Sir,
The concepts of quality assurance and quality control are rapidly gaining popularity in surgical sciences. As rightly predicted, the quality of anaesthesia services is now largely monitored by quality indicators and a large change is taking place in anaesthesia practice.[1] Many hospitals in India are currently going in for National Accreditation Board for Hospitals and Health Care Providers (NABH) accreditation to improve the quality of their health care services. NABH has launched its 5th edition of Standards in April 2020.[2] The chapter 'Care of Patient ' (COP. 13.) in this edition has ten objective elements (OE) that are applicable to anaesthesia services. These are applicable for all kinds of anaesthesia except local anaesthesia. Also, patient assessment, monitoring and documentation are to be done by a qualified anaesthesiologist.
COP. 13.a requires that there should be consistency in anaesthesia services, which should be based on sound clinical practices and standard guidelines. Documented Anaesthesia Policy should contain indications of anaesthesia, types of anaesthesia and should be followed in every location of the hospital.
COP. 13.b requires documented anaesthesia plan after pre-anaesthesia examination (PAE). It should be done in a standardised manner before patient reaches the operation theatre (OT). For elective surgeries, PAE can be done on an outpatient department basis and is valid for 30 days
COP. 13.c requires documented pre-induction assessment of the patient by an anaesthesiologist. In emergency cases, both pre-anaesthesia assessment and pre-induction assessment can be done simultaneously but should be documented separately. In case surgery is deferred, reason and further plan should be documented.
COP. 13.d entails informed consent for administration of anaesthesia, separate from surgery consent, to be taken by the anaesthesiologist. Consent must be different for different types of anaesthesia, be bilingual and has to be signed by the patient.
COP. 13.e explains monitoring during anaesthesia which should include temperature, heart rate, cardiac rhythm, respiratory rate, blood pressure, oxygen saturation and end-tidal carbon dioxide. It should be documented. End-tidal CO2 can be omitted in regional anaesthesia. Anaesthesiologist has to remain present throughout the procedure.
COP. 13.f requires patient to be monitored in the post-anaesthesia period in the OT/recovery room/intensive care unit.
COP. 13.g requires application of defined criteria to transfer the patient from the recovery area. Decision should be documented by the anaesthesiologist. One example of such criteria is Aldrete Discharge Scoring.
COP. 13.h entails keeping printed record of type of anaesthesia and anaesthetic medication used. Document should be timed, dated and signed. Signatures and the author of the entry should be identifiable (by name, employee code, stamp etc.).
COP. 13.i defines requirement of infection control guidelines so that there is no cross infection between patients. It is very important to prevent infection through reuse of equipment. Circuits, laryngoscope blades, suction apparatus etc., should be disinfected with recommended disinfectants.
COP. 13.j stresses upon capturing intraoperative adverse anaesthesia events, documenting them, and communicating to the designated authority for analysis.
The minimum list of documents needed for implementation of OEs related to anaesthesia include anaesthesia manual for all kinds of anaesthesia, PAE cum anaesthesia plan record, pre-induction assessment record, informed consent, anaesthesia record, record of post-anaesthesia monitoring, policy on criteria to shift patient from recovery area, record of criteria to shift patient from recovery area, infection control policy and record of intraoperative adverse anaesthesia events.
The delivery of quality anaesthesia care depends on a reliable foundation of health care inputs, including adequate infrastructure, reliable supplies of equipment and an adequate number of skilled anaesthesia providers[3]; nevertheless, NABH standards ensure this quality. A study showed that sound knowledge and a positive attitude toward NABH accreditation among the medical staff are very important for the success.[4] We feel that previous exposure in NABH accredited hospitals, prior training and knowledge of NABH standards, and provision of NABH manual in the department can certainly make things easier for the anaesthesiologist newly accepting NABH standards.
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Conflicts of interest
There are no conflicts of interest.
REFERENCES
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