07. B Charter of Expectations and Standards for Berega

BEREGA MISSION HOSPITAL

A caring, teaching hospital, where no-one will die of neglect or misconduct

This guideline is intended for any clinical staff dealing with patients

EXPECTATIONS – GENERAL

1.       Staff should be present in the hospital when rostered. When on break, or on call at night, they should be easily reachable – eg able to arrive within 10 minutes. Chai break is 30 minutes in total, from leaving to arriving back.

2.       Admissions should have had a good history, examination, provisional diagnosis, investigations, good record-keeping, and management according to national guidelines, with particular attention to getting it right in the first 24 hours. Beware of drug interactions.

3.       Nurses should perform vital signs twice daily on non-emergency cases – or as directed by the doctor – eg in post-op cases. They should report any concern to the First-on-call or Second-on-Call.

4.       All staff should have a caring attitude to patients, as illustrated by:

a.       Good and sensitive explanations to satisfy the patient;

b.      Knowing the names of patients

c.       Nurses ensuring that investigations reach the lab, and that abnormal results are followed-up

d.      Patients not being left alone uncomforted in frightening or dangerous situations – eg complicated labour, waiting for surgery, critically ill.

EXPECTATIONS – EMERGENCY CASES

1.        Complex/Sick patients should be reviewed promptly in OPD / Labour ward, where there should be a good history, examination, provisional diagnosis, investigations, record-keeping, and management according to national guidelines.

2.       Laboratory investigations on emergency /sick patients, (eg caesarean, meningitis, severe trauma, severely ill), should normally have the result back on the ward within 30 minutes. These results should be communicated by the nurse to the doctor, who should act on them where appropriate.

3.       Complex/Sick patients should be discussed promptly by the First-on-call with the Second-on-Call, and reviewed by the Second-on-Call at the time if needed, and a plan made.

4.       Second-on-Calls should be around the hospital between 07.30 and 14.30, easily available to review worrying patients. They should have done a morning round to identify and record who is sick or at-risk.

5.       A final check of the sick, at risk and in-labour patients should be made before going off-duty by the Doctor in charge of each ward, and these should be handed over to the Second-on-Call.

6.       Nurses should check vital signs every 2 hours for seriously ill ‘sick’ patients. They should keep the record of sick patients up-dated, and should know the plan for these. All observations and plans should be carried out well. This should be recorded in the end-of-shift report in a Ward Report Book.

7.       Any First-on-Calls coming on or off duty, plus all Second-on-Calls, should be at the morning report and weekly meeting, if not on leave. Sick/Complex patients should be handed over at this meeting, stopping to discuss each individually. Thereafter the night First-on-Call should accompany the Second-on-Calls to the ward to hand over any particularly sick patients.

8.       At the weekend, the night First-on-Call should review the sick/complex admissions with the Second-on-Call before going off duty, at 07.30, accompanied by the First-on-Call coming on duty.

9.       When an emergency attendance is required – eg an emergency Caesarean for obstructed – all staff should be present and ready to begin with 30 minutes. The patient by that time should have been fully prepared – eg IV fluids, drugs, Hb, X match, consent.

10.   When a nurse calls a doctor, she should enter this in the record, along with how and when s/he called the doctor. When a doctor sees a patient, a date, time and signature should accompany the entry in the notes.

EXPECTATIONS – LABOUR WARD   

1.       Midwives should see and assess any admission within 30 minutes of her arrival. In every case, the midwife needs to assess and record in the notes:

a.       Is the woman in labour?

b.      Is she normal? If not, the Second-on-Call needs to be informed, and needs to see the woman within 30 minutes - or more quickly where needed.

c.       Certain conditions are emergencies and need to be dealt with immediately by the midwife, and reviewed promptly thereafter by the Second-on-Call: eg obstructed labour; PPH; eclampsia; fetal distress; haemorrhage.

2.       When a woman is in active labour – ie more than 3cm dilated with good contractions coming at least every 5 minutes – she should be entered on a partograph. When the partograph becomes abnormal, the Second-on-Call should be notified right away.

3.       A woman in active first or second stage of labour should have a midwife with her at all times, even during tea breaks, although in busy times a single midwife might need to be covering more than one woman in labour. (The aim is eventually that, in normal circumstances, there would be two midwives per shift, plus one other nurse or attendant.)

4.       The fetal heart should be listened to every 30 minutes in the first stage, and every 5 – 10 minutes in the second stage. In both cases, this should be done immediately after a contraction.

EXPECTATIONS – EDUCATION AND TRAINING

1.       Opportunities should be taken by all staff to teach and learn appropriately – eg teaching of the First-on-Calls and nursing students on the job.

2.       There should be a programme of on-the-job training for all staff eg monthly.

3.       Where vital educational needs are identified, these should be dealt with appropriately.

4.       There should be a mechanism for learning from deaths and from serious incidents.This guideline is intended for any clinical staff dealing with patients.