Volume 2 Issue 7, July 2015

Editorial
Parulekar SV

Postnatal Ward

Gynecology OPD

Antenatal OPD

Infertility OPD

Receiving Room (RR)

Taking Over Patients On Emergency Day

Labor Ward

Antenatal Ward

Gynecology Ward

Indoor Paper

Operation Theater

Post Operative Care Of Gynecological Patients

Post Cesarean Section

Cardiopulmonary Resuscitation

Seropositive Patients

Unmarried Gravida

Collection Of Urine For Microbiologic Study

Collection Of Endocervical Swab For Microbiologic Study

Collection Of Wound Swab For Microbiologic Study

Blood /Blood Product Transfusion

Acquiring Blood from other Banks Affiliated to Federation of Mumbai Blood Banks

Discharge

Abscond Procedure

Female Sterilization / Tubal Ligation (TL)

Vaginal Birth After Cesarean Section (VBAC)

Vacuum Delivery

Obstetric Forceps Application

Postpartum Haemorrhage (PPH)

RGJY

Interdepartmental References

Transfer Of Patient From Other Hospital To KEM Hospital

Transfer Of Patient From Other Department To Gynecology Department

All Departmental Meetings

Perinatal Mortality (PNM) Audit Meeting

Maternal Death Audit Meeting

Quiz July 2015

Announcement

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 Period of gestation Spontaneous/induced Medical/surgical 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.