Sr.

No Point
Are imaging personnel using appropriate
1
safety equipment/ devices?

Is there a record of usage, administration

2
and disposal of narcotic drugs?

Does the labelling of drug have name,

3 UHID, dose, date strength when more than
one drug is loaded before administration?

4 Is fridge temperature record present?

5 Is privacy maintained during procedures?

Are patients protected from physical abuse

6
& neglect?

7 Is patient’s information confidential?

Is patients consent taken before carrying

8
out any procedure?

Are admissions or discharge to home or

9 transfer to another organization is
documented in emergency unit?
Is staff able to demonstrate and take
10 actions to report and eliminate/minimize
risks?

11 Does medical record have copy of death

certificate?
Is any information disclosed without patient
12
authorization?

Is the waste collected, segregated,

13 transported and disposed as per the
Biomedical Waste regulations ?

Do the sterilized drums and trays have date

14
of expiry?

Is any documented hospital mission

15
present?
Is copy of basic Tariff List including bed
16 charges, OT charges, ICU bed charges,
packages, etc. present?
 What is the parameter for patient
17
identification?

Does the continous process of quality

improvement programme and patient
18
safety programme gets updated atleast
once in a year?

Is the documented operational and

19 maintenance (preventive and breakdown)
plan adhered?

Are all the medical gas cylinders stored in

20
racks or in chains?
 assessor's remark Proposal
Radiology personnel neither using shields appropriately nor using Photo of TLD badges & shields
TLD badges with staff

Photo of narcotic/high-risk
no record of narcotic usage found
register required

Photo of all staff training, while

staff are not aware of appropriate labelling of deugs prepering a dilute medicine &
training record sheet

Photo of fridge temp. record

Though fridge temp record are present but drugs are not being kept
required & Photo of 2 to 8
as per storage temp......as found during assessment vaccines which
degree medicine/inj. Which is
need to be kept in -20 degree are kept in 2-8 degree
kept in the fridge
Photo of curtains or separators
no curtains available in between beds
require
Photo of vulnerable patient
vulnerable patient assessment not dont assessment form with stamp &
sign
Photo of Patient rights &
no display found responsibility display

though consents are being taken but it's incomplete,not Photo of surgical consent,
bilingual,neither mention complication ,not signature of bilingually, mention complication,
doctor,patient and witness found & sign of doctor & stamp

Photo Patient transfer register

though register is there but patient UHID number is missing and
according to formate & stamp
exact disposition to which ward is not mentioned sign

Photo of staff training & record,

staff are not aware of incident reporting process (Incident report Process Policy
- Dhimant)
Photo of Death certificate with
death certificate format is also not appropriate stamp & sign

no system is in place to take patient authorisation

Photo of BMW bucket in close

BMW bins found open in various places......central biomedical waste
manor also Photo of BMW area
area is not kept under lock and key which is keep lock & key

Photo of Autoclave drum with

no expiry date found Autoclave date & expired Date

mission vision are not displayed anywhere Photo of display mission & vision

Photo of tariff list including all

though tariff list is present but it contains only OPD charges besic charges with stamp & sign
 require photo of staff Training on
Patient identification, training
staff are not aware of identifying patients with name and UHID
record with stamp & sign & photo
neither patient identification band present of patient identification band in
use

neither minutes of meetings are documented nor indicators are

Dhimant
being used as Quality improvement tool

photo of preventive maintenance

equipments are not numbered neither preventive maintenance plan plan, Register & require
found equipment calebration report as
well as sticker

Photo of cylinders with chain or

thorough out the hospital cylinders are found without chain or stand Stand