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Laws & Acts ?
Ayurvedic Proctology ?
Gujarat State Law ?
Quackery in Practice
Any System Practice ?
IPC & Tips of Safe Practice
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
To be Continued from… 2nd Annual Conference of SPA
• To study recent trend of ayurvedic proctology practice
–On line open Survey
• Interpretation of out come of survey
• Guideline to set up Ayurvedic Proctology Hospital / clinic
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
11.40%
8.60%
5.70%
18.60%
72.90%
4.30%
UG/Intern
PG Scholars
PhD Scholars
Faculty
Practitioners
Others
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Category of Voluntary Participants of Survey (n=70)
1.40%
67.10%
40.00%
2.90%
8.60%
4.30%
27.10%
2.90%
0.00%
15.70%
BSAM
BAMS
Certificate Cources
RAV
PG Diploma
MD Shalya
MS Shalya
MD/MS Ayu (Other)
MD Ayu Sangyaharan
Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Registered Qualification (n=70) recognized from University /State Board OR CCIM
*Other… fellowship in MUHS, LLB, MHM, MD(AM) etc.
*PG Diploma, RAV, Certificate courses etc have no amendment in IMCC Act 1970.
*Other… clinic, MCIM, Gov of Guj, Bombay Nursing Home Act etc.
62.90%
62.90%
35.70%
1.40%
38.60%
2.90%
18.60%
Local Municipal Corporation
BMW
GPCB
ISO/NABH
Procto Asso
NA/None
Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Registration of your Hospital / Clinic? (n=70)
*Other… NA – PG Scholars
91.40%
71.40% 50.00%
30.00%
30.00%
38.60%
24.30%
14.30%
15.70%
0.00%
5.70%
Daily OPD
IPD
BMW
Sterilization Autoclaving -…
Sterilization OT Fumigation
OT anesthesia
Modern Medicine Stock
Kshara Sutra Making
Emergency / On Call Dr
None
Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Maintenance of Registers (n=70)
*Other… NA – PG Scholars & Anesthesia Form
85.70%
70.00%
68.60%
41.40%
24.30%
45.70%
37.10%
27.10%
71.40%
4.30%
OPD Case Sheet
IPD Case Sheet
Details of Pre-OP-Post
Post OP Charts
KS Chart in Fistula
Copy of Bill & Receipts
Lab & Imaging Investi.
Photo of Patient with Consent
Informed Written Consent
Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Documents/Record keeping (n=70)
*Other… NA – PG Scholars & >48 Hr Institute attached Hospitals
64.30%
42.90%
20.00%
1.40%
Day Care
24-48 Hr
More than 48 Hr
Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Avg. Post OP Indoor Stay? (n=70)
*Day Care – within 24 Hr, having safe & danger effects
70% 20%
10%
Discharge Summery after Surgery (n=70)
Yes
No
Other
25.40%
68.70%
6%
Hospital Record Electronic / Software (n=70)
Yes
No
Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*Other… software made by local engineer, personal SW, Excel Sheet
*Other… when pt want, as per requirement, NA,
93%
3%
4%
Medico-legal for Ano-Rectal Surgery (n=70)
No
Yes
Other
40.00%
28.60%
23%
17%
13%
Medi-claim for Ano-Rectal Surgeries (n=70)
Yes
No
Never Try
Tried butrejected
Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*Other… Case-less facilities, 50-50, Gov. Hospital, attached with
modern Surgeon !!!!
* Other… Some times & No FIR Lodge due PM report
85%
15%
Are You Calling Anaesthetic for Surgery ?(n=70)
Yes No 86.60%
13.40%
Is anaesthetic are supporting/Coming to your clinic/hospital for Surgery ?(n=70)
Yes NoDr Shreyas Bhalodia Sushrut Proctology
Association Conference 2016 @ Jamnagar
61.20% 14.90%
12%
10%
2%
Each & Every Surg
Often
Occasionally
Never
Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*Other… mild sedation with local Anesthesia
On Which frequency you are calling anaesthetic ? (n=70)
*Other… NA – PG Scholars
69.70%
43.90%
30.30%
6.10%
19.70%
1.50%
16.70%
1.50%
LA
Suddle Block
Spinal Anast.
Pudendel N. Bl.
Short GA
Complete GA
IV Seddation + LA
Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Our Skill in Anaesthesia (based on Teaching, Training & Practice) **
(n=70)
* As per IMCC Act 1970 and drug & Cosmetic act 1945
Yes / No 50-50 as per state policy
Other… NA – PG Scholars Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
97.00%
86.60%
98.50%
65.70%
37.30%
10.40%
97.00%
95.50%
64.20%
82.10%
9%
4.50%
9%
Hemograme
BT-CT-P.T.
Glucose Esti.
RFT
LFT
Lipid Profile
HIV Screening
HbSAg Screening
Physician Fitness
Urine MR
Stool MR
Thyroid Profile
Other
Pre OP Investigations* (n=70)
* Imaging investigations not included
Other… own medical store, Modern for poor Patient, ayu & modern both prescribing Dr Shreyas Bhalodia Sushrut Proctology
Association Conference 2016 @ Jamnagar
30.30%
6.10%
40.90%
56.10%
42.40%
4.50%
Ayurved Only
Modern Only
Ayurved & Emergency Modern
Ayu. , Modern & Surgical +Anesthetic
Ayurved & Prescribing Modern
Other
Medicines & Dispensing (n=70) IMCC Act 1970 and drug & Cosmetic act 1945
*Sales Tax, VAT, Drug Licenses, FASSI etc may be applicable
Did you know List of Licenses and Statutory Obligations* ?
73.10%
23.90%
3% No Yes Other
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
http://nabh.co/documents_Ayurveda.aspx
Registration of Dr as well as Hospital / Clinic
Documentation & Record Keeping Physically and/or electronically
Premises Set up
Qualified Nursing / OT / Para Medical Staff
Clerical /account/Housekeeping etc. staff
Legal advisor for Tax & MLC
Recent up dates
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Registration of Dr for qualification in Recognized university
i.e. GAU Act 1961 etc.
State council Board i.e. Guj. Medi. Prac. Act 1963 / IMCC 1970
CCIM Compulsory for faculty Practitioners who practicing across India
As per law – “MLC No Value” Any certificate/degree/diploma/ PG diploma courses offered by various universities / autonomous institutes / guru are not being recognized until details are not amended in IMCC Act 1970 or other act related to AYUSH Ministry
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Clinical Establishment (Registration & Regulations) Act 2010 (23 of 2010) Not applicable in Gujarat Till date
Bio-medical Waste (Management & Handling) Rules 1998 under section 6,8 & 25 of Environment & Pollution control Act, 1986, the Central Govt. of INDIA Applicable in Gujarat (even for AYUSH)
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Gujarat Pollution Control Board if Indoor Facility or Monthly OPD>1000 patients in Clinic/
Hospital/ Laboratory
The Bombay Nursing Homes Registration Act 1949 - in some state / Municipal corporations
In Local Municipality or Municipal Corporation
Shop Act License
– some insurance company ask “Form C”
– not mandatory depends on local authority
Professional Tax - Must
NABH Accreditation / ISO Accreditation Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
• Hospital Premises
– Situation
– Easy approach (Ground floor / 1st floor / Lift)
– Easy transportation
– Well ventilated & lightend
– Area (Sq. Meter / Fit ) per Gov. Rules & Regulation
• Clinical Establishment Act 2010
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Dispensaries * Physical infrastructure –
• Space requirement – Minimum 100 sq. ft.
• Dispensing counter – as per requirement.
Human resource –
• Minimum one doctor, one pharmacist and a multipurpose worker
Equipments requirement –
• Stethoscope – 1
• B.P. apparatus – 1
• Torch – 1
• Thermometer – 1
• Tongue depressor – 1
• Weighing machine – 1
• X – Ray view box – 1
• Hammer – 1
• Kharala - 1
• Others as required
Furniture requirement –
• Doctor’s table – 1
• Doctor’s chair – 1
• Chairs for attendants – 2
• Examination table – 1
• Patient’s stool – 1
• Foot step - 1
Others –
• Display the name of doctor with the degree.
• Registration number of the doctor
• Fee
• Timing of the clinic
• Experience of the doctor
• Dispensing counter with signage
• Name of the pharmacist with degree and experience
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*Clinical Establishment Act 2010
Clinic * Physical infrastructure –
• Space requirement – Minimum 100 sq. ft.
Human resource –
• Minimum one doctor and a multipurpose worker
Equipments requirement –
• Stethoscope – 1
• B.P. apparatus – 1
• Torch – 1
• Thermometer – 1
• Tongue depressor – 1
• Weighing machine – 1
• X – Ray view box – 1
• Hammer – 1
• Others as required
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*Clinical Establishment Act 2010
Therapy Centre* Physical infrastructure –
• Space requirement – Minimum 150 sq. ft.
• Therapy room
Human resource –
• Minimum one doctor,
• one pharmacist cum panchakarma therapsit
• multipurpose worker
• HOSPITAL WITH MINIMUM OF 10 BEDS
– Physical infrastructure (Space requirement )
• OPD – 100 Sq. ft , IPD – 500 Sq. ft
– Human resource (Each one) –
• Doctor , Pharmacist/nurse , Attendant, Multipurpose worker
• HOSPITAL UPTO 11 - 25 BEDS
– Physical infrastructure (Space requirement )
• OPD – 250 Sq. ft , IPD – 1250 Sq. ft
– Human resource
• Doctor – 2, Pharmacist – 1, Nurses – 2, Attendant – 1, Multipurpose worker – 1
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*Clinical Establishment Act 2010
Cont . . .
• 26 – 50 BEDDED HOSPITAL
• 51 – 100 BEDDED HOSPITAL
• HOSPITALS HAVING MORE THAN 100 BEDS
• TEACHING HOSPITALS
– All the teaching Hospitals must fulfil all the minimum standards as per the gazette notification of CCIM regd. no. D.L. 33004/99 no. 115 dated 22.04.2013 New Delhi.
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*Clinical Establishment Act 2010
Out-Patient Department for an Ayurvedic Hospital
The basic infrastructure must have following sections
1. Reception & waiting hall
2. Registration counter
3. OPD medical record room
4. Clinics / consultation room
5. Dressing room (mandatory for hospitals more than 50 beds)
6. Procedure room (mandatory for hospitals more than 50 beds)
7. Minor OT (optional but mandatory for hospitals more than 100 beds)
8. Dispensary (mandatory for hospitals more than 50 beds)
Other facilities which are required in the OPD are listed below –
1. Proper provision for drinking water and electricity
2. Toilet facilities for patients
3. OPD cafeteria (Optional)
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*Clinical Establishment Act 2010
5.Dressing room
minimum of 100 sq. ft.more than 50 beds
6.Procedure Room - This is required in the hospitals having more than 100 bed strength where agnikarma, kshara karma like procedures can be performed for the OPD patients.
7. Minor OT –more than 50 beds
400 – 500 outpatient where many minor OPD surgical procedures as well as Kshara sutra application can be performed. The minimum area required for the minor OT is 100 sq.ft.
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*Clinical Establishment Act 2010
General specifications for IPD Classification of ward accommodation –
• Primary – Bed accommodation , Nursing station , Treatment room
• Secondary – Doctor’s room , Nurses’ room , Clean utility
• Sanitary – Toilet block , Dirty utility , House keeper
• Ancillary – – Kitchen (required for hospitals having more than 50 beds)
– Day room
– Stretcher trolley
Dr Shreyas Bhalodia Sushrut Proctology
Association Conference 2016 @ Jamnagar
*Clinical Establishment Act 2010
Operation theatre mandatory for the hospitals having more than 100 beds however it is optional for the hospitals below 100 beds. Total Area – 2700 sq. ft. Functional distribution –
– 1. Major OT with attach toilet & bathroom – 2. Minor OT – 3. Scrub room – 4. Sterilization store – 5. Equipment store – 6. Recovery room
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar *Clinical Establishment Act 2010
Minimum Equipments for Proctology OT
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Legal & statutory requirements List of statutory compliance Authorization under
biomedical waste rule 1998 for management and handling of biomedical waste.
No objection certificate from competent fire authority.
Vehicle registration certificate for ambulance.
Right to information act. Consumer protection act Clinical establishment act
2010.
Legal aspects Societies registration act
1860 Consumer protection act Drug & cosmetic act Patients’ bill of right Medical negligence Drug handling Hospital infection Anesthesia – given with
proper & valid consent. Invasion of privacy Handling of medical records
Dr Shreyas Bhalodia Sushrut Proctology
Association Conference 2016 @ Jamnagar
*Clinical Establishment Act 2010
Records maintenance & reporting
Medical records – The medical record of the hospital has following documents –
– 1. Clinical document
– 2. Scientific document
– 3. Administrative document
– 4. Legal document
Reports*
• Average daily census ward wise, specialty wise
• Average length of stay
• Bed occupancy rate
• Bed turnover rate
• Outpatient clinics – number of new cases, number of repeat cases, specialty wise break up, Unit wise break up of cases
• Left against medical advice (LAMA) rate
• Number of X-Ray done – OPD, IPD
• Number of laboratory investigations
• Number of surgical operations
• Number of panchakarma done – break up of various procedures for OPD & IPD
• Number of delivery done along with other gynecological procedures.
• Numbers of para surgical procedure done in the breakup of agnikarma, jalaukavcharana etc.
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
*mandatory for the hospitals having more than 100 beds & teaching hospitals
RECORDS TO BE MAINTAINED Outpatient Register
Inpatient Register
Operation Theatre register
Case sheets –OPD/IPD, Consent
Medico legal register
Laboratory Register
Radiology and imaging register
Discharge summary
Medical certificate in duplicate
Complaint register
Number of beds system-wise and specialty
Total Discharges
Staff Registers i.e Salary – Attendance – Qualification etc.
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar *Clinical Establishment Act 2010
Signage Radiation Hazard Signage
Biomedical Waste Segregation
Danger Signage
General Instructions Like ‘No Smoking’, ‘Keep Silence’, ‘Use Dustbin’, Etc. At Various Patient And Visitor Areas In The Hospital
Hand--washing Techniques Compliant With WHO Guidelines At All Hand Wash Basins
How To Use Fire Extinguisher
Important Phone Contact Numbers Of Hospital Authorities
Required By Regulations Like PNDT, Lifts, Fire, Etc.
Of Material Safety Data Sheet At All Locations Where Hazardous Materials Are Stored
Patient Rights And Responsibilities In Opd, Emergency And Wards
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Dr Degree & Registration
Bio-medical Waste Certificate
GPCB Certificates
Various Notifications From Gov. of Guj., CCIM, AYUSH, Court Decisions etc.
News Papers Cuttings with Date
*Clinical Establishment Act 2010
Informed Written Consent
• In Consent must write
Early and/or late complication of Surgical procedure and anesthesia in local language.
Name of Surgeon, Assi. Surg. Anesthetic and OT Assi.
Never do any photography /Live Surgery without Consent
In Operative Cases
• Never Forget Anesthetic Note in indoor case with Adv
Antibiotics & Analgesics SOS
Procedure Name
Vital Remarks
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
Never use guarantee word for any treatment
Landmark judgments for AYUSH Dr • Dr. Mukhtiar Chand & Ors vs The State Of Punjab
& Ors on 8 October, 1998 http://indiankanoon.org/doc/484509/
• Smt. Kalpana Ben vs Dr. Kalposh V. Parikh etc. on 3 August, 2012 – KS Surgery Death Case http://indiankanoon.org/doc/115200537/
• THE HONOURBLE MR.JUSTICE K.CHANDRU http://www.ismga.net/uploads/5/4/6/4/5464496/chand
ru_udgement.pdf
• Poonam Verma vs Ashwin Patel & Ors on 10 May,1996 http://www.indiankanoon.org/doc/611474/
37
www.ayurvedauniversity.edu.in
www.ccimindia.org www.clinicalestablishments.nic.in
www.gujrathealth.gov.in www.indianmedicine.nic.in
www.nabh.co/documents_Ayurveda.aspx www.slideshare.net/drsurendrachaudhary/
Dr. Surendra Chaudhary,
Medical Officer, former, District Ayurveda &Unani Officer, Gautambudh Nagar(Noida)
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
• Faculties of
– JSAC, Nadia (2002-07)
– IPGT & RA, Shalya Dept
(2008-11)
• All members of SPA
• All members of SAAN
• Gujarat Action Committee
• NIMA – Gujarat
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
www.aumayurved.com
Dr Shreyas Bhalodia Sushrut Proctology Association Conference 2016 @ Jamnagar
For Any Assistance on Any MLC /Medi-claim Issues
Contact me 24 X 7
Dr. Shreyas G. Bhalodia
+91 98254 51215 or
+91 7878151215
shreyas.ayurved@gmail.com
Take home message . . .
Document your Practice
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