Archived Volumes of Past Issues

Editorial

Parulekar SV

A checklist is an old concept in management. Checklists are used in all wakes of life. The preflight checklists in aviation industry, checklists for software engineering, operations procedures in industry, open source litigation, ornithologiy, and tracking of sports cards collections are but a few examples of the same. WHO used this concept to develop a checklist for operative procedures, and that is used extensively the world over. The idea behind the use of a checklist is to see that no step of an important procedure is missed, so that there will be no error in the performance of the procedure. Optimum performance of any procedure eliminates all errors which are due to oversight or negligence. Every good clinician uses a mental checklist for every procedure he performs, whether it is a diagnostic procedure or therapeutic one, whether it is a medical procedure or a surgical one. That is sure way of having zero error. We have been using checklists in this manner all our lives, even when we did not know they were called checklists in the past. Unfortunately every person may not do it, or the checklists of different persons may be different. So we wanted to have our checklists in the practice of Obstetrics and Gynecology in our department. One resident doctor suggested that the residents should take up this project under guidance of the faculty. We thought it was a wonderful idea, because a lot of work is done by the resident doctors in tertiary level teaching hospitals, and their involvement in this project would be a great educational experience for them. The resident doctors divided the topics amongst themselves, worked on them, presented their work in joint meetings of all residents and all faculty, corrections were made based on suggestions made and evidence presented by many people, and after a year and half of intensive efforts, we have the checklists ready. It is not possible to list the names of more than sixty resident doctors and thirty three staff members as contributors in this issue of the journal, and hence there are no names of contributors on the contents page. But the credit goes to all of them. Arrangement and formatting of such text coming from so many people was a taxing job. But now it is done and the pain forgotten. I hope this checklist will help all healthcare personnel, who can modify the lists to suit their workplaces, and use them usefully.

Postnatal Ward

Pulse, blood pressure, pallor, pedal edema.

Passage of urine

Passage of stools

Lactation

Breast examination, if any complaints exist

Abdominal examination

Episiotomy care: hygiene, application of antiseptic cream.

Ambulation

Dietary advice

Prescription

Tracing reports if investigations have been sent

Contraception

JSY eligibility

Payment of delivery charges paid for third or subsequent order child

Discharge paper

Photocopy of discharge paper

Immunization

Appointment for follow up visit

Gynecology OPD

Every Monday to Saturday from 8:30 am -12.30 pm, OPD registration paper issued from 7.30 am-10.30 am at counter no.16.

OT diary and histopathology reports file has been brought.

Cytologist is present, and if not, is called.

OPD paper is checked if of respective unit or any other unit.

Old / new registration paper

If old check for stamp of date

OPD REGISTERATION PAPER- FIRST VISIT

Take detailed history in the outside hall

Room No. 6: pass urine

Room No. 5: Pap Smear ( for new patients)-except for unmarried and pregnant patient.

For old patients, trace pap smear.

Room No - 1: to collect blood investigation reports, height and weight if required.

The following items are available in the examination room.

Sterile instruments

Sterile gloves

Cetrimide solution

Cotton

Servant

Draw sheet

Light

Examination

General examination

Systemic examination

Per abdomen

Local examination of the genitals

Per vaginal examination

Provisional Diagnosis is made.

Symptomatic treatment is given.

Investigations are advised.

Next follow up date and day are given.

Prescription is given of drugs not available in hospital.

Investigation forms are given in the outside hall.

If admission required,

The patient and relatives are counseled for admission to ward 15/15A / PPS.

The relative are asked to make admission paper from 17-18 number

The relatives are given directions about where to go.

SUBSEQUENT VISIT

Patient for operative procedure

All investigation are checked.

Pap smear and endometrial aspirate report are checked.

Fitness for anesthesia are checked.

References are made for co-morbidity.

Appointment for admission is given based on the last menstrual period either premenstrually or postmenstrually.

The patient’s name and phone number are entered in the OT diary.

PATIENT FOR MEDICAL LINE OF MANAGEMENT

Reports of advised investigations are checked.

Pap smear report is checked.

Response to treatment is checked. Treatment is changed if there is no response.

PATIENT TO BE REFERRED TO RECEIVING ROOM FOR ADMISSION IN EMERGENCY UNIT (FIRST VISIT ONLY)

Patient is examined by an Assistant Professor or higher officer

Indication for such a transfer is confirmed

Inevitable abortion: os open, products felt, passage of excessive blood and/or blood clots

Ruptured ectopic pregnancy

Obstetric hemorrhage

Placenta previa

Abruptio placentae

Vesicular mole with bleeding

Labor

Obstetric emergency

Eclampsia

Uterine rupture

Antenatal OPD

General

Every Monday to Saturday from 1.30 pm to 4.00 pm.
OPD Registration paper issued from 1.30 pm to3.00 pm.

OPD Registration paper

Respective unit

New/old registration paper

If old then date stamp


NEW REGISTRATION FIRST VISIT

OPD Registration paper

Room No. 1: weight, urine albumin

Room No. 12: pre test counseling

Room No. 4: Blood sample collection for: Blood Group with Rh typing, Hemoglobin, VDRL, HIV, if advised ICT

History in hall:
    • Age, married since, marital status.
    • Chief complaints menstrual history LMP/EDD
    • Medical surgical history
    • Family history, history of previous hospitalization
    • History of hospitalization in present in present pregnancy,history of blood transfusion,
    • Immunization history.
    • Obstetric History of previous pregnancy and abortion in chronological order.
    • Duration of pregnancy.
    • Labour-spontaneous/induced
    • Duration of labor
    • Mode of delivery and outcome-live/stillborn.
    • If operative –indication, type of anesthesia/place of previous operation.
    • Birthweight and sex
    • Present health of child
    • Ante/intra/postpartum complication.
    • Abortion details
      1. Period of gestation
      2. Spontaneous/induced
      3. Medical/surgical
      4. Place
    • Contraception usage.
    • Categorisation of high risk in present pregnancy.
High risk pregnancy stamp if required.

General Examination: Temperature, pulse, blood pressure, pallor, oedema, cyanosis, icterus, thyroid.

Systemic Examination: cardiovascular system, respiratory system, central nervous system, others.

Prescription

Symptomatic treatment given

Investigation advised

Investigation forms given

Advice given

Next follow up date given

Breast feeding counseling done

Contraceptive counseling done

Eligibility for Janani suraksha yojana


FIRST VISIT TO ANTENATAL OPD
ADDITIONAL THINGS TO CHECK

FIRST TRIMESTER

USG-dating scan

Folic acid supplements.

SECOND TRIMESTER

Immunisation status

Malformation scan

Blood sugars

Hematinics and calcium supplements.

THIRD TRIMESTER

Malformation scan

Blood sugars

Immunization status

Pelvic adequacy: 36 weeks or later, in eligible patients


Provided pregnancy continues without complication patient to be seen

Every month till 28 weeks
Every fortnightly till 36 weeks
Then weekly until delivery.

SUBSEQUENT ANC VISIT

Check date and stamp

Room 1

Weight

Urine albumin

Tracing previous reports

Injection tetanus toxoid

Room 12 –tracing HIV reports and post test counseling

Waiting Hall

History

High/low risk: high risk pregnancy label if missed

Weeks of gestation by dates/scan

Vital parameters

Tracing reports

Any fresh complaints, encircling abnormal findings

Examination: Room No. 7, 8, 9, 10, or inner room No. 4

Investigation forms, advice given

Confirmation of whether patient is taking medication correctly

Appointment for follow up visit




Infertility OPD

The availability of the following things in the examination room is confirmed.

Sterile instruments

Sterile gloves

Savlon

Cotton

Draw sheet

Servant

Light

Case paper is issued with date stamp in registration office from 8:00 A.M. to 10:30 A.M.

Parent unit she belongs to and the advice given by the unit is checked.

Entry is made by staff nurse.

Files are screened on priority basis .

FOR IUI

The husband is sent to GORC to give semen sample.

One resident accompanies the husband for sperm washing.

IUI is done within an hour of receipt of sample under supervision of seniors.

One resident waits in OPD with the patient.

Patient is advised follow up.