WARD MANAGEMENT

Dr Ahmad Al-Nawafleh

Hospital ward - block forming a division of a hospital (or a suite of rooms) shared by patients who need a similar kind of care; "they put her in a 4-bed ward"

Hospital in patient services basically covers 1/3 rd of the total hospital complex. The functions of inpatient services are To render nursing care to all patients To provide necessary equipments, essential drugs and all other stores requirements for patients care in an organized manner in the wards It provides opportunity for training medical, nursing and paramedical, nursing and medical staffs besides conducting research work.

CONSTITUENTS
Patient space Nursing space corridors

Outpatient
ien ts Pr ea dm iss ion W ar d ad m iss ion Th ea tre

Inpatient

The process of patient care

Ou tpa t

IC U

Secretary Outpatient Nurse Rehab Nurse Ward Clerk Ward Nurse Junior Doctor Pharmacist Prehab Nurse Physiotherapist anaesthetist consultant

decision line

Types of wards
General wards Speciality wards

Di

sc ha rg e

ar d

Factors to be kept in mind while designing a ward

Movement space Number of beds in a room Bed spacing Position of nursing station Category of the ward Ancillary rooms Ratio of toilet accommodation

PLANNING AND DESIGNING-PHYSICAL FACILITIES

AREA LOCATION SIZE SHAPE ANCILLARY ACCOMODATION WATER AMD ELECTRICITY SUPPLIES COMMUNICATION AIR-CONDITIONING

Physical facilities Area requirement per bed= 70-90 sq. feet Area separated from noise and disturbances Approachable from support services like laboratory, imaging and Blood Bank Movement space Wards can be T-shaped, L-shaped, Rectangular shaped Can have single/double corridor Nightingale pattern, Riggs pattern

Riggs pattern
Modern trend is to have cubicles of 1,2,3,4,5 beds in each cubicle Advantages 1.Patient beds not visible to outside visitors except for visiting hours 2. Gives a more clean and tidy look 3. It provides as a barrier against psychological shock for other patients during emergency situations. 4. More privacy Disadvantages 1.Communication between nurses and patient becomes more difficult 2. Patients deprived of direct observation from nurses 3. Wards become longer, consequently nurses have to run more 4. More nurses are required 5. Costly to build and maintain

ANCILLARY ACCOMODATION
The nurses station should have min space requirements of 20x20 and should have Nursing station with attached bathroom and medicine storage cupboards Counter in open space outside to carry out work A built in drug cupboard for daily use medicines House physicians room

CLEAN UTILITY ROOMS (100-200 sq ft) TREATMENT ROOMS(120-150 sq. feet) WARD KITCHEN / PANTRY (100-120 sq. feet) DAY ROOM STORES (80-130 sq. feet) BATHROOMS 1.URINAL- 1 FOR 12 BEDS 2.WC- 1 FOR 08 BEDS 3.BATH- 1 FOR 12 BEDS WASH HAND BASIN- 1 FOR 10 BEDS JANITORS ROOM (40-60 sq. feet) SLUICE ROOM(150-170 sq. feet)

Auxiliary Accommodation

This includes ward laboratory, seminar rooms, nurses rest rooms, visitors room This is usually common for 2-3 floors

Correlation with bed space and hospital engineering grid

Door 1.2m or 3/4th grids Veranda 1.5 grids Windows 1.2-1.6m Corridors 2.4m Distance between bed centers 7 ft/8 ft Clearance between wall and side of bed in respect of bed Closer to wall: 2 ft Isle between two row of beds: 5 ft Area per bed within the ward therefore need not be more than 70 sq ft * 1 grid1.6x1.6=2.56 sq m

Specialised wards (Neonatal unit)

Set up as an independent unit for care of new-born under supervision of a pediatrician Area requirements in sq ft

Nursery Premature Septic Normal Nurses station with toilet Doctors room Breastfeeding room Store Phototherapy room Sluice room 230 150 150 190 190 115 115 115 115

Duties and responsibilities of personnel for effective functioning of wards

Nursing personnel Endorse patients and give attention to patients comfort and safety Delivers clean medical supplies to patient care units and collect used supplies, instrument sets, rubber goods, etc. Makes general assessment of patients in the recovery room and confers with head nurse nursing management of each patient Accompanies physician on rounds to answer questions, receives instructions and notes patients care requirements. Reports to replacement on next tour on condition of patients or of any untoward or unusual actions taken. May render professional nursing care and instruct patients and members of their families in techniques and methods of home care after discharge

Assigns duties to professional and ancillary nursing personnel based on patients needs, available staff, and service needs. Supervises and evaluates work performance in terms of patient care, staff relations and efficiency of service. Provides for nursing care and cooperates with other members of medical care team in coordinating patients total needs. Identifies and studies nursing service problems and assists in their solutions. Observes nursing care and visits patients to insure that nursing care is carried out as directed and treatment is administered in accordance with physicians instructions and to ascertain needs for additional or modified services. Maintains safe environment for patients. Operates or supervises operation of specialized equipment assigned to unit and provides assistance and guidance to nursing team as required. Visit clinical nursing divisions to oversee nursing care and to ascertain condition of patients. Gives advice for treatments medications, and narcotics, in accordance with medical staff policies in absence of physician. Arranges for emergency operations and relocations of personnel during emergencies. Admits or delegates admissions of new patients.

Cooperates with individual/group in other departments or services in carrying forward the work of the hospital as a whole. Supervises and coordinates activities of nursing personnel engaged in specific nursing services such as Obstetrics, Pediatrics, Surgical or Medical, or from two or more clinical nursing divisions. Determines and makes recommendations concerning hospital wards facilities, equipment and surgical supplies affecting nursing care, and plans for allocation and utilization of space and equipment to ensure safe environment for patients and working personnel

MEDICARE AND BILLING SECTION - Admits, classifies Pay and Medicare Patients, orients patient with regard to privileges, obligations, responsibilities during the course of confinement. Prepares statement of account on service and bills rendered to patient. File records, bills and statement of account.

DIETARY SERVICE Maintain or enhances the health of the patients and personnel by providing them with high quality and nutritious food through an efficient Dietary Service; Provides or serves safe, nutritious and attractive food through careful planning, wise procurement and proper preparation of balanced and satisfying meals within budgetary limits; Implements diet prescription in coordination with physician and nurse; Provides nutrition consultation and education services to patients as well as in-service training to both dietary personnel and other related fields; Promotes and maintains cooperation with other department in the hospital towards total patient care. SECURITY FORCE - Ensure safety of hospital patients, facilities and personnel, maintain peace and order, and enforce hospital rules and regulations

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PERSONNEL SECTION - Development and administration of a comprehensive manpower development program which includes recruitment and selection, promotion, training, employee welfare and benefits, manpower planning and research. PROPERTY AND SUPPLY SECTION - Procurement, storage, inventory, distribution and disposition of hospital supplies, materials, and equipment. HOUSEKEEPING SECTION - Develop and maintain clean, safe and sanitary environment for patients and hospital personnel. LINEN AND LAUNDRY SECTION - Ensure adequate supply of clean linens for patients and hospital units. ENGINEERING AND MAINTENANCE SECTION - Installation, operation and maintenance of electrical, mechanical and communication equipment and allied facilities including buildings and vehicles. MOTOR POOL SECTION (TRANSPORT) - Convey transport patients, hospital officials and personnel to their destination.

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