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DEPARTMENT OPERATING MANUAL Version No: 03

Effective Date :
PM/DOM-03/MED MEDICINE
01/06/18

TABLE OF CONTENT

Sl. No Description Page no

1. Scope of the Department. 2

2. Outpatient Examination 3

3. Admission 4

4. Inpatient Care And Discharge 5

5. SOP for Patient Care Protocol 6

6. Staff Training And Patient Education Procedures 7

7. SOP for Age well clinic 8

8. Protocol for adult vaccination 9
9. SOP for travel clinic 10
10. List of Associated records 15

ANNEXURE

Annexure No. I Role

HOD
Consultant
Annexure No. II Organogram

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1. SCOPE OF THE DEPARTMENT

1.1. Purpose
To ensure the procedures for effective operation of Medical Department and to train
undergraduate & post graduate (DNB) in medicine.

1.2. Scope of the department

Medicine department deals with all in- patients and out patients of Bangalore Baptist
Hospital with various medical problems.

1.3. Responsibility
The Section In-charge to ensure the implementation of the instructions and other
procedures laid down.

1.4. Quality Objectives

1.4.1. The staff will commit to provide treatment with the set standards of professionalism.
This entails confidentiality and quality care for patients.
1.4.2. Treatment would be provided in such a way as to ensure minimum scope for error,
ensuring good accuracy.
1.4.3. Patients will be treated with equality and respect.
1.4.4. Department shall endeavour to value the patients‟ time and minimize waiting time.
1.4.5. Case presentation, seminars, journal clubs etc. for undergraduate & post graduate
are conducted regularly.

Note* -For all the general nursing procedures refer OP- nursing department
operating manual

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2. OUTPATIENT EXAMINATION
2.1.1. Patients who come after the registration are called in according to their „queue‟
number.
2.1.2. They are then seen either by the consultants or by the junior medical staff depending
upon the type of registration made PC/By-choice/general.
2.1.3. They are then quizzed in detail about their complaints subsequently, a good clinical
examination is done provisional diagnosis made and relevant investigations asked
for. The protocol for the history taking and examination is made according to
standard text books of clinical examination. E.g. .Hutchison‟s clinical method.
Patients requiring expert opinion are seen by consultants in addition to the residents.
2.1.4. Patient is then prescribed medication and asked to come back for reports the same
afternoon or the next day to come to a definite diagnosis.
2.1.5. Additional medications are prescribed if necessary.
2.1.6. For any patient who deserves and requests concession the pink social service form is
filled where category (A, B, C, D, E) is to be written by consultants. This sheet and
prescription is sent to social worker with the chart through the OPD aid. After
categorization by social worker, the category is written on the prescription and
countersigned by the HOD and the prescription given to the patient to buy
medicines from the hospital pharmacy. If concession is approved, medicines can be
given for 2 weeks only.

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3. ADMISSION
3.1. Inpatient admission:
3.1.1. Patients who are sick and need admission are either seen in the casualty or in the OP
department.
3.1.2. The admitting doctor follows the procedure as given above.
3.1.3. He then fills up the doctor‟s order sheet in the following order.
a. Admission to appropriate ward notified
b. General condition stated
i. Frequency of monitoring the vital signs indicated
ii. Type of diet specified
c. Appropriate investigation mentioned
d. Drugs to be administered are specified in these generic form and the route of
administration is indicated e.g. Parental / intramuscular / IV etc and the frequency
specified Q4H or Q6H.
e. STAT medications are given before shifting.
f. Allergies to any drug is highlighted in the given column.
3.2. Emergency admission
3.2.1. A patient who is wheeled into the casualty is first seen by the sister on duty and the
casualty doctor on call is intimated.
3.2.2. The casualty doctor intimates the respective department duty doctor as and when
needed.
3.2.3. The duty doctor takes a detailed history and a detailed examination is conducted.
3.2.4. A provisional diagnosis is made and relevant investigations and asked for and
treatment instituted after consultations is made with the on call consultant.
3.2.5. Following this the patient is either admitted to the appropriate ward or discharged,

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4. INPATIENT CARE AND DISCHARGE

4.1. Each ward has an assigned junior medical officer and a consultant in charge.
4.2. The junior medical officer is required to see each of the patients under his care in detail
each day before the consultant arrives.
4.3. They then see the patient together and make appropriate changes in the treatment
recommendation.
4.4. The junior doctor makes all the entries in the blue sheets of the IP chart and documents
the condition of the patient everyday.
4.5. This is done in the standard symptoms, observation, assessment and plan format.
4.6. When a patient makes significant improvement or when the team feels that a particular
patient is fit to go home, then the patient is discharged.
4.7. The patient is given a formal discharge summary with clear instruction about the
medication that he needs to take when he is at home.
4.8. Recommendation about his follow-up visit is also made.

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5. SOP FOR PATIENT CARE PROTOCOL

5.1. All patients should be treated with most respect by all the staff of Medicine department.
5.2. All outpatients should be courteously told about the waiting time, availability of the
doctors, procedure fees etc.
5.3. Patients should be suitably directed to various areas of the hospital by the nursing staff as
and when necessary.
5.4. Staff should try to avoid conflict with the patients as far as possible in an inevitable
circumstances help should be sought from doctors, guest relation officers or other
administrative staff at the earliest.
5.5. When a patient is for admission or surgery the approximate costs are explained,
availability of different types of wards and facilities are explained in brief.
5.6. Wherever possible, when a patient is called back for a procedure or investigation
appointments are given and are strictly adhered to.

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6. STAFF TRAINING AND PATIENT EDUCATION PROCEDURES

6.1. Staff training
6.1.1. At the time of joining all new staff undergo a department induction programme by a
senior staff.
6.1.2. New staffs are made to read department operating manual at the time of joining.
6.1.3. For professional development, all staffs are encouraged to attend academic
meetings, seminars and discussion in the hospital.
6.1.4. All the doctors are encouraged to attend CMES and workshops and it is mandatory
to attend at least two workshops/conference in a year.
6.1.5. All the staff including nursing staff undergo training by the appropriate personnel
whenever these is a new instrument or a new procedure is started in the out patient
department.
6.2. Patient education
6.2.1. All patients are educated about their condition diagnosis, treatment options,
medications given, risks and complications, preventive aspects and follow up
advice.
6.2.2. When specialist dietary advice is necessary patients should be referred to dietician.
6.2.3. For some specific conditions, leaflets are developed by the department of Medicine
6.2.4. For interested patients website addresses are given so that they can get more
information about their problem.

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7. SOP FOR AGE WELL CLINIC

7.1. Patients who visit AGE WELL clinic can book appointments through telephone or get
registered after coming into the hospital.
7.2. Initial assessment by a geriatric nurse followed comprehensive geriatric assessment to
development of personalized care plan. After personalized care plan is put in place, they
will receive necessary care and intervention.
7.3. They will be referred to other medical specialities if required.
7.4. This centre will provide facilities for health promotion ie. talks on common health issues
advising them on balanced diet, prevention of falls vaccination.
7.5. Some of exclusive services provided includes
7.5.1. Falls specialist services
7.5.2. Osteoporosis and metabolic bone clinic
7.5.3. Adult vaccination
7.5.4. Health screening
7.5.5. Cancer screening
7.5.6. Diabetic specialist clinic for older adults
7.5.7. Memory and behaviour assessment clinic
7.5.8. We work closely with other specialties to provide holistic care.

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8. PROTOCOL FOR ADULT VACCINATION

8.1. Purpose: To lay down the guidelines for adult vaccination
8.2. Scope : Adult vaccinations
8.3. Responsibility: Consultants & residents (Medicine Dept)
8.4. Procedure:
8.4.1. All patients who require vaccination will be identified by the junior doctor or
consultant.
8.4.2. Consultant in charge for the inpatients will either prescribe the vaccine or counter
sign to validate.
8.4.3. Vaccination orders for outpatients should be validated by a consultant.
8.4.4. Vaccination sticker will be provided to notify the patient‟s vaccination status in both
the outpatient/ inpatient record.
8.4.5. It is mandatory for the junior doctor to document details regarding the vaccination in
the discharge summary if it is administered during the course of that particular
admission

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9. SOP FOR TRAVEL CLINIC

9.1. Purpose – Is to prevent, diagnose and treat any infection or medical condition that could
harm the traveler.
9.2. Scope – Tourists, travelers to different places in India and those crossing international
borders, pre travel assessment, returning travelers and to update travel vaccination status,
prior to travel.
9.3. Responsibility – Medical records, PRO, OPD Nurse, Doctors & Medical secretary.
9.4. Procedures
9.4.1. Appointment through phone by MRD / PRO and inform doctor.
9.4.2. Patient registers in MRD for travel health clinic / or Medicine OPD / by prior
appointment.
9.4.3. After registration PRO takes charge of the clients, helps them to fill up the
Questionnaire and then the client meets the doctor.
9.4.4. Assessment and screening of the patient will be done by the consultant in third floor
on Monday and Thursday (2pm to 4pm) / and as an emergency on other days in
MOPD
9.4.5. Doctor will assess the clients fitness for travel and vaccination status.
9.4.6. PRO is to guide the client for diagnostic test, referrals, vaccines etc
9.4.7. Patient is sent to the injection room for vaccination with prescription and the vaccine
/ vaccination card (Assigned Staff to follow SOP on patient identification and Safe
injection practice).
9.4.8. Nursing staff will document in the vaccination card – name of vaccine / date of
expiry / Route of administration (stick the details if available)
9.4.9. Travel certificate will be issued on hospital letter head with the doctor‟s name and
hospital seal and date
9.4.10. Client will be given education on destination specific prevention measures of
diseases / and other specific issues concerning health.
9.4.11. Handouts if required will be given
9.4.12. PRO to get feedback and follow up for next visit.

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TRAVEL CLINIC VACCINATION CARD

Name: ……………………………………………

Hospital no: …………………………………….

Age…………………… Sex……………………..
Address…………………………………………..
Telephone No…………………………………….

Inj Name 1st 2nd 3rd Booster Given Due Remarks

date Date
Td
Tdap
MMR
Varicella
Influenza
Hep-A
Hep-B
Twinrix[Hep A&B]
Typhoid
Japanese Encephalitis
Polio
Pneumococcal
Anthrax
Yellow fever

Sign of the staff

Clinic Days & Timing – Monday& Thursday between 2pm to 4pm

For appointment contact – 08022024618/330

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TRAVEL KIT
Sl.No Item Quantity
1 EYE PAD 1
2 COTTON ROLL 1
3 BAND AID 2
4 ADHESIVE TAPE 1
5 COTTON BALLS 1
6 TRIANGULAR BANDAGE 1
7 GAUZE PADS 2
8 GAUZE 7.5x7.5 cms 2
9 GAUZE 5 x 5 cms 4
10 GLOVE PACKAGE PAIR 2
11 TOURNQUET 1
12 TWEEZER 1
13 SAVLON 1
14 FIRST AID TAPE 1
15 SURGICAL COMBINED DRESSING 7.5 X 7.5 cms 1
16 STERILE DRESSING WITH GAUZE PAD 18 X 18 cms 1
17 TRIANGULAR BANDAGE 1
18 LATEX GLOVE PAIR 1
19 WOUND WIPERS 2
20 CPR SHIELD 1
21 STRETCHED BANDAGE 5cm x 3mts 1
22 FIRST AID GUIDE 1

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TRAVEL KIT

Sl.No Tablets Quantity Each Cost

1 TAB. DOLO 650 mg 10
2 TAB.PAN –D 10
3 TAB. DOMSTAL 10
4 TAB.LOPERAMIDE 10
5 TAB.DISPIRIN 300mg 10
6 TAB. ALLEGRA 180mg 10
7 PAPER PLASTER 2.5 5
8 TAB. CIPLOX TZ 10
9 CAP.AUGMENTIN 625MG 15
10 TAB.LEVOCET 10
11 TAB.DEXAMETHASONE 4MG 10
12 TAB DOXY 10
13 TAB.FALICGO SP KIT 1 kit
14 SCISSOR 1
15 ALCHOL SWABS 5
16 THERMOMETER 1
17 POVIDONE 1
18 OMINIGEL 1
19 SOFINOX CREAM 1
20 1% HYDROCORTISONE 1
21 ORS PACKETS 1
22 ROLLER BANDAGE 7.5cm x 2.5mts 2
23 PAIN BALM 1
24 ANTI – SEPTIC CREAM 1

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9.5. Role of Nurses

9.5.1. Assist clinic
9.5.2. Vaccinations
9.6. Role of MIS
9.6.1. EMR – Help retrieve counting specific information as and when necessary
9.7. Role of Doctor
9.7.1. Pre-travel Assessment
9.7.2. Travel vaccination
9.7.3. Returning travel
9.7.4. Education regarding
9.7.5. Travel kit use
9.7.6. Signage‟s / Place / Cleaning
9.7.7. Travel health clinic
9.7.8. Travel Vaccination
9.8. PHARMACY – To stock all Vaccines
9.9. Referrals –
9.10. Certificate – BBH Letter Head with hospital stamp & personal stamp
9.11. Appointment – Timings
9.12. Consultation room

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10. ASSOCIATED RECORDS

10.1. CSSD Register R/NS/OPD/10
10.2. Inventory &Condemn register R/NS/OPD/12
10.3. Linen inventory &mending register R/NS/OPD/13
10.4. OPD register R/NS/OPD/16
10.5. Admission register R/NS/MOPD/01
10.6. Staff clinic register R/NS/MOPD/02
10.7. Inj. T.T.& other injection administration register R/NS/MOPD/03
10.8. Inj.Hepatitis vaccine register R/NS/MOPD/04
10.9. Inj.H1N1 vaccine register R/NS/MOPD/05
10.10. Emergency trolley register R/NS/MOPD/07
10.11. G.R.B.S. Note book R/NS/MOPD/08
10.12. Flu clinic register R/NS/MOPD/09
10.13. OPD leave requisition book R/NS/MOPD/10
10.14. Meeting minutes register R/NS/MOPD/11
10.15. New items list book R/NS/MOPD/12
10.16. Stock book R/NS/MOPD/13
10.17. Rheumatology clinical appointment card R/MOPD/01
10.18. Lab Register (R/NS/MOPD/14)
10.19. Triage Register (R/NS/MOPD/15)
10.20. Forms
10.20.1. Rheumatology clinic appointment card REC/MOPD/01

Signature: Signature:

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ANNEXURE I
1. ROLE OF HEADS OF DEPARTMENTS
1.1. HODs of all departments will conduct random weekly checks (chart audits) of the OP
chart to monitor.
1.1.1. Time at which patient is seen to determine waiting time.
1.1.2. History taking and examination.
1.1.3. Appropriate tests.
1.1.4. Accurate diagnosis.
1.1.5. Justified, Accurate, Cost effective & complete treatment.
(HODs of single consultant departments shall conduct the monthly audits of at least 5
charts together with the Chief/Asst. Chief of Medical staff)
These random weekly checks shall be recorded in an Out-patient/Casualty chart audit
register.
1.2. HODs of all Departments will conduct weekly checks (chart audits) of a discharged
patient chart to monitor.
1.2.1. Accuracy of treatment.
1.2.2. Cost effectiveness of treatment.
(HODs of single consultant departments shall conduct the monthly audits of at least
5 charts together with the Chief/Asst. Chief of Medical staff)
These random weekly checks shall be recorded in an In-patient chart audit register.
1.3. The HODs will also be part of the Quality Assurance Committee conducting quarterly
review of
1.3.1. The Out-patient/Casualty chart audit registers.
1.3.2. The In-patient chart audit registers
1.3.3. The Appointment time check register.

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2. ROLE OF DOCTORS/CONSULTANTS
2.1. Consultations
2.1.1. Consultants should see PC (Private Consultation) patients within 30 minutes of
appointment time.
2.1.2. Doctors should enter the time of starting the consultation in the chart below the date
stamp and the nurse‟s time.
2.1.3. Doctors should take a comprehensive history as appropriate and should write it
down in the chart.
2.1.4. The need for appropriate tests should be explained to the patient, and then ordered
by the doctors.
2.1.5. The Doctors should make a provisional or actual diagnosis and explain it to the
patient.
2.1.6. The Doctor should prescribe medication that is justified, cost-effective and this
should be explained to the patient.
2.2. Admissions
2.2.1. On admitting the patient, the Doctors should write the orders clearly.
2.2.2. The time of admission should be entered in the admission/discharge time sheet.
2.2.3. Routine PC patients and Emergency patients should be placed in bed within half an
hour of being admitted by the doctor.
2.2.4. Routine General patients should be placed on bed as soon as bed is available as
admitted by the doctor
2.2.5. Doctors should ensure that the in-patient treatment is accurate, precise, properly
documented, and that the list/procedures are appropriate and cost-effective.
2.3. Discharges
2.3.1. All routine planned discharges shall be done the previous day.
2.3.2. Only emergency discharges, discharge against medical advice, transfers, 24 -24
hour admissions and discharges on request shall be done the same day.
2.3.3. When discharging a patient, doctors should also mention the time of discharge in
the admission/discharge time sheet.

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2.3.4. Doctors should write the discharge summary in time; it should also be accurate and
informative.
2.4. Casualty
2.4.1. Casualty – Doctors should attend a patient prioritized as critical emergency within 5
minutes of arrival of the patient in the casualty.
2.4.2. The doctor should make as accurate a diagnosis as possible and enter it in the order
sheet.
2.4.3. Patient and relatives should be informed in detail regarding the condition of the
patient and treatment plan. This shall be entered in the Doctors orders sheet as
“explained condition and treatment to patient and relatives”.

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Annexure II
Organogram

Director

Deputy Director

Chief Medical Staff

Asst. Chief Medical Staff

HOD

Consultants Charge Nurse

Registrars Team leader

PGs/JMO/SHO Staff Nurse

Nursing Aide

House keeping

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