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RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL (RGGGH)

Located in Chennai, Tamil Nadu, is one of the largest government hospitals in India.
It serves as a tertiary care centre and provides a wide range of medical services to patients,
including specialized care in various departments such general medicine, surgery, paediatrics,
orthopaedics, cardiology, neurology, oncology, ophthalmology, dermatology, psychiatry, and
more
History: RGGGH has a rich history dating back to the 17th century when it was established by
the British East India Company. Over the years, it has evolved into one of the largest and oldest
government hospitals in India.

Infrastructure : The hospital boasts extensive infrastructure and facilities to cater to a wide range
of medical specialties and services. It has numerous wards, operation theatres, intensive care
units (ICUs), outpatient departments (OPDs), diagnostic facilities, and specialized clinics.

Teaching Institution : RGGGH serves as a teaching hospital affiliated with the Government
Kilpauk Medical College and the Stanley Medical College. It plays a crucial role in medical
education and training, providing hands-on experience to medical students, interns, residents,
and fellows across various specialties.
Accessibility : As a government hospital, RGGGH aims to provide affordable and accessible
healthcare services to all sections of society, including economically disadvantaged individuals.
It serves as a primary referral center for patients from Chennai city and surrounding districts.
Community Outreach : In addition to providing clinical care, RGGGH is actively involved in
community outreach programs, health awareness campaigns, and preventive healthcare
initiatives aimed at promoting public health and well-being in its catchment area.

Patient Load : Given its reputation, accessibility, and comprehensive services, RGGGH tends to
have a high patient load, with 8000-10000 thousands of patients visiting the hospital daily for
consultations and 3000 in patients for treatments, surgeries, and other medical interventions.

Overall, Rajiv Gandhi Government General Hospital (RGGGH) stands as a significant healthcare
institution in Chennai and plays a vital role in providing quality healthcare services, medical
education, and community health outreach in the region.

SERVICE AT A GLANCE:

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SUPER SPECIALTIES

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  Anaesthesiology &  Trauma & Spine Surgery
Critical Care Medicine
 Internal & Respiratory Medicine  Neuro Surgery

 Gastro Enterology  Paediatric Neuro Surgery

 Nephrology  Urology

 Neurology  Medical & Surgical Oncology

 Cardio-thoracic & Vascular  Plastic-Surgery, Aesthetic &

surgery Reconstructive Surgery
 Minimally Invasive (Laparoscopic)  Dermatology
Surgery
GENERAL SPECIALTIES

 Medicine  Ophthalmology

 Surgery  ENT

 Paediatrics  Chest & Allergy

 Orthopaedics & Joint  Diagnostic Radiology & Imaging

Replacement
SUPPORT SERVICES

 Physiotherapy & Rehabilitation  Dietician

 Health Check-up Schemes (Preventive Check-up)

24 HOUR SERVICES

 Accident & Emergency  X-Ray

 Pharmacy  Ambulance Facility

 Pathology & Lab Services

Excellence in Health Care Since 1664.

IMPACT OF APPLICATION OF INTERNATIONAL PATIENT SAFETY GOALS ON PATIENT SAFETY

CULTURE IN A TERTIARY CARE CENTRE UNDER PROCESS FOR NABH ACREDITATION

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INTRODUCTION

Health care delivery systems have become more efficient and also become more complex, with greater
application of new technologies and therapies, which requires adopting the international patient safety
goals to improve the patient safety environment to simulate better patient care rendered by the
hospital staff to improve patient outcomes while minimizing possible adverse events The simplest
definition of patient safety by World Health Organization (WHO) is the prevention of mistakes and side
effects to patients associated with health care. Promoting a culture of safety has become one of the
columns of patient safety. As healthcare facilities make every effort to improve their quality of care and
provide their service in an adequate standard, focusing on patient safety has become a priority.

PHILOSOPHY OF PATIENT SAFETY GOALS

The philosophy of patient safety goals revolves around ensuring the well-being, dignity, and safety of
patients throughout their healthcare journey.

Patient safety goals are grounded in ethical principles, commitment to excellence, collaboration, and a
system-based approach to healthcare delivery. By prioritizing patient-centered care, continuous
improvement, and advocacy, healthcare providers can create a culture of safety that enhances the well-
being and dignity of patients.

VISION

The vision of patient safety goals encompasses a future where every individual receives safe, high-
quality healthcare, free from preventable harm or errors.

Vision Statement: Safeguarding Every Patient, Every Time

Mission:
To create a healthcare environment where patient safety is paramount, and every person entrusted to
our care receives the highest standard of safety, compassion, and respect.

Core Values:

Safety: We prioritize patient safety above all else, implementing rigorous measures to prevent harm and
ensure the well-being of every individual.

Compassion: We approach each patient with empathy, understanding their unique needs, fears, and
vulnerabilities, and providing care that is gentle, supportive, and respectful.

Excellence: We strive for excellence in all aspects of healthcare delivery, continually seeking
opportunities for improvement and innovation to enhance patient safety and outcomes.

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Collaboration: We foster a culture of collaboration and teamwork among healthcare providers, patients,
and families, recognizing that effective communication and coordination are essential for optimal
patient safety.

Integrity: We uphold the highest ethical standards, acting with honesty, transparency, and
accountability in all our interactions and decisions, and earning the trust and confidence of those we
serve.

Goals:

1. Zero Harm: Our ultimate goal is to achieve zero preventable harm to patients, eliminating medical
errors, adverse events, and healthcare-associated infections through systematic approaches to patient
safety.

2. Empowered Patients: We empower patients to actively participate in their own care, providing them
with the information, education, and support they need to make informed decisions and advocate for
their health and safety.

3. Culture of Safety: We cultivate a culture of safety within healthcare organizations, where all staff
members are engaged, empowered, and committed to identifying and addressing safety concerns,
speaking up about potential risks, and promoting continuous improvement.

4. Learning Organization: We embrace a learning organization model, where every adverse event, near
miss, or patient safety issue is viewed as an opportunity for organizational learning and improvement,
driving systemic changes to prevent recurrence and enhance patient safety.

5. Equity and Inclusion: We prioritize equity and inclusion in patient safety efforts, ensuring that all
individuals, regardless of their background, identity, or socio-economic status, receive equitable access
to safe, high-quality healthcare that respects their dignity and values.

6. Community Engagement: We engage with patients, families, caregivers, and community stakeholders
as partners in patient safety, soliciting their input, feedback, and participation in decision-making
processes to ensure that healthcare services are responsive to their needs and preferences.

Together, we can build a future where patient safety is not just a goal but a reality for every individual
seeking care.

Problem Statement: To study the relation between the application of international patient safety goals
and patient safety culture in the tertiary care hospital.

OBJECTIVES :

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 I. Detecting the impact of application of international safety goals on patient safety culture.
II. Describing the level of application of international safety goals
III. Detecting the outcome of implementation of International Patient Safety Goals

SIGNIFICANCE OF THE STUDY

This study gives a general review about variables (international Safety goals and patient safety culture)
and their correlations.
In addition, this study provides effect of implementation of international patient safety goals on patient
outcomes

FRAMEWORK

Creating a robust framework for patient safety culture involves several key components to ensure a
comprehensive approach to fostering a culture of safety within healthcare organizations. Here's a
framework that encompasses essential elements:

1. Leadership Commitment: Strong leadership commitment is essential to prioritize patient safety as a

core value within the organization. Leaders should visibly support and actively participate in patient
safety initiatives.

2. Clear Communication: Effective communication channels should be established to facilitate the

sharing of information related to patient safety issues, incidents, and improvements across all levels of
the organization.

3.Teamwork and Collaboration: Encourage teamwork and collaboration among healthcare professionals
to promote a supportive environment where individuals feel comfortable speaking up about safety
concerns and working together to implement solutions.

4.Continuous Learning and Improvement: Implement mechanisms for continuous learning and
improvement, such as regular training sessions, performance feedback, and opportunities for staff to
participate in quality improvement projects.

5.Patient and Family Engagement: Involve patients and their families in decision-making processes
related to their care, and encourage open dialogue to address their concerns and preferences.

6.Safety Reporting Systems: Implement a robust system for reporting adverse events, near misses, and
unsafe conditions, and ensure that reports are thoroughly investigated and acted upon to prevent
recurrence.

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7.Transparency and Accountability: Foster a culture of transparency and accountability by openly
sharing information about patient safety performance, outcomes, and lessons learned from incidents.

8.Resource Allocation: Allocate sufficient resources, including staffing, training, and technology, to
support patient safety initiatives and ensure that safety remains a top priority.

9. Culture of Just and Fair Accountability: Promote a culture where individuals are held accountable for
their actions in a fair and just manner, with a focus on learning from mistakes rather than assigning
blame.

10. External Benchmarking and Collaboration: Participate in external benchmarking initiatives and
collaborate with other healthcare organizations to share best practices and learn from each other's
experiences in improving patient safety.

11. Integration into Organizational Policies and Procedures: Embed patient safety principles into the
organization's policies, procedures, and governance structures to ensure consistency and sustainability.

12. Measurement and Evaluation: Establish key performance indicators (KPIs) and metrics to monitor
the effectiveness of patient safety initiatives and identify areas for improvement.

By incorporating these elements into a comprehensive framework, healthcare organizations can

cultivate a culture of safety that prioritizes the well-being of patients and fosters continuous
improvement in quality of care.

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CONCEPTUAL FRAMEWORK

STRUCTURE

PROCESS

OUTCOME

IMPROVE PATIENT SAFETY CULTURE

STRUCTURE

a) Policy Development:

Policies related to IPSGs were formulated such as Patient Identification, Effective communication, High
Alert medications, Handover communication, ensure correct site, procedure and patient, policy on
prevention of fall and policy for care of vulnerable patients and disseminated to all the relevant
stakeholders.

b) Mentors:

Area-wise champions or Mentors were identified and trained so that they can train other staff down the
line. Mentors were selected from Floor Coordinators, Nursing supervisor/ Team Lead or In-charge

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c)Audit Checklist

Various audit checklists, specific to an area for different cadre of staff like General Observation, doctors,
Nurses and paramedics was developed and used while performing the assessment

NABH Patient safety Goals include

 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 health care-associated infections.
 Goal Six - Reduce the risk of patient harm resulting from falls.

GOAL 1- IDENTIFY PATIENTS CORRECTLY.

This goal stated that before any procedure, surgery, medication administration, dispensing of
medication or any other situation which is related to patient, the identity of patient must be confirmed.
In Health Care settings it is suggested that patient identification must be done with at least two
identifiers. These identifiers could be Patient’s name & UHID (Unique Healthcare Identity).

If any patient doesn’t have name or patient is in condition where he/she unable to confirm their name,
that type of patient could be named as UNKNOWN 1 & 2 and so on and with this name an UHID should
be generated

GOAL 2 -- IMPROVE EFFECTIVE COMMUNICATION.

This IPSG emphasizes on the effective communication between the Healthcare personnel. This goal
prevents the patient from any kind of risk which may rise due to communication gap between the
healthcare personnel. According to this goal the information of the patient has to be confirmed in a
proper way before taking any kind of decision which is related to patient.

In any healthcare setting there are two major conditions where the communication played a vital role in
patient treatment. They are as below: 1. When the treating consultant is unable to take patient’s call
physically or in case when he gives verbal order

Condition related to verbal order

First of all, we will not follow any verbal order and it is also the responsibility of the healthcare
management that they make policy in this regard. The healthcare management needs to define some
condition in which verbal order will be accepted.

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These conditions may be like as follow:

a. Life threatening situations

b. Serious nature of patients conditions such that if medication is not administered it may lead to
permanent harm or even death of the patient

c. Anti-diabetic drug orders

d. Reporting of critical test results (report in 15 min)

If we face any of the condition stated above then the procedure to take verbal order will be as followed:
If the consultant is giving orders telephonically then we have to follow our READ BACK policy. During this
condition we follow the steps define below –

a. The receiver (recipient) documents the complete order

b. The receiver (recipient) reads back the message as he/ she has heard, written and interpreted it.

c. The sender or the individual giving the order confirms that such recording and interpretation of the
order is correct & documents it

1. During shift change or handing over the patient to another staff

The risk of communication gap increases when the staff hand over patient one to another. These
situations occurs when –

a. During shift change

b. Inter Department patient transfer

c. Inter Hospital patient transfer

d. Shifted to OT

e. Shifted from Recovery Area

During these situations, to minimize the risk related to communication gap during shift change or during
handing over the patient to another staff. Staff should follow the EFFECTIVE COMMUNICATION policy.
Staff will handover patient according to ISBAR.

I – INTRODUCTION Documented details of patient and handing over as well as taking over staff detail.

S- SITUATION About the patient condition in which the patient is going to handing and taking over.

B- BACKGROUND All detail regarding patient diagnosis, clinical history, comorbidities, treatment given
and incident etc.

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A -ASSESMENT Details regarding patient vital record, RBS, Pain, Intake/Output, and Systemic
Examination etc.

R- RECOMMENDATION If any special instruction regarding patient care as patient diet, NPO, pending
examinations and their reports pending medication, planned discharge etc. need to document under
this column

GOAL 3- Improve the safety of high-alert medications.

High risk medications are those that having heavy risk of causing significant harm when they are used in
error. Although mistakes may or may not be more common with these drugs, the consequences of an
error are clearly more devastating to patients. To improve the safety of high-risk medication, we have to
strengthen our policy regarding high-risk medication dispensing, storage, documentation, administration
and monitoring.

Safeties during dispense of high-risk medication

Indent need to be verified by at least two personnel.

Safeties during administration of high-risk medication:

High Risk Medications need to be stored in a separate highlighted (often use red colour) place and these
drugs should be locked

Safeties during storage of high-risk medication:

All high-risk medication needs to be highlighted when documented. These drugs should be easily
recognized

Safeties during documentation of high-risk medication:

When it is needed to administer any high risk medication to the patient, staff should follow 5 Rights of
medication (Right patient, Right route, Right medication, Right dose, and Right time)

Safeties during monitoring of high-risk medication:

All indicated high risk medication need monitor after administration.

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Goal 4 -ENSURE CORRECT SITE, CORRECT PROCEDURE -CORRECT PATIENT
SURGERY.

Patient needs more care when he/she undergone any surgical procedure. Surgical care of the patient is
most essential part of healthcare.

Patient safety needs to be ensured at each point as pre-operative care, Peri-Operative care, and post-
operative care. To ensure the surgical safety we must follow:

a. Concerned surgeon/ team member will do surgical site marking with indelible marker pen.

b. The mark should be a circle or oval, remain visible after the application of skin preparation. It is
desirable that the mark should also remain visible even after the patient is prepped or draped

1st Check: OT staff nurse goes to the respective floor/ward/ ICU/ emergency to bring the patient to the
respective OT.

The nurse escorting the patient will carry out the check of following:

I. The patient’s identity against the clinical records

II. The patient’s identity and procedure against the clinical records.

III. The patient’s identity and procedure against the operating list that the correct body part has been
marked in relation to the information in the clinical notes.

2nd Check: Prior to anesthesia, Operating surgeon (or senior member of the team) will:

I. Inspect the site mark and check it against the patient’s supporting documentation
II. Re-check imaging studies are available in the operating theatre or suite III. Check that the
correct implant is available (if applicable)

3rd Check/Time Out- Final Verification: Just before the actual procedure begins, a final verification will
be performed as a part of “TIME OUT” by all team members present.

Time Out: A pause, just prior to performing a surgical or other procedure, during which any
unanswered questions or confusion about patient, procedure, or site are resolved by the entire surgical
or procedural team. The circulating nurse will initiate the Time out procedure; members of the team
will verbally verify the following:

a. Patient identity

b. Procedure to be performed

c. Site of the procedure, noting the position of the patient

d. Presence of images (properly labelled and displayed)

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e. Presence of required implants and any special equipment.

f. Availability of correct implants and any special equipment or special requirements

Documents and reports availability

GOAL 5: REDUCE THE RISK OF HEALTHCARE ASSOCIATED INFECTIONS(HAI)

It is the responsibility of healthcare management to prevent their patients from the Healthcare
Associated Infection (HAI). In this regard healthcare need to be followed all HIC protocols guided by
WHO & CDC. To prevent the patient from HAI, the healthcare needs to follow policies given below:

I. Hand Hygiene (Hand Rub, Hand Wash, Hand Scrub, and 5 moments of hand hygiene
II. Bundle Care (VAP, CAUTI, CLABSI and SSI)
III. Bio Medical Waste Management
IV. Cleaning, Disinfection and Sterilization
V. Cleaning surveillance
VI. Swab Cultures of Critical Care Areas
VII. Standard Precautions etc.

GOAL 6: REDUCE THE RISK OF PATIENT HARM RESULTING FALLS

It is very important to reduce the risk of slip, trip and fall in the organisation because slip, trip and falls
are led to sentinel events.

To reduce the risk of patient harm resulting from falls, the healthcare management has to keep the
points in mind as given below:

I. Proper fall risk assessment need to be done for each patient

II. Vulnerable patient should not be alone

III. Side rails should be open.

IV. Frequent Monitoring needed for vulnerable patients and those patients who are having fall risk

V. All wheel chairs and stretchers should have safety belts

VI. Patient & Family education on slip, trip and fall

VII. Facility rounds on defined intervals

VIII. Regular maintenance of all facilities

IX. No manhole should be open

X. The terrace area should be covered with four feet boundary.

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XI. Terrace area should be accessible by authorized personnel only.

b) PROCESS
TRAINING

Regular training sessions for mentors and on job training sessions for mentors to strengthen and
inculcate the policies into work processes and routine.

STAFF ENGAGEMENT

Celebration of Patient Safety week, conducting programs spread over 7 days involving
interactive Quiz sessions, play and skit by staff, poster making competition

RESEARCH AT HOSPITAL INCLUDES THE FOLLOWING ACTIVITIES:

 Study of NABH standards(chapters).

 Understanding the policies and procedures, practices of hospital with the help doctors and
administration department.
 Observing policies and procedures of various department
 Creating protocols to illustrate all and provide feedback and suggestion

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