Inspection Format for Hospital/Nursing Home

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1 Inspection Format for Hospital/Nursing Home 1. General Information a. Name of establishment: : b. Phone No: c. Address of establishment d. Whether Establishment New/ Old e. Name of the proprietor:. f. Address of the proprietor : g. Nature of firm: Ownership/ Partnership/ Registered company/voluntary Organisation/ Society/PSU h. Empanelled Under JSY/RSBY/ EMRI Building a. Type of Building- Own/ Rented/ Leased b. Well connected with roads 3. OPD Area a. In OPD, Proper signage, Name of Doctor, Qualification, Speciality With available services, timings and phone number b. Space requirements: As Follows Space requirements Minimum std(sq.ft) Dimensions present Consultation room+ Waiting area+ Treatment 200 c. Disable Friendly ramp d. Waiting room with adequate sitting arrangement e. Provision of safe drinking water 1

2 f. Ventilation g. Lighting h. Power backup i. Toilets(Separate for male and Female) j. General Hygiene and Cleanliness : k. Fire Safety equipment l. Provision for privacy of female patients : m. Provision of safe drinking water : Consultation Room a. separate cabins for various disciplines. b. doctor s chair, table, c. patients chair, d. wash basin, e. X Ray film view box f. other set of tools as may be required for different disciplines. 5. Emergency Kit a. Ambu bag : b. Oxygen Cylinder c. IV infusion Set and IV fluid : d. Emergency Medicines f. Suction Machine 2

3 6. IPD Area a. Space requirements: as follows Item Area Required Remark Minimum floor space per bed in ward Minimum distance between centre of two beds Minimum clearance between bed and wall Minimum width of doors in the wall 100 sq. ft. for one bed andadditional60 square feet for every additional bed in the room 6. ft. 6 inches 3 ft. Minimum area to be provided for the bath & 36 sq. ft. toilet Number of urinals 1 per 6 bed Number of toilets and baths Number of wash basins Minimum area of operation theatre (sterile zone) Minimum area for instrument serialization 1 per 6 bed 1 per 10 bed 300 sq feet 50 sq. ft. Minimum area for scrubbing up(there should be 25 sq. ft. proper zoning into protective, clean zone and sterile zone Labor room with Toilets Minimum area for Doctor s duty room Nurses Station Ward store Trolley bay Consulting room & examination room IPD Contd 140 sq. ft sq. ft. 100 sq. ft.(with toilet) 100 sq. ft.(with toilet) 100 sq. ft. 30 sq. ft. 120 Sq. ft. Wards a. Condition of Beds : b. Condition of Mattress c. Condition of linen: d. Stool for Attendant e. Bed Head Ticket f. Records maintenance ( Registers Available ) g. PPEs used by staff h. Oxygen Cylinder Present i. Needle Cutter present j. BMW Management k. Disinfection of infected linen in 1% hypochlorite solution before sending to laundry 3

4 7.Operation Theatre Zoning in OT Complex : Items Available:- a. Slipper stand b. Clean slippers c. Emergency Medicine tray d. Drug trolley e. Instrument Trolley f. Hub cutter g. Macintosh for OT tables h. Cupboards for instruments i. Bio Medical Waste Bins j. Power back up Equipments in The O.T a. Boyles Apparatus b. Multi-Para Monitor c. Suction machine(electric/ foot operated) d. Oxygen Cylinder with Mask e. Nitrous Oxide cylinder f. Shadow less lamps g. Fumigation Record h. Entries in the records complete i. Consent form j. Scrub Area present k. Elbow Operated taps present l. Tiling of the Operation theatre m. Autoclave machine available 4

5 n. Autoclave machine working o. Pressure Gauze of Autoclave Working p. CSSD q. Bilogical Indicator used for Autoclave (signalac tape) Swab culture from OT examined and records maintained r. BMW Management: 8. Labor Room a. Pre Partum Room present : b. Post Partum Room present c. Labor table with steps New Born Baby Corner a. Radiant Warmer : b. Newborn Resuscitation kit c. Laryngoscope d. Mucus Extractor e. Weighing machine Trays a. Emergency Medicine Tray b. Baby Tray c. Episiotomy Tray- d. MVA Tray- e. Delivery Tray f. Medicine Tray Others a. Curtains between two Labor Table Present b. Delivery Kits available 5

6 c. Tiling of the Labor room d. Protocols for NBCC Displayed e. Protocols for Hypothermia Management Displayed f. Running Tap Water Available g. Provision of warm water h. 24x 7 / On call Gynaecologist Available i. Trained nurse to assist during delivery Present j. Adequate Power back up Present Minimum equipments required for labour room a. Foetal monitor (Doppler or cardiotocograph) b. One suction machine / foot suction machine c. B.P. Instrument d. Thermometer e. Foetoscope - f. oxygen cylinder g. catheter, and nebulizers h. Dressing trolley. i. Instruments & equipments required for Emergency j. obstetric care. ( LSCS, Obstetric hysterectomy, Forceps, ) k. Defibrillator l. Fire fighting equipment 9. Diagnostics a. X-ray b. USG c. CT- Scan d. MRI- Scan e. Basic Pathological Tests 6

7 f. Diagnostics As per the prescribed Standards 10. Human Resource a. (Doctors) Degree from recognized university/institute and registration under Council recognized by the Chhattisgarh Sate Government, for the particular discipline (Allopathy/Ayush): (Attach Separate sheet if required ) Specialty / Discipline Super Specialist General Surgeon Physician Obstetrician & Gynaecologist Paediatrics Orthopaedics ENT Specialist Anaesthetist Eye surgeon Dental Surgeon Pathologist Radiologist Psychiatrist Dermatologist General Practitioner (allopathy) General practitioner (ayush) Specialist of AYUSH Desirable Qualifications DNB/MCH/DM/ Post PG Diploma/ Fellowship MS/DNB, (General Surgery) MD/DNB, (General Medicine) DGO (OBG)/MS/DNB/MD DCH/MD(Paediatrics)/DNB MS/DNB/D. ORTH MS/DLO MD(Anaesthesia)/DNB/DA MD/MS/DOMS/DNB/(Ophthalmology) BDS MD/DNB/DCP MD/DNB/DMRE/DMRD/DMR MD/DPM/DNB MD/DNB/Diploma MBBS/ or any other degree in allopathic medicine BAMS/BHMS/ BUMS/Siddha/Yoga Post Graduate in AYUSH Category of Staff For How many Patients Number to be provided RMO/GDMO 20 beds or its part 1 Nurses and Midwife 20 beds or its part 1 General Duty attendant 20 beds or its part 1 Sweeper 10 beds or its part 1 *This is on 8 hourly basis(per shift) 7

8 b. No of Paramedical Staff : (Attach Separate Sheet) : 12. Biomedical Waste Management a. Clearance from Pollution Control board b. Availability of Colour coded Bins c. Disposal- Outsourced /Within facility d. If within the facility e. Deep Pit or and Sharp Pit 13. Registers a. OPD and Stock of life sving Drugs b. Birth and Death Register c. Labor room Register d. IPD register e. JSY payment (if empanelled) f. PCPNDT Register g. Stock Registers h. USG Register i. Radiology and Imaging register j. Lab register k. MTP Register l. OT register m. MLC register n. Register for National Programmes o. Complaint register Note: Apart from above, any other defined, relevant Standards, mentioned in the Chattishgarh Upcharyagriha Tatha Rogopchar Sambandhi Sthapanaye Anugyapan Niyam, 2013, has to be added in this Inspection format. 8

9 Member Inspection Team Member Inspection Team Member Inspection Team District District District Opinion :- This is Certified that the Inspection team has examined Clinical establishment Address.. on.. and found various parameters as per the standards mentioned in the Upcharyagriha Tatha Rogopchar Sambandhi Sthapanaye Anugyapan Niyam, This was put before the District Committee. On behalf of the committee, I here by recommend/do not recommend for Issuance of registration/ license to the aforesaid clinical establishment. Place Date. Chief Medical & Health Officer District.. 9

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