NABH Patient Safety Goals 2026: All 6 IPSGs Explained with Implementation Guide

The NABH International Patient Safety Goals (IPSGs) — modelled on the Joint Commission's National Patient Safety Goals — are the six core patient safety objectives that every NABH-accredited hospital in India must implement and measure. IPSGs address the most common, most preventable causes of patient harm: wrong patient surgery, medication errors, healthcare-associated infections, patient falls, wrong site surgery, and communication failures. This guide explains each IPSG, the specific NABH requirements, and how hospitals implement them in 2026.

IPSG 1: Identify Patients Correctly

The problem it addresses: Wrong-patient errors — administering medication, blood transfusion, or performing a procedure on the wrong patient — are among the most catastrophic preventable adverse events in hospitals.

NABH requirements:

• All patients must have a standardised patient identification wristband with at least two patient identifiers (name + date of birth, OR name + hospital registration number — NOT room/bed number).
• Before administering any medication, performing any procedure, or collecting any specimen, the healthcare worker must verify the patient's identity by checking the wristband against the order.
• Infants and unconscious patients must have wristbands with identifiers — family members' verbal identification alone is insufficient.
• NABH specifically evaluates that the wristband policy is documented, staff are trained, and compliance is audited regularly (minimum monthly audit of wristband compliance).

Technology support: Barcode wristbands printed at registration with patient ID — scanner at nursing station verifies identity before each medication administration (BCMA — Barcode Medication Administration).

IPSG 2: Improve Effective Communication

The problem it addresses: Communication failures are the leading root cause of sentinel events in hospitals — particularly verbal or telephone orders, SBAR (Situation-Background-Assessment-Recommendation) handovers, and critical value reporting from labs.

NABH requirements:

• Read-back protocol for verbal/telephone orders: When a doctor gives a verbal or telephonic order (common in Indian ICUs at night), the receiving nurse must write down the order, read it back to the doctor, and receive confirmation before acting. This Read-Back must be documented in the clinical record.
• Critical value reporting: When a lab or imaging result is critically abnormal (e.g., potassium 6.8 mEq/L, haemoglobin 4.2 g/dL, CT showing large haemorrhage), it must be reported to the treating doctor within a defined timeframe (typically 30-60 minutes). The doctor must acknowledge receipt. This Read-Back + time stamp must be documented.
• Standardised handover: Every patient handover — shift handover (nurse-to-nurse), doctor handover (consultant-to-on-call), OT-to-ICU transfer — must follow a standardised tool (SBAR or iSBAR). NABH assessors check handover documentation during accreditation visits.

IPSG 3: Improve the Safety of High-Alert Medications

High-alert medications are drugs that have a heightened risk of causing significant patient harm when used in error — even if the error is a common one (wrong dose, wrong route). NABH follows the ISMP (Institute for Safe Medication Practices) list:

• Concentrated electrolytes (potassium chloride injection, concentrated sodium chloride) — must not be stocked in patient care areas; must be diluted in pharmacy before dispensing.
• Anticoagulants (heparin, warfarin, low-molecular-weight heparins) — require independent double-check before administration.
• Insulin — all types; requires independent double-check; "insulin syringes only" rule.
• Chemotherapy agents — require pharmacist verification, double-check by two nurses, and BCMA at bedside.
• Neuromuscular blocking agents (succinylcholine, vecuronium) — must be stored separately, labelled "PARALYZING AGENT - CAUSES RESPIRATORY ARREST", must never be stored where other vials are kept.

NABH requires: A hospital-specific High-Alert Medication list, documented storage requirements for each, and a clear verification protocol (double-check, independent calculation, BCMA) for each high-alert drug. These protocols must be audited quarterly.

IPSG 4: Ensure Safe Surgery (Correct Site, Correct Procedure, Correct Patient)

Wrong-site, wrong-procedure, wrong-patient surgery are the most dramatic and most preventable surgical errors. NABH mandates the WHO Surgical Safety Checklist as the implementation tool for IPSG 4:

• Sign-In (before anaesthesia induction): Anaesthetist verifies patient identity, surgical site/side, consent, allergies, and anaesthesia machine check.
• Time-Out (before skin incision): The entire surgical team pauses. Surgeon verbally confirms patient identity, procedure, side/site (consistent with surgical site marking), surgeon-specific concerns, antibiotic prophylaxis given within 60 minutes, anticipated critical steps and blood loss, imaging displayed if relevant.
• Sign-Out (before patient leaves OT): Nurse confirms: procedure performed, correct specimen labelling, equipment counts complete (no retained instruments), key concerns for recovery.

Surgical site marking: For any procedure involving laterality (left vs. right), multiple levels (spinal surgery), or multiple digits — the surgeon must mark the site with an indelible marker BEFORE the patient enters the OT. NABH assessors check OT records to verify WHO Checklist compliance is documented for 100% of elective cases.

IPSG 5: Reduce the Risk of Healthcare-Associated Infections (HAIs)

HAIs — infections acquired in the hospital that were not present on admission — affect 5-10% of hospitalised patients globally. In India, HAI rates in ICUs can be significantly higher without proper infection control. NABH IPSG 5 focuses on hand hygiene as the single most effective intervention:

• WHO 5 Moments of Hand Hygiene: Before patient contact, before aseptic procedure, after body fluid exposure, after patient contact, after contact with patient surroundings. Staff compliance with all 5 moments must be audited monthly (minimum 200 observations per unit per month) and the audit result displayed in each unit.
• Alcohol-based hand rub (ABHR) placement: At every patient bedside, at every entry/exit point of the unit, in all procedure areas. ABHR must always be available — a compliance failure if staff arrive for a procedure and ABHR is empty.
• Bundle care protocols: VAP bundle (Ventilator-Associated Pneumonia prevention), CLABSI bundle (Central Line-Associated Blood Stream Infection), CAUTI bundle (Catheter-Associated Urinary Tract Infection) — evidence-based care bundles that must be documented for every relevant patient.

IPSG 6: Reduce the Risk of Patient Falls

Patient falls are the most common adverse event in hospitalised patients — and a major cause of prolonged hospitalisation, liability claims, and NABH non-conformities. IPSG 6 requires:

• Fall risk assessment at admission: Every patient must have a standardised fall risk assessment within 2 hours of admission — using Morse Fall Scale (for adults) or Humpty Dumpty Scale (for children). High-risk patients are identified and interventions implemented immediately.
• High-risk labelling: High-risk fall patients must have a yellow fall-risk wristband AND a yellow marker on their bed. All staff (including housekeeping and visitors) are trained to recognise these markers.
• Fall prevention interventions: Documented care plan for each high-risk patient — bed in low position, call bell within reach, non-slip footwear, toileting schedule, bedrails up, adequate lighting, hourly rounding.
• Post-fall review: Every fall (even without injury) must trigger a documented review — what happened, why, what changes are made to prevent recurrence. Falls involving injury require a Root Cause Analysis reported to the hospital's Patient Safety Committee.

Frequently Asked Questions About NABH Patient Safety Goals

What are the 6 NABH IPSGs?

The 6 NABH International Patient Safety Goals are: (1) Identify patients correctly — two-identifier wristband verification; (2) Improve effective communication — read-back for verbal orders, critical value reporting; (3) Improve safety of high-alert medications — concentrated electrolytes, anticoagulants, insulin; (4) Ensure safe surgery — WHO Surgical Safety Checklist, site marking; (5) Reduce HAI risk — WHO 5 moments hand hygiene, bundle care; (6) Reduce patient fall risk — Morse Fall Scale assessment, high-risk labelling. These are evaluated during every NABH assessment visit.

How often must NABH patient safety audits be conducted?

NABH standards require: hand hygiene compliance audits — monthly (minimum 200 observations per unit); patient wristband compliance — monthly; fall risk assessment compliance — monthly; WHO checklist compliance — checked for 100% of elective surgical cases; medication double-check compliance for high-alert drugs — quarterly. All audit results must be presented to the Quality Committee and corrective actions documented.

What is the WHO Surgical Safety Checklist and is it mandatory in India?

The WHO Surgical Safety Checklist is a 19-item checklist performed in three phases (Sign-In, Time-Out, Sign-Out) before every surgical procedure. It is mandatory for all NABH-accredited hospitals and strongly recommended by the Ministry of Health. Studies show it reduces post-operative complications by 36% and in-hospital deaths by 47% when correctly implemented. NABH assessors verify WHO checklist implementation by reviewing 10-20 randomly selected OT records during accreditation visits.