1. ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology ARAVIND EYE CARE SYSTEM Aravind Eye Hospital & Postgraduate Institute of Ophthalmology DEPARTMENT OF INPATIENT Management Strategies In In-patient Services

2.  An overall plan for the OA nursing department provides for establishment of a number of units or wards  The process of administration must enter into these wards Introduction

3. Good Ward Management Factors 1.Planning 2.Scheduling 3.Data Management 4.Motivation 5.Strategy management

4. Factors involved in good ward management 1.Planning  A planned program for each day’s work  Provision of supplies and equipment for efficient work  Well planned assignments

5. 2. Scheduling   Beginning the day   Preventing Interruptions   Establishment of ward routines   Well arranged time for personnel

6. 3. Data Management  Accurate record keeping  Full reports 4. Motivation:  Establishment of good working relationship within the ward and other associates  Maintenance of high morale among all members of the staff

7. 5. Strategy Management  A thorough knowledge of all duties performed in the wards  Use of democratic methods in establishment of ward policy  Orientation of new staff members  Maintenance of a suitable environment  Clear understanding of doctors order  Good teaching and supervision

8. Components of ward management   Patient care   Personnel management   Supplies and equipment   Environment cleanliness

9. Patient Care:  All activities necessary to provide nursing care  Necessary to assess the needs of the patients and plan for their recovery  Helping physician in carrying our procedures  Preparing equipment for assisting physician with tests and therapeutic measures of OA leads to patient care

10.  Giving medicine and carrying out treatment  Observing the patient for any untoward reaction following treatment and making necessary measures to combat them also  The ward manager is in charge of the smooth running of all preoperative and postoperative requirements

11. 1.Personnel management:  Assignments of OAs for patient care can be given according to the no. of patients  Allocation of personnel is done to fulfill the immediate needs of the individual hospitals  The management must make sure that the ward rounds are done as per the norms  The ward should have a sufficient number of cleaners to keep the ward clean and tidy  They should be supervised effectively

12. 2. Supplies and equipment:  Ensure that all supplies and equipments are on hand in the ward  If there is any problem with the equipment, it should be rectified by sending either to the maintenance department or calling  Ensure that there is sufficient medicine in the ward

13. 3. Environment Cleanliness:  Cleanliness in the ward is essential for good patient outcome  To maintaining the cleanliness of the ward  If problems are found, the housekeeping department should be informed immediately  A checklist must be followed daily for the proper maintenance of the ward  Dustbins must be kept inside the patient’s room as well as outside in a few places  Toilets and bath rooms are cleaned at regular intervals

14. Roles and responsibilities of OA  Preoperative and postoperative care is a critical component of nursing  OAs in wards are responsible for ensuring continuity of ophthalmic care before and after surgery  Providing physical and psychological support to patients during their stay  Ward OAs have the major responsibility from the time patient’s are admitted till they are discharged

15. The various roles are:  Patient Interaction  Monitoring  Executing  Assisting  Documentation  Total number of beds

16. Patient Interaction  Ensuring that the physical, mental and medical requirements of patients admitted for surgery are met  Entering patients name, medical records number, time of admission, receipt number and other relevant details in admission and discharge slip  Giving orientation about the room to patients  Providing preoperative and discharge instructions to patients  Accompanying patients for checkup by the ward physician

17. Monitoring  Rechecking preliminary investigations before surgery  Check that all patients details are in order  Confirm availability of right IOL. Diopter (especially unusual power) +/- 8.00 – 23.00

18. Execution  Administering medications conscientiously  Pre rounds preparation  Sterilization of equipment and instruments  Routine change of linen in rooms  Leading pre and post operative patients to medical officers at wards for eye check-ups  Attending phone calls, complaints and doing the needful. Inform the surgeons about complicated cases

19. Assisting  Assisting the ward ophthalmologists in slit lamp examination of patients the day after surgery  Assisting the ward ophthalmologists in keratometry and A – scan examination before surgery

20. Documentation  Enter the patient Information, MR number, advance receipt number, time of admission and discharge  If the patient is scheduled for surgery, write their name in the surgery list, M.R. number, type of surgery etc  Write discharge instructions in the pad  Daily morning find out the bed census and write in the note book and also on the notice board

21. Census should contain: Total number of beds Total number of occupied beds  No of vacant beds is calculated by adding the admission and deducting the discharge  Maintain surgery note book with (Name, MR.No, Room no. and type of surgery)  After surgery, the type of surgery and name of the surgeon is added and this is helpful in taking surgery statistics  Preparing the census report and attending the meeting weekly

22. Role of Ward Incharge  Monitoring  Patient Interaction  Documentation  Communication

23. Monitoring  Checks whether the advance is paid or not  Checks the patient details (Name, MR.No, & Room surgery details) are entered in the admission register  Checks that medicines are purchased  Maintains the bed census board in the floor  Cross checking the bed census report generated in ward with that generated in admission and discharge counter

24. Patient Interaction  Discharge Instructions are prepared and given to patients  Patient queries and requirements are addressed

25. Documentation  Discharge summary is prepared  Entering follow up dates and time in the register after consultation with the patient according to their availability  Relevant medical and reimbursement certificates are prepared and issued to patient

26. Communication  Inform surgical complications to the surgeons  Follow up the out going Inter Departmental consultations

27. Role of Ward Ophthalmologist / OA / Manager  Performing examination to reconfirm all test findings and correlate with records  Supervising administration of preoperative medications  Checking with the patient for past history of sensitivity or allergy to anesthetic agents  Deciding to type of anesthetic (Topical / Local / General) Cont…..

28.  Devoting special attention to complicated and high risk patients  Obtaining physicians certificate of fitness for patient with systemic problems  Ensuring that appropriate identification stickers are placed on the case file covers for patients with any systemic problems or allergies  Post of review for all patients  Ward rounds and discharge of patients Cont…..

29.  Medical reports / certificates  Review of any surgical complications  Gives a written report to the night duty doctors on any patient who need extra care (or) injections  Should keep these patients case sheets accessible to the duty doctors

30. Role of ward housekeeper  Cleanliness  Documentation  Appliances

31. Cleanliness  Ensure that the ward is kept clean  Planning and procurement of cleaning materials required for hospital is done  See that the ward is decorated with appropriate wall hangings and flower arrangements  Wall hangings, doors and windows furniture are all cleaned regularly  Bed covers are kept clean and appropriate colours are used in different rooms

32. Documentation  Inventory list of furniture, electrical equipment, plumbing and carpentry materials  The required inventory of cleaning materials is maintained and transferred to the required area when required  The linen stock is maintained

33. Appliances  Tube lights, fans, buckets and other amenities are repaired and replaced as required