Hospital Training Report-I

A
PRESENTATION
A REPORT FILE OF HOSPITAL
TRAINING
(2021-2022)

Hospital Training Report
MOHAMMDABAD, FARRUKHABAD
AKARSHIT PRAJAPATI
B. PHARM IIIrd YEAR
ROLL NO.: 1908720500004
DR. OM PRAKASH SCHOOL OF PHARMACY
NISAI, FARRUKHABAD

Dr. Om Prakash School Of Pharmacy
Nisai, Farrukhabad
Certificate
This is to certify that MR. AKARSHIT PRAJAPATI is a student of B.Pharm
(IIIrd year) of Dr. Om Prakash school of Pharmacy Nisai, Farrukhabad.
They have prepared ‘A report on Hospital Training’ under the supervision of
Mr. Brajesh Kumar(Assistant Professor).
External Examiner- Supervisor
Name- Mr. Brajesh Kumar
Date- Assistant Professor
Signature- Dr. Om Prakash school of
pharmacy

Declaration
I hereby declare that the project entitled “Report on Hospital Training”,
embodies my own unaided work.
Place: Farrukhabad AKARSHIT PRAJAPATI
Date: 02/02/2022

ACKNOWLEDGEMENT
Firstly, I would like to thank the management of our institute Dr. Om Prakash
school of Pharmacy for my work.
I would also like to think our Director Mr. Alok Sir for providing his guidance
thought the work.
I would like to acknowledgement the continuous encouragement and help
extended to me by my friends for preparing this review work.
I would like to thank my teachers for providing guidance and giving the article
regarding my work.
My thanks are due to my Parents and my Family whose moral support has
been always showered upon all the steps.
Last but not the least I thank “GOD” who has patronized me with
consciousness and love to ladder the success.

LIST OF CONTENT
Certificate
Declaration
Acknowledgement
List of contents
Chapter-1 1
Chapter-2 2-3
Chapter-3 4-5
Chapter-4 6-10
Chapter-5 11-12
Chapter-6 13-15
Chapter-7 16-21
Chapter-8 22-25
Chapter-9 26-28
Chapter-10 29
BIBLIOGRAPHY
Objective of Hospital Training
Introduction to Hospital
Hospital departments
Emergency ward
General ward
Surgical ward
Pathology
Injection Room
Patient observation chart
Conclusion

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Dr. Om Prakash school of Pharmacy Page 1
Objective
 To promote scientific management of hospital and advancement of
health care so as to make it rational, responsive and cost efficient,
both to consumer and providers.
 To promote the development of high quality of hospital care in the
community and the country so as to provide a satisfactory
environment to the patient and also to the doctors for clinical
research.
 To promote a forum for exchange of ideas and information among the
health planners, academicians, administration and general public or
improvement of hospital and health services.
 To develop norms and standards for accreditation of the institute of
health care and adopt means of continuous evaluation of such
institutions so as to improve upon the quality of health care.
 To provie the opportunities for taining and research in all aspects of
hospital/health administration.
 To update the knowledge and skills of personnel involved in health
administration for the management of these institutions through
continuing education programmes.
 To create parameters of standards of teaching and training in the
field of hospital administration and accreditation of such institutions.
 To promote research in the field of hospital administration and
disseminate research findings among the users.
CHAPTER-1

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Introduction to Hospital
A hospital is basically a health care institution providing patient treatment
with specialized staff and equipments. Which is popularly Hospital is
in Mohammdabad district Farrukhabad is one of the ancient cities famous
for Carpet City in the world the biggest Leather exporter and education
Hub. It is one of the oldest government hospital of the city more than 50
years, with advancement of technology and with increasing demand of
health sector this hospital is keeping peace and fulfilling the demand of
needy people. It is equipped with modern Lab facilities, ECG, 2D, ECHO,
XRAY, ULTRASOUND 3D COLOR DOPLAR, 24 hours running.
QUALITY OBJECTIVES
 Integrate advanced nursing knowledge, ethical principles and clinical
excellence in advanced practice nursing within an area of
specialization, excellence in the pursuit of knowledge, holistic care of
the patient, and integrating the principles of common good and social
justice.
 Develop the role of the advanced practice nurse with commitment to
excellence and quality outcomes
 Utilize research and evidence to assist in the development and
validation of nursing science.
 Integrate theoretical and scientific concepts that influence leadership
in advanced practice roles consistent with education, practice and
research.
 Participate in the process of health policy development for continued
improvement of health care systems.
 Engage in lifelong learning, and the professional development of self
and others.
 Effective collaborators of healthcare committed to improving best
practices in health promotion, disease prevention, quality, safety and
equality.
 Ethically responsive nursing leaders who advocate influencing policy
decisions to improve healthcare that is effective, timely, efficient and
equitable for all members of society.
 Best quality patient care.
 Judicious use of drugs and appropriate interventions.
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 Compliance with highest standard of medical ethics.
 Carry out all processes right from the first time,
 Care compassion and courtesy,
 Efficiency-never ending improvements
 Maintenance of highest standard of hygiene and cleanliness.

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HOSPITAL DEPARTMENTS
SECTION IN SAMUDAYA SWATHYA KENDRA MOHAMMDABAD
1- OPD (Out Patient Department)
2- Emergency wards
3- General wards
4- Surgical wards
7- Pathology
8- Dispensing
9- Injection Room
10- Patient Observation Chart
APPROVALS-
 Building build under strict guidance for complete compliance of
NABH, NABL and even international approved JCI norms.
 Corporate tie up with client like CGHS,ECHS and TPA approval.
 Tie up with insurance company under approval to give maximum
advantage to the patients.
OPD (Out Patient Department)
OPD means an Out Patient Department of a hospital. It is the section of the
hospital where patients are provided medical consultations and other
allied services.
It has following parts and services-
 Consultation chambers where patients are provided medical,
surgical or allied (physiotherapy, dietetics) consultation and expert
opinion.
 Examination rooms where patients can be examined for any
disease condition.
 Diagnostics which have radiology, pathology, microbiology and
other diagnostic services and/or sample collection points
 Pharmacy which provides medications to the patients.
Other services can be part of it on need basis.
The importance of OPD is such that it is considered one of the most
valuable departments of hospital.
 It provides 30–35% of hospital revenue by ways of consultation
fees, diagnostic tests etc.
CHAPTER-3

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 It is point of entry for more than 50% of IPD patients.
 It is a screening point (triage) for patients according to treatment
need.
 It is a reflection of popularity of hospital as more popular hospitals
would have more patients coming to OPD by choice. Patients also
get the first impression of the hospital by visiting OPD.

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Emergency wards
An emergency department(ED), also known as anaccident &
emergencyDepartment (A&E),emergency room(ER )orcasualty
department.
An emergency is a medical treatment facility specializing in emergency
medicine, the acute care of patients who present without prior
appointment; either by their own means or by that of an ambulance. The
emergency department is usually found in a hospital or other primary
care center. Due to the unplanned nature of patient attendance, the
department must provide initial treatment for a broad spectrum of
illnesses and injuries, some of which may be life-threatening and
require immediate attention. In some countries, emergency
departments have become important entry points for those without
other means of access to medical care.The emergencydepartments of
most hospitals operate 24 hours a day, although staffing levels may be
viridian attempt to reflect patient volume.
Firstaid- First aid is the assistance given to any person suffering a
sudden illness or injury, with care provided to preserve life, prevent the
condition from worsening, and/or promote recovery.
Aims- The key aims of first aid can be summarized in three key points,
sometimes known as 'the three P's
Preserve life: the overriding aim of all medical care, including first aid,
is to save lives and minimize the threat of death
Prevent further harm: also Sometimes called prevent the
condition from
worsening, ordanger of further injury, this covers both external factors,
such as moving a patient away from any cause of harm, and applying first
aid techniques to prevent worsening of the condition, such as applying
pressure to stop a bleed becoming dangerous.
CHAPTER-4

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Promote recovery: first aid also involves trying to start the recovery
process from the illness or injury, and in some cases might involve
completing a treatment, such as in the case of applying a plaster to a small
wound.
Key Skills- In case of tongue fallen backwards, blocking the airway, it is
necessary to hyperextend the head and pull up the chin, so that the tongue
lifts and clears the airway.
Certain skills are considered essential to the provision of first aid
and are taught ubiquitously. Particularly the "ABC"s of first aid, which
focus on critical life-saving intervention, must be renderedbefore
treatment of less serious injuries.
ABC stands for Airway, Breathing, and Circulation. The same mnemonicis
used by all emergency health professionals. Attention must first bebrought
to the air way to ensure it is clear. Obstruction(choking) is a life-
threatening emergency.
Following evaluation of the airway, a first aid attendant would determine
adequacy of breathing and provide rescue breathing if

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necessary.Assessment of circulation is now not usually carried out for
patients who are not breathing, with first aiders now trained
to go straight to chest compressions (and thus providing artificial
circulation) but pulse checks may be done on less serious patients.
Some organizations add a fourth step of "D" for Deadly bleeding or
Defibrillation, while others consider this as part of the Circulation step.
Variations on techniques to evaluate and maintain the ABCs depend on
the skill level of the first aider. Once the ABCs are secured, first aiders
can begin additional treatments, as required. Some organizations
teach the same order of priority using the"3Bs":Breathing, Bleeding, and
Bones(or "4Bs":Breathing, Bleeding, Burns, and Bones). While the ABCs
and 3Bs are taught to be performed sequentially.
Preserving life:- In to stay alive, all persons need to have an open
airway—a clear passage where air can movein through
themouthornosethrough thepharynxand down into the lungs,
withoutobstruction.Consciouspeople will maintain their own airway
automatically, but those who areunconscious (with aGCSof less than 8)
may be unable to maintain a patent airway, as thepart of the brain
which automatically controls breathing in normal situations may not
befunctioning.
If the patient was breathing, a first aider would normally then place them
intherecovery position, with the patient leant over on their side, which
also has the effect ofclearing the tongue from the pharynx. It also
avoids a common cause of death in unconsciouspatients, which is
choking on regurgitated stomach contents. The airway can also
becomeblocked through a foreign object becoming lodged in the pharynx
or larynx, commonlycalledchoking. The first aider will be taught to deal
with this through a combination of ‘back slaps’ and ‘abdominal thrusts’.
Once the airway has been opened, the first aider would assess to see if
the patient is breathing. If there is no breathing, or the patient is not
breathing normally, such as artificial breathing, the first aider would
undertake what is probably the most recognized first aid procedure
cardiopulmonary resuscitation or CPR, which involves.
breathing for the patient, and manually massaging the heart to
promote blood flow around the body.

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Promoting recovery:-
The first aider is also likely to be trained in dealing with injuriessuch as
cuts, grazes or bone fracture. They may be able to deal with the
situation in its entirety (a small adhesive bandage on a paper cut), or
may be required to maintain the condition of something like a broken
bone, until the next stage of definitive care (usually an ambulance)
arrives.
Medical emergency
Altitude sickness- whichcan begin in susceptible people at altitudes as
low as 5,000 feet, can cause potentiallyfatal welling of the brain or lungs.
Anaphylaxis- a life-threatening condition in whichthe airway can
become constricted and the patient may go intoshock. The reaction
canbecause by a systemic allergic reaction to allergens such as insect
bites or peanuts.Anaphylaxis is initially treated with injection of
epinephrine.
Battlefieldfirst aid- Thisprotocol refers to treating shrapnel, gunshot
wounds, burns, bone fractures, etc. as seeneither in the ‘traditional’
battlefield setting or in an area subject to damage by large-
scaleweaponry, such as abombblast.
Bone fracture- a break in a bone initially treated bystabilizing the
fracture with asplint.
Burns- which can result in damage to tissues and lossof body fluids
throughthe burn site.
Cardiac Arrest- which will lead to death unless CPRpreferably
combined with an AED, is started within minutes.There is often no time
to wait forthe emergency services to arrive as 92 percent of people
suffering a sudden cardiac arrestdie before reaching hospital according
to the American Heart Association.
Choking, blockageof the airway which can quickly result in death
due to lack ofoxygenif the patient’s tracheais not cleared, for example by
theHeimlich maneuver.
Heart attack- or inadequate blood flow to the bloodvessels
supplying the heart muscle.

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Heat stroke- also known as sunstroke orhyperthermia,which tends to
occur during heavy exercise in high humidity,or with inadequate
water,though it may occur spontaneously in some chronically ill
persons. Sunstroke, especially whenthe victim has been unconscious,
often causes major damage to body systems such asbrain,kidney, liver,
gastric tract. Unconsciousness for more than two hours
usually leads topermanent disability. Emergency treatment involves
rapid cooling of the patient
Heavy bleeding- treated by applying pressure (manually andlater
with apressure bandage) to the wound site and elevating the limb
ifpossible.
Hyperglycemia(diabetic coma) andHypoglycemia(insulin shock).
Hypothermia, or Exposure- occurs when a person’s core body
temperature falls below 33.7 °C (92.6°F). Firstaid for a mildly
hypothermic patient includes rewarming, which can be achieved by
wrappingthe affected person in a blanket, and providing warm drinks,
such as soup, and high energy food, such as chocolate. However,
rewarming a severely hypothermic person could resulting a fatal
arrhythmia, an irregular heart rhythm.
Poisoning- which can occur by injection, inhalation, absorption, or
ingestion
Seizures- or a malfunction in the electrical activity in the brain.
Three types of seizures include a grand mal (which usually
features convulsions as well as temporary respiratory abnormalities,
change in skin complexion, etc.) and petit mal (which usually features
twitching, rapid blinking, and/or fidgeting as well as altered
consciousness and temporary respiratory abnormalities).
Muscle strains and Sprains- a temporary dislocation of a joint that
immediately reduces automatically but may result in ligament damage.
Stroke- a temporary loss of blood supply to the brain.
Wound sand bleeding- Including lacerations, incision sand abrasions,
Gastrointestinal bleeding, avulsion sand Sucking chest wounds, treated
with an occlusive dressing to let air out but not in.

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GENERAL WARDS
A general ward is a large room in a hospital where people who need
medical treatment stay general in the wards.
Intravenous simple mean within vein.therapies administered
intravenously are often included in the designation of specialty drugs .
Intravenous infusions are commonly referred to as drips because
many system administration employ to a drip, which prevent air from
entering the blood stream and allows as estimation of flow rate .
Intravenous therapy may be used to correct electrolyte imbalance, to
deliver medication, for blood transfusion are as a fluid replacement to
correct,for example dehydration intravenous therapy can also be used for
chemotherapy.
Compare with other route of administration, the intravenous route is the
fastest way to deliver fluids and medication throughout the body. The
bioabilability of the medication is 100% in IV therapy. During intravenous
therapy, it use are as follows:-
i) Administration of drips
Chapter-5

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ii) Administration of cannula
iii) Administration of injection
iv) Measurement of blood pressure and temperature
v) provides oxygen

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Surgical Wards
Surgical wards contain different types injured patients, accidental patient, etc.
Surgical wounds can be classified as follows-
Dressing techniques-
The following dressing techniques are easy to do and require no
sophisticated equipment. Clean technique is usually sufficient. Pain
medication may be required as dressing changes can be painful. Gently
cleanse the wound at the time of dressing change.
A.Wet-to-dry
Indication: to clean a dirty or infected wound.
Technique: Moisten a piece of gauze with solution and squeeze out the
excess fluid. The gauze should be damp, not soaking wet. Open the gauze
Photo A and place it over top of the wound to cover it Photo B. You do not
need many layers of wet gauze. Place a dry dressing over top. The dressing
is allowed to dry out and when it is removed itpulls.
How often: Ideally, 3-4 times per day. More often on a wound in need of
debridement, less often on a cleaner wound. When the wound is
clean, change to a wet-to-wet dressing or an antibiotic ointment.
Chapter-6

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B. Wet-to-wet
Indication: to keep a clean wound clean and prevent build-up of exudates.
Technique: Moisten a piece of gauze with solution and just barely
squeeze out the excess fluid so it’s not soaking wet. Open the gauze and
place it overtop of the wound to cover it. Place a dry dressing overtop.
The gauze should not be allowed to dry or stick to the wound.
How often: Ideally, 2-3 times a day. If the dressing gets too dry, poor
saline over the gauze to keep it moist.
C. Antibiotic ointment
Indication: Antibiotic ointment is used to keep a clean wound clean
and promote healing.
Technique: apply ointment to the wound- not a thick layer, just a thin
layer is enough. Cover with dry gauze.
How often: 1-2 times per day.
D. When to do which dressing
Remember, the goal is to promote healing. We know that a moist
environment facilitateshealing.
• For a clean wound, it is best to use a wet-to-wet or ointment based
dressing
• For a wound in need of debridement the wet-to-dry technique
should be done until the wound is clean and then change to a different
dressing regimen.
Sharp Debridement:
When a wound is covered with black, dead tissue or
thick gray/green debris, dressings alone may be inadequate. Surgical
removal- sharp debridement– is necessary to remove the dead tissue to
allow healing.
Technique:-
Sedation or general anesthesia may be required. However, usually the dead
tissue has no sensation, so debridement may be done at the bedside or in
the outpatient setting.

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Photos A & B: Using a forceps, grasp the edge of the dead tissue and use a
knife or sharp scissors to cut it off of the underlying wound.
Bleeding tissue is healthy, so cut away the dead stuff until you get to a
bleeding base.
may have to do this a little at a time, and repeat this procedure as needed
until all of the necrotic tissue has been removed.
Photo C shows the wound after three weeks of wet-to-dry dressings.

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PATHOLOGY
Pathology is the branch of medical science primarilyconcecerning the
examination of organ, tissue and bodily fluids in order to make a diagnosis
of disease.
Hospital pathology concerns the laboratory analysis of blood, urine and
tissue sample to examine and diagnose disease.typically ,laboratories will
process samples and provides result concerning blood counts, blood
clotting ability or urines electrolytes.
In Pathology Lab , Blood Test Report:-
Blood tests allow a doctor to see a detailed analysis of any disease
markers, the nutrients and waste products in your blood as well as how
various organs (e.g., kidneys and liver) are functioning. Below, I’ve
explained some of the commonly measured indicators of health. During
a physical examination, your doctor will often draw blood for chemistry
and complete blood count (CBC) tests as well as a lipid profile, which
measures cholesterol andrelated elements. Here is a brief
explanation of the abbreviations used in measurements followed by
descriptions of several common test components.
Deciphering Blood TestMeasurements:-
Blood tests use the metric measurement
system andabbreviations such as the following:-
§ cmm-----------------cells per cubic millimeter
§ fL (femtoliter)-----fraction ofone-millionth of a liter
§ g/dL-----------------grams per deciliter
§ IU/L-----------------international units per liter
§ mEq/L---------------mille equivalent per liter
§ mg/dL----------------milligrams per deciliter
§ mL--------------------milliliter
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§ mmol/L--------------mill moles per liter
§ ng/m------------------Lnanogramspermilliliter
§ pg(Pico grams)-------one-trillionth of a gram
Complete Blood Count (CBC):-
The CBC test examines cellular elements in the blood, includingred blood
cells, various white blood cells, and platelets. Here is a list of the
components thatare normally measured, along with typical values. If your
doctor says you’re fine butyourtests results are somewhat different from
the range shownhere, don’t be alarmed.
Some labs interpret test results a bit differently from others, so
don’t consider thesefigures absolutes.
WBC (white blood cell) leukocyte count Normal range: 4,300 to
10,800cm
White blood cells help fight infections, so a high white blood cell
count could be helpfulfor identifying infections. It may also indicate
leukemia, which can cause an increase in thenumber of white blood cells.
On the other hand, too few white blood cells could be caused by certain
medications or health disorders.WBC (white blood cell) differentialcount
Normal range:
§ Neutrophils ------40% to 60% of the total
§ Lymphocytes ----20% to 40%
§ Monocytes--------2% to8%
§ Eosinophils ------1% to 4%
§ Basophils---------0.5% to 1%
This test measures the numbers,shapes, andsizes of various types of
white blood cells listed above. The WBC differential count also showsif the
numbers of different cells are in proper proportion to each other.
Irregularities inthis test could signal an infection, inflammation,
autoimmune disorders, anemia, or otherhealth concerns.
RBC (red blood cell) erythrocyte countNormal range: 4.2 to 5.9
million cm ,We
have millions of red blood cells in our bodies, and this test measures
the number ofRBCs ina specific amount of blood. It helps us determine
the total number of RBCs and givesus an idea of their lifespan, but it

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does not indicate where problems originate. So if thereare
irregularities, other tests will be required.Hematocrit (Hct)Normal
range: 45% to 52% for men; 37% to 48% for womenUseful for
diagnosing anemia, this test determines how muchof the total blood
volume in the body consists of RBC Hemoglobin (Hgb)Normalrange:
ü 13 to 18 g/dL for men
ü 12 to 16 g/dL for women
Red blood cells contain hemoglobin,which makes blood bright red.
More importantly, hemoglobin delivers oxygen fromthe lungs tothe
entire body; then it returns to the lungs with carbon dioxide, which we
exhale. Healthyhemoglobin levels vary by gender. Low levelsof
hemoglobin may indicate anemia.
Mean corpuscular volume (MCV)
Normal range: 80 to 100 femtolitters
This test measures the averagevolume of red blood cells, or the average
amount of space each red blood cell fills.
Irregularities could indicate anemia and/or chronic fatigue syndrome.
Mean corpuscularhemoglobin (MCH)
Normal range: 27 to 32 Picograms
This test measures the average amountof hemoglobin in the typical red
blood cell. Results that are too high could signal anemia,while those too
low may indicate a nutritional deficiency.
Mean corpuscular hemoglobinconcentration (MCHC)
Normal range: 28% to 36%The MCHC test reports the
averageconcentration of hemoglobin in a specific amount of red blood
cells. Here again, we arelooking for indications ofanemia if the count is
low, or possible nutritional deficiencies if it’shigh.
Red cell distribution width (RDW or RCDW)
Normal range: 11% to 15%With this test, weget an idea ofthe shape
and size of red blood cells. In this case, “width” refers to ameasurement
of distribution, not the size of the cells. Liver disease, anemia,
nutritionaldeficiencies, and a number of health conditions could cause
high or low RDW results.
PlateletcountNormal range:150,000 to 400,000 mLPlatelets are small

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portions of
cells involved inblood clotting. Too many or too few platelets can affect
clotting in
different ways. Thenumber of platelets may also indicate a health
condition.
Mean Platelet Volume (MPV)Normalrange: 7.5 to 11.5
femtolitersThis test
measures and calculates the average size ofplatelets. Higher MPVs
mean theplatelets are larger, which couldput an individual at risk fora
heart attack or stroke. Lower MPVs indicate smaller platelets, meaning
the person is atrisk for a bleeding disorder.
AST (aspartate aminotransferase)Healthy range:10 to 34 IU/LThis
enzyme
is found in heartand liver tissue, so elevations suggest problems may be
occurring in one or both of thoseareas.
Bilirubin, Healthy range: 0.1 to 1.9 mg/dLThis provides information
about liver
andkidney functions, problems in bile ducts, and anemia.
BUN (blood urea nitrogen)Healthy range:10 to 20 mg/dL.This is
another measure
of kidney and liver functions. High values mayindicate a problem with
kidney function. A number of medications and a diet high inproteincan
also raise BUN levels.
BUN/ creatinine ratioHealthy ratio of BUN to creatinine: 10:1 to
20:1 (men and older individuals may be a bithigher)This test shows if
kidneys are eliminatingwaste properly. Highlevels of creatinine, a by-
product of muscle contractions, are excretedthrough the kidneys and
suggestreduced kidney function.
Calcium, Healthy range: 9.0 to 10.5mg/dL (the elderly typically score a
bit lower)Too
much calcium in the bloodstream couldindicate kidney problems;
overly active thyroid or parathyroid glands; certain types ofcancer,
including lymphoma; problems with the pancreas; or a deficiency of
vitamin D.

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Chloride, Healthy range: 98 to 106 mEq/LThis mineral is often
measured as part of
anelectrolyte panel. A high-salt diet and/or certain medications are
often responsible forelevations in chloride. Excess chloride may
indicate an overly acidic environment in the body.It alsocould be a red
flag for dehydration, multiple myeloma, kidney disorders, or
adrenalgland dysfunction.CreatinineHealthy range 0.5 to 1.1 mg/dL for
women0.6 to 1.2 mg/dL formen (the elderly may be slightly lower)
The kidneys process this waste product, so elevationscould indicate a
problem with kidney function.
Fasting glucose (blood sugar), Healthy range: 70to 99 mg/dL for the
average
adult (the elderly tend to score higher even when they
arehealthy)Blood sugar levels can be affected by food or beverages you
have ingested recently,your current stress levels, medications you may
be taking, and the time of day. Thefastingblood sugar test is done after
at least 6 hours without food ordrink other thanwater.
Phosphorus, Healthy range: 2.4 to 4.1 mg/dLPhosphorus plays an
important role in
bonehealth and is related to calcium levels. Too much phosphorus
could indicate a problem withkidneys or the parathyroid gland. Alcohol
abuse, long-term antacid use, excessive intake ofdiuretics or vitamin D,
and malnutrition can also elevate phosphorus levels.
Potassium, Healthyrange: 3.7 to 5.2 mEq/LThis mineral is essential for
relaying
nerve impulses, maintainingproper muscle functions, and regulating
heartbeats. Diuretics, drugs that are often takenfor high blood
pressure, can cause low levels of potassium.
Sodium, Healthy range: 135 to 145mEq/LAnother member of the
electrolyte family,
the mineral sodium helps your body balancewater levels and helps with
nerve impulses and muscle contractions. Irregularities in sodiumlevels
may indicate dehydration; disorders of the adrenal glands; excessive
intakeof salt,corticosteroids, or pain-relieving medications; or problems
with the liver or kidneys.
LipidPanel (or Lipid Profile), The lipid panel is a collection of tests

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measuring
different typesofcholesterol and triglycerides (fats) in your
bloodstream.

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INJECTION ROOM
In a word, an injecting room is a place where drug users can inject
narcotic substances in a supervised environment without risking police
interference. But services provided by injecting rooms can also
be expanded to include hygiene-enhancing information, offering
clean injection equipment, the presence of trained health workers and
injection advice. When the setting up of injecting rooms is discussed in
Norway, what is meant is specially outfitted rooms either standing alone
or as part of a wider activity and/or care service for drug users, where
heroin users can inject under the supervision of trained health staff and
where guidance and advice is readily available. ‘Health room’ may
therefore be a more apt designation of the possible future function of this
initiative, and, in the Norwegian debate, the two names are used more or
less in equal measure. One essential precondition underlying the
establishment of injecting/ health rooms is that the people who make use
of them shall avoid risk apprehension by police authorities in connection
with the injection process (possession and use of drugs).
INTRAVASCULAR:-
Placing a drug directly into blood stream;-May be intravenous (into a
vein) or intra-arterial (into an artery).Drug solution in injected directly
into the lumen of a vein so that it is diluted in the venous blood. The drug
is carried to the Heart and circulated to the tissues.
Drugs in oily vehicle or those that cause haemolysis should not be given by
this route.Since the drug is introduced directly into blood, the desired
concentration of the drug is achieved immediately which is not possible by
CHAPTER-8

[HOSPITAL TRAINING]
any other procedure. This route is of prime importance in emergency. Also
certain irritant drugs could be given by this route.
Advantages- precise, accurate and immediate onset of action ,100%
bioavailability
Disadvantages: risk of embolism, high concentration attained rapidly
leading to greater ,risk of adverse effect.
INTRAMASCULAR (I.M.)-In humans, the best site is deltoid muscle in the
shoulder or the gluteus muscle in the buttocks. This method is suitable for
the irritating substances that cannot be given by subcutaneous route.
The speed of absorption from site of injection is dependent on the
vehicle used, absorption is quick from aqueous solutions and
slow from oily preparations. Absorption is complete, predictable and
faster than subcutaneous route.
Advantages- Suitable for injection of drug in aqueous solution ( rapid
action) and drug in suspension or emulsion (sustained release )
Disadvantages- pain at the site of injection

[HOSPITAL TRAINING]
SUBCUTANEOUS ROUTES:-( Under the skin)
The drug is dissolved in a small volume of vehicle and injected beneath the
skin from where the absorption is slow and uniform. Substances causing
irritation to the tissues should not be injected otherwise they will cause
pain and necrosis (deadening of tissues) at the site of injection.
This method is particularly useful when continuous presence of the drug in
the tissues is needed over a long period. The usefulness of this method is
enhanced by the use of depot preparations from which the drug is released
more slowly than it is from simple solution rosis (deadening of tissues) at
the site of injection. e.g. insulin
INTRADERAMAL ROUTE:-(into the skin )
Drug are injected into papillary layer of skin. For example tuberculin
injection for mantoux test and BCG vaccination for active immunization
against tuberculosis.BCG: Bacillus-Calmette-Guerin.
INTRATHECAL ROUTE (into the spinal canal )-
Blood brain barrier often prevents the entry of certain drugs into the
central nervous system. Also the blood CSF barrier prevents the
approach of drugs to the meninges. Thus when local and rapid effects
of drugs on meanings are desired the drugs are injected into
Subarachnoid (between arachnoids smater and parameter) space and
effects of the drugs are then localized to the spinal nerves and meninges
e.g. intrathecalinjection of streptomycin in tuberculosis and meningitis
used to be used by this route but with the invention of third generation
cephalosporin’s it is not used any more to treat these conditions. The
injection of local anesthetics for the induction of spinal anesthesia is
given by this route.(the three membranes covering the brain and
spinal cord from outside to inward are Duramater, arachnoids mater and
piamater) e.g. sinalanesthetics.
INTRAPERITONEAL ROUTE ( into the peritoneum cavity)-

[HOSPITAL TRAINING]
The peritoneum offers a large absorbing surface area from which drugs
enter circulation rapidly but primarily by way of portal vein. Hence First-
Pass effect not avoided. This is probably the most widely used route of
drug administration in laboratory animals. In human, it is very rarely
employed due to the dangers of infection and injury to viscera and blood
vessels. e.g. peritoneal dialysis in case of renal insufficiency.

[HOSPITAL TRAINING]
PATIENT OBSERVATION CHART
Monitoring and documenting physiological observations is a key
component of recognition and response systems. An observation and
response chart is a document that allows the recording of patient
observations, and specifies the actions to be taken in response to
deterioration from the norm. The purpose of these charts is to support
accurate and timely recognition of clinical deterioration, and prompt action
when deterioration is observed. The way in which observation charts are
designed and used can contribute to both the poor recording of
observations and failure to interpret them correctly.
Observation and response charts should-
 be designed according to human factors principles
 have the capacity to record the core physiological observations
specified in Element 1.6 of the National Consensus Statement
(respiratory rate, oxygen saturation, heart rate, blood pressure,
temperature and level of consciousness)
 specify the physiological parameters and other factors that trigger an
escalation of care
 Specify the actions required when care is escalated.
Five track and trigger observation and response charts (ORCs) designed
using human factors principles are available from the Commission.
 ADDS chart with blood pressure table 2012
 ADDS chart without blood pressure table 2012
 Single parameter system with four response categories 2012
 Single parameter system with two response categories 2012
 Single response system with two response categories adapted for day
procedure services 2012
The clinical and organisational aspects of the observation and response
charts need to be customised for local use. The PDF files of the observation
charts are not modifiable. Facilities will need access to the InDesign
program to make the required modifications to the charts. The
InDesign files are available on request so that individual facilities can
modify the charts for local use.
It is important to note that the Commission does not recommend making
changes to the design features of the charts. These charts have been
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[HOSPITAL TRAINING]
designed with the benefit of human factors expertise to ensure they are
user friendly, and fit for the purpose of supporting accurate and timely
recognition of clinical deterioration.
It is imperative to read the ORC fact sheets below prior to making
modifications and implementing a chart.
 EE1 ORC1 fact sheet: Introducing an observation and response chart
 EE1 ORC2 fact sheet: Modifying the observation and response chart
for local use
 EE1 ORC3 fact sheet: Potential practice changes associated with
implementing an observation and response chart
 EE1 ORC4 fact sheet: Training clinicians to use the observation and
response charts
 EE1 ORC5 fact sheet: Why is it crucial to test any non-approved ORC
modifications
 EE1 ORC6 fact sheet: How to conduct a behavioural study to test
chart modifications
Using the observation and response charts
One of the developmental criteria in National Safety and Quality Health
Service Standard 9: Recognising and Responding to Clinical Deterioration
in Acute Health Care is that when using a general observation chart, it is
designed according to human factors principles. If acute health facilities are
not using a state-wide observation chart, or one of the Commission
observation and response charts, then to meet this criteria they must
demonstrate that any non-approved modifications have been formally
tested to assess potential risks. See EE1 ORC2 fact sheet Modifying the
observation and response chart for local use (PDF 215KB) for a list of
approved modifications.
Facilities are responsible for evaluating their systems to ensure that trigger
thresholds, parameters, and responses are safe for use in the population of
patients for whom they provide care. An escalation mapping exercise
should be done to identify the parameters, thresholds, levels of
abnormality, and responses that will be included in the recognition and
response systems. The Commission has developed an escalation mapping
tool (PDF 290 KB). A worked example of the escalation mapping tool (PDF
452 KB) is also available.
There is little evidence regarding ideal trigger thresholds for use in

[HOSPITAL TRAINING]
recognition and response systems. The clinical parameters and trigger
thresholds included on the Commission observation and response charts
have been subject to review by the program’s Advisory Committee. Trigger
thresholds may need to be adjusted by some hospitals in order to increase
their specificity. Response actions included on the charts are generic
placeholders only and must be altered to provide clear and specific local
guidance on the process for escalating care.
In addition, it is necessary for hospitals and health services to ensure that
any action taken to change their existing observation charts are consistent
with state or territory decisions or programs. For example, in NSW, use of
the Between the Flags Standard Adult General Observation Chart is
required in most public facilities.

[HOSPITAL TRAINING]
Conclusion
The project Hospital Training is the working in a hospital. The process
takes care of all the requirements of an average hospital and is capable
to provide easy and effective storage of information related to patients
that come up to the hospital.
It generates test reports; provide prescription details including various
tests, diet advice, and medicines prescribed to patient and doctor. It
also provides injection detail and billing facility on the basis of patient’s
status whether it is an indoor or outdoor patient.
The system also provides the facility of backup as per the requirement.
Patients who are non-local language speakers or come from migrant
populations or ethnic minority groups often are not able to
communicate effectively with their clinicians to receive complete
information about their care. At the same time, clinical staff is often not
able to understand the patients’ needs or to elicit other relevant
information from the patient.
Professional interpreter services should be made available
whenever necessary to ensure good communication between non-local
language speakers and clinical staff.
The task force brings together practitioners, managers, scientists
and community representatives with specific expertise and competence
in policy-relevant knowledge in thefield.
CHAPTER-10

Hospital Training Report-I

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