5 Labour Room Laqshya Assessment Toolkit (2).xlsx

	A	B	C	D	E	F	G	J
1	National Quality Assurance Standards 2016
2	Checklist for Labour Room
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10	Assessment Summary
11	Name of the Hospital					Date of Assessment
12	Names of Assessors					Names of Assessees
13	Type of Assessment (Internal/Peer/External)					Action plan Submission Date
14	Labour room Score Card
15	Area of Concern wise Score					Labour Room Score
16	A	Service Provision	50%			50%
17	B	Patient Rights	50%
18	C	Inputs	50%
19	D	Support Services	50%
20	E	Clinical Services	50%
21	F	Infection Control	50%
22	G	Quality Management	50%
23	H	Outcome	50%
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25		Major Gaps Observed
26	1
27	2
28	3
29	4
30	5
31		Strengths / Good Practices
32	1
33	2
34	3
35	4	Z
36	5
37		Recommendations/ Opportunities for Improvement
38	1
39	2
40	3
41	4
42	5
43		Signature of Assessors
44		Date
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46	Checklist for Labour Room
47	Reference No	Measurable Element	Checkpoint	Compliance	Assessment Method	Means of Verification	Remarks	%
48		Area of Concern - A Service Provision						50
49	Standard A1	The facility provides Curative Services						50
63	ME A1.14	Services are available for the time period as mandated	Labour room service is functional 24X7	1	SI/RR	Verify with records that deliveries have been conducted in night on regular basis
68	Standard A2	The facility provides RMNCHA Services						50
69	ME A2.1	The facility provides Reproductive health Services	Availability of Post Partum IUD insertion services	1	SI/RR	Verify with records that PPIUD services have been offered in labour room
70	ME A2.2	The facility provides Maternal health Services	Availability of Vaginal Delivery services	1	SI/RR	Normal vaginal & assisted (Vacuum / Forcep ) delivery
71			Availability of Pre term delivery services	1	SI/RR	Check if pre term delivery are being conducted at facility and not referred to higher centres unnecessarily
72			Management of Postpartum Haemorrhage	1	SI/RR	Check if Medical /Surgical management of PPH is being done at labour room
73			Management of Retained Placenta	1	SI/RR	Check staff manages retained placenta cases in labour room . Verify with records
74			Septic Delivery & Delivery of HIV positive Pregnant Women	1	SI/RR	Check if infected delivery cases are managed at labour room and not referred to higher centres unnecessarily
75			Management of PIH/Eclampsia/ Pre eclampsia	1	SI/RR	Check services for management of PIH/ Eclampsia are being proved at labour room
76	ME A2.3	The facility provides Newborn health Services	Availability of New born resuscitation	1	SI/OB	Check if labour room has a functional New born resuscitation services available in labour room
77			Availability of Essential new born care	1	SI/OB	Check essential newborn care provisions such as Keeping baby on mother's abdomen, immediate drying of baby, Skin to skin contact, delayed chord clamp, initiation of breast feeding, recording of vitals and Vit. K are provided
80	Standard A3	The facility Provides diagnostic Services						50
82	ME A3.2	The facility Provides Laboratory Services	24 *7 Availability of point of care diagnostic tests	1	SI/OB	HIV, Hb% , Random blood sugar , Protein Urea Test
107		Area of Concern - B Patient Rights						50
108	Standard B1	The facility provides the information to care seekers, attendants & community about the available services and their modalities						50
109	ME B1.1	The facility has uniform and user-friendly signage system	Availability of departmental signage's	1	OB	Numbering, main department and internal sectional signage, Restricted area signage displayed. Directional signages are given from the entry of the facility
110	ME B1.2	The facility displays the services and entitlements available in its departments	Necessary Information regarding services provided is displayed	1	OB	Name of doctor and Nurse on duty are displayed and updated. Contact details of referral transport / ambulance displayed
113	ME B1.5	Patients & visitors are sensitised and educated through appropriate IEC / BCC approaches	IEC Material is displayed	1	OB	Breast feeding, kangaroo care, family planning etc (Pictorial and chart ) in circulation & waiting area
114	ME B1.6	Information is available in local language and easy to understand	Signage's and information are available in local language	1	OB	Check all information for patients/ visitors are available in local language
117	Standard B2	Services are delivered in a manner that is sensitive to gender, religious and cultural needs, and there are no barrier on account of physical economic, cultural or social reasons.						50
118	ME B2.1	Services are provided in manner that are sensitive to gender	Only on duty staff is allowed in the labour room when it is occupied	1	OB	Pregnant woman, her birth companion, doctor, nurse/ANM on duty, and other support staff only, is allowed in the labour room
120	ME B2.3	Access to facility is provided without any physical barrier & friendly to people with disabilities	Availability of Wheel chair or stretcher for easy Access to the labour room	1	OB
121			Availability of ramps and railing & Labour room is located at ground floor	1	OB	If not located on the ground floor availability of the ramp / lift with person for shifting
122	ME B2.4	There is no discrimination on basis of social and economic status of the patients	Check care to pregnant women is not denied or differed due to discrimination	1	OB/PI	Discrimination may happen because of religion, caste, ethnicity, cast, language, paying capacity and educational level.
124	Standard B3	The facility maintains privacy, confidentiality & dignity of patient, and has a system for guarding patient related information.						50
125	ME B3.1	Adequate visual privacy is provided at every point of care	Availability of screen/ partition at delivery tables	1	OB	Screens / Partition has been provided from three side of the delivery table or Cubicle for ensuring visual privacy
126			Curtains / frosted glass have been provided at windows	1	OB	Check all the windows are fitted with frosted glass or curtains have been provided
127			No two women are treated on common bed/ Delivery Table	1	OB/PI	Check that observation beds and delivery tables are not shared by multiple women at the same time because of any reason
128	ME B3.2	Confidentiality of patients records and clinical information is maintained	Patient Records are kept at secure place beyond access to general staff/visitors	1	SI/OB	Check records are not lying in open and there is designated space for keeping records with limited access. Records are not shared with anybody without permission of hospital administration
129	ME B3.3	The facility ensures the behavior of staff is dignified and respectful, while delivering the services	Behavior of labour room staff is dignified and respectful	1	OB/PI	Check that labour staff is not providing care in undignified manner such as yelling, scolding , shouting, blaming and using abusive language, unnecessary touching or examination
130			Pregnant women is not left unattended or ignored during care in the labour room	1	OB/PI	Check that care providers are attentive and empathetic to the pregnant women at no point of care they are left alone.
131			Care provided at labour room is free from physical abuse or harm	1	OB/PI	Check if the physical abuse practices such as pinching, slapping, restraining , pushing on the abdomen, extensive episiotomy etc.
132			Pregnant women is explicitly informed before examination and procedures	1	OB/PI	Check if care providers verbally inform the pregnant women before touching, examination or starting procedure.
133	ME B3.4	The facility ensures privacy and confidentiality to every patient, especially of those conditions having social stigma, and also safeguards vulnerable groups	HIV status of patient is not disclosed except to staff that is directly involved in care	1	SI	Check if HIV status of pregnant women is not explicitly written on case sheets and avoiding any means by which they can be identified in public such as labelling or allocating specific beds.
134	Standard B4	The facility has defined and established procedures for informing patients about the medical condition, and involving them in treatment planning, and facilitates informed decision making						50
135	ME B4.1	There is established procedure for taking informed consent before treatment and procedures	Consent is taken before delivery and or shifting	1	SI/RR	Check the labour room case sheet for consent has been taken
138	ME B4.4	Information about the treatment is shared with patients or attendants, regularly	Labour room has system in place to involve patient's relative in decision making about pregnant women treatment	1	PI	Check if pregnant women and her family members have been informed and consulted before shifting the patient for C-Section or referral to higher center
140	Standard B5	The facility ensures that there are no financial barrier to access, and that there is financial protection given from the cost of hospital services.						50
141	ME B5.1	The facility provides cashless services to pregnant women, mothers and neonates as per prevalent government schemes	Check all services including drugs, consumables, diagnostics and blood are free of cost in labour room	1	PI/SI	Check if there are no user charges of any services in labour room . Ask Pregnant women and their attendants if they have not paid for any services or any informal fees to service providers
146		Area of Concern - C Inputs						50
147	Standard C1	The facility has infrastructure for delivery of assured services, and available infrastructure meets the prevalent norms						50
148	ME C1.1	Departments have adequate space as per patient or work load	Adequate space as per delivery load	1	OB	Labour tables should be placed in a way that there is a distance of at least 3 feet from the sidewall, at least 2 feet from head end wall, and at least 6’ from the second table
149	ME C1.2	Patient amenities are provided as per patient load	Availability of patients amenities such as Drinking water, Toilet & Changing area	1	OB	Dedicated Toilets for Labour Room area and Staff Rooms. LDR concept for Labour Room should have attached toilet with each LDR unit . Toilets are provided with western style toilet seats. Drinking water Facility within labour room For Pregnant women & companion
150	ME C1.3	Departments have layout and demarcated areas as per functions	Labour Room layout is arranged in LDR concept	1	OB	Labour Room and associated services are arranged according to Labour-Delivery-Recovery Concepts with each LDR unit comprising of 4 Labour Beds and dedicated Nursing Station and New Born Corner
151			Availability of Registration Area & Waiting area	1	OB	Dedicated reception and registration area the entry of Labour Room Complex with registration desk and seating arrangement for 30 people in waiting area
152			Availability of Triage and Examination Area	1	OB	Dedicated Triage & Examination room with two examination beds for segregation of High & Low Risk patients Entry to the labour room should not be direct. Check if there is any buffer area
153			Dedicated nursing station and Duty Rooms	1	OB	One common Nursing station for Conventional Labour Room Dedicated Nursing station for Each unit if LDR concept is followed
154			Availability of Storage Area	1	OB	A dedicated sub store with cabinets and storage racks for storing supplies Separate Clean room & Dirty Utility room for Storing Sterile and Used goods respectively
155			Availability of Newborn Care area	1	OB	One Dedicated Newborn care area for each four tables. Incase of LDR dedicated NBCA for each unit.There should be no obstruction between labour table and Newborn corner for swift shifting of newborn requiring resuscitation Radiant Warmer Should have free space from three sides
156			Availability of Staff Room & Doctor's Duty Room	1	OB	Dedicated rooms for Nursing staff and Doctors provided with beds, storage furniture and attached toilets
157	ME C1.4	The facility has adequate circulation area and open spaces according to need and local law	Corridors connecting labour room are broad enough to manage stretcher and trolleys	1	OB	Corridor should be wide enough that 2 stretcher can pass simultaneously without any hassle