PLANNING AND ORGANISING OF HOSPITAL UNITS OF HOSPITAL UNITS

AND DIASTER MANAGEMENT

Hospital:-Hospital is an integral part of social and medical organisation,the function of
which is to provide for population complete health care,both curative and preventive,and
whose out-patient services reach out to family and its home environment,the hospital is
also a centre for training of health worker and for biosocial research(world health
organisation)
Characterstics of hospital:-

 Building constructed as hospital

 Clean and tidy

 Away from noise, floods and dust

 Has required facilities

 Adequate medical staff and equipment with avaialibility of 24 hour staff.

Hospital Administrator:- He must be familiar with details of planning and

construction. He will also advice on selection of equipment, organization of hospital and
matters relating to initial development of hospital.

Sound organizational planning for Hospital nursing service:-

 A written statement of purpose and objectives of nursing service:-
The statement of purpose or beliefs of nursing service is in keeping with hospital belief
regarding patient care and is approved by administarion.

 A plan of organisation:- commonly diagrammed as organization chart,the plan

indicates area of responsibility,to whom and for whom each person is
accountable.this is interwoven with with organization plan of hospital,therefore
indicating inter as well as intradepartment relationships.

 Policy and administrative manuals:-policies are established within department

to guide the nursing staff.These might include such items as regulations for
exchange of information when tours of duty change and regulations for charting
nurses notes.these are reviewed and revised at regular intervals.

 Nursing practice manuals:-

Written procedures are available as evidence that standards of performance
have been established for safe effective care while considering best use of available
resources and personnel

 Nursing service budget:-

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 This is statement of plan for nursing service expressed in accounting terms.the
nursing service budget is concerned primarily with four budget forms-
salary,supplies and expenses,equipment and capital expenditure.

 A master staffing pattern:-

It serves as a guide in planning vacation coverage,as a time table for replacement
of personnel, as a support for budgetary requests as an aid in forecasting future
needs.

 Plans for appraisal of nursing:-in addition to provision of adequate

supervision,there are one or more techniques for the continues evaluation of
nursing care such as ward conferences,nursing rounds,analysis of accident
reports,patient and employee opinion polls,the nursing staff.

 Nursing service administarive meetings:-

The opportunity for free communication and a share in planning and evaluation is
provided through regular meetings of the director of nursing or her representative
with day,evening and night assistants,with supervisors,head nurses and total
nursing staff.

 Advisory committee:-
Membership on standing or special committees provides for active participation
of staff members in problem solving.these committees are advisory to director of
nursing.after carefully weighing the advice of committees,she makes the final
decisions about matters within her area of responsibility and becomes accountable
for their implementation.she makes decisions about matters to be reffered to the
hospital administrator.

 Adequate facilities,supplies and equipment:-

Written job descriptions and job specifications:-
Written job descriptions help prevent duplication of fuction.qualifications for each
category of personnel are defined in terms of responsibilities to be assumed.

 Personnel records:-
Are kept on each staff member,including such information as application for
employment,record of personal interview,verification of credentials,letter of
acceptance,personal data card,salary,performances evaluation record etc.
Personnel policies:-They are personnel centered but based on needs of institution.they
represent an informal aggrement between hospital and employee.

 Health services:-
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 The plan of health care for employee is set forth in written policies which govern
preemployment physical examinations,periodic reexaminations and provision of
diagnostic,preventive and therapeutic measures.
In service education of nursing personnel:-

 Programmes are conducted which provide

 Orientation

 Skill training

 Contnuing education

 Leadership and management development

Meetings with personnel from other departments:-
The opportunity for communication a share in planning,evaluation and co-operation.co-
ordination of activities is provided through regular meetings of director of nursing with
administrator,other department heads,members of medical staff,with committee for care
of improvement of care of patients and other group involved in providing patient care.

HOSPITAL DEPARTMENTS
The out patient department:-
It is the point of contact between hospital and community.many patients gain their first
impression of hospital from OPD.the activities of OPD will influence those of all other
departments of hospital and activities of all other departments of hospital will produce the
effect on those of OPD.all patients suffering from diseases of minor,serious,acute,chronic
nature are first examined in the OPD.
The OPD shoud be within the main body of hospital.the department should be
located close to public entrances,particularly where public transportation is provided.the
department should also be adjacent to casualty and emergency service and admitting
unit.at entrance there should be reception and enquiry countres,with proper
communication facilities like telephone etc.the OPD space can be utilised for emergency
services.it is also effective to have clinics of different speciality,X-
ray,labortory,pharmacy,rehabilitation centre,injection room and other facilities depending
on type of hospital. The number and type of clinics will depend on needs of patients
served and interest of medical personnel.in modern days we have number of clinics like
eye,ear,nose,throat,dental,medical,surgical,obstetric and gynae also mental health
clinics,paediatrics etc.
There are three aspects of out-patient work that need to be considered.:-
1.Emergencies and accidents
2.Unreferred patients
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 3.Referred patients
Medical unit :-The surge unit in teaching hospital will be called as department of
medicine. In general hospital, medical units are usually headed by senior physician with
their associates whereas in teaching hospital, there will be head of department and
professors, asst.professors lecturers and clinical tutors.
The medication services for disease entitles that may be further divided into sub
specialities such as neurological, thoracic, gastroenterological, dermatological etc. units.
The nurses play a vital role in medical units, that is they take over all responsilbility to
respective wards and manages wards effeciently for welfare of patients in all aspects
related to nursing profession and also taking main roles and responsibilities in assessing
conditions, identifying problems, providing direct care to patients.
Surgical units:-
The operation thetre shoud have following facilities:-
1. The operating room consists of OT tables.
2. A lay-up room which connects directly with operating room,is used to prepare trolleys
wih all the eqipment needed for an operation.much of sterilised material comes to this
room in package for the CSSSD.
3. Wash up room:- opening immediately off the operating room contains sinks and
disposal lifts.all used and dirty material goes into this room.
4. Anaesthesia room:-which is also open directly into operating room is equipped
permanently for use of anesthetist.
5.Scrubbing up room:-In which surgeons and nurses scrub up and put on sterilised
gloves. gowns, gloves and masks.
In addition it should also be equipped with necessary, equipments, suuplies which
includes linen, surgical instruments, OT tables, boyer appratus,0 2,N2 and other
gases.
Also ideal to have recovery room attached to OT for reception of patients immediately
folowing surgery.
The maternity unit:-This unit or department should serve both in physical set up and
personnel to provide every care and comfort for lying in mother and her new
born.the extent of provision that should be made for institutional confinements is
conditioned as:-
1. The number of women who should desire a hospital bed if it were avaialable.
2. The number of women who ought on medical grounds to have a hospital delivery.

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 3.The length of stay in hospital of a normal case.
The antenatal care is a great preventive branch of obstetrics.to prvide expectant care to
mother
Paediatric unit:-The paediatric services of hospital should form part of an integrated
servicesto community.in peadiatric clinics,more space,haave to be kept open to enable a
clinic to accept patient without appointments who present themselves with urgent
conditions.In designing the paediatric unit the needs of two groups must be
considered:those of patient and his parents and those of hospital staff.the special
requirement in planning for children includes provision of large proportion of isolatin
rooms and facilities for mothers to come into hospital with their children.there is also a
need for large play rooms and for a school room.there must be separate glasswalled
cubicle is desirable for each infant.
Dental department/unit:-The dental department in general hospital should largely a
referral centre for cases of diagnosis or operative difficulty sent to hospital by dental
surgeons either in private practice or working in clinics.
Department of radiology or X- ray department:-it deals with radio diagnosis and radio
therapy.there are number of diagnostic procedures performed in X-ray department such
as barium meal,intravenous pyelogram,myelogram etc.
Department of pathology/laboratory:-the primary function of pathology services is to
give assistance to attending doctor in diagnosis and treatment of patients.
Investigations made by this service is to give assistance to attending doctor in diagnosis
and treatment of patients. tisues, blood, bonemarrow, cerebrospinal fluid and other body
fluids,excretions and other materials collected from or administered to patients are
examined.The medical labortries may be divided into two groups:-
Hospital labortries and Public health labortries.
Department of psychiatry:-psychiatry as a basic medical science,as a field of
therapeutics and as a branch of public health and preventive medicine can also play its
part in general hospital endevour to improve education.training and research.
It should include ;- An out patient department, liason services for contact with mental
hospitals,long stay annexes, pre and after care faclilities and general and psychiatric
community services, day and night treatment facilities and an in patient unit.
Department of pharmacy:- The main function of this department will include stocking
of drugs and other medical supplies and equipment and distribution of drugs and
others to different departments as and when they required and also manufacturing of
medication in hospital pharmacies. The stock is handled by chief of pharmacy
department in collaboration with medical superintendents and resident medical officer
of hospital.

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Laundry:-
It is closely associated with nursing services.the person who manages laundry must be
familiar with problems of nursing services.Nursing supervisors can be taken on rounds
of laundry periodically to know problems.Surgical linen are autoclaved in surgical area
to ensure sterility and further safeguard patients.Isolation techniques established by
nursing should be followed by nursing personnel where applicable.all linen levels are
established by nursing and nursing services advices type of linen required for them to
work in wards and other departments.
Accident and emergency department(casualty department):-
It is one of department which works round the clock. It is very essential that receptionist
and staffing pattern of OPD should be available on reception round the clock so that she
can answer to various questions queries of patients. This department should have
following facilities room for police constable,room for driver,doctor examination
cubicles,stores and room for keeping patients which are brought dead.If department is
large ie more than 50 accidents and emergency patients are attending such department 24
hours this is called as miniature hospital.The other facilities are on spot observation
beds,emergency ward,laboratory including window for blood bank, pharmacy.X-ray
machine,ECG facilities etc. It is also essential that it should be supported by ambulance
network.
Dietary department:- The goals of dietary service in hospital includes:-
1. Optimum nutrition of patient
2. The maintenance of morale
3. The dietic education of patients
4. The achievement of these goals with maximum effectiveness and resulting economy.
The proper nutrition of patients require intelligent purchasing of equipment and
goods,professional planning of standard and therapeutic diet,scientific food production
and well planned system distribution of food.
The moral function will apply equally to food prepared for hospital personnel requires
consideration of aesthetics of food service including colour,consistency and temperature.
The educational function are interrelated.soundly planned,prepared and served meals
provides education to patients and discharge ship also provides to patients.
The nursing department has a right to expect the dietary personnel to be trained in correct
food handling techniques and know proper utensils to use for food serving.nurses are
expected to discharge doctor from making rounds at meal times so that there will be no
dressing done on patients during that time.
Type of dietary service:-It is classified as:-
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1) Centralized
2) Decentralized
Centralised:-the entire food may be served in cetral kitchen and then sent to wards on a
trolley through servants or through some other mode and then carried to individual
patients by the ward staff.
Decentralised dietary service:-in this system the food is sent to wards in containers
where it must be kept hot until serving. In this type of service,the dietiticians or nurses
may have the charge to serve the food. In this system,the diet orders are given through
incharge nurse.
Whatever the system may be,there should be organised system for daily checking of diet
against doctor’s orders and should be treated as essential.
Central sterile supply services department:-
CSSSD is supposed to store, sterilize,maintain and issue those instruments.materials and
garments which are required to sterilised.it should have direct lines of communication
with all wards,operation theatres,out patient and casualty departments and to lesser extent
with X-ray and pathology department.
Factors determining amount and type of material supplied from central supply
department:-
a) cost of equipment and frequency of use in particular unit.
b) The ease and rapidity with which equipment can be obtained.
c) The facilities in ward for care,sterilization and storage of equipment.this includes
personnel to clean and test the articles.
d) The facilities in central supply for same finction.
e) The amount of up-keep involved and technical ability needed to achieve it.
Items sterilized

 Needles and glass syringes

 Rubber goods (Gloves, catheters, tubing's)

 Treatment & Diagnostic sets ( LP, Aspiration, BM, Bone Biopsy etc.)

 Dressing, Cut down trays

 OT Linen and instrument

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  Linen to all wards
Location

 It should be in close proximity to areas it mainly serve .i.e. OT, ICU,CCU,

Surgical Wards and Emergency.

 Away from the main traffic flow.

 Easy access to boiler for steam.

Size

The size of the department varies as per size of the hospital.

i) Up to 100 bedded hospital only peripheral unit (TSSU).

Up to 400 bedded hospital only CSSD Central Unit.

More than 500 beds both Central and peripheral unit.

Average area requirement is 1 sq mt/ bed including all units.

There should minimum six basic division in CSSD

1.Receiving counter and storage of soiled items.

2.Cleaning area.

3.Drying area.

4.Packaging area.

5.Sterilizations area.

6.Sterile storage and issue counter.

Advantages of central supply system:-

1.)It is very efficient and it saves many man-hours required for nursing care of patients.
2.)A small amount of not much or infrequently used articles may be stored in hospital
without much effect on economy.
3).The responsibility of nurses become less as there is less equipment to store and
maintain.thus,clean and orderly working environment can be maintained.
4.)The work of wrapping or cleaning equipment can be done by less skilled,non
professional staff,therby saving nurses time for nursing activities.
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5.)Borrowing from different wards is minimised.
6.)There is less amount of wastage of equipment,as exact amount of equipment required
in ward is supplied.
7.)Less number of personnel handles sterilisation of equipment in central department so
that sterilization can be easily done here.
8.)The equipment is kept in good condition and delays due to impairment of equipment
are minimum.
9.)There is more facility for cleaning and maintenance of equipment when managed
centrally.
10.)mechanical defects are detected early and articles can be repaired before damage is
great.
Disadvantages:- If there is centralisation of all equipment,then there is possibility of
delay in acquiring the items at the right time.however,this can be overcome by having
each ward stock with supplies and sets sufficient in number to meet daily
requirements.in same way,the equipment which might be needed in an emergency for
particular service can be stocked in minimum amount in ward.
Department of nursing:-Nursing personnel composed of professional nurses,nurses as
practioner, and nursing assistants of various types constitutes the largest single body of
personnel in hospitals and nursing department of hospital.

DIASTER MANAGEMENT
Introduction
 Disaster is an occurrence arising with little or no warning, which causes serious
disruption of life and perhaps death or injury to large number of people.
 It is may be a man made or natural event that causes destruction and devastation
which cannot be relieved without assistance.
Disaster cycle:- The three aspects of disaster management correspond to different phases
viz.
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1.Disaster response
2.Disaster preparedness
3.Diaster mitigation
Management sequence of sudden onset disaster
Disaster management plans
Aims of disaster plans
 To provide prompt and effective medical care to the maximum possible in order
to minimize morbidity and mortality
Objectives
 To optimally prepare the staff and institutional  resources for effective
performance in disaster situation
 To make the community aware of the sequential steps that could be taken at
individual and organizational levels
THE DISASTER PLANNING:-

The purpose of disaster planning is to reduce a community vulnerability to the

tremendous consequences of disaster.

CHARACTERISTICS OF DISASTER PLANNING:-

 Based on realistic assessment: - The disaster plan is based on a realistic assessment of

potential problems that has happen e.g. destruction to property material impried of
communication.
 Estimation of injuries: - Estimates of types of injuries that results from disaster most
likely to occur in area & possible destruction of health facilities.
 Plan should be brief & concise; - The plan is brief, concise 7inclusive of all can
provide disaster aid.
 The plan is approved by all agencies.

COMMON ELEMENT OF DISASTER PLANNING:-

 Authority: - Issues warning & official responses & is the central authority for disaster
declaration.
 Communication: - Warning to public & how communited whatever by television,
radio, police loudspeakers including chain of notification & restriction.
 Equipment &supplies; - Sources are supplied according to usual & special needs e.g.:
food, clothing.

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 Human resources;- It include health professional emergency &disaster specialist ,
government & voluntary agencies, engineers ,wealth specialist , community leader.
 Team coordination; - Central operation, staging area , chain of command.
 Transportation; - Traffic control, access& escape routes ,control the risk of victim
related.
 Documentation: - Details of disaster plans , how &where disseminated, procedure for
managing record of injuries, death,& supplies.
 Rescues: - Search & rescues operations, details of removal of victim& immediate first
aid.
 Acute care :- Detailed role description of health care workers for immediate emergency
care.
 Supportive care :- It include shelter management.
 Recovery: - Post disaster team meeting, press conference, & reports to media.
 Evaluation :- Revision of disaster plan based on results.

PRINCIPAL OF DIASTER PLANNING:-

 Planning: - Disaster planning according to specific population needs. Planning

is a ongoing process. The planning is a continuous process that changes as
community circumstances changes.
 Information: - Provide information regularly to the community to correct
misconception. People should be given information & details about extend of
the disaster to enable them to take appropriate action.
Lack of information rather than too much information causes inapproxiate
response by community members.

. Involvement: - Involve the entire community in planning process. The disaster

. Plan should co-ordinate with entire community. So that the large number of
people should be involved in its development.

. Flexible: - The disaster plan should be flexible. The plan is changeable.

According to need of the community. Flexible plan fit into the specific situation.

Team members reasonability :- Role & responsibility of team member should

be identified by position or title not by name of individuals.
 Use routine working methods & procedures in the disaster plan which will
eliminate the need to learn new procedures &prevents confusion at disaster site.
Disaster management committee

The following members would comprise the disaster management committee under the
chairmanship of medical superintendent/ director
 Medical superintendent/ director
 Additional medical superintendent
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  Nursing superintendent/ chief nursing officer
 Chief medical officer (casualty)
 Head of departments- surgery, medicine, orthopedics, radiology, anesthesiology,
neurosurgery
 Blood bank in charge
 Security officers
 Transport officer
 Sanitary personnel
Disaster control room
 the existing casualty may be referred as the disaster control room.
Rapid response team
 The medical superintendent will identify various specialists, nurses and
pharmacological staff to respond within a short notice depending up on the time
and type of disaster.
 The list of members and their telephone numbers should be displayed in the
disaster control room.
Information and communication
 the disaster control team would be responsible for collecting, coordinating and
disseminating the information about the disaster situation to the all concerned.
Disaster beds
 Requirement of beds depends up on the magnitude of the disaster.
 Utilization of vacant beds, day care beds, and pre-operative beds
 Convalescing patients, elective surgical cases and patients who can have
domiciliary care or opd management should be discharged
 Utility areas to be converted in to temporary wards such as wards with side
rooms, corridors, seminar rooms etc.
 Creating additional bed capacity by using trolleys, folding beds and floor beds
Logistic support system
 Resuscitation equipments
 IV sets, IV fluids,
 Disposable needles, syringes and gloves
 Dressing and suturing materials and splints
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  Oxygen masks, nasal catheters, suction machine and suction catheters
 Ecg monitors, defibrillators, ventilators
 Cut down sets, tracheostomy sets and lumbar puncture sets
 Linen and blankets
 Keys of these cupboards should be readily available at the time of disaster
Training and drills
 Mock exercise and drills at regular intervals are conducted to ensure that all the
staff in the general and those associated with management of causalities are fully
prepared and aware of their responsibilities. 
Elements of disaster plan
A disaster plan should have the following elements
 Chain of authority
 Lines of communication
 Routes and modes of transport
 Mobilization
 Warning
 Evacuation
 Rescue and recovery
 Triage
 Treatment
 Support of victims and families
 Care of dead bodies
 Disaster worker rehabilitation
Activation of disaster management plans
 Standard operating procedures (SOPs)
 Reception area
Triage
 Priority one- needing immediate resuscitation, after emergency treatment
shifted to intensive care unit
 Priority two- immediate surgery, transferred immediately to operation
theatre.
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  Priority three- needing first aid and possible surgery- give first aid and
admit if bed is available or shift to hospital
 Priority four- needing only first aid-discharge after first aid.
 Documentation
 Public relations.
 Essential services.
 Crowd management/ security arrangement.
Disaster management cycle
Prevention                     ------>        preparedness
         I                                                         v
                                               
Recovery                <---------            response       
Phases of disaster management
 Prevention phase
 Preparedness phase
 Response phase
 Recovery phase
Prevention phase
 Identify community risk factors and to develop and implement programs to
prevent disasters from occurring.
Preparedness phase
 Personal preparedness
 Professional preparedness

Key organizations and professionals in disaster management

Health care community

 Hospitals
 Health professionals
 Pharmacies
 Public health departments
 Rescue personnel

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Non-health care community
 Fire fighters
 Municipal or government officials
 Media
 Medical examiners
 Medical supply manufactures
 Police

Community preparedness
 The level of community preparedness for a disaster is only as high as the people
and organization in the community make it.
 Community must have adequate warning system and a back up evaluation plan to
remove people from the area of danger
Response phase
The level of disaster varies and the management plans mainly based on the severity or
extent of the disaster.
Recovery phase
 During this phase actions are taken to repair, rebuilt, or reallocate damaged homes
and businesses and restore health and economic vitality to the community.
 Psychological recovery must be addressed.Both victims and relief workers should
be offered mental health activities and services.

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DISASTER MANAGEMENT
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Application to nursing service and education:-
1.Evaluates the organisational structure frequently.
2.Encourage employees to follow chain of command and gives counselling and guidance
to enable them to do so.
3.Supports personnel in advisory(staff) positions.
4.Models responsibility and accountability for subordinates.
5.Assists nursing staff to see how their roles are congruent with and complement
common organisational tasks.
6.Encourages upward communication.
7.Explains organisational culture to subordinates.
8.Counsel employees who do not follow chain of command.

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