Sunday, 10 June 2012

What’s new in NABH 3rd Edition for Hospitals? [Chapter 2: Care of Patients] – Part 2

COP-8 in the revised edition is the corresponding COP-6 in 2nd edition. Nothing much changes in this standard, except that a new objective element has been added. COP-8a reads as “Documented policies and procedures are used to guide the care of patients in the intensive care and high dependency units” which basically deals with issues which were left out in the previous edition. The element recommends that the documentation should include information on how care is organized, what is the procedure of monitoring the patients and what would be the nurse-patient ratio.

The standard COP-8 in the 2nd edition only covered care of high-risk obstetrics patients. The corresponding standard COP-10 in the 3rd edition expands the scope of this stand by covering obstetric care. The revised standard statement (COP-10) states that “Documented policies and procedures guide obstetric care.” The standard opens with a new objective element COP-10a stating “There is a documented policy and procedure for obstetric services.” The standard also incorporates a new objective element COP-10d which states that “Documented procedures guide provision for ante-natal services.” This is followed up by another new objective element COP-10f which states that “Appropriate pre-natal, peri-natal and post-natal monitoring is performed and documented.” These are welcome changes in this standard as NABH views the obstetric care in totality. From the experience of changes in some standards in AAC, we can expect that future revisions will come out with further guidelines on ante-natal services and pre-natal, peri-natal and post-natal monitoring. Overall, three new objective elements have been added to this revised standard.

In the standard COP-11, which corresponds to COP-9 of 2nd edition, there are not many changes in the existing objective elements. Only a new objective element has been added COP-11a which states that “There is a documented policy and procedure for paediatric services.

COP-12 in the 3rd edition deals with care of patients undergoing moderate sedation, which corresponds to standard COP-10 in 2nd edition. Two new objective elements have been introduced in this revised standard. COP-12a states that “Documented procedures guide the administration of moderate sedation” and COP-12b states that “Informed consent for administration of moderate sedation is obtained”. These two objective elements fill the gap that existed between the standard’s definition and the objective elements elaborating the standard itself.

COP-13 (in 3rd edition) has tried to removed confusion arising out of various interpretations of the terms ‘anesthetist’ and ‘qualified individual’ used in the earlier standard COP-11 in 2nd edition. COP-13 replaces each of these terms with an ‘anesthesiologist’ thereby clarifying that the physician qualified for this job has to do it. COP-13 deals with the administration of anesthesia. There are two new objective elements added to this standard – COP-13i and COP-13j. COP-13i states that “The type of anaesthesia and anaesthetic medications used is documented in the patient record” while COP-13j reads as “Procedures shall comply with infection control guidelines to prevent cross-infection between patients.

Two new objective elements have been added to COP-14 (COP-12 in 2nd edition) covering surgical procedures. “Patient, personnel and material flow conforms to infection control practices” and “Appropriate facilities and equipment/appliances/instrumentation are available in the operating theatre” have been added as COP-14h and COP-14i respectively. But the objective element on monitoring of surgical site infection rate (COP-12j in 2nd edition) has been removed from this standard and will be addressed in HIC-4.

In the 2nd edition, COP-14 addressed pain management issues and COP-16 is the standard that deals with the topic in 3rd edition. So while the earlier standard required the hospital to support assessment and management of pain for all patients, the new definition makes it mandatory for all patients to undergo screening for pain. The revised standard provides provision for the same through two new objective elements. COP-16b requires that “All patients are screened for pain” and COP-16c recommends that “Patients with pain undergo detailed assessment and periodic re-assessment”.

Standard COP-17 in 3rd edition (corresponding to COP-15 in 2nd edition) provides additional requirements on rehabilitative services through three new objective elements in addition to the existing requirements. COP-17c states that “Care is guided by functional assessment and periodic re-assessment which is done and documented by qualified individual(s)”, COP-17d requires “Care is provided adhering to infection control and safe practices” and COP-17f mandates that “There is adequate space and equipment to perform these activities.

The last standard in the chapter, COP-20, deals with end of life care (corresponding to COP-18 in 2nd edition). The revised standard has done away with the objective element on autopsy and organ donation (COP-18d of 2nd edition) and has introduced a new objective element, COP-20d which requires that “Symptomatic treatment is provided and where appropriate measures are taken for alleviation of pain”.

In conclusion, in the chapter COP in the revised edition of NABH (3rd edition), there was an addition of 37 new objective elements and 2 new standards (which contributed 14 of the 37 new objective elements). 4 objective elements of COP in 2nd edition were also removed. Therefore, chapter COP in 3rd edition has 20 standards and 136 objective elements.

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