Download - Nursing Guidelines ( Draft)
GUIDELINES FOR NURSING PRACTICE
Nursing department IGMH 2006
1
CONTENTS
Foreword...............................................................................................................6
SECTION ONE - General guidelines................................................................7
Admission............................................................................................................8
Know your patient..............................................................................................9
Recording of vital signs....................................................................................10
Administration of medication..........................................................................11
Intake & output................................................................................................13
Communication.................................................................................................14
Pre-operative management..............................................................................15
Post –operative management...........................................................................16
Documentation..................................................................................................17
Telephone/ verbal order guideline:.................................................................20
Transfering patients.........................................................................................21
Discharge...........................................................................................................22
Leaving aginst medical advice.........................................................................23
Death care..........................................................................................................24
Care of dead foetus/ baby................................................................................25
Filling death forms and delivery forms……………………………………………………26
Vaccination........................................................................................................26
Appendix-A / orientation on admission..........................................................27
Appendix- B / patient’s record /chart arrangement......................................28
Appendix – C / filling death forms and delivery forms.................................30
Appendix – D -checklist for ward sisters........................................................31
SECTION TWO (ward specific guidelines)
Daily tasks of nurses of private wards............................................................36
Daily tasks of pediatric ward nurses...............................................................41
Daily tasks of medical ward nurses.................................................................48
Daily tasks of gynae ward nurses....................................................................54
2
Daily tasks of ENT ward nurses......................................................................60
Shift routines for surgical ward nurses..........................................................64
Daily tasks of isolation ward nurses................................................................69
Daily tasks of accidents and emergency department nurses........................75
Daily task of ICCU nurses...............................................................................77
Daily tasks of O.P.D nurses.............................................................................93
Daily task for staff working in the dialysis unit.............................................95
Theatre guidelines............................................................................................99
theatre lists...........................................................................................................................99
preparation of the theater...................................................................................................100
points to be remembered by the scrub nurse and the circulating / floor nurse..................101
protocols to be followed in the operating rooms...............................................................102
protocols to be followed while in operation theatre complex............................................103
routine cleaning of operation theatre.................................................................................104
daily tasks of nurses working in operation theatre.............................................................105
daily tasks of attendants working in operation theatre.......................................................108
Acknowledgement...........................................................................................113
Admission protocol for labour patients........................................................114
On going care during first stage of labour...................................................116
Care of patients with foetal distress..............................................................120
Care of patients with previous lscs in labour...............................................121
Care of patient during second stage of labour.............................................122
Assisting a vacuum delivery..........................................................................126
Management of third stage of labour...........................................................127
Expectant management of third stage: (is not encouraged).......................128
Retained placenta...........................................................................................128
Manual removal of placenta..........................................................................129
Management of fourth stage of labour.........................................................130
Management of PPH......................................................................................131
Performing an episiotomy..............................................................................132
3
Repair of an episiotomy.................................................................................133
Care of new born............................................................................................135
Neonatal resuscitation....................................................................................137
preparation for delivery......................................................................................................137
post resuscitation:..................................………………………………………………….137
Transferring newborn babies to nursery.....................................................138
Nursing care of patients with ante partum hemorrhage............................138
Management of patients with pih in labour.................................................139
Use of magnesium sulphate for pre- eclampsia and eclampsia..................140
Care of patients with malpresentations........................................................142
Management of cord prolapse.......................................................................143
Administration of oxytocin for induction and augmentation of labour....144
Cerviprime instillation for induction of labour...........................................145
Extra amniotic saline instillation..................................................................146
Care of patients with infectious disease in labour.......................................147
Infection control practices in labour room..................................................149
Care of the patient after abortion.................................................................151
Routine investigation checklist......................................................................153
Admission checklist........................................................................................154
Emergency pre- operative checklist..............................................................155
Documentation checklist................................................................................156
Appendix A: patient unit preparation..........................................................158
for first stage of labour:..............................................................................................……158
for second stage of labour:.................................................................................................158
for severe PIH / eclampsia:................................................................................................159
Appendix B / orientation to labour room.....................................................160
Appendix C: articles/ equipments needed for procedures performed in
labour room
normal delivery:.................................................................................................................161
equipments needed for resuscitation in delivery room:.....................................................162
4
medications needed for new born resuscitation:................................................................162
urinary catheterization:......................................................................................................163
cerviprime instillation:.......................................................................................................163
culdocentesis:.....................................................................................................................163
extra amniotic saline instillation:.......................................................................................164
episiotomy suturing:...........................................................................................................164
dilatation and curettage (d & c):........................................................................................165
Appendix D: check list for ward sister / ward incharge
(labour room)..................................................................................................166
Appendix E: responsibilities of shift in-charges (labour room).................170
Appendix F: daily tasks of nurses working in labour room.......................171
Appendix G: daily tasks of attendants working in labour room................177
Rhc-routines....................................................................................................182
Quality & maintenance of work & working environment..........................187
Infection controll guideline for rhc staff......................................................196
Shift routines for Rhc staff...............................................................................203
FOREWORD
5
Improving & strengthening nursing care is an element of nursing profession. Nursing
department is proud to produce a Manual of Practical Guidelines to be used by the nurses of
IGMH. These guidelines are developed mainly aiming to standardize & improve the quality
of nursing care. Most of the procedures, protocols, & standards included in these guidelines
are already in practice. However, these guidelines will help in standardizing the practice of
these procedures in all the areas of the hospital.
Nursing Department greatly acknowledges the contribution of all nurses who were involved
in developing these Guidelines. I am sure these guidelines will serve as a valuable reference
manual for all the nurses and students working in IGMH.
Aminath Saeed Firaq
Director of Nursing
Nursing Department
6
SECTION ONE
GENERAL GUIDELINES
7
ADMISSION1. Make the unit ready with all the necessary equipments depending on the condition /
type of patient.
2. Receive & greet the patient with a warm welcoming smile.
3. Check the patient’s folder for correct name, address (temporary & permanent), treating
doctor, date & time of admission, and details (name, address, contact number) of the
guardian or relative.
4. Call him/her by name and introduce yourself in a pleasant manner.
5. Check doctor’s orders, prioritize and implement care accordingly. e.g.:
a) Carry out emergency orders immediately.
b) Make necessary arrangements to do urgent investigations.
c) When necessary give special instructions such as NPO, bed rest, without
delay.
6. Check all necessary documents. All admissions should have the following documents.
a) Admission slip / Doctors prescriptions
b) Nurses notes/observation chart /treatment chart (casualty admissions)
c) Other documents if any e.g. Referral letters
7. Take a detail report if the patient is accompanied by a nurse.
8. Assess the patient:
a) Observe for conditions such as restless, confused, level of consciousness etc.
b) Record Bp, pulse, respirations and check weight.
c) Check FHS for obstetric patients.
d) Take history of present complaint, past medical and surgical problems,
ongoing treatment if any, and other relevant histories.
e) Take obstetric and gynea history for relevant conditions.
9. Inform the medical officer or consultant.
10. Enter the admission in the daily census & relevant registers.
11. Orient the patient and relatives to the ward / room and hospital (refer Appendix-A).
12. Inform about the necessary items required during the hospital stay.
13. Instruct the relative / patient to be responsible for their own valuable items such as
money and mobile phones.
14. Inform coordinator about critically ill patients.
8
KNOW YOUR PATIENT
All nurses should know the following information of all patients under their care.
1. Identification (name, age, sex, bed number, address, diagnosis (provisional & final).
2. Past & present medical / surgical /obstetric & gynaecological history.
3. Status such as allergies, G6PD & chronic problems.
4. Stability of vital signs & investigation reports
5. General condition, present complaints & prognosis of illness.
6. Treating & other referral doctors.
7. Previous & ongoing treatment as well as response to medications.
8. Type of diet required.
9. Urinary & bowel habits.
10. Mobility (walking, walk with support, wheel chair, stretcher)
11. Position to be maintained ( e.g. lateral/supine position, leg or arm elevation etc)
12. Socio-economic status (e.g. family support, welfare assistance etc)
9
RECORDING OF VITAL SIGNS
1. Record vital signs every 4th hourly for all the patients & then according to the
condition & necessity.
2. Follow the standard procedure for checking the vital signs, (Refer the procedure
manual).
3. Take immediate actions & inform the doctor for any deviations from normal.
4. Record of vital signs under special conditions:
e.g.
- Before administering indicated drugs such as antihypertensive drugs, digoxin etc
- Before performing certain procedures such as blood transfusion, before transferring
the patient to the theater, endoscopy or any other major invasive procedures.
5. Document vital signs correctly and legibly in the appropriate charts in time.
10
ADMINISTRATION OF MEDICATION
1. Right Patient:
1. Check the patient by name, age, address and bed number.
2. Check the patient if he/she is ready or in a stable condition to receive the particular
prescribed medicine.
E.g. condition of vital signs, food intake, bowel movements, urine output etc
2. Right Medicine:
*Check the name, dosage, route, & expiry date
1. Check & compare the prescribed medication order in the folder (name, dosage,
route & timings) and the treatment chart.
2. Check & compare the medicine (name, dosage, and route & expiry date) & the
written order.
3. Clarify from the concerned doctor in any doubtful situation.
3. Right Dose:
1. Check & take or prepare the right dose of medicine.
2. Get counter checked by another nurse for indicated drugs such as insulin & narcotics
etc.
3. Prepare the medication according to the instructions e.g. correct dilution, aseptic
technique etc.
4. Always label the IV fluids prepared with other medications, with the added drug’s
name, amount, dosage, date & time.
4. Right Route
1. Check the advised route of medication.
2. Check the site – IV / IM / SC, eye, ear, skin, tubings etc, for condition & patency to
administer the drug.
5. Right Time:
1. Check the time & timings for medication.
2. Check the time of last dose of the particular medicine administered.
3. All medications to be administered in time.
11
After Medication Administration:
1. Check relevant Vital signs for indicated drugs.
2. Observe the condition & immediate response to drug. If unusual symptoms are
observed check vital signs.
3. When needed give necessary instructions to the patient about the desired action of the
drug and its possible side effects.
Eg. Drowsines s/ sleepiness after narcotic administration
Symptoms of hypoglycemia after insulin dose.
Urine out put after diuretics. Etc.
4. Provide immediate care & inform to the doctor for any adverse side affects.
5. Document & sign in the appropriate charts /record books accurately & clearly in
time.
6. Replace & store the balance (if any) medicine properly labeled with name, dosage,
date and time of use (if required).
Points to Remember:
1. All prescription must be written by the doctors.
2. Check the name, age, and sex and bed number before handing over a prescription.
3. Explain to the relative/patient when handing over the prescription to buy the
medicine.
4. Check the prescription & medicine after receiving them.
5. All medications must be taken by the patient in the presence of a nurse. Do not
leave the medicine at bedside for the patient to take at a later time.
6. Avoid administering medications prepared or taken by another nurse.
7. Hand over the balance prepared medication to the next shift nurses.
8. All medication errors of any kind must be reported to the senior nurse & the doctor
in the shift.
9. All medication errors must be written in detail in the incident book & reported to the
ward in charge.
12
INTAKE & OUTPUT
1. Maintain Intake /Output chart for all indicated patients from 7.00am to 7.00am.
2. Explain & instruct the patient and relatives about maintaining intake & output chart.
3. Provide a graduated measuring cup & a measuring jar to all necessary patients.
4. Intake should include the total amount of oral intake (foods/fluids) and parental
infusions.
5. Out put should include the total amount of urine passed, aspirations, vomitus and
drainages along with the total number of bowel movements.
6. Observe or ask & record the total amount, color, & consistency of output.
7. All the measurements should be seen by a nurse.
8. Take action for any abnormal observations/measurement.
e.g. heamaturia, hematemisis, Poor oral intake, less urine out put, constipation,
loose motion etc.
9. Record the intake & output in time & complete at the end of each shift.
10. Calculate the total Intake and Output /24hours at the end of night shift.
13
COMMUNICATION
Nurse - Patient
1. In each shift after taking over visit all the patients.
2. Greet, smile, address by name & introduce yourself.
Enquire how he/she is feeling or doing.
Enquire about pain, sleep, diet, bowel movements or whatsoever related to his /her
problems.
3. Explain the condition (progress / deterioration) during the doctors’ rounds.
4. In high risk cases keep a written record of the explanations provided for the patient/
relatives.
5. Explain to the patient and relatives about starting /discontinuing / withholding any
treatment.
6. Explain prior to performing each procedure / investigation.
7. Communicate with patient and provide health education according to their needs
(time can be given while performing procedures).
8. Explain any delay in carrying out an expected procedure e.g. cleaning, bath,
handing over the discharge summery etc.
Nurses & other members of the health care team
1. Respect each other & other members of the health care team.
2. Acknowledge & greet to each other & other senior members of the team.
3. Conversations should be polite, understanding & professional.
4. Do not use mobile phones & do not share personal conversations at the time of
patient care and during the ward rounds
5. Follow the telephone manners during telephone conversations.
6. Resolve conflicts according to the protocols..
7. Help each other & other wards when they are in need.
14
PRE-OPERATIVE MANAGEMENT
1. Check patient’s identity (name, age, sex, address, bed/room number)
2. Check the type & nature of posted surgery
3. Check if instructions of anesthetists and surgeon’s instructions are carried out
4. Recheck validity of consent & signature by the relative/guardian
5. Check investigation results & informed to the concerned people
6. Instruct & explain the importance of the concerned relative/guardian to stay near by
the theatre throughout the surgery.
7. Enquire about the donor & instruct the donor should be available in the hospital (in
front of theatre) at the time of surgery
8. Check if any of the medication of ongoing treatment to be administered before shifting
to Theater.
9. Check patient preparation for surgery
Skin or part preparation,
Fasting status
Bowel /preparation & results
Pre medication
Catheterization, IV cannula or IV fluids (if required)
Changing clothes & removing jewelries, nail polish etc.
Removal of dentures, contact lenses or other appliances that needs to be
removed.
Personal hygiene (bath taken /sponge given)
10 Make sure if bladder is emptied just before shifting to the theater
11. Check vital signs
12. Complete all documents
15
POST –OPERATIVE MANAGEMENT
1. Prepare the unit according to the type of case to be received.
2. At the time of taking over from the OT nurse check the following.
Level of consciousness
Operation site
Post-operative orders (surgeons & anesthetist)
3. After transferring the patient to the unit, carry out the following
Position the patient according to the instructions.
Position & secure the drainages, catheters, IV fluids etc.
4. Check vital signs once in every 15 minutes for 1 hour, if stable for half hourly for 2
hours, & then routinely.
5. Explain the condition & provide necessary instruction to the relatives.
NPO hours,
Maintenance of patient position & mobility.
Purpose of catheters, drainages etc.
6. Observe & take actions for any possible complications & inform the doctor.
7. Prioritize & carry out orders.
16
DOCUMENTATION
Nursing documentation should have the following principles:
Principle 1: Nursing documentation is aimed at serving the interests of the
patients.
- The record should contain relevant and patient focused information only.
- Nursing records should not be used as a forum for criticizing other professionals nor
should it be used as route for complaints.
- Avoid bias and describe observations of behavior rather than labeling the patient.
(E.g. Instead of writing as patient being uncooperative document the exact behavior
of the patient).
Principles 2: Frequency of documentation:
- Frequency of documentation is ultimately a professional judgment. The frequency of
entries depends on several factors. These include
- The physical and mental condition of the patient
- The method of documentation used by the organization
- Any other obligations (legal or other wise) that the health record must fulfill.
- Nursing documentation should contain the initial assessment of the patient when
taking over as well as the assessment done before handing over
- In circumstances where a client is in unstable health, it is necessary to document more
frequently than in circumstances where the client is more stable condition.
Principle 3: The documentation records events chronologically and in a timely
manner.
- Entries should be chronological sequence, with time, date, name, signature and
designation of the staff.
- All entries must be made as close as possible to the care or treatment provided.
Waiting until the end of a shift to write the report should be avoided as it increases the
possibility of errors and omissions.
- Documentation should never be done ahead of time.
17
- While using electronic monitors and if the time on the printouts is not the exact time,
make sure that the correct time is written on the printouts.
- Space should not be left in a client’s record for documentation to be completed at a
later time.
Principle 4: The documentation should be factual, concise, legible, and up to
date.
- All entries should be brief, complete and clear-cut.
- All entries should be made in black or blue ink and any blank areas must be ruled
out.
- All the entries must include a date, time of documentation.
- A person making any documentation in a patient record must be identified. Therefore
all entries in the health records including signatures should be legible. Nurses should
enter their name (not the initials) and designation clearly in the space provided for the
purpose.
- When writing drug doses, as a legibility caution use leading zeros for decimals (e.g.
0.5 units of syntocinon) and avoid terminal zeros (e.g. do not write 10 units of
syntocinon instead of 1 unit).
- The most common reason for drug errors is illegible or questionable handwriting.
Therefore, to avoid errors care should be taken to write neatly and to avoid spelling
mistakes. Grammar and cleanliness are also worthwhile.
- Duplication of information should be avoided. It is not necessary to repeat
information that is recorded else where in the patients health record. (E.g. when
medications are entered in the treatment sheet it need not be repeated in the nurses
notes).
- Document specific information: Don’t state, “Patient’s condition informed to
doctor”. Document exactly what was informed to the doctor?
- Avoid use of generalized phrases such as “wound improved”. State in objective
terms: size, drainage odour.
Principle 5: Errors should be corrected accurately.
- Correct errors openly and honestly. The content in question must remain visible so
that the purpose of correction is understood.
18
- Errors should be corrected by drawing a line through the incorrect information. But
the time, date and signature of the person altering the record should be clearly
written. It is also advisable to record the reason for alteration.
- Correcting, modifying or altering someone else’s document is illegal and is
considered as professional misconduct.
- Under no circumstance should correction ink be used or scribble over an entry
or tear off an entry. This will be considered as tampering.
Tampering: Tampering is not only the willful act of destroying the record. Crossing out
incorrectly or wiping out information and squeezing a little information are also forms of
tampering. Leaving blank lines can help the subsequent users to tamper the records by
altering them. Therefore a line should be drawn through empty spaces.
Principle 6: The documentation should be in an approved format.
- Nurses should ensure that the documentation is done in a language approved by the
organization.
- Ensure that patients name and inpatient number is written in all forms.
- Internationally acceptable abbreviations should be used in the document and no
abbreviation should be used unless it has a clear meaning.
- All entries must be signed. A () mark indicates correct or right and it cannot be
considered acceptable as a substitute for a signature.
- Each entry must begin with a date, time and should end with a signature, name and
title.
Principle 7: The documentation should contain entries recorded by the
individual nurse who provided the care.
Nurses should not document on behalf of others.
All persons who provide care for the patient should make entries of their observations
and interventions in the records.
Principle 8: documentation should demonstrate that the nurse has fulfilled
her duty of care to the patient.
- All care, advice and any specific nursing management plans should be documented
clearly.
- Any refusal for treatment or advice should be noted.
19
Late entries:
Late entries can be done for information that was not recorded in a timely fashion and if
omission of the information would impact the care. When a late entry is needed, the
following needs to be documented:
- current date/time
- entry for date and time of happening
- Signature/name
e.g. 2/3/2006, 9 a.m. late entry for March 1, 2006, 10 a.m.
A late entry must be made within 24 hours with the authorization from the ward incharge.
Telephone/ verbal order guideline:- Clearly determine the clients name room/ bed number and diagnosis.
- Write down the order exactly as stated by the physician
- Repeat the prescribed orders back to the physician.
- Use clarification questions to avoid misunderstanding
- Document in the nurses’ notes as a telephone order or a verbal order including date,
time and name of the physician giving the order.
- Ensure that the physician writes the order in the patient’s folder later.
- Verbal orders should be double checked when appropriate.
20
POINTS TO REMEMBER- Write nurses notes after taking over, in-between after care or
performing a procedure and at the end of each shift.
- Record the attending doctor’s visit whenever the nurse sends a call or
special visit done by the doctor
- Write the condition, complaints, progress and other observations
E.g. after a wound dressing, write if the wound is healing, bleeding, not
improving or other conditions of the wound observed during the procedure.
- Do not write pending works, & investigations to be done in the nurse’s
note, but pending works can be written and hand over to the next shift
- Recording should be done by the responsible nurse only
- Complete nurses notes & other records before leaving hospital/HC
TRANSFERING PATIENTS
While transferring patients from ward to ward or to other hospitals the following steps
should be carried out.
1. Check fitness and doctor’s order for transfer.
2. Check and arrange a staff to accompany the patient if required.
3. Check if bed or room is available / ready with the necessary items or equipments.
4. Make transfer memo.
5. Complete & prepare all the records and other belongings.
6. Arrange means of transport.
7. Document in the census & and other registers.
8. Inform to the ward or to the concerned department / hospital (when possible) just
before shifting
9. Continue IV & oxygen during the transfer if on flow.
10. Observe condition during the transfer.
11. Provide a complete report (from the time of admission till date & time) to the
receiving nurse and handover all the documents, medications, investigations such as
scan, X-rays etc.
12. Inform to the patient, relatives, and to the respective ward if there is any delay.
21
DISCHARGE
When discharging a patient from the hospital ensure that the following steps are carried
out.
1. Check discharge order.
2. Enquire if medical certificate is required.
3. Collect investigation results or result collecting slips.
4. Check the discharge summary for compete information (name age, address,
diagnosis etc
Check discharge summary for special information such as final diagnosis, treatment
tubal ligations, IUFD, neonatal deaths etc.
5. Settle the payment.
a) Write the date & time of discharge in the folder cover.
b) Complete service notification including operation slips.
c) Stamp “discharge” & mark the type of discharge.
d) Hand over the folder cover to the concerned person after explaining to bring back
the folder cover & the bill.
e) Receive & enter the information to the concerned records (census & registers)
6. Discharge advice.
a) Check the discharge medicine; label the drugs with the timings & dosage.
b) Explain how to take drugs with proper instructions.
c) Provide health education on diet, activity & exercise for all patients.
d) Explain about exclusive breastfeeding for all breastfeeding mothers.
e) Provide special information for clients like diabetes, hypertension, CRF, post-
operative etc.
f) Teach procedures like, dressing, cleaning, catheter care, sitz bath etc.
g) Demonstrate & get return demonstration of procedures like Ryles tube feeding,
Etc. This need to be done from the time of discharge planning.
7. Explain and handover discharge summary, investigations reports, x-rays, pending result
collecting slips etc.
8. Explain about the follow up visits & appointments.
9. File the chart in order (refer Appendix B)
22
LEAVING AGINST MEDICAL ADVICE
1. Ensure if the risks of leaving against medial advice is clearly informed by the doctor.
2. Complete LAMA form, explains & take signature from the concerned relative or
guardian.
3. Remove the appliance such as IV cannulas.
4. Complete bill settlements according to the discharge procedure.
5. Check the discharge summary if it indicates “Leaving Against Medical Advice”.
6. Check the discharge summary for the stated risks & brief them to the patient &
relatives.
23
DEATH CARE
1. Inform to the relatives / guardian immediately after death declaration (these
information & explanation should be given by the concerned doctor).
2. Inform to the consultant, nurse – coordinator, and to other concerned people.
3. Complete death form & hand over to the relatives/guardian to make necessary
arrangements for funeral.
4. Provide brief information about the procedure to take the dead body home or
cemetery.
5. Inform to the public relation coordinator & direct the relative /guardian to the public –
relation counter for further assistance & to arrange ambulance and for further
assistance.
6. Handover the folder cover (after completing & stamping [death & discharge]) with
service notification for bill settlement.
Cleaning the dead body:
1. Inform to the relatives about cleaning the dead body
2. Remove the IV fluids and other tubing.
3. A Maldivian nurse should guide or accompany during the cleaning procedure.
Respect the religious and cultural values during the procedure.
4. Dead body must be handled carefully & provide special attention not to expose the
dead body.
5. Clean the dead body & dress any wound.
6. Perform the procedure according to the procedure manual.
Documentation:
1. Complete nurses notes, and other charts clearly with all the details of the process.
2. Document the details in the census, admission & death register.
3. Hand over the investigation reports & x-rays.
4. Order the file according to the chart arrangement protocols (refer Appendix B).
Transferring the dead body
1. Confirm if ambulance is ready
2. Inform to public relation counter just before transferring.
3. A nurse should accompany to the ambulance.
24
CARE OF DEAD FOETUS/ BABY
Inform the mother and the relatives about the death as soon as possible.
Death care should be given according to the Muslim tradition regardless of the
gestational age.
Clean the foetus/ baby gently with warm water and olive oil. If the baby is macerated
give special attention as the skin may get peeled off while cleaning.
If there is bleeding from the cord tie the cord with silk or any type of thread. Do not
use a cord clamp.
If possible the baby’s chin should be supported firmly with a bandage and the knot
should be placed over the head.
Fold the arms with the right hand over the left and keep over the abdomen. Tie on the
wrist with a bandage.
Put the legs together and tie over the ankle with a bandage.
If there is excessive secretions plug the nostrils with cotton.
Show the baby/ foetus to the mother and the relatives
Always cover the baby/foetus with a sheet and never expose the body unnecessarily.
Fill delivery form and death form and hand over to the relatives (refer Appendix C).
The relatives should be told to give a name to fetus and the name should be entered in
the death form. When sex cannot be identified it should be taken as a male.
Enter in the delivery register if the baby is more than 28 weeks of gestation and enter
in the abortion register if less than 28 weeks.
When the formalities for burying the baby is over and when transport is ready hand
over the baby to the relatives (a nurse should accompany).
FILLING DEATH FORMS AND DELIVERY FORMS
25
Delivery forms and death forms should be filled in the following conditions:
A delivery form and a death form should be given to each aborted fetus. All delivery
forms and death forms should be filled completely before handing over to relatives.
If there is no fetus, a delivery form need not be given, but a death form has to be
issued with the identification of the product of conception along with mother’s name.
eg. Name: Aishath’s (aborted membrane)
If sex of the fetus is not identified, it should be taken as a male fetus.
VACCINATION
Prior to vaccination of a baby confirm the following.
1. Check identity of the baby (check & compare the identity of the mother with the
baby’s name tag)
2. Assess the baby & ensure that the baby is fit for vaccination
3. Reconfirm the vaccination status of the baby from the nursing records & double
check with another staff.
4. Inform & give detail information to the parents about vaccinating the baby
5. Take the baby along with necessary records for vaccination
6. A bystander who could give correct information needed to complete the vaccine
card should accompany the baby.
After vaccination:
1. Assess the baby’s condition after vaccination
2. Show the BCG site to the parent (s) and give instruction related to post
vaccination care
3. Ensure that the necessary documentation has been completed.
4. Hand over the vaccination card & explain the vaccination schedule to the parent(s)
APPENDIX-A / ORIENTATION ON ADMISSION
Greet & smile to the patient & relatives
26
Tell that you will be looking after the patient in your shift.
Explain that nurses will be working in four shifts
Tell the patient /relatives to inform nurses regarding any problem with the patient and other
problems related patient care.
Orientation to place: Show the location of toilet, hot water, fridge and drinking water
Explain location of the pharmacy & canteen
Explain about the day room, activities and closing timings
Advice the relatives to inform the nurses if any of the facilities provided by the
hospital is not in working condition e.g. fan, electricity etc
Explain about the rules of the hospital: Patients are not allowed to go out of the hospital
Explain about the visiting hours
Explain that other than visiting hours only one responsible bystander can stay with the
patient. If the patient is sick it will be necessary for two people to stay with the
patient.
Advice to bring the necessary toilettries & cutleries
Smoking is not allowed in the hospital premises. Explain them about the danger of
smoking in close proximity to oxygen sources`
Explain about the doctor’s visiting trimmings depending upon the consultant and departments
Explain that doctor’s will be visiting usually daily once & then depending upon the condition
of the patient
Explain that the medical officer of the department will be visiting for any complaints
Room Orientation:
Hand over the AC /TV remote & show other items in the room
Explain about the bell-calling systems
Explain how to use telephone
Tell them politely to use the slippers for going to toilet
Take special consent for admission of psychiatric patient
APPENDIX- B / PATIENT’S RECORD /CHART ARRANGEMENT
1 History sheet
27
2 Progress and management sheets
3 Investigation reports (Lab, scan, ct, X-ray
4 Nurses notes
5 Observation and special sheets (diabetic /neurological)
6 Input and output charts
7 TPR sheets
DEATH CHART
- Death summary
- Death certificate /Form
- Then 1-8
DISCHARCH CHARTS
- First, discharge summary
- Then 1-8
SURGICAL PATIENTS
After progress sheet
- PAC notes
- Consent
- Surgery notes
- Anaesthesia notes
- Then 3-8
OBSTETRIC PATIENT’S CHART
- After progress sheet
- Partogaph
- Labour progress
- Then 3-8
- Service notification form
- Prescription – in case of death
- Nursing assessment form
- Investigation result forms
28
- IV orders
- Personal hygiene plan
- Condition explain form
- Operation slip
- Referral letters
- Casualty prescription
- Transfer slip
- Admission slip
- Communicable disease notification form
Checking of death forms
Coversheet
Patient details
Admission coversheet
Time of death
Date of death
Death stamp
Discharge stamp
Summary filled
Inside folder
Death certificate with stamp
APPENDIX – C / FILLING DEATH FORMS AND DELIVERY FORMS
Delivery forms and death forms should be filled in the following conditions:
29
A delivery form and a death form should be given to each aborted fetus. All delivery
forms and death forms should be filled completely before handing over to relatives.
If there is no fetus, a delivery form need not be given, but a death form has to be
issued with the identification of the product of conception along with mother’s name.
eg. Name: Aishath’s (aborted membrane)
If sex of the fetus is not identified, it should be taken as a male fetus.
APPENDIX – D -CHECKLIST FOR WARD SISTERS
DAILY (Section-A)
1. Check whether- daily inventory taken.
30
- missing/borrowed items replaced.
2. ” - census (transfer in/transfer out/discharge).
3. ” - narcotics inventory taken.
- narcotics cupboard locked.
- narcotics register maintained regularly.
- narcotics cupboard key with senior staff nurse.
4. - emergency trolley (drugs/equipments/instruments).
5. ” - store room locked at all times.
6. ” - temperature/intake & output chart/files filled/updated
(during ward rounds and report giving)
7. ” - all medication sheets filled accurately
8. ” - all special investigations (USG, CT scan, ECG)
appointments, reports etc.)
9. ” - all operation slips entered on OR day/latest by the first post op-day.
10. ” - PAC’s done, consent taken (by the appropriate person)
11. ” - welfare letters are given
12. ” - linen checked, sent & returned
13. ” - infection control practices
- Waste disposal/sharp disposal
- Cleanliness/disinfection of equipments & instruments
Nursing Department 2005
14. ” - patient care components – according to the care plan.
- patient allocation
- allocated nurses go on round with doctor
- all doctor’s orders are carried out properly
- daily care given
31
- all records completed
- all registers completed.
- maintenance of intake/output chart for whom all required
(even if no doctor’s order)
15. ” - all ward equipments in working order.
16. ” - overall cleanliness /tidiness of ward
17. ” - communication between shifts
18. ” - follow up when things go wrong /broken items/missing items in the ward
19. ” - attendants handover to next shift attendants (mops dry, buckets emptied,
- dustbins emptied, kidney trays washed, dirty utility in clean state)
” - nurses and attendants report before going off duty (other shifts to the senior staff on duty)
20. ” - update the changes in the duty register in the nursing department.
21. ” - tidiness of the ward.
22. Reporting- Incidents that need immediate reporting.
Nursing Department 2005
WEEKLY (Section-B)
WARD STOCK
- Identifying consumables required for the next week.
- Write & send indent book to Nsg Dept.on the previous day before 12.00nn.
32
DUTY ROTA
- Send Duty Rota on Tuesday before 12.00nn to Nsg Dept.
- To be made by ward sister/in-charge nurse only
CLEANLINESS (thorough cleaning/disinfection/deep cleaning)
- treatment room
- patient unit
- clean utility room
- dirty utility room etc.
- fans, windows, etc.)
EQUIPMENT
- disinfection (trolleys/suction machine/IV stand etc.)
- serving of all equipments- oiling of trolley wheels et.
- order/replace broken items
CASE SHEETS -DISPATCH
- Charts arranged in order
- Death case sheets stamped and documents filed in order/death summary filled.
- Dispatch weekly or biweekly
CHECK AUTOCLAVED ITEMS
- Re-autoclaving after 2 weeks
(Please allocate to senior nurses/junior nurses accordingly and do over all check).
REPORTING - Necessary information (patient care/staff progress/additional requirements etc. to
the Nursing Department).
Nursing Department 2005
MONTHLY (Section –C)
- Reviewing a nursing procedure of a case presentation
- C/S of treatment rooms
CHECK INVENTORY (3-6 monthly) of ward stock, Equipments / machinery
33
DISPATCH equipments/instruments which cannot be repaired
EXPIRY DATE drugs and emergency medications
RECORDS & REPORTS maintenance of ward registers and files
REVIEW CLASS identifying weakest area – (present in the ward)
MONITORING staff progress/patient care (appraisal review after 6 months)
REPORTING necessary information (patient care/staff progress/additional requirements
etc. to the Nursing Department).
- Ward linen - Check total linen count
- Maintenance of paint, lights, curtains.
- Ward meetings – the special events of the month.
ANNUALLY (Section-D)
FULL INVENTORY OF WARD
NEW IMPROVEMENTS TO THE WARD –suggestions and ideas etc.
BUDGET-items required for the following year budget
LEAVE SCHEDULE OF THE STAFF
COMPLETING STAFF APPRAISAL
34
SECTION TWO
WARD SPECIFIC GUIDELINES
DAILY TASKS OF NURSES OF PRIVATE WARDS
Morning shift:
Report to the ward at 7:30 am
35
Checking inventory, emergency trolley, Narcotics
Send autoclaving items to CSSD/ collect linen from laundry
Take handover from the night shift nurses
Check the treatment charts, vital charts, Intake output charts and diabetic chart and
kick count chart
Visit patients, talk with the patients, ask how they are feeling, about patient diet,
bowel habits
Giving morning care.
Prepare patients going for surgery and labour room.
Check IV fluids and drainages, remove if there is any empty IV bottle/
Check the cannula site and operation site, wounds, for soakage
Check fetal heart
Ask mothers about breast feeding, / passed urine/me conium
Check baby’s skin for colour and dehydration
Prepare the trolley for doctor’s rounds
Collect pending investigation reports before rounds
Bed making
Check and prepare for special investigations/get appointments for (Scan, CT, X-ray,
endoscopy, audiometry, echo,)
Assist doctors to the ward round
Carry out morning orders
Administer morning medications if any
Check vital signs, if any alteration give SOS medications/other required interventions
(tepid sponging, hot water bag) / inform to doctor
Documentation
Check the overall cleanliness of the ward.
Give baby bath/ cord care/eye care/baby’s weight
Give bed baths if any/ hair wash/ any other necessary interventions (back
care/position changing)
Wound Dressings and Episiotomy care
Collect autoclaved things
Visit patients and check the present conditions
Complete the discharges as soon as possible
Vaccination of babies before 1:00 pm
36
Empty urinary drainages and measure/ maintain intake out put
Complete documentation
Hand over to the next shift
Check overall cleanliness of the ward
Go through the reading materials/message book/work assignment book
Carry out special work assignments
Report to shift in charge before leaving the ward
Second Shift:
Report to the ward at 1:00 pm
Check inventory, emergency trolley, narcotics
Take over from the previous shift
Check the treatment charts, vital charts, Intake output charts and diabetic chart and
kick count chart
Visit patients, talk with the patients, ask how they are feeling, about patient diet,
bowel habits
Check IV fluids and drainages, remove if there is any empty IV bottle/
Check the cannula site and operation site, wounds, for soakage
Check fetal heart
Ask mothers about breast feeding, / passed urine/meconium
Provide breast feeding counseling
Check baby’s skin for colour and dehydration
Administer afternoon medication after lunch
Check vital signs
Make the patient comfortable, put off the lights, draw the curtains, make the room
cozy for the patients, allow them to rest
Send autoclaving items to CSSD/ collect linen from laundry
Back care/change positions
Wound Dressings and Episiotomy care
Carry out special nursing interventions like, nebulization, steam inhalation, provide
hot water bag
Make the patient ready for the visiting hour
Check the cleanliness and tidiness of the ward
Complete Documentation
37
Hand over to the next shift
Check overall cleanliness of the ward
Go through the reading materials/message book/work assignment book
Carry out special work assignments
Report to shift in charge before leaving the ward
Evening shift:
Report to the ward at 6:00pm
Checking inventory, emergency trolley, Narcotics
Take handover from the second shift nurses
Check the treatment charts, vital charts, Intake output charts and diabetic chart and
kick count chart
Visit patients, talk with the patients, ask how they are feeling, about patient meals,
bowel movements
Check IV fluids and drainages, remove if there is any empty IV bottle/
Check the cannula site and operation site, wounds, for soakage
Check fetal heart
Ask mothers about breast feeding, / passed urine/meconium
Check baby’s skin for colour and dehydration
Skin preparation/ give enema
Advise and explain about NPO for surgery and other investigations
Back care/change positions
Wound Dressings and Episiotomy care
Vital signs
Administer medication
Carry out special nursing interventions like, nebulization, steam inhalation, provide
hot water bag
Make the patient ready for sleep, draw curtains, put off the lights,
Complete Documentation
Hand over to the next shift
Check overall cleanliness and tidiness of the ward
Go through the reading materials/message book/work assignment book
Carry out special work assignments
Report to shift in charge before leaving the ward
38
Night duty:
Report to the ward at 11:45pm
Checking inventory, emergency trolley, Narcotics
Take handover from the second shift nurses
Check the treatment charts, vital charts, Intake output charts and diabetic chart and
kick count chart
Visit patients, see whether patients are comfortable and settled for night’s sleep.
Check IV fluids and drainages, remove if there is any empty IV bottle/
Check the cannula site and operation site, wounds, for soakage
Check fetal heart
Ask mothers about breast feeding, / passed urine/meconium
Check baby’s skin for colour and dehydration
Make census/ arrange case sheets
Documentation
Wash injection trays/carbolize the trolleys/arrange the treatment room/ utility rooms
Give enema/prepare the patient for surgery/check skin preparation
Ensure about NPO status, keep patient prepared for special investigation/surgery
Morning care/bed baths
Back care/change positions
Vital signs
Administer morning medication/pre-anesthetic medications
Wound Dressings and Episiotomy care
Carry out special nursing interventions like, nebulization, steam inhalation, provide
hot water bag
Check baby’s weight and document
Check the cleanliness and tidiness of the ward
Complete Documentation
Hand over to the next shift
39
DAILY TASKS OF PEDIATRIC WARD NURSES
Morning shift
Report to ward on time
Check ward inventory of all biomedical equipments and stationeries
Check narcotics inventory (Should be checked by the shift in-charge: amount &
expiry date)
Check emergency trolley (check drugs for the correct amount & expiry dates,
equipments and other items for good working condition. Immediate action has to be
taken for replacing missing drugs from emergency trolley & repairing of any
equipments not in good working condition)
(IF ANYTHING IS MISSING ON INVENTORY CHECKS, IT SHOULD BE
WRITTEN IN THE MISSING BOOK AND REPLACED BEFORE SHIFT IS
OVER)
40
Take report from the previous shift nurse
Shift in-charge should check with the previous shift in-charge for any
special handover
Visit patients after report
- Communicate with patients and parents; ask regarding their condition, oral
intake, whether breakfast taken or not and regarding comfort and
inquire about their queries
- Touch the patient and feel the skin for hyperthermia or hypothermia (if felt
hyperthermia check temperature, if skin is cold cover the child
with sheet)
- Check the bedside records for correct entry of patients’ name, diagnosis,
check the temperature sheet, observation sheets and intake out
put charts for correct entry.
- If patients are on intravenous fluids check the IV site for any swelling,
phlebitis or induration. And check the IV fluid for correct
amount of drop rate
- For all dengue patients, pulses on dorsales pedis should be checked for
volume. (If you feel that the pulses are weak or not felt, check
the blood pressure immediately)
Shift in charge should allocate patients and assign work for each staff
Check the allocation book for your assigned patients and work
Visit patients and introduce yourself as their shift nurse
Make the bed and give morning care for patients as required
Prepare for doctors rounds (round trolley should be prepared with patients chart,
treatment sheets, required investigation slips and tray with torch & tongue
depressor and calculator)
Check for any pending investigations and collect the report before the rounds
Take rounds with doctors ( Ensure that report regarding patient is given to doctors on
round, all new reports are shown, show the treatment sheet and inquire about
all the medications whether to continue or discontinue or for any other
changes, ensure that parents enquiries are answered and condition is explained
by the doctors)
If investigations are ordered make memo and send samples to laboratory
41
If patients are posted for any special investigations ensure that patient is prepared and
sent to the concerned department on time
After rounds give prescription for all medications
Give morning medications and injections
Take vitals, blood pressure, temperature, pulse and respiration and if required O2
saturation.
Give midday medication and injections
Make the patient comfortable
Check the cleanliness and tidiness of unit
Receive new admissions and carry out the admission procedure
Check and supervise attendants work and whereabouts
Complete documentation (service notifications should be filled, all medications
marked, intake output and observations should be entered, write the nurses
notes as well.)
Give 2pm medication as required, inquire and assess for any new symptoms
If patients are discharged
- Inform the medical officer for preparation of discharge summary
- Explain the discharge procedure and the time it will take for discharge
preparation
- Remove IV cannula and prepare patient for discharge
- Give for payment and ensure that operation slip is attached
- Explain discharge medications, review dates and if any pending reports are
there for collection very clearly.
Handover to next shift
Check the missing book, replace any items taken in your shift
Report to ward in-charge or shift in-charge before going of
Second shift
Report to ward on time
Check ward inventory of all biomedical equipments and stationeries
Check narcotics inventory (Should be checked by the shift in-charge: amount &
expiry date)
Check emergency trolley (check drugs for the correct amount & expiry dates,
equipments and other items for good working condition. Immediate action has to be
42
taken for replacing missing drugs from emergency trolley & repairing of any
equipments not in good working condition)
(IF ANYTHING IS MISSING ON INVENTORY CHECKS, IT SHOULD BE
WRITTEN IN THE MISSING BOOK AND REPLACED BEFORE SHIFT IS
OVER)
Take report from the previous shift nurse
Shift in-charge should check with the previous shift in-charge for any
special handover
Visit patients after report
- Communicate with patients and parents; ask regarding their condition, oral
intake, whether lunch taken or not and regarding comfort and
inquire about their queries
- Touch the patient and feel the skin for hyperthermia or hypothermia (if felt
hyperthermia check temperature, if skin is cold cover the child
with sheet)
- Check the bedside records for correct entry of patients’ name, diagnosis,
check the temperature sheet, observation sheets and intake out
put charts for correct entry.
- If patients are on intravenous fluids check the IV site for any swelling,
phlebitis or induration. And check the IV fluid for correct
amount of drop rate
- For all dengue patients, pulses on dorsales pedis should be checked for
volume. (If you feel that the pulses are weak or not felt, check
the blood pressure immediately)
Shift in charge should allocate patients and assign work for each staff
Check the allocation book for your assigned patients and work
Visit patients and introduce yourself as their shift nurse
Check for any pending reports and collect the reports and inform the reports to doctor
Check cleanliness and tidiness of ward
Prepare the unit and patient for an afternoon nap and plan nursing care so that patient
is not disturbed during this period
If pending or evening discharges are there attend to this immediately
- Inform the medical officer for preparation of discharge summary
43
- Explain the discharge procedure and the time it will take for discharge
preparation
- Remove IV cannula and prepare patient for discharge
- Give for payment and ensure that operation slip is attached
- Explain discharge medication and review dates and if any pending reports are
there for collection very clearly.
- Check the patients charts & compare the treatment sheet with the doctors
orders for the latest changes/double check whether orders are carried out
Assess patient in-between and provide nursing care accordingly
Check and supervise attendants work and whereabouts
Take vital signs and give medications or injections at evening time
Complete documentation (service notifications should be filled, all medications
marked, intake output and observations should be entered, & write the
nurses notes)
Handover to next shift
Check the missing book, replace any items taken in your shift
Shift in-charge should fill their checklist
Report to ward in-charge or shift in-charge before going off duty
Third shift
Report to ward on time
Check ward inventory of all biomedical equipments and stationeries
Check narcotics inventory (Should be checked by the shift in-charge: amount &
expiry date)
Check emergency trolley (check drugs for the correct amount & expiry dates,
equipments and other items for good working condition. Immediate action has to be
taken for replacing missing drugs from emergency trolley & repairing of any
equipments not in good working condition)
(IF ANYTHING IS MISSING ON INVENTORY CHECKS, IT SHOULD BE
WRITTEN IN THE MISSING BOOK AND REPLACED BEFORE SHIFT IS
OVER)
Take report from the previous shift nurse
Shift in-charge should check with the previous shift in-charge for any
special handover
44
Visit patients after report
- Communicate with patients and parents; ask regarding their condition, oral
intake, regarding comfort and inquire about their queries
- Touch the patient and feel the skin for hyperthermia or hypothermia (if felt
hyperthermia check temperature, if skin is cold cover the child
with sheet)
- Check the bedside records for correct entry of patients’ name, diagnosis,
check the temperature sheet, observation sheets and intake out
put charts for correct entry.
- If patients are on intravenous fluids check the IV site for any swelling,
phlebitis or in-duration. And check the IV fluid for correct
amount of drop rate
- For all dengue patients, pulses on dorsales pedis should be checked for
volume. (If you feel that the pulses are weak or not felt, check
the blood pressure immediately)
Shift in charge should allocate patients and assign work for each staff
Check the allocation book for your assigned patients and work
Visit patients and introduce yourself as their shift nurse
Check the patients charts compare the treatment sheet with the doctors orders for the
latest changes or to double check whether orders are carried out
Prepare the patient and unit for visitors visit
Give 10pm medication and injections
Identify and confirm patients who need to be fasting for investigations, surgery etc.
Check for any pending reports and collect the reports and inform the reports to doctor
Prepare the unit for night sleep and ensure that patients are not disturbed
unnecessarily
Assess patient in-between and provide nursing care accordingly ( check especially for
drop rate of IV fluids and IV check site for any inflammation)
Check and supervise the work of attendants work and whereabouts
Complete documentation (service notifications should be filled, all medications
marked, intake output and observations should be entered, write the nurses
notes as well.)
Handover to next shift
Check the missing book, replace any items taken in your shift
45
Report to ward in-charge or shift in-charge before going off duty
Night shift
Report to ward on time
Check ward inventory of all biomedical equipments and stationeries
Check narcotics inventory (Should be checked by the shift in-charge: amount &
expiry date)
Check emergency trolley (check drugs for the correct amount & expiry dates,
equipments and other items for good working condition. Immediate action has to be
taken for replacing missing drugs from emergency trolley & repairing of any
equipments not in good working condition)
(IF ANYTHING IS MISSING ON INVENTORY CHECKS, IT SHOULD BE
WRITTEN IN THE MISSING BOOK AND REPLACED BEFORE SHIFT IS
OVER)
Take report from the previous shift nurse
Shift in-charge should check with the previous shift in-charge for any
special handover
Visit patients after report
- Communicate with patients and parents; ask regarding their condition, oral
intake, whether breakfast taken or not and regarding comfort and
inquire about their queries
- Touch the patient and feel the skin for hyperthermia or hypothermia (if felt
hyperthermic check temperature, if skin is cold cover the child
with sheet)
- Check the bedside records for correct entry of patients’ name, diagnosis,
check the temperature sheet, observation sheets and intake out
put charts for correct entry.
- If patients are on intravenous fluids check the IV site for any swelling,
phlebitis or induration. And check the IV fluid for correct
amount of drop rate
- For all dengue patients, pulses on dorsales pedis should be checked for
volume. (If you feel that the pulses are weak or not felt, check
the blood pressure immediately)
46
Shift in charge should allocate patients and assign work for each staff
Check the allocation book for your assigned patients and work
Visit patients and introduce yourself as their shift nurse
Explain nil per oral orders to parents as required
Prepare the patient and complete everything for morning
Plan nursing care so that patient is not disturbed during sleep
Visit patients frequently and observe the IV sites for disconnections, swelling and IV
drop rates
Ask the attendant to clean all areas of ward, wash trays and supervise their work
Ensure that patient take a feed before morning medication
Check vitals and give 6am medication/injections as required, inquire and assess for
any new symptoms
Send early morning investigations and collect the reports before rounds
If patients are posted for any special investigations ensure that patient is prepared
Check the cleanliness and tidiness of unit
Receive new admissions and carry out the admission procedure
Complete documentation (service notifications should be filled, all medications
marked, observations entered, and intake output calculated for 24 hours and
nurses notes written.)
Handover to next shift
Check the missing book, replace any items taken in your shift
Report to ward in-charge or shift in-charge before going off duty
DAILY TASKS OF MEDICAL WARD NURSES
FIRST SHIFT
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
47
Check the emergency trolley (check whether all equipments are in working
condition).
Check the daily census
Check the general cleanliness of the ward
Send linen to laundry/ Send Physio referral book and CSSD items
Take report from the previous shift
Visit patients after report and check patient’s condition (sleep, breakfast, comfort,
e.t.c.)
Check IV fluids/drainages/catheters)
Check vital signs for necessary patients & document
Prepare for doctors rounds.
Collect all due investigation results from the concerned departments
Give any due medications/feeding etc.
Do rounds with doctors & make sure that patient’s condition is explained to the
relatives
Check & identify the necessary medications that are over
Carry out due orders.
Send notification for cases with communicable diseases
Send required investigations and take appointments from other departments as needed
Check, prepare patients going for special investigations (USG, CT scan, X- ray,
endoscopy e.t.c)
Check preparation & send patients for the above investigations on time
See that autoclaved items are collected from the CSSD.
Report any unusual incidence to the shift coordinator.
Complete documentation.
Sponge bath & morning care
Monitor the morning care (senior nurses)
Change dressing
Change of tubes, catheter etc
Check vitals
Maintain I/O charts
Carrying out doctors orders
Do a round to check the patient’s condition
48
Make patients comfortable
12.00 n. change of position of bed ridden patients (change nappy)
Complete documentations
Pack used trays and clean/disinfect the treatment room
Check if all the above is done
Make necessary preparations to send the discharged patients home
Handing over to the next shift
Take / assist in the special treatments (nebulizations, dressings, Ambulations, sit up
on chair
Check cleanliness of the ward / unit
Report to the ward in charge on shift in charge going off duty
SECOND SHIFT
Report to ward on time
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Check the census
Check the general cleanliness of the ward
Take report from the previous shift
Visit patients after report and check patient’s condition (about rest / sleep, lunch,
comfort, e.g.)
Check IV fluids/drainages/catheters)
Check vital signs for necessary patients & document
Prepare for doctors rounds if necessary
Do rounds & carry out orders prioritizing them
Collect all due investigation results from the concerned departments
Give any due medications/feeding etc.
49
Send required investigations and take appointments from other departments as needed
Complete documentation.
Make the patients comfortable
Complete documentation.
Prepare patients for afternoon rest (draw curtains)
Check & prepare patients going for special investigations not completed in the
morning (scan, CT, X-ray, endoscopy)
Giving injections, nebulizations
Administering medications, giving NG feeds
Back care /change of nappy & positioning of bedridden patients
Send used linen / used trays to Laundry & CSSD
Collected items from the CSSD & laundry
Report any unusual incidence to the shift coordinator.
Maintain I/O charts and check vital signs
Re-check doctors orders
Complete documentations & hand over to the next shift
Check the cleanliness of the ward / unit
Report to the ward in charge on shift in charge going off duty
THIRD SHIFT Report to ward on time
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Check the daily census
Check the general cleanliness of the ward
Take report from the previous shift
Visit patients after report and check patient’s condition (about rest & comfort, e.g.)
Check IV fluids/drainages/catheters
Check vital signs for necessary patients & document
Collect all due investigation results from the concerned departments
50
Re-check doctors orders
Carry out any due orders
Do a round & check patient’s condition
Make the patients comfortable
Complete documentation.
Check, prepare & give specific instructions for patients going for special
investigations in the next morning (e.g: fasting, full bladder )
Administer medications, and carry out procedures e.g dressing, feeding etc.
Back care /change of nappy & positioning of bedridden patients
Prepare patients / unit for sleep (draw curtains / switch off necessary lights)
Send used linen to laundry
Report any unusual incidence to the shift coordinator.
Maintaining I/O charts / observation chart / vitals chart / Diabetic chart
Check cleanliness & tidiness of the ward
Complete documentations & hand over to the next shift
Report to the ward in charge on shift in charge going off duty
NIGHT SHIFT Report to ward on time
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Complete the daily census
Check the general cleanliness of the ward
Take report from the previous shift
Visit patients after report and check patient’s condition (about rest & comfort, e.g.)
Check IV fluids/drainages/catheters
Check vital signs for necessary patients & document
Collect all due investigation results from the concerned departments
Re-check doctors orders
51
Carry out any due orders
Do a round & check patient’s condition
Inform the concerned doctors about any deterioration in the patient’s condition
Make the patients comfortable
Complete documentation.
Check, prepare & ensure that the instructions are understood by the patients going for
special investigations in the next morning (e.g: fasting, full bladder )
Administer medications, and carry out procedures e.g dressing, feeding etc.
Back care /change of nappy & positioning of bedridden patients
Report any unusual incidence to the shift coordinator.
Complete I/O charts / observation chart / vitals chart / Diabetic chart
Check cleanliness & tidiness of the ward
Check the routine cleaning of the ward (washing of all the medication cups and all the
trays).
Check and arrange patient files
Check & prepare the registers & books in the ward
Identify medical patients in other wards & update the notice board
Give early morning care, back care & change position
Check vital signs
Give early morning injections & medications
Collect lab. samples make memos & send them to lab
Pack used articles & keep them ready for autoclaving
Check general cleanliness of the ward
Complete documentations & hand over to the next shift
Report to the ward in charge on shift in charge going off duty
52
DAILY TASKS OF GYNAE WARD NURSES
Morning shift
Report to ward on time
Check ward inventory and emergency trolley
Check narcotics inventory
Check FHS of the antenatal patients and whether the patient has maintained kick
count chart by the allocated staff
Check the treatment charts and baby charts whether medication had been given
Take report form the previous shift nurses (targeted time is before 7:45am)
Visit patients after report and check patient’s condition (about sleep, comfort,
contraction, bleeding, feeding, etc.)
Give morning care
Assess the patients who are having contractions and inform SOS by the allocated staff
Check for blood investigation reports, and get them from the lab, before rounds.
Prepare for doctors rounds.
Check and prepare patients going for special investigations (scan, CT, X-ray,
endoscopy, NST).
Check, prepare and send patients for the above investigations/ surgeries on time.
Give morning medications
Check vitals, FHS and kick count chart
Give perineal care and check for bleeding PV for cases like post natal mothers, post
operative cases, threatened abortion cases etc
53
Check IV fluids and drainages.
Do rounds with Doctors.
Carry out orders.
Do a round and check the patients’ condition.
Make patients comfortable
Give health education for the patients
Check the cleanliness and tidiness of the ward.
Complete documentation.
Complete the discharges as soon as possible.
Give bath for babies
Take babies for vaccination
Send blood investigations.
Send patients for other investigations.( scan, NST, BPP and surgeries as required)
Take/ assist in the special treatments (nebulizations, dressings, patient activity, sit up
on chair, ambulation)
Give perineal care for the postnatal mothers
Make patient comfortable.
Give SOS medication if necessary.
Maintain intake output chart
Check whether back care and positions are changed as required.
Complete documentation.
Check the cleanliness and tidiness of the ward/ unit.
Hand over to next shift.
Report to ward in charge or shift in charge before going off duty.
Write the leaving time in the over time sheet if stayed after 2:30pm by the shift in
charge
Afternoon shift
Report to ward on time
Check ward inventory and emergency trolley
Check narcotics inventory
Check FHS of the antenatal patients and whether maintained kick count charts by the
allocated staff
54
Check the treatment charts and baby charts whether medication had been given
Take report form the previous shift nurses.
Visit patients after report and check patient’s condition (about rest, lunch,
comfort – repositioning, room temperature, quietness of the room, sleep
etc)
Prepare patients for afternoon rest (draw curtains).
Check and prepare patients going for special investigations and surgeries not
completed in the morning (scan, CT, X-ray, endoscopy).
Check whether any patient has to be prepared for special investigation or surgeries for
next day.
Check, prepare patients for the above investigations.
Check for blood investigation reports, and get them from the lab.
Give afternoon medications
Check vital signs, FHS and kick count chart
Give perineal care and check for bleeding PV for cases like post natal mothers, post
operative cases, threatened abortion cases etc
Check IV fluids and drainages.
Do a round and check the patients’ condition.
Make patients comfortable.
Check the cleanliness and tidiness of the ward.
Give sos pain killers and keep patient ready for visitors.
Complete the discharges as soon as possible.
Complete documentation.
Send blood investigations.
Take/ assist in the special treatments (nebulizations, dressings etc.)
Take/ assist in checking the vitals.
Check whether back care and positions are changed as required.
Make patients comfortable, and tidy the ward.
Complete documentation.
Check the cleanliness and tidiness of the ward.
Hand over to next shift.
Report to ward in charge or shift in charge before going off duty
Write the time of leaving if stayed after 8:00pm by the shift inchrge
55
Evening shift
Report to ward on time
Check ward inventory and emergency trolley
Check narcotics inventory
Check the treatment charts and baby charts whether medication had been given
Check FHS of the antenatal patients and whether maintained kick count charts by the
allocated staff
Take report form the previous shift nurses.
Visit patients after report and check patient’s condition (about rest, comfort –
repositioning, room temperature, quietness of the room, sleep medication, pain
medication, etc.)
Check for urgent blood investigation reports, and get them from the lab..
Give evening medications and injections.
Make patient comfortable for dinner.
Check the cleanliness and tidiness of the ward.
Check vitals, FHS and kick count chart
Give perineal care and check for bleeding PV for cases like post natal mothers, post
operative cases, threatened abortion cases etc
Check IV fluids and drainages.
Do a round in the ward and check patients’ condition.
Explain the procedure about IOL for the posted patients
Patients who are posted for surgeries, fasting to be explained
Make sure all surgery patients has done PAC, Local preparation, all routine
investigation, cross match, consent etc
Make patients comfortable.
Carry out any emergency orders.
Take/ assist in the special treatments (nebulizations, dressings, patient activity like
ambulation, sit up on chair etc.)
Check whether back care and positions are changed as required.
Check and make patient comfortable for the night.
Give SOS medication if necessary.
Check the cleanliness and tidiness of the ward.
56
Complete documentation.
Hand over to next shift.
Report to ward in charge or shift in charge before going off duty.
Write the time of leaving if stayed later than 1pm by the shift incharge
Night Shift
Report to ward on time
Check ward inventory and emergency trolley
Check narcotics inventory
Check FHS of the antenatal patients and whether maintained kick count charts by the
allocated staff
Check the treatment charts and baby charts whether medication had been given
Take report form the previous shift nurses.
Visit patients after report and check patient’s condition (sleep, comfort –
repositioning, room temperature, quietness of the room, sleep medication, pain
medication, etc.)
Complete the census.
Check the cleanliness and tidiness of the ward.
Check the routine cleaning of the ward for the previous day (washing of all the
medication cups, all the trays like IV tray, mouth care tray, injection tray etc.).
Check IV fluids, drainages etc.
Do a round in the ward and check patients’ condition.
Carry out any emergency orders.
Identify and confirm patients who need to be fasting for investigations, operations etc.
Complete the documentation.
Check vitals, FHS and kick count chart
Give perineal care and check for bleeding PV for cases like post natal mothers, post
operative cases, threatened abortion cases etc
Check IV fluids and drainages.
Check weight for PIH patients as required
Check urine sugar and urine albumin for patients with PIH and GDM
Start IV fluids for all surgery cases by 6am.
Give enema for patients who are posted for surgeries and IOL
57
for major surgeries like LSCS, Hysterectomy, do catheterization
Give early morning care, back care and change of positions as required.
Give early morning injections and medication.
Check the cleanliness and tidiness of the ward.
Send things for autoclaving
Complete documentation.
Shift the first case to OT by the allocated staff when OT informs
Start shifting IOL patient to the L/R by the allocated staff
Hand over to next shift.
Report to ward in charge or shift in charge before going off duty.
Record going off time if exceed after 8:00am by the shift in charge
Special points to remember
All the un usual incidents to be reported to the coordinator
Any case of MLC admitted to the ward should be informed to the coordinator and
MLC form should be completed by the GMO and send it to CEO office on the
following day
Send all the charts for dispatching to medical records when the patient is discharged
All unmarried mothers should be informed to counseling coordinator
Any IUFD, high risk patients, sick patients should be informed to coordinator
Gynae ward standing order to be followed by all the staff (eg, checking FHS 2 hourly)
Vaccination protocol should be followed
Work as a team and build good relationship between coworkers
58
DAILY TASKS OF ENT WARD NURSES
Morning shift
Report to ward on time.
Check ward inventory.
Check narcotics inventory.
Take report from the previous shift nurses.
Prepare for doctors rounds.
Visit patients after report and check patient’s condition (about sleep, breakfast,
comfort, etc.)
Check prepare patient’s going for surgery.
Give morning care.
Check soakage of dressing color of finger of pop hand /leg.
Check and prepare patients going for special investigations (scan, CT, X-ray,
endoscopy).
Check, prepare and send patients for the above investigations on time.
Check for blood investigation reports, and get them from the lab, before rounds.
Give morning medications and injections.
Monitor the morning care (senior nurses).
Check IV fluids and drainages. positions, tractions
Do ward rounds with Doctors.
Carry out orders.
Do a rounds check the patients’ condition
Make patients comfortable.
59
Check the cleanliness and tidiness of the ward.
Complete documentation.
Complete the discharges as soon as possible.
Send blood investigation.
Send patients for other investigations.
Take/assist in the special treatments (nebulizations, dressings, ambulations, sit up on
chair), exercises of finger pop hand / leg.
Take/ assist in checking the vitals pulse of pop hand.
Make patient comfortable.
Give sos medication I check soakage of dressing necessary.
Check whether back care and positions are changed as required.
Complete documentation.
Check the cleanliness and tidiness of the ward/unit.
Hand over to next shift.
Report to ward in charge or shift in charge going off duty,
Doctors round start at 7:45am
Afternoon shift
Report to ward on time.
Check ward inventory
Check narcotics inventory
Take report from the previous shift nurses.
Visit patients after report and check patient’s condition (about rest, lunch, comfort-
repositioning, room temperature, quietness of the room, sleep etc.)
Check soakage of dressing.
Prepare patients for afternoon rest (draw curtains)
Check and prepare patients going for special investigations not completed in the
morning (scan, CT, X-ray, endoscopy.)
Check whether any patient has to be prepared for special investigation for next day.
Check, prepare patients for the above investigations.
Check for blood investigation reports, and get them from the lab.
Give afternoon medications and injections.
Check IV fluids and drainages positions of tractions
60
Do a round and check the patient’s condition.
Check soakage of dressing.
Make patients comfortable.
Check the cleanliness and tidiness of the ward.
Give sos pain killers and keep patient ready for visitors.
Complete the discharge as soon as possible
Complete documentation.
Send blood investigations.
Give and /assist in the special treatments (nebulizations, dressings etc), Exercise of
finger of pop hand leg.
Check whether back care and positions are changed as required.
Make patients comfortable, and tidy the ward.
Check soakage of dressings
Check the cleanliness and tidiness of the ward.
Hand over to next shift.
Report to ward in charge or shift in charge before going off duty.
Preparation of patients for surgery (shaving consent etc).
Evening shift
Report to ward on time
Check ward inventory
Check narcotic inventory
Take report from the previous shift nurses,
Visit patients after report and check patient’s condition (about rest, lunch, comfort-
repositioning, room temperature, quietness of the room, sleep etc.)
Check soakage of dressing and color of finger of pop hand /leg.
Check for urgent blood investigation reports, and get them from the lab..
Give evening medications and injections
Make patient comfortable for dinner.
Check the cleanliness and tidiness of the ward.
Check IV fluids and drainages.
Do a round and check the patient’s condition.
Carry out any emergency orders.
61
Make patients comfortable.
Complete documentation
Check whether back care and positions are changed as required
Take/assist in the special treatments (nebulizations, dressings, Exercises of finger pop
hand / leg.
Give/ assist in checking the vitals and check pulse of pop hand/leg
Give sos medication if necessary.
Check and make patients comfortable for the night.
Check the cleanliness and tidiness of the ward.
Complete documentation
Hand over to next shift.
Report to ward in charge or shift in charge before going off duty
Night Shift
Report to ward on time
Check ward inventory
Check narcotic inventory
Take report from the previous shift nurses,
Visit patients after report and check patient’s condition (sleep comfort-repositioning,
room temperature, quietness of the room, sleep medication sos.)
Check soakage of dressing and color of fingers of pop hand /leg.
Complete the census.
Check the cleanliness and tidiness of the ward.
Check the routine cleaning of the ward for the previous day (washing of all the
medication cups, all the trays like IV tray, mouth care tray, injection tray etc.
Check IV fluids and drainages position and tractions.
Do a round and check the patient’s condition.
Carry out any emergency orders.
Identify and conform patients who need to be fasting for investigations, operations.
Complete documentation
Take/ assist in checking the vitals and pulse of pop hand/leg
Give Early morning care, back care and change of positions as required,
Give early morning injections and medication.
Check the cleanliness and tidiness of the ward.
62
Complete documentation.
Hand over to next shift.
Report to ward in charge or shift in charge before going off duty
SHIFT ROUTINES FOR SURGICAL WARD NURSES
FIRST SHIFT
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check if all equipments are in working condition).
Check the daily census
Check the general cleanliness of the ward
Send linen to laundry/ Send Physio referral book and CSSD items
Take report from the previous shift
Visit patients after report & check patient’s condition (sleep, breakfast, comfort, e.t.c.)
Check IV fluids/drainages/catheters)
Check & prepare patients going for surgery
Send patients for surgery as per request from OT
Give morning care
Check soakage of dressings
Check vital signs for necessary patients & document
Receive patients from OT
Monitor the immediate post operative cases
Prepare for doctors rounds.
Collect all due investigation results from the concerned departments
Give due medications
Do rounds with doctors & make sure that patient’s condition is explained to the
relatives
Check & identify the necessary medications that are over
63
Carry out due orders.
Send notification for cases with communicable diseases
Send required investigations and take appointments from other departments as needed
Check, prepare patients going for special investigations (USG, CT scan, X- ray,
endoscopy e.t.c)
Check preparation & send patients for the above investigations on time
See that autoclaved items are collected from the CSSD.
Report any unusual incidence to the shift coordinator.
Complete documentation.
Sponge bath & morning care
Monitor the morning care (senior nurses)
Change dressing
Change of tubes, catheter etc
Check vitals
Maintain I/O charts
Carrying out doctors orders
Do a round to check the patient’s condition
Make patients comfortable
12.00 nn. change of position of bed ridden patients (change nappy)
Complete documentations
Pack used trays and clean/disinfect the treatment room / dressing trolleys
Check if all the above is done
Make necessary preparations to send the discharged patients home
Handing over to the next shift
Take / assist in the special treatments (nebulization, dressings, Ambulation, sit up on
chair)
Check cleanliness & tidiness of the ward / unit
Report to the ward in charge on shift in charge going off duty
SECOND SHIFT
Report to ward on time
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
64
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Check the census
Check the general cleanliness of the ward
Take report from the previous shift
Visit patients after report and check patient’s condition (about rest / sleep, lunch,
comfort-repositioning, room temperature, quietness of the place e.t.c)
Monitor the immediate post-operative cases
Check IV fluids/drainages/catheters/soakage ofdrssings)
Check vital signs for necessary patients & document
Prepare for doctors rounds if necessary if needed
Do rounds & carry out orders prioritizing them
Collect all due investigation results from the concerned departments
Give any due medications/feeding etc.
Send required investigations and take appointments from other departments as needed
Complete documentation.
Make the patients comfortable
Complete documentation.
Prepare patients for afternoon rest (draw curtains)
Check & prepare patients going for special investigations not completed in the
morning (scan, CT, X-ray, endoscopy)
Prepare patients posted for surgery (shaving, consent etc)
Administer medications (SOS /routine), give NG feeds
Check IV fluids/drainages/catheters/soakage of drssings)
Back care /change of nappy & positioning of bedridden patients
Send used linen / used trays to Laundry & CSSD
Collected items from the CSSD & laundry
Report any unusual incidence to the shift coordinator.
Maintain I/O charts and check vital signs
Re-check doctors orders
Complete documentations
Check the cleanliness of the ward / unit
65
Handover to the next shift
Report to the ward in charge on shift in charge going off duty
THIRD SHIFT Report to ward on time
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Check the daily census
Check the general cleanliness of the ward
Take report from the previous shift
Visit patients after report and check patient’s condition (about rest & comfort, e.g.)
Check IV fluids/drainages/catheters
Check vital signs for necessary patients & document
Collect all due investigation results from the concerned departments
Re-check doctors orders
Carry out any due orders
Do a round & check patient’s condition
Make the patients comfortable
Complete documentation.
Check, prepare & give specific instructions for patients going for special
investigations in the next morning (e.g: fasting, full bladder )
Give specific instructions to patients posted for surgery
Administer medications, and carry out procedures e.g dressing, feeding etc.
Back care /change of nappy & positioning of bedridden patients
Prepare patients / unit for sleep (draw curtains / switch off necessary lights)
Send used linen to laundry
Report any unusual incidence to the shift coordinator.
Maintaining I/O charts / observation chart / vitals chart / Diabetic chart
Check cleanliness & tidiness of the ward
66
Complete documentations & hand over to the next shift
Report to the ward in charge on shift in charge going off duty
NIGHT SHIFT Report to ward on time
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Complete the daily census
Check the general cleanliness of the ward
Take report from the previous shift
Visit patients after report and check patient’s condition (about rest & comfort, e.g.)
Check IV fluids/drainages/catheters/soakage of dressings
Check vital signs for necessary patients & document
Collect all due investigation results from the concerned departments
Re-check doctors orders
Carry out any due orders
Do a round & check patient’s condition
Check immediate post operative cases
Inform the concerned doctors about any deterioration in the patient’s condition
Make the patients comfortable
Complete documentation.
Check, prepare & ensure that the instructions are understood by the patients going for
special investigations in the next morning (e.g: fasting, full bladder )
Administer medications, and carry out procedures e.g dressing, feeding etc.
Give early morning care , back care and change of positions as required
Report any unusual incidence to the shift coordinator.
Complete I/O charts / observation chart / vitals chart / Diabetic chart
Check cleanliness & tidiness of the ward
Check the routine cleaning of the ward (washing of all the medication cups and all the
trays).
67
Check and arrange patient files
Check & prepare the registers & books in the ward
Give early morning care, back care & change position
Check vital signs
Give early morning injections & medications
Collect lab. samples make memos & send them to lab
Pack used articles & keep them ready for autoclaving
Check general cleanliness of the ward
Complete documentations & hand over to the next shift
Report to the ward in charge on shift in charge going off duty
DAILY TASKS OF ISOLATION WARD NURSES
FIRST SHIFT
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Check the daily census
Check the general cleanliness of the ward
Send linen to laundry/ Send Physio referral book and CSSD items
Take report from the previous shift
Visit patients after report and check patient’s condition (sleep, breakfast, comfort,
e.t.c.)
Take appropriate infection control measures while visiting patients
Ensure if all personal protective equipments are available for the day
Check IV fluids/drainages/catheters)
Check vital signs for necessary patients & document
Prepare for doctors rounds.
68
Collect all due investigation results from the concerned departments
Give any due medications/feeding etc.
Do rounds with doctors & make sure that patient’s condition is explained to the
relatives
Check & identify the necessary medications that are over
Carry out due orders.
Send notification for cases with communicable diseases
Send required investigations and take appointments from other departments as needed
Check, prepare patients going for special investigations (USG, CT scan, X- ray, e.t.c)
Check preparation & send patients for the above investigations on time
See that autoclaved items are collected from the CSSD.
Report any unusual incidence to the shift coordinator.
Complete documentation.
Sponge bath & morning care
Monitor the morning care (senior nurses)
Change dressing
Change of tubes, catheter etc
Check vitals
Maintain I/O charts
Carrying out doctors orders
Do a round to check the patient’s condition
Make patients comfortable
12.00 n. change of position of bed ridden patients (change nappy)
Complete documentations
Pack used trays and clean/disinfect the treatment room trolleys
Check if all the above is done
Make necessary preparations to send the discharged patients home
Disinfect cubicles after patients leave the room
Handing over to the next shift
Take / assist in the special treatments (nebulizations, dressings, Ambulations, sit up
on chair
Check cleanliness of the ward / unit
Report to the ward in charge on shift in charge going off duty.
69
SECOND SHIFT
Report to ward on time
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Check the census
Check the general cleanliness of the ward
Take report from the previous shift
Visit patients after report and check patient’s condition (about rest / sleep, lunch,
comfort, e.g.)
Take appropriate infection control measures while visiting patients
Check IV fluids/drainages/catheters)
Check vital signs for necessary patients & document
Prepare for doctors rounds if necessary
Do rounds & carry out orders prioritizing them
Collect all due investigation results from the concerned departments
Give any due medications/feeding etc.
Send required investigations and take appointments from other departments as needed
Complete documentation.
Make the patients comfortable
Complete documentation.
Prepare patients for afternoon rest (draw curtains)
Remind to mimize visitors during the visiting hours
Check & prepare patients going for special investigations not completed in the
morning (scan, CT, X-ray, endoscopy)
Giving injections, nebulizations
Administering medications, giving NG feeds
Back care /change of nappy & positioning of bedridden patients
Send used linen / used trays to Laundry & CSSD
Collected items from the CSSD & laundry
Disinfect cubicles after patients leave the room
70
Report any unusual incidence to the shift coordinator.
Maintain I/O charts and check vital signs
Re-check doctors orders
Complete documentations & hand over to the next shift
Check the cleanliness of the ward / unit
Report to the ward in charge on shift in charge going off duty
THIRD SHIFT Report to ward on time
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Check the daily census
Check the general cleanliness of the ward
Take report from the previous shift
Visit patients after report and check patient’s condition (about rest & comfort, e.g.)
Check IV fluids/drainages/catheters
Check vital signs for necessary patients & document
Collect all due investigation results from the concerned departments
Re-check doctors orders
Carry out any due orders
Do a round & check patient’s condition
Make the patients comfortable
Complete documentation.
Check, prepare & give specific instructions for patients going for special
investigations in the next morning (e.g: fasting, full bladder )
Administer medications, and carry out procedures e.g dressing, feeding etc.
Back care /change of nappy & positioning of bedridden patients
Prepare patients / unit for sleep (draw curtains / switch off necessary lights)
Send used linen to laundry
Report any unusual incidence to the shift coordinator.
71
Maintaining I/O charts / observation chart / vitals chart / Diabetic chart
Check cleanliness & tidiness of the ward
Complete documentations & hand over to the next shift
Report to the ward in charge on shift in charge going off duty
NIGHT SHIFT Report to ward on time
Check ward inventory (check whether all the equipments are in working condition
and if there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the
previous shift and see that it is entered in the narcotics register).
Check the emergency trolley (check whether all equipments are in working
condition).
Complete the daily census
Check the general cleanliness of the ward
Take report from the previous shift
Visit patients after report and check patient’s condition (about rest & comfort, e.g.)
Check IV fluids/drainages/catheters
Check vital signs for necessary patients & document
Collect all due investigation results from the concerned departments
Re-check doctors orders
Carry out any due orders
Do a round & check patient’s condition
Inform the concerned doctors about any deterioration in the patient’s condition
Make the patients comfortable
Complete documentation.
Check, prepare & ensure that the instructions are understood by the patients going for
special investigations in the next morning (e.g: fasting, full bladder )
Administer medications, and carry out procedures e.g dressing, feeding etc.
Back care /change of nappy & positioning of bedridden patients
Report any unusual incidence to the shift coordinator.
Complete I/O charts / observation chart / vitals chart / Diabetic chart
Check cleanliness & tidiness of the ward
72
Check the routine cleaning of the ward (washing of all the medication cups and all the
trays).
Check and arrange patient files
Check & prepare the registers & books in the ward
Identify medical patients in other wards & update the notice board
Give early morning care, back care & change position
Check vital signs
Give early morning injections & medications
Collect lab. samples make memos & send them to lab
Pack used articles & keep them ready for autoclaving
Check general cleanliness of the ward
Complete documentations & hand over to the next shift
Report to the ward in charge on shift in charge going off duty
73
DAILY TASKS OF ACCIDENTS AND EMERGENCY DEPARTMENT NURSES Morning (1 st shift), Afternoon (2 nd shift) & Evening (3 rd shift);
Report to ward on time
Check inventory (ER, narcotics, dressing room, procedure room)
Take report from the previous shift nurses
Visit patients during taking over and check patients’ condition
Receive the new patients and accompany/direct them to the bed
Make patients comfortable; ask the patient’s complaints
Take/assist in checking vitals, procedures
Inform the concerned doctor and attend patients along with doctors
Carry out doctor’s orders
Administer stat medications immediately
Monitor patients’ conditions frequently till stable
Check IV fluids, drainages (if any)
Send lab investigations on time and collect reports on time
Take /assist in the special treatments (nebulizations, dressings, etc)
Do a round and check patients' condition from time to time
Complete documentations of all procedures (maintain the census register properly)
Try and shift all admissions to the respective wards as soon as possible
Complete the discharges as soon as possible
Inform all incidences (minor/ major) to shift-in-charge at all times
Keep ER ready at all times
Maintain the cleanliness and tidiness of the casualty complex
Keep casualty complex (dressing room, procedure room, blood bank,) ready at all
times
Maintain a professional relationship with other team members
Report to shift-in-charge when ever leaving ER
Hand over to next shift staff
Report to next shift-in-charge before going off duty
Night (4 th shift);
74
Report to ward on time
Check inventory (ER, narcotics, dressing room, procedure room)
Take report from the previous shift nurses
Visit patients during taking over and check patients’ condition
Receive the new patients and accompany/direct them to the bed
Make patients comfortable; ask the patient’s complaints
Take/assist in checking vitals, procedures
Inform the concerned doctor and attend patients along with doctors
Carry out doctor’s orders
Administer stat medications immediately
Monitor patients’ conditions frequently till stable
Check IV fluids, drainages (if any)
Send lab investigations on time and collect reports on time
Take /assist in the special treatments (nebulizations, dressings, etc)
Do a round and check patients' condition from time to time
Complete documentations of all procedures (maintain the census register properly)
Try and shift all admissions to the respective wards as soon as possible
Complete the discharges as soon as possible
Inform all incidences (minor/ major) to shift-in-charge at all times
Clean and maintain the tidiness the casualty complex (dressing room, procedure
room, blood bank) and keep ready for morning shift
Keep casualty complex (dressing room, procedure room, blood bank, ER) ready at all
times
Maintain a professional relationship with the other team members
Report to shift-in-charge when ever leaving ER
Hand over to morning shift staff
Report to morning shift-in-charge / ward sister before going off duty
DAILY TASK OF ICCU NURSES
75
7.30 am – Report for duty
7.30 am to 7.45am
Check inventories (narcotics, daily drug inventory, daily inventory, emergency trolley
etc). Replace if anything is missing from emergency trolley
Enquire about missing items, broken things and clear all doubts before taking the
report
Count and enter laundry linen
Count and send CSSD things
7.45am to 8.15am – Take patient report from previous shift nurses
8.15am to 8.30am - Take over special instructions and check allocated patients
8.30am 8.45 am – Bedside take over of individual assigned patients
Check at bedside
All allocated patient’s chart whether it is completed or not
All IV lines / IV sites / IVF balance and labels / any drugs added / CVP lines / dialysis
catheter (if any) in situ.
If urine catheter in situ check urine bag (colour and amount if any urine present)
Loaded injections balance and labels (if any)
Unit cleanliness and left over food containers
If patient on ventilator – check whether tubings are connected properly and water
collection in the tubings and drain cups / check humidifier if water to be filled
Check current settings of the ventilator
Check whether test lung and test tube are on the ventilator and nebuliser is attached to
the ventilator
Check bedside oxygen cylinder whether it is full, ambu bag with oxygen connection
and reservoir bag is ready in good working condition
Cardiac monitor for rhythm and whether chest leads are properly connected or not and
whether finger pulse probe is connected or not
76
Whether bedside equipments (suction machine / infusion pumps / cardiac monitor etc)
are in good working conditions
Whether all nursing interventions are recorded legibly / any investigations pending /
any reports to be collected
Specific interventions like I/O of the patient / vital signs / saturation / oxygen intake /
CVP ( if on ventilator) / sleep pattern / personal hygiene / bowel
8.45am to 9.00am
Check vital signs and record
Assess patient’s conscious level and pupil reaction
Assess GCS for relevant patients
Endotracheal suctioning and oral suctioning (for ventilator patients) – observe
secretion (amount and color)
Flush arterial line (if present) every hourly or as ordered
Check patient’s file ( read nurses notes and doctors orders)
Compare treatment chart with doctors orders
Attend ward round
Carry out doctor’s orders
Make sure the relatives are explained about the patient condition by the treating
doctor
Check all medicines and get prescription from the doctors
Receive laundry items and CSSD items, count and replace
Inform shift in-charge if any balance remaining
9.00am to 10.00am
Check vital signs and record
Inform any abnormalities and carry out orders
Do suctioning if necessary
If patient is getting RT feeding Q3hrly, give the feed list and explain the relatives (if
not done previously)
Give feeding and record
If patient is on normal diet request the relatives to bring food and serve to the patient
77
Empty and wash the food containers. Do not leave unfinished food in the locker
For patients on ventilator, give back care and observe the skin for skin laceration,
bedsores, edema, and any other skin problems
Give sponge bath or toilet bath for other patients
While giving mouth care check whether patient has loose teeth, bleeding gums, dry
and cracked lips, tongue if coated etc
While giving back care and turning the patient, check whether the air mattress is
working or not (if it is there)
While giving catheter and perineal care observe the perineum and catheter site for any
abnormalities. Inform the duty medical officer and carry out orders
Give catheter care with betadine solution by using aseptic technique
Clean perineal area with soap and water
Give hair wash every Saturday
Flush CVP line and measure CVP (if on ventilator) and record
Maintain hygiene chart
Check, prepare and send patients for special investigations on time
Assist in physiotherapy sos
Change position as advised
Start writing nurses notes
10.00am to 11.00am
ET and oral suctioning if necessary
Check vital signs and record
Any abnormalities inform to duty medical officer and carry out orders
Re-check vitals after carrying out orders (eg: if temperature is high)
Keep all the patients ready for visitors
Check the cubicles and make the patient neat
11.00am to 12.00pm
78
Check vital signs and record
Allow one relative at a time to visit the patient
Spend time to talk with them and clarify their doubts
Give prescription if any
If any other items like toiletries or drinking water is finished, ask the relatives to get it
Receive the CSSD things, count and replace all items
Take a break of 10 -15 minutes during this time (two staff can go together)
12pm to 1.15 pm
Check vital signs and record
Inform and carry out orders if any abnormalities
Administer due medication if any
RT feed if patient is on Nasogastric feeds
Serve lunch for those on normal diet
Record in I/O chart
Check ventilator tubings again. If water is collected empty drain cups and tubings
Refill humidifier with sterile water (if necessary)
Complete nurses notes and re-check whether the chart is complete or not
Go through page by page and check whether all information is complete or not
Keep patient and cubicle clean
If any bed is vacant prepare the cubicle and keep ready to receive another patient
Check if any equipment or any place needs a repair work and inform
If any item is borrowed make sure it is returned or else report it to the next shift
nurses
Report if any item is given to another ward. Try to get it back before you hand over to
next shift nurses
Check whether patient has to replace any drugs. If so, replace it before you hand over
Check the emergency trolley and make sure it is ready to use
Check all ventilators not in use and keep it ready for next use
Check defibrillator and ECG machine and keep it ready for next use
Check and keep the standing wreck ready. Replace all the items
79
Check whether attendants have completed their work (sweeping, mopping, cleaning
toilets, changing sodium hypochlorite, emptying dustbin, laundry, CSSD things,
washing slippers, gloves washed and packing, changing rubber sheets etc)
Check the over all cleanliness of the ward is maintained or not
Be ready to handle any emergencies in the ward. Do not neglect other patients while
you attend emergencies
If patient is on ventilator, check the timings for medications and administer
accordingly
Collect all reports of investigations sent and enter where appropriate
Complete your work and chart including round order book
Complete the registers as appropriate
Enter all services rendered in the service notification book
1.15 pm to 1.45 pm
Give a detail report of your patients and handover to the next shift nurses
Allow the next shift nurse to check patient’s bedside and charts
Give her time to clarify her doubts before you leave
1.45 pm to 2.30 pm
Wash and pack all the trays used
Write your name and date legibly while keeping trays for autoclave
Arrange nurses counter
Attend any emergencies during that shift
Report to shift in-charge of the next shift before leaving the ward
SECOND SHIFT
80
1.00 pm – Report for duty
1.00 pm to 1.15 pm
Check inventories (narcotics, daily drug inventory, daily inventory, emergency trolley
etc). Replace if anything is missing from emergency trolley
Enquire about missing items, broken things and clear all doubts before taking the
report
1.15 pm to 1.45 pm – Take patient report from previous shift nurses
1.45 pm to 2.00 pm - Take over special instructions and check allocated patients
2.00 pm to 2.15 pm – Bedside take over of individual assigned patients
Check at bedside
All allocated patient’s chart whether it is completed or not
All IV lines / IV sites / IVF balance and labels / any drugs added / CVP lines / dialysis
catheter (if any) in situ.
If urine catheter in situ check urine bag (colour and amount if any urine present)
Loaded injections balance and labels (if any)
Unit cleanliness and left over food containers
If patient on ventilator – check whether tubings are connected properly and water
collection in the tubings and drain cups / check humidifier if water to be filled
Check for whether test lung and test tube are on the ventilator and nebuliser is
attached to the ventilator
Check current settings of the ventilator
Bedside oxygen cylinder whether it is full and whether ambu bag with oxygen
connection and reservoir bag is ready and in good working condition
Cardiac monitor for rhythm and whether chest leads are properly connected or not and
whether finger pulse probe is connected or not
Whether bedside equipments (suction machine / infusion pumps / cardiac monitor etc)
are in good working conditions
Whether all nursing interventions are recorded legibly / any investigations pending /
any reports to be collected
81
Specific interventions like I/O of the patient / vital signs / saturation / oxygen intake /
CVP ( if on ventilator) / sleep pattern / personal hygiene / bowel
2.15pm to 2.30pm
Check vital signs and record
Assess patient’s conscious level and pupil reaction (SOS)
Endotracheal suctioning and oral suctioning (for ventilator patients) – observe
secretion (amount and color)
Flush arterial line (if present) every hourly or as ordered
Check patient’s file ( read nurses notes and doctors orders)
Compare treatment chart with doctors orders
Attend ward round (sos)
Carry out doctor’s orders
Make sure the relatives are explained about the patient condition by the treating
doctor
Check all medicines and get prescription from the doctors (if any)
2.30 pm to 3.30 pm
Check vital signs and record
Inform any abnormalities and carry out orders
Do suctioning if necessary
If patient is getting RT feeding Q3hrly, give the feed list and explain the relatives (if
not done previously)
Give feeding and record
If patient is on normal diet request the relatives to bring food and serve to the patient
Empty and wash the food containers. Do not leave unfinished food in the locker
For patients on ventilator give back care and observe the skin for skin laceration,
bedsores, edema, and any other skin problems
While giving back care and turning the patient, check whether the air mattress is
working or not (if it is there)
While giving catheter and perineal care observe the perineum and catheter site for any
abnormalities. Inform the duty medical officer and carry out orders
Give catheter care with betadine solution by using aseptic technique
Clean perineal area with soap and water
Flush CVP line and measure CVP (if on ventilator) and record
82
Maintain hygiene chart
Change position as advised
Check, prepare and send patients for special investigations on time (if not sent in the
morning)
Prepare patients for afternoon rest
Start writing nurses notes
3.30 pm to 4.30 pm
ET and oral suctioning if necessary
Check vital signs and record
Any abnormalities inform to duty medical officer and carry out orders
Re-check vitals after carrying out orders (eg: if temperature is high)
Check the cubicles and make the cubicle and patient neat
Check and count the laundry things and CSSD things with the attendants
Send laundry and CSSD things
4.30 pm to 5.30 pm
Check vital signs and record
Keep all the patients ready for visitors
Give prescription if any
If any other items like toiletries or drinking water is finished, ask the relatives to get it
Receive laundry things, count and replace
Inform shift in-charge if any balance remaining
Take a break of 10 -15 minutes during this time (maximum two staff can go together)
5.30 pm to 6.15 pm
Check vital signs and record
Inform and carry out orders if any abnormalities
Administer due medication if any
RT feed if patient is on Naso-gastric feeds
Serve a snack if on normal diet
Record in I/O chart
83
Allow one relative at a time to visit the patient
Spend time to talk with them and clarify their doubts
Check ventilator tubing again. If water is collected empty drain cups and tubing
Refill humidifier with sterile water (if necessary)
Complete nurses notes and re-check whether the chart is complete or not
Go through page by page and check whether all information is complete or not
Keep patient and cubicle clean
If any bed is vacant prepare the cubicle and keep ready to receive another patient
Check if any equipment or any place needs a repair work and inform
If any item is borrowed make sure it is returned or else report it to the next shift
nurses
Report if any item is given to another ward. Try to get it back before you hand over to
next shift nurses
Check whether patient has to replace any drugs. If so, replace it before you hand over
Check the emergency trolley and make sure it is ready to use
Check all ventilators not in use and keep it ready for next use
Check defibrillator and ECG machine and keep it ready for next use
Check and keep the standing rack ready. Replace all the items
Check whether attendants have completed their work (sweeping, mopping, cleaning
toilets, changing sodium hypochlorite, emptying dustbin, laundry, CSSD things,
washing slippers, gloves washed and packing, changing rubber sheets etc)
Check the over all cleanliness of the ward is maintained or not
Be ready to handle any emergencies in the ward. Do not neglect other patients while
you attend emergencies
Communicate with the shift in-charge always
If patient is on ventilator, check the timings for mediations and administer
accordingly
Collect all reports of investigations sent and enter where appropriate
Complete your work and chart including round order book
Complete the registers as appropriate
Enter all services rendered in the service notification book
6.15 pm to 6.45 pm
84
Give a detail report of your patients and handover to the next shift nurses
Allow the next shift nurse to check patient’s bedside and charts
Give her time to clarify her doubts before you leave
6.45 pm to 8.00 pm
Wash and pack all the trays used
Write your name and date legibly while sending trays for autoclave
Arrange nurses counter
Report to shift in-charge of the next shift before leaving the ward
THIRD SHIFT
6.00 pm – Report for duty
6.00 pm to 6.15 pm
Check inventories (narcotics, daily drug inventory, daily inventory, emergency trolley
etc). Replace if anything is missing from emergency trolley
Enquire about missing items, broken things and clear all doubts before taking the
report
6.15 pm to 6.45 pm – Take patient report from previous shift nurses
6.45 pm to 7.00 pm - Take over special instructions and check allocated patients
7.00 pm to 7.15 pm – Bedside take over of individual assigned patients
Check at bedside
All allocated patient’s chart whether it is completed or not
All IV lines / IV sites / IVF balance and labels / any drugs added / CVP lines / dialysis
catheter (if any) in situ.
If urine catheter in situ check urine bag (colour and amount if any urine present)
Loaded injections balance and labels (if any)
85
Unit cleanliness and left over food containers
If patient on ventilator – check whether tubings are connected properly and water
collection in the tubings and drain cups / check humidifier if water to be filled
Check current settings of the ventilator
Bedside oxygen cylinder whether it is full and whether ambu bag with oxygen
connection and reservoir bag is ready and in good working condition
Cardiac monitor for rhythm and whether chest leads are properly connected or not and
whether finger pulse probe is connected or not
Whether bedside equipments (suction machine / infusion pumps / cardiac monitor etc)
are in good working conditions
Whether all nursing interventions are recorded legibly / any investigations pending /
any reports to be collected
Specific interventions like I/O of the patient / vital signs / saturation / oxygen intake /
CVP ( if on ventilator) / sleep pattern / personal hygiene / bowel
7.15 pm to 7.30 pm
Check vital signs and record
Assess patient’s conscious level and pupil reaction (SOS)
Endotracheal suctioning and oral suctioning (for ventilator patients) – observe
secretion (amount and color)
Flush arterial line (if any) every hourly or as ordered
Check patient’s file ( read nurses notes and doctors orders)
Compare treatment chart with doctors orders
Carry out doctor’s orders
Check all medicines and get prescription from the doctors (sos)
a. pm to 8.30 pm
Check vital signs and record
Inform any abnormalities and carry out orders
Do suctioning if necessary
If patient is getting RT feeding Q3hrly, give the feed list and explain the relatives (if
not given previously)
Give feeding and record
If patient is on normal diet request the relatives to bring food and serve to the patient
Empty and wash the food containers. Do not leave unfinished food in the locker
86
Give back care and observe the skin for skin laceration, bedsores, edema, and any
other skin problems
While giving back care and turning the patient, check whether the air mattress is
working or not (if it is there)
Give back care and catheter care
While giving catheter and perineal care observe the perineum and catheter site for any
abnormalities. Inform the duty medical officer and carry out orders
Give catheter care with betadine solution by using aseptic technique
Clean perineal area with soap and water
Flush and measure CVP (if on ventilator) and record
Maintain hygiene chart
Change position as required
Start writing nurses notes
8.30 pm to 9.30 pm
ET and oral suctioning if necessary
Check vital signs and record
Any abnormalities inform to duty medical officer and carry out orders
Re-check vitals after carrying out orders (eg: if temperature is high)
Check the cubicles and make the patient neat
Receive CSSD things (if ready), count and replace all items
Inform shift in-charge if not received or if any balance remaining
9.30 pm to 10.30 pm
Check vital signs and record
Give prescription if any
If any other items like toiletries or drinking water is finished, ask the relatives to get it
Administer medications if any
Take a break of 10 -15 minutes during this time (maximum two staff can go together)
10.30 pm to 12 midnight
Check vital signs and record
Inform and carry out orders if any abnormalities
Administer due medication if any
87
RT feed if patient is on Naso-gastric feeds
Serve dinner for those on normal diet
Empty and wash the food containers. Do not leave unfinished food in the locker
Record in I/O chart
Check ventilator tubing again. If water is collected, empty drain cups and tubing
Refill humidifier with sterile water (if necessary)
Complete nurses notes and re-check whether the chart is complete or not
Go through page by page and check whether all information is complete or not
Keep patient and cubicle clean
If any bed is vacant prepare the cubicle and keep ready to receive another patient
Check if any equipment or any place needs a repair work and inform
If any item is borrowed make sure it is returned or else report it to the next shift
nurses
Report if any item is given to another ward. Try to get it back before you hand over to
next shift nurses
Check whether patient has to replace any drugs. If so, replace it before you hand over
Check the emergency trolley and make sure it is ready to use
Check all ventilators not in use and keep it ready for next use
Check defibrillator and ECG machine and keep it ready for next use
Check and keep the standing rack ready. Replace all the items
Check whether attendants have completed their work (sweeping, mopping, cleaning
toilets, changing sodium hypochlorite, emptying dustbin, laundry, CSSD things,
washing slippers, gloves washed and packing, changing rubber sheets etc)
Check and count the laundry things and send to laundry
Check the over all cleanliness of the ward is maintained or not
Be ready to handle any emergencies in the ward. Do not neglect other patients while
you attend emergencies
Supervise attendants at all times
Communicate with the shift in-charge always
12 midnight to 1.00 am
88
Check vital signs and record
ET and oral suctioning if necessary
Administer any due medications
If patient is on ventilator, check the timings for mediations and administer
accordingly
Collect all reports of investigations sent and enter where appropriate
Receive laundry things, count and replace all linen
Inform shift in-charge if any balance remaining
Complete your work and chart including round order book
Complete the registers as appropriate
Enter all services rendered in the service notification book
Give a detail report of your patients and handover to the next shift nurses
Allow the next shift nurse to check patient’s bedside and charts
Give her time to clarify her doubts before you leave
Pack all the trays used and send it for autoclave
Write your name and date legibly while sending trays for autoclave
Arrange nurses counter
Report to shift in-charge of the next shift before leaving the ward
NIGHT DUTY
11.45 pm – Report for duty
11.45 pm to 12.00 am
Check inventories (narcotics, daily drug inventory, daily inventory, emergency trolley
etc). Replace if anything is missing from emergency trolley
Enquire about missing items, broken things and clear all doubts before taking the
report
Arrange to send the service notification book to counter
Make the midnight census
Prepare the shift in-charge book and ward round book
89
12.00 am to 12.30 am – Take patient report from previous shift nurses
12.30 am to 12.45 am - Take over special instructions and check allocated patients
12.45 am to 1.00 am – Bedside take over of individual assigned patients
Check at bedside
All allocated patient’s chart whether it is completed or not
All IV lines / IV sites / IVF balance and labels / any drugs added / CVP lines / dialysis
catheter (if any) in situ.
If urine catheter in situ check urine bag (colour and amount if any urine present)
Loaded injections balance and labels (if any)
Unit cleanliness and left over food containers
If patient on ventilator – check whether tubings are connected properly and water
collection in the tubings and drain cups / check humidifier if water to be filled
Check current settings of the ventilator
Bedside oxygen cylinder whether it is full and whether ambu bag with oxygen
connection and reservoir bag is ready and in good working condition
Cardiac monitor for rhythm and whether chest leads are properly connected or not and
whether finger pulse probe is connected or not
Whether bedside equipments (suction machine / infusion pumps / cardiac monitor etc)
are in good working conditions
Whether all nursing interventions are recorded legibly / any investigations pending /
any reports to be collected
Specific interventions like I/O of the patient / vital signs / saturation / oxygen intake /
CVP ( if on ventilator) / sleep pattern / personal hygiene / bowel
1.00 am to 1.15 am
Check vital signs and record
Assess patient’s conscious level and pupil reaction (SOS)
Endotracheal suctioning and oral suctioning (for ventilator patients) – observe
secretion (amount and color)
Check patient’s file ( read nurses notes and doctors orders)
Arrange patient file
Replace necessary sheets and file extra sheets from the chart board
Compare treatment chart with doctors orders
90
Carry out doctor’s orders (if any)
Check all medicines and get prescription from the doctors (SOS)
1.15 am to 3.15 am
Check vital signs and record
Inform any abnormalities and carry out orders
Do suctioning if necessary
Start writing nurses notes
ET and oral suctioning if necessary
Any abnormalities inform to duty medical officer and carry out orders
Re-check vitals after carrying out orders (eg: if temperature is high)
Check ventilator tubing again. If water is collected empty drain cups and tubing
Refill humidifier with sterile water (if necessary)
Complete nurses notes and re-check whether the chart is complete or not
Go through page by page and check whether all information is complete or not
If any bed is vacant prepare the cubicle and keep ready to receive another patient
Check if any equipment or any place needs a repair work and inform
If any item is borrowed make sure it is returned or report it to the next shift nurses
Report if any item is given to another ward. Try to get it back before you hand over to
next shift nurses
Check whether patient has to replace any drugs. If so, replace it before you hand over
Check the emergency trolley and make sure it is ready to use
Check all ventilators not in use and keep it ready for next use
Check defibrillator and ECG machine and keep it ready for next use
Check and keep the standing wreck ready. Replace all the items
Check whether attendants have completed their work (sweeping, mopping, cleaning
toilets, changing sodium hypochlorite, emptying dustbin, laundry, CSSD things,
washing slippers, gloves washed and packing, changing rubber sheets etc)
Check and count the laundry things and CSSD things with the attendants
Check the over all cleanliness of the ward is maintained or not
Be ready to handle any emergencies in the ward. Do not neglect other patients while
you attend emergencies
Communicate with the shift in-charge always
91
12 midnight to 1.00 am
Check vital signs and record
ET and oral suctioning if necessary
Administer any due medications
If patient is on ventilator, check the timings for mediations and administer
accordingly
Collect all reports of investigations sent and enter where appropriate
Complete your work and chart including round order book
Complete the registers as appropriate
Enter all services rendered in the service notification book
Give a detail report of your patients and handover to the next shift nurses
Allow the next shift nurse to check patient’s bedside and charts
Give her time to clarify her doubts before you leave
Pack all the trays used and send it for autoclave
Write your name and date legibly while sending trays for autoclave
Arrange nurses counter
Attend any emergencies during that shift
Report to shift in-charge of the next shift before leaving the ward
Flush CVP line and measure CVP (if on ventilator) and record
DAILY TASKS OF O.P.D NURSES
Morning Shift
Report to ward on time.
Check ward inventory.
Arrange the consulting rooms for morning shifts doctors.
Send and receive items from C.S.S.D.
Check the temperature of fridge and record.
Check the laundry linen.
Start the dressings and injections on time.
Sending samples to laboratory.
Assisting the cases with the doctors in minor O.T.
Preparing for the vaccination for the new born and routine vaccination.
Inspection the conditions of the patients wounds.
92
Check the cleanliness and tidiness of the rooms and area.
Washing and packing the instruments.
Giving of I /V and I/M injections.
Carbonizing of the beds and trolleys.
Cleaning the rooms for the 2nd shift.
Handing over to the 2nd shift.
Afternoon shift
Report to the ward on time.
Check ward inventory.
Taking over from the 1st shift.
Continue vaccination.
Continue dressings and injections.
Sending specimens to laboratory.
Assisting cases in minor O.T.
Sending and collecting things from C.S.S.D.
Cleanliness of the rooms.
Carbonizing of the beds and rooms.
Check the cleanliness and tidiness of the rooms and area.
Hand over to the 3rd shift.
Evening Shift ( 3 rd Shift)
Report to the ward on time.
Check ward inventory.
Taking over from the 2nd shift.
Arranging the rooms.
Continue of the dressings and injections.
Assisting of minor cases in minor O.T.
Check the cleanliness of the rooms and area.
Carbonizing of rooms.
Prepare for closing the rooms.
93
DAILY TASK FOR STAFF WORKING IN THE DIALYSIS UNIT
MORNING SHIFT
Report ward on time
Check the ward inventory
Check narcotics inventory
Rinse the RO machine
Disinfection of dialysis machine
Check pre-dialysis weight and vital signs of the patient
Make the patient comfortable
Check and send pre-dialysis investigations if necessary
Check fistula /catheter site
Start dialysis
Monitor vital signs ½ hourly
Observe complications like hypotension,,nausea,vomiting,headache etc
Collect blood reports
Inform the doctor if necessary
Carry out any emergency orders
Complete documentation
Check the cleanliness and tidiness of the ward / centre
Prepare disinfectant solution ( clear surf )
Terminate the dialysis after completion
Check and send post dialysis investigation if necessary
Do pressure dressing to access site
Disinfection of the dialysis machine
94
Clean the dialysis machine with clear surf and carbolize the bed
Keep the patient for observation( at least for 15 mnts)
Send the patient home with the relative
Hand over to next shift
Report to ward in charge or shift in charge before going off duty
AFTERNOON SHIFT
Report ward on time
Check the ward inventory
Check narcotics inventory
Take report from previous shift nurses
Visit patients after report and check patients’conditions
Check pre-dialysis investigation, weight and vital signs of the patient
Make the patient comfortable
Check and send pre-dialysis investigations if necessary
Start dialysis
Monitor vital signs ½ hourly
Observe for any complications like hypotension,nausea,vomiting,headache etc
Collect blood reports
Inform doctor if necessary
Carry out any emergency orders
Complete documentation
Check the cleanliness and tidiness of the ward / centre
Terminate the dialysis after completion
Check and send send post dialysis investigation if necessary
95
Do pressure dressing to access site
Disinfection of the dialysis machine
Clean the dialysis machine with clear surf and carbolize the bed
Keep the patient for observation( at least for 15 mnts)
Send the patient home with the relative
Hand over to next shift
Report to ward in charge or shift in charge before going off duty
EVENING SHIFT
Report ward on time
Check the ward inventory
Check narcotics inventory
Take report from previous shift nurses
Visit patients after report and check patient’s conditions
Check pre-dialysis investigations, weight and vital signs of the patient
Make the patient comfortable
Check and send pre-dialysis investigations if necessary
Start dialysis
Monitor vital signs ½ hourly
Observe complications like hypotension, nausea, vomiting, headache etc
Collect blood reports
Inform doctor if necessary
Carry out any emergency orders
Complete documentation
Check the cleanliness and tidiness of the ward / centre
96
Terminate the dialysis after completion
Check and send post dialysis investigation if necessary
Do pressure dressing to access site
Disinfection of the dialysis machine
Clean the dialysis machine with clear surf and carbolize the bed
Keep the patient for observation( at least for 15 mnts)
Send the patient home with the relative
Check the routine cleaning of ward for the next day (washing of all the medicine cups,
trays and clean trolleys etc.)
Write down in communication book if anything special happens
THEATRE GUIDELINES
THEATRE LISTS
1. Theatre list should be sent on the previous day before 17:00 hrs to theatre and wards
97
2. Cases with co-morbidity, (e.g. Diabetes, HTN,COPD) should be well prepared and
well communicated with concern anaesthetist and concern staff, in order to avoid last
minute cancellations of the case
3. Anaesthetist should do a preliminary check up of PAC workup on the night before
surgery
4. The theatre list should mention any special needs the case might have (e.g. C-arm,
change of or table, instruments, ICU bed)
5. Theatre list would accommodate cases such that the list should finish on time at the
end of the OT day. The emergency team (anaesthetist/theatre staff) should not be
over burdened with routine cases
6. If an emergency list was brought forward it should be entertained first in spite of
the nature /type of surgery (there is no emergency/semi emergency or less
emergency cases).
7. In case if there is an LSCS and another emergency then preference will be given to
the LSCS
8. No operating department should take advantage and utilize other department
OR’s saying they have an emergency. i.e. they should accommodate emergency list
in their ongoing list. If an emergency occupies another departments OR on their
Operation day then the respective department to be given the OR which empties first.
9. The time taken by the emergency would be compensated at the end of the list (i.e. if
an hour taken by the emergency case, then the theatre will function till 15:00 hrs
instead of 14:hrs)
10. If any one wants to use the theatre on days which are not theirs then permission
must be obtained from the sister in-charge of the theatre and the surgeon concerned
11. In the event of a procedure has to be changed or done by the surgeon for which
consent has not been obtained, this must be immediately informed by the responsible
staff in that OR to the relative who had signed the consent form. After the surgery is
over it is the duty of the attending surgeon to call the relative and explain the reason
for the procedure.
PREPARATION OF THE THEATER
1. Cleanliness
Check whether the theatre is clean enough to start surgery.
98
2. Sterility status
Check whether the theatre is carbolized thoroughly, if it is the first case in the
morning.
Carbolize the bed, mayo stand instrument trolleys in between cases.
3. Anaesthesia machine
Check whether the machine is functioning properly. All necessary connections are
working.
Check the colour of soda lime, no leakage from any tubing’s or breathing bag.
Laryngoscope and other necessary items are available and working.
4. Drugs
Keep all the necessary drugs ready and check the expiry date. Make sure the drug
was stored at the correct temperature.
5. Sets and bundles
Check the label for correct set, the autoclave tape for sterility and date of
autoclaving.
Arrange the sets and bundles in the correct places.
6. Consumables
Check whether all the consumables are available and check the expiry date.
7. Equipments
Connect the equipment and check whether it is working and clean.
8. Lighting
Check the light whether it is working and adjust them
99
POINTS TO BE REMEMBERED BY THE SCRUB NURSE AND THE CIRCULATING /
FLOOR NURSE
1. Make sure that you strictly follow the instructions which are placed on the walls of
scrub area.
2. Make sure that all the aseptic procedures are followed during and after scrubbing
3. If the circulating/ floor nurse find you unsterile please change your gown & gloves.
4. Do not open the second layer of the bundle or the set unless you are scrubbed,
gowned and gloved.
5. Scrub nurse’s gloves has to be open and given to her/his hand by the floor nurse once
he /she is scrubbed & gowned
6. Do not open gloves, sutures or any sterile item straight to the operating table or field.
Give them to the scrubbed nurse instead.
7. Make sure that all surgical appliances (cautry machines, suction machine, incubator,
warmer, extension boards, and instruments) are in proper order.
8. Make sure that you are properly covered through out the surgery.
9. Make sure that the sterile field is maintained.
10. Be aware that you are sterile at all times.
11. When ever you or team finds that some thing is unsterile please correct it then and
there.
12. Do not let unscrubbed staff to enter the sterile field.
13. Maintain proper count and documentation.
14. Scrub nurse and circulating/floor nurse should take count together.
Thank you for your cooperation .it’s the patient who will benefit and it is us who will be
satisfied at the end of the day.
100
100
PROTOCOLS TO BE FOLLOWED IN THE OPERATING ROOMS
1. Protective gloves are to be worn at all times when working with potentially
contaminated materials.
2. The major door to the operation room is just being used for bringing and taking the
patient only.
3. Go to the operation room when it is really necessary.
4. Use one small door for getting in and out of the operating room when cases are
going on.
5. The doors to the operating rooms should always remain closed.
6. The number of staff present in OT and the staff movement should be limited to
minimum.
7. Sterile gowns are to be worn after scrubbing.
8. Discussions / conversations between theatre staff during an operation should be
limited.
9. The surgical hand disinfection (scrubbing) is to be followed according to the
instructions which are placed on the walls of scrub area.
10. After every surgical case, the operating team must dispose their gloves and gowns in
the allocated areas.
101
101
PROTOCOLS TO BE FOLLOWED WHILE IN OPERATION THEATRE COMPLEX
1. All personnel should change into theatre clothes in the allocated changing rooms.
2. Under garments (like petticoat and baniyan) should not be visible.
3. The hair must be completely covered by the theatre caps.
4. Jewelries on the hands and forearms, as well as wrist watches are not permitted.
5. Nail polish (colored and colorless) is not permitted.
6. Before entering all operating areas, a face mask must be worn. this must cover the mouth
the nose and all facial hair (e.g. beards moustaches).
7. To leave the operating theatre with surgical attire is prohibited.
8. The OT staffs must change their facial mask when ever necessary ( e.g. when moist)
9. Face mask should not be kept hanging at the neck, instead should be removed and kept in
pocket if not wearing.
10. Used theater attire must be disposed off properly to the allocated hampers in the
respective change rooms.
11. A hygienic hand disinfection is necessary before entering and leaving the operating theatre
before sterile procedures
after possible contamination (cleaning the nose,visiting the toilet)
Before and after cleaning the patient.
12. Only the theatre staff and the surgical team can enter theatre.
13. Outside staffs should get permission from the theatre in-charge before entering the theatre at all times.
14. Foot wear is to be changed whenever soiled with body fluid
15. Eating or drinking is prohibited out side tearoom.
(Pay attention to change of plans).
102
102
ROUTINE CLEANING OF OPERATION THEATRE
Daily cleaning
Carbolize with carbolic solution after every case and with hypochlorite solution every morning
OT 1/2/3
Scrub room 1/2/3
Clean utility 1/2
Dirty utility 1/2/3
Sterile corridor
Sterile store
Equipment store
Weekly cleaning
Wash with washing detergent and water and clean with hypochlorite solution.
OT 1/2/3
Scrub room 1/2/3
Clean room 1/2
Sterile corridor
Dirty utility
Clean store
Packing room
Equipment store
Sterile store
Monthly cleaningWash with washing detergent and water and clean with hypochlorite solution.
Pre-op room
Post-op room
Outside area
103
103
DAILY TASKS OF NURSES WORKING IN OPERATION THEATRE
Morning Shift
Report to OT on time
Check inventory
Take report
Check the daily posting
Check the O T list
Bring patient
Check blood investigations reports PAC and consent.
Prepare their respective OT/place
Check narcotic inventory
Check the cleanliness and the tidiness of the OT
Make sure first patient for each OT is in OT by 7:50 am
Start scrubbing as soon as the doctors(anaesthetists and surgeons) enter the theater
Pack instrument sets and bundles whenever possible
Hand over to the next shift staff before going off duty
Complete documentations (report book)
Report to in charge before leaving at 2:30 pm
Second shift
Report to OT time
Check inventory
Check narcotic inventory
Take handover of their respective places and relieve the morning staff
Packing of equipments, bundles sets gowns etc
Replace items before packing
Wash and Carbolize the OT s
104
104
Clean and tidy the other areas
Carbolize the stretcher and accessory stand
Complete documentations and registers
Check the next day OT lists and confirm the cases and their wards
Check the cleanliness and the tidiness of the OT
Confirm the necessary items for next days surgery are packed and autoclaved
Check the machines whether in working order
Wash up all items and keep ready for the next day
Prepare items like gauze, D/pads packs etc
Hand over to next shift staffs
Report to shift in charge before leaving
Third shift
Report to OT time
Check inventory
Check narcotic inventory
Take handover of their respective places and relieve the staff
Check the next day OT lists and confirm the cases and their wards
Check the cleanliness and the tidiness of the OT
Confirm the necessary items for next days surgery are packed and autoclaved
Receive linen, fold(properly) and packing bundles
Arrange the changing rooms (male and female) and cleaning the stores
Carbolize packing rooms and clean stores
Check the cleanliness and the tidiness of the OT
Report to shift in charge before leaving
Night shift
105
105
Report to ward time
Check inventory
Check narcotic inventory
Take handover of their respective places and relieve the staff
Complete documentations and registers
Check the next day OT lists and confirm the cases and their wards
Check the cleanliness and the tidiness of the OT
Confirm the necessary items for next days surgery are packed and autoclaved
Arrange the theaters
Check the Anaesthesia machine and laryngoscope
Keep the theater ready for the morning shift (routine cases)
Arrange the changing rooms (male and female) and cleaning the stores
Inform the wards to bring first cases by 7:40 am
Patients for all theaters to be inside OT by 7:50 am
Complete documentations (report book)
Report to shift in charge before leaving
Check the sterility of the OT (carbolize)
FRIDAYS
Check the sets and bundles and sent for autoclaving those that require re autoclaving
Wash the whole OT complex
Clean with sodium hypo chloride solution
Replace items in sets e.g. ortho implants
NOTE During all shifts keep the whole theater clean this includes the pre op and post op with the
corridor area and where we keep our gas cylinders too
Replace items in sets before packing e.g. ortho implants to be replaced
DAILY TASKS OF ATTENDANTS WORKING IN OPERATION THEATRE
106
106
Morning shift
Report to OT on time
Take over from the night shift attendant
Check the general cleanliness of OT complex
Do not keep hypo chloride solution in basin for more than 30minutes
Take instruments to CSSD and collect it when autoclaved
Keep equipment inside OR’s e.g. Suction /Cautry and check the table
Check whether dirty utility rooms are closed/locked
Check paper towel dispenser and keep it filled
Clean the stretchers
Clean/mop OR’s properly and quickly in between cases
Keep stretchers ready all time with the pillows and rubber sheet
Check for sharp disposals and change it when it is 2/3rd full
Keep the counter slippers properly and wash it whenever dirty
Give urinals to patients if asked by a nurse
Assist patients to the toilet if required (ONLY WHEN ASKED BY A NURSE)
Answer the bell, but DO NOT give any information regarding patients. call a nurse to
give any information to the relatives
Cut gauze
Check patients toilet frequently and clean as needed
Wash kidney trays and disinfect them if used (keep in 0.5%sodium hypochlorite
solution for 10mins. DO NOT LEAVE THEM FOR MORE THAN THE
SPECIFIED TIME)
Wash all the toilets thoroughly
Clean doors, windows and other furniture’s
Wash suction bottle and suction tubing after each case
Clean and disinfect pre and post operative thoroughly when patients are transferred
Take dirty linen to laundry DO NOT TAKE DIRTY LINEN ALONG WITH ANY
THING CLEAN(STICK BIOHAZARDABLE)
Take things to CSSD
Wash the slippers.
107
107
Out side attendant has to go to wards to bring patients to OT as well as to shift patients
out when ever asked.
Do not enter OR during surgery unless asked
Be present outside the OR’s
Take linen to laundry and collect clean linen
Be prompt whenever called to anyone
Hand over to the next shift
Report and get permission from the shift in charge before leaving the OT or going off
duty.
Keep drinking water in tea room
Evening shift Report to OT on time
Take over from the morning shift attendant
Check the general cleanliness of the OT complex
Take instruments to CSSD and collect it when autoclaved
Collect clean linen from laundry(count them properly and inform to the shift in charge if
there is any problem)
Clean stretchers
Assist patients to the toilet if required (ONLY WHEN ASKED BY A NURSE)
Answer the bell, but DO NOT give any information regarding patients. Call a nurse to
give any information to the relatives
Check patients toilet frequently and clean as needed
Wash kidney trays and disinfect them if used (keep in 0.5%sodium hypochlorite
solution for 10 minutes. DO NOT LEAVE THEM FOR MORE THAN THE
SPECIFIED TIME)
Wash suction bottle and suction tubing after each case
Clean and disinfect pre and post operative thoroughly when patients are transferred
Oxygen tubing and change water in the humidifier
Take dirty linen to laundry DO NOT TAKE DIRTY LINEN ALONG WITH ANY
THING CLEAN(STICK BIOHAZARDABLE)
Keep the store room clean
108
108
Wash the slippers
Keep the counter slippers properly and wash it whenever asked by a nurse
Hand over to the next shift
Report and get permission from the shift in charge before leaving the OT or going off
duty.
Keep drinking water in tea room
Night shift
Report to the OT on time
Take over from the evening shift attendant
Check the general cleanliness of the OT complex
Assist patients to the toilet if required (ONLY WHEN ASKED BY A NURSE)
Answer the bell, but DO NOT give any information regarding patients. Call a nurse to
give any information to the relatives
Cut gauze
Check patients toilet frequently and clean as needed
Wash all kidney trays and disinfect them if used (keep in 0.5%sodium hypochlorite
solution for 10 minutes. DO NOT LEAVE THEM FOR MORE THAN THE
SPECIFIED TIME)
Wash suction bottle and suction tubing after each case
Clean and disinfect pre and post operative thoroughly when patients are transferred
(change water in the humidifier)
Assist the nurses in cleaning and disinfecting the OR’s
Take dirty linen to laundry DO NOT TAKE DIRTY LINEN ALONG WITH ANY
THING CLEAN(KEEP BIOHAZARDABLE)
Wash the slippers
Keep the counter slippers properly and wash it whenever asked by a nurse
Hand over to the next shift
Report and get permission from the shift in charge before leaving the OT or going off
duty.
109
109
Keep drinking water in tea room
`
110
110
Midwifery guidelines
Acknowledgement
These guidelines have been prepared with the aim of providing guidance for the proper
management of patients admitted to labour room. They are based on the interventions described
in the manual “Integrated Management of Pregnancy and Childbirth (IMPAC)” published by
WHO. In addition, protocols prepared by Dr. Jumailath Begam in 1995 were also used as a
reference in preparing these guidelines. Nursing department greatly acknowledges Dr. Jabeen Ali
Shareef and Dr. Mohamed Aseel Jaleel who gave their advice and opinion to complete these
guidelines. In addition, contributions given by the doctors in the department of obstetrics and
111
111
gynaecology are appreciated. Our thanks are also due to Dr. Abdullah Niyaf for his contributions
on newborn care. Furthermore, nurses working in labour room have contributed immensely to
make these guidelines. Nursing department wishes to thank all those who have helped to prepare
them.
It is hoped that these guidelines will be useful not only for the staff of IGMH but also to the
students and nursing staff working throughout Maldives.
Nursing department
IGMH
ADMISSION PROTOCOL FOR LABOUR PATIENTS
Confirm identity of the patient (check the patient’s name, age and address on the folder).
Make sure all ANC records are available. These records should be attached to the inpatient
folder.
ANC card
Scan reports
Blood investigation reports
Urine reports
112
112
Referral letters (if any)
On admission take a brief history with emphasis on the following.
Gravida/para
LMP and EDD as per dates and scan
Problems with previous pregnancies/deliveries.
Rh status
Allergies
History of medical problems
Onset of labor
Membranes-ruptured or intact.
The following documents must be completed for all labour patients:
Labour ward admission
Daily census
Partograph (when the cervical dilatation is 4cms or more.)
New born sheet.
If investigations are not available send for all routine investigation. This includes: urine R/E,
Hb, PCV, blood grouping and Rh typing, RBS, G6PD, VDRL, HbsAg and HIV screening.
For all patients in labour have one pint of blood cross matched. If the patient’s Hb is low or
gives history of severe PPH in last deliveries arrange for 2 donors.
Do an abdominal palpation and confirm the lie, presentation and position of the fetus. Note if
the foetal movements are felt.
Record temperature, BP, pulse and FHS and uterine contraction. Note the frequency and
intensity of uterine contractions. Normal fetal heart rate ranges from 120 to 160 beats per
113
113
minute. The rate may increase or decrease during a contraction, hence foetal heart should be
checked only when the uterus is relaxed.
P/V examination should be done unless contraindicated, to assess if the patient is in labour. A
vaginal examination should be performed only following adequate explanation.
DO NOT DO P/V in the following conditions:
Ante partum hemorrhage
Low lying placenta.
All patients in labour should have perineum shaved and a disposable enema should be given
unless contraindicated. (Contra indications include severe PIH, cervix fully dilated, APH
abnormal presentations).
Document all the findings and notify the medical officer or the gynaecologist on call.
On admission assess the patients personal hygiene and if required provide an assisted bath/
sponge bath.
Once the patient has been assessed, give an adequate explanation to the patient and the
relatives.
While caring for the woman in labour give special emphasis to the principles in the
ethical and professional code of conduct for nurses. This includes:
Respecting the woman’s right to privacy and modesty while doing procedures.
Draw curtains and drape the patient while performing a vaginal examination.
Maintain confidentiality.
Show empathy.
Provide sufficient information before performing any procedures (If language is a
barrier ask some one for help).
Recognize professional accountability borne for actions and omission
114
114
ON GOING CARE DURING FIRST STAGE OF LABOUR
If there are no problems/ risk factors, for all patients in labour with term gestation and vertex
presentation the following care is to be followed.
Assess the general condition of the patient with emphasis to edema, pallor, cyanosis and
hydration.
Record blood pressure on admission and 4 hourly if normal. If the diastolic is more than 90
record BP every half hourly or as per the doctor’s advice. Notify any abnormal recordings to
the duty doctor (BP is not to be taken during contraction).
Check temperature on admission and every 4-6th hourly unless otherwise indicated. If the
patient is febrile notify the doctor.
Record pulse on admission and half hourly. Notify the doctor if tachycardia is there (pulse
should not be taken during a contraction).
Record FHS on admission and every half hourly or more frequently if indicated. FHS should be
checked following a contraction and in between contractions. It should be counted for ONE
FULL MINUTE. If there is any foetal tachycardia (>160 bpm), foetal bradycardia (<120 bpm)
or irregular foetal heart rate notify the doctor immediately. (For additional care refer to care of
patients with foetal distress).
Assess the uterine contractions on admission and every hourly in the latent phase (upto 3cm)
and every half hourly in the active phase (from 4-10cm). Contractions should be checked for its
frequency and duration. Frequency of contractions is assessed by the number of contractions in
a 10-minute period. Duration is measured in seconds from the time the contraction is first felt
abdominally, to the time the contraction phases off. In the active phase contractions should
115
115
occur at least three times every ten minutes each lasting > 40 seconds with adequate relaxation
in between. If contractions are not satisfactory inform the doctor.
If there is no contra indications a P/V examination should be performed every 4 hourly in the
first stage to assess the progress of labour.
Follow aseptic techniques while performing a P/v examination and be as gentle as possible.
Ensure patients privacy during the procedure. The following findings should be recorded:
o Position, dilatation and effacement of the cervix
o Presenting part and its level
o Presence of caput or moulding
o Membranes: presence or absence of membranes and the colour of liquor if
membranes are ruptured.
o Liquor: present or absent, colour
o Ensure that no cord is felt
If the membranes are ruptured liquor should be carefully examined for meconium if the fetus
is in the vertex presentation. A slight degree of meconium without foetal heart abnormality is
a warning for the need for caution. Thick meconium may indicate the need to speed up
delivery hence if meconium is present in the liquor inform the doctor.
Slight green color. Thin meconium.
Green to dark color Moderate meconium.
Dark green with flakes of meconium Thick meconium.
After each vaginal examination FHS should be recorded.
A partograph should be filled for all patients in the active phase of labour. Dilation of the
cervix is plotted with an X, descent of the fetal head is plotted with an O, and uterine
contractions are plotted with differential shading. The first recording on the partograph should
be on the alert line and if the progress of labor is normal, plotting of cervical dilatation should
remain on the Alert Line or to left of it.
116
116
Descent of the head should always be assessed by abdominal examination (by Rule of
Fifths felt above the pelvic brim) immediately before doing a vaginal examination. When
2/5 or less of the fetal head is felt above the level of symphysis pubis, the head is engaged,
and by vaginal examination, vertex is at the level of ischial spines (0 station).
Recording of the condition of the membranes and liquor in the partograph should be as
follows:
Intact membranes - I
Ruptured membranes + Clear liquor- C
Ruptured membranes + Meconium-stained liquor - M
Ruptured membranes + Blood-stained liquor- B
Ruptured membranes + Absent liquor- A
Presence of moulding should be recorded in the partograph as follows:
1: Sutures opposed.
2: Sutures overlapped but reducible
3: Sutures overlapped and not reducible.
Encourage oral fluids during labour unless otherwise indicated.
Encourage regular 2 hourly voiding and record when urine is passed. A full bladder is
uncomfortable and may inhibit the progress of labour by inhibiting the decent of the
presenting part. Where there is a palpable bladder and the woman is unable to void, consider
urinary catheterization.
Attend to the patients’ personal hygiene as required. Provide oral care every 4 hourly or as
required. Provide early morning care for all patients. Perineal care should be given according
to the needs of the patient.
117
117
Encourage the woman to move about freely when in early labour unless contraindicated. Eg if
the patient is leaking or bleeding.
Teach breathing exercises for coping with labour pains. Encourage the patients not to push
before full dilatation of cervix.
The patients’ condition should be explained to the relative’s atleast twice in each shift and at
any events or changes in the treatment line.
Allow the patients to talk to the relatives over phone if they wish to. If they are in labour
room for too long they should be taken out to meet the relatives.
Complete documentation and give proper handover when the shift changes.
CARE OF PATIENTS WITH FOETAL DISTRESS
Foetal brady cardia in the absence of contraction or persisting after a contraction and foetal
tachycardia in the absence maternal tachycardia is suggestive of foetal distress. Thick
118
118
meconium stained liquor in vertex presentation may also be suggestive foetal distress. If any
of these conditions are observed inform a gynecologist immediately
General management:
Place the woman on left lateral position
Administer oxygen 4-6 liters per minute.
Stop oxytocin if being administered (with advice from a doctor)
Record the foetal heart rate every 10- 15 minutes.
Start a plain pint of ringer lactate.
Explain to the patient and the relatives about the baby’s condition.
Check for explanatory signs of foetal distress:
Bleeding
If vaginal examination is done feel for the cord pulsation. If felt, manage as cord
prolapse.
Observe the colour of liquor if the membranes are ruptured
Record the findings.
CARE OF PATIENTS WITH PREVIOUS LSCS IN LABOUR
On admission collect the history and find out the indication for LSCS. Inform the
gynaecologist or the medical officer as soon as possible.
119
119
If the woman is in labour monitor the progress of labour using a partograph. If the cervical
dilatation crosses the alert line inform a gynaecologist.
Monitor the maternal pulse, foetal heart rate and uterine contractions every half hourly.
Monitor the woman’s blood pressure every hourly and temperature every 4th hourly
Encourage the woman to void every 2 hourly and observe the colour of urine. When the
woman is in active labour catheterize her. If hematuria is observed inform a gynaecologist.
Watch for signs of impending rupture.If any of these findings are observed inform a
gynaecologist or a medical officer immediately:
Rapid maternal pulse
Persistant abdominal pain and scar tenderness
Foetal distress.
Record all the findings.
CARE OF PATIENT DURING SECOND STAGE OF LABOUR
When possible all the deliveries must be conducted in the second stage room and the following
steps should be ensured.
When the cervix is fully dilated, shift the patient to the second stage room.
120
120
Paediatric medical officer should be informed for all the deliveries.
A pediatrician must be notified in cases of
Severe foetal distress
Thick meconium stained liquor
Instrumental deliveries
Premature deliveries
Undue delay
Fot patients at risk (PIH, DM, IUGR, postdated pregnancy)
Gynaecologist on call must be notified in cases of
Foetal distress
Thick meconium stained liquor with or without foetal heart abnormalities
Prolonged second stage of labour (more than 1 hour in primis and more than half
an hour in multis)
Heart disease
Multiple gestation
Breech presentations
Patients with bad obstetric history
Undue delay
patients at risk (PIH, DM, IUGR, postdated pregnancy)
Prepare the delivery room. (Refer to appendix C for articles/equipments needed
for delivery)
Prepare the baby receiving area. The following things should be available:
Baby warmer (should be kept ON)
Ambu bag and mask in working condition
Laryngoscope
Suction machine in working condition
Oxygen
Meconium aspirator
ET tubes, suction tubes no: 8 & 10, nasogastric tubes.
121
121
Emergency drugs (Inj. Adrenalin, Inj. naloxone if the mother has received a
narcotic, Inj. soda bicarb, normal saline)
Warm baby sheets and sterile pads.
Nursing observations:
Assess the patient for signs suggestive of satisfactory progress in the second stage
of labour. This includes steady descend of the presenting part and the onset of
expulsive phase.
Monitor the uterine contractions. If contractions are not adequate inform a
gynecologist.
Observe the color of liquor. If meconium is present inform the gynecologist.
Record FHS every 5 minutes. If there is any foetal heart abnormalities inform a
gynecologist.
Perform a vaginal examination once every hour.
The following things should be avoided.
Premature positioning
Uterine manipulation
Stretching of perineum
Unnecessary frequent PV
Catheterization unless indicated.
Maintain adequate hydration by encouraging adequate oral fluids if not contra
indicated.
Encourage the patient to empty her bladder at the beginning of the second
stage.
Teach pushing techniques to the patient
If the presenting part is high keep the patient on left lateral position and
encourage her to push with contractions. Do not put the patient on lithotomy position
too early
Ensure cleanliness of the patient and the birthing area.
122
122
Provide a supportive and an encouraging atmosphere and ensure patient’s
privacy and confidentiality. Do not allow unnecessary visitors inside delivery room
while the patient is giving birth. Only staff and doctors on duty are allowed in
second stage room.
While conducting delivery the following steps should be followed:
Wash hands and wear personal protective equipments.
Talk to the patient and explain every procedure throughout the second stage.
If the patient is to be delivered in lithotomy position while positioning put both
legs together on the stirrups. Ask the patient if she is comfortable and adjust the
level accordingly.
Clean the patient’s perineum and inner thighs with an antiseptic solution
(betadine).
Drape the patient (with lithotomy sheet and leggings).
Encourage the woman to push with contractions.
If an episiotomy is needed infiltrate the perineum with 1% lignocaine and perform
an episiotomy with a contraction when the foetal head crowns.(refer to guideline
for performing episiotomy).
Ensure the following steps during the delivery of the head:
Place the fingers over the foetal head to maintain flexion.
Support the perineum as foetal head is delivered.
Once the head is delivered ask the woman not to push.
If meconium is present suction the baby’s mouth and nose.
Feel around the baby’s neck for the umbilical cord. If the cord is around the neck
but loose, slip it over the baby’s head. If the cord is tight doubly clamp and cut it
before unwinding from the neck.
Ensure the following steps during the delivery of shoulders.
Wait for the external rotation of the head.
Place a hand on each side of the baby’s head and ask the woman to
push with contraction.
Apply downward traction to deliver the anterior shoulder. Avoid
excessive tracton as this may result in brachial plexus injury.
123
123
Lift the baby’s head anteriorly to deliver the posterior shoulder.
Support the perinium during the delivery of the shoulders.
In case of shoulder dystocia:
Call for a gynaecologist.
Ask the woman to flex both thighs bringing her knees as far a apart
as possible toward her chest.
Have an assistant apply suprapubic pressure downwards to assist the
delivery of shoulders. Do not apply fundal pressure as it can
further impact the shoulders.
Clamp and cut the cord and hand over the baby to an assistant.
If the mother is Rh –ve collect cord blood for Hb, PCV, blood grouping and Rh typing,
reticulocyte count, direct coomb’s test, serum bilirubin total and direct serum bilirubin.
Palpate the abdomen to rule out the presence of any additional baby(s), if not already
confirmed by USG.
Proceed to do active management of third stage or do the expectant management.
ASSISTING A VACUUM DELIVERY
A vacuum extraction may be needed in when there is
124
124
Foetal distress
Delay in second stage of labour
Maternal exhaustion
Maternal heart disease
Explain to the women and the relatives about the need for a vacuum extraction.
Assemble all equipments / instruments needed for a vacuum extraction.
All instruments needed for a vaginal delivery (delivery bundle)
Vacuum cup
Rubber tubing
Vacuum extractor
Check the connections of the vacuum extractor and ensure that it is functioning well.
When the vacuum cup is applied to the foetal head ask an assistant to create a vacuum of
0.8kg/cm2 negative pressure by using the pump (up to the red mark on the vaccum
apparatus).
Contimnue to monitor foetal heart rate in between contractions.
Maintain asepsis throughout the procedure.
At the delivery of the foetal head release the pressure of vacuum.
After the birth of the baby assess the maternal and foetal complications:
Maternal:
Tears in the genital tract may be present. Examine the woman for any tears in the
vagina or the cervix (The doctor who performs the vacuum will usually do this).
Foetal:
All babies born by a vacuum will have a caput. Explain to the mother that it harmless.
Examine for scalp abrasions. If any abrasions are there clean and determine the extent
of the abrasion.
Inform a pediatric medical officer and carry out any orders given.
Show the baby to the mother and the relatives and explain abut the laceration.
MANAGEMENT OF THIRD STAGE OF LABOUR
Active management of third stage:
125
125
Active management of third stage is encouraged as it helps to prevent PPH. This includes:
Administration of oxytocin
Controlled cord traction
Uterine massage.
The following steps must be followed in the active management of third stage:
Administration of 10 units of oxytocin I.M or 5 units I.V within one minute of
delivery of the baby.
Clamp the cord close to the perineum.
Apply controlled cord traction along with counter traction. Never
pull the cord with out counter traction as it can cause uterine in version.
Keep slight tension on the cord and wait for a uterine contraction.
With a contraction gently pull the cord downwards to deliver the
placenta while continuing to apply counter traction.
If the placenta does not descend with 30- 40 seconds of controlled
cord traction do not continue to pull. But gently hold the cord and wait for another
contraction.
As the placenta is delivered hold it in two hands and gently turn it
until the membranes are twisted.
Once the placenta is delivered carefully examine it for
completeness
126
126
EXPECTANT MANAGEMENT OF THIRD STAGE: (IS NOT ENCOURAGED)
Wait for signs of placental separation. This includes:
Gush of blood
Lenghthening of the cord
Uterine contraction.
Deliver the placenta using controlled cord traction.
As the placenta is delivered hold it in two hands and gently turn it until the membranes
are twisted.
If not contra indicated, administer injection ergometrine when the
placenta is delivered. Contra indications include: PIH & heart disease. Check the blood
pressure before giving ergometrine.
Once the placenta is delivered carefully examine it for completeness.
RETAINED PLACENTA
Inform a gynecologist
Catheterize the bladder or ensure that the bladder is empty.
Start an IV line. (oxytocin infusion may be started).
Explain to the woman and the relatives about her condition.
Watch for any undue bleeding.
Accurately document the interventions carried out.
127
127
MANUAL REMOVAL OF PLACENTA Explain to the woman and her relatives and get their consent for the procedure.
Provide emotional support for the woman.
Carryout any advice given by the doctors.
Prepare the articles necessary for manual removal of placenta:
sterile gloves
sterile lithotomy sheet
leggings
antiseptic solution
dettol cream
Post procedure:
Administer IV ergometrine if not contraindicated.
Continue oxytocin infusion as per doctor’s advice.
Examine the placenta
Monitor vital signs every half hourly or as advised.
Palpate the uterine fundus to ensure that it is well contracted.
watch for any undue bleeding
Accurately document the interventions carried out.
128
128
MANAGEMENT OF FOURTH STAGE OF LABOUR
Remove the drapes and soiled linen. Give a clean gown to the patient
Remove both legs from the stirrups at the same time and then lower both legs down at the
same time to prevent cramping
Provide care of the perineum. Evaluate the perineal area for signs of developing edema
and/or hematoma. Predisposing conditions includes prolonged second stage, delivery of
a large infant, rapid delivery, forceps delivery.
An ice pack may be applied to the perineum to reduce swelling from episiotomy and
manual manipulation of the perineum during labor.
Apply a clean perineal pad between the legs.
Obtain a complete set of vital signs, evaluated the fundal height and firmness, and
evaluate the lochia. Keep the patient in labour room for 2 hours under observation.
Following observations should be made.
Record blood pressure and pulse and uterine contraction every half hourly.
Inform the doctor if the fundus remains boggy. Encourage the patient to massage
the uterus over the abdomen.
Observe for signs of hemorrhage. Causes of PPH may include
Uterine atony.
Vaginal or cervical lacerations.
Retained placental fragments.
Bladder distention.
Observe patient's urinary bladder for distention. Full bladders may actually
cause postpartum hemorrhage because it prevents the uterus from contracting appropriately.
Assessment for perineal hematoma.
Look for discoloration of the perineum.
129
129
Listen for the patient's complaints or expression of severe perineal
pain.
Observe for edema of the area.
Observe/listen for patient's feeling the need to defecate if forming hematoma is creating
rectal pressure.
Inform the doctor of abnormal findings.
Discontinue IV on a normal patient once she is stable
Complete notes and transfer the stable patient to the ward
MANAGEMENT OF PPH All post partum women must be monitored closely to determine PPH.
In cases of PPH the priorities in managing the patient are as follows.
Call for help (call for a gynecologist or a medical officer)
Start an IV line.
Perform a rapid assessment of the woman’s general condition which should
include blood pressure, pulse, respiration and temperature.
Find the cause for bleeding: To find out the cause examine the cervix, vagina and
perineum for tears. Check if the placenta is complete or not.
Stop the bleeding: If the cause of PPH is trauma to cervix, vagina or perineum, repair it under
aseptic precautions.
If the cause of PPH is uterine atony, follow these steps:
catheterize the bladder
Massage the uterus to expel the blood clots.
Start an IV infusion as per the doctor’s advice.
Give oxytocin as per doctor’s order
Monitor the blood pressure and pulse closely and watch for signs of shock.
Explain the patient’s condition to the relatives.
130
130
Anticipate the need for blood transfusion and arrange blood.
Keep an accurate record of the blood loss and interventions carried out.
If bleeding continues, check the placenta for completeness and if there are signs of retained
placental fragments inform a gynecologist.
PERFORMING AN EPISIOTOMY
Apply an antiseptic solution to perineum before performing episiotomy.
Infiltrate perineum with 1% xylocaine
Infiltrate beneath the vaginal mucosa, beneath the skin of perineum and deeply into
the perinial muscle.
Aspirate to be sure that no vessel has been penetrated. The woman can suffer
convulsion and death if IV xylocain is given.
Xylocain should be injected continuously while the needle is slowly withdrawn.
Anesthesia is more effective when one third of the injection is given first and two
further injections are made one on either side of the incision line. The needle must be
redirected just before the tip is withdrawn to avoid a second prick. Xylocain takes 3-4
minutes t o take effect.
Episiotomy should be performed only when crowning takes place (When the perineum is
thinned out and 3-4 cm of the baby’s head is visible during a contraction).
If episiotomy is given too early it will fail to release the presenting part and cause hemorrhage
from the cut vessels. In addition the levator ani muscles will not have time to be displaced
laterally and may be incised.
If episiotomy is performed too late there will not be time to infiltrate the prineum with
anesthetic.
131
131
The incision is best made during a contraction when the tissues are stretched so that there is
clear view of the area and bleeding is less likely to be severe.
A single deliberate cut of 2-3 cm is made while inserting two fingers into the vagina to
protect the baby’s head. Medio-lateral is best, as it avoids danger of damage to anal
sphincture. This begins at the mid point of fourchette and is directed at 45 degree angle to the
midline.
The baby’s head and shoulders should be controlled as they deliver to prevent an extension of
the episiotomy.
If there is any delay before the head emerges pressure should be applied to the site to
minimize bleeding.
REPAIR OF AN EPISIOTOMY
Carefully examine the episiotomy for any extensions and other tears.
Apply an antiseptic solution around the site of the incision.
Ask the patient if she had any reaction to suture material in the earlier deliveries or at any
other time.
Choose an appropriate suture material. Although 2-0 chromic catgut is commonly used
for patient with history of catgut allergies vycril may be used. For patients with catgut
allergy inform a gynaecologist before suturing the episiotomy.
Close the vaginal mucosa using continuous 2-0 suture. Continuous suture gives better
homeostasis.
132
132
Start the repair 1cm above the apex of the episiotomy. Continue the suture to the level of
the vaginal opening.
Close the perineal muscle using interrupted 2-0 sutures. Good approximation of tissues is
important as the strength of pelvic floor will depend on the adequate repair of this layer.
Close the skin using interrupted stitches. Avoid too many stitches.
Sutured area should be inspected in order to confirm haemostasis.
Vaginal examination should be done to ensure that the vaginal introitus has not been
narrowed.
Rectal examination is made in order to ensure that no sutures have penetrated the rectal
mucosa. Any such sutures to be removed to prevent fistula formation.
If the episiotomy is extended through the anal sphincter or rectal mucosa call a
gynecologist.
133
133
CARE OF NEW BORN
Make sure that all equipments and drugs for resuscitation are ready and in good working
order, before delivery. (Refer to newborn resuscitation guideline for list of drugs and
equipments.)
At birth an initial assessment should be performed for all the babies and the following
conditions should be observed.
Clear of meconium
Breathing or crying
Good muscle tone
Colour pink
Term gestation
If the baby has no apparent problems and if all of the above criteria are met provide routine
care. Routine care includes drying the baby, clearing the airway, providing warmth.
If the baby is born with a problem/condition that requires urgent intervention care should
provided as follows.
When born with meconium stained liquor suctioning of the mouth and nose as soon as
the head is born. While doing suction care should be given not to suction deep in the
throat as it may cause bradycardia or the baby may stop breathing.
If the baby is not breathing or crying dry and remove wet cloth, keep baby under
radiant warmer, clear the air way and provide tactile stimulation. Tactile stimulation
should be given by flicking the soles of the foot twice and gentle rubbing of the back.
134
134
If the baby does not start breathing initiate newborn resuscitation (refer to guidelines
for newborn resuscitation)
If the baby has cyanosis oxygen can be administered.
Assess baby’s condition, at 1minute, 5 minutes and 10 minutes after birth using apgar
scoring.
The cord should be clamped with cord clamp and cord care should be given with spirit.
Provide eye care for the baby with sterile swabs and saline
For all babies with term gestation vitamin K 1mg should be administered intramuscularly to
the thigh muscle. For preterm babies and babies with low birth weight dosage of vitamin K
would depend on the doctor’s order.
Anal patency for the babies should be checked at birth using a rectal thermometer/rectal tube
Oesophageal patency should be checked using a nasogastric tube.
Clean and dress baby.
An identification label should be attached to baby’s leg as soon as possible. The label should
be legibly written with the following details:
- Mothers name and address
- Date and time of birth
- Sex
- weight of baby
Baby should be shown to the mother as soon as possible.
Breast feeding should be initiated within the first half an hour of birth and necessary
assistance should be provided for the mother while feeding.
135
135
Inform the relatives of the baby’s condition and show the baby to the relatives.
The newborn sheet should be completely filled and a nurses note should attached to the
newborn sheet before the baby is transferred to postnatal ward.
NEONATAL RESUSCITATION
Preparation for delivery1. Anticipate need for resuscitation;
Ante partum and intra partum history may help to identify the possibility of a
depressed or asphyxiated newborn.
2. Personnel;
When neonatal asphyxia is expected’ two staff should be present in the delivery room
and be prepared to work as a team to perform a complete resuscitation. The person
conducting the delivery should not be considered as one of the resuscitators.
Initiating resuscitation should not be delayed.
3. Equipments;
Equipments and medications should be checked daily and before each delivery.
Used items should be cleaned as soon as possible after resuscitation.
The delivery room should be kept warm and the radiant heater should be preheated, to
prevent excessive heat loss.
Pre warming of towels and blankets is helpful.
(Refer to appendix C for equipments and medications needed for resuscitation)
136
136
Post resuscitation:
Baby’s condition should be explained to parents as soon as possible.
If condition of the baby allows, show the baby to mother and relatives.
Initiate breast feeding as soon as possible if condition allows.
Keep a close observation on the baby.
Accurate documentation is very important.TRANSFERRING NEWBORN
BABIES TO NURSERYExplain to the mother why the baby is being transferred
to nursery
Inform the nursery before shifting the baby.
Ensure that the baby is wrapped in a blanket to prevent heat loss.
If the baby requires oxygen transfer the baby in the incubator.
Show the baby to the mother and the relatives before shifting to nursery.
Ensure the newborn sheet and the nurses notes are completed and handed over to the nursery
staff. If the baby has received any medications document it in the treatment sheet.
NURSING CARE OF PATIENTS WITH ANTE PARTUM HEMORRHAGE
Assess the general condition of the woman record the vital signs including foetal heart rate.
Call for a gynecologist.
If foetal distress is evident, manage as for foetal distress and prepare the patient provisionally
for LSCS.
Send for all routine investigations including cross match (send minimum 2crossmatches)
Start an IV line. Assess the amount of bleeding and restore the blood volume as advised by
the doctor.
Do not do a vaginal examination: Check the scan reports and rule out placenta previa.
Explain the patient’s condition to the relatives.
Monitor the foetal heart rate every 15 minutes.
Accurately document the interventions carried out
137
137
MANAGEMENT OF PATIENTS WITH PIH IN LABOUR
On admission:
Collect the history and check whether the patient is on any medications.
Do a general examination and asses the woman for edma.
Send for all routine investigation including a crossmatch. Get advice from a
gynecologist or medical officer for any special investigation.
Record the vital signs including foetal heart rate.
If the diastolic blood pressure is more than 100 inform a gynaecologist or a medical officer.
Monitor the blood pressure every hourly or as indicated
Monitor foetal heart rate and uterine contractions every half hourly.
If the diastolic BP is more than 100 donot allow the women to walk to the toilet alone. Offer a
bedpan and monitor urine output.
Maintain strict intake and out put.
Start an IV line to keep the vein open.
Watch for signs of impending eclampsia:
Headache
Blurred vision
Do not leave the woman alone and keep the bed rail as a safety precaution.
Keep the equipments ready for the management of a convulsion
Air way
Suction machine
Suction tubes
Oxygen
Ambu bag and mask with tubing
Drugs (inj Diazepam, inj Epsolin, inj magnesium sulphate)
In case of convulsion:
Clear airway
Adminster oxygen at 4-6 liters/ minute
138
138
Inform a gynaecologist or medical officer
Protect the women from injury
Position the woman on her side to reduce the risk of
aspiration
If any narcotic is administered carefully monitor the foetal heart sounds and inform a
pediatrician at the time of delivery. Keep injection Naloxone ready to resuscitate the baby.
USE OF MAGNESIUM SULPHATE FOR PRE- ECLAMPSIA AND ECLAMPSIA
Minimum requirements for the administration of magnesium sulphate
PR greater than 16/min
Urine out put atleast 30ml/hour
Knee jerk should be present
Preparation of 50% magnesium sulphate for use:
1. IV loading dose: 4gm magnesium sulphate over 10 minutes
Magnesium sulphate is supplied in 2ml ampules and 4 ampules (8ml) would provide 4 gms.
Dilute this amount to a volume of 20 ml by adding 12 ml of normal saline. Give this slowly over
10 minutes.
2. IM maintenance: 5gm of 50% magnesium sulphate solution in each buttock initially and then
on alternate buttock four hourly. 5 ampules (10ml) of the solution for each 5gm to be mixed with
1ml of 2 % lignocaine syringe to be mixed in the same syringe. .
Assessment & Drug Effects
When magnesium sulphate is given IV, patient requires constant observation. Check BP
and pulse 10-15 min or more often if indicated/ as ordered by the gynecologist.
Monitor patients with high levels of magnesium very closely as cardiac arrest may occur
in such cases. Plasma levels in excess of 4 mEq/L are reflected in depressed deep tendon
reflexes and other symptoms of magnesium intoxication. Cardiac arrest occurs at levels in
excess of 25 mEq/L.
139
139
Early indicators of magnesium toxicity (hypermagnesemia) include cathartic effect,
profound thirst, feeling of warmth, sedation, confusion, and depressed deep tendon
reflexes.
For women receiving magnesium sulphate, monitor urine out put every hourly and if it
falls below 30ml/ hour inform a gynecologist
Before each repeated parenteral dose, patellar reflex should be tested. Depression or
absence of reflexes is a useful index of early magnesium intoxication. Also check
respiratory rate and character and urinary output. Therapy is generally not continued if
urinary output is less than 100ml during the 4 h preceding each dose.
Newborns of mothers who received parenteral magnesium sulfate within a few hours of
delivery should be observed for signs of toxicity, including respiratory and neuromuscular
depression.
140
140
CARE OF PATIENTS WITH MALPRESENTATIONS
Common mal presentations include:
Breech
Face
Brow
Trasverse lie/ oblique lie.
A breech or a face presentation may be allowed for a vaginal delivery. But inform a
gynecologist.
General management of fist stage of labour for face presentation and breech presentation is
the same as that of a vertex presentation.
In a breech presentation when the membranes are ruptured perform a vaginal examination to
exclude cord prolapse.
Meconium stained liquor is common in a breech presentation and it is not a sign of foetal
distress.
In a brow presentation, trasverse lie or in an oblique lie the woman is likely to have cesarean
section. Inform a gynecologist immediately when these presentations are suspected. If the
woman is in labour keep her provisionally prepared for cesarean section until a gynecologist
decides for the management.
141
141
MANAGEMENT OF CORD PROLAPSE
Following spontaneous rupture of membranes perform a vaginal examination to exclude cord
prolapse.
An abnormal foetal heart rate, especially bradycardia may also indicate cord prolapse. A
vaginal examination should be performed to rule out cord prolapse.
Immediate action:
Call for urgent help. Inform a gynecologist immediately.
Explain to the woman what has happened
Get an assistant to explain to the relatives what has happened and the emergency
measures that may be needed.
Relieve the pressure on the cord by holding the presenting part off the cord, especially
during contractions.
Monitor foetal heart rate carefully.
Adminster oxygen at 4-6 liters /minute.
Start an IV line.
Position the woman with her buttocks elevated to allow the fetus to gravitate towards
the diaphragm. (this position can be by keeping a pillow underneath the patients
buttocks or by raising the foot end of the bed). These measures must be continued
until foetus id delivered or until the patient is shifted to theater.
Keep the woman prepared provisionally for cesarean section until a gynaecologist
decides the management plan.
142
142
ADMINISTRATION OF OXYTOCIN FOR INDUCTION AND AUGMENTATION OF LABOUR
Oxytocin should only be administered with the advice from a gynaecologist. For routine
inductions ensure the necessary investigations including crossmatch is ready. If not, inform
the gynaecologist before starting the oxytocin infusion.
Oxytocin should be used with caution as fetal distress can occur with hyperstimulation and
rarely uterine rupture can occur.
Administer Oxytocin in an IV fluid (dextrose or ringer lactate) and gradually increase the
drop rate according to the doctor’s order until good contractions are established. Contractions
are considered as good when the woman gets about 3 contractions in 10 minutes each lasting
for atleast 40 seconds. When good contractions are established maintain the infusion rate.
Do not leave a woman receiving oxytocin alone and check the arm position inbetween as it
can alter the flow rate.
Carefully monitor the women receiving oxytocin for the following:
Blood pressure and pulse rate
Foetal heart rate every half hourly. Always check the foetal heart immediately after a
contraction. If there is foetal distress stop the oxytocin drip and inform a
gynaecologist. Manage foetal distress according to the protocols provided.
Uterine contractions every half hourly. If hyper stimulation occurs stop the infusion
and inform a gynaecologist.
Rate of infusion. Increase the infusion rate according to the doctor’s advice.
Properly document the findings.
143
143
CERVIPRIME INSTILLATION FOR INDUCTION OF LABOUR
Ensure that the necessary investigations including crossmatch are ready. If not, inform the
gynaecologist.
Prior to the instillation of cerviprime monitor the woman’s vital signs and foetal heart rate.
Ask the woman to empty her bladder prior to the instillation.
Prepare the articles needed (refer to appendix C)
Immediately after instillation check the foetal heart rate.
Ask the woman to take bed rest as per the doctor’s advice.
Keep the woman in the labour room under observation and monitor the uterine contractions
and record the foetal heart rate every 30 minutes.
If there are no contraction the woman may be transferred to ward. Advice the woman to
report with contractions or leaking.
The woman may be allowed to take soft diet if there are no contractions
Before transferring the patient to ward ensure that all the documentation is complete.
EXTRA AMNIOTIC SALINE INSTILLATION Receive the patient and take proper hand over from the ward nurse.
144
144
Check the doctor’s order.
Check whether routine investigations and cross match is done.
Check whether patient and the relatives have been explained about the procedure. If not
already done, explain the procedure to the patient and a close relative and get their consent. If
language is a barrier, call for help.
Check and record patient’s vital signs.
Change the patients dress to a hospital gown.
Ask the patient to empty her bladder.
Prepare the articles needed for the procedure (refer to appendix C)
Keep the patient on lithotomy position. When positioning both legs
should be put on the stirrups at the same time. Ask if the patient is comfortable and level the
stirrups accordingly.
Ensure that adequate privacy is provided for the patient.
Assist the doctor with the procedure. While assisting the procedure
ensure that strict aseptic technique is followed.
After the procedure make the patient comfortable and watch for
uterine contractions, leaking or bleeding PV.
Disinfect the articles used, as per infection control guidelines.
Properly document the procedure. While documenting follow the
guidelines for nursing documentation.
Monitor and record vital signs.
Maintain bed rest as per doctor’s order and carry out any further
orders.
Explain the patient’s condition to the relatives.
Before transferring the patient to ward provide information to the
patient regarding the conditions that she should report to the nursing staffs. These include
Leaking
Bleeding
If the catheter bulb comes out /If pains increase.
If the patient does not have contractions, transfer the patient to
ward as per doctors advice.
145
145
CARE OF PATIENTS WITH INFECTIOUS DISEASE IN LABOUR
Patients with infectious disease in labour may either need isolation or additional precautions
to prevent the spread of infection. Those with communicable diseases need to be isolated. But
those with infections such as hepatitis B/ HIV and other blood bourn disease does not need
isolation.
Patients who need isolation in labour should be given the same nursing care given to other
patients in 1st, 2nd, 3rd, and 4th stage of labour. The patient should get the same respectful
treatment that is given to any other patient.
Patients with communicable diseases need to be nursed in a separate room with separate
equipments. All the unnecessary furniture and equipments should be removed from the room.
While caring for the patient the nurse must follow the practice of medical and surgical
asepsis. Wear all personal protective equipments to prevent the spread of infection. Do not let
soiled linen and other articles touch the uniform.
Hand washing is the most important method of controlling the spread of infection. Wash
hands thoroughly using an antibacterial solution:
Before and after the procedures.
After contact with blood and body fluids.
Things used for the patients with infectious diseases need to washed separately. Keep
separate equipments for the patients where necessary. (eg bedpans). Before washing the
instruments soak them in 0.5% sodium hypochlorite for 10 minutes.
Put contaminated things in a separate plastic bag and label it as “BIO HAZARD”.
Dispose of urine, feces and vomits at once. Mop up any spilled fluids immediately using the
standard precautions. (Make sure that the attendants understand the restrictions and supervise
them while cleaning the spillage).
Mental support for isolated patients:
Carefully explain the patient and the relatives why the restriction is necessary.
Make sure that the patient does not feel emotionally isolated.
Communicate with patient.
Support the patient to go through labour as others.
146
146
Airborne transmission precaution:
Patient placement: place the patient in an individual room if available.
Respiratory protection: wear a mask when giving care for the patient.
Patient transport: Limit patient transport to essential purpose only. If movement is
necessary minimize the risk of infection to others by placing a mask on the patient.
Environmental control: ensure appropriate environmental and equipment cleaning,
disinfection and sterilization. All surface areas should be disinfected with 0.5% sodium
hypochlorite solution
Contact transmission precaution:
Use personal protective clothing and practice hand washing:
When equipments are shared decontamination of the equipments are necessary before
using on another patient.
All surface areas should be disinfected with 0.5% sodium hypochlorite solution.
Droplet transmission precaution:
Patient placement: place the patient in an individual room if available
Respiratory protection: wear a mask when giving care for the patient.
Environmental control: All surface areas should be disinfected with 0.5% sodium
hypochlorite solution.
147
147
INFECTION CONTROL PRACTICES IN LABOUR ROOM
Recommended infection control practice are based on the following principles
Every person (patient or staff ) must be considered potentially infectious;
Hand washing is the most practical procedure for preventing cross contamination.
Wear gloves before touching anything wet – broken skin, mucous membranes,
blood or other body fluids (secretions or excretions).
Use barriers (protective goggles, face masks and aprons) if splashes and spills of
any body fluids (secretions or excretions) are anticipated.
Use safe work practices, such as not recapping or bending needles, proper
instrument processing and proper disposal of waste. Soak used instruments in
0.5% sodium hypochlorite for 10 minutes before washing them
Handling of sharps
Use each needle and syringe only once.
Do not disassemble needle and syringes after use.
To prevent needle stick injuries, put used disposable syringes and needles, scalpel
blades and other sharp items in puncture-resistant containers for disposal immediately
after use. Keep these containers as close as possible to where sharp objects will be used.
Do not recap-if disposable needles are not available and if recapping need to be
practiced, use the “One handed” recap method:
General house keeping:
o The floor should be cleaned at least three times in 24 hours using 0.5% sodium
hypochlorite
o Thorough cleaning of delivery room should be done at least once a month.
o High dusting should be done at least weekly.
o All surfaces should be disinfected with 0.5% hypochlorite solution once a day and when
the patient is transferred.
o Toilets should be cleaned three times a day using detergent
148
148
o Wash basins should be cleaned at least twice a day.
Additional precautions
The hepatitis B and/or HIV status of all the patients should be determined.
If Positive: Linen which is used should be sent to laundry marked as “BIO HAZARD”
Post delivery:
All babies born to hepatitis B surface anti body positive mothers are immunized against
hepatitis B as soon as possible. If the mother is known to be HBe antigen positive inform
a pediatrician.
149
149
CARE OF THE PATIENT AFTER ABORTION
Death or expulsion of fetus before 28th weeks of gestation either spontaneously or by induction is
termed as abortion.
Rights of women:
All women presenting with abortion has a right for immediate and quality care regardless
of of their marital status, religion, age, socioeconomic status, sexual behaviors, political
beliefs and whether tried for unsafe abortion
All women have a right for INFORMATION regarding their clinical condition and the
treatment planned for her
They have a right to discuss their concerns and express their own views regarding their
condition in a confidential environment. The information provided by the patient should
be treated CONFIDENTIALY unless it is required in a life threatening situation
They have a right for PRIVACY when ever undergoing any examination as it helps to
protect her confidentiality and promotes a sense of security and dignity
Immediate care
If a woman is admitted with vaginal bleeding perform a rapid assessment of her clinical
condition
Check for signs of shock (assess all vital signs)
Check the amount and duration of bleeding (passage of any clots)
Signs of any infection or injury
Get a detail medical and obstetric history of the patient using effective communication
techniques
History should include the last menstrual date
History of abdominal pain
History of fever
150
150
History passage of clots
Past medical history
Secure an intravenous line keeping shock in mind
Send all routine investigations and a cross match
In suspected unsafe abortions observe for signs of infection and any injury
Inform the consultant on call
In case of the need for D&C proper explanation of the procedure and its risks should be
explained both to the woman and her family/husband
Women should be prepared for D&C
An informed consent should be taken from the woman/husband before the procedure
Woman should be made as comfortable as possible during the procedure and her stay in
hospital
Provide as much privacy as possible for the woman during the procedure
Provide pain medication/sedation as ordered by the consultant
After care
Respect the religious and cultural beliefs of the couple
Show the products of conception to the husband as well as to the woman
If a fetus is there allow the mother to touch if she wants to
All the D&C has to be entered in the D&C register
It is essential to provide adequate counseling to the couple after the complication is dealt
with.
In case of unsafe abortion provide counseling regarding the availability of family planning
methods which can be started immediately
Hand over a delivery/death form depending on the products of conception
151
151
ROUTINE INVESTIGATION CHECKLIST
Investigation for labour patients
Hb
PCV
Bloog grouping and Rh typing
G6PD
Random blood sugar
HIV screening
HbsAg screening
VDRL
Investigations for PIH
All routine investigation
Blood urea
Serum creatinine
Uric acid
BT/CT
Investigation for babies born to Rh negative mothers
Hb
PCV
Blood grouping and Rh typing
Reticulocyte count
Serum bilirubin-total
Serum bilirubin- direct.
Direct coomb’s test.
Investigations for septic screening (Babies)
TC/DC
ESR
Blood culture.
CRP
152
152
Investigations for birth asphyxia
Blood gas anal
Admission checklist
153
153
Emergency Pre- operative checklist
154
154
Documentation checklist
155
155
Appendix
156
156
APPENDIX A: PATIENT UNIT PREPARATION
For first stage of labour: Bed ready with curtains around the bed
Oxygen with tubing
Doppler /BP apparatus / thermometer /Stethoscope
P/C bowl,Gloves, Dettol cream (for P/V examination)
IV fluids and medication (listed in the daily inventory)
IV tray/ injection tray/ IV stand
Water
Feeding cup / medicine cup
Kidney tray
Dustbin
Relevant papers for documentation.
For second stage of labour:
Delivery bed with stirupps
Doppler
Suction machine with tubing
Suction tubes no: 8 (if liquor is clear ) no: 10 (if liquor is meconium stained)
Oxygen with tubing
Light
IV fluids and medication (listed in the daily inventory)
BP apparatus / Stethoscope
IV tray/ injection tray/ IV stand
Water
Feeding cup / medicine cup
Kidney tray
Delivery set (refer to appendix C)
Newborn resuscitation equipments and medication (refer to appendix C)
157
157
For Severe PIH / eclampsia:
Keep the unit ready as for patients with first stage of labour. In addition keep the following things
ready.
Bed rails
Adult Suction machine with suction tubes
Air ways
Splints
Tongue depressor
For the administration of magnesium sulphate keep the following things ready:
o 50% magnesium sulpphate
o 10 ml of 10% calcium gluconate.
o Injection normal saline
o Injection 2% lignocaine
o Clinical hammer
o 20 ml syringe
o 10 ml syringe
o Foley’s catheter with syringe
158
158
APPENDIX B / ORIENTATION TO LABOUR ROOM
On admission orient the patient and the relatives to the labour room with emphasis on the
following points.
Relatives are not allowed inside labour room.
Patients are not allowed to bring in their mobile phones or any valuables to labour
room.
Once patient is in active labour she will stay in the labour room till delivery.
All the patients will be attended by the doctor on duty/call (even if she has done her
antenatal checkups by a different doctor).
Relatives should stay in the place allocated for them and if they need to get any
information regarding the patient’s condition contact a nurse or a doctor on duty.
Relatives can talk to the patient over phone at any time they want (i.e if the condition
of the patient allows).
To keep the patients belongings a cupboard will be given. The key should be handed
over to labour room when the patient gets transferred to another ward. Relatives
should be advised not to keep any valuable item in this cupboard.
After delivery all patients will be kept in labour room for at least 2 hours.
Once patient is admitted the relatives can book for a room if they wish to. But when
the patient is due for transfer from labour room she will be shifted to a general ward if
the room is not due.
159
159
APPENDIX C: ARTICLES/ EQUIPMENTS NEEDED FOR PROCEDURES PERFORMED IN LABOUR ROOM
Normal delivery:
Sterile delivery set containing
1 gown with long sleeves,
1 lithotomy sheet
2 leggings
1 baby sheet
2 drapes
2 artery forceps
1 cord cutting scissor
1 episiotomy scissor (if needed)
Pad, gauze
Small bowl with an antiseptic solution
In addition,
Local anesthetics
Dettol cream
Personal protective equipments (plastic apron, mask, shoe cover, sterile gloves)
Oxygen
Doppler
Bed side suction machine if meconium is present.
For Vacuum extraction keep an appropriate size of vaccum cup with tubing and vaccum
apparatus ready
160
160
Equipments needed for resuscitation in delivery room:
Radiant heater.
Baby stethoscope.
Oxygen with flow meter and tubing.
Neonatal resuscitation bag.
Face masks of different sizes.
Oral airways
Suction machine with tubing.
Suction catheters: 5F or 6F, 8F & 10F.
Endotracheal tubes; 2.5, 3.0, 3.5& 4.0mm.
Laryngoscope with straight blade no: 0 & 1.
Needles and syringes.
Feeding tube 8F and syringes.
Umbilical vessel catheterization tray.
Umbilical catheters 3.5 & 5F.
Medications needed for new born resuscitation:
Epinephrine (1:10,000).
Naloxone
Volume expander(normal saline).
Sodium bicarbonate.
161
161
Urinary Catheterization:
A sterile tray containing
A sponge holding forceps
Gauze
Cotton
In addition,
Urinary catheter (appropriate size)
Urine bag
Distilled water and syringe
Antiseptic solution
Xylocaine jel
Cerviprime instillation:
A sterile tray containing
2 sponge holding forceps
1 speculum (sim’s / cusco’s)
Small bowl for antiseptic solution
Gauze
Lithotomy sheet
Personal protective equipments
Culdocentesis:
P/ C bowl with cotton
Sterile lithotomy sheet
Speculum (cusco’s)
Sponge holding forceps
Long needles 18G, 20G, 21G (L/P needles)
10 ml syringe
Antiseptic solution
162
162
Antiseptic cream
Personal protective equipments
Extra amniotic saline instillation:
A sterile tray containing
1 Speculum
1 Sponge holding forceps
1 vulsellum
1 artery forceps
1 Lithotomy sheet
Small bowl with betadine solution
Gauze pieces
In addition,
22 FR foley’s catheter
14 FR or 16 FR catheter and urine bag and 5cc of distilled water, if urinary
catheterization is needed
Syringes (20cc, for inflating intra cervical catheter and 5cc for inflating urinary catheter).
Clamp (a cord clamp may be used)
1 pint of normal saline and IV set
Johnson’s Plaster (to fix the catheter)
Xylocaine gel
Dettol cream
Personal protective equipments
Episiotomy suturing:
A sterile tray containing
Needle holder
Artery forceps
Dissecting forceps (toothed and non toothed)
Scissors
Gauze / tampoon
In addition,
163
163
Injection Xylocain 1 %
5ml Syringe with needles
Antiseptic solution
Personal protective equipments
Dilatation and curettage (D & C):
A sterile tray containing
1 set of Hega’s dilators
3 Sponge holding forceps
1 Vulsellum
1 Uterine sound
1 Sims’ speculum
Curettes (blunt & sharp)
Small bowl for antiseptic solution
Lithotomy sheet
In addition,
Pesonal protective equipments
Antiseptic cream
Antiseptic solution
164
164
APPENDIX D: CHECK LIST FOR WARD SISTER / WARD INCHARGE
(LABOUR ROOM)
DAILY
1. Check whether – daily inventory taken
– Missing/borrowed items replaced
2. Check whether – census(transfer in/transfer out/discharge)
3. Check whether – Narcotics inventory taken
– Narcotics register maintained regularly
– Narcotics cupboard key with senior staff nurse
4. Check whether – Emergency trolley (drug/equipments/instruments in both adult and
neonatal resuscitation
5. Check whether – store room locked at all times
6. Check whether – temperature/intake& output chart/files filled/updated ( during ward
rounds and report giving)
7. Check whether – all medication sheets filled accurately
8. Check whether – all special investigations (USG, CT scan, ECG, appointments, reports
etc)
9. Check whether – PAC’s done, consent taken (by the appropriate person)
10. Check whether – welfare letters are given
11. Check whether – linen checked, sent & returned
12. Check whether – infection control practices
– waste disposal/sharp disposal
– cleanliness /disinfection of equipments & instruments
– thorough disinfection of delivery bed and trolley after each delivery
– disinfection of patient unit
– used instruments/ bundles sent for autoclaving
13. Check whether – delivery forms handed over
14. Check whether – patient care components according to the care plan
– patient allocation
165
165
– allocated nurses go on round with doctor
– all doctor’s orders are carried out properly
– daily care given
– all records completed
– all register completed
– malignance of intake/output chart for whom all required (even if no
doctor’s order
15. Check whether – all ward equipments in working order
16. Check whether – overall cleanliness/tidiness of ward
17. Check whether – communication between shifts
18. Check whether – follow up when things go wrong/broken items/missing items in ward
19. Check whether – attendants handover to next shift attendants(mops dry, buckets emptied,
dustbins emptied, kidney tray washed, dirty utility in clean state
– nurses and attendants report before going off duty (other shifts to the
senior staff on duty)
20. Check whether – update the changes in the duty register in the nursing department
21. Reporting – incidents that need immediate reporting
WEEKLY
WARD STOCK
- Identifying consumables required for the next week
- Write & send indent book to Nsg Dept. on the previous day before 12.00nn
DUTY ROTA
- Send duty rota on Wednesday before 12.00nn to Nsg Dept.
- To be made by ward sister only
CLEANLINESS
- treatment room
- patient unit
166
166
- clean utility room
- dirty utility room etc
- fans, windows, racks etc
EQUIPMENT
- serving of all equipments – oiling of trolley wheels etc
- order/replace broken items
CASE SHEETS-DISPATCH
- Charts arranged in order
- Death case sheets stamped and documents filed in order/death summary filled
- Dispatch weekly or biweekly
CHECK AUTOCLAVED ITEMS
- Re-autoclaving after 2 weeks
- (Please allocate to senior nurses/junior nurses accordingly and do over all check)
REPORTING
- Necessary information (patient care/staff progress/ additional requirements etc. to the
nursing department )
MONTHLY
REVIEW CLASS: identifying weakest area – (present in the ward)
- reviewing a nursing procedure of a case presentation
INFECTION CONTROL: washing and C/S of delivery room
CHECK INVENTORY - (3-6monthly) of ward stock, Equipments / machinery
167
167
- ward linen – check total linen count
- maintenance of paint, lights, curtains
- ward meetings – special events of the month
DISPATCH equipments/instruments which cannot be repaired
EXPIRY DATE of drugs and emergency medications
RECORDS & REPORTS: maintenance of ward registers, files
- Birth census
- Narcotic report
MONITORING: staff progress/patients care (appraisal review after 6 months)
REPORTING: necessary information (patient care/staff progress/additional requirements
etc. to the nursing department)
ANNUALLY
FULL INVENTORY OF WARD
ANNUAL BIRTH CENSUS
NEW IMPROVEMENTS TO THE WARD – suggestions and ideas etc.
BUDGET- items required for the following year budget.
LEAVE SCHEDULE OF THE STAFF
STAFF APPRAISAL
168
168
APPENDIX E: RESPONSIBILITIES OF SHIFT IN-CHARGES (LABOUR ROOM)
Ensure that the inventory has been checked by the responsible person (according to the duty
schedule). If the staff allocated for checking inventory has changed duty or has taken sick
leave allocate another staff to check it. DONOT LEAVE THE INVENTORIES
WITHOUT BEING CKECKED.
Verify whether all items necessary for the shift is available. If not, take from the store (If it is
not available in the store inform the ward in-charge).
Ensure that the store room is locked at all times.
Make sure that the narcotic cupboard is locked at all times and if a narcotic is used it should
be entered in the register.
Take hand over of all patients and make sure that the staff responsible for each patient reports
the progress of their patients to you.
Attend the doctors round along with the staff responsible for each patient (when appropriate).
Visit all the patients as often as possible and make sure that they are not left alone.
If there is any problem with any patient make ensure that the responsible doctor is informed
(if the medical officer cannot be contacted for any reason, inform the duty gynecologist
directly).
Make sure that the condition of patients are explained to the relatives at the given times.
Any problem in the ward should be informed to the coordinator and ward in-charge without
delay.
Meet the shift coordinator / supervisor when she comes for rounds and inform the condition
of patients.
Supervise the work of attendants and other staffs and delegate their work equally.
At the end or beginning of each shift check the necessary registers and make sure that the
registers are completed.
169
169
APPENDIX F: DAILY TASKS OF NURSES WORKING IN LABOUR ROOM
Morning Shift
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition and if
there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the previous
shift and see that it is entered in the narcotics register).
Check the emergency trolley and neonatal resuscitation tray (check whether all
equipments are in working condition).
Check the general cleanliness of labour room
Send instruments for autoclave.
Take report from the previous shift.
Get introduced to the allocated patients and check their condition (check vital signs, FHS,
FM, uterine contraction).
Check IV fluids and if syntocinon drip is on flow check the drop rate and uterine
contraction.
Prepare for doctors rounds.
Receive and prepare patients for induction of labour.
Check for investigation reports and get them from laboratory (If cord blood has been sent
make sure that the reports are collected without delay and handed over properly).
Collect reports from the laboratory and hand over to the relevant wards with out delay.
Give any due medications.
Do rounds with doctors.
Explain the patients’ condition to relatives.
If any patient is kept in labour room for a long time, take her out and let the relatives meet
her.
Carry out orders.
Complete documentation.
170
170
Make the patients comfortable (mobilize the patient if possible).
Monitor the patients condition (check FHS, Vital signs and uterine contraction as needed).
Do not leave the patients alone when they are in pain.
Inform the progress of patients to duty doctors and carry out any emergency orders.
Explain the condition of patients to relatives and inform the relatives if there is any
change in the line of treatment.
Send the attendants to collect clean linen from laundry.
Collect bed sheets and gowns from the OT/ wards.
See that autoclaved items are collected from the CSSD.
Hand over delivery forms of LSCS mothers.
Pack used instruments, gloves etc.
Check the cleanliness of labour room before handover to the next shift.
Report any unusual incidence to the shift coordinator.
Complete documentation.
Hand over to the next shift.
Report to the ward incharge or shift incharge before leaving the ward or before going off
duty.
Afternoon Shift
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition and if
there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the previous
shift and see that it is entered in the narcotics register).
Check the emergency trolley and neonatal resuscitation tray (check whether all
equipments are in working condition).
Check the cleanliness and tidiness of labour room.
Take report from the previous shift.
Get introduced to the allocated patients and check their condition (check vital signs, FHS,
FM, uterine contraction).
171
171
Check IV fluids and if syntocinon drip is on flow check the drop rate and uterine
contraction.
Complete documentation of the findings.
Give any due medications
Check for investigation reports and get them from laboratory (If cord blood has been sent
make sure that the reports are collected without delay and handed over properly).
Collect reports from the laboratory and hand over to the relevant wards with out delay.
Do rounds with doctors and carry out orders
Explain the patients’ condition to relatives.
If any patient is kept in labour room for a long time, take her out and let the relatives meet
her.
Check if any delivery forms need to be handed over and remind the relatives to collect the
forms.
Monitor the patients condition (check FHS, Vital signs and uterine contraction as needed).
Do not leave the patients alone when they are in pain.
Inform the progress of patients to duty doctors and carry out any emergency orders.
Explain the condition of patients to relatives and inform the relatives if there is any
change in the line of treatment.
Check whether instruments need to be autoclaved and send to CSSD.
Receive autoclaved items from the CSSD.
Pack used instruments, gloves etc.
Check the cleanliness of labour room before handover to the next shift
Report any unusual incidence to the shift coordinator and ward incharge.
Complete documentation
Hand over to the next shift.
Report to the shift incharge before leaving the ward or before going off duty.
Evening Shift
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition and if
there are any thing missing get it replaced by the previous shift nurses).
172
172
Check narcotics inventory. (Check whether any narcotics have been used in the previous
shift and see that it is entered in the narcotics register).
Check the emergency trolley and neonatal resuscitation tray (check whether all
equipments are in working condition).
Check the cleanliness and tidiness of labour room.
Take report from the previous shift.
Get introduced to the allocated patients and check their condition (check vital signs, FHS,
FM, uterine contraction).
Check IV fluids and if syntocinon drip is on flow check the drop rate and uterine
contraction.
Complete documentation of the findings.
Give any due medications
Check for investigation reports and get them from laboratory (If cord blood has been sent
make sure that the reports are collected without delay and handed over properly).
Collect reports from the laboratory and hand over to the relevant wards with out delay.
Explain the patients’ condition to relatives.
Make the patients comfortable.
If patient is kept in labour room for a long time, take her out & let the relatives meet her.
Check if any delivery forms need to be handed over and remind the relatives to collect the
forms.
Monitor the patients condition (check FHS, Vital signs and uterine contraction as needed).
Do not leave the patients alone when they are in pain.
Inform the progress of patients to duty doctors and carry out any emergency orders.
Explain the condition of patients to relatives and inform the relatives if there is any
change in the line of treatment.
Pack used instruments, gloves etc.
Check the cleanliness of labour room before handover to the next shift
Report any unusual incidence to the shift coordinator and ward incharge.
Complete documentation
Hand over to the next shift.
Report to the shift incharge before leaving the ward or before going off duty.
173
173
Night Shift
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition and if
there are any thing missing get it replaced by the previous shift nurses).
Check narcotics inventory. (Check whether any narcotics have been used in the previous
shift and see that it is entered in the narcotics register).
Check the emergency trolley and neonatal resuscitation tray (check whether all
equipments are in working condition).
Take report from the previous shift
Get introduced to the allocated patients and check their condition (check vital signs,FHS,
FM, uterine contraction).
Check IV fluids and if syntocinon drip is on flow check the drop rate and uterine
contraction.
Complete documentation of the findings
Give any due medications
Check for investigation reports and get them from laboratory (If cord blood has been sent
make sure that the reports are collected without delay and handed over properly).
Collect reports from the laboratory and hand over to the relevant wards with out delay.
Complete the census and write newborn census.
Check the routine cleaning of the ward (washing of all the medication cups and all the
trays).
Explain the patients’ condition to relatives.
Monitor the patients condition (check FHS, Vital signs and uterine contraction as needed).
Do not leave the patients alone when they are in pain.
Inform the progress of patients to duty doctors and carry out any emergency orders.
Explain the condition of patients to relatives and inform the relatives if there is any
change in the line of treatment.
Make the patients comfortable.
174
174
If patients are kept in labour room for observation switch off lights and help them to take
rest.
Give morning care.
Prepare patients for induction of labour.
Receive patients from wards for induction of labour.
Pack used instruments; gloves etc and prepare it to send for autoclave.
Check the cleanliness of labour room before handover to the next shift
Report any unusual incidence to the shift coordinator and ward incharge.
Complete documentation
Hand over to the next shift.
Report to shift incharge/ward incharge before leaving the ward or before going off duty.
175
175
APPENDIX G: DAILY TASKS OF ATTENDANTS WORKING IN LABOUR ROOM
Morning Shift
Report to ward on time.
Take over from the night shift attendant.
Check the general cleanliness of labour room.
Take instruments to CSSD and collect it when autoclaved.
Collect clean linen from the laundry.
Collect bed sheets and gowns from the OT/ wards.
Take specimens to laboratory. DO NOT WAIT TO FINISH OTHER WORK.
Clean wheel chairs and stretchers.
Accompany patients to wards /OT along with a nursing staff.
Collect reports from laboratory.
Take investigation reports to wards and get signature of the staff who receives the
report.
Assist patients to toilets if required. (ONLY WHEN ASKED BY A NURSE)
When asked by nurses stay with the patients.
Answer the bell, but DO NOT give any information regarding patients. Call a nurse to
give any information to relatives.
Make gauze, swabs and pads.
Check patients’ toilet frequently and clean as needed.
Wash kidney trays and disinfect them if a patient vomits. (Keep in sodium hypochlorite
solution for 10 minutes. DONOT LEAVE THEM FOR MORE THAN THE
SPECIFIED TIME ).
Clean doors, windows and other furniture.
176
176
Wash suction bottles and suction tubing after each delivery.
Clean and disinfect patients unit thoroughly when patients are transferred. (wash used
oxygen tubing and change water in the humidifier)
Take dirty linen to laundry DO NOT TAKE DIRTY LINEN ALONG WITH ANY
THING CLEAN
Take things to CSSD.
Check the general cleanliness of labour room
Wash the slippers.
Hand over to the next shift.
Report to the shift incharge/ward incharge before leaving the ward or before going off
duty.
Evening Shift
Report to ward on time.
Take over from the morning shift attendant.
Check the general cleanliness of labour room.
Take instruments to CSSD and collect it when autoclaved.
Collect clean linen from the laundry.
Collect bed sheets and gowns from the OT/ wards.
Take specimens to laboratory. DO NOT WAIT TO FINISH OTHER WORK .
Clean wheel chairs and stretchers.
Accompany patients to wards /OT along with a nursing staff.
Collect reports from laboratory.
Take investigation reports to wards and get signature of the staff who receives the report.
Assist patients to toilets if required. (ONLY WHEN ASKED BY A NURSE)
When asked by the nurses stay with patients.
Answer the bell, but DO NOT give any information regarding patients. Call a nurse to
give any information to relatives
Make gauze, swabs and pads.
Check the patients’ toilet frequently and clean as needed.
177
177
Wash kidney trays and disinfect them if a patient vomits. (Keep in sodium hypochlorite
solution for 10 minutes. DONOT LEAVE THEM FOR MORE THAN THE
SPECIFIED TIME) .
Wash suction bottles and suction tubing after each delivery.
Clean and disinfect patients unit thoroughly when patients are transferred. (wash used
Oxygen tubing and change water in the humidifier)
Take dirty linen to laundry. DO NOT TAKE DIRTY LINEN ALONG WITH ANY
THING CLEAN
Wash the slippers.
Check the general cleanliness of labour room
Hand over to the next shift.
Report to the shift incharge/ward incharge before leaving the ward or before going off
duty.
Night Shift
Report to ward on time.
Take over from the evening shift attendant.
Check the general cleanliness of labour room.
Take specimens to laboratory. DO NOT WAIT TO FINISH OTHER WORK.
Accompany patients to wards /OT along with a nursing staff.
Collect reports from laboratory.
Take investigation reports to wards and get the signature of the staff who receives the
report.
Assist patients to toilets if required. (ONLY WHEN ASKED BY A NURSE)
When asked by the nurses stay with patients.
Answer the bell, but DO NOT give any information regarding patients. Call a nurse to
give any information to relatives
Make gauze, swabs and pads.
Check the patients’ toilet frequently and clean as needed.
Wash all the kidney trays and disinfect them. (Keep in sodium hypochlorite solution for
10 minutes. DONOT LEAVE THEM FOR MORE THAN THE SPECIFIED TIME) .
178
178
Wash suction bottles and suction tubing after each delivery.
Clean and disinfect patients unit thoroughly when patients are transferred. (wash used
Oxygen tubing and change water in the humidifier)
Assist the nurses in cleaning and disinfecting the delivery room.
Take dirty linen to laundry. DO NOT TAKE DIRTY LINEN ALONG WITH ANY
THING CLEAN
Wash the slippers.
Check the general cleanliness of labour room
Hand over to the next shift.
Report to the shift incharge/ward incharge before leaving the ward or before going off
duty.
179
179
REPRODUCTIVE HEALTH CENTRE
RHC-ROUTINES
QUALITY OF MAINTENANCE OF WORK & WORKING ENVIRONEMNT
INFECTION CONTROL GUIDELINE
DAILY TASKS OF NURSES
DAILY TASKS OF SHIFT SUPERVISOR
SHIFT ROUTINES FOR CLINICAL ASSISTANTS
SHIFT ROUTINES FOR RECEPTIONINTS
SHIFT ROUTINES FOR ATTENTANDS
180
180
RHC-ROUTINES
ChargingAll the investigation will be charged
Consultations and other services such as injections are given free
AppointmentsInstruct all antennal clients to confirm appointments 2 days prior to the consultation date. Notify
the confirmation. Appointment with no confirmation will be cancelled & those appointments can
be given to the requested clients. Extra appointments cannot be given without asking the
consultant on duty.
Patients who come with leaking PV, Bleeding PV, and pain abdomenInform to the nurse and the doctor on duty.
Quickly take history
If required direct them to casualty.
Inform to casualty staff before sending them
If needed accompany them to casualty, provide wheel chair or stretcher
Or provide an appointment depending upon the situation.
ANC registration for new clientsPregnancy confirmation result must be there before 4 months of pregnancy.
If they have confirmed with home kit ask them to do urine gravindex (give investigation slip)
If they have not confirmed ask them to do beta HCG (at least one month aminorrhoea)
181
181
Registration MemoFor all new patients Registration memo must be made and the hospital number must be entered in
their concerned clinic registers.
Investigation reportsAll investigation reports (including reports from islands, private clinics) which are done during
the present pregnancy should be entered on the ANC card & write the date of the investigation
done
Investigations (G6 PD DIFICIENT, NEGATIVE BLOOD GROUP, ALLERGIC MEDICINES)
should be written in RED INK.
High Risk PregnanciesHigh risk patients will be consulted only on Sundays and Wednesdays of the week.
A high risk list is maintained in the RHC. Due visit of all clients should be marked in the high
risk list. This list will be evaluated by weekly to identify the due visits and delay visits will be
reminded.
Family Planning Items.Condoms, Oral Pills & inj, Depo must issued throughout the day from 7.30am till 10.00pm.
All clients should be counseled before introducing any family planning method.
Family planning drugs and devices are issued only for family planning purposes.
NSTNST can be done for the RHC patients and Inpatients only. History and condition of the patient
should be assessed before receiving patients from Wards. Clarify the indication for NST. Do not
receive patients on stretcher, cases such patients in active labour, with premature contraction on
duvadilon drip, eclampsia, APH e.t.c. Make memo & maintain records.
182
182
If you are unable to contact the consultant who advised NST, then please call the Gynae MO on
duty to show the report.
Foetal distressIf you identify foetal distress while doing NST or checking FHS, please start Oxygen
immediately & inform the doctor immediately. Also double check with another staff. Document
correctly & accurately
Serum BillirubimSerum Billirubin is done according to the Doctor’s advice after postnatal consultation. Make
memo & maintain records
Urine Albumin,For anyone urine albumin will be done if high blood pressure is being noticed during the
registration. For PIH cases urine albumin will be done for all their visits.
Writing nurses notesNurses’ notes should be written to all clients after NST, newborns admitting after Serum bilirubin
results, antenatal clients admitting after urine albumin/high /low BP, high/low blood sugar
identified at RHC.
Clients with fainting episodes /weakness /leaking PV/ bleeding PV, active labour, diagnosed by
the consultant.
Note: the above mentioned patients should be accompanied by RHC nurse & proper handover
should be given to the nurse of the other ward. Transfer them by wheel chair or stretcher
depending upon the condition of the patient. Make necessary arrangements to transfer them as
soon as possible.
183
183
VaccinesInj. T.T is provided in accordance with the DPH protocols for antenatal mothers and adolescents.
All vaccines other than inj. T.T should be bought by clients
Ward VisitsWard Visits should be done daily to assess the conditions of antenatal and postnatal mothers.
Health education is provided according to their needs.
All the postnatal mothers will be explained about exclusive breast feeding, care of episiotomy or
LSCS wound, cord care & family planning.
Staff should attend to calls made by the ward staff to assist difficult cases of breast feeding.
Health EducationHealth education is given to all clients according to their needs.
Monthly forums are conducted according to a schedule prepared for each month.
The topics for forums are breast feeding, Labour & Labour Room Orientation, Baby bath &
newborn care, and to different high risk groups.
Points to be highlighted during registration for family planning Explain about physiological changes after delivery
involution of uterus
pelvic floor muscle changes
hemoglobin level
o Time is required for the body to adjust the above mentioned processes. It is also
important not to get pregnant again until the body is ready for that. So it is
advisable to follow one of the family planning methods until the decision to have
another baby.
184
184
Inform about the family planning clinic during the postnatal visit
Explain about the procedure/appointments of the family planning clinic
Family planning counseling
Family planning devices – free of charge
Available time
Maintenance of Records All clients’ data are entered to RHC computer soft wear program.
Pap smear reports are entered to computer program and each Pap smear report is filed
with the examination form.
List of high risk patients are maintained. The due visit for each patient will be marked to
monitor their follow-up visits and outcome after delivery will be noted.
Antenatal exercise For all clients ANC EXERCISE fitness form must be explained & filled at 5 months after
anomaly scan.
If a client requests to join the AN exercise classes, proper instructions must be given about the
date, timings, payment & about the necessary items required
Clients details should be entered into the registers & a copy of the completed fitness form should
be given to the physiotherapy department
Pelvic assessmentPelvic assessment form should be given to all clients at 32 weeks during the registration.
Gynecologists will be fixing a date for pelvic assessment after explanation
185
185
QUALITY & MAINTENANCE OF WORK & WORKING ENVIRONMENTEach individual staff is allocated special work in order to maintain the quality work done at
RH centre as well as to maintain a convenient working environment
ANTENATAL CLINICMaintenance of Antenatal registers & ANC cards
Check if registers are properly labeled & neatly maintained
Check if serial no. is followed correctly.
Check if all information (personal identification, medical /obs. /surgical history) is complete.
Check if Bp & weight are entered in each visit.
Check if results (blood, urine, & scan etc) are entered on each visit.
Identify & report incomplete records. The report should include the specific date, type of
record date, & the name of the responsible staff.
Maintenance of ANC statistics
Complete statistics from January – November 2006 at the end of November.
Check if daily statistics are entered to the daily sheet & computer
Prepare a format for statistics report during the 2nd week of October & confirm.
Report the progress of statistics report once every week.
Breastfeeding forum Make monthly schedule for breastfeeding forums.
Ensure all mothers at 6 months of pregnancy are noted down& called for breastfeeding
forums.
Check the no. of clients called for forums.
Check the no. clients attended for sessions.
186
186
Check the no of husbands attending forums.
Check the total no. of clients who attended to ANC at & after 6 months.
Maintain statistics
Labour & Labour room orientation forum
Make monthly schedule for labor /labor room orientation forums.
Ensure all mothers at 7 months of pregnancy are noted down& called for forums.
Check the no. of clients called for forums.
Check the no. clients attended for sessions.
Check the no. of husbands attending forums
Check the total no. of clients who attended to ANC at & after 7 months.
Maintain statistics
New born care forum Make monthly schedule for new born care forums.
Ensure all mothers at 8 months of pregnancy are noted down& called for forums.
Check the no. of clients called for forums.
Check the no. clients attended for sessions.
Check the no. of husbands attending forums
Check the total no. of clients who attended to ANC at & after 8 months.
Maintain statistics
Maintenance of Inj. Tetanus stock & record Check condition & temperature of the fridge daily
Check stock balance weekly & write requisition to DPH whenever necessary
Write the total no. of doses available & total no. of doses issued at the end of each week
Check if all records are entered properly
Maintain cleanliness of the fridge
187
187
ANTENATAL HIGH RISK CLINIC
Maintenance ANC High Risk statistics
Complete statistics from January – November 2006 at the end of November.
Check if daily High Risk cases are entered to the daily sheet & computer
Conduct high risk forums
Maintain record of high risk outcome after delivery
Report the progress of statistics report once a month
High risk clients follow up visit Maintain record of high risk visits with follow up date
Call & confirm if follow up visits are not done
Arrange appointment to those who got delayed due to appointment overbooking
Arrange forum or provide health education on the high risk factor
Antenatal exercise Check antenatal exercise request book daily
Always keep the AN exercise register updated
Ensure if fitness forms are filled for all mothers at 5 months after anomaly scan
Ensure if all forms (fitness forms, item list, and appointment slip) are in the file
Ensure if all copies fitness forms are filed & a copy is sent to the physiotherapy dept.
188
188
POSTNATAL CLINIC
Quality of maintenance of registers
Check if registers are properly labeled & neatly maintained
Check if serial no. is followed correctly.
Check if all information (personal identification, medical /obs. /surgical history) is complete.
Check if details of mother & newborn are entered in each visit.
Identify & report incomplete records. The report should include the specific date, type of
record date, & the name of the responsible staff.
Maintenance of PNC statistics
Complete statistics from January – November 2006 at the end of November.
Check if daily statistics are entered to the daily sheet & computer
Prepare a format for statistics report during the 2nd week of October & confirm.
Report the progress of statistics report once every week.
Conducting forums
Conduct forums on complimentary feeding after delivery between 4 & 6 months
Conduct forum monthly once or twice
189
189
FAMILY PLANNING CLINIC
Quality of maintenance of Family Planning registers & cards
Check if registers are properly labeled & neatly maintained
Check if serial no. is followed correctly.
Check if all information (personal identification, medical /obs. /surgical history) is complete.
Check if Bp, weight & other information are entered in each visit.
Check if investigation results are entered if any.
Identify & report incomplete records. The report should include the specific date, type of
record date, & the name of the responsible staff.
Maintenance of Family Planning Stock
Check if daily statistics are entered
Check if all the issued items are entered in the registers
Check if stock balance tally with the issued item numbers.
Maintain monthly stock balance /no. of users report form
Sending Family Planning reports to DPH
Send Family planning reports to DPH once in every 3 months
Send Family planning stock request to DPH once in 6 months
Conduct Family Planning Forums
Start conducting family planning forums from November onwards once in a month
190
190
WELL WOMEN CLINIC
Quality of maintenance of Well Women registers & forms
Check if registers & forms are properly labeled & neatly maintained
Check if serial no. is followed correctly.
Check if all information (personal identification/ history & other relevant information) is
complete.
Check if results (Pap smear, blood, urine, & scan etc) are entered on each visit.
Check if all the forms (pap smear & well women forms) are filed in order
Identify & report incomplete records. The report should include the specific date, type of
record date, & the name of the responsible staff.
Pap smear forms
Collect Pap smear forms daily from the OPD & file them in a separately.
Get reports from the Laboratory weekly once, attach with Pap smear forms and file them.
Enter the data to the computer program on weekly basis.
Keep all files properly labeled with dates.
ADOLSCENT HEALTH CLINIC
Quality of maintenance of registers, files & forms
Check if registers are properly labeled & neatly maintained
Check if serial no. is followed correctly.
Check if all information (personal identification & other relevant history) is complete.
Check if all the forms are complete & filed in order
Check if the vaccine register is maintained properly
191
191
Identify & report incomplete records. The report should include the specific date, type of
record date, & the name of the responsible staff.
MAINTENACE OF ANTENATAL LEAFLETS Arrange leaflet packs & keep ready for distributing patients
Remind to request for leaflets before getting them over
Keep leaflets neatly arranged
MAINTENACE OF POSTNATAL LEAFLETS Arrange leaflets in the cupboard & in other places
Remind to request for leaflets before getting them over
Keep leaflets neatly arranged
MAINTENANCE OF MODELS Check models register weekly once
Maintain lending /receiving items properly
MAINTENANCE OF WARD VISIT RECORDS Check & report if ward visits are not done daily
Check if all the columns of the ward visits are filled accurately
SUPERVISION OF INVENTORY Check if the inventory is checked daily
Check & report missing items
Check & maintain lending& borrowing book
192
192
SUPERVISION OF RECEPTION Remind all staff to keep the reception neatly &tidily
Check if reception inventory is maintained
Check if all appointment registers are labeled & maintained properly
Ensure & report if all posted staff for the reception stay in the reception
Remind about the rules of using reception telephone
Report problems of reception
MAINTENANCE OF LIBRARYBooks & videos
Keep the library books neatly arranged at all times
Check library register once a week
Maintain a record of lending / receiving items
CLEANLINESS & ARRANGEMENT OF COMSULTATION ROOMS Check if all areas of rooms are properly cleaned
Check if all items in the rooms are neatly arranged
Check if all sterile items in the room are not outdated
Make sure thorough cleaning is done once a week
Check if all instruments working condition
Identify & maintain repair & maintenance
Ensure that all documents / forms & files in the room are in place
CLEANLINESS & ARRANGEMENT OF REGISTRATION ROOM Check if all areas of the room are cleaned properly
Check if all items are arranged neatly kept in place
Maintain all fliers in the registration room
Ensure if all instruments are in working condition
Ensure thorough cleaning is done once a week
193
193
CLEANLINESS & ARRANGEMENT OF HEALTH EDUCATION ROOM Check if all areas of the room are cleaned properly
Check if all items are complete arranged neatly
Ensure thorough cleaning is done once a week
CLEANLINESS & ARRANGEMENT OF HEALTH EDUCATION ROOM Check if all areas /tables in the waiting area is cleaned daily
Check if all items are arranged neatly
Ensure thorough cleaning (chairs / leaflet cupboards , TV) is done once a week
CLEANLINESS & ARRANGEMENT OF VACCINE ROOM Check if all areas of the room are cleaned properly
Check if all items are arranged neatly kept in place
Ensure if all instruments are in working condition
Ensure that sharps & other waste are handled properly
Ensure thorough cleaning is done once a week
CLEANLINESS & ARRANGEMENT OF TREATMENT ROOM Check if all areas of the room are cleaned properly
Check if all items are arranged neatly kept in place
Ensure if all instruments are in working condition
Ensure that sharps & other waste are handled properly
Ensure thorough cleaning is done once a week
CLEANLINESS & ARRANGEMENT OF COUNSELLING ROOM Check if all areas of the room are cleaned properly
Check if all items are arranged neatly kept in place
Ensure if FP models & other items are in place
Ensure thorough cleaning is done once a week
194
194
CLEANLINESS & ARRANGEMENT OF DEMONSTRATION ROOM Check if all areas of the room are cleaned properly
Check if all items are arranged neatly kept in place
Ensure if all equipments are in working condition
Identify & report maintenance & repair work
Ensure thorough cleaning is done once a week
CLEANLINESS & ARRANGEMENT OF STORE ROOM Check if all areas of the room are cleaned properly
Check if all items are arranged neatly kept in place
Ensure thorough cleaning is done once a week
INFECTION CONTROLL GUIDELINE FOR RHC STAFF
Daily disinfection of all examination couches daily with sodium hypochlorite
Hand washing solution (betadine & chlorhedexine solution) must be available in all
consultation rooms
Clean all rooms thoroughly once a week according to the cleaning schedule
Wash all dustbins once a week
Wash all hand washing solution bottles once a week
Wash / through clean of both treatment rooms once a month.
Clean all fans once in 2 weeks
Wash curtains once a month
Bring sodium hypochlorite daily from CSSD
Wash all trays daily in 3rd shift
Check items required for re autoclaving once a week in the 3rd shift
Send forceps with jar for autoclaving everyday if it has been opened & used
Follow instructions for tray packing for packing used instruments
Disinfect all thermometers /stethoscopes daily in the third shift
Wash & dry the mop after every use
Ensure if mop bucket is washed after every use
195
195
Supervise (shift in charge) attendants during & after cleaning
Supervise attendants - handling of linens, waste, & autoclaved items
All staff should follow universal precaution during procedures
All staff should use sterillium for hand disinfection in-between procedures if hand washing is
not possible e.g before giving inj. T.T
All staff should present self neatly, should maintain short nails & no jewelries
Through cleaning & washing of RH centre once in 3 months
Reception & waiting area
Clean & mop the reception area daily twice.
Clean & arrange all tables daily
Clean the top of the counter with sodium hypochlorite daily at the end of all clinics.
Clean the telephones with spirit at the end of all clinics.
Clean thoroughly the reception area & counter once in a week.
Registration room
Clean & mop daily
Clean the weighing machine, height scale and table tops daily
Clean the stethoscope daily with spirits
Thorough cleaning once a week
Dust & clean inside the cupboard, table drawers
Wash table top with soap & water
Disinfect with sodium hypochlorite
Health Education Room
Clean all areas of the room & mop the room daily
Clean all equipments in the room daily
Thorough cleaning once a week
Dust & clean leaflet cupboard
Dust & clean the TV rack
196
196
Wash table top with soap & water
Treatment room (down stairs)
Clean all areas of the room & mop the room daily
Carbolize the examination couch with sodium hypochlorite
Clean inside the cupboard
Disinfect NST machine daily / wash cloth belt once a week
Treatment room (up stairs)
Clean all areas of the room & mop the room daily
Carbolize the examination couch with sodium hypochlorite daily
Change sheets in-between patients
Clean the cupboard & cardiac table top daily with sodium hypochlorite
Keep sterile items separately from non sterile items
Through cleaning once a week
-Dust and clean all areas of the room with sodium hypochlorite including walls & fans
Demonstration Room
Clean all areas of the room & mop the room daily
Clean all equipments in the room daily
Thorough cleaning once a week
Clean inside the cupboard once a week
Clean all chairs once a week
Clean all areas of the room once a week
All consultation rooms
Clean & mop all rooms daily
Clean table tops daily
Wash table tops with soap & water once a week
Ensure the wash basin is cleaned well
Disinfect all examination couches daily with sodium hypochlorite
Keep hand -washing solutions & sterillium solution in all rooms
Disinfect dopplers /Bp apparatus daily
197
197
Disinfect baby mat & measuring tape daily in the 3rd shift
Counseling Room
Clean all areas of the room & mop the room daily
Clean all equipments in the room daily
Thorough cleaning once a week
Clean inside the cupboard once a week
Clean all chairs once a week
Clean all areas of the room once a week
Store Room
Clean all areas of the room & mop the room daily
Clean all equipments in the room daily
Thorough cleaning once a week
Clean inside & top of the cupboards once a week
Office
Clean all areas of the room & mop the room daily
Clean all equipments in the room daily
Wash the table top daily
Thorough cleaning once a week
Clean inside & top of the cupboards once a week
198
198
INSTRUCTIONS FOR TRAY PACKING
Wash instruments / article with diluted soap solution.
Dry immediately with a clean towel
Handle the instruments / article care fully and gently.
Check for proper functioning of instruments / articles.
Keep only sufficient amount of instruments in the tray.
Make sure instruments are enough for a particular procedure.
Keep cotton balls / gauze enough for a particular procedure.
Keep autoclaving indicator before closing the tray
Make sure the wrapper is large enough to cover the tray completely.
Check and label properly.
Fix the autoclaving indicator outside the label (not on the tray cover) and write the date and
name (who packs tray) on the plaster.
Make sure all the trays and articles are accurately written in the book before sending for
autoclaving.
Special instructions
Soak soiled instruments in 0.5% sodium hypochlorite solution for 5 minutes before
washing.
199
199
UNIVERSAL PRECAUTIONProtect health care providers from exposure to disease spread by blood, other body fluids such as
HIV, hepatitis B, MRSA e.t.c
Procedures for universal or standard precaution
1. Hand washing
2. Clothing (uniform/gown)
3. Shoes
4. Caps
5. Mask-patient & staff protection
6. Safe injection practices
Additional precaution
1. Air borne, Contact, Inoculation or Parenteral,
2. Faeco-oral routes, multiple routes.
Transmission- based precautions are special precautions taken in addition to standard precautions
for known infections based on the mode of transmission of the infection.
SHARP DISPOSAL1. Use sharps container for disposing cotaminated needles, blades e.t.c
2. Do not pass sharps to one another
3. Do not recap/if recapping use the correct method
4. Practice safe injection practices
200
200
5. Discard sharps container when 2/3 full
WASTE DISPOSAL1. Double bag/biohazard labeled infectious waste/ attendant must wear rubber gloves for
transferring waste materials
2. Send out of the place as soon as possible
Soiled material after procedure (norlant /copper-T insertion)
Small dressings-episiotomy/surgical wounds.etc
Motion cleaning/nappies
LINEN1. Put soiled linen directly into black bag
2. Count the amount of linen correctly
3. Double bag/biohazard labeled soiled linen
4. Send to laundry as soon as possible
BLOOD/ VOMITUS/ OTHER BODY FLUIDS1. Put sodium hypocrite over the spilled fluid
2. Cover with newspaper and leave for a few minutes
2. Attendant must wear rubber gloves for taking them put them into a plastic bag
3. Mop the area – use the separate mop
4. Wash, clean the mop in bleach & dry
RECEIVING A CLIENT WITH A COMMUNICABLE DISEASE1. If a client is notified with any communicable disease, she should be taken to one of the free
OPD consultation for consultation.
2. Inform the gynaecologist on duty.
201
201
3. Inform to the OPD nurses station & arrange the room
4. All appropriate measures should be taken by the staff
5. Preferably an immuned staff should accompany if possible.
6. If the diagnosis is confirmed after consultation, then used instruments, sheets & examination
couch, chair must be disinfected before next patient
SHIFT ROUTINES FOR RHC NURSES
FIRST SHIFT
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition and if
there are any thing missing get it replaced by the previous shift nurses).
Check appointments, staff on duty & doctors duty rota
Check allocated areas of all staff & prepare to start work according to the clinics of the day
Check if rooms are ready for consultations
Check the general cleanliness of the place
Send attendant to collect linen & autoclaved items
Check report & statistics of the previous day
Check the message book
Take delivery list of the previous day & send to the physiotherapy department
Check & record the vaccines & fridge temperature
Prepare for registration & health education
Check & distribute linen & autoclaved items to rooms
Ensure all clients who need health education are given health education.
Report any unusual incidence to the nurse in charge & shift coordinator.
Clean & arrange consultation rooms at the end of the clinics
Wash & pack used intruments
Complete report & statistics
Handing over to the next shift
Complete other assigned works / assist in registration of patients if necessary
Check cleanliness & tidiness of all the areas
202
202
Report to the ward in charge on shift in charge going off duty
SECOND SHIFT
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition and if
there are any thing missing get it replaced by the previous shift nurses).
Check appointments, staff on duty & doctors duty rota
Check allocated areas of all staff & prepare to start work according to the clinics of the day
Check the general cleanliness of the place
Check if rooms are ready for consultations
Take report from the previous shift
Check if statistics report is correct & complete
Check vaccines & fridge temperature
Prepare for registration & health education
Ensure all clients who need health education are given health education.
Do ward visits
Help family planning clinic
Report any unusual incidence to the nurse in charge & shift coordinator.
Clean & arrange consultation rooms at the end of the clinics
Complete report & statistics
Handing over to the next shift
Complete other assigned works
Check cleanliness & tidiness of all the areas
Report to the ward in charge on shift in charge going off duty
203
203
THIRD SHIFT
Report to ward on time.
Check ward inventory (check whether all the equipments are in working condition and if
there are any thing missing get it replaced by the previous shift nurses).
Check appointments, staff on duty & doctors duty rota
Check allocated areas of all staff & prepare to start work according to the clinics of the day
Check the general cleanliness of the place
Check if rooms are ready for consultations
Check the total number & type of family planning procedures
Take report from the previous shift
Check if statistics report is correct & complete
Check vaccines & fridge temperature
Prepare for counseling, procedure, registration
Prepare for adolescent health clinic
Report any unusual incidence to the nurse in charge & shift coordinator.
Clean & arrange consultation rooms at the end of the clinics
Check & replace all necessary items for the consultation rooms
Count & maintain family planning stock
Wash all trays
Disinfect all articles stethoscope, telephones, baby mat, measuring tape etc.
Complete report & statistics
Complete other assigned works
Check cleanliness & tidiness of all the areas
Write special reports on the message book or on the notice board
Swtich off all lights, air-conditions (except demonstration room & treatment room), close all
doors & recheck before closing the place
204
204
SHIFT SUPERVISOR
(Shift supervisor will be one of the nurses on duty)
JOB DESCRIPTION
Check the total number of staff (nurses, clinical assistants, doctors) on duty.
Check the total number of appointments and the number of doctors on duty.
All staff should inform to the SHIFT SUPERVISOR regarding any information (order) given
by a doctor, from other departments, or any other staff.
Receptionists should inform to the SHIF SUPERVISOR regarding any information (order)
given by a doctor or other staff.
SHIFT SUPERVISOR must take action regarding any delay in doctor’s consultation, delay in
attending to duty by staff etc.
All staff must inform their sick leaves to the SHIFT SUPERVISOR.
Ensure that staff posted to all areas, and remain in their posts during clinic hours. And also
ensure all the clinics function properly on time.
Any staff who leaves the posted area for any valid reason (e.g. treatment room) must inform
to the SHIFT SUPERVISOR.
Check the reception for any new Memos, Letters, cards etc.
We all are responsible to minimize the telephone and computer use. However the SHIFT
SUPERVISOR has the authority to observe long telephone calls (>3 minutes) and remind
about the IGMH rules for telephone and internet use.
Monitor and check if the following records are maintained.
Inventory book / Report & statistics file
FP Books
HE books and lists
ANC/PNC
205
205
Computer data etc:
Supervise the cleanliness of all the areas.
Identify repair work and missing items.
SHIFT ROUTINES FOR CLINICAL ASSISTANTS
Check posted consultation room according the particular room check list.
Make the consultation rooms ready according to the type of clinic
Call patients according to their serial numbers after Doctors arrival.
Translate & explain what doctor’s wants to explain patients
Guide the patient for doctor’s examination.
Assist to the doctor to complete investigation forms, prescription for the doctor and explain to
the patient.
Enter each patient’s record for the computer data system.
Maintain cleanliness of the room throughout the consultation.
Completing other allocated tasks (eg: entering records for the data system, assisting to
prepare health education materials) during the off time
206
206
FLOOR STAFF
(Floor staff will be one of the clinical assistant on duty.)
JOB DESCRIPTION
Greet & smile people whoever comes inside the RH centre.
Guide them to the counter.
Explain the procedure for the new comers. (ie: they have to go through the registration, health
education, and then consultation.)
Identify and guide people who need registration, health education, and consultation
(address/call them by their names).
Identify and guide to people who requires breast feeding.
Inform to a nurse about inj. T.T. NST etc. & other procedures
Direct or explain how to go to other departments and their procedures (eg: scan, x-ray)
Check health education check list before they go home.
Maintain health education status file.
RECEPTIONISTS
Greet who ever enters into the Reproductive Health Centre
Enquire the purpose of visit and provide information or make arrangements to fulfill their
needs.
Giving appointments to those who need to attend to the concerned clinics.
Maintaining record of appointments.
Distribute appointments according to the doctor’s duty roster.
207
207
Receive & handover items (eg: letters/cards/circulars) to the concerned staff in time.
Maintain stationeries /books for the reception.
ެެގ�� ްނ� ުޓ� ަޑ�ްނ� ްނ� ުޓ� ުޓ� ެއ� ްފ� ުލ� ިޝ� ަވ� ާތ�
ީޓ� ުއ� ްށ�ިޑ� . ުއ ްނ� ުރ� ުކ� ީޓ� ޯޕ� ުރ�
. ްނ� ުރ� ުކ� ީޓ� ޯޕ� ަމ ުރ� ްނ ުދ� ުއ� ަމ ެޗ� ުއ� ްސ� ުއ� ެވ� ުއ� ުދ� ުއ� ްނ� ުއ ުރ� ުކ� ުކ� ާލ� ެޗ� ަބ ޯތ� ުރ� ްށ� ުހ� ުއ ަމ ޯތ� ުހ ުކ� ުރ� ޯތ ުފ� ުކ� 'ްސ�
ްސ� ުފ� ުރ ެގ� ުހ� ްނ� ޯތ ްނ� ޯތ ުދ ުރިޑ�ުފ ަބ ިޑ� ުކ �ުރ� ަމ ުޒ� ެގ �ެވ� ުދ ުއ� ެގ ުކ� ުރ� ޯތ ީޓ �ާލެވ� ުކ ުއ� ަބ ްނ� ްނ� ުރ� ީޓ ަމ ިޑ�ުކ� ޯތ ުރ ަމ� ުފ� ުއ� 'ުއ� ' ' . ްނ� ާލ� ުފ�ޯތ� ްނ� ުހ� ުފ� ުކ ްނ� ަމ�ުއ� ުކ� ުރ� ުކ� ުފ� 'ުފ�ާޅ� ްސ�
ްނ� ެގ� ުރ� ޯތ� ްނ� ުކ� ުހ� ޯތ ުރ� ެވ�ުހ� ުއ� ުރ ެގ ޯތ� ްސ� ުއ� ެވ� ުއ� ެގ ުރިޑ�ުއ� ަބ ަމ� ުކ ްނ� �ުރ� ުކ ުހ ުފ ުއ� ުކ� ުއ� ުއ ޯތ� ުފ� ުހ. ްނ� ުރ� ުކ� ުފ� ުރިޑ� ްސ� ަބ ިޑ�ްނ� ުކ ުއ� ާލ�ުރ ުކ� ޯޕ� ުއ� ުހ ަމ� ުއ ިޑ� ްސ�
. ްނ� ުއ� ްނ ެގ�ްސ� ެގ� ްނ� ްށ� ެގ� ުއ ަމ ުއ� ުފ�ޯތ� ުހ ެޗ� ުއ� ުކ� ުދ� ޯތ ްނ� ްށ� ެގ� .ިޑ� ުއ ްސ� .ުއ� ްސ� .ުއ� ުއ� ްސ� ްށ� ުއ ިޑ�ުރ� 'ާލ�ްނ� '
ާޅ��ްސ� ުފ ުފ� ުރ ެގ� ުހ� ްނ� ޯތ ްނ� ޯތ ުދ ުރިޑ�ުފ ަބ ިޑ� ުކ �ުރ� ަމ ުޒ� ެގ �ެވ� ުދ ުއ� ެގ ުކ� ޯތ ުރ� ީޓ �ްނ� ުއ� ުކ ަމ� ަމ� ާލެވ� ްނ� ުއ� ުރ ަބ ީޓ 'ިޑ�ުކ� ' ' ަމ�ުއ� ުރ� ުކ� ުފ� 'ްސ�
. ްނ� ުރ� ުކ� ުފ� ުކ� ްސ� ްނ� ުއ� ަބ� ީޓ� ުދ� ިޑްސ� . ުއ ްނ� ާލ� ުފ�ޯތ� ްނ� ުހ� ުފ� ުކ ްނ� ުކ�
ްނ� ުދ� ާލ�ްސ� ުހ� ްނ� ަބ� ީޓ� �ުއ� ުކ ުޒ� ުއ� ެގ� ެގ ުކ� ޯތ� ޯތ ެގ� ެވ ްސ� ުހ�
ްނ� ުއ� ުފ� ުދ� ްށ� �ުކ ޯޕ�ުރީޓ� ްށ� ުރ� ެޗ�ުރަޖ ްނ� ީޓ� ުއ� ުފ� ްނ� ިޝ� ުރ� ެގ� ުކ� ަމ� ުއ� ްނ� ުދ� ެގ� ަމ� ްނ� ްނ� ީޓ� ުއ� ުއ� ިޑ�
208
208