recent trend & guidelines for ayurvedic proctology practice

Laws & Acts ?

Ayurvedic Proctology ?

Gujarat State Law ?

Quackery in Practice

Any System Practice ?

IPC & Tips of Safe Practice

Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar

To be Continued from… 2nd Annual Conference of SPA

• To study recent trend of ayurvedic proctology practice

–On line open Survey

• Interpretation of out come of survey

• Guideline to set up Ayurvedic Proctology Hospital / clinic


11.40%

8.60%

5.70%

18.60%

72.90%

4.30%

UG/Intern

PG Scholars

PhD Scholars

Faculty

Practitioners

Others


Category of Voluntary Participants of Survey (n=70)

1.40%

67.10%

40.00%

2.90%

8.60%

4.30%

27.10%

2.90%

0.00%

15.70%

BSAM

BAMS

Certificate Cources

RAV

PG Diploma

MD Shalya

MS Shalya

MD/MS Ayu (Other)

MD Ayu Sangyaharan

Other


Registered Qualification (n=70) recognized from University /State Board OR CCIM

*Other… fellowship in MUHS, LLB, MHM, MD(AM) etc.

*PG Diploma, RAV, Certificate courses etc have no amendment in IMCC Act 1970.

*Other… clinic, MCIM, Gov of Guj, Bombay Nursing Home Act etc.

62.90%

62.90%

35.70%

1.40%

38.60%

2.90%

18.60%

Local Municipal Corporation

BMW

GPCB

ISO/NABH

Procto Asso

NA/None

Other


Registration of your Hospital / Clinic? (n=70)

*Other… NA – PG Scholars

91.40%

71.40% 50.00%

30.00%

30.00%

38.60%

24.30%

14.30%

15.70%

0.00%

5.70%

Daily OPD

IPD

BMW

Sterilization Autoclaving -…

Sterilization OT Fumigation

OT anesthesia

Modern Medicine Stock

Kshara Sutra Making

Emergency / On Call Dr

None

Other


Maintenance of Registers (n=70)

*Other… NA – PG Scholars & Anesthesia Form

85.70%

70.00%

68.60%

41.40%

24.30%

45.70%

37.10%

27.10%

71.40%

4.30%

OPD Case Sheet

IPD Case Sheet

Details of Pre-OP-Post

Post OP Charts

KS Chart in Fistula

Copy of Bill & Receipts

Lab & Imaging Investi.

Photo of Patient with Consent

Informed Written Consent

Other


Documents/Record keeping (n=70)

*Other… NA – PG Scholars & >48 Hr Institute attached Hospitals

64.30%

42.90%

20.00%

1.40%

Day Care

24-48 Hr

More than 48 Hr

Other


Avg. Post OP Indoor Stay? (n=70)

*Day Care – within 24 Hr, having safe & danger effects

70% 20%

10%

Discharge Summery after Surgery (n=70)

Yes

No

Other

25.40%

68.70%

6%

Hospital Record Electronic / Software (n=70)

Yes

No

Other


*Other… software made by local engineer, personal SW, Excel Sheet

*Other… when pt want, as per requirement, NA,

93%

3%

4%

Medico-legal for Ano-Rectal Surgery (n=70)

No

Yes

Other

40.00%

28.60%

23%

17%

13%

Medi-claim for Ano-Rectal Surgeries (n=70)

Yes

No

Never Try

Tried butrejected

Other


*Other… Case-less facilities, 50-50, Gov. Hospital, attached with

modern Surgeon !!!!

* Other… Some times & No FIR Lodge due PM report

85%

15%

Are You Calling Anaesthetic for Surgery ?(n=70)

Yes No 86.60%

13.40%

Is anaesthetic are supporting/Coming to your clinic/hospital for Surgery ?(n=70)

Yes NoDr Shreyas Bhalodia Sushrut Proctology

Association Conference 2016 @ Jamnagar

61.20% 14.90%

12%

10%

2%

Each & Every Surg

Often

Occasionally

Never

Other


*Other… mild sedation with local Anesthesia

On Which frequency you are calling anaesthetic ? (n=70)

*Other… NA – PG Scholars

69.70%

43.90%

30.30%

6.10%

19.70%

1.50%

16.70%

1.50%

LA

Suddle Block

Spinal Anast.

Pudendel N. Bl.

Short GA

Complete GA

IV Seddation + LA

Other


Our Skill in Anaesthesia (based on Teaching, Training & Practice) **

(n=70)

* As per IMCC Act 1970 and drug & Cosmetic act 1945

Yes / No 50-50 as per state policy

Other… NA – PG Scholars Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar

97.00%

86.60%

98.50%

65.70%

37.30%

10.40%

97.00%

95.50%

64.20%

82.10%

9%

4.50%

9%

Hemograme

BT-CT-P.T.

Glucose Esti.

RFT

LFT

Lipid Profile

HIV Screening

HbSAg Screening

Physician Fitness

Urine MR

Stool MR

Thyroid Profile

Other

Pre OP Investigations* (n=70)

* Imaging investigations not included

Other… own medical store, Modern for poor Patient, ayu & modern both prescribing Dr Shreyas Bhalodia Sushrut Proctology


30.30%

6.10%

40.90%

56.10%

42.40%

4.50%

Ayurved Only

Modern Only

Ayurved & Emergency Modern

Ayu. , Modern & Surgical +Anesthetic

Ayurved & Prescribing Modern

Other

Medicines & Dispensing (n=70) IMCC Act 1970 and drug & Cosmetic act 1945

*Sales Tax, VAT, Drug Licenses, FASSI etc may be applicable

Did you know List of Licenses and Statutory Obligations* ?

73.10%

23.90%

3% No Yes Other


http://nabh.co/documents_Ayurveda.aspx

http://nabh.co/documents_Ayurveda.aspx

Registration of Dr as well as Hospital / Clinic

Documentation & Record Keeping Physically and/or electronically

Premises Set up

Qualified Nursing / OT / Para Medical Staff

Clerical /account/Housekeeping etc. staff

Legal advisor for Tax & MLC

Recent up dates


Registration of Dr for qualification in Recognized university

i.e. GAU Act 1961 etc.

State council Board i.e. Guj. Medi. Prac. Act 1963 / IMCC 1970

CCIM Compulsory for faculty Practitioners who practicing across India

As per law – “MLC No Value” Any certificate/degree/diploma/ PG diploma courses offered by various universities / autonomous institutes / guru are not being recognized until details are not amended in IMCC Act 1970 or other act related to AYUSH Ministry


Clinical Establishment (Registration & Regulations) Act 2010 (23 of 2010) Not applicable in Gujarat Till date

Bio-medical Waste (Management & Handling) Rules 1998 under section 6,8 & 25 of Environment & Pollution control Act, 1986, the Central Govt. of INDIA Applicable in Gujarat (even for AYUSH)


Gujarat Pollution Control Board if Indoor Facility or Monthly OPD>1000 patients in Clinic/

Hospital/ Laboratory

The Bombay Nursing Homes Registration Act 1949 - in some state / Municipal corporations

In Local Municipality or Municipal Corporation

Shop Act License

– some insurance company ask “Form C”

– not mandatory depends on local authority

Professional Tax - Must

NABH Accreditation / ISO Accreditation Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar

• Hospital Premises

– Situation

– Easy approach (Ground floor / 1st floor / Lift)

– Easy transportation

– Well ventilated & lightend

– Area (Sq. Meter / Fit ) per Gov. Rules & Regulation

• Clinical Establishment Act 2010


Dispensaries * Physical infrastructure –

• Space requirement – Minimum 100 sq. ft.

• Dispensing counter – as per requirement.

Human resource –

• Minimum one doctor, one pharmacist and a multipurpose worker

Equipments requirement –

• Stethoscope – 1

• B.P. apparatus – 1

• Torch – 1

• Thermometer – 1

• Tongue depressor – 1

• Weighing machine – 1

• X – Ray view box – 1

• Hammer – 1

• Kharala - 1

• Others as required

Furniture requirement –

• Doctor’s table – 1

• Doctor’s chair – 1

• Chairs for attendants – 2

• Examination table – 1

• Patient’s stool – 1

• Foot step - 1

Others –

• Display the name of doctor with the degree.

• Registration number of the doctor

• Fee

• Timing of the clinic

• Experience of the doctor

• Dispensing counter with signage

• Name of the pharmacist with degree and experience


*Clinical Establishment Act 2010

Clinic * Physical infrastructure –


Human resource –

• Minimum one doctor and a multipurpose worker

Equipments requirement –

• Stethoscope – 1

• B.P. apparatus – 1

• Torch – 1

• Thermometer – 1

• Tongue depressor – 1

• Weighing machine – 1

• X – Ray view box – 1

• Hammer – 1

• Others as required



Therapy Centre* Physical infrastructure –


• Therapy room

Human resource –

• Minimum one doctor,

• one pharmacist cum panchakarma therapsit

• multipurpose worker

• HOSPITAL WITH MINIMUM OF 10 BEDS

– Physical infrastructure (Space requirement )

• OPD – 100 Sq. ft , IPD – 500 Sq. ft

– Human resource (Each one) –

• Doctor , Pharmacist/nurse , Attendant, Multipurpose worker

• HOSPITAL UPTO 11 - 25 BEDS

– Physical infrastructure (Space requirement )

• OPD – 250 Sq. ft , IPD – 1250 Sq. ft

– Human resource

• Doctor – 2, Pharmacist – 1, Nurses – 2, Attendant – 1, Multipurpose worker – 1



Cont . . .

• 26 – 50 BEDDED HOSPITAL

• 51 – 100 BEDDED HOSPITAL

• HOSPITALS HAVING MORE THAN 100 BEDS

• TEACHING HOSPITALS

– All the teaching Hospitals must fulfil all the minimum standards as per the gazette notification of CCIM regd. no. D.L. 33004/99 no. 115 dated 22.04.2013 New Delhi.



Out-Patient Department for an Ayurvedic Hospital

The basic infrastructure must have following sections

1. Reception & waiting hall

2. Registration counter

3. OPD medical record room

4. Clinics / consultation room

5. Dressing room (mandatory for hospitals more than 50 beds)

6. Procedure room (mandatory for hospitals more than 50 beds)

7. Minor OT (optional but mandatory for hospitals more than 100 beds)

8. Dispensary (mandatory for hospitals more than 50 beds)

Other facilities which are required in the OPD are listed below –

1. Proper provision for drinking water and electricity

2. Toilet facilities for patients

3. OPD cafeteria (Optional)



5.Dressing room

minimum of 100 sq. ft.more than 50 beds

6.Procedure Room - This is required in the hospitals having more than 100 bed strength where agnikarma, kshara karma like procedures can be performed for the OPD patients.

7. Minor OT –more than 50 beds

400 – 500 outpatient where many minor OPD surgical procedures as well as Kshara sutra application can be performed. The minimum area required for the minor OT is 100 sq.ft.



General specifications for IPD Classification of ward accommodation –

• Primary – Bed accommodation , Nursing station , Treatment room

• Secondary – Doctor’s room , Nurses’ room , Clean utility

• Sanitary – Toilet block , Dirty utility , House keeper

• Ancillary – – Kitchen (required for hospitals having more than 50 beds)

– Day room

– Stretcher trolley

Dr Shreyas Bhalodia Sushrut Proctology



Operation theatre mandatory for the hospitals having more than 100 beds however it is optional for the hospitals below 100 beds. Total Area – 2700 sq. ft. Functional distribution –

– 1. Major OT with attach toilet & bathroom – 2. Minor OT – 3. Scrub room – 4. Sterilization store – 5. Equipment store – 6. Recovery room

Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar *Clinical Establishment Act 2010

Minimum Equipments for Proctology OT


Legal & statutory requirements List of statutory compliance Authorization under

biomedical waste rule 1998 for management and handling of biomedical waste.

No objection certificate from competent fire authority.

Vehicle registration certificate for ambulance.

Right to information act. Consumer protection act Clinical establishment act

2010.

Legal aspects Societies registration act

1860 Consumer protection act Drug & cosmetic act Patients’ bill of right Medical negligence Drug handling Hospital infection Anesthesia – given with

proper & valid consent. Invasion of privacy Handling of medical records

Dr Shreyas Bhalodia Sushrut Proctology



Records maintenance & reporting

Medical records – The medical record of the hospital has following documents –

– 1. Clinical document

– 2. Scientific document

– 3. Administrative document

– 4. Legal document

Reports*

• Average daily census ward wise, specialty wise

• Average length of stay

• Bed occupancy rate

• Bed turnover rate

• Outpatient clinics – number of new cases, number of repeat cases, specialty wise break up, Unit wise break up of cases

• Left against medical advice (LAMA) rate

• Number of X-Ray done – OPD, IPD

• Number of laboratory investigations

• Number of surgical operations

• Number of panchakarma done – break up of various procedures for OPD & IPD

• Number of delivery done along with other gynecological procedures.

• Numbers of para surgical procedure done in the breakup of agnikarma, jalaukavcharana etc.


*mandatory for the hospitals having more than 100 beds & teaching hospitals

RECORDS TO BE MAINTAINED Outpatient Register

Inpatient Register

Operation Theatre register

Case sheets –OPD/IPD, Consent

Medico legal register

Laboratory Register

Radiology and imaging register

Discharge summary

Medical certificate in duplicate

Complaint register

Number of beds system-wise and specialty

Total Discharges

Staff Registers i.e Salary – Attendance – Qualification etc.

Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar *Clinical Establishment Act 2010

Signage Radiation Hazard Signage

Biomedical Waste Segregation

Danger Signage

General Instructions Like ‘No Smoking’, ‘Keep Silence’, ‘Use Dustbin’, Etc. At Various Patient And Visitor Areas In The Hospital

Hand--washing Techniques Compliant With WHO Guidelines At All Hand Wash Basins

How To Use Fire Extinguisher

Important Phone Contact Numbers Of Hospital Authorities

Required By Regulations Like PNDT, Lifts, Fire, Etc.

Of Material Safety Data Sheet At All Locations Where Hazardous Materials Are Stored

Patient Rights And Responsibilities In Opd, Emergency And Wards


Dr Degree & Registration

Bio-medical Waste Certificate

GPCB Certificates

Various Notifications From Gov. of Guj., CCIM, AYUSH, Court Decisions etc.

News Papers Cuttings with Date


Informed Written Consent

• In Consent must write

Early and/or late complication of Surgical procedure and anesthesia in local language.

Name of Surgeon, Assi. Surg. Anesthetic and OT Assi.

Never do any photography /Live Surgery without Consent

In Operative Cases

• Never Forget Anesthetic Note in indoor case with Adv

Antibiotics & Analgesics SOS

Procedure Name

Vital Remarks


Never use guarantee word for any treatment

Landmark judgments for AYUSH Dr • Dr. Mukhtiar Chand & Ors vs The State Of Punjab

& Ors on 8 October, 1998 http://indiankanoon.org/doc/484509/

• Smt. Kalpana Ben vs Dr. Kalposh V. Parikh etc. on 3 August, 2012 – KS Surgery Death Case http://indiankanoon.org/doc/115200537/

• THE HONOURBLE MR.JUSTICE K.CHANDRU http://www.ismga.net/uploads/5/4/6/4/5464496/chand

ru_udgement.pdf

• Poonam Verma vs Ashwin Patel & Ors on 10 May,1996 http://www.indiankanoon.org/doc/611474/

37

http://indiankanoon.org/doc/484509/



http://www.ismga.net/uploads/5/4/6/4/5464496/chandru_udgement.pdf

http://www.ismga.net/uploads/5/4/6/4/5464496/chandru_udgement.pdf

http://www.indiankanoon.org/doc/611474/

www.ayurvedauniversity.edu.in

www.ccimindia.org www.clinicalestablishments.nic.in

www.gujrathealth.gov.in www.indianmedicine.nic.in

www.nabh.co/documents_Ayurveda.aspx www.slideshare.net/drsurendrachaudhary/

Dr. Surendra Chaudhary,

Medical Officer, former, District Ayurveda &Unani Officer, Gautambudh Nagar(Noida)


• Faculties of

– JSAC, Nadia (2002-07)

– IPGT & RA, Shalya Dept

(2008-11)

• All members of SPA

• All members of SAAN

• Gujarat Action Committee

• NIMA – Gujarat


www.aumayurved.com


For Any Assistance on Any MLC /Medi-claim Issues

Contact me 24 X 7

Dr. Shreyas G. Bhalodia

+91 98254 51215 or

+91 7878151215

[email protected]

Take home message . . .

Document your Practice

recent trend & guidelines for ayurvedic proctology practice

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