Instrumento de supervisión 6

Listas de control de actividades de asistencia Programa APS

Región
Instit./Servicio Centro de Salud Nº 7
Personal Partera

1. Lista de comprobación para evaluar una toma de datos (anamnesis) en

visita prenatal1

Nombre de la paciente Escala de calificación

Nombre de la partera 0 = Pregunta omitida
Nombre del supervisor 1 = La técnica básica necesita revisión;
Programa pregunta mal expresada
Lugar 2 = Comprende la técnica básica, pero
Fecha necesita más práctica
3 = Velocidad, estilo y forma satisfactorios
4 = Velocidad, estilo y forma excelentes

Para la calificación, rodear con

un círculo la cifra que convenga
Antecedentes obstétricos: 0 1 2 3 4
Menarquia 0 1 2 3 4
Ciclo menstrual ..... días 0 1 2 3 4
(varía de .... a .... días) 0 1 2 3 4
Embarazos 0 1 2 3 4
Abortos 0 1 2 3 4
Número de hijos vivos 0 1 2 3 4
Número de hijos nacidos muertos 0 1 2 3 4
Embarazos anteriores 0 1 2 3 4
(rellénese un formulario por separado para cada uno) 0 1 2 3 4
Embarazo actual 0 1 2 3 4
Anticoncepción 0 1 2 3 4
Tipo 0 1 2 3 4
Fecha de interrupción de la anticoncepción 0 1 2 3 4
Ultimo periodo menstrual 0 1 2 3 4
Ultimo periodo menstrual previo 0 1 2 3 4

1
Véase KATZ, F.M. & SNOW, A. Evaluación del rendimiento de los trabajadores de la salud. Manual de
formación y supervisión. Ginebra, Organización Mundial de la Salud, 1981 (Cuadernos de Salud Pública, N°
72), p. 55.
2. Lista de control para la supervisión de un parto en el hogar 1

Nombre de la PT __________________ Observada por _________________

Residencia de la PT ________________ Fecha de Observación ___________

Actualización Comentario
Más2 Menos2 N.O.2
Reconocimiento del comienzo del parto
1. Pregunta sobre la presencia y duración de:
- Dolores de espalda o calambres abdominales
- Expulsión de un líquido rosa o hemorragia
- Contracciones uterinas
- Ruptura de la <bolsa de aguas>
2. Examina el abdomen para determinar
- La posición del feto
- La duración de las contracciones
- La intensidad de las contracciones
Preparación para el parto
1. Selecciona el lugar del parto
- Tranquilo, limpio y ventilado
- No congestionado, con sitio suficiente para disponer el
material
2. Prepara el equipo para el parto
- Se cepilla las manos
- Saca el contenido del estuche de parto
- Hierve las tijeras
- Dispone de material para encontrarlo fácilmente
- Cubre el material con una tela limpia hasta que ha de
usarlo durante el parto
- Obtiene un recipiente para los restos
- Cubre los órganos de la mujer con un lienzo limpio

1
Véase: Parteras tradicionales. Ginebra. Organización Mundial de la Salud, 1979 (OMS, Publicación en Offset
N° 44), pp. 70-73.
2
«Más» puede significar sí o satisfactorio. «Menos» puede significar no o insatisfactorio. «N.O.» significa no
observado.
Instrumento de supervisión 7

Escala de aptitudes para actividades de Programa APS

comunicación y de promoción Región
Instit./Servicio Centro de Salud Nº 16
Personal Ayudante médico (o
enfermero diplomado)

1. Comunicación/aptitud para llevar a cabo una entrevista 1

Durante la entrevista de un ayudante médico con un paciente, el supervisor le observará y

podrá calificarle de acuerdo con los siguientes criterios y discutir con él su actuación.

Critica de la entrevista I Escala de aptitudes

Instrucciones: La evaluación de cada ayudante médico se hará respecto a todas las variables,
poniendo una marca (\I) en la casilla correspondiente a su rendimiento, entre los signos «S»
(satisfactorio) e «1» (insuficiente). Si el ayudante médico no puede ser evaluado respecto a
alguna variable, la marca se pondrá en la columna de la derecha.

No se
Criterios satisfactorio (S) Criterios insuficientes (I) puede
evaluar
1. Observaciones iniciales
Saluda al paciente por su nombre, dándole la Presentación brusca. Dedica tiempo
mano; se presenta; explica la finalidad de la insuficiente a los gestos sociales.
entrevista y anuncia la duración; obtiene el Presentación y explicación confusas de
consentimiento del paciente. Dedica tiempo la finalidad de la entrevista. Insensible a
suficiente a establecer contacto. Cuida de la las necesidades del paciente respecto a
comodidad y confidencialidad de la comodidad, intimidad o inquietud. Asume
entrevista. un papel más autoritario que colaborador
Observaciones: Observación:

S I

No se
Criterios satisfactorio (S) Criterios insuficientes (I) puede
evaluar
2. Comunicación no verbal
Se interesa por lo que dice el paciente No mira al paciente, le vuelve la espalda
mirándole a los ojos, inclinándose hacia o se pone de pie prematuramente
delante, animándole con la mirada y cortando la entrevista. Sus modales y
asintiendo con la cabeza (si corresponde) gestos reflejan una falta de interés y
preocupación por el paciente.
Observaciones: Observación:

S I

1
Véase KATZ, F.M. & SNOW, A. Evaluación del rendimiento de los trabajadores de la salud. Manual de
formación y supervisión. Ginebra, Organización Mundial de la Salud, 1981 (Cuadernos de Salud Pública, N°
72), pp. 120-121.
 No se
Criterios satisfactorio (S) Criterios insuficientes (I) puede
evaluar
3. Aptitudes para hacer una entrevista
Hace preguntas sencillas, breves y francas. Hace constantemente preguntas
Formula preguntas categóricas sólo cuando cerradas y termina prematuramente la
necesita información específica. discusión. Formula preguntas confusas o
complicadas.
Observaciones: Observación:

S I

No se
Criterios satisfactorio (S) Criterios insuficientes (I) puede
evaluar
4. Entrevista - Resumen
Resume periódicamente el contenido de la No esclarece las respuestas confusas
entrevista. Formula pregunta para esclarecer del paciente. No resume la situación o lo
el sentido y obtener una comprensión hace sólo al final de la entrevista.
completa de la historia clínica.
Observaciones: Observación:

S I
 I. CLINICAL SERVICES

Name of Facility: ______________________________________ Date __________________

Name of Data Collector _________________________________

To complete this checklist:

- Review the last 10 postabortion 10gbook cases. -Interview at least one key provider.
- Observe at least one patient receiving MV A services.
- Make a separate copy of the checklist for each provider interviewed or each patient observed.
- Ask each patient for permission to observe her session before doing So using the statement
below. If she agrees, have her sign the consent form provided with Form 1. If she does not agree,
thank the patient í3nd continue only after receiving Consent from another patient.

Statement Requesting Consent:

Hello, my name is _______________, and I am working with a team to monitor the quality of services.
We would like to improve the services provided by this facility by observing the treatment you will
receive. I will not write down your name on the data collection form. Everything I observe will be kept
strictly confidential and only shared with other team members. No one will be able to identify you from
the information we collect. Your participation is voluntary, and you do not have to allow me to observe
if you do not want to. If you do not wish to participate, this will not affect the care or services you
receive. Do I have your permission to continue?

Checklist I Rrank Comments on Plan for

1 = Poor or Problems or strengths Improvement
Rarely/Never Encountered
2 = Adequate or
Sometimes What did you find? What are the
3 = Very Good or causes of the problems or
Routinely/ strengths?
Always
1 2 3
1. How well did providers (doctors and nurses)
follow MVA treatment protocols? [OBSERVA
TION]
2. How thorough were the post-operative
instructions given to patients?
[OBSERVATION]
3. How often are providers supervised to
monitor the safety of the services they
provide? [INTERVIEW]
4. How often are major complications related
to abortion (presenting and/or procedural)
reviewed by a medical committee?
[INTERVIEW]
5. How often are abortion-related maternal
deaths reviewed by a medical committee?
[INTERVIEW]
6. How often are the providers involved in
cases with major complications or deaths
informed of the outcome of a committee's
review? flNTERVIEW]
7. What percentage of postabortion patients
with uterine sizes ≤ weeks are treated with the
MVA procedure? [logbook]
Column totals
Total Number of points ___________ (add column totals) Copy to Summary Page
Checklist Score _________________ (number of points  21) Copy to Summary Page
List any additional information sources used to answer the above questions:
_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Please record additional comments below:
 II. MANAGEMENT AND ORGANIZATION OF SERVICES

Name of Facility: ______________________________________ Date __________________

Name of Data Collector _________________________________

To complete this checklist:

- Interview at least one key provider
- Make a separate copy of the checklist for each provider interviewed

Checklist II Rrank Comments on Plan for

1 = Poor or Problems or strengths Improvement
Rarely/Never Encountered
2 = Adequate or
Sometimes What did you find? What are the
3 = Very Good or causes of the problems or
Routinely/ strengths?
Always
1 2 3
1. How often are MVA-trained providers
available during the hours the facility is open?
2. How sufficient the number of MVA-trained
staff for the number of postabortion patients
treated?
3. How often are MVA procedures performed
outside the operating theater (e.g., procedure
room, casualty area, outpatient area)?
Rank
1= more than 10 hours
2= 5 to 10 hours
3= less than 5 hours
1 2 3
4. How long do patients with imcomplete
abortion without serious complications
routinely wait before being treated?
5. Following treatment, how long are
incomplete abortion patients hospitalized
before being discharged from the facility?
Column totals
Total Number of points ___________ (add column totals) Copy to Summary Page
Checklist Score _________________ (number of points  21) Copy to Summary Page
List any additional information sources used to answer the above questions:
_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Please record additional comments below:
 III. TRAINING OF POSTABORTION CARE PROVIDERS

Name of Facility: ______________________________________ Date __________________

Name of Data Collector _________________________________

To complete this checklist:

- Interview at least one key provider
- Make a separate copy of the checklist for each provider interviewed

Checklist III Rrank Comments on Plan for

1 = Poor or Problems or strengths Improvement
Rarely/Never Encountered
2 = Adequate or
Sometimes What did you find? What are the
3 = Very Good or causes of the problems or
Routinely/ strengths?
Always
1 2 3
1. How often is MVA included in regular
training activities for staff. Physicians /
consultants
2. How often is MVA included in regular
training activities for physicians-in-training
(e.g., interns, residents/house officers)?
3. How often is MVA included in regular
training activities for nurses?
4. Before using MVA on their own, how often
are newly-trained providers observed /
evaluated to assess their clinical skills in the
procedure?
5. How often are staff trained in all major
aspects of postabortion care (e.g., MVA
procedure, pain management, infection
prevention, postabortion family planning, etc)?
Column totals
Total Number of points ___________ (add column totals) Copy to Summary Page
Checklist Score _________________ (number of points  21) Copy to Summary Page
List any additional information sources used to answer the above questions:
_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Please record additional comments below:
 IV. LEVEL OF SUPPORT FOR THE USE OF MVA

Name of Facility: ______________________________________ Date __________________

Name of Data Collector _________________________________

To complete this checklist:

- Interview at least one of each cadre of staff: physician, administrator, nurse.r
- Make a separate copy of the checklist for each individual interviewed

Checklist IV Rrank Comments on Plan for

1 = Poor or Problems or strengths Improvement
Rarely/Never Encountered
2 = Adequate or
Sometimes What did you find? What are the
3 = Very Good or causes of the problems or
Routinely/ strengths?
Always
1 2 3
1. What are the attitudes of physicians and
physicians-in-training toward the use of MVA?
2. What are the attitudes of facility officials /
administrators toward the use of MVA?
3. What are the attitudes of other staff toward
the use MVA (e.g., nurse, social workers,
counselsors, etc.)?
Column totals
Total Number of points ___________ (add column totals) Copy to Summary Page
Checklist Score _________________ (number of points  21) Copy to Summary Page
List any additional information sources used to answer the above questions:
_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________
Please record additional comments below:
 Preliminary Assessment of Postulation care Training and Services

Summary Table of Scores

Record the number of points and percentage obtained in each section

Checklist (maximum number of points possible for each # of

Percentage Commnets
checklist) points
I. Clinical Services (21 points)
II. Management and Organization of Services (15)
III. Postabortion Family Planning and Other Reproductive
Services (18)
IV. Training of Postabortion Care Providers (15)
V. Level of Suport for the Use of MVA (9)
VI. Supplies, Equipment and Treatment Areas (15)
VII. Infection Prevention and Pain Management (33)
VIII. Services Statistics (9)
IX. Patient Satisfaction (6)

Total Number of Points Scored - a

Total Possible Program Score - b 141

Calculate the total program score as a percentage by dividing the total number of points scored )a) by
the total number of possible points (b):

A = total number of points

b = total possible number of points (141)

a/b = ________ x 100 = ________ % Total Program Score

 MODULE I
CLINICAL SERVICES

A. MVA Teatment Protocols

To complete questions 1 -3:
 Find and review any written abortion treatment protocols. A department chief, chief resident, or
staff physician in charge of postabortion care/MV A services may know jf one exists and help
you locate a copy.

MARK ONE RESPONSE

1. Is there a written MVA treatment protocol currently available at this facility?

_________ yes

_________ no [GO TO QUESTION #4]

2. If yes, ask to see a copy.

_________ copy seen

_________ copy not seen [GO TO QUESTION #4]

3. After reviewing the protocol, mark the column labeled EXISTS if the step exists in the written
protocol, and most of the examples cited are part of the step. Leave this column blank if the
step does not exist in the protocol, or if the step exists but most of the examples cited are not
part of the step. Note any comments.

Treatment Protocol Exists To: Exists Comments

a. Assess patient´s status 3a.
- Medical history, presenting sings / symptoms, vital sings, date of
last menstrual period (LMP)
- Anxiety level
- Order necessary laboratory tests
b. Assure necessary materials, supplies, instruments are available in 3b.
procedure room before initiating intervention
c. Establish rapport with patient 3c.
- Discuss examination, MVA procedure
- Listen to patient´s concerns and answer questions
d. Use universal precautions (infection prevention) practices 3d.
- Hand washing
- Glove use for pelvic exam and procedure
e. Assess uterus 3e.
- Size, position, possible trauma
f. Identify cervical laceration or sings of trauma 3f.
- Symptoms of reproductive tract infections
- Other complication
g. Administer antibiotics, if needed 3g.
h. Assure cannulae are sterile/HLD and rinsed of caustic solutions 3h.
i. Prepare syringe and check vacuum tightness 3i.
j. Select cannula 3j.
- Based om uterine size and cervical dilation
k. Inspect cannula and syringe for sings of wear 3k.
l. Swab cervix and vagina with antiseptic solution 3l.
m. Evaluate need for anesthesia, analgesia, anxiolytic 3m.
- Based on patient´s physical condition and emotional state
 Treatment Protocol Exists To: Exists Comments
n. Administer paracervical block or the medications 3n.
o. Allow time for medications to take effect 3º.
p. Dilate the cervix id needed 3p.
- Without causing trauma
q. Insert cannula and attach syringe 3q.
- Without causing trauma
r. Use no-touch technique to acoid contamination of cannula 3r.
s. Move cannula effectively to empty the uterus 3s.
t. Solve technical problems if they arise 3t.
- Clogged cannula, syringe full
u. Stop evacuation when sings of completion are present 3u.
v. Examine aspirate 3v.
- Assure tissue was consistent with patient´s condition and history
- Send sample to pathology laboratory if needed
w. Decontaminate onstrument immediatel y after the procedure 3w.
x. Monitor patient for complications and treat any that occur 3x.
y. Discuss postoperative care with patient 3y.
- Explain the importance of a follow-up visit
- Describe waming sings
- Provide written information
- Answer any of the patient´s questions
z. Assure that family planning counseling and services are provided it 3z.
the patient desires
- Refer as necessary

To complete questions 4- 5:

- Observe at least one patient receiving MV A services. including steps such as any pre-
procedure counseling with the patient. preparing instruments and supplies, performing the
evacuation, and monitoring recovery.
- Make a separate copy of this section for each patient observed.
- Ask each patient for permission to observe her session before doing so using the statement
below. If she agrees. have her sign the consent form provided with Form 2. If she does not
agree, thank the patient and continue only after receiving consent from another patient.

Statement Requesting Consent:

Hello, my name is _____________, and I am working with a team to monitor the quality of services.
We would like to improve the services provided by this facility by observing the treatment you will
receive. I will not write down your name on the data collection form. Everything I observe will be kept
strictly confidential So that no one will be able to identify you from the information we collect. me to
observe if you do not want to. If you do not wish to participate, this will not affect the care or services
you receive. Do I have your f'ermission to continue?