I. Visiting and accompanying system
(a) Visiting patients should be in accordance with the specified time, two people at a time. Preschool children are not allowed to bring into the ward, and infectious patients are generally not allowed to visit and accompany.
(ii) Visiting a critically ill patient can be done with a critical notice and special arrangements can be made by the medical staff.
(3) Visitors must abide by the rules of the hospital, follow the instructions of the medical staff, not unauthorized access to medical records and other medical records, not to take the patient out of the hospital, do not talk about matters that hinder the patient's health and treatment, and do not sleep in the patient's bed. They should keep the ward clean and quiet, and are not allowed to smoke or drink alcohol. You should take care of public property and save water and electricity.
(d) Where the visiting and accompanying staff damage or lose hospital goods, they should be responsible for paying.
The management system of medicine cabinet in ward
(1) All medicines in medicine cabinet in ward can only be supplied to hospitalized patients according to their medical instructions, and other personnel are not allowed to take them privately.
(2) The medicine cabinet in the ward should be managed by a special person who is responsible for receiving and keeping the medicines.
(c) Regular counting and checking of medicines to prevent backlogs and deterioration. If any medicine is found to be precipitated and discolored, expired, or with fuzzy labels, it shall be stopped and reported to the Pharmacy Department for treatment.
(d) Poison, anesthesia, restricted drugs, should be set up for special drawer storage, strictly locked, and according to the need to maintain a certain number of base, after the use of strictly in accordance with the "Poison, anesthesia, restricted drugs management regulations".
(e) Pharmacy Department of the ward small medicine cabinet, should be regularly checked and verified whether the type and quantity of drugs, whether the phenomenon of expiration and deterioration, poison, anesthesia, restricted drugs management is in line with the provisions.
Three, ICU admission principles and the scope of disease
ICU is the admission of critically ill patients, where the vital signs are unstable and there is a hope of rescue, can be admitted to the ICU. in principle, to be hemodynamic stabilization and respiratory channel after the establishment of the ICU, so as to avoid the risk of danger on the way to the transfer.
Specific diseases:
(i) various kinds of severe shock: (ii) severe heart failure; (iii) severe myocardial infarction; (iv) severe cardiac arrhythmia; (v) acute lung injury, ARDS: (vi) severe respiratory failure: (vii) severe acute renal insufficiency; (viii) severe hepatic insufficiency; (ix) MODS (MOF); (+) DIC; (xi) severe metabolic dysfunction; (xi) severe metabolic dysfunction. ) severe metabolic dysfunction; (xii) coma; (xiii) severe fluid imbalance; (xiv) various kinds of severe poisoning; (xv) severe heatstroke; (xvi) severe trauma and multiple injuries; (xvii) crush syndrome; (xviii) fat embolism syndrome; (xix) severe obstetric complications; (xx) cardiopulmonary and cerebral resuscitation; and (xxi) post-operative period of major surgeries, operations and general anesthesia.
In principle, the following conditions should not be transferred to ICU
1. Infectious diseases.
2. The terminal state of various chronic diseases, such as advanced malignant tumors.
3. Economic conditions do not allow.
Four, ICU patient management
(a) ICU duties: maintenance of vital organ function, vital signs stabilization, correction of water-electrolyte balance imbalance, nutritional support, infection prevention and control, a variety of tests, monitoring.
(2) Clinical departments ICU must understand each other to collaborate. Serious compound injuries, cross-disciplinary patients, major changes in treatment programs, implementation, patients in and out of the ICU indications for the selection of issues, in principle, by the ICU and various departments **** with the consultation, the ICU must fully respect the views of the specialty treatment. When there is disagreement on the treatment plan, the consultation can be done through intra-hospital consultation. When the disagreement on the indications and the direction of referral cannot be resolved, the ICU director shall decide, with authority and responsibility.
(3) ICU must speed up the turnover and increase the utilization rate according to the priority of the disease.
(4) All systems related to medical management, such as: difficult patient discussion, death discussion, etc. are implemented in accordance with the unified regulations, and if necessary, the ICU and the relevant departments **** with the participation.
(5) ICU and clinical departments to implement the benefits *** enjoy, risk *** share the principle of distribution
V. Ward management system
(1) Ward by the head nurse is responsible for the management of the attending or senior residents to actively assist.
(2) In order to ensure a good working environment for intensive care and to prevent cross-infection, this room does not retain a chaperone, and family members may leave a phone number to keep in touch.
(3) Physicians at all levels are strictly required to perform their duties according to their job responsibilities. The chief physician checks the room at least once a week, the attending physician checks the room at least twice a week, and the critically ill patients check the room and make rounds at any time.
(4) Involving major rescue matters, need to immediately report to the chief of the department, and reported to the Medical Department and the relevant hospital leadership, in person to participate in the command of rescue. Involved in a variety of disputes over the treatment of patients should be promptly reported to the Medical Office and the relevant departments.
(v) keep the ward clean, comfortable, quiet, safe, avoid noise, walk lightly, close the door lightly, operate lightly, speak lightly.
(f) Medical staff must wear uniforms, neat and tidy, wear masks when necessary, no smoking in the ward.
(vii) staff must adhere to their posts, conscientiously fulfill the shift handover system, strictly implement the technical operating procedures, and should gradually establish a variety of critical patients rescue procedures and intensive care norms.
(viii) The head nurse is fully responsible for the custody of the ward property, equipment, and respectively assigned to special management, the establishment of accounts, regular inventory. If there is a loss, identify the cause in a timely manner and deal with it according to the regulations. When managers are mobilized, handover procedures should be done.
(ix) the room all kinds of rescue equipment and medicines should be well prepared to ensure that the management of a person, placed in a fixed, available at any time, and have a person to check, timely replenishment, updating, maintenance and disinfection.
VI. Reception and handling of medical disputes
(1) The receptionist should be responsible, listen patiently to the visitors, remember carefully, do not take any issue lightly, and do more to guide the work.
(ii) receptionists should be calm and collected, not immediately give a positive or negative answer. After investigation and analysis, patiently explain to the visitor. Before the medical dispute is discussed and a clear conclusion is made by the Medical Accident Appraisal Committee, no section or individual can give an unauthorized affirmative answer to the dispute.
(3) Where there is a dispute in the medical records by the Medical Department notified the case room for sealing, after the sealing of the medical records in addition to the person in charge of the medical disputes of the relevant personnel to review any individual has no right to borrow. If the department for case discussion by the department head or designate a person responsible for the custody and timely return to the case room, not scattered lost.
(d) If the dispute is caused by blood transfusion, transfusion, must immediately check the receipt of the process of vouchers, residual fluid promptly sent to the examination and the original packaging of the liquid properly sealed until the dispute is resolved. If the dispute is caused by drugs, be sure to save the empty ampoule or physical: such as a variety of instruments caused by the dispute, be sure to have witnesses after the scene inspection before leaving the scene.
(e) the dispute over the death, to mobilize the family within 48 hours to conduct an autopsy to find out the cause of death, such as family members do not agree to the autopsy can not be held responsible for the consequences of the consequences of disagreement with the autopsy is responsible for.
(6) for self-injury during hospitalization, suicidal tendency of patients to notify the family and the unit to take precautions, once found, such as patients with the possibility of resuscitation should be quickly carried out on-site resuscitation and immediately reported to the medical department and the security department. If you need to go to the rescue room to rescue and move is not destroying the scene, it is legal, such as patients without the possibility of rescue, patients should not move temporarily, through the security department, the public security organs for the record before moving. Missing patients during hospitalization should be designed to find and report to the security department, medical department, nursing department in a timely manner.
(VII) disputes once investigated and verified to give the patient's family to reply to the handling of disputes should be analyzed on the basis of the principles of characterization, treatment policy.
(viii) general medical disputes, the medical department managers can be resolved in a timely manner after investigation. Major medical events, disputes can not be resolved in a timely manner need to have a complaint material, and to be submitted for accident identification.
Seven, check-up system
(a) resident physicians every working day to participate in the check-up, observation of changes in the condition of the diagnosis, treatment, understanding of the sick and injured patients' thinking, life situation: the superior physician check-up, the physician should be prepared to report on the condition.
(2) The chief resident physician or physician on duty shall lead the resident, trainee and intern to conduct evening check-ups.
(3) The attending physician shall conduct general checkups and daily focused checkups on the patients in the group (ward) once a week. Check the medical care work, focusing on solving the diagnosis and treatment of difficult cases and clinical teaching.
(4) The chief of the department, the head (deputy) chief physician weekly checkup on the patients of this section once or the deputy chief physician weekly checkup twice, check the quality of medical care, solve the difficult problems, and organize clinical teaching in a planned manner. The attending physician, chief resident, head nurse and related personnel should accompany the room check.
(5) Physicians at all levels should strengthen their visits to patients before and after critical and major surgery and special examinations and treatments, grasp the changes in their conditions, deal with them in a timely manner in case of any situation, and report to the higher-level physicians or apply for consultation in case of any difficult problems.
(F) the head nurse organizes nursing staff to conduct a nursing checkup once a week, and if necessary, ask the head of the department, the chief (deputy) chief physician or attending physician to guide, check the quality of nursing care, study and solve difficult problems, combined with practical clinical teaching.
VIII. Physician on duty, shift handover system
(a) a duty physician, according to the situation can be added to the second line, the third line, and the establishment of duty log book.
(2) The physician on duty arrives at work before the end of the day, accepts medical work assigned by physicians at all levels, and makes ward rounds. Critically ill patients must do a bedside handover, and the physician in charge of the hospital bed shall not leave without the physician on duty being in place.
(3) beds in charge of residents should be key patients before the end of the patient's condition and treatment of advice into the shift book, on-duty physician should be a good record of the course of the disease, and choked into the duty log.
(4) The physician on duty is responsible for the timely handling of the patient's temporary situation, and in case of any difficult problems, he should consult a superior physician.
(E) the duty physician is responsible for emergency admissions of patients with preliminary diagnosis and treatment, should complete the emergency admissions medical records.
(6) The physician on duty is responsible for emergency consultation tasks within the hospital.
(vii) The physician on duty must be in his/her assigned position and indicate to the nurse on duty where he/she is going when he/she must leave for work.
(viii) The physician on duty the next morning should hand over the condition and treatment of emergency and priority patients.
Nine, transfer, transfer system
(a) the hospital is limited to technical and equipment conditions, for patients who can not be diagnosed and treated, by the departmental discussion or by the director of the department proposed by the medical department for approval by the president or the vice president in charge of the business, in advance, contact with the hospital of the transfer to obtain consent to the transfer of hospitals.
(2) If the patient needs to be transferred to a foreign hospital for treatment, the patient should be proposed by the chief of the department, reviewed by the medical department, and approved by the dean or vice president for business, and then reported to the provincial or municipal basic medical insurance office for approval of the formalities.
(3) patients transferred to the hospital, such as the estimate of the possible aggravation of the disease or death on the way, should be hospitalized to deal with the stabilization of the condition or the danger of passing, and then transferred to the hospital. Critically ill patients should be escorted by medical personnel when transferring to the hospital.