Philosophy of Nursing Service Department in Hospital
Philosophy of Nursing Service Department in Hospital
Philosophy of Nursing Service Department in Hospital
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Formulate and interpret nursing service policies in the context of general
policies of the hospital for improvement of nursing care.
Assist the hospital authorities for preparation of budget by involvement.
Participate in interdepartmental programmes and other programmes
conducted by other disciplinaries for improvement of hospital services.
INTRODUCTION :
Fixed equipments is not a part of the structure of the building but is attached
to its walls or floor such as strelizers and sinks.
Refrigator
Air conditioners
Tables, screen, labour room tables
IV stands, bed side lockers
Other diagnostic equipments like
Auto analyzers
Cell counter
Eliza readers
Aterial blood gas analyser
Pulse oximeter
Defibrillator
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Cardiac monitors
Specialized endoscopes
Boyle ‘s apparatus
Oxygen and nitrous gas cylinder
Cooking LP gas cylinders
Incinerators for biowaste management
1) Scope of services
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o Centrifuge – a small centrifuge that can accommodate six 15ml
tubes should be available.
o Water bath – used for stabilising temperature at 25, 37, 42, or
56degree Celsius.
o Incubator/oven- a small hot air oven to carry out standard
cultivations and sensitisations.
Refrigerator – an ordinary household refrigerator with a freezer unit, for
storing preparations, vaccines, blood etc.
istillation and purification apparatus - it should be made of metal that
resists acid, and alkali and should be free standing.
Portable electrocardiograph
Defibrillator( external)
Portable anaesthetic unit – 2 small aesthetic units should be obtained,
complete with a range of masks.
Respirator – it should be applicable for prolonged administration during
post operative care.
Dental chair unit- a complete unit should be available to carry out
standard dental operations.
Suction pump –one portable and one other suction pump are required.
Operating theatre lamp- one main lamp with at least 8 shadows lamp and
an auxiliary of 4 lamp units.
Delivery table- it should be standard and manually operated.
Diathermy unit – a standard coagulating unit which is operated by hand
or foot switch, with variable poor control.
4) Other equipment
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autoclave – for general stabilisation
Small sterilisers- for specific services- eg. Stabiliser
cold chain and other preventive medical equipment
ambulance
Equipment which is not in good repair or ready for use is often more
troublesome than if it were missing altogether. The nurse or doctor and the
patient may be ready for a treatment and the light will not work , the stove fails
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to heat, scissors refuse to cut. The situation is not only embarrassing but is
wasteful of time and wearing on the nerves of all concerned. Unclean or
unsterile equipment causes delay especially if discovered after all else is in
readiness for a treatment .
The preparation for a single treatment may take the nurse to several
rooms for equipments. This is unnecessary use of time and energy .For
convenience in working, all necessary equipments and supplies for a
particular treatment should be kept in one unit even though it may mean the
duplication of materials in more than one place. For eg. , a hot water bag,
cover, thermometer and a pitcher for filling the bag should be in one room
near the source of water supply. If trays for sterile treatments are prepared in
one room and unsterile treatment in another there needs to be a supply of
rubber protectors, draping, and cleansing materials in both rooms.
1. General store
2. Dietary department and
3. Pharmacy department
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When planning for the purchase of articles , budgeting is done not only for the
actual price of articles but also for the additional costs that are involved such as
;
Selection of article- while buying articles it has to meet the standards. Indian
Standards Institution is the national agency set up to bring standardisation of
articles in India. Articles that meet the criteria specified by the Indian Standard
Institution will be marked by ISI markings. The articles bought should provide
safety to the patient and personnel. Faulty instruments and equipments cause not
only inconvenience in the patient care, but also it may cause the loss of life.
Purchasing article:
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All surgical instruments used in a hospital should be sterilisable and
they should stand the tests for leakage , hydraulic pressure tests for
bursting etc
Should have accuracy in measurements
Should have ease of operation
Most hospitals have a central department where equipments and supplies are
stored and from which they are distributed to the units. The type of materials
that is kept in the central supply room varies from hospital to hospital. In some
hospital the central soppy room deals with only the sterile supplies and ward
trays. In other hospitals all types of equipment such as oxygen, suction, ward
trays, catheters, syringes etc are stored here.
Standards
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Exchange system
Inventory
Requisitions
STANDARDS :
These are established quantities which are required to meet the needs of a
particular ward division. For eg. A ward may have a standard of six 2 cc.
Syringe which is the number the head nurse should keep on hand at all times.
when is broken the pieces are exchanged for a new one if this is the system
which exists in the institution. If one is lost , it should be replaced, but total
number should not exceed six which is the standard for her ward.
1. The bed complement for equipment, the census for supplies. Supplies
being expendable, are ordered frequently, either daily or weekly as a rule. More
will be needed if the ward is fully occupied than if it is half or three-fourths full
of patients. For supplies, in other wards, the standard is not a set figure but is
fixed only to the extent of a given number per patient. Equipment, on the other
hand ,is provided on the basis of the maximum number of patients, that is the
bed complement.
2. Type of service: A surgical ward will need more instruments and
dressings, a medical ward more syringes and physical examination equipment.
3. Age of patients: Children need different types and amounts of equipment
and supplies than adults require.
4. Sex: Men and women sometimes require different kinds of equipment.
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6. Cost of items: A head nurse might have as large a standard of inkwells as
she wishes whereas she probably will be limited to one costly ophthalmoscope.
EXCHANGE SYSTEM :
INVENTORY :
REQUISITIONS:
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A requisition is a written order for supplies and equipment or for their repair,
Requisitions are made by the individual who is responsible for the maintenance
of supplies and equipment. This may be the head nurse or someone else
specifically delegated the responsibility. She should be wholly familiar with the
needs of the ward and the method of ordering. It is important that the same
individual do the ordering from week to week in so far as possible because she
will have a better knowledge of the ward's needs.
Ideally there would be just enough supplies on a ward to meet the day's
demands. Reordering is generally done when the amount on hand reaches a
prescribed minimum. The minimum is set so that there will be a small reserve
on hand when the new stock arrives.
FREQUENCY OF ORDERING :
Hospitals usually designate specific times for ordering certain types of
materials depending upon the following factors :
1. Perishability : foods, such as milk, eggs, fruit must be ordered
daily.Sterile supplies which may become outdated are also ordered
each day or every other day.
2. Storage space on the wards. There may not be room enough for
more than a
week's supply of some items.
3. Cost and convenience of handling and filling requisitions and of
transportation . It is not often practical to have deliveries more frequently
than once a week for most nonperishable supplies. New equipment to 'ring
up the standard is often ordered on a special day such as the first ordering
day of each month.
Requisition Forms.:
The forms used for ordering vary with the hospital. Some have one form
for all supplies and equipment with a separate one for repairs or construction.
Some have different colors designating from which department the supplies
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come—storeroom, dietary department, surgical supply room, laboratories,
housekeeping department, linen room, pharmacy. Some hospitals use printed
forms, one for each department, listing available articles and the quantities to
be ordered . Sometimes standards for ordering, such as. five pounds soap
powder per ward per week, one cake of soap per patient per week are
included. According to this standard and the amount on hand the head nurse
indicates the quantity needed.
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Requisitions for Exchange Items:
Articles for exchange may be listed on the regular requisition form or a
special one. Complete specifications are necessary as with other requisitions.
Duplicate copies of the order may be required, one to accompany the articles
for exchange, the other to be sent with the set of requisitions for approval.
Requisitions for Replacements:
To bring up the supply to standard or to increase the standard, requisitions
accompanied by a statement explaining their need may be required .
Requisitions for Repair or Construction:
These are usually written on a special form and give an exact description of
the job to be done.
Method of Ordering Supplies.
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in this way may be wasted. This is one of the important reasons why ordering
should be done by the same individual consistently and certainly never by one
who has not received complete instructions and supervision
Ordering Linen.
Methods of ordering linen often vary from those of other supplies.
METHOD 1.
Sometimes each ward is issued a standard supply of linen in which
case it is labeled with the name of the ward and the date of issue.
The latter helps to determine the life of the article. After laundering,
the linen is sorted and returned to the proper win.
Maintaining standards is achieved by inventory and replacements for
worn or lost linen in the same way as other equipment is replaced.
This system requires the time of maids to sort it by wards and it also
permits linen to be stocked on the shelves when the census is light.
A larger total supply is therefore needed than would otherwise be
necessary.
METHOD 2.
Some hospitals consider it less expensive and more efficient to use a
central linen room. The linen which is issued is marked with the name
of the hospital but is not designated for a specific ward.
All linen is returned after laundering to the central linen room, Sorting
of torn articles is done either to the laundry or in the linen room,
preferably the former because tears are more easily detected as articles
are being folded.
Mending is done in the sewing room. When a central linen room is
used distribution to the wards may be accomplished by one of several
methods.
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One method requires a requisition from the head nurse who estimates
the ward needs on the basis of a standard; that is, one sheet per patient
per day plus enough extras for patients who need an additional supply
and enough to make up fresh beds following the discharge of patients.
A daily shelf count must be made as a guide in ordering. This method
involves considerable time on the part of the head nurse and is apt to
lead to shortages due to hoarding on wards where needs are not
accurately estimated.
METHOD 3.
TO overcome these disadvantages another distribution method is
sometimes used. Linen issued to the wards daily or at periodic
intervals in accordance with a fixed standard in relation to the number
and type of patients and the number of discharges.
The calculation of needs is made in the linen room. A shelf count is
made on each ward by a member of the linen room staff or by the
ward maid and the amounts on hand are deducted from the estimated
needs.
This method saves considerable time for the head nurse and works in a
satisfactory manner in many institutions where it has been tried.
Sometimes linen is put up in bundles, one for each patient, containing
the usual daily allotment of a sheet, pillow case, face towel, and such.
An extra supply of each item is sent for emergency use and for
patients who may require additional linen. Complete sets of linen each
containing the items necessary to make up a unit are also sent, the
number corresponding with the number of patients to be discharged.
To minimize handling and save time for the ward staff the daily
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bundles may be delivered directly to patient's rooms the afternoon or
evening before they are to fee used
In a busy ward, the head nurse cannot carry responsibility for all
details of ward management.
Indeed if she tries to do so she will not be a very successful
administrator. Some aspects of management in regard to supplies and
equipment can easily be delegated to other individuals.
A student nurse may have a short experience in assuming
responsibility for supplies and equipment, usually in connection with
her treatment room assignment.
In some instances a nurse's aide or the ward clerk can perform the
mechanical aspects of this function.
A non-nurse assistant could relieve the head nurse of the entire
responsibility in this area
Any one of these individuals could easily keep a check on the amounts in
cupboards or on shelves ready for use making sure that there is always enough
available. The excess is kept in storage and a small amount removed at a time
to keep the shelves stocked Workers should be instructed to see that the oldest
supplies are placed where they will be used first and to remove outdated
surgical goods for resterilization. Supplies need to be kept well labeled and
arranged so that they can be easily located and quickly identified. Both
equipment and supplies must be protected against damage or deterioration.
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KEEPING THE TREATMENT ROOM IN ORDER.
If equipment is sterilized on the ward, this responsibility as well as the
task of keeping the treatment room in order and the cupboards and drawers
clears can be specificallv delegated to a nurse with a maid or aide to assist
her. It should be the definite responsibility of one individual to make sure
that ample supplies are available for the evening and night nurses, especially
when it is difficult to obtain materials from a central source after certain
hours.
TAKING INVENTORY.
The individual assigned to the task of handling supplies and equipment
may also take the periodic (daily and weekly) counts of equipment as
necessary to keep track of it. She keeps the head nurse informed of losses
and misplacement of equipment and shortages in supplies. She also may
make the daily or weekly report of supplies on hand to be used by the head
nurse in writing requisitions. Preparation of broken or worn equipment for
exchange and compiling the necessary lists is a function the head nurse
herself need not perform.
The only way to ensure the efficient management of the activities associated
with supplies and equipment is to establish a definite routine and set up
specific directions for its accomplishment. This material should be placed in
writing and used for teaching the person to whom the duties art delegated.
Directions should be in usable form and located conveniently for reference.
Time is saved when methodical measures are adopted for mechanical
functions.
REPORTING DEFICIENCIES.
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It should be the function of every individual to report breakage,
equipment which is in need of repair and low stocks of material. Again, if
there is to be efficiency, a definite system for reporting should be instituted.
Preferably a written memorandum is made of the information to be reported.
A notebook or a spindle with pencil and paper at hand are useful if they are
located in a convenient place, are checked daily, and if necessary measures
are taken to correct the shortages. A system for tagging impaired equipment
and a definite place for depositing it should be known to all. Here again it is
advisable that a uniform system be adopted throughout the hospital to save
confusion. Daily review of supplies on hand and frequent checking of the
condition of electric, plumbing and other equipment will minimize the
amount of reporting which the staff will need to do.
The head nurse will find it advisable to review with nurses who are new
to the ward the care to equipment which is specific for the service, stressing the
points which experience has shown to need emphasis. If she can arrange to give
orientation conferences for new interns and medical students, information
relative to the doctors' responsibility for the care of equipment and economical
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use of supplies may be included in the discussion. Conferences of this nature
pay large dividends in general good feeling and cooperation as well as in
economies.
2. Preparation of lists which give amounts and types of sterile goods
needed for dressings and treatments characteristic of the service :
It is wise to come to agreement on matters of this type with the resident of
the service. The lists should be signed by both the head nurse and the resident
and kept in an accessible place. They may be posted on a bulletin board in the
treatment room or placed on cards in a file box. A very convenient method is to
encase them in sheets of washed x-ray film and file them in a loose-leaf note-
book. This permits the lists to be used easily and prevents soiling and wear.
3. Use of illustrative material and bulletin boards to emphasize the costs
of equipment and the need for its careful handling.
Attractive posters and line drawings can be very effective A display of
damaged materials indicating their costs attracts a great deal of attention.
Comparative studies of the cost of supplies or broken equipment are challenging
if the information is made attractive enough to be read. Posters or statements
indicating ways in which wasted money could have been profitably spent are of
interest to all groups. It is well known that any material on a bulletin board must
be attractive to be noticed and changed frequently if it is to be read. Posters can
often be saved and re-used as new groups of students and interns are assigned to
the service.
4. Group conference are an effective method of teaching :
Report on amount of breakage , if short and presented is an interesting way,
can produce discussion which leads to greater awareness of the problem a
display of the broken and worn equipment ready to be sent for exchange may be
accompanied by a discussion of causes and prevention of destruction
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CONCLUSION
Health care services are the result of a number of materials used in the process.
Supplies and equipment are a vital factor in the hospital economy. The hospital
must all times be supplied to meet daily needs and any emergency situation. At
the same time it must realize that idle materials represent a cash outlay which
brings no return. Supplies and equipment contribute in an important way to the
efficiency of the ward and to the quality of patient care.
BIBLIOGRAPHY :
Jean Barrett, Ward Management and Teaching, Konark publishers, fourteenth edition,
2003
Dr A G Chandorkar, Hospital Administration and Planning, Paras medical publisher,
first edition, 2004
http://currentnursing.com/nursing_management/planning_equipments_and_supplies_i
n_hospitals.html
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