Development of ECO Standards for NABH

Development of Eye Care Organisations (ECO) Standards for
National Accreditation Board for Hospitals (NABH)

 


Dr. R D Ravindran
Chairman, Aravind Eye Care System
Madurai

There is an increasing requirement to get NABH accreditation for various purposes. The available NABH Health Care Organisations (HCO) and Small Health Care Organisations (SHCO) standards in practice for accreditation are meant for multispecialty hospitals and several elements related to obstetrics, radioactive drugs, intensive care unit etc., are not applicable for eye care organizations. Moreover HCO and SHCO categorization of the hospitals are based on the number of beds and is not specific to the specialties like ophthalmology which are mostly daycare based. Keeping in mind, the enormous number of eye care organizations and the magnitude of ocular surgeries in the country, the need for exclusive standards for eye care was realized by All India Ophthalmological Society (AIOS). On the initiative of All India Ophthalmological Society to formulate exclusive standards for eye care organizations, a technical committee of experts was formed by NABH in 2015 including members from AIOS as well.

After several rounds of meetings by the expert group for Eye Care Standards, the NABH – Eye Care Organizations (ECO) standards were formulated after obtaining public feedback from various stakeholders and approval of the NABH Board. The ECO standards were released in September 2016 and the following key points have been incorporated into the standards.


Members in the Photo (From Left to Right): Dr Suneeta Dubey, Dr Kashipa Harit, Dr Tejas D Shah, Dr Gagan Dudeja, Dr Anthony Basile, Dr K.K. Kalra, Dr Basudeb Ghosh, Dr Nirmal Fredrick, Dr R.D.Ravindran, Dr D.Chandrasekhar

Highlights of NABH ECO Standards

  1. NABH ECO standards are applicable exclusively to standalone Eye Care Organizations only.
  2. The Statutory needs that were required for NABH – HCO and SHCO were optimized to ensure patient safety requirements. The following licensing requirements are mandatory for accreditation under eye care standards
    • Registration under Clinical Establishment act / state / Local body registration
    • Consent and authorisation from Pollution Control Board to generate and mange biomedical waste, air Pollution and water pollution management
    • Fire NOC or audit certificate / License from approved agencies
    • B scan registration under PCPNDT act (state license)
    • HOTA & Eye bank licence
    • Building Plan Approval, Lift licence & Pharmacy licence
  3. Scope of services for eye hospitals was discussed and decided to include the following services and the scope and requirements of such services have been defined
    • Comprehensive ophthalmology
    • Cataract services
    • Cornea services (with or without corneal Transplant)
    • Refractive surgery
    • Orbit & Oculoplasty
    • Glaucoma
    • Vitreo-retinal services
    • Pediatric ophthalmology and strabismus
    • Neuro-ophthalmology
    • Uvea services
    • Contact lens
    • Low vision and rehabilitation
  4. Given the enormous number of surgeries conducted in ophthalmology, the OT standards with respect to air quality, reusing of single use devices and protocols for sharing of multidose vials were customized without compromising the safety requirements.
    • Requirement of Air quality were specified to suit eye hospitals
    • Requirement of unidirectional flow has been emphasized
    • Autoclaving and Sterilization techniques have been defined
  5. The actual need for licensed qualified nurses in regular NABH standards are very high as per bed ratio and no provisions are made for allied health personnel to be part of the care team. In eye care standards, these requirements have been modified to accommodate and credential refractionists, optometrists and mid-level ophthalmic personnel and also defined the need and role of qualified nursing personnel in eye care organisations.
    • Paramedical personnel are privileged to apply eye drops, prepare and assist in surgeries and helping in basic life support (BLS)
    • Qualified nurses would be needed to perform procedures like starting intravenous (IV) lines, assisting in general anaesthesia procedures (GA) and in advanced life support (ACLS)
  6. In eye care standards, privileges are given to all doctors who are part of the team instead of the surgeon alone for various aspects of perioperative care especially in larger/teaching/high volume setup.
    • Preoperative assessment
    • Taking consent
    • Administering local anaesthesia
    • Postoperative care
    • Discharging and follow up of the patient
  7. Role of General Anaesthesia in ophthalmology, protocols for local/ topical anaesthesia, General Emergency management of patients during hospitalization were developed to suit ophthalmic hospitals.
    • Pre Assessment for GA
    • Assessment on the day of surgery
    • Administering local anaesthesia
    • Monitoring and documentation of GA
    • Post anaesthesia recovery and shifting
    • Adverse events management, recording and follow up
  8. Ophthalmic imaging services requirements have been defined in ECO (Eg. OCT, FFA etc.)
  9. ECO defines the minimum requirements of a prescription (medical prescription as per MCI format, spectacle prescription or contact lens prescription etc.)
  10. ECO defines the minimum requirements of a prescription (medical prescription as per MCI format, spectacle prescription or contact lens prescription etc.)
  11. Telemedicine process standards are added in ECO.
  12. Standardization of abbreviations
  13. List of Key Performance Indicators as per requirements of Eye Care Services and Clinic Audit Protocols have been created Some of the Key Performance Indicators (KPI) to be monitored for Eye Care Organizations (as applicable)
    • Waiting time for initial assessment in OPD
    • Patient satisfaction OPD/IPD – Sample Size
    • Reporting Errors per 1000 Investigations – Lab/Biometry
    • Percentage of reports matching clinical diagnosis B-Scan, OCT, Histopathology
    • Medication error – Prescription/Administration/Combinations
    • Adverse drug reactions
    • Adverse anaesthesia events
    • Percentage of unplanned
    • return to OT – Cataract and
    • peciality wise (Glaucoma, Retina, Cornea etc.)
    • Percentage of Rescheduling of Surgeries
    • Percentage of change in planned surgery per operatively
    • Endophthalmitis Rate within 30Days
    • Percentage of stock outs for emergency drugs
    • No of variations in mock drills – once a year
    • Incidence of Falls
    • Percentage of staff provided pre
    • exposure of prophylaxis
    • Critical equipment downtime
    • Satisfaction index OP / IP
    • Waiting time for services diagnostics
    • Employee satisfaction
    • Employee attrition
    • Employee absenteeism
    • No of sentinel events
    • Percentage of near miss
    • Needle stick injuries Medical records not having discharge summary
    • Medical records without proper consent
    • Percentage of missing
    • inpatient records
    • Hand hygiene compliance
    • Wrong prescription/spectacle

Overall in NABH eye care specific standards, some of the original elements have been modified to capture what is applicable to eye care. Some of the objective elements have been removed keeping in view the resources available in
the eye care hospitals, functional requirements of eye care service providers, with emphasis on standards for infrastructure such as building, equipment, manpower, medication management, infection control and patient safety norms.

With these modifications, most of the standalone eye care hospitals will now be able to go for accreditation, facilitating continuous recognition of various Insurance schemes and 3rd party recognition. These modified standards will not only make accreditation possible, but also brings in better understanding of quality, patient safety, patient centered culture amongst the team members and also the need to `follow continuous quality improvement to attain best outcomes for our patients with lowest level of risks.