OPDs

Out-Patient Department (OPD) Requirements (NABH 5th Ed.)

Chapter AAC - Assessment of Patients

1. Registration and Admission (AAC 2a, 2b, 2c, 2d, 2e):

   • OPDs must follow written guidance for registering and admitting patients. (AAC 2a)

   • Every patient registered in the OPD must receive a Unique Hospital Identification Number (UHID) at the end of registration for identification and continuity of care; all records should have this UHID. (AAC 2b)

   • Patients are accepted in the OPD only if the hospital can provide the required service; staff must be aware of the services provided and whom to contact for clarification. (AAC 2c)

   • Written guidance must address managing patients during non-availability of services (e.g., managing waiting lists, communication when OPD slots are full). (AAC 2d)

   • Access to healthcare services in the OPD must be prioritized according to the patient's clinical needs (triage system if applicable). (AAC 2e)

2. Patient Transfer/Referral (AAC 3b, 3c, 3d, 12f):

   • If a patient seen in OPD requires transfer or referral to another facility, it must be done appropriately and safely, including documenting the reason. (AAC 3b)

   • Accompanying staff during such transfers/referrals from OPD must be appropriate to the patient's clinical condition. (AAC 3c)

   • A summary of the patient's condition and treatment given in the OPD must be provided during transfer/referral, and a copy retained. (AAC 3d)

   • Referral of patients from the OPD to other departments/specialities must follow written guidance, including mentioning the reason, urgency (graded), and ensuring they are seen within a defined timeframe. (AAC 12f)

3. Initial Assessment (AAC 4a, 4b, 4c):

   • Initial assessment for Out-patients (OPs) must be done using a standardized format. (AAC 4a)

   • For OPs, the initial assessment should include vital parameters. (AAC 4a interpretation)

   • The initial assessment must be performed by qualified personnel as defined by the hospital for OPD settings. (AAC 4b)

   • The organisation must define and document the time frame within which the initial assessment for OPs is performed based on their needs (e.g., triage time, time to be seen by doctor). (AAC 4c)

4. Follow-up (AAC 5b):

   • Out-patients must be informed of their next follow-up appointment or requirements, where appropriate.

   • This follow-up information should be documented in the medical record/OP sheet. (AAC 5b)

5. Scope of Services (AAC 1c, 1d):

   • The scope of healthcare services provided by each OPD specialty/department must be defined (including inclusion/exclusion criteria). (AAC 1c)

   • The organisation's defined healthcare services (including OPD specialties) must be prominently displayed in a manner understood by patients and visitors (bilingual/pictorial, e.g., boards, brochures, electronic displays). (AAC 1d)

Chapter COP - Care of Patients

1. Clinical Care Pathways (COP 1e):

   • Evidence-based clinical care pathways relevant to common conditions seen in OPD must be developed, consistently followed, and reviewed periodically (e.g., develop 2 pathways annually and review them). (COP 1e)

2. Procedure Management (COP 7d):

   • Care must be taken to prevent adverse events like wrong patient, wrong procedure, and wrong site during minor procedures performed in the OPD.

   • This requires using a documented checklist (e.g., based on WHO safe surgery), using two identifiers to identify the patient, site identification/marking, and involving the patient/relatives. (COP 7d)

3. Emergency Department Triage/Initial Care (COP 3i):

   • The emergency department (often linked or functioning as acute outpatient care) must identify opportunities to initiate treatment at the earliest when the patient is in transit or arrives.

   • From the first communication/arrival, a file is created to record appropriate information (patient weight, age, provisional diagnosis, ongoing treatment from referring organisation) to facilitate early care initiation. (COP 3i)

4. Specific Patient Groups - Obstetrics/Neonates/Paediatrics:

   • Antenatal Services (COP 10d, 10e): If antenatal services are provided in the OPD setting, SOPs for assessment, immunisation, diet counselling, and frequency of visits must exist, and an antenatal card should be used. Obstetric patient assessment must include maternal nutrition assessment, preferably by a dietician. (COP 10d, 10e)

   • Paediatric Assessment (COP 11e): Paediatric assessment in the OPD must include growth, developmental, and immunization assessment, maintaining and updating growth charts and immunization records. (COP 11e)

   • Child's Family Education (COP 11g, 57, 84): The child's family members seen in the OPD must be educated about nutrition, immunisation, and safe parenting (e.g., breastfeeding, weaning, malnutrition, obesity). This point was listed multiple times (COP 11g, 57, 84).

   • Child/Neonate Abduction/Abuse Prevention (COP 11f, 83): Measures must be in place to prevent child/neonate abduction and abuse, relevant if paediatrics OPD is provided (SOP, rapid response, testing, staff training, awareness). Listed multiple times (COP 11f, 83).

5. Vulnerable Patient Safety (COP 16b, 25):

   • A safe and secure environment must be provided for vulnerable patients visiting the OPD (e.g., elderly, disabled) (fall prevention measures, ramps with railings, grab-bars). (COP 16b, 25)

6. Fall Risk Identification (COP 16c, 58):

   • Patients visiting the OPD who are at risk of falling should be identified using a validated tool (e.g., Morse Fall Scale, Paediatric assessment scale) and managed according to written guidance (e.g., universal precautions in waiting areas). Listed multiple times (COP 16c, 58).

7. Pain Management Education (PRE 5f, 85):

   • Patients and/or family in the OPD should be educated on various pain management techniques when appropriate, considering their beliefs. Listed multiple times (PRE 5f, 85).

Chapter MOM - Management of Medication

1. High-Risk Medications (MOM 3c, 26):

   • The organisation must define a list of high-risk medications. If these are stored or dispensed in the OPD pharmacy or procedure rooms, safeguards must be in place. (MOM 3c, 26)

2. Medication Prescription (MOM 4a, 4b, 4c, 4d):

   • Medication prescription for Out-patients must be in consonance with good practices/rational guidelines, ensuring clinicians are trained. (MOM 4a)

   • OPD prescriptions must adhere to minimum requirements (patient name/UHID, drug details including generic composition (mandatory), strength, dosage, instruction, duration, total quantity, prescriber name/signature/registration number). (MOM 4b)

   • Error-prone abbreviations must not be used. Prescriptions should preferably be in capital letters. Errors or illegible prescriptions must be initialled after a single strikethrough and rewritten. (MOM 4b)

   • Drug allergies and previous adverse drug reactions must be ascertained and documented prominently (e.g., sticker) before prescribing in the OPD. (MOM 4c)

   • A mechanism must be in place to assist clinicians in the OPD with appropriate prescribing (e.g., access to information to identify drug reactions, food-drug interactions, therapeutic duplication, dose adjustments - electronic or physical). (MOM 4d)

3. Verbal Orders (MOM 4e, 31):

   • While less common for routine OPD, if verbal orders are permitted (e.g., in an urgent situation within the OPD), safe medication management practices must be followed (SOP defining who can give/when, authentication, approved formulary list, repeat back, countersigning within 24 hours). (MOM 4e, 31)

4. Medication Reconciliation (MOM 4h, 60):

   • Medication reconciliation may occur when a patient visits the OPD after a hospitalisation or is being seen by multiple specialists, and should be documented. Listed multiple times (MOM 4h, 60).

5. Antimicrobial Usage (HIC 3e, 89):

   • An appropriate antimicrobial usage policy based on institutional culture data must be established and documented, guiding the prescribing of antibiotics in the OPD for identified clinical conditions. Listed multiple times (HIC 3e, 89).

Chapter PRE - Patient and Family Rights

1. Rights Awareness (PRE 1a, 1b, 32, 33):

   • Patient and family rights and responsibilities must be documented, prominently displayed in the OPD areas (bilingual), and they must be made aware of them (e.g., via pamphlets).

   • These rights must be actively promoted for patients visiting the OPD (e.g., providing educational material). Listed multiple times (PRE 1a, 1b, 32, 33).

2. Respect and Privacy (PRE 2a, 2b, 62, 63):

   • Respect for patient and family values, beliefs, preferences, cultural needs, and requests for spiritual needs must be maintained during their OPD visit (e.g., how they wish to be addressed, dietary discussions).

   • Personal dignity and privacy must be maintained during examination, procedures, and consultation in the OPD, with necessary guidelines developed. Listed multiple times (PRE 2a, 2b, 62, 63).

3. Protection and Confidentiality (PRE 2c, 2d, 64, 65):

   • Patient and family must be protected from neglect or abuse in the OPD areas.

   • Patient information handled in the OPD must be treated as confidential, with effective measures to maintain confidentiality of records and during consultations. Listed multiple times (PRE 2c, 2d, 64, 65).

4. Treatment Decisions (PRE 2e, 2f, 66, 67):

   • Patient and family in the OPD have the right to refuse treatment discussed during the consultation; the treating doctor must explain options, consequences of refusal, and document the same.

   • Patient and family in the OPD have the right to seek an additional opinion; the organisation must respect this decision and facilitate access to relevant information/evaluation. Listed multiple times (PRE 2e, 2f, 66, 67).

5. Informed Consent (PRE 2g, 4a, 4b, 4c, 4d, 4e, 68):

   • Informed consent must be obtained by the treating doctor or a member of the treating team before any invasive/high-risk procedures or treatments performed in the OPD.

   • The consent process must adhere to statutory norms.

   • Informed consent must include information on the procedure, its risks, benefits, and alternatives, and specify who will perform it (in a language understood by the patient/family).

   • The organisation must define who can give consent when the patient is incapable.

   • Informed consent must be taken by the person performing the procedure. Listed multiple times (PRE 2g, 4a-e, 68).

6. Information Sharing (PRE 2j, 2k, 2l, 3a, 3b, 3c, 3d, 3e, 3f, 71, 72, 73, 74, 75, 76, 77, 78):

   • Patient and family must have access to their clinical records maintained for their OPD visits. (PRE 2j, 71)

   • Patient and family in the OPD must be informed about the name of the treating doctor, proposed care plan, and healthcare needs.

   • Patient rights regarding information sharing with self and family must be respected.

   • Proposed care, including risks, alternatives, and benefits, must be explained by the treating doctor in understandable language and documented.

   • Expected results and possible complications must be explained.

   • The care plan should be prepared in consultation with the patient/family.

   • Results of diagnostic tests and the diagnosis must be explained, including implications.

   • Any change in the patient's condition must be explained in a timely manner. Listed multiple times (PRE 2k, 2l, 3a-f, 72, 73, 74, 75, 76, 77, 78).

7. Complaints and Feedback (PRE 2h, 7c, 37, 69):

   • Patient and family visiting the OPD have the right to complain, and information on how to do so must be known to them (displayed, e.g., via feedback forms, OVR).

   • The organisation must have a mechanism to redress patient complaints originating from the OPD, with a defined mechanism, timeframe, responsible persons, and action documentation. Listed multiple times (PRE 2h, 7c, 37, 69).

8. Cost Information (PRE 2i, 6a, 6b, 70, 86, 87):

   • Patient and family visiting the OPD must be informed about the expected costs of treatment and made aware of the pricing policy for OPD services.

   • A relevant and updated tariff list must be available to patients in the OPD, uniform and transparent. Listed multiple times (PRE 2i, 6a, 6b, 70, 86, 87).

9. Patient Education (PRE 5a, 5b, 5c, 5d, 5e, 5g, 5h, 5i):

   • Patient and/or family in the OPD must be educated in a language and format they can understand (counseling, printed/audio-visual materials). (PRE 5a)

   • Patient and/or family should be educated about the safe and effective use of medication, potential side effects, and food-drug interactions, when appropriate for their OPD-prescribed medications. (PRE 5b, 5c)

   • Education on diet, nutrition, immunisations, disease process, complications, prevention strategies (stress, exercise, diet changes, smoking cessation, substance abuse), and preventing healthcare associated infections (e.g., hand washing) should be provided when relevant to their condition discussed in the OPD. (PRE 5d, 5e, 5g, 5h, 5i)

   • Special educational needs must be identified and addressed. (PRE 5i)

10. Financial Implications of Change (PRE 6d):

    • Patient and family should be informed about financial implications when there is a change in the care plan discussed in the OPD (e.g., need for expensive investigation, decision for surgery/admission). (PRE 6d)

11. Patient Experience Capture (PRE 7a, 7b, 36, 88):

    • The organisation must have a mechanism to capture patient experience related to their OPD visit (e.g., communication with doctors/nurses, waiting time, environment, responsiveness, medication communication, overall rating). Listed multiple times (PRE 7a, 7b, 36, 88).

12. Communication Standards (PRE 8b, 8c, 8d, 38, 39, 40):

    • Special situations in the OPD requiring enhanced communication must be identified (e.g., breaking bad news). (PRE 8b, 38)

    • Enhanced communication must be done effectively in these situations. (PRE 8c, 39)

    • The organisation must ensure no unacceptable communication occurs in the OPD (e.g., abusing patients, disrespecting sentiments). (PRE 8d, 40)

13. Reporting Rights Violations (PRE 1d, 91):

    • The organisation must have a mechanism to report violations of patient and family rights occurring in the OPD setting (e.g., OVR), and train staff. Listed multiple times (PRE 1d, 91).

Chapter HIC - Hospital Infection Control

1. Hand Hygiene (HIC 2d, 3b, 42, 44):

   • Adequate and appropriate facilities for hand hygiene must be accessible to healthcare providers and patients/visitors in all patient-care areas in the OPD (washbasin, hands-free tap, soap, drying facility, handrub).

   • The organisation must adhere to hand-hygiene guidelines, displaying instructions near hand washing areas. Listed multiple times (HIC 2d, 3b, 42, 44).

2. Standard and Transmission-Based Precautions (HIC 3a, 3c, 43, 45):

   • The organisation must adhere to standard precautions at all times in the OPD (e.g., during examinations, procedures).

   • The organisation must adhere to transmission-based precautions if patients with communicable diseases are seen in the OPD (e.g., appropriate usage of PPE, managing flow). Listed multiple times (HIC 3a, 3c, 43, 45).

3. Safe Injection Practices (HIC 3d, 46):

   • The organisation must adhere to safe injection and infusion practices in the OPD if these services are provided (one needle, one syringe, one time). Listed multiple times (HIC 3d, 46).

4. Environmental Controls (HIC 4a, 47):

   • Appropriate engineering controls must be in place in the OPD areas to prevent infections (e.g., adequate spacing, air quality in waiting areas, consultation rooms). Listed multiple times (HIC 4a, 47).

5. Housekeeping (HIC 4c, 48):

   • The organisation must adhere to housekeeping procedures in the OPD areas (cleaning frequency, disinfectants, blood/body fluid clean up). Listed multiple times (HIC 4c, 48).

6. Biomedical Waste (BMW) (HIC 4d, 49):

   • Biomedical waste generated in the OPD (e.g., from injections, minor procedures, dressings) must be handled appropriately and safely (segregation, collection, storage as per color-coded bags). Listed multiple times (HIC 4d, 49).

7. Construction Risk (HIC 4b, 90):

   • If there is construction or renovation affecting the OPD area, the organisation must design and implement a plan to reduce the risk of infection, involving the HIC team. Listed multiple times (HIC 4b, 90).

Chapter FMS - Facility Management & Safety

1. Patient Safety Infrastructure (FMS 1a):

   • Patient-safety devices and infrastructure must be installed in the OPD areas (e.g., non-slip flooring, grab bars in washrooms/consultation rooms, appropriate seating). (FMS 1a)

2. Signage (FMS 2c, 42):

   • There must be internal and external sign postings in the organisation, clearly indicating the location of OPDs and specific clinics, in a manner understood by patients and families (bilingual/pictorial). Listed multiple times (FMS 2c, 42).

3. Utilities (FMS 2d, 2e, 43):

   • Adequate potable water and electricity must be available round the clock in the OPD areas, with alternate sources as backup. Water quality must be monitored. Listed multiple times (FMS 2d, 2e, 43).

4. Security (FMS 3b, 44):

   • Operational planning must identify OPD areas requiring extra security (e.g., waiting areas, cash counters) and describe access for staff, patients, and visitors. Listed multiple times (FMS 3b, 44).

5. Waste Management (Non-BMW) (FMS 3d, 45):

   • There must be a procedure which addresses the identification and disposal of material(s) not in use in the OPD (e.g., old furniture, expired documents). Listed multiple times (FMS 3d, 45).

6. Hazardous Materials (FMS 3e, 3f, 54, 55):

   • Hazardous materials used in the OPD (e.g., cleaning supplies, laboratory reagents if applicable) must be identified and used safely. A plan for managing spills must be implemented, and staff trained. Listed multiple times (FMS 3e, 3f, 54, 55).

7. Equipment Management (FMS 4b, 4d, 4h, 5b, 5d):

   • Equipment used in the OPD (medical and non-medical) must be inventoried, periodically inspected, and calibrated for proper functioning (e.g., BP apparatus, stethoscopes, weighing scales, examination lights, office equipment). (FMS 4b, 4d, 4h, 5b, 5d)

8. Emergency Exit Plan (FMS 7b, 61):

   • A documented and displayed exit plan must be available in the OPD areas in case of fire and non-fire emergencies. Listed multiple times (FMS 7b, 61).

Chapter HRM - Human Resource Management

1. Staff Training (HRM 3a, 4c, 5b, 5d, 5e, 5f, 6a, 6b, 6c, 6d, 6e, 6f, 6g):

   • Staff working in the OPD must receive induction training. (HRM 3a)

   • Training must occur when job responsibilities change or new equipment is introduced in the OPD. (HRM 4c)

   • OPD staff must be trained in handling vulnerable patients (if seen). (HRM 5b)

   • OPD staff must be trained in healthcare communication techniques. (HRM 5d)

   • Staff involved in direct patient care in OPD should be trained in CPR (BLS), depending on the setup and patient acuity. (HRM 5e)

   • OPD staff must be trained in infection prevention and control periodically. (HRM 5f)

   • OPD staff must be trained on the organisation's safety programme, risk management (spills, hazardous materials), incident handling, occupational safety, disaster management, and fire/non-fire emergencies (their specific roles). (HRM 6a-f)

   • OPD staff must be trained on the organisation's quality improvement programme. (HRM 6g)

2. Staff Welfare & Rights (HRM 7b, 8b, 9c, 9d):

   • OPD staff must be aware of the appraisal system. (HRM 7b)

   • The disciplinary and grievance handling mechanism must be known to all categories of staff in the OPD. (HRM 8b)

   • Health checks must be done at least once a year for staff dealing with direct patient care in the OPD, and findings documented. (HRM 9c)

   • The organisation must provide treatment for OPD staff who sustain workplace-related injuries. (HRM 9d)

3. Nursing Staff Competence & Privileging (HRM 12a, 12b, 12d, 12e, 12f):

   • Nursing staff in the OPD must be permitted by law/regulation/organisation policy to provide care without supervision.

   • Their education, registration, training, and experience must be verified and documented.

   • They must be granted privileges in consonance with their qualifications.

   • Their duties must be known to them and other departments.

   • They must care for patients as per their privileging. (HRM 12a, 12b, 12d, 12e, 12f)

Chapter IMS - Information Management System

1. Medical Record (IMS 3a, 3c, 3d, 4b):

   • A unique identifier (UHID) must be assigned to the medical record for OPD visits and used on every sheet/entry. (IMS 3a)

   • The medical record for OPD visits must provide a complete, up-to-date, and chronological account of patient care. (IMS 3c)

   • Authorised staff must make entries in the medical record for OPD visits, and the SOP should define who makes entries and the content. (IMS 3d)

   • The medical record must contain details of assessments and consultations performed in the OPD. (IMS 4b)