TELEMEDICINE Adapt and Adopt Newer Modalities of Teaching-Learning Which Will Be the New Normal for the Foreseeable Future
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The Quarterly Bulletin of the Dept of Hospital Administration, AFMC MISSION STATEMENT “Department of Hospital Administration strives to impart the highest quality education, training and research in the field of healthcare administration and health facility planning. The department also endeavours to be the nodal point for healthcare quality and accreditation in Armed Forces Medical Services” PLACE: PUNE YEAR - 1 Message from Editor’s Desk ISSUE - IV It is an honour to pen down the editorial for this edition of NEETI, which is being released at a time when we have all faced and overcome the challenges of dealing with the Covid Pandemic. O C T 2 0 2 0 It is only during adversity that the true character of men is revealed. And it is during challenging times that all the Leadership Qualities of a Hospital Administrator are truly tested. The faculty and residents of our department have led the way in planning, designing and operationalizing two Covid Hospitals recently, a INSIDE THIS 1000 bedded facility at Delhi and another 500 bedded at Muzaffarpur, Bihar. The practical hands on experi- ISSUE: ence earned by the residents during these deployments will serve them well during their future endeavours. Legal Bugle 1 The pandemic has also reiterated the importance of Situational Leadership in today’s world, forcing us all to TELEMEDICINE adapt and adopt newer modalities of Teaching-Learning which will be the new normal for the foreseeable future. Lastly it has brought into focus the importance of Evidence Based Clinical Practice like never before, Treat Safe 2 even shining a light on difficult to discuss topics like the reliability of research findings and the role of PATIENT FALLS Pharmaceutical and Medical Equipment Manufacturers in Healthcare Delivery. To that end “Strong Medicine” has been chosen for the book review in this edition. In the Patient Management Tool 3 Safety segment, we discuss Patient falls as a preventable occurrence in hospitals and Root Cause Analysis as ROOT CAUSE a tool for Quality Improvement. ANALYSIS Here’s hoping that you enjoy reading this edition as much as we have enjoyed putting it together. Case Study 4 WORK STUDY -Col Surekha Kashyap (Prof & Offg HoD) RT-PCR Projects & Works 5 TELEMEDICINE ACCEPTANCE OF NECESSITY ‘The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease Book Review 6 and injuries, research and evaluation, and for the continuing education of health care STRONG MEDICINE providers, all in the interests of advancing the health of individuals and their Seven Elements of communities.’ (WHO) Pl find e-copy at: Tele-medicine . www.afmc.nic.in/ Restrictions on prescribing medi- Departments/HospitalAdm/ Context publications.html Neccessity in India cines Identification of RMP and Patient 3.2 million sq km (7th largest List ‘O’- “Over the counter drugs” Editorial Board country geographically in the Medicines that deemed necessary dur- Mode of communication world) ing public health emergencies (video, audio, text or asyn- Patron : Varied landscape & far flung List ‘A’-safe & low potential for abuse chronous) Lt Gen Nardeep Naithani areas Consent (Implied or Ex- List ‘B’-prescribed during in-person Deficient healthcare facility plicit) to be taken Vice Patron : consult for the same medical illness Type of consultation Maj Gen R M Gupta, VSM 75% qualified doctors-urban centres List Prohibited-Schedule X drugs, (First or Follow up within Narcotics & Psychotropic Editor-in-Chief : 68% rural population deprived 6 months for same illness) Brig A K Naik from direct access substances Patient Evaluation Rapid technological changes Patient Management Editors : Col Surekha Kashyap “Telemedicine as a modality shall act Col Saroj Kumar Patnaik as an instrument for equitable distri- bution of healthcare resources in Lt Col Shashikant Sharma India” Assoc. Editors : Lt Col Lavneesh Tyagi Maj Bipul Kumar Singh Maj Neelesh Patel Dr Nidhi Sharma ISRO Telemedicine programme started in 2001 & it has been connecting remote/rural/medical college hospitals and Mobile Units through the Indian satellites to major specialty hospitals in cities and towns. Patient Falls (International Patient Safety Goals) Falls are the second leading cause of accidental or unintentional injury deaths worldwide. Each year an estimated 6,46,000 individuals die from falls globally of which over 80% are in Types of falls low and middle income countries. Adults older than 65 yrs of age suffer the greastest number of fatal falls. 37.3 million falls that Accidental fall : are severe enough to require medical attention occur each year. (WHO) Caused by accident & can be prevented through universal Studies show falls occur at a rate of 3–5 per 1,000 bed-days precautions applied to all pa- (medalerthelp.org/blog/falls-in-the-elderly-statistics/) tients Anticipated physiological Risk factors: Most patient falls are caused by a combination of fall : factors. Few of the causes are Caused by underlying medical Risk assessment Previous fall history problems or symptoms Gait instability and lower limb weakness Risk assessment of a patient is a Unanticipated physiological Urinary incontinence, frequency or the need continuous process starting right fall : for toileting from the admission of the patient Caused by an underlying medi- Agitation, confusion or impaired judgement in the hospital till the time patient is discharged fit and cal or physiological problems Aged patients extended if the home care that has not been diagnosed Medications like sedation hypnotics continues. Monitoring Patient Risk Assessment ToolMonitoring can be Can be done through the done through the inci- incident reporting of falls dent reporting of falls and calculation of the fall and calculation of the rate as Falls per 1,000 occu- fall rate as Falls per pied bed days on a monthly 1,000 occupied bed basis days on a monthly basis Falls in healthcare facil- ities can be Expensive, Dangerous and Deadly 11,000 fatal falls occur each year in hospitals Fall injuries increase hospital stays by an average 6.3 days According to the CDC, injuries from falls are estimated to be among the top twenty MOST Suggested Measures EXPENSIVE medical Role of Hospitals & Universal Precautions to prevent Patient Falls conditions In 2013, total cost of healthcare Side rails to be raised for all patients. Patient and family to be informed and fall injuries was $ 34 BIL- educated on need to raise side rails. LION Safety First signage to be appropriately placed as applicable Call Bells to be kept within patient’s reach By 2021, the total cost of these fall injuries could be as much as Toilet and Nutritional needs of the patient to be met 67.7 BILLION Transfer assistance to be provided with appropriate tagging to ensure proper $ communication of vulnerable patient Even falls that don't cause injury Restraints to be applied whenever clinically indicated can cause fear of falling leading Hook & Loop alarm belt to physical decline, depression Environmental Control to be provided including and social ISOLATION i) Floors to be kept dry in ward and toilet ii) Patient to be educated not to walk holding the food trolley or STEADI -Stopping Elderly other objects containing wheels Accidents Deaths & Injuries) iii) Grab bars to be located properly in toilets and bathroom initiative. iv) Staff to ensure assistance during patient movement or walking (CDC) P A G E 2 “The best way to find yourself is to loose yourself in the service of others” - Mahatma Gandhi Root Cause Analysis oot cause analysis (RCA) is a structured method R “For want of a nail the shoe was lost, for want of a shoe the used to analyze serious adverse events. Initially de- horse was lost, for want of a horse the knight was lost, for want veloped to analyze industrial accidents, now widely of a knight the battle was lost, for want of a battle the kingdom deployed as an error analysis tool in health care to was lost. So a kingdom was lost—all for want of a nail.” move quality efforts forward. As healthcare organisations become more atient safety events can cause serious harm or death. To address & complex, processes are interdependent P prevent these threats, healthcare organisations must dig deep to unearth increasing the risk of failures. the root cause(s) and develop solutions that address the problems from a These failures result in - systems perspective. Tragedy for individuals served A multidisciplinary team analyzes the sequence of events leading to the error, Add cost to the already overburdened with the goals of identifying how the event occurred (through identification of healthcare system active errors) and why the event occurred (through systematic identification and Adversely affects the public’s perception analysis of latent errors) Leads to litigations The ultimate goal of RCA is to prevent future harm by eliminating the latent Affects healthcare professionals who are dedicated to the well-being of their patients errors that so often underlie adverse events. Fish Bone Diagram A WORK STUDY TO OPTIMISE THE TESTING CAPACITY OF A COVID 19 LABORATORY IN A TERTIARY CARE TEACHING HOSPITAL Methodology: A cross-sectional descriptive work study was carried Potential increase in daily testing capacity was determined utilizing the out to determine the maximum testing capacity of the existing COVID 19 techniques of Time Study. Observed time and Standard time for all the laboratory in a tertiary care teaching hospital steps was calculated providing an allowance ranging from 10% - 20% OBSERVED ALLOW- STANDARD Results : Processing a batch of 96 reactions takes a Steps Work Station TIME ANCE TIME standard time of 08h and 09 persons with 01 RNA (a) (b) (c) (d) = (b + c) work station and 01 RT-PCR machine.