     
PATIENT CARE
UNIT:
Scope of Service:
The
surgical clinic provides nursing care to patients prior to admission for surgery
and after discharge from surgery, as wall as patients with medical problems.
There are 16 examination and consultation rooms, divided into 5 modules. The
clinic serves approximately 3,000 – 3,500 patients of all ages monthly. We are
governed by hospital policies and procedures are standardized in line with JCIA
requirements.
Frequent
Procedures/Services/Functions:
·
Surgery : *
Urology
* Andrology
* Thyroid Surgery
* Plastic Surgery
* Breast Surgery
* General Surgery
* Paediatric Surgery
* Surgical Oncology
* Neuro-surgery ( including
specialized adult and paediatric neuro-endocrine, neuro-vascular, neuro-muscular
and pituitary surgery)
* Combined Hepatobilary and Pancreatic
Surgery
* Colo-rectal Surgery
* Combined Cleft Palate Surgery
* Pre/Post Renal Transplant Surgery
* Erectile Dysfunction
·
Medical : *
Neurology
* Epilepsy
* Neuro-muscular
* Multiple
Sclerosis
* Movement
Disorder
* Nephrology
* Neuro-psychology
·
Nurse Clinic: *
Surgical Wound Care
* Stoma
Procedures
·
Medication Administration
·
Wound care
·
Rigid procto-sigmoidoscopy
·
Rectal biopsy
·
Hemorrhoid banding
·
Anal and stoma dilatation
·
Tissue expansion
·
Ventricular drain aspiration
·
Skin biopsy
·
Change Eternal feeding tubes
Hours of Operations:
5 days per
week
Saturday – Tuesday : 0800 – 1800 hrs
Wednesday
: 0800 – 1700 hrs
CRITERIA FOR
ADMISSION TO THE SERVICE
·
Patients approved for tertiary
care with the need for surgical interventions or medical treatment and follow-up
through Medical Eligibility/ Royal Order.
·
Referrals from Emergency Room,
other Out-patients and In-patients areas, staff and dependants referrals.
STAFFING PLAN
Number and mix of staff:
Total
FTE’s 28
Head Nurse 1
Staff Nurse I 11
Staff Nurse
II 6
Medical
Translator 5 (shared between many other Ambulatory
Care
clinics)
PCA 2
Ward
Clerk 1
Nursing Clinical Coordinators 2
(Neurology, Movement Disorder)
Shift assignments are made by the charge
nurse and based on the following:
In each
specialty, a primary nurse or team leader is assigned to oversee the total needs
of that clinic module and to work together with the physicians/ team to provide
quality delivery of patient care and enable the patients to be able to relate to
a specific named nurse if necessary when there is no clinic on that day of the
week.
The nurse
coordinates all activities in the clinic, checks charts, orders missing charts
and X-rays via the ward clerk, assesses patients upon arrival in clinic, ensures
all relevant results are available, enters all orders on computer, assists the
medical staff when examining patients or carrying out procedures done outside of
the clinic i.e. to Day Procedure Center, arranging admissions and maintains the
efficiency of the clinic.
One or two
other associate nurses are also assigned to assist the primary nurse and relieve
her/ him during her/ his leave etc. staff also rotate around the various
specialties within surgical clinics to develop their skills. A
bilingual staff member is assigned to facilitate
better communication between the health provider,
patient and the patient’s family as required.
Nurses also
take care of medication refills and arrange take home supply orders for all
walk-in patients at any time of the day.
In the Nurse
clinics, patients are assessed and managed primarily by a nurse upon initial
referral by a doctor with prescribed initial physician orders.
Surgical Nurse Wound Care Clinic takes care of patients
needing wound management for pressure sores, chronic/ fungiating and palliative
care wounds, extensive breast surgery, pilonidal sinus, all general wounds,
suture/ clip removal, drain output measurement/ shortening and removal, wound
evaluations and home care instructions, i.e. intermittent self-catheterization,
teaching patient careers wound management, giving injections and teaching
self-administration where appropriate. Wound debridement and tissue expansions
are also done by physicians in his clinic. Change of catheters, bladder
irrigation, change of Nasogastric and PEG tubes are done as required for
patients. Psychological support is also maintained. The Nurse Clinical
Coordinator (Wound care) can be paged to come and offer advice on questions
regarding complex wound management if required.
Patients who need to be followed-up for the care of
stomas are seen by the Enterotomal nurse in Stoma Nurse Clinic.
Patients
needing teaching on how to feed a cleft lip/ palate baby are the Nurse Clinical
Coordinator (Cleft Lip/ Palate) in the combined Cleft Lip/ Palate Clinic and
followed up by her in her own office as required. She also attends the
pre-surgery clinic held once a month.
Patients who
have movement disorders will be followed up by the Nurse Clinical Coordinator
(Movement Disorder) upon request by the doctor.
Method of adjusting to staffing
variances:
The
Head Nurse makes adjustments in staffing on a daily morning and afternoon
assessment based on the volume of patients/ procedures, skill level of staff and
number of bilingual or non-bilingual physicians attending the clinic. When
additional staff are needed, adjustments in assignments are made from different
units within surgical clinics are cross-trained.
Orthopedic clinic nurses generally float to the following units:
·
Orthopedic Clinic
·
Other clinics on a daily basis
if those other areas need short-term cover for e.g. sick leave.
QUALIFICATIONS OF STAFF:
- Current license from Saudi Council
-
Current license from the country
of origin
-
Bachelor of Nursing for certain
nationalities
-
Mandatory Education as per
current hospital policy requirements while under employment at KFSH&RC, i.e.
Fire safety, Infection Control,
Performance
Improvement, Wound Care, Pressure Ulcer care, Customer Service Care, Point of
Care Testing.
-
BCLS
-
Fire & Safety
-
Community CPR
-
Fire & Safety
-
Community CPR
-
Fire & Safety
-
Community CPR
HOW ARE INSERVICES/CONTINUING
EDUCATION PROGRAM PROVIDED TO MAINTAIN STAFF COMPETENCY?
-
Staff
meeting is held monthly and additional meetings are scheduled as needed.
-
Staff
Development courses/ in-services offered by Training and Development, New
Horizons, Nursing Education and Research or clinical departments are posted
on the bulletin board to encourage staff to see what is available and how to
apply to attend.
-
Staff
are encouraged to give/ coordinate educational programs for their peers and
colleagues. SNI's are required to give two in-services annually.
-
Competency based practice check-offs are an annual requirement assessed by
the Clinical Instructor.
-
Attendance at Skills Marathons where applicable.
-
Using
the hospital Intranet and completing all on-line mandatory courses.
-
New
polices or review of policies and procedures require an in-service
facilitated by either one of the clinic staff or the Clinic Instructor.
-
Staff
learning needs are identified and relevant in-services are then arranged.
-
Annually
staff identify a list of in-services on topics they would like covered and
this is then given to the Clinical Instructor to facilitate.
-
All new
equipment and procedures are introduced by mandatory education and
certification in the competency as required.
-
Symposium and workshops sponsored by Academic Affairs where applicable
-
All Ward
Clerks and PCA’s are facilitated to attend during working hours up to grade
3 level English Language classes.
-
Training
as required for Saudi nationals.
Required Competencies:
-
Adult/
Paediatric Physical Assessment
-
Oxygen
Therapy
-
Suctioning
-
Catherization
-
Computer
Skills
-
Medications Administration
-
Aseptic
technique
-
Age
Specific Care
-
Point of
Care Testing
METHOD OF COMMUNICATION WITH OTHER
DEPARTMENTS:
Internal and External Methods of
Communication:
·
Internally, direct communication
between physicians and other team occurs throughout each day.
·
Bulletin boards, APP/ IPP,
Management Notifications and Memorandums folders. Minutes of Meetings folders.
·
Monthly scheduled staff meetings
and others as needs dictate.
·
Ambulatory Care Management Team
Meetings monthly.
·
Externally, the Surgical clinic communicates with
nursing units and multiple other departments via phone, fax, cc-mail, e-mail,
internal mail and written memos. Certain staff representing Surgical Clinic sits
on other committees and attends those meetings (e.g. Wound Care Committee,
Nursing Informatics Committee, and Practice Committee) and feed back to all
staff at our monthly meetings
Describe Collaborative Relationships With
Other Departments:
·
The Surgical clinic strives to
maintain open communication with all departments.
·
Staff from the surgical clinic
participate in clinical pathway development with personnel from other
departments.
·
Social service personnel and
Patient Relations have an office each on the second floor.
·
Appointment clerks are available
on the second floor to facilitate registration, opening encounters and changing
or making of appointments.
·
Some of the clinics are combined
clinics offering a combination of professionals to see the patients and families
on that clinic day (e.g. Cleft Palate, Neuro-surgical clinics).
·
Service coordinators attend the
pre/ post Renal Transplant clinic.
·
Nutrition Services utilize a
clinic room to see patients referred from the second floor clinics.
Goals of the Department:
·
Provide consistent, safe and
high standards of care.
·
Support the Mission Statement of
the hospital
·
Empower staff to develop
leadership and critical thinking skills.
Plan to Improve Quality of Service:
·
To participate in JCIA
accreditation preparation
·
To participate in further
computerization of Nursing documentation to improve patient care and support the
installation of ICIS phase II.
·
To locate and provide a more
suitable environment in which wound care can be delivered at a high standard.
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