MANDALUYONG CITY MEDICAL CENTER
DEPARTMENT OF PATHOLOGY AND LABORATORY DEPARTMENT
I. GENERAL DESCRIPTION
A. Overview / Introduction
The Laboratory Service has been established to give adequate support to the clinician in the diagnosis and therapy of patient and to help detect pathologic changes prior to its manifestation of signs and symptoms thru the use of diagnostic procedures (Chemical, Microscopic, Hematologic, Serologic, Histologic, Bacteriologic, Immunologic nuclear and electronic and other procedures or techniques) on the following: blood and body fluid, tissues, secretions and excretions and washing.
This manual is prepared:
1. To answer the need for basic information
2. To serve as guide in the day to day operation of the Department of Pathology outlining policies and standard operating procedures.
3. To provide guidelines in the performance of duties and responsibilities, evaluation procedures.
4. To serve as reference material on the Health Facility, its equipment and setup personnel.
5. As management tool for health managers and administrators.
B. Historical Background
The Laboratory Services started in the Philippines with the coming of the 26th Medical Laboratory of the 6th United States Army. They trained high school graduates to work as laboratory technicians. Upon their departure, the Medical Laboratory was endorsed to the National Department of Health, which did not take so much interest. Dr. Pio de Roda with the approval of the Health Officer established the first Medical Laboratory utilizing the equipment and reagents left by the 26th Medical Laboratory.
Upon the approval of the Phil. Med. Technology Act of 1969 MT’s are required to undergo written exam. Given by the MT Board before the could practice The Mandaluyong Hospital Laboratory was setup in March 1985 with equipment, supplies and personnel coming from the Plainview Health Center. The Laboratory was established primarily to give adequate laboratory support to the hospital physician in the diagnosis and therapy of patient and to help detect pathologic changes prior to the manifestation of signs and symptoms. The Laboratory was located in the ground fool area of the hospital. 3 Medical Technologists manned the Laboratory
namely: Luz de Castro, Loreta Doria, and Mercy Ocampo. An ECG technician was also with the Laboratory, Enriqueta Lim. After a month Ms. De Castro requested to be back at her former area of assignment. The Laboratory was left with only 2 licensed medical Technologists. Only routine examinations were done. CBC, Urinalysis and Fecalysis and Gram stain for Social Hygiene patients. The Laboratory is open on 24 hours basis.
In 1987, the Laboratory was assigned a Pathologist in the person of Dr. Anarose D. Cariaga. Nov. of the same year we started admitting Med. Tech. Intern to train in our Laboratory for 6 months.
C. Definition
The Department of Pathology is that section of the hospital that provides examinations of different body fluids, secretions, excretions and tissues with the use of various procedure and techniques that may employ manual method or automated method.
D. Guiding Principles
The department of Pathology shall provide the Hospital:
1. with highest quality of laboratory services for quality patient care
2. Personnel who exercise courtesy and prudence in the performance of their job, that includes confidentiality of result/report
E. Concepts
1. Encouragement, establishment and maintenance of highest standards and principles of the practice
2. Dedication of laboratory personnel to provision of competent service.
3. Continuity of education and application of new scientific (advances) development in our specialty
4. Evaluation of quality of service
F. Ethics
1. Confidentiality of result/report
2. Practice courtesy and prudence
3. Punctuality and reliability of result with the shortest time-around-time possible
4. Service oriented
II. DEPARTMENT OF PATHOLOGY
A. Philosophy
To provide the hospital with highest quality of laboratory services for quality patients care. (To be able to give a high reliable result while observing confidentiality, releasing result promptly as to be relevant to medical practitioner in courteous and punctual manner)
B. Mission
1. To be able to give accurate, precise and dependable results at the earliest possible time.
2. To aid clinician in documentation of their clinical impression
3. To serve as station in the networking program of the Department of Health
4. To get involved in projects spearheaded by DOH and other health agencies / association
5. To work the expansion of laboratory services
C. Vision
1. To serve as referral center catering to the needs of both government and private practitioners.
2. To be recognized as tertiary level laboratory
3. To acquire state of the art equipment, including advances in Information Technology
4. To reach the level of full automation
D. Objectives
1. General
i. To be able to give accurate, precise and dependable results at the earliest possible time to the clinicians to aid them at the most critical, decisive moments of patients care.
ii. To be able to document the clinical impression of the clinician
iii. To be able to serve as a referral center catering to the needs of private practitioners, barangay health centers and other nearby laboratories with lesser capabilities.
iv. To be able to serve as a station in the networking program of the department of Health.
v. To be able to participate actively in the Quality Control Program of the Bureau of research Laboratories.
2. Specific
i. To expand laboratory services
ii. To acquire state of the art equipment
iii. To strive to increase our knowledge, apply scientific technologies in our specialty
iv. To strengthen the competency of personal
v. To develop the latest testing skills
E. General Policies & standards
i. Request
• Laboratory requests must be properly accomplished. All request slips should have the following data:
i. Complete name of patient including middle name
ii. Age and sex
iii. Hospital Identification number
iv. Ward
v. Date
vi. Type of specimen
vii. Examination desired
viii. Clinical impression
• Only request with complete information ill be entertained
• Incomplete request shall be returned to requesting physician for completion
• The requesting physician should affix their signature above their printed name in the request form
• No phone-in request shall be entertained
• Request from OPD shall be entertained and accepted until 10:00 A.M.
• All incoming requests must be registered in the General Entry. Logbook stationed at the reception area
• Requests received should be stamped with date and time received. It should contain the signature of the receiver.
• The staff/intern in the reception area shall see to it that the specimen accompanied by the request is forwarded into the appropriate section for recording and processing
• All requests of missing patients or patient who refuse extraction are to be entered in the Entry Logbook, to include the test not done and the reason for refusal to serve as waiver. The request should be countersigned by ward personnel preferably by Nurse-on-Duty to attest to the patient’s refusal or absence.
LABORATORY PROCEDURES (OPD)
|Physician |Prepares lab request |
|Patient / Companion |Presents lab request to the laboratory department |
|Lab Aide/Med. Tech |Checks if requested examination is available. |
| |Advise patient/companion to pay corresponding charges to the |
| |Cashier. |
|Patient / Companion |Pay the assess amount of examination |
| |If patient is unable to pay full amount, proceed to MSS, OMD, |
| |Admin Office for evaluation and discount |
| |Pay the assessed amount at the cashier. |
| |Present OR to the Lab. together with the specimen or for |
| |extraction of blood sample. |
|Lab Aide/Med. Tech |Receive the specimen and request and records in the general |
| |logbook. |
| |Advise patient to comeback at 4:00 PM to claim result |
| |Send specimen to section responsible . |
| |Process specimen |
| |Records result in the logbook and transcribe to office |
| |laboratory form |
|Patient / Companion |Present Official Receipt when claiming result |
LABORATORY PROCEDURES (ER)
|Physician |Prepares necessary Lab request. |
|Companion |Present request to lab to check if examination is available. |
| |Proceed to cashier for payment of laboratory examination. |
| |Upon payment proceed to Laboratory present OR and specimen / |
| |for blood extraction |
|Lab Aide/Med. Tech |Receive specimen, extract blood and label. |
| |Advise patient to come back after 2 hrs. for the result |
|Med. Tech |Process specimen, record in the logbook and transcribe to |
| |official lab result form. |
|Companion |Present O.R. when claiming result |
LABORATORY PROCEDURES (IN-PATIENT)
|Physician |Writes order on patient chart. |
|Ward Nurse |Prepares request and instruct patient companion to submit |
| |request to the laboratory. |
|Lab Aide/Med Tech. |Receives request and remind patient companion to give |
| |appropriate instructions to the patient. (All requests must be |
| |in before 4 pm) |
|Before 6:00 the following morning |
|Med. Tech |Takes request and proceeds to the ward to get the sample needed|
| |for the requested procedure |
| |Labels specimen taken and proceeds to the laboratory for |
| |processing. |
| |Records result in the result logbook and transcribe in the |
| |official result form. |
|Ward nurse |Collect the result form and attached to the patient chart. |
ii. Collection /Submission of Specimens
• Chemistry
i. Specimens are received up to 10:00 a.m. only
ii. After 10:00 a.m. only STAT, ICU and ER specimen will be accepted.
• Hematology, Serology, Clinical Microscopy and Parasitology
i. All OPD requests will be received up to 10:00 a.m.
ii. Specimens from the wards maybe accepted anytime up to 4:00 p.m.
iii. After 4:00 p.m. only STAT, ICU and ER specimens will be accepted
iv. For patient below 7 years old, fecalysis and urinalysis from Pedia ward maybe received for routine examination after 4:00 p.m. due to problem in collecting the specimen.
• Cytology and Histopathology
i. Specimens maybe received anytime. These should be properly fixed in their appropriate chemical fixative.
ii. Check request for patient history, age, LMP, specimen source
• Blood Bank
i. Request for blood transfusion maybe received anytime
• Microbiology
i. Request is received anytime.
ii. Check if specimen container is sterile.
F. General Functions
1. Department In General
The Department of Pathology is in charge of the different examinations done on different body tissues and body fluids like blood, secretions, washings and excretions.
The Laboratory is divided into different sections:
i. Hematology
• Clinical Microscopy and Parasitology
• Chemistry
• Blood Bank
• Serology
• Microbiology
• Histopathology
• Examinations done in different Sections:
i. Hematology
1. CBC
2. Hgb-Hct
3. Platelet CT
4. CT-BT
5. Malarial Smear
6. Peripheral Smear
7. ESR
8. Reticulocytes
ii. Blood Bank
1. Compatibility Testing
2. ABO Blood typing
3. Rh typing
4. Direct coombs test
5. Indirect coombs test
6. Du Testing
iii. SEROLOOGY
1. ASO
2. RF
3. CRP
4. RPR
5. Widal Test
6. Troponin I
iv. CHEMISTRY
1. FBS
2. RBS
3. OGTT
4. OGCT
5. BUN
6. Creatinine
7. Cholesterol
8. HDL
9. LDL
10. Triglyceride
11. ALK Phosphates
12. Acid Phosphates
13. SGOT/ AST
14. SGPT/ ALT
15. Amylase
16. Sodium
17. Potassium
18. Chloride
19. Calcium
20. CK
21. CK-MB
22. LDH
23. Total protein
24. Albumin
25. TPAg
26. Bilirubin, Direct & Indirect
v. CLINICAL MICROSCOPY
1. Routine Urinalysis
2. Pregnancy Test
3. Routine Fecalysis
4. Occult Blood
5. Concentration Tech.
vi. MICROBIOLOGY
1. AFB
2. GRAMS
3. KOH PREP
4. Culture
5. Culture & Sensitivity
vii. CYTOLOGY
1. Pap’s Smear
2. FNAB
3. Histopath of Surgical Specimen
The Laboratory is composed of the following personnel:
i. Anarose D. Cariaga-Alvarado M.D., F.P.S.P. ( AP-CP )
ii. Sierra Roma S. Hernandez M.D., F.P.S.P. ( AP-CP )
iii. Mercy S. Hugo-Ocampo, RMT
iv. Wilma B. Garcia-Jaramillo, RMT
v. Verlyn Simbulan-Santos, RMT
vi. Charina R. Gargantilla-Bilbao, RMT
vii. Dannie Boy P. Quilatan, RMT
viii. Vivian S. Bautista- Alquino, RMT
ix. Michelle H. Miguel, RMT
x. John Norman R. Bilbao, RMT
xi. Arnette L. Magpantay, RMT
xii. Mary Ann J. Anos-Joyas, RMT
xiii. Corazon C. Oliveros-Villaruz, RMT
xiv. Aileen Philline A. Magcalas-Dizon, RMT
xv. Arianne T. Flores, RMT
xvi. Million L. Guittap, RMT
xvii. Dorcass C. Laylay, RMT
1. All are graduate of respective University
2. All are board passers
The group works as a team to provide a relevant result at the earliest possible time to confirm or aid the clinician in their diagnosis of disease.
House Rules:
i. The Laboratory offers 24 hours service, everyday.
1. OPD patients are accepted Monday to Saturday
2. Only ER cases are accepted on Sundays and Holidays
ii. Official attire is clean white uniform/ blazer worn over decent working clothes
iii. Name plates/Identification Card should be worn everyday
iv. No other footwear except shoes will be worn in the laboratory
v. Technologist are expected to take care of laboratory equipments, instruments, and supplies
vi. Technologist should report immediately any breakdown or loss of laboratory property. All these are recorded and filed
vii. Quality Control is done to assure the medical reliability of laboratory data
viii. Schedule of duties:
8:00 a.m. to 4:00 p.m. – 8 hours duty
4:00 p.m. to 8:00 a.m. – 16 hours duty
III. ORGANIZATIONAL SETUP / STRATEGIES AND PROCEDURES
A. Organization
B. Work Flow
1. HEMATOLOGY
2. MICROSCOPY
3. CLINICAL CHEMISTRY
REQUEST RECEIVED BY MT ON DUTY
MT CHECKS THE REQUEST
SEND MT TO REQUESTING
DEPARTMENT
MT DOES THE EXTRACTION
MT SENDS TO APPROPRIATE SECTION
ENTER INTO LOGBOOK AND ASSIGN
LAB. NUMBER, TIME IS ALSO NOTED
PROCESS THE SPECIMEN
MT READS THE RESULT
MT RECORDS THE RESULT IN THE
LOGBOOK
MT TRANSCRIBES THE RESULT IN THE
OFFICIAL RESULT FORM
RESULT IS READY AT 4:00 P.M.
IF ABNORMALLY LOW OR ABNORMALLY
HIGH, RESULT IS RELEASED IMMEDIATELY
ABNORMAL RESULTS ARE REPEATED
BEFORE THE RESULT IS RELEASED
4. SEROLOGY
MT ON DUTY RECEIVED REQUEST
MT CHECKS THE REQUEST
ASSIGNED MT EXTRACT FROM
OPD PATIENT OR GO TO
REQUESTING DEPARTMENT TO
EXTRACT BLOOD FROM PATIENT
MT SENDS SPECIMEN TO APPROPRIATE
SECTION
MT PROCESS THE SPECIMEN
MT READS THE RESULT
MT RECORDS RESULT IN LOGBOOK
MT TRANSCRIBE RESULT IN OFFICIAL
RESULT FORM
RESULT IS READY AT 4:00 P.M.
5. BLOOD BANK
6. CYTOLOGY ( PAP’S & FNAB )
MT RECEIVED REQUEST
MT CHECKS THE REQUEST AND THE
SPECIMEN
MT RECORDS AND ASSIGNS THE
SPECIMEN A LABORATORY REFERENCE
NUMBER
MT LABELS SLIDES AND FIX THE
SPECIMEN
MT OR PATHOLOGIST DOES THE
MICROSCOPIC EXAMINATION
MT RECORDS RESULT IN THE LOGBOOK
MT TRANSCRIBES RESULT IN OFFICIAL
RESULT FORM
RESULT IS READY FOR CLAIMING AFTER
A WEEK
7. MICROBIOLOGY
8. REQUISITION
MT SUBMITS REQUEST PER SECTION
EVERY MONDAY MT MAKES
REQUISITION, FILL UP FORM IN 3 COPIES
SUBMIT TO STOCKROOM FOR
CLEARANCE – TO CHECK IF STOCKS
ARE AVAILABLE
SUBMIT TO ADMIN. OFFICER FOR
SIGNATURE AND APPROVAL
RETURN REQUISITION TO STOCKROOM
STOCKROOM PREPARES THE
REQUESTED ITEMS
C. Staffing Pattern
1. HEAD – PATHOLOGIST
2. CHIEF MEDICAL TECHNOLOGIST
3. HEMATOLOGY & SPECIAL HEMA SUPERVISOR
4. CHEMISTRY & DRUG TESTING SUPERVISOR
5. MICROBIOLOGY & MICROSCOPY SUPERVISOR
6. BLOOD BANK & BLOOD TRANSFUSION SERVICES & SEROLOGY SUP
7. SENIOR MEDTECHS
8. JUNIOR MEDTECHS
i. HEAD PATHOLOGIST
• Reports to the laboratory twice a week
• Oversees the general management of the laboratory
• Checks the accurateness of all procedures and tests results
• Review with the CMT all problematic cases.
• Holds special lectures to MTS for updates and continuing education in laboratory medicine
• Formulates administrative policies of the department of pathology with CMT in line with the objectives and policies of the hospital
• Meets all laboratory personnel at least once a month and recapitulates problems and incident encountered in the section.
ii. CHIEF MED-TECH
• Goes on duty eight hours everyday monday to friday
• Oversees the daily activities of the laboratory
• Takes charge of the procurement of all the laboratory supplies both programmed and emergency
• Review with section supervisor problems encountered in their section.
• Receives written report from all section supervisor regarding:
i. Number of tests per section
ii. Inventory of all equipment and supplies in each section
• Prepares monthly report of the laboratory.
• Checks quality assurance of the different section
• Approves schedules and rotation of duties of all laboratory personnel
• Evaluation of all laboratory personnel performance and proficiency to be submitted to the pathologist
• Attends meetings and seminars for the laboratory
• Prepares requirement for licensure.
iii. SECTION SUPERVISOR
• Goes on duty every Monday to Friday for eight hours
• Oversees the daily activities of his/her section
• Supervises the work in the section
• Prepares monthly report of the section:
i. Number of test done in the section
ii. Inventory of equipment and supplies in the section
iii. Repair of existing equipment
• Submit to CMT the monthly quality control chart of the section.
• Receives the referral for problematic cases and after thorough review refers to CMT
• In charge of the general cleanliness of the section.
iv. ROTATING MED-TECH
• Goes on eight hour day duty and sixteen hour duty every four days.
• Perform routine laboratory procedures.
• Prepares and process laboratory tests
• Prepares reagents and laboraotry apparatus for use during the tests.
• Record results in section logbook and transcribe to official result form
• Responsible for maintenance of cleanliness in the laboratory.
D. Equipment Facilities
5 Units BINOCULAR MICROSCOPE
NIKON ECLIPSE E
SERIAL # 816436 12-16-08 Functioning
817397 12-16-08 Functioning
818085 12-16-08 Functioning
819522 12-16-08 Functioning
819648 12-16-08 Functioning
2 UNITS OLYMPUS MODEL CX21 FSI
SERIAL # 7A 07790 6-20-07 Functioning
7F 07808 11-6-07 Functioning
1 UNIT OVEN DIGITAL WTC BINDER
MODEL ED 53 12-1-97 Functioning
1 UNIT INCUBATOR DIGITAL WTC BINDER
MODEL ED 52 12-1-97 Functioning
1 UNIT HOT PLATE MAGNETIC
STIRRER 10-10-97 Functioning
1 UNIT TEST TUBE ROTATOR 10-10-97 Functioning
1 UNIT PRESS TO MIX 10-10-97 Functioning
1 UNIT BACTICINERATOR 10-15-98 Functioning
1 UNIT SENSI-DISC TAMPING DEVICE
12 PLACER 10-15-98 Functioning
1 UNIT VITALAB SELECTRA 2 11-11-99 Functioning
1 UNIT WATERBATH WB 14
MEMMERT SERIAL # 1400.0309 10-19-01 Functioning
1 UNIT BLOOD COLLECTION SCALE 03-30-96 Functioning
1 UNIT PLASMA SEPARATION STAND 03-30-96 Functioning
1 UNIT CLINICAL CENTRIFUGE 9-22-09 Functioning
HERAEUS LABOFUGE
THERMOSCIENTIFIC
SN # 41011443
1 UNIT PLATALET ROTATOR/ 9-22-09 Functioning
SHAKER
MF NO 0908005
1 UNIT MEDICA EASY STAT 12-16-08 Functioning
SN 1008031001
1 UNIT HEMATOCRIT CENTRIFUGE 07-09-09 Functioning
BOECO H 240
SN 0000 – 408 – 01 – 00
1 UNIT ClLINICAL CENTRIFUGE 12-16-08 Functioning
HERMLE LABORTECHNIK
SN 60080402
2 UNITS HEMATOLOGY ANALYZER 12-16-09 Functioning
CELLENIUM 19
SN RK 93101323
1 UNIT BLOOD BANK REFRIGERATOR 12-16-08 Functioning
MBR-704GR
SN 07120008
1 Unit BRAND ROTOR MIX 03-30-96 Functioning
PIPETTE SHAKER 8 PLACER
SN 04159401
1 Unit PIPETTE SHAKER RINSER 03-30-96 Functioning
JAR
E. Clientele
1. Services Offered to:
i. In-patient
ii. OPD-ER patients
iii. Patient from nearby clinics/health centers
iv. Senior Citizen
v. PCSO sponsored patient
vi. Indigent patient of Mandaluyong
vii. Patient from Outreach Program of hospital
F. Strategies and Procedures of Service / SOP’s
The Department of Pathology is responsible for the different examinations done on different tissues and body fluids like blood, secretions, and excretions, which are requested by the physician.
1. Procedure on the different sections of the department:
i. Checks the request if properly filled up
ii. Checks the specimen if they are fit for examination
iii. If accepted they are directed to appropriate sections
iv. Requests for a specimen are stamped with time received, assigned a reference number and with signature of receiver.
v. OPD request is received up to 10:00 a.m. HEMA/MICROSCOPY/CHEMISTRY/SEROLOGY. STAT and ICU request are received anytime.
2. Clinical Chemistry Operating Procedure
i. The laboratory will approve and record procedures for all tests and these are to be strictly followed. Established procedures are to be filed in SOP book.
ii. The method in our SOP will not be altered or deleted without the approval of laboratory head
iii. Quality Control will be plotted each day by the technologist who performs the tests before results are reported.
• Tests which are outside ( 2 Standard Derivation will be discussed with the laboratory head before they are reported.
• If after all attempts have failed to bring the test into control, the results will be reported with the statement.
Control in Excess of ( 2 S.D.
• Supervisor of chemistry will be responsible for the accuracy of all tests, which are reported, whether tests are run at nights or during routine working hours.
• All reagents will be dated. Any reagents, which show deterioration visually or from quality control data, will be discarded immediately.
• Tests will be calibrated when there is any major change in any parts of the procedure such as new reagent test. No calibration curve will be used longer than six months.
3. Clinical Microscopy
i. MT should be careful in handling and collecting specimens since most of them contain dangerous pathogenic organisms.
ii. Check if specimen is fit for examination
iii. Specimen container should be labeled with patients name and date
iv. Laboratory personnel should be properly trained in urinalysis test technique specially in microscopic analysis
v. Technologist must not be color-blind
vi. Ensure that specimen is properly collected
vii. The sooner the specimen gets to the laboratory the better. Standing without refrigeration for even ½ hour may result in bacterial overgrowth and deterioration of fragile casts.
viii. Reagents and equipments should be monitored to assure reliable dependable results.
ix. Each section have approved and recorded procedure.
4. Parasitology
i. MT should be careful in handling and collecting specimen since most of them contain dangerous pathogenic organism
ii. Check if specimen is fit for examination
iii. Specimen container should be labeled with patient’s name and date
iv. Laboratory personnel should be properly trained in parasitology examination techniques specially microscopic analysis
v. Technologist must not be color-blind
vi. Ensure that specimen is properly collected
vii. For helominths, examine the specimen within 3-4 hours. For amoebas, examine within 30 min.
viii. Reagents and equipment should be monitored to assure reliable, dependable result
5. Hematology
i. MT should be careful in handling and collecting blood/specimen
ii. Check if specimen is fit for examination
iii. Specimen should be labeled and recorded
iv. MT must be well trained in hematologic examinations specially the microscopic examinations
v. Be sure the specimen is properly collected
vi. Make sure that all glassware are clean and dry
vii. Properly calibrated apparatus must be use
viii. Proper techniques must be employed in the performance of the test
ix. Reagents and equipment must be monitored
6. Blood Bank
i. MT should be careful in handling and collecting blood specimen
ii. Check the request for blood type and number of units requested by the physicianCheck if blood type is available, if not, coordinate with other institution ( Red Cross, RMC, Polymedic and other member of the Zonal Blood Bank ) Inform relative that they have to fill the requirement of the blood source.
iii. Recheck blood type of donor
iv. Perform compatibility testing
v. If compatible release the crossmatching result to the ward. If incompatible replace unit with another unit of same type
vi. The ward nurse / ward personnel should present the crossmatching result form to get the blood unit from the laboratory.
vii. MT should be well trained in Blood Bank procedure
viii. Crossmatching result should be released as soon as it is done.
ix. In emergency cases, blood can be released after the saline phase but the doctor should sign the waiver. Proceed with the crossmatching and inform the physician if they could go on with or stop the transfusion.
7. Microbiology
i. MT accepts request and specimen anytime
ii. MT checks data and record in the General Logbook
iii. Specimen together with the request is sent to responsible section and assigned a reference number
• For AFB & Gram’s Stain Request
i. MT checks the specimen whether fit for examination
ii. MT process the specimen
iii. MT prepare the slide and fix ths specimen
iv. MT labels and stain the slides
v. MT/Pathologist does the microscopic examination
vi. MT records result in logbook
vii. MT transcribes result in the official result form
viii. Result is ready in 3 to 5 days
• For Culture and Sensitivity Request
i. MT checks the specimen if fit for examination and Plant specimen in appropriate culture media
ii. Incubate culture plate w/specimen for 24 hours
iii. MT makes initial reading after 24 hours
iv. If there is no growth, incubate again for 24 hours
• Those without growth
i. Incubate again for 24 hours
ii. If still no growth release result as NO GROWTH
• Those with growth:
i. MT does the Biochemistry analysis or sensitivity
ii. Incubate for 24 hours
iii. Read result and record
iv. Issue final result
• For Blood Culture
i. MT incubate culture plate for 5 days before declaring no growth
8. Cytology
i. Check the request and the specimen if fit for examination
ii. Check the label and record in the logbook
iii. Stain with AFB/Grams/Pap Smear
iv. Pathologist reviews the slide
v. MT records results in section logbook
vi. Result is ready for release to claimant
9. Histopath
i. MT receive specimen, checks the request and source of specimen
ii. Check if specimen is fixed with 10% formalin
iii. If fit for exam, specimen is assigned a laboratory number and recorded
iv. Patient or patients relative is given a claim stub which states the date when result is ready for release.
IV. ADMINISTRATIVE POLICIES
A. General / Basic Qualification Standards of the Different Position Levels
1. MEDICAL TECHNOLOGIST I
i. Education — Bachelor’s Degree in Medical Technology or Bachelor of Science in Public Health
ii. Experience — 3 months externship
iii. Training — none required
iv. Eligibility — RA 1080
2. MEDICAL TECHNOLOGIST II
i. Education — Bachelor’s Degree in Medical Technology or Bachelor of Science in Public Health
ii. Experience — 1 year of relevant experience
iii. Training — 4 hours of relevant training
iv. Eligibility — RA 1080
3. MEDICAL TECHNOLOGIST III
i. Education — Bachelor’s Degree in Medical Technology or Bachelor of Science in Public Health
ii. Experience — 2 years of relevant experience
iii. Training — 8 hours of relevant training
iv. Eligibility — RA 1080
4. MEDICAL TECHNOLOGIST IV
i. Education — Bachelor’s Degree in Medical Technology or Bachelor of Science in Public Health
ii. Experience — 2 years of relevant experience
iii. Training — 8 hours of relevant training
iv. Eligibility — RA 1080
5. MEDICAL TECHNOLOGIST V
i. Education — Bachelor’s Degree in Medical Technology or Bachelor of Science in Public Health
ii. Experience — 3 years of relevant experience
iii. Training — 16 hours of relevant training
iv. Eligibility — RA 1080
B. Functions and Responsibilities of the Staff/Personnel
1. JOB DESCRIPTION
i. Head Pathologist
• Oversees the general management of the laboratory
• Checks the accurateness of all procedures and test results
• Reviews with the Chief Med. Tech all problematic cases
• Holds special lectures to MT for updates and continuing education in laboratory medicine.
• Formulates administrative policies of the Department of Pathology with CMT in line with the objectives and policies of the hospital.
• Meets all laboratory personnel at least once a month and recapitulates problems and incidents encountered in the section
ii. Medical Technologist V CMT
• Oversees the daily activity of the laboratory
• Takes charge in the procurement of all laboratory supplies (both emergency and scheduled)
• Review with section chief problems encountered per section
• Receives written report from all section chief regarding
i. Number of tests done per section
ii. Inventory of all equipment and supplies
• Prepares monthly report of laboratory
• Checks quality assurance program of each section
• Approves schedules and rotation of duties of all laboratory personnel
• Evaluation of all laboratory personnel performance and proficiency to be submitted to the head pathologist.
iii. Medical Technologist IV – Section Chief
• Oversees the daily activity of his/her section
• Supervises the work and prepares schedule of duties of Senior and Junior MT
• Prepares monthly report of section as to
i. Number of tests done
ii. Inventory of equipment and supplies
iii. Repair of existing equipment
• Submit to CMT the monthly quality control chart of section
iv. Medical Technologist III – Senior MT
• Assumes supervisory duties in the absence of section chief
• Performs both routine and special laboratory procedures upon request
• Supervise work of Junior MT
• Receives the initial referral for problematic cases and after a thorough review refers to section chief or CMT
• Assists the section chief in preparing monthly reports and quality control chart.
v. Medical Technologist II – Junior MT
• Perform routine laboratory procedures in the LAB.
• May perform special procedures under the direct supervision of Senior MT
• Records daily all test results in the corresponding logbook
• In charge with daily maintenance and safekeeping of all laboratory equipment’s belonging to the section.
• In charge of general cleanliness of the laboratory
vi. Medical Technologist I – Entry Level of MT
• Performs routine laboratory procedures under supervision
• Prepares and process laboratory tests
• Prepares reagents and laboratory apparatus for use during the test
• Enter result in official result form and record in logbook
C. RECRUITMENT / HIRING / TERMINATION
1. Recruitment
i. Applicant must be of legal age, graduate of B.S. Medical Technology
ii. Applicant has passed the board exam given by PRC.
iii. Applicant must submit the following credentials:
• Application letter
• Diploma
• Transcript
• Curriculum Vitae with picture
iv. Applicant must take the written examination on a prescribed date
v. Applicants will be interviewed by the department’s consultant on a prescribed date
2. Hiring
i. Applicant who passed the examination given by the different sections and passed the interview by the pathologist will undergo 3 months familiarization with the operation and at the same time performance of the applicant will be assessed.
ii. If there is a vacancy, the applicant is given recommendation after proper evaluation. If there is no vacancy, the application of the qualified candidate for a position is kept on file.
3. Termination
i. Gross incompetence esp where health/safety risk result.
ii. Gross negligence, gross neglect of duty
iii. Unsafe working practices
iv. Gross defiance of proper instructions or standing order
v. Gross insubordination
vi. Gross abuse ( colleagues, public violence or fighting
vii. Ill treatment/mishandling of patient
viii. Sexual misconduct at work
ix. Unfitness for duty thru alcohol or drug intoxication
x. Vandalism of property
xi. Timekeeping fraud
xii. Breach of security or confidentiality
xiii. Reprimand
xiv. Absenteeism
xv. Abuse of uncertified sickness facility
xvi. Unauthorized lateness
xvii. Cause of disharmony among employee
xviii. Written warning
xix. Refusal to arrange holidays to suit operational requirement
xx. Refusal to comply with reasonable reorganization
xxi. Not observing established standard of appearance
V. TRAINING / MANPOWER DEVELOPMENT
A. Rationale
1. To develop skill in different / advance development
2. To strengthen competency of the laboratory personnel
3. To upgrade the capability of MTs
4. To upgrade MT’s with standardized procedure
5. To upgrade the knowledge of laboratory personnel
B. Objectives
1. Professional Development
2. Organizational
3. Community Service
C. Training & Education
1. Existing (Brief Description of Present Set-up)
2. Needs (Rationale / Justification)
3. Future Plans (Specific Time Table)
VI. REPORTS/RECORD/FILES/FORMS
A. Collection of Existing Forms
VII. QUALITY ASSURANCE
A. Desired Job Performance
1. Per Personnel (Specific Checklist Desired Performance)
2. Per Service Areas/Sections (Indicators)
B. Evaluation & Methods
1. Per Personnel (Methodology of Evaluation/Performance)
2. Per Service Areas/Section (Methodology of Evaluation/Performance)
C. Code of Conduct
1. All laboratory personnel should report on time and wear the prescribed uniform including their respective. All are required to sign in and sign out in the logbook
2. Lunch break should be taken alternately on a decking system so that there is always a laboratory staff available.
3. Proper written endorsement must be out after every shift or as need arises
4. Emergency leave of absence
i. The lab. Personnel should notify the laboratory as early as possible so that proper replacements could make.
ii. All others leave of absence. Should be failed within 2 weeks prior to the intended leave.
iii. The approval of the above by head PATHO is recommended by CMT and will depend in the availability of the lab. Staff.
5. All members of the lab should try to work in harmonious relationship with each other. All problems can be discussed in courteous or logical manner
6. VL should be filed 5 days in advance.
7. Request for exchange of outers bet personnel must be made official & duly signed by both the reliever & the one relieved. This should be done one week in advance.
8. Special leaves like B-DAY; Anniversary should be filed 1 month in advance.
VIII. CARE AND MAINTENANCE OF EQUIPMENTS
A. MICROSCOPE
1. To be done weekly
i. Check physical condition of the power cord, plug and grounding system including other parts.
ii. Clean the unit
iii. Lubricate the roller and other movable parts.
iv. Check the adjustments of the iris diaphragm and condenser assembly.
2. Notes
i. Avoid exposing the unit to high temperature, dust and vibration
ii. Cover the unit when not in use
iii. Report any malfunction.
B. CENTRIFUGES (MICROHEMATOCRIT & CLINICAL)
1. To be done weekly
i. Check physical condition of the power cord, plug and grounding system Switches, controls, gaskets, cover latch and rubber footing.
ii. Clean the unit.
2. Notes
i. Prepare proper balancing of load and check speed intervals if possible.
ii. Unplug unit when not in use
iii. Cover the unit when not in use
iv. Report any malfunctions.
C. LABORATORY INCUBATOR / OVEN
1. To be done weekly
i. Check physical condition of the power cord, plug, knobs, switches and Grounding system.
ii. Clean interior and exterior of the unit.
iii. Using external thermometer, check the accuracy of the temperature and the calibration of the thermostat.
iv. Using the stopwatch, check the timer’s calibration.
2. Note
i. If the inside chamber is stained, wipe off with moist cloth. Never was with water.
ii. Install or store the unit in a location away from direct sunlight and splashes of reagents and water.
iii. Avoid exposing the unit to shocks and vibrations.
iv. Report any malfunction.
D. WATER BATH
1. To be done daily
i. Check the physical condition of the power cord, plug, grounding system, Switches, control and motor
ii. Check if the temperature in the tank responds with the temperature Control setting.
E. BLOOD BANK REFRIGERATOR
1. To be twice a month
i. Check the physical condition of the power cord, plug. Knobs, grounding system, switches, controls and gasket.
ii. Check if there’s enough space between the items inside the unit to allow air circulation.
iii. Clean the unit.
2. Note
i. Check if the door closes tightly after every opening
ii. Do not splash water on the surface to avoid short circuit.
iii. Monitor temperature reading daily.
iv. In case condensation forms on the front glass due to very humid environment wipe it off with soft dry cloth.
v. Unplug before cleaning.
vi. Check AVR meter
vii. Use only single plug socket for power source.
viii. Report any malfunctions.
F. AUTOCLAVE
1. Procedure before using
i. Clean the unit
ii. Check the power cord and the grounding system
iii. Check the physical condition of the gauges, water level indicator, valve switches, door gasket, and safety valve.
iv. Drain the boiler once a month, check water level before using. Always use distilled water or rain water.
2. Note
i. Never open the door when the chamber is still pressurized.
ii. Sometimes there is water when you look at the water level indicator. Once in a while release the water trapped in the sight glass by opening the cock below it and add water in the boiler.
iii. Switch off the unit when not in use.
iv. Report abnormalities or malfunctions.
G. HEMATOLOGY ANALYZER
i. Clean the unit
ii. Check the power cord and the grounding system of the unit
iii. Check the physical condition of the probes and switches
iv. Check the connection to the AVR
Note
i. Do probe cleanser cleaning when the accumulated analyzed whole blood samples reach 300.
ii. Do E-Z cleanser cleaning to clean tubing and bath
iii. Do Lyse test in case of abnormally high WBC
H. SELECTRA VITALAB
1. Clean the unit. Be sure it is turned off.
2. Check the power cord and the grounding system of the unit.
3. Check its connection to the AVR.
i. Note
• Prior to starting, check if there is sufficient amount of printer paper
• Use 0.1 N NaOH in cleaning of container for system liquid and waste.
• Use 10 % of Sputofluol in cleaning of sample/reagent needle
• Use pure Sputofluol in cleaning of the system
• Change rotor after every 10,000 tests
I. EASY RA MEDICA
1. Check the connection of the equipment to UPS
2. Check the physical condition of the switches, grounding system.
i. Note
• Do probe cleaning daily.
• Do ISE module cleaning and calibration daily.
• Check dilutor pump, probe, waste/diluent, and pump tubes.
• Clean probe with 70% isopropyl alcohol.
• Check tubings for wear or leaks.
• Do precision test weekly.
• Monthly cleaning: Bleach diluent and waste bottle, clean wash cup and duct filter.
J. EASY STAT MEDICA
1. Check the the power cord and the grounding system of the unit
2. Be sure to leave the analyzer connected to power when a reagent module is in place.
3. Use only 10% bleach in cleaning the outside surface of the unit.
4. Replace component according to schedule.
K. LABORATORY AIRCON
1. Use air conditioning unit alternately.
2. Report to maintenance any malfunction.
IX. CODE OF ETHICS:
1. Accept the responsibilities inherent to being a professional
2. Uphold the law and shall not participate in illegal work
3. Act in a spirit of fairness to all and in a spirit of brotherhood toward other members of the profession.
4. Accept employment from more than one employer only when there in no conflict of interest.
5. Perform my task with full confidence, absolute reliability and accuracy
6. Share my knowledge and expertise with my colleagues
7. Contribute to the advancement of the professional organization and other allied health organizations
8. Restrict my praises, cristicisms, views and opinios within constructive limits
9. Treat any information I acquired in the course of my work as strictly confidential.
10. Uphold the dignity and respect of my profession and conduct myself with reliability, honesty and integrity.
11. Be dedicated to the use of clinical laboratory science to promote life and benefit mankind.
12. Report any violations of the above principles of professional conduct to the authorized agency and the Ethics Committee of the organization.
DEPARTMENT OF RADIOLOGY
Overview/Introduction
The Department of Radiology of the Mandaluyong City Medical Center has been in existence since 1996. It falls under the Ancillary Service, which provide various diagnostic services using X-ray facilities.
The newly renovated X-ray Department uses the newly acquired Toshiba 640 MA X-ray machine with fluoroscope, a 300 MA portable X-ray machine and an automatic processor all of which were obtained through the courtesy of Senator Neptali Gonzales. These have the capacity to produce excellent quality images, enabling rapid diagnosis facilitated by experience medical and technical staff.
Historical Background
A. Overview / Introduction
Wilhelm Conrad Roentgen, a German physicist, discovered x-rays on November 8, 1895. While engaged in cathode tube electrical discharge experiments, he noticed that some barium platinocyanide near the tube emitting blue light. He called the newly discovered tube-derive radiation X-RAYS to indicate that their nature was unknown. Later, the German Medical Society logically named the discovery ROENTGEN RAYS in honor of the great accomplishments made by this physicist.
A century has come and done since this great scientific achievement. In this span of time, humanity has found many ways to utilize the properties of X-rays. In particular, the contribution of X-rays in the field of medicine has been immeasurable. Radiographic methods of enormous technical progress made in radiographic systems, including X-ray equipment, film and intensifying screens. Radiation medicine has been playing an important role in the diagnosis and treatment of cancer. X-ray translucent photography has found wide applications in medical care.
B. History of Radiology in the Philippines
1. The first strings in the practice of Radiology as a specialty in our country came in 1948 after the liberation. The pioneering group, dubbed “The magnificent Seven” who drafted the first Constitution and By-Laws of the Association included the following:
i. Dr. Paterno Chikiamco (President)
ii. Dr. Ramos Paterno (Secretary-Treasurer)
iii. Dr. Paulino Garcia
iv. Dr. Daniel Ledesma Sr.
v. Dr. Carlos Marquez
vi. Dr. Hilario Zialcita
vii. Dr. Carlos Vergel De Dios
2. The association they formed was originally called the Philippine Radiological Society. During these early years, radiology was not considered a specialty and attending physicians interpreted X-rays films in most hospitals.
3. It was in August 21, 1970 that the new Constitution and By-Laws changed the name of the association to the Philippine College of Radiology, as it is now known, following the suggestion of Dr. Chikiamco. So active was the association that it covered the Philippine Medical Association’s award for the “Most Active specialty Society” in 1976 and 1977 during the term of office of Dr. Leon Lopez. In 1978, Dr. Roberto Reodica Sr., initiated the move to establish closer rapport of the association with the government through the Radiation Health Office.
C. Definition
1. Radiologic technology has its own unique language by which members of the profession communicate with each other. Radiographers must be familiar with two forms of terminology. The first, which is medical terminology, deals with the terms used to describe the anatomy and pathology of the human body. The second term refers to a system of techniques for extracting information on the target sites of a sample, the object of investigation by X-rays, which is carried out as variations in the number of X-ray photos. The purpose of radiography is to provide the medical staff the best possible X-ray images to be used for diagnostic purposes.
D. Guiding Principles
1. The Department of Radiology:
i. Shall not discriminate against anybody and shall attend to all patients regardless of creed, race, belief or political affiliation.
ii. Shall focus on patients at all times acting with dignity, sincerity and genuine concern
iii. Shall always work with honesty, dependability, level-headness and morality
iv. Shall provide the highest level of technical know-how in the performance of Radiology, employing courtesy, empathy, compassion and privacy of patient and family.
2. The Department of Radiology:
i. Concepts
• Radiologic personnel should bear in mind that their profession is a public trust and that they should at all times maintain and uphold the dignity and integrity of their profession and protect it from misinterpretation.
• Radiologic personnel should be aware of the supreme authority of the state and should adhere to the Constitution, RA 7431 and other laws and the rules and regulations promulgated pursuant to such laws.
ii. Others
• Moral Discipline
i. Remember that only the attending physician is allowed to answer inquiries of the patient about the results and condition of the patient.
ii. Be ready to face unreasonable demands
iii. Only qualified radiologists are authorized to interpret radiographs.
iv. Results are not given by telephone
v. To avoid the risk of being misunderstood or of causing damage to patients, doctors as well as to the hospital’s reputation, avoid discussion with the patient, relatives and even co-workers issues regarding patients
vi. Be skillful professionally so as to gain more confidence and cooperation from the patient.
• Ethics
i. The code of Ethics is designed to encourage ethical professional conduct and to establish standard and acceptable behavior so that both the profession and the public they serve may know what is expected and what is not permissible.
ii. Technologists’ Credo… that we may serve humanity with fidelity, uphold the dignity, honor and objectives of the Radiologic Technology profession to the best of one’s ability and render service without any mutual reservation to the practice of Radiologic technology…
Department/(Section Nomenclature)
A. Philosophy/Mission/Vision
1. The Department of radiology of the Mandaluyong City Medical Center upholds the devotion of the hospital to provide health care services primarily for indigent patients of the City of Mandaluyong. This mission is in accordance with the mayor’s vision that “NO MAN SHALL BE DENIED ACCESS TO HOSPITALIZATION BY REASON OF POVERTY”
B. Objectives
1. To be able to provide the best radiologic diagnostic services available to as many patients as possible at the lowest cost, regardless of race, nationality, religion or status in life, strictly adhering to the general principles of the Code of Ethics and applying it accordingly and with patients’ safety in mind.
C. General Policies & standards
1. The Department of Radiology, which is under the Hospital’s ancillary Services, aims to provide radiologic diagnostic services to the patients of the Mandaluyong City Medical Center.
Organizational Set-up / Work flow / strategies and Procedures
A. Organizational Set-up
CITY MAYOR
MEDICAL DIRECTOR
ANCILLARY SERVICES
DEPARTMENT OF RADIOLOGY
RADIOLOGISTS AND RADIOGRAPHERS
B. X-RAY PROCEDURE
• PORTABLE X-RAY REQUEST
C. Staffing Pattern
1. Brief Job Description
a) Radiologist- a licensed doctor of medicine who has specialized in radiology, he/she interprets the radiographs and gives out the official results of such examinations
b) Radiographer/Radiologic Technologist/Radiologic technician
c) Receptionist/Secretary – performs clerical jobs
2. Relationship
CHAIRMAN, DEPARTMENT OF RADIOLOGY
RADIOLOGISTS
RADIOLOGIC TECHNOLOGIST SECRETARY
D. Equipment Facilities
1. The Department of Radiology is presently equipped with:
a) List
1) Toshiba X-Ray Apparatus
(X-RAY Generator)
150Kv, 640mA
Model: KXO-15E
The KXO-15E is an x-ray general provided with a two-tube control system which can be used to perform fluoroscopic examination and every type of radiography, when combined with an x-ray diagnostic table.
2) X-RAY Diagnostic Table: Model: DT-KEL/Z1
Model DT-KEL/Z1 is a versatile 90/15 diagnostic x-ray table applicable to the various Radiographic/Fluoroscopic diagnosis.
3) Vertical Bucky Stand: Model: BS-01
This is bucky stand widely applicable to vertical position x-ray examination. The usable cassette size ranges from 24 cm x 30 cm to 35 cm x 43 cm (8 x 10 to 14 x 17). The grid can be replaced from the front.
4) Floor to ceiling Tube Stand: Model: DS-TA-54/21
This unit is a floor to ceiling type tube stand to be combined with a general x-ray table or diagnostic x-ray table. Its components are all more or operated manually, and are fixed by means of electromagnetic brokers.
5) Beam Limiting Device: Model: TF-GTL-6
This beam limiting devices, model TF-GTL-6 is designed for a wide range of general purpose radiography in combination with a Toshiba X-ray tube and tube support unit. This is a multi-shutter beam-limiting device, which cuts off x-radiation outside the desired field to improve image resolution. It also reduces the dose to both patient and equipment operator.
6) Diagnostic Variable X-RAY Collimator: Model: TF-10M-1
This device is a remote controlled, power driven variable collimator to be attached to an x-ray unit to adjust the size of the x-ray field.
7) Bucky Device: Model: BD-02
This model BD-02 Tishiba oscillating Bucky is intended primarily for in-table mounting with grid-driving mechanism and cassette tray.
8) X-RAY TV Monitor: Model: TVM-20C
The TVM-20C is a compact, high-performance medical x-ray display monitor for observing TV Fluoroscopic, images. The TVM-20C is 12 inch CRT (diagonal size) feature a 110 deflection angle which makes it possible to obtain images with a 185 mm diameter by circle-blanking the camera.
9) X-RAY TV Camera: Model: MTV-100B
This unit is a diagnostic x-ray TV camera for the 6”I.I. used in combination with x-ray system for special examinations. The main body is composed of a camera section integrated with an optical system. A 408,000 pixel CCD is used as the imaging element and the photo multiplier is built into the optical system.
10) Mobile X-RAY Apparatus (Capacitor Discharged) 300 mA, 100KV: Model: KCD-10M-7
This apparatus possesses the functions of automatic x-ray tube recharging and wave-tail cut off, and enables radiographic control by the grid of a rotating anode type triode.
11) Beam Limiting Device: Model: TF-TLF
The TF-TLF contains a dark x-rat shutter that can cut off double x-ray beams, and a variable multi-diaphragm collimator that may used to select the radiation field and cut off focus x-ray beams.
12) AGFA CLASSIC E.O.S. AUTOMATIC PROCESSOR
Three fast processing cycles for optimal processing quality in accordance with the film type that is used.
13) Protective Devices
a) 2 pieces strataflex (Roland) rubberized lead apron 3 mm Pb (Blue) – 2
b) Tubberized gloves (Black) 1.5 Pb.
c) 1 Female Gonadal Shield 1.5 mm Pb.
d) 1 Male Gonadal Shield 1.5 mm Pb.
e) 1 Pedia Gonadal Shield 1.5 mm Pb.
f) 1 Upright movable Gonadal Shield 1.33 mm Pb.
14) Cassettes
a) 2 sets 35 x 43 cm film cassette with intensifying screen (regular lanex) KODAK
b) 2 sets 30 x 35 cm film cassettes with I.S. (regular lanex) KODAK
c) 2 sets 10 x 12 film cassettes with I.S. (regular lanex) KODAK
d) 2 sets 8 x 10 film cassettes with I.S. (regular lanex) KODAK
e) 1 set 14 x 17 film cassettes with I.S. (high speed) Blue
f) 2 sets 11 x 14 film cassettes with I.S. (high speed) Blue
g) 1 set 8 x 10 film cassettes with I.S. (high speed) Blue
h) 1 set 14 x 17 Grided cassettes with Soyee Grid ratio 8.1
i) 1 set Caliper (42 cm length/aluminum)
15) Negatoscope
6 viewing frames 14 x 17
16) Barter
Movable 1-5 mm Pb with leaded glass window
E. Responsibilities:
1. All items / requirements that are issued / received (MR) to the department should be taken cared. Any losses and damages of these properties should be accounted by the staff under its supervisions.
2. The Department of Radiology is a fully air-conditioned area with an X-ray room, dark room, viewing room, reception area, reading area and comfort room facilities.
3. Other necessary equipment and supplies are as follows:
a) Lead gowns, lead aprons, lead gloves
b) X-ray plates and cassettes, developing solutions
c) Film badges, film lead markers
d) Contrast materials, barium enema equipments
e) Typewriter
f) Typewriting paper, union skin paper, carbon paper
g) Folders, envelopes
h) Pens, pencils, pentel pens
i) Meniographing paper, stencils
j) Cellophane tape, liquid paper erasers, fasteners, punchers, stapler, staples
k) Filing boxes and cabinets
l) Scissors, calculator, rulers, red making pencils
m) X-ray request forms, borrower’s slip, charge slips
n) Record books or logbooks
o) Linen, such as pillow cases, bed sheets, blankets, towel, gowns
Clientele
A. All patients of Mandaluyong City Medical Center consultants and residents, whether private or charity cases.
Strategies and Standard Operating Procedures
A. Requests and scheduling of X-Ray Examinations
1. The x-ray department shall be open for 24 hours for emergency cases.
2. Official X-ray request forms from the X-ray section should be distributed to the different departments regularly
3. Official X-ray request form is as follows: (see appendix A)
4. All x-ray request forms should be properly accomplished. Only request forms with complete information will be entertained. The requesting physicians should affix their signature in the request form.
5. X-ray request forms from private physicians outside the Mandaluyong City Medical Center will not be entertained. Patients who wish to avail of the X-ray examinations from the Mandaluyong City Medical Center should be evaluated by the MCMC Senior House Officer who consequently would request for the examination.
6. X-ray request forms from physicians of the First Integrated Pediatric Community Outreach Program will be honored at the Mandaluyong City Medical center provided the Pediatric Chief resident countersigns the request form.
7. X-ray request form from physician of the Mandaluyong City Medical Center provided that the X-ray Chief Resident of Senior House Officer transfers the request to a Mandaluyong City Medical Center official X-ray request form.
8. X-ray request forms for all special procedures should be approved by the Chief Resident/Consultant on duty or Senior House Officer so as to avoid indiscriminate requests.
9. Special X-ray examinations will be available from Mondays to Saturdays in the mornings and should be scheduled in the X-ray department.
10. Requests for special procedures should be scheduled with the Senior X-ray technician at least a day prior to the examination so as allow proper preparation for the procedure. The X-ray technician should maintain a logbook for the scheduled special examinations. He should log down the necessary information of all patients for the special procedures in the official logbook as follows:
Date Name Procedure Pay/charity OR No. Physician
11. X-ray technician should stamp the Date and Time of the special Procedure and sign the patients’ request form.
12. The X-ray technician should brief the patient on necessary preparations for the procedure and give the patient a list of needs and steps for the preparation.
13. The number of patients for special X-ray examinations will be limited per day as follows:
Escophagogram/UGIS/Barium Enema 1
KUB-IVP 1
Others (Oral Cholecystogram/SIS/Colonogram)/
T-Tube Cholangiogram, etc.) 1
Special procedures can be done on a case to case basis at the discretion of the Radiologist.
14. The medical and nursing staff should also brief the patients on the necessary preparations for certain examinations. (refer to Appendix B)
15. A medical or nursing staff should accompany In-Patients scheduled for special examinations for the day to the X-ray room with the patient’s chart.
16. Out-Patient schedule for special X-ray examinations for the day should be required to be at the Mandaluyong City Medical Center Radiology Department by 7:30 a.m.
17. The X-ray technician after taking the regular and special X-ray examinations of the patient should request the patients to come back for the result the next day.
18. The portable X-ray machine should only be used for special and critical patients in the wards, at the ICU or the Operating Room.
19. Only trauma cases should be accepted for emergency special procedures. The request form should be completely accomplished with the signature of the requesting resident and consultant.
20. Examinations for Out-Patient will only be entertained during office hours. Beyond 5:00 p.m. requests from the Emergency Room will be entertained. OPD cases should be asked to come back the following working day for their examination.
21. The Mandaluyong City Medical Center Radiology Consultants will not officially read X-rays from other institutions and clinics.
22. In patients scheduled for x-ray examinations should be accompanied by a medical or nursing staff to the ultrasound room with the patient’s chart.
B. Procedures for Payment
1. All patients should bring their completely accomplished X-ray request forms for the X-ray technician who will check the requests. The X-ray technician gives the charge slip to the patient before sending him to the cashier to donate the corresponding X-ray fee.
2. During office hours, patients who wish to avail of indigent rates should be evaluated by the Medical social Service (MSS) or by the Radiology Chief Resident or by the Chief of Ancillary Services. Only X-ray request forms with the MSS stamp or signature of the aforementioned should be considered as charity or indigent.
3. All green card or senior citizen card holders should have their cards verified at the Administration Office Medical Social Services and have their request countersigned before they can avail of the benefits.
4. After office hours and for emergency cases, the Senior House Officer on duty (SHO) should evaluate the patients who wish to avail of indigent rates.
5. Patients then donate at the cashier and present their official receipt and request forms to the X-ray technician.
6. The rates for the examinations are as follows: (see Appendix C)
Administrative Policies
A. General/Basic Qualifications Standards of the Different Position Levels
1. Radiologist
a) Must have completed the standard three-year residency in Radiology at an established X-ray facility in an accredited hospital or institution
2. Radiologic Technologist
a) A graduate of Radiologic technology who has possessed the RA 1080 licensure examination as a radiologic technologist.
3. Secretary
a) A Civil Service eligible employee who has passed all requirements of a hospital employee.
B. Functions and Responsibilities of the Staff/Personnel
1. Job Description
a) Chief Radiographer
1) Aside from the routine works of Medical X-ray Technician I also
2) Prepare weekly schedule of technician/secretary
3) Perform fluoroscopy and special procedures with Radiologist consent
4) Attend to the availability of department supplies, such as X-ray films, solutions and other office supplies.
5) Make the final evaluation of students and preparing their statement of accounts
6) Coordinate with affiliated schools regarding student’s contract of affiliation.
7) Maintain the condition of X-ray machine and processor.
8) Repairing some minor trouble of machine
9) Responsible for annual renewing of license
10) Maintain department’s cleanliness
b) Medical X-ray Technicians
1) Receiving X-ray requests of patients from ward, emergency room and Out-Patient department completely filled up and signed by the requesting physician.
2) Do the recording of patient’s data in logbook
3) Responsible for signing bill of charges of In-Patient as well as the Out-Patient
4) Bringing X-ray plates for initial reading to the radiologist or requesting physician who wishes to see the finished radiograph
5) Instruct and schedule patients how to prepare the special examination
6) Releasing results and coordinates with receptionist regarding sizes of plates and prices.
7) Filling X-ray plates to envelop for file.
8) Perform ordinary examination such as skull x-ray, chest x-ray, extremities etc., specified in the requesting physician.
9) Assist the radiologist in fluoroscopy and other special procedure.
10) Prepare finished radiograph for reading
11) Responsible for guiding, evaluating and teaching students about hospital routine especially x-ray department routine.
12) Maintain department cleanliness
c) X-RAY Secretary
1) Receive X-ray request from ward, OPD, ER. Signed by the attending physician.
2) Do the recording of patients data in logbook.
3) Responsible for signing the bill of charges of In-Patient as well as the Out-Patient
4) Type X-ray results (Radiological Report) cards for file
5) Responsible for sorting X-ray plates in preparation for interpretation by the radiologist and always is aware of the position and markings.
6) Filling X-ray cards and putting the X-ray plates to an envelop for file
7) Filling X-ray results for hospital and patient references
8) Releasing result and coordinates with receptionist regarding sizes of plate and prices.
9) Taking care of the interns once they are in the department
10) Do the annual statistic report
11) Responsible to keep all documents of the Radiology Department
12) Maintain the department’s cleanliness
C. Recruitment/Hiring/Termination
1. Recruitment/Hiring
2. Regular
3. Contractual
4. Casuals
Training/Manpower Development Position Levels
A. Rationale
B. Objectives
C. Training & Education Residency
1. Existing (Brief Description of Present Set-up)
2. Needs (Rationale/Justification)
3. Future Plans (Specific Time Table)
Reports/Records/Files/Forms
A. Collection of Existing Forms
Quality Assurance
A. Desired Job Performance
1. Per Personnel (Specific Checklist Desired Performance)
2. Per Service Areas/Section (Indicators)
B. Evaluation Methods
1. Per Personnel (Methodology of Evaluation/Performance)
2. Per Service Area/Section (Methodology of Evaluation/Performance)
C. Code of Conduct
Ultrasound Section
I. Job Description
a. Perform all sonographic procedures under the clinician supervisor.
b. Assist the sonologist in performing the special procedures such as endovaginal / transvaginal , cranial , chest Ultrasound.
c. Manipulate machine and set the proper sound and exposure factor.
d. Ensure patients safety and privacy within the department area.
e. Gather patient medical history and other related information for clinical correlation.
f. Regular maintenance for ultrasound machine.
g. Secure sonoprint copy of every examination for hospital records.
h. Give proper instruction and preparation for every procedure before and during examination.
i. Make your patients feel welcome and comfortable.
II. Guidelines For Examinations
a. Request and scheduling of ultrasound examinations:
i. The ultrasound section shall be open from monday to friday from 8:00 am to 5:00 pm.
ii. All ultrasound request forms should be properly accomplished (patient’s name, age, room and bed number, pertinent medical history, clinical impression, diagnosis). Only request form with complete information will be entertained. The requesting physicians should affix their signature in the request form.
iii. Only ultrasound request from MCMC physicians should be entertained by the ultrasound section, in the meantime, because of the limited supply of the section.
iv. Request for schedule ultrasound examinations for the admitted (inpatient) for the day should be given to the ultrasound technologist before 10:00 am so as to enable her to make the necessary preparation for the procedure.
v. The ultrasound section, in the meantime, will be accommodating a maximum of 30 patients per day because of the limited supply of the section.
vi. The medical and nursing staff should brief patients on the necessary preparation for certain examinations, such as;
1. Hbt/ upper abdomen/ whole abdomen/ gallbladder - npo 6-8 hours
2. Pelvic (1st trimester ),non-pregnant / prostate / urinary bladder – drink 6-8 glasses of water 1-2 hours prior to examination – patients should be full bladder
vii. Inpatients scheduled for ultrasound examinations should be accompanied by a nursing staff to the ultrasound room with the patient’s chart.
viii. The medical staff requesting for an ultrasound guided aspiration biopsy should schedule the procedure with the ultrasound technologist and should be done only at the ultrasound room is available.
ix. The nursing staff should gets the ultrasound results and give it to the attending physician for the inpatients.
b. Procedures for payment:
i. All patients should bring their ultrasound request form to the ultrasound Technologist who will check the requests. The ultrasound technologist gives the charge slip to the patients before sending him to the cashier to donate the corresponding ultrasound fee.
ii. Patients who wish to avail of discounted rates should be evaluated by the Medical social service (MSS) or by the administration. Only ultrasound
iii. Request forms with the mss stamp or the administrator’s signature should be considered as charity or indigent and be given the necessary discounts.
iv. All senior citizen card holders should have their cards verified in the Administration office and have their requests countersigned before they can avail of the benefits.
v. Patients should present their official receipt and request form to the Ultrasound Technologist before the examination.
vi. The rates for the examinations are as follows; ( see appendix a )
appendix a
pelvic ( transabdominal - php 200.00
transvaginal - 400.00
biophysical profile - 400.00
hbt (liver, gallbladder) - 350.00
liver, gallbladder, pancreas - 380.00
liver - 250.00
upper abdomen - 400.00
(liver, gallbladder, pancreas, spleen)
pancreas - 250.00
gallbladder - 250.00
spleen - 250.00
kidneys - 250.00
kub - 300.00
( kidneys, urinary bladder )
fetal aging - 200.00
prostate gland - 300.00
lower abdomen -
(kub, prostate ) male only 600.00
(kub, pelvic/ transvaginal) female only 700.00
cranial - 300.00
whole abdomen - 700.00
(liver, gallbladder, pancreas, spleen, kidneys, UB, uterus or prostate)
vii. The time of each examination depends on the procedures being requested such as;
1. Pelvic / transvaginal / bps - 5 – 10 minutes
2. Kidneys, urinary bladder - 5 - 10 minutes
3. Upper abdomen - 10 – 15 minutes
4. Whole abdomen - 15 – 20 minutes
5. Cranial - 5 – 10 minutes
6. Prostate - 5 – 10 minutes
7. Chest - 5 – 10 minutes
c. Record keeping and filling
i. The ultrasound technologist should log down the necessary information of all the ultrasound patients in the official ultrasound record book as follows;
Date name procedures pay/charity or# amount
ii. Ultrasound results should be made in duplicate with the original copy to be given to the patients and the second copy to be kept on file at the ultrasound room for future reference.
iii. Official results of the ultrasound examinations will be available within 24 hrs. from the time the ultrasound examination was done.
iv. The ultrasound technologist should monitor the supplies ( thermal paper, ultrasound gel, etc…) and enter it in the logbook to determine the flow and balance per month.
v. The ultrasound technologist should be responsible for scheduling the maintenance of the ultrasound machine.
III. Conduct in the ultrasound section
a. Eating or drinking is strictly prohibited inside the ultrasound room so as to protect the ultrasound machine from insect infestation.
b. Smoking is strictly prohibited in the ultrasound room.
c. There shall only be one patient at a time on the ultrasound room to avoid congestion.
d. The ultrasound machine cannot be moved out of the ultrasound room for any reason .all inpatient should be brought down to the ultrasound room for their respective procedures. This is to avoid hazard and possible accidents to the machines.
IV. Work Flowchart for Outpatient Ultrasound
a. Inpatient patient
b. Out-patient patient
REHABILITATION MEDICINE SECTION
I. GENERAL DESCRIPTION
A. Overview/Introduction
Rehabilitation has been defined by DeLisa et al as the development of a person to the fullest physical, psychological, social, vocational, avocational, and educational potential consistent with his or her physiological or anatomic impairment and environmental limitations.
Keeping in mind this meaning, there is an equal importance of defining three terms that are really associated with this term. They are impairment, disability and handicap. Whereas impairment refers to the either permanent or transient loss of an anatomic part of physiologic facility, disability deals with the resultant loss function (which again may be lasting or temporary). Handicap, on the other hand, refers to the patient’s inability to cope with the demands placed on him/her based on his/her age, education, civil status, vocation and the like. In other words, a handicapped person is a burden to society.
Based on the above facts, it is envisioned that the Section of Rehabilitation Medicine of the Mandaluyong City Medical Center (MCMC) would help patient’s who have suffered neurological, cardiovascular, pulmonary, and/or musculo-skelatal diseases which may transitory, require a prolonged period of convalescence or permanent, regain their opportunity to enjoy a satisfactory high quality of life consistent with the medical condition.
B. Historical Background
In 1996, Hon. Mayor Benjamin S. Abalos saw the need to put up a center where rehabilitation care would be instituted for his constituents needing for such task. Rehabilitation medicine specialists and professionals responded to form the core of the present staff of this newly created section.
C. Definition
1. Rehabilitation Medicine - is the medical science of instituting care so that a person after a debilitating state could revert back to the fullest physical, psychological, social, vocational, avocational and educational potential consistent with his or her physiological or anatomic impairment and environmental limitations that enable him to approximate resemblance of a normal function.
D. Guiding Principles
To employ an acceptable rehabilitation modality to enable one to go back to the mainstream of normal life. This is in essence a human principle that guide the practice of rehabilitation medicine.
E. Concepts
The concept of rehabilitation is to be part of a multidisciplinary team whose goal encompasses screening, curative and rehabilitative function.
F. Ethics
Modalities of rehabilitation are discussed with the other members of the multidisciplinary team thus allowing coordination and maximum benefits to the patient. Family members and the patient will be involved in the conceptualization of the patient’s management to foster understanding and cooperation with the process but most of all, allowing the patient to decide freely and with dignity his rehabilitation.
II. Rehabilitation Medicine (Professional Service, Ancillary Division)
A. Philosophy
To help disabled to regain maximum functionality so he could enjoy a productive life and resume his role in the society.
Mission
To rehabilitate even the poor so that they could have a chance to overcome poverty.
Vision
No man by reason of poverty will be deprived of a competent rehabilitation for the future will see a rehabilitation section complete with all the modern equipment’s and able to extend services beyond the boundaries of poverty, sectoral demarcations and far beyond the boundaries of Mandaluyong City.
B. Objectives
1. General
i. To be able to perform diagnostic rehabilitation procedures
ii. To be able to employ curative as well as rehabilitative modalities and management
iii. To be able to take part in a multidisciplinary team whose goal is to help bring one to regain his normal production role in the society.
2. Specific Objectives
i. To provide the diagnostic evaluation of patients afflicted with neurologic, cardiovascular, pulmonary, and/or musculo-skeletal disorders.
ii. To attend to these conditions and, in coordination with the attending physician/surgeon, prescribe and implement a comprehensive rehabilitation program
iii. To perform the appropriate physiatric examination (which includes a functional evaluation) as related to the patient’s condition
iv. To aid the patient to attain his maximal potential in spite of his/her condition
v. To increase the awareness of physicians regarding the scope of the specialty in the holistic care of patients.
vi. To maintain or improve the patient’s strength, range of motion, ability to perform activities of daily living, and/or functional capacity to the highest level possible during the course of recovery from a debilitating condition.
vii. To prevent or limit the complications and resultant disability and/or handicap concomitant with their disease entity.
viii. To facilitate the patient’s adaptation to and use of assistive devices and other such appliances
ix. To alleviate the pain related to certain disease conditions.
x. To facilitate the healing/recovery process
xi. To initiate the eventual reintegration to these patients into the mainstream of society
xii. To report and update on a monthly basis census data pertaining to this section services to the Planning Development Education and Research.
3. General Policies & Standards
i. Section Meetings
These meetings are held to promote continuous communication among the members of the rehabilitation medicine team. All members of the staff are required to attend this with the section chief presiding and the chief physical therapist acting as secretary.
ii. In – Service Program
This program will be held in order to enhance the knowledge and skills of the members of the rehabilitation team.
• In the event a seminar which would be deemed to a beneficial for the staff and the patients would be available, members of the staff would be encouraged to attend. A request for financial funding will be made to the appropriate office in order to help the attendee.
• Although financial assistance can not be assured, efforts will be exerted to allow the staff members to attend on official time.
• Members interested in attending such a for should file a written request to the section head stating the pertinent information about the scientific session. This should be submitted at least 4 weeks prior to the event.
• After attending the symposium, the attendee is encouraged to actively participate in an echo seminar in orders to disseminate the information gathered.
iii. Equipment Maintenance
• All equipment is to be kept in their proper places to prevent unnecessary damage or loss.
• These machines are to be checked weekly by the staff physical therapist to ensure their proper functioning.
• Any malfunctioning of the equipment will be reported to the Maintenance Department who will attend to this request
• If the damage of the instrument is beyond the capability of the Maintenance Department, the chief therapist, after informing the section chief, will report the matter to the supplier from whom the device was procured
• Records should be kept on all pulled-out machines, which will include the name and signature of the person who pulled out the machine, when was done, and the serial numbers.
• Upon return of the machine, the chief therapist then tests the machine prior to receiving it from the supplier/repair shop.
• In the event of loss of any equipment, the chief therapist must immediately inform the section head of this development.
• The party deemed liable for the loss or damage of the equipment will be responsible for replacing or repairing the said device.
iv. Requisition of Supplies
• While the chief physical therapist is assigned to take charge of all supplies requisition for the section, it is the physical therapy aide that will maintain and request for the supplies to be used in the section
• The aide will be responsible for making an inventory of all supplies available. He/she will also prepare the necessary forms for their requisition.
• A file is kept of all supplies received. These are recorded in a logbook together with the date these were acquired.
• In the event of urgent requisitions, these may be allowed with the proper form prepared.
v. General Functions
The general function of the present day Rehabilitation Section is to provide physiotherapy to musculo-skeletal conditions as a result of a disease process, aging and occupational related ergonopathies.
However, in the future, the following functions will be needed:
• Cardio Rehabilatory functions
• Psychoemotional counseling
III. Organizational Set-up/Strategies and Procedures
A. Organization
MAYOR
HOSPITAL DIRECTOR
DEPUTY DIRECTOR for PROFESSIONAL SERVICES
CHIEF, ANCILLARY DIVISION
CHIEF, REHABILITATION SECTION
SECRETARY REHABILITATION CONSULTANTS
STAFF PHYSICAL THERAPIST
PHYSICAL THERAPIST AID
B. Work Flow
1. On Out-patient Rehabilitation Consultation (New Patient)
2. Filing of Records/ Consultants of Patients with on going program:
3. Retrieval of Records/Inquiry of Rehabilitation records
C. Staffing Pattern
From Monday to Friday
| |Chief, Rehab. |Consultant |Physical Therapist |Aid Therapist |Secretary |
|8:00-5:00 p.m. |1 |1 |1 |1 |1 |
The Chief, Rehabilitation Section supervises and implements the section’s objectives. Reports to the Ancillary Chief.
The Rehabilitation Consultant assists in the supervision of the section and gives rehabilitation consultations. Reports to the Rehabilitation Section Chief.
Physical Therapist employs/implement rehabilitation modalities in accordance to the prescribed plan of the consultant. Reports to the Chief and consultants.
The Therapist Aid assists the physical therapist. Reports to the Therapist.
The Section Secretary is responsible for the regulation of consultation flow, does clerical aspects and filing of records. Reports to the Chief and consultants.
D. Equipment Facilities
E. Clientele
1. Referred In-patients
2. Referral from OPD clinics
3. Referral from other agencies
4. Patient primarily consulting for rehabilitation care.
F. Strategies and Procedures of Service/SOP’s
1. Scope of Service
i. The scope of the service in the Section will include the following modalities and procedures aimed at:
• Assessing the neuro-musculo-skeletal status of the patient
• Maintaining or improving the current muscle strength and joint mobility
• Preserving or restoring the ability to perform activities of daily living (which includes ambulating)
• Preventing or limiting disability
• Alleviating pain
• Maximizing functional independence
ii. The following procedures will not be performed in or by personnel of the Section:
• Procedures involving invasive techniques (aside from injections) such as acupuncture
• Non-therapeutic massage
• Carrying out of physical therapy procedures, which are not prescribed by physiatrists, affiliated with the center.
iii. The following are the modalities/procedures that may be applied or performed by the personnel of the Section
• Heat therapy
• Cryotherapy
• Electrotherapy
• Therapeutic massage
• Therapeutic exercise (which includes strengthening and mobilization)
• Traction
• Patient education
• Training in activities of daily living
• Fitness evaluation and training
• Application/prescription of bandaging, taping, prosthesis / orthosis
2. Hours of Operation
i. The section shall provide both outpatient and in-patient services form 8:00 a.m. to 12 nn (with cut-off time for the morning therapy session at 11:00 a.m.) and from 1:00 p.m. to 5:00 p.m. (with cut-off time for the afternoon therapy sessions at 4:00 p.m.)
ii. The center will operational from Monday to Friday excluding holidays.
iii. The physiatrists will be available for consultation at designated times and days during the week.
3. Operational Procedures
i. Upon receiving either an in-patient or outpatient referral of a potential patient of the section, the physiatrist must evaluate the patient and prescribe the appropriate rehabilitation program. Entries will be placed in the respective forms of the section and a summary of the evaluation will be placed in the patient’s main medical records, which shall be returned to the Hospital’s main files.
ii. Patients are seen on the first come first serve basis. In the event that the physiatrists concerned is not around or is not holding clinics that day, the patient is asked to return on the said physician’s day of duty.
iii. After the physiatrist’s evaluation, the patient may asked to undergo a rehabilitation program. The patient will then be given by the physical therapist a Bill of Charges for the consultation and therapy services, which the former must present, to the Social Worker.
iv. After being interviewed by the social worker, the patient will be classified. He may be classified as an indigent patient (which means he will receive free treatment) or be asked to pay a fee appropriate to his economic capacity.
v. After setting the charges, the patient then will return to the section for his physical therapy (where he will be treated on a first come, first served basis.)
vi. As far as the in-patients are concerned, the attending physician should note on the patient’s order sheet in the medical chart his desire for a referral to the section.
vii. At this point, the nurse should notify the concerned physiatrists and should forward to the section secretary or chief physical therapist the appropriate referral form which will list the patient’s name, room/bed number, referring physician, and the name of the physiatrist being referred to.
viii. The secretary or the chief physical therapist will then inform the physiatrist of the new referral
ix. Only physical therapist procedures and other rehabilitation measures prescribed by the physiatrist with the center will be carried out.
4. Filing System
i. All active files will be kept in the section
ii. These charts will be filed alphabetically. The physiatrists, physical therapist, and secretary may pull out these records. All other hospital personnel will need prior clearance from the section chief for access to these records
iii. The active file will be regularly cleaned out by the physical therapist. The records of patients who have either been discharged or have failed to return for their treatment are placed in a separate inactive file.
5. Patient Courtesy
i. Patients should be called for treatment using Mr. or Mrs. with their last name.
ii. The patient should be escorted into the treatment room
iii. The practitioners should be friendly and introduce themselves
iv. The clinician should explain the treatment program to the patient and should answer all questions of the patient related to their regimen.
v. The therapist should safeguard the privacy and protect the sense of decency of the patient during the latter’s treatment
vi. The practitioner should refrain from discussing the case except in a case presentation/discussion forum.
6. Rest Period
Each employee is entitled to a one-hour lunch break. As there is only one therapist and one aide in the section, arrangements must be made to make sure that there is at least one person manning the section during the lunch period.
7. Maintenance of Quality of Service
The section will maintain the quality care by observing the following:
i. Regular monitoring and updating of progress notes which will serve as an effective and efficient communication tool between the members of the rehabilitation team.
ii. Observing the staff (which includes the interns) as they relate to and interact with patients.
iii. Monitoring the feedback of patients, their companions/relatives, physicians and other related health personnel in an effort to continually strive to improve patient care
iv. Encourage continuing education of the staff
v. Conduct in-service training for staff
vi. Hold regular staff meetings to discuss the problems and accomplishments of the center
vii. Maintain and update the equipment and facilities of the section in order to optimally treat the patients.
IV. Administrative Policies
A. General/Basic Qualification Standards of the Different Position Levels
1. Section Chief
i. Graduate of a recognized rehabilitation medicine training program
ii. Philippine Board of Rehabilitation Medicine – certified physiatrist
iii. Member and fellow of the Philippine Academy of Rehabilitation Medicine
iv. Of good moral character
2. Physiatrist
i. Graduate of a recognized rehabilitation medicine training program
ii. PBRM – certified physiatrist or board eligible physiatrist. (He/she will have any two years from the appointment to complete these requirements. Failure to accomplish this may be a basis for non-re-appointment)
iii. Member of the Philippine Academy of Rehabilitation Medicine
iv. Of good moral character
3. Physical Therapist
i. Education – Bachelor’s degree in Physical Therapy
ii. Experience – none required
iii. Training – none required
iv. Eligibility – RA 1080
4. Secretary
i. Education – Completion of two years studies in college
ii. Experience – none required
iii. Training – none required
iv. Eligibility – Career Service (Sub-professional) First Level Eligibility
B. Functions and Responsibilities of the Staff/Personnel
1. Job Description
i. Section Chief
• Supervise the overall operation of the section
• Conduct staff appraisal and is responsible for the planning and implementation, formulation of section objectives
• Perform internal evaluation of the section to attain quality care services
• Perform consultation services and rehabilitative management to patient consulting for rehabilitation
ii. Physiatrist
• Provide the medical evaluation and rehabilitation program prescription for the out-patients
• For the inpatients, the assessment and prescription have to be accomplished within 24 hours after receiving the referral
• Coordinate the various facets of the rehabilitation team as they all serve the patient’s needs
• Supervise the staff of the section (which may include the interns)
• Re-evaluate and update the prescription of his/her patient’s
• Attend meetings called by the Section Chief and actively participate in these
• Assist the Section Chief in matters that would improve the working conditions and delivery of service (such as in-service lectures) as directed by the Chief
iii. Physical Therapist
• Implement the prescription as provided by the physiatrist which may include physical agents and therapeutic exercises.
• Conduct an initial evaluation, provide progress-notes/re-evaluation notes, and formulate a discharge summary for all patients seen.
• Supervise the interns and aides as they apply various treatment modalities to the patients.
• Instruct the patients and their relatives with the home programs that may help in the recovery/rehabilitation of the patient
• Maintain the working condition of the equipment, availability of supplies and cleanliness and safety of the treatment areas
• Provide the necessary census/reports pertinent to the operations of the center
• Notify the physiatrist of a referral
• Attend section meetings called by the Section Chief.
iv. Physical Therapy Aid
• Help in maintaining the cleanliness of the treatment area which may include changing the linen/towels in the area as well as turning on the appropriate appliances
• Bring soiled linen/towel to the laundry service and ensure that these are returned
• Monitor the availability of supplies and, in the event that these run out, secure the necessary supplies.
• Assist in the transfers and transport of patients
• Apply selected treatment modalities under the supervision of the physical therapist
• Carry out activities that would assist the physiatrist and physical therapist in delivering the best possible care for the patients
• Turn off all lights and appliances after clinic hours
• Attend section meetings as called by the Section Chief
v. Secretary
• Maintain the patient records through a systematic filing system
• Prepare the charts of the patients for evaluation by the physiatrist
• Keep a record of the patients for re-evaluation by the physiatrist
• Assist the patients in their physical therapy and consultation requirements
• Notify the physiatrist of any in-patient referrals
• Maintain records of the section meetings
• Attend the section meetings as called by the Section Chief
2. Recruitment/Hiring/Termination
i. Recruitment/Hiring
• Regular
• Contractual
• Casuals
V. Training/Manpower Development Position Levels
A. Rationale
B. Objectives
C. Training & Education Residency
1. Existing (Brief Description of Present Set-up)
2. Needs (Rationale/Justification)
3. Future Plans (Specific Time Table)
VI. Reports/Records/Files/Forms
A. Collection of Existing Form
VII. Quality Assurance
A. Desired Job Performance
1. Per Personnel (Specific Checklist Desired Performance)
2. Per Service Areas/Sections (Indicators)
B. Evaluation % Methods
1. Per Personnel (Methodology of Evaluation/Performance)
2. Per Service Area/Section (Methodology of Evaluation/Performance)
DENTAL SECTION
I. GENERAL DESCRIPTION
A. Overview / Introduction
Dentistry is a recognized service focusing on dental aspect of care. However, in some hospitals, dental care provided only when circumstances necessitates calling a local practitioner in to see a patient whoa develops a dental problem while hospitalized for non-dental reason. Still in other hospitals, dental or surgery departments have been woven into the regular fabric of medical, surgical and rehabilitative activities of the hospital according to the locally determined lines.
This manual will outline the dental practice in Mandaluyong City Medical Center.
B. Historical Background
Since 1994, the Dental Service have existed as a component in this hospitals’ basic delivery of medical and related services.
C. Definition
Dentistry – is the branch in medicine that deals with the diagnosis, treatment and promotion of dental care.
D. Guiding Principles
In the performance of hospital duties, the Dental Service is part of the multi-disciplinary team consisting of the physician and nurses from other specialties. It is the responsibility of the dental staff to work with the other members of the organization; (1.) to serve the needs of the patients; (2.) in order give the dental patients comprehensive care. The dentist must work with the physician. Accepts referrals and institute a dental hygiene program.
E. Concepts
Promotion of dental hygiene and care as part of preventive and curative concern of the hospital as a whole.
F. Others
1. ETHICS:
Like all medical profession, confidentially and upholding human dignity is observe
II. Dental Section: Profession Service/Ancillary Division
A. Philosophy
One major determinant of one’s health is nutrition. Nutrition in turn is dependent on dental health. Having a quality dental care therefore assures one of quality health.
Mission
The dental service mission is to:
1. Promote dental hygiene
2. Give preventive & curative dental care
Vision
Out vision is to see that Mandaluyong residents and all hospital patients as a satisfied recipients of a well equipped dental clinic able to give quality dental services by itself and as part of the multi-disciplinary team in this institution.
B. Objectives
1. General Objectives:
i. To be able to do preventive aspect of dental care.
ii. To be able to take part in a multi-disciplinary institutional quality health care.
2. Specific Objectives
i. To be able to attend to all outpatient consultation for dental care whether curative or prophylactics.
ii. To be to promote good oral hygiene.
iii. To be able to accept and perform dental care in accordance to the multi-disciplinary approach of care and referrals.
iv. To be able to report and update on dental health surveillance/services on a monthly basis.
C. General Policies & Standards
On Future Training or Interns
Dentists serving a hospital or residency must work side by side with the physician in the interests of good patient care. In order to do so, he must learn to work efficiently and knowledgeably in the hospital environment, from the admission to the discharge of patients and in his every day activities.
The interns and residents work as a team and are responsible for the visiting staff for their duties. Although the resident is often given the responsibilities of being in charge of the interns, he is still accountable for his activities to the Chief of Dental Services and Head of the Dental Clinic on each individual day.
Internship and residency training are formal part of dentist’s post-graduate education, therefore there should be official and permanent record kept by the Chief of Dental Services, record should include:
1. Time spent during different activities during training
2. No. of different types of patients treated.
3. No. of operations of different types performed.
4. Extent of experience and training in special areas – anesthesia, pathology, etc.
5. Confidential reports on the trainee by the visiting staff members with whom he has worked.
On Consultations:
All patients consulting at the OPD will be treated on a first-come first-serve basis except if there is an urgent medically accepted justification.
The dental clinic will be open every 8:00 a.m. up to 5:00 p.m. from Monday to Friday except holidays. After office hours, services will be on referral basis subject to the nature of condition or medical justification. However, in emergency cases, dental emergencies should be acted upon beyond the call of duty and schedule of said personnel.
On Promotion of Dental Hygiene:
All patients should be given instructional materials and insights in the promotion of dental health.
The dental service should perform recording and accurate reporting of the dental status of patients through a comprehensive census reporting and statistical analysis in the provision of care on a monthly basis.
On Requisition of Supplies:
All requisition of supplies will be based on the pattern of consumption and in accordance with the basic services rendered.
All equipment issue should be checked of status. Upkeep, maintenance and care be charged to the service. The services will be accountable in cases of losses or damages as a result of improper use.
D. General Functions
The General Function will be divided into:
1. Promotion of Good Hygiene:
i. Prophylasis
ii. Preventive Information Drive
2. Curative
i. Dental Extraction
ii. Dental Fillings
iii. Other Dentics
iv. Other dental interventions
III. Organizational Set-up / Strategies and Procedures
A. Organization
MAYOR
DIRECTOR
DEPUTY DIRECTOR for PROFESSIONAL SERVICES
CHIEF, ANCILLARY DIVISION
DENTAL SECTION CHIEF
(Dentist IIB)
DENTIST I
DENTIST I
DENTAL AIDE/SECRETARY
B. Work Flow
Out-patient are admitted directly by the department as to first come first serve basis, but emergency cases referred are given priorities while in-patients referred are also visited.
Work Flow on OPD Consultation
Referral to other clinics
C. Staffing Pattern
The dental clinic will be open every 8:00 a.m. to 5:00 p.m., Monday to Friday except holidays with staffing as following:
Dentist II Dentist I Dentist Aide
8:00-5:00 p.m. 1 2 1
• Dental Service Chief is a Dentist II with a salary grade of 16
• Dentist I – salary grade is 13
• Dental Aide – salary grade is 4
1. Job Description
i. The chief of the Dental Service
Responsible to: Ancillary Chief
Responsible for: Dentist I
Dental Aide
• Responsibilities / Duties:
i. To supervise the overall operation of the dental service
ii. To evaluate and appraise the performance of the dental staff
iii. To report to the ancillary chief matters pertaining to the service
iv. To report and submit census/reports and matters of statistical value to the Planning, Development, Education and research Office and to the Ancillary Chief.
v. To be able to recommend improvements of services
vi. To be able to plan, implement and evaluate services in accordance to the service objectives and guidelines.
vii. To account for the services performance and equipment under his inventories.
viii. To be able to perform dental procedure in accordance to his sections’ basic services.
ii. Dentist I
Responsible to: Chief of the Dental Services
Responsible for: Dental Aide
• Responsibilities/Duties:
i. Assists the dental chief in his function and performance as assigned in accordance to these tasks.
ii. Supervise the dental aide in the preventive and curative phase and services.
iii. Appraise dental aide of performance.
iv. Perform dental procedures in accordance to his capabilities as Dentist I.
iii. Dental Aide:
Responsible to: Dental Chief and Dentist I
• Responsibilities/Duties
i. Performs assist functions to both Dentist II and Dentist I.
ii. Performs in accordance to the supervision of Dentist II and Dentist I.
D. Equipment Facilities
1 – Dental Chair and Unit with stool
1 – Compressor unit
1 – Sterilizer
1 – Air-conditioning unit
1 – Electronic Anesthesia Machine
1 – Electric Fan
1 – Radio
1 – Cabinet
1 – Table
1 – Light curing machine
Hand Instruments
a. 10 pcs. Forceps use for tooth extractions
b. 3 pcs. Elevators
c. 2 pcs. Bars
d. 2 pcs. Dental syringes
e. 3 pcs. Gum separator
f. 4 pcs. Mouth mirror
g. 1 set Scaler
h. 4 pcs. Explorers
i. 2 pcs. Excavators
j. 3 pcs. Cotton pliers
k. 2 pcs. Spatula
l. 1 Highspeed Handpiece
m. 1 Micromotor Handpiece
n. 1 Othoplier
o. 1 Mixing spatula
p. 1 Mixing bowl
q. 3 sets Impression tray
r. 1 Surgical scissors
s. 1 Hemostatic forceps
t. 1 set of burs
u. 1 Rongue forcep
v. 1 curette
w. 1 amalgam carrier
x. 2 egg varnisher
y. 1 dycal applicator
z. 1 Amalgam Pluger
All equipment facilities listed all under the responsibilities of the department. Table and Air-conditioning unit was given and installed by the hospital for the department use, while the rest of the equipment the practicing dentist brought facilities listed to the hospital.
We hope to have additional very useful equipment facilities in the future such as:
1. X-ray machine – Cephalometric, pier-apical
2. Portable motor engine
3. Canterize machine
4. Ultrasonic scaler
5. Endodentic sets of instruments
Air-conditioning unit must be open 9:00 a.m. daily Monday to Saturday and must be close 6:00 p.m. same days. Dental unit and chair with stool must be clean before the days operations and after daily operation. Sterilize must be changed with water before the days operation. All hand instruments must be washed with soap and water and must be sterilized after each use. Operator should clean the light during machine and electronic anesthesia with cotton and alcohol after each use, procedure should also be dental handpieces.
E. Clientele
1. Anyone who needs dental treatment and would like to seek dental service of the hospital in the out-patient service
2. A multi-disciplinary referral
3. All institutional referrals upon approval of the Senior House Officer or Chief of Clinics.
A. Strategies and Procedures of Service/SOP’s
1. Registration of Dental Patients
Morning - 9:00 a.m.
Afternoon - 2:00 p.m.
2. No dental treatment during Sundays and Official Public Holidays
3. During Special Hospital Activities (Conferences and Lectures)
A skeleton force will be provided.
Cancellation of dental consultation for activities other than those mentioned will be subject to approval by the Chief of Clinics or Head of the Ancillary Services upon recommendation of the dentist.
4. Dental treatment must start at 9:00 a.m. and 2:00 p.m. Monday-Saturday. Dentist is expected to be in the Dental Clinic at these times.
5. Dental patients must be register directly at the Dental Clinic on a first come first serve basis except on emergency cases like in vehicular accident where victims must be given attention ahead of the others. Dentist would then fill-up his medical chart and a separate dental chart.
6. Dental record should consist of the oral examination with the dental diagnosis and treatment duly signed by the dentist.
7. Daily Census Report should be prepared by the dentist and submitted to the OPD Chief yearly.
8. Patients who are considered for admission shall be sent to ER for further re-evaluation and management and shall be included in ER census
9. It is expected from the dentist that all-possible treatment, medications and advises are properly explained to the patients or to his companion prior to his discharge, department must be referred first before given any possible dental treatment.
IV. Administrative Policies
A. General Basic Qualification Standards
1. Dentist II (Grade 16)
i. Education-Doctor of Dental Medicine of Dental Surgery
ii. Experience-1 year relevant experience
iii. Training-4 hours of relevant training
iv. Eligibility-RA 1080
2. Dentist I (Grade 13)
i. Education-Doctor of Dental Medicine or Dental Surgery
ii. Experience-none required
iii. None required
iv. Eligibility-RA 1080
3. Dentist Aide (Grade 4)
i. Education-High School Graduate
ii. Experience-none required
iii. Training-none required
iv. Eligibility-none required
B. Recruitment/Hiring/Termination
1. Recruitment
Recruitment of regulars will depend on availability of position as outline in out Enabling Act. Recruitment of contractual and casual will depend on needs of the service, upon the recommendation of the section chief and ancillary chief and approval of the director.
2. Termination
After due proves and in accordance to the civil service code and the hospital code, dental staff proven guilty will penalized accordingly.
Malpractice and any deviation from this hospital code of ethics, policies, guidelines or mandated by this manual will be acted on with administrative prerogatives by hospital authorities.
V. Training/Manpower Development Position Levels
A. Rationale
To be able to update the dental service with current trend in dental management.
B. Objectives
The service-training objective is to be able to attend post-graduate seminars and dental conventions annually so as to keep with recent trends in dental management.
C. Training & Education Residency
None for the moment
VI. Reports/Records/Files/Forms
A. Existing Forms
1. Patients’ Chart Form:
This contains some personal data of the patient, present condition of the oral cavity as a whole needed as personal record of the patient also for the treatment and evaluation, this record should be filled up before and after treatment for the benefit of the patients and the dentist. This chart should be filled up every time patients goes to the hospital seeking dental treatment and oral examination must be changed yearly.
2. Census Report
This contains number of old and new patients recorded daily and totaled monthly, submitted yearly to the Administrative Office. This report is needed to know how many patients have been attended for a year, this is being done daily and submitted to the administrative office yearly. This benefits the department.
3. Accomplishment Report
This contains the service rendered yearly for the old and new patients who seek dental treatment, this is needed to know that patients were given proper dental service. This is filled daily, receive by the administrative office for the benefit of the department. This is done daily submitted yearly.
VII. Quality Assurance
A. Performance Appraisal
1. Dental Chief
i. Basic Function:
• Oversee and supervise a smooth and well coordinated service that attains is goals.
• Able to plan and implement, appraise and set objectives.
• Perform dental service/procedure
• Submit reports and comply with superior with works that at least acceptable.
ii. Behavioral:
• Attendance
• Tardiness
• Relationship
2. Dentist I
i. Basic Function:
• Oversee and supervise a smooth and well coordinated service that attains its goal. Assist dentist II in the supervision
• Able to plan and implement, appraise and set objectives.
• Perform dental service/procedure
• Submit reports and comply with superior with works that are at least acceptable.
ii. Behavioral:
• Attendance
• Tardiness
• Relationship
3. Dentist Aide
i. Basic Function:
• Assists and is receptive to supervision
• Always eager to learn and complies and finish tasks with well judge initiative
ii. Behavioral:
• Attendance
• Tardiness
• Relationship
B. Service Performance
1. The service performance will be evaluated in accordance to:
i. The accomplishment of set of set of objectives
ii. Solution to unexpected problem
iii. Innovations/plans for further improvement of service
iv. Quality/Quantity indicators:
• No. of dental consultation and its procedures
i. Per month
ii. Per day
• No. of dental morbidity per procedure
i. Per month
ii. Per day
C. Methods of evaluation will be accordance to the principle of management by objectives and result evaluation.
ECHOCARDIOGRAM SECTION
I. GENERAL DESCRIPTION
A. Overview / Introduction
The ECG section is a vital and necessary area in helping and serving people who are suspected of having heart or cardiac problem. It also serves as a guide to physicians in rendering an approach, not only in the diagnosis, but also in the management through the information and/or data that the ECG provides. This manual will discuss the service guidelines and policies.
B. Historical Background
While dissecting frogs, around 1855, Kollicker and Mueller found that when a motor nerve to a frog’s leg was laid over the isolated beating heart, the leg kicked with each heartbeat.
In the mid 1880’s, Ludwig and Waller found that the heart’s rhythmic electrical stimuli would be monitored from a person’s skin. The Einthoven, a brilliant man who took a large permanent magnet and suspended a silvered wire through holes drilled in both poles of the magnet. So Einthoven projected a tiny light beam across the dancing silvered wire, and it’s rhythmic movements were recorded as waves on a scroll of moving photographic paper. After further studies, research, experiments and scientific manipulations the ECG evolved in 1901. From then and up to now, the echocardiogram has become an indispensable tool in the cardiac movement.
C. Definition
ElectroCardioGram (ECG) is a machine, which records the electrical activity of the heart, providing a valuable permanent record of its function.
These electrical activities are the impulses, which represents various stages of cardiac stimulation. Also this machine also provides information as to the rate and rhythm of the heart.
D. Guiding Principles
The guiding principles of the ECG section is to assists aid and provide the vital information and data from an echocardiographic procedure facilitate which aid the physicians in the formulation of a correct diagnosis. An appropriate diagnosis precedes a proper and adequate management especially to cardiac patients. We in the echocardiogram section believe that our service should go beyond the boundaries of poverty.
E. Concepts
To provide and establish a basic echocardiogram procedure for the detection of heart problems.
F. Others
1. Ethics
II. Department /(Section Nomenclature)
A. Philosophy
The philosophy of the service is to detect heart problems early so as to prevent cardiac complications and morbidity before they go beyond treatment.
Vision
ECG section will be an integral part of an expanded “Heart Station” which includes other medical equipment, which provides a more effective ancillary for cardiac diagnosis. The envisioned equipment’s and capabilities are as follow: 2 echo, Doppier, treadmill machine
Mission
To provide echocardiogram services to patient’s seen at the outpatient department, emergency room, the wards and other areas within the hospital system.
B. Objectives
1. General
To make available and provide ECG service to patient’s and to patient’s of this hospital and to aid the physicians through the echocardiogram procedure in the accurate diagnosis and management of cardiac patients
2. Specific
i. To provide and perform echocardiogram to the patient’s referred from:
• Out patient department
• Emergency room through an ECG roving machine
• Wards also through an ECG roving machine stationed at the ER
ii. On a 24 hour basis and catering to 100% of all referrals
iii. To perform the echocardiogram service as an integral part of any call for cardio-pulmonary resuscitation and emergency code on a 24 hour basis and able to respond to 100% of all emergency situations.
C. General Policies and Standards
1. Except for emergency cases/situations, the referring unit before any procedures should accomplish an official an official request
2. Request from doctors not connected with the hospital is channeled to the appropriate medical personnel at the OPD for evaluation
3. Indiscriminate requests results to wastage of resources. Therefore, a clear medical indication determined by a recognized hospital medical personnel and staff should be secured
D. General Functions of the ECG Section
To perform electrocardiogram procedure on patients seen at the emergency room, outpatient and in the wards after a thorough request.
III. Organizational Setup/Strategies and Procedures
A. Organization
MAYOR
HOSPITAL DIRECTOR
DEPUTY DIRECTOR for PROFESSIONAL SERVICES
CHIEF, ANCILLARY DIVISION
MEDICAL SPECIALIST I
(CARDIOLOGY)
ECG/MED. EQUIPMENT TECH. II
ECG/MED. EQUIPMENT TECH. I
B. Work Flow
1. ECG Procedure (OPD/WARD)
2. ECG Procedure (Emergency)
3. Staffing Pattern
i. ECG Technician (Med. Equip. Tech. II)
Reporting from 8:00 a.m. to 5:00 p.m. Monday to Friday
• Responsible to Medical Specialist/Cardiologist for operation; Ancillary chief for administrative problem
• Responsible for ECG Medical Equipment Technician I
• To report for work at Mandaluyong City Medical Center, ECG Section 7:30 a.m. to 4:30 p.m.
• To make and submit accomplished Daily Time Record every month
• To render service to all patients with authorized requests for ECG (OPD, ER, In-patient)
• To assist in emergency or coded calls where ECG is part of the team
• To collate, mount and forward ECG strips to the cardiologist on duty for official reading
• To log in a record book all data and official results of ECG taken
• To file all forms as hospital records on a monthly basis with ECG number for access
• To make and submit an Annual Census and Report
• To attend to meetings as required or called for by proper hospital authorities
• To be accountable to the ECG equipment integrity and report status and problems to the Ancillary Chief
ii. Assistant ECG Technician
Report from 4:00 pm to 12:00 pm Monday to Friday
• Responsible to Medical Specialist/Cardiologist for operation; Ancillary chief for administrative problem
• Responsible for ECG Medical Equipment Technician I
• To report for work at Mandaluyong City Medical Center, ECG Section 7:30 a.m. to 4:30 p.m.
• To make and submit accomplished Daily Time Record every month
• To render service to all patients with authorized requests for ECG (OPD, ER, In-patients)
• To assist in emergency or coded calls where ECG is part of the team
• To collate, mount and forward ECG strips to the cardiologist on duty for official reading
• To log in a record book all data and official results of ECG taken
• To file forms as hospital records on a monthly basis with ECG number for access.
• To make and submit an Annual Census and Report
• To attend to meetings as required or called for by proper hospital authorities
• To be accountable to the ECG equipment integrity and reports status and problems to the Ancillary Chief
• Report to the ECG Technician II for necessary supervisions
• Assume the responsibility of ECG Technician II in her absence
4. Equipment Facilities
i. One unit Kenz ECG machine 106 permanently stationed at the ECG area (Heart Station) with accessories
ii. One unit examining table with foot stool and cushion mattress
5. Clientele
i. All patients with proper requests from Mandaluyong City Medical Center Doctors
ii. Mandaluyong City Medical Center Physicians
iii. Hospital management and staff
iv. Hospital personnel
6. Strategies and Procedures of Service/Sop’s
i. Request and Scheduling of ECG Examination:
• The ECG Section shall be open from Monday to Friday from 8:00 am to 5:00 pm.
• All ECG request forms should be properly accomplished (Patient’s Name, Age, Room, and Bed Number, Pertinent Medical History, Clinical impression, Diagnosis). Only request form with complete information will be entertained. The requesting physician shall affix his/her signature in the request form.
• Only ECG request from MCMC physicians will be entertained by the ECG Section, in the meantime, due to the limited supply of the section.
• In-patients scheduled for ECG examination should be accompanied by a medical or nursing staff to the ECG Room with the patient’s chart.
ii. Procedures for payment
• All patients should bring their ECG request form to the ECG Technologist who will check the request. The ECG Technician will ask the patient to proceed to the Cashier for payment of the ECG fee.
• Patients who wish to avail of discount rates should be evaluated by the Medical Social Service (MSS) or by the administration. Only ECG request forms with the MSS stamp of the Administrator’s signature should be considered as charity or indigent and be given the necessary discounts.
• All cardholders (MandaCare and Senior Citizen) should have their cards verified in the Administration Office and have their requests countersigned before they can avail of the benefits.
• Patients should present their official receipt and request form to the ECG Technician before the examination.
iii. Record Keeping and Filing
• The ECG Clerk should log down the necessary information of all the ECG patients in the official ECG record book as follows:
DATE NAME AGE O.R. # AMOUNT PAY/CHARITY
• ECG Patients receive the original copy of the ECG results.
• Official results of the ECG examinations will be available two to three days from the time of examination.
• The ECG clerk should monitor the supplies (ECG paper, paste, alcohol) and enter it in the logbook to determine the flow and balance per month.
• The ECG Technician is responsible for the maintenance of the ECG machine.
iv. Conduct in the ECG Section
• Eating or drinking is strictly prohibited inside the ECG Room
• Smoking is strictly prohibited in the ECG Room
• There shall only be one patient at a time inside the ECG Room to avoid congestion.
v. On ECG Procedure Request
• All ECG strips taken the whole night and or weekends or holidays should be recorded and logged in and pasted in an official form for official reading by the cardiologist
• Emergency calls should be given priority and responded, if necessary with exigency
• All non-emergency in-patient is done at 1:30 p.m. up to 4:30 p.m.
• Payment for ECG procedures, after billing should be referred to the cashier for proper billing/collection procedure
• Patient classified as indigent, should be given proper consideration and benefit
• Bill of charges should be attached to charts for in-patients
• All procedures should be logged, recorded before being mounted in an official from for official reading
IV. Administrative Policies
A. General/Basic Qualification Standards of the Different Position Levels
1. MEDICAL SPECIALIST
i. Education – Doctor of Medicine
ii. Experience – 1 year of relevant experience
iii. Training – 4 hours of relevant training
iv. Eligibility – RA 1080
2. MEDICAL EQUIPMENT TECHNICIAN II
i. Education – Completion of relevant two years studies in college or Completion of relevant medical laboratory technician course
ii. Experience – 1 year of relevant experience
iii. Training – 4 hours of relevant training
iv. Eligibility – Equipment Technician
3. MEDICAL EQUIPMENT TECHNICIAN I
i. Education – Completion of relevant two years studies in college or Completion of relevant medical laboratory technician course
ii. Experience – none required
iii. Training – none required
iv. Eligibility – none required
B. Functions and Responsibilities of the Staff/ Personnel
1. Equipment Tech II
i. To render ECG service to all ER/OPD/RM./WARD patients with official requests from Mandaluyong City Medical Center Physicians
ii. To put into a logbook all patients taken ECG (name, age, disposition, results)
iii. To paste ECG strips in official form to prepare for official reading by the cardiologist
iv. To keep all results by months/years
v. To release only official results to patients
vi. To collect all ECG strips done after office hours first thing in the morning the following day
vii. To make annual ECG report
viii. Report and account services perform/output to the ancillary chief
2. Equipment Tech I
i. To render ECG service to all ER/OPD/RM./WARD patients with official requests from Mandaluyong City Medical Center Physicians
ii. To put into a logbook all patients taken ECG (name, age, disposition, results)
iii. To paste ECG strips in official form to prepare for official reading by the cardiologist
iv. To keep all results by months/years
v. To release only official results to patients
vi. To collect all ECG strips done after office hours first thing in the morning the following day
vii. To make annual ECG report
C. Recruitment/Hiring/Termination
1. Recruitment
All applicants will forward their application to the Ancillary chief who will perform initial screening and interview. An examination will also be given. The Ancillary Chief will then forward his recommendation to the Hospital Director for approval before same application can be forwarded to the Office of the Mayor for his official approval.
2. Termination
Termination results if:
i. Upon voluntary resignation
ii. End of contract, if contractual
iii. Based on performance and after thorough evaluation, the staff have failed to show improvements as to the attitude, process and work output
iv. Found and determined to have violated the Civil Service Code, Hospital guidelines/policies, and Code of Ethics
v. Found and determined to be involved in criminal or illegal acts.
V. Training / Manpower Development Position Levels
A. Rationale
To be able to be updated on new trends/new technologies in cardiologic ancillary procedures such as:
1. Thread mill
2. 2D echo
B. Objectives
To attend seminars and training courses on the use of new technologies in ECG, in the use of Thread Mill tests and 2D echo
1. Training & Education Residency
i. Existing (Brief Description of Present Set-up)
ii. Needs (Rationale/Justification)
iii. Future Plans (Specific Time Table)
VI. Reports/Records/Files/Forms
A. Collection of Existing Forms
VII. Quality Assurance
A. Desired Job Performance
1. Per Personnel (Specific Checklist Desired Performance)
2. Per Service Areas/Sections (indicators)
B. Evaluation & Methods
1. Per Personnel (Methodology of Evaluation/Performance)
2. Per Service Area/Section (Methodology of Evaluation/Performance)
PULMONARY CARE UNIT
I. PHILOSOPHY
A. MISION:
To deliver adequate pulmonary care to the constituents of Mandaluyong:
1. By providing adequate and prompt aerosol therap to services;
2. Assisted Ventilatory Care
B. VISION:
To be an outstanding facility in the center with the deliveries of health care by way of providing adequate pulmonary services.
II. ORGANIZATIONAL STRUCTURE:
CITY MAYOR
HOSPITAL DIRECTOR
CHIEF, PULMONARY CARE UNIT
CHIEF, RESPIRATORY THERAPIST
SENIOR RESPIRATORY THERAPIST
RESPIRATORY THERAPIST
III. GENERAL JOB DESCRIPTION
A. RESPIRATORY THERAPIST
1. Perform extraction for arterial blood gas analysis and interpretation.
2. Administer various inhalation therapy like compressor-driven nebulization, ultrasonic nebulization (USN), intermittent positive pressure breathing therapy (IPPBT), in-line nebulization including instruction on proper technique.
3. Administer respirator to patients needing ventilatory support as per doctor’s order.
4. Determine spontaneous breathing parameters (SBP), Peak End Expiratory Pressure (PEEP), pulse oximetry and peak expiratory flow rates (PEFR).
5. Assist the physician in weaning of patients from mechanical ventilators.
6. Observe and evaluate immediate response and reaction of patients undergoing ventilation therapy.
7. Administer oxygen therapy either by low flow delivery devices or high flow devices.
8. Assume responsibility for proper functioning and care of respirators and other respiratory therapy equipments.
9. Administer the proper technique on chest physiotherapies.
10. Perform and assist the patient during Pulmonary Function Testing (PFT).
11. Assist in performing cardio-pulmonary resuscitation (CPR).
12. Assumes responsibility for proper disinfections/sterilization of all respiratory therapy equipments.
B. STAFF RESPIRATORY THERAPIST/S
Brief description of the general functions of the position:
Performs pulmonary services to in and out – patients.
1. SPECIFIC DUTIES AND RESPONSIBILITIES:
i. Sets up ventilators and adjust its setting according to the attending physician’s orders.
ii. Makes rounds of patients hooked to ventilators at least 2 times during his/her duty.
iii. Extract Arterial Blood Gases (ABG) and relays the result immediately.
iv. Delivers Aerosol Therapy to in and out-patients.
v. Performs non-invasive monitoring to critically ill patients (02 saturation monitoring and Capnography).
vi. Perform Chest Physiotherapies to patients with retained secretions.
vii. Performs Intermittent Positive Pressure Breathing to in and out-patients.
viii. Prepares charge slips for all pulmonary services done.
ix. Accompanies the ambulance conduction team for patient transport when need arises.
x. Responds to Emergency Codes being ready for STAT ABGs, assist in manual resuscitation and intubation of the patient.
xi. Keeps work area clean and orderly.
xii. Performs other duties as maybe assigned by superiors.
2. Qualification Standards
i. Graduated of any paramedical course.
ii. 3-6 months training in Respiratory Therapy
iii. 1year continuous service
iv. Civil service eligible (Professional Level)
C. SECTION CHIEF
1. Coordinates and supervises all activities of the section.
2. Acts as the liason between the section and the management.
3. Recommends the appointment and promotion of Respiratory Therapist.
4. Recommend the implementation of disciplinary and administrative sanctions against employees who commit grave misconduct in the performance his/her duties and responsibilities.
5. Implements the Department of Medicine training, research and service programs in relation to the activities of the section.
6. Prepares the budget, reports development plans of the section.
7. Qualification Standard
i. Licensed medical practitioner
ii. 3-5years practice in Pulmonary Medicine
D. CHIEF RESPIRATORY THERAPIST
Assist the section chief in the management and supervision of the section, is responsible for the education and training of the Respiratory Therapist and student interns, sees to it that all pulmonary services are done efficiently.
1. Specific duties and responsibilities:
i. Assist the section chief in the management and supervision of the section.
ii. Makes spot check rounds to units where pulmonary services are being delivered.
iii. Records and updates the daily services rendered.
iv. Prepares the schedule of duties of the section
v. Monitors the purchases and issuances of supplies.
vi. Performs regular inventory of drugs and supplies received and issued.
vii. Performs daily preventive maintenance of all equipments.
viii. Checks the daily attendances of personnel and student interns.
ix. Prepares the monthly, annual and other reports of the section.
x. Supervises the daily activities of Respiratory Therapist and student interns.
xi. Presides over the monthly meetings of the section.
xii. Conducts regular lectures to Respiratory Therapists and student interns.
xiii. Conducts in-service training to other departments whenever requested.
xiv. Represents the section in hospital conferences and meetings.
xv. Is a member of the Infection Control Committee and is responsible for the section’s compliance to the hospital’s policies regarding infection control.
xvi. Assist in the conduct of research in Pulmonary Medicine by way of data collection, analysis and interpretation.
xvii. Takes over the duties and responsibilities of the Respiratory Therapist when the need arises.
xviii. Perform other duties as maybe assigned by superiors.
xix. Qualification Standards:
• Graduated of any paramedical course (preferably graduate of B.S Respiratory Therapy).
• Has undergone intensive training in Respiratory Therapy.
• Five -year continuous services
• Civil Service eligible (Career Professional Level)
IV. POLICIES AND PROCEDURES
A. RESPIRATORY CARE ORDERS
1. PURPOSE: To assure respiratory therapy is ordered appropriately.
2. POLICY:
i. Respiratory care staff will verify respiratory prescriptions specifies the type, frequency, and duration of treatment and as, appropriate, the type and dose of medication, the type of diluents, and the oxygen concentration and other respiratory services on the patient’s chart. The therapist will ask for an official request from as prepared by the nurse-on-duty per physician’s order.
ii. The therapist will only perform the specified treatment or order based on physician’s request written on the patient’s chart. If the order is only verbalized by the physician, the therapist will ask the nurse/ physician to write it down on patient’s chart.
3. RESPONSIBILITY:
i. Will verify that PHYSICIAN’S prescription specifies the type, frequency and duration of treatment and, as appropriate, the type and dose of medication, the type of diluent’s, and the oxygen concentration, etc.
ii. Will document the above for verbal orders from a physician.
iii. Will implement emergency orders immediately during an emergency situation and transcribe as a verbal order upon resolution of the emergency (in case of STAT orders).
iv. Will contact the physician for all orders that are incomplete or provide potential harm to the patient.
v. Will follow hospital approved respiratory care Protocols when appropriate.
B. MEDICATION NEBULIZER (Hand held & In-line )
1. PURPOSE:
i. To deliver aerosolized medication to the patients who can voluntarily initiate and maintain moderate to large tidal volume.
ii. To deliver in-line aerosolized medication to mechanically ventilated patients.
2. POLICY:
i. Respiratory Care Unit will administer the medication using the small-volume medication nebulizer upon notification of an appropriate physician order. The physician order should include: frequency, medication and dosage. If dosage of the medication is not ordered, unit dose will be given one time, the physician will contacted for clarification prior to any further therapy.
3. SYNONYMS: Aerosol Therapy, Inhalation Therapy, Nebulization
4. TECHNIQUE/ RESPONSIBILITY
i. The NOD/ Physician will notify the therapist of any order or change of current order received via telephone call/ direct verbal communication.
ii. Obtain appropriate equipment and medications necessary to perform therapy.
iii. Verify physicians written order on the chart. Notify NOD if there are any errors for immediate correction.
iv. Review patient’s chart to gather pertinent information such as indication and contra-indication of therapy.
v. Wash hands before and after treatment. Strictly follow infection control protocol (see infection control manual).
vi. Identify patients (ID band) and introduce himself/ herself to patients.
vii. Position the patients, auscultate, monitor pulse and respiration before, during, and treatment.
viii. Assemble equipment:
• Med. Neb disposable set-up with appropriate delivery device (mouthpiece, nose clip, aerosol mask, T-piece, face tent, or trachea collar with reservoir tubing).
• Instill appropriate medication.
• Connect to appropriate pneumatic source, (oxygen flow meter, air flow meter, for suspected CO2 retainers, or ventilator nebulizer connection for in- line nebs), and set appropriate flow to produce reasonable aerosol mist.
ix. Explain procedure and goals of therapy to patient.
x. Administer treatment. Monitor patients for complications (tachycardia, paradoxical bronchospasm ect).
xi. Discontinue therapy upon complete nebulization of medication unless adverse reactions occur.
xii. Encourage the patient to cough and expectorate. Document the characteristics of sputum (i.e., color, consistency, and amount).
xiii. Empty nebulizer cup, shake dry, and keep in appropriate place.
xiv. Documentation on the flow sheet form to include: medication (concentration and volume) nebulized, duration of therapy, and the source gas utilized; heart rate, resp. rate, and breath sound (before and after therapy); and cough and sputum characteristics, patient’s subjective response to therapy.
xv. Document the number of treatment given and the time on the desk copy of the master schedule (patient’s cardex) for charging purpose.
C. VENTILATORY CARE
1. PURPOSE
i. To provide guidelines for managing the patient/ ventilator system and documenting in the medical record or ventilator flow sheets.
2. POLICY:
i. All mechanical ventilators are set-up, monitored and maintained by Respiratory Care Personnel (assigned respiratory therapist). All patient related interventions are documented in the medical record/ ventilator flow sheets. The Respiratory Therapist will also do the charging.
3. RESPONSIBILITY:
i. Obtain the ventilator. Test the ventilator, humidifier and the circuit function. Check ordered setting’s on patient chart and notify physician or NOD if any errors in orders are present.
ii. Wash hands before and after all interventions with patient /ventilator system. Follow applicable infection control guidelines.
iii. Verbally re-assure and comfort the patient. Place patient on ordered settings. Activate and set humidifier as appropriate.
iv. Notify physician as necessary for order clarification, suggested modifications, or to communicate significant changes in patient’s status.
v. Optimize ventilator settings and alarm to maximize patient comfort and safety while adhering to physician ordered ventilators parameters. Activate appropriate external monitors alarm.
vi. Check patient/ventilator system. Document on the ventilator flow sheet.
4. AREAS OF CLARIFICATION:
i. Any therapist who observes what appears to be some aspect of ventilator/ humidifier malfunction is responsible to promptly report the occurrence to his/her supervisor. If the occurrence is potentially life threatening, the patient is placed on alternative manual or mechanical ventilation. The supervisor is responsible to promptly assess the situation, document and remove the ventilator as applicable. An equipment malfunction report is filled out describing order what circumstances and at what settings the malfunction occurred.
5. VENTILATOR CHECKS
i. Ventilator checks are documented every two to four hours as possible and otherwise to reflect changes in ventilator’s parameters and changes in oxygen concentration. Respiratory Care Department ventilator Flow Sheet is stamped with the patient’s respirator (bedside). All applicable spaces are completed as part of each check.
6. GUIDE FOR CHARTING ON VENTILATOR FLOW SHEET:
CATEGORY DESCRIPTION
Ventilator type ( No.) Type/ model of ventilator
Number assigned by departmental biomedical personnel
DATE Date of ventilator check/ setting change, circuitry
change.
TIME Time of ventilator check/ setting change, circuitry change.
MODE Indicates type of mechanical ventilation employed.
FIO2 Ordered oxygen concentration. FIO2 must be analyzed at least once per shift and with each change in O2 concentration.
SET TIDAL VOLUME Physician prescribed tidal volume as set by machine control (s).
RETURNED TIDAL VOLUME Returned tidal volume for all machine assisted breaths in A/C, IMV, and/ or PCV. Acceptable Vt is defined as one within 100mls of Vt when ordered Vt is one liter or less. Volume within 10% of ordered Vt are acceptable for Vt >1000mls.
SPONTANEOUS TIDAL VOL. Returned Vt for all breathes in PS and CPAP modes.
SET FREQUENCY Frequency ordered by physician. Set by adjusting and verifying the position of the rate control.
SPONTANEOUS FREQUENCY Number of spontaneous breaths/min generated in the IMV or CPAP modes. Number of PS bpm.
TOTAL FREQUENCY Total breaths recorded per minute.
FLOW Flow rate set in volume control modes and adjusted on ventilator control panel.
SENSITIVITY Pressure below baseline observed on manometer required to initiate a patient generated breath.
PEAK PRESSURE Maximum system pressure observed during a typical Vt delivery during a machine generated breath.
PLATEAU PRESSURE System pressure observed during a successful breath hold maneuver.
PEEP The amount of set end-pressure. When auto-peep is detected, chart set peep over the total peep.
STATIC COMPLIANCE Returned Vt + Plateau P – PEEP
DYNAMIC COMPLIANCE Returned Vt + Peak P – PEEP
HIGH PRESSURE ALARM Set 10-15cwp higher than a patient’s PIP on a typical Vt.
LOW PRESSURE ALARM Set 5-10cwp below the PIP on a typical Vt.
DELAY An alarm should activate 3-4 sec. After a prescribed breath is missed. If an external P alarm is utilized, the number of seconds until alarm activation is recorded.
SYSTEM TEMPERATURE Should be maintained between 30-37 degrees C as measured at the patient wye and presented on the digital display on the Fisher & Paykel humidifier.
SIGH VOLUME Physician ordered Vs (factory preset or set at bedside by RCP).
SIGH RATE MULTIPLES Rate (sighs/hr, sighs/100 breaths);Indicate multiple sigh demonstrated in the following example (e.g. 3x2, where 3 is the sigh rate and 2 is the multiple).
VOLUME ALARMS Chart volume alarms as follows:
( Vt or Vminute) Bear-low Vt; Siemens 900C-High minute volume over low minute volume; PB 7200ae and Infrasonics Star 2000-low Vt over low minute volume.
SpO2/ HR Record O2 saturation (measured via pulse oximetry) over heart rate.
ABGs Document as to reelect associated ventilator setting.
SET PRESSURE LEVEL Record in PS modes. Document amount of positive inspiratory pressure ordered by physician.
I:E RATIO Chart when this ratio is used as a therapeutic ventilator parameter manipulated by the RCP or by physician order.
BLANK ROW May be used to record the inspiratory waveform, events of suctioning, or otherwise be used at the RCPs discretion.
SIGNATURE First initial, last name, and credential.
THERAPIST NOTES (Back Document baseline/subsequent
Of Ventilator Flow) assessment to include breath sound.
Sheet tube size and placement; use of MLT or MOV technique; number, placement and status of chest tubes; verification of FIO2; calibration of ETCO2 monitor, presence and function of bag, mask and flow meter system; closed suction, filter, circuit change outs; apnea parameters; and ventilator parameters.
NOTE: A new one is replaces breathing circuitry to each patient every two days (48 hrs).
D. WEANING FROM MECHANICAL VENTILATION
1. PURPOSE:
To enhance the transmission from the reliance on mechanical ventilation to spontaneous ventilation.
2. POLICY:
Respiratory care will be responsible for making ventilator changes during weaning procedure as per physician order.
NOTE: When weaning parameters are ordered, the patient’s spontaneous RR. Vt, Min. volume, SVC, and MIP will be measured unless other specific tests are ordered. See “Ventilator Parameters” Policy.
3. TECHNIQUE / RESPONSIBILITY:
i. Verify physician’s written order on the chart.
ii. Identify patient and introduce yourself, and explain the procedure.
iii. Initiate parameter change as per physician’s order.
iv. Observe the patient for any clinical and physiological instability.
v. Assess the patient for the effect of the procedure.
vi. Document on the weaning flow sheet your observations and the results. Documentation should include the patient’s vital signs before and after the change, what the change in parameter was, and the patient’s Sp02, and/or ABG before and half hour after the changes.
E. ARTERIAL BLOOD GAS SAMPLING
1. PURPOSE
To obtain arterial blood for analysis of the patient’s respiratory and metabolic status.
2. POLICY:
An arterial blood gas sample will be obtained only in the written order of a physician. The respiratory therapist on –duty (RTOD) is allowed to perform a radial arterial puncture. After two unsuccessful attempts, the RTOD should contact another qualified staff member to perform the procedure. If there is no other available staff, the RTOD will have the discretion to choose the next site of choice, which is the brachial arterial site. If the RTOD still fails, and still there is no qualified staff to do the sampling, the RTTOD should notify the nurse staff on duty (NOD) or the physician on duty. This procedure is a shared responsibility of the therapist, nursing staff and the physician. The assigned physician will give the final approval if the therapist can try other sites of puncture such as femoral or dorsalis pedis arteries or if the procedure can be deferred.
3. TECHNIQUE/ RESPONSIBILITY:
i. The nurse-on-duty/ physician-on-duty will notify the RTOD for arterial blood sampling via phone or direct communication.
ii. Collect all necessary equipments.
iii. The therapist must verify physician’s written order in the patient’s chart. Notify the physician and the nurse if the is error in the order. Review the chart for contraindications or precautions to procedure.
iv. Wash hands and follow appropriate Infection Control process.
v. Enter room and identify himself/herself by name and department to patient and/or visitors.
vi. Identify patient verbally and by identification bracelet.
vii. Perform assessment and evaluation. Take necessary data such as patient’s respiratory rate, FIO2 and type of O2 device attached (if any), aged and other important data, which can affect the respiratory/ metabolic result of the ABG.
viii. Explain procedure to patient.
ix. Assemble equipment. Do non- sterile gloves.
x. Palpate radial artery site. Perform Allen’s Test: This is to determine the patency of the radial-ulnar loop. Occlude the ulnar and radial arteries. Have the patient clench his/her first until blanching occurs. Release the ulnar artery; if the entire hand returns to normal color within 5secs, the radial-ulnar loop is patent, and the site maybe chosen for an arterial puncture. If the entire hand does not return to its normal color, the patency is questionable, and the artery should not be used for puncture
xi. Scrub the puncture with an antiseptic
xii. Palpate the radial artery with the tips of the first two fingers on the non-dominant hand, and locate the exact puncture site.
xiii. Hold the heparinized syringe in the dominant hand, with the bevel of the needle up; puncture the radial artery at a 45 -degree angle, with the needle pointing upstream.
xiv. When there is a flash of the arterial blood in the hub of the needle, aspirate 1-2cc for adults or 0.5-1cc for pediatric/neonate of blood into the syringe.
xv. Withdraw the syringe and apply pressure to the site for minimum of 5 minutes, (10 mis. For patients receiving anticoagulants, Persantin Dextran, or aspirin in large doses) or until the bleeding stops. The patient should be instructed to call the nurse immediately if the bleeding resumes or a hematoma forms. Tape the punctured site with dry cotton.
xvi. Expel air bubbles from syringe, and carefully remove and discard needle appropriately, Cap the syringe with the stopper provider. Mix blood sample properly by rotating/rolling the syringe between two palms or fingers. Don’t mix blood by shaking.
xvii. Label the syringe with the patient’s name/ID sticker. Place green IDP(infectious disease precautions) label on the specimen of all patients with infectious diseases.
xviii. Place the labeled syringe on ice in the appropriate specimen container along with the lab. Requisition slip taken from the NOD. Complete appropriate charting and charging.
xix. Check puncture site again and reassure patient by answering any questions they may have. Discard any trash before leaving patient’s room and wash hands.
xx. Analyzed blood sample through the ABG machine without any further delay, nut mix well before feeding through the machine. Record the results in the laboratory logbook and relay to NOD/physician via phone or direct issuance. The result should correlate with patient’s condition.
4. AREAS OF CLARIFICATION:
i. Indications for ABG sampling:
• To assess oxygenation
• To assess ventilation
• To assess acid-base status
ii. Hazards and Precautions:
• Patient on anticoagulant therapy
• Patient w/ hemodialysis
• Hematoma
• Nerve spasm
• Severing of the artery/arteriospasm
• Infection
• Thrombosis
• Loss of limb
5. PROTOCOLS FOR RELAYING ABG RESULTS:
i. For In-patients
• The result will be delayed via phone or direct communication (release of “wet reading” from the print out paper of the ABG machine). The results will be relayed only to the nurse-on-duty or the physician-on-duty and properly identified by the therapist.
ii. For Out-patients
• The therapist can release the official result after entering data on the laboratory logbook and playing the appropriate charge by the sender of the specimen on the cashier section and the official receipt number is returned to the pulmonary laboratory. The official result form of the ABG (out-patient) can be released even without the interpretation of the pulmonologist. If the sender ot the center which sends the ABG sample demands for the official interpretation, the therapist can still release the official result provided that she/he will give the assurance that the interpretation will be relayed to the center as soon as possible.
6. PROTOCOLS FOR ‘SEND-OUT” SPECIMEN
i. In case the ABG machine of the hospital is not available due to some unavoidable reasons i.e. the ABG machine is busted, and there are some needed request for ABG sampling, the respiratory therapist must notify the NOD or the physician immediately and wait for further orders.
ii. If the ABG sampling is really needed and insisted by the physician, the therapist must coordinate with the NOD to ask for immediate relative if he/she agrees for the send-out ABG. If the patient has no immediate relative beside the patient or if the relative is too old or too young for send out ABG, the physician on duty or the attending physician will have to decide for deferment of the request and the therapist will wait for any further orders. The respiratory therapist on duty is not allowed to send out ABG samples.
RELEASE OF ABG RESULTS FOR IN-PATIENTS:
OFFICIAL ABG RESULTS WITH INTERPRETATION WILL BE RELEASED AFTER CHECKED/SIGNED BY THE PULMONOLOGIST AND PROPERLY TYPEWRITTEN BY THE RESPIRATORY THERAPIST.
F. CHEST PHYSIOTHERAPIES
1. PURPOSE:
i. To loosen and aid in the removal of lung secretions, and to promote re-expansion of lung tissues.
2. POLICY:
i. Respiratory care practitioners are responsible for performing one or more of the aspects of chest physiotherapies to pediatric and adult patients as prescribed by the physician’s written order. If a specific location is specified per physician’s order, the equal and opposite area of the chest will be percussed and/or drained also. All positions are modified according to patient’s condition and tolerance. The physician will be contacted if the patient is determined to have contraindications for the procedure.
3. TECHNIQUE/RESPONSIBILITY:
i. The nurse-on-duty/physician-on-duty will notify the therapist on duty of any orders received from patient care area via phone or direct communication.
ii. Verify physician’s order on chart
iii. Review patient’s chart for pertinent information necessary to complete the patient evaluation. Review recent chest x-ray reports if pulmonary involvement was not specified in physician’s order.
iv. Wash hands, and follow universal precautions.
v. Identify patient verbally with ID bracelet, and introduce self to patients and visitors by name and department.
vi. Explain procedure and goals of the therapy.
vii. Perform evaluation and assessment (breath sounds, HR, RR, etc.)
viii. If contraindications are presents, notify the physician.
ix. Position patient appropriately as designated by physicians’ order or chest x-ray. Every patient is to be placed in each position for percussions or drainage for 3-5 minutes. The entire procedure should take approximately twenty minutes.
x. Have patient sit-up and cough after each position change.
xi. Assess patient for sputum production, and possible increase work of breathing frequently. Assure that the patient uses oxygen during therapy if ordered.
xii. Wash hands and follow universal precautions.
xiii. Document all pertinent data (HR,RR, position, duration of therapy, lung, fields treated, sputum production and adverse affects) on the respiratory staff notes and complete appropriate department charting and charges.
xiv. Notify physician if patient would benefit form other forms of therapy.
4. AREAS OF CLARIFICATION:
i. CONTRAINDICATIONS AND HAZARDS OF THERAPY (AS SPECIFIED BY THE AARC CLINICAL PRACTICE GUIDELINES):
• All positions are contraindicated for:
i. Intracranial pressure >20 mmHg
ii. Head and neck injury until stabilized
iii. Active hemorrhage with hemodynamic instability
iv. Recent spinal surgery or acute spinal injury
v. Bronchopleural fistula
vi. Pulmonary edema with CHF
vii. Pulmonary embolism
viii. Patients who do not tolerate position changes
ix. Rib fracture, with or without flail chest
x. Surgical wound or healing
• Trendelenburg position is contraindicated for:
i. Intracranial pressure >20 mmHG
ii. Patients in whom increased intracranial pressure is to be avoided
iii. Uncontrolled hypertension
iv. Distended abdomen
v. Esophageal surgery
vi. Recent gross hemoptysis related to lung cancer
vii. Uncontrolled airway at risk for aspiration
• Reverse trendelenburg is contraindicated for:
i. The presence of hypotension or vasoactive medication.
• Percussion or vibration is contraindicated as described above and additionally:
i. Recent epidural spinal infusion anesthesia.
ii. Recent skin grafts, or flaps on the thorax.
iii. Burns, open wounds and skin infections of the thorax.
iv. Recently placed transvenous pacemaker or subcutaneous pacemaker.
v. Osteomyelitis of the ribs.
vi. Osteoporosis
vii. Coagulopathy
viii. Complained of the chest wall pain.
NOTES:
Chest physiotherapies may consist of chest percussion and/or vibrations, postural drainage, positioning, and turning. If the patient is ordered for aerosol therapy also, the patient should receive the nebulizer first. This will allow wetting of secretions and dilution to assist the CPT.
If complication arises, stop therapy, position patient in the resting position and notify physician.
G. PEAK FLOW
1. PURPOSE
i. To provide a consistent method/tool to estimate the patient’s ventilatory Status, and for early recognition of deterioration and/or improvement in the patient’s respiratory condition.
2. POLICY:
i. Peak flow measurements will be performed as specified by physician order’s, and/ or as part of the therapist assessment. Also called Peak Expiratory Flow Rate (PEFR).
H. TECHNIQUE/ RESPONSIBILITY:
1. The NOD/ physician will notify Therapist of order, from a phone call, received from patient care area.
2. The RTOD will verify physician’s written order in the patient’s chart.
3. Notify the nurse and the physician if there is an error in the order.
4. Collect all necessary equipment (Peak Flow Meter and Mouthpiece).
5. Wash hands and follow appropriate Infection Control process.
6. Do non-sterile gloves (optional).
7. Identify patient verbally and with identification band.
8. Introduce himself/herself to the patient and visitors by name and department.
9. Assemble appropriate equipment.
10. Assure patients posture is optimal for procedure (standing). Perform patient evaluation and assessment (HR, RR, BP).
11. Instruct the patient on goals of therapy and the correct procedure. Family members of pediatric patients should also be instructed.
12. Attach a disposable mouthpiece to the Peak Flow meter and place marker at the bottom of the scale.
13. Instruct the patient to hold the peak flow meter vertically, but do not obstruct the opening or the path of the marker.
14. Instruct the patient to take deep breath as possible, close lip tightly around mouthpiece to make a tight seal, use nose clips if necessary. Instruct patient to blow out as hard as fast as they can into the mouthpiece, this will cause the marker to move up the scale. The final position of the marker is the patients Peak Flow.
15. Repeat steps 10-12 of three measurements. Continuously instruct and coach the patient on the correct procedure. Allow the patient to rest between each procedure.
16. Record the patient’s best effort (highest value) as their Peak Flow in liters per minute.
17. Record any and all pertinent clinical data [HR, RR, BS, Peak Flow values (achieved and predicted), and any adverse effects] in the patient’s chart.
18. Complete appropriate charting and charging.
19. Leave area clean and neat.
20. Wash hands after exiting patient’s room.
I. AREA OF CLARIFICATION
NOTES:
In some cases, Peak Flows will be obtained before and after bronchodilator therapy for all patients admitted with Reactive Airway disease and asthma. Unless specified by the physician, Peak flows will be measured TID, both on adult/ pediatric wards.
Normal predicted Peak Flow values are based on se, age, and height. These values are listed in the instructions of the Peak Flow Meter.
J. INCENTIVE SPIROMETRY
1. PURPOSE
i. To encourage patient’s sustained maximal inspiration, for aid in augmentation of their lung value, to prevent or reverse atelectasis and its sequela. IS may also be performed to determine the pre-operative “baseline” inspiratory capacity.
2. POLICY
i. Respiratory care will supply the Incentive Spirometer and perform the therapy along with patient teaching upon physician’s order.
3. TECHNIQUE/ RESPONSIBILITY
i. The NOD/Physician will communicate all new orders of IS to the respiratory therapy department via phone or direct verbal communication.
ii. Upon notification of IS order, verify the correctness of the order with the physician’s written order.
iii. Review patient’s chart for indications and possible contraindications.
iv. Obtain Incentive Spirometer and deliver to patient.
v. Identify the patient. Identify yourself to patient/visitors.
vi. Explain the procedure and clinical objectives.
vii. Assemble apparatus and determine patient’s predicted Inspiratory Capacity using a nomogram (if Available).
viii. Position and instruct the patient.
ix. Coach the patient to achieve the best results possible and to teach them so that they can perform the task by themselves.
x. Duration of therapy should be at least 10 successful inspiratory efforts. Successful efforts= patient exhale normally, place mouthpiece between teth and seals with lips, inhale slowly through mouthpiece maximally, holds inspiration for 1-3 seconds, then exhale slowly to FRC and relaxes before next effort.
Note: Therapy may be modified if patient is unable to make seal with mouthpiece.
xi. Monitor patient’s HR, RR, breathe sounds before during and after the procedure. Evaluate that the goals of the therapy are met.
xii. Have the patient cough periodically throughout the procedure and at the end of the procedure.
xiii. Notify the physician and nurse promptly ASAP in the presence of any of the following unexpected situations:
• The HR changes the baseline by 20% or becomes >/= 120 bpm.
• Onset of wheezing.
• Significant worsening of dyspnea.
• Decrease in patient sensorium, or decreased patient cooperation.
• Sudden onset of chest pain.
xiv. When finished, leave the incentive spirometer where the patient can easily reach it.
xv. Document patient’s HR,RR,BS before, during and after the treatment, their position, their IC, breath hold if utilized, characteristics of their cough, patient teaching performed and patient subjective response to the therapy.
4. AREAS OF CLARIFICATION:
i. Indications for Incentive Spirometry (IS)
ii. Prevent atelectasis
iii. Existing atelectasis
K. SUCTIONING
1. PURPOSE
i. To assist in the removal of secretions or foreign material fro a patient’s airway, when they are unable to do so for themselves.
2. POLICY:
i. Suctioning is a responsibility respiratory care shares with nursing personnel. Suctioning will be the responsibility of the Respiratory Care Unit during therapies and in conjunction with ventilator inspections. Respiratory care will observe universal precautions when performing this procedure.
3. RESPONSIBILITY:
i. Assign Respiratory therapist to patient care area.
• Identify patient and determine if suctioning is indicated.
• Determine method of suctioning (whether tracheal, nasotracheal, etc.)
• Assemble equipment and supplies.
i. Suction regulator and tubing (nursing personnel should obtain this equipment)
ii. Appropriate sterile catheter.
iii. Gloves (sterile or non-sterile).
iv. Water based lubricant.
v. Appropriate oxygen delivery system and/or resuscitation bag/mask, (oxygen must be available in the event the patient suffers an adverse reaction).
vi. Nasal trumpet (if indicated).
vii. (Personal protection equipment).
viii. Normal saline (without preservatives).
• Wash hands.
• Explain procedure to patient and family.
• Select appropriate vacuum for suctioning:
i. ADULTS = 100 to 150mmhg
ii. PEDIATRICS = 80 to 100mmhg
iii. INFANTS = 60 to 80mmhg
• Place lubricant on sterile surface.
• Evaluate patient for HR, RR, color, accessory muscle use, etc.
• Position patient.
4. NASOTRACHEAL PROCEDURE:
i. Pre-oxygenate patient.
ii. Adjust regulator to desired vacuum.
iii. Apply P.P.E and sterile gloves.
iv. Lubricate nasal trumpet and gently insert into nares (if indicated)
v. Lubricate catheter and introduce it into the nares / nasal trumpet (use normal saline to lubricate pediatrics catheters).
vi. Advance the catheter till breath sounds are heard through the catheter vent port.
vii. Connect the suction tubing to the catheter.
viii. Applying intermittent suction, rotate and widraw the catheter.
ix. Oxygenate patient.
x. Evaluate patient for adverse reactions.
xi. Complete charting.
xii. Assure patient comfort.
xiii. Discard equipment..
NOTE: The patient should be monitored for adverse reactions during suctioning.
5. TRACHEAL AND ENDOTRACHEAL SUCTION:
i. Pre-oxygenate patient.
ii. Adjust regulator to desired vacuum.
iii. Apply P.P.E. and sterile gloves.
iv. Connect the suction tubing to the catheter.
v. The patient may be lavaged with 2-5ml naCl (without preservatives) if secretions are tenacious.
vi. Introduce sterile suction catheter into the patient’s artificial airway.
vii. Applying intermittent suction, rotate and withdraw the catheter.
viii. Oxygenate/ ventilate patient as necessary.
ix. Evaluate patient for adverse reactions.
x. Repeat procedure if necessary.
xi. Complete charting.
xii. Assure patient comfort.
xiii. Discard equipment.
NOTE: The patient should be monitored for adverse reactions during suctioning.
6. CLOSED SYSTEM IN-LINE SUCTION:
i. Connect in-line suction system to patient circuit (ventilator or T-bar).
ii. Affix expiration date system.
iii. Pre-oxygenate patient.
iv. Adjust regulator to desired vacuum.
v. Adjust P.P.E. and non-sterile gloves.
vi. Connect the suction tubing to the catheters’ control valve.
vii. Unlock the control valve.
viii. Grip system T-Piece and advance catheter until resistance is met.
ix. Apply intermittent suction and withdraw the catheter.
x. To lavage the airway, introduce the catheter several centimeters and instill normal saline through the irrigation port (do not apply suction until after normal saline has been delivered).
xi. Apply intermittent suction and withdraw the catheter.
xii. Oxygenate/ ventilate patient.
xiii. Evaluate patient for adverse reactions.
xiv. Repeat procedure if necessary.
xv. When suction procedure is completed, flush the catheter by instilling normal saline through the irrigation port and applying suction.
xvi. Lock control vale.
xvii. Assure patient comfort.
xviii. Complete charting.
NOTE: The patient should be monitored for adverse reactions during suctioning.
7. ASSOCIATED COMPLICATIONS OF SUCTIONING
The complications of pulmonary suction include the following:
i. Hypoxia/ Hypoxemia
ii. Vagal stimulation/ bradycardia
iii. Cardiac arrhythmia
iv. Laryngospasm/ bronchospasm
v. Tissue damage
vi. Infection
vii. Tachycardia
L. TRANSPORT PATIENT WITH OXYGEN
1. PURPOSE:
i. To ensure adequate oxygenation and safety of patient on 02 therapy/ respirator during transport.
2. POLICY:
i. Transport of patient on O2 therapy.
• The following hospital personnel should be present when transporting patient.
i. At least one (1) ER/ICU nurse.
ii. At least one (1) Respiratory Therapist if the patient to be transported is hooked to M.V.
iii. Resident physician-on-duty and/or attending physician.
iv. One (1) Nursing Aide.
3. RESPONSIBILITY:
i. Wash hands before and after the procedure.
ii. Collect and assemble equipment.
iii. Identify yourself to the patient and visitors.
iv. Identify patient by wristband.
v. Explain procedure to patients/relative.
vi. Assist patient’s respiration and heart rate.
vii. Turn cylinder on and open flow meter to desired flow.
viii. Disconnect patient’s 02 tubing from wall outlet and attach to transport flow meter.
ix. Assist with transport of patient to designated room or location.
x. Disconnect 02 tubing from transport cylinder, connect to wall 02 outlet/ cylinder, and check liter flow.
xi. Observe patient for changed in respiratory and/ or heart rate.
xii. Resume other duties after checking patient and/or oxygen source.
xiii. Assist with patient transport back to patient care area with requested to do so.
xiv. Document transport in patients medical chart and complete necessary charge documents.
NOTE: The respiratory therapist on duty stays with patient during the procedure if the patient is critically ill or upon request by the physician.
4. Computation for duration of flow:
i. DOF (mins) = (0.28 x PSIG) / liter flow
5. FACTORS FOR DURATION OF FLOW:
Size D= 0.16
E= 0.28
G= 2.41
H/K= 3.14
M. PREVENTIVE MAINTENANCE FOR RESPIRATORY EQUIPMENT
1. PURPOSE:
i. To ensure the safety and optimum performance of our respiratory equipments and maximize its useful life.
2. POLICY:
i. To Respiratory Care Department will perform preventive maintenance on respiratory equipment.
3. RESPONSIBILITY:
i. MANAGERS/ SUPERVISORS
• Cooperate with the respiratory biomedical technician to locate and secure equipment for maintenance.
• Inform the biomedical technician about observations concerning about usage that could be helpful when performing preventive maintenance.
ii. BIOMEDICAL TECHNICIAN
• Perform the following preventive maintenance tasks in accordance with the established work standards:
i. Functional operation inspections.
ii. Complete electrical safety inspection.
iii. Mechanical conditions and damage inspection.
iv. Replacement of parts recommended by manufacturer, user or biomedical observation.
v. Corrected maintenance as necessary.
vi. Additional required testing, calibration, or service specified by equipment manufacturer.
vii. Documentation of worked performed as required.
• Assure all preventive maintenance work maintain current status.
• Review any new department equipment for inclusion in the preventive maintenance program.
• Report excessively unclean or abused equipment to a manager.
• Review service manuals and keep up to date on the latest technical bulletins from manufacturers, government agencies, and independent research groups concerning equipment maintenance procedures.
4. AREA OF CLARIFICATION:
i. NOTES
The equipment inventory and tracking system is to be kept current in order to effectively manage and maintain our equipment.
The interval preventive maintenance is determined at the initial inspection. The formula used is based upon function, risk, and required maintenance. A copy of a formula and the maintenance number assigned to each type of equipment is to be kept current and on file in the respiratory biomedical department. At minimum, required safety inspections will be performed on an annual basis.
N. PROCESSING AND STERILIZATION OF RESPIRATORY EQUIPMENTS
1. PURPOSE:
i. To assure that all non-disposable equipment will be sterilized and/ or disinfected to prevent contamination of cross- contamination of infectious causing micro-organisms to patients.
2. POLICY:
i. All equipment will be changed as designated per procedures. Permanent equipment will be returned to the Respiratory Care processing Room by the therapist responsible for the area and placed in the room for the equipment technicians to disinfect.
ii. The equipment technicians will disassemble, wash place through cold sterilization on procedure, rinse, dry, reassemble, and place in appropriate closure. “Soiled” and “Clean” areas in both rooms are designated and specific tasks should be carried out in those areas only.
3. TECHNIQUE/ RESPONSIBILITY
i. Wear appropriate “Personal protective Equipment” (PPE), when handling any contaminated equipment at all times. PPE equipment includes resistant gown, gloves and protective eyewear.
ii. Send all permanent canisters in appropriate bag for “steam autoclave” to Central Stores as per manufacturers recommendations.
iii. Change Glutaraldehyde solution every four weeks. The solution wikll be monitored daily, prior to use, by testing the strength of solution with indicator strips. Should the test strip indicate that the solution is no longer effective, the solution will be changed and the manager informed.
iv. Monitor glutaraldehyde vapor annually to assure the safety of the area for the employees. The information will be reported to the Medical Director and the Director of Respiratory Care/ Pulmonary Diagnostics Services.
v. Place permanent equipment discontinued from patient use in clear plastic bag to return to the department. If contaminated with blood or bloody secretions, place equipment in plastic bag and label with isolation tape.
vi. Discard all disposable items in the appropriate containers in the patient’s room.
vii. Return all equipment to the Respiratory Care Department, place inside the equipment room in the appropriate area or counter.
viii. Break equipment down into appropriate parts for washing and disinfecting.
ix. Wash all visible contaminant from surfaces.
x. Submerse equipment in glutaraldehyde solution Metricide for overnight.
xi. Equipment surfaces, electronic equipment, and equipment that cannot be immersed will be disinfected with glutaraldehyde solution.
xii. Place equipment in dryer appropriately from soiled equipment area.
xiii. No equipment should touch the bottom of the dryer floor.
xiv. Hang all tubing from tubing side appropriately.
xv. Remove equipment from dryer side in room.
xvi. Assemble equipment when it is thoroughly dry (visible inspection).
xvii. Make ready and assemble on clean counter top designated for such purposes.
xviii. Package, label and place on shelf in appropriate area for use.
xix. Clean all surfaces of equipment and carts with wexcide & alcohol.
xx. Wipe the surface with the solution and allow to air dry.
xxi. Return monitors to the Respiratory Care storage room.
xxii. Push ventilators to make ready area for calibration.
xxiii. Calibrate and check ventilators. Assure they are ready for operation.
xxiv. Set up and cover with plastic bags all portable Birds ventilators, CPAP & Bi-PAP equipment. This includes replacing air and bacteria filters.
xxv. Place all “ready to use” equipment in the storage area.
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Give request together with the receipt to the Ultrasound Technician and wait for your turn until your name was called
Pay at the Finance Section
Go to the Ultrasound Room and ask the Ultrasound Technician for the price, preparationg and schedule
Nurse gets the results and gives it to the attending physician for reading
Nurse and one (1) utility worker will bring the patient at the Ultrasound Room for examination
Nurse brings and gives the request to the Ultrasound Techinician and ask for the preparation and time of examination
Doctor gives request at the Nurse Station
CLERK INFORMS THE RADIO. TECH. OF REQUEST
CLERK CHECK FOR THE FOLLOWING:
1. AUTHENTICITY OF DOCTOR’S REQUEST
2. CLEARANCE FORM
• SHO or/and
• SENIOR ROD
3. EMERGENCY INDICATION
PORTABLE X-RAY WILL BE MADE AVAILABLE TO REQUESTING AREA
X-RAY REQUEST (PORTABLE TO BE FORWARDED BY THE RESPECTIVE AREA STAFF
RECEIVED BY RADIOLOGY CLERK
IF PROCEDURE IS INVASIVE, INFORM CONSULTANT FOR SCHEDULE
IF NON-INVASIVE
X-RAY TECH. PERFORMS
XRAY AS PER REQUEST
PATIENT PRESENT RECEIPT TO RADIOLOGY CLERK
IF CLAIMING FOR DISCOUNT OR INDIGENCY CASHIER REFER PATIENT TO SOCIAL WORKER
SOCIAL WORKER CLASSIFY AND BILL ACCORDINGLY
CLERK SCHEDULE PROCEDURE
ADVICE OPD CONSULTANT
RADIOLOGY CLERK LOG, CHECK REQUEST FOR M.D. SIGNATURE
IF NO M.D. SIGNATURE
IF SIGNED, CLERK BILLS PATIENT ACCORDING TO THE PROCEDURE TO BE DONE
PATIENT PAYS TO THE CASHIER
PATIENTS WITH X-RAY REQUEST
Get the Ultrasound request from the OPD Doctor
Get results a day after the examination. Present the receipt to get the result
MAYOR
HOSPITAL DIRECTOR
DEPUTY DIRECTOR for ADMINISTRATIVE AFFAIRS
DEPUTY DIRECTOR for PROFESSIONAL SERVICES
NURSING SERVICE
HEAD
ANCILLARY SERVICES
HEAD, DEPT. OF PATHOLOGY
CHIEF, MEDICAL TECHNOLOGIST
JUNIOR STAFF
MICROBIOLOGY SECTION STAFF
HEMATOLOGY SECTION STAFF
CLIN. MICROSCOPY SECTION STAFF
CLINICAL CHEMISTRY SECTION STAFF
BLOOD BANK SECTION STAFF
Request received from ICU and ER
Med. Tech. on duty note the request
Request received from Ward
Request is brought in by patients (OPD)
In-Patient
Out-Patient
Assigned Med. Tech. to do extraction / inform patient to comeback at 3:00 PM
Assign an MT-Intern or a Med. Tech. to go to requesting department
Med. Tech does the extraction
Med. Tech submits specimen to section responsible
Med. Tech receiver checks the specimen and enters and assign an ID # into the logbook if specimen is fit for examination/time of receipt is recorded
Process by Med. Tech Interns/staff
Microscopic examination done by Med. Tech. Staff
Result is recorded in the logbook
Result is transcribe to official result form and signed by Med. Tech
Result released to requesting department by MT/Intern
New Patient will secure and OPD form and register
OPD chart will be forwarded by admitting/records personnel to the OPD nurse
OPD nurse will distribute and forward all charts to Rehab. Clinic and received by the secretary
Secretary will then call the patient in accordance to chronology or according to medical prioritization
Rehabilitation consultant assess/evaluate
Prescribe Rehabilitation plan/modalition
Physical Therapist and aide will implement rehabilitation modalities
After completing session rehabilitation, patient will be briefed by secretary for his follow-up
After consultation, patient records will be filed and kept in the section
Physical Therapist will classify records into active / inactive files
Active files are always made available to patients with on-going program
Rehabilitation staff will directly retrieve records
Non-Rehabilitation Staff personnel
Request the chief of the section
Gives clearance
Records Release
New Patients
Secure record at OPD Section
The record section staff will give the record to the dental clinic
Patient will be called
Clinic Consultation
Out-Patients
Will go directly to dental section
Secretary will secure old record from clinic files
Patient will be called
Clinic consultation
The dentist will fill-out referral Sheet:
1. with proper S-O-A-P
2. reason for referral
3. indicate if emergency urgent or non-emergency
Patient if emergency will be assisted to the ER
Patient seen at ER/specific specialty
OPD Patient
Request from physician (Request should be complete with data like: name, age, impression, date and legible signature)
Non-Indigent
Indigent
Non-Indigent
They are requested to go to Medical Social Service for classification
Technician verifies request, then ask patient or relative to go to finance for payment of procedure
ECT taken with advice to patient to comeback after 3-7 days for issuance of official result
After all opd patients are taken, strips are pasted on the official form, cut into further strips by the ECG Tech. for submission for official reading by cardiologist. Also, all patients taken ECG their data are recorded in a logbook when after official reading is made, all results are entered into the logbook
Once with everything done, complete with official results, strips pasted on the official form are filled into folders with corresponding “Control Number” per month or by month for filing and thus kept
During office hours all ECG Tech. responds to emergency request for ECG procedure. After office hours, the requesting resident performs for such
Once called for emergency ECG either as coded or other stat calls from any area, technician immediately attends to call with the use of the roving ECG machine stationed at the ER to be brought anywhere
Once taken, strips are given to the requesting physicians for “Wet” reading
For non-ward patients relative are forwarded with the bill of charges for payment to the cashier
The technician forwards ward patients bills of charges to the ward nurse for collection to the patient’s chart
INDIGENT
NON-INDIGENT
Relatives pay at the cashier immediately claiming the official receipt
Technician refers patient to Medical Social Service
ECG form are then collated for official reading by the cardiologist
ER/ICU
OPD
IN-PATIENT
Request is received by M.T. on duty with specimen
M.T. checks if specimen is fit for examination
M.T. send specimen with request to proper section
Specimen is assigned a Lab. Ref. No. and M.T. records specimen in the logbook
M.T.-1 process the specimen
M.T. does the microscopic work
Result is recorded in the logbook OR# of OPD is recorded
Transcribe result in the official result form
If Stat-release result as soon as it is done
If not-result is placed in the result box till the patient or ward personnel claims the result
ORDER FOR BLOOD IS RECEIVED BY MT ON DUTY
BLOOD TYPE OF PATIENT IS RECHECKED BY MT
MT CHECKED AVAILABILITY OF BLOOD, IF BLOOD REQUIRED IS NOT AVAILABLE, THE LAB CONTACT RMC/POLYMEDIC AND OTHER ZONAL BB TO SECURE BLOOD. INSTRUCT RELATIVE TO GET THE UNIT THE LAB RESERVE FOR THEIR PATIENT
WHEN BLOOD IS AVAILABLE, RECHECK BLOOD TYPE OF BLOOD UNIT AND RECORD IN BB LOGBOOK, PROCEED WITH COMPATIBILITY TESTING
MT RECORD RESULT IN BB LOGBOOK IF NOT COMPATIBLE RETURN UNIT REPLACE WITH ANOTHER UNIT AND PROCEED AGAIN WITH COMPATIBILITY TESTING, IF COMPATIBLE RELEASE UNIT TO WARD.
MT ACCEPTS REQUEST TOGETHER WITH THE SPECIMEN
CHECKS DATA & RECORD IN GENERAL LOGBOOK
SPECIMEN IS SENT TO SECTION RESPONSIBLE 7 A REFERENCE # IS ASSIGNED
FOR AFB GRAM’S REQUEST
FOR CULTURE & SENSITIVITY
MT PROCESS THE SPECIMEN PREPARE AND FIX SPECIMEN
MT LABELS AND STAIN SLIDE
MT/PATHOLOGIST DOES MICROSCOPIC EXAM
MT RECORD RESULT IN LOGBOOK
MT TRANSCRIBE RESULT IN OFFICIAL FORM
RESULT IS READY FOR RELEASE
MT PLANT SPECIMEN TO APPROPRIATE CULTURE MEDIA
INCUBATE FOR 24 HOURS
MT MAKES INITIAL READING
INCUBATE
W/ GROWTH
W/O GROWTH
MT DOES BIOCHEM OR SENSITIVITY
INCUBATE FOR 24 HOURS.
RELEASE RESULT AS NO GROWTH
READ RESULT AND RECORD
ISSUE FINAL RESULT
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