Planning and management of clinical service department
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Planning and management of clinical service department
- 1. PLANNING AND MANAGEMENT OF CLINICAL SERVICE DEPARTMENT PRESENTED BY DR.PRIYANKA
- 2. DEPARTMENTAL PLANNING AND DESIGN (1) Outermost zone, which is the most community oriented with • · out-patient department • · emergency department • · administration • · admitting office, reception (2) Second zone, which receives workload from • · diagnostic X-ray • · laboratories • · pharmacy (3) Middle zone between outer and inner zones • · operating department • · intensive care unit • · delivery (4) Inner zone, in the interior but with direct access for the public • · wards and nursing units (5) Service zone, disposed around a service yard ~ • · dietary services • · laundry and housekeeping&· storage • · maintenance and engineering • · mortuary·
- 3. CASUALTY •ORGANIZATIONAL CHART CEO COO Chief Nursing Officer CMO Nurse Manager Clinical Assistants Staff Nurse Unit Clerk Housekeeping Staff
- 4. Staffing Responsibility Matrix ACTIVITY PERSON INITIATING PERSON SUPERVISING /ATTENDING THE ACTIVITY Personnel Morning Night Receiving the patient Nurse/ security/House Nurse Manager /CMO CMO 1 on duty 1 on duty keeping boy 1 on call 1 on call Medico legal case Staff nurses / CMO / Staff CMO / Nurse Manager Nurse General M Evening Night Death CMO CMO/Consultant or Medical orders Staff nurse/CMO Consultant ni Carrying out Staff nurse /CMO Nurse Manager n procedures /Consultant g Urgent Staff nurse /CMO CMO / Blood Bank Nurse Manager 1 - - - diagnostics/blood officer Staff Nurse - 2 2 2 transfusion Ambulance driver - 2 2 2 Patient brought in Staff nurse/CMO CMO / CNO Ambulance attendant - 1 1 1 dead Male Attendant - 2 1 1 Indenting medicines Staff nurses Nurse Manager Requesting for CMO Consultant/CMO •RECORDS AND REGISTERS MAINTAINED IN diagnostics THE DEPARTMENT Transfer out of Staff Nurse / CMO CMO / Consultant / Casualty Register patient Nurse Manager Laboratory Specimen Dispatch Register Daily inventory Staff nurses Nurse Manager Daily Inventory Register Nurses records Staff nurses Nurse Manager Equipment Staff nurses / Nurse Manager Assignment Register management Communication Register Infection control in Staff nurses Nurse Manager / HICC Medical Record Dispatch Register ward / Procedure Morgue Register Room MLC Forms/Register Waste disposal Staff nurses/Housekeeping Nurse Manager Death Certificate staff /Supervisor Medical Records CMO/consultant CMO / CNO / MRD Complaints Staff nurses Nurse Manager / CNO / PRO CMO duty schedule -in-Charge Ambulance driver – Manager Admn Manager Admn duty schedule House keeping staff Supervisor house keeping Supervisor house keeping
- 5. OPD •ORGANOGRAM CEO DIRECTOR MANAGER DIRECTOR HOD - NURSING MEDICAL PROFESSIONAL PATHOLOGY SERVICES SERVICES EXECUTIVE CONSULTANTS TECHNICIAN NURSE (Blood Sample Collection) STAFF ATTENDANTS TECHNICIANS NURSES FRONT OFFICE STAFF IN OPD
- 6. – Staffing – Working Hours • Customer Relations Staff: • The OPD should be open 12 hours PRO, Reception and every day from 8 a.m Enquiry, Registration and The basic requirements of an Appointments outpatient • Billing Counter, waiting lobby. • · reception and waiting areas, • Nursing Staff : Procedure • · consultation rooms, Room Staff Nurse • · examination rooms, • Housekeeping Staff: • · treatment rooms, and Attendants to maintain cleanliness and to assist • · staff and supply areas. to 8 p.m. in transporting patients to emergency, screening or diagnostics.
- 7. •PATIENT FLOW CHART ENTRANCE (arrival of patient) Patient taking prior appointment ENQUIRY (received / registered) Time confirmed to patient Referred to billing If investigation required by Consultant Referred to concerned Consultant Patient to be referred to billing If investigation is not required by Consultant Patient goes for collection of sample Follow up is explained to the patient Patient comes for collection of report the next day Patient leaves the hospital
- 8. • OUT PATIENT OPERATIONS:- 1)OPD Registration 2)Consultation 3)Admissions or Diagnostic 4)Pharmacy • OPD DEPARTMENTS :- 1) Pediatric OPD 2)Antenatal Clinic/ Gynaecology 3) Dental Clinic 4) Ear Nose & Throat 5)Ortho 6)Medicine • INVENTORY MANAGEMENT:- The OPD will maintain the following Inventory Records. 1)Equipment and Instruments2)Linen3)Emergency trolley4)Stationery5)Hand wash 6)Dustbins7)Gloves 8)stethoscope9)Hand Towel10)BP apparatus. • RECORDS AND REGISTERS MAINTAINED:- • 1) Communication Register • 2)Laundry Register • 3)Inventory Register • 4)Immunization Register • 5)Consultant Performance Record • 6)CSSD Book • 7)Ante Natal Record • 8)Equipment Register • 9)Vaccine Stock Register
- 9. IN PATIENT DEPARTMENT CEO •ORGANIZATIONAL CHART COO Consultants Chief Nursing Officer RMO Nurse Manager Team Leader Staff Nurse Health Care Asst. Unit Clerk Hospital Attendants
- 10. – Staffing (Per Shift) – Shifts • R.M.O. - 2 • R.M.O.s will be on 8 hour shifts. They • Nurse Manager 2 (Morning & will hand over at 7 am, 2 pm and at 9 Evening One Each) p.m. • Team Leader - 2 (Morning & • Team Leaders will be on 8 hours shift Evening One Each) .They will hand Over & Take Over at 7 • Staff nurses -1 : 6 patients am & 2 pm. They will be on duty from 7 am to 3 pm, 2 pm to 10 pm. • Health Care Assistants - 2 • Staff Nurses will be on 8 hour shifts. • Female attendant -3 They will hand over and take over at 7 • Male attendant -3 am, 2 p.m. and 9 p.m. • The Nurse Manager will be on duty from 7 am to 3 p.m.,2 pm to 10pm. • The Nurse Manager will be on duty from 9 pm to 7 am & 2 pm to 10 pm when deputed by Chief Nursing officer as Shift Coordinator •
- 11. ACTIVITY PERSON INITIATING PERSON SUPERVISING Admission procedures Doctor/Nurse/Front Office Nurse Manager, Consultant, Unit Clerk Executive Front Office Diagnosis RMO / Consultant Consultant Treatment/ Medication RMO/Consultant Consultant/Nurse Manager Tests RMO/Consultant Nurse Manager/ Consultant Records Staff nurse/RMO Nurse Manager/ Consultant Transfers Staff nurse/RMO Nurse Manager/ Consultant Discharge Staff nurse/RMO Nurse Manager/ Consultant, Executive Front Office Follow-up Nurse Manager Consultant, Chief Nursing Officer Ward Protocol Nurse Manager Chief Nursing Officer/Shift Coordinator Nursing Procedures Staff Nurse Nurse Manager/Educator/Shift Waste Management /RMO/Health Care Assistant Coordinator Nurse Manager/Facility Manager Infection Control Staff Nurse/RMO/Consultants Nurse Manager/Chief Nursing Officer Infection Control Nurse Facility Manager/Chairman Infection Control Committee
- 12. IPD OPERATIONS Admission of the Patient in the Ward:-1)Planned 2)Emergency – registration – Allotment of room and bed – Deposits – Allotment of visitor’s pass – Schedule Of Planned Procedure/Surgery/Investigations • Transfer In of Patient Within Hospital • Transfer Out Within the Hospital • Patient Transfer to Operation Theatre/Procedure Room • Consultant / R.M.O. ‘s Rounds NURSING MANAGEMENT OF PATIENTS IN THE WARD • Handing Over Process • Requisition for Emergency Investigations • Collection of Reports • INDENTING FROM CSSD • MAINTENANCE OF EQUIPMENT • BILLING • VISITORS POLICY • DISCHARGE OF THE PATIENT • DEATH • MEDICO-LEGAL ASPECT OF PATIENT MANAGEMENT
- 13. DIAGNOSTIC SERVICES INVESTIGATIONS RADIOLOGICAL SEROLOGICAL
- 14. Radiology CEO COO IMAGING SERVICES SL EQUIPMENT MAKE/MODEL . N O. 1 COMPUTERIZED CR 35 / DRYSTAR 5503 CONSULTANT RADIOLOGY HOD 2 200 MA HF X-RAY UNIT MULTIPHOS 3 100 MA PORTABLE X-RAY X-RAY MULTIMOBILE 2.5 FRONT OFFICE UNIT SR TECHNICIAN ASSISTANT 4 SONOGRAPHY VOLUSON PRO 730 GE LOGIQ E (PORTABLE) GE 5 MAMMOGRAPHY MAMMOMAT 3000 NOVA TECHNICIAN (SIEMENS) STAFF NURSE •ORGANIZATIONAL CHART ASSISTANTS
- 15. RADIOLOGY Functioning RECORDS AND REGISTERS MAINTAINED IN THE DEPARTMENT • Enquiry • Appointment Scheduling • Appointment Booking Register • Registration • X – Ray Register • CT scan Register • Payments • Sonagraphy Register • IMAGING REPORTS • Mammography Register • Inventory Register for X- Ray Film • Dispatch of Reports • Inventory register for contrast • QUALITY ASSURANCE PROGRAMME • Inventory Register for Materials FOR IMAGING SERVICES • Inventory Register For Linen • Inventory Register For medicine (VERIFICATION / VALIDATION / • Inventory Register For CSSD MONITORING / CALIBRATION) • Dispatch Register • Request for Follicular Study • Form F - Form for Maintenance of Record with respect to Pregnant Woman by Genetic Clinic / Ultrasound / Imaging Centre (Radiology)
- 16. LABORATORY CEO DIRECTOR Histopathologist/ PATHOLOGY consultant QUALITY CONTROL MANAGER TECHNICAL SUPERVISIOR SENIOR TECHNICIANS JUNIOR TECHNICIANS PATHOLOGY STAFF/FRONT OFFICE HOUSEKEEPING STAFF
- 17. Responsibilities and Authorities Quality Manager • Selection, approval and commencement of test methods. • Overall control of quality and advising and • Designing and implementation of internal and external monitoring all aspects of quality in the Q.C.program. laboratory. • Ensure the smooth running of the department . • Ensure that all equipments are operational • Check all the quality control, record • Supervise the staff keeping of daily and planned • Provide Continuous Medical Education maintenance, and calibration of • Evaluate competency of Staff at regular intervals. equipment. • To ensure confidentiality • Ensure the staff follows all SOPs • Address any complaints, requests or suggestions from patients / Staff / Doctors. • Planning and organizing audits and • Ensure good staff morale. reviews. • Review MIS. • Ensuring that the details of the reviews • Manage the overall efficient and effective administration of the laboratory including approval of are recorded. the indents/purchase requisitions for the material • Give a feedback to the Director Pathology raised by the Lab Technical Supervisor. about the staff performance. • Define, implement and monitor standards of performance and quality improvement of the medical • Prepare and maintain a schedule for laboratory services. continuous training programme for the • Review the laboratory policies regularly lab staff. • Work towards lab improvement in terms of processes, systems & workload. • Maintain & correlate record of quality • Review any new examination procedures which are indicators of the lab. developed in-house. • Review operational procedures with the Laboratory Director, once in 6 months. •
- 18. MANAGEMENT SYSTEM IN PATHOLOGY • The management system of Path-lab is based on the policies and the procedures that are documented and are for complying to the requirements of ISO-15189. • The entire documentation of the laboratory is in the form of Quality Manual,Procedures,Work instructions, forms and formats,charts,check list ,safety &Regulatory Norms etc. DOCUMENT STRUCTURE ↓ QUALITY MANUAL ↓ PROCEDURE MANUAL ↓ WORK INSTRUCTIONS ↓ CHARTS ,REPORTS,FORMS ,RECORDS
- 19. OPERATION THEATRE •ORGANIZATIONAL CHART CEO COO CHIEF CHIEF NURSING ANAESTHESIOLOGIST OFFICER ASSISTANT NURSE ANAESTHESIOLOGIST MANAGER ANAESTHESIA TEAM LEADER TECHNICIAN STAFF NURSE O T ASSISTANT OT HOUSE KEEPING ATTENDANT STAFF
- 20. – Staffing The Operation Theatre will have the following Staff : ACTIVITY PERSON PERSON INITIATING SUPERVISING • Anaesthesiologist OT booking Staff Nurses / Nurse Manager • Asst Anaesthesiologist Assistant • Nurse Manager Handing and taking over Staff Nurses Nurse Manager • Team Leader Equipment management Staff Nurses / Nurse Manager • Staff Nurses Anaesthesiologist / Attendant • Anaesthesia Technician Information to Consultant Nurse Manager Consultant • OT Attendant Requesting for diagnostics / Staff Nurses Nurse Manager • OT Assistant sending samples for • House keeping staff : histopathology • Male Key handling. Staff Nurses Nurse Manager Medical orders RMO Consultant • Female Nurses records Staff Nurses Nurse Manager stores Staff Nurses Nurse Manager PROCESSES:- OT Anaesthesia stores Anaesthesia • OT Booking Technician • OT Timings Daily inventory Staff Nurses Nurse Manager • Preparation of OT List Nursing procedures Staff Nurses Nurse Manager Infection control in OT Staff Nurses Nurse Manager • Cancellation of Surgery Waste disposal Staff Nurses / Nurse Manager • Implants Housekeeping Staff Death RMO/Consultant Manager Admin/CNO Complaints Staff Nurses Nurse Manager / CNO Indenting CSSD Linen, Staff Nurses Nurse Manager Consumables. Responsibility Matrix
- 21. DAILY TASKS RECORDS AND REGISTERS MAINTAINED IN THE • Getting the Trolleys Ready DEPARTMENT • Entry of Patient into OT • Narcotic Register • On the O.T. Table • Pathology Register • Recovery and Transfer to Ward • Daily Inventory Register • Disposal of waste • Daily Cleaning - Prior to Commencement of • OT Consumables Charge Sheet Surgery • Communication Register • Cleaning in Between Cases • Booking Register(Hard copy and soft copy) • Cleaning at the Close of Day • Operation Register • Weekly Cleaning: to be Done on Sundays • Fumigation Register • Fumigation of O.T. • HISTOPATHOLOGY SAMPLES AND SPECIMENS • OT Daily Maintenance Register • Billings • OT Complaint Register Requirements:- O.T. Tables • OT Implant Register - Ortho – Boyle’s Apparatus • OT Implant - Ophthalmic Register – Trolleys • Charge Sheet OT – C-ARM • Operation Record – Microscope and other accessories used in O.T. • Pre-Operative Anaesthesia Chart – Cauterizing machines • OT Consumables Charge Sheet Ortho – X-ray viewing Box • Labour Anaelgesia Chart – Suction Apparatus • OT Handing Over & Taking Over Patient’s – Linen Register
- 22. INTENCIVE CARE UNIT CEO COO CHIEF INTENSIVIST CHIEF NURSING OFFICER CLINICAL ASSISTANT NURSE MANAGER TEAM LEADER STAFF NURSE HEALTHCARE ASSISTANT UNIT CLERK HOSPITAL ATTENDANTS, HOUSEKEEPING STAFF
- 23. Responsibility Matrix Sr. No. Activity Person Initiating Person Supervising 1 Admission procedures Doctor/Nurse/Front Office Executive Front Office 2 Admission of patient Staff nurses Nurse Manager / Chief Intensivist 3 Handing and taking over Staff nurses/Registrar Chief Intensivist / Nurse Manager 4 Information to Consultant Registrar Chief Intensivist / Nurse Manager 5 Medical orders Registrar/ Chief Intensivist Chief Intensivist / Consultant 6 Carrying out procedures Registrar/staff Nurse Chief Intensivist/Consultant/Executive Consultant Intensivist 7 Indenting medicines Staff nurses Nurse Manager 8 Requesting for diagnostics Staff nurses Chief Intensivist /Consultant/ 9 Transfer in/out of patient Registrar/staff nurse Chief Intensivist/Consultant/Executive Consultant Intensivist 10 Daily inventory Staff nurses Nurse Manager 11 Nurses records Staff nurses Nurse Manager 12 Equipment management Staff nurses Nurse Manager / Biomedical Engineer 13 Stock Staff nurses Nurse Manager 14 Nursing procedures Staff nurses Nurse Manager 15 Infection control Staff nurses Nurse Manager 16 Waste disposal Staff Nurses/Housekeeping Nurse Manager staff 17 Medical Records RMO/consultant/unit Nurse Manager /Chief Intensivist 18 Accidents & MLC RMO/consultant/clerk unit Nurse Manager /Chief Intensivist 19 Death RMO/consultant/clerk unit Nurse Manager /Chief Intensivist 2520 Complaints Staff nurses Nurse Manager /Chief Intensivist/CNO
- 24. TRANSFER FROM TRANSFER FROM CATH TRANSFER FROM WARD / LAB CASUALTY/OPD O. T. Admission of patient in ICU CRITICAL CARE MANAGEMENT RECOVERED EXPIRED FORMALITIES FOR TRANSFER TO WARD POST LIFE CARE
- 25. DIALYSIS UNIT CEO • ADMISSION OF A PATIENT • STANDING ORDERS IN THE UNIT COO • INSTRUCTIONS TO THE PATIENT • TRAINING CHIEF OF NEPHROLOGY RECORDS AND REGISTERS MAINTAINED IN THE DEPARTMENT • Admission Register AKD MANAGER • Procedure Register • Communication Register TECHNICI AN • Daily Inventory Register (only for Dialysis department) STAFF NURSE • Hemodialysis Record • Dialysis Flow Chart HOUSE KEEPING • Consent Form (Consent for Vein Catheterization & Hemodialysis) • Investigation Chart for Renal Dialysis
- 26. PHYSIOTHERAPY Sr.No Key Personnel Responsibility Authority . CEO 1 Physiotherapist Consultation, Supervise & assessment maintain & treatment facilities COO of patient. available in Physiothera py / SPECIALITY PHYSIOTHERAPIST rehabilitativ CONSULTANTS e services Department TRAINEE PHYSIOTHERAPISTS 2 Trainee Assisting Handling Physiotherapist consultant equipments HOUSEKEEPING physiotherapi st 3 House Keeping Maintaining NIL Staff cleanliness of PHYSIOTHERAPIS PSYCHIATRIST CONCERNED the T CONSULTANTS department. Taking care of equipments. Wheeling patients to Responsibility Matrix the department.
- 27. Functional and space requirements in outpatient department Registration OPD Reception Enquiry Waiting Admin OPD Waiting OUT CLINICS LAB INVESTIGATION X-ray Inj & Wards Pharmacy Dressing
- 28. People Involved • In general, the people involved in this process are: • · Health planners, functional planners, financial planners and physical planners. • · Architects • · Engineers (such as civil, mechanical and sanitary) • · Quantity surveyors • · Finance managers • · Staff responsible for procurement of supplies • · Staff members such as doctors/nurses, clients/end users
- 41. THANK YOU