Supportive supervision checklist on IMCI - basics

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5. Infection control at IMCI corner5.1 Do they use disposable syringes during IM/IV injection? Yes........ No........5.2 Safety precaution to give injection (using gloves, cleaning surface with alcohol and Yes........ No........discarding syringes after use)?5.3 Source of water for hand wash? Yes........ No........5.4 Soap and/or disinfectant (like chlorhexidine or alcohol) for washing hand? Yes........ No........5.5 Safe disposal box with cover? Yes........ No........If any problems related to the IMCI corner are found, what actions are needed to be taken? Develop and ensuresupport plan also.Action/s to be taken by supervisee:Action/s to be taken by supervisor:6. Job aid and supplies ( make a tick mark when correct) and write N/A where not feasibleLogistics Available Adequate enough in Functioning Remarkstock for one monthIMCI case recording formMother’s cardReferral slipChart bookletARI timer(functioning)ThermometerWeight machineNebuliser MachineSpacerMicroscope for malaria testRDT strips and reagent for malariaAmbubagBP Cuff for Tourniquet testIMCI reporting format (HMIS)Suction MachineNG tubeCup, Spoons for ORTDisposable SyringesInsulin SyringesAbsorbent clean cloth/ soft but strongtissue for ear wickingMedicineORS packetCapsule Vitamin A ( 50000 i.u.)Capsule Vitamin A ( 200000 i.u.)Tab. AmoxicillinSyrp. AmoxicillinTab.Paed Cotrimoxazole (120mg)Tab. Cotrimoxazole (480mg)Syrp. CotrimoxazoleTab. Ciprofloxacin (100mg)Tab. Ciprofloxacin (250mg)Tab. Nalidixic Acid (500 mg)Tab. Doxicycline (100mg)Tab. ErythromicynSyrp. ErythromicynInj. Cholarmphenicol4Not ApplicableNot Applicable
Available Adequate enough in Functioning Remarkstock for one monthTab. Coartem (140mg)Tab. Chloroquine ( 150 mg)Syrp. ChloroquineTab. PrimaquineTab. Quinine (300mg)Inj. Quinine ( 150mg/2ml)Inj. Quinine( 300mg/2ml)Capsule. Clindamycin (300 mg)Tablet Artesunate (50mg)Injection Artesunate (60 mg)Supositorry Artesunate 50mgSupositorry Artesunate 100mgInj. ArthemeterInj Diazepam 10 mg/2mlTab.ZincTab. Iron – folic acidSyrp. IronTab/Cap. MultivitaminTab. AlbendazoleSyrp. Pyrantel PalmoateCholramphenicol eye ointmentTetracycline eye ointmentTab. Paracetamol 500mgTab. Paracetamol 100mgSyrp. ParacetamolSyrp. SalbutamolInhaler SalbutamolCiprofloxacin ear dropGention Violet (0.25%)IV fluid: Ringer lactate SolutionIV fluid: 9% Normal SalineIf you found any gaps regarding drugs and logistics, discuss and make an activity and support plan to addressthe problemsAction/s to be taken by supervisee:Action/s to be taken by supervisor:Not ApplicableSupervision:Did anybody visit this centre for IMCI <strong>supervision</strong> in Yes.......... NO.........last three months (quarter)?Ask them to give you the last <strong>supervision</strong> report? Date ........./........./.........Supervisor’s designation...............................................Progress of the last decision/s which was/were taken during last visit?Signature of Supervisee:___________________Date:.............../................/.............Signature of Supervisor:___________________Date:.............../................/.............Please leave a copy of signed report to respective facility before leaving and send one copy to district within 7 days of visit5
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Supportive supervision checklist on IMCI - basics

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