NURSING

SERVICES
MANUAL
AIIMS,
New Delhi
NURSING SERVICES MANUAL

NURSING
SERVICES
MANUAL
AIIMS,
All India Institute of Medical Sciences
New Delhi
New Delhi, India
 NURSING SERVICES MANUAL
AIIMS, New Delhi, India

Editors
 Ms. Kamlesh Chandelia, Chief Nursing Officer, AIIMS
 Dr. Anoop Daga, Officer I/c, Hospital In-service Education

Co-Editors
 Ms. Rebecca Herald
 Ms. Srinithya Raghavan
 Ms. J. Subbulakshmi

First Edition

Year of Publication: 2021

Published by:
Office of Chief Nursing Officer
All India Institute of Medical Sciences
New Delhi
 LIST OF CONTRIBUTORS

 Ms. Kamlesh Chandelia, Chief Nursing Officer, AIIMS

 Ms. Hanumati Devi, NS, NIE
 Ms. Kaushalya Mann, DNS
 Ms. Violet Sheela Moss, DNS
 Ms. Rebecca Herald, Nursing In-service Educator, Hospital
 Ms. Srinithya Raghavan, Nursing In-service Educator, Hospital
 Ms. J. Subbulakshmi, Nursing In-service Educator, Hospital
 Ms. Anjalidevi. M. Nursing In-service Educator, NSC
 Ms. Nisha Thomas, Nursing In-service Educator, CTC
 Ms. Dainy Thomas, Nursing In-service Educator, CTC
 Ms. Sunita Sansanwal, Senior Nursing Officer, Hospital
 Ms. Archna Singh, Senior Nursing Officer, NSC
 Ms. Pratima Noel Dass, Senior Nursing Officer, NSC
 Ms. Sushmita Pasi, Nursing Officer, NSC
 Mr. Uma Shanker Agrawal, Nursing Officer, Dr. BRAIRCH
 Ms. Preethy S., Nursing Officer, NIS, Hospital
 Mr. Raghunathan N., Nursing Officer, NIS, Hospital
 Dr. Anoop Daga, Additional Professor, Hospital Administration
 Dr. Anant Gupta, Assistant Professor, Hospital Administration
 Dr. Charan Raj, Senior Resident, Hospital Administration
 Dr. Kshitija Singh, Senior Resident, Hospital Administration
 From The Director’s Desk

It gives me a great pride and joy in presenting the Nursing Services

Manual for All India Institute of Medical Sciences, New Delhi.

Knowledge gained through education has been the driving force for
progress of mankind. This coupled with human experience has helped
to provide quality care. The workforce of nurses is an extremely vital
component of healthcare and they act as direct interface between the
hospital and patients. Working in a large tertiary care institute places
several demands upon them for efficient discharge of their
responsibilities.

This manual provides guidance to all the issues encompassing job

responsibilities, code of conduct, nursing organization, leave rules,
ward management and information on various aspects of nursing
services.

I am sure that this manual will provide a fresh and engaging

perspective on the aforementioned subjects for all the nursing
manpower.

Dr. Randeep Guleria

Director
All India Institute of Medical Sciences
New Delhi
 From The Medical Superintendent’s Desk

Greetings!

I am honored to be able to write the foreword for Nursing Services

manual, AIIMS. The excellent writing and contents of the manual
cover issues applicable to various facets of nursing services, which
are commonly faced in healthcare settings.

AIIMS Hospital has the legacy of keeping highest standards of

Nursing Care. Indeed, on any given day, nursing professionals
handles a wide array of responsibilities ranging from patient care,
ward management, human resources, facilities management, as well
as attendants’ management This manual is aimed at standardizing
the administrative policies & procedures with respect to nursing
services, assisting in training new staff and having information readily
available to the nursing fraternity.

I congratulate the nursing in-service education team of AIIMS for their

commitment and effort for bringing out this manual.

Dr. D.K. Sharma

Medical Superintendent
All India Institute of Medical Sciences
New Delhi
 From The Chief Nursing Officer’s Desk

Nursing services forms an integral part of any health care facility.

Nursing task force is considered the backbone of patient care. This
Nursing Services Manual aims at providing a positive resource to
nurses, so that they can significantly improve the quality, wellbeing
and safety for patients working in one of the largest tertiary care
institution.

My congratulations to Nursing In-Service Education (NIE) Team,

Hospital for successfully taking out the 1st edition of Nursing Services
Manual. I also congratulate NIE Educators at entire institute for their
contribution in making this manual a knowledge resource.

This manual will be helpful for nursing professionals working at

various patient care facilities and will also assist in training new staff.
It will provide key information about the Nursing Services in an easy-
to-use and practical manner.

Ms. Kamlesh Chandelia

Chief Nursing Officer
All India Institute of Medical Sciences
New Delhi
 Table of Contents

S.No. Topics Page No.

1. Nursing Profession- an overview 1-2
2. Nursing Services at AIIMS- Overview 3-4
3. Job Responsibilities of nursing professionals: 5-10
4. Code of Conduct for nursing professionals 11-14
5. Duty Timings 15-16
6. Dress Code 17-18
7. Leave Rules 19-20
8. Admission, Discharge & Misc. Ward Procedures 21-32
9. Handing and Taking Over 33-35
10. Record Keeping 36-38
11. Hospital Infection Control Programme at AIIMS 39-40
12. Workplace Violence 41-42
13. Sexual Harassment at workplace 43-48
14. Disaster Management 49-56
15. Fire Safety in Hospital 57-60
16. Nursing In-service Education 61-64
17. Nursing Informatics at AIIMS 65-67
18. Disciplinary Proceedings 68-76
19. Patient Safety 77-80
20. COVID-19: Resources for Nursing Officers 81
Appendix 82-83
Chapter 1

NURSING PROFESSION- AN OVERVIEW

INTRODUCTION:

Nursing profession is considered a caring profession. To begin with, it

was an art and a vocation; now it is considered a scientific profession.

EFFECTIVE NURSING:

Effective nursing is based on nursing process which is an organized

and systematic approach to nursing care that prioritizes patient’s
assessment and management.

Entire nursing process consists of four phases:-

 ASSESSMENT- It is not only initial but integral, ongoing

component of the whole nursing process.

 PLANNING AND IMPLEMENTATION- In this phase, the nurse

formulates and implements the care.

 EVALUATION- This phase decides whether the action taken

has met the identified needs or not. This is the final step of
care and it also reviews the whole care plan. A comprehensive
and Quality care is possible only with the evaluation phase of
nursing process.

Core Values In Delivering Patient Care:

 Treating patient with honesty and respect.

 Developing good partnership between patient and the care
givers.
 Alleviating pain and suffering.

1
 Providing clean and safe environment.
 Protecting comfort and well being.
 Protecting the rights of patients as well as addressing the
spiritual and cultural needs.
 Involving the staff in planning and decision making
 Efficient and effective team work
 Effective communication and understanding between the team
 Supporting staff to reach their full potential.
 Positive reinforcement.
 Recognizing achievement at all levels in the organization.

Reference:
 Brunner & Suddarth’s, Text book of Medical and surgical
Nursing, Vol.1
 Potter Perry, Fundamentals of Nursing, 6th edition

2
Chapter 2

NURSING SERVICES AT AIIMS

INTRODUCTION

Nursing service is an integral part of AIIMS, which aims at high quality

nursing care to the patients and community. The professional nurses
work in an environment that encourages professionalism and
expertise in providing comprehensive patient care with the members
of allied disciplines in the hospital.

The hierarchy of nursing services at AIIMS is as per following

organization chart:

ORGANISATION OF NURSING SERVICES AT AIIMS

CHIEF NURSING OFFICER

NURSING SUPDT

DY. NURSING SUPDT.

ASSTT.NURSING SUPDT.

Senior Nursing Officer -CLINICAL SUPERVISOR

Nursing Officer ----STUDENT NURSE

3
MANPOWER NORMS FOR NURSING:

In order to provide effective nursing care in AIIMS, New Delhi, SIU

Norms (Ministry of Finance, Department of Expenditure, Govt of India,
Year 1991-1992) are being followed in clinical areas and are as
follows;

 01 Senior Nursing Officer for 3.6 Nursing Officers.

 01 ANS for 4.5 Senior Nursing Officers.
 01 DNS for 7.5 ANS.
 01 Nursing Supdt for 250-500 beds.
 01 CNO for 500 or more beds.

4
Chapter 3

JOB RESPONSIBILITIES OF NURSING

PROFESSIONALS

NURSING OFFICER

Nursing Officer is directly responsible to Senior Nursing Officer (Ward

In-Charge) for total nursing care of the patient assigned to him/her

1) DIRECT PATIENT CARE

1. Admission and discharge of the patients

2. To maintain the personal hygiene of the patients,

including bathing, care of mouth, back, nails, hair etc.

3. Care of pressures points as needed.

4. To assist the patient in elimination, offering and

removing the bed pans and Urinals.

5. Bed making.

6. Assist in feeding the weak and debilitated patients.

7. Writing of diet sheet, Supervision and distribution of

diets.

8. Assist in physiotherapy, ambulation and rehabilitation.

9. Carry-out patient’s teaching and demonstration according

to the need.

10. Counseling the patients, and relatives.

11. Care of the dying and dead.

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 12. Administration of Medicines and Injections to the
patients.

13. Assist in administration of intravenous injections,

infusion and Transfusion.

14. Observing, recording and reporting of vital signs e.g.

T.P.R. and Blood pressure.

15. Carry out technical procedures, such as Naso-gastric

intubation, Gastric Gavage and Lavage, Oxygen Therapy,
Dressing and Irrigation, Enema, Catheterization hot and
cold applications, suction etc.

16. Collecting, labeling and dispatch of specimens.

17. Preparation for and assistance in clinical tests and

medical/surgical procedures.

18. Urine testing for sugar, and albumin.

19. Observation, recording and reporting of all procedures

and tests.

20. Escorting serious patients to and from the department/

wards for investigations.

2) WARD MANAGEMENT

1. Handing over and taking over charge of patients, and

ward inventory in each shift.

2. Maintenance of therapeutic environment in the ward.

3. Keeping the ward clean and tidy.

4. Routine care and cleaning of dressing trolleys, cupboards

apparatus, mackintosh etc.

5. Care of clean and soiled linen.

6
 6. Disinfection of linen, beds, floor and bed pans, and
fumigation of rooms etc.

7. Preparation of room, trolleys, and sets for procedures.

8. Preparation of surgical supplies.

9. Maintaining interpersonal relationship with patients,

relatives and health team members.

10. Orientation of new staff/students.

11. Demonstration and guidance to student nurses.

12. Participation in staff education and staff meetings.

13. Participation in professional activities.

14. Demonstration and supervision of domestic staff.

15. Report about the medico-legal cases if any admitted in

the ward. To keep the senior nursing officials informed
of the happenings / in the ward like fire, absconding
patients, theft etc.

16. Any other duty that may be assigned by Senior Nursing

Officer from time to time.

SENIOR NURSING OFFICER

The Senior Nursing Officer is responsible to the Assistant Nursing

Superintendent or the total care of patients in the wards and
supervision of the Nursing Officer, student nurses and Domestic staff.
She would also be assisted by Nursing Officer, Clinical and Domestic
staff. The main aim of the Senior Nursing Officer should be to foster
team spirit in her area of works as a team leader.

7
1) NURSING CARE OF PATIENTS

1. Assess the total needs of patients and prepare plan of

nursing care.

2. Admission and discharge of patients.

3. Demonstrate and carry out efficient nursing care, taking

care of personal comfort and toilet of patients,
administration of drugs and treatment, observation and
recording of vital parameters.

4. Supervise patients diet.

5. Attending rounds with Medical/Nursing personnel.

6. Assist Medical staff in examination of patients and

treatment.

7. Participate and help with clinical investigations/

procedures.

8. Demonstrate and carry out preoperative and post-

operative care of patients.

9. Maintenance of patient’s records.

10. Care of patient’s personal effects in accordance with

hospital rules.

11. Giving and receiving reports.

12. Follow prescribed rules in case of accident or death of a

patient.

13. Give information and health education to patients and

their attendants.

14. Intimation to nursing supervisors of any emergency or

unusual occurrence in the ward.

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2) WARD MANAGEMENT

1. Handing over and takeover charge of patients at the end

of the shift.

2. Assignment of work to nursing Officer and domestic

staff.

3. Co-ordinate and facilitate work of other staff, e.g.

physical therapist, social worker, dietitian, voluntary
worker etc.

4. Maintaining good inter personal relationship among all

categories of staff and with patients and their relatives.

5. Maintain cleanliness of ward, its annexes and

environments. Proper upkeep and repairs of linen and
ward equipment.

6. Make indents for drugs, surgical supplies, stores and

issue.

7. Keep custody of dangerous drugs and record of their

administration.

8. Daily check of emergency drugs and life savings

equipments.

9. Maintenance of stock registers, inventories.

10. Investigate complaints if any.

9
3) TEACHING AND SUPERVISION

1. Orientation of new staff and student nurses.

2. Participate in service education of nursing personnel

and attend staff meetings.

3. Impart planned and incidental teaching.

4. Supervise Nursing officer and student nurses.

5. Supervise domestic staff.

6. Consult and co-operate with nursing tutor in arranging

clinical teaching.

7. Perform any other duty as may be specified from time to

time.

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Chapter 4

CODE OF CONDUCT FOR NURSING

PROFESSIONALS

The purpose of the Code of Conduct is to guide nurses in their day-to-

day practice and help them to understand their professional
responsibilities in caring for patients in a safe, ethical and effective
way.

Principles

1. Respect for the Dignity of the person

 Nurses respect each person as a unique individual.

 Nurses respect and defend the dignity of every stage of human
life.
 Nurses respect and maintain their own dignity and that of
patients in their professional practice. They believe that this
respect is mutual with patients.
 Nurses respect all people equally without discriminating on the
grounds of age, gender, race, religion, civil status, family status,
sexual orientation, disability (physical, mental or intellectual)

2. Professional Responsibility and Accountability

 Nurses are expected to show high standards of professional
behaviour.
 Nurses are professionally responsible and accountable for
their practice, attitudes and actions; including inactions and
omissions.

11
  Nurses recognise the relationship between professional
responsibility and accountability, and their professional integrity.
 Nurses advocate for patients' rights.
 Nurses recognise their role in the appropriate management of
health care resources.

3. Quality of Practice
 Nurses who are competent, safety-conscious and who act with
kindness and compassion, provide safe, high-quality care.
 Nurses make sure that the health care environment is safe for
themselves, their patients and their colleagues.
 Nurses aim to give the highest quality of care to all people in
their professional care.
 Nurses use evidence-based knowledge and apply best practice
standards in their work.

4. Trust and Confidentiality

 Trust is a core professional value in nurses' and midwives'

relationships with patients and colleagues.

 Confidentiality and honesty form the basis of a trusting

relationship between the nurse or midwife and the patient.
Patients have a right to expect that their personal information
remains private.
 Nurses and midwives exercise professional judgment and
responsibility in circumstances where a patient's confidential
information must be shared.

5. Collaboration with others

 Professional relationships with colleagues are based on mutual
respect and trust.

12
  Nurses and midwives share responsibility with colleagues for
providing safe, quality health care. They work together to
achieve the best possible outcomes for patients.
 Nurses and midwives recognise that effective and consistent
documentation is an integral part of their practice and a
reflection of the standard of an individual's professional
practice. They support the ethical management of the
documentation and communication of care.
 Nurses and midwives recognise their role in delegating care
appropriately and in providing supervision.

Expected Conduct/ Etiquettes while on Duty:

1) All the nurses are expected to perform their tasks as per the
duties assigned by the nurse in charge.
2) A nurse is expected to be punctual in attendance and duty
timings. In case she/he is late for any genuine reason, then
the same should be informed to the ANS telephonically at the
earliest and later in writing as well.
3) Nurses are liable to be transferred from one Patient Care
Area to another and they must accept the decision of the
Nursing Superintendent. In case of any genuine reasons for
inability to accept the transfer, the same would have to be
stated in writing to the Nursing Superintendent.
4) In case a nurse wants a transfer, the same request should be
addressed to the Nursing Superintendent in writing.
5) Nurses should not accept and/or demand any gifts in cash or
kind from patients or their relatives or Pharmaceutical/ any
other firms.
6) All patient information and other hospital information are to be
considered confidential and should not be communicated in
any form to any unauthorized staff/person.
7) All nurses shall register with the Delhi Nursing Council for
practice in the institution.

13
8) As employees of the hospital, nurses are strictly prohibited
from giving any medicine to any person except to those it is
ordered to be given by the treating doctor to the patients
9) Prior intimation about daily duties of the Nursing staff will be
appropriately notified, in the duty schedule. Any changes in
the duty would require prior written request and approval of
the ANS.
10) The nursing staff should ensure that effective patient care is
being provided in the hospital.
11) On duty, nurses should be in station and be attentive at all
times.
12) Sleeping during duty hours is prohibited.

Reference:
 American Nurses Association (ANA), (2001), Code of
Ethics for Nurses, American Nurses Association,
Washington, D.C.

 Code of Ethics & Professional Conduct, Indian Nursing

Council

14
Chapter 5

DUTY TIMINGS AT AIIMS FOR NURSING

PROFESSIONALS

Duty Timings In Ward Block /IPC

Pattern Duty Time Privileges

A 08.00 AM - 4.00 PM ½ Day Off on
08.30 AM – 4.30 PM Saturday
Straight Shift 09.00 AM – 5.00 PM Sunday Holiday
10.00 AM - 6.00 PM Off on all Gazette.
11.00 AM – 7.00 PM holidays
National
Holidays/year - 03
Restricted
holidays/year – 02
Casual leave – 08
B Morning Shift: 07. 30 am – Monthly 08 offs
02.00 pm National
03 Shift duties Evening Shift: 01.30 pm – Holidays/year- 03
08.30 pm Casual leave – 10
Night Shift: 08.00 pm –
08. 00 am

Duty Timings In Operation Theatre

Pattern Duty Time Privileges

A Reference ward block Reference ward block
pattern “A” pattern “A”

Straight Shift
B Morning Shift: 07. 30 am – Monthly 08 offs
03.30 pm National

15
03 Shift duties Evening Shift: 03.00 pm – Holidays/year- 03
09.30 pm Casual leave – 10
Night Shift: 09.00 pm –
08. 00 am

Duties of Different Categories of Nursing Staff In Ward Block

Nursing officer Pattern A + B

Senior Nursing Officer Pattern A + B
Asst. Nursing Supdt. Pattern A + B

Duties of Different Categories of Nursing Staff in Operation

Theatre

Nursing officer Pattern A + B

Senior Nursing Officer Pattern A + B
Asst. Nursing Supdt. Pattern A

Reference::
Circular dated 28.05.2009; Director Office;AIIMS;Dy No:001537

16
Chapter 6
DRESS CODE

1. UNIFORM COLOR:
Dark Blue for all nursing personnel up to ANS HR
Light blue for DNS, Nsg. Suptndt. and Chief Nursing officer

2. SHOES:
Black leather shoes/ Sandals with or without buckles.
(Maximum heel 1.5 inch allowed)

3. SOCKS:
Natural skin color

4. COAT/APRON
Half sleeves white color for nursing officers, senior nursing
officers and ANS(UG)
Three fourth sleeves white color for ANS (HR), DNS, NS and
CNO

5. SWEATER:
Black for Nursing officer, Senior nursing officers and ANS
White for DNS, NS and CNO

6. HAIRPINS/ HAIR BAND: Black

7. TYPE OF APPAREL:
Salwar & Kamezfor nursing officers, senior nursing officers
(UG) Saree with blouse for Senior nursing officers (HR), ANS,
DNS, NS and CNO

8. FOR MALE NURSES:

Navy blue Formal trousers and light blue shirts half sleeve in
summer and full sleeve in winter

17
 9. DESIGNATION PLATE:
 Black base with white color letter for nursing officers, senior
nursing officers (UG)
 White base with black color letter for Senior nursing officer
(HR) and ANS (UG)
 Maroon base with white color letter for ANS (HR)
 Golden base with Black letter for DNS, NS and CNO

Professional Dress-up and Personal Hygiene

1. Functionality and Grooming

1.1 Nurses must be able to bend, stoop, reach and lift in the
course of patient care.
1.2 Grooming is important for a nurse.
1.3 Wrinkled uniforms, scuffed shoes or dirty fingernails do not
present an image that inspires confidence in the patient.

2. Infection Control
2.1 Finger nails should be clipped, no nail paints allowed.
2.2 Rings should be limited or removed for the same reason.
2.3 Nursing uniforms are frequently subject to spills and stains
and should be laundered regularly.

3. Personal Hygiene
3.1 The nurse is expected to maintain cleanliness.
3.2 Maintain proper hair cleanliness.
3.3 Women’s hair should be tied up tidily with black clips and
pins.
3.4 Men’s hair should be well groomed.
3.5 Men’s beard should be properly trimmed and maintained.
3.6 Personal hygiene should be maintained.
3.7Wear clean, properly ironed uniform.

18
Chapter 7

LEAVE RULES

 Leave Rules: Booked leave application, permission letters,

NOC etc. should be sent at least 20 days prior to the CNO
office. No leave without the proper sanctioning will be allowed
to be availed.
 Short leave/Emergency leave cannot extend beyond 10
days and for this leave application should be sent to CNO
office two days prior to proceeding for leave.
 Only 30% of the sanctioned nursing strength can be given
leave at a time.
 For absenteeism, verbal report is valid for only 24 hours.
Beyond that period, written leave has to be submitted by the
employee. Otherwise, absent report in writing to be sent to
the CNO office by the ANS. (Reference: vide circular dated
10.04.2018 No.F.20 -10/2018-Estt.I)
 In morning shift duties, half day casual leave (afternoon)
starts from 11.30 am and not before that. During evening
and night duties no half days/CL/ Earned Leave is
allowed. Only medical leave can be taken in emergency.
 When OFFs are arranged for going outstation by any nursing
personnel, an undertaking for the same should be taken by
the ANS of the ward. Further, after returning from leave, the
ANS should deploy them only on morning shift and not on
evening and night shifts.
 Joining should always be taken in the forenoon only

 Study Leave
1. All eligible nurses will be issued “NOC” by the administration
subject to their fulfilling eligibility criteria. (vide Circular dated
02.03.2107; No F.58/UN(pt)/2016-Estt-(H.))

19
  The employee must have satisfactorily completed
probation and rendered at least five years of
regular continuous service.(including probation
period)
 Permission is granted to study only in Institutes
of national importance or PGIMER, RAK,
NIMHANS and AIIMS

ALL COMMUNICATION FOR AVAILING ANY KIND OF LEAVE

SHOULD ALWAYS BE THROUGH PROPER CHANNEL

20
Chapter 8

ADMISSION, DISCHARGE & MISC. WARD

PROCEDURES

WARD MANAGEMENT: GENERAL REQUIREMENTS

 The Nurse should know her ward thoroughly with detailed

knowledge of the activities, equipment status, ward procedures
etc. He/She must be completely aware of the hospital policies
and their implications on the ward operations and the
interrelated departments of the hospital.
 Nursing staff should follow the nursing procedure manual for
any standard procedure.
 The nurses should be familiar with the department/unit,
ward/OT procedures, equipment functioning, furniture and
fixtures, types of cases admitted -their criticality and level of
care etc.
 The nurse in-charge is to make a schedule of
activities/assignments on a daily basis, to be followed by the
other nurses.
 The nurse should not leave the station until and unless the next
duty nurse has reported to duty and the new nurse being
briefed.
 Orientation of all new nursing staff by ANS is required to guide
and instruct them with the policies of the ward management,
duty structuring, routine for emergencies, familiarize with the
equipment, supplies, store and medicines of the ward.
 The New staff should be assigned to a senior staff nurse for
one week to become familiar with the functioning of the ward.

21
  All the medicines and other items indented are to be
maintained in a log book, which would enable pilferage check.

ADMISSION OF A PATIENT

Admission in the ward is either from Out Patient Department or

Emergency Service and directly in special cases.

1. Admission is given to those patients who fulfill the criteria for

admission.
2. It is advised by the doctor of concerned dept/unit and the
admission slip is given by the senior resident of the concerned
unit. For private ward admission, the admission slip is given by
Officer In charge Private Ward.
3. The patient should be instructed to present the admission slip to
the clerk at the Central Admission Office. The Central Admission
Office directs the patient to the ward where he or she is to be
admitted.
4. The admission is then made in the admission Office after paying
advance hospitalization charges for 10 days.[Rs35/ - + Rs.25/-,
admission Charge/ day charge and Rs.60/- for short admission.
The admission office generates a “face-sheet” of the patient1
5. For short admission under day care hematology, only Rs.35/- is
charged and admission charge of Rs.25/- is exempted

Criteria for General Ward admissions:

(a) Patients seen in general OPD, who are sick enough or have a
diagnostic problem needing detailed investigations, are admitted
directly.

22
(b) Patients seen in speciality clinics, being run under the purview of
general disciplines, needing admission may also be admitted in
general wards under the unit-on-call for that day of the week.

(c) Patients presenting in the casualty with acute and serious illness
needing hospitalization can also be admitted in general wards.

Admission Procedure for the Emergency Wards:

1. There are three emergency wards:

C-6, D-6 and New Emergency Ward (specified Beds) for

emergency admission only from casualty. The CMO, in
consultation with the Senior Resident of the unit-on-call,
decides on the admission.

2. The CMO fills in the admission slip and directs the patient to
the Central Admission Office for generating the Face Sheet for
admission, as described above.

3. Respective departments should shift their patient from

emergency wards within 48 hours failing which their routine
OPD admissions will be blocked by the Duty Officer.

4. Several patients are referred from casualty to other Govt

Hospitals for lack of availability of beds in one hospital.
However, some cases such as intubated patient, follow up
case of AIIMS or EHS patient, any serious condition likely to
deteriorate further on his way to another hospital, are not
referred/transferred and are given admission on priority.

5. The Duty Officer coordinates their admission going through the

hospital ward census, which he/she receives at 8.30 p.m. daily.

23
 However, it is the responsibility of the unit (to whom the patient
belongs) to transfer the case back to their own ward at the
earliest so that admission of other units does not suffer the
next day.

Admission procedure for the private ward:

1. Generally, Private Wards admissions are “Elective” admissions

of patients, who can afford to pay the charges.
2. A consultant advises the admission of the patient to the private
wards on the OPD card.
3. These patients are registered and kept on a waiting list. When
a room falls vacant, they are informed about the vacancy by
post or by telephone and are advised to report on a particular
date and time.
4. Patients being admitted in private ward will have to pay an
advance for10 days charges, at the time of admission i.e. :
o For ‘B’ Class Rooms Rs.22,200/-[Rs.20,000/- Room rent
advance of 10 days and Rs.2,000/- Diet charges
advance of 10 days]
o For ‘A’ Class Rooms Rs. 32,200/-[Rs.30,000/- Room
rent advance of 10 days and Rs. 2,000/- Diet charges
advance of 10 days]

As the private ward patients are admitted as and when a

vacancy arises, it is generally not possible to co-ordinate it with the
admission day of the unit to which the consultant belongs.

24
FOR EHS:

1. There are separate but limited number of EHS beds available

in AB-7, AB-6, D-1.New private ground floor also has dedicated
rooms for EHS patients. Senior officials (pay level 10 & above)
are admitted on other private ward rooms as well.

2. An EHS patient needing hospitalization is referred to the

relevant general or specialty department for consultation.

3. From there the patient is admitted on EHS beds. If no EHS bed

is available the patient may be admitted on the emergency
ward beds or even on regular ward beds.

4. However, these patients must immediately be transferred to

the EHS beds as soon as they fall vacant.

5. In no case should an EHS beneficiary be sent to other

hospitals without the permission of the Medical Superintendent.

6. Duty officer in control room should be contacted for allotment

of EHS beds. These earmarked beds are under the control of
Duty Officer in control room.

7. Various departments have earmarked EHS beds in their own

departments. EHS patient should get first preference in
departmental EHS bed

Criteria for Short Admission:

1. Protocol to be followed when a patient admitted in AIIMS

hospital as a ‘Short admission’ patient.

25
 NURSES’ RESPONSIBILITIES:

1. Nursing officer in charge on duty provides the bed to the

patient on presentation of the admission papers (face sheet)
provided that the patient is physically present in the hospital
premises

2. The admission sheet should have: Name, age & sex, address,
consent signature of patient if conscious and major or the
relative if patient is not in a condition to sign or in case of
minor.

3. Patient is received. Weight, height and vital signs are checked.

4. History about present illness, past medical history, drug history

and any drug allergy is obtained.

5. Patient and the family are oriented to the ward.

6. Admission is informed to the resident doctor of concerned

department/unit.

7. Whenever a foreigner reports for treatment in the hospital,

he/she may be advised to get registered himself/herself with
FRRO, Delhi FRRO concerned. The particulars of the foreign
national admitted in the ward should be filled in the prescribed
C-Form and sent to MRD.

DISCHARGE OF A PATIENT

1) Discharge is planned by the unit doctors once the patient fulfils

the criteria.

2) Patient and the family is explained prior to actual discharge.

26
3) Private Ward patients may also be discharged by 12:00 noon
or patients have to pay charges for that day also. Sister
Incharge Private Ward should also be informed of discharge of
paying patients well in advance to enable her to get the bills
cleared in time.

4) Special care is taken for discharge of EHS patients.

Ambulance service is available for discharged EHS patients
(if so required) for transport to residence, which is available
only till 8:30 p.m. EHS patients should preferably be
discharged from wards during the morning and afternoon
hours.

5) A detailed discharge summary is prepared by the resident

doctor that includes the history, various investigations done in
the hospital, the treatment given, the medicines advised and
the recommendations for the follow up.

6) The nurse has to check the various bills and to ensure that the
patient has cleared the entire bill.

7) All the investigations, reports, OPD card(s) and imaging

studies to be handed over to the patient during discharge and
receiving of the same to be mentioned number wise at the
back of the face sheet.

8) Health education is given about the discharge medicines, diet

and the follow up.

9) Once the patient has left, bed is shown as vacated in the

computer and the discharged patient cannot be shifted on a
virtual bed.

27
 10) The Vacant bed is cleaned and disinfected and kept ready for
the new patient.

11) Ensure that the actual date of discharge in the discharge

summary and the TPR sheet (Nurses chart) should be the
same.

12) As per the guidelines of MCI, all the files of discharge/ death/
Abscond/ LAMA patients must be handed over to the MRD
staff within 48 Hours( Working Days)

13) Further, if any obstetric and Gynae department patient has

been registered under ‘JSSK’ and later on takes a private ward
bed, the nurse on duty should convert the payment category of
mother and Newborn from the MRD on the very same day or
latest by the next working day.

TRANSFER OF PATIENT

1) A patient can be transferred from one ward to another ward or

from one centre to another centre.

2) Transfer order is written by the resident doctor in the instruction

book.

3) Transfer notes is printed out through CPRS which contains

patient details and the treatment.

4) Information is given to staff in the counter of the ward to which

the patient is to be transferred.

5) Patient and the attendant are explained about the transfer.

28
 6) General condition and the vitals of the patient is checked and
recorded before transferring.

7) If the patient is on oxygen, ventilator or sick, the resident doctor

of concerned unit has to accompany the patient.

8) Once the patient has been transferred, it is entered in the

computer.

9) Once the patient has been transferred (after being entered in

the computer) to any other center of AIIMS, a new center
specific CR. No is generated while the UHID No. remains the
same.

LAMA

1) It is Leaving or Left Against Medical Advice. It is also called

Discharge Against Medical Advice (DAMA)

2) The patient has the right to leave the ward if he /she is not
satisfied with the care.

3) In that case, patient is counseled and is allowed to leave.

4) The resident has to get the signature from the patient/ relative
in the face sheet that he is leaving against advice.

5) The resident is supposed to write the notes and fill the face
sheet discharge column as LAMA.

6) The nurse’s record should have the proper documentation of

the general condition, vitals and the other appropriate
observations of the patient.

29
 7) The nurse must ensure that the file is collected properly and
dispatched. No document should be ordinarily given to the
patient. However if the patient/attendant insists on getting a
discharge summary/treatment summary given during the
period of hospitalization, such a summary can be given by the
concerned resident doctor specifically endorsing on it(in bold
letters) the fact that the patient is leaving against medical
advice.

8) If the patient is terminally ill or on ventilator staff must ensure

that the patient is shifted in ambulance safely with oxygen and
other necessary equipments.

9) Once the patient has left, the details are entered in the
computer and the bed is shown as vacated.

ABSCOND REPORT

1) Abscond report is a legal document stating that the patient is

missing from his/her bed in the ward.

2) When the patient is not found on his/ her bed for more than
four hours, it must be informed to the unit duty doctor.

3) If the patient is absent for more than 12 hours a detailed report

about the patient and the time since he is missing is mentioned
and is declared as absconded.

4) The abscond report is written by the doctor and the copies are
sent to Duty Officer, Security officer, CNO and Medical Record
Department.

30
 5) In case of MLC cases, it is very important to inform the police
officer about the abscond report.

6) A copy of abscond report is attached to the file and dispatched.

7) The bed is shown as vacated in computer as absconded.

PATIENT CARE AFTER DEATH

1. Two sets of the e -Death Certificates should be prepared and

signed by the Resident doctor (Senior or Junior) concerned.

2. In the case of M.L.C., the death certificate should be marked

M.L.C. at the top and the MLC information slip be filled up by
the Sister-in-charge/Staff Nurse on duty and sent to the Police
Officer in the Casualty, for further necessary action.

3. Appropriate care and packing of dead body is to be followed

according to the protocol given in the infection control manual

4. An adhesive plaster bearing the name of the patient in indelible

ink is put on the right wrist, chest and on the sheet of the
deceased.

5. The other copies of the ‘Death Slip’ with rest of the papers of
the Death Certificate are sent to the Central Admission Office.
The staff in CAO completes the ‘Death Register’ from the
Death Certificate.

6. The CAO will issue the ‘death slip’ to the relative of the
deceased after stamping ‘The Body may be released’ and
obtain the signature of the relative/ friend in the Death

31
 Register. Then the dead body can be handed over to the family
with a copy of the ‘Death Slip’.

7. If the body is to be kept in mortuary, the staff in mortuary will

handover to the relatives of the deceased the dead body along
with the death slip which was sent to them earlier, in exchange
of the death slip from the CAO, keeping this as an
acknowledgement from the relative(s).

8. In case the body is sent to the mortuary and the next of

kin/relatives are not present. Then with the help of details on
the death information slip the Central Admission Office informs
the relatives/next of kin by telephone. On their arrival the body
is handed over to them from the mortuary, the procedure for
this being the same as described above.

9. Dispatch the file to MRD within 48 hours

32
Chapter 9

HANDING AND TAKING OVER

INTRODUCTION:

For maintaining the continuity of care and improving the quality of

care, effective inter-shift information communication is important.
Handover error can endanger patient safety. A nursing handover
occurs when one nurse hands over the responsibility of care for a
patient to another nurse. When a nurse hands over responsibility of
care to another nurse there is an opportunity for error if all the
important medical information is not shared thoroughly and efficiently.

Always:

 Keep on tips the important lab results.

 Organize transmission of information.

 Focus on medical and nursing needs of the patient.

 Communicate effectively
Using checklist for handing over and shift change can prevent missing
of important information.

Points to Remember:

 Patient particulars
 Diagnosis/ surgery done
 Advanced diagnosis
 Short history
 Post- op day (if applicable)
 Medications/ antibiotic day
 Any allergies
 Oxygen
 External devices

33
  Lab investigations
 Nutrition/ Intake Output
 Ambulation
 Pending procedures
 Documents
 Payments

Handing over and change of shift should be recorded and details

discussed critically

Handing/Taking over Protocol:

 Detail handing and taking over of the unit/ward should be done by

the staff on duty and the patient should be handed over at the
bedside.

 The senior most nursing officer of the outgoing team should lead
the handover.

 Doctor’s order should be carried out before handing over to the

incoming staff.

 Outgoing staff should communicate information accurately,

succinctly and professionally.

 All incoming staff should attend taking over responsibility.

 The incoming staff should check all drugs and ensure that
articles and emergency equipment are functional in every
shift.

 Check that all the bedside charts are complete prior to handover.

 Allow the patient to seek clarification, and ask question and

confirm information.

 Confidentiality should be maintained at all time. Sensitive

information should be shared within professionals only.

34
 During handover, incoming staff should undertake a safety check
of the patient’s environment.

 Ensure patient care is continued without any lapses during

handing taking process.

 The staff on duty is/are solely accountable and answerable for any
events/ activities that occur during their duty time.

Key Points:

 Suction, oxygen, or other equipments are in working condition and

easily accessible.

 Dressings, drain, intravenous fluids, and infusion pumps are

secure and correct.

 Handing and taking over of the articles should be done in every

shift by the nurses before taking over of the patients.

 All basic articles should be checked for functionality.

 Sign on the inventory book/assignment book after taking over.

35
Chapter 10

RECORD KEEPING
Introduction:

 A record is a permanent written communication that documents

information relevant to a client’s health care management.
 Clinical record keeping is an integral component in good
professional practice and the delivery of quality healthcare.
 Regardless of the form of the records (i.e. electronic or paper),
good clinical record keeping should enable continuity of care
and should enhance communication between different
healthcare professionals.
 Nurses are subject to increasing scrutiny regarding their
record-keeping.

Purpose of documentation:
 Legal documentation
 Reimbursement& Insurance Claims
 Patient care analysis

Appropriate records are to be maintained for the department

functioning in the areas of:
 Inventory of drugs – emergency.
 Bed occupancy of the ward.
 Maintain a log book for recording the breakdown of any
equipment (the data required would be equipment name,
company name, if on maintenance contract (yes/no), time/date
of failure, time/date of equipment made functional, reported to
whom).
 Record has to be maintained, if the equipment is borrowed by
any department or service area and when it has been returned.
 Other records for management purposes should be maintained
like:

36
 Complete Patient File should contain:

1) Face-sheet - MR-1
2) Discharge summary or
death form - MR-2
3) Patient history - MR-3
4) Progress record - MR-4
5) Doctor orders - MR-5
6) Intake out-put chart - MR-6
7) Consent and operation notes - MR-7
8) Anesthesia records
9) Nurses daily record - MR-8
10) Consultation record - MR-9
11) Temperature chart - MR-10

How to improve record-keeping:

 Get into the habit of using factual, consistent, accurate,

objective and unambiguous patient information;

 Use your senses to record what you did, such as ‘I heard’, ‘felt’,
‘saw’, and so on;

 Use quotation marks where necessary, such as when you are

recording what has been said to you;

 Ensure there is a reasoned rationale (evidence) for any

decision recorded,

 Ensure notes are accurately dated, timed, and signed, with the
name printed alongside the entry (initials should be avoided);

 Follow the SMART model (Specific, Measurable, Achievable,

Realistic and Time-based) or similar when planning care;

37
  Write up notes as soon as possible after an event and, by law,
within 24 hours, making clear any subsequent alterations or
additions;

 Document any objections you may have to the care that has
been given;

 Timing, legible, permanence, correct spelling and grammar

 Sequence, appropriateness and completeness.

 Do not include jargon, meaningless phrases (for example ‘slept

well’), irrelevant speculation, and offensive subjective
statements;

 Confidentiality of the patient and hospital records to be

maintained.

Records Maintenance Period at AIIMS

 Stock Register -- 20 years

 Drug Indent Books -- 5 years
 Drug Account Books – 5 years
 Indent Books (Non-consumable) – 20 years
 Indent Books (Consumable) – 5 years
 Treatment Books – 5 years
 Doctors Order Books – 5 years
 Daily Drugs Books – 5 years
 Report Books – 5 years
 Loss & Breakage Books – 5 years
 Repair Books – 5 years
 Blood Bank Books – 5 years
 Specimen Books – 5 years

38
Chapter 11

HOSPITAL INFECTION CONTROL PROGRAMME

AT AIIMS

AIIMS Hospital has a well-defined Hospital Infection Prevention

& Control Programme which is managed by Hospital infection Control
Committee (HICC)

HOSPITAL INFECTION CONTROL COMMITTEE (HICC)

COMPOSITION

Chairman: Medical Superintendent

Members:

 Heads of Clinical Departments

 Chief of Centers
 Superintending Engineer
 Infection Control Nurse
 Engineering Services

Member Secretary: Faculty member from Department of Hospital

Administration

HICC CORE GROUP

From within the HICC, a core group has been formed on the
lines of Infection Control Team to look after the surveillance activities
and handling day to day problems. It also implements the educational
and training programmes for the hospital staff.

The Department of Microbiology is responsible for monitoring

of healthcare associated infections and anti-microbial resistance,

39
disinfection and sterilization as well as surveillance activities in which
they are assisted by the Infection Control Nurses.

Infection Control Nurses: Six experienced nurses are

appointed full time on this position in main AIIMS Hospital and their
functions are described below.

FUNCTIONS OF INFECTION CONTROL NURSES

1. Regular visits to all wards and high risk units to monitor

infection control practices.
2. Recording details of patients with healthcare associated
infections
3. Collection of samples from different areas of the hospital
for monitoring disinfection, sterilization and air quality and
sending them to the lab.
4. Daily visit to microbiology laboratory to ascertain results of
samples collected for surveillance and to liaise between
microbiology department and clinical departments.
5. Compilation of ward wise, discipline wise and procedure
wise statistics for HCAI.
6. Monitoring and supervision of infection among hospital
staff.
7. Training of nursing aides and paramedical personnel on
correct hygiene practices and techniques.

REFER HOSPITAL INFECTION CONTROL MANUAL

 https://www.aiims.edu/en/component/content/article/236-notices/
miscellaneous/ 10158-aiims-infection-control-manual.html

40
Chapter 12

WORKPLACE VIOLENCE IN HEALTHCARE

SETTINGS

The National Institute for Occupational Safety and Health defines

workplace violence as “violent acts, including physical assaults and
threats of assault, directed toward persons at work or on duty.”
Enforcement activities typically focus on physical assaults or threats
that result or can result in serious physical harm. However, many
people who study this issue and the workplace prevention programs
highlighted include verbal violence—threats, verbal abuse, hostility,
harassment, and the like—which can cause significant psychological
trauma and stress, even if no physical injury takes place. Verbal
assaults can also escalate to physical violence.

In hospitals and other healthcare settings, possible sources of

violence include patients, visitors, intruders, and even coworkers.
Examples include verbal threats or physical attacks by patients, a
distraught family member who may be abusive or even become a
gang violence in the emergency department, a domestic dispute that
spills over into the workplace, or coworker bullying.

Workplace violence risk factors vary by healthcare setting, but

common factors include the following:

Patient, Client and Setting-Related Risk Factors

a. Working directly with people who have a history of violence,
abuse drugs or alcohol, gang members, and relatives of
patients or clients;
b. Transporting patients and clients;
c. Working alone in a facility or in patients’ homes;
d. Poor environmental design of the workplace that may block
employees’ vision or interfere with their escape from a violent
incident;
e. Poorly lit corridors, rooms, parking lots and other areas;
f. Lack of means of emergency communication;

41
 g. Prevalence of firearms, knives and other weapons among
patients and their families and friends; and
h. Working in neighborhoods with high crime rates.

Organizational Risk Factors

a. Lack of facility policies and staff training for recognizing and
managing escalating hostile and assaultive behaviors from
patients, clients, visitors, or staff;
b. Working when understaffed—especially during mealtimes and
visiting hours;
c. High worker turnover;
d. Inadequate security and mental health personnel on site;

Healthcare facilities can reduce workplace violence by following

comprehensive workplace violence prevention programme.

An effective programme includes five key components:

a. Management commitment and worker participation

b. Worksite analysis and hazard identification
c. Hazard prevention and control
d. Safety and health training
e. Recordkeeping and program evaluation

A workplace violence prevention programme can also fit effectively

into a broader safety and health management system, and it can help
our facility enhance employee and patient safety, improve the quality
of patient care, and promote constructive labor-management
relations.

Reference:

 Occupational Safety and Health Administration (OSHA). 2015.

Guidelines for preventing workplace violence for healthcare
and social service workers. No. 3148-04R.

42
Chapter 13

SEXUAL HARASSMENT AT WORKPLACE

“No woman shall be subjected to sexual harassment at any

workplace.”

The Sexual Harassment of Women at Workplace, (Prevention,

Prohibition and Redressal) Act, 2013, is an act to provide protection
against sexual harassment of women at workplace and for the
prevention and redressal of complaints of sexual harassment and for
matters connected therewith or incidental thereto.

It is the right of every woman to be safe and secure at workplace

environment irrespective of her age or employment/work status.
Hence, the right of all women working or visiting any workplace
whether in the capacity of regular, temporary, adhoc, or daily wages
basis is protected under the Act.

It also includes persons working on a voluntary basis, co-worker,

contract worker, probationer, trainee, and apprentice or called by any
other such name.

Few Definitions:

Workplace is defined as “any place visited by the employee arising

out of or during the course of employment, including transportation
provided by the employer for undertaking such a journey.”

As per this definition, a workplace covers both the organised and un-
organised sectors.

An Aggrieved Woman means- in relation to a workplace, a woman

of any age who is employed or not and who alleges to have been
subjected to any act of sexual harassment by the respondent.

A Respondent means a person against whom the aggrieved woman

has made a complaint

43
What constitutes Sexual Harassment at Workplace?

“Sexual Harassment” includes anyone or more of the following

unwelcome acts or behaviour, (Whether directly or by implication),
namely:

1. Physical contact or advances;

2. A demand or request for sexual favors;

3. Making sexually colored remarks;

4. Showing pornography;

5. Any other unwelcome physical, verbal or non-verbal conduct of a

sexual nature

The following circumstances if occur or are connected with any act or

behaviour of sexual harassment may also amount to sexual
harassment:-

1. Implied or explicit promise of preferential treatment or threat of

detrimental treatment in her employment.
2. Implied or explicit threat about present or future employment
status
3. Interference with work or creating an intimidating or offensive/
hostile work environment for her.
4. Humiliating treatment likely to affect her health and safety.

Complaints Committee/s

The Act provides for two kinds of complaint mechanisms:

1. Local Complaints Committee (LCC): Every district has a LCC for

establishments with less than ten workers or if the complaint is
against the employer himself.

44
2. Internal Complaints Committee (ICC): Every workplace has to
have an ICC with at least one-half of the total members nominated be
women.

The Internal Complaint Committee shall have the same powers as are
vested in a civil court under the Code of Civil Procedures, 908 when
trying a suit for:
1. Summoning and enforcing the attendance of any person and
examining him on oath
2. Requiring the discovery and production of documents and any
other matter which may be prescribed.

COMPLAINT AND INQUIRY PROCEDURE

Any aggrieved woman may make a complaint within a period of three

months from the date of incident and in case of a series of incidents,
within a period of three months from the date of last incident to the
Internal Complaint Committee.

The time limit may be extended by the committee if they are satisfied
of the circumstances which prevented the woman from filing a
complaint within the said period.

The complaint should be in writing and all reasonable assistance to

file the complaint in writing should be made by the committee.

Where the aggrieved woman is unable to make a complaint (due to

physical or mental incapacity or death or otherwise), her legal heir or
such other person as may be prescribed may make a complaint.

The notice to the respondent is to be given within seven days of

receiving copy of the complaint.

The inquiry should be completed within a period of ninety days

The inquiry is made in accordance with the provisions of the service

rules applicable to the respondent.

45
During the inquiry, the ICC on basis of written request:

1. Transfer the aggrieved woman or the respondent to any other

workplace or
2. Grant leave to the aggrieved woman up to a period of three months
(in addition to leave she would be otherwise entitled)

The report is submitted to the employer on completion of inquiry

within ten days from the day of completion of the inquiry and report to
be made available to the concerned parties.

Where the Internal Committee arrives at the conclusion that the

allegation is malicious and forged or misleading documents have
been produced, or any witness has given false evidence it may
recommend to the employer to take action against as per the service
rules.

WHAT SHOULD THE COMPLAINT CONTAIN?

Date

Time

Description of
Complaint Content Incident(s)
Respondant's Name

Parties working
Relatonship

46
REDRESSAL MECHANISM:
An appeal to the court or tribunal in accordance with the provision of
the service rules applicable to the said person may be made.

The appeal should be made within ninety days of the

recommendations

WHAT CAN A COMPLAINANT EXPECT?

A trained, skilled and competent Complaints Committee, a time
bound process, information, confidentiality, assurance of non-
retaliation, counseling or other enabling support where needed and
assistance if the complainant opts for criminal proceedings.

RIGHTS OF THE COMPLAINANT

 An empathetic attitude from the Complaints Committee so that
she can state her grievance in a fearless environment
 A copy of the statement along with all the evidence and a list of
witnesses submitted by the Respondent
 Keeping her identity confidential throughout the process.
 In case of fear of intimidation from the respondent, her
statement can be recorded in absence of the respondent
 Right to appeal, in case, not satisfied with the recommendations/
findings of the Complaints Committee

RIGHTS OF THE RESPONDENT

 A patient hearing to present his case in a non-biased manner
 A copy of the statement along with all the evidence and a list
of witnesses and complainant
 Confidentiality of identity throughout the process
 Right to appeal

47
Committee at AIIMS:

 An Internal Complaint Committee for Sexual Harassment

of women at workplace (ICCSHWW) exists at AIIMS.
 For any other grievance apart from harassment of sexual
nature are addressed by the women grievance cell of the
institute

Women’s helpline Number at AIIMS

011-26593333

011-26594444

Control Room

011-26593308

AIIMS, New Delhi committed towards the

safe workplace.

Reference:

 Handbook on sexual harassment of women at workplace

(Prevention, Prohibition and Redressal) Act, 2013. Ministry of
Women & Child Development, Government of India)

 Protocol for Sexual Assault Victims:

https://www.aiims.edu/en/forensic-patient-care/sexual-assault-
accused-medicolegal-examination-1.html

48
Chapter 14

DISASTER MANAGEMENT

INTRODUCTION:

Disaster is any occurrence that causes ecology disruption, loss of

human life and deterioration of health services on a scale sufficient to
warrant an extraordinary response from the community or area.
Disaster occurs suddenly and unexpectedly, disrupting normal life and
infrastructure of social services including health care systems. For this
reason a country’s health system and public health infrastructure must
be organized and kept ready to act in any emergency situation as well
as under normal condition.

DEFINITION OF DISASTER

Disaster is defined as “any occurrence that causes damage,

ecological disruption, loss of human life, deterioration of health and
health services, on a scale sufficient to warrant an extraordinary
response from outside the affected community or area.” (WHO)

Disaster Plan of AIIMS Hospital

Disaster Committee:

The following officers of AIIMS hospital will form the Disaster

Committee under the chairmanship, Hospital Management Board.

�Prof & Head, Deptt. Of Orthopaedics

�Prof. In charge, Accident& Emergency Services

�Prof. & Head, Deptt. of Surgery

�Prof. & Head, Deptt. of Medicine

49
 �Prof.& Head, Deptt. of Forensic Medicine

�Prof. & Head, Deptt. of Neuro Surgery

�Prof.& Head, Deptt. of Anaesthesiology

�Prof. & Head, Deptt. of Radio-diagnosis

�The Nursing Superintendent

�Officer In charge of all Supportive Hospital Services

�Prof.& Head, Deptt. of Gastroenterology

�Secretary, Hospital Management Board

Types of Disasters Expected:

�Vehicular accidents and aircraft emergencies �Bullet and Blast

injuries

�Collapse of a building Fire Food poisoning – Gastro Enteritis

�Any other like drowning etc.

HQ for Disaster plan coordination:

�Control Room: Room No 12, Tel: 26862663, 26593308 round the

clock

�MS Office, Tel: 26594700, 26861389

Information and Communication:

�Receiving information at Radio Telephone Desk which is already

established in all the conference areas

�One Hot lines from Police HQ in the Control Room

�Direct arrival of casualty without any prior intimation Details to be

ascertained on the Hot lines are

�Time and place of occurrence Nature of accident Approximate number

of causalities �Source of information Authenticity

50
Activating the Plan:

�On receipt of information from authentic source the Duty Officer will
activate the plan and inform the MS, Chairman, HMB and Security Officer
Reception Centre

�For moderate load : The present Casualty OPD will function as the
reception area

�For heavy load : Main hall of ground floor OPD will be converted into
reception area

�Police and Security personnel of AIIMS will act as Traffic Controllers

directing the patient and relatives to the respective reception centres

First Aid and Sorting : Triage

�For Moderate Load : Existing casualty Medical Team will function for
First aid and sorting

�For heavy Load : The centre will manned by 4 teams each consisting of
:

�One General Surgeon

�One Orthopaedic Surgeon

�One Physician

�One Anaesthetist

�Two Sisters

�Two Nursing Orderlies

�One sweeper

�A team of two Stretcher Bearers each having one stretcher

The responsibilities of First Aid Centre will be

�Quick sorting of causalities into

51
�Priority one : Needing immediate resuscitation

�Priority two : Immediate surgery

�Priority Three : Needing first-aid & possible surgery

�Priority Four: Needing only first-aid

�Action : Priority one will be attended to in Casualty and if need arises

will be sent to AB-VIII, ICU

�Priority two will be transferred immediately to casualty OT and MOT

�Priority three will be given first-aid and admitted if bed is available or

transferred to other hospital

�Priority four will be given first-aid and discharged home.

The area marked for holding ward: Corridors AB & D wing, first floor
Brought in dead or those who may die while receiving/resuscitation will
be segregated. Temporary morgue for keeping dead bodies will be
created in the long verandah opposite the mechanical laundry.
Necessary identification and handing over of bodies to the relative after
medico legal clearance will be done in this area. This will function under
care of the Department of Forensic Medicine.

Additional Bed Space:

�In addition to the area marked on first floor, AB-1 & D-1 extra bed
space will be created as follows:

�Utilisation all pre-operative beds in AB-7

�Any vacant beds will be requisitioned by the MS for this purpose

�By discharging following categories of patients

�Convalescing patients needing only nursing care

�Elective surgical cases

�Patients who can have domiciliary care or OPD advise

52
�Ward side rooms and Seminar rooms of the wards may have to be
used temporarily

Linen Stores:

�A room in D wing, (SF 1) room 1st floor is earmarked for this purpose
following stores will be transferred to that room from the stores

�Mattress – 40 �Bed Sheets - 120

�Blankets – 80 �Pillows and cover - 60

�Patient clothing female- 30 �Patient clothing male - 30

�IV Stand – 60 �O2 cylinder - 20

Drugs and Equipment:

�The Medical and Surgical Stores Officer will be called at once to open
the store. As an immediate measure the buffer stock earmarked in
casualty will be utilised. All essential drugs will be stocked in the medical
stores and issued on orders of MS, DMS, Duty Officer. Dressing material
and items of surgical stores are similarly kept in reserve. A dozen
emergency trays containing life saving drugs will be kept ready in medical
stores. For first few hours and for immediate use the drugs will be
requisitioned from emergency stock lying with sister I/C of Casualty.

�Approximately 400 bottles of Crystalloids are kept available by the

Crystalloids store. I/C stores will be at once sent for reporting on duty.

Emergency Blood Bank:

�Efforts shall be made for blood of all the available groups to the stocked
in plenty. Volunteers and Voluntary Organisation will be approached to
donate as much blood as possible.

Staff:

�Medical Staff : In addition to members of regular clinical units the

faculty members of para and preclinical discipline will be asked to render
help to assist the clinical staff in managing the causalities. The duty

53
roster of regular consultants and standby doctors is to be made available
in control room.

�Nursing Staff : A pool of nursing staff will be created by the Nursing

Supdt. So that nursing staff is available at short notice. This pool should
be out of nurses staying in the hostel for operational reasons. Duty roster
will be sent to the duty officer by Sanitary Supdt.

Volunteers:

�Volunteers will be invited by the coordinated efforts of Faculty I/C

HospAdmn and two MHA residents, if necessary Documentation Centres
�For small load of casualty; documentation shall be done at the casualty
OPD itself
�For large load of casualty; it is to be established in ground floor OPD at
the central registration office
of OPD. The staff working at registration counter and nursing staff will be
utilised for documentation and identification volunteers may also be used
for this purpose

Hospital Security:

�Security of staff, patients and hospital building and equipment being of

paramount importance, during such disasters, the security officer has
been requested to tune up and organise the security arrangements for
this purpose

Food Service:

�Supply of nourishment to the patients and emergency duty staff will

start immediately by the staff of the dietary services under direct
supervision of Head of the Department of Dietetics or Dietician-in-charge
of Kitchen. Most of the patient for first 24-48 hrs will be using only liquid
or semi solids. By then efforts can made supply of proper meals.

Information Services:

�Faculty of Hospital Administration will function as information officer

and all information to press, radio and other media, individuals,

54
organisations, government or otherwise will be issued by him. He will get
prior clearance from competent authorities before issue of such
information.

Engineering and Maintenance Service:

�The engineers will make sure that water and electricity is made
available without interruption. All the standby electric power generators
will be regularly checked, inspected and maintained in excellent
serviceable condition.

Discharge Procedure:

�After appropriate treatment the casualties fit to be discharged shall be

discharged to go home or to other hospital for convalescence. For all
cases discharged the destination will be noted by the hospitals and police
informed.

Success of Plan:

�Disaster is an emergency situation. Timely help of every individual is

needed to make this plan a success to reduce the Mortality and
Morbidity. In such state of affairs the individual and personnel
consideration take low priority in the face of duty to the profession for
sake of amelioration of human suffering.

PRINCIPLES OF DISASTER NURSING

Nurses have very important role in disaster management. Team must

understand the disaster plans at their workplace and community and will
participate in disaster drills.

1. Rapid assessment of the situation and of nursing care needs.

Triage and initiation of life-saving measures first.
2. The selected use of essential nursing interventions and the
elimination of nonessential nursing activities.

55
3. Adaptation of necessary nursing skills to disaster and
other emergencies. The nurse must use imagination and
resourcefulness in dealing with a lack of supplies, equipment,
and personnel.
4. Evaluation of the environment and the mitigation or removal of
any health hazards.
5. Prevention of further injury or illness.
6. Leadership in coordinating patient triage, care, and transport
during times of crisis.
7. The teaching, supervision, and utilization of auxiliary medical
personnel and volunteers.
8. Provision of understanding, compassion, and emotional support
to all victims and their families.

56
Chapter 15

FIRE SAFETY IN HOSPITAL

What is Fire
Fire is rapid oxidation of a fuel evolving heat, particulates, gases and
non-ionizing radiation.

Types of Fire

57
Type of Fire Extinguishers

All fire extinguishers operate in the same way, which can easily be
remembered with another acronym, P.A.S.S., which stands for:

P – Pull the pin in the nozzle of the extinguisher;

A – Aim the nozzle at the base of the fire;
S – Squeeze the handle; and
S – Sweep from side to side, covering the fire.

What to do in case of Fire

Everyone has a role and responsibility in the event of a fire
emergency, which may involve the rescue of residents and others,
assisting with moving them to safety, sounding the alarm, or just
staying out of the way of firefighters and other designated emergency
response personnel. All healthcare staff should know the following:

 Their facility’s Fire Emergency Plan;

 The location of pull/call boxes;
 The location of and how to use a fire extinguisher;

58
  Places of safe refuge; and
 Evacuation procedures.

If a fire occurs, there will be confusion, excitement, and nervousness.

To help staff prepare, providers should routinely conduct fire safety
training and practice drills using different scenarios. An easy acronym
to help staff retain the information is R.A.C.E., which stands for
Rescue, Alert/Alarm, Confine/Contain, and Extinguish/Evacuate.
Each of these steps should be accomplished while responding to a
fire emergency at any location throughout the building.

Role of Nursing Officers:

1. To get trained in fire safety (A detailed fire safety manual is
available)
2. To be alert in case of fire and inform the appropriate authority
3. To prevent any possible source of fire at their work place
4. In case of small fire help in extinguishing of the fire and
evacuation of patients
5. Senior nursing officer to train the new joined nursing officer or
transferred nursing officer of all the fire plan of their ward.

It is important for staff to remember the following:

 Never use elevators to evacuate a fire area.
 Evacuate people closest to danger first, then ambulatory
residents, followed by non-ambulatory residents, and lastly,
critical residents on life support (because they are not in
immediate danger and will need more time and care).
 If possible, move resident charts with the resident.

59
 All staff members should know the primary and secondary safe
areas and route of evacuation according to the facility’s fire plan,
which should be openly displayed.

FIRE CONTROL ROOMS & PHONE NOs.

 Main Hospital / CNC - 26593333/4444
 RPCOS- 26594427
 BRAIRCH - 29575047
 CDER - 26542307
 JPNATC – 26731130

60
Chapter 16

NURSING IN-SERVICE EDUCATION

INTRODUCTION:

Education plays an important role in achieving organizational goals

through a combination of organizational and the workforce interests.
Nowadays, training is an essential factor contributing to greater
efficiency of the staff and organizations.

In-service training of nurses plays an indispensable role in improving

the quality of inpatient care. Need to enhance the effectiveness of in-
service training of nurses is an inevitable requirement. The
empowering education can facilitate occupational tasks and achieving
greater mastery of professional skills among the nurses.

In addition to the theoretical knowledge, vocational training should

enhance the technical capacity and quality of services, leading to
innovation. Training programs must be organized in such a way that
they enhance the beneficial capabilities of nurses. One of the main
features of in-service training is applicability of theory knowledge to
practical in every nursing procedure.

Nurses play an important role in improving health standards. Hence,

they need to be updated about theoretical and practical knowledge in
this field. In fact, in-service training serves to update the staff's
occupational knowledge and professional skills and improve the best
practices for fulfilling various tasks and responsibilities. Another
important aspects concerning the in-service training of the nursing
staff is their active participation in such programs which leads to
effective learning and development in their field of work.

A well structured in-service education program has been initiated

since January 2011. Initially it started with twice a week class of one

61
hour each, which was later on increased to thrice in a week. Two
classes in a week are conducted for the bedside nurses (Nursing
Officer and Senior Nursing Officer),where as one class in a week is
for senior nurses (Sister In-charges and above).

The Goal of nursing in service programme is to empower nurses by

maximizing their knowledge base, licensure needs through various
modalities like:

 Conferences
 Workshops
 Training Programme
 Weekly Classes
 Quiz
 Role play
 Group Discussion
 Quality Improvement Initiative
 Research
 Public Awareness Programme
 School Health programme
 Development of Various Nursing Modules and SOP’s

NURSING IN-SERVICE EDUCATION ACTIVITIES

I. Clinical Teachings
Clinical teaching is provided with an objective of upgrading standard
of nursing care and solving practical issues in the area itself. This
initiative was started w.e.f 1st January 2015, with an active
participation of bedside nurses and supervisory nursing personnel of
the clinical areas. From August 2018 onwards clinical teaching
handed over to ANS In Charge of the respective wards.

62
II. In Service Education Weekly Classes
Weekly update lectures arranged for nursing personnel on various
ward management related topics.

Classes for CNO/NS/DNS/ANS/SNO HR:

 Safe Staffing
 Hepatic Disorders
 Stroke
 Cardiac Emergencies I
 Cardiac Emergencies II
 Acute Kidney Injuries
 Respiratory Emergencies
 SIU & Staffing
 Corona Virus
 Overview of Malignancies

Classes for Senior Nursing Officers/Nursing Officers

 Management of Patients on Ventilator
 Hepatic Disorders
 Stroke
 Cardiac Emergencies I
 Cardiac Emergencies II
 Acute Kidney Injuries
 Respiratory Emergencies
 SIU & Staffing
 Corona Virus
 Overview of Malignancies

63
III. Conferences and workshops:
 Annual NURSICON Conference
 Critical care Nursing Update for bedside nursing personnel.
 Mental Health At Workplace for Senior Nursing Officers
 Soft Skills& Communication workshops for nurses.
 Workshops with hands on training for the Pediatric, Intensive
care unit and Emergency Nurses.

64
Chapter 17

NURSING INFORMATICS AT AIIMS

All India Institute of Medical Sciences, New Delhi is a medical college

and research institute at New Delhi, India.. The hospital ensures to
provide affordable health care for the poorest of patients without
compromising the quality.

For the clarity and credibility of the work progressing in AIIMS and to
be in accordance with the current information age it has been
imperative to adopt and adapt to the latest technology developments
to achieve high quality care. AIIMS being premier medical institute
and supreme temple of learning in India has sought effective and
latest technology to provide standardized health care. As a major
thrust towards computerization, hospital information system and
electronic medical record were implemented in AIIMS

The successful implementation of the AIIMS e-Hospital Project and

the AIIMS OPD Transformation Project, transformed AIIMS to India’s
fully digital public hospital. This has benefited lakhs of patients and
relatives visiting AIIMS, reducing the average waiting time of patients
and increasing the transparency and accountability in the functioning
of public sector healthcare institutions and which is most marked in
the delivery of emergency services as well as out-patient (OPD)
services.

This which required proper planning by stake holders and a core team
of officials collaborated cordially and constructively for the planning
and implementation of e hospital modules at AIIMS.

MODULES OPERATIONAL AT AIIMS

The modules were developed and customised by NIC based on the

requirements of AIIMS.These modules were organized in two sections
are as follows:

65
  e-Hospital modules
 In-house modules

e-Hospital modules

 OPD Appointment Module

 IPD (Admission/Discharge/Transfer) Module
 Laboratory Module
 Billing Module
 Dietary Module
 Laundry Module
 Inventory Module
 e-Blood Bank (BOTS module)

In-house modules

 e-MLC((Snomed Integrated)
 Patient Display system (Snomed Integrated)
 Quality Assurance module
 Vitals entry (Snomed Integrated)
 e-OT list
 e-birth module (Snomed Integrated)
 e-death note (NDRI) (Snomed Integrated)
 e-Roster

NURSING INFORMATICS SPECIALIST (NIS)

Nursing Informatics specialist was started in AIIMS with a mission of

digitalisation of AIIMS .

Functions and roles of NIS

The three major functions of nursing informatics specialist are

coordination, patient care, education & research.

66
Role of NIS in digitalisation caters to various areas which include
direction in developing various programmes along with developers,
training to all staff, coordinating with the implementation of software
and emergency nurse coordinator providing assistance to patients
24X7.In addition to the above said, the following assignments are also
being entrusted to NIS roles:

1. Prepare, educate and provide technical support to end users

/staff when a new application is integrated into the healthcare
workflow
2. Proactively assist users (faculty members, doctors, nurses and
staff) for all IT related issues at their end, and if necessary with
the help of computer facility.
3. Interaction with the end users for IT related issues, sorting the
issues, if necessary in coordination with computer facility

i. In case of configuration issues: Configuring the

templates, configure mappings wherever applicable.
Creating new user Ids/Roles, transfer/change of roles and
mappings.
ii. In case of error /bugs: Bringing this into notice of the
concerned officers of computer facility for rectification and
follow- up with them until the issue is resolved
iii. In case of new user requirements: Bringing this into the
notice of Prof-in charge computer facility for their
approval and follow up the same.
iv. For hardware/network issues: lodging the complaint at
help desk and follow up until the issue is satisfactorily
resolved.

67
Chapter 18

DISCIPLINARY PROCEEDINGS

Introduction: Every Government servant shall at all time, maintain

absolute integrity, decorum of conduct and devotion to duty and shall
not commit any act which amounts to personal immorality or failure to
discharge duties properly.

A Government servant is expected to discharge his duties sincerely

and observe utmost discipline of conduct. Any omission or
commission in due discharge of his duties will warrant disciplinary
action against him as per the provisions of the CCS (Classification,
Control and Appeal) Rules, 1965.

CCS (CCA) Rules, 1965 basically form part of the reward and
punishment sub-system under personnel management system of
organization. It provides a mechanism for dealing with erring
employees whose behavior does not conform to the prescribed
organizational norms – either by express provision or by necessary
implications.

The rules cover the following aspects:

a) What penalties can be imposed on an erring employee? (Rule

11)
b) Who imposes these penalties? (Rule 12 and 13 )
c) What is the procedure to be followed for imposing these
penalties? (Rule 14, 15, 16, 18, 19, etc.)
d) What remedies are available to the employee after a penalty
has been imposed? (Rule 22 to 29A)
e) Issues which are incidental to the above. (Rule 10 [i.e
suspension which is a step in aid for conducting inquiry], 31 to
35, etc.)

68
Complaint: Vigilance Manual (2017 Ed) defines complaint as a piece
of statement or information containing details about offences alleged
to have been committed under the Prevention of Corruption Act,1988,
or malpractice/ misconducts under Conduct Rules governing specified
categories of public servants.

Anonymous or pseudonymous complaints: When the complaint is

done anonymously or with the name of some person other than the
actual complainant, usually no action is taken in these cases.

False complaint: If a complaint is found to be malicious, vexatious or

unfounded, departmental or criminal action as necessary may be
initiated against the author of false complaints.

Preliminary investigation, also known as Fact Finding Inquiry, is the

process of checking the veracity of a complaint and if the complaint is
true, to collect evidence in support of the charge. It may be carried out
departmentally or by police as the situation warranted.
Possible actions on the Preliminary Investigation report are as
under:
a) Closure of the case: In case the investigation report indicates
that no misconduct has been committed, the case may be
closed.
b) Action against false complaints: If it is found that complaint
was malicious, vexatious or unfounded departmental or
criminal action may be initiated against the complainant
c) Administrative action: This includes issue of warning,
clarification to the decision making authorities, etc.
d) Minor Penalty Proceedings
e) Major penalty proceedings
f) Criminal prosecution

SUSPENSION (Rule 10 of CCS (CCA) Rules, 1965)

Suspension is a temporary deprivation of office. The contract of
service is not terminated. However, the Govt. servant placed under
suspension is not allowed to discharge the functions of his office

69
during the period of his suspension. It is not a penalty under the CCS
(CCA) Rules, 1965. It is only an intermediate step. However, it visits
the Government servant with civil consequences. An appeal lies
against the order of suspension (under Rule 23(i)) and the employee
is entitled to receive subsistence allowance during the period of
suspension.

Rule 10(1): As per rule 10(1) a government servant may be placed

under suspensionunder the following situations:
I. Where a disciplinary proceeding is contemplated or is pending;
or
II. Where in the opinion of the competent authority, he has
engaged himself in activities prejudicial to the interest of the
security of the State; or
III. Where a case against him in respect of any criminal offence is
under investigation, inquiry or trial;
IV. When Government servant is involved in dowry death case

Deemed suspension: Deemed suspension is a case when a

Government Servant is considered to be under suspension without a
conscious decision of any of the authorities i.e. the rules create a
legal fiction in which though no actual order is issued it is deemed to
have been passed by operation of the legal fiction. Such a
suspension is deemed to have arisen consequent to the happening of
certain events. Nevertheless an order is required to be passed by the
competent authority

Rule 10(2)
During the service period, a person is deemed to have been placed
under suspension in the following cases:-
1. From the date of detention in custody (whether on criminal
charge or otherwise) for a period exceeding 48 hours.
2. From the date of conviction for an offence leading to
imprisonment for a period exceeding 48 hours if he is not
forthwith dismissed or removed or compulsorily retired

70
 consequent upon such conviction. (48 hours will be computed
from the commencement of the imprisonment).

Government servant to intimate his/her arrest/conviction:

Although the Police Authorities will send prompt intimation of arrest
and/or release on bail etc., of a Government servant to the latter’s
official superior as soon as possible after the arrest and/ or release
indicating the circumstances of the arrest etc., but it is also the duty of
the Government servant who may be arrested, or convicted, for any
reason to intimate promptly the fact of his arrest/conviction and
circumstances connected therewith to his official superior even
though she/he might have been released on bail. Failure to do so will
render him liable to disciplinary action on this ground alone.

Revocation of the order of suspension and the Review

Committee.
Rule 10(5): The general rule is that an order of suspension made or
deemed to have been made may at any time be modified or revoked
by the competent authority.
Rule 10(6): An order of suspension made or deemed to have been
made will not be valid after a period of 90 days unless it is extended
after review by the Review Committee constituted. This review has to
be done before expiry of ninety days from the effective date of
suspension. If it is decided to further continue the suspension, it shall
not be continued beyond 180 days at a time. After 180 days, the
review has to be done again.
On the conclusion of the disciplinary proceedings, if a minor penalty is
imposed, suspension is regarded as unjustified and full pay and
allowances and other consequential benefits are given to him/her and
the period of suspension is treated as duty.

Subsistence allowance: A Government servant placed under

suspension or deemed suspension is not entitled to salary but is
entitled to draw for the first three months subsistence allowance at an
amount equal to leave salary during half pay or half average payplus
dearness allowance as admissible on such amount (i.e. pro-rata) but

71
CCA and HRA as admissible to him before suspension. The matter is
regulated by the provisions of F.R.53. The order for subsistence
allowance is usually passed simultaneously with the order of
suspension or as early as possible to avoid hardship to the concerned
Government servant.

Review of Subsistence Allowance: If the period of suspension

exceeds 3 months, the amount of subsistence allowance may be
increased or decreased up to a maximum of 50% of the amount being
drawn by him during the first three months, depending on whether the
reasons for continued suspension are attributable directly or indirectly
to the Government servant.

PENALTIES:
The following penalties may, for good and sufficient reasons and as
hereinafter provided, be imposed on a Government servant, namely:-
Minor Penalties -
(i). Censure: An order of “Censure” is a formal and public act
intended to convey that the person concerned has been guilty
of some blameworthy act or omission for which it has been
found necessary to award him a formal punishment, and
nothing can amount to a “censure” unless it is intended to be
such a formal punishment and imposed for “good and sufficient
reason” after following the prescribed procedure. A record of
the punishment so imposed is kept on the officer’s confidential
roll and the fact that he has been ‘censured’ will have its
bearing on the assessment of his merit or suitability for
promotion to higher posts.
There may be occasions, on the other hand, when a
superior officer may find it necessary to criticize adversely the
work of an officer working under (e.g. point out negligence,
carelessness, lack of thoroughness, delay etc.) or he may call
for an explanation for some act or omission and taking all
circumstance into consideration, it may be felt that, while the
matter is not serious enough to justify the imposition of the
formal punishment of ‘censure’ it calls for some informal action

72
 such as the communication of a written warning, admonition or
reprimand, if the circumstances justify it, a mention may also
be made of such a warning etc., in the officer’s confidential roll;
however, the mere fact that it is so mentioned in the character
roll does not convert the warning etc. into “censure”. Although
such comments, remarks, warning etc., also would have the
effect of making it apparent or known to the person concerned
that he has done something blame-worthy and, to some extent,
may also effect the assessment of his merit and suitability for
promotion, they do not amount to the imposition of the penalty
of ‘Censure’ because it was not intended that any formal
punishment should be inflicted.
(ii). Withholding of his/her promotion;
(iii). Recovery from pay of the whole or part of any pecuniary loss
caused by him/her to the Government by negligence or breach
of orders;
(iiia) Reduction to a lower stage in the time-scale of pay by one stage
for a period not exceeding three years, without cumulative effect and
not adversely affecting his/her pension.
(iv). Withholding of increments of pay;
Major Penalties –
(v). Same as provided for in clause (III) (a), reduction to a lower
stage in the timescale of pay for a specified period, with further
directions as to whether or not the Government servant will
earn increments of pay during the period of such reduction and
whether on the expiry of such period, the reduction will or will
not have the effect of postponing the future increments of his
pay;
(vi). Reduction to lower time-scale of pay, grade, post or Service for
a period to be specified in the order of penalty, which shall be a
bar to the promotion of the Government servant during such
specified period to the time-scale of pay, grade, post or Service

73
 from which he was reduced, with direction as to whether or not,
on promotion on the expiry of the said specified period –
a) The period of reduction to time-scale of pay, grade, post or
service shall operate to postpone future increments of his pay,
and if so, to what extent; and
b) The Government servant shall regain his original seniority in
the higher time scale of pay, grade, post or service;
(vii) Compulsory retirement;
(viii) Removal from service which shall not be a disqualification for
future employment under the Government;
(ix) Dismissal from service which shall ordinarily be a disqualification
for future employment under the Government.
Provided that, in every case in which the charge of possession of
assets disproportionate to known-sources of income or the charge of
acceptance from any person of any gratification, other than legal
remuneration, as a motive or reward for doing or forbearing to do
any official act is established, the penalty mentioned in clause (viii)
or clause (ix) shall be imposed.
Provided further that in any exceptional case and for special reasons
recorded in writing, any other penalty may be imposed.
Explanation: The following shall not amounted to a penalty within
the meaning of this rule, namely:—
(i). withholding of increments of pay of a Government servant for
his failure to pass any departmental examination in
accordance with the rules or orders governing the Service to
which he belongs or post which he holds or the terms of his
appointment;
(ii). stoppage of a Government servant at the efficiency bar in the
timescale of pay on the ground of his unfitness to cross the
bar;

74
 (iii). non-promotion of a Government servant, whether in a
substantive or officiating capacity, after consideration of his
case, to a Service, grade or post for promotion to which he is
eligible;
(iv). reversion of a Government servant officiating in a higher
Service, grade, or post to a lower Service, grade or post, on
the ground that he is considered to be unsuitable for such
higher Service, grade or post or on any administrative ground
unconnected with his conduct;
(v). reversion of a Government servant, appointed on probation to
any other Service, grade or post, to his permanent Service,
grade or post during or at the end of the period of probation in
accordance with the terms of his appointment or the rules and
orders governing such probation;
(vi). replacement of the services of a Government servant whose
services had been borrowed from a State Government or an
authority under the control of a State Government, at the
disposal of the State Government or the authority from which
the services of such Government servant had been borrowed;
(vii). compulsory retirement of a Government servant in
accordance with the provisions relating to his superannuation
or retirement;
(viii). termination of the services—
a. of a Government servant appointed on probation, during
or at the end of the period of his probation, in accordance
with the terms of his appointment or the rules and orders
governing such probation; or
b. of a temporary Government servant in accordance with
the provisions of sub-rule (1) of rule 5 of the Central Civil
Services (Temporary Service) Rules, 1965; or
c. of a Government servant, employed under an agreement,
in accordance with the terms of such agreement.

75
 (ix). Any compensation awarded on the recommendation of the
Complaints Committee referred to in the proviso to sub-rule
(2) of rule 14 and established in the Department of the
Government of India for inquiring into any complaint of sexual
harassment within the meaning of rule 3 C of the Central Civil
Services (Conduct) Rules, 1964.
Common procedure for imposing penalties: following rule sections
CCS (CCA) rules 1965 are followed for imposing penalties:
Rule 14- Procedure for imposing major penalties
Rule 15- Action on inquiry report
Rule 16- Procedure for imposing minor penalties
Rule 17 –Communication of orders
Rule 18- Common proceedings

Appeal: Government servant may prefer appeal as per the provisions

of rule 22-25 of CCS (CCA) rules 1965 except in following orders
against which no appeal lies

(i). Any order made by the President;

(ii). Any order of an interlocutory nature or of the nature of a step-
in-aid of the final disposal of a disciplinary proceeding, other
than an order of suspension;
(iii). Any order passed by an inquiring authority in the course of an
inquiry under Rule 14.

Period of limitation of appeal:

No appeal preferred shall be entertained unless such appeal is
preferred within a period of 45 days from the date on which a copy of
the order appealed against is delivered to the appellant.
The Appellate authority may entertain the appeal after the expiry of
the said period, if it is satisfied that the appellant had sufficient cause
for not preferring the appeal in time.

FURTHER READING: Central Civil Services (Classification, Control

and Appeal) Rules, 1965. https://dopt.gov.in/ccs-cca-rules-1965

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Chapter 19
PATIENT SAFETY

Patient safety

The delivery of safe, high-quality patient care is of utmost importance

to nurses. As nursing care spans all areas of care delivery, nurses are
well placed to prevent harm to patients and improve the quality and
safety of healthcare delivered across all settings. As such, nurses
should be central to the design and operation of all health providers’
patient safety systems and processes.

(Reference: International Council of Nurses

https://www.icn.ch/nursing-policy/icn-strategic-priorities/patient-safety)

What is Patient Safety?

Patient Safety is a health care discipline that emerged with the

evolving complexity in health care systems and the resulting rise of
patient harm in health care facilities. It aims to prevent and reduce
risks, errors and harm that occur to patients during provision of health
care. A cornerstone of the discipline is continuous improvement
based on learning from errors and adverse events

The Burden of harm

Many medical practices and risks associated with health care are
emerging as major challenges for patient safety and contribute
significantly to the burden of harm due to unsafe care. Below are
some of the patient safety situations causing most concern.

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 1. Medication errors are a leading cause of injury and avoidable
harm in health care systems: globally
2. Health care-associated infections occur in 7 and 10 out of
every 100 hospitalized patients in high-income countries and
low- and middle-income countries respectively
3. Unsafe surgical care procedures cause complications in up
to 25% of patients. Unsafe injections practices in health care
settings can transmit infections, including HIV and hepatitis B
and C, and pose direct danger to patients and health care
workers; Diagnostic errors occur in about 5% of adults in
outpatient care settings, more than half of which have the
potential to cause severe harm.
4. Unsafe transfusion practices expose patients to the risk of
adverse transfusion reactions and the transmission of
infections
5. Radiation errors involve overexposure to radiation and cases
of wrong-patient and wrong-site identification
6. Sepsis is frequently not diagnosed early enough to save a
patient’s life. Because these infections are often resistant to
antibiotics, they can rapidly lead to deteriorating clinical
conditions
7. Venous thromboembolism (blood clots) is one of the most
common and preventable causes of patient harm, contributing
to one third of the complications attributed to hospitalization.

NURSING AS THE KEY TO IMPROVING QUALITY THROUGH

PATIENT SAFETY

Nursing has clearly been concerned with defining and measuring

quality long before the current national and State-level emphasis on
quality improvement. Florence Nightingale analyzed mortality data
among British troops in 1855 and accomplished significant reduction
in mortality through organizational and hygienic practices.14She is

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also credited with creating the world’s first performance measures of
hospitals in 1859.

Many have often viewed nursing’s responsibility in patient safety in

narrow aspects of patient care, for example, avoiding medication
errors and preventing patient falls. While these dimensions of safety
remain important within the nursing purview, the breadth and depth of
patient safety and quality improvement are far greater. The most
critical contribution of nursing to patient safety, in any setting, is the
ability to coordinate and integrate the multiple aspects of quality within
the care directly provided by nursing, and across the care delivered
by others in the setting

promote safety!

(Reference: https://www.who.int/news-room/fact-sheets/detail/patient-
safety )

WHO SURGICAL SAFETY CHECKLIST

(Ref.https://www.who.int/patientsafety/topics/safe-
surgery/checklist/en/)

The WHO Surgical Safety Checklist was developed after extensive

consultation aiming to decrease errors and adverse events, and
increase teamwork and communication in surgery. The 19-item
checklist has gone on to show significant reduction in both morbidity
and mortality and is now used by a majority of surgical providers
around the world.

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80
Chapter 20

COVID-19: RESOURCES FOR NURSING

OFFICERS

During the currently rapidly evolving pandemic of COVID-19,

guidelines, recommendations and advisories are issued by hospital.
These are available at following link:
https://covid.aiims.edu/

In addition, Hospital Infection Control Committee organises large no.

of training programmes and created online learning resources for
Capacity Building of Health Professionals. Resource material is
available on following topics

 Infection Prevention & Control Guidelines

 Updated Infection Prevention & Control Guidelines
 Appropriate use of PPEs
 PPE- Donning & Doffing
 Hand hygiene
 Safe intubation
 PICC lines
 Arterial lines
 NP swab sampling
 Other Sample Packing and Transport
 Clinical Management Guidelines
 Dead Body Management

These Learning Resources are available at:

https://covid.aiims.edu/training/

COVID-19 Special Training Course for Nurses is available

at:https://saral.aiims.edu/enrol/index.php?id=641

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Appendix:

FORMAT FOR Medicine & Equipment Audit

**************

Medicine & Equipment audit need to be done by different wards/ areas/

departments.

Medicine Audit (Format)

Area/ ward/ Department: ____________________

Nodal officer:______________________________

External audit team (Nodal Officer):____________

Date of external audit:_______________________

1. Crash-cart:
a. Has the crash-cart checklist been maintained: Yes/ No
b. Are the drugs located in designated places within crash-cart: Yes/ No
If no, please elaborate:
c. Any near expiry/ expired medicines in the crash cart: Yes/ No
If yes, details:

Sl No. Name of the drug Date of expiry

2. Medicine sub-store:

Sl No. Name of the drug Date of expiry

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 Equipment audit (Format)

Area/ ward/ Department:____________________

Date:_______________

Nodal officer:______________________________

External audit team (Nodal Officer):___________

Date of external audit:_______________________

Sl Equipment Quantity Functional Critical/ Date of Under Remarks

No Status Non- installation warranty/ (By
critical CMC/ external
AMC audit
team)

*Nodal officer of respective ward/ area/ department to arrange the equipment in

descending order of criticality/ importance for functioning of ward/ area/
department and the respective columns to be prefilled in readiness.

The equipment will be physically assessed by the external audit team before
filling the last column

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