The document summarizes the standards for hospital accreditation in Bangladesh. It is divided into two major sections: patient-focused standards and hospital-focused standards. The patient-focused standards section includes 5 chapters covering topics like patient safety, management, medication management, and patient/family rights. The hospital-focused standards section also includes 5 chapters on quality management, infection control, facility safety, governance, and information/communication. Each chapter further outlines the specific standards within that area. The document provides an overview of the accreditation standards that were being finalized.

1. Workshop on
Finalization of Hospital Accreditation
Standards
September 08, 2012
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

2. Draft | Hospital Standards
• The hospital standards are first divided into two major
sections:
1. Patient-Focused Standards [5 chapters]
2. Hospital-Focused Standards [5 chapters]
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

3. Draft | Patient Focus Standards | 5 Chapters
• Patient-focused standards section is extended into 5
chapters:
1. Patient Safety Goals [PSG]
2. Total Patient Management [TPM]
3. Critical Care Management [CCM]
4. Total Medication Management [TMM]
5. Patient and Family, Rights and Education [PFRE]
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

4. Draft | Hospital-Focused Standards | 5 Chapters
• Hospital-focused standards section is further extended
into another 5 chapters:
1. Quality and Risk Management [QRM]
2. Infections Control and Prevention [ICP]
3. Facility Safety and Equipment Management [FSEM]
4. Governance and HR Management [GHM]
5. Information and Communication [IAC]
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

5. Patient Focus Standards| Chapter 1
6 (six) Patient Safety [PSG] Goals
PSG.1 Identify Patients Correctly
PSG.2 Improve Effective Communication
PSG.3 Improve the Safety of High-Alert Medications
PSG.4 Ensure Correct-Site, Correct-Procedure, Correct-
Patient Surgery
PSG.5 Reduce the Risk of Hospital–Associated Infections
PSG.6 Reduce the Risk of Patient’s Falls
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

6. Patient Focus Standards| Chapter 2
Total Patient Management [TPM]
• Admission to the Hospital
• Continuity of Care
• Assessment of patient
• Laboratory Services
• Radiology and Diagnostic Imaging Services
• Uniform Care Delivery
• Care of High-Risk Patients and Provision of High-Risk Services
• Food and Nutrition Therapy
• End-of-Life Care
• Discharge, Referral, and Follow-Up
• Transfer of Patients | Transportation
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

7. Patient Focus Standards| Chapter 3
Critical Care Management [CCM]
• Management Responsibility
• Sedation Care
• Anesthesia Care
• Surgical Care
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

8. Patient Focus Standards| Chapter 4
Total Medication Management [TMM]
• Management Responsibility
• Selection and Procurement
• Storage
• Ordering and Transcribing
• Preparing and Dispensing
• Administration
• Monitoring
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

9. Patient Focus Standards| Chapter 5
Patient & Family, Rights & Education [PFRE]
• Patient and Family Rights
• Informed Consent
• Research
• Organ Donation
• Patient and Family Education
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

10. Hospital-Focused Standards| Section 2 | Chapter 1
Quality and Risk Management [QRM]
• Leadership and planning
• Design of Clinical and Managerial Processes
• Data Collection for Quality Measurement
• Analysis of Measurement Data
• Gaining and Sustaining Improvement
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

11. Hospital-Focused Standards| Section 2 | Chapter 2
Infection Control and Prevention [ICP]
• Leadership and Coordination
• Focus of the Program
• Isolation Procedures
• Barrier Techniques and Hand Hygiene
• Integration of the Program with Quality Improvement and Patient
Safety
• Education of Staff about the Program
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

12. Hospital-Focused Standards| Section 2 | Chapter 3
Facility Safety and Equipment Management [FSME]
• Leadership and Coordination
• Safety and Security
• Hazardous Materials
• Disaster Readiness
• Fire Safety
• Medical Equipment
• Utility Systems
• Staff Education
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

13. Hospital-Focused Standards| Section 2 | Chapter 4
Governance & HR Management [GHM]
• Governance of the Organization
• Leadership of the Organization
• Direction of Departments and Services
• Organizational Ethics
• HR Planning
• Orientation and Education
• Medical Staff Credentials | Clinical Privileging
• Ongoing Monitoring and Evaluation of Medical Staff
• Nursing Staff Credentials
• Other Health Care Practitioners Credentials
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

14. Hospital-Focused Standards| Section 2 | Chapter 5
Information and Communication [IAC]
• Communication with the Community
• Communication with Patients and Families
• Communication between Practitioners within and outside of the
Organization
• Leadership and Planning
• Patient Clinical Record
• Aggregate Data and Information
Government of the People’s Republic of Bangladesh
Directorate General of Health Services (DGHS)

15. THANK YOU
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