quality of health care services for rsby network hospitals in the state of gujarat district______

Quality of Health Care services for RSBY Network Hospitals in the State

of Gujarat district______

Quality of health care in RSBY : Pilot in the State of Haryana- Ambala

2

Quality in medicine

WHO- DALY, LE

Long term outcomes

-1 yr mortality/ visitation

Short term outcomes- Hospital mortally.

Process indicators-Response time etc.

Structural quality- Availability as per norms

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• Almost 4 years completed by RSBY in state.• 28.1 lakh families (approx. 54 lakh population)

covered.• 29 hospitals (Public-1 and Private-28)

empanelled as RSBY network hospitals.• No consistent nationally applicable quality

improvement process.• Introduction of Quality Management System

for RSBY Empanelled Hospitals.

Introduction

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– To enable the provision and coordination of health services which are:

– Equitable– Patient centered– Safe– Effective– Integrated– Efficient

– To maintain continuous improvement in quality of services provided.

– To encourage hospitals to achieve levels of quality over a period of time.

Objectives

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Operational Plan

Quality of health care in RSBY : Pilot in the State of Haryana- Ambala 5

Empanelment cum grading

criteria

5 Point grading scale (E to A Grade)

Comprehensive Quality Criteria Check list provided by Ministry of Labor and

Employment

Admittance level is “E” Grade

Grading mechanism

Districts chosen for Pilot (____)

Quality Criteria Form

Hospitals visited and assessed

Analysis and Grade given after assessment

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Grade-E– Basic Empanelment criteria and entry level. – Includes 10-medical beds, 24 hours drinking water

supply, one toilet for every 12 in-patient beds, basic system and internet connectivity.

– Medical officer with qualified nursing staff, OT sterilization, PNDT Act followed, clean bed sheet, mattresses, bedpans etc, IPD records, Labor room requirements.

– Hospitals not fulfilling Grade-E will be given 3 months time to upgrade to acceptable level.

Grading criteria

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7 Grade-D– Grade D is accepted level in RSBY– Includes patient mobility within hospital like ramp,

an information provider, documented evaluation and management of patient, informed consent, providing discharge summary and other documents to patient.

– OT specifications fulfilling, mopping of all areas of hospital, emergency power back up.

– System of registration of patient, provision of privacy, female attendant.

– Privacy of patient and emergency power back up etc.– Will be motivated to attain to C Level.

Grading criteria-2

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Grade-C– Augmenting supportive services. – Dietary services, laboratory, radiological services.– Proper nursing units managed by registered

qualified and experienced nurse.– Patient care by medical and nursing professionals,

documented rounds, pre-post operative care of patients, arrangements to meet emergency.

Grading criteria-3

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Grade-B– Included Intensive Care Unit .– Blood Bank, documented infection control

practices, proper radiology services, mortuary services,

– Zoning of OT complex.– AMC of major medical equipments etc.

Grading criteria-4

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Grade-A– 24x7 emergency services.– 24x7 pharmacy facility.– Qualified anesthesiologist to attend ICU.– Hospital management system in place.

Grading criteria-5

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www.rsby.gov.in

Grading criteria-6


ACCESS ANDPHYSICAL FACILITIES

ManagementAvailability of StaffEvaluation and Care of PatientsOperating DepartmentLaboratory servicesRadiology Diagnostic ServicesInfection Control PracticesHospital Waste ManagementSupport ServicesAccess to Blood BankPatient Rights and Education

Infection Control

Practices

Health and Safety

Labor RoomICU

•10 inpatient medical beds for inpatient health care.•Availability of 24 hours drinking water supply•One toilet for every 12 in-patient beds •Adequate privacy in OPD•Running tap water is facility hospital•Warm water for winter months.•Access to road allowing to Ambulance•Hospital accessible by wheelchair; Ramp•Reception desk Emergency electric supply.

•Maintaining of medical record•Documented lines of responsibility•Management system in place•Written and dated job descriptions•Written agreement with working Doctors•Regular monitoring and review meeting

•1 medical officer & 1 nurse at all times•1information provider at all times•Registered nurse qualified and/or experienced per ward•There is a system for calling specialists in an emergency•Emergency department have MBBS 24x7 basis

•Pre admission physical examination and medical history taken written informed consent is taken•A copy of the Discharge summary / Death Summary is provided to the patient/attendant•IPD patients are evaluated at least twice a day•After examining the course of action on the OPD card is endorsed•If patients are transferred to another hospital copiesof their clinical notes accompany them

•OT sterilisation facilities functional.•Adequate lights and Air conditioning in each OT•Height adjustable OT Table, shadowless lamp•The operating theatre fully equipped for its purpose•Informed patient concern andPre-operative care•Emergency power supply for OT•Zoning of OT•AMC for all major equipments.•Sterilabels used for autoclaving

•Test results should be recorded in the Labregisters, requisition slipand on the OPD card•A system for registration of all investigations for identification •Written, dated and signed procedures for thecollection, reception, handling, abeled, storage,transportation and disposal of samples•All laboratory equipment is subject to a plannedinspection, and calibration •Staff are offered appropriate immunisations

•The services and facilities satisfy statutoryrequirements under the PNDT Act•Test results should be recorded not only in the x-rayregisters, requisition slip and the OPD card•Female attendant to accompany female patients during radiological procedures•Arrangements are in place for dealing with out of hours or emergency requests.•There is an in-charge radiology/ or the radiologist Signs IN LOCAL LANGUAGE warning women of childbearing age has dangers of radiation in pregnancy.•The protection of staff conforms to the BARCguidelines

•The waste disposal is in accordance with the Biomedical waste management & handling rules1998•The health facility has a valid license from the PCB•Availability of colour coded Bin in each ward•Collection of waste done as per guidelines in wards,OPD,OT, labour room.•Waste treated with bleach or any solution before disposal

•Fresh clean bedsheets and changed when required for the patient.•Bed mattresses of the patients are in good shape•Clean bedpans and urinal pans and dustbin areavailable .•Dietary services are made available to patients.•Hygine delivery in place to the IPDs Laundary system in place

•The health facility has mechanisms in place foradequate quantity of blood without loss of time.•Storage center meets the licensing requirement of the Drugs and Cosmetic Act and Supreme Court rules•Blood collected is labeled appropriately with the donors name, registration number, blood group, date and time of collection and date of expiry, tests carried out.

•There is adequate provision for patient privacy in the form of screens and curtains etc•Rights and responsibility of the patients/ Informationfor patient education are displayed at prominentplaces in the health facility.•The facilities available and services provided and the charges are also prominently displayed•There is adequate provision for patient privacy in the form of screens and curtains etc•There is evidence that there is a documentedgrievance redressal mechanism which is practised

•Maintaining of necessary records as required and providing necessary records of the insured patient to the Insurer or his representative / Government / Nodal Agency as and when required.•There is evidence that the hospital has adocumented policy on creation and maintenance ofmedical records which is practiced

•All emergency telephone numbers concerned withHealth and Safety are displayed •Pictograms indicating fire exits and escape routesare properly displayed•Relevant safety information is available including Safety regulations,Fire precautions, AIDS/HIV/Other guidelines •Hospitals records should be maintained on all Accidents,Errors, Incidents,Near misses and Violent episodes.• There should be evidence of management actionarising from incident reporting i.e. each case isindividually investigated, evaluated and acted upon.

•The Labour room/OT should have Delivery table Anesthetic machine with emergencyoxygen supplies resuscitation equipment and drugs for infants and adults•There is a suitably experienced and qualified doctor responsible for the day to day management of the unit.•A trained mid-wife/nurse is present at every birth.•Records kept after discharge include maternity notes and birth registration•The hospital has 24 hour on-site cover from qualified medical doctors (including anesthesiologist An emergency power system provides heat and light in the event of a mains power failure.•A qualified pediatrician to attend Newborn.

•Designated air conditioned space•Standard ICU bed equipment for the constant monitoring for vitals emergency crash cart, defibrillator ventilators, suction pumps, bedside oxygen facility•Anesthesiologist-Intensivist •Nursing Staff: B.Sc Nursing/Diploma: have 2 years of ICU care of Ratio 1: or 2:1

•Mopping of all areas at least twice a day with disinfectant Shredders / needle destroyers are available in all clinical areas •Mechanisms to ensure toilet sanitation (duty roasters for sweepers)•Documented Infection control protocols in place•Regular documented autoclaving of instruments &linen•Carbolisation of the OT, Labor Room after everyprocedure

17 Sub criteria

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Grading -7

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Criteria Count

Access and facilities 23

Management 8

Availability of Staff 5

Evaluation and care of inpatient 8

Anesthesia 4

Operating departments 10

Laboratory services 10

Radiology services 13

Infection control 7


13

Grading-8

Criteria Count

Hospital waste management 7

Support services 7

Access to blood bank 6

Patient rights and education 8

Medical records 3

Health and safety 9

Labour room if available 6

Intensive care unit 426th September 2012


Grading mechanism

14

Districts for Pilot Study

Hospitals visited and assessed• Empanelment

cum grading criteria filled1

• Infrastructure and services assessed

Analysis and grade given after assessment• Grade from E

to A

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www.rsby.gov.in

Grading Criteria


Grade Benchmark

Below E less than 15 (the hospital will not be meeting in any of given criteria properly.

Grade E 15 or less than 50% of D

Grade D E (>15) + < 14 of D + 25 % of C

Grade C E + D + 80 % of C + 80% of B

Grade B E + D + 80 % of C + 80% of B + 50 % of A

Grade A E + D + C + B + A

E-19,D-32,C-32, B-31, A-24 26th September 2012

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a) Hospitals not meeting detailed empanelment criteria will be given time to improve or would be de-empanelled

b) Hospitals meeting just the revised empanelment criteria will be placed in the lowest grade E. These hospitals would continue to be empanelled providers but would be advised to work towards achieving next higher grade within next 3 months failing which it will be de-empanelled.

c) Hospitals meeting and exceeding the empanelment

criteria would be graded from Grade D-A. (

Follow up

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26th September 2012

Thanks for kind attention

More details on:

www.rsby.gov.in

Or Dr K Madan Gopal

[email protected]

[email protected]

9717773732

http://www.rsby.gov.in/

mailto:[email protected]



quality of health care services for rsby network hospitals in the state of gujarat district______

Documents

quality of services

patient care

levels of quality

ambala slide

rsby network hospitals

rsby empanelled hospitals

grading criteria

state of haryana