Outpatient Care Facility Assessment Checklist professionals... · Outpatient Care Facility...

Outpatient Care Facility Assessment Checklist

Outpatient Care Facility Name:

Facility Category: _______________________________________________________________________________________

Date of Assessment: Start time: End time:

Valid E-mail Address: _____________________________________ Contact No./s__________________________________

No. Description Yes No N/A Remarks

1. General Consideration and Accessibility

1.1. Facility outdoor signage is matching the DHA and Department of Economic Development (DED) trade name

1.2. Facility/building steps flooring are slip-resistant

1.3. Handicapped ramp elevation is less than 25 degrees

1.4. Building/facility elevator can accommodate wheel chairs

1.5. Clinical services of the facility is clearly displayed for patients/visitors and matching the approved services in Sheryan System

1.6. Facility operating hours is clearly display outside the facility main entrance

1.7. Reception location provides visual control of the waiting area

1.8. Separate Male and Female waiting area

1.9. Waiting area seats ratio is 2:1 for each consultation room

1.10. Waiting area chair material is cleanable and washable

1.11. Dedicated Pediatric waiting area (if service is provided)

1.12. The physician(s)/dentist(s) or healthcare professionals information displayed in the internal boards are matching the DHA license

1.13. At least one wheelchair is available in the facility

1.14. DHA facility license is clearly displayed is prominent area

1.15. Charter of Patients’ Rights and Responsibilities in two languages Arabic and English are displayed

1.16. Price list of medical services are displayed/accessible to patients and visitors

1.17. Emergency contact number for local police and Dubai Civil Defense are displayed

1.18. Patient registration form is available

1.19. Complaint/suggestion forms are accessible to patients/visitors

1.20. Flooring surface of the facility are clean, washable and without crack


1.21. No wooded materials or carpet flooring are used in treatment and procedure room

1.22. Dedicated Male and female toilet(s) are available

1.23. Accessible disabled restrooms in the facility or within the same building is available

1.24. All health facility corridors are more than 1.12 m

2. Consultation & Examination Rooms

2.1. Facility rooms space is not less than 12 m2 for consultation and examination (for consultation room only 9 m2)

2.2. Hand-washing station with hand soap and tissue is available all rooms

2.3. Hand washing educational posters available at the Hand-washing stations

2.4. Non-refillable hand sanitizer dispenser is available in each room with educational posters

2.5. Healthcare professionals can demonstrate proper hand hygiene technique

2.6. No storage is permitted under consultation/examination rooms sink

2.7. General and Medical waste collection bags/container are available in each room and properly labelled

2.8. Items found in collection bags/container are segregated as per each color code

2.9. Sharp containers kept above the ground level

2.10. No sharp containers filled more than 3/4 full

2.11. Washing and cleaning of curtains/privacy partitions is conducted and documented

3. Treatment/Procedure/Observation Rooms

3.1. Treatment room space is not less than 7.5 m2 for each bed

3.2. Observation room (if available) is convenient to the nursing station securing visual control

3.3. If specific procedures are conducted in the room e.g. casting, dermatology, etc. The room size is not less than 11.15 m2

3.4. Hand-washing station with hand soap and tissue is available inside the treatment/procedure room

3.5. Hand washing educational posters available at the Hand-washing station

3.6. Hand sanitizer dispenser is provided in each room with educational posters

3.7. Sharp containers kept above the ground level

3.8. No sharp containers filled more than 3/4 full

3.9. Needle recapping/separating is not practiced


3.10. Single-use gauze and cotton are used

3.11. A lockable refrigerator for medication use (No food is stored)

3.12. Refrigerator thermometer is available with daily monitoring chart

3.13. Sample medication (if available) are stored in the treatment/ procedure room with updated record including expiry dates

3.14. Multiple use medications opening date is labelled with validation date as per manufacturer’s instruction

3.15. Emergency medications are available as per Outpatient Care Regulation (see appendix 8 in the regulation for details)

3.16. Emergency medications are securely stored

3.17. Medication inventory is available with documented expiry dates

3.18. Expired medications are properly segregated, labeled, and documented

3.19. Storage and usage of controlled/semi-controlled medications are documented and updated

3.20. No unregistered medications are available in the facility

3.21. Nutritional Supplements and cosmetic products are not sold or dispensed in the facility

3.22. Instruments/medications cupboards are clean, tidy and properly labelled

3.23. Crash trolley with defibrillator OR Automated External defibrillator (AED) is available and easily accessible in the facility

3.24. All healthcare professionals have valid training/certification of Basic Life Support (BLS)

3.25. If Cardiology Exercise Tolerance Testing (ETT) services is provided, the Cardiologist has a valid training/certification for Advanced Cardiac Life Support (ACLS)

3.26. Glucometer Quality control is performed regularly as per manufacturer’s instruction

3.27. Healthcare professionals are aware of actions to be taken if Glucometer quality controls out of acceptable ranges

3.28. Glucometer Quality control records are available for 4 months

4. Child Immunization

4.1. Register is used for recording information about child immunization (i.e manual or electronic records) remains in the health facility

4.2. Healthcare professionals are able to articulate standard procedures in case of adverse events

4.3. Severe adverse events forms are available

4.4. Anaphylaxis kit is available

4.5. Inventory of vaccines including expiry dates are available


4.6. Vaccine refrigerator is equipped with thermometer to ensure monitoring between 2 – 8 0C

4.7. The refrigerator is used only for vaccines and medication

4.8. Refrigerator temperature monitoring chart is completed twice daily

4.9. Refrigerator have an uninterrupted electric supply

4.10. Alternative refrigerator is available in the event of a break down or repair of vaccine refrigerator

4.11. Unused expired vaccines are disposed as per policy

4.12. Healthcare professionals are aware about the immediate action in case of electrical failure

4.13. Healthcare professionals knows how to read Vaccine Vial Monitor (VVM) color changes

4.14. Health professionals providing immunization attended specific trainings which includes guidelines/information on vaccine use, storage and the maintenance of the cold chain, etc.

4.15. Healthcare professionals are aware of multi vial policy

4.16. Vaccine carrier/s and thermometer are available

5. Anesthesia (level II)

5.1. Only Chloral Hydrate or Nitrous Oxide are used in the facility

5.2. If Nitrous Oxide is used, a training certificate for Dentist is available

5.3. Vital signs monitoring equipment are available including Blood pressure, ECG 3 leads and pulse oximeter

5.4. Records of vital monitoring for each case is maintained

5.5. The physician/dentist providing level II anesthesia has a valid ACLS certification or Pediatric Advanced Life Support (PALS) if pediatric service is provided

6. Dental

6.1. Room and dental chair arrangement ensure patient privacy (patient’s face directed away from clinic door)

6.2. Hand-washing station with hand soap and tissue is available inside dental rooms

6.3. Hand washing educational posters available at the Hand-washing station

6.4. Non-refillable hand sanitizer dispenser is available in dental room with educational posters

6.5. Sterile surgical gloves are available for invasive patient procedures

6.6. Protective Eyewear/Face Shields are available and used

6.7. Protective clothing are available and used


6.8. Dental Assistant/Nurse can demonstrate proper dental environment cleaning/ methods.

6.9. Dental Assistant/Nurse have an access to DHA Guidelines on Dental Infection Prevention and Safety or similar dental guidelines

6.10. Testing of dental water quality is conducted regularly and a document is maintained (Bacterial counts in the water should be < 200 CFU/mL)

6.11. Only sterile irrigant such as sterile water or sterile saline is used for dental surgical procedures

6.12.

Discharging water and air for a minimum of 20-30 seconds after each patient from any device connected to the dental water system that enters the patient's mouth (e.g., hand pieces, ultrasonic scalers, air/water syringes) is practiced.

6.13. At the end of each day, the ultrasonic cleaner tank is emptied, cleaned and left dry

6.14. Flushing of waterlines at the start of the day to reduce overnight or weekend biofilm accumulation is performed

6.15. Sharp containers are kept above the ground level

6.16. No sharp containers are filled more than 3/4 full

6.17. Needle recapping/ separating is not practiced

6.18. General and Medical waste collection bag/container is available

6.19. No storage is permitted under the sink in dental rooms

6.20. Dedicated area for dental instrument sterilization with sink is available which is separate from the dental room

6.21. Autoclave/Sterilization indicators and records are maintained for each cycle

6.22. Weekly monitoring of sterilizers using biological indicator for each sterilizer load (if applicable) is available

6.23. Sterile instruments are checked regularly to ensure the sterility and removal of damaged pouch

6.24. Stock rotation is maintained according to the principle "first-in first out" so that older items are used first

6.25. Staff immunization status for Hbv is documented

6.26. Thyroid lead Apron is available

6.27. Radiation protection program is documented

6.28. FANR licensed is available for dental radiology equipment (intraoral and OPG)


7. TCAM Services and Supplies

7.1. No selling/dispensing of TCAM medications in the facility

7.2. Only approved and registered medicinal products and oils are available in the facility as part of patient treatment (as per Outpatient Regulation)

7.3. Only disposable supplies of Traditional Chinese Medicine are used; including acupuncture needles, moxibustion and cupping supplies

7.4. Compounding of TCAM medication is not conducted in the facility

8. Phlebotomy area and Clinical Laboratory

8.1. Laboratory accreditation is valid

8.2. If Laboratory Services is outsourced, a valid signed contract/ agreement is available between the facility and the outsourced provider

8.3.

If specimen is collected for laboratory investigations the following are available:

reclining chair or gurney

hand-washing Station

Safe Sharp disposal

Curtain to ensure patient privacy

8.4. Sample collection manual is available

8.5. Specimen transport carriers are available

8.6. Timeframe for maintaining and transporting specimens are documented

8.7. Turn-around time is documented for specimen sent outside the facility

8.8. An active Full/part time Licensed Clinical Pathologist is available to supervise the laboratory

8.9. Access to the laboratory area is restricted to authorized personnel only

8.10. A dedicated sample receiving area in the laboratory is identified

8.11. Laboratory technician(s) are aware of sample acceptance or rejection criteria

8.12. A permanent, sequential logbook or electronic record of received samples is in place

8.13. Laboratory working countertops are monolithic, heat resistant, antimicrobial and impermeable

8.14. Foot/elbow/sensor operated hand-washing station with hand soap, tissue and hand sanitizer dispenser are available


8.15. Laboratory cupboards are clean, tidy and properly labelled

8.16. Laboratory coats are only worn in the laboratory and removed before leaving

8.17. Clinical sink for laboratory use is available

8.18. Emergency shower is available

8.19. Stand-alone/disposable eye wash bottles is available

8.20. Spill Kit is available

8.21. Periodic Emergency Shower and eyewash station checking procedure is conducted and documented

8.22. Laboratory staff are using closed footwear

8.23. At least two designated storage refrigerators for samples and reagents/solvents are available

8.24.

If microbiology service is provided, a separate dedicated area is available with the following:

biological hood Level II (kept closed if not in use)

biological hood filters are changed as per the Manufacturer’s recommendation and documented

with negative pressure

Separate dedicated area for autoclave

8.25. No Food and beverages are available in the laboratory premises

8.26. Abnormal results are reviewed and signed by the pathologist

8.27. Samples are disposed according to the facility policy but not exceeding seven days

8.28. Safety cabinet for hazardous materials is available

8.29. List of hazardous materials used in the laboratory is available

8.30. Material Safety Data Sheet (MSDS) is available and easily accessible

8.31. Calibration of pipettes and thermometers is performed and documented regularly

8.32.

Written Policy and Procedures on the following are available: Quality Assurance manual

Laboratory Standard Operating Procedures

Sample preparation and storage/disposal


8.33.

Written Policy and Procedures on the following are available (Cont.): Reporting of results (if applicable)

Instrument calibration

Quality control and corrective action

Equipment performance evaluation

Validated Reagents & supplies

Test performance

9. Diagnostic Imaging Services

9.1. If diagnostic imaging services is outsourced, a valid signed contract/ agreement is available between the facility and the providers

9.2. Specific radiology registration form is available

9.3. Ten Days Rule for women of child bearing age is followed

9.4. Radiation warning signs and posters are available

9.5. Green/Red warning light sign indicating when the X-ray beam is OFF/ON is available

9.6. Federal Authority for Nuclear Regulation (FANR) license is available

9.7. Conventional radiography room size shall be at least 15 m2

9.8. Dedicated patient gowning area with safe storage for valuables and clothing is available

9.9. Radiography room shielding thicknesses comply with FANR and DHA requirements

9.10. Digital Film processing is available

9.11. Quality assurance for digital imaging is conducted and documented

9.12. Dosimeter are maintained and measurements are recorded

9.13. Policy for pregnant Healthcare Professionals is available

9.14. Various type of Lead aprons are available and mounted in specialized hanger

9.15. Annual testing of aprons is conducted and documented

9.16. Ultrasound room measurement not less than 7 meters with accessible patient toilet within the room

9.17. X-ray equipment are subject to periodic Quality Control testing and calibration are conducted and documented

9.18. Last quality control testing of x-ray machine is documented

9.19. Records confirming testing and maintenance of x-ray machine is available

9.20. Patient Registry Logbook or electronic records is available

9.21. At least 1 DHA licensed Consultant/Specialist Radiologist must supervise the services on part time basis to provide reports


9.22. At least 1 full time licensed radiographer is available

9.23. Training records on Radiation Safety for Radiation Safety Officer (radiologist/radiographer) is available

9.24. All radiology investigations conducted in the facility are reported by the radiologist within the specified time frame as per the organization policy

9.25. Copy of the radiology reports (electronic/manual) are archived in patient files

10. Medical Equipment and Supplies

10.1. General storage area for equipment and supplies are available

10.2. Manufacturer’s maintenance manuals available

10.3. Preventive Maintenance (PM) contract for all medical equipment in the facility are available

10.4. Valid PPM labels is available on each equipment

10.5. Documentation of failure incidence and repairs are available

10.6. Operational and Safety manuals are available

10.7. Installation and maintenance service logbook for all equipment is available

10.8. No extension cords are used in the facility

10.9. Healthcare Professionals new equipment training program is available and documented

11. Human Resources and Administration

11.1. The Medical Director of the facility is available and matching Shreyan system

11.2. DHA is notified within 10 days in case of changing the Medical Director

11.3. All healthcare professionals working in the facility maintain a valid DHA license

11.4. Healthcare professional staffing ratio is meeting the DHA requirements

11.5. All Healthcare professional display ID badges/DHA license during their practice in the facility

11.6. A dedicated employee is available for administrative and insurance activities

11.7. Dedicated personal(s) in the facility responsible for the DHA online sick leave purchasing and attestation

11.8. No manual sick leave forms available/issued by facility

11.9. Facility sick leave charges is matching the DHA official charges


11.10. Staff are aware of the procedures and reporting requirements of Dubai Statistics Centre (DSC)

11.11. Statistics reporting is conducted regularly as per the DSC requirements

11.12. Dedicated complaint files is maintained in the facility

11.13. List of procedures/interventions requiring informed consent is available in the facility

11.14. No promotional activities for any medicinal/ Nutritional Supplements or cosmetic products is conducted in the facility

11.15. DHA approval is obtained for all promotional and campaign activities outside the facility

11.16. The facility management prohibits displaying of materials, pictures or advertisements violating the public morality and ethics.

11.17. Documented Continuing Professional Development (CPD) activities for all healthcare professionals is available

11.18. DHA is notified for suspending of any clinical services within 10 days

11.19. Staff lounge with lockers for staff personal belongings are available

12. Policies and Procedures

12.1.

Documented policies and procedures in the facility are available including but not limited to the following:

Infection Prevention and Control Policies and Guidelines

Medical and Hazardous waste management

Medication management

Patient transfer and referral Policy

Fire and Safety Plan

Radiation Safety (if applicable)

Complaint Management Policy and Feedback Procedure

Health Record Management and Retention Policy

Staff Orientation and Training Program

Lost and Found Items Policy

13. Health Records

13.1. A unique identification number is created for each new file with a copy of official ID

13.2. Allergy status is documented in each patient’s health record

13.3. Initial assessment is conducted for each patients

13.4. Pain Assessment is conducted for all newly registered patients ( e.g. pain scale tool)

13.5. Each healthcare professionals note/entry must be identified and authenticated with stamp and signature


13.6. Time and date of each visit is documented

13.7. Patient identification data is available in all forms/records within the patient health file

13.8. If Electronic Health Record (EHR) is used, entries are authenticated by staff username and password

13.9. EHR are meeting all of the above requirements

13.10. Informed consent is available (if applicable)

13.11. Approved abbreviation list is available in the facility

13.12. Un-approved abbreviations are not used in the patient health records

13.13. No abbreviations are used in consent forms

13.14. Secure filing cabinets/storage for paper based health records are available

13.15. Access to the filing area is restricted

13.16. Retention and destruction of health record is in compliance with DHA regulations and guidelines

14.

Infection Prevention and Control

14.1. A designated Infection Control Coordinator is available

14.2. Infection control audit tool/checklist is available

14.3. Staff are aware of the universal/standard precautions

14.4. Cleaning and disinfection of toys and play area (if available) is documented

14.5. Staff can demonstrate safe handling and disposal of sharps

14.6. Staff are aware of needle stick management and post-exposure prophylaxis

14.7. Staff are aware of the proper use of antiseptic/disinfectants based on manufacturer’s instruction

14.8. Health care worker are aware of the management of blood or body fluids spillage

14.9. Approved list of antiseptic and disinfectants is available

14.10. Infection Prevention and Control training sessions are conducted and documented for all health care workers (including administrative staff and contracted employees)

14.11. Vaccination record of all health care worker are maintained and updated

14.12. Staff are aware of the DHA Infectious Diseases Notification system for reporting communicable disease


14.13. Staff have an access to list of communicable disease required reporting as per the local and federal regulations

15. Hazard and Waste Management

15.1. All bags are tied, labeled and secured before leaving the place of generation (e.g. treatment room)

15.2. Medical wasted bags are removed daily from place of generation

15.3. Independent medical waste storage area with proper ventilation is available

15.4. Medical waste are removed in the storage area at maximum on weekly basis

15.5. Valid contract is available with a specialized company to regularly collect, transport and discard medical waste

16. Fire and Safety

16.1. All facility fire extinguishers are maintained with valid date

16.2. Fire evacuation maps are posted in the facility

16.3. Self-illuminated emergency “exists signage” are available

16.4. Basic fire safety training is provided for all staff and documented evidence is maintained in staff files

16.5. Staff able to verbalise the acronym and its meaning to be followed in case of fire

Important note: Required structural changes apply only to new purpose-built facilities, or existing buildings that require renovation, or in a

combination of both.

Inspector’s name and signature:

1. Name: Signature:

2. Name: Signature:

3. Name: Signature:

Name and Signature of Facility Representative/s:

1. Name: Signature:

2. Name: Signature:

Outpatient Care Facility Assessment Checklist professionals... · Outpatient Care Facility...

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