PhilHealth Benchbook

2005

2. Patient Care Standards

2.1 Access

Goal: The organization is accessible to the community that it aims to serve.

Standards	Status
2.1.1 The organization informs the community about the services it provides and the hours of their availability.
Criteria
- Information detailing the clinical services offered and hours of their availability is strategically5 distributed and prominently posted.
- Clinical services are appropriate to patients’ needs and the former’s availability is consistent with the organization’s service capability and role in the community.
- The community is aware of clinical services offered and times of availability.

⁵ The following example distinguishes prominent from strategic: if a clinic is located far from the main street, then the signage should be located at the street corner nearest the clinic. Otherwise it would not be seen. That is strategic. Making the signage big enough to be seen from a block away is prominent.

Standards	Status
2.1.2 Physical access to the organization and its services is facilitated and is appropriate to patients’ needs.
Criteria
- Entrances and exits are clearly and prominently marked, free of any obstruction and readily accessible.
- Directional signs are prominently posted to help locate service areas within the organization.
- Alternative passageways for patients with special needs (e.g., ramps) are available, clearly and prominently marked and free of any obstruction.
- Major service areas have nearby waiting facilities that are clean, well-lit, adequately ventilated and equipped with appropriate fixtures and furniture.
- The organization documents, follows policies and procedures, and provides resources for the safe and efficient direction of patients, their families and visitors, and staff traffic.
- Patients, their visitors and staff can efficiently and safely move within the confines of the organization.

2.2 Entry

Goal: The entry processes meet patient needs and are supported by effective systems and a suitable environment.

Standards	Status
2.2.1 Patients receive prompt and timely attention by qualified professionals upon entry.
Criteria
- Patient waiting times are routinely monitored, evaluated and improved based on standards and procedures developed by the organization. Depending on their needs, patients are seen within the planned waiting period.
- Patients are informed of the cause of any delay in the delivery of services.
- Patients are satisfied with the actual waiting time.

Standards	Status
2.2.2 The organization documents and follows policies and procedures, and provides resources to ensure proper patient triaging.
Criteria
- The staff follows policies and procedures in determining and prioritizing patients’ clinical needs and in identifying clinical services that will best address them.
- The staff follows policies and procedures in determining admissibility of patients or the need for referral to other organizations.
- Patients are correctly and efficiently assigned to the clinical services appropriate to their needs.

Standards	Status
2.2.3 The organization uniquely6 identifies all patients including newborn infants, and creates a specific patient chart for each patient that is readily accessible to authorized personnel7.
Criteria
- All patients are correctly identified by their patient charts.
- The patient charts contain identifiers unique to each patient.
- Patient charts are appropriately and systematically indexed to facilitate retrieval and storage and to avoid duplication or loss.

⁶ To uniquely identify a patient may mean making the patient number a lifetime number.

⁷ The organization itself determines the limits of who are authorized personnel in any given situation.

Standards	Status
2.2.4 The health professional8 responsible for the care of the patient obtains informed consent for treatment.
Criteria
- Prior to admission, patients and/or their families are appropriately informed by authorized qualified personnel of their disease, condition or disability, its severity, likely prognosis, benefits, and possible adverse effects of various treatment options, and the likely costs of treatment.
- Patients and/or their families demonstrate knowledge of their disease, condition or disability, its severity, likely prognosis, benefits, and possible adverse effects of various treatment options, and the likely costs of treatment.

⁸ Doctors are not the only providers of care within the organization; hence health professional is preferred to encompass a wider spectrum of health care providers.

Standards	Status
2.2.5 Planning for discharge begins upon entry into the organization and ensures a coordinated approach to discharge and continuing management.
Criteria
- Patients and/or their families are informed of the expected (barring any complications) approximate duration of treatment, the extent or frequency of re-assessment, the likely outcomes and their need for follow-up care after discharge.
- Patients and/or their families are informed of the need for and availability of resources to continue care after discharge.

⁸ Doctors are not the only providers of care within the organization; hence health professional is preferred to encompass a wider spectrum of health care providers.

2.3 Assessment

Goal: Comprehensive assessment of every patient enables the planning and delivery of patient care.

Standards	Status
2.3.1 Each patient’s physical, psychological and social status is assessed.
Criteria
- An appropriately comprehensive history and physical examination is performed on every patient within 24 hours from admission. The history includes present illness, past medical, family, social and personal history.
- Whenever appropriate, mental status examinations, psychological evaluations and nutritional and functional assessments are performed on the patient.

Standards	Status
2.3.2 Appropriate professionals9 perform coordinated and sequenced patient assessment to reduce waste and unnecessary repetition.
Criteria
- Based on collaboratively developed policies and procedures, qualified personnel conduct initial assessments in an efficient and systematic manner to avoid repetition.
- The order of assessment is determined by the patient’s prioritized needs.^10
- Previously obtained information obtained is reviewed at every stage of the assessment to guide future assessments.

⁹ This is not about determining who is qualified because this should have been done already at the credentialing process. Rather it is about determining who are appropriate for the roles in patient care. For example, a qualified radiologist is not appropriate to make a pre-operative assessment.

¹⁰ The optimal order of assessment could be pre-determined through clinical pathways based on clinical practice guidelines, or other forms of evidence.

Standards	Status
2.3.3 Assessments are performed regularly and are determined by patients’ evolving response to care.
Criteria
- During the course of management, qualified personnel re-assess the patients’ physical and psychological conditions according to the patient’s needs.
- Re-assessment is done whenever the patients’ condition take an unexpected turn.
- Re-assessment results in a review of the patients’ management.
- Qualified personnel give patients for surgery pre-operative physical and pre-anesthetic assessment.
- The status of post-operative patients is assessed upon admission into, during confinement and upon discharge from the recovery area.

Standards	Status
2.3.4 Assessments are documented and used by the health care team to ensure effective communication and continuity of care.
Criteria
- Legible written records of the initial and ongoing assessments are accomplished for each patient and kept in the patient chart.^11
- Medical records are stored in an area that is safe and accessible to all members of the health care team, and whenever appropriate, to external providers.^12

¹¹ Results of re-assessment may be documented as problem-oriented progress notes in SOAP (subjective complaints/objective findings / assessment / plan) form for each patient and kept in the medical record.

¹² The term external providers includes, but is not limited to, other health care providers to whom the patient is referred for continuity of care.

Standards	Status
2.3.5 Diagnostic examinations appropriate to the provider organization’s service capability and usual case mix are available and are performed by qualified personnel.
Criteria
- Policies and procedures for the standard performance, monitoring and quality control of diagnostic examinations are documented and monitored.
- Policies and procedures for accessing and referring patients to approved external providers when diagnostic services are not available within the provider organization are documented and monitored.

Standards	Status
2.3.6 Assessments of patients with special needs are determined by policies and procedures that are consistent with legal and ethical requirements.
Criteria
- Policies and procedures identify patients with special needs and the specific types of assessment appropriate to their needs.^13

¹³ Patients with special needs include infants, school-age children, adolescents, the elderly and the disabled, victims of alleged or suspected sexual abuse or violence, patients with emotional or behavioral disorders, patients with drug dependencies or alcoholism.

2.4 Care Planning

Goal: The health care team develops in partnership with the patients a coordinated plan of care with goals.

Standards	Status
2.4.1 The care plan addresses patients’ relevant clinical, social, emotional and religious needs.
Criteria
- The plan, aside from delineating responsibilities, includes goals to be achieved, services to be provided, patient education strategies to be implemented, time frames to be met, resources to be used.^14

¹⁴ Clinical pathways derived from clinical practice guidelines and other types of clinical evidence should be developed or implemented for the top 10 cases of admissions and / or consultations. For more information, refer to Part III.

Standards	Status
2.4.2 The care plan is consistent with scientific evidence, professional standards, cultural values, medico-legal and statutory requirements.
Criteria
- The care plan is developed by a multidisciplinary team of health professionals within the organization.
- The care plan is developed following search and appraisal of published scientific literature.
- Expert judgment, practice standards and patients’ values are considered in developing care plans.

Standards	Status
2.4.3 The organization ensures that information about the patient’s proposed care is clear and readily accessible to designated multidisciplinary health care providers and other relevant persons.
Criteria
- Care planning is documented in the patient chart.
- Clinical pathways, algorithms and problem-oriented notes15 in SOAP format are incorporated in the medical record.

¹⁵ Problem oriented notes may take other forms aside from SOAP, such as SOAPIE, etc.

2.5 Implementation of Care

Goal: Care is delivered to ensure the best possible outcomes for the patient.

Standards	Status
2.5.1 Care is delivered in a timely, safe, appropriate and coordinated manner, according to care plans.
Criteria
- In the management of clinical pathway-covered conditions, the order and timing of treatments follow the pathway.
- Orders for treatments are implemented within time intervals established by the organization.
- Referrals to other specialties are made according to established pathways or guidelines.
- Results of referrals are communicated to relevant members of the health care team and are considered in the management.

Standards	Status
2.5.2 Rights and needs of patients are considered and respected by all the staff.
Criteria
- Patients receive explanations on the nature of a test or treatment, the need for it prior to administration, its likely effects and side effects, and what patients can do to cope with them.
- Patients’ wish to decline tests or treatments is respected.

Standards	Status
2.5.3 Care is coordinated to ensure continuity and to avoid duplication.
Criteria
- Policies and procedures that determine the extent of duplicate assessments and treatments performed by trainees respect patients’ rights, and are documented and monitored.

Standards	Status
2.5.4 Appropriate personnel educate patients and/or their families to help them understand patients’ diagnosis, prognosis, treatment options, health promotion and illness prevention strategies.
Criteria
- The organization documents and implements policies and procedures, and provides resources to promote interactive, appropriate and relevant educational programs for patients.
- Patients are aware of their roles and responsibilities in their health care.

Standards	Status
2.5.5 Drugs are administered in a standardized and systematic manner in the provider organization.
Criteria
- Drugs are administered in a timely, safe, appropriate and controlled manner.^16
- The provider organization documents and follows policies and procedures and allocates resources for the training, supervision and evaluation of professionals who administer drugs.^17
- Only qualified personnel order, prescribe, prepare, dispense and administer drugs.
- Regular review of prescription orders is undertaken by appropriately trained staff to ensure safe and appropriate use of drugs.^18
- Prescriptions or orders are verified and patients are identified before medications are administered.
- Telephone orders are countersigned by the ordering physicians not later than standards set by the organization and based on statutory requirements.
- Discontinued or recalled drugs are retrieved and safely disposed of according to established policies and procedures.
- Drugs are selected and procured based on the organization’s usual case mix and according to policies and procedures that are consistent with scientific evidence and government policies.
- Drug administration is properly documented in the patient chart.
- Policies and procedures for detecting, reporting and monitoring adverse effects are documented and monitored.

¹⁶ The processes of administering drugs should be documented in flowcharts. See Part III (Flow Chart) for more information.

¹⁷ The Generics Act, National Drug Policy and the PhilHealth “Positive” List of Reimbursable Drugs are examples of these government policies.

¹⁸ This is to ensure that prescriptions are written correctly (e.g., in generic form), and that precautions for drug-drug and drug-food interactions have been adequately addressed.

Standards	Status
2.5.6 Treatment procedures are performed in a standardized and systematic manner in the provider organization.
Criteria
- Treatment procedures are performed in a timely, safe, appropriate and controlled manner.^19
- The provider organization documents and reviews policies and procedures and allocates resources for the training, supervision and evaluation of professionals who perform procedures.
- Only qualified personnel order, plan, perform and assist in performing procedures.
- Orders are verified, and patients are identified before treatment procedures are performed.^20
- Treatment procedures are legibly and accurately documented in the patient chart by qualified personnel.^21
- Medical devices and equipment are used, maintained, stored and disposed based on technical specifications.
- Medical devices and equipment are selected and procured based on the organization’s case mix, staff expertise, service capability and according to policies and procedures that are consistent with scientific evidence and government policies.

¹⁹ The processes of performing the most common treatment procedures should be documented in flowcharts. See Part III (Flow Chart) for more information.

²⁰ Armbanding may be one method for identifying patients for surgery. The actual operative site may be marked indelibly beforehand.

²¹ Treatment records should document who did what to whom, when and for what indication. An appropriately adequate description of the procedure and operative findings should be included in the records.

Standards	Status
2.5.7 The care of patients with special needs is governed by policies and procedures that are consistent with legal and ethical requirements.

2.5 Evaluation of Care

Goal: The health care team routinely and systematically evaluates and improves the effectiveness and efficiency of care delivered to patients.

Standards	Status
2.6.1 Data relating to processes and outcomes of patient care are analyzed to provide information for care improvement.
Criteria
- The organization routinely collects process and outcomes data from its provision of patient care.
- The organization provides resources for the formal and collaborative evaluation of care using analysis of process and outcomes data.
- Results of evaluation of care are fed back to the health care providers concerned.
- Results of evaluation of care are routinely presented and discussed in meetings of top management.^22

Standards	Status
2.6.2 The health care team takes action to address any improvements required.
Criteria
- Evaluation of care leads to formal and collaborative performance improvement activities that harness the resources of appropriate services.

²² There are many clinical tools that can be used to evaluate care, including medical audit, utilization review, sentinel event monitoring and incident reporting. For more information on how to conduct these routine assessments of care, refer to Part III.

Standards	Status
2.6.3 Quality improvement activities are documented, enable continuous quality improvement and incorporate the following elements: . Monitoring, assessment, analysis and evaluation of activities . Appropriate and timely action . Evaluation of the effectiveness of any action taken . Feedback of evaluation results

2. 7 Discharge

Goal: Care is coordinated between the organization and other health care providers in the community to ensure that the needs of the patient are continuously met.

Standards	Status
2.7.1 The discharge plan is part of the patient’s care plan and is documented in the patient chart.
2.7.2 The organization provides information about the continuing management plan to the patient and relevant health care providers in a manner that maintains patient confidentiality and privacy.
2.7.3 The organization arranges access to other relevant community health services23 in a timely manner, and ensures that patients are aware of appropriate services before discharge.
2.7.4 Patients understand the discharge plans and their responsibilities for continuing management.

²³ Examples of other relevant community health services include, but are not limited to, rural health units (RHU), Botika sa Barangay, etc.

Patient Care

ACCESS STANDARDS

• information about services

• access to services

Goal: The organization is accessible to the community that it aims to serve.

ENTRY STANDARDS

• prompt and timely attention

• efficient triaging

• unique patient identification

• informed consent

• planning for discharge and continuing care

Goal: The entry processes meet patient needs and are supported by effective systems and a suitable environment.

ASSESSMENT STANDARDS

• physical, psychological, social assessment

• coordinated assessment by professionals

• regular assessments

• proper documentation of assessments

• appropriate diagnostics

• special needs assessments

Goal: Comprehensive assessment of every patient enables the planning and delivery of patient care.

CARE PLANNING STANDARDS

• relevant to patients’ needs

• evidence-based care plan

• clear and accessible information on care nion is

accessible to the community that it aims

Goal: The health care team develops in partnership with the patients a coordinated plan of care with goals.

health care team develops in partnership with the patients a coordinated plan of care with goals.

IMPLEMENTATION OF CARE STANDARDS

• timely, safe, appropriate and coordinated care delivery

• respect for patients’ needs and rights

• coordinated care delivery among professional

• patient education• standardized drug administration

• standardized treatment procedures• appropriate care for patients with special needs

Goal: Care is delivered to ensure the best possible outcomes for the patient.

EVALUATION OF CARE STANDARDS

• analysis of process and outcomes data

• actions for improvement activities

Goal: The health care team routinely and systematically evaluates and improves the effectiveness and efficiency of care delivered to patients.

CARE PLANNING STANDARDS

• discharge plan

• continuing management plan

• patient access to community health services

• patient understanding of discharge plan

Goal: Care is coordinated between the organization and other health care providers in the community to ensure that the needs of the patient are continuously met.

is delivered to ensure the best possible outcomes for the patient. GOAL