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2019 | January-June | Volume 7 | Issue 1

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Maj Gen Sunil Kant

Cost Containment in Healthcare

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/jrfhha-7-1-iv  |  Open Access |  How to cite  | 


Guest Editorial

GK Rath

National Cancer Institute, AIIMS, Delhi: A Pathbreaking Project to Bring in a New Era in Cancer Care in India

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/jrfhha-7-1-vi  |  Open Access |  How to cite  | 


Original Article

Ravinder Ahlawat, Amit Lathwal, Sanjay Arya

To Study the Attitude of Staff in a Tertiary-care Trauma Center toward Patient's Relatives

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Family of the patient, Indoor ward, Trauma center

   DOI: 10.5005/jp-journals-10035-1102  |  Open Access |  How to cite  | 


Background: In the developed countries, there is a building consensus for more open visiting polices and changing the role of family as the active care provider. Kangaroo mother care is one such accepted norm, which has transformed the organization of obstetrics and pediatrics ward. It is the right time to check for the readiness of our hospital staff for involving relatives as a co-care provider in our settings. In this part of globe, the presence of patient's relatives 24 × 7 in a public hospital is an accepted norm; however, their role has not been studied by the hospital administration and adequate provision has not been translated in the hospital architecture. Aims: To assess the knowledge and attitude of employees working at the apex acute care hospital, New Delhi toward patient's relatives. Setting and design: The study design is a survey research using a self-administered questionnaire to elucidate knowledge and attitude of healthcare workers in the apex trauma center. Materials and methods: A knowledge-and-attitude survey based on a questionnaire was undertaken during July 2016, among willing employees. The performa was distributed to different wards and areas, and was gathered the next day. The questionnaire was developed with the help of the faculty of hospital administration, and a beta analysis was performed before the final application. Results: A total of 159 performas were collected, of which 2 were rejected because of being incomplete. An estimated 93.6% respondents favor the idea of family staying at the bedside of a patient in the wards. Most of respondents were young, have 5–10 years of service, were well qualified, and were well versed with patient-care-giving practices. The factors favoring family stay in wards were ease to handle patients with accompanying family, family role in perceived faster recovery, emotional support to the patient, positive role of family in patient feeding, and role of family in reducing patient safety incidence. However, the role of family members in HAI and concerns for the privacy of the relatives were negatively related to the family stay in wards. The majority were not satisfied with the provisions made for the relatives in the hospital. A very high percentage believe that the design of the hospital needs to be changed for providing more space for relatives. The idea of introducing a foldable bed was accepted by a huge majority. Conclusion: With the accumulation of the knowledge that severe hospital-acquired infection (HAI) incidences are not affected by the presence or absence of the relatives near the patient, the level of anxiety, incidences of cardiac complication, and stress hormones’ level in the blood are favorably affected by the presence of relatives; family involvement is not just an administrative issue, and it has found clinical implication also. It is time to give bigger roles to the family for patients staying at the hospital.


Original Article

Rajesh Harsvardhan, Tulika Gupta, Hem Chandra, Aprajita Jaiswal, Madhu Rendra Kumar

Impact of an Intervention on Hand Hygiene Practices among Various Categories of Healthcare Workers at a Tertiary Healthcare Teaching Institute in Lucknow, Uttar Pradesh, India

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:5] [Pages No:6 - 10]

Keywords: Hand hygiene, Hospital acquired infection, Infection

   DOI: 10.5005/jp-journals-10035-1105  |  Open Access |  How to cite  | 


Introduction: Healthcare-associated infections are major burdens for patients, society, and healthcare management. An infection control program is considered efficient which, when used appropriately, restrict the spread of infection among patients and staff in hospital. Materials and methods: The present study was conducted in a tertiary healthcare teaching institute from May 2017 to April 2018. The intervention program included following elements: administrative support, education and training, monitoring and feedback. Microsoft excels and Statistical Package for Social Sciences version 23 (SPSS 23) were used for statistical analysis. Observations and results: The compliance with hand hygiene practices was observed to have been better by 24.37%, postintervention. And out of eight preidentified areas, the maximum 30% improvement in compliance with hand hygiene was found in neurosurgery ICU.


Original Article

Rajat Prakash, Shashikant Sharma, Ashutosh Sharma

Healthcare Failure Mode and Effect Analysis: Dispensing Errors in the Pharmacy of an Outpatient Department of a Public Sector Tertiary-care Teaching Hospital

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:8] [Pages No:11 - 18]

Keywords: Failure mode and effect analysis, Medication errors, Patient safety, Quality

   DOI: 10.5005/jp-journals-10035-1106  |  Open Access |  How to cite  | 


Background: Dispensing failures mean that a breach has occurred in one of the last safety links in the use of drugs. Although most failures do not harm patients, their existence suggests fragility in the process and indicates an increased risk of severe accidents. Materials and methods: To address these gaps in our understanding of dispensing errors, we conducted a direct observational study to determine the various failure modes, categorize the types of errors, and evaluate their potential to cause patient harm using healthcare failure mode and effect analysis (HFMEA). Results: The high-risk failure modes identified were as follows: patient unable to understand the prescription, illegible prescription, medication dispensed to wrong patient, counseling about new dose does not occur or ineffective, and patient taking incorrect dose. Conclusion: None of the steps in the drug-dispensing process were free of potential failure modes, but six failure modes emerged as the most vulnerable steps [with risk priority numbers (RPNs) over 168]. The most critical elements in the dispensing of drugs in the present setting were where patient does not understand proper use of prescription of potentially dangerous drug interaction (RPN 432) followed by illegible prescription. There is a dire need of application of systems theory with actions needed at every level of drug dispensing mechanism. Quality tools such as HFMEA and root cause analysis are warranted to forecast various failure modes and to find out root causes of adverse events that happen.


Original Article

Suman R Kashyap, Seema Sachdeva, Yangchen Dolma, Anita Sarin, Shakti Kumar Gupta

Knowledge, Practice and Attitude of Hepatitis B Infection and its Prevention among Nurses in a Tertiary Eye Care Center of Delhi

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:5] [Pages No:19 - 23]

Keywords: Hepatitis B virus, Infection prevention, Vaccination

   DOI: 10.5005/jp-journals-10035-1104  |  Open Access |  How to cite  | 


Background: Hepatitis B infection is a common disease all over the world. According to its endemicity, countries are divided into three groups (high, intermediate, low). India falls in the intermediate endemicity zone (prevalence of 2–8% with an average of 4%). The risk of contracting hepatitis B virus (HBV) is four times greater for healthcare workers, compared to that of the general adult population. So, the study was aimed to assess knowledge, practice, and attitude of nursing officers regarding hepatitis B infection and its prevention, its association with selected variables, and correlation between knowledge and practice. Materials and methods: A cross-sectional survey was carried out among 180 nursing officers working in an ophthalmic center of a tertiary care hospital using 38 items, self-administered questionnaire with three sections for knowledge, practice, and attitude regarding HBV infection and its prevention. The data were collected in the morning and evening shift as per the subject's availability after obtaining a written consent from subjects. The analysis was performed using the statistical analysis software. Results: Among 180 respondents, 8% had poor knowledge whereas 92% showed adequate knowledge about HBV infection and its prevention. Poor knowledge was apparent in items like diet required in hepatitis infection (29%); otherwise, in rest all the areas, adequate knowledge was observed. Regarding practice, 14% had poor practices whereas 86% showed good practices. With regard to attitude, majority of the subjects had positive attitude for the items like risk of getting HBV infection (80%), importance of HBV vaccination (97%), and using universal precaution (98%). Uncertainty and disagreement showing negative attitude was observed in items like revealing the HBsAg+ve status at work (73%), sharing utilities with an infected person (71%), feeling stressed to take care of an infected patient (38%), fear of social isolation (80%), and vaccination for an HBV-infected patient (60%).


Original Article

Priya Darshini M Pedagandham, Swapnil B Tak

A Statistical Model to Estimate the Number of Registration Desks Required to Minimize Patient Wait Time in the Outpatient Department of a Multispecialty Hospital

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:5] [Pages No:24 - 28]

Keywords: Hospital, Patient load, Patient registration, Resource planning, Wait time

   DOI: 10.5005/jp-journals-10035-1101  |  Open Access |  How to cite  | 


Introduction: Gap between demand and limited availability of resources often lead to delays, which in turn affect the patient flow in a typical hospital setting. Registration of new patients at front desk is one such place. Delays in the registration process can have an unwanted effect on patient-hospital relationship. Hence, it is important to reduce the delay. Aim: To identify various reasons for delay in the registration process of a multispecialty hospital, and develop a statistical model to estimate number of desks to be operated to reduce the wait time. Materials and methods: In a period of two weeks, a total of 923 new patient registrations were observed to collect the time consumed for various events of the registration process. Correlation analysis and statistical modelling are used in the study. Results and discussion: It was found that various factors such as literacy level of patients, mode of payments, age etc. do not show significant correlation with the registration time, except for the hourly patient load. The number of patients arriving in an hour (patient load) showed a significant correlation, suggesting that number of desks operated on regular basis was not sufficient to handle occasional high loads. A simple model that accounts for hourly patient load, estimating the number of desks to be operated in a given hour, to minimize the wait times at registration desk has been suggested. Conclusion: The model indicates that in the current setting, most of the times the resources were either underutilized or overloaded. The delays in registration process can be reduced by operating optimal number of desks as determined by the proposed model (i.e. function of hourly patient load).



Roghayeh Bakhshi, Soad Mahfoozpour, Khalil Alimohammadzadeh, Hamed Norouzi, Hamid Zaferani Arani

Impact of the Presence of Resident Specialists on the Emergency Department Performance Index at Hospitals of Mashhad University of Medical Sciences, Mashhad, Iran

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:4] [Pages No:29 - 32]

Keywords: Department performance index, Emergency department, Hospital, Resident specialists

   DOI: 10.5005/jp-journals-10035-1099  |  Open Access |  How to cite  | 


Aim: The main purpose of an emergency department (ED) is providing high quality services in the shortest possible time. Presence of resident specialists is one of the elements in healthcare reform plan which has been implemented with the aim of resolving the main problems of the healthcare system. This study examines the impact of the presence of resident specialists on the emergency department performance index (EDPI) at hospitals of Mashhad University of Medical Sciences (MUMS). Materials and methods: In this cross-sectional study, changes in EDPI were investigated over a period of June 2013 to June 2014 (before the presence of resident specialists) and June 2014 to June 2015 (after the presence of resident specialists). All hospitals in MUMS which implemented the presence of resident specialists were selected by the census method. Hospital General Information Form was used to collect data. Information required were collected and recorded after obtaining the permission from the health department. After collection, data were analyzed by SPSS 19. Results: The percentage of disposed patients within 6 hours before the presence of resident specialists was 80.96% and after the presence of resident specialists was 89.07%. The percentage of leaving the ED in 12 hours before the presence of resident specialists was 86.21% and after the presence of resident specialists was 88.76%. Conclusion: According to the results, it can be concluded that the EDPI in hospitals of MUMS after the presence of resident specialists has shown a significant difference, and improved, except for those left ED in 12 hours.



Influence of Leadership Commitment on Patients’ Satisfaction within Hospitals in Nairobi, Kenya

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:6] [Pages No:33 - 38]

Keywords: Leadership commitment, Patients' satisfaction, Total quality management

   DOI: 10.5005/jp-journals-10035-1103  |  Open Access |  How to cite  | 


The study examined the influence of leadership commitment on patients’ satisfaction with hospitals in Nairobi. A positivist research philosophy was applied in this study. A mixed research design was used to target employees and patients of hospitals within Nairobi, from whom data were collected through a self-administered questionnaire. The target population was the hospital employees and patients of level-four, level-five, and level-six public and private hospitals within Nairobi. Simple random sampling was used to select hospitals, while stratified random sampling was used to select the employees and patients. The data were collected from the closed-ended questionnaire, which was coded, analyzed, and presented in tables. The study findings showed that leadership commitment (β = −0.254, p = 0.001) and organization factors (β = 0.142, p = 0.00) had a significant influence on customer satisfaction. The leadership in healthcare should realign the staff inputs toward improving patient experiences.



AK Mohiuddin

Framework for Patient Safety

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:10] [Pages No:39 - 48]

Keywords: Errors, Healthcare professionals, Medication, Patient, Reporting, Risk, Safety

   DOI: 10.5005/jp-journals-10035-1100  |  Open Access |  How to cite  | 


Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription/dispensing/administration errors) and prescribing faults due to flawed medical decisions can result in harm to patients. Any step in the prescribing process can kindle errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the recording of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common. Inadequate awareness or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially incorrect medications. An unsafe working environment, complex or undefined procedures, and inadequate communication among healthcare personnel, particularly between doctors and nurses, have been identified as significant underlying factors that contribute to prescription errors and prescribing faults. Active interventions aimed at reducing prescription and prescribing faults are strongly recommended. These should be dedicated on the education and training of prescribers and the use of online aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid recording and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically. Objective: Discussion and projection of medication safety and the strategies to improve its efficiency. Methods: The research is conducted through secondary data search from several sources including books, technical newsletters, newspapers, journals, and many other sources. The present study was started since the beginning of 2018. PubMed, ALTAVISTA, EMBASE, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials was thoroughly searched. The keywords were used to explore different publishers’ journals such as Elsevier, Springer, Willey Online Library, and Wolters Kluwer that were extensively followed. Findings: A medication intervention is a sophisticated technique of both arts and science. Improvement is valued when the total system coordination brings an overall improvement in every aspect of prescribing, dispensing, administration, and monitoring. Error in any stage ruins the effort of the total system.



Ashwini Jogade, Pradyummna Oak, Rajendra Patankar, Deepak Patkar

Effectiveness of “Code White”: Joint Association of Administrator and Clinicians for Delivering Effective Treatment in Stroke Patients

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:4] [Pages No:49 - 52]

Keywords: Mechanical thrombectomy, Stroke, Thrombolysis

   DOI: 10.5005/jp-journals-10035-1107  |  Open Access |  How to cite  | 


Stroke is the sudden death of brain cells due to lack of oxygen caused by blockage of blood flow or rupture of an artery to the brain. The common symptoms include sudden loss of speech, weakness, or paralysis of one side of the body. Other symptoms could include black-out, sudden loss of vision, problems with balance and coordination, and difficulty in swallowing. It could be a cause of mortality and morbidity, if not treated in time. The field of stroke medicine has changed considerably in recent years with the development of hyperacute treatments such as thrombolysis, mechanical thrombectomy, and measures of secondary prevention. There are challenges in the diagnosis and management process due to the complex need and urgency of the patient treatment. The management of Nanavati Super Speciality Hospital using the assembly line technique proactively took a project of prompt and comprehensive management of stroke patients; in fact, a special emergency response code—“Code White”—was created to handle patients with stroke during emergency. The doctors, staff and administrative staff were sensitized and trained, and simulation exercises done for quick diagnosis, effective delivery of treatment, and to expedite the procedure. The doctors also prepared skits to train the resident doctors and the nursing staff. This article will review the measures taken, effectiveness of multidisciplinary approach of Code White in the treatment of patients with stroke.


Haemovigilance Programme of India

[Year:2019] [Month:January-June] [Volume:7] [Number:1] [Pages:1] [Pages No:53 - 53]

   DOI: 10.5005/jrfhha-7-1-53  |  Open Access |  How to cite  | 


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