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Alat Pantau Sistem Kinerja Klinik di Puskesmas – 18 Mar 2014 i

Instruments to monitor

Clinical Performance System at Community Health Center

Alat Pantau Sistem Kinerja Klinik di Puskesmas – 18 Mar 2014 1

DAFTAR ISI

A. Pedoman Pengisian Alat Pantau Sistem Kinerja Klinik ………………………………………………………………. 1

B. Daftar Singkatan………………………………………………………………………………………………………………………. 11

C. Alat Pantau 1: …………………………………………………………………………………………………………………….……. 12

• Respon Emergensi Obstetri-Neonatal di Puskesmas/Klinik Swasta………………...…………………….. 13

• Daftar Kelengkapan Troli Emergensi Neonatal……………………………………………………………………… 15

• Daftar Kelengkapan Troli Emergensi Ibu……………………………………………………………………………….. 17

D. Alat Pantau 2: ………………………………………………………………………………………………………………………….. 20

• Pelayanan Emergensi Obstetri dan Neonatal di Puskesmas/Klinik Swasta……………………………. 21

E. Alat Pantau 3: ………………………………………………………………………………………………………………………….. 24

• Rujukan Emergensi Obstetri dan Neonatal di Puskesmas/Klinik Swasta …………………………….... 25

F. Alat Pantau 4: ………………………………………………………………………………………………………………………….. 28

• Perlengkapan dan Peralatan PONED di Puskesmas/Klinik Swasta ……………………………………….. 29

• Daftar Tilik Persiapan Kegawatdaruratan PONED ………………………………………………………………… 30

G. Alat Pantau 5: ………………………………………………………………………………………………………………………….. 34

• Pencegahan Infeksi di Puskesmas ………………………………………………………………………………………... 35

2 Alat Pantau Sistem Kinerja Klinik di Puskesmas – 18 Mar 2014

A. GUIDELINES To FULFILL THE CLINICAL PERFORMANCE SYSTEM MONITORING TOOLS

Quality improvement process aims to change services from “actual practice” to “desired practices” in accordance with standards recognized. For that there are several key points that can make quality improvement process takes place. :

Involvement and sense of belonging from officers/staff: the staff of all levels should be involved in this process. Patient-oriented: the patient needs and expectations must be met. Focus on systems and process: should always keep in mind that bad quality of service is often a result of poor

systems and process, or difficulty in implementing a standard rather than the individual errors. Aware of high cost and efficient. Continuous learning, development and capacity building.. The continuous quality improvement.

To meet those keys, the quality improvement process then should follow the cycles as seen in Figure 1. This cycle starts with data collection and analysis. The purpose of the data collection and analysis is to identify the gap between the existing condition and desired standards condition in the service of maternal and neonatal emergency.


Activities done in cooperation with the team in health facilities which consist of the Head of Community Health Center, doctor, and midwife coordinator at the health facility in the form of participatory assessment at the beginning, so that officers at all levels are involved from the beginning with efforts related to the improvement of quality in the framework of the implementation of clinical governance. However, considering one of the goal of the instrument is as a management tool, so it driven to an independent assessment. The implementation of the monitoring instruments leads to identify the performance gap-the gap that should be minimized or eliminated. The manager and the officer then analyze the causes of disparities and applies the appropriate intervention to fix – for example the emergency trolley which is not ready to use, emergency medications which is not always available, audits are not perform at health facilities, lack of knowledge and skills of officers and others.

Gambar 1. Siklus Peningkatan Kualitas

Managers are encouraged to emphasize on the action and start off with a simple intervention that achieved tangible early results thus creating momentum change and acquiring the skills of management changes gradually to bridge the gap more complex.

BEST PRACTICES

(Best Practice)

Asesment and analysis

Evaluation progress and

follow up

ACTUAL PRACTCES

Developing an action plan

Implementing solutions


Clinical Performance System Monitoring Tools and how to use it.

A description of the Tools

Alat Pantau Sistem Kinerja Klinik adalah daftar standar kinerja yang diatur berdasarkan diagnosis utama yang menjadi fokus penyelamatan Ibu hamil dan neonatus, serta beberapa “cross‐cutting themes”. Manfaat alat pantau ini adalah : • Memuat kriteria verifikasi yang mudah diamati dengan opsi-opsi jawaban “ya”, “tidak” dan “tidak

diaplikasikan.” • Mengukur tingkat kinerja yang diterapkan pada fasilitas atau institusi. • Membantu mengidentifikasi kesenjangan kinerja. • Membangun secara objektif tingkat kinerja yang diinginkan.

Alat Pantau Sistem Kinerja Klinik Puskesmas

Alat Pantau Sistem Kinerja Klinik di Puskesmas terdiri dari 5 instrumen, yaitu: • Alat Pantau 1. Respon Emergensi Obstetri-Neonatal di Puskesmas/Klinik Swasta • Alat Pantau 2. Penilaian Ketrampilan di Puskesmas/Klinik Swasta • Alat Pantau 3. Rujukan Emergensi Obstetri dan Neonatal di Puskesmas/Klinik Swasta • Alat Pantau 4. Perlengkapan dan Peralatan PONED di Puskesmas/Klinik Swasta • Alat Pantau 5. Pencegahan Infeksi di Puskesmas/Klinik Swasta


Bagaimana menggunakan alat pantau ini:

Alat Pantau ini digunakan untuk melakukan asesmen di fasilitas. Di setiap area, standar-standar mempunyai instruksi khusus tentang bagaimana dan dimana mengumpulkan/memverifikasi informasi yang dibutuhkan serta beberapa pengamatan yang diinginkan.

Ada beberapa cara untuk mendapatkan data yaitu dengan: pengamatan terstruktur langsung, mengkaji dokumen, wawancara dan melakukan simulasi klinik. Data-data tersebut pada mulanya didapatkan secara bersama-sama antara tim pendamping dengan tim dan aktor di fasilitas kesehatan. Hal ini diperlukan, selain sebagai suatu bentuk implementasi dari kegiatan pendampingan juga sekaligus menjadikan penilaian ini lebih valid karena adanya unsur eksternal (yaitu tim pendamping).

Selanjutnya, sebagai bagian dari siklus peningkatan kualitas maka tim dan aktor di fasilitas kesehatan dapat melakukan evaluasi secara mandiri.

Tim pendamping adalah merupakan suatu tim yang terdiri dari para klinisi yang bertugas membina dan juga memverikasi hasil asesmen: spesialis Kebidanan, spesialis Anak, Dokter Umum, Bidan dan Perawat baik dari institusi kesehatan (Dinkes, RSUD) atau pusat pelatihan klinik kesehatan reproduksi seperti P2KS atau P2KP dan organisasi profesi (POGI, IDAI, IDI dan IBI).

Pengumpulan informasi mengenai standar‐standar berdasarkan:

• Pengamatan langsung. • Mengkaji dokumen administrasi dan rekam medis. • Wawancara terarah.


Pada saat menggunakan pengamatan terstruktur secara langsung:

• Perkenalkan diri Anda dan jelaskan alasan dilakukan penilaian. • Gunakan alat bantu penilaian sebagai panduan pengamatan. • Jangan berikan umpan balik pada saat penilaian. • Upayakan untuk obyektif dan bersikap sopan pada saat penilaian.

Pada saat mengkaji dokumen:

• Perkenalkan diri Anda dan jelaskan alasan dilakukan penilaian. • Identifikasi sumber-sumber informasi yang benar (misal: formulir administrasi, catatan statistik, catatan

pelayanan). • Mengkaji dokumen dengan menggunakan alat bantu penilaian. • Meminta petugas yang bertanggung jawab di area/ruangan tersebut untuk melengkapi dan/atau mengklarifikasi

informasi. • Upayakan untuk obyektif dan bersikap sopan pada saat penilaian.

Pada saat melakukan wawancara:

• Perkenalkan diri Anda dan jelaskan alasan dilakukan penilaian • Identifikasi anggota staf yang biasanya melakukan kegiatan atau tindakan. • Lakukan wawancara dengan anggota staf menggunakan alat bantu/daftar tilik • Gali pertanyaan untuk mendapat jawaban yang tepat; jangan mengasumsikan jawaban. • Minta petugas untuk menunjukkan dokumen, alat atau bahan yang sesuai. • Upayakan untuk obyektif dan bersikap sopan pada saat penilaian.


Bagaimana cara mengisi alat pantau ini: 1. Lengkapi data identitas fasilitas sebelum melakukan pengisian instrumen termasuk informasi lengkap

petugas yang melakukan penilaian. 2. Catat segera informasi yang dikumpulkan. 3. Terdapat 3 kolom penilaian, yaitu “Ya,” “Tidak” atau “N/A”. 4. Tuliskan tanda “√” pada kolom “Ya” kalau prosedur tersebut dikerjakan atau alat yang dimaksud tersedia

sebagaimana yang disebutkan dalam standar. 5. Tuliskan tanda “√” pada kolom “Tidak” jika prosedur tidak dilakukan atau tidak dilakukan dengan benar 6. Tuliskan tanda “√” pada kolom “N/A” apabila kondisi yang dibutuhkan tidak berlaku atau ketika digunakan

metode lain pada kriteria verifikasi. 7. Jangan biarkan salah satu dari 3 kolom tersebut kosong

Kolom Catatan/komentar – kolom ini sangat berguna untuk melakukan analisis dan sebaiknya dimanfaatkan sebanyak mungkin oleh staf fasilitas untuk memberi penjelasan terhadap pengisian dalam kolom Y dan T. Contohnya kolom ini dapat digunakan untuk menuliskan catatan atau mendokumentasikan bagaimana suatu kriteria yang perlu dipenuhi, atau keterangan mengapa metode yang berbeda digunakan dalam menentukan kriteria verifikasi.

Setelah menilik seluruh kriteria verifikasi yang diminta pada setiap instrumen, maka staf menuliskan nilai pada kolom ”NILAI”. Penilaian diberikan kepada tiap-tiap nomor dalam instrumen penilaian, dan apabila terdapat lebih dari satu kriteria verifikasi pada nomor tersebut, nilai ”1” hanya diberikan jika semua kriteria verifikasi dijawab dengan ”YA”.

Pada contoh dibawah ini, kriteria verifikasi pertama adalah “Ya” karena selama pengamatan terdapat catatan di fasilitas yang mendokumentasikan jadwal tugas tim emergensi obstetri-neonatal di unit yang bersangkutan.

Sedangkan, semua kriteria verifikasi nomor 2 dituliskan ”Tidak” karena pada saat pengamatan ditemukan bahwa troli emergensi obstetri dan neonatus tidak lengkap.


NO NILAI STANDAR KINERJA KRITERIA VERIFIKASI YA TIDAK N/A CATATAN 1 Tim emergensi siap dipanggil

untuk penatalaksanaan setiap ibu hamil, bersalin atau post-partum dan neonatus yang berada dalam kondisi mengancam jiwa terkait adanya komplikasi

Catatan di fasilitas yang mendokumentasikan jadwal tugas tim emergensi obstetri-neonatal di unit yang bersangkutan.

Tim emergensi terdiri dari:

bidan, perawat, dokter umum

√

2 Peralatan dan perlengkapan untuk penatalaksanaan emergensi obstetri - neonatal tersedia dan selalu dalam kondisi siap pakai.

Periksalah apakah peralatan dan perlengkapan berikut terdapat pada troli emergensi obstetri-Neonatal atau wadah yang sama fungsinya:

• Troli emergensi obstetri √

• Troli emergensi neonatus Lihat Lampiran daftar standar kelengkapan troli emergensi obstetri- neonatal

√

3 Pemeriksaan rutin dan teratur terhadap kelengkapan dan kesiapan troli emergensi obstetri-neonatal.

Periksalah apakah terdapat daftar tilik troli emergensi obstetri- neonatal yang berisi:

• Daftar tilik set peralatan lengkap pada troli atau wadah tersebut √

• Jadwal pengecekan pada setiap pergantian dinas petugas

√

4 Fasilitas kesehatan melakukan pengkajian kasus pada semua rujukan emergensi di ibu hamil/persalinan/ postpartum dan neonatus ke rumah sakit

Mengkaji catatan di fasilitas yang mendokumentasikan pengkajian kasus untuk kondisi berikut:

• Rujukan emergensi neonatus ke Rumah Sakit √ Tidak ada kasus

• Rujukan emergensi ibu hamil/persalinan/postpartum ke RS

√

Tidak ada kasus

Pada kriteria verifikasi ke empat adalah “N/A” karena kondisi yang diinginkan tidak ada (tidak ada kasus), sedapat mungkin berikan catatan pada kolom “CATATAN” untuk menjelaskan hal tersebut.


Tabel perhitungan

Pada akhir setiap instrumen ada tabel perhitungan: Total Standar Kinerja

Total Standar Diobservasi 6

Total Pencapaian Standar

% Pencapaian %

Untuk mengisi tabel diatas, semua standar diperiksa kembali dan di hitung berapa standar yang berhasil dicapai untuk diisi pada baris pertama. Kemudian dihitung persentasinya.

Bagaimana menilai dan merangkum hasil penilaian: Pemberian angka menggunakan alat pantau:

• Setiap standar mempunyai nilai 1 poin. • Untuk standar yang sesuai, maka semua kriteria verifikasi harus “ya” atau “tidak dilakukan” • Apabila kriteria verifikasi tidak sesuai (N/A) maka hal ini akan mengurangi total standar yang dinilai.


Mengembangkan Rencana Aksi dan Tim Organisasi

Setelah setiap asesmen, petugas (tim dan aktor di fasilitas kesehatan) harus mengembangkan sebuah Rencana Tindak Lanjut (RTL) yang strategis, yang di dalamnya berisi rencana operasional untuk memandu implementasi dari proses peningkatan. Rencana-rencana ini relatif merupakan alat pantau yang sederhana yang menggambarkan kesenjangan dan penyebab yang perlu diminimalisasi, intervensi khusus yang harus dilakukan, orang-orang yang terlibat, kerangka waktu pelaksanaan dan penunjang potential yang dibutuhkan. Identifikasi orang-orang yang bertanggung jawab dan menentukan kerangka waktu merupakan hal yang sangat penting karena mereka memenuhi kegiatan tindak lanjut dalam perencanaan. Rencana operasional harus dikembangkan berdasarkan analisa hasil dari data awal atau asesmen pantauan lanjutan oleh tim yang terdiri dari staf fasilitas dan pimpinan yang bekerja di bagian pemberi layanan yang berbeda yang sedang ditingkatkan. Selain hasil penilaian ini tim dan aktor di fasilitas kesehatan disarankan juga mengumpulkan data tambahan yang sifatnya kualitatif khususnya terkait dengan implementasi dari Principles of Good Care di fasilitas kesehatan, seperti Komunikasi, Pengorganisasian tempat kerja, Privasi, Pencegahan Infeksi dan Dokumentasi. Berdasarkan data-data kualitatif tersebut serta hasil penilaian dari alat pantau sistem kinerja maka Tim dan Aktor bersama-sama menyusun RTL yang dievaluasi setidaknya setiap 3 bulan atau sesuai dengan waktu yang dijadwalkan.

Penting untuk memahami bahwa proses biasanya diawali dari kelompok kecil orang-orang yang berkomitmen karena hal ini luar biasa memerlukan dukungan luas untuk inisiatif-inisiatif baru. Selain itu, penting menemukan orang-orang yang berkomitmen untuk suatu inisiatif dan melibatkan mereka sejak awal.

Tugas utama dari kelompok orang-orang yang berkomitmen tersebut adalah mengatur/mengkoordinasikan tim untuk mengimplementasikan proses peningkatan. Sebagaian besar proses akan tergantung pada kerja tim, sehingga perlu dikembangkan sekelompok orang yang berkomitmen pada kualitas melebihi apapun. Tim-tim sebaiknya


terdapat di tiap-tiap area intervensi, di mana mereka melakukan analisis dari semua data yang dikumpulkan, membuat rencana strategis, mengimplementasikannya serta memonitor pencapaiannya.

Sangat disarankan untuk bekerja dalam suatu jejaring dalam mengimplementasi rencana-rencana. Bekerja dalam jejaring akan mendorong pertukaran pengalaman dan saling mendukung, sehingga mendorong percepatan pencapaian perubahan yang positif.

Proses ini juga menunjukkan sebuah aksi yang berangkat dari dasar (petugas lini depan), klien/pasien dan keluarga serta keterlibatan masyarakat. Tujuan utama dari keseluruhan proses ini adalah menyediakan dukungan bagi petugas kesehatan, manajer dan komunitas berupa sebuah instrumen sederhana yang mendayagunakan dan meningkatkan kemampuan mereka untuk menguatkan proses penyediaan pelayanan kesehatan.

Dalam mengidentifikasi ‘kesenjangan’, tim harus selalu mengingat bahwa ada kesenjangan yang:

• Tidak membutuhkan analisis yang kompleks karena solusinya sederhana dan sangat jelas (misal; menunjuk penanggung jawab untuk sebuah tugas, mengganti peralatan yang rusak, mengorganisasi peralatan agar lebih efisien dan efektif).

• Berada dalam kendali fasilitas dan dapat diatasi dengan memobilisasi sumber-sumber lokal yang ada (misal; memodifikasi beberapa prosedur, melakukan redistribusi tenaga/staf).

• Berada dalam kendali yang ada di luar fasilitas dan biasanya membutuhkan mobilisasi dari sumber-sumber diluar fasilitas (misal; perubahan kebijakan, penambahan gaji, penambahan staf, persetujuan untuk dana baru).

Sebagaimana disebutkan sebelumnya, mulai dengan kesenjangan yang paling mudah untuk diselesaikan lalu secara bertahap melanjutkan ke kesenjangan- kesenjangan yang lebih kompleks.


B. Abbreviation ASI : Air Susu Ibu / Breast-milk

DTT : Disinfeksi Tingkat Tinggi (High level Desinfection)

ETT : Endo Tracheal Tube

IBI : Ikatan Bidan Indonesia (Indonesian Midwife Association)

IDAI : Ikatan Dokter Anak Indonesia (Indonesian Pediatrician Association)

IDI : Ikatan Dokter Indonesia (Indonesian Doctor Association)

PMI : Palang Merah Indonesia (Indonesian Red Cross)

PMK : Perawatan Metode Kanguru (Kangoroo Mother Care)

PONED : Pelayanan Obstetri Neonatus Essensial Dasar (Basic Emergency Obstetric

Neonatal Care/ BEONC)

POGI : Perkumpulan Obstetri dan Ginekologi Indonesia (Indonesian OGBYN

Association)

RS : Rumah Sakit (Hospital)

SOP : Standard Operational Procedure

UGD : Unit Gawat Darurat (Emergency Room)


C. Monitoring Tools 1:

• Obstetric-Neonatal Emergency Response at Community

Health Center/Private Clinic

• List of Neonatal Emergency Trolley

• List of Maternal Emergency Trolley


Monitoring Tools 1 Obstetric‐Neonatal Emergency Response

in Community Health Center/Private Clinic

Name of Facility___ _______ _______________________________________________________________________________________________________

District, City : ____________________________________________________________________________________________________________________________________

Assessed by: __________________________________________________________________Date: ____________________________________

Guidelines : Mark √ the column in each criteria of verification in accordance with the findings of the research conducted. Write downs on the column when required necessary additional information or other problems. (use sheet in the back if needed )

NO SCORE PERFORMANCE STANDART VERIFICATION CRITERIA Y N N/A NOTE

1. Emergency team is ready for any called to treat pregnant women, in labor, postpartum and neonates within a condition that threaten life related to complication.

Notes in a facility that documents the schedule of Obstetric-neonatal emergency team is in unit concerned.

Emergency team consist of midwives: nurse, and general practitioner

2. Tools and equipment for emergency obstetric neonatal-treatment are available and always in a ready to use condition

Please check whether the following equipment and supplies are there on emergency obstetric neonatal-trolley or in a container with the same function:

Obstetric Emergency Trolley

Neonatal Emergency Trolley

See annex for standard list of complete emergency obstetric neonatal-trolley .



3. Routine and regular checks of completeness and readiness of the emergency obstetric-neonatal trolley

Please check whether there is a list of emergency

obstetric neonatal-trolley containing:

The list of sets of complete equipment on trolleys or

container

Schedule checking on every changing shift

4. Poster contains algorithms/Job-aids on management of obstetric neonatal emergency attached clearly on each unit.

Poster contains Algorithms/job aids mounted and clearly to be used by staff

Postpartum hemorrhage

Eclampsia

Shock

Maternal Sepsis

• Labour difficulty

Neonatal Resuscitation

• Seizures

• Neonatal Sepsis

• Severe Dehydration

• Hypothermia

• Hypoglicemia

5. Community Health centers/clinics , schedule and do the exercise/demo as an obstetric- neonatal emergency team, routinely.

Record/log on each unit/room that have a schedule for clinical practice/demo condition as follows:

Shock Postpartum Hemorrhage Eclampsia Neonatal Resuscitation List participants of clinical practice/demo resuscitation.


The Total of Performance Standart

5

Total Standart being Observed Total Standart Achievement % Achievement


LIST OF NEONATAL EMERGENCY TROLLEY

Guidelines: Mark √ in column available if there completeness corresponding when observation do. Write down on columns when required necessary additional information or other problems.

NO SCORE DESCRIPTION Y N N/A NOTE

1. Balloon equipment and hood

Ambu bag

3 size hood (small, middle, large)

Source of oxygen with regulator flow (size up to 10L)

Hose Oxygen for resuscitation.

2. SUCTION INSTRUMENT

Suction balloon.

Mechan ic suct ion and tube .

Suct ion catheter ,,5F, 6F, 8F,10F, 12F, and 14F

Nasogastrict tube no 8F and spuit 20 ml

Mekoneum suction tools

3. INTUBATION TOOLS

Laryngoscope wi th s t ra ight leaves no 0 (preterm) and no 1 (aterm)

Extra bulb and batteries for Laryngoscope

Endotracheal tube no 2.5, 3.0, 3.5, 4.0,mm in internal diametre

Stilet if any

Scissor

Plaster


Alcohol Swab


4. Medicine

Epinephrin 1: 10.000 ( 0,1 mg/ml )

Isotonic cristaloid (NaC L 0.9% or Ringer Laktat) for adding the

Volume 100 or 250cc

• Phenobarbital 60, 65, 130 mg/cc

• Ampicilin and gentamisin 10mg/cc • Dextrose 10 % 250 ml • NaCl solution 0,9% for rinse • Orogastric Tube5F (if Avaliable) • Umbilical Catheter 3,5F • Sterile HandSchoen • Scalpel • Iodium solution • Three way stopcock • Spoit 1, 3, 5, 10, 20, 50 cc

5. Other :

Handschoen

Stethoscope

Plaster ½ atau ¾ inchi1 1 Buku resusitasi neonatus panduan pelatihan bagi bidan dan perawat PERINASIA hal 1-26


The Total of Performance Standart 5 Total Standart being Observed Total Standart Achievement % Achievement


LIST OF MATERNAL EMERGENCY TROLLEY

Guidelines: Mark √ in column available if there completeness corresponding when observation do. Write down on columns when required necessary additional information or other problems


1.

Instruments

Ambu bag, hood, hose of oxygen, 1oxygen canule

The battery, a battery that supplies a ready to use.

Neerbaken.

Folley catether no 16,18 and urine bag

Suction Cathether no 18.

Gudel with 2 measurement no 90mm and 100 mm

Tube of Oxygen equipt with flow meter

Masker oxgen

Spyghmomanometer

Stethoscope

Tourniquet

Laryngoscope with extra bulb

Endo Tracheal Tube / ETT no 7 or 7,5



Stilet for ETT

Spoit 5 cc for filling ETT cuff with air

2.

SUPPLIES OF DRUG EMERGENCY

Common Medication

Adrenaline

Atropine sulfate

Dextrose 40%

Diazepam

Diphenhydramine or phenergan

Ephedrine

Lidocain

Dexamethason

Sodium bicarbonat 8,4 %

Obstetric Medicines :

• Ergotamine inj

• Labetalol or hydralazine inj

• Magnesium sulfat 20% or 40%

• Oxytosin inj

OTHER INVENTORY

Plaster

Povidone iodine 10% and alcohol


NO NILAI DESKRIPSI YA TIDAK N/A CATATAN

Sterile kassa

Venous catheter / Abocath size 14, 16, 18 ,20

Ringer lactate Infusion, Nacl 0.9 % and complete set of infusion kit

Water for Injection

Surgical Blade

Xylocain Jelly for intubation

• chromic catgut 3 no 3,0 and no 2,0

Steril Handschoen

Handschoen No. 6½, 7, 7½, and No.8

Naso gastric tube / NGT no 18

1Emergency obstetric care AMDD hal b-32, PONED buku acuan hal 14-3 dan petunjuk teknis penggunaan DAK bid. Kes thn 2009 peralatan PONEK hal 1



D. Monitoring Tools 2 :

• Obstetric and Neonatal Emergency Care in Communily Health Center / Private Clinic


Monitoring Tools 2 Obstetric and Neonatal Emergency Care in Community Healh Center/Private Clinic

Name of Facility ___ _______ _______________________________________________________________________________________________________

District, City : ____________________________________________________________________________________________________________________________________

Assessed by: __________________________________________________________________Date: ____________________________________

Guidelines: Mark √ the column in each criteria of verification in accordance with the findings of the research conducted. Write downs on the column when required necessary additional information or other problems. (use sheet in the back if needed)

NO SCORE PERFORMANCE STANDART VERIFICATION CRITERIA Y N N/A NOTES

1.

Health professionals in health facilities are competent to do the management of postpartum haemorrhage/perform management of Shock on the client or model

Documenting competencies with simple skills assessment or simulating case by using the list for: management of Post Partum Hemorhage /Shock .

* Assessment of skills can be made after assessment of the facilities in the different sessions * Documentation shows that 80% of the health workers are competent to perform skills assessed with simple direct assessment at the service or simulating case using the list.


NO SCORE PERFORMANCE STANDART VERIFICATION CRITERIA Y N N/A NOTES

2 Health professionals in health facilities are competent to do the Active Management of Kala III Labor on the client or model.

Documenting competencies with simple skills assessment or simulating case by using the list for: Active Management of Kala III Labor..

Assessment of skills can be made after assessment of the facilities in the different sessions

Documentation shows that 80% of the health workers are competent to perform skills assessed with simple direct assessment in the service or simulating case using the list.

3.

Health professionals in health facilities are competent to perform management of severe Pre‐eclampsia / Eclampsia.

Documenting competencies with simple skills assessment or simulating case by using the list for management of severe Pre‐eclampsia / Eclampsia



4. Health professionals in health facilities are competent to perform management of neonatal resuscitation

Documenting competencies with simple skills assessment or simulating case by using the list for management of neonatal resuscitation

* Assessment of skills can be made after assessment of the facilities in the different sessions




5 Health professionals in health facilities are competent to perform steps to Early Breastfeeding Initiation and Breastfeed correcly.

Documenting competencies with simple skills assessment or simulating case by using the list for: Early Breastfeeding Initiation.


Documentation shows that 80% of the health workers are competent to perform skills assessed with simple direct assessment in the service or simulating case using the list

6.

Health professionals in health facilities are competent to perform Kangaroo Mother Care

Documenting competencies with simple skills assessment or simulating case by using the list for Kangaroo Mother Care.

Assessment of skills can be made after assessment of the facilities in the different sessions Documentation shows that 80% of the health workers are competent to perform skills assessed with

simple direct assessment in the service or simulating case using the list.

7. Health facilities have a system that applies to the assessment of clinical skills required for Obstetric and Neonatal Emergency Care

Reviewing records on facilities about the assessment skills system including:

• Assessment Schedule

• List of Health workers who has ben assessed



E. Monitoring Tools 3:

• Obstetric and Neonatal Emergency Referral System in Community Health Center and Private Clinic


Monitoring Tools 3 Obstetric‐Neonatal Emergency Referral System in Community Health Center/Private Clinic

Name of Facility ___ _______ _______________________________________________________________________________________________________

Distric, City: ____________________________________________________________________________________________________________________________________

Assessed by: __________________________________________________________________Date: ____________________________________

Guidelines: Mark √ the column in each criteria of verification in accordance with the findings of the research conducted. Write down on the column when required necessary additional information or other problems. (use sheet in the back if needed)


1.

Community Health Centers/Clinics have ambulances or four-wheeled vehicles that can be used to referral case of Obstetric and neonatal emergency.

Observe and check for the following: • Ambulance or four-wheeled vehicles that function . • Budjet for gasoline and to deliverer • List of available driver • Available list of personnel that can do deliverer

2. Ambulance or four-wheeled vehicle have the equipment

and supplies for management of emergency obstetric and neonatal.

Observe and check the ambulance for the equipment and supplies as follows: • Neonatal Rescucitation Set • Partus Set, consist of: amount

clamp Kelly or Kocher 2 Umbilical cord sccissor 1 Epissiotomi Knife 1

. ½ Kocher 1



Steril Handschoen 2

umbilical cord clamp 1

Nelaton catheter no.12 1

A small cloth or small duk 1

Mucus Suction 1

Spuit 2,5 ml or 3 ml 1

Clean Cloth 4

Clean Towel

Qui l l t for mothers

Urotonica drug

Nifedipin or labetolol or atenolol

Infusion set and Fluid

Needles and syringes with sterile disposable

Tubes and hose oxygen

Stethoscope and Sphygmomanometer

3. Community Health Centers/Clinics have a communication system with hospital for referral of emergency obstetric and neonates

Checking for all these in Community Health Center::

Directory of all network services that can be contacted for obstetric and neonatal referral, attached in a place that can be seen clearly .

The referra l hospital can be reach by Phone or SMS.

Blood donor list and PMI are available through the directory .



4. Community Health Centers/Clinics have a Standart Operating Procedure or Guidelines to referr the sick neonates to hospital which consist of:

• Historical disesase • Phisical examination • Therapy that given before

being transferred

Review the documents or the necessary guidelines of SOP to refer all neonates with :

• Birth weight < 2000 g

• Severe Dehidration

• Breathing difficulties

• The sign of infection/Sepsis

• Seizure

5. Community Health Centers/Clinics have a standard Operational Procedure (SPO) or guidelines for pregnant /labour women/postpartum with complications to go to the hospital which consist of: • Historical disesase • Phisical examination • Therapy that given before

being transferred,

Review the SPO documents or the necessary guidelines to refer all pregnant /women in labour/postpartum woman that have complications in accordance with:

• Stabilization before referral

• Administer ing Magnesium Sulfate for severe pre-eclampsia / eclampsia

• Giving steroids antenatal to mothers with premature delivery.

6. Health facilities do a study case on all emergency referral in maternity/postpartum and neonatal.

Reviewing records in the facility that documenting case studies for the following conditions:

• Neonatal Emergency Referral to the hospital

• Maternal Emergency Referral to the hospital


F. Monitoring Tools 4:

• Supplies and Equipment for Management of BEONC at

Community Health Center /Private Clinic

• List of BEONC Emergency prepareness


Monitoring Tools 4

Supplies and Equipment for Managemnet of BEONC at Community Health Center/ Private Clinic

Name of Facility: ___ _______ _______________________________________________________________________________________________________

District , City: ___________________________________________________________________________________________________________________________________

Assessed by: __________________________________________________________________Date: ____________________________________

Guidelines: Mark √ the column in each criteria of verification in accordance with the findings of the research conducted. Write down on the column when required necessary additional information or other problems. (use sheet in the back if needed).


1.

Equipment and supplies for the management of BEONC are available and ready to use and stored properly at the community health centers/private clinics

Check whether the following tools/equipments are available at the facility: • See list below



THE LIST OF BEONC EMERGENCY PREPARENESS Mark √ the column in each criteria of verification in accordance with the findings of the research conducted. Write downs on the column when required necessary additional information or other problems

I. MEDICINE √ NOTE

Oxitocyn inj ( 5 ampoule): In fridge

Metil ergometrin maleat inj (4 ampoule ): In fridge

Procain or lidokain inj (4 ampoule)

Adrenalin inj (1 ampoule)

Antibiotics :

1. Ampicilin or Amoxicillin Intra Venous

2. Gentamicin Intra Venous

3. Metronidazole Intra Venous/PO

Infusion fluid :

o NaCl 0,9%

o Ringer lactate

Dexamethason (5 ampoule)

40% atau 20% (10 flacon)

Lidocain (20 ampoule)

Antiseptic solution (Povidon iodine 10%)

Oxigen with flowmeter


I. MEDICINE √ NOTE

Antihypertensi drug: nifedipine or hydralazine or atenolol or

methyldopa

Calsium gluconate 10%

II. INSTRUMENT √ NOTE

1. Instrument A. DELIVERY SET:

Episciotomi Scisscor (1 pcs)

Umbilical cord clamp (2 pcs )

Umbilical cord scissor ( 1 pcs)

umbilical cord strap ( 1 pcs)

steril kassa

small bowl Dysposable spuit 10 ml ( 2 pcs )

B. HECTING SET: • Needle holder (25 cm)

Anatomic Pincet ( 1 buah )

Scissor ( 1 buah )

cromic suture no. 0

steril kassa


C. VACUM EXTRACTOR *)

Metal bowl or silastik (small, medium, large)

Rubber hose ( 2 pcs )

Towing Bowl ( 1 pcs )

vacum Bottle with manometer (1 pcs )

vacum pump ( 1 pcs ) Other option: vacum bowl made from plastic or

rubber .

II. INSTRUMENT √ NOTE

D. OTHERS INSTRUMENT : • Ambu bag (1 set)

ovum clamp ( 2 pcs )

cunam tampon ( 1 pcs )

Dysposable spuit 5 cc with needle no 23 ( 2 pcs )

Rubber cathether ( 1 pcs )

Bowl /plate for the placenta • Medical chart including the special control form and inform

consent .

• Self Protectiion tools (3 Set) • Handschoen DTT/sterile Handschoen ( 4 pcs )

• Floodlight lamp ( 1 pc)

• Laenec stesthoscope ( 1 pc)/doppler

• Stethoscope and Sphygmomanometer (1 pc)


III. BABY √ NOTE

1. Instrument

Mucus suction (manual /electric)

Tongue spatel ( 1 pcs )

Dry cloth and cleant towel to clean the body and face ( 2 pcs )

• Clean, dry and warm desk for resuscitation (1 pcs)

Incubator , if any ( 1 pcs )

Cutting and tying the umbilical cord (1 pcs)

10 cc spuit and needle no 23 (2 pcs )

Intravenous cathether no 24 G and wings needle (1pcs)

Nasogastric feeding tube for umbilical cathetherisation

Diapers and blanket

Ambu bag (Perinasia)

2. Drugs*)

• Phenobarbitol 60, 65, atau 130 mg/cc

• Epinephrin 1:10000 20cc

• Antibiotics: ampicillin inj or penicillin procain or gentamicin

• Aquabidestilate and 10% dextrose %

*) Especially for BEONC Community Health Center


G. Monitoring Tools 5 :

• Prevention of Infection in Community Health Center


Monitoring Tools 5

Prefention of Infection in Comunity Health Center

Name of Facility: ___ _______ _______________________________________________________________________________________________________

District, city : ____________________________________________________________________________________________________________________________________

Assesed by: __________________________________________________________________Date: ____________________________________

Guidelines: Mark √ the column in each criteria of verification in accordance with the findings of the research conducted. Write downs on the column when required necessary additional information or other problems. (use sheet in the back if needed).


1.

The community health center looks clean

At the following venues look clean*:

• Lounge

• Examination room

• Emergency room

• Delivery room

• Postpartum Room

• Laboratory Room

* There is no dust, blood, waste, used needles and syringes, as well as no nest of spiders.

NB: According to the room in the health facilities which in assessment. 2. Equipment and materials for

prevention of infection is available in Emergency Unit.

Check whether available :

• Washbasin with water flows or covered with buckets of tap

• liquid soap near the sink/bucket



• Personal hand towel

• Examination handschoen

• Plastic apron

• Mask

• Google glasses

• Shoes/slippers with front covered

• Dry bins with plastic bags

• wet trash can with plastic bags

• DTT water in closed container

• spray bottle filled with chlorine 0.5% and a cloth

• DTT/sterile tools place (place of partus sets, hechting sets) with ready-made sterile equipment

• Container for needle loaded until ¾ full.

• Korentang

• Storage to keep the equipment

3. Equipment and materials for

prevention of infection is

available in delivery room

Check whether available:





• Sterile handschoen




• Wet trash can with plastic bags

• Bucket to soak dirty cloth in the detergent

• Buckets to water with DTT (high level desinfectan)

• Container for chlorine 0.5%

• household gloves

• Plastic Apron

• Mask

• Google glasses


• Containers for DTT water in trolley


• DTT/sterile equipment container (place of parturition sets, hechting sets) with ready-made sterile equipment


• Korentang

• a cabinet for equipment storage

4. Equipment and materials for prevention of infection available in parturition/postpartum room.

Check whether available:





• Plastic Apron



• Mask



• wet trash can with plastic bags

• container for chlorine 0.5%


• DTT/sterile tools place (place of partus sets, hechting sets) with ready-made sterile equipment


• Korentang

5. Clean water are available Check wheter: • There is enough water in the health center for the purposes of hygiene, equipment and other materials

6. There are sharps disposal containers

Whether in health center available:

Sharps disposal containers are made of thick

plastic/hard cardboard/cans covered with

enough holes to include syringes and other

sharps spuit.

Sharps disposal containers placed near

where sharps are used.

The needle and spuit carts immediately

discarded into sharps disposal containers .



Sharps disposal container is closed tightly

and taken to be discarded when it is three-

quarters full .

Each sharps container disposal are used only

for once and then disposed of according to

the rules of garbage disposal.

7. Antiseptic, disinfecting materials and other materials available in sufficient amounts to use for one month.

Check out the warehouse and/or the storage, compare the previous month based on usage in the form

of stock control, do the following materials are available in sufficient amounts:

Antiseptic :

• Ethyl or isopropyl alcohol( 60-90%) or

• Chlorexidine gluconate( 2-4%) (e.g: Hibiclens*, Hibiscrub< Hibitane

• Jodium ( 1-3%) or Iodophors ( e.g., Betadine®)

Desinfectan :

• Clorin 0,5 %

8. The cleaning materials available and ready to use

Check whether:

• Antiseptic ingredients are available in a small container and can be reused for everyday use.

• The container washed with soapy water until completely clean, rinsed with clean water and then dried before being recharged

• Disposable containers are labeled with the date

• Kassa or cotton stored in dry container

without any antiseptic



• Tools and other materials stored in the container to dry without any antiseptic • Korentang stored in the container without any antiseptic

• Ask if the solutions are changed daily or if it was dirty

9. A preparation of washing instrument based on recommendations

Do the staff in charge of washing equipment in the delivery room follow these recommendation :

Soak up the instrument used in aqueous solution

of chlorine 0.5 % for 10 minutes,

Chlorine solution recently prepared early in

the day or earlier if required

Plastic containers used for decontamination

After 10 minutes, the instrument removed

from a solution of chlorine and rinsed off

immediately

2 choices to make solution of chlorine (a and b) A. How to make a solution of chlorine 0.5% of the concentrated liquid form

If using a concentration of 6%, 1 part bleach mixed with 11 part of water ** or

If using a concentration of 5.25%, 1 part bleach mixed with 9 parts water **, or

B. How to make 0,5% chlorine solution from chlorine powder

If using calcium hipoklorida (35%), 14 g of bleach powder mixed with 1 L of water ** or

If using calcium hipoklorida (70%), 7 g of bleach powder mixed with 1 l of water**



10. Decontamination of instruments and other materials

Check whether :

• Chlorine solution, always prepared early in the day or earlier if you have dirty

• Container labeled by date and time.

• Plastic containers used for decontamination

• equipment and other materials soaked in a solution of chlorine 0.5% for 10 minutes before being brought to wash

• equipment and materials brought in a bucket or container leak to room leaching

• syringes and its needle which have been used, are in a solution of chlorine decontamination 0.5% before it is put in the container of a sharp tool to puncture resistant

11. There is room for processing instruments with the right groove to avoid cross contamination

Check whether:

• There is separate room between the instrument room and the processing action

• well ventilated

• Has good lighting

• Has strict entrance

• There is a reception desk for dirty materials/instruments

• There is minimum one place to wash with water

flows



• There is a table to dry instruments.

• Has steamer that well-functioning .

• Have shelves/cupboards for storage the instruments

• Have clamp rack with cloth to dry clean gloves

• There is closed cabinets for storing materials/instruments (doors or curtains to cover the clean instruments on the shelf) and access to a storage cabinet or cupboard enclosed restricted access.

• Dirty linen or medical waste should not be brought into this room

• There was no fluid or water spills on the floor

• Clean materials/instruments is placed on one side

of the room and dirty materials/instruments is in the

opposite side.

• Have place and adequate disposal of dirty water

12. Washing tool and other materials was done right

Check whether the officer that clean the instruments are using:

• Household rubber glove

• Eye and face protection

• Plastic Apron

• Rubber boots or shoes enclosed

• Soft brush

• Use a detergent (liquid or powder without acid or amonia)

• Brushing instruments below the water's surface

including cleaning up blood and other substances



Remove the parts of the appliance, wash the dent, gears and hinges that have brushed

• Rinse the instrument with clean water carefully

• Dry the instrument by the wind or dry with a clean dry towel

• Wash hands with water flows and soap for 10-15 second and dry it with personal clean towel, a paper towel or wash your hand with solut ion of a lcohol glycer in 3-5 ml unt i l dry

13. DTT process is done properly

Check whether the cycle of DTT below, followed

Boiling;

• Equipment parts have been removed and cleaned, soaked up entirely below the surface of the water.

Closing boiling place

• Equipment/Instrument boiled for 20 minutes counted

from the water starts boiling

After 20 minutes, the instrument is issued using korentang or gloves that have been on DTT/sterile then stored in containers that have DTT •

Using DTT Steamer;

• Fill water to taste into a pot to generate steam for 20

minutes



• Put the instrument/tools into the stemer.

Keep the steamer covered.

• Did not add content in a process already begun

Began to turn on the timer when the steam starts to

come out of the sieve

• Steaming for 20 minutes

(Note : if health facility already done the steril proses forequipment, give 1 to number 13 , only if the pabila fasilitas kesehatan sudah menggunakan proses sterilisasi untuk alat‐alat, maka berikan nilai 1 pada nomor ini (13) hanya jika proses sterilisasi tersebut dikonfirmasi telah sesuai standar)

14. There are shelf life system for material storage/DTT /Sterile

Check whether :

• Clean materials kept separate from DTT materials

• Materials/equipments are used immediately

• wrapped packages and/or DTT containers have written the processing date

• There is a system of rotation and inventory systems to control the use of DTT

• Packages/materials are not encased in a torn, dusty, humid, or oily

15. Waste disposed properly to avoid others getting hurt and contaminated

Check whether; Contaminated liquid waste (blood, urine, feces and body fluids) disposed in the following ways:

• Thrown into the toilet or the sink with the exhaust system

• Sink is rinsed with water after all the liquid

trash/waste being discharged

• Container objects/sharp instruments burned, deposited, or encapsulated.



. • solid waste (cotton wool, gauze, and other materials contaminated blood and organic material) is burned or hoarded

• Officers wear eye protection and household gloves.

If the trash is burned, ask if:

• Flow in this area is watched and can only be accessed by officer

• Area should not be accessed by other staff, community and pet

• Garbage burned in an area that has been

determined to be burned

• Trash sent to burning area

• Upon burned, flames could be seen to ash.

• Ash from burning materials disposed like trash that is not contaminated

• there was no garbage on the ground

OR

If the garbage piled up in the hole, ask if: • The landfill area should not be accessed by other

staff, community, or pets.

• Landfill is fenced with a low absorption material a low absorption rate (e.g. clay)

• Landfill at least 50 metres from water source and

must a flood free area

• The hole hoarding around 1 square meters and in depth of 2 m



• Garbage that is thrown to the ground piled up to 10-15 cm per day

• last Layer as thick as 50-60 cm

• The hole hoarding at least for 30-60 days

• There was no garbage in the yard

OR Encapsulated, ask if • Sharp objects/ sharp instruments sharp collected

in an anti leak and anti puncutre containers?

• Box that has been full fill with materials such as cement or clay .

• Objects and sharp materials are in the middle of cement/clay dried in the sun to be harden.

• Material have been hardened and sharp objects invisible

• Container closed tightly (sealed)

• Molds or containers that piled up (can be made into bricks etc.):



16. There is a special storage for keeping the washing instrument , for the toilet, floor and windows.

Check whether:

• Equipment are stored in a special place

• liquid cleansers are stored in closed container

• The cleaning equipment (MOP, broom etc.) stored by hanging

• Cleaning equipment of fabric (cloth) is stored in a dry condition

Note: If waste management conducted by third parties like dept. or contractor, make sure the community health center’s officers knows clearly the process of waste management conducted by the third party

The Total of Performance Standart 16

Total Standart being Observed Total Standart Achievement % Achievement

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