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

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

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.

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.

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

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.

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.

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.

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

• 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.

• 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.

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.

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.

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.

Sole objective of healthcare financing is that rich and poor should be treated equally as poverty is not a disability and wealth is not an advantage. Approximately, 78% of Indian population spends for healthcare from out of pocket expenditure, remaining by salary, agriculture, business, etc. Only 3% population is covered by health insurance. Prime minister (PM) fund is one of the methods to offset the treatment cost from poor.

Present paper is aimed to highlight the contribution of PM fund for patients getting treatment at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) hospital and efforts made by hospital for its optimal utilization.

Retrospective studies were carried out in 2010 and July 2013 for contribution received form PM fund for indoor poor patients treatment during last 5 years, number of patient availed/not availed financial assistance, reasons for not availing, on the line of problem solving process. Efforts made by SGPGIMS for its optimal utilization were also highlighted.

During financial year 2007-2008 to 2009-2010, total 1246 patients received the fund of worth USD 1.30 million (₹ 78792750.00) and only USD 1.09 million (₹ 65569869.00) was utilized by 1110 (89%) patients. One hundred and thirtysix (10.91%) patients did not utilize. Hospital administration made efforts for optimal utilization by minimizing the barriers, consequently it improved the utilization by 8.20%. During financial year 2010-11 to 2011-12, USD 1.85 million (₹ 111081789.00) was received for 1450 patients, out of which 730 patients have already utilized and 682 are still using the fund (total 1412/97.40%) and 38 patients (2.60%) did not use it.

Simple efforts made by hospital improved the utilization of PM fund by 8.20% and poor were really benefited. Hospitals should also fulfill the social responsibility by facilitating the patients.

Chandra H, Bhardwaj ND, Mansoor F, Mandal R, Srivastava DC, Harsvardhan R. Optimal Utilization of Government Assisted Financing for Poor Patients: Facilitation by a Hospital. Int J Res Foundation Hosp Healthc Adm 2015;3(1):25-28.

As intensive care units (ICUs) are very resource intensive, length of stay (LOS) is of prime importance. This study was done to analyze the LOS in different ICUs and analyze it against a set benchmark.

This retrospective study was conducted from April to June 2013 on patients admitted during January to March 2013 in the neurosurgery ICU (NICU), medical ICU (MICU), high dependency unit (HDU) and isolation ICU of a large multispecialty hospital in Pune (India). As per the quality manual of the hospital, benchmark LOS was considered as 3.08 days for ICU. Mean and median LOS was analyzed through Student's t and Chi-square test; proportion of short (<2 days) and long stay (>4 days) patients was also computed.

Out of 835 patients admitted to the NICU, MICU, HDU and Isolation ICU, the overall mean LOS was 3.37 ± 5.54 days which was statistically significant at a p-value <0.001 (t = 17.58, 95% CI 3-3.75). The overall mean LOS was higher than the benchmarked 3.08 days but still within the optimal range of 2 to 4 days. Mean LOS was statistically significant when tested for department-wise variations with a Chi-value of 173.56 (p-value < 0.001, LR = 113.75). Highest mean LOS was observed for isolation ICU and lowest for MICU. 360 (43.1%) were short stay, 141(16.8%) were long stay and remaining were optimal stay patients.

The mean LOS for the ICUs varied significantly across the type of ICUs which needs to be continuously monitored. Mean LOS variation across ICU type indicates need for separate benchmarks.

Shukla K, Chandrashekhar P, Kumar N, Devade PK. A Descriptive Study of Length of Stay at an Intensive Care Unit. Int J Res Foundation Hosp Healthc Adm 2015;3(1):29-32.

Standardized handovers have been known to improve outcome, reduce error and enhance communication. Few, if aany, comparative studies on clinical handovers have been conducted in the India.

To study clinical handover practices among nurses and doctors in a neurosciences center in India.

This descriptive and cross-sectional study was conducted over 4 months in a 200 bedded public sector tertiary care facility in New Delhi, India.

The handover practices of nurses and resident doctors in a neurology ward were assessed across shifts, weekdays and weekends using a pretested checklist. Ten elements were observed under the categories of time, place, record, process, staff interaction and patient communication. Outcomes were analyzed using z-test, analysis of variance (ANOVA) and Spearman's correlation coefficient.

Three hundred and eighty-two handovers each of nurses and doctors revealed varying adherence for time (44%), place (63%), documentation (50%), process (78%), staff interaction (50%) and patient communication (45%) related elements with overall compliance being 55%. Doctors fared better only in process elements and bedside handovers; however, only nurses had a statistically significant fall in levels over weekends and in night shifts. Staff interaction and patient communication were positively correlated and bedside handover was negatively related to handover duration in both groups. No statistically significant difference was found between the two groups when assessed as categories.

Study revealed a need for a system change and standardization of clinical handovers. Greater administrative commitment, use of technology, customized training and leadership development will aid in continuity of care, promote patient safety and ensure better outcomes.

Kumar P, Jithesh V, Vij A, Gupta SK. Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India. Int J Res Foundation Hosp Healthc Adm 2015;3(1):33-40.

Singh S, Gupta SK, Arya S, Sharma DK, Aggarwal V. Adverse Drug Reaction Policy in a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2015; 3(1):41-47.

Shweta K, Gupta SK, Chandrashekhar R, Kant S. Planning and Designing an Isolation Facility in Hospitals: Need of the Hour. Int J Res Foundation Hosp Healthc Adm 2015;3(1):48-56.