Medpoint Healthcare

Sustainable Healthcare Logistics: Implementing Circular Economy Principles in Modern Hospital Waste Management

medpointhcg@gmail.com (Medpoint Healthcare) — Wed, 29 Jul 2026 07:44:26 +0530

Abstract

Modern healthcare facilities generate massive amounts of waste, straining both municipal infrastructure and ecological systems. Transitioning from a linear "take-make-waste" model to a circular economy is no longer just an environmental ideal—it is an operational necessity. This article explores how sustainable healthcare logistics can integrate circular principles into hospital waste management to reduce environmental impact, ensure regulatory compliance, and lower operational costs.

The Healthcare Waste Crisis

Hospitals operate 24/7, consuming vast quantities of single-use plastics, chemical reagents, and specialized equipment. This intensive consumption results in complex waste streams that require specialized handling.

[Linear Model]  Extraction ──> Single-Use Manufacturing ──> Hospital Consumption ──> Incineration/Landfill
                                                                                     │
[Circular Model] Procurement ──> Optimized Use ──> Sterilization & Segregation ─────┴─> Vendor Take-Back & Reuse

The standard linear disposal method relies heavily on autoclaving and incineration. While effective for pathogen destruction, these energy-intensive processes release greenhouse gases and destroy valuable raw materials. Implementing a circular framework mitigates these issues by maintaining the highest utility and value of products, components, and materials at all times.

Pillars of Circular Logistics in Healthcare

1. Green Procurement and Inventory Optimization

Circular logistics begins before a product ever enters a medical facility. Green procurement strategies shift purchasing power toward eco-designed goods.

Upstream Supply Chain Audits: Prioritise vendors that utilize minimalist, biodegradable, or highly recyclable packaging.
Predictive Inventory Management: Deploy AI-driven tracking systems to align purchasing with actual patient volume, drastically reducing the volume of expired, unused medical supplies.
Product-as-a-Service (PaaS): Shift from buying complex medical machinery to leasing models. Under PaaS agreements, manufacturers retain ownership and remain responsible for servicing, upgrading, and recycling equipment at the end of its lifecycle.

2. Point-of-Care Waste Segregation

The economic viability of recycling hospital materials depends entirely on the purity of the waste streams. Mixing hazardous bio-waste with non-hazardous plastics ruins the recycling potential of both.

Advanced Color-Coding: Implement strict, standardized color-coded bin systems across all departments to separate clinical, chemical, recyclable, and general municipal waste.
Point-of-Generation Sorting: Train nursing and surgical staff to segregate non-contaminated packaging, clean plastics, and paper products directly at the bedside or operating theatre before contamination occurs.

Waste Category	Color Code	Circular Pathway
Non-Hazardous Plastics	Blue	Mechanical recycling into non-clinical goods
Organic/Food Waste	Green	Industrial composting or anaerobic digestion
Clinical/Bio-hazard	Yellow	High-efficiency autoclaving followed by specialized shredding

3. Closed-Loop Material Recovery

Hospitals generate high volumes of technical nutrients—high-grade polymers and metals that are highly prized by recyclers if kept uncontaminated.

Medical Plastic Reclamation: Clean, non-infectious plastics (such as saline bottles, irrigation trays, and packaging) can be safely granulated and reprocessed into industrial or commercial products.
Reprocessing of Single-Use Devices (SUDs): Partner with regulated third-party reprocessors to clean, test, and re-sterilize specific surgical instruments (like harmonic scalpels or electrophysiology catheters), safely returning them to service at a fraction of the cost of new items.

Implementation Challenges and Strategic Solutions

Regulatory Compliance and Patient Safety

The foremost barrier to circular practices in healthcare is the strict mandate for infection control. Patient safety cannot be compromised for environmental metrics.

Solution: Establish clear boundaries between infectious waste and recyclable materials. Focus initial circular initiatives on non-clinical areas, administrative wings, and non-contaminated surgical packaging before expanding to patient-contact materials.

Cultural and Behavioral Friction

Hospital staff operate under high-stress conditions where clinical outcomes take absolute priority over waste sorting.

Solution: Design waste disposal systems that require minimal cognitive load. Place recycling fixtures directly within the natural workflow of the staff, and use clear visual iconography rather than dense text instructions.

Conclusion

Transitioning to sustainable healthcare logistics requires a systemic shift in how medical institutions view material life cycles. By integrating circular economy principles into daily operations, modern hospitals can transform their waste management from an expensive environmental liability into a streamlined, cost-effective, and ecologically responsible system.

Redesigning Emergency Room Layouts Using Patient Flow Simulation for Faster Care

medpointhcg@gmail.com (Medpoint Healthcare) — Sat, 27 Jun 2026 09:13:15 +0530

Emergency rooms (ERs) are under immense pressure. Long wait times and crowded hallways frustrate patients and exhaust medical staff. Traditional ER layouts often make these problems worse by creating physical bottlenecks.

Hospitals are now using patient flow simulation to solve this. This technology acts like a digital twin of the ER. It lets administrators test new layout designs virtually before moving a single piece of furniture.

Here is how simulation software is reshaping ER layouts to deliver faster care.

The Problem with Traditional ER Layouts

Most traditional ERs use a linear, department-based design. Patients move from waiting areas to triage, then to treatment rooms, and finally to labs or discharge.

This setup causes major issues:

· High Foot Traffic: Patients, nurses, and doctors constantly cross paths in narrow hallways.

· Hidden Bottlenecks: Staff cannot see when a specific area, like radiology, is backing up.

· Wasted Steps: Nurses spend too much time walking back and forth to supply closets.

What is Patient Flow Simulation?

Patient flow simulation is a computer modeling tool. It takes real hospital data—like patient arrival times, injury types, and treatment speeds—and maps out the entire ER process.

The software creates an animated, data-driven map of the ER. It simulates hundreds of virtual patients moving through the space simultaneously. This allows hospitals to spot exactly where delays happen and test layout changes safely in a digital world.

How Simulation Changes ER Layouts

Simulation data helps hospitals move away from rigid, old-fashioned layouts. Instead, they build smart, flexible spaces designed around patient needs.

1. Creating Split-Flow Pathways

Simulation models prove that minor injuries clog up main ER beds. Modern layouts now use a split-flow design.

Low-severity patients go to a "Fast Track" lounge with comfortable chairs instead of beds. High-severity patients go straight to advanced trauma bays. This keeps the main ER clear for critical cases.

2. Moving Point-of-Care Testing Closer

In old layouts, the lab is often far from the ER. Simulation shows that walking back and forth for blood tests adds hours to a patient's stay.

New designs place mini-labs and digital X-ray machines directly inside the ER pod. Results come back faster, and patients never leave their care zone.

3. Implementing Modular Care Pods

Instead of one massive, confusing room, modern ERs use self-contained pods. Each pod has its own team of doctors, nurses, beds, and supplies.

Simulation shows that pods reduce staff walking distances drastically. This layout keeps teams focused and gives patients more private, quiet environments.

The Real-World Benefits

Redesigning an ER using simulation data brings massive improvements to hospital operations:

· Shorter Wait Times: Patients get placed in beds much faster.

· Lower Leave Rates: Fewer patients walk out before being seen by a doctor.

· Better Staff Morale: Nurses and doctors spend less time walking and more time healing.

· Cost Savings: Hospitals avoid expensive construction mistakes by testing ideas virtually first.

The Future of ER Design

Data is proving to be just as important as bricks and mortar in modern healthcare. By using patient flow simulation, hospitals can build ER layouts that adapt to human needs. The result is a calmer workspace for medical professionals and a much faster path to healing for patients.

How Our Pharmacy System Stops Medication Errors Before They Reach You

medpointhcg@gmail.com (Medpoint Healthcare) — Mon, 22 Jun 2026 07:05:42 +0530

Our digital pharmacy system reduces medication errors by up to 54% using real-time validation and automated cross-checks. By replacing paper scripts with an advanced e-prescribing network, we completely eliminate handwriting misinterpretations and manual transcription errors.

Patient safety is at the core of everything we do. Here is a breakdown of how our digital system monitors and protects your health at every step of the dispensing process.

Eliminating the "Sloppy Handwriting" Risk

Manual data entry and hard-to-read paper notes have historically been leading causes of pharmacy miscalculations.

· Direct E-Prescribing: Doctors securely transmit digital prescriptions straight to our system.

· Dropdown Standardization: Predefined dropdown menus replace free-text abbreviations. This eliminates typos regarding drug forms, strengths, and frequencies.

· Zero Transcription: Systems match provider orders directly to our local inventory. This removes the risky process of copying details from one screen to another

Integrated Clinical Decision Support (CDS)

Our software acts as an automated second opinion, analyzing patient profiles the second a script is received.

· Interaction Detection: The system cross-checks new prescriptions against your entire medication history. It immediately flags dangerous drug-to-drug interactions.

· Allergy Safeguards: Your documented drug allergies are locked into the software. The system triggers a hard stop if a conflicting chemical or compound is ordered. [

· Demographic Tuning: Automated algorithms calculate correct dosages based on age, weight, kidney function, and liver health. This is especially crucial for pediatric and elderly care.

Barcode Verification at the Counter

We do not rely on visual checks alone. Before a medicine reaches a patient, it must clear a digital barcode verification checkpoint.

· Package Matching: Pharmacists scan the manufacturer’s barcode printed directly on the product.

· The "Five Rights" Check: The platform automatically confirms the scan against the digital prescription. This ensures the right patient gets the right drug, dose, route, and time.

· Batch Tracking: Integrated tracking logs batch numbers and expiration dates. This ensures expired products never leave the shelf.

Clear Communication and Smart Follow-Ups

Safety protocols continue even after you leave our counter or receive your delivery.

· Localized Labeling: Dispensing labels print out with highly specific, easy-to-read dosage instructions.

· Automated Reminders: Patients can opt into direct WhatsApp or text notifications. These messages alert you exactly when to take a dose or when a refill is due.

· Unified Records: Your digital history is kept up to date across providers. This prevents therapy duplication if you consult different specialists

Minimizing Postoperative Infection Rates Through Next-Generation Robotic Sterilization Protocols

medpointhcg@gmail.com (Medpoint Healthcare) — Thu, 18 Jun 2026 06:40:16 +0530

Surgeons can perform flawless procedures, yet microscopic enemies in the operating room (OR) can still compromise patient outcomes. Surgical site infections (SSIs) remain a costly, dangerous challenge for modern hospitals. Traditional manual cleaning relies heavily on human consistency, which leaves room for error. Next-generation robotic sterilization protocols are changing this landscape by eliminating human error and lowering infection rates.

The Reality of Surgical Site Infections (SSIs)

SSIs prolong hospital stays, increase medical bills, and threaten patient lives.

· The Cost: SSIs add billions to healthcare system expenses annually.

· The Cause: Hard-to-reach surfaces, complex surgical tools, and airborne pathogens.

· The Limit: Human teams face time constraints and hidden fatigue.

How Next-Gen Robotic Sterilization Works

Robotic systems do not replace human environmental services teams. Instead, they elevate the cleaning standard to a level manual wiping cannot achieve.

[Manual Prep & Clearing] ➔ [Robotic Deployment] ➔ [Automated UV-C / Vapor Cycle] ➔ [Digital Verification Log]

· No-Touch Disinfection: Robots use autonomous navigation to map out the OR.

· UV-C Light Technology: High-intensity ultraviolet light destroys pathogen DNA within minutes.

· Hydrogen Peroxide Vapor (HPV): Specialized bots release a fine mist that penetrates porous surfaces and complex instrument hinges.

· Shadow Reduction: Smart sensors move the robot around obstacles to eliminate shadows where bacteria hide.

Key Benefits for Hospitals and Patients

Adopting automated sterilization protocols yields measurable improvements across clinical and financial metrics.

· Lower Infection Rates: Clinical studies show drastic drops in hospital-acquired infections.

· Faster Turnover: Robots sanitize rooms rapidly, keeping surgical schedules on time.

· Verifiable Data: Systems log every cleaning cycle to prove compliance for hospital audits.

· Staff Safety: Automation protects human workers from harsh chemical exposure.

The Future of Sterile Operating Rooms

The next phase of robotic sterilization connects directly with hospital logistics. Future ORs will feature built-in robotic docking stations. These bots will deploy automatically the moment a patient leaves the room. By combining artificial intelligence, real-time data tracking, and advanced physics, healthcare facilities are making post-op infections a preventable problem of the past.

The Secret to Patient Retention in Competitive Urban Markets

medpointhcg@gmail.com (Medpoint Healthcare) — Fri, 10 Apr 2026 09:17:00 +0530

Effective Patient Retention Strategies For Private Clinics In Competitive Urban Markets

medpointhcg@gmail.com (Medpoint Healthcare) — Fri, 10 Apr 2026 08:47:00 +0530

In competitive urban markets, private clinic patient retention relies on a shift from reactive care to a proactive wellness partnership. Urban patients increasingly demand the same level of convenience and personalization they experience in banking or retail.

Core Retention Strategies

Implement "Consumer-First" Technology:
- Self-Service Portals: Offer 24/7 online scheduling and digital intake forms to eliminate physical paperwork and reduce front-desk friction.
- Automated Communication: Use AI-driven SMS or email reminders for appointments, medication refills, and preventive screenings.
- Telehealth Options: Provide virtual follow-ups to overcome urban logistical barriers like traffic and limited patient time.
Enhance the In-Clinic Experience:
- Aggressive Wait-Time Management: Excessive delays are a primary driver for switching providers. Use digital signage to provide real-time status updates, which can reduce perceived wait times by up to 35%.
- Staff Soft-Skills Training: Train every staff member—not just doctors—in empathy and conflict resolution, as a single negative interaction can permanently damage loyalty.
- Premium Environment: Maintain a clean, modern space with amenities like free Wi-Fi and charging stations to signal a high standard of care.
Deepen Patient Relationships:
- Hyper-Personalization: Use a healthcare-specific CRM to track non-medical details like life milestones or specific communication preferences.
- Continuity of Care: Ensure patients consistently see the same provider to build long-term trust and better health outcomes.
- Post-Visit Engagement: Send automated follow-up summaries and personalized health content (e.g., condition-specific blogs) to remain "top-of-mind" between visits.

Strategic Loyalty and Financial Models

Urban clinics can leverage structured loyalty programs and transparent financial practices to differentiate themselves:

Program Type	Description	Examples of Rewards
Wellness-Based	Rewards proactive health actions.	Points for annual check-ups or hitting fitness goals.
VIP Memberships	Tiered benefits for frequent patients.	Priority scheduling, free valet parking, or pharmacy discounts.
Co-Branded	Partnerships with local urban businesses.	Discounts at nearby gyms, organic cafes, or spas.
Cumulative	Spend-based discounts or free services.	Every 5th or 10th visit/procedure is free or discounted.

Financial Transparency: Reduce "billing anxiety" by providing clear, good-faith estimates before procedures and offering flexible, interest-free payment plans for high-cost treatments.

Measuring Success (KPIs)

To refine these strategies, clinics should monitor:

Patient Retention Rate: The percentage of patients who return multiple times.
Net Promoter Score (NPS): A metric derived from feedback surveys to gauge overall patient satisfaction and likelihood of referral.
Patient Lifetime Value (PLV): The total revenue a single patient generates over their relationship with the clinic

Comprehensive Biomedical Waste Segregation and Disposal Guidelines for Modern Medical Facilities

medpointhcg@gmail.com (Medpoint Healthcare) — Fri, 3 Apr 2026 06:49:00 +0530

The management of biomedical waste (BMW) in modern medical facilities is strictly regulated to prevent infection and environmental damage. In 2026, compliance centers on source-level segregation using a four-stream color-coded system and advanced digital tracking.

1. 2026 Color-Coding & Segregation Standards

Proper segregation at the point of generation is the most critical step, reducing hazardous waste volume by up to 20%.

Yellow (Infectious/Non-Plastic):
- Waste Type: Human/animal anatomical waste, soiled dressings, expired medicines, and microbiology lab waste.
- Disposal: High-temperature incineration (\(>1200^{\circ}C\) for cytotoxic drugs) or plasma pyrolysis. Deep burial is only permitted in remote areas with no access to treatment facilities.
Red (Contaminated/Recyclable Plastic):
- Waste Type: Tubing, IV sets, catheters, urine bags, and syringes (without needles).
- Disposal: Autoclaving or microwaving followed by shredding. These are then sent to authorised recyclers.
White (Translucent/Sharps):
- Waste Type: Needles, scalpels, blades, and fixed-needle syringes.
- Disposal: Puncture-proof containers only. Treatment involves sterilization followed by shredding or encapsulation.
Blue (Glassware & Implants):
- Waste Type: Broken or discarded glass vials, ampoules, and metallic body implants.
- Disposal: Disinfection (e.g., sodium hypochlorite) followed by recycling.

2. Modern Operational Mandates

Medical facilities must integrate digital and safety protocols into their daily operations.

Digital Tagging: Every waste bag must have a unique barcode linked to a national API for real-time tracking from the clinic to the final incinerator.
Storage Limits: Untreated waste cannot be stored on-site for more than 48 hours.
Pre-treatment: Laboratory waste, microbiological samples, and blood bags must be disinfected or sterilised on-site before being handed over for final disposal.
Worker Safety: All waste handlers must receive full immunization for Hepatitis B and Tetanus. They must be provided with heavy-duty puncture-resistant gloves, masks, and protective gowns.

3. Compliance & Legal Framework

Failure to follow the Bio-Medical Waste Management Rules 2026 carries significant penalties.

Requirement	2026 Standard
Annual Report	Must be uploaded to a national digital portal by June 30th.
First-time Fines	Up to ₹1 Lakh for improper segregation or delayed reporting.
Severe Violations	Imprisonment up to 5 years under the Environment Protection Act.
Transport	GPS-tracked, white vehicles with red/black biohazard symbols.

Emergency Power Failure Survival Drill For Ventilator Dependent Patients In Intensive Care

medpointhcg@gmail.com (Medpoint Healthcare) — Tue, 31 Mar 2026 05:44:00 +0530

For ventilator-dependent patients in an ICU, the first 60 seconds of a power failure are critical for survival. The immediate priority is maintaining oxygenation through manual ventilation if mechanical support fails.

IMMEDIATE SURVIVAL PROTOCOL (THE FIRST 60 SECONDS)

1. Call for Help: Shout for assistance immediately to ensure multiple staff members can manage the patient and troubleshoot equipment simultaneously.

2. Verify Patient Status: Look for chest rise and listen for air movement. If the patient is not breathing or the ventilator has stopped, do not waste time on the machine initially.

3. Initiate Manual Ventilation: Disconnect the patient from the ventilator circuit and attach a manual resuscitation bag (Ambu bag) with a 100% oxygen source.

· Squeeze the bag once every 5 to 6 seconds.

· Confirm correct usage by watching the chest rise; if the stomach rises instead, reposition the head.

4. Confirm Power Source: Check if the ventilator has automatically switched to its internal battery backup. If it has, and the patient is stable, reconnect to the ventilator to free up staff hands.

EXTENDED MANAGEMENT & TROUBLESHOOTING

· Verify Red Outlets: Ensure all life-critical equipment (ventilators, monitors, infusion pumps) is plugged into emergency "red" outlets connected to the hospital’s backup generators.

· Monitor Battery Life: Frequently check the remaining battery charge on all devices. Most modern ventilators provide 6 to 10 hours of backup, but high settings (high pressure or rate) will deplete batteries faster.

· Conserve Power: If medically safe and after consulting a physician, consider reducing power-heavy settings like breath frequency or pressure to extend battery life.

· Switch to Portable Oxygen: If the central wall oxygen supply fails (e.g., during disasters like earthquakes), switch to portable oxygen cylinders.

· Manage Critical Medications: Use battery-powered infusion pumps and ensure medications requiring refrigeration are kept in coolers with ice packs if the outage is prolonged.

DRILL & PREPAREDNESS CHECKLIST

· Essential Equipment at Bedside: Always keep an Ambu bag, a backup suction machine with a spare battery, and a pulse oximeter within arm's reach.

· Staff Training: Conduct regular simulations focusing on "Code Black" (utility failure) protocols and manual ventilation techniques.

· Maintenance: Test ventilator batteries at least once a month and maintain a rigorous preventative maintenance schedule.

· Evacuation Planning: Develop and practice a vertical evacuation plan using stairs for when elevators are non-functional, ensuring respiratory support can be maintained during transit.

Safe Handling and Disposal Procedures for Cytotoxic Drugs in Oncology Care Units

medpointhcg@gmail.com (Medpoint Healthcare) — Mon, 30 Mar 2026 07:53:00 +0530

Safe handling and disposal of cytotoxic drugs in oncology units require a rigorous "cradle-to-grave" approach to minimize occupational exposure and environmental contamination. Key procedures include:

1. Personal Protective Equipment (PPE)

PPE is the primary line of defense and should be worn throughout the entire medication circuit:

· Gloves: Use two pairs of powder-free, chemotherapy-grade gloves (e.g., nitrile, polyurethane, or neoprene). Change them every 30 minutes or immediately if torn or contaminated.

· Gowns: Disposable, lint-free, low-permeability gowns with long sleeves and tight-fitting cuffs that fasten in the back. Change gowns at the end of a procedure, if contaminated, or every 3.5 hours during drug preparation.

· Facial Protection: Wear a full face shield or goggles in combination with a fluid-resistant mask if there is a risk of splashing.

· Respiratory Protection: Use fit-tested N95 or N100 respirators when there is a risk of airborne powders or aerosols.

2. Preparation and Administration

· Engineering Controls: All mixing and preparation should occur in a centralized area within a Class II, Type B biological safety cabinet (BSC) that exhausts to the outside through HEPA filters.

· Handling Techniques: Use Luer-lock connectors and needleless systems to prevent leaks and puncture wounds.

· Surface Protection: Cover work surfaces with disposable, absorbent, plastic-backed pads to catch any drips or leaks.

· Air Purging: Never purge air from intravenous tubing using a solution that already contains the cytotoxic drug.

3. Transport and Storage

· Storage: Maintain a dedicated negative-pressure storage area for cytotoxic drugs.

· Packaging: Prepared drugs should be placed in clear, leak-proof plastic bags and then into a rigid, shock-resistant, and properly labeled transport container.

· Identification: All containers and waste must be clearly identified with the standard "Cytotoxic" hazard symbol.

4. Waste Disposal

"Cytotoxic waste" includes anything that has come into contact with the drugs, such as packaging, PPE, syringes, tubing, and even soiled patient linens or diapers.

· Segregation: Segregate cytotoxic waste from regular and infectious medical waste.

· Containers: Use puncture-proof, leak-proof sharps containers and bags clearly labeled with the "Cytotoxic" hazard symbol.

· Incineration: The only acceptable method for final disposal is high-temperature incineration (at or above 1200°C).

5. Spill Management and Exposure

· Spill Kits: Readily accessible spill kits containing full PPE, absorbent materials, and decontaminating agents must be available in all areas where drugs are handled.

· Accidental Exposure:

o Skin/Clothing: Immediately remove contaminated clothing and wash the skin with soap and water for at least 15 minutes.

o Eyes: Flush eyes with water or isotonic solution at an eyewash station for at least 15 minutes

Our Core Service

medpointhcg@gmail.com (Medpoint Healthcare) — Wed, 28 Jan 2026 08:54:00 +0530

Medpoint Portfoiio

medpointhcg@gmail.com (Medpoint Healthcare) — Wed, 28 Jan 2026 08:51:00 +0530

Prioritizing patients in an emergency setting

medpointhcg@gmail.com (Medpoint Healthcare) — Fri, 20 Jun 2025 10:48:00 +0530

In an Outpatient Department (OPD), patient prioritization involves ranking patients based on their clinical needs to ensure efficient and equitable care. This process helps manage limited resources and ensures those with higher needs, such as emergency cases, receive attention before less urgent cases. Many hospitals provide a scale for prioritizing patients in an emergency setting.

Factors Influencing Prioritization:

· Severity of illness:

Patients with more severe conditions
are generally prioritized.

· Urgency of the situation:

Patients requiring immediate intervention, like those with life-threatening conditions, are prioritized.

· Risk of harm:

Patients at risk of falling, bleeding, infection, or airway obstruction should be prioritized.

· New-onset symptoms:

Patients with new-onset symptoms or life-threatening conditions take precedence over routine care.

· Potential for rapid deterioration:

Patients whose condition could worsen quickly if not addressed promptly should be prioritized.

· Specific healthcare needs:

Some patients may require specialized care or interventions that necessitate earlier access to resources.

Benefits of Prioritization:

· Improved efficiency:

By prioritizing patients, healthcare providers can focus on those with the most pressing needs, streamlining the workflow.

· Fair and equitable care:

Prioritization ensures that those in the most urgent need receive timely attention, promoting fairness in healthcare delivery.

· Reduced wait times:

Prioritization can reduce wait times for patients who are not in dire need, improving their overall experience.

· Better resource utilization:

By focusing on the most critical cases, healthcare resources can be used more effectively and efficiently.

Tools and Techniques:

· Triage systems:

These systems use a standardized approach to assess patients and assign them a priority level based on their clinical needs.

· Prioritization tools:

These tools can be used to help healthcare providers make informed decisions about patient prioritization.

· Data analysis:

Analyzing patient data can help identify patterns and trends in patient needs, allowing for more efficient prioritization.

Ethical Considerations:

· Fairness and equity:

Prioritization systems should be designed to ensure that all patients receive a fair and equitable level of care.

· Transparency and accountability:

The prioritization process should be transparent and accountable, allowing patients to understand the rationale behind their placement in the queue.

· Patient autonomy:

Patients should have the opportunity to express their preferences and concerns about their care.

In hospitals, patient prioritization involves a process to determine who needs immediate attention based on the severity and urgency of their medical condition. This is often achieved through triage, a systematic method that assesses patients upon arrival and assigns them a priority level.

Triage in Emergency Departments:

· Initial Assessment:

Patients are quickly assessed upon arrival to determine the urgency of their condition.

· Priority Levels:

Patients are categorized into different priority levels based on their condition, with the most critical cases receiving immediate attention.

· Ongoing Monitoring:

Triage nurses continuously monitor patients and may re-assess or escalate their priority if their condition changes.

Factors Influencing Prioritization:

· ABCs (Airway, Breathing, Circulation):

Conditions affecting airway, breathing, or circulation are given top priority.

· Life-Threatening Conditions:

Patients with immediately life-threatening conditions are prioritized over those with less severe issues.

· Patient Acuity:

The severity of a patient's condition is a key factor in prioritization, with more acute conditions requiring immediate attention.

· Resource Availability:

Hospitals may also prioritize based on available resources and staff.

Prioritization in Other Settings:

· Waiting Lists:

Patient prioritization is also used in non-emergency settings, such as waiting lists for procedures or specialist appointments.

· Pharmacy Services:

In pharmacy, prioritization may be based on factors like high-risk medications or complex regimens.

· Nursing Care:

Nurses use prioritization principles to focus on the most critical needs of their patients, considering factors like Maslow's Hierarchy of Needs.

Examples of Prioritization:

· A patient with a severe airway obstruction would be prioritized over a patient with a minor headache.

· A patient with a heart attack would be prioritized over a patient with a mild cold.

· In a pharmacy setting, a patient taking multiple high-risk medications would be prioritized for pharmacist consultation.

Prioritizing patient care involves focusing on the most urgent and critical needs of patients while considering the overall well-being and safety of all patients under care. This can be achieved by utilizing tools like Maslow's Hierarchy of Needs, the ABCs (Airway, Breathing, Circulation), and by considering the patient's current condition and potential risks.

Examples of Prioritizing Patient Care:

· Addressing life-threatening situations:

A patient with a sucking chest wound would be prioritized over a patient with new-onset leg pain and swelling, as the sucking chest wound is a more immediate threat to life.

· Using the ABCs:

In a medical emergency, ensuring a patient has a clear airway, breathing effectively, and has adequate circulation is paramount.

· Utilizing Maslow's Hierarchy:

Addressing physiological needs (food, water, warmth, rest) takes precedence over safety and security needs, which in turn take precedence over belonging and love needs.

· Focusing on unstable patients:

Patients with unstable vital signs (low blood pressure, high heart rate) should be prioritized over patients with stable vital signs.

· Addressing pain management:

Patients experiencing significant pain should be addressed promptly, as uncontrolled pain can negatively impact recovery and overall well-being.

· Ensuring patient safety:

Implementing safety protocols and addressing potential hazards in the care environment are crucial.

· Clear communication and collaboration:

Clear communication and collaboration among healthcare professionals can prevent medical errors and improve patient outcomes.

· Involving patients and their families:

Empowering patients and their families to participate in their care plan can lead to better outcomes and a more positive experience.

· Continuity of care:

Ensuring seamless transitions between care settings and providers can reduce readmissions and improve patient outcomes.

· Self-care for healthcare providers:

Prioritizing self-care can help healthcare providers maintain their physical and mental well-being, allowing them to better care for patients.

Patient prioritization tools are instruments designed to help clinicians and decision-makers manage healthcare resources effectively, particularly in situations with limited access to care, by ranking patients based on specific criteria to ensure equitable and efficient delivery of services. These tools aim to support the prioritization process, making it more transparent and fair. They can be used in various clinical settings, including rehabilitation programs, hospital pharmacies, and emergency departments.

Key aspects of patient prioritization tools:

· Purpose:

To manage patient access to care by ranking referrals and allocating limited resources.

· Functionality:

They often involve scoring patients based on pre-determined criteria, such as clinical urgency, risk factors, and potential benefits from interventions.

· Examples:

· Clinical Prioritization Programs: Tools used to categorize patients in order of clinical urgency, considering their condition, risk factors, and potential health inequalities.

· Emergency Department Triage: Systems like the Jump-START algorithm are used to quickly assess and prioritize patients based on their immediate needs.

· Pharmacy Prioritization Tools: Tools designed to identify patients who would benefit most from pharmacist interventions, such as medication reviews.

· Outcome Prioritization Tools (OPT): Instruments that help patients and providers align on the importance of different health outcomes.

Considerations:

Prioritization tools may need to address social equity considerations, such as the impact of ethnicity or deprivation on health outcomes, to ensure fair access to care.

Implementation:

Successful implementation of these tools often requires stakeholder engagement and consideration of potential facilitators and barriers to adoption.

Benefits:

Prioritization tools can help ensure that patients receive timely and appropriate care, improve the efficiency of healthcare services, and reduce the burden and distress associated with difficult decision-making.

	1: Stable Client	2: Moderate-Risk Client	3: Complex Client	4: High-Risk Client
Assessment	· Q8h VS · A & O X 4	· Q4h VS · CIWA < 8	· Q2h VS · Delirium · CIWA > 8	· Unstable VS
Respiratory	· Stable on RA	· O2 < 2L NC	· O2 > 2L NC	· O2 via mask
Cardiac	· VS	· Temp < 98.7 F · Pacemaker/AICD · HR > 130	· Change in BP · Temp > 100.3 F	· Unstable rhythm · Afib
Medications	· PO/IVPB	· TPN, heparin infusion, blood glucose, PICC for blood draws	· CBI · 1 unit blood transfusion · Fluid bolus	· > 1 unit blood transfusion · Chemotherapy
Drainage Devices	· < 2 JP, hemovac, neph tube	· Chest to water seal · NG tube	· Chest tube to suction · Drain measured Q2 hrs	· Drain measured Q1 hr · CT > 100 mL/2 hrs
Pain Management	· Pain well- managed with PO or IV meds Q4 hrs	· PCA, nerve block · Nausea/Vomiting	· Q2h pain management	· Uncontrolled pain with multiple pain devices
Admit/Transfer/Discharge	· Stable transfer, routine discharge	· Discharge to outside facility	· New admission, discharge to hospice	· Complicated post-op
ADLs and Isolation	· Independent	· Assist with ADLs · Two-person assist out of bed · Isolation	· Turns Q2h · Bedrest · Respiratory isolation	· Paraplegic · Total care
Client Score	Most = 1	Two or > = 2	Any = 3	Any = 4

Disaster Kit

medpointhcg@gmail.com (Medpoint Healthcare) — Thu, 3 Apr 2025 18:42:00 +0530

· Torch with fresh batteries and spare batteries

· Candles, lighter, waterproof matches

· Soap, antiseptic (e.g. Dettol), alcohol hand sanitizer, plastic gloves and face mask (if possible)

· Bottle of water and several non-perishable packaged food items (e.g. dry fruit / nuts / biscuits)

· Spare clothing and footwear

· Medical kit: bandage, topical antibiotic and antiseptic, sticking plaster, essential medicines for any existing medical conditions, common medicines

· Insect repellant, mosquito net, wet wipes, sanitary goods, toiletries as necessary

· Plastic bucket or additional plastic bottle for transporting clean drinking and washing water

· Your list of National / City emergency contact numbers, family member telephone numbers, contact point, email addresses etc

· Important documents, insurance details, medical prescriptions,

· Spare waterproof plastic bag

· Water and non-perishable food

· Dust mask

· Fire extinguisher

It’s time to disrupt the existing hospital business model

medpointhcg@gmail.com (Medpoint Healthcare) — Fri, 11 Aug 2023 09:11:00 +0530

Business models often change quite dramatically over time in the American economy. Think of booksellers; Amazon changed the concept of a bookseller and its book retailing vision led to the radical diversification of its product line.

Some business models are more resistant to change, with firms concentrating on specialization rather than engaging in organizational innovation and diversification. Take the example of hospitals. Within our health system, hospitals carry out a “repair shop” function, and, despite new technologies and advancing professional skills, that function and business model has changed little for over a century.

True, there has been some alteration at the margin. Walk-in clinics and many physician offices now provide some services that used to require a trip to the hospital emergency room or a hospital admission; but that has not done much so to reshape the basic concept of a hospital. It is also true that hospital administrators have become much more businesslike in managing cost and improving quality. But hospitals have altered little in an institutional or functional sense.

Things could change, however. One school of thought sees hospitals radically improving efficiency by becoming highly specialized “focused factories.” Like the placekicker on a football team, the argument goes, hospitals will reduce the range of services they provide and concentrate on providing a small number of services as efficiently as possible, with patients going to different hospitals for different procedures. According to this view, hospitals should cease thinking of themselves as a one-stop shop offering a wide range of services, thus going in the opposite direction of Amazon.

However, another school of thought would encourage hospitals to evolve in a different direction. According to this view, hospitals would become far more involved as “hubs” in communities, orchestrating a wide range of non-medical social services—even such things as housing—that contribute in some way to health.

Hospitals should be “hubs” that emphasize social services over medical repair

There is a good reason to advance this second model and turn hospitals into hubs that provide a range of social services. In America, we have over medicalized health; we assemble impressive—and very expensive—medical technology to fix people when they are sick or injured. However, we spend proportionately far less than other countries for social services that address so-called determinants of health that contribute to better health and reduce the need for medical care.

We spend proportionately far less than other countries for social services that address so-called determinants of health that contribute to better health and reduce the need for medical care.

If one combines medical spending and social service spending for the advanced industrialized countries, as a proportion of GDP, the United States ranks just a little above the average. But looking at medical care as a percentage of that combination, the US is the outlier. We spend about 64 percent of the combination on medical care, while the average for those countries is 37 percent—and yet our health outcomes for many conditions are often much worse. Countries with more balanced social service and medical spending generally have better health outcomes, and we see a similar pattern among US states. So we would likely see a significant improvement in health if we spent less on hospital care and more on social services to address such things as poor nutrition, stress in low-income households, and unsafe conditions in elderly housing that increase the probability of falls.

Barriers to disruption

Switching funds from medical care to social services and housing, however, is not exactly a welcome idea to the typical chief financial officer of a hospital. It is true that many hospital administrators recognize that the health of their patients would improve if there were more integration of hospital-provided services with social services, such as making sure discharged patients received support services in their community. Most administrators also agree that offering hospital staff to train individuals and community institutions in prevention techniques would improve community health. However, in the manner of “no good deed goes unpunished,” administrators point out that they have no financial incentive to spend hospital money to reduce the need for hospital services and hence reduce revenue. Indeed, their financial incentive is NOT to reduce the demand for hospital care. This is often referred to as a “wrong pockets” problem; a situation in which we would have better outcomes if one institution or sector invested money, but because the primary benefit accrues to another institution or sector there is no incentive to make that investment.

Some hospital systems with a broader social mission—such as some catholic hospitals—do develop partnerships with low-income housing groups and with social service organizations. But this is largely a philanthropic activity. To solve the wrong pockets problem, however, it has to be in the business interest of hospitals to diversify well beyond providing medical services.

How to get hospitals on board with reinvention

Getting such diversification to work financially requires encouragement in the form of both sticks and carrots. For a number of years, hospitals serving Medicare patients have faced a financial stick in the form of readmission penalties. If a hospital treats and discharges a Medicare patient with certain conditions, and the patient is readmitted to any hospital within 30 days with the same diagnosis, the first hospital is essentially fined by Medicare. That has caused many hospitals to explore a variety of ways to arrange community services and even housing to make it less likely the patient will return to hospital.

It is important, however, to look at positive steps to make it economically rational for hospitals to do less repairing and instead provide more non-medical services themselves, or partner with other institutions to improve health. That requires such things as changing the payment rules for Medicare and Medicaid to allow hospitals to be reimbursed for delivering or organizing a wide range of non-medical services that have been demonstrated to improve health, including supportive housing. Private health insurance plans also need to explore ways to reimburse non-medical services that improve health, and reduce medical costs, rather than just reimbursing medical services. If we take serious steps to pay for improved health in this way, rather than paying only for repairing people, we would begin to transform the business model of the American hospital.

Patient Safety Goals

medpointhcg@gmail.com (Medpoint Healthcare) — Sat, 1 Jul 2023 08:04:00 +0530

Patient Safety Goals Declaration

We hereby declare that our hospitals patient safety is at the heart of our ability to offer consistent, reliable quality care as guided by JCI/QCI/NABH International Patient Safety Goals dated ______. That is why, we are committed to taking every possible step to assure Your safety. Towards this, we have launched the Patient Safety Declaration which is followed by across the hospitals.

International Patient Safety Goals

Goal One - Identify patients correctly.

Goal Two - Improve effective communication.

Goal Three - Improve the safety of high-alert medications.

Goal Four - Ensure safe surgery.

Goal Five - Reduce the risk of health care-associated infections.

Goal Six - Reduce the risk of patient harm resulting from falls.

The Declaration:

We have a separate ID number for Identify patients correctly.

We have a person designated for patient safety.

We have a Patient Safety Committee with representatives from medical services, nursing, engineering, housekeeping, pharmacy and infection control that shall meet every quarter.

We have training program for all our employees on patient safety issues.

We have educate our patients on patient safety issues.

We have a policy and implemented system on reporting of adverse events within the hospital.

We have collect rates for the following patient safety indices:

Hospital associated infections

· UTI

· SISI

· CALBSI

· VAP

Patient fall

Pressure ulcer

Needle stick injuries

Medication errors

As we know that the best outcomes occur when everyone is involved in patient safety, we believe that all staff shall join hands to form a National Patient Safety Network for sharing of the best practices in patient safety. Every staff shall endeavour to prevent the ‘Never Events’ listed by the National Quality Forum.

Authorised Signatory

Date :

NMC guidelines for build up Medical college in India

medpointhcg@gmail.com (Medpoint Healthcare) — Fri, 9 Jun 2023 08:16:00 +0530

Indian Medical Education has undergone tremendous changes in the recent years with revamp in curriculum, no of seats, fee structure etc. The number of medical colleges which stood at 381 in 2014 has increased to 596 medical colleges as of 12 January 2022. The number of UG seats have increased from 51,348 before 2014 to 89,875 seats as of March 29, 2022 which is an increase of 75 per cent. The numbers of PG seats have increased by 93 per cent from 31,185 seats before 2014 to 60,202 seats. The Central Government has made huge efforts to upgrade the existing Medical Education System. In 2020 NMC i.e. National Medical Commission replaced the Medical Council of India (MCI) paving the way as a new regulator.

The Government has also relaxed the norms for setting up of medical colleges in terms of requirement for faculty, staff, bed strength and other infrastructure. In order to tackle the shortage of faculty, Diplomate of National Board (DNB) qualification has been recognized for appointment as faculty members. NMC has made significant efforts in changing the curriculum the previous edition being that of 1997.

The new curriculum stresses on the importance of ethics and communication competencies. Also the new standards set by NMC for opening of medical colleges envisages a skill laboratory in every medical institution. It provides a facility where students can practice and improve their skills in a safe environment, mitigating the limitations of learning on live patients. These skill labs will recreate the clinical environment and provide a much greater opportunity for learning through mannequins and computerized simulation.

Despite the government being successful in increasing the number of medical seats in our country, it is still the shortage of seats and expensive medical education fees that is driving our youth abroad.

There are 13 lakh one thousand three hundred nineteen allopathic doctors registered with the State Medical Councils and the National Medical Commission (NMC) as on November 2021 with Doctor Population ratio of 1:834. Also there are also two lakh 89 thousand registered dentists, 32 lakh 63 thousand registered nursing personnel and 13 lakh allied and Healthcare professionals in the country.

Even with the adequate Doctor to Population ratio, India has an overall shortfall of 76.1 per cent specialist doctors at the Community Health Centres (CHCs) in rural areas.

Eligibility to Start a Medical College

1. A State Govt./Union Territory;

2. A University;

3. An autonomous Body promoted by Central or State Government or under a Statute for the purpose of medical qualification;

4. A society registered under the Societies Registration Act, 1860 for corresponding Acts in States; or

5. A public Religious or Charitable Trust registered under the Trust act, 1882 or the WAKFS Act, 1954.

6. Companies registered under The Company Act, 1956

Qualifying criteria i.e. conditions to be fulfilled for starting a medical college

1. Medical education must be one of the objectives of the applicant in case the applicant is an autonomous body, registered society, charitable trust & companies registered under Companies Act.

2. The medical college or medical institution shall be housed in a unitary campus of not less than 20 acres of land except in mega cities and ‘A’ class cities

3. Further provided that, in Metropolitan areas, the medical college should have the total built up area required for adequate infrastructure, including medical college, affiliated teaching hospital, residential quarters and other infrastructure required as per the applicable Minimum Standard Requirement Regulations, in the unitary piece of land owned and possessed by them.

4. The applicant must submit the Essentiality Certificate from the concerned State Govt./ Union Territory for establishment of the proposed medical college.

5. The Consent of Affiliation from the concerned University

6. The hospital owned and managed by the appropriate Government should be minimum 300 bedded hospital with necessary infrastructural facilities capable of being developed into a teaching institution.

7. The minimum 300 bedded hospital has to be transferred by the Government to the applicant trust/society/company through an appropriate Memorandum of Understanding of minimum of 33 years or by way of lease of 99 years preferably but in any case not less than 33 years.

8. The hospital should have all the feasibility for it being periodically upgraded including the augmentation of the number of beds and commensurate teaching units and teaching compliment as prescribed by the Governing Regulations with respect to the permitted annual intake for the college of 50/100/150/200/250 as the case may be.

9. The applicant has not admitted students in the proposed medical college.

10. The applicant provides two performances Bank guarantee valid for a period of 5 years in favor of MCI for the prescribed sums varying according to the number of admissions, one for the establishment of the medical college and the other for the teaching hospital. Government Medical Colleges are exempted from submitting performance Bank guarantees.

11. Hired or rented building shall not be permitted and the college shall be set up only in the plot earmarked for that purpose.

SCHEDULE FOR RECEIPT OF APPLICATIONS FOR ESTABLISHMENT OF NEW MEDICAL COLLEGES/RENEWAL OF PERMISSION AND PROCESSING OF THE APPLICATIONS BY THE CENTRAL GOVERNMENT & MEDICAL COUNCIL OF INDIA

S.NO STAGE OF PROCESSING

1 Receipt of applications by the Central Government.

2 Forwarding application by the Central Government to Medical Council of India.

3 Technical Scrutiny, assessment and Recommendations for Letter of Permission by the Medical Council of India.

4 Receipt of reply/compliance from the applicant by the Central Government and for personal hearing thereto, if any and

forwarding of compliance by the Central Govt. to the Medical Council of India.

5 Final recommendations for the letter of permission by the Medical Council of India

6 Issue of Letter of Permission by the Central Government.

Are you planning to build or restructure or venture in any Medical Colleges in India?

 Medpoint Healthcare has mapped all on possibilities and eligibilities to start up a medical college in India. mail at medpointhcg@gmail.com

SUGGESTED NURSES PATIENT RATIO FOR INDIA HOSPITALS

medpointhcg@gmail.com (Medpoint Healthcare) — Thu, 8 Jun 2023 08:29:00 +0530

SUGGESTED ADVISORY ON STAFFING OF NURSING PERSONNEL

FOR ACCREDITATION OF HOSPITALS

Based on feedback received from healthcare organizations /assessors/other stakeholders regarding clarity on staffing requirements for nursing personnel, the following is suggested.

S.no	Department / Area	Nurse:Patient Ratio

1	ICU- Ventilator Beds	1:1 each shift
2	ICU- Non-Ventilator Beds	1:2 each shift
3	High Dependency Unit (HDU)	1:3 each shift
4	Inpatient beds	1:6 each shift
5	Operation Theatre (OT)	2 nurses per table each shift
6	Emergency - Ventilator Beds	1:1 each shift
7	Emergency- Other Beds	1:4 each shift
8	OPD	As per workload
9	Various Procedures	As per workload
10	Labor table	1 nurse per table each shift
11	Supervisor staff	As applicable
12	Infection Control Nurse	1 for 100 beds

The above nurse patient ratio is an advisory and numbers are arrived based on available guidelines and inputs from various stakeholders.

During assessment the team shall also consider the following and assess the overall intent of this advisory (to ensure patient safety and clinical care are not compromised) and not merely at numbers alone before commenting on the adequacy of nurse patient ratio.

§ Scope of services of the healthcare organisation

§ Nature of clinical care being provided (acute care /chronic care /domiciliary/ Rehabilitation)

The above advisory will reviewed periodically based on feedback /inputs from various stakeholders.

Measuring appropriateness of diagnostic imaging

medpointhcg@gmail.com (Medpoint Healthcare) — Wed, 26 Apr 2023 07:33:00 +0530

Upper airway

Retropharyngeal abscess:

· look for widened prevertebral shadow (normal prevertebral width equal to vertebral body width at C4 level) or neck flexion

Inhaled foreign body:

· if clinical suspicion that FB in neck or upper resp tract signs

· rarely, a sharp FB may have perforated ST and imaging of the neck may be indicated

· See Inhaled foreign body guideline

Acute epiglotitis:

· the diagnosis is made clinically NOT radiologically

See upper airway obstruction CPG

Chest xray (frontal view)

Lateral CXR rarely indicated and should be discussed with a consultant
Pre-operative CXR NOT to be done routinely at any age.

Respiratory indications:

Infection - to exclude pneumonia
Inhaled foreign body

· most lodge in intrathoracic tracheobronchial tree.

· Need films in full inspiration and expiration to demonstrate air trapping or collapse.

Chest trauma

· for air leak, haemothorax or wide mediastinum.

· Rib views rarely indicated.

Pneumothorax - full inspiratory films adequate

Asthma/ Bronchiolitis - Consider only if:

· diagnosis unclear

· SEVERE attack - not responding to standard therapy
possible air leak.

· NB. Focal signs +/- fever are most likely due to mucus plug and viral illness rather than pneumonia.

Cardiac indications:

Clinical cardiomegaly or heart failure.

· Large thymic shadow is normal under the age of 2 years.

· Normal cardio-thoracic ratio 0.5 ( infants up to 0.6 )

Heart murmurs - If careful examination suggests innocent murmur, no need for urgent CXR - but arrange appropriate follow up.

Hypertension - CXR is seldom useful.

Neonates (<6wks):

Septic screen - CXR indicated unless clear focus elsewhere
Respiratory distress - to exclude congestive cardiac failure or cardiomegaly

Limb xrays & other imaging modalities

Comparative and Stress Views - rarely necessary and should not be routinely taken. However may be useful for complex fractures (after consultation) if initial xrays unclear (eg. elbow)

Specific Indications/Contraindications:

Trauma

Xray of the suspected fracture as well as the joints above and below if signs and symptoms suggest bone injury. If in doubt about the site of injury, seek senior help rather than xraying the entire limb.

· Follow up films after reduction of a displaced # should be done to assess position.

If a fracture is clinically suspected but xrays normal, discuss with consultant and if in doubt treat as if fracture present.

· Additional views are sometimes useful (eg. radial head views) and other fractures (eg. stress # or toddler #) might need Bone Scan or CT (these requests should be discussed with ED consultant & orthopaedics and appropriate follow-up arranged).

See limb fracture CPG

Non accidental injury (to be seen by registrar or consultant)

If child > 2yr xrays should be limited to sites of clinically suspected injury.
Complete Skeletal Survey if child < 3 years (not available after-hours unless urgent)
± Bone Scan (if < 3yr) - can complement skeletal survey
Suspect NAI if:

· metaphyseal #

· marked or unusual epiphyseal separation

· # of spine or ribs

· unexplained skull # ± intra cranial injury

See Non-accidental injury CPG

Acutely painful hip

Plain xrays (AP and frog-leg lateral) will demonstrate slipped upper femoral epiphyses, Perthe's and fractures.
USS/ bone scan may be indicated depending on clinical findings (discuss with specialty team or treating consultant).

See acutely painful hip guideline

Acutely swollen joint

See acutely swollen joint guideline

Osteomyelitis

Early XR often shows no bony abnormality but may have deep soft tissue swelling.
Bone scan/MRI will demonstrate an abnormality earlier than XR (needs orthopaedic team input)

See Osteomyelitis & Septic Arthritis guideline

Septic Arthritis

Normal XR or Bone scan does not exclude septic arthritis.
Ultrasound may be useful to demonstrate a joint effusion and soft tissue abnormality (discuss with orthopaedic team or treating consultant)

See osteomyelitis & septic arthritis guideline

Metabolic disorders

Rickets - XR of one wrist +/- one knee is most useful.
Osteogenesis Imperfecta - very low threshold for xray.

Pulled Elbow

If injury mechanism and examination suggest radial head subluxation, xray is unnecessary.

Abdominal xrays

Suspected bowel obstruction/ perforation

A plain AXR will demonstrate most obstruction (dilated loops).
An erect AXR is indicated to exclude perforation

Suspected intussusception

A normal AXR does not exclude intussusception but is useful to exclude perforation or bowel obstruction in suspected intussusception.

See intussusception guideline

Foreign Bodies

Ingested opaque FB requires a single survey AP film (mouth to anus).
Routine follow-up films are NOT indicated unless clinical symptoms develop.

See ingested foreign body guideline

Suspected Abdominal Mass

Initial investigation - plain AXR and ultrasound, then further as indicated

Blunt abdominal trauma

Needs early assessment by General Surgery.
CT scan is the best modality for diagnosing intra-abdominal injury.

Unnecessary AXRs

If unsure whether AXR would be helpful - ask consultant or registrar for advice

AXR not indicated for:

Vague central abdominal pain.
Gastroenteritis.
Haematemesis.
Pyloric stenosis.
Uncomplicated appendicitis.
Chronic constipation, encopresis or enuresis (in the Emerg. Dept setting )

Abdominal & pelvic ultrasounds

If an urgent ultrasound is necessary, the patient should be discussed with the surgeon &/or the treating consultant.

Specific indications:

Suspected intussusception

Ultrasound by experienced operators is the diagnostic modality of choice for intussusception.
However these patients are potentially unstable and should only be sent for ultrasound after appropriate resuscitation including an IV, and treatment as well as notifying the surgeons and the treating consultant

See intussusception guideline

Suspected pyloric stenosis

Ultrasound is a very sensitive test for pyloric stenosis

See pyloric stenosis guideline

Abdominal pain

or iliac or pelvic pain in the pubertal female with possible ovarian pathology (requires full bladder), or if potential renal tract obstruction, early ultrasound recommended.
Abdominal ultrasound is a useful tool for many other abdominal pain presentations however urgency of the request should be proportional to the symptoms.

Urinary tract imaging

Bacteriologically proven first UTI usually requires renal tract US (particularly <4 years old) but only occasionally MCU

See urinary tract infection guideline

Intracranial and skull imaging

Specific Indications for Skull Xrays (SXR):

Only indicated in well-appearing children

NAI

as part of skeletal survey (more sensitive than Bone Scan for skull fracture)

Plagiocephaly

Craniosynostosis (prematurely fused sutures) accounts for the minority of abnormal skull shapes. A SXR is useful to evaluate sutures but is ideally done via outpatient follow-up (Craniofacial or neurosurgical unit- RCH Deformational head clinic)

There are no other routine indications for skull XRay and any such requests should be discussed with the treating consultant.

Specific Indications for CT Brain:

The treating consultant should discuss the need for all CT scans.
The Neurosurgical team should be involved before CT for the unwell or potentially unstable patient who may need urgent interventions.

Head Trauma

Useful for rapid diagnosis of suspected intracranial injuries and is the preferred investigation if clinical evidence of intracranial injury.
Clinical deterioration is usually an indication for repeat CT examination.

See Head injury guideline

Depressed conscious level of unknown cause

CT scan is indicated after appropriate stabilising treatment.

See Coma guideline

Headaches

Clinical evaluation is the most important factor in determining the need for imaging.

CT scan indications:

Abnormal neurological signs.
Unexplained decrease in visual acuity.
Headaches with seizures.
Marked change in behaviour.
Enlarging head
Symptoms of raised intracranial pressure.
Increasing frequency of unexplained headaches or new onset of severe or persistent headache

See headache guideline

Seizures

Persistent abnormal neurological signs/impaired conscious state.
Focal neurological signs or EEG findings.
Failure to respond to anticonvulsant therapy.
Neurocutaneous lesions.

See afebrile seizures guideline

Abnormal Size / Shape Of Skull

Clinical examination is usually sufficient to diagnose abnormality of the skull.

Large head - rapidly enlarging head needs imaging-US or CT scan.
Small head - nearly always pathological secondary to abnormal brain growth. Evaluate with CT or MRI scan, which is usually best organised via the managing outpatient physician

Specific Indications for cranial ultrasound:

Large head

Rapidly enlarging head with open fontanelle.

Neurological concerns in neonates/ infants

Clinical usefulness will vary depending on size of fontanelle and indications and should be discussed with the radiologist.

Spinal imaging

Any investigations other than plain xrays should be ordered in consultation with the treating consultant &/or the appropriate specialty team.

NB. Down syndrome children have increased risk of C1-2 instability.

Specific indications in Trauma:

Cervical spine

A normal Spinal Xray series or CT scan will not allow clearance of the neck in the unconscious or uncooperative patient

See cervical spine trauma guideline

Thoraco-Lumbar Spine

Children poorly localise the level of the injury, therefore imaging the full length of thoraco-lumbar spine may be necessary (discuss with treating consultant).
If neurological signs present do a CT or MRI scan after consultation with Neurosurgery.

Specific Non-trauma indications:

Scoliosis

Plain films should include the entire spine

Potential cord compression

Needs discussion with the treating consultant and neurosurgical team.

Suspected focal vertebral pathology

Choice of imaging modality needs discussion with the treating consultant.

GUIDELINES ON RECALL AND RAPID ALERT SYSTEM FOR DRUGS

medpointhcg@gmail.com (Medpoint Healthcare) — Tue, 20 Dec 2022 08:51:00 +0530

Sivakumar murugesan

Hospitals Project , Patient Safety and Quality Improvement Consultant

Medpoint Provides NABH Accreditation Consultancy Services to Healthcare Organisations.As part of our service here we publish drug recall procedure guidelines for your reference.

Introduction:

Recall is an action taken to withdraw/remove the drugs from distribution or use including corrective action for which deficiencies are reported in quality, efficacy or safety. The defective products related to quality includes Not of Standard Quality, Adulterated or Spurious drugs. Safety and efficacy related recalls include serious adverse reactions and death. Recalls also include drugs prohibited under the Provisions of Drugs & Cosmetics Act and also those products for which product licenses are suspended/cancelled.

Rapid Alert System is to transmit only those alerts whose urgency and seriousness cannot permit any delay in transmission. Assessment must be made of the seriousness of the defect, its potential for causing harm to the patient or harm to animals (in case of veterinary product), consumers, operators and the environment.

Background:

In the Drugs & Cosmetics Act & Rules, there are references for product recalls, complaint and adverse reactions in Para 27 & 28 of Schedule M and also conditions of license for defective product recall in Rule 74(j) and Rule 78(i), but effective and uniform recall procedure, with time lines at every level of supply chain is required and at present auditing and accountability is not in place. This has been observed in instances where drugs declared as not of standard quality by Government Analyst, incidents where serious adverse effects or death have been reported, in case of banned drugs under Section 26 A, defects where in voluntarily the manufacturer withdraws drugs from the market etc.

Scope:

These guidelines is applicable to all quality defective product reports and to all reported incidents of safety and efficacy received for all drugs including vaccines & biological. These guidelines are expected to be followed by licensees (manufacturers, importers, stockists, distributors, retailers) and the recall could be voluntary or statutory. The procedure may also be used by Drugs Control Authorities of Central or State when urgent action is required to protect public or animal health. These guidelines would help in adopting to stepwise procedures to be followed in recall strategy and also help in recall evaluation at every level and achieve compliance within the time frame.

Definitions:

Recall: Removal or correction of marketed products for the reasons relating to deficiencies in quality, safety or efficacy, including labeling considered to be in violation of the laws.

Batch Recall: Process for removal of selected batch/es of a product which are found to be defective and pose health risk to the consumers if left in the market.

Batch (Lot): A specific quantity of material produced in a process or series of processes so that it is expected to be homogeneous within specified limits.

Customer: Any person, firm or party buying/receiving goods from the company for storage, distribution and sale.

Voluntary Recall: A recall initiated by the licensee (in case of loan licensee jointly the contract giver and contract acceptor) as a result of abnormal observation in any product quality during periodic review (Internal / External) or investigation of a market complaint or any other failures.

Statutory Recall: A recall directed by Drug Control Authorities after notifying that product is considered to be in violation of the laws. e.g., Declared as Not of Standard Quality by Government Analyst and Banned under 26A of Drugs and Cosmetics Act 1940 (as amended from time to time)and as well as contravention of Rule 104-A of Drugs & Cosmetics Rules1945( as amended from time to time)

Recall Classification:

Recall classification is a numerical designation, I, II, or III, that is assigned to a particular product recall that indicates the relative degree of health hazard by country regulatory authorities.

In case of not of standard quality drugs, the recommendations of 39^th DCC guidelines for category A,B and C may be accordingly adopted for Class I, Class II and Class III until further recommendations if any. All banned Drugs & Products for which license is suspended, cancelled which are in circulation in market shall also be considered to be Class I recalls only.

Class I is a situation in which there is a reasonable probability that the use of, or exposure to, a defective product will cause serious adverse health consequences or death and as well as banned under 26A of Drugs and Cosmetics Act 1940.

Class II is situation in which the use of, or exposure to, a defective product may cause temporary adverse health consequences or where the probability of serious adverse health consequences is remote.

Class III is a situation in which the use of, or exposure to, a defective product is not likely to cause any adverse health consequences.

Recall Procedures:

Any batch of a product not meeting the defined quality standards has to be recalled from the market. Recall can be of two types; Voluntary Recall and Statutory Recall.

Voluntary Recall:

Voluntary recall can be triggered by any incident that affects the quality, safety and efficacy of the batch/product in question such as

1. If the batch or batches are found to be not complying with the regulatory specifications during the post marketing stability study

2. If the batch is found to be defective during investigation of market complaint.

3. During any failure investigation, if it is observed that the failure under investigation might have adverse quality impact on already released batch (e.g. possibility of contamination, mix-up, degradation etc).

4. If any unusual observation is noted during visual inspection of retention samples which indicate an impact on quality of the product after investigation.

5. If the post marketing surveillance reports /pharmacovigilance reports indicates that there is serious safety risk associated with the product.

Statutory Recall:

Statutory recall can be triggered in response to the direction or mandate by the Drug Regulatory Authorities (Central/State) in one or more of the situations as follows :

1. To recall the drug product/batch, considered to be in violation of the laws, it administers such as not of standard quality etc.

2. To recall the banned drugs.

3. Labeling and / or Promotional materials, that are considered to be in violation of law.

4. Product, violation Rule 106 (Diseases under Schedule J)

Levels of Recall:

The level (or depth) of recall of a product/batch shall be determined based on recall classification and level to which distribution has taken place.

There are three levels of recall such as consumer/user, retail and wholesale.

Consumer or User Level: which may vary with product, including any intermediate wholesale or retail level. Consumer or user may include individual consumers, patients, physicians and hospitals.

Retail Level:- recall to the level immediately preceding consumer or user level. It includes retail groceries, pharmacies, hospital pharmacies, dispensing physician, institutions such as clinics and nursing homes, etc.

Wholesale Level: all distribution levels between the manufacturer and retailer.

All Class I recalls shall be executed to the levels of Wholesale/Distributors, retail, and consumer. In such cases, public announcements shall be made using print/electronic media aids viz. Newspapers, Television, Radio etc.

All Class II recalls shall be executed up to the levels of wholesale and retail. All Class III recalls shall be executed up to the levels of wholesale.

Time Lines for Effective Recall System & Rapid Alert:

Based on the category of risks involved, a time line of within 24 hours up to a maximum of 72 hours for Class I recall, for class II recall up to a maximum of 10 days and for Class III recall up to a maximum of 30 days is allowed.

The time line for initiation of recall procedure to commence from the receipt of information as notified by the concerned State/ Central Drugs Control Department under statutory recall or voluntary recall by the manufacturer on its own.

The recall has to be initiated immediately without any prejudice of the outcome of Section 25(3) and Section 25(4) of the Drugs & Cosmetics Act 1940 for adducing the evidence. The time line for stopping sale/distribution of defective product under Class I shall be ensured within 24 hours and the physical recall being completed within 72 hours. The Class II and Class III recalls shall be ensured upto 10 and upto 30 days respectively.

Procedure for Rapid Alert & Recall System:

As soon as the product/batch(es) to be recalled is/are identified, licensee or representative of licensee or QA in charge shall review the information related to the defective product/batch(es) and decide about recall as per the procedure established.

The decision on recall of the defective product/batch shall be made within 24 Hours up to maximum of 72 Hours for Class I recall upon receipt of the intimation.

Within 24 Hours of the decision taken for the recall of the product/batch(es) the communication shall be sent stating the severity of the defect, using the fastest mode of communication which may include email, telephone, fax, SMS etc to the entire supply chain.

The licensee/representative of licensee where the product is marketed shall inform the concerned regulatory authorities where the product batch(es) in question was distributed immediately after the decision of recall has been taken. Further actions on recall will be undertaken according to class of recall.

Recall classification of the product/batch in question shall be done based on the risk assessment in line with the recall classification as given in definition.

It shall be the responsibility of the manufacturer and marketing company to inform up to retail level on the reason of recall in his freeze stock notice.

It shall be the responsibility of distributor/marketing company/ retailer to inform the stock position of product being recalled to his immediate supplier or manufacturer and also his area Drugs Inspector.

The recall notice received, the stock at that time, the procedure for freezing the stock and returned back records shall be maintained by the distributor/retailer and shall be made available for verification by area Drugs Inspector who shall verify and report on its timely freezing and return.

Stepwise Recall Procedure:

The licensee/representative of licensee/Quality Head in charge shall enter the details in the ‘Recall Log’ and assign a unique recall reference number representing the serial number for a particular year in which the recall has been initiated.

The licensee/representative of licensee/ Quality Head in charge shall inform the Distributor/Marketing Company with fastest mode of communication which may include email, telephone, fax, sms etc. to stop further distribution of the batch(es) in the stock and call back the stock available with the distributors, retailers etc, depending on the seriousness of the defect.

“Product/batch Recall Notice” shall be filled and sent by licensee/representative of licensee/ Quality Head in charge to Distributor / Marketing Company.

Distributor / Marketing Company shall immediately check the distribution record to identify the Customers and Warehouse, depots where the subject product / batches have been distributed and forward the copies of the Recall Notice to them for further necessary action.

The Head of depot(s) shall fill ‘Recall Notification’ and forward it to all distributors to return all unsold stock. Simultaneously, the Heads of respective depots

/ware houses shall block the available stock. The Distribution Head shall ensure the blockage of stock for further sale by reviewing the record.

The distributor(s) shall send the “Return Feedback” along with goods (if any) to the depots. All the returned stocks shall be further forwarded to the ware houses.

The Head of ware houses shall send a periodical report to licensee/representative of licensee /QA head of the stock available with them and the returns received from depots.

Head of ware house shall reconcile the stocks of the recalled materials against the total quantity of distributed material and fill the “Summary Report of Product / Batch Recall”. The copy shall be forwarded to licensee/representative of licensee/QA in charge for review and necessary action.

The recall of the product/batch shall be completed depending on the class of recall within the stipulated time.

Follow-Up Action of Recalled Goods:

The follow-up action consists of a check on the effectiveness of the recall, an investigation of the reason for the recall and remedial action taken to prevent a recurrence of the defect.

The licensee/representative of licensee/QA Head shall monitor the recall process of product/batch to determine whether the recall is progressing satisfactorily.

The stocks of recalled goods shall be placed under “Quarantine” and stored separately under lock and key in a secure area until further decision.

Wherever required, QA Head of the manufacturing site shall perform the physical inspection of recalled goods and collect sample from recalled goods for investigation to establish the root cause of the product quality defect.

The investigation of the recalled batch(es) shall be conducted as per the SOP of the licensee, on “Investigation of Non-conformities” to identify the root cause of the failure and initiate corrective and preventive actions

Impact assessment shall be conducted on other batches of the concerned product and further extended to batch(es) of other product(s), wherever applicable.

If the cause of recall is established to be quality issue associated with any of the raw material used, then the traceability of that material shall be established in all the product/batches.

Alternatively execute the transaction through records to identify the batches / products in which the identified material has been used.

Monitoring the relevant data i.e. Material, Plant and Batch Number in respective fields.

Identify the raw material traceability in different formulations and its functions.

List all raw materials along with batch numbers and the respective quantities used in those batches.

List all the products along with batch numbers and the respective quantities used in those batches.

Calculate the total quantity by adding individual quantities used in various products / batches.

Monitoring of the material movement to get the complete overview of stock for that particular material in the plant and extract the information about total quantity received and the balance quantity.

The balance stock, if any shall be verified against the actual physical stock available. QA shall block the remaining available stock.

All material shall be accounted for after the reconciliation

The decision to recall, if necessary, any of the impacted batches shall be made after product quality assessment.

Based on conclusion of the investigation findings, the QA Head / representative of licensee shall direct the Distributor / Marketing Company for appropriate disposition of the batch(es) of the recalled goods as per the regulations.

MOCK RECALL:

Mock recall shall be carried out for at least one batch of any product, dispatched for sale where maximum distributors are involved, to test the effectiveness of the arrangements of recall. Effectiveness of recall procedure can also be checked by ‘evaluation of a real recall’.

During mock recall traceability shall be performed for at least, one of the raw material used in the batches identified for mock recall.

Mock Recall shall be performed at least once for the longest distribution chain and whenever there is a change in distributor/marketing company.

Records of such mock recall should be maintained by the QA Head of the company.

References:

1. The Drugs & Cosmetics Act 1940 & Rules 1945.

2. The WHO TRS for GMP Guidelines.

3. Work Shop on Recall & Rapid Alert System, held at New Delhi Office from 27^th to 30^th August 2012 organized by CDSCO in collaboration with WHO.

4. USFDA documents on recall.

5. The Guidelines on Recall & Rapid Alert System for Drugs including Biologicals and Vaccines.

NABH Entry Level SHCO Checklist for Chapter 4 to 10

medpointhcg@gmail.com (Medpoint Healthcare) — Tue, 20 Dec 2022 07:37:00 +0530

CHAPTER 4

PATIENT RIGHTS AND EDUCATION (PRE)

INTENT OF CHAPTER

§ Organization defines the patient rights and responsibilities.

§ Staff is trained to protect patient rights.

§ Patient and family members are informed about their rights and educated about their responsibilities, cost and mechanism of addressing grievances.

1. DISPLAY

1. Patient rights and responsibilities

2. Mechanism for grievance

2. LIST OF CONSENTS

1. General Informed consent

2. Informed consent for surgery

3. High risk consent for surgery

4. Informed consents for Anesthesia

5. High risk consents for Anesthesia

6. Consents for blood transfusion

7. Consents for procedure

8. Consent for critically ill /Ventilation

Note -

1. Each consent should include reason for respective procedure, benefits, possible risk and complications.

2. Consents should be bilingual in format and taken Preferably one language can be a local language

CHAPTER-5

HOSPITAL INFECTION CONTROL (HIC)

INTENT OF CHAPTER

§ The programmed is documented and aims at reducing/eliminating infection risk to patients, visitors and care providers.

§ The organization proactively monitors adherence to infection control practices.

§ Adequate facility should be available for protection of staff.

§ Biomedical waste is managed as per policies and procedures.

1. MANUAL

Sr.No

Standard

Reference

Document

Expected Content

HIC 1

Infection control manual

This should include standard universal precautions, cleaning and general housekeeping practices, disinfection and sterilization practices, use of PPE, Post exposure prophylaxis and BMW management.

2. DISPLAYS

1. Five moments of hand washing

2. Seven steps of hand washing

3. BMW categories for waste disposal.

3. REGULATORY REQUIREMENTS

1. Bio-medical Waste Management and Handling Authorization.

CHAPTER – 6

CONTINUOUS QUALITY IMPROVEMENT (CQI)

INTENT OF THE CHAPTER

§ The standards introduce the subject of continual quality improvement and patient safety.

§ The organization should identify and collect data on structures, processes and outcomes.

§ The collected data should be collated, analyzed and used for further improvements.

1. HOSPITAL QUALITY IMPROVEMENT PROGRAMME

Sr.No

Standard

Reference

Document

Expected Content

CQI 1

Quality Improvement programme

This can be done for different department of the hospital such as IPD, OPD, OT, Emergency, Laboratory, ICU etc

This should include parameters to be monitored, data collection mechanism, plan for analysis and corrective and preventive actions.

For example, OPD waiting time, OT Utilization, OT

cancellation, Percentage of medication errors etc.

Note- For entry level certification SHCO can select indicators as per the priority of the organizations

CHAPTER -7 RESPONSIBILITIES OF MANAGEMENT (ROM)

INTENT OF THE CHAPTER

§ The standards encourage the governance of the organization in a professional and ethical manner.

§ The responsibilities of the management are defined. The services provided by each department are documented.

§ Leaders ensure that patient-safety and risk-management issues are an integral part of patient care and hospital management.

1. DOCUMENTS REQUIRED

§ Organogram - This should explain organizational pattern of the hospital. Organogarm can be the vertical or horizontal or mix.

§ Define the responsibilities of management.

§ Document the services provided by the each department.

2. DISPLAYS

§ Vision and Mission Of the organization

§ Quality policy and quality objectives

§ Organogram

§ Services provided by each department.

3. STATUTORY AND REGULATORY REQUIREMENTS

1. Bio-medical Waste Management and Handling Authorization

2. Registration Under Clinical Establishment Act (or similar)

3. Registration with Local Authorities.

4. License to operate (CT/ Interventional Radiology (IR) or Relevant radiological installations.

5. Registration for PNDT ( as applicable)

6. License for Blood Bank ( as applicable)

7. License for MTP ( as applicable)

8. Licenses for pharmacy ( as applicable)

4. MOU’s

• All Out sources services

1. Laundry

2. BMW Management

3. Security

4. Canteen

5. Housekeeping

6. Parking

CHAPTER 8

FACILITY MANAGEMENT AND SAFETY (FMS)

INTENT OF THE STANDARDS

§ The standards guide the provision of a safe and secure environment for patients, their families, staff and visitors.

§ To ensure this, the organization conducts regular facility inspection rounds and takes the appropriate action to ensure safety.

§ The organization provides for equipment management, safe water, electricity, medical gases and vacuum systems.

§ The organization plans for emergencies within the facilities and the community.

1. SAFETY PROGRAMME

Sr.No

Standard

Reference

Document

Expected Content

FMS 1

Safety programmed

This should include details of plans and provisions for detection, abatement and containment of fire and non-fire emergencies.

Emergency color codes, Plan for mock drills, system to identify the potential safety and security risks, including hazardous materials. Plan for Facility inspection rounds to ensure safety, Plan for safety education programmed, documented operational and maintenance (preventive and breakdown) plan for medical equipments, electricity, water, Medical gas

and vacuum.

DISPLAYS/ SIGNAGES

1. Fire exit route and Maps

2. Floor Maps

3. Entry restricted signages as applicable e.g laundry, Electricity room, CSSD etc

4. Directions signage’s as required

CHAPTER -9

HUMAN RESOURCE MANAGEMENT (HRM)

INTENT OF THE STANDARDS

This is based on the organization’s mission, objectives, goals and scope of services. Effective human resource management involves the following processes and activities:-

§ Acquisition of Human Resources which involves human resource planning, recruiting and socialization of the new employees.

§ Training and development relates to the performance in the present and future anticipated jobs. The employees are provided with opportunities to advance personally as well as professionally.

§ Motivation relates to job design, performance appraisal and discipline.

§ Maintenance relates to safety and health of the employees.

The term “employee” refers to all salaried personnel working in the organization. The term “staff” refers to all personnel working in the organization including employees, “fee for service” medical professionals, part-time workers, contractual personnel and volunteers.

1. STANDARD OPERATING PROCEDURES (SOP’S)

Sr.

Standard

Reference

Name of SOP’s

Expected Content

HRM 2a

Disciplinary and grievance handling Procedure

This should include mechanism of handing employee grievances, time line of handling grievances, Details grievance and redressal committee which includes composition,

frequency of meeting etc

2. OTHER DOCUMENTATION

Organizations should have following things while preparing this chapter

1. All cadres of employee should have written job description signed by head of the department and self signed by employee him self

2. Identification of occupational hazards their risk and measures taken for prevention.

3. Organization should maintain personal files of all the employees which should include qualification documents, bio-data, joining letters, leave record, disciplinary actions and health record.

4. Organization should conduct annual health check-up for the entire employee including immunization.

CHAPTER- 10

INFORMATION MANAGEMENT SYSTEM (IMS)

Intent of Standards

§ This chapter emphasizes the requirements of a medical record in the hospital.

§ The organization will lay down policies and procedures to guide the contents, storage, security, issue and retention of medical records.

1. STANDARD OPERATING PROCEDURES (SOP’S)

Sr.

Standard

Reference

Name of SOP’s

Expected Content

IMS 3

Procedures for maintaining Confidentiality, integrity and security of records, data and information.

§ This should address mechanism maintaining

§ Confidentiality, integrity and security of records, data and information.

§ Timely and accurate dissemination of data and storing, retrieving data.

§ Safeguarding of data/ Records against loss, destruction and tempering.

§ Privileged health information is used for the purposes identified or as required by

Law

IMS 4

Documented procedures exist for retention time of records, data and information.

§ This should address retention period of each type of medical record such as OPD, IPD, MLC, Death etc.

§ The process also provides expected confidentiality and security as well as

methods for destruction of medical records.

MANAGEMENT OF MEDICATION CHECK LIST FOR NABH ENTRY LEVEL SHCO

medpointhcg@gmail.com (Medpoint Healthcare) — Mon, 19 Dec 2022 09:15:00 +0530

INTENT OF CHAPTER

§ The organization has a safe and organized medication process.

§ The organization should have a mechanism to ensure that the emergency medication are standardized through the organization, readily available and replenished in a timely manner.

§ Required medications are always stocked and well within the expiry dates.

§ Process also includes monitoring of patients after administration and procedure for reporting and analyzing adverse drug events, which include errors and events.

1. STANDARD OPERATING PROCEDURES (SOP’S)

Sr.No

Standard

Reference

Name of SOP’s

Expected Content

MOM 1

Procedure for

organization of pharmacy services and

usage of medication

Procedure should include Purchase, storage, Prescription and dispensation of medication, List of lookalike and sound alike medication, procurement

and usage of implantable prosthesis

MOM 2

Procedure to guide the prescription of

medication

Procedure should include who can write the orders, location of writing orders, define high risk

medication and process to describe them.

MOM 3

Procedure to guide the

dispensing of medication

Medication checking system prior to dispensing including high risk medication.

MOM 4

Procedure to guide the Administration of medication

Verification prior to administration, Prepared medication is labeled prior to preparation of second drug, records of administration including disposal

of narcotics and psychotropic medications

2. FORMS AND FORMATS

Sr.No	Standard Reference	Name of form and format	Expected Content
1	MOM 2	Medication Prescription sheet	Doctor name and registration no, prescription no, date, patient full name, address and phone no, age sex, weight, medication prescribed, signature, name and stamp of doctor.
2	MOM 4	Medication chart ( Administration)	Patient demographics, Any previous drug allergies, date and time of order, name of the drugs (in capital letters),amount of dose, route, frequency, duration, time, signature of staff administrating the medication.
3	MOM 5	Adverse event reporting form	This should include description of reaction, details of suspected medication and immediate action taken etc.

3. REGULATORY REQUIREMENTS

1. Drug Retail License

2. Drug Bulk License

3. Narcotic Drug License

CARE OF PATIENT (COP)CHECK LIST FOR NABH ENTRY LEVEL SHCO

medpointhcg@gmail.com (Medpoint Healthcare) — Mon, 19 Dec 2022 09:12:00 +0530

INTENT OF CHAPTER

§ This chapter aims to guide and encourage patient safety as overall principle for providing care to patients.

§ Specific services such as intensive care, surgery, blood transfusion, and emergency, Anesthesia, Obstetrics and Pediatric are addressed.

§ The organizations are encouraged to identify and adapt clinical guidelines to maintain uniformity in patient care.

REQUIREMENTS

1. STANDARD OPERATING PROCEDURES (SOP’S)

Sr.No

Standard

Reference

Name of SOP’s

Expected Content

COP 2

Documented procedure to guide emergency services including ambulance.

-Procedure for handling MLC

-Procedure for Admission, Discharge and referral.

-Procedure for use and maintenance of

ambulance

COP 3

Documented procedures defines rational use of blood and blood products

-Indications for use of blood components.

-Procedure for Requesting for blood products.

-Obtaining inform consent for donation transfusion.

-Procedure of transportation, administration and monitoring blood transfusion services.

-Reporting and recording of blood

transfusion reaction.


3	COP 4	Documented procedure to guide the care of patient in intensive care and high dependency unit.	-Admission and transfer of patient. -Monitoring, Reporting and recording of patient care events. -Staffing and equipment management.
4	COP 5	Documented procedures to guide the care of obstetrics services.	-Procedure includes regular antenatal check-up, maternal nutrition and postnatal care.
5	COP 6	Documented procedures guide the pediatric patients.	-Nutritional assessment, Immunization assessment. -Procedure addresses identification and security measures to prevent child abduction and abuse. - Mechanism of educating children’s and family about nutrition, immunization and safe parenting.
6	COP 7	Documented services to guide the administration of anesthesia	-Procedure for pre-anesthesia assessment and documentation of anesthesia plan. -Immediate post operative re- evaluation. -Obtaining informed consent for anesthesia. -Procedure of intra-operative monitoring, post anesthesia status and documentation.
7	COP 8	Documented Procedure to guide the care of patient undergoing surgical services	Procedure includes documentation of pre-operative assessment, and diagnosis. Obtaining the informed consents, Prevention of adverse events, Documentation of post operative notes, post operative plan of care, infection control practices in OT.

2. FORMS AND FORMATS

Sr. No	Standard Reference	Name of form and format	Expected Content
1	COP 2 c	Transfer referral form to another organization	Patient demographics, Chief complaints, course in hospital, Investigations, treatment given, reason for referral, special recommendations for further management. Contact Details of hospital, Signature and stamp of referring doctor.
2	COP 3b	Blood transfusion Consent form	This should include reason for blood transfusion, expected benefits and risk.
3	COP 3	Blood component request form	Patient demographics, previous history of transfusion, Indication of transfusion, blood component required, name and signature of phlebotomist.
4	COP 3	Blood transfusion monitoring form	Patient demographics, Check point for patient name, ID No, Label for blood group etc. Name of component, Transfusion start time, vitals during transfusion (monitoring at least for every 30 min), Transfusion end time, adverse reaction if any, Total volume infused, signature of doctor and signature of nurse.
5	COP 3c	Reporting of adverse blood reaction	Details of blood component, time of start and end, details of reaction, analysis which includes errors in transportation, storage, administration and post transfusion biochemistry and microbiology report, corrective and preventive action (if any)
6	COP 7 b	Pre anesthesia assessment (PAC) form	Patient demographics, diagnosis, proposed surgery, chief complaints, allergy, past history, general examination, airway examination, systemic examination, routine or special investigation results, special advices, plan of anesthesia with ASA grade, signature of anesthesiologist

			with date and time. Immediate preoperative assessment can be incorporated in the last part of PAC which should include level of consciousness, pulse rate, BP and SpO2.
7	COP 7 e	General anesthesia consents	Name of surgery, name of anesthesia planed, benefits and risk, signature of patient, relative, anesthesiologist with date and time.
8	COP 7 e	High risk anesthesia consents	Name of surgery, name of anesthesia planed, reasons for high risk, signature of patient, relative, anesthesiologist with date and time.
9	COP 7 f	Anesthesia Monitoring Form	Regular and periodic recording of heart rate, cardiac rhythm, respiratory rate, blood pressure, oxygen saturation, airway security and potency and level of anesthesia.
10	COP 7 g	Post anesthesia status monitoring form.	This should result in fitness of patient for transfer from recovery room after anesthesia. Aldrete’s score is one of the good references.
11	COP 8 b	Informed consents for surgery	Name of proposed surgery, name of surgeons, Possible outcome, possible complications and risk signature of patient, relative, surgeon with date and time.
12	COP 8 b	High risk consents for surgery	Name of proposed surgery, name of surgeons, reason for high risk, signature of patient, relative, surgeon with date and time.
13	COP 8 c	Surgical Safety check list	As per WHO guidelines as given in references of this document

3. TRAININGS

1. Training on Security Measures to prevent child abduction and abuse ( Code Pink)

2. Implementation of Surgical safety check list

3. All other necessary trainings as per the scope and need of the organization

4. REGULATORY REQUIREMENTS

1. License for blood bank or blood storage centre. (If any)

ACCESS, ASSESSMENT AND CONTINUITY OF CARE (AAC) CHECK LIST FOR NABH ENTRY LEVEL SHCO

medpointhcg@gmail.com (Medpoint Healthcare) — Mon, 19 Dec 2022 09:06:00 +0530

INTENT OF THE CHAPTER

§ The organization defines the scope of services and provides information to patients about services available.

§ All patients visiting organizations should be registered and assessed in OPD, IPD or Emergency.

§ The laboratory and Imaging services are provided by competent staff in a safe and secure environment.

§ A Standard approach to be used for referring or transferring patients to other organizations including discharge.

REQUIREMENTS

1. STANDARD OPERATING PROCEDURES (SOPS)

Sr.No	Standard Reference	Name of SOP’s	Expected Content
1	AAC 2	Documented registration, admission and transfer process	-Registration process to OPD, IPD and emergency. -Two Identifications (E.g. Full name and UIN ) -Procedure should address the expected time for registration and admission at all level.
2	AAC 5b	Procedure guide collection, Identification, handling, safe transportation, processing and disposal of the specimen.	-Define how to collect, Method of collection, preparation etc, safe handling and transportation. -Mechanism of disposal of specimen as per BMW management rule 2016. -Organization can define time frame at each of these steps.
3	AAC 7	The organization has a defined discharge process.	-Address discharge of general patient including medico-legal. -Define the content of discharge summary.

2. DISPLAYS

1. Services - Provided in the organizations should be prominently displayed.

2. Admission Criteria to ICU- In case organizations providing ICU services criteria for ICU admission should be displayed in emergency unit and in respective ICU.

3. Scope of Laboratory/ Imaging Services- In case Organization Providing In house laboratory/ imaging services scope (list of laboratory tests) should be displayed at prominent location at laboratory/ imaging department.

4. Radiation safety signage’s – It should be displayed at prominent location at imaging department.

3. FORMS AND FORMATS

Sr.No	Standard Reference	Name of form and format	Expected Content
1	AAC 3	OPD Assessment form	Patient demographics with two identifications, Chief complaints, Past history, history of allergies, nutritional assessment, General examination, Provisional diagnosis, investigations, treatment, follow-up, emergency contact numbers.
2	AAC 3	IPD Assessment form	Patient demographics with two identifications, Chief complaints, History of present Illness, past medical and surgical history, general examination, local examination, systemic examination, Results of Investigations, Provisional diagnosis, Care plan, signature of doctor with stamp.
3	AAC 5	Laboratory Requisition form	Patient demographics, Unique ID no, Diagnosis, Name of consultant, Brief clinical history, details of investigations required, Signature and stamp of doctor.
4	AAC 6	Imaging	Patient demographics, Unique ID no, Diagnosis, Name of

Requisition

form

consultant, Brief clinical history, details of investigations

required, Signature and stamp of doctor.

AAC 7

Discharge summary

Patient demographics, date of admissions and discharge, diagnosis, name of treating doctor, allergies, chief complaints, a course in hospital, Investigations, treatment given, Operations

/procedure performed, advice on discharge and follow-up advice, details of when and how to contact in an emergency.

Signature and stamp of doctor.

4. TRAINING

1. Staff should be oriented to the Services available in the organization.

2. Staff should be trained in Laboratory and Imaging safety.

5. REGULATORY REQUIREMENTS

1. Licenses for Radiological installations

Fire Safety Guidelines for New and Existing Hospitals and Healthcare Facility

medpointhcg@gmail.com (Medpoint Healthcare) — Tue, 29 Nov 2022 09:13:00 +0530

Medpoint Hospitals Project Provides Fire Safety Guidelines for New and Existing Hospitals and Healthcare Facility:+91 8838051686

Sivakumar Murugesan\: Consultant :Hospitals Project

Provisions laid down in this chapter shall establish the minimum requirements for a reasonable degree of safety from fire emergencies in hospitals, such that the probability of injury and loss of life from the effects of fire are reduced. All healthcare facilities shall be so designed, constructed, maintained and operated as to minimize the possibility of a Fire emergency requiring the evacuation of occupants, as safety of hospital occupants cannot be assured adequately by depending on evacuation alone.

Hence measures shall be taken to limit the development and spread of a fire by providing appropriate arrangements within the hospital through adequate staffing & careful development of operative and maintenance procedures consisting of:

1. Design and Construction;

2. Provision of Detection, Alarm and Fire Extinguishment;

3. Fire Prevention

4. Planning and Training programs for Isolation of Fire; and,

5. Transfer of occupants to a place of comparative safety or evacuation of the occupants to achieve ultimate safety.

Expected Levels of Fire Safety In Hospitals

Hospitals shall provision for two levels of safety within their premises:

1. Comparative Safety: which is protection against heat and smoke within the hospital premises, where removal of the occupants outside the premises is not feasible and/or possible. Comparative Safety may be achieved through:

a. Compartmentation

b. Fire Resistant wall integrated in the Flooring

c. Fire Resistant Door of approved rating

d. Pressurized Lobby, Corridor, Staircase

e. Pressurized Shaft (All vertical openings)

f. Refuge Area

g. Independent Ventilation system

h. Fire Dampers

i. Automatic Sprinkler System

j. Automatic Detection System

k. Manual Call Point

l. First Aid

m. Fire Fighting Appliances

n. Fire Alarm System

o. Alternate Power Supply

p. Public Address System

q. Signage

r. Fire Exit Drills and orders

2. Ultimate Safety: which is the complete removal of the occupants from the affected area to an assembly point outside the hospital building. Ultimate Safety may be achieved through:

a. Compartmentation

b. Fire Resistant Door of approved rating

c. Protected Lobby, Corridor, Staircase and Shaft

d. Public Address System

e. Signage

f. Fire Drills and orders

Structural Elements of Fire Safety

Open Spaces

1. Hospitals shall make provisions for sufficient open space in and around the hospital building to facilitate the free movement of patients and emergency/fire vehicles.

2. These open spaces shall be kept free of obstructions and shall be motorable.

3. Adequate passage way & clearance for fire fighting vehicles to enter the hospital premises shall be provided.

4. The width of such entrances shall be not be less than 4.5 mtrs with clear head room not less than 5 mtrs.

5. The width of the access road shall be a minimum of 6 mtrs.

6. A turning radius of 9 mtrs shall be provided for fire tender movement.

7. The covering slab of storage/static water tank shall be able to withstand the total vehicular load of 45 tone equally divided as a four point load (if the slab forms a part of path/drive way).

8. The open space around the building shall not be used for parking and/or any other purpose.

9. The Set back area shall be a minimum 4.5 mtrs.

10. The width of the main street on which the hospital building abuts shall not be less than 12 mtrs & when one end of that street shall join another street, the street shall not be less than 12 mtr wide.

11. The roads shall not be terminated in dead ends.

Basements

1. Basements, if provided shall be of type-1 construction and material used shall conform to class A material.

2. Basements shall be used only for parking vehicles and shall be protected with automatic sprinkler systems.

3. Each basement shall be separately ventilated.

4. Each vent shall have a cross-sectional area (aggregate) not less than 2.5% of the floor area spread evenly round the perimeter of the basement.

5. A system of air inlets and smoke outlets shall be provided & clearly marked as “AIR INLET” & “SMOKE OUTLET”.

6. Clear headroom of minimum 2.4 mtrs shall be provided for the entire basement.

7. A minimum ceiling height of any basement shall be 0.9 mtrs and maximum 1.2 mtrs above the average surrounding ground level.

8. The access to the basement shall be separate from the main and alternative staircase providing access and exit from higher floors. Where the staircase continues, in the case of buildings served by more than one staircase, the same shall be of enclosed type serving as a Fire Separation between the basement and higher floors.

9. Open ramps shall be permitted if they are constructed within the building line and surface drainage does not enter the basement.

10. The staircase of the basement shall be of enclosed type having fire resistance not less than 02 hrs & shall be situated at the periphery of the basement to be entered at ground level from the open air and in such a position that smoke from any fire in the basement shall not obstruct any exit serving the ground & upper stores of the building. The staircase shall communicate with the basement through a lobby provided with fire resisting, self closing doors of 02 hrs resistance. Additional stairs shall be provided if travel distance does not meet specifications given in Table 22 of the NBC.

11. For multi-storey basements, one intake duct may serve all basement levels, but each level & basement compartment shall have a separate smoke outlet duct or ducts. The ducts shall have the same fire resistance rating as the compartment itself.

12. Mechanical extractors for smoke venting system from lower basement levels shall also be provided. The actuation of the system shall be incorporated with the detection and sprinkler systems. The performance of the system shall be superior than standard units. (13) Mechanical extractors shall have an interlocking arrangement, so that extractors shall continue to operate and supply fans shall stop automatically with the actuation of fire detection system.

13. Mechanical extractors shall be designed to permit 30 air changes per hour in case of a fire emergency.

14. Mechanical extractors shall have an alternate source of electricity supply.

15. Ventilation ducts shall be integrated with the structure of the building and shall be made out of brick masonry or reinforced cement concrete as far as possible. Wherever this duct intersects the transformer area or an electrical switch board, fire dampers shall be provided.

16. The basement shall not be permitted below the ward block of a hospital.

17. No cut outs to upper floors shall be permitted in the basement.

18. An openable window on the external wall shall be fitted with locks that can be easily opened.

19. All floors shall be compartmented by a separation wall with 2 hrs fire rating, such that

20. each compartment shall have a surface area not exceeding 750 sq. mtr. Floors which are fitted with sprinkler systems may have their surface areas increased by 50%. In long building fire separation wall shall be at distances not exceeding 40 mtrs.

21. Lift/Elevators shall not normally communicate with basements; if, however, Lifts are in communication, the lift lobby of the basement shall be pressurized. A positive pressure between 25 & 30 Pascal (Pa), shall be maintained in the lobby & a positive pressure of 50 Pa shall be maintained in the Lift shaft. The mechanism for pressurization shall act automatically with the Fire Alarm. Provision shall be made to operate the system manually as well. The Lift car door shall have a Fire resistance rating equal to the Fire resistance of lift enclosure. The material used for interior finishing shall conform to class-1 materials.

Means of Escape/Egress

A means of escape/egress is a continuous and unobstructed way to exit from any point in a building or structure to a public way. Three separate and distinct parts of an escape/egress are:

a. The Exit access,

b. The Exit, and

c. The Exit discharge.

1. A means of Escape/egress comprises the vertical and horizontal travel and shall include intervening room spaces, doorways, hallways, corridors, passageways, balconies, ramps, stair enclosures, lobbies, and horizontal exits leading to an adjoining building at the same level.

2. The exits in Healthcare facilities should be limited to doors leading directly outside the building, internal staircases and smoke proof enclosures, ramps, horizontal exits, external exits and exit passage.

3. Exits shall be so arranged that they may be reached without passing through another occupied unit.

4. Vertical evacuation of occupants within a health care facility is difficult and time consuming. Therefore, horizontal movement of patient is of primary importance. Because of the time required to move patients, exit access routes should be protected against Fire effects. Spaces open to the corridors shall neither be used for patients’ sleeping, as treatment rooms nor for storing hazardous material.

Internal Staircases

1. Internal staircases shall be constructed with non-combustible materials

2. Internal stairs shall be constructed as self-contained units along an external wall of the building constituting at least one of its sides and shall be completely closed

3. A staircase shall not be arranged around a Lift shaft.

4. Hollow combustible construction shall not be permitted

5. The construction material shall have 02 hrs fire resistance.

6. Minimum width of stairs shall be 2 mtrs.

7. Width of the tread shall not be less than 300 mm.

8. The height of the riser shall not be less than 150 mm and the number of stairs per flight shall not exceed 15

9. Handrails shall be provided at a height of 1000 mm, which is to be measured from the base of the middle of the treads to the top of the handrails.

10. Banisters or railings shall be provided such that the width of staircase is not reduced.

11. Minimum head room in a passage under the landing of a staircase and under the staircase shall be 2.2 mtrs.

12. The staircase shall be continuous from ground floor to the terrace and the exit door at the ground level shall open directly to the open spaces or a large lobby.

13. The number of people in between floor landings of staircases shall not be less than the population on each floor for the purpose of the design of the staircase.

14. Fire/Smoke check doors shall be provided for a minimum of 2 hrs fire resistance rating.

15. (15) Lift openings and any other openings shall not be permitted.

16. (16) No electrical shaft and panel, AC ducts or gas pipelines, etc. shall pass through or open onto the staircases.

17. No combustible material shall be used for decoration/wall panelling in the staircases.

Protected Staircases

Provisions given for internal staircases shall apply to protected staircases. Also, additional safeguards shall be provided as under:

1. The staircases shall be enclosed by walls having 02 hrs fire resistance

2. The external exit doors at ground floor shall open directly onto open spaces or a lobby and Fire & Smoke check doors shall be provided.

3. Protected staircases shall be pressurized. Under no circumstances shall they be connected to a corridor, lobby and staircase which is unpressurized.

4. Pressurization systems shall be incorporated in protected staircases where the floor area is more than 500 sq. mtr. The difference in pressurization levels between staircase and lobby/ corridor shall not be greater than 5 Pa. Where 2 stage pressurization system is in use the pressure difference shall be as under:

a. In normal conditions - Minimum 8Pa to 15 Pa.

b. In emergency conditions - 50 Pa.

5. The pressurization system shall be interconnected with the automatic/manual fire alarm system for actuation.

External Staircases

1. External staircases serving as a required means of egress shall be of permanent fixed construction.

2. External staircases shall be protected by a railing or guard. The height of such a guard/railing shall not be less than 1200 mm.

3. External staircases shall be separated from the interior of the building by walls that are fire resistant and have fixed or self closing opening protectives’, as required for enclosed stairs. External staircases shall extend vertically from the ground to a point 3 meters above the topmost landing of the stairway or the roof line whichever is lower, and atleast 3 meters horizontally.

4. All openings below and outside the external staircases shall be protected with requisite fire resistance rating.

5. External staircases shall be so arranged to avoid any discomfort/obstruction for persons with a fear of heights, from using them.

6. External staircases shall be so arranged to ensure a clear direction of egress to the street.

7. External staircases shall be continuous from the ground floor to the terrace level

8. The entrance to the external staircases shall be separate and remote from internal staircases.

9. External staircases shall have a straight flight with a width not less than 2 mtrs, a tread not less than 300 mm, a riser not more than 150 mm and the number of risers shall be limited to 15 per flight.

10. The handrail shall have a height not less than 1000 mm and not exceeding 1200 mm.

11. Banisters shall be provided with a maximum gap of 150 mm.

12. Stair treads shall be uniformly slip resistant and shall be free of projections or lips that could trip stair users

13. External staircases used as fire escapes shall not be inclined at an angle greater than 45o from the horizontal

14. Unprotected steel frame staircases shall not be acceptable means of egress; however steel staircases in an enclosed compartment with a fire resistance of 2 hrs will be accepted as means of escape.

15. Elevators constitute a desirable supplementary facility though they are not counted as required exits. Patient’s lifts shall have sufficient space for Stretcher trolley.

Horizontal Exits

A horizontal exit implies that the occupants will be transferred from one side of a partition to the other. Essential fire safety provisions for horizontal exits are as follows:

1. Width of the horizontal exits shall be same as the exit doorways.

2. A horizontal exit shall be equipped with at least one fire/smoke door of minimum 2 hrs fire resistance of self closing type. Further they shall have direct access to the fire escape staircase for evacuation.

3. A refuge area of 15 Sq. Mtr. or an area equivalent to 0.3 Sq Mtr. per person for the number of occupants in two consecutive floors, whichever is more, shall be provided on the periphery of the floor or preferably on an open air cantilever projection with at least one side protected with suitable railings/guards with a height not less than 1 mtr.

4. Within the aggregated area of corridors, patient rooms, treatment rooms, lounges, dining area and other low hazards areas on each side of the horizontal exit, a single door may be used in a horizontal exit given that the exit serves one direction only. Such doors shall be swinging doors or a horizontal sliding door.

5. Where there is a difference in the level between areas connected by a horizontal exit, ramps not more than 1 in 10 mtr slope shall be provided. The steps shall not be used.

6. Doors shall be accessible at all times from both sides.

7. A horizontal exit involving a corridor 8 ft or more in width serving as a means of egress from both sides of the doorway shall have the opening protected by a pair of swinging doors arranged to swing in the opposite direction from each other.

8. An approved vision panel is required in each horizontal exit. Center mullions are prohibited.

9. The total exit capacity of other exits (stairs, ramps, doors leading outside the building) shall not be reduced to below one third of the amount that is required for entire area of the building.

Exit Doors

1. Every door and every principal entrance that also serves as an exit shall be so designed and constructed that the way of Exit travel is obvious and direct.

2. Width of the doors shall be minimum 2 mtr and other requirements of the door shall comply with the NBC.

3. Doors shall not be equipped with a latch or lock that requires the use of tool and/or key from the egress side. Mental hospitals are permitted for door locking arrangements.

4. Where door locking arrangements are provided, provision shall be made for the rapid removal of patients by such reliable means as remote control of locks or the keys of all locks made readily available to staff who are in constant attendance.

5. Doors in fire resistant walls shall be so installed that they may be normally kept in an open position, but shall close automatically. Corridor doors opening into the smoke barrier shall be not less than 2000 mm in width. Provision shall also be made for double swing single/double leaf type doors.

6. The fire resistance rating of doors shall meet fire resistance rating of construction material.

Corridors and Passageways

1. The minimum width and height of corridors and passage ways shall be 2.4 mtr. The exit corridor and passage ways shall have a width not less than the aggregate required width of Exit doorways leading from them in the direction of travel to the exterior. Corridors shall be adequately ventilated.

2. Corridor walls shall form a barrier to limit the transfer of smoke,toxic gases and heat.

3. Transfer grills, regardless of whether protected by fusible link operated dampers, shall not be used in corridor walls or doors.

4. Openings if required in corridor walls for specific use, shall be suitably protected.

5. Fixed wired glass opening vision panel shall be permitted in corridor walls, provided they don’t exceed 0.84 Sq Mtr in area and are mounted in steel or other approved metal frames.

Compartmentation

1. In buildings or sections occupied by bed ridden patients where the floor area is over 280 Sq Mtr., facilities shall move patients in Hospital beds to the other side of a smoke barrier from any part of such a building or section not directly served by approved horizontal exits from the floor of a building to outside.

2. Any section of the building more than 500 Sq.Mtr. shall be suitably compartmented with fire resistance of not less than 2 hrs.

3. Every storey used by inpatients for sleeping or treatment shall be divided into not less than two smoke compartments

4. Every storey having an occupant load 50 or more persons, regardless of use, shall be divided into two smoke compartments.

5. The size of each smoke compartment shall not exceed 500 Sq Mtrs.

Ramps

1. All ramps shall comply with the applicable requirements for stairways regarding enclosure, capacity and limiting dimensions except in certain cases where steeper slopes may be permitted with inclination less than 1 in 8 ( under no condition shall the slopes greater than 1 in 8 be used).

2. Ramps shall be surfaced with approved non skid & non slippery material.

Service Shafts/Ducts

1. Service shafts/ducts shall be enclosed by walls with 2 hr and doors with 1 hr fire resistance rating. All such ducts/shafts shall be properly shielded and facilities shall be available to control fires along these shafts/ducts at all levels.

2. A vent opening at the top of a service shaft shall have an area between one fourth and half of the area of the shaft.

3. Refuge chutes shall have openings at least 1 mtr above the roof level for venting purpose and they shall have an enclosure wall of non combustible material with fire resistance rating of 2 hrs. They shall not be located within the staircase enclosure or service shaft and be as far away from the exit as possible.

4. The inspection panels and doors of air conditioning shafts shall be well fitted, with a fire resistance rating of 1 hr.

Openings in Separation Walls and Floors

1. At the time of designing openings in separation walls and floors particular attention shall be paid to all factors that will help limit the spread of fire through these openings and the fire ratings of these structural members shall be maintained.

2. For type 1 to 3 construction, a door way or opening in a separation wall on any floor shall be limited to 5.6 Sq.Mtr. in area with a maximum height/width of 2.75 mtr. Every wall opening shall be protected with fire resistant doors having the fire rating of not less than 2 hrs. in accordance with accepted standards.

3. Every vertical opening between the floors of a building shall be suitably enclosed or protected as necessary to prevent the spread of fire, smoke and fumes such that there is a reasonable level of safety for the occupants using the means of egress. It shall be ensured to provide a clear height of 2100 mm in the passage

Fire Stop or Enclosure of Openings

1. Where openings are permitted for external walls they shall not exceed 3/4th the area of the wall and shall be protected with fire resisting assemblies or enclosures with a fire resistance equivalent to that of the wall in which these are situated. Such assembles and enclosures shall also be capable of preventing the spread of smoke and fumes through the openings so as to facilitate the safe evacuation of building in case of a fire.

2. All openings in the floors shall be protected by vertical enclosures extending above and below such openings. The walls of such enclosures shall have a Fire resistance of not less than 2 hrs. and all openings therein shall be protected with a fire resisting assembly.

3. For type 4 constructions, openings in separation walls or floors shall be fitted with 2 hrs fire resisting assemblies.

4. Openings in the walls and floors which provide access to building services like cables, electrical wiring, telephone cables, plumbing pipe etc. shall be protected by enclosures in the form of ducts/shafts with a fire resistance of not less than 2 hrs.

5. The inspection doors for electrical shafts and ducts shall have fire resistance rating not be less than 2 hrs and all other service shafts and ducts shall have a fire resistance rating not less than 1 hr.

6. Medium and low voltage wiring in shafts/ducts shall either be armoured or run through a metal conduit. The space in between the conduit pipes and the walls/slabs shall be filled by a filler material that has a fire resistance rating of not less than 1 hr. The above parameters shall not be applied on patients and goods lift well opening.

Non-Structural Elements of Fire Safety

Underground Static Water Tank for Fire Fighting

Provisions shall be made for a dedicated fire fighting tank, of suitable capacity as per NBC P-IV, that shall remain full at all times. However, special attention shall be given to calculating the actual capacity of the water tank to ensure its compatibility to the installed fire fighting system.

1. A four way collecting head shall be provided at an easily accessible location near the tank.

Fire Pump Room

1. Provisions shall be made to have a centralized room to house the pumps that supply water to the various fire fighting systems. The pumps shall be as per NBC P-IV.

2. The following pumps shall be installed:

a. Jockey Pump: An electrically driven centrifugal single/two stage pump of 280 LPM capacity shall be installed to maintain the system pressure upto 7 kg/cm2. They shall be activated automatically whenever the pressure falls below 5.5 kg/cm2.

b. Main Fire Pump: An electrically driven centrifugal Multi stage pump of 2850 LPM capacity shall be installed to feed the Fixed Fire Fighting System. Provisions shall be made for an alternate electric supply with a changeover switch for this pump.

c. Diesel Fire Pump: A diesel driven prime mover multi stage pump of 2850 LPM capacity shall be installed to feed the Fixed Fire Fighting system in case of failure to main Fire Pump.

Yard Hydrant

1. Provision shall be made to install a yard hydrant throughout the premises. The distance between two successive hydrants shall not exceed 45 mtr.

Wet Rising Mains

1. A vertical rising main of G.I. C class steel pipeline with an internal diameter of 100 mm shall be provided from the ground floor to the top most floor of the hospital along with hydrant outlets fitted at the height of 0.9 mtr from the flooring at each floor.

2. First Aid hose reels with a diameter of 25 mm and length of 45mtrs, shall be provided at each floor fitted with a 6.5mm diameter shut off type nozzle.

3. An air release valve shall be provided at the top of the rising main.

4. A Fire service inlet shall be provided at the ground floor.

Hose Box

1. A glass front cabinet containing two RRL type delivery hoses, each 15 mtrs in length and with a diameter of 63mm instantaneous coupling fitted with associated branch pipe, shall be provided.

Automatic Sprinkler System

1. The entire building including the basements shall be fitted with sprinklers connected to a gong bell/fire detection panel, which shall be located in the central control room.

2. The entire building including the basement shall be fitted with an Automatic Fire Detection and Alarm system comprising of smoke detectors, and manual call points which shall be connected to the fire alarm panel in the central control room.

3. The sprinkler, fire detection and alarm systems shall be provided with an alternative source of power supply.

4. Initiation of required fire alarm system shall be by manual means or by means of any detection device.

5. An internal audible alarm shall be incorporated.

6. Pre-signal systems are prohibited.

7. Corridors shall have an approved automatic detection system.

Emergency and Escape Lighting

1. Emergency lighting shall be powered from a source independent of the normal lighting system.

2. Emergency lights shall clearly and unambiguously indicate the escape routes.

3. Emergency lighting shall provide adequate illumination along escape routes to allow the safe movement of persons towards and through the exits.

4. Emergency lighting shall be provided in a manner to ensure that fire alarm call points and fire fighting equipments provided along the escape routes are readily located.

5. The horizontal luminance at floor level on the center line of an escape route shall be not less than 10 lux. Additionally, for escape routes that are upto 2 mtrs in width, 50% of the route width shall be lit to a minimum of 5 lux.

6. The emergency lighting shall be activated within one second of the failure of the normal lighting.

7. The luminaries shall be mounted as low as possible but at least 2 mtrs above the floor level.

8. Emergency lighting shall be designed to ensure that a fault or failure in any open luminaries does not further reduce the effectiveness of the system.

9. Emergency lighting luminaries and their fittings shall be of non flammable type.

10. The emergency lighting system shall be capable of continuous operation for a minimum of 1 and a half hours (90 minutes).

Identify Early Warning Signs Of Change In Patient Deterioration

medpointhcg@gmail.com (Medpoint Healthcare) — Fri, 18 Nov 2022 07:46:00 +0530

Medpoint:Identify Early Warning Signs Of Change In Patient Deterioration

Identify Early Warning is not uncommon for hospitalized patients to exhibit early warning signs before deteriorating. The key to optimal outcomes is recognition of these warning signs followed by an appropriate and timely response. Have you ever called the Rapid Response Team (RRT)? What triggered your call? In most U.S. hospitals, a single warning sign, such as a sudden drop in blood pressure, may trigger a call.

Very often, the feeling that “something is just not right” prompts the call. But is there a way to quantify what might be going wrong in order to address the problem earlier?

Enter the Early Warning Scoring System, or EWSS, which can encourage early intervention, timely transfer to a higher level of care and prevention of codes. EWSS originated in the United Kingdom. Over the last few years, U.S. hospitals have begun to utilize the tool here in the states. Implementing EWSS “adds another layer of early detection to the RRT system” (IHI, n.d.) and allows the healthcare team to intervene earlier.

One widely used version is the Modified Early Warning System (MEWS). Healthcare personnel enter vital signs on a chart form that has red-shaded zones to identify findings outside the normal range for six vital signs, namely: Respiratory rate, heart rate, systolic blood pressure, level of consciousness, temperature and hourly urinary output.

When any one of these signs falls into a red zone, the nurse determines a MEWS score for the patient, assigning a number between 0-3 to each of the six vital signs (as shown in the MEWS algorithm chart, below). The nurse then adds the individual scores for a total MEWS score. If the total score is 4 or higher, the nurse is to call the patient’s provider and alert the RRT

Identifying Patient Deterioration

Early identification of patient deterioration is key to intervening for serious conditions like sepsis. However, early indicators can present subtly, making detection difficult and subjective.

Adding complexity, there are often several signs or symptoms that—when they present together—can indicate the onset of a condition far more serious than what may be diagnosed by just looking at

one of those signs or symptoms individually. Connecting the dots to see the complete picture becomes vital to enabling faster, more informed decisions on providing care.

· Patient acuity levels are rising, but staff-to-patient ratios generally are not.

· A wider range of staff members, with varying levels of clinical training and experience, are taking patient vital signs.

· Some important indicators of deterioration are not consistently part of routine vitals acquisition (e.g., respiratory rate, Is & Os, level of consciousness).

· Vitals are not typically monitored continuously in this setting. Rather, they are spot-checked during rounds every four to six hours, depending on the patient. Time spent assessing the patient during those visits to the bedside becomes critical in collecting comprehensive information and making it actionable so that clinicians can react quickly in order to impact patient outcomes.

MEWS Chart

Hospitals’ protocols and procedures vary in the use of EWSS. Some use the RRT for consultation as well as intervention. Other institutions may not utilize all six of the MEWS parameters, or may modify the tool for specific patient populations such as pediatrics or obstetrics

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In some settings, vital signs entered into the EMR “automatically populate a data warehouse that supports a patient risk tool that includes early warning scores for the previous four days as well as patient lab values for the last eight hours, key medications, and so forth. The patient risk tool also shows graphs of patient vitals for the past 48 hours.” The nurse evaluates these reports and decides whether to call the attending physician, alert the RRT, or continue to monitor the patient (IHI, n.d.). Another teaching hospital color codes their levels of EWSS scores (Duncan, et al., 2012):

• Green = normal

• Yellow requires the charge nurse to reassess.

• Orange requires the charge nurse to reassess and notify the resident.

• Red requires that the nurse notify the RRT and resident.

• Orange or red requires resident-to-resident handoff reporting at the bedside.

Use these early warning signs to detect patient deterioration and gain the benefits of early intervention.

RN.com now offers a new course entitled: The Chain of Command Protects Your Patients and You. This 2 contact hour activity reviews some clinical examples of common risk-for-deterioration scenarios and early warning signs that should be acted upon immediately, and suggests ways in which the nurse can successfully navigate the chain of command to prioritize patient safety.

Importance

Deterioration in a patient’s clinical condition frequently occurs over several hours before a critical event, providing hospital staff with a potential window of opportunity for intervention if detection of signs and symptoms occurs early.
Evidence-based practices to address early clinical deterioration include implementation of a rapid response team (RRT).
Quickly providing clinical caregivers with intelligently filtered information regarding specific patient conditions at the bedside can improve clinical decision support.
To aid in early detection, track and trigger methods (TTMs) assign a number score to specific signs and symptoms the patient may be either exhibiting or verbalizing.

The use of early warning scores—especially automated scores, as opposed to manual calculations—has been shown to improve effectiveness.

Nurses who used analytic decision-making activated Rapid Response Teams (RRTs) about twice as much as those using their intuition.²
Modified Early Warning Score (MEWS) calculations three times per day have been shown to result in two times as many RRT calls and decrease the number of ICU transfers by 40%.³
A pediatric unit’s implementation of a Pediatric Early Warning Score (PEWS) resulted in 85% of children with PEWS ≥3 improving their condition within 24 hours of a rapid medical intervention.⁴

EARLIER WARNING SIGNS OF DETERIOARTION IN CLINICAL CONDITIONS

CLINICAL CONDITIONS	EARLIER WARNINGS	MANAGEMENT
MI(Myocardial Infarction)	· Severe chest pain · Pain in back radiate to L arm · Excessive/ Breathlessness + in some cases	· Complete bed rest,O2 inhalation st&sos maintain BP Chart/TPR
CVA – Cerabrovascular Accident(Stroke)	· Weakness upper / lower extremities or one side of the body irrelevant talk · Slurred Speech · Difficulty to walking	· O2 inhalation st& SOS diet NG tube feeding(if can’t able to eat diet) · Continuous catheterization
Pulmonary Edema	· Breathlessness · Cough C or without expectoration · Tiredness · Palpitation present in severe cases	· Bed rest with propped up position,O2 inhaltion · Diet: Normal
Acute pancreatitis	· Abdomen pain especially right upper · Fever · Nausea and vomiting · Indigestion · Loss of appetite · Abdominal pain radiate to back	· Diet NPO,if severe pain give supportive measures immediately
Cholelithiasis	· Pain upper abdomen · Nausea,Vomiting · Indigestion	· It severe pain give supportive measures
Rhinosporidiosis	· Unilatertal nasal obstruction Rhinoceros post nasal discharge with cough	· Nasal packing (if epitaxis) Give supportive measures
Dengue fever	· High fever with chills · Heaviness of head · Pain in points/Muscle · Extreme tiredness · Loss foappetities	· Diet: More fluid intake observe ½ hearlty(TO PREVENT SHOKE)
Meningitis	· Fever with chills · Headache with pain in back muscles,neck · Stiffness of neck · Nausea and vomiting · Loss of appetite	· Maintain TPR chest give supportive me
Pregnancy induced hypertension	Headache,Vomiting,Blurring of vision	Admit,Maintain TPR BP control
Anteparturm Hemorrhage	Painful bleeding during pregnancy Abruptio placenta	Admit,MonitorTPR,Arrange for Blood transfusion
	Painless bleeding placenta previa	Admit,MonitorTPR,Arrange for Blood transfusion
Hyperemesiagravidorum	Continuous vomiting giddiness	Admit,Monitor TPR, Start IVF

A Solution for Improving Detection and Assisting in Faster Care Decisions

It can seem daunting to incorporate a process for collecting the information important to detecting patient deterioration—and put it to use to aid in clinical decision support. An approach to consider is making this an integral and intuitive part of the vital signs collection process that clinicians perform every day.

Welch Allyn Connex® vital signs devices can help hospitals combine vital signs measurement with the collection of additional patient observational information—all in a single workflow.

Vital signs and additional collected information are automatically calculated to generate an overall patient score—directly on the device at the bedside.

Clinicians are prompted with messages providing specific response actions based on the patient score and your facility’s protocols.

Complete information can then be sent directly to the patient’s record in the EMR.

Sivakumar Murugesan

Consultant Patient Safety and Quality Improvement