SUMMARY OF FINDINGS

INFIRMARY
VIAN FAMILY HOSPITAL
4048 Que Grande St., Ugong, Valenzuela City
Date of Monitoring: June 07, 2018 FULL COMPLIANCE DATE: _____________________

Date Prepared: October 03, 2018

FINDINGS:
 Proof of Clinical Practice Guidelines (CPG) (Top 5 cases of Admissions/Consultations)
 Proof of Creation, Membership, and Minutes of Meeting for the following committees:
Committee Creation/Order Policy Minutes of meeting
Credentialing and Privileging x  x
Waste Management x  x
Patient Safety x x x
Infection Control x  x
Emergency and Disaster Preparedness x x x
CQI x  x
Grievance x x x
Selections and Promotions x x x
 Proof of Annual accomplishment report
 Policies for Dietary, Linen/Laundry
 Valid Memorandum of Agreement with Ambulance
 Presence of annual plan for training activities
 Proof of orientation conducted to new personnel
 Proof of designation of Infection Control Physician and Infection Control Nurse
 Policy for sterilizing of equipment, instruments, supplies
 Presence of policies in reporting of notifiable diseases
 Presence of Quality Improvement Program and proof of implementation
PROGRAMS
 Designation of HEMS Coordinator
 Newborn Screening for Hearing logbook
 Proof of Family Planning acceptors or logbook
PERSONNEL
 Copy of the following:
- Chief of hospital/medical director - PRC license, certificate of trainings attended, COE or Appointment
- Administrative officer/personnel officer – Diploma , Contract
- Medical records officer –trainings, ICD-10 trainings and Records Management Training
- Clerk - Contract, trainings
- Supply Officer/Storekeeper - Contract, trainings
- Laundry Worker – contract
- Cook - contract
- PHYSICIANS; NURSES – to hire 2 additional nurses, submit diploma, PRC ID and Contract
Doctor’s Name Diploma Valid PRC Contract/ Nurse’s Name Diploma Valid Contract/
MOA PRC MOA
Dr. Ramoy x x  Felix Garcia x  
Dr. Tanchoco x x  Evelyn Ducut x x 
Dr. Annie x x x Carl Rayos  x 
Dr. Kenneth x x x Randolph Ceneta  x 
Alvin  x 
Jovie Tabiñas   
Joharah Mallari   
Bernard x x 
Edna Mabassa (Supervisor)   
PHYSICAL PLANT REQUIREMENT
 Provision of PWD toilet
 Re-plan Delivery Service facility (Present approved floor plan by HFSRB and the as-built plan)

EQUIPMENT/INSTRUMENT
Submit photo and official receipt of the following:

ADMINISTRATIVE SERVICE EMERGENCY ROOM

 Ambulance  Wheelchair\Wheeled stretcher with side
rails

NURSING UNIT/WARD
 Patient bed with side rails

E-CART CONTENTS BASIC ER SUPPLIES

 Aspirin USP grade 325mg/tablet  Biomedical refrigerator
 Hyoscine N-butyl-bromide 20mg/vial  Cardiac board
 Methylprednisolone 4mg/tablet  Gloves
 Metoclopramide 10mg/ampule  Hydrogen peroxide
 Phenobarbital 30mg/ml IV or 30mg tablet  Nasal cannula
 Pyridoxine 1g/ampule  Povidone iodine
 protective face shield or mask
 Pulmonary Function Test
 Spine board with straps
 Splinting devices
 Face mask (standard)
 Sterile gauze
 Sutures
 Syringes
 Urethral catheter
 Urine collection bag
 Waterproof aprons