Document Name : DAY CARE MANUAL

No. of Pages: 01-72

Date Created : 02.02.2024

Date of Implementation: 04.02.2024

Date of Revision : 01.02.2025

Issue No: 01
Version No: 00

DESIGNATION –RMO

Name : Dr. Sarika

Prepared By

Signature:

Designation – MEDICAL ADMIN

Name : Dr. Y L. Bhargav

Reviewed By:

Signature :

DESIGNATION – MEDICAL DIRECTOR

Approved By: Name : [Link] Kiran

Signature:
 CONTENTS

Chapter-III ManagementofMedication 38
31 Medication administration—BasicRules 38
32 Authorized Staff for Medication Administration 39
33 Prescription Order – for Medication 39
34 Storage of Medication 39
35 Look alike Sound A like Medicines 40
36 High Risk Medicines 40
37 Indenting of Medicines through HIS and
41
Receiving of Medicines
38 Drug and IV Fluid Calculation 42
39 Administration of Medication 42
40 ChemotherapyAdministration 48
41 Chemo therapy related adverse drug reaction 48
&management
42 MultiDose Vials 48
43 IntraMuscularInjections 48
44 Subcutaneous Injection 50
45 Crash Carts– Arrangement&Checklist 51
46 Cardio Pulmonary Resuscitation(CPR) 53
47 Thrombophlebitis and Extravasation 55
48 DischargeProtocol 59
Chapter-IV SpecimenCollection 60
49 Blood Sample Collection 60
50 Urine Sample Collection 63
51 Throat Swab Collection 64
52 Wound Swab Collection 65
Chapter-V EmergencyPatientsManagementProtocols 66
53 Anaphylaxis 66
54 Hemorrhage 67
55 Electricshock 67
56 Drugoverdose 67
57 Seizures 68

Chapter-VI OtherProtocols
58 Applicable NABH Standards 70
59 Quality Indicators 75
60 Listof Applicable Hospital Policies 76
61 Listof Documents and Records 77
62 Listof References 78
63 Interaction with other departments 79
64 Unitinduction Documentation sheet 80
 AMENDMENT STATUSSHEET

RevNo Date Section Page Revision in Brief Approved By

Revised No

1. INTRODUCTION
".
Nursing staff also covers the following process in each functional area.
S PROCESS PROCESSOUTLINES
N Receive & greet the patient, collect identity stickers &bands,orient the ward and
facilities,conduct age specific nurse’s initial assessment(Special focus on pain scale
1 Receiving New Admission rating&vulnerable patient identification),follow Doctor's order and start nursing care
plan.

Receive & greet the patient,collect all documents and,check ID band , room
Receivingtransferpatients-
2 orientation, follow Doctor's order and start nursing care plan,enter in the
STABLE
admission & discharge register
Confirm that the doctor writes the discharge notes, refund medicine and indent
take-home medicines,inform the patient,get the clearance slip,handover all the
3 DischargeProcess documents,discharge teaching,remove the cannula and enter in the discharge
register.

Check the medications to bead inistered, prepare the medication&carry

MedicationAdministrationPr the medication alongWITH FILEto patient bed, check medication
4
ocess RIGHTS&administer medication and finally document.

5 Indents Indent in HIS as per consultant advice

6 Refund Non utilized medications of patients, list them in there fund HIS and send it
across the pharmacy.
On handing over provide information on patient's status, medications,
treatment plans, significant status changes, new tests& its [Link] taking
Handing&TakingOver
7 over check whether the hand over tasks has been completed and plan the care
ofPatients
&things to do in prior pertaining to the hand over information.
 After admission(regular Work hours)-inform dietician on new
admission(DuringLate hour admission/Holidays)-depending upon the doctor’s
8 DietRequest advice whether it is a therapeutic dietor on the choice of patient, Nurse send the
diet information to the F&B Dept

Generally not to take any valuables but incase of emergency takevaluables,list

itinthevaluablehandoverregister&mentionthecolorof
9 Patientvaluablehandover
metalalso ,handovertorelativesand takeacknowledgement

Daily inventory check responsibility is given to a nurse pertaining to the area,

stock registeristo be checked any breech in the inventory is notified &
10 Inventorymanagement immediate investigation is done to track the missing [Link] items on near
expiry are replaced before three months.

3. ORGANOGRAM
CHIEF OPERATING OFFICER

NURSING SUPERTENDENT

NURSINGINCHARGE

SENIOR STAFF NURSE

STAFF NURSE

CHAPTER-I - STANDARD OPERATINGPROCEDURES

4. Admission and Assessment of the

Patient ADMISSION OF THE PATIENT

Information from Admission Counter regarding admission (Non booking patient)
5. ReceivingofthePatient

Greet &‘Receive’the patient and the family and make him/her comfortable Introduce yourself to the
patient.
Maintain effective nurse–patient relationship Update bed status (occupied) after receiving the patient
6. Receiving of the Patients Files
Appointment list is given to the Medical Record Department from the reception to procure the files in
hand one 0daypriorFornon-appointmentpatientsinformMRDto procurethefileCheckthepatient’sfilesbeforereceiving
 7. NursingAssessment on Admission
Checkthebloodtestreportandanyothertestsifadvisedpreviously(Lowhemoglobin,whitebloodcellcounts,plateletcounts)
andanyfreshcomplaintsafterprevioustreatment(fever,cold,cough,diarrhea,vomiting,breathlessness,[Link]
f ChemoTherapy) Checkheightweight,vital signs andrecord
8. UniversalPrecautions orStandardPrecautions
UniversalprecautionsareHandHygiene and PPE

Hand Hygiene

Hand WashingandCareofHands:

[Link],
handsmustal ways be washedbefore andafterpatientcontact Atthebeginningand endofeachshift
Immediatelyafteraccidentalskincontactwithblood orother bodyfluids Aftertouchingin animateobjectslikelyto
becontaminatedbyblood orsalivafrompatientsBefore andafter touchingeyes, nose,faceor mouth,and usingthetoilet Before
andafter eating,drinking,smoking,applyingcosmeticsor insertingcontactlenses Beforegoinghomeattheend oftheshift
HandWashingTechnique with SoapandWater:
Remove alljewelries (watch, ring, and bracelet). Checksurfacesofhandsforsores, scrape
utsorhangnailsWethandwithrunningwater Scrubhands, nailsand for earmswithliquidgermicideagent
Sevenstepsofhandwashingto beimplementedthisshouldbe performedwithvigorouslatheringand
goodmechanicalfrictionTheuseof anantimicrobialhandwashingproductwillnotmake up for
[Link]

HandWashingTechniquewith AlcoholGel:
Remove all jewelries (watch, ring, andbracelet). Checksurfaces
ofhandsforsores,scrape,cutsorhangnailstakeapproximate5ml (2 press) ofalcoholgel,scrubhands, nailsand
forearmswithliquidgermicideagentSevensteps ofhand washingto be implementedthisshould be
performedwithvigorouslathering and goodmechanicalfriction Theuseof anantimicrobialhandwashingproduct willnotmake
up forpoortechnique Dryhands thoroughly.
PPE (Personal ProtectiveEquipment)
ArticlesRequired:
Goggle
sCapM
askGo
wnGlo
ves
Shoecover

When toWear thePPE:

Use appropriate type of barrier precaution for the type of procedure being performed and the type of exposure
anticipated. Wash hands between caring for different patients and after removing gloves. Wear gloves when direct
contact with moist body substances ([Link],sputum, blood, urine, cerebrospinal, synovial, pleural, peritoneal,
pericardia land amniotic fluids, semen and vaginal secretions).Wear a gown when clothing is likely to be soiled by a
body fluid. Wear a mask and goggles or glasses when splashes of a body fluid are anticipated ([Link] the most
invasive procedure).Wear a face protection (face shield) during procedure that is likely to generate droplets of blood or
body fluid to prevent exposure to mucous membrane of the mouth, nose [Link] hands or other skin surfaces
thoroughly and immediately if contaminated with blood, body fluids containing visible blood or other body fluids. Be
cautious while handling needles, scalpe blades laboratory instruments, also when performing procedures, cleaning
instruments, handling sharp instruments and disposing of used needles, etc. Place used needles, disposable syringes,
scalpel blades, and other sharp [Link] of put on PPE: Shoe cover Cap Gown Mask Goggles Gloves Order of
takeoutthePPE:GlovesGogglesMaskGownCapShoecoverWeightMeasurementWashhandswithsoapandwater oral
coholge l Every patient care unit has a balanced weight scaleWeight to be checked at the time of admission documented
in the chart When there is concern about the patient’sweight,weightsmay be done morefrequentlyas ordered bythe
Doctor The patient is weighed with clothes on, nothing in any pockets and without shoes on the same
balancedscale is used for every weight and document weight RecordingVital SignsWhen to Take:On admission, Daily
routine– 4th hourly, any changes in patient’s general condition.
ARTICLES REQUIRED:
Thermometer (Digital) Sphygmomanometer (Digital o rmanual) Different size BP cuffs Stethoscope
DAY CARE RECORD CHART PROCEDURE:
Collect the above-mentioned articles Explain the procedure and its purpose to the patient Assess the patient’s condition.
Assess there cording site Ask if he had taken any hot or cold drinks. If yes,wait for10-15minutes before checking the
temperature Make the patient sit on the recliner chair comfortably with for arm supported and the palm
[Link] Recording Wash hands with soap and water oral coholgel Clean the thermometer with AHD swab
Keep the thermometer in the axilla (for1 minute for oral and 2 minutes for axilla)once its giving the alarm slowly take
out the thermometer and read the recorded temperature and record in the [Link] check the respiration and
Heart rate after the procedure clean with AHD swab Assess the pain level with reference to the scale made available
and inform Consultant Mark the vitals in the chart immediately Report to the concerned doctor immediately incase of
any abnormality and record Check vital signs for all the patients fourth hourly.
Thethermometer tube cleaned with a AHD swab before and after use Battery replacement is indicated by a flashing
battery icon on the display screen Blood Pressure Monitoring-Manual
DEFINITION:
SPHYGMOMANOMETER:
A device consisting of an inflatable compression cuff linked to a simple air pump and a mercury manometer or an
aneroid gauge
AUSCULTATION:
A methodof determining systolic and diastolic pressures by listening to the arterial sounds
PALPATION:
A methodof determining systolic pressure by manually feeling the change in the radial pulse
Purpose:
Blood pressure measurement is important before and after administration of chemo medicines
Procedure:
Check BP apparatus for working conditionWash hands with soap and water oral coholgel Expose the arm for about five
inches above the elbow. Remove any restrictive clothing from the arm Cuff should be secure and fit
s nugly Center rubber bladder of cuff over brachialartery and wrap cuf firmly and smoothly around the arm,one inch
above the bend of the elbow (antecubital space).Position armsocuffis
atheartlevelIfneitherarmcanbeused,thecuffmaybewrappedaroundthethighandthestethoscopediscplacedatthepoplitealarter
y
NOTE:
Placebloodpressurecuffonnon-operativesideofallpost-
operativepatientsdonotcheckthebloodpressureforbabiesuptooneyearonanewpatient,youmayestimatethesystolicreadingby
[Link],findtheradialorpoplitealpulseInflatethecufftoabout30mmabovethe
pressureatwhichthepulsedisappearsDeflatethecuffslowlythelevelofpressure atwhichthepulsereturnsisnoted
[Link]:ThediastolicpressureisnotmeasuredthiswayDeterminebloodpressurebytheausc
ultatorymethod,asfollows:Locatestrongestpulsationofbrachialarterywithfingersandputstethoscopediaphragmagainsttheba
reskinatthisplaceAdjustearpiecesofstethoscopetopositionbestsuitedforyouInflatecuff,withairvalveclosed,toabout30mmab
ovetheexpectedsystolicpressureWhilewatchingmanometerscale,openthevalvetoallowslowescapeofair
notereadingwhenfirstsoundis heard. Continueto releaseairslowly, notingreadingof lastaudiblesound(ora change inthe
sound).Openthevalvecompletelyto releaseallairfromthecuffNOTE:If cuff
waspreviouslyinflated,droppressureto"0"beforere-
[Link]:[Link],wait20to30secondsbeforere-
[Link],itmaybenecessarytorecordbloodpressurewiththepatientintwo-
threedifferentpositionsBloodPressureMonitoring–with ElectronicMachine:Check BPapparatusforworkingcondition
washhands with soap andwateror alcoholgelexposethearmfor aboutfiveinchesabove the [Link]
anyrestrictiveclothingfromthe arm Cuffshouldbesecure andfitsnuglyPressthestartbuttonwaitfor 1
minuteandreadtherecordedBP,[Link]:Recordthe
vitalsignsimmediatelyaftercheckingTransferofPatientArticlesRequired:Patientfile,folder andanyold
recordsPatient’sMedicinesPatient’sBelongingsProcedure:Confirmwrittenorder
fortransferInformpatientandpatientattendantsaboutthetransferConfirmavailabilityof
bed/roomnumberfromtheadmissioncounterCheckand
Confirmwiththestaffnurseoftheareaforthereadinessoftheallottedroom/Bed to occupy
thepatientRaisethepatientbedtransferrequestinHIStotheBedManagerPatientsshouldbetransferin
safemannerAssignednursewillassesstheneedformodeoftransportWashhandswithsoapand
wateroralcoholgelIfpatienttobeshiftedinwheelchair&[Link],beforeshiftingthepat
ientAllpatientsshouldbe coveredwithhospitalbedsheet.
(RighttoDignity)Ensurepatient’sattendantaccompaniesthepatientduringtransfer to [Link]
ofpatientincludingmedicalrecords,medications,X-ray
films,spirometer,[Link] /oxygencylinderifrequiredArrangeformode
oftransport,wheelchair/Trolley/[Link](Patientfile,folder,
anyoldrecordsandMedicines)withhandovernotesHighlightthespecialneedsofthepatientoranyprecautionstobetakene.g:pot
entialtofall,pressuresoreand/orotherdisabilitiesBringbackTrolley/wheelchair, anylinenwhich belongs to
her/hisunitBloodGlucoseLevelMonitoring(GRBS-GlucometerRandomBloodSugar)and managementGlucometeris kept
in NursingStationNursingStaffaretrainedhowto theuseGlucometerAnydefector malfunctionof theGlucometerisreported
tothebiomedicalengineerGlucometerthataredefective ormalfunctioningarereturnedto
purchasedepartmentandpurchasereplacestheinstrumenttotheunituponrequestPatientswhorequireglucosemonitoringaretau
ghtto
checktheirownbloodwhentheyareabletodemonstrateunderstandingoftheprocessArticlesRequired:GlucometerBloodGluco
seTestStripsLancetsAHD swabDryCottonswabProcedure:CheckGlucometerfor workingconditionWashhandswithsoap
andwater oralcoholgelCleanthesitewithAHDswabInsertthetest striptothe
GlucometerObtainthecapillarybloodusingarecommendedlancingdeviceandanappropriatetechniqueAvoidexcessivesquee
zingofthe puncturesitePlaceonedropblooddirectlytothetargetareaoftheteststripDiscardtheusedlancetin
sharpcontainerPresstheprickedareawithdrycottonwithpressuretopreventthebleeding
TheteststartsautomaticallyGlucometerdisplaybloodglucoselevelOncethetestisover,remove the test stripfromthe
Glucometerdiscardtheusedteststripin
sharpcontainerDocumenttheresultsinthediabetesfollowupchart/observationchartEnterprocedureorderin
HISNursingDocumentation(DayCareRecord)Beginwithdate andtimeand end withfullname,EmpIDand
appropriatesignatureNotesshould be
writtenComplete,Accurate,Relevant,Factual,Timely,ClearlyOrderly&SequentialStressthe
abnormalfinding&variationsPresenceof treatmentPatientsresponseto theinterventionsRecordan
[Link] inpatientconditionandnotificationDescribethestatus ofthepatientatthe time
ofadmission,transferfromone nursingunittoanother,or at thetime ofdischargeDo [Link] a
mistake draw alinethroughtheentryand write“mistakenentry”Donotleavevacantspaces– Fillin asinglelineto
preventsomeoneelsewritingin thatspaceNursingEmpowermentPurpose:Toempowernurses ondecisionmakingin
relationto patient’shealthcareneedsTo demonstrateautonomy and assertivenessin
problemsolvingapproachtowardspatientcarePolicy:Itiscarriedoutbyaregisterednurseandmustbesupportedwiththedocume
ntaryevidenceofactiontakenonindependentjustificationProcedure:Nursesareempoweredtomakeindependentdecisionforpo
sitioning,backcareanduseofcomfortdevicesinregardto pressureulcerbased on
BradenScoreAssessmentNursesensuresafetyofpatientbyensuringuseofhandrubbyallthehealthcareproviderscominginconta
ctwiththe [Link] triagingindependentlyand informtheoutcome
oftheassessmentasrequiredNurseinitiatecodebluebasedonthepatientconditionbyherindependentclinicaljudgmentNursema
kesanannouncementinregardtovarioushospitalcodesaspertheneedNursesareempoweredandmotivatedtoreportMedication
Errorsand [Link]:Appropriatenursingformto beusedas [Link]:Allparts of
theformspecified to befilled timely,specificallyand [Link] berecordedin thetimeguidelinesas
[Link] blockof chartingwithfullsignatureandtitleshould [Link].
CHAPTER [Link]

Criticalvaluesshould [Link]
adviceCriticaltestvaluesmustbeinformedconsultantwithin30 minutesfromtheresultis available inthe
[Link] beinformedconsultantimmediatelybythe dutyDoctor/[Link]
[Link] clinicalpathology

Parameter Lessthan Morethan

Hemoglobin 7 gm/dL 19.0 gm/dl.
9
TotalWBCcount 1x 10 /L 50x 109/L
Neutophils ANC<500 ---
Platelet 30x 109/L 800x 109/L
INR --- 4
PTT --- 60 s
Malariascreen Positive
Microbiology and Virology:[Link] and
[Link] andcytology:Resultoffrozensection /intra –
[Link]:PCR:PML – RARCytogenetic:
(15:17)[Link]:Cardiacmarkers(CK -
MB,TroponinI&proBNP)areconsideredcriticalandwillbeinformedconsultant regardlessof thevalue.

Parameter Lowwarning Highwarning

Amylase(U/L) - 500
Bilirubin(mg/dL) - 2
Calcium(mg/dL ) 7 12
Ionized calcium(mg/dL) 3.5 5
CK(U/L) - 1000
Creatinine(mg/dL) - 3
Glucose(mg/dL) 60 250
Potassium(mmol/L) 3 5.5
Sodium(mmol/L) 120 150
Urea(mg/dL) - 40
Uricacid(mg/dL) - 12
Ammonia(µg/dL) - 30
Magnesium(mg/dL ) 1.5 -
Phosphorus(mg/dL) - 8
[Link]:Hand
rubTourniquetAmpoulecutterGlovesIVF: as pertherequirementIVSet3 wayconnector
(Ifrequired)Cottonballs(inthebox)AHDVenflow:AspertherequirementTegaderm
[Link] IVlineinsertionshouldbe
assembledatpatientsideCheckforanyallergiestoantiseptics,adhesives,[Link]
tshouldbesitinthereclinerchairExplaintothepatientAssesspatientcomplianceandgainthepatient'scooperationChoseagoodvei
nwithno phlebitisAvoidcannulationdistaltoanyrecentveinpuncture,siteof ajoint,
([Link]&anticubitalfossa)IVline insertionSHOULD NOT BEDONEon Mastectomyand axillarynode
clearancesideIVline insertionSHOULD NOT BEDONEONUPPER LIMBSIfpatienthadSVCS(SUPERIOR VENACAVA
SYNDROME )Applicationof tourniquetabove the10– 12
[Link]
cturesiteafterithasbeenpreparedInsertthevenflowchosenveinabout1-
2cmintotheveinObservetheflashbackforconfirmation ofentry in theveinReleasetourniquetHoldtheneedlestilland
completelyadvancetheplasticcatheterHold armup or havepressureappliedproximaltothecatheterRemove needle
partConnectpreparedfluid,medicineIf itisnotusedimmediatelyflushwith2ml
heplock/normalsalineputonthebungSecurewithDressingtegadermDispose ofcontaminatedmaterialsas perthe
BMWmanagementWhenapatientisreceivingIVtherapy,assignedNurseisresponsibleforcareoftheIVanddeliveryoftheprescri
bedIVfluids and [Link],identifytheproblemsandcorrectsthemDiscontinueIV’swhenthereis
anorderto discontinuetheIVtherapyIntravenous TherapyIntravenoustherapyisadministered bya
[Link]:RN starts anintravenousinfusion,adjustdriprates,and do IVtherapyas ordered
bythe
[Link](IV,IM,)aresenttoCDMRforreconstitutionalongwithchemoorderf
rom,[Link]/
trainindOncologistnurseintheappropriatesolutionasmentionedinthechemoorderformandlabeledonthemixedmedicinebott
lewithchemolabel(includespatientname,UHID, drugname,dosage,fluid,date) andsend tothe unitformwhereithas [Link]
there is anysuspicionof phlebitisofanIVsite,remove the cannula
andtakeappropriatemeasuresTheIVdressingisreplacedwhenthecatheterisremovedorreplaced,orwhenthedressingbecome
sdamp,loosened,or [Link] AccessDevise(CVAD)GeneralInformation:CVADis madefromanon-
irritatingmaterialsuch as siliconandtitanium,whichmeansthatitcanbeleftin place inavein forlongperiods
oftimeCentralVenousAccessDevice(CVAD)providesasystemfortheintravenousadministrationmedications,bolusinjections,I
VF,bloodproducts,TPN,[Link]
peripheralvenousaccessPhysicianperformsinsertion of CVADCVAD
insertiondoneunderlocalAnesthesiaorGeneralAnesthesiaThepositionofthecatheteris checkedwith anX-
rayafterinsertionWithanyCVADthereisariskofinfection,[Link]
etipofthe [Link] betimeswhenitis not possibletotakebloodsamplesfromthe
CVADProtocol:ManagementoftheCVADisperformedbyaqualifiedstaffnurseExplainthepatientaswellas
theattenderaboutCVADAdherencetoStandardPrecautionsandsteriletechniqueisrequiredduringinsertion,dressing,connecti
ng,disconnectingtubing,closing,flushing,administrationofmedications,bolusinjections,IVF,TPN,bloodproducts,bloodsample
collection,deaccessportneedlefromportNote:Competencyvalidationincludesassessment bya qualifiedobserverof
thenecessary knowledge,skills,
andabilitytoperformsaidprocedure,aswellasappropriatedocumentationinthefileoftheregisterednursewhoperformsthepro
cedureThequalifiedstaffnurseisalertforthepossiblecomplicationsordislodgementofthe
[Link],chillsorflu-
likesymptoms,painoraburningsensationwhileinjecting,arm,neckorshoulderispainfulandswollen,suddenonsetofchestpainor
difficultyinbreathing,dischargeand/
orrednesstrackingacrossthechest(implantedport),leakingunderthedressing,increasedanddecreasedWBCs,phlebitis(rednes
s,edema,
pain,leakage)GeneralGuidelinesforintravenousadministrationmedications,bolusinjections,IVF,bloodproducts,TPN,bloodsa
mplecollectionandflushing:Adherenceto StandardPrecautionsand steriletechniqueis
requiredduringinsertion,dressing,connectinganddisconnectingtubing,closingKeepallunusedlinesclampedatallthetimeClam
p the lumenwitheveryentranceandexitofthelineBeforeaccessinghubconnections,cleanthehub
withchlorhexidineswabandIVtubing(whiletheconnection is closed)Flush:10mlwithHeparin1000units/ml(5ml)
+Distalwater5mlorHeplock10mlafteradministrationmedications,bolusinjections,IVF,bloodproducts,TPN,bloodsamplecolle
ctionand discontinued,(closing)Iflumenflusheseasily butunabletoaspirate,repositionthepatient-suchaselevateheadofbed,
turnpatienttorightorleftside,placepatientflat,or raisethepatient’sarmon thesame sideasthe CVAD above the
[Link],slowlyMonitorcloselyforcontinuedpatencyIfunabletoflushaline,[Link]
[Link]“Clotted-do not use”When CVADisdiscontinued,
(closing)inspectthecatheterforintactness,redness,edema,leakage,suturearein placeIfredness,edema, pain,leakage, suture
arenotin [Link]
needfulIfpatientisrestlessorpullingontubes,obtainorderforuseofsafetydevice(Restrainsafterconsulting)topreventdiscontin
uation oflineIfacultureofthecathetertipisordered,usesteriledressingset,gloves,andscissors/
[Link] sterilecollectioncontainerandsend
tolabforculturesensitivitytestPlacegauzedressingon site,applypressureto prevent bleedingand observe
forbleedingIfremovalof catheterisordered,usesteriledressingset,gloves, andscissors/forcepstoremove the
catheterPlacegauzedressing onsite,apply pressuretopreventbleeding
andobserveforbleedingNote:ChemoportisremovedunderlocalAnesthesiaorGeneralAnesthesia
byPhysicianDocumentprocedure andpresenceofbloodreturnandalsopatient’stoleranceof
procedureTypesofCVAD:ImplantablePortCentrallines(skin-
tunneledvenouscatheters)ImplantablePortDefinition:AnimplantedportisatypeofCVADthatisinsertedunderthesurfaceofski
nintosubcutaneoustissue,[Link]
creservoirwithasiliconcover,[Link]
eportis
[Link]
t can beprickup to2000times andcan beremainin the bodyfor morethan5yearsWhenthe
portnotinuse,thepatientcancarryoutnormalactivities(exceptcontactsportsandswimming)Portcanbeusedonthesamedayoft
heinsertionPortneededtobeflushedoncein 4to 6
[Link]
trictionon activities iscontactsports,suchasrugby,which shouldbe avoided incasetheportis
damagedPurpose:Topermitrepeatedaccessforshortorlong-
termintravenousadministrationmedications,IVF,TPN,bolusinjections,bloodsamplecollectionAHD(chlorhexidine)Sterileglo
ves ofappropriatesizeHeparin 1000units/ml(5ml) + Distalwater 10mlor Heplock10ml10 cc syringe
x1Transparentdressing(TegadermNo-
8526)IVadministrationtrolleyLignocaine1%withoutepinephrine(optional)MaskProcessofAccessing:Assemblerequiredarticl
esfor accessingthe centralvenousportatbedsidePositionpatient(supineposition).Provideprivacy, expose portsitePuton
maskWashhandswithsoap andwater oralcoholgel as perpolicyPut on
sterileglovePlacesterilepaperfromopenedglovepackageonpatient’schest,justbelowtheportOpenthegloveanddressingsetby
assistantIfLignocaineisused,injectata5ºangle,0.05to0.10cc1%intradermal,attheintendedneedleinjectionsite.(The
sitewillremainnumbed upto
15minutes)PrepthesitewiththreeAHDswabsusingfrictioninacircularmotionOpenthechemoportneedlepackageentirely,keep
ingitsterileAttachfilled10mlsyringewithHeparin1000units/ml(5ml) + Distalwater 5mlorHeplock10mlPalpatearea
ofportprior topockthe needletodeterminethepreciselocationofportseptumSupportportwiththenon-
dominanthand,usingboththumb and indexfingertostabilizetheportWithdominanthand,using
afirm,smoothmotionatthepoint, penetrate the centeroftheseptumata90ºangleuntiltheneedlehitsthebottomof
thereservoir.CheckPatencyMaintainSterilityPlacethecontentsoftwopackagesoffolded2X2gauzeoneachsideoftheportNeedl
eorunderneaththeneedleandonegauzeshouldbeplacedontopoftheportdonotallowtheneedletobepulledbackwhenplacingt
hegauzeCheckforbloodreturnandflushtheportwith10mlsyringewithHeparin1000units/ml(5ml)
+Distalwater5mlorHeplock10mlPlacetransparentdressing(tegaderm)overaccessedportandlabelwithdateand time
ofinsertionofportneedleDocumentprocedure andpresenceofbloodreturnandalsopatient’stoleranceof
[Link] toadministerIntravenousmedications,IVF, andBolusInjections:Identifythe
correctpatientKeepreadythe medicineandChemo [Link]
(supineposition).Provideprivacy, expose portsiteCheckChemo orderformchartaccordingtothe drugadministrationpolicyto
ascertaintype ofmedicationCheckthe 5rightsof medicationadministration(Rightpt, drug,dosage,route,time)Puton
maskWashhandswithsoap andwater oralcoholgel as perpolicyPut on
sterileglovePerformprocedureusingaseptictechniquePreparedrugsasperintravenoustherapyguidelinescleanbionectorusing
[Link] todryAttachsyringecontaining10mlsyringewithHeparin1000units/ml(5ml)
+Distalwater5mlorHeplock10mltobionectorusingclockwise¼[Link],injectusingpositivepress
uretechnique,[Link]
[Link],removeemptysyringeandconnectsyringeorIVdripcontainingintravenousmedicationtoconnectoran
d commenceinfusionIfsyringepumpisused,connectthesyringetoconnector–
viaextensionline,securesyringetothepumpandcommenceinfusionIfinfusionpump is usedsecurethedriptotheinfusionpump
and startsinfusionClosethedripset&clampstheport,removeemptysyringe,discardandattach2ndmedicationsyringe/
IVDrip,unclamp bothclamps and recommenceinfusion.WhiledisconnectingattachsyringecontainingHeparin1000units/
ml(5ml)+[Link]& clamp the
portDocumentmedicationadministration
inchemoorderfromWithdrawingofBlood:Articlesrequired:HandwashsolutionSteriledressingsetSterilegloves
ofappropriatesizeAHDSyringes-10mlx 2, 5mlx1Heparin 1000units/ml(5ml) + Distalwater 10mlor
Heplock10mlrequiredvacutainersProcedure:AssemblerequiredarticlesforaccessingthecentralvenousportatbedsidePositio
npatient(supineposition).Provideprivacy, exposeportsitePuton maskWashhandswithsoap andwater oralcoholgel as
perpolicyPuton
sterileglovePerformprocedureusingaseptictechniquePlacesterilepaperfromopenedglovepackageonpatient’schest,justbelo
wtheportOpenthedressingsetbyassistantClean,catheterhub andcatheterlinewithAHD swaband allowto
dryAttachfilled10mlsyringewithHeparin 1000units/ml(5ml) + Distal(Distilledwaterforinjection)water5mlor
Heplock10mlpush2-
3mlofpreparedheparinsolutionclampthecathetertake10mlnewsyringeopenclampwithdrawing10mlbloodagainclamp
andtakenew syringecollecttherequiredmlof
bloodforinvestigationAftertakentherequiredsampleinjectthewithdrawn10mlbloodslowlyflushwithheparinsolutionandclos
etheclampEntertheinvestigationin HIS and sendthebloodsampletothelabalongwiththelab
samplesendingrequestDocumentprocedureDe-accessingof
Portneedle:Articlesrequired:HandwashsolutionSteriledressingsetAHD (chlorhexidine)Sterilegloves
ofappropriatesizeSterilegloveHeparin 1000units/ml(5ml) + Distalwater 5mlor Heplock10mlMicroporeSyringes-10mlx
1Procedure:Assemblerequiredarticlesforde-
accessingthecentralvenousportneedleatbedsidePositionpatient(supineposition).Provideprivacy, exposeportsitePuton
maskWashhandswithsoap andwater oralcoholgel as perpolicyPut on
sterileglovePerformprocedureusingaseptictechniqueOpentheglove and
dressingsetbyassistantPlacesterilepaperfromopenedglovepackageonpatient’schest,justbelowtheportClean,catheterhuba
ndcatheterlinewithAHD swab andallow todryAttachfilled10mlsyringewithHeparin1000units/ml(5ml)
+distalwater5mlorHeplock10mlopenclampcheckthe bloodreturnandfleshWhileflushingthelast 1mlof
heparinsolution,close clamp on tubingto preventbloodrefluxintointernalcatheterResttheside ofthedominanthand on
chestwhenpullingoutthe portneedle(toavoid rebound ofneedle)andsupportthe portin placewiththeindexfingerandthumb
ofthenon-dominanthandCleansitewithAHD
swabPlacegauzedressingonsite,applypressuretopreventbleedingandobserveforbleedingDocumentprocedureandpresence
of
bloodreturnFlushingport:Theportshouldbeflushedwhenthereareextendedperiodsbetweeninjections,infusions,orbloodsa
mplingsusingasteriletechniquewithHeparin1000units/ml(5ml)+ Distalwater5mlor
heplock10mlTheportshouldbeflushedoncein4to6weeksifitnotusedbyusingsteriletechniquewithHeparin1000
units/ml(5ml)Distal
water5mlorHeplock10mlPatientEducation:Patient/FamilyEducation:Priortoinsertionofthedevice,thepatient/
familyshouldbeeducatedregardingThepurposeanditsfunctionActivityrestrictions(contactsports andswimming)Careforthe
portsiteInstructionson homecarepriorto [Link]
least:Unlessthedeviceisaccessed(needleortubingattached), nospecialcareis
neededIfthepatientistobedischargedwithanaccessedportaldevice(needleandtubingattached),thephysicianmustbeawareth
attheportis accessedon dischargeandwhy,andthisinformationmustbedocumentedin themedicalrecord. The
siteshouldbecoveredwithatransparentimpermeabledressingandthepatientandfamilyinstructedtokeepthedressingclean
anddryand nottoattemptto cut,remove and/orotherwisealterthedressingor access
inanywayThepatientandattenderiseducatedtoregularlyinspectedandnotifiedimmediatelyforinfection,redness,leakage,pur
ulent drainage,bruising, or tenderness,feverandgeneralizedtirednessThephysicianshouldbeconsultedforinstructionon
anylimitationsofactivitywhichmay cause problemswiththeportCentrallines(skin-tunneled
venouscatheters)Definition:Skintunneledcentralvenouscatheteralsocalledexternalcatheter or
centrallineisalong,flexibletube. One
endofthecatheterisplacedintovein(e.g:Subclavian,jugular,femoral)oftheheartandtheotherend
[Link] 3-
6months(Ifnoinfection)Whenthecentrallinenotinuse,the patientcancarryoutnormalactivities(except contactsportsand
swimming)CentrallinecanbeusedonthesamedayoftheinsertionCentrallineneededtobeflushedoncein 7
daysPurpose:Topermitrepeatedaccessforshortorlong-
termintravenousadministrationmedications,IVF,TPN,bolusinjections,[Link]:Arti
clesrequired:[Link] (chlorhexidine).Sterilegloves ofappropriatesize.Heplock10ml.10 cc syringe x
[Link](TegadermNo-
8526).[Link]:Assemblerequiredarticlesfor accessingthe
[Link](supineposition).Provideprivacy, expose [Link]
[Link] andwater oralcoholgel as [Link] the dressingwhichis
[Link] glovepackage on
patient’schest,[Link] sitewiththreeAHD
[Link] and
[Link] of folded2X2 [Link] notallow thecathetertobe
pulledbackwhenplacingthe [Link](tegaderm)overaccessedline andlabelwithdateand time
[Link] andpresenceofbloodreturnandalsopatient’stoleranceof [Link]
administerIntravenousmedications,IVF, andBolusInjections:Identifythe [Link]
[Link](supineposition).Provideprivacy, expose
[Link] orderformchartaccordingtothe drugadministrationpolicyto ascertaintype
ofmedication.Checkthe5rightsof medicationadministration(Rightpt, drug,dosage,route,time)Puton
maskWashhandswithsoap andwater oralcoholgel as perpolicyPut on
sterileglovePerformprocedureusingaseptictechniquePreparedrugs as
perintravenoustherapyguidelinesCleanbionectorusingthe AHD [Link]
dryAttachsyringecontaining10mlsyringeheplock10mltobionectorusingclockwise¼[Link],inj
ectusingpositivepressuretechnique,andobserveforanyswellingaroundcentral
[Link],removeemptysyringeandconnectsyringeorIVdripcontainingintravenousmedicati
ontoconnectorand commenceinfusionIfsyringepumpisused,connectthesyringetoconnector–
viaextensionline,securesyringetothepumpandcommenceinfusionIfinfusionpump is usedsecurethedriptotheinfusionpump
and startsinfusionClosethedripsetandclampthecentralline, remove emptysyringe,discardandattach2ndmedicationsyringe/
IVDrip,unclamp both clamps and [Link]
[Link] dripsetand clamp the
[Link]
[Link]:Articlesrequired:HandwashsolutionsteriledressingsetSterilegloves
ofappropriatesizeAHDSyringes-10mlx 2, 5mlx1 Heplock10mlRequiredvacutainersProcedure:Assemblerequiredarticlesfor
accessingthe centralline atbedsidePositionpatient(supineposition).Provideprivacy, expose
centrallinesitePutonmaskWashhandswithsoap andwater oralcoholgel as perpolicyPut on
sterileglovePerformprocedureusingaseptictechniquePlacesterilepaperfromopenedglovepackageonpatient’schest,justbelo
wtheportOpenthegloveanddressingsetbyassistantClean,catheter huband catheterlinewithAHD swaband allow
todryAttachfilled10mlsyringewithheplock10mlpush2-
3mlofheplocksolutionclampthecathetertake10mlnewsyringeopenclampwithdrawing10mlbloodagainclampandtakenewsy
ringecollecttherequiredmlofbloodforinvestigationAftertakentherequiredsampleinjectthewithdrawn10mlbloodslowlyflush
withheplocksolutionandclosetheclampEntertheinvestigationin HIS and sendthebloodsampletothelabalongwiththelab
samplesendingrequestDocumentprocedureClosingofcentral
line:Articlesrequired:HandwashsolutionSteriledressingsetAHD (chlorhexidine)Sterilegloves
ofappropriatesizeHeplock10mlTransparentdressing(TegadermNo-8526)Syringes-10mlx
1Procedure:Assemblerequiredarticlesforde-
accessingthecentralvenousportneedleatbedsidePositionpatient(supineposition).Provideprivacy, exposeportsitePuton
maskWashhandswithsoap andwater oralcoholgel asperpolicyPut on sterilegloveRemove the dressingwhichis
presentPerformprocedureusingaseptictechniquePlacesterilepaperfromopened glovepackage on
patient’schest,[Link],catheterhub andcentralr
linesitewithAHDswab and allow to dry.Attachfilled10mlsyringeheplock10mlopen clamp
[Link] 1mlof heplocksolution,closeclamp on tubingto
preventbloodrefluxintointernalcatheterPlace thecontentsoftwopackagesoffolded2X2gauzedressing
onthecentrallinesiteand coverwith the transparentdressing(tegaderm)overgauzedressingandlabelwithdate andtime
[Link]’stoleranceof
[Link]:Thecentrallineshouldbeflushedwhenthereareextendedperiodsbetweeninjections,infu
sions,orbloodsamplings usinga steriletechniqueHeplock10mlThecentrallineflushinganddressingmustbe done oncein a
week&as [Link]:Patient/FamilyEducation:Priortoinsertionofthedevice,thepatient/
familyshouldbeeducatedregarding ThepurposeanditsfunctionActivityrestrictionsCareforthecentrallineInstructionson
[Link] least:Thecentrallinesiteiscoveredwith
atransparentimpermeabledressingand thepatientandfamilyinstructedto keepthedressingcleanand
dryIfthepatientistobedischargedwithanaccessedcentralline(needleandtubing
attached),thephysicianmustbeawarethatthecentrallineisaccessedondischargeandwhy,andthisinformationmustbedocume
[Link]
edtokeepthedressingcleanand dryandnottoattempttocut,removeand/orotherwisealterthedressingoraccessin any
wayThepatientandattenderiseducatedtoregularlyinspectedandnotifiedimmediatelyforinfection,redness,leakage,purulent
drainage,bruising, or
tenderness,feverandgeneralizedtirednessThephysicianshouldbeconsultedforinstructiononanylimitationsofactivitywhichm
aycauseproblemswiththecentrallineBlockage:Unusuallyhighresistanceencounteredwhileadministeringanyagentthroughth
[Link],Theadministrationofthefluidstopp
[Link]:Kinkingofthecatheterdueto [Link] the distalendagainst the wallof
[Link] [Link] [Link]
OutputMeasurement(DayCareRecord)Explainthepatientas well astheattenderabouttheimportanceofintake and
[Link],date,timeandamount,typeoffluidandtheadministrationtotalofthefluidintheintakeandoutputchartatt
he [Link] enterin
[Link]&[Link]
eticsand canpreventhyperkalemia [Link] care
ChemotherapyandproceduresDefinition:Aformalagreementthatapatient/attendersignaturetogivepermissionforatreatme
nt(medical,surgical,radiationetc.)afterexplainingthebenefits,risks,complicationsandquestionhave beenanswered
[Link]:InformedconsentisobtainedbytheConsultantortheassistantfora
llthetreatment(medical,surgical,radiationetc.)Toassurecorrectsiteprocedure,informedconsentdocumentationincludeswhe
nthepatienthasbeengivensufficientinformationso thathe/sheunderstandsthe natureofhis/

hercondition,thenatureandpurposeoftheproposedtreatment,thebenefits,risksandconsequencesoftheprocedureortreatm
ent,thefeasiblealternativeprocedureortreatmentandtheprognosisiftheprocedureisnotperformed
[Link]:Thefollowinginformationshouldbe
filledbeforetakingthesignatureofpatient/attender:Patientfullname,UHID,Age,Sex,Consultantname,DateandTimeDetailof
thetreatmentorprocedurename in particularconsentformSiteofprocedure-
[Link]-
routinediagnosticortherapeuticproceduresperformed in
thehospital,andnothavingaspecificconsentformthefollowingconsentformwillbeused:-Anyprocedureunderanyformof
anesthesiaAspirationcytologyBiopsyBonemarrowaspirationandbiopsyCatheterizationofmajorvesselsLumbarpunctureEndo
scopyof GIor respiratorytractInvasiveradiologicalproceduresGeneralConsent:GeneralConsent istakenatthetime
ofadmission [Link]:Thepriorityorderofsurrogatedecisionmakersis-
spouse,adultchildren,parents,adultbrothersorsisters,adultgrandchildren,significantother (closefriend).Closefriendmay
sign the consentformonlyin an [Link] signtheconsent
onbehalfofthepatientif:Thepatientis aminor(lessthan 18yearsofage)Thepatientis mentallyincapableof
[Link] [Link] 3 [Link]
physicallyincapableofsigningthe
[Link]“surrogatedecisionmaker”butmaybemodified
as perthepatientwishesor [Link]–minorspilllessthan
30mlmajorspillmorethan 30mlInformhazmatofficerContentsofComprehensiveSpillKit(Tobeusedfor
cytotoxic,blood/bodyfluids,Biohazard&MercurySpillManagement)

SlNo ContentsWithSpecification Quantity

 1 4%SodiumHypochloritesolutionortabletsof 500mlor 4Tablets
Dichlorolisocyanurate (NaDCC)
2 UnsterileGloves 5 pairs
3 DisposableApron 2 No
4 FaceMask– Regular 5 No
5 FaceMask– N95 (Chemospill) 1 No
6 AbsorbentPaper 5 Sheets
7 KidneyTray 1 No
8 Forceps 1 No
9 Goggles 1 No
10 YellowTrashCover 2 No
11 Block(Cytotoxicwaste) TrashCover 2 No
12 Card boardpieces(Anythickmaterial) 2 Pairs
13 Container with 1 No
alid(smallspecimencontainer)
14 Syringewithoutneedle(10cc) 1 No
15 Cap 2 No
16 Shoecover 2 Pairs
SpillManagementProtocol(CytotoxicDrugs):[Link]
chalkAssessthesituationanddeterminewhetherit’[Link]
spill(inareasotherthanCDMR)ismorethan100mlconsideritasmajorspilland
[Link].FormajorspillwearN95mask.
[Link] usinga
[Link]-
cleanablecontaminateditemsinCytotoxicWaste(BlackwithCytotoxicsymbol)[Link]
toPersonnel:Remove and
[Link]
[Link],removecontacts,ifpresent,[Link]
ushtheaffectedeye(s)withcopiousamountsofwater foratleast20 minutes,whileholdingbacktheeyelid(s).Staffshouldbe
senttotheemergency/[Link]
thproblems thatmightbe relatedto
[Link](Blood/BodyFluids/
BMW):[Link]
kupbrokenglass/sharps/
[Link]
ngpapertowelsordisposableabsorbentmaterialtoabsorbthebulkofthebloodorbodysubstances.Prepare1%SodiumHy
pochloritesolutionbydilutingthe100mlof4%[Link]
uid(quantityofthesolutiontobe approximatelyequaltothequantityofthespillage)andleaveitfor [Link] 20
minutes,remove the absorbentpaper and discarditin
[Link] a
[Link] PPEsusedas pertheBIO–
[Link](MercurySpill):Minimizetrafficaroundtheareathathas
[Link] [Link] onfacemaskin
ordertopreventbreathingof [Link] alljewelryfromhands andwrists
sothatthemercurycannotcombine(amalgamate)[Link]
ment(Rubbergloves,goggles,maskandapron)Locateallmercurybeadscarefully.Fill1/3rdof
[Link]
[Link] abroomor a
[Link] of cloth,carpet,mat,[Link] [Link] notsendthemfor
[Link] totheBiomedicalEngineerforre-use of [Link](Chemicals
inGeneral):Determineifthereis animmediatehealththreatto youor
yourneighborsIfso,alertneighbors,[Link] MSDSANDREAD THE
[Link],flammability, or otherpropertiesofmaterial(seelabeland
MSDS)Forflammables,remove
orturnoffallignitionsourcessuchasmotors,pumps,fridges,storedinflammablegases,[Link]
minor,begincleanupprocedureWear on gloves,eyeprotection,labcoat,etc.,Contain
andabsorbspillusingabsorbentsappropriateforthe [Link],
[Link] and
[Link],rags,equipment,[Link](SilverNitrate–
usedforFumigation):Smallamounts ofdilutesilvernitratesolution canbe flusheddown asinkwith alargequantityof
[Link] or heavydutyglovesmaybe
[Link]
[Link]
lowlyoveraperiodofhoursandareinitiallybrown,[Link],theycan
notusuallybe removedwithsoap and water,butgraduallydisappear asnew [Link]
and may
[Link]:[Link]
ganicnitratesareoxidizers and may
[Link]:[Link]
[Link]:Washoffwithsoapand
[Link]: [Link] shouldNOT cleanupa
spillif:Youdon’tknow whatthe
[Link]
[Link] symptoms
ofexposureMonitoringRefrigeratorTemperatureAllmedicationrefrigeratorsonpatientcareunitsaremonitoredthetem
perature ofthe refrigerator2-8degreeoneachshiftand documentedin [Link]
[Link] writetheadmissionanddischargeregister
andnightshiftstaff (NMD)updatesthecensusformTheMRDstaffwillverifytheaccuracyof
[Link]
isused on [Link] [Link]
[Link](nameandtitle)[Link]
legalname and no [Link]/blue
penCorrectanyerrorsinnurse’snotesbydrawingalinethrougherror,writingtheword"error"abovetheerrorandplacing
bracketsaroundtheerror,withtheinitials of thepersonmakingthe [Link]
progressnoteswiththe [Link]
toMRDafterPatientDischargedAftercomplicationsof allrecordfilesalongwiththefolderwillbesentto
[Link].C
HAPTER-IIIManagementofMedicationMedicationAdministrationBasicRules:Indentthe medicinesin HISwiththe
doctor’sorder&itcome [Link] medicinebeforereceivingand sign on
thebillcopy(twocopies)[Link](original)havetogiveittopatient/
[Link] creditpaymenttwocopieshave to [Link]
[Link]’trelyon the drugscolor,shape,orlocation
[Link]’tadministeranydrug-includingoverthe counterdrug,withoutadoctor’sorder.7
Medicationadministrationrights hasto
befollowedRightPatientRightMedicineRightDoseRightTimeRightRouteRightDocumentationRightObservation(postmedi
cationadministration)Checkthe labelagainst thedoctors’orderin
[Link]&verifychemoorderformthreetimes:WhenreceivingthedrugWhensendingthemedicine to
CDMRBeforeadministrationof
medicationWhenyoucheckthedrugname,[Link]
e anydoubtsaboutthedrugyou are giving,
[Link] ina quiet,well-
[Link]
[Link]’tgivedrugsanothernursehasprepared.“If
youdon’tknowadrugandit’sdosage,don’tgiveituntilyoufindoutDon’ttrytointerpretillegiblehandwriting, if have
anydoubtaskthe [Link] drugata [Link] patientbyhis IDband-don’tjustaskhis name
orcheckhisbed [Link],Documentonthe chemo orderformto
[Link] aspertheinstructionsofmanufacturerNursemustbethroughwith drugand
fluidcalculationNurse's shouldbetrained instartingIV’sAllmedicationsshould beadministered
byLicensedNursesonlyThetrainingclassesincludesfluidandelectrolytes,IVsolutions,CVAD,IVmedications,operating
syringepump,startingand [Link] for MedicationAdministrationAllmedicationsshould
beadministered
byLicensedNursesonlyPrescriptionOrderforMedicationGeneralGuidelinesThechemoorderformisusedasaprescriptio
[Link],[Link]
blechecksordersagainst the chemo orderformand validate correcttranscriptionandcorrectindentedmedicinehas
beensendfrompharmacyStorageofMedicationGeneralStorageCondition:Medicationsarestoredin
theflooraccordingto
themanufacturer'srecommendationAllmedicationsarestoredindesignatedareawhichissufficienttoensurepropersanit
ation,temperature,light,ventilation,moisturecontrol,segregation,and
[Link]&[Link] 24 hrs
[Link]
mperaturerangeof2to8degreeCandtherest ofthedrugsarestored at [Link]
allrefrigeratorsand recordingisdonein [Link] isfoundrepetitively,itwillbenotified
tomaintenance/[Link],alldrugswillberemoved&[Link]
uiredtemperaturerange of2to 8degreeC [Link]
Sound AlikeMedicinesConsiderations:“Lookalike and Soundalike”drugsasthosewhichare:Similarin
Packing,appearanceofthedosage formSimilarwhenwrittenas a
[Link] on
LASADrugsAtPrescribingend:To writechemo [Link] andbrandnames on chemo
[Link] MedicinesListispreparedofLASAdrugsessentiallyincludingallthedrugswithLookAlike–
[Link] Displaythe LASA list&colorcodingnextto
areaswherelookorsound-alikeproductsarestoredStoreproductswithlookorsound-alikenames in different
locationsAdministrationofLASADrugIdentificationofLASA drugs should
[Link] medicine to bedonebeforeadministrationHigh Risk MedicinesHigh
Risk Medicationsaredrugsthathave a highriskof causingsignificantpatientharmwhen theyareusedTominimize
theriskincludestrategiessuchas:Improvingaccessto [Link] High-
RiskmedicationsStandardizingthe ordering,storage,preparation,administration and
monitoringoftheseproductsEventualpromotionof
usingTallmanlettering,[Link]:CytotoxicagentsHeparininfusionsConcentratedelectrolyteInsulin–
bothcontinuousinfusionsand [Link](anti-
thromboticdrugs)[Link] usedin acuteconditionseg-
Electrolytes,PlasmaExpanders,[Link],druginteractionpotentialSpecialprecaution:H
[Link]
[Link]
bt,[Link] DeptofClinicalPharmacologyif any ADR
occurred.(WithADRForm)Avoidunapprovedabbreviations in
[Link]
RNas [Link],consumablesand deliversto
[Link](twocopies)alongwithti
[Link](original)havetogiveittopatient/[Link]
creditpaymenttwocopieshave to [Link]
andIVFcalculationIVFCalculation:TheNursingstaffmustbethrough in drugand
[Link]:Totalvolume(inml)ofIVF×
Dropfactor(dropsperml)TotaldurationoftimeinMinutesThemicrodriptubingsetdelivers60 drops
permilliliter(ml)offluid.Themacrodriptubingsetdelivers15 drops permilliliter(ml)[Link] delivers
20dropspermilliliter(ml)[Link]:Volume= Desireddose/Availabledose
xQuantityAdministrationofmedicineMedicationsarepreparedforadministrationand administratedonlybya
LicensedNurseDrugsshouldadministeredas soon as
possibleafterpreparationPreparationandadministrationofmedicationsincludesthefollowing:Whenadministeringthe
medicationstothepatient,eachpatientisidentifiedbypatient ID Bandandthefull nameof
thepatientThechemoorderformis
read,thedrug,dosage,route,dateandtimecarefullybeforeadministrationofmedicinesPrior
toeachmedicationadministrationthenursepreparingthepremedicationsas
[Link]
[Link]
[Link]
patientmouth tomake sure theoral medicationswereswallowedObservationfor30minutesafteradministration
ofmedicationAfteradministrationwritethetime on thechemo orderformand sign alongwithnameWhena
patientrefusesmedication,informthe consultantanddocumentin [Link] isresponsible toreportand
documentif
[Link]
ursingpersonnelwhoadministermedicationsaremonitoredthrough the
qualityimprovementprocessAllnursingpersonnelwho
administermedicationsarerequiredtoattendcontinuingnursingeducationclassesona
regularbasisChemotherapyAdministrationIntroduction:Itreferstocytotoxicdrugsusedto
treatcancerorthecombinationofthesedrugsinto [Link]
workbyimpairingmitosis(cellDivision),[Link] to
[Link] cellto undergoapoptosis(socalled“programmed
celldeath”)DefinitionofChemotherapy:-Chemotherapyistheuse ofchemicalsubstancesusedto [Link]
known aschemotherapyor antineoplastic andaretherapeuticagents,usedprimarilyforthetreatmentof
[Link] arehighlytoxic andconsideredtobe
carcinogenic,mutagenic&/orteratogenic. Most chemotherapydrugs arealsocytotoxicmeaningtheyaredetrimentalor
destructive tocellswithin the [Link]:-Able [Link]:-Ableto produce a
permanentchangeinthe geneticmaterialof [Link]: -Able tocauseabnormalitiesin an embryo or
fetusthatmay lead [Link]:TotreatthecancerpatientsTo
preventaccidentalcontaminationresultinginexposureofpersonneltocytotoxic and hazardousdrugsshouldbe
[Link]:Chemo orderformChemotherapeuticDrugs,other
requiredmedicationsandconsumablesIVtherapytrolleyCVAD
/PeripherallineNitrileglovesSyringepump/CardiacmonitorifrequiredEmergency
medications(crashtrolley)Suctionsetup/O2setupPreChemoTherapyAdministrationProcedures:Explaintothepatient
andfamilyaboutthechemotherapyAllchemotherapyordersmustbewritten and signedby a
[Link]
[Link]’scurrentheightandweightandCalculateBodySurface
Areas(BSA)arenotedonthechemoorderformTheDoctorhastoverifies,completebloodCount,RFT&LFT,hydrationstat
us,pre-medicationsallthe [Link] be verifiede.g.:-
MUGA,ECHO, [Link] the medication,dosage,routeof
administration,durationofadministration,andshouldbe written
onthechemotherapyorderformPrechemotherapychecklistshouldbefilledbynursealongwithBSA=Height(incm)xWeig
ht(inkgs)/3600=√Consentto betakenpriortoadministration ofchemotherapyeachcycleChemoreconstitutionhasto be
done bythe [Link] tobe administeredIV,IM, are sentto
CDMRforreconstitutionalongwithchemo order,chemoconsentandprechemo
[Link] CDMR byClinicalPharmacologist
intheappropriatesolutionasmentionedin thechemo orderformand labeled
onthemixedmedicinebottlewithchemolabel(includespatientname,UHID, drugname,dosage,fluid,date)and sendto
theunitformwhere ithascomePatientshouldbeencouraged
[Link]:Allnursingstaffwhoadmini
sterscytotoxicdrugsshouldfollow theguidelinesregardingtheroute-and accessdevice-
[Link]/whohavecertified(completedthe OncologyCertificationCourse)willonlybe
initiateandadministeredChemotherapyagentsExplaintothepatientbeforestartingthetherapyStartthepremedication
asperchemotherapyorder aftersendingthe chemomedicinetothe CDMRAllchemotherapy mustbeverifiedwithchemo
order andchemolabelbyadministeringnursebeforeadministering(flow
rateshouldbeaccordingtofluidcalculation)IVbolus
injectionshouldbegivenwithrunningline(normalsaline0.9%)Nitrileglovesmustbe
[Link] discardedinthe
[Link] on thechemo
orderformand sign alongwithnameDocumentationto becompletedbythe
administeringnursePostChemotherapyAdministrationProcedures:MonitorforanyAdverseDrugReactionifanyreacti
onsstopmedicationimmediately&informconsultantandasadvisedExtravasationskitmustbereadilyavailableonthenur
[Link]
[Link]
DrugReactionsandManagementADRAnadversedrugreaction(ADR) isan
[Link] occur followinga singledoseor prolongedadministrationofa drugor
resultfromthe combination oftwo or [Link](ADE)refers toanyinjuryoccurringatthetime a
drugis
usedHypersensitivityReactions:Anallergicreactionalsoreferredtoasahypersensitivityreactionisanoveractiveormisdire
ctedimmuneresponsethatresults inlocaltissueinjuryor changesthroughoutthe bodyin responseto
[Link] anditching,rashes,shortnessof
breath,wheezing, and lowbloodpressure,[Link] prevent/reducethehypersensitivityreactionsbeforegiven
thechemotherapydrugs pre medicationshould begiven as per
consultantadvicee.g.:Dexamethasone,Ranitidine,Pheniraminemaleate(Avil),Parecetamol,HydrocortisoneManagem
ent:IfpatienthavehypersensitivityreactionsstopthemedicineimmediatelyCheckthe vitalsigns and [Link]
theconsultantandfollowtheinstructionsasadvisedWritethe ADR formand give
ittotheclinicalpharmacologydepartmentChemotherapyrelatedsideeffectsCommonSideEffects:Nauseaand
vomitingMucositiesDiarrheaConstipationMyelosuppression orBoneMarrow
SuppressionormyelotoxicityBladderorurinarytoxicitiesDermatologicalreactionsFertilityproblemsOthers:-Depend
uponthedrugs usede.g:Peripheralneuropathy,pulmonaryfibrosisNausea and vomitingNauseaand vomitingare
common side effectsofchemotherapydrugsthatareused [Link]-vomiting(antiemetic)and anti-
nauseamedicationshould beadministered ½hour priorto beadministrationof
chemotherapyforallpatients.e.g:Granisetrone,Ondansetrone,Dexamethasone,[Link]
medicationincludesfordelayednausea and vomitingManagement:Checkthe
vitalsignsAssesspatienthydrationleveland informto theconsultant.(HydrationandIVantiemetics tobe given
andinvestigation:-CBC,electrolytesto besentasperconsultantadvice)Ifelectrolytesimbalancecorrectionto be given
itmay be oralorIVhas pertheconsultantadviceMucositiesThemouth and digestivetractarecomposed
ofcells(mucosa)thataremoresensitive to [Link] be relatedto thecanceritself,butmoreare
oftendue tochemotherapyor [Link] daysfollowingchemotherapydepend ondrugs used
patientsmay experiencea burningsensation,followed [Link] ulcerationdevelops,patientmay be
treatedwithsupportive as OP/IPuntilthecellsregeneratethemselves,whichtakesabout7to [Link] to
themucosa canfacilitateinfections,suchasCandida [Link]
[Link] betreatedwithtropicalanti-fungal. Wheninfectionismoresevere,oralketoconazole,fluconazole,or
intravenousamphotericinmaybe [Link] oralcomfortand nutrition,butadequatecarecan
[Link]:[Link]
primaryimportance,andshould be [Link] 3to 4times a
daywith a [Link] shouldrinsetheirmouth3-4times a daywithsaltwater, or
[Link]:Mouth
[Link],analgesics andanesthetics can
beused(Ifconsultantadvised)Xylocaineviscousis alocalanalgesics andanestheticavailableas gelor sprayusedto
decreasepain, buthas ashortduration [Link] usedpriorto meals,as
[Link](sucralfate)[Link]
ldnotbe used asthey may [Link], hot, [Link]
beput onsoftmoist food andliquidsDry mouth(xerostomia )canoccur in certainpatientsand can
beeasilytreatedwithdrinkingfluids,sodas,sucking Icechips,eatingfreshfruitsetc.(Skinremovablefruits
andhomemade)Preparationcontainingalcoholorglycerinshouldnotbe usedbecausethey may irritateoraggravate
[Link]-cancerdrugscandamage the
digestivetract,attimesleadingtodiarrhea.Specificdrugsparticularlyassociatedwithdiarrheaare5-
FU,methotrexate,cytarabine,[Link]
hould beadvisedwithdischargesummaryand should beeducatedtopatientand attenderhow andwhento
[Link]:Checkthe vitalsignsAssesspatienthydrationleveland informto theconsultant.
(HydrationandIVantidiarrhealtherapyto be givenand investigation:-CBC,electrolytesto be sent as
perconsultantadvice)Ifelectrolytesimbalancecorrectionto be given itmay be oralorIVhas
pertheconsultantadviceAdequatefluidintakeiscriticalinorderto [Link],soup or non-
caffeinatedbeverage isadequatein milddiarrhea,andoralfluidreplacementpreparationis
[Link] ina
[Link] a numberof drugsusedinthemanagementof
patientswithcancer,including:-Narcoticanalgesics,ChemotherapydrugsVincristine(Oncovin),vinblastine,and
vinorelbine(navelbine),and calcium-
[Link]
advisedwithdischargesummaryandshould be educatedto patientandattenderhowand when to
[Link]:Checkthe vitalsignsAssesspatientandinformto [Link] as
pertheconsultantadviceAdequatefluidintakeisimportantin
[Link]
ecreasein production ofcellsresponsibleforprovidingimmunity(leukocytes),carryingoxygen(erythrocytes),and/
orthoseresponsiblefornormalbloodclotting(thrombocytes)duetochemotherapyor
[Link]:Lowwhitebloodcell(Totalanddifferential)countsThrombocytopenia:LowplateletcountA
nemia:Lowred bloodcellcountManagement:In orderto speedup therecoveryand the activityof
WBCs,drugsGCSFs(Granulocyte ColonyStimulatingFactors)shouldbeadministeredas perthe
[Link](RDP or SDP dependupon plateletcount)should
beadministeredasperthe [Link] bloodtransfusion or oralsupplements (PRBCor
Wholeblooddependupon hemoglobin)shouldbeadministered as
[Link]
bladderandureterbothcyclophosphamideand ifosfamidecanirritatethebladder andureterleadingto a
[Link] asurinaryburningor
[Link]:Preventionofcystitisisachievedthroughfrequentvoidingan
d [Link],either
takenorallyorintravenously,dilutetheurinesuchthattheoffendingmetabolitesofthesedrugswillnotdamage the
liningofthebladder [Link]-protectantdrugcalledMESNA willbe given 0, 4,8 Hoursor
continuousinfusionasperthe Regimen used (MESNAis givenstartingwithifosfamide,after 4 hrsfromstartingand
after 8
hrsfromstaringofifosfamide,)[Link]
cardiactoxicity,such as doxorubicin,daunorubicin andtrastuzumab(herclon,biceltis) orradiationtherapyto the
[Link] decreasetheadverseeffectofchemotherapyis to
givedoxorubicin ina [Link]:MUGA or ECHO
(aspertheconsultantadvise)scanshouldbedonebeforestartingon thesedrugsandafter3cycles.Afterevery3 doses of
trastuzumab (herclon,biceltis).If EFis below 50%the drugs should notbegiven andinformto
[Link]
[Link],menopause,sterilityand
evenosteoporosis(fromestrogensdeprivation).Menmay have low
[Link] ofcomplicationsof
pregnancy,birthdefects,andmalignancyin [Link]-
dosevialsareusedwhenindicatedforadministration of [Link]-dosevialis openedas perinstructions onthe
vial, and [Link]-dosevialisconsideredexpiredonitsfactory-
labeledexpirationdate,oronemonthfromthe dateitwasopenedIntramuscularInjectionArticlesRequired:Chemo
orderformMedicine(Vialorampoule)Syringes-2ml/5mlSterilewaterforinjectionifneededIVTherapyTrolleyProcedur
e:Checkchemo orderform,medicationrightsandexpirydateIdentifypatient bycheckingidentificationbandand
byaskingpatientnameExplainproceduretothepatientAssesspatientcomplianceandgainthepatient'scooperationProvi
deprivacyGatherallarticlesatbedside ofthe
patientWashhandsLoadtheinjectionsinthesyringeaccordingtothechemoorderformofthepatientandaccordingtothedr
ugcalculationIf in powderform,dilutewithsterilewaterPrepareanairlockbydrawing0.2cc ofairin
syringe&[Link] dressdrapedoverbodypartsnotrequiringexposureAssisttothepatientliesflaton
[Link] [Link] swab, applythe swab atthe
centerofthesiteandrotateoutward in acirculardirectionforabout5cmRemove needlecapfromneedle
bypullingitstraightoffHoldsyringecorrectlybetweenthumb and forefingerof dominant handholdas
dartwithpalmdownPositionnon-dominanthandatproperanatomicallandmarksholdtheskintightwith thenon-
dominanthand andinjecttheneedlequicklyat90 anglesdeepintomuscleand [Link]
musclebetweenthumb and otherfingers
[Link]&withdrawtocheckanyvesselinjury,Ifbloodappearsinthesyringerem
oveneedlediscardmedicationandsyringe and repeatprocedureIf no blood injectthe
medicineslowlyWithdrawneedlewhileapplyingAHD [Link]
[Link] discardedinthe
[Link] on thechemo orderformand
signalongwithnameAskpatientforacutepain,burning,numbness ortinglingand [Link]
medicationin [Link]:Chemo
orderformMedicine(Vialorampoule)Syringes-2ml/5mlSterilewaterforinjectionifneededIVTherapyTrolleyProcedur
e:Checkchemo orderform,medicationrightsandexpirydateIdentifypatient bycheckingidentificationbandand
byaskingpatientfullnameExplainproceduretothepatientAssesspatientcomplianceandgainthepatient'scooperationPr
ovideprivacyGatherallarticlesatbedside ofthe patientWashhandsLoad theinjectionsinthe syringeaccordingtothe
MARof thepatientand accordingto the drugcalculationIf in
powderform,dilutewithsterilewaterOuterposterioraspectof [Link] frombelow costalmargin to
[Link] of upperback, upper
ventral/[Link]-
[Link]
skinelevatessubcutaneoustissue and maydesensitizearea.Injectneedlequicklyandfirmlyat45
[Link]&withdrawtocheckanyvesselinjury,Ifblood
appearsinthesyringeremoveneedlediscardmedicationandsyringe and repeatprocedureIf no blood injectthe
medicineslowlyWithdrawneedlewhileapplyingAHD swab
[Link] [Link]
discardedinthe [Link],burning,numbness
ortinglingand [Link] medicationin [Link]
Medications&Equipment’sDayCare unitobtain andmaintainsuppliesforimmediateand emergentcareof
[Link]:-emergency medicationbox,an IVtrayand
[Link] fromPharmacyon
indent/[Link] onindent/[Link]
crashcart,IVtray,intubationtrayeverymonthfor nearexpirymaterialsand
[Link] becheckedmonthlyand aftereveryusage andto bedocumentedinthe
[Link] defibrillator,laryngoscope,to becheckedeveryshiftand
documentThechecklistandcontentswould bethe same in
allthetimeArrangementoftheCrashCart:Crashcartispresentinthedaycareas
percrashcartchecklist&[Link] CheckList:
Checked byName:
Date: Time: Signature:
Medicines/ consumableswithnearbyexpirydates:
Drug/Consumable ExpiryDate Drug/Consumable ExpiryDate

DUEDATEFORNEXT CHECKING:
Particulars RequireNo ActualNo Remarks
[Link]
Laryngoscopepediatric& 1 each
adultwithdifferentsizesof blades
Boogie 1

E/TtubesNo- 1 each
2.5,3,3.5,4,4.5,6,6.5,7,7.5,8,8.5,9
LMA-1, 2, 3, &4 1 each
SuctioncathetersNo-10,12,14,16 2 each
O2masks – AdultandPediatric 1 each
Nebulisationmaskadultandp 1 each
ediatric
Nonre-breathingoxygenmask 1
CentrallinecatheterssinglelumenN 1
o. 16
YankarSuction(Poly suctionset) 1
1stSHELF
[Link] 10 Ampoules
[Link] 10 Ampoules
[Link] 05 Ampoules
[Link] 03 Ampoules
[Link]énaline(Adrenor) 05 Ampoules
2nSHELF
Ambu bagpediatric& adult 01each
Miglisforceps 01
Inj. 2% Lignocaine 01 Vials
Inj. 2% 01 Vials
Lignocainehydrochloride(Xyloca
[Link](Lasix) 05 Ampoules
[Link] 02 Ampoules
[Link] 02 Vials
Inj. Cardarone/Durone 05 Ampoules
[Link](Eptoin) 10 Ampoules
[Link] 02 Ampoules
[Link]/cpressin8mg 2 Ampoules
Inj.Hydrocortisone100mg 2 Vials
[Link] 2 Ampoules
LEFTFIRST
Oralairwaysize 1 to4 1 each
2%XylocaineJelly 1
StickingPlaster 1
LEFT SECOND
Cannula(Vasofix)size18,20, 22, 24 02 each
IVset(Dripset) 3
3 wayextensions 25, 50,100 cm 1 each
Tegaderm IVand Centralline 1 each
Tournicate 2
LEFT THIRD
Arteriallines/Pressurebags 1
RIGHT FIRST
SYRINGES(followingsizes)
01ml 2
02ml 5
05ml 5
10ml 5
20ml 5
50ml 2
RIGHT SECOND
Inj.Midazolam10ml 02 Vials
[Link] 02
ECG Electrodes 10Nos
RIGHT THIRD
Glovessize 6, 6.5, 7, 7.5, 8,8.5 02 each
BOTTOM SHELF
NS500ml(Plastic)&100ml 02 Bottleseach
DNS (500 mlPlastic) 02 Bottles
 RL (500 mlPlastic) 02 Bottles
25% Dextrose(100 mlPlastic) 02 Bottles
Haemaccel 01 Bottles
Hydroxyethylstarch (Hester) 01 Bottles
Normalsaline(500ml) 01 Bottles
OTHER ITEMSTOBEPRESENT
Scissorsto breakthe seal 1
INTHE
OxygenCylinder 1
Trolleycheckedfor movementofthe
wheels
CardioPulmonaryResuscitation(CPR)ToprovideastandardresponsepatternfromtheCodeBlueTeamforanycardio-
[Link]
hepatient’sfunctionalintegritybyprovidingthenecessarylifesupportmeasures,undertheAmericanHeartAssociationStandard
sof AdvancedCardiacLifeSupportPurpose:To providea basis for an organizedresponseto acardio-
[Link]:Ineveryindicated"CodeBlue"situation,cardio-
pulmonaryresuscitation(CPR)willbeinitiatedbyanytrainedpersonnel(BLS)inthe [Link]
callthespecifichospital number111toalertthe"CODEBLUE"teamshe/hewillinitiatethe
CPRMessagewillbee.g.:“CodeBlueatTower,Floor,Ward/Departmentandbednumber/
roomno,repeattwiceonPASThemessagewillfirstbeannouncedonPASbyEPBX Assistantstating:
“CodeBlueatTower,Floor,Ward/Departmentand bednumber/roomno twiceThecrashcartwillbe broughtto
thesiteimmediatelyAreanursewillinitiatethefollowingasindicated,tillthecodeblueteamarrivesPull curtainsto
[Link] wall,[Link]
patientif carotidpulseis absentOpenairwayRescueventilationwithairway,O2,ambu
bagandmaskTheCodeBlueteamwillrespondto thealertarea ina rapidand [Link]
Blueteam areasfollows:Intensivist,ICU nurse,areaNurse&supervisorondutyExtranursingstaffinvicinityof CODE to standby,
toassist [Link]:willassumemedicalresponsibilityfor the Code [Link]
and [Link]–Responsibilities:IVaccess20 or18 G cannulain toa
largerveinAdministerthemedicationsas perIntensivistorderCPRAttachelectrodesto defibrillator
andstartmonitoringleadIIDefibrillation,ECG [Link]-Responsibilities:Calls
[Link] nurseinwithdrawing/[Link],drugs used
[Link]-Responsibility:[Link]/
[Link]
atientto ICUif
requiredDocumentationMedicalemergency/ArrestEventRecorderwillberecordedbynursingsupervisor&completedbyIntens
ivist,MedicalOfficer.&the samewillbeevaluated [Link] bythenurseassigned
[Link] to
[Link]
softhecrashcartwillbe replenished and kept readyforuseThrombophlebitis and ExtravasationDefinition:Thrombophlebitis
is aninflammation ofa veinThrombus =BloodclotPhlebitis= VeininflammationExtravasationis aaccidentalleakage
andinfiltration of [Link] thesubstancethatis
extravasatedintothetissue,thedegree of injurycan range froma verymildskinreactionto [Link]
causedamage to thesurroundingtissue,nerves,tendons,orjoints. Somevesicantsdrugs cancauseextensivenecrosis,damage
and continueforseveralweeks [Link] a seriouscomplicationof
[Link] excisionofthe affectedarea,skingraftingand
[Link]:Explaintothepatients toinformif anypain,tingling, burningoraltersensation atthe
site andalongthe chestwall,neckand shoulderforCVP [Link] oneormore
ofthefollowingsymptomshaveoccurred:Observethecannulationsite forsign ofswelling,redness,leakage and
[Link] burning,[Link] bloodreturnisobtained and resistance
isfelton theneedleofthe syringe [Link] [Link]
[Link]:-Withreducepainsensationorpoorcirculation,SVCSpatients,veryyoungor
old patients,multipleveinspunctureorcannulasites,[Link] the cannulaApplytheice
packintermittentlyfor30 minutes inevery2 hoursfor 24
hours(Hotpackforvincaalkaloids)Thecoldpack/[Link] drygauze or
tissuepaperbetweentheskinand [Link] 1%creamevery6
hoursforthenext7days orforaslongaserythemacontinuesDrugs:-Analgesics,NSAIDS andAntibioticsDMSO:-
DimethylSulphoxide(DMSO)50 %every2 hoursatthe Extravasationsitefor
[Link].Infiltratethesitewith1500units of Hyaluronidasein 1ml
[Link]
theareatofacilitatedispersionSurgical:Bypassofthevein and amputation israrelyneededbutmay be recommendedin
somesituationsDocumentationFollowupPreventionofExtravasation:Onlyappropriatelytrainedstaffcan
administercytotoxicchemotherapyCarefullyselectionoftheappropriatesiteandvein(ideallyuse alargevein
inthehand)forcannulationwillminimize the riskofextravasations and willrestrictthedamage to tissuesif
[Link] anew goodsite,veinratherthanexisting
canulasiteandveinwithnophlebitisLocalwarmingwillhelptodilatethevein inthe handNevergive the chemotherapyin
theinnerwristwherethereis alittletissuecoveringand theanticubital fossawherethe veinsaredeepandlongerandmay
delaytheonsetof painand [Link] thejointsand vascularproblemswithimpairedcirculation(
lyphedema,patientwithperipheralcirculatorydisease)Avoidcannulationdistaltoanyrecentveinpuncture,siteof ajoint,
([Link] wrist&anticubitalfossa)IVline insertionSHOULD NOT BEDONEon Mastectomyand axillarynode
clearancesideIVlineinsertionSHOULD NOTBEDONEON UPPER LIMBSIfpatienthadSVCS(SUPERIOR VENACAVA
SYNDROME)Avoidsitesofprevious radiation
[Link] minimize theriskof repeated vein-
puncture [Link] bycheckingveinpatencyfree flow
ofsaline,erythemaand [Link] aninfusionmayindicateextvasationincreaseresistancemay
indicateadisplacedcannulaUse ofa CVAD
[Link] drugsinto a
[Link]
withestablishedfastflowingdrip(Normalsaline0.9%).Earlydetection ofsign
ofextravasationsPeripheralvesicantinfusionsmustnotbeadministeredvia an infusion [Link] ofinfusionpumpswithhigh
flowpressurecanincreasetheriskof injuryto
[Link]
patient’scondition,iffoundtobe fitadvicefor dischargeordersforthe
[Link] getitsigned
[Link] bereturnedandreturned
tothepharmacyMedications on discharge are indented bythenursingstaffasadvised inthedischargesummaryand
insurancepolicy(Allinsurancepatient3 daysdischargemedication andlessthan Rs 5000/-should
beindent.)[Link] alongwiththebillcopy
beforereceivingand sign on thebillcopy(twocopies)[Link]
billcopy(original)havetogive itto patient/[Link] creditpaymenttwocopieshave to
giveittopharmacyattendarOncethemedicinesreceived fromthe pharmacy,checkthe updatesand activitycardis
[Link] billisreadyPCC or Nurseinforms the patientrelativesto paythe [Link]
[Link]/nurseonself-
administrationofdrugs,wherepatientcanunderstandandfollow,wherethepatientisaminororpatientisunabletofollow,thenex
tofkinisexplained andsignatureshould betaken onthe dischargesummary&[Link]
by ----------------------DischargeSummaryis explainedto me and
Ihaveunderstood---------------------(Patient/AttenderSignatureCHAPTER-
IVSpecimenCollectionBloodSampleCollectionNursesaretrained
incollectionofbloodsample/ArticlesRequired:IVtherapyTrolleyVacuntainer/CollectionTubesSyringesProcedure:Checkthe
doctororder forinvestigationVerifythe patient'[Link],dietaryrestrictions,medications,timing, and
medicaltreatmentProperlabelingofvacuntainerwithPatientname,UHID,Consultant,Age/
Sex,Date,timebeforedrawingthebloodExamples
oflabeledvacuntainerareshownbelowEntrytobedoneinHISanddocumentedinthespecimendispatchregisterincludingPatient
name,UHID,Consultant,Age/Sex,Date,timeinvestigationname/names and [Link] drawnin
a specificordertoavoidcross-contaminationof [Link]:First-
blood culturebottleSecond-
coagulationtubeifjustaroutinecoagulationassayistheonlytestordered,[Link]
oncernregardingcontaminationbytissuefluidsorthromboplastins,thenonemaydraw a [Link] -non-
additivetubeWashthehandsIVtherapytrolleyforbloodsamplecollectionshouldbe assembledatpatientsideCheckfor
anyallergiesto antiseptics,adhesives, orlatex byaskingthe [Link]
besitinthereclinerchairExplaintothepatientAssesspatientcomplianceandgainthepatient'scooperationChose a
goodveinwithnophlebitisApplicationof tourniquetabove the 2inchesofselectedveinPut on glovesPalpation
ofveinCleantheskinwithAHDunidirectionalswabbing andallow skinto dryDonottouchthevenipuncture
siteafterithasbeenpreparedVeinpuncture:Theneedleshouldforma 15 to 30degreeanglewiththesurface of thearm,insertthe
needlethroughtheskinandintothelumen ofthe [Link] and
excessiveprobingObservetheflashbackforconfirmationofentryintheveinWhenthelasttubeto bedrawn isfilling,remove the
tourniquetRemove the needleusinga swiftbackwardmotionPressdown onthe gauzeoncetheneedleis outofthe
arm,applyingadequatepressureto avoidformationof ahematomaMixallappropriatetubesatthe patientsideDispose
ofcontaminatedmaterialsas perthe BMWmanagementRemovegloves and washhandsDeliverspecimens as soonas
possibletothelaboratoryalongwithregisterandgetacknowledgementfromthe labstaffDispose ofcontaminatedmaterialsas
perthe BMWmanagementDocumentationNOTE:Vacuntainerwithadditivesmustbe
[Link] be obtainedwhenthe bloodisnotthoroughlymixedwiththeadditive.1.
BloodSample CollectionforbloodCulture and SensitivityPurpose:To diagnosethepresenceofmicroorganismin the
bloodstream&to determinethesensitivityof microorganismsto particularantibiotics andto
facilitatethechoiceofappropriateantibioticsIndications:Havingtemperatureelevation>38.5ºto 39º[Link] or
symptoms ofsepsis(fever,chills,elevatewhitebloodcellscount,lethargy).Follow
upevaluationinthepatientwithprevioussepticemiatreatedwithantibioticsAvoid blood samplecollectionfromthe
mastectomyside-testresults may be
[Link](Superiorvenacavasyndrome )avoidcollectionofbloodsample
fromupperlimbsHematoma- may cause erroneoustest [Link]
isnotpossible,[Link]/bloodtransfusion– may dilutethespecimen,
so collectfromthe [Link],satisfactorysamplesmay be drawnbyfollowingtheseprocedures:Turnoffthe
IVforatleast30-60minutesbeforecollection ofbloodApplythetourniquetbelowthe [Link] veinotherthantheone
withthe [Link] [Link] 5 mlof
bloodanddiscardbeforedrawingbloodsamplefortestingEdematousextremities -tissuefluidaccumulationalterstest
resultsDocumentationArticlesRequired:IVTherapyTrolleyBloodculturebottles(aerobicandanaerobic)SyringesProcedure:Foll
owthestepsasbloodspecimencollectionprocedureBloodculturesampleshould be collectedbeforestartingthe
antibioticsPrimaryconcernforbloodculturetestispreventingcontaminationofthebloodfromskinorganismsObtain10mlblood,po
ur gentle5mltotheeachaerobicandanaerobicbloodculturebottlesMentionIf
Bloodculturesampleiscollectedfromcentralline,chemoportDocumentationUrinesampleCollectionfor UrineRoutine
andCultureSensitivityPurpose:ToassessurinarytractinfectionTo diagnosethepresenceofmicroorganismin theurine&to
determinethesensitivityof microorganisms toparticularantibioticsand
tofacilitatethechoiceofappropriateantibioticsIndications:Havingtemperatureelevation>38.5º to 39º
[Link](fever,chills,elevatewhitebloodcellscount,lethargy)Followupevaluat
ionin
thepatientwithprevioustreatedwithantibioticsArticlesRequired:SterilespecimencollectionbottleProcedure:Checkthe
doctororder forinvestigationandenter in HISVerifythe patient'[Link],dietaryrestrictions,medications,timing,
and medicaltreatmentProperlabelingofspecimenbottlewithPatientname,UHID,Consultant,Age/
Sex,Date,timeInstructpatientto washwithsoapand water and drywithtissuesand(midstem) void
alittleurineintotoiletbowlandthenvoidintosterilespecimenbottleUrineculturesampleshould be collectedbeforestartingthe
antibioticsEntryto bedone in HIS and documentedinthe specimendispatchregisterincludingPatient
name,UHID,Consultant,Age/Sex,Date,timeinvestigationnameandordernumberDeliverspecimens
tothelaboratoryalongwithregister and getacknowledgement fromthe labstaffDocumentinthe
patientsfileThroatswabcollectionfor
culture&sensitivityArticlesRequired:SterileGlovesCultureswabTonguedepressorKidneytrayProcedure:Checkthe
doctororder forinvestigationandenter in HISProperlabelingofspecimenbottlewithPatientname,UHID,Consultant,Age/
Sex,Date,timeEntrytobedoneinHISanddocumentedinthespecimendispatchregisterincludingPatientname,UHID,Consultant,
Age/Sex,Date,timeinvestigationname/names and
[Link]
patientAssesspatientcomplianceandgainthepatient'scooperationProvideprivacyMake thepatientto sitinfrontof
[Link] dryWearglovesKeepthetongue down witha tonguedepressorrubvigorouslywith acottonwool
swabovereachtonsiloverthebackwallof the pharynxandoveranyotherinflamed [Link] ofcontaminatedmaterialsas
perthe BMWmanagementPlacepatientin comfortablepositionRemove the gloves and wash handsDeliverspecimens
tothelaboratoryalongwithregister and getacknowledgementfromthe labstaffDocumentinthe
patientsfileWoundswabcollectionforculture&sensitivityPurpose:Todiagnosethepresenceofmicroorganism&todeterminet
hesensitivityofmicroorganismstoparticularantibioticsandtofacilitatethechoiceof
appropriateantibioticsIndications:Havingtemperatureelevation>38.5ºto 39º[Link] or symptoms
ofsepsis(fever,chills,elevatewhitebloodcellscount,lethargy).Follow
upevaluationinthepatientwithprevioussepticemiatreatedwithantibioticsArticlesRequired:[Link]
Hand
rubSterileGlovesDressingsetBetadinesolutionBetadineointmentAHDHeatSealPackA&CMicroporeCultureswabOthertopical
ointmentifconsultantadvisedProcedure:Followthestepsas dressingprocedure CHAPTER-
VEmergencyPatientsManagementProtocolsAnaphylaxisPolicy and
GeneralStatement:[Link],anaphylaxi
smayleadto shock,airwayobstruction,[Link]
theEmergencyMedicalSystem,informtothedutydoctor/consultant/physiciannurses
andotheremployeesrespondtoallsuspected cases of anaphylaxisandrenderfirst-
[Link],clinicalprivilegesandthelawsregulatingthe
[Link]:Anaphylaxis,alsoknown as "AllergicShock"is a severeallergicresponseto
medicationsandotherallergycausingsubstancessuchasinsectstings,[Link]
smaybeclassifiedaccordingtothelevelofthereactionand [Link]:Generalizeditching-
slurredspeechNasalcongestion-rapidpulseDifficultybreathing-palpitationsCough-nausea and
vomitingBluenessoftheskinDiarrheaand crampingFainting,lightheadedness-wheezing-
dizzinessSkinrednessandinflammation-anxietyNasalflaring–striderLowor
reducedbloodpressureManagement:MildReactionsAssesspatientandobtainhistory,i.e.,recentmedication,stings,bites,inges
[Link]
[Link] /[Link] managed at
[Link] patientsfileHemorrhage:-Internal and
ExternalPolicy:Alldiagnosedcasesofhemorrhage,eitherinternalorexternal,notincludingsmallopenwoundsthatcanbe
treatedbyfirstaidmeasures,arereportedtotheDutyDoctor,supervisor ondutyProcedure:Smallopen woundsmay be treated
bystaffnursewithfirst aid(appliedpressureand
drysteriledressing).Casesinvolvingpossibleinternalinjuries,fractures,bleedingdisorders,infection,dehydration,changeinvital
signs,uncontrolled bleeding, or headinjurieshave thefollowingordersinitiatedimmediatelyAssessvitalsignsand raisethe
codeblueIVRingerlactateorNormalSalinesolutionrunasfastaspossiblewith18
gaugeneedletoprepareforbloodorplasmatransfusionTreatthepatientaccordingto
theintensivistorderDocumentinthepatientsfileElectricShockPolicy:Firstaidcare given to a
[Link]:Switchoffcurrentifpossibleorremovethepatientfromthesourceofcurren
twithnon-conductingmaterialsuchas a woodenbroomor [Link] done,the
[Link] be [Link] and mange as
[Link] of secondandthirddegreeburnswithsteriledressingsStartan
IVwithRinger Lactate orNormalSalinesolutionusinga 18 gaugeVitalsigns to
becheckedfrequentlyIncidenttoberaisedNotifyhospitalGeneralManagerMedicineDocumentinthe
patientsfileDrugOverdosePolicy:Allcases ofpoisoningestion or overdosearereportedto the DutyDoctorProcedure:Whena
poisonhasbeenswallowedAssesspatientandtypeandamountof [Link] and mange as
perthecodeblueguidelinesInquiriesofthefamily,friends,[Link]
[Link] ICUand the
patientshouldbestrictobservationNotifyhospitalGeneralManagerMedicineIncidenttoberaisedSecuretheroomand do
notremove anyitems fromthe [Link] patientsfileSeizure

Policy: Thefollowingprotocolforseizuresisformulatedforusebythemedicalstaffattheirdiscretionandbythenursingstaffwhe
n no physicianor nursepractitionerisimmediatelyavailable.
Definition:Seizureisasuddenandoftenviolentcontractionandrelaxationofthemuscles,causedbyuncontrolled
electricalactivityinthe [Link]:Briefblackoutorperiod ofconfusedbehaviorDroolingor
frothingatthemouthGruntingor snorting -localizedtinglingortwitchingofan isolatedbodypartLoss
ofbowelorbladder [Link]-lossofconsciousnessTemporaryabsence of
breathingVigorousmuscle spasmswithtwitchingandjerkingofextremitiesCauses:Historyof
epilepsyMedications(thathaveloweredtheseizurethreshold)PoisoningHeadinjuryHeatstrokeFeverElectroly
teimbalance(hypernatremia-fromexcessivefluidconsumption)Procedure:Identifythe seizure
[Link] and mange as
perthecodeblueguidelinesBepreparedtodescribeitindetail,includinganyinformationthatmayhelpwithdiagn
osisandtreatment,i.e.,recentexcessivefluidconsumption,fallorheadinjuries,recentchangesinmedications,p
ossibleexposuretotoxins,poisonsorillegaldrugs
[Link],completebloodcellcount,electrolyt
es,bloodglucose,[Link] notrestrainthe [Link] notplaceanythingbetweenthevictim’s
teethduringa seizure. DO NOTmovethe [Link] nottryto make the victimstop [Link]
notperformrescuebreathing,even if [Link]
notgiveanythingbymouthuntilseizureshavestopped&
[Link],i.e.,furniture,fallingGentlysuctionsecretionsinnose
and/ormouth,[Link] at4 to6 L/minute,Do turnthepatientontheirsideif
[Link] is suspectedadminister100mlof 25%glucoseIVTreatthepatientas
pertheadviceofthedoctorDocumentinthe patientsfileCHAPTER-
VIOtherProtocolsApplicableNABHStandardsStdNo Standard Measurestaken
bytheDepartmentAAC.3Thereisan appropriate Refer PolicyonTransferof [Link]
transferorreferralof patientswhodonotmatchtheorganizationalresourcesAAC.4 Duringadmissionthe
Planofcareisexplained bythe [Link]/orfamily
Wheneverthepatient/familyneeds anymembers areeducatedto
clarificationorfurtherexplanationthe samemakeinformeddecisions shallbe given bythe
[Link].5 Patientscaredfor bythe
Allthepatientwhogetsadmittedforthefirstorganizationundergo antimewillbe
assessedcompletelyas perestablishedinitial protocol writtenin [Link]
subsequentadmissionsonlythe changesfromthe previousadmission arenoteddown.
[Link].6 Allpatientscaredbythe
 Regularreassessmentis documented inorganizationundergo a nurse’[Link]
Initialregular reassessment assessment&[Link].13 Patientcareiscontinuous
Communicationchannelsarekeptopenand multi-disciplinaryin amongallthe [Link]
isdonenature throughvariousrecordsinthecasefile,handingovertakingovernotes,referralforms
[Link].14 Theorganizationhasa Refer policyon dischargeofpatientsDocumented

AAC.1 Organizationdefinesthecontent Refer policyon dischargeofpatients

5 ofthedischarge
summary
COP.1 UniformCare ofPatientsis Patientswiththesamehealthproblems and
providedin all settings of careneeds,receive the samequalityof
the organizationandis healthcarethroughoutthe organization
guided bythe applicable irrespective ofcategoryof wards.
laws,regulationsand
guideline
COP.2 EmergencyServices are Therearespecificprotocolsdocumentedin
guided bypolicies, [Link]
procedures,applicable are mentionedinthe SafetyManual.
laws andregulations
COP.4 Policies andprocedures Theprotocolfor providingCPRis given in
guide thecareofpatients [Link]
requiringcardiopulmonary trainedin CPRona regular [Link]
resuscitation eventsofCPRarerecordedbythe nursing
[Link]
post-eventanalysisandaccordingly
preventive/correctiveactionsaretaken.
COP.5 Policies andprocedures Consentistakenbeforeeverytransfusion
definerationaluseofblood patientsareeducated aboutthetransfusion,
&bloodproducts risks,complications,[Link] the eventof
transfusionreaction,theformis filledup and
forwardedtoTransfusionCommittee.
COP.6 Policies andprocedures Admission&dischargecriteriaforICUis
guide thecareofpatients defined,nursingstaffareawareofthese
in theIntensiveCareand [Link]
HighDependencyUnits through

COP.7 Policies andprocedures Refer policyon vulnerablepatients

guide thecareof
vulnerablepatients
(Pediatric,physicallyand/
or mentallychallenged)
COP.9 Policies Refer policyon Pediatricpatients

andproceduresguide andalltheprotocolsrelated topediatricpatients.

COP.1 thecareofPediatricpatients
Policies Refer policyon ModerateSedation
0 andproceduresguide
thecareofpatientsundergo
ingmoderatesedation
COP.1 Policies Refer OT protocols
2 andproceduresguide
thecareofpatientsundergo
ingsurgicalprocedures
COP.1 Policies Refer policy
3 andproceduresguide onRestraints
thecareofpatientsunderre
straints(physicaland/orch
COP.1 Policiesandprocedures Refer policyon PainManagement
4 guideappropriatepain
management
COP.1 Policies andproceduresguide ReferpolicyonEndofCar
8 theend oflifecare e.

MOM. Policies LASAand Highriskmedicinelistis

3 andproceduresguid madeavailablein
e thestorage allthenursingunits,storageconditionsarec
ofmedication hecked,refrigeratortemperatureis
[Link]
MOM. Policies Refer Managementof medicationmanual.
4 andproceduresguide
theprescription
ofmedications

MOM. Policies Refer Managementof medicationmanual.

5 andproceduresguide
thesafedispensingof
MOM. Therearedefinedprocedure
medicines Refer theprotocolsinthismanualand
6 sformedicationadministrat alsoManagementof medicationmanual.
ion
MOM. Patients Patientandfamilymembers
7 andFamilyMembersareed areeducated
ucatedaboutsafemedicatio [Link]–
n andfood druginteractionis
MOM. Patientsaremoni Patientsaremonitoredafter medicationadministrationfor anykindof
8 toredaftermedic [Link]
ationadministrat suchaneventClinicalPharmacologistisinformedand
ion thentheADRformis filled upand given to
clinicalpharmacologydepartment

MOM. Policies Refertointegrativeoncology manual.

9 andproceduresguide
theuseof
NarcoticDrugs&Psychot
MOM. Policies Refer Managementof medicationmanual.
10 andproceduresguide
theusage
PRE.2 ofchemotherapeutic
Patientandfamilyrightssup Dietarypreferencesareworshiprequirementso
portindividualbeliefs,valu fthe patient/familyarefulfilled
esandinvolvethepatientan [Link],dignity,privacya
dfamilyindecision- nd
makingprocess. confidentialityaremaintainedthroughoutthec
[Link]

the patientorfamilyagreesto it.(Incase

ofminor,parentsand
mentallyunstable,unconsciouspatientsattende
d hastoagreesto it) Incase of
refusaloftreatmentthedoctorexplainstheconse
[Link]
takenbeforechemotherapy,surgicalprocedure
,investigationconducted,transfusion,participa
 PRE.3 Documentedprocessforobt Refer policyon informedconsent

ainingpatientand/
orfamily’sconsentexistsfor
informeddecisionmakinga
PRE.4 Patientandfamilieshave Educationis givenatallstages of care.

arighttoinformationand
educationabouttheirheal
HIC.4 thcareneeds.
Thehospitaltakesaction Infectionratesare
sto [Link]
preventorreducetherisks ationispassed ontothenursingstaff
ofHospitalAssociatedIn regardingtheperformanceintheirareaandalsot
fections(HAI) in heimprovementmeasuresto betaken by them.
HIC.8 Statutoryprovisionswithreg Wasteis segregatedandcollectedindifferent
ardto bio- [Link] is
medicalwaste(BMW)mana donebytheinfectioncontrolteam.
CQI.5 gementare
Thereisan complied. Nursingauditsarecarriedoutbytheseniornurses
establishedsystemfor .Documentsarechecked on a
auditofpatientcareservices [Link] the
IMS.3 Theorganizationhasacomplete nursingcareactivitiesis carriedatleastoncein 3
[Link]
andaccurate ecordentryis
medicalrecordforeveryp [Link] contents
atient ofamedicalrecordismadeavailableintheformo

IMS.4 f checklistwhichis filedin the samefile.

Themedicalrecordreflectsconti Themedicalrecordcontainsinformationfromadmissiontilldischarge.
nuityof care
IMS.5 Policies Allstaffaretrainedandre-

andproceduresarein trainedtomaintainconfidentiality,integrityandsecurityof

placeformaintainingconfid [Link]/familycan

entiality,integrityand accessthemedicalrecordonlythroughMRD.

IMS.7 securityofinformation
Theorganizationregularlyc Medicalrecordsarereviewed on
arriesoutreview aregularbasisthroughdeficiencychecklistinth
ofmedicalrecords. [Link]
andgives theinformation on
QualityIndicators [Link]
 Indicators Datacollectedfor analysis

Numberofpatientsfor AdmissionRegister
whominitialassessmentcompletedwithin 30 minutes
Numberof fallswithinjuries QualityIndicatorRegister
Numberof fallswithoutinjuries QualityIndicatorRegister
Numberof extravasations QualityIndicatorRegister
Numberof Medicationerrorsreported QualityIndicatorRegister
Numberof AdverseDrugReactionsreported QualityIndicatorRegister
Percentageofmedicationchartswithillegiblewriting(observed QualityIndicatorRegister
duringthe month)
Numberof otheradverseevents QualityIndicatorRegister
[Link] of Applicable Hospital Policies

SN Policy&Procedure on DocNo
1 RegistrationandAdmission RCH/POLICY/01

2 Nonavailabilityof beds RCH /POLICY/02

3 Transfer of patients RCH /POLICY/03

4 InitialAssessment&Regularreassessment RCH /POLICY/04

5 Discharge ofPatients RCH /POLICY/05

6 EmergencyCare RCH /POLICY/06

7 HandlingMedicoLegalCases RCH /POLICY/07

8 Code Blue RCH /POLICY/08

9 Vulnerablepatients RCH /POLICY/09

10 Moderatesedation RCH /POLICY/11

11 PatientIdentification RCH /POLICY/12

12 Restraints RCH /POLICY/13

13 PainManagement RCH /POLICY/14

14 Researchactivities RCH /POLICY/15

 15 End oflifecare RCH /POLICY/16

16 Medicalgases RCH /POLICY/17

17 Informed Consent RCH /POLICY/18

18 Sentinelevents RCH /POLICY/19

19 RiskManagement RCH /POLICY/20

20 Smoking RCH /POLICY/21

21 InformationManagement RCH /POLICY/22

22 MedicalAudits RCH /POLICY/23

23 Patient&VisitorComplaints RCH /POLICY/24

24 PatientValuables RCH /POLICY/25

A. ListofDocuments and RecordsListofRegisters:

SN Title RecordNo Entriesmade by

1. Master Inventory REG/NUR/01 NursingStaff

2. DailyDrugInventoryC REG/NUR/02 NursingStaff
heckingRegister
3. CrashcartRegister REG/NUR/03 NursingStaff
4. StaffAllocationRegister REG/NUR/04 NursingStaff

5. GlucometerRegister REG/NUR/05 NursingStaff

6. Lending/Borrowing-Equipments REG/NUR/06 NursingStaff

7. CSSD Register REG/NUR/07 NursingStaff

8. DefibrillatorCheckingRegister REG/NUR/08 NursingStaff
9. WardStockRegister REG/NUR/09 NursingStaff

10. Things and EquipmentRegister REG/NUR/10 NursingStaff

11. BiomedicalComplaintRegister REG/NUR/11 NursingStaff
12. BiomedicalEquipmentRegister REG/NUR/12 NursingStaff
13 DepartmentalTrainingRegister REG/NUR/13 NursingStaff

14 ChemoDrugMixingRegister REG/NUR/14 NursingStaff

15 QualityIndicatorRegisters REG/NUR/15 NursingStaff
ListofReferencesICU-Protocolsand AlgorithmsInfectionControlManualSafetyManualRadiationOncology-
DepartmentalManual