score card

1. √√
Department of Health
National Rabies Prevention and Control Program
CERTIFICATION OF ANIMAL BITE TREATMENT CENTER (ABTC) & ANIMAL BITE CENTER (ABC)
DOH/CHD CERTIFICATION / SELF ASSESSMENT FORM

2. CERTIFICATION STANDARDS
Major Requirements: YES NO
1. ABTC Staff attended training from DOH recognized institution
2. Trained Physician on Management of Animal Bites
3. Cold Chain Equipment (Refrigerator & vaccine carrier)
Survey Item Criterion
PART I PART II
Evidence of Progress and
Achievements
ABTC Rating Surveyor’s Comments Survey Team
Rating
Goal I: The Animal Bite Treatment Center/Animal Bite Center provides a safe and effective physical environment to its patients and staff
Standard I The ABTC/ ABC is easily located and patients have convenient and safe access to the center
1.1 There is appropriate
signage bearing the name of
the ABTC/ABC to assist
patients accessing the center
Needs repainting for the signage 1
1.2 Physical access is
appropriate for the needs of
the patients
2
1.3 Entrance/exit are clearly
marked and free of
obstruction
2
1.4 There are resources to
inform patients of the daily
schedule of the facility
2
TOTAL RATING 7
√
√
√
Rating Scale:
0 – Non Compliant
1 – Incomplete
2 – Complete
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3. COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(To be completed by the survey team only. The team must make comments on items where there are disagreements on information provided by the Animal Bite Treatment Center/Animal
Bite Center staff.)
Goal: The Animal Bite Treatment Center / Animal Bite Center provides a safe and effective physical environment to its patients and staff.
Standard 1: The Animal Bite Treatment Center / Animal Bite Center is easily located and patients have convenience and safe access to the center.
DOH/CHD Certification/Self Assessment Form
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4. Certification Standards
Survey Item Criterion
PART I PART II
Evidence by Progress and
Achievements
ABTC Rating Surveyor’s Comments Survey Team
Rating
Goal I: The Animal Bite Treatment Center / Animal Bite Center provides a safe and effective physical environment to its patient and staff.
Standard 2 The Animal Bite Treatment Center /Animal Bite Center provides facilities for the comfort and privacy of its patients and staff.
This standard will be achieved when:
2.1 The ABTC/ ABC maintains
a clean environment within
and immediately outside its
premises.
2
2.2 There are resources and
processes to ensure the
quality of patients’ waiting
time.
2
2.3 The area is well lighted
appropriate for the
assigned purpose
2
2.4 Privacy of the patient is
ensured
2
TOTAL RATING 8
Rating Scale:
0 – Non Compliant
1 – Incomplete
2 – Complete
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5. DOH/CHD Certification/Self Assessment Form
COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(To be completed by the survey team only. The team must make comments on items where there are disagreements on information provided by the Animal Bite Treatment Center/Animal Bite
Center staff.)
Goal: The Animal Bite Treatment/Animal Bite Center provides a safe and effective physical environment to its patients and staff.
Standard 2: The Animal Bite Treatment Center / Animal Bite Center provides facilities for the comfort and privacy of its patients and staff.
Standard 1: The Animal Bite and Treatment Center is easily located and patients have convenient and safe access to the center.
Goal: The Animal Bite Treatment Center provides a safe and effective physical environment to its staff and patient.
Standard 1: The Animal Bite and Treatment Center is easily located and patients have convenient and safe access to the center.
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6. Certification Standards
Survey Item Criterion
PART I PART II
Evidence by Progress and
Achievements
ABTC Rating Surveyor’s Comments Survey Team
Rating
Goal I: The Animal Bite Treatment Center / Animal Bite Center provides a safe and effective physical environment to its patients and staff.
Standard 3 The Animal Bite Treatment Center / Animal Bite Center provides safety of its patients and staff.
This standard will be achieved when:
3.1 The ABTC/ABC has
adequate clean water and
soap for wound care,
personal hygiene and
sanitation purposes.
2
3.2 The ABTC/ABC maintains
appropriate levels of
cleanliness and
antisepsis of physical
area, equipment and
instruments.
2
3.3 General wastes, sharps,
pathological and
infectious waste,
pharmaceutical and
chemical wastes are
appropriately segregated,
safely handled and
disposed of according to
accepted safe disposal
practices.
2
TOTAL RATING 6
Rating Scale:
0 – Non Compliant
1 – Incomplete
2 – Complete
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7. COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(To be completed by the survey team only. The team must make comments on items where there are disagreements on information provided by the Animal Bite Treatment
Center/Animal Bite Center staff.)
Goal: The Animal Bite Treatment Center / Animal Bite Center provides a safe and effective physical environment to its patients and staff.
Standard 3: The Animal Bite Treatment Center/Animal Bite Center is easily located and patients have convenient and safe access to the center.
DOH/CHD Certification/Self Assessment Form
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8. Certification Standards
Survey Item Criterion
PART I PART II
Evidence by Progress and
Achievements
ABTC
Rating
Surveyor’s Comments Survey Team
Rating
Goal II: Patients receive adequate and effective diagnostic and therapeutic services at every category of their management and treatment.
Standard 4 All patients have continuous access to accurate and reliable animal bite exposure management and treatment.
This standard will be achieved when:
4.1 A physician completes and
documents the relevant
history for each patient.
2
4.2 The ABTC/ABC
implements policies and
procedures for assuring
the quality of animal bite
management and
treatment.
N/A
4.3 If ARV/RIG is not available
in ABTC/ABC, policies and
procedures for referring
patients to another ABTC
are implemented and
monitored for
effectiveness.
N/A
4.4 ARV/RIG are securely
stored under appropriate
conditions with proper cold
chain management.
N/A
TOTAL RATING
4.5 There are documented,
disseminated, and
Echo-seminar and lectures are given to EAMC Personnel
especially those who giving direct patient care to be
2
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9. implemented procedures
to identify and address the
risks of contamination of
patients and staff.
informed of the basic management and prevention on
possible contamination. Personnel are entitled of a free Pre-
Exposure Prophylaxis/Post-Exposure Prophylaxis.
TOTAL RATING 2
Rating Scale:
0 – Non Compliant
1 – Incomplete
2 – Complete
COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(To be completed by the survey team only. The team must make comments on items where there are disagreements on information provided by the Animal Bite Treatment Center/Animal
Bite Center staff.)
Goal: Patients receive adequate and effective diagnostic and therapeutic services at every category of their management and treatment.
Standard 4: All patients have continuous access to accurate and reliable animal bite exposure management and treatment.
DOH/CHD Certification/Self Assessment Form
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10. DOH/CHD Certification/Self Assessment Form
Certification Standards
Survey Item Criterion
PART I PART II
Evidence by Progress and
Achievements
ABTC Rating Surveyor’s Comments Survey Team
Rating
Goal II: Patients receive adequate and effective diagnostic and therapeutic services at every category of their management and treatment.
Standard 5 A comprehensive management approach is developed and followed for all patients.
This standard will be achieved when:
5.1 All treatment is consistent
with the National Rabies
Prevention and Control
Program existing policies
and guidelines.
2
5.2 Flow charts of patient
management and
treatment from entry to
separation are present to
facilitate quality care and
are accessible to patients
and staff.
2
5.3 Comprehensive evaluation
of the patient’s progress is
made and documented at
each visit.
2
5.4 Health Education is
provided to all patients and
encourage adherence to
management and
treatment regimen
2
TOTAL RATING
Rating Scale:
0 – Non Compliant
1 – Incomplete
2 – Complete
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11. 5.5 Policies and procedures
for detecting PEP
defaulters and getting
them back for treatment
are implemented and
monitored for
effectiveness.
N/A
TOTAL RATING 8
COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(To be completed by the survey team only. The team must make comments on items where there are disagreements on informations provided by the Animal Bite Treatment Center/Animal
Bite Center staff.)
Goal: Patients receive adequate and effective diagnostic and therapeutic services at every category of their management and treatment.
Standard 5: A comprehensive management approach is developed and followed for all patients.
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12. DOH/CHD Certification/Self Assessment Form
Certification Standards
Survey Item Criterion
PART I PART II
Evidence by Progress and
Achievements
ABTC Rating Surveyor’s Comments Survey
Team Rating
Goal III: The health staff adheres to clear policies and guidelines on efficient ABTC / ABC operation.
Standard 6 The ABTC / ABC maintains accurate and updated records and reports of all animal bite victims.
This standard will be achieved when:
6.1 Each patient is uniquely
identified from entry and
throughout the course of
management and
treatment.
2
6.2 The ABTC / ABC maintain
a database of patient
records and enables easy
access by staff.
2
6.3 The ABTC / ABC keep
track of all registered
animal bite victims.
2
6.4 Maintains quarterly reports
of both animal and human
bite victims.
2
6.5 Maintains an updated
inventory of ARV/RIG and
other logistics.
n/a
TOTAL RATING 8
Rating Scale:
0 – Non Compliant
1 – Incomplete
2 – Complete
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13. The DOH/CHD Certification Self Assessment and Survey Tool
COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(To be completed by the survey team only). The team must make comments on items where there are disagreements on informations provided by the Animal Bite Treatment Center/Animal
Bite Center staff.)
Goal: The health staff adheres to clear policies and guidelines on efficient ABTC/ABC operation.
Standard 6: The ABTC/ABC maintains accurate and updated records and reports of all animal bite victims.
DOH/CHD Certification/Self Assessment Form
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14. Certification Standards
Survey Item Criterion
PART I PART II
Evidence by Progress and
Achievements
ABTC Rating Surveyor’s Comments Survey Team
Rating
Goal IV: The ABTC/ABC provides quality services with competent manpower to its patient.
Standard 7 The ABTC/ABC has complete manpower complement performing assigned tasks.
This standard will be achieved when:
7.1 The ABTC/ABC has qualified
personnel trained on Animal Bite
Management
0
7.2 There are personnel responsible
for the following:
0
7.2.1 Diagnosis and Management
7.2.2 Provision of ARV/RIG
7.2.3 Logistics Management
7.2.4 Information Management
7.2.5 Financial Management
TOTAL ]RATING
Rating Scale:
0 – Non Compliant
1 – Incomplete
2 – Complete
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15. COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(To be completed by the survey team only. The team must make comments on items where there are disagreements on informations provided by the Animal Bite Treatment Center/Animal
Bite Center staff.)
Goal: The ABTC/ABC provides quality services with competent manpower to its patient.
Standard 7: The ABTC/ABC has complete manpower complement performing assigned tasks.
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16. OVERALL RATING AND SUMMARY PER GOAL
STANDARD MAXIMUM RATING
TOTAL
ABTC RATING ASSESORS
1 8 7
2 8 8
3 6 2
4 10 8
5 10 8
6 10 0
TOTAL 52 32
_________________ ________________
RATER RATER
COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY THE SURVEY TEAM
(To be completed by the survey team only. The team must make comments on items where there are disagreements on information provided by the Animal Bite Treatment Center/Animal Bite
Center staff.)
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