training of medical personnel and ensuring their quality assessment system for medical practice .
how to achieve accreditation nationally and international
Compensation plan for a small hospital (csd project)Sufi Nouman Riaz
developing a compensation or pay structure for a small hospital that is comprising of at least 50 employees.
the hospital that is selected is "healer's center".
intro+job descriptions+pay structure+additional benefits.
worthy contribution from different presenters.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. •An Intensive Care Unit is a specially staffed and
equipped, separate area of the hospital dedicated to the
management of patients with life-threatening illnesses,
injuries and complications, and monitoring of potentially
life-threatening conditions, operating in cooperation with
other departments integrated in a hospital.
5. Determine minimal training requirements for
physician.
Determine minimal training requirements for
nurses.
Determine duration of training.
Develop continuous education program.
In services education for new equipments and
procedures.
TRAINING
6.
7. •
State or quality of being adequately or “well qualified” to
perform a specific role.
1) Training/Education
• Medical School
• Residency/Fellowship
• Continuing Medical
Education
2) Certification
• Board Certification
• Maintenance of
Certification
3) Public Reporting of
Outcomes
Assessing Clinical Competence:
CLINICAL COMPETENCE
8. Airway
• Assessment and maintenance of the
airway including an unexpected
difficult intubation
• Endotracheal intubation
• Replacement of a preexisting
tracheostomy tube
Breathing
• Ventilation by bag and mask
• Application of conventional positive
pressure mechanical ventilation
• Application of non-invasive ventilation
• Use of advanced ventilation
techniques excluding those listed as
non-core
• Special gas admixture administration
(heliox, NO)
• Fiberoptic bronchoscopy in the
intubated patient
• Thoracocentesis
• Thoracostomy tube insertion
Circulation
• Placement of arterial lines
Placement of central venous lines
• Utilization, zeroing and calibration of
transducers
• Application and maintenance of pulmonary
artery catheter
• Cardiac output measurements and other
derived calculations from pulmonary artery
catheter
• Electrocardiogram (ECG) interpretation
• Defibrillation
• Elective cardioversion
• Cardiac overdrive pacing
• Temporary transvenous pacemaker
• Temporary transcutaneous pacemaker
• Pericardiocentesis
9. Central Nervous System (CNS)
Declaration of brain death
Lumbar puncture
Monitoring the degree of neuromuscular
blockade with peripheral nerve stimulation
Renal
Insertion of a temporary hemodialysis
catheter
Management of continuous renal
replacement therapy
Gastrointestinal
•Intra-abdominal pressure monitoring
•Peritoneal tap
Nutrition
Determination of a nutrition plan including
TPN Transport
Transport
Organization and supervision of the
transport of critically ill patients
Neurocritical core privileges:
• Management of thrombolytic therapy.
• Management of patients after peripheral
and cerebral endovascular procedures.
• Management of cerebral perfusion
pressure.
10. Effectiveness: the effect of
care on Mortality and Health.
QUALITY
Efficiency: The effect per unit
cost.
Satisfaction: Acceptability of the
patients, their relatives and staff,
including the ability to meet external
demand.
Continuity
Staff satisfaction
Safety
Availability
(Access to
service)
Customer satisfaction
Time
management
11. • Accreditation is an integral part of quality and it is not a one time
process.
• Quality team was found to allow management towards quality and
accreditation.
• Necessity of maintaining continous quality after accreditation:
If the standards are not maintained as they were at time of
accreditation, the quality care will suffer and the license will be
cancelled by the accreditation agency.
12. • Patient care in the icu is related to patient satisfaction so
questionnaire on satisfaction was filled by patients/ relatives.
• Prepared checklist for surprise check for the icu and the staff
whether they are following the criteria of care or not.
13.
14. A CHECKLIST is prepared for surprise check of the icu to check whether the staff were
following the criteria or not:
• The standards of checklist are:
Documented polices and procedures guide the care of patients requiring cardiopulmonary
resuscitation.
Documented procedure guides the performance of various procedures.
Documented polices and procedures guide the care of patients in the icu and high dependency
units.
Documented polices and procedures guide the care of patients requiring appropriate pain
management.
Documented polices and procedures guide the end of life care.
Hospital infection protocol: the infection control program is supported by the management and
includes training of the staff.
15.
16. • Quality indicators- quality assurance in
the icu:
1. To maintain high standard of hygiene and
cleanliness.
2. To prevent hospital acquired infection.
3. Morbidity and Mortality.
4. Incidence Reporting.
5. Daily maintenance/ checking of vital
equipment.
6. Priority of patient comfort and home
feeling.
7. Staff professionalism and looking.
• Quality indicators examples in the icu:
1. Needle stick injury (NSI).
2. Central line associated blood stream
infection (CRBSTI).
3. Incidence of pressure sores.
4. Catheter associated urinary tract infection
(CAUTI).
5. Ventilator associated pneumonia (VAP)
6. Surgical site infection (SSI).
7. Fall rate.
8. Reintubation rate within 48 hours of
intubation.
9. Return to the icu within 48 hours of
discharge.
17. • Needle stick injury:
No of NSIs reported in a month / total no of inpatients days in a
month ☓ 100
• Central line associated blood stream infection (CRBSTI):
No of central line associated blood stream infections in a month / no
of central line days in a month ☓ 100
• Incidence of pressure sores:
No of incidence of pressure sores developed after admission to the
hospital / patient days ☓ 100
18. • Catheter associated urinary tract infection:
No of CAUTI / no of catheter days ☓ 100
• Ventilator associated pneumonia:
No of VAP / no of ventilator days ☓ 100
• Fall rate:
No of episodes of fall of patients without injury / total no of patients
discharged-death ☓ 100
19. • Reintubation rate:
Reintubation leads to prolonged stay, longer ventilation and higher
nosocomial infection.
No of patients reintubated / no of patients extubated ☓ 100
• Rate of return to icu within 48 hours:
No of cases returning to icu within 48 hours / no of patients shifted
out from the icu in a month ☓ 100
• Surgical site infection (SSI)
• No of SSI cases / total no of surgeries ☓ 100
20. • An clinical quality
SCORECARD
(specifically designed
for utilization in the
ICU) is designed to
see the impact on
various performance
metrics for ICU
attending physicians
and nurses.
36. • Teamwork in the intensive care unit (ICU) refers to the
leadership, decision-making, communication, and
coordination behaviors used by multidisciplinary team
members to provide patient care.
PLANNING TEAM
37. • The planning phase of a new ICU is organized by a multidisciplinary team
including, at least:
✻The director of the future ICU.
✻A representative of the medical staff.
✻The head nurse.
✻The architect.
✻A representative of the hospital management.
✻An engineer.
✻Safety officer.
✻The hospital infection control specialist.
✻Representatives of referring medical and surgical departments in the hospital.
✻A representative of a patients’ association participation should be considered.
PLANNING TEAM
38. Organization and responsibilities:
• Intensive care medicine is the result of close cooperation among doctors,
nurses, and allied health care professionals (AHCP).
• An efficient process of communication has to be organized between the
medical and nursing staff of the ICU.
o Poor communication during rounds and handovers (or handoffs) is a cause of medical error.
o Units with high levels of nurse-doctor collaboration have improved patient mortality rates and
reduced average patient length of stay.
• Tasks and responsibilities have to be clearly defined.
PLANNING TEAM
39. • Staff meetings together with physicians, nurses, and AHCP must be
regularly organized in order to carry out the following:
– Discuss difficult cases and address ethical issues.
– Present new equipment.
– Discuss protocols.
– Share information and discuss organization of the ICU.
– Provide continuous education.
PLANNING TEAM
40. Polices and procedures
• Standard treatment protocol to be followed.
• Silence to be observed
• All new admission/ discharge to be informed to the icu in charge
• All admissions/ discharge to be registered.
Staff standing order
• Proper joining at the time of the shifts.
• Daily round of the physician and icu team to take decision for change of
plan or treatment.
• Instructions and maintenance of input and output chart.
• Cleaning and maintenance of equipments.
• Checking and replacement of essential drugs.
41. • Daily rounds
Formal daily rounds are organized to give information and
plan therapy.
All ICU health professionals involved in direct patient care
should participate in these rounds.
42. Treatment policy
• Responsibility lies with the charge of unit admitting the case.
• No direct admission to icu but transferred from unit.
• 20% of icu beds to be vacant for emergency admission.
• Admission only on recommendation of the icu director subjected
to available bed.
• A vacant bed is allocated in original ward for patient return.
• Continuity of treatment is per view of icu in charge in consultation
with unit in charge.
45. • Each ICU must have a MEDICAL DIRECTOR= SPECIALIST STAFF
• Who takes overall responsibility for the operation of the Unit.
• Has the sole administrative and medical responsibility for this unit and cannot hold
top-level responsibilities in other departments or facilities of the hospital.
• The specialist provides patient management, administration, teaching, research, audit and ICU
based activities inside and outside of the ICU as required.
46. • The head of the ICU should be a Fellow of the College and a senior accredited
specialist in intensive care medicine as defined at country level, usually with a
prior degree in anesthesiology, internal medicine, or surgery and have had a
formal education, training, and experience in intensive care medicine.
• The director-specialist professional activities (administrative and medical
management of the unit) are devoted full-time (full time comitment) or at least
75% of the time to intensive care.
• The consultant should provide reasonable working hours and leave.
(The ICU roster must allow reasonable working hours and leave.)
47. • In smaller ICUs, there must be at least one specialist rostered to the
unit at all times.
• In larger ICUs, more than one specialist should be rostered to the Unit
(one per pod of 8-15 beds).
49. MEDICAL STAFF MEMBERS:
• They assist the head of the ICU.
• Are experienced physicians certified and qualified in intensive care
medicine.
• They define admission and discharge criteria and carry the
responsibility for diagnostic and therapeutic protocols in the ICU.
• The regular medical staff members of the ICU treat patients with
consultation of the specialists in different medical, surgical, or
diagnostic disciplines whenever necessary.
50. • An important task is to supervise and teach the doctors in training
in training centers.
• The number of staff required will be calculated according to the
number of beds in the unit, number of shifts per day, desired
occupancy rate, extra manpower for holidays and illness, number
of days each professional is working per week, and the level of
care and as a function of clinical, research, and teaching workload.
• Extended work shifts have been shown to negatively impact the
safety of patients as well as medical staff.
51. • Duties and services outside of the ICU:
Such as emergency response (e.g. rapid response teams) and
outreach services.
Must be staffed by personnel additional to those required for
managing patients within the ICU.
Must not compromise care of patients within the ICU.
Resources for these activities must be provided.
52. • There must be at least one other REGISTERED MEDICAL
PRACTITIONER with an appropriate level of experience rostered to
the ICU at all times.
• These medical practitioners must have appropriate orientation and
training and be competent in providing advanced life support.
54. NURSING STAFF:
• Should be formally trained in intensive care medicine and
emergency medicine.
• The head nurse has experience and is in charge of education and
evaluation of the competencies of the nurses.
• Division 1 registered nurses (RN) are responsible for direct patient
care. any activities that involve direct contact with the patient.
• Enrolled nurses (Division 2 RNs) (PRN) may be allocated duties to
assist registered nurses.
55. • There should be a designated senior nurse in charge of each ICU with
a post-registration qualification in intensive care.
• All registered nurses must be competent in providing advanced life
support and undertake refresher training annually.
• In addition to clinical expertise, some nurses may develop specific
skills (e.g., human resource management, equipment, research,
teaching new nurses).
56. • The appropriate nursing staff: patient ratio and the total number of
nursing staff required by each unit depends on: many variables such
as the total number of patients, severity of illness of patients,
methods of rostering, as well as individual policies for support and
monitoring in each unit.
• In morning administrative shifts, there should be an increase of 25-
30% in the nursing number.
57. • The Australian College of Critical Care Nurses (ACCCN) guidelines
require a minimum of 1:1 for ventilated and other critically ill
patients, and 1:2 nursing staff for lower acuity patients (clinically
determined).
• 1:3 and 1:4 in intermediate care units.
• Greater ratios may be required for patients requiring complex
management.
58. HEAD NURSE:
• A dedicated, full-time experienced nurse with post registration qualification,
who is responsible for the functioning and quality of the nursing care.
• Should be supported by at least one deputy head nurse able to replace him
(her).
• The head nurse should ensure the continuing education of the nursing staff.
• Head nurses and deputy head nurses should not normally be expected to
participate in routine nursing activities.
• The head nurse works in collaboration with the medical director, and together
they provide policies and protocols, and directives and support to the team.
59. NURSES IN TRAINING:
• Nurses in specialty training for intensive care and emergency
nursing must be trained in ICUs under the supervision of sufficient
training personnel.
• They should not be seen as substitute for regular intensive care
nursing staff but may be gradually assigned to patient care
according to their actual level of training.
60. ALLIED HEALTH CARE PERSONNEL:
• PHYSIOTHERAPISTS:
One physiotherapist with dedicated training and expertise in critically ill patients
should be available per five beds for level III care on a 7 day/week basis.
• TECHNICIANS:
Maintenance, calibration, and repair of technical equipment in the ICU must to
be organized. This facility can be shared with other departments of the hospital
but a 24-h availability has to be organized with priority for the ICU.
• INFECTION CONTROL SPECIALIST.
61. • RADIOLOGY TECHNICIAN:
Should be on call around the clock. Interpretation of the medical imaging by the
radiologist must be available at all times.
• CLINICAL PHARMACIST:
Should be available to consult during normal working hours.
A sufficient collaboration with pharmacy is of particular importance with respect
to patient safety.
• EQUIPMENT- SAFETY OFFICER:
Larger ICUs should have an equipment officer to coordinate and oversee the
selection, maintenance of equipment and disposables for the Unit.
62. • DIETICIAN:
Should be on call during normal working hours.
• SPEECH AND LANGUAGE THERAPIST:
Should be available to consult during normal working hours.
• PSYCHOLOGIST:
Should be available to consult during normal working hours.
• OCCUPATIONAL THERAPIST:
Should be available to consult during normal working hours.
63. • CLEANING PERSONNEL:
- A specialized group of cleaning personnel familiar with the ICU environment
should be available for the ICU.
- They should be familiar with infection control, prevention protocols, and hazards
of medical equipment.
- Cleaning and disinfection of the patient areas are performed under the nurse’s
supervision.
- A checklist of the cleaning status must be kept.
- Regular updates should be provided to ensure cleaning protocols reflect best
practice.
Editor's Notes
ايه الفرق بين الصورة الاولانية و التانية هي محاضرة النهارده.. هي ال ستاندارد هي ال كواليتي هي الاكريديتيشن هي النظام و هي الفرق بين النجاح و الفشل ولو حد قال انها مشكلة امكانيات فالامكانيات جزء لكن لما تعمل عملية ويبل مدتها 10 ساعات و تستهلك فيها ستاف تخدير و ستاف جراحه و تمريض و غرف عمليات و تخرج المريض علي عناية يتحط فيها علي سرير مش بيتجرد بطريقة صح لو خدت منه سواب هتلاقي سودوموناس و كليبسيلا العيان يطلع يوم والتاني كويس علي ما الميكروب يدخل جسمه اليوم التالت يسخن و يدخل في سيبسيس يبقي انت ضيعت كل محهودك و حدث ولا حرج لانك عالاقل لم تحسن ما في ايدك من امكانيات عشان تطلب المزيد
و بما ان كلامنا عن العناية المركزة فبالتبعية تعريف وحدة العناية المركزة
الالجوريزم بسيط لكن تطبيقه صعب .. حضرتك عايز توصل للaccreditation هتطبق ال كواليتي علي المنشأه و ال تريننج علي الأشخاص لما تخلص هتعمل لنفسك ايفالويشن لو نجحت فيه هتسجل نفسك و تطلب الاعتماد ال اكريديتيشن تعالوا نتكلم علي كل واحدة لوحدها
خمس نقط يحددولك عنصر التدريب لازم تحددهم .... اقل تدريب لاخصائي العناية 4 سنين مثلا يكون فيهم عمل المانيوالز الفلانيه كام مرة باللوج بوك و شاف كام حالة ام اي و كده .... نفس الكلام بالنسبة للتمريض و نفس الكلام .. وتصمم نظام تعليمي مستمر يربط الاجيال و كمان يجهزهم لاستيعاب الامكانيات الجديدة والاجهزة
طب هل التدريب بيفرق .. عملوت درراسة في 2017 في الهند عن لو عملوا نظام تدريبي مصمم جيدا و طبقوه في الاماكن قليلة الامكانيات هيلاقوا فرق ووجدوا في فرق كبير مقارنة بغيرهم
طيب هدف الترينينج ده ايه هدفه انه يديني طبيب competent يعني ايه كومبيتينت يعني التعريف و ده بقيمه عن طريق تلت حاجات اتعلم و اتدرب – خد شهادات – ساهم في النشر و البحث و الانتاح المجتمعي
و عشان احدد انه كومبيتينت لازم طبيب العناية يكون عنده هذه المهارات ة
تاني عنصر في المنظومة للوصول للاعتماد بعد التدريب للاشخاص فهو ال كواليتي للمكان و تنظيم العمل و ده بيشتمل علي سبع عناصر رئيسة نجاحك في كل عنصر منهم يوصللك في النهاية للجودة الي تؤهلك للاعتماد ونقولهم بعد كده نفسرهم .....
مثال بسيط مريض عايز يعمل قسطرة علي القلب فانت هتقوله انك عندك السبع عناصر دول و بناء عليه انا عندي جودة كويسه اول ززززززز
و اهمية ال satisfaction score انه ممكن يديك صورة مختلفة تماما عن الشغل ابسط شيء نقطة دم علي السرير ... انت باصص للمريض بمنظور طبي و الاعتماد غير مقتصر علي منظور طبي فقط
وبالتالي عشان نحسن الجودة محتاجين نحدد لكل شيء داخل الوحدة شيك ليست
هنا تقول موضوع المونيتور مفصول و العيان ميت
الاسكور كارد ده حاجه مرهقة بالنسبة للطبيب الي بيعتبرها dirty paperwork الي اشتغل في اي مكان بيسعي للجوده و الكواليتي بيلاقي مسءولة الجوده بتحطلة خمس ست ورقات يملاهم عن العيان و بتراحعهم وراه كل يوم بالرغم من ان دي حاجه اساسية ومهمة في التوثيق لكل شيء
الالجوريزم بسيط لكن تطبيقه صعب .. حضرتك عايز توصل للaccreditation هتطبق ال كواليتي علي المنشأه و ال تريننج علي الأشخاص لما تخلص هتعمل لنفسك ايفالويشن لو نجحت فيه هتسجل نفسك و تطلب الاعتماد ال اكريديتيشن تعالوا نتكلم علي كل واحدة لوحدها
معيار صعب الوصول اليه ليس بهذه السهولة طيب ايه الدليل
ان قبل 2018 كان هناك نظام في الاعتماد و هو نظام مشترك بين وزارة الصحة و اللحنة التنفيذية للاعتماد وده بيشمل اعتماد المستشفيات الحامعية و الخاصة و الهيىئات و المعاهد بوليهم لوايح خاصة بيهم للاعتماد ... بعد 2018 تم تأسيس جاهار و ده اختصار general authority for healthcare يي شىي and regulation accreditation او السلطة العامة لاعتماد الرعاية الصحية و التنظيم .بموجب القانون رقم 2 لسنة 2018
كانوا ماشيين بالقواعد القديمة في الاعتماد لحد سنة 2021 لما طلعوا قواعدهم الجديدة في كتابهم جاهار هاند بوك و شرحوا فية طريقة التقييم و التقدييم و هنوضح الاختلافات بينها و بين القديم كمان سنة 2022 خدوا اعتماد امريكي للوائحهم و ده زود من قوتهم
National safety requirement ودي بيدي في كل عنصر فيها سكور و يجمعهم في الاخر
كل واحد من دول تحته criteria ويبدأ يعلم فيها
و يبدأ يعلم فيهم كده و يجمع السكور في الاخر ولصعوبة الحصول علي الاعتماد في معظم مستشفياتنا
لك ان تتخيل ان في مصر 17 مستشفي فقط معتمدة و ده علي موقع gahar.gov.eg و في الاسكندرية فقط مستشفي الشرطه من يونيو 2021الي حاصلة علي الاعتماد
و تقدم لطلب الاعتماد 20 مستشفي فقط في الجمهورية منهم 2 في الاسكندرية فقط اندلسية الشلالات في 8 2022 و الصفوة في 8 2022
هيئة الاعتماد المصرية دخلت كمان الاعتماد و ده خارج موضوعنا بس الشيء بالشيئ يذكر لمراكز الاشعه و المعامل و الصيدليات
يعني محافظة الاسكندرية حتي هذة اللحظة مستشفي و مركز اشعة فقط معتمدين و مستشفييتين و معملين مقدمين علي الاعتماد
و بالتالي فالاعتماد هي عملية مستمرة تجدد حسب الجودة و تجبرك علي استمرارية الالتزام
العملية التنظيمية للعناية ليها دور كبير من بداية التصميم حتي الشغل