The NABH 6th edition draft has been released in January 2024. Here I have given a brief summary of the important changes that can be expected when the final version is released for implementation
I have identified 37 possible significant changes in the 6th Edition
What I have given here is only an assumption based on the draft. The final version may be different from the draft
You can expect the 6th edition to have lesser numbers of Objective Elements, as seen in this comparative chart. Numbers of Chapters and Standards remain unchanged
CHAPTER 1 - Access Assessment and Continuity of Care
Important changes expected
Change No.1
AAC.7 and AAC.8 of 5th edition have been combined in AAC.7 of 6th edition
5th edition AAC.7 - There is an established laboratory quality assurance programme.
5th edition AAC.8 - There is an established laboratory safety programme.
6th edition AAC.7 - There is an established laboratory quality assurance and safety programme.
Change No.2
A new Objective Element has been incorporated in AAC.7, 6th edition
This new Objective Element is
AAC.7-c - Laboratory participates in proficiency testing / external quality assurance scheme.
This new Objective Element may actually be AAC.7-b of 5th edition - The programme addresses verification and/or validation of test methods.
We will know it only after the final version is released, because the draft does not contain the Interpretations of the Objective Elements
Change No.3
AAC.10 and AAC.11 of 5th edition have been combined in AAC.9 of 6th edition
5th edition AAC.10 - There is an established quality assurance programme for imaging services.
5th edition AAC.11 - There is an established safety programme in imaging services.
6th edition AAC.9 - There is an established quality assurance and safety programme for imaging services.
Change No.4
In Chapter 1 of 6th edition, a new Standard AAC.11 has been introduced
This new Standard is
The preventive and promotive health services are provided in a safe, collaborative and consistent manner.
The new Standard AAC.11 has 5 Objective Elements
The salient points covered in this new Standard are:
- Implementation of preventive and promotive health care as per the scope of services
- Promotive and preventive evidence based and contextual age-appropriate screening for non-communicable diseases
- Mental health screening and appropriate intervention, wherever needed
- Evidence based and contextual paediatric and adult immunization
- A multi-disciplinary approach in imparting health education on life-style modifications
Change No.5
6th edition AAC.12 - The organisation has an established discharge process
(in the 5th edition this Standard is AAC.13)
A new Objective Element has been introduced in AAC.12, 6th edition:
AAC.12-f - The care shall be provided by expanding access to health practices through domiciliary visits, wherever applicable.
Change No.6
AAC.12-g of 6th edition states that - The organisation monitors the discharge time, sets appropriate benchmarks and makes continual improvement.
AAC.13-f of 5th edition states that - The organisation conforms to the defined timeframe for discharge and makes continual improvement.
This, according to me, is an improvement upon AAC.13-f of 5th edition
CHAPTER 2 - Care of Patients
Important changes expected
Change No.7
COP.1 of both the editions - Uniform care to patients is provided in all settings of the organisation and is guided by written guidance, and the applicable laws and regulations.
“applicable laws and regulations” have been removed from the 6th edition
Change No.8
5th edition COP.1-c - Care shall be provided in consonance with applicable laws and regulations.
This Objective Element is not there in COP.1 of 6th edition
The details of this should be available only after release of the final version of the 6th edition
Change No.9
COP.10 of both the editions - Organisation provides safe obstetric care.
The 6th edition has introduced 4 new Objective Elements, these are:
COP.10-e - Organisation encourages and welcomes the presence of a birth companion during labour.
COP.10-f - Organisation treats pregnant woman and her companion cordially and respectfully, ensures privacy and confidentiality for pregnant woman during her stay.
COP.10-g - The treating doctor explains danger signs and important care activities to pregnant woman and her companion.
COP.10-k - Organization shall adhere to legal and defined Assisted Reproductive Technology (ART) practices.
Change No.10
COP.11 of both the editions - Organisation provides safe paediatric services.
The 6th edition has introduced one new Objective Element:
COP.11-h - The organisation provides for adolescent friendly health care services.
The Interpretation will be available only after the final version of the 6th edition is released
CHAPTER 3 - Management of Medication
Important changes expected
Change No.11
MOM.1
5th edition MOM.1 - Pharmacy services and usage of medication is done safely.
6th edition MOM.1 - Pharmacy services and medication management is done safely.
The word management has been incorporated in the new edition. And this change has been reflected also in the Objective Elements, wherever applicable
Change No.12
MOM.9
5th edition MOM.9 - Narcotic drugs and psychotropic substances, chemotherapeutic agents and radioactive agents are used in a safe manner.
6th edition MOM.9 - Narcotic drugs and psychotropic substances, chemotherapeutic agents and radio-pharmaceuticals are used in a safe manner.
“Radioactive agents” has been replaced with “radio-pharmaceuticals”. And this change has been reflected also in the Objective Elements, wherever applicable
CHAPTER 4 - Patient Rights and Education
Important changes expected
Change No.13
PRE.3 of both the editions - The patient and/or family members are educated to make informed decisions and are involved in the care planning and delivery process.
5th edition PRE.3-a - The Patient and/or family members are explained about the proposed care, including the risks, alternatives and benefits.
6th edition PRE.3-a - The patient and / or family members are explained about the proposed care (including the risks, benefits, alternatives), expected results and possible complications.
In PRE.3-a of 6th edition the requirements of 5th edition PRE.3-b and PRE.3-c have been included. That is why, these two Objective Elements have been removed from the 6th edition
Change No.14
PRE.5 of both the editions - Patient and families have a right to information and education about their healthcare needs.
The 6th edition has introduced a new Objective Element
PRE.5-j - The organisation has a mechanism to promote patient engagement to enhance clinical outcomes, safety and quality.
CHAPTER 5
Important changes expected
Change No.15
In the 5th edition the heading is – Hospital Infection Control (HIC)
In the 6th edition, this has been changed to - Infection Prevention and Control (IPC)
Change No.16
IPC.2 - The organisation provides adequate and appropriate resources for infection prevention and control.
(HIC.2 of 5th edition)
5th edition HIC.2-a - The management makes available resources required for the infection control programme.
6th edition IPC.2-a - The management makes available resources required for the infection control programme including allocation of adequate funds from its annual budget.
In the 6th edition, the requirement of 5th edition HIC.2-b has also been incorporated. That is why in the 6th edition this Objective Element has been removed
Change No.17
HIC.3 of 5th edition - The organisation implements the infection prevention and control programme in clinical areas.
In the 6th edition IPC.3, “control programme” has been changed to “control processes”
Change No.18
5th edition HIC.3-f - The organisation implements the antimicrobial usage policy and monitors the rational use of antimicrobial agents.
This is not there in the 6th edition. This requirement may have been incorporated into some other Objective Element. We will come to know of it only after the final version is released
Change No.19
IPC.5 - The organisation takes actions to prevent healthcare associated infections (HAI) in patients.
(HIC.5 of 5th edition)
5th edition HIC.5-b - The organisation takes action to prevent infection-related ventilator associated complication / ventilator-associated pneumonia.
6th edition IPC.5-b has been changed to - The organisation takes action to prevent ventilator-associated pneumonia.
Change No.20
5th edition HIC.5-c - The organisation takes action to prevent catheter linked blood stream infections.
6th edition IPC.5-c has been changed to - The organisation takes action to prevent central line associated blood stream infections.
CHAPTER 6 - Patient Safety and Quality Improvement
Important changes expected
Change No.21
PSQ.1 of both the editions - The organisation implements a structured patient-safety programme.
5th edition PSQ.1-e - Designated clinical safety officer(s) coordinates implementation of the clinical aspects of the patient-safety programme.
This Objective Element has been removed from the 6th edition, maybe because Objective Element PSQ.1-d is almost similar to this (PSQ.1-d - Designated patient safety officer(s) coordinates implementation of the patient safety programme.)
Change No.22
PSQ.2 of both the editions - The organisation implements a structured quality improvement and continuous monitoring programme.
In the 6th edition, a new Objective Element has been added
PSQ.2-d - The quality improvement programme focuses on appropriateness of clinical care.
Change No.23
PSQ.3 of both the editions - The organisation identifies key indicators to monitor the structures, processes and outcomes, which are used as tools for continual improvement.
5th edition PSQ.3-e - The organisation has a mechanism to capture patient reported outcome measures.
This Objective Element has been added to PSQ.4-d of 6th edition
Change No.24
PSQ.4 of both the editions - The organisation uses appropriate quality improvement tools for its quality improvement activities.
6th edition PSQ.4-b - The Quality improvement projects shall include improvements in patient care delivery and hospital operations which will have an impact on cost and efficiency.
I am presuming the PSQ.4-c and PSQ.4-d of 5th edition have been indicated here, because these two Objective Elements of the 5th edition are not there in PSQ.4 of the 6th edition.
The details can be known only after the final version is released
5th edition PSQ.4-c is - The organisation uses appropriate statistical tools for its quality improvement activities.
5th edition PSQ.4-d is - The organisation uses appropriate managerial tools for its quality improvement activities.
CHAPTER : 7 - Responsibilities of Management
Important changes expected
Change No.25
ROM.1 of both the editions - The organisation identifies those responsible for governance and their roles are defined.
6th edition has included one new Objective Element
ROM.1-g - Those responsible for governance shall develop clinical governance framework.
Change No.26
ROM.2
5th edition ROM.2 - The leaders manage the organisation in an ethical manner.
6th edition ROM.2 - Those responsible for governance manage the organisation in an ethical manner.
in the 6th edition, “The leaders” has been replaced with “Those responsible for governance”
Change No.27
5th edition ROM.2-a - The leaders make public the vision, mission and values of the organisation.
This Objective Element is not evidenced in the 6th edition
Change No.28
6th edition has incorporated a new Standard as ROM.3
6th edition ROM.3 - Management ensures sustainability in hospitals by addressing environmental, social and economic factors from long term well-being of healthcare system and community.
This new Standard ROM.3 has 7 Objective Elements
The salient points covered in this new Standard are
- Those responsible for governance have to:
- Address the organisation’s sustainability programme in terms of Environment Social and Governance (ESG) responsibility
- Take initiatives towards an energy-efficient and environmentally friendly hospital.
- Address the organisation’s social responsibility.
- Promote staff well-being
- Take responsibility for sustainable procurement practices
- Ensures financial sustainability of the hospital’s healthcare services
- Encourage employees to use common / public transportation to reduce the environmental impact of commuting and carbon footprint. – I personally would not like to have this as a part of NABH accreditation programme
Change No.29
ROM.4 (5th edition) and ROM.5 (6th edition)
5th edition ROM.4 - The organisation displays professionalism in its functioning.
6th edition ROM.5 - The top leadership of the organisation displays professionalism in its functioning.
“The organization” has been replaced with “The top leadership of the organization”
NOTE:
In the 6th edition it is ROM.5 because a new Standard (ROM.3) has been introduced
Change No.30
ROM.5 (5th edition) and ROM.6 (6th edition)
5th edition ROM.5 - Management ensures that patient-safety aspects and risk-management issues are an integral part of patient care and hospital management.
6th edition ROM.6 - Top leadership ensures that patient-safety aspects and risk-management issues are an integral part of patient care and hospital management.
in the 6th Edition, “Management” has been replaced with “Top leadership”
This change has also been reflected in all the Objective Elements of ROM.6
CHAPTER : 8 - Facility Management and Safety
Important changes expected
Change No.31
5th edition FMS.2-g - The organisation takes initiatives towards an energy-efficient and environmentally friendly hospital.
This Objective Element has been removed from 6th edition FMS.2, because it has been made a part of the new Standard ROM.3 of 6th edition
Change No.32
5th edition FMS.6-c - The procedures for medical gases address the safety issues at all levels.
This has been removed from 6th edition, may be because this has already been addressed in FMS.6-b - Medical gases are handled, stored, distributed and used in a safe manner.
Change No,33
5th edition FMS.7-a - The organisation has plans and provisions for early detection, abatement and containment of the fire, and non-fire emergencies. *
In the 6th edition, this Objective Element has been broken up into two separate parts for fire and non-fire emergencies
6th edition FMS.7-a - The organisation has plans and provisions for early detection, abatement, containment of fire and evacuation in the event of fire emergencies.
6th edition FMS.7-b - The organisation has plans and provisions for identification, and management of non-fire emergencies.
Change No.34
5th edition FMS.7-e - The organisation has a service continuity plan in case of fire and non-fire emergencies
This is not there in 6th edition. This could have been incorporated in some other Objective Element.
We will be able to know it only after the Interpretations are made available in the final version of 6th edition
CHAPTER : 9 - Human Resource Management
Important changes expected
Change No.35
HRM.3 of both the editions - Staff are provided induction training at the time of joining the organisation.
In the 6th edition, a new Objective Element has been introduced
HRM.3-j - Staff is trained on information systems, information security, information use and management.
Change No.36
5th edition HRM.9-a - Staff well-being is promoted.
This is not there in the 6th edition, because it has been made a part of the new Standard ROM.3
CHAPTER : 10 - Information Management System
Important changes expected
Change No.37
IMS.1 of both the editions - Information needs of the patients, visitors, staff, management and external agencies are met.
In the 6th edition, a new Objective Element has been introduced
IMS.1-h - The organisation shall make efforts to use digital health technology to improve operational efficiency, patient safety and patient experience.
These are the important changes expected in the 6th Edition of NABH
