ANNEXURE III
Minimum Standards for 10 bedded General Nursing Home, Surgical Nursing Home and Maternity Home

I. Functional Programme For A Nursing Home
II. Human Resource Requirements
III. Minimum requirements for Space and Equipments in General Nursing Home, Surgical Nursing Home and Maternity Home.

I Functional Programme For A Nursing Home

a. Emergency First Aid - The basic minimum functions provided by a nursing home should include Emergency First Aid as mentioned in the rules document.
i. Emergency first aid includes airway maintenance, Intra Venous drip, wound care and dressing, haemostasis, shock management, splint, severe pain management and starting of nasal O2.
ii. Emergency first aid services should be provided to all patients in need of them and assistance in arrangements made to transport them irrespective of their capacity to pay.
iii. A nursing home which claims to provide Emergency Cardiology Services should possess intensive care facilities.
b. Define disciplines of treatment -When the NH applies for registration, they should broadly define the disciplines of treatment offered and the facilities should match these.
c. Type of facilities - The type of facilities provided at the Nursing Home, e.g. Emergency Cardiac Care Unit, Orthopedic and Trauma Care Hospital etc, should be displayed prominently. (Detailed list of minimum services would be available to patients)
d. Declare routinely offered facilities - The nursing home should declare on its sign boards / notice boards / informational literature about the nature of facilities routinely offered and should not ordinarily treat those patients for which facilities are not routinely available in that nursing home.
i. Regarding General Surgical Services: A general surgical nursing home should declare the range of surgical services provided there and adhere to the same.
ii. In case a surgical nursing home provides 'Emergency General Surgical Facilities', this should be clearly mentioned in the functional programme of the nursing home as well as in any information brochure put up by the nursing home. In such nursing homes emergency care for cases of acute abdomen, strangulated hernia, torsion testis, etc. would be provided. For this purpose access to X-ray facilities, Blood Bank and Ultrasonography should be available.
iii. Regarding Maternity Facilities: All nursing homes providing maternity facilities (with and without OT) should provide basic obstetric and neonatal facilities.

1. Maternity Homes with OT - All such maternity homes should have an equipped Operation Theatre and should be able to carry out procedures like suction and evacuation, dilatation and curettage, Lower Segment Cesarean Section and Hysterectomy on an emergency basis. Every maternity home should have a working arrangement with nearby blood banks and all due care be taken to anticipate the blood transfusions and arrange for the same. Also ultrasonography facilities should be available within one hour. The functional programme of the nursing home should mention nearest availability of neonatal intensive care facilities.

2. Maternity Homes without OT - Maternity Homes may be run without an Operation Theatre. Access to ultrasonography facilities must be made available in reasonable time. Every maternity home should have a working arrangement with nearby blood banks and all due care be taken to anticipate the blood transfusions and arrange for the same. The functional programme of the nursing home should mention nearest availability of neonatal intensive care facilities.

3. Pathology laboratory - The Nursing Home may or may not have a Pathology laboratory. The type and extent of laboratory facility to be available for a nursing home would depend on the functional programme of the nursing home. The functional program of the Nursing Home must indicate if they have a Bedside Laboratory or a Hematology, Biochemistry and Pathology Laboratory.

4. Bedside Laboratory - laboratory is one where only basic essential tests such as Haemogram, Urine Routine including Microscopy, Blood Sugar with Glucometer, Bleeding Time- Clotting Time, Blood Grouping, Typing and Cross-matching, Urine Pregnancy Tests (HCG) are conducted.

5. Hematology, Biochemistry and Pathology laboratory - When a full fledged Hematology, Biochemistry and Pathology laboratory is situated within the hospital, provisions shall be made for the following minimum procedures to be performed on site - Blood counts, urinalysis, blood glucose, blood urea and nitrogen, bleeding time, clotting time, blood grouping, typing and cross-matching, and other tests. Provision shall also be included for specimen collection and processing. A separate toilet facility should be provided close to the pathology section. A qualified Pathologist must be on call to interpret findings.

6. Radiology - The NH may or may not have an X-ray facility. In nursing homes providing emergency surgical/ trauma facilities, following X-ray services should be made available, either by contract with nearby radiology facility or by portable facility- X ray chest, abdomen, pelvis, femur and skull. In case radiotherapy or nuclear medicine facilities are provided, guidelines by local statutory bodies should be followed.

7. ECG - Portable ECG facilities should be available in all nursing homes round the clock.

II Human Resources Requirements

1. Medical personnel - In case the Consultant / Supervising Doctor is resident in or very near to the Nursing Home, a DMO need not be employed. The consultant/doctor must be able to attend to the patient in 5 to 10 minutes.

2. Nursing staff - One nurse for 10 beds or part there of on every shift and if on different floors then in same proportion on different floors. Taking into account the weekly offs and leaves, this would mean totally more than 3 nurses employed per 10 beds. There should be one qualified nurse for the Operation Theatre. She should train other ward nurses to enable them to manage emergencies. They may also function as O.T nurses when required.

3. Adequate efforts need to be taken to procure qualified nurses. For the time being nurses from all courses, of a minimum duration of six months, meant for training nurses, may be considered qualified nurses. Seats in government colleges for Nursing need to be increased, as also relevant courses for Nursing need to be introduced to bridge the gap.

4. Training for Nursing Aids - For nursing aides with no formal qualification to be a nurse but with minimum three year's experience currently working in a nursing home, the Nursing Home should send them for a formal nurses' training programme recognized by the government, government approved Council or Open University.

5. Nursing aids -
a. One ayahbai or one ward boy for every 10 beds in three shifts. Taking into account the weekly offs and leaves, this would mean totally more than 3 nursing aids/ ward boys employed per 10 beds.
b. Ayahbai/ward boy/sweeper need to undergo training in nursing care skills like measuring of urine output, assisting in inserting an I.V. line, transferring patients from trolleys to beds, etc.,

6. Other Paramedical staff -of paramedical staff should be adequate to satisfy basic functions as specified in the functional program.

7. Engineering staff -
a. One plumber (To be available on call)
b. One electrician (on call)

8. Administrative and Ancillary staff - Receptionist should be available during OPD hours or as specified in relevant minimum standards.

III Minimum requirements for Space and Equipments in General Nursing Home, Surgical Nursing Home and Maternity Home
(Not applicable to specialties like Pediatrics, Ophthalmology, ENT)

Zones in a 10 bedded Hospital: A 10 bedded hospital would have the following zones and infrastructure within the designated zones. CLICK HERE TO SEE TABLE