Wednesday, 30 May 2012

What’s new in NABH 3rd Edition for Hospitals? [Chapter 1: Access, Assessment and Continuity of Care]

The 3rd edition is an attempt to bring specificity to certain aspects of patient care covered in various chapters. There is also a bit more clarity introduced in certain standards. So let’s look at what’s new in the first chapter, i.e. Access, Assessment and Continuity of Care.

Many of the objective elements of AAC in 2nd edition began with the phrases “The policies and procedures guide….” or “Policies  guide….” and in the 3rd edition, the word ‘Documented’ has been added in the beginning of these sentences. So AAC-2a would read as “Documented policies and procedures are used for registering and admitting patients.” or AAC-3d now reads as “The documented procedures identify staff responsible during transfer/referral.” Clearly NABH wants HCOs to document their process, policies and procedures very clearly and not to leave things to the imagination of the employees. Even unwritten policies followed consistently in the organization should now get documented so that there is a visible evidence to establish compliance.

AAC-2 has a new objective element added to the list – “A unique identification number is generated at the end of registration.” In relation to this, the standard on discharge summary (previously AAC-15, now AAC-14) also has a new objective element – “Discharge summary contains the patient's name, unique identification number, date of admission and date of discharge.” This new addition hints towards NABH’s advice to hospitals to go for computerization, i.e. implement a hospital information system (HIS) or hospital management system (HMS).

In 2nd edition, AAC-3 began with the following objective element – “Policies guide the transfer of unstable patients to another facility in an appropriate manner.” AAC-3 missed out on covering patients who would get transferred into a hospital. So a new objective element AAC-3a – “Documented policies and procedures guide the transfer-in of patients to the organization” tries to address this issue. AAC-3b becomes more specific with the text – “Documented policies and procedures guide the transfer-out/referral of unstable patients to another facility in an appropriate manner.”

Standard AAC-4 from 2nd edition (During admission the patient and/ or family members are educated to make informed decision) has been scrapped because the chapter on Patient Rights and Education (PRE) deals with this issue adequately.

The standard on ‘initial assessment’ deals about content of assessment, person responsible for this activity, time frame of this activity and other contents of the initial assessment. In edition 3, standard AAC-4 (earlier AAC-5) comes up with 3 new objective elements: “Initial assessment of in-patients includes nursing assessment which is done at the time of admission and documented”, “The plan of care is countersigned by the clinician in-charge of the patient within 24 hours” and “The plan of care includes goals or desired results of the treatment, care or service” to include the roles of nurses and clinicians in initial assessment.

The standard “Patients cared for by the organization undergo a regular reassessment” (AAC-6 in 2nd edition) was silent about whether it covered OP patients, IP patients or both. Standard AAC-5 in 3rd edition takes care of this confusion with the inclusion of two new objective elements – “Out-patients are informed of their next follow-up, where appropriate” and “For in-patients during reassessment the plan of care is monitored and modified, where found necessary”.

The standards dealing with laboratory and imaging services (AAC-7 and AAC-10 in edition 2) defined scope of their services in terms of “requirements of the patients”. Of course this was very ambiguous. So the edition 3 has aligned these to the documented scope of services of the hospital. The new standards AAC-6 and AAC-9 read as “Laboratory services are provided as per the scope of services of the organization” and “Imaging services are provided as per the scope of services of the organization” respectively. In each of these standards, 2 new objective elements have also been introduced. “The infrastructure (physical and manpower) is adequate to provide for its defined scope of services” and “Results are reported in a standardized manner” expand the scope of these standards.

Since the chapter Facility Management and Safety (FMS) contains standards on safety, edition 3 has done away with the objective element “Policies and procedures guide the safe use of radioactive isotopes for imaging services” (AAC-12h in 2nd edition).

AAC-12 of 2nd edition also defined objective element AAC-12c as “Written policies and procedures guide the handling and disposal of radio-active and hazardous materials”, so there was some scope left for HCOs to follow their own policies which may be in conflict with or non-compliance of statutory guidelines. The new standard AAC-11c removes this conflict by stating the element as “Handling, usage and disposal of radio-active and hazardous materials are as per statutory requirements.”

A new aspect was added to the standard “Patient care is continuous and multidisciplinary in nature” with the inclusion of the objective element “Transfers between departments/units are done in a safe manner” (AAC-12e in 3rd edition).

In all, compared to 2nd edition, 3rd edition has scrapped 5 objective elements and 1 standard (which had 4 of the 5 scrapped objective elements). The new edition has also introduced 13 new objective elements. Therefore chapter AAC in 3rd edition has 14 standards and 90 objective elements.

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