philosophy of hospita l 2003
TRANSCRIPT
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GENERAL HOSPITAL
Philosophy of hospital
The ethos of this hospital is 'LIFE IS TOO PRECIOUS SAVE IT AT ALL
COSTS. Service before self has been the motto of the pioneers of this in always
situation which has percolated down to next generation who have joined the line.
The philosophy of the hospital is that no patient should been turned away
because he is too poor to pay.Pride Values
V - Value Diversity other cultures, other perspectives
A - Anticipate what people needL - Listen actively
U - Understand the power of teamwork
E - Excel in service
We all envision a system in which those who give care take great pride in theirwork, and those who receive care are confident in trusting the care they receive.Providing a safe environment with the highest possible quality healthcare is atthe very core of our Patients First philosophy. It is deeply embedded in the fabricof this hospital. here are some of the highlights of our emphasis on quality:
First, we work hard to recruit and retain a highly qualified and experienced staff.We are extremely fortunate to have all professional nursing staff (only RN's orLPN's) in all of our departments or services. Few other hospitals can make thisstatement. All our physicians must be credentialed before they can practice inthe hospital and are regularly monitored via a rigorous peer review process.
Second, we maintain an active Quality Program, supported by a Medical directorand the equivalent of two full time staff persons. This program follows up onpatient feedback, and proactively searches for performance improvement andrisk reduction opportunities. For instance, they are currently working to minimizehandwritten orders errors by improving penmanship and eliminatingmisinterpretations from potentially confusing abbreviations.
In addition, our quality program tracks our progress on national Patient SafetyGoals and evidence based medicine, comparing our results against otherhospitals across the country. Action steps are implemented to remedy situationswhere gaps exist between our results and "Best Practice'. We are one of very fewhospitals having public goals that are published twice each year so thecommunity can clearly see our results.
Third, a major initiative ,General is continuity of care. As much as possible wetry to assign the same care team to each patient. This helps minimize errors that
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can happen at the hand off as a series of different care providers treat the sameperson. Additionally, we have recently made provisions to have a full-timehospitalist physician available to care for inpatients. This will assure that the careteam has maximum opportunity to work together to provide excellent care. Thiscontinuum of care is further supported by a follow up phone call from a nurse
shortly after discharge, and the option for continuing services through ouroutpatient departments or Home Health Care.
Finally, it is committed to having well informed patients and families playing anactive role in treatment decisions. We know that family and patient involvementspeeds recovery. If you or a family member utilizes hospital services, pleaseknow that all our staff welcomes questions and supports your desire to becomeinvolved. Dont be afraid to ask. No question is unimportant. No caregiver is toobusy to stop and talk with you. Some key areas you might want to ask aboutare:
Medications Expectations and care options
Comfort items such as the temperature in the room, getting something
to eat or even changing to a different bed.
The issue can be resolved.
Also, never lie silent in the face of pain. Always let your care team know if youare in pain. Should you worry about falling, please ask for assistance if you haveto get out of bed. You and your family are a critical part of your care team.Become involved, it will speed your recovery.
As with everything, the proof is in the pudding. The main goal of our activequality program is your overall experience with our care delivery system. If youare not satisfied, we have failed, no matter how good your clinical care. Werecognize every patient defines quality for themselves, and therefore, we mustgive you the personalized service you expect. High patient satisfaction is vital toour continuing ability to serve the community in the manner you demand. Werealize that quality is a never-ending journey that requires our daily focus anddedication.
OBJECTIVES
Objectives of a hospital are
Provide care of sick & injured.
Prevention of diseases & promotion of health
Diagnosis & treatment of diseases
Rehabilitation & vocational training
Medical education
Research
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Staffing patterns of 200 bed hospital in India:-
LISTOF STAFF S. NO.
OF STAFF
MEDICAL OFFICER PCMS I
2
MEDICAL OFFICER PCMS II 4
ANAESTHETIST 1
PATHOLOGIST
1
RADIOLOGIST1
BIOCHEMIST
1
DENTAL SURGEON
1
CASUALTY MEDICAL OFFICER
3
HOUSE SURGEONS
1O
MATRON
1
NURSING SISTERS 10
STAFF NURSES 32
RADIOGRAPHER
1
PHERMACISTS
5
LAB.ASSTT.GRADE I
4
LAB. ASSTT.GRADE II
LAB .ATTENDANTS
2
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DIETICIAN
1
COOKS
4
HEAD COOK
1
STENOGRAPHER
1
ACCOUNANT
1
STOREKEEPERS
3
CLERKS
2
DENTAL MECHANIC
1
CARPENTER/PAINTER
1
CARETAKER/STEWARD
1
CHOWKIDAR
3
MALI
2
OTHER CLASS IV POSTS INCLUDING SWEEPERS 81
REGISTRAR
-
HAWALDAR
-
ASSISTANT MATRON
1
CASHIER
1
HEAD CLERK
2
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OPERATION ROPM ASSISTANT
1
ELECTRICION
1
BARBAR
-
PLUMBER
1
RECRUITMENT POLICY- it has been accepted that here is a need for the
sound recruitment policy,because faulty recruitment policy inflicts a
permanent weakness upon the administration .
The basic elements of the sound recruitment policy should include thefollowing-
Discovery and cultivation of the employment market for post
marketing a job in the public private services.
Use of attractive recruitment literature and publicity.
Use of scientific test for determining abilities of the candidates.
Tapping capable candidatesfrom within the services.
Placement programme which assigns the right man to right job.
A follow up probationary programme as an integral part of the
recruitment process.
PROCESS OF RECRUITMENT
Strategy
development
where when Applicants
Personnel
Job
Job analysis
Recruitment
planning
numbers,
Employer
Searching
activation, selling
message,media
appl
ican
scre
enin
hire selec
Evaluation and
control
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METHODS OF RECRUITMENT-
Direct methods- it includes employee contacts, manned exhibits and
waiting list are used .
In scouting representatives of the organization are sent to educational and
training institutions.
Manned exhibits include sending recruiters to seminars and conventions,
some organization prepare the waiting list of the candidate who have
indicated there interest in jobs ,through mails and telephone.
Indirect methods-
advertisement in newspaper,journals and radio.
Third party methods-
public employment exchange
management consulting firms
professionals societies
temporary help societies
trade unions
labour contractors
reservations- reservations for the persons belonging to particularcastes and communities
Interview assessment form
Name: Date time:
job title: ref.no.
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Criteria
Questions
Answers/reference
Applicantsanswers
scores
Signature:
Name:
TRAINING IN HOSPITALS-
Every teaching hospital institution has an attached hospital which
provides clinical material for teaching and training of the student in such
hospitals also provide facilities for research both for the teachers and the
students. The method of teaching the patient in a research cum teaching
hospital varies from available in a general hospital. Apart from the training
the patient is used for teaching and research. Here the patient is firsthandled by the trainee who examines him thoroughly ,records his details
history and suggest the diagnosis and treatment.the case is then
presented by the trainee to the teacher . the treatment is prescribed by
the consultant only.
In this way the patient besides receiving the treatment also acts as the
material for teaching. He is used for research by the teachers and the
trainee.
The objectives of the training institutions are-
To develop pattern of teaching for diploma, undergraduates and post
graduates in all the branches of the hospital also as to demonstrate the
high standard of education.
To bring together as far as may be in one place educational facilities of
the highest order for the training of personnel in all important branches.
To attain self sufficiency by the students to meet the needs for specialist
and medical teachers in the country.
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THE NEHRU HOSPITAL IN NEW DELHI HAS A BED STRENGTH OF 798; .the
research is carried in various departments of the institution .members of
the faculty implemented research schemes funded by various agencies
including 30 by institutions over 160 by ICMR 15 by CISR,one by
department of science and technology ,govt of India ,6 by ministry ofhealth and family welfare.
In addition to the basic and applied research on the national priority areas
such as malnutrition ,leprosy, cancer malaria,rehablitaion therapies,
parasitic diseases including the prevention and treatment of diseases to
the lower classes of the societies.
The institution is equally involved in the research for the rural and
community health problems. the institute has recently recognized for
carrying out research on immediate health priorities areas of UTChandigarh with particular reference to environmental pollution related
diseases, their diagnosis prevention and treatment.
PHYSICAL SETUP
OUT PATIENT DEPARTMENT:-
OBJECTIVE & SCOPE OF SERVICES1 Provision of general medical services to outpatients on
scheduled/unscheduled basis:-
Preventive & promotive services [immunization, screening,antenatal clinics, well baby clinics]
Curative[consultation, investigations ,therapeutic procedures,speciality services]
Follow-up of discharged patients, chronic illnesses, postnal clinic. Rehabilitation[physiotherapy, occupational therapy, prosthetics &
orthotics]
2 Family welfare services; counseling
3 Health educations
4 Medical, nursing paramedical education
LOCATION OF O OPD:-
Near the main roads & close to main hospital entrance, but withsufficient space to provide for parking etc.& to noise &dust
pollution.
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The outpatient department should be located close to mainentrance& with independent approach, should be segregated fromthe inpatient so that pt. visiting the outpatient department neednot passthrough the inpatient department.
Separate from in patient &other department but connect with
them. OPD SHOULD BE CLOSE To:
-Medical records
-Laboratory
-Radiology
-Pharmacy
Patient Flow
Dispensed with
prescription
New patient Reception OPD Counter Respective OPDs
Laboratory X-Ray Ultrasound
Follow up patient Inpatient Department counter
IPD
OT
OPD Clinics in the hospital
There are following OPDs in the hospital:
General Medicine
Pediatrics
General surgery
Orthopedic
Obstetrics & Gynecology
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Physiotherapy
Neurosurgery
Dietary
Dental surgery
EMERGENCY DEPARTMENT
The emergency department is a very critical& sensitive unit of any
hospital & is involved in the management of emergency cases. The
emergency service provides immediate, emergency diagnostic &therapeutic care to the patients with-injuries by accidents ,sudden
attacks of illness or exacerbation of disease
OBJECTIVES & SCOPE OF SERVICES
Provision of immediate relief to & management of the arriving atthe hospital with acute medical & surgical emergencies forexampleAcute myocardial infraction, Shock ,Status asthmaticsetc.
Managing accidents victims providing first aid, treatment of minorinjuries & referred to appropriate specialized or hospital, in casespecialized care is necessary & can not be provided in thehospital.
Attending all medico-legal formalities, including documentation ofclinical conditions & other particular & initiation to & liaison withthe police.
Attending the patients coming outside the routine outpatientworking hours & screening them for admission.
Observation them for short period to determine whether theyneed admission
Providing out patient care.
Consultation& the Examination Room Equipped with:-
Doctors seating arrangement with office furniture Examination couch
BP Instrument Stethoscope Clinical thermometer Torch
PROCEDURE ROOM Equipped with facilities for minor
procedures like suturing ,Endotracheal intubation Dressing ,
Plaster , Catherterisation ,Ryles tube,Operation theatre
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light,Suction machine,Oxygen cylinders,Boiler,Drip stand,
Glucometer etc.
TREATMENT ROOM Equipped
-DC Shock machine
2 beds for treatment
Cardiac table
Instrument for vaccination
TOILET
TREATMENT ROOM
The department has one treatment room, which isused in case the patient has to be kept under observation for
some time. The treatment room is used for vaccination
purpose as well as for chemotherapy &blood transfusion in
case of thalassemia patient .Vaccination are done daily except
on Sundays by the sister incharge in emargency treatment
room . She vaccinates around 20bcases on an average per
day. The patient who are receive blood opera transfusion&
chemotherapy are taken of sister incharge.
FUNITURE SET-UP
Bed-5,cardiac table& defibrillator
OPERATION THEATRE -Minor operations are performed in
the procedure room, which can be called minor operation
theater .In case of any major operation such as Head
injury the operations are performed in main operation
theatre of the hospital by the consultants.
FACILITIES PROVIDED IN THE EMERGENCY DEPARTMENT:-
Medical-
All medical emergency cases such as Gstroenteritis, Pyrexia, Malaria
etc can be managed in emergency department
Surgery-
Patients of head Injury, Infraction &Shock etc. can be handled at the
emergency department.
Diagnostic
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The diagnostic services that can be done in emergency department
are-ECG, Blood sugar etc.
OTHER SERVICES
Vaccination Blood transfusion Injection
Critical Patient Flow
Critical Emergency consultant
Patient Department Examines
Payment & Vitals
Registration at OPD Checked
Investigations (ECG,blood suger etc)
Emergency care given to the patient
(IV Fluids, Suction, Endotracheal intubation)
Treatment Initialled
Discharged Admitted to hospita
Inpatient Department(IDP)-
IPD that department of the hospital in which the
patients are generally kept for more than a day for close
monitoring.
General Ward- Wards of the patients who are not critically ill but
need continues care or observation & have to be in bed. Theseinclude wards for medical, Surgical, ENT & eye disciplines.
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Wards For Specialties-Wards for patient who are suffering &
needs hospitalization in a particular Specialties like
orthopedic,paediatric, obstetric & gynecology.
Intensive care unit Wards for acute coronary , post operative &
critically ill patient.
DISTRIBUTION OF BEDS
DEPARTMENT NO.OF BED
MEDICAL 4O
SURGICAL WARD 40
ORTHOPAEDIC 3O
ISOLATION 5 EY E & ENT 10
MATERNITY 30
NEUROLOGY 20
PEADIATRIC 1O
RECOVERY 5
EMERGENCY 10
Patient flow Reception OPD
IPD IPD
Counter counter
Dispen
sed with prescription
Emergency
General ward facilities:-
Nursing station
Treatment room
Ward pantry
Ward store
Sluice room
Day space Sanitary
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Ward ventilation:-
Mechanical ventilation is costly & lacks flexibility
Natural ventilation is cheap
Ward lighting
The lighting of patients room & other areas in the ward has to
satisfy the needs of the pts. well as requirements of the nsg.
staff.The total lighting effect should be such as to contribute to
the general dcor& be free of glare to the recumbent pt. Lighting
installing in a ward call for:-
General lighting
Reading lighting
Examination lighting
Night lighting
A TYPICAL GENERAL MEDICAL WARD
It has the following:-
Doctors duty room
Nursing station
Two halls separated by a wall for the bed of the patients
Examination room
Store
Kitchen
Toilets in the corridor
Seating arrangements for attendants in corridor.
VARIOUSE OTHER ARTICLES PRESENT IN A TYPICAL GENERAL
WARD:-
Medicine trolley Oxygen cylinder
IV Drip stands
Fowlers bed[28]
Side table
Stool for attendants
Cardiac table
Thermometer
BP Instrument
AP Bottle with stand ,for humidification purpose
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Suction apparatus
Wheel chairs
Fire extinguishers
A TYPICAL PRIVATE ROOM IN THE PRIVATE WARD:-It has the following
2 Rooms, one for pt & other for attendant
Room are separated by curtain
It is Centrally air cooled
Attached toilets
2 beds
Chair,table&support stand
Cardic table
INTENSIVE CARE UNITS
The superspeciality hospital has intensive care unit, which
provide services to the pts suffering from acute conditions such
as myocardial infraction,strock, angina etc.These units are
divided into the following specialities:-
ICCU
ICU NICU
CCU
MICU
SCNU
PHYSICAL FACILYTIES & LAYOUT- The ICU& ICCU has:-
-Doctors duty room equipped with beds& other necessary
furniture
-Hall with curtains separating the floler beds
-Shoe removing room
-Toilet
-Waiting space for attendants in the corridor
-Telephone
-There are beds, cardiac tables& side table for pt.
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-The doors are in two parts,&1 part is smaller wich remains
close& is opened only when the streastcher has to be passed.
BED CAPACITY-
ICCU& ICU CAN ACCOMMODATE 8 &10 BED RESPECTIVELY
TYPE OF BED IS FOWLER
EQUIPMENT-
-ICCU EQUIPMENT
Bed side monitors
Central monitor 8 channel
ECG Machine
Glucometer
Humidifier
Pulse oxymeter
Ophalmoscope
Defibrillatir
Ventilator
Sphygmomanometer
Stethoscope
Clinical thermometer Torch
ICU EQUIPMETS :-
-Bed side monitors
-ECG Machine
-Humidifier
-Infusion pump
-Pulse oxymeter
-Nebulizer
-Ventilatior
-Opthalmoscope
-Pressure monitoring line with monitors
-Sphygmomanometer
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-Stethoscope
-Clinical thermometer
-Torch
STAFF
-Consultant Doctor
-Resident Doctor
-Sister incharge
-Nursing Staff
-Technicians
-Ward boys
-Sanitary attendants
EMERGENCY TROLLEY
DRESSING TROLLEY
TWO BUCKETS FOR STERILISATION WHICH HAVE CIDEX.
Operation Theatre(OT)-
OT suit of a hospital is a very complex
workshop & most important facility of the surgical
department. The hospital has the following OT
o 2 Emergency OT tables
o Orthopedic -3Tables
1 OT table for general operations
2 OT tables for orthopaedic operation
o 2 OT tables
1 OT tables for general operation
1OT table for gynaecology operations
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o 2 OT tables
On alternative days Cardiac, Eye &
ENT
Physical facilities- The OT has-
Show- removing room
Changing room with attached toilets
Sister incharge & nursing room
Gynecology OT room
Scrubbing & wash up room
Minor OT room
Sterilization room
Post operative room
The entire OT is AC.
Diagnostic Department
The diagnosis department in the hospital-
1. X- Ray department
2. Sonography
3. Endoscopy
4. 2-D colour Dopper
5. ECG
6. EEG
7. Laboratory Department
The space required for these facilities are given beiow-
Reception cum Registration with waiting areas & toilets
Radiography & Fluorocscopy room
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Film Developing & processing Room
Film Drying
Contrast Studies & preparation room
Stores
X Ray Record room
Radiologiests Room
Room for techinician, nurses
Toilets ( Male/ Female)
Patient Flow-
Patient investigation cash counter
reception counter
Diagnosticdepartment
SUPPORTIVE SURVICES
The supportive services in the hospital are:
-Blood bank
-Central sterile Supply Department (CSSD)
-Medical record Department
-Laundry
-Housekeeping
-Electronics Data Processing Department
-Communication System
-Public relation
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-Materials Department
-Maintenance Department
AUXILIARY SERVICES:-
Registration& indoor case records-
Registration is a must for a hospital to enroll no patient with
proper entry in OPD cards & keep track of the revisit of the
patients. Medical records help in regulating admission of
patients. It helps in codifying the record according to internal
disease index. It also collects statistics of hospital stay of
patients, i c, admission, discharge, average stay ,etc for future
planning & management.
Stores
The central store receives, stores & issues bulk items
which can, with advantage, be stored centrally. Stores are of
different typesPharmacy store, chemical stores, Linen store,
Surgical stores, glassware stores, Stock-policy should be devised
in such a way that visit & essential items are always available. It
should be managed by a competent stores officer.
Transport
Transport requiremenets for the carriage of supplies&
patients are:-
A] trolleys
B] Stretchers
C] Wheel chairs
It is preferable to have a central transport gang to shift
the patients. Supplies should also be distributed to all wards by
the central areas.
Mortuary
Each hospital should have a cold storage area or mortuary,
where dead bodies are kept before they are claimed by the
relations. Sometimes post-mortems need to be done for medico-
legal reasons. Unclaimed bodies should he disposed off
according to rules.
Dietary services
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The dietics department plays an important role in providing
the hospitals menu to the specific needs of the patients as the
quality of diet contributes a great deal in the treatment of the
patients. This department is to ensure the selection of the food to
meet the requirements of the patients. The department should beadequately & correctly fed with daily information regarding the
number of patients & types of patients so that food can be
prepared accordingly . This department must be managed by
well-qualified& trained dietician
Engineering& maintenance services
The hospital building ,furniture& other equipments are
essential for the efficient functioning of the hospital especially in
a large hospital. Therefore, there is need to have a separatedepartment of engineering & maintenance service to provide
immediate services and keep the hospital effective & efficient.
Hospital security:-
Hospitals are not immune from the threat of societys criminal
element. Thus ,establishment of hospital security force is
essential to ensure the safety of patients & the staff. In a
teaching-cum-research hospital & other large hospitals,
appointment of the security staff has become a matter of greatimportance. The security officer must be appointed on the basis
of his experience either in defense services or police services.
Under him, there can be other staff depending upon the size of
the hospital. Hospital security department must have active
liaison with the local police in the area so that they can
supplement each others effort.
MATERIAL MANAGEMENT-
Men money and material are the keys to the development .they assume
considerable importance in corporate functioning as well as in national
economy.
ESSENTIALS PRINCIPLES-
Right item
Right quantity
Right price
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Right source
Right delivery
Right methods
Right people
PURPOSES OF MATERIAL MANAGEMENT-
To develop a system of supplies whereby there will be right quantity of
stock of items properly stored ,easily retrievable and distributed close
to the points of usage ,wherever required ata given time.
The reduction in the inventory costs both carrying cost and ordering
cost.
To ensure that the resources available are used most effectively and
the stores are purchased at the most economical price consistent with
quality.
To bring about the coordination among the various sections in the
organization.
To ensure that the production does not suffer.
To ensure that the sale of finished goods is not effected.
To avoid the wide fluctuations in production.
PRINCIPLES OF INVENTORY MANAGEMENT-
1. Determination of order of quantity.
2. Determination of reorder point of record level.
DRUG MANAGEMENT-
The purpose of drug management is to use drug wisely and avoid
drugs and therefore to enough for patients needs.
EDUCATING STAFF IN THE USE OF DRUGS.
Put one or more copies of simple book on
pharmacology in the library
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Make notes on the common drugs
Make notes on the common drugs.
Set out the doses of common drugs.
Hold staff meetings to discuss staff wastge
Inform all staff about the cost of various drugs
EDUCATING PATIENTS ABOUT DRUGS-very often patients take drugs in a
wrong way .they either reduce the dose to make the treatment last longer
or increase it hoping for a quicker cure.
EXPLAINING PATIENT THE USE OF DRUGS-
Each drug has a specific action .adrug used in one condition is not used inother condition.
The size of the drug is very important if it is too little it acts to weakto cure
the condition,if it is too large it may poison the patient.
CONTROLLING LIFE SAVING DRUGS-
Make a list of life saving drugs
Place them together in one shelf
Check the shelf frequently
PREPACKING DRUGS FOR OUT PATIENT DEPARTMENT-
This means that full course of treatment with a certain table is put in
small envelops or folded papers before the out patient sessions.
MANAGING EQUIPMENT-
It include- ordering ,storing ,controlling, maintaining and standardization.
Ordering- it is to analyse the requirement based on past experience and
future requirements.this has to done carefully otherwise it can result in
unnecessary purchases.
Storing equipment must be stored carefully otherwise there is degree if
pilferage or breakage. inventory of store must be maintained an d proper
accounts must be maintained.
Issuing each ward and unit must be responsible for the equipment
issued to them. They should keep li aison with the store to replenish theconsumed articles or repairs of some other articles.
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Controlling and maintaining equipment- this is the most important aspects
of equipment management as it has been observed that most of the non
expendable equipment remains out of order for along time.
Codification not Standardization- in any undertaking having a large
number of items ,codification
Is essential.it hardly needs any emphasis that codification of items is
prerequistee for introduction of mechanization in stock control and
purchase.
RECORD MANAGEMENT-
Record management is a programme that involves the
functions of creating, administering, retaining, submitting
& destroying records.
o Medical record
Medical record is a clear, concise & accurate history
of the patients life & illness, written from health &
medical point of view . thus the medical record
comprises three general section-
I. A general section covering administrative &
personal data. The socio economic record of
the patient include-the name of the patient ,
fathers or husband name, Age , sex , religion,
income, patients Address & adders of the
nearest relative . other admission information
include are-date of admission , in patient
number, the name of the nursing unit & bed
number. This sheet is prepared in the central
Admitting office.
II. A nurse section where the observations of the
trained nurses & detail of treatment
administrated. The part of the medical record
consists of graphic charts relating to
Temperature, Respiration, BP& other
observations maintained, intake output charts
& medicine administrated.
III. A medical section containing statements on thestudies , observations , conclusions & activities
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of a them ending doctors or of the intern or
resident worker under him. Medical section of
record consist:
o History Sheet
o Physical examination sheet
o Provisional diagnosis
o All the investigation reports
o Physician order sheet
o Treatment, medical or surgical
o Anesthesia record
o Operation record
o Obstetric record
o Consultancy record
o Progress report
o Final diagnosis
o Discharge summary
o In death- cause of death
o Autopsy report
OTHERS ARE
Vital signs
Operation theater records
Emergency records
Turnbed patient record etc
BIBLIOGRAPHY:-
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Faisal Khan Dr. Mohd , khan dr. Humera,Management of superspeciality hospitals Ed.-1st
2005. Pp-76
Barrett jean, Ward Management& teaching
Ed.-1st p-147.
Basavanthappa B.T. Nursing
administrationEd-1st, ,2005,pp-155
Goel S. E. Hospital administration &
managementEd 2nd .2007 pp- 1-70
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