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Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
5. Scope of Services
The nursing department provides round the clock services in the following departments
I. Departments:
Emergency Room (ER): - Includes Triage in all hospitals and High Dependency Unit (HDU) in
some of the hospitals. Nurse patient ratio is 1:2.
Triage: All patients coming to ER are assessed and sorted for first aid, stabilization and
admission or stabilization and discharge
High Dependency Unit (HDU): - This unit caters to all critically ill patients requiring close
monitoring and constant observation and nursing care without artificial ventilation. High
dependency Unit has a nurse patient ratio of 1:3
Intensive Care Units: Intensive Care Units consists of monitored intensive care beds where
in all critically ill or postoperative cases are taken care of. The nurse patient ratio here is
1:1.25 –2. The units are equipped with bedside monitors, central monitoring system, facility
for invasive and non-invasive ventilation and other invasive monitoring facilities. The name
of the ICU can vary from unit to unit depending on the patient population that it caters to.
Some of the common specialty ICUs is as follows –
Cardiac Surgical Intensive Care Unit/Surgical Intensive Care Unit (CSICU/SICU) - All Cardio
Thoracic Vascular Surgery (CTVS) post-op patients are taken care till the day they are fit to
be transferred back to patient rooms. Some critically ill pre-op patients are also admitted to
this unit.
In hospital where no separate CSICU, other specialty cases TKR, THR, Craniotomy) and
surgical patients who require critical monitoring and ventilatory support are also admitted
to the unit.
Pediatric Intensive Care Unit (PICU) –
This is the pediatric ICU who require critical monitoring, ventilator support are admitted
Coronary Care Unit (CCU) - All critically ill cardiac patients are admitted here. All post PTCA,
post PPI, Post EPS, RFA, non-surgical closure of ASD & VSD & post ICD implantation patients
are also kept here in the immediate post-procedure period. The stay varies from few hours
to 1-2 days. In units where separate CCU is not present, patients are admitted in either SICU
or MICU.
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
Medical Intensive Care Unit (MICU) - This unit caters to non surgical all critically ill patients.
Wards - The wards consist of single rooms, twin and triple sharing and ward rooms. The
nurse patient ratio here is 1:6 or 1:7
Operation Theaters - Consists of all operation theaters according to specialty. Multispecialty
Operation Theater services include Eye, ENT, General surgery Gynecology, Plastic Surgery,
Gen. Surgery Dental and Urology. In units specializing in Neuro, Ortho, and Cardiac,
surgeries specific OTs and /or time slots are demarcated unless the hospital has special OTs
for these specialties. The nurse table ratio is 2:1
Cardiac Operation Theater (COT) – In units with dedicated cardiac OT, all types of cardio-
thoracic surgeries are done. Commonly done surgeries are CABG, MVR, AVR, DVR,
Correction of TOF, ASD & VSD, and Repair of Aortic Aneurysms. Thoracic and vascular
surgeries are infrequently undertaken
Renal Operation Theater (ROT) - In units with dedicated ROT all types of renal surgeries are
undertaken.
Ortho Operation Theater (OOT) - In units with dedicated Ortho OT all types of ortho
surgeries are undertaken including joint replacements.
Catheterization Laboratory (Cath Lab) - All invasive cardiac procedures are done here. The
procedures done here include: CAG, PTCA, TPI, IABP insertion, PPI, EPS, RFA, IVC Filter, ASD
& VSD closure & ICD implantation.
Out Patient Department (OPD) - Here all in-house and empanelled consults have slots for
their consultation. The nursing here supports Non-Invasive Cardiology, Radiology, Nuclear
Medicine, Diabetic Clinic & Blood Bank also. Nurses here render assistance to the
consultants in way of taking vital signs and assisting in OPD Procedures.
Dialysis Unit - The Dialysis Unit runs in two/ three shifts and all outpatient and in-patient
dialysis is undertaken here. Portable dialysis units are used for bedside dialysis of critically ill
admitted patients.
II. Services cover the following areas:
Patient Assessment
Patient admissions in all units take place through Triage in emergency cases and during
nonworking hours/holidays and through OPDs during working hours.
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
All beds are kept ready for the patient’s admission at all times. Beds are allocated by IPD in
consultation with the respective unit in charges. As soon as the patient arrives, initial
assessment is done by the assigned nurse, by checking the documents, collecting relevant
history and doing a quick physical examination.
The patient needs are identified, and necessary medical/nursing orders are carried out. The
patient and significant others are given orientation to the ward, patient protocols are
explained.
All the investigative/therapeutic and nursing procedures are explained to the patient and
significant others. All the necessary and relevant patient education is carried out by the
designated nurse or the nurse patient educator (if the unit has one)
The types and ages of patients served
Patients of all age group are admitted to the units. Patient acuity ranges from completely
dependent patients in ICUs to partially dependent patients in the wards.
The extent to which the level of care/ service provided meets customer needs
The nursing department caters to meet cent percent nursing needs of the clients. The
recommended staffing is maintained round the clock. To improve the efficiency levels of the
staff; continuing education programs are planned and carried out by the Nursing Education.
Appropriateness, clinical necessity, timeliness of support service provided
The Nursing Department maintains the intensity of service provided 24X 7 in all units except
in OPD’s which are closed during non-working hours/holidays. On call services are provided
by Dialysis nurses in nonworking hours/ holidays.
III. Interdepartmental communication
Nursing maintains Interdepartmental communication with the following departments-
F & B (Food and Beverages)
Diet for patients is always requested by the Nurse
Appropriate therapeutic diet is planned by dietician after nutritional assessment.
Appropriate intimation is provided by the Nurse to dietetics department when a diet
is changed or when there is a patient transfer/discharge.
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
Engineering & Bio Medical Department
The Charge Nurse sends the request for maintenance & repairs to these
departments as soon as the need is identified.
The nurses share joint responsibility for handling /care of biomedical equipments
and other fixtures in the patient care areas
The Nursing team works in conjunction with Engineering and Bio Medical to ensure
timely check and preventive maintenance of all equipments and fixtures is done.
Biomedical and Engineering department is called periodically for training needs of
nurses about biomedical equipments training by the nursing education as and when
required.
Laundry
Nurses liaises with Laundry for all linen requirement as per the hospital protocol
House Keeping
Nurses are supported by House Keeping to ensure a clean and safe environment in all areas
as per set hospital standards.
Inpatient Department (IPD)
Does accurate & timely co-ordination with IPD on transfers, admission, discharges &
deaths
Filling up of billing activity (as per set guidelines of the hospital)
Clearance for procedures & surgeries are obtained from IPD desk
Discharge clearance is obtained from IPD before physically allowing the patient to
leave the hospital.
Stores
Indent all consumables, drugs and stationery from the stores.
Buffer stock given in the units is the responsibility of nurses and they facilitate audits
as and when required
Return unused drugs and consumable
Central Sterile Supply Department (CSSD)
CSSD supports nurses by supplying all sterile items for the units.
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Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
Items are either taken as stock or loaned from CSSD.
Nurses are responsible for ensuring proper storage and count of all CSSD items.
Radiology
Send requests through HIS appropriately
Take appointments before sending patients for ultrasound/CT/Carotid Studies
Inform once again before sending the patient for a test
Get someone ready to pick patient after investigation
X-ray films not reported to be sent soon after the doctor has seen them
Knowledge of necessary preparations for radiological procedures
Laboratory
Tests to be done should be indicated clearly in the forms and entered appropriately
in the system (Modified)
Check samples before sending for any clotted/inadequate sample etc.
Ask for the reports through HIS of tests done and inform doctor immediately after
receiving reports
Inform in advance to Lab person for collecting samples for biopsies/Mxt test
Write clearly the type of fluid/tip of lines/type of catheter when sending for cultures
Blood Bank / Blood storage
Give pre-information regarding blood demand
Send appropriate requests through system and double check on phone
Proper labeling – only stickers
Send samples of grouping and cross matching without delay
Know the protocol for blood returns in case of reaction
Send appropriate forms after administration of blood safely
Take consents for HIV tests.
Medical Records Department (MRD)
Completion of discharge/death files as per hospital standards
Dispatching files to MRD after ensuring proper arrangement of patient record)
Handling MLC files
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
Information Technology (IT)
Support for Hospital Information System (HIS) and for Hardware
Human Resources (HR)
HR coordinates the recruitment of nurses.
Nursing works in close coordination with HR is respect to: Attendance, leave, service
bonds; monthly performance allowance, medical insurance, remunerations and staff
welfare.
6. Nursing Manpower planning
Nursing Manpower planning is done every year taking into consideration the following
I. The business growth plan of the unit
New Medical Programs
New Departments
New Services
II. The current manpower deployment versus the nursing norms
III. The projected Occupancy for the year to come
Nursing Norms
Fortis Nursing Norms are derived from various sources such as guidelines laid down by
NABH staffing guidelines, Indian Society of Critical Care Medicine guidelines for staffing of
critical care units.
S.No Department Manning Norms
1 Wards Ratio 1:6
Staffing plan
The staffing is done based on occupancy and the required staffing ratios are maintained
round the clock through redeployment of staff in each shift by the shift-nursing supervisor
as and when required. Please Refer Acuity tool in Annexure I
Monthly Duty Roster
Purpose
To maintain required nurse patient ratios.
To ensure equal distribution of shifts to all staffs.
Each staff will get one weekly off every week. (Sunday – Sunday must reflect one off).
Every shift must have a proper mix of staff to ensure the required quality of care.
After long leave all the staff will be assigned to morning shift or evening shift only
Compensatory off will be given only if the supervisor justifies the extra duty Attendance
should reflect these accurately. After night duty an off is compulsory. None can come on
morning or evening. Nurse In charges to ensure that hard copies of duty rosters are
submitted to the Nursing office before the first of the next month after duly uploading it
into the system
Contingency Plan
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
Purpose
To ensure sufficient manpower in the areas with deficient staff
Floater policy
Shift supervisors are responsible to float in and out of nurses in order to ensure all areas are
adequately staffed in quantity and quality. Unit In-charge/shift in-charge must send the staff
without delay to the directed Units.
The nurse who comes for help must introduce herself/himself to the Unit In charge/Shift in
charge.
The In charge will assign patients as per the capabilities and needs.
A brief orientation as to where to find what will be given by the In charge.
Medications will be always administered under supervision.
In charges will ensure that the nurse who is floated into his/her unit is relieved for the tea
and lunch breaks
In charges to ensure that the nurses are relieved at the end of the shift in a timely manner.
Calling off duty nurses
In time of acute surge in patient load, shift supervisor maintains Nurse patient ratio by
calling in nurses living locally or those living in staff hostel provided for by the hospital.
At times nurses continuing into the next shift due to sudden staff shortage caused by
unplanned leave are provided for with food and appropriate time back. This is done at the
discretion of the shift supervisor
Leave Policy
Purpose : To ensure effective utilization of staff to ensure safe nursing care.
Annual leave plan is made for a period of 12 months (April to March)
Annual leave plan will be submitted to Nursing Office in the first week of January.
The in-charge needs to start working on plan well in advance in conjunction with the
concerned ANS/supervisor, so that the leave plan permits only the no. of staffs that
could be on planned leave at one point of time.
The staffs who do no avail the leave as planned are not guaranteed annual leave at
another time of their convenience.
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
Leave plans once approved by NS/CNOs cannot be changed unless the NS/CNOs
approves it again.
Any extension of planned leave without a valid reason will be treated as leave
without pay.
Public holidays can be clubbed with planned leaves and the same must be
mentioned in the leave form as suffixed or prefixed.
Nurses availing planned leave must report to the nursing office before proceeding
for leave and on resuming duty.
All CL/SL etc. must be submitted for approval within 48 hrs of resuming duty;
otherwise they shall be treated as absent.
The responsibility of submitting leave application in time lies exclusively with the
employee
Ward In-charge, supervisor to oversee and ensure its adherence.
All In-charges will confer with area ANS/supervisor; for granting unplanned leaves
and get approval from HOD.
Casual Leaves, when a particular department is light, can be given only after
consulting ANS/Supervisor/HOD to ensure no staffing issues in other areas
Sick leave must be informed minimum 2 hours before starting of duty. The staff
when sick must report to OPD/ER as per the hospital protocol
Any leave for more than 2 days will need to be informed to HOD for approval
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
DEPARTMENTAL STRUCTURE (ORGANOGARM)
CNO/NS
DCNO/DNS
Unit In-Charge
Clinical Patient
Shift In-charge (Sr. Staff
Instructors Educators
Nurse)
Staff Nurse
10.In-Service Education
This program is intend to update the knowledge and practices of nursing professionals
Purpose
To provide trainings based on training need analysis
To ensure all nursing team members are updated with reviewed SOPs
To ensure adequate nursing team members are trained to provide (ACLS) Advanced
Cardiac Life Support
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
To ensure adequate nursing team members are trained to provide Pediatric
Advanced Life Support (PALS) and Neonatal Resuscitation
To provide training on Safe and effective use when any new biomedical equipment
is introduced
To provide Skill based training when any new product is introduced such as IV
cannula etc.
To provide guidelines before implementing any new medical record document or
change in format
To reorient the nurse about knowledge and practice when change of department
and change of responsibility is done
Continuous Nursing Education Program includes-
Daily afternoon class
Area Specific Training
Service Excellence Training
Orientation Training for Change of Department
Orientation Training for Change of Responsibility
Daily afternoon class
Daily class is for all evening shift nursing team
Training Calendar is rolled out at the beginning of the month
These classes include topics based on training need analysis and mandatory training
topics
Training of staffs done when new equipment are introduced in the system
Area Specific Training
It focuses on specific nursing procedures carried out in the unit
It also focuses on type of nursing care provided in the respective unit
As per training need analysis , if any one unit has certain training needs accordingly
focused sessions are conducted
It is driven by charge nurse
Service Excellence Training
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
The modules are:
Patient First
LEAP
Corporate grooming
Telequettes
Email Etiquettes
Orientation Training for Change of Department
The Nurse who is posted to a new department undergoes On the Job Training for
his/her new department
Effectiveness Check
Training is validated through skill verification and subsequent certification as
applicable or evaluator tests
Training certificates and skill verification practical re-demonstration on the job
11.Nursing Empowerment
Chief Nursing Officer is the driving force for nursing Empowerment. Every Nurse is
empowered to take decisions about patient safety and recovery. Doctors and other
departmental personnel are always approachable and follow teamwork approach. Nurses
are empowered to inform patient’s condition to Consultants directly.
Early Warning Score Assessment, Safety codes are placed to handle medical emergencies
like cardiac arrest and stroke. Innovation is encouraged by nurses to improve patient care
and safety, quality, process improvement and service timeline. Nurse driven quality
improvement projects are conducted. Charge nurses, clinical instructors, senior staff nurses
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Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
are members of all important hospital committees. Planning of training calendar is done
with active involvement of nurses.
Structured program exists for enhancing clinical competency and leadership skills of nursing
professionals; as knowledge is the basic requirement to exercise empowerment of the team
12.Shift Handover/Endorsement
Purpose: To ensure continuity of care
A structured shift hand over is done among assigned nurses in the units also
amongst shift supervisors
Shift hand over communication is based on communication guideline of SBAR (
Situation, Background, Assessment, Record)
It is documented at every shift change and signed off by both duty staff nurses
Shift handover involve active participation of patient, whenever possible
Charge Nurse or senior staff nurse monitors the complete shift handover is carried
out and essential information is handed over effectively.
Formats of Endorsement guideline and documentation can be referred in Annexure
III and IV.
13.Nursing Audits
Objective
To ensure that our clients get care with the accepted International standards
Nursing Audits are conducted to evaluate the services provided to our clients. The results of
these audits are then compared with the accepted standard checklists that we have.
Training and re-audits are done if required to ensure that the care provided by our nurses
meet the client’s need and according to the established standards. Following are a few of
the audits-
Infection Control Audits
Nursing Process compliance audit
Nursing Care Bundle audit
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Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
HAPU prevalence audit
Patient and Unit Safety audit
Medication safety audit
Crash cart audit
Nursing Quality and Patient Safety
We believe that quality improvement is an on-going process and as the front line deliverers
of patient care, we have a major and responsible role to play in improving and maintaining
quality care to patients and families.
We also believe that improving and maintaining quality of nursing personnel is equally
important to achieve the above.
We believe that constant efforts to work hard in hand with other services to achieve the
above are equally crucial and all efforts will be made to achieve the organizational goals.
Goal
Nursing Quality Improvement Committee (NQIC) aims to ensure that a constant process is
undertaken so that all the patients and families leave Fortis with a positive experience and
to prepare nurses adequately for the said role based on regular monitoring, auditing,
counseling and evaluation.
Objectives
Develop nursing sensitive quality indicators
Develop tools to measure the outcomes
Evaluate monthly and plan and implement corrective actions
NQIC would also be responsible to meet with staff who have low performance levels,
attitude problems etc. For this purpose only the HOD, ANS/Supervisor and
concerned unit in-charge will meet the staff for counseling session.
The counseling session would be documented in the staff diary with the signatures
of all members.
NQIC meeting is part of monthly unit in-charges meeting. ANS / Sr. Nsg Supervisor to
ensure presence of deputed members as indicated
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
The NQIC will concentrate initially on the frequently detected problem areas in the
department.
NQIC will gradually work toward establishing indicators and establishing
methodologies at par with international hospitals.
NQIC will be responsible for educating all nursing staff on the quality improvement
activities.
NQIC will educate unit in-charges to initiate their own quality improvement activities
in their respective areas.
NQIC will ensure active participation in the Quality improvement program of the
hospital.
NQI committee will consist of
Chairperson: Chief Nursing Officer
Coordinator: Deputy Chief Nursing Officer
Members (Permanent): All unit Charge Nurses
Members: Deputed staff (3)
NURSING QUALITY INDICATORS
The following quality indicators are adopted by department of nursing as per guideline laid
by international Nursing bodies
1. Pressure Ulcers:
The incidence of pressure ulcers would be less than 4 among all ICU patients. The measure
would be computed as:
Number of patient with Hospital Acquired Pressure Sore X 1000
Total no. of patient days
The incidence of pressure ulcers would be 0% in all other patients.
All patients received with pressure ulcer from outside will exhibit improvement in the level
of their ulcer.
2. Patient Falls
The rate per 1000 patient days at which patients experience an unplanned descent to the
floor during the course of their hospital stay. The measure would be computed as
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Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
Total No. of patient Falls X 1000
Total no. of patient days
3. Patient Satisfaction with Pain Management
A measure of patient perception of the hospital experience related to satisfaction with pain
management.
Definition: Patient’s opinion of how well nursing staff managed their pain as determined by
scaled responses to a uniform series of question designed to elect patient views regarding
specific aspects of pain management. The questions would be administered to a sample of
all patients admitted to the hospital. All surgeries requiring more than 3 days of hospital
stay.
4. Patient Satisfaction with Educational Information:
A measure of patient perception of the hospital experience related to satisfaction with
patient education.
Definition: Patient opinion of nursing staff efforts to educate their regarding their
conditions and care requirements as determined by scaled responses to a uniform series of
questions designed to elicit patient views regarding specific aspects of patient education
activities. The questions would be administered to a sample of all patients admitted to the
hospital for acute care services. Necessitating more than 3 days of hospital stay.
Patient Satisfaction with Nursing Care
A measure of patient perception of the hospital experience related to satisfaction with
nursing care.
Definition: Patient opinion of care received from nursing staff during the hospital stay as
determined by scaled responses to a uniform series of questions designed to elicit patient
views regarding satisfaction with key elements of nursing care services. The questions would
be administered to a sample of all patients admitted to the hospital for acute care services.
Hospital Acquired Infection:
List of Hospital Acquired Infection and measure to calculate rates are:
CLABSI: Central Line Associated Blood Stream Infection
No. of CLABSI X 100
Number of central line days
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
CAUTI: Catheter Associated Urinary Tract Infection
No. of CAUTI X 100
Number of catheter days
15.STATUTORY OBLIGATIONS
CONSUMER’S PROTECTION ACT - Implication on Nursing Practice
Consumers of health care are increasingly demanding to have a say in matters affecting
their health care. As consumers have become more aware of their rights, conflicts between
patients, health care professionals and institutions have developed. Nursing is affected by
this kind of situation in which nurses are also expected to answer questions, explain
procedures and respect the rights and requests of the patient. Nurses are challenged to
become advocates for clients.
The Consumer Protection Act enacted by the Parliament in 1986, has been drastically
amended and its scope greatly widened by the amendment of 1993. The Act now covers all
kind of services an all kinds of consumer transactions whether made in cash or in kind. It
NURSING
Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
protects the consumer form the burden of restrictive and unfair trade practices and enables
the consumer forums and commissions to award compensation not only for monetary loss
in purchasing defective material or in hiring deficient services but also for mental pain,
suffering and harassment caused by defective goods or services. Services rendered by
hospitals & members of medical profession for consideration constitutes as defined in the
Act. Deficiency in medical services gives the patient as a consumer the right to claim
compensation, (Poonam Verma vs Ashwin Patel (1996) 4SCC332.)
Nursing as a professional and nurses as an individual have long been advocating for the
welfare of their patients. The impact of health care consumer movement has been to
promote increased accountability on the part of all health professionals including nurses.
Today’s nurse practitioners must be aware of nursing standards, legal issues in nursing, legal
limits of nursing and legal liabilities otherwise he/she will be the first person to be penalized
from the legal standpoint.
Special legal concerns in professional Nursing practices:
Service areas of nursing practices are particularly fraught with legal risk.
Crime: Violation of any law governing the practice of any licensed professional may be
prosecuted as a crime even if no actual harm occurs to the patient e.g. giving medication
without physician’s prescription. Torts are a civil wrong committed against a person & may
be either intentional or unintentional. Physical, emotional, economical harm may also result
in tort. Negligence is the failure to act as a reasonably prudent person e.g. any nurse who
does not meet accepted standard of care or who perform duties in careless fashion runs a
risk of being found negligent. Reighton (1975) identifies some of the common acts of
negligence.
Negligence: fall of a patient from bed, failure to communicate charges in client’s condition,
use of defective apparatus; abandonment; infection due to lack of aseptic techniques; loss
or damage to client’s property; burns from hot water bottle, heating pads, enema, douches
& baths; overlooked sponges in operative procedures; error in identification of patient
including babies.
Malpractices: is the negligence on part of a health care professional Malpractice occurs
when a professional fails to act as a reasonably prudent professional under specific
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Administration
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Nursing Department: Administrative SOP Pages /1- 56
circumstances that leads to harm or injury to patients. For example at bed time the nurse
fails to put protective side rails on the bed of elderly disoriented patient and patient falls
from the bed sustaining injuries; other examples are the nurse fails to carry out medical
orders, the nurse abandon a patient needing care; nurse fails to make an accurate
assessment of patient and act on assessment
Assault and Battery: Assault is the threat or an attempt to make bodily contact with other
person without consent. Battery is unconsented or unlawful touching of a parson e.g. a
nurse threats a patient who doesn’t eat meal, the patient may assault her in return giving
the patient an injection against his/her will even on a physician’s prescription is battery.
Patients have the right to refuse treatment even if the treatment would be in the best
interest.
Informed Consent: All patients should be given an opportunity to grant informed consent
prior to treatment. Nursing also must obtain consent for nursing measures to be
undertaken. Nurses can witness patient’s signing of informed consent documents but are
not responsible for explaining the proposed treatment nor are they responsible for
evaluating whether the physician has truly explained the significant risk, benefits and
alternative treatment.
Invasion of Privacy: A claim of invasion of privacy also may be brought against a nurse e.g. if
client has a V.D., the nurse should not disclose the information except if directly relates to
care and Rx. A nurse’s unwanted intrusion in private family matters is another example of
invasion of privacy.
False Imprisonment: Making a person stay in a place against his/her wishes is false
imprisonment.
Defamation of Character: Any communication that injures and individual’s reputation and is
disclosed by another person is considered libel (written) or slander (oral). For example if a
nurse tells a client that his physician is incompetent, he/she could be hold liable for slander.
The nurse who writes such a comment could be sued for libel.
Preventing Legal Problems In Nursing Practice: Legal responsibilities in nursing practice are
becoming of greater importance day by day. But many nurses view the law with
apprehension because they fear being named in a malpractice law suit. With increased
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emphasize on client’s rights nurses today must understand their legal obligations and
responsibilities towards clients. Nurses who give competent care based on their education
will seldom need to worry about a malpractice lawsuit. There are a number of effective
strategies that professional nurses can use to limit the possibility of legal action.
Practice In Safe Setting: in order to be truly safe nurse must be committed to safe patient
care. The safest situation is one in which agency employ an appropriate number and quality
of patients; procedures and personal practice that promote quality improvement; keep
equipments in good condition; provide orientation to new employees; supervise all level of
employees.
Communicate With Other Health Professionals: The professional nurse must have open
and clear communication with nurses, physician and other health care professionals. No
matter how good the nursing is if the nurse fails to maintain clinical records, in the eyes of
the law the care did not take place.
Meet The Standard Of Care: The single most important protective strategy for the nurse is
to be a knowledgeable and safe practitioner of nursing and to meet the standard of care
with all patients. Meeting the standard of care involves being technically competent,
keeping up to date with nursing standard of care, boundaries within which nurse practice. If
a nurse does not perform duties within accepted standard of care they may place
themselves in jeopardy of legal action. Indian Nursing Council Act’s give authority to the
council to maintain standard in the field of nursing education and practice of health care
innovations. TNAI is another source of uplifting standard of nursing care. International code
for nurses is subscribed by TNAI.
Promote Positive Inter Personal Relationship: Even in the face of untoward outcomes from
health care providers, it s usually the unhappy patient that sues. Therefore, the best
strategy for the professional nurse is prevention of legal action through positive inter
patient relationships with patient and team members.
Legal issues confronting practicing nurses today are many but the nurse should view the law
not with apprehension but as a helpful adjunct to define nursing practice.
INDIAN NURSING COUNCIL ACT 1947:
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Administration
FORTIS HEALTHCARE LIMITED
NSG/ADM/1.0
Nursing Department: Administrative SOP Pages /1- 56
The Indian Nursing Council, which is the statutory body, came into being through Act that
was passed through the Indian Parliament in 1947, which regulates the nursing education
and practice in the country.
The Indian Nursing Council functions through the State Councils who is responsible for
registration of nurses who have successfully completed and attained entry-level
qualification in nursing. (Baccalaureate program in Nursing for 4 years and Diploma in
Nursing and Midwifery for 3 and half years) It is the function of the council to declare that
such qualification is a legally recognized qualification for the purpose of this act.
However the Act does not have any provision for regulating nursing practice in the states. It
also does not have any system of national examination for nurses’ registration to ensure
standards of nursing education and practice. Neither does it offer any guidelines for
continuing education and systematic ongoing competency assessment for continuation of
nursing licensure.
The Nurses working in different states also need to register with the State Nursing Council.
The state nursing council issues permanent or temporary registration to nurses practicing
within areas under its jurisdiction as per its policies.
16.Management of Information
PURPOSE:
To ensure complete and accurate flow of information in the department to all the nurses.
PROCEDURE:
NS holds nursing departmental meeting every month within 5 days of Hospital
Monthly Review meeting.
NS, ANSs, Supervisors, In-charges and shift in-charges attend the meeting.
Minutes of the meeting are recorded and circulated.
Following Departmental Meeting, every unit is expected to have unit meetings for
dissemination of information and plan of actions decided in the departmental
meeting.
This meeting is also a forum for discussing issues of staff and other related issues.
The minutes of the meeting is sent to NS, and ANS via E-mail or hard copy.
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Area ANS are required to conduct a meeting with their in-charges and form agenda
to be discussed in the monthly meeting.
Apart from the above scheduled meetings HOD can call for emergency meetings of
short duration to tackle emergent issues.
General body meeting will be held once in 3 months.
S. No Report Frequency Purpose
1. NQIP Report Monthly to be To ensure all nurses meet that set
submitted to HOD by standards. To encourage good
20th by respective Unit workers.
In-charges To facilitate corrective actions for
those who have problems.
2. Evaluations 6 Months after joining As per mentioned in the section
and then yearly “Evaluations”
3. Incident Reports As and when required This is for information to higher
authorities and for further action to
prevent such incidents.
4. Attendance Record Monthly Submitted by unit in-charge with
hours worked by each staff in their
unit.
5. Monthly Monthly Minutes of the meeting held
Departmental monthly with unit in-charges,
Meeting supervisors, ANS & NS along with
NQIC members.
6. Unit In-charges Monthly Minutes of the unit meeting held
Monthly Report after departmental meeting for
dissemination of information and
discussion for quality improvement
activities.
7 Unit In-Service Minimum once in a Attendance record submitted by
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Attendance Record month unit in-charges for in-service
conducted in the unit.
8 Unit Statistics Monthly Submitted by unit in-charges in the
approved format at the end of every
month.
9. Daily Report Daily Submitted by shift supervisor for
the purpose of census.
10 Daily Nursing report Daily Submitted by Unit In-charges to
report daily activities
11 ER statistics Daily ER census
12 Incident reports Monthly To collect data of any untoward
incidents
13 Infection Control Monthly To ensure compliance to infection
Statistics control measures.
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EQUIPMENT
Telephones.
Nurse’s notes.
DOCUMENTATION
The nurse will record all events accurately and completely in her nurse’s notes and will close
the notes once it is confirmed that the police is informed by the security
PREVENTIVE MEASURES:
All patients must be in prescribed uniform with ID band till the time of discharge
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SOP NSG/ADM/1.0
Version : 1.0 Prepared by: CNO, Nurse Educator ,DCNO
Effective from: 01/April/2016 Reviewed by : Roselind Mathews (Regional Nursing Head)
Review date: 31/March/2017 Approved by: Michael Moorhead (National Nursing Head)