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Thursday, December 20, 2007

Criteria for Accreditation of CEmONC Centres

Criteria for Accreditation of 24 Hour Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) Centres - ie Maternal and Child Health Centres

Casualty services

  • A pregnant woman in labour or distress on entering the hospital at any time during the day or night is directly taken to the obstetric casualty and immediately examined by a professional with midwifery skills and decision taken within fifteen minutes.
  • If there are signs or bleeding, convulsions or shock, she should be immediately attended by the Obstetrician on duty and necessary treatment to be initiated.
  • Send the mother to the labour room, ward or operation theatre, depending on the signs and symptoms.
  • No pregnant woman in labour or distress should be turned away from the hospital for any reason at any time of the day or night.
  • Casualty should be located close to the labour room and theatre.
  • Casualty to receive advance intimation about the arrival of the mother and keep the specialist team ready with blood, if needed.
  • Casualty should have the following round the clock:
  • An obstetrician
  • Life saving drugs and IV fluids
  • Facility for examining the patient (including pv)
  • Emergency protocols
  • Telephone connection in the casualty, labour room and blood bank
  • Patient transport system within the institution

Emergency Obstetric Procedures
Vaccum extraction
Forceps delivery
Emergency Hysterectomy
Manual removal of placenta
Dilation and Curettage
Blood transfusion

Separate theatre for above obstetric procedures.
The Government shall provide at least 4 obstetricians, 4 paediatricians, 2 general surgeons and 2 anaesthetists to each CEmONC centre.

Emergency Newborn Care
Every delivery to be attended by a staff nurse trained in newborn resuscitation.
Paediatricians to be available in the institution round the clock for emergency interventions
Emergency Protocol should be available

Laboratory Services
24 hours laboratory services including
Blood grouping, typing and cross matching
All routine examinations such as haemoglobin, blood glucose, urine sugar, albumin.

Post Natal Care
All normally delivered mothers should be observed in the labour room for at least two hours after delivery. Before transferring the mothers to the postnatal ward, pulse, BP, firmness of the uterus and amount of vaginal bleeding should be checked.

In the postnatal ward vital signs and height of the uterus should be monitored once in two hours for the first six hours and once in six hours till 24 hours. Twice a day monitoring until discharge should follow this.

Those mothers who had instrumental vaginal delivery should be observed in the labour ward for six hours after delivery before transferring the mother to the postnatal ward pulse, BP, firmness of the uterus, urine output and amount of vaginal bleeding should be checked. Postnatal care in the ward is similar to the care provided for normal vaginal delivery.

Post Operative Care
For the first two hours after surgery, staff nurse remains at the bedside to monitor patient continuously.
Hourly checkups of vital signs (temperature, pulse, BP, and urine output), for the next six hours.
Forth hourly check up of vital signs by staff nurse for next two days and thereafter twice daily till discharge.
Check up by doctor at least once during the first two hours and every sixth hourly for three days and then twice daily till discharge.

Records and Registers
Parturition Register
Case Records
Reporting Formats
Referral register

Ambulance Services
For referral
Ambulance with driver and fuel available 24 hours.
Linkages with other ambulance providers.
Casualty to have telephone attender who will organise the transportation.

Adherence to standard emergency treatment protocol
Standard emergency treatment protocol should in the casualty, in labour ward and in theatre.
The obstetrician and staff nurse posted in the labour ward and theatre should be thorough with emergency protocol.

Quality of provider- Patient interaction
Patient treated with respect and dignity.
Privacy and confidentiality assured.
Informal payment from patients strictly banned.
Informed consent obtained from the family for major procedure.
Procedures clearly explained to family members.
A female attendant to be permitted in labour room while ensuring asepsis.



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