On the basis of regulatory documents and approved sanitary and epidemiological requirements, the organization of work of the reception department is carried out. The guidelines developed by Roszdravnadzor contain practical suggestions on the procedure for internal quality and safety control of a medical institution, including the emergency room, which are used in all medical institutions. The admission department is most often located in a building where there are basic medical resources. For example, departments such as resuscitation, surgery. The quality of assistance to an individual will depend on the precise organization of the work of the hospital's admission department. In large organizations, there may be two or more located in different buildings. In addition, they can be divided for patients: emergency and planned.
General Provisions
There must be access to the reception department for access of ambulance vehicles. The emergency room interacts with all departments of the hospital. The main principle of his work is responsibility for the health and life of citizens. The head doctor sets its structure and schedule. The responsibilities of the department staff are described in the job descriptions. The head of the reception department is the head. The medical staff of the admission department must have the skills to conduct basic cardiopulmonary resuscitation, be aware of the principles of emergency medical care, and have a neat appearance, a medical gown or medical uniform, shoes and a name tag.
The functioning of the reception is carried out around the clock without interruptions throughout the year. The deputy chief doctor oversees the organization of the work of the hospital admissions department. The management of this unit on weekends and holidays, as well as in the evening and at night, is assigned to the doctor on duty.
Reception Room Functions
The list of functions is quite wide and includes:
- Reception, inspection, registration and assessment of the status of the applicant.
- Providing emergency and emergency care.
- Maintaining and filling out various documentation.
- Accounting for patients who received outpatient care, including cases of denial of hospitalization, as well as hospitalized patients.
- Conducting sanitary and hygienic procedures for newly admitted patients.
- Distribution of patients by disease profiles and severity of condition.
- The work of the admission department is also aimed at carrying out activities that help to recognize and prevent the further spread of infection.
- Isolation of infants with infectious pathologies for subsequent transfer to special hospitals, sanitization.
- Determining the method of transporting patients to the necessary departments and its implementation.
- Reception and temporary storage of patients' belongings from the moment of their admission to the ward until the transfer to the staff of the ward to which the patient is hospitalized, or the issue to their representative.
- Willingness to work in emergency situations or with especially dangerous infections and the possession of appropriate skills.
Requirements
The device and organization of work of the reception department depends on the profile and on the level of medical care (level 1, 2, 3). The following rooms should be provided in the emergency room:
- The registry is a place where patients are admitted to hospitalization and primary medical documents are issued.
- The waiting room, which houses the patients and the people who accompany them. This room is equipped with chairs, a table. Information stands contain information about the operating hours of hospital departments, which products are allowed to patients, etc.
- An insulated vestibule or corridor for moving around cabinets.
- Examination rooms, in which examination and some types of examinations are carried out (ECG, temperature measurement, etc.) and a preliminary diagnosis is made.
- A room with a bath or shower, the so-called sanitary inspection room with a separate changing room.
- Diagnostic room, which is intended for patients with an unknown diagnosis.
- Antishock (operational).
- The insulator, those who are suspected of infectious pathology are placed in it.
- Cabinets in which they perform various manipulations: injections, dressings.
- X-ray room.
- The office of the doctor on duty, senior nurse, head of the department.
- The laboratory where the biomaterial is taken and its research is carried out.
- Room for staff.
- Sanitary (toilet) room.
- Wardrobe room where the outer clothing of patients admitted to hospital treatment is stored.
In large hospital complexes in this department, other rooms can also be located. An ultrasound, endoscopic, X-ray room and laboratory should be placed next to the emergency room. In the emergency room should be backup sources of food, drinking water, oxygen, hot water, communication channels. It is also necessary to ensure the possibility of using mobile medical equipment with autonomous power. The reception department, as a rule, is not higher than the second floor.
Responsibilities of a Nurse
Organization of the work of the inpatient department of the hospital is impossible without the average medical staff. Consider the functional (instruction) of a nurse, which consists of the following measures:
- familiarization with the direction of the patient for hospitalization;
- escorting the patient to the doctor’s office;
- listening to the complaints of the individual who independently turned to the emergency room and referring him to the doctor on duty;
- filling out primary medical documentation;
- performing various manipulations prescribed by a doctor;
- assistance during the inspection;
- monitoring the status of patients who are in the emergency room;
- compliance with the doctor’s instructions related to the implementation or preparation of diagnostic and other manipulations;
- in a timely manner, the transmission of a telephone message to the police department, emergency notice to Rospotrebnadzor, etc .;
- control, and in some cases direct participation in the sanitization of patients;
- taking biomaterial for research;
- receipt and storage of drugs;
- control over the work of nurses;
- record keeping;
- compliance with sanitary norms and rules in the department;
- preparation of necessary reports;
- drawing up an inventory of the patient’s clothes, transferring them for disinfection and further, for storage;
- examination of the patient and his belongings for the presence of head lice; if necessary, processing;
- regular training in courses, attendance at conferences and classes that are organized specifically for paramedical personnel.
Reception unit
In hospital-type healthcare facilities, patient care begins at the in-patient department. Organization of work by order of the head of the institution, as well as control over the activities of this department is assigned to one of his deputies. This is one of the significant divisions, which is intended for:
- admission of patients;
- initial inspection;
- measuring anthropometric data;
- if necessary, carrying out sanitary and hygienic treatment of patients entering the hospital;
- medical (emergency) care.
The life of patients depends on the proper organization of work of the reception department of a medical organization, as well as on the coordinated and qualified work of medical personnel in severe (urgent) conditions. Each patient initially enters this department, so it is important that he builds trust in doctors and that he feels care and good attitude.
Work in this unit is carried out in the following order:
- registration (registration) of patients;
- examination by a doctor of the emergency room; if necessary, experts are invited;
- sanitary and hygienic processing.
It should be noted that the offices of the department are located in the same sequence.
Organization of work: reception and registration of patients
Ways of patients entering the emergency room:
- specialized vehicles (ambulance);
- in the direction of the attending doctor of the clinic to which the individual is attached for medical care;
- in the direction of the draft board;
- independent circulation, it is called "gravity flow";
- transfer from other health facilities around the clock.
Those in need of emergency help are immediately placed in the intensive care unit or intensive care unit, bypassing the emergency room.
There are three types of hospitalization of patients, which depend on the method of its delivery to the hospital:
- emergency;
- planned;
- By gravity.
The organization of work of the admission department upon admission of a patient in serious condition is as follows. First of all, he is provided with the necessary assistance by a nurse and urgently invites a doctor of the emergency room, who decides on the need for inpatient treatment. Next is the nurse:
- prepares its registration;
- sends to the examination room for examination and various manipulations (medical and diagnostic).
In the case when the delivered patient is unconscious and there are no documents with him, the nurse, after examination by the doctor, provides emergency medical care and only then fills out the primary documentation. Before identifying a person, the patient is considered “unknown”, which is reflected in all documents. Then she informs the police by telephone of the arrival of an unknown patient.
If a patient was brought to the emergency room for a disease that arose suddenly, or the individual died in the ward, the nurse reports these cases to relatives by telephone. In addition, a mark is made in a special journal.
Infectious hospital emergency room
A feature of the organization of the work of the reception department of the infectious diseases hospital is the flow-through mode. Patients from the moment of their admission and up to discharge should not be in contact with other patients. All patients admitted to the hospital are admitted to special wards, called boxes. These rooms have a separate entrance and exit, the reception hall and the box are separated by glazed double doors. All doors are locked. Such rooms are available in any infectious diseases hospital and each of them is intended for certain pathologies: meningitis, scarlet fever, etc. The doctor examines the patient in this room, and after the diagnosis is established, he is transferred to the appropriate department. If a mixed infection is detected, then the patient is determined in a separate room.
Functions of the staff of the admission department of the infectious diseases hospital
Primary medical documentation is filed for each applicant. The nurse will fill out a special form that lists the things that the patient left in the facility. In addition, she sends a request to the kitchen, which indicates which diet is recommended by the doctor of the admission department. Organization of work is as follows:
- sanitization, which was called primary;
- disinfection and disinfection of things of the patient;
- the discharges are subject to disinfection;
- the question of how to deliver the individual to the department (on foot or using a stretcher, gurney) is being decided;
- after examination, the doctor prescribes emergency manipulations that must be performed: sowing feces on the intestinal group, taking biomaterial on diphtheria bacillus, etc.
A nurse examines the skin, hair on the head and clothes of the patient. After examination, he is dressed in the clothes of the hospital and transferred to the appropriate department. Next, the nurse disinfects this room and prepares it for a new patient.
Organization of work of the nurse of the admission department
The nurse is an assistant to the doctor. Her responsibilities are quite diverse and oblige to possess certain professional skills. The nurse must carefully follow all the appointments and orders of the doctor. In the emergency room, she monitors the flow of patients, monitors the sanitary-epidemiological regimen in order to avoid the appearance of nosocomial infection. The nurse submits to the head, senior nurse and doctor (on duty). When organizing work in the emergency room, the nurse should know:
- documentation kept in the department and the rules for its completion;
- organization and structure of the emergency room;
- the procedure for pre-medical examination of the individual;
- regulatory documents governing the sanitary-epidemiological regime;
- telephone numbers of emergency and specialized services (firefighters, police, ambulance, drug or psychiatric dispensary, etc.);
- the technique and algorithm for various manipulations: the introduction of drugs, gastric lavage, enemas, taking biomaterial, etc.
- rules for transporting patients with or suspected of being infected with HIV;
- rules for processing requirements - invoices for obtaining medicines and medical equipment;
- rules for the preparation of disinfectants;
- regulation of the reception of patients by a doctor depending on their condition.
Nursing staff
Compliance with the principles of ethics and deontology plays an important role in organizing the work of a nurse in a hospital ward. Such qualities as:
- mercy;
- organizational skills;
- hard work;
- accuracy;
- friendliness;
- decency;
- common sense;
- professional awareness;
- creative thinking and some others help the patient to quickly become accustomed and feel the care and attention that he needs so much.
Significant theses characterizing medical ethics include:
- prohibition of harming the patient;
- respect for the profession;
- observance of medical confidentiality;
- respect for the personality of the patient.
Medical deontology combines all the views and rules of conduct of medical personnel, which contribute to increasing the effectiveness of therapy and minimize the occurrence of undesirable consequences. There are certain norms and standards that are mandatory for nurses to admit. In organizing the work of paramedical personnel, a special place is also held by respect for the rights of the individual. Bioethics - this concept stands for study when ethical aspects arise in problem situations. Its main principles are:
- good deeds;
- justice;
- humanity;
- respect for personality.
Keeping medical secrets relevant for both nurses and doctors. It is forbidden in the presence of patients or their relatives to discuss the diagnosis, reflect on treatment tactics, question the correctness of medical appointments, etc. You must be careful and sensitive, refer to the patient by name and patronymic and “you”.
The work of nurses
Health care facilities have different patient care systems:
- Two-stage - doctor and nurse. In this case, the nurse follows the instructions, appointments and recommendations of the doctor, carries out all the necessary procedures, and also provides patient care.
- Three-stage, which in addition to the previous one also includes a younger nurse.
The organization of the work of the younger nurse of the admission department is assigned to the nursing staff. If they work in specialized hospitals (infectious, neuropsychiatric, anti-tuberculosis, etc.), then they regularly conduct classes at which they acquire the knowledge necessary to obtain special skills in the emergency room of these institutions. The duties of the primary medical staff of the emergency room of any institution include:
- cleaning the chambers of the department;
- escorting the patient to the department or to the procedure;
- carrying out sanitary treatment of an individual;
- help to patients.
All actions performed by medical personnel, including junior ones, are regulated. For example, according to current orders, the organization of work of the reception department during the implementation of sanitization includes the following manipulations:
- hygienic shower, bath or rubbing the patient with a damp rag, as well as shaving, if necessary - cutting hair and cutting nails;
- extermination of insects during their detection during the inspection, i.e., disinsection;
- dressing the individual in clean underwear and clothing.
Thus, with a three-stage patient care system, part of the duties of the nursing staff is assigned to the junior.
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