Adhiparasakthi Dental College Process Manual PDF

- ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:01 APDH/NABH/COP/01 V...

- ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:01 APDH/NABH/COP/01 Version: 3 Issue: 1 03/05/2023 of 68 1.0 PURPOSE: 1.1 To guide the APDCH staff for uniform care of patients in all the departments which is guided by the written guidance, applicable laws, regulations and guidelines 2.0 SCOPE: 2.1 Front Office-Receptionist/ Patient care 2.2 Out-Patient department 2.3 Medical Record officer 2.4 HIS (Hospital Information System) 2.5 Quality coordinators 2.6 All Out patients 3.0 RESPONSIBILITY: 3.1 Correspondent 3.2 Principal 3.3 Department heads 3.4 Doctors 3.5 Staff Nurse 3.6 Patient care coordinators 3.7 QMS coordinators 3.8 Medical record officer 3.9 Front Office Staff- Receptionist 3.10 Information technology team PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:02 APDH/NABH/COP/01 Version: 3 Issue: 1 03/05/2023 of 68 4.0 ABBREVIATION: 4.1 NABH : National Accreditation Board for Hospitals and Healthcare providers 4.2 COP : Care of Patients 4.3 APDCH : Adhiparasakthi Dental College and Hospital 4.4 OPD : Out Patient Department 4.5 SOP : Standard Operating procedure 4.6 UHID : Unique Hospital Identification number 4.7 QMS : Quality Management system 4.8 HIS : Hospital Information System 4.9 DHSP : Dental Health Care Service Provider 4.10 MAPIMS : Melmaruvathur Adhiparasakthi Institute of Medical Sciences 5.0 DEFINITION: 5.1 Out patients: Patients who visit the hospital for consultation, investigations and/or treatment and leave without getting admitted. 5.2 Registration: This is the procedure of obtaining personal details of the person seeking dental services in our hospital, entering the details in to our data management system by allotting UHID. 6.0 REFERENCE: 6.1 NABH: National Accreditation Standards for Hospitals and Health Care Service providers, Third Edition, April,2023/COP 6.2 COP 01: Uniform care of patients is provided in all departments of the DHSP and is guided by written guidance, applicable laws, regulations and guidelines PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:03 APDH/NABH/COP/01 Version: 3 Issue: 1 03/05/2023 of 68 7.0 POLICY This policy shall provide guidelines with emerging human rights for uniformity of patient care. We should recognize, acknowledge and value difference across all people and their backgrounds. We should treat everyone with courtesy and consideration and ensure that no one is belittled, excluded or disadvantaged in any way, shape or form. The Uniformity of patient care shall be guided up on the prevailing national and international laws. 7.1 All patients shall be treated alike irrespective of their religion, caste, social status, financial ability etc. The safety of all patients seeking health care at this hospital shall be the prime responsibility of this hospital. A uniform patient care system must be laid down in all areas so as to provide excellent service. 7.2 APDCH Hospital shall practice evidence based medication, the doctor prescribes a medication based on the drug available in the hospital formulary. When a drug known to produce reactions is to be given by injection, it should be done only after giving the patient a test dose. The full dose should be given only after the test dose result is studied and found to be safe. 7.3 The medical and life supporting equipment shall be kept in prime serviceable condition. All staff working in these areas should be familiar with the working of these equipments. 7.4 The supervisors and staff working at these units shall ensure the best possible care provided to all patients giving priority attention to the serious category. 7.5 APDCH shall deliver uniform care to all patients irrespective of the care settings in OP services. 7.6 Laboratory facility, Diagnostics, and Nursing Care services shall be uniformly provided to all patients irrespective of category. 7.7 APDCH ensures same quality and protocols of healthcare facility throughout the organization irrespective of the category.  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:04 APDH/NABH/COP/01 Version: 3 Issue: 1 03/05/2023 of 68 7.8 Organization shall have a uniform process for identification of patients and at a minimum uses two identifiers. 7.9 Uniform care shall be guided by written guidance which reflect applicable laws & regulations. 7.10 Evidence based medicine and clinical practice guidelines shall be adopted to guide patient care whenever possible. 8.0 PROCEDURE: 8.1 The Uniformity of patient care is guided by the prevailing national and international laws and the laws of the land. The hospital abides and complies with the statutory and regulatory guidelines published from time to time by the State and Central Government Rules. The hospital ensures that patients with the same dental problems and care needs receive the same quality of dental care throughout the organization. The policy embraces Diversity, Dignity and Inclusion in line with emerging Human Rights for uniformity of patient care. All the patients undergoing any special investigation require informed consent which is taken uniformly. MLC cases that are referred from the MAPIMS for a dental care are provided with services uniformly. There are no differences among rich patients, poor patients or cast wise differentiation in terms of care. Health is the essential commodity for all and APDCH hospital is committed to provide it to its patients uniformly as per national and international laws. 8.2 Organization has a uniform process for identification of patients and at a minimum uses two identifiers i.e., UHID and phone number, patient’s name and age. 8.3 Uniform care is guided by written guidance which reflect applicable laws & regulations.  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:05 APDH/NABH/COP/01 Version: 3 Issue: 1 03/05/2023 of 68 8.4 Evidence-based medicine and Evidence based clinical practice: Evidence-based medicine requires careful and judicious use of current best evidence in making decisions about the care of individuals. Evidence-based practice is an approach that promotes the collection ,interpretation, and integration of valid, important, and applicable patient-reported, clinician- observed, and derived evidence. In addition to the collection, evaluation, and interpretation of data, EBP emphasizes the dissemination of information so that the evidence can reach clinical practice. Therefore, well thought-out and careful clinical planning involves both individual clinical expertise and the best available external clinical evidence. Where adapting the clinical practice guidelines are not feasible, sound clinical practices shall guide the delivery of care. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:06 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 1.0 PURPOSE: 1.1 The purpose of this policy is to ensure that emergency services in APDCH are delivered effectively, safely, and in compliance with legal and regulatory requirements. 2.0 SCOPE: 2.1 All the hospital areas 3.0 RESPONSIBILITY: 3.1 Department heads 3.2 Doctors 3.3 Staff Nurse 3.4 Patient care coordinators 3.5 QMS coordinators 3.6 Medical record officer 3.7 Front Office Staff- Receptionist 4.0 ABBREVIATION: 4.1 NABH : National Accreditation Board for Hospitals and Healthcare providers 4.2 COP : Care of Patients 4.3 MLC : Medico legal cases 4.4 MAPIMS : Melmaruvathur Adhiparasakthi Institute of Medical Sciences 5.0 REFERENCE: 5.1 NABH: National Accreditation Standards for Hospitals and Health Care Service providers, Third Edition, April,2023/COP 5.2 COP 02: Emergency services are guided by written guidance, applicable laws and regulatory process PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:07 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 6.0 POLICY : 6.1 Emergency care shall be provided in consonance with statutory requirements and in accordance with the written guidelines. All emergency care services shall be provided in full compliance with applicable national and local laws, regulations, and statutory requirements. The facility shall develop and maintain written guidance, protocols, and procedures for managing dental emergencies, which all staff are required to follow. These documents shall be regularly reviewed and updated to reflect any changes in legal or clinical standards. Staff involved in the provision of emergency care shall receive regular training.Training programs will include updates on any changes in laws or internal guidelines and ensure that staff understand their roles in compliance with these standards. The facility will ensure that all necessary resources, including emergency equipment, medications, and trained personnel shall be available and maintained according to the written guidelines and statutory requirements. Emergency resources shall be regularly checked and documented to ensure they meet the standards required by law and the facility’s protocols. All emergency care provided shall be thoroughly documented and will include the patient’s condition, care provided, staff involved, and any follow-up actions. The facility shall maintain records of all emergency interventions in a manner that is compliant with legal standards and facilitates audit and review processes. The facility shall commit to ensuring that all emergency care is provided in a manner that respects patient rights and prioritizes patient safety. Informed consent shall be obtained and patients or their families will be fully informed about the nature of the emergency, the proposed treatment, and any risks involved. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:08 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 6.2 Medico-legal cases shall be managed in accordance with statutory requirements. The facility shall provide required dental services for the medico-legal cases (MLCs) referred from MAPIMS in strict accordance with statutory requirements and legal obligations. 6.3 Transfer/referral of a patient to another organization in an emergency situation shall be carried out in an organized manner. In cases where an emergency patient is transferred to another healthcare organization, a comprehensive transfer note shall be provided to the patient or their representative. The transfer note shall include detailed information on the patient’s condition, treatment provided, instructions for follow-up care, and any necessary medications. It shall also comply with statutory documentation requirements. The facility shall ensure that any transfers to other organizations are conducted safely, with proper communication and coordination between the sending and receiving facilities. Transfer protocols shall be documented and include criteria for transfer, methods of transport, and procedures for ensuring the patient’s safety during the transfer. The facility shall regularly monitor and audit its emergency care services and transfer procedures to ensure compliance with statutory requirements and adherence to written protocols. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:09 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 7.0 PROCEDURE : 7.1 Management of medical emergencies and medically compromised patients 1. Preventing medical emergencies in dental chair is the prime goal. 2. Patients under medical management for systemic diseases are referred to concerned specialist for written consent and fitness. Without which procedures are not performed. 3. Patient and guardian are aware of the risks associated with the disease. 4. Necessary blood investigations are done. 5. Emergency drugs, crash cart is pre-arranged if any undue situation is anticipated. 6. High risk category patients are preferably operated in dental OP MAPIMS. Pre-Operative Management 1. Detailed medical history of the patient to be recorded. 2. Medical condition of patient to be mentioned in the consent form. 3. Previous dental history to be recorded. (untoward incidence during dental extraction/ dental surgery should be recorded priorly) 4. Previous hospitalization of the patient and the reason for the same to be documented. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:10 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 SOP Anaphylaxis 1. Assessment of circulation, airway, breathing, and mental activity. 2. Call for medical help from MAPIMS. 3. Administer Adrenalin IM 1:1000 dilution, 0.3 ml for more than 30 kgs, 0.15 ml for 15 – 30 kgs and 0.075for less than 15 kgs reassess check BP. It can be given to a maximum of 3 dosages. 4. If blood pressure not rising, give NS IV (volume expander). 5. If bronchospasm present give inhalational Salbutamol if not relived give aminophylline 5mg/kg over 30 minutes IV. 6. Administer Diphenhydramine 50mg IV if pruritus present. SOP Cardiac Arrest 1. Assess for circulation, airway, breathing. 2. If there is no pulse, start with BLS- CPR. 3. Make the patient to lie down on the floor near the dental chair before starting CPR. 4. Call for Code blue, activate medical response team immediately. 5. IV epinephrine 1mg every 3 -5 minutes. 6. IV Amiodarone 300mg bolus. 7. Continue CPR until medical help. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:11 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 SOP Asthmatic Patients 1. Position – sitting upright inclining forward. 2. Assessment of circulation, airway, breathing. 3. Administer high concentration of oxygen to obtain PaO2 > 92%. 4. If bronchospasm present give inhalational salbutamol if not relived start aminophylline 5mg/kg over 30 minutes IV. 6. Intravenous hydrocortisone 200mg. 7. Call for medical help from MAPIMS. 8. If not relived administer salbutamol IV and IV aminophylline 5mg/kg over 20 minutes followed by 1mg/kg/hr continuous infusion. SOP Seizures 1. Assessment of circulation, airway, breathing positioning patient in supine position on a flat surface. 2. Call for medical help. Stop all procedures and remove all sharp objects from near patient 3. Establish IV line. 4. Midazolam 1 ml (1 mg)/min OR Diazepam 0.1 – 0.3mg/kg IV. 5.Intravenous Infusion of 25- 50 ml of 50% Dextrose. 5. Phenytoin 15 -25mg/kg loading dose diluted in NS is given slowly iv over 15 minutes, maintenance dose is 5mg/kg in 2 divided doses. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:12 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 SOP Syncope 1. Place the patient in supine with leg elevated position (Trendelenburg position). 2. Assess circulation, airway ,breathing. 3. Administer oxygen. 4. Loosening of clothing. 5. Respiratory stimulant: aromatic ammonia. 6. Sprinkle cold water over face. 7. If bradycardia persists, administer atropine 6mg IV. 8. If still not responding support respiration by administering oxygen. SOP Choking 1. Assess airway, breathing, and circulation. 2. Position- left lateral decubitus and encourage to cough forcefully. 3. If foreign object present, do 5 blow backs. 4. If not retrieved, do Heimlich Maneuver.. 5. If object is seen, use Magil’s intubation forceps, suction or finger swipe to remove the object. 6. Airway cannot be established go for invasive procedures cricothyroidotomy, tracheostomy. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:13 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 Management of diabetic patients and hypoglycemia 1. Monitoring Vitals – BP, Pulse. 2. Blood investigations – Random blood sugar (Routinely done) Below 200 mg/dl extraction is proceeded. 3. Newly diagnosed diabetic patients will need to undergo thorough medical investigation and opinion from Physician. 4. Uncontrolled diabetic status – Medical fitness required. Patient will be referred to MAPIMS for written consent and fitness. 5. Further investigations – Hba1c (Glycosylated haemoglobin Values) 6. Regular meal should not be skipped by patient. 7. Medication as advised by treating physician. 8. Preferred early appointment. Management of Hypertensive patients 1. Monitoring Vitals – BP, Pulse. 2.. BP under control (systolic 100 to 140mmhg Diastolic 80 to 90 mm/hg). 3. Preferably early appointments. 4. Uncontrolled hypertension patient – Medical fitness required. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:14 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 5. Referred to MAPIMS for written consent and fitness. 6. Regular meal should not be skipped by patient. 7. Medication as advised by treating physician. SOP Bleeding disorders 1. Bleeding disorders – Genetic conditions- Haemophiliac patients, Von Willibrand Disease etc. 2. Patient is referred to specialist (Haematologist). 3. Consent for procedure obtained from treating physician. 4. Treatment performed after necessary blood investigations and transfusion of required Factor VIII or Cryoprecipitate as advised by hematologist. 5. Procedure strictly performed only in dental OP MAPIMS. SOP Patient under Anticoagulants/ Antiplatelet drug 1. Thorough medical history obtained. 2. Patient is referred to treating doctor for consent and advice to stop the anticoagulant/antiplatelet as required. 3. Necessary blood investigations – BT, CT, PT, PTT, INR as ordered by physician. 4. If bridging dose of anticoagulant is necessary, specialist incharge will administer drug in MAPIMS and procedure performed in MAPIMS dental OP. 5. Standard preparations to control bleed – Eg. - Sutures, Abgel, Surgicel to be kept ready. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:15 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 SOP Patient with Liver Disorders 1. Signs of liver disease – Jaundice, Spider Naevi , Finger Clubbing ,Palmer Erythema , Sialosis, Gynaecomastia. 2. Patient have risk of impaired hemostasis. 3. The use of any drug should be discussed with physician. 4. Erythromycin, Metronidazole,Tetracycline should be avoided. 5. Aspirin and NSAIDS should be avoided –risk of gastric hemorrhage. Management of patient with Acute adrenal insufficiency: Patients on long term steroid therapy are at risk of Acute adrenal insufficiency. 1. Termination of the dental treatment and position comfortably if asymptomatic, supine with feet elevated slightly, if symptomatic. 2. Circulation-Airway-Breathing. [BLS], as needed. 3. Definitive care: Monitor vital sign, summon medical assistance, obtain emergency kit and oxygen, Administer glucocorticosteroids. 4. Consider additional hospital management: provide BLS as needed establish IV access if needed. 5. Transfer to hospital if patient is unconscious. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:16 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 Management of Hypoglycemia 1. Recognize symptoms like sweating, confusion, and dizziness. 2. Stop the dental procedure immediately. 3. Check blood glucose levels with a glucometer. 4. If conscious, give 15-20g of fast-acting carbohydrates (e.g., juice). 5. Recheck glucose levels after 15 minutes; repeat if necessary. 6. Continuously monitor the patient until stable. 7. Administer 1 mg glucagon if the patient is unconscious. 8. Call emergency services if the condition does not improve. 9. Once conscious, provide a long-acting carbohydrate. 10. Document the incident and recommend follow-up with a physician. Management of Hyperventilation 1. Recognize symptoms such as rapid breathing, dizziness, and tingling in extremities. 2. Stop the dental procedure immediately. 3. Reassure and calm the patient to reduce anxiety. 4. Encourage the patient to slow their breathing by taking deep, controlled breaths. 5. Have the patient breathe into a paper bag or cupped hands to rebalance carbon dioxide levels. 6. Position the patient comfortably, preferably in a semi-reclined position. 7. Monitor vital signs, including pulse and respiration rate. 8. If symptoms persist, consider administering oxygen. 9. Continue to reassure the patient until normal breathing resumes. 10. Document the incident and advise follow-up with a healthcare professional if necessary. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:17 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 Management of patient with thyroid disorders 1. Detection by history, examination, referral for medical evaluation. 2. T3,T4,TSH evaluation, surgical procedure to be taken up only if TFT are within normal range. 3. Recognition of fever, abdominal pain delirious or psychotic- discontinue dental treatment, activate emergency team, position the patient supine with feet elevated. 4. Asses and perform the BLS as needed and hospitalization of the patient. Infective endocarditis prophylaxis: Cardiac conditions that need IE prophylaxis are, 1. Prosthetic cardiac valve 2. Previous infective endocarditis 3. Congenital heart disease 4. Cardiac replacement recipients Dental procedures for which IE prophylaxis is recommended: All the dental procedure that involve manipulation of gingival tissues or the periapical region of the teeth or perforation of the mucosa. The following procedure does not need prophylaxis: 1. Routine anaesthetic injection through non-infected tissue. 2. Taking dental radiograph. 3. Placement of removable and orthodontic appliances. 4. Shedding of primary teeth. 5. Bleeding from trauma to the lip and mucosa. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:18 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 ANTIBIOTICS REGIMENS: Situation Medication Dosage Adults: 2.0 g; children: 50 mg/kg orally 1 h before Standard Amoxicillin procedure prophylaxis Adults: 2.0 g IM or IV; children: 50 mg/kg IM or IV within 30 Unable to take oral Ampicillin min before procedure medication Adults: 600 mg; children: 20 mg/kg orally 1 h before Allergic to Penicillin Clindamycin or procedure Cephalexin Adults: 2.0 g; children; 50 mg/kg orally 1 h before or procedure cefadroxil or Azithromycin or Adults: 500 mg; children: 15 mg/kg orally1 hbefore procedure clarithromycin Clindamycin or Adults: 600 mg; children: 20 mg/kg IV within 30 min before Allergic to penicillin procedure and unable to take oral medications Adults: 1.0 g; children: 25 mg/kg IM or IV within 30 min Cefazolin before procedure PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:19 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 7.2 Management of a medico-Legal Case The facility provides required dental services for the medico-legal cases (MLCs) referred from MAPIMS in strict accordance with statutory requirements and legal obligations and they will be documented in HIS. 7.3 Procedure for Transfer and Referral of Emergency Patients to MAPIMS 1. Assessment and Decision for Transfer: o Clinical Evaluation: Patient’s condition is evaluated to determine if transfer to MAPIMS is necessary for specialized care or higher-level treatment. Decision is based on clinical criteria and in consultation with appropriate healthcare professionals. o Documentation: Reason for the transfer in the patient’s medical record, including clinical findings and the need for specialized care will be documented. 2. Preparation of Transfer Note: o A comprehensive transfer note includes: ▪ Patient’s identification details ▪ Summary of medical condition and treatment received ▪ Reason for transfer and destination facility ▪ Follow-up care instructions and any prescribed medications ▪ Contact information for both the sending and receiving facilities o Issuance: Transfer note to the patient or their representative at the time of before transfer is provided and a copy is added to the patient’s medical record. 3. Patient and Family will be informed the reasons for the transfer, the process, and follow- up care instructions. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:20 APDH/NABH/COP/02 Version: 3 Issue: 1 03/05/2023 of 68 4. Receiving Facility is informed about the transfer, provide them with relevant patient information, and confirm acceptance. Ensure that the receiving facility is prepared to accept the patient and provide necessary care. 5. Arrangements for Emergency Transfer: o Appropriate emergency transportation is provided through an ambulance associated with MAPIMS equipped to handle the patient’s medical needs with a BLS trained staff. Transport service providers are notified of the patient’s condition and any special requirements. 6. Documentation of Transfer Process: o All the aspects of the transfer process, including the time and date of the transfer, mode of transport, receiving facility details, and any communications with the receiving facility or transport service are documented. 7. Post-Transfer Follow-Up: o Confirmation: Follow up is done with the receiving facility to confirm that the patient has arrived safely and that the necessary care has been provided. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:21 APDH/NABH/COP/03 Version: 3 Issue: 1 03/05/2023 of 68 1.0 PURPOSE: To guide the staff of APDCH during an emergency in case of cardio-pulmonary arrest. 2.0 SCOPE: 2.1 Front Office-Receptionist/ Patient care 2.2 Out-Patient departments 2.3 Medical Record officer 2.4 Quality coordinators 2.5 All Out patients 3.0 RESPONSIBILITY: 3.1 Department heads 3.2 Doctors 3.3 Staff Nurse 3.4 Patient care coordinators 3.5 QMS coordinators 3.6 Medical record officer 3.7 Front Office Staff- Receptionist 4.0 ABBREVIATION: 4.1 NABH : National Accreditation Board for Hospitals and Healthcare providers 4.2 COP : Care of Patients 4.3 ACLS : Advanced cardiac life support 4.4 BLS : Basic life support PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:22 APDH/NABH/COP/03 Version: 3 Issue: 1 03/05/2023 of 68 4.5 CPR : Cardio- pulmonary Resuscitation 4.6 DHSP : Dental Health Care Service Provider 4.7 MAPIMS : Melmaruvathur Adhiparasakthi Institute of Medical Sciences 5.0 DEFINITION: 5.1 CPR: An emergency procedure consisting of external cardiac compression and artificial respiration; the first treatment for a person who has collapsed and has no pulse and has stopped breathing; attempts to restore circulation of the blood and prevent death or brain damage due to lack of oxygen. 5.2 BLS: Basic Life Support (BLS) is the level of medical care which is used for the patients with life- threatening illnesses or injuries until the patient can be given full medical care. 5.3 ACLS: Advanced cardiac life support or Advanced Cardiovascular Life Support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life threatening medical emergencies, as well as the knowledge and skills to deploy those interventions. 6.0 REFERENCE: 6.1 NABH: National Accreditation Standards for Hospitals and Health Care Service providers, Third Edition, April,2023/COP 6.2 COP: 3 Cardio-pulmonary resuscitation services are available, when required, in the DHSP PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:23 APDH/NABH/COP/03 Version: 3 Issue: 1 03/05/2023 of 68 7.0 POLICY: All patients who suffer cardiac arrest and / or respiratory arrest at our hospital shall be resuscitated in accordance with Basic Life Support (BLS)/ACLS procedure. A Code Blue team is effectively trained in ACLS / BLS. The hospital follows American Heart Association guidelines. The steps involved in CPR are displayed in emergency department and high risk areas of the hospital. All doctors, nursing staff and ambulance drivers shall be trained in CPR. All members of the health care team working in APDC Hospital who have contact with patients will be trained and equipped to a level appropriate to their expected role, to resuscitate patients who suffer a cardiopulmonary arrest in the hospital. The minimum standard is Basic Life support (BLS). Code Blue Committee shall be responsible for ensuring that appropriate training takes place. All resuscitation attempts (actual events or mock drill) will be audited to maintain and improve standards of practice. Resuscitation equipment will be used when needed. All staff shall know where to locate equipment at the time it is needed and training is provided to a level appropriate to the persons expected role. Equipment and medications for use during cardio-pulmonary resuscitation shall be available in various areas of the organization.Each patient care area shall have designated nursing in- charge, who is responsible for checking the daily status of readiness of all resuscitation equipment and drugs.  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:24 APDH/NABH/COP/03 Version: 3 Issue: 1 03/05/2023 of 68 All CPR events shall be recorded in medical record of the patient and a post event analysis of the same shall be done by another doctor, the person performed CPR is not authorized to carry out the Post Event Analysis, the report shall be assessed by Code Blue Committee. Corrective and preventive measures shall be taken and communicated to all concerned based on post event analysis. 8.0 PROCEDURE: Whenever a requirement for providing CPR becomes necessary at any department, the requirement of BLS and ACLS Code Blue team assistance arises. An announcement is requested by the department staff nurse through emergency dial 111 to the hospital telephone exchange operator/reception staff to make a general announcement to get the assistance. While making the announcement a code word named as “CODE BLUE “at (dept name) is repeated three times over the public addressing system by the telephone exchange operator/ reception staff. On hearing this CODE BLUE announcement BLS / ACLS trained staff reaches to the place or department concerned to provide help. Simultaneously during this process, trained doctors or staff who are near to the patient assesses if the patient is unresponsive and not breathing or only gasping and the below mentioned steps should be followed Position the Patient: Lay the patient flat on their back on a firm surface. Open the Airway: Tilt the head back and lift the chin to open the airway. Check for Breathing: Look, listen, and feel for breathing for no more than 10 seconds. Start Chest Compressions: Place hands on the center of the chest and perform 30 compressions at a depth of 2 inches, at a rate of 100-120 per minute.  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:25 APDH/NABH/COP/03 Version: 3 Issue: 1 03/05/2023 of 68 Provide Rescue Breaths: After 30 compressions, give 2 rescue breaths by pinching the nose and covering the patient’s mouth, ensuring chest rise. Continue CPR: Repeat the cycle of 30 compressions ,2 breaths until help arrives or the patient recovers. Use AED if Available: Attach AED pads, follow prompts, and deliver a shock if advised The events during a cardio-pulmonary resuscitation are recorded by the nursing staff after completing the procedure in the patient’s case record. A post-event analysis of all cardiac arrests shall be done by the Code blue team. These will be regularly audited to evaluate the effectiveness of resuscitation procedures and reports are submitted to the Code Blue Committee. Corrective and preventive measures are taken based on the post-event analysis. It is the responsibility of Nursing in charge and HR Manager to ensure that clinical staff attends resuscitation training and annual updates. It is the responsibility of Nursing in charge and Doctor in-charge of Code Blue team to ensure that non-clinical staff knows how to access and initiate an emergency / cardiac arrest call. It is the responsibility of the Nursing in charge, Supervisor to ensure that any resuscitation equipment in their working area is kept clean and functional, and that it is checked on a daily basis. All concerned personnel, or newly appointed staff are informed of the emergency telephone number and the location of any resuscitation equipment. Unit / departmental staff in charge provides this information at the beginning of their duty. Organized team works effectively to provide CPR services to patients in emergency.  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:26 APDH/NABH/COP/03 Version: 3 Issue: 1 03/05/2023 of 68 9.0 Code Blue Team Members: Correspondent Chairman NABH coordinator Member Periodontist Member Oral and Maxillofacial Surgeon Member Prosthodontist Member Endodontist Member Nursing In charge Member MRD In charge Member Security Personnel Member Responsibilities: Committee members are responsible to analyze the code blue events periodically and review the result of code blue, patient condition and effectiveness of code blue. Resuscitation Trolleys: The resuscitation equipment is usually stored on specific trolleys. These trolleys are located in OP departmental areas, usually centrally near the nurse’s station or high dependency area. Each staff is responsible to familiarize themselves with the location and use of emergency equipment in their clinical area. Standard Precaution: Staffs have a responsibility to take appropriate action to ensure their own and others safety during a resuscitation attempt. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:27 APDH/NABH/COP/03 Version: 3 Issue: 1 03/05/2023 of 68 Training: The HR department maintains records of training attendance. They will conduct CPR training classes for nursing and all staffs on a periodic basis. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:28 APDH/NABH/COP/05 Version: 3 Issue: 1 03/05/2023 of 68 1.0 PURPOSE: 1.1 To guide the staff of APDCH to provide safe paediatric services 2.0. SCOPE: 2.1 Department of Pedodontics and Preventive Dentistry and other concerned departments 3.0. RESPONSIBILITY: 3.1 Dental professionals, support staff involved in the provision of paediatric dental services 4.0. ABBREVIATION: 4.1 NABH : National Accreditation Board for Hospitals and Healthcare providers 4.2 COP : Care of Patients 5.0. REFERENCE: 5.1 NABH: National Accreditation Standards for Hospitals and Health Care Service providers, Third Edition, April,2023/COP 5.2 COP: 5 The organisation provides safe paediatric services 6.0 POLICY: Organization shall provide paediatric services based on sound clinical practices/ standard treatment guidelines. This shall include assessment of paediatric patients, organization of care and addressing special care needs. Child-friendly environment shall be provided with age-appropriate equipment and a play area. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:29 APDH/NABH/COP/05 Version: 3 Issue: 1 03/05/2023 of 68 The organization shall develop individualized care plans for each paediatric patient, involving parents or guardians in decision-making and maintaining clear communication. Organization shall assess and update staff competency in handling paediatric cases. Safety measures shall be implemented including childproofing where necessary. Standardized procedures for paediatric care, including treatment protocols, sedation practices, and emergency responses specific to children and management of children with special health care needs shall be documented and implemented. Patients shall be managed with appropriate behaviour management techniques and additional support to reduce anxiety and stress in children. Paediatric patients shall be continuously monitored during and after procedures to ensure their safety and well-being. Effective communication shall be ensured with patients and families about treatment plans, outcomes, and follow-up care shall be done along with an informed consent for the procedures performed. This policy shall insist on documenting and reporting incidents or safety concerns to facilitate timely resolution and continuous improvement. Emergency procedures specific to paediatric care, including protocols for handling medical emergencies shall be documented. Regular drills and training exercises to ensure preparedness for identification and management of child abduction/abuse shall be conducted. 7.0 PROCEDURE : SCOPE OF PAEDIATRIC SERVICES 1. Oral Prophylaxis & Oral Hygiene 2. Extraction 3. Aesthetic Dental Procedures 4. Preventive Resin Restoration PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:30 APDH/NABH/COP/05 Version: 3 Issue: 1 03/05/2023 of 68 5. Restoration 0f Carious Teeth 6. Root Canal Treatment 7. Pulp Therapy - Pulpotomy & Pulpectomy 8. Interceptive Orthodontic Procedures 9. Minor Oral Surgeries 10. Apexification &Apexogenesis 11. Topical Fluoride Application 12. Pit & Fissure Sealant 13. Stainless Steel Crown 14. Space Maintainers 15. Management of Traumatic Injuries 16. Dental & Diet Counselling 17. Dental procedures under laser 18. Conscious Sedation 19. Full mouth Rehabilitation under General Anaesthesia SPECIAL HEALTH CARE NEEDS MANAGEMENT Special health care needs are any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. Standard operating procedures for children with special health care needs consists of protocols to be followed which will aid in ease and increasing the efficacy of the treatment procedure. Surgery performed on pediatric patients involves a number of special considerations unique to this population. Several critical issues deserve to be addressed. These include: PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:31 APDH/NABH/COP/05 Version: 3 Issue: 1 03/05/2023 of 68 Preoperative evaluation: a. Medical - Important considerations in treating a pediatric patient include obtaining a thorough medical history, obtaining appropriate medical and dental consultations, anticipating and preventing emergency situations, and being prepared to treat emergency situations. b. Dental - It is important to perform a thorough clinical and radiographic preoperative evaluation of the dentition as well as extraoral and intraoral soft tissues. Radiographs can include intraoral films and extraoral imaging if the area of interest extends beyond the dentoalveolar complex. Behavioral considerations: Behavior guidance includes the patient's development, education level, cognitive ability, cooperation in medical settings, triggers for uncooperative behavior, soothing strategies, adherence to schedule or routine, current therapies, and other beneficial accommodations. Comprehensive clinical examination- It includes evaluation of the head, neck, and oral structures, along with caries- and periodontal-risk assessment. Caries-risk assessment provides a means of classifying caries risk at a point in time and therefore should be applied periodically to assess changes in an individual's risk status. It also should include assessments of occlusion, habits and traumatic injuries. Informed consent: Informed consent is obtained from legal guardian/parent of patient. Procedure: Understanding the patient's cognitive level, oral aversion and triggers to negative behavior. Patients with hearing or visual impairment may require nonverbal communication and cues with the help of the caregiver. Treating active disease prior to any major medically-necessary procedures. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:32 APDH/NABH/COP/05 Version: 3 Issue: 1 03/05/2023 of 68 Deferring all elective dental treatment during active phases of medical care if a child is immunocompromised or at hematologic risk. Prescribing antibiotic prophylaxis if risk for infective endocarditis or distant site infection is high. Thorough knowledge of indications and contraindications for the use of pharmacologic agents in relation to the patient's medical condition. Preventive strategies :-Individuals with special health care needs may be at increased risk for oral diseases. Guidance is given on following areas Brushing with a fluoridated dentifrice twice daily along with the use of mouth wash A non- cariogenic diet for long term Application of sealants, topical fluorides Anticipatory guidance about risk of trauma Transitioning into adult dentistry:- When patients with special health care needs reach adulthood, their oral health care needs may extend beyond the scope of the pediatric dentist's practice. A coordinated transition from a pediatric to an adult dental facility is critical for extending the level of oral health and health trajectory established during childhood. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:33 APDH/NABH/COP/05 Version: 3 Issue: 1 03/05/2023 of 68 7.1 CODE PINK - ACTIVATION, SECURITY ALERT AND RECORD MANAGEMENT Objective: To ensure prompt and effective response to incidents of suspected abduction or unauthorized removal of children (Code Pink), maintain robust security management practices, and ensure accurate and secure record-keeping. 1. Code Pink Activation Definition and Purpose: Code Pink is activated when there is a suspected or confirmed abduction or unauthorized removal of a child from the facility. This protocol is designed to ensure a swift and coordinated response to secure the child’s safety. Activation Procedure: Immediate Notification: Staff who suspect or observe a child abduction or unauthorized removal must immediately notify the nearest supervisor or security personnel and call for Code Pink activation using the designated communication system (emergency dial 111) Code Pink Announcement: Upon activation, an audible announcement of Code Pink will be made throughout the facility thrice to alert all staff to the situation. Response Team: A Code Pink Response Team, including security personnel and designated staff members, will be deployed to manage the situation. The team will be responsible for searching the premises, liaising with law enforcement, and coordinating with other departments. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:34 APDH/NABH/COP/05 Version: 3 Issue: 1 03/05/2023 of 68 Search and Containment: Search Procedures: Conduct a systematic search of the facility, including all exits, rooms, rest rooms and grounds. Security personnel will monitor and control all exits to prevent unauthorized departure. Law Enforcement Notification: Notify local law enforcement immediately and provide them with relevant information about the incident and any potential suspects. Post-Incident Procedures: Debriefing: Conduct a debriefing session with the Code Pink Response Team to review the response and identify areas for improvement. Incident Report: Document the incident in detail, including actions taken, individuals involved, and outcomes. Submit the report to the relevant authorities and file it in the incident management system 2. Security Management There should be a limited entry of unauthorised personnel to sensitive areas CCTV cameras in strategic locations, including entrances, exits, and paediatric care areas should be managed and monitored. Ensure cameras are functioning correctly and footage is reviewed periodically. Regular security patrols of the facility, including checking for any security breaches or vulnerabilities should be conducted. Provide regular training for staff on security procedures, including how to handle security breaches and emergencies. Conduct periodic drills to ensure readiness. Develop and implement clear emergency procedures for various security incidents and ensure they are communicated to all staff. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:35 APDH/NABH/COP/05 Version: 3 Issue: 1 03/05/2023 of 68 Maintain accurate and comprehensive records of all incidents, including Code Pink activations, security breaches, and emergency responses. Include details such as date, time, individuals involved, actions taken, and outcomes. Ensure all records related to security and incidents are stored securely and are accessible only to authorized personnel. Review and update security and record management policies annually or as needed to address changes in regulations or improvements in practices. Conduct regular audits of security management and record-keeping practices to ensure compliance with internal policies and external regulations. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:36 APDH/NABH/COP/05 Version: 3 Issue: 1 03/05/2023 of 68 7.2 IDENTIFICATION AND MANAGEMENT OF CHILD ABUSE 1. OBJECTIVE: To ensure a coordinated and effective response to incidents of child abuse or suspected child abuse within the facility. 2. SCOPE: Doctors, staff members, nursing, administrative, and support staff. 3. DEFINITION: (Child Abuse): A designated emergency indicating a suspected or confirmed incident of child abuse requiring immediate attention and intervention. 4. PROCEDURE: IDENTIFICATION AND ACTIVATION: Any staff member who suspects or witnesses an incident of child abuse must immediately notify their supervisor and call for an emergency service using the facility’s designated emergency communication system (Emergency call number: 111). Provide essential details such as the location, nature of the incident, and any immediate safety concerns. IMMEDIATE RESPONSE: A trained response team, including security and child protection personnel, will be dispatched to the scene immediately. Safety of the child will be ensured and remove them from immediate danger if possible. The response team will secure the area and ensure privacy for the involved parties. Concerned staff will assess and provide necessary care to the child, documenting any injuries or signs of abuse. DOCUMENTATION AND REPORTING: Detailed documentation of the incident must be completed by all involved personnel. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:37 APDH/NABH/COP/06 Version: 3 Issue: 1 03/05/2023 of 68 1.0 PURPOSE: 1.1 To define policies guiding the care of vulnerable patients. 2.0 SCOPE: 2.1 The entire scope of services provided to elderly, children below 14 year old, pregnant women, extreme weakness due to prolonged illness, physically and / or mentally challenged patients, critically ill, patients under sedation, anesthesia, patient’s on chemotherapy and dialysis 3. 0 RESPONSIBILITY: 3.1 Management 3.2 Doctors 3.3 Nursing staff 3.4 Other support staff 3.5 Patient care coordinators 3.6 QMS coordinators 3.7 Front Office Staff- Receptionist 4.0 ABBREVIATION: 4.1 NABH : National Accreditation Board for Hospitals and Healthcare providers 4.2 COP : Care of Patients 5.0 DEFINITION: Vulnerable: Those patients who are prone to injury and disease by virtue of their age, sex, physical, mental and immunological status e.g. infants, elderly, physically and mentally challenged those on immunosuppressive and / or chemotherapeutic agents. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:38 APDH/NABH/COP/06 Version: 3 Issue: 1 03/05/2023 of 68 6.0 REFERENCE: 6.1 NABH: National Accreditation standards for Hospitals and Health Care Service providers, Third Edition, April,2023/COP 6.2 COP: The organisation identifies and manages patients who are at higher risk of morbidity/mortality 7.0 POLICY: 7.1 The hospital shall offer special care taken as per the following laws and Acts to elderly patients, mentally and physically challenged people who are considered as vulnerable group. The vulnerable patients shall be kept in safe and secured environment to reduce the risk of abuse. Informed consent shall be obtained from patient attendee / relative if required as per policy Persons with Disabilities Act, 1995. Mental Health Act, 1997. Guardians and Wards Act, 1890. Consumer Protection Act, 1986. Protection of Human rights act. 7.2 Staff shall be trained to provide care for the patients under vulnerable group. All patients aged 65 years and above and infants and children (below the age of 14) Pregnant patients Patients with limited physical mobility Specially those who cannot perform their daily necessary activities of living Patients with impaired mental function PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:39 APDH/NABH/COP/06 Version: 3 Issue: 1 03/05/2023 of 68 An unconscious patient left alone or unattended. Patients on wheel chairs, trolleys, walking aids hearing aids. Limited physical mobility Impaired mental function Impaired communication or language problems Patient with impaired bladder function 7.3 Organization identifies and manages patients who are at risk of fall where a validated tool shall be used for the assessment of the patients who are at risk of fall 7.4 Organization shall identify and manages patients who need restraints and provide care to them by the trained and competent professionals 8.0 PROCEDURE: Care of Vulnerable Patients: Prompt attention and service is provided while minimizing waiting times in OPD & diagnostics for vulnerable patients. For all group of vulnerable patients, Green flag symbol identification is reflected in HIS and PRIORITY FIRST signage label is pasted in UHID card with green color code. Elderly patients who are having difficulty in walking are identified and all help is ensured to them to see the doctor. Organization provides safer environment considering the requirements of vulnerable patients like fall prevention measures, ramps, grab bars in rest rooms, wheel chair facility. Physically challenged patients are provided with a wheel chair to go about in the hospital to avail various facilities. Vulnerable patients are not left alone at any given time. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:40 APDH/NABH/COP/06 Version: 3 Issue: 1 03/05/2023 of 68 A female attendant guides female patients and children of both genders towards rest rooms Any special requests made by the patient/family are respected. Relatives are explained about patient condition and educated about diet and health activities. The nursing staff and the attendees shall show maximum tolerance and patience while dealing with these patients. Attendants/relatives shall be encouraged to be with them whenever advisable. Special care should be taken by the treating doctor or the attending nurse/technician to explain things related to the disease and treatment carefully and patiently. Informed consent is obtained from the persons directly related to the patient like father, mother, brothers or sisters and guardian while treating a child or mentally challenged patient Everything about the proposed procedure / treatments are informed along with possibilities of likely complications that may arise. 9.0 Policy and care for Pregnant patients: All treatment should be done only after consultation with the patient’s Gynecologists. According to FDA drug classification for pregnant patients, only drugs which fall under category A and category B will be prescribed to pregnant patients. Radiographic investigations will be avoided as far as condition permits but when there is absolute indication for radiograph for further management, radiographic views with minimal exposure will be advised Elective surgical procedures if absolutely indicated will be performed in the second trimester after obstetrician fitness for the procedure. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:41 APDH/NABH/COP/06 Version: 3 Issue: 1 03/05/2023 of 68 In third trimester if the patient requires any oral surgical procedure, procedure shall be performed at dental OPD at MAPIMS after obtaining fitness from obstetrician Whenever possible all the elective surgical procedures will be postponed until postpartum. Supine position should be avoided to prevent supine hypotensive syndrome in which a supine position causes a decrease in cardiac output, resulting in hypotension, syncope and decreased uteroplacental perfusion In addition, the supine position may cause a decrease in arterial oxygen tension and increase the incidence of dyspepsia from gastroesophageal reflux secondary to an incompetent lower esophageal sphincter. Finally, the supine position poses an increased risk of developing deep venous thrombosis by compression of the inferior vena cava leading to venous stasis and clot formation The ideal position of the gravid patient in the dental chair is the left lateral decubitus Position. 10.0 Procedure for identification and management of patients who are at risk of fall Universal fall precautions are safety measures implemented across all healthcare settings to prevent falls among patients, regardless of the individual fall risk. These precautions are standardized practices designed to create a safe environment and reduce the likelihood of falls. Universal Fall Precautions 1. Patient Education: Educate all patients and their families about the risk of falls, especially in an unfamiliar environment like a hospital. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:42 APDH/NABH/COP/06 Version: 3 Issue: 1 03/05/2023 of 68 Encourage patients to ask for assistance when needed, particularly when getting up or moving around. 2. Environment Safety: Ensure the patient's surrounding areas are free of clutter and tripping hazards. Keep the floor dry and clean, immediately addressing spills or wet surfaces. 3. Adequate Lighting: Ensure that patient areas are well-lit. 4. Proper Footwear: Encourage patients to wear non-slip, supportive footwear when walking or standing. 5. Use of Mobility Aids: Ensure that patients who require mobility aids, such as wheel chairs have them within easy reach. Provide assistance when needed and ensure that the aids are in good condition. 6. Toileting Safety: Offer regular assistance with toileting, especially for patients who may need help. Ensure the bathroom is accessible and safe, with handrails and non-slip mats in place. 7. Medication Management: Review Medications: Regularly review the patient’s medications to identify those that may increase fall risk, such as sedatives, antihypertensives, or diuretics. Adjust Doses: Collaborate with the healthcare provider to adjust or discontinue medications that contribute to fall risk where possible. 8. Monitoring and Supervision: Regularly check on patients, especially those at higher risk of falls, and offer assistance as needed. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:43 APDH/NABH/COP/06 Version: 3 Issue: 1 03/05/2023 of 68 Management of Patients at Risk of Falls 1. Risk Assessment Initial Assessment: A thorough fall risk assessment of vulnerable patients is done using a standardized tool i.e Tinetti Balance and Gait Assessment. Ongoing Reassessment: Regularly reassessment of the patient’s fall risk, particularly after any significant change in their condition, medication, or treatment is done. TINETTI BALANCE AND GAIT ASSESSMENT: The Tinetti Balance and Gait Assessment is a widely used tool for evaluating balance and gait in elderly patients and those at risk of falls. It helps identify individuals who are at increased risk of falling and provides a basis for implementing fall prevention strategies. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:44 APDH/NABH/COP/06 Version: 3 Issue: 1 03/05/2023 of 68 2. Personalized Care Plan Personalized fall prevention care plan is decided based on the patient’s specific risk factors. This plan should include interventions tailored to their physical and cognitive status. Patient and their family are involved in developing the care plan, ensuring they understand the precautions and the importance of adhering to them. 3. Following Universal Fall Precautions 4. Safe Mobility Practices are followed like patient wears non-slip footwear when ambulating. 5. Patient and Family Education is provided on the risk of falls, the reasons for precautions, and how they can help prevent falls and importance of calling for assistance and following safety measures. 6. Emergency Preparedness A protocol for responding to falls is followed which includes immediate assessment for injury, notifying the healthcare provider, and documenting the incident is followed. After any fall, circumstances are reviewed and the care plan is modified to prevent future falls. 11. 0 Procedure for identification and management of patients who need restraints Dental services for Uncooperative patients are managed with the help of physical restraints (least invasive as possible like mouth prop) after getting informed consent from the parents or relatives or guardian. The reason for using the restraint and the time frame during which they are used are documented in the patient record. Only competent and trained professionals perform the dental procedures with restraints. Policy and procedure for the restraints usage are maintained by the concerned departments. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:45 APDH/NABH/COP/ Version: 3 Issue: 1 07/10 03/05/2023 of 68 1.0 PURPOSE: 1.0. To assure quality dental surgical services to the patient and to prevent any adverse event. 1.1. To ensure procedural sedation is performed in a safe and consistent manner 1.2. To define policies guiding care of patient undergoing surgical procedures 2.0 SCOPE: 2.1. Minor - Operation theatre and the departments performing the dental surgical procedures 3.0 RESPONSIBILTY: 3.1.Doctors 3.2.Nursing and paramedical staff 4.0 ABBREVIATION: 4.1 NABH : National Accreditation Board for Hospitals and Healthcare providers 4.2 COP : Care of Patients 5.0 REFERENCE: 5.1 NABH: National Accreditation tandards for Hospitals and Health Care Service providers, Third Edition, April,2023/COP 5.2 COP 7: Procedural sedation is provided in a consistent and safe manner 5.3 COP 10: Written guidance governs the care of patients undergoing dental procedures PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:46 APDH/NABH/COP/ Version: 3 Issue: 1 07/10 03/05/2023 of 68 6.0 POLICY: Surgical procedures and competency levels: All minor surgical procedures shall be undertaken by the specialized surgeons or under their supervision by the training doctors as per the list of surgical procedures included in the scope of each department. Pre-operative assessment and provisional diagnosis: All patients undergoing surgical procedure (routine) shall have an assessment done preoperatively and a provisional diagnosis that shall be documented. The pre-operative assessment shall be done by the surgeon performing the surgery or a credentialed doctor from the team. As per the surgeon advice, patient shall be prepared for the procedure. Informed consent: The concerned surgeon or a doctor member of the team shall obtain an informed consent for surgery from the patient/relative prior to the procedure. The consent shall be sought after proper explanation of the benefits, risks and complications involved performing the said procedure. In case, the operative plan is changed intra-operatively, a fresh consent shall be sought from the patient/relative. Prevention of adverse events: All patients undergoing surgical procedure shall be properly identified through UHID number and name and preoperative checklist should be verified by the Pre- OP in charge / minor OT in-charge. Site of surgery on patient shall be marked by surgeon prior to surgery. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:47 APDH/NABH/COP/ Version: 3 Issue: 1 07/10 03/05/2023 of 68 Preoperative notes including assessments, diagnosis, instructions shall explain the procedure to be performed and should be documented prior to surgery in the HIS. The relevant preoperative instructions will be provided to all the concerned including patient/family. WHO safe surgery checklist shall be used to avoid any adverse incidents. Qualification of performing surgeons: Doctors qualified by law shall be permitted to perform the procedures Such doctors shall be credentialed and given privileges to conduct the said procedures in this hospital. Documentation of procedure in the operative note and post procedure management Post-operative notes shall be prepared by the surgeon which includes procedure performed; plan of care and status of the patients which is documented in HIS Post procedure management shall be provided with specific instructions for the patient Infection control protocols: The theatre or the area where surgery is performed shall be cleaned and disinfected All staff shall adhere to standard precautions, hand washing, using the PPEs and safe handling of the patients. Filters shall be assessed every month and serviced accordingly in the minor -OT Equipped Operation Theatre: The Operation Theatre complex shall have the necessary facilities for conducting the said procedures, changing rooms, equipments, appliances and instrumentation. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:48 APDH/NABH/COP/ Version: 3 Issue: 1 07/10 03/05/2023 of 68 There shall be facility to collect waste materials and linens as per infection control protocol. Quality assurance programme shall be followed for the surgical services periodically 7.0 PROCEDURE: All the patients who are to undergo surgery have full details of their medical condition in their case records. Depending on medical condition the patient may have surgical procedures. Surgical patients have the preoperative assessment and the provisional diagnosis documented prior to the surgery. Before procedures, the surgeon examines the patient and makes an assessment of his/her condition based on the clinical presentation of the case, signs and symptoms, and results of the investigations. After diagnosis is made, this is documented in the patient medical record before patient is taken up for minor surgery. This is done mainly to avoid adverse events like wrong site, wrong patient and wrong surgery etc. All patients admitted for minor surgery undergoes the following tests: Basic blood investigations and others if applicable. If the surgeon comes across any abnormal findings in the pre -operative tests, it has to be documented in the patient’s records and this has to be informed to the patient’s relatives. Apart from the general consent which is obtained routinely from patients undergoing surgery, they should be informed about the procedure, its probable outcome, and its possible outcome and its probable rare complications. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:49 APDH/NABH/COP/ Version: 3 Issue: 1 07/10 03/05/2023 of 68 The patient is prepared for surgery as follows: Artificial dentures and jewelry are removed (and receipt given or handed over to authorized people), Nail polish is cleaned. The patients depending on their physical condition are shifted to the minor OT by wheel chair. Once the patient has been received at the minor OT, sterile OT gown/dress is draped. All type of surgeries performed in this hospital are by well qualified, experienced surgeons who have had extensive training and expertise in their particular fields. Complex surgeries are sometimes performed by a team of doctors, each dealing with his /her specialty. Prior to surgery the medical record shall be reviewed, the condition of the patient shall be checked and surgical safety checklist before induction of anesthesia, before Incision and before the patient leaves the operating room shall be completed by the surgeon. All the events during the stages of local anesthesia are monitored. As a part of quality assurance programme, the minor OT and the other areas where dental surgical procedures are performed and its surrounding areas are under the strict supervision by the infection control nurse and minor OT In-charge and the hospital infection surveillance team who ensures absolute sterility of the operation areas so as to avoid the risk of transmission of infection. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:50 APDH/NABH/COP/ Version: 3 Issue: 1 07/10 03/05/2023 of 68 The plan also includes monitoring of surgical site infection rates. The hospital infection control team conducts regular documented surveillance which includes monitoring of surgical site infection sites. Culture swabs are taken from infected or suspected wound sites to analyze them with the aim to prevent or reduce the risk of hospital associated infections. Surveillance of Minor Operation Theatres: Each health care establishment undertaking surgery must have a specific protocol for operating room procedures, including specific requirements for surgical hand washing routines and handling of sharps. All instruments used in an operation must be sterile. The principles of sterile aseptic technique must be applied to all operating room procedures. The principle of ‘confine and contain’ must be applied at all times for all patients. Sterile drapes must be used for the patient; staff must wear full sterile operating room personal protective clothing. Patients should inform their doctor of their infectious status. Preoperative testing of patients should be on clinical indication. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:51 APDH/NABH/COP/ Version: 3 Issue: 1 07/10 03/05/2023 of 68 All staff in the surgical team should be vaccinated against hepatitis B. Surgical staff should not perform exposure-prone procedures if they are considered actively infectious with human immunodeficiency virus, hepatitis B virus or hepatitis C virus. Staff with dermatitis or skin wounds should be excluded from the team. The operating room should be cleaned as soon as practicable after surgery, including the correct disposal of sharps and clinical waste and cleaning of all surfaces. Reusable instruments should be thoroughly washed as soon as possible after use and must then be thoroughly cleaned in a designated clean-up area before sterilization. PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:52 APDH/NABH/COP/ Version: 3 Issue: 1 07/10 03/05/2023 of 68 ANNEXURE : SURGICAL SAFETY CHECKLIST Sign in All Team Members - After receiving patient inside Minor OT (Before Administration of Local Anaesthesia Team Brief: All Team Members Introduction of team and roles Concerns relating to: Staff/ Equipment/ Surgery/ Anaesthesia/ Medication/ Monitoring/ Emergency drug/ Resuscitation equipment addressed. Patient Full Name: Out Patient Number: Date of Birth: Address: Consultant: Clinic/Department: Surgical Procedure Surgical Procedure Description Impaction 1. Minor Oral Surgery 2. Pre Prosthetic surgery Extraction 3. Biopsy Transalveolar extraction 4. Incision & Drainage 5. Cyst Enucleation Minor Oral Surgical Procedure 6. Open reduction and Internal fixation 7. Mucocele Excision 8. Implant 9. Surgical exposure of impacted teeth 10. Soft tissue suturing 11. Others PREPARED BY VERIFIED BY APPROVED BY NABH COORDINATOR PRINCIPAL CORRESPONDENT  ADHIPARASAKTHI DENTAL COLLEGE AND HOSPITAL PROCESS MANUAL – CARE OF PATIENTS Doc No: Issue Date: Page:53 APDH/NABH/COP/ Version: 3 Issue: 1 07/10 03/05/2023 of 68 Team Members: Operating surgeon and Assistant / Dental Nurse Operating student and supervising staff, assistant /dental nurse The assistant/assisting dental nurse checks patient details, treatment details, date and signatures on consent form with operator/supervising staff. Sign In/Time out/Sign Out/Debrief stages should be read out loud by designated checklist coordinator wh