NABH 6th Edition PRE Chapter: Patient Rights and Education Explained

What the PRE chapter is about

NABH's intent for PRE is that the hospital defines, protects and promotes the rights and responsibilities of patients and families, trains staff to protect them, and tells patients about them when they arrive. Expected costs are explained clearly, informed consent covers risks, benefits and alternatives, patients are educated in a language and manner they understand, and the hospital captures patient experience (including patient reported experience measures, PREMs) and encourages patient engagement to improve outcomes, safety and quality.

Every Core element must score at least 4 out of 5 at every assessment. Our 6th Edition overview explains the scoring. NABH marks eight PRE elements with an asterisk, meaning they must be documented: PRE.1.a, 1.b, 4.a, 4.d, 7.c, 8.a, 8.b and 8.c.

The 8 standards at a glance

Protecting rights (PRE.1)

Rights and responsibilities are documented, displayed and explained; actively promoting them is an Achievement element. Three Core elements follow: the hospital protects patient and family rights, has a mechanism to report a violation of those rights, and top leadership monitors and analyses violations and takes corrective and preventive action (PRE.1.e).

Evidence that works: rights and responsibilities displayed in the local language and English at admission, OPD and wards; a violation reporting route that staff can describe; leadership meeting minutes that review reported violations.

The rights NABH lists (PRE.2)

PRE.2 spells out what patient and family rights include: respect for values, beliefs, cultural and spiritual needs; dignity and privacy during examination and treatment; protection from neglect or abuse; confidentiality of patient information (Core); refusing treatment; seeking another opinion; informed consent before blood transfusion, anaesthesia, surgery, research and any invasive or high-risk procedure (Core); complaining; knowing the expected cost; access to their clinical records; and knowing the treating doctor's name, the care plan and progress. Letting the patient decide what information about their care is shared with them and with family is an Achievement element.

Involvement in care (PRE.3)

The patient and family are told about the proposed care, including its risks, benefits and alternatives, the expected results and possible complications (PRE.3.a, Core; three 5th Edition elements were merged into it). They are told test results and the diagnosis, and kept informed promptly when the patient's condition changes. Preparing the care plan with the patient and family, and multidisciplinary counselling where appropriate, are Achievement elements.

Informed consent (PRE.4)

Three of the four Core elements in PRE.4 are about how consent is taken:

• Consent is obtained wherever it is required (PRE.4.a). NABH's change notes say the interpretation now includes the HIV and AIDS (Prevention and Control) Act, 2017.
• Consent explains the procedure, its risks, benefits and alternatives, and who will perform it, in a language the patient understands (PRE.4.c).
• Consent is taken by the person performing the procedure (PRE.4.e).

The process must also follow statutory norms, and the hospital defines who may consent for a patient who cannot decide independently.

Evidence that works: procedure-specific consent forms in the languages your patients speak; forms signed by the operating surgeon or anaesthetist, not a junior or a nurse; a policy on consent for minors, unconscious patients and patients who lack capacity; HIV testing consent and counselling records.

Patient education (PRE.5)

Education is given in a language and format the patient and family understand (PRE.5.a, Core). It covers safe use of medicines and side effects, food-drug interactions, diet and nutrition, immunisation (the interpretation now stresses paediatric immunisation), pain management, the patient's disease and its prevention, and preventing healthcare-associated infections. Identifying special educational needs is an Achievement element, and a mechanism to promote patient engagement to improve outcomes, safety and quality (PRE.5.j) is the chapter's only Excellence element and new in this edition.

Evidence that works: education leaflets in local languages; education documented in the patient record by the person who gave it; discharge counselling on medicines and diet.

Costs and tariffs (PRE.6)

Patients and families must know the pricing policy for out-patient, emergency, ICU and in-patient care (PRE.6.a, Core). The relevant tariff list is available, expected costs are explained, and patients are told about the financial implications when the care plan changes. Clinical establishment rules in states that follow the central Act also require rates to be displayed.

Evidence that works: a displayed tariff and package list; written cost estimates given at admission; a record that the family was told when an unplanned ICU stay or procedure changed the estimate.

Feedback and complaints (PRE.7)

The hospital captures feedback, including patient satisfaction, and redresses complaints through a defined mechanism (PRE.7.c, Core). Patients know how to give feedback or complain, feedback and complaints are reviewed within a defined time and corrective action follows. Capturing the wider patient experience, which the interpretation now explains as PREMs, is an Achievement element.

Evidence that works: feedback forms and an online channel; a complaint register with dates received, investigated and closed; monthly analysis with actions; a displayed grievance officer's name and number.

Communication (PRE.8)

Communication with patients and families must be effective, and the hospital identifies special situations that need enhanced communication (such as breaking bad news, a serious adverse event or end-of-life care) and handles them well. NABH's change notes say the interpretation now expands on SPIKES, a widely used protocol for breaking bad news. The hospital also ensures there is no unacceptable communication, and monitoring how well communication works is an Achievement element.

What changed from the 5th Edition

• The intent now emphasises PREMs and patient engagement.
• New: a mechanism to promote patient engagement (PRE.5.j, Excellence).
• Three elements on explaining care were merged into PRE.3.a.
• Interpretations now cover the HIV and AIDS Act, 2017 for consent, paediatric immunisation, patient and family education needs, PREMs and the SPIKES protocol.

How assessors test PRE

PRE is tested at the bedside. Assessors ask patients whether they were told about their rights, their diagnosis, the expected cost and how to complain. They read consent forms to see whether risks and alternatives were explained and whether the surgeon signed, check that education was given in the patient's language, and follow one complaint from the register to its closure. A tariff list kept in a drawer does not count as available.

Getting PRE ready

1. Display rights and responsibilities and the tariff in the local language and English.
2. Replace generic consent forms with procedure-specific forms and train doctors to take consent themselves.
3. Write a pricing policy and give written estimates at admission.
4. Set up a complaint register with defined timelines and leadership review.
5. Train staff on communication and breaking bad news, and audit consent and education records monthly.

Our NABH documents checklist lists the PRE 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