philosophy In the good of others, lies our own it is in following this motto that Pramukh Swami Maharaj has

s always been traveling. His travels are for the spiritual upliftment of all. He has built hundreds of Mandirs for God, traveled across the world to visit devotees homes, yet does not own a car or any other property. This selfless travel is Vicharan - to travel for the good of others, for the spiritual upliftment of others. Mission

" To provide state of the art treatment to all, irrespective of caste, creed or religion at affordable cost "
Vision

" To become the world's best tertiary healthcare provider "

goals of the Intensive Care Unit are to:

Provide multidisciplinar y patient care on a concentrated and continuous basi

2. Provide a multidisciplinary approach / plan to patient care which includes i from all relevant healthcare professionals.

3. Provide quality nursing care b ased upon the nursing pro cess of assessmen includes biophysical, environmental, educational and psychological need s of the patient and family, planning, intervention and evaluation. 4. Recruit, orient, assign and maintain a highly qualified professional staff, competent to provide individualized, concentrated care and to provide for the continuity of care.

5. Provide environment conducive to the continuous quality improvement of t medical, nursing, respiratory care and other healthcare professional staff.

6. Ensure that standards for professional nursing practice, as defined by the Jo Commission on Accreditation of Hospitals, states regulatory codes and the Nurse Practice Act, are implemented, evaluated and monitored. Director of Department Director of Medical Administration Program Direc

Intensive Care Services 01-01-0020 3

nursing, respiratory care and other healthcare professional staff, students from 7. Provide an environment conducive to the educational needs of the medical, healthcare institutions, patients and families.

8. Provide for and participate in relevant research that investigates problems a provides opportunities to improve patient care.

9. Participate in programs that enhance healthcare education and research with the community.

10. Affect a system of co llaborative, multidisciplinary approach to unit management that places responsibility and accountability of interdepar tmenta functions on the unit team members.

The Intensive Care has to organize and promote the Quality of Care administered to patients admitted to Intensive Care Units. The Intensive Care is open for all health professionals involved in intensive care medicine.

The Intensive Care Unit will maintain the quality of patient care and achieve their goa by accomplishing the following objectives:

1. Written guidelines of nursing care that are reviewed on an annual basis and enforced by the nursing and medical staff. Such standard are kept cu rrent by regular review. 2. Written policies and procedures those are standardized and are available to staff as a referen ce. Th ey are updated b y r egular review.

3. A planned, on-going system of monitoring and evaluation of medical, nursi Director of Department Director of Medical Administration Program Direc

Goal: 1. Develop the ability to rapidly evaluate, diagnose, Intensive Care Services 3

01-01-0020 stabilize, and treat critically ill adult patients.

patient care quality will be performed through the continuous Improving Organizational Performance Program.

4. Job descriptions are kept current. Staff performance is evaluated on an an nual basis and mutual goals for continued dev elopment will be set to maintain competency. 5. Recertification is kept updated as required and records are kept in the unit. These include: a. Skills checklist and competencies b. Basic Life Support c. Advanced Cardiac Life Support d. Fundamentals of Critical Care Support e. Rapid Response f. Mechanical Ventilation

6. Multidisciplinar y consultations for patients are instituted, as appropriate, by th medical and nursing staff. 7. Continuing education is provided through a collaborative effort between ICU provided by the staff and through needs identified via introduction of new procedures/equipment, incident monitoring, performance evaluation and self assessment. 8. Students of accredited healthcare institutions are directly supervised by appropriate staff members. 9. Research protocols are always available in the unit. 10. Selected staff participatesand/ or community professionalresearch programs through the Hospital in community educational and organizations.

Objectives: 1. Demonstrate effective communication with patients, their families, and professional associates (*ICS). 2. Demonstrate respect, compassion, and integrity (*PR). 3. Demonstrate the ability to perform an appropriate history and physical exam (*PC) 4. Demonstrate the ability to develop an appropriate differential diagnosis and treatment plan (*MK). 5. Demonstrate appropriate clinical decision making skills (*PC) 6. Understand the pathophysiology of respiratory failure, shock, and cardiac arrest (*MK). 7. Learn the principles of hemodynamic monitoring and ventilator management (*PC). 8. Demonstrate procedural skills that are technically proficient with level of training (*PC). 9. Learn the basic resources available for the care of the ICU patient (*SBP). 10. Learn the appropriate information resources (i.e., textbooks, handbooks, online resources, etc.) available for care of patient (*PBL)

Clinical practice
A doctor is engaged in clinical practice, if he or she assesses, diagnoses, gives advice, treats or makes reports, whether face-to-face or otherwise, with a patient, or with a group of patients or a population. This definition includes the activities of public health medicine and medical administration.

policies All doctors in clinical practice vocationally registered within a vocational scope of practice should be involved in recertification programmes.One of its aims is that, in time,many NHS services will be based on clinical guidelines,reflecting good research evidence, the endorsementof national bodies and the views of patients and theirfamilies. The role of the guidelines is not to restrict clinical freedom, but rather to help health professionalsand their patients make decisions about appropriate healthcare for specific conditions

Non-clinical practice
A doctor is practising non-clinical medicine if he or she is not engaged in clinical practice as defined above, but is engaged in such activities as medical informatics, contributing to medical media, teaching to members of the profession and students (without direct patient contact), research not involving humans, medical advisory, board or committee work (this list is not exhaustive) for which an annual practising certificate is required. The doctor in non-clinical practice may recertify via a collegial relationship with another doctor to ensure the doctor is maintaining competence and taking part in continuing professional development (CPD) or forming a relationship with an educational supervisor within an organisational appraisal system that includes requirements for CPD. If a doctor working in non-clinical practice can satisfy Council that their work has no risk to public health and safety they may apply to be exempt from recertification. Such exemptions are considered individually by Council and only granted when it is clear public safety is not at risk. The doctor may also be able to claim a reduction of the APC fee (dependent on income) or waiving of the APC fee (if retired and giving service to the profession).

Policies .Ongoing MHB expectations of directly funded academic appointees 2. Consistency of appointees funded activity with national and MHB policy 3. Performance of directly funded appointees 4. Funding arrangements 5. Administrative issues relating to positions 6. Establishment of future position

Overview Positive performance outcomes are the purpose of an induction program. So you need to design induction programs that will help new employees assimilate quickly, understand their tasks and the standard of work expected. Choose cost-effective methods and tools, make sure its planned and conducted in cooperation with line managers, and be sure to include a plan for follow up and evaluation. This learning resource will help you plan an induction program for staff new to your organisation. Induction The process of receiving and orienting employees when they first join an Organization

Who is involved? The induction process is best carried out as a cooperative effort between HR, line management and line staff. The people who know the jobs best, particularly in terms of socialisation, are the workers in the work area. For this reason, your induction process needs to take a dual direction one where management or HR involvement will provide orientation for new employees to the wider organisation and its functions, including pay details, occupational health and safety regulations, and conditions of employment. The other direction will be an orientation to the work area, including the

requirements of the job, and developing workplace relationships with fellow workers and team leaders

Implementation tips In terms of program methodology it's more effective, even though it takes more planning, to conduct induction in incremental stages. This allows for short intakes of information rather than providing an intensive single period crammed with new information. This way, the new employee will be able to remember more information. Another way to improve the effectiveness of learning is to allow the new employee to learn about their new environment in an interactive, participative way. For example, consider if new employees would benefit from having a site map with key features identified for them to tick off on their tour of the organisation. Likewise, determine if there is any benefit for new employees to have a key-point checklist to find and read the policy manual once they are on the job, or to find out information themselves by interviewing key staff according to a checklist. Make a checklist of essential items to be covered by inductees. Have both the new employee and the person accompanying them tick the checklist when each item is done. When the checklist is completed, have a copy sent to the employees file in HR.

Leadership Team Often an organizations senior managers or department heads, the leadership team is the group that must pull together to lead your organization. The leadership team is responsible for the strategic direction of your organization, The leadership team plans, sets goals, provides guidance to, and manages your organization. Motivation or Employee Morale Team Known by different names in various organizations, the Employee Morale Team plans and carries out events and activities that build a positive spirit among employees. The teams responsibilities can include activities such as hosting employee lunches, planning company picnics, fund raising for ill employees, and fund raising for philanthropic causes. The team leads the celebration of company milestones, employee birthdays, and the arrival of new babies. The team sponsors company sports teams. You can have fun with this team as the teams only limit is the imagination of the team members. Safety and Environmental Team The team ensures the safety of employees in the work place. The team takes the lead in safety training, monthly safety talks, and the auditing of housekeeping, safety, and workplace organization. Recycling and environmental policy recommendations and leadership are provided by the team as well. Employee Wellness Team The wellness team focuses on health and fitness for employees. Most popular activities include walking clubs, running teams, and periodic testing of health issues such as high blood pressure screening. The wellness team can sponsor whole person wellness activities such as how to make a budget or lunch and learns about investment products not investment advice. Culture and Communication Team The team works to define and create the defined company culture necessary for the success of your organization. The team also fosters two-way communication in your organization to ensure employee input up the chain of command. The team may sponsor the monthly newsletter, a weekly company update, quarterly employee satisfaction surveys, and an employee suggestion process. Start several company teams, such as these, and nurture their success. When employees see successful teams, more employees become interested in serving on the teams. The

teams make the company a better place to work and provide the opportunity for real employee involvement and commitment. Incident

This concerned an elderly woman of 86 years who had a dementing illness and severe self-neglect. She was already known to the SSD because of these factors and her refusal to accept any form of assistance. There were no relatives. Admission to hospital occurred as a result of a physical injury (she accepted this). As she was also already known to the psychiatric services, she was admitted to a psychiatric ward for elderly people within a general hospital complex. She received the necessary physical treatment in this way. The full psychiatric examination conducted while she was in hospital determined that her dementia was indeed very severe and her capacity extremely limited. She quickly began to refer to the hospital as home and was extremely disoriented, both temporally and spatially. When she was physically well enough for discharge, several multidisciplinary meetings were held and the options discussed. The psycho-geriatrician considered that the woman was too ill to return home and that she should be admitted to residential care. A Guardianship Order under the 1983 Mental Health Act was considered but rejected (largely because it was not felt to be appropriate solely as a means of securing admission to residential care, in line

with the Code of Practice for the Mental Health Act). The woman's spatial disorientation was such that she believed herself to be at home already and the eventual decision taken was to move her, for a trial period, to a residential home specialising in the care of mentally ill elderly people. The psycho-geriatrician agreed to offer re-admission to hospital should the transition prove to be unsuccessful. The move worked well and the woman settled into her new environment fairly rapidly and agreed at a review to stay there. Attempts to terminate the tenancy of her former home were confounded for a time as she interpreted this as attempts to evict her from the residential home. However, this difficulty was eventually resolved. She remained living in the home until her death 18 months later. Although the decision taken on behalf of this client was not with her full and informed consent, it was not taken lightly and indeed was shared between the various professionals involved. It was not possible to determine what her former views prior to becoming cognitively impaired might have been as there were no relatives and no friends/neighbours in evidence who dated back to that time. The decision represents the principle of best interests, but, attempts were made to avoid the worst excesses of paternalism and to handle the matter with the sensitivity which the situation required. The outcome appeared to be satisfactory too, with the quality of the

client's life seemingly improved by the residential care. sbar

SBAR is an easy to remember mechanism that you can use to frame conversations, especially critical ones, requiring a clinician's immediate attention and action. It enables you to clarify what information should be communicated between members of the team, and how. It can also help you to develop teamwork and foster a culture of patient safety. The tool consists of standardised prompt questions within four sections, to ensure that staff are sharing concise and focused information. It allows staff to communicate assertively and effectively, reducing the need for repetition. The tool helps staff anticipate the information needed by colleagues and encourages assessment skills. Using SBAR prompts staff to formulate information with the right level of detail. A sample NHS SBAR template to show how to use SBAR in your hospital can be viewed in the following document: SBAR diagram. A detailed description of the steps involved: S Situation: Identify yourself the site/unit you are calling from Identify the patient by name and the reason for your report Describe your concern Firstly, describe the specific situation about which you are calling, including the patient's name, consultant, patient location, code status, and vital signs. An example of a script would be: "This is Lou, a registered nurse on Nightingale Ward. The reason I'm calling is that Mrs Taylor in room 225 has become suddenly short of breath, her oxygen saturation has dropped to 88 per cent on room air, her respiration rate is 24 per minute, her heart rate is 110 and her blood pressure is 85/50. We have placed her on 6 litres of oxygen and her saturation is 93 per cent, her work of breathing is increased, she is anxious, her breath sounds are clear throughout and her respiratory rate remains greater than 20. She has a full code status." B Background: Give the patient's reason for admission Explain significant medical history You then inform the consultant of the patient's background: admitting diagnosis, date of admission, prior procedures, current medications, allergies, pertinent laboratory results and other relevant diagnostic results. For this, you need to have collected information from the patient's chart, flow sheets and progress notes. For example:

"Mrs. Smith is a 69-year-old woman who was admitted ten days ago, following a MVC, with a T 5 burst fracture and a T 6 ASIA B SCI. She had T 3-T 7 instrumentation and fusion nine days ago, her only complication was a right haemothorax for which a chest tube was put in place. The tube was removed five days ago and her CXR has shown significant improvement. She has been mobilising with physio and has been progressing well. Her haemoglobin is 100 gm/L; otherwise her blood work is within normal limits. She has been on Enoxaparin for DVT prophylaxis and Oxycodone for pain management." A Assessment: Vital signs Contraction pattern Clinical impressions, concerns You need to think critically when informing the doctor of your assessment of the situation. This means that you have considered what might be the underlying reason for your patient's condition. Not only have you reviewed your findings from your assessment, you have also consolidated these with other objective indicators, such as laboratory results. If you do not have an assessment, you may say: "I think she may have had a pulmonary embolus.'" "I'm not sure what the problem is, but I am worried." R Recommendation: Explain what you need - be specific about request and time frame Make suggestions Clarify expectations Finally, what is your recommendation? That is, what would you like to happen by the end of the conversation with the physician? Any order that is given on the phone needs to be repeated back to ensure accuracy. "Would you like me get a stat CXR? and ABGs? Start an IV?" "Should I begin organising a spiral CT?" "When are you going to be able to get here?" Incorporating SBAR may seem simple, but it takes considerable training. It can be very difficult to change the way people communicate, particularly with senior staff.

Examples The multidisciplinary team meeting is an example of the process in action. Many clinicians are present. Most will be in a position to help formulate the most appropriate management for the patient. The doctor directly responsible presents the present situation and the relevant background. The assessment will include a discussion with the clinician to clarify the clinical findings and a joint review of the results of all relevant investigations. Recommendations will be agreed by all present. These will be documented in the patient's records for implementation.

Another example where this tool would add to clarity and better care is the emergency call to a sleeping senior colleague for advice about patient management. When woken in the night it takes some time to absorb the facts and respond. This is greatly aided by a clear presentation of the situation, the background, the assessment and the proposed treatment. In the surgical situation it is possible and even quite likely that the senior colleague is needed to help with the assessment and / or to carry out the recommended surgery. The request for direct help should be made clear as part of the recommendation so there is no misunderstanding. After all, it would not be surprising if the senior colleague's preference was to go back to sleep!