Thursday, August 16, 2018
Wednesday, August 15, 2018
Patient Discharge Flow Chart
Patient Discharge Flow Chart
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After confirming all applicable
amounts activity sheet sent for cross check and after that for billing
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Consultant/ EMO informs to Nursing In
charge about discharge of Patient 2hrs before of discharge
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EMO on duty prepares the discharge
summary with help of patient case record same forwarded to consultant
signature
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Relative/
attendant of patient sent to billing dept for bill amt Paid.
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If file is complete then it should be
entered in MRD Excel Sheet & put it on right order or place. If not
file sent back to respective Nursing Station for completing. Then again
sent it to MRD for record keeping
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Patient file handed over to MRD within
48hrs
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File with bill copy sent back to
Nursing Station
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Patient discharged & discharge
summary handed over to patient or attendant at the time of discharge. The
staff nurse counsel the patient regarding diet, medication, follow up
procedure.
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Admission/ Indoor Registration Flow Chart
Indoor Registration Flow Chart
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Consultants /EMO/ PCA defines/
elaborate Like room types, diet of patient, patient rights &
responsibility
Payment
method, attendant visiting policy, plan of care, expected result
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Patient escorted to ward by ward boy/
lady & at the same time Patient admission information given to relevant
Nursing Station
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Patient file contains Registration
Slip, Admission form, Consent, Case paper, in case of MLC a MLC report
generated as per hospital policy
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Pre fixed amount should be pay by
patient at the time of IP registration
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Advised
admission in OPD/ Emergency
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Patient/
attendant advised to meet Consultant or EMO or PCA
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In
case of emergency patient counsel by EMO
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Patient came back to registration
counter for IP registration
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Guidelines for Vulnerable Patients
Vulnerable Patients
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Patients < 12 years > 60 years,
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Victims of abuse/neglect
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Physically challenged
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Language barrier
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Patients who cannot perform ADL (acts
of daily living)
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Patients with suicidal tendency
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ICU patients
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Bed ridden
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Illiterate
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Comatose patients
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Pregnant woman
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State
the measures to ensure patients right to confidentiality?
·
Covering
the patient during transport
·
Knocking
the door before entering patient room
·
Refraining
from discussing patients related information in a public area
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Ensuring
curtains are drawn during all procedures
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Ensuring
door is closed during patient’s consultation & examination.
MLC GUIDELINES
MLC GUIDELINES
A medico legal case is where a person is injures or harmed
in any way & needs medical attention for it:
a. Vehicular
accidents
b. Attempted
suicides
c.
Suspected homicides
d. Death
occurring under suspicious conditions
e.
Rape
f.
Poisoning
g. Assault
(including sexual assault
h. Burns
i.
BD
j.
If doctor suspects any foul
play/activity
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Medico legal & police intimation
forms are filled by CMO and police IS Informed by the Physician
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MLC on admission, discharge to home,
TRANSFER to another hospital or death- is documented & the police is
intimated.
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All original reports of MLC cases to be
retained
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Nurses shall take the left thumb
impression, and two marks of identification on the MLC sheets & staff nurse
will pack, seal and label the material collected like clothing / stomach
contents/ bullet/ pellet etc.
SOP to prevent Adverse Events during Surgery
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SOP to prevent
Adverse Events during
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Sr.
No.
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Process
Flow
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Responsibly
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1
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It is verified from the patient
that he has stopped the medicines as per the advice of the doctor.
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Treating
Doctor
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2
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The
surgery site is marked and cleaned by betadine.
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Nurse Asst./
OT incharge
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3
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Pre-operative
check list is filled in.
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4
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OT
nurse while receiving the patient verifies from the patient his/her name and
surgery that is planned.
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5
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Doctor
asks the patient his/her name and the chief complaint or the type of surgery
that is going to be performed.
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Doctor
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6
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Before
starting the surgery/ induction of anesthesia, TIME OUT done, the OT Nurse
loudly announces the name of the patient, the type of surgery, type of implant
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Nurse
Asst.
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7
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If
any discrepancy at any point of time arises, the surgery is withheld until
the discrepancy is resolved.
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Treating
Doctor
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SOP FOR TRANSFER OF PATIENT WHEN MEDICAL FACILITY IS NOT AVAILABLE
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SOP for referral out or transfer out
of patient when Medical professional is not present in the premises
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Sr.
No.
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Process
Flow
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1
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Transfer
out or referral out shall be done through OPD consultation.
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2
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The
staff will talk to Medical Director and find out if He/ She can come
immediately or the patient should be transferred to the nearest hospital. The
Patient or the accompanying person is briefed about this situation and guided
to the nearest health care facility as advised by Medical Director. Travelling
arrangement is discussed and if required suitable ambulance is called for
transportation.
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3
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Verbal
consent for transfer out/referral out is obtained from the patient or
relative or accompanying person.
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4
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The
order for transfer out/referral out shall be mentioned in the OPD case
sheet with patient’s name, date, time.
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SOP for Medico Legal Case
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SOP for Medico Legal Case
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Sr.
No.
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Process
Flow
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1
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All
complaints and events shall be recorded.
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2
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Each event
shall be recorded in detail including the date, time and place of the event
and involvement of person and/or objects during the event.
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3
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Each case
should be intimated to the relevant police station by phone after counselling
the patient and relatives about the hospital policy and procedures. The name
and buckle number with designation of the police personnel who has taken down
the information along with date and time shall be noted.
A written
intimation shall be prepared and given to the police.
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4
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All MLCs
after registration are to be issued for OPD/IPD cases and should be marked
“MLC”, MLC number shall be stamped on all paper and patient records.
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5
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Clinical
notes shall be entered in IPD/OPD case paper.
a. Examine
the patient for all types of injuries. Take a detailed history of the
event. Start the medical management as required. Inform the concerned
Consultant accordingly; proceed further with the necessary investigations.
b. For
all MLCs, the patient record must be filled
up and all columns completed.
c. While
filling the record, place special emphasis on identification marks, who the
patient was brought by, the site of accident, name, age, sex, date, time of
arrival and detailed examination of the injury.
d. In
assault or trauma cases, the left thumb impression of the patient along with
two marks of identification is mandatory to identify the patient – whether
conscious or unconscious.
e. Obtain
the consent of the patient and a declaration that “I have shown all my
injuries to the Doctor on Duty”. This is mandatory in assault cases.
f. No
information about any document or investigation shall be released in any MLCs
unless an authority letter from the patient himself or court order, and/or a
police requisition note is received.
Police requisition should pertain to queries.
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6
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A separate
entry in the register shall be maintained for each MLC with the required
information.
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7
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A
counter-signature from the police station shall be taken from the
representative in a patient’s MLC form/book.
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8
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The time of
informing the police and time of arrival of the police shall be entered in
the MLC form.
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9
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In case the
police do not arrive within two to four hours of MLC report, a reminder shall
be sent asking for an acknowledgement.
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10
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If any
patient registered under MLC dies during hospitalization, post mortem is a
mandatory procedure and the patient’s body shall not be handed over to the
patient’s relative but to the respective police station in order for the post
mortem to be conducted at the district hospital.
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11
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A case
summary shall be provided to the police at the time of handing over the dead
body for submission to the district hospital.
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12
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When MLCs are
discharged, the relevant police station shall be notified.
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13
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A copy of
all reports of investigations shall be kept in the MRD file before
discharging the patient.
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14
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After
handing over the documents and reports to the patient, the patient or relatives
signature shall be obtained for the MRD file.
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15
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After
discharge, MRD files of all MLCs shall be stored separately and be under the
control of designated person.
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16
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Admin
shall preserve the copy of the signed certificate in the patient’s record.
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17
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At
the time of handing over the certificate to the police, the designation and
the buckle number of the police shall be noted in the second copy and the
signature of the police taken.
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18
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The
original injury certificate shall only be issued to the police and not to the
patient or relative.
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