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1.  ORIGINAL ARTICLE
Policies and Procedures for Sound-alike and Look-alike Medications
Sheetal Singh, Angel R Singh
[Year:2017] [Month:January-June] [Volume:5 ] [Number:1] [Pages:53] [Pages No:15-20] [No of Hits : 619]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1071 | FREE

ABSTRACT

The sound-alike and look-alike (SALA) drug is one of the most common causes of medication error and is of fear globally. Thus, the probability for error due to confusing drug names is very high. The SALA drug names have become a significant challenge to pharmacists, nurses, patients, and doctors . With thousands of drugs currently on the market, the probability for error is significant. The purpose of this article is to formulate a policy that would help in minimizing medication errors arising with the use of SALA medications.

Keywords: Medication errors, Medication management, Patient safety, SALA medications

How to cite this article: Singh S, Singh AR. Policies and Procedures for Sound-alike and Look-alike Medications. Int J Res Foundation Hosp Healthc Adm 2017;5(1):15-20.

Source of support: Nil

Conflict of interest: None

 
2.  ORIGINAL RESEARCH
Patient Satisfaction in Tertiary Private Hospitals in Najran, Kingdom of Saudi Arabia
Jordan H Llego, Mohammad O Al Shirah
[Year:2017] [Month:January-June] [Volume:5 ] [Number:1] [Pages:53] [Pages No:42-46] [No of Hits : 532]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1074 | FREE

ABSTRACT

Aim: This study is aimed to assess the level of satisfaction of patients in tertiary private hospitals in Najran, Kingdom of Saudi Arabia.

Materials and methods: This study used descriptive crosssectional design through a survey questionnaire.

Results: A great majority (57%) of respondents are male. Almost half (46.7%) of the respondents are 26 to 35 years old, some (30.3%) are more than 35 years old. The majority (54.5%) of hospitalized patients are married. Some (35.8%) of them reached the secondary level and some (31.5%) completed college. A great majority (57.6%) of the respondents’ salary was below 5,000 SR. A great majority pay their hospitalization by themselves (60.6%). Mean scores revealed: For facilities, the mean was 4.12, standard deviation (SD) = 0.85. For general services, the mean was = 4.13, SD= 0.77. The physician services scored mean = 4.06, SD= 0.88. The highest level of satisfaction according to mean is nursing services with mean= 4.22, SD= 0.80 and the lowest among the variables is convenience with mean= 4.05, SD= 0.84. The overall level of patient satisfaction with the services they received indicated by the mean is 3.91, SD= 1.1.

Conclusion: Researchers conclude that patients catered by the private tertiary hospitals in Najran Saudi Arabia are more of males, at middle adulthood, and are married who reached the secondary level and have an income of below 5,000 SR and have no health insurance. The level of satisfaction of patients in the private tertiary hospitals is satisfactory and that nursing service has the highest satisfaction level, which is very satisfactory.

Clinical significance: The findings of this study are beneficial to the success of the organization. A patient who is satisfied will spread his experience to other people. A satisfied patient will also equate to return of investment. Meeting satisfaction of patients will also decrease the risk of malpractice lawsuits.

Keywords: Malpractice lawsuits, Patient satisfaction, Tertiary private hospitals.

How to cite this article: Llego JH, Al Shirah MO. Patient Satisfaction in Tertiary Private Hospitals in Najran, Kingdom of Saudi Arabia. Int J Res Foundation Hosp Healthc Adm 2017;5(1):42-46.

Source of support: Nil

Conflict of interest: Noen

 
3.  ORIGINAL ARTICLE
Comparative Analysis of Cost of Biomedical Waste Management in Rural India
Bryal D’souza, Arun MS, Bijoy Johnson
[Year:2016] [Month:January-June] [Volume:4 ] [Number:1] [Pages:50] [Pages No:11-15] [No of Hits : 1433]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1053 | FREE

ABSTRACT

Introduction: The quantum of waste generated from medical care and activities is a global matter of concern. Improper management of biomedical waste (BMW) has a grave health impact on the community, health care professionals, and the environment.1 It is mandatory by law that every medical organization that generates waste should have a system, process, and resources in place for segregating BMW within the organization for proper disposal. The present article deals with the understanding of various costs associated in BMW management process that will help the health care organization to prioritize their spending and focus on areas that require spending to achieve compliance in process of BMW management.

Materials and methods: Descriptive cross-sectional study was carried out, to study the compliance of BMW management at three different hospitals with respect to Bio-Medical Waste (Management and Handling) Rules, 2011. A retrospective study was conducted to analyze cost data for a 1-year time period. Cost involved in BMW management was analyzed and classified as capital and recurring costs. The study was undertaken in Udupi taluk, and the taluk comprises 11 hospitals (1 Government and 10 private hospitals). The hospitals were selected using convenient sampling as taking permission to conduct the study was difficult. Only three hospitals were permitted to carry out the study.

Results and discussion: Compliance was found to be better in accredited hospital than in nonaccredited hospital. This could be attributed to strict adherence to standard operating procedures and regular training of staff. Cost involved in BMW management was analyzed as capital and recurring costs. Since most of the hospital outsource final disposal, capital costs are significantly less compared to recurring costs. Among the recurring costs, maximum expenditure is on consumables like color-coded bags. Cost per bed per day for handling BMW was calculated and it was found to be higher in smaller hospitals.

Keywords: Biomedical waste, Cost analysis, Health care waste, Medical waste.

How to cite this article: Bryal D’souza, Arun MS, Johnson B. Comparative Analysis of Cost of Biomedical Waste Management in Rural India. Int J Res Foundation Hosp Healthc Adm 2016;4(1):11-15.

Source of support: Nil

Conflict of interest: None

 
4.  ORIGINAL ARTICLE
A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior
VK Tadia, R Ahlawat, SK Arya, DK Sharma
[Year:2016] [Month:January-June] [Volume:4 ] [Number:1] [Pages:50] [Pages No:31-34] [No of Hits : 1322]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1057 | FREE

ABSTRACT

It is generally believed that big changes can be brought about by big interventions. Sometimes, small interventions also can show spectacular results. This case describes the impact of simple intervention, audit and feedback on change in the behavior of clinicians. In this case, the impact of simple intervention in the form of passive feedback has been documented. All the prescriptions received in pharmacy during the period of study were scrutinized for specific prescription errors. An overall error rate of 0.12% was observed in phase 1 of the study, which was reduced to 0.04% during phase 2 of the study after implementation of the intervention, which further dropped to zero during phase 3. It was concluded that a simple audit and feedback nudged the recipients of the feedback to modify their behavior.

Keywords: Audit, Feedback, Nudge, Passive feedback, Prescription behaviour.

How to cite this article: Tadia VK, Ahlawat R, Arya SK, Sharma DK. A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior. Int J Res Foundation Hosp Health Adm 2016;4(1):31-34.

Source of support: Nil

Conflict of interest: None

 
5.  ORIGINAL ARTICLE
Why switch to Rental? Costing of Laundry Services at an Apex Tertiary Care Hospital from the View of Outsourcing based on Rental Linen Management Services
VK Tadia, SK Gupta, SK Arya, A Lathwal, K Jain, R Ahlawat
[Year:2016] [Month:July-December] [Volume:4 ] [Number:2] [Pages:66] [Pages No:79-88] [No of Hits : 1297]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1064 | FREE

ABSTRACT

Introduction: Modern hospitals are matrix organizations with a high investment in terms of capital, labor, and resources. It is imperative for the hospital administration to provide right material of right quality at the right time. Hospitals that set up in-house laundry operations generally make the decision without thoroughly identifying and accounting for total linen and laundry costs. Now evidence has emerged that hospitals that outsource were seeing improved linen utilization rates. If proper and clean linen is not provided, this can result in patient dissatisfaction. Further, innovations in laundry equipment have led to tremendous increases in efficacy. So, there is a need to ascertain the cost incurred in providing linen and laundry services so as to gauge the plausibility of transitioning to outsourcing-based models.

Aims and objectives: To study the cost incurred in providing linen and laundry services at an apex tertiary care hospital and to evaluate outsourcing model based on rental linen management.

Materials and methods: A descriptive, cross-sectional, retrospective, record-based study was conducted during a period of 1 month from March 1, 2016 to March 31, 2016.

Observations: The quantity of monthly linen washed in Dr Rajendra Prasad Centre was found to be 22,465 kg. The monthly laundry expenditure in Dr RP Centre was Rs. 1,415,295. The linen procurement expenditure per month at Dr RP Centre was Rs. 419,386. So total expenditure on linen and laundry per month at Dr RP Centre was Rs. 1,834,681. Thus, cost/kg (with inclusion of linen cost) was Rs. 82.

Discussion and conclusion: The rate quoted by a leading vendor to supply washed, sterilized linen to the hospital was Rs. 55 per kg. Since the expenditure incurred per kg at Dr RP Centre was Rs. 82, this amounted to a saving of around Rs. 27 per kg. It would mean saving of around Rs. 606,555 per month and Rs. 7,278,660 per annum. So, it was recommended that rental linen management services may be hired for Dr RP Centre after taking care of functional, operational, and strategic contingency.

How to cite this article: Tadia VK, Gupta SK, Arya SK, Lathwal A, Jain K, Ahlawat R. Why switch to Rental? Costing of Laundry Services at an Apex Tertiary Care Hospital from the View of Outsourcing based on Rental Linen Management Services. Int J Res Foundation Hosp Healthc Adm 2016;4(2):79-88.

Source of support: Nil

Conflict of interest: None

 
6.  ORIGINAL ARTICLE
Incidence of Patient Identification Errors observed before Medication and Procedure/Intervention.
Ritwik Chawla, Saakshi Kaushik
[Year:2016] [Month:July-December] [Volume:4 ] [Number:2] [Pages:66] [Pages No:100-106] [No of Hits : 871]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1066 | FREE

ABSTRACT

Objectives: To identify the number of individuals for whom double identification check was done before administering medication and before procedure/intervention, as per Continual Quality Improvement 3j indicator of National Accreditation Board of Hospitals (4th edition) and hospital policy.

Materials and methods: The study was a concurrent, observational recording of the study population which included doctors/ surgeons, nurses, and/or technicians before administration of any medication and before beginning of any procedure/intervention. The observations were recorded on a prepared checklist to find the compliance of incidence of patients’ double identification.

Results: A total of 34 observations were recorded before administering medication to a patient. In 18 cases, wristbands were not being used, and identification details were incorrect in 4 cases. Of 34 cases, identifiers were illegible in 6 cases. The major area where the error was high was noncompliance to verbal confirmation of identity (ID) and checking it from the patient’s file. Out of 34 observations before a procedure/intervention, 9 errors were identified in cases where the ID band was not used for verification, and identification details on the band were illegible in 5 cases. In six cases, the patient’s name was not verbally confirmed with the patient or carer. Furthermore, in 10 cases, verbally confirmed name was not checked with the patient’s file. Out of 34 cases, double identification was not done in 13 cases.

Conclusion: Many nurses, doctors, and technicians in clinical settings do not verify patient ID before performing a task, resulting in more than one-third of staff not conforming themselves with the double identification procedure. The study also showed that over three-fourths of the total invasive procedures are compliant to double identification. On the contrary, noninvasive procedures showed less than one-fourth compliance to double identification.

Keywords: Band, Compliance, Double identification, Identification, National Accreditation Board for hospitals and health care providers, Wristband.

How to cite this article: Chawla R, Kaushik S. Incidence of Patient Identification Errors observed before Medication and Procedure/Intervention. Int J Res Foundation Hosp Healthc Adm 2016;4(2):100-106.

Source of support: Nil

Conflict of interest: None

 
7.  ORIGINAL ARTICLE
Lead Time in Drug Procurement: A Study of Tertiary Care Teaching Hospital of North India
H Anand, V Siddharth, V Goyal, VK Koushal
[Year:2016] [Month:January-June] [Volume:4 ] [Number:1] [Pages:50] [Pages No:16-19] [No of Hits : 721]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1054 | FREE

ABSTRACT

Pharmaceutical procurement is a complex process that involves many steps, agencies, and manufacturers. Procurement lead time is defined as the time required to acquire the supplies and services and then placing them in the hands of the user. This study was done to study the lead time in drugs procurement at Government Medical College and Hospital, Chandigarh. It was aimed at calculating the average lead time in the procurement of drugs for year 2009-2010 in Pharmacy Department. Observational study along with retrospective record analysis was done to calculate the average internal and external lead time. Standardized format was used to retrieve data from the procurement records. Average lead time between the preparation of indent and receipt of drugs was observed to be 162 days, out of which 117 days (71%) accounted for internal lead time and external lead time was 47 days (29%). Internal lead time was approximately four times that of external lead time. Various reasons were noted for longer duration of internal lead time and every effort should be made to bring it down to the minimum, so as to ensure the availability of the right medicine in the right quantity, in the right time at the right place.

Keywords: Drug Procurement, Lead time, Pharmacy.

How to cite this article: Anand H, Siddharth V, Goyal V, Koushal VK. Lead Time in Drug Procurement: A Study of Tertiary Care Teaching Hospital of North India. Int J Res Foundation Hosp Healthc Adm 2016;4(1):16-19.

Source of support: Nil

Conflict of interest: None

 
8.  ORIGINAL ARTICLE
Prescriptions Written in Capital Letters in Compliance with National Accreditation Board of Hospital Standards
Saakshi Kaushik, Ritwik Chawla, Shalini Bhalla
[Year:2016] [Month:July-December] [Volume:4 ] [Number:2] [Pages:66] [Pages No:89-99] [No of Hits : 614]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1065 | FREE

ABSTRACT

Objectives: (1) To study compliance rate of prescriptions written in capital letters according to continual quality improvement (CQI) 3j indicator of National Accreditation Board of Hospital (NABH) (4th edition). (2) To study compliance to doctors and patient detail, legibility of prescriptions, strength and dose, frequency, route of administration, dosage form, abbreviation for drug, allergy detail, and leading zeros in the dose.

Materials and methods: Convenient randomly selected Medication Administration Record (MAR) sheets from wards and intensive care units (ICUs) were studied. One hundred thirty-two prescriptions were identified for errors pertaining to doctor’s details, patient’s details, and medication details. Errors were captured on a prepared checklist for a period of 11 days. Results were analyzed by Microsoft Excel.

Results: Results were expressed in percentages for wards and ICUs respectively. Six hundred twenty four and 652 drugs were observed in wards and ICUs respectively. Doctor’s name was present in 79.6 and 83.3%. Out of 55 prescriptions in both wards and ICUs, patient’s name compliance was 94.5 and 96.4% and patient’s weight was 83.6 and 81.8% respectively. Compliance for drugs in capital was 98 and 100% for wards and ICUs respectively. Details pertaining to medication were also found out subsequently on various parameters.

Conclusion: The study revealed that the level of completeness of handwritten prescriptions was low in terms of doctor’s details and patient’s weight, which indicates unsatisfactory commitment of the prescribers to follow the hospital guidelines of prescribing. Majority of prescriptions showed compliance to medication written in capital but still the compliance to clear and legible prescriptions is three-fourths of the total prescriptions.

Keywords: Accreditation, Compliance, Medication administration record, NABH, Prescriptions, Quality.

How to cite this article: Kaushik S, Chawla R, Bhalla S. Prescriptions Written in Capital Letters in Compliance with National Accreditation Board of Hospital Standards. Int J Res Foundation Hosp Healthc Adm 2016;4(2):89-99.

Source of support: Nil

Conflict of interest: None

 
9.  ORIGINAL ARTICLE
How Prepared are Hospital Employees for Internal Fire Disasters? A Study of an Indian Hospital
Kasturi Shukla, Priyadarshini Chandrashekhar, Shweta Mehta
[Year:2016] [Month:January-June] [Volume:4 ] [Number:1] [Pages:50] [Pages No:20-24] [No of Hits : 588]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1055 | FREE

ABSTRACT

Introduction: In case of internal disasters, such as fire in hospitals, health services to the community are severely hampered with the additional morbidity of victims, such as employees and visitors present when the disaster strikes. Risk assessment and fire preparedness are most crucial proactive measures to prevent fire disasters and minimize the loss in a hospital; however, scanty studies are available on this topic.

Materials and methods: This cross-sectional study was conducted at a multispecialty hospital in Mumbai, Maharashtra (India), during March-April 2014. Fire-Safety Preparedness Framework (FSPF) was designed with four domains (risk and vulnerability assessment, response mechanisms and strategies, preparedness plan and information management) for evaluation of fire safety preparedness of hospital employees. Baseline variables were summarized; instrument was tested for reliability using Cronbach’s alpha and content validity through review by experts. The number of correct responses for each question was further analyzed across the type of employee.

Results: The instrument showed high reliability (Cronbach’s alpha = 0.89, p-value ≤ 0.01) and content validity. A total of 207 employees (mean age 32 ± 8.3 years, 63% females) consented and participated in the study. Out of 20 questions, awareness was high (≥ 90%) only for three questions from “Response mechanism and strategies” domain. For the remaining questions, awareness was moderate to low. The awareness varied highly with the type of employee.

Conclusion: The FSPF is a reliable tool for application in the Indian context for hospital employees. Disaster preparedness training and drill need to involve employees from all departments as awareness levels varied highly with type of employee.

Keywords: Disaster preparedness, Fire safety, Hospital.

How to cite this article: Shukla K, Chandrashekhar P, Mehta S. How Prepared are Hospital Employees for Internal Fire Disasters? A Study of an Indian Hospital. Int J Res Foundation Hospc Health Adm 2016;4(1):20-24.

Source of support: Nil

Conflict of interest: None

 
10.  ORIGINAL ARTICLE
To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center
Madhav Madhusudan Singh, Shakti Kumar Gupta, YK Gupta, DK Sharma, Aarti Kapil
[Year:2015] [Month:January-June] [Volume:3 ] [Number:1] [Pages:56] [Pages No:13-24] [No of Hits : 7631]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1031 | FREE

ABSTRACT

Introduction: As antimicrobial resistance continues to increase and new antimicrobial development stagnates, antimicrobial stewardship programs are being implemented worldwide. The goal of antimicrobial stewardship is to optimize antimicrobial therapy with maximal impact on subsequent development of resistance. Thirty to fifty percent of hospitalized patients receive antimicrobial therapy. Previous data suggest that inappropriate use results in higher mortality rates, longer lengths of stay, and increased medical costs. Antimicrobial stewardship programs (ASPs) reduce the improper use of antimicrobials and improve patient safety. Despite increased awareness about the benefits of these programs, few medical and surgical ASPs exist and fewer comprehensive studies evaluate their effects.

Aim: To study the antimicrobial stewardship program in a large tertiary care teaching center.

Objectives

  • To study the antibiotic prescribing practices in a tertiary care government hospital
  • To compare the antibiotic prescribing practices with the standard guidelines available with the hospital
  • To make recommendation if any for rational use of antibiotics.

Materials and methods

  • Review of literature
  • Prospective study of 15 days in selected general medicine and general surgery ward in which 5 to 6 reading will be taken in to know the antibiotic prescribed to patients.
  • Retrospective study of 15 days for study of patient records to know the antibiotic prescribed to patients.
  • Interaction with faculty and senior residents of general medicine and surgery to know about the pattern of infection and antibiotic prescription.
  • Interaction with microbiology department and their faculty to know the microbial resistance pattern and possible suggestion which need to be incorporated in antibiotic Stewardship program.

Results: The present study on antibiotic prescribing practices was undertaken in a super specialty hospital at New Delhi. A sample size of 100 case records was considered. There is no such stewardship program in tertiary care hospital, although it was demanded in various forum and meetings. There are no recommendations available either for patients of renal failure or other such compromised metabolic or immune states in the form of written antibiotic stewardship program of the hospital. The appropriateness of antibiotics prescribed in the case records was examined in light of the antibiotic stewardship program of the hospital. It was found that the overall adherence to antibiotic stewardship program was nil as no existing antibiotic stewardship program is exiting in this hospital. Gautum Dey in a study conducted at this hospital in New Delhi found that in 40.7% preoperative cases and 60.3% postoperative cases two or more than two antibiotics were given. The author has also commented that there was no evidence of adhering to antibiotic stewardship program or utilising culture and sensitivity reports to guide the therapy. The data obtained from the present study on further analysis has shown that in seven cases, the antibiotics prescribed were inadequate in terms of dose and duration. Thus resulting in an apparently lower cost of treatment than what was recommended by the antibiotic stewardship program of the hospital. Although such inappropriate prescription results in increased chances of antibiotic resistance, the immediate or short-term effects are not very conclusive. It is observed that there were 26 (26%) cases in medical and 12 (12%) cases in surgery disciplines in which the initial and final diagnosis was different. Uncertainty about the final diagnosis promotes empirical prescribing practices.

Conclusion: Antimicrobial stewards are a prominent part of local and national efforts to contain and reverse antimicrobial resistance. A range of intervention options is available with varying levels of resources and can yield substantial improvements in morbidity, mortality, quality of care, and cost. The cost of delivering such programs is dwarfed by the benefits and provides an opportunity for hospital epidemiologists to garner support. This suggests that antimicrobial management programs belong to the rarefied group of truly cost saving quality improvement initiatives. Considering the enormous implications of antibiotic resistance, it is necessary that we act in haste, lest our wonder drugs and magic bullets become ineffectual. Future systems promise greater integration and analysis of data, facilitated delivery of information to the clinician, and rapid and expert decision support that will optimize patient outcomes while minimizing antimicrobial resistance. They may also offer our best hope for avoiding an ‘Antibiotic armageddon’. In addition, the ASP plays an integral role in providing guidance to clinicians and ensures that the appropriate antimicrobial agents are used.

Keywords: Antibiotic, Stewardship program, Antimicrobial resistance, Rational use.

How to cite this article: Singh MM, Gupta SK, Gupta YK, Sharma DK, Kapil A. To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center. Int J Res Foundation Hosp Healthc Adm 2015;3(1):13-24.

Source of support: Nil

Conflict of interest: None

 
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