Standard Standard FERTILITY CLINIC .1 Standard

126 Operation Policy In Obstetrics and Gynaecology Services 4. The clinic waiting time will be less than 30 minutes 5. Patient on follow up would be seen by a specialist or medical officer 6. All laboratory investigation will be taken and the results reviewed by the subspecialistfellow in reproductive medicine at the initial visit. 7. Counselling is initially done by subspecialist in Reproductive Medicine and the subsequently by the doctor. 8. The indications, benefits and side effects of respective HRT and various options of management would be discussed and explained to all patients by specialist. 9. The plan for each patient would be clearly documented in the folder. 10. Appropriate HRT has to be tailored for all patients 11. Subsequent follow up would be as follow :- a. Initial visit b. 6 weeks later c. Monthly for 3 months d. 3 monthly for a year e. 6monthly for life or until stopping HRT 12. At each visit, the breast and abdomen should be examined 13. Yearly fasting blood sugar, fasting lipid profiles and liver function test must be taken 14. 3 yearly mammogram and pap smear should be done OPERATIONAL POLICIES 127 Operation Policy In Obstetrics and Gynaecology Services 15. Any abnormality when patient is on HRT shall be managed by a multidisciplinary team consisting of the gynaecologist, breast and endocrine surgeon and oncologist. 16. Patient who are at low risk may continue HRT for life after being counselled 17. High risk patients should not be commenced on HRT but instead treated symptomatically 18. Bone Density Dexa scans may be done in some patients with evidence of significant family history or who complain of joint or back pains. Measurable elements of 19.5.1 1. Waiting time for new appointment 2. Waiting time in clinic to see doctor. 3. Cases seen by subspecialist in reproductive medicinefellow. 4. Number of investigations sent and reviewed in clinic 5. Audit Evidence of continuous monitoring of above standards and remediable actions taken Std: 100 19.6 ART CENTRE 19.6.1 Standard ART laboratory is made up of three areas. Andrology laboratory, embryology laboratory and cryopreservation area are fully accredited. OPERATIONAL POLICIES 128 Operation Policy In Obstetrics and Gynaecology Services Intent of 19.6.1 The embryologist wills oversea all functions, maintenance, quality controls and sterility of the embryo lab and cryopreservation area and report back to Head of Unit. The andrologist or embryologist will oversea the Andrology lab and report back to Head of Unit. All schedules and daily ongoing must be reported to Head of Unit. The Fertility Nurse Coordinator is to ensure that appropriate coordination occurs between Reproductive Medicine Consultant Specialist and anaesthetist as well as the referring doctors specialist and consultant from satellite centres. The Fertility Coordinator Nurse is to ensure that prior to ovum pick up and embryo transfer, the appropriate counselling has been done and that doctors have signs all forms included in the consent. Only subspecialist or credentialled consultant and specialist are permitted to do ovum pick up and embryo transfer. Specialist in training should be supervised prior to being privileged to do this procedure. All data needs to be key-in by the end of that day into the fertility database backed up and stored prior to shut down for the day. All forms and reports need to be filled out, filed and copies send to respective satellite centers. Separate surgical operative procedures, quality control protocols, management protocols for ART center stored in soft and hard copy with stringent security and confidentiality exercised. OPERATIONAL POLICIES