hospital iii
TRANSCRIPT
INDIAN HEALTH CARE INDUSTRY• 35 Billion dollars a 10% growth every year• Employees about 4 million people • An additional 2 million beds to be added to existing 1.1
million costing 82 billion dollars• Tertiary care growing at Faster rate• 0.91 GDP expected, to touch 2% GDP• Refurbish units and Foreign investments. Banks assisting
medical technologies at about 5 billion dollars with an increase another 2 billion dollars
• Health city concepts• Bed Space : Conventional 50 Sqm
Specialization 70 Sqm Futuristic 135 Sqm
HOSPITAL PLANNING I. Viability and Feasibility:1The type of services to be provided-secondary care /
tertiary careSophistication in building plan & equipmentsInvestments & returns he is looking for Feasibility : The potent ional of the planned institutionThe medical facilities that are made availableThe migration pattern of the patientsCompetition from the existing hospitals and new
entrants
Planned Reporting :
1. Required medical Departments as per above observations
2. Recommend required equipments such for required human resources as per above requirement
3. Financial performance for a period of operation short term or long term
4. To arrive at competition date to plan future expansion
5. To plan future expansions
II. Land Selection Architecture and Design Consultant, Core Team and As per Vasthu
III. Finance IV. Equipment V. Time FrameVI. HR Policy in selectionVII. Romance with Chaos- Disaster planningVIII. Hospital Planning : Stage 1 : Facility PlanningStage 2 : Institutional PlanningStage 3 : Strategic PlanningVIII.Hospital MarketingIX. Tariff, Pricing, Packages and Insurance
HOSPITAL PLANNING AND DESIGN
1. Hospital Lay Out
2. Design soundness
3. Hospital Safety :
a. Fire
b. Flood
c. High Wind
d. Earth Quakes
e. Blast
PHYSICAL ENVIRONMENT
1.Light
2.Colour
3.Sound
4. Climate:a. Temperature
b. Humidity
5. Ventilation :a. Health Hazards
b. Specialized Cleaning
Building Elements and Materials
• Slip Hazards-Floors
• Ramps, Steps and Stairs
• Walls and Ceiling
• Elevators Shielding
• Openings-Doors and Windows
HOSPITAL INSTALLATIONS
1. Electric Supply:
a. Arrangements for Continuous supply
b. Generating Sets
c. Portable Emergency Lights
d. UPS
e. Voltage Stabilizers
f. Duplicate Feeders
2.Water Supply
3. Sanitary Equipment:
a.Wash basins
b. Water Closet
4. Life Safety and Emergency Power
5. Communication System
6. Medical Gases, Pipe air and vacuum
General Standards for Details and Finishes
Hospital with an organized emergency
service shall have the emergency access well marked to facilitate entry from the public roads or streets serving the site. Other vehicular or pedestrian traffic should not conflict with access to emergency station. Access to emergency services shall be located to incur minimal damage from floods and other natural disasters.
Rooms which contain both tubs, shower and or water closet for important use shall be equipped with doors and hardware permitting emergency access from the outside when such rooms have only one opening, the doors shall open outward or in a manner that will avoid pressing a patient who may collapsed within the room.
The minimum door size for in patient bedrooms shall be 110 m wide and 210m high to provide clearance for movement of beds and other equipment like mobile X-ray unit. Doors to other rooms used for stretchers and or wheel chairs shall have a minimum width of 80 cm. Door width and height shall be the nominal dimension of the door leaf ignoring projections of frame and tops. For that matter 10 cm for width and 5 cm for height may be added to arrive at the door way opening.
Patient rooms or suites intended for 24 hours occupancy shall have windows that can be opened from the inside to vent noxious fumes and smoke products and to bring in fresh air in emergencies. Operation of such windows shall be restricted to inhibit possible escape or suicide.
Dumb waiters shall not open directly into a corridor or exit, but shall open into a room with a fire resistance rating of not less than one hour.
Thresholds and expansion joint covers shall be flush with the floor surface to facilitate the use of wheel chairs and carts. Expansion and seismic joints shall be constructed to restrict the passage of smoke.
Mirrors shall not be installed at hand washing fixtures in food preparation areas nurseries, clean and sterile supply, scrub sinks, or either area where asepsis control would be lessened by hair combing.
Floors and walls penetrated by pipes, ducts and conduits shall be tightly sealed to minimize entry of rodents and insects. Joints of structural elements shall be similarly sealed.
Ceilings, including exposed structure in areas normally occupied by patients or staff in food preparation and food storage areas, shall be cleanable with routine house-keeping equipment. Acoustic installation and lay in ceiling, when used, shall not interfere with infection control.
In operating rooms, delivery rooms for cesarean sections, isolation rooms and sterile processing rooms, provide ceilings that contain a minimum number of fissures, open joints or crevices and minimize retention or passage of dirt particles. Wall finishes for such rooms shall also be free for fissures open joints, or crevices that may retain or permit passage of dirt particles.
In psychiatric patient rooms, toilets and seclusion rooms, ceiling construction shall be monolithic to inhibit possible escape or suicide. Ceiling mounted air and lighting devices shall be security type. Ceiling mounted fire prevention sprinkler heads shall be of the concealed type.
PREVENTIVE MAINTENANCE PROGRAMME
Selective use of music, with adequate concern for patient comfort.
Ensure patient control of light within their territorial space, access to unfiltered day light for long term patient.
Select warm or cool colour appropriately to activity level intended to space.
Maintain an optimal thermal condition of patient and staff.
Ensure periodical change of filter to provide the correct level of temperature and humidity control.
Periodical cleaning of air-conditioning ducts system through a specialist contractor preferably by deploying compressed air technique.
Restore frequent cleaning of floors with devices like vacuum, mopping, brushing, machine cleaning, chemicals cleaning, waxing or so on related to usefulness of flooring material related to function.
Maintain high hygienic standards for walls and ceiling. Repainting and cleaning schedule must not hamper the working efficiency of adjoining area.
Shielded surfaces must be checked and repaired against any damage or leakage to ensure radio frequency interference-proof environment and elimination of Electromagnetic interference.
Effective working of builder’s hard ware of doors and windows must be assured through periodical checks. Self closing device must work smoothly, emission of nasty sound in its working should be at once eliminated.
Glass pans must be kept clean through an easily accessible means for cleaning. Broken glass must be replaced. Brushing up, not picking up of broken glass pieces is recommended.
Building must be frequently inspected for loose slate, bricks, stone, plaster etc, such repairs under no circumstances be delayed or kept in abeyance.
Where there is a variation in floor level, sufficient illumination at all hours must be provided.
Elevator call button’s shall not be activated by heat or smoke. Elevator doors should strike within a minimum impact and should promptly reopen.
Occurrence of rust, damp conditions, stagnation of water, leakage and seepage corrosion, scale formation in water supply system should be avoided through periodical inspection.
Water course must be dechlorinised, overhead tanks cleaning and good maintenance practices must be adhered to.
Regular cleaning of cooling towers be undertaken. Water droplets produced by fans within the cooling tower should not be allowed to result in contaminated situation.
Patient toilets must be cleaned at least twice a day to safeguard against risk of cross infection.
Gas connections must not be interchanged. Piped gas fault must immediately be attended.
Avoid mechanical or physical pressure on cables, which may deform insulation and may reduce its ability to withstand voltage pressure.
Select properly and lay cables on trays to achieve high reliability over voltage surges and over heating of joints and terminals.
Ensure smooth and proper working of circuit breaker mechanism.
Electrical equipment must not be connected to the outlet points with loose leads or bare ends or wires.
To one out-let point and connecting wires must be matching to take the specified load of equipment to be connected.
Heating appliances light and fans must be switched off when any room is to be locked or left unattended.
All the electrical appliances, equipment must be properly earthed.
All electric, water supply, air-conditioning and other services involving use of plants and machinery must be maintained to remain good working conditions through periodical checks regular upkeep and proper maintenance drive.
GEOGRAPHICAL, ENVIRONMENTAL AND MISCELLANEOUS FACTORS
1. Meteorological Information Temperatures Rainfall Humidity
2. Geographical Information Existing road and rail communications Terrain : mountains, reverine, plain Surrounding district boundaries Susceptibility to quakes /floods Ecology-atmospheric pollutants from adjoining industries
and other sources, proximity of sources of noise such as air-fields or rail/tracks
Building height restrictions due to proximity of airports.
3. Miscellaneous Availability of Trained ManpowerWaterElectricitySewage disposal
ExampleDataDirect population –6,00,000Indirect population –8,00,000Admission per year per 1000 –165Population Direct populationAdmission per year per 1000 – 55Population Indirect PopulationAverage length of stay in days – 10Occupancy rate desired -85%
Admission per year = 6,00,000 X 165
(direct population) 1000 = 99,000
Admission per year = 8,00,000 X 65
(in direct population) 100 = 44,000
Total admission per year = 1,43,000
Total Bed days per year = 1,43,000 X 10 = 1,43,000
Total beds required with = 1,43,000
100% Occupancy 365 = 3918
Total beds required with = 3918 X 100
85% Occupancy 85 = 4610
Total beds with 100% occupancy
85%
LAND REQUIREMENTS
Site Cover percentage
= Total ground floor area of all buildings X 100
Total area of site available
Floor area ratio (FAR) It is the ratio of the total covered area on all floors of a building to the total area of the site, ei. if a hospital building standing on a plot of land and measuring 12,000 Sq. Meter has four floors, each floor having 1,500 Sq. meter floor area (total floor area on all floors 6,000 Sq. Meter) the FAR at this site will be two.
DISTRIBUTION OF FLOOR SPACE BY WARDS AND DEPARTMENTS
________________________________Wards OPD Diagnostic ADM Service
& Therapeutic Deptts
____________________________________________
37-45% 12-18% 18-22% 8-12% 15-20%
____________________________________________
BREAK DOWN SPACE REQURIMENTS GENERAL HOSPITAL
Area Sq. ft. per bedNursing units 250-280Nursery 12-18Delivery suite 15-20Operations theatres 30-50Physical Medicine 12-18Radiology 25-35Laboratory 25-35Pharmacy 4 - 6CSSD 8-25Dietary 25-35
Area Sq. ft. per bedMedical Records 8-15Housing Keeping 4-5Laundry 12-18Mechanical installations 50-75Maintenance workshop 4-6Stores 25-35Public Areas 8-10Staff Facilities 10-15Administration 40 – 50
Total 567-751Circulation 115-140Total Net area 682-891
CIVIL ASSETS
1. Land and location
2. Hospital Buildings
3. Internal Electrification and Lighting
4. Internal Water supply
5. Public health services6. Lightening Protection7. lift and dumb waiters8. Structured cabling9. Intelligent Buildings10. Hospital Roads Pathways and
Drives11. Articulture, Arboriculture and
Landscaping
12. Medical gases
13. IT services
14. Compound wall
15. Ventilation
‘Building including internal services
FINANCES1. By a group2. NGO3. Governmental4. Individuals 5. Trustees6. Pharmactical Companies7. Health Care Companies8. Quasi Government Organisation9. Medical Colleges
COMPONENTS OF EBD (Evidence Based Design)
1. Patient Room 2. Sound absorbing tiles and carpeting 3. Adequate ventilation 4. Easy Navigation 5. Natural light 6. Room with a view 7. Operating Room and ICU Neonatel
Intensive care
CLINICAL SERVICESOut Patient Services : Functions and Typesa. Ambulatory Services Specialist Diagnostic and Medical Opiniona. Referral Patientb. Medical Rehabtationc. Health Promotion and Health Educationd. Training Medical Studentse. Epidemiological Social clinic research and Periodic assessment of clinical outcomef. Preventive and Promotional services Eg.Immunization, Screening and antenatal
TYPES
a. Centralised outpatient services
Eg. Polyclinics
b. Decentralised Outpatient services
Eg. Speciality clinics
c. Satellite clinics
PLANNING CONSIDERATIONS Physical facilities and Layouts a. Location b. Principles of Planning layoutc. Layout : 1.Double loaded single corridor with rooms on each side of the corridor
2. Double corridor for the entry from opposite sides of the room
3. Triple corridor which provides two rooms of examination treatment rooms on each side of
the staff corridor Contd….
Physical Facilities : Public Areas (Entrance Zone)
1. Entrance Easily accessible with wide door
2. Reception and Information 3. Registrations and Records area4. Waiting area5. Public toilets and wash room6. Snack bar
CLINICAL AREAS
Sub waiting area
Consultation room: 15 to 17 Sq. Meter area
Special Examination Room :
ANCILLARY FACILITIES Injection Room : 062 to 0.86 Sq. Meter per
patient
Treatment and Dressing Room : 12 to 16 Sq. Meters
Pharmacy Waiting area should be comfortable
AUXILIARY FACILITIES1. Laboratory 15 to 20 Sq. meters2. Radiology 3. Blood Bank4. Health Education Facilities5. Medical and Service Facilities6. Screening Clinic7. Demonstration Rooms 8. Preventive and Promotive Health
Facilities
ADMINISTRATIVE AREASAdministrative Office Business OfficeHouse Keeping Storage Facilities : a. General Stores b. Drug Stores
c. Linen stores
CIRCULATION AREAS
Includes corridors stairs, lifts etc. This occupies 30% of the total building
EQUIPMENTS Wheel chairs, stretchers, consultation
room cum examination room should have work table physician desk wall mounted cabinets x-ray view box revolving stools and chairs besides, examination couch, washbasin instrument trolley all OPDs should have equipments for resustation of patient collapsing suddenly
STAFFING
Staffing level for outpatient services should be depended on analysis of the objectives of the Departments and the volume of work load in each of its functional areas.
ORGANIZATIONAL AND MANAGERIAL CONSIDERATIONS
a. Policy : To achieve continuity of high quality care with modern techniques
b. Procedures : To implement appointment systems to spread out the reporting time of patient
c. Managerial Consideration : It is the first point of contact between patient and the Hospital so the management has to give maximum importance in not getting overcrowding and long waiting times
ACCIDENT AND EMERGENCY SERVICES
Definition : Urgent and high quality medical care to prevent loss of life and limbs and to initiate action for restoration of normal healthy life
Functions : To Provide immediate and Life saving medical care to patients
To liaison with courts and police in medico legal cases wherever required to provide ambulance services
To fulfill role of information and communication center during disasters
Education Training and Research for the medical staff
PLANNING CONSIDERATIONS
o Location
oSpace Requirements and Patient Load
oPhysical Facilities and Layout
oArchitectural Design
oCommunication
STAFFING CONSIDERATIONS
Categories :
a. Professional
b. Nurses
c. Paramedical Staff
d. Casual Staff
POLICY AND PROCEDURES
Ambulance Services Registration and Records Investigations and Management Admissions and Referrals Medico Legal Issues
EQUIPMENT REQUIRMENTS Essential Equipment :
1. Centralised piped oxygen and suction supply
2. Airways outlets and resuscitation bags
3. Wall mounted / portable manometer
4. Portable defibrillator, ECGs and cardia monitors
5. Respiratory aids eg. Ambu bag venti mask and nebulizer
6. Crash Trolley
7. Slit lamp, Loop, adequate number of trolley wheel chairs
OPERATION THEATRES
TYPES OF OPERATIONS :
Micro Surgery:
Cryo Surgery :
Laproscopic Surgery:
Bio Medical Laser :
NUMBER OF OPERATING ROOMS
o Number and type of surgeons
o Type Of Hospital
o Hospital Policy and procedures
o Hospital bed complement
o Number and nature of elective and emergency surgery anticipated
o Number of operations per day
o
DESIGN CONSIDERATIONSa. Locationb. Size of the Operating Room 40-60SqMetersc. Number of Operating Roomsd. Grouping of Operation Theaterse. Zoning- Protective,clean,sterile&disposalf. Electricalg. Air-conditioning and Ventilationh. Pendenti. Plumbing /Sanitary Installationj. Fire Fighting
ELECTRICALa. Light operational luminence 2000-3000 candles/sq.Mb. Reflectance (Glare)Clothes & instrumentsc. Colour Composition- particularly of skind. Operating Light-4000-10,000 lux,shadowless,heat
radiation,positioning,mirror for anesthesist,lamp not more than 2 mts above ground,camera for viewing,sterile handle accessories should be handy
e. General Light-500-2000 lux to avoid shadowsf. Fiber Optic Operation Lamp-cold lightg. Uninterrupted Power Supplyh. Standby Generatori. Stable Electrical Supply-stand by power j. Also air condition ventilation
o Expected average length of stay of surgical patients
o Expected turn over interval in operation theatre
o Size of an average OT listo estimated time for cleaning between
operationso Time allowed for staff breakso Amount of time operating suites can be
equipped and staffedo Amount of time reserved for emergency useo Allowance for septic patients
Number of Operating Suites and Number of Operations Per Day
No. of operations per day
= No. of surgical beds x % of BOR x 365
ALS x 100 x Number of working days in that Hospital
maintanance• Minimises risk of hospital infection• Minimises unproductive movement of staff,
supplies and patient• Increases efficiency of staff working in the
operation suites• Ensures smooth work flow• Reduces hazards in the operating suites• Ensures proper positioning of the equipment• Ensures optimum utilization of the operating
suits.
INTENSIVE CARE UNIT
Definition :Is a specific area Hospital where sophisticated monitoring, titrated life support, specific therapy and specialized nursing, can best provided for potentially salvageable, critically ill patients with life threatening illness or injury.
TYPES OF ICUICTU : Intensive Care and Therapy UnitCICU : Coronary Intensive Care UnitPICU : Pulmonary Intensive Care UnitBICU : Burns Intensive Care UnitOICU : Obstetric Intensive Care Unit NICU : Neonatal Intensive Care UnitANCU : Acute Nursing Care UnitMICU : Medical Intensive Care UnitSICU : Surgical Intensive Care Unit
STAFF REQUIREMENTS Medical Staff : Director /Incharge of ICU
Senior Resident / Registrar Two junior Staff on 12 hrs duty may be Post Graduate students
Junior Residents : Day and Night Nursing Staff : Nurse Patient Ratio1:1/1:2 during Day time1:2 /1:3 during Night time Contd…
Intensive Care Unit Staff Requirements for 8 beds:Incharge Nurses 4Trained Nurses 32Nurses in Training 6SHO / Registrar (On rotation) 4Consultant 1Domestic Staff 4Ward Administrator 2Secretary 1 Peon 1Director of ICU 1Physiotherapist 2Radiographers 3Biochemistry Technician 1Blood Bank Technician 1Bacteriological Technician 1
EQUIPMENT REQUIREMENTS
Monitoring EquipmentTherapeutic EquipmentFiberoptic BrobnchoscopeInfusion setsWall mounted ManometerVentilatorsDefibrillatorsPulse Oxymeters
POLICY AND PROCEDURES
Admission Procedure : Patient with Multiple injuries or after major surgery
for observation, monitoring and support Patients requiring support of airway and artificial
ventilation of lungPatient requiring support to maintain cardiovascular
integrity including those in haemorrhagic shockPatients requiring control of toxemia of metabolic
or infective origin (including pneumonia) Patients who are donor or recipient of transplant.
POLICIES a. Patient admitted to ICU remain the
clinical responsibility of consultant/unit head
b. Bed is kept in the appropriate ward to await there return
c. No patients are directly admitted to ICUd. Patients coming directly from casualty are
transferred from other hospitals are first shown admitted under special unit in ward and then shifted to ICU in exceptional cases
e. Admission to ICU shall normally be by recommendation of ICU Consultant
f. Admission will be made to ICU only bed is available
g. The consultant of ICU will be responsible for maintain continuity of care and for initiating treatment decided upon at morning rounds after consulting with physicians and whom patient is admitted the senior resident may initiate such treatment as indicated in emergency however consultant must be informed about it.
DAY TO DAY CARE AND DISCHARGE PROCEDURE
Liaison with the parent unit is essential for proper treatment of patients in ICU
Daily ICU rounds shall be held in morning at 9-11 AM along with doctors of parent unit
The treatment instituted to patients is written by the senior resident posted in ICU
Discharge of patient is taken in consultation with consultant of the parent unit
Patient who have recovered and stable can be discharged Patients in whom immediate threat is alleviated Patients in whom immediate threat is alleviated but expected to die
shortly Patients in whom death is imminent even if intensive care is
continued
IN PATIENT SERVICES
Functions : 1. To provide highest quality of medical and nursing
care to the patients2. To provide necessary equipments essential drugs
and other stores required for patient care3. To make the patient feel almost in the home by
taking care of Physiological and psychological needs
4. To provide facility to meet the needs of the visitors
5. To provide highest degree of job satisfaction for nursing and medical staff which includes training and research
PHYSICAL FACILITIES The wards constitute 35 to 50% of hospital
area and should be located well inside the hospital to avoid cross infection and adjacent to laboratory blood bank, imaging CSSD etc. The area per bed is 70 to 90 Sq. ft. but in acute obstetrics and orthopedics it is 100 to 120 Sq. Ft per bed the distance between the two rows of the bed is 5 ft. distance between two beds is 4 ft. , clearance between bed head and wall should be 1 ft. the standard dimension of hospital bed is 6ft 6 inches X 3 ft. 3 inches
SHAPE AND DESIGN1. Open Ward Houses about 35 patients 2. The length of the ward was not less than
96 ft. Advantages of Open Ward1. Nurses have ample visibility and direct
observations of the patient at all times2. Cross ventilation is maintained 3. Natural light is available 4. It is economical to contract and
maintain Contd…..
Disadvantages of Open Ward :1. Noise lack of Privacy2. Danger of cross infections3. Constant glare to patients
RIG WARD1. Each cubical having 1,2,4 or 6 beds arranged
parallel to longitudinal wallsAdvantages and Disadvantages1. Communication between the nurses and the
patients becomes more difficult 2. The patients are deprived of direct observation by
the nurse the wards become longer more number of nurses required costly to built and maintain.
Ancillary Accommodation
1. Nursing Station : Nerve Center location is as per design 2. Treatment room 3. Clean utility room 100 to 200 Sq.ft4. Ward kitchen or pantry 5. Day room6. Stores7. Dirty utility room 8. Bath and Toilets : a. Urinal 1 for 16 bedsb. WC 1 for 8 bedsc. Bath 1 for 12 bedsd. Wash basic 1 for 10 beds
9. Janitor’s Room
AUXILIARY ACCOMMODATION
a. Duty Room for doctors
b. Seminar room attendant room
c. Side room laboratory
d. Locker room for the staff
e. Wheel chair/ Trolley bay
FACTORS INFLUENCING IMPATIENT CARE
1.General 2. Hospital Staff3. Educational and Training4. Physical Facilities and Equipments5. Clinical and Service Facilities6. Effective use of beds7. Quantum of work 8. Administration
ROLE OF NURSING SERVICES
To assist the individuals, sick or well, in the performance of those activities contributing to its health or recovery or peaceful death he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.
General Role : Round the clock nursing services Monitoring and coordinating nursing care assisting other professionals in implementing their
plans of careSpecific Role Access to patient care needs Plan and provide nursing care interventions Prevent complications and promote improvement in
patient comfort and well being Alert other care professionals to patients conditions Documentation
FUNCTIONS OF NURSING CARE SERVICES
Actual care of nursing care services all aspects and treatment The organization and administration of nursing services Education and Practices Quality Control Supervision Looking after the stores Establishment of Communication system for Nursing
personnel Education for the health services Counseling for health personnel patient and public Formulation of Policies, Standards, and goals for nursing
services
JOB DESCRIPITON OF WARD INCHARGE (SISTER)
Qualifications : a. Registered Nurse, Registered Midwife with seven years
experience as staff nurseb. Registered Nurse, Registered Midwife with Diploma in
ward administration and six years experience as staffc. B.Sc. Nursing with five years experience as staff nursed. She must be registered with the State Nursing CouncilRatio : Sister for every 25 bed medical surgical and periodical
wards For each shift ICU, CCU, Labour room, Operation
Theatre, overall OPD, Gynic OPD etc.
Causality and Emergency one for each shift
Leave Reserve 30%
Reportable to Nursing Superintendent
DUTIES AND RESPONSIBILITIESa. Distributing ward duties to staff nurses students and class IVb. Making plans for recognition for ward and maintaining discipline c. Maintaining suppliesd. Giving and receiving nursing reports of day and night e. Keeping custody of dangerous drugs and records of administrationf. Writing confidential reports of staff nursesg. Reporting immediately incident of importance to higher authoritiesh. Weekly roaster for nurses i. General cleanliness of the ward supervising the laundry holding the
meetings with ward staff to work out difficulties
j. Seeing the Doctors orders of carried out k. She must not allow any nursing personnel to give I.V.
fluids, Blood transmission or take blood sample for investigations
l. Seeing that medications dressing nursing procedures investigations and other treatments are carried out
m. Report patients conditions to doctors when they come on rounds
n. Accompany the doctors during their rounds and brain to doctors attention any point of importance
o. Seeing that the preparations of transport of patients to OTs and other departments properly
p. Verifying the patients coming from OPD from other departments for admissions to particular department and that papers of patients are in order without which the patient should not be admitted apart from this she is also a teacher for nursing students
JOB DESCRIPITON OF STAFF NURSEQualification : General nursing and midwifery or B.Sc. nursing from
recognized university Duties : Administrativea. Help the ward in chargeb. Maintain general cleanliness of the wardc. Write the diet register and supervise d. Maintain drug registerse. Supervise medicines given by students f. Maintain emergency trays and date of expiry of drugs g. Take over duty from previous nurseh. instruments supplies and drugs etc.i. Information about serious patients j. supply necessary linen
k. Administer injections tablets and liquid medicines as per the routesl. Prepare patients for operation with documentation m. accompany the doctors on rounds and take instructions n. see that specimens are sent to laboratory with documentation o. Insist the unit doctors prepare and sign the documentationp. Keep blood transmission tray ready to help the doctor procedureq. A staff nurse is not allowed to give I.V. infusions or blood
transmissions r. observe patients condition and report to ward in charge or duty doctors. Check every new admission and prepare documentation as per norms
and particularly when the patient is transferred from one ward to another
t. Maintain temperature charts or special charts this been particularing MLC
u. Write day and night orders and maintain ward static's
• counseling including how to take medicines properly on discharge
• Apart from this teaching activities to students nurses
Ratio-Staff Nurses and Nursing Sister Department Nursing Sister Staff Nurses1. General Medical 1 for 25 beds 1 for 3 beds
and surgical ward
2. ICU, ICCU and other 1 for each shift 1 for each bed per shift
special wards
3. Labour Room 1 for each shift 4 for each shift
4. O.T. 1 for each shift 3 per table for shift
5. Obs. & Gynae 1 overall 1 for each room
1 for Gynae OPD of department
6. Out patient Dept.1 for each OPD Actual Needs
7. Pediatrics 1 each shift 1 for two beds
8. Casualty&Emergency1 each shift 1 for two beds
9. Leave Reserve 30% in all categories
Note : Norms vary from time to time
ROLE OF NURSING SERVICES
To assist the individuals, sick or well, in the performance of those activities contributing to its health or recovery or peaceful death he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.
General Role : Round the clock nursing services Monitoring and coordinating nursing care assisting other professionals in implementing their
plans of careSpecific Role Access to patient care needs Plan and provide nursing care interventions Prevent complications and promote improvement in
patient comfort and well being Alert other care professionals to patients conditions Documentation
FUNCTIONS OF NURSING CARE SERVICES
Actual care of nursing care services all aspects and treatment The organization and administration of nursing services Education and Practices Quality Control Supervision Looking after the stores Establishment of Communication system for Nursing
personnel Education for the health services Counseling for health personnel patient and public Formulation of Policies, Standards, and goals for nursing
services
JOB DESCRIPITON OF WARD INCHARGE (SISTER)
Qualifications : a. Registered Nurse, Registered Midwife with seven years
experience as staff nurseb. Registered Nurse, Registered Midwife with Diploma in
ward administration and six years experience as staffc. B.Sc. Nursing with five years experience as staff nursed. She must be registered with the State Nursing CouncilRatio : Sister for every 25 bed medical surgical and periodical
wards For each shift ICU, CCU, Labour room, Operation
Theatre, overall OPD, Gynic OPD etc.
Causality and Emergency one for each shift
Leave Reserve 30%
Reportable to Nursing Superintendent
DUTIES AND RESPONSIBILITIESa. Distributing ward duties to staff nurses students and class IVb. Making plans for recognition for ward and maintaining discipline c. Maintaining suppliesd. Giving and receiving nursing reports of day and night e. Keeping custody of dangerous drugs and records of administrationf. Writing confidential reports of staff nursesg. Reporting immediately incident of importance to higher authoritiesh. Weekly roaster for nurses i. General cleanliness of the ward supervising the laundry holding the
meetings with ward staff to work out difficulties
j. Seeing the Doctors orders of carried out k. She must not allow any nursing personnel to give I.V.
fluids, Blood transmission or take blood sample for investigations
l. Seeing that medications dressing nursing procedures investigations and other treatments are carried out
m. Report patients conditions to doctors when they come on rounds
n. Accompany the doctors during their rounds and brain to doctors attention any point of importance
o. Seeing that the preparations of transport of patients to OTs and other departments properly
p. Verifying the patients coming from OPD from other departments for admissions to particular department and that papers of patients are in order without which the patient should not be admitted apart from this she is also a teacher for nursing students
JOB DESCRIPITON OF STAFF NURSEQualification : General nursing and midwifery or B.Sc. nursing from
recognized university Duties : Administrativea. Help the ward in chargeb. Maintain general cleanliness of the wardc. Write the diet register and supervise d. Maintain drug registerse. Supervise medicines given by students f. Maintain emergency trays and date of expiry of drugs g. Take over duty from previous nurseh. instruments supplies and drugs etc.i. Information about serious patients j. supply necessary linen
k. Administer injections tablets and liquid medicines as per the routesl. Prepare patients for operation with documentation m. accompany the doctors on rounds and take instructions n. see that specimens are sent to laboratory with documentation o. Insist the unit doctors prepare and sign the documentationp. Keep blood transmission tray ready to help the doctor procedureq. A staff nurse is not allowed to give I.V. infusions or blood
transmissions r. observe patients condition and report to ward in charge or duty doctors. Check every new admission and prepare documentation as per norms
and particularly when the patient is transferred from one ward to another
t. Maintain temperature charts or special charts this been particularing MLC
u. Write day and night orders and maintain ward static's
• counseling including how to take medicines properly on discharge
• Apart from this teaching activities to students nurses
Ratio-Staff Nurses and Nursing Sister Department Nursing Sister Staff Nurses1. General Medical 1 for 25 beds 1 for 3 beds
and surgical ward
2. ICU, ICCU and other 1 for each shift 1 for each bed per shift
special wards
3. Labour Room 1 for each shift 4 for each shift
4. O.T. 1 for each shift 3 per table for shift
5. Obs. & Gynae 1 overall 1 for each room
1 for Gynae OPD of department
6. Out patient Dept.1 for each OPD Actual Needs
7. Pediatrics 1 each shift 1 for two beds
8. Casualty&Emergency1 each shift 1 for two beds
9. Leave Reserve 30% in all categories
Note : Norms vary from time to time
NURSING SERVICES ORGANISATION AND ADMINISTRATION
Nursing as a Profession : Florence Nightingale Pioneer in model nursing and model
hospital administration laid down standards and started school of nursing in 1860 in London.
In India Organised training for nurses started around 1854 with opening of school for mid wise at Madras One school open at Calcutta for nursing in 1859 and Madras 1871
Following Bhore Committees recommendations in 1946 Indian Nursing council was found in and around 1949 with the object of standardising training for Nurses in India
Functions of Nursing Care Services The actual provision of nursing care services and treatment The Organisation and Administration f Nursing servicesEducation and Practice Quality ControlSupervision Provision for financial resources, and procuring materials
and supplies The establishment of communication system for nursing
personal other health workers, patients health authorities.Educational and Health services Counselling for patients
and public Essential information Research and studies concerning all
aspects of nursing
Director of Nursing
Or
Nursing Superintendent
Dy. Asst. Director
or
Matron
Supervisor Supervisor Supervisor Supervisor
Med.Services (Surg. Services) (OT) (Obs. Unit)
Head Nurse Head Nurse Head Nurse Head Nurse
Staff Nurse Staff Nurse Staff Nurse Staff Nurse
NURSING SUPERINTENDENT
Qualification : Master in Nursing with any Speciality with 6 years
experience of which 3 years in administration or
Post Basic BSC Nursing with 3 years experience in any position or
Basic BSC Nursing with 10 years total profession
Responsible for planning and Organisation in Hospitals
a. Preparing a Philosophy and Objectives for the Nursing Department in accordance with those of Hospital
b. To see all the service areas are managed as per their needs Utilizing the Speciality of nurses in particular areas only eg. Psychiatry and Pediatrics
c. Planning in staff as per INC recommendations
d. Cooperating with authorities during emergencies
e. Preparing an organizational chart showing channels of communications
2. General Administration :a. Framing Personal polices, keeping within the Frame
work of Government Rules and Regulations
b. Interpreting and implementing the policies of Governing body the hospital and the INC
c. Carrying out the correspondence with hospitals within and out
d. Attending the correspondence from outside agencies
e. Proposals for special equipment conducting the rounds of ward and departments
f. Preparing the job descriptions for the staff
g. Investigating complaints taking disciplinary action
h. Preparing annual statistics and projecting man power needs handling grievances and solving problems
i. To see the ward procedure manual is maintained in all the wards
j. Sanctioning the leave to nursing personal and keeping the record of the same
k. Writing confidential reports reading and analyzing daily reports on hospital situation and informing the same to higher authorities
l. Taking active interest in staff programmes through orientation of new staff, in service Education programme encouraging and recommending interested nurses to get further training and higher education,performance and evolution
2. Experimenting with newer duty and staffing patterns
3. Miscleaneous 1. Giving leadership to Nursing Department 2. Encouraging Nursing personal to become
members of professional association 3. Participating in meeting, workshop, seminars of
local, stating or national level 4. Providing counseling services to nursing services
The Nurse –patient Ratio as per the SIU(staff inspection unit ) Norms
General ward 1:6Special Ward 1:4Nursery 1:2Labour Room 1:1ICU 1:1OT Major 1:2OT Minor 1:1Causality 1:35Burn 1:2OPD 1:40
Physical Medicine and RehabilitationDisability and RehabilitationDisease – Impairment – Disability – Handicap The programs associated with disability 1. National Leprosy Eradication Programme2. Blindness Control Programme3. Iodine Deficiency Disorders Control Programme4. National Mental Health Programme5. National AIDS control Programme6. Universal Immunization programme including the
Child Survival and Safe Motherhood (CSSM) Programme.
Ministry of Health and Family Welfare in its 5th conference of Central Council of Health and family welfare in 1997 passed following resolutions :
Establishment of Centers for Rehabilitation in the district Hospitals trained manpower to tackle the problem of within the community and for transfer of Technology to grassroots level strengthen the research causation and prevalence of disability in the community
To start PMR Department in every medical college and Trained Doctors and Paramedical staff
Apex institutes under ministry of Health and Family welfare
All India Institute of Medicine and Rehabilitation Mumbai
All India institute Medical Sciences New Delhi All India Institute of Speech and hearing National Institute of Medical Health and Nuro
Sciences Department of Rehabilitation, Safdarjung Hospital
Apex Institutes under Ministry of Social Justice and Empowerment :
National Institute for visually Handicap Dehradun Ali Yavar Jang National Institute for Hearing Handicap
Mumbai National Institute for Mentally Handicap Secunderabad Institute of Physically Handicap New Delhi National Institute for Rehabilitation Training and Research
Cuttack National Institute for Orthopaedically Handicapped Calcutta ALIMCO at Kanpur is the premier institute to assist
ambulation There are 17 Vocational Rehabilitation Centers in the Country and 40 special employment Exchanges for disability.
Disability It is defined as an existing difficulty
in performing one or more activities. Subject to age and sex
Impairment Loss of abnormality of body
structure of a physiological or psychological function
a. Activity Limitation b. Participation Restriction
Prevention of Disability
Primary Prevention
Secondary Prevention
Tertiary Prevention
Rehabilitation defined “as the combined and coordinated use of medical, social, educational and Vocational measures for training and retraining the individual to the highest level of functional ability”
Medical Causes of Disabilities : 1. Congenital Disorders • Genetic : Mental Retardation, hearing impairment, speech
disturbances, Visual impairment, genito urlnary malformations, CHD and Digestive Systems Disorders
a. Non-genetic Perinatal disability, low birth weight Malnutrition, Severe anaemia , Pregnancy anaemia Diseases during pregnancy like rubella, Syphilis,
Tetanus, Drug use. Complications during delivery birth drama brain damage,
and Respiratory distrubances
2. Communicable Diseases
Common poliomyelitis, TB, Leprosy, Trachoma others Meningitis, Encephalitis, Herpes, Osteomyelitis, Venereal diseases, Septic arthritis, Chronic Eye infections, Otitis media, and AIDS
3. Non communicable Somatic Diseases
Back disorders, Paralysis, Arthrosis, Rh. Arthritis, Heart conditions, CVA, Palmonary Dysfunctions, Epilepsy, Vision impairments, Hearing impairments, Diabetes and cancer
4.Functional and Psychiatric Disorders :
Psychotic eg. Schizophrenia
Non-psychotic eg. Phobic states
5. nd Drug Abuse
Alcoholism
6. Trauma And Injuries Traffic accidents : rail, road, air, seaWork Accidents : industrial, agricultureHome AccidentsOther sourcesRecreation and sports War and civil unrest Natural CatastrophesEarthquakeFloodsCyclones
7. Mal Nutrition :Protein calorieVitamin XerophthalmiaNutritional anaemia 8. Other Causes:Exposure to toxic substances in air, water, foodUnsuccessful suicidal attemptsCrime : inflicting bodily injury , psychological
disturbance
Iatrogenic disturbance
Common cause of Disability
Visual : Cataract, trachoma, Trauma, Congenital, Vit A deficiency
Hearing : Congenital nerve deafness, Chronic otitits media, Noise pollution
Speech : Congenital, Brain damage
Loco motor : Poliomyelitis, Amputation, Cerebral palsy, Accidents.
Mental : Congenital, Cerebral Palsy, Cretinism
REHABILITATION Physical / Mental RehabilitationPhysio social Rehabilitation Educational Rehabilitation Vocational Rehabilitation
Rehabilitation Approaches-Community base Rehabilitation- Institution based Rehabilitation - Outreach Programme
PHYSICAL LAYOUT, STAFFING AND EQUIPMENT
• Physical Layout : it differs from design to design and space available must satisfy MCI Norms in Medical Colleges
• Staffing : Director Professor (PMR)1.
Associate Professor (PMR) 2. Assistant Professor (PMR) 2.Senior Resident (PMR)4 Junior Resident (PMR) PG Students 4 Junior Resident House Surgeons 10 Senior Physiotherapist 2 Physiotherapist 10 Senior Occupational Therapist 2 Occupational Therapist 10 Contd….
Audiologist and speech Therapist 2 Multi Rehabilitation workers 10 Sr. Medical Officer 1 Medico Social worker 1 Psychologist 1, Vocational Counselor 1 Workshop manager 1, Sr. Prostheuisist and Orthosist 2 Prosthtist and Orthotist 4 Prosthetic and Orthotic Technician 12 Teacher 2 Craft Instructor 2 Technicians in various trades 4 Administrative Officer 1 Head Clerk 1 Accounts clerk 1 Stenographer 2 Typist 2 Personal Assistant 2 UDC 2 LDC 4 Nurses 2 Nursing Orderly 10 Safaiwala 6 Driver 2 Peon 2 Contd….
Infrastructure : Medical Section and OPD ServicesPhysiotherapy servicesOccupational Therapy ServicesHearing and Speech Therapy servicesMedico social ServicesPsychological and Vocational servicesIndoor ServicesOperation Theatre ServicesAdministrative BlockPublic Utility ServicesWheel Chair and Trolley ServicesWaiting SpaceDharamshala for Attendants Contd….
EQUIPMENT
- Diagnostic Equipment
- Therapeutically Equipment
- Surgical Equipment
LABORATORY SERVICESFunctional ComponentsHistopathalogyClinical Pathology Micro Biology HaematologyBi-chemistry Research LaboratoriesNutrition and MetabolismInfectious DiseasesImmuno Histo Chemistry Serology and Endocranalogy
1. Histo Pathology : Laboratory performing organ, tissues, cell examinations for the diagnosis of various types of diseases and abnormalities
Examination of tissues/ Organs from living/ Dead body in the form of either surgical specimal biopsy or autopsy
2. Clinical Pathology : All body fluids such as blood urine, sputum, stool, pleural, Peritoneal fluids are examined for physical chemical bacteriological microscopic examination of normal and abnormal contains
3. Micro Biology : Study of Microbes such as bacteria, viruses, parricides etc. The study involves identification, morphological and cultural studies, serology and sensitive organs responsible for causing the disease or commonly found as commensals
4. Hematology :Branch of laboratory science in which study of blood and blood components is done for detection of various abnormalities in normal and ill-health
5. Clinical Pathology : Science which determines and measures various chemical substances in normal and abnormal amounts produced during disease process includes examination of clinical substances, hormones, ingimes isoengymes, vitamin's and metabolites
6. Clinical Research Laboratories : Laboratories which deal with research related to patient care system development of techniques, methods and applications, therapeutic drugs, reagents, kits, equipment development and animal experimentation
BIO CHEMICAL TEST 1. Hemoglobin 2. Total Protein 3. Albumin 4. Urea 5. Glucose
6. Bilirubin 7.Alkaline Phosphates8. Calcium 9. Phosphorus 10. Sodium 11.Potassium 12. Chlorides 13. Amylase
14. Aspertate Transaminse 15. Alkalne
Transaminse 16. Cholesterol 17. Urate 18. Bicarbonate 19. Creatinin 20. Tryglisarides
RADIO DIAGNOSIS AND IMAGING SERVICES
Types of Services : Radiology is linked images of human bodies and these images can be achieved either by transmission or by emission
Transmission : Transmission is a technique there is a source which emits race and which are picked up after reflection from body part and taken on plate or screened.
Eg. X-rays, CT Scan and Ultrasound
Emission : Involves giving a dose of radioisotopes or Radionuclides to the patients which are picked up by target organs or cells and emit gamma race which are recorded, by camera
1. X-rays: oldest radiodianostic tool, the principle is transmission of x-rays from a source to specified part of the body and images are taken on films
2. Ultrasound and colour Doppler : No biological hazards and most used equipment because of low cost and easy accessibility
3. Computer assisted tomography / CAT Scan has astonishing clarity of details of morphology previously seen only at necropsy or Anatomy atlas. Conventional roentgenography is valuable in evaluating tissue with large differential density, it can not clearly distinguish most soft tissue structures and display overlapping super imposed shadow of the area under investigation but CT images has over come this images and provides sensitive well demarcated and detail images. CT is most specific in brain and spin and injuries
4. Magnetic Resonance imaging: Non invasive morality concept is magnetic field created over the body being evaluated by strong magnet which results in emission of radio frequency signal by hydrogen nuclear of the tissues after they have been RF vs in presence of strong magnetic field. The RF signal so emitted has characteristic's called relaxation time. T1 Relaxation time (longitudinal Magnetization ) T2 Relaxation time useful in CNS disorders and also cardiology and gastro enterology
5. Positron Emission Tomography (PET) Helps in studying physiology in human
body by using isotopes of half life to obtain information regarding fundamental metabolic process Pet is based on three dimensional restructure of brain section using positron enmity radio nuclides it helps to measure quantitatively regional cerbel blood flow, blood volume, oxygen metabolism glucose transport and metabolism, neurotransmitter metabolism.
6. Mammography : An x-ray based morality commonly used to detect breast diseases and an advanced version being digital mammography, commonly used for screening breast cancers.
7. Nuclear Imaging: Radio active tracers (radio nuclides ) or applied to medical situations the studies can be vivo I.e,. Studies requiring injection of Radionuclides into patient involving absorption excretion and hematology uptake and imaging studies such as renal scan lever scan bone scan thyroid scan thallium scan for myocardial perfusion and others.
Invitro do not require injection to the patient done in laboratories by using radio nuclide on tissues such as thyroid hormone assay by radio immune assay method the techniques that are used in single photon Emission Computed Tomography (SPECT) and Gamma Camera
SPECT : Less expensive system can also cross blood brain barrier. For eg. Isopropyl amphetamine has been used to detect abnormalities like epilepsy, Alzheimer's and Parkinson's
PHYSICAL FACILITIES : a. Expected work load .b. Location c. Areas: 1. Patient waiting area
2. Circulation area 3. Technical area
4. X-ray rooms , 40 Sq Meters 5. Space
6. Related areas for x-ray department 7. Ultra sound unit 25 Sq Meters8. CT area 110 to 120 Sq meters 9. MRI center 125 to 130 Sq. Meters10. Mammography 15 to 20 Sq. Meters11. Nuclear Imaging 110 to 120 Sq. meter
d. Supportive Areas :
1. Consultation Rooms 10 Sq. Meters
2. Conference room Adequate accommodation
3. Library
4. Store Room
5. Staff Room
6. Record Room
e. Layout and flow Activity
f. Communication
g. Equipment Installation
h. Heating ventilation and air-conditioning system (HVAC)
i. Electric source and backup system
j. Future Expansions
Equipment Maintenance
Preventive Maintenance Concurrent maintenance Breakdown maintenance
Annual Maintenance Contract
1. Duration of Contract
2. Periodicity of visits and check points
3. spares should be available without delay details of payment schedule breakdown time and number of breaks
4. Penalty class
BIOLOGICAL EFFECTS OF RADIATION HAZARDS
Radiation injuries can arise from various sources eg. Gamma, BETA, Alfa and Neutrons the effects can be acute and chronic
Acute Ration Effects : Also called radiation (ARS) few hours to one week after exposure classified under
Prodromal ie. Within few hour lasting few days Laten Period ie., last in few days or weeksManifest Phase ie., recovery occurs with in six
week of exposure
Chronic or Delayed Effects a. Shortening of life spanb. Cataract formationc. Chronic Radio Dermatistd. Leukemiae. Cancer f. Decreased fertilityg. Genetic mutation h. Epilation
Radiation Protection and Safety Radiation Protection and Monitory Principles in layout of a Diagnostic X-ray
room a. The x-ray tube should never point towards the
control room
b. the X-ray tube should never point towards the dark room
c. The X-ray tube should never point towards window or door
d. The control should be far away from the tube
VIDEO IMAGING MODALITIES Digital Radiography Digital Subtraction angiography's also
known digital vascular imaging computed raised tomography
Sonography Echocardiography Thermograph Cardia Catheterization laboratory ,Magnetic resonance imaging and Nuclear
medicines scanning
BLOOD TRANSFUSION SERVICES Role and Functions :a. Recruitment of donors and
maintenance of donor recordsb. Collection, storage and preservation
of blood and blood componentsc. Laboratory proceduresd. Teaching, training and researche. Clinical/therapeutic functions.
TYPES /CATEGORIES OF BLOODCat 1 : Hospitals consuming 3-7 units of blood
/bed/year bed strength 100-400 Space required 100 Sq M It includes district hospitals, Corporation Hospitals
Cat 2 : Hospitals consuming 8 to 15 units of blood /bed/year bed strength 400-1000 space required 300 Sq. M. It includes medical college specialized Hospitals
Cat 3 : Hospital consuming more than 16 units of blood /Bed/Year Bed strength > 1000 space required 895 Sq. M It includes super specialization Hospitals Metro Pollitan Medical Colleges
LOCATION AND SPACE Donor Recruitment area Bleeding Complex Therapeutic area LaboratoriesAdministrative and Clerical officesTeaching Facilities
EQUIPMENT1. Refrigerator: For routine work With alarm system temperature display
and recording also with 24 hrs power supply stainless steel inside with pull out shelves No. 3 are required one for storing untested blood one for tested blood one for cross-matched blood
2. Table Top Centrifuge : capable of taking minimum of 16-20 12X100 mm tube and micro plate carrier
3. Water bath 37ºC with temperature control of + 10ºC of fiber glass
4. Incubator 37 C with temperature control of + 10ºC
5. Hot Air oven for drying glass ware
6. Micro scope binocular
7. 1 Kg balance for weighing blood bags during collection
8. Tube stripper cutter and aluminum clips to seal kid bags
9. BP apparatus
10 Domestic Refrigerator for storing anti-sera kits etc.
11. PH meter12. VDRL Agitator13. Blood bag stand (stainless) for keeping bag
upright14. Test tube racks/test tubes and glass slides,
marker pencils etc15. Flexible table lamps with concave mirror16. Blood bags single (350 ml. And 450 ml.)
and multiple (double, triple and multiple)17. Sera for grouping and other reagents18. Distillation and double distillation plant
For Blood Component work
1. Blood bank refrigerated centrifuge: for 450 ml blood bags Temperature of 0-25 ºC
2. Freezer : 70 º and 20 º with alarm system temperature display and continuous power supply
3.Dielectric Tube Sealer
4.Plasma Separation stand
5. Tube stripper, Cutter and aluminum rings
6. Platelet Agitator cum incubator for platelet storage
7. Cryoprecipitate Thawing Bath
8. Laminar air flow
9. Weighing scale of 2 KG with sensitivity of 100 mg
10. 1Kg balance in 5 mg increments of weighing plasma bags
11 Computers and printers etc
For Screening of the Blood
1. Elisa system with washer incubator and Reader
2. Kits for HIV HbsAg, HCV, VDRL
STAFFING
Bleeding ComplexI II III
1. Jr. Doctor 1 1-2 2
2. Nurses 2 3 4
3. Social workers 1 2 3
4. Lab. Attendant 1 1 2
Laboratory I IIIII
1. Technical Supervisor 1-2 4
2. Technical Assistant2 4 8
3. Lab Technician 4 11 13
4. Lab Assistant 1 2 4
5. Lab Attendant 2 4 5
Donor Organizer I II III
1. Associated OS 1 2
2. Social Worker 2 5 10
3. Vehicle + Driver Os 13
Service Staff I II III
1. Clerk Typist OS 12
2. Store Keeper OS 1 1
3. Cleaner Sweeper OS 1 2
Medical Doctor –MD I II III
Transfusion, MD (Pathology)
1. Professor1
2. Asst. Professor 1 1
3. Lecturer 2 3
Selection of Donor1. Age between 18 to 65 years
2. Body wit high : 110 ponds or more for 450 ml of blood
3. Temperature less than 37.5 C
4. Pulse between 50-100 beats per minute
5. Blood Pressure systolic between 90-180 mm
6. Hemoglobin 13.5 g/dl male 12.5g/dl female
7. Specific gravity :> 1.055male and >1.053 female
Deferral : 1. Permanent: History of viral hepatitis, ,
jaundice , malignant, leukemia, convulsion, abnormal bleeding tendency HbsAg test, serious cardiopulmonary disease,
2. Temporary : cold, flu, diabetes, tuberculosis, Syphilis and other infections Diseases of heart, lungs, kidneys, stomach, or liver.
3. A minimum of 72 hours deferral is made for a donor who has consumed aspirin
Blood Components :1. Packed Cells2. Fresh frozen Plasma3. Platelet rich plasma4. Platelet concentrate5. Single donor Plasma6. Cryo-precipitates7. Factor VIII concentrate8. Factor IX concentrate9. Hemoglobin
Indications : 1. Packed Cells : Sever anaemia and edema, Chronic
Leukemia, Chronic Hypoplastic and Aplastic anamias, Hemolytic anaemia
2. Fresh Frozen Plasma : deficiency of coagulation factors DIC, Thrombocytopenic purpura, Neutralization
3. Cryoprecipitate : Von willebrands disease, renal failure, Congenital platelet disorders, Haemophilia, Christmas disease
4. Specific Immunoglobulins : used for passive immunization for varicella, Tetanus Hepatitis Cytomagalovirus infections
5. Hyper immune Gammaglobulins : Primary Rh-immunization in case of Hemolytic disease of the newborns
6. Fresh Blood : massive Transfusion, Bleeding disorders
Blood Transfusion Reactions :About 2-4 % transmissions lead to minor or
major reactions. 1. Clerical Mistakesa. Upto 80 % of cases are due to incorrect
labeling of samplesb. Errors in wr4iting the correct particulars on
requisitionc. Confusion in identity of the patient2. Technical Errors
a. Wrong grouping and cross matching
b. Rare blood group
PHARMACY SERVICES
Functions of Pharmacy :
Purchasing, Storing, Distribution of Drugs
Ensuring potency and quality of drugs during the storage of Hospitals
Supply of drugs to inpatients, wards of various departments including causality OT
Dispensing drugs for OP servicesMaintenance of formulary system and
implementation of drug committees Furnishing the drug information to
professionalsAdhering to loss concerning to
pharmacy(ethics)Maintaing records of books for
purchase and sale of drugsPatient Education
Drug Committees 1.Hospital Medical Superintendent -Chairman2. Head of the Medical Department3. Head of Surgical Department4. Head of OBG & Gynae Department5. Head of Periodic Department6. Nursing superintendent7. Chief Pharmacist- Secretary Functions Prepare Hospital formulary of
accepted drugs in Hospitals Selection of Suppliers and to keep overall check of pharmacy
ABC Analysis Classification percent percent
of items of items
A 10 70
B 20 20
C 70 10
VED analysisV E D
A AV AE AD
B BV BE BD
C CV CE CD
ABC and VED classification matrix
Central Sterile Supply Department (CSSD)
Functions of CSSD
1. To receive and process used and un sterilse supplies and sets from nursing units, OPD, operation theatres, labour rooms, etc.
2. To sterilize and dispense sterile articles to user units
3. To maintain an uninterrupted supply of bacteriological safe supplies at all times
4. To undertake studies for improvement of sterilization practices and processing methods to provide supplies economically
5. To impart training to hospital personnel in safe hospital practices
6. To participate in hospital infection control programme
7. To advice hospital administration on suitability of supplies and equipment from sterilization point of view.
SPACE REQUIRED AND ACTIVITIESUp to 100 beds 10Sqft per bedUp to 200 beds 9-10 sq ft per bedUp to 300 beds 8-9 sq ft per bed300 and above 7-8 sq ft per bed
These Activities comprise of the following1. Receipt of used supplies2. Accounting3. Washing, Cleaning and drying4. Sorting5. Gauze cutting and assembling6. Packing7. Sterilisation8. Sterile storage9. Issue
Equipment1. Autoclave Mechanical and Electrical2. Dry oven 3. Grass cutter4. Ultra sound washer5. ETO 6. Storage cupboards and racks high pressure water
lids7. Needle sharpener8. Cleaning and Decontamination devices9. Glove processing unit Testing apparatus indicator tapes and bacter logical
indicators
STERILISATION PROCESS Freezing the article from all living
organisms including bacteria fungus spores and viruses , Sterilisation process in use in hospitals in India
1. Heat sterilization a. By steam b. By dry heat2. ETO Sterilisation3. Chemical Sterilisation 4. Radiation Sterilisation Not done in hospitals as a routine
STANDIRDISATION OF TAX FOR SURGARIES
Cut down set lumber puncher set Sternal puncher set Catheterisation set Bladder wash set Liver biopsy set Fine-needle aspiration cytology (FNAC) Paracentesis set Suturing Set Thoracic aspiration Set Incision and drainage set Tracheotomy set
Medical Records Def: McGibony Defined medical record as clinical
scientific, administrative and legal document relating to patient care in which are recorded a sufficient data written in sequence of events to justify diagnosis and warrant treatment and end results
Also as simply a systematic documentation patients personal and social data history of his or her ailment, clinical findings, investigations, diagnosis, treatment given, and an account of follow up and final outcome
Serves as clinical document, Scientific document, an Administrative document and a legal document
It is a privilege communication the information from which cannot be released without the consent of patient but it is also an impersonal document when its contents are used for research and training without this closing to whom it belongs to.
FUNCTIONS OF MEDICAL RECORDSPatient Needs
a. Serves as story of patients passage through hospital eg. Medical certificate, diagnosis etc.
b. Serves as re-admission record and subsequent course in the hospital
c. A written report of family history and personal history
d. For insurance claims union benefits and Industrial compensation
Physician Needs :a. Practise of Scientific medicine based on recorded
facts
b. Continuity of medical care
c. Evaluation of his or her own capabilities and short comings
d. Effective communication for the medical team
e. Can be promptly retrieved for study and research
f. As a material source to survey the result of treatment in particular disease and title
g. Medical audit
Institute Needs :a. Generating hospital statisticsb. Teaching and Researchc. Admission Controld. Planning of servicese. Improving the quality of Caref. Safeguard in MLC casesg. The testimony based on recorded facts
is given greater consideration than testimony depended on memory
Health Authorities Needs :
a. The records are important to the public health authorities as they contain reliable information regarding morbidity and mortality patterns
b. Reports like births and deaths, infectious diseases, notifiable diseases, Statistics regarding insurance of diseases and types and number of family planning procedures
MEDICAL RECORDS PURPOSE The medical record is indispensable from the standpoint of
the patient, the doctor, and the hospital and for medical education and research. The purpose it serves in relation to these aspects is as under :
The patient : you will agree that the primary reason fro record keeping is to improve the care of the patient. It is essential for immediate diagnosis, treatment and for the future welfare of the patient. Every illness, however, minor involves study and examination to the extent that it is impossible for any individual to keep all details in mind. The written report is evidence that the patient’s care is being handled in a scientific manner. Other points in relation to this are :
• It serves to document the clinical story of the patient’s illness and course of the disease.
• It serves to avoid omission or unnecessary repetitions of diagnostic and treatment measures.
• It assists in continuity of care in the event of the future illness.
• It serves as evidence in the event of when the legal question arises.
• Provides necessary information for insurance, contributory health scheme or for the employment purposes.
The doctor : From the point of view of doctor, the medical records serves as :
• Assurance of quality, quantity and adequacy of diagnostic and therapeutic measures undertaken.
• An assurance of orderly continuity of medical care.
• Evaluation of medical practice.
• An aid in research and the continuing education of health professionals
• A protection in the event legal question arises.
The hospital : From the hospital point of view the medical records are necessary for following purposes to :
• Document the type and quantity of work undertaken and accomplished
• Furnish proof of the type and quantity of care rendered to the patient.
• Evaluate the proficiency of the individual doctor, of r administration and clinical purposes.
• Evaluate the services of the hospital in terms of accepted norms and standards
• Protect the hospital in the event of legal matters.• Serve as an administrative record of personnel performance
and staffing needs, for budget preparation, justification for physical facility allocation and utilization, for statistical data for administrative use and evaluation, for estimating equipment and supply utilization and needs.
Medical Education and Research : Medical records can also be used for the medical
education and research in following ways :
• Recorded observations are the basis for all clinical research.
• Group studies of records by the medical staff serve to further the education of doctors and other health personnel
• Medical records supply pertinent data for the use by public health authorities in control of the diseases.
STAFFING :
The staffing of medical records department depends upon the size, type and services being provided by the hospital. Dr. JR. McGibony has suggested staffing pattern for a 500 bedded non-teaching hospital as under
• Medical Record Officer :1
• Medical Record Technician :4
• Clerks :3
• Peon :1
• Statistician :1
For comprehensive services in addition to MRO staff as under may be considered for a teaching hospital of 500 bed and above. Each category of personnel should be computer literate.
Admission and Inquiry Office Asst. Medical Record Officer :1Medical Record Technicians :5Medical Record Attendant :4Receptionist : 5Central Record Office Asst. Medical Record Officer : 1Medical Record Technicians/Asst. Medical Record Technicians/Clerks:8Statistical Asst. :1
CODING AND INDEXINGCoding In each medical records International
Code Number is assigned to the diagnosis based on “International Classification of Disease” issued by the World Health Organisation. This is to bring about accuracy and uniformity in the reporting of the diseases by the various hospitals.
Indexing The various forms of indexing as under
of the medical records is done depending upon the purpose :
a. Alphabetic or Master Index : Indexing based on patient’s name sequenced in the alphabetic order. The primary purpose of a name index is to provide entry into the filing system and finding out medical record for a patient. The patient index card is usually 3”x5” card giving identification data, registration number, address, date of admission, a date of discharge, diagnosis and department to which admitted.
b. Disease index : Disease index is a catalogue of cards of 3”x5” or 5”x8”, maintained to find out groups of clinical records of patients having the same diagnosis. Besides patient’s identification data, age, sex, result of treatment and complication may be also mentioned.
c. Operation index : it is a catalogue containing the details of patients who have undergone the operations. Additional details such as site, procedure used, postoperative complication as a result may be documented.
d. Physician’s index : catalogue containing the details of all patients treated by particular physicians. Analysis of such records may be utilized for evaluating the performance of a physician. Columns can be made into the card based on the information desired.
e. Unit index : Details of all the patients treated in a particular unit are indexed. There records may ultimately be utilized to evaluate the performance of a particular unit.
REPORTS AND RETURNSWide ranging reports and returns can be
generated in the medical records department. The basic purpose of these reports are :
a. Evaluating the quality of care being rendered
b. Locating the deficiencies in :
i. Means : Staff, Physical facilities, equipment including plants and machine
ii. Methods : Operating policies and procedures
iii. End results : outcome of the benefits derived by the community from the hospital.
c. Effectiveness of hospital administration and d. Prevention of the diseases. The types of reports and their frequency will vary with the
type of hospital and their administrative requirement. The reports may be generated daily, weekly, monthly quarterly and annually depending upon the requirement,. There reports generally pertains to :
a. Vital Statisticsb. ADT Analysis (Admission, Discharge and Transfer
Analysis)c. General Health Statistics Comprehensive list of such reports and returns cannot be
laid out since there will be so much variation from hospital to hospital. Some of the re reports that can be commonly generated by the hospital are :
a. Reports Related to Hospital Bed Daily Census Maximum patients on any one day Minimum patients on any one day Daily average Bed occupancy rate Total patient days care Bed turn over interval
b. Admission Daily admission Daily admission unit/Speciality wiseTotal admission over a period Patients distribution by age, sex,
religion and region
c. Discharges Daily dischargesTotal patients discharged over a
periodDays of care to the patients
dischargedAverage length of stay
d. Deaths Daily number of deaths Total deaths over a period Total deaths over 48 hours Net death rate Gross death rate Foetal death rate Maternal death rate Infant death rate Post operative death rate Anesthetic death rate
e. Work load Statistics : Total number of outpatients :- New Cases- Repeat Cases Total number of operations Total number of X-ray and other related
investigations Total number of lab investigations/lab
wise investigations Department wise workload statistics
f. Hospital Care Evaluation Statistics : Post operative infection rate Post operative complication rate Caesarian section rate Autopsy rate Consultation rate Rate of normal tissue removed Percentage of disagreement between final and
pathological diagnosis Gross result of treatment, I.e,, patients
recovered, improved or not relieved.
Following will give you clear understanding of some of the most commonly used terms :
Admission
Admission is the acceptance of a patient by the hospital for inpatient service, which may be for investigation and /or treatment. Normal babies born in the hospital are not considered as admissions. The premature or diseased newborns are considered admission. As a general rule the newborn figures are not mixed up with other hospital data. These figures should be tabulated separately.
Discharge : Discharge is the release of an inpatient. Death of an
admitted patient is also considered as discharge.
Hospital Deaths Death of a n admitted patient is considered as a
hospital death. Death of a patient in the casualty, OPD or in an ambulance, before the actual admission of the patient is not counted as the hospital death.
Total deaths of hospitalized patients is known as Gross Deaths. Total deaths after 48 hours of admission is considered net deaths.
Patients Day A patient day is the period of service rendered to an
inpatient between the census taking hours of two successive days. While co0unting, the day of discharge of an inpatient is not counted, irrespective of the time of discharge. Similarly the day of the admission is counted always regardless of t he time of admission
Patient day is a valuable unit used for expressing the various activities of a hospital such as patient days of service rendered during a given period, cost of food per patient per day etc.
Bed complement Bed complement is the number of hospital beds normally
available for use by the inpatient. It includes the following types of beds :
a. Adult beds
b. Cribs
c. Bassinets for use of infants other than new borns
d. Incubators of premature
e. Casualty ward beds
f. Post-operative warded beds
g. Intensive care unit beds
h. Isolation beds
i. Staff sickness beds
The following types of beds are not included in the bed complement of a hospital
a. Recovery room beds
b. Observation beds of casualty
c. Examination beds
MEDICO LEGAL ASPECTS OF MEDICAL RECORDS
A.COMPLETE
B. Adequate
C. Accurate
D. Legible
Ownership of the Medical Records
A. As a personal document
B. As impersonal Document
Indian Evidence Act of 1872as Amended
A. In the court of Law
B. Life Insurance Corporation of India
C. Income Tax
D. Patient will
E. Queries regarding birth or death
HOSPITAL ACQURIED INFECTION (HAI)Also called Noscomial infections responsible for 1. Long stay hospital 2. Antibiotic Misuse3. More no. of investigations4. Cost of Treatment goes upTo the Hospital 1. Qualitative utilisation of beds reduced2. Productivity loss3. Drug resistance4. Loss of Reputation5. Spread of Infection6. Risk to the employee by Resistatant Pathogens 7. Cost of maintenance of services 8. More load on clinical and supportive services
• Interrelation of source of infectionAir
Endogenous Apparatus
Instruments
Fomites
ENVIRONMENT
Other Patients
Patient
Hospital Personnel
Agent a. Virusesb. Bacteria – conventional pathogens like
staphylloccocci group-A, streptococci and solmonelle conditional pathogens like pseudomonas, proteus
c. Fungi d. Protozoale. 25-50% due to gram negative 10% of
infection due to staphylloccocci and stephilococas aresta producing unlimited forms of diseases
Sudomonos infection in burns and urinary tract infections
Ecoli in catheter associated urinary tract infections
Solmenalle in fecull contamnell and other cases
Organisms responsible for human infections
Organisms Percentage E coil 20Staphylococcus aureus 11Other Staphylococci 11Pseudomonas 9Klebsiella 9Proteus 8Other Mixed 32
Route of spread of infectious
a. Droplet infection Eg. Sneezing, coughing and nose blowing
b. Contact route : Patient to patient nurse to patient direct contact with each other indirect contact by way of instrument and dressing
c. Environmental route : water and Food
d. Intravenous route :Eg. Central venus Catheterisation 90%
Manifestation of Hospital Infection :
Inform of bacterimea, RTI , Gastro entities, meningitis and skin infectious UTI and wound infections are seen after surgery
Staphococco, streptocacous , E coli and Pseudomonas responsible for bacterimea -
Klebshelli,Ecoli and streptococcus in respiratory infectious
- E-coli and solmanella GI Tract infections
- Klebshelli and pnumococcus in meningities
Streptococcus,steplococus, E-coli, Pseudomonas with infected wounds
E-coli and proteus with UTI. About 40% of all Noscomial infections
High Risk areas in Hospital1. Age
2. Primary ailments
3. Diminished body resistance due to Immuno suppressive drugs
4. Indiscriminative use of antibiotic steroids
5. Areas – Nurseries, Intensive Care unit, Dialysis nit, Oran transplant unit, Burn unit, Isolation ward, Cancer ward, Operation theatres, Delivery rooms, Post-operative ward
Hospital Infection control Program
a. Identification and reporting of Infection
b. Good hygiene and aseptic techniques
c. Personal orientation and CME
d. Coordination of all Departments with Medical audit committee
Infection Control Committee includes representatives from medicine, Surgery, obg and gynae, pediatrics, pathology, administration, nursing staff and microbiology
Representative of House Keeping Staff : dietary department, engineering, pharmacy, OTs,CSSD are also required . The important officers are Hospital Epidemiologist, Infection control Officer and Chairman
COMMON CHEMICALS USED FOR DISINFECTION
o Phenols and Cresols Eg. Lysol and Settleo Alcohol Eg. Ethyl Alcoholo Halogen : Eg. Iodine and chlorine compoundso Aldehyde : Formoline Qlutardihyde 2%o Dye : Eg. Gentian Violet o Acid :Eg.Boric acid and carbolic acid o Gas : Eg. Ethylene oxideo Oxidizing Agent : Eg. Hydrogen Peroxideo Surface active Soap
Role and Functions of ICC
1. Determine the method of surveillance and reporting
2. Lay down criteria for reporting all types of infections,
Effective Control Measures People : Repeated studies confirm
hospital personnel as significant carriers. Conscientious washing of hands between patient contacts effectively prevents spread of cross-infection.
Aseptic Techniques :Insertion and removal of catheters, surgical tubing's, drainage tubes and packs need strict no-touch techniques even while they are done outside of operation theatre
Segregation of Contaminated Instruments
Linen, sputum cups, bedpans, urinals and similar items
Disinfection Practices: Phenolic compounds are active against gram-negative organisms ammonium compounds against staphylococci streptococci and lodophores and hypo chlorites have a broad spectrum of action.
Sterilisation Practices : Must be meticulously by a trained person.
All steam and ethylene oxide sterilizers should checked at least once each week with a suitable live spore preparation by the laboratory.
Isolation Facilities ; With communicable diseases and those vulnerable to infection. Such facilities must be made available in ICU nurseries burn unit and transplant unit. Wearing of mask gown and gloves must be mandatory
Antibiotic Policy : Major problem multi drug resistance due to extensive use of certain antibiotics
Precautions for the Staff : Staff should immunized against cholera typhoid or hepatitis –B all the food handlers working in dietary department must be periodically screened . Persons with nose and throat infections must be temporarily removed from nurseries ICU and operation theatres.
Out Patient Department : If there is acute communicable condition the patient should be segregated
Dietary Services : temperatures in refrigerators and deep freezers must be checked stored food and supplies Fruit and Vegetables should be examined for infection before consumption
Careful handling of soiled linen : Soiled linen should be considered as potent ional infected and treated with care. Packed in separate bags and clearly labelled should be process separately at water temperatures above 70 degrees for 25-30 minutes good.
House Keeping : Cleaning of walls, floors, window panes bed side screens and tables should be cleaned with disinfected
Terminal Disinfection : Terminal Disinfection of isolation rooms must be carried out before permitting the room for reuse.
Air Hygiene in Operation Theatres: Air filters should be frequently cleaned.
Developing a sense of Awareness : Training and retrain in the precautionary measures for prevention and control.
AIDS AND DISINFECTION
Twenty five per cent ethyl alcohol, 2 per cent glutaraldehyde and 0.2 per cent sodium hypo chlorite have shown to be adequate for Disinfection of instruments and contaminated surfaces.
Disinfection of Hands : is the most important step for prevention of infection, and this applies with AIDS also. Is alcoholic rubs.
Disinfection of Instruments : Two percent alkaline glutaraldehyde can achieve complete Disinfection given sufficient contact time. Instrument parts containing rubber, plastic Fiberoptic and lenses can also be disinfected or sterilized by alkaline glutaraldehyde.
Test Specimens : Dispatched only in sealed, watertight containers
Gloves : Should be worn by all personnel who come into contact with blood blood constituents, tissue, body fluids or excretions and potentially contaminated surfaces of HIV-infected patients
Gowns : worn when there is possible risk of contact with secretions, excretions or blood.
Face marks : coughing patients should wear a mask , transmission of pneumocystis carinii infection visitors and nursing staff should wear masks in presence of AIDS patient.
Goggles : some form of eye protection, dentists and for physicians surgeons and nurses in bronchoscope endoscopies and ENT surgery possibly also in resuscitation measures.
Hands : Disinfected before and after contact with patients
Surfaces :Surfaces and furnishing treated immediately with disinfectant.
Syringes and Needles : discarded into a firm sharps container.
Resuscitation : Mouth-to mouth resuscitation should be available at bedside of every AIDS patients
Disposables : Contaminated disposables must be disposed in accordance with procedures for infectious wastes by incineration
Instruments : ethylene oxide or other suitable disinfectant Breathing tubes must be cleaned carefully and disinfected after use by every patient laryngoscopes and endotrachial tubes.
Accommodation : Disordered immune system of possible communicable diseases which might be dangerous for AIDS patients should not share rooms with AIDS patients.
PHYSICAL FACILITIES AND LAYOUT
Layout : a. Receipt and Storage Areab. Day Storec. Preparation Aread. Cooking Areae. Service Areaf. Dish washing and pot washing areag. Record Roomh. Staff Room
Receipt and Storage Area:
a. Day Store
b. Preparation Area
c. Cooking Area
d. Service Area
e. Dish Washing and Pot/Pan Washing
f. Other Facilities
MANAGERIAL ISSUES1. Regular Cleanliness of the food preparation area
2. Regular maintenance of equipment and proper day to day cleaning of utensils, crockery, cutlery etc.
3. Periodical health check up of staff working in department is essential. This should be done every year. Proper health record of each employee should be main trained
4. The employees should be given 2-3 sets of uniforms and ensure they wear it.
5. On the job training of new employees who join the department should be done.
6. Food prepared should be checked by the dieticians before serving.
7. The menu should be displayed
8. Dieticians and officer in-charge should make regular visits towards and enquire from the staff and the patients about any observations in the diets served.
9. Budgetary provisions act as a regulatory mechanism to control costs. Working out food costs regular (Weekly/monthly), helps in guiding the department.
10. Proper maintenance of records in the department regarding materials received, daily issue, number of diets served, etc.
POLICIES AND PROCEDURES1. The Dieticians/Officer Incharge of the dietary service
should be responsible for determining the quantity/quality of food items to be purchased.
2. Dieticians should form part of the team of identify the sources of purchase either spot purchase or on rate contract basis. They should determine the frequency of purchasing different items.
3. The procedures for purchase should be laid down. It will be economical and convenient to have most of the food items on rate contract basis fixed for a year.
4. Power of emergency purchases whenever required should be delegated to the officer in-charge of the service.
5. The food items received should be inspected by a team comprising of 3-4 members which should include Dietician/Officer in-charge as well. After receipt of goods the stocks should be entered in the stock registers and maintain proper consumption records under the supervision of the controlling officer.
6. The storage bins, racks, cupboards, refrigerators, coolers etc,. Should be properly maintained and kept clean.
7. Proper sanitation and cleanliness including rodent control measures should be observed.
8. A supervisory staff should be available in the patient kitchen during all the working hours.
9. Work schedule should be planned properly avoiding split shifts as far as possible,.
10. Dieticians should visit the wards everyday and have liaison with the staff nurses and the patients.
11. Requisition of different diets from the wards should be signed by the sister in-charge giving the bed number, ward number and the type of diet required by the patient.
12. Nurses should also check and supervise the distribution of meals in the wards.
13. Supplementary requisitions for those patients who are admitted late in the day, should also be entertained by the dietary department.
14. Service timings should be fixed with due regard to the traffic on floor, lifts and local food habits of the people in general.
15. Menus should be planned in advance and also displayed everyday on a notice board in the main kitchen. The meals should supply physiological needs and should be appealing and attractive to the patients.
16. Records pertaining to the diets served should maintained on daily basis and complied on weekly and monthly basis. Cost analysis of diets should be worked out every week/month.
17. Charges for meals for staff members and visitors should be fixed by a committee involving management and staff members which should be reviewed periodically.
Types of Therapeutic Diet1. High energy well balanced: wasting disease and under
nourish
2. Low energy well balanced: Obesity & Likely Diabetics
3. Very low protein, low to moderate energy: Acute GN / HE
4. Very low protein moderate energy: acute renal failure
5. Low protein sodium restricted : chronic renal failure
6. High protein sodium restricted : Nephrotic syndrome or Hypoalbuminaemia
7. Very low fat high carbohydrate: Hepatic or obstructive jaundice, malabsorption and steatorhoea.
8. Low sodium low energy : Heart Failure
9. Reduced saturated fats :to lower plasma cholesterol
10. Gluten Free: Coeliace disease
11. High fiber diet: Diverticulosis and constipation
12. Liquid/semi liquid : chewing or swallowing malignant disease of GIT
13. Bland soft diet : peptic ulcer and GI tract diseases
14. Tube Feeds : Surgery of head and neck, Esophageal obstruction gastrointestinal surgery, severe burns, comatose patients etc.
TYPES OF LAUNDRY SERVICES
1. In-plant System
2. Rental System
3. Contract System
4. Co-operative System
CATEGORIES OF LINEN IN HOSPITAL
1. Store Linena. Patient Linen, body linen, Bed linenb. Staff Linen : c. Department Linen2. Laundry Linena. Soiled linenb. Infected Linenc. Foul Linend. Radio-active Linen
PLANNING CONSIDERATIONLinen Requirements With 100% bed occupancy should have 6 sets of
linen per patient 1. One set in patient bed2. One set en-route to laundry3. One set in process in laundry4. One set ready for use5. Two sets for active storage for work and use
in case of emergencies 2.5 kg/bed/day can be taken as average
HOSPITAL - IV
HOSPITAL PLANNING AND DESIGN
0.7 beds per 1000 population presently available required one bed per 1000 population for 2020
2.5 beds per 1000 population in metro cities like Delhi and Mumbai
Reasons and absence of Realistic National Health Policy Haphazard medical care planning and inadequate funds
Present cost of equipping Hospital as per norms is Rs.4 lakhs per bed
1
PATIENT CARE AND HIGH QUALITY
• Provision of Appropriate Technical equipment and facilities necessary to support Hospital Objectives
• An organization structure that assigns responsibility appropriately and requires accountability for various functions within the institutions
• Continuous review of care provided by physicians nursing staff and paramedical staff and other Hospital Activities
2
EFFECTIVE COMMUNITY ORIENTATION
1. A Governing body of persons who have demonstrated concern for the community and leadership ability
2. Policies that assures availability of services to all the people in the Hospital service area
3. Participation of Hospitals in the community programs to provide preventive care
4. Public information programs that keeps the community identified with Hospital goals and objectives 4
ECONOMIC VIABILITY1. A corporate organization that accepts responsibility for
sound financial management in keeping with desirable quality of care
2. Patient care objectives that are consistent with projected service demands, availability of operating finances and adequate personal and equipment
3. Planned program of expansion based only on demonstrated community need
4. Specific program of funding that will assure replacement, improvement and expansion of facilities and equipment without imposing too much cost burden on patient charges
5. An annual budget that will permit the hospital to keep pace with times
6. 5
ORDERLY PLANNING
1. Acceptance by Hospital Administrator for short and long range planning supported by financial organizations and Architectural advisors
2. Establishment of short and long range objectives with a list of priorities and target dates
3. Preparation of functional programs that describes short range objectives and the facilities equipment and staffing 6
A SOUND ARCITECTURAL PLAN
1. Engaging an architect experienced in hospital design and construction
2. Selection of site large enough to provide future expansion and accessibility of population
3. Recognition of neat of uncluttered traffic patterns within and without the Hospital for movement of Physicians, Hospital staff, Patients and visitors and efficient transportation of supplies
4. An architectural design that will permit efficient use of personal, inter changeability of rooms and provides flexibility
5. Adequate attention to important concepts such as infection control and disaster planning 7
CLASSIFICATION OF HOSPITALS
1. Private (Personal)
2. Partnership
3. Private (Family) Trust
4. Public Charitable Trust
5. Cooperative Society
6. Private Limited Company
7. Public Limited Company 8
HOSPITAL PLANNING TEAM
1. All the people involved in delivery as well as utilization of services are concerned with Hospital Planning i.e., people, patients , nursing, medical staff and management
2. Technical Requirements of a particular professional group in isolation have led to creation of physical forms limited in their utility
a. Hospital Consultant
b. The core group
c. Hospital Architect 9
• Phases of Planning inception
• feasability studies
• Outline proposal
• Scheme Design
• Detail Design
• Tender Action
• Construction
• Commissioning
• Shake down10
BED CAPACITY OF THE HOSPITAL
1. Observation of beds equipments and staff for over night dues
2. Pediatric bassinets and incubators in pediatric departments However, beds in the following areas do not form a part of bed count :
a. Vaccinate and incubators in the maternity suite
b. Labour rooms
c. Causality and emergency departments
d. Recovery room
e. Any which are not equipped and staffed for over night dues 11
REQUIREMENTS FOR PLANNING STRUCTURE
A. Soil StructureB. Public Utilities a. Water- ISI Suggest 455 liters of water per
consumer day LPCD for hospitals of 100 beds and over overall requirement of water in hospitals is estimated at 300-400 Liters per day
b. Savage Disposal solid waste from Hospitals is approximated 1 kg per bed per day Liquid affluence will be same as the hospital requirement of water i.e., between 300-400 liter per bed per day 12
HOSPITAL PROJECT STAGING -Stage aFunctional Content ! Project Team
Outline brief ! Assessment of functional content
! Submission to owners (Govt. Private Organisation, etc.)
for approval
! Site appraisals, gross floor areas
! Building space Draft master plan
! Estimation of cost and phasing
! Appraisal of work by owners
13
Stage B
Operational ! Operational Policies
Policies !Departmental and
interrelated activities
!Departmental and hospital policies
!Development control plan
!Budget cost
! Continuous informal discussion with
owners through –stage B
14
Stage C
Schedules of
Accommodation, ! Schedules of accommodation
Sketches final !Sketch drawing
Cost estimate ! Equipment schedules component estimates
!Cost revenue and staffing estimates
!Final Cost approval
15
Stage D
Detail design working !Working drawings
Drawings- tender action !Engineering detail
!Bills of Quantities
!Calling Tenders
16
Stage F
Commissioning ! Staff assembly and training
!Equipment and supplies assembly
!Testing of installations
!Opening
17
Stage E
Contract and
construction ! Assessment of tenders
!Award of contract
! Construction
! Engineering commissioning
c. Power requirement of Electric power is approximately 1 KV on per bed per day basis
Besides stand by generator is also necessary
Elementsrequiring consideration and analysisMorbidity Statistics
Prevalence of
• Communicable disease• Degenerative Diseases• Accidents rate• Specific disease/disorders
Measurement of • Death rate• Birth rate• Maternal mortality rate• Infant mortality rate
Demographic • Age and sex profile• Population density• Occupational characteristics• Extent of urbanisation• Extent of migratory population• Economic development of the area
Socio-economics
Statistics
• Economic status of the community• Literacy and educational standard• Social habits and socio-cultural
grouping• Housing conditions• Styles of living• Industrialization
Hospital
Statistics
• Type of existing hospital services• Admission rates• Diseases-specific admission rates• Hospital beds in the region• Utilization of existing health and hospital
services• Extent and effectiveness of general practitioner
services
LEVELS OF MEDICAL CARE
Level of Care Medical Facility Level of decision maker
1. Primary Dispensary, Primary General practitioner
health centre of sub- medical asst. centre multipurpose worker
2. Secondary District hospital(Inter Mostly general practimediate) or equivalent ioner partly specialists
3. Tertiary Provincial or similar Specialists hospital (regional)
4. Quatenary Institute of research Super-specialists,and higher training researchers
Geographical, environmental and miscellaneous factors
1. Meteorological Information
• Temperatures
• Rainfall
• Humidity
2. Geographical information
• Existing road and rail communications
• Terrain: mountainous, riverine, plain
• Surrounding district boundaries
• Susceptibility to quakes/floods
• Ecology-atmospheric pollutants from adjoining industries and other sources, proximity of sources of noise such as air-fields or rail/tracks
• Building height restrictions due to proximity of airports
3. Miscellaneous !Trained manpower
availability of !Water
!Electricity
!Sewage disposal
MASTER PLAN IN ITS TOTALITY
Circulation routes
a. Internal Circulation
b. External Circulation
Other Requirements
a. Distances
b. Compactness
c. Parking
for each inpatient bed there is likely to atleast one visitor per day
and for each inpatient there will be about three outpatients
d. Landscaping : Preferably best located on relatively high ground
e. Visual Impact
f. Linearity
ZONAL DISTRIBUTION AND INTER RELATION OF DEPARTMENTS
A. Hospital Stores
B. CSSD
C. Hospital Kitchen
D. Hospital Workshop
E. Laundry
A. Miscellaneous
1. Size of the location of the water tanks
2. Location of the Hospital incinerator
3. Boiler house for supply of steam to laundry, CSSD and Kitchen
4. Garages of ambulance and staff vehicles
5. Mortuary of storage of dead bodies and post mortem room
6. Residential campus of specialists, residents, nurses and other essential staff.
7. A “Community Centre” with grocery and fruit shop, barber’s shop, and a community hall
8. Dharmshala or choultry for attendants and relatives of the patients to stay.
Space requirements total gross building total area (building gross) 782-1005 sq. ft. this includes stairs corridors ducks, wall thicknesses, and mechanical area
Taking liberal figures of 1000 sq. ft. per bed the land requirements for 500 hospital bedded would be an area of one hectare for every 25 beds
BREAK DOWN OF PROJECT COSTS1. Acquisition of site 2. Site survey, investigations3. Landscaping4. Construction contract-building with fixed
equipment 5. Supervision and inspection 6. Equipment diagnostic and therapeutic 7. Movable equipment 8. Architect fees 9. Consultants Fees10. Site engineer fees
Categorization of Services Group I : Services required immediately telephones
domestic services, Central liner services, stores and works department
Group II : Requiring lengthy period of preparation CSSD for trial runs, X-ray, OT , Pharmacy.
Group III : May be partially open before patient admitted paramedical services and OPD
Group IV : Will not operational until all above departments are open - wards
Plants and Equipments Required in A General Hospital
Physical Plant :• Lifts• Refrigeration and air-conditioning• Fixed sterilizers• Incinerators• Boilers• Pumps• Kitchen equipment• Mechanical laundry• Central Oxygen, suction• Generator
Hospital furniture and appliances• Beds• Stretchers• Trolleys• Wheelchairs• Bedside lockers• Dressing drums• Kitchen utensils• Bedside lamps• Movable screens• Hand wash stands• Operation tables• Instrument trolleys• Bedpans• Waste bins• Hospital linen
General Purpose Furniture and Appliances
1. Office machines
• Intercom sets
• Typewriters
• Calculators
• Cash registers
• Filling systems
• Electronic exchange
• Computer
2. Office Furniture3. Crockery and cutlery Diagnostic and therapeutic equipment1. Equipment for general use• Surgical instruments• BP Instruments• Suction machines• Rehabilitation department equipment• Physiotherapy department equipment• Sterilizers• Equipment for clinical laboratory• Voltage stabilizers• Refrigerators• Chemical analyzers-microscopes
2. Equipment interacting with patients during
diagnostic and therapeutic procedures
• Short-way diathermy machines
• Electric cautery machine
• Defibrillators
• X-ray machines
• Monitoring equipment
• Respirators
• Incubators
• ECG machines
• USG machines
