Management Strategies in In-Patient Services
Introduction
An overall plan for the OA nursing department provides for establishment of a number of units or wards. So the process of administration must enter into these wards.
Factors involved in good ward management
i. Planning
- A planned program for each day's work
- Provision of supplies and equipment for efficient work
- Well planned assignments
- Delegation of responsibility
ii. Scheduling
- Beginning the day on time
- Preventing interruptions
- Establishment of ward routines
- Well arranged time for personnel
iii. Data management
- Accurate record keeping
- Full reports
iv. Motivation
- Establishment of good working relationship within the ward and with other associates
- Maintenance of high morale among all members of the staff
v. Strategy management
- A thorough knowledge of all duties performed in the wards.
- Use of democratic methods in establishment of ward policy.
- Orientation of new staff members
- Maintenance of a suitable environment
- Clear understanding of doctor's orders
- Good teaching and supervision
Components of ward management
- Patient care
- Personnel management
- Supplies and equipment
- Environment cleanliness
Patient care
This includes all activities necessary to provide nursing care concerned with comfort and well being of every patient. It is necessary to assess the needs of the patients and plan for their recovery. Helping physician in carrying out procedures, preparing equipment for assisting physician with diagnostic tests and therapeutic measures of OA leads to patient care. Giving medicine and carrying out treatment, observing patient for any untoward reaction following treatment and making necessary measures to combat them also play an important part in patient care. The ward manager is in charge of the smooth running of all preoperative and postoperative requirements.
a) Personnel management
Assignment of OAs for patient care can be given according to the number of patients. Allocation of personnel is done to fulfill the immediate needs of the individual hospitals, for example the paying section, speciality section, free section and camp section. The Management must make sure that the ward rounds are done as per the norms. Ward round is a tool of supervision, evaluation and teaching. The ward should have a sufficient number of cleaners to keep the ward clean and tidy. They should be supervised effectively.
b. Supplies and equipment
Ensure that all supplies and equipment as listed in unit I are on hand in the ward. If there is any problem with the equipment, it should be rectified by sending either to the maintenance department or calling the technician to take steps to repair it. OA must be sure that there is sufficient medicine in the ward.
c. Environment cleanliness
Cleanliness in the ward is essential for good patient outcome. Everyone contributes to maintaining the cleanliness of the ward.
The OA should ensure cleanliness of all areas. If problems are found, the housekeeping department should be informed immediately and rectify the problem. A checklist must be followed daily for the proper maintenance of the ward.
Dustbins must be kept inside the patient's room as well as outside in a few places, so that bits of paper , used cotton and other waste will not be strewn around. Toilets and bath rooms are cleaned at regular intervals.
Roles and Responsibilities of OA
Preoperative and postoperative care is a critical component of nursing for it determines the patient's state of mind before surgery and attitude towards the hospital. OAs in the wards are responsible for ensuring continuity of ophthalmic care before and after surgery, and for providing physical and psychological support to patients during their stay. They have the major responsibility from the time patients are admitted till they are discharged.
Their various roles are outlined below
Patient interaction
- Ensuring that the physical, mental and medical requirements of patients admitted for surgery are met.
- Entering patients name, medical records number, time of admission, receipt number andother relevant details in admission and discharge slip.
- Giving orientation about the room to patients.
- Providing preoperative and discharge instructions to patients.
- Accompanying patients for checkup by the ward physician.
Monitoring
- Rechecking preliminary investigations before surgery
- Check that all patient details are in order
- Confirm availability of right IOL Diopter (especially unusual powers)+/- 8.00-23.00
Execution
- Administering medications conscientiously
- Pre rounds preparation
- Sterilization of equipment and instruments
- Routine change of linen in rooms
- Leading pre and post operative patients to medical officers at wards for eye check-ups
- Attending phone calls, complaints and doing the needful. Inform the surgeons about complicated cases.
Assisting
- Assisting the ward ophthalmologists in slit lamp examination of patients the day after surgery
- Assisting the ward ophthalmologists in keratometry and A-scan examination before surgery
Documentation
- Enter the patient information, MR number, advance receipt number, time of admission and discharge
- If the patient is scheduled for surgery, write down their name in the surgery schedule list, MR number, type of surgery etc.
- Write discharge instructions in the pad
- Daily morning find out the bed census and write down in a note book and also on the notice board. Bed census contains the following
Total number of beds
Total number of occupied beds
Number of vacant beds. It is calculated by adding the admission and deducting the discharge.
- Maintain surgery note book. It contains the name of the patient, MR number,room number and type of surgery.
- After surgery, the type of surgery and name of the surgen is added and this is helpful in taking surgery statistics.
- Preparing the census report and attending the meeting weekly.
Role of ward in charge
Monitoring
- Checks whether advance is paid or not.
- Checks that patient details (Name, MR. No, and Room. No, Surgery details ) are entered in admission register.
- Checks that medicines are purchased.
- Maintains the bed census board in the floor.
- Cross checking the bed census report generated in ward with that generated in the admission and discharge counter.
Patient interaction
- Discharge instructions are prepared and given to patients (discharge counselling)
- Patient queries and requirements are addressed
Documentation
- Surgery list is prepared and distributed.
- Discharge summary is prepared.
- Entering follow-up dates and time in the register after consultation with the patient according to their availability.
- Relevant medical and reimbursement certificates are prepared and issued to patients.
Communication
- Inform surgical complications to the surgeons.
- Follow up the out -going interdepartmental consultations
Role of ward ophthalmologist / OA / Manager
- Performing examination to reconfirm all test findings and correlate with records.
- Supervising administration of preoperative medications.
- Checking with the patient for past history of sensitivity or allergy to anesthetic agents.
- Deciding on type of anesthesia (local / general) the patient will need depending on patients age, physical and mental well-being.
- Devoting special attention to complicated and high risk patients.
- Obtaining physicians certificate of fitness for patients with systemic problems.
- Ensuring that appropriate identification stickers are placed on the case file covers for patients with any systemic problems or allergies.
- Post-op review of all patients.
- Ward rounds and discharge of patients.
- Medical reports / certificates.
- Review of any surgical complications.
- Gives a written report to the night duty doctors on any patient who need extra care or injections. The OA should keep these patients' case sheets accessible to the duty doctors.
Role of ward housekeeper
Cleanliness
- Ensure that the ward is kept clean.
- Planning and procurement of cleaning materials required for hospital is done.
- See that the ward is decorated with appropriate wall hangings, photos and flower arrangement.
- Wall hangings, doors and windows, furniture are all cleaned regularly
- Bed covers are kept clean and appropriate colors are used in different rooms.
Documentation
- Inventory list of furniture, electrical equipment, plumbing and carpentry materials.
- The required inventory of cleaning materials is maintained and transferred to the required area when required.
- The linen stock is maintained. ,/li>
Appliances
- Tube lights, fans, buckets and other amenities are repaired and replaced as required
Records and Registers
Admission Register
| Room NO | MR. No | Patient name | Date of admission | Surgery detail | Systemic diagnosis | Blood Sugar value | BP Forenoon & afternoon | Remarks |
IOL Review Register
| Date | MR. No | Patient name | 1st review date | 2nd review date | Time | Remarks |
Phaco Follow up Register
| Date | MR. No | Patient name | Review date | Time | Remarks |
Reimbursement Register
| Date | MR. No | Patient Name | Advance receipt number | Discharge bill number | Medicine Bil number | Ward OA Signature | Number of bills | Patient's Signature |
Reports generated
1. Follow up note
A follow up note is prepared daily and sent to medical records department from the ward to facilitate retrieval of case sheets prior to the arrival of patients the next day, so that waiting time is reduced.
2. Handing over and taking over
This report is prepared everyday by day duty ward assistants and handed over to the night duty ward assistants. It deals with information regarding patients with systemic problems. It will help in paying special attention and care to patients who are at risk. Also the vital signs are taken, noted, and entered by night duty sisters so that it can be reviewed during examination the following day.
3. Discharge report
A list of patients discharged is prepared everyday by the ward coordinator and sent to the admission and discharge counter to let them know the room vacancies as well as the telephone utilization. It enables the admission and discharge counter to re allot the vacant rooms to new patients and also to include telephone charges in the bills for discharged patients.
4. Microbiology test requisition form
A test requisition form is sent from the ward by the in charge to the diagnostic laboratory in case any investigations are completed.
5. Ward census report
Ward census report is prepared twice a week that is on every Tuesday and Saturday. This helps cross checking information entered in ward with that of admission and discharge counter. Details regarding settlement of bills, with information about addition or deduction of rental charges in the bills of patients who had shifted their rooms are also given.
Monitoring mechanisms
The following activities need to be monitored
Patient flow and arrival: Patient arrival should be anticipated and required room type and the bed should be ready before patient arrives.
Register to be maintained of patients present and new patients admitted
2. Supplies and equipment: Weekly checking of the stock of stationary and drugs. Weekly checking of the functioning of all equipment and reporting if there is any flaw.
3. Staff attendance, performance and discipline: Daily monitoring the attendance of staff and to make necessary substitute arrangements for absentees. Punctuality of the staff is also monitored.
4. Cleanliness of the ward: Daily monitoring the cleanliness of the wards, rooms and waste transport and disposal. Daily checking of the bed, linen and other supplies in the rooms and also the interior decorations of the rooms.
5. Patient feed back and suggestion: Taking patient feedback on the quality of care.
The following meetings are conducted to monitor the functioning of the department
i. Weekly meeting: A weekly meeting is conducted by the nursing superintendent where several issues like postings, classes for trainees, work related problems, patient satisfaction, and any other complaints are dealt with. This will be attended by ward in charge of all floors, and OAs. Ensure that any corrective measures needed are undertaken to facilitate proper functioning of the department.
ii Quarterly meeting: Once in three months infection control meeting is conducted which is attended by ophthalmologists, nursing superintendent, operation theatre OA , ward OA. This is to help prevent the chances of infection by any means.
Communication system
Telephone intercoms are the most common communication mode in the hospital. Intercoms can be used as a mode of communication within the department or within different departments. Intercoms can also be useful for the external customers like the patient or the patient attendants to get the regular information of the hospital. This method needs a telephone operator or a receptionist to receive calls and to transfer the calls to the respective extensions. This method of communication reduces the delay in the transfer of a message either inter departmental or intra departmental level.
Other methods of communication are the reports or the requisitions sent from one department to another or within the department such as
- Indent from ward to the stores for supplies.
- Lab requisition from ward to lab for the specific test to be done.
- Prescription to pharmacy and to the patient.
- Discharge summary to patient.
- Registration number or MRD number communicates details regarding the patient to all the departments.
Inter departmental links
i. Housekeeping
Housekeeping is a non - revenue producing service department in the hospital. It helps in providing a clean, comfortable and safe environment in the ward, which ultimately ends up in patient satisfaction. Smaller hospitals may find it difficult to have a separate house keeping department, so they entrust the responsibility to one or a few persons.
ii. Maintenance department
This department helps in keeping furniture, fixtures and facilities in ward in working order. It also takes care of plumbing, carpentry, electricity and civil works in the ward.
iii. Operation theater
Operation Theater is directly related with ward because an operated patient is admitted for a minimum three hours (day care). This relationship will help in providing better care to the patient.
iv. Personnel
Ward coordinates with personnel department for recruitment, salary, administration, identity cards for staff, promotions and exit formalities.
v. Catering
Catering department takes care of the food requirements of patients admitted to ward. They can supply food in the rooms itself as per the order given. Special foods for diabetic patients should also be made available. Catering department could be established in hospitals if they feel the necessity of it.
vi. Stores
The coordination with stores ensures the availability of day to day requirements of the wards. Materials can be indented from stores in daily / weekly / monthly basis according to the requirement. The medicines used in surgery are replenished by patients who will purchase the same from pharmacy and hand over them. These will be sent to the main stores.
vii. Medical records department
A healthy relationship with the MRD will allow smooth receiving and providing all the needed information and data that are closely related with patient care during their stay in the hospital and also during the revisit.
viii. Pharmacy
With the help of pharmacy the ward is able to function efficiently by providing all the necessary medication to the patients round the clock.
Summary
Strategies for managing patient care, ward rounds and ward environment have been discussed in this unit. Registers and records are to be accurately maintained in the ward waste disposal should be effectively done, to prevent and control infection. This also contributes to patient satisfaction.
Key points to remember
- Most of the patient's interaction will be with the OA
- Their knowledge and attitude is very important to the patient's overall experience
- They play a pivotal role in the smooth functioning of the ward
- Records and registers are to be maintained to generate accurate and necessary reports
- The OA interacts with the housekeeper to guarantee a clean and pleasant environment
Student exercise
Answer the following
- List ten factors involved in good ward management.
- Describe the duties of ward manager.
- Which investigations must be rechecked before cataract surgery?
- What is the role of ward house keeper?
- What are the records and registers maintained in the ward?
- Discuss the communication system within the hospital.
