Quality Assurance

1. Nurse role:

Please review the records and capture if Nurse / MPW has attended any of the following cases/activities in past months:

Activity	Yes/No	Remarks
Antenatal care
Postnatal care
Immunization
Contraceptive distribution
Counselling services
CBAC / NCD monitoring
Vector borne diseases prevention activities
Community Epidemic management support
EHR data / prescription audit
Record maintenance & reporting
Others

2. Patient Follow up and Referral Management:

• Is active follow up being done with patients for scheduled visit? Yes ( ) No ( )

3. Teleconsultation (feedback from doctors who tele consult (facility or agile)

Rate the following on a scale of 5 (where 5= excellent, 4= good, 3= optimal, 2= less than optimal, 1= poor, 0 is very poor)

• Video Clarity ( )
• Audio clarity ( )
• Overall Call Quality ( )
• Barcode scanner precision ( )
• Printing of prescription ( )
• Uploading Documents ( )

Observe a tele-consult and record the following (record observations)

Parameter	Yes	No	Remarks
Nurse
Did the Nurse probe and record the chief complaint properly?
Did the Nurse probe about allergies and record properly?
Did the Nurse record the Blood pressure? (how many readings)
Did the Nurse record the Temperature/ SPO2?
Did the Nurse ensure privacy during the tele-consult? (drawing curtain etc.)
Did the Nurse explain dosage of medication and follow up date properly?
CONSULTING DOCTOR/ SPECIALIST
Did he/ she clearly seek complaint?
Did he/ she explain diagnosis clearly?
Did he/ she explain follow up advice?
Did He/ she explain possible side effects?
Did the prescription have any out EDL drugs?
Did the patient receive drugs after the consultation?

4. Clinical Protocols:

Observe and record if basic precautions are being taken for the following:

PARAMETER	YES	NO	REMARKS/ REASONS
Hand hygiene
Protective glove use
Injections and blood sampling
Disinfection of reusable equipment
Waste segregation

5. Nurse / MPW feedback and satisfaction:

	Dissatisfied	Neutral	Satisfied
Role clarity and training to deliver services
Opportunity to use skills and knowledge
Opportunity to increase your knowledge or skills through tele consults?
Coordination and relation with coworkers with MPW / Pharmacist / MO
Support from supervisors
Technical support available
Total working hours