PRINCIPLE OF MANAGEMENT
PRINCIPLE OF
MANAGEMENT
MAIN PRINCIPLES OF MANAGEMENT
Division of work – helps to develop familiarity in the work
Authority – must be given power/right to command others
Discipline – maintaining discipline by formal or informal agreement
Unity of command – the principle of one superior
Unity of direction – one plan of action for a group of activities in the
organization with same objectives
The organizational goals should supersede the individual’s objectives
Remuneration – wages must be fair to the type of work done
Centralization – decision should be made centrally
Scalar chain – line of authority or organization chart
Order – the right person should be in the right place of work
Equity – all employees should be treated fairly and equally
Stability of tenure of the personal – long term employment
Initiative – allow all level of employees to show initiative and creativeness
Give spirit to encourage team work
VISION AND
MISSION PPUM
VISION
To be an excellent institutional that give born to a leadership in emergency
services activity to the patient , teaching and practices to student and the
public
Environment research related to emergency method and having
administration systems that is skill full , systems and efficient
Mission
Having mission towards existence authority of PTJ . Having high integrity in
giving excellent emergency services to patient , giving best teaching and
practices , to move research effort and to build capability administration
systems
Methods in achieving emergency patient , safe treatment services with the
help of right evaluation that can continue high quality of treatment
Towards achieving the best academic education level to medical students ,
student nurses , public and to government and private agency
Towards achieving the best research standard in trauma and emergency
Towards achieving satisfying services to patient and next kin with the effort
shortening of time that is warm and nice
ORGANIZATION
CHART OF UMMC
ORGANIZATION
CHART OF
NURSING
ADMINISTRATION
TEAM LEADER
RESPONSIBILITY AS A TEAM LEADER
1) Before ward round
♪ perform other specified duties whenever assigned
♪ taking report from the team leader of the early shift
♪ chart down any plan or activity for patient on that day
♪ make sure all equipment and form is ready
♪ patient investigation result are update
♪ prepare laptop for ward round
♪ inform doctor about patient complain
♪ give privacy to the patient during ward round
♪ record doctor’s order
♪ do treatment in a form (BK-MIS-384-EDI)
2) Do checklist on CSSU
♪ record the used item in CSSU record book
♪ total all of the unused and used item
3) Inventory item in ward
♪ find the total of items regards by inventory book
♪ make sure the items in good condition
♪ make sure the items in correct place
♪ top up the drug that had been used
♪ record in inventory book
♪ record all the new items in inventory book
♪ sign on every sheet
4) Check DDA drugs
♪ recheck and recount again DDA drug and DDA book to detect where DDA
drug miss counting occur
5) Round with sister
♪ make rapport / greet sister
♪ inform total of staff that on duty and total patient in ward
♪ give explanation about patient condition
♪ thanks to sister
6) Medication in ward stock
♪ identify what day of pharmacy will comes to the ward
♪ check all medication ( oral & intravenous ) quantity and condition
♪ list medication that needed
♪ contact pharmacy for checking
♪ inform pharmacy if any problem
7) Order medication
♪ check doctor’s order in patient note
♪ prepare prescription
- oral medication ( BK-MIS-073-501 )
- intravenous medication ( BK-MIS-118-EOI )
♪ make sure the prescription are fill
♪ send prescription to pharmachy
♪ make sure total medication enough
8) Nursing 24hours report
♪ fill the form
- name of leader
- total of patient
- total of admission
- total of discharge
- total of patient dead
♪ put personal information about patient
♪ do report related patient dead
♪ do report every shift
RESPONSIBILITY AS A CUBICLE NURSE
a) report taking and take note important information
b) assess patient condition in the cubicle
c) tidy up client unit and help in 14 ADL
d) ready medication trolley
- prepare medication follow by 6R
e) prepare round trolley
- ensure all forms are available
- any investigation result are ready
f) follow doctor’s round
- tell the doctor about patient complain
- discuss patient condition
- take doctor order
g) take vital sign
h) help doctor in doing procedure
i) do nursing report
WARD ROUND
BEFORE DURING AFTER
I. taking report from
staff nurse of the
early shift
II. preparation for a
ward round
●preparation trolley
form
work ship
stationary
nursing care plan
medication cardex
torchlight
spatula
ophthalmoscope
turning fork
needle
syringe
● result of all
investigation
I. follow doctor’s
round
II. listen to the
discussion
III. write in the note
● check for plan
include further
investigation and
treatment
IV. give opinion
V. do changes at care
plan
VI. read doctor order
before changes to
others patient
I. look over the list
that you made and
work out
II. update nursing
cardex
III. delegate works to
team members
accordingly
IV. do own round to
ensure
implementation
V. complete all
documentation
VI. pass patient’s
report to another
staff in the next shift
ADMISSION ,
DISCHARGE , AND
TRANSFER IN &
OUT PATIENT
RESPONSIBILITY AS A CLERK
1)Duty from 0800 hours until 1700 hours
2)Responsibility in charge before to the ward from transit
a) make sure all client folders have a name
b) ready the bed
c) record admission to the book
d) make sure all specimen must be label
e) update patient details
3)Admission procedure
a) answer calling from transit , acute medical care or rhesus for admission
process to the ward
- agree the requesting of admission if the ward has empty bed
- take important of client details and condition
b) wait client come in to the ward with the staff at admission counter
- enter client name in the ward list
- prepare bed , equipment needed and clothes for new admission
c) client come greet them , accept the admission politely and smile
d) Paste client’s stickle in admission book and TL book
e) Enter client name , registered number and specific team in white board
f) Take client folder and take the report from staff there
- make sure client folder is complete
- old note keep properly
g) prepare client name tag
h) bring client and his/her things to the empty bed
i) help the staff taking vital sign and do orientation
j) record all information rightly in the folder
4)On discharge procedure
a) staff nurse at the cubicle will complete all the procedure and the
documentation on client
b) complete all the bill and the form for discharging
c) complete appointment card if client has appointment after discharge
d) wait the doctor summary and complete history of client for discharge
e) delete client name in the computer and white board
f) call client relative to come to the counter
g) give the bill and prescription of medication
h) all the procedure done client can go home rightly
5)Management of specimen collection
a) ensure the specimen from right client
b) send correct specimen to the laboratory
c) laboratory forms have to fill completely
d) collect specimen with correct technique
e) collect the specimen with correct time
f) ensure the specimen is in the correct container
g) ensure specimen bottle has been label
h) record all the specimen in the book including name , registration number
i) pack specimen with form
j) send specimen to the right units
k) see a result of specimen
l) update client information
6)Transfer in and out procedure
TRANSFER IN TRANSFER OUT
1) there is empty bed in the ward
2) call any ward that we had lodged
before to take back that client
3) edit client name in the patient list
in the computer
4) prepare bed , needed equipment
and clothes
5) waiting for the staff there to send
the client
6) they came to the ward , taking
new and current plan and that
client and bring him to the bed
7) continue nursing observation and
management of client as usual
1) answer call from another ward
that had lodged their patient to this
ward , if there want back their
patient so we have to send that
client as soon as possiblebecause
they had empty bed just now
2) delete client name in the computer
and white board
3) complete current procedure and
documentation
4) tidy up client his properties
5) send client kindly
6) give client folder to the TL at the
counter
7) passed new and current plan to
their staff properly
7)On lodger procedure
a) call the ward that has empty bed to lodger the stable client for a fews day
because the current ward has to take new admission and at the same time ,
ward do not has empty bed
b) if get the ward
- edit client name in computer
- enter client name in list name of lodger patient at white board
c) complete client procedure and documentation
d) tidy up client and client’s property
e) bring client , properties , folder and old note accompanied by attendant to the
ward
f) pass report completely about the client including the medication and current
plan
g) leave client kindly
DEATH
MANAGEMENT
(NORMAL ,
MEDICAL LEGAL
CASES)
8)On death procedure
NORMAL MEDICAL LEGAL INFECTION
1) ensure the death
with written at
patient note
2) ensure result of
strip ECG show
asystole
3) inform family
members
4) prepare dead body
level , give it to the
staff who is the
last office
procedure
5) do the mortuary
procedure
6) prepare dead body
registry form
7) wait until body is
taken
8) explain to family
member about the
form and
discharge bill
9) write nursing
report
1) report to police
about the death
2) inform the family
about medical legal
police case
3) inform ward
manager
4) prepare the death
registry form ,
medico legal form
and consent for
autopsy
5) tell the family to wait
at PTJ forensic until
police investigation
done
6) ensure the note is
wrote by police
officer in the report
of medical legal
case
1) contact inspector of
Jabatan Kesihatan
Daerah
2) ensure the medical
officer complete the
forms
3) do mortuary
procedure except
for HIV/AIDS
4) for HIV/AIDS
- handle the
body with
prevention
- put into zip bag
if have any
feces or blood
- -put infection
tape
- Ensure causes
of death did not
write diagnose
“HIV” or “AIDS”
MEDICATION IN
DDA CUPBOARD
HANDLING OF DDA ( AKTA DADAH MERBAHAYA )
a) Explain principles and your responsibilities in handling DDA drugs
● DDA cupboard’s key should be keep by TL or sister
● keep DDA book inside DDA cupboard
● straightly record every time taking out the DDA drug by double sign of staff
nurse inside DDA book
● check of DDA drug every shift to tally the total of take out and stock of
medication
● TL should be passed over report to another shift TL in the same shift
b) State :
i. Dangerous Drug Act 1952
An act make further and provision for the regulating of importation ,
exportation , manufacture , sell and use of opium or certain other
dangerous drug load substances .
ii. Poison Act 1952
An act to regulate the importation , possession manufacture ,
compounding , storage , transport , sale and use of poison
c) State the drugs that available in DDA cupboard
●therapeutic effect
●side effect
GENERIC TRADE NAME ACTION SIDE EFFECT
NAME
1)IV Morphine
10mg/ml
1)Morphine Hp
2)Morphine Elson
3)Morphine Lp
Epidural
-for moderate to
severe pain ,
Lt.ventricular
failure , or
terminal care
and palliative
care post op
1)hypotension
2)nausea
3)vomiting
4)constipation
5)sweating
6)apnea
2)IV Pethidine
50mg/ml
1)Demeral
hydrochloride
-for moderate to
pre op
medication and
adjunct to
anesthetic
1)constipation
2)dry mouth
3)anorexia
4)fatigue
5)sweating
3)IV Diazepam
15mg/ml
1)Valium
2)Diazemuls
-management for
anxiety ,
theraphy in
convulsive
disorder,
sedation, induce
relax
1)fatigue
2)drowsiness
3)nausea
4)vertigo
4)IV Tramal
100mg/2ml
1)Ultram -management of
moderate to
severe pain in
adult whop
require around
the clock pain
1)sweating
2)nausea
3)anorexia
4)headache
5)IV Midazolam
5mg/ml
1)Hypnovel -general
anesthetic before
administration of
others anesthetic
1)apnea
2)headache
3)drowsiness
4)depressions
6)IV Nalaxon
0.4mg
1)Narcan -antidote for
Morphines
-combine
Competitively
with opiate
receptors and
block or reverse
the action
narcotic
analgesics
1)hypotension/
hypertension
2)nausea & vomit
3)tremors
sweating due to
reversal of
narcotic
depression
7)Tab
Lorazepam
1mg
1)Ativan -reduces anxiety ,
relief muscle
spasm and
effective
sedation
1)confuse
2)drowsiness
3)ataxia
RESPONSIBILITIES IN ADMINISTERING DDA DRUGS
1) Bring along the cardex during administering DDA drugs
2) Apply 7R
3) Monitor client progress by looking to the any present of side effect of
medication
4) Notify doctor immediately if anything happen
RESPONSIBILITIES IN DDA STOCK
1) Recheck and recount again DDA drug and DDA book to detect where the
DDA drug miss counting occur e.g.
● wrong total of DDA drug
● discard the drug but not enter inside book
2) If still not found or tally :
● inform sister ward in charge
● make police report
3) Expired or almost expired drug
Expired
● call pharmacy and informed
● double check the expired date with 2 staff nurse
Almost expired
● put the drug infront of the other drug
● ask other team to use the in front first
4) Broken ampule
● discard the ampule inside sharp bin
● enter the broken ampule inside DDA by use the word “ discard “
5) Balance drugs in ampule
● should be discard
● if the same patient still can be use
6) Drugs almost or out of stock
● call pharmacy
● do ordering in DDA
PROCESS OF ORDERING DDA DRUGS
1) Check for total number of DDA and record in DDA book
2) Write in DDA ordering book 2 copies
3) Counter check with sister
4) Call pharmacy
5) Wait until pharmacy call back
6) Go to pharmacy together with DDA book and ordering book 2 coppies ( staff
nurse only should go to to take the medication )
DEFRIBRILLATOR
● Indication / usage
An emergency procedures that delivers direct current without
regard to the cardiac cycle
Early defibrillation to improves survival in clients experiencing VF
For dysrhythmia such as VT , VF or asystole
To treat ventricular fibrillation immediately
● Method of usage
Turn on the defibrillator . Set in defibrillator mode
Turn ECG recording on for a continuous printout of events during
the procedure
Set the energy level and change the paddles . initial defibrillation
is usually performed at 200 joules
Place conductive pads on the chest , or spread conductive paste
evenly on the paddles
Position the paddles holding them firmly on the chest wall
Ensure that no one is touching the client or the bed
Depress the button on each paddle simultaneously to discharge
the energy
Immediately resume CPR
Evaluate cardiac rhythm and for a pulse after approximately 2
minutes
● Method of defibrillation testing
Open defibrillator machine’s cover
Assess the defibrillator machine overall
Check all the connection wire on defibrillator machine
Open the paper placement site
Turn the knob to ON
Wait wave come out from the monitor
Turn the knob to the 100joules for testing
Press button charge
Quickly press the button at the paddles
Turn off the knob
Cover the machines back
Paste the result in yhe defibrillator testing book
Write your comment in the book , below the result slip and do not forget to put
on your signature
RESUSCITATION
TROLLY
EQUIPMENT OF TROLLEY RHESUS
●FIRST DRAWER
1) Laryngoscope
Function – to facilitate the ETT with
introducer and magill forcep , prevent
tongue backward
Care – check with laryngoscope blade
and handle , make sure light is
functioning
2) Airway
Function – to open airway , remove
secretion
Care – put in the mouth with slotted
down and turn 180◦
3) Silicon Face Mask
Function – prevent the O2 disappear
to atmosphere , facilitate O2 into the
airway or mouth
Care – ensure the mask clean and not
leaking
4)Introducer
Function – to shape the ETT
Care – clean with water
5)Yunkersucker
Function – suck secretion in the
mouth
Care – clean with water
6)Magill forceps
Function – to hold ETT , to facilitate
intubation
Care – open and close , insert it
through laryngoscope
7)Cuff inflate
Function – to inflate ETT ballon 8)K.Y jelly
Function – use as lubricator
Care – ensure rhesus trolley has K.Y
Jelly
9)Cotton Tape
Function – to hold ETT
Care – place at clean area
10)IV Canula
Function – for intravenous infusion
Care – place at clean area and make
sure have many type of size canula
11)Needle
Function – to take blood ,give injection
Care – always top up in all size
12) 3 Way Connection
Function – to connect tubing in one
line
Care – connect the connector at
canula
13) IV tubing
Function – for IV transfusion
Care – connect to the canula
14) Syringe
Function – for blood taking , injection
or transfusion
Care – prepare several size
13) Specimen Bottle
Function – for bood investigation
Care – ensure the expired date
14) Vecutainer / Butterfly
Function – taking blood
Care – ensure expired date
15) Resuscitation box
Function – give medication during
rhesus
Care – check box every shift
16) Anesthetic box
Function – for anesthesia
Care – check box every shift
19)ECG Electrode
Function – ECG monitoring
Care – count the electrode
20) Glove
Function – maintain sterility
Care – change if it is expired
21) Plaster
Function – plaster that needed
Care – ensure box of the plaster in the
trolley
22) Oxygen Jar
Function – to supply oxygen
Care – ensure the expired date
23) High Flow Mask
Function – to facilitate o2 to the lung
Care – ensure expired date
24) Nasogastric Tube
Function – to supply nutrition by
using a tube from naso or oral to the
stomach
Care – ensure expired date