CHECK LIST FOR SNCU MENTORING

A. GENERAL DETAILS

1. Name of the unit:

2. Address:

3. Website (if present):

4. Year in which operations started:

5. Incharge of the Neonatal Unit: (Designation: )

Qualification (each qualification to be separated by a semi-colon ; e.g. MD; DCH):

Telephone no.: Mobile: Fax: E-mail:

6. Does the unit receive any Technical Support from other agencies Yes / No
like UNICEF, NIPI, any NGO, etc.
If yes, mention the name of organization: and their co-ordinator:

B. UNIT’S PERFORMANCE

S.No.
Parameter Value/Details

1 Available number of beds in the unit

2a Total inborn babies admitted (monthly)
2b Total out born babies admitted (monthly)
2c Total number of babies admitted with LBW (low birth weight)

3a Total number of babies referred-out due to surgical reasons (monthly)

3b Total number of babies referred-out due to non-surgical reasons (monthly)

3c Total number of babies referred-in (monthly)
4a Mortality figures – inborn (monthly)
4b Mortality in out born babies (monthly)
4c Mortality in LBW babies (monthly)

i.
ii.
The five (5) commonest diagnoses
5 iii.
(in last one year or since inception if unit is <1yr old)
iv.
v.

Babies immunized with OPV, BCG and Hepatitis-B vaccines before discharge from SNCU
6
(%)
C. FACILITIES OFFERED

S.No. Value/Details Availability

1 24-hr delivery and newborn care support Yes / No

2 24-hr on-call support by a qualified Paediatrician Yes / No

3 Facilities for respiratory support (CPAP, etc.) Yes / No

Radio-diagnostics – X-ray (essential) and/or USG/CT (either sourced from the hospital or
4 Yes / No
from an private radiology centre under an MOU)

Laboratory services (either sourced from the hospital lab or from an private lab under an
5 Yes / No
MOU)
6 Immunization services Yes / No
7 Blood transfusion services Yes / No
8 Neonatal transport service Yes / No

9 24-hr electricity backup (generator, UPS, solar power, etc.) Yes / No

10 24-hrs water supply (either direct or through storage tanks) Yes / No

11 Stores – both medical and general stores Yes / No

(see the adjoining
12 Equipments (available in the Unit)
list)

List of available equipments in the SNCU

(Mention the number available and functional number of equipments against each item)
Number
Number Number
S.No. Lying
Particulars Currently Currently
Unused
Available Functional
Monitoring Equipments
1 Stethoscope with neonatal chest piece
2 Non-invasive BP monitors
3 Pulse oximeter
4 Low reading clinical thermometers
5 Room thermometers
6 Electronic weighing scale
7 Mechanical weighing scale
Equipment for Management of Conditions
8 Radiant warmer (with Servo control)
9 Phototherapy unit
Resuscitation equipments
10 Self inflating bag
11 Foot operated suction apparatus/mucus trap
12 Central O2
13 O2 cylinders
14 O2 concentrators
Equipments for investigations
15 Micro hematocrit
16 Dextrometer
17 Multistix
18 Bilirubinometer
19 Microscope
General equipments
20 Generators
21 UPS
22 Refrigerator
23 Wall clock with second’s hand
24 Autoclaving equipments
25 Surgical instruments
26 Spot lamps
27 Syringe hub cutters
28 ECG machine
29 Measuring tape (vinyl coated, 1.5 m)
30 Infusion stands
31 Air conditioners
Heat convectors or hot-air blowers (to maintain ambient
32
temperature)
Note: List modified from the FBNC Operational Guidelines for Implementation. MoHFW; 2011.

D. FUNCTIONAL AREAS

Response
Mention whether service is available or
S.No. Area
not, if YES, then mention the area (in
sq.ft.)

1 Available area per bed (in sq.ft./bed)* (number)

2 Baby receiving room Yes / No -
3 Breast feeding area Yes / No -
4 Special room for invasive procedures Yes / No -
5 Isolation room (for infected babies) Yes / No -
6 Intravenous fluids preparation area Yes / No -
7 Oxygen bay (in stand alone facility) or availability of central oxygen Yes / No -
Step down room for non-critical/stable babies to stay with their mothers
8 Yes / No -
If “Yes”, then mention number of beds available for mothers
* Area per bed = (total area of the SNCU) / (total number of beds in SNCU)

E. CLINICAL SUPPORT SERVICES

S.No. Services Response

Mention whether service is available or
not, if YES, then by which mode of the
following:
In house/Parent Hospital/ Outsourced
1 House keeping services Yes / No -
2 Ambulance services Yes / No -
3 Autoclaving / CSSD (of parent hospital) Yes / No -
4 Laundry Yes / No -
5 Kitchen services (for mothers) Yes / No -
Information Technology (facilities in the unit but managed by
6 Yes / No -
parent hospital or by an outsourced agency)
7 Maintenance of facility Yes / No -
 8 Management of Bio-Medical Waste (BMW) Yes / No -
9 Pharmacy Yes / No -
10 Security Yes / No -
Supply Chain Management (drugs, consumables and other
11 Yes / No -
materials)
Referral services (if yes, mention the name of the most commonly,
12 Yes / No -
referred to centre)
* For all “outsourced” services the unit should have at least a copy of MOU for the same.

F. HUMAN RESOURCES

S.No. Group Number Availability per shift

(M/E/N) *
1 Doctors
2 Resident Doctors
3 On-call consultants
4 Nurses
5 Technicians
6 Housekeeping staff
7 Others, please give details here:
* Considering three shifts of (M, E, N) Morning, Evening and Night duties

PRACTICES FOLLOWED AT THE FACILITY

I. Care at birth
• Prevention of infection by means of infection control measures Yes / No
• Provision of warmth – thermal care protocols Yes / No
• Resuscitation measures and protocols Yes / No
• Care of umbilical cord Yes / No
• Early initiation of breast feeding – when after birth is it started Yes / No
• Weighing the newborn – adequate availability of weighing scales Yes / No
• Protocols for hand washing and eye & cord care Yes / No
• Remarks (if any) :

II. Care of normal newborn

• Breast feeding / feeding support to mother-baby unit – protocol for the same Yes / No
• Remarks (if any) :

III. Priority Signs

• Awareness about “Priority signs” is very important for the staff to
identify sick neonates who need immediate assessment and admission
to SCNU. Is staff aware of these “Priority Signs”? Yes / No
• Remarks (if any) :
IV. Care of sick newborn
• Managing of low birth weight infants <1800 grams – protocols for same Yes / No
• Managing all sick newborns (except those requiring mechanical ventilation
 and major surgical interventions) – as per the guideline1 Yes / No
• Phototherapy for newborns with hyperbilirubinemia – protocols for same Yes / No
• Follow up of all babies discharged from the unit and high risk newborns Yes / No
• Immunization services – as per MOHFW/GOI guidelines Yes / No
• Referral services –Protocol followed for referring in of a newborn Yes / No
• Protocol for transfer of a sick newborn to a referred to facility Yes / No
• Remarks (if any) :

V. Warm chain
• Protocol followed for maintenance of “Warm Chain” Yes / No
• Remarks (if any) :

VI. Correct technique of breast feeding

• Does the staff inform/teach the mother how to breast feed the newborn Yes / No
• Remarks (if any) :

VII. Care for pre-term baby

• Daily weighing of baby Yes / No
• Promotion of breast feeding Yes / No
• Promotion of skin to skin care Yes / No
• Maintenance of feeding tube Yes / No
• Involvement of mother and family in care of the baby Yes / No
• Remarks (if any) :

VIII. Fluid Management

• Protocol for managing intravenous (IV) fluids in newborn Yes / No
• Protocol for rational use of antibiotics Yes / No
• Remarks (if any) :

IX. Infection Control

• Protocols for cleaning of equipments and facility Yes / No
• Protocols for Bio-Medical Waste management (as per guidelines) Yes / No
• Remarks (if any) :

Signature ...................................

Name of Mentor .......................

1
Facility Based Newborn Care Operational Guide – Guidelines for Planning and Implementation. MOHFW (2011)