NABH Quality Indicators

What is NABH?

NABH means National Accreditation Board for Hospitals & Healthcare Providers.

NABH accreditation is a process that recognizes healthcare services for their quality and safety requirements. Accreditation guarantees that healthcare providers adhere to certain quality standards. It gives the hospital or healthcare provider a seal of approval.

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Here is the list of NABH quality indicators

Average time taken for initial assessment of patients admitted in IPD

Sum of time taken for initial assessment of all admitted patients in a period

Total number of patients admitted in that period

Note: The time taken can be taken from the time when patient was registered for admission till the time at which initial assessment was completed and documented.

Percentage of IPD patients for whom the initial assessment was completed within defined timeframe

Number of patients for whom the initial assessment was completed within a defined time frame

Total number of patients admitted

Note: Timeframe for initial assessment of patient getting admitted must be defined by the hospital

Average time taken for initial assessment of patients coming to emergency

Sum of time taken for initial assessment of all patients who accessed emergency services in a period

Total number of patients who accessed emergency services in that period

Note: The time taken can be taken from the time at which a patient arrived at emergency department till the time at which initial assessment was completed and documented.

Percentage of emergency patients for whom the initial assessment was completed within defined timeframe

Number of patients in emergency for whom the initial assessment was completed within a defined time frame

Total number of patients admitted

Note: Timeframe for initial assessment of emergency patients must be defined by the hospital

Percentage of in-patients wherein the plan of care with desired outcomes is documented and countersigned by the clinicians

Number of case records in which plan of care with desired outcomes is documented and countersigned by the clinicians

Total number of case records checked

Note: This can be further broken down into subcomponents such as case records with documented plan of care, documented desired outcomes and countersigned

Percentage of in-patients wherein screening for nutritional needs has been done

Number of admitted patients who has been screened for nutritional requirements

Total number of patients admitted

Note: Nutritional screening format can be used and is required for all admitted patients

Reporting error rates (per 1000) in laboratory

Number of lab reports in which errors detected

Number of lab reports checked

Note: The error rates can be separately calculated for each unit of laboratory

Percentage of re-dos in laboratory

Number of lab tests which must be repeated in a period

Total lab tests conducted in that period

Note: Only those repeat test shall be considered in calculation, where the reason of repeating is related to errors, mistake or quality issues

Percentage of lab reports co-relating with clinical diagnosis

Number of lab reports in which the diagnosis matches with the clinical diagnosis of the doctor

Total lab tests conducted

Note: While higher correlation shall be expected, it may not necessarily be 100%

Percentage of adherence to safety precautions by employees working in labs

Number of observations that indicates adherence to safety precautions in a period

Total number of observations made in that period

Note: Safety precautions must be clearly defined. Data must be gathered through random monitoring of practices followed by staff. Most safety precautions shall be related to safety from infection, bio-medical waste and safety from chemicals.

Reporting error rates (per 1000) in Imaging

Number of lab reports in which errors detected

Number of lab reports checked

Note: The error rates can be separately calculated for each imaging modality

Percentage of re-dos in Imaging

Number of Imaging tests that must be repeated in a period

Total Imaging tests conducted in that period

Note: Only those repeat test shall be considered in calculation, where the reason of repeating is related to errors, mistake or quality issues

Percentage of Imaging reports co-relating with clinical diagnosis

Number of Imaging reports in which the diagnosis matches with the clinical diagnosis of the doctor

Total Imaging tests conducted

Note: While higher correlation shall be expected, it may not necessarily be 100%

Percentage of adherence to safety precautions by employees working in Imaging

Number of observations that indicates adherence to safety precautions in a period

Total number of observations made in that period

Note: Safety precautions must be clearly defined. Data must be gathered through random monitoring of practices followed by staff. Most safety precautions shall be radiation safety and infection control

Medication error rate or Medication error per 1000 patient days

Number of medication errors reported in a period

Total number of medication administration events

Note: For data on medication errors a strong medication error reporting system must be in place.

This indicator can further be divided into various types of medication errors, such as administration error, dispensing error, error of route, error of dose etc.

Percentage of adverse drug reactions

Number of patients who suffered adverse drug reactions in a period

Number of admitted patients in that period

Note: Adverse drug reaction and medication error shall be defined and should not overlap with each other

Percentage of adverse drug reaction due to high-risk medicine

Number of patients developing adverse drug reaction from high-risk medicines in a period

Number of patients given high-risk medicine in that period

Note: List of high-risk medicines shall be specified by the hospital and any adverse reaction happening due to these medicines shall be counted for this indicator

Percentage of medical records with error-prone abbreviations

Number of medical records which contains error-prone abbreviations

Number of medical records screened

Note: List of accepted abbreviations shall be determined by the hospital and any abbreviation other than that shall be considered as error prone

Percentage of modification of anesthesia plan

Number of patients in whom anesthesia plan was modified immediately before induction of anesthesia

Number of patients that have undergone anesthesia

Note: Each patient must undergo pre-anesthesia check-up in which anesthesia plan (type of anesthesia and anesthetic agent) is determined. Any change in this plan shall be considered as a modification

Percentage of unplanned ventilation following anesthesia

Number of patients who required unplanned ventilator support following anesthesia

Number of patients who were given anesthesia

Note: Unplanned ventilation is the situation in which patient must be put on the ventilator after surgery, due to complications resulting from anesthesia

Percentage of re-scheduling of surgeries

Number of planned surgeries re-scheduled or cancelled

Number of surgeries planned

Note: This indicator can further be classified as per causes of re-scheduling for the management to take appropriate corrective and preventive measures

Compliance rate to surgical safety practices

Number of surgical patients in which all surgical safety practices where adhered

Number of surgical patients’ cases reviewed

Note: For surgical safety practices, ‘WHO surgical safety checklist can serve as a good reference material’. The compliance rate of individual practices can also be calculated for detailed analysis.

Percentage of cases who received prophylactic antibiotic within specified timeframe

Number of surgical patients who has received prophylactic antibiotic

Total number of patients undergone surgery

Note: The hospital must define the timeframe for giving prophylactic antibiotics.

The documentation of administration of antibiotics and the time shall be done for getting data

Percentage of transfusion reactions

Number of patients who developed blood or blood component transfusion reaction

Number of patients who underwent blood or component transfusion

Note: To get data for this indicator a transfusion administration form must be filled for each transfusion, which shall have a column for indicating reactions if any

Percentage of blood and blood components wasted

Units of blood and blood components wasted or discarded in a period

Total units of blood and blood components under storage during that period

Note: Blood and blood components being discarded because of unfit in lab tests, shall not be counted as wastage. Wastage shall be because of reasons of expiry, errors, poor storage conditions etc.

Percentage of blood component usage

Total units of blood components transfused to patients

Total units of whole blood plus blood components transfused to patients

Note: The percentage should be high

Turn-around time for the issue of blood and blood components

Sum of time taken for issuing blood blood taken in each requisition

Total number of requisitions for blood and blood component

Note: The time taken shall be considered from the time of receipt of requisition till the time of dispatch of blood or blood component

Percentage of blood and blood components issued within defined time frame

Number of blood and blood component requisitions that were issued within defined timeframe

Total number of requisitions received blood and blood component

Note: The time taken shall be considered from the time of receipt of requisition till the time of dispatch of blood or blood component

Percentage of blood and blood components issued within defined time frame

Number of blood and blood component requisitions that were issued within defined timeframe

Total number of requisitions received blood and blood component

Note: The time frame must be defined by the organization

Catheter associated Urinary Tract Infection (CA-UTI) rate

Number of patients developing CA-UTI in a period

Total urinary catheterization days in that period

Note: CA-UTI shall be determined clinically (CDC guidelines must be followed). The catheterization days shall be calculated as sum of number of days each patient spent with urinary catheter in the period of calculation.

Ventilator associated pneumonia (VAP) rate

Number of patients developing VAP in a period

Total ventilator days in that period

Note: VAP shall be determined clinically (CDC guidelines must be followed).

The ventilator days shall be calculated as sum of number of days each patient spent on ventilator in the period of calculation.

Central line catheter associated blood stream infection (CA-BSI) rate

Number of patients developing CA-BSI in a period

Total central line days in that period

Note: CA-BSI shall be determined clinically (CDC guidelines must be followed). The central line days shall be calculated as sum of number of days each patient spent with central line catheter in the period of calculation

Surgical site infection (SSI) rate

Number of patients developing SSI in a period

Total number of clean surgeries performed in that period

Note: CA-BSI shall be determined clinically (CDC guidelines must be followed). This can be further bifurcated in superficial, deep and organ/space infections due to surgeries.

Gross mortality rate

Total number of deaths happened in the hospital in a period

Total number of deaths discharges during that period

Note: All deaths (including deaths in emergency and ICU) shall be counted. In denominator all types of discharges shall be considered

Net mortality rate

Total number of deaths that happened after 48 hours of admission of the patient

Total number of deaths and discharges during that period

Note: Deaths happening within 48 hours (about 2 days) of discharge should also be counted in numerator

ICU specific mortality rate

Total number of deaths in ICU patients in a period

Total number of patients discharged from ICU in that period

Note: On similar lines, condition specific or specialty specific deaths rates can also be calculated.

Return to ICU within 48 hours

Number of patients who were re-admitted to ICU within 48 hours of being discharged from ICU

Total number of patients discharged from ICU

Note: The patients who were discharged against medical advice from ICU should be ignored

Return to emergency within 72 hours with similar presenting complaints

Number of patients who returned to emergency within 72 hours with similar presenting complaints

Total number of patients discharged from emergency

Note: The patients who were discharged against medical advice from emergency should be ignored

Re-intubation rate

Number of patients who must be re-intubated after ex-tubation

Total number of ex-tubation done during the period

Note: Data on re-intubation and ex-tubation shall be taken from individual medical record or a master register

Percentage of research activities approved by ethics committee

Number of research activities approved by ethics committee

Number of research proposal submitted to ethics committee

Note: Applicable to hospital undertaking clinical research

Percentage of patients withdrawing from clinical research

Number of patients withdrawing from research study

Number of patients originally enrolled in the study

Note: Applicable to hospital undertaking clinical research

Percentage of protocol violations/deviations in clinical research study

Number of serious adverse events reported to ethics committee

Number of serious adverse events identified

Note: Applicable to hospital undertaking clinical research

Error rates during shift handovers

Number of errors detected in patient during shift changes

Number of hands over records reviewed

Note: A handover checklist must be available against which errors can be detected

Percentage of medical error due to wrong identification of patient

Number of medical errors reported that happened due to wrong identification of patient

Total number of medical errors reported

Note: A robust system of medical error reporting must be in place to get appropriate data

Hand hygiene compliance rate

Number of observations in which staff with hand hygiene guidelines

Total number of observations made

Note: Hand hygiene guidelines must be specified. Data shall be gathered through monitoring

Compliance rate to medication prescription in capitals

Number of prescriptions in which are written in capital letters

Total number of prescriptions checked

Note: Not applicable, if prescription is computerized

Percentage of procurement through local purchase

Value of drugs and consumables through local purchase

Total value of drugs and purchased in that period

Note: Local purchases are unplanned, emergency purchases which increase the cost of purchasing

Percentage of stockouts for emergency drugs

Number of emergency drugs on the stock-out

Total number of emergency drugs

Note: Stock out is a situation when the inventory level of the medicine has gone below the defined minimum level

Percentage of drugs and consumables rejected before preparation of goods receipt note

Number of drugs and consumables rejected before preparation of goods receipt note

Total number of drugs and consumables received

Note: The data can be taken through a random sample of items that were checked

Percentage of variation from procurement process

Number of times standard process was not followed

Total number of procurements done

Note: A standard operating process for procurement must be in place to calculate this indicator

Percentage of variations observed in mock drills

Number of variations observed in mock drills

Total number of observations made

Note: This should be separately calculated for different mock drills such as code blue, code red, code pink, disaster handling etc.

Patient fall rate per 1000 patient days

Number of patient fall reported in a period

Total patient days in that period

Note: Patient fall must be defined. Generally, all kind of fall (fall from bed, in washroom, on stairs, while walking etc.) must be counted

Hospital-associated pressure ulcer rate

Number of patients developing associated pressure ulcers

Number of bedridden patient days

Note: Criteria for determining pressure ulcers shall be specified. Patients at risk of developing pressure ulcers must be identified

Percentage of staff provided pre-exposure prophylaxis

Number of staff who pre-exposure prophylaxis

Total healthcare staff

Note: Pre-exposure prophylaxis can be given for different conditions such as Hepatitis, certain kinds of Pneumonia etc.

Bed Occupancy Rate

Total patient days in a period

Total bed days available during that period

Note: Total patient days is the sum of days spent by each admitted patient in hospital. Total bed days is the product of the number of functional beds in hospital with the number of days in that period.

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