devsofttech_hms_ci4/.agents/skills/hms-nabh-compliance/SKILL.md

name	description
hms-nabh-compliance	Use when building, testing, or auditing hospital workflows for NABH (National Accreditation Board for Hospitals & Healthcare Providers) compliance, including the 13 statutory informed consent forms, initial medical/nursing assessments, clinical audit criteria, SBAR nursing handovers, and discharge summary quality checks.

HMS NABH Accreditation & Clinical Governance Skill

This skill guides the agent through implementing, maintaining, and auditing hospital processes against NABH (5th Edition) hospital accreditation standards in E-Atria HMS.

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1. 13 Statutory Informed Consent Templates

NABH mandates that all procedures, admissions, high-risk interventions, and surgical operations have documented informed consent signed by the patient (or legal guardian) and doctor.

The 13 statutory templates are seeded in the database via App\Database\Seeds\Data\IpdDocumentSeedData:

Code	Template Title	Key NABH Mandatory Fields
NABH-IPD-01	Admission Request & Initial Assessment Form	Provisional diagnosis, primary consultant, vitals, allergy history, patient/attendant declaration
NABH-IPD-02	General Informed Consent for Medical Treatment	Explanation of treatment plan, potential risks, rights of patient, attendant signature
NABH-IPD-03	Informed Consent for Surgical Procedure / Operation	Named procedure, operating surgeon, alternative therapies explained, possibility of conversion/extension
NABH-IPD-04	Informed Consent for Administration of Anesthesia	General / Spinal / Epidural / Regional / Sedation, ASA physical status grade, fasting hours confirmed
NABH-IPD-05	High-Risk Informed Consent	Documented severe comorbidities, ICU requirement, explicit mortality risk disclosure, two witness signatures
NABH-IPD-06	Blood & Blood Component Transfusion Consent	PRBC / FFP / Platelets / Cryoprecipitate, adverse reaction disclosure, right to refuse
NABH-IPD-07	ICU / HDU Admission Informed Consent	Critical care management, central venous line, invasive arterial monitoring, mechanical ventilation
NABH-IPD-08	Discharge Against Medical Advice (DAMA / LAMA)	Declaration acknowledging refusal of medical advice, clinical risks of premature discharge, legal indemnity waiver
NABH-IPD-09	Consent for Bedside / Invasive Diagnostic Procedure	Pleural tap, Ascitic tap, Lumbar puncture, Endoscopy, Bone marrow biopsy
NABH-IPD-10	Refusal of Treatment / Specific Procedure Consent	Informed refusal documentation detailing potential health deterioration resulting from refusal
NABH-IPD-11	Chemotherapy / Specialized Medical Therapy Consent	Chemotherapeutic agents, cycle number, cumulative toxicity, extravasation risk
NABH-IPD-12	Restraint Application Consent	Physical / chemical restraint indication, patient safety rationale, alternative interventions attempted
NABH-IPD-13	Release of Medical Information / Records Consent	Third-party insurance / TPA disclosure authorization, medico-legal release

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2. Inpatient Clinical Care Standards (COP - Care of Patients)

1. Initial Assessment Timelines:
   • Doctor Assessment: Must be completed within 24 hours of admission (or immediately in Emergency/ICU). Contains past history, allergies, personal history, systemic examination, provisional diagnosis, and initial care plan.
   • Nursing Assessment: Must be completed within 2 to 4 hours of admission. Contains nutritional screening, fall risk assessment (Morse Fall Scale / Hendrich II), pressure ulcer risk assessment (Braden Scale), and pain assessment.
2. Nursing Handover Protocol (SBAR):
   • Shift handovers must adhere to the SBAR Framework:
     • S (Situation): Patient name, age, bed no, admitting consultant, current diagnosis.
     • B (Background): Admission date, surgical history, known allergies, baseline vitals.
     • A (Assessment): Current shift vitals, pain status, abnormal lab values, pending reports.
     • R (Recommendation): Pending doctor orders, next medication doses, scheduled scans.
3. Medication Administration & Safety (MOM):
   • High-alert medications (e.g. Concentrated Electrolytes, Insulins, Anticoagulants, Chemotherapy) must require double-nursing check before administration.
   • Look-Alike Sound-Alike (LASA) drugs must be segregated with tall-man lettering.

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3. Discharge Summary Quality Standard (AAC - Access, Assessment & Continuity of Care)

Under NABH, a discharge summary is a medico-legal document. It must be handed over to the patient at the time of discharge and contain:

1. Hospital UHID, IPD Number, Admission Date & Time, Discharge Date & Time.
2. Admitting Consultant, Department, and Operating Surgeon (if surgical).
3. Primary & Secondary Final Diagnoses with ICD-10 codes.
4. Reason for Admission & Brief Clinical History.
5. Key Physical Findings on Admission.
6. Summary of Pertinent Laboratory, Imaging & Diagnostic Reports.
7. Detailed Hospital Course, Surgical Procedures with Operative Findings.
8. Patient's Condition at Discharge (Vitals, Wound Status, Ambulation).
9. Discharge Medication Chart (Generic Name, Strength, Dosage, Route, Frequency, Duration).
10. Urgent Warning Signs / Emergency Red Flags (e.g., severe chest pain, breathlessness, sudden high fever, wound bleeding).
11. Scheduled Follow-up Date, Time, and OPD Room / Consultant Name.
12. Treating Consultant Doctor's Name, Qualifications, and Signature.

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4. Digital Scans & Document Archiving (nabh_ipd_scans)

• Physical signed consent forms, outside lab reports, and signed anesthetic fitness sheets uploaded via DoctorDocument.php are stored in nabh_ipd_scans.
• Categorized strictly by standard NABH code (NABH-IPD-01 to 13).
• Linked to ipd_id, patient_id, uploaded_by, and timestamped for clinical audit trail.