DEPARTMENTAL REPORT ON IN-PATIENT

DEPARTMENT
 CONTENT
Introduction

Organisational Structure

Physical details of Department

Services Of Department

Recommendation

Conclusion

INTRODUCTION
In a hospital-based health care delivery system, inpatient services are the most important and
largest single part of the hospital, forming approximately 35-50% of the whole hospital complex.
.
Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in
modern medicine and the emergence of comprehensive out-patient clinics ensure that patients are
only admitted to a hospital when they are extremely ill or have severe physical trauma. Patients
are assigned an award or a room based on the type of care they need and the availability of the
bed.

ORGANOGRAM OF THE DEPARTMENT

In the department the staff patient ratio is 1:10 while the standard ratio is 1:6.

The duty of staff is divided into three shifts

Morning- 7am-2pm
Evening- 2pm-9pm
Night-9pm-7am

PHYSICAL DETAILS OF THE IPD

IPD Block Stack plan -

Seventh IPD (Private & Deluxe wards)
floor 

Sixth floor IPD (Semi private ward)

Fifth floor IPD (Semi private ward)

Fourth floor IPD (general Ward)

Third floor IPD (general ward)

Second floor  IPD (general Ward+ Semi private ward)

First floor  IPD (general ward+ private ward) + MIBG (meta-iodo-benzyl-guanidine)

Ground  DMG, Cafeteria, Cash-Counter, 

The dimension of the general ward room is 8.7m x 8.3m and the area allotted per bed is 2.7m x
2.5m
The dimension of semi-private room is 3.8m x 8.6m and the area allotted per bed is 3m x 2.4m
The private room is 8.5m x 4.1m.

The bedside amenities in the IPD general ward are-

● Bed head panel which consists of 1UPSand 3 normal sockets, telephone socket, O2 Panel,
a vacuum panel, patient nurse call system dashboard.
● Cardiac table
● Drawer
● Low leg stool
● Chair
 ● I.V stand
● Curtain
For semi-private ward the amenities which get added is
● Attendant bed
● Fridge
● T.V
While in the case of private ward amenities get added is
● Head panel with all UPS port
● Pantry area
● Sofa and table for attendant
● Separate washrooms
In the deluxe suite the following amenities get added

● Sofa and table

● T.V for visitor
● Cardiac table
● Fridge

LAYOUT OF AN IPD WARD WITH GENERAL AND SEMI PRIVATE ROOM

Semi Semi
pvt
room
1 2 3 4 5 pvt
room
MEDICATION

EQUIPMENT
DRESSING

UTILITY
SOILED
STORE

STAFF NURSE Waiting

ROOM

Handic

DOCTORS
ROOM

ROOM

NURSE
ROOM
PANTR
STAFF

Public
toilet
TOILE

LOUNGE STATION
ROOM STATION
room toilet
ap
T

ELECTRICAL

F A Sta
H STAIRS H
Semi pvt
room 7 6 PUBLIC
LIFT
Hub
room ff
Service
lift
ROOM

C U lift

LAYOUT OF AN IPD WARD WITH ONLY SEMI PRIVATE ROOM

 1
12 11 10 9 8 7
6 5 4 3 2

MEDICATION

EQUIPMENT
PANTRY

DRESSING

UTILITY
SOILED
STORE
STAFF NURSE Waiting

ROOM

Handic
DOCTORS

ROOM

ROOM
NURSE

ROOM
STAFF

Public
toilet
TOILE

LOUNGE STATION

toilet
ROOM STATION
room

ap
T

ELECTRICAL
F Sta
13
H STAIRS
AH
U 17 16 15 14 PUBLI
C LIFT
Hub
room ff
Service
lift

ROOM
C a lift

LAYOUT OF AN IPD WARD WITH ONLY PRIVATE ROOM AND DELUXE SUITE

8 7 6 5 4 3 2 1 DELUXE 2 DELUXE 1
MEDICATION

EQUIPMENT
PANTRY

DRESSING

Handicap
UTILITY
SOILED
STORE

STAFF Waiting
ROOM

NURSE
ROOM

ROOM

DOCTORS NURSE
ROOM
STAFF

Public
toilet
TOILE

LOUNG STATIO
toilet

ROOM STATIO
E N N room
T

ELECTRICAL

F Sta
H STAIRS
AH
U 15 14 13 12 11
PUBLI
C LIFT
Hub
room ff
Service
lift
ROOM

C lift
FLOORWISE DISTRIBUTION OF DMG and Services

FIRST FLOOR
Classification of Discipline
ward

HDU currently Medical oncology

taking the general
category patients-9

MIBG ward-2 Nuclear medicine

Private ward-7 Surgical oncology

MIBG WARD- A procedure used to find neuroendocrine tumours, such as neuroblastomas and
pheochromocytomas. A small amount of a substance called radioactive MIBG is injected into a
vein and travels through the bloodstream. Neuroendocrine tumour cells take up the radioactive
MIBG and are detected by a scanner. The MIBG scan is named after the chemical ‘iodine-131-
metaiodobenzylguanidine’ or MIBG for short.
In this section of the IPD no nursing staff is allowed to enter due to risk of radiation.

SECOND FLOOR

Classification of Discipline
ward (with total bed
no.)

General -21 Medical oncology

General -14 Radiation oncology

Semi-pvt - 6 Radiation oncology

THIRD FLOOR
Classification of DMG
ward (with total bed
no.)

General -24 Head and neck

/PED/Neuro

General -15 Urology

/gynaecology/neck

Semi-pvt -4 Head and neck

/PED/Neuro

Semi-pvt -2 BST/paediatric

FOURTH FLOOR
Classification of DMG
ward (with total bed
no.)

General -41 GI/thoracic/

BST/PED/Breast

FIFTH FLOOR
Classification of DMG from which the
ward (with total bed patient are admitted
no.)

Semi -pvt -34 Head & neck/

For surgical gynaecology
oncology /neuro /Urology
/GI/thoracic/BST/Bre
ast
SIXTH FLOOR
Classification of DMG from which the
ward (with total bed patient are admitted
no.)

Semi-pvt – 34 Head & neck/

For medical gynaecology
oncology /neuro /Urology
/GI/thoracic/BST/Bre
ast

SEVENTH FLOOR
Classification of DMG from which the
ward (with total bed patient are admitted
no.)

Deluxe suite-2 Head & neck/

gynaecology
/neuro /Urology
/GI/thoracic/BST/Bre
ast

Private room Head & neck/

For surgical gynaecology
oncology /neuro /Urology
/GI/thoracic/BST/Bre
ast

RELATION WITH OTHER DEPARTMENT

● REGISTRATION OFFICE (PRC BUILDING)
The main role of PRC building is to ensure the admission and discharge process of
patients smoothly.

● ICU –
● OT- when a surgery is planned for a patient the nursing staff ensures that all the protocols
are followed without any mistake. A surgical checklist is there for the patient before the
patient is transferred to the preparation room. After the checklist is confirmed, the patient
is transferred.

● LAB- as the patient is admitted they need timely check-up for their progress in their
health so that the patient urine/blood/stool sample is transferred to the lab. The billing for
the same is done through the smart card which is there for every patient who is admitted
in hospital. The attendant doesn’t have to go anywhere for bill payment.

● CSSD- The CSSD is one of the important departments which supplies all sterilised
equipment and consumables to the IPD. following are the name of consumables and
equipment which is supplied by CSSD-
Dressing set
Clipping removal
Tracheostomy set
ICV set
Bladder wash tray
Injection tray
Sucher tray

If the department requires any new equipment or consumables for that the IPD has to
indent the list of items through material management system HIS. A slip is generated for
the same that slip is sent to the Assistant nursing administration from there the slip is
forwarded to in charge of CSSD. A confirmation will be received from CSSD and the
indent item will be supplied to the IPD department.

● FOOD AND NUTRITION- This department is one of the important departments which
is responsible for the supply of food in communication with consultants and dieticians.
For every patient there is a different requirement so according to each patient the food is
supplied to the department.

SOP GUIDELINES

BIO-MEDICAL DEPARTMENT- this department is one of the supportive departments

which provide assistance and maintenance of the machines/devices which are used in patient
treatment.
 ● Some of the following items are
Monitor
Pulse Oximeter
BP Apparatus
Infusion Pump
Syringe Pump
ECG Machine
Defibrillator
Glucometer
Thermometer
Stethoscope
Suction Machine
O2 Cylinder
Adapter Cable
ECG Leads
Air Mattress
Weight Machine
Trimmer
AED Machine
Suction Apparatus
Biomedical waste management department
In IPD, two assigned workers from the housekeeping department have responsibility to
collect the biomedical waste. A checklist is maintained by the member collecting the
waste.

ADMISSION PROCESS
This process starts from the PRC building as and when the patient is advised by the doctor. The
PRC office informs the IPD via HIS and a receipt is generated in the PRC building which is
carried by the patient to the floor /ward mentioned in the receipt.
The admission slip has details of Floor, room no. bed no. in a decided coding.
The coding is indicated by combination of floor, ward and bed no.
The category of patient will also be there on the admission slip.

DISCHARGE PROCESS
As and when the patient is declared discharged by the consultant, the nursing staff sends DI i.e.,
discharge information to the PRC office fifth no. counter. Then the person on PRC checks about
the dues and balance if any. Then the person is declared discharged and a confirmation slip is
handed to the patient attendant which is submitted in the nursing station where the patient was
admitted. A discharge card is given at the end of the procedure.

When a patient is discharged department keeps the following document

● Order sheet
● Nurses record
● TPR sheet
● Nursing notes
● Checklist for OT

If the patient leaves against medical advice (LAMA) the file is kept by the department itself.
At the final a discharge checklist is filled which includes the following checks
● Is Discharge intimation done?
● Has clearance given by CRO/PRC?
● Is all bills status become clear?
● Are the medical records (order sheet, Doctors note, Nurses notes) were in custody of
Nursing?
● Is there Possession of any hospital asset by the patient or his/her relatives?
● Have Counselling for follow-up visits and medication?
● Did the attendant pass get recovered?
● Is discharge summary issued?
● Is cause of death certificate issued (in case of death)
● Is the patient attender instructed/guided properly about the procedure of getting a Death
Certificate?

PROTOCOL RELATED TO DEATH OF PATIENT

The nursing staff gives the DI (DISCHARGE INTIMATION) to the PRC section with the status
showing the patient is dead. The PRC checks the no dues status of the patient and gives a
confirmation slip to the attendant which then is submitted to the ward where the patient was
admitted earlier. Then the nursing staff maintains Form-4 which consists of details of the patient.
This form 4 consists of 3 pages which are of pink, yellow and white colour. Out of 3 copies
yellow one is handed over to the attendant, white one is forwarded to the MS office and pink one
is kept in the book itself for record. Another form which is Form-2 is also maintained which is
filled by the patient attendant, later on forwarded to MS office. Once this process is done a slip is
maintained which has 3 copies. That slip is used for security identification of the body. The slip
is pasted on the head and toe of the body while one is given to the security man. The security
man cross checks the details so that no scope for body interchange remains. Then finally the
body is handed to the attendant.
In case it is not possible to take away the body on the day of death. The attendants are required to
fill a mortuary request form, in which if the request is approved from the mortuary the body can
be stored in the mortuary.

Documentation Process
● The nursing staff maintains a register indicating the following details. This register is
used as a formal communication channel between the ward and MS office. The register
contains the following details.

NAME OF THE PT.

CASENO
AGE
SEX
CATEGORY
DMG
DIAGNOSIS
CAUSE OF DEATH
DATE OF ADMISSION
DATE OF DEATH
TIME OF DEATH
FORM NO.2
CLEARANCE NO.
SIGNATURE OF TAKING BODY BY ATTENDANT
WARD WITH CC NO.
Ms OFFICE SIGN WITH CC NO.
Another register is maintained for the record of IPD where the death happened ; this
register contains the details.

● When a patient is discharged the following details are maintained in the register.
PATIENT NAME
CASE NO.
DMG
DIAGNOSIS
CONTACT NO
CLEARANCE
REMARK
SIGN
After the 15 days of death the patient attendant gets the legal death certificate from MS office.

BOOKS AND FORMS MAINTAINED IN IPD

Books / register maintained List of forms
Sending book ICU admission
IV Fluid book Frozen section
General inventory Fine needle aspiration cytology
Bio medical inventory X ray forms
Narcotics register USG
Leave demand book CT
Communication book MRI
OT Register CHEMOTHERAPY CONSENT
CSSD Book Cytopathology
Billing book Surgical pathology
O2 register Medical oncology
Investigation book HIV consent form
Admission discharge book Nuclear medicine
Laundry book Bio imaging
Microbiology book Microbiology
Chemo billing book Informed consent or Refusal for blood
transfusion
MTS attendance Narcotics checklist
Blood bank book Oxygen cylinder checklist
Procedure entry book Bio-chemistry sample manual form
PICC flushing book Feedback form
Assignment book Discharged checklist
Patient shifting register Circular file
Crash cart register Consent for surgery
Leave book Discharge summary
Capital communication book
Condemned item book
Epidural register
Consultant round register
Admission discharge MIBG
Billing register
Ot shifting register
Sponging book
Death record book
Cytology book

ROLE OF NURSING UNIT

To provide the highest possible quality of nursing care for patients
To provide the necessary equipment, essential drugs and store all the required medicine for
patient care in an organised manner in the ward.
To provide facilities to meet the needs of the visitors and attendants.
To maintain the records and maintain the details related to patients.

Nursing Duty Handover System

I observed this process during changing of duty shift at 1:45PM
In this process the nursing staff whose shift is getting over brief about the ongoing situation
about each patient.
In this the details of progress from the following mentioned book is explained.
● Sending referral book
● Inventory book
● I.V fluid book
● Admission and discharge book

RECOMMENDATION
During the study I observed the following points which can be considered to adopt which will
bring enhancement to the IPD.
1. I found there were signs which were labelled in the wrong place. In the department this
can create mismanagement or can increase the time of delivering a service.
2. The colours of the dustbin were not in the standard code. This holds the potential to
create a biomedical hazard and the SOP from the government directs that this should be
followed strictly. People can accidentally throw the waste in the wrong bin.
3. I see an urgent need of resuming the patient nurse call system. This is to be suggested
because at a time there are only 4 nursing staff and 4 housekeeping staff . Which makes
the ratio of 1:10 against the standard of 1:6. In some conditions every second can decide
the life and death of a patient. This patient nurse call system can help to minimise that
gap.
 4. There can be a provision of patient attendant orientation about self management. This can
help the patient attendant to educate themself regarding the proper usage of services.
Which has the potential of reducing infection risk, biomedical hazards, and misuse of
resources.

CONCLUSION

After spending four days in IPD I got to experience and learn many new things. With all the
strong and weak situations the IPD is delivering its services very smoothly and strongly 24x7.
The staff over there are very much passionate and dedicated about the roles and responsibilities
they are assigned. The liaison with other supportive departments are running smoothly without
any fail. The nursing staff is punctual and housekeeping as well about their duty. I observed a
friendly environment among the staff working in the IPD.