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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  ORIGINAL ARTICLE
A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior
VK Tadia, R Ahlawat, SK Arya, DK Sharma
[Year:2016] [Month:January-June] [Volume:4 ] [Number:1] [Pages:50] [Pages No:31-34] [No of Hits : 1255]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1057 | FREE

ABSTRACT

It is generally believed that big changes can be brought about by big interventions. Sometimes, small interventions also can show spectacular results. This case describes the impact of simple intervention, audit and feedback on change in the behavior of clinicians. In this case, the impact of simple intervention in the form of passive feedback has been documented. All the prescriptions received in pharmacy during the period of study were scrutinized for specific prescription errors. An overall error rate of 0.12% was observed in phase 1 of the study, which was reduced to 0.04% during phase 2 of the study after implementation of the intervention, which further dropped to zero during phase 3. It was concluded that a simple audit and feedback nudged the recipients of the feedback to modify their behavior.

Keywords: Audit, Feedback, Nudge, Passive feedback, Prescription behaviour.

How to cite this article: Tadia VK, Ahlawat R, Arya SK, Sharma DK. A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior. Int J Res Foundation Hosp Health Adm 2016;4(1):31-34.

Source of support: Nil

Conflict of interest: None

 
2.  ORIGINAL ARTICLE
Why switch to Rental? Costing of Laundry Services at an Apex Tertiary Care Hospital from the View of Outsourcing based on Rental Linen Management Services
VK Tadia, SK Gupta, SK Arya, A Lathwal, K Jain, R Ahlawat
[Year:2016] [Month:July-December] [Volume:4 ] [Number:2] [Pages:66] [Pages No:79-88] [No of Hits : 667]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1064 | FREE

ABSTRACT

Introduction: Modern hospitals are matrix organizations with a high investment in terms of capital, labor, and resources. It is imperative for the hospital administration to provide right material of right quality at the right time. Hospitals that set up in-house laundry operations generally make the decision without thoroughly identifying and accounting for total linen and laundry costs. Now evidence has emerged that hospitals that outsource were seeing improved linen utilization rates. If proper and clean linen is not provided, this can result in patient dissatisfaction. Further, innovations in laundry equipment have led to tremendous increases in efficacy. So, there is a need to ascertain the cost incurred in providing linen and laundry services so as to gauge the plausibility of transitioning to outsourcing-based models.

Aims and objectives: To study the cost incurred in providing linen and laundry services at an apex tertiary care hospital and to evaluate outsourcing model based on rental linen management.

Materials and methods: A descriptive, cross-sectional, retrospective, record-based study was conducted during a period of 1 month from March 1, 2016 to March 31, 2016.

Observations: The quantity of monthly linen washed in Dr Rajendra Prasad Centre was found to be 22,465 kg. The monthly laundry expenditure in Dr RP Centre was Rs. 1,415,295. The linen procurement expenditure per month at Dr RP Centre was Rs. 419,386. So total expenditure on linen and laundry per month at Dr RP Centre was Rs. 1,834,681. Thus, cost/kg (with inclusion of linen cost) was Rs. 82.

Discussion and conclusion: The rate quoted by a leading vendor to supply washed, sterilized linen to the hospital was Rs. 55 per kg. Since the expenditure incurred per kg at Dr RP Centre was Rs. 82, this amounted to a saving of around Rs. 27 per kg. It would mean saving of around Rs. 606,555 per month and Rs. 7,278,660 per annum. So, it was recommended that rental linen management services may be hired for Dr RP Centre after taking care of functional, operational, and strategic contingency.

How to cite this article: Tadia VK, Gupta SK, Arya SK, Lathwal A, Jain K, Ahlawat R. Why switch to Rental? Costing of Laundry Services at an Apex Tertiary Care Hospital from the View of Outsourcing based on Rental Linen Management Services. Int J Res Foundation Hosp Healthc Adm 2016;4(2):79-88.

Source of support: Nil

Conflict of interest: None

 
3.  ORIGINAL ARTICLE
Comparative Analysis of Cost of Biomedical Waste Management in Rural India
Bryal D’souza, Arun MS, Bijoy Johnson
[Year:2016] [Month:January-June] [Volume:4 ] [Number:1] [Pages:50] [Pages No:11-15] [No of Hits : 557]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1053 | FREE

ABSTRACT

Introduction: The quantum of waste generated from medical care and activities is a global matter of concern. Improper management of biomedical waste (BMW) has a grave health impact on the community, health care professionals, and the environment.1 It is mandatory by law that every medical organization that generates waste should have a system, process, and resources in place for segregating BMW within the organization for proper disposal. The present article deals with the understanding of various costs associated in BMW management process that will help the health care organization to prioritize their spending and focus on areas that require spending to achieve compliance in process of BMW management.

Materials and methods: Descriptive cross-sectional study was carried out, to study the compliance of BMW management at three different hospitals with respect to Bio-Medical Waste (Management and Handling) Rules, 2011. A retrospective study was conducted to analyze cost data for a 1-year time period. Cost involved in BMW management was analyzed and classified as capital and recurring costs. The study was undertaken in Udupi taluk, and the taluk comprises 11 hospitals (1 Government and 10 private hospitals). The hospitals were selected using convenient sampling as taking permission to conduct the study was difficult. Only three hospitals were permitted to carry out the study.

Results and discussion: Compliance was found to be better in accredited hospital than in nonaccredited hospital. This could be attributed to strict adherence to standard operating procedures and regular training of staff. Cost involved in BMW management was analyzed as capital and recurring costs. Since most of the hospital outsource final disposal, capital costs are significantly less compared to recurring costs. Among the recurring costs, maximum expenditure is on consumables like color-coded bags. Cost per bed per day for handling BMW was calculated and it was found to be higher in smaller hospitals.

Keywords: Biomedical waste, Cost analysis, Health care waste, Medical waste.

How to cite this article: Bryal D’souza, Arun MS, Johnson B. Comparative Analysis of Cost of Biomedical Waste Management in Rural India. Int J Res Foundation Hosp Healthc Adm 2016;4(1):11-15.

Source of support: Nil

Conflict of interest: None

 
4.  ORIGINAL ARTICLE
To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center
Madhav Madhusudan Singh, Shakti Kumar Gupta, YK Gupta, DK Sharma, Aarti Kapil
[Year:2015] [Month:January-June] [Volume:3 ] [Number:1] [Pages:56] [Pages No:13-24] [No of Hits : 7220]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1031 | FREE

ABSTRACT

Introduction: As antimicrobial resistance continues to increase and new antimicrobial development stagnates, antimicrobial stewardship programs are being implemented worldwide. The goal of antimicrobial stewardship is to optimize antimicrobial therapy with maximal impact on subsequent development of resistance. Thirty to fifty percent of hospitalized patients receive antimicrobial therapy. Previous data suggest that inappropriate use results in higher mortality rates, longer lengths of stay, and increased medical costs. Antimicrobial stewardship programs (ASPs) reduce the improper use of antimicrobials and improve patient safety. Despite increased awareness about the benefits of these programs, few medical and surgical ASPs exist and fewer comprehensive studies evaluate their effects.

Aim: To study the antimicrobial stewardship program in a large tertiary care teaching center.

Objectives

  • To study the antibiotic prescribing practices in a tertiary care government hospital
  • To compare the antibiotic prescribing practices with the standard guidelines available with the hospital
  • To make recommendation if any for rational use of antibiotics.

Materials and methods

  • Review of literature
  • Prospective study of 15 days in selected general medicine and general surgery ward in which 5 to 6 reading will be taken in to know the antibiotic prescribed to patients.
  • Retrospective study of 15 days for study of patient records to know the antibiotic prescribed to patients.
  • Interaction with faculty and senior residents of general medicine and surgery to know about the pattern of infection and antibiotic prescription.
  • Interaction with microbiology department and their faculty to know the microbial resistance pattern and possible suggestion which need to be incorporated in antibiotic Stewardship program.

Results: The present study on antibiotic prescribing practices was undertaken in a super specialty hospital at New Delhi. A sample size of 100 case records was considered. There is no such stewardship program in tertiary care hospital, although it was demanded in various forum and meetings. There are no recommendations available either for patients of renal failure or other such compromised metabolic or immune states in the form of written antibiotic stewardship program of the hospital. The appropriateness of antibiotics prescribed in the case records was examined in light of the antibiotic stewardship program of the hospital. It was found that the overall adherence to antibiotic stewardship program was nil as no existing antibiotic stewardship program is exiting in this hospital. Gautum Dey in a study conducted at this hospital in New Delhi found that in 40.7% preoperative cases and 60.3% postoperative cases two or more than two antibiotics were given. The author has also commented that there was no evidence of adhering to antibiotic stewardship program or utilising culture and sensitivity reports to guide the therapy. The data obtained from the present study on further analysis has shown that in seven cases, the antibiotics prescribed were inadequate in terms of dose and duration. Thus resulting in an apparently lower cost of treatment than what was recommended by the antibiotic stewardship program of the hospital. Although such inappropriate prescription results in increased chances of antibiotic resistance, the immediate or short-term effects are not very conclusive. It is observed that there were 26 (26%) cases in medical and 12 (12%) cases in surgery disciplines in which the initial and final diagnosis was different. Uncertainty about the final diagnosis promotes empirical prescribing practices.

Conclusion: Antimicrobial stewards are a prominent part of local and national efforts to contain and reverse antimicrobial resistance. A range of intervention options is available with varying levels of resources and can yield substantial improvements in morbidity, mortality, quality of care, and cost. The cost of delivering such programs is dwarfed by the benefits and provides an opportunity for hospital epidemiologists to garner support. This suggests that antimicrobial management programs belong to the rarefied group of truly cost saving quality improvement initiatives. Considering the enormous implications of antibiotic resistance, it is necessary that we act in haste, lest our wonder drugs and magic bullets become ineffectual. Future systems promise greater integration and analysis of data, facilitated delivery of information to the clinician, and rapid and expert decision support that will optimize patient outcomes while minimizing antimicrobial resistance. They may also offer our best hope for avoiding an ‘Antibiotic armageddon’. In addition, the ASP plays an integral role in providing guidance to clinicians and ensures that the appropriate antimicrobial agents are used.

Keywords: Antibiotic, Stewardship program, Antimicrobial resistance, Rational use.

How to cite this article: Singh MM, Gupta SK, Gupta YK, Sharma DK, Kapil A. To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center. Int J Res Foundation Hosp Healthc Adm 2015;3(1):13-24.

Source of support: Nil

Conflict of interest: None

 
5.  RESEARCH ARTICLE
Application of 3D Music Inventory Control Technique for the Controlled Drugs in Intensive Care Unit of a Tertiary Care Hospital
Sameer Mehrotra, Sunil Basukala, Pawan Kapoor, Sunil Kant, RK Ranyal, Punit Yadav, Swati Varshney, SK Patnaik, Madhav Madhusudan Singh
[Year:2015] [Month:January-June] [Volume:3 ] [Number:1] [Pages:56] [Pages No:5-9] [No of Hits : 2628]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1029 | FREE

ABSTRACT

Approximately 35% of annual hospitals budget is spent on buying materials and supplies, including medicines. The medical store is one of the most extensively used facilities of the hospital and hence it is essential that health managers use scientific methods to achieve efficient management and patient satisfaction.

Aims and objectives: To apply selective inventory control techniques for the drugs used in intensive care unit of tertiary care teaching hospital.

Materials and methods: The annual consumption and expenditure incurred on each item of controlled drugs in medical intensive care unit (ICU) for the years 2013 to 2014 was analyzed, and inventory control techniques, i.e. ABC, VED and ABC-VED matrix analysis, were applied.

Results: It was observed that 13 medicines (43.33%) out of 30 were classified in the category1 (AV + BV + CV + AE + AD) for stringent control.

Conclusion: Scientific inventory control management to be applied for efficient management of medical stores.

Keywords: ABC, VED analysis, Inventory control.

How to cite this article: Mehrotra S, Basukala S, Kapoor P, Kant S, Ranyal RK, Yadav P, Varshney S, Patnaik SK, Singh MM. Application of 3D Music Inventory Control Technique for the Controlled Drugs in Intensive Care Unit of a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2015; 3(1):5-9.

Source of support: Nil

Conflict of interest: None

 
6.  REVIEW ARTICLES
Planning and Designing of Clinical Engineering Department in a Hospital
Madhav Madhusudan Singh, Saroj Kumar Patnaik, Pradeep Srivastva, Harish K Satia, Mahavir Singh
[Year:2015] [Month:July-December] [Volume:3 ] [Number:2] [Pages:79] [Pages No:129-134] [No of Hits : 1241]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1049 | FREE

Abstract

Biomedical/clinical engineering departments (CED) with expertise in engineering and technology management have a vital role to play in determining the potential for implementation and cost-effectiveness of new medical technologies through technology assessment. It provides planned preventive maintenance and repair facility in a state of optimum operational efficiency along with conducts training and research in clinical engineering. For a successful design, the workflow should be kept in mind in terms of its functional needs that are related to space. The clinical engineering and maintenance unit may consist of functional areas dependent on the operational policy and service demand. Heating, ventilation and air-conditioning (HVAC), lighting and acoustic, electrical, fire planning should be done with deliberation and as per specification.

Keywords: Biomedical/clinical engineering, Planned preventive maintenance, Repair facility.

How to cite this article: Singh MM, Patnaik SK, Srivastva P, Satia HK, Singh M. Planning and Designing of Clinical Engineering Department in a Hospital. Int J Res Foundation Hosp Healthc Adm 2015;3(2):129-134.

Source of support: Nil

Conflict of interest: None

 
7.  ORIGINAL ARTICLE
Code Blue Policy for a Tertiary Care Trauma Hospital in India
Sheetal Singh, DK Sharma, Sanjeev Bhoi, Sapna Ramani Sardana, Sonia Chauhan
[Year:2015] [Month:July-December] [Volume:3 ] [Number:2] [Pages:79] [Pages No:114-122] [No of Hits : 1111]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1047 | FREE

Abstract

“Code Blue” is generally used to indicate a patient requiring resuscitation or in need of immediate medical attention, most often as the result of a respiratory arrest or cardiac arrest. When called overhead, the page takes the form of “Code Blue, (floor), (room)” to alert the resuscitation team where to respond. Every hospital, as a part of its disaster plans, sets a policy to determine which units provide personnel for code coverage. In theory, any emergency medical professional may respond to a code, but in practice the team makeup is limited to those with advanced cardiac life support or other equivalent resuscitation training. Frequently, these teams are staffed by physicians (from anesthesia and internal medicine in larger medical centers or the emergency physician in smaller ones), respiratory therapists, pharmacists, and nurses. A code team leader will be a physician in attendance on any code team; this individual is responsible for directing the resuscitation effort and is said to “run the code”. This phrase was coined at Bethany Medical Center in Kansas City, Kansas. The term “code” by itself is commonly used by medical professionals as a slang term for this type of emergency, as in “calling a code” or describing a patient in arrest as “coding”.1

The purpose of this study is to make available policy with regard to Code Blue which can be followed in a tertiary care hospitals. It was a descriptive cross-sectional study carried out between January and June 2015. The study population included doctors, nursing personnel, paramedical staff and quality managers of tertiary care hospital from public and private hospitals. Checklist was made after an exhaustive review of literature which was then improvised. The checklist was discussed in focused group discussion held on 1 June 2015, and suggestions were incorporated. Validation of the checklist was also done by experts in various private and public hospitals. Subsequently, interaction was done with study population against the backdrop of the checklist and Code Blue policy was formulated.

Keywords: Cardiac arrest, Code Blue, Crash cart.

How to cite this article: Singh S, Sharma DK, Bhoi S, Sardana SR, Chauhan S. Code Blue Policy for a Tertiary Care Trauma Hospital in India. Int J Res Foundation Hosp Healthc Adm 2015;3(2):114-122.

Source of support: Nil

Conflict of interest: None

 
8.  RESEARCH ARTICLE
Personal Protective Equipment used for Infection Control in Dental Practices
AP Pandit, Neha Bhagatkar, Mallika Ramachandran
[Year:2015] [Month:January-June] [Volume:3 ] [Number:1] [Pages:56] [Pages No:10-12] [No of Hits : 1018]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1030 | FREE

ABSTRACT

The potential size of India’s dental market is vast and is expected to become one of the largest single country markets for overseas dental products and materials. The total market for the dental equipment and materials is estimated to be around US$ 90 million annually. There are more than 1, 80,000 dental professionals in India, 297 dental institutes and over 5,000 dental laboratories. Thus, there is a huge potential for the market of personal protective equipment (PPE) used for infection control in dentistry. India’s market for dental products is extremely dynamic, with a current estimated growth rate of between 25 and 30%. Overall, the dental market is expected to grow by 20%.1
The personal protective equipment used in the practice of dentistry in India. Since dentistry is predominantly a surgical discipline, it leads to exposure to the pathogenic microorganisms harbored in blood, body fluids and other potentially infectious material. Thus, the use of adequate and good quality PPE is imperative for infection control in dental practice. With the growing potential of India’s dental market, the growth of the market for PPE is inevitable. But, it is equally important to raise the awareness among dental community about good quality products adhering to required standards to prevent the usage of low-cost, uncertified and sub-standard products that decrease the safety levels of personnel.
The present study is conducted with a view to observe the personal protective equipment used for infection control in dental practices.

Keywords: Personal protective equipments, Infection control, AAMI standard, Dental practice.

How to cite this article: Pandit AP, Bhagatkar N, Ramachandran M. Personal Protective Equipment used for Infection Control in Dental Practices. Int J Res Foundation Hosp Healthc Adm 2015;3(1):10-12.

Source of support: Nil

Conflict of interest: None

 
9.  RESEARCH ARTICLE
Beyond Accreditation: Issues in Healthcare Quality
Feroz Ikbal
[Year:2015] [Month:January-June] [Volume:3 ] [Number:1] [Pages:56] [Pages No:1-4] [No of Hits : 1016]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1028 | FREE

ABSTRACT

In the last few years, there is an increased interest among Indian Healthcare institutions to get accredited from bodies, such as national accreditation board for hospitals and healthcare providers (NABH), Joint Commission International (JCI), Australian Council on Healthcare Standards (ACHS), and college of american pathologists Laboratory accreditation programme (CAP), etc. Hospital administrators, clinicians, academicians, promoters of the hospitals, policy makers and even government feel that accreditation is a panacea for all the problems associated with healthcare quality. But with the incidence of fire in one of the NABH accredited hospital in a metropolitan city, questions began to be asked on the correlation between quality and accreditation. Most of the hospitals use accreditation as a promotional tool, rather than a tool for continuous quality improvement. Often the entire focus of quality in a hospital is confined to the process of accreditation and re-accreditation. Time has come to think on the entire process of accreditation of hospitals in India, though it has a history of less than a decade. This paper intends to discuss various issues of quality in hospitals, outside the realms of accreditation. Need for strengthening and re-engineering the accreditation is also discussed. Accreditation essentially identifies the capability of the hospital to deliver quality care. It does not assure that hospitals delivers quality care. This aspect of accreditation has been often forgotten by the various stakeholders in healthcare. In this paper, an attempt is made to discuss other issues of quality, such as spurious drugs, quality of biomaterials, such as stents and biomedical equipments, quality of human resources, etc. which are often neglected by health institutions in its obsession to accreditation.

Keywords: Quality, Healthcare institution, Obsession, Accreditation.

How to cite this article: Ikbal F. Beyond Accreditation: Issues in Healthcare Quality. Int J Res Foundation Hosp Healthc Adm 2015;3(1):1-4.

Source of support: Nil

Conflict of interest: None

 
10.  ORIGINAL ARTICLE
Impact of Nutritional Services of Anganwadi Workers in Improving Nutritional Status of Infants in Delhi: A Study by Mixed Method Technique
Sanjeev Davey, Anuradha Davey, S Vivek Adhish, Rajni Bagga
[Year:2015] [Month:July-December] [Volume:3 ] [Number:2] [Pages:79] [Pages No:57-64] [No of Hits : 1004]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10035-1037 | FREE

Abstract

Background: Despite the presence of integrated child development services (ICDS) program in rural area of Delhi, the real impact of nutritional services of ICDS program on nutritional status of infants is not very clear, therefore, studying this area may provide new insights in this field.

Materials and methods: This study was carried out from 1st January 2015 to 31st March 2015 (3 months). All children up to 1 year of age (in AWC 1 and 2 area of a one rural ICDS block) were examined for their nutritional status by weight for age criteria. The registered infants of both these Anganwadi centers (AWCs) and their mothers were simultaneously observed for all kind of nutritional services they received from Anganwadi workers (AWWs) by way of key informants interviews and this was further confirmed by applying secret customer technique.

Results: The prevalence of mild to moderate malnutrition among infants in both the AWC area (AWC 1 area—6 months to 1 year category—52.9%, AWC 2 area (from 0–6 months and 6 months–1 year—69.3%) was higher. The key feeding factors identified for such scenario were: Improper colostrums feeding, wrong age of initiation of semisolid feeding, exclusive breast-feeding not done for 6 months, etc. [especially for AWC 2 area (p < 0.05) and AWC 1 area (p > 0.05)] among the AWCs. These factors were further confirmed by poor efforts of both AWWs in providing nutritional services toward mother and infants.

Conclusion: Anganwadi workers need to focus on quality of nutritional services provided toward mothers of infants and this area needs regular monitoring and supervision from ICDS and health system meticulously.

Keywords: Anganwadi center, Anganwadi worker, Impact, Infant, Integrated child development services, Mixed methods, Nutrition.

How to cite this article: Davey S, Davey A, Adhish SV, Bagga R. Impact of Nutritional Services of Anganwadi Workers in Improving Nutritional Status of Infants in Delhi: A Study by Mixed Method Technique. Int J Res Foundation Hosp Healthc Adm 2015;3(2):57-64.

Source of support: Nil

Conflict of interest: None

 
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