type E (End-of-Use) Reactions: These reactions occur when a drug is withdrawn,
resulting in a rebound or withdrawal response. An example is rebound hypertension after
sudden discontinuation of antihypertensive medication.
 Type F (Failure) Reactions: These reactions occur when a drug fails to produce the
intended therapeutic effect. For example, a patient may not respond to an antibiotic due
to bacterial resistance.

 Symptoms and Severity: Adverse drug reactions can manifest in various ways, ranging from
mild to severe. Common symptoms include nausea, vomiting, rash, dizziness, headache,
diarrhea, and fatigue. In severe cases, adverse drug reactions can lead to organ damage,
anaphylaxis, cardiovascular events, or even death.
 Risk Factors: Certain factors increase the risk of experiencing an adverse drug reaction.
These include individual susceptibility, age (the very young and elderly are often more

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vulnerable), concomitant use of multiple medications, underlying medical conditions, genetic
factors, and drug interactions.
 Reporting and Monitoring: Adverse drug reactions should be promptly reported to
healthcare providers and regulatory authorities. Reporting systems help identify trends,
improve drug safety, and inform regulatory decisions. Healthcare professionals monitor
patients closely for adverse drug reactions during treatment and adjust medications as
necessary. A separate register should be maintained.
 Prevention and Minimization: Adverse drug reactions can be minimized through proper
prescribing practices, patient education about potential side effects, accurate medication
reconciliation, regular monitoring, and reviewing the patient's medication history to identify
drug interactions or contraindications.
 Pharmacovigilance: Pharmacovigilance is the science and activities related to the detection,
assessment, understanding, and prevention of adverse drug reactions. It plays a crucial role in
ensuring drug safety and identifying any previously unrecognized risks associated with
medications. If a person suspects they are experiencing an adverse drug reaction, it is
important to seek medical attention promptly. Healthcare professionals can evaluate the
symptoms, discontinue or adjust the medication if necessary, and provide appropriate
treatment or management strategies.

Adverse Drug Reaction vs. Medication Error: It's important to distinguish between an ADR
and a medication error. An ADR refers to the patient's unwanted response to a drug, whether
prescribed and administered. On the other hand, a medication error refers to a mistake in the
medication process, such as prescribing, dispensing, or administering the wrong medication or
dose.

** Any kind of Drug Reaction or Medication Error if any should be recorded and reported.

What is Blood Transfusion Reaction?

A blood transfusion reaction refers to an adverse reaction that occurs as a result of receiving a
blood transfusion. Although blood transfusions are generally considered safe, complications can
occur in rare instances. These reactions can vary in severity and may range from mild to life-
threatening. It's important to closely monitor patients during and after transfusions to promptly
identify and manage any adverse reactions.

Types of Transfusion Reactions:

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 Immune reactions
 Non immune reactions
 Immediate
• During or within few hours of transfusion
 Delayed
• Days or weeks after the transfusion

Specific blood transfusion reactions include:

 Febrile Non-Hemolytic Reaction: This reaction is characterized by the development of


fever during or shortly after the transfusion. It is often accompanied by chills, headache,
and mild discomfort. It is typically caused by the recipient's antibodies reacting to white
blood cells in the donated blood.
 Allergic (Hypersensitivity) Reaction: Allergic reactions can occur due to sensitivity to
proteins or other substances in the transfused blood. Symptoms may include hives,
itching, flushing, wheezing, shortness of breath, and, in severe cases, anaphylaxis.
 Acute Hemolytic Transfusion Reaction (AHTR): Acute hemolytic reactions happen
within 24 hours of transfusion. This is a severe and potentially life-threatening reaction
caused by the recipient's immune system attacking and destroying the transfused red
blood cells. It can result from intravascular haemolysis, or ABO blood group
incompatibility or other red cell antibodies, or extravascular haemolysis or Rh minor
group incompatibility. Sign & Symptoms include fever, chills, back pain, chest pain,
Hypotension, Tachycardia, hemoglobinuria (red or brown urine), Dyspnoea and
disseminated intravascular coagulation (DIC).

 Delayed Hemolytic Reaction: This type of reaction can occur days to weeks after a
transfusion. This hemolytic reaction happen after 24 hours, usually occur two weeks after
but can go up to 30 days post transfusion. It is characterized by the recipient's immune
system mounting an immune response against the transfused red blood cells, resulting in
their destruction. Symptoms include gradual decline in hemoglobin levels, jaundice, and
sometimes fever.

 All type or any type of transfusion reaction should be recorded in a register with proper
details.

** Always check latest Guidelines from NACO / National Blood Transfusion Council
(NBTC) in this regard.

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What are the procedures for secure storage of Narcotic and Psychotropic drugs?

• All Narcotic and Psychotropic drugs available in the hospital must be listed as per EDL
and displayed.
• Drug substances like Narcotics, Psychotropic drugs and other potent drugs shall be stored
in their designated cupboard/drawer under double lock system with signages outside.
• One key for the same shall be with the Sister-In charge and the other with the on duty Staff
nurse / any other person (Two different people)
• Narcotic & Psychotropic drugs will be released only on the signed requisition of the
Doctor/MO.
• List of availability must be updated after each use.

What are the procedures of patient Hand over, whenever staff duty change happens?

Patient handovers often referred to as "shift handovers" or "shift change reports," are crucial in
hospitals to ensure continuity of care and patient safety when there is a change in staff duty. Proper
handovers help convey important patient information accurately and comprehensively.

Whenever hand over is given it should be in bed side and as per SBAR method.
Providing patient handover using the SBAR (Situation, Background, Assessment, Recommendation)
format is an effective way to convey important patient information in a clear and structured manner.

Here's how to give a patient handover using SBAR:

1. Situation (S): Start the handover by providing a brief and concise overview of the patient's
current situation. Include the following information:
a. Patient's name and age.
b. The primary reason for admission or the main concern.
c. A brief statement of the patient's current condition, such as "The patient is stable" or
"The patient's condition is deteriorating."
2. Background (B): Provide the necessary background information about the patient. This
section should cover:
a. Relevant medical history, including chronic conditions or recent surgeries.
b. Allergies or sensitivities.
c. Key vital signs and trends, such as blood pressure, heart rate, respiratory rate,
temperature, and oxygen saturation.
d. Current medications, dosages, and administration routes.
e. Any recent laboratory results, diagnostic tests, or imaging findings.

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f. Important events during the shift, such as interventions, responses to treatment, or
changes in the patient's status.
3. Assessment (A): Describe your assessment of the patient's current clinical status. This section
should include:
a. The patient's signs and symptoms.
b. Any concerns, potential complications, or changes in condition.
c. Response to interventions or treatments.
d. Pain level, if applicable.
4. Recommendation (R): Provide your recommendations for the patient's ongoing care and any
actions that should be taken. Include:
a. Specific plans for treatment or management.
b. Medication changes, dosage adjustments, or any new prescriptions.
c. Upcoming procedures, tests, or consultations.
d. Any special patient needs or concerns.

o Code status, advance directives, or other important preferences.

When giving a patient handover using SBAR, it's important to be clear and concise, focusing on the
most relevant information. Here are some additional tips:

 Use plain language and avoid medical jargon.


 Speak in a calm and organized manner.
 Encourage the receiving healthcare provider to ask questions for clarification.
 Be prepared to provide further details if requested.
 Document the handover information in the patient's medical record or handover report.
 Ensure a smooth transition of care by confirming that the receiving healthcare provider
acknowledges the handover and is ready to assume responsibility for the patient.

SBAR is a valuable communication tool in healthcare settings, promoting effective and structured
information exchange. It helps ensure that all relevant patient information is conveyed accurately,
improving patient safety and continuity of care.

Handover register should be properly maintained.

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What are the procedures to check drug before administration / dispensing?

Checking a drug before administration or dispensing is a critical step in ensuring patient safety. The
following are general procedures that healthcare professionals typically follow to verify and
administer medications safely:

1. Prescription Review: Verify the prescription or medication order. Ensure that it is legible
and complete. Confirm that the order includes the patient's name, the drug name, dosage,
route of administration, frequency, and any other relevant information.
2. Patient Identification: Confirm the patient's identity using at least two patient identifiers
(e.g., name and registration no. / date of birth)
3. Patient Education: Provide the patient with information about the medication, including
route of administration, potential side effects, and any other relevant information.
4. Drug Storage: Ensure that the drug is stored appropriately, considering factors such as
temperature, light exposure, and expiration date.
5. Medication Label Check: Check the medication label against the medication order. Verify
the drug name, strength, dosage form, and concentration.
6. Expiration Date Check: Confirm that the medication has not expired.
7. Dosage Calculation: If the medication requires dosage calculations, double-check the
calculations to ensure accuracy.
8. Allergy Check: Confirm that the patient does not have any known allergies to the
medication.
9. Drug Interactions: Check for potential drug interactions with other medications the patient is
currently taking.
10. Documentation: Document the medication administration or dispensing, including the date,
time, dose, route, and any other relevant information.
11. Follow-Up Monitoring: Monitor the patient for any adverse reactions or side effects after
medication administration.
** Always follow the specific guidelines and procedures established by your healthcare institution.

What is Kangaroo Mother Care (KMC)?

Kangaroo Mother Care involves skin-to-skin contact between a mother and her newborn, similar to
how a kangaroo carries its joey in a pouch. This method has been shown to have several benefits for
both the mother and the infant. KMC is typically initiated soon after birth and involves placing the
baby, wearing only a diaper, on the mother's chest. The baby's skin is in direct contact with the
mother's skin, providing warmth, comfort, and facilitating bonding.

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Key components of Kangaroo Mother Care include:

 Skin-to-Skin Contact: The baby is placed on the mother's chest, usually under her clothing,
in direct skin-to-skin contact. This helps regulate the baby's temperature and promotes
bonding.
 Exclusive Breastfeeding: KMC encourages exclusive breastfeeding, as the baby is in close
proximity to the mother's breast and can feed as needed.
 Temperature Regulation: The mother's body heat helps regulate the baby's temperature,
especially important for premature or low-birth-weight infants who may struggle with
maintaining their body heat.
 Breathing and Heart Rate Stability: KMC has been shown to stabilize the baby's
respiratory rate and heart rate, leading to improved overall physiological stability.
 Emotional Bonding: The close physical contact fosters emotional bonding between the
mother and the baby.

Kangaroo Mother Care

What are the process for end of life care and death & Procedures for decent communication of death?

Facility should have a defined procedure for record of death of the admitted patient and
communication with the relatives. Hospital should have a defined procedure for record of death of the
admitted patient and communication with the relatives.

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Clinical policy of care at the end of life and the professional practice it guides should:

 Be respectful to the dignity of both patient and caregivers;


 Be sensitive to and be respectful of the patient's and family's wishes;
 Should use the most appropriate measures that are consistent with patient‘s choices
 Should try to arrange for alleviation of pain and other physical symptoms;
 Should be able to access and manage psychological, social, and spiritual/religious problems;
 Should offer continuity (the patient should be able to continue to be cared for, if so desired,
by his/her primary care and specialist providers);
 Should provide access to any therapy which may realistically be expected to improve the
patient's quality of life, including alternative or nontraditional treatments;
 Should be respectful to the right to refuse treatment
 Should be respectful to the physician's professional responsibility to discontinue some
treatments when appropriate, with consideration for both patient and family preferences.
 Death of a patient is handled carefully with concern without complacency. Counselling of next of
kin with empathy is importance. All help in shifting the body from the hospital is extended to the
next of kin. The dead body is released as soon as possible after completion of all formalities.
 Acknowledgement for receipt of the body and the Death Certificate is obtained from next of
kin/legal representative and handing-over of the body to patient‘s relatives. It is ensured that
hospital staff takes due care and concern in this respect. Due arrangements are made if preserving
the body in the mortuary is found necessary.
Security staffs of the hospital should be present till the departure of the deceased and ensure
orderliness in handing over the body to the next of kin. ** It should be done as per the hospital
policy & G.O. Always seek administrative approval in this regard

How Rapid Initial assessment of Pregnant Women to identify complication and Prioritize care are
done ?

Recording of vitals and FHR. Immediate sign if following danger sign are present - difficulty in
breathing, fever, severe abdominal pain, Convulsion or unconsciousness, severe headache or
blurred vision.

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Department:

Pediatrics Ward

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What are the Criteria for Initial Assessment?

 Check process of initial assessment, triage, and identification of emergency, priority &
non urgent signs are defined & followed.
 Check time for initial assessment done is recorded in BHT

What are procedures for periodic monitoring of pediatric patients?

Monitoring must be done as per the instruction of Medical Officer. On a general - check for TPR
chart, I/O chart, any other vital required is monitored viz lower chest in drawing, coma score or
level of consciousness [AVPU: Alert, Responding to Voice, responding to Pain, Unconscious],
temperature and body weight].

How to identify high risk patients and ensure their care?

Identification is done as per the clinical findings & triage is done and provides emergency
treatment keeping in mind the ABCD steps: Airway, Breathing, Circulation, Coma, Convulsion,
and Dehydration.

High risk patients are identified and treatment given on priority as per the instruction of Medical
Officer. Here are some common categories of pediatric high-risk patients:

 Premature Infants: Babies born before 37 weeks of gestation are considered premature
and often require specialized care due to underdeveloped organs and systems.
 History of Neonatal Intensive Care Unit (NICU) stay: Infants who have spent time in
the NICU may face ongoing health challenges related to their prematurity or other
medical issues.
 Children with Chronic Medical Conditions: Kids with chronic conditions such as
diabetes, asthma, congenital heart defects, or autoimmune disorders are considered high-
risk due to the ongoing management of their health.
 Immunocompromised Children: Those with weakened immune systems, either due to
medical treatments like chemotherapy or certain medical conditions, are at a higher risk
of infections.
 Genetic Disorders: Children with genetic disorders, such as cystic fibrosis, Down
syndrome, or sickle cell disease, may require specialized care to manage their conditions.
 Children with Neurological Disorders: Conditions like epilepsy, cerebral palsy, or
neurodevelopmental disorders may place children at a higher risk for various health
challenges.

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 Children with Complex Medical Needs: Some children have multiple medical issues or
complex medical needs, requiring coordinated care from various specialists.
 Children with Respiratory Conditions: Chronic respiratory conditions like
bronchopulmonary dysplasia or severe asthma can increase the risk of respiratory
infections and complications.
 Children with Cardiac Conditions: Those with congenital heart defects or other cardiac
issues may require ongoing monitoring and interventions.
 Children with Developmental Delays: Kids who experience delays in physical,
cognitive, or social development may require additional support and medical attention.

How Triage of sick children is done as per protocols?

Screening of sick child is done to prioritize management as per classification: Emergency sign,
priority sign & non urgent sign. Triage of sick children is done as per the clinical guideline
by the Medical officer. If needed all emergency & priority sign need to be stabilize and if
instructed referred to higher centre for management.

What are the emergency signs in Sick child?

Obstructed or absent breathing, severe respiratory distress, central cyanosis, signs of shock
(cold hands, capillary refill time longer than 3 s, high heart rate with weak pulse, and low or
immeasurable blood pressure),coma, convulsions signs of severe dehydration in a child with
diarrhea and any other sign & symptoms assessed by the Medical Officer.

What are the Assessment & Management of airway due to breathing obstructions / failure?

 Monitoring must be done as per the instruction of Medical Officer. On a general Assess
airway & breathing- severe respiratory distress, central cyanosis & obstructed/absent
breathing (any of sign positive)-
 Check –
(1) If foreign body aspirated. Manage airway in choking child. Management of choking
child, by back slap, chest thrust (infant) back blow (child >1 yr.)
(2) If no foreign body is aspirated -Manage air way, give oxygen & keep child warm.
Proceed for full investigation & treatment

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What are the priority signs in Sick child?

Tiny infant: any sick child aged < 2 months, Temperature: child is very hot, Trauma or other
urgent surgical condition, severe Pallor , Poisoning , Severe Pain ,Respiratory distress, Restless,
continuously irritable or lethargic, visible severe wasting, Oedema of both feet & major burn.

What are the Assessment & Management of Hypoxaemia?

Assessment & Monitoring must be done as per the instruction of Medical Officer. As a general -

 Early signs confusion, restlessness & shortness of breath.


 Determine oxygen level using pulse oximeter.
 Oxygen supplementation - when child is in respiratory distress & SPO2 is <90%.
 Child with emergency signs but without respiratory distress receive oxygen therapy-
if SPO2 is <94%.
 Investigate for underlying cause - viz. Asthma, Pneumonia, Anaemia, ARDS etc

What are the Assessment & management of circulation failure cases?

Assessment & management must be done as per the instruction of Medical Officer. As a general

 Cold bodies with capillary refill longer than 3 sec/ fast & weak pulse. Any sign positive.
 Check for any bleeding, give oxygen & keep child warm.
 If malnourishment seen: child is lethargic /unconscious- Insert IV line & Give IV
glucose, if child is not lethargic & unconscious- give glucose orally / nasogastric tube,
proceed for full investigation & further treatment.

What are the sign & symptoms of severe pneumonia in children 2 months to 5 yrs.?

 Cough or difficulty in breathing in children with at least one of the following condition :
 Central Cyanosis or oxygen saturation <90%
 Server respiratory distress (labored of very fast breathing (RR<70 per minute) or severe
lower chest in drawing or head nodding or stridor or grunting)
 Sign of pneumonia with general danger sign (inability to breastfed or lethargy or reduced
level of consciousness or convulsions)

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What are the categories of Anemia on basis of HB level among the children?

Among children between 6 month and 5 yrs.

 >11 gm/dl- No anaemia


 10 - 10.9 gm/dl- Mild anaemia
 7- 9.9gm/dl-Moderate anaemia
 <7gm/dl- Severe Anaemia

Among children between 5 yrs-10 yrs.

 11–11.4 gm/dl- Mild anaemia


 8 – 10.9 gm/dl- Moderate anaemia
 <8 gm/dl - Severe anaemia

What are indications for blood transfusion due to severe Anemia?

Assessment & Monitoring must be done as per the instruction of Medical Officer. As a general -

 All children with Hb ≤4 gm/dl,


 Children with Hb 4–6 gm/dl with
 any of the following:
– Dehydration
– Shock
– Impaired consciousness
– Heart failure
– Deep and laboured breathing
– Very high parasitaemia
 (>10% of RBC)

How Care of children with Developmental Dysplasia of Hip is done?

Assessment & Monitoring must be done as per the instruction of Medical Officer. As a general -

 Management in child up to 4 months - Application of Pavlik Harness


 Management of Child above 4 years - Closed Reduction and hip spica application
 Follow-up with the patient referred back from tertiary hospitals
 Frequent Skin care

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What are the clinical presentations of Acute Hepatitis?

Assessment & Monitoring must be done as per the instruction of Medical Officer. As a general -

 Signs of Jaundice, unexplained weight loss, loss of appetite, fatigue etc


 Acute case - elevations in the concentration of alanine and aspartate aminotransferase
levels (ALT and AST); values up to 1000 to 2000 international units/L are typically seen
during the acute phase with ALT being higher than AST.
 Chronic is clinically salient

What are the care protocols of children returned back from surgery?

It must be done as per the instruction of Medical Officer and as per the latest clinical guidelines.
As a general -

• Staff frequently assesses the surgical site in case of any redness; discharge the case in
charge is informed immediately.

• Staff counsels the mother on the techniques of feeding infant post surgery

• Diet - Soft, mashed diet to be provided to children post surgery. Do not give hard,
crunchy foods

In cases of cleft lip and cleft palate: General & Specific care directed by Orthodontics viz.
Mouth care is maintained post surgery use gauze lock and mouthwash for cleaning. Don't use
brush for 3 weeks. Use the arm string/ restrain to avoid thumb/ finger sucking etc

What are the procedures of patient Hand over, whenever staff duty change happens?
Patient handovers often referred to as "shift handovers" or "shift change reports," are crucial in
hospitals to ensure continuity of care and patient safety when there is a change in staff duty. Proper
handovers help convey important patient information accurately and comprehensively.
Whenever hand over is given it should be in bed side and as per SBAR method.

Providing patient handover using the SBAR (Situation, Background, Assessment, Recommendation)
format is an effective way to convey important patient information in a clear and structured manner.

Here's how to give a patient handover using SBAR:

5. Situation (S): Start the handover by providing a brief and concise overview of the patient's
current situation. Include the following information:

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o Patient's name and age.
o The primary reason for admission or the main concern.
o A brief statement of the patient's current condition, such as "The patient is stable" or
"The patient's condition is deteriorating."
6. Background (B): Provide the necessary background information about the patient. This
section should cover:
o Relevant medical history, including chronic conditions or recent surgeries.
o Allergies or sensitivities.
o Key vital signs and trends, such as blood pressure, heart rate, respiratory rate,
temperature, and oxygen saturation.
o Current medications, dosages, and administration routes.
o Any recent laboratory results, diagnostic tests, or imaging findings.
o Important events during the shift, such as interventions, responses to treatment, or
changes in the patient's status.
7. Assessment (A): Describe your assessment of the patient's current clinical status. This section
should include:
o The patient's signs and symptoms.
o Any concerns, potential complications, or changes in condition.
o Response to interventions or treatments.
o Pain level, if applicable.
8. Recommendation (R): Provide your recommendations for the patient's ongoing care and any
actions that should be taken. Include:
o Specific plans for treatment or management.
o Medication changes, dosage adjustments, or any new prescriptions.
o Upcoming procedures, tests, or consultations.
o Any special patient needs or concerns.
o Code status, advance directives, or other important preferences.

When giving a patient handover using SBAR, it's important to be clear and concise, focusing on the
most relevant information. Here are some additional tips:

 Use plain language and avoid medical jargon.


 Speak in a calm and organized manner.
 Encourage the receiving healthcare provider to ask questions for clarification.
 Be prepared to provide further details if requested.
 Document the handover information in the patient's medical record or handover report.

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 Ensure a smooth transition of care by confirming that the receiving healthcare provider
acknowledges the handover and is ready to assume responsibility for the patient.

SBAR is a valuable communication tool in healthcare settings, promoting effective and structured
information exchange. It helps ensure that all relevant patient information is conveyed accurately,
improving patient safety and continuity of care. Handover register should be properly maintained.

What are the procedures to check drug before administration/ dispensing?

Checking a drug before administration or dispensing is a critical step in ensuring patient safety. The
following are general procedures that healthcare professionals typically follow to verify and
administer medications safely:

1. Prescription Review: Verify the prescription or medication order. Ensure that it is legible
and complete. Confirm that the order includes the patient's name, the drug name, dosage,
route of administration, frequency, and any other relevant information.
2. Patient Identification: Confirm the patient's identity using at least two patient identifiers
(e.g., name and date of birth)
3. Patient Education: Provide the patient with information about the medication, including
route of administration, potential side effects, and any other relevant instructions.
4. Drug Storage: Ensure that the drug is stored appropriately, considering factors such as
temperature, light exposure, and expiration date.
5. Medication Label Check: Check the medication label against the medication order. Verify
the drug name, strength, dosage form, and concentration.
6. Expiration Date Check: Confirm that the medication has not expired.
7. Dosage Calculation: If the medication requires dosage calculations, double-check the
calculations to ensure accuracy.
8. Allergy Check: Confirm that the patient does not have any known allergies to the
medication.
9. Drug Interactions: Check for potential drug interactions with other medications the patient is
currently taking.
10. Documentation: Document the medication administration or dispensing, including the date,
time, dose, route, and any other relevant information.
11. Follow-Up Monitoring: Monitor the patient for any adverse reactions or side effects after
medication administration.

** Always follow the specific guidelines and procedures established by your healthcare institution.

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What are the functional Equipment/Instruments for emergency Procedures are to be kept?

 Self-inflating bags & mask with oxygen reservoir: newborn (250 ml), infant (500) &
paediatric (750 mL), Newborn, Infant, child masks (00,0,1), Oxygen concentrator (if
assured power supply) or oxygen cylinder (as backup) with regulator, pressure gauge and
flow meter,
 Suction pumps (electric & foot operated), Nebuliser, Infusion pump, Laryngoscope
handle and blades: curved 2,3; straight 1,2; handle 0 size, Pulse oximeter (adult /
paediatric probes),Noninvasive blood pressure monitoring (infant, child cuffs).
 Other necessary Equipment/Instruments for emergency procedures are to be kept as per
the hospital policy, tire and based on administrative guidelines.

How stabilization protocols are being followed?

It must be done as per the instruction of Medical Officer and as per the latest clinical guidelines.
As a general -

Stabilization includes some or all:

1. Securing the airway.


2. Establishing secure venous access.
3. Correcting poor perfusion and acidaemia.
4. Obtaining a full history.
5. Carrying out a full physical examination.
6. Performing baseline investigations, e.g.; a chest X-ray, electrolytes or glucose.
7. Performing acute ‗aetiological‘ investigations, e.g.; blood culture before giving
antibiotics.
8. Initial treatment of the causative pathology, e.g.; bronchodilators for asthma and
antibiotics for sepsis.
9. Deciding on the location of continuing care.
10. Arranging transfer to an appropriate unit (like paediatric ward) or health facility.

What are the common causes of respiratory distress in new-born?

 Pre Term : RDS, Congenital pneumonia, hypothermia & hypoglycaemia


 Term: Transient tachypnoea of new-born (TTNB), meconium aspiration, pneumonia,
asphyxia
 Surgical cases: Diaphragmatic hernia, Tracheo - esophageal fistula, B/L choanal atresia

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 Other causes: Congenital heart disease, acidosis, inborn errors of metabolism, or any
other cause diagnosed by the medical officer.

How assessment & grading of hypothermia is done ?

 Normal Axillary temp- 36.5 -37.5 OC


 Cold Stress- 36.4- 36OC
 Moderate Hypothermia- 35.9- 32OC
 Severe Hypothermia- <32OC.
 Assessment through Axillary temp., Skin temperature (using radiant warmer probe) and
Human touch.

What are the clinical conditions in which baby can exhibit signs of hypothermia?

LBW, preterm babies, hypoglycemia, sclerema, DIC and internal bleeding. Hypothermic babies
show signs of lethargy, irritability, poor feeding, tachypnoea / apnoea etc.

What are the management protocols for hyperthermic babies?

Management protocols for hyperthermic babies should do as per the Instruction of Medical
Officer as per the guidelines. As a general following may be followed after consulting with
doctors -

Examine every hyperthermia baby for infection –


1. If temp. is above 39OC, the neonate should be undressed and sponged with tepid water at
app. 35OC until temperature is below is below 38 C O

2. If temp. is 37.5- 39 C: Undressing & exposing to room temp is usually all that is
O

necessary.
3. If due to environmental Temperature: move baby into colder environment & using loose
& light clothes.
4. If due to device - remove the baby from source of heat
5. Give frequent breastfeeds to replace fluids. If the baby cannot breastfeed, give EBM. If
does not tolerate feeds, IV fluids may be given
6. Measures the temp. hourly till it become normal.

** Always check latest clinical guidelines in this regard.

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What are the therapeutic doses of Vitamin D and Calcium Supplementation?

 It should be done as per the instruction of Medical Officer. As a general following may
be followed after consulting with doctors
o For neonates and infants till 1 year of age, daily 2000 IU of vitamin D with 500
mg of calcium for a 3-month period is recommended. At the end of 3 months,
response to treatment should be reassessed
o From one year onwards till 18 years of age, 3000-6000 IU/day of vitamin D
along with calcium intake of 600-800 mg/day is recommended for a minimum of
3 months.
o Aware side-effects of excessive administration of Vitamin - D can lead to hyper
vitaminosis, particularly in infants.

How management of abscess and inverted nipple of mothers are done?

(1) If an abscess is suspected in one breast, advise the mother to continue feeding from the other
breast & refer for consultation

(2) Inverted/flat nipple- corrected using syringe

What is High Alert Drugs and what are the cautious administration of high alert drugs?

High alert drugs are medications that have a heightened risk of causing significant harm to
patients if used in error. These drugs have a greater potential for adverse effects due to their
characteristics, dosage forms, or potential for medication errors..

To ensure that the right doses of high-alert drugs are administered, healthcare facilities follow
strict processes and protocols. These processes involve multiple layers of checks and
verifications to minimize the risk of errors.

Here is an outline of the typical steps involved in the process:

 Drug Formulary and Policies: Healthcare organizations should establish a drug


formulary that includes high-alert medications, or the facility should list the names of
High Alert Drugs with the existing medication available. This formulary or lists
outlines the approved drugs, their indications, dosing guidelines, and precautions as per
approved EDL. Policies and protocols must be developed to ensure the safe use of
high-alert drugs.

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 Labeling: High Alert Medications will be prescribed, dispensed, and administered using
practices that are proven safe. High Alert Medications should have “HIGH ALERT
MEDICATION” labels on storage shelves, containers, product packages and loose
vials or ampoules. Any changes of brand /colour / preparation of High Alert
Medications must be informed as soon as possible.

Strategies To Reduce ERRORS due TO HIGH ALERT DRUGS:

1. List of High Alert Medications within the facility shall be identified.

2. High Alert Medications should have HIGH ALERT MEDICATION label on storage

shelves and or loose vials/ ampoules.

3. High Alert Medications should be kept in secure places with an IEC of maximum

dosage of each drug.

4. High Alert Medications should Not be prescribed in abbreviation or in short forms, and

should be prescribed in generic names with proper dosage, route & patient name.

5. High Alert Medications must be double checked before they are prepared, dispensed

and administered to the patients.

6. All High Alert Medications issued from the pharmacy must be counterchecked and

verified by another pharmacy staff prior to dispensing for the purpose of medication

safety and accuracy. If the any prescription is not legible it should be verified by the

doctor.

7. Verbal communications of medication order on high alert medication are Not

Recommended and in case of emergency it should be immediately rechecked via spelling

of the drug for verification and documented with signature of the doctor.

8. After administration of High Alert Medications proper medication record should be

maintained and patient need to be closely monitored for any adverse event.

9. After use stock of High Alert Medications should be properly updated and counter

signed by the authority.

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What are LASA drugs?

LASA Stands for Look Alike and Sound Alike (LASA) Medicines:

Look Alike Sound Alike (LASA) medications are drugs that are visually similar in physical
appearance or packaging and/or names of medications that have spelling similarities or
similarity during pronunciation. Eg : Lora-zepam, Clona-zepam, Dopa-mine-Dobuta-mine

Strategies to avoid errors with LASA medications:

1) List of LASA drugs should be available at the facility

2) During Storage - Use Tall Man lettering to emphasize differences in medications with
sound-alike names. eg- DOPamine & DOBUTamine.

3) Use additional Warning labels for look-alike medicines.

4) Store LASA medication separately from LASA pair with proper labeling.

5) Prescription should clearly specify generic name of medication, dosage and complete
direction for use.

6) During dispending or drug administration - Identify medicines based on its name and strength
and double check.

7) Ensure proper documentation.

What is Adverse Drug Reaction?

An adverse drug reaction (ADR), also known as an adverse drug event (ADE), refers to any
unwanted or harmful response to a medication. It occurs when a patient experiences a negative
reaction after taking a drug, whether it is prescribed, over-the-counter, or even herbal or
alternative remedies. Adverse drug reactions can range from mild and tolerable side effects to
severe and life-threatening complications.

Here are some key points about adverse drug reactions:

 Types of Adverse Drug Reactions: There are different types of adverse drug reactions,
including:
 Type A (Augmented) Reactions: These are predictable and dose-dependent reactions
that are an extension of the drug's known pharmacological effects. For example,
drowsiness caused by sedating antihistamines.

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 Type B (Bizarre) Reactions: These are unpredictable reactions that are unrelated to the
known pharmacological action of the drug. They often occur in susceptible individuals
and can range from mild to severe. Examples include severe allergic reactions or
anaphylaxis.
 Type C (Chronic) Reactions: These reactions are associated with long-term use of a
drug and may develop gradually over time. An example is drug-induced osteoporosis
from long-term corticosteroid use.
 Type D (Delayed) Reactions: These reactions have a delayed onset, occurring days,
weeks, or even months after drug exposure. An example is drug-induced liver injury.
 Type E (End-of-Use) Reactions: These reactions occur when a drug is withdrawn,
resulting in a rebound or withdrawal response. An example is rebound hypertension after
sudden discontinuation of antihypertensive medication.
 Type F (Failure) Reactions: These reactions occur when a drug fails to produce the
intended therapeutic effect. For example, a patient may not respond to an antibiotic due
to bacterial resistance.

 Symptoms and Severity: Adverse drug reactions can manifest in various ways, ranging from
mild to severe. Common symptoms include nausea, vomiting, rash, dizziness, headache,
diarrhea, and fatigue. In severe cases, adverse drug reactions can lead to organ damage,
anaphylaxis, cardiovascular events, or even death.
 Risk Factors: Certain factors increase the risk of experiencing an adverse drug reaction.
These include individual susceptibility, age (the very young and elderly are often more
vulnerable), concomitant use of multiple medications, underlying medical conditions, genetic
factors, and drug interactions.
 Reporting and Monitoring: Adverse drug reactions should be promptly reported to
healthcare providers and regulatory authorities. Reporting systems help identify trends,
improve drug safety, and inform regulatory decisions. Healthcare professionals monitor
patients closely for adverse drug reactions during treatment and adjust medications as
necessary. A separate register should be maintained.
 Prevention and Minimization: Adverse drug reactions can be minimized through proper
prescribing practices, patient education about potential side effects, accurate medication
reconciliation, regular monitoring, and reviewing the patient's medication history to identify
drug interactions or contraindications.
 Pharmacovigilance: Pharmacovigilance is the science and activities related to the detection,
assessment, understanding, and prevention of adverse drug reactions. It plays a crucial role in
ensuring drug safety and identifying any previously unrecognized risks associated with

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medications. If a person suspects they are experiencing an adverse drug reaction, it is
important to seek medical attention promptly. Healthcare professionals can evaluate the
symptoms, discontinue or adjust the medication if necessary, and provide appropriate
treatment or management strategies.

Adverse Drug Reaction vs. Medication Error: It's important to distinguish between an ADR
and a medication error. An ADR refers to the patient's unwanted response to a drug, whether
prescribed and administered. On the other hand, a medication error refers to a mistake in the
medication process, such as prescribing, dispensing, or administering the wrong medication or
dose.

** Any kind of Drug Reaction or Medication Error if any should be recorded and
reported.

What is Kangaroo Mother Care (KMC) ?

Kangaroo Mother Care involves skin-to-skin contact between a mother and her newborn, similar to
how a kangaroo carries its joey in a pouch. This method has been shown to have several benefits for
both the mother and the infant. KMC is typically initiated soon after birth and involves placing the
baby, wearing only a diaper, on the mother's chest. The baby's skin is in direct contact with the
mother's skin, providing warmth, comfort, and facilitating bonding.

Key components of Kangaroo Mother Care include:

 Skin-to-Skin Contact: The baby is placed on the mother's chest, usually under her clothing,
in direct skin-to-skin contact. This helps regulate the baby's temperature and promotes
bonding.
 Exclusive Breastfeeding: KMC encourages exclusive breastfeeding, as the baby is in close
proximity to the mother's breast and can feed as needed.
 Temperature Regulation: The mother's body heat helps regulate the baby's temperature,
especially important for premature or low-birth-weight infants who may struggle with
maintaining their body heat.
 Breathing and Heart Rate Stability: KMC has been shown to stabilize the baby's
respiratory rate and heart rate, leading to improved overall physiological stability.
 Emotional Bonding: The close physical contact fosters emotional bonding between the
mother and the baby.

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Department:

SNCU

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What are the Criteria defined for Endotracheal Intubation?

The Criteria should be decided and it should be done as per the instruction of Medical Officer &
latest clinical guidelines. As a general following may be followed after consulting with doctors

 To suction trachea in presence of meconium when newborn is not vigorous


 If positive pressure ventilation is not resulting into adequate clinical improvement
 To improve efficacy of ventilation after several minutes of bag & mask ventilation or
ineffective bag & mask ventilation.
 To facilitate chest compressions and ventilation and to maximize the efficiency of each
ventilation.
 For special cases like giving endotracheal medication & suspected diaphragmatic
hernia
 Other conditions assessed by the Medical officer

What are the emergency signs in Sick new born & action required?

 Hypothermia temp.< 35.50C,


 Apnoea or gasping breathing, Severe respiratory distress rate > 70/min , severe
retraction, grunt,
 Central cyanosis, shock, cold periphery, CFT > 3 sec, weak or fast pulse,
 Coma, convulsion &encephalopathy.
 Other sign & symptoms assessed by the Medical Officer
 Action: Urgent intervention, Stabilize and admit in SNCU

What are the priority signs in Sick new born & action required?

 Weight less than 1800 g (tiny neonates) or > 3800g.


 Temp. 36.5 OC -35.5OC,
 Lethargy/Irritable/Restless/Jittery
 Refusal to feed
 Respiratory distress rate > 60, no or minimal retraction,
 Abdominal Distention,
 Severe jaundice appear in <24hrs/stains palms and soles/lasts >2 weeks, severe pallor,
 Bleeding From Any Site,
 Congenital Malformation,
 Action: immediate assessment, attended on priority & need to be admitted in sncu

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What are management protocols of babies < 1800 gm (34 weeks)?

It should be done by the instruction of Medical Officer and by following the latest
guideline. In general –
 Use of Overhead radiant warmer or incubator to keep baby warm. Regular monitoring of
axillary temp at least once every 6-8 hrs .
 Planning the nutrition and fluids of babies considering type of feeding, quantity ,
frequency and modality of feeding
 Manage any other complication as per protocol

What are the frequency & type of feeding to LBW?

It should be done by the instruction of M.O and by following the latest guideline. In
general –
 LBW babies should fed with mother's milk every 2 hrs. Starting immediately after birth.
 Ensure LBW babies receive 'hind milk'.
 Multi fortified breast milk should be given to pre term <32 weeks / 1500 gm, who fail to
gain weight despite of breastfeeding
 Minimum entral feeds: Small volume of expressed breast milk i.e. 12 to 24 ml/kg/day
given every 1-3 hours delivered intra gastric.

What are the various techniques /modes of feeding to LBW?

It must be done as per the instruction of Medical Officer. As a general -

 Minimum entral feeds: Small volume of expressed breast milk i.e. 12 to 24 ml/kg/day
given every 1-3 hours delivered intra gastric.
 Non nutritive sucking: In premature or small babies - to develop sucking behavior &
improve digestion of feed
 Gavage feeds: Using feeding catheter - baby is fed with 10 ml syringe (without plunger)
attached toward outer end of tube & milk is allowed to trickle by gravity. The baby
should be placed in left lateral position for 15-20min to avoid regurgitation.
 Katori Spoon Feed: Feeding with spoon or paladai, especially neonates with gestation
of 30-32 weeks or more are in position to swallow. Take required amount of expressed
breast milk in katori, place the baby in semi upright posture. Fill the spoon with milk, a
little short of brim, place it at lips of the baby and let the milk flow into babies mouth
slowly, the baby will actively swallow the milk.

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How to monitor intake & output to prevent fluid overload?

It should be monitored as per the instruction of Medical Officer & latest clinical guidelines. As a
general following may be followed after consulting with doctors-

 IV-fluids are given are compared with prescribed volume & recorded in fluid monitoring
chart every 2 hrly.
 Measure blood glucose every 6-8hrs and take action for low (<45mg/dl) or high
(150mg/dl) blood glucose
 Daily monitoring: of weight, urine output, frequency of passage of urine, and sign of over
hydration.

How growth is monitored in LBW babies?

Babies checked for weight (daily), head circumference (weekly) and length (fort-nightly).
Fenton's growth chart is used for pre term babies. WHO growth chart is used from corrected age
of 40 weeks

What is Fenton's growth chart?

The Fenton Growth Chart is a specific growth chart used for assessing the growth of preterm
infants, particularly those born before 37 weeks of gestation. It is named after Dr. Tanis R.
Fenton, who developed this growth chart to better represent the growth patterns of preterm
infants compared to traditional growth charts designed for full-term infants. The Fenton Growth
Chart takes into account the unique growth trajectories of premature infants, who often have
different growth patterns and developmental milestones compared to their full-term counterparts.
This chart is particularly useful for healthcare professionals in monitoring the growth and
development of preterm infants. The Fenton Growth Chart includes data on weight, length, and
head circumference, and it provides percentiles specific to gestational age.

What is Kangaroo Mother Care (KMC) ?

Kangaroo Mother Care involves skin-to-skin contact between a mother and her newborn, similar to
how a kangaroo carries its joey in a pouch. This method has been shown to have several benefits for
both the mother and the infant. KMC is typically initiated soon after birth and involves placing the
baby, wearing only a diaper, on the mother's chest. The baby's skin is in direct contact with the
mother's skin, providing warmth, comfort, and facilitating bonding.

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Key components of Kangaroo Mother Care include:

 Skin-to-Skin Contact: The baby is placed on the mother's chest, usually under her clothing,
in direct skin-to-skin contact. This helps regulate the baby's temperature and promotes
bonding.
 Exclusive Breastfeeding: KMC encourages exclusive breastfeeding, as the baby is in close
proximity to the mother's breast and can feed as needed.
 Temperature Regulation: The mother's body heat helps regulate the baby's temperature,
especially important for premature or low-birth-weight infants who may struggle with
maintaining their body heat.
 Breathing and Heart Rate Stability: KMC has been shown to stabilize the baby's
respiratory rate and heart rate, leading to improved overall physiological stability.
 Emotional Bonding: The close physical contact fosters emotional bonding between the
mother and the baby.

What are the management of mild hypothermia (temp <35.5- 36.4OC)?

It should be done as per the instruction of Medical Officer & latest clinical guidelines. As a general
following may be followed after consulting with doctors-

 Provide KMC to re warm baby with mild hypothermia or warm the room using radiant
heater or other heating devices if KMC is not possible.
 Cover adequately & ensure to replace cold clothes with warm clothes
 Keep room warm (26-28OC) & draught free
 Continue breastfeeding
 Monitor temp. & capillary filling time during re earning. Watch for apnoea and
hypoglycaemia .
 Monitor axillary temp every 1/2hr till it reaches 36.5 O C, then hourly for next 4 hrs, 2 hrly
for 12 hrs thereafter 3 hrly as routine

What are the and symptoms of hypoglycemia is new-borns?

Symptoms of hypoglycaemia:

 Jitteriness, irritability
 Lethargy, limpness
 Weak or high pitched cry
 Poor feeding , vomiting
 Tachycardia (>180/min)

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 Sweating
 Hypothermia
 Poor respiratory effort or apnoea, tachypnoea
 Cyanosis
 Seizures or coma

What are the techniques of estimating blood sugar using regent strips in neonates?

Common site - Heel.

 Ensure heel is not cold. Heel can be warmed by holding it in hand for few minutes
 Make needle stick puncture (after following the essential guidelines) of posterolateral
aspect of heel & avoid making deep puncture.
 Follow instructions on reagent strip bottle for obtaining blood sample analysis.
 If blood glucose is low send blood sample to lab for confirmation

What are the Discharge & follow up protocols are followed LBW babies?

It should be done as per the instruction of Medical Officer & latest clinical guidelines. As a general
following may be followed after consulting with doctors-

 Consistently demonstrate weight again for 3 consecutive days


 Mother should be confident in feeding the neonate
 The required nutritional supplements started
 BCG, Hep. B and OPV is given to baby
 Methods of temperature regulation viz. KMC and other skills are taught to mother and
adequately practices in hospital
 Mother/parents are available to identify danger sign

How Grading of Hypoxic Ischemic Encephalopathy (HIE) is done & recorded on case sheet?

It should be done by the Medical Officer using Levene's grading of HIE - assessment of
consciousness, tone, seizure activities and autonomic disturbances like sucking & respiration -
Severity is decided. Sequential grading is done every 8-12 hrs to assess the progression of HIE.

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How Clinical monitoring or bed side tests of asphyxiated babies are performed?

It should be done as per the instruction of Medical Officer & latest clinical guidelines. As a general
following may be followed after consulting with doctors-

 Levene's staging for neurological status


 Downe's Score for respiratory status
 Cardiovascular status- i.e. heart rate, colour, CRT, peripheral pulses, non- invasive BP
 Abdominal circumferences- to rule out ileus
 Urine output - to check for serum electrolytes, blood urea & serum creatinine
 Monitoring of Blood surger

What are the technique to check CRT & its interpretation?

It should be done as per the instruction of Medical Officer & latest clinical guidelines. As a general
following may be followed after consulting with doctors-
Gentle pressure is applied by the tip of finger on central part of the body such as chest for 3-5
seconds by slowly counting from 1 to 5. This result in to blanching and area refill & it become pink
after the tip of finger is lifted. Normal CRP is <3 sec. A prolonged CRT indicates poor circulation
and tissue perfusion.

How to manage Neonatal shock?

It should be done as per the instruction of Medical Officer & latest clinical guidelines. As a general
following may be followed after consulting with doctors-

 Maintain TBAC
 Hypoxia: Maintain SPO2- 90-94%
 Hypoglycaemia- Maintain normal blood glucose- (>45 mg/dl)
 Hypothermia- Maintain temp _ 36.5-37.5 O C
 Fluid resuscitation: infuse fluid bolus of 10ml/kg or normal saline over 20-30 min.
 Administration of Inotropes

What are the difference in spasm due to tetanus and jitteriness?

 Spasm due to tetanus: Appear after 48hrs, Involuntary contraction of muscles, fists
often persistently and tightly clenched, Trismus opisthotonus, triggered by touch, light &
sound and Baby is conscious throughout, often crying with pain.

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 Jitteriness: Provoked by stimulus, abolished by restraining, Not associated with
autonomic changes, examination of neonatal is normal b/w seizure episodes & EEG is
normal.

What are the diagnostic approaches for seizure?

In sick babies: blood glucose, serum ionized calcium, serum sodium & Sepsis screen. Detailed
history is taken and examination is done after initial acute management to determine the
underlying cause.

What are the classifications of Neonatal Sepsis?

It should assess by the Medical Officer & as on latest clinical guidelines. As a general -

 Early onset sepsis (EOS): where sign & symptoms of sepsis appear within 72 hrs of
birth due to pathogens in maternal genital tract or delivery area, respiratory distress due
to congenital pneumonia.
 Late onset of Sepsis (LOS): where sign appear after 72 hrs of age due to pathogens from
hospital or community. LO is commonly presented as Septicaemia, pneumonia, or
meningitis

What are the signs of Neonatal Sepsis?

It should assess by the Medical Officer & as on latest clinical guidelines. As a general -

 Clinical picture is highly variable. Sign & symptom are minimal, subtle or non specific.
 Clinical manifestation of neonatal sepsis: Lethargy, refuse to suckle, poor cry or high
pitched cry or excessive cry, comatose, abd. Distension, diarrhoea, vomiting,
hypothermia, poor perfusion, sclera, poor weight gain, shock, bleeding, renal failure,
cyanosis, tachypnoea, chest retraction, grunt, apnoea, fever, seizures, neck retraction,
bulging fontanel etc.

What are the Laboratory investigations are performed to confirm neonatal sepsis?

It should be done as per the instruction of Medical Officer & latest clinical guidelines. As a general
following may be followed after consulting with doctors-

 Direct method: Isolation of micro-organism from blood, CSF, urine or pus.

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 Indirect method: Leukopenia (TLC< 5000/cu mm), Neutropenia (ANC< 1800/cu mm),
Immature neutrophil to total neutrophil ratio (>0.2), Micro ESR(>15mm 1st hour)
positive C Protein.
 Any of the 2 or more tests come positive indicate sepsis.
 Lumber puncture : must be performed in all cases with late onset of sepsis

What are the alert sign of neonatal pathological jaundice?

Clinical Jaundice in first 24 hrs of life or Total serum bilirubin (TSB) increasing by 5mg/dl/day
or 0.5mg/dl/hr or TSB >15mg/dl to Conjugated serum bilirubin >2mg/dl or clinical jaundice
persisting for > 14 days in term and > 21 days in preterm infants.

** Always check the latest Clinical guidelines and instruction of Medical Officer in this regard.

What are the criteria of clinical assessment of severity of Jaundice neonate as per Kramer's
criteria?

Kramer's criteria:

 Jaundice limited to face: Serum Bilirubin - about 6mg/dl,


 Jaundice extended to trunk- 9mg/dl,
 Extended to abdomen - 12mg/dl.
 Extended to legs -15mg/dl
 Extended to feet & hand – 19 to 20mg/dl

What are the common causes of hyperthermia?

 Sepsis
 Environmentt. too hot for baby
 Wrapping the baby in too many layers of clothes, esp. in hot humid climate
 Keeping newborn close to heater/hot water bottle
 Leaving the under heating devices i.e. radiant warmer, incubator, phototherapy that is not
functioning properly and/or not check regularly.

What are the common causes of respiratory distress in newborn?

 Pre Term : RDS, Congenital pneumonia, hypothermia & hypoglycaemia

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 Term: Transient tachypnoea of newborn (TTNB), meconium aspiration, pneumonia,
asphyxia
 Surgical cases: Diaphragmatic hernia, Trachea - esophageal fistula, B/L choanal atresia
 other causes: Congenital heart disease, acidosis, inborn errors of metabolism

What are the common breastfeeding problems & its management?

 Inverted/flat nipples - Treatment- A 20ml plastic syringe can be used to draw out nipple
gently
 Sore nipple, due to incorrect attachment or frequent washing with soap & water or pulling
the baby off while he is still sucking. Treatment- Correct positioning & attachment. Apply
hind milk after feed & nipple should be aired, to allow healing in between feeds. In case of
fungal infection suspected- refer to specialist or provide anti fungal medication
 Breast engorgement: Treatment - Ensuring early & frequent feeding & correct attachment.
Apply local warm water packs & analgesics (paracetamol). Milk should be gently expressed
to soften the breast.
 Breast abscess: treatment- treated with analgesics & antibiotics. The abscess is to incised &
drained.
 Reduced milk supply: if baby is not gaining weight- Ask mother to feed more frequently
especially during night. Make sure proper attachment & back massage is useful for
stimulating lactation

What is High Alert Drugs and what are the cautious administration of high alert drugs?

High alert drugs are medications that have a heightened risk of causing significant harm to
patients if used in error. These drugs have a greater potential for adverse effects due to their
characteristics, dosage forms, or potential for medication errors..

To ensure that the right doses of high-alert drugs are administered, healthcare facilities follow
strict processes and protocols. These processes involve multiple layers of checks and
verifications to minimize the risk of errors.

Here is an outline of the typical steps involved in the process:

 Drug Formulary and Policies: Healthcare organizations should establish a drug


formulary that includes high-alert medications, or the facility should list the names of
High Alert Drugs with the existing medication available. This formulary or lists
outlines the approved drugs, their indications, dosing guidelines, and precautions as per

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approved EDL. Policies and protocols must be developed to ensure the safe use of
high-alert drugs.

 Labeling: High Alert Medications will be prescribed, dispensed, and administered using
practices that are proven safe. High Alert Medications should have “HIGH ALERT
MEDICATION” labels on storage shelves, containers, product packages and loose
vials or ampoules. Any changes of brand /colour / preparation of High Alert
Medications must be informed as soon as possible.

Strategies To Reduce ERRORS due TO HIGH ALERT DRUGS:

1. List of High Alert Medications within the facility shall be identified.


2. High Alert Medications should have HIGH ALERT MEDICATION label on storage
shelves and or loose vials/ ampoules.
3. High Alert Medications should be kept in secure places with an IEC of maximum
dosage of each drug.
4. High Alert Medications should Not be prescribed in abbreviation or in short forms,
and should be prescribed in generic names with proper dosage, route & patient name.
5. High Alert Medications must be double checked before they are prepared, dispensed
and administered to the patients.
6. All High Alert Medications issued from the pharmacy must be counterchecked and
verified by another pharmacy staff prior to dispensing for the purpose of medication
safety and accuracy. If the any prescription is not legible it should be verified by the
doctor.
7. Verbal communications of medication order on high alert medication are Not
Recommended and in case of emergency it should be immediately rechecked via
spelling of the drug for verification and documented with signature of the doctor.
8. After administration of High Alert Medications proper medication record should be
maintained and patient need to be closely monitored for any adverse event.
9. After use stock of High Alert Medications should be properly updated and counter
signed by the authority.

What are LASA drugs?

LASA Stands for Look Alike and Sound Alike (LASA) Medicines:

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Look Alike Sound Alike (LASA) medications are drugs that are visually similar in physical
appearance or packaging and/or names of medications that have spelling similarities or
similarity during pronunciation. Eg : Lora-zepam, Clona-zepam, Dopa-mine-Dobuta-mine

Strategies to avoid errors with LASA medications:

1) List of LASA drugs should be available at the facility

2) During Storage - Use Tall Man lettering to emphasize differences in medications with
sound-alike names. eg- DOPamine & DOBUTamine.

3) Use additional Warning labels for look-alike medicines.

4) Store LASA medication separately from LASA pair with proper labeling.

5) Prescription should clearly specify generic name of medication, dosage and complete
direction for use.

6) During dispending or drug administration - Identify medicines based on its name and strength
and double check.

7) Ensure proper documentation.

What is Adverse Drug Reaction?

An adverse drug reaction (ADR), also known as an adverse drug event (ADE), refers to any
unwanted or harmful response to a medication. It occurs when a patient experiences a negative
reaction after taking a drug, whether it is prescribed, over-the-counter, or even herbal or
alternative remedies. Adverse drug reactions can range from mild and tolerable side effects to
severe and life-threatening complications.

Here are some key points about adverse drug reactions:

 Types of Adverse Drug Reactions: There are different types of adverse drug reactions,
including:
 Type A (Augmented) Reactions: These are predictable and dose-dependent reactions
that are an extension of the drug's known pharmacological effects. For example,
drowsiness caused by sedating antihistamines.
 Type B (Bizarre) Reactions: These are unpredictable reactions that are unrelated to the
known pharmacological action of the drug. They often occur in susceptible individuals

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and can range from mild to severe. Examples include severe allergic reactions or
anaphylaxis.
 Type C (Chronic) Reactions: These reactions are associated with long-term use of a
drug and may develop gradually over time. An example is drug-induced osteoporosis
from long-term corticosteroid use.
 Type D (Delayed) Reactions: These reactions have a delayed onset, occurring days,
weeks, or even months after drug exposure. An example is drug-induced liver injury.
 Type E (End-of-Use) Reactions: These reactions occur when a drug is withdrawn,
resulting in a rebound or withdrawal response. An example is rebound hypertension after
sudden discontinuation of antihypertensive medication.
 Type F (Failure) Reactions: These reactions occur when a drug fails to produce the
intended therapeutic effect. For example, a patient may not respond to an antibiotic due
to bacterial resistance.

 Symptoms and Severity: Adverse drug reactions can manifest in various ways, ranging from
mild to severe. Common symptoms include nausea, vomiting, rash, dizziness, headache,
diarrhea, and fatigue. In severe cases, adverse drug reactions can lead to organ damage,
anaphylaxis, cardiovascular events, or even death.
 Risk Factors: Certain factors increase the risk of experiencing an adverse drug reaction.
These include individual susceptibility, age (the very young and elderly are often more
vulnerable), concomitant use of multiple medications, underlying medical conditions, genetic
factors, and drug interactions.
 Reporting and Monitoring: Adverse drug reactions should be promptly reported to
healthcare providers and regulatory authorities. Reporting systems help identify trends,
improve drug safety, and inform regulatory decisions. Healthcare professionals monitor
patients closely for adverse drug reactions during treatment and adjust medications as
necessary. A separate register should be maintained.
 Prevention and Minimization: Adverse drug reactions can be minimized through proper
prescribing practices, patient education about potential side effects, accurate medication
reconciliation, regular monitoring, and reviewing the patient's medication history to identify
drug interactions or contraindications.
 Pharmacovigilance: Pharmacovigilance is the science and activities related to the detection,
assessment, understanding, and prevention of adverse drug reactions. It plays a crucial role in
ensuring drug safety and identifying any previously unrecognized risks associated with
medications. If a person suspects they are experiencing an adverse drug reaction, it is
important to seek medical attention promptly. Healthcare professionals can evaluate the

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symptoms, discontinue or adjust the medication if necessary, and provide appropriate
treatment or management strategies.

Adverse Drug Reaction vs. Medication Error: It's important to distinguish between an ADR
and a medication error. An ADR refers to the patient's unwanted response to a drug, whether
prescribed and administered. On the other hand, a medication error refers to a mistake in the
medication process, such as prescribing, dispensing, or administering the wrong medication or
dose.

** Any kind of Drug Reaction or Medication Error if any should be recorded and
reported.

How extra support are being provided to establish breastfeeding in mother's having pre term &
LBW babies

 The support should be given after consultation and instruction of the Medical Officer
 SNCU ensures mother has begun the expression of milk within 6 hrs of delivery.
 Encourage the mother's to repeat expression of milk 8-10 times per day to maintain flow of
production & to feed the baby
 The baby should put in breast every 2-3 hrs for feeding or non nutritive suckling (NNS)
 SNCU ensures preterm milk is given to pre term babies

How management of apnoeic baby is done?

 It should be given after consultation and instruction of the Medical Officer


 Maintain temperature
 Stimulate to breathe by rubbing the back or flicking the sole. If does not begin to breathe,
provide PPV with bag & mask immediately
 Check blood glucose
 Administer appropriate drugs if baby is pre term with no other evident cause of apnoea
 If apnoeic spells are recurrent, obtain sepsis screen along with blood culture and initiate
treatment for sepsis

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How to provide oxygen therapy what are the oxygen weaning protocols?

It should be done by the Medical Officer & as on latest clinical guidelines. As a general -

 Pulse oximeter is used to check oxygen saturation -should be maintained b/w 90-94%
 Saturation below 90% should be treated using oxygen supplementation. Ensure at NO
TIME babies under supplemental oxygen should have oxygen saturation above 95%
 Nasal prongs & head box is used to deliver oxygen. Adjust flow of oxygen 0.5-2.0
L/min with Nasal prongs to achieve target saturation.
 Adjust the flow of oxygen (3-5L/min) to achieve desired oxygen saturation

Oxygen Weaning Protocols:

It should be done as per the instruction of Medical Officer. Once baby's oxygen saturation on
pulse oximeter is 90-94%, gradually wean oxygen. Reduce the oxygen flow rate by 1/2litre/min
every few minutes to observe the oxygen saturation. If oxygen saturation remain in normal range
gradually remove oxygen.

When colostrum is given to baby & its importance ?

 Women produce colostrum in first few days after delivery. It is thick yellowish in colour
& contain antibodies, white blood cells and other anti infective proteins.
 Importance: Help to fight diseases that baby is likely to be exposed after delivery. Help
to clear baby's gut of meconium. Clear bilirubin from the gut & also help to prevent
hyperbilirubinemia.

What are the importances of hind milk?

Comes towards end of feed, rich in fat content and provide more energy. LBW babies with poor
weight gain may feed with expressed hind milk.

What are the positioning & attaching the baby to mother’s breast ?

Proper positioning and attachment are crucial for successful breastfeeding. Here are some
guidelines for positioning the baby and attaching them to the mother's breast:

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A. Positioning:

 Comfortable Seating: Choose a comfortable chair or use pillows to support your back
and arms. Being comfortable helps both you and your baby relax during feeding.
 Cradle Hold: Hold your baby in your arms, supporting their head with the crook of your
arm. The baby's body should face you, with their nose in line with your nipple.
 Cross-Cradle Hold: Hold the baby with the opposite arm from the breast you're feeding
on. Support the baby's head with your hand and use your arm to support their body.
 Football Hold: Hold the baby under your arm on the same side as the breast you're
using, like holding a football. Support the baby's head with your hand.
 Side-Lying Position: Lie down on your side with the baby facing you. Bring the baby
close and support their head with your arm.

B. Attachment:

 Nose to Nipple: Ensure the baby's nose is level with your nipple so that they can easily
latch on.
 Mouth Wide Open: Gently touch your baby's lower lip with your nipple to encourage
them to open their mouth wide.
 Chin First: Bring the baby to the breast with their chin leading. Aim to get as much of
the lower part of the areola (the dark area around the nipple) into the baby's mouth.
 Deep Latch: The baby's mouth should cover a significant portion of the areola, not just
the nipple. A deep latch ensures that the baby can effectively extract milk and reduces the
likelihood of nipple pain or damage.
 Ears, Shoulders, and Hips Aligned: Make sure the baby's head is tilted slightly
backward, with their ears, shoulders, and hips in a straight line.
 Comfortable Sucking Rhythm: Listen for a rhythmic sucking and swallowing pattern.
The baby should take deep sucks, followed by pauses.

C. Watch for Signs of Hunger or Fullness:

Pay attention to the baby's cues. If they are hungry, they will show signs like rooting, sucking on
hands, or making sucking motions.

Remember, each mother and baby pair is unique, so finding a position and latch that work for
both of you is essential

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Department:

NRC

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What are the Admission criteria for NRC?

NRC has established criteria for admission. Medical Officer or concerned person will decide
based on the condition of the patient. As a general -

Children 6-59 months:

 Any of the following: MUAC <115mm with or without any grade of oedema or
 WFH < -3 SD with or without any grade of oedema or Bilateral pitting oedema +/++ (children
with oedema +++ always need inpatient care) with - any of the following complications:
Anorexia (Loss of appetite), Fever (39 degree C) or Hypothermia (<35oC),Persistent
vomiting,
 Severe dehydration, Not alert, very weak, apathetic, unconscious, convulsions
 Hypoglycaemia, Severe Anaemia (severe palmar pallor),Severe pneumonia, Extensive
superficial infection

Infants < 6 months

 Infant is too weak or feeble to suckle effectively (independently of his/her weight-for-


length).
 or WfL (weight-for-length) <–3SD (in infants >45 cm)
 or Visible severe wasting in infants <45 cm
 or Presence of oedema both feet
** Always ask Medical officer regarding this and latest clinical guidelines

How Physical Examination & Provisional Diagnosis is done and recorded?

 It should be done by a Medical Officer or Trained Professional only as per the latest
guideline. Generally following points may be checked -
 H/O Recent intake of food and fluids, Usual diet, Breastfeeding, Duration and frequency
of diarrhoea and vomiting, Type of diarrhoea (watery / bloody), Chronic cough, Loss of
appetite, Family circumstances, Contact with tuberculosis, Recent contact with measles,
Known or suspected HIV infection & immunization is taken & recorded.
 Check details of : Shock (cold hands, slow capillary refill, weak and rapid pulse),Palmar
pallor, Eye signs of vitamin A deficiency:
 Dry conjunctiva or cornea, Bitot‘s spots
 Corneal ulceration, Keratomalacia and
 Localizing signs of infection, including ear and throat infections, skin infection or
pneumonia

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 Mouth ulcers, Skin changes of kwashiorkor is seen & recorded

How Triage & Initial Assessment is done?

Triage is the process of rapidly screening sick children. Triage must be done for all pediatric
patients coming to the health facility.
It should be done by a Medical Officer or Trained Professional only as per the latest
guideline. Generally following points may be checked -

The first step is to check every child for emergency signs and provide emergency treatment as
necessary keeping in mind the ABCD steps: Airway, Breathing, Circulation, Coma, Convulsion,
and Dehydration.

 Assessment of vital signs: This includes measuring the patient's temperature, heart rate,
blood pressure, and respiratory rate. Any abnormal vital signs may indicate the need for
immediate medical attention.
 Medical history: The patient's medical history is obtained, including any previous
medical conditions, surgeries, allergies, and medications.
 Physical examination: A thorough physical examination is performed to check for any
signs of illness or malnutrition, such as wasting or stunted growth.
 Nutritional assessment: The patient's nutritional status is evaluated through
measurements such as weight, height, mid-upper arm circumference (MUAC), and body
mass index (BMI). This information helps to determine the severity of malnutrition and
the appropriate treatment plan.
Triage Flow Chart:

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Laboratory Tests & Investigations:
Following laboratory tests should be done for the children admitted to a health facility for
management of SAM.

Each admitted SAM child should be diagnosed the following test after admission in NRC:

o Screening of Primary Complex (T.B)


o Haemoglobin or packed cell volume in children with severe palmar pallor
o Blood glucose
o Serum electrolytes eg; (sodium, potassium, and calcium whenever possible)
o Urine culture
If T.B has detected in some patients, make sure that they should be treated as per the NTEP.
protocol.
Screening for infections:

 Total and differential leukocyte count, blood culture


 Urine routine examination
 Urine culture
 Chest x-ray
 Mantoux test
 Screening for HIV after counseling (only when suspected , based on history and
 clinical signs and symptoms)
 Any other specific test required based on geographical location or clinical
presentation e.g. Celiac Disease, malaria etc.

What are the Discharge Criteria from Nutrition Rehabilitation Centre?

It should be assessed / decided by the Medical Officer & as on latest clinical guidelines.

As a general -

1. Oedema has resolved.

2. Child has achieved weight gain of & gt; 15% and has satisfactory weight gain for
3 consecutive days (& gt;5 gm/kg/day)

3. Child is eating an adequate amount of nutritious food that the mother can prepare
at home.

4. All infections and other medical complications have been treated

5. Child is provided with micronutrients

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6. Immunization is updated

How follow up of children discharged from NRC is done?

It should be decided by the medical officer and should be as per the hospital specific policy and
administrative guidelines under trained professional only as per the latest guideline.

Generally following points may be followed -

 Children discharged from NRC should be followed up at the community level to ensure
appropriate feeding, follow up at the NRC for scheduled visits and to identify children who are not
responding to treatment for referral to the facility level. NRC should have a complete list of PHCs,
Subcentres/HWC and Anganwadis in its catchment area, so they can refer the child to the
appropriate health facility closest to their community.
 Close collaboration and information sharing between NRC and community based care (at PHC,
Sub- center/HWC and AWC) are essential. The list of SAM children discharged from NRC should
be shared with area specific ANM and ICDS supervisors. These children should be enrolled in the
AWC and given supplementary food as per the guidelines. The AWWs should prioritize these
children for home visits, every week in the first 4 weeks and then once in 2 weeks till the child is
discharged from the program. During the home visits, AWW should observe feeding and provide
appropriate counseling and support to the mothers. These children should be weighed every week
at AWC. The ASHA AND AWW should ensure that these children return for the scheduled follow
ups at the NRC. The ANM will also follow up the children discharged from NRC during the
VHNDs till they exit from the nutrition rehabilitation program.

How Counseling of mothers / caregiver before discharge is done ?

(1) Preparation and feeding the child, how to give prescribed medication, folic acid, vitamins
and iron at home, how to give home treatment for diarrhoea, fever and acute respiratory
infections.

(2) Advice includes the information about the nearest health centre for further follow up.

(3) Time of discharge is communicated to patient in prior.

(4) Advice includes feeding recommendations as per IMNCI

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What are the criteria for Blood transfusion of SAM child?

Blood transfusion is required (1) Hb is less than 4 g/dl (2) or if there is respiratory distress and
Hb is between 4 and 6 g/dl.

What are the conditions in which blood transfusion is not done / repeated?

It should be assessed by a Medical Officer or Trained Professional only as per the latest
guideline. Generally following points may be checked -

(1) Blood transfusion should not be started until the child has begun to gain weight.

(2) Following the transfusion, if the Hb remains less than 4 g/dl or between 4 and 6 g/dl with
continuing respiratory distress, DO NOT repeat the transfusion within 4 days.

How Management of sick SAM child is done based on emergency sign?

It should be done by a Medical Officer or Trained Professional only as per the latest guideline.
Generally following points may be checked -

1. Airway and breathing- Any sign positive- Provide basic life support, give oxygen, make
sure child is warm, insert IV & begin fluids

2. Circulation -if positive- Apply pressure to stop bleeding if child is bleeding, give oxygen,
make sure child is warm, insert IV & begin fluids. If Child is SAM (Age less than 2months)
Give Glucose IV or orally or NG tube (depending up on condition) & proceed for full
assessment

3. Coma Convulsing- if positive- Manage Airways- Position the child, check and correct
hypothermia, If convulsions continue give IV calcium / anticonvulsant

4. Severe dehydration due to diarrhoea: Make sure head is warm, Insert IV line & give fluids.
If age is less than 2 month - do not start IV, proceed for full assessment

What are the priority signs of a baby in NRC?

Tiny baby (<2 months), Bleeding, Pallor (severe) Malnutrition: Visible severe wasting,
Respiratory distress, Trauma or other urgent surgical condition, Oedema of both feet,
Temperature <36.5°C or > 38.5°C, Restless, continuously irritable, or lethargy, Poisoning &
Burns (major)

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What are the 10 steps for management of SAM?

(1) Treat /Prevent Hypoglycaemia

(2) Treat and prevent Hypothermia

(3) Treat and prevent dehydration

(4) Correct electrolyte imbalance

(5) Treat/ prevent infection

(6) Correct micro nutrient deficiency

(7) Start cautious diet

(8) Achieve catch up growth

(9) Provide sensory stimulation and emotional support

(10) Prepare follow up after recovery

What are the treatments of dehydration in SAM children without shock is done?

It should be done by a Medical Officer or Trained Professional only as per the latest guideline.
Generally following points may be checked -

(1) Oral rehydration- amount based on child's weight- every 30 min for 1st 2 hrs- 5ml/kg weight.
Further, alternate hours for up to 10 hrs- 5ml/kg (Add 15ml of potassium chloride to 1l ORS)

(2) Starter diet is given in alternate hours (e.g. 2, 4, 6) with reduced osmolarity ORS (e.g. 3, 5, 7)
until the child is rehydrated.

(3) Signs every half hour for the first two hours, then hourly: Respiratory rate, Pulse rate, Urine
frequency, Stool or vomit frequency & Signs of hydration

What are the sign of improved hydration & over hydration in NRC children?

Signs of improved hydration: (any of 3)

 Child is no longer thirsty


 Child is less lethargic
 Slowing of respiratory and pulse rates from previous high rate
 Skin pinch is less slow
 Child has tears

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 Sign of over hydration
 Increased respiratory rate and pulse.
 Jugular veins engorged
 Puffiness of eye

How treatment of hypothermia is done in NRC?

It should be done by a Medical Officer or Trained Professional only as per the latest guideline.
Generally following points may be checked -

 Assess- If axillary temp below- 35OC or rectal temp is below 35.5 OC

 Start feeding immediately (or start rehydration if needed).

 Re-warm. Give skin to skin contact: kangaroo technique) and cover them, OR clothe the
child including the head, cover with a warmed blanket and place a heater or lamp
nearby. Remove wet clothing/bedding

 Feed 2-hourly (12 feeds in 24 hours).

 Treat hypoglycaemia,

 Give 1st dose of antibiotics (as instructed by Medical Officer)

 Take temp. every 2 hrs -stop re-warming when it rises above 36.50 C

 Follow the instruction of Medical Officer for further treatment

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Department:

Operation Theatre &


Maternity O.T

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What are the Procedures for taking informed consent before treatment and procedures?

• The Hospital requires consent for all invasive or therapeutic procedures. All consents must be
in local language and explained to the patient / relatives. For all cases, the general consent form
is filled and signed either by the patient if possible or the patient representative if the patient is
not is a state to give his consent. In case of a patient incapable of giving consent, it is taken from
the patient representative or guardian.

• In case of minor, legal guardian should sign the consent, i.e any one who is willing to take care
of the patient..

• Life-sustaining measures are not withheld for lack of formal consent if there is no time to
obtain the consent for urgent procedures.

• There are three types of consent forms mandatorily operational in all facilities as per decision
of State, the form materials have been circulated by State as a policy decision to all hospitals –

1. General Consent form for procedure


2. Consent form for anesthesia
3. High risk consent

• Other than this three, Consent is required for elective blood transfusions and HIV testing.
• Consent is to be signed by all the patients admitted in the ward

• In case patient/ next to kin is illiterate then the thumb impression of the patient is taken which
is witnessed by a neutral person.

• Consent form signing is the responsibility of the doctor admitting the patient.

• Nursing staff or Rogi Sahayaks may help in that procedure.

What are the procedures for Grievance Redressal system?

• Facility should have provision of Complain Box in all wards accessible to patient/ patient
relatives and visitors.
• Display of process for Grievance Redressal must be written in local language
• Contact person / whom to contact should be displayed with contact number
• There should be a provision of regular checking of grievances
• Grievance Redressal register must be updated

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• All grievances must be discussed in the monthly meeting as per stipulated timeline (as per
policy) and follow-up register must be filled.

What is High Alert Drugs and what are the cautious administration of high alert drugs?

High alert drugs are medications that have a heightened risk of causing significant harm to
patients if used in error. These drugs have a greater potential for adverse effects due to their
characteristics, dosage forms, or potential for medication errors..

To ensure that the right doses of high-alert drugs are administered, healthcare facilities follow
strict processes and protocols. These processes involve multiple layers of checks and
verifications to minimize the risk of errors.

Here is an outline of the typical steps involved in the process:

 Drug Formulary and Policies: Healthcare organizations should establish a drug


formulary that includes high-alert medications, or the facility should list the names of
High Alert Drugs with the existing medication available. This formulary or lists
outlines the approved drugs, their indications, dosing guidelines, and precautions as per
approved EDL. Policies and protocols must be developed to ensure the safe use of
high-alert drugs.

 Labeling: High Alert Medications will be prescribed, dispensed, and administered using
practices that are proven safe. High Alert Medications should have “HIGH ALERT
MEDICATION” labels on storage shelves, containers, product packages and loose
vials or ampoules. Any changes of brand /colour / preparation of High Alert
Medications must be informed as soon as possible.

Strategies To Reduce ERRORS due TO HIGH ALERT DRUGS:

1. List of High Alert Medications within the facility shall be identified.

2. High Alert Medications should have HIGH ALERT MEDICATION label on storage

shelves and or loose vials/ ampoules.

3. High Alert Medications should be kept in secure places with an IEC of maximum

dosage of each drug.

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4. High Alert Medications should Not be prescribed in abbreviation or in short forms, and

should be prescribed in generic names with proper dosage, route & patient name.

5. High Alert Medications must be double checked before they are prepared, dispensed

and administered to the patients.

6. All High Alert Medications issued from the pharmacy must be counterchecked and

verified by another pharmacy staff prior to dispensing for the purpose of medication

safety and accuracy. If the any prescription is not legible it should be verified by the

doctor.

7. Verbal communications of medication order on high alert medication are Not

Recommended and in case of emergency it should be immediately rechecked via

spelling of the drug for verification and documented with signature of the doctor.

8. After administration of High Alert Medications proper medication record should be

maintained and patient need to be closely monitored for any adverse event.

9. After use stock of High Alert Medications should be properly updated and counter

signed by the authority.

What are LASA drugs?

LASA Stands for Look Alike and Sound Alike (LASA) Medicines:

Look Alike Sound Alike (LASA) medications are drugs that are visually similar in physical
appearance or packaging and/or names of medications that have spelling similarities or
similarity during pronunciation. Eg : Lora-zepam, Clona-zepam, Dopa-mine-Dobuta-mine

Strategies to avoid errors with LASA medications:

1) List of LASA drugs should be available at the facility

2) During Storage - Use Tall Man lettering to emphasize differences in medications with
sound-alike names. eg- DOPamine & DOBUTamine.

3) Use additional Warning labels for look-alike medicines.

4) Store LASA medication separately from LASA pair with proper labeling.

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5) Prescription should clearly specify generic name of medication, dosage and complete
direction for use.

6) During dispending or drug administration - Identify medicines based on its name and strength
and double check.

7) Ensure proper documentation.

What is Adverse Drug Reaction?

An adverse drug reaction (ADR), also known as an adverse drug event (ADE), refers to any
unwanted or harmful response to a medication. It occurs when a patient experiences a negative
reaction after taking a drug, whether it is prescribed, over-the-counter, or even herbal or
alternative remedies. Adverse drug reactions can range from mild and tolerable side effects to
severe and life-threatening complications.

Here are some key points about adverse drug reactions:

 Types of Adverse Drug Reactions: There are different types of adverse drug reactions,
including:
 Type A (Augmented) Reactions: These are predictable and dose-dependent reactions
that are an extension of the drug's known pharmacological effects. For example,
drowsiness caused by sedating antihistamines.
 Type B (Bizarre) Reactions: These are unpredictable reactions that are unrelated to the
known pharmacological action of the drug. They often occur in susceptible individuals
and can range from mild to severe. Examples include severe allergic reactions or
anaphylaxis.
 Type C (Chronic) Reactions: These reactions are associated with long-term use of a
drug and may develop gradually over time. An example is drug-induced osteoporosis
from long-term corticosteroid use.
 Type D (Delayed) Reactions: These reactions have a delayed onset, occurring days,
weeks, or even months after drug exposure. An example is drug-induced liver injury.
 Type E (End-of-Use) Reactions: These reactions occur when a drug is withdrawn,
resulting in a rebound or withdrawal response. An example is rebound hypertension after
sudden discontinuation of antihypertensive medication.

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 Type F (Failure) Reactions: These reactions occur when a drug fails to produce the
intended therapeutic effect. For example, a patient may not respond to an antibiotic due
to bacterial resistance.

 Symptoms and Severity: Adverse drug reactions can manifest in various ways, ranging from
mild to severe. Common symptoms include nausea, vomiting, rash, dizziness, headache,
diarrhea, and fatigue. In severe cases, adverse drug reactions can lead to organ damage,
anaphylaxis, cardiovascular events, or even death.
 Risk Factors: Certain factors increase the risk of experiencing an adverse drug reaction.
These include individual susceptibility, age (the very young and elderly are often more
vulnerable), concomitant use of multiple medications, underlying medical conditions, genetic
factors, and drug interactions.
 Reporting and Monitoring: Adverse drug reactions should be promptly reported to
healthcare providers and regulatory authorities. Reporting systems help identify trends,
improve drug safety, and inform regulatory decisions. Healthcare professionals monitor
patients closely for adverse drug reactions during treatment and adjust medications as
necessary. A separate register should be maintained.
 Prevention and Minimization: Adverse drug reactions can be minimized through proper
prescribing practices, patient education about potential side effects, accurate medication
reconciliation, regular monitoring, and reviewing the patient's medication history to identify
drug interactions or contraindications.
 Pharmacovigilance: Pharmacovigilance is the science and activities related to the detection,
assessment, understanding, and prevention of adverse drug reactions. It plays a crucial role in
ensuring drug safety and identifying any previously unrecognized risks associated with
medications. If a person suspects they are experiencing an adverse drug reaction, it is
important to seek medical attention promptly. Healthcare professionals can evaluate the
symptoms, discontinue or adjust the medication if necessary, and provide appropriate
treatment or management strategies.

Adverse Drug Reaction vs. Medication Error: It's important to distinguish between an ADR
and a medication error. An ADR refers to the patient's unwanted response to a drug, whether
prescribed and administered. On the other hand, a medication error refers to a mistake in the
medication process, such as prescribing, dispensing, or administering the wrong medication or
dose.

** Any kind of Drug Reaction or Medication Error if any should be recorded and reported.

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What is Blood Transfusion Reaction?

A blood transfusion reaction refers to an adverse reaction that occurs as a result of receiving a
blood transfusion. Although blood transfusions are generally considered safe, complications can
occur in rare instances. These reactions can vary in severity and may range from mild to life-
threatening. It's important to closely monitor patients during and after transfusions to promptly
identify and manage any adverse reactions.

Types of Transfusion Reactions:

 Immune reactions
 Non immune reactions
 Immediate
• During or within few hours of transfusion
 Delayed
• Days or weeks after the transfusion

Specific blood transfusion reactions include:

 Febrile Non-Hemolytic Reaction: This reaction is characterized by the development of


fever during or shortly after the transfusion. It is often accompanied by chills, headache,
and mild discomfort. It is typically caused by the recipient's antibodies reacting to white
blood cells in the donated blood.
 Allergic (Hypersensitivity) Reaction: Allergic reactions can occur due to sensitivity to
proteins or other substances in the transfused blood. Symptoms may include hives,
itching, flushing, wheezing, shortness of breath, and, in severe cases, anaphylaxis.
 Acute Hemolytic Transfusion Reaction (AHTR): Acute hemolytic reactions happen
within 24 hours of transfusion. This is a severe and potentially life-threatening reaction
caused by the recipient's immune system attacking and destroying the transfused red
blood cells. It can result from intravascular haemolysis, or ABO blood group
incompatibility or other red cell antibodies, or extravascular haemolysis or Rh minor
group incompatibility. Sign & Symptoms include fever, chills, back pain, chest pain,
Hypotension, Tachycardia, hemoglobinuria (red or brown urine), Dyspnoea and
disseminated intravascular coagulation (DIC).

 Delayed Hemolytic Reaction: This type of reaction can occur days to weeks after a
transfusion. This hemolytic reaction happen after 24 hours, usually occur two weeks after
but can go up to 30 days post transfusion. It is characterized by the recipient's immune

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system mounting an immune response against the transfused red blood cells, resulting in
their destruction. Symptoms include gradual decline in hemoglobin levels, jaundice, and
sometimes fever.

 All type or any type of transfusion reaction should be recorded in a register with proper
details. A register with details documentation should be maintained. it should be
promptly reported to healthcare providers and authorities in prescribed forms. Samples
(Blood bag with residual blood) should be send back to authority with proper labeling
and documentations.

** Always check latest Guidelines from NACO / National Blood Transfusion Council
(NBTC) in this regard.

What are the procedures for secure storage of Narcotic and Psychotropic drugs?

• All Narcotic and Psychotropic drugs available in the hospital must be listed as per EDL
and displayed.
• Drug substances like narcotics and other potent drugs shall be stored in their designated
cupboard/drawer under double lock system with signages outside.
• One key for the same shall be with the Sister-In charge and the other with the on duty Staff
nurse / any other person (Two different people)
• Narcotic drugs will be released only on the signed requisition of the Doctor/MO.
• List of availability must be updated after each use.

What are the procedures of patient Hand over, whenever staff duty change happens?

Patient handovers often referred to as "shift handovers" or "shift change reports," are crucial in
hospitals to ensure continuity of care and patient safety when there is a change in staff duty. Proper
handovers help convey important patient information accurately and comprehensively. Whenever
hand over is given it should be in bed side and as per SBAR method.
Providing patient handover using the SBAR (Situation, Background, Assessment, Recommendation)
format is an effective way to convey important patient information in a clear and structured manner.

Here's how to give a patient handover using SBAR:

1. Situation (S): Start the handover by providing a brief and concise overview of the patient's
current situation. Include the following information:

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a. Patient's name and age.
b. The primary reason for admission or the main concern.
c. A brief statement of the patient's current condition, such as "The patient is stable" or
"The patient's condition is deteriorating."
2. Background (B): Provide the necessary background information about the patient. This
section should cover:
a. Relevant medical history, including chronic conditions or recent surgeries.
b. Allergies or sensitivities.
c. Key vital signs and trends, such as blood pressure, heart rate, respiratory rate,
temperature, and oxygen saturation.
d. Current medications, dosages, and administration routes.
e. Any recent laboratory results, diagnostic tests, or imaging findings.
f. Important events during the shift, such as interventions, responses to treatment, or
changes in the patient's status.
3. Assessment (A): Describe your assessment of the patient's current clinical status. This section
should include:
a. The patient's signs and symptoms.
b. Any concerns, potential complications, or changes in condition.
c. Response to interventions or treatments.
d. Pain level, if applicable.
4. Recommendation (R): Provide your recommendations for the patient's ongoing care and any
actions that should be taken. Include:
a. Specific plans for treatment or management.
b. Medication changes, dosage adjustments, or any new prescriptions.
c. Upcoming procedures, tests, or consultations.

o Any special patient needs or concerns.


o Code status, advance directives, or other important preferences.

When giving a patient handover using SBAR, it's important to be clear and concise, focusing on the
most relevant information. Here are some additional tips:

 Use plain language and avoid medical jargon.


 Speak in a calm and organized manner.
 Encourage the receiving healthcare provider to ask questions for clarification.
 Be prepared to provide further details if requested.
 Document the handover information in the patient's medical record or handover report.

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 Ensure a smooth transition of care by confirming that the receiving healthcare provider
acknowledges the handover and is ready to assume responsibility for the patient.

SBAR is a valuable communication tool in healthcare settings, promoting effective and structured
information exchange. It helps ensure that all relevant patient information is conveyed accurately,
improving patient safety and continuity of care. Handover register should be properly maintained.

What are the procedures to check drug before administration/ dispensing?

Checking a drug before administration or dispensing is a critical step in ensuring patient safety. The
following are general procedures that healthcare professionals typically follow to verify and
administer medications safely:

1. Prescription Review: Verify the prescription or medication order. Ensure that it is legible
and complete. Confirm that the order includes the patient's name, the drug name, dosage,
route of administration, frequency, and any other relevant information.
2. Patient Identification: Confirm the patient's identity using at least two patient identifiers
(e.g., name and date of birth)
3. Patient Education: Provide the patient with information about the medication, including
route of administration, potential side effects, and any other relevant instructions.
4. Drug Storage: Ensure that the drug is stored appropriately, considering factors such as
temperature, light exposure, and expiration date.
5. Medication Label Check: Check the medication label against the medication order. Verify
the drug name, strength, dosage form, and concentration.
6. Expiration Date Check: Confirm that the medication has not expired.
7. Dosage Calculation: If the medication requires dosage calculations, double-check the
calculations to ensure accuracy.
8. Allergy Check: Confirm that the patient does not have any known allergies to the
medication.
9. Drug Interactions: Check for potential drug interactions with other medications the patient is
currently taking.
10. Documentation: Document the medication administration or dispensing, including the date,
time, dose, route, and any other relevant information.
11. Follow-Up Monitoring: Monitor the patient for any adverse reactions or side effects after
medication administration.
**Always follow the specific guidelines and procedures established by your healthcare
institution.

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What is Kangaroo Mother Care (KMC)?

Kangaroo Mother Care involves skin-to-skin contact between a mother and her newborn, similar to
how a kangaroo carries its joey in a pouch. This method has been shown to have several benefits for
both the mother and the infant. KMC is typically initiated soon after birth and involves placing the
baby, wearing only a diaper, on the mother's chest. The baby's skin is in direct contact with the
mother's skin, providing warmth, comfort, and facilitating bonding.

Key components of Kangaroo Mother Care include:

 Skin-to-Skin Contact: The baby is placed on the mother's chest, usually under her clothing,
in direct skin-to-skin contact. This helps regulate the baby's temperature and promotes
bonding.
 Exclusive Breastfeeding: KMC encourages exclusive breastfeeding, as the baby is in close
proximity to the mother's breast and can feed as needed.
 Temperature Regulation: The mother's body heat helps regulate the baby's temperature,
especially important for premature or low-birth-weight infants who may struggle with
maintaining their body heat.
 Breathing and Heart Rate Stability: KMC has been shown to stabilize the baby's
respiratory rate and heart rate, leading to improved overall physiological stability.
 Emotional Bonding: The close physical contact fosters emotional bonding between the
mother and the baby.

What are the process for end of life care and death & Procedures for decent communication of death?

Facility should have a defined procedure for record of death of the admitted patient and
communication with the relatives.

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Hospital should have a defined procedure for record of death of the admitted patient and
communication with the relatives.

Clinical policy of care at the end of life and the professional practice it guides should:

 Be respectful to the dignity of both patient and caregivers;


 Be sensitive to and be respectful of the patient's and family's wishes;
 Should use the most appropriate measures that are consistent with patient‘s choices
 Should try to arrange for alleviation of pain and other physical symptoms;
 Should be able to access and manage psychological, social, and spiritual/religious problems;
 Should offer continuity (the patient should be able to continue to be cared for, if so desired,
by his/her primary care and specialist providers);
 Should provide access to any therapy which may realistically be expected to improve the
patient's quality of life, including alternative or nontraditional treatments;
 Should be respectful to the right to refuse treatment
 Should be respectful to the physician's professional responsibility to discontinue some
treatments when appropriate, with consideration for both patient and family preferences.

 Death of a patient is handled carefully with concern without complacency. Counselling of next of
kin with empathy is importance. All help in shifting the body from the hospital is extended to the
next of kin. The dead body is released as soon as possible after completion of all formalities.
 Acknowledgement for receipt of the body and the Death Certificate is obtained from next of
kin/legal representative and handing-over of the body to patient‘s relatives. It is ensured that
hospital staff takes due care and concern in this respect. Due arrangements are made if preserving
the body in the mortuary is found necessary.
Security staffs of the hospital should be present till the departure of the deceased and ensure
orderliness in handing over the body to the next of kin.

** It should be done as per the hospital policy. Always check permission and administrative
approval in this regard.

What is OSCE / Full form of OSCE?

Objective Structured Clinical Examination (OSCE) is a clinical skills assessment method that is
based on objective testing to test clinical skill performance and competence in skills.

The assessment will consist of 4 OSCE stations. These will test the knowledge and skills of our
staffs:

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- Active Management 3rd Stage Labour (AMTSL)

- Postpartum Haemorrhage (PPH) / Shock management

- Eclampsia Management

- Newborn Resuscitation

What is Respectful Maternity Care ?

Respectful Maternity Care (RMC) is an approach to maternal health care that emphasizes the
importance of providing respectful and dignified care to women during pregnancy, childbirth, and the
postpartum period. It recognizes the rights of women to be treated with dignity, respect, and
kindness, regardless of their background or circumstances. The RMC framework seeks to ensure that
childbirth is a positive and empowering experience for women, fostering a supportive and respectful
environment.

Some important points of RMS are -

1. Confidentiality and privacy is protected

2. The woman is protected from physical harm or ill treatment.

3. The woman‘s right to information, informed consent, and choice/preferences is protected.

4. The woman is treated with dignity and respect.

5. The woman receives equitable care, free of discrimination.

6. The woman is never left without care.

7. The woman is never detained or confined against her will.

How blood is ordered for the patient according to the MSBOS (Maximum Surgical Blood Order
Schedule) in OT ?

The Maximum Surgical Blood Order Schedule (MSBOS) is a protocol used in operating rooms
(OT) to determine the appropriate quantity and type of blood products that should be available during
a surgical procedure. It helps ensure that the right amount of blood is on hand in case a patient
experiences significant bleeding during surgery. The main goal of MSBOS is to reduce the
unnecessary use of blood transfusions, minimize costs, and improve patient safety. It sets guidelines

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for the quantity and type of blood products that should be readily available in the operating room for
different types of surgeries. The MSBOS is typically based on the type of surgery, the patient's
medical condition, and the estimated blood loss associated with the procedure. It is designed to
minimize the unnecessary use of blood products while ensuring that they are readily available when
needed. The schedule helps reduce the risks associated with transfusions, such as transfusion
reactions and transfusion-related infections, and also helps conserve blood resources.
Here's a general overview of how MSBOS works in the operating room:

1. Surgical Assessment: The surgeon, anesthesiologist, and other healthcare providers involved
in the surgery assess the patient and the specific surgical procedure. They consider factors
such as the patient's health, the surgical technique, and the expected blood loss.
2. Blood Product Selection: Based on the assessment, the team determines the type of blood
products that may be needed. These products may include packed red blood cells, fresh frozen
plasma, platelets, and cryoprecipitate.
3. Cross-Matching and Availability: A certain number of blood units are cross-matched and
made available in the operating room or in the hospital's blood bank, ready to be transfused if
necessary. The exact number and types of units are determined by the MSBOS.
4. Transfusion Thresholds: The MSBOS establishes specific thresholds for when a transfusion
should be initiated. These thresholds are typically based on the patient's hemoglobin or
hematocrit levels and clinical signs of bleeding.
5. Documentation: All steps in the MSBOS process, from the assessment to the transfusion,
should be well-documented to ensure that the protocol is followed correctly and that blood
products are used judiciously.

The primary goal of the MSBOS is to promote patient safety, reduce the risks associated with
unnecessary blood transfusions, and optimize the use of blood products.

What is the Procedure for monitoring and reporting Transfusion complication?

It must be informed to the Medical Officer and to be done as per the latest guideline. On a general-
During the transfusion, stay alert for signs and symptoms of a reaction, such as fever or chills, flank
pain, vital sign changes, nausea, headache, urticaria, dyspnea, and broncho spasm. Optimal
management of reactions begins with a standardized protocol for monitoring and documenting vital
signs. As dictated by facility policy, obtain the patients vital signs before, during, and after the
transfusion.

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Ask the Medical officer for guidance, but as a general if you suspect a transfusion reaction, take these
immediate actions after consulting:

 Stop the transfusion.


 Keep the I.V. line open with normal saline solution.
 Notify the physician and blood bank.
 Intervene for signs and symptoms as appropriate.
 Monitor the patient‘s vital signs.

Also return the blood product to the blood bank and collect laboratory samples according to facility
policy. If and when clinically necessary, resume the transfusion after obtaining a physician order.
Carefully document transfusion-related events according to facility policy; be sure to include the
patients vital signs, other assessment findings, and nursing interventions.

Why Pre-anaesthetic Assessment is done?

After consulting with the doctor, pre-anaesthetic assessment provides information needed to:

1. Select the type of anaesthesia to be administered and plan anaesthetic care


2. Identify any medicine sensitivities
3. Safely administer the appropriate anaesthetic and
4. Enquire about any relevant medical history

When to carry out an Anaesthetic Assessment?

1. An anaesthetic assessment of a patient for elective surgery should be performed a day before
the anaesthesia is administered
2. An anaesthetic assessment of a patient for emergency surgery should always be done before
the patient is taken to theatre
3. The medical assessment of surgical patients is documented before the start of the anaesthesia

Interpret and act on any abnormal findings (e.g. blood pressure, haemoglobin, blood glucose,
etc.) of the patient

What are Procedures for monitoring process during anesthesia ?

During Anaesthesia and Surgery it should done as per the latest guidelines & as recommended by the
doctor.

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1. Each patient's physiological status should be monitored and recorded during anaesthesia and
surgery
2. The anaesthetist monitors and records the physiological status of the patient during
anaesthesia, and enters the anaesthetic, medication and intravenous fluids used in the patient's
anaesthetic record
3. The anaesthetist should have access to the patient care notes and know the findings of the
medical examination. It is important that each health professional has access to the records of
other care providers, in accordance with the healthcare facility policies and guidelines

What are the Procedures for ensuring Surgical Safety?

A Surgical Safety Checklist is a tool used in healthcare settings, particularly in surgical procedures,
to enhance patient safety and reduce the risk of errors during surgery. The World Health Organization
(WHO) introduced a widely adopted Surgical Safety Checklist. The Surgical Safety Checklist is a
standardized tool meant to encourage communication and teamwork among surgical team members,
including surgeons, anesthesiologists, nurses, and other healthcare providers. It helps prevent errors,
promote accountability, and reduce the risk of complications during surgery .Adhering to the Surgical
Safety Checklist has been shown to significantly improve patient safety by reducing the incidence of
wrong-site surgery, surgical site infections, and other preventable adverse events. It's an essential part
of the safety culture in many hospitals and surgical centers worldwide.

In order to implement the Surgical Safety Checklist during surgery, a single person must be made
responsible for checking the boxes on the list. This designated Checklist coordinator will often be a
circulating nurse, but it can be any clinician or healthcare professional participating in the operation.

The Checklist divides the operation into three phases, each corresponding to a specific time period in
the normal flow of a procedure — the period before induction of anaesthesia (Sign In), the period
after induction and before surgical incision (Time Out), and the period during or immediately after
wound closure but before removing the patient from the operating room (Sign Out). In each phase,
the Checklist coordinator must be permitted to confirm that the team has completed its tasks before it
proceeds further. As operating teams become familiar with the steps of the Checklist, they can
integrate the checks into their familiar work patterns and verbalize their completion of each step
without the explicit intervention of the Checklist coordinator. Each team should seek to incorporate
use of the Checklist into its work with maximum efficiency and minimum disruption, while aiming to
accomplish the steps effectively. The use of surgical safety checklist must be as per the hospital
policy.

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How Monitoring and Recording of the Patient’s Post-anaesthetic Status is done?

It should be done by trained personnel / Medical officer as per the guideline. General way to
assess may be done as per following after consulting with the doctor & hospital authority.

1. Each patient's post-anaesthetic status should be monitored, and the patient is discharged from
the recovery area in accordance with accepted guidelines. Physiological monitoring provides
reliable information about the patient's status during the administration of anaesthesia and the
recovery period.
2. Monitoring methods depend on the patient's pre-anaesthetic status, anaesthetic choice, and the
complexity of the surgical or other procedure performed during anaesthesia. In all cases,
however, the monitoring process is continuous, and the results are entered into the patient's
record. Monitoring during anaesthesia provides the basis for monitoring during the post-
anaesthetic recovery period. The ongoing, systematic collection and analysis of data on the
patient's status in recovery may support decisions about moving the patient to other settings
and less intensive services.
3. Only experienced OT nurse or designated member of the operating team may carry out
monitoring in the recovery area. Recording of monitoring data provides the documentation to
support discharge decisions.
4. The anaesthetist decides whether the patient can be discharged from the recovery area to
another level of care
5. Standardized criteria developed by medical personnel are used to make discharge decisions.
The following may be done after consulting with the doctor & hospital authority:

1. Monitoring findings are entered in the patient's record


2. Established criteria are used to make decisions regarding the patient's discharge from the
recovery room
3. The signatures of those handing over and those receiving the patient are recorded

What are the Procedures for postnatal care as per guidelines?

It should be done after consulting with the doctor and as per the guideline. On general following steps
may be done.

Woman is placed in recovery position.

 Vitals signs are monitored every 15 minutes first hour and every 30 minutes next hour.
 Assessment of consciousness level is done every 15 min until women is alert.
 Clear airway is ensured.

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 Transfusion is given if necessary
 If vital signs become unstable or hematocrait continues to fall despite transfusion, woman
is returned to OT as bleeding may be the cause / as instructed by the doctor
 Management of gastro intestinal functions, dressing & wound care, pain management,
bladder care, administration of antibiotics, suture removal, management of fever, and
ambulation done as per standard guidelines.
 Vital of mothers and baby are monitored regularly.
 Medication is administered when required and prescribed by the doctor.

 The patient is encouraged to start breast feeding the child within 1/2 hour of delivery.

What are the procedure for continuity of care during interdepartmental transfer (procedure of
handing over while receiving patient form OT to indoor) ?

It should be done after consulting with the doctor and as per the guideline. On general following steps
may be done.

1. Before the patient is transferred to a ward, she must be completely awake and orientated
2. Muscle relaxing medication must have worn off completely
3. The respiration must be satisfactory
4. The pulse rate must be normal
5. All reflexes must have returned
6. The patient must be handed over to the ward nurse with all the relevant information
7. A complete report must be given to the ward nurse, with the relevant information on the type
of operation performed
8. Post-operative orders and prescribed medication which the patient must receive
9. OT staff must accompany the patient to a ward

What are the procedures for postnatal care as per WHO Guidelines?

It should be done as per the instruction of Medical Officer and as per the latest guideline. The general
WHO guidelines are -
The World Health Organization (WHO) provides guidelines for postnatal care, which is the care
provided to mothers and newborns in the period immediately after childbirth and up to six weeks
postpartum. Postnatal care is essential to ensure the health and well-being of both the mother and the
newborn, as well as to support the transition to motherhood and the initiation of breastfeeding. Here
are the key procedures and recommendations for postnatal care as per WHO guidelines:

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1. Immediate Care After Childbirth:
o Assess the newborn's vital signs and condition, including skin color, respiratory rate,
heart rate, and temperature, within the first hour after birth.
o Provide warmth, skin-to-skin contact, and early initiation of breastfeeding.
2. Monitoring of the Mother:
o Assess the mother's vital signs, including blood pressure, pulse, and temperature, and
provide care for any postpartum complications, including hemorrhage, infection, or
hypertensive disorders.
3. Breastfeeding Promotion and Support:
o Support and promote early initiation of breastfeeding within the first hour after birth.
o Provide guidance and support for proper breastfeeding techniques, positioning, and
frequency.
o Encourage exclusive breastfeeding for the first six months of life.
4. Pain Management:
o Address and manage any postpartum pain or discomfort, such as perineal pain after
vaginal delivery or incision pain after a cesarean section.
5. Hygiene and Infection Prevention:
o Promote good hygiene practices for the mother and newborn to prevent infection.
o Ensure proper handwashing and perineal care.
6. Emotional Support and Mental Health:
o Assess the emotional well-being of the mother and provide emotional support.
o Screen for and address postpartum depression and other mental health concerns.
7. Vaginal and Perineal Care:
o Provide guidance on perineal care and healing for women who have had vaginal
deliveries.
8. Family Planning and Contraception:
o Discuss and provide information on family planning and contraception options to
support the woman's reproductive health and reproductive rights.
9. Newborn Care:
o Conduct a thorough newborn assessment, including weight, length, head
circumference, and overall health.
o Screen for congenital anomalies and conditions.
o Provide newborn care education and support to parents.
10. Immunizations:
o Administer appropriate immunizations to the newborn as per guideline, such as
hepatitis B vaccine and vitamin K.

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11. Postnatal Follow-Up:
o Schedule and ensure follow-up visits for the mother and newborn, as appropriate, to
assess their health and address any concerns or complications.
12. Family and Social Support:
o Encourage involvement of family members and a supportive social environment
during the postnatal period.

Postnatal care is a critical period for monitoring maternal and newborn health, addressing any
postpartum complications, and providing guidance and support to ensure a smooth transition to
motherhood.

What is Anesthesia Safety Checklist and its importance?

The Anesthetic Safety Checklist is a protocol designed to enhance patient safety during the
administration of anesthesia in medical procedures. It serves as a standardized tool to ensure that
critical steps are followed and key information is communicated among members of the healthcare
team. The checklist is typically implemented before, during, and after anesthesia to minimize the risk
of errors and improve overall patient outcomes.

The importance of the Anesthetic Safety Checklist lies in its ability to:

 Enhance Communication: The checklist promotes effective communication among


members of the healthcare team, including surgeons, anesthesiologists, nurses, and other
support staff. This helps ensure that everyone is on the same page regarding the patient's
condition, medical history, and the plan for anesthesia administration.
 Identify and Address Potential Risks: By systematically going through the checklist,
healthcare providers can identify potential risks and address them proactively. This includes
checking for allergies, confirming the patient's identity, and verifying that all necessary
equipment is available and functioning properly.
 Standardize Procedures: Standardization is crucial in healthcare to reduce variability and
improve consistency in patient care. The checklist provides a standardized approach to
anesthesia administration, helping healthcare providers follow established best practices and
guidelines.
 Improve Patient Safety: Ultimately, the primary goal of the Anesthetic Safety Checklist is to
enhance patient safety. By systematically addressing key elements related to the anesthesia
process, the checklist helps prevent errors, minimize complications, and contribute to overall
positive patient outcomes.

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 Facilitate Team Coordination: Anesthesia administration involves a multidisciplinary team.
The checklist encourages teamwork and collaboration by ensuring that all team members are
aware of their roles and responsibilities. This can be particularly important in high-stakes
situations where effective coordination is crucial.
 Documentation and Accountability: The checklist serves as a documented record of the
steps taken during the anesthesia process. This documentation can be valuable for reviewing
and improving procedures, as well as for addressing any concerns or issues that may arise. It
also establishes accountability by clearly outlining the responsibilities of each team member.

What are the procedures to check drug before administration/ dispensing?

Checking a drug before administration or dispensing is a critical step in ensuring patient safety. The
following are general procedures that healthcare professionals typically follow to verify and
administer medications safely:

1. Prescription Review: Verify the prescription or medication order. Ensure that it is legible
and complete. Confirm that the order includes the patient's name, the drug name, dosage,
route of administration, frequency, and any other relevant information.
2. Patient Identification: Confirm the patient's identity using at least two patient identifiers
(e.g., name and date of birth)
3. Patient Education: Provide the patient with information about the medication, including
route of administration, potential side effects, and any other relevant instructions.
4. Drug Storage: Ensure that the drug is stored appropriately, considering factors such as
temperature, light exposure, and expiration date.
5. Medication Label Check: Check the medication label against the medication order. Verify
the drug name, strength, dosage form, and concentration.
6. Expiration Date Check: Confirm that the medication has not expired.
7. Dosage Calculation: If the medication requires dosage calculations, double-check the
calculations to ensure accuracy.
8. Allergy Check: Confirm that the patient does not have any known allergies to the
medication.
9. Drug Interactions: Check for potential drug interactions with other medications the patient is
currently taking.
10. Documentation: Document the medication administration or dispensing, including the date,
time, dose, route, and any other relevant information.

11. Follow-Up Monitoring: Monitor the patient for any adverse reactions or side effects after
medication administration.

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How to ensure the accuracy of verbal / telephonic orders?
Verbal orders are rechecked before administration either by spelling or though telephonic message in
regards to the name of the drugs, dosage, route, and frequency. Verbal orders are documented in the
case sheet

What do you mean by the term High Risk patients & Vulnerable Patients?

Vulnerable patients and high-risk patients are terms commonly used in the medical field to refer
to individuals who are more susceptible to experiencing negative health outcomes or
complications due to various factors. These factors can include pre-existing medical conditions,
weakened immune systems, age, and other relevant characteristics.

 High-Risk Patients:
High-risk patients are individuals who have a higher likelihood of experiencing complications or
adverse outcomes due to prognosis of the medical or disease condition if intervention is not
given properly.

High risk patients include those:

 Any patient who might have bad prognosis without proper intervention
 Unable to understand the care processes or participate in decision making
 All Medical & life threatening emergency cases
 Patients requiring resuscitative services
 Patients requiring blood and blood products
 Patients who are comatose or/& mechanically ventilated
 Patients who are immune-suppressed
 Hemodialysis patients
 Patients in restraints
 Patients undergoing moderate and deep sedation
 Immunocompromised patients,
 pregnant women with danger sings
 Any other patients with complicated clinical conditions

 Vulnerable Patients: Vulnerable patients are those who have an increased susceptibility to self-harm
or adverse outcomes knowingly or unknowingly due to various factors. These factors may include
socioeconomic status, age, disabilities, mental health conditions, and more. Healthcare providers

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often need to take extra precautions and tailor their care approaches when dealing with vulnerable
patients to ensure their safety and well-being.
Vulnerable patients include but not limited to -

 Any patient who can cause self harm


 Infants
 Children
 Physically challenged individuals
 Elderly and frail
 Patient with Mental disorders / disability
 Sexual victims
 Prisoners
 Other individuals less able to protect themselves

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Department:

Post Partum Unit

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How the privacy, confidentiality & dignity of patient and related information are maintained?

Following parameters must be maintained at PP unit-

1. Availability of screen at Examination Area should be there


2. One Patient should be seen at a time in clinics
3. Privacy at the counselling room should be maintained
4. Confidentiality of HIV reports at ICTC should be ensured strictly.
5. Behaviour of staff should be empathetic and courteous
6. Privacy and confidentiality of HIV should be maintained

How Storage of medicines/ drugs and consumables is done at PP Unit?

The priority is to ensure that the product integrity is maintained.

 Medications must be stored according to the manufacturer‘s recommendations, and monitored


appropriately. In the event where storage conditions fall outside of the recommended range as
specified by the manufacturer, the integrity and quality of the medication may become
affected.

 The majority of vaccines require storage in ILR, at 2 to 8 degrees Centigrade

 Some other medications require refrigeration to ensure their viability and quality. These
temperature-sensitive products include pharmaceuticals, clinical trial medicines and vaccines
which require storage between +2° C and +8° C. The World Health Organization (WHO)
recommends that special refrigeration storage conditions are checked and monitored
regularly, and that appropriate date is recorded for refrigerated medications to ensure storage
conditions are both preserved and within the allowable limits.

 Vaccines should be stored as per guidelines

 There is separate shelf /rack for storage near expiry drugs.

 Drugs and consumables should be stored away from water and sources of heat, direct
sunlight. Drugs are not to be stored at floor and adjacent to wall.

What are the Procedure for referral / transfer to other hospital?

When a patient in PP Unit is referred to other higher centre for the purpose of investigation/
management the following points must be observed:

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1. Referral must be done my concerned person / Medical Officer and intimation must be given
to the hospital authority.
2. Referral is to be clearly written in PP Unit ticket mentioning the exact cause of referral along
with relevant history, findings of the patient and name of the referring doctor
3. Documents and registers must be updated
4. Referral vehicle, if available may be utilised.
5. Referral linkage with higher tier centre is to be maintained
6. Information regarding referral is to be shared with the hospital in charge.
7. Similarly for referred-in patient from lower tier facilities, record is to be maintained
8. There should be system for follow up of referred patient with records
9. ICTC should have functional linkages with ART and State referral labs

What are the Procedure for periodic monitoring of patients in PP Unit?

It should be done as per the latest clinical guidelines and as per the medical advice. Patient Vitals are
to be monitored and recorded periodically as per the condition of the patient. Critical patients are
monitored continually by monitors. Vitals are to be recorded in vital signs chart; to be kept at bed
side.Nurse starts the treatment as per the instructions on Bed Head Ticket (BHT).

What are the Procedures of diagnostic services and Laboratory or other Investigations in PP Unit ?

 In case laboratory/ radiology investigations are required to be performed, investigation


requisition form is filled by the doctor/ PP Unit attendant.
 Only those investigations which are not available in hospital and essential for arriving
diagnosis are prescribed for outside. The expenditure so incurred for investigation can be
reimbursed as per the policy.
 After the investigation, patient comes back to PP Unit for the consultation.
 Final diagnosis is arrived on the basis of investigation reports and clinical findings.
 It should be done as per the latest clinical guidelines and as per the medical advice.

What are the Procedures for Pre-testing Activities in PP Unit?

It is the responsibility of the person taking the sample to:

 Ensure all appropriate sterile equipment is within date and all packaging is intact.
 Explain procedure and rationale to patient, answering any questions.
 Check patient identification.

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 Ensure patient meets any special requirements e.g. fasting etc
 Take the sample into the appropriate specimen container for the tests required.
 Dispose of all needles into sharps bin when finished sampling.
 Dispose of all contaminated material into BMW bin as per guideline
 Label the specimen container fully
 Place in the bag attached to the form.
 Ensure the form is properly completed
 Container is then labelled properly after the sample collection maintaining standards.
If, on sending a specimen for testing and further testing is required, please contact the
appropriate laboratory department to investigate the feasibility of using the initial specimen for
analysis as age of specimen may impact on the validity of results. Lack of a request form should
not impede the processing of an urgent result. In the event of analytical failure and where repeat
testing is required, it may be necessary to request a fresh sample.

What are the Family planning counselling services to given to every mother as per WHO guideline?

Guidelines and policies to provide family planning counseling services to every mother as part of
comprehensive maternal and reproductive healthcare. These guidelines aim to promote reproductive
health, reduce maternal and child mortality, and empower individuals and couples to make informed
choices regarding family planning. Here are the key family planning counseling services
recommended as per Government of India guidelines in hospital settings:

1. Information and Education:


o Mothers should receive comprehensive information about various contraceptive
methods, their effectiveness, benefits, and potential side effects.
o Counseling should include information on spacing and limiting family size to promote
reproductive health.
2. Counseling Sessions:
o Healthcare providers should offer individual or group counseling sessions for mothers,
ensuring privacy and confidentiality.
o Counseling should be non-judgmental, client-centered, and culturally sensitive.
3. Choice of Contraceptive Methods:
o Mothers should be provided with a range of contraceptive options to choose from,
including reversible and permanent methods.
o The choice of method should consider the mother's and family's preferences, health
status, and cultural beliefs.

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4. Counseling on Postpartum Family Planning:
o Family planning counseling should be integrated into postpartum care, providing
mothers with an opportunity to discuss contraceptive options during the postpartum
period.
5. Health Assessments:
o Healthcare providers should conduct health assessments to determine the medical
eligibility of mothers for different contraceptive methods based on their medical
history and current health status. Along with this information and access to emergency
contraception should be provided for women who have had unprotected sex or
contraceptive failure to be given.
6. Dual Protection:
o Encourage the use of methods that offer dual protection, providing protection against
both unintended pregnancy and sexually transmitted infections (STIs).
7. Reproductive Rights and Privacy:
o Recognize and respect the reproductive rights of mothers, ensuring that they have the
right to decide the number and spacing of their children.
o Privacy and confidentiality should be maintained during counseling sessions.
8. Accessibility and Availability:
o Ensure that family planning services and a variety of contraceptive methods are
accessible, affordable, and available to all mothers, regardless of their socioeconomic
status.
9. Continuity of Care:
o Provide ongoing family planning counseling and support to mothers over time, as their
contraceptive needs and preferences may change.
10. Quality of Care:
o Family planning services should be delivered with a focus on quality, ensuring
informed choice and informed consent.
11. Provider Training:
o Healthcare providers should receive appropriate education and training to deliver
high-quality family planning counseling services.
12. Data and Monitoring:
o Collect and monitor data on contraceptive use, unmet needs, and the effectiveness of
family planning programs to inform decision-making and program improvements.

** Always check latest guideline/ G.O in this regard to provide accessible and high-quality
family planning counseling and services to mothers and women.

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What are the case selection criteria for family planning as per guideline?

The case selection criteria must be as per the latest guideline and may include the following:

1. Eligibility for Sterilization (Tubectomy and Vasectomy):


o Sterilization is a permanent method of contraception. In India, eligibility criteria for
sterilization procedures include age, parity (number of living children), and spacing
between children.
o For women seeking tubectomy, the government typically recommends that they
should be at minimum age as pre guideline or have at least two living children.
Spacing between children should be at least 3 years.
o For men seeking vasectomy, the government generally recommends that they should
be at least minimum age as pre guideline or have at least two living children.
2. Eligibility for Long-Acting Reversible Contraceptives (LARCs):
o LARCs, such as intrauterine devices (IUDs) , PPIUCD, and hormonal implants, are
highly effective but reversible methods of contraception.
o Generally, women of reproductive age who desire effective long-term contraception
and have no contraindications can use LARCs.
3. Oral Contraceptives (Birth Control Pills):
o Birth control pills are suitable for most women of reproductive age who do not have
contraindications, such as a history of certain medical conditions, smoking, or a high
risk of blood clots.
o They may be an appropriate choice for women who desire a reversible method of
contraception and can adhere to a daily pill regimen.
4. Condoms and Other Barrier Methods:
o Barrier methods, including male and female condoms, are suitable for most
individuals and can be used by individuals of all ages and reproductive stages.
o These methods provide protection against both unintended pregnancy and sexually
transmitted infections (STIs).

5. Hormonal Contraceptive: Methods use hormones to prevent pregnancy by interfering with


the normal hormonal fluctuations of a woman's menstrual cycle. Depot Medroxy progesterone
Acetate (DMPA) is a hormonal contraceptive method commonly known as the contraceptive
injection. An injectable synthetic progestin that provides contraception for three months with
each injection

6. Emergency Contraception:

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o Emergency contraception can be used by individuals who have had unprotected sex or
experienced contraceptive failure. There are no specific eligibility criteria for this
method.
7. Counseling and Informed Choice:
o Regardless of the method chosen, informed choice and counseling are crucial. Clients
should receive comprehensive information about the benefits, potential side effects,
and usage of the selected contraceptive method. Their consent and autonomy should
be respected.

7. Medical Eligibility Assessment:

o Clients seeking family planning services should undergo a medical eligibility


assessment, which takes into account their medical history and current health status.
o The assessment helps determine the suitability of various contraceptive methods based
on the individual's health and potential contraindications.

The case selection criteria may vary depending on the specific contraceptive method, so
healthcare providers should consider the relevant factors for each method when assessing
eligibility. The overall goal is to ensure that clients have access to a range of family planning
options and receive the method that best aligns with their individual needs, health, and
reproductive goals. Informed choice, informed consent, and privacy should be maintained
throughout the process. ** Always check latest guideline and G.O in this regard.

What is the Procedure for initial assessment of patients in PP Unit?

It should be done as instructed by the concerned person / Medical Officer and as per the latest
guideline.
The Procedure for initial assessment should be done as per protocol which may include:

History Specific information which should be obtained as part of the medical history includes:

�Menstrual History - date of last menstrual period (LMP); cycle details including length of cycle,
duration and amount of flow, dysmenorrhoea, regularity of periods.

�Obstetric history - number of pregnancies and living children and mode of delivery, date of last
childbirth, number and date of abortion/MTP; current pregnancy status.

�Contraceptive history - when and what was the last contraceptive used. If discontinued, when and
why.

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�Medical History

History of illness and other medical conditions in the past or at present to screen out the diseases as
mentioned under the medical eligibility criteria. Rule out any febrile illness, coagulation disorder or
diabetes. Immunization status for tetanus. Any known drug allergies especially to analgesics and
other medications. Current medications and reason.

Physical Examination

This should include a general examination, examination of abdomen and pelvis and any other
examination as indicated by the client‘s medical history or general physical examination.

General examination

 Pulse, blood pressure, respiratory rate, temperature


 Body weight, general condition, pallor and nutritional status
 Auscultation of heart and lungs
 Signs of anaemia: such as
pale skin or conjunctiva
rapid pulse (> 100/min)
systolic murmurs

Abdominal examination

 Suprapubic or pelvic tenderness


 Masses or gross abnormalities
 Surgical scars

Pelvic examination

Ensure that the client has passed urine before performing a pelvic examination

 Inspect external genitalia for abnormalities and lesions.


 Enlarged groin nodes
Speculum examination

 Check for abnormal vaginal discharge


 Check cervix for purulent cervicitis
 If indicated by history and physical findings and a microscope is available, obtain specimens
of vaginal and cervical discharge for diagnostic studies.

Bimanual examination

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 124
 Check for cervical motion tenderness
 Determine size, shape, position and mobility of uterus
 Check for mass or tenderness of the adnexa, active PID, etc.
 Check for signs of pregnancy
 Check for uterine abnormalities
 Recto-vaginal examination is performed only if findings on bimanual examination are
doubtful, for example, mass in cul de sac.
 Check pouch of Douglas for mass or tenderness

What is the Procedure for follow-up/ reassessment of Patients in PP Unit?

• If follow up of patients is advised, then it should be done as per the guideline and pbased on the
patient‘s clinical condition. As a general - Check the medical record or referral form, if available,
for background information on the client and the surgical procedure.
• Ask the client if she has experienced any problems or had any complaints since the surgery.
Specifically, ask if the woman has experienced any of the following:

a. vaginal discharge or bleeding


b. wound discharge or bleeding
c. fever
d. pain or any other problem

• Examine the operative site to assess healing and the absence of infection.
• Clean the operative site.

• Remove non-absorbable sutures, if used.

• Treat or refer for any complications indicated by the examination.

• Remind the client to return to the facility if she misses a menstrual period or shows

other signs of pregnancy.

• Document the follow-up visit in the client‘s medical record, including complaints, diagnosis
and treatment.

How MMA drug protocols are followed as per guidelines?

• First Visit (Day 1) - 200 mg Mifepristone (oral)

• 2nd Visit (Day 3) -400 mcg Misprostole (sublingual/ buccal/ vaginal/oral)

• 3rd Visit (Day 15)- Confirm & ensure complete abortion

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 125
** Check latest guidelines in this regard

What is High Alert Drugs and what are the cautious administration of high alert drugs?

High alert drugs are medications that have a heightened risk of causing significant harm to
patients if used in error. These drugs have a greater potential for adverse effects due to their
characteristics, dosage forms, or potential for medication errors..

To ensure that the right doses of high-alert drugs are administered, healthcare facilities follow
strict processes and protocols. These processes involve multiple layers of checks and
verifications to minimize the risk of errors.

Here is an outline of the typical steps involved in the process:

 Drug Formulary and Policies: Healthcare organizations should establish a drug


formulary that includes high-alert medications, or the facility should list the names of
High Alert Drugs with the existing medication available. This formulary or lists
outlines the approved drugs, their indications, dosing guidelines, and precautions as per
approved EDL. Policies and protocols must be developed to ensure the safe use of
high-alert drugs.

 Labeling: High Alert Medications will be prescribed, dispensed, and administered using
practices that are proven safe. High Alert Medications should have “HIGH ALERT
MEDICATION” labels on storage shelves, containers, product packages and loose
vials or ampoules. Any changes of brand /colour / preparation of High Alert
Medications must be informed as soon as possible.

Strategies To Reduce ERRORS due TO HIGH ALERT DRUGS:

1. List of High Alert Medications within the facility shall be identified.

2. High Alert Medications should have HIGH ALERT MEDICATION label on storage

shelves and or loose vials/ ampoules.

3. High Alert Medications should be kept in secure places with an IEC of maximum dosage

of each drug.

4. High Alert Medications should Not be prescribed in abbreviation or in short forms, and

should be prescribed in generic names with proper dosage, route & patient name.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 126
5. High Alert Medications must be double checked before they are prepared, dispensed and

administered to the patients.

6. All High Alert Medications issued from the pharmacy must be counterchecked and

verified by another pharmacy staff prior to dispensing for the purpose of medication

safety and accuracy. If the any prescription is not legible it should be verified by the

doctor.

7. Verbal communications of medication order on high alert medication are Not

Recommended and in case of emergency it should be immediately rechecked via spelling

of the drug for verification and documented with signature of the doctor.

8. After administration of High Alert Medications proper medication record should be

maintained and patient need to be closely monitored for any adverse event.

9. After use stock of High Alert Medications should be properly updated and counter signed

by the authority.

What are LASA drugs?

LASA Stands for Look Alike and Sound Alike (LASA) Medicines:

Look Alike Sound Alike (LASA) medications are drugs that are visually similar in physical
appearance or packaging and/or names of medications that have spelling similarities or
similarity during pronunciation. Eg : Lora-zepam, Clona-zepam, Dopa-mine-Dobuta-mine

Strategies to avoid errors with LASA medications:

1) List of LASA drugs should be available at the facility

2) During Storage - Use Tall Man lettering to emphasize differences in medications with
sound-alike names. eg- DOPamine & DOBUTamine.

3) Use additional Warning labels for look-alike medicines.

4) Store LASA medication separately from LASA pair with proper labeling.

5) Prescription should clearly specify generic name of medication, dosage and complete
direction for use.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 127
6) During dispending or drug administration - Identify medicines based on its name and strength
and double check.

7) Ensure proper documentation.

What is Adverse Drug Reaction?

An adverse drug reaction (ADR), also known as an adverse drug event (ADE), refers to any
unwanted or harmful response to a medication. It occurs when a patient experiences a negative
reaction after taking a drug, whether it is prescribed, over-the-counter, or even herbal or
alternative remedies. Adverse drug reactions can range from mild and tolerable side effects to
severe and life-threatening complications.

Here are some key points about adverse drug reactions:

 Types of Adverse Drug Reactions: There are different types of adverse drug reactions,
including:
 Type A (Augmented) Reactions: These are predictable and dose-dependent reactions
that are an extension of the drug's known pharmacological effects. For example,
drowsiness caused by sedating antihistamines.
 Type B (Bizarre) Reactions: These are unpredictable reactions that are unrelated to the
known pharmacological action of the drug. They often occur in susceptible individuals
and can range from mild to severe. Examples include severe allergic reactions or
anaphylaxis.
 Type C (Chronic) Reactions: These reactions are associated with long-term use of a
drug and may develop gradually over time. An example is drug-induced osteoporosis
from long-term corticosteroid use.
 Type D (Delayed) Reactions: These reactions have a delayed onset, occurring days,
weeks, or even months after drug exposure. An example is drug-induced liver injury.
 Type E (End-of-Use) Reactions: These reactions occur when a drug is withdrawn,
resulting in a rebound or withdrawal response. An example is rebound hypertension after
sudden discontinuation of antihypertensive medication.
 Type F (Failure) Reactions: These reactions occur when a drug fails to produce the
intended therapeutic effect. For example, a patient may not respond to an antibiotic due
to bacterial resistance.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 128
 Symptoms and Severity: Adverse drug reactions can manifest in various ways, ranging from
mild to severe. Common symptoms include nausea, vomiting, rash, dizziness, headache,
diarrhea, and fatigue. In severe cases, adverse drug reactions can lead to organ damage,
anaphylaxis, cardiovascular events, or even death.
 Risk Factors: Certain factors increase the risk of experiencing an adverse drug reaction.
These include individual susceptibility, age (the very young and elderly are often more
vulnerable), concomitant use of multiple medications, underlying medical conditions, genetic
factors, and drug interactions.
 Reporting and Monitoring: Adverse drug reactions should be promptly reported to
healthcare providers and regulatory authorities. Reporting systems help identify trends,
improve drug safety, and inform regulatory decisions. Healthcare professionals monitor
patients closely for adverse drug reactions during treatment and adjust medications as
necessary. A separate register should be maintained.
 Prevention and Minimization: Adverse drug reactions can be minimized through proper
prescribing practices, patient education about potential side effects, accurate medication
reconciliation, regular monitoring, and reviewing the patient's medication history to identify
drug interactions or contraindications.
 Pharmacovigilance: Pharmacovigilance is the science and activities related to the detection,
assessment, understanding, and prevention of adverse drug reactions. It plays a crucial role in
ensuring drug safety and identifying any previously unrecognized risks associated with
medications. If a person suspects they are experiencing an adverse drug reaction, it is
important to seek medical attention promptly. Healthcare professionals can evaluate the
symptoms, discontinue or adjust the medication if necessary, and provide appropriate
treatment or management strategies.

Adverse Drug Reaction vs. Medication Error: It's important to distinguish between an ADR
and a medication error. An ADR refers to the patient's unwanted response to a drug, whether
prescribed and administered. On the other hand, a medication error refers to a mistake in the
medication process, such as prescribing, dispensing, or administering the wrong medication or
dose.

** Any kind of Drug Reaction or Medication Error if any should be recorded and reported.

How to ensure safe and potent vaccines?

Before beginning your immunization session, and before giving each vaccine, follow these steps to
ensure that every dose that you are going to give is safe and effective:

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 Check label: Make sure the label on the vaccine vial is attached and clear enough to read. If
you find that the label is not clear enough to read or has come off, discard the vial.
 Check vaccine: Check that the vaccine being given is the correct one.
 Check expiry: Look for the expiry date on the vial. If the expiry date has passed, do not use
the vial; Discard it.
 Check the vaccine vial monitor (VVM) on vials to make sure that the vaccine is in the
usable stage.

What is Open Vial Policy?

Open Vial Policy has been developed to minimise and prevent vaccine wastage under the UIP.
It permits the reuse of partially used multi dose vials of relevant vaccines under UIP in succeeding
sessions up to 28 days PROVIDED certain conditions are fulfilled. It is essential that the policy is
followed correctly, so as to minimize wastage, adverse effects following immunization and ensuring
that the vaccination is effective.
Open Vial Policy is valid for the following vaccines:
• DPT, Td & TT,
• Hepatitis B,
• Oral Polio Vaccine (OPV)
• PCV
• Haemophilus influenzae type B (Hib) containing Pentavalent vaccine and
• injectable Inactivated Poliovirus Vaccine (IPV).

Open Vial Policy does NOT apply to:


• Measles,
• BCG and
• Japanese Encephalitis (JE) vaccines.
• Rotavirus vaccine

Provided that certain conditions are upheld, a vial of the vaccine that has been opened during a
session can be utilized for multiple immunization sessions WITHIN a period of 28 DAYS.
• The expiry date has not passed.
• The vaccines are stored under appropriate cold chain conditions both during transportation and
storage in cold chain storage point.
• The vaccine vial septum has not been submerged in water or contaminated in any way.
• Aseptic technique has been used to withdraw vaccine doses. (That is needle/septum has not been

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 130
contaminated in anyway)
• The vaccine vial monitor (VVM), has not reached/crossed the discard point.

A vaccine vial should be DISCADED if any of the following conditions are met and the Medical
Officer or Supervisor should be informed:

A vaccine vial should be DISCADED if any of the following conditions are met and the
Medical Officer or Supervisor should be informed:
o VVM reached/crossed discard point (for freeze dried vaccine, before
reconstitution only) or vaccine vials without VVM or disfigured VVM.
o No label/partially torn label and/or writing on label not legible.
o Any vial thought to be exposed to non-sterile procedure for withdrawal.
o Open vials that have been under water or vials removed from a vaccine carrier
that has water.
o If vaccine vial is frozen or contains floccules or any foreign body.
o If there is breakage in the continuity of the vials (crack/leaks).
o If there is any reported AEFI following use of any of the vaccine vial, do not
use it, and retain it safely.

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Department:

Intensive Care Unit /


Critical Care Unit

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How control temperature and humidity and record of same is maintained in ICU / CCU ?

The temperature inside the main ICU/ CCU should be maintained at (20˚- 26˚C), round the clock
preferably by thermostatic Control. While the babies in the main CCU and step down units can
be kept warm by use of warmers at the prescribed temperature, arrangement has to be made to
separately control temperature in the neonatal ward at a higher level so that hypothermia can be
avoided. Relative humidity of 30 % – 60% should be maintained while avoiding condensation
on wall and window surfaces.

What is ‘CLABSI’ & ‘COTI’ in ICU?

CLABSI and COTI are two types of healthcare-associated infections that can occur in the Intensive
Care Unit (ICU). They are both serious and can have significant implications for patient safety.
Here's what they stand for and some information about each:

1. CLABSI - Central Line-Associated Bloodstream Infection:


o Definition: A CLABSI is an infection that occurs when microbes (bacteria or other
pathogens) enter the bloodstream through a central venous catheter, which is a
catheter inserted into a large vein, often in the neck or chest, to administer medications
or fluids or to monitor a patient's hemodynamic status.
o Risk Factors: Patients in the ICU often have central lines in place. CLABSI can occur
due to a variety of factors, including improper insertion or maintenance of the central
line, contamination of the catheter or dressing, and the patient's weakened immune
system.
o Symptoms: CLABSI can cause fever, chills, hypotension, and other signs of systemic
infection. Laboratory tests, such as blood cultures, are used to diagnose the infection.
o Prevention: Preventing CLABSI involves strict adherence to infection control
practices, including proper hand hygiene, using sterile techniques during line insertion
and maintenance, and minimizing the duration that central lines are in place.
2. COTI - Catheter-Associated Urinary Tract Infection:
o Definition: A COTI is an infection that occurs when pathogens (commonly bacteria)
enter the urinary tract through a urinary catheter, which is a tube inserted into the
bladder to drain urine. Urinary catheters are frequently used in critically ill patients.
o Risk Factors: Patients in the ICU are at an increased risk of COTI due to the use of
urinary catheters. Inappropriate catheter use, poor aseptic technique during catheter
insertion, and prolonged catheterization are common risk factors.

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o Symptoms: COTI can cause urinary symptoms, such as increased frequency and
urgency, discomfort, and cloudy or foul-smelling urine. Systemic symptoms, like
fever and malaise, may also be present.
o Prevention: Preventing COTI involves the appropriate use of urinary catheters (only
when necessary), strict aseptic technique during insertion, maintenance, and removal,
and minimizing the duration of catheterization. It's also essential to keep the catheter
and the urinary drainage system clean.

Preventing CLABSI and COTI is a critical component of patient safety in the ICU. Healthcare
providers should follow strict protocols and guidelines for the insertion and maintenance of central
lines and urinary catheters, as well as maintaining a high level of hand hygiene and infection control
practices. Prompt recognition of any signs of infection and immediate intervention are essential in
managing and preventing these infections in the ICU.

What are the different types of ICU Scoring Systems?

The scoring systems most frequently applied to critically ill patients: those that predict risk of in-
hospital mortality at time of ICU admission (APACHE, SAPS, and MPM), and those that assess
and characterize current degree of organ dysfunction (MODS, SOFA, and LODS).

Acute Physiology and


Chronic Health Evaluation
Provides an indication of risk of in- (APACHE)
hospital death of groups of ICU
Outcome Risk Risk of in-
patients based on the degree of Simplified Acute
Prediction hospital death
physiologic derangement on ICU Physiology Score (SAPS)
admission
Mortality Probability
Model (MPM)

Sequential organ failure


assessment (SOFA)

Define degree of organ failure. Can be Multiple organ Degree of


Organ
used as sequential scores to assess dysfunction score organ
Dysfunction
effect of new therapies (MODS) dysfunction

Logistic organ dysfunction


score (LODS)

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What is SOFA Score in ICU?

The SOFA score, which stands for Sequential Organ Failure Assessment, is a widely used clinical
tool in the Intensive Care Unit (ICU) to assess the severity of a patient's organ dysfunction or failure.
It helps healthcare providers track a patient's condition over time and estimate the risk of mortality.
The SOFA score is useful for identifying patients who are at a higher risk of adverse outcomes,
including death.

The SOFA score assesses the functioning of six different organ systems, assigning a score from 0 to 4
for each system. The systems evaluated are:

1. Respiratory System: Assesses the patient's oxygenation and ventilation. The score is based
on the partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) ratio and
the need for mechanical ventilation.
2. Coagulation: Measures the platelet count or the need for platelet transfusions.
3. Liver: Evaluates bilirubin levels and liver function tests such as the international normalized
ratio (INR).
4. Cardiovascular System: Assesses blood pressure and the use of vasopressors to maintain
blood pressure. The score is based on the mean arterial pressure (MAP).
5. Central Nervous System: Evaluates the level of consciousness using the Glasgow Coma
Scale (GCS) or the use of sedation.
6. Renal System: Assesses kidney function using serum creatinine levels and urine output.

The SOFA score assigns a score of 0 to 4 for each system, with higher scores indicating more severe
dysfunction or failure. The total SOFA score is the sum of the scores for all six organ systems and
can range from 0 (no organ dysfunction) to 24 (maximum dysfunction). A higher SOFA score is
associated with an increased risk of mortality.

The SOFA score is typically used in the ICU for the following purposes:

1. Assessment of Severity: It provides an objective measure of the severity of organ


dysfunction in critically ill patients.
2. Prognostication: It helps predict the patient's risk of mortality. Higher SOFA scores are
associated with a higher risk of death.
3. Monitoring: The SOFA score can be used to monitor changes in a patient's condition over
time. An increase in the SOFA score may indicate worsening organ dysfunction.
4. Research: It is often used in clinical research to assess the impact of interventions or to
stratify patient groups based on disease severity.

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The SOFA score is typically calculated on a daily basis for patients in the ICU. An increase in the
SOFA score over time can signal deteriorating organ function and a higher risk of mortality.
Healthcare providers use the SOFA score as a tool for clinical decision-making, including the
assessment of the effectiveness of interventions and the need for specific treatments or interventions.

What is High Alert Drugs and what are the cautious administration of high alert drugs?

High alert drugs are medications that have a heightened risk of causing significant harm to
patients if used in error. These drugs have a greater potential for adverse effects due to their
characteristics, dosage forms, or potential for medication errors..

To ensure that the right doses of high-alert drugs are administered, healthcare facilities follow
strict processes and protocols. These processes involve multiple layers of checks and
verifications to minimize the risk of errors.

Here is an outline of the typical steps involved in the process:

 Drug Formulary and Policies: Healthcare organizations should establish a drug


formulary that includes high-alert medications, or the facility should list the names of
High Alert Drugs with the existing medication available. This formulary or lists
outlines the approved drugs, their indications, dosing guidelines, and precautions as per
approved EDL. Policies and protocols must be developed to ensure the safe use of
high-alert drugs.

 Labeling: High Alert Medications will be prescribed, dispensed, and administered using
practices that are proven safe. High Alert Medications should have “HIGH ALERT
MEDICATION” labels on storage shelves, containers, product packages and loose
vials or ampoules. Any changes of brand /colour / preparation of High Alert
Medications must be informed as soon as possible.

Strategies To Reduce ERRORS due TO HIGH ALERT DRUGS:

1. List of High Alert Medications within the facility shall be identified.

2. High Alert Medications should have HIGH ALERT MEDICATION label on storage

shelves and or loose vials/ ampoules.

3. High Alert Medications should be kept in secure places with an IEC of maximum

dosage of each drug.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 136
4. High Alert Medications should Not be prescribed in abbreviation or in short forms,

and should be prescribed in generic names with proper dosage, route & patient name.

5. High Alert Medications must be double checked before they are prepared, dispensed

and administered to the patients.

6. All High Alert Medications issued from the pharmacy must be counterchecked and

verified by another pharmacy staff prior to dispensing for the purpose of medication

safety and accuracy. If the any prescription is not legible it should be verified by the

doctor.

7. Verbal communications of medication order on high alert medication are Not

Recommended and in case of emergency it should be immediately rechecked via

spelling of the drug for verification and documented with signature of the doctor.

8. After administration of High Alert Medications proper medication record should be

maintained and patient need to be closely monitored for any adverse event.

9. After use stock of High Alert Medications should be properly updated and counter

signed by the authority.

What are LASA drugs?

LASA Stands for Look Alike and Sound Alike (LASA) Medicines:

Look Alike Sound Alike (LASA) medications are drugs that are visually similar in physical
appearance or packaging and/or names of medications that have spelling similarities or
similarity during pronunciation. Eg : Lora-zepam, Clona-zepam, Dopa-mine-Dobuta-mine

Strategies to avoid errors with LASA medications:

1) List of LASA drugs should be available at the facility

2) During Storage - Use Tall Man lettering to emphasize differences in medications with
sound-alike names. eg- DOPamine & DOBUTamine.

3) Use additional Warning labels for look-alike medicines.

4) Store LASA medication separately from LASA pair with proper labeling.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 137
5) Prescription should clearly specify generic name of medication, dosage and complete
direction for use.

6) During dispending or drug administration - Identify medicines based on its name and strength
and double check.

7) Ensure proper documentation.

What is Adverse Drug Reaction?

An adverse drug reaction (ADR), also known as an adverse drug event (ADE), refers to any
unwanted or harmful response to a medication. It occurs when a patient experiences a negative
reaction after taking a drug, whether it is prescribed, over-the-counter, or even herbal or
alternative remedies. Adverse drug reactions can range from mild and tolerable side effects to
severe and life-threatening complications.

Here are some key points about adverse drug reactions:

 Types of Adverse Drug Reactions: There are different types of adverse drug reactions,
including:
 Type A (Augmented) Reactions: These are predictable and dose-dependent reactions
that are an extension of the drug's known pharmacological effects. For example,
drowsiness caused by sedating antihistamines.
 Type B (Bizarre) Reactions: These are unpredictable reactions that are unrelated to the
known pharmacological action of the drug. They often occur in susceptible individuals
and can range from mild to severe. Examples include severe allergic reactions or
anaphylaxis.
 Type C (Chronic) Reactions: These reactions are associated with long-term use of a
drug and may develop gradually over time. An example is drug-induced osteoporosis
from long-term corticosteroid use.
 Type D (Delayed) Reactions: These reactions have a delayed onset, occurring days,
weeks, or even months after drug exposure. An example is drug-induced liver injury.
 Type E (End-of-Use) Reactions: These reactions occur when a drug is withdrawn,
resulting in a rebound or withdrawal response. An example is rebound hypertension after
sudden discontinuation of antihypertensive medication.
 Type F (Failure) Reactions: These reactions occur when a drug fails to produce the
intended therapeutic effect. For example, a patient may not respond to an antibiotic due
to bacterial resistance.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 138
 Symptoms and Severity: Adverse drug reactions can manifest in various ways, ranging from
mild to severe. Common symptoms include nausea, vomiting, rash, dizziness, headache,
diarrhea, and fatigue. In severe cases, adverse drug reactions can lead to organ damage,
anaphylaxis, cardiovascular events, or even death.
 Risk Factors: Certain factors increase the risk of experiencing an adverse drug reaction.
These include individual susceptibility, age (the very young and elderly are often more
vulnerable), concomitant use of multiple medications, underlying medical conditions, genetic
factors, and drug interactions.
 Reporting and Monitoring: Adverse drug reactions should be promptly reported to
healthcare providers and regulatory authorities. Reporting systems help identify trends,
improve drug safety, and inform regulatory decisions. Healthcare professionals monitor
patients closely for adverse drug reactions during treatment and adjust medications as
necessary. A separate register should be maintained.
 Prevention and Minimization: Adverse drug reactions can be minimized through proper
prescribing practices, patient education about potential side effects, accurate medication
reconciliation, regular monitoring, and reviewing the patient's medication history to identify
drug interactions or contraindications.

Adverse Drug Reaction vs. Medication Error: It's important to distinguish between an ADR
and a medication error. An ADR refers to the patient's unwanted response to a drug, whether
prescribed and administered. On the other hand, a medication error refers to a mistake in the
medication process, such as prescribing, dispensing, or administering the wrong medication or
dose.** Any kind of Drug Reaction or Medication Error if any should be recorded and reported.

What is Blood Transfusion Reaction?

A blood transfusion reaction refers to an adverse reaction that occurs as a result of receiving a
blood transfusion. Although blood transfusions are generally considered safe, complications can
occur in rare instances. These reactions can vary in severity and may range from mild to life-
threatening. It's important to closely monitor patients during and after transfusions to promptly
identify and manage any adverse reactions.

Types of Transfusion Reactions:

 Immune reactions
 Non immune reactions

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 Immediate
• During or within few hours of transfusion
 Delayed
• Days or weeks after the transfusion

Specific blood transfusion reactions include:

 Febrile Non-Hemolytic Reaction: This reaction is characterized by the development of


fever during or shortly after the transfusion. It is often accompanied by chills, headache,
and mild discomfort. It is typically caused by the recipient's antibodies reacting to white
blood cells in the donated blood.
 Allergic (Hypersensitivity) Reaction: Allergic reactions can occur due to sensitivity to
proteins or other substances in the transfused blood. Symptoms may include hives,
itching, flushing, wheezing, shortness of breath, and, in severe cases, anaphylaxis.
 Acute Hemolytic Transfusion Reaction (AHTR): Acute hemolytic reactions happen
within 24 hours of transfusion. This is a severe and potentially life-threatening reaction
caused by the recipient's immune system attacking and destroying the transfused red
blood cells. It can result from intravascular haemolysis, or ABO blood group
incompatibility or other red cell antibodies, or extravascular haemolysis or Rh minor
group incompatibility. Sign & Symptoms include fever, chills, back pain, chest pain,
Hypotension, Tachycardia, hemoglobinuria (red or brown urine), Dyspnoea and
disseminated intravascular coagulation (DIC).

 Delayed Hemolytic Reaction: This type of reaction can occur days to weeks after a
transfusion. This hemolytic reaction happen after 24 hours, usually occur two weeks after
but can go up to 30 days post transfusion. It is characterized by the recipient's immune
system mounting an immune response against the transfused red blood cells, resulting in
their destruction. Symptoms include gradual decline in hemoglobin levels, jaundice, and
sometimes fever.

 All type or any type of transfusion reaction should be recorded in a register with proper
details.

** Always check latest Guidelines from NACO / National Blood Transfusion Council
(NBTC) in this regard.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 140
What are the procedures for secure storage of Narcotic and Psychotropic drugs?

• All Narcotic and Psychotropic drugs available in the hospital must be listed as per EDL
and displayed.
• Drug substances like narcotics, and other potent drugs shall be stored in their designated
cupboard/drawer under double lock system.
• One key for the same shall be with the Sister-In charge and the other with the on duty Staff
nurse / any other person.
• Narcotic drugs will be released only on the signed requisition of the Doctor/MO.
• List of availability must be updated after each use.

What are the procedures of patient Hand over, whenever staff duty change happens?

Patient handovers often referred to as "shift handovers" or "shift change reports," are crucial in
hospitals to ensure continuity of care and patient safety when there is a change in staff duty. Proper
handovers help convey important patient information accurately and comprehensively.

Whenever hand over is given it should be in bed side and as per SBAR method.
Providing patient handover using the SBAR (Situation, Background, Assessment, Recommendation)
format is an effective way to convey important patient information in a clear and structured manner.

Here's how to give a patient handover using SBAR:

1. Situation (S): Start the handover by providing a brief and concise overview of the patient's
current situation. Include the following information:
a. Patient's name and age.
b. The primary reason for admission or the main concern.
c. A brief statement of the patient's current condition, such as "The patient is stable" or
"The patient's condition is deteriorating."
2. Background (B): Provide the necessary background information about the patient. This
section should cover:
a. Relevant medical history, including chronic conditions or recent surgeries.
b. Allergies or sensitivities.
c. Key vital signs and trends, such as blood pressure, heart rate, respiratory rate,
temperature, and oxygen saturation.
d. Current medications, dosages, and administration routes.
e. Any recent laboratory results, diagnostic tests, or imaging findings.

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f. Important events during the shift, such as interventions, responses to treatment, or
changes in the patient's status.
3. Assessment (A): Describe your assessment of the patient's current clinical status. This section
should include:
a. The patient's signs and symptoms.
b. Any concerns, potential complications, or changes in condition.
c. Response to interventions or treatments.
d. Pain level, if applicable.
4. Recommendation (R): Provide your recommendations for the patient's ongoing care and any
actions that should be taken. Include:
a. Specific plans for treatment or management.
b. Medication changes, dosage adjustments, or any new prescriptions.
c. Upcoming procedures, tests, or consultations.
d. Any special patient needs or concerns.
e. Code status, advance directives, or other important preferences.

When giving a patient handover using SBAR, it's important to be clear and concise, focusing on the
most relevant information. Here are some additional tips:

 Use plain language and avoid medical jargon.


 Speak in a calm and organized manner.
 Encourage the receiving healthcare provider to ask questions for clarification.
 Be prepared to provide further details if requested.
 Document the handover information in the patient's medical record or handover report.
 Ensure a smooth transition of care by confirming that the receiving healthcare provider
acknowledges the handover and is ready to assume responsibility for the patient.

SBAR is a valuable communication tool in healthcare settings, promoting effective and structured
information exchange. It helps ensure that all relevant patient information is conveyed accurately,
improving patient safety and continuity of care.

Handover register should be properly maintained.

What are the procedures to check drug before administration/ dispensing?

Checking a drug before administration or dispensing is a critical step in ensuring patient safety. The
following are general procedures that healthcare professionals typically follow to verify and
administer medications safely:

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1. Prescription Review: Verify the prescription or medication order. Ensure that it is legible
and complete. Confirm that the order includes the patient's name, the drug name, dosage,
route of administration, frequency, and any other relevant information.
2. Patient Identification: Confirm the patient's identity using at least two patient identifiers
(e.g., name and date of birth)
3. Patient Education: Provide the patient with information about the medication, including
route of administration, potential side effects, and any other relevant instructions.
4. Drug Storage: Ensure that the drug is stored appropriately, considering factors such as
temperature, light exposure, and expiration date.
5. Medication Label Check: Check the medication label against the medication order. Verify
the drug name, strength, dosage form, and concentration.
6. Expiration Date Check: Confirm that the medication has not expired.
7. Dosage Calculation: If the medication requires dosage calculations, double-check the
calculations to ensure accuracy.
8. Allergy Check: Confirm that the patient does not have any known allergies to the
medication.
9. Drug Interactions: Check for potential drug interactions with other medications the patient is
currently taking.
10. Documentation: Document the medication administration or dispensing, including the date,
time, dose, route, and any other relevant information.
11. Follow-Up Monitoring: Monitor the patient for any adverse reactions or side effects after
medication administration.

** Always follow the specific guidelines and procedures established by your healthcare
institution.

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Department:

Indoor Patient
Department (IPD)

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How Privacy, Confidentiality and Dignity of patient is maintained in IPD?

 Ensures adequate visual privacy (screens, curtains) at point of care.


 Dressing and examination of patient should be done at enclosed area.
 Provision for separate ward for men and women.
 Patient records should be kept in secured place beyond the access of general staff or visitors.
 Behaviour of the staff should be empathetic and courteous irrespective of caste, religion,
gender or socio-economical status.
 Confidentiality of patient‘s condition having social stigma should be safe guarded.

How maintenance of critical Equipment is done in IPD?

 Up to date manufacturer‘s instructions for operation and maintenance of equipments shall be


kept in the IPD so that the same can be readily available to staff when required.
 Defective/Out of order equipments shall be labeled and stored appropriately away from traffic
area, until it has been repaired
 Daily dusting/ dry wiping of equipments shall be done by housekeeping staff.
 The Sister in charge shall do a daily check on the functioning of equipments every morning
before commencement of testing procedure and should tally the same in checklist provided by
State.
 All equipments shall be covered under AMC/CMC including Preventive maintenance.
 The IPD wards‘ Sister-In charge shall maintain an updated record on AMC & Preventive
maintenance in equipment register.
 Preventive maintenance shall be carried out as per Maintenance Schedule for each individual
equipment based on manufacturer‘s recommendations.
 Maintenance / Service report shall be obtained from service agency and after verification
marked as O.K.
 Designated Staffs ensures that all necessary instruments / equipment / furniture /consumables
are available in the clinic before start of day.
 Any deficiency is noted and discussed with Hospital in charge for correction and corrective
action.
 Breakdown and maintenance register should be maintained along down time of criticical
equipment should be calculated.

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How proper storage of drugs and consumables are done in IPD?

 The drug stock shall be stored in their respective places on racks, shelves or in drawers with
proper labeling. Direct storage of cartons on the floor shall be avoided so as to prevent damage
by moisture.
 Stock shall be arranged neatly in alphabetic order with the label bearing the name of the
product in front.
 First expiry Fist out method / or nay other relevant method should be used.
 Controlled drug substances like narcotics, and other potent drugs shall be stored in their
designated cupboard/drawer under double lock system. One key for the same shall be with the
Sister In-Charge/ Ward sister and the other with on duty Staff Nurse.
 High risk Medications like sound alike and look-alike drugs or reagents or chemicals shall be
stored separately along with proper labeling. A list of commonly used look alike & sound alike
rugs shall be prepared and displayed at the nursing station. The substances considered in this
list shall be doubly checked to ensure the name, dosage etc.
 Heavy items shall be stored in lower shelves. Fragile items shall not be stored at the edges of
the shelves.

 Empty and filled cylinders are to be labelled and kept separately.

 There should be specified place to keep expiry and near expiry medicines in drug store. All the
shelves/racks containing medicines are to be labelled. .

 Drugs and consumables are stored away from water and sources of heat, direct sunlight.

 Drugs are not to be stored at floor and adjacent to wall.

How management of expiry and near expiry drugs are maintained?

 There should be a separate register for near expiry and expiry drugs
 SMIS system is inbuilt to alert user about expiry drugs and dates of expiry by generating
alerts.
 It is the responsibility of the IPD sister in charge to check the validity and the expiration date
of drug products throughout the ward
 Every product dispensed by the pharmacy shall carry an expiration date.
 Medications that are going to be expired within 3 months shall be marked in all medication
storage areas (inpatient, and nursing units). These medications, which will be expired within

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THREE (3) months, are to be arranged in separate shelves. This will be called as near Expiry
Drugs.
 In case of presence of expired medications, the Sister in charge / concerned person should
make the proper documentation and intimation to the hospital authority and dispose of the
expired medication in proper waste bin as per BMW guideline. This bag should be labeled
with the name of the medication, expiry date, and quantity of the expired medication.

How crash cart trolley to be replenished in IPD?

Reorganizing a crash cart trolley is a critical task to ensure that life-saving equipment and
medications are readily accessible in emergency situations. Proper organization can make a
significant difference in response time and patient outcomes. Here are steps to help you reorganize a
crash cart trolley:

1. Review Protocols and Guidelines: Start by familiarizing yourself with your facility's
protocols, guidelines, and any regulatory requirements for crash cart. These guidelines will
provide you with a framework for what should be included in the cart.
2. Clear the Cart: Remove all the contents from the crash cart trolley. This allows you to start
with a clean slate and ensures that you can thoroughly inspect and clean each item.
3. Categorize Items: Group the contents into categories based on their purpose or function.
Common categories might include airway management, medication, defibrillation (if any),
vascular access, and monitoring equipment. Name and Expiry dates of all medicines must be
written.
4. Check Expiration Dates: Inspect all medications and medical supplies for expiration dates.
Replace any expired items and make a note of when they were replaced. Regularly check and
restock these items to maintain their freshness.
5. Prioritize Equipment: Identify the most critical items that need to be readily accessible in an
emergency. These typically include items for airway management (e.g., endotracheal tubes),
cardiac arrest (e.g., defibrillator pads), and medications like epinephrine and atropine.
6. Determine Storage: Choose appropriate storage for each category. This may include bins,
trays, drawers, or pockets. Use clear containers if possible, so you can quickly identify the
contents.
7. Labeling and Color Coding: Consider labeling each storage area and using color-coding
systems to make it easy to locate items quickly. For example, you can use red for cardiac-
related items and blue for airway management or as per the hospital policy.

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8. Regular Maintenance: Establish a schedule for regular maintenance. This should include
checking expiration dates, restocking used items, and ensuring that all equipment is in good
working order.
9. Documentation: Keep a detailed inventory of all items in the crash cart. This inventory
should include item names, quantities, and expiration dates. Make sure to update this
inventory whenever there are changes or restocking.

What are the procedure for taking informed consent before treatment and procedures in IPD?

The Hospital requires consent for all invasive or therapeutic procedures. All consents must be in
local language and explained to the patient / relatives. For all cases, the general consent form is
filled and signed either by the patient if possible or the patient representative if the patient is not
is a state to give his consent. In case of a patient incapable of giving consent, it is taken from the
patient representative or guardian.

• In case of minor, legal guardian should sign the consent, i.e any one who is willing to take care
of the patient..

• Life-sustaining measures are not withheld for lack of formal consent if there is no time to
obtain the consent for urgent procedures.

• There are three types of consent forms mandatorily operational in all facilities as per decision
of State, the form materials have been circulated by State as a policy decision to all hospitals –

1. General Consent form for procedure


2. Consent form for anesthesia
3. High risk consent

• Other than this three, Consent is required for elective blood transfusions and HIV testing.
• Consent is to be signed by all the patients admitted in the ward

• In case patient/ next to kin is illiterate then the thumb impression of the patient is taken which
is witnessed by a neutral person.

• Consent form signing is the responsibility of the doctor admitting the patient.

• Nursing staff or Rogi Sahayaks may help in that procedure.

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What are the procedure for Grievance Redressal system ?

• Facility should have provision of Complain Box in all wards accessible to patient parties
and visitors.
• Display of process for Grievance Redressal must be written in local language
• Contact person / whom to contact should be displayed.
• There should be a provision of regular checking of grievances (as per policy)
• Grievance Redressal register must be updated
• All grievances must be addressed as per stipulated timeline and followup register must be
filled.
• Grievances must be discussed in the monthly meeting.

What is High Alert Drugs and what are the cautious administration of high alert drugs?
High alert drugs are medications that have a heightened risk of causing significant harm to
patients if used in error. These drugs have a greater potential for adverse effects due to their
characteristics, dosage forms, or potential for medication errors..

To ensure that the right doses of high-alert drugs are administered, healthcare facilities follow
strict processes and protocols. These processes involve multiple layers of checks and
verifications to minimize the risk of errors.

Here is an outline of the typical steps involved in the process:

 Drug Formulary and Policies: Healthcare organizations should establish a drug


formulary that includes high-alert medications, or the facility should list the names of
High Alert Drugs with the existing medication available. This formulary or lists
outlines the approved drugs, their indications, dosing guidelines, and precautions as per
approved EDL. Policies and protocols must be developed to ensure the safe use of
high-alert drugs.

 Labeling: High Alert Medications will be prescribed, dispensed, and administered using
practices that are proven safe. High Alert Medications should have “HIGH ALERT
MEDICATION” labels on storage shelves, containers, product packages and loose
vials or ampoules. Any changes of brand /colour / preparation of High Alert
Medications must be informed as soon as possible.

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Strategies To Reduce ERRORS due TO HIGH ALERT DRUGS:

1. List of High Alert Medications within the facility shall be identified.


2. High Alert Medications should have HIGH ALERT MEDICATION label on storage
shelves and or loose vials/ ampoules.
3. High Alert Medications should be kept in secure places with an IEC of maximum
dosage of each drug.
4. High Alert Medications should Not be prescribed in abbreviation or in short forms, and
should be prescribed in generic names with proper dosage, route & patient name.
5. High Alert Medications must be double checked before they are prepared, dispensed
and administered to the patients.
6. All High Alert Medications issued from the pharmacy must be counterchecked and
verified by another pharmacy staff prior to dispensing for the purpose of medication
safety and accuracy. If the any prescription is not legible it should be verified by the
doctor.
7. Verbal communications of medication order on high alert medication are Not
Recommended and in case of emergency it should be immediately rechecked via
spelling of the drug for verification and documented with signature of the doctor.
8. After administration of High Alert Medications proper medication record should be
maintained and patient need to be closely monitored for any adverse event.
9. After use stock of High Alert Medications should be properly updated and counter
signed by the authority.

What are LASA drugs?

LASA Stands for Look Alike and Sound Alike (LASA) Medicines:

Look Alike Sound Alike (LASA) medications are drugs that are visually similar in physical
appearance or packaging and/or names of medications that have spelling similarities or
similarity during pronunciation. Eg : Lora-zepam, Clona-zepam, Dopa-mine-Dobuta-mine

Strategies to avoid errors with LASA medications:

1) List of LASA drugs should be available at the facility

2) During Storage - Use Tall Man lettering to emphasize differences in medications with
sound-alike names. eg- DOPamine & DOBUTamine.

3) Use additional Warning labels for look-alike medicines.

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4) Store LASA medication separately from LASA pair with proper labeling.

5) Prescription should clearly specify generic name of medication, dosage and complete
direction for use.

6) During dispending or drug administration - Identify medicines based on its name and strength
and double check.

7) Ensure proper documentation.

What is Adverse Drug Reaction?


An adverse drug reaction (ADR), also known as an adverse drug event (ADE), refers to any
unwanted or harmful response to a medication. It occurs when a patient experiences a negative
reaction after taking a drug, whether it is prescribed, over-the-counter, or even herbal or
alternative remedies. Adverse drug reactions can range from mild and tolerable side effects to
severe and life-threatening complications.

Here are some key points about adverse drug reactions:

 Types of Adverse Drug Reactions: There are different types of adverse drug reactions,
including:
 Type A (Augmented) Reactions: These are predictable and dose-dependent reactions
that are an extension of the drug's known pharmacological effects. For example,
drowsiness caused by sedating antihistamines.
 Type B (Bizarre) Reactions: These are unpredictable reactions that are unrelated to the
known pharmacological action of the drug. They often occur in susceptible individuals
and can range from mild to severe. Examples include severe allergic reactions or
anaphylaxis.
 Type C (Chronic) Reactions: These reactions are associated with long-term use of a
drug and may develop gradually over time. An example is drug-induced osteoporosis
from long-term corticosteroid use.
 Type D (Delayed) Reactions: These reactions have a delayed onset, occurring days,
weeks, or even months after drug exposure. An example is drug-induced liver injury.
 Type E (End-of-Use) Reactions: These reactions occur when a drug is withdrawn,
resulting in a rebound or withdrawal response. An example is rebound hypertension after
sudden discontinuation of antihypertensive medication.

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 Type F (Failure) Reactions: These reactions occur when a drug fails to produce the
intended therapeutic effect. For example, a patient may not respond to an antibiotic due
to bacterial resistance.

 Symptoms and Severity: Adverse drug reactions can manifest in various ways, ranging from
mild to severe. Common symptoms include nausea, vomiting, rash, dizziness, headache,
diarrhea, and fatigue. In severe cases, adverse drug reactions can lead to organ damage,
anaphylaxis, cardiovascular events, or even death.
 Risk Factors: Certain factors increase the risk of experiencing an adverse drug reaction.
These include individual susceptibility, age (the very young and elderly are often more
vulnerable), concomitant use of multiple medications, underlying medical conditions, genetic
factors, and drug interactions.
 Reporting and Monitoring: Adverse drug reactions should be promptly reported to
healthcare providers and regulatory authorities. Reporting systems help identify trends,
improve drug safety, and inform regulatory decisions. Healthcare professionals monitor
patients closely for adverse drug reactions during treatment and adjust medications as
necessary. A separate register should be maintained.
 Prevention and Minimization: Adverse drug reactions can be minimized through proper
prescribing practices, patient education about potential side effects, accurate medication
reconciliation, regular monitoring, and reviewing the patient's medication history to identify
drug interactions or contraindications.
 Pharmacovigilance: Pharmacovigilance is the science and activities related to the detection,
assessment, understanding, and prevention of adverse drug reactions. It plays a crucial role in
ensuring drug safety and identifying any previously unrecognized risks associated with
medications. If a person suspects they are experiencing an adverse drug reaction, it is
important to seek medical attention promptly. Healthcare professionals can evaluate the
symptoms, discontinue or adjust the medication if necessary, and provide appropriate
treatment or management strategies.

Adverse Drug Reaction vs. Medication Error: It's important to distinguish between an ADR
and a medication error. An ADR refers to the patient's unwanted response to a drug, whether
prescribed and administered. On the other hand, a medication error refers to a mistake in the
medication process, such as prescribing, dispensing, or administering the wrong medication or
dose.

** Any kind of Drug Reaction or Medication Error if any should be recorded and reported.

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What is Blood Transfusion Reaction?

A blood transfusion reaction refers to an adverse reaction that occurs as a result of receiving a
blood transfusion. Although blood transfusions are generally considered safe, complications can
occur in rare instances. These reactions can vary in severity and may range from mild to life-
threatening. It's important to closely monitor patients during and after transfusions to promptly
identify and manage any adverse reactions.

Types of Transfusion Reactions:

 Immune reactions
 Non immune reactions
 Immediate
• During or within few hours of transfusion
 Delayed
• Days or weeks after the transfusion

Specific blood transfusion reactions include:

 Febrile Non-Hemolytic Reaction: This reaction is characterized by the development of


fever during or shortly after the transfusion. It is often accompanied by chills, headache,
and mild discomfort. It is typically caused by the recipient's antibodies reacting to white
blood cells in the donated blood.
 Allergic (Hypersensitivity) Reaction: Allergic reactions can occur due to sensitivity to
proteins or other substances in the transfused blood. Symptoms may include hives,
itching, flushing, wheezing, shortness of breath, and, in severe cases, anaphylaxis.
 Acute Hemolytic Transfusion Reaction (AHTR): Acute hemolytic reactions happen
within 24 hours of transfusion. This is a severe and potentially life-threatening reaction
caused by the recipient's immune system attacking and destroying the transfused red
blood cells. It can result from intravascular haemolysis, or ABO blood group
incompatibility or other red cell antibodies, or extravascular haemolysis or Rh minor
group incompatibility. Sign & Symptoms include fever, chills, back pain, chest pain,
Hypotension, Tachycardia, hemoglobinuria (red or brown urine), Dyspnoea and
disseminated intravascular coagulation (DIC).
 Delayed Hemolytic Reaction: This type of reaction can occur days to weeks after a
transfusion. This hemolytic reaction happen after 24 hours, usually occur two weeks after
but can go up to 30 days post transfusion. It is characterized by the recipient's immune
system mounting an immune response against the transfused red blood cells, resulting in

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their destruction. Symptoms include gradual decline in hemoglobin levels, jaundice, and
sometimes fever.
 All type or any type of transfusion reaction should be recorded in a register with proper
details.
** Always check latest Guidelines from NACO / National Blood Transfusion Council
(NBTC) in this regard.

What are the procedures for secure storage of Narcotic and Psychotropic drugs?

• All Narcotic and Psychotropic drugs available in the hospital must be listed as per EDL
and displayed.
• Drug substances like narcotics and other potent drugs shall be stored in their designated
cupboard/drawer under double lock system.
• One key for the same shall be with the Sister-In charge and the other with the on duty Staff
nurse / any other person (two different person)
• Narcotic drugs will be released only on the signed requisition of the Doctor/MO.
• List of availability must be updated after each use.

What are the procedures of patient Hand over, whenever staff duty change happens?

Patient handovers often referred to as "shift handovers" or "shift change reports," are crucial in
hospitals to ensure continuity of care and patient safety when there is a change in staff duty. Proper
handovers help convey important patient information accurately and comprehensively. Whenever
hand over is given it should be in bed side and as per SBAR method.
Providing patient handover using the SBAR (Situation, Background, Assessment, Recommendation)
format is an effective way to convey important patient information in a clear and structured manner.

Here's how to give a patient handover using SBAR:

1. Situation (S): Start the handover by providing a brief and concise overview of the patient's
current situation. Include the following information:
a. Patient's name and age.
b. The primary reason for admission or the main concern.
c. A brief statement of the patient's current condition, such as "The patient is stable" or
"The patient's condition is deteriorating."

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2. Background (B): Provide the necessary background information about the patient. This
section should cover:
a. Relevant medical history, including chronic conditions or recent surgeries.
b. Allergies or sensitivities.
c. Key vital signs and trends, such as blood pressure, heart rate, respiratory rate,
temperature, and oxygen saturation.
d. Current medications, dosages, and administration routes.
e. Any recent laboratory results, diagnostic tests, or imaging findings.
f. Important events during the shift, such as interventions, responses to treatment, or
changes in the patient's status.
3. Assessment (A): Describe your assessment of the patient's current clinical status. This section
should include:
a. The patient's signs and symptoms.
b. Any concerns, potential complications, or changes in condition.
c. Response to interventions or treatments.
d. Pain level, if applicable.
4. Recommendation (R): Provide your recommendations for the patient's ongoing care and any
actions that should be taken. Include:
a. Specific plans for treatment or management.
b. Medication changes, dosage adjustments, or any new prescriptions.
c. Upcoming procedures, tests, or consultations.
d. Any special patient needs or concerns.
e. Code status, advance directives, or other important preferences.

When giving a patient handover using SBAR, it's important to be clear and concise, focusing on the
most relevant information. Here are some additional tips:

 Use plain language and avoid medical jargon.


 Speak in a calm and organized manner.
 Encourage the receiving healthcare provider to ask questions for clarification.
 Be prepared to provide further details if requested.
 Document the handover information in the patient's medical record or handover report.
 Ensure a smooth transition of care by confirming that the receiving healthcare provider
acknowledges the handover and is ready to assume responsibility for the patient.

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SBAR is a valuable communication tool in healthcare settings, promoting effective and structured
information exchange. It helps ensure that all relevant patient information is conveyed accurately,
improving patient safety and continuity of care. Handover register should be properly maintained.

What are the procedures to check drug before administration/ dispensing?

Checking a drug before administration or dispensing is a critical step in ensuring patient safety. The
following are general procedures that healthcare professionals typically follow to verify and
administer medications safely:

1. Prescription Review: Verify the prescription or medication order. Ensure that it is legible
and complete. Confirm that the order includes the patient's name, the drug name, dosage,
route of administration, frequency, and any other relevant information.
2. Patient Identification: Confirm the patient's identity using at least two patient identifiers
(e.g., name and date of birth)
3. Patient Education: Provide the patient with information about the medication, including
route of administration, potential side effects, and any other relevant instructions.
4. Drug Storage: Ensure that the drug is stored appropriately, considering factors such as
temperature, light exposure, and expiration date.
5. Medication Label Check: Check the medication label against the medication order. Verify
the drug name, strength, dosage form, and concentration.
6. Expiration Date Check: Confirm that the medication has not expired.
7. Dosage Calculation: If the medication requires dosage calculations, double-check the
calculations to ensure accuracy.
8. Allergy Check: Confirm that the patient does not have any known allergies to the
medication.
9. Drug Interactions: Check for potential drug interactions with other medications the patient is
currently taking.
10. Documentation: Document the medication administration or dispensing, including the date,
time, dose, route, and any other relevant information.
11. Follow-Up Monitoring: Monitor the patient for any adverse reactions or side effects after
medication administration.

**Always follow the specific guidelines and procedures established by your healthcare
institution.

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How dietary services are available as per service provision and nutritional requirement of the
patients?

Nurse informs the dietary department/ Kitchen for patient‘s diets according to the doctor‘s advice.
Cooked Diet is supplied as per requisition made from wards. Nutritional assessment of patient is to
be done as required and directed by doctor There is procedure of requisition of different type of diet
from ward to kitchen as per hospital policy. Diet should be circulated by using diet trolley.

What are the sufficient space between two beds to provide bed side nursing care and movement?

As per norms space between two beds should be at least 4 ft and clearance between head end of bed
and wall should be at least 1 ft and between side of bed and wall should be 2 ft.

What is STG & Its purpose?

A Standard Treatment Guideline (STG) is a set of systematically developed recommendations or


guidelines for the diagnosis, treatment, and management of specific medical conditions or diseases.
These guidelines are designed to standardize medical care and ensure that patients receive evidence-
based, effective, and high-quality treatment. Here are some key aspects of STGs and their
importance:

1. Evidence-Based Care: STGs are developed based on current medical evidence and clinical
research. They incorporate the best available knowledge about the diagnosis, treatment, and
management of specific medical conditions. This ensures that patients receive care that is
grounded in scientific evidence, improving the chances of successful outcomes.
2. Consistency: STGs provide a uniform approach to the management of medical conditions.
They help healthcare providers, including doctors, nurses, and other medical professionals,
deliver consistent and standardized care, reducing variations in treatment approaches.
3. Quality Improvement: STGs are a valuable tool for quality improvement in healthcare. By
following established guidelines, healthcare facilities can better monitor and evaluate the
quality of care provided to patients. This can lead to improved patient safety and outcomes.
4. Cost-Effective Care: Standard Treatment Guidelines can help healthcare organizations
optimize resource allocation and reduce unnecessary tests, treatments, and hospital stays. This
can result in cost-effective care and efficient healthcare delivery.
5. Education and Training: STGs serve as educational resources for healthcare professionals.
They provide a framework for training and continuing medical education, helping to keep
healthcare providers updated on the latest research and treatment options.

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6. Patient-Centered Care: STGs prioritize patient safety and well-being. By adhering to
evidence-based guidelines, healthcare providers can offer patients the most effective and
appropriate treatments, leading to better health outcomes.
7. Clinical Decision Support: STGs can be integrated into electronic health records (EHRs) and
other healthcare information systems. This enables healthcare providers to receive real-time,
evidence-based guidance at the point of care, helping them make informed decisions.
8. Reduced Medical Errors: Standardized care reduces the likelihood of medical errors, as it
ensures that healthcare providers follow best practices in diagnosis, treatment, and patient
management. This can lead to fewer adverse events and better patient safety.
9. Legal and Ethical Considerations: Adhering to STGs can have legal and ethical
implications. If a healthcare provider deviates from established guidelines without a valid
reason, it may raise concerns about the quality of care provided and could lead to legal or
ethical challenges.
10. Continuous Updates: STGs are regularly updated to reflect advances in medical knowledge
and changes in clinical practice. This ensures that healthcare providers are working with the
most current information and recommendations.

What is the process to ensure the accuracy of verbal / telephonic medicinal orders in IPD?

Ensuring the accuracy of verbal or telephonic medicinal orders in a hospital is vital to patient safety
and the quality of healthcare. Miscommunication or errors in medication orders can lead to serious
consequences. Here is a process to help ensure the accuracy of such orders:

1. Verification and Authorization:


o Only authorized healthcare professionals, typically physicians, nurse practitioners, or
physician assistants, should be allowed to give verbal or telephonic medication orders.
o Verify the identity and authorization of the person providing the order.
2. Read-Back and Verification:
o When receiving a verbal order, the healthcare provider taking the order should read it
back to the prescriber to confirm accuracy.
o The prescriber should confirm or correct any discrepancies during this read-back.
3. Spell-Back for Complex Medications:
o For complex medication names or those that sound similar, use a "spell-back"
approach where the prescriber spells out the drug name.
o This helps eliminate any confusion due to sound-alike or look-alike medications.
4. Use Standardized Terminology:

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o Ensure that both the prescriber and the person taking the order use standardized
terminology and abbreviations.
o Avoid unclear abbreviations and symbols.
5. Double-Check Dosages and Frequencies:
o Verify the dosage, frequency, and route of administration.
o Ensure that the dose aligns with the patient's weight and medical condition.

6. Document and Time-Stamp:


o Document the medication order accurately, including the prescriber's name, date, time,
and the specific medication details. Whenever the doctor comes taje the signature of
the doctor mentioning details of verbal prescription.
o Time-stamp the entry to ensure clarity on when the order was given.

7. Question Unusual Orders:

o If an order seems unusual, unclear, or high-risk, do not hesitate to seek clarification


from the prescriber.
o Discuss the order with a clinical pharmacist or a senior healthcare provider if
necessary.

Once the Medical Officer reaches the facility, update the record with signature.

Name few common High Alert Drugs available in IPD & what are the Process for identifying and cautious
administration of high alert drugs?

Some common high alert drugs are – Electrolytes like Potassium chloride, Opioids, Neuro muscular
blocking agent, Anti thrombolytic agent, Insulin, Warfarin, Heparin, Adrenergic agonist etc.

What are the Procedures for maintaining, updating of patients’ clinical records?

Patient‘s complete medical records are available at all the times during their stay in Hospital. Every
page in the medical record has patient‘s name, identification number and name of the ward.

Documentation within the medical record follows the logical sequence of date, time. Drug
prescription chart, diagnostic results, nursing care plan are kept as separate sections for prompt easy
access. Data recorded or communicated on admission, handover and discharge is recorded using
standard format. Every entry in the medical record is dated, timed (preferably in 24-Hour format),
legible and signed by the person making the entry. Deletion and alterations are countersigned. Every

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entry made in medical record identifies the person who is responsible for decision making. An entry
is made in the medical records whenever a patient is seen by a doctor.

Consent form and resuscitation status statements must be clearly recorded in medical records.

Facility should have established procedure for maintaining and updating patient‘s clinical records.

i) Day to day progress of patients should be recorded in BHT


ii) BHT should contain all treatment plan, procedure and prescription on a daily basis.
iii) Treatment Chart and Registers
iv) Records should be identified and numbered
v) There should be adequate storage and retrieval facility of Medical Records

What are the Procedure for patients leaving the facility against medical advice, absconding, etc ?

LAMA-

In case the patients and relatives wish to get discharged from the hospital before complete recovery,
the provision of the same is made.

 The doctor on duty/ specialist discusses the consequences and risk to the patient and relatives.
The patient, relatives, concerned doctor and the nurse on duty sign the consent for discharge
against medical advice.

 A discharge summary is handed over to the patient/relative with the medical advice and it is
mentioned on the discharge card that patient is being discharged against medical advice.

Absconding-

 If a patient absconds from hospital without informing any concerned staff member then this
information is mentioned in the patient record, ward master is informed stat as soon as the
matter is noticed.
 Police has to be intimated that the patient has absconded with or without hospital property.

How to ensure safe and potent vaccines?

Before beginning your immunization session, and before giving each vaccine, follow these steps to
ensure that every dose that you are going to give is safe and effective:

 Check label: Make sure the label on the vaccine vial is attached and clear enough to read. If
you find that the label is not clear enough to read or has come off, discard the vial.

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 Check vaccine: Check that the vaccine being given is the correct one.
 Check expiry: Look for the expiry date on the vial. If the expiry date has passed, do not use
the vial; Discard it.
 Check the vaccine vial monitor (VVM) on vials to make sure that the vaccine is in the
usable stage.

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Department:

Blood Bank

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What are the donor selection criteria of Blood Bank as per Guideline?

The Government of India has established guidelines and criteria for the selection of blood donors to
ensure the safety of the blood supply and reduce the risk of transfusion-transmitted infections. The
criteria for donor selection in blood banks are typically based on the recommendations of the
National AIDS Control Organization (NACO) and the Drug Controller General of India (DCGI). The
donor selection criteria for blood banks in India are in line with international standards and include
the following factors:

1. Age: Donors must be between 18 and 60 years old. Some blood banks may have a lower age
limit for first-time donors, often starting at 17.
2. Weight: The minimum weight requirement is typically 45 kilograms or 110 pounds. This
criterion ensures that the donor can tolerate the blood volume loss without adverse effects.
3. General Health: Donors should be in good general health, without any acute illnesses or
symptoms of infection on the day of donation.
4. Hemoglobin Level: The minimum hemoglobin level for blood donation is usually 12.5
grams/deciliter for females and 13.5 grams/deciliter for males. This is to ensure that the donor
has adequate iron levels to donate without affecting their health.
5. Pulse Rate: Donors should have a normal resting pulse rate, typically between 50 and 100
beats per minute.
6. Blood Pressure: Blood pressure criteria may vary slightly among blood banks. In general,
donors should have a systolic blood pressure (the top number) between 100 and 180 mm Hg
and a diastolic blood pressure (the bottom number) between 50 and 100 mm Hg.
7. Temperature: Donors should not have a fever on the day of donation.
8. Travel History: Donors may be deferred if they have traveled to or lived in malaria-endemic
areas in the recent past. The specific travel history and deferral period may vary by region.
9. Medical History: Donors are asked about their medical history, including any past or current
illnesses, surgeries, and medications. A history of certain medical conditions, such as
infectious diseases, may result in temporary or permanent deferral.
10. High-Risk Behaviors: Donors who engage in high-risk behaviors, such as unprotected sex,
drug injection with shared needles, or involvement in sex work, are typically deferred due to
an increased risk of bloodborne infections like HIV, hepatitis B, and hepatitis C.
11. Pregnancy and Breastfeeding: Pregnant or breastfeeding individuals are usually deferred
from donating blood.
12. Previous Donations: The interval between successive blood donations is usually specified.
For whole blood donation, this is typically 56 days (8 weeks), while for platelet or plasma
donation, it can be shorter.

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13. Recent Transfusions: Donors who have received blood transfusions in the recent past may
be deferred.
14. Recent Tattoos or Body Piercings: Donors with recent tattoos or body piercings may be
deferred due to an increased risk of infection.

These criteria are in place to protect both the donor and the recipient and to maintain the safety
and integrity of the blood supply. It's important for blood banks to adhere to these guidelines to
ensure the quality and safety of donated blood. Additionally, blood banks may have additional
criteria or specific guidelines, so it's essential to consult the relevant authorities for the most up-
to-date information.

** Always check for latest NACO guideline in this regard. The above statement is only for
reference.

How Testing of Donated Blood is done as per NACO guideline?

The National AIDS Control Organization (NACO) in India has established guidelines for the testing
of donated blood to ensure its safety and prevent the transmission of infectious diseases. The testing
process for donated blood typically includes several key steps, and the guidelines may evolve over
time to address emerging infectious diseases and new testing technologies. As of my last knowledge
update in January 2022, here are the basic steps involved in testing donated blood according to
NACO guidelines:

1. Pre-Donation Screening: Before blood donation, donors are screened through a


questionnaire and an interview to assess their eligibility. Questions related to their medical
history, recent travel, and high-risk behaviors are asked to identify potential risks.
2. Blood Collection: Blood is collected from eligible donors using sterile and single-use
collection equipment to prevent contamination.
3. Blood Component Separation: Whole blood collected from donors is typically separated
into its components, such as red blood cells, plasma, and platelets, using a centrifuge.
4. Laboratory Testing: Various laboratory tests are performed on the donated blood to ensure
its safety. These tests may include:
o HIV Testing: To detect the presence of the human immunodeficiency virus (HIV).
o Hepatitis B Surface Antigen (HBsAg) Testing: To check for hepatitis B infection.
o Hepatitis C Testing: To screen for hepatitis C virus.
o Syphilis Testing: To detect syphilis infection.

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o Malaria Testing: To identify the presence of the malaria parasite, especially if the
donor has a history of travel to malaria-endemic areas.
o Blood Grouping and Compatibility Testing: To determine the donor's ABO and Rh
blood group and ensure compatibility with the recipient's blood type.
5. Nucleic Acid Testing (NAT): Some blood banks in India also use nucleic acid testing to
detect viral infections, such as HIV, hepatitis B, and hepatitis C, during the "window period"
when antibodies may not yet be detectable. NAT is a more sensitive method of screening for
these infections.
6. Confirmatory Testing: If an initial screening test is reactive, confirmatory tests are
performed to establish the presence of the infection. This is particularly important for HIV
and hepatitis.
7. Result Reporting: The results of the screening and confirmatory tests are reported, and the
blood is classified as either safe for transfusion or unsuitable. Unsuitable blood is discarded,
and the donor is typically informed of the result.
8. Storage and Distribution: Safe blood is appropriately stored and can be distributed for
transfusion as needed.

** Always check for latest NACO guideline in this regard. The above statement is only for
reference.

What records of donor assessment is maintained?

It should be done as per the latest G.O and guidelines. Following Donor Records may be maintained:

• Demographic details of donor

• Identification number

• Donor selection record

• Medical history

• Physical examination.

• Donor deferral records

• Donor's blood collection record

• Date of collection

• Batch No. and bag manufacturer's name

• Segment number on the donor tubing

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• Particulars of donor

• Identification number

• Amount of blood collected

• Time and duration of collection

• Signature of phlebotomist and medical officer

• Donor Reactions

• state of donation reaction when occurred needs to be mentioned along with the description,
management details and action taken for prevention in future.

** Always check latest guidelines in this regard. The above statement is only for reference.

What Register/records are maintained in Blood Bank as per guidelines?

Lab records are to be labeled and indexed

 Each blood bank and transfusion service should develop a practical record keeping system,
which serves its needs.
 The record system should make it possible to trace a unit of blood / component from source
(donor and collecting facility) to final destinations.
 The system should ensure confidentiality of donor and patient records
 Records should be legible and corrections should be initialled.
 Date of performance of procedures, tests and interpretation should be recorded.
Records include -

1. daily group wise stock register,


2. daily temperature recording of temperature dependent equipment,
3. stock register of consumables and non consumables,
4. documents of proficiency testing,
5. records of equipment maintenance,
6. records of recipient,
7. compatibility records,
8. transfusion reaction records,

** Always check latest guidelines in this regard. The above statement is only for reference.

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How Pre donation counseling is done before donation?

Pre-donation counseling by trained staff should be made available maintaining privacy and
confidentiality. Pre-donation information should include:

 Modes of transmission leading to risk behaviour and self exclusion for patient's safety.
 Alternative testing site
 Tests carried out on donated blood
 Confidentiality of test results
 Need for honest answers in view of window period.
A questionnaire should be prepared in Bengali and local languages which is simple and easy to
understand to be answered by the donor. For donors who are illiterate, assistance should be given by
donor registration staff.

**Always check for latest NACO guideline in this regard. The above statement is only for
reference.

How Blood Unit Identification is done?

 A numeric or alphanumeric system should be used, that will make it possible to trace any unit
of blood or component from source to final destination and to recheck records applying to the
specific unit.
 The numeric and alphanumeric identification on label should be provided by the collecting
facility to each unit of blood/its components.
 This number should be documented for traceability.
 Any advanced technology for identification such as barcode system is preferable.
 A maximum of two numeric or alphanumeric identification should be on a blood or
component container i.e., that of the original collecting facility.
 This does not preclude use of a patient identification.
 Donor's name should not be written on the label. In case of transfer of blood unit to another
blood bank, original label with the same identification should be retained.

LABELLING FOR WHOLE BLOOD/COMPONENT

After processing the blood, a final label should be affixed on the bag with the following information.

 Name of the product i.e., whole blood or component or intended component.


 The numeric or alphanumeric identification.

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 The date of collection and expiry.
 The name and amount of anticoagulant and the approximate volume of blood collected.
 For platelet concentrate, plasma and for component obtained through apheresis, the
approximate volume of the components should be indicated.
 Colour Scheme:
The following colour code is used to differentiate the ABO group label
Blood group O - Blue
Blood group A - Yellow
Blood group B - Pink
Blood group AB - White
 Storage temperature, expiry date.
 ABO and Rh type.
 Interpretation of HBsAg/HCV/HIV 1 & 2/VDRL/malaria test/unexpected antibodies
 Name, Address and Manufacturing license number of the collecting facility.

** Always check for latest NACO guideline in this regard. The above statement is only for
reference.

What are the procedure for storage and transportation of blood in Blood Bank ?

REFRIGERATORS AND FREEZERS FOR STORAGE

A designated area should be used for storage to limit deterioration and prevent damage to materials in
process and final products. The access to such areas should be controlled.

 Refrigerators or freezers in which blood and blood components are stored should be used for
storage of blood, blood components and blood samples only and not for any other items. All
reagents should be stored in separate refrigerators in the specific laboratories.
 Blood bank refrigerator/walk-in-cooler should have inside temperature of 40C ± 20C and
should have a system to monitor temperature continuously or at least the temperature should
be recorded every 4 hours. An alarm system and a provision for alternate power supply should
be available.
 Deep freezer should have inside temperature of -300C or -800C having temperature
indicator/recording facility with alarm system and provision for alternate power supply.
 Platelet incubator with agitator should have inside temperature of 220C +20C having
temperature indicator/recording facility with alarm system and provision for alternate power
supply. The equipment should keep the platelet units in continuous gentle agitation.

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 Adequate alternate storage facility and written display of instructions to maintain the blood
and components in the event of failure of power or equipment should be provided in the area
of preservation.
 The alarm of all storage equipment should signal in an area that has adequate personnel
coverage round the clock to ensure immediate corrective action.
TRANSPORTATION

 Whole blood, red cell concentrate, should be transported in a manner that will maintain a
maximum temperature of 100C ± 20C.
 Platelet/ granulocyte concentrate stored and transported at 220C ± 20C.
 Components stored frozen should be transported in a manner to maintain them frozen.
When these are issued for transfusion, these should be thawed at 370C prior to issue. The
temperature during transport should be monitored.

** Always check for latest NACO guideline / G.O in this regard. The above statement is
only for reference.

What are procedure for issuing blood in blood bank ?

Blood should be issued from the blood bank along with the blood cross matching report form.

 A portion of the integral tube with at least one numbered segment should remain attached
with the blood bag being issued.
 The cross matching report form should have patient's first name with surname, age, sex,
identification number, ward, bed number, ABO and Rh(D) type.
 The form should have donor unit identification number, segment number, ABO and Rh(D)
type and expiry date of the blood.
 Interpretation of cross matching report and the name of the person performing the test and
issuing the blood should be recorded.
 A label or a tag with patient's name, hospital, identification number, blood unit number
assigned by the collecting/intermediary facility, interpretation of the cross matching test,
should also be attached to the blood bag container before it is released from the blood bank.
 Each unit of blood should be visually inspected before issue. It should not be issued if there is
any evidence of leakage, hemolysis or suspicion of microbial contamination such as unusual
turbidity, or change of colour.

URGENT REQUIREMENT OF BLOOD-

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 Blood or blood components should be issued before completion of routine cross matching
tests in cases where delay in providing blood may jeopardize the patient's life, on receipt of a
signed written request of the treating physician stating that the clinical condition of the patient
requires urgent release of blood before completing ABO and Rh(D) tests and compatibility
testing. Records of such requests should be retained for 5 years as per the relevant standards.
 The donor tag or label on the blood container and the cross match report form should indicate
that compatibility testing has not been completed at the time of issue.
However, standard compatibility test should be completed promptly. If discrepancy in the result
is noted, the concerned clinician should be informed immediately to discontinue the transfusion.

** Always check for latest NACO guideline / relevant guideline in this regard. The above
statement is only for reference.

What are procedures for monitoring and reporting Transfusion complication?

DETECTION, REPORTING & EVALUATION

 Each blood bank should have a system for detection, reporting and evaluation of suspected
adverse reaction to transfusion (Hemovigilance).
 In the event of suspected transfusion reaction, the personnel attending the patient should
notify immediately the responsible physician and transfusion service with necessary
documentation and appropriate samples.
 All suspected transfusion reactions should be evaluated promptly. The evaluation should not
delay proper clinical management of the patient.
 The details of all cases along with the interpretation of evaluation should be recorded and
reported to the transfusion committee.
 There should be a written protocol for the investigations of transfusion reactions.
 Reported cases of serious reactions should be evaluated.

IMMEDIATE COMPLICATION

 If there are symptoms or findings suggestive of a haemolytic transfusion reaction, transfusion


should be discontinued and the following must be done immediately and records maintained.
 The label on the blood container and all other records should be checked to detect if there has
been an error in identifying the patient or the blood unit.
 A post transfusion properly labelled blood sample, (avoiding haemolysis) should be obtained
from the patient and sent to transfusion service along with blood container and attached
transfusion set.

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 The patient's post-reaction serum or plasma should be inspected for evidence of haemolysis,
comparing with pre-transfusion sample.
 A direct antiglobulin test should be done on the post transfusion specimen and on pre reaction
sample for comparison.
 Based on evaluation of clinical findings, review of accuracy of records and results of
laboratory tests, additional tests should be done such as:
 Determination of ABO and Rh(D) types on pre and post reaction blood
sample from the patient and from the blood bag.
 Repeat tests for unexpected antibodies in donor and recipients‘ blood and repeat cross-match
using pre and post reaction blood samples of the patient and donor blood from the bag.
 Examination of post transfusion urine should be carried out for haemoglobin and its
metabolites.
 Determination of bilirubin concentration in serum should be obtained preferably 5 to 7 hours
after the transfusion.
 Supernatant plasma and remaining blood in the blood container as well as the post-reaction
sample of the patient should be tested for smear and culture.
 Expiry dated blood units should be tested periodically for bacteriological smear and culture. If
investigations are suggestive of a haemolytic reaction or bacterial contamination, patient's
physician should be informed immediately.

DELAYED COMPLICATIONS

 Weak antibodies in recipient's serum directed against antigen on the donors red blood cells
undetectable at the time of pre transfusion tests, may appear after a week and result in delayed
haemolysis or unexplained fall in haemoglobin. Appropriate tests should be done to detect the
cause of reaction. A record should be maintained in patient's medical file.
 Reported cases of suspected transfusion transmitted disease should be evaluated. If
confirmed, the involved blood unit must be identified in the report. Attempt should be made
to recall the donor for retesting and counseling. Other recipients who received components
from the suspected blood unit should also be investigated.

Always check for latest NACO guideline in this regard. The above statement is only for
reference.

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Department:

Laboratory

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How Privacy, Confidentiality and Dignity of patient are maintained in Laboratory?

 Laboratory staff does not discuss the lab result outside.


 Patient records should be kept in secured place beyond the access of general staff or visitors.
 Behaviour of the staff should be empathetic and courteous irrespective of caste, religion, gender
or socio-economical status.
 Confidentiality of patient‘s condition having social stigma should be safe guarded.

What are the established systems for maintenance of critical Equipment in Laboratory?

 Up to date manufacturer‘s instructions for operation and maintenance of equipments shall be


kept in the department so that the same can be readily available to staff when required.
 Defective/Out of order equipments shall be labelled and stored appropriately away from traffic
area, until it has been repaired
 Daily dusting/ dry wiping of equipments shall be done by housekeeping staff. The laboratory
technician shall do a daily check on the functioning of equipments every morning before
commencement of testing procedure.
 All equipments shall be covered under AMC/CMC including Preventive maintenance.
 The Laboratory-In- charge shall maintain an updated record on AMC & Preventive maintenance
in equipment register.
 Preventive maintenance shall be carried out as per Maintenance Schedule for each individual
equipment based on manufacturer‘s recommendations.
 Maintenance / Service report shall be obtained from service agency and after verification marked
as O.K.
Any measuring equipment or device needs to be tested and checked for its accuracy and calibrated
whenever the need arises.

Calibration -

 Is extremely important in achieving quality control of the highest standard in medical


equipment.
 Is done with the help of specialized testing and calibrating equipment.
 Should be done at least once a year
 State Policy is that Calibration will be done by Eastern Regional Test laboratory ERTL, a
Government of India Concern with office headquarters at Kolkata.
 Should be done for almost the entire range of medical equipments available in ward which are
measuring instruments.

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 Should be concluded by documenting the test results and issuing a calibration report.

What information is recorded in Request form at laboratory?

 Name and identification number of patient,


 Name of authorized requester,
 Type of primary sample,
 Examination requested,
 Date and time of primary sample collection
 Date and time of receipt of sample by laboratory
 Any other as per the hospital policy and guidelines

What is EQAS?

The External Quality Assurance Services (EQAS) programs include specimen packs and
documentation (reports); results are compared to other laboratories using the same
methodologies, instruments, and reagents. EQAS is a system through which laboratories can
assess and improve the reliability and precision of their test results by comparing their
performance with other laboratories.

ABOUT CMC-EQAS :

The attainment of quality service in a laboratory requires a comprehensive Quality Assurance


Program which includes both Internal and External quality control material.

The Department of Clinical Biochemistry, Christian Medical College, Vellore under the banner
of The Association of Clinical Biochemists of India (ACBI) is conducting an External Quality
Assessment Scheme (EQAS) since 1978. The Participants represents all the states of India and
also Andaman and Nepal. The participating laboratories include teaching and non-teaching
hospital laboratories, government as well as private, small hospitals, private clinics and
diagnostic centers.

It is a twelve month program starting from January to December every year. Those who wish to
enroll their laboratories during the middle of a cycle can do so by paying the same registration
fee, but those labs who report results for at least six months alone are eligible for the
participation certificates at the end of the cycle.

The basic operation involves preparation of a master pool of human serum as per WHO
recommended procedure, dispensing the correct volume into the vials and lyophilization.
Homogeneity and stability checks are done as per the ISO 13528:2015 standards. The

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lyophilysed vials are sealed, well packed in thick envelops and distributed through courier
service or postal service to all the participating laboratories.

Dispatch of samples is done once in four months, during the 3 of April, August and December.
The laboratories are requested to reconstitute the correct sample, analyse and enter the results in
the web site before the 20th of every month. Any amendments can be made only till the 25th of
the month and it should be sent through an e mail only clearly mentioning the lab number and
reason for amendment. Once the report is published on the net, no amendment can be made.
Evaluation of the report is based on WHO and ISO 13528:2015 recommend expressions such as
Robust mean for the assigned value and SDI (Z score) for individual parameters. Details on
monthly report and the statistical tools are available on the monthly summary page. Evaluated
monthly report is uploaded into the net by 1st Week of the succeeding month.

Each laboratory is assigned a lab number and they are requested to secure the pass word. The
participants are requested not to share or discuss their results with other laboratories before the
release of report on to the web site of CMC vellore. After the completion of the cycle the
yearly summary is updated into the web site for individual labs and certificates are sent to the
eligible laboratories.

The CMC-EQAS providers maintain confidentiality of the participants‘ demographics, results,


reports or any other information provided by them. The EQA program has created awareness
among participants and proved to be a valuable exercise and the numbers of laboratories are
steadily increasing every year.

Why EQAS of Laboratory is needed?

External Quality Assessment Scheme (EQAS) for laboratories is needed for several important
reasons:

1. Quality Assurance: EQAS is a critical component of quality assurance in laboratory testing.


It helps ensure that the results generated by a laboratory are accurate and reliable, which is
essential for making informed clinical or diagnostic decisions.
2. Error Detection: EQAS helps identify errors, inconsistencies, or inaccuracies in laboratory
testing procedures. By comparing a laboratory's results to known reference values, any
discrepancies can be detected and addressed.
3. Improvement of Laboratory Performance: Participation in EQAS programs encourages
laboratories to continually improve their testing methods and maintain high standards. When

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discrepancies are identified, laboratories can take corrective actions to enhance their
performance.
4. Patient Safety: Inaccurate or unreliable test results can have serious consequences for patient
care. EQAS helps reduce the risk of misdiagnosis or incorrect treatment by ensuring that
laboratories produce trustworthy results.
5. Inter-laboratory Comparison: EQAS allows laboratories to compare their performance with
other laboratories, both nationally and internationally. This fosters healthy competition and
drives laboratories to meet or exceed established quality standards.
6. Regulatory Compliance: As per NQAS guideline, require laboratories to participate in
EQAS programs as part of their quality assurance and compliance measures.
7. Standardization and Harmonization: EQAS can contribute to the standardization and
harmonization of laboratory tests and methods, which is crucial for consistency and
comparability of results across different laboratories and regions.

What are the Importance of Internal Quality Assurance System" (IQAS) in Laboratory?

The Internal Quality Assurance System (IQAS) in a laboratory is of paramount importance for
several reasons:

1. Consistency and Reliability: IQAS ensures that laboratory testing procedures are consistent
and reliable over time. This consistency is crucial for producing accurate and dependable test
results.
2. Error Detection and Correction: IQAS allows for the early detection of errors and
inconsistencies in laboratory processes. When issues are identified, corrective actions can be
taken promptly to prevent inaccurate results from being reported.
3. Compliance with Standards: An effective IQAS helps laboratories adhere to international,
national, and industry-specific standards and regulations. This is essential for maintaining the
quality and legality of laboratory services.
4. Efficiency and Productivity: Through regular monitoring and process improvement, IQAS
can lead to more efficient laboratory operations. This can reduce the likelihood of retesting
and other resource-intensive activities.
5. Professional Development: IQAS typically includes training and continuing education for
laboratory staff, ensuring that they are well-trained, up-to-date with best practices, and
capable of performing their duties competently.
6. Documentation and Traceability: IQAS involves maintaining comprehensive records of all
laboratory activities, ensuring that there is a clear and traceable history of each test and result.
This documentation is valuable for auditing and traceability purposes.

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7. Continuous Improvement: IQAS fosters a culture of continuous improvement within the
laboratory. It encourages staff to regularly review processes, adopt best practices, and
innovate when necessary, leading to higher quality testing procedures.
8. Enhanced Reputation: A laboratory with a strong IQAS is likely to have a good reputation
and be trusted by healthcare providers, patients, and regulatory agencies. Trust is critical in
healthcare, and an IQAS contributes to maintaining that trust.
9. Data Integrity: In an age where data is increasingly relied upon for diagnosis and treatment,
IQAS ensures the integrity of the data generated by the laboratory, minimizing the risk of data
errors or manipulation.

How critical reference values and procedure for immediate reporting of results are maintained?

 Laboratory shall have established Biological reference interval for examination of various results
and identified critical intervals for which immediate notification is needed. This shall be made
available in the laboratory and displayed prominently in the workbench area.
 All laboratory tests results, which are so far from the reference range that they indicate a
potentially dangerous condition requiring immediate attention, shall be intimated to the concerned
consultant within 30 min of knowledge of the test result.
 The result shall also be informed to the ward nurse in case of an inpatient.
 In the case of an outpatient, the result shall also be intimated to the patient directly through
available telephone or mobile number.
 The technician reporting the critical test result must record and then read back the critical test
result, in its entirety, to the individual accepting the result.
 The laboratory shall maintain a critical result reporting register to record the communication of all
critical results; it should record the signature of the individual receiving the report and reporter of
the test result, details of result & time of reporting.
 The laboratory should also maintain a display of critical test values in the laboratory testing area
and a copy of it provided at all nursing stations.

What procedure for validation of results of reagents, stains, media and kits etc. wherever required
are maintained in Laboratory?

1. Quality of newly purchased reagents should be validated against suitable control/reference


material prior to use. Validation data should be properly documented. In-house prepared reagents
should also be checked periodically for stability and a record of the same should be maintained.

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2. Full validation is required when there is no suitable performance specification available, for
example, with novel tests or technologies. This process involves assessing the performance of the
test in comparison with a 'gold standard' or reference test that is capable of assigning the sample
status without error (ie, a test that gives 'true' results). In simple terms, validation can be seen as a
process to determine whether we are 'performing the correct test'. In the field of medical genetics,
with the almost complete absence of reference tests or certified reference materials, the reference
should be the most reliable diagnostic method available. It is worth noting that the gold standard
does not have to comprise results from a single methodology; different techniques could be used
for different samples and in some cases the true result may represent a combination of results
from a portfolio of different tests. To avoid introducing bias, the method under validation must
not, of course, be included in this portfolio.

Validation data can be used to assess the accuracy of either the technology (eg, sequencing for
mutation detection) or the specific test (eg, sequencing for mutation detection in
the BRCA1 gene). Generally, the generic validation of a novel technology should be performed
on a larger scale, ideally in multiple laboratories (inter-laboratory validation), and include a
much more comprehensive investigation of the critical parameters relevant to the specific
technology to provide the highest chance of detecting sources of variation and interference.

What are Biological reference interval and its importance for its examination of various Laboratory
results?

Biological reference intervals, also known as reference ranges or reference values, are the ranges of
normal values for various laboratory tests and measurements in a healthy population. These intervals
provide a basis for comparing an individual's test results to the expected range for a specific analyte
(substance or component being measured). The reference intervals help healthcare professionals
assess whether a patient's results fall within the expected range, which can be important for
diagnosing and monitoring various medical conditions. These intervals provide a frame of reference
for healthcare professionals to assess and interpret individual patient test results. Biological reference
intervals can vary depending on factors such as age, sex, geographic location, and the specific testing
methods used by a laboratory. They are typically established through extensive testing of a large
sample of healthy individuals.

The importance of biological reference intervals in the examination of various laboratory results is as
follows:

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1. Clinical Decision-Making: Biological reference intervals serve as a crucial tool for
healthcare providers when interpreting laboratory results. By comparing an individual's test
values to the established reference intervals, healthcare professionals can quickly identify
whether a result falls within the expected range or deviates from it.
2. Diagnostic Criteria: Reference intervals are often used as diagnostic criteria. Results falling
outside these intervals may indicate an abnormality, prompting further investigation or the
initiation of specific medical interventions.
3. Patient Health Assessment: Healthcare professionals use reference intervals to assess a
patient's overall health. Deviations from reference values can signal potential health issues or
conditions that need attention.
4. Monitoring Disease Progression: Reference intervals are used to monitor the progression of
diseases or conditions. For patients with known medical conditions, changes in test results
over time can indicate how the disease is evolving or how well treatment is working.
5. Individualized Care: Biological reference intervals can be customized for specific patient
populations, such as different age groups, genders, and geographic regions. This
personalization ensures that the reference intervals are relevant to the specific group being
assessed.
6. Preventive Medicine: Reference intervals play a role in preventive medicine. They help
identify early signs of disease or conditions that may not yet be causing symptoms. Detecting
issues at an early stage can facilitate early intervention and better health outcomes.
7. Quality Assurance: Laboratories use reference intervals to assess the accuracy and precision
of their testing procedures. Regular monitoring of results against reference intervals is part of
a laboratory's quality assurance program.
8. Research and Clinical Studies: Reference intervals are critical in research and clinical trials,
as they provide a standard for evaluating the results of experimental treatments and
interventions.
9. Health Screening Programs: Reference intervals are used in health screening programs,
such as cholesterol checks or glucose tests, to identify individuals at risk of certain health
conditions.
10. Communication with Patients: When healthcare providers discuss test results with patients,
reference intervals help explain the significance of the findings and why further evaluation or
treatment may be necessary.

It's important to note that while reference intervals are valuable, they are not absolute thresholds for
health or disease. Variability in the healthy population, as well as factors like age, gender, and
genetics, can lead to individual differences in test results. Therefore, healthcare professionals

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consider clinical context, medical history, and other factors when interpreting results and making
treatment decisions.

What is critical intervals in laboratory and why it is important in Laboratory ?

Critical intervals, also known as critical values or critical results, refer to laboratory test values that
are significantly outside the established reference intervals and have the potential to indicate a life-
threatening or clinically significant condition. These values typically fall outside the normal reference
range and are considered to be so abnormal that they require immediate attention from healthcare
providers. Critical intervals are essential in laboratory testing for the following reasons:

1. Patient Safety: Critical intervals serve as an important safety mechanism to identify results
that may pose an immediate risk to the patient's health. Identifying these values promptly can
be lifesaving.
2. Rapid Intervention: When a critical value is detected, it triggers an immediate response from
healthcare providers, ensuring that appropriate intervention or treatment is initiated without
delay.
3. Timely Communication: Laboratories are required to communicate critical values to the
responsible healthcare provider as soon as they are identified. This ensures that the healthcare
team is aware of the critical result and can take immediate action.
4. Reducing Medical Errors: Prompt identification and communication of critical values help
reduce the risk of medical errors, such as misdiagnosis or delayed treatment.
5. Patient-Centered Care: Critical values emphasize the importance of patient-centered care by
prioritizing the well-being of the individual. They ensure that the patient receives timely and
appropriate medical attention.
6. Clinical Decision-Making: Critical intervals play a vital role in clinical decision-making,
allowing healthcare providers to make informed decisions about the patient's care and
treatment plan.
7. Quality Assurance: Monitoring and addressing critical intervals are part of a laboratory's
quality assurance program, ensuring that testing procedures are accurate and reliable.
8. Legal and Regulatory Compliance: Many healthcare facilities and laboratories have policies
and procedures in place for handling critical intervals to comply with legal and regulatory
requirements.

Few Examples of critical values may include:

 Extremely high or low blood glucose levels.

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 Extremely high or low levels of electrolytes (e.g., potassium, sodium, calcium).
 Hemoglobin or hematocrit levels indicating severe anemia.
 Critical values for coagulation tests, such as a prolonged prothrombin time (PT) or activated
partial thromboplastin time (APTT), indicating a risk of severe bleeding or clotting disorders.
 Abnormal blood gas values, indicating respiratory or metabolic issues.
 Positive blood culture results indicating a serious infection.

How Samples of medico legal cases are identified?

Requisition and reports are marked with MLC and reports are handed over to authorized personnel
only. Any other activities should be as per hospital policy.

How External Quality Assurance Program implemented as per NTEP program?

**It should be done as per NTEP guidelines. As a general Onsite evaluation done Monthly Random
Blinded rechecking (RBRC) done Monthly

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Department:

Radiology

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How Privacy, Confidentiality and Dignity of patient is maintained in USG Department?

 USG department has provision of privacy while taking sonography


 X ray department must have provision of privacy while taking X ray
 Radiology staff will not discuss the lab result outside.
 Patient records should be kept in secured place beyond the access of general staff or visitors.
 Behaviour of the staff should be empathetic and courteous irrespective of caste, religion, gender
or socio-economical status.
 Confidentiality of patient‘s condition having social stigma should be safe guarded.

What are the procedure for handing over of patients during transfer to X-Ray department ?
 For radio diagnostic investigations of Inpatients, the ward staff nurse shall give a call or send
a call book via GDA? Scavenging staff to radiology department to give information about
sending the patient and ensure availability of required necessities before transfer.
 Safe transfer of the patient shall be ensured on trolley by the aaya/ward boy.
 The ward boy/aaya shall handover the patient & his/her records to the Radiology staff and
wait until the investigation is over, patient‘s attendant if available can also accompany the
patient during this interdepartmental transfer.
 The radiology staff shall view the test requisition details mentioned in the patient records and
document necessary details in the department master register.
 The patient shall then be taken towards the testing area for conduction of required diagnostic
investigation.
Following conduction of the required investigation, the patient shall be handed over to the ward
boy/aaya for safe transfer back to the ward.

What are the procedures for taking X ray in emergency conditions?

1. Before they are brought in, the department of radiology should be informed about emergency
room patients who require radiology services. Initial management must be administered to
any ER patient prior to any x-ray examination.
2. The technologist who receives the phone call for ―STAT‖ x-ray portable services should
endorse the request to another technologist assigned to do portable x-ray procedures (at Ward,
ICU, NICU, PICU, CCU and OR). The request form for such procedures should be received
by the department following the phone call.

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What are the statutory guidelines for registration of the Ultrasound scans machine for Antenatal
scan?

1. Ultrasound Machine Purchased will be registered with Health Department.


2. Form B will be issued by the health department after registration.
3. A Registration number will be allotted to the radiology department in form B.
4. Statutory requirements are as follows:
a. Certificate of Registration should be displayed in the ultrasound scan room.
b. Posters from the Health department (in local language) should be displayed in the
ultrasound scan room. Contents of the display are as follows: Sex determination is
ILLEGAL board should be displayed in English & local language in OPD and in the
department.
c. Scanned Patient details should be preserved as per guideline from the date of Scan.
d. PNDT act copy to be kept in the department.
e. Consent forms F & G should be taken from the Patient before doing Antenatal checkup.
f. Total number of Antenatal Scans done should be sent to the following every month on or
before 5th through Register post to the DMCHO /Dy CMOH- III office .
g. Xerox copy of the same should be filed and preserved in the department.

How Confidentiality of Reports is maintained?

Confidentiality of patients and their test reports are ensured through the following:

1. In the course of Performing work responsibilities all information with regard to patient, their
family, their physician and / or the hospital is kept confidential.
2. All the staff of the department are cautioned not to discuss any such information with others.
3. Personnel are expected and ensured to conduct themselves with professional dignity at all times.
4. Radiologist are the only persons authorized to inform reports to the doctors.

What is PCPNDT act?

The PCPNDT Act stands for the "Pre-Conception and Pre-Natal Diagnostic Techniques Act." It is a
law in India that was enacted in 1994 and amended in 2003 to address the issue of female feticide and
the declining sex ratio due to the misuse of diagnostic techniques for sex determination during
pregnancy. The PCPNDT Act aims to regulate and prohibit the misuse of pre-conception and pre-
natal diagnostic techniques for the purpose of sex determination, and to prevent the sex-selective
abortion of female fetuses. It sets out various provisions for the registration of diagnostic centers,

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penalties for non-compliance, and other measures to promote gender equality and prevent female
feticide.The act is part of efforts to address gender imbalance and promote the rights and well-being
of female children in India by discouraging the use of medical techniques to selectively abort female
fetuses.

What is E-LORA & AERB?

eLORA = E Licensing of radiation application

AERB = Atomic Energy Regulatory Board

All institutes having medical diagnostic, radiological equipments and X ray require license from
AERB.

Steps for obtaining ‗Licence‘ through e-LORA

Step 1: Register your institute with eLORA

Step 2: Declaration of x-ray equipment details with eLORA

Step 3: If declared x-ray equipment already has valid AERB Licence/Registration: Record Licence
details If declared x-ray equipment does not have valid AERB Licence/Registration: Obtain AERB
Licence for operation

Steps for Licensing

1. Go to AERB Website (www.aerb.gov.in)

2. Go to eLORA link

3. Register Institute:

a. Input all Institute details in the tab


b. Input employer details
c. Attach required documentations like voter ID card, Pan card of the institutional head
or employer.

After the above successful steps we will get a login id and a reference number of applications in the
valid pre given official email id.

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A. REGISTRATION AND DECLARATION OF EXISTING EQIPMENTS:

Pre Requisition of obtaining license

1. Availability of Qualified Radiological worker.


2. Availability of safety tools.
3. Layout of Shield details.
4. QA test report
5. Radiation Survey Report

1. Availability of Qualified Radiological worker:

Radiological worker can be of three types

1. Radiation Worker
2. Non Radiation Worker
3. Radiological Worker

For licensing of X ray equipment one radiology technician or operator and one Medical Officer is
essential (Name of Qualified Radiological worker can be added by add employee tab) TLD batch
serial number need to uploaded here.

For licensing of CT scan or Interventional Radiology (e.g. – C-Arm, Angiography e.t.c) it is


mandatory to have 01 RSO (Radiological Safety Officer). For being RSO any MO / qualified X ray
technician having 03 years experience is essential after registering as RP (Radiation Professional) in
eLORA website.
For CT Scan and IR licensing uploading reference number of RSO certificate is essential

[RSO approval : If the institution don‘t have a licensed RSO institution can apply for RSO approval
to the AERB website by providing employer name and proposed RSO name which shall be duly
signed by both with seal of the institution. RSO approval will be reviewed by AERB and after
acceptance notification will come to the eLORA account.]

2. Availability of Safety Tools:

Examples of safety tools are- Protective Aprons, protective Rubber Flaps, Protective barrier with
viewing window etc. Each should have proper lead lining as per the following –

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Protective Barrier – 1.5 mm lead lining
All doors or leaf doors – 2.00 mm of lead lining
Apron, Thyroid & Gonad Shield should have 0.25 mm of lead lining.

3. Layout of Shield details:

For X Ray, room size should be 450 x 400 cm .


All walls should be minimum 9 inch thick made of brick and single leaf door should be 2.00 mm of
lead lining.
Walls in front of the exposure should have 0.15 – 0.17 lead lining.

For CT Scan room size should be 400 x 625 cm


All walls should be minimum 9 inch thick made of brick and single leaf door should be 2.00 mm of
lead lining.
Walls in front of the exposure should have 0.15 – 0.21 lead lining.

4. Quality Assurance test report:

Quality Assurance test should be done for each radiological equipment from AERB authorised
agencies within every one or two year. The report should be duly signed and stamped by the
authority. During application scanned copy of the report need to be uploaded.

5. Radiation Survey Report:

Get Radiation survey report from the equipment supplier or from authorized AERB agencies.
Provide the values of maximum radiation level at different areas:

 Outside Door
 Behind Chest Shield
 Patient waiting area etc

During application scanned copy of the report need to be uploaded

After successful submission of the above tabs acknowledgement will come to the registered mail.

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B .REGISTRATION AND DECLARATION OF NEW EQIPMENTS:

1. After supply of new equipment, installation report from supplier need to be updated to the
AERB website.

2. After approval of the installation report by AERB license can be applied within 06 months
from the acceptance of installation report.

3. For application of new equipments three tabs needs to be filled.


a. Employee details - (Details of each qualified radiological worker.)
b. Safety tool details - (Details of lead apron, rubber flap, window shield etc.
c. General details - (Equipment related details, serial number etc.)

4. After this room layout details and Quality Assurance test report of the new equipment needs
to be uploaded.

5. Following this radiation survey report should be uploaded by the institution, where the
Radiation survey report of the equipment can be given by the supplier of the equipment or any
AERB authorized agency.

After successful submission of the above tabs acknowledgement will come to the registered mail.
** Always check Website for latest guidelines

AERB has no license fee for the entire process.

How the X-Ray department identifies vulnerable patients and ensure their safe care ?

As with any aspect of medical care, knowing that a patient is or could be pregnant is important
information.

Diagnostic x-ray studies that may involve direct radiation exposure of the developing embryo include
(a) x rays of the back (lumbar spine) for evaluating a lower back pain or a nerve route pain,

(b) Intravenous pyelogram (IVP) to examine kidney function,

(c) Upper GI series for evaluation of gastrointestinal symptoms,

(d) Lower GI series (barium enema) to examine the structure and function of the large intestine,

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(e) X-ray studies of bladder function,

(f) X-ray studies of the gallbladder and gallbladder function,

(g) X-ray studies of the structure and function of the uterus and tubes with the procedure known as a
hysterosalpingogram (HSP),

(h) X-ray studies of the pelvis and hips due to hip pain, and (i) standard abdominal x rays.

These studies may expose the embryo or the ovaries to radiation- and to be considered as
vulnerable.

What information is in Request form contain?

Request form contains information:

 Name and identification number of patient,


 Name of authorized requester,
 Examination requested,
 Type of X ray,
 Date and time of X ray taken and date and time of receipt of X ray from X ray
department

What are the process of taking and handling X ray ?

Diagnostic X-Ray Procedures

 Various types of diagnostic x-ray procedures are ordered for different reasons.

Before the Exam

 Most routine x-rays do not require patient to prepare for the exam.

 However, special studies, such as contrast radiography or barium enemas, will require patient to
follow special instructions from attending doctor.

 Patient may be asked to make dietary changes leading up to the time of exam.

 Patient may also be asked to leave your jewellery at home, along with other metal objects that
could interfere with the x-ray images.

 Patient may be asked to avoid using deodorants, body powders, or creams or the day of
appointment.

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 If patient has had a reaction to contrast medium in the past or if patient might be pregnant, as
exposure to radiation may produce birth defects- it must be known beforehand.

 If patient has questions about a health condition that could affect his/her exam, technologist or
radiologist must know that.

During the Exam-

 Once patient has changed into smock or gown, a technologist will escort him into the x-ray room
where he will stand, sit, or lie on a table that is near an x-ray machine. An apron or shield may be
placed over his body to protect sensitive organs during the exam. The machine will take several
x-rays, and patient may be asked to adjust his position during the test. It is important that he
remains still during each examination.

After the Exam

 Patient may be asked to wait until the radiologist reviews his images to be sure additional
images aren‘t needed.

 If patient ingested a contrast medium or barium, it is important that patient drinks plenty of liquid
over the 24-48 hours following your scan to help you pass the material.

The radiologist will review the images and send a report to doctor, who will notify patient of any
findings.

What id TLD badge ?

TLD stand for "Thermoluminescent Dosimeter." Thermoluminescent dosimeters are devices used in
radiology and radiation protection to measure and monitor the dose of ionizing radiation received by
individuals. These dosimeters can be worn as badges, typically on the person's clothing, and they
record the cumulative radiation exposure over time.

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Department:

Pharmacy

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How forecasting and indenting drugs and consumables are done?

 Forecasting of drugs and consumables shall be done scientifically based on past year‘s
consumption rate and disease load. If possible Pharmacist in charge may take similar 3 months of
the previous year‘s stock into account for calculation and forecasting of drugs.
 Pharmacist in-charge shall prepare list of items and materials to be indented after checking the
stock availability. This indent in proper format shall be forwarded to Superintendent for approval.
After approval from Superintendent the indent is forwarded to Store keeper of Main stores. Mai
stores places indents monthly to DRS on line in SMIS.
 A Goods Issue Note (GIN) must be issued on paper duly stamped and signed against each issue.
A copy of the same has to be handed over to the Indenting unit along with the physical items for
record.

How proper storage of drugs and consumables are done?

Storage of medicines:

 The priority is to ensure that the product integrity is maintained.

 Medications must be stored according to the manufacturer‘s recommendations, and monitored


appropriately. In the event where storage conditions fall outside of the recommended range as
specified by the manufacturer, the integrity and quality of the medication may become affected.

 The majority of medications only require storage at room temperature, which is typically below
25° C.

 Some other medications require refrigeration to ensure their viability and quality. These
temperature-sensitive products include pharmaceuticals, clinical trial medicines and vaccines
which require storage between +2° C and +8° C. The World Health Organization (WHO)
recommends that special refrigeration storage conditions are checked and monitored regularly
and that appropriate date is recorded for refrigerated medications to ensure storage conditions are
both preserved and within the allowable limits.

 Empty and filled cylinders are to be labelled and kept separately.


 There should be specified place to store medicines in Pharmacy and drug store.
 All the shelves/racks containing medicines are to be labelled in pharmacy and drug store.
 Product of similar name, LASA drugs and different strength are stored separately. Sound alike
and look alike medicines are stored separately in patient care area and pharmacy.
 Heavy items are stored at lower shelves/racks.

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 Fragile items are not to be stored at the edges of the shelves.
 There is separate shelf /rack for storage near expiry drugs.
 Drugs and consumables are stored away from water and sources of heat, direct sunlight etc.
 Drugs are not to be stored at floor and adjacent to wall.

How management of expiry and near expiry drugs are done ?

Dispensing counter should have system to check the expiry of drugs::

SMIS system is inbuilt to alert user about expiry drugs and dates of expiry by generating alerts.

1. It is the responsibility of the pharmacy department to check the validity and the expiration
date of drug products throughout the hospital.
2. Every product dispensed by the pharmacy shall carry an expiration date.
3. Drug label generated by the pharmacy department should carry the medication‘s expiry date.
4. The inpatient pharmacy has to keep the medications that will expire in the next 90 days in a
designated shelf for nearly expired medications to be labeled properly during dispensing.
5. Medications that are going to be expired within 3 months shall be marked in all medication
storage areas (inpatient, outpatient pharmacy and nursing units). These medications, which
will be expired within THREE (3) months, are to be arranged in separate shelves in the
pharmacy store.
6. Monthly inspections are regularly conducted in all pharmacy facilities and a monthly
inventory carried out for each nursing unit.
7. Medications stocked on patient care areas (floor stocks) are checked by nursing personnel,
and verified by a pharmacist on a monthly basis.
In case of presence of expired medication the pharmacist should make the proper documentation
and dispose of the expired medication in Bio Medical Waste Bin as per guideline. This bag
should be labeled with the name of the medication, expiry date, and quantity of the expired
medication.

How periodically replenishing the drugs in patient care areas are maintained?

In OPD Pharmacist in charge should always take stock of available medicines in Dispensary to avoid
stock outs. He/She will be informed about stock positions by Pharmacists in charge of Medicines in
Dispensary.

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If certain items are in short supply, hospital in charge has to be informed about the shortfall
immediately so that drugs are replenished before they are exhausted.

What is the Procedure for secure storage of narcotic and psychotropic drugs ?

Controlled drug substances like narcotics, and other potent drugs shall be stored in their designated
cupboard/drawer under double lock system. One key for the same shall be with the pharmacist and
the other with Store-In-charge.

Narcotic / psychotropic drugs will be released only on the signed requisition of the Doctor/MO.

What are the Process for identifying and cautious administration of high alert drugs?

High Alert Medications will be prescribed, dispensed, and administered using practices that are
proven safe. High Alert Medications should have ―HIGH ALERT MEDICATION‖ labels on storage
shelves, containers, product packages and loose vials or ampoules.

Examples of high alert labels:

2. High alert stickers for containers or product packages


3. High alert stickers for ampoules or vials
4. High Alert Medications to be dispensed to patients need not be labeled as high alert
5. High alert labels for storage shelves in pharmacy
6. High Alert Medications must be double checked before they are prepared, dispensed and
administered to the patients. A system shall be established whereby one health care provider
prepares the drug and another counterchecks it.
7. All High Alert Medications issued from the pharmacy must be counterchecked and verified
by another pharmacy staff prior to dispensing for the purpose of medication safety and
accuracy.
8. Any changes of brand/colour/preparation of High Alert Medications must be informed to the
users as soon as possible.
Strategies To Reduce ERRORS due TO HIGH ALERT DRUGS:

1) List of High Alert Medications within the facility shall be identified.

2) High Alert Medications should have HIGH ALERT MEDICATION label on storage shelves
and or loose vials/ ampoules.

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3) High Alert Medications should be kept in secure places with an IEC of maximum dosage of
each drug.

4) High Alert Medications should Not be prescribed in abbreviation or in short forms, and
should be prescribed in generic names with proper dosage, route & patient name.

5) High Alert Medications must be double checked before they are prepared, dispensed and
administered to the patients.

6) Verbal communications of medication order on high alert medication are Not Recommended
and in case of emergency it should be immediately rechecked via spelling of the drug for
verification and documented with signature of the doctor.

7) After administration of High Alert Medications proper medication record should be


maintained and patient need to be closely monitored.

8) After use stock of High Alert Medications should be properly updated and counter signed by
the authority.

What are LASA drugs?

LASA Stands for Look Alike and Sound Alike (LASA) Medicines:

Look Alike Sound Alike (LASA) medications are drugs that are visually similar in physical
appearance or packaging and/or names of medications that have spelling similarities or
similarity during pronunciation. Eg : Lora-zepam, Clona-zepam, Dopa-mine-Dobuta-mine

Strategies to avoid errors with LASA medications:

1) List of LASA drugs should be available at the facility

2) During Storage - Use Tall Man lettering to emphasize differences in medications with sound-
alike names. eg- DOPamine & DOBUTamine.

3) Use additional Warning labels for look-alike medicines.

4) Store LASA medication separately from LASA pair with proper labeling.

5) Prescription should clearly specify generic name of medication, dosage and complete
direction for use.

6) During dispending or drug administration - Identify medicines based on its name and strength
and double check.

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7) Ensure proper documentation.

What are the Procedures for maintaining, updating of patients’ clinical records and their storage?

General:

 Pharmacy records are labelled and indexed


 Pharmacy should have adequate facility for storage of records
 All notes and orders are dated and signed (include day, month, and year).
 All notes are legible and include clear, concise and pertinent patient information.
 Orders & registers & stock ledgers are authenticated and signatures mentioning name and
professional title of the author are there.
Storage ::

Completed Files are kept in the Storage area as per chronological registration numbers (i.e. Year-
Month-Registration No.) in master files that are labeled and numbered.

What is Inventory Management?

Inventory management refers to the process of overseeing, controlling, and optimizing a inventory of
drugs / equipments/ instruments / other goodsetc. It involves various activities related to acquiring,
storing, tracking, and managing inventory items in a way that ensures efficient operations and
optimal utilization of resources. Effective inventory management aims to strike a balance between
having enough stock to meet patient demand while minimizing excess inventory that ties up storage
space.

Definitions of some Key components of inventory management include:

 Inventory Tracking: Monitoring the movement of items as they enter and exit the inventory,
allowing maintaining accurate records of stock levels and changes.

 Demand Forecasting: Predicting future demand for inventory based on the previous three
months consumption or for any emergency situation to ensure that enough stock is available
to meet this demand without leading to overstocking or stock outs.

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 Reorder Point/ Level or Minimum Stock: Determining the minimum level of inventory at
which new orders should be placed to replenish stock before it runs out, considering lead
times and demand fluctuations.

 Lead Time: The time between placing an order and receiving the items is the lead time.
Hospitals consider this time when deciding when to indent.

 Buffer Stock: Maintaining a Safety Stock of extra inventory to account for unexpected spikes
in demand or delays in supply, preventing stock outs during unexpected situations, usually
25% extra from the average three months consumption.

 Economic Order Quantity (EOQ): Calculating the optimal order quantity that minimizes
the total cost of ordering and holding inventory, considering factors like order costs, carrying
costs, and demand.

 Just-in-Time (JIT) Inventory: A strategy that aims to minimize inventory by receiving


goods only when they are needed, reducing excess inventory and associated costs.

 Waste Reduction: Minimizing product waste and spoilage by managing expiration dates,
shelf life, and handling procedures.

What are FIFO, LIFO and FEFO Inventory Management?

FIFO, LIFO, and FEFO are different inventory management methods used to determine the order in
which inventory items are used. These methods have implications for, accounting, and overall
inventory management practices. Here's what each method entails:

1. FIFO (First-In, First-Out): FIFO is an inventory management method where the oldest
inventory items are assumed to be the ones used first. In other words, the items that enter the
inventory first are the ones that are also considered to be used first. This method is
conceptually similar to how goods move through a queue or line - the first item in is the first
one to be processed.

2. LIFO (Last-In, First-Out): LIFO is an inventory management method where the newest
inventory items are assumed to be used first. This means that the most recently acquired or
produced items are the ones attributed to sales or usage before older items.

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3. FEFO (First-Expire, First-Out): FEFO is a specialized inventory management method often
used in dealing with perishable goods or items with early expiration dates, such as food,
pharmaceuticals, and chemicals. In FEFO, the inventory with the earliest expiration date is
assumed to be used first to minimize wastage due to expiration.

What is ABC analysis?

ABC analysis, also known as the ABC classification or ABC method, is a widely used technique in
inventory management and optimization. It categorizes items in a given inventory into three groups
based on their relative importance, value, or impact on the overall performance of the system. This
technique helps to allocate their resources and efforts more effectively by focusing on the most
critical items.

In the context of a hospital's inventory management, ABC analysis can be applied to medical
supplies, medications, equipment, or other resources that the hospital needs to function efficiently.

Here's how it works:

 Group A (High Priority): This group includes items that have the highest value or impact on
the hospital's operations. These are typically high-cost items, critical medications, or supplies
that are needed for emergency situations. A relatively small number of items often account for
a significant portion of the inventory's value or usage.
 Group B (Medium Priority): This group contains items of moderate value or importance.
These items are necessary for routine operations but might not have the same criticality as
Group A items. They have a medium impact on the hospital's overall functioning.
 Group C (Low Priority): This group consists of items with the lowest value or importance.
These items are often numerous and inexpensive, but they still contribute to the smooth
functioning of the hospital. Examples might include office supplies or non-urgent medical
supplies.

The goal of the ABC analysis is to prioritize the management and control of items based on their
classification. Hospitals can use this information to:

 Ensure Availability: Group A items should always be available to prevent disruptions in


critical medical procedures or patient care.
 Optimize Inventory Levels: Group B items can be managed with moderate attention to
balance cost and availability.

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 Simplify Procurement and Storage: Group C items can be managed more loosely due to
their lower impact on operations.

By categorizing inventory items in this way, hospitals can make informed decisions about reorder
points, safety stock levels, procurement strategies, and storage space allocation.

What is VED analysis?

VED analysis is another technique used in inventory management, particularly in the context of
hospitals and healthcare facilities. VED stands for Vital, Essential, and Desirable, and it's a method of
categorizing items in an inventory based on their criticality to the healthcare operations. This analysis
helps hospitals ensure the availability of essential items and manage their inventory more effectively.

 Vital Items (V): These are items that are absolutely essential for the hospital's operations and
patient care. These items are crucial for saving lives and providing critical medical
interventions. Examples might include life-saving medications, specialized medical
equipment for emergency situations, and supplies needed for intensive care units etc.
 Essential Items (E): Essential items are important for the hospital's routine functioning and
patient care. While they might not be immediately life-saving, they are necessary for various
medical procedures and treatments. Examples could include common medications, general
antibiotics, standard medical equipment, and supplies needed for regular patient care etc.
 Desirable Items (D): Desirable items are those that enhance the comfort and convenience of
patients and staff but are not critical for medical care. These items can include supportive
medical supplies, Vitamins or antioxidants, amenities for patient rooms, and administrative
supplies etc.

Here's how VED analysis benefits hospital inventory management:

 Priority Management: Hospitals can focus their attention and resources on ensuring the
availability of vital and essential items, minimizing the risk of running out of critical supplies.
 Resource Allocation: By categorizing items, hospitals can allocate resources more effectively,
making sure that the most crucial needs are met first.
 Inventory Optimization: The analysis can guide inventory replenishment strategies, reorder
points, and stock levels for different categories of items.
 Risk Mitigation: Hospitals can identify potential risks associated with the scarcity of vital
items and develop contingency plans to address such situations.

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VED analysis should be regularly reviewed and updated to accommodate changes in hospital
operations and medical practices.

How Inventory Demand Forecasting are done in hospitals?

 Historical Data Analysis: This method involves analyzing historical consumption data
to identify patterns and trends. Hospitals can use past usage data (eg; of last three
months) for specific items to predict future demand.

 Seasonal and Cyclical Patterns: Some medical supplies and treatments might be
affected by seasonal or cyclical patterns. Hospitals can use historical data to identify
these patterns and adjust their inventory levels accordingly.

 Forecasting for Special Events: Hospitals can predict demand for specific items
related to special events, medical camps, health awareness campaigns, or community
health programs or any disaster events recently happened.

Definitions of some Key components of inventory management include:

 Inventory Tracking: Monitoring the movement of items as they enter and exit the inventory,
allowing maintaining accurate records of stock levels and changes.

 Demand Forecasting: Predicting future demand for inventory based on the previous three
months consumption or for any emergency situation to ensure that enough stock is available
to meet this demand without leading to overstocking or stock outs.

 Reorder Point/ Level: Determining the minimum level of inventory at which new orders
should be placed to replenish stock before it runs out, considering lead times and demand
fluctuations.

 Lead Time: The time between placing an order and receiving the items is the lead time.
Hospitals consider this time when deciding when to indent.

 Buffer Stock: Maintaining a Safety Stock of extra inventory to account for unexpected spikes
in demand or delays in supply, preventing stock outs during unexpected situations, usually
25% extra from the average three months consumption.

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 Economic Order Quantity (EOQ): Calculating the optimal order quantity that minimizes
the total cost of ordering and holding inventory, considering factors like order costs, carrying
costs, and demand.

 Just-in-Time (JIT) Inventory: A strategy that aims to minimize inventory by receiving


goods only when they are needed, reducing excess inventory and associated costs.

 Waste Reduction: Minimizing product waste and spoilage by managing expiration dates,
shelf life, and handling procedures.

What are the importance of rational use of drugs?

The rational use of drugs requires that the drug is prescribed for a particular patient after proper
diagnosis of a health problem. Prescriptions should promote the rational use of drugs. Rational use of
drugs requires that a particular patient with a specific health problem receives drugs according to the
following:

1. Appropriate dose,
2. Appropriate dosage form,
3. Appropriate route of administration,
4. Appropriate frequency of administration,
5. Appropriate duration of treatment,
6. Appropriate information to the patient, Adequate follow up

Importance of Rational use of Drugs are –

 Patient Safety: The primary goal of rational drug use is to ensure the safety and well-being of
patients. Using drugs inappropriately, whether through misuse, overuse, or underuse, can lead to
adverse reactions, treatment failures, and harm to patients.

 Effective Treatment: Rational drug use ensures that patients receive the right medication at the
right dose for the right duration. This maximizes the effectiveness of treatment, leading to better
outcomes and quicker recovery.

 Preventing Antimicrobial Resistance: Inappropriate use of antibiotics and other antimicrobial


drugs can contribute to the development of antimicrobial resistance. Rational drug use is crucial in

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preventing the emergence of drug-resistant pathogens, which can have devastating consequences for
public health.

 Cost-Effective Healthcare: Rational drug use can help control healthcare costs. It avoids
unnecessary or ineffective treatments, reducing the financial burden on healthcare systems and
patients.

 Minimizing Side Effects: Proper drug use reduces the risk of adverse side effects. Unnecessary or
incorrect drug use can lead to side effects and complications, further burdening the healthcare system.

What do you mean by the Bincard Method system used in pharmacy ?

The Bincard method is a system used in pharmacy and inventory management to keep track of the
quantity and status of items in stock. It is a manual system, primarily used for managing the
inventory of pharmaceuticals and other products in a pharmacy or a healthcare setting. The Bincard
system is designed to provide a real-time record of stock levels, making it easier to reorder items as
needed and maintain accurate inventory control.

Here's how the Bincard method typically works:

1. Bin Cards: Each item in the pharmacy's inventory has its own dedicated bin card. A bin card
is a record that is kept in a designated location (the bin) where the product is stored. The bin
card includes information such as the product's name, description, stock quantity, date of
receipt, date of issue, and the balance on hand.
2. Recording Transactions: When new stock is received, the pharmacist or inventory manager
updates the bin card for that product by recording the quantity received and the date. When a
product is dispensed to a patient or used in some way, the quantity issued is recorded on the
bin card, along with the date.
3. Balance Calculation: The balance on hand is continuously updated by subtracting the
quantity issued from the quantity received. This calculation provides an up-to-date record of
how much of each product is currently in stock.
4. Reordering: The Bincard system helps in determining when to reorder products. When the
balance on hand reaches a predetermined minimum level (the reorder point), it signals that it's
time to place an order to replenish the stock.

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5. Inventory Control: By maintaining accurate bin cards and using the information to reorder
products as needed, the Bincard system helps pharmacies and healthcare facilities to control
inventory efficiently, reduce the risk of stockouts, and avoid overstocking.

The Bincard Method is often used in conjunction with other inventory management systems to
ensure the efficient and accurate tracking of pharmaceuticals and medical supplies.

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Department:

Auxiliary Services

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How defined diet schedule for the patients are maintained?

Diet schedule should be maintained as per the latest hospital policy and G.O. Over all the process
may be - The daily diet menu will be prepared by the competent authority of ward and will be handed
over to the diet contractor for compliance. The amounts as prescribed in the diet scale are to be used
as raw materials for preparation of the cooked meals as per menu. The health facility is at liberty to
make alterations in the diet menu while adhering to the raw materials in the prescribed diet scale if
advised by the doctor. The scales are to be displayed as signage in every ward. Hospitals should have
a provision of special diets for needy patients after consulting with the doctor.

What are the standard procedures for preparation, handling, storage and distribution of diets, as
per requirement of patients?

The system of cooked food supply for indoor patients has been outsourced to agency selected through
competitive bidding process. The preparation, handling, storage and distribution of diets should be
done as per the hospital policy. But as a general following may be useful.

1. The deployed staff of kitchen shall collect indents/diet requisitions from the wards at
scheduled times from Dietician/ Sister-in-Charge of Ward/ appropriate authority of health
facility.
2. They shall prepare and cook the food items as per the indents/ requisitions.
3. They shall provide clean drinking water and cooked food to patients in the wards at scheduled
times. They shall wash their hands with soap before cooking food, peeling/ cutting vegetables,
serving diet to patients etc.
4. They shall clean the tables, furniture and fixtures, floor and work area of the kitchen as well
as all pantry areas of the wards before serving meals and after patients finish consuming
meals.
5. They shall clean dishes in which the meals are served with clean hot water and eco-friendly
branded dish washing powder/ soap/ liquid before and after serving of meals. The dishes
should be served to patients in clean condition after hygienic transport from the kitchen/ wash
area to the wards.
6. The deployed staff shall collect food-waste from wards after patients finish consuming the
meals and dispose the same along with kitchen waste. They shall collect the food-waste while
they collect the used dishes from wards.
7. They shall dispose the food-wastes from wards and the kitchen-waste in black plastic garbage
bags at the place and in mode as per instruction of competent authority of health facility.

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8. The staff supplying food to the patients should be literate and be able to read and act upon diet
order/ requisition slips.
9. Dietary department has system to calculate the number of diets to be prepared-
a. The nursing personnel of indoor wards calculate the dietary
b. requirement of the patient in the
c. diet requisition form prescribed by the State Govt. and sends it to the facility manager
who in turn makes a summary of requirements and sends it to the kitchen supervisor.
10. Dietary department has procedure for procurement of perishable and non perishable items
d. The agency supplies cooked food and thus procures perishable and non perishable
items from open market at his own cost.
11. Perishable items are stored in the cold room or refrigerators.Perishable items llike milk, cheese,
butter, egg, vegetables, and fruits shall be stored in refrigerators. In refrigerator keep Raw &
ready to eat food separate. Raw food should be kept on the lowest shelf in the fridge. All the
food containers shall be stored above floor level. A Stock register shall be maintained to record
the stock quantity available. A temperature monitoring device shall be used on the refrigerator
and temperature shall be recorded daily on a daily temperature monitoring checklist. The freezer
unit should be defrosted regularly.
12. Non perishable items are kept in racks/ storage container, in ventilated and rodent proof room-
Non perishable items like grains, pulses shall be contained in clean air tight containers and kept
on racks in ventilated and rodent proof room
13. Food is prepared by trained staff, ensuring standards practices
14. Distribution of the diet shall be made in presence of nursing personnel as per diet requisitions
furnished.
15. Distribution of the food is done in covered food trolleys- After preparation of the food, it shall
be shifted into the designated vessels of the food trolley with all necessary precautions to
maintain hygiene. Food shall be transported from kitchen to the ward in covered vessels only.
The diet delivery personnel/steward shall proceed with the food trolleys and the diet List
towards each ward for service. The diet delivery personnel/steward shall always use gloves and
clean ladles for serving food to patients Food shall be served to patients in clean plates and
bowls provided by the hospital. After serving the diet delivery personnel/steward shall take
acknowledgement signature on the diet slip/diet register for diet supplied from the Nurse-In
charge /staff nurse of the ward. Foods prepared to be served at a later time are cooked, chilled,
and reheated at appropriate temperatures to prevent contamination or microbial growth.
16. Dietary department has system to check the quality of food provided to patient
17. Dietary department has procedure to collect and dispose of kitchen garbage at defined interval
and place-

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e. The deployed staff shall collect food-waste from wards after patients finish consuming
the meals and dispose the same along with kitchen waste. They shall collect the food-
waste while they collect the used dishes from wards.
f. They shall dispose the food-wastes from wards and the kitchen-waste in black plastic
garbage bags at the place and in mode as per instruction of competent authority of
health facility.
18. There is practice of calculating and maintaining buffer stock in Kitchen
19. Department maintains stock and expenditure register in Kitchen
20. There is system to replenish raw food material

How Linen department perform periodic physical verification of linen inventory ?

Laundry activities are operated through contracted service provider, whose staff cleans the hospital
linen.

The service provider serves as per the guidelines laid in the contract. Hospital. Management is
responsible to handle & manage contractors and maintain a copy of their contract for reference &
records. Linen keeper/s maintain/s stock register s of all sorts of linen items to be used in the hospital.

a) Linen department has separate trolley for distribution of clean linen and collection of dirty
linen. Linen department maintains separate trolleys for distribution of clean linen and
collection of dirty linen.
b) All the linen is transported in closed leak proof bags, containers with lids or covered carts to
washing area. Infectious and non-infectious linen is transported separately.
c) Linen department has system of sorting of different category of linen before putting in to
washing machine.

Procedures for changing of linen in patient care areas-

1. Bed linens will be changed every day, and/or whenever bed linen is soiled.

2. All torn or stained linen is to be placed in the mesh bag located near the dirty linen carts or
chutes. Linens are not to be thrown into trash or other bags.

3. Upon discharge, any linen left in a patient room should be placed in the dirty linen bag for
reprocessing.

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CLASSIFICATION OF LINEN

TRANSPORTATION OF LINEN

Linen collected from different areas of the hospital needs to be transported in the covered
trolleys to the laundry

• Dirty and soiled linen needs to be transported in separate trolleys (YELLOW for soiled linen,
GREEN for dirty linen)

• A dedicated trolley for transportation of linen needs to be used and trolleys used for waste
collection or any other purpose should not be used for transportation of linen

• During transportation it is to be ensured that the bags used for collection of linen are properly
tied

• In case of any spillage of the soiled linen during transport, the linen needs to be securely placed
in the transportation trolley and cleaning of the surface is undertaken as per the spill
management protocol of the hospital.

To minimize aerosolisation of any organisms contaminating linen, linen should not be rinsed,
shaken or sorted in the clinical area. The personnel should keep his/her hands away from face
while handling linen

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•The collected linen needs to be stored at a designated place i.e. in dirty utility of the area of
generation.

What is ICD coding for Medical Records department and what is the importance?

ICD, or the International Classification of Diseases, is a system of medical coding that is widely used
in medical records departments and healthcare settings around the world. The current version is ICD-
10, but there is also ICD-11, which is under development. These coding systems are used for several
purposes in the medical records department:

1. Diagnosis Coding: ICD codes are used to represent specific medical diagnoses. When a
patient is diagnosed with a medical condition, the healthcare provider assigns an appropriate
ICD code to that diagnosis. This coding is essential for tracking and documenting a patient's
medical history and conditions.
2. Procedure Coding: In addition to diagnosis coding, there is a related system known as ICD-
10-PCS (Procedural Coding System), which is used to code medical procedures. This is
particularly important in hospital settings, where it is used to code surgeries, medical
treatments, and other procedures performed on patients.
3. Billing and Reimbursement: ICD codes play a crucial role in the billing and reimbursement
process. Health insurance companies and government healthcare programs use these codes to
determine the medical necessity of services and to process claims for healthcare services
rendered. Accurate coding is vital to ensure proper reimbursement.
4. Epidemiology and Public Health: ICD codes are used for public health surveillance and
epidemiological studies. They help track the prevalence of diseases and conditions within
populations and enable the monitoring of disease trends.
5. Medical Research: Researchers use ICD codes to study disease patterns, outcomes, and
treatment efficacy. These codes make it easier to conduct large-scale healthcare studies and
clinical trials.
6. Health Information Management: In the medical records department, health information
management professionals are responsible for maintaining accurate patient records. ICD
coding is a fundamental aspect of this process, ensuring that records are complete and
standardized for easy retrieval and analysis.
7. Quality Improvement: ICD codes can be used to assess the quality of healthcare services
provided. By tracking outcomes and the incidence of particular diseases or conditions,
healthcare facilities can identify areas for improvement in patient care.

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8. Administrative Functions: ICD coding is used for administrative purposes, such as tracking
resource utilization, reporting to regulatory bodies, and maintaining compliance with
healthcare regulations.

The most widely used version is ICD-10, but ICD-11 has been developed and is gradually being
adopted.

ICD codes used in medical records departments typically fall into the following categories:

1. ICD-10-CM (Clinical Modification): This is the version of ICD-10 used in the United
States. It provides additional detail, specificity, and clinical context to ICD-10 codes, making
it more suitable for billing, insurance claims, and medical record-keeping.
2. ICD-10-PCS (Procedural Coding System): ICD-10-PCS is used for coding medical
procedures and interventions. It includes specific codes for surgeries and other medical
procedures performed in healthcare settings.
3. ICD-11: ICD-11 is the latest version of the ICD, which was released by the World Health
Organization. It offers an updated and more comprehensive coding system to reflect advances
in medical knowledge and changes in healthcare practices.

The main purpose of ICD coding in the medical records department, as per WHO guidelines, is to:

 Accurately record and classify diagnoses and health conditions of patients.


 Enable international comparability of health statistics and data.
 Support healthcare providers, researchers, and policymakers in monitoring and understanding
disease patterns and trends.
 Facilitate the exchange of health information between healthcare systems and providers.
 Assist in the billing and reimbursement process, as well as healthcare management and
quality improvement initiatives.

ICD coding is a standardized system that plays a crucial role in medical records departments by
enabling the accurate and systematic recording of patient diagnoses, procedures, and other healthcare
information. This coding system is essential for patient care, billing, research, and healthcare
management.

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What are the procedure for issuing of the records by the Medical Records Department ?

The Medical Record in-charge shall issue photocopies of concerned patient‘s records on request from
the patient / authorized representative on receipt of a written requisition slip for the same duly
approved and signed by the RMO / doctor. The issue is recorded in the Issue Register
Treating doctors can access the Medical Record of the patient as and when required only after written
permission from RMO / doctor and a separate register is maintained for issuing it.
The Medical Record in-charge issues the photocopies of Medico Legal Case medical records to
police personnel on receipt of a written requisition slip duly approved and signed by hospital in
charge.

Medical record storage & retrieval


 Medical Record Clerk shall enter the details of received Medical Records in Record Receiving
Register. Separate register is maintained for ‗MLC‘ and non ‗MLC‘ records.
 Medico Legal Case Records shall be stored in almirah under lock and key. All the Medico Legal
Case records have a ‗MLC‘ seal on it.
 Non Medico Legal Case Records shall be stored on racks in chronological order.
 Birth log book comes from Labor Room and entry shall be made in birth report and sent to
municipality office.
 Medical Record clerk shall make death report from Death Register and sends the report to
municipality office.

Medical-record Security and confidentiality


All medical records of death cases and Medico Legal Cases shall be maintained in lock and key at
Medical Record Room.

Destruction of medical records


On completion of the retention period (as per G.O) the Medical records shall be destroyed by
shredding with prior written permission from CMOH / MSVP or higher official from State
Headquarter.

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Department:

NBSU (CHC)

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How NBSU has a system to control temperature and humidity?

Temperature inside main NBSU should be maintained at (22-26OC), round the clock preferably
by thermostatic control. Relative humidity of 30-60% should be maintained

What are the procedures to check the temperature of radiant warmer, phototherapy units in NBSU?

Each equipment used should have servo controlled devices for heat control with cut off to limit
increase in temperature of radiant warmers beyond a certain temperature or warning mechanism
for sounding alert/alarm when temp increases beyond certain limits

How NBSU has system to control the sound producing activities and gadgets ?

Background sound should not be more than 45 db and peak intensity should not be more than
80db.

How Initial assessment of all new-born's is done like Silverman Anderson Score?

Silverman-Anderson Score: The Silverman-Anderson Score, also known as the Silverman


Score or Silverman-Anderson Respiratory Distress Score, is a clinical assessment tool used to
evaluate the respiratory distress and overall respiratory status of newborn infants, especially
those born prematurely. This score helps healthcare providers determine the severity of
respiratory distress in neonates and guide appropriate interventions. The Silverman-Anderson
Score assesses various clinical signs related to respiratory function.

The scoring system typically includes the following components:

1. Nasal Flaring: The presence or absence of flaring of the nostrils when the infant breathes.
2. Grunting: The presence or absence of audible grunting sounds during expiration.
3. Retractions: Assessment of chest wall retractions (intercostal, subcostal, and sternal) during
inspiration.
4. Cyanosis: The presence or absence of bluish discoloration of the skin, especially around the
lips or extremities, indicating inadequate oxygenation.

Each component is scored on a scale from 0 to 2, with 0 indicating normal or no distress, and 2
indicating severe distress. The individual scores for each component are summed to obtain the overall
Silverman-Anderson Score. The higher the total score, the more severe the respiratory distress.

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The Silverman-Anderson Score is a valuable tool for clinicians, particularly in neonatal care units to
assess and monitor the respiratory status of newborns, identify those who may require respiratory
support, and guide treatment decisions. It is important to note that the scoring system may vary
slightly in different clinical settings, and it is often used in conjunction with other clinical
assessments and diagnostic tests to provide a comprehensive evaluation of a newborn's respiratory
condition.

What are the Criteria for admission in NBSU?

Please refer to FBNC manual page 21 Chart-3 in this regard.


General criteria -
 Birth weight < 1800g or gestation < 34 weeks
 Large baby (> 4.0 kg)
 Perinatal asphyxia
 Apnea or gasping
 Refusal to feed
 Respiratory distress(Rate > 60/minute or grunt/retractions)
 Severe jaundice (Appears > 24 hours/stains palms & soles/lasts > 2 weeks)
 Hypothermia < 35.40 C or hyperthermia > 37.50 C
 Central cyanosis
 Shock ( Cold periphery with CFT > 3 seconds and weak and fast pulse)
 Coma, convulsion, encephalopathy
 Abdominal distension
 Diarrhoea / Dysentery
 Bleeding
 Major malformations

For observation after delivery –


The following infants should be observed in the NBSU for at least 24 hours after delivery:
- Infants depressed at birth
- Meconium - stained infants
- Infants born after a traumatic delivery
- Infants of diabetic mother
- Infants small for gestational age, and / or < 2.4 kg
- Large for gestational Age > 4.0kg
- Infants born by emergency LSCS

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Immediate admission after delivery
The following infants are immediately admitted after delivery
- Infants severely depressed at birth, e.g. Apgar score less than or equal to five at five minutes.
- Any respiratory distress.
- Infants less than 34 weeks gestation or less than 1800g at birth or SGA.
- Infants with meconium aspiration.
- Infants with major or severe congenital anomalies (does not include, for e.g. Down Syndrome)

Admission from postnatal ward to NBSU


The following signs and symptoms signify a sick infant and should therefore be admitted from
postnatal ward after consulting with Medical officer.
- Delayed or persistent respiratory distress
- Apnoeic or cyanotic spells
- Abnormal behaviour or activity including recurrent vomiting, abdominal distention,
- Suspected sepsis
- Evidence of bleeding or excessively pale infants.
- Jaundice if it occurs before 24 hours of age or bilirubin is equal to or exceeds a level of 15
mg/dl before 48 hours or if considered to be in phototherapy range according to reference charts.
- Persistent hypothermia not responding to simple measures.
- Hypoglycaemia –severe / recurrent / non- responding to feeds alone.

What are the Procedure for ensuring timely and accurate nursing care as per treatment plan ?

To ensure timely and accurate nursing care as per treatment plan, documentation of all
treatments given must be recorded. Nurses should record data collected through all aspects of the
nursing process. As a general rule, any information that is clinically significant should be
documented. Nursing documentation should reflect information on the client‘s status at
discharge, any instructions provided (verbal and written), arrangements for follow-up care and
evidence of the clients understanding, and family involvement as appropriate.

How to ensure right medicine is given to right new-born?

The following particulars shall be independently double checked against the prescription or
medication chart at the bedside by two appropriate persons before administration:

• Patient‘s name and RN


• Name and strength of medications

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• Dose
• Route and rate (pump setting and line placements when necessary)
• Expiry date
• Avoid administration of High Alert Medications if prescribed verbally. In cases of
emergency, phone orders have to be repeated and verified as per the proper guideline.

What are the processes of Discharge of patient?

It should be decided by the Medical Officer based on clinical guidelines & G.O. On a general –
 Assessment of the patient is made on daily basis.
 Discharge slip is prepared by the M.O. and entry is made in the discharge register by ward in-
charge.
 Mother is briefed about post discharge care and hygiene, nutrition for self & Newborn, Exclusive
breastfeeding follow-up advice, keeping baby warm, complete immunization of newborn post-
partum visits, family planning and other advices as applicable. She is also counselled about the
danger signs that should be immediately reported to the hospital about herself and the child.

Discharge planning involves the following activities:


Development of a care plan for post discharge care.
Arranging for the provision of services, including patient/family education and referrals.
The Nurse in charge as well as the duty doctor shall be responsible for coordinating the
discharge with other team members.
The following criteria shall be met by baby for discharge
 Baby is able to maintain temperature without radiant warmer
 Baby is hemodynamically stable (normal CFT, strong peripheral pulses)
 Baby accepting breast feeds well
 Primary illness has resolved
 In addition to the above, mother should be confident of taking care of the baby at home.
The discharge summary shall contain the following information -
- Details of the patient including Hospital IP Number
- Date of admission and date of discharge
- Name of the doctor in charge of the case
- Patient history
- Reason for admission.
- Significant findings.
- Diagnosis

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- Investigation results.
- Details of any procedure performed.
- Medication.
- Other treatment given.
- Course in the hospital
- Follow up
a. Advice.
b. Medication
- Instructions regarding when and how to obtain urgent care
During discharge, the parents should be counseled on Medication intake, care at home, diet &
nutrition, any medical precautions & infection control measures and identifying symptoms requiring
immediate medical care.

What are the Emergency Signs of a baby in NBSU?

Newborns classified as ―Emergency‖ require urgent intervention and emergency measures. All
such newborns will be admitted to NBSU after initial stabilization.
 Hypothermia (temp <360 C)
 Apnea or Gasping respiration
 Severe respiratory distress (rate>70, severe retractions, grunt)
 Central cyanosis
 Shock (cold periphery, CFT> 3 secs, weak & fast pulse)
 Coma, convulsions or encephalopathy

Priority Signs (Assess and act rapidly) :

Newborns classified as ―Priority‖ are sick and need rapid assessment and admission to NBSU.
 Cold stress (temp 36.40C – 360C)
 Respiratory distress (rate>60, no retractions)
 Irritable / restless / jittery
 Abdominal distension
 Severe jaundice
 Severe pallor
 Bleeding from any sites
 Major congenital malformations

 Weight less than 1800 gm or more than 4 kg


** Always check latest clinical and Government Guideline in this regard.

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Department:

Blood Storage Unit


(CHC)

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How Facility maintains Privacy, Confidentiality and Dignity of patient in BSU ?

 BSU staff does not discuss any lab result outside.


 Patient records should be kept in secured place beyond the access of general staff or visitors.
 Behaviour of the staff should be empathetic and courteous irrespective of caste, religion, gender
or socio-economic status.
 Confidentiality of patient‘s condition having social stigma should be safe guarded.

What are the form and formats are available at point of use of BSU ?

All forms and formats required for BSU work must be indexed and their supply is to be ensured
throughout the year. Printed formats for requisition and reporting are to be made available.

The following Standard formats should be available-

 Format for requisition form,


 Blood transfusion reaction form,
 Referral slip

What are the Register/records are maintained as per guidelines in BSU?

 Each BSU and transfusion service should develop a practical record keeping system, which
serves its needs.
 The record system should make it possible to trace a unit of blood/component from source
(donor and collecting facility) to final destinations.
 The system should ensure confidentiality of donor and patient records
 Records should be legible and corrections should be initialled.
 Date of performance of procedures, tests and interpretation should be recorded.

Records include-

1. Daily Group Wise Stock Register,


2. Daily Temperature Recording Of Temperature Dependent Equipment,
3. Stock Register Of Consumables And Non Consumables,
4. Documents Of Proficiency Testing,
5. Records Of Equipment Maintenance,
6. Records Of Recipient,
7. Compatibility Records,
8. Transfusion Reaction Records And Donors Records Etc.

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What are the procedures for the Cross matching of blood in BSU?

It should be done as per the latest guideline. As a general following may be useful -

REPEAT TESTING OF DONOR BLOOD

The BSU performing cross matching should confirm ABO and Rh (D) group of all blood units using
a sample obtained from an attached segment.

TESTING OF RECIPIENT BLOOD

Determination of ABO type

ABO type should be determined by testing red cells with anti-A, anti-B, anti-AB sera and testing
serum or plasma for expected antibodies with fresh pooled A, B and O Cells (pool of 3 for each
group) using tube/ Microplate method/gel technology (manual or automated). Either monoclonal or
polyclonal antisera may be used.

Determination of Rh(D) type

The Rh(D) type should be determined with anti-D reagent from 2 different sources (Ref.D.2.0) by
tube/ microplate method/gel technology. If negative it should be labelled as 'Rh(D) negative'.

Test for detection of unexpected antibodies

Serum of the recipient should be tested for unexpected antibodies with pooled O Rh(D) positive cells
or screening red cell panel at room temperature by saline technique and at 370C by albumin/enzyme
as well as indirect anti-globulin test with proper controls (positive, negative and end point). If on
screening, antibody/ies are detected, the antibody/ies should be identified by red cell panel, if
possible. A control system using red blood cells sensitised by IgG, Anti-D must be used with anti-
globulin tests to detect false negatives.

CROSS-MATCH

A sample of donor cells from a segment attached to the bag and recipient serum or plasma should be
cross-matched. The method used should demonstrate ABO incompatibility and clinically significant
unexpected

complete and/or incomplete antibodies and should include an anti-globulin test. If there is no
previous record of presence of antibodies and if clinically significant antibodies are not detected
during antibody screening test, the anti-globulin cross-match should not be required. If clinically
significant antibody/ies are detected in recipient, blood lacking corresponding antigens on cells
should be cross-matched or by trial method the blood which is compatible should be issued. In

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certain clinical conditions, where auto antibodies are present, the least incompatible unit should be
issued.

Minor cross matching using donor's serum or plasma and recipient‘s cells should not be necessary as
tests for complete and incomplete unexpected antibodies in donor samples are mandatory.

**Always check for latest G.O / NACO guideline in this regard. The above statement is
only for reference.

What are the procedures for monitoring and reporting Transfusion complication in BSU?

DETECTION, REPORTING & EVALUATION

 Each BSU should have a system for detection, reporting and evaluation of suspected adverse
reaction to transfusion (Hemovigilance).
 In the event of suspected transfusion reaction, the personnel attending the patient should
notify immediately the responsible physician and transfusion service with necessary
documentation and appropriate samples.
 All suspected transfusion reactions should be evaluated promptly. The evaluation should not
delay proper clinical management of the patient.
 The details of all cases along with the interpretation of evaluation should be recorded and
reported to the transfusion committee.
 There should be a written protocol for the investigations of transfusion reactions.
 Reported cases of serious reactions should be evaluated.

IMMEDIATE COMPLICATION

 If there are symptoms or findings suggestive of a haemolytic transfusion reaction, transfusion


should be discontinued and the following must be done immediately and records maintained.
 The label on the blood container and all other records should be checked to detect if there has
been an error in identifying the patient or the blood unit.
 A post transfusion properly labelled blood sample, (avoiding haemolysis) should be obtained
from the patient and sent to transfusion service along with blood container and attached
transfusion set.
 The patient's post-reaction serum or plasma should be inspected for evidence of haemolysis,
comparing with pre-transfusion sample.

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 A direct anti-globulin test should be done on the post transfusion specimen and on pre
reaction sample for comparison.
 Based on evaluation of clinical findings, review of accuracy of records and results of
laboratory tests, additional tests should be done such as:
 Determination of ABO and Rh(D) types on pre and post reaction blood
sample from the patient and from the blood bag.
 Repeat tests for unexpected antibodies in donor and recipients‘ blood and repeat cross-match
using pre and post reaction blood samples of the patient and donor blood from the bag.
 Examination of post transfusion urine should be carried out for haemoglobin and its
metabolites.
 Determination of bilirubin concentration in serum should be obtained preferably 5 to 7 hours
after the transfusion.
 Supernatant plasma and remaining blood in the blood container as well as the post-reaction
sample of the patient should be tested for smear and culture.
 Expiry dated blood units should be tested periodically for bacteriological smear and culture. If
investigations are suggestive of a haemolytic reaction or bacterial contamination, patient's
physician should be informed immediately.

DELAYED COMPLICATIONS

 Weak antibodies in recipient's serum directed against antigen on the donors red blood cells
undetectable at the time of pre transfusion tests, may appear after a week and result in delayed
haemolysis or unexplained fall in haemoglobin. Appropriate tests should be done to detect the
cause of reaction. A record should be maintained in patient's medical file.
 Reported cases of suspected transfusion transmitted disease should be evaluated. If
confirmed, the involved blood unit must be identified in the report. Attempt should be made
to recall the donor for retesting and counselling. Other recipients who received components
from the suspected blood unit should also be investigated.
 All reported cases of unexplained acute liver dysfunction occurring between two weeks
to 6 months after the transfusion of blood or components should be investigated as
possible post transfusion hepatitis. The donor of the implicated unit should be informed,
counselled and permanently deferred.

****Always check for latest G.O / NACO guideline in this regard. The above statement is
only for reference.

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Department:

General Clinic
(UPHC)

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What advice Counseling and Information on sexual and reproductive health related issues are
given in UPHC ?

Advice on topic related to Growth and development, puberty, sexuality concern, myths &
misconception, pregnancy, safe sex, contraception, unsafe abortion, menstrual disorders,
anaemia, sexual abuse, RTI/STI's etc.

What are the Registration and consultation of patients is done in UPHC?

1. OPD tickets are generated from ticket generation counter and patient demographic details are
entered in the OPD ticket.
2. After the patient is registered, one unique registration number is generated at registration counter
and the patient is directed to the doctor for OPD consultation.
3. Separate system for registering old OPD patients will function for maintaining proper records of
total daily patients.

What is the Procedure for referral?

 When a patient in OPD is referred to other higher centre for the purpose of investigation/
management the following points must be observed.
 Referral is to be clearly written in OPD ticket mentioning the exact cause of referral along with
relevant history, findings of the patient and name of the referring Doctor.
 Referral linkage with higher tier centre is to be maintained
 There should be system for follow up of referred patient

What Promotive ARSH Services are provided in UPHC ?

The following services are available:

1. Counselling and provision of emergency &reversible contraceptive


2. Counselling on abuse & dependence on alcohol, drug, smoking & tobacco etc.
3. Counselling services for Menstrual hygiene
4. Information and advice on sexual and reproductive health related issues
5. Referral Services for early and safe termination of pregnancy and management of post abortion
complication
6. Availability of IEC material for AFHC : IEC for Nutrition, Sexual reproductive health, Mental
Health, Gender based violence, NCD & Substance abuse

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7. Services for Tetanus immunization
8. Services for Prophylaxis against Nutritional Anaemia & Nutrition Counselling (Haemoglobin
estimation, weekly IFA tablet, and treatment for worm infestation)
9. Treatment of Common RTI/STI's
10. Treatment and counselling for Menstrual disorders
11. Treatment and counselling for sexual concern for male and female adolescents
12. Management of sexual abuse amongst Girls
13. Management of malnourishment cases
14. Referral Linkages to ICTC and PPTCT
15. Referral services of Antenatal natal check up for pregnant adolescent : Nutritional
Counselling, Contraceptive counselling, Couple counselling ANC check-up, Ensuring
institutional delivery

What are the Information and advice on sexual and reproductive health related issues are given ?

Advice on topic related to Growth and development, puberty, sexuality concern, myths &
misconception, pregnancy, safe sex, contraception, unsafe abortion, menstrual disorders,
anaemia, sexual abuse, RTI/STI's etc.

How Patients are counselled for self drug administration?

Providing Medication calendars /schedules, time to take medications, medicine related


information sheets, specific packaging‘s such as pill boxes/ envelope, indicating the time/
frequency of dose.

What is High Alert drugs?

High alert drugs are medications that have been identified as having a higher risk of causing
significant harm or potentially fatal consequences if used incorrectly. These drugs require
special attention and precautions in their prescribing, preparation, dispensing, and administration
to minimize the risk of errors. High alert drugs are often associated with a higher risk of adverse
events due to factors such as narrow therapeutic indices (the difference between a therapeutic
dose and a toxic dose is small), complex dosing regimens, and potential for serious side effects.

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Department:

Maternity Health
(UPHC)

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How Antenatal Checkup are being conducted in UPHC ?

Registration and First ANC Visit-

Any pregnant women requiring services during antenatal period visit hospital is registered at
registration counter and OPD slip is issued to her.

• Pregnancy is confirmed by conducting urine examination using pregnancy test kit (Nischay)

• Last Menstrual Period (LMP) is recorded and Expected date of delivery (EED) is calculated
for pregnant woman.

• Pregnant Women‘s present and past history taken including any illness or complication during
present & previous pregnancy.

Mother & Child Protection Card-

 For each ANC registration a Mother & Child Health Card is issued to pregnant women.
 All the details including family identification, pregnancy records, institutional identification, next
due date of ANC visit, findings of ANC examination and investigations, post natal care, care of
baby, details of immunization, growth child etc. is recorded on this card at different stages of ante
and post natal care.
 Pregnant woman is instructed to bring this card at every subsequent visit to the hospital

Early registration & Minimum 4 ANC Check-up :

Schedule of Visit-

4 ANC visit of every registered pregnant woman is insured as per the following schedule

1st Visit- Within 12 Weeks

2nd Visit – Between 14- 26 Weeks

3rd Visit – Between 28 -34 Weeks

4th Visit – Between 36 Weeks and term.

If a women comes for registration later in her pregnancy, is also registered and care is provided.

Antenatal Checkup

 On each visit Patients history & complaints are taken and physical examination for weight, blood
pressure, respiratory rate, pallor, edema and citrus is done.

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 On each visit abdominal palpation for fetal growth, fetal lie and auscultation for fetal heart sound
and breast examination is done according to stage of pregnancy.
 Laboratory test for Hemoglobin, urine albumin & urine sugar is done on each visit.
 Tests for blood group and Rh factor, Syphilis (VDRL/RPR), HIV, blood sugar, malaria &
Hepatitis B are also done for each pregnant woman.
 Regular dose of folic acid is given 1st trimester onwards and Iron folic acid on subsequent
trimester for at least 100 days.
 First dose of tetanus toxoid injection (Inj. TT) is given as soon as possible after ANC
registration.
 A second dose given after one month from the 1st one.
 At each ANC visit pregnant women is counseled for nutritional requirements, recognizing
danger sign of labour, birth preparedness, breast feeding institutional delivery, arrangement of
referral transport, family planning etc.

What are the procedure for identification and management of anaemia ?

1. Line listing of pregnant women with moderate and severe anaemia is to be done and reported.
2. Anaemia is classified as :
 >11 gm% - absence of anaemia
 10 to 11 gm% - mild
 7 – 10 gm% - moderate anaemia
 <7 gm% severe anaemia

3. Prophylactic dosage of IFA – one tablet per day for six months during ANC & PNC.
4. Therapeutic dosage of IFA – two tablets per day for six months during ANC & PNC.
5. Line listing of severely anaemic women are maintained at the UPHC.

Staffs track and maintain record in the improvement in Haemoglobin level of anaemic woman in
subsequent ANC visit.

What are the procedures for Postnatal visits & counseling of Mother and Child ?

1. Mother is educated & counselled about danger signs during puerperium –


 Excessive PV bleeding,
 breathing difficulty,

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 convulsion,
 severe headache,
 abdominal pain,
 foul smelling lochia,
 urine dribbling,
 perineal pain,
 painful & redness of breast
2. Mother is educated & counselled about danger signs of baby –
 Poor sucking/feeding,
 abnormal cry,
 lethergy,
 failure to pass stool or urine,
 not feeding at all,
 purulent eye or chord discharge,
 yellow discoloration of eye,
 convulsions,
 fever or feel cold
 abdominal pain,
3. Mother is counselled/ Educated during postnatal visit -
 importance of keeping baby warm,
 proper positioning of baby to avoid suffocation,
 immunization,
 hand washing & personal hygiene & appropriate care of cord

At what interval Testing of PW for Gestational Diabetes Mellitus (GDM) are done as per protocols ?

Testing for GDM twice during ANC, 1st testing during first antenatal contact, 2nd testing 24-28
weeks even if 1st testing is negative. There should be 4week gap between 2 test & if she present
beyond 28 weeks -1 test

When Tetanus Toxoid (2 Dosages/ Booster) are been administered during ANC visits ?

TT1 (at the time of registration) and TT2 (one month after TT1) has been given to Primi gravida
& Booster dose for women getting pregnant within three years of previous pregnancy

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Department:

New Born & Child


Health (UPHC)

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What are the primary management of emergency signs are new born are taken care of ?

The management of emergency signs consist of –Resuscitation

-Management of Hypoglycemia

-Management of Hypothermia

-Management of shock

How Screening of children coming to OPDs using weight for height and/or MUAC is done ?

Screening children coming to outpatient departments (OPDs) using weight for height and/or mid-
upper arm circumference (MUAC) is a common practice in healthcare settings to assess their
nutritional status and identify potential cases of malnutrition. This method is especially valuable in
resource-limited settings where more comprehensive assessments may not be feasible. Here's how
this screening process typically works:

1. Measurement of Weight and Height:


o Children are weighed on a calibrated scale. It's essential to ensure the scale is regularly
calibrated to obtain accurate measurements.
o Height or length (in children under two years) is measured using a stadiometer or
length board.
2. Calculation of Weight-for-Height:
o Weight-for-height (also known as weight-for-length in children under two years) is
calculated using growth standards or z-scores, such as the World Health Organization
(WHO) Child Growth Standards. The most common metric used is the Weight-for-
Height Z-score (WHZ).
o WHZ is calculated by comparing the child's weight to a reference population of
children of the same age and gender. It's expressed in standard deviation units (Z-
scores) from the median. A WHZ less than -2 standard deviations indicates acute
malnutrition, while a WHZ less than -3 indicates severe acute malnutrition.
3. Measurement of Mid-Upper Arm Circumference (MUAC):
o A MUAC tape is used to measure the circumference of the child's upper arm, usually
at the midpoint between the tip of the shoulder and the tip of the elbow.
o MUAC measurements can be compared to age-specific reference values. A MUAC
less than a certain cutoff point (e.g., 115mm for children aged 6-59 months) may
indicate acute malnutrition.
4. Interpretation and Classification:

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o Based on the WHZ and/or MUAC measurements, children can be classified into one
of several categories, including well-nourished, moderately malnourished, or severely
malnourished.
o The specific cutoff points for classification may vary based on the growth standards
and guidelines used in the healthcare facility.
5. Referral and Intervention:
o Children identified as moderately or severely malnourished through this screening
process should be referred for further assessment and treatment by healthcare
professionals.
o Treatment typically involves therapeutic feeding, medical care, and nutritional
counseling.

Screening using weight-for-height and/or MUAC is a simple yet effective way to identify children at
risk of malnutrition. However, it's important to note that while these measurements are valuable
indicators of acute malnutrition, they do not provide a comprehensive assessment of overall
nutritional status.

How early screening & referral of children coming with any of 4 Ds under RBSK is done?

The "4 Ds" under the Rashtriya Bal Swasthya Karyakram (RBSK), a program aimed at
providing healthcare services to children, refer to four common health conditions that need early
screening and referral for intervention. These conditions are Defects at birth, Diseases,
Deficiencies, and Developmental Delays. Here's how early screening and referral of children
coming to the OPD (Outpatient Department) with any of these 4 Ds typically work:

1. Identification and Screening:


o Children coming to the OPD are screened for any of the 4 Ds through a systematic and
standardized process.
o The healthcare provider, often a pediatrician or a healthcare worker, performs a
thorough assessment to identify the presence of these conditions.
2. Defects at Birth:
o Conditions such as congenital heart defects, neural tube defects, and cleft lip/palate
fall under this category.
o Children born with these defects may be identified through physical examinations,
medical history, and, if necessary, diagnostic tests.
3. Diseases:

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o Common childhood diseases like pneumonia, diarrhea, and other communicable or
non-communicable diseases are screened for.
o Healthcare providers will assess symptoms, perform diagnostic tests if required, and
provide appropriate treatment or referral.
4. Deficiencies:
o Nutritional deficiencies, including vitamin and mineral deficiencies, are screened for.
o Children with nutritional issues may be identified through physical examination and
dietary assessment.
5. Developmental Delays:
o This category includes conditions like delayed motor skills, speech, and cognitive
development.
o Healthcare providers may use developmental screening tools to assess a child's
development and identify any delays.
6. Referral and Intervention:
o If a child is identified with any of the 4 Ds, they are referred for further assessment,
diagnosis, and appropriate intervention.
o Referral could be to specialists, diagnostic centers, or other healthcare facilities for
comprehensive evaluation and treatment.
7. Record Keeping:
o All screening and referral information is properly documented to ensure a child's
health history is accessible for future visits and continuity of care.
8. Follow-Up:
o Children who are referred for further evaluation and treatment should receive follow-
up care to monitor their progress and adjust interventions as necessary.

What resuscitation equipment is need to be available?


Otoscope, tongue depressor, view box, ambu bag(0-10 years and >10 years) 0-1 face mask,250 ml
bag and mask, 0,1 blade(straight)for largyngoscpe, ET tube.

What is the procedure for complimentary feeding & feeding during illness as per GoI guideline?

The Government of India (GOI) provides guidelines for complementary feeding and feeding during
illness as part of its national nutrition and child health programs. These guidelines aim to ensure the
proper nutrition and care of infants and young children. Here is an overview of the procedures for
complementary feeding and feeding during illness as per GOI guidelines:

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Complementary Feeding (6-24 months of age):

1. Introduction of Complementary Foods: The GOI recommends introducing complementary


foods around the age of six months, alongside continued breastfeeding. Complementary foods
should be nutrient-dense and age-appropriate.
2. Home-Based Complementary Foods: Encourage mothers and caregivers to prepare and
provide age-appropriate, locally available, and culturally acceptable foods. These should
include a variety of cereals, pulses, fruits, vegetables, dairy products, and animal-source
foods.
3. Frequency and Consistency: Initially, start with 1-2 meals a day and gradually increase to 3-
4 meals a day as the child's appetite and capacity for food intake grow. Complementary foods
should be semi-solid or soft in consistency.
4. Nutrient-Dense Foods: Prioritize nutrient-dense foods that are rich in essential vitamins and
minerals, such as iron, vitamin A, and zinc. Iron-rich foods are particularly important to
prevent anemia.
5. Safe Food Handling: Emphasize the importance of proper hygiene and safe food handling
practices during food preparation and feeding to prevent illness.
6. Responsive Feeding: Encourage responsive feeding, where the caregiver pays attention to the
child's hunger and fullness cues and allows the child to eat at their own pace.
7. Limit Sugary and Salty Foods: Avoid the introduction of sugary and salty foods in the
child's diet. These can lead to unhealthy eating habits.

Feeding During Illness:

1. Continued Breastfeeding: Continue breastfeeding during illness. Breast milk provides


essential nutrients and antibodies that can help the child recover.
2. Hydration: Offer the child more fluids, including clean, safe water and oral rehydration
solution (ORS) if needed, to prevent dehydration during illness.
3. Soft, Easily Digestible Foods: Provide soft, easily digestible foods, such as rice-based
porridge or khichdi, when the child's appetite returns. Avoid spicy, fatty, and hard-to-digest
foods during illness.
4. Frequent, Small Meals: Offer frequent, small meals to the child rather than large, heavy
meals. This can make it easier for the child to eat and digest food.
5. Consult Healthcare Provider: If the illness is severe, persistent, or associated with specific
dietary recommendations (e.g., for allergies), consult a healthcare provider for guidance on
feeding during illness.

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6. Medication and Supplements: Administer prescribed medications and supplements as per
the healthcare provider's instructions, especially if the child has specific dietary needs due to
the illness.
7. Oral Feeding: In cases of severe illness, where the child is unable to eat orally,
hospitalization and intravenous (IV) fluids may be necessary. Consult a healthcare provider
for appropriate care.

How Severe Dehydration as per clinical protocol are managed ?


It should be done as per the instruction of Medical Officer. As a general - 100ml/kg of ringer
lactate/Normal saline, Infants 30ml/kg -1hour + 70ml/per kg 5hr for Child -30ml/kg-30min. + 70
ml/kg 2 1/2 hrs, ORS 5ml/kg/hr followed by reassessment

What are the Treatment of diarrheal with no dehydration ?


It should be done as per the instruction of Medical Officer. As a general - Give fluids, zinc
supplements and food and advise to continue ORS at home , Advise mother when to return
immediately. Follow up in 5 days if not improving.

What is the Treatment of Persistent Diarrheal as per clinical protocol?


It should be done as per the instruction of Medical Officer. As a general Single Dose-Vit A, Zinc
Sulphate 20 mg daily for 14 Days, Follow up in 5 days &feeding of children

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Department:

Family Planning
(UPHC)

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What are the Records for Family Planning services and abortion are maintained?

Registers should be maintained as per the hospital policy and G.O. But essential registers are -
IUCD insertion register, removal register, IUD follow up register , Counselling register, abortion
records as per MTP act

What is GATHER approach?

The "GATHER" approach is a mnemonic that healthcare professionals and organizations use to guide
and improve their delivery of family planning services. It helps ensure that family planning programs
are client-centered, respectful, and comprehensive. The GATHER approach stands for:

1. Greet: Begin the family planning encounter with a warm and respectful greeting. Make
clients feel welcome and valued.
2. Ask: Engage in open and non-judgmental communication by asking clients about their
reproductive health needs and goals. This step involves active listening and empathy to
understand the client's unique situation.
3. Tell: Provide clear, accurate, and unbiased information about the available family planning
methods, including their benefits, risks, and effectiveness. Tailor the information to the
client's individual needs and preferences.
4. Help: Collaborate with the client to select the most appropriate family planning method based
on their preferences, needs, and circumstances. Offer guidance and support to ensure the
client makes an informed decision.
5. Explain: Explain how to use the chosen family planning method correctly and consistently.
Address any concerns or questions the client may have about the method.
6. Return: Encourage clients to return for follow-up visits, as appropriate, and ensure they have
access to ongoing support and services. Provide information on where and how to obtain
additional supplies or seek help if needed.

The GATHER approach is designed to promote client autonomy and informed decision-making in
family planning. It emphasizes the importance of treating clients with respect and dignity while
providing them with comprehensive information and support. By following this approach, healthcare
providers can better meet the needs of their clients and improve the overall quality of family planning
services. It's a client-centered approach that recognizes the importance of individual choice in family
planning decisions.

NQAS, LaQshya & MusQan Staff Interview Manual Page no. 237
What information is given about optimal pregnancy spacing and its benefits to patients ?

The importance of timely initiation of an FP method after

Key Messages - Recommended interval before attempting next pregnancy (24 Month)

Recommended Interval before attempting next pregnancy after abortion -6 Month

Recommended minimum age to conceive - 19 years

What are the eligibility criteria for Lactation Amenorrhea method?

1. If women exclusively breastfeed her baby including night feeds

2. Less than six month after delivery

3. Women's' menses is not returned

What are the benefits and limitation of Lactational Amenorrhea Method?

 Benefits- Promotes breastfeeding, effective immediately, no medicine or side effect.


 Limitation- All three criteria to be met for effectiveness.

What are the indication and method of administration of ECP?

Within 72 hours, second dose 12 house after first dose

What are the case selection criteria for family planning as per guideline?

The case selection criteria may include the following:

1. Eligibility for Sterilization (Tubectomy and Vasectomy): Sterilization is a permanent


method of contraception. In India, eligibility criteria for sterilization procedures include age,
parity (number of living children), and spacing between children.
For women seeking tubectomy, the government typically recommends that they should be at
least 23 years old or have at least two living children. Spacing between children should be at
least 3 years. For men seeking vasectomy, the government generally recommends that they
should be at least 25 years old or have at least two living children.

2. Eligibility for Long-Acting Reversible Contraceptives (LARCs):

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LARCs, such as intrauterine devices (IUDs) and hormonal implants, are highly effective but
reversible methods of contraception. Generally, women of reproductive age who desire
effective long-term contraception and have no contraindications can use LARCs.
3. Oral Contraceptives (Birth Control Pills): Birth control pills are suitable for most women
of reproductive age who do not have contraindications, such as a history of certain medical
conditions, smoking, or a high risk of blood clots. They may be an appropriate choice for
women who desire a reversible method of contraception and can adhere to a daily pill
regimen.
4. Condoms and Other Barrier Methods: Barrier methods, including male and female
condoms, are suitable for most individuals and can be used by individuals of all ages and
reproductive stages. These methods provide protection against both unintended pregnancy
and sexually transmitted infections (STIs).
5. Emergency Contraception: Emergency contraception can be used by individuals who have
had unprotected sex or experienced contraceptive failure. There are no specific eligibility
criteria for this method.
6. Counseling and Informed Choice: Regardless of the method chosen, informed choice and
counseling are crucial. Clients should receive comprehensive information about the benefits,
potential side effects, and usage of the selected contraceptive method. Their consent and
autonomy should be respected.
7. Medical Eligibility Assessment: Clients seeking family planning services should undergo a
medical eligibility assessment, which takes into account their medical history and current
health status.The assessment helps determine the suitability of various contraceptive methods
based on the individual's health and potential contraindications.

The case selection criteria may vary depending on the specific contraceptive method, so
healthcare providers should consider the relevant factors for each method when assessing
eligibility and most important as per G.O and guidelines.

How MMA drug protocols are followed as per guidelines ?

It should be done under the supervision and instruction of Medical Officer. As a general -

 First Visit (Day 1) - 200 mg Mifepristone (oral)


 2nd Visit (Day 3) -400 mcg Misprostole (sublingual/ buccal/ vaginal/oral)
 3rd Visit (Day 15)- Confirm & ensure complete abortion

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How Surgical Procedures abortion services for 2nd trimester are done as per guidelines ?

It should be done under the supervision and instruction of Medical Officer. As a general -

1. Check aspirator retains vaccum & choose appropriate size cannula.

2. Prepare Women for procedure (form c & pain management)

3 Clean cervix twice with Antiseptic sol.

4. Adminster paracervical block (lignocaine)

5. Dilate Cervix using cannula

6. Suction of utrine content

7. Inspect tissue

What are the spacing methods of family planning as per Govt of India guideline?

Spacing methods are contraceptive methods that allow for the spacing of pregnancies and help
maintain an appropriate time interval between pregnancies. Here are some of the spacing methods for
family planning as per the Government of India guidelines:

 Oral Contraceptive Pills (OCPs):


o These are hormonal pills taken daily to prevent pregnancy. They are highly effective
when used correctly.
 Injectable Contraceptives:
o Injectable contraceptives are administered every few months to provide protection
against pregnancy.
 Intrauterine Device (IUD):
o An IUD is a small, T-shaped device inserted into the uterus by a healthcare provider.
It provides long-term contraception, ranging from 3 to 10 years, depending on the
type.
 Condoms:
o Male and female condoms are barrier methods that provide protection against both
unintended pregnancy and sexually transmitted infections (STIs).
 Lactational Amenorrhea Method (LAM):
o LAM is a natural method of contraception that relies on breastfeeding and the absence
of menstrual periods during the postpartum period. It is effective when certain criteria
are met.

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 Copper-T Intrauterine Device (IUD):
o This is a type of IUD that does not contain hormones. It is suitable for women who
prefer non-hormonal contraception.

How ORS therapy is provided as per guidelines at UPHC?

Oral Rehydration Solution (ORS) Therapy for Children: Guidelines

1. Recognition of Dehydration: Caregivers and healthcare providers should recognize the signs
of dehydration in children, including dry mouth, sunken eyes, lethargy, decreased urine
output, and increased thirst.
2. Early Initiation: Start ORS therapy as soon as diarrhea is recognized. Early initiation is
crucial to prevent severe dehydration.
3. ORS Solution Preparation:
o Use pre-packaged ORS sachets or prepare ORS at home by mixing the appropriate
amount of ORS powder with clean, safe water. Follow the instructions on the ORS
packet.
o Do not use any extra salt, sugar, or other substances in the ORS solution.
4. Age-Appropriate Dosing:
o Administer ORS in age-appropriate doses based on the child's weight. The general
rule is to give the child as much ORS solution as they want to drink.
o Provide small, frequent sips of ORS to prevent overhydration or discomfort.
5. Continuous Feeding: Encourage breastfeeding for infants and the continuation of a normal
diet for older children alongside ORS therapy. Continue to feed children their usual foods.
6. Proper Mixing of ORS: Ensure the ORS powder is thoroughly mixed with water to achieve
the recommended concentration. Avoid using excessive or inadequate water.
7. Duration of Therapy: Continue ORS therapy until diarrhea subsides and the child's condition
improves. The goal is to replace lost fluids and maintain hydration.
8. Zinc Supplementation: For children with diarrhea, zinc supplementation is recommended.
Zinc can reduce the duration and severity of diarrhea.
9. Monitoring: Continuously monitor the child's hydration status. Be alert to signs of
improvement in hydration (e.g., improved activity, less thirst, moist mouth), and be aware of
potential signs of severe dehydration.
10. Seeking Medical Attention: If a child's condition worsens or if there are signs of severe
dehydration (e.g., sunken fontanelle, extreme lethargy, no urine output), seek immediate
medical attention.

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11. Preventing Contamination: Ensure that ORS and water are stored and prepared in clean
containers to prevent contamination.
12. Hygiene and Sanitation: Promote good hygiene and sanitation practices to prevent the
spread of diarrheal diseases.
13. Awareness and Education: Raise awareness about ORS therapy and the importance of early
intervention in communities and among caregivers.

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Department:

Immunization
(UPHC)

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What are the Immunization of Newborn (Zero Dose) is given ?

Zero Dose -OPV, HBV & BCG

What are the Immunization of Infants are given ?

OPV 123, DPT 123, /Pentavalent Hepatitis 123, Measles 1& 2

What are the Immunization of Children given ?

DPT Booster, OPV Booster, JE , DT booster, TT

What are the dosage of Vitamin A given ?

1st dose at 9 month with measles, 2nd to 9th dose 16 month with DPT/OPV booseter, then 1
dose every 6th month up to age of 5 yrs'

How Immunization of Pregnant Women are given ?

TT1 & 2

TT Booster

How Emergency Drug Tray is maintained at Immunization Room?

Drugs for managing anaphylactic reaction - Inj Adrenaline (clearly labelled), Inj Hydrocortisone
, Injection Chlorpheniramine, IV Fluid (LR, 0.9% IVSodium chloride),IV Set, Airway, tongue
depressor, ET tube, Ambu bag & oxygen, BP apperatus with child cuff & sethoscope

What is AEFI?

AEFI stands for Adverse Events Following Immunization. It refers to any unwanted or
unexpected medical occurrence that follows the administration of a vaccine. AEFIs can range
from mild and common side effects like pain or swelling at the injection site or a mild fever to
more serious and rare adverse events. The purpose of monitoring and reporting AEFIs is to
ensure the safety of vaccines and to detect and investigate any potential safety concerns.

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It's essential to understand that serious AEFIs are uncommon, and the vast majority of people
experience only mild and temporary side effects following vaccination.

What is the shelf life of Vit A once it is opened ?

6-8 weeks. Check for if date of opening has been marked on the bottle.

What are the four Stages of VVM check of vaccine?

The Vaccine Vial Monitor (VVM) is a temperature-sensitive label used to monitor the exposure of
vaccines to excessive heat. It helps ensure that vaccines remain within the recommended temperature
range during storage and transportation. The VVM check typically involves four stages:

1. Pre-Activation Stage: This is the initial stage before the vaccine vial is used. The VVM label
is in its original state, and it is not yet activated. At this stage, the label appears uniform, with
no color change.
2. Activation Stage: Once the vaccine vial is exposed to heat or reaches a critical threshold
temperature, the VVM label begins to activate. This stage is marked by a gradual change in
color on the label. The color change represents the cumulative heat exposure over time.
3. Passive Stage: The VVM label enters the passive stage after activation. In this stage, the
color change on the label remains stable and does not continue to progress, as long as the
vaccine is stored within the recommended temperature range. This indicates that the vaccine
is safe to use.

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4. Critical Stage: If the vaccine is exposed to excessive heat, the VVM label will reach the
critical stage. At this point, the label undergoes a more rapid and irreversible color change.
This signals that the vaccine may no longer be safe and effective and should not be used.

Healthcare workers and vaccine providers use the VVM as a visual indicator to assess the quality of
vaccines. When the VVM label reaches the critical stage, it signifies that the vaccine has likely been
compromised by heat exposure and should not be administered.

How check freeze damage for T-Series vaccines?

Checking for freeze damage in vaccines, including T-Series vaccines, is crucial to ensure their
effectiveness and safety. Freeze damage can occur when vaccines are exposed to temperatures below
their recommended storage range, which can render them ineffective or even harmful. Here are steps
to check for freeze damage in vaccines:

1. Visual Inspection:
o Examine the vaccine vials or containers for any visible signs of damage. Look for
changes in the appearance of the vaccine, such as cloudiness, precipitation, or the
formation of particles.
o Check the integrity of the vial or container. If there are signs of cracks, breakage, or
leakage, this could indicate freeze damage.
2. Temperature Monitoring:
o Review the temperature logs or data from the storage units where the vaccines are
stored. Check if there have been any temperature excursions outside the recommended
storage range, especially freezing temperatures.
3. Shake Test:
o Perform a shake test on the vaccine vial. Gently shake the vial and observe whether
the contents appear clumpy, cloudy, or discolored. These changes may indicate freeze
damage.
4. Temperature-Sensitive Labels:
o Many vaccines, including T-Series vaccines, may have a Vaccine Vial Monitor
(VVM) or similar temperature-sensitive label. Check the VVM for any color changes
that indicate exposure to freezing temperatures.
5. Record Review:

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o Review the vaccine storage and handling records to ensure that the vaccines have been
stored within the recommended temperature range. Any deviations from this range
should be investigated.
6. Consultation with Experts:
o If there are any doubts or concerns about freeze damage, consult with healthcare
professionals or vaccine experts who can provide guidance and make an informed
assessment.
7. Safety Precautions:
o If there is a strong suspicion of freeze damage or if the vaccine's integrity is
compromised, do not use the vaccine. Properly dispose of the damaged vaccine
according to local regulations and guidelines.

What are the 4 key Messages after vaccination/ immunization?


Vaccine Details, Next vaccination date, Minor Adverse effect may occur, Safe keeping of
immunization card. Apart from this ask to wait for 30 minutes after any vaccination/
immunization.

How to ensure safe and potent vaccines ?

Before beginning your immunization session, and before giving each vaccine, follow these steps to
ensure that every dose that you are going to give is safe and effective:

 Check label: Make sure the label on the vaccine vial is attached and clear enough to read. If
you find that the label is not clear enough to read or has come off, discard the vial.
 Check vaccine: Check that the vaccine being given is the correct one.
 Check expiry: Look for the expiry date on the vial. If the expiry date has passed, do not use
the vial; Discard it.
 Check the vaccine vial monitor (VVM) on vials to make sure that the vaccine is in the
usable stage.

What is Open Vial Policy?

Open Vial Policy has been developed to minimize and prevent vaccine wastage under the UIP.
It permits the reuse of partially used multi dose vials of relevant vaccines under UIP in succeeding
sessions up to 28 days PROVIDED certain conditions are fulfilled. It is essential that the policy is
followed correctly, so as to minimize wastage, adverse effects following immunization and ensuring

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that the vaccination is effective.
Open Vial Policy is valid for the following vaccines:
• DPT, Td & TT,
• Hepatitis B,
• Oral Polio Vaccine (OPV)
• PCV
• Haemophilus influenzae type B (Hib) containing Pentavalent vaccine and
• injectable Inactivated Poliovirus Vaccine (IPV).

Open Vial Policy does NOT apply to:


• Measles,
• BCG and
• Japanese Encephalitis (JE) vaccines.
• Rotavirus vaccine

Provided that certain conditions are upheld, a vial of the vaccine that has been opened during a
session can be utilized for multiple immunization sessions WITHIN a period of 28 DAYS.
• The expiry date has not passed.
• The vaccines are stored under appropriate cold chain conditions both during transportation and
storage in cold chain storage point.
• The vaccine vial septum has not been submerged in water or contaminated in any way.
• Aseptic technique has been used to withdraw vaccine doses. (That is needle/septum has not been
contaminated in anyway)
• The vaccine vial monitor (VVM), has not reached/crossed the discard point.

A vaccine vial should be DISCADED if any of the following conditions are met and the Medical
Officer or Supervisor should be informed:

A vaccine vial should be DISCADED if any of the following conditions are met and the
Medical Officer or Supervisor should be informed:
o VVM reached/crossed discard point (for freeze dried vaccine, before
reconstitution only) or vaccine vials without VVM or disfigured VVM.
o No label/partially torn label and/or writing on label not legible.
o Any vial thought to be exposed to non-sterile procedure for withdrawal.
o Open vials that have been under water or vials removed from a vaccine carrier
that has water.
o If vaccine vial is frozen or contains floccules or any foreign body.
o If there is breakage in the continuity of the vials (crack/leaks).
If there is any reported AEFI following use of any of the vaccine vial, do not use it, and retain it
safely.

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Department:

Communicable
Disease (UPHC)

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What are the NVBDCP drugs is to be available ?

Artesunate, Chloroquine phosphate, Primaquine, Pyrimethamine, Quinine sulphate, Sulfadoxine


+ Pyrimethamine

How Reporting is done on Form 01 (MF 2) ?

For reporting of blood smear. Reporting format contain information about patient‘s name, age,
sex and slum, etc. A code number is given to each patient in terms of blood smear number for
identification of each fever case screened, for tracing out to provide radical treatment and also
for follow up

What Form / Format for testing and Diagnosis of TB under RNTCP ?

 Mycobacteriology culture/sensitivity test form


 Laboratory form for sputum examination
 tuberculosis treatment Card
 referral treatment form
 transfer form
 Any other form / formats as per guidelines

What is the Treatment for confirmed P. Vivax Malaria is done as per protocols?

P.vivax cases should be treated with chloroquine for three days and Primaquine for 14 days.
Primaquine is used to prevent relapse but is contraindicated in pregnant women, infants and
individuals with G6PD deficiency. ** Always check latest guidelines in this regard.

What information about when to report back of Malaria cases are provided?

Patients should be instructed to report back in case of haematuria or high colored urine /
cyanosis or blue coloration of lips and Primaquine should be stopped.

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What are the Treatment for Confirmed P. falciparum is done as per protocols?

P. falciparum cases are treated with ACT (Artesunate 3days+Sulphadoxine- Pyrimethamine 1


day) This is accompanied by single dose of Pramaquine preferably day 2). However, there is
resistance to partner drug SP in NE, it is recommended to use ARTEMETHER( 20 mg) -
LUMEFANTRINE (120 mg (ACT-AL) as per age specific dose schedule for the treatment of pf
cases in NE (contraindicated in 1st trimester of pregnancy & for children weighting <5 years).
** Always check latest guidelines in this regard

What are the Treatment of uncomplicated P. falciparum Malaria in pregnancy is done as per
protocols?

Pregnant women with uncomplicated Falciparum should be treated 1st trimester: Quinine, 2nd
&3rd trimester: ACT. ** Always check latest guidelines in this regard

What are the Treatment of mixed infection is done as per protocols?

Mixed infections with P. falciparum should be treated as falciparum malaria. However,


antirelapse treatment with primaquine can be given for 14 days, if indicated. ** Always check
latest guidelines in this regard

How Treatment of falciparum failure cases is done as per protocols?


Falciparum malaria should be given alternative ACT or quinine with Doxycycline. Doxycycline
is contraindicated in pregnancy, lactation and in children up to 8 years. ** Always check latest
guidelines in this regard

How to identify severe cases of malaria especially severe manifestation of P falciparum?


Severe malaria have one or more of following features: impaired consciousness/coma,Repeated
generalized convulsions, Renal failure (Serum Creatinine >3 mg/dl), Jaundice (Serum Bilirubin
>3 mg/dl), Severe anaemia (Hb <5 g/dl), Pulmonary oedema, Hypoglycaemia (Plasma Glucose
<40 mg/dl), Circulatory collapse/shock, DIC, Hyperpyrexia,Hyperparasitaemia (>5% parasitized
RBCs ), Haemoglobinuria etc. ** Always check latest guidelines in this regard

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What are the different coloured blister packs of ACT+SP is available for different age group
especially for field staff as per National TB Control Program?
Pink for 0-1 year, yellow for 1-5 yrs, green for 5-8 yrs, Red for 9-14 yrs & white for 1 5& above.
For NE: pack colour and regimen vary by body weight & age group, Yellow: weight for 5to 14
kg and age for> 5 month to <3 years, green: weight 15 to 24 kg age >3 to 8yrs, Red : weight 25-
34 kg, age 9 to 14 yrs, white:weight > 34 kg,and age >14 yrs. ** Always check latest guidelines
in this regard

How category wise treatment regimen is given to patient under National TB Control Program?

 Category I- New sputum smear-positive


 Seriously ill** new sputum smear-negative
 Seriously ill** new extra-pulmonary-
 Category II- Sputum smear-positive Relapse
 Sputum smear-positive Failure
 Sputum smear-positive Treatment After Default
 Other * Always check latest guidelines in this regard

How Patient wise box are colour coded as per category under National TB Control Program?

Red - Category I, Blue -Category -II,

How all the doses of DOTS of intensive phase is taken as per guideline

Under supervision of DOT provider/Community DOT provider if any dose is missed patient
must be contacted within 1 day and dose is administrated on following day

How in continuous phase DOTS doses is taken as per guideline ?


First dose in taken under supervision of DOT provider/Community DOT provider and for
subsequent doses for week is self administrated. Empty blisters are contacted within next
scheduled visit

What action taken by DOT provider if they fail to retrieve such patient?
Reported to next level supervisor (PHW/MO- PHI/STS/ MO-TB)

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What Protocols for treatment for TB during pregnancy and Post natal Period is adhered?
Discontinuation of Streptomycin, Chemoprophylaxis of baby in case of smear positive mother

How follow up of smear examination for New smear positive patient is done as per guidelines?
First follow up sputum examination is done at the end of 2 months of intensive phase. Follow up
sputum examination is done at the end of 2 month of continuation phase and finally at the end of
treatment.

How follow up smear examination for re -treatment patients as per guidelines?


First follow up sputum examination is done at the end of 3 months of intensive phase. Follow up
sputum examination is done at the end of 2 month of continuation phase and finally at the end of
treatment.

How follow up smear examination for smear negative patients as per guidelines?

Two smears are examined during the follow-up visit at the end of 2 months of the intensive
phase and again at the end of treatment

What are the Physical Examinations done as per guidelines of National Leprosy Eradication
Program?
Dryness of hands & feet, swelling & redness of patches and joints, Wasting of muscle, visible
deformity in hand, feet, eye, Redness on palm or sole, callous, Blister, ulcer, High stepping gait
or any change in gait, Appearance of new lesions or expansion of existing lesion, Absence of
blink in the eyes, Redness and watering in the eyes

How Examination of eye as per guidelines of National Leprosy Eradication Program?

Look for any redness of the eye, Note ―watering from the eye‖ from history and observation,
Observe for blink – Present or Absent, Look for lid gap or inability to close one or both eyes
(Lagophthalmos) and check for normal strength of eye closure, Check the visual acuity of each
eye separately, using a Snellen‘s chart.

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How Management of disability grade I as per guidelines of National Leprosy Eradication Program?

If the duration of disability grade 1 i.e. anesthesia along the course of trunk nerve is recent (< 6
months), a course of Prednisolone is to be started to treat neuritis.

What are the Standard adult treatment regimens for MB leprosy is followed?

Rifampicin: 600mg once in month, Clofazimine: 300mg once in month & 50mg every day,
Dapsone: 100 mg (for 12 month)

What are the Standard adult treatment regimens for PB leprosy is followed?
Rifampicin: 600 mg once in month, Dapsone; 100 mg daily (for 6 month)

What Standard children (10-14yrs) treatment regimen for MB leprosy is followed?


MB: Rifampicin:450mg once in month,Clofazimine: 150mg once in month,50 mg daily,
Dapsone: 50 mg daily (12month). PB: Rifampicin: 450 mg once in month, Dapsone; 50 mg
daily (for 6 month)

What are the adverse reactions to MDT and their management?

Like Red urine, anaemia, brown discoloration of skin, gastro intestinal upset. Management
reassurance, given iron and folic acid, counselling & give drug with food

What are the leprosy reaction and their treatment?

2 types of reaction: Type 1- Reversal reaction, Type 2- Erthyma Nodosum leprosum(ENL)

How Referral out of Patient as per guideline of National Leprosy Eradication Program?
Referral of cases where lepra reaction is difficult to manage, complicated ulcer, eye problem,
reconstruction surgery cases, persons needing grade II foot wear, follow up of RCS.

How early diagnosis & referral of HIV suspected cases is done?

Rapid Kit test done for suspected cases & if case found positive, referred to ICTC

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Department:

Non Communicable
Disease (UPHC)

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How Survey for prevalence of various eye diseases & Health Education for prevention of various
eye diseases are done?

Nutrition education (prevent vit A deficiency), Water & sanitation education (Trachoma
Control) Maternal & child health education (Reduce retinopathy of prematurity), Health
education (Prevention of eye trauma, hypertension & diabetic retinopathy)

What type of identification & treatment of common mental disorders are done in OPD?
Anxiety Neurosis, Mild depression

How Diagnosis of hypertension is done as per protocol?


Stage 1 hypertension: Systolic 140/159, diastolic 90/99. Stage 2 hypertension: Sysolic: 160 or
higher Diastolic 100 or higher. Based on at least 2 or more properly measured BP reading in
sitting position.

How Risk assessment for cardio vascular disease is done as per guideline?

Awareness of behavioral & psychological risk factor & medical officer calculate 10 year risk for
fatal & non fatal cardio vascular event using WHO / ISH risk predication chart.

WHO / ISH risk predication chart: The World Health Organization (WHO) and the
International Society of Hypertension (ISH) have developed risk prediction charts to estimate an
individual's risk of experiencing fatal and non-fatal cardiovascular events over a specific time
frame. These charts are used to assess cardiovascular risk based on various factors such as age,
sex, blood pressure, smoking status, and other relevant variables. The specific charts and
algorithms may vary based on the region and population for which they are designed. Therefore,
I can provide a general overview of the risk factors commonly considered in these charts, but for
precise risk assessment, you should refer to the specific risk prediction chart applicable to your
region or consult a healthcare professional.

Common risk factors considered in cardiovascular risk prediction charts include:

1. Age: Cardiovascular risk typically increases with age. Older individuals are at higher risk.
2. Sex: Men and women may have different risk profiles, with men often having a higher risk.

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3. Blood Pressure: High blood pressure (hypertension) is a major risk factor for cardiovascular
events.
4. Smoking: Current or past smoking significantly increases the risk of cardiovascular events.
5. Diabetes: Individuals with diabetes are at higher risk of cardiovascular disease.
6. Cholesterol Levels: Elevated levels of LDL cholesterol and low levels of HDL cholesterol
can increase risk.
7. Family History: A family history of cardiovascular disease may increase risk.
8. Body Mass Index (BMI): Obesity or being overweight is associated with increased
cardiovascular risk.
9. Physical Activity: Lack of physical activity or a sedentary lifestyle can contribute to risk.
10. Diet: An unhealthy diet high in saturated and trans fats, salt, and low in fruits and vegetables
can increase risk.
11. Alcohol Consumption: Excessive alcohol consumption may raise cardiovascular risk.
12. Previous Cardiovascular Events: Individuals with a history of heart attacks, strokes, or
other cardiovascular events are at higher risk for subsequent events.

These risk factors are typically incorporated into cardiovascular risk prediction algorithms to estimate
the likelihood of experiencing a cardiovascular event, such as a heart attack or stroke, within a
specified time frame (e.g., 10 years). The risk prediction chart provides a numerical estimate of risk,
which can help guide healthcare providers in making decisions about preventive measures, lifestyle
changes, and medication.

The use of these charts typically involves the following steps:

1. Collecting Risk Factor Information: Gather information about the individual's risk factors,
including age, gender, blood pressure, cholesterol levels, smoking status, and diabetes status.
2. Calculating Risk Score: Use the appropriate risk prediction chart or online tool to calculate
the individual's risk score based on the collected risk factor information. The chart will
provide a numerical risk score.
3. Interpreting Risk Score: The calculated risk score is typically associated with categories that
indicate the risk level, such as low, moderate, high, or very high risk. This classification is
used to estimate the probability of experiencing a cardiovascular event over a specific time
period, usually 10 years.
4. Clinical Decision-Making: The risk assessment can guide healthcare providers in making
clinical decisions. For example, it can help determine the need for lifestyle modifications,
medications, or more intensive management to reduce the risk of cardiovascular events.

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5. Regular Reassessment: Risk prediction should not be a one-time assessment. Regular
reassessment of risk factors and re-evaluation of the individual's cardiovascular risk are
recommended, especially as risk factors may change over time.

What are the 5 As and 5 Rs of tobacco cessation counseling?

5 As (Ask, Advice, Assess, Assist & Arrange) and 5 Rs (Relevance, Risk, Reward, Roadblock &
Repetition)

How management & referral of chronic supportive otitis media (CSOM) as per Govt of India
guideline?

The management and referral of Chronic Suppurative Otitis Media (CSOM) in India follow
guidelines provided by the Government of India and the Ministry of Health and Family Welfare.
CSOM is a chronic ear infection with persistent ear discharge, which can lead to hearing loss and
other complications. Here are the general principles for the management and referral of CSOM in
India:

Management of CSOM:

1. Clinical Assessment: CSOM should be diagnosed based on clinical evaluation by a


healthcare provider. This may include examining the ear for signs of infection, perforation of
the eardrum, and the type and characteristics of ear discharge.
2. Treatment:
o Medical Management: In most cases, CSOM can be managed medically. This
involves cleaning the ear, administering antibiotics, and addressing any underlying
causes, such as allergy or nasal congestion.
o Topical Ear Drops: Antibiotic ear drops may be prescribed to treat the ear infection.
o Pain Management: Pain and discomfort can be managed with appropriate pain
relievers.
o Hearing Assessment: Hearing assessment should be conducted, and appropriate
interventions like hearing aids may be considered if hearing loss is significant.
3. Regular Follow-up: Patients with CSOM require regular follow-up to monitor treatment
progress, ensure the infection is resolving, and evaluate hearing status.
4. Hearing Rehabilitation: For individuals with hearing loss due to CSOM, hearing
rehabilitation and counseling may be necessary.

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5. Preventive Measures: Patients and caregivers should be educated about the importance of
ear hygiene, avoiding water entry into the ear, and preventing trauma or foreign body
insertion.
6. Referral Criteria: Referral should be considered if the following criteria are met:
o Severe complications like facial nerve paralysis or labyrinthitis.
o Inadequate response to medical treatment.
o Suspicion of cholesteatoma (a destructive middle ear growth).
o Children with recurrent or persistent ear discharge with hearing loss.
o Patients with immunocompromised conditions who are at higher risk for severe
infections.

Referral of CSOM:

1. Referral to Specialist: Patients meeting the referral criteria should be referred to an ear, nose,
and throat (ENT) specialist for further evaluation and management.
2. Timely Referral: Timely referral is crucial to prevent complications and address any
underlying issues. The referral should be prompt and coordinated with the specialist's
availability.
3. Documentation: Healthcare providers should maintain accurate and complete medical
records and referral documentation to ensure the patient's information is communicated
effectively to the specialist.
4. Communication: Effective communication between primary healthcare providers and
specialists is essential for a seamless referral process and continuity of care.

** Always check latest Clinical Guideline in this regard

How to assessment Mental anxiety and Depression?

Mental anxiety and Depression can be assessed by using ‗DASS‘ scale.

The Depression, Anxiety, and Stress Scale (DASS) is a widely used self-report questionnaire
designed to measure the severity of symptoms related to depression, anxiety, and stress. It consists of
three subscales, each focusing on a different aspect of mental health:

 Depression: This subscale assesses symptoms related to dysphoria, hopelessness, devaluation


of life, self-deprecation, lack of interest or involvement, anhedonia (inability to experience
pleasure), and inertia.

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 Anxiety: The anxiety subscale measures symptoms of autonomic arousal, skeletal muscle
effects, situational anxiety, and subjective experience of anxious affect.
 Stress: This subscale evaluates difficulty relaxing, nervous arousal, being easily upset or
agitated, and having a tendency to be easily overwhelmed and impatient.
Respondents rate the extent to which they have experienced each symptom over the past week on a
Likert scale. The DASS provides separate scores for each subscale, indicating the severity of
symptoms in each domain.

Typically, the scores for each subscale are interpreted as follows:

 Normal: 0-9
 Mild: 10-13
 Moderate: 14-20
 Severe: 21-27
 Extremely Severe: 28+
It's important to note that while the DASS can provide valuable insights into an individual's
emotional well-being.

** DASS scale can be downloaded from Internet

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Department:

Outreach (UPHC)

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How Routine & special outreach sessions are conducted at defined intervals?

At least one routine outreach session in area each month & at least one special outreach session
every week in slum area /vulnerable population by designated ANM

What are the Point of Care Diagnostic Services available?

Pregnancy test, Hemoglobin, Urine Albumin, Malaria Slides, glucose strips & Blood Pressure

What are the Contraceptives available in ASHA Kits?

Condoms and Oral Contraceptive Pills, Emergency Contraceptive Pills

What are the Antipyretic available in ASHA Kits?

Tab. Paracetamol, Tab. Dicyclomine

What are the availability of Topical (locally Applied) drugs in ASHA Kits?

Tetracycline ointment, Povidine Iodine ointment Tube, G.V. Paint, Sprit

What are the availability of Nutritional Supplement in ASHA Kits?

Zinc tablets, Tab. Iron Folic acid, ORS Packets

What are the availability of Diagnostic Kits in ASHA Kits

nischay kit,rapid diagnostic kit,Slides for Malaria & Lancets

What are the availability of functional Measuring equipments in ASHA Kits

BP Apparatus, thermometer, weighing scale, measuring tape, Stethoscope

What are the availability of Antibiotics ins in ASHA Kits

Cotrimoxazole syrup, Pediatric cotrimoxazole tablets,

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How Early registration of Pregnant women is ensured by the ANM?

ANC records for ensuring that majority of ANC registration is taking place within 12th week of
Pregnancy in ANC register

What are the High risk pregnancy cases which would need referral to Higher Centre(FRU) ?

Anaemia, Bad obstetric history, CPD, PIH, APH, Medical Disorder complicating pregnancy,
Malpresentation, fetal distress, PROM, obstructed labor, rupture uterus, & Rh negative

How to identify Hypertension / Pregnancy Induced Hypertension?

Hypertension - Two consecutive reading taken four hours apart shows Systolic BP >140 mmHg
and/or Diastolic BP > 90 mmHg

How to identify Pre-Eclampisa?


Pre - Eclampsia- High BP with Urine Albumin (+2)

Imminent eclampsia -BP >140/90 with positive albumin 2++, severe headache, Blurring of
vision, epigastria pain & oligouria

How to classify anaemia according to Haemoglobin Level ?

 >11 gm% -Absence of Anaemia,


 10 to 11 gm% Mild Anaemia,
 7-10 gm% Moderate Anaemia
 <7 gm% Severe Anaemia

What are the prophylactic & Therapeutic doses of IFA?

Prophylactic - one IFA tablet per day for at least 100 days starting from first trimester

Therapeutic - 2 IFA tablet per day for three months

What are the Counseling provided during the ANC check-up as per protocol?

Counseling regarding birth preparedness, identification of danger signs, nutrition, breast feeding
and family planning

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How counseling pregnant women is done during the home visits?

Pregnant women is counseled for Postpartum care , Hygiene, Nutrition, Contraception,


Breastfeeding, Registration of Birth and Identification of danger signs.

What are the schedule of 6 Home visits are provided by ASHA?

On 3rd, 7th , 14th, 21st , 28th and 42nd Day. Records that for identified new-born visits have
been timely made by ASHA

How to identify danger signs and referral for Newborn?

 Weight <1.8 kg
 Temperature > 99 degree
 Yellowness in eyes/Skin persistent for more than 14 day after birth.

How home based management of Hypothermia is done by ASHA ?

If temperature is <97F then advice the mother to keep the baby warm through increasing room
temperature and providing skin to skin contact

How ORS therapy is provided as per guidelines during Outreach Sessions?

Oral Rehydration Solution (ORS) Therapy for Children: Guidelines

1. Recognition of Dehydration: Caregivers and healthcare providers should recognize the signs
of dehydration in children, including dry mouth, sunken eyes, lethargy, decreased urine
output, and increased thirst.
2. Early Initiation: Start ORS therapy as soon as diarrhea is recognized. Early initiation is
crucial to prevent severe dehydration.
3. ORS Solution Preparation: Use pre-packaged ORS sachets or prepare ORS at home by
mixing the appropriate amount of ORS powder with clean, safe water. Follow the instructions
on the ORS packet. Do not use any extra salt, sugar, or other substances in the ORS solution.
4. Age-Appropriate Dosing: Administer ORS in age-appropriate doses based on the child's
weight. The general rule is to give the child as much ORS solution as they want to drink.
Provide small, frequent sips of ORS to prevent overhydration or discomfort.
5. Continuous Feeding: Encourage breastfeeding for infants and the continuation of a normal
diet for older children alongside ORS therapy. Continue to feed children their usual foods.

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6. Proper Mixing of ORS: Ensure the ORS powder is thoroughly mixed with water to achieve
the recommended concentration. Avoid using excessive or inadequate water.
7. Duration of Therapy: Continue ORS therapy until diarrhea subsides and the child's condition
improves. The goal is to replace lost fluids and maintain hydration.
8. Zinc Supplementation: For children with diarrhea, zinc supplementation is recommended.
Zinc can reduce the duration and severity of diarrhea.
9. Monitoring: Continuously monitor the child's hydration status. Be alert to signs of
improvement in hydration (e.g., improved activity, less thirst, moist mouth), and be aware of
potential signs of severe dehydration.
10. Seeking Medical Attention: If a child's condition worsens or if there are signs of severe
dehydration (e.g., sunken fontanelle, extreme lethargy, no urine output), seek immediate
medical attention.
11. Preventing Contamination: Ensure that ORS and water are stored and prepared in clean
containers to prevent contamination.
12. Hygiene and Sanitation: Promote good hygiene and sanitation practices to prevent the
spread of diarrheal diseases.
13. Awareness and Education: Raise awareness about ORS therapy and the importance of early
intervention in communities and among caregivers.

These guidelines are essential for effectively managing dehydration in children due to diarrhea and
reducing morbidity and mortality. ** Always Check latest Guidelines in this regard.

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Department:

National Health
Program (PHC)

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What is Anaphylaxis and AEFI?

Anaphylaxis and AEFI (Adverse Events Following Immunization) are both terms related to the
field of immunization and healthcare. They refer to different aspects of reactions that can occur
after receiving vaccines.

Anaphylaxis:
Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur shortly
after exposure to an allergen, including certain components of vaccines. Anaphylaxis involves
a rapid and severe immune response that can affect multiple body systems, leading to
symptoms such as difficulty breathing, swelling of the face and throat, a sudden drop in blood
pressure, and hives. Anaphylaxis requires immediate medical attention, as it can lead to shock
and even death if not treated promptly with medications like epinephrine (adrenaline). In the
context of vaccines, anaphylactic reactions are rare but are a recognized concern. Healthcare
providers are trained to identify and manage anaphylactic reactions during the administration
of vaccines. People with a history of severe allergic reactions to vaccine components or other
allergens should consult their healthcare provider before receiving vaccines.

AEFI (Adverse Events Following Immunization):


An adverse event following immunization (AEFI) is any untoward medical occurrence which
follows immunization and which does not necessarily have a causal relationship with the usage
of the vaccine. The adverse event may be any unfavorable or unintended sign (e.g. Abscess
following vaccination), abnormal laboratory finding (e.g. Thrombocytopenia following
measles vaccination) symptom or disease (e.g. Disseminated BCG infection following BCG
vaccination).
Types:
 Minor - Usually occur within a few hours of injection. Resolve after short period of
time and pose little danger.
 Severe - Can be disabling and, rarely life threatening. Most do not lead to long-term
problems. Must be reported
 Serious – Extreme condition may lead to death or persistent or significant disability.
Inpatient hospitalization is needed.

** All categories of AEFI are to be recorded in AEFI register

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WHO cause specific definition of AEFIs:

In summary, anaphylaxis is a severe reaction that can occur after exposure to allergens,
including vaccine components, while AEFI refers to any adverse medical event that follows
immunization. Healthcare providers and regulatory agencies play a critical role in monitoring
and managing these events to ensure the safety and effectiveness of vaccines.
** Always check latest Clinical & Departmental Guidelines in this regard.

Which AEFI cases to be reported immediately to MO/ District Immunization Officer?


Death , Anaphylaxis, Toxic Shock Syndrome, Hospitalization , Disablity etc.

What is the Cycle time for reporting FIR / PIR?


24 hrs for FIR & 7 Days for PIR

What to do in case of early signals of outbreak?


During analysis of data if staff encounters unusual increase in no. of cases in a particular
category, they have to notify on telephone same to DSU, A written report /mail can follow
subsequently.

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How assessment for identification of ARI, diarrhoea, malnutrition and Other Illness are done ?

 ARI: Chest indrawing difficulty in breathing ,coughing, fever, fast breathing


 Malnutrition: Weakness/wasting, check weight for age, check height for weight
 Diarrhoea: Sunken eyes, lethargic, unconscious, restless, irritable, pinch skin

When not to give pentavalent vaccines ?

If child had severe allergic reactions in previous dose of immunization and if Child has severe acute
illness.

How to cover if some of the dosages missed during Immunization ?

DPT can be given till 2 year, OPV till 5 year. Do not start the schedule if some dosages are missed ,
instead administer the dosage needed to complete the series

What is 5 As and 5 Rs of Tobacco cessation counseling ?

5 As (Ask, Advice, Assess, Assist & Arrange) and 5 Rs (Relevance, Risk, Reward, Roadblock &
Repetition)

How Survey for prevalence of various eye diseases & Health Education for prevention of various eye
diseases is done ?

Nutrition education (prevent vit A deficiency), Water & sanitation education (Trachoma Control)
Maternal & child health education (Reduce retinopathy of prematurity), Health education (Prevention
of eye trauma, hypertension & diabetic retinopathy).

How Early detection, diagnosis, treatment and referral for health problems are done under School
Health Programme ?

Assessment of Anaemia/Nutritional status, visual acuity, hearing problems, dental check up, common
skin conditions, Heart defects, physical disabilities, learning disorders, behaviour problems.

What Immunization of Infants are provided under UIP ?

OPV 123, DPT 123, /Pentavalent Hepatitis 123, Measles 1& 2

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What is the schedule for Vit A supplementation?

1st dose at 9 month with measles, 2nd to 9th dose at 16 month with DPT/OPV booseter, then 1 dose
every 6th month up to age of 5 yrs

What is the guideline for collecting sputum for smear microscopy?

Two sample will be collected: Early morning-Spot

How follow up of smear examination for new smear positive patient is done?

First follow up sputum examination is done at the end of 2 months of intensive phase. Follow up
sputum examination is done at the end of 2 month of continution phase and finally at the end of
treatment. ** Always check latest NTEP guideline in this regards.

How follow up smear examination for re -treatment patients is done as per guidelines?

First follow up sputum examination is done at the end of 3 months of intensive phase. Follow up
sputum examination is done at the end of 2 month of continution phase and finally at the end of
treatment. ** Always check latest NTEP guideline in this regards

How follow up smear examination for smear negative patients is done as per guidelines?

Two smears are examined during the follow-up visit at the end of 2 months of the intensive phase and
again at the end of treatment.

How to identify cases of suspected malaria?

Fever is cardinal symptom. It may be intermittent with or without priodicity or continuous, Fever in
many cases accompanied with rigours & chills. Headache, myalgia, arthralgia, anorexia, nausea &
vomiting.

What is contraindicated for administration of Primaquine ?

Primaquine is used to prevent relapse but is contraindicated in pregnant women, infants and
individuals with G6PD deficiency.

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When Patient on malaria treatment (specially on Primaquine) about when to report back?

Patients should be instructed to report back in case of haematuria or high colored urine / cyanosis or
blue coloration of lips and Primaquine should be stopped.

What is the treatment for Confirmed P. falciparum as per protocols?

** It should be done as per latest G.O and Clinical guideline. As a general following may be useful -
P. falciparum cases are treated with ACT (Artesunate 3days+Sulphadoxine- Pyrimethamine 1 day)
This is accompanied by single dose of Pramaquine (preferably day 2). However, there is resistance to
partner drug SP in NE, it is recommended to use ARTEMETHER ( 20 mg) - LUMEFANTRINE (120
mg (ACT-AL) as per age specific dose schedule for the treatment of pf cases in NE (contraindicated
in 1st trimester of pregnancy & for children weighting <5 years.

What is the treatment of uncomplicated P. falciparum Malaria in pregnancy as per protocols ?

** It should be done as per latest G.O and Clinical guideline. As a general following may be useful –

Pregnant women with uncomplicated Falciparum should be treated 1st trimester: Quinine, 2nd &3rd
trimester: ACT.

What is the treatment of mixed infection as per protocols ?

** It should be done as per latest G.O and Clinical guideline. As a general following may be useful –

Mixed infections with P. falciparum should be treated as falciparum malaria. However, antirelapse
treatment with primaquine can be given for 14 days, if indicated.

What is the treatment of falciparum failure cases as per protocols?

** It should be done as per latest G.O and Clinical guideline. As a general following may be useful –

Falciparum malaria should be given alternative ACT or quinine with Doxycycline. Doxycycline is
contraindicated in pregnancy, lactation and in children up to 8 years.

How to identify severe cases of malaria especially severe manifestation of P falciparum?

Severe malaria have one or more of following features: impaired consciousness/coma, Repeated
generalized convulsions, Renal failure (Serum Creatinine >3 mg/dl), Jaundice (Serum Bilirubin >3
mg/dl), Severe anaemia (Hb <5 g/dl), Pulmonary oedema, Hypoglycaemia (Plasma Glucose <40

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mg/dl), Circulatory collapse/shock, DIC, Hyperpyrexia, Hyperparasitaemia (>5% parasitized RBCs ),
Haemoglobinuria etc.

How Physical Examination is done under National Leprosy Eradication Programme as per guidelines?

Assessment of - Dryness of hands & feet, swelling & redness of patches and joints, Wasting of
muscle, visible deformity in hand, feet, eye, Redness on palm or sole, callous, Blister, ulcer, High
stepping gait or any change in gait, Appearance of new lesions or expansion of existing lesion,
Absence of blink in the eyes, Redness and watering in the eyes.

How examination of eye is done under National Leprosy Eradication Programme as per guidelines?

Assessment for any redness of the eye, Note ―watering from the eye‖ from history and observation,
Observe for blink – Present or Absent, Look for lid gap or inability to close one or both eyes
(Lagophthalmos) and check for normal strength of eye closure, Check the visual acuity of each eye
separately, using a Snellen‘s chart or by counting fingers at 6 meters.

How Management of disability grade I is done under National Leprosy Eradication Programme as per
guidelines?

** It should be done as per latest G.O and Clinical guideline. As a general following may be useful –

If the duration of disability grade 1 i.e. anaesthesia along the course of trunk nerve is recent (< 6
months), a course of Prednisolone is to be started to treat neuritis.

What are the adverse reactions to MDT and their management

** It should be assessed by the Medical officer and management to done as per latest G.O and
Clinical guideline. As a general following may be useful –

Adverse reactions includes but not limited to - Red urine, anaemia, brown discoloration of skin,
gastro intestinal upset. leprosy reaction are of 2 types: Type 1- Reversal reaction, Type 2- Erthyma
Nodosum leprosum(ENL). Management reassurance, given iron and folic acid, counselling & give
drug with food.

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What are the criteria to diagnosis the cases of HIV in window period ?

Require testing after 12 weeks

What are the criteria to diagnosis the case of HIV in emergency case ?

** It should be assessed by the Medical officer and to done as per latest G.O and Clinical guideline.
As a general following may be useful –

For women with an unknown HIV status and in labour, the labour room nurses or medical officer will
provide basic information on HIV/AIDS and about HIV testing. Thereafter, a single HIV test will be
performed. A repeat sample will be collected and tested on the next working day and sent the ICTC.
Blood sample may be sent from the hospital ward or other department, in such cases the ICTC ensure
that the patient has been counseled by the doctor and the blood sample is received with a requisition
slip. Post-test counselling will be provided by the ICTC counsellor in the ward. Whole blood samples
of all pregnant women who are diagnosed to be HIV-positive in an ICTC will be sent to the nearest
ART centre with CD4 testing facility for estimation of the baseline CD4 count.

What are the criteria to diagnosis HIV in new born ?

For diagnosis HIV in new born test should be done when infant is of 6 weeks old and second one at
six month of age.

How to calculate the quantity of vaccines and syringes based on estimated beneficiaries?

No. of Beneficiaries X Wastage/Dosages per multidoages vial

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Health & Wellness
Centre (HWC)
Sub Centre

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What First aid, referral & follow up services for high risk pregnancies are provided in HWC –
SCs ?
APH, PIH, Pre eclampsia, Severe Anaemia, IUGR, Multiple pregnancies, Gestational Diabetes ,
Hypothyroidism, Syphilis and bad obstetric history.

How identification, primary management & prompt referral of sick new born & infant are
done at HWC SC?

New Born: Low birth weight newborn <1800gms, Preterm, Sepsis, Birth asphyxia, Congenital
anomalies Infant: ARI, Diarrhoea, Jaundice, anaemia & malnutrition, developmental delays

What types of primary management, referral & follow up services for Childhood ailments are
done in HWC-SC?

Identification & follow-up of Anaemia, malnutrition, Vaccine preventable diseases, ARI,


Diarrhoea, Fever, ENT problems, Skin infections, Worm infestations, Poisoning, injuries/
accidents, 4D's,Sickle cell anaemia.

What Education, Counselling and referral services for Adolescent health are provided ?

Prevention & treatment of anaemia and other deficiencies, Counselling on life style, menstrual
hygiene, harmful effects of tobacco/substance abuse and sex education

What type of family planning services are available in HWC-SC ?


Provision of contraceptive including ECP,OCP, Injectables, condom, IUCD.

What type of Education, Counselling and referral services for family planning services are
given in HWC-SC ?
(1) Information about Family planning options to eligible clients

(2) Motivate families for spacing b/w 2 children

(3) Counselling to support couple in choosing the FP methods, Provide correct & appropriate
information about chosen method.

(4) Post abortion contraceptive counselling

(5) Referral & support for sterilization, Abortions & GBV

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How identification and referral for Obstetric and Gynaecological Conditions are done ?

 Dysmenorrhoea, Vaginal Discharge, Mastitis, Breast lump, Pelvic Pain and Pelvic
Organ Prolapse,
 Identification and management for RTI/STI

What are the Preventive & promotive services under NVBDCP provided in HWC-SC ?

Malaria, Dengue, Chinguniya, Filariasis, KalaAzar, Japanese Encephalitis

How Case detection, treatment, referral & follow up of cases under NVBDCP is done ?

(1) Diagnostic services, primary management, referral & follow up of complicated cases.

(2) Mass drug administration in case of filarasis & immunization in JE

How Preventive & promotive measures under NTEP are given?

Community engagement, facilitate referral, promote treatment completion & reducing stigma

How Case detection, treatment, referral & follow up of cases under NTEP are done in HWC-SC
?

Early identification, link with designed microscopy centre, referral & follow up of complicated
cases, & medication compliance

How Preventive & promotive measures under NLEP are done ?


Community engagement, facilitate referral, promote treatment completion & reducing stigma

How Case detection, treatment, referral & follow up of cases under NLEP are done in HWC-
SC?
Diagnostic services, primary management, referral & follow up of complicated cases, &
medication compliance

How Preventive & promotive services under NACP is done ?


Prevention & promotion among high risk behaviour groups, support to patient living with
HIV/AIDS.

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How preventive & promotive measures under NVHCP are done in HWC-SC?

Community engagement/ peer support, facilitate referral, promote treatment completion,


Convergence with other departments.

What are the diseases for which Identification, management and referral of acute illness &
minor aliments are done HWC-SC?

Fever, URIs, ARIs, Diarrhoea, Scabies, Rashes/ Urticaria, Abscess, Cholera, Dysentery,
Typhoid, Helminthiasis, Headache, Body aches, Joint aches.

What are the diseases for which preventive & promotive measures for acute illness are
monitored in HWC-SC?

Water born diseases (diarrhoea, dysentery, enteritis) Helminthiasis, rabies,musculosketal


disorders (osteoporosis, arthritis, aches )

What are the availability of services for Hypertension?

Screening, treatment compliance and follow up of all positive cases, referral & follow up for
complications and refill of drugs

What are the availability of services for Diabetes?

Screening, Diagnosis, treatment compliance and follow up of all diagnosed cases, referral &
follow up for complications and refill of drugs

What are the availability of services for Nonalcoholic fatty liver disease (NAFLD)?

Screening, treatment compliance and follow up of all positive cases, referral & follow up for
complications and refill of drugs

What are the availability of services for Cancers?

Oral, Breast, Cervical Cancers. Screening, linking with the specialist, 2 way referral& follow up
treatment compliance and complications

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What are the availability of services for respiratory diseases?

Screening, early identification , treatment compliance and follow up of all diagnosed cases,
referral and follow up for complications , refill of drugs for diseases such as COPD & Asthma.

What are the availability of services for locally prevalent health diseases & substance abuse?

Early identification, referral, & follow up care for disease such as Pneumoconiosis, Dermatitis,
Lead Poisoning, Fluorosis etc. & for substance abuse such as tobacco, Alcohol & others.

How Preventive & promotive services under NCD is done at HWC-SC?

Community engagement to promote healthy life style & address risk factor. Counselling and
IEC activities regarding harmful effects of NCDs

What are the availability of services for Ophthalmic Diseases?

 Screening & referral of Blindness, Refractive errors, Visual Acuity, Cataract


 Identification and primary treatment of Conjunctivitis, dry Eye, Trachoma, foreign
body, eye injuries
 Follow up medicines for chronic eye disease such as Cataract and glaucoma

How Preventive & promotive services for Ophthalmic diseases are done at HWC-SC?

Awareness generation, vit A prophylaxis for eye (6month -5yr), eye examination for pre term
(less than 32 weeks)

What are the availability of services for ENT Services diseases?

Identification, primary management and referral( if required) for Common Cold, , URI,
Tonsillitis, Pharyngitis, Laryngitis and Sinusitis , Epistaxis, Otomycosis, Otitis Externa, ASOM
, removal of foreign bodies, /Injuries, thyroid swelling.

How Preventive & promotive services for ENT diseases are done at HWC-SC?

Awareness generation about causes & prevention of ENT problem viz. Protection from
excessive noise, Safe listening (< 85db), improving acoustic environment, avoid self medication
and not to attempt foreign body removal at home

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What are the availability of services for early identification & referral services for oral Health
conditions?

Identification, primary management of irregular arrangement of teeth & Jaws (Malocclusion) ,


Dental Fluorosis, Cleft lip & palate, Abnormal growth , patch or ulcers, oral cancers

What are the availability of services for symptomatic management & referral services for oral
Health conditions in HWC-SC?

Gum diseases (Gingivitis, Periodontitis), Dental caries and dental emergencies (Tooth ache,
Tooth injuries , uncontrolled bleeding and abscess)

What are the services available for elderly care in HWC-SC?

 General Awareness about - Healthy life style, social security scheme for elderly and
promote active & healthy aging , identification of age related ailments and increase
supportive environment in families
 Mapping of elderly Population
 Comprehensive Geriatric assessment by Primary health Care team
 Domiciliary visits to bed ridden patients

What are the services available for palliative care in HWC-SC?

(1) Population enumeration & empanelment of cases requiring palliative care

(2) Palliative care assessment

(3) Home visit for psycho- social support and basic nursing care

(4) Dispense drugs & consumables as per requirement

What are the services available for medical Emergencies including trauma & burns in HWC-
SC?

1. Stabilization and referral services for minor injuries, animal bites, poisoning, burn,
Respiratory arrest, cardiac arrest, fractures, shock, chocking, fits, drowning,
haemorrhage, cellulitis, Acute gastro-intestinal conditions & Genito- urinary conditions
2. Identification & referral for Cysts, Lipoma, , haemorrhoids, hernia, hydrocele,
varicose veins, bed ulcers, phimosis etc.

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What are the services available of mental health in HWC-SC?

Identification, counselling & referral for Anxiety, hysteria, Depression, Neurosis, Dementia,
Mental Retardation, Autism

How Preventive & promotive services for mental health diseases are done at HWC-SC?

Awareness generation ,stigma & discrimination reduction ,community engagement, patient


support, facilitate referral, promote treatment completion etc

What is GATHER approach?

The "GATHER" approach is a mnemonic that healthcare professionals and organizations use to guide
and improve their delivery of family planning services. It helps ensure that family planning programs
are client-centered, respectful, and comprehensive. The GATHER approach stands for:

1. Greet: Begin the family planning encounter with a warm and respectful greeting. Make
clients feel welcome and valued.
2. Ask: Engage in open and non-judgmental communication by asking clients about their
reproductive health needs and goals. This step involves active listening and empathy to
understand the client's unique situation.
3. Tell: Provide clear, accurate, and unbiased information about the available family planning
methods, including their benefits, risks, and effectiveness. Tailor the information to the
client's individual needs and preferences.
4. Help: Collaborate with the client to select the most appropriate family planning method based
on their preferences, needs, and circumstances. Offer guidance and support to ensure the
client makes an informed decision.
5. Explain: Explain how to use the chosen family planning method correctly and consistently.
Address any concerns or questions the client may have about the method.
6. Return: Encourage clients to return for follow-up visits, as appropriate, and ensure they have
access to ongoing support and services. Provide information on where and how to obtain
additional supplies or seek help if needed.

The GATHER approach is designed to promote client autonomy and informed decision-making in
family planning. It emphasizes the importance of treating clients with respect and dignity while
providing them with comprehensive information and support. By following this approach, healthcare
providers can better meet the needs of their clients and improve the overall quality of family planning

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services. It's a client-centered approach that recognizes the importance of individual choice in family
planning decisions.

What are the health promotion activities & wellness session given by HWC-SC ?

VHSNC/Self help group/ Patient support groups, Health promotion campaign and multisectoral
convergence.

What counseling services for Eat Right are given by HWC-SC ?

(1) Eat Healthy: (a) Nutrition during first 1000 days of Life (b) Balanced diet (c) Food
fortification (d) Food to avoid

(2) Eat Safe: (a) Hygiene & Sanitation (b) Food Safety & Safe food practices (c) Food
Adulteration

What are the availability of basic diagnostic services including NHP at HWC-SC ?

Point of care diagnostics including RDKs as per Service delivery Hb, UPT, Urine dip stick
(albumin & Sugar) , Blood sugar, Malaria -RCT, RCT for dengue, collection of sputum sample
for TB, HIV RCT, VIA test, Test for Iodine in salt (kit), Water testing for faecal contamination
& chlorination, HBs Ag for hepatitis B, filariasis ( endemic areas), Syphilis (RTK)

What are the expanded ranges of services provided by HWC-SC?

Care in pregnancy & child birth, Neonatal & infant healthcare services, childhood & adolescent
healthcare services, family planning & reproductive healthcare services, communicable diseases
including NHPs, Common communicable disease & out patient care, Non communicable
diseases, common ophthalmic & ENT problems, Oral health, elderly & palliative care,
Emergency medical services & Mental health aliments

For what diseases affirmative action and special precaution is taken for maintaining privacy
& confidentiality to vulnerable and marginalized sections?

HIV, Leprosy , Abortion, domestic Violence, psychotic cases, GBV, abuses etc

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What are the services of linkages of providing care, counseling and Protection of vulnerable
and marginalized section?

Victims of Violence including domestic violence/ Gender Based Violence, terminally ill
patients, orphan, elderly etc. Linkage and support for treatment, counselling & Legal Support

What are the no discrimination policies in HWC-SC?

(1) there is no discrimination due to religion, cast and tribe

(2) there is no discrimination due to gender

(3) there is no discrimination due to socio economic status

(4) there is no discrimination due to ethnicity & language

What type of Anaesthetics agents available in HWC-SC?

Oxygen & Lignocaine topical (5%)

What type of Anti-allergic available in HWC-SC?

Levocetirizine tablet (5mg) , Levocetirizine Oral liquid , Hydrocortisone Succinate injection


100mg, Pheniramine inj 22.75mg/ml, Adrenaline inj 1mg/ml

What type of information regarding illness and minor ailments are recorded & updated using
IT platform?

Diagnosis, assessments, treatment plan, drugs prescribed, and follow up etc are recorded &
updated for all cases by HSC

What type of information regarding RMNCHA care seekers are recorded & updated using IT
platform ?

Diagnosis, assessments, treatment plan, drugs prescribed, and follow up etc are recorded &
updated for all cases by HSC/ referral centre

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What type of information regarding cases of communicable diseases is recorded & updated
using IT platform?

Diagnosis, assessments, treatment plan, drugs prescribed, and follow up etc are recorded &
updated for all cases by HSC/ referral centre

What type of information regarding cases of Non- communicable diseases are recorded &
updated for each case using IT platform?

(1) CBAC form is filled and complete details are updated in portal.

(2) Diagnosis, assessments, treatment plan, drugs prescribed, and follow up etc are recorded &
updated for all cases by HSC/ referral centre

What are the roles & responsibilities of Jan Arogya Samiti (JAS) ?

(1) Maintenance of HWC - cleanliness, hygiene, safe drinking water, clean toilet, BMW disposal
& clear signage.

(2) Management of grievances

(3) Ensure conduct of social audits & public hearing

(4) Coordinate celebration of Annual health calendar days

(5) Effective implementation of community level programmes viz. VISHWAS, SABLA, Eat
right campaign of FSSI, farmer groups, Self help groups, women groups, Milk unions etc.

JAS meetings are held at what intervals?

Monthly

What information are monitored in Micro planning to conduct VHND by HWC staff &
frontline workers?

(1) Advance communication regarding date & venue.

(2) Line listing of pregnant women requiring ANC, TB patients, infant or children requiring
immunisation, left or drop out children & malnourished

(3) Estimation about number of people expected to attend VHND are calculated in advance

(4) The coverage against estimation

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What type of health promotion & disease presentation activities are performed during
VHNDs?

(1) Awareness generation for various Health program

(2) Need based counseling & interventions

(3) List of topics covered during VHNDs in preceding quarter

What type of health promotion & disease prevention activities are performed by ASHA?

(1) Identify the individual with health risk

(2) Community mobilization for screening

(3) Holding or Support village meetings or campaigns for awareness generation & life style
modification

(4) Support treatment compliance for pregnant women, new born, NCD & acute of chronic
conditions as per service provision

(5) Number of new individuals identified with health risk & mobilized for screening in
preceding quarter

(6) Number of individual supported treatment compliance in preceding quarter

How the facilities ensure multi sectoral convergence for health promotion and primary
prevention?

Member from Education, WCD, ICDS, rural development/ municipal bodies, FSSAI & ICDS
etc are involved for health promotion and primary prevention.

What are the guiding principles to be followed to constitute Patient support groups for
various issues/ disease conditions?

(1) Identify the potential member & encourage them to join by explaining them the advantages
of joining

(2) Friends, relatives, frontline workers and patients suffering from same disease conditions.

(3) PSGs meetings should be open to all community members

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How HWC promotes wellness & health promotion through Yoga?

(1) Identify pool of local yoga instructors

(2) Prepare & disseminate weekly/monthly schedule of classes for community yoga trainings

How the HWC provide follow up/re assessment for cases under RMNCHA?

Reassessment /follow up as per schedule for all cases including critical /high risk patients.

Follow up includes - Treatment compliance, review of parameters, monitoring of side effect,


adherence to life style modification, timely detection of complication and continuity and
adequacy of treatment.

How the HWC provide follow up/re assessment for cases under Communicable diseases &
Non Communicable diseases?

Reassessment /follow up as per schedule for all cases including critical / high risk patients.

Follow up includes - Treatment compliance, review of parameters, monitoring of side effect,


adherence to life style modification and timely detection of complication and continuity and
adequacy of treatment.

How the HWC provide follow up/re assessment for other clinical conditions?

For Eye, ENT, oral, elderly & palliative, mental health etc -follow up includes - Treatment
compliance, monitoring of side effect, adherence to life style modification and timely detection
of complication and continuity and adequacy of treatment.

What are the referral procedure in place to ensure continuity of care?

1) Colour coded Referral slip (if possible), referral in or out register/portal, Advance
communication, prior appointment with specialist, referral vehicle (if required) & follow up.

(2) IT system to track upward & downward referrals to ensure the continuity of care

How medication orders are written legibly and updated?

(1) Every medical advice is accompanied with date, time and signature. Check orders/
instructions are comprehendible

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(2) Ask the staff what protocols are followed in case orders/instructions are not legible due use
of abbreviations, handwriting etc

What are the procedure to check the drugs before administration and dispensing?

(1) Drugs are checked for expiry and other inconsistency before administration, single dose vial /
ampule are not used for more than one dose & separate sterile needle is used every time.

(2) Check prescription from referral centre is verified every time before dispensing of the drugs
from HWC /in home visits

How Patients are counselled for self drug administration?

It is done by - Providing Medication calendars /schedules, time to take medications, medicine


related information sheets, specific packaging‘s such as pill boxes/ envelope, indicating the time/
frequency of dose.

What is High Alert drugs?

High alert drugs are medications that have been identified as having a higher risk of causing
significant harm or potentially fatal consequences if used incorrectly. These drugs require
special attention and precautions in their prescribing, preparation, dispensing, and administration
to minimize the risk of errors. High alert drugs are often associated with a higher risk of adverse
events due to factors such as narrow therapeutic indices (the difference between a therapeutic
dose and a toxic dose is small), complex dosing regimens, and potential for serious side effects.

What are the 6 Rs of drug administration?

Right Patient, Right Drug, Right Route, Right Time, Right Dose & Right Documentation.

How any untoward / adverse drug events are recorded and reported?

Recording and reporting unwanted or adverse drug events (ADEs) is a critical aspect of medication
safety in healthcare settings. The process for recording and reporting ADEs typically follows a
structured and standardized approach to ensure that healthcare organizations can learn from these
events, take corrective actions, and prevent future occurrences. Here are the general steps involved in
recording and reporting ADEs:

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1. Identification and Documentation:
o Healthcare providers identify and document ADEs as soon as they are recognized.
o Information about the ADE, including the patient's details, the drug involved, the
event's description, and any relevant clinical information, is recorded.
2. Classification and Severity Assessment:
o ADEs are classified and assessed for their severity. Common classifications include
mild, moderate, and severe.
o The severity of an ADE is determined based on the harm or potential harm it caused to
the patient.
3. Causality Assessment:
o A causality assessment is performed to determine the likelihood that the drug caused
the adverse event. Common tools for this assessment include the Naranjo algorithm
and the WHO-UMC causality assessment system.
4. Reporting to Regulatory Authorities:
o In many countries, healthcare facilities and professionals are required to report certain
types of ADEs to regulatory authorities or agencies responsible for drug safety. This is
often done through formal reporting systems.
o Reporting requirements may vary by country and regulatory agency. For example, in
the United States, healthcare providers can report ADEs to the FDA through the
MedWatch program.

5. Internal Reporting:
o Healthcare organizations often have internal reporting systems for ADEs. Healthcare
providers are encouraged to report ADEs internally to their institution's patient safety
or quality improvement teams.
6. Communication and Feedback:
o Communication about ADEs, their causes, and preventive measures is essential within
healthcare organizations. This information is shared with staff to promote learning and
awareness.
7. Education and Training:
o Healthcare professionals may receive additional education and training on medication
safety, ADE recognition, and reporting as part of the overall improvement strategy.
8. Follow-up and Monitoring:
o The progress of preventive measures is monitored, and the impact on ADE reduction
is evaluated. The process is iterative to continually improve patient safety.

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What are the procedure for CPR ?

Cardiopulmonary resuscitation (CPR) without an automated external defibrillator (AED) involves


chest compressions and rescue breaths to maintain circulation and oxygenation. Here are the steps for
performing CPR on an adult without an AED:

1. Check for Responsiveness:


o Gently tap the person and shout loudly, "Are you okay?"
o If the person does not respond and is unresponsive, proceed with CPR.
2. Call for Help:
o If someone is with you, ask them to call emergency services immediately.
o If you are alone, call emergency services yourself if possible, or do so after
performing the first cycle of CPR.
3. Open the Airway:
o Place the person on their back on a firm surface.
o Tilt their head backward slightly to open the airway.
4. Check for Breathing:
o Place your ear near the person's mouth and nose while looking at their chest.
o Check for normal breathing (taking more than occasional, gasping breaths). If the
person is not breathing normally, move on to the next steps.
5. Start Chest Compressions:
o Place the heel of one hand in the center of the person's chest (usually just below the
nipple line).
o Place your other hand on top of the first hand.
o Keep your arms straight and position your shoulders directly over your hands.
o Use your upper body weight to push down hard and fast, compressing the chest at
least 2 inches (5 cm) deep and at a rate of 100-120 compressions per minute.
o Allow the chest to fully recoil (come back up) after each compression without lifting
your hands off the chest.
6. Provide Rescue Breaths:
o After 30 compressions, give 2 rescue breaths.
o Maintain an open airway and pinch the person's nose shut.
o Give a breath that lasts about 1 second and makes the chest rise visibly.
o Repeat with a second breath.
o Continue with cycles of 30 compressions followed by 2 rescue breaths.
7. Continue CPR:

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o Continue the cycles of compressions and rescue breaths until emergency medical help
arrives or the person starts breathing normally, shows signs of life, or an AED
becomes available for use.
8. Monitor the Person:
o Continuously monitor the person's condition and provide CPR until professional
medical help arrives.

How HWC ensures timely availability of ambulances services for emergency cases ?
(1) ambulances are called & patient is shifted with information to higher centre
(2) Transfer register is maintained to record the details of the referred patient

How staff screen & refer cases of common ophthalmic aliments?

 Cataract: Clouded/ blurred or difficulty with vision at night, sensitivity to light and
glare, Need for brighter light for reading , seeing "halos" around lights, frequent changes
in eyeglass , Fading or yellowing of colours mostly age related.
 Presbyopia: having eyestrain or headaches/ fatigue after reading/ doing close work,
 Glaucoma: Severe eye pain, reddening of the eye,
 Sudden onset of visual disturbance- in low light,
 Corneal Disease: Visual impairment, blurred or cloudy vision, severe pain in the eye,
tearing, and sensitivity to light

How identification & primary management common ophthalmic conditions including


emergencies are done ?

 Conjunctivitis: Redness, itching, watery discharge from eyes and crusting around eyes.
 Trachoma: usually affect both eyes and may include: Mild itching and irritation of the
eyes and eyelids, discharge from the eyes, eyelid swelling, light sensitivity
(photophobia).
 Xeropthalmia: conjunctiva dries out, thickens, and begins to wrinkle, inability to see in
dim light, progress lesions form cornea and deposits of tissue are called Bitot‘s spots.
 Redness in eyes, removal of foreign body & allergic reactions,, eye injury and acid/
alkaline /chemical exposure etc
 Management: Symptomatic treatment, Counselling for eye care and referral if required.

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What type of promotion & supportive activities for ophthalmic care are given in HWC?

Awareness about contagious eye disease, personal hygiene, cleanliness of environment to


prevent the spread of trachoma, do's & do not's for eye care during eye infection, life style
modification, avoid myths & mis conceptions, mobilize children for vit A prophylaxis,
distribution of spectacles, follow up of referral, post operative and cases required long term
medications. Motivation for eye donation

How Screening of population for ENT aliments are done at HWC?

(1) Community based new born screening till 6 weeks of age- through home visit/ immunization,
Children- 6 week -18 yrs. -Screening through RBSK , Adults & elderly - through whisper test.

(2)Check opportunistic & planned screening form is used for early identification

How identification & primary management of common ear problems are done at HWC ?

 Acute suppurative Otitis media: irritability, ear pain, neck pain, fullness in ear, lack of
balance.
 Otitis Externa: Ear pain, itching & irritation in & around ear, ear discharge
 Otomycosis: Fullness, redness of outer ear, itching, pain.
 Ear Discharge: Otoscopy. Identification of discharge: any fluid leaking out is ear wax.
A ruptured eardrum can cause a white, slightly bloody, or yellow discharge from the ear.
Dry crusted material on a child's pillow is often a sign of a ruptured eardrum
Ear Wax removal : By syringing / instrumentation, foreign body removal.
 Treatment: Symptomatic treatment - analgesics & ear drops & warm compression
where ever required

How identification & management of nose problem are done at HWC ?

Common cold, blocked nose, injury, sinusitis, rhinitis, epistaxis and foreign body in anterior
part of nasal cavity

Treatment: Symptomatic treatment, nasal packing in case of nasal bleed, Analgesic, Nasal
drops/spray, Antibiotic may be deferred in children-two years or older with mild symptoms.
Refer the patient if persist for more than 5 days.

How diagnostic tools for identification of Nose aliments are done at HWC ?

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Patency test: Check the patency of each naris by standing directly in front of the patient and
occluding the patient's left naris with the index finger of your right hand. Ask the patient to
breathe normally through the right naris. Repeat by occluding the patient's right naris with the
index finger of your left hand and ask the patient to breathe through the left naris. Normally the
patient will be able to exhale through the unoccluded naris. Nasal obstruction is present if the
patient is unable to exhale through the nares.

Cotton wisp: Fluff of cotton is held against each nostrils & its movements are noticed when
patient inhale & exhale

How Identification & primary management of throat aliments are done at HWC ?

Injury, pharyngitis, laryngitis, URI, tonsillitis.

Treatment: Symptomatic treatment: Analgesic, antibiotic, Refer the patient if persist more than 5
days.

How to perform Heimlich maneuver/ dislodge obstruction from windpipe ?

The Heimlich maneuver, also known as abdominal thrusts, is a technique used to help dislodge an
obstruction from a person's windpipe (trachea) and is an emergency procedure for choking victims.
Here's how to perform the Heimlich maneuver on an adult, child, or infant:

For an Adult or Child (Over 1 Year Old):

1. Assess the Situation: Determine if the person is actually choking. If the person can cough
forcefully or speak, they may be able to clear the obstruction on their own. If they cannot
breathe, speak, or have difficulty breathing, then they likely need the Heimlich maneuver.
2. Stand Behind the Person: Position yourself behind the choking person, making sure you are
both stable. Encourage the person to lean forward.
3. Make a Fist: With one hand, make a fist with your thumb pointing inward.
4. Place Your Fist: Place the thumb side of your fist against the person's upper abdomen, just
below the ribcage and above the navel.
5. Grasp Your Fist: Grasp your fist with your other hand and use a quick, upward thrust to
create inward pressure. You should aim to compress the abdomen in an upward motion to
force the air out and dislodge the obstruction.
6. Repeat: Continue with rapid, upward abdominal thrusts until the object is expelled or the
person can breathe on their own or becomes unconscious.

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7. Call for Help: If the person remains unable to breathe or loses consciousness, call 911 or
your local emergency number and begin CPR, if necessary.

For an Infant (Under 1 Year Old):

The Heimlich maneuver for an infant is slightly different due to their smaller size and fragility:

1. Assess the Situation: Determine if the infant is actually choking. If they can cough or make
noise, they may be able to clear the obstruction on their own. If they cannot breathe, cough, or
make any sound, they likely need the Heimlich maneuver.
2. Hold the Infant: Place the infant face-down on your forearm, with their head lower than their
body. Use your thigh or lap for support.
3. Give Back Blows: Using the heel of your hand, give the infant up to five back blows between
the shoulder blades.
4. Turn the Infant: Carefully turn the infant onto their back while supporting their head.
5. Give Chest Thrusts: Place two or three fingers in the center of the infant's chest, just below
the nipple line, and give quick, gentle chest thrusts.
6. Repeat: Continue with back blows and chest thrusts until the object is expelled or the infant
can breathe or becomes unconscious.
7. Call for Help: If the infant remains unable to breathe or loses consciousness, call 911 or your
local emergency number and begin CPR, if necessary.

It's important to note that you should always seek professional medical evaluation after a choking
incident, even if the obstruction is cleared, as complications can arise. Additionally, it's essential to
stay calm and call for emergency help if the person does not respond to the Heimlich maneuver or
loses consciousness.

How Promotion & supportive activities for ENT services done in HWC-SC?

(1) Educating community about healthy ENT habits, awareness protection against excessive
noise, safe listening & improving acoustic environment.

(2) Teach for early care seeking behaviour for allergies & common ENT problems teach how to
instil nasal/ear /eye drops, teach how to pinch nose in case of epistaxis, perform Heimlich
maneuver etc

3) Follow up for treatment compliance

(4) Identified cases requiring surgery, hearing aid fitting or rehabilitative therapy

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How primary management & referral for Oral health conditions are done in HWC-SC?

 Tooth decay: Discoloration/ hole, sensitivity, pain, swelling / pus.


 Gum Diseases: Foul smell, bleeding, loose teeth, swollen gums
 Dental Fluorosis: White/ Yellow/ brown discoloured patched on teeth Treatment:
After symptomatic relief at H WC refer to dentist at CHC/DH.
 Malocclusion : Reverse bites, protruding/forwardly placed teeth spacing between teeth.
Treatment: Cessation of habits such as thumb sucking, mouth breathing. Refer to dentist
at DH.
 Cleft lip/palate: Split lip/gap in palate, inability to feed the baby. Refer to dentist at DH
 Oral Cancer: White/red patch, non healing ulcer, reduced mouth opening, change in
voice, lump in neck. burning sensation, inability to eat spicy food. Use of CBAC form is
filled and case is referred at appropriate level

How Screening of oral health conditions is done as per protocol ?

(1) Filling of CBAC form (more than 30yrs - Check records screening is not limited up to oral
cancers it should include screening of other dental conditions as well )

(2) Check linkage with RBSK (0-18 Yrs.)

(3) Rest 18-29 yrs. - under opportunistic screening

What are the common MNS (Mental, neurological & substance use) conditions?

 Common Mental Disorders( CMDs) : Depression, Anxiety/panic disorders,


psychosomatic disorders
 Severe Mental Disorder (SMDs) : Schizophrenia, Bipolar disorder, severe depression
 Child & Adolescent Mental Health disorder (C& AMHD): Conduct disorder,
Attention deficit disorder (ADHD), oppositional defiant disorder
 Epilepsy & dementia (Alzheimer's disease)
 Substance use disorder (SUD): Tobacco, alcohol & drug use disorder

What are the specific tools for early identification & screening of MNS is done at HWC-SC?

(1) Community informant decision tool (CIDT) is used for identification by ASHA/MPW/CHW

(2) Standard screening tools are used by CHO viz: Screening tool for dementia, Screening tools
for Epilepsy, patient health Questionnaire (PHQ-9) for depression, suicide risk assessment &

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Alcohol use disorder identification test (AUDIT) for alcohol disorders. Check staff is trained to
use these tools.

(3) Number cases screened & identified

What are the basic management, referral & follow up of MNS is done at HWC-SC?

Awareness & use of techniques for psychosocial intervention:(1) Psychoeducation,


psychological first aid, relation techniques (breathing exercise), basic suicide management, basic
counselling (problem solving & behaviour activation), community based rehabilitation, first aid
for overdose/ intoxication etc. (2) Dispensing of medicines as per prescription (3) Review &
counsel periodically Home/ community/ HWC and (4) Provide adherence support for treatment
(5) Side effects and toxicities for prescribed medications

How promotion & supportive activities for mental health services are done at HWC-SC?

(1) Awareness about improving mental health literacy, understanding of common symptoms,
reduction in social stigma, technique of self care, community based rehabilitation, Life style
modification etc

(2) Awareness & advocacy about society problems that act as risk for mental health conditions
viz. gender based violence, abuse, suicide ideation & substance dependence

How Case detection is done for Malaria?

(1) Fortnightly Home visit & testing people with current/ recent fever & chills in past 14 days
using RDT.

(2) Malaria detection in cases presenting with fever at HWC

(3) Detection by using RDT/Microscopy. (Microscopy- result should be made available within
24 hrs)

(4) Negative RDT cases strongly suspected of malaria cross checked by microscopy

(5) Check HWC is aware of confirmed malaria cases in its catchment area

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How Malaria treatment is done as per protocols?

(1) Treatment should be started within 24 hrs of detection.

(2) P. Vivax - Chloroquine/ 3days and Primaquine/14 days. (Contraindicated in pregnant female
or infant or G6PD deficiency/ P- falciparum- ACT

(3) Algorithm for treatment & diagnosis is available

At what condition Malaria cases are referred as per protocols ?

Persistence of fever even after 48 hrs of treatment, continuous vomiting, headache, dehydration,
change in sensorium, convulsions, bleeding & clotting disorders, severe anaemia, Jaundice &
hypothermia

What are the diagnostic & management of dengue as per protocols ?

(1) Diagnostic- RDK

(2) Management- Bed rest, cold sponging & symptomatic treatment.

(3) Check HWC is aware of dengue cases in its catchment area

How support, supervision & manage presumptive, confirmed & on treatment cases including
DR- TB patients are done at HWC?

(1)Provision of DOTS at Sub-centre, proper documentation and follow-up, home based support,
regular screening of cases for common adverse effects, ensure compliance & completeness of
course

(2) Check HWC is aware of presumptive, confirmed & on treatment cases in its catchment area

How HWC-SC identifies and ensures referral of suspected cases of Leprosy?

(1) Pale & reddish patches on the skin, skin thickness, shiny & reddish, numbness & tingling,
painful tender nerves, weakness of hands, feet or eyelid, swelling & lumps in the face & ear
lobes impaired sensation.

(2) Sensory testing for screening: touching the tip of pen on patch to feel sensation 2 times (once
with eyes & 2nd with closed eyes)

(3) Referral of suspected cases to higher centre. First dose initiated at higher centre

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How delivery of subsequent doses of MDT and follow up of persons under treatment?

Ensure delivery/ availability of 2nd dose onward drugs, pulse dose to be given in presence of
ANM/MPW, completion of treatment, identification of signs of neuritis, reactions etc for
treatment cases. Referral in case MCR footwear if required/ referral for complications

How awareness about leprosy & availability of its treatment is done by the HWC towards the
community?

Common activities are - Health education to community regarding signs and symptoms of
leprosy, its complications, curability & availability of free of cost treatment, self care &
encourage the patient to bring his/her contacts to check-up

What are the symptoms & syndrome under surveillance in IDSP is done at HWC ?

Fever, Cough less than 2 weeks duration, acute flaccid paralysis more than 15 yrs. of age,
diarrhoea (3 or more loose stool /day), Jaundice, Raise the signal for action in case of for any
unusual health event /death

How analysis & reporting of information for syndromic surveillance is done?

(1) Preliminary analysis & reporting of collected data to MO- PHC on every Monday

(2) Check any action has been undertaken using IDSP data

What are the process of population identification and referral for hypertension?

(1) Population enumeration -filling of CBAC form for all above 30Yrs of age- Screening at
HWC on fixed day approach-referral of suspected cases to higher centre for Consultation -
follow up of those who are diagnosed with hypertension & ensuring that they adhere to
treatment plan- identify warning signs of complication & refer to higher centre.

(2) Re screening of population (new and old) at periodic intervals - every year

What are the sign & symptoms of Hypertension ?

Systolic/ Diastolic BP of over 140 /Over 90 mm of Hg. (confirm at least after 2 reading )

Severe Headache, fatigue, nausea, sweating, feeling faint & confusion, vision problem, chest
pain, shortness of breath.

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What are the promotional & supportive activities for Hypertension is done at HWC?

Awareness generation - (a)Risk factors: overweight & obesity, Physical inactivity & stress (b)
Healthy life style: diet, exercise, avoidance tobacco & alcohol, (c ) Counselling for Lifestyle
modification (d) importance of regular follow & compliance to medication

What are the process of population identification and referral for diabetes?

(1) Population enumeration -filling of CBAC form for all above 30Yrs of age- Screening at
HWC on fixed day approach-referral of suspected cases to higher centre for consultation - follow
up of those who are diagnosed with hypertension & ensuring that they adhere to treatment plan-
identify warning signs of complication & refer to higher centre

(2) Re screening of population (new and old) at periodic intervals -every year

What are the sign & symptoms of diabetes?

Random blood sugar 140mg/dl and mg/dl. Frequent urination, increased hunger, excessive thirst,
unexplained weight loss, extreme tiredness, blurred vision, slow wound healing numbness or
tingling hands or feet & sexual problems.

How patient is counselled about identification & immediate management hypoglycaemia by


staff of HWC?

Counseling about not to miss/skip meal, take up frequent and small meals, increase physical
activity and side effects of anti diabetic drugs. Hypoglycaemia: Symptoms; tremors,
nervousness, anxiety, sweating, irritability, confusion, Heart beat increase, headache etc.
Management: Take 5-6 toffees/ Mishri/1 table spoon sugar/honey/ 2-3 teaspoon of glucose/ 3-4
tea spoon of sugar/ half cup of juice or cold drink. If symptoms persists patient should be taken
to higher centre for further management.

What are the risk factors of Nonalcoholic fatty liver disease (NAFLD) ?

1) All overweight or obese cases with diabetes or prediabetes symptoms or elevated blood lipids
or elevated blood pressure

(2) All such cases are screened for:

● Abdominal Obesity (waist circumference of ≥ 90 cm in men or ≥ 80 cm in women)

● Family H/O diabetes, hypertension, heart diseases and cancers

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● Obesity (BMI>=25kg/m2)

● Oedema examination

What promotional & supportive activities for diabetes are done by HWC?

Awareness generation - (a) Risk factors: overweight & obesity, Physical inactivity & stress (b)
Healthy life style: diet, exercise, avoidance tobacco & alcohol, (c ) Counselling for Life style
modification (d) Importance of regular follow & compliance to medication (e) Counselling
about diabetes related complication viz. Retinopathy, neuropathy & kidney failure etc.

How cancer screening services are provided through HWC?

(1) At SC/ outreach/screening for Breast, cervix & oral cancer.

(2) Screening is undertaken by trained personnel (LHV/Staff nurse/MO) can be done in outreach
session/screening day.

(3) Screening of cervical cancer is conducted on site where privacy & facility for sterilization is
available (4) Repeat screening -every 5yrs

What are the sign & symptom of cervical cancer?

Vaginal bleeding between periods, menses longer or heavier than usual, post menopausal
bleeding, bleeding & pain during/after sexual intercourse, smelly vaginal discharge, pain during
urination etc

What are the sign & symptom of Breast cancer?

Lump in breast/under arm area, thickening or swelling of breath, puckering /dimpling of breath
skin, redness in nipple area, nipple discharge /blood, constant pain etc

What are sign & symptom of Oral Cancer?

Difficulty in chewing or swallowing, mouth ulcers persist for more than 3 weeks, persistent pain,
lump, thickening in cheek, white/red patch on gums/ tongue/tonsil etc

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What methodology followed for cancer screening?

(1) Visual Inspection by Acetic Acid for cervical, (2) Oral Visual Examination for oral cancer
(3) clinical breast examination for Breast. (4) Discuss interpretation of results if done at
SC/outreach session/screening day

How promotional & supportive activities for diabetes is done ?

Awareness generation - (1)Risk factors: smoking, multiple sexual partner, unprotected sex,
family history, overweight, lack of physical activity (2) Healthy life style: diet, exercise,
avoidance tobacco & alcohol, (3 ) Counselling for Life style modification (4) importance of
regular follow & compliance to medication

What are the 5A approach for confirmation and referral of cases for Tobacco/alcohol/
substance abuse?

5A approach - Ask, advise, Assess, Assist & Arrange

(1) History taking and referral to identified de addiction centre.

(2) Advise to quite in cleat, strong and personalized manner

(3) Attempt to Quit

(4) Involve family & friends, remove substances from their adjacent area, Arrange follow up
visit

(5) motivate by re enforcing & intense follow up

What are the promotional & supportive activities for Tobacco/alcohol/ substance abuse is
done ?

(1) For Withdrawal symptoms (2) Life style support changes (3) Engagement/ linkage with
patient support groups (4) Support encouragement by family & friends

How counseling of mother's for nutrition & hygiene maintenance under Eat right initiative ?

Counsel mother's for nutritious diet during first 1000 days of life

(1) Stage 1 (During Pregnancy): Balance & nutritious diet including important nutrients like
iodine, folic acid, iron, vit B12 etc.

(2) Stage 2 ( Period from birth of child to 1 yr.): Early initiation of exclusive breastfeeding for
initial 6 months, initiation of Complementary feeding on completion of 6 months with continued
Breastfeeding

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(3) Stage 3 (Period between 12 month to 24 months of child age): Complementary feeding &
its preparation with right consistency, quantity, frequency, density & variety.

How staff counsel and guide the mother's about household preparation of complementary
feeds?

(1) Guide about household measurement with household utensils

(2) Awareness on ingredients, quantity & frequency of complementary feeding for children up
to 2 yrs.

How primary health care team generate awareness in community about balanced diet ?

(1) Generate awareness about 4 major food groups (food pyramid) - a. Cereals & millets

b. Vegetables & fruits, c. Milk & animal products d. Fats/ oils, sugar & nuts

(2) Limit the consumption of foods high in fats, sugar & salts

How primary health care team generate awareness in community about food fortification?

(1) Awareness on benefits of fortified food

(2) Identification of fortified food available in market (+F logo)

How primary health care teams generate awareness in community about Eat safe practices?

Awareness generation about maintaining personal & environmental hygiene while cooking food
(viz. handwashing, regular bathing, wearing clean clothes, keeping kitchen clean, taking pest
control measures, waste disposal, using kitchen waste for compositing etc)

How primary health care teams generate awareness in community about food safety?

(1) Awareness generation about logos on packed food viz. fssai, ISI, +F, green and red dots for
vegetarian and non vegetarian food items.

(2) Safe storage of perishable & non perishable food

(3) Precautions to be taken while cooking & serving the meals.

(4) Awareness about common tests for food adulteration (Key ring test)

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What is Key ring test for food adulteration?

The "key ring test" you mentioned is a simple and unofficial test often used to check for the presence
of formalin, a chemical commonly used as a preservative in food items, particularly in some
countries to prevent fish and meat from spoiling. The test is not a scientific or highly reliable method
for detecting formalin or other food adulterants, but it is a quick and easy field test that may raise
suspicions. Keep in mind that official food safety tests are carried out in laboratories by trained
professionals.

Here's how you can perform the key ring test:

Materials Needed:

1. A key ring
2. A small glass of water
3. A small glass of milk or a milk-based product (suspected to contain formalin)

Procedure:

1. Fill one glass with water and another with the milk or milk-based product you want to test.
2. Place the key ring into the glass of water.
3. Dip the key ring into the milk or milk-based product.
4. Observe the key ring after removing it from the milk. If the milk contains formalin, the key
ring may develop a film or residue on its surface.
5. If there is a noticeable change in the appearance or texture of the key ring, it may be an
indicator of potential adulteration with formalin.

However, it's important to emphasize that the key ring test is not scientifically validated, and its
results can be influenced by various factors, including the temperature, composition of the milk or
milk-based product, and other substances present. For accurate and reliable testing of food
adulteration, it is recommended to use official laboratory methods and consult food safety authorities
or professionals.

How elderly population is mapped & screened by HWC staff?

(1) Mapping of elderly population in category of Bed bound ,restricted & mobile elderly,
destitute, poor & single

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(2) Screening using comprehensive Geriatric assessment tools

(3) Primary management & timely referral

What are the various geriatric tools used for elderly population?

(1) Activity of daily living

(2) Geriatric depression scale,

(3) Mini mental state examination.

(4) Check how many cases are identified & referred (if required)

How promotional & supportive activities for Geriatric care are done at HWC?

(1) Health education regarding healthy aging, environmental modifications, nutritional


requirements, life style & behaviour changes (2) Educate family members for looking after
disabled elderly person (3) Linkage with support group & day care centre. (4) Motivate to join
annual health check-up at village level

How screening, basic management & referral of palliative Care patient is done?

(1) Assessment using Palliative care screening tool by CHO / MPW

(2) Scheduled visits to patients/ families for basic nursing care/drugs or consumables dispensing
/psycho social support.

(3) Referral of palliative patients based on pain score

How Home based palliative care services are being provided?

(1) Palliative care team is constituted, comprising of CHO, MPW, ASHA & volunteer.

(2) Updated roster for undertaking scheduled visits.

(3 Compliance to roster

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How promotional & supportive activities for palliative care?

(1) Health education regarding needs of palliative patients (2) Educate family members for
routine home based care (3) Linkage with support group & day care centre. (4)Help in assessing
various services as needed

What are the danger signs of new born & infant?

Not able drink or breast feed, vomiting, convulsions, lethargy Discharge from cord, pallor,
cyanosis, Jaundice, pustules, hypothermia, unable to pass stool/urine, fever, diarrhoea, indrawing
of the chest (2-12 months-50 breaths/min & 12-5yrs-40 breaths/min)

How ETAT protocol for infants at HWC Sub centre are being followed ?

The Emergency Triage, Assessment, and Treatment (ETAT) protocol is primarily designed for
healthcare facilities, including primary health centers, that have some medical resources and trained
staff. Subcentres, which are smaller healthcare facilities typically found in rural areas, may not have
the same resources and capabilities as larger health centers or hospitals. However, basic care for
infants can still be provided at subcentres, and healthcare providers in such settings can follow a
simplified version of the ETAT protocol.

Here is a simplified version of the ETAT protocol for infants at subcentres:

1. Assessment:

 Begin by assessing the infant's general condition, including breathing, circulation, and level of
consciousness.
 Check vital signs such as heart rate, respiratory rate, temperature, and oxygen saturation if
available.
 Assess for signs of distress, such as difficulty breathing, cyanosis (bluish skin), or altered
consciousness.

2. Triage:

 Based on the assessment, categorize the infant into one of the following groups:
o Emergency: Infants with life-threatening conditions, such as severe respiratory
distress, severe dehydration, or altered consciousness.
o Urgent: Those who require prompt care but are not immediately life-threatening.

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o Non-urgent: Stable infants who can be seen in the regular queue for routine care.

3. Basic Treatment:

 Provide immediate interventions as necessary, such as:


o Oxygen therapy if the infant has severe respiratory distress or low oxygen saturation.
o IV access if possible for fluid administration or medication. If IV access is not
available, consider intraosseous (IO) access if trained to do so.
o Hydration and oral rehydration for infants with dehydration.
o Medications as prescribed for specific conditions.

4. Monitoring:

 Continuously monitor the infant's vital signs and clinical condition.


 Adjust treatment based on the infant's response to interventions.

5. Referral:

 For infants with conditions that cannot be adequately managed at the subcentre, consider
arranging timely referral to a higher-level healthcare facility. Ensure that the family or
caregivers are informed and understand the need for referral.

6. Documentation:

 Accurately document the infant's condition, assessment findings, treatment administered, and
response to treatment in the patient's record.

7. Continuing Education:

 Healthcare providers at subcentres should receive regular training and continuing education to
maintain their skills in assessing and managing pediatric emergencies.

It's important to note that subcentres may have limited resources and may not have the capacity to
provide advanced medical care. In such settings, healthcare providers may need to prioritize
stabilization and timely referral for infants with severe or complex conditions. The focus is on
providing the best care possible within the available resources and capacity. Local healthcare
guidelines and protocols should be followed to ensure the appropriate care of infants in subcentres.

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What are the post natal care counselling done by HWC?

Exclusive breast feeding, cord care, maintenance of temperature, promoting hygiene practice,
support for high risk babies.

What guidelines are being followed for reconstituted vaccines which are not to be used after
recommended time?

(1) BCG, measles and JE vaccines are constituted and till when these are valid for use. Those
should not be used beyond 4 hours after reconstitution.

(2) Vials should be kept in plastic box with label ' NOT TO BE USED' & discarded after 48
hrs/ before the next session, whichever is earlier.

What are the four Stages of VVM check of vaccine?

The Vaccine Vial Monitor (VVM) is a temperature-sensitive label used to monitor the exposure of
vaccines to excessive heat. It helps ensure that vaccines remain within the recommended temperature
range during storage and transportation. The VVM check typically involves four stages:

5. Pre-Activation Stage: This is the initial stage before the vaccine vial is used. The VVM label
is in its original state, and it is not yet activated. At this stage, the label appears uniform, with
no color change.
6. Activation Stage: Once the vaccine vial is exposed to heat or reaches a critical threshold
temperature, the VVM label begins to activate. This stage is marked by a gradual change in
color on the label. The color change represents the cumulative heat exposure over time.
7. Passive Stage: The VVM label enters the passive stage after activation. In this stage, the
color change on the label remains stable and does not continue to progress, as long as the
vaccine is stored within the recommended temperature range. This indicates that the vaccine
is safe to use.
8. Critical Stage: If the vaccine is exposed to excessive heat, the VVM label will reach the
critical stage. At this point, the label undergoes a more rapid and irreversible color change.
This signals that the vaccine may no longer be safe and effective and should not be used.

Healthcare workers and vaccine providers use the VVM as a visual indicator to assess the quality of
vaccines. When the VVM label reaches the critical stage, it signifies that the vaccine has likely been
compromised by heat exposure and should not be administered.

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How check freeze damage for T-Series vaccines ?

Checking for freeze damage in vaccines, including T-Series vaccines, is crucial to ensure their
effectiveness and safety. Freeze damage can occur when vaccines are exposed to temperatures below
their recommended storage range, which can render them ineffective or even harmful. Here are steps
to check for freeze damage in vaccines:

1. Visual Inspection:
a. Examine the vaccine vials or containers for any visible signs of damage. Look for
changes in the appearance of the vaccine, such as cloudiness, precipitation, or the
formation of particles.
b. Check the integrity of the vial or container. If there are signs of cracks, breakage, or
leakage, this could indicate freeze damage.
2. Temperature Monitoring:
a. Review the temperature logs or data from the storage units where the vaccines are
stored. Check if there have been any temperature excursions outside the recommended
storage range, especially freezing temperatures.
3. Shake Test:
a. Perform a shake test on the vaccine vial. Gently shake the vial and observe whether
the contents appear clumpy, cloudy, or discolored. These changes may indicate freeze
damage.
4. Temperature-Sensitive Labels:
a. Many vaccines, including T-Series vaccines, may have a Vaccine Vial Monitor
(VVM) or similar temperature-sensitive label. Check the VVM for any color changes
that indicate exposure to freezing temperatures.
5. Record Review:
a. Review the vaccine storage and handling records to ensure that the vaccines have been
stored within the recommended temperature range. Any deviations from this range
should be investigated.
6. Consultation with Experts:
a. If there are any doubts or concerns about freeze damage, consult with healthcare
professionals or vaccine experts who can provide guidance and make an informed
assessment.
7. Safety Precautions:
a. If there is a strong suspicion of freeze damage or if the vaccine's integrity is
compromised, do not use the vaccine. Properly dispose of the damaged vaccine
according to local regulations and guidelines.

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What are the 4 key Messages after vaccination/ immunization?
Vaccine Details, Next vaccination date, Minor Adverse effect that may occur, Safe keeping of
immunization card. Always ask to 30 minutes to wait after any vaccination.

What are the procedures to check drug before administration/ dispensing?


 Check the patient name / age and unique number
 Check the drug name and compare with the drug prescribed by the doctor
 Check for expiry and other inconsistency before administration
 Check single dose vial are not used for more than one dose
 Check for any open single dose vial with left over content intended to be used later on
 Check for separate sterile needle is used every time for multiple dose vial
 Check in multi dose vial needle is not left in the septum
 In case of any adverse drug reaction it should be recorded and reported

How to conduct Shake test for DPT, DT and TT?


The "shake test" is a common practice used to check the reconstitution of vaccines such as DPT
(Diphtheria, Pertussis, Tetanus), DT (Diphtheria, Tetanus), and TT (Tetanus Toxoid) vaccines
after reconstitution with a diluents. This ensures that the vaccine powder and the diluents have
mixed properly, and the vaccine is ready for administration.

The "shake test" of a vaccine is a quality control procedure used to verify the solution is uniform
and ready for safe and effective administration.

The process involves gently shaking the reconstituted vaccine vial to check for the following:

 Homogeneity: The solution should appear uniform and well-mixed without any visible
clumps, particles, or separation. Any signs of incomplete mixing could indicate that the
vaccine might not be effective or safe to administer.
 Absence of Sediment: There should be no sediment at the bottom of the vial, as this
could indicate that the vaccine components have not mixed properly.
 Consistency: The solution should have a consistent color and texture throughout,
without variations or color changes.
 Lack of Frothing or Foaming: Vigorous shaking could lead to frothing or foaming,
which could affect the vaccine's accuracy and dosage.

Tilt the vial to observe the solution's uniformity. It should appear homogeneous and well-mixed,
without any visible clumps or sediment.

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The shake test is an important step in ensuring the quality and efficacy of vaccines. Improper
reconstitution can lead to under dosing or overdosing, which can impact the vaccine's
effectiveness and safety.

It's important to note that the specific procedures for reconstitution and performing the shake test
may vary based on the type of vaccine and the manufacturer's instructions. Always follow the
manufacturer's guidelines

What is anaphylaxis and AEFI?


Anaphylaxis and AEFI (Adverse Events Following Immunization) are both terms related to the
field of immunization and healthcare. They refer to different aspects of reactions that can occur
after receiving vaccines.

Anaphylaxis:
Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur shortly
after exposure to an allergen, including certain components of vaccines. Anaphylaxis involves
a rapid and severe immune response that can affect multiple body systems, leading to
symptoms such as difficulty breathing, swelling of the face and throat, a sudden drop in blood
pressure, and hives. Anaphylaxis requires immediate medical attention, as it can lead to shock
and even death if not treated promptly with medications like epinephrine (adrenaline). In the
context of vaccines, anaphylactic reactions are extremely rare but are a recognized concern.
Healthcare providers are trained to identify and manage anaphylactic reactions during the
administration of vaccines. People with a history of severe allergic reactions to vaccine
components or other allergens should consult their healthcare provider before receiving
vaccines.

AEFI (Adverse Events Following Immunization):


AEFI refers to any untoward medical occurrence that follows immunization, which might or
might not be related to the vaccine itself. AEFI can encompass a wide range of reactions, from
mild and transient to serious and rare. It includes both expected reactions, such as soreness at
the injection site or mild fever, as well as unexpected reactions.
AEFI surveillance is crucial for monitoring the safety of vaccines and ensuring their ongoing
effectiveness. Healthcare systems and regulatory authorities have mechanisms in place to
collect and analyze information about adverse events after vaccination. This helps identify
potential safety concerns and ensure that vaccines are safe for public use.
Types:

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 Minor - Usually occur within a few hours of injection. Resolve after short period of
time and pose little danger.
 Severe - Can be disabling and, rarely life threatening. Most do not lead to long-term
problems. Must be reported
 Serious – Extreme condition may lead to death or persistent or significant disability.
Inpatient hospitalization is needed.

** All categories of AEFI are to be recorded in AEFI register

WHO cause specific definition of AEFIs:

In summary, anaphylaxis is a severe reaction that can occur after exposure to allergens,
including vaccine components, while AEFI refers to any adverse medical event that follows
immunization
** Always check latest Clinical & Departmental Guidelines in this regard.

How assessment for identification of ARI, diarrhoea, malnutrition and Other Illness are done
?

 ARI: Chest indrawing difficulty in breathing ,coughing, fever, fast breathing


 Malnutrition: Weakness/wasting, check weight for age, check height for weight

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 Diarrhoea: Sunken eyes, lethargic, unconscious, restless, irritable, pinch skin

How assessment for identification of possible serious bacterial infections among young infant
(0-59 days) & children (2 -59 months) is done ?

Young infant- Not able to feed or convulsion or fast breathing >60/ min or severe chest
indrawing or axillary temp 37.5 OC or more or movement only when stimulated

Children - General danger signs, or chest indrawing - very severe or severe pneumonia

Fast breathing - RR -2-11month >or equal 50/min

12-59 months> or equal 40/min- Pneumonia

How management of possible serious bacterial infection are done as per protocols?

(1) Give first dose of oral Amoxicillin and injectable Gentamycin.

(2) Treat or prevent low sugar (breastfeed/ age appropriate feed)

(3) Warm the young infant if temp is less than 35.5 OC.

(4) Advise mother to keep young infant warm & refer urgently to hospital

What is BRAIDED Approach of family planning counseling?

The BRAIDED approach is a framework used for family planning counseling and discussions. It
stands for the following key elements:

B - Benefits: Start the counseling by discussing the benefits of family planning with the individual or
couple. Explain how it can help them achieve their reproductive goals, improve their health, and
enhance their overall well-being. Mention benefits such as better spacing between pregnancies,
reduced maternal and child mortality, and improved economic and social outcomes.

R - Risks: Provide information about the potential risks or side effects of different contraceptive
methods. It's important to address concerns and clarify any misconceptions. Discuss both common
and rare side effects and complications, emphasizing that the benefits often outweigh the risks.

A - Alternatives: Present the various family planning options available to the individual or couple.
Explain the different methods, their efficacy, how they are used, and their advantages and

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disadvantages. Make sure the individuals are aware of the full range of choices, including both short-
acting and long-acting methods.

I - Individualization: Tailor the counseling to the specific needs, preferences, and circumstances of
the person or couple. Consider factors like age, medical history, reproductive goals, and personal
beliefs. This helps in choosing the most suitable contraceptive method.

D - Decision: Encourage the individual or couple to actively participate in the decision-making


process. Allow them to ask questions and express their concerns and preferences. The final choice
should be informed and based on shared decision-making between the provider and the individual or
couple.

E - Education: Provide comprehensive education on the selected contraceptive method. Explain how
it works, how it should be used, and what to expect. Discuss the importance of consistent and correct
use to maximize its effectiveness.

D - Documentation: Ensure that proper documentation is maintained, including the method chosen,
any informed consent, and follow-up appointments if necessary.

The BRAIDED approach is designed to facilitate open and respectful communication between
healthcare providers and individuals or couples seeking family planning services. It empowers
individuals to make informed choices that align with their unique circumstances and preferences
while also ensuring they understand the benefits, risks, and alternatives of the chosen method. This
approach promotes contraceptive knowledge, adherence, and satisfaction, ultimately contributing to
better reproductive health outcomes.

What are the options, indications & methods for administration for Oral Contraceptives?

(1) Hormonal (Combined oral pill) ,Non Hormonal (Chaya) & Emergency Contraceptives.

(2) Combined oral Pill taken at fixed time daily

ECP_ within 72hrs, second dose 12hrs after first dose

Chhaya / Centchroman: to be taken twice a week for the first 3 months followed by once a
week thereafter. Check for Chhaya / Centchroman eligibility is checked & confirmed by MO.
Dose may be started by trained HCW

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How IUD insertion & follow up is done as per standard protocol?

No touch technique, Speculum and bimanual examination, sounding of uterus and placement.
Follow up : when to return / removal of IUCD. Check In case of 2nd trimester abortion IUCD is
provided by Qualified Medical officer

What Injectable Contraceptives are given as per protocols?

Check the eligibility for injectables are checked & confirmed by MO. Dose may be started/
continue by trained HCW. Depot MPA can be given IM or Subcutaneous,

IM: single dose vial with disposal syringe & needle. Subcutaneous: Pre filled AD syringe

What are the case selection criteria for methods for family planning?

For sterilization: 22-49 yrs.- (female) & 22-60yrs (male), married, youngest child is at least one
year & spouse has not opted for sterilization. Counselled & referred to Higher centre

How post sterilization follow up are done at HWC for supporting & encouraging the clients?

Female Sterilization: Certification is issued one month after the surgery or after the first
menstrual period, whichever is earlier.

Male Sterilization; Certificate is issued only after three months once the semen examination
shows no sperm, certificate can be delayed till 6 months if the semen shows sperm after 3
months

How education & counselling services for adolescent is done ?

Nutritional Counselling, advice on topic related to Growth and development, puberty, myths &
misconception, pregnancy, safe sex, menstrual disorders, anemia, sexual abuse ,RTI/STI's etc.

How treatment & referral of common RTI/STI's, Nutritional Anaemia & Menstrual disorders
are done at HWC?

Haemoglobin estimation, weekly IFA tablet, and treatment for worm infestation, Symptomatic
treatment , counselling , TT at 10 and 16 year. Referral linkages to ICTC and PPTCT

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What are the ANC check-up as per recommended schedule done at HWC?

4 ANC Visits

 (1st - < 12 Weeks


 2nd - < 26 weeks
 3rd - < 34 weeks
 4th >34 to term)
ANC registers whether all 4 ANC covered for most of the women (sample cases). One ANC
visit is attended by Medical Officer (Preferably 3rd Visit -28-34 Weeks)

How Comprehensive Obstetric history is recorded?

(1) History of pervious pregnancies including complications and procedures done, if any, is
taken. History of current or past systemic illness like Hypertension, Diabetes, Tuberculosis,
Rheumatic Heart Disease, Rh Incompatibility, malaria, etc. is taken.

(2) Allergies to drugs, any treatment taken for infertility.

What Physical Examination & vitals of Pregnant Women is done on every ANC visit?

Pulse, Respiratory Rate, Pallor, Oedema. Height, weight & BP has been measured and recorded
at every ANC visit Observation and Correction of Flat or Inverted Nipples, Palpation for any
Lumps or Tenderness

How abdominal Examination of pregnant women is done as per protocol?

Measurement of Fundal Height (ask staff how she correspond fundal high with Gestational
Age), Auscultation for foetal heart sound, Palpation for Foetal lie and Presentation

What diagnostic test for every pregnant women is done ?

 1.Check for Haemoglobin, confirmation of pregnancy, urine albumin & sugar blood,
blood sugar, Malaria. Check randomly any 3 MCP card/ ANC record for Haemoglobin
test is done at every ANC visit and values are recorded.
 Haemoglobin & urine albumin & sugar test is done on every ANC visit

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How to identify Pre-Eclampsia ?

 Pre - Eclampsia- High BP with Urine Albumin (+2)


 Imminent eclampsia -BP >140/90 with positive albumin 2++, severe headache, Blurring
of vision, epigastria pain & oliguria in Urine

How to identify Hypertension / Pregnancy Induced Hypertension?

Hypertension & Pre Eclampsia, (Hypertension - Two consecutive reading taken four hours apart
shows Systolic BP >140 mmHg and/or Diastolic BP > 90 mmHg

What clinical conditions need referral to higher centre (FRU)?

Severe Anaemia, Bad obstetric history, CPD, PIH, APH, Medical Disorder complicating
pregnancy, Malpresentation, foetal distress, PROM, obstructed labour.

Classify anaemia according to Haemoglobin Level?

 >11 gm% -Absence of Anaemia,


 10 to 11 gm% - Mild Anaemia,
 7-10 gm% Moderate Anaemia
 <7 gm% Severe Anaemia

How to identify high risk cases based on abdominal examination?

Identification and referral of cases with Cephalo-pelvic presentation, Malpresentation, medical


disorder complicating pregnancy, IUFD, amniotic fluid abnormalities.

How prophylactic & therapeutic dose of IFA & progress is monitored ?

1. Prophylactic - one IFA tablet per day for six months during ANC &PNC.

2. Therapeutic dose- double the dose in case of anaemia.

3. Improvement in haemoglobin label is continuously monitored and recorded

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What is the danger signs during pregnancy counseled to recognize?

Swelling (oedema), bleeding even spotting, blurred vision, headache, pain abdomen, vomiting,
pyrexia, watery & foul smelling discharge & Yellow urine

How Pregnant women is counselled diet, rest, breast feeding & family planning ?

 Increase Dietary Intake


 Diet rich in proteins, iron, vitamin A, vitamin C, calcium and other essential
micronutrients. Initiate breastfeeding especially colostrum feeding within an hour of
birth.
 Do not give any pre-lacteal feeds. (Sugar, water, Honey)
 Ensure good attachment of the baby to the breast.
 Exclusively breastfeed the baby for six months.
 Breastfeed the baby whenever he/she demands milk.
 Follow the practice of rooming in. Different Options available including IUCD,
PPIUCD, vasectomy, long acting injectable, etc.

What counseling is provided to recognize sign of labour & arrange for referral transport for
pregnant women’s ?

A bloody, sticky discharge and regular painful uterine contractions. ANM / CHO provide
contact number and transport to the pregnant lady.

How to ensure safe and potent vaccines?

Before beginning your immunization session, and before giving each vaccine, follow these steps to
ensure that every dose that you are going to give is safe and effective:

 Check label: Make sure the label on the vaccine vial is attached and clear enough to read. If
you find that the label is not clear enough to read or has come off, discard the vial.
 Check vaccine: Check that the vaccine being given is the correct one.
 Check expiry: Look for the expiry date on the vial. If the expiry date has passed, do not use
the vial; Discard it.
 Check the vaccine vial monitor (VVM) on vials to make sure that the vaccine is in the
usable stage.

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What is Open Vial Policy?

Open Vial Policy has been developed to minimise and prevent vaccine wastage under the UIP.
It permits the reuse of partially used multi dose vials of relevant vaccines under UIP in succeeding
sessions up to 28 days PROVIDED certain conditions are fulfilled. It is essential that the policy is
followed correctly, so as to minimize wastage, adverse effects following immunization and ensuring
that the vaccination is effective.
Open Vial Policy is valid for the following vaccines:
• DPT, Td & TT,
• Hepatitis B,
• Oral Polio Vaccine (OPV)
• PCV
• Haemophilus influenzae type B (Hib) containing Pentavalent vaccine and
• injectable Inactivated Poliovirus Vaccine (IPV).
Open Vial Policy does NOT apply to:
• Measles,
• BCG and
• Japanese Encephalitis (JE) vaccines.
• Rotavirus vaccine

Provided that certain conditions are upheld, a vial of the vaccine that has been opened during a
session can be utilized for multiple immunization sessions WITHIN a period of 28 DAYS.
• The expiry date has not passed.
• The vaccines are stored under appropriate cold chain conditions both during transportation and
storage in cold chain storage point.
• The vaccine vial septum has not been submerged in water or contaminated in any way.
• Aseptic technique has been used to withdraw vaccine doses. (That is needle/septum has not been
contaminated in anyway)
• The vaccine vial monitor (VVM), has not reached/crossed the discard point.

A vaccine vial should be DISCADED if any of the following conditions are met and the Medical
Officer or Supervisor should be informed:

A vaccine vial should be DISCADED if any of the following conditions are met and the
Medical Officer or Supervisor should be informed:
o VVM reached/crossed discard point (for freeze dried vaccine, before
reconstitution only) or vaccine vials without VVM or disfigured VVM.

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o No label/partially torn label and/or writing on label not legible.
o Any vial thought to be exposed to non-sterile procedure for withdrawal.
o Open vials that have been under water or vials removed from a vaccine carrier
that has water.
o If vaccine vial is frozen or contains floccules or any foreign body.
o If there is breakage in the continuity of the vials (crack/leaks).
o If there is any reported AEFI following use of any of the vaccine vial, do not
use it, and retain it safely.

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INVENTORY
MANAGEMENT
SYSTEM

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Hospitals maintain a wide range of inventory items to support patient care, medical procedures, and
operational needs. The types of inventory in hospitals can be categorized into several main groups:

1. Medical Supplies: These are consumable items used in patient care and medical procedures.
They include:
 Bandages, dressings, and wound care supplies
 Gloves, masks, and other personal protective equipment (PPE)
 Syringes, needles, and medical instruments
 Catheters and tubing
 Gauze pads and swabs
 IV (intravenous) fluids and administration sets
 Disposable medical equipment (e.g., blood pressure cuffs)

2. Pharmaceuticals: Hospitals stock a variety of medications to treat patients. Pharmaceutical


inventory includes:
 Prescription medications
 Over-the-counter medications
 Anesthetics and pain relievers
 Antibiotics and antivirals
 Vaccines and immunizations

3. Surgical Supplies: These items are used in surgical procedures and other invasive medical
interventions:
 Surgical instruments and tools
 Surgical drapes and gowns
 Sutures and staples
 Surgical gloves

4. Diagnostic Equipment and Supplies: Inventory related to diagnostic procedures includes:


 Imaging supplies (e.g., contrast agents)
 Laboratory reagents and testing supplies
 Diagnostic test kits

5. Patient Care Equipment: Hospitals maintain various equipment to monitor and support
patients' health:
 Patient monitors (e.g., vital signs monitors)

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 Respiratory equipment (e.g., ventilators)
 Mobility aids (e.g., wheelchairs, walkers)
 Infusion pumps
6. Emergency Supplies: Hospitals need to be prepared for emergencies, and their
inventory may include:
 Trauma kits and emergency medical supplies
 Disaster response supplies

7. Office Supplies and Administrative Items: These are essential for the operational aspects of
the hospital:
 Office stationery (paper, pens)
 Administrative forms
 Cleaning supplies

8. Facility Maintenance Supplies: Inventory for maintaining the hospital facility includes:
 Cleaning / disinfection and janitorial supplies
 Maintenance tools and equipment

9. Food and Nutrition Inventory: For hospitals with kitchens or dietary services, this inventory
includes:
 Food supplies for patient meals
 Nutritional supplements

10. Linens and Bedding: Inventory for patient comfort and hygiene includes:
 Bed linens
 Towels and washcloths

11. Administrative and operational equipment (computers, printers)


 Furniture and fixtures
 Educational materials for patients

Proper inventory management is crucial in hospitals to ensure that the right items are available when
needed, patient care is not compromised, waste is minimized, and costs are controlled. Hospitals
often employ specialized inventory management systems and protocols to manage these diverse
inventory items efficiently.

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What is Inventory Management?

Inventory management refers to the process of overseeing, controlling, and optimizing a inventory of
drugs / equipments/ instruments / other goodsetc. It involves various activities related to acquiring,
storing, tracking, and managing inventory items in a way that ensures efficient operations and
optimal utilization of resources. Effective inventory management aims to strike a balance between
having enough stock to meet patient demand while minimizing excess inventory that ties up storage
space.

Definitions of some Key components of inventory management include:

 Inventory Tracking: Monitoring the movement of items as they enter and exit the inventory,
allowing maintaining accurate records of stock levels and changes.

 Demand Forecasting: Predicting future demand for inventory based on the previous three
months consumption or for any emergency situation to ensure that enough stock is available
to meet this demand without leading to overstocking or stock outs.

 Reorder Point/ Level: Determining the minimum level of inventory at which new orders
should be placed to replenish stock before it runs out, considering lead times and demand
fluctuations.

 Lead Time: The time between placing an order and receiving the items is the lead time.
Hospitals consider this time when deciding when to indent.

 Buffer Stock: Maintaining a Safety Stock of extra inventory to account for unexpected spikes
in demand or delays in supply, preventing stock outs during unexpected situations, usually
25% extra from the average three months consumption.

 Economic Order Quantity (EOQ): Calculating the optimal order quantity that minimizes
the total cost of ordering and holding inventory, considering factors like order costs, carrying
costs, and demand.

 Just-in-Time (JIT) Inventory: A strategy that aims to minimize inventory by receiving


goods only when they are needed, reducing excess inventory and associated costs.

 Waste Reduction: Minimizing product waste and spoilage by managing expiration dates,
shelf life, and handling procedures.

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What are FIFO, LIFO and FEFO Inventory Management?

FIFO, LIFO, and FEFO are different inventory management methods used to determine the order in
which inventory items are used. These methods have implications for, accounting, and overall
inventory management practices. Here's what each method entails:

4. FIFO (First-In, First-Out): FIFO is an inventory management method where the oldest
inventory items are assumed to be the ones used first. In other words, the items that enter the
inventory first are the ones that are also considered to be used first. This method is
conceptually similar to how goods move through a queue or line - the first item in is the first
one to be processed.

5. LIFO (Last-In, First-Out):LIFO is an inventory management method where the newest


inventory items are assumed to be used first. This means that the most recently acquired or
produced items are the ones attributed to sales or usage before older items.

6. FEFO (First-Expire, First-Out):FEFO is a specialized inventory management method often


used in dealing with perishable goods or items with early expiration dates, such as food,
pharmaceuticals, and chemicals. In FEFO, the inventory with the earliest expiration date is
assumed to be used first to minimize wastage due to expiration.

What is ABC analysis?

ABC analysis, also known as the ABC classification or ABC method, is a widely used technique in
inventory management and optimization. It categorizes items in a given inventory into three groups
based on their relative importance, value, or impact on the overall performance of the system. This
technique helps to allocate their resources and efforts more effectively by focusing on the most
critical items.

In the context of a hospital's inventory management, ABC analysis can be applied to medical
supplies, medications, equipment, or other resources that the hospital needs to function efficiently.

Here's how it works:

 Group A (High Priority): This group includes items that have the highest value or impact on
the hospital's operations. These are typically high-cost items, critical medications, or supplies
that are needed for emergency situations. A relatively small number of items often account for
a significant portion of the inventory's value or usage.

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 Group B (Medium Priority): This group contains items of moderate value or importance.
These items are necessary for routine operations but might not have the same criticality as
Group A items. They have a medium impact on the hospital's overall functioning.
 Group C (Low Priority): This group consists of items with the lowest value or importance.
These items are often numerous and inexpensive, but they still contribute to the smooth
functioning of the hospital. Examples might include office supplies or non-urgent medical
supplies.

The goal of the ABC analysis is to prioritize the management and control of items based on their
classification. Hospitals can use this information to:

 Ensure Availability: Group A items should always be available to prevent disruptions in


critical medical procedures or patient care.
 Optimize Inventory Levels: Group B items can be managed with moderate attention to
balance cost and availability.
 Simplify Procurement and Storage: Group C items can be managed more loosely due to
their lower impact on operations.

By categorizing inventory items in this way, hospitals can make informed decisions about reorder
points, safety stock levels, procurement strategies, and storage space allocation.

What is VED analysis?

VED analysis is another technique used in inventory management, particularly in the context of
hospitals and healthcare facilities. VED stands for Vital, Essential, and Desirable, and it's a method of
categorizing items in an inventory based on their criticality to the healthcare operations. This analysis
helps hospitals ensure the availability of essential items and manage their inventory more effectively.

 Vital Items (V): These are items that are absolutely essential for the hospital's operations and
patient care. These items are crucial for saving lives and providing critical medical
interventions. Examples might include life-saving medications, specialized medical
equipment for emergency situations, and supplies needed for intensive care units etc.
 Essential Items (E): Essential items are important for the hospital's routine functioning and
patient care. While they might not be immediately life-saving, they are necessary for various
medical procedures and treatments. Examples could include common medications, general
antibiotics, standard medical equipment, and supplies needed for regular patient care etc.

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 Desirable Items (D): Desirable items are those that enhance the comfort and convenience of
patients and staff but are not critical for medical care. These items can include supportive
medical supplies, Vitamins or antioxidants, amenities for patient rooms, and administrative
supplies etc.

Here's how VED analysis benefits hospital inventory management:

 Priority Management: Hospitals can focus their attention and resources on ensuring the
availability of vital and essential items, minimizing the risk of running out of critical supplies.
 Resource Allocation: By categorizing items, hospitals can allocate resources more effectively,
making sure that the most crucial needs are met first.
 Inventory Optimization: The analysis can guide inventory replenishment strategies, reorder
points, and stock levels for different categories of items.
 Risk Mitigation: Hospitals can identify potential risks associated with the scarcity of vital
items and develop contingency plans to address such situations.

VED analysis should be regularly reviewed and updated to accommodate changes in hospital
operations and medical practices.

How Inventory Demand Forecasting are done in hospitals?

 Historical Data Analysis: This method involves analyzing historical consumption data
to identify patterns and trends. Hospitals can use past usage data (eg; of last three
months) for specific items to predict future demand.

 Seasonal and Cyclical Patterns: Some medical supplies and treatments might be
affected by seasonal or cyclical patterns. Hospitals can use historical data to identify
these patterns and adjust their inventory levels accordingly.

 Forecasting for Special Events: Hospitals can predict demand for specific items
related to special events, medical camps, health awareness campaigns, or community
health programs or any disaster events recently happened.

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DISASTER
MANAGEMENT &
FIRE SAFTEY

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What do you mean by Disaster and what are the disasters can happen in hospitals?

Disaster, as defined by the United Nations, is a serious disruption of the functioning of a


community or society, which involves widespread human, material, economic or environmental
impacts that exceed the ability of the affected community or society to cope using its own
resources. Disaster management is how we deal with the human, material, economic or
environmental impacts of said disaster, it is the process of how we ―prepare for, respond to and
learn from the effects of major failures‖. Though often caused by nature, disasters can have
human origins.

Types of disaster in hospitals:

1. Natural Disasters:
 Earthquakes: Earthquakes can cause structural damage to hospital buildings,
disrupt utilities, and impact medical equipment.
 Floods: Flooding can damage facilities, medical equipment, and disrupt access
to hospitals, affecting patient care.
 Hurricanes and Cyclones: These storms can cause power outages, structural
damage, and flooding, impacting hospital operations and patient care.
 Wildfires: Wildfires can threaten hospitals in their path, causing evacuations
and affecting air quality.
 Tornadoes: Tornadoes can cause severe damage to hospital structures and
infrastructure.
2. Human-Made Disasters:
 Fires: Fires within or near hospitals can lead to evacuations, damage to facilities,
and compromise of critical resources.
 Industrial Accidents: Chemical spills, explosions, or other industrial accidents can
pose immediate risks to hospitals and their patients.
 Terrorist Attacks: Attacks, such as bombings or chemical incidents, can result in
mass casualties and significant infrastructure damage.
 Radiological Incidents: Nuclear accidents or radiological events can lead to
contamination and require specialized medical responses.
 Mass Casualty Incidents: Events like mass shootings or major accidents can
overwhelm hospital resources and capacity.
3. Health Emergencies:
 Pandemics: Disease outbreaks, like the COVID-19 pandemic, can strain healthcare
systems and require adaptation of hospitals to treat large numbers of patients.
 Biological Threats: Biological incidents, such as the release of harmful pathogens,
can require specialized responses to protect healthcare workers and patients.
4. Technological Disasters:
 Power Outages: Power failures can disrupt hospital operations, affecting medical
equipment and patient care.

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 IT System Failures: Malfunctions or cyberattacks on hospital IT systems can
compromise patient records and disrupt communication.
5. Fire:
Building Fires: Fires within hospital buildings can endanger patients, staff, and
infrastructure, and require evacuation and firefighting efforts.

6. Infrastructure Failures:
 Water Supply Contamination: Contaminated water supply can impact patient care
and hygiene standards.
 Medical Gas Leaks: Medical Gas leaks can pose risks to hospital safety and
emergency conditions for patients and require immediate interventions.
 Miscellaneous:

7. Structural Failures: Building collapses or structural issues can lead to dangerous


situations within the hospital.Accidents involving vehicles transporting patients, medical
supplies, or staff can impact hospital operations.

Hospitals should have comprehensive disaster preparedness and response plans in place to
address these different types of disasters. These plans include strategies for evacuation, patient
care prioritization, communication, resource allocation, and collaboration with external agencies.
Training staff, conducting drills, and regularly updating plans are essential to ensure a hospital's
readiness to handle various types of disasters.

What is Disaster Management?

Disaster management refers to the systematic process of preparing for, responding to, recovering
from, and mitigating the impact of disasters. A disaster is an event that causes significant
disruption, destruction, and human suffering, often overwhelming the capacity of the affected
community to cope using its own resources. Disaster management involves a range of activities
aimed at minimizing the negative effects of disasters and ensuring the safety and well-being of
individuals, communities, and societies.

The key 5 (Five) phases of disaster management are:

1. Response: During the response phase, immediate actions are taken to save lives, protect
property, and meet basic human needs. This includes search and rescue operations,
providing medical care, setting up temporary shelters, and delivering food, water, and
medical supplies.
2. Recovery: After the immediate response, the recovery phase focuses on restoring
normalcy and rebuilding affected communities. This can include repairing damaged

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infrastructure, providing psychological support to survivors, and restoring essential
services.
3. Prevention and Risk Reduction: Disaster management also includes efforts to
enhance community resilience and reduce vulnerabilities to future disasters. This
involves educational programs, community engagement, and implementing measures to
prevent similar events from causing as much damage in the future.
4. Mitigation: This phase focuses on reducing the risk and impact of disasters before they
occur. It involves measures to lessen the vulnerability of communities and infrastructure.
Mitigation efforts can include building resilient infrastructure, implementing land-use
planning regulations, and raising public awareness about potential hazards.
5. Preparedness: Preparedness involves planning, training, and establishing systems to
ensure an effective response when a disaster occurs. This phase includes developing
emergency response plans, conducting drills and exercises, stockpiling essential supplies,
and training personnel.

Disaster Management 5 phases Cycle:


What actions to be taken to prevent any disaster in hospitals?

Preventing disasters in hospitals involves a combination of proactive measures to reduce risks


and vulnerabilities, as well as effective preparedness and response plans to manage potential
incidents. Here are actions that hospitals can take to prevent disasters:

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1. Formulation of Disaster Management Committee in hospitals: A team comprising
of different members of hospitals to be taken for the formulation of Disaster
Management Committee in hospitals. Role & responsibility of every members of the
committee need to be defined and the committee should meet in regular intervals with
proper documentations

2. Risk Assessment: Identify and assess potential hazards and vulnerabilities specific to
the hospital's location, infrastructure, and operations.Implement measures to mitigate
risks, such as reinforcing buildings against earthquakes, securing hazardous materials,
and improving fire safety.

3. Emergency Preparedness and Planning: Develop comprehensive emergency


response plans that address various types of disasters, including natural and man-made
events. Establish clear roles and responsibilities for hospital staff during emergencies.

4. Regular Training and Mock Drills: Train hospital staff regularly on emergency
procedures, evacuation plans, and the use of life-saving equipment. Conduct emergency
drills to ensure that staffs are familiar with their roles and can respond effectively during
a crisis.

5. Regular Maintenance and Inspections: Conduct routine maintenance and inspections


of hospital equipment, infrastructure, and safety systems to identify and address potential
issues before they become critical.

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What do the A B C ratings mean on Fire Extinguishers?

“A” TRASH–WOOD–PAPER:

Fire extinguishers with a Class A rating are effective against fires involving
paper, wood, textiles, and plastics. The primary chemical used to fight these
fires is mono-ammonium phosphate, because of its ability to smother fires in
these types of materials.

“B” LIQUIDS:

Fire extinguishers with a Class B rating are effective against flammable liquid
fires. These can be fires where cooking liquids, oil, gasoline, kerosene, or
paint have become ignited. Two commonly used chemicals are effective in
fighting these types of fires. Mono-ammonium phosphate effectively smothers
the fire, while sodium bicarbonate induces a chemical reaction which extinguishes the fire.

“C” ELECTRICAL EQUIPMENT:

Fire extinguishers with a Class C rating are suitable for fires in “live”
electrical equipment. Both mono-ammonium phosphate and sodium
bicarbonate are commonly used to fight this type of fire because of their non-
conductive properties.

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FIRE MANAGEMENT
The R.A.C.E. method for responding to a fire emergency:

R- Rescue : Move patients and assist visitors or impaired employees away from
immediate danger of fire or smoke.

A - Alert others : Pull / Press alarm as soon as possible, Call fire department‘s
number and state the location, type of fire and size. Notify co-
workers.

C –Confine / Close all doors and windows to stop spreading of the fire; During
Contain :
evacuation close the doors behind you.
Select the appropriate fire extinguisher. (ABC type)
Move people (patients, visitors, staff) to next lateral fire
E –Extinguish
and Evacuate : compartment, Staff on floors above the fire use fire stairwells to
evacuate. Don‘t use lift.

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THE P-A-S-S TECHNIQUEFOR USINGFIRE EXTINGUISHER
IN CASE OF FIRE, USE THE FIRE EXTINGUISHER IN THE FOLLOWING WAY -

Pull the pin. It is there to prevent accidental discharge.


P
Aim low at the base of the fire. This is the where the
A FIRE source is.
Squeeze the lever above the handle. Release to stop the
S flow.
Sweep from side to side. Move towards the fire, aiming
S low at its base. Sweep until all flames are extinguished.
Repeat if necessary.

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QUALITY
MANAGEMENT
SYSTEM

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ASSESSMENT METHODOLOGY UNDER NATIONAL QUALITY ASSURANCE
STANDARDS:

In view to evaluate any healthcare facility under the ambit of National Quality Assurance
Standards or NQAS, the principles of Quality Measurement structures grouped into eight(08)
Area of Concern (AoC). Each AOC are again divided into different Standards and each
Standard has specific Measurable Elements (ME). These standards and measurable elements
are checked in each department through specific Checkpoints. All check points for a
department are collated, and collectively they shape an evaluation tool referred as Checklists.

The (08) eight Area of Concern are as follows:

A Service Provision
B Patient Rights
C Inputs
D Support Services
E Clinical Services
F Infection Control
G Quality Management
H Outcome

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To assess all the measurable elements and checkpoints, markings are done in the
following manner -
 2 marks for full compliance – where all requirements are meeting
 1 mark for partial compliance – where 50% - 99 % are meeting
 0 Mark for Non Compliances – where <50% are meeting

For the assessment the following Assessment Methods are used to assess any health
facility:

i) Observation(OB)
ii) Record Review(RR)
iii) Staff Interview(SI)
iv) Patient Interview (SI)

What is Quality Management System ?

A Quality Management System (QMS) is a structured framework or set of procedures and


processes designed to ensure that an organization consistently produces products or delivers
services that meet or exceed customer expectations and comply with regulatory and quality
standards. The primary purpose of a QMS is to focus on quality improvement, customer
satisfaction, and organizational efficiency. Here are some key components and principles of a
QMS:

1. Quality Policy: The organization's quality policy outlines its commitment to quality and
serves as a guiding statement for all quality-related activities.
2. Quality Objectives: Specific, measurable objectives are established to drive continuous
improvement in areas like product or service quality, customer satisfaction, and
efficiency.
3. Documented Procedures: A QMS typically includes documented procedures and work
instructions that outline how various processes within the organization should be carried
out. This ensures consistency and standardization.
4. Risk Management: Identifying, assessing, and mitigating risks is an integral part of a
QMS, as it helps prevent quality issues and compliance failures.
5. Employee Training and Competence: Employees are trained to perform their roles
effectively and to understand the importance of quality in their work.
6. Process Control: Quality control and monitoring processes are established to ensure that
products or services consistently meet defined quality standards.

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7. Supplier Management: Organizations often evaluate and monitor the performance of
their suppliers to ensure they meet quality standards and support the organization's goals.
8. Data Analysis: Data and metrics are collected and analyzed to identify trends, patterns,
and opportunities for improvement.
9. Corrective and Preventive Actions: When issues or non-conformities are identified, the
organization takes corrective actions to address immediate concerns and preventive
actions to prevent similar issues from recurring.
10. Continuous Improvement: A core principle of QMS is the pursuit of continuous
improvement. Organizations regularly assess their QMS and make adjustments to
enhance quality, efficiency, and customer satisfaction.

What is Process Mapping?

Process mapping is the process of creating a visual representation of a critical and semi critical
process. A process map is a planning and management tool that visually or graphically describes
the flow of work. Using process map it helps to show a series of events that produce an end
result. A process map is also called a flowchart, process flowchart, process chart, functional
process chart. The purpose of process mapping is to improve efficiency. Process maps provide
insight into a process, helps our team to brainstorm ideas for process improvement, increase
communication and provide process documentation. There are numerous symbols available for
process mapping but we have incorporated the basic symbols required for mapping hospital
processes:

Oval i. Ovals show input to start the process or output at the end of the process.

ii. Boxes or rectangles show task or activity performed in the process.

iii. Arrows show process direction flow.

iv. Diamonds show points in the process where a yes/no questions are asked or
a decision is required. Usually ―yes / no‖ (binary) decisions.

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A process analysis is a step-by-step description of how to do something. A good process analysis
will explain each step in detail so that the reader knows exactly what to do, how to do it, and
what to expect at each step.

Steps for improving process efficiency

1. Look for areas where there is room for improvement.

2. Make a plan for how to improve the process.

3. Implement the plan and track the results.

4. Make changes as needed to improve efficiency.

What is Quality Tools & Quality Methods?

Quality tools are specific techniques or instruments used to analyze and solve quality-
related problems, make data-driven decisions, and improve processes. They are often
applied within the context of a broader quality management approach.

These seven basic quality control tools, which introduced by Dr. Ishikawa, are:

1) Check sheets;

2) Stratification or Flowcharts

3) Histograms;

4) Pareto charts;

5) Cause-and-effect diagrams / Fish Bone Diagram;

6) Scatter diagrams;

7) Control charts.

1) Check sheets: A check sheet is a structured forms prepared for collecting and analyzing
data. This is a generic tool that can be adapted for a wide variety of purposes. Check-
sheet is a list of check off items that permit data to be collected quickly and easily.

2) Stratification or Flowcharts: Stratification is a technique used in combination with

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other data analysis tools. When data from variety of sources has been lumped together,
the meaning of the data is impossible to see. Stratification is a method of dividing data
into sub–categories and classifying it based on group, division, class.

3) Histograms: It is a frequency distribution diagram in the form of bar graph used to study
the density of data and put in different classes. Histogram helps in prioritizing factors and
identifying which are the areas that need utmost attention immediately.

4) Pareto charts: Pareto chart is named after Vilfredo Pareto. Pareto chart revolves around
the concept of 80/20 rule which underlines that large majority of problems (80%) are
produced by a few key causes (20%) which are often referred as Vital Few, whereas
remaining 20% of problem or failure is caused by 80% of many minor factors referred as
Trivial Many. The very purpose of Pareto Chart is to highlight the most important
factors that are the reason for major cause of problem or failure.

5) Cause-and-effect diagrams / Fish Bone Diagram: A Cause-and Effect Diagram is a


tool that shows systematic relationship between a result / effect and its possible causes.
It is an effective tool to systematically generate ideas about causes for problems and to
present these in a structured form. To indentify the cause of problem finding the Root
cause analysis or why –why analysis is essential via proper brainstorming.

6) Scatter diagrams: It is used for showing a correlation between multiple values of two
variables (dependent & independent variables) graphically in X & Y axis. The
relationship can be linear, curvilinear, exponential etc. Stronger the correlation, stronger
the relationship will hold true. The variables can be positively or negatively related
defined by the slope of equation derived from the scatter diagram.

7) Control charts: A statistical tool to determine if a process is in control. Control charts


are also called Statistical process control. It measures how a process changes over time.
Data are plotted in time order. A control chart always has a central line for the average,
an upper line for the upper control limit (UCL), and a lower liner for the lower control
limit (UCL). These lines are determined from historical data.

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Quality Methods - refer to systematic approaches or methodologies that guide an
organization in its overall quality management efforts. They provide a structured framework
for managing quality and often involve a set of principles, practices, and techniques.

Example – PDCA, Lean Kizen, 5s, Six Sigma,

What is PDCA cycle?

The PDCA cycle, also known as the Deming Cycle or the Plan-Do-Check-Act cycle, is a
problem-solving and continuous improvement methodology. It was developed by Dr. W.
Edwards Deming, a prominent figure in quality management, and it provides a structured
approach for organizations to achieve and sustain continuous improvement in their processes and
products. The PDCA cycle consists of four interconnected stages, each of which plays a specific
role in the improvement process:

1. Plan (P): In the first stage, organizations identify a problem or opportunity for
improvement. They set clear objectives and goals for what they want to achieve. Key
steps in the "Plan" stage include:
o Defining the problem or goal.
o Collecting relevant data.
o Analyzing the data to identify the root causes of the problem.
o Developing a plan for improvement, which includes defining specific actions,
responsibilities, and timelines.
2. Do (D): The "Do" stage involves implementing the idea created in the "Plan" stage in a
small scale. It's where the proposed changes are put into action. Key steps in the "Do"
stage include:
o Executing the planned actions.
o Documenting the changes made.
o Collecting data during the implementation.
3. Check (C): In the "Check" stage, organizations assess the results of the changes made
during the "Do" stage. This involves comparing the actual outcomes with the expected
outcomes. Key steps in the "Check" stage include:
o Evaluating whether the implemented changes have led to the desired
improvements.
o Analyzing the data collected to determine the impact of the changes.

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o Identifying any gaps between expected and actual results.
4. Act (A): The "Act" stage is where organizations take corrective actions based on the
results and insights obtained in the "Check" stage. It involves adjusting the plan and
process as necessary to achieve the desired outcomes. Key steps in the "Act" stage
include:
o Making necessary adjustments or refinements to the plan.
o Implementing improvements based on the data and findings.
o Continuing to monitor the process and measuring the impact of the changes.

The PDCA cycle is iterative and continuous, with each cycle feeding into the next. As
organizations go through multiple cycles, they aim to refine their processes, achieve better
results, and continuously improve. The PDCA cycle is a fundamental concept in quality
management and is widely used in various industries to drive quality improvement, problem-
solving, and process optimization.

What is Lean Management in Hospital & what do you mean by MUDAs?

Lean management is a management philosophy and approach that originated in


manufacturing, particularly in the Toyota Production System. Over time, the principles of
lean management have been adapted and applied to various industries, including healthcare.
In a hospital setting, lean management focuses on improving efficiency, reducing waste, and
enhancing the quality of patient care.

MUDA, which means "waste" in Japanese, is a key concept within lean management. In the
context of healthcare, including hospitals, MUDA refers to any activity that consumes
resources (time, personnel, materials) but does not add value to the patient or contribute to
the quality of care. Identifying and eliminating MUDA is a fundamental aspect of lean
management in hospitals.

SEVEN MUDAS are: Transport, Inventory, Motion, Waiting, Over Production, Over
Processing, Defects. TIMWOODS is an acronym used to identify waste / Mudas

What is 5s ?

5S is a foundational methodology within the broader Kaizen approach to continuous


improvement. It's a systematic and structured method used to organize and improve the
workplace by eliminating waste, enhancing efficiency, and promoting a culture of cleanliness
and order. The 5S method consists of five Japanese words, each starting with the letter "S,"
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representing key principles for workplace organization and maintenance. The 5S elements are as
follows:

1. Seiri (Sort): The first step in 5S is "Sort," which involves identifying and eliminating
unnecessary items and clutter from the workplace. This decluttering process helps create
a more organized and efficient environment. The goal is to keep only what is essential for
the work process and remove everything else.
2. Seiton (Set in Order): After sorting, the "Set in Order" step focuses on arranging
necessary items and tools in a logical and organized manner. It ensures that everything
has a designated place and is easily accessible. This reduces wasted time spent searching
for tools and materials.
3. Seiso (Shine): "Shine" emphasizes the importance of cleanliness and regular
maintenance. It involves cleaning and maintaining the workplace to prevent dirt, debris,
and defects. A clean and well-maintained environment can help prevent safety hazards
and improve the overall work environment.
4. Seiketsu (Standardize): "Standardize" involves establishing and maintaining
standardized work practices and procedures of previous three S‘s. This ensures that
everyone follows the same best practices and that processes are consistent.
Standardization is key to maintaining the gains achieved through the previous three S's.
5. Shitsuke (Sustain): The final step, "Sustain," is about developing a culture of discipline
and continuous improvement. It encourages employees to uphold the 5S principles,
continually monitor their adherence, and make incremental improvements to the process.

5S is often regarded as the foundation of Kaizen (continuous improvement) because it creates a


structured and organized environment in which ongoing improvements can be implemented
more effectively.

Define the hierarchy of documents for implementation of Quality management system in


healthcare facilities

The hierarchy of documents for the implementation of a Quality Management System (QMS) in
healthcare facilities typically includes the following:

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On Top – Quality Policy & Quality Objectives:

 Quality Policy - Policy is a reflection of the goals of the organization it can be used as a
filter for decisions. It describes the principles and values that guide decision-making
within the organization.
 Quality Objectives - A quality objective is something organization aim for or try to
achieve. To achieve the long term goal of Quality policy measurable statements are
referred as Quality Objectives. It should be SMART and aligned to meet customer
satisfaction.

At Middle – Quality Manual, Procedure and Work Instructions subsequently:

 Quality Manual: Quality Manual is the apex document of organization‘s. It provides a


framework for implementing and maintaining quality standards and processes, as well
as ensuring compliance with regulatory requirements.
 Quality Procedures/ SOP: A set of documented procedures that describe the steps and
processes required to achieve specific quality objectives. These procedures include
instructions on What, When, Who and How to perform tasks.
 Work Instructions: Detailed instructions that outline the steps required to carry out
specific tasks or processes. These may include step-by-step instructions for clinical
procedures, equipment maintenance, or record-keeping processes & other instructions.

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At Base – Records & Formats:

 Quality Records: Documents that provide evidence of compliance with quality objectives,
including test results, inspection reports, and audit records.
 Formats: Standardized forms and formats are used to document and track quality-related
activities, such as incident reporting, equipment maintenance, and quality audits.

What is SMART Quality Objectives?

SMART is an acronym used to create well-defined and effective quality objectives. Quality
objectives are specific, measurable, achievable, relevant, and time-bound targets or goals that an
organization or team sets to improve its quality management system and overall performance.
Here's what each letter of the SMART acronym represents in the context of quality objectives:

1. S - Specific: A quality objective should be specific and clearly defined. It should answer
the "who, what, where, when, and why" questions. This means it should be explicit about
what is to be achieved and who is responsible for achieving it.
2. M - Measurable: Quality objectives should be measurable, meaning that there should be
a way to track and quantify progress and success. Measurable objectives help determine
whether the goal has been achieved or not.
3. A - Achievable: Quality objectives should be achievable, which means they should be
realistic and attainable within the resources and constraints of the organization.
Objectives that are too ambitious or unattainable can lead to frustration and failure.
4. R - Relevant: Quality objectives should be relevant and aligned with the hospitals
strategic goals and quality improvement priorities. They should contribute to the overall
success of the organization.
5. T - Time-Bound: Quality objectives should have a defined timeframe for achieving the
goal. Setting a deadline creates a sense of urgency and helps in monitoring progress.

By following the SMART framework when setting quality objectives, organizations can create
clear and meaningful goals that are more likely to be achieved. These objectives help guide the
organization's quality management efforts and provide a basis for measuring performance and
continuous improvement.

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What is Root Cause analysis?

Root Cause Analysis (RCA) is a systematic and structured approach used in Quality
Management Systems (QMS) to identify the underlying causes of problems or non-
conformities within an organization. The primary goal of RCA is to determine the
fundamental reasons for quality issues or deviations from established standards, rather than
just addressing the symptoms or immediate, superficial causes.

Here are some of the key tools and methods employed in the healthcare setting:

1. The "5 Whys" Technique: This method involves asking "why" repeatedly to drill down
to the root cause of a problem. By asking "why" multiple times (typically five times), you
can uncover deeper underlying factors contributing to an issue.
2. Fishbone Diagram (Ishikawa or Cause-and-Effect Diagram): This visual tool helps
identify potential causes of a problem by categorizing them into key categories such as
people, process, equipment, environment, and more. It's particularly useful for exploring
multifaceted issues.
3. Failure Mode and Effects Analysis (FMEA): FMEA is a structured approach to
identifying and prioritizing potential failure modes in processes or systems. It evaluates
the severity, occurrence, and detectability of potential issues to determine which require
the most attention.
4. Pareto Analysis: Pareto analysis is often used in conjunction with Pareto charts to
prioritize and focus on the most significant contributing factors to a problem. It helps
determine which issues should be addressed first for the most substantial impact.

What is FISHBONE analysis?

Fishbone analysis, also known as Ishikawa or cause-and-effect analysis is a problem-solving


technique used to identify and analyze the potential causes of a specific problem or issue.
This is a valuable tool for Root causes analysis. The method gets its name from the visual
representation of the analysis, which resembles a fishbone.

Here's a breakdown of the fishbone analysis process:

 Define the Problem: Clearly articulate the problem or issue that needs to be addressed.
This problem statement will be the "head" of the fishbone diagram.

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 Create the Fishbone Diagram: Draw a horizontal line to represent the backbone of the
fish (the problem statement). Extend diagonal lines (the "bones") from the backbone,
resembling the structure of a fish skeleton.
 Identify Categories of Causes: Label each branch with categories of factors that could
contribute to the problem. Common categories include People, Process, Equipment,
Materials, Environment, and Management.
 Identify Possible Causes: Brainstorm and list potential causes or factors within each
category. Encourage input from team members or stakeholders who have different
perspectives on the problem.
 Analyze and Prioritize Causes: Examine the potential causes and identify those that are
most likely to contribute to the problem by using Pareto chart.. Consider the impact and
likelihood, Continue to drill down into each potential cause until you reach the root
causes, which are the fundamental issues contributing to the problem.
 Develop Solutions: Once the root causes are identified, develop strategies to address
them. These solutions aim to eliminate or mitigate the factors causing the problem.
Fishbone diagrams are particularly useful in a team-based problem-solving environment.
They provide a visual representation of the various factors contributing to a problem,
fostering a more comprehensive understanding of the situation. The method was developed
by Kaoru Ishikawa, a Japanese quality control expert, and it is often associated with quality
management and continuous improvement processes.

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What is 5 why or ‘why-why’ analysis?

The "5 Whys" technique is a problem-solving method aimed at getting to the root cause of
an issue by repeatedly asking the question "Why?" The idea is to explore the cause-and-
effect relationships behind a problem and identify the underlying factors contributing to it.
The "5 Whys" technique is simple yet powerful and is often used in various industries,
particularly in quality management and continuous improvement processes.

 Identify the Problem: Clearly define the problem you want to address. This
problem will be the starting point for the analysis.
 Ask "Why?" and Identify the First Cause: Ask why the problem occurred and
identify the first cause. This cause becomes the basis for the next "Why?" question.
 Repeat the Process: For each identified cause, ask "Why?" again. Continue this
process iteratively, probing deeper into the cause-and-effect relationships.
 Continue Until Root Cause is Identified: Continue asking "Why?" about each
response until you reach a point where further questioning doesn't reveal additional
meaningful information. The goal is to identify the root cause, which is the
fundamental reason behind the problem.
 Implement Corrective Actions: Once the root cause is identified, develop and
implement corrective actions to address the root cause and prevent the recurrence of
the problem.
The "5 Whys" technique helps teams move beyond superficial problem-solving and
encourages a deeper understanding of the issues at hand. It helps to avoid treating symptoms
rather than addressing the underlying causes. While the name suggests asking "Why" five
times, the number of iterations can vary depending on the complexity of the problem.
Sometimes it may take more or fewer iterations to reach the root cause. The "5 Whys"
technique is a valuable tool for Root causes analysis, continuous improvement, problem-
solving, and quality management. It promotes a systematic and logical approach to problem
resolution by digging into the core issues that need attention.

What is P.I.C.K chart?

For Prioritization : Some of the Tools used are: PICK Chart & Pareto‘s Analysis.

The PICK chart was originally developed by Lockheed Martin for organizing process
improvement ideas and categorizing them during the Identify and Prioritize Opportunities
Phase of a Lean Six Sigma project. The acronym PICK stands for the four possibilities:

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Possible, Implement, Challenge, and Kill/ Kick. This is a visual tool for organizing ideas
and making decisions. PICK charts are useful for focusing improvement team discussions
and achieving consensuses on which are the best solutions to solve a problem

When faced with multiple improvement ideas a PICK chart may be used to determine the most
useful. There are four categories on a 2*2 matrix; horizontal is scale of payoff (or benefits),
vertical is ease of implementation. By deciding where an idea falls on the pick chart four
proposed project actions are provided; Possible, Implement, Challenge and Kill (thus the name
PICK).

 Low Payoff, easy to do – Possible

 High Payoff, easy to do – Implement

 High Payoff, hard to do – Challenge

 Low Payoff, hard to do – Kill / Kick

The vertical axis, representing ease of implementation would typically include some assessment
of cost to implement as well. More expensive actions can be said to be more difficult to
implement.

Sample PICK chart

Payoff Low Payoff High

easy to do Possible Implement

hard to do Kill / Kick Challenge

What is Pareto Principle and Analysis?

The Pareto Principle, also known as the 80/20 Rule, is a principle named after the Italian
economist Vilfredo Pareto. The principle states that, for many phenomena, roughly 80% of
the effects/ problems come from 20% of the causes. In other words, a small number of
factors contribute big problems to the overall outcome. This principle is applicable in
various fields, including economics, business, quality management, and decision-making.

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When applied to problem-solving or analysis, the Pareto Principle suggests that focusing
efforts on the most significant factors or causes can lead to more effective results. This
concept is commonly used in Pareto Analysis.

Difference Between Pareto & Pick Chart for Prioritization of Gap closure:

• Pareto’s Analysis: The pareto chart collects and arranges data based on frequency
of occurrence.

• PICK Chart (Possible, Implement, Challenge, and Kill/ Kick): Pick chart categorizes
process improvements based on value impact of implementation.

Here's how Pareto Analysis works:

 Identify the Problem or Issues: Clearly define the problem or issues you want to
address. This could be defects, errors, complaints, or any other issue that needs
attention.
 Collect Data: Gather data related to the identified issues. This could involve
tracking occurrences, analyzing customer feedback, or monitoring specific
processes.
 Categorize the Data: Categorize the data into different groups or categories. This
helps to identify patterns and understand the distribution of the issues.
 Calculate Percentages: Determine the percentage of each category relative to the
total number of occurrences. This is where the 80/20 Rule often comes into play, as
you may find that a small percentage of categories contribute to the majority of
issues.
 Create a Pareto Chart: Construct a Pareto Chart, a bar graph that displays the
categories in descending order of frequency or impact. The left vertical axis
represents the frequency or impact, while the right vertical axis represents the
cumulative percentage.
 Identify the Vital Few: Identify the categories that make up the top 20% (or any
other significant percentage) on the Pareto Chart. These are often referred to as the
"vital few" or the critical factors that need attention.
 Take Action: Focus your efforts on addressing the vital few issues. By tackling the
most significant factors, you can potentially achieve a more substantial impact on
overall improvement.
Pareto Analysis is a valuable tool for prioritizing efforts, allocating resources efficiently,
and addressing the most critical issues that affect the desired outcomes. It helps
organizations and individuals make informed decisions based on the principle that not all
factors contribute equally to a problem or goal.

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Pareto Chart

Why a Pareto Chart is a valuable tool for quality improvement in a hospital ?

 Prioritization of Issues: Hospitals often face numerous challenges related to


patient care, safety, and operational efficiency. A Pareto Chart allows healthcare
professionals to identify and prioritize the most significant issues by focusing on the
key factors that contribute to the majority of problems. This enables the hospital to
address critical issues first, leading to more effective improvements.
 Targeted Improvement Strategies: By understanding which factors contribute
most to problems, hospitals can develop targeted improvement strategies. This
allows for more focused interventions and interventions that directly address the root
causes of issues, leading to sustainable improvements.
 Continuous Monitoring and Evaluation: The Pareto Chart is not only useful for
initial problem identification but also for ongoing monitoring and evaluation.
Hospitals can use Pareto Charts to track changes over time and assess the
effectiveness of implemented interventions. This promotes a continuous cycle of
improvement and helps maintain high standards of quality.
 Data-Driven Decision-Making: Pareto Charts are based on data analysis,
providing a visual representation of the distribution of issues. Data-driven decision-
making is crucial for effective quality improvement in healthcare. It ensures that
decisions are evidence-based and grounded in the actual patterns observed in the
hospital's operations and outcomes.

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INFECTION
PREVENTION
AND CONTROL
PRACTICES


“ Answers in this segment are general purpose only for the preparation of Staff

Interview (SI) as per NQAS, LaQshya & MusQan checklist which may be subject to
change over time.
This should NOT be considered as any Infection Prevention and Control Guidelines or
Government Order. Always follow latest International, National and State

Guidelines and policies in regard s to Infection Prevention and Control Practices. ”

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What is Hospital Accrued Infection (HAIs) ?

Infections which are acquired in hospitals and other healthcare facilities, where the patient must
have been admitted for reasons other than the infection are called health-care associated
infections / Hospital Accrued Infection (HAIs) or nosocomial infections.

For a HAI, the infection must occur:

 up to 48 hours after hospital admission


 up to 3 days after discharge
 up to 30 days after an operation

According to Healthcare Infection Control Practices Advisory Committee (HICPAC) and the
CDC Standard Precautions are group of infection prevention practices that apply to all patients
and residents, regardless of suspected or confirmed infection status, in any setting in which
healthcare is delivered and include:

1. Hand hygiene
2. Use of personal protective equipment (e.g., gloves, gowns, face masks etc)
3. Management of spillage
4. Cleaning of Critical and Semi Critical Areas
5. Decontamination , Disinfection and Sterilization of instruments
6. Safe injection practices
7. Segregation & Management of Bio Medical Wastes
8. Management of sharps
9. Additional - Airborne Precautions, Droplet Precautions & Contact Precautions

Chain of Transmission of HAI

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What is Barrier Nursing?

The Barrier Nursing is a nursing technique by which a patient with an infectious disease is
prevented from infecting other people is called barrier nursing

Why do we need Barrier Nursing?

• To reduce the risk of spread of certain infections or antibiotic resistant germs to other
patients and staff.

• To protect patients from infection if they have a weak immune system due to disease or
taking certain drugs

What is Personal Protective Equipment (PPE) ?

Personal protective equipment (PPE) is a protective device used to protect both yourself and your
patient from the risks of cross-infection. It may also be required for contact with hazardous
chemicals and some pharmaceuticals.

Steps of wearing PPE:

Before wearing PPE always wash your hands. General chronologies of wearing PPE are -

1. Shoe / Shoe cover (ensure hand hygiene)


2. Plastic Apron
3. Cap (ensure hand hygiene)
4. Mask
5. Eye Shield (if required)
6. Gown
7. Gloves

Basic principles for use of PPE are:

1. PPE should be chosen according to the risk of exposure.


2. Avoid any contact between contaminated (used) PPE and surfaces, clothing or people
outside the patient care area
3. Discard the used PPE in appropriate disposal bags, and dispose off as per BMW Rules,
4. Change PPE completely and thoroughly and wash hands each
5. Do not share personal protective equipment
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HAND WASHING & HAND HYGIENE:

Hand washing is THE SINGLE most important measure in reducing the spread of infection.
Hands are the principle route of cross infection. The level of hand hygiene will be determined by
the activity or area of practice.
All hospital staff including Nurses, Doctors, O.T. Technicians, Lab Technicians, Nursing
orderlies, food handlers and housekeeping staff should perform hand hygiene as per method.

PREFERRED MEDIUM OF HAND HYGIENE :

A. Soap and Water (Hand Wash) :


 Before joining the duty & after end of daily duty
 Before & after any invasive procedure
 When visibly dirty
 When visibly soiled with blood or other body fluids
 After using toilet
 Suspected or proven exposure to potential spore forming pathogens
 Whenever needed for prevention of infection

B. Alcohol-Based Hand Rub(ABHR): Hand disinfection with alcohol based hand


rub preferably with chlorhexidine and alcohol should be used as per the (5) five
moments of hand hygiene method

N.B: Soap and (ABHR) should not be used concomitantly

All clinical areas in the hospital including consultation chambers, nursing stations, phlebotomy
centres and critical care areas along with other relevant areas like wash rooms should have:

 Hand washing deep sink


 Clear unobstructed access to the hand washing sink
 Availability of running water at point of use
 Liquid soap
 Hand washing posters should be placed at each sink
 Taps used for hand washing should preferably be elbow taps.

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5 MOMENTS OF HAND HYGIENE:

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HAND WASHING TECHNIQUE:

There are many ways to clean hands. Different guidelines like WHO, CDC have different steps
of hand washing. But as approved by the authorities of Dept of H&FW of the State of West
Bengal and to ensure the uniformity SIX main steps of hand washing are –

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Steps before Starting Hand Wash:

 Roll up your sleeves


 Keep nails short and pay attention to them when washing your hands – most microbes on
hands come from beneath the fingernails
 Do not wear artificial nails or nail polish
 Remove all jewellery (rings, watches, bracelets)

Sequence of events:

1. Wet hands under running water.


2. Dispense one pump of soap into cupped hand.
3. Make a leather or foam
4. For general purpose hand wash for minimum 2 minutes vigorously and thoroughly by
following six step
5. Rinse hands thoroughly under running water
6. Dry hands with single use tissue paper or air dry.

SURGICAL HAND HYGIENE

Surgical hand hygiene is standard care prior to any surgical procedure. Surgical hand preparation
reduces the release of skin bacteria from the hands of the surgical team, for the duration of the
procedure, incase of an unnoticed puncture of the surgical glove releasing bacteria to the open
wound. In contrast to the hygienic hand wash or hand rub, surgical hand preparation eliminates
the transient and reduces the resident flora. It also inhibits growth of bacteria under the gloved
hand.

Patient Hand Hygiene:

Hand hygiene for patients must be encouraged as it is equally as important in the prevention and
control of infection. Staff must ensure that patients are afforded an opportunity to hand wash.

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USE OF PPE (Personal Protective Equipment) :

In determining the type of personal protective equipment to use for a given procedure,
Healthcare facilities should consider the following factors:

 Probability of exposure to blood and body substances;


 Amount likely to be encountered;
 Type of body substance involved; and
 Probable route of transmission of infectious agents
Full protective wear, including double gloves, protective eye/face-shields, protective footwear
and impermeable gowns or aprons, is recommended for operating room or any critical area or
dealing with infectious patient as per guidelines

a) FOOTWEAR / SHOE COVER :


Dedicated personalized closed toe non-slip footwear must be available for all regular theatre
staff in the theatre complex. Shoe cover may be worn before entering to the critical or semi
critical areas, or as per hospital policy. Boots should be worn if there is a high risk of heavy
blood/body fluid loss. Within the operating theatre there should be a provision of spare theatre
shoes. Scavenging staff must wear full Shoe Cover while handling infectious materials or Bio
Medical Wastes.

b) GOWNS AND APRONS:


The purpose of wearing gowns and aprons is to protect susceptible patients from infection and
protect the wearer from contamination as well as maintaining the uniform or clothes worn under
the apron in a clean and dry state. Gowning must be done before all invasive procedures.

Gowns and aprons should not be worn outside the area they are intended to be used. Remove
your gowns/aprons when moving out of area they are intended to be used. If the gown is touched
or brushed by an un-sterile object the gown is then considered contaminated. The contaminated
gown must be removed using the proper technique and then a new sterile gown should be
donned.

c) HEAD CAP :
Head cap covers the hairs of the health care provider in order to prevent the contamination of the
sterile high risk areas.

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Round Non Woven - Buffet Cap

d) EYE WEAR :
Protection of the mucous membranes of the eyes, mouth and nose from procedures that involve
splashing or spraying of blood, body fluids or bone chips is essential. Protective eye wear
covering front and side of the eyes, or full face visors must be worn by the surgical scrub team
and those performing invasive procedures. These should either be disposable or cleaned
according to manufacturer‘s instructions after use. Ordinary prescription spectacles do not
provide sufficient protection. Visors cannot be used with magnifying loupes and should,
therefore be fitted with side shields.

e) MASKS :

Masks offer protection against potential splashing of the mouth and face during certain
procedures such as minor operations, physical decontamination or cleaning instruments with a
brush.

The type of mask best suited to a particular situation depends on the body substances likely to be
encountered and the nature of the activity. There are two main types of masks used in health
care:

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 Surgical masks —fluid-repellent paper filter masks worn during surgical and dental
procedures
 Particulate filter personal respiratory protection devices (N95 respiratory protection
devices)—close fitting masks capable of filtering 0.3-μmparticles and worn when attending
patients with active pulmonary tuberculosis / other high infectious patient.
Mask must:

- Be fitted and worn according to the manufacturer‘s instructions;


- Not be touched by hand while being worn;
- Cover both mouth and nose while worn;
- Be removed as soon as practicable after they become moist or visibly soiled;
- Be removed by touching the strings and loops only; and not be worn loosely around
the neck, but be removed and discarded as soon as practicable after use.

A surgical mask is worn primarily to protect the patient from bacteria exhaled by operating room
personnel. Every individual in the operating theatre should wear a mask when prosthesis /
implant surgery is taking place. The mask must fit snugly to the face to prevent passage of air
around the sides and fogging of glasses if worn. A fresh mask should be donned immediately
before beginning the scrub procedure and it is not considered sterile. If the mask becomes damp,
droplets from the nose and mouth can easily pass though it and the mask no longer serves as a
barrier to germs, therefore the mask should be changed after each procedure and more often if it
becomes damp. A mask should never be allowed to dangle around the neck, placed in a pocket or
on a clean surface and should only be handled by the ties after it is removed. Careful handling of
a used mask by the ties prevents the spread of micro organisms throughout the surgical suite. As
soon as the mask is removed it should be placed in a designated receptacle and the hands should
be washed.

CORRECT METHOD OF WEARING AND REMOVAL OF MASK :

• Choose the appropriate mask size

• Perform hand hygiene before putting on a mask

• The mask should fit snugly over the face

• The metallic strip upper most (if any metallic strip present)

• For the masks without a coloured side, the side with folds should face downwards on the
outside and with the metallic clip uppermost (Image 1)

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• For tie-on surgical mask, secure upper tie at the crown of head. Then secure lower tie at the
nape (Image 2)

• For ear-loops type, position the elastic bands around both ears

• Mould the metallic strip over nose bridge so that the mask fits snugly over the face (Image 3)

• Extend the mask to fully cover mouth, nose and chin (Image 4)

• Avoid touching the mask after wearing. Otherwise, perform hand hygiene before and after
touching the mask

• When taking off tie-on surgical mask, unfasten the tie at the nape first; then unfasten the tie at
the crown of head (Image 5)

• For ear-loops type, hold both the ear loops and take off gently from face. Avoid touching the
outside of face mask during taking off as it may be covered with germs.

• After taking off the surgical mask, discard in appropriate Bio Medical Waste bin and perform
hand hygiene.

f) GLOVES :

The use of disposable gloves is part of the Standard Precautions concept, which offers consistent
guidelines for infection control programmes. As part of personal protective equipment, gloves
prevent contact with blood, body fluids, and mucous membranes. They also protect the patient
from contamination by the micro-organisms from the wearer‘s hands; and preferable it should be
changed after each procedure to further minimize the risk of infection.

Gloves are worn when dealing with: Any blood or other body fluids, such as synovial fluid,
peritoneal fluid, amniotic fluid, pleural fluid, any wound or broken skin. Handling chemicals or

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disinfectants, which could cause skin irritation. As a general rule, if the risk is to the patient then
‗Sterile’ gloves are required. If the risk is to the user then ‗Non-sterile’ gloves will probably be
sufficient. When handling chemical disinfectants you may need to wear industrial or utility
gloves.

Important points to remember regarding gloves and going procedures:

 Gloves should be used during all patient-care activities that may involve exposure to
blood and all other body fluid (including contact with mucous membrane and non-intact
skin), during contact precautions and outbreak situations.
 Prolonged use of gloves for contact precautions in the absence of considering the
need to perform hand hygiene can result in the transmission of germs.
 It is important that health-care workers are able to differentiate between specific
clinical situations when gloves should be worn and changed and those where their use
is not required (see The Glove Pyramid). Moreover, the health-care worker should be
accurately informed on the moment for donning and removing gloves.

The Glove Pyramid:

To aid decision making on when to wear (and not wear) gloves. Gloves must be worn according
to STANDARD and CONTACT PRECAUTIONS. The pyramid details some clinical examples
in which gloves are not indicated, and others in which examination or sterile gloves are
indicated. Hand hygiene should be performed when appropriate regardless of indications for
glove use.

The Glove Pyramid


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Summary of the indications for gloving and for glove removal

Indication

Gloves on 1. Before a sterile procedure / invasive procedure

2. When anticipating contact with blood or another body fluid, regardless

of the existence of sterile conditions and including contact with non-

intact skin and mucous membrane

3. Contact with a patient (and his/her immediate surroundings) during

contact precautions.

Gloves off 1. As soon as gloves are damaged (or non-integrity suspected)

2. When contact with blood, another body fluid, non-intact skin and

mucous membrane has occurred and has ended

3. When contact with a single patient and his/her surroundings, or a

contaminated body site on a patient has ended

4. When there is an indication for hand hygiene.

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MANAGEMENT OF SPILL:

It is vital that any spillage must be attended to as soon as possible. Assessment of hazards and
associated risks to health must be undertaken to ensure the health and safety of employees,
patients and other visitors to the health care premises.

In a hospital, hazardous substances such as body fluids, drugs, cleaning fluids and other
chemicals are in very close proximity to hundreds of people each day. Thus in hospital spillage
of blood, body fluids or chemicals can occur at any time due to broken or faulty equipment or
human error. Any such spill poses risk to the staff, visitors and patients who are extremely
susceptible to infection.

A. BLOOD AND BODY FLUID SPILL :

Spill Kit Contents:

• Utility gloves x 2 pairs


• PPE Kit
• Absorbent material like newspaper or blotting paper
• Hypochlorite solution of proper strength
• Waste collection bag

Spill kit must be immediately replenished after use and stored at the original location after every
use.

Management of Blood Spillage:

 Make the people aware about spill


 Cordon off the area.
 Identify the spill kit.
 Wear PPE.
 Put soaking paper (brown paper, newspaper and tissue paper) over the spill.
 Make fresh bleaching solution of proper strength (as per guideline).
 Pour this prepared solution over the covered spill (outer to inner)
 Leave for contact time ideally
 After contact time put another paper covering the soaked paper and then remove the
soaked paper.

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 Discard this to Yellow Bio Medical Waste Bin in the unit.
 Mop and clean the area as per guideline
 Remove the PPE & discard it in the Yellow bag.
 Do the hand washing.
 Report the spill

B. MERCURY SPILL :

Spill Kit Contents:

 Personal protective equipment (PPE)


 Air-tight, sealable plastic bags (small and large sizes)
 Small, air-tight, rigid plastic container or glass bottle half filled with water or vapour
suppression agent for collecting elemental mercury
 Air-tight, puncture-resistant, rigid plastic jar or container with a wide opening for
collecting Mercury-contaminated broken glass
 Scoop
 Tools required for removing mercury:
- Flashlight (electric torch) to locate shiny mercury beads
- Plastic-coated playing cards or thin pieces of plastic/ any other material to push
mercury beads into a scoop,or pan; if these are not available use index cards, pieces
of cardboard, or stiff paper.
- Small plastic scoop or plastic dust pan to catch the mercury beads.
- Tweezers to remove small broken glass pieces.
- Eyedropper or syringe (without needle) to draw up large mercury beads
- Duct tape or sticky tape to pick up tiny mercury droplets.
- Vapour suppression agents- Small quantities of a propylene glycol solution or sodium
thiosulphate or copper sulphate may also be used as vapour suppression agents (if
available)

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Management of Mercury Spillage:

Attempt has to be made to make hospital mercury free. Mercury containing equipments should
be replaced Still if Spill occurs, following methods should be used -

 Make the people aware about spill


 Cordon off the area.
 Identify the spill kit.
 Remove all Jewellery
 Put on PPE
 Open the Window and Switch off AC
 Pick up any broken glass if any
 A syringe (without needle) shall be used to suck the beads of mercury. Collected mercury
needs to be placed slowly and carefully into an unbreakable plastic container/glass bottle
with an airtight lid half filled with water.
 After removing larger beads, use sticky tape to collect smaller hard-to-see beads.
 If possible , commercially available powdered sulphur or zinc may be used which stains
and make mercury a darker colour which makes smaller beads easier to see (powder
sulphur may be used because
(i) it makes the mercury easier to see since there may be a colour change from
yellow to brown and
(ii) it binds the mercury so that it can be easily removed and suppresses the
vaporisation of any missing mercury
 Place all the materials used during the clean-up, including gloves, mercury spills
collected from the spill area into a leak-proof plastic bag or container with lid and seal
properly and label as per these guidelines.
 Such collected waste should be stored in a designated area only.
 All the bags or containers containing items contaminated with mercury should be marked
properly and labelled with following details: ―Hazardous Waste, Handle with Care‖, date
of storage/generation, name and address of the hospital along with the contact number.
 The storage room should be provided with Mercury Spill Kit provision, proper
ventilation (preferably with exhaust fan). The storage room needs to have smooth tiled
floor with adequate slope, and lighting arrangement.
 The toxic division of the CBWTF will collect it separately.

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CHEMICAL SPILL:
Chemical spills can be prevented in the workplace by:

 Ensuring appropriate chemical containers are used with seals that are in good condition
(i.e. glass containers for corrosive chemicals)
 Ensuring all chemicals are stored appropriately
 Provision of chemical spill proof locked cupboards and storage areas
 Ensuring appropriate equipment and procedures are in place for chemical spill
management.

Chemical Spill Kit :

 Universal Spill Absorbent: 1:1:1 mixture of Flor-Dri (or unscented kitty litter), sodium
bicarbonate and sand. This all-purpose absorbent is good for most chemical spills
including solvents, bases and acids (with the exception of hydrofluoric acid).
 Absorbent pads and rolls: ‗HazMat‘ absorbent pads.
 Acid Spill Neutraliser: Sodium bicarbonate, sodium carbonate or calcium carbonate
 Alkali (Base) Neutraliser: Sodium bisulphate, boric acid or oxalic acid
 Solvents/Organic Liquid Absorbent: Inert absorbents such as clay and sand
 PPE
 Hand protection: Chemical resistant safety gloves
 Eye protection: Safety goggles
 Body protection: Laboratory coat/apron
 Foot protection: Enclosed footwear, shoe covers
 Respiratory protection: Mask/Respirator (All personnel should be properly fit tested
before using a respirator).

I. Neutralising Acid Spills: Acid spills can be neutralized with sodium bicarbonate,
sodium carbonate, or calcium carbonate.

II. Neutralising Alkali Spills: Alkali spills can be neutralised with sodium bisulphite, boric
acid or oxalic acid. Many alkalis can result in serious burns to skin and eyes, so it is
necessary to proceed with extreme caution.

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CLEANING OF CRITICAL AND SEMI CRITICAL AREAS :

The hospital environment is a complex one and contains a large variety of microbial flora.
Various parts of the hospital environment can harbour reservoir(s) of microbes many of which
can constitute an infection risk to patients as well as visitors and healthcare workers.
Transmission of microbes from the environment to the patients and healthcare workers through
direct and indirect contact with the environment has been well documented. Surfaces with higher
frequency of hand contact are more likely to be a source of infection than surfaces with low
degree of contact. Thus high touch surfaces (e.g., handles, bedside tables, etc.) in the patient care
area are a more significant source of infection than low touch surfaces such as walls and floors.

 Cleanliness of Wards
 Cleanliness of Procedure Areas
 Cleanliness of Ambulatory Areas (OPD, Emergency, Lab)
 Cleanliness of Circulation Area
 Cleanliness of Auxiliary Areas
 Cleanliness of Toilets
 Use of Standard Materials and Equipment for Cleaning
 Use of Standard Methods of Cleaning.

The cleanliness activities taken up by the hospital need to ensure minimum following:

 There is no visible dirt/grease/stains in any area of the hospital including roof top,
floors and walls
 There are no cobwebs/bird nests and other incubations due to pests and animals
 There is no seepage on the roofs and walls of the hospital
 Patients mattresses, furniture, fixtures are without grease and dust
 There is no foul smell in any area of the hospital
 The floors of the different areas of the hospital are to be kept dry. When wet
mopping is used, appropriate safety measures need to be adopted by the hospital like
use of signage (Wet Floor)
 There is availability of appropriate cleaning and disinfection materials and equipment
needed for different areas
 The hospital uses standard methods of cleaning for different areas

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 The hospital ensures that monitoring of cleanliness activities is done at pre-defined
intervals and corrective actions are taken when needed.
 The drainage and sewage is well maintained to avoid any leakage, blockage and easy
flow through the drain.

GENERAL CLEANING PRACTICES FOR ALL HEALTHCARE SETTINGS:

Before Cleaning:

a. Check for precautions signs


b. Wear PPE and equip with proper cleaning equipments and solutions
c. Remove clutter before cleaning
d. Gather materials required for cleaning before entering the room
e. Visibly check and ensure all cleaning equipment itself is clean
f. Clean hands before entering the room
g. Prepare chemical dilutions and put on gloves before beginning cleaning.

During Cleaning:

a. Progress from the least soiled areas to the most soiled areas and from high surfaces to low
surfaces
b. General direction for cleaning – from clean to dirty and from top to down Begin cleaning
from windows and walls first (if needed). Clean walls from top to down. Clean all wall
mounted items (e.g., switches, hand rub bottles, etc.). Next, clean all floor based items –
beds, lockers, chairs, IV stands, waste bins etc. Pay particular attention to high touch
surfaces like handles, bedrails, door knobs etc. Make sure all horizontal surfaces are
cleaned.
c. Cleaning the bed: Check all sides of the mattress for soiling Wipe mattress with
disinfectant (if there is waterproof cover). Otherwise, soiled mattresses should be
replaced. Wipe the removed mattress with plenty of disinfectant and thoroughly dry.
d. Remove gross soil (visible to naked eye) prior to cleaning and disinfection
e. Minimize turbulence to prevent the dispersion of dust that may contain micro-organisms
f. Never shake mops
g. Use dust control dry mop prior to wet/damp mop. Do not use brooms
h. The hospital must ensure that all staff uses correct concentration of cleaning solution; for
this purpose housekeeping staff should be trained in the preparation of solution of
cleaning and records of the same need to be kept.

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i. Do not ‗double-dip‘ mops (dip the mop only once in the cleaning solution, as dipping it
multiple times may re contaminate it)
j. An area of 120 square feet to be mopped before re-dipping the mop in the solution
k. Cleaning solution to be changed after cleaning an area of 240 square feet (This does not
apply to critical areas like OT and ICU)
l. Change more frequently in heavily contaminated areas, when visibly soiled and
immediately after cleaning blood and body fluid spills
m. Be alert for needles and other sharp objects. Safely handle and dispose sharps into
puncture proof container.
n. Clean the hands on leaving the room.
o. The hospital should ensure that it has adequate number of buckets, carts and cleaning
equipment for meeting the cleaning requirements of the hospital.
p. It is to be ensured by the hospital that separate equipment is used for cleaning of general
and critical areas.

Equipment for Cleaning:

1. Three bucket system


2. Wet mops (microfiber mops preferable. If other types are used, use non-
lining material).
3. Dry (dust) mops
4. Long handled dust mops
5. Rubber floor wipers
6. Hand mops
7. Dust pans

After Cleaning:

a. Do not overstock rooms


b. Tools used for cleaning and disinfecting should be cleaned and dried between uses
a. It is preferable that wet mops should be laundered in hot water or soaked in clean water
with bleaching powder 0.5% for 30 minutes. Wash with detergent and water to remove
the bleach &
b. Launder mop heads daily
c. All washed mop heads should be dried thoroughly before re-use
d. Clean sanitation cart and carts used to transport biomedical waste daily.

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e. Cleaning of trolleys: Remove all materials stored on trolleys and clean the entire trolley.
Clean the wheels by running them 10-15 times over a Turkish towel soaked with soap
and water.

Cleaning and Disinfection Methods for Wet Mops, Buckets and Cleaning Trolleys

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ROUTINE CLEANING OF FLOORS:

A. Mopping Floors using Dust Control Mop (microfiber) :


 Working from clean areas to dirty areas
 Remove debris from floor and dry any wet spots
 Remove gum or other sticky residue from floor
 Starting in the farthest corner of the room, drag the mop toward you, then push it away,
working in straight, slightly overlapping lines and keeping the mop head in full contact
with the floor
 Do not lift dust mop off the floor once you have started, use swivel motion of frame and
wrist to change direction
 Move furniture and replace after dust mopping, including under and behind bed
 Carefully dispose of debris, being careful not to stir up dust
 Replace mop head/pad when soiled and after mopping a room.

B. Mopping Floors using Wet Loop Mop and Bucket :

 Prepare fresh cleaning solution using appropriate PPE


 Place ‗wet floor‘ caution sign outside of room or area being mopped
 Use Three bucket system for mopping as per guideline
 Divide the area into sections (eg. corridors may be divided into two halves, lengthwise, so
that one side is available for movement of traffic while the other is being cleaned)
 Immerse mop in cleaning solution (Sodium Hypochlorite / other disinfectant) and wring
out.
 Push mop around skirtings first, paying particular attention to removing soil from
corners; avoid splashing walls or furniture
 In open areas use a figure of eight (8) stroke / S curve method in open and wide spaces,
overlapping each stroke; turn mop head over every five or six strokes. While in small
spaces, starting in the farthest corner of the room drag the mop toward you, then push it
away, working in straight, slightly overlapping lines and keeping the mop head in full
contact with the floor.
 Repeat until entire floor is done
 Change the mop head when heavily soiled or at the end of the day.

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Three Bucket Trolley

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DECONTAMINATION, CLEANING, DISINFECTION & STERILISATION OF
INSTRUMENTS

DECONTAMINATION: A process to reduce the growth of micro-organism for further


processing. Decontaminate instruments and other items by placing them in a plastic container of
0.5% Hypochloride solution. Let them soak for 10 minutes (instruments mainly).

Users should put instruments and other items into the solution as soon as they are finished using
each item. Open or unlock jointed instruments, such as haemostats and scissors. Disassemble
those instruments with sliding or multiple parts.

After 10 minutes, remove the items from the Hypochlorite solution and either rinse with water
(not under running water) or clean immediately. Do not leave items in the solution for more
than 10 minutes, since excessive soaking in the solution can damage instruments and other
items. Always wear utility gloves when removing instruments and other items from a chlorine
solution. Dried out instruments then can be taken for further processing.

CLEANING: Cleaning is the removal of foreign material (e.g., soil, and organic material)
from objects and is normally accomplished using water with detergents. Use a soft brush or old
toothbrush, detergent, and water, and scrub instruments and other items vigorously to
completely remove all blood, other body fluids, tissue, and other foreign matter. Dip items
under the surface of the water while scrubbing and cleaning to avoid splashing. Allow items to
air-dry (or dry them with a clean towel).

Note: Instruments that will be further processed with chemical solutions must dry completely to
avoid diluting the chemicals; items that will be high-level disinfected by boiling do not need to
be dried first.

DISINFECTION: Disinfection is a process where most microbes are removed from defined
object or surface, expect bacterial spores. Disinfection can be done by any of the two (2)
methods :

1. HLD (High Level Disinfection): It destroys all microorganisms including


vegetative bacteria, fungi, viruses including enteroviruses and mycobacterium
tuberculosis except bacterial spores. Dip the instruments in 2% or 2.45 %

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Glutaraldehyde for 20 minutes for HLD. Then clean the instrument with
demineralised water and air dry for further use.

2. Boiling: 20 minutes after reaching boiling point lid on at boiler machine. Do not
add or remove instruments during boiling.

STERILISATION: The use of a physical or chemical procedure to destroy all micro-organisms


including large numbers of resistant bacterial spores. Sterilization can be done by any of the two
(2) methods:

 Steam Sterilization: Exposure to steam saturated with water as a general at 121°C for 20
minutes, in an autoclave (as a general rule, may subject to change based on product /
items). Please note these cycle parameters differ as per autoclave type (gravity/dynamic
air removal) and materials for autoclaving along with as per type of autoclave. Signalock
Strip indicator should be used to assess and check the sterility of the materials.

 Chemical Sterilization: This is sterilization with the use of chemicals also known as
cold sterilisation. This is often used for instruments likely to be damaged by heat. It is
based on the premise that it would kill endospores after prolonged exposure (10-24
hours). Chemical sterilisation may be achieved through use of 2% or 2.45 %
Glutaraldehyde Solution, by immersing the instruments for a minimum contact time of 10
to12 hours.

Horizontal Autoclave Machine for Steam Sterilization

Process of Steam Sterilization in Autoclave Machine:

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Check Water

Vacuum position

Switch On Main/Power

Switch On Machine

Articles for Autoclaving to be inserted into the Autoclave & close the door securely
(upto steam position)

Wait for 15-20 minutes until continuous steam is coming out from the rear side the pipe

Steam position

Wait till pressure reaches 15-20lb (Outer Chamber pressure gauge)

Sterilization position

20lb pressure in inner chamber pressure gauge and temperature will show
at least 121o C in dial thermometer

Start counting time for sterilization


Keep trays, instruments, linen: 35-40 mins/ rubber goods & glass: 5mins

Switch off Machine

Switch off Main

Exhaust position

Pressure goes down from 20lb to 0lb (Inner Chamber pressure gauge)

Vacuum position (For drying items)

Wait for 30 mins for linen, instruments & trays, 20 mins for rubber goods & 10 mins for glass

Take out the autoclaved articles properly

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HANDLING LINEN:

i. Bed linen is to be changed daily and whenever soiled with blood or body fluids.
ii. Patient‘s gown is to be changed every day and whenever soiled with blood or body fluids.
iii. Dry dirty linen is to be sent to the laundry for regular wash.

The Basic Principles of Linen Management Are As Follows:

i. Place used linen in appropriate bags at the point of generation


ii. Contain linen soiled with body substances or other fluids within suitable impermeable
bags and close the bags securely for transportation to avoid any spills or drips of blood,
body fluids, secretions or excretions.
iii. Do not rinse or sort linen in patient care areas (sort in appropriate areas)
iv. Handle all linen with minimum agitation to avoid aerosolisation of pathogenic micro-
organisms.
v. Separate clean from soiled linen, and transport/store separately
vi. Wash used soiled linen (sheets, cotton blankets) in hot water (if applicable) and detergent,
rinse and dry preferably in a dryer or in the sun
vii. Autoclave linen before being supplied to the operating rooms/theatres
viii. All the linen generated from patient care areas should be segregated into dirty and
infected linen.
ix. Linen generated from different areas of the hospital needs to be collected in different
colour coded trolleys
x. Dirty linen needs to be collected in a Green coloured trolley and soiled linen in
Yellow coloured trolley. The laundry management protocol of the hospital needs to
include segregation guidelines for all the staff of the hospital
xi. To minimize aerosolisation of any organisms contaminating linen, linen should not be
rinsed, shakenor sorted in the clinical area. The personnel should keep his/her hands away
from face while handling linen. Its preferable to have a closed bag.
xii. The collected linen needs to be stored at a designated place i.e. in dirty utility of the area
of generation.

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INJECTION SAFETY & SAFE DRUG ADMINISTRATION

WHO defines a safe injection as ―A safe injection does no harm to recipient, does not expose the
health care worker to any risk, and does not result in waste that is dangerous for the community‖.
To achieve is, the injection need to be administered using a sterile gloves and needle and
employing the correct techniques. Injection safety, or safe injection practices, is a set of
measures taken to perform injections in an optimally safe manner for patients, healthcare
personnel, and others.

SAFE INJECTION PRACTICES:


To make sure that entire process of administering an injection is safe, the equipment used,
techniques applied and process involved should be in a most safe and hygienic member .

1. Hand Hygiene is one of the most important standard precautions for preventing the
spread of diseases/infection. Hand hygiene must be ensured before and after every
episode of care that involve direct contact with patients
2. Medicines : It is the nurse‘s responsibility safely to prepare and give the drugs ordered by
the doctor. If not given properly, medicines can be harmful or even fatal.
3. It is also important to know if a patient is allergic to a drug. Ask your patients about any
bad reactions they have had to drugs in the past or any medicines forbidden for them. For
safe administration of drugs: give the right dose of the right drug to the right patient in
the right route at the right rate at the right time.
4. When giving medications, the nurse needs to be aware of possible interactions between
the patient‘s different drugs. Drug interactions can sometimes harm the patient.
5. Use sterile disposal syringe & needle for each injection.
6. Pierce the rubber sheath of the vial after cleaning with 70% alcohol swab.
7. Clean the neck of the ampoule with 70% alcohol swab.
8. Use separate needle for dissolving & withdrawing medicine from vial for each injection.
9. Avoid letting needle touch contaminated surface (e.g. outer edges of ampoule or vial,
outer surface of needle cap, table surface etc.)
10. Clean the site for injection as per guidelines
11. Always wear sterile gloves before giving injection
12. Scrub the hub & cannula cap for 15 seconds
13. Keep the cap of cannula on sterile field always before giving injection.
14. Push/ inject medicine slowly to avoid extravasations
15. Do not disassemble the needle & syringe after use

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16. Do not recap, bend or break needles before disposal
17. Cut off the plastic hub of used syringe with hub cutter
18. Maintain hand hygiene
19. Record of all the data

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 Never administer medications from the same syringe to more than one patient,
even if the needle is changed.

 After a syringe or needle has been used to enter or connect to a patient‘s IV it is


contaminated and should not be used on another patient or to enter a medication vial.

 Never enter a vial with a used syringe or needle.

 Never use medications packaged as single-dose vials for more than one patient.

 Assign medications packaged as multi-dose vials to a single patient whenever possible.

 Do not use bags or bottles of intravenous solution as a common source of supply for
more than one patient.

 Follow proper infection control practices during the preparation and administration of
injected medications.

 Wear a surgical mask when placing a catheter or injecting material into the spinal
canal or subdural space.

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BIO MEDICAL WASTE SEGREGATION AND MANAGEMENT:

Bio-Medical Waste means waste that is generated during the diagnosis, treatment or
immunization of human beings or animals or in research activities pertaining thereto or in the
production or testing of biological or in health camps, including the categories mentioned in
schedule I appended to these rules. The Segregation and Management of Bio Medical Waste in
hospitals should be as per the latest guidelines published by the “Central Pollution Control
Board, Ministry of Environment, Forest and Climate Change, Government of India ’’

Important Points for Segregation and Managing Bio Medical Waste:

1. All Bio Medical Waste Bins should be covered & foot paddle operated.
2. Adequate number of colour coded bins / containers and bags should be available at the
point of generation of bio-medical waste.
3. General waste (wastes in Black Bins) should not be mixed with Bio Medical Waste.
4. Waste Handler should wear proper PPE before handling any Bio Medical Wastes.
5. Bio medical wastes from different departments of the hospital should be transported to
the common collection site in a covered Bio Medical Transportation Trolley and
preferably wheel-barrow.
6. There should be a dedicated area for central waste collection (common collection site),
which should be away from public access with separate rooms for different color coded
wastes. The wall of the Common Collection Site is preferably having wall tiles with a
provision of water and the doors should have a provision of lock & key. Bio hazard
symbol should be present in front of the door of Common Collection Site. Bio Medical
Wastes should not be stored in the common collection site more than 48 hours.
7. General Wastes should not be kept in the common collection site.

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Latest G.O of Bio Medical Waste Management (Govt. of WB)

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SHARPS MANAGEMENT, SHARP INJURIES AND POST EXPOSURE PROPHYLAXIS

Safe handling and disposal of sharps is a vital component of the Standard Precautions approach
to reduce the risk of transmission of blood borne virus.

Disposal of Sharps:

1. An adequate number of sharps containers, are located and conveniently placed in clinical
areas.
2. Needles hub cutting should be done
3. Sharps (needles, scalpel blades, razor blades and glass ampoules etc) should be placed
into a Puncture Proof Container.
4. Needle must not to be recapped, bent or broken.
5. Sharps containers should be sealed and closed when two-thirds to three-quarters full.
6. Sharps containers when carried are held away from the body.
7. Use needle safety devices where there are clear indications that they will provide a safer
system of working.
8. Needle collection tray in needle destroyer must be emptied in the morning by the coming
nursing staff or more frequently if required. It should never be overfilled

Sharp injuries: This part is designed as guidance for all Health Care Workers in handling
needle-stick injuries and exposure to blood and body fluids. An exposure that might place HCW
at risk for HBV, HCV, or HIV infection is defined as:

Sharp Injury-a percutaneous injury (e.g , a needle stick injury (NSI) or cut with a sharp object

Blood and body fluid exposure (BBF)-Contact of mucous membrane or non-intact skin (e.g,
exposed skin that is chapped, abraded or affected with dermatitis) – Contact with

blood, tissue, or other body fluids that are potentially infectious.

Main Risks from Needle-Stick Injury and Blood Contamination The main concern is the
transmission of blood-borne viruses, i.e.

 Hepatitis B (HBV)
 Hepatitis C (HCV)
 Human Immunodeficiency Virus (HIV)

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Assessing the Nature and Risk of Exposure:

 Mild Exposure (mucous membrane/non-intact skin with small volumes)


- A superficial wound (erosion of the epidermis) with a plain or low calibre needle

-Contact with the eyes or mucous membranes, subcutaneous injections small-bore


needles

 Moderate Exposure (mucous membrane/non-intact skin with large volumes/


percutaneous superficial exposure with solid needle). A cut or needle stick injury
penetrating gloves

 Severe Exposure (percutaneous with large volume) An accident with a high calibre
needle (>18 G) visibly contaminated with blood.

In case of Needle Stick Injury, all staff must know –

• Whom to report
• Nodal Person for counseling
• When to take PEP
• Where to go
• Where PEP is available

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POST EXPOSURE PROPHYLAXIS (PEP):

A designated doctor in the health facility should assess the staff exposed for the risk of HIV or
HBV transmission after the accidental exposure as defined above. This evaluation should be
made rapidly, so as to start any treatment as soon as possible after the accident (ideally within
two hours but certainly within 24 hours).

This assessment should be made thoroughly (because not every accidental exposure requires
prophylactic treatment).

The first dose of PEP should be administered within the first few hours of exposure. PEP taken
after 72 hours may be less effective hence the risk must be evaluated as soon as possible. If the
risk is insignificant, PEP could be discontinued, if already commenced.

Two main factors determine the risk of infection:

• The nature of exposure

• The status of the source patient

PEP must be initiated as soon as possible preferably within 2 hours of exposure. Regimen of
PEP to be prescribed must be decided on the basis of the type of exposure and HIV/ Hep B
vaccination status of the source person. HIV/HBV testing of the source patient must not delay
the decision to start PEP. PEP must be started and then the patient can be sent for further
consultation, if required. In the case of a high risk exposure from a source patient who has been
exposed to or is taking antiretroviral medications, consult an expert to choose the PEP regimen,
as the risk of drug resistance is high

Expert consultation should be sought in case of exposed. Details on PEP regimen, side effects of
PEP, amount of medication to be dispensed, anti retroviral drugs, HCV Chemoprophylaxis and
PEP regimen should be explained by the MO.

** Please check latest NACO Guidelines on PEP / consult the Medical Officer.

REPORTING OF NEEDLE STICK INJURIES

• All needle stick injuries or exposure, need to be reported to the appropriate authority as decided
by the hospital in a standard format.

• All the staff of the hospital needs to be made aware of such reporting format.

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• All the records related to the reporting of needle stick injuries, PEP provided and follow up
need to be maintained by the hospital.

AIR EXCHANGE: (If Applicable)

Air exchange in high sterile zone is extremely essential. AHU (Air Handling Unit) helps to
maintain the air changes & provide laminar air flow – which helps to maintain asepsis &
infection control.

Laminar air flow : Movement of air in uniform velocity in parallel lines . Standard operating
room ventilation filters air with the removal of 80–97% of particles > 5 μm. Laminar air flow
systems equipped with HEPA (High-Efficiency Particulate Air) filters remove 99.97% of
particles > 0.3 μm. It is preferable that HVAC should perform 6-12 air changes / hour.

Negative pressure Room : A negative pressure room in hospital is used to contain airborn
pathogens within the room. It can be done by at least 12 air change / hour to maintain 0.01 inch
water colum (wc) negative pressure.

Positive pressure Room: This room is used to ensure that outside pathogens does not enter the
room, mainly at sterile zone. It requires done by at least 12 air change / hour to maintain 0.03
inch –wc with the help of HEPA filter. HEPA (High-Efficiency Particulate Air) filters remove
99.97% of particles > 0.3 μm.

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FUMIGATION:

 Eco Shield / Slivicide: It is a mixture of hydrogen peroxide & Silver Nitrate Solution (11
% hydrogen peroxide & 0.01 % Silver Nitrate). 200 ml ecoshild / silvicide should be
mixed with 800 ml distilled water for 100 cu.ft. The mixed solution is kept in the fogger
machine. Place the fogger machine is one corner of the room, placing the nozzle elevated
45‘ to the opposite direction. A folded towel can be placed put under the machine to
avoid slipping as it vibrates. Start the fogger & close the room. Allow the fogger to run
until a fog can seen in the OT atmosphere. Turn off the fogger & keep the room closed
for 01 hour. Open the room & ensure the sterility by swab test..

 Bacillocid : It is the most advanced & safe way of fumigation. All the above process
before using silvicide should be followed, but the chemical in fogger machine is to be
used as Bacillocid. Here 2 % of 100 ml Bacillocid should be mixed with 5 liter of water
& after fogging by fogger machine, keep the door closed for 6 hours. . Open the room &
ensure the sterility by swab test.

What is Antimicrobial Resistance (AMR)?

Antimicrobial Resistance (AMR) refers to the ability of microorganisms, such as bacteria,


viruses, parasites, and fungi, to resist the effects of antimicrobial drugs. Antimicrobial drugs
include antibiotics, antivirals, antifungals, and antiparasitic medications. AMR occurs when

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these microorganisms evolve and adapt in ways that render the drugs ineffective, making
infections more difficult to treat and increasing the risk of the spread of diseases.

What is Patient Safety?

Patient safety refers to the prevention of errors and adverse effects to patients associated with
healthcare. It involves the identification, analysis, and mitigation of risks to ensure a safe and
secure environment for patients during the provision of healthcare services. Patient safety is a
critical aspect of healthcare delivery, aiming to reduce the likelihood of harm and improve
overall quality of care.

Key aspects of patient safety include:

 Preventing Medical Errors: Patient safety initiatives aim to reduce and prevent
medical errors, which can occur at any point in the healthcare process, including
diagnosis, treatment, medication administration, and communication among healthcare
providers.
 Ensuring Quality Care: Patient safety is closely linked to the delivery of high-quality
healthcare. Quality care involves not only effective and evidence-based treatments but
also attention to patient preferences, clear communication, and the avoidance of
unnecessary risks.
 Improving Communication: Effective communication among healthcare providers, as
well as between healthcare providers and patients, is crucial for patient safety.
Miscommunication can lead to errors, misunderstandings, and adverse events. Clear and
open communication is essential for preventing harm.
 Implementing Safety Protocols and Guidelines: Healthcare organizations often
establish safety protocols, guidelines, and best practices to standardize care processes
and minimize the risk of errors. These may include checklists, standardized procedures,
and protocols for identifying and managing potential risks.
 Promoting a Culture of Safety: A culture of safety involves creating an environment
where healthcare professionals feel comfortable reporting errors and near misses
without fear of reprisal. It encourages learning from mistakes, implementing
improvements, and continuously striving to enhance patient safety.

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 Medication Safety: Medication errors can have serious consequences for patients.
Patient safety efforts include strategies to prevent medication errors, such as accurate
prescribing, dispensing, administration, and monitoring of medications.
 Patient Engagement: Involving patients in their care and decision-making processes is
an important aspect of patient safety. Informed and engaged patients are more likely to
actively participate in their care, report concerns, and adhere to treatment plans.
 Continuous Monitoring and Learning: Patient safety is an ongoing process that
requires continuous monitoring, analysis, and learning. Healthcare organizations
conduct root cause analyses and use incident reporting systems to identify areas for
improvement and implement corrective actions.

Patient Safety Goals:

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Measures to improve adherence to standard precautions

• Staff education in hand hygiene, standard precautions


• Ready access to PPE
• Visual reminders at the patient bedside in the form of posters, along with verbal
• reminders from supervising staff
• Bundling of supplies in designated supply carts or pre-organized packs to provide
immediate access to PPE and facilitate their use in resuscitation settings
• Monitoring of adherence through ―safety‖ rounds
• Possible disciplinary action if there are repeated lapses in adherence

PREPARATION OF CHLORINE SOLUTION:

0.5 % chlorine solution from 1% Sodium Hypochlorite Solution


(1 Lit Sol.)

• Take a can of hypochlorite solution


• Take a 1 liter of plastic Mug
• Pour the 1 liter hypochlorite solution in a plastic Mug
• Pour the hypochlorite solution in a plastic bucket
• Add 1 liter of water in a plastic bucket
• Stir 10 seconds
• Prepare 0.5% chlorine solution
• Cover the bucket with lid,
• Label the solution, Store it in a shade.
• Do not store in direct sunlight

Any concentration can be used to make a dilute chlorine solution by applying the following
formula:
[% chlorine in liquid bleach / % chlorine desired] – 1 = Total parts of water for each
part bleach
 To make a 0.5% Chlorine solution from 1% bleach solution i.e. Sodium Hypochlorite
solution (1% / 0.5%) –1 = 0.5 Parts water for each part of Hypochlorite Solution is
needed.
 So to prepare 0.5 % Chlorine solution from 1% supplied Hypochlorite Solution equal
half amount of water is needed.

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0.5 % chlorine solution from calcium hypochlorite / bleaching powder containing 35%
active chlorine: (1 Lit Sol.)

• Take 30 to 50 ml of water from 1 liter


• Pour 3 flat table spoon (14.3gms approx) in 30 to 50 ml of water
• Stir 10 seconds
• Take a paste of chlorine
• Pour the paste in rest amount of water, and again stir 10 seconds
• Cover the bucket with lid,
• Label the solution, Store it in a shade. Do not store in direct sunlight

If using bleach powder, calculate the ratio of bleach to water by using the following formula:
(% Chlorine desired / % chlorine in bleach powder) x1000 = Number of grams of powder
for each litre of water.

To make a 0.5% chlorine solution from calcium hypochlorite powder containing 35% active
chlorine: 0.5% / 35%x1000=14.3gms powder chlorine

Therefore, you must dissolve 14.3 gms of calcium hypochlorite powder (approx 3 leveled
spoon) in each litre of water use to make a 0.5% chlorine solution

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What is ‘CLABSI’ & ‘COTI’?

CLABSI and COTI are two types of healthcare-associated infections that can occur in the
Intensive Care Unit (ICU). They are both serious and can have significant implications for
patient safety. Here's what they stand for and some information about each:

1. CLABSI - Central Line-Associated Bloodstream Infection:


o Definition: A CLABSI is an infection that occurs when microbes (bacteria or
other pathogens) enter the bloodstream through a central venous catheter, which is
a catheter inserted into a large vein, often in the neck or chest, to administer
medications or fluids or to monitor a patient's hemodynamic status.
o Risk Factors: Patients in the ICU often have central lines in place. CLABSI can
occur due to a variety of factors, including improper insertion or maintenance of
the central line, contamination of the catheter or dressing, and the patient's
weakened immune system.
o Symptoms: CLABSI can cause fever, chills, hypotension, and other signs of
systemic infection. Laboratory tests, such as blood cultures, are used to diagnose
the infection.
o Prevention: Preventing CLABSI involves strict adherence to infection control
practices, including proper hand hygiene, using sterile techniques during line
insertion and maintenance, and minimizing the duration that central lines are in
place.
2. COTI - Catheter-Associated Urinary Tract Infection:
o Definition: A COTI is an infection that occurs when pathogens (commonly
bacteria) enter the urinary tract through a urinary catheter, which is a tube inserted
into the bladder to drain urine. Urinary catheters are frequently used in critically
ill patients.
o Risk Factors: Patients in the ICU are at an increased risk of COTI due to the use
of urinary catheters. Inappropriate catheter use, poor aseptic technique during
catheter insertion, and prolonged catheterization are common risk factors.
o Symptoms: COTI can cause urinary symptoms, such as increased frequency and
urgency, discomfort, and cloudy or foul-smelling urine. Systemic symptoms, like
fever and malaise, may also be present.
o Prevention: Preventing COTI involves the appropriate use of urinary catheters
(only when necessary), strict aseptic technique during insertion, maintenance, and

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removal, and minimizing the duration of catheterization. It's also essential to keep
the catheter and the urinary drainage system clean.

Preventing CLABSI and COTI is a critical component of patient safety in the ICU. Healthcare
providers should follow strict protocols and guidelines for the insertion and maintenance of
central lines and urinary catheters, as well as maintaining a high level of hand hygiene and
infection control practices. Prompt recognition of any signs of infection and immediate
intervention are essential in managing and preventing these infections in the ICU.

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...…. C. S. Lewis

National Health Mission


Health & Family Welfare Department
Government of West Bengal

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