Area of

Concern
E
Clinical
Services
 Overview
• The ultimate purpose of existence of a hospital is to provide
clinical care
• Most critical and important are clinical processes
• Define directly Outcome of services and Quality of care
• Largely depend on RR, and SI as OB may be difficult for
assessment of some clinical procedure
• Assessment requires thorough domain knowledge
WHAT ‘AREA OF CONCERN-E’ COVERS

Standard E 10-
Standard E1- E9 Standard E17-E23
E16
General Clinical RMNCH+A & NHP
Specific Clinical Clinical Processes
Processes
Processes
 WHAT GENERAL CLINICAL PROCESSES
(E1 to E9) COVERS.

E1. REGISTRATION, E2. CLINICAL ASSESSMENT E3. CONTINUITY OF CARE

CONSULTATION & ADMISSION & REASSESSMENT AND REFERRAL

E4. NURSING CARE E5. HIGH RISK & VULNERABLE E6. STGs & GENERIC DRUGS

E7. SAFE DRUG E8.MANTAINING, UPDATING, E9. DISCHARGE OF PATIENT.

ADMINISTRATION STORAGE OF RECORDS
SPECIFIC CLINICAL PROCESSES
E10 E11 E12
Intensive Care Emergency Diagnostic
Services Services

E13 E14 E15

Blood Bank & Anesthesia Surgical
Transfusion Services

E16
End of Life
Care
 Clinical Processes Related to
RMNCH+A & NHP
E17 E18 E19
Antenatal Intranatal Post Natal
Care Care Care

E20 E21 E22

Newborn & Family Adolescent
Child Health Planning & Health
Abortion

E23
National
Health
Programs
Standard The facility has defined procedures for registration,

E1 consultation and admission of patients

 The facility has defined procedures for registration, consultation
Standard
E1 and admission of patients.

 Unique identification no. is given

ME E1.1  Demographic details of the patients Applicable to All
Registration are Recorded Clinical departments

ME E1.2  Patients are called one by one

OPD  History & Provision Diagnosis is written
Consultation 
Applicable to OPD
Patients are not consulted in standing
 Clinician are not involved in administrative work

 Admission is done by written order

Applicable to all
ME E1.3  Time of Admission is written
Indoor Departments,
Admission  There is no undue delay in admission
Emergency
 Criteria of admission is defined

ME E1.4 All Indoor

Non  Check for how facility cope with surplus
Availability of Department &
patients. Is there any provision for extra beds
Beds Emergency
Checklist
OPD
 The facility has defined and established procedures for clinical
Standard E2 assessment and reassessment of the patients.
 The facility has defined and established procedures for clinical
Standard
E2 assessment and reassessment of the patients.

There is established procedure for initial

ME E2.1 All Patient Care
Assessment assessment of patients. Department

There is established procedure for follow-up/

ME E2.2 All Patient Care
Reassessment reassessment of Patients departments
Checklist - Maternity Ward
 The facility has defined and established procedures for continuity
Standard E3 of care of patient and referral.
 The facility has defined and established procedures for continuity
Standard
E3 of care of patient and referral.

ME E3.1
The facility has established procedure for continuity of All Patient Care
Interdepartment
al Transfers Areas
care during interdepartmental transfer.

ME E3.2 The facility provides appropriate referral linkages to the patients/Services All Patient Care
Referral Areas
for transfer to other/higher facilities to assure the continuity of care.

ME E3.3 A person is identified for care during all steps of

Responsibility
All Patient Care
of Care care Areas Except OPD

The facility is connected to medical colleges Outpatient

ME E3.4
Telemedicine through telemedicine services Departments
Checklist – Pediatric Ward
 The facility has defined and established procedures for nursing
Standard E4 care
 The facility has defined and established procedures for nursing
Standard
E4 care

ME E4.1 Procedure for identification of patients is established at All patient Care

Patient
Identification the facility Departments

ME E4.2 Procedure for ensuring timely and accurate nursing All Patient Care
Nursing Care
Accuracy
care as per treatment plan is established at the facility. Departments

ME E4.3 There is established procedure of patient hand over,

Patient
All Patient Care
Handover whenever staff duty change happens. Departments
 The facility has defined and established procedures for nursing
Standard
E4 care

ME E4.4
Nursing records are maintained. All Patient Care
Nursing
Records Departments

ME E4.5 There is procedure for periodic monitoring of

All Patient Care
Patient
Monitoring patients Departments
Checklist-ICU
 The facility has a procedure to identify high risk and vulnerable
Standard E5 patients
 The facility has a procedure to identify high risk and vulnerable
Standard
E5 patients

ME E5.1 The facility identifies vulnerable patients and

Vulnerable
All Patient Care
Patients ensure their safe care Departments

ME E5.2 The facility identifies high risk patients and

All Patient Care
High Risk
patients ensure their care, as per their need Departments
Checklist –ICU
 The facility follows standard treatment guidelines defined
by state/Central government for prescribing the generic
Standard E6
drugs & their rational use
 The facility follows standard treatment guidelines defined by
StandardE
6 state/Central government for prescribing the generic drugs & their

rational use

ME E6.1 The facility ensured that drugs are prescribed in

Generic Drug
All Patient Care
Prescription generic name only. Departments

ME E6.2
Standard There is procedure of rational use of drugs All Patient Care
Treatment Departments
Guidelines
Checklist -IPD
Prescriptions….
Prescriptions……
Prescriptions……
 The facility has defined procedures for safe drug administration.
Standard E7
Standard The facility has defined procedures for safe drug administration.
E7

ME E7.1
There is process for identifying and cautious All Patient Care
High Alert
Drugs Areas
administration of high alert drugs

ME E7.2 Medication orders are written legibly and

Legible All Patient Care
Medication adequately. Areas
Orders

ME E7.3 There is a procedure to check drug before

Drug
All Patient Care
Administration administration/dispensing Areas
Standard The facility has defined procedures for safe drug administration.
E7

There is a system to ensure right medicine is

ME E7.4 All Patient Care
Right Patient given to right patient Areas

ME E7.5
Patient is counseled for self drug administration. All Patient Care
Self Drug
Administration Areas
Checklist- SNCU
 The facility has defined and established procedures for maintaining,
Standard E8
updating of patients’ clinical records and their storage.
 The facility has defined and established procedures for
Standard
E8 maintaining, updating of patients’ clinical records and their

storage.
ME E8.1 All the assessments, re-assessment and All Patient Care
Assessment
Records investigations are recorded and updated. Areas

ME E8.2 All treatment plan prescription/orders are All Patient Care

Medical Orders
Records recorded in the patient records. Areas

ME E8.3 Care provided to each patient is recorded in the

Treatment
All Patient Care
Records patient records Areas

ME E8.4 Procedures performed are written on patients

Procedure
All Patient Care
Records records Areas
 The facility has defined and established procedures for
Standard
E8 maintaining, updating of patients’ clinical records and their

storage.
ME E8.5 Adequate form and formats are available at All Clinical
Form &
Formats point of use Departments

Register/records are maintained as per All Clinical

ME E8.6
Registers guidelines Departments

ME E8.7 The facility ensures safe and adequate storage

Storage of
All Clinical
Records and retrieval of medical records Departments
Checklist- Labour Room
Checklist- Labour Room
 The facility has defined and established procedures for discharge
Standard E9 of patient.
 The facility has defined and established procedures for discharge
Standard
E9 of patient.

ME E9.1 Discharge is done after assessing patient

Assessment All Patient care
Before readiness Departments
Discharge

Case summary and follow-up instructions are All Patient care

ME E9.2
Follow Up provided at the discharge. Departments

Counseling services are provided during

ME E9.3 All Patient care
Counseling discharges wherever required Departments

The facility has established procedure for patients

ME E9.4
leaving the facility against medical advice, All Patient care
LAMA Departments
absconding, etc.
Checklist – Nutritional Rehabilitation Center
Checklist – Nutritional Rehabilitation Center
Checklist – Nutritional Rehabilitation Center
Thank You