Patients Care & Safety Needs required in a hospital

Patients Care & Safety Needs 
Dr Puneet Kumar Misra  B.Sc ,BHMS

Patient – A Person who is ill or who is undergoing treatment of disease.

Outpatient –a patient who came to the hospital, clinic or dispensary for diagnosis and /or treatment but does not occupy a bed.

Inpatient – a patient who came to the hospital or other health care facility for diagnosis or treatment that requires an overnight stay.

Treatment – The Management & Care of a patient for the purpose of combating disease or disorder.

Care – The Service rendered by member of the health professions for the benefit of a patient. (Dorland’s illustrated medical dictionary 31st edition)

 Hospital – The Hospital is a complex combination of specialized activities and the chief objective of the hospital is of course, to provide adequate care and treatment to its patient. The fundamental goal of the hospital is to provide accommodation for the sick and injured to give medical & nursing care directed towards their recovery and rehabilitation. The recovery and rehabilitation of patient is achieved by the optimal performance of various services units of hospital. The hospital is a major social institution for the delivery of the health care, offers considerable advantages to both patient and society. Hospitalization protects both family from many of the disruptive effects of caring for the ill in the home and operates as a means of guiding the sick and injured into medically supervised institutions where their problems are less disruptive for society as a whole.

Patient care service

 Outpatient Department– The Outpatient department is the need of mild ill person which required advice for illness or non urgent / routine medical care. The aim of the OPD early diagnosis using the best possible latest method and include prophylactic examination for detection of undiagnosed diseases. The scope of the OPD is provide  the preventive, curative, diagnostic, rehabilitation service for disabilities along with counseling for marriage & child birth. It is commonest accessibly service of the health care by the major population of community.  Day care service – the day care  units is need of  ambulatory patients admitted to the hospital do not require the full professional care ,it is use full for psychiatric patient .these service are utilized In certain specialty like ophthalmology, gastroenterology, chemotherapy, nephrology especially dialysis etc, the procedures are of a shorter duration and do not require prolonged stay in the hospital. For many minor procedures or treatments, patients can avoid overnight hospitalization.

Accident & Emergency service include Disaster Management (A & ED)
The department of emergency service is well equipped with necessary trained manpower, equipment and supplies are the  first need of severe acutely ill / injured person which required immediate/Urgent medical care.  The definition of emergency by American College of Emergency Physicians (ACEP) emergency service as any health care service provided to evaluate and /or treat any medical condition such that a prudent layperson possessing an average knowledge of medicine and health, believes that immediate unscheduled medical care is required. But the concept of emergency department as a specialty within the hospital organization was first put forward by American College of Surgeons .The emergency department varied as per need of patient condition   and resource available in the hospitals i.e. accident & trauma, medical, surgical, poisoning, burn, obs & gyna, pediatric, etc. the emergency service in the hospital provide immediate care for ambulatory patient on OPD basis and critical ill and injured on IPD basis. The facility of ED in the hospital is easily accessible from main entry through proper signage and preferably ground floor in case of multistoried hospital.

National Academy of Service, USA has classified emergency into four Major types.

Type I major emergency facility– This type of service seen in large hospital, teaching hospital & tertiary hospital which provided specialized facilities (diagnostic & therapeutic) with 24 hours availability of  specialist.

Type II basic emergency facility– This type seen in general hospital   and manage by medical officer (MO) round the clock & respective specialists are on call duty

Type III stand by emergency facility – This type seen in the PHC (Primary health center) or CHC (community health center) levels and manage by trained nurses round the clock and MO on call duty.

Type IV referral   emergency facility – This type typically seen at sub center level manage by ANMs or Trained nurses, only provided the first aid, and referred according  to severity &  needs of patient .

Disaster plan – Disaster is regarded as a particular type of emergency, And aim of the hospitals to provide effective medical care through the maximum possible usage of available  human  and hospital resource in order to minimize morbidity and mortality resulting from any disaster in a community .

Ward service
The ward is the part of the health care system they provide the care as well as welfare service to the patient. The words are divided on the basis of their service

 General Ward. – if patient having no need the life saving care but mildly ill and needing of minimum assistance  or  observation   nursing care for  treatment and routine investigation are admitted in general  word,  where patient-nurse ratio is 5:1.(teaching) 6:1(non teaching),and  area for per bed is around is 100-120 sq.ft.

Specific/ Specialized Wards

Intensive care unit
This unit provided round the clock service to the patient needs the life saving care with necessary trained staff and equipment with completely aseptic measure due to acutely sick cases, and all specialists provided round the clock service as the need of the patient. Here patient-nurse ratio is 1:1.(Teaching/non teaching). And area for per bed is around is 120-150 sq.ft.

Coronary care unit (CCU)   is also an intensive care unit for the acutely sick cases of cardiac Patient. Neonatal intensive care unit/ premature baby unit (NICU/PBU) is also an intensive care unit  for the new born baby  with completely aseptic  measure as per need of the condition of the new born  under observation  of neonatologists/pediatricians and here patient nurse ratio is 3:1.

Surgery department & Operation theatre
When the condition of patient is needed some or special surgical facilities for the saving of life or better quality of life then the operation theatre is the prime need of different kind of surgeons. But during the Process of various surgeries the aim of surgeon is the successful and safe surgery.  The successful surgery is the ability of the surgeon and condition of patient but the safe surgery is issue of operation theatre management & design. The design of the OT briefly divided into four zone -1) protective zone 2) clean zone   3) aseptic zone  4) disposal zone. The aim of the zone in OT is maintain Strict aseptic and sterile atmosphere   at all times in the OT during the process of operation, because freshly incised or traumatized tissue can easily become infected. Therefore anything unsterile in contact with the patient is potentially dangerous and can transfer microbes into the open wound. All operative procedures are performed under sterile conditions. The main operation room is situated in the aseptic zone where actual surgical procedures are done. The asepsis atmosphere is the vital factor for the success of surgical process. Therefore the operating suites are should be independent or away from general traffic & corridors.

Pharmacy service –The pharmacy service is the prime need  of  severe to mild ill patient after the proper examination and prescription  by the Doctor in the OPD as well   inpatient for further treatment as well as management. The existence of the service is depend upon the scope of the health organization, if the hospital is small in size i.e. 20 bedded or 50 beds with availability of routine health care service included some surgical procedure, there are no need huge variety and amount of drugs and other material of treatment, but in case of large size i.e. 100,200,500 beds hospitals the scope of the pharmacy service as the need of hospital specialties. For the large size hospital the concept of floor pharmacy/ward pharmacy/departmental pharmacy are occurred. This service is nothing it is a sub store which near to ward / floor/department and its aim to provide the help to nurse for more time to the patient care. The entire services are handling by pharmacy educated pharmacist and at least one window in OPD pharmacy for every 200 outpatient is required. the location of it  prefers should be away from the high heat area , well lighted, ventilated, free from dust with provided comfortable to patient and others.  The pharmacy service controls by the, drugs and cosmetics act and rule 1940, the pharmacy act, 1948.(1.The branch of health science dealing with the preparation, dispensing, and proper utilization of drugs 2.a place where drugs are compounded or dispensed )(Dorland’s illustrated medical dictionary 31st edition)  .

Diagnostic service
The existence of this service is depend upon the scope of the health organization services but in routine condition the   Laboratory service unit & imaging service unit is commonly exist

Laboratory service – the aim of the laboratory service to providing diagnostic & management information to the physician for better early quality care of the patient, and data of investigation is essential for diagnosis, prognosis and treatment of disease .the some hematology, biochemistry & microbiology investigation is the clinical demand for the common practice. The quality issues of the laboratory investigation result are control by the guide lines   given by the NABL for small to large size laboratory. The pathologist is the head of the lab and technician perform the analytical work by the help of lab attend; phlebotomist is responsible for the blood collection along with other types of investigation specimen. The staff and area is dependent upon the scope of the laboratory service.

Radio imaging service– it is frequently called as x-ray department and it is one of the most important components of the hospital. Fundamentally the image service linked to help in the diagnostic & management information to the physician and surgeon for better early quality care of the patient, and it is essential for diagnosis, and treatment of disorder. The departmental activity control under direction of radiologist and technical work performed by technician.   The modern trend imaging service includes the angiography, mammography, sonography, CT scan & MRI. The radiation is hazardous for human being therefore the atomic energy regulatory board (AERB) issued the guidelines   for installation and working condition of the equipments. For the Personnel monitoring of radiation exposed the most convenient way the regular wear the TLDs badges and its measuring by the Bhaba Atomic Research Center (BARC).  As above described diagnostics service some other diagnostic service is also available but it is attached with specialists units i.e. ECG, TMT, Eco, from cardiac units and EEG, ENC, EMG is attached with neurology units.

Patient Safety & Security service
The patient safety is multi dimension issue, at one hand it is medical errs and on other hand it is due to some unsafe environmental condition. Under this section we are focus on the issue of unsafe environmental condition. The unsafe environmental condition means dirty and infectious condition around the patient during hospitalized condition and infection travels due to the medical personnel activity around the patient during the treatment. The all issue of unsafe environment is control through the follow of hospital infection control policy. The all unsafe condition of infection is control by the optimal service of fallowing department of hospital.

Housekeeping service – this service may be defined as that branch of general management which deals with cleanliness of the hospital include, general environment hygiene, sanitation, disposal of waste using appropriate methods, infection control, pest & rodent control, odour control and interior decoration also.  The cleanliness and sanitation is a part of quality care of patient during hospital stay. The one sanitary attendant over 10 beds is recommended on the basis of round the clock service. More sanitary attendant may be required for the ICU/emergency words .under the sanitation staff perform the dusting, sweeping, mopping, polishing and washing.  The collection, transportation   of segregated waste material at source is also done by housekeeping staff inside of the hospital and disposal of material is issue of the treatment authority as per rule of health care waste management or Bio- Medical Waste (Management and Handling) rules.

Laundry– the main function of the laundry is supply and distribution of the clean linen for patient and dress material of staff using during the treatment of patient. During the normal course laundry receive the proper segregated linen i.e. soiled linen, Foul linen , infected linen, and foul infected linen. The soiled linen direct send the laundry for washing, foul linen contain faeces /excretions firstly send in the central sluicing plant then in the laundry for washing, infected linen, and foul infected linen firstly treated in the central disinfection area before washing in the laundry .normally one washer man/dhobi is required for 60-75 kg linen or 30 bedded hospital on the basis of 2.5kg linen  per bed to be washed .

Sterilization service /TSSU / CSSD – the linen and other instruments is used in the high risk area e.g. ICU, OT, NICU, burns wards and other is needed the infection free. Therefore after washing of linen in the laundry they are not supply in the related department. After the washing process of the linen in laundry and instruments at source units   are packed in the proper way and send for the autoclaving. The small hospitals below then 100 bedded this process managed by the TSSU (theatre sterile supply unit) while in the larger hospitals the separate CSSD (central sterile supply department) is running.

Hospital fire service – it is the indispensable part of general safety programme. The training of the all hospital personnel is the per-requisite including nurse and night watch man must have a minimum grounding in the fire protection and determinate to eliminate the cause of the fire outbreak .therefore the each hospital should be properly equipped with enough number of fire extinguishers in all the patient care area and high risk area as per the classification of fire. The class A fire due to the ordinary combustible material (wood, paper, fabric) class B fire is due to flammable liquids (sprit, alcohol, petrol, paint)  and) Class C fire is due flammable gas (LPG). Class E fire is due to the electrical instrument or electric. The water is of course most common fire fighting media for the class A fire but in the case B & C fire the foam   and powder forming fire extinguishers is necessary.

Dietary service– this utility service of hospital is one of the most important services contributing to the recovery of the patient’s health, through scientifically prepared diets and diets counseling. The patient comes to the hospital for medical care because they are ill and diets planning decide the standard of food in terms of calories and food components as per clinical requirement.  U.S. public health service show the need of space for this service is 30-40 square feet per bed for pantries, food storage and staff locker room. The standard way of the work in the kitchen is 1) Storage in (room / refrigerator), 2) Pre-Preparation (washing, peeling, cutting,) 3) Preparation (Cooking, finishing, portioning, assembly and distribution).

Physical medicine & rehabilitation– this branch of medicine deals the approach those patients which disabled due to either congenital or acquired causes, therefore the all age group patients comes under its service. Disability is defined as an existing difficulty in the performing one or more activity which is accordance with the subject of age, sex and normative social role are generally accepted as essential basic components of daily living due to congenital or acquired causes.   . Rehabilitation is the stage of tertiary prevention takes all available measures to reduce or limit impairments, disabilities and minimum suffering caused by existing disability due to congenital or acquired causes, and individual reached up to the highest possible level of functional ability. This service includes physical therapy, occupational therapy, audiology, speech therapy, prosthetics, orthotics and psychosocial work. The main goal of the rehabilitation is the restoration of the physical, social, psychological and vocational potentials of disabled person to the maximum extent possible, so that he can function in as normal way as possible.

Medico social service– gradually a need was felt for someone who could study the total background of a patient ,including the physical, cultural, psychological and social factors ,share this understanding with the physician and work on the social aspect of illness in order to makes medical treatment effective .medical social work came into existence to meet this need . it is a part of medical care should have integration with overall  study ,planning and  treatment of the patient . it is also essential to develop a system of referral of patient to the medico-social service by the physicians so that  the service are directly available to the patient and family . The one medical social worker is the minimum need of 50 beds and 200 OPD patients.

Hospital engineering & maintenance service – the role of the Hospital engineering & maintenance service in fact starts at the stage of the hospital planning itself. The hospital engineering comprises of the most important element of the hospital utility service. The hospitals department varied in the nature and provided the excellent service to patient care with the help of properly functioning medical equipment and others. All these need constant attention and maintenance, to prompt repair and upkeep of all equipment of the hospital.  Because doctors and nurses are free from this burden of action associated with engineering service so that their full attentions are devoted to their primary duty of patient care, the Hospital engineering & maintenance service paying the role of all the issue of equipments.

Ambulance service – The goal of ambulance services is to either provide treatment to those in need of urgent medical care, with the goal of satisfactorily treating the presenting conditions, or arranging for timely removal of the patient to the next point of definitive care. Ambulance a vehicle equipped for taking sick or injured people to and from hospital, especially in emergencies The ambulance service is the BSL(basic life supports ) and ASL(advance life supports ) types on the basis of facility to care for the patient available in the vehicle . the some  hospital having own ambulance  service while few hospital arrange from the outsource.

Medical record department– The medical records department is essential for every hospital irrespective of size or types, it is under control of medical records officer/ asstt medical records officer and Manage by medical records worker/technician/clerk with the help of peon/medical records attendant .the adequate and trained staffs are essential for proper handling of medical records in the hospitals. According to ISI(1982) the 273 sq meters is requires for 500 beds hospital but in general condition minimum 125 to 175 sq feet is needed for 50 beds hospital along with proper staffing . The proper medical records is use full in the condition of treatment, hospital administration, hospital statistics ,legal issues, evidence based practice, medical audit and during the quality certification and accreditation. The characteristics of the good medical records are accurate, adequate, complete, confidential and retrievable. The medical records of the hospital retain as per service e.g. OPD up to 5y,IPD up to 10 y, medico legal case permanently /finalized till case ,psychiatric case life long, Pediatric case  for 10 y they attend maturity.

Reference 

  • 1) Park Textbook of Preventive and Social Medicine 22nd edition
  • 2) Theme II resource management and quality control block 3hospital information system and quality management NIHFW
  • 3) Theme IV patient care and support service block 1patient care services -I NIHFW
  • 4) Theme IV patient care and support service block 2patient care services -II NIHFW
  • 5) Theme IV patient care and support service block 3 Hospital support services – NIHFW
  • 6) Theme IV patient care and support service block 4 hospital utility services NIHFW
  • 7) NABH Guide book to accreditation standards for homoeopathy hospitals 2nd edition July 2016
  • 8) NABH Guide book to accreditation standards for hospitals 4th edition December 2015
  • 9) NABH Hospital Infection Control (HIC) Manual for Small Healthcare Organizations (SHCOs)
  • 10) Dorland’s illustrated medical dictionary 31st edition

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