assessment tool for use of core technical standards for...

Assessment Tool for Use of Core Technical Standards for Supporting the Quality Assurance Systems (Accreditation, Regulation etc.)

ANC Standards

S. No. Standard Verification criteria

Resp

onse

(Y/N

/NA

)

Triangulation and Source (Y/N/NA)

Comments

Applicability (ANC-Only/ BEmONC/ CEmONC)

Obs

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Cas

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Prov

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in

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Ph

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# C

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(Y/N

)

(Y/N

)

1 Provider conducts an appropriate and adequate assessment of clinical condition of pregnant woman and fetus in all ANC visits

1.1 Establishes gestational age

1.1.1 Establishes concurrence between LMP and fundal height for estimation of gestational age

ANC UPWARDS

1.1.2 Uses an ultrasound scan in the first or second trimester to confirm gestational age where possible

ANC UPWARDS

1.2

Takes appropriate history (medical, surgical, obstetric and personal) and performs general and systemic examination (Box 1)

1.2.1

Takes appropriate history (medical, surgical, obstetric and personal) and performs general and systemic examination

ANC UPWARDS

1.3 Records weight of pregnant woman during all ANC visits 1.3.1 Records weight of pregnant woman

during all ANC visits ANC UPWARDS

1.4 Conducts abdominal examination 1.4.1 Conducts abdominal examinations as

appropriate ANC UPWARDS

1.5 Records FHR 1.5.1

Functional doppler/fetoscope/stethoscope is available

ANC UPWARDS

1.5.2 Records FHR as appropriate ANC UPWARDS


Resp

onse

(Y/N

/NA

)


Comments


Obs

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tions

Cas

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Prov

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in

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Ph

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Y/N

/NA

# C

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# Pr

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(Y/N

)

(Y/N

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1.6

Performs PV examination during 4th ANC visit (37weeks or more) to check for pelvic adequacy (Box 2)

1.6.1 Uses correct technique for PV examination ANC UPWARDS

1.6.2 Rules out CPD and records PV examination findings ANC UPWARDS

1.6.3 Adequate sterile equipment, gloves and supplies are available ANC UPWARDS

2 Provider screens for key clinical conditions that may lead to complications during pregnancy

2.1 Testing facilities/linkage to testing facilities are available 2.1.1

Provision/easy access for following tests - Hb estimation, proteinuria strips, OGTT, HIV testing, POC/RPR for syphilis, blood grouping and typing, blood glucose estimation, malaria testing, HBsAg and urine routine and microscopy is available

ANC UPWARDS

2.2 Screens for anemia 2.2.1 Estimates Hb at each scheduled ANC visit ANC UPWARDS

2.3 Screens for hypertensive disorders of pregnancy

2.3.1 Functional BP instrument and stethoscope at point of use is available ANC UPWARDS

2.3.2 Records BP at each ANC visit ANC UPWARDS

2.3.3 Performs proteinuria testing during each scheduled ANC visit ANC UPWARDS

2.4 Screens for DM (as per relevant national guidelines) 2.4.1

Uses/Refers for standard 75gm OGTT for screening of GDM at first ANC visit and repeats OGTT test at second ANC visit (24 -28 weeks) if negative in first screening

ANC UPWARDS

2.5 Screens for HIV 2.5.1 Screens/refers for HIV during first ANC visit in all cases, and in fourth ANC visit in high ANC UPWARDS


Resp

onse

(Y/N

/NA

)


Comments


Obs

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Cas

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Prov

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in

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Ph

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Y/N

/NA

# C

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# Pr

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(Y/N

)

(Y/N

)

risk cases

2.5.2 Facilitates testing and treatment of spouse/partner ANC UPWARDS

2.6 Screens for hepatitis B (if applicable and as per relevant national guidelines)

2.6.1 Screens/refers for HBsAg testing during first ANC visit in all cases ANC UPWARDS

2.7 Screens for syphilis 2.7.1 Screens/refers for syphilis in first ANC visit in all cases, and in fourth ANC visit in high risk cases

ANC UPWARDS

2.8 Screens for malaria 2.8.1 Screens for malaria as per the national guidelines. ANC UPWARDS

2.9 Establishes blood group and Rh type during first ANC visit 2.9.1 Establishes blood group and Rh type

during first ANC visit ANC UPWARDS

3 Provider ensures adequate preventive care for key clinical conditions which can lead to complications in pregnancy

3.1 Ensures adequate preventive care for anemia

3.1.1 Prescribes IFA supplementation to all pregnant woman as per relevant national guidelines

ANC UPWARDS

3.1.2 Prescribes single dose of albendazole (400mg) after first trimester (preferably during the second trimester)

ANC UPWARDS

3.2 Ensures adequate preventive care for neonatal tetanus 3.2.1 Ensures two doses of tetanus toxoid one

month apart as early as possible ANC UPWARDS


Resp

onse

(Y/N

/NA

)


Comments


Obs

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tions

Cas

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s

Prov

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in

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Ph

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Y/N

/NA

# C

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# Pr

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(Y/N

)

(Y/N

)

3.3 Ensures adequate preventive care for pre-eclampsia/ eclampsia

3.3.1 Prescribes calcium supplementation 1.5-2gms per day 20 weeks onwards ANC UPWARDS

3.4 Ensures adequate preventive care for malaria

3.4.1 Advises all women to sleep under long-lasting insecticide treated bed nets ANC UPWARDS

3.4.2 Prescribes intermittent prophylaxis treatment of malaria (if applicable) as per national guidelines

ANC UPWARDS

Intra- & Immediate Postpartum Care Standards


Resp

onse

(Y/N

/NA

)

Triangulation and Sources (Y/N/NA)

Comments

Applicability (ANC

Only/BEmONC/ CEmONC)

Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

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Phys

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ve

rific

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Y/N

/ N

A

# C

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# Pr

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(Y/N

)

(Y/N

)

1 Provider conducts an appropriate and adequate assessment of clinical condition of pregnant woman and fetus at the time of admission

1.1

Elicits comprehensive obstetric, medical and surgical history and conducts examination (Box 1)

1.1.1 Documents obstetric, medical and surgical history in case record BEmONC

UPWARDS

1.1.2 Documents the presentation and lie of the fetus in the case record at admission

BEmONC UPWARDS

1.2 Assesses gestational age correctly 1.2.1

Assesses and records gestational age through either LMP or Fundal height or USG (if available)

BEmONC UPWARDS

1.3 Records fetal heart rate 1.3.1

Functional Doppler/fetoscope/stethoscope at point of use is available

BEmONC UPWARDS

1.3.2 Records FHR at admission BEmONC UPWARDS

1.4 Records mother’s blood pressure

1.4.1 Functional BP instrument and stethoscope at point of use is available BEmONC

UPWARDS

1.4.2 Records mother`s BP at admission BEmONC UPWARDS

1.5 Records mother’s temperature

1.5.1 Functional thermometer at point of use is available BEmONC

UPWARDS

1.5.2 Records mother' s temperature at admission BEmONC

UPWARDS


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC


Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

terv

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Phys

ical

ve

rific

atio

n

Y/N

/ N

A

# C

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# Pr

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(Y/N

)

(Y/N

)

2 Provider ensures respectful and supportive care for the pregnant woman coming in for delivery

2.1

Treats pregnant woman and her companion cordially and respectfully (RMC), ensures privacy and confidentiality for pregnant woman during her stay

2.1.1 Curtains are installed in labor room to ensure privacy to pregnant woman BEmONC

UPWARDS

2.1.2

Treats pregnant woman and her companion cordially and respectfully (RMC), ensures privacy and confidentiality for pregnant woman during her stay

BEmONC UPWARDS

2.2 Encourages the presence of birth companion during labor

2.2.1 Encourages the presence of birth companion during labor BEmONC

UPWARDS

2.3

Explains danger signs and important care activities to pregnant woman and her companion during the stay (for the woman and her newborn)

2.3.1

Explains danger signs and important care activities to pregnant woman and her companion during the stay (for the woman and her newborn)

BEmONC UPWARDS

3 Provider monitors the progress of labor in every case by using partograph and adjusts care accordingly

3.1 Monitors progress of labor regularly on various parameters (Box 9)

3.1.1 Initiates partograph plotting when cervical dilatation is >=4 cms in appropriate column on the alert line

BEmONC UPWARDS

3.1.2 Plots all parameters in the partograph BEmONC UPWARDS


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC


Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

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Phys

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ve

rific

atio

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Y/N

/ N

A

# C

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# Pr

actic

ed

(Y/N

)

(Y/N

)

3.2 Interprets partograph correctly and adjusts the care according to findings

3.2.1

If parameters are not normal, identifies complications, records the diagnosis and makes appropriate adjustments in the birth plan

BEmONC UPWARDS

4 Provider conducts a rapid initial assessment and performs immediate newborn care (if baby cried immediately)

4.1

Delivers the baby and places on mother’s abdomen to conduct immediate newborn care - drying and assessment of baby's breathing

4.1.1 Places two pre-warmed towels on mother's abdomen before delivery

BEmONC UPWARDS

4.1.2 Delivers and places the baby on mother's abdomen

BEmONC UPWARDS

4.1.3 Dries the baby immediately and wraps in second warm towel

BEmONC UPWARDS

4.2 Performs delayed clamping of cord 4.2.1

If baby's breathing is normal, delays the clamping of cord for 1-3 minutes till the cord pulsations stop

BEmONC UPWARDS

4.3 Assesses the newborn for any congenital anomalies

4.3.1 Records presence or absence of any congenital anomalies

BEmONC UPWARDS

4.3.2 Ensures specialist attention for newborns with congenital anomalies

BEmONC UPWARDS

4.4 Ensures early initiation of breastfeeding 4.4.1 Initiates breast feeding within one hour

of birth BEmONC UPWARDS


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC


Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

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Phys

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ve

rific

atio

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Y/N

/ N

A

# C

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# Pr

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(Y/N

)

(Y/N

)

4.5 Weighs the baby and administers Vitamin K

4.5.1 Baby weighing scale is available BEmONC UPWARDS

4.5.2 Vitamin K injection is available BEmONC UPWARDS

4.5.3 Records baby weight and administration of vitamin K

BEmONC UPWARDS

5 Provider performs newborn resuscitation if baby does not cry immediately after birth

5.1 Performs recommended initial steps for resuscitation within first 30 seconds

5.1.1 Checks for functionality of neonatal resuscitation kit and availability of shoulder roll before every delivery

BEmONC UPWARDS

5.1.2

Performs following steps within first 30 seconds on mothers abdomen: Suction if indicated; dries the baby and rubs the back 2-3 times; immediate clamping and cutting of cord; and shifting to radiant warmer if baby still not breathing

BEmONC UPWARDS

5.1.3

Performs following steps within first 30 seconds under radiant warmer: Positioning, Suctioning, Stimulation, Repositioning (PSSR)

BEmONC UPWARDS

5.2 Initiates bag and mask ventilation for 30 seconds if the baby is still not breathing

5.2.1 Functional ambu bag with mask (size 0 and 1) is available

BEmONC UPWARDS

5.2.2 Initiates bag and mask ventilation for 30 seconds if baby still not breathing

BEmONC UPWARDS


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC


Obs

erva

tions

Cas

e re

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s

Prov

ider

in

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Phys

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ve

rific

atio

n

Y/N

/ N

A

# C

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# Pr

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(Y/N

)

(Y/N

)

5.3

Takes appropriate action if baby doesn’t respond to ambu bag ventilation after golden minute

5.3.1 Functional oxygen cylinder (with wrench) and new born mask are available

BEmONC UPWARDS

5.3.2 Assesses breathing, if baby still not breathing, continues bag and mask ventilation; starts oxygen

BEmONC UPWARDS

5.3.3 Checks heart rate/cord pulsations BEmONC UPWARDS

5.3.4 Calls for advance help/arranges referral

BEmONC UPWARDS

5.4

*Performs next level ofresuscitation in babies not responding to initial resuscitation- when chest rise is seen after bag and mask but heart rate continues to be < 60/pm (only at facilities where specialist care for newborn or SNCU is available)

5.4.1 Performs chest compressions at the rate of 3 compressions to 1 breath till the heart rate is > 60 beats/minute

*Only at facilitieswhere specialist care for newborn or SNCU is available


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC


Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

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Phys

ical

ve

rific

atio

n

Y/N

/ N

A

# C

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# Pr

actic

ed

(Y/N

)

(Y/N

)

6 Provider performs Active Management of Third Stage of Labor (AMTSL)

6.1 Performs AMTSL and examines the placenta thoroughly

6.1.1 Palpates mother's abdomen to rule out second baby

BEmONC UPWARDS

6.1.2 Administers injection Oxytocin 10 I.U. IM/IV within one minute of delivery of baby

BEmONC UPWARDS

6.1.3 Performs controlled cord traction (CCT) during contraction

BEmONC UPWARDS

6.1.4 Performs uterine massage BEmONC UPWARDS

6.1.5 Checks placenta and membranes for completeness before discarding

BEmONC UPWARDS

7 The facility adheres to universal infection prevention protocols

7.1

Instruments and re-usable items are adequately and appropriately processed after each use

7.1.1 Facilities for sterilization of instruments are available

BEmONC UPWARDS

7.1.2 Instruments are sterilized after each use BEmONC UPWARDS

7.1.3 Delivery environment such as labor table, contaminated surfaces and floors are cleaned after each delivery

BEmONC UPWARDS

7.2 Biomedical waste is segregated and disposed of as per the guidelines

7.2.1 Color coded bags for disposal of biomedical waste are available

BEmONC UPWARDS

7.2.2 Biomedical waste is segregated and disposed of as per the guidelines

BEmONC UPWARDS

7.3 Performs hand hygiene 7.3.1 Performs hand hygiene before and BEmONC


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC


Obs

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tions

Cas

e re

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s

Prov

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in

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Phys

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ve

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atio

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Y/N

/ N

A

# C

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# Pr

actic

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(Y/N

)

(Y/N

)

before and after each procedure, and sterile gloves are worn during delivery and internal examination

after each procedure, and sterile gloves are worn during delivery and internal examination

UPWARDS

8 Provider identifies and manages severe Pre-eclampsia/Eclampsia (PE/E)

8.1 Identifies mothers with severe PE/E

8.1.1 Dipsticks for proteinuria testing in labor room are available

BEmONC UPWARDS

8.1.2 Records BP at admission BEmONC UPWARDS

8.1.3

Identifies danger signs such as severe headache, blurring of vision, difficulty breathing, epigastric pain, reduced urine output; or presence of convulsions

BEmONC UPWARDS

8.2

In cases of severe PE/E, gives correct first dose of MgSO4 and refers to higher center or manages appropriately (Box 4)

8.2.1 MgSO4 (at least 14 ampoules) is available

BEmONC UPWARDS

8.2.2

Gives correct first dose of MgSO4 (5 mg with 1 ml of 2% Xylocaine in each buttock deep IM (10 mg)) and refers to higher center

BEmONC UPWARDS

8.2.3

Injection MgSO4 is appropriately administered (5 mg with 1 ml of 2% Xylocaine in each buttock deep IM (10 mg); 4gms (8ml) with 12 ml Normal saline IV slowly followed by maintenance dose of 5mg with 1 ml of 2% Xylocaine in alternate buttock

BEmONC UPWARDS


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC


Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

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Phys

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ve

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atio

n

Y/N

/ N

A

# C

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# Pr

actic

ed

(Y/N

)

(Y/N

)

deep IM every 4 hours for 24 hours after the last convulsion or delivery whichever occurs later)

8.3 Facilitates prescription of anti-hypertensives (Box 5)

8.3.1 Antihypertensive are available BEmONC UPWARDS

8.3.2 Facilitates prescription or prescribes anti-hypertensives in case of hypertension in pregnancy

BEmONC UPWARDS

8.4 Ensures specialist attention for care of mother and newborn

8.4.1 Ensures specialist attention for care of mother and newborn

BEmONC UPWARDS

9 Provider identifies and manages Postpartum Hemorrhage (PPH)

9.1 Assesses uterine tone and bleeding per vaginum regularly after delivery

9.1.1 Assesses uterine tone and bleeding per vaginum regularly

BEmONC UPWARDS

9.2 Performs initial steps of management as per the protocol in case of PPH

9.2.1 Calls for help /assistance, while continuing uterine message

BEmONC UPWARDS

9.2.2 Starts IV fluids BEmONC UPWARDS

9.2.3 Manages shock if present BEmONC UPWARDS

9.2.4 Identifies specific cause of PPH BEmONC UPWARDS

9.3 Manages atonic PPH 9.3.1 Initiates 20 IU oxytocin drip in 1000 ml of ringer lactate/normal saline at the rate of 40-60 drops per minute

BEmONC UPWARDS


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC


Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

terv

iew

Phys

ical

ve

rific

atio

n

Y/N

/ N

A

# C

heck

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# Pr

actic

ed

(Y/N

)

(Y/N

)

9.3.2 Continues uterine massage BEmONC UPWARDS

9.3.3 If uterus is still relaxed, gives other uterotonics as recommended

BEmONC UPWARDS

9.3.4

If uterus is still relaxed, performs mechanical compression in the form of bimanual uterine compression or external aortic compression or balloon tamponade

BEmONC UPWARDS

9.3.5 If uterus is still relaxed, refers to higher center while continuing mechanical compression

BEmONC UPWARDS

9.4 Manages PPH due to retained placenta/placental bits

9.4.1

Identifies retained placenta if placenta is not delivered within 30 minutes of delivery of baby or the delivered placenta is not complete

BEmONC UPWARDS

9.4.2 Initiates 20 IU oxytocin drip in 1000 ml of ringer lactate/normal saline at the rate of 40-60 drops per minute

BEmONC UPWARDS

9.4.3 Refers to higher center if unable to manage

BEmONC UPWARDS

9.4.4 Performs MRP BEmONC UPWARDS

10 Provider ensures care of newborn with small size at birth

10.1 Facilitate specialist care in newborn weighing <1800 gm 10.1.1 Facilitates specialist care in newborn

<1800 gm (refer to FBNC/seen by BEmONC UPWARDS


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC


Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

terv

iew

Phys

ical

ve

rific

atio

n

Y/N

/ N

A

# C

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# Pr

actic

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(Y/N

)

(Y/N

)

pediatrician)

10.2 Facilitates assisted feeding whenever required 10.2.1 Facilitates assisted feeding whenever

required BEmONC UPWARDS

10.3 Facilitates thermal management including kangaroo mother care

10.3.1 Facilitates thermal management including KMC

BEmONC UPWARDS

(C-section Standards) 11 Provider reviews clinical practice related to C-section at regular intervals

11.1

Ensures classification as per Robson’s criteria and reviews indications and complications of C-section at regular intervals

11.1.1

Ensures that all C‐section cases are classified as per the modified Robson’s criteria and rates of different categories are monitored

CEmONC

11.1.2 Reviews all cases of induction and C-section through a clinical audit CEmONC

11.1.3 Ensures that rate of complications of C-sections are periodically monitored CEmONC

Post Natal Care Standards


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC Only/ BEmONC/ CEmONC)

Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

terv

iew

Ph

ysic

al

verif

icat

ion

Y /

N /

NA

# C

heck

ed

# Pr

actic

ed

( Y/N

)

( Y/N

)

1 Provider ensures adequate postpartum care package is offered to the mother and newborn

1.1 Ensures at least 4 postpartum visits for the mother

1.1.1

Ensures minimum 4 postpartum visits for the mother: after discharge at 2 - 3 days (If discharged early), 7-14 days, 6 weeks and 6 months after delivery (or as per national guidelines)

BEmONC UPWARDS

1.1.2 Prepares postpartum visit schedule and shares written record with the mother and her family

BEmONC UPWARDS

1.1.3 Ensures additional 2 to 3 visits in cases of babies with any complication

BEmONC UPWARDS

1.2 Conducts proper physical examination of mother and newborn

1.2.1

Conducts mother’s examination: breast, perineum for inflammation; status of episiotomy/tear suture; lochia; calf tenderness/redness/swelling; abdomen for involution of uterus, tenderness or distension

1.2.2

Conducts newborn’s examination: assesses feeding of baby; checks weight, temperature, respiration, color of skin and cord stump


Resp

onse

(Y/N

/NA

)


Comments

Applicability (ANC Only/ BEmONC/ CEmONC)

Obs

erva

tions

Cas

e re

cord

s

Prov

ider

in

terv

iew

Ph

ysic

al

verif

icat

ion

Y /

N /

NA

# C

heck

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# Pr

actic

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( Y/N

)

( Y/N

)

1.3 Identifies and appropriately manages maternal and neonatal sepsis

1.3.1 Checks mother's temperature BEmONC UPWARDS

1.3.2 Gives correct regimen of antibiotics BEmONC UPWARDS

1.3.3 Checks baby’s temperature and other looks for other signs of infections

BEmONC UPWARDS

1.3.4 Gives correct regime of antibiotics/refers for specialist care

BEmONC UPWARDS

1.4 Identifies and appropriately manages postpartum maternal depression

1.4.1 Makes correct diagnosis of postpartum maternal depression after ruling out postpartum blues based on history

BEmONC UPWARDS

1.4.2 In cases of postpartum blues, provides emotional support and counsel’s family on the condition. Follows up in 2 weeks, and refers for specialist care if required

BEmONC UPWARDS

1.4.3 In cases of postpartum depression, provides emotional support and refers for specialist care

BEmONC UPWARDS

1.5 Ensures to offer FP services

1.5.1 A basket of choice of PPFP services is available at the facility

BEmONC UPWARDS

1.5.2 Provider is trained for PPFP services being offered at the facility

BEmONC UPWARDS

S0Ps for using Standards-Based Assessment Tool

About Tool A Standards Assessment tool will be used to collect data to assess the practices followed at individual facility at regular intervals (recommended once every 6 months).

Contents of Tool Tool comprises of the following sections:

Facility details/Identifiers

Standards, Components & Verification criteria

Triangulation methods Facility Details/Identifiers:

Data Element Explanation Response State State name where facility exists. Also

name of province/country can be added if applicable

Write name of the State

District District Name where facility exists Write name of the district

Facility Name Name of the facility Write name of the facility

Provider/In Charge name

Name of Provider/ In Charge name Mention name of provider/ In charge (Labor room) of facility

Date of assessment

Date when assessment is done in DD/MM/YYYY format (e.g. 05/09/2012)

Write the date when assessment is done for the facility

Name of the assessor

Name of the person(s) who performed the assessment.

Write name of the assessor(s)

Snapshot of Tool

The number of standards in the tool varies depending on the type of facility. Each standard contains a set of components which should be followed in order to meet the

standard. Each component can be verified by verification criteria, which the assessor triangulates by either directly observing clients or through demonstration on models, or triangulated through case records, providers’ interviews and physical verification of the instrument(s)/equipment required to perform a practice. The cells of relevant triangulation methods for each verification criteria have been kept open for data entry, while the other methods which are not relevant for criteria have been shaded dark. The table below explains about each verification criteria and the type of response that should be entered

Triangulation Criteria Explanation Response

Observation Observation of practices at facility. This can be done either by directly observing

the practice of provider on clients (if available) or asking them to demonstrate skills on models.

If provider correctly performs the skills according to verification criteria, mark it as ‘Y’. If provider is not able to practice correctly, then mark as ‘N’.

If there are no cases for observation, the response will be NA and other triangulation methods will be applied.

Observation of any practice performed by provider has most priority. If the case is available at facility to observe, there is no further need to triangulate that practice through other methods

Y/N/NA

Case records Triangulation of relevant practice through case records should be done if the observation is not possible.

At least 5 case records need to be checked.

Number of case records checked

Number of case records indicating the performance of practice

Providers interview

Providers` knowledge is assessed by asking questions relevant to performing the practice/skill to be verified.

(E.g. Questions to ask for triangulating the recording BP at admission: What examinations you perform at time of admission? Probe further if BP is measured at admission, also ask to perform the procedure if performed)

Attempt should be made to interview maximum number of providers.

Y/N

Physical Verification

Availability of instruments/supplies is checked physically at intended point of use.

If available mark ‘Y’, if not available mark ‘N’.

Y/N

Decision rules:

Decision rule for triangulation criteria:

If verification is possible by means of observation, no further triangulation is required. The relevant verification criterion is considered as ‘Y’ if the

practice/skill observed is being correctly performed on the client as per the standards. If observation is not possible, then go for further triangulation methods as below.

For case records, 50% or more of checked case records should indicate that the practice is performed at the facility.

For Provider interview, all provider(s) interviewed should correctly respond for the verification criteria to be considered as ‘Y’.

For physical verification, the instruments/supplies should be physically checked at intended point of use.

For verification criteria to be considered as ‘Y’, all relevant triangulations for those particular criteria should indicate the performance of that practice or skill by the provider.

For a standard to be considered as ‘Y’ in the Response column, all the verification criteria under the practice should have score of ‘Y’ in the Score column.

A standard will be scored either 0 or 1 depending on the responses. If the responses of all practices performed under a standard are ‘Y’, then the standard will score 1 point. If one or more responses for practices under a standard is ‘N’, the standard scores 0 points.

Example of decision rule

Interpretations Verification criteria 1.1.1: Observation was possible and the practice under 3.

observation was performed hence the score = ‘Y’. No further triangulation was required.

Verification criteria 1.4.1: Observation was possible and practice under observation 4.was not performed hence the score = ‘N’. No further triangulation was required.

Verification criteria 1.5.1: The instrument could be physically verified at intended 5.point of use, hence the score = ‘Y’.

Verification criteria 1.3.1: Observation was not possible (‘NA’), hence further 6.triangulation was done. a. 5 Case records were checked, out of which 3 indicated practice was performed

(i.e. more than 50%). b. Providers were interviewed and the correct response was obtained.

Since all triangulation methods indicate that practice is being performed at the facility, the score is ‘Y’.

Verification criteria 1.6.3: The instrument could not be physically verifies at intended 7.point of use, hence score = ‘N’.

Verification criteria 1.5.2: Observation was not possible (‘NA’), hence further triangulation 8.was done. c. 5 Case records were checked, out of which 2 indicated practice was performed

(i.e. less than 50%). The practice is negative. d. Providers were interviewed and they gave correct responses.

Since all triangulation methods do not indicate that practice is being performed, the score is ‘N’.

Verification criteria 1.6.1 is ‘N’ ‘since observation was not possible (NA) and provider 9.did not give correct response when interviewed.’

Standard no. 1 will be scored as 0 as verification criteria 1.4.1, 1.5.2, 1.6.1, 1.6.2 & 1.6.3 are ‘N’.