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Prescription audit study from a tertiary care private hospital in Kolkata, India
Subhrojyoti Bhowmick, Shubham Jana, Saksham Parolia, Anupam Das, Protim Saren
January-June 2019, 1(1):13-18
Introduction: Prescription writing is an important aspect of safe medication practices. Prescriptions should adhere to best practices mentioned in the World Health Organization guidelines and the National Accreditation Board for Hospitals and Healthcare Providers guidelines. Aim: Evidence about prescription audit study conducted in developing countries like India is scarce, especially from the Eastern part of the country. Hence, the current prescription audit study was conducted in a tertiary care private hospital in Eastern India in the city of Kolkata. Materials and Methods: This study presents an assessment of the quality of prescribing practice in a tertiary care private hospital in Kolkata. Six thousand four hundred and six medicine cards (6406) of inpatients were prospectively analyzed for the duration of 6 months. Results: The audit revealed that only 69.24% of medicine cards had captured drug allergy, 99.53% had mentioned the route of administration, 99.85% had dose strength, 99.89% had mentioned the frequency of dose, and only 75.35% had mentioned the indication/diagnosis of patients. Surprisingly, 90.75% of medicine cards had an error-prone abbreviation which was an issue of major concern. Conclusions: The audit report was shared with the clinicians every month along with regular training of good prescribing practices, which improved the quality of prescribing practice. Regular prescription audit followed by dedicated clinical pharmacology team along with constant communication with clinicians can improve the quality of prescriptions in long run.
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Laboratory quality improvement: Act or perish
Rateesh Sareen, Menka Kapil, Gajendra Nath Gupta
January-June 2019, 1(1):2-6
The increasingly dominant role of laboratory medicine in clinical decision-making and the simultaneous pressure on cost containment have led to careful evaluation and identification of preventable causes of errors in total testing process of laboratory analyte. The patient-centric health-care delivery system mandates the need to formulate policies and procedures based on international guidelines to minimize errors of laboratory professionals or nonlaboratory operators. The paper summarizes various areas of laboratory that are prone to errors so that the laboratory can redesign the system and make it resistant to errors unknowingly committed by health-care professionals.
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Quality and patient safety – A global agenda
Pawan Kapoor
January-June 2019, 1(1):1-1
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Level of compliance to quality standards and staff attitude toward adopted practices in a specialty hospital
Surendra Kumar, Rajesh Kumar Grover
January-June 2019, 1(1):7-12
Introduction and Aim: NABH accreditation is seen as an assurance towards quality services and patient safety. We conducted study at a 150 bedded, NABH non-accredited, speciality hospital to identify extent of compliance of practices and policies of the hospital with NABH standards for patient centric activities and to study staff attitude towards practices followed. Materials and Methods: In 5 patient-centered activities chapters of the NABH standards, 61 standards with 403 observable elements were identified applicable to the hospital. The prevalent practices of the staff were observed (each element observed 50 times), relevant records checked to assess compliance with the NABH standards. A sample population of staff (doctors, nurses, technicians) was randomly selected and interviewed on a set of 9 questions to assess awareness of hospital policies and rationale of the practices followed. Results: Compliance to NABH documentation requirements was 37%. Where predefined policies were present, a highly uniform practice (uniform on ≥80% observations) was observed for 96% elements, high uniformity was observed for only 15% elements in cases where no predefined policies were present. The hospital performed best on standards in 'Hospital Infection Control', where documentary compliance was 60%; and 78% elements complied at ≥80% observations with 63% complying at all observed times. The compliance rate was least for standards in 'Patient Rights and Education' where documentations compliance was 14% and only 37% elements complied at ≥80% observed times. Only 50% of the sampled population was aware of all departmental policies while 12% was completely ignorant of the policies. Practices of most of the care providers, 76%, was based on learning by seeing others doing the job, while some (18%) followed verbal instructions. Deviations from established practices were common and gave rise to near misses (66% responders). Most of the care providers, 85%, did not report such events; events not resulting in obvious harm to the patient and consideration that the event was not because of one's own fault were major factors for underreporting. Introduction of checklists and regular training was recognised as a means to prevent such events. Conclusion: The hospital needs to formulate more policies and SOPs. Training and sensitisation of staff regarding work protocols and safety measures were infrequent and inadequate.
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