Blood Bank forcasting model

Introduction:

i

Goa Medical College is the successor of the 'Escola Medico Cirungica de Goa'(Medical-Surgical School of Goa) established by the Portuguese in the year 1842. It is one of the oldest medical colleges in Asia teaching medicine. Its motto is ‘Truth is Eternal and Beautiful.’ Originally located in Panjim, in Panjim, the  the college was moved to Alto-Bambolim to Alto-Bambolim in 1993. The college has been under ii the Goa the Goa University University since 1986 before which it was under the Bombay the Bombay University. GMC admits 100 students for undergraduate M.B.B.S. Course, while 72 Post - Graduate are admitted every year. The Goa Medical College Hospital were initially operating from Panaji and Ribandar, shifted to Bambolim in the year1991, has presently 1000 beds, whereas 80 bedded TB and Chest Disease Hospital functions from St.Inez, Panaji. Similarly, a 20 bedded Rural Health and Training Centre is situated in Mandur. The entire complex at Goa Medical College, Bambolim is spread in an area of 11, 34,798 Sq Mts. Departments involved in Teaching, Training and providing Patient care.

General Medicine General Surgery Orthopedic Ophthalmology Ear Nose & Throat Skin & V.D. Pediatrics Obst. & Gynecology

Preventive & Social Medicine Nephrology Neurology Neurosurgery Urology Plastic Surgery Anesthesiology Radiology & Radiotherapy

iii

Anatomy Physiology Biochemistry Pharmacology Microbiology Pathology Forensic Medicine Psychiatry

Goa Medical College subordinate offices T.B. & Chest Diseases Primary Health Centre, Urban Health Centre, St. Cruz Hospital, St. Inez,Panaji Goa Mandur, Tiswadi

Infrastructure :

iv

There are total 1100 beds at the hospitals of Goa Medical College. The Out-Patient-Department is run by the Clinical Departments from 9.00 A.M to 1.00 P.M. on all working days, while special Clinics are conducted in the afternoon by these depart ments. The Casualty runs for 24 hrs on all days proving Emergency and Trauma services. Pre Hospital emergency care is provided  by the 108 ambulance service. There are 12 Routine and 6 Emergency Operation Theaters, which conduct major to minor operation routinely and in emergency X-Ray, Ultra-sound, CT Scan and MRI facilities are available ECG, Stress - Test and Colour Doppler facilities are available. Radiotherapy facilities are available for cancer patients. Haemodialysis is provided for renal failure patients. Pediatric Surgery, Urology, Plastic surgery is being developed. Similarly, Cardiology and Cardio Thoracic Surgery is also under consideration.

General Surgery The department of General Surgery is a special branch which has the scientific knowledge and clinical expertise for the management of adults across the spectrum for a variety of communicable as well as non communicable disease. People with diabetes, hypertension, heart disease, malaria, and stroke would be managed by the department of internal medicine.

General Surgery Wards Male General Surgery Male General Surgery Female General surgery

Ward 110 Ward 111 Ward 109

Patients Flow Patient from OPD Block Patient from Causality

Registration OPD

Registration OPD @ Causality

General Surgery OPD (OPD is only

Same day admission to

o en on Wednesda /Saturda

IPD @ atient’s Condition.

Consultant Doctors/Residents involve in decision making process for admitting the patient to the Gen. Surgery y IPD ward depending upon the patient’s condition.

Patient Admission form is filled at OPD

Admission form is handed over to

Patient is shifted to Gen. Surgery OT

IPD staff and the atient is admitted.

as per his/her condition

Discharge of patient is purely based on the consulting doctor. Discharge form and all the reports are handed over to patient before discharging

Ward layout of IPD

Size of Staff in IPD

30 Beds (divided into 2 Units)

2 Consultant Doctors

2 Sr. Resident Doctors Unit – I

Unit – II

15 Beds

15 Beds

3 Jr. Resident Doctors

10 Nurses

2 Nurses per shift. There are 3 shifts of 6, 6 & 12 hours.

Department/Units within Gen. Surgery Ward

1. 2. 3. 4. 5. 6.

Bed accommodation area  Nursing Station/area Doctor’s room Medicine & supplies room Washroom Housekeeping closet

Staffing compared with MCI Guidelines

S.no

Number of

MCI Guidelines

No. In GMC

1

Beds in the ward

180

90*

2

Professor/Consultants

12

12

3

Sr. Residents

6

6

4

Jr. Residents

18

18

5

Staff Nurses

1 : 3 (1 nurse per 3  patients)

1 : 7.5 (1 nurse per 7.5 patients)

*as per our sightings. There were 150 beds mentioned in the GMC website. The only drawback is the inadequate staff nurses. More nurses are required mainly in the evening and night shifts. The wards are moped twice a day. The washrooms are just adjacent to the few

corner beds and its best to increase the gap between those. In case the number of patents referred to IPD increase, few extra beds will be added accordingly, this may cause spacing and traffic movement problems within the ward. The double door system is in place, but the doors were always open. There was no security/guard on the watch and anyone can enter/leave the ward.

Layout of General Surgery Ward

Medicine/su

Nurses Desk

pplies room

ENTRAN CE

Doctor’s room

Wash Room

HKC*

Nephrology The Nephrology ward provides care for men and women requiring treatment for a range of common conditions affecting the urinary tract. These can involve the following     

kidneys ureter  bladder  prostate urethra

The nephrology department is located in the seco nd floor of the main OPD block. Patients with problems relating to kidney function are referred to the department. After an initial review by the consultants they were required to undergo mandatory diagnostic tests such as  blood tests, urine tests, ultrasonography, kidney biopsy etc. Based on the test results obtained they were given the respective treatment. The Nephrology ward is similar to that of General Surgery in the process of patient admission from OPD wards. Few differences can be not ed as follows.

Ward layout of Nephrology

Size of Staff in Nephrology

28 Beds (divided into 2 Units)

1 Consultant Doctors

1 Sr. Resident Doctors Unit – I

Unit – II

14 Beds

14 Beds

2 Jr. Resident Doctors

8 Nurses

2 Nurses per shift. There are 3 shifts of 6, 6 & 12 hours.

Department/Units within Nephrology Ward

1. 2. 3. 4. 5. 6.

Bed accommodation area  Nursing Station/area Doctor’s room Medicine & supplies room Washroom Housekeeping closet

Most of the wards have the same layout. There is a double doo r system at the entrance to reduce the level of contamination.

Wash

ENTR ANCE

Room Medicine/supplies room

Doctor’s room

Nurses Desk

HKC*

Comparison of Layout of Nephrology Ward

Wards: General Surgery vs. Nephrology S.No 1 2 3 4 5 6 7 8 9 10

Comparison Factor No. of beds in each ward Beds occupancy rate Consultants Consultant to beds ratio Sr. Residents Jr. Residents Staff Nurses to beds ratio Dress Room Patient/attendant traffic Cleanliness/Hygiene

11 12

Double door entrance Location

General Surgery

30 100 % 4 1 : 7.5 2 6 1 : 15 Yes More Cluttered, cotton/bandage pieces on floor Doors are almost kept open st 1 Floor of OPD block

Nephrology

28 100 % 1 1 : 28 1 2 1 : 14 No Normal Normal Remain closed nd 2  Floor of OPD Block

Laundry The laundry section is located in the basement of the OPD building. The employees in the laundry section receive the clothes for laundry at the laundry receiving area. Sorting of clothes is done here. Each item received is noted down manually along with the ward number. Management of these clothes is centralized. But the clothes from the OT/ Gynecology department and the clothes with bloodstains are handled / washed separately to avoid infection. Coloured and white clothes are arranged separately as bleach is used for white clothes only. The washing procedure has 4 step:

I. Main washer  (Quantity: 4, Capacity: 100Kg/cycle)-The clothes are fed here and are washed with hot water and Clax. Clax is a liquid laundry detergent specially formulated for use in specialized laundry applications. The time taken for this activity is 45 minutes15 minutes each cycle. Presently only 3 are functional. II. Hydro extractor  (Quantity: 4, Capacity: 35 Kg)-This activity takes 10-20 minutes. Hydro-extractors squeeze out the excess water. Clothes include pants, shirts, bed sheets and towels. III. Drying tumbler   (Quantity: 3)-This activity takes around 40 minutes. Pants, shirts and towels are dried here. The bed sheets are not dried in the drying tumbler. IV. Steam press : The pants and shirts are ironed using the steam press. V. Flatwork ironer: The bed sheets are ironed using this machine. This process takes hardly 2-3 minutes. After the clothes are ironed, they are brought to the sorting room where they are arranged and put in the particular shelf according to ward number. The laundry in charge (Mr. Pandurangan) checks the conditions of the clothes. If they are worn out, they are discarded. And if they are torn a bit, they are given to the tailor for mending. After that the ward staff collects the laundry as and when required.

Around 3000 clothes are washed daily. Annual Maintenance Contract (AMC) is given out to a Mumbai based maintenance company which is responsible for servicing of the machines as and when required. The laundry consists of 22 people currently. Goa Medical College facilitates laundry for other hospitals like Asilo, Institute of Psychiatry & Human Behaviour, District Hospital, etc. Staffing compared with MCI Guidelines S.no 1 2 3 Issues:

1. 2. 3. 4.

Laundry Staff Supervisors/In-charge Dhobi/Washer men/Women Packer/Sorter

MCI Guidelines 2 12 12

GMC 1 10 11

The machines, especially hydro-extractors are breaking down due to overload. Improper water and steam supply which effects the regular washing cycle. Inadequate staffing Pending work due to inadequate staffing and improper functioning if machines

Improvements :

1. More people should be employed in the laundry section to segregate work load. 2. Extra linen should be purchased for emergency situations. 3. Old machines need to replace with new advanced machines to improve efficiency.

Central Sterile Services Department (CSSD): It’s also called as ‘Sterile Processing Department’ and is an integrated department in hospital which takes care of sterilization of hospital equipment, devices, dressings and linen of hospital. In hospital the sterilization is mainly done by autoclave process and Steam sterilization. But other sterilization methods are also followed like Ethylene Oxide sterilization and heat sterilization which include dry and moist sterilization. Staffing compared with MCI Guidelines S.no

1 2 3 4 5 6

Laundry Staff

Matron Staff Nurse Technical Assistant Technician Ward Boys Sweeper

MCI Guidelines

1 4 8 8 8 4

CSSD has the following area marked out for its functions:

1) Unsterile load and separating area 2) Linen folding and packing area 3) Autoclave Rooms

GMC

1 4 3 2 4 2

4) Storage area for sterilized load 5) OT lift Duties :

When load is received on CSSD it’s sorted out as metal, rubber, plastic, paper, cloth and glass bottles. Vessels and liquids are autoclaved separately with extra package to prevent moisture. Different temperatures are used for different material. Sets are stacked against each other leaving space for steam to pass through. Autoclave taps which changes to dark green on completion of sterilization from white. Clothing :

The personnel working in CSSD have to wear aprons and head coverings so that any minor hair or anything can’t contaminate the sterilization area. That includes Green Gown/Pant, Head sling/Cap, Masks, Rubber Protective padded gloves, slippers etc. As discussed above Autoclave is the most preferred method and considered safe which use steam under pressure in a high vacuum steam sterilization. The steam is used at 30 Kgs/cm3; Temperature at 120C to 126 C for 55 minutes. The process of autoclaving includes 4 steps:

Switch on and slow exhaust to build pressure Sterilization rises to 120 C after half an hour Fast Exhaust and temperature and pressure drops. Dry vacuum is installed sets are dried and moisture removed Precautions:

Use rubber footwear at all times Dry hands while handling switches  Notify repeated errors of the switches Close water valves as per the instructions. Use of padded gloves for handling autoclave Stay away from machine while opening the door to prevent steam Burns. After Autoclave is complete the load is separated and is sent to respective wards and separate register is maintained for receiving and returning load. Treatment with Linen:

Surgeon aprons, big towels, medium towels and slit towels used for operations sent from OT’s to laundry washing drying, which are in turn sent to CSSD for sterilization. Torn linen stretched before packing every day.

Casualty Ward The Casualty ward in Goa Medical College is a medical treatment facility specialized in care of  patients who come without prior appointment, either by their own means or by an ambulance. The department is well equipped to deal with any kind of injury of the patient as the injury is un  planned and they cannot decided the course of treatment of the patient beforehand.

Registration Types Plain White Paper (Rs.20)

Free Paper (for BPL)

Pink Paper (MLC)

The department is open 24hours in a day and the staff works in 2 shifts, 12 hours per shift. The department is situated on the ground floor with a dedicated entrance and the staff, which includes nurses and doctors who are available round the clock for patient care. The cases are prioritized on the basis of their clinical needs and this procedure is called a Triage. In GMC the patients who come to the emergency ward are taken to a room dedicated for the procedure of triage, there the patients are examined by a doctor who then further gives directions to which department the  patient should be taken. T he priority is decided on the basis of severity, first priority is given to Myocardial Infarction patients or severe accident cases with neurological damage and then other  patients are provided with a treatment. As soon as the patient arrives in the Casualty ward he/she is taken directly for an examination and after the patient is provided with the immediate aid then the registration process follows. The registration is divided into three categories, first is a plain registration paper which has the basic information about the patient like name, age, religion, contact number of a relative etc. The plain  paper is for 20 rupees. The second category for registration is a free paper which is provided to  people who cannot afford to pay 20 rupees for the registration process. The third category is a MLC paper, it covers the medico legal cases like assault, rape cases, domestic violence cases, hit and run cases etc which has any kind of legal proceedings involved in it. In case of a medicolegal case a MLC paper is made which is free of cost and is maintained by the hospital. Medico Legal services are registered at the registration counter next to casualty There are around 180 patients admitted in the casualty ward every day on an average. On an average there are 15- 18 cases of accidents registered every day. Observations :

The ward is a little under staffed, especially at the recept ion counter, where only one attendant is  present for night duty. Units in Casualty

1. Reception 2. Public Relation office 3. Medico-legal office

4. 5. 6. 7.

Waiting area Washrooms Triage room Diagnostic Services –  CT Scan, X-ray

Ambulance

An ambulance  is a vehicle used for moving of sick or injured people to, from or between places v of treatment for an illness or injury,   and in some instances will also provide out of hospital medical care to the patient. Basic Life Support (BSL) Equipments O2 cylinder  wheelchair  scoop spine board stretcher 

Other Equipments

heck saw blade hammer  gloves masks

Sphygmomanometer  Suction machine needles and syringes

Equipments inside an Ambulance

fire extinguisher  Ambu bag Emergency Drugs Atropine Avil Magnesium Sulphate Disprin Deriphylline Frusemide Etophylline

i

"Goa Medical College, Panaji at Medical Council of India Website". View details of college –  Goa Medical College, Panaji . Retrieved 25 June 2011. ii  Faridah Abdul Rashid (July 2012). Research on the Early Malay Doctors 1900 – 1957 Malaya and Singapore. Xlibris Corporation. pp. 27 –. ISBN 978-1-4691-7243-9 . Retrieved 6 April 2013. iii http://www.gmc.goa.gov.in/index.php/en/departments. iv http://www.gmc.goa.gov.in/index.php/en/about-us v Skinner, Henry Alan. 1949, "The Origin of Medical Terms". Baltimore: Williams & Wilkins