Guidelines for medical officer for IUCD insertion

Guidelines for medical officer for IUCD insertion

As you all know that intrauterine contraceptive device ( IUCD ) is one of the most effective reversible contraceptive method.

Some important contraindication for its use are :-

1. Pregnancy

2. Pelvic inflammatory disease ( PID )

3. Abnormal vaginal bleeding.

4. Cancer of cervix or uterus.

5. H/O ectopic pregnancy.

6. Congenitally malformed uterus.

7. Pelvic tumours.

8. Valvular heart disease.

Cu T should be inserted with care if patient had cesarean section in last three months.

Counselling

Every client should be counselled to help decide to plan his / her family and to choose a method based on informed choice. Whenever possible spouse/partner should be counselled.

Once a client has chosen Cu T as a method for family planning, provide her relevant information and clarify her doubts.

                    1  The likely problems during Cu T insertion and for few months after insertion.

2. Effectively period.

3. Need to check whether Cu T is in place .

4. Need to come for follow up after periods , after 3 months ,every year and report if there is problem like some pain abdomen ,if she misses her period or if she has continuous vaginal bleeding or if she cannot feel the thread.

Timing of Cu T insertion :-

• -Within some days of last menstrual period ( LMP ) .
• -4-6 weeks postpartum ( after ruling out pregnancy ).
• -Immediately after MTP / abortion.
• -During lactational amenorhoea (after ruling out pregnancy)

Pelvic examination:-

• Ask the client to empty the bladder and lie on examination table on her back with flexed knees.

• Autoclave equipments should be ready before hand .

• Wash and scrub hands and wear sterile gloves.

• Inspect external genitalia and look for any wart, boil,growth or discharge.

• Clean the introitus and do the pelvic examination to see the size and direction of uterus and to rule out any pelvic infection or tumour.

• Insert Sim's speculum.

• Retract anterior vaginal wall with anterior vaginal wall retractor and inspect cervix for any infection,growth,polyp or discharge.

• Clean the cervix.

• Hold the anterior lip of cervix with volsellum and give gentle traction downwards.

• Insert uterine sound gently ( if uterus is ante verted the curve of the sound should be facing abdomen ). Introduce sound gently into uterus till a slight resistance of fundus of uterus is felt. Determine the length of uterus by placing finger against the sound at the level of external os. . It is normally between 6 – 9 cm.

• Load the Cu T.

• Align the flange and the folded arms of Cu T in a horizontal position.

• Adjust the flange at the measured length of uterus.

• Grasp the volsellum and introduce loaded Cu T with plunger into the uterus till a slight resistance is felt.

• Hold the volsellum and plunger with one hand and withdraw the tube downwards.

• Again gently push the insertion tube until a slight resistance is felt.

• Remove the plunger.

• Withdraw insertion tube gently.

• Cu T the strings 2 – 3 cm. from exernal os.

• Remove the volsellum and speculum.

• Wash the gloved hands . Remove the gloves and put them for sterilisation.

The above guidelines are prepared by Dr Sadhna Rajvanshi

--
Dr Marwah

PROBLEMS RELATED TO STORE

  Inventory shortage / excess vis-à-vis stock register

   Pilferage

   Inefficiency

     Improper checks

    Issue without indents

     Error in posting of entries

 SOLUTIONS

    PERIODICAL STOCK VERIFICATION

  SURPRISE CHECKS IN THE DISPENSARIES ARE THE PART OF PERIODICAL STOCK VERIFICATION

 PERIODICAL 100% STOCK VERIFICATION

      IT'S A REQUIREMENT UNDER GFR RULE 115 ( I).

    TO BE CARRIED OUT ONCE A YEAR

    IT IS DIFFERENT FROM AUDIT.

    A TEAM AND A SUBSTITUTE TEAM, EACH COMPRISES OF CMO, PHARMACIST AND LDC WILL WORK UNDER THE CONTROL OF ADDL. DIRECTOR OF CONCERNED ZONE.

 

TEAM WILL CARRY OUT 100% STOCK VERIFICATION OF ALL THE STORES OF HOSPITALS, DISPENSARIES AND UNITS UNDER THE CONTROL OF RESPECTIVE ZONE

 

A SEPARATE TEAM WILL CONDUCT THE 100% STOCK VERIFICATION OF MSD, AYURVEDIC ,HOMEOPATHIC AND UNANI STORES

 

IN ADDITION TO 100% STOCK VERIFICATION ,THE TEAM WILL SUBMIT THE REPORT OF OBSOLETE/ SURPLUS/ UNSERVICEABLE STORES TO THE ADDL. DIRECTOR (MSD)

 

IN CGHS, THIS ANNUAL EXERCISE ALSO INCLUDES

 

       EXAMINATION OF I P O'S REGARDING PENSIONERS AND GENERAL PUBLIC CARDS.

      MASTER REGISTER  FOR REVALIDATION OF PENSIONER / GENERAL PUBLIC CARDS ACCORDING TO THE CGHS COMPENDIUM.

      EMERGENCY AUTHORITY SLIPS 

    LOCAL PURCHASE PROCEDURE  FOR INDENT OF INADMISSIBLE, FOOD, COSMETICS AND ADVERTISED ITEMS

 

PROCEDURE OF INSPECTION

     ALL THE INDENTS HAVE BEEN ENTERED INTO THE STOCK REGISTER

     VERIFY ALL THE STORE ITEMS INCLUDING DRUGS ( INCLUDING LOCAL PURCHASE) AND NON DRUGS ITEMS

    AN INVENTORY OF DEAD STOCK ARTICLES SUCH AS PLANT, MACHINERY, FURNITURE, EQUIPMENTS AND FIXTURES ETC, SHOULD BE MAINTAINED AT THE SITE OF DEAD STOCK

     INSPECTION TEAM SHOULD VERIFY THE ARTICLES AND RECORD THE RESULT ON THE INVENTORY

     VERIFICATION SHOULD BE DONE IN THE PRESENCE OF PERSON RESPONSIBLE FOR THE CUSTODY OF THE STORE

     ALL DISCREPANCIES NOTICED SHALL BE BROUGHT TO ACCOUNT IMMEDIATELY SO THE STORE ACCOUNT MAY REPRESENT THE TRUE STATEMENT OF THE STORE

     SHORTAGES, DAMAGES AND OBSOLETE/ SURPLUS/ UNSERVICEABLE STORES SHALL BE REPORTED TO THE H O D

      THE INSPECTION TEAM SHOULD GET THE SIGNATURES OF STOCK HOLDER, IN CHARGE OF THE DISPENSARY ALONG WITH SIGNATURES OF HIS TEAM ON EVERY PAGE OF THE REPORT

      PREPARE THE REPORT IN DUPLICATE.( ORIGINAL FOR IAU (HQ) AND DUPLICATE FOR DISPENSARY). MSD AND RESPECTIVE ZONES MAY BE INFORMED REGARDING THE SAME

     VERIFY THE INVENTORY OF DIFFERENT SECTIONS (INJECTION ROOM ,LAB. DRESSING ROOM ETC. ) FROM THE STOCK LEDGER

    COMMENT UPON THE CONDEMNATION REGISTER, BREAKAGE REGISTER.

      DATE OF LAST CONDEMNATION/ DEWEEDING AND SANCTION FOR THE SAME HAS BEEN RECEIVED AND REFLECTED INTO THE STOCK REGISTER

      EXAMINE THE UNCLAIMED REGISTER

      WHETHER INDENT – ISSUE / RECEIPT REGISTER FOR LOCAL PURCHASE MEDICINES IS MAINTAINED?

      WHETHER INDENTS, TOKEN OF RECEIPT TO THE CHEMIST, ARE RETURNED IN TIME?

      WHETHER DISCREPANCIES FOUND DURING LAST YEAR 100% STOCK VERIFICATION ARE RECONCILED AND REPORTED TO THE H O D.

--
Dr Marwah

World Kidney Day

World Kidney Day

(March 13-2008)

World Kidney Day

World Kidney Day is religiously celebrated on the second Thursday in the month of march each year, in 6 continents, stretching across 80 countries.
The purpose of this health day is to focus on those vital organs-kidneys- that tirelessly function to keep us alive, healthy and fit. Another important goal of the day is to spread awareness among the masses about Chronic Kidney Disease –a condition that it is common, harmful, yet, treatable.

Dr Marwah

The slogan of World Tuberculosis Day 24th march 2008

I Am Stopping TB'
I am stopping TB is more than slogan. It is the start of a two-year campaign that belongs to people everywhere who are doing their part to Stop TB.
This year's World TB Day is about celebrating the lives and stories of people affected by TB: women, men and children who have taken TB treatment; nurses; doctors; researchers; community workers--anyone who has contributed towards the global fight against TB.
The slogan, I am stopping TB , says that everyone can take an active role in helping all people in need gain access to accurate TB diagnosis and effective treatment,

Patients can stop TB by becoming active participants in their own cure and taking all their anti-TB drugs as prescribed.
Health workers can stop TB by staying alert to the symptoms of the disease and providing prompt diagnosis and treatment.
Scientists can stop TB by engaging in needed research to develop new diagnostics, new drugs and new vaccines.
Teachers can stop TB by educating their students about this age-old scourge.
Communities can stop TB by sharing information to help prevent the disease and get treatment to those who need it.

Dr Marwah

Guidelines Updated for Administration of Combination MMRV Vaccine

The updated ACIP recommendation now reads as follows: "Combination MMRV vaccine is approved for use among healthy children aged 12 months – 12 years. MMRV vaccine is indicated for simultaneous vaccination against measles, mumps, rubella, and varicella. ACIP does not express a preference for use of MMRV vaccine over separate injections of equivalent component vaccines (i.e., MMR vaccine and varicella vaccine)."

The ACIP also advocated that a work group be convened for in-depth analysis of data regarding the increased risk for febrile seizures after the first dose of MMRV vaccine. On the basis of these findings and other information that becomes available, the CDC, FDA, and ACIP will consider future policy options, communicate updates, and implement further necessary actions.

If you want to read it in details, please visit the following website at the address given below.
http://www.medscape.com/viewarticle/571507
--
Dr Marwah

Computerization in CGHS

Computerization in CGHS

Kidwai Nagar CGHS dispensary was fully computerised on 10 march 2008.
Chemist is not making any entry in the indent submitted by the dispensary since 11th march 2008.
How is he supplying the indent to the dispensary? Probably he is following the old system.
He is not supplying the medicines in the morning. If  he is fined for the delay, he starts misbehaving.


CGHS / NIC server was very slow since morning today. Its very difficult to work in the dispensary.
NIC should do something about server, otherwise it will be a big failure.

NIC bosses should come and work one full day in the dispensary. Then they will realize the
problems faced by the public as well as Doctors working in the dispensary.


Dr Marwah

Computerisation In CGHS

Kidwai Nagar dispensary is computerised since 10th march 2008.
On 15th march 321 patients attended the dispensary.

Main problems are :

1. Net is very slow.
2. NIC server is slow and around 11.00 am either it is very slow or could not be contacted.
3. Chemist / MSD authority could be issued from the computer but the report can not be generated.
4. More over Chemist / MSD authority are not serial numbered.
5. Permission software for investigation and treatment from private recognised hospital is incomplete.
6. Some items are shown in the inventory but they could not be issued.
7. Previously indented items if repeated are shown without any choice of selecting as indented/ chemist authority / MSD authority.
8. Pharmacist cannot find when the patient has drawn the medicine before .
9. There should be special module for the pharmacist distributing the local purchase medicines.
10. Linux and Mozila browser are outdated and need to be updated. NIC people are not able to do it in spite of repeated request.

Solutions

• CGHS should install their own server or NIC should upgrade their server.
• MTNL connection should be 512 kb connection.
• There should be a special module for the pharmacist distributing the local purchase medicines.
• RAM may be increased to 1 GB.
• Linux and Mozila browser may be updated.
• NIC should modify the software keeping  above points in view.
• Provisions should be made so that reports in different formats  could  be generated

Dr Marwah