Department of MedicineHospital Tengku Ampuan RahimahKlang

22 Aug 2009

Outline

Medical department Ward Work Clinic (Physician’s Clinic) On call duties Teaching / CMEs and Mentor-mentee system Leave Assessment Ethics

Wards8A, 8B: Male Medical Wards7A, 7B: Female Medical Wards8C: First Class (mixed)Periphery Wards (lodgers: 7C, 4B)5C : ICU4C : CCU, High dependencyG2 : Male Dengue, IsolationG3 : Female Dengue, Nephro, HematoHDU (Haemodialysis Unit)

Wards

232 in-patients beds. (Total hospital beds: 893)

400-500 in-patients in any one day Bed occupancy rate of 150-160%!High turnover 20-30 admissions and 20-

30 discharges per ward day.150 out-patients in any clinic day

Specialties

General MedicineNephrologyHaematologyGastroenterology++Visiting subspecialty

Neurology (visits once a month)Rheumatology (visits once a month)

Staff

Doctors: Consultants: 5 (Total Doctors: ~700) Specialists: 11 Medical Officers: 24 + 2 House Officers: 41 Nurses: Sisters: 13 (Total Nurses: 821) Staff Nurses: 204 Jururawat Masyarakat: 5 Assistant Nurses: 4 Medical Assistants: 19 (Total MA: 142)

We will always have a bed under the bed for you!

Wad 8A - B0R 150%

Wad 8B – BOR 160%

4246 50

5462 63

73

0

10

20

30

40

50

60

70

80

2002 2003 2004 2005 2006 2007 2008

Average Daily Medical Admissions (More than 500 admissions in a week!)

15500

16712

18446

19711

23066

26,634

22477

0 5000 10000 15000 20000 25000 30000

2002

2003

2004

2005

2006

2007

2008

YEARLY MEDICAL ADMISSIONS

Ward Work

Ward Specialist, MO, Sister, SRNs, Attendance Blood taking: complete by 8.00am (Hence, coming to

work by 7.00am) Ward rounds:

Know your patients Everyday

After rounds: Additional bloods/scans requests Trace results New cases Discharges

Ward Work – Case Clerking

Screen immediately, inform MO/ Specialist of ill cases

Full clerking within 1 hourDate and TimeSigned and Rubber StampedWriting must be legibleRe-clerk patients if not clerked by same

HO on admission and transfer in cases

Ward Work - Discharges

After consultation with MO/SpecialistDone on the same dayPrescription slipsAppointment for F/URelevant investigation forms

Brief summarySignature

Referrals/memosMCs

Ward Work - Prescription Slips

Patient’s name, I/C and diagnosis Doctor’s signature & NAME Controlled items:

Specialist’s signature Duration:

Maximum: 6/12 TB medication only for a week Monthly supply of medications

No abbreviations

Ward Work - Prescription Slips (cont.)

Commonly-prescribed items:5 -7 days

Do not prescribe NSAIDs:For CRF patients With concomitant Antacids

Self-purchase:Separate slip

Ward Work - Discharge Summary

Is a case summary Includes:

Patient’s particulars Presenting complaint(s) Physical findings Relevant investigations Progress in ward Final diagnosis Medications Plan on TCA Investigation results to be traced on TCA

Within 72 hours, not to be taken out from the ward!Bad summary = problems on TCA!

Ward Work - Investigation results

Reviewed on the same day (before 4.30pm), including CXR and urgent CT

Take action on abnormal results

If in doubt, ASK! (MO or Specialists)

Passover to HO on-call

Ward Work

NO VERBAL PHONE ORDERS

INFORM WHEREABOUTS AT ALL TIME

Ward Work - Procedures

Tagging log (complete within tagging period)

Feedback assessment (every 2/52)

Case summaries (before change in ward duty)

Log book (Observe, assist, carry out)

Ward Work - Death Reviews

At the time patient is certified dead (consult MO/specialist)

Summary within 3 days

Brief, concise

Case notes not to be brought out of wards!

TOTAL OUT PATIENT ATTENDANCE 2004-2008

2936

18173

21109

2304

2082823132

2757

2305725814

2720

2243025150

3044

22793

25837

0

5000

10000

15000

20000

25000

30000

2004 2005 2006 2007 2008

Kes Baru

Kes Ulangan

Jumlah

Clinic

Roster to take blood investigation and assist MO in the clinic

8am to 1pm and Mon 2-5pm

Blood investigations : Mon-Fri Assist in clinic: Mon-Thu

Be punctual

On call duties

New HO tag till 11pm for 7-10 daysFill up tagging log8 HOs on-call per day:

8A (2)8B (2)7A (1)7B (1) 7C(1)G2 (1) G3 (1)

HO Teaching/ CME

Hospital CME – alt Wed 3.30-4.30pmDepartment HO Tutorials – Thurs 2.30-

3.30pmDepartment Mortality Meeting – Fri

11.30am- 12.30pm

ATTENDANCE 80%

Mentor-mentee system

Not all HOs attached to the department will be given a mentor (Specialist and senior MO)

Only 2 groups of HOsFirst posting in Medical DepartmentHOs who are extended

Annual Leave

8 days leave in 4 monthsPlanned leaveEmergency leave/Sick leaveAssigned leave

Specialist in charge: Dr. Ameen/ AngIf more than 8 days of leave taken during

the posting, HO will be extended!

Assessment

After 3 months By 2 consultants Assessment of basic medical knowledge,

emergency medicine, performance in ward, CME attendance and attitude

Verbal warning will be given if below satisfactory

Written warning and extension if still below par

Department of Medicine

More casesMore exposureMore learningMore experience

Better doctors

Super HOs in the Medical Dept…….

Roller Skate

Ethics

Definition: Set of Principles or MoralHonesty

DedicationEmpathyAltruism

ConscientiousEtc etc etc…..