Tagore Hospital & Heart Care Centre, Jalandhar

Quality Improvement Plan

Introduction
Vision
Our Vision is to be recognized as a leader in the field of quality healthcare by achieving professional excellence
and the ability to consistently fulfill our patients need.

Mission
Our Mission is to serve the community with dedication and to continuously engage in upgrading our healthcare
delivery system through quality intervention, involvement of all functionaries and excellent leadership.

Scope of Services
The hospital provides services in the following departments

GENERAL MEDICINE
GENERAL SURGERY
LAPAROSCOPIC SURGERY
ORTHOPAEDICS

JOINT REPLACEMENT

DIABETES CARE CENTRE

CARDIOLOGY

CARDIOTHORACIC SURGERY

NEUROLOGY

GASTROENTEROLOGY

All types of medical services

Major/ minor general surgical operations
All types of Laparoscopic Surgeries
Trauma, Complicated fractures treatment,
Interlocking nail
All types of joint replacement & spine
Surgery
Comprehensive Diabetic Care including
Education, dietary management
Diabetic foot clinic, Special Clinic for
Diabetic pregnant women & children.
ECG, TMT, Colour Doppler, Echo/ TEE,
Holter Study, Angiography, Angioplasty (Coronary &
Peripheral), Stent Implantation, Pacemaker/ AICD
Implantation, EPS.
Bypass Surgery (CABG), Valve
Replacement, Repair of congenital defects, Vascular &
Lung Surgery.
Advanced Stroke ICU, Thrombolysis, EEG,
Video EEG, NCV, EMG, Visual/ Auditory/ Somatosensory
Evoked potentials, Botox Therapy.
Diagnostic & Therapeutic UGI-Endoscopy
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Variceal Band Ligation, Sclerotherapy/ Clip Application,

Electro coagulation for bleeding peptic ulcer, Colonoscopy/
flexible Sigmoidoscopy, ERCP.
Hem dialysis, Peritoneal Dialysis, CAPD
Functional Endoscopic Sinus Surgery,
Endoscopic adenoidectomy & Tonsillectomy, Micro
laryngeal Surgery, Microear Surgery.
Phacoemulsification Cataract Surgery,
Medical & Surgical treatment of glaucoma Squint
&Oculoplastic Surgery, Fundus Fluorescein Angiography,
Laser Treatment for retinal diseases, Computerized Eye
testing.
Normal delivery, Caesarian, MTP,
Tubectomy, Infertility treatment & high risk obstetrics
Endourology, Laparoscopic urology,UroOncology, Andrology, Lithotripsy, Urodynamics,
Urosonology, Reconstructive
Urology, Pediatric urology.
Treatment for ageing skin/ acne scars/
Pigmentation, Electro Surgery for skin tags/ Warts/ Moles,
Electrolysis (Facial hair removal).
Cardiac Anesthesia, Anesthesia to high risk
patients
Management of all types of Medical and
Surgical emergencies round the clock.
Dietary management of all OPD & IPD
Patients.
Counseling for OPD & IPD patients
Physiotherapy for OPD & IPD patients

NEPHROLOGY
ENT

OPHTHALMOLOGY

GYNAE & OBSTETRICS

UROLOGY

DERMATOLOGY

ANAESTHESIA

CASUALTY SERVICES

DIETETICS

PSYCHOTHERAPY
PHYSIOTHERAPY
PULMONOLOGY & CHEST MEDICINE
IMAGING
Spiral CT scan, Ultrasound, Colour Doppler,
X-ray & Portable X-ray for IPD
LABORATORY SERVICES
Bio-Chemistry,
Hematology,
Histopathology
Microbiology,
Serology
BLOOD BANK
Govt. recognized licensed Blood Bank
PHARMACY
Dispensing Medicines as per prescription
Maintaining cold chain for necessary drugs

If required the following consultants can be called to manage a patient

NEURO-SURGEON
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 PSYCHIATRIST
PEDIATRICS
NEONATOLOGIST
The Hospital provides following services:OPD

The Hospital runs the OPD for all departments 6

Days a week from 9am to 2 pm (M)
5pm- 7pm (E)

CASUALTY

A medical officer on around the clock duty is the first

Medical person to receive the Casualty and he gives first aid to the patient.
The appropriate consultant/consultants on call duty are informed. The
consultants come and see the patients in the casualty.
IN PATIENT SERVICES The Patient is admitted in the hospital through
Either OPD or CASUALTY.
ICCU & NEURO ICU
Patients requiring intensive management are kept in the
ICCU/ Neuro ICU. An Intensivist is on duty round the clock to manage
these cases apart from the Medical Officers on duty.
DAY CARE SERVICES- When the stay of patient is required only for few hours like
Eye/ ENT/ minor surgical procedures, the patients are admitted &
discharged on the same day.
Imaging, Laboratory and Pharmacy services are available around the clock.

The following Quality Improvement Plan serves as the foundation of the commitment of the hospital to
continuously improve the quality of the treatment and services it provides.

Quality.
Quality healthcare services that are provided in a safe, effective, patient-centered, timely, equitable, and
recovery-oriented method.
THHCC is committed to the ongoing improvement of the quality of care its patients receive, as evidenced by
the outcomes of that care. The organization continuously strives to ensure that:
The treatment provided incorporates evidence based, effective practices;

The treatment and services are appropriate to each patients needs, and available when needed;

Risk to patients, providers and others is minimized, and errors in the delivery of services are prevented;

Patients individual needs and expectations are respected; patients or those whom they designate
have the opportunity to participate in decisions regarding their treatment; and services are provided with
sensitivity and caring;

Procedures, treatments and services are provided in a timely and efficient manner, with appropriate
coordination and continuity across all phases of care and all providers of care.
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Quality Improvement Principles

Quality improvement is a systematic approach to assessing services and improving them on a priority basis.
The THHCC approach to quality improvement is based on the following principles:

Patient Focus. THHCC is focusing on his patients and on meeting or exceeding their needs and
expectations.

Recovery-oriented. Services are characterized by a commitment to promoting and preserving wellness

and to expanding choice. This approach promotes maximum flexibility and choice to meet individually
defined goals and to permit person-centered services.

Employee Empowerment. Effective programs involve people at all levels of the organization in
improving quality.

Leadership Involvement. Strong leadership, direction and support of quality improvement activities
by the governing body and CMD are key to performance improvement. This involvement of
organizational leadership assures that quality improvement initiatives are consistent with provider
mission and/or strategic plan.

Data Informed Practice. Successful QI processes create feedback loops, using data to inform practice
and measure results. Fact-based decisions are likely to be correct decisions.

Statistical Tools. For continuous improvement of care, tools and methods are needed that foster
knowledge and understanding. THHCC will use a defined set of analytic tools such as run charts, cause
and effect diagrams, flowcharts, Pareto charts, histograms, and control charts to turn data into
information.

Prevention over Correction. Continuous Quality Improvement entities seek to design good processes
to achieve excellent outcomes rather than fix processes after the fact.

Continuous Improvement. Processes must be continually reviewed and improved. Small incremental
changes do make an impact, and providers can almost always find an opportunity to make things better.

Continuous Quality Improvement Activities

Quality improvement activities emerge from a systematic and organized framework for improvement. This
framework, adopted by the hospital leadership, is understood, accepted and utilized throughout the organization,
as a result of continuous education and involvement of staff at all levels in performance improvement. Quality
Improvement involves two primary activities:
Measuring and assessing the performance of hospital services through the collection and analysis of
data.

Conducting quality improvement initiatives and taking action where indicated, including the
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o design of new services, and/or

o Improvement of existing services.
The tools used to conduct these activities are described in Appendix A, at the end of this Plan.
Leadership and Organization
Leadership
The key to the success of the Continuous Quality Improvement process is leadership. The following describes
how the leaders of the THHCC provide support to quality improvement activities.
The Quality Assurance Committee provides ongoing operational leadership of continuous quality improvement
activities within the hospital. It meets quarterly and consists of the following individuals.
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)

C.M.D.
HOD, Cardiac Surgery
HOD, Cardiology
HOD, Surgery
HOD, Anesthesiology
HOD, Radiology
HOD, Medical Laboratory
Hospital Administrator
NS
Purchase Manager
Quality Manager
Infection Control Nurse

The responsibilities of the Committee include:

Developing and approving the Quality Improvement Plan.

As part of the Plan, establishing measurable objectives based upon priorities identified through the use
of established criteria for improving the quality and safety of hospital services.

Implementing quality indicators.

Periodically assessing information based on the indicators, taking action as evidenced through quality
improvement initiatives to solve problems and pursue opportunities to improve quality.

Establishing and supporting specific quality improvement initiatives.

Reporting to the Board of Directors on quality improvement activities of the hospital on a regular basis.

Formally adopting a specific approach to Continuous Quality Improvement (such as Plan-Do-CheckAct: PDCA).

The Leaders support QI activities through the planned coordination and communication of the results of
measurement activities related to QI initiatives and overall efforts to continually improve the quality of care
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provided. This sharing of QI data and information is an important leadership function. Leaders, through a
planned and shared communication approach, ensure the Board of Directors, staff, patients and family members
have knowledge of and input into ongoing QI initiatives as a means of continually improving performance.
This planned communication may take place through the following methods;
Story boards and/or posters displayed in common areas.

Sharing of the hospitals annual QI Plan evaluation.

Newsletters and or handouts.

a) The quality improvement plan of the hospital will be displayed in common areas by the means of
posters/boards to communicate its plan to the patient and staff both.
b) Evaluation of quality improvement plan from previous year will be also shared with all stakeholders to
take initiatives for improvement.
c) Handouts and or circulars are also sent to the concerned person or department for the feedback on the
performance of services provided by them.
Goals and Objectives
The Quality Improvement Committee identifies and defines goals and specific objectives to be accomplished
each year. These goals include training of clinical and administrative staff regarding both continuous quality
improvement principles and specific quality improvement initiative(s). Progress in meeting these goals and
objectives is an important part of the annual evaluation of quality improvement activities.
The following are the ongoing goals for the hospital QI Program and the specific objectives for accomplishing
these goals for the year 2016-17.

To implement quantitative measurement to assess key processes or outcomes;

Sl.
No.

STD/
OE

Indicator

CQI3a

a. Time for initial

assessment of indoor
patients
b. Time for initial
assessment of
Patients attending
emergency services

CQI3a

Percentage of cases (inPatients) where in care

plan
with
desired
outcomes is Documented
and counter signed by the
clinician.

Present Scenario
a) 28 Mins for
doctors & 14
mins
for
nurses
b) 14 mins for
doctors & 9
mins
for
nurses

Target for 2016-17

Plan of Action

a) 5 mins for
doctors & 2
mins
for
nurses
b) 2 Mins for
doctors & 2
mins
for
nurses

97 %

100 %

CQI3a

CQI
3a

CQI3b

CQI3b

CQI3b

CQI3b

Percentage of cases (inPatients)

wherein
screening for nutritional
needs has been done.

Percentage of cases (inPatients) where in the

nursing care plan is
documented.
Number of reporting
errors/ 1000 investigation
Rate of re-dos.
Percentage of report corelating with clinical
diagnosis.
Percentage of adherence
to safety precautions by
employees working in
diagnostics.

81 %

100 %

100 %

100%

0.1 %

3 %

18%

3 %

100 %

100%

100%

100%

Re-dos will be counted only in

the cases of poor sample and or
improper positioning.

CQI3c

Incidence of medication
errors (Medication errors
per patient days)

Under-Reporting

3 %

It was observed during data

validation that the time
taken for initial assessment
of patients entered in the
register is the time of
writing first note in patient
file. So, it has to be
written exact time on which
the patient is firstly
assessed by the RMO or
Nursing Staff.
It will be audited by
identifying that file in
which
consultants
signature is missing and
after that those consultants
will be counseled by
CMD/BOD.
While taken feedback from
dieticians; it was pointed
out
that
nutritional
screening
of
patients
lacking in files are those
which were admitted after
their duty hours. When next
day they went to assess that
patient usually that patient
had been sent for any
investigation.
It
was
advised, to take a list of all
new admissions after their
duty hours in the morning
and go for the nutritional
screening of those patients.

All types of medication

errors
(Prescription,
Transcription, Dispensing,
Administration
&
Monitoring)
will
be7
monitored by nursing tutor
on daily basis. She has to
report
to
quality

Performance Measurement
Performance Measurement is the process of regularly assessing the results produced by the program. It
involves identifying processes, systems and outcomes that are integral to the performance of the service
delivery system, selecting indicators of these processes, systems and outcomes, and analyzing information
related to these indicators on a regular basis. Continuous Quality Improvement involves taking action as
needed based on the results of the data analysis and the opportunities for performance they identify.
The purpose of measurement and assessment is to:

Assess the stability of processes or outcomes to determine whether there is an undesirable degree of
variation or a failure to perform at an expected level.

Identify problems and opportunities to improve the performance of processes.

Assess the outcome of the care provided.

Assess whether a new or improved process meets performance expectations.

Measurement and assessment involves:

Selection of a process or outcome to be measured, on a priority basis.

Identification and/or development of performance indicators for the selected process or outcome to be
measured.

Aggregating data so that it is summarized and quantified to measure a process or outcome.

Assessment of performance with regard to these indicators at planned and regular intervals.

Taking action to address performance discrepancies when indicators indicate that a process is not stable
is not performing at an expected level or represents an opportunity for quality improvement.

Reporting within the organization on findings, conclusions and actions taken as a result of performance
assessment.

Quality Improvement Initiative

Once the performance of a selected process has been measured, assessed and analyzed, the information
gathered by the above performance indicator(s) is used to identify a continuous quality improvement initiative
to be undertaken. The decision to undertake the initiative is based upon hospital priorities. The purpose of an
initiative is to improve the performance of existing services or to design new ones. The model utilized at Name
of hospital is called Plan-Do-Check-Act (PDCA).

Plan - The first step involves identifying preliminary opportunities for improvement. At this point the
focus is to analyze data to identify concerns and to determine anticipated outcomes. Ideas for improving
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processes are identified. This step requires the most time and effort. Affected staff or people served are
identified, data compiled, and solutions proposed

Do - This step involves using the proposed solution, and if it proves successful, as determined through
measuring and assessing, implementing the solution usually on a trial basis as a new part of the
process.

Check - At this stage, data is again collected to compare the results of the new process with those of the
previous one.

Act - This stage involves making the changes a routine part of the targeted activity. It also means
Acting to involve others (other staff, program components or patients) - those who will be affected by
the changes, those whose cooperation is needed to implement the changes on a larger scale, and those
who may benefit from what has been learned. Finally, it means documenting and reporting findings and
follows up.

Evaluation

Evaluation of quality improvement program will be conducted on regular basis. Monthly data will be
analyzed and a root cause analysis of any non-compliance will be shared with the CMD, BODs &
quality assurance committee for further action by quality manager.

Validation and analysis of data

A countercheck of data collection method will be done to ensure accuracy of data collected by quality manager on
regular basis.
If any unexplained trend occurs during analysis then data collection method will also rechecked and if any
deficiency found in data collection method then it will be revised.
For any deficiency or unwanted result, appropriated root cause analysis will be done and corrective-preventive
action should be initiated.
Feedback received regarding care and services will be shared with all categories of staff members on monthly
basis.

Patient Safety Program

Introduction
S Sense the error
A Act to prevent it
F Follow Safety Guidelines
E Enquire into accidents/Deaths
T Take appropriate remedial measure
Y Your responsibility
Hospital is a people intensive place which provides services to sick people round the clock24 hours daily 365 days a year.
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The hospital atmosphere is filled with emotions, excitement, life & happiness, death & sorrow. Since hospital operates
under continuous strain, it gives rise to irritation, confrontation, conflicts & aggression, threatening the life of hospital
staff & hospital properties.
Hospital Safety includes : Safety of Place, People, Property
Safety of place includes- Infrastructure, Fire, Mechanical
Safety of property includes- Store, Assets, Equipments
Safety of people includes- Staff, Visitor, and Patient.
Patient Safety
Patient safety is the absence of preventable harm to a patient during the process of healthcare. The discipline of patient
safety is the coordinated efforts to prevent harm to patients, caused by the process of health care itself. It is generally
agreed upon that the meaning of patient safety isPlease do no harm.
Scope: Hospital Wide
Objective:
To provide a planned, ongoing, comprehensive, coordinated and integrated Hospital- wide mechanism to objectively and
systematically monitor and evaluate the safety of patient care, promptly identify and resolve problems, plan education to
improve patient safety and to reduce medical errors throughout the organization.
The Patient Safety program is reviewed annually to assure the programs objectives are attained and that improvement to
patient care and service delivery is made.
Definitions:

Sentinel Event: Unexpected incident involving death or serious physical or psychological injury, or the
risk thereof. The fundamental objective of sentinel event reporting is corrective in nature and the
identification of appropriate actions to prevent recurrence.
Near Miss or close call: An event or situation that could have resulted in an accident, injury, or
illness, but did not, either by chance or timely intervention. It is a serious error or mishap that has the
potential to cause an adverse event but fails to do so because of chance or because it is intercepted.
Latent Failure: An error precipitated as a consequence of management and organizational processes
that poses the greatest danger to complex systems. Latent failures cannot be foreseen but, if detected,
they can be corrected before they contribute to mishaps.
No Blame Culture: A non-punitive encouraging voluntary reporting of adverse events.
Risk: Is any exposure to a harmful event. It is directly related to hazard and vulnerability and, inversely,
to capacity.
Adverse Drug Reaction: Any undesirable or unexpected medication related event that requires
discontinuing a medication or modifying the dose, requires or prolongs hospitalization, results in
disability, requires supportive treatment, is life threatening or results in death, results in congenital
anomalies, or occurs following vaccination.
Medication Error: Any preventable event that may cause or lead to inappropriate medication use or
patient harm while the medication is in control of the health care professional, patient or consumer.

Patient Safety Includes

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Environmental Safety

Medical Safety

Surgical safety

Electrical Safety

Equipment Installation Safety

Patient Safety

Laboratory Safety

Blood Safety
1. Environmental Safety:

Sanitation
Infection Control
BMW

Radiation Safety

There is a direct link between work environment and patient safety. Therefore, if not addressing work
environment, we are not addressing patient safety. Healthy work environments do not just happen.
Adequate light
Adequate ventilation, exhaust fan
Stairs with hand rails
Window-door-closer
Slip preventing floors
Fire extinguishers and fire alarms
Prevent noise pollution
Heavy and fixed beds
Safe wheel chairs and trolleys
No water logging in bathrooms
Call bell system for patients
Adequate no. of bed screens to maintain privacy of the patient.
2. Medical Safety :

Legible Writing prescription by doctors

Prescription orders should be written in Capital letters
Wrong medicines or wrong does or wrong patient.
Wrong injection, wrong does or wrong patient, wrong route of administration.
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Drip sets, air bubbles, over hydration, drip speed.

Oxygen flows check empty gas cylinders.
Clear, written medication guidelines.
Identification of each patient with similar patient names.
Proper handing taking over during change of shift.
Look alike and Sound Alike LASA drugs.

a) Medication orders should be written legibly in ink and should include:

Patients name and location (ward, room No, and bed No etc.).
Medication Generic Name.
Dosage, frequency and route of administration
Signature of the physician.
Date and hour the order was written.
b) Any abbreviations used in medication orders should be agreed to and jointly adopted by the medical,
nursing, pharmacy, and medical records staff of the hospital. Lately, in the interest of patient safety,
Do Not Abbreviate should be practiced.
c) Before dispensing the drug the pharmacist must confirm if any doubt, Availability of prescribed drug/
dose and date of expiry etc.
Resolve questions or problems with drug orders before the drug is dispensed and administered.
Eliminate errors which may arise when drug orders are transcribed into another form for use by
the pharmacy.
d) To check at least two patient identifiers before providing care, treatments or services.
Patient name and UHID number
e) Discourage Telephonic orders.
f) Examine safety Alert (Orange Band for vulnerable, Red for Allergy).
3. Surgical Safety
Pre-operative evaluation by the surgeon.
Consent of the patient/ relative in writing.
Proper identification of patient, name wrist band.
Proper identification mark of parts to be operated.
Pre-operative fitness report from anesthesiologist.
Pre- anesthetic check-up
Anesthetic Safety.
Ensure no foreign body left inside.
Safety measures from ward to OT & coming back (Safety check list).
Prevention of surgical wound infections.
Use of Surgical safety Performa in all operations.
Check Safety alerts (Red for Allergy Alert, Orange for Fall Risk).
4. Equipment Installation Safety

Regular checking of equipments

Proper earthling to avoid shock

Regular maintenance & repair

Training of nurses & technical staff

Preventing inadvertent harm to patients requires use of human factors engineering principles.

The hierarchy of hazard control will be:

Eliminate hazard
Guard against hazard
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Train to avoid hazards

Warn against hazards

New Devices

Acceptance,
Safety inspection,
Compatibility,
Education,
Procedures, and
Appropriate purchasing documents.
When in doubt,
Have CE (Certified Equipment) check.

Why Reporting Medical Device Problems

Prevent future problems and protect patients, staff, families, and visitors
Achieve performance improvement goals
Assist Risk Management with claims or litigation
Provide information to manufacturers and/or Food and Drug Administration
Publicize report for the general good of patients and health care providers
Effect changes in policies and procedures of procurement
When to Report
When you think a device has or may have caused or contributed to any of the following outcomes (for a
patient, staff member or visitor):
Death
Serious injury
Minor injury
Close calls or other potential for harm
Individuals Role
Identify actual and potential problems, adverse events, close calls with medical devices
Report the problem or adverse event to your supervisor, according to policy and procedure
Make sure your report includes details
Remove the device; keep all affected items, save the packaging
5. Electrical Safety
Safety fuses with each equipment
No loose wires or connection
Properly plugged and fixed
If short circuit call electrician
Electricity back up battery/ generator
Use of CVT/UPS
6. Fire Safety
Use Fire proof material for construction.
Have obstacle free fire exit in all areas.
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Smoke detectors and water sprinklers on the roof of all floor/rooms/wards.

Fire Hydrants in all Buildings.
Fire Extinguishers in all areas.
Training in Fire management.
Frequent mock drills.

For more details please refer to Hospital Safety Manual.

7. Blood Safety
Proper grouping & cross matching.
Proper labeling of group, name of the patient.
Control of mismatch reaction.
Standard operating procedure.
Screening against HIV, Hepatitis. VDRL, Malaria.
Inform adverse reaction to BB.
Consent before blood transfusion.
For more details please refer to Blood Bank Manual.

8. SANITATION- INFECTION CONTROL- BMW DISPOSAL

Sanitation

Infection Control

BMW Disposal

Proper segregation & transportation of biomedical wastes.

Sanitation & hygiene of different parts of hospital to avoid infection.
Use of sterile procedures.
Safety in use of autoclave, needle destroyers.
Formation of hospital infection control committee.
Implementation of care bundles.
Effective disinfection & sterilization activities.
Avoid re-processing of single use devices.
Investigation of all hospital acquired infections.
Environmental & water culture test for all areas.
Use of proper antibiotics in right doses in right time.
Reorientation of Resident doctors & Nursing staff.
Liquid waste management.
Strictly follow the standard precautions.
Provision of Pre-exposure & Post exposure prophylaxis for all employees.
For more details please refer to Infection Control Manual.
9. Laboratory Safety
Avoid needle prick & spillage of blood/body fluids
Spillage kit
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 MSDS sheet
HAZMAT kit
Care in handling chemicals
Proper labeling of samples before processing
Collection of adequate sample
Adherence to Safety Precautions
Proper disposal of BMW
Pretreatment of liquid wastes, culture plates etc. before segregation.
Validation of test reports.
For more details please refer to Lab Safety Manual.
10. Radiation Safety
Use of Lead apron & TLD badges
Radiation safety signage
Screening of patients before radiological investigations.
Consent before administration of contrast.
Check of lead aprons & TLD badges on defined intervals.
For more details please refer to Radiation Safety Manual.
How medical errors can be prevented by patients

1. Make sure that your doctor knows about every medicine you are taking. This includes prescription and over-thecounter medicines and dietary supplements, such as vitamins and herbs.
2. Bring all of your medicines and supplements to your doctor visits. Your medicines can help you and your doctor
talk about them and find out if there are any problems.
3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
4. When your doctor writes a prescription for you, make sure you can read it.
5. Ask for information about your medicines in terms you can understandboth when your medicines are
prescribed and when you get them:
What is the medicine for?
How am I supposed to take it and for how long?
What side effects are likely? What do I do if they occur?
Is this medicine safe to take with other medicines or dietary supplements I am taking?
What food, drink, or activities should I avoid while taking this medicine?
6. When you pick up your medicine from the pharmacy, ask:
Is this the medicine that my doctor prescribed?
7. If you have any questions about the directions on your medicine labels, ask if "four times daily" means taking a
dose every 6 hours around the clock or just during regular waking hours.
8. Ask your pharmacist for the best device to measure your liquid medicine.
9. Ask for written information about the side effects your medicine could cause. If you know what might happen,
you will be better prepared if it does or if something unexpected happens.
10. If you are in a hospital, consider asking all healthcare workers who will touch you whether they have washed
their hands. Hand washing can prevent the spread of infections in hospitals.
11. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will follow
at home.
About your new medicines.
When you can get back to your regular activities.
Continuing old medicines before your hospital stay.
When to come back to the hospital for check up.
12. If you are having surgery, make sure that you and your surgeon all agree on exactly what will be done.
Surgeons are expected to sign their initials directly on the site to be operated on before the surgery.
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13. If you have a choice, choose a hospital where many patients have had the procedure or surgery you need.
Research shows that patients tend to have better results when they are treated in hospitals that have a great deal
of experience with their condition.
14. Speak up if you have questions or concerns.
15. Make sure that someone, such as your primary care doctor, coordinates your care.
16. Make sure that all your doctors have your important health information.
17. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.

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