PRINCIPLE OF

MANAGEMENT

MAIN PRINCIPLES OF MANAGEMENT

Division of work – helps to develop familiarity in the work

Authority – must be given power/right to command others

Discipline – maintaining discipline by formal or informal agreement

Unity of command – the principle of one superior

Unity of direction – one plan of action for a group of activities in the

organization with same objectives

The organizational goals should supersede the individual’s objectives

Remuneration – wages must be fair to the type of work done

Centralization – decision should be made centrally

Scalar chain – line of authority or organization chart

Order – the right person should be in the right place of work

Equity – all employees should be treated fairly and equally

Stability of tenure of the personal – long term employment

Initiative – allow all level of employees to show initiative and creativeness

Give spirit to encourage team work

VISION AND

MISSION PPUM

VISION

To be an excellent institutional that give born to a leadership in emergency

services activity to the patient , teaching and practices to student and the

public

Environment research related to emergency method and having

administration systems that is skill full , systems and efficient

Mission

Having mission towards existence authority of PTJ . Having high integrity in

giving excellent emergency services to patient , giving best teaching and

practices , to move research effort and to build capability administration

systems

Methods in achieving emergency patient , safe treatment services with the

help of right evaluation that can continue high quality of treatment

Towards achieving the best academic education level to medical students ,

student nurses , public and to government and private agency

Towards achieving the best research standard in trauma and emergency

Towards achieving satisfying services to patient and next kin with the effort

shortening of time that is warm and nice

ORGANIZATION

CHART OF UMMC

ORGANIZATION

CHART OF

NURSING

ADMINISTRATION

TEAM LEADER

RESPONSIBILITY AS A TEAM LEADER

1) Before ward round

♪ perform other specified duties whenever assigned

♪ taking report from the team leader of the early shift

♪ chart down any plan or activity for patient on that day

♪ make sure all equipment and form is ready

♪ patient investigation result are update

♪ prepare laptop for ward round

♪ inform doctor about patient complain

♪ give privacy to the patient during ward round

♪ record doctor’s order

♪ do treatment in a form (BK-MIS-384-EDI)

2) Do checklist on CSSU

♪ record the used item in CSSU record book

♪ total all of the unused and used item

3) Inventory item in ward

♪ find the total of items regards by inventory book

♪ make sure the items in good condition

♪ make sure the items in correct place

♪ top up the drug that had been used

♪ record in inventory book

♪ record all the new items in inventory book

♪ sign on every sheet

4) Check DDA drugs

♪ recheck and recount again DDA drug and DDA book to detect where DDA

drug miss counting occur

5) Round with sister

♪ make rapport / greet sister

♪ inform total of staff that on duty and total patient in ward

♪ give explanation about patient condition

♪ thanks to sister

6) Medication in ward stock

♪ identify what day of pharmacy will comes to the ward

♪ check all medication ( oral & intravenous ) quantity and condition

♪ list medication that needed

♪ contact pharmacy for checking

♪ inform pharmacy if any problem

7) Order medication

♪ check doctor’s order in patient note

♪ prepare prescription

- oral medication ( BK-MIS-073-501 )

- intravenous medication ( BK-MIS-118-EOI )

♪ make sure the prescription are fill

♪ send prescription to pharmachy

♪ make sure total medication enough

8) Nursing 24hours report

♪ fill the form

- name of leader

- total of patient

- total of admission

- total of discharge

- total of patient dead

♪ put personal information about patient

♪ do report related patient dead

♪ do report every shift

RESPONSIBILITY AS A CUBICLE NURSE

a) report taking and take note important information

b) assess patient condition in the cubicle

c) tidy up client unit and help in 14 ADL

d) ready medication trolley

- prepare medication follow by 6R

e) prepare round trolley

- ensure all forms are available

- any investigation result are ready

f) follow doctor’s round

- tell the doctor about patient complain

- discuss patient condition

- take doctor order

g) take vital sign

h) help doctor in doing procedure

i) do nursing report

WARD ROUND

BEFORE DURING AFTER

I. taking report from

staff nurse of the

early shift

II. preparation for a

ward round

●preparation trolley

form

work ship

stationary

nursing care plan

medication cardex

torchlight

spatula

ophthalmoscope

turning fork

needle

syringe

● result of all

investigation

I. follow doctor’s

round

II. listen to the

discussion

III. write in the note

● check for plan

include further

investigation and

treatment

IV. give opinion

V. do changes at care

plan

VI. read doctor order

before changes to

others patient

I. look over the list

that you made and

work out

II. update nursing

cardex

III. delegate works to

team members

accordingly

IV. do own round to

ensure

implementation

V. complete all

documentation

VI. pass patient’s

report to another

staff in the next shift

ADMISSION ,

DISCHARGE , AND

TRANSFER IN &

OUT PATIENT

RESPONSIBILITY AS A CLERK

1)Duty from 0800 hours until 1700 hours

2)Responsibility in charge before to the ward from transit

a) make sure all client folders have a name

b) ready the bed

c) record admission to the book

d) make sure all specimen must be label

e) update patient details

3)Admission procedure

a) answer calling from transit , acute medical care or rhesus for admission

process to the ward

- agree the requesting of admission if the ward has empty bed

- take important of client details and condition

b) wait client come in to the ward with the staff at admission counter

- enter client name in the ward list

- prepare bed , equipment needed and clothes for new admission

c) client come greet them , accept the admission politely and smile

d) Paste client’s stickle in admission book and TL book

e) Enter client name , registered number and specific team in white board

f) Take client folder and take the report from staff there

- make sure client folder is complete

- old note keep properly

g) prepare client name tag

h) bring client and his/her things to the empty bed

i) help the staff taking vital sign and do orientation

j) record all information rightly in the folder

4)On discharge procedure

a) staff nurse at the cubicle will complete all the procedure and the

documentation on client

b) complete all the bill and the form for discharging

c) complete appointment card if client has appointment after discharge

d) wait the doctor summary and complete history of client for discharge

e) delete client name in the computer and white board

f) call client relative to come to the counter

g) give the bill and prescription of medication

h) all the procedure done client can go home rightly

5)Management of specimen collection

a) ensure the specimen from right client

b) send correct specimen to the laboratory

c) laboratory forms have to fill completely

d) collect specimen with correct technique

e) collect the specimen with correct time

f) ensure the specimen is in the correct container

g) ensure specimen bottle has been label

h) record all the specimen in the book including name , registration number

i) pack specimen with form

j) send specimen to the right units

k) see a result of specimen

l) update client information

6)Transfer in and out procedure

TRANSFER IN TRANSFER OUT

1) there is empty bed in the ward

2) call any ward that we had lodged

before to take back that client

3) edit client name in the patient list

in the computer

4) prepare bed , needed equipment

and clothes

5) waiting for the staff there to send

the client

6) they came to the ward , taking

new and current plan and that

client and bring him to the bed

7) continue nursing observation and

management of client as usual

1) answer call from another ward

that had lodged their patient to this

ward , if there want back their

patient so we have to send that

client as soon as possiblebecause

they had empty bed just now

2) delete client name in the computer

and white board

3) complete current procedure and

documentation

4) tidy up client his properties

5) send client kindly

6) give client folder to the TL at the

counter

7) passed new and current plan to

their staff properly

7)On lodger procedure

a) call the ward that has empty bed to lodger the stable client for a fews day

because the current ward has to take new admission and at the same time ,

ward do not has empty bed

b) if get the ward

- edit client name in computer

- enter client name in list name of lodger patient at white board

c) complete client procedure and documentation

d) tidy up client and client’s property

e) bring client , properties , folder and old note accompanied by attendant to the

ward

f) pass report completely about the client including the medication and current

plan

g) leave client kindly

DEATH

MANAGEMENT

(NORMAL ,

MEDICAL LEGAL

CASES)

8)On death procedure

NORMAL MEDICAL LEGAL INFECTION

1) ensure the death

with written at

patient note

2) ensure result of

strip ECG show

asystole

3) inform family

members

4) prepare dead body

level , give it to the

staff who is the

last office

procedure

5) do the mortuary

procedure

6) prepare dead body

registry form

7) wait until body is

taken

8) explain to family

member about the

form and

discharge bill

9) write nursing

report

1) report to police

about the death

2) inform the family

about medical legal

police case

3) inform ward

manager

4) prepare the death

registry form ,

medico legal form

and consent for

autopsy

5) tell the family to wait

at PTJ forensic until

police investigation

done

6) ensure the note is

wrote by police

officer in the report

of medical legal

case

1) contact inspector of

Jabatan Kesihatan

Daerah

2) ensure the medical

officer complete the

forms

3) do mortuary

procedure except

for HIV/AIDS

4) for HIV/AIDS

- handle the

body with

prevention

- put into zip bag

if have any

feces or blood

- -put infection

tape

- Ensure causes

of death did not

write diagnose

“HIV” or “AIDS”

MEDICATION IN

DDA CUPBOARD

HANDLING OF DDA ( AKTA DADAH MERBAHAYA )

a) Explain principles and your responsibilities in handling DDA drugs

● DDA cupboard’s key should be keep by TL or sister

● keep DDA book inside DDA cupboard

● straightly record every time taking out the DDA drug by double sign of staff

nurse inside DDA book

● check of DDA drug every shift to tally the total of take out and stock of

medication

● TL should be passed over report to another shift TL in the same shift

b) State :

i. Dangerous Drug Act 1952

An act make further and provision for the regulating of importation ,

exportation , manufacture , sell and use of opium or certain other

dangerous drug load substances .

ii. Poison Act 1952

An act to regulate the importation , possession manufacture ,

compounding , storage , transport , sale and use of poison

c) State the drugs that available in DDA cupboard

●therapeutic effect

●side effect

GENERIC TRADE NAME ACTION SIDE EFFECT

NAME

1)IV Morphine

10mg/ml

1)Morphine Hp

2)Morphine Elson

3)Morphine Lp

Epidural

-for moderate to

severe pain ,

Lt.ventricular

failure , or

terminal care

and palliative

care post op

1)hypotension

2)nausea

3)vomiting

4)constipation

5)sweating

6)apnea

2)IV Pethidine

50mg/ml

1)Demeral

hydrochloride

-for moderate to

pre op

medication and

adjunct to

anesthetic

1)constipation

2)dry mouth

3)anorexia

4)fatigue

5)sweating

3)IV Diazepam

15mg/ml

1)Valium

2)Diazemuls

-management for

anxiety ,

theraphy in

convulsive

disorder,

sedation, induce

relax

1)fatigue

2)drowsiness

3)nausea

4)vertigo

4)IV Tramal

100mg/2ml

1)Ultram -management of

moderate to

severe pain in

adult whop

require around

the clock pain

1)sweating

2)nausea

3)anorexia

4)headache

5)IV Midazolam

5mg/ml

1)Hypnovel -general

anesthetic before

administration of

others anesthetic

1)apnea

2)headache

3)drowsiness

4)depressions

6)IV Nalaxon

0.4mg

1)Narcan -antidote for

Morphines

-combine

Competitively

with opiate

receptors and

block or reverse

the action

narcotic

analgesics

1)hypotension/

hypertension

2)nausea & vomit

3)tremors

sweating due to

reversal of

narcotic

depression

7)Tab

Lorazepam

1mg

1)Ativan -reduces anxiety ,

relief muscle

spasm and

effective

sedation

1)confuse

2)drowsiness

3)ataxia

RESPONSIBILITIES IN ADMINISTERING DDA DRUGS

1) Bring along the cardex during administering DDA drugs

2) Apply 7R

3) Monitor client progress by looking to the any present of side effect of

medication

4) Notify doctor immediately if anything happen

RESPONSIBILITIES IN DDA STOCK

1) Recheck and recount again DDA drug and DDA book to detect where the

DDA drug miss counting occur e.g.

● wrong total of DDA drug

● discard the drug but not enter inside book

2) If still not found or tally :

● inform sister ward in charge

● make police report

3) Expired or almost expired drug

Expired

● call pharmacy and informed

● double check the expired date with 2 staff nurse

Almost expired

● put the drug infront of the other drug

● ask other team to use the in front first

4) Broken ampule

● discard the ampule inside sharp bin

● enter the broken ampule inside DDA by use the word “ discard “

5) Balance drugs in ampule

● should be discard

● if the same patient still can be use

6) Drugs almost or out of stock

● call pharmacy

● do ordering in DDA

PROCESS OF ORDERING DDA DRUGS

1) Check for total number of DDA and record in DDA book

2) Write in DDA ordering book 2 copies

3) Counter check with sister

4) Call pharmacy

5) Wait until pharmacy call back

6) Go to pharmacy together with DDA book and ordering book 2 coppies ( staff

nurse only should go to to take the medication )

DEFRIBRILLATOR

● Indication / usage

An emergency procedures that delivers direct current without

regard to the cardiac cycle

Early defibrillation to improves survival in clients experiencing VF

For dysrhythmia such as VT , VF or asystole

To treat ventricular fibrillation immediately

● Method of usage

Turn on the defibrillator . Set in defibrillator mode

Turn ECG recording on for a continuous printout of events during

the procedure

Set the energy level and change the paddles . initial defibrillation

is usually performed at 200 joules

Place conductive pads on the chest , or spread conductive paste

evenly on the paddles

Position the paddles holding them firmly on the chest wall

Ensure that no one is touching the client or the bed

Depress the button on each paddle simultaneously to discharge

the energy

Immediately resume CPR

Evaluate cardiac rhythm and for a pulse after approximately 2

minutes

● Method of defibrillation testing

Open defibrillator machine’s cover

Assess the defibrillator machine overall

Check all the connection wire on defibrillator machine

Open the paper placement site

Turn the knob to ON

Wait wave come out from the monitor

Turn the knob to the 100joules for testing

Press button charge

Quickly press the button at the paddles

Turn off the knob

Cover the machines back

Paste the result in yhe defibrillator testing book

Write your comment in the book , below the result slip and do not forget to put

on your signature

RESUSCITATION

TROLLY

EQUIPMENT OF TROLLEY RHESUS

●FIRST DRAWER

1) Laryngoscope

Function – to facilitate the ETT with

introducer and magill forcep , prevent

tongue backward

Care – check with laryngoscope blade

and handle , make sure light is

functioning

2) Airway

Function – to open airway , remove

secretion

Care – put in the mouth with slotted

down and turn 180◦

3) Silicon Face Mask

Function – prevent the O2 disappear

to atmosphere , facilitate O2 into the

airway or mouth

Care – ensure the mask clean and not

leaking

4)Introducer

Function – to shape the ETT

Care – clean with water

5)Yunkersucker

Function – suck secretion in the

mouth

Care – clean with water

6)Magill forceps

Function – to hold ETT , to facilitate

intubation

Care – open and close , insert it

through laryngoscope

7)Cuff inflate

Function – to inflate ETT ballon 8)K.Y jelly

Function – use as lubricator

Care – ensure rhesus trolley has K.Y

Jelly

9)Cotton Tape

Function – to hold ETT

Care – place at clean area

10)IV Canula

Function – for intravenous infusion

Care – place at clean area and make

sure have many type of size canula

11)Needle

Function – to take blood ,give injection

Care – always top up in all size

12) 3 Way Connection

Function – to connect tubing in one

line

Care – connect the connector at

canula

13) IV tubing

Function – for IV transfusion

Care – connect to the canula

14) Syringe

Function – for blood taking , injection

or transfusion

Care – prepare several size

13) Specimen Bottle

Function – for bood investigation

Care – ensure the expired date

14) Vecutainer / Butterfly

Function – taking blood

Care – ensure expired date

15) Resuscitation box

Function – give medication during

rhesus

Care – check box every shift

16) Anesthetic box

Function – for anesthesia

Care – check box every shift

19)ECG Electrode

Function – ECG monitoring

Care – count the electrode

20) Glove

Function – maintain sterility

Care – change if it is expired

21) Plaster

Function – plaster that needed

Care – ensure box of the plaster in the

trolley

22) Oxygen Jar

Function – to supply oxygen

Care – ensure the expired date

23) High Flow Mask

Function – to facilitate o2 to the lung

Care – ensure expired date

24) Nasogastric Tube

Function – to supply nutrition by

using a tube from naso or oral to the

stomach

Care – ensure expired date