Annex­1: Checklist for Assessment of IUCD Provider’s Performance, Follow­up and On­site Coaching (Skill Assessment) Name of the Health Facility: ……………………………………….……………………….
District: ………………
Type of Health Facility:………..
Name of Provider: …………………………………,
Designation: ………………..
Coached by:………………
Date of Coaching:……/……/…
Key to type of service
for which checklist
criteria apply
A = IUD Counseling
B= IUD Insertion
C = IUD Follow-up
D = IUD Removal
Scoring Key
Proficient -- Provider demonstrates ability to perform procedure, executing all
indicated tasks without guidance; does not require further training
P (3)
Competent -- Provider acceptably demonstrates ability to perform procedure, executing
most of the indicated tasks and all of the necessary (highlighted) tasks with little or no
C (2)
guidance; while sufficiently competent to provide services, the provider would benefit
from continued intermittent oversight to improve confidence and overall ability.
Need Improvement-- Provider does not acceptably demonstrate ability to perform
procedure and does not execute the necessary (highlighted) tasks; provider must
NI (1)
continue with training or supervised practice before beginning IUD service delivery
Y or N
Service
Checklist to assess provider’s skill level relative to performance expectations for IUD service delivery
Skills Expectations
Demonstrated Ability /
Cases Observed
I
II
III
IV V
PRE-INSERTION (NON-CLINICAL)
1.
a)
b)
c)
A
d)
e)
f)
g)
h)
i)
j)
k)
2.
A
Performs pre‐insertion counseling according protocol
Interacts with client in a respectful manner
Asks the client questions to help clarify her reproductive health needs
Explains what the IUD (and other methods if client has not already decided to use IUD) is, how it works, and how it might meet her reproductive health needs Explains possible IUD side effects and reassures client that they are not harmful and that they usually subside over time Explains potential complications involved with IUD use and reassures client that she is unlikely to experience any problems, especially if she has the IUD inserted by a skilled provider who knows how to minimize risks Explains eligibility criteria and procedures for assessing client eligibility
Explains insertion procedures Checks to make sure that client understands key messages conveyed
Answers any questions the client has
Assists client in making a decision about using the IUD (or another method if appropriate) Respects client's choice of family planning methods and does not try to convince her to use one method over another Performs non‐clinical aspects of pre‐insertion screening according to protocol
a) Determines that client is not pregnant (acts accordingly if she is) b) Takes client's medical history 1 Y or N
Service
Skills Expectations
Demonstrated Ability /
Cases Observed
I
II
III
IV V
PRE-INSERTION (CLINICAL)
3. Performs pre‐insertion counseling according protocol
a) Reviews client's reproductive health history to ensure that client meets initial criteria for IUD. If client does not, appropriate steps are taken. If client does meet criteria, provider proceeds with clinical screening. b) Instructs client to empty her bladder if necessary
c) Has HLD instrument pan, supplies, and light source available
d) Helps client onto exam table e) Washes hands with soap and water
f) Tells the client what is going to be done and answers any questions she may have g) Checks for signs of severe anemia h) Performs abdominal exam ‐‐ palpates abdomen and checks for suprapubic or pelvic tenderness and adnexal abnormalities i) Drapes client for vaginal exam j) Puts new exam (disposable) or HLD or sterile (reusable) gloves on both hands
k) Performs vaginal exam ‐‐ checking for ulcers, lesions, sores, or discharge
l) If no problems found, proceeds to bimanual exam. If problems found, performs speculum exam next. m) Performs bimanual exam checking for cervical, adnexal, or uterine abnormalities that would preclude insertion n) Uncovers instruments for speculum exam
o) Assembles HLD (or sterile) speculum
p) Inserts speculum q) Performs speculum exam, locates cervix checking for any signs of cervical or vaginal problems that might preclude insertion at this time r) Makes appropriate findings based decision on whether or not to proceed with insertion and explains decision to client s) If decision is to NOT insert the IUD at this time, then terminates exam and explains reasons to client and makes recommendations for other method and for any necessary treatment needed. t) If decision is to go ahead with insertion, then the provider obtains informed consent appropriate to the setting and proceeds with the procedures that follow Insertion
4. Performs pre‐insertion task according protocol
a) Loads the IUD inside the sterile package according to package instructions/protocols b) Swabs cervix and vagina with antiseptic
c) Gently grasps cervix with tenaculum or Vulsellum Forceps
d) Sounds the uterus to check positioning of uterus
e) Sets depth gauge on the loaded IUD inserter to the depth of the sound
f) Inserts the IUD using the withdrawal technique
g) Cuts strings and gently removes tenaculum
5. Performs post‐insertion tasks according to protocol
a) Processes instruments and consumables (places used instruments in chlorine solution for decontamination, disposes of waste materials properly, removes reusable gloves and places them in chlorine solution) A
B
2 Y or N
Service
Skills Expectations
b)
c)
d)
e)
f)
g)
Demonstrated Ability /
Cases Observed
I
II
III
IV V
Washes hands with soap and water
Schedules a follow‐up appointment with client for 3‐6 weeks after insertion
Gives client a referral card for follow‐up if does not provide follow‐up care
Records insertion according to record keeping protocols
Reviews key messages for women who have just had an IUD inserted (refer to table in protocols section 6.4) Assesses client to make sure that she feels well and observes her for 15 minutes before sending her home FOLLOW-UP
6.
a)
b)
c)
d)
e)
7.
C
C
a)
b)
c)
d)
e)
Conducts client assessment according to protocol
Assesses client’s satisfaction with IUD
Assesses for common side effects Screens for warning signs (PAINS) Addresses any questions or concerns the client may have
Reviews key IUD messages (see textbox 2.2.1) with client
Performs physical exam where indicated (for first routine checkups and where infection may be suspected for other return visits) Explains to client why and how she will do the pelvic exam
Prepares the client while ensuring dignity and privacy
Performs a speculum exam and checks to make sure the string is visible and that there is no partial or complete expulsion Explains findings and reassures the client
Appropriately manages any side effects or complications that the client is experiencing (according to procedures outlined in Table 3, section 7.3) REMOVAL
8.
a)
b)
c)
9.
a)
b)
c)
d)
e)
f)
10.
a)
b)
c)
Conducts pre‐removal counseling
Asks the client her reason for removal and answers any questions she may have Reviews the client's present reproductive goals
Describes the removal procedure and what to expect
Removes IUD according to protocol
Washes hands thoroughly with soap and water
Puts new exam (disposable) or HLD or sterile (reusable) gloves on both hands
Inserts HLD or sterile speculum and looks at length and position of strings
Swabs cervix and vagina with antiseptic
Grasps strings close to the cervix and pulls gently but firmly to remove the IUD Shows client the IUD and places it in chlorine solution for decontamination
Performs post‐removal tasks according to protocol Places used instruments in chlorine solution for decontamination
Disposes of waste materials according to guidelines
Removes reusable gloves and places them in chlorine solution or disposes of disposable gloves d) Washes hands thoroughly with soap and water
e) Records IUD removal according to PSI record keeping protocol
f) Assists client in selecting and obtaining new contraceptive method if desired
g) Keeps client at clinic for 15 minutes for observation to make sure she feels fine before leaving D
D
3 Y or N
Service
Demonstrated Ability /
Cases Observed
I
II
III
IV V
Skills Expectations
INFECTION PREVENTION
B
,
C
,
D
11. Practices proper infection prevention procedures before, during, and after the procedure according to protocol a)
Instruments and supplies are ready and available for use at time of procedure for which they are needed b) IUD package is not opened until after it is loaded and at time of procedure
c) Procedures for hand washing and use of exam gloves are followed
d) Proper client cleansing procedures are followed
e) “No touch” technique is used when inserting the IUD
f) Instruments, gloves, and other items are processed and stored according to protocol Score Calculation:
1. Insertion Score:
Score of (1-5) and 11
------------------------------- x 100%
Total Score (Total 159)
2. Follow up Score:
Score of (6-7) and 11
------------------------------ x 100%
Total Score (Total 48)
= -------------------
= ---------%
= -------------------
= ---------%
= -------------------
= ---------%
3. Removal Score:
Score of (8-10) and 11
------------------------------ x 100%
Total Score (Total 66)
Index Score:



Proficient
= >90%
Competent
= 69-89%
Need Improvement = <69%
4 Overall Impression to Skill Level of Service Provider:
Total Score Percent and Category = ……………………………………………
Impression……………………………………………………………………….
Recommendation:
1. ………………………………………………………….………………….
2. ……………………………………………………………………………..
3. ……………………………………………………………………………..
Total number of IUCD inserted by the provider till date: Coached by: Signature: 5 Guidelines for filling Assessment of IUCD Provider’s Performance, Follow up and On­site Coaching Form Objective:
The main objective of this checklist is to assess quality of service provider, update about
recent changes and to encourage the providers to apply these in their routine practices.
Responsibility: This checklist is mainly filled by the Coach or Quality Assurance Consultant assigned by
PSI office and handed over to the office on the same day of CSD visit.
Guidelines:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
The first introductory part of checklist, coach should be filled according to the sub-headings
provided at top.
Competency of service provider is divided into 3 category i.e. Proficient (P= score 3), Competent
(C= score 2) and Need Improvement (NI = 1). The broad category of the provider will be provided
in the Index score as percentage.
Coach should observe 5 clients receiving services at every section of service provider outlet.
In each cell of the cases observed, Coach should put score 1-3 and put summed score at the top of
each section.
For the each type of services e.g. Insertion, Removal or Follow up services, infection prevention
part should be included in each.
For overall competency score calculation, coach has to separate the purpose like Insertion, Follow
up or Removal services. In each service, see the score calculation given at the last page.
Competency of each case should calculate and put average score.
The average score will put on the total score and mention the category of service provider.
Coach should mention the impression of competency of service provider and recommend further
based on the score and competency observed in each client.
The form should be filled and sign on the same day of observation, and handed over to PSI staff.
Checklists collected from coach should send to MIS section of Head office.
Action plans are made and implemented for every provider by identifying their areas of
improvements to address their needs.
This checklist should fill for every provider at service site and follow up coaching for the same
provider after 3 months.
6 Annex 2: Knowledge Assessment Test Name of the Provider: Date‐ Instructions: Circle the letter that corresponds to the correct answer.
1. Who is the best-qualified person to choose a contraceptive method for a woman in
good health?
a. a trained physician
b. a woman’s mother in law
c. the woman herself
d. the person who counseled her
2. Women who are not in a mutually faithful relationship (i.e., she or her partner
have other sexual partners) may be at increased risk of
a. uterine perforation with IUD insertion
b. Sexually Transmitted Infections (STIs)
c. ovarian cancer
d. all of the above
3. The IUD not only protects a woman from undesired pregnancy, but also from
a. developing fibroids
b. HIV infection
c. anemia
d. all of the above
e. none of the above
4. When an IUD client presents with a late period, you should rule out
a. allergy to copper
b. pregnancy
c. cervical cancer
d. PID
5. Following the insertion of an IUD, you should recommend that the client, even if
she has no problems, have it checked after
a. three days
b. one week
c. six weeks to twelve weeks
7 d. three to six weeks
6. The most likely mechanism of action of the IUD is that
a. it interferes with implantation
b. it interferes with fertilization
c. it interferes with ovulation
d. it acts as a barrier to prevent sperm from entering uterus
7. The IUD is NOT an appropriate contraceptive method for a woman who
a. is taking rifampin
b. is not sure she wishes to have a tubectomy
c. has unexplained vaginal bleeding
d. gave birth six weeks ago
8. During counseling on the IUD, a client should be informed that common side
effects of the IUD may include
a. nausea
b. headaches
c. mild cramping and light spotting
d. heavy vaginal discharge
9. The IUD is
a. 90 - 95% effective
b. greater than 99% effective
c. 100% effective
d. none of the above
10. Correctly loading the TCu 380A IUD in the sterile package
a. should be done only if sterile gloves are available
b. assures that the IUD will remain sterile until it is removed from the package
c. is not necessary for physicians
d. all of above
11. One of the point is not among the five warning signs in IUCD clients
a. Period late or no period
b. Abdominal pain
c. Infection
d. Not feeling well
e. Ectopic pregnancy
8 12. In counseling a woman about the advantages of the TCu 380A IUD, you would
inform her that the IUD
a. is permanent
b. is less effective
c. has few side effects for most women
d. interferes with sexual intercourse
e. is effective in preventing anemia
13. Which of the following conditions are precautions which influence the suitability
of IUD for a particular woman?
a. pregnancy
b. three or more children
c. not at risk for STIs
d. history of candidiasis
e. retroverted uterus
14. Prior to IUD insertion, a pelvic exam is performed to
a. determine uterine position and size
b. rule out ante-flexion
c. rule out retro-version
d. rule out presence of ectopic pregnancy
15. Physical examination of a prospective IUCD client must include at least:
a. abdominal and bimanual exams
b. abdominal and pelvic (speculum and bimanual) exams
c. breast, abdominal and pelvic (speculum and bimanual) exams
d. general, breast, abdominal and pelvic (speculum and bimanual) exams
16. After an IUD insertion all metal instruments used should be
a. decontaminated with soap and water
b. decontaminated in 0.5% chlorine solution for 10 minutes
c. cleaned with formaldehyde and water
d. high level disinfected by autoclaving (unwrapped) for 20 minutes at 106 kPa pressure
at 1210 degrees
17. Key infection prevention activities for IUD insertion include
a. washing hands carefully
b. cleaning the cervix and vagina with an antiseptic solution
c. decontaminating, cleaning, and high-level disinfecting, or sterilizing all instruments
9 d. proper contaminated waste disposal
e. all of the above
18. Reasons for follow up visits after an IUD insertion can include
a. first check up one week after insertion
b. first check up three to six weeks after insertion
c. first check up 6 months after IUCD insertion
d. removal when the IUD has been in place for one year
19. The following is warning sign that you should explain to an IUD client, which
indicate that she may be having a problem with her IUD and should seek medical
attention:
a. cramping with menses
b. increased length of menstrual cycle
c. Mild vaginal discharge
d. string is longer than usual/Missing string
20. IUD clients should be counseled
a. before the insertion
b. after insertion
c. during each follow up visit
d. all of the above.
Total Score: Percentage: 10 Guidelines for filling Knowledge Assessment Test Objectives: The main objective of this test is to assess the knowledge of the service provider during
Quality Assurance visit
Responsibility: This test is mainly filled by the service provider herself and checked by the Quality
Assurance Consultant to assess the knowledge of provider.
Guidelines:
1. Every service provider is given the knowledge assessment test during the Quality Assurance visit to self assess her knowledge. 2. The service provider is given 20 sets of questions to answer and at the end of the test her marks is used to assess her knowledge about IUDs. 3. In case she has given any incorrect answers to the question the coach corrects her to ensure that the provider has correct informations on IUDs. 11 Annex 3: Quality Assurance Checklist Sector ID:
Date:
District ID:
Name of health facility:
Channel:
Health Facility Code:
Name of the service provider:
Name of the coach:
Health Facility assessment Yes/No Adequate space for service delivery? Is privacy maintained? Service delivery forms available? Registration/Counseling Counseling Aids available? Individual counseling done? Informed Choice of Family planning? Is consent taken before service delivery? Medical screening History of the client taken properly? Vitals recorded? Correct Bimanual/pelvic examination findings? Checklist for screening followed? Service delivery Loading of IUCD done by non‐touch technique? 12 High fundal placement of IUCD 5. Post counseling
Clients explained about the possible side effect of LTM? Clients explained about the follow up? Clients explained about designated point of contact in case of any AE and complication? Clients explained about the warning signs? 6. Infection prevention
Instruments opened in virex? All the instruments sterilized properly? Waste materials disposed properly? Summary Quality of service= Total no. of YES X 100 = 20 Index Score: More than 90% = Quality standard met (Good) Less than 90% = Quality not met (Bad) Impression: Recommendations: 1……………………………………………………………………………………. 2……………………………………………………………………………………. 3……………………………………………………………………………………. Visited by: Signature:
13 Guidelines for filling Quality Assurance Checklist Objective: The main objective of this checklist is to assure the quality of service provided at
service site, performance skills and knowledge of provider.
Responsibility: This Checklist is filled by the Quality Assurance Consultant assigned by the PSI office and handed over to the office on the same day of Quality Visit. Guidelines: 1. There are 6 sets of questions that are made according to the IUCD service deliver y protocol. 2. There are 20 questions regarding health facility, counseling, medical screening, service delivery, post counseling and infection prevention services available at the clinic support day. 3. If the index score is more than 90% it refers that the quality standards has been met at the clinic support days and if the score is less than 90% then the quality standard is low. 4. Recommendations are given by the Quality Assurance Consultant to improve the quality of service delivery. 5. When the final process is completed online reporting is done in the MIS system. 6. An action plan is made and implemented to address the issues of the Quality Assurance visits so that the quality standards are met. 14