self assessment form (saf)
TRANSCRIPT
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7/25/2019 Self Assessment Form (SAF)
1/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
SurveyItem
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTSCenter
"ating#
Surveyors$ Comments Survey
Team
"ating#
oal The T! DOTS Center "rovides a safe and effective "hysical environment to its staff and "atients#$# The T! DOTS center is
easily located and
"atients have convenient
and safe access to the
center#
This standard %ill &e achieved %hen'
%&%& There is appropriatesignage bearing the name
of the TB DTS center to
assist patients accessing
the center&
%&'& Physical access is
appropriate for the needsof patients&
%&& Entrances and e)its are
clearly mar*ed and free ofobstruction and other
ha+ardous conditions&
%&,& There are resources to
inform patients of the
daily and hourly schedule
of TB DTS services-ensure the .uality of
patient /aiting&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%
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7/25/2019 Self Assessment Form (SAF)
2/25
The PhilCAT Certification Self-assessment and Survey Tool
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' The T! DOTS Center "rovides a safe and effective "hysical environment to its staff and "atients#
Standard $' The T! DOTS center is easily located and "atients have convenient and safe access to the center#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
'
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7/25/2019 Self Assessment Form (SAF)
3/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
oal The T! DOTS Center "rovides a safe and effective "hysical environment to its staff and "atients
0# The T! DOTS Center"rovides facilities for the
comfort and "rivacy of
its "atients and staff#
This standard %ill &e achieved %hen'
'&%& The TB DTS center
maintains a clean and
/holesome environment/ithin and immediately
outside its premises&
'&' There are resources andprocesses to ensure the
.uality of patient /aiting&
'& The lighting in each area
of the center is
appropriate for the
assigned purpose of thearea&
'&, The privacy of the staff1
patient encounter is
assured&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
-
7/25/2019 Self Assessment Form (SAF)
4/25
The PhilCAT Certification Self-assessment and Survey Tool
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' The T! DOTS Center "rovides a safe and effective "hysical environment to its staff and "atients#
Standard 0' The T! DOTS center "rovides for the "rivacy and comfort of its "atients and staff#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
,
-
7/25/2019 Self Assessment Form (SAF)
5/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
oal The T! DOTS Center "rovides a safe and effective "hysical environment to its staff and "atients#
1# The T! DOTS center"rovides for the safety of
its "atients and staff#
This standard %ill &e achieved %hen'
&% There is ade.uate clean
/ater for personal hygiene
and sanitation purposes&
&' The TB DTS center
maintains appropriate
levels of cleanliness andantisepsis of all physical
areas- e.uipment andinstruments&
& 4eneral /aste- sharps-
pathological and
infectious /aste-pharmaceutical and
chemical /astes are
appropriately segregated-
safely handled anddisposed of according to
accepted safe disposalpractices&
&, TB drugs are securelystored under appropriate
storage conditions&
&5 Sputum and other body
fluids are collected in a
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
5
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7/25/2019 Self Assessment Form (SAF)
6/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
safe and hygienic /ay&
&6 There are documented-disseminated and
implemented procedures
to identify and address theris*s of contamination of
staff and patients from
sources of infectious
diseases&
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' The T! DOTS Center "rovides a safe and effective "hysical environment to its staff and "atients#
Standard 1' The T! DOTS center "rovides for the safety of its "atients and staff#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
6
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7/25/2019 Self Assessment Form (SAF)
7/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
oal Patients receive ade2uate and effective dia.nostic and thera"eutic services at every "hase of their mana.ement from screenin. for T! to
reha&ilitation#,& All "atients under.o a
com"rehensive
assessment to facilitate
the "lannin. and
delivery of treatment#
This standard %ill &e achieved %hen'
,&% Appropriate professionalsobtain and document the
relevant history for each
patient&
,&' A physician completes
and documents the
relevant physicale)amination for each
patient&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
7
-
7/25/2019 Self Assessment Form (SAF)
8/25
The PhilCAT Certification Self-assessment and Survey Tool
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' Patients receive ade2uate and effective dia.nostic and thera"eutic services at every "hase of their mana.ement from screenin. for T! to
reha&ilitation#
Standard 3' Patients receive ade2uate and effective dia.nostic and thera"eutic services at every "hase of their mana.ement from screenin. for T! to
reha&ilitation#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
8
-
7/25/2019 Self Assessment Form (SAF)
9/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
SurveyItem
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTSCenter
"ating#
Surveyors$ Comments Survey
Team
"ating#
oal' Patients receive ade2uate and effective dia.nostic and thera"eutic services at every "hase of their mana.ement from screenin. for T! toreha&ilitation#
4# All "atients have
continuous access to
accurate and relia&le T!
dia.nostic tests#
This standard %ill &e achieved %hen'
5&% All patients undergo
sputum microscopy by a
.ualified and trained
microscopist&
5&%&% The TB DTScenter plans and
implements policies andprocedures for assuring
the .uality of sputum
microscopy results&
5&%&' If sputummicroscopy facilities are
not available in the TB
DTS center- policies
and procedures for
referring patients toaccessible centers are
implemented and
monitored foreffectiveness&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
9
-
7/25/2019 Self Assessment Form (SAF)
10/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
5&%& E)ternal providers
of sputum microscopy arecontracted based onpolicies and procedures
that include accreditation
status and the presence of
.uality control systems&
5&' Policies and procedures
for referring patients to
accredited and accessible
:1ray facilities areimplemented and
monitored for
effectiveness&
5& Policies and procedures
for referring patients to an
appropriately constitutedand accessible TB
Diagnostic Committee are
implemented and
monitored foreffectiveness&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%;
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7/25/2019 Self Assessment Form (SAF)
11/25
The PhilCAT Certification Self-assessment and Survey Tool
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' Patients receive ade2uate and effective dia.nostic and thera"eutic services at every "hase of their mana.ement from screenin. for T! to
reha&ilitation#
Standard 4' All "atients have continuous access to accurate and relia&le T! dia.nostic tests#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%%
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7/25/2019 Self Assessment Form (SAF)
12/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
oal Patients receive ade2uate and effective dia.nostic and thera"eutic services at every "hase of their mana.ement from screenin. for T! to
reha&ilitation#5# A care "lan is develo"ed
and follo%ed for all
"atients#
This standard %ill &e achieved %hen'
6&% All treatment is consistent
/ith the
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7/25/2019 Self Assessment Form (SAF)
13/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
6&, Education is provided to
all patients to help themunderstand their medicalcondition and prognosis
and to encourage their
adherence to the treatment
regimen and healthpromotion 2 illness
prevention activities&
6&5 An appropriately
comprehensive evaluationof the patient$s clinical
progress is made and
documented at each visit&
6&6 Policies and procedures
for detecting treatment
defaulters and gettingthem bac* into treatment
are implemented and
monitored for
effectiveness&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%
-
7/25/2019 Self Assessment Form (SAF)
14/25
The PhilCAT Certification Self-assessment and Survey Tool
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' Patients receive ade2uate and effective dia.nostic and thera"eutic services at every "hase of their mana.ement from screenin. for T! to
reha&ilitation#
Standard 5' A care "lan is develo"ed and follo%ed for all "atients#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%,
-
7/25/2019 Self Assessment Form (SAF)
15/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
oal Patients receive ade2uate and effective dia.nostic and thera"eutic services at every "hase of their mana.ement from screenin. for T! to
reha&ilitation#7 Patients have continuous
access to safe and
effective anti-T!
medications throu.hout
the duration of their
treatment#
This standard %ill &e achieved %hen'
7&% The TB DTS Center has
developed and
implemented policies and
procedures for assuring acontinuous supply of TB
drugs to all its patients for
the entire si) months
duration of therapy&
7&' The TB DTS center
maintains an appropriatebuffer stoc* of anti1TB
medications&
7& The TB DTS Center has
developed and
implemented policies andprocedures for assuring the
.uality and safety of its
TB drugs&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%5
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7/25/2019 Self Assessment Form (SAF)
16/25
The PhilCAT Certification Self-assessment and Survey Tool
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' Patients receive ade2uate and effective dia.nostic and thera"eutic services at every "hase of their mana.ement from screenin. for T! to
reha&ilitation#
Standard 6' Patients have continuous access to safe and effective anti-T! medications throu.hout the duration of their treatment#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%6
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7/25/2019 Self Assessment Form (SAF)
17/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
oal The mana.ement and staff adhere to clear and colla&oratively develo"ed "olicies and "rocedures for the efficient o"eration of the T!
DOTS center#8& Policies and "rocedures
for "rovidin. care to
"atients are develo"ed+
disseminated+
im"lemented and
monitored for
effectiveness#
This standard %ill &e achieved %hen'
8&% The TB DTS center$s
policies and procedures
are consistent /ith theorgani+ation$s goals-
statutory re.uirements-
accepted standards- and
the TB DTS center$scommunity
responsibilities&
8&' Policies and procedures
for patient referral to other
services are implemented
and monitored foreffectiveness&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%7
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7/25/2019 Self Assessment Form (SAF)
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The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Survey Item Survey Item Survey
Item
Survey Item Survey
Item
8& Patient default rates are
monitored and policies andprocedures are developed
and implemented toimprove default rates& The
policies and procedures
are monitored for
effectiveness&
8&, Policies and procedures
for identifying and
/or*ing /ith e)ternal
groups in providing DTSservices are developed-
implemented and
monitored for
effectiveness&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%8
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7/25/2019 Self Assessment Form (SAF)
19/25
The PhilCAT Certification Self-assessment and Survey Tool
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' The mana.ement and staff adhere to clear and colla&oratively develo"ed "olicies and "rocedures for the efficient o"eration of the T! DOTS
center#
Standard 7' Policies and "rocedures for "rovidin. care to "atients are develo"ed+ disseminated+ im"lemented and monitored for effectiveness#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
%9
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7/25/2019 Self Assessment Form (SAF)
20/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
oal The mana.ement and staff adhere to clear and colla&oratively develo"ed "olicies and "rocedures for the efficient o"eration of the T!
DOTS center#8# Policies and "rocedures
for mana.in. "atient
information are
develo"ed+ disseminated+
im"lemented and
monitored for
effectiveness#
This standard %ill &e achieved %hen'
9&% Each patient is uni.uely
identified from entry and
throughout the course ofmanagement&
9&' The TB DTS center
maintains a database of
patient records and relatedregistries and enables the
staff to easily access these
databases&
9& Policies and procedures
for ensuring the security
and confidentiality ofpatient information are
developed- implemented
and monitored for
effectiveness&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
';
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7/25/2019 Self Assessment Form (SAF)
21/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
9&, The TB DTS center
submits complete andaccurate reports to allrelevant agencies in a
timely manner&
9&5 The TB DTS center
regularly revie/s itsrecords to assess and
improve performance&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
'%
-
7/25/2019 Self Assessment Form (SAF)
22/25
The PhilCAT Certification Self-assessment and Survey Tool
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' The mana.ement and staff adhere to clear and colla&oratively develo"ed "olicies and "rocedures for the efficient o"eration of the T! DOTS
center#Standard 8' Policies and "rocedures for mana.in. "atient information are develo"ed+ disseminated+ im"lemented and monitored for effectiveness#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
''
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7/25/2019 Self Assessment Form (SAF)
23/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#oal The T! DOTS center staff "rovide efficient and com"etent DOTS services#
$9# The T! DOTS Center
has an ade2uate num&er
of 2ualified "ersonnel
s:illed in "rovidin.
DOTS services#
This standard %ill &e achieved %hen'
%;&% An ade.uate number of
.ualified and appropriately
trained personnel provideand are accountable for the
follo/ing functions0
%;&%&% >eadership-
management and overallresponsibility for the
operations- resources and
performance of the TB
DTS center
%;&%&' Clinical patient care
services
%;&%& Diagnostic services-
including sputum
microscopy
%;&%&, Drug management
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
'
-
7/25/2019 Self Assessment Form (SAF)
24/25
The PhilCAT Certification Self-assessment and Survey Tool
PhilCAT CERTIFICATION STANDARDS
Survey
Item
Criterion Evidence of Progress and Achievements
(Completed by TB DTS Center!
DTS
Center"ating#
Surveyors$ Comments Survey
Team
"ating#
%;&%&5 Information
management
%;&%&6 =inancialmanagement
%;&' Personnel follo/ clear 3ob
descriptions-
responsibilities andaccountabilities&
%;& All personnel areresponsible for safety in
the /or*place and the
.uality of the service theydeliver&
%;&, Personnel receive up to
date training based on
training needs assessment&
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
',
-
7/25/2019 Self Assessment Form (SAF)
25/25
The PhilCAT Certification Self-assessment and Survey Tool
O(ERA)) RATIN AND CO**ENTS+ CO**ENDATIONS AND RECO**ENDATIONS !, SR(E, TEA*
(To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with
information provided by the TB DOTS center.)
oal' The T! DOTS center staff "rovide efficient and com"etent DOTS services#
Standard $9' The T! DOTS Center has an ade2uate num&er of 2ualified "ersonnel s:illed in "rovidin. DOTS services#
Ratin. (please tic* appropriate overall rating for this standard!
Non-
Achievement
)o%
Achievement
*oderate
Achievement
E/tensive
Achievement
#"ating scale0
%& Non Achievement1 The re.uirements of standard 2 criterion are not met&
'& Low Achievement 1 The re.uirements of standard 2 criterion are scarcely met& Moderate Achievement1 The re.uirements of the standard 2 criterion are generally met in most circumstances&
,& Extensive Achievement1 The re.uirements of the standard 2 criterion are fully met in the ma3ority of circumstances and have been for some time&
'5