ER Service Standards

Emergency Department Service Standards

For General Hospitals

Disclaimer The authors views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

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ACKNOWLEDGMENTS

Emergency medicine focuses on the diagnosis and treatment of acute illnesses and trauma that require immediate resuscitation and treatment. It is a field of practice based on the knowledge and skills required for the prevention, diagnosis, and management of acute and urgent medical and surgical cases.

Emergency physicians are tasked with seeing large number of patients, treating their illnesses and referring them to the hospital as necessary. It requires a broad field of knowledge and advanced procedural skills often including; trauma resuscitation, basic cardiac life support, and basic airway management, etc

This series of documents and publications provides the necessary guidelines for specialists, planners, managers, health providers, and those working with communities to improve the provision of essential and lifesaving care for patients. This series covers four areas: clinical and medical care, planning and management, community development.

We would like to thank the many dedicated people who have contributed to the development of these materials. Through proper application of the principles, approaches, and actions incorporated in this series, quality services can be made accessible and available to patients who need them most.

It is my sincere hope that this series of documents will contribute to improving the health and well-being of patients in our country.

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CONTRIBUTORS

The Emergency Department Service Standards for General Hospitals was modified from the original volume (Emergency Department Service Standards for Level II General Hospitals) developed by the Ministry of Health and Population in Egypt under the Healthy Mother/Healthy Child Project in collaboration with the United States Agency for International Development (USAID) and its technical assistance contractor, John Snow, Inc. The technical working group contributed to the original volume and adapted the material to suit the needs of Jordanian hospitals.

Ministry of Health Technical Working Group Dr. Jamal Qunash Director of Emergency Directorate at MOH Dr. Basel Abu-Sabha Director of Emergency Department at Al-Basheer Hospital Dr. Ali Awwad Emergency Medicine Specialist at Al-Basheer Hospital Reviewers Professor Sabry Hamza Chief of Party / Health Systems Strengthening II (HSSII) Project Dr. Anwar Al-Khasawneh Emergency Task Manager / Health Systems Strengthening II (HSSII) Project Formatting and Operational Assistance Ms. Sarah Salaytah Executive Assistant / Health Systems Strengthening II (HSSII) Project

Emergency Department Service Standards for General Hospitals

vii

TABLE OF CONTENTS

FOREWORD.................................................................................................................................................... I

ACKNOWLEDGMENTS ............................................................................................................................ III

CONTRIBUTORS ..........................................................................................................................................V

TABLE OF CONTENTS ........................................................................................................................... VII

TABLE OF FIGURES .................................................................................................................................. XI

ABBREVIATIONS AND ACRONYMS .................................................................................................. XIII

INTRODUTION ........................................................................................................................................ XIII

CHAPTER 1: UNDERSTANDING EMERGENCY DEPARTMENTS IN GENERAL HOSPITALS .. 3

1. UNDERSTANDING EMERGENCY DEPARTMENT ...................................................................... 3 2. HISTORY ............................................................................................................................................ 3 3. DEPARTMENT LAYOUT ................................................................................................................. 3 4. SIGNAGE ............................................................................................................................................ 4 5. CRITICAL CONDITIONS HANDLED ............................................................................................. 4 6. NON-EMERGENCY USE .................................................................................................................. 5 7. SCHEMATIC DESIGN/ FUNCTIONAL REQUIREMENTS ........................................................... 6

CHAPTER 2: EMERGENCY SERVICE STANDARDS FOR GENERAL HOSPITALS ................... 13

1. INTRODUCTION ............................................................................................................................. 13 2. EMERGENCY DEPARTMENT ENTRY......................................................................................... 13 3. WAITING HALL .............................................................................................................................. 13 4. RECEPTION/REGISTRATION ....................................................................................................... 13 5. RECEPTION AND REGISTRATION OFFICE ............................................................................... 13 6. PUBLIC RELATIONS ...................................................................................................................... 15 7. PHARMACY ..................................................................................................................................... 15 8. ACCOUNTING ................................................................................................................................. 15 9. PUBLIC TOILETS ............................................................................................................................ 15 10. STORE (STRETCHERS & WHEELCHAIRS) ................................................................................ 15 11. POLICE ............................................................................................................................................. 15 12. TRIAGE ROOM ................................................................................................................................ 15 13. RESUSCITATION ROOM, EQUIPPED FOR LIFESAVING PROCEDURES (FOR ADULTS

AND PEDIATRICS) ......................................................................................................................... 19 14. EXAMINATION ROOM .................................................................................................................. 27 15. OBSERVATION ROOM .................................................................................................................. 31 16. OPERATING ROOM (FOR MINOR SURGERY) ........................................................................... 35 17. PLASTER ROOM ............................................................................................................................. 39

Table of Contents

viii

18. ISOLATION ...................................................................................................................................... 42 19. CLEAN UTILITY ............................................................................................................................. 44 20. DIRTY UTILITY............................................................................................................................... 44 21. STORE ROOM .................................................................................................................................. 44 22. NURSING STATION ........................................................................................................................ 46 23. PHYSICIANS OFFICE .................................................................................................................... 46 24. NURSES OFFICE ............................................................................................................................ 48 25. STAFF REST ..................................................................................................................................... 49 26. DOCTOR ON CALL ......................................................................................................................... 49 27. STAFF CHANGE .............................................................................................................................. 50 28. PERSONNEL .................................................................................................................................... 50 29. DEPARTMENT ADMINISTRATION ............................................................................................. 53 30. INFECTION CONTROL PROCEDURES ........................................................................................ 54 31. BEHAVIORAL ASPECTS OF EMERGENCY CARE .................................................................... 55 32. CLINICAL PROCEDURE ................................................................................................................ 58 33. PATIENT TRANSFER ..................................................................................................................... 61 34. CRASH CART .................................................................................................................................. 61

CHAPTER 3: QUALITY ASSURANCE MONITORING SYSTEM ...................................................... 67

1. INTRODUCTION ............................................................................................................................. 67 2. ASSESSING COMPLIANCE WITH STANDARDS ....................................................................... 68 3. SUPERVISORY TEAMS AT THE HOSPITAL DIRECTORATE (HD) AND QUALITY

DIRECTORATE (QD) LEVELS ...................................................................................................... 68 4. SERVICE STANDARDS MONITORING CHECKLISTS .............................................................. 68 5. CONDUCTING EMERGENCY DEPARTMENT ASSESSMENTS ............................................... 69 6. EMERGENCY DEPARTMENT SELF-ASSESSMENTS................................................................ 69 7. HOSPITAL /QUALITY DIRECTORATE ASSESSMENTS ........................................................... 70 8. VERIFYING EMERGENCY DEPARTMENT ASSESSMENT SCORES ...................................... 70 9. SOLVING COMPLIANCE PROBLEMS ......................................................................................... 71 10. WRITING RECOMMENDATIONS FOR IMPROVEMENT .......................................................... 72 11. QUARTERLY REPORTS ON EMERGENCY DEPARTMENT COMPLIANCE SCORES ......... 72 12. PRESENTATION OF EMERGENCY DEPARTMENT COMPLIANCE SCORES ....................... 73

CHAPTER 4: EMERGENCY DEPARTMENT MONITORING CHECKLISTS FOR GENERAL HOSPITALS .................................................................................................................................................. 77

1. SERVICE STANDARDS FOR TRIAGE ROOM ............................................................................. 77 2. SERVICE STANDARDS FOR RESUSCITATION ROOM, EQUIPPED FOR LIFESAVING

PROCEDURES (FOR ADULTS AND PEDIATRICS) .................................................................... 79 3. SERVICE STANDARDS FOR OBSERVATION ROOM ............................................................... 83 4. SERVICE STANDARDS FOR OPERATING ROOM (FOR MINOR SURGERY) ....................... 86 5. SERVICE STANDARDS FOR PHYSICIANS OFFICE ................................................................. 90 6. SERVICE STANDARDS FOR NURSES OFFICE ......................................................................... 91 7. SERVICE STANDARDS FOR RECEPTION /REGISTRATION OFFICE .................................... 92


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8. SERVICE STANDARDS FOR STOCK ROOM .............................................................................. 93 9. SERVICE STANDARDS FOR PERSONNEL ................................................................................. 95 10. SERVICE STANDARDS FOR DEPARTMENT ADMINISTRATION .......................................... 98 11. SERVICE STANDARDS FOR INFECTION CONTROL PROCEDURES .................................... 99 12. SERVICE STANDARDS FOR BEHAVIORAL ASPECTS OF EMERGENCY CARE ............... 100 13. SERVICE STANDARDS FOR CLINICAL PROCEDURES ......................................................... 103 14. CRASH CART ................................................................................................................................ 107

CHAPTER 5: EMERGENCY DEPARTMENT MONITORING CHECKLISTS FOR GENERAL HOSPITALS - CRITICAL SERVICE STANDARDS ONLY ................................................................ 111

1. SERVICE STANDARDS FOR TRIAGE ROOM ........................................................................... 111 2. SERVICE STANDARDS FOR RESUSCITATION ROOM, EQUIPPED FOR LIFESAVING

PROCEDURES (FOR ADULTS AND PEDIATRICS) .................................................................. 112 3. SERVICE STANDARDS FOR OBSERVATION ROOM ............................................................. 115 4. SERVICE STANDARDS FOR OPERATING ROOM (FOR MINOR SURGERY) ..................... 116 5. SERVICE STANDARDS FOR PERSONNEL ............................................................................... 118 6. SERVICE STANDARDS FOR CLINICAL PROCEDURES ......................................................... 120 7. SERVICE STANDARDS FOR CRASH CART ............................................................................. 122

CHAPTER 6: CLINICAL PERFORMANCE MONITORING ............................................................. 125

1. CLINICAL INDICATORS MONITORING CHECKLIST ............................................................ 127 2. CLINICAL PRACTICE INDICATORS FOR EMERGENCY MEDICAL SERVICES ................ 130 3. EMERGENCY DEPARTMENT SERVICE STANDARDS COLLECTIVE CHECKLIST FOR

GENERAL HOSPITALS ................................................................................................................ 131 4. EMERGENCY DEPARTMENT SERVICE STANDARDS COLLECTIVE CHECKLIST FOR

GENERAL HOSPITALS CRITICAL ........................................................................................... 135 5. PERCENTAGE COMPLIANCE ACTUAL SCORE FOR GENERAL HOSPITALS ................... 137 6. PERCENTAGE COMPLIANCE ACTUAL SCORE FOR GENERAL HOSPITALS -

CRITICAL ........................................................................................................................................ 138 7. EMERGENCY DEPARTMENT SERVICE STANDARDS RECOMMENDATIONS FOR

IMPROVEMENT ............................................................................................................................ 139


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TABLE OF FIGURES

FIGURE 1: EMERGENCY DEPARTMENT ................................................................................ 7

FIGURE 2: ZONE 1 ......................................................................................................................... 8

FIGURE 3: ZONE 2 ......................................................................................................................... 9

FIGURE 4: ZONE 3 ....................................................................................................................... 10

FIGURE 5: CRASH CART ........................................................................................................... 63


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ABBREVIATIONS AND ACRONYMS

A

ABG Arterial Blood Gas ACLS Advanced Cardiac Life Support AIA American Institute Of Architects ARI Acute Respiratory Infection ASAP As Soon As Possible ATLS Advanced Trauma Life Support

B

BCLS Basic Cardiac Life Support BEOC Basic Essential Obstetric Care BLS Basic Life Support BP Blood Pressure

C

CBT Competency-Based Training COPD Chronic Obstructive Pulmonary Disease CPR Cardiopulmonary Resuscitation CQIS Continuous Quality Improvement System CT Computed Tomography CVP Central Venous Pressure

E

ECG Electrocardiogram ED Emergency Department EMS Emergency Medical Services EMT Emergency Medical Technician EOC Essential Obstetric Care ET Endotracheal

F

FP Financial Planner

G

GP General Practitioner

Acronyms and Abbreviations

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H

H2 Hydrogen HIS Health Information System HM/HC Healthy Mother/Healthy Child

I

ICU Intensive Care Unit IU International Unit IV Intravenous IVF Intravenous Fluid

M

MCH Maternal And Child Health MD Medical Doctor Mg Magnesium MgSO4 Magnesium Sulfate MOHP Ministry Of Health And Population

N

NSAID Nonsteroidal Anti-Inflammatory Drug

O

O2 Oxygen

P

PHC Primary Health Care PRO Patient Relations Officer

Q

QA Quality Assurance

R

RR Respiratory Rate

U U/S Ultrasound


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INTRODUCTION

Over the past decade, Jordan was able to achieve and maintain remarkable outcomes in improving the health status of all Jordanians.

Emergency medicine focuses on the diagnosis and treatment of acute illnesses and trauma that require immediate resuscitation and treatment. It is a field of practice based on the knowledge and skills required for the diagnosis, and management of urgent and acute medical and surgical cases.

Emergency physicians are tasked with seeing large number of patients, treating their illnesses, and referring them to the hospital as necessary. It requires a broad field of knowledge, training, and advanced skills often including; basic cardiac life support, basic airway management, and trauma resuscitation, etc.

Across Jordan, emergency medical services face many challenges; mainly the quality of services, shortage of trained staff, and infrastructure challenges (size, and design).

Due to increasing number of population, and increasing number of casualties resulting from high incidence of road traffic accidents, the ministry of health (MOH) is taking active steps to improve the status of infrastructure and staff working in the emergency departments(ED) of MOH hospitals.

This publication is intended to serve as a convenient reference, a guide for service delivery, and a tool to support performance improvement. This will improve the MOH potentials to get accreditation for the emergency departments at the government hospitals across Jordan.

This series of documents and publications provides the necessary guidelines for specialists, planners, managers, and health providers to improve the provision of essential and lifesaving care for patients.

This publication covers six areas: understanding ED, emergency services standards, quality assurance monitoring system, ED monitoring checklists, and clinical performance monitoring.

It is our sincere hope that this series of documents will contribute to improving the health and well being of patients in Jordan.


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Chapter 1: Understanding Emergency

Departments in General Hospitals


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CHAPTER 1: UNDERSTANDING EMERGENCY DEPARTMENTS IN GENERAL HOSPITALS

1. UNDERSTANDING EMERGENCY DEPARTMENT The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life threatening and require immediate attention.

2. HISTORY The first specialized trauma care center in the world was opened in 1911 in the United States at the University of Louisville Hospital in Louisville, Kentucky.

3. DEPARTMENT LAYOUT A typical emergency department has several different areas; each specialized for patients with particular severities or types of illness.

Upon arrival to the ED, an individual typically undergoes a brief triage (sorting) interview to help determine the nature and severity of their illness or injury. Individuals with serious illnesses or injuries are then seen by a physician more rapidly than those with less severe symptoms or injuries. After initial assessment and treatment, patients are admitted to the hospital, stabilized and transferred to another hospital, or discharged.

In the triage area, patients are seen by a triage physician/nurse, who completes a preliminary evaluation, before they are transferred to another area of the ED or a different department in the hospital. Patients with life- or limb-threatening conditions may bypass triage and may be seen directly by a physician.

The resuscitation area is a key area of an emergency department. It usually contains several individual resuscitation bays, usually with one specially equipped for pediatric resuscitation.

Each bay is equipped with a crash cart (defibrillator, airway equipment, oxygen, intravenous lines and fluids, and emergency drugs). Resuscitation areas also have monitor, ECG machines, and often limited X-ray facilities to perform chest, skull, and pelvis films. Other equipment may include non-invasive ventilation (NIV) and portable-ultrasound devices.

The general medical area is for stable patients who still need to be confined to bed (note that a "bed" in the ED context is almost always a trolley rather than a full hospital bed). This area is often very busy, filled with many patients with a wide range of medical and surgical problems. Many will require further investigation and possible admission.

Patients who are not in need of immediate treatment are sent to the minors area. Such patients may still have been found to have significant problems, including fractures, dislocations, and lacerations requiring suturing.

A pediatric area for the treatment of children has recently become standard, to dedicate separate waiting areas and facilities for children. Some departments employ a play therapist whose job is to put children at ease to reduce the anxiety caused by visiting the emergency department, as well as provide distraction therapy for simple procedures.

Chapter 1: Understanding Emergency Departments in General Hospitals

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Contemporary EDs typically do not maintain a dedicated area for obstetrics. Such patients who present to the ED are sent to the obstetrics/maternity ward or the Labor and Delivery suite, unless there is another medical condition that requires treatment first.

Many hospitals have a separate area for evaluation of psychiatric problems. These are often staffed by psychiatrics and mental health nurses and social workers. There is typically at least one room for people who are actively a risk to themselves or others (e.g. suicidal).

4. SIGNAGE A hospital with an emergency department usually has prominent signage reading Emergency or Accident and Emergency (often in white text on a red background) and an arrow to indicate where patients should proceed.

5. CRITICAL CONDITIONS HANDLED

5.1 Cardiac Arrest Cardiac arrest may occur in the ED/A&E or a patient may be transported by ambulance to the emergency department already in this state. Treatment is basic life support and advanced.

Life support as taught in advanced life support and advanced cardiac life support courses. This is an immediately life-threatening condition which requires immediate action in salvageable cases.

5.2 Heart Attack Patients arriving to the emergency department with a myocardial (heart attack) are likely to be triaged to the resuscitation area. They will receive oxygen and monitoring and have an early ECG: aspirin will be given if not contraindicated or not already administered by the ambulance team; morphine or diamorphine will be given for pain; sublingual (under the tongue) or buckle (between cheek and upper gum glycerin trinitate (nitroglycerine) (GTN or NTG) will be given, unless contraindicated by the presence of other drugs, such as drugs that treat erectile dysfunction.

An ECG that reveals ST segment elevation or new left bundle branch block suggests complete blockage of one of the main coronary arteries. These patients require immediate reperfusion (re-opening) of the occluded vessel. This can be achieved in two ways: thrombolytic (clot-busting medication) or percutaneous transluminal coronary angioplasty (PTCA). Both of these are effective in reducing significantly the mortality of myocardial infarction. Many centers are now moving to the use of PTCA as it is somewhat more effective than thrombolytic if it can be administered early. This may involve transfer to a nearby facility with facilities for angioplasty.

5.3 Trauma Major trauma, the term for patients with multiple injuries, often from a road traffic accident or a fall, is treated by a trauma team who have been trained using the principles taught in the internationally recognized advanced trauma life support (ATLS) course of the American college for surgeons. Some other international training bodies have started to run similar courses based on the same principles.

The services that are provided in an emergency department can range from simple x-rays and the setting of broken bones to those of a full-scale trauma center. A patient's chance of survival is greatly improved if the patient receives definitive treatment (i.e. surgery or reperfusion) within one


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hour of an accident (such as a car accident) or onset of acute illness (such as a heart attack). This critical time frame is commonly known as the "golden hour."

Some emergency departments in smaller hospitals are located near a helipad which is used by helicopters to transport a patient to a trauma center. This inter-hospital transfer is often done when a patient requires advanced medical care unavailable at the local facility. In such cases the emergency department can only stabilize the patient for transport.

5.4 Mental Illness Some patients arrive at an emergency department for a complaint of mental illness. In many jurisdictions (including many U.S. states), patients who appear to be mentally ill and to present a danger to themselves or others may be brought against their will to an emergency department by law enforcement officers for psychiatric examination. From the emergency department, patients thought to be mentally ill may be transferred to a psychiatric unit (in many cases involuntarily).

5.5 Asthma and COPD Acute exacerbations of chronic respiratory diseases, mainly asthma and chronic obstructive pulmonary disease (COPD), are assessed as emergencies and treated with oxygen therapy, bronchodilators, steroids or thyophilline, have an urgent chest x-ray and arterial blood gases and are referred for intensive care if necessary. Non invasive ventilation in the ED has reduced the requirement for intubations in many cases of severe exacerbations of COPD.

6. NON-EMERGENCY USE Emergency departments around the world are increasingly being used for non-emergency care because of overburdened healthcare systems. Many people, afflicted by minor injuries or illnesses late at night or at times when their doctor's office is closed, reforced to resort to attending the ED. This is especially true for conditions with distressing symptoms, such as a child's ear infection. People in lower socioeconomic classes are more likely to use the ED for primary care services, as they typically find it inconvenient or impossible to miss work for a visit to the General Practitioner (GP), or who may be unable to afford an office visit (where a physician or clinic may refuse treatment for inability to pay).

In the United Kingdom, it has become more popular to visit the A&E since it became mandatory for patients to be fully treated and discharged from the department within four hours of arrival. Also, the introduction of the new contract for primary care doctors in that country decreased the accessibility of GP services. Under this contract GPs can opt out of on-call cover, and patients sometimes present instead to the A&E.

Patients attending the ED for minor complaints do not contribute significantly to the overall workload of the department. (Despite the level of complaints in the general public and by health staff). Studies, in Australia at least, have shown that improved after-hours GP access has no effect on ED workload or waiting times.

In the United States, and many other countries, hospitals are beginning to create areas in their emergency rooms for people with minor injuries. These are commonly referred as Fast Track or Minor Care units. These units are for people with non life-threatening injuries. The use of these units within a department has been shown to significantly improve the flow of patients through a department and to reduce waiting times. Urgent Care clinics are another alternative, where patients can go to receive immediate care for non-life-threatening conditions.


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7. SCHEMATIC DESIGN/ FUNCTIONAL REQUIREMENTS Based on international standards, AIA standards, and proper medical planning, the schematic design for the ED was made to meet the functional requirements of the ED. See (figure1).

The emergency department schematic design cover the level of services specific to the Emergency Department, including:

ED entry Waiting area Reception and registration office Public relations Police room Triage room Resuscitation room Examination/treatment room Observation area ( male and female) Operating room Isolation/decontamination room Ultrasound Clean utility Dirty utility Laboratory Radiology Pharmacy Physicians office Nursing station Plaster room Head office Nurses office Staff rest Stock rooms Staff change Department administration Infection control procedures Behavioral aspects of emergency care Clinical procedures Patient transfer Each item will be discussed in relation to its physical structure, furniture, equipment, supplies and medications, whenever it is relevant.


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Figure 1: Emergency Department

Observation Area Wards

(male/female) Isolation Nursing station Utilities

Entry / Public Area

Pedestrian / relatives entry Waiting area Reception / registration Accounting Pharmacy Police (PRO) Counseling Stretchers / wheelchairs Public toilets Direct access to triage

Treatment Area

Triage Exam / treatment Isolation Decontamination Resuscitation Ultrasound Dirty utility Clean utility Storage Nursing station

Medical Supporting Services Area

Operating theater Plaster room X-Ray Lab Equipment store

Supporting Services

Staff rest Doctor on call Head office Staff change Communication

Patient walk in Ambulant Entry

Discharge or Admission to Hospital



Zone 1 Zone 2 Zone 3


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Figure 2: Zone 1

Entry / Public Area

Pedestrian / relatives entry Waiting area Reception / registration Accounting Pharmacy (PRO) Counseling Stretchers / wheelchairs Police Public toilets Direct access to triage

Walk in Entry


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Figure 3: Zone 2

Treatment Area

Triage Exam / treatment Isolation Decontamination Resuscitation Ultrasound Dirty utility Clean utility Storage Nursing station

Medical Supporting Services Area

Operating theater Plaster room X-Ray Lab Equipment store


Ambulant Entry



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Figure 4: Zone 3

Observation Area

Wards (male/female) Isolation Nursing station Utilities



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Chapter 2: Emergency Service Standards

for General Hospitals


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CHAPTER 2: EMERGENCY SERVICE STANDARDS FOR GENERAL HOSPITALS

1. INTRODUCTION The service standards are the criteria for the procedures, supplies, and conditions essential for quality health care services. Each standard is considered to be essential for full, effective provision of the services. The Emergency Department Service Standards are based upon nationally-approved clinical protocols for the diagnosis, management and prevention of common health problems. This document includes Protocols for Emergency Department Teams. These clinical protocols and service standards were developed from international research on the most medically effective and cost-efficient practices. If followed correctly by health providers, the number of deaths from major medical, surgical and child emergencies can be reduced by a significant estimated percentage.

The Emergency Department Service Standards are organized into the three levels of care (as shown in Table 1) that are provided within a medium size general hospital. (NOTE: Not all facilities provide the full range of services as listed below for each level of care, some facilities may provide more and some facilities provide fewer services.) A "generic" organizational structure for (General Hospitals), Emergency Department is illustrated in Figure 1.

2. EMERGENCY DEPARTMENT ENTRY Patient Entry (Walk in) Ambulant Entry

3. WAITING HALL Adequate waiting space

4. RECEPTION/REGISTRATION Adequate space

5. RECEPTION AND REGISTRATION OFFICE Forms used:

Out-Patient Form The form must include: Patient's personal data Patient's complaint Diagnosis Treatment

Chapter 2: Emergency Service Standards for General Hospitals

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Observation Form The form must include: Patient's diagnosis Patient's vital signs Patient's physical examination Fluid chart Medication chart Investigations (laboratory, radiology, blood bank requests) Consultation request

Register for Inpatient Admission The form must include: Diagnosis in Emergency Department Service to which patient is admitted Name of attending specialist/consultant Patient's documents and investigation results Patient's condition upon transfer:

o Stable o Unstable o Critical

Patient's transfer from Emergency Department done by: o Porter o Nurse o Doctor

Consultation Form The form must include: Name, position, specialty of requester physician and requested physician Diagnosis Reason for consultation Urgency of consultation (urgent, ASAP, routine) Reply

Mortality Register This must include: Date and time of admission Date and time of death Diagnosis Treatment Investigations Cause of death


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6. PUBLIC RELATIONS Adequate space

7. PHARMACY Adequate space

8. ACCOUNTING Adequate space

9. PUBLIC TOILETS Adequate number for Males and Females

10. STORE (STRETCHERS & WHEELCHAIRS) Adequate space

11. POLICE Adequate space

12. TRIAGE ROOM The goal of triage is to rapidly assess and identify life, or limb threatening emergencies. All patients who present to the Emergency Department (ED) for care will be seen by a physician.

Expected Activities To establish priorities for patient care, classify patients into emergent, urgent and non-

urgent. To respond quickly to possible life threatening illness or injuries and escort them

immediately to the resuscitation room with an ongoing appropriate care. To provide access for all people seeking medical care. To provide a safe, assuring environment while awaiting therapeutic interventions for minor

complaints.

12.1 Physical Structure

12.1.1 Room Specifications o One room (at least) should be available to be used as triage room. o The room should not be less than 20 m2. o Floors must be covered by porcelain tiles or plastic tiles. o Walls must be painted with a washable paint. o Paint and/or ceramic tiles must be light in color to facilitate observation of cleanliness.


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12.1.2 Cleanliness The room must be observed to be clean (no observable dust, dirt, trash, hospital wastes or spider webs), including:

o Floors o Furniture o Equipment o Instrument o Doors and Windows o Walls o Lighting Fixtures o Ceilings

12.1.3 Illumination o Sufficient lights must be available, considering room area, including natural light

(windows with screens to keep insects out). o Electric lights must be in good condition (all bulbs/tubes functioning, securely fixed,

with safe wiring and switches).

12.1.4 Ventilation o Adequate ventilation considering room area, including natural sources (e.g. windows)

must be available. o Electrical fans or air conditioners must be in good condition.

12.1.5 Electrical Sockets o Three sockets (at least) must be available, appropriately distributed in the room

considering placement of equipment, and in good condition (i.e. securely fixed and without hazards).

12.1.6 Sink o Hand washing facilities must be available. o Adequate drainage of the basin must be observed.

12.2 Furniture The furniture listed below must be present in the triage room in the indicated minimum

quantities. The following conditions must be observed: o All furniture must be clean (free of dirt, dust, stains, fluids, etc.). o All plastic or cloth fabric must be intact (no holes or tears). o Metal surfaces must be free of rust or stains. o All furniture must be in sturdy condition (no loose or unstable parts). o Painted surfaces must be intact and free of major scratches. o If furniture has wheels, the wheels must be present and in working condition.


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12.2.1. Examination Table (Adult) o Two-Three examination tables o Each table must be allocated at least 7.4 square meters of room area. o The table must be covered with foam and plastic sheet without any tears. o The table must be covered with a clean sheet.

12.2.2. Privacy Screens o One privacy screen for each bed in the room must be available.

12.2.3. Waste Receptacles o One waste receptacle for each bed in the room must be available. o Plastic liner must be in the receptacle. o One waste receptacle for medical waste.

12.2.4. Instrument Cabinet o One cabinet at least must be available. Glass panel and shelves must be free of cracks.

12.3 Equipment The equipment listed below must be present in the triage room in the indicated minimum

quantities. The following conditions must be observed: o All equipment must be clean (free of dirt, dust, stains, fluids, etc.). o Metal surfaces must be free of rust or stains. o All equipment must be in sturdy condition (no loose or unstable parts). o Painted surfaces must be intact and free of major scratches. o On equipment with wheels, the wheels must be present and in working condition. o Instruments ready for use must be sterilized. o All electrical equipment must be observed to be properly operational, with working

switches, safe wiring and secure plugs.

12.3.1. One Ambo Bag With Adult And Pediatric Size Masks

12.3.2. Central Suction System

12.3.3. Central Oxygen Supply System

12.3.4. One Sphygmomanometer, Adult And Pediatric Cuffs

12.3.5. One Stethoscope, adult

12.3.6. One Stethoscope, Pediatric

12.3.7. Thermometers


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12.3.8. ENT Examination Set

12.3.9. One X-Ray Viewer

12.4 Supplies

12.4.1. Disposable Plastic Syringes

12.4.2. Disposable Latex Gloves

12.4.3. Wooden Tongue Depressors

12.4.4. Antiseptics (Betadine Alcohol)

12.4.5. Medicated Cotton

12.4.6. Adhesive Surgical Tape (Plaster)

12.4.7. Strong Plastic Bags for Garbage

12.4.8. Soap (Sterilium)

12.4.9. K-Y Jelly

12.4.10. Torch

12.5 Standing Orders

12.5.1. Patient complaints, vital signs, and level of consciousness are recorded by the nurse within 5 minutes.

12.5.2. Emergency department residents assess the case within 10 minutes and triage cases into A, B, C according to urgency and severity of the case: o Emergent (A): (A) cases will be shifted to resuscitation room. o Urgent (B): (B) Cases will go either to observation room or be treated in the treatment

room. o Non-urgent (C): (C) Cases will be treated in the treatment room.

12.5.3. Emergency department specialist will assess all (A) cases in the resuscitation room within 5 minutes.

12.5.4. Emergency department specialist will see (B) and (C) cases on request of the resident within 10 minutes.

12.5.5. All pregnant women will be send to the obstetric room to be seen by the resident & or specialist within 5 minutes.


19

12.5.6. Urgent cases will be shifted to resuscitation room and will be managed by emergency department resident and specialist within 5 minutes.

12.5.7. Timing of consultation will be recorded in every room in a log book.

13. RESUSCITATION ROOM, EQUIPPED FOR LIFESAVING PROCEDURES (FOR ADULTS AND PEDIATRICS)

Expected Activities Perform resuscitation procedures for all life threatening illnesses or injuries for adults and

pediatrics.

13.1. Physical Structure

13.1.1. Room Specifications o Two rooms, one for Trauma Emergencies, The other for Medical Emergencies. o The room must be at least 24 m2. o Additional space with cubicle curtains for privacy may be provided to accommodate

more than one patient at a time in the trauma room. o The room must be used exclusively for resuscitation. o Floors must be covered by porcelain tiles or plastic tiles. o Walls must be painted with a washable paint or covered by ceramic tiles. o Paint and ceramic tiles must be light in color to facilitate observation of cleanliness.

13.1.2. Cleanliness The room must be observed to be clean (no observable dust, dirt, trash, hospital wastes or spider webs), including:


13.1.3. Illumination o Sufficient light must be available, considering room area, including natural light

(windows with screens to keep insects out). o Ceiling mounted operation light with good range mobility and adequate power to allow

the different interventional procedures (other ceiling light of adequate power may be used).

o Electric lights must be in good condition (all bulbs/tubes functioning, securely fixed, with safe wiring and switches).


20

13.1.4. Ventilation o Adequate air conditioning must be available, considering room area. o The air conditioner must be in good working order with observed ability to adequately

cool the resuscitation room. o To maximize the efficiency of the air conditioner, doors and windows in the

resuscitation room must be able to be securely closed.

13.1.5. Electrical Sockets o Six sockets (at least) must be available, appropriately distributed in the room

considering placement of equipment, capable of handling required electrical loads of equipment in the resuscitation room, and in good condition (i.e. securely fixed and without hazards).

13.1.6. Basin o A basin with hot and cold water, soap, and clean towel must be available in the room. o The faucet levers must be capable of being turned off with the elbow. o Adequate drainage of the basin must be observed.

13.2. Furniture The furniture listed below must be present in the resuscitation room in the indicated

minimum quantities. The following conditions must be observed: o All furniture must be clean (free of dirt, dust, stains, fluids, etc.). o All plastic or cloth fabric must be intact (no holes or tears). o Metal surfaces must be free of rust or stains. o All furniture must be in sturdy condition (no loose or unstable parts). o Painted surfaces must be intact and free of major scratches. o If furniture has wheels, the wheels must be present and in working condition.

13.2.1. Operating Table (or ICU bed) o The table must have adjustable height. o The table must take Trendelenburgs and reverse Trendelenburgs positions. o The table must have two arm pieces to support patient's arms in abduction. o The table must provide free access to patient from all sides.

13.2.2. Two Instrument Cabinets o Glass panels and shelves must be free of cracks.

13.2.3. One Drawer Cabinet

13.2.4. Two Instrument Tables (Mayo Stands)

13.2.5. Two IV Stands o Some of them may be part of resuscitation table.


21

13.2.6. One Examination Lamp

13.2.7. Two Waste Receptacle o The receptacle must have a lid. o Plastic liner must be in the receptacle.

13.2.8. Crash Cart It must contain adequate number of drawers for:

o One drawer for emergency medications. o One drawer for airway management (Ambo Bag, O2 masks, nasal cannulae, oral and

nasal airway, ET tubes, Stylet, laryngoscopes [adult and pediatric blades]). o One drawer for IV cannulae and transfusion set. o One drawer for catheters (urinary, suction, CVP). o One drawer for IV fluids. o It must have:

Resuscitation board attached.

Portable O2 cylinder attached.

A space to carry a defibrillator and ECG monitor.

Wheels in good working conditions.

13.2.9. Counter Space


13.3. Equipment The equipment listed below must be present in the resuscitation room in the indicated

minimum quantities. The following conditions must be observed: o All equipment must be clean (free of dirt, dust, stains, fluids, etc.). o Metal surfaces must be free of rust or stains. o All equipment must be in sturdy condition (no loose or unstable parts). o Painted surfaces must be intact and free of major scratches. o On equipment with wheels, the wheels must be present and in working condition. o Instruments ready for use must be sterilized. o All electrical equipment must be observed to be properly operational, with working


13.3.1. One Ambo Bag With Anatomical Masks - Adult Size, Pediatric Size

13.3.2. Two Suction Devices (Central & Mobile)

13.3.3. Two Laryngoscopes, Adult, Pediatric o With blades of different sizes. o One spare bulb must be available. o If operated by disposable batteries, a spare set of batteries must be available.


22

13.3.4. Stylet for ET tubes

13.3.5. Complete Central Oxygen Supply System (Pipe, O2 Regulator, Wrenches, O2 Mask and Cannula) o Spare cylinder must be completely full. o Must indicate that the cylinder to which it is attached is at least partially full. o One open end wrench for attaching regulator to cylinder. o One special wrench for opening and closing oxygen cylinder valve.

13.3.6. Defibrillator o Must have adult and pediatric pedals. o Automated, or manual. 13.3.7. ECG Monitor

13.3.8. Pulse Oximeter

13.3.9. Two Infusion Pumps

13.3.10. One Sphygmomanometer with Different Cuff Sizes for Adult And Pediatric

13.3.11. Stethoscope, Adult

13.3.12. Stethoscope, Pediatric

13.3.13. Two Thermometers

13.3.14. Glucometer

13.3.15. Hammer

13.3.16. Torch

13.3.17. One Handling Forceps

13.3.18. Trauma Scissors

13.3.19. ENT Examination Set

13.3.20. Instrument Set Pack o Stitching pack

Scalpel and blade size 11 and 15

One needle holder

One toothed forceps

One stitch scissors

Sterile drapes (perforated towel)

Sterile gauze swabs

Xylocaine 1-2%


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o Venous cut down pack


Small artery forceps, 2 pairs

Small dissecting scissors, 1 pair

Stitch scissors, 1 pair

One small toothed forceps

One small non-toothed forceps

One needle holder

Two pair narrow skin retractors (langenbeck)

Prolene3/0 on cutting needle

Vicryl3/0 on round needle

Antiseptic solution

Sterile gauze swabs

One small kidney dish

Adhesive tape

Xylocaine 1-2%

Syringes 5ml, 10ml

Sterile drapes (perforated towels)

Sterile gloves, 1 pair

o Chest tube insertion pack


Large artery forceps, 2 pairs

Long dissecting scissors, 1 pair

Stitch scissors, 1 pair

One small toothed forceps

One small non-toothed forceps

One needle holder

Two pair narrow skin retractors (langenbeck)

Silk 2/0 on cutting needle

Vicryl 3/0 on round needle

Antiseptic solution

Sterile gauze swabs

One small kidney dish

Adhesive tape

Xylocaine 1-2%

Syringe 2ml, 5ml


Sterile gloves 1 pair


24

o Central venous pressure line (CVP) pack


One needle holder

One toothed forceps

One stitch scissors

Four sterile drapes (towels)

Sterile gauze swabs

Xylocaine 1-2%


Syringe 5ml, 10ml (with needle)

Antiseptic solution

Silk 2/0 cutting needle

Central venous pressure catheter

Central venous pressure manometer

Three way stop-cock

o Intubation set

Magill forceps

Stylet

Endotracheal tubes different sizes

Laryngoscope adult

Laryngoscope pediatric

Batteries

Bulbs

Suction catheters, different sizes

Oral airway, different sizes

K-Y jelly

The instruments in the kit which are ready for use must be sterilized.


25

13.4. Supplies The supplies listed below must be available in adequate quantities, considering the utilization level of the facility. Item No. Item Unit 13.4.1. IV Cannula, Different Sizes (Pediatric and Adult) Each 13.4.2. Infusion Set Each 13.4.3. Disposable Syringe, (Different Sizes) Each 13.4.4. Suction Catheter, Different Sizes Each 13.4.5. Yanker Suction Each 13.4.6. Foley Catheters, Different Sizes Each 13.4.7. Urine Collecting Bag Each 13.4.8. Urine Test Stick Container 13.4.9. Chest Tubes, All Sizes Each 13.4.10. Cvp Catheters, Different Sizes Each 13.4.11. Peritoneal Lavage Catheter Each 13.4.12. O2 Masks Each 13.4.13. O2 Nasal Cannulae Each 13.4.14. Examination Gloves Each 13.4.15. Surgical Gloves, Different Sizes Pair 13.4.16. Silk Sutures, Different Sizes Pack 13.4.17. Prolene, Different Sizes Pack 13.4.18. Vicryl, Different Sizes Pack 13.4.19. Cutting And Round Needles Each 13.4.20. Disinfectant - Alcohol, Betadine Container 13.4.21. Gauze Swabs And Bandage Roll 13.4.22. Surgical Tape, 2.5, 7.5 Cm Roll 13.4.23. Cervical Collar (Different Sizes) Each 13.4.24. Hair Cover Each 13.4.25. Surgeon's Mask Each 13.4.26. Shoe Covers (Medium & Large) Each 13.4.27. Tongue Depressors Box 13.4.28. Glucometer Strips Box 13.4.29. Soap, Hand Washing, Sterilium Each 13.4.30. Plastic Bag, Medical & None-Medical Waste Receptacle Each

13.5. Medications The medications listed below must be available in adequate quantities, considering the utilization level of the facility:


26

Item No. Item Unit 13.5.1. Aminophylline Ampoule 13.5.2. Salbutamol Inhaler 13.5.3. Suitable Antibiotics Ampoule 13.5.4. Antihistamine Ampoule 13.5.5. Calcium Gluconate Ampoule 13.5.6. Dextrose 10% Or 25% IV Bag 13.5.7. Dextrose 5% IV Bag 13.5.8. Normal Saline Solution IV Bag 13.5.9. Ringers Lactate IV Bag 13.5.10. Diazepam Ampoule 13.5.11. Epinephrine Ampoule 13.5.12. Heparin Ampoule 13.5.13. Hydrocortisone Ampoule 13.5.14. Insulin, Soluble Vial 13.5.15. Magnesium Sulfate Ampoule 13.5.16. Erythromycin Eye Drops Bottle 13.5.17. Morphine Ampoule 13.5.18. Nifedipine Capsule 13.5.19. Naloxone Ampoule 13.5.20. Pethidine Ampoule 13.5.21. Protamine Sulfate Ampoule 13.5.22. Sodium Bicarbonate 8.4% IV Bag 13.5.23. Vitamin K( 1 Mg Or 10 Mg) Ampoule 13.5.24. Xylocaine 1%, Or 2% Vial 13.5.25. Dopamine Ampoule 13.5.26. Dobutamine Ampoule 13.5.27. Antiemetic Ampoule 13.5.28. Suitable Non-Steroidal Anti-Inflammatory Nsaid Injection Ampoule 13.5.29. Atropine Ampoule 13.5.30. Antispasmodic Injection Ampoule 13.5.31. H2 Receptor Antagonist Ampoule 13.5.32. Amiodorone Ampoule 13.5.33. Rapid Sequence Induction (RSI) Drugs Ampoule

13.6. Standing Orders

13.6.1. ABCs of resuscitation are started immediately by the resident and nurse.


27

13.6.2. Emergency department specialist or surgeon will lead the resuscitation within 5 minutes.

13.6.3. Two wide bore IV lines must be started within 5 minutes; blood sample is sent for type and save then IV line is run with normal saline or lactated ringer.

13.6.4. O2 administration by an appropriate method will be started within 5 minutes if indicated.

13.6.5. Vital signs are recorded within 10 minutes.

13.6.6. Blood must be available within 30 minutes, upon request.

14. EXAMINATION ROOM Expected Activities Examining patients Recording Vital Signs Give treatment to minor cases


14.1.1. Room Specifications o Two rooms at least must be available; One for males, the other for females. o The room area must be not less than 30 m2.(7.4m2 for each bed )

Each patient bed area shall have space at each bedside for visitors, and provision for

visual privacy from casual observation by other patients and visitors.

Hand-washing stations Shall be provided for each four treatment cubicles.

Toilet room. One toilet room shall be provided for each eight treatment cubicles.

Shower room. One shower room shall be provided for each sixteen cubicles. May be

combined with the toilet room.

Nourishment area. It shall include a sink, work counter, refrigerator, storage

cabinets, and equipment for hot and cold nourishment between meals. o Floors must be covered by porcelain tiles or plastic tiles. o Walls must be painted with a washable paint. o Paint and/or ceramic tiles must be light in color to facilitate observation of cleanliness.


o Floors o Furniture o Equipment o Instrument


28

o Doors and Windows o Walls o Lighting Fixtures o Ceilings

14.1.3. Illumination o Sufficient lights must be available, considering room area, including natural light

(windows with screens to keep insects out). o Electric lights must be in good condition (all bulbs/tubes functioning securely fixed,


14.1.4. Ventilation o Adequate ventilation considering room area, including natural sources (e.g. windows)

must be available. o Electrical fans or air conditioners, if available, must be in good condition.

14.1.5. Electrical Sockets o Six sockets (at least) must be available appropriately distributed in the room considering

placement of equipment, capable of handling required electrical loads of equipment, and in good condition (i.e. securely fixed and without hazards).

14.2. Furniture The furniture listed below must be present in the observation room in the indicated


14.2.1. Six (or More) Beds o The bed must be furnished with mattress, linens, Macintosh oilcloth, and pillowed bed

cover.

14.2.2. One Desk

14.2.3. Chair

14.2.4. One or two Instrument Cabinets o Glass panels and shelves must be free of cracks.

14.2.5. Three Or More Instrument Tables


29


14.2.7. Five Or More Privacy Screens

14.2.8. Six Waste Receptacle o The receptacle must have a lid. o Plastic liner must be in the receptacle.

14.2.9. IV Stand o At least one for each bed.

14.3. Equipment The equipment listed below must be present in the Treatment room in the indicated



14.3.1. Six Sphygmomanometers (Fixed at Each Bed), Adult

14.3.2. Two Sphygmomanometers Pediatric Cuffs

14.3.3. One Stethoscope, Adult and Pediatric

14.3.4. Central Suction System (at Each Bed)

14.3.5. Twelve Lead ECG Machine

14.3.6. Medical Thermometers

14.3.7. Central Oxygen Supply System (Pipe, O2 Regulator, Wrenches, O2 Mask and Cannula ) at Each Bed

14.4. Supplies

14.4.1. Disposable Plastic Syringes (Different Sizes)

14.4.2. Disposable Examination Gloves

14.4.3. Sterile Surgical Gloves

14.4.4. Cannulae (Different Sizes)


30

14.4.5. Infusion Sets

14.4.6. Disposable Urinary Catheters (Different Sizes)

14.4.7. Urine Collection Bags


14.4.9. Strips to Detect Sugar, Acetone, Albumin in Urine

14.4.10. Antiseptics (Betadine - Alcohol)


14.4.12. Adhesive Surgical Tape

14.4.13. Strong Plastic Bags for Garbage NOTE: The above items may be present in a nearby room and readily accessible. Supplies for one week must be available, according to hospital consumption.

14.5. Medications

Item No. Item Unit 14.5.1. Antipyretic Ampule or Suppository 14.5.2. Antihistamine Ampoule 14.5.3. Magnesium Sulfate Ampoule 14.5.4. Aminophylline Ampoule 14.5.5. Lasix Ampoule 14.5.6. Hydrocortisone Ampoule 14.5.7. Nifedipine Capsule 14.5.8. Soluble Insulin Vial 14.5.9. Adrenaline Ampoule 14.5.10. Antiemetic Ampoule 14.5.11. Normal Saline IV Bag 14.5.12. Glucose 5% IV Bag 14.5.13. Ringers Lactate Solution IV Bag

NOTE: The above items may be present in a nearby room and readily accessible. Supplies for one week must be available, according to hospital consumption.


31


14.6.1. Vital signs will be recorded by the nurse within 5 minutes.

14.6.2. The emergency department resident will assess the case, and whenever is necessary.

14.6.3. The emergency department specialist (If available) will assess the case on request.

14.6.4. The relevant specialist will see the case on request.

14.6.5. Timing of consultation will be recorded in a logbook.

15. OBSERVATION ROOM Expected Activities Observation of patients for whom further assessment is needed. Give treatment during observation period.


15.1.1. Room Specifications o Two rooms must be available, male & female. o The room area must not be less than 30 m2.

Each patient bed area shall have space at each bedside for visitors, and provision for

visual privacy from casual observation by other patients and visitors.

Hand-washing stations shall be provided for each four treatment cubicles.

Toilet room. One toilet room shall be provided for each eight treatment cubicles.

Shower room. One shower room shall be provided for each sixteen cubicles. May be

combined with the toilet room.

Nourishment area. It shall include a sink, work counter, refrigerator, storage

cabinets, and equipment for hot and cold nourishment between meals. o Floors must be covered by porcelain tiles or plastic tiles. o Walls must be painted with a washable paint. o Paint and/or ceramic tiles must be light in color to facilitate observation of cleanliness.


o Floors o Furniture o Equipment o Instrument o Doors and Windows


32

o Walls o Lighting Fixtures o Ceilings

15.1.3. Illumination o Sufficient lights must be available, considering room area, including natural light

(windows with screens to keep insects out). o Electric lights must be in good condition (all bulbs/tubes functioning securely fixed,



must be available. o Electrical fans or air conditioners, if available, must be in good condition.

15.1.5. Electrical Sockets o Five sockets (at least) must be available appropriately distributed in the room

considering placement of equipment, capable of handling required electrical loads of equipment, and in good condition (i.e. securely fixed and without hazards).

15.2. Furniture The furniture listed below must be present in the observation room in the indicated


15.2.1. Four (or More) Beds o The bed must be furnished with mattress, linens, Macintosh oilcloth, and pillowed bed

cover.

15.2.2. One Desk

15.2.3. Chair

15.2.4. One Instrument Cabinet o Glass panels and shelves must be free of cracks.

15.2.5. One Instrument Table



33

15.2.7. Three or more Privacy Screens

15.2.8. Four Waste Receptacle o The receptacle must have a lid. o Plastic liner must be in the receptacle.

15.2.9. IV Stand o At least one for each bed.

15.3. Equipment The equipment listed below must be present in the observation room in the indicated



15.3.1. One Sphygmomanometer, Adult and Pediatric Cuffs

15.3.2. One Stethoscope, Adult and Pediatric

15.3.3. Central Suction System

15.3.4. Twelve Lead ECG Machine

15.3.5. Medical Thermometers

15.3.6. Central Oxygen Supply System (Pipe, O2 Regulator, Wrenches, O2 Mask and Cannula)

15.4. Supplies

15.4.1. Disposable Plastic Syringes (Different Sizes)

15.4.2. Disposable Examination Gloves

15.4.3. Sterile Surgical Gloves

15.4.4. Cannulae (Different Sizes)

15.4.5. Infusion Sets

15.4.6. Disposable Urinary Catheters (Different Sizes)


34

15.4.7. Urine Collection Bags


15.4.9. Strips to Detect Sugar, Acetone, Albumin in Urine

15.4.10. Antiseptics (Betadine - Alcohol)


15.4.12. Adhesive Surgical Tape

15.4.13. Strong Plastic Bags for Garbage NOTE: The above items may be present in a nearby room and readily accessible. Supplies for one week must be available, according to hospital consumption.

15.5. Medications

Item No. Item Unit 15.5.1. Antipyretic Ampoule or Suppository 15.5.2. Antihistamine Ampoule 15.5.3. Magnesium Sulfate Ampoule 15.5.4. Aminophylline Ampoule 15.5.5. Lasix Ampoule 15.5.6. Hydrocortisone Ampoule 15.5.7. Nifedipine Capsule 15.5.8. Soluble Insulin Vial 15.5.9. Adrenaline Ampoule 15.5.10. Antiemetic Ampoule 15.5.11. Ringers Lactate Solution IV Bag 15.5.12. Glucose 5% IV Bag 15.5.13. Normal Saline IV Bag

NOTE: The above items may be present in a nearby room and readily accessible. Supplies for one week must be available, according to hospital consumption.


35


15.6.1. Vital signs will be recorded by the nurse within 5 minutes then every 30 minutes, or as needed.

15.6.2. The emergency department resident will assess the case every 30 minutes and whenever is necessary.

15.6.3. The emergency department specialist (If available) will assess the case on request.

15.6.4. The relevant specialist will see the case within 30 minutes on request.

15.6.5. Timing of consultation will be recorded in a logbook.

16. OPERATING ROOM (FOR MINOR SURGERY) Expected Activities Perform minor interventional procedures for stable non-emergent patients who suffer no

obvious life threatening conditions.


16.1.1. Room Specifications o The room must be at least 5m x 7m (35 m2). o The room must be used exclusively for minor surgery. o Floors must be covered by porcelain tiles or plastic tiles. o Walls must be painted with a washable paint or covered by ceramic tiles. o Paint and ceramic tiles must be light in color to facilitate observation of cleanliness.




36


(windows with screens to keep insects out). o Electric lights must be in good condition (all bulbs/tubes functioning, securely fixed,


16.1.4. Ventilation o Adequate air conditioning or fans must be available, considering room area. o The air conditioner must be in good working order with observed ability to adequately

cool the delivery room. o To maximize the efficiency of the air conditioner, doors and windows in the delivery

room must be able to be securely closed.

16.1.5. Electrical Sockets o Five sockets (at least) must be available, appropriately distributed in the room

considering placement of equipment, capable of handling required electrical loads of equipment in the delivery room, and in good condition (i.e. securely fixed and without hazards).

16.1.6. Basin o A basin with hot and cold water, soap, and clean towel must be available in the room o The faucet levers must be capable of being turned off with the elbow. o Adequate drainage of the basin must be observed.

16.2. Furniture The furniture listed below must be present in the operating room in the indicated minimum


16.2.1. One Operating Table

16.2.2. One Instrument Cabinet o Glass panels and shelves must be free of cracks.

16.2.3. One Drawer Cabinet


37

16.2.4. Two Instrument Tables (Mayo Stands) o One table for sterilized instruments. o One table for contaminated instruments.

16.2.5. Two IV Stands o May be part of operating table.


16.2.7. Good Ceiling Light (Operation)

16.2.8. One Swivel Stool

16.2.9. One Step Stool

16.2.10. One Wheel Chair

16.2.11. One X-ray viewer

16.2.12. Two Waste Receptacle o The receptacle must have a lid. o Plastic liner must be in the receptacle.

16.3. Equipment The equipment listed below must be present in the operating room in the indicated



16.3.1. Central &Mobile Suction Device

16.3.2. Central Oxygen Supply System (Pipe, O2 Regulator, Wrenches, O2 Mask and Cannula) o Spare cylinder must be completely full. o Must indicate that the cylinder to which it is attached is at least partially full.

16.3.3. One Sphygmomanometer, Adult and Pediatric Cuffs

16.3.4. One Stethoscope, Adult


38

16.3.5. One Stethoscope, Pediatric

16.3.6. One Handling Forceps

16.3.7. Instrument Set Packs o Stitching packs


One needle holder

One toothed forceps

One stitch scissors

Four sterile drapes (towels)

Sterile gauze swabs

16.4. Supplies The supplies listed below must be available in the indicated quantities, considering the utilization level of the facility:

Item No. Item Unit 16.4.1. IV Cannula, Different Sizes Each 16.4.2. Infusion Set Each 16.4.3. Disposable Syringe, Different Sizes Each 16.4.4. Suction Catheter, Different Sizes Each 16.4.5. Nasogastric Tube, Different Sizes Each 16.4.6. Urinary Catheters, Different Sizes Each 16.4.7. Urine Collecting Bag Each 16.4.8. Prolene , Different Sizes, Cutting Needle Pack 16.4.9. Vicryl , Different Sizes, Cutting and Round Needles Pack 16.4.10. Disinfectant - Alcohol, Betadine Container 16.4.11. Examination Gloves Each 16.4.12. Surgical Gloves, Different Sizes Pair 16.4.13. Gauze Swabs And Bandage Roll 16.4.14. Medicated Cotton Roll 16.4.15. Surgical Tape, 2.5, 7.5cm Roll 16.4.16. Hair Cover Each 16.4.17. Surgeon's Mask Each 16.4.18. Shoe Covers (Medium and Large) Each 16.4.19. Tongue Depressors Box 16.4.20. Torch Each 16.4.21. K-Y Jelly Each 16.4.22. Soap, Hand Washing, Sterilium Each 16.4.23. Plastic Bag, Large Waste Receptacle Each


39

16.5. Medications The medications listed below must be available in adequate quantities, considering the utilization level of the facility. The medications may be presented in a nearby room and readily accessible.

Item No. Item Unit 16.5.1. Aminophylline Ampoule 16.5.2. Suitable Antibiotics Ampoule 16.5.3. Antihistamine Ampoule 16.5.4. Calcium Gluconate Ampoule 16.5.5. Dextrose 10% or 25% IV Bag 16.5.6. Dextrose 5% IV Bag 16.5.7. Ringer Lactate 16.5.8. Normal Saline Solution IV Bag 16.5.9. Epinephrine Ampoule 16.5.10. Hydrocortisone Ampoule 16.5.11. Insulin, Soluble Vial 16.5.12. Nifedipine Capsule 16.5.13. Naloxone Ampoule 16.5.14. Natural Vitamin K 10 mg Ampoule 16.5.15. Xylocaine 1% or 2% Vial 16.5.16. Suitable Non-Steroidal Anti-Inflammatory NSAID Injection Ampoule 16.5.17. Atropine Ampoule 16.5.18. Antispasmodic Injection Ampoule 16.5.19. H2 Receptor Antagonist Ampoule

17. PLASTER ROOM Expected Activity Application of different types of casts


17.1.1. Room specifications o Room area must not be less than 3mx4m (12m2). o Floor must be covered with porcelain tiles and plastic tiles. o Walls must be painted with a washable paint. o Paint and/or ceramic tiles must be light in color to facilitate observation of cleanliness.


40


o Floors o Furniture o Equipment o Instruments o Doors and Windows o Walls o Lighting Fixtures o Ceilings


(windows with screens to keep insects out). o Electric lights must be in good condition (all bulbs/tubes functioning, securely fixed and



must be available. o Electrical fans or air conditioners, if available, must be in a good working condition.

17.1.5. Electrical Sockets o Two sockets (at least) must be available, appropriately distributed in the room

considering placement of equipment and in good condition (i.e. securely fixed and without hazards).

17.1.6. Telephone o A telephone (internal line) must be available in a good working condition.

17.2. Furniture The furniture listed below must be present in the plaster room in the indicated minimum



41

17.2.1. One (or More) Beds (Couch) o The bed must be furnished with mattress, linens, Macintosh oilcloth, and pillowed bed

cover.

17.2.2. One Desk

17.2.3. Chair

17.2.4. Two Side Chairs


17.2.6. One Or More Privacy Screens


17.2.8. IV Stand

17.2.9. One or More Drawer Cabinets


17.2.11. Good Ceiling Light

17.2.12. One Swivel Stool

17.2.13. One Step Stool

17.2.14. One Wheel Chair

17.2.15. One X-ray viewer


17.3. Equipment The equipment listed below must be present in the Cast room in the indicated minimum

quantities. The following conditions must be observed: o All equipment must be clean (free of dirt, dust, stains, fluids, etc.). o Metal surfaces must be free of rust or stains. o All equipment must be in sturdy condition (no loose or unstable parts). o Painted surfaces must be intact and free of major scratches. o On equipment with wheels, the wheels must be present and in working condition. o Instruments ready for use must be sterilized.


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o All electrical equipment must be observed to be properly operational, with working switches, safe wiring and secure plugs.

17.3.1. Electrical Saw

17.3.2. Two Medium Sizes Basins

17.3.3. One Plaster Scissors

17.4. Supplies The supplies listed below must be available in the indicated quantities, considering the utilization level of the facility:

Item No. Item Unit 17.4.1. Plaster, Different sizes Each 17.4.2. Examination Gloves Each 17.4.3. Gauze Swabs and Bandage Roll 17.4.4. Medicated Cotton Roll 17.4.5. Surgical Tape, 2.5, 7.5 cm Roll 17.4.6. Soap, Hand Washing, Sterilium Each 17.4.7. Soft ban, and or Stochonet Roll 17.4.8. Plastic Bag, Large Waste Receptacle Each

18. ISOLATION Expected Activity Examination of patients( Special cases)


18.1.1. Room Specifications o Room area must not be less than 3mx4m (12m2). o Floor must be covered with porcelain tiles and plastic tiles. o Walls must be painted with a washable paint. o Paint and/or ceramic tiles must be light in color to facilitate observation of cleanliness.


o Floors o Furniture o Equipment o Instruments o Doors and Windows


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o Walls o Lighting Fixtures o Ceilings





must be available. o Electrical fans or air conditioners, if available, must be in a good working condition.

18.1.5. Electrical Sockets o Two sockets (at least) must be available, appropriately distributed in the room


18.1.6. Telephone o A telephone (internal line) must be available in a good working condition.

18.2. Furniture The furniture listed below must be present in the seclusion room in the indicated minimum


18.2.1. One bed o The bed must be furnished with mattress, linens, Macintosh oilcloth, and pillowed bed

cover.

18.2.2. Two Side Chairs

18.2.3. One Privacy Screen

18.2.4. One Waste Receptacle o The receptacle must have a lid. o Plastic liner must be in the receptacle.


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18.2.5. IV Stand

18.2.6. Good Ceiling Light

18.3. Equipment The equipment listed below must be present in the Cast room in the indicated minimum

quantities. The following conditions must be observed: o All equipment must be clean (free of dirt, dust, stains, fluids, etc.). o Metal surfaces must be free of rust or stains. o All equipment must be in sturdy condition (no loose or unstable parts). o Painted surfaces must be intact and free of major scratches. o On equipment with wheels, the wheels must be present and in working condition. o Instruments ready for use must be sterilized. o All electrical equipment must be observed to be properly operational, with working


19. CLEAN UTILITY Adequate size

20. DIRTY UTILITY Adequate Size

21. STORE ROOM Expected Activity Storage of materials and supplies for emergency department use. Provide enough materials and supplies in case of mass accidents or disasters.


21.1.1. Room Specifications o Room area must not be less than 4m x 4m (or 16 m2). o Floors must be covered with porcelain tiles or plastic tiles. o Walls must be painted with a washable paint. o Paint and/or ceramic tiles must be light in color to facilitate observation of cleanliness.


o Floors o Furniture o Equipment


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o Instruments o Doors and Windows o Walls o Lighting Fixtures o Ceilings





must be available.

21.1.5. Electrical Sockets o Three sockets (at least) must be available, appropriately distributed in the room


21.2. Furniture The following furniture must be present in the storage room in the indicated minimum


21.2.1. Shelving Cabinet o Adequate shelf heights. o Easy accessibility. o Enough shelves.

21.2.2. One Filing Cabinet

21.2.3. Two Waste Receptacle (Small) o The receptacle must have a lid. o Plastic liner must be in the receptacle.


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21.3. Equipment

21.3.1. One Refrigerator o Fourteen cubic feet (at least). o Both refrigerator and freezer compartments should be in good working order. Extra stock of the following should be available.

21.3.2. IV Stands

21.3.3. Sphygmomanometers

21.3.4. Sphygmomanometer Cuffs, Different Sizes

21.3.5. Thermometers

21.3.6. Wheel Chairs and Trolleys

21.4. Supplies

22.4.1. Stock supply of one week must be available in the stock room at all times

22.4.2. Enough stock supply to deal with mass accidents and disasters must be present

22. NURSING STATION Adequate space

23. PHYSICIANS OFFICE Expected Activity Administrative work of staff physicians.


23.1.1. Room Specifications o Room area must not be less than 3m x 4m (or 12 m2). o Floors must be covered with porcelain tiles and plastic tiles. o Walls

Documents

ER Service Standards