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.
