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G B Pant Institute of Post-Graduate

Medical Education & Research

(GIPMER )

Why this program ?

• To welcome new employees to GIPMER

• Prepare you for their new role.

• It provides an introduction to the working environment at GIPMER and the set-up of the employee within the organisation.employee within the organisation.

• It informs you of our expectations

• It provides you an opportunity to ask questions: clear any doubts and understand the workplace better

Enable the new starter to

become a useful, integrated member of the team

GBPH – GIPMER …

…the journey…the journey

The inception of G B Pant Hospital

Foundation stone laid in October 1961

Commissioned in April 1964

By Prime Minister Pt Jawaharlal Nehru

GIPMER : Institution Profile

• Foundation stone laid in October 1961

• Commissioned in April 1964 by the then Prime Minister Pt Jawaharlal Nehru

• Tertiary care centre of NCT of Delhi with speciality departments of Cardiac, Neuro, and Gastrosciencesdepartments of Cardiac, Neuro, and Gastrosciencesand Psychiatry and associated departments

• 1964 - GB Pant Hospital; 2014-15 – GIPMER

• 229 beds to over 700

• OPD attendance 35000 (1970) to > 7.5 lakhs (2015)

How G B Pant has grown

over the years :

Silver Jubilee 1989

2010 Common Wealth Games

Golden Jubilee 2014

Golden Jubilee :

Coffee table Book Release

Golden Jubilee : Stamp Release

100

10000

1000000

8522

590

229

189669

7029

350

1756

752809

29244

714

4586

year 1964

year 1989

year 2015

1

100

OPDIPD

No of bedsOperation

156year 2015

Massive Increase In Volume :

In Geometric Proportions !!

Our GIPMER complex

• Various blocks– Academic block :

• Auditorium

• Conference Hall

• Various department offices

• Labs• Labs

• Library

– A block : Director office and administration, Wards and OTs

– B block : Amir Chand Block – Wards, OTs and ICUs

– C Block : Arrhythmia centre & cardiac facilities

– D block : Labs, OPD , Private wards, General ICU, Blood bank, Sample collection

GIPMER : An overview

A Block

General Ward

O T – ICU complexes: Neurosurgery and Gastrosurgery

Epilepsy monitoring unit

B-Block – Amir Chand Block

GF – Red Alert area;

MRI facility

Wards, OTs

Operation theaters: inside view

A-block and Amir Chand Block

D-Block

Heart attack and Brain attack Unit

Neurology and Cardiology

D Block

Indoor Nursing facilities

Blood Bank /

Microbiology/Biochemistry/Hematopathology and

Cytopathology

(C-Block)

All cardiology facilities including

2 digital cath labs: C Block

Academic block

Seminar

room, Auditorium, L

abs, Departmental

offices

Academic block : Ground floor

• Seminar Room and Auditorium

• Stores

• EM Lab facility

Academic block : 1st floor

Cardiology

• Faculty strength – 15

• DM Cardiology

• Daily Morning OPD – 4th Floor-D block

• 4 special clinics in afternoon:• Pacemaker Clinic

Cardiac Surgery - CTVS


• MCh CTVS

• Daily OPD

• Special OPD for children

• 96 beds (24 for ICU)• Pacemaker Clinic

• Hypertension Clinic

• Paediatric Cardiology;

• Interventional Cardiology

• Round the clock cardiac cathlab

• Echocardiography – C block arrhythmia centre

• 102 beds,22- ICU and paeds

• Wards- Amir Chandblock, Arrhythmia block

• 96 beds (24 for ICU)

• Ward – A block

• OT and ICUs in B block

• Surgeries – CABG, valvular

surgeries, mediastinal tumors,

• Vascular surgery including

coronary and carotid and

aortic

Academic block : 2nd floor

Gastroenterology


• DM Gastroenterology

• Daily Morning OPD –2nd Floor-D block

• Endoscopy room - 3rd floor B block

Gastro-Intestinal

Surgery


• MCh GI Surgery

• Daily Morning OPD –2nd Floor-D block

• Gall Bladder Clinic

• Liver Transplant Unit-12 bedsblock

• ERCP – 3rd floor B block

• EUS – 2nd floor D block

• Labs- R No 205 Acad blk• Celiac disease

• Breath tests

• 50 general beds (8 ICU)

• Wards- Amir Chand, A block

•

• Liver Transplant Unit-12 beds

• 3 OTs A block and B block

• 72 general beds (30 ICU)- B Block

• Wards- Amir Chand block, A block

• GB surgery, Whipples, Liver resections, Colorectal, gastro-esophageal surgeries

Academic block : 3nd floor

Microbiology

• Faculty strength - 5

• Academic Block: bacteriology

• D Block: • Bacteriology,

• Mycobacteriology & IF lab

• Serology

Pathology


• Academic block

– Histopathology Lab R No 319

– Frozen sections R No322

– Immunopathology Lab R No • Serology

• Hospital infection Control

• Mycology

• Mycobacteriology

• Virology

• R No 125, Emergency Lab

• Sample collectionD Block: 9-4 pmAcademic Block: 9am-4 pmEmergency lab: 4pm-9 am

– Immunopathology Lab R No

332 – IHC, IF, FISH

– EM Lab, Molecular Lab - GF

• D-Block

– Haematology

– Cytology, FNAC

– Urine analysis

– Molecular Lab

Academic block : 4th floor

Library

• > 6500 Books

• Journals till Dec 2015

• Reading room, computer

Biochemistry


• 24x7 tests available

• Routine biochemistry: LFT, KFT, Lipid profile, Blood Sugar

• Hormonal Assays- TFT, pituitary • Reading room, computer

facility with internet

access, photocopy facility

• Library card required

• Issue period – 2 weeks

• Timing 9am-4pm

• Reading room outside main

library

• Hormonal Assays- TFT, pituitary hormone, adrenal profile

• Coagulation profile

• Bone Markers-Ca, Phosphorus, VitD, PTH, Magnesium

• Vit B12, Iron studies

• Drug assay, tumor markers

• Fluid Biochemistry and Urine for microalbumin etc.


Neurology


• Daily OPD – D Block 3rd Floor

• CNS Infection Clinic

• Epilepsy Clinic

• Nerve Muscle Clinic

Neurosurgery


• 83 general beds (22 ICU, 12-high dependency)

• Ward 3,4 – A block, ICU-16,17• Nerve Muscle Clinic

• Behavioural Neurology Clinic

• Movement Disorder Clinic

• Stroke Clinic

• Dept of Physiotherapy

• EEG, EMG Labs

• Wards 1,4,5 in A Block

• ICU- A-block

• 6-Modular OTs – A block

• Tumors –brain, spinal, aneurysms, malformations, endoscopic and endovascular procedures, spinal surgery, skull base surgery, epilepsy surgery, stereotactic procedures, Ozone nucleolysis


Psychiatry


• Daily OPD

• Child and adolescent psychiatry clinic

• Juvenile and adult De-addiction

Anaesthesiology

• 20 faculty posts

• 12 OTs

• General ICU, services provided in CCU, endoscopy • Juvenile and adult De-addiction

clinic

• Modified ECT facility and alcohol de-addiction group counseling

• 36 beds, Ward-2 A-block – 5 juvenile de-addiction beds

• MD Psychiatry program

• Training for BSc Nursing, PGD in Geriatric Medicine

• Certification of mentally disabled

provided in CCU, endoscopy room, ECT , MRI/CT, suites

• PAC Clinic

• Pain clinic

• Red alert area

• ACLS training lab

• CSSD and pipeline services

D- Block : Floor-wise distribution

• Ground floor : Help Desk : Senior citizens, physically handicapped, VIPs ( MP / MLAs)

• First Floor : – Sample collection : Path, Micro, Biochemistry, Serology

– Laboratories

– Economically Weaker Section helpdesk– Economically Weaker Section helpdesk

• Second Floor :– Occupational Therapy

– Physiotherapy

• OPDs : 2nd floor – 4th Floor

• 3rd Floor : OPD in charge

• 4th : Room No 419 : Pre-Anaesthesia-Clinic & Pain Clinic

D- Block : Key departments

Radiology Department

Ground Floor


• X-Ray, USG, CT Scan, Colourdoppler – 24 hour facility

• USG guided FNAC

Blood Bank

First Floor

• Incharge – Dr N R Laskar

• Donor Screening Blood grouping, Blood collection, cross matching

• Elisa testing for Transfusion • Barium swallow, Ba

meal, Barium enema

• IVP, PTC, Sinogram

• Therapeutic procedures : biliarydrainage, stenting, drainage of abscess, hydatid cyst ablation, RFA of liver tumours

• Elisa testing for Transfusion transmittted diseases (HIV, HCV, HbsAg, VDRL & MP)

• Blood component preparation:

• Platelet rich plasma, platelet concentrate, Packed red blood cells, fresh frozen plasma, cryoprecipitate

• Donor Apheresis

• Blood & Blood components issue

MCh/DM. ALUMNI

SUBJECT STARTED YR NO.OF SEATS

IN YEAR

2016

TOTAL NO.

ENROLLED TILL

2016

First Alumni

CARDIOLOGY 1973 7 185 Ramesh arora

NEUROLOGY 1976 6 118 Jayaram SR

CTVS 1977 6 118 BS MurthyCTVS 1977 6 118 BS Murthy

GASTRO 1983 3 102 Nirmal Km.

N Surgery 1983 6 121 RC Misra

GIS 1992 3 55 Puneet dhar

Gross total 31 699

MD/DNB alumni

SUBJECTS STARTING YEAR NO. of seats 2016/

Total enrolled

First Alumni

Psychiatry MD 1983 1/ 3 (68) HP Jhingan/Jaswal

Radiology MD

DNB

1984-1993

1999

1

2 (32)

Praveen Gulati

Amit sharma

Pathology MD,PHD 1983-2003 (14) Meera SikkaPathology MD,PHD 1983-2003 (14) Meera Sikka

Cardiac Anaes DNB 2014 1 / (22) Ashish Gandhi

Microbiology

MD,PHD

1983-2003 14+6 (22) Sunil Gupta

Biochemistry PHD 4 Anita Fotedar

Total 162 Appx.

Staff Strength

Staff Strength

Faculty 106

Medical Officers 21

Residents 347Residents 347

Nursing Staff 1090

Technical Staff 384

Others 821

Not all heroes wear Not all heroes wear Not all heroes wear Not all heroes wear Not all heroes wear Not all heroes wear Not all heroes wear Not all heroes wear

capes…capes…capes…capes…capes…capes…capes…capes…

… some wear Lab coats !… some wear Lab coats !… some wear Lab coats !… some wear Lab coats !… some wear Lab coats !… some wear Lab coats !… some wear Lab coats !… some wear Lab coats !

Technical staff

Nursing Staff

Hospital Karamcharis

Conduct In The Hospital

• General conduct

• Communication

• Documentation

White coat/uniform

• The white coat originated in scientific laboratories

• Adopted as the standard of dress by physicians in the late 19th century 19th century

• Advantages : – ease of recognition

– need for carrying medical items

– Carry reference books

– Mobile phones!!

– “When all else fails, you can simply look in your pockets”

• ‘Keep them clean.’

• Short length of the white coat worn by medical worn by medical students and the full length ones worn by most physicians

Mandatory to where white coat and/or

carry hospital ID card

Punctuality !!

• “Punctuality is not just limited to arriving at a

place at right time, it is also about taking

actions at right time.”

– Amit Kalantri– Amit Kalantri

Punctuality

• Timings: As per your department

• 9am-4pm, 8am-2pm, 2pm-8pm, 8pm-8am

• Handover responsibilities

LATE IS UNACCEPTABLE

Key Issues

Communication Skills

• Verbal Communication

53

• Written Communication :

Documentation

Key Issues

• Communication Skills

• Clinical Documentation

54

• Interdepartmental consults

• Role of Emergency

Consultant on Call

Key Communication Skills

• Make a personal

connection

55

• Empathy

• Reflective listening

• Agenda setting

Communication Matters

• Health outcomes

• Diagnostic accuracy

• Adherence or concordance

• Patient satisfaction

56

• Patient satisfaction

• Clinician satisfaction

• Complaints and litigation

Effective Doctor-Patient Communication Importance

• Accurate diagnosis.

• Enhancing patient compliance to treatment

plans. plans.

• Contribute: doctor clinical compt & self-

assurance.

• Contributing to patient satisfaction.

• Contributing to cost and resource

effectiveness by preventing unnecessary.

Core communication skills:

• Doctor-patient interpersonal skills. • Doctor-patient interpersonal skills.

• Information gathering skills.

• Information giving skills.

Advanced communication skills

• Skills for motivating

patient adherence to

treatment plans. treatment plans.

• Skills for specific

situations.

Core Communication Skills

• Creating an appropriate

environment

• Greeting others.

Doctor-patient interpersonal skills

• Greeting others.

• Empathy.

• Showing respect and interest.

• Showing warmth and support.

• Using appropriate language.

a) Appropriate balance of open to closed questions:

Open question:

• To achieve information.

• To allow patients the freedom of response.

• To establish an atmosphere of two-way communication.

Information gathering skills

• To establish an atmosphere of two-way communication.

Closed questions:

• To achieve specific information/ Limited choice of response

b) Silence:

• To allow time for the patient to collect his thoughts.

• To assess levels of anxiety.

• Clarifying the information given to the

patient.

• Active listening: To show that the

Information gathering skills

therapist is attending closely the patient.

• Sequencing of events.

• Directing the flow of information.

• Summarizing.

• Providing clear and simple information.

• Using specific advice with concrete

examples.

Information giving skills:

examples.

• Pushing important things first.

• Using repetition (restatement).

Clinical Documentation

“If it’s not documented in the medical record then it

didn’t happen.”

The medical record belongs to the patient.

Documentation

Documentation is a form of communication.

It should be done timely. It is impt NOT to avoid or

shy away from documenting in the medical record.

Documenting is a critical component to the delivery

of healthcare.of healthcare.

• The record is a legal

document so understand

that what you write is

Documentation

that what you write is

memorialized permanently.

• What you don’t write is

questioned forever.

Why Document?

• Ensure continuity of care:

• Plan and evaluate a patient’s

treatment

• Create a permanent record for

future care future care

• Database to evaluate effectiveness

of treatment

• Facilitate research

• Recollect a memory and/or

justify/defend care provided.

Take a Note: Tips for Documentation

To help protect against an allegation of

falsifying a medical record:

• Date, time, and sign every entry• Date, time, and sign every entry

• Make entries immed/soon after care is given

• Write legibly

• Be thorough, accurate, and objective

• Only used approved abbreviations

• Documentation is only as valuable as the

legibility of the note. If a note is not readable

due to penmanship or articulation then it

Take a Note: Tips for Documentation

due to penmanship or articulation then it

serves no purpose and can do more damage.

• The first thing done in court is to enlarge the

medical record and have the author of given

note read it.

Finally…...

Document intelligently and clearly !!

Interdepartmental Coordination and

communication

Holistic Approach

Challenges and Choices

3 inter-departmental challenges that affect the patient

care

• Workflow:

– ineffective inter-departmental interactions:

Clinical-non clinical and clinical-clinical

• Ineffective information handoffs

• Ineffectiveness of current information technologies

ID coordination: Practical tips

• Write a clear Note: need and urgency of Ref.

• Communicate: if needed on phone

• Cooperate whenever feasible: Avoid • Cooperate whenever feasible: Avoid

shrugging off: its waste of time and resource

and hampers patient care .

• Don’t hesitate to contact your senior if

needed.

Emergency Consultant on Call

The Balancing Act

Role: Emergency Call Duty

• Provide direct senior clinical input into serious/complex cases out-with the expertise serious/complex cases out-with the expertise of other hospital teams

• Provide telephone advice on clinical, medico-legal and ethical issues.

Elaborate Role

• To provide senior clinical leadership to the ED

• Providing

– direct clinical care to individual patients

– the supervision and support of doctors in training in – the supervision and support of doctors in training in

EM and other specialties

– a close working relationship with Departmental and

Hospital management teams to ensure safe systems

and processes are in place for all patients attending

with emergent and urgent conditions.

EM consultant: Not needed?

• Should not be recalled to hospital solely to deal • Should not be recalled to hospital solely to deal

with a build up of less serious cases

• Must not be expected to make up for any deficit

in staffing or other resource.

Consent Form

Not merely another document to sign

• Information to the patient

OR

• Its for self defense…

DIAGNOSIS CONSENT SPECIAL MENTION

CRANIOTOMY Shaving /Cutting bone CRANIECTOMY /

PRESERVATION of bone in

ABD.

VP Shunt Brain- hematoma/migration

Abdomen-

Perforation/obstruction

Device related-

Obstruction/migration/infecti

ons/

Device may be kept life long

Delayed problems

Multiple Revisions

Glioma Bleeding/meningitis/neurologi Not curative..Glioma Bleeding/meningitis/neurologi

cal deficits Hemiplegia/speech

dysfunction/

Not curative..

Bx/ Subtotal removal

Recurrences always..

Life expectations poor

R/T and CT in post op..

Spine surgery with implants Neurological deficits may

worsen/bladder bowel

involvement

Implant failures

Mal-positions ???

ANEURYSM Clipping /coiling SAH is a dynamic ongoing

event,, successful procedure is

to stop rebleed ONLY and …..

Death Summary

A Death Summary contains a subset of the normal Discharge Summary headings. Key differences include the following:

• Discharge Date will be replaced by Date Expired or Date of Death.or Date of Death.

• Discharge Diagnoses will be replaced by Final Diagnoses.

• Cause of Death may be dictated as an explicit heading.

It’s common for a death summary to contain only Final Diagnoses and Hospital Course sections.

Documentation

• Inform Police MLC cases…

• Inform Hospital for Notifying disease

• Inform Organ Donation Committee

• Check and fill Death Forms carefully • Check and fill Death Forms carefully

• Complete notes

• Save investigations and preserve for records

later

• Attend fast rather than delay

• If more than one calls, give priority

• Always write your name and contact no legibly on the consultations attended

Working at GIPMER : Managing Interdepartmental Consultations

the consultations attended

• In case of likely delay inform

• Inform the consultant in case of critical / expert advice situations

• Once seen, it should be a part of your routine to follow up the cases in your rounds

Role of consultant call on duty

• Inform and seek opinion for all critical

admissions

• VIP referrals and staff admissions

• In case of conflict situations• In case of conflict situations

• In the morning next day do a briefing of your

duty

• Wear white coat

• Punctuality

• Courteous in behaviour

• Write legibly

• Prescription : Need to be careful

Working At GIPMER :

Our Expectations From Residents In OPD

• Prescription : Need to be careful – Only Generic Drugs

– In capitals

– Drugs as per EDL

• Enter the investigation results on OPD sheet

• Signature & Stamp / Name in Capitals

• White coat

• Be present at place of work at inform sister / JR in case you are leaving for calls etc

• Write your name & contact number on the board / make it available in the ward

• Keep your duty rooms neat & tidy

Working At GIPMER :

Our Expectations From Residents While

On Ward Duty

• Keep your duty rooms neat & tidy

• Handover on completion of duty

• Inform the consultant on call about all the critical events handled during duty hours

• Avoid conflicts and confrontations with patient attendants & staff

• In case of un-resolved issues seek immediate help from CMO on duty and consultation from Consultant on Call

• In case of security concerns : inform CMO and security in-charge

• Diagnostic tests

• Screening tests

• Monitoring tests

Tests should not be performed unless the

Working at GIPMER :

Seeking investigations

Tests should not be performed unless the

expected benefit exceeds the expected risks

Consent form may be required for certain tests

Critical reporting information

When sending sample to the Lab:

Label specimens properly : It helps

1. Name of the patient

2. Age and gender

3. CR No. /OPD no MANDATORY

4. Ward and Bed No.

5. Clinical specimen type (wherever applicable)

6. Date and time of collection

7. Send sample immediately/on schedule

91

Filling forms

•Form should include at least:–Name

–OPD/CR No

–Age and sex

–Date

–Referring doctor

•At least two of these “identifiers are required to match” before •At least two of these “identifiers are required to match” before issuing report

•Except in blood bank – all identifiers should match

•Handwriting – legible/ use CAPITALS if required

•Any important or urgent requisition should be highlighted :Time of collection for Emergency samples

•Relevant clinical details

Where and how samples are to be sent

Sample How Where

Histopathology – biopsy/surgical

specimen

In 10% formalin Room 319/320

Academic Block

Histopathology – Frozen** section Plain Room 322 Pathology

Department

Collection centre for OPD patients – D Block 1st floor, Room 125

Haemogram (CBC, ESR, platelets, PS) 2 mL in EDTA vacutainer, for

ESR\1.8 mL in Black

vacutainer

Room 130 D Block

Urine for Routine In clean vial Room 125A D block

FNAC/ sample of FNA/fluid for

cytology

In clean vial Room 131 – D block

Urine for active sediment In a clean vial Room 131 – D block

Tests for autoimmune profile Red top plain vacutainer Room 332 Academic

Block

Where and how samples are to be sent

Sample How Where

Serological tests In plain vial except for HIV

ELISA in EDTA vial

Room no 119 D Block

Blood culture 5 ml in conventional blood

culture bottle

8-10 ml in Bactec bottles

Room no 308

Room no 127 D block

Pus, respiratory secretions, drain fluids Sterile culture tube Room no 308Pus, respiratory secretions, drain fluids

& fluids from sterile sites for bacterial

& fungal culture

Sterile culture tube Room no 308

Academic block

Urine and Tb culture Sterile culture bottle Room no 127 D block

Stool sample for microscopy & culture Clean container Room no 127 D block

Routine biochemistry Plain Red topped vacutainer Room 129 D Block

Blood Sugar Grey sodium fluoride

vacutainer

Room 129 D Block

Coagulation profile (PT/INR) Light Blue topped Na citrate Room 129 D Block

Grievance redressal

• Grievances often encountered :

– A – long queues

– B – non-availability of drugs

• Key role of concerned HOD as first step to

grievance redressal

Managing conflicts

beyond office hours

• Role of Emergency CMO : No 9718599007

Accounts & Administrative

RequirementsRequirements

Procedure for release of

First Salary of an Employee

� An employee on his joining the Institute, one is required to submit the followings for processing the payment of first Salary:

• ECS form

• Photocopy of Administrative Order taking him/her on the Strength of the Institute

• Photocopy of Administrative Order taking him/her on the Strength of the Institute

• Status of his residential accommodation

• Photocopy of Pan Card of the employee

• Photocopy of cancelled cheque

• LPC in case of employee joing or transfer from other department

Procedure For Reimbursement Of

Medical Bills

• For reimbursement of Medical Claim by an employee, the followings are required:

• Prescribed form as duly filled

• Photo copy of Health card.

• Photo copy of OPD card

• Original bills • Original bills

Reimbursement Of Medical Bills

Procedure For Availing Leaves

• Entitlement :

– Casual leave

– Earned leave

– Medical leave– Medical leave

• Leave encashment procedure

Extension of tenure

• Work & Conduct report from HOD

• Application / Covering letter forwarded by

HOD

• Give at least ~ 2 weeks in advance• Give at least ~ 2 weeks in advance

Absent without intimation

• Verbal warning

• Seek explanation in writing

• If repeated, extension may not be possible

• Absent report to hospital administration to • Absent report to hospital administration to

initiate disciplinary proceedings

Patient Safety And Hand HygienePatient Safety And Hand Hygiene

What is Patient Safety ?

Patient safety can be defined as the

‘prevention of errors and adverse effects

to patients associated with healthcare’to patients associated with healthcare’

- WHO

In India : Today

The Need for ‘Better Health Care’ is on the rise

&

‘Safety During Patient Care’ is a Normal Expectation

GIPMER is No Exception

What the patient looks for ?

It isn’t just a question of finding a GOOD, RELIABLE DOCTOR

But

Also finding the

Healthcare System that is SAFE

• Patient safety is a serious global public health issue. Estimates show that in developed countries as many as one in 10 patients is harmed while receiving hospital care.

• At any given time, 1.4 million people worldwide • At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals

• Of every hundred hospitalized patients at any given time:– 7 in developed and

– 10 in developing countries will acquire Health Care-associated Infections (HAI)

Dr Ashish Jha, Professor Of Health Policy And Management

Harvard School Of Public Health

(Times of India September 21, 2013)

National Board of Hospitals and Healthcare Providers,

India : February 2014

• Even after tremendous growth of the healthcare industry in India, there are as many as 98,000 patients succumbing to death every year due to medical errors.

• More than 20 per cent could have led a comfortable life if not for that one gross medical negligence.

• Age Group :– 37 per cent patients were children below 15 years of age – 37 per cent patients were children below 15 years of age

– 11 per cent were senior citizens with perfect health conditions.

• Of these, only 20-27 per cent approached the consumer court for redress. – While 12 percent withdrew midway due to the tedious process and time

taken for action,

– 2 per cent hung on to that slim chance of getting something out of the hospital.

– Only 3 big cases of compensation have been awarded to hapless relatives of patients since 2010

Pre Hospital PhasePre Hospital Phase

Chain of Health Care System

In In -- Hospital PhaseHospital Phase

Outcome of Hospitalization: Miracle <---------------------------------> Tragedy

Best Outcome : Miracle

On Admission : GCS 3/15

On Discharge : GCS 15/15

Always expect this to happen to allAlways expect this to happen to all

Worst Outcome : Tragedy

On Admission : GCS 15/ 15

On Discharge : GCS 3/15

Outcome of Hospitalization : Miracle <--------------------------------> Tragedy

Never expect this should happen

JCI Patient Safety Goals : 2016JCI Patient Safety Goals : 2016A Quick Overview & it’s relevance in NACC

Will discuss these in due course

Goals : From Six to Seven

• Using two patient identifiers : e.g. Name & Date of Birth NOT including patient’s room or location as identifier

• Before administering medications, blood, or blood products

• Before taking blood and other specimens for clinical testing

NPSG 1 : Identify patient correctly

• Before taking blood and other specimens for clinical testing

• Before providing treatments and procedures

• Policies and procedures support consistent practice in all situations and locations

http://www.si.mahidol.ac.th/th/division/soqd/admin/news_files/285_18_2.pdf

Peri-operative period : Special concerns

Establishing Identity of unconscious

patients is essential for patient safety

NPSG 2 : Improve staff communication

The most common cause of medical errors is

miscommunications


Unconscious / altered consciousness

patients need special precautions

Get important test results to the right staff person on

time.

NPSG 2 : Improve staff communication

• FIVE RIGHTS :

Right Drug, Right Patient, Right Dose, Right Time, Right Route.

• Label all medications, color coding

• Maintain and communicate accurate patient medication

information

• Standardized packaging and presentation

NPSG 3 : Use medicines safely

• Standardized packaging and presentation

• Take extra care with patients who take medicines to thin their

blood.

• Record and pass along correct information about a patient’s

medicines.


Unconscious / altered consciousness patients

More vulnerable

Need special precaution

NPSG 4 : Use Alarm Systems Safely

Make improvements to ensure

that alarms on medical equipment that alarms on medical equipment

are heard and responded to on time.

As of January 1, 2016

establish policies and procedures for managing the alarms

• Clinically appropriate settings for alarm signals

• When alarm signals can be disabled ?

• When alarm parameters can be changed ?

• Who in the organization has the authority to set alarm parameters ?

NPSG 4 : Use Alarm Systems Safely

• Who in the organization has the authority to set alarm parameters ?

• Who in the organization has the authority to change alarm parameters

• Who in the organization has the authority to set alarm parameters

to “off”

• Monitoring and responding to alarm signals

• Checking individual alarm signals for accurate settings, proper operation,

and detectability

NPSG 5 : Prevent Infection

• Use the hand cleaning guidelines from the Centers for Disease Control (CDC) or the World Health Organization (WHO).

• Use proven guidelines to prevent :

– infections that are difficult to treat.

– infection of the blood from central lines.

– infection after surgery.

– infections of the urinary tract that are caused by catheters.

Hand washing : Mainstay to avoid infections

Will be informed by the next speaker

how its done !!

NPSG 6 : Identify patient safety risks

RISK OF FALL

• Implements a process for the initial assessment of patients for fall risk

• Measures are implemented to reduce fall risk for those assessed to be at risk.

• Measures are monitored for results, both successful fall • Measures are monitored for results, both successful fall injury reduction and any unintended related consequences

SUICIDE

• Find out which patients are most likely to try to commit suicide.


Unconscious , agitated patients or those with motor deficit

more prone to Injury & fall

NPSG 7: Prevent mistakes in surgery

• Make sure that the correct surgery is done on the

correct patient and at the correct place on the

patient’s body.

• Mark the correct place on the patient’s body where


the surgery is to be done.

• Pause before the surgery to make sure that a mistake

is not being made.

High Compliance Of A Practice :

Established as Culture

WeNeed to develop

Patient Safety Culturein Indian Healthcare System

&

definitely in GIPMER

What Is Culture?

“Culture is what people do

when no one is looking!”when no one is looking!”-Herb Kelleher, Former CEO Southwest Airlines

Patient Safety Culture: A Better System

Safer

Better Education

Better Design

Better IT Adoption

Safer Care

Design

Better Stories

Better Team

Adoption

ISNACC has to contribute in all these areas

Working at GIPMER :

Hand Hygiene PracticesHand Hygiene Practices

Hospital acquired infections

• Infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting

• Significance:– Functional disability & emotional stress – Functional disability & emotional stress

– Increased length of stay

– 8th most common cause of death

– HAI rate: 5-25%

– Development of multi drug resistance

– Medicolegal and economic implication

• 1/3 of HAI preventable

Elements of standard precautions

• Hand hygiene

• Personal protective equipment:

gloves, gowns, masks, goggles and face shields

• Respiratory hygiene or cough etiquette

• Safe injection practices

• Environmental cleaning and disinfection

5 moments of hand washing

Handwash or handrub??

• Rub hands for hand hygiene

• Wash hands when visibly soiled

• Right time

• Right way• Right way

• Hand wash: 40-60 sec

• Hand rub: 20-30 sec

Hand hygiene compliance globally <40%Pittet and Boyce. Lancet Infectious Diseases 2001

Working at GIPMER :

BMW management

Biomedical Waste Management

Definition – “Bio Medical Waste” is the waste

which is generated during diagnosis, testing,

treatment, immunization or in research

activities or in the production /testing of

biological products from Humans or Animalsbiological products from Humans or Animals

Waste Segregation Most crucial step

Done at the point of generation

Hospital waste can be broadly be defined

into two categories

• Risk Waste

• Infectious Waste

• Pathological Waste

• Sharps

• Non – Risk Waste

• presents no greater risk, than Normal domestic garbage waste from a home

• Sharps

• Pharmaceutical Waste

• Chemical Waste

• Radioactive Waste

waste from a home i.e.

• - Paper

• - Packaging

• - Food Waste etc.

Yellow Bags

� Human/ animal anatomical waste,

� All infectious, Non sharp, Non plastic waste

� Soiled waste swabs , dressings, bandages,

� Pathological waste, � Pathological waste,

� Drapes linen etc

� Expired/ Discarded medicines

� Microbiology, all clinical samples( after autoclaving onsite)

Red Bags

• Infectious, non sharp plastic waste,

plastic culture tubes, plates, drains, urine plastic culture tubes, plates, drains, urine

bags, gloves, I/v sets, syringes without

needle etc.

Waste Sharps

� White Translucent sharps containers

� Discard directly into a leak-proof,

puncture resistant container

Blue

Card board boxes with Blue Markings

• Broken or discarded glassware

• Metallic body implants• Metallic body implants

Black Bags

� General Non infectious waste.

� Kitchen Waste.� Kitchen Waste.

� Paper

� Packaging, Cardboard

Acknowledgements

ALL THE FACULTY & STAFF OF GIPMERALL THE FACULTY & STAFF OF GIPMER

Key Resource Persons

• Dr Daljit Singh : Director Professor & Head Neurosurgery• Dr Daljit Singh : Director Professor & Head Neurosurgery

• Dr Mohit Gupta, Professor Cardiology

• Dr Puja Sakhuja : Director Professor & Head Pathology

• Dr Poonam Loomba : Professor Microbiology

• Dr Rajiv Chawla : Medical Director

g b pant institute of post-graduate medical education ...delhi.gov.in/doit/gbph/indprog.pdf · how...

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