Social Health: Self Assessment Empanelment Evaluation Criteria Process

Self Assessment Empanelment Evaluation Criteria Process will include that each service provider will have default access to the Empanelment of online digital development as a user to enter profile data, select assessment values, and rating score against each critical condition of service provision, and also select values from below check-list. In the end, this input will be submitted. A representative of the health team will personally visit the service provider for checking and verification of provided data. Finally, the approving committee will approve, reject or suggest improvements to the service provider.

Lookup Types are Rating and Assessment and lookup values are the on-call following:

The lookup type is check-List and lookup values for essential standardized check-list are as follows.

Primary Healthcare.
Secondary Healthcare.
Tertiary Healthcare.
Rehabilitation Center.
Palliative Care.
Registration from Health Care Authority.
Tax Payer.
Bank Account with the name of service provider/hospital.
Multiple health facilities minimum of 3 departments including medical, general surgery, and gynecology/obstetrics.
Ten or more beds.
Less than ten beds.
Provide 24/7 services including emergency services.
Adequate number of medical officers including women medical officers.
Willing to provide health services at pre-negotiated rates.
Agree on payment mechanisms with the insurance company.
Allocate a focal person for complaint resolution.
Have a dedicated team to manage claims.

The Set of Business Rules

Health Facilities.
Management.
Infection Control, Hygiene, and Waste Management.
Human Resources.
Clinical Practice.
Operating Theater.
Casualty.
Intensive Care Unit.
Maternity Service.
Laboratory Service.
Radiology.
Pharmacy Services.
Blood Bank.
Patient’s Rights.

The Values of Business Rules against Set of Business Rules may be the following standards already set above regarding Empanelment Evaluation Criteria. The user will only select the rating codes and abbreviations against each value of business rules.

Health Facilities

At least ____ number of inpatient medical beds. The requirement of beds can be reduced up to ____ minimum requirement basis on available infrastructure in rural areas.
Accessibility of facilities for patient movement.
Wheelchairs and Stretchers are available at reception and are functional for patients.
The service provider and its departments are signposted and a site plan is displayed at a central place for orientation.
A reception desk with a receptionist is open during operating hours.
Patients admitted to service providers have easy access to the allotted bed with fresh linen.
Separate wards for males and females.
Adequate toilets and bathrooms are available inwards. At least one toilet for every twelve patients with warm water in the winter season.
Portable water and electrical power or alternates are available 24/7.

Management

The service provider has the right skills mix, infrastructure, and equipment for the services provided.
The services to be performed are by the listed service in registration.
There are clear job descriptions available for clinical and non-clinical staff.
Service providers have access to ambulance service in twenty minutes.
The ambulance service is contracted or owned.
Electricity, telephone, water, civil engineering are contracted out.
The details of contracted services are available.
Patient records are maintained in a database through the use of a unique identification number or in other forms of unique identification.
Where referrals have been made, the patient’s records include the indication for referral.

Infection Control, Hygiene, and Waste Management

Gloves, gowns, masks, soap, and disinfectants are available for situations where there is a risk of infection.
Sufficient funding for proper sanitation in toilets and other public utilities should be kept and services may be outsourced.
Sufficient covered and clean dustbins for patients, visitors, attendants, and staff, and these are emptied regularly.
Cleaners are trained and provided with sufficient and appropriate equipment and accessories. Their work should be according to cleanliness and sanitation policies and procedures.

Human Resources

The healthcare practitioners are registered with the appropriate professional regulatory authority.
The practitioners are trained, experienced, and entitled to the roles they undertake.
Written and dated job descriptions are available for all posts specifying at least the following: Job title, grade, job purpose and objectives, responsibility, accountability, and review date.
A duty resident medical officer and a nurse are physically available 24/7 in service providers.
The duty medical officer should have an MBBS or equivalent degree approved by the country's authority with one-year house job experience.
The nurse should have a bachelor’s degree in nursing approved by the country’s authority.
One duty medical officer for every 20 indoor patients should be available 24/7.
At least one Physician or consultant 0n-call may be called on at any time to provide services.
A service provider providing surgical facilities should have a surgeon and anesthetist and they should be available on call.
A nursing home providing maternity facilities should have an Obstetrician, gynecologist, anesthetist, and neonatologist on call round the clock.
Service providers providing surgical facilities should have a qualified operation theater nurse on every shift.
Every ward should have one ward boy/girl 24/7 with a maximum 12 hours shift.

Clinical Practice

Patients who arrive in an emergency (nursing home) should be immediately checked by the duty medical officer or at least within half an hour.
The mechanism for referral to higher-level service providers is available in case of unavailability of service.
ECG facilities should be available round the clock.
Medical devices intended for single-use should not be reprocessed for reuse.
The patient record is sufficiently detailed to enable the patient to receive effective treatment and care and includes details of admission, date, and time of arrival. Patient assessment and medical examination sheet containing history pertinent to the condition being treated including details of the present, history. A registered medical doctor should diagnose each entry. Details of the patient treatment plan and follow-up plans, diagnostic test orders and results, progress notes written by medical, nursing and allied health staff to record all significant events such as alterations in the patient’s condition and responses to treatment and care Record of any near misses, incidents or adverse events. Medication sheet recording each dose given. Treatment record Observation charts, e.g. temperature chart, input and output chart, head injury chart, and diabetic chart. Specialist consultation reports, Mode of discharge, e.g. left against medical advice (LAMA) or discharge on will. In case of death, details of circumstances leading to the death of patients should be available.

Operating Theater

A height-adjustable OT Table and a cold, shadow less Operating light are available.
The anesthetic induction area/room and operating theater are equipped with safe and well-maintained equipment specific for OT activities including but not restricted to the following:

Anesthetic machine
Laryngoscopes
Endotracheal tubes/laryngeal masks
Airways
Nasal tubes
Suction apparatus and connectors
Oxygen
Drugs and IVs required for planned anesthesia
Drugs for emergencies Monitoring equipment including ECG, ETCO2, temperature monitoring, pulse oximeter, and blood pressure
Suction machine
Instrument
cleaning/decontamination/ sterilization facilities
Adequate light sources

Adequate lighting, Air conditioning, and Ventilation are provided in each OT.
The operating area is of sufficient size to accommodate the patient, the anesthetist, the surgeon, and the assistants for surgery.
Procedures are available and up to date for the following:

Informed patient consent
Pre-operative assessment
Post-operative care

Casualty

Is it managed at all times by a suitably qualified and experienced nurse, doctor department assistant?
A procedure exists for referral for specialist care if necessary.
The entrance is signposted from outside the service provider.

Intensive Care Unit (ICU)

Registered nurses in the ICU have completed formal in-service training or a recognized course in intensive care and at least one is present on all shifts.
A suitably experienced doctor is available at all times.

Oxygen
Suction
Compressed air
ECG monitoring.

Facilities in the unit include

CVP monitoring.
Pulse oximetry.
Blood pressure monitoring.
Utheon calorimetry.
Ambient and patient temperature monitoring.
Glucometer.
Electrolyte machine.

Maternity Services

The maternity department is managed by a suitably qualified, registered, and experienced nurse, doctor, or senior midwife for normal delivery.
The maternity department has 24/7 on-site cover from a qualified medical doctor, obstetrician & gynecologist, and an anesthesiologist.
Written procedures and guidelines are used consistent with the service provider’s policies and functions for:

Antenatal care and booking/registration.
Postnatal care.
Perinatal care.
Identifying high-risk pregnancies.
Admission to the labor room/ward.
Planning, treatment, and mode of delivery.
Plan for managed pain during delivery.
Delivery monitoring process.
Referral.
Discharge including discharge summary.
Birth record and certificate.

A trained nurse is present at every birth.
A guideline on summoning medical assistance at any time during labor is used by nurses and midwives.
For C Section an anesthetist and obstetrician with relevant qualifications and experience are available for mothers with an epidural, C Section, emergency breach and instrumental deliveries, multiple or high-risk deliveries, instrument deliveries or C-sections, emergency resuscitation, and women with eclampsia.
The delivery room is equipped with a functioning, safe, and well-maintained equipment specific for deliveries including but not restricted to the following:

Fetoscope. The delivery table can be turned to the Trendelenburg position.
An anesthesia machine with emergency oxygen supplies in case of management of complicated deliveries.
Endotracheal tubes, laryngoscope in case of surgery. Resuscitation equipment and drugs for infants and adults Intravenous crystalloid and plasma expanders.
Weighing machine for the baby.

Laboratory Services

Availability of services from a licensed clinical laboratory is mandatory. A Contract of Service or Memorandum of Agreement with a clinical laboratory located within the locality can be done, provided that results for emergency cases are transmitted within one hour.
It is managed by a suitably qualified and experienced medical technologist.
The staff has access to sufficient laboratory equipment to carry out their jobs safely.
There are designated storage areas for specimens, reagents, and records.

Radiology

The services of a licensed radiology facility should be available, which may be contracted out but must be situated near the healthcare facility to ensure the availability and timeliness of services.
If the radiology services are available within the healthcare facility then a trained radiologist (either on-site or visiting) is responsible for the clinical direction of the department and the safety of the client/patients and the radiologist.
Radiology services are administered by a qualified, registered radiologist or radiographer with defined responsibility for all non-clinical aspects of the department.
Diagnostic imaging is performed only upon a signed written request from a qualified medical practitioner.
The urgency of the situation will require reporting times, e.g. films or scans for emergency patients are reported within one hour and routine reports are reported within 24/7.
There is a provision for a female attendant to accompany female patients during radiological procedures.
There are prominently displayed signs in the local language warning women of childbearing age of the dangers of radiation in pregnancy.

Pharmacy Services

The services of a pharmacy should be available, which may be contracted out but must be situated close to the healthcare facility to ensure the availability and timeliness of services.
The pharmacy services if available within the healthcare facility must be managed by a qualified pharmacist.
Medicines are stored on shelves enabling protection from the adverse effects of light, e.g. glass windows painted white, dampness, and temperature extremes.
Heat sensitive and/or light-sensitive medicines/vaccines are stored in a controlled environment to keep them in optimum condition.

Blood Bank

The blood bank services should be available, which may be contracted out but must be situated close to the health care facility to ensure the availability and timeliness of blood in emergencies.
An effective blood cold chain should be ensured.
Blood collected is labeled appropriately with the donor’s name, registration number, blood group, the time of collection, and the date of expiry.
The blood bank maintains records of procurement, issues, and transfusion of blood, cross-matching, and any issue related to blood and blood components. The records are kept for at least 5 years.

Patient’s Rights

Guidance and advice are provided to the patients at the registration counter.
The reception area and wards display information about the organization, including

The rights of the patients.
Services and facilities are available in the hospital for beneficiaries.
Feedback and complaints pathways.

Written patient consent is obtained for the proposed care or treatment.
There is a documented process for collecting, prioritizing, reporting, and investigating complaints that are fair and timely.
There are adequate provisions for patient privacy in the form of screens and curtains.
In the case of a male doctor attending a female patient, there is provision for a female attendant to be present during such an event.