Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
This set of quality improvement tools was developed to support the Government of Nepals efforts to increase
skilled birth attendance in Nepal. It was created to help strengthen inservice training sites that provide quality and
standardized skilled birth attendant (SBA) skills training for the thousands of healthcare providers.
In 2006, the National Health Training Center (NHTC) of the Ministry of Health and Population (MoHP) developed
the Maternal and Newborn Care Learning Resource Package (MNC LRP) for Skilled Birth Attendants (SBAs) to
train and upgrade existing healthcare providers (namely auxiliary nurse midwives, staff nurses and medical
officers) in SBA skills as defined by the National Policy on Skilled Birth Attendants (2006).
To quickly start up this training, NHTC assessed a number of sites, provided some equipment and initiated training
in early 2007. NHTC wanted also to ensure the quality of the trainingfor example those sites conducting SBA-
related training using the MNC LRP were providing an interactive, competency-based training environment and a
clinical practice experience was consistent with the content defined in the LRP. NHTC and various stakeholders
felt this quality improvement process could be an ongoing process, which led to the development of this set of
tools. Derived from the LRP itself, these tools define the minimum standards for a range of service and training
activities. They help standardize and improve both the MNC services in participating facilities and the quality of
inservice training.
The standards-based tools were developed in July 2007 and field-tested in eight SBA inservice training sites in
Nepal. An orientation for training site staff was conducted on how to use the tools for self-assessment, monitoring
and quality improvement, followed by site visits to support staff through this process. This revised set presented
here was finalized in October 2007 based on training sites staff feedback. These tools will be used by all NHTC
SBA inservice training sites to improve and then maintain quality of SBA training.
NHTC would like to acknowledge those who contributed to the development of these tools in support of national
efforts to expand quality SBA training.
NHTC conducted several activities to develop these tools through a series of workshops in February, July and
August 2007. Participants in these activities included representatives from Family Health Division (FHD), National
Health Training Center (NHTC), Nepal Family Health Program (NFHP), World Health Organization (WHO),
Support to Safe Motherhood Programme (SSMP), Nick Simons Inc. (NSI), Maternity Hospital (MH), Lalitpur
Nursing Campus, Koshi Zonal Hospital, Bharatpur Hospital, Lumbini Zonal Hospital, Seti Zonal Hospital, AMDA
Hospital, Baglung District Hospital, Dhulikhel Hospital, Tribhuwan University Teaching Hospital (TUTH), Nepal
Nursing Council (NNC), United Nations Fund for Population Activities (UNFPA), Kathmandu Medical College
(KMC), Council for Educational and Vocational Training (CTEVT), United Mission to Nepal (UMN), United Nations
International Childrens Educational Fund (UNICEF) and JHPIEGO, Save the Children, US/ACCESS.
Notably, staffs from SBA inservice training sites were essential to the development and field-testing process.
Special thanks to all the staffs working to improve the quality of SBA training at the following sites: Seti Zonal
Hospital, Kailali District Hospital, Bharatpur Hospital, Maternity Hospital, Koshi Zonal Hospital, Dhulikhel Hospital,
Baglung Hospital, AMDA Hospital and Lumbini Zonal Hospital.
NHTC recognizes and appreciates the United States Agency for International Development (USAID) support to the
ACCESS Program. Also, recognized are the contributions of ACCESS staff and consultants who provided the
technical assistance in the development of these quality improvement toolsespecially by Sarala Adhikari, Lalit
Mani Dhakal, Anne Hyre and Geeta Sharma.
Arjun B. Singh
Director
National Health Training Center
INTRODUCTION TO SBA QUALITY TRAINING IMPROVEMENT TOOLS
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 1: Page 1 of 7
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 1: Page 2 of 7
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
4. Staff properly disposes of Syringes with needles are:
sharps in each room. Immediately placed in sharp container without recapping.
Containers are closed and disposed of when filled (3/4 full).
5. Antiseptics are properly Antiseptics are kept in small, closed and reusable containers for daily use.
prepared. Antiseptics are stored in cool and away from direct sunlight.
Gauze and cotton are stored in containers without antiseptics.
Reusable containers are washed with soap and water and dried before being
refilled with antiseptic solution.
Auxiliary instruments such as thermometers, probes and other materials are
stored in dried containers without antiseptic or disinfectant solutions.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 1: Page 3 of 7
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 1: Page 4 of 7
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
7. Instruments are properly Observe during the cleaning, whether the personnel responsible:
cleaned. Uses clean water, detergent (liquid or powder) and a soft brush.
Disassembles instruments with multiple parts.
Cleans instruments in soapy water with a soft brush until all blood and
organic material is gone (especially instruments with teeth, joints or screws).
Thoroughly rinses the instruments with clean water until all the detergent was
removed.
Dries the instruments with a clean towel or airdry.
8. Staff use personal protective Observe during cleaning of materials and instruments that the personnel
barriers during cleaning of responsible use the following protective barriers:
instruments. Utility gloves
Plastic apron
Closed shoes
Visor or protective goggles
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 1: Page 5 of 7
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 1: Page 6 of 7
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
12. The IP practices during Observe if:
handling waste are Housekeeping personnel (e.g. ward attendant, sweeper) in labor, postpartum
performed according to the and newborn wards wear utility gloves when handling waste.
standards. Waste is transported to the interim storage area or for disposal in adequate
closed containers.
Housekeeping personnel (e.g. ward attendant, sweeper) wash hands after
handling waste and removing utility gloves.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 1: Page 7 of 7
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 1 of 10
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 2 of 10
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
4. The facility has an adequate Observe if:
examination/procedure room The room is clean and well-maintained.
for antenatal care (ANC). The room is well ventilated.
The examination/procedure area provides privacy for the client:
Curtains or screens to prevent seeing the examination area from the
door.
Handwashing facilities inside or nearby.
5. The room has all necessary Observe that there are:
equipment to provide ANC. Examination table
Foot steps
Proper light source
Container with 0.5% chlorine solution for decontamination
Container with plastic bag for waste
Puncture-proof container for sharps
Speculum
Sphygmomanometer
Adult stethoscope
Fetoscope
Thermometer
Tape to measure fundal height
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 3 of 10
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 4 of 10
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
Instructions: Observe the following standards (912) in sequence with two pregnant women that come for ANC.
First Second
9. The pregnant woman is Observe during care of two pregnant women whether the provider: Woman Woman
received and greeted Y N NA Y N NA
cordially and respectfully. Greets the woman and her companion (if present) in a cordial manner.
Allows the womans companion to remain in the room as her choice.
Explains to the woman and her companion what s/he is going to do and
encourages her to ask questions.
Responds to questions using easy-to-understand language for the client.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 5 of 10
Asks about and records danger signs that the woman may have or has had:
Vaginal bleeding
Respiratory difficulty
Severe headache, blurred vision
Severe abdominal pain
Convulsions/loss of consciousness
Asks about and records previous pregnancies and births (on first antenatal
visit only).
Asks about and records common discomforts of pregnancy and manages
accordingly.
Asks about and records surgical, medical and family history.
Asks about and records any general health problems.
Asks about and records:
Full or partial TT immunization
Current medications and/or herbal treatments
Malaria treatment (if applicable)
Calculates/confirms gestational age.
Calculates/confirms expected due date (EDD)first visit.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 6 of 10
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
First Second
11. The provider correctly Observe during care of two pregnant women whether the provider: Woman Woman
performs a physical Y N NA Y N NA
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 7 of 10
Hemoglobin
Blood grouping and Rh factor
Urinalysis to test albumin
15. The provider assists the Observe during care of two pregnant women whether the provider asks about or First Second
Woman Woman
woman and her companion describes: Y N NA Y N NA
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 8 of 10
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
16. The provider correctly Observe whether the provider describes:
describes danger signs and Vaginal bleeding
symptoms. Respiratory difficulty
Severe headache/blurred vision
Severe abdominal pain
Convulsions/loss of consciousness
17. The provider gives routine Observe whether the provider:
medications and counseling Provides sufficient iron tablets to be taken once daily until next visit.
to the woman. Counsels about eating nutritious food.
Gives TT based on womans need and according to protocol.
Provides albendazole 400 mgone tablet during second trimester.
Provides specific advice and counseling as needed (i.e., common
discomforts, rest, hygiene, breastfeeding).
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 9 of 10
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 2: Page 10 of 10
Nepal SBA Inservice Training Site Quality Improvement Tools for Site Strengthening
TOOL 3: COMPLICATIONS DURING PREGNANCY
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 1 of 12
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 2 of 12
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
3. The provider identifies the Ask the provider "How do you identify the cause of the shock?
specific cause of shock and Take history (patient or accompanying person).
describes the management Perform vaginal obstetric examination if needed.
according to the cause.
Propose diagnosis or identify cause of bleeding.
Ask the provider "What are the next steps?
Perform specific actions to stop the bleeding.
Perform blood transfusion as soon as possible, as needed.
Refer to speciality service (ICU, OR, ER etc.), if needed.
4. The facility has the Observe the availability of:
equipment and drugs for No. 16 or 18 IV cannula
management of shock. Container for taking blood sample
IV equipment
Saline or Ringers lactate
Oxygen cylinder or central supply source in working order
Nasal cannula and mask
Foley's catheter
Urine collection bag
Catheterization set
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 3 of 12
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 4 of 12
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
6. Clinical records show that Determine whether the following information is recorded on the womens clinical
the provider followed the records:
recommended procedures Information on the history of patient's condition 15 minutes subsequent to
DURING a blood transfusion. initiation of transfusion then hourly during transfusion:
General appearance
Temperature
Pulse
Respiration
BP
Liquid intake (IV and oral)
Amount of urine
7. Clinical records show that Determine whether the following information is recorded on the womens clinical
the provider followed and records:
recorded the recommended Information on the history upon completion of the transfusion:
procedures AFTER Duration (time of completion of transfusion)
completing a blood
Volume and type of products transfused
transfusion.
Donor code for product transfused
Whether there was an adverse reaction
Specific actions taken according to the adverse reaction if any
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 5 of 12
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 6 of 12
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
11. The provider performs Performs bimanual examination.
procedural task of MVA. Inserts speculum.
Applies antiseptic to cervix and vagina two times.
Removes any products of conception (POC) hanging from os and check for
any cervical tears.
Puts tenaculum or volsellum forceps on lower lip (7 or 5 o'clock) of cervix.
Inserts the cannula gently through the cervix into the uterine cavity.
Attaches the prepared syringe to the cannula.
Evacuates contents of the uterus.
Ensures sign of completion (e.g. pink foam, grating sensation).
Removes forceps and tenaculum and speculum.
Performs bimanual examination.
Inserts speculum and checks for bleeding.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 7 of 12
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 8 of 12
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
1
Severe pre-eclampsia or eclampsia : Interview a provider who is likely to manage severe pre-eclampsia or eclampsia.
13. The provider correctly Ask the provider What are the signs and symptoms of severe pre-eclampsia and
describes the signs and eclampsia?
symptoms of severe pre- Severe pre-eclampsia:
eclampsia and eclampsia. Diastolic BP equal to or more than 110 mm Hg
20 weeks or more gestation
Proteinuria 3+
Eclampsia:
Convulsions
Diastolic BP equal to or more than 90 mm Hg
20 weeks or more gestation
Proteinuria 2+ or greater
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
1
Instructions to the assessors: Remember that severe pre-eclampsia and eclampsia are managed similarly except that birth must take place within 12 hours following a convulsive
episode and within 24 hours in the absence of a convulsion.
Tool 3: Page 9 of 12
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 10 of 12
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
The provider describes the Provide antihypertensive treatment (if diastolic BP is 110 mm Hg or more if
correct management of no convulsion; 90 mm Hg if convulsion):
severe pre-eclampsia and Plan 1: Hydralazine 5 mg IV slowly every 5 minutes or 12.5 mg IM every
eclampsia (continued) 2 hours, until diastolic BP stabilizes between 90 and 100 mm Hg OR
Plan 2: Nifedipine 5 mg sublingual, repeating the dose if the diastolic BP
is still >110 after 10 minutes
15. The provider correctly Ask the provider What is the correct follow up for woman with severe pre-
describes followup. eclampsia or eclampsia?
Monitor hourly:
BP
Pulse
Temperature
Patellar reflex
FHR
Intake and urine output
Signs and symptoms of pulmonary edema
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 11 of 12
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 3: Page 12 of 12
Nepal SBA Inservice Training Site Quality Improvement Tools for Site Strengthening
TOOL 4: NORMAL DELIVERY AND IMMEDIATE NEWBORN CARE
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 1 of 23
Tool 4: Page 2 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
3. The area designated for first Observe if the area contains:
stage of labor and delivery Sterile gloves
room has appropriate Examination gloves
supplies for provision of
Suture materials
care.
Two clean baby wraps per newborn for warming and drying newborn
Sterile gauze for wiping face and mouth of newborn
Cotton swabs and antiseptic solution (povidine iodine) or boiled water for
cleaning perineum
Disposable syringes and needles
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 3 of 23
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 4 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
5. Appropriate medications are Observe in the labor room that there is:
available for provision of Oxytocin (stored in refrigerator)
routine care in the labor Ergometrine
room.
Lidocaine 1%
IV fluids and sets
Vitamin A
Antibiotic eye ointment for newborn
6. There is a designated Observe if there is a designated trolley with:
emergency trolley that is IV set
easily accessible. IV cannulae (16, 18 gauge)
IV fluid/normal saline
Oxytocin
Syringe 5ml, 10ml, 20 ml
Ergometrine
Magnesium sulphate
Calcium gluconate
Lignocaine 1%
Nefidipine
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 5 of 23
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 6 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
9. Appropriate equipment is Observe if the postnatal ward is equipped with:
available in the postnatal Sphygmomanometer
ward for providing Stethoscope
postpartum care.
Clinical thermometers
IV stand
Working oxygen tank or central supply source in or near the area
Examination gloves
10. There are working toilets for Observe if there is a toilet for women that has:
provider and for women in A door that locks
the first stage labor, delivery An area is clean and well-maintained
and postpartum areas.
A working washbasin
Soap
Container with plastic liner for waste
Working toilet with flush
Shower with hot water
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 7 of 23
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 8 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
The provider properly Asks the woman about her labor: First Second
Woman Woman
reviews and fills out the Y N NA Y N NA
clinical history of the woman When the painful regular contractions began
in labor (continued)
How frequently they are occurring
If her membranes rupture: when, what color and what smell it had
Whether she feels the babys movements
Records the information on clinical history chart.
13. The provider properly First Second
Determine whether the provider (in the labor and delivery rooms): Woman Woman
prepares for the physical Y N NA Y N NA
examination. Ensures privacy with a screen or curtain to separate the woman from others
at least during examination.
Explains to the woman and her companion what the provider is going to do
and encourages them to ask questions.
Asks the woman to empty the bladder and clean the perineum.
Helps the woman to climb up on to the bed or examining table.
Washes hands with running water and soap for 1015 seconds and dries
with an individual clean towel or allows hands to airdry.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 9 of 23
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 10 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
15. The provider properly First Second
Observe if the provider: Woman Woman
conducts a vaginal Y N NA Y N NA
examination. Explains to the woman what s/he is going to do.
Washes hands with running water and soap for 1015 seconds and dries
with an individual clean towel or allows hands to airdry.
Puts sterile gloves on both hands.
Cleanses the perineum with non-alcoholic antiseptic solution or boiled, warm
water.
Carefully inserts two fingers of the exam hand.
Assesses cervical dilatation, molding, station of presenting part and position.
Carefully withdraws her fingers once the examination has concluded.
Explains findings to the woman.
Gloves are removed after being immersed in 0.5% chlorine solution and
placed in a leak-proof container.
Washes hands with running water and soap for 1015 seconds and dries
with an individual clean towel or allows hands to airdry.
Records all information on the clinical records and partograph.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 11 of 23
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 12 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
The provider uses the Records every 30 minutes: First Second
Woman Woman
partograph to monitor labor Y N NA Y N NA
and make adjustments to FHR
the birth plan when the
Uterine contractions (frequency and intensity over a 10-minute period)
woman goes into active
stage of labor (4cm) Maternal pulse
(continued) Amount of IV solution with oxytocin in drops per minute, medications
and other intravenous liquids, if used
Records temperature every four hours.
Records BP every 4 hours.
At every vaginal examination (every 4 hours or less according to progress of
labor):
Records the condition of the membranes and characteristics of the
amniotic fluid.
Graphs the degree of molding of the head.
Graphs cervical dilation.
Graphs the descent of the head or buttocks.
Records the amount of urine every time the woman urinates.
Records the time of the observations.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 13 of 23
Tool 4: Page 14 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
19. The provider prepares to Observe two women in labor and determine whether the provider (in the labor or First Second
Woman Woman
assist the birth. delivery rooms): Y N NA Y N NA
Has delivery pack and other essential materials available and ready to assist
the delivery:
Sterile tray
Two hemostats (clamps)
One scissors for cutting the cord
One cord clamp or sterile tie
Four clean or sterile towels: one to receive baby; one to dry the baby;
one for under the woman; one for active management
Sterile gauze to clean babys mouth and nose
One syringe with 10 IU of oxytocin
Two pairs of sterile gloves
Ambu bag and mask ready for use.
Has one plastic container with 0.5% chlorine solution for decontamination.
Has one plastic container with lid and a plastic liner to dispose the placenta.
Has one plastic container with a plastic liner for medical waste (gauze, etc.).
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 15 of 23
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 16 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
20. The provider properly assists Observe two women during a delivery and determine whether the provider (in the First Second
Woman Woman
delivery of the head. labor or delivery rooms): Y N NA Y N NA
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 17 of 23
After the emergence of the head, asks the woman to stop bearing down.
Cleans the babys mouth and nose using sterile gauze.
Palpates to determine if cord around neck.
Allows spontaneous external rotation without manipulation.
Carefully takes the babys head in both hands and applies downward
traction until the anterior shoulder has emerged (no neck holding).
Guides the babys head and chest upward until the posterior shoulder has
emerged.
Holds the baby by the trunk and places the baby on a clean dry towel on the
mothers abdomen.
Dries baby vigorously and changes wet towel for a clean dry one.
Cuts/clamps the umbilical cord using sterile scissors under gauze to prevent
blood spurting.
If the baby is breathing normally, passes the baby to mother for skin-to-skin
contact on breast.
If the baby does not begin breathing or is breathing with difficulty, initiates
resuscitation.
Notes time of birth.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 18 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
22. The provider properly Observe two women during a delivery and determine whether the provider (in the First Second
Woman Woman
performs active labor or delivery rooms): Y N NA Y N NA
management of the third Palpates the mothers abdomen to rule-out the presence of a second baby.
stage of labor.
Tells the woman that she will receive an injection and administers 10 IU of
oxytocin IM.
Places the other hand on the womans symphysis pubis (over the sterile
towel).
Maintains firm traction on the cord and waits for the uterus to contract.
Upon contraction, applies firm and sustained downward traction on the cord
with counter traction above the pubis to guard the uterus, until the placenta
is expelled.
If this maneuver does not provide immediate results, stops applying traction,
holding the cord and clamp until the next contraction.
Repeats controlled cord traction during contraction while simultaneously
applying counter traction above pubis to guard uterus.
With both hands, assists in the expulsion of the placenta by turning it over in
the hands without applying traction twisting the membranes.
Massages the uterus with one hand on a sterile cloth over the abdomen until
it contracts firmly.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 19 of 23
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 20 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
24. The provider properly Observe whether the provider (in the labor or delivery rooms):
disposes of the used Before removing gloves:
instruments and medical Discards the placenta in a leak-proof container with a plastic liner.
waste after assisting the
birth. Disposes of medical waste (gauze, etc.) in a plastic container with a
plastic liner.
Puts the soiled linen in a leak-proof container.
Places all reusable instruments in a 0.5% chlorine solution for 10
minutes.
Disposes needle and syringe in a puncture-resistance container, without
removing, recapping or breaking the needle.
Gloves are removed after being immersed in 0.5% chlorine solution and
placed in a leak-proof container.
Washes hands with running water and soap for 1015 seconds and dries with
an individual clean towel or allows hands to airdry.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 21 of 23
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 22 of 23
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
The provider closely Monitors the woman and newborn every hour for the next three hours. First Second
Woman Woman
monitors the woman and Y N NA Y N NA
newborn for at least six Assists the woman with breastfeeding.
hours after the birth
Asks the woman if she has urinated and encourages her to do so whenever
(continued) she wishes.
Records the information on the womans clinical record and reports any
abnormalities.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 4: Page 23 of 23
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 5: Page 1 of 7
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 5: Page 2 of 7
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
4. The provider takes history of Observe if the provider asks the woman:
recent pregnancy and When woman delivered the baby
childbirth (first visit). Delivery place of the baby and who attended the birth
Whether woman had any vaginal bleeding during this pregnancy
Whether woman had any complications during this childbirth
Any complications with the baby
5. The provider takes history of Observe if the provider asks the woman:
present postpartum period About any heavy bleeding since women gave birth
(every visit). Color of vaginal discharge and frequency to change pad/cloth
Any problems with bowel or bladder function
Feels good about baby and ability to take care of the baby
How the family is adjusting to the baby
Feels that breastfeeding is going well
If she has had any complications following previous childbirth
6. The provider takes Observe if the provider asks the woman:
contraceptive history (first Number of children she plans to have
visit). If she has used any family planning method before
If she plans to use family planning in the future
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 5: Page 3 of 7
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 5: Page 4 of 7
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
9. The provider performs Observe if the provider:
physical examination/ Asks the women to empty her bladder.
assessment of general well- Observes gait and movements, behavior and facial expressions.
being (every visit).
Observes general hygienenoting visible dirt and odor.
Checks skinnoting lesions and bruises.
Checks conjunctiva for pallor.
10. The provider performs Observe that the provider observes the women while seated and relaxed and
measurement of vital signs measures blood pressure, temperature and pulse.
(every visit).
11. The provider performs breast Observe if the provider:
examination (every visit). Explains the next steps in the physical examination to the women and obtains
her consent to proceed.
Washes hand thoroughly.
Asks the women to uncover her body from the waist up and examines her
breastsnoting any abnormalities.
12. The provider performs Observe if the provider:
abdominal examination Asks the women to uncover her stomach and lie on her back with her knees
(every visit). slightly bent.
Looks for old or new incisions on the abdomen and gently palpates abdomen
between umbilicus and symphysis pubisnoting size and firmness of uterus.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 5: Page 5 of 7
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 5: Page 6 of 7
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
15. The provider provides Observe if the provider:
specialized care according to Provides HIV counseling (if the woman does not know her HIV status or has
the mothers needs. not been tested for HIV).
Provides information about breast-feeding and breast care, based on the
women's breastfeeding history.
Reviews the women complications readiness plan with her (or develop one if
she does not have one).
Introduces the concepts of birth spacing and family planning.
Provides advice and counseling about diet and nutrition.
Provides advice and counseling about self-care.
Gives TT based on woman's need.
Dispenses sufficient supply of iron/folate until next visit and counsels the
women about taking the pills.
Dispenses other medications (such as vitamin A) if not given immediately
after birth.
Schedules the next visit (second visit within 47 days; third visit within 42
days) or as needed in case of complications.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 5: Page 7 of 7
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 6: Page 1 of 6
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 6: Page 2 of 6
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
6. The provider takes interim Observe whether the provider asks about the following:
history (return visit). Any problem at present and any problem since the last visit
Care received from another caregiver since the last visit
Any changes in the babys condition or routine since the last visit
Any reactions or side effects from immunizations drugs/medications
7. The provider performs a Observe if the provider:
newborn examination (first Washes hands thoroughly for 1015 seconds with soap and water and dries
and every visit). them with a clean, dry cloth or allow them to airdry.
Places the baby on a clean warm surface or examine her/him in the mothers
arms.
Weighs the baby.
Measures respiratory rate and temperature.
Observes color, movements and posture, level of alertness and muscle tone,
and skinnoting any abnormalities.
Examines head, face and mouth, eyesnoting any abnormalities.
Examines chest, abdomen and cord, and external genitalianoting any
abnormalities.
Examines back and limbsnoting any abnormalities.
Washes hands.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 6: Page 3 of 6
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 6: Page 4 of 6
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
The provider correctly Gently points the needle upward, without repiercing skin and injects the
provides BCG vaccination to vaccine with steady pressure for three to five seconds and look for blanching
the baby (continued) of skin.
Places any blood-contaminated items (cotton-wool balls) in a plastic bag or
leak-proof, covered waste container.
Disposes of needle and syringe in puncture-proof container.
Washes hands thoroughly with soap and water and dries with a clean, dry
cloth (or airdry).
9. The provider provides Observe if the provider:
education on breastfeeding. Includes family in discussion of breastfeeding, if possible.
Explains why it is important to breastfeed the baby.
10. The provider assesses Observe if the provider:
breastfeeding. Helps the mother into a comfortable position.
Assists the mother to position the baby:
Looks at how the baby is attached and sucking. Explains to mother how
she can tell if the baby is sucking well.
If the baby is not attached or sucking well, takes the baby off the breast
and tries again.
Lets baby suck as long as s/he wants or until s/he releases the breast.
After breastfeeding burps the baby.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 6: Page 5 of 6
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 6: Page 6 of 6
Nepal SBA Inservice Training Site Quality Improvement Tools for Site Strengthening
TOOL 7: COMPLICATIONS DURING LABOR AND CHILDBIRTH
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 1 of 18
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 2 of 18
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
4. The provider properly Observe the provider, if s/he:
manages delivery of the Allows arms to dis-engage spontaneously.
arms. If the arms are stretched above the head or folded around the neck, uses
Lovsets maneuver:
Holds the baby by the hips and turn half a circle, keeping the back
uppermost.
Applies downward traction at the same time so that the posterior arm
becomes anterior and deliver the arm under the pubic arch by placing
two fingers on the upper part of the arm.
Draws the arm down over the face as the elbow is flexed, with the hand
sweeping over the face.
To deliver the second arm, turns the baby back half a circle while
keeping the back uppermost and applying downward traction to deliver
the second arm in the same way under the pubic arch.
If the babys body cannot be turned to deliver the arm that is anterior first,
delivers the arm that is posterior.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 3 of 18
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 4 of 18
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
Shoulder dystocia: Guided interview
7. The provider states the Ask the provider What is the correct management of shoulder dystocia?
correct management of Provide continual emotional support and reassurance to the woman.
shoulder dystocia. Call for help.
Make an adequate episiotomy.
Ask the woman to flex both thighs, bringing her knees as far up as possible
towards her chest.
Ask an assistant to apply suprapubic pressure downwards to assist delivery.
Wearing HLD gloves, apply firm downwards pressure on the fetal head to
move shoulder that is anterior under symphisis pubis.
If the shoulder is still not delivered, insert a hand into vagina and apply
pressure to shoulder that is anterior to rotate shoulder and decrease shoulder
diameter.
If necessary, apply pressure to shoulder that is posterior in the direction of
sternum.
If the shoulder is not delivered, insert a hand into vagina and grasp the
humerus and sweep the arm across the chest.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 5 of 18
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 6 of 18
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
9. The provider states the Ask the provider What are the next steps to resuscitate the baby if the baby is not
correct technique for breathing after suctioning?
ventilating the baby. If baby still not breathing, place the mask over the babys mouth and nose
and ventilate two times.
If the chest does not rise:
Check head position.
Check that the mask position and seal are correct.
Check for fluid in the mouth. If there is fluid, suction.
Ventilate the baby 2030 times in 30 seconds. When the baby begins to
breathe, stop ventilation.
After every 30 seconds of ventilation, re-assess the babys breathing:
If the baby breathes spontaneously, stop resuscitation. Continue to give
supportive care.
If the baby is not breathing or is gasping and heart rate is <100 (evaluate
for 6 seconds), continue to ventilate 2030 times in 30 seconds and then
re-evaluate.
If the baby still is not breathing after 20 minutes of resuscitation, stop
resuscitating and provide emotional support to family.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 7 of 18
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 8 of 18
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
The provider states the Record the resuscitation effort:
correct post-procedure tasks The newborns condition at birth
(continued) Time resuscitation started
Steps used (stimulation, ventilation)
Time baby breathed normally OR resuscitation stopped
Results of the resuscitation (successful, needed referral, baby died)
Bimanual compression of the uterus: Guided interview
12. The provider states the Ask the provider What are the steps of bimanual compression?
correct procedure for Provide continual emotional support and reassurance.
bimanual compression of If not wearing gloves already, put on HLD or sterile surgical gloves.
uterus.
Insert fist into anterior vaginal fornix and apply pressure against the anterior
wall of the uterus.
Place other hand on abdomen behind uterus, press the hand deeply into the
abdomen and apply pressure against the posterior wall of the uterus.
Maintain compression until bleeding is controlled and the uterus contracts.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 9 of 18
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 10 of 18
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
The provider states correct With the other hand, palpate the femoral pulse to check the adequacy of
procedure for compression of compression.
the abdominal aorta Maintain compression until bleeding is controlled.
(continued) Monitor vaginal bleeding, take the woman's vital signs and make sure that the
uterus is firmly contracted.
Vacuum extraction: Direct observation
16. The provider prepares for Observe if the provider:
vacuum extraction. Prepares the necessary equipment.
Tells the woman what is going to be done, listens to her and responds
attentively to her questions and concerns.
Provides continual emotional support and reassurance.
Ensures that the conditions for vacuum extraction are present.
Makes sure an assistant is available.
Puts on personal protective barriers.
Washes hands thoroughly and puts on HLD or sterile surgical gloves.
Cleans the vulva with antiseptic solution or boiled water.
Catheterizes the bladder, if necessary.
Checks all connections on the vacuum extractor and test the vacuum.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 11 of 18
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 12 of 18
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
18. The provider performs post- Observe if the provider:
extraction tasks. Before removing gloves, disposes of waste materials in a leak-proof container
or plastic bag.
Places all instruments in 0.5% chlorine solution for decontamination.
Removes gloves and discard them in a leak-proof container or plastic bag if
disposing of or decontaminates them in 0.5% chlorine solution if reusing.
Washes hands thoroughly.
Repair of cervical tears: Guided interview
19. The provider states the Ask the provider What steps are required to prepare for repair of cervical tears?
correct preparation for Prepare the necessary equipment.
cervical tear repair. Tell the woman what is going to be done, listen to her and respond attentively
to her questions and concerns.
Provide continual emotional support and reassurance.
Have the woman empty her bladder or insert a catheter.
Put on personal protective barriers.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 13 of 18
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 14 of 18
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
Repair of first and second degree tears: Direct observations
22. The provider prepares for Observe if the provider:
repair of first or second Prepares the necessary equipment.
degree tears. Tells the woman what is going to be done, listens to her and responds
attentively to her questions and concerns.
Provides continual emotional support and reassurance.
Asks about allergies to anesthetics.
Wears personal protective barriers.
23. The provider correctly repairs Observe if the provider:
first and second degree Washes hands thoroughly and put on HLD or sterile surgical gloves.
tears. Applies antiseptic solution to the areas around the tear.
Administers local anesthesia 0.5% lignocaine.
Places the first suture about 1 cm above the top of the vaginal tear.
Using a continuous suture, works down to the level of the vaginal opening
and brings together the torn edges of the vaginal opening.
Repairs the perineal muscle using interrupted sutures. Repairs the skin using
interrupted (or subcuticular) sutures starting at the vaginal opening.
Washes the perineum and puts a clean pad on the womans perineum.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 15 of 18
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 16 of 18
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
26. The provider correctly Ask the provider What are the steps for performing manual of the placenta?
describes the procedure for Wash hands and forearms thoroughly and puts on HLD or sterile surgical
manual removal of the gloves (ensure elbow-length protection).
placenta. Hold the umbilical cord with a clamp and pull the cord gently.
Place the fingers of one hand into the uterine cavity and locate the low edge
placenta.
Provide support to the fundus.
Move the hand back and forth in a smooth lateral motion until the whole
placenta is separated from the uterine wall.
Withdraws the hand from the uterus, bringing the placenta with it while
continuing to provide counter-traction abdominally.
Give oxytocin in IV fluid.
Have an assistant massage the fundus to encourage uterine contraction.
If there is continued heavy bleeding, give ergometrine by IM injection or
prostaglandins.
Examine the uterine surface of the placenta to ensure that it is complete.
Examine the woman carefully and repair any tears to the cervix or vagina or
repair episiotomy.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 17 of 18
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 7: Page 18 of 18
Nepal SBA Inservice Training Site Quality Improvement Tools for Site Strengthening
TOOL 8: ASSESSMENT OF THE NEWBORN WITH A PROBLEM
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 8: Page 1 of 4
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 8: Page 2 of 4
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
4. The provider performs a Observe if the provider:
thorough physical Washes hands thoroughly for 1015 seconds with soap and water and dries
examination of the baby. them with a clean, dry cloth or allow them to airdry.
Places baby on a clean, warm surface under a good light, with the mother or
family present.
Weighs the baby and records the weight.
Explains the findings to the mother during the exam and points out any
abnormalities.
Determines respiratory rate by counting the number of breaths taken in a full
minute.
Takes axillary temperature.
Checks color for pallor, jaundice and cyanosis.
Uses a stethoscope to determine the babys heart rate.
Observes posture and movements.
Checks muscle tone and level of alertness.
Examines the limbs.
Examines the skin.
Examines the umbilicus.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 8: Page 3 of 4
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 8: Page 4 of 4
Nepal SBA Inservice Training Site Quality Improvement Tools for Site Strengthening
TOOL 9: FAMILY PLANNING
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 1 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 2 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
5. The facility has all necessary Observe to verify if the clinic has a minimum of:
instruments and equipment One complete IUCD insertion/removal kit:
to provide family planning Speculum
services.
Tenaculum/volselum
Uterine sound
Sponge-holding forceps
Long scissors for cutting IUCD strings
Instrument container
Speculum for pelvic examination
A heat source and a pot for boiling instruments or autoclave
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 3 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 4 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
7. There are sufficient Observe if there is:
1
contraceptive supplies in the Two weeks stock of the following contraceptive methods:
facility. Combined oral contraceptives (low-dose)/Lo-femanol
Progestin-only injectable contraceptives (Depo Provera)
Emergency contraceptives (EC)
IUCDs (Copper T 380 A)
Condoms (Dhal)
Simple stock maintenance register system
The register which shows that all methods were available in the last one
month
8. There are posters on family Observe in the area where clients are waiting if:
planning methods in the There are posters with general information on FP method
clinic. There is a poster on informed choice (Tiehart):
Posted information is visible.
Posted information is in Nepali, simple and with pictures.
Posted information is up to date with guidelines.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
1
Calculation of two weeks stock: (sum of total items dispensed over 1 month/2)
Tool 9: Page 5 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 6 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
11. The FP client is greeted Observe if the provider:
cordially and respectfully, Greets client.
then asked about her FP Offers client a seat.
needs.
Asks clients name, calls her by name and introduces self.
Obtains or confirms personal information (name, address, etc).
Confirms purpose of the visit.
Assures client of confidentiality:
Says that the information disclosed during the visit will not be shared
with anyone.
Assures necessary privacy during the visit:
Keeps the door or partition closed.
Minimizes people coming in and out of the room during the visit.
Asks the client her reproductive goals and needs for contraception.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 7 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 8 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
14. Pregnancy is ruled out. Observe that the provider:
Explains to the client that it is important to check that she is not pregnant.
Checks that client is within seven days of onset menstrual period.
Rules out pregnancy if beyond day seven:
Abstinence since last menses OR
Using effective contraceptive method OR
Is within six weeks postpartum OR
Is within seven days post abortion OR
Less than six months postpartum, is exclusively breastfeeding and has
not had any menses
If client is more than six months postpartum and has not had any menses, it is
unlikely she is pregnant if she is:
Breastfeeding exclusively
Has no clinical signs or symptoms of pregnancy
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 9 of 25
Tool 9: Page 10 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
17. The woman is given Observe that the provider:
information on COC and its Provides the method of choice.
use. Gives the woman instructions about COC:
How to use the method of contraception
Side effects and what to do if the side effects occur
Problems or complications for which the woman should return to the
health facility
Educates the woman about prevention of STIs and HIV/AIDS:
If she is at risk:
If necessary provides her with condoms, instructs on how to use
them and where to obtain them.
Encourages the woman to repeat the instructions to be sure she understands.
Confirms medical eligibility.
Provides the woman with three cycles of COC.
Schedules a followup visit in three months to make sure that the woman is not
having any problems with the pill.
Records the relevant information in the womans record card.
Thanks the woman and politely says goodbye.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 11 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 12 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
DMPA (choosen as method of choice)
19. DPMA-specific information Observe that the provider:
given to the woman. Asks the woman what she already knows about DMPA and corrects any
misinformation.
Briefly, giving only the most important information, tells the woman about the
DMPA that she has chosen:
How it works
Effectiveness
Advantages and non-contraceptive benefits
Disadvantages
Contraindications
Common side effects and warning signs
Protection against STIs, HIV/AIDS
20. The woman is given Observe that the provider:
information on use of DMPA. Instructs the woman about injection schedule and menstrual bleeding
changes, and have the woman repeat the instructions to be sure she
understands.
Confirms eligibility for DMPA.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 13 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 14 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
22. The woman receives Observe if the provider:
followup counselling. Greets the woman with respect and kindness.
Asks the woman the purpose of her visit.
Reviews her record/chart.
Checks whether the woman is satisfied with her family planning method and
is still using it.
Reassures the woman about side effects she is having and treats them if
necessary.
Asks the woman if she has any questions. Listens to her attentively and
responds to her questions or concerns.
Performs any necessary physical assessment.
If necessary, provides the woman with her contraceptive method (e.g. the pill,
Depo-Provera, condoms, etc.).
Schedules return visit as necessary.
Records relevant information in the womans chart.
Thanks the woman, politely says goodbye and encourages her to return as
needed.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 15 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 16 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
24. A pre-insertion physical Observe if the provider:
examination is conducted. Prepares equipment and supplies (including a light source).
Asks the woman to wash and rinse her genital area with soap and water.
Ensures that she has emptied her bladder.
Helps the woman onto the examination table, positions her comfortably.
Makes sure that she is draped/covered throughout the examination.
Explains each step of the examination to the woman. Encourages her to ask
questions and responds to her questions and concerns.
Palpates the abdomen and checks for lower abdominal (especially
suprapubic) tenderness, masses or other abnormalities.
Washes hands thoroughly and puts on gloves.
Without contaminating them, arranges instruments and supplies on a HLD or
sterile tray.
Gently performs examination of external genitalia, urethral opening, Skenes
and Bartholins glands.
Gently performs speculum examination of vagina and cervix.
Gently removes speculum and sets it in a HLD or sterile kidney basin or
places in 0.5% chlorine solution for 10 minutes for decontamination if another
HLD or sterile speculum is available.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 17 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 18 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
25. The provider inserts the Observe if the provider:
IUCD properly. Tells the woman what is going to be done and encourages her to ask
questions.
Loads Copper T 380A in sterile package.
Puts new examination or HLD surgical gloves on both hands.
Gently inserts vaginal speculum to see the cervix and applies antiseptic
solution two times to the cervix and vagina.
Gently grasps cervix with tenaculum.
Sounds uterus using no-touch technique.
Inserts Copper T 380A IUCD using withdrawal technique.
Partially withdraws the inserter tube and cut IUCD strings to 34 cm length.
Removes inserter tube.
Gently removes the tenaculum and places it in 0.5% chlorine solution for 10
minutes for decontamination.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 19 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 20 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
26. The woman receives post Observe if the provider:
IUCD insertion counseling. Observes the woman for at least 15 to 20 minutes before sending her home.
Reviews side effects and warning signs; reminds the woman to return to the
clinic if these occur.
Reviews how to check for strings.
Instructs the woman to return for followup. Gives her appointment date and
time.
Asks the woman to repeat the instructions to ensure that she understands.
Answers any questions the woman has.
Encourages the woman to return if she has any questions or concerns, for
followup, and if she wants to have the IUCD removed. Politely says goodbye.
Completes IUCD card and records all relevant details on womans
record/chart.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 21 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 22 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
28. The provider removes the Observe if the provider:
IUCD. Performs bimanual examination.
Gently inserts vaginal speculum to see cervix and IUCD strings, applies
antiseptic solution two times to the cervix, grasps strings close to the cervix
with hemostat or other narrow forceps and pulls on strings slowly but firmly to
remove IUCD.
Shows IUCD to woman.
Immerses IUCD in 0.5% chlorine solution for 10 minutes for decontamination.
Then disposes of it in a leak-proof container or plastic bag.
Gently removes speculum and places in 0.5% chlorine solution for 10 minutes
for decontamination.
Before removing gloves, places all instruments in 0.5% chlorine solution for
10 minutes for decontamination.
Disposes of waste materials in a leak-proof container or plastic bag.
Immerses both gloved hands in 0.5% chlorine solution. Removes gloves by
turning inside out.
If disposing of gloves, places in leak-proof container or plastic bag.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 23 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 24 of 25
PERFORMANCE STANDARDS DEFINITION (VERIFICATION CRITERIA) Y/N NA
The woman receives Reassures the woman about side effects she is having and treats them if
followup counseling necessary.
(continued) Asks the woman if she has any questions. Listens to her attentively and
responds to her questions or concerns.
Performs any necessary physical assessment.
If necessary, provides the woman with her contraceptive method (e.g. the pill,
Depo-Provera, condoms, etc.).
Schedules return visit as necessary.
Records relevant information in the womans chart.
Thanks the woman, politely says goodbye and encourages her to return as
needed.
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Tool 9: Page 25 of 25
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________
Comments: __________________________________________________________________________________________________
__________________________________________________________________________________________________