UNIT-I AND III IN PATIENT DEPARTMENT (IPD) DR TRUPTI SONTHALIA MHA-10-12 TISS,MUMBAICONTENT OF IPD SERVICES INTRODUCTION DEFINITION OBJECTIVE FUNCTION DEPARTMENT OF IPD PLANNIG AND ORGANIZATION OF IPD. TYPE OF RECORD FORMS OF WARD SETTING MANAGERIAL ISSUES FACTOR AFFECTING HOSPITAL IPD SERVICES EVALUATION OF IPD SERVICES SUMMAY CONCULSION REFERENCESIN PATIENT DEPARTMENT IN PATIENT DEPARTMENT *Inpatient" means that the procedure requires the patient to be admitted to the hospital, primarily so that he or she can be closely monitored during the procedure and afterwards, during recovery. *An inpatient is “admitted” to the hospital and stays overnight or for an indeterminate time, usually several days or weeks (though some cases, like coma patients, have been in hospitals for years). aeINTRODUCTION ABOUT IPD What is IPD? * The Indoor patient department commences when the patient is being registered and allotted a bed in the ward. * It deals with complete treatment and services provided to the patient during his stay in the hospital. * During his stay in the hospital, every patient is provided various services in terms of consultant’s visits, investigations, procedures, medicines & consumables, room service, diet, etc.IN PATIENT CARE In Patient Care » Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or are have severe physical trauma. Patients enter inpatient care mainly from revious ambulatory care such as referral from a ‘amily doctor, or through emergency medicine departments. The patient formally becomes an "inpatient" at the writing of an admission note. aCONTINU ED In Patient Care The Inpatient Care Department allows to finish course of therapy in an intimate and caring environment. inpatient unit offers evaluation and treatment for a variety of medical conditions. Supported by in-house diagnostic imaging, pharmacy, physical therapy services, and 24-hour clinician supervision the Inpatient Care Department provides Health members with timely and responsive care for a variety of medical issues. services include: Admission for continued care of patients transferred from the hospital after surgery or serious illness, allowing for smoother transition from hospital to home Admission directly from any Yale Health clinical department or from the Acute Care Department for further evaluation, diagnosis or treatment for a range of common medical Ss quire skilled medical services but not anCONTINU ED services include: Admission for continued care of patients transferred from the hospital after surgery or serious illness, allowing for smoother transition from hospital to home Admission directly from any Health clinical department or from the Acute Care Department for further evaluation, diagnosis or treatment for a range of common medical problems Procedures which require skilled medical services but not an overnight stay Physical therapy for inpatients Hospice and palliative care ————OBJECTIVES OF IPD OBJECTIVE: -To provide the highest possible quality of medical and nursing care for an admitted patient.. -To make provision for essential equipments, drugs and all other items required for patient care in an organized manner. -To provide most comfortable and desirable environment on temporary substitution for home. -To fulfill all the basic needs in the hospital like eating, toiletry, sleeping, entertainment etc. -Te facilitate the visit of attendants and visitors. -To provide the atmosphere and facilities for highest degree of job satisfaction of nursing and medical staff and high levels of patient satisfaction.FUNCTION OF IPDFUNCTIONS 1.To provide the highest possible quality of medical and nursing care for the patients. 2.To provide necessary equipment,essential drugs and all other stores required for patient in an organized manner. 3.To furnish most desirable environment substituting as temporary home for the patients. 4.Jo provide facilities to meet the needs of the visitors and attendants. 5.To provide highest degree of job satisfaction for the nursing & medical staff including training & research.FEATURES OF IPDSTEP OF IPD PROCESS Initial Process for IPD Step 1:- When they get confirmation that a patient has arrived with an emergency to their hospital campus, the first thing they do is give a call to ward boys and patient attendants to shift the patient from ambuiance to stretcher. Step 2:- Give a call to principal medical officer. Step 3:-After the principal medical officer examines the patient, they ask him as to where they have to shift a patient. Step 4:- Generally they shift the patient to the recovery ward or ICU and after patient becames stable, only then they shift the patient to the relevant ward, Step S:- After counseling with the PMO/RMO/SMO and permission of the same they do registration of patient in IPD register and in their software too, 3Cont... Step 6:- Making a file and fill the details of patient. Name of Patient Age & Sex Residence address Care taker of patient Mobile No Chief Complaint, etc. Step7:- Fill the patient’s consent form and after telling them the purpose and meaning of the form, get it signed by the patient's relatives. Step 8:- Send the file of patient to the corresponding ward where the Medical Officer has asked the patient to be shifted. Step 9:- Confirmation that the file of patient is received by RMO of the corresponding ward. 4FLOW CHART FOR IPD PROCESS Assigning room & bed to inpatient Click patient's name Co Cick"iase” EeASPECT OF IPD SERVICES Key Aspects Upstream and Downstream Dept. ‘ Sptlenpxamnieon * Upstream Reception and Administration * Bed Allocation and Transfer + Downstream - OT/ICU, Pharmacy, Laboratory, * Consultants visit entry Blood Bank, Billing/Accounting, etc. * Recording Patient’s clinical data * Requisition of investigations required * Requisition to Store & Pharmacy stores for Medicines and Consumables * OT/ICU Billing and ManagementHOSPITAL WARDS Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or have severe physical trauma. Patients are assigned a ward or a room based on the type of care they need and the availability of the bed. Typically, each general ward Consist of 30 beds and each ward provides hospital bed with all facilities for in patient services . When patients request a private room we make every effort to meet their request. We have private rooms, All private rooms have a phone, attached toilet, a closet for personal belongings and a bedside control for contacting a member of the staff.IN PATIENT DEPARTMENT SERVICES Medicine Ward DEPARTMENT Cardiac ward Surgery Ward Chest Medicine Ward Obstetric Ward Gynecology Ward Dermatology Ward ENT Ward Eye Ward Pre Op Ward Post -Op Ward Emergency Reom Injection Room Dental WardCONTINU ED Neurology Ward Nephrology Ward Rheumatology Ward Isolation Infection Ward Pediatric Ward Burn Ward Special Ward/Private Ward Happiness Ward MR Ward Disable Ward Diarrhoea Ward Communicable Ward EtcCRITICAL CARE AREA * NICU * PICU = SICU .HOSPITAL TEAM When admitted to the hospital, patient care is provided by a team of health care professionals trained to meet patient's specific medical needs. The hospital team comprises of 20 units : Medicine (4); Surgery (3); Dermatology (1) ; Psychiatry (1); Paediatrics (2); Obstetrics and Gynaecology (3); Orthopaedics (2); Ophthalmology (2); ENT (1); A professor heads the unit; an associate professor, lecturers, registrars and interns form the team.Forms of Inpatient Ward: There are different types of ward design; 1.Open ward or Nightingale Ward Ot ee tee ee eC MAUL Tie tee teem tie tc tet p) Pete tree ec AL 4.“T” and ‘Y” Shaped Ward 5. ‘L” , ‘H, "E" Shaped Ward.DSTO Tanne m aT This type of ward was designed in 1770 by Frenchman, Peta tee ar mini eat ent e en Ree ea) Pearce iterate nn nr eke eke Per near en enacted SE oe ccs enter a ens reer eaten ttre Nanette ect etree tg Poets nest tats cto netic cnts in etna eee reenter eet end. Bathroom and WC at the other end. Coe Meta Ce acre a tn plenty of fresh air & ventilation.Recicuninstanec? Disadlvantage of Nighiingale wardl eC eng ee ant ce eet pee ee eat Pa ee Rc erry pai a nea oan tne aL Pa ab eer eeNORA ee ane ae en eer a : Pee eu en separated front each other. Each compartments having 4-6 or more beds arranged parallel to the eee eS ey nt ng ec of nursing station; Isolation mom (ior 2) car: be kept finer ‘Advantage BF RIG's Waitl /Bay Ward i& theré would be privacy for patient, Risk of cross infection minimized, Leese es tienen terete Dre ene aaa ee tent etre ‘Communication between patient and nurses more difficult Det ee ne Lc Dee La Beco Eile ua TOURS tkePLANNING AND ORGANIZATION PLANNING AND ORGANIZATION SN x we nue (onePLANNING & ORGANISING IP UNIT POLICY OF HOSPITALS | PHYSICAL FACILITIES -General -Location & area mesa sat] 1a Bird) ’ Specific hospital -Type of patients -Requirement of staff -position of the Head Nurse & Ward ClerkSHAPE/DESIGN- 1.0pen ward 2.Rig’s ward 3.Ancillary accomodation Sa Teleiia-aa el dle) -Treatment room er OlF-TamO) ait avaceley in| Bele M eailta) -Day room -Stores PEllemcele iu) AINE ml ade lola supplies COT TE La Accomodation -Duty room for doctors -Seminar room SACs | Set (Meelelu Melle) ele ai Sela mel R CaCl Pe atts SUE a lesORGANIZATION AND MANAGEMENT OF IPD 1. In patient services includes the ward and nursing station and ail other facilities necessary for good patient care. * To provide care under direct supervision for a patient at the point of illness when dependence on others is at its height by admitting in a hospital bed.HOSPITAL POLICY POLICY OF HOSPITAL The indoor facility creation depends on the policy of the hospital to have the type of services and size of the hospital. (eee General Hospital -Less than 200 beds | (Surg, Med, Ortho) (Usually horizontal explanation), Super Specialty Hospital -More than 300 beds (Nurse, Uro., Burn, Nephro.) (Usually vertical expansion) i Specific Service Hospital (Maternity, Paed., TB, Leprosy, Ortho.)CONTINUED Hospital policy Admission policy Discharge policy Emergency policy Drug formulary policy Infection control policy Bio medical waste management policy General waste policy Visitors policyCOMPONENTS OF WARD = om Mee oe) =e rd ee a a ae =COMPONENTS OF WARD UNITPHYSICAL FACILITIES = “ ~N aLOCATION 1, Should be at the backside of hospital complex to avoid traffic flaw and congestion. 3. Have direct access from OPD and Emergency and OT. 4, Single door entrance to ward complex to restrict the traffic and visitors. 5. Good intramural transportation systems like wide corridors, lifts etc. SIZE 1. The size of the ward or nursing unit varies from 20 ft to 90 ft. 2. The size of the ward depends on — (D) Type of patient to be served vi) Critical care units like ICU, CCU, Past op, burn have small wards where constant attention is required 20 to 30 beds. vili)Patient requiring frequent attention, intermediate ward size 40-50 beds, ix) For chronic long duration stay patients the size may be 70-90 beds. (K)Availability of Nursing and other staff. (L) Positioning of Nursing Station i.e. central, lateral. (M)Close or open ward.PATIENT HOUSING AREA AREA a By Pepe Uae eng iN ING Al 4, Itimiay be devided into various cubicles as per patients requirement, Room Single Bed =~ 120 Sqft Room Double Bed = 160 Sqft Room 4 bedded + 320 Sqft Room 6 bedded = —««400Sq ht Room [cubed = == «125-150 Sq ft 410.1n open ward width should be 20 ft. Bed Area = 70Sqit Space between 2rowbeds - Sit Space between2beds = - =. 3 to Gfeararc of bedhead from wall and rem ober bed 2 Size of each bed 6 Vs ftx 3% ft = 100-120 sqft 120-150 sqft Buon 5.Standard dimension of Lc)WIEN MRLe co en Teeny Ce to ee ears Peas eon Doers er to. erat eee area General ward :Healthy Environment pecan eee ae eT) eu eee et etl Geriatric want: Safety/ comfort Disa bane center of we bd nett es than Obs/Gyne ward - Privacy feet need Teeny ters ees Pierre ieee ete nec ee ee etd od eer ca terecttoll cts ots co) re eer ardfortitir as! MVEnre Tea Treat least 3 feet eto Tier Smrenertoh fete guts Cons fereite Reema nme meter. Height of suspend NIMe terete | ae Recetas then 15% of floor area Neg enmrcee) of trolley,bed .stretcher Door: should not be less 1.2: meter wide and 2 er Bed sicle locker /cupboard-must fale eee VErreett a to: ee coma iicr Other facilities-depending upon Perit ue eee tag ie og tec eth) rence)AUXILARY AREA AUXILARY AREANURSING STATION -Minimum area 20’ x 20° “Sister's changing room and toilet -Cupboards for medicines -Hanging pockets for forms and case sheets -Case sheet racks “Table, stool, chairs TREATMENT ROOM -Physical Examination -B.P instrument, thermometer -Dressing trolley, washing facility -Examination couch, spot light Auxiliary Accomodation Deseo ee Se ern rin pccs Somme BL Store room :200 3q ft See eC is ensSANITARY AREA SANITARY AREAANCILLARY AREA =.=Other Facilities Fe Con ee Mises Ko ene ees electricity; Point should be carefully lesigned with ee eee errant Sa ee Metre eet Pretec a Se ere tes communication source hetween nurse and patient and Preemie Gee ee dose LS Cree este ero eee eae ers 8.36 grade) eet ro nctar tt pee tea ory eer eis er ee oe een esa Coe Perera ELECTRICITY AND WATER SUPPLYMANPOWER REQUIREMENTS STAFFING Ward staffing depends on the size of the ward and criticality of patients. Specialist - 1 per 100 beds GDMO - 1 per 12 beds Sr. Resident == 1 per 12 beds Jr.Resident = - 1 per 4 beds Staff Nurse 1 per 6 beds general one/ bed critical area 1 per 4 beds teaching hospit. 2 Sister In charge- ANS - 2 Group ‘D’ Staff = 1 per 2 bedsWARD DESIGN The objective of ward designing is to facilitate the nursing staff to observe each patient and keep a watch on them. 1. The beds either surround the aay 1. Separated by low _ Nursing Station or on either side. Dine lonr cobietenat fora Gade, 2. Toilets at one end and duty & ov hanninnde hay baot soeaian treatment room on other end. South lone ce macsine boning 3. Good visibility, better ventilation. Eat Bitar or eat beds can be arranged in °x" shape or 5. Disadvantage being 4. Disadvantages are: + Noisy & lack of privacy + Space between beds reduced a + Obstruction in flow of trolty (il) Direct observation not possible + Chances of cross infection (ill) Ward becomes longer igue of nurses. “ Dore start eau 2MANAGERIAL ISSUES Day to day management of inpatient services is usually at 2 levels Implementation of hospital policies is responsibility Of doctor in charge. + _ Nursing Level: Sister in charge is responsible for the over all ward management with inter departmental co-ordination. Objective of the ward management is the optimum utilization of the ward resources to produce maximum out put with comfort and full satisfaction of the patient (Tangible) It is a team function combining the efforts of doctors, nurses and other hospital staff to maintain continuous efficient and effective care through Personal experience, training & advancement (long term).FACTORS OF MANAGERIAL ISSUES EACTORS OF MANAGERIA ISSUE So EES : " ™ ~~ aa e Bea = ill we Tear seucrt’ epecion See] ES on Taking report, specimen Collection, Nursing Care, Temp. record, teaching & Snr 2CONTINU EM Adequate storage Check misuse & wa Indent & receipt Economic use Patient card, Patient record, Charts, indent & stock books Maintenance & repair Ps Breakage, loss, condemnation Report book: Me eae Privacy, noise prevention, we Ventilation, temp., light, _ diet, cleanliness, toilets Reporting to higher Authorities Day, evening & night \ reportFUNCTION OF WARD SISTER EUNCTION OF WARD SISTER == oar ae ue ms OeMANAGEMENT METHOD 1. Ensuring implementation of 1. Ensure implementation Strategic guidelines. guidelines on management 2. Good Working Environment issues. 3. Patient Care & Comfort 2. Timely calculation of 4. Maintaining Efficiency & availability & procurement of effectiveness throughout logistics. 3. Setting standard of quality care. 4. Ward timings & shifts 5. Working Manual 6. Types of records to be maintained 7. Training materials of studentsMONITORING THE IPD SERVICES io oe) from patient care) (Inter unit reiat “aS Se a { awa’TYPES OF RECORD USED IN IPD OPD RECORD IPD CASE FILE EXAMINATION FORM PROGRESS FILE INVESTIGATION RECORD TPR CHART TREATMENT CHART PAC CHART PRE-OP CHECLIST POST —OP CHECKLIST CONSENT FORM 1/0 CHART CULTURE REPORT MICROBIOLOGY REPORT RADIOLOGICAL REPORT DISCHARGE SUMMARYData Types * There are basically 3 Data types in terms of ¢ ERP 1. Operational 2. Transactional 3, Master Cont.. * Reception - Transactional + Administrative ~ Master * OT/ICU Organizational * Laboratory - Organizational + Pharmacy — Organizational * Blood Bank - Organizational * Billing/Accounting - TransactionalFACTORS AFECTING INFLUENCING WARDEVALUATION OF IPD aoe “2> -_ aMETHOD OF EVALUATION CHECKLIST QUALITY ASSURANCE PROGRAM SAFETY PROGRAM PEER REVIEW FEED BACK FROM PATIENTS AND ATTENDANTS OBSERVATION PERFORMANCE APPRAISALSUMMAR Y * Till now we have discussed about in patient services and department how effective and quality way delivery the health care services to the community like introduction, meaning, objectives, function, planning and organizing the IPD services , components , division of services, hospital health team, and their roles and responsibilities, managerial issues and other isssue for services, factor affecting the IPD services, how we are going to evaluate the IPD services .CONCLUSION “NEVERTHELESS, THE TWO SHOULD BE INTEGRATED PHYSICALLY,FUNCTIONALLY AND FROM THE CLINICAL ADMINISTRATIVE POINTS OF VIEW.”REFERENC ES Students references : NHS, Uk guidelines MOH and FW from GOI guidelines MCI guidelines of hospital establishment IPHS guidelines for minimum standard of hospitalTHANKING YOU