Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Quality Connect
National Accreditation
Board For Hospitals &
Healthcare Providers
(NABH)

ISSUE 03
SEPTEMBER 2021
NABH NEWSLETTER |

Sharing Best Practices

in Patient Safety
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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

CHAIRMAN
MESSAGE

Padma Bhushan Dr. B K Rao

Chairman- NABH

I extend my greetings and healthcare bodies opting

best wishes to the team of for assessment at various
NABH as they take stock of levels. The pandemic has not
their activities and endeavors been an obstruction in the
undertaken during the year progress and functioning of
2020-21 and present a report NABH as it has conveniently
for perusal by the authorities. shifted from physical to
virtual webinars, assessments,
Since its inception in 2005, training programs and desktop
NABH has been advancing assessments. Corresponding
constantly towards its objective progress has been witnessed
of ensuring Quality Healthcare in the Quality Connect
to one & all and to the last initiatives like Trainings,
man in the line. Through the Newsletter which not only keep
earnest and enthusiastic spirit, healthcare associates abreast
NABH team has been certainly of NABH’s undertakings,
raising the bar of quality activities, and projects but also
culture in healthcare higher invites articles by the leaders in
and still higher. the sphere of healthcare.

NABH with its dynamic, I wish NABH many more

progressive, receptive,and achievements in future!
resilient approach, is an ever-
evolving body setting new The sky will certainly not be a
destinations and putting in limit.
unflinching efforts towards
their achievement. Its
endeavors towards making
the accreditation process
free from complications and
complexities has resulted in
the ever-increasing number of

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

SECRETARY
GENERAL

Dr. Ravi P. Singh

Secretary General, QCI

This fiscal was a once-in-a-lifetime accrediting over 1,000 private medical multiple ministries and departments
challenge for the Nation, pushing us as laboratories for RT-PCR testing, 137 across the government. We also
an organization to our limits. Looking testing laboratories to test critical created a scheme with the Food Safety
back, we can proudly say that we equipment like medical devices, and Standards Authority of India
have sustained in our mission to bring ventilators, PPE kits and sanitisers; and, (FSSAI) for approval of hygiene rating
quality to the forefront in India despite 6 calibration laboratories for medical audit agencies to help consumers take
extreme adversity, and succeeded to a device calibration of Patient Monitors, informed decisions on food outlets.
large extent. Ventilators, ECG Machines and Pulse
Oximeters. The pandemic also provided us with
The COVID-19 pandemic has had a an opportunity to substantially expand
tremendous impact on economic We forayed into new areas and our digital imprint and many activities
and social activities throughout developed schemes like Workplace and trainings were done digitally due
the world. On-ground third-party Assessment for Safety and Hygiene to restrictions on movement. We
assessments, in particular, became (WASH) for all workplaces to assist were honoured to collaborate with
difficult to conduct since they were in their preparedness to mitigate Department for Promotion of Industry
not categorized as essential services. COVID-19 risks. Under this, 300 and Internal Trade (DPIIT), Ministry
Despite the challenges posed by these organizations were assessed and of Commerce and Industry to create
unprecedented circumstances, QCI saw ~1,500 participating organizations a marathon of webinars under the
newer areas of operation opening up, were trained. We assisted in fast banner of Udyog Manthan from Jan 4th,
which we had neither anticipated nor tracking redressal of COVID-19 related 2021 to March 2nd, 2021 to foster a
planned for. The Boards and Divisions grievances through Department of mindset of quality inspired productivity
within QCI found a way to remain Administrative Reforms and Public across Indian industry.
committed to its mission, and leveraged Grievances (DARPG), with ~30,000
these opportunities for creating positive grievances cleared at an average I compliment NABH on quickly adapting
change. disposal time of 1.45 days. to the new normal. NABH has proved
its resilience in the face of adversity,
In the initial period of the pandemic, FY 2020 – 2021 also saw the unveiling and its ability to rise above the odds. I
we collaborated with NITI Aayog in of many new initiatives by QCI. A would like to thank all our staff and our
preparing a roadmap for ramping proud example of this is the National esteemed partners for their support,
up COVID-19 daily tests in the Program/Project Management Policy collaboration and the opportunity to
country. Subsequently, during fiscal Framework with NITI Aayog, which is serve the nation. We shall continue to
year 2020-21, we played our part in currently being set in motion, and has adapt, grow, and strive for the best.
the fight against this pandemic by received tremendous support from

QUALITY | SAFETY | WELLNESS August 2021 | 3

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

EDITORIAL

Dr. Atul Mohan Kochhar

CEO, NABH

Dear Colleagues At NABH, we use every such

celebration as an opportunity to
NABH Standards, benchmarked reinforce our commitment to the
to the best in the world, have cause of patient safety and quality.
been built upon a matrix of all-
encompassing Safety and quality for The focus this year, is on maternal
all – patients, staff and even facility. and new-born safety, particularly
during childbirth
Since 2019, every 17th September,
has been established to be This year, we must raise global
celebrated as the World Patient awareness on the issues of maternal
Safety Day. The primary purpose is and new-born safety, strive for
adoption of best practices at the
point of care, engage multiple
stakeholders and adopt effective
and innovative strategies We must
also, call for urgent and sustainable
actions by all stakeholders to scale
up efforts, reach the unreached.

Let us also, reaffirm our

commitment to the cause of Patient
Safety and Quality.

Let us take best quality practices

Let us light and freely share to enhance global understanding in healthcare to the last man in the
the Candle of Knowledge and of patient safety, increase public line.
Hope, to create awareness, engagement in the safety of health
dispel ignorance and aim for care and promote global actions to Jai Hind.
a disease free society. enhance patient safety and reduce
patient harm.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

PAT I E N T S A F E T Y
from The Doctor’s
Point of View

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Dr. Prashant Kelkar

Dy Chief Medical Officer
(Pediatrics), JNPT Hospital,
Navi Mumbai

Communication- The Key to Patient

Safety in Clinical Practice
“These illiterate ignorant village folk… caregivers, their relative inability to express The following are some of the possible
how careless they can be,” the doctor was themselves and the immaturity of their interventions:
muttering…Sakhubai had gone home with internal organs. a. Improve reporting and encourage a
three bottles of medicines for her 5-year-old blame free culture of safety. Culture of
daughter. She had returned to the hospital Slonim and colleagues, in a study done in safety was hitherto a very subjective
as the child was vomiting after Sakhubai USA, found 1.86–2.96 medical errors per subject, but now, with the requirement
gave her the anti-scabies lotion to drink, 100 discharges of hospitalized children. of accreditation standards, including
applied the antihistaminic on the body and Incidence of medical errors in a tertiary care NABH, mandating measuring safety
put the worms medicine in her eyes with pediatric unit in central India was 35.5% culture objectively, it is hoped that
a dropper lying at home. Did the doctor and severe morbidity due to the errors was reporting will improve.
bother to think for a minute WHO had really seen in 2.4%. The frightening fact of these
been careless….? b. Analysis and corrective action based on
figures is not the figures themselves, but the
the reported errors.
exponentially possible numbers of errors
Although generalization of the statement which go undetected or unreported. c. Redesigning facilities, processes and
may seem blasphemous, the fact of the systems within the healthcare setting,
matter remains that patient safety is It is thus imperative that we take all so that they become error-proofed to
an issue which does not carry so much measures possible to reduce errors and the extent possible
importance in the mind of the clinician, as improve patient safety. d. Having a multi-disciplinary and
much as the proper treatment of the patient. multi-stakeholder approach towards
Of course, as more and more hospitals gear The ultimate aims of improving patient patient care, including appropriate
up for accreditation, clinicians have also safety are documentation of care, clinical
started understanding the importance of handovers etc. This includes involving
a. Reducing healthcare infections
quality care and patient safety, but a lot still the most important stakeholder-the
remains to be done in this area. b. Reducing complications during
patient, in care.
procedures and surgeries
e. Training of all staff on patient safety
Although this article will focus on patient c. Reducing injuries-physical, drug-
safety in pediatric patients, as this is my related, fluid-related, skin-related etc A survey done on members of the Pediatric
domain of practice, the issues and possible International Patient Safety and Quality
d. Reducing psychological harm (an
solutions can also be extrapolated to adult Community (PIPSQC) in 2015 about what
aspect which is often overlooked and
population; the only difference being that they regarded as the top patient safety
ignored)
in pediatrics, we are dealing with a subset interventions revealed the following 10
of patients who are more vulnerable by e. Reducing unnecessary interventions
interventions that they considered most
virtue of the fluid nature of their growth relevant in paediatric practice namely
What then is the solution for reducing errors
and development, their dependency on
and improving care in clinical settings?

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

1. Hand hygiene normal thing”, said Ruhana’s mother example of verbal communication is what
who had brought the child with a frank occurs between the doctor and the pediatric
2. Team training
abscess at the Pentavalent vaccine patient and family. Most pediatricians
3. Clinical pharmacists immunization site. for example, would want the patient to
4. Infection barriers return to them after visiting the pharmacy
Could all these errors have been avoided by in order to explain the usage of the drugs
5. CVL bundles
good communication? It certainly seems so. (despite getting instructions from the
6. Pre-op checklist pharmacist). In case of paediatrics, non-
7. Consent I am sure we all recollect the grand rounds of verbal communication plays significant role
our residency days in the teaching hospitals. in creating trust between the healthcare
8. Do-not-use abbreviations
The unit head, all residents and nurse staff and the often scared and wary tiny tot,
9. Rapid-response teams in-charge as well as nurses, sometimes allowing for better assessment, as well as
10. Medication reconciliation student nurses, used to go from patient ensuring better compliance to care.
to patient, the rounds sometimes lasting
A closer look at both the solutions and the hours together…that was the best example Technology has been constantly changing
survey findings above reveals the obvious of communication with all stakeholders. At healthcare for several decades, and even in
focus on adequate, appropriate and one go, it fostered communication among the arena of communication, technological
effective communication. the doctors, between doctors and nurses, advances have proved a major boon to
between teacher and student and between prevent errors. Patients can use the internet
COMMUNICATION then seems to be the key doctor and patient. In todays’ day especially to gather additional information, can get
strategy in reducing errors. To illustrate this, in non-teaching hospitals, this may not be instructions in their emails, and can access
let me quote a few real-life examples heard, practically possible, hence we need to devise their laboratory reports and health records,
witnessed or experienced (names changed ways and means to communicate, with the just as providers can also easily access data
to protect identity): primary aim of reducing errors (although at their fingertips. Social networking is being
good communication has its other collateral used extensively in healthcare settings to
1. Miss Anjali was prescribed Insulin benefits too, such as strengthening the bond share information rapidly. Telemedicine
in the dose of 4.0 units. The nurse of trust between stakeholders). can help primary physicians reduce their
misread it as 40 units, leading to critical diagnostic and therapeutic errors by getting
hypoglycaemia Who should communicate with who? In expert opinions, and robots can prevent
a healthcare setting everybody should surgical errors by the precision levels that
2. “Sir, the swab count is wrong! “, communicate effectively with each other; they work on.
exclaims Sr Jessy, as the surgeon doctors among themselves, doctors with
continues to close the wound nurses, nurses with each other, nurses with Healthcare systems are very complex, hence
paramedics, management with employees, to expect that simple interventions towards
3. Patient Roy a 6-year-old boy brought trainers with trainees, and most importantly patient safety will have transformational
with paracetamol toxicity. He had been healthcare workers with the patient and impact is unrealistic, and persistent research
advised to give paracetamol “SOS” family. In paediatrics, the last carries and evaluation of interventions is necessary
for fever, and parents gave the child even more importance and may extend to to develop safer healthcare systems.
paracetamol every half hour as fever extended family members, other caregivers Nevertheless, it can still be argued that the
was not reducing and even school staff. simplest tool that is available at all levels of
healthcare namely effective communication,
4. When the mother reported a wound Communication, in the context of patient can go a long way in improving patient
on the back of Miss Anju, who was in safety can either be in a written form or safety for pediatric practice in particular
hospital for two weeks, a grade 4 ulcer in a verbal manner. Examples of written as well as in other healthcare settings in
was noticed by the nurse. Initial grade 1 communication include clinical care general.
pressure ulcer was not communicated documentation, prescriptions (written
and allowed to deteriorate to grade 4 legibly, without abbreviations generally Thought to ponder- “The most important
following safe prescription practices), thing in communication is hearing what isn’t
5. “I was told that there will be pain at documented handovers, checklists, patient said” (Peter Drucker)
the injection site, so I thought it is a education material etc. The most important

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

PAT I E N T S A F E T Y
from The Nursing Officer's
Point of View

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Dr. Jothi Clara Micheal

Director of Nursing (Strategies & Planning)
- India Operations Division, Parkway
Healthcare India Private Ltd. (Gleneagles
Global Group and Continental Hospitals).

Clinical Best Catches as a Strategy to

Promote Error Prevention Culture and
Boosting the Morale of Bedside Nurses
An ounce of proactive & predictive role of a Nurse
is worth a pound of cure and safety.

Placing safety in the hands of bedside Here this nurse, by her timely presence of master their skills and sharpen their clinical
nurses is the trust component. Nurses, are mind, did a great job and qualifies to be the judgement over the period of time. Such
clinicians, who are highly capable when best nurse. This is a known fact across the nurses do the best catches shift after shift,
the right environment is fostered for their globe; which is why doctors prefer certain assuring safety and quality care which is
excellence. There has been a paradigm shift nurses with competency and trust. When not documented or published. That is the
over the last two decades in the approaches such a rationale is shared while honouring reason why nurses are still Unsung Heroes
to error prevention culture building. best nurses, there shall be no grievances of Health care. This paper is an attempt to
Primarily and the most vital to this strategy or professional rivalry but learning and bring to limelight the silent catches nurses
are the clinical knowledge domain of the motivation to prove their exceptional step- do, to preserve the reputation of hospitals,
nurses and the clinical competency level ups or performances. Thanks to NABH and clinicians and bring about better clinical
they possess in bedside care. QCI for its role in contributing by bringing outcomes contributing directly to the
nursing governance to visibility. There bottom line and indirectly to the top line in
What went wrong is the usual question is a mind shift from what went wrong to hospitals business. Over the years, nurses
asked by the leaders in health care and this what went right? This strategic approach have played a significant role in identifying
is not less common in nursing leadership is positive and interesting and engages best catches in their respective units, which
too. A few years ago, I shifted my perspective bedside nurses. not only has saved the patients’ lives but
in seeing who is the best nurse and how has also aided in a speedy recovery. The
do we identify them? Is it because she/he Nurses are truly the first and the last line medication management initiative helps the
is nice with the team members or does all of defence in health care, as they spend nurses identify during her assessment that
that she/he is asked to do by the reporting maximum time next to the patient and they a patient with penicillin allergy had been
authorities or she is able to perform to meet are available across the HCO with various prescribed a penicillin derivative. Her timely
the key responsibility area (KRA)? How job descriptions such as Dialysis Nurse, identification prevented the patient from an
does the best nurse stand out from other Cath Lab Nurse, Emergency Trauma care anaphylactic reaction, rather than blindly
nurses? In 2015 one of the cardiothoracic Nurse, Critical Care Nurse, Transplantation following orders. In another instance, a
surgeons narrated in my interview with Nurse, Oncology Nurse, Blood bank – patient was advised Inj Meropenem 2.25gm
him that during his difficult surgery he Apheresis Nurse, Ortho Nurse, Obstetrical by the doctor in the rounds, but it was
was amazed by his nurse who extended Nurse, Neonatal Nurse, Paediatric Nurse, transcribed as Inj Piptaz 2.25mg, the nurse
the C Clamp, which helped him to identify Operation Theatre Nurse etc. Not always identified and prevented a transcription
the vessel and ligate. If not for that timely do they learn from doctors; they also teach leading to administration error. In another
action the patient would have bled to death. doctors in their area of expertise as they example Inj Doxorubicin 50mg was indented

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

for a patient, but the pharmacy dispensed slightly displaced from the fixed position
Inj Cisplatin 50mg. The nurse identified and and informed the intensivist. Chest X-ray
rectified the dispensing error. The nurse at was taken and the displaced ET tube was
the OT had requested for A-ve blood along repositioned and confirmed. Her accurate
with the prescription, but the blood bank assessment skills prevented the patient
issued A+ve blood. The nurse identified from detoriating. From the above examples,
the error upon receiving the product and it is clearly evident that a competent and
returned the blood to the blood bank. The vigilant nurse can prevent a lot of errors
oncology nurse prior to administration with her proactiveness. The role of the nurse
of calcium gluconate identified that the initiatives and practitioners in the hospital
patient’s heart rate was only 50bpm and settings increases the quality of care, clinical
administered Tab Alupent for heart rate outcomes and patient satisfaction.
regulation. Her timely assessment prevented
the patient from deterioration. The hospital Can best catches happen naturally or
infection control nurse (HICN) during her should it be nurtured? I would strongly say
regular rounds identified that 13 patients that it has to be nurtured for the reason;
had bloodstream infection, it was identified it is directly proportionate to nursing
that the patients had a growth of ralstonia empowerment and nursing governance.
mannitolilytica in the culture. On doing a Nurses must know why they must do an act
root cause analysis it was identified that against what she has to do. “Why” is very
the sterile water was contaminated and powerful in clinical practice E.g. Why 10
the product was recalled. Therefore, this rights of medications to be followed while
timely and vigilant action of the HICN administering medicine? Why a patient has
further prevented bloodstream infections to be turned? Why side rails have to be up
in other patients. The pain management in all patients? Why enteric-coated drugs
nurse during her inpatient assessment for cannot be given for patients of RT feeds?
a paediatric child diagnosed with testicular Why bundle care to be adhered to? etc. This
torsion identified that the child was actually enhances her critical thinking skills, thereby
having pain at McBurney’s point. Ultrasound enabling her to think out of the box and
was taken and was identified that the child be vigilant. Best catches during holidays
had ruptured appendicitis and the child was and nights is a measure to say that quality
taken for surgery immediately. Her skills is improving reflecting the organizational
in accurate pain assessments enabled the philosophy and believing nursing
child to receive appropriate treatment and philosophy – Professionalism, Expertise and
thereby the clinical outcome of the patient Advocacy.
was good. The tissue viability nurse assessed
a patient who was transferred from the Across hospitals in all our Gleneagles Global
operation theatre to NICU post laminectomy. Hospitals in India Operations Division we
She had multiple erythematous patches use this as a nursing quality indicator on
all over the body, not just at the pressure a month to month basis. This has not only
points. It was suspected to be a drug allergy boosted the morale of the nurses but has
by the clinicians, but she applied Allevyn developed an error prevention culture. The
pad for all the major pressure points. The empowered role of initiatives and specialist
patches slowly disappeared in two days, nurses in the various units of the hospital
and it was identified that the patient has reported an increased level of patient
developed erythematous patches due to satisfaction, timely identification of errors Nurses are truly the
pressure. Further, the pressure injury was and escalation leading to better clinical first and the last line of
prevented and the patient had a speedy outcomes of the patient. Let us empower defence in health care,
recovery, which minimized the length of and nurture more and more Best Catches
hospital stay. The critical care nurse during towards assuring safer care and trust among
as they spend maximum
her assessment found that the ET tube was the health care system. time next to the patient

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

PAT I E N T S A F E T Y
from The Hospital
Administrator’s
Point of View

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Dr. Shakti Datt Sharma

M.D., D.A., D.H.A

Patient Safety in Healthcare Facilities

– Administrator’s point of view
Medical errors are a leading cause of harm, The administrators must proactively identify Employee Training and
injury and unnecessary deaths in patients and address patient safety issues, utilizing
all over the world. These errors end up all available data at their disposal, in order
Growth
costing the healthcare industry billions of to prevent any adverse events. Patient
A well trained staff is the first step in
rupees each year. It is becoming increasingly care records must be reviewed at a specific
reducing safety risks. Incentivising
important that the administrators of organization defined timeline, to determine
certifications, training and providing the
healthcare facilities take a keen interest if there are any common errors that may be
latest guidelines to employees aids their
in patient safety and ensure that patients preventable. Undermentioned are some of
growth and improves the quality of care
receive reliable care, which enables them to the patient safety features for health care
they can provide, thereby improving patient
maintain good health in the long run. facility that may be incorporated in their
experience.
routine practices:
The hospital administrators plays a crucial
role in developing a strategic patient safety
program and incorporating it into the
Listen and Communicate Targeted Educational
workplace culture in such a way that it is
Programs
considered a high priority by the healthcare
workers. Every healthcare environment must Listening to patients goes a long way in
making them feel comfortable. Improved Healthcare personnel might need to
prioritize patient safety and administrators
communication between patients and interface differently with different groups of
can implement a variety of controls to make
healthcare providers allows the staff to fine patients. For instance, a child undergoing a
hospital operations as seamless, efficient
tune their care. Increasing the frequency of treatment might need to be spoken to in a
and secure as possible. The administrators
rounds can help in achieving this goal. different way than a senior undergoing the
must create, maintain and document
same procedure.
policies and procedures designed to ensure
safety of patients and train and educate
their healthcare staff to follow the said Collect Patient Feedback
controls. Additionally, they must continue to Technological Aids
evaluate their policies against best practices
The patient’s feedback regarding processes,
published in the health care industry to drive Newer and improved technology, helps
procedures and level of care they received
continuous improvement. This helps prevent the healthcare providers deliver better
can provide a more objective perspective
unnecessary complications and enables the care with more efficiency and significantly
that the staff may not be able to gauge by
healthcare facility to provide high-quality lower rates of errors. It has been seen that
themselves. This may highlight any gaps in
patient care and treatment. health care facilities are reluctant to procure
the system that can be improved upon or
remediated. newer gadgets citing various reasons

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

including return
on investments,
but it has to be
emphasized by the
good administrators
that getting newer
technological aids
ultimately saves cost
in the long run helps in
reducing medical errors.

Consistent Schedules
Over-work, stress, long working hours
Safety
can all contribute to exhaustion and
Checklist
inadvertently lead to avoidable mistakes.
as a global
Keeping consistent schedules will allow
initiative to
employees to avoid burnouts, decrease
prevent and reduce the
stress and be more focussed and efficient
adverse consequences and to improve
during their shifts. Maintaining adequate
patient safety during surgical procedures.
HCW: patient ratio goes a long way in Every individual working in the health
achieving goals of patient safety. care facility plays a role in delivering
quality patient care and ensuring
Reduce Risk During patient safety. It is also important

Audit and Assess Discharge that the HCW safety is ensured by the
administrators. The administrators are
Discharges are points of extreme risk for responsible for leading their staff in these
Conducting audits and assessments with
patient safety since inpatient care ends efforts by crafting a good patient safety
external organizations and professionals
and the patient is transferred from the program that’s designed to minimize
can help observe and analyze the
hospital or healthcare facility to other the likelihood of errors. Such programs
environment from a fresh and unbiased
primary or domestic care. Lack of proper require constant reviews, analysis and
perspective. The results of such an
evaluations and preventive measures comparisons against new guidelines and
assessment can steer the healthcare
during discharge might cause significant best practices. Brainstorming of newer
facility to address the highest priority
harm to the patient. techniques and gathering creative ideas
concerns and implement improvements
from professionals should be done to
thereby improving the quality of patient
implement continuous improvement.
care they provide.
Under the watchful eyes of regulatory
Facility Rounds authorities, it can be a stressful exercise
for administrators to improve the patient
Use Tool Kits & The administrators should take daily/ outcomes. But it can prove to be a
weekly facility rounds and the scope of rewarding and fruitful experience once
Implement Checklists inspections should include survey of every their efforts are acknowledged, and
nook and corner of the health care facility patient safety goals and clinical service
Toolkit can be used to deliver and
to detect, assess the hazard potential with excellence are achieved.
implement quick improvements.
respect to every possible hazard reported
Conducting surveys amongst the
or not reported. Such rounds facilitate
healthcare staff on patient safety can also
speedy allocation of priorities, allocation
help highlight any issues that might have
of funds and implementation of corrective
been missed previously. World Health
measures.
Organization has published a Surgical

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

PAT I E N T S A F E T Y
from The Architect’s
Point of View

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Dr. Deepti Gupta

Architect, Project Manager,
and Engineer, Visiting Professor
(School of Planning and
Architect, New Delhi)

Hospital Infrastructure
for Patient Safety
A hospital is a very complex building now looking at a scenario where we in an efficient manner. While designing a
due to its very complex set of functions. might have to upgrade our codes, norms hospital we need to take care of the various
It is important that it is designed and and regulations. In a hospital, the most departments, the connectivity between
built in such a way that each and every important factor is the safety of patients. each department, and most importantly,
requirement of the hospital is fulfilled. The This includes general safety, safety of the we need to take care of patient safety and
infrastructure requirements of a hospital are patients who are not mobile or are on life ease of movement. Compartmentation and
quite unique and complex, and therefore support, safety in case of fire, safety from isolation of different facilities and different
require special attention. There are many the point of health and hygiene, avoiding patients is also required in various places.
guidelines, regulations, laws and codes to cross-contamination at every cost. Ease When we speak of separation and isolation
help ensure that the patient safety and care of access and egress for patients is also in the context of a hospital, it may be in
is maintained. As such it was always quite important. There are multiple aspects in terms of not only physical isolation, but also
complex to design a hospital with adequate Planning, Designing and Commissioning in terms of air. Eg., if a patient is suffering
and efficient infrastructure, but post Covid of Health Care Infrastructure. They range from a communicable
people are waking up to further challenges from Policy making, site selection, budget disease, the
presented by this world wide pandemic. allocation, Planning and designing, exhaled
Even the most advanced countries, with construction and project air
the top most medical facilities have not management, to day to day
been able to get a grip functioning of a hospital
on the situation,
and we are

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

cannot be allowed to come in

stages like: Project feasibility Mechanical,
contact with other people, and needs
- Need of the healthcare Electrical and Plumbing Services, include::
to be filtered before being released into
facility ,Legal feasibility, HVAC - Heating, ventilation and air
the atmosphere. Conversely if a patient
Socio-economic cost-benefit conditioning. Electrical - Energy supply
is in a precarious condition, eg, a patient
analysis, or commercial viability as and distribution, Lighting Plumbing -
suffering from intensive burns, or a patient
the case may be, Site selection, Budgetary Water supply, drainage and plumbing,
in advanced stages of AIDS, then it may not
availability etc. Planning- Project Planning Sewage disposal Fire safety - detection
be safe for them to breathe the same air as
considering Time, Cost and Quality Design and protection by firefighting and timely
exhaled by others, and we need to provide
- Considering all spatial and infrastructure egress. Escalators and lifts. Information
them with filtered air. Similarly Operation
requirements and technical aspects, and communications technology (ICT)
Theaters and clean rooms will have very
including engineering services, keeping in networks. Lightning protection.Security
high standards of filtration etc. Hospitals
mind Patient Safety and comfort. Structural and alarm systems. Building Management
have a large number of Departments,
design- for structural stability of the systems. Specialist building services for
each with their unique requirements and
buildings. Services design- of Mechanical, hospitals would also include systems for:
design considerations. The departments in
Electrical and Plumbing systems, in short Bacteria and humidity control, Emergency
a Hospital may vary according to the size
MEP Construction and project management power, Specialist gas distribution, Special
of the hospital as well as its purpose and
considering Time, Cost and Quality and TQM provisions for radiology labs, operating
speciality. The various facilities in a hospital
Operations and facilities management of the theatres. Building services play a central
may be: OPD Emergency IPD - wards and
hospital Regular maintenance and upgrade role in contributing to the design of a
rooms OTs - different sizes ICUs and NICUs
A few decades ago buildings were smaller hospital building, and the building services
Speciality departments like Oncology
and simpler. But now they are bigger, design must be integrated into the overall
Diagnostics Labs including Path and
more complex, and provide more comfort building design from a very early stage. In
Radiology Medical gases Laundry Dietary
and safety. To achieve higher levels of the subsequent issues of the newsletter, we
department - food and kitchen Blood bank
comfort, we have to design the MEP services will further elaborate on the various aspects
Waste Management Mortuary In order to
according to the desired standards.. MEP, or of Hospital Infrastructure for Patient Safety.
commission a hospital, there may be many

16 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Dr. Eesha Arora Narang

Assistant Director-NABH

Accreditation Enhancing the

Culture of Patient Safety

There can be no dual opinion that the adequate safety measures are available, measures for blood and body fluid exposure
Accreditation has contributed significantly e.g. PPE, dressing materials, disinfectants, prevention. The organisation ensures that
towards raising the standard of the fire extinguishers etc. and safety issues health care providers use appropriate
safety culture for both the patients & the should be addressed at all the levels. The personal protective equipment to prevent
healthcare workers. The accreditation organisation ensures that safety precautions blood and body fluid exposures. The
focuses on patient safety based upon have been adhered to while transporting organisation should strive to eliminate
national/international standards, through patients to and from the imaging services. the use of needle devices whenever safe
process of self and external evaluation. The Care of Patients deals in providing care and effective alternatives are available. It
Compliance with the standards is adhering to infection control and safety states that the organizations could consider
essential for achieving accreditation which practices. Safety is paramount when using providing needle devices with safety
undoubtedly results in higher quality of care narcotics, chemotherapeutic agents and features.
and patient safety. radioactive agents. A Multidisciplinary
committee is responsible for evaluating Chapter 6 is dedicated to Patient safety
The current 5th edition of hospital medication use, and patient safety & Quality Improvement. The standards
accreditation standards accredited by ISQua incidents involving medications. The encourage an environment of patient safety.
includes objective elements designated committee shall update information on The organisation implements a structured
as Core, Commitment, Achievement rational use, medication errors, medication patient-safety programme. The program is
& Excellence that focus on developing management, adverse drug reactions and developed, implemented and maintained
the culture of safety. For a glance at the patient safety, especially in the context of by a multidisciplinary safety committee. The
objective elements related to safety, the high-risk medications. A bio-safety cabinet committee is responsible for pro-active risk
Imaging services should comply with legal of class II (preferably IIA) with appropriate assessment. The same shall be done using
and other requirements, all the statutory personal protective equipment shall be used tools like Hazard Identification and Risk
requirements are to be met with such as for preparing/mixing chemotherapeutic Analysis (HIRA), Failure Modes and Effects
Atomic Energy Regulatory Board (AERB) drugs Analysis (FMEA) in both clinical and non-
clearance, dosimeters, lead shields, lead clinical processes and areas. The patient-
aprons, signage, display as per Pre- The Hospital Infection control specifies safety programme is documented as a
conception and Pre-natal diagnostics standards about healthcare provider’s manual which is comprehensive and covers
techniques (PC-PNDT) Act, reports to the safety where the organisation implements all the major elements related to patient
competent authority, etc. The organisation occupational health and safety practices safety affecting clinical and support services.
shall have a Radiation Safety Officer. There to reduce the risk of transmitting
has to be an established safety programme microorganisms among health care National/international patient-safety
in Lab & Imaging services. It ensures that providers & the organisation implements goals/solutions are implemented. The

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

organisation should have a robust incident patient safety and the approach to its within the organisation. The organisation
reporting system. The organisation implementation. Departmental leaders are could develop its procedures based on
identifies and monitors key indicators to involved in patient safety. The management Material Safety Data Sheets (MSDS).
oversee patient safety activities. Sentinel makes available adequate resources Competent personnel operate, inspect, test,
events shall be defined. All incidents are required for patient safety and earmarks and maintain equipment and utility systems.
investigated, and appropriate action is adequate funds from its annual budget The necessary infrastructure and tools like
taken. in this regard. The management uses the a ladder, voltmeter, spanner and relevant
feedback obtained from the workforce to PPE norms like safety boots, gloves shall be
The programme covers incidents ranging improve patient safety. available.
from “no harm” to “sentinel events”.
The organisation has a system in place to The procedures for medical gases address
Designated patient safety officer(s) provide a safe and secure environment. the safety issues at all levels.
coordinates implementation of the patient- Patient-safety devices and infrastructure
safety programme & the designated clinical are installed across the organisation and Credentialing and privileging of health-care
safety officer(s) coordinates implementation inspected periodically. For example, grab professionals (medical, nursing and other
of the clinical aspects of the patient-safety bars, bed rails, signposting, safety belts on para-clinical professional) are done to
programme. The organisation performs stretchers and wheelchairs, alarms both ensure patient safety. The induction training
proactive analysis of patient safety risks visual and auditory where applicable, includes training on safety. The training shall
and makes improvements accordingly. The warning signs like radiation or biohazard, incorporate aspects of patient, visitor, and
management should support the patient call bells, fire-safety devices, etc. staff safety. This includes training on ‘codes’.
safety and quality programme. The patient- Staff are trained in the organisation’s safety
safety programme is reviewed and updated Facility inspection rounds to ensure safety programme, in occupational safety aspects,
at least once a year. are conducted at least once a month. in the organisation’s disaster management
plan and in handling fire and non-fire
The management creates a culture of The organisation’s environment and emergencies. The organisation promotes
safety. The management needs to measure facilities operate to ensure the safety of staff well-being and addresses their health
its safety culture regularly (at least once patients, their families, staff, and visitors. and safety needs.
a year). This should be measured using Patient safety aspects in terms of structural
validated surveys example, the Manchester safety of hospitals, especially of critical areas The above stated objective elements make
Patient Safety Framework (MaPSaF), Safety are considered while planning, designing it evident that there is a direct and close
Attitudes Questionnaire, AHRQ Surveys and construction of new hospitals and relationship between accreditation and
on Patient Safety Culture (SOPS™). The re-planning, assessment, and retrofitting of culture of patient safety.
management should act on their patient existing hospitals.
safety culture assessment results.
The organisation conducts electrical
The leaders at all levels in the organisation safety audits for the facility. The hazardous
shall be aware of the intent of the materials are identified and used safely

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Sharing Best Practices

Under Various Goals

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Nisheeth Shankar Shrivastava

Article on International
Patient Safety Goals (IPSG)

International Patient
Safety Goals
Joint Commission International (JCI) has introduced IPSGs in 2006. These goals are patient centric goals. These are the goals which are used
to prevent the patient from any risk. There are six IPSGs which are updated time to time from they have introduced. First update of IPSGs was
made in 2011 after that second update of IPSGs was made in 2017 (at present we are following same). These IPSGs are as follows:

Identify Improve the Reduce the Risk of

Patient Safety of High Healthcare Associated
Correctly Risk Medication Infections (HAI)
G o a l :1 Goal:3 Goal:5

Goal:2 Goal:4 Goal: 6

Improve Effective Ensure correct site, Reduce the Risk of Patient
Communication Correct - Procedure Harm Resulting From
Correct - Patient Surgery FallsResulting From Falls

G o a l :1 This goal stated that before any it is suggested that patient condition where he/she unable
procedure, surgery, medication identification must be done with to confirm their name, that type
Identify Patient administration, dispensing of at least two identifiers. These of patient could be named as
Correctly medication or any other situation identifiers could be Patient’s UNKNOWN 1 & 2 and so on and
which is related to patient, name & UHID (Unique Healthcare with this name an UHID should be
the identity of patient must be Identity).If any patient doesn’t generated.
confirmed. In Health Care settings have name or patient is in

Goal:2 This IPSG emphasizes on the proper way before taking any kind 1. When the treating
effective communication between of decision which is related to consultant is unable to take
Improve Effective the Healthcare personnel. This patient. patient’s call physically or
Communication goal prevents the patient from any in case when he give verbal
kind of risk which may rise due to In any healthcare setting there are order
communication gap between the two major conditions where the
healthcare personnel. According communication played a vital role Condition related to verbal
to this goal the information of the in patient treatment. They are as order:
patient has to be confirmed in a below:

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

First of all we will not follow any order COMMUNICATION policy. Staff will
verbal order and it is also the b. The receiver (recipient) reads handover patient according to
responsibility of the healthcare back the message as he/ ISBAR.
management that they make she has heard, written and
policy in this regard. The interpreted it. I – INTRODUCTION
healthcare management needs to
define some condition in which c. The sender or the individual Documented details of patient
verbal order will be accepted. giving the order confirms that and handing over as well as taking
These conditions may be like as such recording and over staff detail.
follow: interpretation of the order is
correct & documents it
a. Lifethreateningsituations S- SITUATION
b. Serious nature of patients About the patient condition in
conditions such that which the patient is going to
1. During shift change or handing and taking over.
if medication is not
handing over the patient to
administered it may lead to
another staff
permanent harm or even
B- BACKGROUND
death of the patient
The risk of communication gap All detail regarding patient
c. Anti-diabetic drug orders increases when the staffs hand diagnosis, clinical history,
d. Reporting of critical test over patient one to another. These comorbidities, treatment given
results( report in 15 min) situations occurs when – and incident etc.

If we face any of the condition a. During shift change

stated above then the procedure b. Inter Department patient A -ASSESMENT
to take verbal order will be as transfer Details regarding patient vital
followed: record, RBS, Pain, Intake/Output,
c. Inter Hospital patient transfer
and Systemic Examination etc.
• If the consultant is giving d. Shifted to OT
orders telephonically then we e. Shifted from Recovery Area
have to follow our READ BACK R- RECOMMENDATION
During these situations, to
policy. During this condition If any special instruction regarding
minimize the risk related to
we follow the steps define patient care as patient diet, NPO,
communication gap during shift
below – pending examinations and their
change or during handing over
the patient to another staff. Staff reports pending medication,
a. The receiver (recipient) planned discharge etc. need to
should follow the EFFECTIVE
documents the complete document under this column.

Goal:3 High risk medications are To improve the safety of high risk need to be verified by at least two
those that having heavy risk of medication, we have to strengthen personnel.
Improve the causing significant harm when our policy regarding high risk
Safety of High they are used in error. Although medication dispensing, storage, Safeties during storage of
Risk Medication mistakes may or may not be documentation, administration high risk medication: High Risk
more common with these drugs, and monitoring. For these we may: Medications need to be stored in
the consequences of an error a separate highlighted (often use
are clearly more devastating to Safeties during dispense of red colour) place and these drugs
patients. high risk medication: Indent should be locked.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Safeties during documentation Safeties during administration Safeties during monitoring high
of high risk medication: All high risk medication: When it is risk medication: All indicated
high risk medication need to be needed to administer any high high risk medication need to
highlighted when documented. risk medication to the patient, monitor after administration.
These drugs should be easily staff should follow 5 Rights of
recognized. medication (Right patient, Right
route, Right medication, Right
dose, and Right time).

Goal:4 Patient needs more care when records The patient’s identity team. The circulating nurse will
he/she undergone any surgical and procedure against the initiate the Time out procedure;
Ensure correct procedure. Surgical care of the operating list that the correct members of the team will verbally
site, Correct patient is most essential part of body part has been marked in verify the following:
- Procedure healthcare. Patient safety needs relation to the information in
Correct - Patient to be ensured at each point as the clinical notes. a. Patientidentity
Surgery Pre-operative care, Peri-Operative 2nd Check: Prior to anesthesia, b. Procedure to be performed
care, and Post-operative care. To operating surgeon (or senior
ensure the surgical safety we must c. Site of the procedure, noting
member of the team) will:
follow: the position of the patient

I. Inspect the site mark and d. Presence of images (properly

a. Concerned surgeon/ team check it against the patient’s labeled and displayed)
member will do surgical supporting documentation e. Presence of required
site marking with indelible
II. Re-check imaging studies are implants and any special
marker pen.
available in the operating equipment.
b. The mark should be a circle theatre or suite f. Availability of correct
or oval, remain visible after
III. Check that the correct implants and any special
the application of skin
implant is available (if equipment or special
preparation. It is desirable
applicable) requirements
that the mark should also
remain visible even after the Documents and reports
3rd Check/Time Out- Final availability
patient is prepped ordraped
Verification: Just before the
1st Check: OT staff nurse goes to actual procedure begins, a final
the respective floor/ward/ ICU/ verification will be performed as
emergency to bring the patient a part of “TIME OUT” by all team
to the respective OT. The nurse members present.
escorting the patient will carry out
the check of following: Time Out: A pause, just prior
to performing a surgical or
I. The patient’s identity against other procedure, during which
the clinical records any unanswered questions
or confusion about patient,
II. The patient’s identity and procedure, or site are resolved by
procedure against the clinical the entire surgical or procedural

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Goal:5 It is the responsibility of I. Hand Hygiene ( Hand Rub, V. Cleaning surveillance

healthcare management to Hand Wash, Hand Scrub, and VI. Swab Cultures of Critical Care
Reduce the Risk prevent their patients from the 5 moments of hand hygiene Areas
of Healthcare Healthcare Associated Infection II. Bundle Care (VAP, CAUTI, VII. Standard Precautions etc.
Associated (HAI). In this regard healthcare CLABSI and SSI)
Infections (HAI) need to be followed all HIC
protocols guided by WHO & CDC. III. Bio Medical Waste
To prevent the patient from HAI Management
the healthcare need to follow IV. Cleaning, Disinfection and
policies given below: Sterilization

Goal:6 It is very important to reduce the III. Side rails should be open. VIII. Regular maintenance of
risk of slip, trip and fall in the all facilities
IV. Frequent Monitoring needed
Reduce the Risk organisation because slip, trip and for vulnerable patients and IX. No manhole should be open
of Patient Harm falls are lead to sentinel events. those patient who is having X. The terrace area should
Resulting From To reduce the risk of patient harm fall risk
Falls resulting from falls, the healthcare be covered with four feet
management has to keep the V. All wheel chairs and boundary.
points in mind as given below: stretchers should have safety XI. Terrace area should be
belts accessible by authorized
I. Proper fall risk assessment VI. Patient & Family education personnel only.
need to be done for each on slip, trip and fall
patient VII. Facility rounds on defined
II. Vulnerable patient should not intervals
be alone

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 Newsletter
GOAL 1 Identify Patient
National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Correctly

SANRAKSHAN - Bar Coded Medication Administration Process to ensure correct patient Medication Administration
Ms.Padma Jayprakash ,Ms. Kahkasha, Dr Archana Bajaj, Ms. Soumali
Max Super Speciality Hospital Shalimar Bagh Delhi 110088

“A drive to protect patient from medication errors and reduce adverse drug event”

AIM Process Flow Results Conclusions

BCMA Compliance
implemented and
Implementation of Complaint by 95%
Barcode Medication
Administration

To Reduce Medication

Strategy
Error

To sensitize Doctors and  Identify bottle neck for

Nursing Staff about non compliance in
Medication Safety BCMA
Key Drivers  Strengthening BCMA
Rationale process
 Identify drivers
 Improving Escalation
 BCMA uses barcodes to pathway
prevent human errors in
the distribution of
prescription medications
at hospitals. It makes sure Bibliography
that patients receive the Addition of electronic prescription transmission
correct medications at the to computerized prescriber order entry:

correct time by Key to Success Effect on dispensing errors in community

pharmacies.[Am J Health Syst Pharm. 2011]

electronically validating A systematic review of the effectiveness of

interruptive medication prescribing alerts in
and documenting hospital CPOE systems to change
prescriber behavior and improve patient
medications safety.[Int J Med Inform. 2017]
Improving Patient Safety Through the Design
and Development of a Computerized
Provider Order Entry for Parenteral Nutrition
Linked to a Barcode Medication
Administration Record.[Stud Health Technol
Inform. 2017]
Effect of e-prescribing systems on patient
safety.[Mt Sinai J Med. 201

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 Newsletter
GOAL 2 Improve Effective
National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Communication

ISBAR -Tool for Effective

Communication in Nursing Practice

Introduction f. Random flipping of entire file to gather Aim of The Study

information
The Joint Commission reported poor Hence the need for standardised structured Ensure effective communication during
communication is a contributing factor in handover tool was felt handover-takeover through the use of a
more than 60% of all hospital adverse events structured tool
they reviewed. Figure: a) Patient Handover Checklist

The ISBAR tool is regarded as a

communication technique that increases
Objectives
patient safety and is current ‘best practice’
to deliver information in critical situations. a. To identify the time taken for handover
b. To create ISBAR tool with vital
information

Need for the Study c. To educate nurses through simulation

based training via videos
It was observed that handover-takeover d. To create awareness among health care
process was monotonous and unstructured team members
leading to failure in effective communication e. To analyse the compliance of ISBAR tool
between the RN. documentation
f. To develop confidence in nurses
Various reasons observed were as follows:
through effective communication

a. The existing handover format was just

a checklist Figure: b) Live Video record of Handover-
Takeover
Methodology
b. Lack of space for documentation of
vital information Study setting: SRCC Narayana Children’s
c. Lack of standardised systemic method Hospital, Mumbai.
of handover takeover
Participants: Registered Nurses
d. Cannot provide the current patient
picture Research approach: Evaluative research
approach Sampling technique: Non-
e. Handover form was never used as a
probability purposive. Sample Size: 30 files
reference

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Tool: Structured Communication format- 2. Patient 3.Educating nurses through simulation

ISBAR based training via videos
a. Ensure patient safety
Process a. Training was conducted through video
b. Ensure patient satisfaction.
recording of handover in ISBAR format.
a. Brainstorming on content of ISBAR c. Provide quality care to patients
sheet b. Note pad was circulated among RN
b. Training of RN on ISBAR sheet-virtual c. Ongoing Supervision of RN
and simulated
3. Employee
c. Sensitization of other disciplines
regarding ISBAR sheet a. Confidence in communicating
d. Audit of documentation compliance effectively
and inspection of time required for b. Vital information available at a glance
handover in post phase for reference
e. Analysis of the effectiveness of the c. Ensure employee satisfaction
ISBAR sheet

Results
Virtual Recording Of
Handover Through Isbar Analysis and Interpretation of the data was 4. Create Awareness among health care
based on the projected objectives of the
Tool team members
study
a. Filled ISBAR template as a guide was
1.Time taken for handover displayed on departmental notice
boards
The time taken for handover was reduced
b. WhatsApp communication to all
from 4.42 mins to 4.02 mins
healthcare team members regarding
ISBAR
2. Structured Communication Tool-ISBAR
format

Benefits
1. Organisation

a. Effective communication between

healthcare members minimising error
in communication.
b. Elevates standard of care and
organization safety.
5.Analyse the compliance of ISBAR tool
c. Meets accreditation standards
documentation

Documentation compliance of 98% was

found in the month of December 2020 for 30
samples collected in Wards and ICU settings

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

6. Develop confidence in nurses

Conclusion
Health care team members i.e Nurse
Managers,Consultants and RN found the ISBAR improved communication among
tool extremely beneficial as RN to RN during handover-takeover and
to consultations on patient rounds. The
a. It was more reliable than the handover structured format helped to improve the
checklist which was existing in the accuracy of handover and takeover process
system
b. Readily available data at a glance
c. Easy reference Future Scope
Initiate ISBAR communication in

RN were vocal in communicating patient

a. Emergency codes
information during rounds
b. Telephonic conversations
A structured framework was available to c. Email
initiate communication among healthcare
d. Among other healthcare team
team members
members-Doctors, Physiotherapist,
Dietician
A narrative was written by an RN expressing
the benefits of ISBAR format and the ease in
giving handover-takeover with the format

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 Newsletter
GOAL 3 Improve the Safety of High
National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Risk Medication

Dr. Deepmala Karodiwal & Mr. Rushikesh Raut.

Kamalnayan Bajaj Hospital
Aurangabad, Maharashtra, India

Safety Practices for High

Risk Medications
Abstract Background
Aim - The aim of this study was to compare As per article published In a tertiary care 300 bedded hospital,
the trend of medication error related to numerous medicines are prescribed on
by WHO in March 2017
high risk medications before and after re- daily basis for various types of patients
implementation of preventive measures. News release GENEVA out of which 50-55 patients are admitted
Approximately, 30% of to receive treatment using high alert
Methods: The retrospective data of high problems occurring during medication. Hospital Drug formulary needs
risk medication errors from 1 st September to be maintained for all type of medicines
hospitalization are related
2020 to 15 th December 2020 was collected including high alert medicines. All these
and identified. Analysis of medication errors
to medication errors. A factors lead to an increase in the probability
was done. Preventive measures were re- number of studies have of errors related to high risk medication. A
implemented to streamline the process. shown that medication strong system to reduce and prevent the
errors are one of the main medication errors is required with more
Results: Frequency of high alert medication focus on high alert medication related errors
causes leading to disability
errors we found to be reduced considerably due to seriousness of consequences.
after development and implementation of and death in up to 6.5% of
preventive strategy. hospital admissions Initially errors related to near misses were
identified as
Conclusion: Strategies developed for As per data 43 million
preventing high risk medication errors were people are injured I. Concentrated electrolytes and
successful. worldwide each year due Chemotherapeutic drugs were
more, as concentrated electrolyte
to unsafe medical care of
Keywords: High risk medication, and chemotherapeutic drugs were
Medication errors, Adverse drug reaction, which India records 5.2 not verified, counter checked &
Body Surface area, Bio safety cabinet , Cold million medical injuries documented by the nursing staff.
chain, Double lock, Verbal orders, Read back annually. Medication II. LASA medication errors were more
policy.
errors cause at least one frequent during verbal orders.
death every day and injure III. Storage of LASA drugs using separate
Introduction labels and color coding was not
approximately 1.3 million
appropriate.
A Medication Error (ME) is any preventable people annually in the
United States of America IV. In case of insulin self-administration,
event that may cause or lead to
verbal order from doctor to nurse, and
inappropriate medication use or patient alone. RBS was not implemented.
harm while the medication is in the control
of the health care professional or patients .

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Materials & Methods The target groups of constructed strategies Concentrated electrolyte management:
included duty doctors, pharmacists, and Administration of concentrated electrolyte
Pharmacotherapeutic committee’s nurses. The high alert ME were identified to patient is double signed by nurses in the
approved list of high risk medication was and calculated as mentioned previously. drug chart. Caution label was prepared and
taken into consideration. Errors reported Reducing trend of medication errors stuck on every concentrated electrolyte
to the pharmacy, nursing staff, & clinical related to high alert drugs was seen. The before dispensing from IP Pharmacy.
pharmacists during daily ward round were redeveloped prevention strategies focused No verbal order was allowed. Clinical
taken for the study. on aspects like high alert drugs storage in pharmacist reviewed the medicine order for
pharmacy, routine training for high alert dose and dilution instruction and indication
errors, proper communication with duty before administering the medicine.
doctors, nursing staff and pharmacists.
Need of Study Insulin: Insulin regulates the metabolism
Identification of High risk Medications : To of carbohydrates, fats and proteins by
Project Phase 1 (Problem Identification) help in identification of high risk medicines promoting the absorption of glucose from
the acronym A-PINCH was developed. the blood into fat, liver and skeletal muscle
The data of high risk drugs related cells. Some of the most common insulin
medication errors during 1st September A - Concentrated Antibiotics
related problems that can occur are over
2020 to 15th December 2020 was collected. administration, diet changes and verbal
P - Potassium & Concentrated Electrolytes
The stages of medication error i.e. rescribing orders. Patient refuses to eat or forget to
error, transcribing error, dispensing error, eat or have an unexpected mealtime delay
I - Insulin & its bi-products
indenting error, wrong dose, wrong drug, but the nurse administers the insulin. If the
wrong route were identified and high alert N - Narcotics, Sedatives, Antidepressants, patient is given a morning dose at night, or
ME rate was calculated using following Antipsychotics, Anaesthetics, Skeletal vice versa can happen if any verbal orders
equation. muscle relaxants . in case of insulin are given. Strict policy of
verbal orders was implemented. Education
Number of High Alert Medication Errors x 100 related to administration of insulin for
High Alert ME Rate =
Total no of Medication Errors nursing staff are by made by Diabetologist.
To maintain storage conditions of Insulin,
Phase 2 (Problem monitoring and C – Chemotherapeutic Drugs after being dispensed from Pharmacy
elimination) Department cold chain is maintained
H - Heparin its derivatives, Ionotropes, & along with it until it arrives in ward & after
The collected medication errors were Thrombolytics administration of the same it is being stored
presented to the Pharmacotherapeutic in refrigerator in wards.
Committee (PTC) of the hospital. The Cytotoxic medications: Medication Errors
strategies for prevention of medication related to Chemotherapeutic medication Heparin: In administration of Heparin,
errors were constructed by PTC as per the were the most serious. For chemotherapy hemorrhage can occur at virtually any site in
causes of errors: protocol formats were developed with patients. An unexplained fall in hematocrit,
details of dose calculation with BSA fall in blood pressure, severe hypertension
I. High alert drugs storage in pharmacy and standard dose. Protocol is signed major surgery or patient diagnosed with
and wards separate with appropriate by consultant & the same is re-assured hemophilia, thrombocytopenia and
labeling. by the trained chemo nurse and clinical some vascular diseases. Heparin dose
pharmacist. During Chemotherapy patients is continuously monitored by clinical
II. Training for high alert drugs to duty
are observed by nurse for ADR. To avoid pharmacist. Dosage was regulated by
doctors, pharmacy staff and nursing
exposure related issues all dilutions are frequent blood coagulation tests like PT
staff.
strictly prepared in biological safety cabinet -INR. Opening and discard label was made
III. Updating of high alert drugs list, time (class II, Type B1) for safety of medicine and compulsory for storage of medicine.
to time. environment.
IV. Regular audits for monitoring safety Body Surface area(BSA) Narcotics: These are the drug having
practices of high risk drugs √ Ht in cm x Wt in Kg capacity of addiction hence may get
BSA =
3600

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

abused in hospital by healthcare workers on the basis of medication errors was

or patients. Due to this narcotics have to circulated in wards for implementation. The
be monitor more specifically in hospital. Pharmacotherapeutic committee considered
Prescription related to Narcotics & Skeletal the drug items that may cause medication
muscle relaxants are accepted in pharmacy errors such as drug that had two strengths
department only if they contain the and same drug with multiple brands.
following;

1. Name of patient
2. Name of Drug
3. Dose of Drug
4. Quantity
5. Date
6. Name & registration number of Consultant
7. Stamp & Signature.

All prescriptions related to narcotics

were strictly under observation of clinical
pharmacist and pharmacy Manager.
Duplicate prescription is used to issue
narcotics to patient. The administration
of narcotics dose is under observation of
Intensivists & Anaesthetists. Documentation
of Narcotics issued in wards is being
maintained through verification by
quantities of used ampoules. Narcotics
are stored in double lock and prescription
should be in capital letters and written by
registered Consultants only. The study found
no errors as protocols were being followed.
Training for high alert b. 0.1 mg should be mentioned as 0.1
LASA drugs storage: It was observed that mg & not .1 mg
medications
LASA drugs were put in the same place or IV. Frequently occurred errors found for
near each other. The Pharmacy Department example:
Workshop was conducted for safety
modified drug shelves and rearranged
practices of high risk medications for duty a. Tab. Doxolin (Doxophyline ) as brand
the drugs. From our observation Tall man
doctors and nurses. name and Tab. Doxy(doxycycline)
lettering was not found to be very effective
as generic & brand name get
for storage of medications in Pharmacy
Training Topics: confused hence staff were trained
department hence LASA were separated by
for the search of Generic and Brand
colour coding to prevent LASA medication
I. Rights of Medication names of drugs from Hospital’s
errors . In addition, the printed reflective
II. Name of Drugs to be mentioned drug formulary and online medical
sticker was used for identification LASA
in CAPITAL letters to avoid integrated system.
drugs were kept separately in rack (Image
1). Updated list of LASA medication misinterpretation / confusion b. Inj. Heparin 5000 IU TDS was being
III. Usage of Decimal points rescribed to patient but nursing
staff did not identified the correct
a. 10 mg should be mentioned as 10
strength & instead of administering
mg & not 10.0 mg

30 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

1 ml out of 5 ml from vial of Inj. VI. Calculated Pediatric doses are being VII. For correct administration of
Heparin 25000 IU, Whole Vial of 5 counter checked based on Child’s, medications IV flow rates have been
ml was being administered to the weight ,Childs age in months & childs displayed in the wards.
patient. age in years.
VIII. Nurses, duty doctors, pharmacists
c. For duty doctors error spotted was I. Clark rule are trained for verbal order policy
wrong transcription for example Inj. a. It uses Child’s Wt & reimplementation of read back
Biotrexate 15 mg was transcribed as policy. Reconfirmation of the medicine
Inj. Biotrexate 150 mg . b. Who are less than 1 years of age order from consultant regarding any
V. For counter check of dose transcribed c. Wt in Pounds & never in Kg discrepancy/doubt & repeat back the
being counter checked by using body dose digits. For example: one five for 15
d. Child’s Dose =
surface area based calculations as and five zero for 50.
Average adult dose x Child’s weight in pounds
150
II. Fried’s rule
To prevent medication errors regular
√Ht in cm x Wt in Kg a. Who are less than 2 years of age
BSA = Medication Safety round were conducted by
3600
b. It uses age in months Clinical Pharmacist and on the job training is
given to nurses and duty doctors. During the
c. Child’s Dose =
round errors were identified and on the spot
Average adult dose x Child’s age in monthsa
education are given to concerned persons.
150
III. Young’s rule
a. Children with 2 or more years
b. Child’s Dose =
Average adult dose x Child’s age in monthsa
Childs age in years +12

Table 1. Sound alike list of High risk drugs

SR.
SOUND ALIKE 1S OUND ALIKE 2
No.
1. CYCLO PHOSPHAMIDE CYCLOC EL / CYCLO SPORINE /CYCLO KAPRON
2. LARI NATE LARINJECT
3. DOXO RUBICIN DOXO FYLLINE / DOXO CYCLINE
4. VINB LASTIN VINC RISTIN
5. CISPLATIN CARBOPLATIN
6. DOXORUBICIN DAUNORUBICIN
7. CALAPTIN CIPLACTIN
8. PACLITAXEL DOCETAXEL
9. OXALIP ATIN OXYT OCIN
10. THALI DOMIDE LINALI DOMIDE
11. PROCARBAZINE DACARBAZINE
12. UROKINASE STREPTOKINASE
13. RITUXIMAB TRASTUZUMAB
14. XYLO TIN XYLO CAINE
15. HOSIT STROCIT
16. XYLO TIN XYLO CAINE

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Updating High risk Tool kit for High Risk Drugs Tool kit for Verbal Order
Audit
medications list
PARAMETER YES/ NO PARAMETER YES/ NO PARAMETER YES/NO

New updated list for high risk drugs was

MR NO OF PATIENT NAME OF PATIENT NAME OF THE PATIENT
introduced by combined efforts of doctors,
pharmacists and nursing department as NAME OF NAME OF PATIENT REGISTRATION
CONSULTANT CONSULTANT WHO NUMBER
per the drug availability and trend of errors. GAVE ORDER
Updated list was distributed to all wards and WARD NAME NAME OF STAFF WHO NAME OF DRUGS
pharmacy . ADVISED ORDER
NAME OF HIGH RISK NAME OF STAFF WHO DOSE
DRUG RECEIVED ORDER

INDICATION FOR HIGH WARD NAME ROUTE

Audit by clinical RISK DRUG

pharmacist IS HIGH RISK DRUG

VERIFIED BY ASSIGNED
DATE & TIME OF
VERBAL ORDER
FREQUENCY OF
ADMINISTRATION
NURSE?
Ward rounds were conducted on daily basis NAME OF ASSIGNED WHAT WAS THE MEDICATION ORDERS
and error found were informed to concerned NURSING STAFF PURPOSE OF CALL TO
CONSULTANT
doctors and corrected immediately and
IS HIGH RISK DRUG NAME OF MEDICATION I. LEGIBLE & CAPITAL
summarized reports were discussed in COUNTER CHECKED BY ADVISED BY DOCTOR LETTERS
Pharmacotherapeutic Committee. SENIOR NURSE ?
NAME OF SENIOR DOSE ADVISED BY II. DATE & TIME
NURSING STAFF DOCTOR
LABELLING IS DONE READ BACK POLICY III. SIGN OF
Audits FOR HIGH RISK DRUG WAS FOLLOWED OR PRESCRIBING DOCTOR
NOT & REGISTRATION
NUMBER
a. High risk Drug audit IS ADMINISTRATION TO AVOID CONFUSION DRUG ALLERGY
CHART DOUBLE SIGNED SPELLING WAS SPELLED MENTIONED
b. Verbal order audit AFTER OR NOT
ADMINISTRATION?
PATIENT IS BEING IS VERBAL ORDER PRESENCE OF
c. Prescription Audit MONITORED AFTER DOCUMENTED IN THERAPEUTIC
ADMINISTARTION OF MEDICAL RECORD? DUPLICATION
HIGH RISK DRUGS
REMARKS IF ANY VERBAL ORDER FORM POSSIBILITY OF DRUG -
IS BEEN SIGNED BY DRUG & FOOD DRUG
DOCTOR WHO GAVE INTERACTIONS
ORDER WITHIN 24 HRS MENTIONED

ERROR PRONE
ABBREVIATIONS USED

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Result and Discussion

Figure 1 shows the comparison of no.
of medication errors related to high risk
medication in Phase 1 & Phase 2 study. This
figure show that the number of medication
errors related to high risk medication from
16th December 2020 till date is reduced
to one. It is observed that total error also
somewhat decreased due to continuous
training of staff nurses, duty doctors, &
pharmacists on Safety Practices of High Risk
Medications & daily surveillance round by
clinical pharmacist for the implementation,
monitoring & audit for safety practices of
high risk medications is consistent.

Additional Measure V. Pharmacotherapeutic Committee: IV. NABH 4th edition December 2015
PTC Chapter 4 management of medication
Staff who prevents a medication error form – standard 2 – Hospital Formulary,
VI. Look Alike and Sound Alike : LASA
occurring are rewarded and encouraged in a standard 3 – Storage of medication,
VII. Weight: Wt standard 4 – Rational prescription of
daily routine round.
VIII. Height: Ht medication, standard 8 – Near misses,
Conclusion: The developed strategies for the medication errors & Adverse drug
prevention of high alert medication errors reaction are analysed, standard 9 –
were successful. However, the surveillance References Usage of Narcotic Drugs & standard 10
of the high alert medication error rate – Usage of Chemotherapeutic agents.
should be further monitored for continuous I. Medication Safety in High-risk V. Joint Commission on Accreditation of
effectiveness. Situations. Geneva: World Health Healthcare Organizations (2001) High
Organization; 2019(WHO/UHC/ Alert Medication drug names.
SDS/2019.10).
VI. ISMP Medication Safety Alert! Volume
II. Remingtons essential of Pharmaceutics
Abbreviation - Edited by Linda A. Felton, Chapter
6, Issue 21, October 17, 2001.

9 - Metrology and Pharmaceutical

I. Medication Error : ME
Calculations.
II. Body Surface Area : BSA
III. https://www.expresshealthcare.in/
III. Random Blood Sugar: RBS healthcare-it/medical-errors-
IV. Adverse Drug Reaction: thethird-leading-cause-of-
ADR deaths/420524/

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 Ensure correct site,
Newsletter
GOAL 4
National Accreditation Board For Hospitals & Healthcare Providers (NABH)
Correct - Procedure
Correct - Patient Surgery

Riya M Rajan
OT Staff Nurse,
Giridhar Eye Institute

Ensuring Safe Surgery

An instantly recognized mark
for surgical-site identification
and involving the patient in A checklist or other process to verify
the marking process to be preoperatively the correct site, correct
done. procedure, and correct patient and all the
documents and equipment needed to be
The full surgical team to on hand, correct, and functional.
conduct and document a
time-out procedure just Policies and procedures to be
before starting a surgical developed that support uniform
procedure. process to ensure the correct site,
correct procedure, and correct
patient, including medical and dental
procedures done in the settings other
than the operating theatre.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

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 Newsletter
GOAL 5 Reduce the Risk of Healthcare
National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Associated Infections (HAI)

Mrs. Mariyamma Thomas

Mrs. Suneetha V
Mrs. Nagalakshmi. Y
Department of Hospital Infection Control,
KIMS Hospital, Secunderabad

Abstract are identified at 53.3% collectively under

“Effectiveness various parameters such as Swelling, pain,
redness leakage, occlusion. In order to
Peripheral venous catheters (PVCs) are
of Insertion and some of the most commonly utilized prevent peripheral intra venous catheter
related blood stream infections PIVA bundles
medical devices in health care settings. Main
Maintenance uses of a peripheral intravenous catheter
are the administration of intravenous
and insertional maintenance, assessment
bundles are effective.

Bundles in fluids, blood sampling, administration of

medications and blood products. Despite
Preventing the advantages, PIC insertion is associated
with some complications. The most common
Introduction
Peripheral complication associated with PIC insertion is
phlebitis with reported incidence ranges from
Peripheral venous catheters (PVCs) are some
of the most commonly utilized medical
Intravenous 25% to 59%. Phlebitis not only causes patient
discomfort and frequent catheter change
devices in health care settings. Primary
care physicians are the first responders in
Catheter Related it may also cause further complications
like cellulitis, septicemia, DVT, and make
majority of the cases that reports to hospital.
One of commonly performed and at times
Blood Stream the patient stay in the hospital for a longer
time and increase the cost of health care.60
lifesaving procedure performed in hospital is
placement of peripheral intravenous catheter
Infections in (PIVC) insertion and maintenance bundles
checklist of patients, admitted in selected
(PIC). Incidence rate of intravenous catheter
placement in a patients admitted to hospital
Selected Critical critical care units patients evaluated from
(May 2020 to October 2020) 6 months data
is about 50%. Main uses of a peripheral
intravenous catheter are the administration
was collected by examining patients PIVA
Care Unit Patients” bundles, their feedback and observations
of intravenous fluids, blood sampling,
administration of medications and blood
of peripheral intravenous catheter insertion
products.
and maintenance practices of their
concerned staff nurses through PIVC care
Despite the advantages, PIC insertion is
bundle assessment checklist as per the CDC
associated with some complications. The
guidelines. Data reveals that, blood stream
most common complication associated
infections are not being identified but
with PIC insertion is phlebitis with reported
inflammatory changes and documentation
incidence ranges from 25% to 59%. Phlebitis
errors are found. In coherence to the
not only causes patient discomfort and
objectives the study Insertion practices
frequent catheter change it may also
are identified 80%, dressing practices 88%,
cause further complications like cellulitis,
implementation of flushing practices at
septicemia, DVT, and make the patient stay
63.3% and with nursing assessment and
in the hospital for a longer time and increase
care practice- errors, inflammatory changes
the cost of health care.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Intravascular catheters are indispensable in in order to analyse the effectiveness of maintenance practices of their concerned
modern-day medical practice, particularly in practices initiated by health care providers staff nurses through PIVC care bundle
intensive care units. Although such catheters in the hospitals in relation to peripheral assessment checklist as per the CDC
provide necessary vascular access, their use intravenous catheter insertion and the way guidelines.
puts patients at risk for local and systemic these practices are implemented and follow
infectious complications, including local to mitigate the infections and inflammation
site infection, catheter-related bloodstream of blood vessel which are an outcome if not
infections (CRBSI), septic thrombophlebitis, followed. Findings and Results
endocarditis, and other metastatic
infections (e.g., lung abscess, brain abscess, To achieve the objective of the study data
osteomyelitis, and endophthalmitis). was collected and analyzed under following
Problem Statement sections-
The catheter retained in a blood vessel is
the most common cause of bloodstream A prospective study to assess the
Section-I:
infections, and catheter-related bloodstream effectiveness of insertion and maintenance
bundles in preventing Peripheral PIVC Insertion Practice Elements
infection (CRBSI) has been the subject of
extensive surveillance and research. Intravenous catheter related blood stream
infections in selected critical care unit
Section-II:
patients in KIMS Hospitals Secunderabad.
Blood stream infection (BSI) is one of the
PIVC Dressing Practice Elements
most devastating preventable complications
in Critical Care Units. It has far-reaching
consequences resulting in prolonged length Section-III:
of hospital-stay, high costs to the individual Aims/Objectives:
PIVC Flushing Practice Elements
and exchequer, and, in many instances, loss
of life. I. To assess the Peripheral Intravenous
Catheter related to blood stream Section-IV:
Phlebitis is an inflammation of the vessel infection among patients in selected
PIVC Nursing Assessment and Care Practice
wall and it manifest as localized pain, critical care units
Elements
redness, edema and palpable venous cord. II. To evaluate the effectiveness of
Factors contributing to development of Insertion and Maintenance Bundle
phlebitis are divided into four main groups in Preventing Peripheral Intravenous
namely, Catheter related to blood stream
infection in critical care unit patients.
I. Patient factors such as age, gender and
underlying conditions;
II. Chemical factors such as type of drugs
Methodology
and fluids;
A quantitative approach with prospective
III. Mechanical factors such as catheter observational research design was carried
material, size and duration of out to assess the effectiveness of insertion
cannulation; and maintenance bundle in preventing
Section-I: Insertion
IV. A health professional practice. peripheral intravenous catheter related Practice Elements
blood stream infection in selected critical
care units patients 60 (PIVC) insertion Insertion practice elements assessment
and maintenance bundles checklist of data results revealed that practices related
The research study on “assess
patients, admitted in selected critical care to insertion of peripheral intravenous
theeffectiveness of insertion and
units patients evaluated from (May 2020 to catheter among 60 patients with peripheral
maintenance bundles in preventing
October 2020) 6 months data was collected intravenous catheters and their PIVA bundles
Peripheral Intravenous catheter related
by examining patients PIVA bundles, their and PIVC assessment and care checklist`
blood stream infections in selected
feedback and observations of peripheral
critical care unit patients” conducted
intravenous catheter insertion and

37 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

The Insertion practice elements are being

met by 88% out of 100% .

The observations are as follows.

I. Usage of Sterile transparent IV

dressings is 92.5%.
II. During insertion hand washing
practice was met by 65%.
III. Alcohol based hand rubs are available
at bed side was only 85. %
IV. Skin antisepsis with single use CHG
based application practice was 92%
V. Insertion site is cephalic or basilic vein
for adults 100%
VI. Extensions used to avoid
manipulations and types of extension
were met by 94%
VII. Split septum needleless connectors
used and scrubbed before each use
was 75%
VIII. All tubing clean of blood/drugs was
met by 98.3%

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Section-II: Dressing Practice

Elements
As per the observations dressing practice elements are
maintained by 88%.

I. Dressing practice elements assessment checklist

consist of 4 items such as Loose, moist, soiled and
type of dressing used after intravenous catheter.
II. Without Loose dressing it is identified as 98%
III. Without Moist dressing it is identified as 90%.
IV. Without Soiled dressing it is identified as 66.4%.
V. Highest being Tegaderm with 97% while Dyno-Plast
dressing was identified as lowest with 3%.

Section-III: Flushing Practice

Elements
Flushing practice elements assessment checklist consist
of 3items which are related to flushing practices before
and after IV injection through peripheral intravenous
catheter.

Observations regarding Flushing Practice elements

are as follows.

I. Single use prefilled 0.9% NS flushing usage is

identified as 97%.
II. Ideal amount and frequency of flushing is followed
by 50%.
III. Flushing before and after IV injections is followed
by 43%.
Overall flushing practices are followed by 63.3%

39 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Section-IV: Nursing to peripheral intravenous catheter insertion, worldwide. J Hosp Med 2018:13(5).
assessment, care and document errors. https://doi.org/10.12788/jhm.3039.
Assessment and Care
II. Marsh N, Webster J, Larson E,
Practice Elements Medical & Nursing Education: On the Cooke M, mihala, Rickard CM.
basis of research findings, interventions Observational Study of peripheral
Nursing assessment and care practice & strategies should be primarily focused intravenous catheter outcomes
elements results found that incident rate on health care professionals, especially in adult hospitalized patients: a
of nursing assessment and care practicing physicians and nurse’s education & training multivariable analysis of peripheral
errors were 53.3% collectively under to minimize the incidence of peripheral intravenous catheter failure. J Hosp
parameters. intravenous catheter insertion, assessment Med 2018; 13(2):83-9. https://doi.
care and document errors, to create a safe org/10.12788jhm.2867.
I. Routinely assessed catheter patency and cooperative working environment.
by heath care providers is 80% III. (3) Umschied CA, Mitchell MD, Doshi
JA, Agarwal R, Williams K, Brennan
II. Proper practice flushing protocols and Medical & Nursing Practice: The study
PJ. Estimating the proportion of
proper documentation of procedures findings reveal the faults and errors in
health care – associated infections
are followed by 53.4%. peripheral intravenous catheter insertion,
that are reasonably preventable
assessment care and document process that
III. Educate and engage patient in PIVC and the related mortality and costs.
raise the demand for more focused medical
assessment and care is followed by Infect control Hosp Eppidemoil
and nursing practice to strengthen the
7 %. 2011:32(2):101-14. .https://doi.
defense systems of hospital and minimize
IV. Unused lines are clamped and Closed org/10.1086/657912.
the harms occurring to the patient.
IV sets used are 96.6%. IV. Zing W Cartier V, Inan C, Touveneau
V. Assessment for PIVC complications Conclusion: Blood stream infections are S, Theriault M, Gayet -Ageron A,et
such as inflammatory changes not being identified but inflammatory al. Hospital wide Multidiscilinary
(Swelling, pain, redness leakage, changes and documentation errors are ,Multimodal intervention programme
occlusion) are identified as 53.3%. found. In coherence to the objectives the to reduce central venous catheter-
study Insertion practices are identified 80%, Associated bloodstream infection.
dressing practices 88%, implementation of Plos One.2014;9;e93898. Available
flushing practices at 63.3% and with nursing from. https://doi.org/10.1371/journal.
assessment and care practice- errors, pone.0093898.
inflammatory changes are identified at V. European Centre for Disease
53.3% collectively under various parameters prevention and Control. Surveillance
such as Swelling, pain, redness leakage, report: Point Prevalence survey of
occlusion. In order to prevent peripheral healthcare associated infections and
intra venous catheter related blood stream antimicrobial use in European acute
infections PIVA bundles and insertional care hospitals. Stockholm: ECDC,2013;
maintenance bundles are effective. Available from: http://ecdc.europa.eu/
Implications
enpublications/healthcare associated
-infections-antimicrobial -use-PPS.pdf.
Hospital Administration: The study
findings enlighten the areas, nature & types References VI. Harbarth S,Sax H, Gastmeier P.
of peripheral intravenous catheter insertion, preventable proportion of nosocomial
assessment, care and document errors. It I. Alexandrou E, Ray Barruel G,Carr infections: an overview of published
can be helpful for hospital administrators PJ, Frost SA, Inwood S, Higgins reports. J Hosp Infect 2003;54:258-
those are involved in quality assurance and N, et al, Use of short peripheral 266.Available from: https://doi.
quality assessment activities to identify and intravenous catheters:Characteristics, org/10.1016/S0195-670(03)00150-6.
bridge the slips, lapses, or mistakes related management, and outcomes

40 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter
GOAL 6 Reduce the Risk of Patient
National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Harm Resulting From Falls

41 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

With The Strong Commitment

and Regular Trainings Lets

Achieve the IPSGs!!!

In every healthcare facility, the chances of occurring errors is similar. In a big healthcare setup with the perfect
manpower, the errors are identified but in small one the same are unknowingly hidden. The implementing IPSGs means
bringing an effective system in the facility to create safe and error free environment for their patients..!!

Let’s confidently implement the International Patient Safety Goals (IPSGs)!

01
1. For all purpose always use full name of the Patient
Identify patients correctly 2. Register every patient with UID (Unique Identification No.)
3. Tie Patient with ID bands containing full name & UID No.

Improve effective
02
1. Use ISBAR for accurate handover and transfer the information
2. Provide planned & detailed induction training programme
communication 3. Organize training on communication skills for every staff

Improve the safety of high- 1. Follow ISMP’s High-Alert Medications (HAM) list and updates

alert medications 03 2.
3.
Appropriately display the list & keep HAMs under lock & key
Administer HAM’s following all R’s with proper double check
4. Under Lock & Key

04
1. Follow & implement WHO’s Surgical Safety Checklist
Ensure safe surgery 2. Follow & implement NABH OT Air Conditioning Guidelines
3. Regularly conduct the training for very staff and doctor

Reduce the risk of health

05
1. Prepare a HIC (Hospital Infection Control) Team & Committee
2. Organize training on HIC for every staff (Repeat Six Monthly)
care-associated infections 3. Promote WHO’s Hand hygiene Techniques & Moments

Reduce the risk of patient

06
1. Prepare a Hospital Safety Management Team & Committee
2. Organize training on safety policies (include in Induction also)
harm resulting from falls 3. Educate & promote raising on incident reporting form

The only purpose of the IPS Goals is to improve the overall patient safety in the Healthcare facility. Identifying patients
correctly makes sure that each patient gets the correct treatment. Effective communication reduces the every potential
error. ISMP (Institute for Safe Medication Practices) guideline helps safe medication administration. CDC (Centres for
Disease Control and Prevention) and World Health Organization (WHO) use proven guidelines to prevent infections that
are difficult to treat. WHOs surgical safety checklist prevents mistakes in surgery.
All required to achieve these goals is the TOP Management’s strong commitment and regular trainings to their every
staff including doctors. An appropriate display of these goals in hospital’s OPD and IPD areas can be effective way to
educate everyone. Always remember to communicate the achieved success in the form of data display online and offline
ways to their staff, patient and vendors. This will increase the confidence of implementing the IPSGs!!!

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CASE STUDY
Newsletter 1 National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Nayana Das & Riya Varghese

Executive, Department of Quality, MVR Cancer
Centre And Research Institute, Kozhikode

A Review on The Measures Taken to Minimize

The Noncompliance on IPSGS at MVR Cancer
Centre and Research Institute, Kozhikode

Abstract
The purpose of this study was to integrate very helpful in terms of understanding the of safe care, with a high degree of quality,
these six core goals of IPSG which focus noncompliance to the IPSGs and ways they based on the expectations of the community
on patients safety overall. So, if we work can overcome it. This would also help the population. Patient safety remains a
on these six IPSG goals we can definitely staff to improve the quality and safety of priority issue on the agendas of healthcare
have a better impact and outcome in terms patient care as these are the two integral practitioners, hospitals, and governments.
of patient safety. Patient safety is one of parts of hospital. Moreover, patient safety is a crucial principle
the essential components to consider for of healthcare, and almost every factor in a
the healthcare delivery system. As such, healthcare setting is associated with some
various programs are entered by healthcare degree of risk to patient safety. Thus, the
institutions to monitor their services Keywords ultimate aim in all healthcare settings is
including patient safety goals in order to the promotion of patient safety, which
achieve high patient satisfaction rate. One International Patient Safety Goals, Joint constitutes one of the largest threats to
of these programs is called accreditation. Commission International (JCI), Root Cause the quality of care delivered. Patients must
Accreditation is an internationally Analysis (RCA), Corrective and Preventive be able to obtain excellent care, under
recognized evaluation process used to Action (CAPA), Incident Reporting (IR), World safe clinical practice conditions, which
assess, promote and guarantee efficient and Health Organization (WHO) could contribute to improvements in the
effective quality of patient care and patient patient’s condition and treatment plan. In
safety. This study will provide valuable addition, the provision of safe, effective, and
information regarding the awareness quality healthcare is necessary for many
of IPSG and its implementation in the
Introduction
healthcare facilities and organizations, to
in the Hospital. In a nutshell, following better serve patients and family. In the 21st
1.1 Introduction to International Patient
International Patient Safety Goals (IPSGs) century, trends for greater transparency
Safety Goals (IPSGs):
in clinical areas would reduce number of and performance monitoring have become
issues, like for staff it would help them to established in many industries. There is
The safety and quality of patient care are
minimize the risk of errors and for patients no doubt that healthcare systems across
fundamental issues for every healthcare
to decrease their burden of healthcare and the world now recognize the need to pay
organization that aims for the provision
acquiring quality of care. This project was attention to patient safety. The IPSGs

43 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

(International patient safety goals) represent will be required to display compliance with specific requirements for the response to
proactive strategies to reduce risk of medical the following international patient safety adverse events; the prevention of accidental
error and reflect good practices proposed by goals. harm through the analysis and redesign of
leading patient safety experts. Incorporating vulnerable patient systems (e.g. the ordering,
these new tools into our requirements is a Almost 50 percent of Joint Commission preparation and dispensing of medications);
significant step. JCI introduced the IPSGs in standards are directly related to safety, and the organization’s responsibility to tell
2006 and surveyors have been evaluating addressing such issues as medication use, a patient about the outcomes of the care
compliance with these goals during infection control, surgery and anesthesia, provided to the patient— whether good or
accreditation surveys in 2006, but these transfusions, restraint and seclusion, staffing bad.
findings have not affected the accreditation and staff competence, fire safety, medical
decision. Beginning 1 January 2007, hospitals equipment, emergency management, and
accredited by joint commission international security. These standards also include

G o a l :1 Use at least two (2) ways to identify Goal:2 Implement a process/procedure for
a patient when giving medicines, taking verbal or telephone orders or
Identify Patients blood or blood products; taking Improve Effective for the reporting of critical test results
Correctly blood samples and other specimens Communication that requires a verification “read-back”
for clinical testing, or providing any of the complete order or test result by
other treatments or procedures. The the person receiving the information.
patient’s room number cannot be NOTE: Not all countries permit verbal or
used to identify the patient. telephone orders

Goal:3 Remove concentrated electrolytes Goal:4 Use a checklist, including a “time-out” just
(including, but not limited to, before starting a surgical procedure, to
Improve the potassium chloride, potassium Eliminate ensure the correct patient procedure and
Safety of High- phosphate, sodium chloride >0.9%) Wrong-site, body part. Develop a process or checklist
alert Medications from patient care units. Wrong-patient, to verify that all documents and equipment
Wrong-procedure needed for surgery are on hand and correct
Surgery and functioning properly before surgery
begins. Mark the precise site where the
surgery will be performed. Use a clearly
understood mark and involve the patient in
doing this.

Goal:5 Goal:6
Assess and periodically reassess each
Reduce the Comply with current published and Reduce the Risk patient’s risk for falling, including the
Risk of Health generally accepted hand hygiene of Patient Harm potential risk associated with the patient’s
Care–acquired guidelines. Resulting from medication regimen, and take action to
Infections: Falls decrease or eliminate any identified risks.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Literature Review
A research study was done on International conducted to identify Australian studies, Aim
standards of patient care in King Hussain published from 2002 to 2008, on the extent
Cancer Center, Jordan .The purpose of and causes of medication incidents and
the study was to explain rapid changes on adverse drug events in acute care. Results
international standards. Sources including of incident reporting from hospitals show The aim of the study is to review the measures
personal interviews, document review that incidents associated with medication adopted in the hospital to minimize the
and on-site observations were combined remain the second most common type of violation of IPSGs at MVR Cancer Centre and
to conduct a robust examination of incident after falls. Research Institute, Kozhikode.
KHCC’s rapid changes. The changes which
occurred at the KHCC during its formation Omission or overdose of medication is the
and leading up to its Joint Commission most frequent type of medication incident Objective
International (JCI) accreditation can reported. Studies conducted on prescribing
be understood within the conceptual of renal excreted medications suggest
I. To review the incident reports and asses
frame of the transformational leadership that there are high rates of prescribing
the measures adopted to minimize the
model. Interviewees and other sources errors in patients requiring monitoring and
IPSGs violation.
for the case study suggest the use of medication dose adjustment. Research
inspirational motivation, idealized published since 2002 provides a much II. To improve the effectiveness of the IPSG
influence, individualized consideration stronger Australian research base about the Goals for improving patient safety and
and intellectual stimulation, four factors factors contributing to medication errors. quality of care.
in the transformational leadership model, Team, task, environmental, individual
had significant impact upon the attitudes and patient factors have all been found to
and motivation of staff within KHCC. As a contribute to error. To conclude, medication- Methodology
result it achieved improved levels of quality, related hospital admissions remain a
expanded cancer care services and achieved significant problem in the Australian The review was based on the incidents
Joint Commission International ccreditation healthcare system. Medication incidents reported from the month of July 2020 – Dec
under new leadership over a three-year remain the second most common type of 2020.
period (2002–2005). A study was done on incident reported in Australian hospitals.
medication errors and patient safety in 2006. Study Design: A quantitative, descriptive,
A study conducted on reporting of incidents research design was used.
The study focused on the word error has and near misses in NHS-London.. The
drawn attention to prevention and what can purpose of the study was to find out the Study Location: The study was performed
be done to minimize mistakes and improve cases of under reporting of incidents and at MVR Cancer Centre and Research
patient safety. The study says the word near misses as it is still a problem in NHS Institute, Kozhikode.
error means an act that through ignorance, There were 974000 patient safety incidents
deficiency, or accident, departs from or and near misses in 2004-2005 reported, but Study Duration: From July 2020 – December
fail to achieve what should be done. As a as per National Patient Safety Agency, they 2020.
result, the researcher says all health care failed to get accurate information on serious
institutions to follow 5 RIGHTS of medication incidents and death .The investigating body Sample size: 6months data (Incident
administration to avoid medication errors found that doctors are less likely to report Reports)
thus improve patient safety. incidents than other group of health care
providers. To top it all, the NHS simply has Study Tool- Analysis done based on the
This study was done on medication safety in no idea how many people die each year incident reports related to the violation of
the Australian acute care setting. The study from patient safety incidents. The report IPSGs and the effectiveness of the Corrective
was done to examine the extent and causes concludes that sufficient progress has been and preventive actions taken to improve the
of medication incidents and adverse drug made to achieve the Department’s plan to patient safety and quality care.
events in acute care. A literature search was guarantee a safer NHS for patients.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Data Analysi and

Interpretation
The data’s were taken from the incidents The corrective and preventive actions Conclusion
reported in the month of July to December suggested were followed, thus it minimized
2020.The incidents were selected based on the incidents related to IPSG violation. Non-compliance to the IPSGs was decreased
non-compliance to IPSGs. A percentage from the month of July-December 2020.
analysis and graphical representation was Measures Taken As the measures adopted were followed
done. and frequently evaluated. Accepting and
I. Retraining and revaluation done adapting to the changes by the staffs were
regarding the IPSG. Daily monitoring the success to reduce the incidents on IPSGs.
was done to minimize such incidents.
II. Handovers from the nursing as well
as in the doctor’s side were properly
followed by the clinical teams this
References
has been evaluated by the quality
I. Joint Commission International
department.
Accreditation Standards for
III. Chemo Templates and Chemo stickers Hospitals: available from www.
were implemented in the hospital to jointcommissioninternational.org
reduce the IPSG 3 violation. That is
II. Joint Commission International
From the graph non-compliance to IPSG 1 used to monitor the medicine which is
Center for Patient Safety: available
in the month of July was 12% and in August administered with the dose mentioned.
from www.jcipatientsafety.org
14.20%.It has been decreased to 5% in the IV. Patient and family education forms
III. Gibson T, School of Nursing and
month of December 2020. Non-compliance in the bilingual language were
Midwifery, University of South
to IPSG 6 was 4 to 5% from the month of July implemented to create awareness
Australia; Nurses and Medication error:
to October and 0 incidents were reported in about the risk of fall.
a discursive reading of literature.
the month of December.
V. WHO surgical safety checklist, Pre-
IV. The JCAHO patient safety event
OP checklist and policies on safe
Non-compliance to IPSG 3 in September was taxonomy: available from intqhc.
surgery were framed for the surgical
10% and 0 incidents were reported in the oxfordjournals.org/content/17/.
department.
month of December.
VI. Two (2) Identifiers 1. Name and 2.UHID
No (unique hospital identification
number) were used. Barcodes were
Findings generated before collecting the
laboratory samples. Barcode contains
Root cause analysis was done for all the the patient’s details (Name, UHID,
incidents related to IPSGs and the corrective Department, Room No…etc.).Patient ID
and preventive actions are suggested band or Wrist Bands were placed on the
accordingly and evaluated by checking the patient’s wrist after getting admitted in
process followed in the organization. the hospital.

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CASE STUDY
Newsletter 2 National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Perioperative Hypothermia During

Arthroscopic Shoulder Surgeries –
A Quality Improvement Project

Introduction II. To determine the compliance of the induction. We commenced prewarming

warming methods used to prevent patients in the preoperative waiting area.
Perioperative hypothermia is defined hypothermia. A third audit was done 6 months later to
as core body temperature < 36°C. complete the cycle.
III. To correct any lacunae and improve
Patients undergoing surgery are prone the quality of patient care.
to hypothermia due tocoldenvironment
IV. To raise awareness among
and anaesthesia induced impairment
perioperative health care team on the Results
of thermoregulation. Perioperative
importance of recognition, prevention
hypothermia causes problems such as
and treatment of hypothermia. Initial audit revealed the incidence
morbid cardiac events, coagulopathy,
of hypothermia at induction - 68%,
increased blood transfusion requirements,
hypothermia at extubation - 48%, ambient
surgical wound infectionsand patient
Methodology OT temperature -190 C, warm intravenous
dissatisfaction. During arthroscopic
fluids usage -76% and usage of forced
shoulder surgery, a large amount of
An initial prospective audit was performed air warmer -100%. The second audit
irrigation fluids is used to improvethe
on 25 patients undergoing arthroscopic showed the incidence of hypothermia at
clarity of surgical field. But since these
shoulder surgeries which revealed a high induction – 44%, hypothermia at extubation
fluids are stored at room temperature,
incidence of hypothermia. After analysing -28% and 100% compliance in usage of
they exacerbate hypothermia. Hence,
the data, we implemented the use of warm intravenous fluids and forced air
we conducted this project to quantify
blankets in pre-operative area, increased warmer. The third audit showed incidence
the incidence of hypothermia during
the ambient temperature in operation of hypothermia at induction – 20%,
arthroscopic shoulder surgeries and to
theatre (OT) to 21 from 19, educated nurses, hypothermia at extubation -8% and 100%
reduce its occurrence.
ensured compliance in usage of warm compliance in usage of warm intravenous
intravenous fluids and forced air warmer. We fluids and forced air warmer.
re-audited 6 months later. While there was
Aims some improvement, still significant number
of patients were already hypothermic at
This audit was conducted
at our hospital with
following objectives.

I. To establish
the incidence
of hypothermia
during
arthroscopic
shoulder surgery
at our hospital.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Keywords
Perioperative hypothermia, prevention,
audit, shoulder arthroscopy

References
Sessler DI. Perioperative thermoregulation
and heat balance. Lancet 2016;387:2655-64

Duff J, Di Staso R, Cobbe KA, et al. Preventing

hypothermia in elective arthroscopic
Discussion decrease due to body heat redistribution. shoulder surgery patients : a protocol for
a randomized controlled trial. BMC Surg
While perioperative hypothermia continues After prewarming the patients in 2012;12:14
to be a very common complication, preoperative area in addition to the above
it is neither innocuous nor inevitable. measures, there was 54% reduction NICE and warm. British Journal of
While maintaining normothermia is of hypothermia at induction and 71% Anaesthesia 2008;101:293-295
recommended by several international reduction of hypothermia at extubation in
bodies, managing the patient’s temperature our third audit. Scott E, Buckland R. A systematic review
during arthroscopic shoulder surgeries of intraoperative warming to prevent
poses unique challenges. Extravasation of Presentation of the results, education of OT postoperative complications. AORN 2006;
large volumes of irrigation fluid is common. nurses, technicians, anaesthesiologists and 83:1090-1113
Preventive methods include skin surface surgeons resulted in increased awareness
warming, warm and humidified circuit and about perioperative hypothermia and its Steelman VM, Chae S, Duff J, Anderson MJ,
administeringfluids using specific warming prevention leading to improvement in Zaidi A. Warming of irrigation fluids for
devices. quality of patient care. prevention of perioperative hypothermia
during arthroscopy: a systemic review and
Surprisingly our initial audit found metanalysis. Arthroscopy 2018;34:930-942
high incidence of hypothermia during
Conclusion
arthroscopic shoulder surgeries.The areas Yoo HS, Park SW, Yi JW, Kwon MI, Rhee
identified for improvement were- OT YG.The effect of forced-air warming during
Our audit emphasises that simple multi-
temperature, proper use of forced air arthroscopic shoulder surgery with general
disciplinary interventions like the use
warmer, compliance in use of warm iv fluids. anesthesia. Arthroscopy 2009; 25: 510-514
of blankets in the pre-operative area,
We worked on these aspects by involving the
increasing the ambient temperature in OT,
whole perioperative team. There was 35%
education of nurses, strict compliance with
reduction of hypothermia at induction and
the use of warm intravenous fluids and
42% reduction of hypothermia at extubation
continuous forced air warmer decreases
in second audit. Although National Institute
the incidence of perioperative hypothermia
for Health and Care Excellence clinical
during shoulder arthroscopic surgeries.
guideline recommends prewarming to
However, we have noticed that prewarming
prevent perioperative hypothermia, it is
the patients in addition to the above
not routinely performed due to practical
measures significantly decreases the
restrictions. 30 minutes of prewarming is
incidence of perioperative hypothermia
needed to gain heat content exceeding the
during shoulder arthroscopic surgeries and
amount of redistribution. Therefore, raising
should become standard of care for such
peripheral temperature in advance might be
patients.
meaningful in preventing core temperature

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CASE STUDY
Newsletter 3 National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Impact of Application of International

Patient Safety Goals on Patient Safety
Culture

Health care delivery systems have become Objective Frame Work

more efficient and also become more
complex, with greater application of I. Detecting the impact of application of
new technologies and therapies, which international safety goals on patient
requires adopting the international patient safety culture.
safety goals to improve the patient safety
II. Describing the level of application of
environment to simulate better patient care
international safety goals
rendered by the hospital staff to improve
patient outcomes while minimizing possible III. Detecting the outcome of
adverse events The simplest definition of implementation of International
patient safety by World Health Organization Patient Safety Goals
(WHO) is the prevention of mistakes and side
effects to patients associated with health
care. Study Importance
Promoting a culture of safety has become This study gives a general review about
one of the columns of patient safety. As variables (international Safety goals and
healthcare facilities make every effort to patient safety culture) and their correlations.
improve their quality of care and provide In addition, this study provides effect of
their service in an adequate standard, implementation of International patient
focusing on patient safety has become a safety goals on patient outcomes.
priority.

Problem Statement
To study the relation between the
application of international patient safety
goals and patient safety culture in the
hospital.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

A) Structure
Policy Development

Policies related to IPSGs were formulated

such as Patient Identification, Effective
communication, High Alert medications,
Handover communication, ensure correct
site, procedure and patient, policy on
prevention of fall and policy for care of
vulnerable patients and disseminated to
all the relevant stakeholders

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Mentors

Area-wise champions or Mentors were identified

and trained so that they can train other staff
down the line. Mentors were selected from Floor
Coordinators, Nursing supervisor/ Team Lead or
In-charge

Audit Checklist

Various audit checklists, specific to an area for

different cadre of staff like General Observation,
doctors, Nurses and paramedics was developed
and used while performing the assessment

IPSG &
Policy &
other Score Remarks
Process
processes

Check ALL IN PATIENTS (in the area being audited)

IPSG 1
Including CONFUSED/ UNCONSCIOUS/ COMATOSED

In case the full

Check Contents of White ID band name has not
- Max UHID No. been
IPSG 1 - IP/ ER No.

- Age/ Sex form to be

checked

known allergies
IPSG 1
the Red ID band.
-Red and white band to be on the same wrist of the

To put

your score
- before proceeding with blood transfusion
aspect as per
IPSG 1
- being done while serving special diet to the GO may be
required to be
- During imaging - USG, X Ray audited as per

areas
Check for correct sample labelling in ICU (Blood,

IPSG 1

box

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

IEC Material

Posters and education material in form of

Handbooks were distributed to the staff so
ready reference and ease of availability

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

B) Process
Training Staff Engagement

Regular training sessions for Mentors and Celebration of Patient Safety Week, program spread over
On job training sessions taken by mentors 7 days involving interactive Quiz sessions, play and skit by
to strengthen and inculcate the policies into staff, poster making competition.
work processes and routine.

TRAINING SESSIONS FOR MENTOR/ STAFF

PATIENT SAFETY WEEK CELEBRATION

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Audit & Analysis

Audit by Central Quality Team, based on International Patient Safety Goals using checklist developed in-house are conducted in
every quarter. Results are shared with Management for preparation of action taken report and gap closures

C) Outcome
Through regular training and compliance monitoring by the audits, staff has become more aware of the policies and procedure
related to IPSGs thus resulting in better patient outcome such as gradual reduction in Hospital Acquired Infections.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Conclusion
The result shows that there is an agreement result indicates that there is a significant Goals variables are strong relationships.
among participants on high application application of the international patient Furthermore, the relationship between
of each international patient safety safety goals in the hospital. This indicates total International Patient Safety Goals and
goals variable (Patient Identification & that the medical staff recognize the Patient Safety Culture is very strong, Thus
communication, Safety of medications importance of the application of the implementation of International Patient
& surgery and Infections & fall hazards International Patient Safety Goals variables. Safety Goals fuels the Patient Safety Culture
reduction), which indicates that there is with improved patient outcomes.
an agreement on high presence of these The results also show that the relationships
variables in the hospital. The overall between International Patient Safety

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Poster Contest Winners

First Prize
Dr. Paresh Shah
Dhirubhai Ambani Occupational Health and
Family Welfare Cenre, Jamnagar, Gujarat, India

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Second Prize
Dr. Shine Anil
Narayana Health
SRCC Children's Hospital

International Patient Safety Goal: The Best Practices

Identify Patients Correctly
Structure: Snippet on SOP circulated in Process: Awareness in the form of poster in Outcome: Audit
I WhatsApp respective department
IPSG 1 audit compliance: Department-
P wise
Streamline ID band

100%
S 100% 80% 80%
70%
80% 80% 80% 80% 80% 78%
80%
G 60%
policy

60%

: 40%
20%
1 0%
GW5 GW4 SICU HDU PICU NICU GW2 BMT PVT ER Total

Improve Effective Communication

Structure: Snippets on SOP circulated in Process: Awareness Simulation Video and Outcome: Audit
WhatsApp Posters
I
Critical Result
Stamp P
S
G
ISBAR Handover
Tool
:
2

Improve Safety of High Alert Medication

Structure : Snippets on SOP circulated in Process: Awareness in the Outcome: Audit
WhatsApp form of poster in
I
respective department
P
S
G
:
3

Ensure Correct-Site, Correct-Procedure, Correct- Patient Surgery

Structure : Snippet on SOP circulated in Process: Outcome: Audit
WhatsApp 1.WHO Time out checklist in OT and Cath lab I
2. Surgical
2. Site Infection
Surgical Site Tracking
Infection Tracking P
S
Post discharge call on 7th,30th
G
and 90th day
:
Identified dedicated staff for 4
post discharge calls

Reduce the Risk of Health Care Associated Infection

I
Structure : Snippet on SOP circulated in Process: Alert for HCW contact Outcome: Audit
WhatsApp Infection Control isolation patients Implement 3in 1
P Link Nurses 24 Bundle checklist
S hrs : 10 RN
G
:
Blue curtain ,Red file,PPE
5

Reduce the Risk of Patient Harm Resulting From Fall

Structure : Snippet on SOP circulated in Process: 1. Awareness in the form of poster Outcome: Audit I
WhatsApp in respective department 2. Part of PFE P
form 3. Bilingual teaching materials
S
G
:
6

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Third Prize
Daisy Rani
Wockhardt Hospital Proper fitting
uniforms
Secret 6 REDUCE THE RISK OF PATIENT
HARM RESULTING FROM FALL
Secret 1 IDENTIFY PATIENTS CORRECTLY

Safety straps
Secret 5 Spy report

REDUCE THE RISK

OF HEALTH CARE- Case Study Full Name, UHID Self locking wrist band
ASSOCIATED
INFECTION Proper Training Session Food services and
fitting medicines giver
footwear
after checking 2
Identifiers
ID bands
International Hand Hygiene Exhibition
Day Celebration
No Telephonic
Order
Critical Test Report
Mystery Observers
and Hand Hygiene
Audits
Training records Hand Hygiene
practices
Hand over
Hand Hygiene
Guideline posters Snippet Training Sessions

Counter sign of High Secret 2 IMPROVE

Training sessions EFFECTIVE
Site marking Alert Medications COMMUNICATION
Preoperative
Verification
High Alert
Medication red
High Alert sticker labeling Workshop
Medication red
Surgical/Procedure safety checklist Team introduction Audit IMPROVE THE Screen Savers

4
sticker labeling
SAFETY OF
ENDURE CORRECT-SITE,CORRECT- HIGH ALERT
Secret 4 PROCEDURE,CORRECT- PATIENT SURGERY Secret 3 MEDICATION

Consolation Prize
Ankita Pawar

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Activities by Hospitals
on Patient Safety Day

By Sterling
Hospital
Ahmedabad
on Patient
Safety Day

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

By Mehta
Multispecialty
Hospitals
India Pvt. Ltd.
Chennai, India

Patient Safety Day

" Lighting Up
Orange "

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

By District
Hospital, Ujjain

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Patient safety Talk :

By CARE
Hospitals,
Musheerabad,
Hyderabad

At CARE hospitals
Musheerbad , the unit
had organized a Patient
safety talk which was
given by Dr.Archana, Poster competition :
HOD of Laboratory
medicine at CARE
Hospitals,Musheerabad.
The unit also conducted
poster competition in
which many Nursing and
Admin staff participated.

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Ganga CARE Hospitals, Nagpur

Ramakrishna Care Hospital, Raipur: Fire Training

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

NABH DARSHAN
A robust Health Management
Information System for District
Hospitals in India

Dr. Kashipa Harit Arsh Hashmi

Deputy Director, Project Associate,
NABH PPID

District Hospitals are an essential component after extensive consultations with NITI Aayog, assessors, operationalizing the assessments,
of public healthcare system in India providing Ministry of Health and Family Welfare, Indian coordinating with the state and district level
access to specialised healthcare. In spite of Statistical Institute and multiple field tests. authorities, conducting rigorous quality checks
their critical role in public health, there was A survey instrument based on a mobile of the data collected, presenting the findings
no system to evaluate district hospitals on application was also designed to conduct the with the States and NITI Aayog, drafting the
measurable health outcomes and to assess onsite assessments and data collection. report among others. The efforts of the team
their data management practices. were greatly commended by Mr. Alok Kumar,
More than 400 assessors including NABH Advisor, Health, NITI Aayog when he gave a
In this regard, NITI Aayog, as mandated by the assessors and medical professionals from standing ovation to the team on successful
Government of India, created a framework notable institutes of the country were engaged completion of the assessments.
based on 16 Key Performance Indicators for the assessments. The assessors were
(KPIs) to assess performance outcomes in trained in training programs conducted by NABH recommended actionable policy
district hospitals. The KPIs included number NABH in 17 cities across the country. reforms based on the insights gathered in the
of functional beds, ratio of doctors, number of assessments to NITI Aayog, Ministry of Health
laboratory tests per technicians, C-section rate The assessments of the 731 district hospitals and Family Welfare and State Governments to
among others. The KPIs were based on more were executed simultaneously at a pan India improve data reporting and management at
than 120 data items of Health Management level. The assessors were mapped to the the District Hospitals. This included proposing
Information System (HMIS) which is an online district hospitals and a backend NABH team revisions in IPHS standards, standardisation of
portal where district hospitals submit data on was assigned to the assessors for necessary data definition, trainings on HMIS operations
health indicators. assistance and conducting quality checks of among others.
the data collected. The planning and execution
NABH-QCI was on boarded by NITI Aayog to of the assessments involved multiple The exercise undertaken by NABH is significant
conduct an independent onsite review and challenges given many district hospitals to be as it has revealed comprehensive insights
validation of data items of the KPIs which assessed were situated in sensitive areas of into HMIS and created immense awareness
are submitted by 731 District Hospitals of Nagaland, Jammu & Kashmir, Chhattisgarh among the concerned stakeholders about
the country on HMIS. This was a significant and in difficult terrains of Arunachal Pradesh the importance of HMIS data in developing
exercise given it was the first time any large and Meghalaya, etc. informed policies for public healthcare. It
scale national survey was to be done at the will also facilitate NITI Aayog’s framework
District Hospital level covering all districts NABH successfully completed the assessments for District Hospital ranking and create a
across the country. of 700+ hospitals across the country in a span collaborative and competitive environment
of three months. The entire exercise was towards quality improvement in public
NABH formulated an assessment framework to implemented with the NABH team working on healthcare.
validate the KPIs through onsite assessments multiple tasks like training and mapping the

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Farewell of
Dr. Gayatri Vyas Mahindroo
Senior Director NABH
Celebrations @NABH

Women's Day
Celebration

Doctor's Day
Celebration

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Independence Day
Celebration

Onam Birthday
Celebration Celebration

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 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

World Patient Safety Day

Every year 17th September is traditionally I. Identification and implementation of • Recognition of exemplary work done by
celebrated as “World Patient Safety Day.” the ways to reduce errors in patient employees
The theme decided by the World Health care • Special on-the-job-trainings for staff
Organization for last year, in view of the II. Improving our skills and knowledge members in the field of patient safety
ongoing pandemic, was “Health Worker on all related subjects pertaining to
Safety: A Priority for Patient Safety.” • Poster competition
patient safety
The overall objectives were to enhance • Recognition of Patient Safety
understanding of patient safety, increase III. Actively engaging patients and families Champions in the organization
public engagement in the safety of as partners in their care
• Skits or dance competitions on better
healthcare workers and promote practices IV. Raising public awareness about patient patient / employee safety as the subject
to enhance patient safety and reduce patient safety
harm. The origin of the Day is firmly rooted • Panel discussions with patient safety
V. Nurturing, supporting and promoting experts, healthcare providers, patients,
in the fundamental principle of medicine –
transparency in care through team work representatives of health insurances, or
First, do no harm.
VI. Learning from errors for safeguarding government agencies
The COVID-19 pandemic is presently among interest of patients, and • Information events on special topics
the biggest challenges and threats facing VII. Supporting my professional colleagues such as hygiene or safe medication
the world and humanity, and healthcare in their endeavour of promotion of in clinics, hospitals, pharmacies, or
is passing through its greatest crisis in cause of patient safety. “ nursing homes
patient safety ever! The pandemic has
NABH also encouraged Healthcare • Press releases and media interviews
exerted unprecedented pressure on health
organizations already registered/ The healthcare organizations were asked
systems worldwide. Since health systems
accredited/certified with NABH, and having to share the photographs and details of
can only function with health workers, a
implemented (or may be in the process the activities conducted on the occasion of
knowledgeable, skilled, and motivated
of implementation) the NABH standards World Patient Safety Day so that the same
health workforce is critical for the provision
which focus on the quality healthcare that could be included in the next issue of NABH
of safe care to patients.
leads to the patient safety & employee Newsletter- Quality Connect. Hospitals were
safety, to observe the World Patient Safety asked to share the stories of extraordinary
The COVID-19 pandemic has highlighted
Day on 17th September 2020 as “Health courage or grit on the part of the patients
the huge challenges health workers are
Worker Safety: A Priority for Patient Safety” and /or the staff along with the photographs.
currently facing globally. Working in stressful
& organize motivational activities. The NABH got a very overwhelming response
environments exacerbates safety risks for
health workers, including being infected and healthcare organizations were invited to from the healthcare organizations which is
contributing to outbreaks in the healthcare conduct various activities in their respective published in this issue of the Newsletter.
facility, having limited access to personal organizations. For example
protective equipment and compliance with
other infection prevention and control Virtual Pledge for Patient Safety
measures, and the consequence being
potential harm to patients and healthcare
workers. In many countries, health workers
are exposed to increased risks of infections,
violence, accidents, stigma, illness and
death.

NABH staff decided to take a pledge virtually

to undertake all activities for promotion
of Patient Safety in the health facility,
community, and country. The pledge read as
the following:

“I commit to dedicate myself to make health

care safer by supporting, but not limited to,
following actions, namely:
67 | Issue 03 QUALITY | SAFETY | WELLNESS
 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Darkness unto Light: Pledge 2021

Let’s light a candle for Patient Safety

68 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

Quiz Contest Winners

NABH Newsletter Issue -2

Mohd. Imran Khan

Quality Manager
CMCH, Bhopal

Mr. Suresh V
Enterprise Executive Quality
NU Hospitals Pvt. Ltd
Bengalur

69 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

70 | Issue 03 QUALITY | SAFETY | WELLNESS

 Newsletter National Accreditation Board For Hospitals & Healthcare Providers (NABH)

EDITORIAL Patron Mr. Adil Zainulbhai Chief Editor Dr. Atul Mohan Kochhar

BOARD
Dr. BK Rao
Dr. Ravi Prakash Singh
Editorial Team Dr. Punam Bajaj
Dr. Eesha Arora Narang

Designers Ms. Nidhi Batra | Mr. Deepak Kumar

71 | Issue 03 QUALITY | SAFETY | WELLNESS