CARE OF

VULNERABLE
PATIENT
JINO JACOB Deputy
Nursing Superintendent
PURPOSE

 Identify the population at risks, and provide safety during the care.

 Develop plan of care, for the staff to know on how to take care of identified
vulnerable patients.

 Establish guidelines for the evaluation and management of vulnerable patients in

order to reduce or eliminate situations that put them at risk.

 Provide guideline instructions to ensure a safe environment for vulnerable patients

(Neonates, children and frail, dependent elderly patients who are also at risk for
abuse, comatose patients, pregnant women, and physically and mentally ill
patient).
DEFINITION

 Vulnerable Patient - A person who is in

need of medical care services by reason of
mental or other disability, age or illness and
who is unable to take care of him or herself,
or unable to protect him or herself against
significant harm or exploitation.
 Babies and childrens
 Senior citizens
 Mentally Challenged patients.
 Physically Challenged Patients.
 Unconscious patients.
 Sedated Patients.
 Pregnant Womens.
 Language Barriers.
POLICY
 The physiological, mental, and sociological care needs of vulnerable patients shall receive the
required attention by the All India Institute Medical Science (AIIMS Rishikesh) staff involved in
the patient care process.

 Vulnerable patients shall receive assistance through the admitting and discharge process (if not
accompanied by other family members).

 Relevant records / information of any vulnerable patient should be clear, accessible, and
comprehensive. Careful professional judgments should be made on the basis of this information,
so that appropriate care could be rendered.

 AIIMS Rishikesh shall take appropriate measures to protect children, elderly patients, and other
vulnerable patients, by imposing safety and security measures adopted by the hospital.
PROCEDURE:

 The admitting unit (ER or OPD) nursing staff shall facilitate

the admission of the vulnerable patients after the attending
physician order for admission, by giving them priority and
reduce their waiting time. They shall expedite the admission
as arranged with nursing staff in charge of the receiving unit,
in coordination with the appropriate Allied Medical Services.
PROCEDURE:

 The patient’s-social need Shall be assessed by the

medical, nursing, and social services staff and findings shall
be documented on their respective notes in the patient’s
medical record file.

 The medical and nursing staff shall encourage family

members of vulnerable patients to spend more time with
them while in the hospital. Watchers can be allowed if deem
possible in regular wards.
Care of Neonates and
Pediatrics
 The admitting unit (ER or OPD) staff shall admit all neonates
and children after the attending physician order for admission,
as arranged with nursing staff in charge to the specific care
areas designated for each category, in coordination with the
appropriate Allied Medical Services.
 Neonates born in AIIMS Rishikesh shall be admitted directly to
the New born Nursery or NICU, according to their medical
condition, ensuring that right infant banded against right
mother.
 Trained Nurses and Healthcare Professionals shall provide
appropriate care to neonates and children in pediatric units.

 Children admitted to the pediatric units shall be provided with

age appropriate play activities.
Care of vulnerable
Elderly/Comatose patients

 Evaluation of the vulnerable elderly/comatose patients on

admission shall include diagnosis, pre-hospital and
current medications, and cognitive status.

 Elderly / comatose patients shall be provided with safety

measures by the nursing and medical staff because they
are susceptible to complications that cannot be easily
recognized as they cannot verbalize their conditions.
Care of vulnerable
Elderly/Comatose patients
Vulnerable patients who are determined to be at complete bed


rest for prolonged period of time shall receive proper pressure

ulcer prevention and care.
 The “Braden Scale shall be used for assessing patients on
admission and at regular intervals.
 All pressure ulcers must have a full wound assessment and
care plan with appropriate dressing selection.

 Special care shall be given to elderly bed-ridden, diabetic

patients to prevent pressure ulcer.
 Special care shall be given to prevent deep vein thrombosis
and pulmonary embolism (for patients with risk of
venous thrombosis) by using the available physical and
pharmaceutical means as determined by the medical staff.
Care of vulnerable
Elderly/Comatose patients
 All vulnerable patients shall be assessed for fall by the
nursing staff using the Fall Risk Assessment Tool and shall
be reassessed for fall on a weekly basis and as their
condition evolves.

 Patients identified as fall risk shall receive specific fall

management interventions according to the Policy on Patient
Falls Precaution, which includes general precautions for all
settings and a system to identify and manage patients at risk
for falls. (ADM-Gen 01-038)
Care of vulnerable Mentally
ill patients
 A patient who is dangerous to himself and to others shall be
admitted against his/her will on condition that a next of kin or
relative signs the consent for admission, or permission from
the administration, or in cases brought by police for
assessment, treatment or both.

 Psychiatric patients who are admitted in the ward shall have a

safe therapeutic environment including the protection of
the patient from any injuries.
Care of vulnerable Mentally
ill patients
 Patients, manifesting disturbed behavior of self-injury or to others, or
property, and who cannot be controlled by other means, are restrained
with the written order of physician. (Please refer to Restraint Policy)

 Administer immediately the ordered chemical restraints (medication)

before physical restraints.

 Four points restraints (hands and feet restraints) and a body restraint is
being used. Proper restraint materials can be used as available.

 Restraints should not be too tight so as not to obstruct the circulation and
cause edema. And it must be released once every 15 minutes and
documented with time and signature.
Care of vulnerable Mentally
ill patients
 Adult family members are allowed to visit,
unless otherwise there is a written order from the physician
not to allow a specific visitor.

 Male visitors are not allowed in the

female ward
and vice - versa.
 Visitors below twelve (12) years old are
not allowed inside the
ward.
Provision of Health
Education
Before patient is being discharged home, the physician must provide appropriate health-

teachings on the following:

Disease condition
Medication
Activities of Daily Living
Diet and Exercise
Protection and prevention

 The Physician shall involve patient’s relatives or c discharge instructions and how
to cope up with daily living at home.

 The nursing staff shall inform the relative regarding the unaccompanied family
member (patient) who is already for discharge.