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Questionnaire

Hospital Patient Safety No:

Indicators Questionnaire 04-B02-A01

Hospital Profile

IMPORTANT INSTRUCTIONS – PLEASE READ


• This survey aims to gather information regarding the existing performance measures and
indicators utilized by Philippine hospitals to achieve the six (6) international patient
safety goals (IPSGs).

• NOTE: This is not an audit. The research team will ensure that any identifying information
obtained through this survey will remain strictly confidential and will not be used for any other
purposes other than this research.

• The survey is self-administered and can be considered a form of self-assessment for the
hospitals, which may also help provide insight about their current level of achievement in
relation to the IPSGs. Therefore, it is highly recommended for the respondents to provide the
most accurate information that corresponds to the actual situation in the hospital at the time
of the survey using any available reference or knowledge from a qualified resource person/s.

• Before returning the survey, please check all the pages to ensure that all items have been
answered/ completed. Do not leave any item blank.

RESPONDENT INFORMATION

Name of Main Respondent: _____________________________________


Position/ Designation: _____________________________________

NOTE: Main respondent should be the person deemed most knowledgeable


about the requested information, policies and processes with at least one (1) year
experience in the institution such as hospital administrators, committee heads,
directors, etc. He/ She may request for/ verify information from other persons/
committees within the hospital to ensure the accuracy of the data that will be
provided.

HOSPITAL PROFILE

Health Care Quality and Patient Safety


University of the Philippines Manila – College of Medicine Page 1 of 4
Last update: 19 July 2018 - CAB
Questionnaire
Hospital Patient Safety No:

Indicators Questionnaire
Hospital Profile

Please describe your hospital by providing your answers to each item in the “ANSWER” column using
the corresponding items in the “ANSWER FORMAT/ OPTIONS” column as a guide.

ITEM INFORMATION ANSWER FORMAT/ ANSWER


OPTIONS
HP-1 Fiscal management Private/ LGU-retained/ DOH- LGU
retained/ Other

HP-2 Level based on DOH classification Level 2 / Level 3 Level 3

HP-3 Bed capacity Indicate number 300

HP-4 Number of active staff/personnel Indicate number for each


A. Medical A. 364
(consultants and resident/fellow trainees)
B. Nursing B. 442
C. Ancillary C. 125
D. Administrative D. 231
HP-5 Availability of Electronic Medical Record Yes/No YES, custom made web based portal
If YES, Specify software
HP-6 Presence of Information Manager Yes/No YES, Head of the IT Section

San Lazaro Hospital, Makati Medical


Center, NKTI, Lung Center of the
Philippines, Heart Center of the
HP-7 Referral hospital/s List all applicable Phils.RITM

HP-8 Referring hospital/s (please list all List all applicable LHC, Private/Public Hospital
applicable)

HP-9 PHIC Reimbursement Amount for 2016 Indicate number 94,836,240 ( Accounting Section )

HP-10 Health Facility Enhancement Program Yes/No


(HFEP) recipient yes

HP-11 JCI Accreditation Yes/No No

HP-12 Other Accreditation/s, please specify List all applicable Philhealth, ISO

HP-13 Provider: patient ratios (average) Indicate number for each


A. Doctor: patient (All areas) A.364:300
B. Doctor: patient (ER) B.7:50

Health Care Quality and Patient Safety


University of the Philippines Manila – College of Medicine Page 2 of 4
Last update: 19 July 2018 - CAB
Questionnaire
Hospital Patient Safety No:

Indicators Questionnaire
Hospital Profile

C. Doctor: patient (General ward) C.2:20

D. Doctor: patient (ICU) D.3:30


E. Nurse: patient (All areas) E.442:300
F. Nurse: patient (ER) F.51:50
G. Nurse: patient (General ward) G.5:20
H. Nurse: patient (ICU) H.8:30
I. Pharmacist: patient (All areas) I.23:300
J. Pharmacist: patient (ER) J.3:
K. Pharmacist: patient (General ward) K.3:20
L. Pharmacist: patient (ICU) L.3:30

HP-14 Reporting of Never Events Yes/No


Note: Never Events are serious reportable events, If YES, indicate rate for 2017 No
which are extremely rare medical errors that should
never happen to a patient (National Quality Forum,
2011). Examples are retained foreign object post-
procedure, wrong site surgery and patient suicide
while being cared in a healthcare setting.
HP-15 Reporting of Near-misses Yes/No YES. 7
Note: Near miss is an error that has the potential to If YES, indicate rate for 2017
cause an adverse event (patient harm) but fails to do
so because of chance or because it is intercepted
(World Alliance for Patient Safety, WHO 2005)
HP-16 Reporting of AHRQ PSI Yes/No
If YES, indicate rate for 2017
A. Pressure ulcer rate A.6
B. Death rate among surgical inpatients B.0
with serious treatable conditions
C. Retained surgical item or unretrieved C.0
device fragment count
D. Iatrogenic pneumothorax rate D.0

E. Central venous catheter-related E.


bloodstream infection rate
F. Postoperative hip fracture rate F. 0

G. Perioperative hemorrhage or G.0


hematoma right
H. Postoperative metabolic derangement H.0
rate
I. Postoperative respiratory failure rate I.0

J. Perioperative pulmonary embolism or J.0


DVT rate
K. Postoperative sepsis rate K.

L. Postoperative wound dehiscence rate L.

Health Care Quality and Patient Safety Page 3 of


University of the Philippines Manila – College of Medicine 4
Last update: 19 July 2018 - CAB
Questionnaire
Hospital Patient Safety No:

Indicators Questionnaire
Hospital Profile

M. Accidental puncture or laceration rate M. 27

N. Transfusion reaction count N.5

O. Birth trauma rate - injury to neonate O.63

P. Obstetric trauma rate - vaginal delivery P.22


with instrument
Q. Obstetric trauma rate - vaginal delivery Q.20
w/o instrument
HP-17 Events Rate (indicate last annual/ Yes/No
quarterly/ monthly frequency, if available) If YES, indicate rate for 2017

A. Hospital-acquired pneumonia A.4.67%

B. Ventilator-associated pneumonia B.13.37%

C. Surgical site infection C.7

D. Catheter-related urinary tract infection D.0

E. Falls occurring in the hospital E.35

F. Adverse drug events F.37

G. Medication error rate G.

Kindly check if you have completed answering all items


before returning this to your hospital coordinator.

THANK YOU FOR YOUR TIME.


---END---

Health Care Quality and Patient Safety


University of the Philippines Manila – College of Medicine Page 4 of 4
Last update: 19 July 2018 - CAB

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