Antibiotic Policy

Emergence of antibiotic resistance in pathogens is a global threat to human health and a matter of grave public health concern. Resistance of micro-organisms towards an antibiotic renders it ineffective in curing any disease caused by those organisms. Some micro-organisms develops resistance to a wide range of antibiotics including even to newer and more potent antibiotics such as Carbapenems, making treatment of patient difficult, costly and sometimes impossible.  Due to this antibiotic resistant micro-organisms leads to increased mortality, morbidity and healthcare costs.  

A major reason of emergence of antibiotic resistant strains of micro-organism is indiscriminate and irrational use of antibiotics. It is estimated 50% of antibiotic usage in Indian hospitals are inappropriate and irrational. Hence, there is an urgent need that hospitals formulate and implement appropriate Antibiotic Policy that ensures rational use of antibiotics and prevent any indiscriminate use.  This post describes how should be a hospital’s Antibiotic Policy and what should it contain.

Antibiotic Policy serves as a guideline for doctors to decide which antibiotic shall be used for treating a specific infectious condition. It also states practices that must be followed while using Antibiotics on patients. The antibiotic policy must ideally be developed collaboratively. Pharmacotherapeutic committee or the Infection control committee can take a lead role in formulation of this policy, with inputs from all clinical departments.

An antibiotic policy must include following sections

Code red alert system in hospital

Code red is an emergency code which is used to alert employee and fire-fighting team in case a fire or possibility of fire is detected within the hospital premise. Unexpected fire is considered as an emergency situation and code red system is used to urgently activate a set of action intended to control the fire and prevent any major mishap. The system may slightly vary from hospital to hospital, depending upon how the hospital is structured and organized. Here is a code red system that can be used as a reference by hospitals. (Other codes - Code Blue, Code Pink)

Code Pink system in hospital

Code pink is an emergency code which is used to activate a set of action in case a child/baby is missing from the ward/room. As there is a fair possibility that the missing child/baby is abducted, it is considered as an emergency situation and a predefined set of actions are taken on an urgent basis to safeguard the missing child/baby. The entire system of coordination, communications, decisions and actions followed during such situation is called as a code pink system. (Also check Code Blue, Code Red)

Depending upon how a hospital is structured and organized the code pink system may vary from one hospital to another. The objective, however, remains the same, i.e. ‘Find the missing child as soon as possible’. The objective should be achieved in a manner that other critical activities in the hospital do not get hampered and that unnecessary scare or commotion of public be avoided. An illustrative code pink system has been described below. This can be taken as a reference for developing code pink system by various hospitals. 

Critical findings in Imaging – Policy and procedure

Imaging and Medical laboratory frequently come across critical results or finding of a patient’s diagnostic tests which requires immediate intervention from the doctor to bring the patient out of the criticality. Hence, a hospital must have a policy and procedure in place for identification and quick communication of such results. This posts describes critical findings in imaging (Check critical test results in laboratory –policy and procedure).

Standard Precautions for Infection Control in Hospitals

Standard precautions are the basic infection control practices which must be adhered to while caring any patient in hospital. If fully implemented, standard precaution can drastically reduce the risk of infection to healthcare providers and patients. They are minimum level of precaution and may not be sufficient for special situations which requires special precautions. As these precautions should be taken in all kinds of patient care process they are also called as universal precautions.

Elements of standards precautions are as follows

      

Critical test results in laboratory – Policy and process for identification and communication

Medical laboratory and Imaging frequently come across critical results or finding of a patient’s diagnostic tests which requires immediate intervention from the doctor to bring the patient out of the criticality. Hence, a hospital must have a policy and procedure in place for identification and quick communication of such results. This posts describes critical test results in medical laboratory (Check critical findings in imaging–policy and procedure). 

Critical test results in laboratory are the findings in the lab tests of a patient which indicates that condition of the patient may be critical or even life-threatening.  Such results, when found shall urgently be informed to the treating physician of the patient so that required interventions can be carried out on time and patient can be saved from any possible adversities. To be able to do so, a hospital needs to have a well-developed process of ‘identification and urgent communication of critical test results in lab’. The process should be able to achieve following objectives.

1. Critical test results gets identified within the lab as soon as the test results are obtained
2. No critical test results gets missed from identification
3. Non-critical test results do not get identified as critical
4. The treating doctor of the concerned patients gets to know about the critical test result on an urgent basis

Any lapses in identification and/or communication of critical test results to concerned doctor may lead to severe consequences for patient, including death. Hence, in addition to the process, hospitals must have a policy that mandates compliance to this process by laboratory staff. Following points shall be taken into consideration for policy and system on identification and communication of critical test results in laboratory.

Uniform Care Policy for Hospitals

Healthcare organizations treats patients with different background (such as religion, economic class, literacy level, race, language etc.) and in different settings (such as general ward, sharing room, single room and deluxe room). They are expected to not to discriminate between their patients and provide them a uniform medical care per their clinical requirement. To ensure this, hospitals must have a policy that specifies what constitutes uniform care and what practices must be followed to ensure that patients are not discriminated on the basis of their background or category of their accommodation. The essential part of the policy is provision of uniform medical care and does not applies to those services and facilities that are non-clinical in nature.

Admission of patient: Policy and Procedure

Admission of patient is one of the main process followed in any hospital. It is the first step in providing healthcare to a patient as an in-patient. By admitting a patient, hospital undertakes a high level of responsibility for the care and well-being of the patient and hence it is essential to have relevant policy and procedure for admission in place to avoid any problems later on. It also ensures that the patients are admitted uniformly irrespective of their ethnicity, religion, caste, gender, financial class etc. This post describes relevant points that should be considered while formulating a policy and procedure of admission. (Also read - Registration of patient - Policy and Procedure)

Admission Policy

Registration of patients in hospital – Policy and Procedure

Registration is a process by which a patient’s name and identity are enrolled into the records of the hospital. This is required in order to provide services of the hospital to the patient and to keep a track of various services that are availed by each patient. This is also the first step to generate a medical record of the patient in which all medical details of the patient are documented.

Registration is done with the following objectives
1. To collect basic details of patient related to identity, contacts and demography
2. To create a unique identification number for each and every patient
3. To enter patient’s name in the hospital’s system
4. To generate a record of the patient for documenting further processes related to him/her

To ensure that registration process is carried out smoothly and its objectives are met, a hospital must have a well-defined and documented policy and procedure for carrying out registration of patients. The guidelines given below can help in formulating a relevant policy and procedure for registration.

Employee rights in hospitals

While patients’ rights are an important element to be ensured by healthcare organizations, employees who work in hospitals are also entitled to certain rights. These rights are largely based on our constitution and legal system and apply to all employees irrespective of individual contract that they may have with the employer. Like all other legal requirements applicable to a hospital, the employing organization is also responsible to ensure that employees rights are fulfilled and protected. It is important that all employees are aware of their rights so that same can be ensured. Below is the list of employee rights.

Managing patients during non-availability of beds

One of the common issues that most of the popular hospitals face is that they frequently run out of their bed capacity and find it difficult to accommodate new patients seeking admission. This creates a problem for both, patients and the hospital, and if not handled properly can lead to patient’s dissatisfaction, inadequate care of patient or even losing the patient to other hospitals. It is prudent for hospitals to have the policy to address such situations so that negative impact of unavailability of beds can be prevented. This post describes a sample policy on how can hospitals manage such situations effectively.

POLICY: In case the bed is not available for admitting a new patient following policy shall be followed. Responsibility for implementing this shall be with the admissions staff under the supervision of manager patient care. Understanding of how hospital services are priced is important to address this issue.

Patient identification Policy and Procedure

One of the most common causes of medical errors in healthcare is the incorrect identification of patients. The error can lead to potentially serious consequences such as surgery of a wrong patient or transfusion of wrong blood into a patient. It is vital that hospitals must put into place an effective policy and procedure for identifying a patient. Below are the internationally recommended practices for accurately identifying a patient.

Safe transfer of unstable patient from hospital

One of the critical task that hospitals have to frequently undertake is to transfer a critically ill or unstable patient from one hospital to another. Transfer of such patient are likely to induce various physiological changes, which may adversely affect the health of patient even leading up-to death. Hence, such transfers shall be undertaken with great care and as per evidenced-based guidelines. Following are the key elements and guidelines for safely executing transfer for an unstable patient.

Rape victim's examination at hospital

38,947 rape cases were registered in India in 2016 (data from National Crime Records Bureau). That translates into 106 rape cases every-day or about 4-5 rapes every hour. The data also shows that incidence of rapes is on rise. On the other hand, the conviction rate in rape cases is just 25.5%, as of 2016, which is a reduction from 29.4% of the previous years. With such low conviction rate, the heinous crime of rape is difficult to be contained. One of the biggest reason for low conviction rate is the insufficiency of evidence due to poor quality of medical examination of rape victim. Many doctors and hospitals are not updated and prepared for proper examination of rape victim. Doctors and hospitals can play a big role in increasing the conviction rate in rape cases, thus reducing the number of rape cases occurring in our country. This post is intended to make hospitals aware about how to properly handle the medical examination of rape victims. The detailed protocol of medical examination, as issued by Government of India can be accessed here.

Restraining a patient

Hospitals commonly use restraint on patients as a mean to prevent injury or harm to self or others. However, if appropriate care is not taken, restraint itself can cause serious injuries and even deaths to patients. Also, as restraint is an act of restricting an individual’s freedom of movement, generally against his/her will, it can be considered as an infringement of patient’s rights, if used without strong and valid reason. It is for these reasons, use of restraint on a patient must be guided by a comprehensive policy, that takes care of safety and rights of patients.

The guidelines given below are intended to serve as a reference for hospitals for making their policy on restraint of patients.

Licenses, permits and other legal documents required to open and operate a hospital

There are many regulatory clearances required to establish and operate a hospital. The management of hospital must be aware about all such legal documents, requirements and process to obtain the same. Here is a comprehensive list of applicable legal documents with their brief description and relevant links. Some of these may not be applicable to specific hospitals, depending upon the scope of service, type of infrastructure, location etc.

1. Legal documents required for establishing the business of hospital

Tracer survey method – A great tool for achieving operational excellence in hospital

Providing healthcare to a patient involves multiple departments, professionals and functions. This increases the operational complexity and leads to a variety of problems such as errors, inefficiencies, and even harm to patients. To address such problems, hospitals often follow best practices and standards, recommended by national/international bodies and accreditation programmes. While these standards and practices are well researched, whether or not it improves operational efficiency, depends upon how well have they been implemented or the level of compliance. There are various methods of assessing compliance; such as audits, reviews, surveillance, patients' feedback, indicators and gemba walk. However, one problem with these compliance assessment methods, is that most of them assess each specific function independent of others and fail to assess, how is it translating into actual patient care.

Tracer survey is a unique methodology as it is an integrated assessment of compliance to standards and practices that were required to be followed during care of a particular patient. It gives a comprehensive understanding of hospital’s operational performance and effectiveness in translating standards into actual patient care. Tracer survey is one of the prime survey method used by The Joint Commission in their on-site survey for accreditation.

So how can hospital managers can make good use of this method in achieving operational excellence for their organization? Here is a step by step guide for using Tracer methodology.

Disaster Preparedness checklist for hospitals

Disaster can strike any time and can cause severe catastrophe to us. While it is very difficult to prevent disasters, it is certainly possible to be prepared for facing and handling the disaster situation in a way that ensures minimum damage to life, limb and property. Hospitals are organization that remains full of people round the clock and any disaster affecting hospital can cause heavy damage to life. More-soever, people struck by disaster needs medical care which are provided by hospitals. This makes it very important for hospitals to be prepared for all kind of disasters that are likely in the area where the hospital is located.

Here is a checklist of things that hospitals must be prepared with.

End-of-life care: policies and procedures for hospitals

Patients who are in their end stage of life have unique problems. While they suffer with disease symptoms and treatment side-effects they also face psycho-social, cultural and spiritual issues related to the process of dying. The family of a dying patient suffers with grief and needs help in coping with it. The emotions and sensitivities surrounding a dying patient is significantly higher than other patients. These distinctiveness of a dying patient makes it important for hospitals to understand their unique needs and develop policies and practices to fulfill their rights. Following paragraphs explains some of these needs and how can hospitals help in addressing them.

Organizing policy and procedure documents

There are many functions and operations that are performed in a hospital. Each function and operations are guided by the hospital’s policy on it and is carried out as per the specified procedure. For the sake of standardization, it is important that these policies and procedures are available in written for staff to refer whenever required.  The written policies and procedures are often referred as policies and procedures documents. There is a long list of documents that are required in a hospital and such can differ in its size, form and applicability. This creates problems with managing these documents and leads to frequent errors. What is required is a systematic way of organizing these documents errors and confusions could be avoided. This post describes how to organize policy and procedure documents for an efficient management.