Pannadhaimaasubharti nursing college

Assignment
On
STANDARDS OF PATIENT CARE

SUBMITTED TO - SUBMITTED BY

MRS.SUMITA Mr AAMIR KHAN

READER, MSC.(N) 2015 BATCH
MENTAL HEALTH NURSING DEPT SUBHARTI NURSINGCOLLEGE
SUBHARTI NURSING COLLEGE MEERUT
MEERUT

Standards for patient care:

Patient care of a high quality
Patient care of a high quality should be achieved by the hospital through adopting following
measures.

1. Provision of appropriate technical equipment and facilities necessary to support the

hospitals objectives.
2. An organisational structures the assigns responsibility appropriately and requires
accountability for the various functions within the institution.
3. A continuous review of the adequacy of care provided by physicians, nursing staff
and paramedical personnel and of the adequacy with which it is supported by other
hospital.

General standard of patient care:

Condition:

The general standard of care is applicable:

1. At all times when a paramedic is providing patient care while on duty.

2. To patient care provided by a paramedic where care is general in nature (stated or
implied)
3. To patient care pertaining to certain illness or injury categories/situations as specially
defined with in a general standard care.
4. Under all environmental conditions, with the provide that personal safety is assured or
can be secured without loss of the paramedics life, limb(s) or vital function.

Given’s:

1. Patients.
2. A partner.
3. An operational ambulance (includes air ambulances)or in special situations such as
mass casualty incidents, an emergency first response vehicle.
4. Fully operational patient care equipment as per the MOHLTC provincial equipment
standards for Ontario ambulance services.

A. Personal and patient safety and protection:

The paramedic will:

1. On receipt of a call, confirm call information with dispatch ensure that patient
location and assess information is accurate.
2. Operative the ambulance and utilize ambulance emergency warning devices in a
responsible manner.
3. Use an appropriate alternative route selected is impeded due to traffic, weather etc.
4. Secure the environment if assessment indicates there is no danger to self or other.
5. If there is more than one patient and assess the need for additional resources and the
need for additional resources and assistance.
6. Use EMS rescuer and extrication techniques as required.
 7. Utilize personal protective equipment according to the ambulance service taint care
and transportation standard and take appropriate safety measures where necessary.
8. Protect the patient from hazards and exposure to adverse environmental condition.
9. Ensure safe disposal of sharps in an appropriate sharp container.
10. Secure, lift and carry the patient using appropriate methods and devices.
11. Hand wash after each patient contact.

General measures:

1. Ensure that other operational procedures which impact directly or indirectly on patient
care are carryout on a regular basis specifically.
2. Personal cleanliness, dress, conduct, safety and work performanance.
3. Cleanliness, decontamination, safety, maintenance and routine checks of the
ambulance.
4. Educate all patient care related equipment and supplies.
5. Complication and submission of reports.
6. Assistance with familization and orientation of new or less experienced staff.

B. Patient commutation

1. Identify and introduce themselves to the patient.

2. Advice the patient that they are there to help. If the patient refuses treatment.
3. Attempt to determine the patients name, gender, age and weight.
4. Treat the patient other at scene with respect and country. Exercise tact and diplomacy.
5. Explain assessments and intervention.
6. Provide verbal and where demand appropriate, tactile comfort and reassurance to the
patient and family/friends including unconscious patient.

C. Patient assessment- general principles.

1. On all scene calls, regardless of dispatch priority coding, assume the existence of
serious, potentially life-limb-and /or function threatening conditions until assessment
indicates otherwise.
2. If a physician is at scene, fallow specific procedures as outlined in the physician’s
orders standard, in addition to those outlined in the general standard of care.

D. Patient assessment-environmental assessments.

1. Make scene observations.

2. Seek medical information tags/jewellery, medication and other forms of patient
identification.
3. Collect and transport all patient medications and other relevant identification for
review by receiving facility staff.

E. Patient assessment-historical assessments.

 1. Establish the chief complaint: why did the patient or by standard call for an
ambulance.
2. Elicit history of present illness or incident. Utilize as many appropriate methods as
required, specifically.
3. Question the patient directly: question others at scene.
4. Seek medical or other identification, e.g. medical information tags/jewelry,
medication centres.
5. Observe the patient behaviour.
6. Request/ collect information on allergies, medication and relevant past medical
history users prohibited by time and /or the severity of the patient’s condition or
advise scene circumstances.
7. For inter-facility patient transfers, obtain the following information and /or
transfer documents.
8. Patient history and case infection.
9. Written treatment order by Doctors.
10. Transfer papers,e.g case summary, lab work,
11. Names of hospital staff and equipment accompanying the patient, where applicable,
12. Name of receiving facility and receiving physician, where applicable.

F. Patient assessment-physical assessments.

1. Handle the patient gently. Minimize patient movement and manipulation.

2. Primary patient survey.
3. Note the patient general condition.
4. Ensure manual C-spin posture if trauma is obvious, suspect or unknown.
5. Check ABCs.
6. Level of condition.
7. Cardiac monitoring.
Respiratory arrest; severe respiratory distress
Unconscious/decreased level of consciousness
Collapse;synocope
Chest pain, shortness of breath
CVA
Major or multiple trauma
Hypothermia: heat exhaustion/heart illness
Abnormal vital sign.
8. Unless contraindicated, cover the patient with a blanket after the primary survey.
9. Expose body parts only as required to perform appropriate assessments and
management.
10. Perform the following secondary physical assessments.
Elicit history.
Take vital signs.
Respiratory rate, rhythm and volume.
Skin colour, condition, temperature
 Pulse rate rhythm and volume
Blood pressure
Head to toe assessment based on the history, patient condition/scene
observations
Observe trauma

G. Patient management

1. If the patient is vital sign absent and meet obvious death.

Note: if the patient has a do not resuscitate order to the DNR standard.
2. If critical finding,
3. To establish improve and maintain airway patency, ventilation and circulation and to
control external ward haemorrhage.
4. Ensure appropriate equipment and technique is being applied.
5. To provide advanced life support patient care standard.
6. If the patient is stable and used of specific standards of care.
7. Continue monitor.
8. Ensure the patient comfort and privacy.

H. patient refused of treatment and transport

1. The patient refused treatment and transport explain the possible consequences of such
refused.
2. Provide appropriate documentation.
3. Carryout emergency treatment and transport if the paramedic determines

J Patient care reroute to the recovery facility.

1. Responsible for attending to the patient.

2. Complete the history.
3. Maintained appropriate management.
4. Maintained communication with patient and family.

K. Radio reporting of patient care to receiving family.

Complete the radio report within 2 minutes optimally within 1 minute for most cells.

L. Documentation of patient care

Record the patient’s general condition medication and vital sign.

Keep patient infection confidential.

Emergency department nursing care Standards

The nursing staff in the emergency department supports and maintenance the nursing
care standards of the department of nursing. In the spirit of those standards, the nursing
 staff in the emergency department is expected and required to adhere to the following
standards.

At triage

1. Introduce yourself and extend words of caring and concern regarding the patient’s
injury or illness.
2. Listen to the patient.
3. Do not respond as robot, but respond as caring person. Minimum requirement is one
personnel comment to each patient and family.
4. Maintain eye contact with the patient.
5. Explain the registration and bed placement process.
6. Never leave triage untreated.
7. Be sensitive to gender issues when placing patient in semi private treatment room.

At the beginning of treatment

1. For ambulatory triage patients, primary nurses should introduce themselves to the
patients within minute of a room assignment.
2. Once demographic information is available, refer to the patients by his her name. Do
not continue to refer to the patient as a bed number or a diagnosis through his/her
treatment.
3. Throughout treatment, do not use the name of patients or family members without
permission.
4. Do not refer to the patients as honey, sweetie or dear at any time during his or her
treatment.
5. Be sure to ask the patient. Is anyone with you? Or is there some you would like us to
call for you/
6. Briefly review the visitation policy with the patient and their family.

During treatment

1. Announce yourself and your title when entering the exam room.
2. Explain every intervention and procedure before you being in that in that procedure,
and verify the patient and family understandings.
3. Continuously communicate the process of care and the expected treatment of the
patients. Make sure that the patient knows what to expect next.
4. Ask the patient do you have any questions or needs every time you interact with the
patients.

When question are asked about delays or treatment..

1. Avoid telling a patient i am not your nurse or i don’t know. Advice the patient that
you will have to check on that report and follow up with the patients.
2. Responds to delays in a cooperative and responsible manner, and be sure to emphasis
for any delay.
 3. Do not blame other departments or colleagues for delays; do not make excuses be
positive and proactive.

Admitting and discharging patients

1. Call report and admit the patient within 30 minutes of a bed assignment.
Document any delays.
2. Discharge the patient within 20 minutes of instruction availability and completion
of treatment.

Patient-focused treatment standards.

1. Wear your nametags at all times.

2. Ensure that every patient has a functioning call light at all times.
3. Respond to the call lights immediately.
4. Evaluate every patient for nourishment, and provide food and beverages as
appropriate.
5. Make proactive rounds Minimum requirement is to back the patient every 45 minute
(more frequently if there is a change in patient condition) with documentation of
check; VS assessment and documentation.
6. Check and document the pain status of the patient and the effectiveness of medication
within 30 to 60 minutes of medication, depending on the route of administration.

Team-focused treatment standards.

1. Communicate the process of care and expected treatment internally so that physicians,
nurses, and other care providers are aware of any testing and changes in care. when
patient verbalize.
2. Anticipate your co- workers’ need for assistance without being asked.
3. Limit the use of the intercom to patient emergencies and physician calls. DO NOT
uses the intercom in the following situations.
4. To page staff to the desk.
5. To announce that the paramedics are in an exam room waiting for a nurse.

Emergency department protocols

When questions are asked about delays

1. Listen and respond with empathy and concern.

2. Acknowledge and apologize for the delay.
3. Briefly explain the reason for the delay, communicate a realistic and liberal time
frame, and do not blame other departments or colleagues for the delay.
4. Confirm the patient understands of his or her plan of care.

When questions are asked about treatment.

1. Listen and respond with empathy and concern.

 2. Clarify the question(s) answer and the question confirms the patient understands of
your response.
3. If you do not know the answer, advise the patient that you will have to check on that
information or request that information or request and then follow up with the patient.

When patients verbalize that they are “leaving without being seen”

1. Immediately communicate to the charge nurse that the patient if going LWBS.patients
leaves the emergency department.
2. The charge nurse should evaluate the situation and intervene with the patient as
appropriate.
3. Document the patient
4. Intervention and the results

When patients verbalize that they are leaving against medical advice.

1. Immediately communicate to the charge nurse and the physician that the patient is
going to AM.
2. The physician should evaluate the situation and intervene with the patient as
appropriate.
3. Document the patient intervention and the results and complete the appropriate forms.

When patients use threats and profanity.

1. If the patient uses profanity state the following: “in order or me to be able to help you
need to stop using profanity.
2. Immediately notify the charge nurse of the situation.
3. Implement the security management plan as needed.

Identify patients who are at high-risk for dissatisfaction.

It is important to identify patients who may be high-risk for dissatisfaction in order to use
proactive behaviours (such as those outlined in section 1and 2 above) to keep the patient’s
dissatisfaction from escalating to the point where the patient goes LWBS or AMA.
Proactive behaviours on the part of the emergency department staff may also prevent high
–risk patients escalating to out-of –bounds behaviours such as yoking and using profanity.
Keep in mind that the following patients are a high –risk for dissatisfaction.

1. Patients who have waited over 45 minutes in the lobby.

2. Patients who have waited over 30 minutes to see a doctor.
3. Patients who have spent over 3 hours in the emergency room.

BIBLOGRAPHY:

1. Ontario. Emergency Health Service Branch Ministry of Health and Long-term Care.
Basic life Support Patient Care Standards, January 2007; page 1-18.