OBM752-Hospital Management Unit:4

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OBM752 - HOSPITAL MANAGEMENT
UNIT IV - SUPPORTIVE SERVICES
Medical Records Department - Central Sterilization and Supply Department - Pharmacy -
Food Services - Laundry Services.
Medical Records Department
• The Medical Records department maintains records and document relating to
patient care.
• The importance of the Medical Records department was always these, but now it
has become a more important department because of increasing
✓Medico legal cases such as assaults, attempted suicides, deaths from criminal acts, industrial
accidents, poisoning, and road accidents
✓Consumer cases
✓Teaching in hospitals to postgraduate students
✓Research work
OBM752 HOSPITAL MANAGEMENT 2

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• The main functions are filing, indexing and retrieving medical records by
i. Developing a procedure for the proper flow or records
ii. Developing a statistical reporting systems that includes ward census, daily census, out-
patient census, etc.
iii. Preparing births, deaths and communicable diseases reports which are mandatory
iv. Preparing statistical reports in relation to admission, discharge, coding all diagnosis and
operations according to the international classification of diseases.
• The primary purpose of establishing a Medical Records department is
✓To render service to patients, staff and hospital administration by keeping every thing handy
pertaining to patients, their sex, religion, age, area where they belong to, disease, operation,
whether discharged after satisfactory recovery or left against medical advice or died.
✓Used as primary tools to evaluate the quality of patient care rendered by the medical staff.
✓Widely used for teaching and research purposes.
✓In the context of increasing medico legal cases and consumer cases against hospitals and
treating doctors, well documented medical records are a good legal protection.
✓In such circumstances, every hospital should formulate policies, rules and regulations for the
completion and maintenance of medical records.

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The primary responsibility of each and every treating doctor to review,
✓Correct and countersign records that are written by resident doctors working under him.
✓Each entry in the medical records must be signed by the person making the entry and
his/her signature must be identifiable so that responsibility for authenticity can be fixed.
✓The language used in preparing medical record should be clear, concise, conspicuous and
should not lend itself to misinterpretation.
✓Abbreviations and symbols used should be of acceptable standard.
Roles and responsibility
✓The Medical Records department is generally headed by a Medical Records officer.
✓He should be a graduate with a diploma or degree in Medical Record Technology.
✓Should have 10-15 years experience to his credit as it is a post of responsibility where he is
required to maintain confidentiality and at the same time, to discharge mandatory responsibility
by notifying deaths, births, number of communicable cases reported in the hospital, etc.
✓Reports to the Medical Superintendent and convenes the meeting of the Tissue Committee
monthly.

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Location and Service
✓ Locate the Medical Records department near the Admission Office, Out-Patient department, and
emergency room.
✓ It should also be close to the Senior and Junior doctors' coffee room so that the medical staff may
conveniently drop in and complete the charts of the discharged patients.
✓ In order to provide a fast Medical Record service to all concerned and to foster a close working
relationship and good communication among the related departments.
✓ The location of the Medical Records department becomes more important in small hospitals where
this department is closed at night and the emergency department may need the previous record of
the patient who has been brought in emergency and the Casualty Medical Officer may prefer to
review the record of his last admission.
Location and Service
✓It is a matter of policy of a hospital to keep the emergency record of a patient in the
emergency department, outdoor patients' records in the OPD and indoor patients
records in the Medical Records department.
✓But it has been experienced that most of the hospitals retain only emergency record
of the patients and indoor record of the patients in the Medical Records department.
✓In those hospitals where OPD records of the patients is not retained in the OPD, it
becomes very difficult to defend a complaint filed by a patient in the consumer court.

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Space Requirements
• The Medical Records department requires lots of space as it is required to keep
record of all inpatients, deaths, births, medico legal cases, etc.
• As per the notification issued by the government from time to time and it requires
✓Reception area
✓Work area for record processing, assembling, numbering, indexing, correspondence, etc.,
✓Record storage area
✓Area for completion of medical record by the medical staff
✓Area for the medical records staff
✓sPhotocopier is provided to the Medical Records department, it also requires some area for
keeping the photo copying machine
Central Sterilization and Supply Department
• The method basically involves cleaning, disinfecting and sterilizing before use all
instruments, materials, etc. utilized in patient care.
• From different departments of the hospital like
• OPD clinics
• Treatment rooms
• Casualty
• Wards
• Labour room
• Operation theatre and other departments
• All soiled items are collected in the central sterilization and supply department for
packing, sterilizing and finally, transporting back to the user departments.

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• The central sterilization and supply department plays a crucial role in the
functioning of a hospital.
✓It not only reduces infection but also prevents it to a great extent.
✓The infection rate is higher in India than in the advanced countries like, the UK,
the USA, Australia, and Canada.
✓Because the equipment used in the central sterilization and supply department in India is not
of very high quality.
✓The personnel working in the department also do not take the work of sterilizing the
equipment seriously.
• The method basically involves
• Cleaning
• Disinfecting
• sterilizing before use all instruments, materials, etc
• From different departments of the hospital like OPD clinics, treatment
rooms, casualty, wards, labour room, operation theatre and other
departments, all soiled items are collected in the central sterilization and
supply department for packing, sterilizing and finally, transporting back to the
user departments.

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• Indian hospitals, the central sterilization and supply department is a part of the Nursing Service
department.
• The CSSD in-charge is directly responsible to the Nursing Superintendent because this department
mostly serves nursing units, operation theatre, ICU, PICU, labour room, radiology, pharmacy and
laboratory of the hospital.
• The primary activities of the department are
• Sterilizing
• Storing and distributing the dressings
• Instrument packs
• Gloves
• Catheters
• Sterile linen packs
• Treatment trays, etc.
Main objectives
• To prevent infection by sterilizing equipment and materials
• To sterilize equipment and materials so that reuse of these items can be possible
• To achieve higher efficiency in the areas where sterilized equipment and materials are used
• To reduce the length of stay of patients by providing proper sterilized equipment and materials
• To reduce the cost of maintenance of the hospital by sterilizing the equipment and materials

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Functions
• Receiving the used equipment and materials
• Sorting out the equipment and materials
• Deciding whether any of the equipment and materials are required to be discarded
• To disinfect prior to sterilization
• Assembling equipment sets, linen packs and treatment trays
• Packing equipment sets, linen packs and treatment trays
• Sterilizing
• Labelling and dating
• Storing equipment packs, linen packs and treatment trays
• Issuing
Locations
• Soiled area
✓ Used equipment, linen and treatment trays are brought to the soiled area in the central sterilization and supply department.
✓ Here the used equipments, linen and treatment trays are washed either in steam or hot water.
✓ All these things are sorted, inspected and packed, after packing, they are kept in the autoclave for sterilization.
• Clean area
✓ The storage area should not be damp and at the same time, it should be dust free so that the sterilized materials do not get
disinfected.
• Sterile area
✓ The sterilization room is located next to the operating rooms so that sterile packs can be carried easily.
✓ The advantage of this system is that there is direct communication between the CSSD staff and the OT staff.
✓ Secondly, the transportation of linen and OT equipment from the operation theatre to the central sterilization and supply department
is eliminated.

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Pharmacy
• Pharmacy is a specialized area and it is one of the most extensively used therapeutic facilities of
the hospital, from where fairly high revenue can be generated to meet its expenditure.
• Each and every hospital administrator is required to plan, organize, staff, control and evaluate the
pharmacy department scientifically and professionally by employing qualified and experienced
pharmacists.
• To run the pharmacy of a hospital, the head of the hospital requires qualified pharmacists, sound
organization structure, cooperation of the medical and nursing staff of the hospital.
• He should also keep in mind the modem trend, automation, prepacking, drug distribution, etc.
• Hospitals based in the metropolitan cities are using computer based ordering system,
computerized pricing, billing, cash collection, stock position, etc.
Pharmacy
• All purchases are done as per the formulary prepared by the therapeutic committee of
the hospitals, which makes the job of the chief pharmacist easy and he is not blamed for
not keeping all brands of medicines.
• Each hospital should design its own pharmacy and follow norms and legal
requirements of keeping narcotics and preparing I.V.(Intravenous) solutions.
• Mostly pharmacies keep the essential list of drugs, have their own formulary, set up
policies and procedures, and purchase, receive, store and dispense drugs to outdoor
and indoor patients.
• And their chief pharmacist acts as a PRO of the hospital and meets medical
representatives and the government officials such as drug inspectors.

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Pharmacy
• Working Time
✓ Functions from 7 am to 7 pm without any break round the year
✓ In large size hospitals, pharmacies functions round the clock throughout the year
• Should properly plan, organize staff and control the pharmacy department of the hospital to avoid
drug theft.
• The chief pharmacist is also responsible for
✓ Discarding expired medicines
✓ Issuing guidelines
✓ Ensuring labelling of medicine containers
✓ Recommending drugs to be stocked in the nursing
stations
✓ Checking registration of the pharmacists working
under him
✓ Developing a formulary
✓ Indenting medicines
✓ Receiving supplies
✓ Stocking medicines
✓ Dispensing
Pharmacy
• The number of pharmacists to be employed in a hospital depends upon the policy of the hospital.
• It has been observed that one pharmacist can dispense medicines to 150 patients per day.
• One pharmacist can dispose of one prescription of a patient, whether an out- or an in-patient in
approximately 2 minutes.
• One pharmacist who works 8 hours a day can take care of 100 out-patients as well as 50 in-
patients.
• Every two pharmacists, one pharmacy aid will have to be provided to assist them.
• If the number of pharmacists in a hospital exceeds 7, the Chief Pharmacist should employ one
senior pharmacist to assist him in supervision so that the efficiency of the department may be
maintained.

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Food Services
Food Services
• The food-service department of any hospital caters meals to the patients and plays a significant
role.
• Meals prepared hygienically under the guidance of qualified dieticians, according to the
instructions of the doctors and attractively served to the patients help in their speedy recovery.
• Today the food-service department ranks as one of the major departments of a modern hospital.
• It is responsible for planning, organizing and directing all phases of the dietetic operations which
include
✓ Visiting patient
✓ Consulting their charts
✓ Menu planning
✓ Food preparation
✓ Serving
✓ Budgeting
✓ Record keeping
✓ Performance appraisal of
its personnel
✓ Safety
✓ Sanitation & etc.,

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Food Services
• It is desirable to locate the food service department on the ground floor of the hospital as this
department in the basement is likely to be dingy, dark and poorly ventilated.
• Secondly locating the Food Service department will not violate the Municipal by-laws also.
• The employees' cafeteria is concerned, it is generally close to the Food Service department.
• The patient's meals are carried by the diet aides in the electrically heated food service trolleys to
the wards and served to them on their bed side only.
• While designing the food service department, it should be kept in mind that receiving supplies,
storing, preparing, serving and washing areas, Food service manager's and Dietician's offices should
be as close as possible so that scientific management and logical flow can be ensured.
Food Services
• Once in a while, the dietician should also be present while supplies are being received by the storekeeper.
• The receiving area should be equipped with weighing scales so that the storekeeper and the dietician can check supplies according to
the specifications.
• Once the supplies are received, they are stored in dry and refrigerated areas. For non-perishable items like tea, sugar, spices, etc.
wooden/teel racks are used and for perishable items like meat, eggs, vegetables, foods, etc. refrigerators with varying degrees of
temperature are used.
• The storage area which is meant for perishable(fresh) and non-perishable items should be close to the receiving area. Special
attention should be given to the size of the kitchen of the Food Service department.
• Some hospitals serve only vegetarian food while others non-vegetarian food also. In some hospitals, the employee's food is also
prepared in the same kitchen. Though the chief cook is responsible for cooking the dietician has the overall responsibility for in-
patient food.
• Food prepared for the employees is sent to the hospital cafeteria and the food prepared for the in-patient is sent to the serving room
where patient food trays are assembled according to the menu of each and every patient separately by the diet aides under the
supervision of the dietician.
• After the trays are assembled, they are loaded on food trolleys and sent to patient floors. These food trolleys have in-built electrical
heating arrangement so that the food remains hot.

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Food Services
Food Service department types
1. Supply receiving area
2. Dry storage area
3. Refrigerated storage area
4. Cooking area:
✓ for vegetarian cooking
✓ for non-vegetarian cooking
✓ for western cooking
✓ for special diet cooking
5. For employees cooking
6. Patients serving rooms where patients food trays are
assembled
7. Food service manager office
8. Dietician office
9. Dishwashing area
10. Peeling of vegetables area
11. Visitors' canteen
12. Pot washing area.
Food Services
• The hospitals employ qualified Food Service managers with a diploma or degree in hotel and catering management
and a dietician with a degree in Dietetics after B.Sc. in Home Science or M.Sc. in Nutrition Science.
• Some hospitals engage the workers of the Food Service department through the contractor. It depends upon the
policy of the management, but the Food Service manager and the Dietician are the employees of the hospital.
• One dietary staff member (excluding supervisory staff) is required for approximately 15 to 20 patients.
• In the food-service department of a hospital, the dietician, food storekeeper, cook, cook helpers, bearer and dish
washer work in close co-ordination.
• One dietician can look after up to 200 beds. If the bed strength exceeds 200 beds, another dietician should be
appointed.
• One cook, one cook helper, one bearer and one dishwasher are sufficient to prepare and serve meals for 20
patients/staff members.
• A thirty per cent leave reserve should be appointed, because the food service department functions round the
year.

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Laundry Services
• Laundry and linen services play a major role in hospital functioning. A great deal of space and money is
allocated to this department, which is a major consideration in planning, designing and constructing a hospital.
• The laundry should be located on the ground floor in the open area so that the washed linen can be dried in
the sun as the sun is a very good disinfectant.
• The laundry should also be close to the linen department as well as elevators.
• Some hospitals have chutes through which the dirty linen is dropped on the ground floor from where the
laundry personnel pick up and take to the laundry for washing, drying and ironing.
Laundry Services
Standards adopted United States of America, United Kingdom and India
• American standard
✓An average of 15 pounds per bed per day plus 25 pounds for each operation/delivery.
• British standard
✓60 articles per bed per week at 0.40 kilogram per article.
• Indian standard
✓3-5 kilogram per bed per day.

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Laundry Services
Space required in a hospital laundry
✓ To open the bundles of the linen
✓ For sorting linen
✓ Sluicing and disinfecting area
✓ Clean linen processing area
✓ Drying area
✓ Folding area
✓ Pressing area
✓ Material storage area
✓ Clean linen storage area
✓ Laundry supervisor's office
✓ Laundry personnel's rest room
✓ Toilets
✓ Water softening plant area, if required
✓ Cart storage area
✓ Solution preparation and storage room
✓ Boiler area
Laundry Services
Equipment required in a hospital laundry
✓ Washing machines
✓ Hydro extractors
✓ Iron for pressing clothes
✓ Dryers if open space is not available
✓ Dry linen trolleys
✓ Wet linen trolleys
✓ Sewing machines
✓ Weighing machines
✓ Boiler

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Laundry Services
Manpower
• One laundry operator can wash the linen of 25 to 30 beds and one laundry
orderly can assist in washing the linen of 50 to 60 beds.
• Thirty per cent of laundry operators and laundry orderlies should be kept as the
leave reserve.
• The appointment of laundry supervisor, mechanic and clerk, and the number
employed depend upon the size of the hospital.
Laundry Services
Staffing norms
Norms Workload / Laundry weight
• One washerman can take care
of
150 to 200 kg linen per day. (This includes collection
of linen from different places, washing, drying, folding,
ironing and returning.)
• Each operation in O.T
(Operation Theater)
7 to 8 kg of soiled linen
• Each delivery in L.R. (Labour
Room)
7 to 8 kg of soiled linen
• Each ward patient 5 to 6 kg of bed linen

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References
Text book
• R.C.Goyal, “Hospital Administration and Human Resource Management” PHI - Fourth Edition, 2006.
• G.D.Kunders, “Hospitals - Facilities Planning and Management” TMH, New Delhi - Fifth Reprint, 2007.
YouTube Video
• Medical Record: https://youtu.be/VZ1Wvb0dvGI
• Sterile: https://youtu.be/TfqT-QiKOqE
• One day in Sterile: https://youtu.be/GAOCDMbDvRQ
• Definition Sterile: https://youtu.be/1Qbd48DW9PU
• Pharmacy: https://youtu.be/AuYQC3kqfyY
• Definition Pharmacy: https://youtu.be/h2LsOV1anqQ
• Pharmacy Animation: https://youtu.be/gBl-a5MV8ZE
• Laundry: https://youtu.be/Z-sjZySkIEg
• Laundry Animation: https://youtu.be/2SehC2JOcs8
• Food service: https://youtu.be/Hqj8EkptBMs
• Food Serve: https://youtu.be/hvFbPaWDWtE

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