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Quality care in hco
- 1. QUALITY CHAPTERS 1 - 10
- 2. Scope of Services ο Scope ο Not in scope β life saving treatment ο Each dept ο PMRN β one time ο IP Number ο OP Number ο Prioritization ο Triaging ο Estimated cost form/ financial consent
- 3. Initial Assessment ο Emergency, OPD, IPD ο Vitals β pain ο Weight and height (paed) ο IPD β doctors and nurses ο Time frame β 24 hours documented, emergency β 1 hour, begin β 4-6 hours, Β½ an hour - emergency ο History, examination, vital signs, drug allergies, provisional diagnosis ο Nursing assessment ο Screen all for nutritional assessment β doctor/nurse β OPD/IPD/Emergency
- 4. ο Care plan β main treating doctor needs to countersign within 24 hours β junior doctor can initiate
- 5. Reassessments ο Once daily by treating consultant ο Twice daily by SR ο Thrice daily by JR/PG ο Every shift β nursing staff ο OPD β next follow up date is must ο IPD β vitals, examination findings, medication orders ο Doctors progress notes β each visit ο Round notes β countersign by consultant within 24 hours ο No CST/ continue same treatment
- 6. LAB Services ο For sample collection β PMRN and lab number ο Turn around time for each test is defined and displayed ο Biological reference values ο Critical values ο Critical values communicate to clinician β register ο Each report β name and signature of person reporting the test
- 7. ο Recall of reports β error, mark as recalled/amended in records, date and time for recall, give new report with β CAUTION β please ignore earlier one ο Lab quality assurance β internal / external ο Internal β peer review ο External β exchange sample with outside lab ο Calibration certificates - yearly
- 8. Imaging ο AERB clearance ο Dosimeters, lead shields, lead aprons ο TLD badges β technicians, nurses, doctors, class IV ο Display and signages ο RSO ο Turn around time β for all tests ο Waiting time/ time taken to perform test/ time taken to prepare report ο Critical results reporting ο Recall/Amended reports
- 9. ο Peer review β 10% reports β external/ internal with CAPA ο Appropriateness of investigations asked β discuss with clinician ο Calibration ο Pre exposure screening of patients by radiologist β USG/CT/MRI ο Lead aprons β screen once a year for cracks ο Train nurses, helpers, housekeeping, security on MRI safety
- 10. Patient care ο One doctor β SR/PG responsible for every patient ο Structured clinical handover β doctor and nurse β register ο Inter department transfer β form β documented handover ο Patient record β nursing station β confidential ο Referral β form β opinion/ takeover ο IPD patient β waiting time noted β OPD, lab, radiology ο Critical value alert register β wards, action report - file
- 11. Discharge process ο MLC β police information ο LAMA/DOR β reason to be documented, patient counseling documented, patient declaration, give discharge summary and reports as usual ο Every discharge summary signed by doctor, acknowledged by patient/relatives ο Copy retained in file
- 12. ο Every discharge summary β reason for admission, findings, diagnosis, patient condition at time of discharge, investigation results, procedures, medications, name of primary clinician, follow up and medication orders ο No BD, OD, TDS, QID ο When and how to obtain urgent care β contact number ο Death β cause , PM - findings
- 13. Emergency ο Patient identification bands ο Triaging β Disaster (code yellow) β if more than 6 patients ο Red β 1st priority β most urgent β life threatening shock, hypoxia ο Yellow β 2nd priority β can wait 10-15 min, significant injuries ο Green β non urgent β can wait 30 minutes β localised injuries ο Black β dead patients
- 14. ο MLC β police information ο Decision β Physician ο Beds β 25 , resuscitation β 5 ο All staff including attendants β BLS, selected β ACLS ο Dead on arrival β registration, breaking bad news, police information, PM, storage ο Death certificate/summary β even if brought dead ο Code blue β cardiopulmonary arrest ο Announce β code activated x location x 3 times ο Deactivated
- 15. ο Mock drill for disaster β twice a year ο Crash cart β similar ο CPR protocols β display in emergency, ICU ο CPR team β ACLS training ο Shift wise duty ο All other hospital staff β BLS trained ο Mock drill record
- 16. Procedures ο Identify the patient β PMRN, Name ο Site β surgical safety check list ο Informed written consent ο PPE ο Disinfectants/ sterilisation ο Intra procedure monitoring β pulse, BP, RR and post procedure for 2 hours β another person ο Documentation β steps, post procedure care ο Sign with name, date, time
- 17. Blood transfusion ο Transportation of blood ο Verification of blood and patient ο Consent for blood transfusion and donation β can be valid if multiple transfusion during that admission ο Chronic blood disorders β 6 months once, but endorsed each visit ο Consent β risks, benefits, complications ο Leaflets and booklets β patient and family education β blood bank, wards ο Report β for every patient for transfusion reaction ο feedback from patients ο Training of doctor/nurse/technician - record
- 18. ICU ο Admission and discharge criteria β displayed ο Staff trained for criteria ο Monitor β infection rate, readmission rate within 48 hours, reintubation rate within 48 hours, Cauterisation associated infection, ventilator associated pneumonia ο Patient and family counseling by doctor once a day, when condition changes β documented ο Nurse patient ratio β venti 1:1, non venti 1:2
- 19. Vulnerable patient ο Elderly > 65 years, child < 12 years, physically or mentally challenged, comatosed, under sedation, abused ο Yellow bands (others β white bands) ο Monitor β twice a normal patient ο Risk of falls β bed railing, ramp railings ο Consent β guardians/ relatives ο Training of all hospital staff for vulnerable patients
- 20. Obstetrics ο Assessment β nutrition, immunisation, education ο Display β WE CARE FOR HIGH RISK PREGNANCIES near OPD ο Priveleged nursing staff ο NICU
- 21. Paediatrics ο Well baby clinic ο NICU PICU ο Some posters promoting breast feeding ο Privileged staff ο Breast feeding room β OPD and IPD ο Immunisation, nutrition, growth, development ο Code Pink β child abduction ο CCTV cameras β labour room, NICU, PICU
- 22. ο Family education β nutrition, immunisation, safe parenting ο Growth chart and Immunisation chart displayed in OPD and IPD plus in each patient file ο In patient language ο Child < 12 years ο Infant < 1 year
- 23. Moderate sedation ο Consent ο Sedation by doctor or nurse ο Not by one performing the procedure ο Intra procedure monitoring ο Discharge from recovery area ο Emergency resuscitation equipment ο Anaesthesist on call
- 24. Anaesthesia ο PAC β pre anaesthesia check up β before entering OT or before admission ο Should contain anaesthesia plan β pre medication, type of anaesthesia, medication and investigations review ο Immediate pre op evaluation β in pre op room β any change in plan ο Consent for anaesthesia β risks, benefits, alternatives ο Separate from surgical consent ο During anaesthesia monitoring β documented β temp, HR, PR, RR, BP, SpO2, ETCO2 ο Cardiac rhythm β on monitor β only abnormality to be documented
- 25. ο Recovery area β patient shifting β bon basis of physiological parameters ο Please mention β type, anaesthesia medication, name of anaesthesist ο Sign with date and time and name ο Adverse anaesthesia events β documented ο Change in anaesthesia plan
- 26. Surgical procedure ο Pre op assessment ο Provisional diagnosis ο Consent by operating surgeon ο If procedure changed intra op β fresh consent ο Surgical safety checklist ο Privelege ο Operative notes detail steps and post op care ο Look for post operative complications, surgical site checklist compliance, surgical site infection, change in surgery plan
- 27. OT ο No mixture of sterile and unsterile patients ο Humidity control ο Temperature control ο Pressure differential monitoring ο Filter integrity monitoring β in 6 months ο Look for rational use of antibiotics
- 28. End of life care ο Training of staff ο Pain and palliative ο Respect religious/ social/ cultural beliefs ο REHABILITATIVE SERVICES ο Physiotherapy ο Speech therapy ο Antenatal and post natal exercises
- 29. Patient under restraint ο Physical or chemical ο Who can authorize ο Consent β relatives ο Can be at stretch for 4 hours ο Reason for restraint to be documented ο Signed by clinician or within one hour ο RESEARCH β Ethics committee, consent, right to withdraw from research
- 30. Pain Management ο All patients screen for pain ο 5th vital sign ο Detailed assessment β if required ο All post op β detailed assessment ο Reassessment β cancer pain , neuralgia, arthritis ο Not included β chest pain, labor pain ο Patient and family education ο If pain β reassess β every 4 hours ο Pain scale 0 to5 ο 0 β no hurt, 5 β hurts lot
- 31. Nutritional therapy ο Food distribution β temp control ο Dietician ο Type of diet in consultation with treating doctor ο Written orders for diet ο Kitchen β nothing stored on floor ο Control flies, insects and pests ο Refrigerator β temperature check ο Own food β patient and family counseling
- 32. Drugs ο Drug formulary β approved by DTC ο Reviewed annually if required quarterly ο Non formulary drugs β added on request sent to the MS ο 24 hours duty roaster for pharmacy ο Only prescription by doctor accepted β signed ο Display plan for drugs in racks β on computer ο Restricted entry in pharmacy ο Computerized stock register ο Daily stock check
- 33. Drug storage ο First in first out ο Store in alphabetical order of generic/ trade name ο Room temp β 15 -30 degree C ο Cold temp β 2-8 degree C, vaccines at -20 degree C ο Temp monitoring β twice a day ο Crash cart β uniform ο Nothing on floor β but 6 inches above floor ο Pest and termite control
- 34. ο High risk medicines (risk of adverse outcomes, medication errors, abuse) β stored in red colour boxes β stored under lock and key ο Look alike medicines β stored in yellow colour boxes ο Sound alike medicines β stored in green colour boxes ο LASA β stored apart from each other
- 35. Prescription writing ο Drugs β capital letters ο Name β drug name/trade name, dose, route, frequency β timing ο If 2 drugs β dose of both should be written ο Time of examination ο Signature with name and registration number ο At least MBBS ο No CST, Repeat all, repeat 1,4β¦ ο Clear and legible ο Food drug interactions
- 36. ο At all transit areas β admission, transfer, discharge β medications have to be verified by nursing staff ο Verbal orders β emergency β verified by consultant in 24 hours ο Read back ο No verbal orders for high risk medicines, narcotics, blood, children, neonates and antenatal ο High risk medicines β verified by 2 nursing staff before giving to patient
- 37. ο Check expiry date before administration of drug ο Withdraw expiry drugs 3 months prior ο Identify patient ο Verify dosage, route, timing ο Signature, name and time of who administered ο Infusion β start time, rate of infusion, end time
- 38. ο Alternative brands β authorized by doctor ο If prescription not legible β pharmacist should contact the doctor on phone ο Maintain stock β give requirement atleast 1 month prior ο Recall of drug β adverse health consequences, drug reaction β MS β circular ο Self administration β patient and family counseling, under supervision
- 39. ο Counseling β cash memo ο Expiry date ο Avoid cut strips not having expiry date/ open or tampered bottles ο Drug - drug interactions ο Drug β food interactions
- 40. ο Near miss ο Medication error ο Adverse drug reaction β dose related ο All such incidents should be reported ο LABELLING OF DRUG IN SYRINGE β name of medicine, strength, quantity, expiry date, patient name and PMRN
- 41. Narcotics ο License ο Specific area for storage ο Double locking facility β pharmacist and doctor ο Prescription by doctor ο Duplicate of prescription to be preserved ο Double check by 2nd pharmacist ο Consumed ampules to be returned to pharmacy ο Record register ο Disposed off β running water, witness
- 42. Implants ο Patient and family counseling regarding implant and cost β documented ο Batch and serial number of implant - recorded in patient file, discharge summary and OT register ο If no pre labeled sticker β manufacturer name, batch number and serial number
- 43. Unacceptable practices ο Alcohol and smoking ο Offensive language ο Inappropriate behaviour with women ο Disrespect ο Fighting ο Talking bad about colleagues ο Asking for money ο Bad communication ο Abuse
- 44. Patient rights ο Bilingual display ο Respect for personal dignity and privacy during examination ο Protection from neglect and abuse β trolley and wheel chair belts, bed railing ο Confidentialty β avoid discussion in public places, patient information not to be revealed ο HIV status β cant be written on front of file, OPD slip, cant be revealed
- 45. ο Right to refuse treatment β counsel and document and take acknowledgement ο Right to second opinion β within or outside, give assess to all records ο Written Informed consent β surgery, anaesthesia, procedure, blood transfusion, admission ο Right to know about expected cost of treatment ο Right to assess his records β for closed files within 72 hours ο Right to know the names of health care professionals β I cards and dress code
- 46. ο Right for information about care plan, progress ο Inform about alternatives, expected outcomes, possible complications ο Inform about results of diagnostic tests ο Inform about change in patient condition ο Right over worship and dietary preferences
- 47. Consent ο Risk ο Benefits ο Alternative ο Consequences of not undergoing ο Who will perform ο If patient cant give consent β spouse, son/daughter/parents, brother/sister, legal guardian ο Life threatening no one available β doctor ο Sign, doctor, witness ο Multiple sittings β once in 6 months, endorse each time
- 48. ο If no consent β defer β document counseling and take acknowledgement ο Court consent β if serious condition and consent not given β vulnerable patient , 3rd trimester pregnancy
- 49. Feedback ο Right and responsibilities β explained by admission clerk, PRO, nursing staff ο Any grief β hospital administration ο Right to voice their complaint ο Feedback β experience, communication with doctor, pain management, hospital enviroment, responsiveness of hospital staff, communication about medication and overall rating ο Mechanism of lodging complaint β complaint box β every monday
- 50. Tariff ο Uniform billing policy ο Tariff available at billing counters and registration area ο Explain estimated cost in written β cost form and take acknowledgement β resident doctor/ nursing staff ο Explain costs when change in patient condition
- 51. Patient education ο Medication and side effects ο Diet and nutrition ο Immunisation β influenza, typhoid and hep B ο Diseases, complications ο Life style modifications, dietary changes ο In form of leaflets/ print ο Inform about preventing health care associated infections β handwashing, avoid patient bed ο In patient language
- 52. Hospital infection control ο HIC team β ICO, ICN ο ICO β Microbiologist, privelege ο ICN β privelege β trained ο HIC committee β monthly basis meet ο High risk areas β ICU, OT, Blood bank, CSSD, Dialysis, Labs, Kitchen, Mortuary ο High risk procedures β surgeries > 2 hours, endoscopies ο Antibiotic policy β based on c/s, reviewed once in 3 months (antimicrobials β antibiotics and antifungal) β identify clinical conditions where used ο Notify all notifiable diseases to govt
- 53. ο Staff training regarding HIC β once a year ο Induction training within 15 days of joining ο Policies, procedures and practices of infection control programme ο Separate budget for HIC ο OT β Time gap b/w 2 surgeries β 20 minutes ο Antibiotic β 2 hours before surgery ο Fumigation β gas or smoke β 24 hours β sealed with tape β Bacilo acid ο HIV/HBV/HCV β red colour band with black dots ο TB β blue colour band
- 54. Hand hygiene ο Hand hygiene guidelines β displayed near hand washing area ο Hand washing ο Surgical β no nail polish, short nails, no ornaments, soap and water/ scrub β above elbow β 4-6 minutes ο Hygienic β soap and water - 20-30 sec β before procedure ο Social β food, toilet β 10 sec ο Steps of hand washing
- 55. Surgical
- 56. Hygienic
- 57. Barrier Nursing ο All human blood and other bodily fluids are considered infectious regardless the patient having infection β blood, secretions, excretions except sweat, non intact skin, mucous membrane ο Use of PPE β gloves, gowns, face masks, eye wear/ goggles, foot wear (biomedical waste), apron, cap/ hair cover ο Safe handling and disposal of sharps β needles, scalpels and broken glass, use forceps instead of hand to guide suturing, donβt recap needles β white container puncture proof, needle destroyer ο One needle one syringe only one time
- 58. ο ICU β controlled traffic ο New disposable gown, masks, gloves, caps for each person entering ICU and disposed off within before leaving ο Dialysis β separate machines for positive patients ο Screen patients for HIV, HBV, HCV then every 3 months ο CSSD β Central Sterilization Supply Department ο Critical β surgical/ contact with patient sterile parts/ body fluids β sterilized ο Semi critical β contact much mucous membrane β GI endoscopes β high level disinfection ο Non critical β in touch with intact skin β low level disinfectants
- 59. CSSD ο Unidirectional flow ο Separate areas for receiving, washing, cleaning, packing, sterilization, sterile storage, issue ο Sterilization of all instruments, equipments ο Validation tests for sterilization department β bacteriological strips ο Biological tests β weekly ο Physical and chemical tests β daily ο Each load should have number, content description, temp, pressure and time chart ο Breakdown of sterilization/ change in colour β withdrawl/ recall of such items
- 60. ο Blood Bank/ Labs β white coat, PPE, restricted entry ο Kitchen β refrigerator β 3-7 C ο Periodic screening of kitchen staff for parasites, salmonella typhi every 6 months or if rejoin after 15 days leave or more ο Vaccinated β Hep B, Typhoid, TT ο Before any procedure β clean the site β alcohol swab, savlon, betadine Minimum distance b/w beds β 1- 2 m ο No seepage β fungal growth ο Any renovation β approved by IC committee
- 61. House Keeping ο NO BROOMING/ DRY DUSTING ο Disinfectants/detergents/soap and water ο Mopping should be done/ wet cleaning/ dust attract mops ο If soiled β disinfectants ο For infected areas β mop laundrised before re use ο Dirty water and used disinfectant solution β discarded ο Walls and ceiling β cleaned when dirty ο While cleaning β area condoned off β with wet floor signage
- 62. ο Isolation rooms β contact/ droplet/ air borne infections ο Closed doors with negative pressure ο Prophylaxis β pre and post exposure , Hepatitis B
- 63. Spillage ο Hazardous material β blood, body fluids, microbial cultures, mercury, medical gases, ETO, steam ο Any material which due to its physical characterstic, quantity or concentration can cause real harm to a individual ο Hazmat kits β handle spills ο MSDS β Material safety data sheets ο Code orange/ hazmat ο Spill β minor - < 30 cm β clean using PPE and 1% sodium hypochlorite ο Major - > 30 cm β Code, hazmat kit ο Spillage β cover with paper towel, blotting paper, use 1% sodium hypochlorite poured all around and covered with paper for 10 minutes
- 64. Laundry ο Used linen β hand washed/ machine with gloves ο Infected/ soiled linen β disposable gloves, plastic aprons ο PEST CONTROL ο Rats, flies, mosquitoes, termites ο Fogging ο Spraying ο Glue pads ο Outsourced
- 65. Bio medical waste ο Outsourced ο Visit to site once in 6 months ο PPE ο Colour coded bags ο Collected morning 7-8 am, 1-2 pm, 7-8 pm ο Liquid β no container ο Sharps β needles, blades, scalpels β puncture proof white box containing 1% sodium hypochlorite ο Glass, slides, syringes, vials β Blue bags/bins ο Plastic syringes, IV set, tube, catheter, drains, gloves β Red bags/bins ο Blood/body fluid soaked cotton swab, linen dressing, microbiology and other lab waste, discarded medicines, expiry drugs, anatomical waste β Yellow plastic bags, bins
- 66. ο General waste, eatables, plates, glass, cups β Black bag/bin ο Human anatomical waste β deep burial/ incinerators ο Lab waste - autoclave
- 67. Employee rights and responsibilities ο Employee β regular, Staff β contractual ο Respect and dignity ο Terms and conditions in appointment letter ο Clarity about targets to achieve/job to perform ο Benefits from organisation to be clear ο Responsibilities β discipline, duties, ethics, aware of hospital policies, plan leaves in advance, care about equipments under him/her, discrete, patient interest, wear uniform , I card as required
- 68. FMS ο Hand bars, trolley and wheel chair belts, grab bars, bed railings ο Separate toilet for physically disabled ο NO SMOKING AREA ο Facility round β twice a year in patient areas, once a year β non patient areas ο Safety committee ο Safety education programmes β fire safety, lab safety, occupational safety, radiation safety ο Controlled assess β I Cards ο Round the clock maintenance staff ο Complaint register β date and time of complaint, confirmation of completion of job
- 69. ο GREEN HOSPITAL β rain water harvesting, solar panels, recycling, energy efficient lighting ο Cleaning of water storage tanks, RO unit, STP ο Dialysis water β endotoxin testing, PH, hardness ο Maintenance of lifts, Chiller unit, air conditioners ο Equipment inventory β UIN to each equipment, calibration β once/twice a year as required, quality certificates to be retained, manufacturers certificates/ manual to be retained ο Training of staff in usage of equipment ο Coding of all equipment β Dept/ name of equipment/ serial number
- 70. ο Condemnation of equipment β condemnation committee ο If cost of repair/ renewal exceeds 50% of original value ο Outdated version β cant compete with new version ο Buy back/ sold/ scrap/ retained for spares ο Recall of equipment β letter from company β immediate action ο Complaint about equipment after repair β acknowledged by department
- 71. Medical gases ο Central oxygen plant ο D type oxygen cylinders β 47 liters β 63 ο B type oxygen cylinders β 10 liters β 80 ο A type oxygen cylinders β 5 liters β 13 ο A type nitrous β 30 ο A type carbon dioxide β 15 ο Oxygen β black with white neck ο Nitrous β blue ο Carbon dioxide - grey ο Separate empty, use and full cylinders β mark them ο Gas pipeline β uniform colour code policy
- 73. Sentinel events ο Events cause harm to patient in hospital not related to patient disease for a minimum of 2 weeks of disability or death ο Surgery β wrong patient, wrong site, wrong surgery, death due to surgery, adverse anaesthesia events ο Device β contaminated medication/drug, failure/breakdown of medical equipment ο Protection β discharge of infant to a wrong mother/person, suicide or attempted suicide, no gas/oxygen, nosocromial infection ο Enviroment β blast, fall, slip, electric shock ο Criminal β abduction, sexual assault ο Medical error β medication error ο All sentinel events to be analysed within 24 hours of occuring ο CAPA
- 74. Fire safety ο Code red ο Mock drills twice a year ο Safe exit plans β each floor β displayed ο Alarm activated by pulling down the handle ο Disconnect medical gas flow and put off electric equipments ο Close the doors and windows to prevent fire and smoke from spreading ο Avoid lifts ο 1st horizontal β then β vertical evacuation ο 1st evacuate closure to dangerous area β then ambulatory β then non ambulatory (stretcher or cloth sheet)
- 75. ο USE FIRE EXTINGUISHER- ο P β Pull the pin in the nozzle of extinguisher ο A β Aim the nozzle at the base of fire ο S β Squeeze the handle ο S β Sweep from side to side to contain the fire ο Dial 444 β to activate Code Red ο PREVENTION OF FIRE ο No smoking ο No loose wire ο No inflammable materials β Petrol, LPG, Kerosene oil, candles
- 76. ο Put off lights, fans, electrical equipment when not in use ο Remove the equipment connection from the plug ο CODE VIOLET ο Fights/ violence ο CODE YELLOW ο Disaster ο CODE BLACK ο Terrorist attack/ Bob threat
- 77. Quality ο Quality committee or core committee meets every 3 months β decides the mission, vision, quality policy, quality objectives and service standards ο Quality coordinator/ Quality manager/ Accreditation coordinator ο Audits ο Performance ο Committee meetings ο Hospital clinical audit β once in 6 months ο Patient safety committee β doctors, nurses, engineers, management, security, house keeping
- 78. ο Adverse events β injury related to medical management or failure to manage ο No harm β error is not recognised, deed done but no adverse even happened ο Near miss β error realised in last nick of time and prevented
- 79. HRM ο Employee/ Staff ο Criminal/ negligence background check ο Induction training within 15 days at hospital & departmental level ο Induction record β list of trainers and trainees with signature, content of training ο Feedback is must ο Pre and post test ο Also when job change/ new equipment ο Pre employment medical check up ο Regular free health check up β once a year
- 80. ο Documented ο Credentials β qualification ο Privelege β skills ο Priveleging after 1 month of joining ο Nurse: Patient = 1:5 ο Needle stick injury β donβt squeeze or suck, wash with soap and water, report to emergency
- 81. IMS ο Daily census report ο Birth and death statistics ο Every entry β named, signed, dated, timed β patient file ο Cardiac and respiratory arrest are event of death β not cause ο Copy of PM - file ο MRD ο Restricted access ο Tracer card ο Pest and rodent control ο Fire fighting equipment
- 82. ο Retention of records ο 10 years all IPD ο MLC β permanent ο MTP β permanent ο Birth and death reports - permanent
- 83. Patient responsibilities ο Proper history and credentials ο To be on time ο To take medications regularly, follow advise ο Respect towards staff and other ο No alcohol, smoking, weapons ο No violence ο To share insurance data ο Follow up regularly ο Pay bills ο Give priority to emergencies
- 84. Clinical Audit ο Evaluation of data, documents and resources to check if performance of systems meets specified standards ο Audit of structure β staff, equipment, patient and their records ο Audit of process β procedures, investigations treatment, history taking, BMW, hand hygiene, infection control, communication ο Audit of outcomes β response to treatment, pain relief, sugar/BP control ο Audit atleast every 6 months, desirable 3 months ο Patient name β never to be disclosed
- 85. ο Assessment β time for initial assessment(OPD), documentation of care plan, signed by clinician, nutritional assessment, nursing care plan ο Medical records β discharge summary, ICD coding, consent, missing records, error prone abbreviations, medicine prescription in capitals ο Lab/Radiology β reporting errors, redos, reports correlation with clinical diagnosis, adherence to PPE ο Redos β HP/CT/MRI ο Medical management β medication errors, adverse drug reactions, pain relief following intervention, non availability of consultant on call
- 86. ο Anaesthesia β modification of plan, unplanned ventilation, anaesthesia related death, adverse anaesthesia events, reintubation rate ο Adverse anaesthesia events β hypoxia, arrythmia, cardiac arrest during anaesthesia ο Surgery β unplanned return to OT in same admission, rescheduling of surgeries β cancelled, prolonged beyond 4 hours, Surgical safety checklist adherence, appropriate antibiotic given within 2 hours, timely cesation of antibiotics, cs rate
- 87. ο Blood β transfusion reactions, wastage of blood and blood components, blood component usage, turn around time for issue of blood and blood components ο Infection control βcatheter associated UTI, Ventilator associated pneumonia, central line associated blood stream infection, surgical site infection, hand hygience compliance ο Ventilator associated events β hypoxemia β deterioration in oxygen (>20%) if hypoxemia > 2 days β event, > 4 days β condition, WBC seen on gram stain of respiratory secretions - VAP
- 88. ο Return to ICU within 48 hours, return to emergency within 72 hours ο Clinical research β percentage of research activities approved, percentage of patients withdrawing from study, protocol violations, serious adverse effects ο Patient safety β communication errors icluding handover, patient identification errors, timely refilling of fire extinguishers, sentinel events, near misses, falls ο Pharmacy β turn around time for dispensing medicines, percentage of drugs purchased outside formulary, percentage of stock outs
- 89. ο Patient satisfaction β OPD satisfaction index, IPD satisfaction index, waiting time for OPD and diagnostics (registration β check up), time taken for discharge ( writing discharge summary β final billing) ο Employee satisfaction β employee satisfaction index, attrition index, absenteeism rate, awareness about employee rights and responsibilities ο Employee safety β blood and other body fluids exposure, needle stick injuries, provision of pre exposure prophylaxis ο Variations in mock drills
- 90. ο Bed occupancy rate, average length of stay, OT utilisation rate, ICU utilisation rate, critical equipment downtime ο Nurse patient ratio
- 91. Communication in HCO ο HCW β Physicians, surgeons, anaesthesiologist, dentists, nursing staff, technicians, therapists, pharmacist, dietician β Interprofessional Team ο Supporting staff β engineers, public health, electricians, plumber, security staff, transport, house keeping, attendants, clerical, health workers ο How to communicate? ο b/w health care team themselves ο b/w health care team and patients/relatives ο Not included in any curriculum
- 92. ο Good communication β good outcome ο Bad communication β errors, financial loss, litigation ο Need β ο Doctor patient interview ο Consent ο Nursing assessment ο Problematic areas β breaking bad news, disclosing death, handling aggressive patient/ families, emergency/ disaster, disclosing adverse events, managing angry employee, patient and staff argument handling
- 93. ο Greetings, establish the rappot ο Listen patiently ο Favorable body language β dressing up, sitting posture, eye contact, hand movements ο Show empathy β be in patient position ο Avoid unnecessary medical jargon ο Donβt be judgemental ο Be clear in your talk ο Be brief and specific
- 94. ο Have a positive attitude with a smile ο Be calm but assertive ο Adapt to audience ο Understand body language and non verbal clues ο Be open minded ο BREAKING BAD NEWS β by treating consultant, separate room, give time, should have knowledge of case, in patient language, no jargons, use experience, plan out before with team
- 95. IP SET UP ο IP Team to work together ο To communicate effectively with each other ο To take decisions together β shared decision making ο Division of roles ο Leadership ο Problem areas β education difference, age difference, gender difference, cultural difference, ego ο Donβt understand the roles and responsibilities of each other ο Fatigue, lack of interest, language barrier
- 96. ο To work together β need to learn together as IP team ο Team work ο Centre point β patient ο IP concept β IPE, IPP ο Group discussions ο Role plays ο Videos ο Patient feedback ο Patient complaints ο Direct observation by peers β peer feedback