Benefits
of NABH
NABH is Public
Recognition of achievement of accreditation standard by a healthcare
Organization, Demonstrated through an independent external peer assessment of
that organizations level of performance in relation to the NABH standards.
Though NABH is
integral part of Healthcare service providers as it’s pre-requisite to get
empanelled for various government facilities and insurance facility, as it
provides access to reliable and certified information on facility. The
Insurance Regulatory and Development Authority of India (IRDA) have directed
healthcare providers offering cashless services for allopathic treatment to meet
National Accreditation Board for Hospitals (NABH)’s pre-accreditation entry
level standards.
NABH Accreditation
benefits all stake holders, Patients are the biggest beneficiary, it ensures
high quality of care, along with that it also emphasize over safety of
caregivers. It stimulates continuous quality improvement to a health care
organization. With all that safety
measures NABH also be helpful in competitive advantage.
Entry
Level NABH:
NABH and QCI jointly
released Pre-accreditation Entry Level Certification Standards after healthcare
organization, especially small hospitals, as they found full Accreditation
standards highly challenging to start with in both way financially and space
constraints. It standards has lesser requirements in comparison to full
accreditation.
How
to Design an NABH Compliant Hospital?
Upcoming hospitals
and healthcare organization need to develop hospital in such a way that are
compliant with the NABH standards, though infrastructure wise But NABH Complies
with the laws of land. Usually Indian Hospital designer follows the NBC
(National Building Code of India) It serves as a Model Code for adoption by all
agencies involved in building construction works. The Code mainly contains
administrative regulations, development control rules and general building
requirements; fire safety requirements; stipulations regarding materials,
structural design and construction (including safety); building and plumbing
services; approach to sustainability; and asset and facility management.
Apart from that
Operation theatre and CSSD must have Suitable location and layout which leads
unidirectional flow and zoning. Sufficient space need to plan to ensure that
the activities can be performed properly. HISI (Hospital Infection Society India)
and HTM Guidelines are usefull. stp
How
to get NABH Design Compliance for Existing old set ups?
For Existing
hospitals it is quite challenging to meet with all standers especially in
structural requirements stipulated by NABH in their running set up. Existing
hospital may required some design changes to fulfill minimum requirement in
order to provide quality healthcare services for both patient as well as staff.
Most of the old hospitals get non compliances in total floor area per bad
requirement, Clean & dirty doors separation.
Realizing that
smaller players find it tough to stick some of its size norms, NABH has eased
its stipulation for OT rooms. “In all fairness, not all surgeries really called
for the erstwhile minimum 400 sq ft. However, they still insist on engineering
standards for OTs that often doesn’t add up” NABH not only focuses setting up
quality in healthcare setups but also in operational way too.
Imaging services
shall have adequate space and equipment to meet its defined scope of services
which shall include Physical space, MEP requirements. AERB guidelines could be used as a reference
document for radiation based imaging.
Timely repair of
civil structure like walls, servicing of furniture must be carried out.
Any
Specific Requirement for Medical equipment & fixtures installation
For Medical Gases it
is advised to refer HTM 02-01 or NFPA’s Medical Gas and Vaccum system
installation Handbook. Appropriate safety measures like alarm unit valve boxes
at various location and 24×7 monitoring of plant alarm unit to control gas
pressure.
·
Standby equipment and supplies
facilities must be available in all critical areas.
·
Alternative source for electricity and
water are provided as backup for any failure/shortage.
·
It is preferable that separate Civil,
Electrical, Plumbing HVAC, and piped medical gas drawings are maintained.
·
Equipments are inventoried and proper
logs must be maintained.
Time
period a new hospital can get Accreditation
Accreditation totally
depends on compliances with set standards by NABH, though it focuses more over
operational compliances a new hospital can apply after 6 month of its
operation, after that all its depend over organizational compliances with the
stands, but generally it takes 6 to 8 month to get acreditated. Compliances
probability can be increase by following standards from starting of hospital
with staff training.
Main
challenges faced by organization in accreditation process
The main challenge in
our industry is getting and retaining medical expertise. India has a scarcity of specialized and
super-specialized doctors. New hospitals coming up make retaining doctors more
difficult as they offer attractive packages due to which doctors switch
hospitals once in every 2 to 3 years. While in case of nursing and paramedical
staff their attrition rate is very high, due to which during whole training
module staff remains changing. New staff who haven’t attended previous module
need to get trained again, in this
situation for a consultant continuous online trainings may helpful and same
time here responsibility of HR department increases in both way to retain
trained staff as well as to scheduling properly.
As large number of hospitals face challenges and difficulties in implementing all the Accreditation Standards, NABH developed pre-accreditation entry level certification standards, in consultation with various stake holders in the country, as a stepping stone for enhancing the quality of patient care and safety.
The aim is to
introduce quality and accreditation to the hospitals as their first step
towards awareness and capacity building.
Once pre
accreditation entry level certification is achieved, the hospitals can then
prepare and move to the next stage – progressive level and finally to full
accreditation status. This methodology provides a step by step and staged
approach, which is practical for the hospitals.
Key
areas to emphasize for designing a NABH Compliant Hospital
·
Infrastructure for fire emergencies
like fire water tank, fire alarm, fire exit route.
·
Patient safety alarms, fall prevention
measures for elders, anti-skid tiles, grab bars, ramps with railings for
disabled.
·
Accessible bathrooms for physically
challenged.
·
Central waste collection area.
·
Proper zoning in OT’s and CSSD.
·
An ambulance should have a demarcated
space/parking area. It should also have stock of medicines and necessary
equipment’s.
.
Other
requirements
Various legal clearances related to building
and infrastructure must be in place. These includes,
·
Fire NOC, building occupancy
certificate, Lifts and escalators inspection, boilers permit, Diesel storage
permit, electrical inspection report, ETP inspection report, DG set certificate
etc.
·
Licenses and clearances from AERB for
all Radiation areas and radiation equipment
·
Requirements related to emergency
situation: The intent is to have a facility that provides safety to its
occupants in case of any untoward emergency situation such as fire, flood, mob
attack etc. Following things should specifically be taken care of,
·
Each area that are occupied by people
should have a way for exit in case of emergency situations.
·
Emergency exit (Evacuation) route must
be displayed at appropriate locations such as wards, patient rooms, labs, ICU
etc.
·
In case of vertical rise building,
facility should have provision for evacuation of people from upper floors. This
can be done by having a separate staircase to bring people down from upper
floors directly outside the building, or availability of an open space on each
floor to temporarily collect people of that floor till the time they are
evacuated by external help
·
Firefighting equipment to be available
and accessible to each area of building
·
Dedicated emergency illumination
system, which comes into effect in case of fire
·
Equipment for transporting bed ridden
patients outside the building in case of emergency
·
A safe area earmarked for collection
of people in case of emergency situation
·
Specific facility requirement related
to probable disaster situation of the area in which hospital is located.
·
Requirements related to handling
outside disaster situation: Hospital’s facility must have ability to deal with
patients coming in bulk due to any disaster that occurred outside the hospital,
such as bus accidents, building collapse etc. Some of the provisions that should be
there in the building should be,
·
An identified area which could easily
be prepared for accommodating mass casualty patients
·
A separate earmarked stock of
medicines and consummables in a cupboard to be used only in mass casualty
situations
·
Medicine and consumable for frequently
occurring emergency situation in the area should be kept available. For eg.
Anti-snake venom, if snake bite is a common emergency.
·
Access and patient friendliness: The
facility should enable access of patient to different areas and be user
friendly to them. These include,
·
Signage for directions and names of
areas to be displayed at appropriate locations. All signage and displays should
be at-least in two languages (English and local) and in addition pictorial
signage should be used
·
Display of layout of the facility at
all entrances
·
Display of scope of services and
services not in scope
·
Display of important information such
as timing, visitor policy and general instructions to patients
·
Entire facility should be a no smoking
zone
·
Well maintained ambiance
·
Availability of general utility items
like adequate seating space, public toilets etc.
·
Patient safety related requirements –
It is expected that the facility should be safe for use of patient and staff.
Hospitals are also required to conduct facility safety inspection regularly
accross the hospital. Some of the general things that are observed under this
expectations are,
·
Floors and stairs across the building
(and specially in patient areas) should be non-slippery. If required a signage
to inform people about the hazard should be displayed
·
Electric installations should be safe.
No dangling or naked wires. Rubber mat below all electrical panels to prevent
electric shock to person handling the panels
·
The first and last step of staircase
should have an identification (eg. a coloured line) to prevent people from
accidentally missing it
·
Drinking water should be regularly
tested in a water testing lab for potability
·
The corridors and general movement
area should be devoid of unnecessary obstacles or anything that could cause
accidents
·
The terrace should have border wall to
prevent anyone from accidental falling
·
The land of the hospital should walled
to prevent unguarded entry of anybody, including animals
·
The outside open area of the hospital
should be safe from snakes, pot-holes or any other accidental things
·
CCTV camera should be installed for
security reasons and a notice of same should be displayed
·
The water tanks should be cleaned and
date of cleaning should be displayed
·
Biomedical waste collection area
should be separate, identified and away from general area
·
Road towards emergency should be clear
at all times and should have sufficient space for movement of ambulance
·
Hazardous items like diesel, medical
gases cylinders, bulk chemicals etc. should have a safe place for storage
·
Crash cart should be available and
easily accessible to each patient area, to be used during medical emergency
·
Radiaology and radiation therapy areas
must comply with AERB/BARC regulations
·
Disabled friendly related requirements
– The facility should be as disabled friendly as possible. Important things
that should be considered for this are
·
Disabled friendly toilets is
accessible to patients in each area of the hospital. Such toilets should have
provisions like, leveled entry, wide door and inside to accommodate
wheelchairs, low height commodes, grab bars, anti-slip mats, water jet and
emergency alarm
·
Emergency department must be on ground
floor and with a separate entrance
·
Railing to hold on stairs (low height
and normal height)
·
Ramps or Lifts (sufficient to
accommodate wheelchairs and stretchers)
·
Ramps at all areas where there is a
step and may be accessed by patient
·
Infection prevention – The facility
must be designed in a manner to prevent cross infection between patients.
Things that should be taken care of for this are
·
Inter-bed distance in patient’s wards
should be about 6ft
·
Accessibility of handwashing basins in
each patient areas. Alternatively, hand rub can be made available near each
patient’s bed.
·
CSSD should have zoning to separate
clean, sterile and general areas
·
Operation Theatre should have zoning
and engineering controls. The infrastructure requirements related to OT are
important and has been described in detail by NABH. Please follow this link to
access the same.
In-patient
wards
In-patient wards are
the place where most of the patient care activities happens. While preparing
for NABH, wards requires high amount of attention as a large number of NABH
standards applies to it. This post identifies such requirements and can be used
as a checklist by hospitals preparing for NABH accreditation. The checklist,
being general in nature, must be reviewed for its suitability to individual
hospital, before use.
The checklist is
relevant for an inter-mediate care ward. There are additional requirements for
specialized wards such as ICU, emergency etc. which will be listed under
separate heading in upcoming posts. Readers are requested to subscribe to the
blog through email for getting regular updates on posts.
Before going through
this checklist please also go through ‘Infrastructure checklist for NABH
accreditation’
Physical
facilities related requirements:
·
Sufficient space for carrying out
patient care activities with adequate circulation space
·
Facility should be safe from any
physical injury chances (non-slippery floor, safe electrical fittings, no
accidental spots etc.)
·
Inter-bed distance to be maintained at
around 6 feet
·
Hand washing area easily accessible to
healthcare staff
·
Accessibility of fire-fighting
equipment
·
Crash cart placed at a location from
where it could be immediately accessed when required
·
Patient’s washroom should have safety
arrangements (anti-skid mats, emergency call button, grab bars, disable
friendliness, door opening outside, latch type locking which can be opened from
outside)
·
Adequate privacy arrangement for
patient (especially applicable in multi-bed wards)
·
Availability of all necessary patient
care equipment
·
Bio-medical waste bins as per BMW
rules
·
Separate or segregated storage area
for clean and dirty supplies
·
Emergency exit route and display