HOSPITAL BASED CLINICAL HEALTH 1

WARD ENVIRONMENT

The physical environment must be properly maintained because it plays an important role in

maintaining the physical and mental health.

Effects:

Though the patient pays for their treatment, they have the rights to expect good physical

environment. It includes peace, Noiselessness, good ventilation, light, cleanliness, Orderlies. It

was achieved by building hospitals in outside area. The view should be conclusive (pleasant). The

wall paintings, furnitures, cots must be in pleasant colour.

Noise: Due to noise central nervous system is affected, and there will be decrease in the work

efficiency of staff. Inside the hospital we should reduce noise by using porous material. It avoids

penetration of outside noise. Linoleum clothes can be used over the floors to avoid noise. Linoleum

contains the powdered cork and oil. Subways can be provided for trolleys and stretchers. Then

education to reduce noise.

Ventilation:

Proper flow of air is important in hospital. Hence patient feels a sense of comfort and healthy. It

there is improper ventilation the effects are presence of body odours due to perspiration, increase

temperature, increase humidity, it creates loss of appetite, lassitude (uninterested), swelling

Redness, occurs due to increased temperature, upper respiratory infections, Normal temperature

must be 660 -680F. Cross ventilation and air circulation in ward, Air conditioner also helps to

maintain good ventilation.

Light:

Sunshine is essential for growth and nutrition. It creates the sense of spirit. The wall must be dull

finished hence the light may penetrate easily. But it should not glare. It is essential for closed works

of personnel’s.

Cleanliness:

It is next to godliness. The equipment’s, curtains, linen, bed cover must be clean. Vaccum cleaners

must be used for cleaning Mops can also be used. It is the respect of housekeeping department

administrator should check whether all the equipment’s for cleaning are issued. Isolation ward

must be cleaned often to avoid infection.

Orderlies:

Every essential equipment’s must be placed in right place.

HIERARCHIAL STRUCTURE OF WARD:

The larger the institution the more complex is its organizational structure. Every hospital large or

small however has a basic organizational structure for the performance of its functions.

1 The director of the hospital manages its affairs and keeps the organization running smoothly.

Through his assistance he is responsible for wide expenditure of money to obtain competent

personnel and efficient equipment. With the assistance of department head, he established

personnel policies. He is directly responsible to the board of directors which in turn studies

community needs, rise money and formulate general hospital policies.

2 The Director of nursing service is one of the several department heads, nursing, dietary, medical

social service for example responsible to the director of hospital for competent management of
their department. The director of nursing service keeps in touch with nursing. Needs and assigns

personnel to meet them, instructs her assistants and associates in efficient methods of

administration, assumes responsibility for the growth of the staff. And through her influence with

hospital market provides the facilities for the nursing service and for use of the personnel of her

department.

3. Up through the line then the head nurse is responsible directly to the supervisor or the director

of the nursing service while to the director of hospital and the board of the directors. She is

responsible indirectly. There are other groups in this line of responsibility all are which are directly

responsible to the head nurse.

a) General staff nurses and student nurses who give bedside care to the private patient. They are

responsible to the supervisor and to the director of the nursing, service through the head nurse.

b) Non professional workers (Nurse aids practical nurses, Orderlies and clerks)

c) House keeping personnel (Maids and porters) who in some institutions are responsible through

the head nurse to the supervisor or to the director of the nursing. Service.

4. The night supervisor is an Assistant director of the nursing service and assumes the

responsibility of the nursing service director during the night hours. The ward night nurse is an

Assistant head nurse and carries head nurse responsibilities when incharge of the floor. Thus the

night nurse acting in the place of the head nurse is responsible 9 for following ward policy, for

keeping the head nurse informed of problems, for making suggestions for the good of the ward

organized. She considers herself an integral and an important part of the staff of the ward. Just as

the head nurse is responsible to the director of the nursing service, so the nurse who is acting as
for the head nurse at night is responsible to the night supervisor who is acting as the director of

nursing service.

Responsibilities of Head Nurse

The head nurse in often the person who must put policy into practice. It is she is not the director

of the hospital or the director of the nursing service, who has day by day close contact with the

patient. It is she who meets the patient visitors the head nurse is responsible for seeing that the

patients are well nursed, that the doctor’s orders are carried out, and the ward is properly stocked

with supplies, that equipment is in good working order. It is she who must maintain a healthful

and pleasant physical and social environment for both patients and workers she plans the time and

activities of the personnel and if inefficiency occurs as a result of poor planning, the hospital fails

to receive full value for the money spent on salaries, enormous amount of money are spend on the

equipment and supplies used in the wards. The care taken of equipment to prevent destruction,

unnecessary deterioration and loss and the economical use of supplies depend on the ability,

interest and application of the head nurse. She should continually strive to improve her

administration of the ward and to raise the standards of nursing care. She is faced with a real

challenge no greater service is rendered by anyone in the institution, no position is more in

achieving the chief purpose for which the hospital exists.

FUNCTION OF THE NURSING SERVICE

The nursing department constitutes the largest single group of hospital employees, averaging more

than half of the total properly administered, it is the mainstay of the organization from the

standpoint of supporting administrative requirements, giving effective patient care, and promoting

good public relations while dependent upon all other hospital departments, it serves as a focal-
point for much of the administrative coordination required between departments. The following

are the broad functions of the nursing department.

1. Preventive: To carryout measures for the prevention of disease, for individuals and families

through health education and other media regarding sewerage disposal, environmental sanitation,

safe water supply etc.

2. Promotive: Instructing people, sick and well in measure promoting total health (physical and

mental) through mental hygiene, supervision of nutrition services and so on.

3. Curative: To carryout therapeutic programme including nursing care procedures, medical

treatment under scientific principles, including also personal services aimed at hygiene and

comfort.

4. Restorative: Includes early detection and diagnosis of diseases, intensive care observation,

therapies and referral services.

5. Rehabilitative: Engaging the patient and his family in his recovery including medical, social,

vocational, mental and rehabilitative services.  As a basic function, to assist the individual patient

in performance of those activities contributing to his (or) her health recovery (or to peaceful death).

 As an extension of the above basic function, to help & encourage the patient to carry out the

therapeutic plan initiated by the physician.  As a member of the health team, to assist other

members of the team to plan & carryout the total programme of care.

1. MEDICAL WARD UNIT

This unit should preferably be planned on the ground floor, although this is not be an essential

requirement, to facilitate the transportation of patient to the special departments the principal one
is the x-ray department. The number of bed comprising this unit should be between twenty-five

and thirty, the later being the maximum that should be planned for. No more than eight patients

should be accommodated in any one sickroom. The beds in this unit may be conveniently

accommodated in sickrooms as follows.

 Two eight – bed sickroom - 16

 One four-bed open air balcony sickroom - 4

 One four- be sickroom -4

 Six single sickrooms - 6

30 beds

The medical-ward unit often receives infection cases for observation and confirmation prior to the

patient being transferred to another Hospital. To safeguard the spread of a small separate sluice

room (for soiled linen and bed-pans etc) should be provided and an additional sink installed in the

to the single sick-rooms which later should be equipped with cupboards for

• Vomit bowls and mugs

• Bed-pan and urine bottle colour

• C rockery and cutlery

These articles provided in a distinctive are intended for the sole use of the infectious patient. After

use all are to be sterilized and returned to this sickroom.

Schedule of Accommodation

Rooms are Listed Below

Sickrooms

Solarium Facilities

Recreation Room [40 sq. ft per ambulant patient]

Clinical Room

Sterilizing Room

Treatment Room

Sluice Room

[Urine –Test facilities

Ward Kitchen

Clean – linen stores

Soiled – linen Room

2. SURGICAL WARD UNIT

In small hospitals, the surgical ward unit must be situated on the same floor as the operation

theatres, in order that patients, after an operation, may return to their beds in the shortest possible

time. This does not apply to large hospitals which will have several surgical ward units The number

of beds in this unit should not exceed twenty-eight, No more than eight patients should be

accommodate in any one sickroom. The beds in this unit may conveniently be accommodated is

sickrooms as follows.

* Two eight-bed sick room - 16

* Two four – bed sick rooms -8

* Four single sick rooms -4

28 beds

Schedule of Accommodation

Sickrooms

Cleaners Room

Flower Room

Staff Toilet

Doctors Room

Patients clothes Room

3. INTENSIVE CARE UNIT

Introduction:

To manage critically ill patients or for the observation of patients who are liable to become critical,

it is imperative that the existing facilities of the general ward is inadequate. To meet these ICU are

set. Treatment of a patient in a hospital is often judged by the treatment of care given in ICU. The

construction of ICU started from the development of the two earlier department namely post

operative recovery ward and respiratory care unit.

Location:
The ideal location of the unit should be somewhere in the center of the hospital not far from the

reaches of the ward in the operation theatre (if there is no recovery room), CSSD, lab. The

engineering provision is to be centralized for economy. The recovery room and ICU should be on

either side of the supporting area in ICU required controlled environmental, fresh air and power

service. It should be recorded as an isolated section change rooms have to be provided to change

street clothes to aseptic dress. The area required per bed is approximately 100 sq. ft. The best

arrangement is a cluster of 6-8 beds or 10 single beds unit grouped about a centralized nursing

station with visibility through wired glass separating the patient from the nurse. Here, one or two

isolation beds for infective cases. It must be provided: Small lab

 Medical officer room and lab observation room with water basin

 Storage room for heavy equipment

 Exam room for minor surgery

 Pantry

 Sluice room for urinals, bed pans, suture cups, etc

 Waiting room for relatives Rest and lunch room for staff.

 Workshop for minor repair for apparatus

 Emergency light in the main machine room.

TYPES OF ICU:

The various disciplines of ICU are [unidisciplinary units].

 Medial intensive care including coronary for patients with myocardial infraction.
 Surgical intensive care looking after post operative cases needing intensive treatment and care

 Intensive care for burns-As burns requires specialized aseptic are and fluid replacement.

 Neonatal nursery for abnormal delivery premature babies normally near the delivery room with

therapy requiring life exchange transfusion, incubator treatment with respiratory distress

syndrome, trachoma esophageal fistula

 Dialysis unit for haemodialysis and peritoneal dialysis.

Multi-disciplinary units:

To need strict supervision, extracts ordinary care by specialized staff often will mechanic aids to

support the vital functions like

 Prolonged ventilation, cardiac monitoring and phasing.

 Biochemical corrections of severe metabolic acidosis like diabetic coma, uremia coma.

 Cardiac irregulations

Physical facilities:

 As 24hrs care is required for each patient, adequately trained staff is difficult to obtain you have

to see that all like saving drugs are continuously available. Special care has to be taken and

lifesaving equipment are kept in good condition. Hospital has to formulate policy and establishing

standards for admissions into and discharge from the units. Beds should always be available to the

needy patients. Patients may be unwilling to be transferred from the ward to the unit if they believe

that it is for terminal care.

 Patients relatives are very much worried to the critically ill patients and they remain with the

patients. Hence there is need to provide waiting, sleeping and toilet facilities. Periodical relay of

the information should be given to the relatives about the patients.

Design:

Location of the unit should be near the theatre and emergency to transmit patients quickly.

Location to find such a place in the existing hospital is very difficult. It is difficult to determine

the size of the unit 7-10% of the patents of the hospital may require intensive care you cannot have

a unit with less than 5 beds or more than 15 beds if we need more than 15 beds, we should have

two unit separately. To find space for the size require is very difficult. As each bed needs mined

is very difficult. As each bed needs minimum of 100 sq.ft. to fine 1000 sq. ft. in the existing

hospital is a problem.

Equipment requirements:

The essential equipment and drugs

 Life saving drugs and electrolyte solutions

 Tracheotomy and incubations set

 Dressing trolleys, dressing theratomy and a pleural drainage.

 Emergency trolleys for cardio pulmonary resuscitation ventilators.

 Cardio scope and Defibrillators

 Pace makers, incubators

 O2 tanks, hypothermia machines with electric thermometer, patients ministering system

exhibiting pulse, B.P and ECG at each be head.

 For cardiac cases, equipment to register arrhythmias and produce visual and audible signals.

 O2 and suction supply, Minimum 4-6 electrical points for each bed call systems for patients in

telecommunicating systems with alma in each room for the staff.

 Power supply and special earthling system is provided. Tranquilizers should be placed is

provided Tranquilizers should be placed on monitors. Sufficient space for one bed.

4. POST – OPERATIVE WARD

Recovery room (120 sq. Ft): These are now beginning to be generally required. They will from

part of the theatre suite and not of the wards. They should be in charge of nurses who have been

trained in the problems of post anesthetic recovery. Patients are held in the recovery room until

they have regained consciousness (but not over-night). The aim of the recovery room is two-fold.

 If the patient has a sudden hemorrhage or collapse in the recovery; room, the surgeon who

operated is immediately available. That is not the case that the patient has returned to the ward.

 If there are a number of operations from single wards, as usually happens on the returns of the

patient direct from the theatre, a nurse must be detailed to watch his post-anesthetic recovery. A

nurse also has to accompany the next case to the there. The ward staff may thus be strained to the

point of immobilization relative to the needs of other cases in the ward. Also, necessity will compel

that the post-operative cases will be watched by very junior nurses who probably know little about

it. Recovery rooms are thus benefic to the patient’s welfare and a relief to the ward nursing staff
they should include a sluice and utility room. Note: As these rooms will from part of the theatre

suit, precautions against will be necessary.

5. OUTPATIENT DEPARTMENT

The advantage of an outpatient department or an OPD is that most of the investigations and

treatments can be done here without admitting a patient, thus bringing down the cost of medical

expenditure.

The scope of an OPD includes the following:

• consultation and investigation

• preventive and promotive health care

• rehabilitation services

• health education

• counselling

An OPD is, usually, located at the entrance of a hospital. It must be separate from the inpatient

area connected to it. It should have an easy access to the Medical Record Department (MRD), X-

ray room, laboratory, pharmacy and billing counter. It must be easily accessible to the casualty but

separated from it too.

6. OPERATING THEATER

An operating theater (also known as an operating room (OR), operating suite, or operation suite)

is a facility within a hospital where surgical operations are carried out in an aseptic environment.
Historically, the term "operating theater" referred to a non-sterile, tiered theater or amphitheater in

which students and other spectators could watch surgeons perform surgery. Contemporary

operating rooms are devoid of a theater setting, making the term "operating theater" a misnomer.

Operating rooms are spacious, in a cleanroom, and well-lit, typically with overhead surgical lights,

and may have viewing screens and monitors. Operating rooms are generally windowless, though

windows are becoming more prevalent in newly built theaters to provide clinical teams with

natural light, and feature controlled temperature and humidity. Special air handlers filter the air

and maintain a slightly elevated pressure. Electricity support has backup systems in case of a black-

out. Rooms are supplied with wall suction, oxygen, and possibly other anesthetic gases. Key

equipment consists of the operating table and the anesthesia cart. In addition, there are tables to

set up instruments. There is storage space for common surgical supplies. There are containers for

disposables. Outside the operating room, or sometimes integrated within, is a dedicated scrubbing

area that is used by surgeons, anesthetists, ODPs (operating department practitioners), and nurses

prior to surgery. An operating room will have a map to enable the terminal cleaner to realign the

operating table and equipment to the desired layout during cleaning. Operating rooms are typically

supported by an anaesthetic room, prep room, scrub and a dirty utility room.

Several operating rooms are part of the operating suite that forms a distinct section within a health-

care facility. Besides the operating rooms and their wash rooms, it contains rooms for personnel

to change, wash, and rest, preparation and recovery rooms(s), storage and cleaning facilities,

offices, dedicated corridors, and possibly other supportive units. In larger facilities, the operating

suite is climate- and air-controlled, and separated from other departments so that only authorized

personnel have access.

Temperature and surgical site infections (SSI).

The current operating room design temperature is between 65 and 75 °F (18 and 24 °C). Operating

rooms are typically kept below 73.4 °F (23 °C) & room temperature is the most critical factor in

influencing heat loss. Surgeons wear multiple layers (surgical gowns, lead aprons) and may

perspire into an incision if not kept cool; excessive heat may also decrease concentration and

increase the frequency of errors. Higher temperatures increased subjective physical demand and

frustration of the surgical staff. One option is to heat the patient to prevent surgical site infections

(SSI) and keep the surgical team cool. There is a 3-fold increase in infection for every 1.9 degree

Celsius body temperature decrease and radiation is the major cause of heat loss in patients, and

convection (through air) is the second cause of heat loss. In the first hour it is common for healthy

patient’s temp decrease 0.5-1.5 °C as anesthesia causes rapid decrease in core temperature. One

study found that the most efficient method of maintaining normothermia included using warm

wraps and a heating blanket (commercially known as a Bair Hugger). Additionally, pre-warming

for thirty minutes may prevent hypothermia.

Operating room equipment

• The operating table in the center of the room can be raised, lowered, and tilted in any direction.

• The operating room lights are over the table to provide bright light, without shadows, during

surgery.

• The anesthesia machine is at the head of the operating table. This machine has tubes that

connect to the patient to assist them in breathing during surgery, and built-in monitors that

help control the mixture of gases in the breathing circuit.

• The anesthesia cart is next to the anesthesia machine. It contains the medications, equipment,

and other supplies that the anesthesiologist may need.

• Sterile instruments to be used during surgery are arranged on a stainless steel table.
• An electronic monitor (which records the heart rate and respiratory rate by adhesive patches

that are placed on the patient's chest).

• The pulse oximeter machine attaches to the patient's finger with an elastic band aid. It measures

the amount of oxygen contained in the blood.

• Automated blood pressure measuring machine that automatically inflates the blood pressure

cuff on a patient's arm.

• An electrocautery machine uses high frequency electrical signals to cauterize or seal off blood

vessels and may also be used to cut through tissue with a minimal amount of bleeding.

• If surgery requires, a heart-lung machine or other specialized equipment may be brought into

the room.

• Advances in technology now support hybrid operating rooms, which integrate diagnostic

imaging systems such as MRI and cardiac catheterization into the operating room to assist

surgeons in specialized

Surgeon and assistant equipment

People in the operating room wear PPE (personal protective equipment) to help prevent bacteria

from infecting the surgical incision. This PPE includes the following:

• A protective cap covering their hair

• Masks over their lower face, covering their mouths and noses with minimal gaps to prevent

inhalation of plume or airborne microbes

• Shades or glasses over their eyes, including specialized colored glasses for use with different

lasers. a fiber-optic headlight may be attached for greater visibility

• Sterile gloves; usually latex-free due to latex sensitivity which affects some health care

workers and patients

• Long gowns, with the bottom of the gown no closer than six inches to the ground.

• Protective covers on their shoes

• If x-rays are expected to be used, lead aprons/neck covers are used to prevent overexposure to

radiation

The surgeon may also wear special glasses that help him/her to see more clearly. The circulating

nurse and anesthesiologist will not wear a gown in the OR because they are not a part of the sterile

team. They must keep a distance of 12-16 inches from any sterile object, person, or field.

7. PAEDIATRIC WARD

Paediatric ward contain a 15-bedded ward for admitting children between the age of 2-5 years.

This ward will be designed so that mothers can remain with their children to ensure care and

feeding. These wards will also have an adjacent dining and waiting area for use by mothers and

attendants. Additionally, this ward should have a small play area, which should be safe,

comfortable, well ventilated, have adequate natural lighting, and toys, games, crafts, and other

activities for children of different ages. The play area will be located adjacent to or near the

paediatric ward depending on the availability of adequate space, but not inside the ward. A

caretaker should be assigned to this area for maintenance, ensuring cleanliness and taking care of

children. Additionally, the area should be under constant supervision of designated IPU nursing

staff. It must be ensured that no medical procedures are performed in play area.
Services for newborns and under 5-year children

Newborn and paediatric care are two critical but distinct pillars in Nigeria healthcare delivery

system. Both encompass community level interventions, focusing on disease prevention and health

promotion; as well as specialized health facility-based curative services. The benefit of these

services is further supported by a mechanism for timely identification and prompt referral of sick

newborns and children. The reduction of the rate of morbidity requires a focus on community-

based interventions and health system strengthening at the primary care level, while the reduction

of newborn and under five mortality depends largely on the strengthening of facility-based curative

services.

Guiding principles

• Respecting the rights of every child (and mother) to stay safe and with dignity
• Child friendly environment

• Providing integrated newborn and child health services in accordance with standard protocols

and with required competence

• Designing the infrastructure for easy mobility and comfortable stay

• Training the service providers for necessary behavioural and technical skills

• Due compliance to infection prevention and bio-medical waste management guidelines

• Establishing assured referral linkages at the community and different levels of health facilities

• Monitoring quality of service delivery and quality improvement

• Ensuring functional grievance redressal system both for client and service providers

• Assessing client satisfaction periodically

8. FAMILY PLANNING

DEFINITION OF TERMS

1. Client refers to the patient or beneficiary of reproductive health care.

2. Contraceptive refers to any safe, legal, effective and scientifically proven modern family

planning method, device or health product, whether natural or artificial, that prevents pregnancy

but does not primarily destroy a fertilized ovum from being implanted in the mother’s womb in

doses of its approved indication as determined by the Food and Drug Administration (FDA).

3. Family Planning (FP) refers to a program which enables couples and individuals to decide freely

and responsibly the number and spacing of their children and to have the information and means
to do so, and to have access to a full range of safe, affordable, effective, non-abortifacient modern

natural and artificial methods of planning pregnancy

4. Informed Choice and Voluntarism means effective access to information that allows individuals

to freely make their own decision, upon exercise of free choice and not obtained by any special

inducements or forms of coercion or misinterpretation, based on accurate and complete

information on a broad range of reproductive health services.

5. Interpersonal communication and counseling (IPCC) refers to a face-to-face, verbal and non-

verbal exchange of information. Effective IPCC between health care provider and client is one of

the most important elements for improving client satisfaction, compliance and health outcomes.

6. Management of complications refers to an initial assessment confirming the presence of

complications, medical evaluations, counseling of the patient regarding medical condition and

treatment plan, prompt referral and transfer if patient requires treatment beyond the capability of

the facility, stabilization of emergency conditions and treatment of any complications (both

complications present before treatment and complications that occur during or after the treatment

procedure), conduct of appropriate procedures, health education, and counseling on family

planning, responsible parenthood, and prevention of future complications, among others.

7. Marginalized refers to the basic, disadvantaged, or vulnerable persons or groups who are mostly

living in poverty and have little or no access to land and other resources, basic and social economic

services such as health care, education and water and sanitation, employment and livelihood

opportunities, housing, social security, physical infrastructure, and the justice system. 8. Modern

methods of Family Planning (MFP) refer to safe, effective, non-abortifacient and legal methods or

health products, whether natural or artificial, that are registered with the Food and Drug
Administration (as applicable) to plan pregnancy. Modern natural methods include Billings

Ovulation or Cervical Mucus Method, Basal Body Temperature, Symptothermal Method,

Standard Days Method, Lactational Amenorrhea Method, and other method deemed to be safe,

effective, and natural by the Department of Health (DOH). Modern artificial methods and/or health

products include oral contraceptive pills, condoms, injectables, intrauterine devices, No Scalpel

Vasectomy, Bilateral Tubal Ligation, sub-dermal implants, and any other method deemed to be

safe, and effective by the DOH. 9. Natural Family Planning (NFP) refers to a variety of modern

methods used to plan or prevent pregnancy based on identifying the woman’s fertility cycle

10. Poor refers to members of households identified as poor through the National Household

Targeting System for Poverty Reduction (NHTS-PR) by the Department of Social Welfare and

Development (DSWD) or any subsequent system used by the national government in identifying

the poor.

11. Private Sector refers to the key actor in the realm of the economy where the central social

concern and process are mutually beneficial production and distribution of goods and services to

meet the 3 physical needs of human beings. The private sector comprises of private corporations,

households, and non-profit institutions serving households.

12. Reproductive Health (RH) refers to the state of complete physical, mental and social well-

being and not merely the absence of disease or infirmity, in all matters relating to the reproductive

system and to its functions and processes. This implies that people are able to have a responsible,

safe, consensual, and satisfying sex life, that they have the capability to reproduce and the freedom

to decide if, when, and how often to do so. This further implies that women and men attain equal

relationships in matters related to sexual relations and reproductions.

13. Responsible Parenthood (RP) refers to the will and ability of a parent to respond to the needs

and aspirations of the family and children. It is likewise a shared responsibility between parents to

determine and achieve the desired number of children, spacing and timing of their children

according to their own family life aspirations, taking into account psychological preparedness,

health status, sociocultural and economic concerns consistent with their religious convictions.

14. Service Delivery Network (SDN) refers to the network of health facilities and providers within

the province- or city-wide health systems, offering a core package of health care services in an

integrated and coordinated manner. This is similar to the local health referral system as identified

in the Local Government Code.

15. Unmet need for modern family planning refers to the number of women who are fecund and

sexually active but are not using any modern method of contraception, and report not wanting any

more children or wanting to delay the birth of their next child

ESTABLISHING OR ENHANCING THE PROVISION OF FAMILY PLANNING

SERVICES IN HOSPITALS

The following steps shall be carried out to jumpstart FP service provision in the facility:

1) Appoint the RH Officer or focal person to manage FP service delivery in the hospital

2) Assess current capacity to deliver FP services

3) Identify action points to establish or enhance FP services in the hospital

4) Determine an appropriate management structure or implementation arrangement that will

oversee provision of FP services in the hospital

Step 1: Appoint a focal person (FP Coordinator) who will lead the assessment, organize a team,

and eventually manage FP service delivery. The Chief of Hospital shall designate a Family

Planning Coordinator or focal person who shall be in charge in the rapid assessment of the current

status of FP services being provided in the different units of the hospital. 1

Step 2: Assessing Current Capacity to Deliver Specific Family Planning Services. The FP

Coordinator shall oversee the assessment of the current status of FP services in the hospital. The

designated officer should be familiar with operations of the different sections/units of the hospital

as well as capacity to manage the assessment process by coordinating with all concerned units.

Knowledge on the different FP services is preferred but not necessary.

To carry out the assessment activity, the FP Coordinator shall perform the following tasks:

a. Organize the assessment team

b. Orient the team on the use of the Assessment Checklist

c. Schedule and undertake conduct of assessment activity

d. Consolidate results of the assessment

Step 3: Identify Action Points to Establish or Enhance Family Planning Services in the Hospital

Based from the results of the capacity assessment, list down the gaps that have been identified in

the previous step and determine appropriate interventions

A. Enhance Existing Family Planning Services in the Facility Determine if existing services in the

facility need further improvements. Ensure that there are adequate FP commodities and supply,

enough pool of trained health providers, appropriate space to deliver the service and enough

information materials to generate demand

B. Determine and Prioritize Hospital Units that will be Developed/ Enhanced to Deliver

Appropriate Family Planning Services Hospitals are to deliver the full range of FP services as part

of the service delivery network in their locality

The following points can be considered in addressing gaps:

• Identify the requirements for the hospital to deliver the service. Determine the following: o

Appropriate space to provide the service (with provision of auditory and visual privacy)

• Determine the cost and source of funds for each item required.

• Identify items that can be supported by hospital resources

C. Coordinate with the Provincial Health Office for LGU-owned Hospitals and the DOH Regional

Office for DOH Regional Hospitals and Medical Centers for Assistance Hospitals are expected to

support or have resources for expendable supplies, procurement and maintenance of instruments

and equipment, maintain a pool of trained personnel and support to implementation of logistics

management and information system, reporting and recording mechanisms to monitor progress.

Step 4: Determine an Appropriate Management Structure or Implementation Arrangement that

will Oversee Provision of Family Planning Services in the Hospital The designated FP Coordinator

in the hospital facility shall be the focal person who will manage the provision of specific FP

services in the hospital. He/she is responsible for setting up service provision in the various units

of the hospital. This shall be accomplished through the following activities:

a. Identify the FP providers who have acquired appropriate skills and competencies who will

provide services in the different units of the hospital. While it is not necessary to have 1 FP staff

designated in each unit of the hospital, the offices should be able to set appropriate schedules to

provide these units when required.

b. Orient other staff in the hospital on the availability of services and ensure that interested and

potential FP clients have been properly informed about availability of FP services in the facility

c. Organize the team of FP providers in the hospital and plan out how the different FP services

will be offered in the different units in the facility

d. Determine logistical requirements to implement FP services which shall be included in the

annual plan of the hospital; determine which areas will require technical assistance from PHO or

Regional Health Office

e. Conduct regular monitoring and evaluation of FP service delivery in the hospital

f. Setting up proper recording and reporting of services provided in the different units; consolidate

reports for submission to PHO or appropriate facility conduct quarterly management meetings.

9. OPHTHALMOLOGY

Ophthalmology is a branch of medicine that deals with the diagnosis and treatment of eye

disorders. An ophthalmologist is a physician who specializes in eye care. The credentials include

a degree in medicine, followed by additional four to five years of residency training in

ophthalmology. Residency training programs for ophthalmology may require a one-year internship

with training in internal medicine, pediatrics, or general surgery. Additional specialty training (or

fellowship) may be sought in a particular aspect of eye pathology. Ophthalmologists are allowed

to prescribe medications to treat eye diseases, implement laser therapy, and perform surgery when

needed. Ophthalmologists typically provide specialty eye care - medical and surgical, and they

may participate in academic research on eye disorders.

Following are examples of examination methods performed during an eye examination that

enables diagnosis

• Ocular tonometry to determine intraocular pressure

• Refractor assessment

• Retina examination

• Slit lamp examination

• Visual acuity

Specialized tests

• Optical coherence tomography (OCT) is a medical technological platform used to assess

ocular structures. The information is then used by physicians to assess staging of

pathological processes and confirm clinical diagnoses. Subsequent OCT scans are used to

assess the efficacy of managing diabetic retinopathy, age-related macular degeneration,

and glaucoma.

• Ultrasonography of the eyes may be performed by an ophthalmologist.

Ophthalmology includes subspecialties that deal either with certain diseases or diseases of certain

parts of the eye. Some of them are:

• Anterior segment surgery

• Cornea, ocular surface, and external disease

• Glaucoma

• Neuro-ophthalmology

• Ocular oncology

• Oculoplastics and orbit surgery

• Ophthalmic pathology

• Paediatric ophthalmology/strabismus (misalignment of the eyes)

• Refractive surgery

• Medical retina, deals with treatment of retinal problems through non-surgical means

• Uveitis

• Veterinary specialty training programs in veterinary ophthalmology exist in some countries.

• Vitreo-retinal surgery, deals with surgical management of retinal and posterior segment

diseases