devsofttech_hms_ci4/.agents/rules/nabh_compliance_rules.md

NABH Hospital Accreditation Compliance Rules

This document specifies the NABH (National Accreditation Board for Hospitals & Healthcare Providers, 5th Edition) standards embedded in the E-Atria HMS architecture.

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1. 13 Mandatory Statutory Consent Forms

All IPD admissions and specialized clinical procedures must record explicit, informed patient consent before interventions:

Consent Form ID	Title	Key Mandatory Requirement
NABH-IPD-01	Admission Request & Initial Assessment Form	Demographics, provisional diagnosis, treating consultant, signature within 24h
NABH-IPD-02	General Informed Consent for Medical Treatment	Risks, benefits, hospital policies, patient/attendant signature
NABH-IPD-03	Informed Consent for Surgical Procedure / Operation	Operating surgeon, specific procedure name, alternatives, anesthesia type
NABH-IPD-04	Informed Consent for Administration of Anesthesia	General / Spinal / Epidural / Regional, fasting status, ASA grade
NABH-IPD-05	High-Risk Informed Consent	Explicit documentation of mortality risk, ICU requirement, signed by 2 attendants
NABH-IPD-06	Blood & Blood Component Transfusion Consent	PRBC, FFP, Platelets, adverse reaction warning, refusal rights
NABH-IPD-07	ICU / HDU Admission Informed Consent	Critical care protocols, invasive monitoring, ventilator consent
NABH-IPD-08	Discharge Against Medical Advice (DAMA / LAMA)	Declaration of voluntary discharge against advice, liability waiver
NABH-IPD-09	Consent for Invasive Diagnostic / Bedside Procedure	Endoscopy, Lumbar puncture, CVC, Pleural tap
NABH-IPD-10	Refusal of Medical Treatment / Procedure Consent	Explicit informed refusal documenting medical risks of refusal
NABH-IPD-11	Chemotherapy / Dialysis Specialized Consent	Specific drug protocols, cumulative toxicity risks
NABH-IPD-12	Restraint Application Consent	Physical/chemical restraint reason, alternative trials, periodic review
NABH-IPD-13	Release of Medical Records / Photography Consent	Confidentiality waiver, medico-legal or insurance release

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2. Inpatient Clinical Timelines & Standards

1. Initial Assessment Timeline:

   • Initial Medical Assessment by doctor must be completed within 24 hours of admission (or immediately for emergency/ICU admissions).
   • Initial Nursing Assessment must be completed within 2 to 4 hours of admission.

2. Daily Clinical Progress Notes (SOAP Format):

   • Every inpatient must have daily dated and timed notes adhering to:
     • S (Subjective): Patient complaints, comfort, pain score (1-10).
     • O (Objective): Vitals (BP, PR, RR, SpO2, Temp), systemic physical examination, lab/imaging review.
     • A (Assessment): Current clinical status and diagnosis evolution.
     • P (Plan): Medication changes, investigations ordered, diet, discharge planning.

3. Discharge Summary Mandatory Criteria:

   • Under NABH, a discharge summary MUST contain:
     1. Admission & Discharge Dates & Times.
     2. Primary & Secondary Final Diagnoses (with ICD-10 codes).
     3. Significant Clinical History & Physical Findings on admission.
     4. Results of Significant Diagnostic Tests & Interventions.
     5. Summary of Hospital Course & Treatment Provided.
     6. Condition of the Patient at Discharge.
     7. Discharge Medications (generic name, strength, dosage, route, frequency, duration).
     8. Urgent Warning Signs / Red Flags necessitating immediate emergency return.
     9. Specific Follow-up Date and Consulting Doctor Name.

4. Digital Scanning & Retention (nabh_ipd_scans):

   • Physical paper consent forms and bedside charts scanned into the system are stored in nabh_ipd_scans with proper categorization (NABH-IPD-01 to 13).
   • Scanned records must be retained in accordance with the hospital's medico-legal retention period (minimum 3 years for adult IPD, till age of majority + 3 years for pediatric cases).