What’s new in NABH 3rd Edition for Hospitals? [Chapter 2: Care of Patients] – Part 1

Continuing with our discussion on what’s new in NABH third edition compared to the previous edition, in this post we cover the chapter on Care of Patients (COP).

Like mentioned in the changes in chapter AAC, objective elements in COP also have become more specific. COP-1a begins with uniformity in care delivery in different settings in the hospital. In 3^rd edition, COP-1a also requires care to be uniform for a given health problem. COP-1c and COP-1d in the 2^nd edition required the primary consultant of the patient to sign and provide his name on the treatment orders along with date and time and the care plan be counter-signed by clinician in-charge of the patient. These 2 requirements have been removed from this standard COP-1. These conditions are now addressed in AAC-4 in the revised standards (check here).

In COP-2 in 3^rd edition, a few changes have been made to sentences in the objective elements to bring in specificity. A new objective element COP-2g has also been added – “In case of discharge to home or transfer to another organization a discharge note shall be given to patient”. However, I feel this aspect was adequately addressed in AAC-13d (“A discharge summary is given to all the patients leaving the organization” in revised edition) because this objective element covers all and every kind of discharges happening from the hospital and the remarks in the new objective element also advise the readers to refer to AAC 13 and 14. If being specific was the objective, this could have been dealt with by providing some more explanation in AAC 13 and 14 itself for the emergency patients like they have done for LAMA patients.

COP-3 in 2^nd edition required equipment and emergency medications to be checked on a daily basis (COP-3e and COP-3f) and COP-3d required a checklist of both of these to be maintained. In the 3^rd edition, the checklist part has been added to the existing objective elements of COP-3e and COP-3f and so the particular element COP-3d became redundant. These requirements are now covered under COP-3f and COP-3g as “Equipment are checked on a daily basis using a checklist” and “Emergency medications are checked daily and prior to dispatch using a checklist” respectively. There are also 2 new objective elements introduced in this standard. COP-3b states that “The ambulance adheres to statutory requirements” and COP-3e states that “Ambulance(s) is checked on a daily basis.” Therefore there is a new addition of one objective element in this standard.

In COP-4, the only visible change is in COP-4d. While this element under 2^nd edition required that all cardiac arrests be analyzed, in the 3^rd edition this requirement has been modified and the revised objective element requires all cardio-pulmonary resuscitations to be analyzed.

There are two new standards introduced in COP as “Documented policies and procedures guide nursing care” and “Documented procedures guide the performance of various procedures” finds their place as COP-5 and COP-6 respectively.

The new COP-5 has seven objective elements. These are:

1. “There are documented policies and procedures for all activities of the nursing services.” (COP-5a)
2. “These reflect current standards of nursing services and practice, relevant regulations and purposes of the services.” (COP-5b)
3. “Assignment of patient care is done as per current good practice guidelines.” (COP-5c)
4. “Nursing care is aligned and integrated with overall patient care.” (COP-5d)
5. “Care provided by nurses is documented in the patient record.” (COP-5e)
6. “Nurses are provided with adequate equipment for providing safe and efficient nursing services.” (COP-5f)
7. “Nurses are empowered to take nursing-related decisions to ensure timely care of patients.” (COP-5g)

The new COP-6 also has seven objective elements, as given below:

1. “Documented procedures are used to guide the performance of various clinical procedures.” (COP-6a)
2. “Only qualified personnel order, plan, perform and assist in performing procedures.” (COP-6b)
3. “Documented procedures exist to prevent adverse events like wrong site, wrong patient and wrong procedure.” (COP-6c)
4. “Informed consent is taken by the personnel performing the procedure, where applicable.” (COP-6d)
5. “Adherence to standard precautions and asepsis is adhered to during the conduct of the procedure.” (COP-6e)
6. “Patients are appropriately monitored during and after the procedure.” (COP-6f)
7. “Procedures are documented accurately in the patient record.” (COP-6g)

Because of these two additions in the list, the standard COP-5 in 2^nd edition has now been shifted 2 steps lower in the list and now becomes COP-7 in the revised edition.

COP-7 in the revised edition deals with the standard on rational use of blood and blood products. Compared to the corresponding standard COP-5 in the previous edition, 2 new objective elements have been introduced in this standard. COP-7b states that “Documented procedures guide transfusion of blood and blood products”, so there is specific focus on the activity of transfusion and NABH recommends that its reference guide on ‘NABH standards for blood banks’ be used for preparing the procedures.

The new element COP-7f states that “The organization defines the process for availability and transfusion of blood/blood components for use in emergency”. Hospitals should see this element in context of COP-2 which deals with emergency services.

What's new in NABH Third Edition: Chapter 2 - Care of Patients (Part 2)