Healthcare

INTRODUCTION Unsafe medication practices lead to medication error and causes adverse patient outcomes including prolonged hospital stay, high expenditure, risk of morbidity and mortality. Errors occur due to weak medication systems, underdeveloped processes/policies, human factors etc. COVID pandemic also compromised the compliance in safe medication management & thus led our attention to work more towards medication safety. Our aim is to achieve zero medication error thus ensuring 100% patient safety which is why this extensive project was taken by the management since January 2021 involving the core stakeholders in medication management i.e. pharmacist, doctors, nurses, HR, clinical pharmacists & Quality team.

INTRODUCTION Joint commission defines Culture of Safety (CoS) as ‘a collaborative environment in which skilled clinicians treat each other with respect, leaders drive effective teamwork & promote psychological safety, teams learn from errors and near misses, caregivers are aware of the inherent limitations of human performance in complex systems, there is a visible process of learning and driving improvement.’ Health care continues to have a culture of individual blame, which impairs advancement of a safety culture. Hospital leadership needs to demonstrate its commitment to a culture of safety & hence a TQM approach has been taken at RFH to enhance CoS.

INTRODUCTION A delayed Surgery slot movement not only creates dissatisfaction among consultant, staff and patients but also leads to undue anxiety in patients. From business perspective, Operation Theatres (OTs) are costly to run, & multiple factors influence efficiency. A delay in first case can lead to less operating room (OT) utilization and greater facility costs. Every hour lost causes a loss of Rs. 8000 per operating room. With monthly increase in OR utilisation , first case on time became need of the hour & multidisciplinary team of medical operations, nursing, lab & radiology was assigned for the project.

INTRODUCTION A quality improvement program involves systematic activities that are organized and implemented by diagnostic laboratory to monitor, assess, and improve its quality. Quality checks of any diagnostic laboratory are assessed by conducting regular internal/external audits along with intra/inter department review meetings to identify areas of concern. These areas were identified in pre-analytical, analytical and post-analytical sections of the laboratory based on the scope of work. It is observed that maximum fruitful output in laboratory workflow can be obtained by developing relevant skills in the available workforce thus making skill refinement an important tool in total quality improvement.

INTRODUCTION The outpatient department is an important part of overall hospital functioning and is the first step in patient journey. Its functioning is integrated with almost every other department in hospital. Hence integration of flow of clinical information between OPD, IPD, Diagnostic & other support departments is important for continuity of care. Ensuring continuity of care with physical OPD records for improved patient experience was a challenge. Uniformity in documentation, appropriate storage, archival and timely retrieval being the other concern areas. Experience of patient during OPD visit has significant impact on overall satisfaction hence team agreed to work in this area.

Introduction Clinical quality is defined as the accuracy and completeness of the clinical data for the purposes of clinical care, health services and other secondary uses such as decision support and clinical research. The quality of clinical data can be achieved by the standardization, inspection and evaluation of the data generating processes and tools. Clinical quality is a critical phase in healthcare services, which leads to generation of high quality, reliable and statistically sound data. The primary goal of clinical quality processes is to provide high quality data by keeping the number of errors and missing data as low as possible and gather maximum data for analysis.

Introduction Medical Records Department is an essential part of a hospital. It stores all the patient medical record which has legal/statutory component, confidentiality, privacy and security elements. Taking into consideration the graveness of the department and its work, Quality team did a Risk Identification & assessment in MRD using an FMEA tool to mitigate hazards if any. FMEA is a structured approach to discover potential failures that may exist within the design of a process. It is a qualitative tool for risk management. Its focal point is to reduce or eliminate harm to the staff through the incorporation of preventive measures.

Introduction This QIP was initiated as documentation workload was increasing with each accreditation cycle and doctors / nursing were spending more time on documentations & patient care compromised. Documentation in Patient Medical record is the written and legal recording of the interventions that concern the patient, and it includes a sequence of processes, which constitutes an information base of the situation of patient health condition. This projects started in a phase wise and has been initiated by quality department in collaboration with nursing and medical team to streamline documents, avoid duplication and minimize wastage of resources, Improving patientcare.

Introduction During the monthly Quality & Medical Review -Increasing Lab redos were questioned . The detailed analysis was missing . The Quality team Along with Medical and Nursing & Lab QA formulated a project team to Initiate a QIP to deep dive into Redo's Improve the system where the gaps are identified . The Top management fully supported the initiative and reviewed the progress timely.

Introduction Inventory management includes a series of processes that deal with the flow of drugs from manufacturer to pharmacy store and supplied to various pharmacies in the hospital from where drugs are dispensed to patients according to their needs. This process is known as supply chain management. Inventory control is a challenging process as there several problems arising starting from maintaining sufficient inventory levels and avoiding overstock, fulfilling customer demand, and to minimize inventory burden. Inventory control explains how to optimize the available resources with a view to reduce the material costs and achieving improved capital turn over.

Introduction The Accident & Emergency department is one of the busiest hospital departments with continuous outflow & inflow of patients .The department receives an average daily footfall of 60 patients. Hence effective stock management is vital .Variances in the stock can hamper patient care activities and can often result in revenue leakage

Introduction In this Modern Era, time is one of the most valuable things for every person. Time is also a crucial factor which decides the efficiency and effectiveness of the treatment and ultimately influences outpatients satisfaction on the quality of service provided. This study aims to reduce the extended waiting time in Ophthalmology OPD which was a matter of concern in our hospital as it led to increasing patient complaints and hence affecting patient experience and satisfaction. Waiting time in outpatient departments has become a problem in the healthcare industry all over the world.

Introduction Central-line associated bloodstream infection (CLABSI) is a recognized healthcare-associated infection claiming a heavy toll of morbidity, mortality, resources and reputation. An obnoxiously high rising trend of CLABSI got focussed in the hospital infection control committee (HIC) meeting. The higher management prioritized a project in curtailing its clasp over the patients with the project charter preparation. The infection control team was at its performing stage with one infection control officer and three nurses. The team took up the responsibility for its execution with active management support following the multi-stakeholder meeting.

Introduction Our hospital have identified 250 problems through our facilitator and created a problem bank. The problem bank divided in to department wise. Six departments selected the problems from problem bank and lab one among them. From that we have shortlisted 10 problems in our lab department. Using PQCDSM method we have selected a problem with highest score. Our upper management created a project team with a six members from our lab and coordinated with them in every stage of the project through the facilitator.

Introduction Hospital-Acquired Pressure ulcers (HAPUs) are a major problem in our health care system owing to multiple factors of hospital carelessness and lead to patient’s discomfort, economic hardship, and anguish due to their expensive treatment. HAPUs are indicators of nursing care and reflect the quality of care in hospital settings (Saifollahi et al., 2016). These are preventable errors and by the combined efforts of a multidisciplinary team, they can be mitigated. Using an interdisciplinary team approach, various bundles and checklists are prepared. The top management wants to address this issue and fully supported this initiative by providing the necessary resources.

Introduction Admissions through emergency department contribute to 50% (approximately) of total admissions and 60% of these patients are getting admitted in ICU. A structured Infection control surveillance programme for all high risk areas is in place including structured patient surveillance except in ER. Though a system of sending cultures in suspected cases was existing and ER Team was aware about same but compliance was the concern. This was impacting HAI surveillance too, while labeling HAI Infection Control team was facing tough time in absence of essential information related to previous hospitalization. Hence initiating patient surveillance in ER was need of hour.

STEMI is one of the key clinical indicators of a state of the art cardiology center. However, it is mostly dependent on operational efficiency. Fortis Anandapur had a concern for recurrent delay beyond AHA benchmarks. Same was taken as a Quality Improvement project and problem statement was defined. Outcomes is as stated ahead.

P D Hinduja Hospital has a Nursing college at Andheri. It was brought to the notice of Engineering department that there was an acute shortage of water in the building of Nursing College, which had created inconvenience to Nurses & staff residing in it.

Low back pain is a major clinical problem that results in an important socioeconomic burden, which appears to be increasing despite technical and therapeutic advances in its diagnosis and treatment.

We have heard some amazing stories over the past years about colleagues who have gone the extra mile. We want to recognize those who consistently go that extra mile to make the patient experience within our hospitals the very best that it can be.