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 4th edition 14/86 14/96

3rd Edition AAC 4th Edition AAC Standard NUMBER OE SCOPE 1 3 REGISTRATION & ADMISSION 2 6 TRANSFER & REFERRAL 5 INITIAL ASSESSMENT 4 10 REASSESSMENT LAB 8 LAB QA 7 LAB SAFETY IMAGING 9 IMAGING QA IMAGING SAFETY 11 CONTINUOUS/MULTIDISCIPLINARY CARE 12 DISCHARGE PROCESS 13 DISCHARGE SUMMARY 14 TOTAL 86 4th Edition AAC Standard NUMBER OE SCOPE 1 4 REGISTRATION & ADMISSION 2 7 TRANSFER & REFERRAL 3 5 INITIAL ASSESSMENT 9 REASSESSMENT 6 LAB 10 LAB QA LAB SAFETY 8 IMAGING IMAGING QA IMAGING SAFETY 11 CONTINUOUS/MULTIDISCIPLINARY CARE 12 DISCHARGE PROCESS 13 DISCHARGE SUMMARY 14 TOTAL 96

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 3rd edition 4th edition Care of Patients (COP) 20/136 22/149

4th Edition 3rd Edition COP COP Standard NUMBER OE UNIFORM CARE, LAWS, REGULATIONS & GUIDELINES 1 4 EMERGENCY SERVICES 2 10 AMBULANCE SERVICES 3 9 HANDLING COMMUNITY EMERGENCIES, EPIDEMICS AND OTHER DISASTERS 5 CARDIO PULMONARY RESUSCITATION DOCUMENTED POLICIES and PROCEDURES GUIDE NURSING CARE 6 7 Documented procedures guide the performance of various procedures. RATIONAL USE OF BLOOD & BLOOD PRODUCTS 8 INTENSIVE CARE & HIGH DEPENDENCY UNITS VULNERABLE PATIENTS HIGH RISK OBSTETRIC CARE 11 3rd Edition COP Standard NUMBER OE UNIFORM CARE 1 4 EMERGENCY SERVICES 2 7 AMBULANCE SERVICES 3 8 CARDIO PULMONARY RESUSCITATION 5 NURSING CARE VARIOUS PROCEDURES 6 RATIONAL USE OF BLOOD & BLOOD PRODUCTS INTENSIVE CARE & HIGH DEPENDENCY UNITS VULNERABLE PATIENTS 9 OBSTETRIC CARE 10 PAEDIATRIC SERVICES 11 MODERATE SEDATION 12 ADMINISTRTAION OF ANESTHESIA 13

4th Edition 3rd Edition COP COP Standard NUMBER OE PAEDIATRIC SERVICES 12 8 MODERATE SEDATION 13 ADMINISTRTAION OF ANESTHESIA 14 11 SURGICAL PROCEDURES 15 ORGAN TRANSPLANT PROGRAM 16 4 RESTRAINTS 17 5 PAIN MANAGEMENT 18 REHABILITATIVE SERVICES 19 6 RESEARCH ACTIVITIES 20 NUTRITIONAL THERAPY 21 END OF LIFE CARE 22 TOTAL 149 3rd Edition COP Standard NUMBER OE SURGICAL PROCEDURES 14 11 RESTRAINTS 15 5 PAIN MANAGEMENT 16 REHABILITATIVE SERVICES 17 6 RESEARCH ACTIVITIES 18 NUTRITIONAL THERAPY 19 END OF LIFE CARE 20 TOTAL 136

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 3rd edition 4th edition Management of Medication (MOM) 13/73 13/76

3rd Edition MOM 4th Edition MOM Standard NUMBER OE ORGANIZATION & USAGE OF PHARMACY 1 4 HOSPITAL FORMULARY 2 5 STORAGE OF MEDICATION 3 7 PRESCRIPTIONS OF MEDICATIONS 12 SAFE DISPENSING OF MEDICATIONS 6 MEDICATION ADMINISTRATION 10 PATIENT MONITORING NEAR MISSES, MEDICATION ERRORS, ADR’s 8 NARCOTIC DRUGS & PSYCHOTROPIC SUBSTANCES 9 CHEMOTHERAPEUTIC AGENTS RADIOACTIVE DRUGS 11 IMPLANTABLE PROSTHESIS & MEDICAL DEVICES MEDICAL SUPPLIES & CONSUMABLES 13 TOTAL 73 4th Edition MOM Standard NUMBER OE ORGANIZATION & USAGE OF PHARMACY 1 4 HOSPITAL FORMULARY 2 5 STORAGE OF MEDICATION 3 7 PRESCRIPTIONS OF MEDICATIONS 13 SAFE DISPENSING OF MEDICATIONS 6 MEDICATION ADMNISTRATION 10 PATIENTS ARE MONITORED AFTER MEDICATION ADMINISTRATION NEAR MISSES, MEDICATION ERRORS ,ADVERSE DRUG EVENTS ARE REPORTED & ANALYSED 8 NARCOTIC DRUGS & PSYCHOTROPIC SUBSTANCES 9 CHEMOTHERAPEUTIC AGENTS RADIOACTIVE DRUGS 11 IMPLANTABLE PROSTHESIS 12 MEDICAL GASES TOTAL 76

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 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 3rd edition 4th edition Patients Rights And Education (PRE) 7/46 8/54

4th Edition PRE 3rd Edition PRE Standard NUMBER OE PROTECTION OF RIGHTS & INFORMATION ABOUT RESPONSIBILITY OF CARE 1 5 SUPPORTING INDIVIDUAL BELIEFS & VALUES 2 11 INFORMED CONSENT 3 7 PATIENT AND/OR FAMILY’S CONSENT EXISTS FOR MAKING INFORMED DECISION ABOUT THEIR CARE 4 8 RIGHT TO INFORMATION & EDUCATION ABOUT HEALTHCARE NEEDS RIGHT TO INFORMATION ON EXPECTED COSTS 6 PATIENT’S FEEDBACK AND REDRESSAL OF COMPLAINTS. EFFECTIVE COMMUNICATION WITH PATIENTS AND /OR FAMILIES TOTAL 54 3rd Edition PRE Standard NUMBER OE PROTECTION OF RIGHTS & INFORMATION ABOUT RESPONSIBILITY OF CARE 1 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 RIGHT TO INFORMATION ON EXPECTED COSTS 6 COMPLAINT REDRESSAL PROCESS TOTAL 46

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 3rd edition 4th edition Hospital Infection control (HIC) 9/51 9/54

3rd Edition HIC 4th Edition HIC Standard NUMBER OE HOSPITAL INFECTION CONTROL PROGRAMME 1 6 INFECTION CONTROL MANUAL 2 11 SURVEILLANCE ACTIVTIES 3 8 HOSPITAL ASSOCIATED INFECTIONS 4 PREVENTION & CONTROL OF HEALTHCARE ASSOCIATED INFECTIONS 5 CONTROL OUTBREAKS OF INFECTION STERILIZATION ACTIVITIES 7 BIOMEDICAL WASTE MEASURES (BMW) TRAINING OF STAFF TO SUPPORT HIC PROGRAMME 9 TOTAL 51 4th Edition HIC Standard NUMBER OE HOSPITAL INFECTION CONTROL PROGRAMME 1 6 INFECTION CONTROL MANUAL 2 12 SURVEILLANCE ACTIVTIES 3 9 HOSPITAL ASSOCIATED INFECTIONS 4 SUPPORT TO INFECTION CONTROL PROGRAMME 5 CONTROL OUTBREAKS OF INFECTION STERILIZATION ACTIVITIES 7 BIOMEDICAL WASTE MEASURES (BMW) 8 TRAINING OF STAFF TO SUPPORT HIC PROGRAMME TOTAL 54

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