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Changes in Clinical Standards NABH 4th Edition 2016 Dr. A. L. Basile MS Co Chair Technical Committee, NABH. Medical Director, Star Hospitals. Consultant Ophthalmolgist Section I: Patient-Centered Standards Access, Assessment and Continuity of Care (AAC) 3rd edition 14/86 4th edition 14/96 2 4th Edition 3rd Edition Standard NUMBER OE SCOPE REGISTRATION & ADMISSION 1 3 2 6 TRANSFER & REFERRAL 3 5 INITIAL ASSESSMENT 4 10 REASSESSMENT 5 5 LAB 6 8 LAB QA 7 5 LAB SAFETY 8 5 IMAGING 9 9 IMAGING QA 10 5 IMAGING SAFETY CONTINUOUS/MULTIDISC IPLINARY CARE 11 7 12 7 DISCHARGE PROCESS 13 4 DISCHARGE SUMMARY 14 7 TOTAL 14 86 AAC AAC Standar d NUMBE R SCOPE 1 OE 4 REGISTRATION & ADMISSION 2 7 TRANSFER & REFERRAL 3 5 INITIAL ASSESSMENT 4 9 REASSESSMENT 5 6 LAB 6 10 LAB QA 7 5 LAB SAFETY 8 5 IMAGING 9 10 IMAGING QA 10 6 IMAGING SAFETY CONTINUOUS/MULTIDISCIPLI NARY CARE 11 8 12 9 DISCHARGE PROCESS 13 5 DISCHARGE SUMMARY 14 7 TOTAL 14 96 3 Overall Impact of improvements: AAC Each Service in the scope should be justifiable ◦ appropriate diagnostics and treatment facilities ◦ suitably qualified personnel ◦ out-patient, in-patient and emergency cover Display ‘not in scope’ Imaging services ◦ Screening of Patients ◦ Peer review ◦ Surveillance methodology Overall Impact of improvements: AAC Equipment and Manpower of pathology & radiology depts ◦ Adequacy Actions on critical results ◦ Lab and Imaging ◦ Focus on response Critical results of outsourced services Addressing of reporting errors ◦ Amend or recall Structured handovers ◦ Transitions of care Overall Impact of improvements: AAC Care Plan to reflect the desired outcome. Coordination of care: timelines ◦ Monitoring ◦ Acting on delays ◦ Informing stakeholders Access is prioritized ◦ More sick patients are seen earlier. Early warning system Time taken for discharge ◦ Monitor timelines Section I: Patient-Centered Standards Care of Patients (COP) 3rd edition 20/136 4th edition 22/149 7 4th Edition 3rd Edition Standard NUMBER OE UNIFORM CARE 1 4 EMERGENCY SERVICES 2 7 AMBULANCE SERVICES 3 8 CARDIO PULMONARY RESUSCITATION 4 5 NURSING CARE 5 7 VARIOUS PROCEDURES 6 7 RATIONAL USE OF BLOOD & BLOOD PRODUCTS 7 8 INTENSIVE CARE & HIGH DEPENDENCY UNITS 8 7 VULNERABLE PATIENTS 9 5 OBSTETRIC CARE 10 7 PAEDIATRIC SERVICES 11 8 MODERATE SEDATION 12 8 ADMINISTRTAION OF ANESTHESIA 13 11 COP COP UNIFORM CARE, LAWS, REGULATIONS & GUIDELINES EMERGENCY SERVICES AMBULANCE SERVICES HANDLING COMMUNITY EMERGENCIES, EPIDEMICS AND OTHER DISASTERS CARDIO PULMONARY RESUSCITATION DOCUMENTED POLICIES and PROCEDURES GUIDE NURSING CARE Documented procedures guide the performance of various procedures. RATIONAL USE OF BLOOD & BLOOD PRODUCTS INTENSIVE CARE & HIGH DEPENDENCY UNITS VULNERABLE PATIENTS HIGH RISK OBSTETRIC CARE Standar d NUMBE R 1 OE 2 3 4 10 9 5 5 5 6 7 7 7 8 8 9 8 10 11 5 7 4 8 4th Edition COP 3rd Edition Standard NUMBE R 12 OE Standard NUMBER 14 OE PAEDIATRIC SERVICES 11 RESTRAINTS 15 5 13 14 8 11 PAIN MANAGEMENT 16 5 MODERATE SEDATION ADMINISTRTAION OF ANESTHESIA SURGICAL PROCEDURES 15 11 ORGAN TRANSPLANT PROGRAM RESTRAINTS PAIN MANAGEMENT 16 4 17 18 5 4 REHABILITATIVE SERVICES 19 6 RESEARCH ACTIVITIES 20 6 NUTRITIONAL THERAPY 21 6 END OF LIFE CARE 22 5 TOTAL 22 149 COP SURGICAL PROCEDURES REHABILITATIVE SERVICES 17 6 RESEARCH ACTIVITIES 18 6 NUTRITIONAL THERAPY 19 6 END OF LIFE CARE 20 5 TOTAL 20 136 8 9 Overall Impact of improvements: COP • Emergency Department - • Access QA Brought in dead Communication with ambulance during transit Organ transplant - Full standard Monitoring of patients after procedures • Disaster Management • - Focus on role of Emergency services - Patient care Overall Impact of improvements: COP • Counseling of patients on progress - ICU setting • Clarity on informed consent when needed repeatedly for Blood Transfusions - Single consent with endorsements on repeat • • • Consent for Moderate sedation Reason for restraint Functional assessment (rehab) - Reassessment • Pain alleviation - Initiate and Titrate based on need Section I: Patient-Centered Standards Management of Medication (MOM) 3rd edition 4th edition 13/73 13/76 12 3rd Edition MOM ORGANIZATION & USAGE OF PHARMACY HOSPITAL FORMULARY STORAGE OF MEDICATION PRESCRIPTIONS OF MEDICATIONS SAFE DISPENSING OF MEDICATIONS MEDICATION ADMINISTRATION PATIENT MONITORING NEAR MISSES, MEDICATION ERRORS, ADR’s NARCOTIC DRUGS & PSYCHOTROPIC SUBSTANCES CHEMOTHERAPEUTIC AGENTS RADIOACTIVE DRUGS IMPLANTABLE PROSTHESIS & MEDICAL DEVICES MEDICAL SUPPLIES & CONSUMABLES TOTAL 4th Edition Standard NUMBER OE 1 2 3 4 5 7 4 12 5 6 6 7 10 4 8 5 9 10 11 4 4 4 12 4 13 13 4 73 MOM Standar d NUMBE R OE ORGANIZATION & USAGE OF PHARMACY 1 4 HOSPITAL FORMULARY 2 5 STORAGE OF MEDICATION 3 7 PRESCRIPTIONS OF MEDICATIONS SAFE DISPENSING OF MEDICATIONS 4 13 5 6 MEDICATION ADMNISTRATION PATIENTS ARE MONITORED AFTER MEDICATION ADMINISTRATION NEAR MISSES, MEDICATION ERRORS ,ADVERSE DRUG EVENTS ARE REPORTED & ANALYSED NARCOTIC DRUGS & PSYCHOTROPIC SUBSTANCES 6 10 7 4 8 5 9 4 CHEMOTHERAPEUTIC AGENTS 10 5 RADIOACTIVE DRUGS 11 4 13 Overall Impact of improvements: MOM Strengthening of Inventory management - All areas in HCO - Stock outs Physician samples tracking and management - Address safety in storage, usage and prevent medication errors. Prescriptions have to be in Capital letters - All areas in HCO LASA drug list to be formed from formulary Reconciliation of medications/orders at transitions of care Overall Impact of improvements: MOM Special training for chemo therapeutic drugs and bio safety cabinets Patient education for chemo drugs Strengthen medication administration Strengthen medical supplies Section I: Patient-Centered Standards Patients Rights And Education (PRE) 3rd edition 4th edition 7/46 8/54 16 4th Edition 3rd Edition PRE PROTECTION OF RIGHTS & INFORMATION ABOUT RESPONSIBILITY OF CARE Standard NUMBER 1 PRE OE 5 SUPPORTING INDIVIDUAL BELIEFS & VALUES 2 10 EDUCATING PATIENT/ FAMILY MEMBERS TO MAKE INFORMED DECISIONS 3 7 INFORMED CONSENT 4 8 RIGHT TO INFORMATION & EDUCATION ABOUT HEALTHCARE NEEDS 5 8 RIGHT TO INFORMATION ON EXPECTED COSTS 6 4 COMPLAINT REDRESSAL PROCESS 7 4 TOTAL 7 46 PROTECTION OF RIGHTS & INFORMATION ABOUT RESPONSIBILITY OF CARE SUPPORTING INDIVIDUAL BELIEFS & VALUES INFORMED CONSENT PATIENT AND/OR FAMILY’S CONSENT EXISTS FOR MAKING INFORMED DECISION ABOUT THEIR CARE RIGHT TO INFORMATION & EDUCATION ABOUT HEALTHCARE NEEDS RIGHT TO INFORMATION ON EXPECTED COSTS PATIENT’S FEEDBACK AND REDRESSAL OF COMPLAINTS. EFFECTIVE COMMUNICATION WITH PATIENTS AND /OR FAMILIES TOTAL Standar d NUMBE R OE 1 5 2 11 3 7 4 8 5 8 6 4 7 5 8 6 8 54 17 Overall Impact of improvements: PRE • Patient right to get another opinion - Respect and facilitate the right • New standard on communication - Acceptable and effective communication - Communication in specific situation - Avoiding and identifying unacceptable communication • Stress on capturing patient experience in addition to feedback • Patient educational need identification and addressing it Section I: Patient-Centered Standards Hospital Infection control (HIC) 3rd edition 4th edition 9/51 9/54 19 3rd Edition HIC 4th Edition Standard NUMBER OE HIC Standar d NUMBE R OE 1 6 HOSPITAL INFECTION CONTROL PROGRAMME 1 6 INFECTION CONTROL MANUAL 2 11 HOSPITAL INFECTION CONTROL PROGRAMME SURVEILLANCE ACTIVTIES HOSPITAL ASSOCIATED INFECTIONS PREVENTION & CONTROL OF HEALTHCARE ASSOCIATED INFECTIONS 3 8 INFECTION CONTROL MANUAL 2 12 4 4 SURVEILLANCE ACTIVTIES 3 9 4 4 5 4 6 4 STERILIZATION ACTIVITIES BIOMEDICAL WASTE MEASURES (BMW) TRAINING OF STAFF TO SUPPORT HIC PROGRAMME 7 6 8 5 9 4 TOTAL 9 54 5 4 CONTROL OUTBREAKS OF INFECTION 6 4 STERILIZATION ACTIVITIES 7 5 BIOMEDICAL WASTE MEASURES (BMW) 8 5 TRAINING OF STAFF TO SUPPORT HIC PROGRAMME 9 4 TOTAL 9 51 HOSPITAL ASSOCIATED INFECTIONS SUPPORT TO INFECTION CONTROL PROGRAMME CONTROL OUTBREAKS OF INFECTION 20 Overall Impact of improvements: HIC Clinical privileging of ICN – empowerment of ICNs Rational and safe use of disinfectants Enhanced participation of stakeholders by sharing of HIC data Promote rational use of antimicrobials and monitor its usage Monitoring of MDROs & infection containment due to MDROs Improved patient safety due to pre-defined informed reuse of devices