NABH 6th Edition COP Chapter: Care of Patients Explained

What the COP chapter is about

NABH's intent for COP is uniform care for every patient in every setting: out-patient units, day care, wards, critical care units, procedure rooms and operation theatres. Where the same care is given in different places, it is given the same way. Written guidance and the law guide emergency and ambulance services, CPR, blood transfusion and critical care, and the care of high-risk patients, high-risk pregnancies, children, sedation, anaesthesia, surgery and end-of-life care. Pain, nutrition and rehabilitation complete the picture, transplant programmes need the right skills and systems, and all care providers coordinate and integrate their work. Patient safety is the overarching principle.

NABH's overall summary table prints 135 for COP, but the chapter's own summary page and its category counts both give 136. Every Core element must score at least 4 out of 5 at every assessment; our 6th Edition overview explains the scoring. 45 of the 136 elements carry an asterisk, meaning they must be documented. Standards for services you do not provide (transplant or obstetrics, for example) can be declared not applicable, but you must tell NABH before the assessment.

The 20 standards at a glance

Uniform care and patient identification (COP.1)

Care follows written guidance, and the hospital uses a uniform process to identify patients with at least two identifiers (COP.1.b, Core). Evidence-based clinical practice guidelines or protocols guide care (moved up from Achievement to Commitment), and telemedicine, where offered, is safe, secure and governed by written guidance. Two of the chapter's four Excellence elements are here: clinical care pathways followed across all settings and reviewed periodically (the interpretation says annually), and multidisciplinary care planned on best practice.

Evidence that works: an identification policy (for example, name plus unique hospital ID, never the bed number) with wristbands; adopted clinical protocols for your common conditions; a telemedicine SOP if you offer it.

Emergency, ambulance and disasters (COP.2–COP.4)

The emergency department is an identified, easily accessible area with adequate resources; the interpretation adds that it should preferably have triage, resuscitation and patient holding areas. Emergency care follows the law, including medico-legal cases, and written guidance (COP.2.c, Core). Care starts with triage, waiting patients are reassessed, admissions, discharges and transfers are documented with a note to the patient, and there is a system for patients brought dead or who die within minutes of arrival. Preventing overcrowding and a quality assurance programme are Achievement elements.

Ambulances are fit for purpose, equipped, staffed by trained people, checked daily and have a communication system; starting treatment while the patient is in transit is an Achievement element. For community emergencies, epidemics and disasters, the hospital identifies the likely events, manages them with a documented plan, keeps supplies available and tests the plan at least twice a year (COP.4.d).

Evidence that works: a triage protocol with categories and times; an MLC register and police intimation records; reassessment entries for waiting patients; ambulance daily checklists; a disaster plan with two drill reports a year.

CPR (COP.5)

CPR is available at all times, team roles are followed, equipment and medicines are available in every area, events are recorded, and a multidisciplinary committee analyses every resuscitation (the interpretation now specifies how often it meets), with corrective action.

Evidence that works: code blue team rosters; crash carts with standard contents and check records; CPR event forms; committee minutes reviewing each code.

Nursing care and procedures (COP.6–COP.7)

Nursing care follows written guidance, patient assignment follows good practice, nursing care is integrated with and documented in the overall care, nurses have the equipment they need and are empowered to make decisions within their scope of practice. Acuity-based staffing is an Achievement element (moved down from Excellence).

For clinical procedures, the Core element is preventing wrong patient, wrong procedure and wrong site (COP.7.d). Procedures follow written guidance, are done by qualified people, with consent taken by the person performing them, monitoring during and after, and accurate documentation.

Transfusion (COP.8)

The transfusion scope matches the hospital's services. New elements cover processes for collecting, testing, storing and distributing blood and safe storage from collection until transfusion. The Core element is safe and rational use of blood and components (COP.8.d); the interpretation now adds a hospital transfusion committee. Blood is available for emergencies and routine use within a defined time, with turnaround time monitored. Collecting post-transfusion forms and analysing reactions, and a quality assurance programme, are Achievement elements. Consent for transfusion now sits in the PRE chapter.

Evidence that works: a blood centre licence or an agreement with a licensed blood centre; a transfusion committee with minutes; blood storage temperature logs; transfusion reaction forms and their analysis.

ICU and high dependency units (COP.9)

Critical care follows written guidance, with defined admission and discharge criteria, adequate staff and equipment, procedures for bed shortages, infection control practices and periodic counselling of the family (the interpretation now stresses documenting it, including by video recording). A quality assurance programme is an Achievement element.

Obstetrics and paediatrics (COP.10–COP.11)

Obstetric services are organised safely, high-risk pregnancies are identified, cared for by competent staff or referred, antenatal services are provided (with documentation in antenatal cards), maternal nutrition is assessed, peri-natal and post-natal monitoring is done, and hospitals caring for high-risk pregnancies can care for their newborns. The 6th Edition adds respectful care with privacy and confidentiality, explaining danger signs to the woman and her companion, adhering to legal ART practices, and welcoming a birth companion during labour (Achievement).

Paediatric services are organised safely, neonatal care follows national or international guidelines, staff have age-specific competency, assessment covers growth, development, immunisation and nutrition, families are educated on nutrition, immunisation and safe parenting, and there are measures to prevent child and newborn abduction and abuse. Adolescent-friendly health services are a new Excellence element.

Sedation, anaesthesia and surgery (COP.12–COP.14)

Procedural sedation needs consent, competent staff, a monitoring person who is not the one performing the procedure, minimum monitoring of heart rate, rhythm, respiratory rate, blood pressure, oxygen saturation and sedation level, post-procedure monitoring, discharge criteria, and equipment and staff to rescue a patient who goes deeper than intended.

For anaesthesia, two elements are Core: the pre-anaesthesia assessment leads to a documented anaesthesia plan (COP.13.b), and monitoring during anaesthesia records temperature, heart rate, rhythm, respiratory rate, blood pressure, oxygen saturation and end-tidal CO2 (COP.13.e). A pre-induction assessment is documented, the anaesthesiologist takes consent, post-anaesthesia status is monitored, defined criteria govern transfer out of recovery, and the anaesthesia type and drugs are recorded. Recording adverse anaesthesia events is an Achievement element.

For surgery, the Core element is preventing wrong site, wrong patient and wrong surgery (COP.14.d). Patients have a pre-operative assessment, diagnosis and instructions, the surgeon takes consent, an operative note is written before the patient leaves recovery (now including the post-operative diagnosis, complications and blood loss), post-operative care follows a plan, and OT flow follows infection control practices. A quality assurance programme and surveillance of the OT environment are Achievement elements.

Evidence that works: WHO surgical safety checklists completed in real time; site marking; pre-anaesthesia forms with a plan; intra-operative monitoring charts with EtCO2; recovery discharge scores; operative notes completed before transfer.

Organ transplant (COP.15)

A transplant programme must be legal and ethical (COP.15.a, Core), follow clinical guidelines, and counsel donors and recipients through trained counsellors. Creating awareness about organ donation is also Core (COP.15.d). If you run no transplant programme, agree with NABH before the assessment which COP.15 elements apply to you.

High-risk patients (COP.16)

Four of COP's 13 Core elements are here. The hospital identifies and manages vulnerable patients and patients at risk of falls, pressure ulcers and deep vein thrombosis (COP.16.a to COP.16.d), and manages patients who need restraints.

Evidence that works: risk scores at admission (for example a falls scale and a pressure ulcer scale) repeated on reassessment; prevention bundles linked to the score; DVT risk assessment with prophylaxis orders; a restraint policy with monitoring records.

Pain, rehabilitation, nutrition and end of life (COP.17–COP.20)

Patients are screened for pain, assessed and reassessed, and treated according to their response. Rehabilitation has a scope that matches the hospital's services, functional assessments, enough space and equipment, and care pathways (the chapter's fourth Excellence element). Every admitted patient is screened for nutritional risk, at-risk patients get a nutritional assessment, therapeutic diets are planned together and served according to written orders, and families who bring food are told the diet limits. End-of-life care is consistent, legal (including the Supreme Court's guidelines on advance medical directives), addresses the patient's and family's needs and relieves symptoms and pain; the interpretation now stresses staff training, and a multi-professional approach is an Achievement element.

What changed from the 5th Edition

• The intent now stresses integrated care delivery.
• Obstetrics: new elements on a birth companion, respectful care with privacy, danger signs and ART practices.
• Paediatrics: new adolescent-friendly services element (Excellence).
• Transfusion: new elements on blood collection, testing, storage and distribution; a hospital transfusion committee; consent moved to PRE.
• Level changes: clinical guidelines and protocols moved up from Achievement to Commitment; acuity-based staffing moved down from Excellence to Achievement.
• Interpretations now detail two identifiers, annual pathway updates, emergency triage and holding areas, pre-hospital care, CPR committee frequency, ICU counselling records, OT-to-ICU transfers, fuller operative notes and end-of-life training.

How assessors test COP

COP is tested by following patients. Assessors pick a patient in the emergency department, ICU or ward and read the record against what they see: wristband identifiers, triage category, risk scores and the prevention measures that should follow, pain scores, diet orders and counselling notes. In the OT they watch a time-out, read the anaesthesia chart and check that the operative note was written before transfer. They ask a nurse what she does if a patient falls, check the crash cart, and read the last CPR committee review and disaster drill report.

Getting COP ready

1. Fix the Core elements first: identification, consent and time-outs, anaesthesia documentation, blood use and the four high-risk assessments.
2. Adopt clinical protocols for your common conditions and a triage system for the emergency department.
3. Standardise crash carts and start CPR event reviews.
4. Write the disaster plan and run two drills a year.
5. Audit records monthly for risk scores, pain scores, nutrition screening and operative notes.

Our NABH documents checklist lists the COP policies, and we run 6th Edition gap analyses scored the way assessors score. Hospitals up to 50 beds follow the equivalent chapter in the SHCO standards.

All ten NABH 6th Edition chapter guides: AAC · COP · MOM · PRE · IPC · PSQ · ROM · FMS · HRM · IMS