Indeterminate Forms and L'Hospital's Rule
This chapter delves into the applications of derivatives, including finding extreme values, analyzing function shapes, and calculating limits of indeterminate forms using L'Hospital's Rule. Learn about different types of indeterminate forms and how to apply the rule effectively.
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Changes in Clinical Standards - NABH 4thEdition 2016 Dr. A. L. Basile MS Co Chair Technical Committee, NABH. Medical Director, Star Hospitals. Consultant Ophthalmolgist
Section I: Patient-Centered Standards 3rd 4th edition 14/86 edition 14/96 Access, Assessment and Continuity of Care (AAC) 2
4th Edition 3rd Edition Standar d NUMBE R 1 2 3 Standard NUMBER 1 AAC OE 3 AAC SCOPE REGISTRATION & ADMISSION TRANSFER & REFERRAL INITIAL ASSESSMENT REASSESSMENT LAB LAB QA LAB SAFETY IMAGING IMAGING QA IMAGING SAFETY CONTINUOUS/MULTIDISC IPLINARY CARE DISCHARGE PROCESS DISCHARGE SUMMARY TOTAL OE SCOPE REGISTRATION & ADMISSION TRANSFER & REFERRAL INITIAL ASSESSMENT REASSESSMENT LAB LAB QA LAB SAFETY IMAGING IMAGING QA IMAGING SAFETY CONTINUOUS/MULTIDISCIPLI NARY CARE DISCHARGE PROCESS DISCHARGE SUMMARY TOTAL 4 2 3 4 5 6 7 8 9 6 5 10 5 8 5 5 9 5 7 7 5 4 9 5 6 6 10 7 5 8 5 9 10 11 10 10 11 6 8 12 13 14 14 7 4 7 12 13 14 14 9 5 7 86 96 3
Overall Impact of improvements: AAC Each Service in the scope should be justifiable appropriate diagnostics and treatment facilities suitably qualified personnel out-patient, in-patient and emergency cover Display not in scope Imaging services Screening of Patients Peer review Surveillance methodology
Overall Impact of improvements: AAC Equipment and Manpower of pathology & radiology depts Adequacy Actions on critical results Lab and Imaging Focus on response Critical results of outsourced services Addressing of reporting errors Amend or recall Structured handovers Transitions of care
Overall Impact of improvements: AAC Care Plan to reflect the desired outcome. Coordination of care: timelines Monitoring Acting on delays Informing stakeholders Access is prioritized More sick patients are seen earlier. Early warning system Time taken for discharge Monitor timelines
Section I: Patient-Centered Standards 3rd 4th edition 20/136 edition 22/149 Care of Patients (COP) 7
4th Edition COP 3rd Edition OE Standar d NUMBE R 1 OE Standard NUMBER COP UNIFORM CARE 1 4 UNIFORM CARE, LAWS, REGULATIONS & GUIDELINES EMERGENCY SERVICES AMBULANCE SERVICES HANDLING COMMUNITY EMERGENCIES, EPIDEMICS AND OTHER DISASTERS CARDIO PULMONARY RESUSCITATION DOCUMENTED POLICIES and PROCEDURES GUIDE NURSING CARE Documented procedures guide the performance of various procedures. RATIONAL USE OF BLOOD & BLOOD PRODUCTS INTENSIVE CARE & HIGH DEPENDENCY UNITS VULNERABLE PATIENTS HIGH RISK OBSTETRIC CARE 4 EMERGENCY SERVICES 2 7 AMBULANCE SERVICES 3 8 2 3 4 10 9 5 CARDIO PULMONARY RESUSCITATION 4 5 NURSING CARE 5 7 VARIOUS PROCEDURES 6 7 5 5 RATIONAL USE OF BLOOD & BLOOD PRODUCTS 7 8 6 7 INTENSIVE CARE & HIGH DEPENDENCY UNITS 8 7 7 7 VULNERABLE PATIENTS 9 5 OBSTETRIC CARE 10 7 8 8 PAEDIATRIC SERVICES 11 8 9 8 MODERATE SEDATION 12 8 ADMINISTRTAION OF ANESTHESIA 13 11 10 11 5 7 8
4th Edition COP Standard NUMBE R 12 OE 3rd Edition Standard NUMBER 14 PAEDIATRIC SERVICES 8 COP OE 11 SURGICAL PROCEDURES MODERATE SEDATION ADMINISTRTAION OF ANESTHESIA SURGICAL PROCEDURES ORGAN TRANSPLANT PROGRAM RESTRAINTS PAIN MANAGEMENT 13 14 8 11 RESTRAINTS 15 5 15 11 PAIN MANAGEMENT 16 5 16 4 REHABILITATIVE SERVICES 17 6 17 18 5 4 RESEARCH ACTIVITIES 18 6 NUTRITIONAL THERAPY 19 6 REHABILITATIVE SERVICES 19 6 END OF LIFE CARE 20 5 RESEARCH ACTIVITIES 20 6 TOTAL 20 136 NUTRITIONAL THERAPY 21 6 END OF LIFE CARE 22 5 TOTAL 22 149 9
Overall Impact of improvements: COP Emergency Department - Access - QA - Brought in dead - Communication with ambulance during transit Organ transplant - Full standard Monitoring of patients after procedures Disaster Management - Focus on role of Emergency services - Patient care
Overall Impact of improvements: COP Counseling of patients on progress - ICU setting Clarity on informed consent when needed repeatedly for Blood Transfusions - Single consent with endorsements on repeat Consent for Moderate sedation Reason for restraint Functional assessment (rehab) - Reassessment Pain alleviation - Initiate and Titrate based on need
Section I: Patient-Centered Standards 3rd 4th edition edition Management of Medication (MOM) 13/73 13/76 12
3rd Edition 4th Edition Standard NUMBER Standar d NUMBE R MOM OE ORGANIZATION & USAGE OF PHARMACY HOSPITAL FORMULARY STORAGE OF MEDICATION PRESCRIPTIONS OF MEDICATIONS SAFE DISPENSING OF MEDICATIONS 1 2 3 4 5 7 MOM OE ORGANIZATION & USAGE OF PHARMACY HOSPITAL FORMULARY 1 2 3 4 4 5 4 12 STORAGE OF MEDICATION 7 PRESCRIPTIONS OF MEDICATIONS SAFE DISPENSING OF MEDICATIONS 13 5 6 5 6 6 6 7 MEDICATION ADMINISTRATION PATIENT MONITORING NEAR MISSES, MEDICATION ERRORS, ADR s NARCOTIC DRUGS & PSYCHOTROPIC SUBSTANCES CHEMOTHERAPEUTIC AGENTS RADIOACTIVE DRUGS IMPLANTABLE PROSTHESIS & MEDICAL DEVICES MEDICAL SUPPLIES & CONSUMABLES TOTAL 10 4 MEDICATION ADMNISTRATION PATIENTS ARE MONITORED AFTER MEDICATION ADMINISTRATION NEAR MISSES, MEDICATION ERRORS ,ADVERSE DRUG EVENTS ARE REPORTED & ANALYSED NARCOTIC DRUGS & PSYCHOTROPIC SUBSTANCES 10 8 5 7 4 9 10 11 4 4 4 8 5 12 4 9 4 10 11 12 CHEMOTHERAPEUTIC AGENTS 5 13 13 4 RADIOACTIVE DRUGS 4 73 13 IMPLANTABLE PROSTHESIS 4
Overall Impact of improvements: MOM Strengthening of Inventory management - All areas in HCO - Stock outs Physician samples tracking and management - Address safety in storage, usage and prevent medication errors. Prescriptions have to be in Capital letters - All areas in HCO LASA drug list to be formed from formulary Reconciliation of medications/orders at transitions of care
Overall Impact of improvements: MOM Special training for chemo therapeutic drugs and bio safety cabinets Patient education for chemo drugs Strengthen medication administration Strengthen medical supplies
Section I: Patient-Centered Standards 3rd 4th edition edition Patients Rights And Education (PRE) 7/46 8/54 16
4th Edition Standar d NUMBE R 3rd Edition PRE OE Standard NUMBER PRE OE PROTECTION OF RIGHTS & INFORMATION ABOUT RESPONSIBILITY OF CARE SUPPORTING INDIVIDUAL BELIEFS & VALUES INFORMED CONSENT PATIENT AND/OR FAMILY S CONSENT EXISTS FOR MAKING INFORMED DECISION ABOUT THEIR CARE RIGHT TO INFORMATION & EDUCATION ABOUT HEALTHCARE NEEDS RIGHT TO INFORMATION ON EXPECTED COSTS PATIENT S FEEDBACK AND REDRESSAL OF COMPLAINTS. EFFECTIVE COMMUNICATION WITH PATIENTS AND /OR FAMILIES TOTAL PROTECTION OF RIGHTS & INFORMATION ABOUT RESPONSIBILITY OF CARE 1 5 1 5 2 11 SUPPORTING INDIVIDUAL BELIEFS & VALUES 2 10 3 7 EDUCATING PATIENT/ FAMILY MEMBERS TO MAKE INFORMED DECISIONS 4 8 3 7 INFORMED CONSENT 4 8 5 8 RIGHT TO INFORMATION & EDUCATION ABOUT HEALTHCARE NEEDS 5 8 6 4 RIGHT TO INFORMATION ON EXPECTED COSTS 7 5 6 4 COMPLAINT REDRESSAL PROCESS 7 4 8 6 TOTAL 7 46 8 54 17
Overall Impact of improvements: PRE Patient right to get another opinion - Respect and facilitate the right New standard on communication - Acceptable and effective communication - Communication in specific situation - Avoiding and identifying unacceptable communication Stress on capturing patient experience in addition to feedback Patient educational need identification and addressing it
Section I: Patient-Centered Standards 3rd 4th edition edition Hospital Infection control (HIC) 9/51 9/54 19
3rd Edition 4th Edition Standar d NUMBE R Standard NUMBER HIC OE HIC HOSPITAL INFECTION CONTROL PROGRAMME OE 1 6 HOSPITAL INFECTION CONTROL PROGRAMME 1 6 2 3 INFECTION CONTROL MANUAL 11 2 INFECTION CONTROL MANUAL 12 SURVEILLANCE ACTIVTIES HOSPITAL ASSOCIATED INFECTIONS PREVENTION & CONTROL OF HEALTHCARE ASSOCIATED INFECTIONS 8 3 SURVEILLANCE ACTIVTIES 9 4 4 HOSPITAL ASSOCIATED INFECTIONS SUPPORT TO INFECTION CONTROL PROGRAMME CONTROL OUTBREAKS OF INFECTION 4 4 5 4 5 4 CONTROL OUTBREAKS OF INFECTION 6 4 6 4 7 STERILIZATION ACTIVITIES 5 STERILIZATION ACTIVITIES BIOMEDICAL WASTE MEASURES (BMW) TRAINING OF STAFF TO SUPPORT HIC PROGRAMME 7 6 BIOMEDICAL WASTE MEASURES (BMW) 8 5 8 5 TRAINING OF STAFF TO SUPPORT HIC PROGRAMME 9 4 9 4 TOTAL 9 51 TOTAL 9 54 20
Overall Impact of improvements: HIC Clinical privileging of ICN empowerment of ICNs Rational and safe use of disinfectants Enhanced participation of stakeholders by sharing of HIC data Promote rational use of antimicrobials and monitor its usage Monitoring of MDROs & infection containment due to MDROs Improved patient safety due to pre-defined informed reuse of devices
