Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Dr Mohan Z Mani,
Professor & Head,
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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : IC01 - IC05 Full Version

Awareness and Compliance to International Patient Safety Goals among Healthcare Personnel of a Tertiary Care Hospital in Northern India

Published: October 1, 2022 | DOI:
Dinesh Chandra Joshi, Ravinder Singh Saini

1. Faculty, Department of Hospital Administration, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India. 2. Head, Department of Hospital Administration, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India.

Correspondence Address :
Dr. Dinesh Chandra Joshi,
Faculty, Department of Hospital Administration, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun-248016, Uttarakhand, India.


Introduction: Advances and commitment to patient safety worldwide have grown since the late 1990s which have led to a remarkable transformation in the way patient safety is viewed. Having begun as a subject of minor academic interest, it is now embedded in most healthcare systems worldwide. The International Patient Safety Goals (IPSG) are important guidelines developed by Joint Commission International to promote safe and high-quality patient care. Patient safety is the responsibility of every healthcare personnel who is directly or indirectly involved in patient care.

Aim: To determine the level of awareness amongst doctors, nurses and technicians and their compliance to IPSG in a tertiary care hospital.

Materials and Methods: This observational cross-sectional study was conducted from March to May 2021, in a tertiary care teaching hospital of North India. Stratified sampling technique was used in determining the number of doctors, nurses and technicians required for this study. A validated questionnaire was used to assess the awareness level of healthcare personnel to IPSG. ‘1’ mark was assigned to each correct answer and ‘0’ were awarded to wrong answers. The data was collected and coded in a Microsoft excel database. Descriptive data analysis was done.

Results: A total of 394 patient records/documents were audited for patient safety compliance. It was observed that 339 (86%) documents revealed compliance to all six IPSG. Out of the six goals of IPSG, the best compliance was observed for the fourth goal of IPSG (ensure safe surgery) for which the compliance was 100%. The lowest compliance was observed for 2nd, 5th and 6th goal (improve effective communication, reduce the risk of healthcare associated infection and reduce the patient harm resulting from fall) which was 81%, 80% and 78%, respectively. The awareness questionnaire was given to doctors (n=60), nurses (n=86) and technicians (n=76). The findings revealed that awareness was highest in nurses (84.8%) followed by doctors (81.7%) and technicians (80.2%).

Conclusion: The study has found out that the awareness level of doctors, nurses and technicians towards patient safety goals is good. Further quality improvement in this field can be achieved by conducting on the job training, workshops, lectures and seminars.


Healthcare-associated infections, Look-alike/sound-alike medications, Patient identification

Healthcare is a rapidly evolving field of science and with the advent of sophisticated diagnostic and therapeutic medical equipment the operational environment in hospitals is becoming more complex. This in turn reiterates the need of preventing harm to patients during their treatment in hospitals. Patient safety is a global public health issue and as per World Health Organisation (WHO) newsletter dated 26 August 2019, one in ten patients in developed countries suffer harm while receiving hospital care. However, in developing countries, the probability of patients getting harmed in hospitals is higher. In some developing countries, the danger of healthcare-associated infection is 20 times more than the developed countries. The 55th World Health Assembly (WHA) deliberated upon the report on patient safety and urged member states to pay the closest possible attention to the problem of patient safety; and to establish and strengthen sciencebased systems, necessary for improving patients’ safety and the quality of healthcare, including the monitoring of drugs, medical equipment and technology (1).

The failure to identify patients correctly results in medication errors, transfusion errors, testing errors and wrong person procedures. The most error-prone communications are patient care orders given verbally and over the telephones. Additional error-prone communication is reporting back of critical test results over the phone. Medications that have high-risk for adverse outcomes are Look-Alike and Sound-Alike (LASA) medications. In hospitals, wrong-site, wrong-patient surgery and wrong procedure is an alarmingly common occurrence. Ineffective or inadequate communication between members of the surgical team, lack of patient involvement in site marking and lack of procedures for verifying the operation site are additional causes to these errors. Healthcare-Associated Infections (HAIs) are often serious and even deadly for patients. The International Patient Safety Goals (IPSG) laid down by Joint Commission International (JCI) in 2006 are important guidelines at the international level to promote specific improvements in the process of providing safe and high-quality care to patients (2).

Goal 1- Identify patients correctly: The objective of this goal is two-fold: first, to reliably identify the patient for giving the service or treatment and secondly to match the service or treatment to that particular patient. The identification process used throughout the hospital requires a minimum of two criteria like the patient’s name, MRD/UHID no, birth date and a barcoded wristband (3).

Goal 2- Improve effective communication: Communication is considered to be effective in reducing errors and improving patient safety when it is timely, accurate, complete, unambiguous and well understood by the recipient. Verbal orders are NOT allowed and are acceptable only in life threatening conditions where read back procedure is strictly enforced. All verbal orders are to be countersigned by the doctor who has given orders within 24 hours (4).

Goal 3- Improve the safety of high-alert medications: Any medication, which people often purchase without a prescription, if used improperly can cause injury. Examples of high alert medications include investigational medications, controlled medications, chemotherapy drugs, anticoagulants, psychotherapeutic medications and LASA (5),(6).

Goal 4- Ensure correct site, correct procedure and correct patient surgery (Safe surgery): Patient injury and adverse/ sentinel events resulting from wrong site, wrong procedure and wrong patient surgery are continuous concerns for hospitals. It is mandatory that the site marking is done by the surgeon or the physician of the surgical team. Surgical Safety Checklist (SSC) must be filled to ensure safe surgery/procedure. Site marking has an upward arrow (?) only. Putting a cross (X) is not recommended (2).

Goal 5- Reduce the danger of HAI: Infections common to all or any healthcare settings include Catheter-Associated Urinary Tract Infections (CAUTI), Central Line Associated Blood Stream Infections (CLABSI) or septicaemia and Ventilator Associated Pneumonia (VAP). Hand hygiene guidelines are required to be posted in appropriate areas and staff is required to be educated for proper hand washing and hand disinfection procedures (7).

Goal 6- Reduce the risk of patient harm resulting from falls: Risk of fall is assessed using Morse Fall Scale for adults and Humpty Dumpty tool for paediatric patients. All precautions to prevent patient fall must be taken such as: keeping the bed rails upright, using strap belts while transporting the patients on wheel chair, using fall caution board while moping etc (8).

Patient safety is a serious global public health concern and this gets further compounded by the fact that the awareness level to IPSG is low among healthcare workers. The study conducted by Brasaite I et al., on physicians, nurses and nursing assistants was aimed to describe healthcare professionals’ knowledge regarding patient safety (9). IPSGs aim to encourage specific improvements in patient safety by focusing on six key problematic areas identified by the JCI. By including these key six areas in everyday practice, healthcare providers can improve patient safety and patient outcome. In view of the same, present study was aimed to assess the present state of awareness among healthcare workers to the following IPSGs which are crucial for patient safety.

Material and Methods

This observational cross-sectional study was conducted from March 2021 to May 2021, in a tertiary care teaching hospital of North India. In-principle concurrence was accorded by ethics committee for the study since patient data being audited in this study was of routine nature in the concerned setting and did not breach any patient confidentiality/ethical parameters/or involve any human clinical trials. The healthcare staff that had consented to participate in the study was included in the awareness audit through questionnaire.

Inclusion criteria: Doctors, nurses and technicians serving in critical patient care areas and acute patient care wards where the patient was still under active management of medical staff and who have voluntarily agreed to participate in this study, and were between 25- 45 years of age were included in the study.

Exclusion criteria: Since, the study was focused on high risk critical areas and acute wards, the other wards/departments {(Chronic Patient Care Wards and Outpatient Departments (OPD)} were excluded from the study.

Sampling technique: The stratified random sampling technique was used. A questionnaire, comprising of 15 Multiple Choice Questions (MCQs) and 25 fill-in-the-blanks, based on IPSG, was given to doctors (60), nurses (86), and technicians (76). The questionnaire consisted of basic questions pertaining to IPSG laid down by JCI in 2006.

Pilot study: A pilot study was undertaken to test the validity of the questionnaire prior to its implementation with 5 doctors, 10 nurses and 10 technicians. This pilot study was done on healthcare staff to test the clarity and simplicity of the questions and the appropriateness of the wording in the questionnaire. Modification and reformation were made in some of the questions to ensure better comprehension.

Study Procedure

The study was conducted in two phases:

• In first phase, an audit of documentation pertaining to patient safety criteria in patient records (n=394) was carried out to verify compliance to IPSGs by the staff. Purposeful sampling was used to select these patient records. A checklist of patient safety criteria to be observed for this audit was formulated based on the IPSGs (enclosed as appendix). Checklist criteria which were not at all followed were marked as complete non compliance and which were partially met were marked as partial non compliance.

• Second phase was to study the awareness among the participants with the help of a questionnaire. The sample size was drawn by stratified random sampling technique. 20% of the staff under each subgroup was randomly considered for sampling. The number of willing participants in each category was selected for the awareness study.

The questionnaire was distributed among the participants to assess their awareness to all six patient safety goals. ‘1’ mark was given for right answer and wrong answers were marked ‘0’. Out of the two correct identifiers, even if one option was correctly ticked by the respondents, benefit of doubt was given and one mark was allotted to the answer. Thereafter, the marks obtained in each category were compiled for statistical analysis.

Statistical Analysis

The data was collected and coded in a Microsoft excel database. Descriptive data analysis was done.


A total of 394 patient records/documents were selected for observing compliance towards IPSG. A questionnaire consisting of basic questions pertaining to IPSG and was given to doctors (n=60), nurses (n=86), and technicians (n=76) to check their awareness to these goals. Demographic characteristics of participants in this study in terms of age, gender and professional experience is tabulated in (Table/Fig 1).

The summary of findings of the audit with reference to compliance to each of the goals N (%), non compliance N (%), areas of non compliance, N (partial non compliance) and N (complete noncompliance) to each of the IPSG is tabulated in (Table/Fig 2).

Findings of awareness questionnaire/audit: The MCQs used in the questionnaire are tabulated in (Table/Fig 3). The summary of response/awareness level n (%) among doctors, nurses and technicians to each of the IPSG and overall awareness level is depicted in (Table/Fig 4). It was observed from the survey that as compared to other goals, the awareness among doctors was observed to be low towards, correct site/procedure/patient for surgery (IPSG-4) and risk of patient harm from falls (IPSG-6). Similarly, awareness among nurses to IPSG was found to be lower towards effective communication (IPSG-2), whereas awareness among technicians was lower towards safety of high alert medicines (IPSG-3) and reducing patient harm from falls (IPSG-6).

Statistical analysis of correct responses to questionnaire in relation to age, gender and work experience was carried out and the same is tabulated as under (Table/Fig 5).


This study was primarily aimed at studying the awareness and compliance to IPSG among healthcare workers i.e. doctors, nurses and technicians. Compliance to the patient safety goals which was documented in patient records, was audited to gain insight into the practical implementation of these patient safety parameters. A total of 394 patient records/documents pertaining to high-risk critical patient care areas like operation rooms, Intensive Care Units (ICU), Emergency Department, and acute care wards were audited. The compliance to correct identification of patients (IPSG-1) was 339 (86%). The non compliance as regards IPSG-1 was primarily in two areas i.e. application of patient identification bands and identification of patients before giving medications. This observation synchronises with the findings of Hoffmeister LV and de Moura GM, where in they found that 83.9% of the patients were found to have correctly identified wristbands (10). The compliance to improving effective communication (IPSG-2) was 319 (81%) with a non compliance rate of 75 (19%). Pronovost P et al., observed that, less than 10% of residents and nurses understood the goals of patient care. However, after implementing the safety goals form the percentage of residents and nurses who understood the daily goals increased to over 95% (11). This implies that the non compliance can be reduced by stressing the importance of patient safety goals to the healthcare workers.

The Institute for Safe Medication Practices (ISMP) defines high alert medications as drugs that bear a heightened risk of causing significant patient harm when they are used in error (12). Improving safety of high alert medications assumes great importance in patient safety (IPSG-3). These medicines require special safeguards in terms of proper storage and are required to be kept under lock and key to exercise proper control and restricting accessibility. The findings of the study reveal that compliance to safe storage of high risk medications was 362 (92%). It was observed during the study that the high-risk medication cupboards were not kept locked and these medications including LASA were not properly labeled during storage thereby posing a risk of medication error.

Wrong site, wrong patient and wrong surgery can be prevented if adequate precautions are taken for patient safety. This aspect has to be considered by all healthcare workers i.e. doctors, nurses and technicians. For ensuring safe surgery, a surgical safety check list has been devised by WHO in 2009 (13). This audit revealed that the compliance to safe surgery (IPSG- 4) was 100% thereby indicating that adequate precautions were taken by all healthcare workers to safeguard patients from wrong site surgery. The HAIs delay the healing process thereby increasing the duration or length of stay of patients in hospitals. This directly impinges on the cost of treatment and escalates out of pocket expenses for the patient. IPSG-5 deals with safety against hospital acquired infections. The best way to prevent HAI is by effective hand washing practices. The non compliance of 79 (20%) observed in the study was primarily due to non conformance to hand hygiene and hand washing practices. It was observed during the study that healthcare staff was found skipping moments of hand hygiene and steps of hand washing as given by WHO (14). However, the compliance in this study was 315 (80%) as against the compliance of 43.2% as reported by Sharma S et al., on hand hygiene compliance in an ICU of a tertiary care hospital (7).

According to Mahoney JE et al., fall-related injuries account for upto 15% of rehospitalisations in the first month after discharge from hospital (15). Hence, risk assessment for patient harm from falls is important in hospitals. Humpty dumpty scale for paediatric patients and Morse scale for adults is used for risk assessment of fall (16). As the patients are in a morbid state or are physically weak due to the illness, the fall of patients can happen from wheel chairs/trolley, fall on slippery and wet floors, non use of side railing on patient beds etc. The compliance to reduce patient risk of harm from falls (IPSG-6) in the study was 307 (78%) with a non compliance of 87 (22%). The non compliance observed was primarily due to non use of fall assessment scales and not educating patients on use of safety belts and fall caution on slippery floors especially in wash rooms.

The result of the compliance audit of patient records brought out, that the areas which need more focus are 2nd, 5th and 6th goal of IPSG which are ‘improve effective communication’, ‘reduce the risk of healthcare associated infection’, and ‘reduce patient harm resulting from fall’. These three goals with minimal compliance need adequate focus as they play a very vital role in patient safety.

Questionnaire containing MCQs and fill-in-the-blanks related to international patient safety was given to doctors, nurses and technicians. The demographic characteristics reveal that mean age for the whole population participating in this study was 35±4.9 years with a mean experience of 11.5±4.7 years. The correct responses to the questionnaire also commensurate with the above demographic data, however, the awareness level in female doctors and nurses was observed to be more as compared to their male counterparts except among the technicians. The above findings of the study is at variance with the study findings of Asem N et al., where they observed no difference in knowledge, attitude, and influence scores by personal characteristics as gender, specialty, workplace and experience year (17). It was observed from the questionnaire survey, that awareness of doctors was lower towards correct site/marking for surgery (IPSG-4) and risk of patient harm from falls (IPSG-6), whereas the awareness level among nurses was lower towards effective communication (IPSG-2). The technicians were found to have lower awareness towards safety of high alert medicines (IPSG-3) and reducing patient harm from falls (IPSG-6). The overall awareness was found to be highest in nurses 73 (84.8%) followed by doctors 49 (81.7%) and technicians 61 (80.2%). This was much higher than the findings brought out in the study by Ananya R et al., which revealed the compliance to be 72% in doctors followed by nurses with 69% and paramedics with 68% (2). Another study by Hao HS et al., observed that patient safety grade was higher in doctors and technicians as compared to nurses (18). The results of awareness study clearly indicate the necessity of training of healthcare staff towards the significance of patient safety goals. It is recommended that organising regular symposia/seminars, lectures and on the job training can immensely enhance awareness and compliance to IPSGs.


As the compliance audit of patient records/documents of all patient care areas/wards of the hospital was not possible, in this limited time period, the study was limited to high-risk critical patient care areas like operation rooms, ICU, Emergency Department, and acute patient care wards.


The results of compliance audit and awareness study amplify the present status and knowledge of healthcare staff towards IPSG. Though, the compliance gathered from the data can be termed as good, hospitals must always strive for continuous quality improvement in this area. It was observed that the cause of non compliance with IPSG by staff was inadequate knowledge or reduced concern for safety or a combination of both. Out of the six goals of IPSG, the documented non compliance was observed to be more for 2nd, 5th and 6th goal. Furthermore, the result of awareness among staff was found to be highest in nurses 73 (84.8%) followed by doctors 49 (81.7%) and technicians 61 (80.2%). The study has also brought out the areas of non compliance to each of the patient safety goals. Remedial measures in the form of organising regular symposia/seminars, lectures, workshops and on the job training has been recommended to the hospital authorities. Additionally, the new staff joining the hospital also need to be sensitised on patient safety measures.


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DOI and Others

DOI: 10.7860/JCDR/2022/58145.17113

Date of Submission: Jun 01, 2022
Date of Peer Review: Jul 05, 2022
Date of Acceptance: Sep 10, 2022
Date of Publishing: Oct 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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