Académique Documents
Professionnel Documents
Culture Documents
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SCOPE
The Heart and Lung Unit will encompass an outpatient clinic for treating
patients scheduled for Electrocardiogram (ECG), 2D-Echocardiography, 24
Holter Monitoring, Ambulatory BP Monitoring, Peripheral Venous and Arterial
Duplex Scan, Arterial Blood Gas Extraction, Spirometry, Inhalation Therapy,
Chest Physiotherapy, etc. that are done in a non-admitted set up.
The areas covered include from Central Registration (for consultation/ receiving
of request of a procedure/ treatment), Cashier (to settle the services/
procedure), Heart and Lung Unit, Cashier (additional charges if any) up to
discharge.
POLICY
It is the policy of the Fe Del Mundo Medical Center (FDMMC) Heart and Lung
Unit to:
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ADMINISTRATIVE POLICIES
i.
The Heart and Lung Unit can be used by all affiliated physicians, of Fe Del
Mundo Medical Center (FDMMC) provided they are able to comply with all
the requirements of the FDMMC to be submitted to their department and
approved by the respective chairman.
ii.
iii.
iv.
All regular or non-critically ill patients in the floor/ unit should be seen
within twenty four (24) hours from admission or referral and should make
daily rounds and must put entry to chart every visit.
v.
All Intensive Care Unit (ICU) or emergent cases should be seen within
twelve (12) hours from admission or referral and should make more than
once daily rounds as necessary and must put entry to chart for every
visit.
vi.
All long standing/ status quo patients may be seen in less than once
daily if no new or active medical attention ids needed and only waiting to
be discharged from the hospital due to non-medical reasons or other
hospital policy issues.
vii.
viii.
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ix.
x.
xi.
xii.
xiii.
xiv.
xv.
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OPERATIONAL POLICIES
1.
2.
3.
4.
5.
6.
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7.
8.
Carotid and vertebral duplex scan and transcranial Doppler study will be
officially read/ decked on a weekly basis by affiliated Vascular Cardiologist,
affiliated Neurologist or by choice of requesting Physician and must be a
Certified Fellow of Philippine College of Physicians, Fellow of the Philippine
Heart Association/ College of Cardiology and Fellow of the Philippine
Society of Vascular Medicine or Fellow of Philippine Neurologic Society.
9.
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5. RESPONSIBILITY
6. DEFINITION OF TERMS
Peripheral Venous Duplex Scan is a test that uses sound waves to image
the blood flow to the veins of the arms or legs. The peripheral veins are
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examined to check for deep vein thrombosis 9a blood clot in the large veins
of the arms or legs).
7. REFERENCE DOCUMENTS
8. PROCEDURES/ GUIDELINES
o
o
o
o
o
o
o
o
SCHEDULING OF PROCEDURE
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Fe Del Mundo Medical Center employees for salary deduction- ask patient for
the LOA from the departments payroll or instruct the patient to get LOA.
1. Patients who are entitled for a discount (refer to the discount categories
issued by the accounting: VIPs, or board of directors, etc.
Senior Citizens- ask for senior citizen ID.
Employee discounts- ask for the employee ID. For relatives of
The employees, the employee himself must settle the charges.
2. Instruct the patient to stay at the waiting area and wait for his/her name
to be called if there are patients who came in first.
3. Ask the patient to fill up personal information sheet.
4. Input patients data in the hospital information system and printout
charge slip.
5. Cash basis- give charge slip to the patient or relative and instruct to pay
at the accounting office/ cashier.
6. Discounted procedures are listed on a daily basis for inventory.
VERIFICATION
Verify medical Doctors (MD) written order and patients identification.
Walk-in patients without doctors requests who personally want to undergo a
procedure are accepted provided that they can present a valid ID.
Inform the patient regarding the turnaround time of the result.
ECG result- 3 days
Inform patient that upon the release of the result, anybody can claim it as
long as they bring the official receipt and a valid ID of the patient or the
health card ID, whichever applies.
Proceed with the procedure.
On releasing of the official result, person claiming shall sign on the
department departments copy of the result or logbook, whichever applies.
FORMS
ELECTROCARDIOGRAM (ECG/ EKG)
OUT PATIENT PROCEDURE
1. Introduce self to the patient and explain the procedure thoroughly.
2. Let the patient rest for few minutes and ask to remove metal objects (e.g.
watch, coins, keys, bracelets, belts) for it may interfere with the procedure.
3. Perform hand hygiene.
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4. Instruct to lie down on bed and expose chest and extremities if needed
(securing patients privacy)
5. Clean patients chest and limbs (may use gel) where the electrodes will be
placed using cotton balls with alcohol for better conduction and clear
tracing.
6. Dispose cotton balls properly.
7. Attach the electrodes on designated areas
8. Instruct patient to relax, not to move nor speak while the procedure is
ongoing.
9. Switch on the machine and start with the procedure.
10.Label the tracing with the complete data (complete name, age, gender,
date, time, and requesting doctor of the patient), while doing the procedure.
11.Remove leads and wipe off the gel from the patients chest or limbs with
tissue paper if needed.
12.Perform hand hygiene.
13.Remind the patient regarding the release of the result. Departments phone
number may be given to the patient for follow up of result.
14.Log the procedure.
15.If the patient needs to pull-out the tracing even without official reading, ask
them to sign in the ECG logbook. The patient can borrow the tracing if
urgently needed by the requesting doctor. Patient can choose to return or
not the tracing for official reading.
16.Prepare ECG tracing for reading by attaching it to an ECG template form.
17.Initial reading is done by MROD if available.
18.Final reading is done by the cardiologist.
19.Results are type written by the tech and tracings are attached at the back
of the official result.
20.Official results are released within 72 hours after the procedure.
21.In claiming of the result, the patient or relative needs to show patients
identification and/or receipt or HMO card if any.
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22.Patient or relative will then sign the duplicate form of the result (sign at the
logbook).
23.The duplicate will remain at heart station for filing.
IN PATIENT PROCEDURE
1. Nurse on duty (NOD) endorses request to the Heart and Lung unit.
2. Receive the request from the NOD.
3. Stat requests are coordinated thru phone calls from the NOD and are done
as soon as possible.
4. Requests are received at the nurses station after the procedure. Check
hospital information system for posted request.
5. Print charge slip.
6. Verifies MDs written order in patients chart at nurses station.
7. Perform hand hygiene.
8. Proceed to patients room for the procedure.
9. Introduce self to the patient and explain the procedure thoroughly.
10.Ask to remove metal objects (e.g. watch, coins, keys, bracelets, and belt)
for it may interfere with the procedure.
11.Instruct the patient to lie down on bed (if necessary and expose chest
(securing patients privacy).
12.Clean patients chest and limbs (may use gel) where the electrodes will be
placed using cotton balls with alcohol for better conduction and clear
tracing.
13.Dispose cotton balls properly.
14.Attach the electrodes on designated areas.
15.Instruct patient to relax, not to move nor speak while the procedure is
ongoing.
16.Switch on the machine and start with the procedure.
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17.Label the tracing with the complete data (complete name, age, gender,
date, time, and requesting doctor of the patient),
while doing the
procedure.
18.Remove leads and wipe off the gel from the patients chest or limbs with
tissue paper if needed.
19.Inform patient and requesting MD regarding the initial result (if MROD is
available) if urgently needed.
20. Endorse ECG tracing to NOD for referral and initial reading that will be done
by the MROD. (ECG tracings are endorsed back to Heart and Lung unit for
official reading immediately after the requesting physician or cardiologist
has seen it)
21. Final reading will be done by the decked cardiologist for that week.
22. Official result is released within 72 hours after the procedure.
23.Official result with attached tracing is released to the NOD for the chart
filing.
24.NOD will sign duplicate copy/ logbook. Duplicate copy will remain at Heart
and Lung unit.
Duration of the entire ECG routine procedure: 3-5 minutes
Result: 3 working days
ELECTROCARDIOGRAM
1. PURPOSE
To have a documented policy and procedure on the performance of
electrocardiogram examination.
2. SCOPE
This procedure starts from registration of the patient at the central registration,
give charge slips and instruct to pay at the cashier for service fee/ ECG
(electrocardiogram) procedure, Heart Station up to their discharge.
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The receipt and ECG request of the doctor be given to Heart Station Staff to
render the procedure, result is available for release, and a computer generated
result is filed.
3. POLICY
It is the policy of the Fe Del Mundo Medical Center Heart Station to:
1. Correctly identify patients by their name and date of birth;
2. Receive and check the Medical Doctors written request for the procedure.
3. For HMO- ask patient to get a Letter of Approval/ Authorization (LOA) (and
any valid ID) to HMO office.
4. For COMPANY PAYORS- ask for the companys LOA or referral letter
including patients company ID.
5. For Fe Del Mundo Medical Center employees for salary deduction- ask
patient for the LOA from the departments payroll or instruct the patient to
get LOA.
6. Patients who are entitled for a discount (refer to the discount categories
issued by the accounting: VIPs, or board of directors, etc.
7. For Senior Citizens- ask for senior citizen ID.
8. For Employee discounts- ask for the employee ID. For relatives of
9. The employees, the employee himself must settle the charges.
10.Instruct the patient to stay at the waiting area and wait for his/her name
to be called if there are patients who came in first.
11.Ask the patient to fill up personal information sheet.
12.Input patients data in the hospital information system and printout
charge slip.
13.Cash basis- give charge slip to the patient or relative and instruct to pay
at the accounting office/ cashier.
14.Discounted procedures are listed on a daily basis for inventory.
15.Walk-in patients without doctors requests who personally want to undergo
a procedure are accepted provided that they can present a valid ID.
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4. MATERIALS/ SUPPLIES
5. RESPONSIBILITY
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7. REFERENCE DOCUMENTS
Work Instructions on Electrocardiogram
ECG machine GE Mac 5500 MC 5500 User Manual
Guidelines on Electrode Placement for Electrocardiogram, Holter Monitor,
and Treadmill Stress Test
Guidelines on Assessment and Treatment of Patient with Special Needs
Policy and Procedure on Patient Evaluation Report
Policy and Procedure on Patients Rights and Responsibilities
Policies, Rules and Regulations on Release of Hospital Records
8. PROCEDURE
OUT-PATIENT PROCEDURE
1. Introduce self to the patient and explain the procedure thoroughly.
2. The Heart Station Technician shall schedule the patients at least a day prior
to the examination.
3. For in-patients, the staff nurse must coordinate with the Heart Station Staff
for the schedule, and must encode the request into the system.
NOTE:
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5. The Heart Station Technician shall receive doctors request from the patient/
relative/ companion or check the patients chart (for in-patients) if correct
order was given. He/ she shall identify patients by mentioning their name
and date of birth. Refer policy and procedure on Identify Patient Correctly.
6. For
out-
patients,
the
Heart
Station
Technician
shall
request
the
pre-employment
electrocardiogram
requests,
the
Heart
Station
Technician shall request an identification card from the patient to ensure that
the examination will be performed on the same person, identified in the
form.
10.The Heart Station Technician shall log the date and name of the patient on
the ECG logbook and assign an ECG number. ECG number must be unique
per patient.
11.The Heart Station Technician shall inform the patient or their relatives about
Fe Del Mundo Medical Center Code of Patients Rights and Responsibilities.
12.The Heart Station Technician shall inform the patient about the examination
to be done; refer to Work Instruction for Electrocardiogram.
13.The Heart Station Technician must respect patients privacy and dignity. If
the patient is with special needs, the Heart Station Technician shall place the
patient in a room.
14.Let the patient rest for few minutes and ask to remove metal objects (e.g.
Watch, coins, keys, bracelets, belts) for it may interfere with the procedure.
15.Perform hand hygiene before the procedure.
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16.The Heart Station Technician shall prepare the patients skin. Clean patients
chest and limbs (may use gel) where the electrodes will be placed using
cotton balls with alcohol for better conduction and clear tracing. Dispose
cotton balls properly. Refer to ECG work instruction.
17.The Heart Station Technician shall properly place the electrodes on patients
chest and limbs and instruct patient to relax, not to move nor speak while
the procedure is ongoing. Refer to Guidelines on Electrode Placement for
Electrocardiogram, Holter Monitor, and Treadmill Stress Test.
18.The Heart Station Technician switch on the ECG machine and start with the
procedure. Refer to Work Instruction for Electrocardiogram or ECG GE MC
5500 User Manual.
19.Label the tracing with the complete data (complete name, age, gender,
date, time, and requesting doctor of the patient), while doing the procedure.
20.The Heart Station Technician shall remove the electrodes attached to the
patients when the procedure has been completed. Wipe off the gel from the
patients chest and limbs with tissue paper and dispose tissue paper
properly.
21.The Heart Station Technician shall clean the electrodes used, with cotton and
alcohol.
22.Do handwashing after the procedure
23.Remind the patient regarding the release of the result. Heart Station Unit
phone number may be given to the patient for follow up of result.
24.Log the procedure.
25.Prepare ECG tracing for reading by attaching it to an ECG template form
26.The Resident-on-Duty shall interpret first ECG tracing and the Cardiologist
shall make the final reading/ interpretation.
27.The Heart Station Technician shall correctly encode the interpretation into
the system. And verify accuracy of encoding.
28.The Heart Station Technician shall print three copies of the reviewed final
report. One serves as doctors copy, second is patients copy, and the third
one will be a file copy of the Heart Station.
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29.The Heart Station Technician shall issue the final report to requesting parties.
30.If the patient needs to pull-out the tracing even without official reading, ask
them to sign in the ECG logbook. The patient can borrow the tracing if
urgently needed by the requesting doctor. Patient can choose to return or
not the tracing for official reading.
31.Official results are released within 72 hours after the procedure.
32.in claiming of the result, the patient or relative needs to show patients
33.Identification and/ or receipt or HMO card if any.
34.Patient or relative will then sign the duplicate form of the result (sign at the
logbook). The duplicate will remain at heart station for filing.
35.The Heart Station Technician shall file the draft and the computer generated
report numerically and shall always maintain confidentiality of patients
records.
36.The Heart Station Technician shall file the draft and the computer generated
report numerically and shall always maintain confidentiality of patients
record.
37.The Heart Station Technician shall give patient evaluation form (for outpatients only) to patient/ relative/ companion to evaluate their
performance.
38.
IN-PATIENT PROCEDURE
1. Nurse-on-duty endorses request to the Heart and Lung unit.
2. Receive the request from the Nurse-on-duty.
3. Stat requests are coordinated thru phone calls from the Nurse-on-duty and
are done as soon as possible. Requests are received at the nurses station
after the procedure.
4. Check hospital information system for posted request.
5. Print charge slip.
6. Verifies MDs written order in patients chart at nurses station.
7. Perform hand hygiene.
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AMBULATORY BP MONITORING
1. PURPOSE
To have a documented policy and procedure on the performance of Ambulatory
BP Monitoring.
2.
SCOPE
This procedure starts from registration of the patient at the Central Registration,
give charge slips and instruct to pay at the Cashier for service fee/ Ambulatory
Blood Pressure (ABP) Monitoring procedure, Heart Station up to their discharge.
The official receipt is to be given to the Heart and Lung Unit Staff to render the
procedure.
3.
POLICY
It is the policy of the Fe Del Mundo Medical Center Heart and Lung Unit to:
3.1.
3.2.
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Receive and check the Medical Doctors written request for the
procedure.
3.3
to HMO office.
For COMPANY PAYORS- ask for the companys LOA or referral letter
including
3.5.
For Fe Del Mundo Medical Center employees for salary deduction- ask
patient
categories issued
directors, etc.
3.7.
3.8.
For Employee discounts- ask for the employee ID. For relatives of the
employees, the
3.9.
Instruct the patient to stay at the waiting area and wait for his/her
name to be called if
3.10
3.11
charge slip.
3.12
3.13
undergo a
3.15 Inform patient that upon the release of the result, anybody can claim
it as
long as they
bring the official receipt and a valid ID of the
patient or the health card ID, whichever
applies.
3.16 On releasing of the official result, person claiming shall sign on the
department departments copy of the result or logbook, whichever applies.
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3.18 Inform the patient/ relatives of Fe Del Mundo Medical Center Code of
Patients Rights
and Responsibilities;
3.19
3.20
3.21
3.22
3.23
result; and
3.25
Rules and
4.
MATERIALS/ SUPPLIES
Ambulatory BP device
Cotton Ball
Alcohol
Gel (if needed)
Tissue paper
Ambulatory BP
5.
RESPONSIBILITY
Heart Station Technicians are responsible for:
a. Performing the Ambulatory BP Monitoring as detailed in section 8
procedures
b. Maintaining all patients records in an orderly and organized manner
6. DEFINITION OF TERMS
7.
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Cashier the person with whom the patient settles their bills after
registration.
Heart Station - the section wherein all non-invasive diagnostic
examinations are done.
Ambulatory BP Monitoring a non-invasive method of obtaining blood
pressure readings over a 24-hour period, whilst the patient is in their own
environment, representing a true reflection of their BP.
REFERENCE DOCUMENTS
8. PROCEDURE
OUT-PATIENT PROCEDURE
8.1.1 Introduce self to the patient and explain the procedure thoroughly.
8.1.2 Let the patient sit down and put one arm on table.
8.1.3
8.1.4 Switch on the machine and set to the desire frequency of monitoring
as
follow up of result.
8.1.6 Log the procedure.
8.1.7 If the patient needs to pull-out the tracing even without official
reading,
reading.
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card if any.
8.1.14Patient or relative will then sign the duplicate form of the result (sign
at
filing.
IN-PATIENT PROCEDURE
8.2.1 Nurse on duty (NOD) endorses request to the heart station.
8.2.2 Receive the request from the NOD.
8.2.3 Stat requests are coordinated thru phone calls from the NOD and are
done as soon as
8.2.11Attach the ABP gadget on designated arm and switch on the machine
and start BP
recording.
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8.2.12Label the ABP form with the complete data (complete name, age,
gender, date, time and
gadget.
8.2.13Inform
patient
regarding
physician/cardiologist will
the
result
(MROD
or
attending
explain)
8.2.14
8.2.15
for filing.
Duration of the entire ABP monitoring procedure: 24 hours
Result: 3 working days
9. FORMS
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Cash basis- print charge slip and asks the patient to pay at the
accounting office/
cashier.
HMO card holders- asks the patient for letter of approval from
HMO office
j.
Instruct the patient to sit or lie down on bed and expose chest
(securing privacy)
k. Clean patients chest where the electrodes will be put, using cotton
balls with alcohol.
l.
m. Attach the electrodes cable to the recorder and check for the
connection and ECG tracing.
n. Instruct the patient not to take a bath and to avoid scratching the
areas where the electrodes are attached so as to avoid damaging of
the recorder and acquiring poor ECG tracings.
o. Instruct the patient about what to put on the diary and when to press
the recorder.
p. Instruct the patient to return on the same time of the following day
for removal of the recorder.
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q. On the next day, remove the Holter Monitoring recorder off the
patient.
r.
Check if the recorder has stopped, or wait until the end of the 24
hour period.
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13.Attach the electrodes cable to the recorder and check for the
connection and ECG tracing.
14.Instruct the patient not to take a bath and to avoid scratching the
areas where the electrodes are attached so as to avoid damaging of
the recorder and acquiring poor ECG tracings.
15. Instruct the patient about what to put on the diary and when to
press the recorder.
16. Remove the Holter Monitoring recorder off the patient.
17. Check if the recorder has stopped, or wait until the end of the 24
hour period.
18. Transfer the content of the recorder to the computer scanner.
19. Enter patients information and edit the acquired ECG tracings.
20. Prepare the edited tracings for final reading done by the
cardiologist.
21. Official result will be released within 72 hours after the procedure.
22. Official result will be given to the NOD for chart filing. Duplicate
copy will remain at Heart and Lung Unit for filing.
Done on the first come, first served basis for out-patient by
personal or phone call appointment.
For in-patient, once the department receives the request from the
designated floors and charges are made, the Holter technician goes
to patients bedside to hook the Holter recorder and comes back the
next day to remove the Holter machine.
Result: 3 working days.
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12.Instruct the patient to remove all metals from pockets, jewels, watch,
belt or any materials that
on
patients
status,
if
the
patient
feels
anything
unusual/abnormal.
22.MROD or monitoring cardiologist can stop the test if he/she sees
anything abnormal on the ECG tracing.
23.The patient can stop the procedure if he/she feels anything unusual.
24.Assist the patient during recovery. Until termination of the procedure,
still monitoring the vital signs.
25.Ask the patient to sit down and rest for a while until his/her heart rate
and BP reached the pre
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31.Patient or relative will then sign the duplicate form of the result. The
duplicate will remain at Heart and Lung unit for filing.
IN-PATIENT PROCEDURE
1. Receive and check on the request from the NOD.
2. Check hospital information system for posted request and charging.
3. Verify MDs order in patients chart at nurses station.
4. Nurse on duty brings the patient accompanied by at least one
relative as witness via wheelchair.
5. Inform MROD or assigned/decked cardiologist once patient arrives at
Heart and Lung unit.
6. Introduce self to the patient and explain the procedure.
7. Perform hand hygiene.
8. Input patients data on cardiac monitor.
9. Instruct the patient to remove all metals from pocket, jewels, watch,
belt or any materials that can lead to poor ECG tracing.
10.Offer gown to the patient and assist in changing.
11.Hook patient to TET cardiac monitor.
12.Clean patients chest where the electrodes will be placed, using
cotton balls with alcohol.
13.Attach the electrodes to designated areas.
14.Put the BP apparatus on patients arm and record baseline BP (sitting
and standing)
15.Tell the patient to sit down and watch while the technologist
demonstrates what the patient will
do.
16.Ask the patient if there are any questions regarding the procedure, if
none, continue with the test.
17.On each stage, acquire BP of the patient and update the patient for
change of speed/ inclination.
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CASH basis print charge slip and asks the patient to pay at
the accounting office/cashier.
HMO card holders Asks the patient for letter of approval from
HMO office.
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9. Instruct the patient to lie down on bed and expose chest (securing
patients privacy).
10.Attach the electrodes on designated areas.
11.Instruct to relax, and not to make unnecessary movements while the
procedure is ongoing.
12.Input patients data in the machine and assist on proper positions.
13.Start the procedure.
14.Wipe off gel from chest and remove ECG electrodes.
15.Fill up 2D-Echo form and DVD for official reading.
16.Label DVD.
17.Perform hand hygiene.
18.Prepare the 2D-Echo form and DVD for official reading.
19.Official
reading
will
be
done
by
an
assigned/decker
echo
cardiographer.
20.Official result will be released within 72 hours after the procedure.
21.In claiming of the result, the patient or relative needs to show
identification and/or receipt.
22.Patient or relative will then sign the duplicate form of the result. The
duplicate will remain at Heart and Lung Unit for
filing.
IN-PATIENT PROCEDURE
1. Receive and check on the request from the NOD.
2. Check hospital information system for posted request and charging.
3. Verifies MDs order in patients chart at nurses station.
4. Nurse on duty or nursing assistant brings the patient here in the
Heart and Lung Unit via wheelchair or stretcher.
5. Introduce self to the patient and explains the procedure thoroughly.
6. Perform hand hygiene.
7. Instruct the patient to lie down on bed.
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5. RESPONSIBILITY
Heart and Lung Unit Staff are responsible for:
a. Performing the Ambulatory Peripheral Venous Duplex Scan detailed in
section 8 procedures
b. Maintaining all patients records in an orderly and organized manner
6. DEFINITION OF TERMS
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7. REFERENCE DOCUMENTS
Work Instructions on Peripheral Duplex Scan device User Manual
Guidelines on Assessment and Treatment of Patient with Special Needs
Policy and Procedure on Patient Evaluation Report
Policy and Procedure on Patients Rights and Responsibilities
Policies, Rules and Regulations on Release of Hospital Records
8. PROCEDURES
OUT-PATIENT PROCEDURE
1. Receive and check on the request for Peripheral Venous Duplex Scan
(Verify MDs written order and patients identification).
2. Tells patient to fill up personal information sheet.
3. Inputs patients data in hospital information system.
4. Mode of payment:
CASH basis print charge slip and asks the patient to pay at the
accounting office/cashier.
HMO card holders ask the patient for letter of approval from HMO
office.
yourself
to
the
patient
and
explain
the
procedure
thoroughly.
7. Perform hand hygiene.
8. Instruct the patient to lie down on bed and remove lower garments
except underwear.
9. Cover the extremities with blanket and expose only the area needed
during the procedure.
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room bed
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11.
12.
Label DVD.
14.
Prepare the Peripheral Venous Duplex Scan form and DVD for
official reading.
15.
cardiologist.
16.
procedure.
17.
Official result will be given to the NOD for chart filing. Duplicate
9. FORMS
1.
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PURPOSE
To have a documented policy and procedure on the performance of Peripheral
Arterial Duplex Scan examination.
2. SCOPE
This procedure starts from registration at the Central Registration to register at
the bizbox, charging the service fee and Peripheral Arterial Duplex Scan
procedure, Cashier for payment, Heart and Lung Unit for the procedure up to
their discharge.
The official receipt be given to Heart and Lung Unit Staff to render the
Peripheral Venous Duplex Scan request, result is available for release, and
computer generated result is filed.
3. POLICY
1. Done by appointment.
2.
3.
4.
5.
6.
7.
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4. MATERIALS/ SUPPLIES
5. RESPONSIBILITY
Heart and Lung Unit Staff are responsible for:
a. Performing the Ambulatory Peripheral Venous Duplex Scan detailed in
section 8 procedures
b. Maintaining all patients records in an orderly and organized manner
6. DEFINITION OF TERMS
7.
8.
REFERENCE DOCUMENTS
PROCEDURES
OUT-PATIENT PROCEDURE
1. Receives and checks on the request for Peripheral arterial Duplex Scan
(Verify MDs written order and patients identification)
2. Instructs patient to fill up personal information sheet
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Cash basis print charge slip and asks the patient to pay at the cashier
Patient or relative will then sign the duplicate form of the result. The
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CARDIOLOGY-PULMONARY STAFF
SECTION HEAD
Professional Preparation
i. Must be licensed physician of the Philippines under RA 1080
( with current PRC medical doctor license).
ii. Should be a diplomate/ fellow of the Specialty and
Subspecialty Society of good standing.
iii. Should be a member of the accredited specialist Philippine
health insurance.
Responsibilities
1. Performs quality patient care.
2. Has authority to execute hospital and section policies and
guidelines.
3. Maintains the hospital standards and quality.
4. Coordinate with all the visiting and active consultant.
5. Exercise administrative and operational duties.
6. Make the over-all administrative decisions and planning.
7. Supervise all the cardiology staff and consultants.
8. Attend and participate in the clinical heads and meeting
activities.
9. Coordinate with the all staff concern and suggestions for the
benefit of the cardiology unit.
ACTIVE CONSULTANT
Professional Preparation
1.
2.
3.
4.
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Responsibilities
1. Should use the available ancillary hospital services.
2. Should attend 80% of the Section and Department services.
3. Be willing to teach or educate the cardiology staff
4. Able to attend and be a resource speaker or reactor in any
hospital
conference once he was invited.
5. Willing to rotate as Cardio consultant of the month as
attending
physician of the service patients.
6. An active consultant who fails to meet the prescribed
requirements
in a year period
Removed from the 24 hour duty rotation in the
Department of Medicine.
Will be listed from the active consultant in the
Department of Medicine.
Preventing to be listed in decking schedule .
7. An active consultants who fails to meet the prescribed
requirements in second year.
The consultants will be dropped from the rooster of
active consultant staff.
8. Re-appointment of active consultant is done yearly.
VISITING CONSULTANTS
Professional Preparation
1. Be licensed physician of the Philippine under RA 1080 (with
current PRC medical doctor license).
2. Be diplomate/ fellow of the Specialty and Subspecialty
Society of good standing.
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CARDIOLOGY NURSE
Professional Preparation
1. Be a registered nurse in the Philippines with special training in
cardiology procedures
2. Possess a degree of Bachelor of Science in Nursing with at least
6 months of relevant experience in cardiology procedure.
3. Possess genuine interest and concern to work, have a good
moral character and with good interpersonal relationship with the
patients and other members of the hospital teamwork.
4. Must be punctual at all times.
Rules of Conduct
1. To observe proper decorum and wearing ID at the endoscopy
unit at all times.
2. Behave professionally and any misbehavior or unethical
conduct will subject for suspension and termination of contract
(see hospital code of conduct of employee).
Responsibilities:
1. To assist in the cardiologist with efficient and outmost
professional care
2. To get vital signs (Blood Pressure, Pulse/ Heart Rate, Respiratory
Rate, Temperature) of the patient before and after the procedure;
3. To carry out all orders of the Cardiologist
4. Responsible for the overall supervision of the cleanliness of the
cardiology-pulmonary unit.
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of
the
different
MATERIALS/ SUPPLIES/MACHINES
ELECTROCARDIOGRAM (ECG/EKG)
ECG paper, Cotton balls and alcohol, Face mask, Tissue paper, gel
AMBULATORY BP MONITORING
Cotton balls and alcohol, tissue paper and gel if needed.
TREADMILL EXERCISE STRESS TEST
Treadmill exercise test paper, cotton balls with alcohol and
electrodes. Face mask and gel if needed
24-HOUR HOLTER MONITORING
Electrodes, micropore and holter diary. Face mask and gel if
needed.
2D-ECHOCARDIOGRAPHY AND DOPPLER STUDY
Electrodes, DVD, ultrasonic gel, tissue paper, and 2D-Echo form.
Face mask if needed.
PERIPHERAL VENOUS DUPLEX SCAN
DVD, ultrasonic gel, tissue paper, clean gloves and Peripheral
Venous Duplex Scan form. Face mask if needed.
PERIPHERAL ARTERIAL DUPLEX SCAN
DVD, ultrasonic gel, tissue paper, clean gloves and Peripheral
Arterial Duplex Scan form. Face mask if needed
Stress test machine GE carestream Windows Based OS regular
paper printing (inkjet)
2D Echo Machine Philips iE33 or Siemens Sequola TDI TEE
capable
Venous Arterial Carotid & Transcranial Duplex Scan
Machine: Philips iu 22
ECG Machine GE mac 5500 MC 5500
Holter Machine: GE seerlight/ Rozinn Model RZ 153 +
digital holter recorder
Ambulatory BP monitoring device
Myocardial Perfusion Imaging; Brand Siemens, Model:
Symbia S, Type: Dual
BP Apparatus
FORMS
ECG form
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1. PURPOSE
The aim of Heart and Lung Unit is to have a standard method to be followed by
the Cardiologists/ Pulmonologist/ Therapist in giving procedures/ treatments and
tests.
To establish and operate a Heart and Lung Unit where patient at the hospital, inhouse consultants, and those referred by other (outside) physicians can be
taken cared of as on an out-Patient basis serving Heart and Lung procedures/
treatment.
2. SCOPE
The Heart and Lung Unit will encompass an outpatient clinic for treating
patients scheduled for Electrocardiogram (ECG), 2D-Echocardiography, 24 Hour
Holter Monitoring, Treadmill Exercise Stress Test, Ambulatory BP Monitoring,
Peripheral Venous and Arterial Duplex Scan, Arterial Blood Gas Extraction,
Incentive Spirometry, Pulmonary Function Test, Peak Expiratory Rate, Pulse
Oximetry, Inhalation Therapy, and Chest Physiotherapy .that are done in a nonadmitted set up.
The areas covered include from Central Registration (names enlisted in the biz
box before consultation & rendering procedure/ treatment), Cashier (settles
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their bills after registration), Heart and Lung Unit (render consultation and noninvasive diagnostic are done), up to their discharge.
3. POLICY
It is the policy of the Fe Del Mundo Medical Center (FDMMC) Heart and Lung
Unit to:
GENERAL POLICIES
All pulmonary services are done according to doctors written order and/
or request.
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All medication orders must include the name, exact dosage and
frequency of treatment. Pulmonary Staff has the duty to question the
order if it is unclear or seems inappropriate. To promote accuracy and
consistency in giving treatment to patient the following scheduled has
been suggested:
OD 9AM
Q6 12AM/12PM/ -
6AM/6PM
TID 9AM. 1 PM 5 PM
Q8 6AM 2PM 10 PM
All
request
from
critical
areas
like
Intensive
Care
Unit
(ICU/PICU/NICU)
in
accordance
with
the
manufacturers
published
specifications.
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All items and supplies used during the patients procedures shall be
charged accordingly.
Cost of procedures vary according to the In-patients or Out-patients
status. In-patients rates will vary according to room accommodation.
Spirometry or PFT of all In-patients and Out-patients including those
under HMO, must be charge with a readers fee unless otherwise
specified on the request of the Attending Consultant
Data from charge slips shall be entered in a logbook and must be
signed by the receiving staff or personnel.
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The Physician needs to counter sign the order within a time frame
according to FDMMCs policy. The timeframe is within an hour up to
twenty four 24 hours.
g. The Respiratory Therapist should ensure that all components of a
medication order are documented.
Components of a medication order:
Date and time of order was written
Medication time
Medication dosage
Frequency of medications
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days but the initial unofficial result can be given to the patient, if he/
she requested a copy.
Inhalation Therapy
Request for In-Patients Procedure
Reviewed by:
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MATERIALS/ SUPPLIES
Medical supplies, medical equipment
5. RESPONSIBILITIES
Section Head administrative function, responsible for evaluation of staff
(Respiratory Therapist)
Supervisor Takes responsibility in the supervision of pulmonary staff in all
aspects of work and
or services and prepares work schedule.
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6. DEFINITION OF TERMS
Heart and Lung Unit - the unit wherein all non-invasive diagnostic
examinations are done
.
Central Registration - wherein the patient needs to be enlisted into the
system before
consultation and rendering the examination
Cashier the person with whom the patient settles their bills after
registration.
Mechanical Ventilation a method to mechanically assist or replace
spontaneous breathing.
Weaning a process/ gradual withdrawal from ventilator support
Arterial Blood Gas (ABG) evaluate acid base status, ventilation and
arterial oxygenation.
Pulmonary Function Test (PFT) group of test to measure lung volume
and capacity.
Incentive Spirometry (IS) a method of encouraging voluntary deep
breathing.
Peak Expiratory Flow Rate (PEFR) a test that measure how fast a
person can exhale.
Inhalation Therapy various method of treatment that work when you
inhale.
Chest Physiotherapy a technique used to mobilize or loose secretions in
the lungs and the respiratory tract.
RT Respiratory Therapist
7. REFERENCE DOCUMENTS
Guidelines on Assessment and Treatment of Patients with Special Need
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k) The RT shall educate the patient and his/ her family members regarding the
procedure and record it in Health Education Acknowledgement Form. Patient/
relative shall sign in the acknowledgement portion of the form.
l) The RT shall wash hands and disposed of used materials in the appropriate
disposal bins. Rinse the materials used (e.g Neb Kit, mouth piece for IS) with
water and air dry before repacking in the plastic.
m) The RT shall post and record the procedure done to the patient in Pulmonary
Unit Patient Chart and RCD Patient Logbook. And make appropriate
endorsement.
n) The RT shall hand out to patient/ relative Patient Evaluation Form and shall
collect it before the patient/ relative leaves RCD. Refer to Patient Survey
Form Policy and Procedure.
o) For PFT:
The RT shall forward the Pulmonary Function Test print out (PFT) to the
Pulmonologist for interpretation.
The RT shall transcribe correctly the interpretation made by the
Pulmonologist in the Pulmonary Unit Official Result form.
The RT shall file PFT result by date in a folder.
The RT shall issue the official result to the requesting party. As evidence
that the requesting party received the official result, receiving party shall
acknowledge by signing in the logbook.
p) All information in the RCD Patient Chart and RCD Patient Logbook must be
kept confidential as per Policies, Rules and Regulations on Release of
Hospital Records.
q) Maintenance of Equipment:
Daily endorsement of machine and equipment as part of maintenance.
Machines or equipment that are found defective should be reported
immediately to the Engineering Department. The staff from engineering
will check/ assess the machine, they will make a recommendation
forwarded to
Purchasing Department to coordinate to the supplier.
Instructions from the supplier to follow in Cleaning Respiratory Therapy
Equipment:
Personnel responsible for cleaning the equipment should be
instructed in proper handling methods necessary to reduce the
risk of infection and reduce contamination of the cleaning
area.
Manufacturers recommendations for equipment disassembly,
cleaning, pasteurization, and sterilization should be followed.
All equipment should be thoroughly washed and rinsed before
attempting pasteurization or sterilization. Debris interferes
with the action of pasteurization and sterilization.
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The Heart and Lung Unit can be used by all affiliated physicians, of FDMMC
provided they are able to comply with all the requirements of the FDMMC to
be submitted to their department and approved by the respective chairman.
All regular or non-critically ill patients in the floor/ unit should be seen within
twenty four (24) hours from admission or referral and should make daily
rounds and must put entry to chart every visit.
All Intensive Care Unit (ICU) or emergent cases should be seen within
twelve (12) hours from admission or referral and should make more than
once daily rounds as necessary and must put entry to chart for every visit.
All long standing/ status quo patients may be seen in less than once daily
if no new or active medical attention is needed and only waiting to be
discharged from the hospital due to non-medical reasons or other hospital
policy issues.
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The ICU will be supervised by the current Chairman and Co-Chairman of the
Heart and Lung Unit and he/ she must be a certified Fellow of Philippine
College of Physicians, Fellow of the Philippine Heart Association/ Philippine
College of Cardiology or Fellow of the Philippine Society of Pulmonary
Medicine.
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