SOPs Check list by PHC (Wards)

Ward Name: Name of Head Nurse:

Contact #: Signature:
Date: ______to _______

Serial Indicator Numbers Indicator Numbers

#
Time for Initial Assessment of Indoor & Emergency Patients

1. Total cases admitted Number of cases in

which nursing plan is
From --------to --------
documented
2. Plan & outcome Plan & outcome either not
documented & signed by documented or not signed
Consultant by Consultant
3. Total cases needing Number of cases
nutritional assessment nutritional assessment
performed

Monitoring Use of Blood and Blood products

Total transfusions from ------ to --------

1.
Total reactions from ------ to --------
2.
Number of Major transfusion Number of minor
reactions reported transfusion reactions
reported
Number of blood or blood products wasted
3. due to transfusion reactions
Total wastage
4.
Waste due to expiry of shelf Waste due to storage
life problems

Number of blood Number of whole blood

5. components used transfusions

Turnaround time for blood Turnaround time for whole

6. components blood
 Monitoring Availability and Contents of medical records
Total charts reviewed
7. From ------- to --------
5% statistical principles
8.
Number of charts having Charts with incomplete or
discharge summary absent discharge summary
Medical records with ICD Medical records without ICD
9. code code
Medical records with proper Medical records with
consent incomplete/improper/without
consent
Number of charts available Number of missing charts
10. in record

Monitoring of Invasive Procedures

Total procedures performed
11. from ----------- to ---------
Number of unplanned Number of unplanned
procedures(Emergency) procedures(Elective)
Number of cases Number of cases
rescheduled (Emergency) rescheduled (Elective)
Number of Cases in which
12. prevention protocol of
adverse event followed
Total number of cases Number of cases in which
requiring prophylactic antibiotic given within
antibiotics specified time
 Monitoring of Use of Anesthesia
Number of cases undergoing Number of patients
13. Surgical operations requiring anesthesia
Type of anesthesia Type of anesthesia
14. (General) (Spinal/Local)

Number of cases in Number of cases in

which plan which plan modified
modified(general) (Spinal/Local)
Number of cases in Number of cases in
15. which unplanned which unplanned
ventilation required n ventilation required
(General) (Spinal/Local)
Number of cases in Number of cases in
16. which adverse events which adverse events
reported/documented reported/documented
(General) (Spinal/Local)
Anesthesia related
17. deaths recorded (General) Anesthesia related
deaths recorded
(Spinal/Local)
 Monitoring of Adverse Drug Events
Total admissions in Hospital Number of cases in which
18. from ----------- to -----------. medication errors
reported/identified
Number of drugs dispensed Number of adverse
19. from hospital pharmacy from reactions reported
-------- to --------.
Number of charts in which Number of charts with
20. abbreviations used standard abbreviations
Number of charts in which Total number of treatment
non-standard or error prone charts reviewed
abbreviations used
Total number of patients Number of patients who
21. who received high risk developed adverse reaction
medications or given without
prescription or wrong
medicine used

SOPs Check list by PHC (Anesthesia)

Name of concerned officer:

Contact #: Signature:
Date: ______to _______

Monitoring of Use of Anesthesia

Number of cases undergoing Number of patients
22. Surgical operations requiring anesthesia
Type of anesthesia Type of anesthesia
23. (General) (Spinal/Local)

Number of cases in Number of cases in

which plan which plan modified
modified(general) (Spinal/Local)
 Number of cases in Number of cases in
24. which unplanned which unplanned
ventilation required n ventilation required
(General) (Spinal/Local)
Number of cases in Number of cases in
25. which adverse events which adverse events
reported/documented reported/documented
(General) (Spinal/Local)
Anesthesia related
26. deaths recorded (General) Anesthesia related
deaths recorded
(Spinal/Local)
 SOPs Check list by PHC (Radiology & Lab)

Name & designation of concerned officer:

Contact #: Signature:
Date: ______to _______

Monitoring of Diagnosis Services

27. Number of reporting
errors/1000 investigations.
28. Total investigations Number of investigations
performed needing revision or re-dos
From --------- to ---------
Laboratory

X-Rays

C.T Scan

USG

29. Total number of employees Workers who follow all

working in diagnostics safety precautions
 SOPs Check list by PHC (Blood Bank)

Name & designation of concerned officer:

Contact #: Signature:
Date: ______to _______

Monitoring Use of Blood and Blood products

Total transfusions from ------ to --------

1.
Total reactions from ------ to --------
2.
Number of Major transfusion Number of minor
reactions reported transfusion reactions
reported
Number of blood or blood products wasted
3. due to transfusion reactions
Total wastage
4.
Waste due to expiry of shelf Waste due to storage
life problems

Number of blood Number of whole blood

5. components used transfusions

Turnaround time for blood Turnaround time for whole

6. components blood
 SOPs Check list by PHC (Pharmacy)

Name & designation of concerned officer:

Contact #: Signature:
Date: ______to _______

Monitoring of Adverse Drug Events

Total admissions in Hospital Number of cases in which
30. from ----------- to -----------. medication errors
reported/identified
Number of drugs dispensed Number of adverse
31. from hospital pharmacy from reactions reported
-------- to --------.
Number of charts in which Number of charts with
32. abbreviations used standard abbreviations
Number of charts in which Total number of treatment
non-standard or error prone charts reviewed
abbreviations used
Total number of patients Number of patients who
33. who received high risk developed adverse reaction
medications or given without
prescription or wrong
medicine used