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Methods of smoking cessation
Apexa B Patel, Advaita B Patel, Baldev V Patel
January-June 2016, 3(1):1-8
Smoking is the leading preventable cause of morbidity and mortality worldwide. Cessation of smoking significantly reduces the risk of dying from tobacco-related diseases such as oral cancer, heart diseases, and lung cancer. Since smoking is considered to be a major health hazard in the world, dentists and health-care workers need to consider it seriously and assist their patients in smoking cessation. This review article summarizes different smoking cessation methods, withdrawal symptoms and health benefits due to smoking cessation.
  5,312 2,089 -
Lean six sigma application in reducing nonproductive time in operation theaters
Sanjeev Singh, T. Remya, T. M. Shijo, Dinesh Nair, Prem Nair
January-June 2014, 1(1):1-6
Background: Non Productive Time OT causes potential loss or deferment of revenue for the hospital and internal customer dissatisfaction. The quality tool Lean Six Sigma may help to reduce the non-productive time. Aim: To use elements of a six sigma model to reduce non-productive time in Gastro Intestine Surgery OT. It focuses on the reduction of NPT between Patient In time and Induction Begin time, Induction End time and Incision In time, Patient Out time and OT Readiness Time. Method: In a five phase study using DMAIC (Define. Measure, Analyze, Implement & Control) model, business case, value analysis, brain storming, FMEA (Failure Mode & Effect Analysis), RPN (Risk Priority Number) calculation identified causes and solutions. In six sigma analysis process sigma, target sigma and achieved sigma was calculated. Results: The null hypothesis of no difference in old and new Non Productive Time between Patient In time and Induction Begin time, between Induction End time and Incision and between Patient Out Time and OT Readiness Time was rejected using 2test since the p-value was below 0.05 at 95% confidence level. The process sigma was at 0.91, 0.96 and 0.67 which got improved to 2.55, 2.22 and 3.28 which was better than target Six sigma. Overall bottom line improvement was 4.8CR for the study period by bringing efficiency in the system. Conclusion: The six sigma project in OT resulted in reducing NPTs, helping to take more cases, patient discharge becoming more systematic, and reducing chaos regarding scheduling OT cases.
  5,503 1,849 2
Assessing Indian Public Health Standards for 24 × 7 primary health centers: A case study with special reference to newborn care services
Prahlad Rai Sodani, Kalpa Sharma
January-June 2014, 1(1):12-16
Objectives: The main objective of the present study is to identify the existing gap with respect to Indian Public Health Standards (IPHS) for availability of infrastructure, human resources, investigative services and essential newborn care services at 24 × 7 primary health centers (PHCs) of Bharatpur district of Rajasthan state. Materials and Methods: Data were collected from medical officer in-charge from the study 24 × 7 PHCs to provide required data on infrastructure, human resources, investigative services and newborn health care services through the well-structured questionnaire. Results: It was found that the availability of operation theater, telephone and E-mail facility were not satisfactory. Labor room was available at almost all the 24 × 7 PHCs while nearly 75% of the 24 × 7 PHCs have laboratory and cold chain facility. Shortage of human resources, especially laboratory technician and pharmacist were observed. It was also observed that none of the 24 × 7 PHCs have fully equipped newborn corner. Conclusion: The study depicted that the availability of human resources, infrastructure and facilities for newborn care services at the 24 × 7 PHCs were not satisfactory as per the prescribed IPHS. Efforts are required on priority to strengthen OT, investigative facilities and communication facilities at the 24 × 7 PHCs. Recommendations: It is recommended that availability of pharmacist/compounder shall be as per IPHS norms at the 24 × 7 PHCs. New born care corners established at 24 × 7 PHCs should be provided adequate equipment/items as recommended by the IPHS so as to become effective and functional to provide new born care services in the rural areas.
  5,967 1,033 -
Implementation of surgical safety checklist for all invasive procedures
Akanksha Patel, Vinay Sanghi, Vibhu Ranjan Gupta
July-December 2015, 2(2):41-46
Context: The purpose of this study was to analyze the implementation of the surgical safety checklist (SSCL) for all invasive procedures and compliance with the SSCL to determine further improvements. Aims: To implement the SSCL for all invasive procedures within 6 months and achieve 80% compliance. Settings and Design: Various invasive procedures selected that have comparatively risks of errors. Modified the SSCL based on essential requirements of the procedure. Materials and Methods: The implementation of the SSCL was observed for all identified invasive procedures. Checklists were piloted, rolled out, and monitored. Statistical Analysis Used: Plan-Do-Study-Act (PDSA) and Pareto principle were used for implementing the SSCL and analyzing the hurdles for implementation. Results: During this exercise, the checklist for the various invasive procedures was finalized after a brainstorming sessions with various stakeholders. All the checklists were developed with the help of the World Health Organization (WHO) surgical safety principle between March 2013 and May 2013. Sensitization and training for the checklist were done among all relevant staff. All the checklists were piloted for June 2013 and the compliance of checklist usage was monitored. The sample for audit was decided. The rates of compliance for various procedures during the pilot phase of the study were 50% for dental extractions, 60% for cataract surgeries, 35% for endoscopy, 20% for cystoscopy, 40% for cardiac catheterization procedures, and 0% for bronchoscopy procedures. Compliance reviewed and changes made based on feedback received from users for checklist finalization. After the intervention, compliance monitoring for the same sample size at a defined frequency is done and shared with relevant stakeholders when required. Conclusions: Implementation needs constant monitoring, retraining, and reinforcement until it becomes self-evident and accepted.
  4,355 1,194 1
A study on knowledge and awareness of standard precautions among health care workers at Nizam's institute of medical sciences Hyderabad
Sreenuvasu Mudedla, W Laxmi Tej, KT Reddy, M Sowribala
July-December 2014, 1(2):34-38
Aim: The aim was to assess the knowledge and awareness of standard precautions among heath care workers that is, doctors, nurses, and technicians. Setting and Design: A cross-sectional survey was conducted in September and October 2013 at Nizam's institute of medical sciences, Hyderabad. Materials and Methods: A 40-item questionnaire was provided to 180 health care workers including doctors, medical technicians and nurses to assess their knowledge and awareness of standard precautions under seven divisions namely general information on standard precautions, care of skin and hand washing, personal protective equipment (PPE), procedure for the safe handling and disposal of sharps, postexposure prophylaxis, bio medical waste and linen disposal, knowledge on blood borne and other pathogens. Statistical Analysis: Chi-square test has been used to compare the relevant groups. Results: It was observed that 96 (53.3%) respondents are very knowledgeable and 84 (46.7%) were somewhat knowledgeable. In the very knowledgeable category, there were 38 doctors, 24 nurses and 34 technicians. 48 (57.1%) males and 48 (50%) female respondents were found to be very knowledgeable. With respect to length of service, 21 (53.8%) respondents in 0-5 years of service category, 18 (60%) in 5-10 years category and 57 (48.7%) in >10 years category were found to be very knowledgeable. Conclusions: Knowledge of standard precautions was highest among doctors (63.3%), followed by technicians (56.6%) and nurses (40.0%). There is a significant difference in knowledge and awareness of standard precautions among studied health care professionals (P = 0.031). Knowledge and awareness of standard precautions did not vary significantly between males and females (P > 0.05). There is no significant difference in knowledge and awareness of standard precautions among groups, with respect to length of service (P > 0.05). The studied population was not very knowledgeable in division's namely PPE, sharps disposal and bio-medical waste disposal.
  4,689 795 1
Exploratory study on the knowledge and skill of critical care nurses on endotracheal suctioning
Sruthy T Varghese, KT Moly
January-June 2016, 3(1):13-19
Background and Objectives: A descriptive exploratory study to assess the knowledge and skill of critical care nurses on endotracheal (ET) suctioning was conducted in the eight Intensive Care Units of AIMS, Kochi. The objectives of the study were (1) to assess the knowledge of critical care nurses on ET suctioning, (2) to assess the clinical skill of critical care nurses in performing ET suctioning, and (3) to find out the correlation between knowledge and clinical skill of critical care nurses on ET suctioning. Materials and Methods: The sampling technique used was nonprobability convenience (n = 50). Results: Majority of the participants (70%) had an acceptable level of knowledge. Most of the participants (64%) had least acceptable level of knowledge on the actual suction event and 54% on postsuctioning practice. The nurses who had an acceptable level of skill in performing ET suctioning were 56% whereas skill in practices before suctioning was least acceptable in 86% of the nurses. A significant difference (P < 0.001) was obtained between the current practice observed and the best recommended practice on ET suctioning. The elements of ET suctioning which were not followed by majority of the nurses include auscultation of chest (2%), postsuctioning assessment (2%), wearing apron (6%), maintaining suction pressure (10%), reassuring the patient before (30%) and after suctioning (18%), hand washing before (42%) and after suctioning (28%), time of suction applied (36%), and maintaining the suction catheter's sterility (46%). Interpretation and Conclusion: Even though nurses had an acceptable level of knowledge and skill, inadequacies exist in the practice of various phases of ET suctioning. Hence, training on ET suctioning could be focused specifically to those phases.
  4,426 901 -
Analysis of a multi-centric pooled healthcare associated infection data from India: New insights
Sanjeev Singh, Murali Chakravarthy, Sharmila Sengupta, Neeta Munshi, Tency Jose, Vatsal Chaya
July-December 2014, 1(2):39-43
Aim: The aim of this study was to analyze the multi-center data of healthcare associated infections (HAIs) to assess the infection control (IC) scenario in India in context with Center for Disease Control (CDC)/National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) database. Materials and Methods: Four National Accreditation Board for Hospitals accredited hospitals contributed their raw data on HAIs-number of days and number of infections in all intensive care patients were obtained as per the CDC-NHSN definitions and formulae. Three major device related infections were considered for analysis based on the prevalence of HAIs and discussions with subject experts. All nodal champions from each hospital were trained and common data collection sheet for surveillance in accordance to CDC-NHSN was formed. The pooled means for HAI rates and average of the pooled means for all were calculated using data from them and compared with CDC/NHSN and INICC percentiles. Results: The Indian pooled mean HAI rates for all infections were above CDC/NHSN percentile threshold but below INICC percentile. Ventilator associated pneumonia was considered as a matter of prime concern, crossing P90 line of CDC/NHSN threshold. However, no HAI rate was in the limit of P25. Conclusion: Indian HAI rates were higher when mapped with CDC threshold. This suggests the requirement for more standardized and evidence based protocols to tackle the HAIs with an aim to achieve the benchmark within CDC/NHSN thresholds. However, the 4 hospitals have better HAI rates as compared to pooled INICC database.
  4,185 863 1
A survey of job satisfaction among nurses and its correlate in a tertiary healthcare in Northern Nigeria
Emmanuel Ugwa, Charity Ugwa
July-December 2014, 1(2):29-33
Background: This study was undertaken to assess the levels of job satisfaction and its correlate among nurses in Aminu Kano Teaching Hospital (AKTH); and to compare the levels of job satisfaction between senior and junior nurses. Materials and Methods: This was a cross-sectional study of senior and junior nurses working at various specialties in AKTH, Kano. Ethical clearance and informed consent were obtained. Questionnaires were used to obtain a response from 350 nurses in a five-point Likert scale. The data obtained were analyzed using SPSS version 16.0 statistical software. Descriptive statistics was used. Significant association of job satisfaction and sociodemographic variables was tested using the Chi-square test and Pearson' Coefficient of Correlation. Statistical significance was considered when P < 0.05. Result: The mean ages were 30.26 ± 4.76 and 40.19 ± 5.61 years for junior and senior nurses, respectively, and the difference was statistically significant, (P = 0.001). The mean number of dependents was higher (5 ± 2) for senior nurses compared to junior nurses (4 ± 2), but the difference was not statistically significant. Both age and number of dependents showed very weak positive correlations with job satisfaction. The average duration of service for senior nurses (9.45 ± 4.25 years) was higher than that of junior nurses (3.44 ± 2.00 years), and the difference was statistically significant (P = 0.0001). Most junior nurses had their promotion 4-7 years prior to the study (58.75%) compared to the senior nurses whose promotion was within the past 3 years (64.7%). Nurses in the two groups worked 7-9 h/day (84.3% and 85.3%). Duration of last promotion showed very weak positive correlation with job satisfaction. Conclusion: There are generally high levels of job satisfaction among nurses in AKTH compared with those report from other studies and this showed a very weak positive correlation with promotion. Job satisfaction may improve if nurses are promoted timely.
  3,841 1,183 1
Study to evaluate change of attitude toward acceptance of NABH guidelines: An intra-institutional experience
Mandeep , Naveen Chitkara, Sandeep Goel
July-December 2014, 1(2):52-55
Background and Objective: The next decade shall see a great change in the health care sector and there is a need for standardization of health care delivery at all levels, which at the moment is lacking in India. The standardization can come if we adopt some sort of uniform accreditation. For proper deliverance of health care, the role of medical staff is significant. This asks for an assessment on the attitude of medical staff toward accreditation and then the knowledge on accrediting standards. This study is conducted with the objectives to identify the attitude level of medical staff on accreditation, as well as their knowledge level on NABH standards. Research Methodology: The study was conducted on 10 doctors and 40 nurses of the hospital before and 6 months after the start of accreditation process in the hospital. Samples were selected by simple random method. A questionnaire was used to collect the information about the attitude and knowledge of medical staff about NABH accreditation. Results: The study revealed that medical staff had a positive attitude and improved knowledge about accreditation after 6 months working in a hospital on the way to NABH. The attitude reflected in their positive approach in managing patients under better work atmosphere thus, indirectly reflecting on the benefit to the society as whole. Conclusion: The sound knowledge and a positive attitude toward NABH accreditation among the medical staff are very important. And the same can be accomplished with proper training and good hospital environment.
  4,159 690 2
QCI - Medical laboratory program journey of quality in public medical laboratories": An experience though program evaluation
Bhupendra Kumar Rana, Narendra Shekhar Behera, Sujeeth B. Nair
January-June 2014, 1(1):7-11
Objective: Health being a subject of the state and Accreditation of Healthcare Organisations being a voluntary process, the Quality Council of India (QCI) through National Accreditation Board for Hospitals and Healthcare Providers is creating standards and promoting quality in healthcare. The Medical Laboratory Program, which is designed to improve the Quality of Medical Laboratories, is being implemented by both government and private Laboratories to ensure quality of test results. Materials and Methods: A small program Evaluation study was carried out over a period to understand the level of understanding, usefulness and feedback from the participating Laboratories regarding "QCI - Essential Standards for Medical Laboratories"1 Program. The data was collected and analysed from 55 participating laboratories. Results: The study findings indicated 100% strongly agree that, training programs conducted were really helpful, 98% stated that, this program was instrumental towards Patient Safety and improved the Quality Indicators of laboratory activities. Around 89% of the respondents strongly support the fact that "Educational Materials & technical Supports provided by Med-Lab Team were very useful & helpful to implement the standards" & this Program has helped to "achieve Quality Output with minimal effort & investment". Most of the respondents (4/5 th ) i.e. 80% of the respondents found that implementation of Med-Lab Program was easy & flexible. More than 80% of the respondents have felt either good, very good or excellent on all the parameters that have been spelt out regarding "Post-Implementation impact of Med-Lab Program on various quality Indicators. 53 labs (96%) are satisfied with results on post implementation of the Med-Lab Program and agreed to recommend this program to other labs as well. This is the first such study in India. The findings may be an eye opener for the labs and the state governments who haven't yet participated in the Med Lab Program.
  3,419 850 2
Criteria-based core privileging: Best form of privileging
Akash Sud
July-December 2015, 2(2):61-68
Hospitals are accountable and responsible for all activities & services provided by the individual healthcare providers within their premises. The primary objective of Credentialing & Privileging process is to ensure that hospital and healthcare providers provide services, which are appropriate in scope and quality of their practice. While credentialing involves obtaining, scrutinizing and verifying the qualifications, experience & professional standing of medical practitioners, to judge their competence, privileging is the right of a medical practitioner to provide specific medical care consistent with his/her training, experience and competency. Of the various methods of privileging, Criteria-based core privileging incorporates predefined criteria in conjunction with clinically realistic, well-defined core privileges. This is a scientific approach to privileging in which the privileges for each specialty are predefined and divided into two categories: a) Core Privileges: Privileges that a fully trained, entry-level medical practitioner is qualified to do in a particularly specialty on completing an approved training program. b) Specific (Additional/Non-Core Privileges): Procedures that go beyond the core that would require additional training and/or experience are covered by additional specific privileges. Practitioners who meet predefined criteria are eligible to apply for core privileges, and those who can document additional training and experience may request special (or noncore) privileges. Advantages of Criteria Based Core Privileging are: scientific approach with clearly defined criteria, consistency, and practicality with ease of operationalization. High attrition rates & frequent hiring of medical staff also makes Criteria Based Core Privileging the most suitable form of privileging for Indian Healthcare scenario.
  3,568 678 -
Identifying discharge process factors causing an increased length of stay
Meenal Kulkarni, Anil Parameshwar Pandit, Priyamvada Singh
January-June 2016, 3(1):39-42
Introduction: The purpose of continuous quality improvement programs is to improve health care by identifying problems, implementing and monitoring corrective action, and studying its effectiveness. Aim: The present study aims to find out the present length of stay (LOS) of inpatients at a superspeciality hospital. Objectives: 1. To study the existing system of discharge process of patients, 2. to find out the reasons for the delays, 3. To recommend suitable suggestions to reduce length of stay. Mehodology and Results: By considering the LOS of 128 random patients, 32 from each ward A, B, C, and D. The average LOS (ALOS) was found to be 5.69. Factors have been identified by studying the delays through time and motion study in the discharge process. Recommendations: Recommendations have been made for appropriate changes to be considered to reduce ALOS and bring it to 5.0 so that proper resource utilization occurs, and at the same time, there is an improvement in bed turnover rate and thereby in bed occupancy rates.
  3,124 744 -
Achieving quality in primary health care
Anil P Pandit, Meenal Kulkarni, Swati Sonik
July-December 2015, 2(2):37-40
This review article tries to provide an insight into how we can improve the quality of primary health-care services provided in a primary health center (PHC) setup. Primary health care is essential health care made universally accessible to individuals and acceptable to them through their full participation and at a cost that the community and the country can afford. Unlike the previous approaches (e.g. basic health services, integrated health care, and vertical health services) that depended upon taking health-care services to the doors of the people, primary health-care approach starts with the people themselves.
  1,942 1,332 -
Utility of sample rejection rate as a quality indicator in developing countries
Vibha Gupta, Gita Negi, Meena Harsh, Harish Chandra, Amit Agarwal, Vikas Shrivastava
January-June 2015, 2(1):30-35
Background: The present study aimed at assessing the sample rejection rate during the 1 st year of implementation of the quality management system in the laboratory of a tertiary care medical center in the developing world. Materials and Methods: Retrospective analysis of data relating to rejections of the request forms and samples sent for hematological and biochemistry investigations from inpatients departments after 1-year of implementation of laboratory management system (ISO 15189; 2007) was done. The mean rejection rate was calculated. It was compared with rejection rates reported by various laboratories. The criteria followed for rejection in our laboratory were compared with those laid down by laboratories in previous studies. Descriptive statistics was used in the study. Results: Of the 54,603 request forms and samples received during the study period, 3936 (7.2%) were rejected. Issues related to request forms and issues related to the sample, each accounted for nearly 50% rejections. Among the issues related to request from, the most common reason was "incomplete form" leading to 50% rejection. The most common reason for rejection of the sample was "clotted sample" (27.1%). When rejection rates as well as criteria followed by our laboratory were compared with other laboratories, it was found that 32 different criteria for rejections were followed across various laboratories. However, only one criterion (inadequate volume) was followed by all except one study (90%), suggesting a lack of uniformity over rejection criteria across studies. Conclusions: We found that the rejection rates among various laboratories in developing and developed countries differ. Moreover, the rates differ among various laboratories in developing countries. And the criteria that were followed for rejection differed across studies.
  2,628 401 -
Healthcare risk evaluation with failure mode and effect analysis in established of new dialysis unit
U Albert Anand, Ali Syed Asif, S Muhil, Linta Thomas
January-June 2015, 2(1):15-22
Introduction: Proactive prevention of medical errors is critical in medical practice. Root causes analysis is a conventional method used to deal with errors that result in an adverse event. Aim: The aim of this paper was the application of the failure mode and effects analysis (FMEA) tool used to evaluate the risks to prevent the infections and adverse treatment effect in dialysis for patients and it leads to improving the quality of care provided by Healthcare Organizations and to assure patients' safety. Materials and Methods: FMEA to hemodialysis unit and sequential steps in the FMEA process are explained. Assigned severity, occurrence, and detection scores for each failure mode and calculated the Risk Priority Numbers (RPNs). The RPN was calculated as the product of the three attributes: RPN = occurrence rating × severity rating × detectability rating. Statistical Analysis: Statistical evaluation of plan results was performed with a two-tailed Chi-square test. Results were considered statistically significant at P < 0.05. Results: The Technical Expert Panel analyzed failure modes causes, made recommendations and planned new control measures. After failure mode elimination or reduction, we find out the association of resulting RPN with severity scores, occurrence scores, and detection scores. Conclusions: FMEA has helped in the prospective evaluation of dialysis processes, determination of risks associated with dialysis care and development of solutions and preventive actions. Thus reduce the risk and improving the patient safety of the Dialysis Department.
  2,578 443 -
Awareness related to reporting of adverse drug reactions among health caregivers: A cross-sectional questionnaire survey
Nilesh Arjun Torwane, Sudhir Hongal, Abhishek Gouraha, Eshani Saxena, Kalpesh Chavan
January-June 2015, 2(1):23-29
Aim: The present cross-sectional questionnaire survey was conducted with an aim of assessing the knowledge, attitude, and practice (KAP) related to pharmacovigilance among the health-care professionals in a teaching hospital located in Central India region. Materials and Methods: To assess the demographic details of the health-care professionals, their KAPs toward pharmacovigilance and adverse drug reaction (ADR) reporting; a predesigned, structured, close-ended 18 item questionnaire was used. Results: A total of 392 questionnaires were distributed among the health-care professionals. It was found that only 38.01% health-care professionals comprising 54.43% medical, 38.01% nursing and 19.01% dental professionals were aware regarding the existence of pharmacovigilance program of India. While, only 40.56% health-care professionals felt that ADR monitoring center should be established in every hospital. Similarly, very few health-care professionals, that is, 6.12% have ever reported ADR to pharmacovigilance center. Conclusion: The results of our study indicate that the majority of the health-care professionals had a poor knowledge and attitude about pharmacovigilance. There was a huge gap between the ADR experienced, and ADR reported by the health-care professionals especially among dentist and nursing staff. It has been advised that the health-care professionals; especially dental and nursing, should be trained properly on ADR reporting to improve the current scenario in the pharmacovigilance program of the country.
  2,399 535 2
Public health measures to combat airborne infections in hospitals
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
January-June 2014, 1(1):18-19
  2,397 459 -
Quality in clinical research activities: Role of institution/clinical trial site
Pratibha Pereira
January-June 2015, 2(1):4-8
There is an increasing focus on having quality systems in place during the planning stages of clinical trials. Such systems require the development and implementation of standards for each step. Although this is not imposing something totally new on clinical research, a systematic approach will produce a more reliable and useful end product-high-quality data obtained without compromising the protection of human subjects' rights and welfare. A suggested quality system with standards for each step is addressed in this article. The organization measures and improves when necessary, compliance with organizational policies, procedures, and applicable laws; regulations, codes, and guidance. The organization also measures and improves when necessary, the quality, effectiveness, and efficiency of the clinical trial process to protect the research participant.
  2,211 480 1
New graduate nurses' transition from novice to competence: A step toward quality and safe nursing care delivery
Abanti Gopan
January-June 2015, 2(1):1-3
Nursing Administration globally faces the impact of high attrition of experienced nurses. The challenge of ensuring patient safety and maintaining optimum standards can be taken care of by implementing the preceptorship model and competency based skill development for new nurses easing their transition from novice to competent nurses.
  1,946 687 -
Zika virus disease: An obscure disease which became a public health emergency
Apexa B Patel, Advaita B Patel, Baldev V Patel
January-June 2016, 3(1):9-12
Zika virus remained in relative obscurity for many years, but within a period of just 1 year, it has spread into Brazil, Pacific Island, and throughout the Americas. Zika virus disease has become the fetal infectious disease which is associated with human birth defects and created such global havoc that the World Health Organization declared a public health emergency of international concern. This review summarizes the transmission, distribution, clinical features, diagnosis, prevention, and future perspectives of Zika virus disease.
  1,928 551 -
A retrospective analysis of the NABH feedback forms used for training purpose as a tool for continuous quality improvement
Prashant Paschal, KK Kalra, Bhupendra Kumar Rana
January-June 2016, 3(1):32-38
Introduction: Feedback is one of the crucial elements of learning and achievement, but its outcome can be either positive or negative. Drawing on findings from different trainings on Program On Implementation (POI) organized by NABH, this study reveals the extent to which effectiveness can be accurately measured. The study argues that the participants are in the best position to judge the effectiveness of feedback, but may not always recognize the benefit it provides. Aims and Objectives: The aim and objective of this study are: (1) To find out the effectiveness of the NABH training programs and efficiency of faculties related to its effect on learning, improvement, and achievement. (2) To find out ways to improve the NABH form related to delivery, content, and its appropriateness. Patients and Methods: All the feedback forms were collected from the participants after the successful completion of the program and then the interpretations and comments if any provided by them were viewed and analyzed. Statistical Analysis: Responses were analyzed using average percentage method which reflected the satisfaction level of participants as well as the appropriateness of NABH training (POI) programs. Results: The feedback forms obtained by the participants are analyzed in two ways. (1) Detailed analysis of feedback forms of all the programs together. (2) Program wise analysis. Conclusions: The overall conclusion of the feedback analysis was that NABH needs to take evaluation feedback much more seriously if they are to achieve the dual benefits of greater accountability and more effective learning.
  1,850 503 -
Knowledge levels of medical students about hand hygiene
Dattatreya Prabhakumar, Murali Chakravarthy, Shruthi Nayak, Rajathadri Hosur, Sumant Padgaonkar, Chidanannda Harivelam, Ashwin Bharadwaj
January-June 2016, 3(1):27-31
Introduction: Hand hygiene is one of the least expensive easy to train procedure which can sub substantially decrease hospital associated infections. Healthcare workers perhaps are the major contributors to health care associated infection by their non compliance to this simple practice. It is important that knowledge and training about this preventive measure be inculcated during the training of healthcare workers. Training of young medical students is undoubtedly an important pivot to ensure reduction in hospital associated infections. Aim: A survey regarding hand hygiene practices among medical students was conducted with an aim to find out the knowledge and practices of the students regarding hand hygiene during their interaction with patients and their routine hospital visits. Methods: An electronic survey using 'survey monkey' was conducted in a medical college in the city of Bengaluru to assess the knowledge levels of medical students. Medical students of all the years of education were included. Full fledged doctors were excluded from participation. Results: Our results suggest that knowledge regarding hand hygiene is sub-optimal among the students (40%) and the compliance is low (63%) as a consequence of non availability of hand rubs at various locations. Theoretical knowledge among the medical students was high. More than 70% knew that the gloves cannot be replacement of hand hygiene. But the other details of the procedure of hand hygiene, were not known to them. Only 44% of the respondents an-swered that 10 seconds contact time with an alcohol, 29% answered it as 20 seconds, 23% an-swered as 1 minute and 4% answered 3 seconds. These data suggest that the medical institu-tions must taken upon themselves to train the prospective doctors in this vital, life saving simple. Conclusion: The knowledge levels of medical students about hand hygiene is far below expecta-tions; the administrators should take upon themselves to include this topic in the educational curriculum.
  1,912 423 -
Evaluation of request forms received in blood bank and biochemistry laboratory in a teaching hospital in North India: A comparative study of preanalytical errors
Sonam Kansay, Minni Verma
January-June 2016, 3(1):20-26
Background: Clinical laboratories usually focus their attention on quality control methods and quality assessment programs in dealing with the analytical aspects of testing. However, quality in clinical laboratories cannot be assumed by merely focusing on analytical aspects only. Preanalytical processes are equally important for ensuring quality services since most of the laboratory errors occur in this phase thus influencing patient outcomes and cost. Objective: The aim of this study was to evaluate and compare the level of completion of request forms in blood bank (BB) and biochemistry (BC) laboratory of a teaching hospital in North India. Materials and Methods: A total of 3532 requisitions were received in BB and 18,410 in BC laboratory between November 2014 and April 2015. The information regarding incomplete/inappropriate requisitions and samples in both departments were recorded, compared, and analyzed. Results: The most common deficiency was the absence of clinical/provisional diagnosis among both the outpatient department (OPD) (50.7%) and inpatient department (IPD) (3.2%) request forms in BC. Doctor's name not mentioned in 1.1% of the OPD requisitions and platelet count not mentioned on 7.8% of platelet request forms in IPD requisitions were the most common deficiencies in BB. The only well-documented parameter was the patient's name. Maximum numbers of incomplete requests were received from medicine OPD's followed by Intensive Care Units, emergency and medicine wards. Conclusions: As laboratory data play a significant role in medical diagnosis, incorrect/incomplete data provided to the laboratory significantly affects the comments and successful outcome of the treatment that patient receives. Therefore, clinicians and paramedical staff should be trained to adequately fill all the required information into the request forms and appreciate its importance to patient's management. Furthermore, feedback/interpretation of significant results by the laboratory physicians to the clinicians should be emphasized.
  1,714 319 -
Improvement in the postoperative visual outcome following cataract surgeries by reducing the average residual spherical error
Suman Shree Ramaswamy, Sri Ganesh, Kalpesh H Jain, Deepa Giliyar Krishna
January-June 2015, 2(1):9-14
Background and Context: Lean Six Sigma (LSS) in healthcare was conceived as a national demonstration project by Quality Council of India to launch and manage their continuous quality improvement programs. Aims and Objectives: To explore the potential benefits of applying LSS principles in the clinical domain to enhance patient satisfaction and as a clinical performance indicator. Materials and Methods: Through the supplier, inputs, process, outputs and customers (SIPOC) were identified. On the supplier side there were surgical coordinators, surgeon, optometrists and medical store. Input and process are important in that patient selects lens based on an estimate, intra ocular lens and refraction as analyzed by an optometrist. The define, measure, analyze, improve and control (DMAIC) cycle was used in taking the project further. Results: The residual refractive error was reduced from 0.35D to 0.33D and eventually to 0.25D (3 sigma). Project helped the hospital in terms of tangible and intangible benefits. Number of cataract surgeries surged by 17.75%, giving rise to an increase in financial accrual from rupees 11.5 Cr to 13.5 Cr. Conclusion: A control plan was deployed through visual display of the process flow in out-patient department and monthly review of visual outcomes during clinical audit using average, standard deviation and sigma presented as key performance indicators, to ensure no drift in performance post the closure of the project.
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NABH Training Programmes

January-June 2014, 1(1):20-20
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