HEALTH AND HOSPITAL INFORMATION SYSTEM

HHIT101

R.W.W.M.R.L Dassanayaka

OUM/02/020

0713064607

rixylas@gmail.com
The National Hospital situated in Colombo ,Colombo is the largest city and the commercial,
industrial, cultural and defacto capital of Sri Lanka, with a population of
4,575,000 metropolitan area ,and 555,031in the city limits. It is located on the west coast of
the island and adjacent to Sri Jayawardenepura Kotte(which is the official capital of Sri
Lanka) suburb or the parliament capital of Sri Lanka. Colombo is also the administrative
capital of Western Province, Sri Lanka and the district capital of Colombo District. Colombo
is often referred to as the capital since Sri Jayawardenapura Kotte is a satellite city of
Colombo. Colombo is a busy and vibrant place with a mixture of modern life and colonial
buildings and ruins. It was the political capital of Sri Lanka,

Formerly known as the General Hospital Colombo, the National Hospital was established in
1864 as a small hospital with 100 beds and an OPD. The Victoria Memorial building and the
former administration block are the two oldest buildings still in existence. Over a very long
period of time (143 years) the hospital has grown to be the largest hospital in Sri Lanka was
renamed as National Hospital in September 1995 taking into consideration the services
rendered to the population of the entire country.

The National Hospital situated in Colombo in a 32 acre block of land is the largest teaching
hospital in Sri Lanka and the final referral centre in the country consisting of 3300 beds.
Consisting of 81 wards, 35 operating theatres and 12 intensive care units, it is the training
centre for under graduates and post graduate trainees of the Faculty of Medicine. The nurses
training school, Colombo, PBS, and Schools of Radiography, Pharmacy, Cardiograph,
physiotherapy and occupational therapy are also affiliated to the National Hospital and 2265
nursing officers minors staff 2955 people, medical officers 1120 and other staff around 5000
are work in National Hospital Srilanka.

In national hospital of srilanka have several facilities and several unit,

ACCIDENT SERVICE

ANAESTHESIA AND INTENSIVE CARE

BURNS UNIT
CARDIAC ELECTRO PHYSIOLOGY
CARDIOLOGY
CARDIO-THORACIC SURGERY
DERMATOLOGY
DIABETES AND ENDOCRINOLOGY

ENT
GENERAL MEDICINE
GENERAL SURGERY
GASTROENTEROLOGY
 GYNAECOLOGY
NEPHROLOGY
NEURO SURGERY
NEUROLOGY PLASTIC AND RECONSTRUCTIVE SURGERY
PSYCHIATRY UNIT RADIOLOGY
RHEUMATOLOGY AND REHABILITATION ORTHOPAEDIC SURGERY
OUT PATIENTS DEPARTMENT (OPD) VASCULAR SURGERY
UROLOGY

According to requirement of this assignment, this paper will explain nursing care process of
Accident and emergency service, Accident and emergency service is the one of the most
important unit in Hospital, Accident and orthopaedic service is situated in the regent street,tis
unit have a huge building with Ground floor-& 7th floor,in ground floor we have Admission
centre, Triage section, Recovery Room(RRoom),Accident service Outdoor patient
department(OPD),Accident Service Operation theatre (ASOT),Accident Service Intensive
Care Unit(ASICU),Accident Service High dependence Unit(ASHDU),Accident Service X-
Ray room, Accident service Blood bank and 1St floor with ward 2 ,3,X-Ray Room, Operation
theatre( Orthopaedic) and 2nd floor to 7th floor have male and female wards.

In Accident and Orthopaedic service have 320 beds without ICU and HDU beds, actually this
beds are not enough to Daily admission, lot of patients are admitted to the Accident and
orthopaedic service all over the country..In our section have 287 nursing officers working
heare and quater is 375 nurses however within lack of nursing staff our nurses work with
their maximum energy to save patient life. and 52medical officers,310 minor staff work
heare.

In our Hospital we have Two admission way, one is accident patient admission these patient
admission done by Accident service with s Numbers Eg-:S/B.H.T No ,( S/ 01256 )and
other way is normal clinic patient and other unit admission this admission done by OPD
admission centre.

Normaly in Admission document patient basic information as the name,gender,age of the

patient, contact information of guardian or other person who admitted the patient,patient
properties and cash,source of admission,civil status,and in admission they issued B.H.T
number and save the patient records in record room under B.H.T number,This B.H.T number
include who are the surgeon in,casualty ENT surgeon,cardio Thoracic,orthopaedic
surgeon,neuro surgeon,urology surgeon and vascular surgeon.
Admission

Triage

Patient ASOPD Need

Discharge
conscious, Yes more No
can work treatment
ent

No Yes Ward Discharge

R ROOM

Need No
surgery

Yes
Need
surgery Yes
ASOT
orOTo
No

Need
Patient with
critical No No
critical
care condition

Yes

Yes ASICU

Critical contion
settle,need close No
observetion

Yes
ASHDU

Patient condition
good
When the patient come to the accident service triage Nursing officer assess the patient and
categorise the patients after this procedure if patient with severe condition and need
resuscitation patient sent to the R Room, patients who are ventilate and transfer from other
hospital also sent to R Room, and other patient catergorise trolly side and Can walking, to
trolly side include patient without ventilate but patient with fractures,stab injury ,gunshot
injury, RTA patients, when patient in trolley side if patient become critical patient sent to R
Room, and patient prepare for surgery done by this side,after the surgery patient sent to ward
,if patient with severe contidion patient sent to ASICU orASHDU, in trolly side patient check
by Medical officer and if patient suspected of fractures,spinal cord injury they will get x-ray
if xray show some abnormilities they will get CT ,if suspect internal organ damage or injured
,Ulta sound Scan. if plan to need surgery nursing offcer prepaire the patient,if patient without
severe condition they clean the patient, fulfil the investigation, draw the blood and sent to
blood bank for grouping and DT, if need shaving, shave the patient, during all thease
procedure patient under observation. before the surgery, there are several referral done,if
patient with fracture orthopaedic referral ,vascular injury refer vascular referral, neurosurgical
condition get neurosurgical opinion, when patient with ENT problem refer them and settle
emergency situation and investigationto be done by them,all the team and Casualty surgeon
discuss and do a surgery may be this surgery combine or single surgery, after surgery patient
need ICU care they sent to patient ASICU. patient who can walk on their foot they sent
ASOPD and nurses start to care them,if patient with good condition they just need primary
care after treatment they dischge by OPD, if patient need more treatment they sent patient to
ward.

Im working at Accident service intensive care unit ,it locate in Accident service building
ground floor near the ASOT, ASICU have six beds and have several admission from various
places like RROOM ,ASOT,ASHDU,Neuro trauma Unit,Accident Service wards, it have 26
nursing officers and 6 mediacal officers,7 minior staff persons,

Lets see ASICU activities using flow chat

 Admission

Admission to
ICU

Need With O2 or room

Ventilation No air

Yes
Ventilate the
patient

Patient connect to
multi Monitor

Observation&
manegment

Patient transfer to Need invasive

WD,HDU, another procedure No
ICU

Yes

Is it Emergency? Referral
No B.H.T sent

Treatment Yes Awaiting

Invasive procedure done by

ICU staff
Diagnosis
Procedure

Awaiting Investigation
Now we will see supplementary nursing care process at National Hospital Accident service
Intensive care unit. Nursing care process start with Assessment,Nusing
diagnosis,planning,implementation,evaluaton

Assessment

An registered Nurse uses a systematic, dynamic way to collect and analyze data about a
clint,the first step in delivering nursing care. assessment includes not only physiological data
,but also psychological,sociocultural ,spiritual,economic,and lifestyle factors as wel,as a ICU
nurse we have to assess patient family also,

When the patient admitted to the ICU we Admitted to patient our records, assess patient
condition check patient according to ABCDEF ,if patient already ventilated we check the
patient airway and confirm ET size ,lip level and air entry, if ET not positioning or air entry
not satisfy were re- insert ET tube, and patient connect to the ventilator and set the ventilator
setting.patient without ventilate we connect to the patient oxygen or keep room air according
to medical advice, then patient connect to the multi monitor assess vital sign blood
pressure(BP), pulse Rate(PR),respiration rate(R.R), saturation(spo2) ,if there fracture assess
peripheral pulses. Measure urine output. Then assess the patient trauma
history,injuries,present complain,is there any vital sign deviate from normal ranges.

Nursing diagnosis

Nursing diagnosis is the nurses clinical judgement about the clients response to actual or
potential health condition or needs. nursing diagnosis base on patient condition, nursing
diagnosis change time to time according to patient condition in Accident service ICU nurses
should have good knowledge and skill to identified patient needs, and nurse should alert
about patient vital parameters, investigation reports all these things help to nurse get good
diagnosis, if there are networking system she can easily and quickly approach lab result, other
CT,X-Ray trace reports she can make her diagnose immediately and start to care patient and
safe patient life without complications.

Nursing planning and implementation

Based on the assessment and diagnosis, the nurse sets measurable and achievable short and
long terms goals for her patient, if there patient blood pressure drop she will plan to inform
MO,give fluid bolus, transfuse blood, close observation intake and specially output, check
Central venous pressure finally start to inotrops all these nursing diagnosis and planning
documentation get lot of time, if there data base with nursing diagnosis and planning it is
easy to work without lot of paper work and safe time to work with patient.

Evaluation

Both the patients status and the effectiveness of the nursing care must be continuosly
evaluated, and care plan modified as needed.

Nursing care process is not strictly maintain in ASICU properly, ASICU is most busy place
in our hospital because patient condition change time to time nurse have no time to continue
her nursing care plan properly, documentation is time consuming and it will lead to neglect
patient care.my suggestion in continuing nursing process effectively establish a soft ware
system where nurses can just enter the details of the patient and the system will give all the
suggestion of diagnosis ,planning to select and click only, this will be much easier and have
no chance to mistake diagnosis and planning.
 Admission to ASICU
Nursing care process

Flow chart
Documentation

Nursing Assessment

Patient connect to ventilator

and multi monitor

Write Assessment

Observation finding

Nursing Diagnosis

Nursing planning

Nursing
implementation/care

Need
Investigation Yes investigation
on
No

Awaiting Evaluation
Transfer

result
patient

Evaluation No
satisfied

Yes Patient condition

stable
In these process have several problembs, according to this process it waste time unnecessarily
,most of time waste due to documentation, lot of time repeat document same thing like
Rroom medical officer record patient history ,trauma,fractures, wat are the investigation
done and what are the result. After the ICU admission ICU/MO re writing it,this is time
wasting if there are some data base or soft document ICU/Mo dont want to rewrite,if
software supply check boxes to re checking what are the procedures done in RRoom and
tick it, he just want to check the patient and assess present complain,and enter the manegment
and other disadvantage of paper documentation is nursing officer have to wait to start her
documentation till medical officer write his notes if there network system nursing officer also
can enter the data base same time and start documentation and she can follow the patient
condition.

In the paper documentation nurse have to see monitor and enter the vital sign in observation
chart,if there software ,and network dont want to write in observation chart ,data will be
enter patient data base through monitor.

And another disadvantage is referral system, if there some abnormality in patient one of
system we refer the consultant eg-:patient with intra ventricular haemorrhage. We refer the
consultant neuro sergeon,to refer him we sent to B.H.T and CT films with minor staff person
there are risk to misplace the CT film, may be consultant have to go emergency case or ward
round,so we have to wait when he free, during this period ICU have no ticket ,at that time
patient become worst ,this is risk if there network neuro sergeon or any one can enter the
database and assess the patient ticket,and investigation.

and using networking we can save man power and we can use it necessarily to patient
care,and lot of time we are awaiting to investigation reports, we can reduce this waiting time
through the networking, and also receiving quickly investigation reports , we can get
diagnose immediately and start treatment immediately, sometimes some report receive delay
because of this delay patient life at risk. using software we can save the patient data without
any damage or any misplaces of ticket pages and investigation reports, this system help to
patient when he re admission hospital he can admit same BHT number and save patient detail
in one place this is easy to treat patient. using this IT we can save wasting money and
manpower.

To make this software and networking sucsess ful,it should be properly planned and to train
every nurse for using this hospital information system.when training nursing staff it is very
important to cover each and every nursebecause when undertrained staff is using higj
technology without proper knowledge it will lead to malfunctionining of the instrument and
wrong interpretation of the patient disease also.