ACKNOWLEDGEMENT

A successful project can never be prepared by the single effort or the person to
whom project is assigned , but it also demands the help and guardianship of some
conversant person who helps in the undersigned actively or passively in the
completion of a successful project. It is my honor to get an opportunity to pursue
my summer internship with Fortis Hospital , Mohali . I would like to thank Fortis
Hospital for giving me an opportunity to undertake my summer internship in the IP
Pharmacy of the hospital . I wish to express my sincere gratitude to Dr. Nivedita
for her guidance & encouragement for carrying out this project work. I also wish to
express my gratitude to the officials & other Staff Members of Fortis Hospital who
rendered their help during the Period of my Project work. I also thank Dr.
Amandeep Singh Marwaha (Training & Placement Officer), UIAMS, Punjab
University, Chandigarh, for providing me the opportunity to undergo my Summer
Internship Project at this esteemed institution . Last but not the least I am thankful
to my parents, friends and all well-wishers for blessing me for my success.

Rouble
TABLE OF CONTENTS

S.No. TOPIC PAGE NO.

1 CHAPTER-1
About Company
2 CHAPTER-2
Need and Scope of Study
3 CHAPTER-3
Introduction
4 CHAPTER-4
Review of Literature
5 CHAPTER-5
Theoretical Framework
6 CHAPTER-6
Methodology
7 CHAPTER-7
Result
8 CHAPTER-8
Conclusions and Limitations
9 CHAPTER-9
Bibliography
 CHAPTER-1

About Company

Fortis Healthcare Limited – an IHH Healthcare Berhad Company –

is a leading integrated healthcare services provider in India. It is
one of the largest healthcare organizations in the country with 27
healthcare facilities, 4,300 operational beds and 400 diagnostics
centers (including JVs). Fortis is present in India, United Arab
Emirates (UAE), Nepal & Sri Lanka. The Company is listed on the
BSE Ltd and National Stock Exchange (NSE) of India. It draws
strength from its partnership with global major and parent
company - IHH, to build upon its culture of world-class patient care
and superlative clinical excellence. Fortis employs ~23,000 people
(including Agilus Diagnostics Limited (Formerly known as SRL
Limited)) who share its vision of becoming the world’s most
trusted healthcare network. Fortis offers a full spectrum of
integrated healthcare services ranging from clinics to quaternary
care facilities and a wide range of ancillary services.

The Fortis Memorial research Institute (FMRI) hospital at Gurgaon is the

headquarter and flagship hospital of Fortis healthcare with all the major
facilities at the hospital. It was named as 23rd smart hospital in the world
for the year 2021. FMRI was also named as 22nd best hospital in the
country for the year 2022 by Newsweek.

Vision : "Saving & Enriching Lives"

Mission : "To be a globally respected healthcare organisation known for

Clinical Excellence and Distinctive Patient Care"

Patient Centricity :

● Commit to 'best outcomes and experience' for our patients.

● Treat patients and their caregivers with compassion, care and
understanding.
● Our patients' needs will come first

Integrity :

● Be principled, open and honest..

● Model and live our 'Values'.
● Demonstrate moral courage to speak up and do the right things.

Teamwork :

● Proactively support each other and operate as one team.

● Respect and value people at all levels with different opinions,
experiences and backgrounds.
 ● Put organization needs' before department / self interest.

Ownership :

● Be responsible and take pride in our actions.

● Take initiative and go beyond the call of duty.
● Deliver commitment and agreement made.

Innovation :

● Continuously improve and innovate to exceed expectations.

● Adopt a 'can-do' attitude.
● Challenge ourselves to do things differently.

Our Journey :

Brand Fortis was established in 1996, by our Founder Chairman Late Dr.
Parvinder Singh, who instituted it with the vision :

'to create a world class integrated healthcare delivery system in India,

entailing the finest medical skills combined with compassionate patient
care.'

Fortis Healthcare is the country’s ‘fastest’ growing healthcare group. It has

grown from the first hospital at Mohali (Chandigarh) which opened in 2001
with over 45 healthcare facilities as of today. These include the world
famous Escorts Heart Institute and the erstwhile Wockhardt facilities. From
North to South, East to West, Fortis truly has India covered - the frontier
city of Amritsar, to Ludhiana, Mohali, the National Capital region, Mumbai,
Bangalore, Mysore, Chennai, Kolkata and many more destinations are all
home to Fortis facilities.

Fortis occupies a place of pride in India’s healthcare delivery system.

Brand and the Logo :

The Fortis brand with its distinctive logo is a synthesis of human values of
trust, ethics and service and quality healthcare. We project clinical
excellence, distinctive patient care, transparency in actions & high level of
integrity and excellence is all that we do.

Our logo projects these very values. The integration of the hands (in a
distinctive ‘green’ with a ‘red dot’) and the human figure is completely
seamless and is representative of ‘Fortis’ responsive approach to
healthcare. The green colour of hands is representative of health,
wellbeing, compassion, nurturing and generosity while the red dot gives an
immediate association to our Indian roots, while it is also represents
energy, spirituality, courage and symbol of good luck.

At Fortis it is intrinsically believed that excellence is a not a destination –

but a journey.
 Chapter -2

Need and Scope of study

2.1 Objectives of study :

● To prioritize indents including medications or medical consumables that are
critical for patient safety to ensure that patients receive the necessary care in
a timely manner.
● In situations such as trauma cases or cardiac arrests, indents related to
medications To provide quick access to essential drugs and equipment can
be lifesaving in situations such as trauma cases or cardiac arrests.
● To avoid delays of time sensitive administrations that can have a significant
impact on their effectiveness.
● To urgently provide indents related to medications and supplies for patients
with critical illnesses, such as those in intensive care units (ICUs) or
undergoing major surgeries.
● To reduce errors associated with misinterpreted verbal or telephone
communications of medication orders or test results.
● To manage indents for essential medications that are in short supply
carefully to ensure that they are allocated to patients with the highest need.
● To adhere to legal and regulatory requirements is crucial in a hospital
pharmacy.

2.2 Scope of the study:

In an IP (Inpatient) pharmacy setting, the scope of prioritization of indents

typically involves managing medication orders for hospitalized patients.
Prioritization is essential to ensure the timely delivery of medications to patients
and to address urgent or critical medication needs. Here are some factors that may
influence the prioritization of indents in an IP pharmacy:

● Patient acuity
● Emergency situations
● Time-sensitive medications
● Surgical procedures
● Medication stock levels
● Allergies and contraindications
● Discharge planning
● Therapeutic appropriateness

.
 Chapter - 3

INTRODUCTION

IP Pharmacy mainly delivers the druges to the IPD patients only. Other features of the IP
Pharmacy module consist of the purchase requisition to be given to the purchase department for
the new medicines to be brought which is dependent on ROQ (Re-order level) and QOH
(Quantity in Hand) which is shown in the HIS.
Return indents are kept which are being received by the nurse and the data is entered in the HIS
and it is thoroughly checked whether it is infectious/broken/expired or not incase of which the
indents are not taken back. FIFO ( First In First Out ) method is followed in dispatching of the
medicines to reduce expiry date errors.
The term "indent" is commonly used in some regions to describe the process of requesting or
ordering medications from the pharmacy.

When a healthcare professional, such as a physician or nurse, requires specific medications or

supplies for a patient's treatment, they submit an indent or requisition form to the IP pharmacy.
This form includes details about the patient, the required medications or supplies, dosage
instructions, and any other pertinent information. The pharmacy team then processes the indent
and dispenses the requested items to the designated ward or unit.

The indent process helps ensure that patients receive the correct medications in a timely manner
and facilitates efficient inventory management within the IP pharmacy.
The different types of indents are :
1. Routine Indents: These are the most frequent type of indents in a pharmacy. They
involve requests for specific medications, including prescription drugs, over-the-counter
medications, or controlled substances. Medication indents typically include details such
as the medication name, dosage strength, quantity, and any special instructions.
2. Medical Consumable Indents: Supply indents are used to request non-medication items
or supplies that are necessary for patient care or the functioning of the healthcare facility.
 This can include items like bandages, syringes, infusion sets, dressings, gloves, or other
medical consumables.
3. Stat Indents: In urgent or emergency situations, healthcare providers may submit indents
for critical medications or supplies that are required immediately. These indents often
prioritize the rapid processing and dispensing of the requested items.
4. Ward Stock Indents: Ward stock indents involve requests for medications and supplies
that are needed for routine use within a specific hospital ward or unit. These indents help
maintain a sufficient stock of essential items at the ward level, minimizing the need for
frequent pharmacy requests.
5. Return Indents: When medications or supplies need to be returned to the pharmacy,
such as expired or unused items, return indents are used to initiate the return process and
ensure proper documentation.
 Chapter -4
Review of Literature

R.Ananya et.al ; (2019) conducted a cross-sectional study.The stratified sampling method was
used where the healthcare providers who are directly associated with patients in patient care,were
sub-grouped into doctors, nurses and paramedical staff which include physiotherapists,lab
technicians,radiologists, dieticians,etc. 18% - 20% of the staff under each sub-group was
randomly considered for sampling.A structured observational checklist was used along with
interview and the questionnaire consisted of 20 questions covering all the 6 goals.The study was
carried out from 3rd May 2017 to 15th June 2017 with a sample size of 306 in total.Overall
compliance (category wise) is observed to be highest in Doctors with 72%, followed by Nurses
with 69% and then Paramedics with 68% compliance.
Rafay S.S et.al (2018) conducted a pilot study on the nurses at primary health care settings, in El-
Badrashine directorate, affiliated to the Ministry of Health and Population in Giza governorate
about 10% of the study subjects (15 nurses). The purposes of the pilot study were to test
applicability, feasibility, practicability of the tools. It also helps to estimate the time needed to
complete the questionnaire sheet. All of them received a clear explanation for the study purpose.
According to the results of the pilot study no modification was made to the tools. Those who
shared in the pilot study were involved in the studied sample.Once permission was granted to
proceed with the study, the investigator started to prepare a schedule for collecting the data. Each
nurse was interviewed individually by the investigator who introduced himself and explained the
aim of the study briefly, and reassured them that information obtained is strictly confidential and
would not be used for any purposes other than research. After that, the oral approval was
obtained to collect the necessary data. The study tool was answered by each nurse during the
interview, and the time needed ranged from 20 to 30 minutes, according to understanding and
cooperation of the nurse. The investigator collected data through observing the staff members
individually.

Fadhillah et.al (2018) conducted a study to determine the effect of performance on the goal of
patient safety based on knowledge management of SECI on the adverse events in Jakarta Islamic
Hospital. Method: The research design used a quasi experimental pre post-test with the control
group. The number of samples in the intervention group was 24 respondents and the control
group was 37 respondents. Instruments that are used for patient safety and adverse events with
performance interventions based on knowledge management of SECI patient safety goals. The
analysis used the Mann Whitney and Willcoxon statistical tests. Results of the study showed that
work duration was a factor that affected patient safety, there were changes in patient safety
before and after the intervention in the intervention group compared to the control group. There
is a difference between the intervention group and the control group after being given
performance interventions in Knowledge Management: SECI patient safety goals. Conclusion of
this study recommends regular training for nurses about performance in patient safety:
SECI-based patient safety goals and further research for different control groups of hospitals
with the intervention group.
Amaal Abousallah (2018) conducted a study aimed at describing the impact of International
Patient Safety Goals dimensions on the Private Jordanian Hospitals, from the perception of the
medical staff. The descriptive and analytical method was used. The population is the Private
Jordanian Hospitals that have Joint Commission International Accreditation of patient safety.
The study used the qualitative method by collecting data via questionnaires for a sample that size
of 156, which were distributed among the medical staff in Jordan Private Hospitals. The
questionnaire was adopted from Agency of Healthcare Research & Quality refined by literature
review and panel of referees committee, In addition, the researcher used the Statistical Package
for Social Science (SPSS ver.16) for descriptive statistics. Statistical techniques such as
descriptive statistics, correlation, and simple regressions were used to test the hypotheses. The
results show that there is an agreement on the high application of International Patient Safety
Goals variables among Private Jordanian Hospitals, also the relationship between total
International Patient Safety Goals and Patient Safety Culture is strong, all International Patient
Safety Goals variables have an effect on Patient Safety Culture of Private Jordanian Hospitals.
Finally, the current study recommends considering improving the elements of International
Patient Safety Goals together because they are strongly interrelated and have a positive impact
on the three-level aspects of the patient safety culture.
 Chapter -5

THEORETICAL FRAMEWORK

As per NABH there are six ipsg goals which are listed below :

Goal One - Identify patients correctly.

Goal Two - Improve effective communication.

Goal Three - Improve the safety of high-alert medications.

Goal Four - Ensure safe surgery.

Goal Five - Reduce the risk of healthcare-associated infections.

Goal Six - Reduce the risk of patient harm resulting from falls.

5.1 Patient identification:

The potential for misidentification is an ever -present harm, especially in the debilitated or
unconscious patient. . As well as, the World Health Organization recognizes that patient
misidentification can contribute to medication, surgical and charting errors. Utilize at least two
routes to identify patients.

5.1.1 Paras Hospital’s policy of patient identification :

It is vital that patients are correctly identified before providing health care services. The hospital
shall make a process to identify all patients using at least two identifiers- name of the patient
(First and Last Name of the Patient spelt in full – Initials are NOT PERMITTED) and UHID
number.

Patient identification: When?

1. All patients’ shall be identified:

Ø Before providing treatments- such as administering medications, blood, or blood
products; serving a restricted diet tray
Ø Before performing procedures- such as insertion of an intravenous line or
haemodialysis
Ø Before any diagnostic procedures- such as taking blood and other specimens for
clinical testing, or performing a cardiac catheterization or diagnostic radiology
procedure
Ø Before transferring patients from/to other department

5.1.2 Sources of Patient Identifiers:

Sources of the patient identifiers may include patient, relative (parent, spouse, adult sibling, and
adult son/daughter), guardian, domestic partner/ friend, or transferring facility if the patient is
unable to identify himself or herself or surrogate is unavailable.
If the patient is unable to tell their name (e.g. babies, pre-verbal children, patients’ with
dysphasia, patients on ventilator, expressive disability or mental capacity issues) patient
identification shall be checked by asking the patient's relative or caretaker.

5.2 Effective communication:

Communication failures in healthcare teams are associated with medical errors and negative
health outcomes. These findings have increased emphasis on training future health professionals
to work effectively within teams .Whereas patients need to be able to communicate effectively
with their healthcare providers in order to get healthcare that is tailored to their needs. The whole
verbal and telephone request or test result is written down by the receiver of the request or test
result. The complete verbal and telephone request or test result is read back by the receiver of the
request or test result. The request or test result is confirmed by the individual who gave the order
or test result . The relationship between team communication and patient safety has increased the
emphasis placed on training future health professionals to work within teams.

5.3 Safety of high Alert medication:

Medication safety is important, because medication errors are a common, serious and expensive
type of medical error. Medication errors are typically defined as deviations from a physician’s
order Physicians, pharmacists, and nurses can be involved in the occurrence of medication errors
.Medications are very different and have a wide range of risk profiles. Those with a heightened
risk of causing patient harm are known as high-alert medications; they have serious
consequences for patients when misused .

Medication safety is important because medication errors are the most common type of medical
error and are associated with considerable health care expenses..
A better recognition of what drugs are delivered, whether providers exceed them, and what
responses providers suggest when they respond to them may give insights into how the alerts
themselves should be delivered, and also into policies around significant use.. Before an
operation, label medicines that are not categorized. For example, medicines in cups, tubes, and
basins. This is in the area where drugs and supplies are set up. Take additional care with patients
who take drugs to thin their blood. Record and pass along right information about a patient’s
drugs. Detect what drugs the patient is taking. Compare those drugs to new drugs given to the
patient. Make sure the patient defines which drugs to take when they are at home. Tell the patient
it is significant to bring their up-to-date list of drugs every time they visit a physician . Rules
and/or procedures are developed to address the identification, location, labeling, and storage of
high-alarm drugs. The rules and/or procedures are implemented.

5.4 Ensure correct site, correct procedure correct patient surgery:

Sometimes the problems that you expect to be the easiest to fix turn out to be the most vexing.
Since the Joint Commission first highlighted the problem of wrong-site surgery in 1998, the
issue has been the subject of summits, protocols, checklists and process-improvement projects
across the country .The criteria are presented with the understanding that it is the responsibility
of the healthcare facilities to develop, and establish policies and procedures for identification of
the surgical patient, and emphasis of the correct surgery site and procedure according to
established health care organization protocols Wrong-site surgery is unacceptable but
exceedingly rare, and main injury from wrong- site surgery is even rarer.

Factors that have been shown to increase the risk of wrong –site surgery and invasive procedures
include combined and bilateral diseases, morbid obesity or physical deformity, incomplete or
inaccurate communications, poor booking processes, unusual time pressures, emergency
procedures, and the need for multiple procedures or multiple surgeons.

Wrong site operations are preventable reverse events that often result in patient injury. While
recent index suggests that wrong site operations are rare and harms minimal, incidence of like
catastrophic events can likely be significantly decreased . An immediately recognized mark for
surgical-site identification and includes the patient in the marking process, a checklist or other
process to confirm preoperatively the right site, right procedure, and right patient and that all
documents and equipment needed are on hand, correct, and functional. The complete surgical
team conducts and documents a time-out procedure just before starting a surgical operation.
Policies and procedures are progressing that support a unique process to ensure the right site,
right procedure, and right patient, including medical and dental procedures done in settings other
than the operating unit .

5.5 Reduce the risk of healthcare associated infection:

Nosocomial , or hospital-acquired, infections (more appropriately called health care–associated

infections) are today by far the most common complications affecting hospitalized patients.
National Healthcare Safety Network along with Centers for Disease Control for surveillance has
classified nosocomial infection sites into 13 types with 50 infection sites, which are specific on
the basis of biological and clinical criteria.Utilize the hand cleaning principles from the Centers
for Disease Control and Prevention or the World Health Organization. Put goals for improving
hand washing, the goals to improve hand cleaning. Confirmed principles to prevent infections
that are difficult to manage, principles to prevent infection of the blood from central lines,
principles to prevent infection after catheters .Er surgery and principles to prevent infections of
the urinary tract that are caused.

Identification of risk factors allows clarification of those that are different from those that are not
and facilitates the development of specific interventions to decrease the risk of infection. For
example, avoiding the use of invasive devices altogether by means of alternative strategies (for
example, performing urinary drainage by condom catheter) and decreasing the interval of
utilization of the device (for example, decreasing the number of days of mechanical ventilation)
have been proposed in many guidelines. Strategies to inhibit infections have been subdivided
into various groups (education- based, process-based, and systems-based), but many of the
suggested interventions — like “use antibiotics wisely” or “educate and train staff” have been
vague and difficult to implement.
5.6 Study Model:
 Chapter -6

Methodology
In this study we are mainly focusing on three of the international patient safety goals below
mentioned are the parameters. This is an observational and comparative study in which different
parameters are carefully observed to check if selected patient safety goals are followed or not .
Data is collected through regular audits and observational data in hospitals . Observations were
collected from 60 patients for each parameter after collection and analysis of data necessary
measures such as spot training , seminars , staff awareness programs were done and to check the
improvements and effects of measures taken

Goal 1: Identification of Patient Correctly

Following are the parameters which ensure correct patient identification at paras hospital

6.1 Admitting patients (IP)

Ø The admitting desk shall confirm patient identification through at least two identifiers
such as FULL name and UHID No. on the admission request form.

Ø A non-transferable identification band shall be prepared by the admission staff,

handed over the same with other relevant papers to the ward nurse and will be affixed to
the patient in the ward.

6.2 Identification Bands:

White bands:
 · To be worn by ALL inpatients.

· The ID band should be worn on the dominant arm that is the side used for writing; it is
then less likely to be removed when, for example; intravenous access lines are inserted.

· Placement of ID bands – Priority:

o Right Hand

o Left Hand

o Right Leg

o Left Leg

· The ID band must contain the following clearly printed, legible information of the
patient in black text on a white background:

IN CASE OF ALL IP PATIENTS:

Paras UHID: IP No:

First Name: Last Name:

Date of Birth:
 Age: Sex:

Red ID Band:

· To be worn by patients who have an allergy.

Note – Red ID band is worn in addition to the White band by patients with allergy(s)

· ALL patients MUST be asked if they are allergic to anything when they are admitted /
treated during their initial assessments. Note that an ‘allergy’ can include latex and other
material components as well as medicines.

· It is required that patients with a known allergy wear an additional red identity band, on
the same wrist/ankle as the white band. This will act as a warning to staff to refer to the
patient’s medical notes for further details.

Emergency Department

● On patient arrival, at the time of initial assessment by triage nurse, a triage band will be
applied to the patient according to his/her clinical condition.
● After Registration of patients – Permanent ID band will be applied. This will consist of a
computer generated sticker placed on the Triage Band by the assigned nurse.
 · If an emergency patient gets admitted, the ER ID band will be replaced with an
IP admission band (also includes day care admission).

· In case of allergy, the patient in the Emergency Department should wear an

additional red band along with white colored ID Band specifying the name of allergy.

NEONATES

● Color coded ID bands are used for Babies’ identification. Blue coloured ID bands
are used for male and pink for female infants.
● Two ID bands should be applied to two separate baby limbs by the assigned nurse
immediately after the birth.
● Two people (either a doctor and nurse or nurse & GDA) will accompany the baby
from OT/Labor room to NICU/Nursery.

● The minimum information mentioned on the ID bands is mentioned below:

Male:
Mother’s Name:

UHID No. of Mother:

Gender: Weight:

Date of Birth:

Time of Birth:

Female:

MOTHER

After delivery of the baby, mother to be given an additional ID band with the following
baby’s details
 Mother’s Full Name:

UHID No. of Mother:

Gender: Weight:

Date of Birth:

Time of Birth:

6.3 Vulnerable Patients

Violet colored band should be placed on the patient's wrist along with a violet dot sticker
on the door label.

ALERT!

● DO NOT PROCEED with any IP procedure if the patient has no ID band

● The patient’s room number or location should never be used for identification.
● The Initials of a patient's name should never be used for patient identification.

6.4 Intra-hospital Transfer

When an internal transfer occurs, the receiving staff member shall check the patient's
wristband, with the patient, if the patient has the capacity to do so, along with the medical
notes for positive patient identification.

In case of damage to ID Band

 If the patient's wristband is removed, faded, damaged or unreadable, a replacement
wristband will be applied immediately, by the assigned nurse caring for the patient.

The ID band must not be removed until the discharge procedure is completed.

In other settings below mentioned identifiers can be used :

Outpatient Department

(a) Registration: Patient’s full name

Patient’s date of birth/ Age

(b) Nursing Assessment, Doctors Consult & OPD procedure (including dialysis, endoscopy
lab):

The following details should be verbally confirmed/ matched with invoice before
examining the patient by the consultant (Use any two)

● Patient’s full name

● UHID
● Patient’s date of birth/ Age

Goal 3: Improving the Safety of High-Alert Medications

Following are the parameters with which staff were audited for compliance with goal 3:

3.1 Are high alert medications stored as per policy?

3.2 Are the high alert medications labeled and color coded appropriately?

3.3 Are concentrated electrolytes labeled correctly

and color coded appropriately?

3.4 Are look-alike and sound-alike drugs labeled and color coded appropriately?
3.5 Are near expiry medicines segregated regularly?

3.6 Is double verification done before administration of high alert drugs?

Goal 3 talks about the storage of high alert medication as per regulations. In the hospital, doctors
were not given the responsibility to maintain emergency medicine trolley or crash cart,there by
eliminating them as study subjects for this goal

A collection of aims and objectives, known as the International Patient Safety Goals (IPSG), is
intended to improve patient safety while administering high-alert medicines across the world.
These medications are classified as very high risk and include some antibiotics, anticoagulants,
cardiac medications, chemotherapeutic agents and others. The IPSG’s objective is to increase the
safety of these medications by making critical improvements in healthcare practices.

This IPSG was developed by the JCI as an extension to the WHO Essential Medicines List
(EML). It includes a set of five goals with six objectives that provide guidelines for healthcare
providers and stakeholders on how to improve the safety of high-alert drugs.

Parameters

(HAM) are distinguished by a red sticker with the words “High alert,” which indicates that they
are medications that look and sound similar (LASA), Concentrated electrolytes are kept in
lockable cabinets that are kept apart from other medications and only accessible in emergency
situations.

In the LASA (Look Alike Sound Alike medicines) category, pharmaceutical names that sound
similar to another medication are designated as sound alike medications, and medication names
whose packaging is aesthetically similar to another medication are designated as look alike
medications.
A sound-alike drug is one for which the generic or commercial name of the medication sounds
similar in both spoken and written language. Thus, they have a greater risk of making a
medication-related mistake.

Tall Man writing is used to highlight the distinctions between medicines with similar sounding
names. Using Tall Man lettering, a drug’s name is written in upper case letters to assist
differentiate it from other medications that sound similar, thus reducing the likelihood of
prescription mistakes

Look-alike medicines should be kept apart from their paired counterparts. When at all possible,
avoid keeping the medications in close proximity to one another to prevent mistakes. Additional
warning labels should be used for medications that seem to be the same. To make identification
easier, warning labels should be consistent across the facility in which they are displayed.

Goal 6: Reducing the Risk of Patient Harm Resulting From Falls

Prevention of patient falls during their stay is an important aspect to be taken care of and hence
gave birth to goal 6 of IPSG which is about fall risk assessment, reassessment and measures
taken to prevent fall of patients

1. Fall risk assessment criteria shall be identified and documented. Based on such criteria,
fall risk assessment shall be done for inpatients and outpatients. The assessment shall be based
on situation, location and type of patients as identified.

2. Patients will be assessed for fall risk factors during admission, every morning shift
thereafter till discharge, and as the patient condition warrants. (With any change in
patient condition, if patient is on any sedations / anesthetics, with any change in level of
care and vulnerable patients)

3. Fall risk assessment shall be done for all patients on their every visit in the outpatient
area/ Day Care.

4. Following a fall, assessments and periodic reassessments shall include the potential
risk associated with the patient’s medication regimen.
 5. If determined to be at risk, a plan of care for the patient shall be developed
proactively that utilizes interventions to reduce the risk of patient harm resulting from
falls.

6. Documentation of patient/family education shall be placed in the medical record.

7. Falls Prevention Program requires that the vulnerable patient band (Violet Coloured
Wrist band) be placed on the patient’s wrist and purple colored sticker on the door label.

8. A patient who has experienced a fall shall have an immediate physical assessment,
Primary Consultant notification, and the event documented on an incident report:
including root cause analysis of the same. The reassessment for such patients is done in
every shift.

9. Fall risk assessment to be done when the patient on the following medications –

• Antiepileptics

• Antihistamines

• Antihypertensive/Cardiovascular agent/ B-Blockers/Hypoglycemics

• Cathartic/laxative

• Diuretic

• Pain medication

• Sedative & Benzodiazepine.

Measures are implemented to reduce fall risk for those assessed to be at risk.

Measures are monitored for results, both successful fall injury reduction and any unintended
related consequences.

Near Fall – sudden loss of balance that does not result in a fall or other injury. This can include
an instance where a person slips, stumbles or trips is able to regain control prior to falling.
Unwitnessed Fall – patient is found on the floor and neither the patient nurse nor anyone else
knows how he/ she got there.

Falls are one of the leading causes of accidental deaths in many parts of the world. Implementing
essential changes in healthcare practices can help improve patient safety and reduce risk for
patients to experience harm as a result of falls.

In accordance with the International Patient Safety Goals, six goals have been established to
assist in minimizing the risk of patient injury as a consequence of falls.

6.5 Fall prevention Measures:

Step-up to stop falls:

1. Create a safe environment

· Ensure the patient's necessities are within reach.

· Check bed is at correct height

· Ensure proper lighting in the room

· Clean up floor spills immediately

2. Assess patient’s risk

· Use Morse fall risk assessment tool to identify the risk for falls
 · Assess the risk during admission, Transfer OT, ICU to ward and vice versa),
change of status, after a fall

· Shift wise hand over of all patients at risk of fall.

3. Reduce the patient risk

· Assist weak patients in walking, standing & transferring.

· Do frequent rounds to meet patient needs to avoid fall risk.

· Educate the patient to use bed alarms to alert staff whenever they require
assistance.

· Make sure side rails are raised to avoid falls and use safety belts during all
transfers.

· Educate patients and family regarding orthostatic hypotension, food and drug
interaction, its effects and prevention.

· Avoid slippery foot wears.

4. Evaluate Interventions

· Ensure the completion of post fall assessment and incident reporting.

· Regular interventions for high risk patients.

Patient/Family Education

Educate the patient/family at the level of their understanding of the following:

§ The purpose of fall prevention measures, when used.

§ Measures taken to decrease environmental fall risks.

§ The need to ask for assistance when exiting bed.

§ For high fall risk patients, include information on exercise, nutrition, home safety, and
make a plan for emergency fall notification.
Chapter- 7

Result
After observing above mentioned parameters in sample size of 50 patients data was collected to
know percentage of compliance for each goal

Goal 1 : Patient Identification:

Data was collected from billing area , radiology department ( before patient investigation ) ,
blood sample collection area and different wards

7.1 Reception (Billing Area ) :

This figure here represents percentage of compliance and non compliance of use of two
identifiers at the time of billing red represents non compliance and green represents compliance

Figure-2
7.2 Radiology

Figure-3

7.3 Blood Sample Collection Area

Figure-4
7.4 ID Band

Figure-5

So, based on all of the above mentioned data we can conclude that adherence
to 1st IPSG (i.e Identification of Patient Correctly) at paras hospital is :

Figure-6
It signifies that there is 85% of compliance and 15% of non compliance for
adherence of goal no. 1

Goal No. 2 Fall prevention measures :

7.5 Patient side rails

Figure-7

7.6 Patient attendant

 Figure-8

7.7 Violet ID bands for vulnerable patients

Figure-9
 7.8 Patient Education form :

Figure-10

Based on above mentioned data we can conclude that the adherence to IPSG (Reducing
the Risk of Patient Harm Resulting From Falls ) at Paras Hospital is :

Figure-11
The above mentioned pie chart which shows adherence for goal no : 2 and it signifies 83%
of compliance and 17% of non compliance

Goal 3 : Improving the Safety of High-Alert Medications

We observed adherence to the above mentioned parameters and after analyzing the data got
following results:

Figure-12:

The cumulative data for adherence of goal no. 3 is represented in above mentioned graph
which denotes 86% Compliance and 14 % Non Compliance
 Chapter -8

CONCLUSION AND LIMITATIONS

Though the compliance gathered from the data can be characterized as good, hospitals must
always strive to drive further improvements.It was noted that the cause of non-compliance with
the goals by staff was either a lack of knowledge or excessive workload which reduces the ease
of implementation or sometimes a combination of both.

Doctors and paramedical staff have pointed out that the reason for non-compliance from their
side is due to insufficient training classes conducted while nurses had the classes on a regular
basis but still failed to acknowledge and implement the same.Additionally, it was found that a
few staff lacked the fundamentals and motivation to learn and imbibe the same for which
interventional measures are to be taken and the same were suggested to the hospital.

8.1 Limitations of the study

Since there was no access to the operation theaters and cath labs, Due to the lack of availability
of information on the exact number of dietary staff employed,they could not be included as a part
of the sample.
 CHAPTER - 9
BIBLIOGRAPHY
Ananya, R., Kamath, S., Pati, A., Sharma, A., Raj, A., Soman, B., & Kamath, R. (2019). A study
on adherence to international patient safety goals in a tertiary care cardiac centre in India.
Medico-Legal Update, 19(2), 211-215.

Al-Rafay, S., Shafik, S., & Fahem, S. (2018). Assessment of nurses' performance regarding
international patient safety goals at primary health care settings. IOSR Journal of Nursing and
Health Science (IOSR-JNHS), 7(6), 59-67.

Kaur, P., Vaishya, R., Sibal, A., Loria, G., Prasad, K. H., Reddy, S., ... & Reddy, P. (2022).
Improving patient safety and quality in India's largest hospital network through a dashboard
driven approach-The Apollo Quality Program. Journal of Patient Safety and Risk Management,
25160435221105994.

World Health Organization. (2003). Patient safety (No. WHO/EIP/OSD/2003.5). World Health
Organization.

Shahin, M. A. H. A., & KrimAlshammari, R. (2020). Quality of Care and Patients' Safety
Awareness and Compliance among Critical Care Nurses at Qassim National Hospital: Adopting
IPSGs. Journal of Nursing and Health Science, 9, 1-11.

Fadhillah, H., Hadi, M., Efendi, F., & Tristana, R. D. (2018). International patients safety goals
(Ipsg) based on knowledge management of SECI (socialization, externalization, combination and
internalization) on adverse events at Jakarta islamic hospital. Indian Journal of Public Health
Research and Development, 9(12), 462-468.

Abousallah, A. (2018). The Impact of Application of International Safety Goals on Patient Safety
Culture: A Field Study in Private Hospitals Working in the City of Amman. MEU library
Theses: Middle East University.
Shahin, M. A. H. A., & KrimAlshammari, R. (2020). Quality of Care and Patients' Safety
Awareness and Compliance among Critical Care Nurses at Qassim National Hospital: Adopting
IPSGs. Journal of Nursing and Health Science, 9, 1-11.