Part Two

- Public Policies

·       A brief overview of the policies

·       Evaluation policies

·       Policy on assessment areas and content

·       Timeframe policy for completing the assessment

·       Minimum frequency and re-evaluation content policy

·       Pain assessment, re-evaluation and management policy

·       Nursing plan policy

·       Nursing registration policy

·       Policy for assessing patients for abuse or neglect

·       Minimum medical history and clinical examination policy

·       The policy of identifying the categories of hospital patients most at risk

·       Medical files

·       Policy for uniform and consistent content of the patient’s medical file

·       The policy of who has the authority to write in the patient’s medical file

·       The policy of who has the right to view the patient’s medical file to ensure the confidentiality of the information

·       The policy of protecting medical records and information from loss, damage, tampering, and unauthorized use or access

·       Medical files disposal policy and the duration of keeping records and files

·       Screening process policy to determine patients' medical and nursing care needs

·       Policy of information given to the patient and family upon admission to the hospital

·       Patient management policy in the event that there is no available space for the requested medical service

·       The policy of coordination and cooperation between all departments (including doctors and nursing staff) through the internal departments

·       Policy for terminally ill patients

·       Patient transfer, referral and discharge policy

·       The hospital’s medical emergency response policy

·       Health education policy for patients and their families

·       Unforeseen events policies

·       Incident reporting policy

·       Policy for intensive analysis when unexpected events occur

·       A list of facts that can be reported

·       Patient rights policy

·       Patient responsibilities policy towards the hospital

·       The policy of refusing or not continuing treatment for the patient

·       Patient complaints and suggestions policy

·       Policy for obtaining informed written consent

·       The policy of informing the patient of the outcome and expected costs

·       Patient property preservation policy

·      Patient safety and security policies

·      General standards

·       Correct patient identification policy

·       Patient delivery and receipt policy

·       Policy to avoid incorrect connection of catheters and tubes

·       The policy of preventing patient falls and taking the necessary measures to avoid falls

·       Policy for the safe use of restraint and seclusion

·       Critical Consequences and Critical Warnings Policy

·       Medication-specific standards

·       Policy for handling high-risk medications (including concentrated solutions).

·       A list of high-risk medications

·       The policy of obtaining a list of the treatment that the patient takes when entering the hospital and upon discharge

·       Policy on medicines that are similar in form and pronunciation

·       A list of medications that are similar in appearance and pronunciation

·       Policy for labeling medicines and their containers

·      A list of abbreviations that should not be used in writing medications

A brief overview of the policies

The policies that will be presented are just a model, and the hospital has the right to make the policy in accordance with its work system.

The policy is reviewed every three years unless there is any change in it during those three years.

At the beginning of each policy, fill out the table as follows:

Policy name	Write the name of the policy	Policy number	Numbering as you see the hospital
Policy type	Either public or private	issue number	the first second...
Release Date	History of the Department of Politics	Review Date	Policy revision date
paginate	1,2,3...	Policy adoption	Hospital stamp

Evaluation areas and content policy according to each department

Policy: The hospital is committed to clarifying the areas and contents of the evaluation according to the Artificial Kidney Unit section.

Purpose: To clarify the areas and contents of the assessment according to each section, which helps to provide appropriate medical care to the patient, reach an accurate diagnosis, and develop a treatment plan.

Working procedures:

First: The treating physician:

1-    The initial patient evaluation must include identifying the patient’s personal history, complaints, and family history.

2-    Initial patient evaluation must clarify the patient’s medical history and medical examination, which includes (vital signs - examination of body systems according to specialty and condition).

3-    Reviewing the results of any evaluation conducted on the patient outside the hospital (medical report) before admitting the patient for treatment inside the hospital.

4-    Identifying the patient’s previous treatments and the extent of his response to them in order to:

·    Determine the initial diagnosis.

·    Determine the research required for the patient.

·    Develop an appropriate treatment plan.

·    Identifying the patient’s medical care needs and choosing the best care for him.

5-    The doctor re-examines the patient clinically after reviewing the patient’s complete medical history, within 24 hours of the patient’s admission to the hospital, in accordance with the medical history and medical examination form.

6-    Each of the departments determines the content of the medical evaluation according to the specialty and clinical work guides (heart, women, dialysis, premature infants).

7-    The doctor records the diagnosis, examination results, and medical history in the patient’s file and signs it with the date and time.

8-    The doctor re-evaluates the patient based on the results of the tests and examinations and the progress of his health condition. He registers and signs, writing the date and time in the patient’s file.

Secondly, nursing:-

·       The nursing staff evaluates the patient upon admission to the hospital using the nursing evaluation form.

·       Initial information and data are recorded when the patient enters the department on the patient’s nursing evaluation form:

-       Vital signs (pressure - pulse - respiratory rate - temperature).

-       Weight and height.

-       The presence of allergies.

-       Pain assessment

-       Evaluation of skin condition

-       Assess the patient regarding the possibility of a fall

-       Nutritional assessment.

-       Evaluation of motor activity.

-       The patient’s need for restraint or isolation.

-       Informing the patient of his rights, responsibilities, and hospital policy within 24 hours of admission.

Third, anesthesia:

The anesthesiologist assesses the patient's condition:

Before administering anesthesia according to a pre anesthesia sheet form showing the type of anesthesia planned.

Observing and evaluating the patient during anesthesia according to the form prepared for this purpose.

Evaluating the patient before leaving the recovery room according to the recovery model.

Fourth: Physiotherapist

(Assessing motor, functional, and rehabilitative activity if the patient needs it).

Fifth: The treating physician

Assessing the nutritional needs of patients, especially cases that are sorted according to the evaluation

Nursing upon admission.

Sixth: The social worker

According to his job description (he verifies patient satisfaction, and conducts social research when the patient needs financial, material, educational, or social support).

Responsible:  the doctor - the nursing staff - the social worker.

Forms: (medical report - patient ticket - emergency form - nursing evaluation - anesthesia sheet - physical therapy form - patient satisfaction questionnaire).

References: Egyptian accreditation standards.

Preparation	Review	Confidence

Timeframe policy for completing the assessment

Politics :

Re-evaluating patients in critical and non-critical cases that require long-term (chronic) treatment.

The Purpose :

Ensure proper follow-up and continuity of patient care and evaluation

Working procedures :

First: In acute cases (care - premature infants):

The treating physicians in the departments evaluate and determine the following

Degree of awareness and awareness.

Vital Signs .

Complications occur.

Results of tests and treatment or (surgical interventions).

The extent of response to treatment

The nursing evaluation rate is continuous, and the doctor on duty is called to the department for a critical result (physiological - laboratory - x-ray) and when there is pain, and the doctor re-evaluates.

The re-evaluation of the patient is documented and a follow-up note is recorded at least once per shift (every 24 hours), and any procedures resulting from a call or emergency or important events for the patient are recorded by date and hour.

Second: In non-acute cases:-

Treating doctors evaluate patients in non-acute cases and ensure...

Vital Signs .

Complications occur

Test results and treatment

Patient compliance with treatment and medical instructions.

This is done every 12 hours for the internal department by the specialist or doctor on duty, unless the clinical evidence requires less than that and this is documented in the patient’s file.

Third: Conditions that require long-term treatment (chronic diseases)

The doctors treating the departments that care for patients who need long-term or (chronic) treatment ensure that:

Vital Signs .

Complications occur

Results of tests and treatment

How advanced the disease is

The frequency of re-evaluation shall be once a day by the doctor on duty or as required by clinical evidence and documented in the patient’s file.

The specialist doctor re-evaluates the patient from various specialties while the patient is in the hospital to determine the extent of the response to the treatment and its effectiveness.

The nursing staff on duty re-evaluates the patient each shift to determine the patient's needs

Fourth: Cases that need to be re-evaluated

The treatment plan developed for the patient                      Individualized care plan

Change in patient condition

Diagnosis: Patient diagnosis

Expected outcome of care, treatment or service

The extent of the patient's response to previous treatment

The re-evaluation is documented in the patient's file

The patient should be re-evaluated immediately before anesthesia is administered

Fifth: Content of re-evaluation for nursing

Vital signs: every 6 hours in inpatient departments, every 2 hours in care and premature care, after blood transfusion, before surgical operations, during recovery, and when the patient complains that requires re-measurement, or according to the doctor’s instructions.

The Pain:

Probability of patient falling: every shift.

Skin condition: all skin color during recovery.

Nutritional assessment: when the patient needs it, according to the doctor’s orders.

Measuring blood sugar: according to the doctor’s instructions.

The patient's need for restraint or isolation: according to the doctor's orders

Models:

Medical follow-up form.

the reviewer   :

Egyptian accreditation standards.

Preparation	Review	Confidence

Pain assessment, re-evaluation and management policy

Policy: The hospital is committed to a process of assessment, re-evaluation and pain management

 Purpose: To clarify the process of assessment, re-evaluation, and treatment of pain.

procedures :

1- The responsible nursing staff assesses the pain (according to the following table), determines its severity, describes the pain, and its frequency by asking the patient and looking at the patient’s facial expression (in the event that he is unable to speak or in the event that he is a child), and this is recorded in the pain assessment form and kept in the patient’s file. When the patient enters the hospital.

Policy for assessing patients for abuse or neglect

Policy name	Assess patients for exposure to abuse or neglect				Policy number
Issue date and number			Review Date		number of pages]
Section	Artificial kidney unit

Policy :    The hospital is committed to preventing harm or neglect to patients while they are in the hospital and dealing with such cases as soon as they occur  to eliminate harm or neglect to patients while dealing with them.

Purpose: Develop methods for dealing with patients in cases of abuse or neglect.

Mistreatment: The patient while he is in the hospital, which leads to him being exposed to physical or psychological harm/injury, or both. There are types

Different types of mistreatment can be divided into:

Mental ill-treatment : by affecting the mental state.

Manifestations of mental abuse:

- Verbal assault

-  To threaten

- Intimidation

- Isolation

- Insult

- Humiliation

- Deprivation

Physical mistreatment: by affecting the patient’s physical condition by exposing the patient to (beating, slapping, kicking)

Manifestations of physical abuse:

·       The patient falls

·       The appearance of bed sores in the patient

·       The presence of wounds that are not well cared for

·       Unexplained injuries

·       Physical pain when touched

·       The presence of marks resulting from bites, scratches, abrasions or bruises

·       Unexplained signs of dehydration and malnutrition, sickness, sunken eyes, or eye injuries

·       The presence of blood stains in the underwear

Sexual mistreatment: The patient is exposed to any form of sexual assault/harassment

Physical abuse:

Manifestations of physical abuse:

·       theft

·       Misuse of money and property

·       blackmail

·       scam

·       There are abnormal actions in the patient’s bank account

·       Indifference to spending money

Negligence:

It is any negligence [negligence in treatment]  harming a patient in need without an acceptable medical reason from a responsible person while the patient is in the hospital.

·       People in need: A person who needs the help of another due to (mental disability, age, or brain atrophy/functional dysfunction)  which hinders the person’s ability to protect himself or provide his own care.

·          Types of negligence to which the patient may be exposed:-

·        -   Negligence in  medical and nursing care                        -   Neglecting to administer treatment doses

·        -   Neglect of social and psychological needs                    -   Lack of food/water

·       -   Placing the patient in an unsafe or unsupervised place

procedures :

·       The doctor and nursing staff evaluate the patient’s condition and determine his treatment needs.

·       The doctor and nursing staff inform the patient of the treatment plan and how to implement it.

·        The nursing staff teaches the patient how to call her when needed

·       The social worker visits patients in all departments daily to monitor patients’ complaints in order to report them to management and those responsible for resolving their complaints.

·       In the event that a case of neglect or abuse is discovered, the patient’s treating physician shall be informed:

·       - The doctor evaluates the patient’s condition and identifies manifestations of abuse or neglect, and a report is written with a commitment to physical and psychological treatment of the cases.

·       - The doctor asks the patient to write down his complaint (for the damages he suffered), if he so desires, with or without a signature.

·       - The head of the medical board assigns whomever he deems appropriate to investigate and follow up on the complaint, then the results are presented to him for necessary action.

Responsible: -   Doctor - Nursing staff - Social worker.

Forms:-    Patient Rights and Duties Form - Form for acknowledging the existence of trusts

Preparation	Review	Confidence