deptt manual final
TRANSCRIPT
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 1/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
1
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
Date issued:
Approved By :
Chairman
Name :
Signature :
Reviewed By : Head of the department
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 2/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
2
Name :
Signature :
Created and issued By :
Head of the department
Name :
Signature :
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 3/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
3
Page contents:
A. Introduction
B. Department hierarchy
C. Scope
D. Job Description
E. Out patient consultation:
F. FLOW OF ACTIVITY
G. ANESTHESIA
H. PREOPERATIVE CHECKUP
I. Surgical technique
J. Immediate post operative monitoring
K. Records
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 4/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
4
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 5/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
5
A. INTRODUCTION:
Department of Pediatric surgery is a super specialty department that caters to the
patient population ranging from neonatal and pediatric age groups upto 14 years of
age. In the neonatal age group the diseases commonly found are congenital
malformations like tracheoesophageal fistula, anorectal malformation, congenital
diagphragmatic hernia and intestinal atresias which are incompatible with life and
require urgent intervention to save the life of newborn. Common diseases of pediatric
age group include acute abdomen like appendicitis, Urinary tract infection, inguinal
hernias, and developmental problems only. Treatment of these routine problems
requires a keen observation of the symtoms and prompt actions to limit the damage
caused due the disease. Availability of the world class diagnostic and therapeutic
equipments plays a crushial role in the proper management of the congenital
malformation lowering the overall death rates and improving the survival of the
patients. new dimension at the department through the availability of the latest world-
class equipment, which gives a better outcome for overall patient healthcare
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 6/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
6
management.
The department offers a wide range of pediatric surgery services while maintaining
high standards of care. The aim is to make the best pediatric surgery care accessible
and affordable to people. Service provided includes:
y All pediatric surgery Operations
y Emergency pediatric surgery operations
y Counseling of the expecting parents with congenital malformed fetus
y Counseling of the parents with previous baby with congenital malformations
y Working in close collaboration with gynecologists for prompt surgery of babies
born with congenital malformations in the institute
y Working in close collaboration with pediatricians for prompt surgical
interventions of the babies admitted in the neonatal intensive care units and
pediatric intensive care units for intravenous line maintenance for total
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 7/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
7
parenteral nutrition, exchange transfusions and various other surgical
conditions
y All neonatal and pediatric Cancers amenable to surgery and care thereafter.
The pediatric surgery Operation Theatre is equipped with the latest operating
equipments. Also the advances in anesthetic instruments are available for safe
operative procedure and smooth post operative course.
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 8/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
8
B. DEPARTMENT HIERARCHY:
Op assistant
C. SCOPE OF DEPARTMENT:
Chairman
President
Department of Pediatric
2 Pediatric Surgeons
1 medical officer
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 9/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
9
1. Congenital malformations like Tracheoesophageal fistula, anorectal
malformation
2. Pediatric urological surgeries i.e. hypospadias, VUR,
3. Pediatric neurosurgical surgeries i.e. meningomyelocele, hydrocephalus
4. Pediatric hepatobiliary surgeries i.e. choledochal cyst, EHBA
5. Pediatric plastic surgeries i.e. cleft lip and palate, syndectyly, skin grafting
6. Pediatric oncosurgeries i.e. wilms¨ tumor, sacrococcygeal teratoma
7. Pediatric gastrointestinal surgeries i.e. atresias, hirschsprung¨s disease.
8. Antenatal check up and counseling for congenital malformations
9. Post natal investigations and prompt surgeries for congenital malformations
10. Parental counseling with babies of congenital malformations
D. JOB DESCRIPTION:
1. Pediatric surgery doctors:
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 10/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
10
a. For outpatient procedure
Taking history (detail history regarding past treatment if any, family history,
complaints, symptoms, of present problems)
Examining the patient and carrying out basic evaluation of system concerned
Carrying out special test procedures like per rectal examinations, proctoscopy
Explaining the test results, presenting conditions and further treatment needed
for the patient.
Counseling the patient and attenders if any surgical procedure needed
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 11/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
11
Giving appropriate prescription for problems and explaining the same to the
patient.
Giving appointments for further services.
b. .For In-patient procedure:
Receiving IP list from outpatient.
Carrying out IP rounds
Examine the patients and providing appropriate treatment
In case of post operative (surgery patient) dressing will be done periodically
Discharge advice will be given on time
Discharge summaries will be signed and issued when they get discharge
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 12/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
12
Counsel and educate the patient regarding Do¨s and Don¨t¨s after surgery
Giving appointment for next review (date & time)
c. In- patient procedure:
Carry out IP rounds & counseling the patient and enter in IP register in brief.
Meeting doctors and getting referrals.
Assessment and diagnosing
Counseling the patient.
Discussing the results/ reports with the doctors who referred the case.
Carrying out IP rounds and dressing the wounds.
Removal of chest tubes and various drains during rounds
Appropriately timing the surgeries for previously admitted patients kept on
conservative treatments.
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 13/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
13
Working in associations of anesthetist to get special test done required for safe
anesthesia practice.
Discharging the patients once satisfied with the results of the surgeries
Detailing the patients and attendants about the care to be taken at home.
Sending local purchase requisitions for material not available in the hospital
Timely informing the authorities about the patients not depositing bills on time
d. OP assistant:
Getting the OP key and opening the department on time.
Cleaning and hygiene to be ensured.
Changing the sheets/ mattress/pillows cover
Getting the instruments from CSSD (after autoclave)
Getting the OP register from cash counter
Entering the patients (new/review) OP card in respective doctors OP register.
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 14/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
14
Making the patient set comfortably and explaining the order for doctors
consultation
Issue hospital pamphlets to the patient.
Calling the patients one by one and helping the patient to see the doctors
Assist the doctors when they examine the patient.
Assist when they carry out any special test/ procedure
Examine the patient regarding the procedure to be done.
Payment terms
Write and give requisition form if the doctors ask for further test.
Guide the patient to other department if any further referral made.
Giving payment slip to the patient and check if payment is made.
Note down the appointment dates further review.
Issue the OP card to patients after explaining the prescription to be taken.
e. OUT PATIENT CONSULTATION:
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 15/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
15
Specialist consultation is available between 10 a.m. and 1 p.m., and 4 p.m. and 6
p.m. On all days except Sunday emergency care is available round the clock. Utmost
care is taken to reduce patient waiting times. The department possesses latest
modern diagnostic instruments to assess the patient problems accurately without
much discomfort to the patient. Kindly refer to hospital registration policy.
(KGH/OPD/01)
F. FLOW OF ACTIVITY:
When the patient enters the OP for consultation, they will be made to sit
comfortably and seen one after the other
OP registration done and entered in the respective doctors OP register.
Doctor examine the patients and do basic evaluations and advice the patient if
any special tests needed.
Payments terms for special tests will be explained to the patient.
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 16/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
16
If needed the patient will be referred for further evaluation like x-ray/blood
test/CT scan/ MRI.
If any associated problem present or if the presenting complaint or secondary
to other problems, then appropriate referral made.
Patient will be given detailed for reports along with the prescription slip and
same will be explained to the patient.
Counseling will be given for next review
Patient phone number and contact number address will be taken for if any
further communication required.
G. ANAESTHESIA:
Premeditation was a standard regime given below:
y Tablet Diazepam 5 mg at bedtime on the preoperative night.
y Injection Atropine (10 g/kg to a max of 0.6 mg I/M) 45 min before surgery.
y Injection Pethidine (1 mg/kg to a max of 50 mg I/M) 45 min before surgery.
y Injection Phenergan 25 mg I/M 45 min before surgery.
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 17/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
17
y A combination of standard regional, infiltrative and topical
y Local anaesthesia is used.
H. PREOPERATIVE CHECKUP:
Routine preanaesthetic (PA) check up was done, with demand of special tests if
further confirmation of the condition and suitability for operation is to be assessed for
operations by subjecting the patients to ECG, Blood Sugar (Fasting and PP), X-ray
chest.
I. SURGICAL TECHNIQUE: Standard surgical techniques described in the standard
pediatric surgical textbooks are used.
J. IMMEDIATE POST OPERATIVE MONITORING:
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 18/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
18
Post operatively patients are detained and monitored in the pediatric intensive care
unit for minimum 4 hours. Patients are shifted to non intensive areas only when fully
satisfied about the condition of the patients regarding the safety in post operative
period.
Discharge criteria: The criteria followed for discharge from the detention room are.
y Correct orientation as to time, place and relevant people.
y Stable vitals signs for at least one hour.
y Adequate pain control with oral analgesics.
y Oral diet/fluids commenced without vomiting.
y Minimal bleeding or wound drainage.
y Follow up protocol
y Lesion and pack checked 48 hours post operatively.
y Pack removed after 48 hours where applicable.
y Sutures and dressing removed on fifth day post operatively.
y Rest for 72 hours given post operatively.
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 19/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
19
y Review fortnightly and thereafter if required.
All the relevant data is maintained in a computer database. Informed consent is
obtained from all patients. Prophylactic antibiotics are used in all cases in the form of
oral first generation cephalosporin for 5 days. Prophylactic analgesia in the form of
oral NSAIDS is used in all cases for 5 days post operatively. Patient satisfaction is
asked about at the first fortnightly review in the form of questionnaire. The points
covered were:
(i) Intra-operative and post-operative pain experienced
(ii) Suitability of the surgery as per the operation performed
(iii) Post-operative experience in the clinic and at home
We suggest that certain selection and exclusion criteria be maintained for patient
selection for day care surgery. These are listed briefly below as guidelines.
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 20/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
20
a. Simplicity of the procedure: The operative procedure should be of relatively
short duration.
b. Incidence of postoperative complications: The potential incidence of
postoperative complications should be low and recovery period minimal.
c. General good health of the patient: The patient should be in good health or
have a systemic disease, which is under good control.
d. Patient reliability: Patient should understand and be willing to follow post-
operative instructions.
e. Home situation of the patient: Patients should have some one to take care of
them at home postoperatively.
Patients who should be excluded include those with serious infections, patients
staying alone and those requiring emergency surgery, except those suffering from
uncomplicated fractures, or from other minor trauma routinely treated on an
ambulatory basis.
K. RECORDS MAINTAINED:
8/8/2019 Deptt Manual Final
http://slidepdf.com/reader/full/deptt-manual-final 21/21
QUALITY MANUAL
MANUAL OF OPERATION
FOR
PEDIATRIC SURGERY SERVICE
DATE OF
ISSUE:
17.7.09
OP and IP register of pediatric surgery doctors.
Daily statistics and monthly statistics notes register.
Indent list and issued file.
Referral list and issued file.
Consent file.
CSSD register
Stock register
Pediatric surgery Performa invoice file