clinical from 1 to10.pdf

Introductory Lecture Elias Sidieg Mohammed Hassan (Ph.D.) Biomedical Engineering (BME) Define as a basic research-oriented activity closely related to biotechnology and genetic engineering , i.e., the modification of animal or plants cells to improve and/or develop new microorganisms f...

Introductory Lecture Elias Sidieg Mohammed Hassan (Ph.D.) Biomedical Engineering (BME) Define as a basic research-oriented activity closely related to biotechnology and genetic engineering , i.e., the modification of animal or plants cells to improve and/or develop new microorganisms for beneficial ends. Biomedical engineering: Is the application of engineering principles and design concepts to medicine and biology for healthcare purposes (e.g. diagnostic or therapeutic). This field seeks to close the gap between engineering and medicine: It combines the design and problem solving skills of engineering with medical and biological sciences to advance healthcare treatment, including diagnosis, monitoring, and therapy. Biomedical Engineering Discipline 1- Transport phenomena : To monitor, measure, and model biochemical process. 2- Biomechanics: Study of the mechanical laws relating to the movement or structure of living organisms , how the muscles , bones, tendons and ligaments work together to produce movement. 3- Biomaterials: Design and development of bio-implantable material. 4- Biosensors: Detection of biologic events and their conversion to electrical signals. 5- Physiologic modeling, simulation and control: Use of computer simulations to develop an understanding of physiologic relationships. (Cybernetics) ‫ح‬ٕٚٛ‫اعرخذاو انذاعٕب فٗ دساعح انٕظائف انذ‬ ‫شْا‬ٕٚ‫ٔذط‬ 6- Biomedical Instrumentation: To monitor and measure physiologic events, involves development of biosensors. 7- Medical and Biologic Analysis: To detect, classify and analyze bioelectrical signals. 8- Rehabilitation Engineering: Design and development of therapeutic and rehabilitation devices and procedures. 9- Prosthetic Devices and artificial organs: Design and development of devices for replacement or augmentation of bodily function. Orthosis, Prosthesis 10- Medical Informatics: Patient-related data, interpret results and assist in clinical decision making. 11- Medical Imaging: To provide graphic displays of anatomic detail and physiologic function. 12-Biotechnology: To create or modify biologic material for beneficial ends, including tissue engineering. 13- Clinical Engineering: Design and development of clinically related facilities, devices, systems, and procedures. 14- Biologic effects of Electromagnetic field: Study of the effects of electromagnetic field on biologic tissue. Lecture 2 : Clinical Engineering The management, maintenance, support , development, and quality assurance of medical equipment as part of safe, cost effective and sustainable healthcare delivery.  Evolution of Clinical Engineering Level 1 (1970-1978) – Electrical safety – Corrective maintenance of basic electromedical equipment – Initiation of PM program – Equipment Control Program initiated – 5. Initial involvement in equipment acquisition process  Level 2 (1978-1984) – Center for hazard and recall network – Incident investigation – Significant involvement in acquisition process – 4. Initial involvement in outside service contracts  Level 3 (1984-1989) – Reports directly to administration – Computerized equipment control program with productivity and cost analysis capability – 3. Maintenance of more sophisticated technology including medical imaging and clinical lab.  Level 4 (1989-1993) – Integration of CQI into technology management – Comprehensive service contract management – Computerized ECP with extensive analysis capability – 4. Active participation in equipment planning and facilities development  Level 5 (Future Projection) – Strategic Technology Planning – Technology Assessment – Integration of Clinical and Information Technologies – Home Care technology management – 5. Increasing clinical involvement  Operational Scope: National level. Provincial level. Regional level. 4. Institutional level. (Qualified man and technician have basic Knowledge in different field). Operational level High level. Intermediate level. 3. Low level.  Functions of Clinical Engineering Technology Planning (project management) Technology Assessment Acquisition and Application of Technology Equipment Control Program Preventive and Corrective Maintenance Service Contract Management Development of New Technology Facility Planning and Development Safety and Risk Management Continuous Quality Improvement Education 12. Clinical Equipment Application Technology Planning What types of technology are best suited to satisfy the program needs of this facility? What are the future technology requirements? What technologies are under development? How will they impact patient care? 4. How can technology be better utilized to improve patient outcome, control costs and improve productivity? Technology Assessment Definition: Assessment of medical technology (devices, drugs, procedures, & systems) in term of – Safety – Clinical effectiveness – Cost effectiveness – Ethical (e.g., reproductive technologies) – 5. Legal Acquisition and Application of Technology What equipment do we need to do the job? Is it commercially available? Which of the available models is best? How much will it cost to buy? To operate? Where will it go? Will we need to renovate? Who will use it? Will they need training? Who will service it? How often will it need to be serviced? When will we need to replace it? Needs Assessment 11. Environmental Assessment Equipment Control Program What equipment is in the hospital? (make, model, serial#) Where is it? Who does it belong to? Is it safe? Is it reliable? Is it effective? How is it utilized? Is it easy to use? How frequently is it utilized? Is it time for replacement? What service procedures have been performed, when, what parts were used, how much did it cost? 12.How frequently is preventive maintenance and performance assurance performed? What P.M. procedures are performed? Preventive and Corrective Maintenance In-house or external service? Warranty management Level of in-house service (board level, component level) Corrective-maintenance service process Service facility (size, location, etc.) Size of technical staff Staff training Staff organization  Parts inventory Test equipment Equipment manuals & documentation Diagnostic software Vendor support Frequency of PMs Scheduling PM procedures Service reports 18. Billing rate  Service Contract Management In-house, vendor, third-party, maintenance insurance? Provisions of service contracts Service contract negotiation Monitoring and documentation service contracts 5. Cost analysis  Development of New Technology Needs assessment Research Design and specification Prototype construction, testing and evaluation Construction, testing and documentation of final assembly Regulatory approvals User education Clinical trials, modification, documentation and reporting 9. Add to equipment control program Facility Planning and Development Specifying equipment requirements Liaison between contractor and hospital Project planning and management 4. Ensure conformance to relevant codes & regulations aka ‫ش‬ٛٚ‫يطاتمح انًٕاطفاخ ٔ انًؼا‬ Safety and Risk Management Remain current on all pertinent codes & regulations Interpretation of codes & regulations Implementation and enforcement of codes & regulations Maintain system for responding to published equipment hazard reports Reviewing requests for new technology as to safety and effectiveness Identification of potential hazards Assessing degree of hazard protection required in relation to size of risk Preventing technological change when risk unwarranted or effectiveness not demonstrated Incident investigation and reporting Maintain incident database. Safety policy development Development of safety education programs Representation on hospital safety committee Liaison with manufacturers 15. Liaison with hazard reporting agencies. Continuous Quality Improvement Identify customers Identify and measure improvement needs – Identify critical processes – Identify quality indicators Examine problems and analyze the causes Decide on solutions and action plans to achieve them Implement proposed solutions, measure and evaluate 6. Adopt and standardize improved processes Education Education of Clinical Engineering Education of Clinical Staff Education of Patients 4. Partnership with local Clinical Engineering Technology Programs  Education of Clinical Engineering Attend relevant conferences and seminars Attend vendor service courses Participate in Clinical Engineering professional associations. Read clinical engineering magazines and journals 5. Remain current on developments in medical technology (vendor contacts) Education of Clinical Staff Development of in-service education programs User training on new equipment Annual refresher courses for clinical staff Informal user assistance and training Documentation of user training 6. Education of clinical staff on new developments in medical technology Education of Patients Provide in-service education to patients responsible for the operation of medical devices Training Partnerships Advise local Clinical Engineering Technology programs on curriculum content Assist with training 3. Provide hospital internship program  Continuing Education – Professional Journals and Newsletters – Professional Societies – Internet – Seminars and Conferences Awareness of Program Needs – Frequent communication with users – Involvement with technology related committees Awareness of Technology Resources – Equipment Control Program Lecture 4 : Operational level Low level: Minimal managerial function. Liaison with service provides. Mainly first time line repairs and user error filtering. Functions determined by qualifications and experience. Could be multi-disciplinary –within limits  Hospital Manager Maintenance Manager Maintenance department Clinical Eng. Technician  Intermediate level Managerial functions dictated by needs. Can be multi-disciplinary. Complex repairs at module or board level. Management of outside MRO activities (Medical Repair Organization). In-house user training (given by a full experience). Management of spare parts holdings.  CE Management & administration Technician Technician Electronics Mechanical Assistant Assistant  High level High level managerial function. Using multi-disciplinary in structure.......ٔ ‫ش‬ٚ‫ش ٔانرخذ‬ٕٚ‫اخ ٔانًٕذشاخ ٔانرظ‬ٚ‫ح ذشًم االششاف ػهٗ يخراف االلغاو يصم –انثظش‬ٛ‫انًغإن‬ Provides technical assistance to lower level Management of spare parts. Responsibility of own budget. Provision of full train facilities.  Over all management ‫مدير االدارة العامة‬ Administration Stores ‫المخازن‬ - Anesthetics and respiratory: Anesthesia ,related to ventilators - Electronics : Patient monitoring, diagnostic and therapeutic Equip, laser. - Radiological Equip: X-ray, MRI,US, Radiotherapy. - Optics : Endoscopy , laparoscopy, microscopy. - Surgical Instrument: repairs, sharpening Clinical Engineering Program Structure Governing Board President Vice President Director of Technology Manager Clinical Engineer. Equipment Services Clinical Engineer. Service Service Service Service Group Group Group Group Engineer vs. Technologist vs. Technician Administrative Educational Model Functional Model Model Engineer Broad Technologist Engineer Engineer Technologist Technician Technician Technician Technologist Narrow Centralized vs. Distributed Service Centralized Service Advantages – Lower cost – Increased efficiency – Prevents duplication of function and personnel – 4. Common resource and knowledge base Centralized Service Disadvantages – Lack of individual department control Equipment Specialist vs. Generalist Specialist Advantages – Staff are more capable – More efficient – 3. Job gets done faster Specialist Disadvantages – Staff are less flexible – No cross-training – 3. Uneven workload distribution Single Team vs. Multiple Team (Area Specialization) Multiple Team Advantages – More efficient – Improved familiarity with equipment and users – Clear identification of responsibility by clinical staff and CE staff – Ownership (pride in work) – Accountability – 6. Improved communication between clinical staff and CE staff  Multiple Team Disadvantage – More vulnerable – Technologist may become bored with same range of equipment – Uneven workload distribution Lecture 5 : The Design and Construction of Hospital The Primary Health Care(PHC): Health for all, through curative and rehabilitative services. ‫رٓا ٔذى ٔػغ األعظ انرٗ ذذكى‬ًْٛ‫ح َغثح أل‬ٛ‫ح انظذ‬ٚ‫ٔيإخشا صاد االْرًاو تانشػا‬ ٍ‫اخ ٔي‬ٛ‫ح ٔانًغرشف‬ٛ‫اَشاء انًشاكض انظذ‬ :‫أْى ْزِ األعظ ٔانًغاػذاخ‬.‫ المرتكزات التمنٌة مثل التدرٌب والمرالبة للحاالت المحولة والبحوث التى تختص بها‬-1.‫ المرتكزات االدارٌة مثل التنظٌم واالمدادات‬-2 3. Health education in term of - Hygiene - Nutrition - Child care - AIDS (Acquired Immuno deficiency Syndrome) - Family planning Levels of Care Models supported by (WHO): Family and home. Community health activity. First health facility (Subdistrict ‫ح‬ٛ‫) يُطمح فشػ‬. First referred level (district ٙ‫)د‬. Second referred level (Provincial ًٗٛ‫) أله‬. Third referred level ( National ٗ‫) لٕي‬. 7. High referred level.(ٗ‫)ذخظظ‬ Construction and Equipments  The 100 beds hospital models should contains of: Gynecology and Obstetrics. Primary surgery. Emergency cases. Equipments related diagnosis including : - Laboratory - Basic X-ray services Equipment related therapy. Distribution of drugs. Health education. Staff training (halls & workshop). Maintenance of subordinated facilities. Transport of patients and material. 11. Administration and supervision of district. General construction features & Hospital plans ‫ؾ‬ٛ‫ح ٔػُذ انثذء فٗ انرخط‬ٛ‫اذٓا انرذر‬ُٛ‫اجاذٓا ٔت‬ٛ‫ كم دٔل انؼانى انصانس ذرشاتّ فٗ ادر‬ :‫جة أٌ َؼغ فٗ االػرثاس‬ٚ ‫الَشاء أ٘ يُشأج‬ Building orientation ( e.g., east, west , alignment to avoid excess of solar heat and radiation). Building shape (e.g., single storey building to avoid lift). Solar radiation (e.g., wall shading by generous roof overhang). Ventilation. Terrain features (e.g., tress for shading). 6. Pests (Protection of electrical wiring against rodents). ‫ ػًٕيا ُْانك تؼغ انًرطهثاخ انرٗ ‪ٚ‬جة اٌ ذٕػغ فىٗ االػرثىاس ٔرنىك‬ ‫نهًذافظح ػهىٗ انًثُىٗ يصىم دسجىاخ انذىشاسج انؼان‪ٛ‬ىح ٔانشؽٕتىح ٔأ‪ٚ‬ؼىا‬ ‫‪ٚ‬جة يشاػاج انؼاداخ انرٗ ذخرهف يٍ تهذ انٗ تهذ فًصال فٗ تؼىغ انىثالد‬ ‫ُْانىىك ألغىىاو خاطىىح نهُغىىاء ٔفىىٗ تؼىىغ انىىثالد ُْانىىك تؼىىغ انؼىىاداخ‬ ‫انظذ‪ٛ‬ح يصم ػذو اعرخذاو ٔسق انرٕان‪ٛ‬د ‪.‬‬ ‫ انذساعىىاخ أشثرىىد تانرجشتىىح اٌ انغىىؼح انكه‪ٛ‬ىىح نهًغرشىىفٗ ارا صادخ ػىىٍ‬ ‫‪ 300‬عىىش‪ٚ‬ش فىىاٌ اداسذٓىىا الرظىىاد‪ٚ‬ا عىىٕف ذكىىٌٕ يرؼغىىشج نىىزنك فًؼظىىى‬ ‫انًغرشف‪ٛ‬اخ انرٗ ذغطٗ ادر‪ٛ‬اجاخ انًُاؽك انش‪ٚ‬ف‪ٛ‬ح أ انثؼ‪ٛ‬ذِ يىٍ انًىذٌ‬ ‫انكثىىىشٖ ٔانرىىىٗ ذُشىىىأ ‪ٚ‬جىىىة اٌ ذاخىىىز فىىىٗ االػرثىىىاس انكىىىٕادس أٔ األؽىىىش‬ ‫انًإْهح نرشغ‪ٛ‬م ٔذغ‪ٛٛ‬ش انؼًم تٓا‪.‬‬  ‫العٍاداث الخارجٍت‬ ‫ذؼرثش انؼ‪ٛ‬اداخ انخاسج‪ٛ‬ح أدذ الغاو انًغرشفٗ انشئ‪ٛ‬غ‪ٛ‬ح‪ٔ ،‬نكٍ ‪ٚ‬فؼم‬ ‫ ‬ ‫ػضل دشكح انًشػٗ انخاسج‪ ٍٛٛ‬ػٍ دشكح انًشػٗ انًم‪ًٍٛٛ‬‬ ‫‪.1‬‬ ‫أٌ ذكٌٕ خذيح انًشػٗ انخاسج‪ ٍٛٛ‬تجاَة انطٕاسب أٔ تجاَة تؼغ انخذياخ‬ ‫‪.2‬‬ ‫انًغاػذِ انر‪ ٙ‬ذخذو أ‪ٚ‬ؼا انًشػٗ انًم‪.ًٍٛٛ‬‬ ‫بالنسبة لمدخل العٌادة الخارجٌة فٌجب أن ٌكون لرٌب من المدخل الرئٌسً‬ ‫‪.3‬‬ ‫للمستشفى‪ ،‬وبالتالً ترتب خدمات االستمبال والخدمات اإلجتماعٌة والمحاسبة‬ ‫وغٌرها‪.‬‬ ‫ان تكون العٌادة الخارجٌة فً الطابك األرضً‪ ،‬وإذا كانت فً أكثر من طابك‬ ‫‪.4‬‬ ‫ٌجب أن ٌتوفر االتصال الرأسً الجٌد بٌن الطوابك‪.‬‬ ‫أذا كانت مساحة المستشفى ‪ 3000‬متر مربع ٌجب ان تكون مساحة العٌادات‬ ‫‪.5‬‬ ‫الخارجٌة ‪ % 20-15‬من هذه المساحة الكلٌة‪.‬‬ ‫‪0.5 m2 / pt : space required for waiting & registering.‬‬  ‫يضا‪ٚ‬ا فظم انؼ‪ٛ‬ادج انخاسج‪ٛ‬ح ػٍ انًغرشفٗ‬ ‫ عىىٕٓنح انٕطىىٕل تانُغىىثح نهًىىش‪ٚ‬غ‪ ،‬يىىغ ئيكاَ‪ٛ‬ىىح ذُظىى‪ٛ‬ى انخىىذياخ انًمذيىىح نهًشػىىٗ‬ ‫تشكم يُفظم‪.‬‬ ‫ ئيكاَ‪ٛ‬ح انرٕعغ انًغرمثه‪ ٙ‬د‪ٛ‬س أَٓا نٓا يثُٗ يغرمم‪.‬‬ ‫ ذٕفش دش‪ٚ‬ح دشكح أفؼم نهًشػٗ انخاسج‪ ٍٛٛ‬ف‪ ٙ‬يذأس ٔاػذح‪.‬‬ ‫سلبٌات فصل العٌادة الخارجٌة عن المستشفى‬ ‫ صعوبة اتصال أو تنمل األطباء بٌن العٌادة والمرضى الممٌمٌن بالمستشفى‪ٌ.‬سببب‬ ‫صعوبة إدارٌة بشكل عام‪.‬‬ ‫ الحاجة إلى مضاعفة بعض الخدمات التً لد تكبون مشبتركة مبع ألسبام أخبر مبن‬ ‫المستشفى‪.‬‬ ‫ بعببض خببدمات المرضببى الخببارجٌٌن لهببا عسلببة مببع المستشببفى المركزٌببة ألنهببا‬ ‫تستخدم من لبل المرضى الممٌمٌن بالمستشفى‪ ،‬ومبن هبذه الخبدمات غبرش األشبعة‬ ‫وغرش العسج الطبٌعً والمختبرات والصٌدلٌة وغرش األطباء‪.‬‬  ‫اقسام العٍادة الخارجٍت‬ ‫‪.1‬القسن اإلداري‪:‬‬ ‫ ‬ ‫ٔ‪ٚ‬شًم االعرمثال ٔانًؼهٕياخ ٔاالَرظاس ٔيمظف طغ‪ٛ‬ش ٔيخاصٌ ٔغشف ذُظ‪ٛ‬ىف‬ ‫ ‬ ‫ٔايىىىىىىىاكٍ نهؼىىىىىىىة األؽفىىىىىىىال‪ ،‬ئػىىىىىىىافح ئنىىىىىىىٗ انًكاذىىىىىىىة ا داس‪ٚ‬ىىىىىىىح نهًغىىىىىىى ٕن‪.ٍٛ‬‬ ‫‪.2‬غزف الفحص‪:‬‬ ‫ذظىًى تذ‪ٛ‬ىس ‪ٚ‬غىًخ ذظىىً‪ًٓٛ‬ا ٔيٕلؼٓىا تانرًىذد‪ٚٔ ،‬كىٌٕ يهذىىك تٓىا يخىضٌ طىىغ‪ٛ‬ش‬ ‫ ‬ ‫نالدٔاخ انًغرٓهكح تشكم دٔسٖ‪.‬‬ ‫ٔذمىىغ انغىىشف انًرخظظىىح فىى‪ ٙ‬لهىىة لغىىى انؼ‪ٛ‬ىىادج انخاسج‪ٛ‬ىىح‪ٚٔ،‬خرهف ػىىذدْا دغىىة‬ ‫ ‬ ‫أػذاد انًشػٗ ‪.‬‬ ‫ٔذرٕصع داخه‪ٛ‬ا دغة االذ‪:ٙ‬‬ ‫‪ٚ‬كٌٕ ف‪ ٙ‬انغشفح يكرة نهطث‪ٛ‬ة ٔغشفح فذض ف‪َ ٙ‬فظ انٕلد‪.‬‬ ‫ٔذشًم كم غشفح ف‪ ٙ‬ذظً‪ًٓٛ‬ا انذاخه‪ ٙ‬ئػافح ئنٗ يكرة انطث‪ٛ‬ة ػهٗ يغغىهح ٔيغىادح‬ ‫نهرغ‪ٛٛ‬ش ٔؽأنح نهؼًم ٔجٓاص نشؤ‪ٚ‬ح طٕس األشؼح‪.‬‬  ‫‪ ‬تقسن غزف الفحص حسب وظٍفتها‪:‬‬ ‫ غشف االَف ٔاألرٌ ٔانذُجشج‪ٚٔ:‬جة يشاػاج انخظٕط‪ٛ‬ح ف‪ٓٛ‬ا‪.‬‬ ‫ غشف انؼ‪ ْٙٔ :ٌٕٛ‬ال ذذراض ئنٗ عش‪ٚ‬ش‪.‬‬ ‫ غشف ؽة األعُاٌ‪.‬‬ ‫ غشف انطة انثاؽُ‪ٚٔ :ٙ‬شاػٗ ف‪ٓٛ‬ا انخظٕط‪ٛ‬ح‪.‬‬ ‫ غشف انجهذ‪.‬‬ ‫ غشف األيشاع انُغائ‪ٛ‬ح‪.‬‬ ‫ غشف األؽفال‪ٚٔ :‬شاػٗ أٌ ذكٌٕ يؼضٔنح طٕذ‪ٛ‬ا‪.‬‬ ‫ غشف انؼظاو‪.‬‬ ‫ غشف االػظاب‬ ‫ ‪. 10‬غشف انًغانك انثٕن‪ٛ‬ح‪.‬‬ Lecture 6 : Planning and organization of hospital Planning Planning is a process that is based on the analysis of data and identify needs and assess available resources, and use this analysis in preparation for the change, according to the objectives of a deliberate and pre- defined what? Planning is the management that aims to increase the effectiveness of health programs and services to provide the greatest possible number of individuals with maximum health benefits and at the lowest costs and the development of all the health services in an organized health promotion and restoration and prevention of disease The hospital Institution containing a medical device has a permanent medical facilities include the beds of hypnosis and medical services , that including physician services, to provide diagnosis and treatment of the patient under nursing services. Public hospital It is the hospital which includes multiple medical specialties such as: (internal medicine, general surgery, obstetrics and gynecology, heart disease, diseases of children, dermatology diseases, ear, nose and throat diseases (ENT), bone diseases). managed by government e.g., Ministry of Health this type of hospitals applied the government regulations in their organizations and financial. It is non-profit Private Hospital It is the different activities that are managed on an economic basis, using sophisticated and flexible methods of administrative work on optimization of input activity. To achieve the goals of businesses in the context of compliance with regulations and principles, traditions and customs prevailing ‫اخ‬ٛ‫ انًغرشف‬ٙ‫ؾ ف‬ٛ‫يجاالخ انرخط‬ ‫ذ‬ٛ‫غرف‬ٚ ٌ‫ؾ تانًغرشفٗ ٔانًرٕلغ أ‬ٛ‫ح ألفشاد انًجرًغ انًذ‬ٛ‫اجاخ انظذ‬ٛ‫ دساعح االدر‬- ِ‫ًكٍ أٌ ذؼرشع ئَشاء ْز‬ٚ ‫يٍ خذياخ انًغرشفٗ انًخرهفح يغ دساعح أ٘ يؼٕلاخ‬.‫جاد انذهٕل انًُاعثح نٓا‬ٚ‫انخذيح ٔئ‬ ‫اخ‬ٕٚ‫ح نٓا ٔفما ألٔن‬ُٛ‫ح نهًغرشفٗ ٔأجشاء انثشيجح انضي‬ٛ‫ج‬ٛ‫ ٔػغ انخطح ا عرشاذ‬- ‫ طٕسج‬ٙ‫ح انًرادح ف‬ٚ‫ح ٔانًاد‬ٚ‫ح ٔذثؼا نإليكاَاخ انثشش‬ٛ‫اجاخ أفشاد انًجرًغ انظذ‬ٛ‫ادر‬. ( ‫ح‬ٛ‫ه‬ٛ‫ح ) خطح انًغرشفٗ انرشغ‬ُٕٚ‫خطؾ ع‬  ‫‪ -‬التنسٌك بٌن مختلش الوحدات التشغٌلٌة فً المستشفى لضمان التنفٌذ الجٌد لخطة‬ ‫المستشفى التشغٌلٌة ‪.‬‬ ‫‪ٔ -‬ػغ يٕاطفاخ ٔيؼا‪ٛٚ‬ش نم‪ٛ‬اط أداء انخذياخ انر‪ٚ ٙ‬مذيٓا انًغرشفٗ ‪.‬‬ ‫‪ٔ -‬ػغ يٕاطفاخ نألتُ‪ٛ‬ح ٔانًؼذاخ ٔاألجٓضج انٕاجة ذٕافشْا تانًغرشفٗ ‪.‬‬ ‫‪ -‬ذذذ‪ٚ‬ذ ادر‪ٛ‬اجاخ انًغرشفٗ يٍ انمٕٖ انؼايهح انالصيح ٔػًم خطؾ ذذس‪ٚ‬ة انؼايه‪ٍٛ‬‬ ‫انجذد‪.‬‬ ‫‪ٔ - 7‬ػغ انً‪ٛ‬ضاَ‪ٛ‬ح انؼايح نهًغرشفٗ ْٔ‪ ٙ‬ذركٌٕ يٍ ئجًان‪ ٙ‬انًٕاصَاخ انرفظ‪ٛ‬ه‪ٛ‬ح‬ ‫نهٕدذاخ انرشغ‪ٛ‬ه‪ٛ‬ح انًخرهفح تّ ‪.‬‬  ‫فزٌق التخطٍط‬ ‫‪ٚ‬رطهة ذظً‪ٛ‬ى انًغرشف‪ٛ‬اخ ٔتُاءْا ٔذٓ‪ ٛ‬رٓا العرمثال انًشػ‪ٔ ٙ‬ذشغ‪ٛ‬هٓا يٕاطفاخ‬ ‫خاطح ٔيما‪ٛٚ‬ظ يؼ‪ُٛ‬ح ذمرؼ‪ ٙ‬انفذض ٔانرًذ‪ٛ‬ض انفُ‪ٔ ٙ‬ا داس٘ ٔنٓزا أٔػذد‬ ‫يُظًح انظذح انؼانً‪ٛ‬ح ف‪ ٙ‬ادذ ذماس‪ٚ‬شْا انفُ‪ٛ‬ح ئٌ ذخط‪ٛ‬ؾ انًغرشف‪ٛ‬اخ ػثاسج ػٍ‬ ‫ػًه‪ٛ‬ح ذرً‪ٛ‬ض تطاتغ فُ‪ ٙ‬يؼمذ ٔنٓزا أٔطد أٌ ‪ٚ‬ؼى فش‪ٚ‬ك انرخط‪ٛ‬ؾ خثشاء ف‪ ٙ‬ئداسج‬ ‫انخذياخ انظذ‪ٛ‬ح ٔف‪ ٙ‬األػًال ا كه‪ُٛٛ‬ك‪ٛ‬ح ٔانرًش‪ٚ‬غ ٔكزنك يُٓذع‪ٔ ٍٛ‬يؼًاس‪ٍٛٚ‬‬ ‫نٓى خثشج ف‪ ٙ‬ذظً‪ٛ‬ى انًغرشف‪ٛ‬اخ ٔانرخط‪ٛ‬ؾ انًذَ‪ٔ ٙ‬نٓزا فاٌ انثادص‪ٚ ٍٛ‬شٌٔ ئٌ‬ ‫‪ٚ‬ؼى ػذج ذخظظاخ ‪.‬‬ ‫‪ٚٔ -‬ؼًم ْزا انفش‪ٚ‬ك ذذد ئششاف يجهظ ئداسج انًغرشفٗ ٔل‪ٛ‬ادج كم يٍ يذ‪ٚ‬ش‬ ‫انًغرشفٗ ٔانًُٓذط انطث‪ٔ ٙ‬انًؼًاس٘ انز‪ٚ ٍٚ‬ذرًهٌٕ يغ ٕن‪ٛ‬ح يششٔع‬ ‫انًغرشفٗ يٍ تذا‪ٚ‬رّ ئنٗ َٓا‪ٚ‬رٓا ػهٗ أٌ ‪ٚ‬كٌٕ نهًششٔع يذج صيُ‪ٛ‬ح يذذدج يٍ‬ ‫ذاس‪ٚ‬خ تذء انؼًم ف‪ٔ ّٛ‬درٗ َٓا‪ٚ‬رّ ٔذغه‪ ًّٛ‬نهرشغ‪ٛ‬م‬  ‫مراحل تخطٌط ألامة مستشفى جدٌد أو توسعة مستشفى لائم‬ ‫تتم عملٌة التخطٌط عبر نشاطات متعددة وتمر بما ٌلً من خطوات‬ ‫‪ -1‬تحدٌد منطمة الخدمة للمستشفى ‪:‬‬ ‫الممصود بها المنطمة التً ٌعٌش فٌها سكان ٌتولع إن ٌشملهم المستشفى بخدماته‬ ‫وذلن عن طرٌك رسم الحدود الجغرافٌة للماعدة السكانٌة المراد خدمتها وتحدٌد هذه‬ ‫المنطمة هام جدا إذ على ضوئه ٌتم تحدٌد حجم المستشفى وعدد األسرة فٌه ونطاق‬ ‫خدمات التشخٌص والعسج السزمٌن لهذه المنطمة بعد تمرٌر عن عدد األفراد‬ ‫المحتمل أن ٌستفٌدوا من المستشفى‬ ‫‪ -2‬الدراسة المسحٌة لمعرفة المستفٌد‬ ‫الطرٌمة المباشرة ‪ :‬وتعتمد على سؤال المواطنٌن عن موطن إلامتهم وعن الجهات‬ ‫التً توفر لهم خدمات الرعاٌة الصحٌة وأماكنها‬ ‫الطرٌمة غٌر المباشرة ‪ :‬وتعتمد على السجست الطبٌة الموجودة فى المستشفٌات‬ ‫لمعرفة إلامة المرضى المادمٌن لهذه المستشفٌات وإعدادها ومعرفة نوعٌة األمراض‬ ‫المنتشرة فً المنطمة المراد إلامة مستشفى فٌها‬  ‫كما تسهل االستبٌانات على ممدمً الخدمات الصحٌة فً المناطك المجاورة‬ ‫وتحلٌل سجست الوالدة والوفاة على التعرش على أماكن تجمع السكان وتمدٌر حجم‬ ‫الرعاٌة التً ٌمكن أن تمدمها لهم المستشفى المراد تخطٌطه‬ ‫واٌضا تساعد الدراسة المتعلمة بتسلسل التركٌب الهرمً للسكان فً المنطمة فً‬ ‫تحدٌد مستو الرعاٌة المراد تمدٌمها فمثس المنطمة التً تعداد سكانها ثسثون ألش‬ ‫نسمه ال تحتاج إلى نفس مستو الرعاٌة التً تمدم لمنطمة ٌصل عدد سكانها إلى‬ ‫ملٌون نسمه‬  ‫الوعاٌٍز التخطٍطٍت والتصوٍوٍت للوستشفٍاث‬ ‫‪ٚ -‬فؼم ذؼذد انطشق انًٕطهح نهًغرشفٗ ٔرنك نرجُة االصدداو ٔخظٕص نغ‪ٛ‬اساخ‬ ‫ا عؼاف ئٌ ‪ٚ‬كٌٕ انًٕلغ لش‪ٚ‬ثا يٍ انخذياخ انؼايح األعاع‪ٛ‬ح يصم خطٕؽ انكٓشتاء ٔانٓاذف‬ ‫ٔانظشف انظذ‪ٙ‬‬ ‫‪ -‬شكم األسع يغرط‪ٛ‬م تُغثح ‪2:1‬أ ‪ 3:2‬تذ‪ٛ‬س ‪ٚ‬كٌٕ انؼهغ األكثش ف‪ ٙ‬اذجاِ‬ ‫ششق_غشب أٔ شًال ششق جُٕب غشب أٔ شًال ‪ -‬جُٕب‬ ‫‪ -‬ئرا ٔجذخ خطٕؽ كُرٕس‪ٚ‬ح ف‪ ٙ‬اسع انًششٔع فاألفؼم ئٌ ‪ٚ‬رًاشٗ انًششٔع يؼٓا ٔرنك‬ ‫‪ٚ‬غًخ تٕجٕد أكصش يٍ يذخم ٔأكصش يٍ يغرٕٖ‬ ‫‪ٚ -‬فؼم اخر‪ٛ‬اس األياكٍ انًشذفؼح ٔانخهٕ‪ٚ‬ح َشاء انًغرشف‪ٛ‬اخ‬ ‫‪ -‬أٌ ‪ٚ‬كٌٕ يٕلغ انًغرشفٗ يخظض يشفك طذ‪ ٙ‬دغة انًخطؾ انًؼرًذ‬ ‫‪ -‬يٕافمح ٔصاسج انظذح ػهٗ انًٕلغ‬ ‫‪ -‬أٌ ‪ٚ‬كٌٕ انًٕلغ انًُرمٗ َظ‪ٛ‬فا تؼ‪ٛ‬ذا ػٍ يُاؽك انؼثاب ٔانرهٕز ٔانشٔائخ انكش‪ٓٚ‬ح‬ ‫ٔتؼ‪ٛ‬ذا ػٍ انؼٕػاء‬ ‫‪ -‬أٌ ‪ٚ‬كٌٕ انًٕلغ ػهٗ اذظال تشثكاخ انطشق انشئ‪ٛ‬غ‪ٛ‬ح ٔيذطاخ انًٕاطالخ انؼايح انر‪ٙ‬‬ ‫ذؼًم داخم َطاق انًغرشفٗ‬ ‫‪ -‬هنان عسلة بٌن مساحة األرض وعدد األسرة فً المستشفى‪ ،‬حٌث ٌخصص عادة‬ ‫مساحة ما بٌن (‪)42‬م‪ 2‬لكل سرٌر‪ ،‬كما ٌخصص ‪10‬م‪ 2‬لكل سرٌر من الحدائك‬ ‫ومراعاة إمكانٌة التوسع المستمبلً‬ ‫‪ -‬توفٌر موالش للسٌارات‬ ‫‪ٌ -‬مكن ألامة المستشفى من مبنى واحد أو عدة مبانً‪،‬مع مراعاة الربط بٌنهم بطرق‬ ‫مناسبة‬ ‫‪ -‬التمٌد بأنظمة البناء المعتمدة من ناحٌة االرتفاعات واالرتدادات ونسب البناء‬ ‫‪ٌ -‬تراوح عرض السسلم ما بٌن ‪1.5 - 1.3‬م‪ ،‬وارتفاع الدرجه من ‪ 0.18-0.16‬م‬ ‫‪ -‬توفٌر المصاعد الكهربائٌة فً حالة اإلتصال الرأسً وتكون أبعاد المصعد حسب‬ ‫وظٌفته‪ ،‬مع مراعاة وجود مصعد متعدد األغراض لكل ‪ 100‬سرٌر‪.‬‬ ‫‪ٌ -‬جب أن تكون الممرات مضاءة ومهواة جٌدا وٌجب أال ٌمل عرضها عن ‪2.20‬م‬ ‫‪ -‬استخدام مواد العزل الصوتً المناسبة فً المشروع‬ ‫مراعاة االشتراطات الخاصة بالخدمات الخاصة بالمعالٌن‬  ‫االعتباراث االساسٍت فً تصوٍن الوستشفٍاث‬ ‫‪.1‬البعد االنساني في تصميم المستشفيات‪:‬‬ ‫مع تطور أسالٌب العسج كان ال بد من تطور مماثل فً تخطٌط وتصمٌم المستشفٌات هذا مع‬ ‫العلم عدم وجود اتجاه ثابت فً تصمٌم المستشفٌات فٌجب على المستشفى ان تعطً‬ ‫للمرٌض االحساس باالمان والراحة سواء فً فراغاتها الداخلٌة او الخارجٌة وٌمكن تحمٌك‬ ‫ذلن عن طرٌك الكثٌر من الطرق المعمارٌة كاالضاءة الطبٌعٌة وااللوان وممٌاس الكتل‬ ‫واالحجام‬ ‫‪.2‬المرونة ‪:‬‬ ‫نظرا لتغٌر المستمر فً اسالٌب العسج فٌنبغً ان ٌسمح تصمٌم المستشفى بمرونة كافٌة لتغٌٌر‬ ‫وتبدٌل استعمال الفراغات حسب الحاجة وٌكون ذلن باستخدام مودٌول واسلوب انشاء مرن‬ ‫ٌسمح بتغٌٌر الفراغات الداخلٌة الستٌعاب أنشطة متعددة كذلن اختٌار اسلوب مناسب‬ ‫للتمدٌدات الكهربٌة والمٌكانٌكٌة لتناسب الفراغ عند تغٌٌر استخدامه‬ ‫‪.3‬المابلٌة لسمتداد‪:‬‬ ‫هنان ألسام فً المستشفى تحتاج الى تمدد وتوسع لذلن ٌجب على المصمم ان ٌكون له دراٌة‬ ‫بعملٌة التوسع فً الفراغات مستمبس وان ٌصمم المبنى بحٌث ٌسمح لهذه االمتدادات ان‬ ‫تكون افمٌة او راسٌة وذلن اما بتشكٌل المسالط التً تسمح باالمتداد االفمً او باختٌار‬ ‫النظام االنشائً الذي ٌسمح بمرونة استخدام الفراغات واالمتداد الراسً‬  ‫‪.4‬مرحلة التنفيذ والبناء‪:‬‬ ‫نظرا الرتفاع تكالٌش انشاء المستشفٌات وصعوبة التموٌل لها فمد اصبح انشاء‬ ‫المستشفٌات على مراحل امرا ضرورٌا لكً ٌستفاد من المرحلة االولى لها الى‬ ‫ان ٌتم توفٌر الدعم االزم للمراحل البالٌة‪.‬‬  ‫هزاحل تصوٍن الوستشفى‬ ‫‪ -1‬تحذٌذ نىع الوستشفى وسعتو‬ ‫حجن الوستشفى ‪ٚ :‬رى ذذذ‪ٚ‬ذ دجى انًغرشفٗ انؼاو تانًذٌ ػهٗ اعاط انًؼذل انًؼًٕل ف‪ٔ ّٛ‬ن‪ٛ‬كٍ‬ ‫‪ 2‬عش‪ٚ‬ش نكم انف شخض ٔ‪ٚ‬رٕلف دجى انًغرشفٗ ػهٗ َطاق انرخذ‪ٚ‬ى ٔ‪ٚ‬شاػٗ ػُذ دغاب‬ ‫دجى انًغرشفٗ انض‪ٚ‬ادج انغكاَ‪ٛ‬ح خالل ‪ 20‬عُح انماديح ‪ٚ‬رٕلف دجى انًغرشفٗ ػهٗ‪:‬‬ ‫ ظشٔف انًٕلغ‬ ‫ ػذد انغكاٌ انًطهٕب خذيرٓى‬ ‫ َٕع انرخظظاخ انًطهٕتح تٓا‬ ‫ إَاع انخذياخ انطث‪ٛ‬ح انًطهٕتح تٓا‬ ‫يغادح انًغرشفٗ‬ ‫ ذمذس يغادح انًغرشفٗ ػهٗ أعاط يرٕعؾ ‪42‬و‪ 2‬نهغش‪ٚ‬ش انٕادذ تانؼ‪ٛ‬ادج انخاسج‪ٛ‬ح ٔذشًم‬ ‫ْزِ انًغادح َظ‪ٛ‬ة انًش‪ٚ‬غ يٍ ئجًان‪ ٙ‬ػُاطش انًغرشفٗ‪.‬‬ ‫ ٔذذذد يغادح انفشاغاخ ا َرفاػ‪ٚٔ ، ّٛ‬ؼاف ئن‪ٓٛ‬ا دٕان‪ % 40 ٙ‬نهًًشاخ ٔانًظاػذ‬ ‫ٔانغالنى ٔآتاس انظشف ٔانرٕٓ‪ٔ ّٚ‬عًك انذٕائؾ‪.‬‬ ‫ ٔ‪ٚ‬رى ذمه‪ٛ‬م انؼٕػاء تضسع انشج‪ٛ‬شاخ دائًح انخؼشِ كًا ‪ٚ‬جة أٌ ‪ٚ‬ثؼذ يثُٗ ايغرشفٗ ػٍ‬ ‫انطش‪ٚ‬ك انراتؼّ نهًغرشفٗ ‪ 40‬و ٔػٍ انطشق انؼايّ ‪ 80‬و ‪ ،‬كًا ‪ٚ‬جة اٌ ‪ٚ‬كٌٕ انًٕلغ ػهٗ‬ ‫اذظال تشثكاخ انطشق ٔ يذطاخ انًٕاطالخ انؼايّ ‪.‬‬  ‫‪ -2‬إعذاد بزناهج العول وهتطلباث الوشزوع‪.‬‬ ‫‪ -3‬البذء بإعذاد الفكزه األولٍو للتصاهٍن‪.‬‬ ‫‪ -4‬هناقشت التصاهٍن وهزاجعتها حتى تصل إلى الفكزه النهائٍو الوقبىلو‪.‬‬ ‫‪ -5‬بذء العول بإعذاد التصاهٍن واإلداره التنفٍذٌو لللوشزوع‬  ‫أنىاع الوستشفٍاث‬ ‫أنواع المستشفيات من حيث النوعيه‪:‬‬ ‫المستشفٌات العامه (غٌر المتخصصه(‬ ‫ ‬ ‫المستشفٌات الخاصه أو المتخصصه‪.‬‬ ‫ ‬ ‫المستشفٌات التعلٌمٌه أو الجامعٌه‪.‬‬ ‫ ‬ ‫مستشفٌات للمصابٌن بالحوادث (الطوارئ(‬ ‫ ‬ ‫أنواع المستشفٌات من حٌث الحجم ‪:‬‬ ‫مستشفى ٌسع ‪ 50‬سرٌر ‪.‬‬ ‫ ‬ ‫مستشفى ٌسع ‪ 50‬إلى ‪ 150‬سرٌر ‪.‬‬ ‫ ‬ ‫مستشفى ٌسع من ‪ 150‬إلى ‪ 600‬سرٌر ‪.‬‬ ‫ ‬ ‫مستشفى ٌسع من ‪ 600‬إلى ‪ 1000‬سرٌر‬ ‫ ‬  ‫أنىاع الوستشفٍاث هن حٍث التخصصاث‪:‬‬ ‫– يغرشف‪ٛ‬اخ يكًهّ ذذرٕ٘ أكصش يٍ ‪ 120‬عش‪ٚ‬ش ٔذذرٕ٘ ألم ذمذ‪ٚ‬ش ئخرظاط‪ٙ‬‬ ‫سئ‪ٛ‬غ‪.ٙ‬‬ ‫– يغرشف‪ٛ‬اخ ذخظض سئ‪ٛ‬غ‪ ٙ‬ػهٗ الم ذمذ‪ٚ‬ش أكصش يٍ ‪ 120‬عش‪ٚ‬ش ذرؼًٍ انطة‬ ‫انؼاو ٔانجشادّ انؼايّ‪.‬‬ ‫– يغرشف‪ٛ‬اخ يشكض‪ ّٚ‬ذذرٕ٘ ‪ 200‬عش‪ٚ‬ش ذرؼًٍ انطة انؼاو ٔانجشادّ انؼايّ‬ ‫ٔا خرظاطاخ ا ػاف‪ :ّٛ‬ذٕن‪ٛ‬ذ ‪ٔ ،‬انجشادّ انُغائ‪ٔ ّٛ‬انرٕن‪ٛ‬ذ ٔاألؽفال ٔا‪ٜ‬شؼّ ‪،‬‬ ‫ٔئخرظاطاخ اخشٖ يصم ذخذ‪ٚ‬ش ٔ أَف ٔأرٌ ٔدُجشِ ٔػ‪.ٌٕٛ‬‬ ‫– يغرشف‪ٛ‬اخ يشكض‪ ّٚ‬أكصش يٍ ‪ 650‬عش‪ٚ‬ش تُفظ ا خرظاطاخ انغاتمّ تإلػافّ ئنٗ‬ ‫انًغانك انثٕن‪ٔ ّٛ‬األيشاع انؼظث‪ٔ ّٛ‬انرشش‪ٚ‬خ ٔانرذان‪ٛ‬م انطث‪. ّٛ‬‬ ‫– يغرشف‪ٛ‬اخ كثشٖ ذرؼًٍ أكصش يٍ ‪ 1000‬عش‪ٚ‬ش ٔكافح انرخظظاخ ‪.‬‬ ‫أفؼم ذٕج‪ ّٛ‬نظاالخ انخذيّ ٔانًؼانجّ ْٕ انشًال انششل‪ٔ ٙ‬انشًال انغشت‪ ، ٙ‬أيا‬ ‫–‬ ‫ذٕج‪ ّٛ‬غشف انًشػٗ ف‪ٛ‬كٌٕ جُٕت‪ٛ‬ا أٔ جُٕت‪ٛ‬ا غشت‪ٛ‬ا د‪ٛ‬س انشًظ ذكٌٕ نط‪ٛ‬فّ ف‪ٙ‬‬ ‫انظثاح ٔذجًغ انذشاسِ ػؼ‪ٛ‬ف ‪ٚ.‬ذاؽ يٕلغ انًغرشفٗ ػادج تغٕس ‪ٚ‬فظم ت‪ٍٛ‬‬ ‫انًُطمّ انراتؼّ نهًغرشفٗ ٔت‪ ٍٛ‬انًُاؽك انغكُ‪ ّٛ‬ياػذا انًذخم ‪ٚٔ ،‬فؼم اٌ ذض‪ٚ‬ذ‬ ‫ْزِ انًغافّ ػٍ ػؼف اسذفاع انًثُٗ انًجأس‬  ‫الشروط الرئيسيه الواجب توافرها في أرض المشروع ‪:‬‬ ‫ أن تكون نظٌفه بعٌده عن مناطك الضباب والرٌاح والغبار والدخان والروائح‬ ‫الكرٌهه والحشرات‪.‬كما ٌؤخذ مساحة ‪ 10‬م‪ 2‬حدائك لكل سرٌر‬ Lecture 7 : Planning of departments In patient department: Patient room: These may be private/semi private rooms or multibed general wards. They should be designed to be safe and aesthetically pleasing so as to assist in quick recovery of patient. They must contain space for equipments, staffs and various need of the patient. Nurses control station: should be located and designed in such a way that the nurses can observe the patient room. The work area: related to handling materials necessary for patient care, maintaining communication and records etc. They have to be High quality patient care Comfort to the patient Efficient operation of the unit Meeting the needs of the visitors  Facilities and space required Examination and treatment room with wash basin etc. Cupboard for clean linen. Basket for soiled linen with sink, waste receptacles. Equipment storage room for walkers , IV stands etc Space for storing stretchers and wheel chairs Lockers for staff personal belongings Staff toilet 8- Small laboratory Out patient department Preferably on the ground level with a separate entrance and adequate parking facilities. It should be close to admitting area , MRD , emergency , radiology, services and pharmacy. Attention should be paid to circulation, which results in the smooth flow of various traffic lines traversing the department. Properly signed  Emergency department Should be located on the ground floor with easy access for patients and ambulances Separate entrance for the department Well marked with proper lighting and signs. Should be easily visible and accessible from the street. Should be close to the admitting department, medical records and cashier’s booth, radiology department, lab services, blood bank, elevators and wards Intensive care unit Should preferably be located on the ground floor with convenient access from the operation theatre suit and emergency department and easy accessibility for wards. It consists patient area, staff area, support area. Four basic requirements: Direct observation of the patient by nursing and medical staff Surveillance of physiological monitoring Provision and efficient use of routine and emergency diagnostic procedures and interventions. Recording and maintenance of patient information  What is this ? Monitoring equipment Cardiovascular therapy Respiratory therapy Dialysis equipment Radiological equipment Laboratory equipment others  Obstetrical unit The obstetrical unit should ideally be located close to the labour and delivery room as also to the nursery to avoid exposing the bodies to infection. A room for patient education and group discussions is essential with cheerful decoration is desirable  Newborn unit An area of 30sq.ft/ infant with a space of at least three feet around is recommended All partition should be made of clear glass to permit observation. Furnishing in the full term nursery include a bed side cabinet , incubator ,utility table, wash basin, waste receptacles, outlets for oxygen and suction, facilities for examination etc.  Pediatric unit Equal space should be provided for beds. If patients are allowed to stay with the parents, provision must be made for toilets, sleeping and storage of personal belongings Separate provision for examination and treatment of infants. Each pediatric unit have isolation room with other necessities like washing facilities and sterile gowns and masks. Single room for critically ill and uncontrollable patients Recreation or play room Storage space for toys , linen , recreational materials Walls between patient room and the corridor should have glass panels for viewing Lighting decoration and equipment must create a cheerful atmosphere  Psychiatric unit Consultation area containing staff offices for individual and family care sessions. Conference therapy area for group therapy session. Inpatient area for hospitalizing patients Activities area for occupational recreational therapy. The number of beds should be between 20-24 in order to permit proper observation and treatment and private rooms are preferred. One room for the management of violent patients are desirable. There should be no object which can be used to hurt one self.  Radiology and laboratory services Should be easily accessible to the OPD, casualty and the inpatient wards. Preferably be sited on the ground floor. Adequate reception and registration area Convenient patient flow with minimization of cross traffic. Adequate waiting area Separate entrance for accident and emergency cases in busy hospital Provision of room for technical functioning Flexibility, expandability and upgradability need to be kept in mind while setting the department  Pharmacy Out patient should have ready access to the hospital pharmacy to collect prescription. Staff of wards and department can access it without having to travel a long distance thorough other crowded areas. Suppliers have an access to it from out side Space required for:  Counter  Cash counter  Drugs storage including dressings  Cool and cold storage  Administrative office  Circulation space  Space for compounding and bulk preparation  Hospital store It should be located centrally to the hospital Approachable by supply vehicles and should have separate service entrance Risk of fire and explosion in a medical supplies storehouse, storage of acids, inflammable materials and oxygen and other gas cylinders will require special attention  Central Sterile Supply Department (CSSD) CSSD mostly serves the operation theatre, emergency, casualty department, wards, maternity suit and should be so cited as to be central to all this  Hospital dietary service Should be located taking into consideration the prevailing wind direction so that smoke and kitchen odours are not constantly wafted to patient care area Should be sited at ground level and connected to store with lift Hospital work shop/BME department A large quantum of various types of mechanical and electrical equipment is installed in a hospital and requires repair and preventive maintenance  Laundry Used linen from wards, operation theatres and delivery suites maybe infected, and therefore needs careful handling at an area remote from all other clinical and supportive services areas Space for washing, storing, drying shades and ironing rooms have to be catered for at an appropriate area with plentiful supply of water  Medical record department MRD Should be located immediate to the admission and registration area. Enough space for keeping/storing of patient files Adequate safety Lecture 8 : Patient’s safety management Risks: Electrical Mechanical Laser Radiation Medication. Fire  Safety = absence of errors – A set of processes: identify, evaluate, and minimize hazards and continuously improve – An outcome: manifested by fewer medical errors and minimized risk or hazard  Freedom from accidental injury – from the patient's perspective, the primary safety goal is to prevent accidental injuries Safe environment = low risk of accidents –reduce defects in the process or departures from the way things should have been done –establish operational systems and processes that increase the reliability of patient care. Incidents Clinical incident: Adverse event – Injury caused by medical management rather than the underlying condition of the patient. – An incident that harmed a patient Near miss: An incident which did not reach a patient No-harm incident: An incident which reached the patient but did not cause harm Clinical incidents = Near misses (90%) + Adverse events (10%)  Error – The use of a wrong plan to achieve an aim (i.e., error of planning) – The failure of a planned action to be completed as intended (i.e., error of execution)  Medication-related error One of the most common types of error Substantial numbers of individuals are affected Accounts for a sizable increase in health care costs  Adverse events happen Think about an incident you were involved in What happened? What was the error? What happened next? What should happen after an adverse event? 1. Assessment & treatment of patient to minimise harm 2. Open disclosure 3. Identification & notification of the adverse event 4. Review of circumstances & contributing factors Open disclosure = open communication Open Disclosure refers to open communication when things go wrong in health care and include: 1. An expression of regret. 2. A factual explanation of what happened. 3. Consequences of the event. 4. Steps being taken to manage the event and prevent a recurrence.  Reporting Finally the complete report should be written and documented. Open disclosure is all about: ˚ Encouraging open & effective communication by staff with patients ˚ Acknowledging that adverse events occur ˚ Saying sorry to patients for any harm suffered during their care ˚ Being there for your colleagues if they're involved in an adverse event ˚ Changing the culture from blame to improvement ˚ Making our health system safer Medical Equipment & Electrical Safety A Medical Device is: Any device used in the treatment, therapy or diagnosis of patients  Hospital Bed Wheelchair Defibrillator Infusion pumps, defibrillators, monitors, implantable devices Beds, syringes, IV lines, wheelchairs Syringe  Electrical Safety Considerations If a device has a power cord it must be safety tested by Facilities Services or Biomedical Engineering prior to being put into service Don’t unplug equipment by pulling on the power cord; use the head of the plug Always check the condition of the plug before inserting it into the outlet Types of Current Current range (mA) Physiological effect Threshold 1-5 Tingling sensation Pain 5-8 Intense or painful sensation Threshold of involuntary muscle Let-go 8-20 contraction Paralysis >20-80 Respiratory paralysis and pain Fibrillation 80-1000 Ventricular and heart fibrillation Sustained myocardial contraction Defibrillation 1000-10,000 and possible tissue burns Lecture 9 : Reporting Electrical Hazards Immediately report any non-static electrical shocks to your supervisor Unsafe equipment should also be reported immediately to (Biomedical Services)  Medical Device Reporting (MDR) Regulation Medical Device Reporting is required – If a device may have contributed to a patient or employee’s Death Serious injury Serious illness  General Guidelines Medical Device Incident Management Attend to the medical needs of the patient Report the incident to the appropriate person Complete an occurrence report within 24 hours Remove the device from service – Contact security – Security will store the item in a secure location for further investigation  Do not change the settings on the device Label the device Do not use or discard Describe the malfunction State how you may be contacted If the device is reusable- record: – Serial numbers – Identification numbers  Save all the materials – Don’t take device apart – If you must take it apart –save everything – Save all original packing- if possible  Chemical and Hazardous Material Safety Material safety data sheet - MSDS for most Chemicals and Hazardous Materials Every department is responsible for keeping corresponding MSDS for all hazardous chemicals used in their area The Emergency Department will have a master inventory of all MSDS  Proper Labeling The chemical should remain the original container The original label must remain on all chemicals If a chemical must be transferred to a different container, that new container must be properly labeled Additional labels can be obtained by calling that vendor MSDS Hazard Rating Label Determination Must be prepared and furnished by every manufacturer of a product used today This sheet has several portions which describe the product, its hazardous components (if any), boiling point, flammability, reactivity, how to handle, how to dispose, how to store, conditions to avoid, Blue = Health Red = Flammability Yellow = Reactivity White = Specific Hazard  Code Orange This code is used in the event of a large or extremely hazardous material spill If this were to occur in your area – Move to a safe location – Contact your supervisor – Await further instructions  Biohazard Items Biohazard items include and are not limited to: – Syringes – Blood – Blood and body fluid specimens Lecture 10 : Planning and Designing a Hospital  Hospital must meet two basic fundamental needs Must meet the needs of the patient, it is going to serve adequately. It must be in a size and proportions which the owners or promoters will be able to build and operate  Basic objectives which are to be met by the hospital Sound architectural plan Economic viability Effective community orientation Quality patient care ‫خطة معمارٌة سلٌمة‬ ‫الجدو االلتصادٌة‬ ‫التوجه المجتمعً الفعال‬ ‫جودة رعاٌة المرضى‬  Principles of hospital planning Protection: from unwanted and unnecessary disturbances in order to help speedy recovery Separation: of dissimilar activities Control: the nurses station should be positioned strategically to enable proper monitoring of visitors entering and leaving the ward, infants and children should be protected from theft and infection etc. Circulation: all the departments of a hospital must be properly integrated.  Selection of site  Needs of the community Ease of accessibility Range of services offered Availability of specialists Availability of technology  Study of existing hospital(if any)  Requirements of staff and services  Type of hospital Primary Secondary Tertiary Private Partnership Public charitable trust Cooperative society  Planning of finances Funds required for constructing, furnishing and equipping the hospital. Operating funds: salaries, loans and interest, other maintenance expenses. Arranging financial assistance : patient fees, bed charges, and other modes of revenue generation process.  Equipment planning Built in equipment: These include counters and cabinets in laboratory, Pharmacy and other parts of the hospital, elevators, incinerators, coolers, fixed sterilizing equipment etc. These are usually included in the construction contract and the planning of these equipments is the architect's responsibility Depreciable equipment: This includes equipment that has a life of five years or more and is not purchased through construction contracts. These are large pieces of furniture which have a relatively fixed location and are capable of being moved e.g., diagnostic and therapeutic equipment, laboratory instruments, office furniture etc. Non depreciable equipment: These are small items with a low unit cost and life span of less than five years. These are generally under the control of the store room and are bought through other than construction contracts. They include kitchen utensils , surgical instruments, linen, waste baskets etc