Personal Care of Patients

Admission Procedure

Types of admission

1. Emergency admission
2. Planned admission on the basis of note from the admitting consultant
3. OPD patient requiring immediate admission
4. Telephonic reservation for admission

Admission timings

The timing of admission and surgery may vary from place to place according to the system followed by hospitals.

Admission procedure

A patient is admitted in the hospital on the basis of the written note from the medical officer or physician.

Admission involves the following procedure

In the counselling department, the counsellors explain to them about the disease, type of surgery suggested by the doctor, types of rooms and the facilities available in each type of room and their charges, hospital facilities and charges for the various services to patients and relatives.

If the patient shows willingness to get admitted, they are sent to the admission counter. In hospitals where they do not have separate provisions for an admission counter, the reception counter could be used for the procedure.

At the admission counter, preparation of admission record which will contain name, address, sex, age, admission date, bed number, admission no. medical record number is to be recorded. If a computer is available the details could be computerised. Otherwise all the details are to be legibly written.

To cash paying patients, a receipt should be immediately issued. Patients, for whom the payment will be made by corporate offices, need not be given any receipt.

Patient's medical record (case sheet) is sent along with the patient. In bigger hospitals, junior OA could be utilized to guide the patients to the respective wards.

The ward OA is to receive the patients and enter their names in the admission register.

The ward OA can guide the patient and the attendar to their respective rooms and give them instructions about the facilities in the room. For example, if there is provision for hot water only during stipulated time, it could be informed. In general wards, there will be provision for common bath rooms, and they are shown the location of the lavatory and the bath rooms. The occupants of single rooms are given the room lock and key. If the patient or the attendant asks for any clarifications, the OA must answer cordially and leave the room.

After giving instructions about the drops to be instilled before surgery, the OA tells them the number of times the drop is to be instilled. The patients are likely to use the drops in both eyes, so instruct them that they need to instil drops only in the eye to be operated.

Even if the patient asks a number of questions, they should be answered politely. Sometimes they may ask the same questions repeatedly for which clear answers should be given by the OA.

Information is given about the visiting time of the ward doctor to the patient and the attender. Inform them that OA can be approached anytime for help.

It is the duty of the OA to make the patient's stay comfortable.

Arrangement of Patients Room

Bed making

Skilled bed making is absolutely essential in helping to prevent cross infection. Movement of the bedclothes dislodges microorganisms from the bed into the air. Bed making should be carried out using smooth movements to avoid unnecessary disturbance of the air above the bed, minimizing microorganisms that may be airborne. All the materials required should be available at the bedside before stripping the bed. Bedclothes should be stripped on to a chair placed at the foot of the bed. Care should be taken to prevent the bedclothes from dragging on the floor, picking up microorganisms. Removal of debris from the sheets and straightening out any creases is necessary (Fig. 8.1).

Materials for Bed Making

The required material for bed making is to be kept ready

Bottom sheets, pillow cover, top sheet, cleaning cloth, soap dish with soap, hand towel, laundry bag, any disinfectant.

Procedure

• Take clean bed sheets and clean pillow covers.
• Knock on the patient's door and politely ask permission to enter and make the bed.
• Make polite enquiries about the patient's health, and say a few comforting words.
• Help the patient to get up from the bed and sit on the chair.
• Remove the outer cover of the pillow.
• If the inner cover is clean, do not remove it. Otherwise remove the inner cover also.
• Remove the used sheet from the bed gently and carefully by folding it into four, so that the dust does not fly around. Place this along with the pillow covers with the dirty linen outside the room.

Spreading a clean bed sheet

Method

• Fold the mattress into two and wipe the dust under the mattress with a wet cloth
• Wipe the bed thoroughly with a dry cloth. A damp bed will cause the mattress to smell
• Dust and clean the legs and the portion under the bed in a similar manner
• Make sure that the bed sheet has no stains and is not torn
• Fold it uniformly and place it in the centre of the bed
• Spread the mattress breadth wise on the bed, and tuck one end of the bed sheet under the mattress
• In a similar manner tuck the opposite end. Make sure that there are no creases in the bed sheet after it is so tucked
• The four corners of the bed sheet which remain unfolded should be mitred. To mitre a corner, tuck in along the foot or the head of the mattress, lift the flap of the sheet from a point along the side about 30cm from the corner and tuck in the remaining portion. Now drop the flap and tuck in.
• Tuck in the sides along the length of the bed
• Pat the bed sheet all over to remove any crease
• Inspect the work. There should be no creases or folds.

Putting on a pillow cover

Method

• Change the inner cover only if it is dirty.
• Fold the pillow in two and then slip it into the cover.
• Let the knot of the inner cover go in first so it is not visible once the outer cover is put on.
• The opening of the pillow cover should not be visible.

Arranging the bed

• Place the pillow at the head of the bed.
• After the bed sheet has been neatly spread and the pillow cover has been put on, fold the additional sheet neatly and put it at the foot of the bed.
• Settle the patient comfortably on the bed again, thank, and then leave the room.

Housekeeping

Housekeeping department is responsible for cleanliness, maintenance and aesthetic upkeep of the hospital, to provide a safe, pleasant and infection free environment to the patients. The department activities cover all patient and non-patient areas inclusive of external premises of the hospital.

Procedure for linen

Linen and laundry is the responsibility of the Housekeeping department. The total control and maintenance of linen in the patient areas and consultation rooms is taken care of by linen section. Budgeting, indenting and condemnation of linen is done by the linen in charge. In some hospitals washing of all patient linen and guest laundry is taken care of by the in-house laundry. Issuing of fresh linen to the respective areas is done by the linen section.

Steps to be followed for corbolisation

• This is done in the areas where fumigation is not possible
• Wear mask and pair of gloves
• Switch off the AC and fan
• Remove the soiled linen and fresh linen from the room
• Mix the disinfectant with hot water.
• Thoroughly dust the mattress, cot, couch, cupboard, water jug, glass, foot stool, food trolley, ceiling fan/AC grills, using the hot disinfectant
• Sponge mop the walls with disinfectant
• Sweep and mop the floor with disinfectant
• Put back all things in their appropriate places.
• Make the bed and replace the required linen items/toiletries
• Switch on the AC
• Check the room on completion of the task.

Steps to be followed for fumigation

• Wear gloves and face mask as a precautionary measure
• Leave all items in the room undisturbed
• Seal all outlets for leakage except for the main door
• Pour concentrated solution of formalin on cotton placed on a plastic sheet inside the room
• Seal the main door immediately from outside
• Keep the room sealed for twenty four hours and then clean

Waste disposal

Waste disposal plays a very important role in ward. It is carried out in a very systematic and hygienic manner Fig 8.2.

Colour coding

Different color bins are used to collect waste.
It helps to dispose it easily. For example the under mentioned color scheme is used.

Red color Bin

1. Needles: (draw a tabular column and insert the details)
2. Scalpel blades
3. Broken ampules
4. IV tubes
5. IV lines
6. Syringes
7. Dressing materials like gauze, cotton etc

Yellow color bin

1. Above said items without blood stain

Blue color bin

1. IV fluid bottles
2. Glass vials
3. Glass bottles

Black color bin

1. Cytotoxic drugs
2. Expired drugs

White color bin

1. Household waste
2. Food waste

Waste generation and collection

The waste generated in hospital is classified into 5 categories, these are

1. Anatomical waste: The anatomical waste is collected in red bags: these are mainly generated in operation theatres.
2. Clinical waste: The clinical waste such as plastics and catheters are to be collected in blue bags.
3. Contaminated waste: The contaminated waste such as blood - stained cotton, gauze, bandage, needles, syringes etc. are to be collected in yellow bags from respective areas in the hospital.
4. House hold waste: household waste such as paper, stationary, tea cups etc. are to be collected in white bags.
5. Food waste: The food waste is to be collected in bins.

Other types of waste are assembled in bulk and given to a contractor for disposal

Discharge Procedure

On the day of surgery, (prior to the day of discharge) the duty doctor examines the patients in the ward. If there are no complications, the patient is advised for discharge on the following day after examination by the ophthalmologist. If the patient has any complication, as per the instruction of the ophthalmologist the stay of the patient has to be extended.

The ward OA will inform patients who are to be discharged the following day, and they will do the discharge counselling by giving postoperative instructions regarding use of eye drops, medicines, do's and don'ts after surgery and also fix up review date according to the convenience of patients.

On the day of discharge, the first step in the morning is post operative vision check followed by dilatation. The senior medical officer will finally examine and discharge the patients who have no complications. For those advised for discharge, the case sheets are made ready and is handed over to the admission and discharge counter after which the patients are asked to settle their bills. In the meantime discharge summary is prepared by the ophthalmologist of the ward (Fig. 8.3).

The discharge summary is handed over to patients reminding them about the review date. The ward OA should insist on the importance of review to the patient. Medical certificatesoreimbursement certificates, are issued at the ward station. Employees of any organisation may need a medical certificate to avail leave from the organisation, so the OA should make arrangements for them to get the certificate without delay. The OA who is in charge of issuing these certificates should prepare them meticulously without committing any mistakes.

Summary

The admission and discharge procedures should be very smooth. There should be coordination between the ward OA and the medical record staff. In smaller hospitals there may not be a separate medical record department. One person has to be in charge of the admission and discharge procedure who can communicate with the ward OA about the status of the rooms available. A proper system should be followed according to the flow of patients, and the patients should not face any inconvenience in the admission and discharge procedure. Admission and discharge timing could be fixed according to the administrative convenience of the hospital.

Points to remember

• Receive the patients with a smiling face
• Enter the name, M.R. number, room number, type of surgery in a register
• Guide them to their room and give necessary instructions
• Make their stay a comfortable one
• Inform the time of surgery
• Inform the day and time of discharge
• Always check the order for admission, discharge and preparation

Student Exercise

Write short notes on

1. Bed making in an occupied room
2. Fumigation
3. Toilet cleaning

Answer the following

• List the four types of admission
• Write about waste collection in the ward
• What items are collected in the blue color bin for disposal?
• Draw the flow chart for discharge procedure