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Skills Lab Operational Guidelines

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1. Drawing up timelines and monitoring the progress of the establishment of Skills Lab Organize State level orientation workshop on Skills Lab Issue guidelines including translation of guidelines manuals into local language if needed Maintaining database of trained personnel in the requisite formats and evaluating performance of trainers trainees and Skills Lab The format will be part of the software that will be shared with the states Ensuring timely procurement of equipments mannequins as per the specifications available in annexure 3 of GOI and establishment of Skills Lab Maintaining quality standards of the procured equipments amp other materials through AMC Periodic monitoring of Skills Lab for quality of training and also performance of trainers Identifying the non performers trainers in consultation with Divisional Nodal Officer and replace them promptly Coordinating with the State Nursing in charge for pre service nursing training Keeping district wise database on such delivery points which have been technically upgraded against the target with the help of Skills Lab and mentoring visit by the trainers Identification amp Selection of trainers Organize TOT Responsibilities of Divisional District Nodal Officer The DNO for skill station will undertake the following steps Inspect the site identify infrastructural gaps submit a renovation amp furnishing
2. 5 Skills Lab for training Using Skills lab for In service Education For in service education the 6 day schedule of teaching is to be followed the details of which are available in the training manual except for those candidates who needs reorientation in only a few skills Training methodology should be adhered to the guidelines specified in the training manual on Skills lab It will be a mandatory requirement to use Skills lab for assessment of knowledge and skills during recruitment of new manpower particularly ANM SNs and MOs Skills lab will also be used in induction training for all newly recruited services providers joining Skills Lab Operational Guidelines at health facilities particularly at district level and below Trainees who have successfully completed the training at the Skill Lab will be eligible for performance based incentives They will also be eligible for study leave and enrollment to advance courses in Nursing which shall be supported throught NRHM lab for Using Skills Pre service Education The practicing of the skills should be followed by imparting of the knowledge as per the pre service curriculum There are two options as follows while a particular topic is being discussed Skills Lab practice related to that topic can follow particularly for institution having Skills Lab in their premises faculty concerned will assess the training requirements and
3. 3 Table Design for Training Hall 1 Height approx 5 5 ft a tables of the skill stations should not 4 Width 5 ft daa 3 Depth 2 ft Be NE e E Chae 4 Distance between last and second last racks 2 8 equal to labour table s height c The top of the table should be smooth and water protected Don t use Granite inside the cupboard should be approx 2ft Layout for the Seminar Hall 30x20 ft Skills Lab Operational Guidelines Annexure 3 Specifications of Mannequins and Equipments for Skill Lab General specifications desired for all Mannequins The color of the mannequin should be Caucasian simulating Indian babies adult in medium skin tones The material of the mannequin should be of polyvinyl and silicone rubber free from any carcinogenic agents The texture of the mannequin should be soft and smooth and close to the feel of baby adult skin as relevant The texture must be friction free to demonstrate the desired procedure The Internal parts of mannequin must be realistically sculpted anatomically accurate and feel must be smooth resilient bony as relevant and suitable for simulation The mannequins must be portable and any fittings used in mannequins must be of aluminum or polycarbonate or equivalent The mannequin s durability must be of minimum 2 years The material of the mannequin should withstand extremes of temperature upto 45 degree Celsius The supplier must ensure ma
4. District Nodal Officer Selection of faculty trainer others Training plan Training duration Supervisory amp Mentoring visits Estimation of training load Training calendar Training methodology Skills lab for training Using skills lab for In service Education Using skills lab for pre service Education Prerequisites for Trainers amp job responsibility Selection Process Job responsibility of Trainers Job Responsibilities of Skills Lab Coordinator Training of Faculty Trainer Monitoring and Evaluation Key performance indicators Certification of the trainees Budget Annexures o Oo 0 ON N TDD Do FP FP A OO N NNN 2 a a af N 0 O O 13 15 Abbreviations ANC Ante Natal Care ANM Auxiliary Nurse Midwife ANMTC Auxiliary Nurse Midwife Training College AMTSL Active Management of Third Stage of Labour BCA Breathing Circulation Airway CHC Community Health Centre CMHO Chief Medical Health Officer CMO Chief Medical Officer CTI Central Training Institute DH District Hospital DPM District Programme Manager DPMU District Programme Management Unit EDD Expected Date of Delivery EmOC Emergency Obstetric Care ENBC Essential New Born Care FHS Foetal Heart Sound FRU First Referral Unit GO Government Order Gol Government of India I C In Charge IMEP Infection Management amp Environmental Plan KMC Kangaroo Mother Care LAM Lactational Amenorrhoea Method LHV Lady Health Visitor LR Lab
5. Skills Lab Operational Guidelines Should have heavy duty and rust proof metal body Should have servo and manual control facility Should have SET temperature display on FND LCD by mode selection Must have all modes and timer display on LCD Should have all safety alarms visual display on LCD Should have Skin sensor fail alarm Additional Accessories 3 mattress 6 spare skin temperature probe including connection cable 3 spare heating element 10 spare set of fuses Power cord and fittings with at least 10 meters of wire ELECTRICAL SUCTION MACHINE Should have housing and Base MS Powder coated cabinet with Stainless Steel top Should be mounted on bearing castor wheels with brakes completed with pressure regulator 1 2 H P motor Should have capacity 0 700 mm Hg 10 regulatable flutter free vacuum control knob pressure regulator 25 Ltrs min Should have single rotary vane pump or other equivalent pump Should have wide mouthed 2 x 2 Liter jar Polycarbonate with self sealing bungs and mechanical over flow safety device Should have 8 mm ID x 2 meter tubing non collapsible tube with adaptors PVC Should have bourden type 6 5cm Diameter 0 760 mm Hg calibration Vacuum Gauge Power should be 230 V 50 Hz 2 0 5 Amps 200 watts 110 V on request Should have Noise Level 50 dB A 3 Should have 43 x 30 x 68 cms dimension and weight of 27Kgs Should
6. Skills Lab Operational Guidelines Strengthening competency based training of health care providers for Reproductive Maternal Newborn Child amp Adolescent Health RMNCH A services January 2013 Maternal Health Division Ministry of Health amp Family Welfare Government of India a ory cares Pera Skills Lab Operational Guidelines Strengthening competency based training of health care providers for Reproductive Maternal Newborn Child amp Adolescent Health RMNCH A services January 2013 Maternal Health Division Ministry of Health amp Family Welfare Government of India ART WIR RRA va ARAK Fe Fara Pala aaa ag RAR 110108 Government of India Ministry of Health amp Family Welfare Nirman Bhavan New Delhi 110108 s w n was fam Anuradha Gupta las Additional Secretary amp Mission Director NRHM Telefax 23062157 E mail anuradha gupta hotmail com PREFACE Guidelines and protocols form an integral part of healthcare delivery system However performance and outcomes depend upon acquisition amp adherence to skills while delivering services At present most of the pre service teaching is knowledge based and even in service trainings are largely focused on knowledge Moreover regular CME CNE or post training orientation on the skills is not being conducted In order to optimally utilize the knowledge amp skills learnt by the health care service providers it is important to create opp
7. during mentoring visit 7 Certification of the trainee A Knowledge amp Skill based pre test During training trainer will assess every trainee on each skill station At the end of the training a post knowledge based test and a skill test based on Objective Structured Clinical Examination OSCE for the critical skills shall be done Trainees securing more than 70 will be deemed to have acquired the skills and those securing less than this shall be reoriented as per skill gaps identified A database to this effect will be maintained at the Skills Lab The critical skills to be assessed and the checklist are given in the training manual The trainer will observe the competency acquired by each trainee so that a reorientation plan can be made for the weak trainee The trainee will be issued a certification for participation Format of the Certificate of participation is given in the training manual The credit points grades based on competencies acquired against critical skills shall be part of the trainee database The trainers will carry the record of the competencies acquired by individual trainee during field visit and observe the proficiency of the trainee on site i e the place of posting The trainer based on the proficiency in practicing the skills will first conduct on site mentoring and then only decide whether a particular trainee needs further re orientation at Skill Lab The details of the same will b
8. 3 F2 T1 2 F2 11 2 F2 T1 2 F3 T1 F3 T1 F3 T1 Batch 2 F1 T4 5 6 F1 T4 5 6 F1 14 5 6 F2 T3 4 F2 13 4 F2 13 4 F3 T2 F3 T2 F3 T2 Batch 3 F1 T7 8 9 F1 17 8 9 F1 T7 8 9 F2 T5 6 F2 T5 6 F2 T5 6 F3 13 F3 T3 F3 T3 D stands for district F for facility and T for trainees This will continue till all staff of the selected facilities are saturated F1 F2 and F3 denotes the facility selected in the district and they will not change till all the staff of that facility is trained T denotes trainee and D the district Training methodology Training methods should be interactive sessions discussions demonstration of skills practice on mannequins case studies presentations videos etc e Trainer should limit himself herself to impart knowledge skills as per the guidelines Before the beginning of the training ensure that sufficient teaching material partographs case sheets stationery etc are available Every session needs to be planned with set objectives activities to be performed formats to be used and evaluation of the station Al formats required by the trainer trainee is given in the training manual Performance of the trainee at each station is to be recorded separately The training schedule skills covered differs by the type of trainee e g Staff Nurse and Outreach workers and the details of the day to day programme is available in the trainers manual
9. 4GB Digital Voice Recorder Dictaphone voice recorder should work for recording digitally all the voices and reproduce it with good quality sound Dictaphone should have different recording settings Dictaphone should have digital pitch control facility for different Scene Selection Dictaphone should have Intelligent Noise Cut Low Cut Filter Digital VOR Dictaphone should have Linear PCM MP3 WMA AAC Playback Dictaphone should have Track Mark Theme 2 Infection Prevention Skill station Sterilization AUTOCLAVE The autoclave should be of 20 L capacity and must be Stand Alone Bench Top autoclave Skills Lab Operational Guidelines The autoclave should have automatic single door self sealing with high quality silicone gasket The autoclave should have chamber diameter 25 cm depth 45 cm The autoclave should have pre set automatic cycles for unwrapped instruments wrapped instruments packs The autoclave should have slow exhaust and drying cycles The autoclave should have two automatic programs which are 2 2 bar at 134 C and 1 1 bar at 121 C The autoclave should be fitted with 5 L water reservoir could be manually filled automatic for at least 10 cycles The autoclave should have auto power shut off upon completion of each cycle The autoclave should have 3 removable shelves instrument trays and double safety door locking device The autoclave should have safety feature t
10. Manju Chuggani Principal Jamia Milia College of Nursing participated in the deliberations even on holidays and gave valuable inputs I would like to appreciate the contribution given by Dr S K Sikdar DC FP and Dr P K Prabhakar DC CH for their active contribution in framing these guidelines The technical support given by Dr Manisha Malhotra DC MH Dr Dinesh Baswal DC MH Dr Ravinder Kaur Dr Pushkar Kumar amp Dr Rajeev Agarwal Senior Consultants in MH Division helped in firming the technical components and also in bringing final edited version of this document It is my earnest request to all the State Mission Directors and Program Officers to take personal initiative in creation of skills lab both for in service and pre service trainings in order to ensure that the service providers have a platform for harnessing their skills for provision of quality RMNCH services Nika Dr H Bhushan Jan 2013 List of Contributors Dr Rakesh Kumar 2 Dr J K Das 3 Dr Himanshu Bhushan 4 Dr Manisha Malhotra 5 Dr Dinesh Baswal 6 Dr S K Sikdar 7 Dr P K Prabhakar 8 Dr P Padmanaban 9 Mr KS Prasanth 10 Dr Aboli Gore 11 Dr Poonam Varma Shivkumar 12 Dr Archana Mishra 13 Dr Manju Chhugani 14 Dr Dinesh Agarwal 15 Dr V K Anand 16 Dr Ritu Agrawal 17 Dr Ravichandran 18 Dr Anand Rai 19 Dr Bulbul Sood 20 Ms P Princy Fernando 21 Dr Rashmi Asif 22 Dr Sanjay Gupta 23 Dr Utsuk Dutta 2
11. carry neonatal mannequin during mentoring visits Job Responsibilities of Skills Lab Coordinator Coordinator will be the nodal contact person for all Skills Lab activities Custodian of teaching learning aids including mannequins and ensure its proper maintenance and functionality Ensures conduct of training as per training plan Ensuring proper upkeep and maintenance of all equipments and mannequins Ensuring quality of training and adherence to training guidelines as per GOI manual Ensuring maintenance of database procurement training schedules trainee database mentoring visits etc at Skills Lab Providing enabling environment for trainees and trainers in terms of accommodation transport continuous availability of supplies food and such other day to day requirements which if not provided for can compromise quality in training Ensure setting up of Model Labour room in the institution where Skills Lab is located Ensure sending copies of reports relating to Skills Lab performance including mentoring visits to District and State QA Committee besides the nodal officers Training of Faculty Trainer All TOTS will be of 6 days duration at institutions identified by GOI States will send their requirement of TOT of faculty trainer by name so that a well performing accredited institution can be chosen to get these trainers trained Faculty of these training institutes must be train
12. equivalent to laboratory spectrophotometer Should have large LED display readable in low light working situations display cover durable plastic display in mmol L and mg dl easy switch between both measurements Memory for at least 100 previous tests Device is safety certified according CE 93 42 FDA 510k or equivalent Additional Accessories 10 x box of 100 cuvettes 10 x box of 100 sterile lancets 3 x cleaning set 3 x calibration set 3 x dust cover 3 x storing case OO 10 x spare set of fuses OXYGEN ADMINISTRATION OXYGEN CONCENTRATOR Oxygen concentrator to provide oxygen from atmospheric air OXYGEN ADMINISTRATION Oxygen concentration measured at the flow meter by oxygen sensing device OSD Sound level lt 15 dB Superior grade of molecular sieve with an indicator sensor on the device indicating whether the sieve is functional or non functional Maintenance free rotary proppet valve Oxygen purity approximately 90 Oxygen output approximately 0 5 LPM Pressure approximately 8 psi Double outlet or flow splitter for oxygen delivery Oxygen tube of 2 m length with facility for nebulization with tube amp mask with two humidifier bottles and two cabinet filters Power requirements 220 V 50 Hz Power consumption 450 W Device is safety certified according CE 93 42 FDA 510k or equivalent Additional Accessories 3 spare set of
13. facilities other than delivery points and SCs Step 4 Calculating district wise training load from above groups Step 5 Sending district wise training load along with training plan to State Nodal Officer for preparing State Training Plan Training Calendar A Prioritizing as follows Trainers and supervisors Saturating Delivery points beginning with those providing RMNCH A services Prioritizing on those undergone SBA training Remaining staff Batch Size The batch size is 16 This batch size has been arrived at keeping in mind the schedule of Skill stations where trainings are conducted per day time taken to cover one station and also on the effective trainer trainee ratio Scheduling of batches from high volume facilities like DH one doctor and 2 3 SN and SDH CHC FRU one doctor and 1 2 nurses One staff from PHC can be nominated as trainee so that working of such facilities are not affected So for a batch of 16 trainees about 7 8 facilities can be identified and trainees from these facilities should only be nominated till all the identified trainees of these facilities are trained at the Skills Lab Skills Lab Operational Guidelines Care must be taken to ensure that all the facilities are not drawn from one district and that the trainees of each batch are drawn from more than 1 district Table 1 illustrative Table 1 Scheduling of batches D1 D2 D3 Batch 1 Fl 11 2 3 Er m23 FI T1 2
14. have safety certification according CE 93 42 FDA 510k or equivalent FOOT OPERATED SUCTION MACHINE Should have high performance suction pump for pharyngeal and tracheal suction Should have double acting piston pump providing a combination of large airflow and high vacuum Should have see saw movement of pedal that generates suction every time one side of the pedal is depressed Should have pump chassis complete with valve diaphragms manifold pipe bottom cover cylinder with draw link and valve diaphragm piston O ring pedal with retaining springs aspirating tube with angle connector and combination suction tip Should have pump which can be totally disassembled is easy to clean and disinfect All parts should be autoclaved at 121 C Should have Vacuum maximum of 600 mmHg Should create free airflow at two pumping strokes per second approximately 30 to 40 L min All the parts should be made of high strength long life materials not requiring specific maintenance or storage Should have transparent polycarbonate collection container capacity approximately 1 liter Should have thermoplastic rubber bottom cover Manifold pipe polypropylene gasket O rings and valve diaphragm silicone rubber Should have teflon piston rings Skills Lab Operational Guidelines o Should have aluminum foot pedal Additional Accessories 3 set of silicone rubber suction tubing approx diam 10 mm leng
15. performance indicators are listed below which can capture these essential elements It is the joint responsibility of the QA Committee at district level and the officers of the Skills Lab to ensure that all protocols are adhered to in all the institutions identified as delivery points The QA Committee should also keep a copy of record of the training as well as status on performance and protocol adherence of the trainees and the delivery points mentored by the trainers The Skills Lab Coordinator will ensure sending a copy of various reports to district and state OA Committee besides the nodal officers In all the meetings of the division district OA Committee the trainers of the Skills Lab should be invited The DNO has to ensure that atleast one trainer participates in this meeting to discuss the progress and resolve problems Key performance indicators Every trainer of the skills lab will be allotted a fixed number L3 L2 L1 delivery points for mentoring These allotments responsibility shall be given after a thorough discussion within the Skills Lab faculty under the leadership of DNO The initial batches of the trainees will come from these delivery points only Once 50 of personnel receive training mentoring visit will start by the trainers Key performance indicators State level Percentage coverage of delivery points out of total mentored by Skills Lab Percentage of labour rooms reached achieved qual
16. protocols and quality service delivery in public health institutions Act eS a Dr Rakesh Kumar Jan 2013 Healthy Village Healthy Nation usu mo A aaa Talking about AIDS is taking care of each other ARA DE ARA MER A A ARA Y uta FAM Aare z Io Frain waa ag RA 110011 me ards sera Sra Government of India Dr H BHUSHAN Ministry of Health amp Family Welfare Deputy Commissioner MH Nirman Bhavan New Dethi 110011 Telefax 23062930 E mail drhbhushan gmail com ACKNOWLEDGEMENT Ensuring quality of services in public health facilities is one of the important mandates under National Rural Health Mission To achieve this it is important that the service providers working at the health facilities are proficient in skills for providing better quality services at health facilities particularly with reference to pregnant women mothers and new borns At present the quality of the pre service teaching and in service trainings is largely focused on knowledge and provides limited opportunities for practising the skills So there is a need for creating simulated environment for practicing on mannequins before the trainees are allowed to manage the cases independently The operational guidelines on Skills lab will facilitate the States in developing standardized skills station and also the learner will have opportunity for repeated practice under the supervision of trained supervisors Proficiency based evaluation will help both t
17. surface with foam padded mattress with density approximately 21 25 Kg m3 with infant head shoulder support and Mattress cover should be movable with zipper waterproof washable resistant to cleaning with chlorine based solution and flame retardant Infant table should have side boards transparent acryl drop down and lockable Should be Irradiant at skin level up to 40 UV cm2 nm Should have wavelength 420 to 500 nm with highest intensity at 470 nm integrated cumulative hour timer The power requirement not more than 220 V 50 Hz and power consumption not more than 250 W Phototherapy unit should have device safety certification according CE 93 42 FDA 510k or equivalent Additional Accessories 6 spare blue CFL tubes 3 spare white CFL tube 10 spare set of fuses Skills Lab Operational Guidelines 10 GLUCOMETER Should have direct reading and photometry determination of total amount of glucose in whole blood Should have switch on and auto switch off Should indicate automatic switching on the glucometer zero while Should have automatic indication showing readiness for receiving of blood through strips Should have dual wavelength measurement 660 and 840 nm Sample size one drop of whole blood on disposable cuvette Measuring time approximately 10 seconds Measuring range approximately 0 to 20 mmol Lor O to 400 mg dl Should have accuracy
18. 000 per year Skills Lab Operational Guidelines Annexure 1 List of Skill stations Basic Skills Add on Skills 1 Antenatal Care 2 Intra natal Care Calculation of EDD Recording BP and weight Abdominal examination and auscultation of Foetal Heart Sounds FHS Laboratory Investigations Haemoglobin estimation Sahli s amp Hb Color strips Urine test for aloumin and sugar by uristix Urine pregnancy detection by using kit Rapid Diagnostic Test for malaria Testing blood sugar Preparation of labour room organise a LR trays delivery instrument kit privacy and dignity NBCC Plotting amp Interpreting partograph Cervical Dilatation Normal Delivery AMTSL Providing initial dose of MgS04 for severe pre eclampsia eclampsia management Initial Management of atonic PPH Management of Incomplete abortion MVA Episiotomy repair Complicated delivery Twin breech Assisted delivery forceps ventouse Cord Prolapse Manual Removal of Placenta 3 Complication Management MNH CAB approach Identification amp management of shock IV line amp Blood transfusion catheterization Skills Lab Operational Guidelines 4 New Born Care eo oo eo eo oe Essential Newborn Care for a normal crying baby New Born resuscitation Breast Feeding amp KMC Temperature Recording Radiant warmer Use of Suction machine Counting respiratory
19. 4 Dr Nanthini Subbiah 25 Dr Pushkar Kumar 26 Dr Ravinder Kaur 27 Dr Rajeev Agarwal 28 Dr Paul Francis 29 Mr Dileep Kumar 30 Ms Surekha Soma 31 Dr Uday Kumar 32 Dr Sangeeta Batra JS RCH MoHFW Director NIHFW DC MH MoHFW MH MoHFW MH MoHFW FP MoHFW CH MoHFW Advisor NHSRC Senior Consultant NHSRC MP TAST Bhopal Prof Of OBGY MGIMS Wardha DD MH GoMP Principal Rufaida CON Jamia Hamdard UNFPA UNICEF UNICEF UNICEF Bihar UNICEF Bihar Country Director Jhpiego DC DC DC DC Jhpiego Jhpiego NIHFW NIHFW NIHFW Lead Consultant MH MoHFW Senior Consultant MH MoHFW Senior Mgt Consultant MH MoHFW WHO India President INC INC GM Nursing Everonn Chennai Ipas Maharashtra Team OR Br Boe Shri Vikas Kharage Dr Satish Pawar Dr Shrotri Aparna Dr Vasant Jamdhade Dr Ulhas D Marulkar Mr Shridhar Pandit Dr B S Kamble Dr Adkikar MD NRHM Govt of Maharashtra Joint Director Health Services Maharashtra Consultant Gynaecologist Pune Gynaecologist Nashik Paediatrician Thane PO NRHM Maharashtra Assist Dir IEC Govt of Maharashtra ADHO Pune Table of Contents Introduction Overview Target audience Competency based training in health Objective Setting up of skills lab Prerequisites for skills lab Database to be maintained at skills lab Responsibilities of State Nodal Officer Responsibilities of Divisional
20. Rs 15 000 x 12 months 1 80 000 Multipurpose Health Worker Rs 10 000 x 12 months 1 20 000 Sub Total 38 52 000 Grand total 48 00 000 41 14 800 Skills Lab Operational Guidelines Table 3 Budget for training one batch of 16 participants Item Cost No of participants per batch 16 TA to amp fro travel but disbursement as actual and as per entitlement Rs 3000X16 48 000 DA Accommodation disbursement ANM Nurses 400X10X6days 24 000 as per the type of participant i e Doctor ANM Nurse Doctors 700X6X6 days 25 200 Honorarium to training team of trainers 4 Salary component Teaching Material Course Material amp Mis Expenses Rs 250 X 16 4 000 Lunch and Tea for the Trainee Rs 200 x 16 participants X 6 days 19 200 Sub total 120 400 IOH 10 12 040 Total 132 440 Once a skills lab is established its maintenance cost HR cost along with their mobility support and the training cost for all batch needs to be reflected in the budget plan and PIP Table 4 Budget per mentoring visit of 2 trainers Item Cost Hiring of vehicle 2000 dayX15 days for 15 days field visit including to amp fro journey Rs 30 000 per month DA Accommodation Doctors skills lab trainers both Doctor Nurse other supervisor 1500 Rs 1500 X 2 skills lab trainers X15days Rs 45 000 per month Total per mentoring visit of 15 days Total mentoring visit per year Rs 75 000x12 Rs 75 000 per month Rs 9 00
21. ance replacement etc against any complaints up to the satisfactions of the users irrespective of the location of manufacturing unit The lead time of all equipment s should not be more than 6 weeks after confirmation of written supply order The supplier must ensure the availability of on call service agent from state headquarters within 48 hours from local within 24 hours from outside state within 7 days and incase the problem is not rectified on site at the time of service then it need to be rectified with in next 7 days for minor defects and within 28 days for major defects The equipment s should have three years comprehensive warranty and two years of extended comprehensive warranty Equipment s should include a Hard Carrying Case and study questions Dos and Dont s maintenance guide use of equipment s background information transparencies and videotape user manual with trouble shooting guidance technical manual with maintenance and first line technical intervention instructions and any other relevant teaching training materials in English The equipments should have detailed information of the device features functions detection capabilities method of operation materials alarm capabilities software specifications and operating ranges power source parameter detection ranges etc wherever applicable This description should contain engineering drawings pictures and all devices labeling such as inst
22. book their schedule with the Skills Lab accordingly According to the plan submitted the Skills Lab will allocate timings to the institution The pre service Skills Lab can also be utilized by other government teaching institutions if they do not have such Skills Lab However a prior appointment with the Skills Lab Coordinator with a copy to DNO for scheduling these batches needs to be taken It will be desirable for the private teaching institutes to have similar Skills Lab so that the quality of passed out candidates remain at par with the Government Institutes Since Skills Lab in pre service training is a part of the regular teaching training no honorarium for the ANM GNM School faculty is envisaged Skill lab shall be utilized for competency assessment of ANM GNM in education pre service Prerequisites of Trainers amp Job responsibilities Appointment is suggested for a period of 3 years with annual performance review Retired professionals who have experience working in training programmes and who are willing to travel and have a passion for teaching may be preferred Eligibility Nursing Degree in nursing with 2 3 years experience preferably in the RMNCH A or Diploma in nursing with minimum 5 years experience preferably in the labour room Meeting the registration requirements of the nursing council Willingness to travel to the mentoring sites Aptitude for teaching Eli
23. ch as MDGs there is a need to further accelerate the initiatives with special focus on quality parameters Improvement and achievements on these goals are possible only if the health care delivery system is strengthened with technically competent health care providers at all levels to deliver critical Reproductive Maternal Neonatal and Child Health RMNCH A services at institutional and outreach levels with universal coverage equity and quality Hence capacity building of health care providers to make them proficient in technical skills and knowledge requires key intervention for ensuring the desired outcomes Various types of skill based trainings are being implemented by the States with NRHM support but ensuring practice of standard technical protocols impacting quality of services still remains a challenge Despite the various types of trainings in RMNCH A it is observed that the health care providers are less confident in applying skills Limited focus on assessing the competencies acquired by the trainees during the training inadequate exposure opportunity to practice them during training lack of post training follow up and under utilization of trained manpower at functional health facilities have resulted in compromise of skill acquisition practices and sustenance As a result many trainees who have not acquired the requisite skills continue to provide services impacting quality health outcomes Moreover the opportun
24. d competency amp proficiency status c trainer database mentoring visits d performance of delivery points mentored by trainers in terms of standards protocols etc adhered to must be installed at all Skills Lab and the information could be accessed online by the SNO DNO Trainers QA officers The software can also be used for planning the training schedules as well The training schedules for the various trainees are available in the training manual This software shall be developed by Government of India and shared with the States of State Responsibilities Nodal Officer The designated State Nodal Officer SNO will identify site for Skill Lab with the above mentioned requirements among the different districts or the divisions His responsibilities will be Taking steps for the creation of state of the art Skills Lab as envisioned in the guideline Identification of nodal officers at divisional district level O Selection of Skills Lab sites and establishing the Skills Lab within a set time frame Accreditation of the Skills Lab once it is declared ready by DNO by SOAC NIHFW NHSRC GOI nominated body The States can access the guidelines for accreditation from the GOI nominated bodies Reflecting the budget in the PIP and timely allocation of budget Developing training plan based on the district plan Organizing training of trainers training of Skills Lab trainers including
25. der the National Rural Health Mission One of the key determinants substantially affecting these interventions is the skill sets of the personnel providing service delivery Many of the teams constituted by the Government of India making field visits in the states have repeatedly highlighted the need to augment the skills of health personnel particularly those delivering RMNCH services Even though skill based trainings are being conducted but the health professionals are not able to utilize their skills optimally one of the reasons being lack of re orientation on the skills learnt As such skills laboratory with a standardized set of skill stations focusing on the competencies of the health personnel is the need of the hour With this vision a core group was constituted under the guidance of Maternal Health division Government of India to device standardized skill stations quality mannequins pedagogy and Objective Structured Clinical Examination OSCE methods of evaluation The guideline prepared is a comprehensive document for not only establishing a skills lab but also for mentoring the trained personnel after the training so that the skills learnt can be utilized optimally for improving quality of service delivery The guideline will help various stakeholders and programme officers in establishing skills lab which can impart quality training I am sure the skills laboratories established across the country will ensure practice of
26. e part of the database of the Skills Lab Format 2 in Annexure 4 However since the proficiency can be tested only onsite the task is entrusted with mobile mentors Skills Lab Operational Guidelines 8 Budget Table 2 Budget for establishing Skills Lab Category Non recurring Recurring yearly Cost Civil works Furniture wood work renovation 20 00 000 Electrical work with power back up by 5 KVA generator Water Supply and other ancillary requirements for skills lab including seminar room and office set up New MCH wing have built in skills lab and seminar room etc So no separate budgeting is required for skills lab in these MCH wings for civil works Mannequins amp Equipment as per specification 25 00 000 Consumables amp Supplies 50 000 Teaching learning material 2 Computers 2 Laptops 3 00 000 1 LCD projector 1 screen 1 printer cum Fax cum Photocopier etc POL for Generator diesel 10 liters per day Rs 60 1 72 800 x10 Rs 600 includes oil X 24 days x 12 months Maintenance of Equipments Mannequins Generators 40 000 etc Sub Total 38 00 000 2 62 800 Salary for 1 Doctor Rs 66 000 includes salary Rs 7 92 000 60 000 Rs 5000 for accommodation Rs 1 000 Mobile reimbursement per month x 12 months Salary for 5 Nurse Trainers Rs 46 000 includes salary Rs 40 000 Rs 5000 for accommodation Rs 27 60 000 1 000 Mobile reimbursement per month x 12 months Data Entry Operator
27. ed ENBC practiced Neonatal Resuscitation IUCD insertion Adherence to Infection prevention practices Section C Action taken on the mentor s previous Comments Institution Trained staff To be submitted to CMO amp DNO Database of the same to be updated at the Skills Lab for further action and follow up Listing of Skills is only indicative more can be added as mentoring progresses Mention by name against each skill Signature of Mentor Maternal Health Division Ministry of Health amp Family Welfare Government of India
28. ed first on the full and complete protocols of the Skills Lab and who will be certified by the training institute only when the trainers achieve more than 70 competency These trainers will then conduct at least one to two batches of supervised training in the presence of two national trainers at their place of posting The certificate to the trainers will be issued only after they have conducted the supervised training 2 batches even if 70 competency has been achieved in the TOT The national master trainers will remain available for 6 days of TOT for the supervised training being conducted by these trainers for the trainees defined in the training guideline Skills Lab Operational Guidelines NHSRC PHA division with support amp guidance from Maternal Health division MoHFW will act as the national nodal agency for organizing TOTs supervising of selection process of trainers and guiding the states in setting up of Skills Lab and developing of training plans NHSRC will also help in developing national centres of excellence for Skills Lab training at the identified institutes in the country with support amp guidance from MH division MoHFW 6 Monitoring and Evaluation The Monitoring and Evaluation of the performance of Skills Lab Trainer supervisor Trainee delivery points mentored should be closely linked with the Quality Assurance and Supportive Supervision initiatives of the State A set of key
29. ed over to Skills Lab Coordinator for conducting initial training among the supervisors and mentors Step2 Training load from delivery points The Divisional Nodal Officer District Nodal officer will take updated list of delivery points from the districts under the jurisdiction of Skills Lab and hand over to Skills Lab Coordinator He she will also collect facility wise names of HR posted at delivery points and categorize them into three groups the first being those involved directly in providing RMNCH A services and the second those who sometimes provide services particularly when performing emergency duty The contractual doctors nurses ANMs also have to be included in the list of trainees The information given about the HR from the above group will include details of trainings undertaken by each of the individuals All the above categories will ultimately need to be trained in the Skills Lab However training at Skills Lab will be first given to those health providers who have undertaken SBA BEmOC NSSK F IMNCI trainings Skills Lab Coordinator will then prepare the training load for each batch from each district with timeline for saturating the identified delivery points before undertaking the training in other facilities Step 3 Training load of outreach workers Name wise list of ANMs working at the SCs which are not delivery points Name wise list of ANMs and SNs working at the health
30. entering the champer The spacer should be washable could be sterilized and reusable The spacer should be latex free Skills Lab Operational Guidelines Annexure 4 Supportive Supervision Format 1 Mentoring visits by Skills Lab Team Advance Tour Plan For the Month Year Ta Salou cda location 2 Names of team member 3 Schedule Date From To name of Mode of Expected Remarks including requirements for LCD the facility transport Expenditure etc if teaching sessions are planned at the institution Total expected expenditure Advance if required Signature of the trainer Date Signature of the DNO Date Skills Lab Operational Guidelines Format 2 Tour Report of Mobile Mentors 1 Skills Lab location 2 Name of mentor 3 Period of visit 4 Institution visited 5 Key observations Section A Institutional assessment Remarks specify any Action Timeline hindrances towards points achievement of RMNCH A Care Enabling environment Drugs Et supplies O Availability and performance of FRU teams etc O Any other significant finding Condition of LR O Arrangement of LR O Cleanliness etc O Any other significant finding Condition of OT O Arrangement of OT Aseptic practices etc Any other significant finding Section B Individual assessment Skills Trained Staff Remarks Skill Gaps Partograph maintained AMTSL follow
31. g visits second 4 trainers at skill lab is always ensured even if one or two dedicated skill lab trainers are not available due to any reason 4 Training Plan The initial batches of the trainees will be doctors nurses ANMs supervisors of the attached district hospital training centre and also from all nursing faculty of the SN ANM training institute located in the district One day orientation will be organized in the Skills Lab for Divisional Nodal Officer Divisional PM CMO CS ACMO MS DMS DHO DPHO DD District PM BPM HM and such categories of staff who are not trainers but has a supervisory managerial role This will help in understanding the concept of Skills Lab which will also be of assistance in timely release of funds procurement of mannequins operationalisation of Skills Lab timely nomination of trainees follow up etc Orientation will also help in improving knowledge on supportive supervision when they undertake mentoring visits Training duration 6 days training for each batch 3 batches in a month Supervisory amp Mentoring visits Skills Lab personnel will organize regular mentoring visits every month Duration of the mentoring visit in a particular district will depend upon the area to be covered requirement of the district division and number of trained personnel to be supervised Two trainers will always be in the field on rotation basis to provide
32. gibility Medical MBBS with 2 3 years experience working in RMNCH A Aptitude for teaching Willingness for travel to the mentoring sites Meeting the registration requirements of the Medical Council Selection Process By GOI nominated institutes agency Applications through Open advertisement Popular websites Campus selection Short listing as per TOR For short listing Online written test comprising different types of question scenarios for testing aptitude and knowledge Sample test questions will be Skills Lab Operational Guidelines prepared in consultation with Maternal Health and Nursing division of GOI Further short listing before interview TAJDA for interview by 3 AC to be given to the shortlisted candidates Job responsibilities of Trainers Trainer should establish themselves not only for conducting training but also as a mentor for those who have been trained Will mentor 2 supervisors from the system in every district for continuous mentoring of the health providers involved in RMNCH A care for making joint mentoring visits Mentoring supervisory visits to the delivery points at least 6 days month Preparing annual targets of mentoring institutes in consultation with district and divisional offices Submitting the tour plan in advance to district and divisional in charge and also visit report Format 1 in Annexure 4 The trainers will always
33. have facility for detaching the upper portion and illustrating the anatomical details of posterior side of the simulator deep anatomic structure of the head of femur the shaft of femur the sciatic nerve deep layers of muscles major blood vessels and aspect of bony pelvis underlying the gluteus muscles at any one side by hand painted or molded as relevant O Intramuscular injection training mannequin should have Intramuscular injection in ventrogluteal site below iliac crest on both side left and right O Intramuscular injection training mannequin should have facility for giving Intramuscular injection in lateral thigh at any one side Theme 5 Complication Management MNH Skill Station 1 CAB approach 2 Management of Shock IV catherterization and Urinary catherization ADULT CPR MANNEQUIN Adult CPR mannequin should have features to demonstrate opening of airway head tilt chin lift and jaw thrust techniques Adult CPR mannequin should have disposable airways Adult CPR mannequin should have removable reusable faces Adult CPR mannequin should have a clicker which confirms correct compression depth Adult CPR mannequin should have compression spring for consistent resistance Adult CPR mannequin should have weight 3 9 kg and H x W x D 25 in x 8 5 in x 13 5 in Additional Accessories 6 reusable mannequin faces 6 airways 50 mannequin wipes ADULT IV TRAINING ARM KIT Adult IV training a
34. he trainers and trainees in identifying the weaker area which can be strengthened during the mentoring visits by the skill lab trainers The initiative and guidance of Ms Anuradha Gupta AS amp MD NRHM GOI has helped us in preparing this operational guideline would also like to thank Dr Rakesh Kumar JS RCH MOHFW for his constant technical and administrative support in developing the guidelines for the skills lab I would like to acknowledge the support given by Mission Director NRHM Govt of Maharashtra and his team for facilitating the deliberations and technical assistance Dr J K Das Director NIHFW as the chairperson of the expert group helped us in finalizing the specifications of the mannequins and different skills stations My sincere thanks to Dr P Padmanaban amp Mr K S Prasanth from NHSRC who have been instrumental in preparation of these guidelines I must thank Dr Bulbul Sood Country Director JHPIEGO and her team particularly Dr Rashmi Asif Dr Somesh Kumar and Ms Princy Fernando from JHPIEGO for their proactive support in framing skill stations I would also like to acknowledge the contribution of UNICEF particularly Dr V K Anand Dr Malalay Ahmadzai amp Dr Ritu Agarwal for giving their technical inputs The inputs given by Dr Dinesh Agarwal from UNFPA have been valuable must acknowledge the fact that all the National and State experts particularly Dr Aboli Gore MP TAST Dr Archana Mishra DD MH Govt of MP Dr
35. i e the requisite knowledge and skills to proficiently perform their job The competency based training intends to achieve this objective What are the advantages of competency based training over traditional methods The competency based learning approach provides a means for learners to practice and acquire clinical skills and also upgrade their knowledge It allows facilitators to demonstrate the correct steps and gives an opportunity for repetition and feedback to the learners It permits individualized learning through videos and self practice on mannequins The skill stations help in clearly defining the learning outcomes against each activity being demonstrated at different stations Thus the assessment of the trainees becomes specific for the competencies acquired This will also help in identifying the trainees who are weak in a particular skill getting an opportunity to have their skills reinforced through periodic reorientation Skills Lab serves as a prototype demonstration and learning facility for health care providers so that they develop desired competencies Skills Lab is equipped with various skill stations as per the skill requirements for various cadres of the health care providers This will also aid in institutionalizing the usage of Standard Operating Procedures SOPs and adherence to technical protocols so that they become a part of routine practice Such labs have an edge over other didactic methods by provid
36. i urethral tears Should have one model featuring standard episiotomy Should have features to attach with child birth simulator Additional accessories 3 nos of medial episiotomy model with tears in labia minora 3 nos of mediolateral episiotomy model with peri urethral tears 3nos of mediolateral episiotomy model MANNEQUIN FOR SIMULATION AND MANAGEMENT OF PPH The mannequin should be highly realistic for simulating postpartum hemorrhage The mannequin should have features to manually control the amount of bleeding and the conditions of uterus The mannequin should have features to control dilation of the cervix The mannequin should have the following Full term fetus with placenta and umbilical cord Blood concentrate Fluid collection tray Fluid drain Urine catheter 20 ml syringe oo eee Carrying bag Skills Lab Operational Guidelines The mannequin should have features for training the following Urine catheterization Normal delivery Complete and Incomplete placenta delivery Oxytocin injection Controlled cord traction Bimanual compression of uterus 4 INTRAMUSCULAR INJECTION TRAINING MANNEQUIN O Intramuscular injection training mannequin should have a lifelike human lower torso with intramuscular injection site in upper outer quadrant of palpable gluteal region on both side left and right O Intramuscular injection training mannequin should
37. ing the opportunity for repetitive skill practice simulating clinical scenarios under the supervision of a qualified trainer Objective what will the Skills Lab do A Skills Lab facilitates acquisition reinforcement of key standardized technical skills and knowledge by service providers for RMNCH A services ensures the availability of skilled personnel at health facilities improves the quality of pre service training provides Continuing Nursing Education Continuing Medical Education 3 Setting up of Skills Lab The Skills Lab will have a set of structured skill stations with the specific objective of imparting Skills Lab Operational Guidelines competency in skills The teaching and training at the Skill Lab will be through interactive learning The methodology for such learning focuses on gaining knowledge through power point presentation and discussions use of videos and skill acquisitions through repeated hands on practices on the mannequins These skill stations are of two levels basic and add on Basic skills are the essential skills required for all cadres i e ANM Staff Nurses Lady Health Visitors Medical Officers Nursing supervisors Teachers and Trainers involved in imparting knowledge of RMNCH A services and its supervision The add on stations have skill stations to provide speciliased skills required for Medical Officers Staff Nurses Nursing supervisors and Trainers The list of Skill s
38. ith district hospital any other hospital for exposure visits and real time learning opportunities Prerequisites for Skills Lab One of the critical steps will be to establish a model Labour Room in the attached hospital where defined Standard Operating Procedures SOPs and technical protocols are practiced so that the trainees visiting these facilities can learn to upgrade set up similar facilities at their own institutions Ideally there should be enough space to accommodate all skill stations in one big hall which is about 1500 sq ft Attached to this hall there will be a space of about 300 sq ft which will function as a seminar room where facilities for presentations computer laptop LCD projector screen etc are available Every lab must have net connectivity There should be another small room attached to the lab which will function as office The standard design of the new MCH wing sanctioned by GOI has all these spaces marked Suggestive lay out and plan is available on MoHFW Government of India website Sample layouts amp deisgn are given in annexure 2 The second important requirement is availability of accommodation for 16 trainees not necessarily in the same premises but at least nearer to the training site Skills Lab Operational Guidelines Database to be maintained at Skills Lab A software which is capable of capturing a progress in establishing skills lab b trainee database training loa
39. ities for re training of these health care providers are also limited Another challenging area especially in high focus states is the weak infrastructure poor technical capacity and inadequate teaching learning capabilities of the Nursing Schools and the ANM Training Centres There is no structured plan for Continuing Nursing Education Continuing Medical Education or reorientation training RMNCH A Monitoring visits have also revealed many of the equipments provided to the health facilities remain unutilized for want of operatoinal knowledge and skills Preventive maintenance of these equipments is also limited Hence strengthening the pre service and in service trainings is also critical for ensuring quality of services in health facilities Strengthening pre service training will further reduce the burden on in service trainings of these cadres Overview Comprehensive Skills Lab with skill stations are designed with the aim of acquisition and upgradation of the skills of health care providers to enhance their capacity to provide quality RMNCH A services leading to the improved health outcomes A Skills Lab will comprise of skill stations where the trainees learn through practicing skills on mannequins simulation exercises demonstration videos and presentations The basic objective is the reorientation of the personnel during in service training and continuing medical education of health care providers for RMNCH A service
40. ity standards out of the total delivery points in the state All the standards referred here are as per Maternal and Neonatal Health Tool Kit MoHFW Gol Key performance indicators Divisional District Monthly performance reporting in terms of number of batches as well as absolute numbers out of total planned for the Skills Lab Number of mentoring visits conducted against the total delivery points Percentage of labour rooms reached achieved quality standards out of the total delivery points in the division district Key performance indicators Skills lab Percentage of trainees achieved competencies minimum 70 Percentage of Skills lab performing as per standards out of the total planned in the district Key performance indicators Trainer Percentage of institutions following Infection prevention protocols in Labour room OT and Laboratory among the delivery points allotted Percentage of mentoring visits institutions covered out of the total allotted delivery points Skills Lab Operational Guidelines Key performance indicators Trainee Measurable only after 60 personnel of a particular delivery point got trained at Skills Lab Number of delivery points with model labour rooms set up in the district Number of trainees not adhering to the Clinical Protocols e g AMTSL BMW IMEP ENBC To be measured after 3 months of individual training by the Skills Lab trainers
41. lso talcum powder or silicone gel to avoid friction list of accessories and spare parts with cost and contact details of its supplier preferably within State Delhi The supplier manufacture should list the name and address of technical service providers in India The payment of the mannequin is linked with installation at consignee address demonstration to service providers at consignee address and certification of installation and functionality by the head of the concerned department The suppliers should agree for 10 of payment to be released after 2 years Warranty Period Skills Lab Operational Guidelines General specifications desired for all equipment s The material used for equipment s should be of rust proof high quality PVC stainless steel polyvinyl and silicone rubber as applicable and free from any carcinogenic agents The stainless steel composition must be of 8 to 10 nickel 18 to 20 chromium The fittings of all equipment s must be of stainless steel aluminum The equipment s should be durable of minimum 3 years for repeated use by trainers trainees The supplier must ensure manufacturer s warranty guarantee for the specifiactions and also against manufacturing defects Every manufacturing unit must have an internal system of quality control and supplier should produce the process and certificate from the manufacturers The supplier will be responsible for service mainten
42. mely conduct of the scheduled trainings is to be ensured Nominate two MOs Nurses as mentors supervisors in addition to the Skills Lab trainers for every district to follow up the mentoring visits by the skills lab trainers Facilitate the mentoring visits of the mobile trainers Ensure maintenance of database of the trainees with competencies acquired skills gaps for re training and details of mentoring visits Divisional in charge to communicate to District CMO for ensuring rectification filling of gaps identified during supervisory visits of the Skills Lab trainer Regular reporting of progress to the State Nodal Officer SNO and Divisional Nodal officer DNO Coordination with nursing institutions for the conduct of pre service training using Skills Lab Monitor the key performance and process indicators Selection of faculty trainer others Every Skills Lab will have dedicated staff members consisting of 6 faculties trainers and among them one will be designated as in charge trainer or Skills Lab coordinator Among the 6 faculties one will be MBBS with higher qualification preferably LMO and five graduate post graduate nursing staff Besides this there will be one data entry operator and one grade IV staff as multipurpose worker Out of 6 trainers 2 trainers will always be in the field on rotation basis to provide on site mentoring of the service providers posted in the labour room and
43. nufacturer s warranty guarantee for the specifications and also against manufacturing defects The manufacturing units must have an internal system of quality control and supplier should produce the process and certificate from the manufacturers The supplier will be responsible for service maintenance replacement etc against any complaints up to the satisfaction of the users irrespective of the location of manufacturing unit The Lead time must not be more than 6 weeks after confirmation of written supply order The supplier must ensure the availability of on call service agent from state headquarters within 48 hours from local within 24 hours from outside state within 7 days and incase the problem is not rectified on site at the time of service then its need to be rectified with in next 7 days for minor defects and within 28 days for major defects The warranty for mannequins must be two years from the date of receiving at consignees address All mannequins should include a soft Hard Carrying Case and study questions Dos and Dont s instructions manual maintenance guide background information videotape for demonstrating the use of mannequin user manual with trouble shooting guidance technical manual with maintenance and first line technical intervention instructions and any other relevant teaching training materials in English The mannequins should have additional accessories as listed and a
44. o protect against over pressure and over temperature The autoclave should have audible and visual alert upon cycle interruption or completion The autoclave should have unwrapped cycle time cold 30 min hot 20 min The autoclave should have control panel with alpha numerical display and cycle indicators The autoclave should have air vents situated laterally and need to be manually closed after sterilization TST temperature steam time control spot must be self adhesive and the color changes must be irreversible when sterilized attachable to steam sterilizing containers Power requirement for the autoclave must be 220 V 50 Hz single phase Power consumption of autoclave not more than 3000 W The autoclave should have device safety certification according CE 93 42 FDA 510k or equivalent Additional accessories Set of 3 matching instrument baskets Set of 3 matching sterilizing drums 3 roll of sterilization indicator TST control spots 3 boxes paper sheet and crepe for sterilization pack 3 rolls of adhesive tape for sterilization pack 10 spare set of fuses 1 box TST temperature steam time control spot box of 500 TST plus 1 record sheet 2 Stainless steel cylindrical sterilizing drum of 165mm diameter Thickness steel 0 8 mm Diameter approx 165 mm Height approx 100 mm Theme 3 Family Planning Skill Station 1 Interval IUCD 2 Postpar
45. on site mentoring of the service providers Each field visit should ensure giving enough time at the facility for onsite supervision and mentoring Neonatal resuscitation will be demonstrated and hands on practice on mannequin will be ensured by the trainers during every mentoring visit Field visit teams will be created comprising of 2 trainers from Skills Lab and another from the division district who are trained as trainer supervisor should also join so that mentoring process is strengthened and continuity is maintained A roster will be prepared for all the teams ensuring that at any particular time at least 4 trainers of the Skills Lab are always available at Skills Lab for conducting training In each visit each of the team will mentor at least 2 3 health facilities delivery points Skills Lab Operational Guidelines Each trainer will work against a targeted number of health facilities every year for mentoring so that he she keeps visiting these facilities till the service providers adopt and adhere to the technical protocols Thereafter only periodic mentoring visits need to be conducted Estimation of training load Step1 Training load of supervisors and mentors The trainers supervisors and mentors of RMNCH A services from each district under the jurisdiction of Skills Lab will be listed out by name by the Divisional Nodal Officer District Nodal officer and the list shall be hand
46. ortunities for re orientation not only with regard to knowledge but also to reinforce skills Creating skills lab for pre service amp in service with linkages for post training mentoring is a step in this direction Operational Guidelines for Skills laboratories define standardize skill stations aimed to provide the requisite skills to health professionals A skills laboratory has the advantage that allows a learner opportunities for repetition and feedback and permits individualized learning The learning outcomes can be clearly measured by assessment of performance through Objective Structured Clinical Examination OSCE method The faculty of the skills lab is also trained and mandated to provide supportive supervision and mentoring visits post training to assess the skills being practiced by the trained personnel at the health facility I am sure that the operational guidelines will help the State Policy makers and programme officers in effective planning and implementation of skills based training of health personnel providing RMNCH services Antradha Gupta Jan 2013 WRAL HEA ARA UHR Q VA i E A RRA va uam GO Farag 3 IO Prater waa ad ech 110108 nha write Tama ER Government of India a h Ministry of Health 8 Family Welfare i R n pest ot oe e Nirman Bhavan New Delhi 110108 Telefax 23061723 E mail rkumar92 hotmail com Foreword Ensuring quality healthcare delivery in public health institutions is a priority un
47. other critical service area under RMNCH A activity The selection shall be done by the state with representation from a central organization like NHSRC NIHFW or GOI nominated body Selection will be done strictly as per the GOI defined Terms Of Reference TOR and following the defined selection procedures stipulated by GOI Skills Lab Operational Guidelines The recruited trainers will report to the Divisional Nodal Officer District Nodal Officer These trainers will be dedicated staff for Skills Lab and also for on site mentoring and will not be assigned any other duty Once the trainers are selected they will be trained by the national trainers After training these trainers will have the responsibility of setting up of mannequins and equipments as per the standard plan The trainers will then ensure upgrading the labour room of training centre as a model labour room The skills lab is now ready for receiving the trainees Besides Skill Lab trainers a pool of resource persons as trainers needs to be created to ensure smooth conduct of training and simulatenous mentoring visits The training plan and mentoring visits should be planned in such a way that a pool of resource persons trainers comprising of dedicated trainers and guest faculty is created per skill lab Purposes of creating this resource are one trainers from this pool can always accompany the skills lab trainer during mentorin
48. our Room MO Medical Officer MoHFW Ministry of Health and Family Welfare NHSRC National Health Systems Resource Center NIHFW National Institute of Health and Family Welfare NRP Neonatal Resuscitation Program NSV Non Scalpel Vasectomy Obs Gyn ORS PHC PIP PNC PPH PPIUCD OA RCH RCHO RMNCH A SBA SCs SDM SIHFW SN SPMU TA DA Obstetrician and Gynecologists Oral Rehydration Solution Primary Health Centre Project Implementation Plan Post Natal Care Post Partum Haemorrhage Post Partum Intrauterine Contraceptive Device Quality Assurance Reproductive and Child Health Programme Reproductive and Child Health Officer Reproductive Maternal Neonatal Child and Adolescent Health Skilled Birth Attendant Sub Centre Standard Days Method State Institute of Health and Family Welfare Staff Nurse State Programme Management Unit Travel Allowance Dearness Allowance Skills Lab Operational Guidelines 1 Introduction The Millennium Development Goal 4 amp 5 on Improving Maternal and Child Health aims at reduction of MMR to 109 100 000 live births and IMR to 28 1 000 live births in India by 2015 Reduction of MMR IMR NMR and TFR are priorities of the Government of India Various steps have been taken by GOI and the State Governments for accelerating the pace of decline of key indicators and to achieve the goals amp targets set under NRHM However for achieving 12th plan goals and international commitments su
49. overted parous uterus Five normal cervices Four abnormal cervices Ten fallopian tubes oo 0 2 x 48 hour postpartum uterus with duckbill cervix and fallopian tubes 2 Extra locking pins and thin cervical locking ring Theme 4 Intranatal care Skill Station 1 Pelvic examination includes cervical dilatation and pelvic assessment 2 Normal Delivery 3 AMTSL amp Checking placenta 4 Initial dose of MgSO4 for severe pre eclampsia eclampsia management 5 Episiotomy repair 6 Initial Management of atonic PPH 7 Complicated delivery Twin breech shoulder dystosia ventose and Forceps 1 CHILD BIRTH SIMULATOR ALONG WITH ATTACHMENT FOR CERVICAL DILATATION CLOSED 05 4 CM 6CM 8CM FULLY DILATED CERVIX Features Should have hemi pelvis of adult female with anatomical landmarks like pelvic cavity spine etc Should have manual mechanical birthing system to enable the user to control the rotation and speed of fetus delivery etc Should have articulating fetal baby with adaptors to fit with manual birthing system Should be versatile to change the position of the fetus during the process of birth including descend flexion extension internal and external rotation restitution Should have features for training normal and breech deliveries Should have Inflatable cushions to lift fetus for Leopold maneuver during pregnancy Shall have adaptive birth canal to demonstrate dys
50. plan with Skills Lab Operational Guidelines budget get appropriate approval and initiate renovation amp furnishing to be completed within 3 months The space allocated for skills lab should have uninterrupted power supply water supply adequate lighting and ventilation A provision for class room sessions with LCD projector is to be ensured Parallel steps to be undertaken for procurement of mannequins equipments consumables teaching learning aids computers laptops etc as per list and specifications specified for each skill station Providing enabling environment for trainees and trainers in terms of continuous availability of supplies day to day maintenance and infrastructural requirement food and other such requirements which if not provided for can compromise quality in training Appropriate accommodation needs to be provided to the trainees along with facilities for transport in case it is located at a distance Initiating process of recruitment of trainers i e 1 MO preferably LMO and 5 postgraduate graduate nurses Prepare the training plan as per the training load estimate Submit name wise list of the trainees along with their proposed date of training to Divisional in charge with copy to State Nodal Officer Timely nomination and release of the trainees by Divisional in charge and directives to the District CMO are to be ensured Ti
51. plicas should have features color and skin texture simulating Indian babies Human fetus replicas should be feasible for teaching external development and growth of the fetus Human fetus replicas should be flexible enough to fit inside the abdominal palpation mannequin while demonstrating the leopold maneuver during pregnancy ABDOMINAL PALPATION MANNEQUIN FOR LEOPOLD MANEUVERS DURING PREGNANCY Features The abdominal palpation mannequin should have full size adult female lower torso abdomen and pelvis The abdominal palpation mannequin should have a one piece full term fetus with palpable fontanelles spine shoulders elbows and knees The abdominal palpation mannequin should have upper and lower inflatable cushions with independent inflating devices in the abdominal part of the mannequin Lower cushion when inflated should raise the fetus to desired position Upper cushion when inflated should create a firm abdomen as in the ninth month of pregnancy The abdominal mannequin should be able accommodate the fetus in vertex breech or transverse positions The abdominal mannequin should have the facility to accommodate the fetus of different gestational age demonstrate vertex Breech transverse position delivery and attach the perineum to demonstrate the episiotomy repair Dictaphone Dictaphone should be able to give a simulation of fetal heart sound Dictaphone should have
52. rate Oxygen administration Using Glucometer Setting up an IV line on child arm Using Pulse oximeter Using Nebulizer and Multi dose inhaler with spacer Chest compression and medication New Born Resuscitation Use of Phototherapy machine for new borns with Jaundice Inserting feeding tube in a baby Family Planning Interval IUCD PPIUCD Infection Prevention 00 0 Hand washing Personal Protective attires Preparation of 0 5 chlorine solution amp Decontamination Processing of equipment s cleaning steam sterilization or HLD High Level Disinfection Chemical sterilization of instruments Autoclaving b disinfection and disposal of sharps and needles Segregation of bio medical waste Labour room Operation Theatre sterilization 7 Counselling Plenary 8 Documentation session covered in Seminar room Plenary Skills Lab Operational Guidelines Annexure 2 Layout amp designs for Skill Lab Introduction A few sample designs for the Skills Lab are provided Ifthe layout is in multiple rooms then it should here This is to provide guidance to the nodal officers be close vicinity or should be neighboring and actual construction may be modified depending upon the type of space available However care must be taken not to reduce the minimum space requirements provided here 1500 Sq Ft Space will be good for the skills cabins 4 1 LR NBC O E
53. ries 5x Nickel Cadmium battery RADIANT WARMER Should have O2 cylinder provision Should have mobile newborn resuscitation table with fixed height radiant warmer Should have side trays for accessories Should have four antistatic castors Wheels and 2 wheels with breaks Should have table surface with mattress with infant head shoulder support Mattress padding should have foam density approx 21 25 kg m3 Mattress cover should be removable with zipper waterproof washable resistant to cleaning with chlorine based solution and flame retardant Side boards should be transparent acryl drop down and lockable Hood suspended above the table should integrate heating element and overhead light Overhead light should have 2 x 50W halogen spot with dimming function Heating element should have emitter with parabolic reflector and protected by metal grid and should be with high quality heating element like ceramic Control unit should allow air and skin temperature preset LCD indicator Digital Indicator and radiant heater output servo and manual Display should report system errors sensor failure shock proof with auto regulation for temperature maintenance Power requirement 220 V 50 Hz Power consumption 800 W Should have electronically controlled sensors Skin amp Air with digital display for temperature Should also have separate sensor for continuous digital display of room temperature
54. rm should have full adult arm with clenched fist and tornique position Adult IV training arm should be suitable for practicing IV injections Adult IV training arm should have prominent venous network Adult IV training arm should have anatomically located venous grooves fitted with soft latex tubes closely simulating consistency of human veins Adult IV training arm must have a pliable translucent latex skin stretched over venous network Adult IV training arm should have cephalic basic antecubital radial and ulnar veins Adult IV training arm should have veins in dorsum of hand Skills Lab Operational Guidelines O Adult IV training arm should feature realistic pop as needle enters vein O Adult IV training arm must have a Smoked Lucite base with metal stand Adult IV training arm veins and skin must be replaceable Additional Accessories 4 set of kit with simulated blood concentrate pressure bulb blood dispensing bag 4 sets of spare arm skin for future replacement 3 FEMALE CATHETERIZATION MANNEQUIN Female catheterization mannequin should have adult female lower torso with realistic vulval area and urethral opening Female catheterization mannequin must have internal bladder reservoir for standard catheterization exercises Female catheterization mannequin should have external reservoir bladder mounted on Smoked Lucite with metal stand Female catheterization mannequin
55. ructions for use and promotional materials The equipment s should have additional accessories as listed and also material gel oil to avoid friction and enhance smooth function list of accessories Et spare parts with cost amp contact details of its supplier preferably within State Delhi The payment of the equipment s is linked with installation at consignee address demonstration to service providers at consignee address and certification of installation and functionality by the head of the concerned department The supplier manufacturer should list the name and address of technical service providers in India The equipment s should have power cord wherever required temperature electrode and fittings with at least 10 meters of standard wire and accessories The suppliers should agree for receiving 10 of payment of equipment s after 3 years Warranty Period All equipment s should have device safety certification Skills Lab Operational Guidelines Theme 1 Antenatal Care Skill station Antenatal abdominal palpation and auscultation of fetal heart sound 1 HUMAN FETUS REPLICAS Features Human fetus replicas should be very close to real Human fetus replicas should have actual size showing external development and growth of the fetus for corresponding gestational age Human fetus replica should be available to represent different gestation period 5th and 7th month Human fetus re
56. s The skills lab will also be utilized to train and orient the students pursuing ANM GNM and Midwifery courses The certification will be based on the competencies acquired during the training The Skills Lab will have dedicated trainers who provides on site mentoring to ensure practicing of the skills and adherence to the technical protocols acquired by the trainees Skills Lab Operational Guidelines It is planned that at least one nursing school in every state will be developed as Centre of Excellence which will have one Skills lab Further the Skills lab will also be set up at divisional level comprising of a cluster of 4 to 5 districts and in due course it is so envisaged that every district particularly in high focus states will also have one Skills Lab Target audience The target audience of the Operational guideline on Skills lab is O State and District Trainers Managers and Planners Programme Obstetricians and Gynaecologists Paediatricians Medical Officers Staff Nurses Auxiliary Nurse Midwife and other service providers Faculty of Nursing Schools Colleges and Training Centers Faculty of Medical Colleges who can adapt it for strengthening pre service teaching 2 Competency based training in health What is competency based training A competency is a grouping of elements of knowledge and skills necessary for the effective performance of a job task Competent staff has the ability
57. should have modular urethral valve to prevent fluid leakage Female catheterization mannequin should have inflatable internal bag to lift the bladder anteriorly Female catheterization mannequin should have detachable upper skin to show bladder inflatable bag and foam Female catheterization mannequin should show connection to bladder and vagina with locking ring and rectum Female catheterization mannequin should have removable urinary assembly Additional Accessories 6 spare bladder tanks 6 urethra inserts Theme 6 Essential Newborn care Skill Stations 1 Oe Ne Oe en d _ mi D gt Essential New Born Care New Born Resuscitation KMC Measurement of Body Temperature Newborn Radiant Warmer Use of Suction machine Setting up an IV line on child arm Inserting NG Tube Phototherapy Glucometer Oxygen administration Nebulization and Multi dose inhaler ESSENTIAL NEW BORN RESUSCITATION MANNEQUIN CARE amp The Newborn mannequin should be realistic in size and appearance and also natural weight feel and touch Newborn mannequin should have features for training essential newborn care ENBC and newborn resuscitation Newborn mannequin should facilitate effective bag and mask ventilation chest must rise only with correct technique The newborn mannequin should include the following Squeeze bulbs for simulation of cord pulsation spontaneous breathing a
58. tations with skills is given in annexure 1 Steps Designate a State level Nodal Officer SNO and a District Divisional level Nodal DNO officer for Skills Lab operationalisation and their functioning At State level the State Training Officer or any Programme Officer in charge of training is designated as State Nodal Officer SNO At District Divisional level the officer in charge of Reproductive and Child Health RCH programmes by whatever designation he she is known or the Medical Superintendent of the hospital where training facility is located be designated as District Divisional Nodal Officer DNO Orient the nodal officers in competency based training models and operational guidelines on Skill lab O Selecta location and space for setting up Skills Lab This should ideally be established in the premises of a well functioning District Hospital MCH centre or any other government hospital having adequate delivery load conducting C section adequate Human Resources good and functional Labour Room Operation Theatre and other related services However in case of space constrains this can be located in other training institutions like Regional Health amp Family Welfare Training Centre Divisional Community Training Centres District Training Centres Central Training Institutions Nursing ANM training schools In case the skills lab is established in these training centres then they must be linked w
59. th 1 5 m 3 angle connector and combination acetal suction tip 2 spare valve diaphragms 2 spare piston O ring 2 spare retaining springs PEADIATRIC IV ARM KIT Should have pediatric arm Should have replacement skin and multi vein system Should have simulated blood pack Should have blood bag with tubing and connector Should have clamp and hook Should have 5 syringes Should have mannequin lubricant Additional Accessories 5 replacement skin 5 multi vein system 3 simulated blood pack 3 blood bag with tubing and connector oo 6 3 lubricant OG TUBE INSERTION MANNEQUIN Should look like 0 8 weeks old and Caucasian colour Should have soft and flexible and replaceable face skin and upper body skin Should offer OG exercises to demonstrate tube feeding and gastric suction Placing NP OP tubes must be possible Should have markings for ear canal Should have removable internal parts PHOTOTHERAPY UNIT Phototherapy unit should have heavy sturdy mobile stand Should have four antistatic castors 2 with breaks Should have single head with surface size approximately 0 50 x 0 75 m Should have head height approximately 1 40 to 1 75 m Should have blue light with 4 Compact Fluorescence Tubes CFL approximately 20 W adjustable Should have white light with 2 Compact Fluorescence Tubes CFL approximately 20 W Should have grills to protect the tubes Should have infant table
60. tocia and deal with its relief Should have features to demonstrate cord prolapse Skills Lab Operational Guidelines Shall allow demonstration and practice of placenta previa Should have cervical dilatation attachment for closed Os 4cm 6cm 8cm and fully dilated cervix Should have features simulating represent conditions of the cervix and vagina prior to labor during labor and at birth in a primgravid woman Additional Accessories One detachable padded stomach cover Detachable Manual mechanical birthing system with mounting flange One fully articulating fetal baby with adaptors to fit with manual birthing system One elevating cushion for Leopold maneuvers 6 detachable dilating cervices 6 detachable Vulva 9 vulvar inserts 6 placentas 9 umbilical cords e One 48 hour postpartum uterine activity assembly One postpartum perineal insert Reusable episiotomy repair module set of 3 including medial tears mediolateral tears and standard mediolateral episiotomy 2 sets cervical dilatation attachment for closed Os 4cm 6cm 8cm and fully dilated cervix POSTPARTUM SUTURING TRAINER Should enable use of standard needle holder with 00 or 000 chromic sutures Should have three separate modules for episiotomy Should have one model featuring medial episiotomy with tears in labia minora Should have one model featuring mediolateral episiotomy with per
61. tubing 3 spare set of internal and external filters bacterial 10 spare set of fuses OXYGEN HOOD Should have round shape 3 Medium size approximately height 22 cm diameter 25 cm 3 small size approximately height 18 cm diameter 20 cm Should be autoclavable polycarbonate Should be free from trauma of silicon neck with adjustment flap Should have bilateral oxygen nozzle Should have oxygen tube of 2 m length with one spare set of tubing Skills Lab Operational Guidelines Should have port for oxygen sensor Device is safety certified according CE 93 42 FDA 510k or equivalent NEBULIZER Should be easy to use and clean Should deliver inhaled steroids antibiotics and all commonly prescribed broncho dilators Should have features to respond to breathing pattern i e to increase release of drug on inspiration and to decrease the wastage of drug on expiration Should have mask with different size for adult amp pediatric Flow rate 6 Ipm rising up to 22 Ipm on inspiration Additional Accessories 5 filters 10 masks Each Size 10 mask amp mouth piece 5 replacement mesh 5 set tubing 2 AC DC adapters 10 set of batteries o MULTI DOSE INHALER WITH SPACER The spacer must be of 145ml volume The spacer should be 5 6 long and 2 diameter The spacer should fit with the inhaler It should have silicone one way valve to prevent exhaling air from
62. tum IUCD 1 HAND HELD UTERUS MANNEQUIN Hand held uterus model should show coronal section of uterus ovaries and fimbriae Hand held uterus model should have a clear plastic window permitting easy view of IUD Hand held uterus model should permit easy demo of inserting and removing of IUD Hand held uterus model should be Made of PVC Skills Lab Operational Guidelines FEMALE LOWER TORSO MANNEQUIN WITH NORMAL AND POSTPARTUM UTERUS AND ACCESSORIES Should have full size adult female lower torso abdomen and pelvis with relevant internal landmarks Should have palpable normal and pregnant uteri with realistically sculpted and anatomically accurate ovaries and fimbriae Should have accessories to enhance visual recognition of normal and abnormal cervices Should have removable introits Should have screw design between Uterus and Cervix for fast and easy change out Should be suitable for teaching practicing bi manual pelvic examination Should be suitable for vaginal examination including insertion of speculum uterine sounding and IUD insertion amp removal Should have distal end of vagina to facilitate introduction of a female condom Should have features to demonstrate Minilaparotomy both interval and postpartum tubal occlusion Manual vacuum aspiration MVA visual recognition of normal and abnormal cervices 48 hours postpartum fundal massage Additional Accessories One anteverted uterus One retr
63. uscultation of heart sound and cry Additional Accessories 4External umbilical cords and 6 umbilical ties 4 baby sheets or towels 2 Head cap Skills Lab Operational Guidelines 2 Neonatal mucus sucker easy to open clean autoclavable and reusable 2 Training Stethoscope NORMAL NEW BORN BABY MANNEQUINE KMC Newborn mannequin should weigh close to normal newborn 2 5 3 5 kgs Newborn mannequin should have actual size showing external development amp growth Newborn mannequin should be close to normal skin colour texture and bony feel Newborn mannequin should have moving head flexible upper and lower limbs Newborn mannequin should have baby cap nappy mittens socks Kangaroo Mother Care KMC dress shawl bed sheet for wrapping the mother and baby DIGITAL THERMOMETER MEASUREMENT OF BODY TEMPERATURE Digital thermometer should have o Celsius scale switchable to Fahrenheit Measurement range between 32 C to 43 C Accurate measurement 0 10 C between 32 C to 43 C Liquid crystal display easy to read Features to support manual switch on with beep sound after the temperature is measured and Auto switch off after 10 seconds Water proof and easy to clean Battery powered Lowbattery indicator Certification of safety according CE 93 42 FDA 510k or equivalent Must be safe to use no glass no mercury Additional Accesso
64. very cabin will have table cupboard Et white cum soft board Depending on the size of the neighboring rooms available appropriate no of skills cabin can be accommodated LR and NBC should be situated in one room No skill cabin should be less then 8 X8 The designs indicated are A Type designs for Skill cabins B Design of Tables C Design of Cupboards D Layout of Seminar Hall Rectangular space 40x20 ft BP pea o ES PA 12 12 12 Cabin 03 Cabin 04 Cabin 02 12 gt Cabin 01 12 12 E A AA ci Skills Lab Operational Guidelines Square space 32x32 ft L shaped space 44x15 ft amp 24x20ft Cabin02 Labour Room 15 Cabin 04 Handwash NBC 20 Skills Lab Operational Guidelines B Design of Tables or Marble due to its weight and wear amp 1 Table Size tear a For Skill Stations in the Training Hall qty total 10 tables 3x3x2 5 height x d The tables of the skill stations would have drawer of 2 X 2 5 length x width 4 Table for Seminar Hall b For Seminar Hall qty No 01 U shaped i U Shaped e For the Office Workstations qty No 06 ii Can accommodate 20 people at a stretch 5x2 min d Cabinets 2x3x2 height x length x width iii PA system equipped 2 Table Material iv 2 wooden almirahs with front opening of Made up of Wood Not of Marble Granite glass far keeping books libraty purpose Board of Teak Plywood C Design of Cupboards

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