PRINCIPLE OF MANAGEMENT

MAIN PRINCIPLES OF MANAGEMENT Division of work helps to develop familiarity in the work Authority must be given power/right to command others Discipline maintaining discipline by formal or informal agreement Unity of command the principle of one superior Unity of direction one plan of action for a group of activities in the organization with same objectives The organizational goals should supersede the individuals objectives Remuneration wages must be fair to the type of work done Centralization decision should be made centrally Scalar chain line of authority or organization chart Order the right person should be in the right place of work Equity all employees should be treated fairly and equally Stability of tenure of the personal long term employment Initiative allow all level of employees to show initiative and creativeness Give spirit to encourage team work

VISION AND MISSION PPUM

VISION To be an excellent institutional that give born to a leadership in emergency services activity to the patient , teaching and practices to student and the public Environment research related to emergency method and having administration systems that is skill full , systems and efficient Mission Having mission towards existence authority of PTJ . Having high integrity in giving excellent emergency services to patient , giving best teaching and practices , to move research effort and to build capability administration systems Methods in achieving emergency patient , safe treatment services with the help of right evaluation that can continue high quality of treatment Towards achieving the best academic education level to medical students , student nurses , public and to government and private agency Towards achieving the best research standard in trauma and emergency Towards achieving satisfying services to patient and next kin with the effort shortening of time that is warm and nice

ORGANIZATION CHART OF UMMC

ORGANIZATION CHART OF NURSING ADMINISTRATION

TEAM LEADER

RESPONSIBILITY AS A TEAM LEADER 1) Before ward round perform other specified duties whenever assigned taking report from the team leader of the early shift chart down any plan or activity for patient on that day make sure all equipment and form is ready patient investigation result are update prepare laptop for ward round inform doctor about patient complain give privacy to the patient during ward round record doctors order do treatment in a form (BK-MIS-384-EDI) 2) Do checklist on CSSU record the used item in CSSU record book total all of the unused and used item 3) Inventory item in ward find the total of items regards by inventory book make sure the items in good condition make sure the items in correct place top up the drug that had been used record in inventory book record all the new items in inventory book sign on every sheet 4) Check DDA drugs recheck and recount again DDA drug and DDA book to detect where DDA drug miss counting occur 5) Round with sister make rapport / greet sister inform total of staff that on duty and total patient in ward give explanation about patient condition thanks to sister

6) Medication in ward stock identify what day of pharmacy will comes to the ward check all medication ( oral & intravenous ) quantity and condition list medication that needed contact pharmacy for checking inform pharmacy if any problem 7) Order medication check doctors order in patient note prepare prescription oral medication ( BK-MIS-073-501 ) intravenous medication ( BK-MIS-118-EOI )

make sure the prescription are fill send prescription to pharmachy make sure total medication enough 8) Nursing 24hours report fill the form name of leader total of patient total of admission total of discharge total of patient dead

put personal information about patient do report related patient dead do report every shift

RESPONSIBILITY AS A CUBICLE NURSE a) report taking and take note important information b) assess patient condition in the cubicle c) tidy up client unit and help in 14 ADL d) ready medication trolley prepare medication follow by 6R

e) prepare round trolley ensure all forms are available any investigation result are ready

f) follow doctors round tell the doctor about patient complain discuss patient condition take doctor order

g) take vital sign h) help doctor in doing procedure i) do nursing report

WARD ROUND BEFORE I. taking report from staff nurse of the early shift II. preparation for a ward round preparation trolley form work ship stationary nursing care plan medication cardex torchlight spatula ophthalmoscope turning fork needle syringe result of all investigation VI. IV. V. III. II. I. DURING follow doctors round listen to the discussion write in the note check for plan include further investigation and treatment give opinion do changes at care plan read doctor order before changes to others patient VI. V. IV. III. II. I. AFTER look over the list that you made and work out update nursing cardex delegate works to team members accordingly do own round to ensure implementation complete all documentation pass patients report to another staff in the next shift

ADMISSION , DISCHARGE , AND TRANSFER IN & OUT PATIENT

RESPONSIBILITY AS A CLERK 1)Duty from 0800 hours until 1700 hours 2)Responsibility in charge before to the ward from transit a) make sure all client folders have a name b) ready the bed c) record admission to the book d) make sure all specimen must be label e) update patient details 3)Admission procedure a) answer calling from transit , acute medical care or rhesus for admission process to the ward agree the requesting of admission if the ward has empty bed take important of client details and condition

b) wait client come in to the ward with the staff at admission counter enter client name in the ward list prepare bed , equipment needed and clothes for new admission

c) client come greet them , accept the admission politely and smile d) Paste clients stickle in admission book and TL book e) Enter client name , registered number and specific team in white board f) Take client folder and take the report from staff there make sure client folder is complete old note keep properly

g) prepare client name tag h) bring client and his/her things to the empty bed i) help the staff taking vital sign and do orientation j) record all information rightly in the folder 4)On discharge procedure
a) staff nurse at the cubicle will complete all the procedure and the

documentation on client
b) complete all the bill and the form for discharging

c) complete appointment card if client has appointment after discharge d) wait the doctor summary and complete history of client for discharge e) delete client name in the computer and white board f)

call client relative to come to the counter

g) give the bill and prescription of medication h) all the procedure done client can go home rightly

5)Management of specimen collection a) ensure the specimen from right client b) send correct specimen to the laboratory c) laboratory forms have to fill completely d) collect specimen with correct technique e) collect the specimen with correct time f) ensure the specimen is in the correct container g) ensure specimen bottle has been label h) record all the specimen in the book including name , registration number i) pack specimen with form j) send specimen to the right units k) see a result of specimen l) update client information

6)Transfer in and out procedure TRANSFER IN 1) there is empty bed in the ward 2) call any ward that we had lodged before to take back that client 3) edit client name in the patient list in the computer 4) prepare bed , needed equipment and clothes 5) waiting for the staff there to send the client 6) they came to the ward , taking new and current plan and that client and bring him to the bed 7) continue nursing observation and management of client as usual TRANSFER OUT 1) answer call from another ward that had lodged their patient to this ward , if there want back their patient so we have to send that client as soon as possiblebecause they had empty bed just now 2) delete client name in the computer and white board 3) complete current procedure and documentation 4) tidy up client his properties 5) send client kindly 6) give client folder to the TL at the counter 7) passed new and current plan to their staff properly 7)On lodger procedure a) call the ward that has empty bed to lodger the stable client for a fews day because the current ward has to take new admission and at the same time , ward do not has empty bed b) if get the ward edit client name in computer enter client name in list name of lodger patient at white board

c) complete client procedure and documentation d) tidy up client and clients property e) bring client , properties , folder and old note accompanied by attendant to the ward f) pass report completely about the client including the medication and current plan g) leave client kindly

DEATH MANAGEMENT (NORMAL , MEDICAL LEGAL CASES)

8)On death procedure NORMAL 1) ensure the death with written at patient note 2) ensure result of strip ECG show asystole 3) inform family members 4) prepare dead body level , give it to the staff who is the last office procedure 5) do the mortuary procedure 6) prepare dead body registry form 7) wait until body is taken 8) explain to family member about the form and discharge bill 9) write nursing report MEDICAL LEGAL 1) report to police about the death 2) inform the family about medical legal police case 3) inform ward manager 4) prepare the death registry form , medico legal form and consent for autopsy 5) tell the family to wait at PTJ forensic until police investigation done 6) ensure the note is wrote by police officer in the report of medical legal case INFECTION 1) contact inspector of Jabatan Kesihatan Daerah 2) ensure the medical officer complete the forms 3) do mortuary procedure except for HIV/AIDS 4) for HIV/AIDS handle the body with prevention put into zip bag if have any feces or blood -put infection tape Ensure causes of death did not write diagnose HIV or AIDS

MEDICATION IN DDA CUPBOARD

HANDLING OF DDA ( AKTA DADAH MERBAHAYA ) a) Explain principles and your responsibilities in handling DDA drugs DDA cupboards key should be keep by TL or sister keep DDA book inside DDA cupboard straightly record every time taking out the DDA drug by double sign of staff nurse inside DDA book check of DDA drug every shift to tally the total of take out and stock of medication TL should be passed over report to another shift TL in the same shift b) State : i. Dangerous Drug Act 1952 An act make further and provision for the regulating of importation , exportation , manufacture , sell and use of opium or certain other dangerous drug load substances . ii. Poison Act 1952 An act to regulate the importation , possession manufacture , compounding , storage , transport , sale and use of poison c) State the drugs that available in DDA cupboard therapeutic effect side effect

GENERIC NAME 1)IV Morphine 10mg/ml

TRADE NAME

ACTION

SIDE EFFECT

1)Morphine Hp 2)Morphine Elson 3)Morphine Lp Epidural

-for moderate to severe pain , Lt.ventricular failure , or terminal care and palliative care post op

1)hypotension 2)nausea 3)vomiting 4)constipation 5)sweating 6)apnea

2)IV Pethidine 50mg/ml

1)Demeral hydrochloride

-for moderate to pre op medication and adjunct to anesthetic

1)constipation 2)dry mouth 3)anorexia 4)fatigue 5)sweating

3)IV Diazepam 15mg/ml

1)Valium 2)Diazemuls

-management for anxiety , theraphy in convulsive disorder, sedation, induce relax

1)fatigue 2)drowsiness 3)nausea 4)vertigo

4)IV Tramal 100mg/2ml

1)Ultram

-management of moderate to severe pain in adult whop require around the clock pain

1)sweating 2)nausea 3)anorexia 4)headache

5)IV Midazolam 5mg/ml

1)Hypnovel

-general

1)apnea

anesthetic before 2)headache administration of others anesthetic 3)drowsiness 4)depressions

6)IV Nalaxon 0.4mg

1)Narcan

-antidote for Morphines -combine Competitively with opiate receptors and block or reverse the action narcotic analgesics

1)hypotension/ hypertension 2)nausea & vomit 3)tremors sweating due to reversal of narcotic depression

7)Tab Lorazepam 1mg

1)Ativan

-reduces anxiety , relief muscle spasm and effective sedation

1)confuse 2)drowsiness 3)ataxia

RESPONSIBILITIES IN ADMINISTERING DDA DRUGS 1) Bring along the cardex during administering DDA drugs 2) Apply 7R 3) Monitor client progress by looking to the any present of side effect of medication 4) Notify doctor immediately if anything happen RESPONSIBILITIES IN DDA STOCK 1) Recheck and recount again DDA drug and DDA book to detect where the DDA drug miss counting occur e.g. wrong total of DDA drug discard the drug but not enter inside book 2) If still not found or tally : inform sister ward in charge make police report 3) Expired or almost expired drug Expired call pharmacy and informed double check the expired date with 2 staff nurse Almost expired put the drug infront of the other drug ask other team to use the in front first 4) Broken ampule discard the ampule inside sharp bin enter the broken ampule inside DDA by use the word discard 5) Balance drugs in ampule should be discard if the same patient still can be use 6) Drugs almost or out of stock call pharmacy do ordering in DDA

PROCESS OF ORDERING DDA DRUGS 1) Check for total number of DDA and record in DDA book 2) Write in DDA ordering book 2 copies 3) Counter check with sister 4) Call pharmacy 5) Wait until pharmacy call back 6) Go to pharmacy together with DDA book and ordering book 2 coppies ( staff nurse only should go to to take the medication )

DEFRIBRILLATOR Indication / usage An emergency procedures that delivers direct current without regard to the cardiac cycle Early defibrillation to improves survival in clients experiencing VF For dysrhythmia such as VT , VF or asystole To treat ventricular fibrillation immediately Method of usage Turn on the defibrillator . Set in defibrillator mode Turn ECG recording on for a continuous printout of events during the procedure Set the energy level and change the paddles . initial defibrillation is usually performed at 200 joules Place conductive pads on the chest , or spread conductive paste evenly on the paddles Position the paddles holding them firmly on the chest wall

Ensure that no one is touching the client or the bed

Depress the button on each paddle simultaneously to discharge

the energy
Immediately resume CPR Evaluate cardiac rhythm and for a pulse after approximately 2

minutes

 Method of defibrillation testing Open defibrillator machines cover Assess the defibrillator machine overall Check all the connection wire on defibrillator machine Open the paper placement site Turn the knob to ON Wait wave come out from the monitor Turn the knob to the 100joules for testing Press button charge Quickly press the button at the paddles Turn off the knob Cover the machines back Paste the result in yhe defibrillator testing book Write your comment in the book , below the result slip and do not forget to put on your signature

RESUSCITATION TROLLY

EQUIPMENT OF TROLLEY RHESUS FIRST DRAWER

1) Laryngoscope Function to facilitate the ETT with introducer and magill forcep , prevent tongue backward Care check with laryngoscope blade and handle , make sure light is functioning

2) Airway Function to open airway , remove secretion Care put in the mouth with slotted down and turn 180

3) Silicon Face Mask

4)Introducer Care clean with water

Function prevent the O2 disappear to Function to shape the ETT atmosphere , facilitate O2 into the airway or mouth Care ensure the mask clean and not leaking

5)Yunkersucker Function suck secretion in the mouth Care clean with water

6)Magill forceps Function to hold ETT , to facilitate intubation Care open and close , insert it through laryngoscope

7)Cuff inflate Function to inflate ETT ballon

8)K.Y jelly Function use as lubricator Care ensure rhesus trolley has K.Y Jelly

9)Cotton Tape Function to hold ETT Care place at clean area

10)IV Canula Function for intravenous infusion Care place at clean area and make sure have many type of size canula

11)Needle Function to take blood ,give injection Care always top up in all size

12) 3 Way Connection Function to connect tubing in one line Care connect the connector at canula

13) IV tubing Function for IV transfusion Care connect to the canula 14) Syringe Function for blood taking , injection or transfusion Care prepare several size

13) Specimen Bottle Function for bood investigation Care ensure the expired date

14) Vecutainer / Butterfly Function taking blood Care ensure expired date

15) Resuscitation box Function give medication during rhesus Care check box every shift

16) Anesthetic box Function for anesthesia Care check box every shift

19)ECG Electrode Function ECG monitoring Care count the electrode 20) Glove Function maintain sterility Care change if it is expired

21) Plaster Function plaster that needed Care ensure box of the plaster in the trolley 22) Oxygen Jar Function to supply oxygen Care ensure the expired date

23) High Flow Mask Function to facilitate o2 to the lung Care ensure expired date

24) Nasogastric Tube Function to supply nutrition by using a tube from naso or oral to the stomach Care ensure expired date