BEST PRACTICES TO BE INTRODUCED IN ALL HOSPITALS OF EASTERN RAILWAYS

(A) OPD

1. KEEP ONE SUGGESTION BOX IN OPD LOCKED. IT SHOULD BE OPENED EVERY WEEK & ALL SUGGESTIONS BE ENTERED IN A REGISTER & PUT UP TO SR.DMO-ADM WHO WILL SCRUTINISE & PUT UP TO CMS/MD FOR NECESSARY ACTION.

2. FIX ONE LCD TV & DVD PLAYER IN OPD WAITING AREA AT A HEIGHT OF ABOUT 6-7 FEET. HEALTH EDUCATIVE FILMS OR CARTOON FILMS MAY BE PLAYED TO KEEP PATIENTS HAPPY WHILE WAITING FOR THE DOCTOR.

3. USE PACKET SYSTEM FOR DRESSING & SUTURING. MAKE INDIVIDUAL PACKETS CONTAINING 1 ARTERY FORCEPS,1 TISSUE FORCEPS, 4-6 GAUZE PIECES, COTTON & A BANDAGE ROLL IN EACH PACKET FOR DRESSING & 2 MOSQUITO FORCEPS, 1 NEEDLE HOLDER, 1 TISSUE FORCEPS, 4-6 GAUZE PIECES,COTTON, 1 DRAW SHEET WITH ROUND HOLE & 1 BANDAGE ROLL IN EACH PACKET FOR SUTURING. KEEP ADEQUATE NO. OF THESE PACKETS STERILISED IN 2 DRUMS TO BE USED IN EACH PATIENT. ADEQUATE NO. OF REQUIRED INSTRUMENTS MAY BE LOCALLY PURCHASED AT DIVISIONAL LEVEL.

4. DISPLAY PERFORMANCE CHARTS IN EACH ROOM OF OPD COMPARED WITH LAST 2-3 YEARS

5. ADEQUATE NO. OF PATIENT TROLLIES & WHEEL CHAIRS WITH CUSHION SHOULD BE AVAILABLE IN OPD/ CASUALTY TO SHIFT THE INCOMING PATIENTS TO WARD. ALL PATIENT TROLLIES SHOULD HAVE 1 DRIP STAND & OXYGEN CYLINDER UNDERNEATH WITH DISPOSABLE O2 MASK/ NASAL CANULA COVERED IN A PVC BAG.

6. EACH MONTH/QUARTER, ONE EMPLOYEE FROM AMONG GROUP C & D STAFF SHOULD BE SELECTED AS THE "BEST EMPLOYEE OF THE MONTH / QUARTER" BY A TEAM OF 3 SUPERVISORY STAFF FROM DIFFERENT CADRES BY ROTATION. THE CRITERIA OF SELECTION SHOULD BE PUNCTUALITY, PERSONAL HYGIENE, DEDICATION TO DUTY, DISCIPLINE, ALWAYS IN UNIFORM; KNOWLEDGE OF FIELD, SPECIAL CONTRIBUTION TO PATIENT CARE ETC. CITATION WITH PHOTOGRAPH OF SUCH EMPLOYEES SHOULD BE DISPLAYED IN OPD TILL NEXT EMPLOYEE IS SELECTED.

7. LIST OF "MEDICAL FACILITIES AVAILABLE IN THE HOSPITAL" SHOULD BE DISPLAYED IN OPD ON A GLOW SIGN BOARD/ LCD BOARD

8. LIST OF HVS/CONSULTANTS AVAILABLE & THEIR DAYS & TIMINGS SHOULD BE DISPLAYED IN OPD

9. LOCATION CHART/MAP OF HOSPITAL WITH ROOM NO. SHOULD BE DISPLAYED ON EACH FLOOR OF HOSPITAL APART FROM OPD.

10. TOKEN SYSTEM SHOULD BE INTRODUCED FOR OPD PATIENTS

11. OPD REGISTRATION SHOULD BE COMPUTERISED & ALL MIC SHOULD BE BAR CODED WITH THE HELP OF PERSONNEL DEPTT.

12. AMBULANCE STAFF & HA/AYA SHOULD ALWAYS HELP IN SHIFTING PATIENTS FROM CASUALTY/OPD TO WARD

13. USE GLASS SYRINGES AUTOCLAVED WITH DISPOSABLE NEEDLES FOR INJECTIONS IN OPD. ALWAYS USE 24 G NEEDLED FOR IM/IV INJECTIONS TO AVOID PAIN & TRAUMA OF INJECTIONS.

(B) INDOOR WARDS

1. KEEP ONE CRASH CART WITH ALL EMERGENCY MEDICINES & INJECTIONS, AMBU BAG, LARYNGOSCOPE, ENDOTRACEAL TUBES, FACE MASKS, NASAL CANULAE, SUCTION CATHETERS & OXYGEN CYLINDER IN EACH WARD FOR USE IN EMERGENCY. THE CART MAY BE COVERED WITH A COVER WITH ZIP WHICH CAN BE SEALED TO AVOID PILFEREAGE. INJ.ADRENALINE SHOULD BE KEPT IN A SEPARATE BOX LABELLED IN RED SO AS TO LOCATE EASILY.

2. PROPER MEDICINE DISTRIBUTION TROLLY SHOULD BE MADE AVAILABLE IN EACH WARD. MEDICINES SHOULD NOT BE KEPT AS LOOSE TABLETS/CAPSULES. ONE TRANSPARENT PLASTIC BOX LABLEED WITH BED NO. ON ONE SIDE SHOULD BE USED FOR EACH BED FOR DISTRIBUTION OF MEDICINES. MEDICINES SHOULD BE DISTRIBUTED BY STAFF NURSE HERSELF & NOT HA/AYA

3. PROPER LINEN TROLLEY SHOULD BE PURCHASED TO CARRY LINEN IN WARDS.

4. WARD CLEANING PROTOCOL SHOULD BE PREPARED BY ANO/CHIEF MATRON& A DIARY BE MAINTAINED TO MONITOR CLEANING SCHEDULES IN EACH WARD.

5. NO DRY BROOMING SHOULD BE DONE IN WARDS. FOR WET MOPPING, PROPER MOPS WITH LONG STEEL HANDLES SHOULD BE USED. MOPPING SHOULD BE DONE UNIDIRECTIONALLY.

6. ALL STAFF SHOULD USE MASK & GLOVES WHILE HANDLING SOILED LINEN. NO LINEN SHOULD BE THROWN ON FLOOR BUT KEPT IN SOILED LINEN TROLLEYS.

7. ELECTRIC NEEDLE CUTTERS SHOULD BE USED TO BURN USED NEEDLES WHEREVER INJECTIONS ARE USED.

8. BIO-MEDICAL WASTE SHOULD BE PROPERLY SEGREGATED & DISPOSED OFF AS PER PCB GUIDELINES. HOSP.INFECTION COTROL COMMITTEE SHOULD KEEP A CHECK ON IT REGULARLY.

9. PROPER SIGNAGES (PREFERABLY LCD) IN THE ENTIRE HOSPITAL SHOULD BE AVAILABLE SO THAT PATIENTS DO NOT FIND IT DIFFICULT TO LOCATE ANY PLACE IN THE HOSPITAL.

10. ALL STAFF MUST IN PROPER UNIFORM WITH NAME LAPEL/ IDENTITY CARD WHILE ON DUTY.

11. PATIENT FEED BACK FORMS SHOULD BE FILLED UP AT THE TIME OF DISCHARGE & PUT UP TO CMS/ MD EVERY WEEK BY ANO/ CH.MATRON. THE GRIEVANCES & SUGGESTIONS IF ANY SHOULD BE LOOKED INTO IN A POSITIVE WAY TO IMPROVE THE SERVICES.

12. FOOD TO INDOOR PATIENTS SHOULD BE SERVED IN HOT CASES.

13. AQUA GUARD/ R.O.PLANTS SHOULD BE INSTALLED WITH WATER COOLER FOR SAFE WATER SUPPLY TO PATIENTS IN IPD AS WELL AS OPD. RES.CHLORINE SHOULD BE CHECKED BY H.I. EVERY DAY FROM HOSPITAL & PUT UP TO SR.DMO-ADM

14. ALL WINDOWS & DOORS IN WARDS SHOULD HAVE WIRE MESH TO PREVENT MOSQUITO/FLY NUISANCE.

15. UNIFORM HEALTH SLOGANS MAY BE DISPLAYED IN THE HOSPITAL IN HINDI/ENGLISH/BANGLA

16. CLEANING IN THE WARDS & OPD SHOULD BE MECHANISED. ADEQUATE NO. OF SCUBBER-DRIERS & MOPPERS MAY BE PURCHASED AT DIVISIONAL LEVEL OR THROUGH ERWWO.

C- DISPENSARY

1. PROVIDE PROPER HIGH CHAIRS (REVOLVING) TO PHARMACISTS AT MEDICINE DISTRIBUTION COUNTERS.

2. KEEP UNUSED MEDICINE BOX IN OPD NEAR DISPENSARY (LOCKED) SO THAT PATIENTS CAN DROP UNUSED MEDICINES IN TO IT. ALL THESE MEDICINES SHOULD BE COUNTED & ENTERED IN A SEPARATE REGISTER BY THE PHARMACIST & THEN DISTRIBUTE TO COUNTERS.

3. PHARMACIST SHOULD KEEP ONE DIARY IN OPD IN WHICH ACCOUNTAL OF CASES UNDER RMC/IOD IS KEPT DAILY AS:
OPENING BALANCE NEW SICK FIT CLOSING BALANCE
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& THIS DIARY SHOULD BE PUT UP TO CMS EVERY DAY FOR HIS SIGNATURE

4. ALL CASES IN RMC/IOD > 15 DAYS SHOULD BE PUT UP TO OPD IN CHARGE FOR HIS REVIEW. CASES IN RMC/IOD > 3 MONTHS SHOULD BE PUT UP TO MEDICAL COMMITTEE FOR REVIEW & CASES > 6 MONTHS SHOULD BE PUT UP TO CMS FOR DECISION.

5. PHR I/C SHOULD CHECK EXPIRY DATE OF ALL MEDICINES EVERY MONTH & TAKE APPROPRIATE ACTION

6. ACCOUNTAL OF MEDICINES SHOULD BE DONE EVERY DAY. STOCK REGISTERS SHOULD BE INITIALED BY PHR CONCERNED ON EACH RECEIPT & ISSUE OF MEDICINES IN DISPENSARY.

7. OPD I/C SHOULD CONDUCT SURPRISE RANDOM CHECK OF STOCK REGISTERS OF DISPENSARY & RECORD HIS FINDINGS WITH SIGNATURE & SEAL & DATE

8. ALL ORIGINAL OPD CASE PAPERS OF CASES UNDER RMC/IOD SHOULD BE KEPT IN SICK/FIT COUNTER & NOT THE PHOTOCOPIES. ALL SICK/FIT CERTIFICATES SHOULD BE SIGNED BY THE MEDICAL OFFICER WHO HAS ADVISED THE EMPLOYEE TO BE KEPT IN SICK LIST. FOR OUT STATION EMPLOYEES, TRANSFER CERTIFICATE SHOULD BE ISSUED WHEN HE IS FIT TO TRAVEL.

9. NOMINATE ONE MEDICAL OFFICER FOR RPF/RPSF EMPLOYEES SICK/FIT SO THAT PROPER CHECK CAN BE EXERCISED. FOLLOW ALL INSTRUCTIONS ABOUT RPF EMPLOYEES AS GIVEN IN IRMM-2000

10. LP MEDICINES SHOULD BE ISSUED ONLY ON SIGNATURE OF THE EMPLOYEE CONCERNED OR HIS REPRESENTATIVE.

11. NO UNAUTHORISED PERSONS SHOULD BE ALLOWED TO ENTER THE DISPENSARY.

(D) INTENSIVE CARE UNIT

1. ADMISSION / DISCHARGE CRITERIA SHOULD BE LAID DOWN IN WRITING & AVAILABLE IN ICU AS WELL AS DR'S DUTY ROOM

2. NO ONE SHOULD BE ALLOWED TO ENTER ICU WITHOUT CHANGE OF SHOES & MASK.

3. PERIODICAL FUMIGATION OF ICU SHOULD BE DONE & DATE WHEN IT WAS LAST DONE SHOULD BE DISPLAYED ON THE ENTRANCE OF ICU

4. MEW SCORE (MODIFIED EARLY WARNING SCORE) SHOULD BE CALCULATED FOR EACH ICU PATIENT & DISPLAYED ON A WHITE BOARD ON EACH BED.

5. ONE BOTTLE OF STERILIUM / SIMILAR SOLN.SHOULD BE KEPT NEAR ENTRY OF ICU & ALL DRS & ICU STAFF SHOULD SCRUB THEIR HANDS BEFORE TOUCHING ANY PATIENT IN ICU.

6. CULTURE SWABS SHOULD BE TAKEN FROM ICU EVERY MONTH

7. ALL STAFF POSTED IN ICU SHOULD BE WELL TRAINED IN INTUBATION, CPCR & HANDLING OF ALL EMERGENCIES AS WELL AS OPERATING ALL EQUIPMENTS LIKE MONITORS, VENTILATOR, DEFIBRILLATOR & AED ETC.

8. CHARTS SHOWING OUTCOME OF ICU SHOULD BE DISPLAYED IN ICU

9. CURTAINS IN ICU SHOULD BE OF GOOD QUALITY PVC WHCH CAN BE CLEANED EASILY.

10. ADEQUATE NO. OF CRASH CARTS SHOULD BE AVAILABLE IN ICU WITH O2 CYLINDER & AMBU BAGS

11. DETAILED NOTES INCLUDING MEW SCORE, GLASSGOW COMA SCALE ETC SHOULD BE AVAILABLE IN CASE PAPERS IN SERIOUS CASES.

12. ICU I/C SHOULD TALK TO PATIENT PARTY & APPRISE THEM OF THEIR PATIENT'S CONDITION EVERY DAY. IN SERIOUS CASES MD/CMS SHOULD ALSO TALK TO PATIENT PARTY & COMMUNICATE ABOUT PATIENT'S CONDITION.