ORGANIZATION AND MANAGEMENT OF INPATIENT SERVICES  DR.N.C.DAS
ORGANIZATION AND MANAGEMENT OF INPATIENT SERVICES  <ul><li>In patient services includes the ward and nursing station and  ...
<ul><li>OBJECTIVE: </li></ul><ul><li>To provide the highest possible quality of medical and nursing care for an admitted p...
PLANNING AND ORGANIZATION   PLANNING   POLICY  MONITORING & EVALUATION  WARD  MANAGEMENT   PHYSICAL  FACILITIES   STAFFING...
POLICY OF HOSPITAL   The indoor facility creation depends on the policy of the hospital to  have the type of services and ...
PHYSICAL FACILITIES   PHYSICAL  FACILITIES   LOCATION   AUXILLARY  AREA  SIZE SANITARY  AREA  PATIENT HOUSING  AREA  ANCIL...
LOCATION   <ul><li>Should be at the backside of hospital complex to avoid traffic  </li></ul><ul><li>flow and congestion. ...
PATIENT HOUSING AREA   <ul><li>It may be devided into various cubicles as per patients requirement. </li></ul><ul><li>Room...
AUXILARY AREA   AUXILARY  AREA  NURSING  STATION  PANTRY   TREATMENT  ROOM  UNIT  STORE   CLEAN UTILITY ROOM & CLEAN LINEN...
NURSING STATION   <ul><li>Minimum area 20’  x 20 ‘ </li></ul><ul><li>Sister’s changing room and toilet </li></ul><ul><li>C...
SANITARY AREA   SANITARY  BATH & TOILETS  (1 for 5 beds) SANITATION  STORE (Brooms, mops,  detergent) JANITORS ROOM  (Used...
ANCILLARY AREA   ANCILLARY  AREA  DOCTORS  DUTY ROOM   SISTER  INCHARGE  TROLLEY BAY  WHEEL CHAIR, TROLLEY O 2  CYLINDERS ...
ELECTRICITY AND WATER SUPPLY   <ul><li>24 hours water supply 300 lt/ bed </li></ul><ul><li>Glare free lights, fans and suc...
STAFFING   Ward staffing depends on the size of the ward and criticality of patients. Specialist  - 1 per 100 beds  GDMO -...
WARD DESIGNING   The objective of ward designing is to facilitate the nursing staff to  observe each patient and keep a wa...
MANAGERIAL ISSUES   Day to day management of inpatient services is usually at 2 levels <ul><li>A. Doctors Level : Implemen...
FACTORS OF MANAGERIA ISSUE  MANAGERIAL  ISSUES  KNOWLEDGE OF  WARD DUTIES  ORGANIZATION   DOCTORS  ORDER  ESTABLISHMENT  W...
MANAGERIAL  ISSUES  PROVISION OF  SUPPLIES  RECORD  MAINTENANCE   DUTY ASSIGNMENT TO STAFF  TEACHING & SUPERVISION   MAINT...
FUNCTION OF WARD SISTER   WARD  SISTER   ENSURE GOOD  NURSING CARE   HOUSE KEEPING  SANITATION  DIETS IMPLEMENTING  DOCTOR...
MANAGEMENT METHODS   MANAGEMENT  STATEGIC  MANAGEMENT   OPERATIONAL  MANAGEMENT  <ul><li>Ensure implementation guidelines ...
MONITORING   MONITORING  LEVEL PATIENT  SATISFACTION   MAINTENANCE OF EQUIPMENT & REPAIR  LOGISTICS  LEVEL  EDUCATION  MET...
EVALUATION  EVALUATION  STRATEGIC ISSUES  & GUIDELINES   MEDICAL  AUDIT  BED TURN OVER RATE   SUPPLIES & DISTRIBUTION   EX...
FACTORS INFLUENCING PATIENT CARE   FACTORS  ATTITUDE & MOTIVATION OF  STAFF  LACK OF  PROPER ADMN.   SHORTAGE/  PILFERAGE ...
HOSPITAL ADMINISTRATION MADE EASY http//hospiad.blogspot.com An effort solely to help students and aspirants in their atte...
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Inpatient services

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Inpatient services

  1. 1. ORGANIZATION AND MANAGEMENT OF INPATIENT SERVICES DR.N.C.DAS
  2. 2. ORGANIZATION AND MANAGEMENT OF INPATIENT SERVICES <ul><li>In patient services includes the ward and nursing station and all other facilities necessary for good patient care. </li></ul><ul><li>To provide care under direct supervision for a patient at the point of illness when dependence on others is at its height by admitting in a hospital bed. </li></ul>
  3. 3. <ul><li>OBJECTIVE: </li></ul><ul><li>To provide the highest possible quality of medical and nursing care for an admitted patient. </li></ul><ul><li>To make provision for essential equipments, drugs and all other items required for patient care in an organized manner. </li></ul><ul><li>To provide most comfortable and desirable environment on temporary substitution for home. </li></ul><ul><li>To fulfill all the basic needs in the hospital like eating, toiletry, sleeping, entertainment etc. </li></ul><ul><li>To facilitate the visit of attendants and visitors. </li></ul><ul><li>To provide the atmosphere and facilities for highest degree of job satisfaction of nursing and medical staff and high levels </li></ul><ul><li>of patient satisfaction. </li></ul>
  4. 4. PLANNING AND ORGANIZATION PLANNING POLICY MONITORING & EVALUATION WARD MANAGEMENT PHYSICAL FACILITIES STAFFING WORD DESIGNING
  5. 5. POLICY OF HOSPITAL The indoor facility creation depends on the policy of the hospital to have the type of services and size of the hospital. POLICY TYPE OF HOSPITAL BED STRENGHT General Hospital (Surg, Med, Ortho) Super Specialty Hospital (Nurse, Uro., Burn, Nephro.) Specific Service Hospital (Maternity, Paed., TB, Leprosy, Ortho.) <ul><li>Less than 200 beds </li></ul><ul><li>(Usually horizontal explanation) </li></ul><ul><li>More than 300 beds </li></ul><ul><li>(Usually vertical expansion) </li></ul>
  6. 6. PHYSICAL FACILITIES PHYSICAL FACILITIES LOCATION AUXILLARY AREA SIZE SANITARY AREA PATIENT HOUSING AREA ANCILLARY AREA
  7. 7. LOCATION <ul><li>Should be at the backside of hospital complex to avoid traffic </li></ul><ul><li>flow and congestion. </li></ul><ul><li>Have direct access from OPD and Emergency and OT. </li></ul><ul><li>Single door entrance to ward complex to restrict the traffic and visitors. </li></ul><ul><li>Good intramural transportation systems like wide corridors, lifts etc. </li></ul>SIZE <ul><li>The size of the ward or nursing unit varies from 20 ft to 90 ft. </li></ul><ul><li>The size of the ward depends on – </li></ul><ul><li>Type of patient to be served </li></ul><ul><li>Critical care units like ICU, CCU, Post op, burn have small wards </li></ul><ul><li>where constant attention is required 20 to 30 beds. </li></ul><ul><li>Patient requiring frequent attention, intermediate ward size 40-50 beds. </li></ul><ul><li>For chronic long duration stay patients the size may be 70-90 beds. </li></ul><ul><li>Availability of Nursing and other staff. </li></ul><ul><li>Positioning of Nursing Station i.e. central, lateral. </li></ul><ul><li>Close or open ward. </li></ul>
  8. 8. PATIENT HOUSING AREA <ul><li>It may be devided into various cubicles as per patients requirement. </li></ul><ul><li>Room Single Bed - 120 Sq ft </li></ul><ul><li>Room Double Bed - 160 Sq ft </li></ul><ul><li>Room 4 bedded - 320 Sq ft </li></ul><ul><li>Room 6 bedded - 400 Sq ft </li></ul><ul><li>Room ICU bed - 125-150 Sq ft </li></ul><ul><li>In open ward width should be 20 ft. </li></ul><ul><li>Bed Area - 70 Sq ft </li></ul><ul><li>Space between 2 row beds - 5 ft </li></ul><ul><li>Space between 2 beds - 3 ½ to 4 ft </li></ul><ul><li>Clearance of bed head from wall 1 ft and from other bed 2 ft </li></ul><ul><li>Size of each bed 6 ½ ft x 3 ¼ ft </li></ul>
  9. 9. AUXILARY AREA AUXILARY AREA NURSING STATION PANTRY TREATMENT ROOM UNIT STORE CLEAN UTILITY ROOM & CLEAN LINEN STORE DINNING & DAY ROOM/ RECREATION
  10. 10. NURSING STATION <ul><li>Minimum area 20’ x 20 ‘ </li></ul><ul><li>Sister’s changing room and toilet </li></ul><ul><li>Cupboards for medicines </li></ul><ul><li>Hanging pockets for forms and case sheets </li></ul><ul><li>Case sheet racks </li></ul><ul><li>Table, stool, chairs </li></ul>TREATMENT ROOM <ul><li>Physical Examination </li></ul><ul><li>B.P instrument, thermometer </li></ul><ul><li>Dressing trolley, washing facility </li></ul><ul><li>Examination couch, spot light </li></ul>
  11. 11. SANITARY AREA SANITARY BATH & TOILETS (1 for 5 beds) SANITATION STORE (Brooms, mops, detergent) JANITORS ROOM (Used brooms, mops, buckets, Mugs) WASH BASIN DIRTY UTILITY ROOM (Sizzled linen, bed pan, Specimens, stool & Linen wash, urine, blood)
  12. 12. ANCILLARY AREA ANCILLARY AREA DOCTORS DUTY ROOM SISTER INCHARGE TROLLEY BAY WHEEL CHAIR, TROLLEY O 2 CYLINDERS WARD SIDE LAB. ATTENDANT ROOM STAFF CHANGING ROOM & LOCKER PATIENT LOCKER SEMINAR ROOM
  13. 13. ELECTRICITY AND WATER SUPPLY <ul><li>24 hours water supply 300 lt/ bed </li></ul><ul><li>Glare free lights, fans and suction </li></ul><ul><li>Gas pipe line connection </li></ul><ul><li>Air condition/ cooler </li></ul>
  14. 14. STAFFING Ward staffing depends on the size of the ward and criticality of patients. Specialist - 1 per 100 beds GDMO - 1 per 12 beds Sr. Resident - 1 per 12 beds Jr. Resident - 1 per 4 beds Staff Nurse - 1 per 6 beds general one/ bed critical area 1 per 4 beds teaching hospital. Sister In charge- 2 ANS - 1 Group ‘D’ Staff - 1 per 2 beds
  15. 15. WARD DESIGNING The objective of ward designing is to facilitate the nursing staff to observe each patient and keep a watch on them. DESIGNING OPEN WARD OR FLORENCE NIGHTANGLE RIG’s WARD UNILATERAL BILATERAL <ul><li>1. The beds either surround the </li></ul><ul><li>Nursing Station or on either side. </li></ul><ul><li>2. Toilets at one end and duty & </li></ul><ul><li>treatment room on other end. </li></ul><ul><li>3. Good visibility, better ventilation. </li></ul><ul><li>4. Economical & easy to construct. </li></ul><ul><li>5. Disadvantage being </li></ul><ul><li>Noisy & lack of privacy </li></ul><ul><li>Space between beds reduced </li></ul><ul><li>Obstruction in flow of trolly </li></ul><ul><li>Chances of cross infection </li></ul><ul><li>Fatigue of nurses. </li></ul><ul><li>1. Separated by low partitions to </li></ul><ul><li>Different cubicles of 4 or 6 beds </li></ul><ul><li>2. These beds may be on one side </li></ul><ul><li>Or both sides of Nursing Station </li></ul><ul><li>3. The beds can be arranged in ‘X’ shape or </li></ul><ul><li>‘ z’ shape with nursing station at centre. </li></ul><ul><li>4. Disadvantages are:- </li></ul><ul><li>Communication between nurse and </li></ul><ul><li>patient hampers </li></ul><ul><li>(ii) Direct observation not possible </li></ul><ul><li>(iii) Ward becomes longer </li></ul><ul><li>(iv) More staff required </li></ul>
  16. 16. MANAGERIAL ISSUES Day to day management of inpatient services is usually at 2 levels <ul><li>A. Doctors Level : Implementation of hospital policies is responsibility </li></ul><ul><li>Of doctor in charge. </li></ul><ul><li>Nursing Level : Sister in charge is responsible for the over all </li></ul><ul><li>`` ward management with inter departmental co-ordination. </li></ul><ul><li>Objective of the ward management is the optimum utilization of the ward resources to produce maximum out put with comfort and full satisfaction of the patient (Tangible) </li></ul><ul><li>It is a team function combining the efforts of doctors, nurses and other hospital staff to maintain continuous efficient and effective care through personal experience, training & advancement (long term). </li></ul>
  17. 17. FACTORS OF MANAGERIA ISSUE MANAGERIAL ISSUES KNOWLEDGE OF WARD DUTIES ORGANIZATION DOCTORS ORDER ESTABLISHMENT WARD ROUTINE PLANNING OF DAILY WORK SCHEDULE AND POLICY ORIENTATION OF NURSING STAFF STARTING WORK IN TIME PLANNING FOR LOGISTICS PLANNING & PREPARATION FOR OPERATIONS (Night Report, handing Taking report, specimen Collection, Nursing Care, Temp. record, teaching & Supervision)
  18. 18. MANAGERIAL ISSUES PROVISION OF SUPPLIES RECORD MAINTENANCE DUTY ASSIGNMENT TO STAFF TEACHING & SUPERVISION MAINTENANCE OF ENVIRONMENT REPORTING GOOD WORKING RELATION & TEAM SPIRIT MONITORING AND EVALUATION Adequate storage Check misuse & waste Indent & receipt Economic use Patient card, Patient record, Charts, indent & stock books Maintenance & repair Breakage, loss, condemnation Report books Privacy, noise prevention, Ventilation, temp., light, diet, cleanliness, toilets Reporting to higher Authorities Day, evening & night report
  19. 19. FUNCTION OF WARD SISTER WARD SISTER ENSURE GOOD NURSING CARE HOUSE KEEPING SANITATION DIETS IMPLEMENTING DOCTOR ADVISE CONSTANT MONITORING OF WARD FUNCTION SUPERVISION AND GUIDANCE OF OTHER STAFF ORIENTATION AND DIRECTION TO WARD STAFF
  20. 20. MANAGEMENT METHODS MANAGEMENT STATEGIC MANAGEMENT OPERATIONAL MANAGEMENT <ul><li>Ensure implementation guidelines on management issues. </li></ul><ul><li>Timely calculation of availability & procurement of logistics. </li></ul><ul><li>Setting standard of quality care. </li></ul><ul><li>Ward timings & shifts </li></ul><ul><li>Working Manual </li></ul><ul><li>Types of records to be maintained </li></ul><ul><li>Training materials of students </li></ul><ul><li>Ensuring implementation of </li></ul><ul><li>Strategic guidelines. </li></ul><ul><li>2. Good Working Environment </li></ul><ul><li>3. Patient Care & Comfort </li></ul><ul><li>4. Maintaining Efficiency & </li></ul><ul><li>effectiveness throughout </li></ul>
  21. 21. MONITORING MONITORING LEVEL PATIENT SATISFACTION MAINTENANCE OF EQUIPMENT & REPAIR LOGISTICS LEVEL EDUCATION METHODS & LEVELS HOUSE KEEPING DIETS/ INVESTIGATIONS OFF STATION ACTIVITIES/ SUPERVISION RECORD KEEPING ADMINISTRATIVE PROCESS (away from patient care) (Inter unit relation)
  22. 22. EVALUATION EVALUATION STRATEGIC ISSUES & GUIDELINES MEDICAL AUDIT BED TURN OVER RATE SUPPLIES & DISTRIBUTION EXIT INTEVIEW PERFORMANCE LEVEL OF STAFF RECORD KEEPING
  23. 23. FACTORS INFLUENCING PATIENT CARE FACTORS ATTITUDE & MOTIVATION OF STAFF LACK OF PROPER ADMN. SHORTAGE/ PILFERAGE OF LOGISTICS VISITORS & ATTENDANTS ADEQUATE CLINICAL FACILITY &SERVICE EFFECTIVE USE OF BED WORK LOAD & OVER CROWDING TOO MUCH RECORD KEEPING INTER & INTRA GROUP CONFLICTS SHORTAGE OF TRAINED STAFF EDUCATION & REORIENTATION OF STAFF
  24. 24. HOSPITAL ADMINISTRATION MADE EASY http//hospiad.blogspot.com An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. hospi ad DR. N. C. DAS

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