Philosophy of Nursing Service department in hospital

o The Department of Nursing Service of Hospital recognizes and

appreciates the objectives of the hospital and acknowledges that the
primary purpose of nursing id to provide the highest quality of
nursing care services that is possible in assisting the patient with
meeting his daily living needs wherever he is located along the
illness-health continuum.
o The Department of Nursing believes that the hospital is basically
an organization of human beings, representative of many
professions and occupations, which perform specialized work in
which all their skills and achievements are focused on the primary
goal of patient care.
o The Department of Nursing believes that quality in nursing care
and management of nursing services is achieved through
professional nurses who assist in the development of
comprehensive programmes of delivering patient care.
o Nursing Department of the hospital is to administer high-quality,
cost-effective care to patients and families, provide health
promotion programmes to all people, maintain a supportive
environment for education of professional nurses and promote
career development of nursing employees.

Objectives of Nursing Service in Hospital includes:

o Management of nursing care and services.
o Education, training and staff development programmes.
o Nursing research and community health programmes as follows:
Management of nursing Care and Services
 Initiate a set of human relationships at all levels of nursing personnel to
accomplish their job and responsibilities through systematic management
process by establishing flexible organizational design.
 Establish adequate staffing pattern for rendering efficient nursing service
to clients and its management.
 Develop and implement proper communication system for
communicating policies, procedures and updating advance knowledge.
 Develop and initiate proper job description for nursing personnel at all
levels and all units for proper delivery of nursing care.
 Assist hospital authorities for effective personnel management.
 Share nursing information system with other discipline functioanaries in
the hospital.

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  Formulate and interpret nursing service policies in the context of general
policies of the hospital for improvement of nursing care.
 Assist the hospital authorities for preparation of budget by involvement.
 Participate in interdepartmental programmes and other programmes
conducted by other disciplinaries for improvement of hospital services.

Education,Training and Staff Developments

 Encourage a stimulating environment in which the personnel have
opportunities to be creating innovators in the improvement of nursing
service.
 Develop and initiate orientation and training programmes for new
employees in co-operation with authorities and other health discipline.
 Create an atmosphere that conductive to give proper required learning
experiences for the students.
 Assist in the development of a sound, constructive programme of
leadership in nursing to assure intellectual administration and
management to safeguard, conserve and preserve nursing resources of the
hospital.
 Initiate programmes to improve the practice of nursing in keeping with
advances in the relative areas and disciplines affecting the quality of
nursing.
Research
 Participate in identifying the areas for research.
 Participate in the application of data and research.
 Provide conducive environment for research.

PLANNING EQUIPMENTS AND SUPPLIES IN NURSING CARE UNIT:

INTRODUCTION :

Materials are essential resources to achieve the objectives of a health care

organization. It is appear that hospital spend from 15 to 20 percent of their
annual budget on the supplies and equipments , exclusive of linen and food ,
which are used in the ward of the hospital . The proper management of
materials inventories is extremely important in the proper functioning of a
hospital. The hospital administrator will have to play a vital role in making sure
that adequate material in right quantity and quality are made available to various
units of the hospital
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 Supplies are expendable items or those articles which are used up and must
be reordered periodically such as soap, paper towels, stationery ,food, sterile
goods . These are the material required in the hospital for diagnosing and
treating of aliments or activities. Some of the materials used in the hospital
are :bandages ,gauze, dressing materials, syringe ,needles, forceps ,plaster, linen
,utensils which are directly to the treatment of various types, various chemicals
and reagents or ready kits for pathological biochemical or microbiological
investigation ; x – ray plates, radio diagnostic materials and drugs used in
radiology department .

Equipments includes more permanent articles and may be classified as

fixed or movable.

Fixed equipments is not a part of the structure of the building but is attached
to its walls or floor such as strelizers and sinks.

Movable equipment includes furniture , instruments, syringes, dishes. The

other equipments includes the following :

 Refrigator
 Air conditioners
 Tables, screen, labour room tables
 IV stands, bed side lockers
 Other diagnostic equipments like
 Auto analyzers
 Cell counter
 Eliza readers
 Aterial blood gas analyser
 Pulse oximeter
 Defibrillator

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  Cardiac monitors
 Specialized endoscopes
 Boyle ‘s apparatus
 Oxygen and nitrous gas cylinder
 Cooking LP gas cylinders
 Incinerators for biowaste management

For eg. ESSENTIAL EQUIPMENTS FOR A 50 BEDDED DISTRICT

HOSPITAL (WHO)

1) Scope of services

 Essential clinical services- medicine, surgery, paediatrics., OBG,  and

acute psychiatry (when necessary)
 Optional clinical services – oral surgery, orthopaedic surgery,
otolaryngology, neurology and psychiatry.
 Essential clinical support- anaesthesia, radiology and clinical laboratory
 Optional clinical support services- pathology and rehabilitation including
physiotherapy.

2) Essential medical equipment

 Diagnostic imaging equipment –it include x-ray and ultrasound

equipment. X-ray equipment can be stationary in one room or mobile
 laboratory equipment –
o microscope
o blood counter
o analytical balance
o calorimeter( spectrophotometer)

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 o Centrifuge – a small centrifuge that can accommodate six 15ml
tubes should be available.
o Water bath – used for stabilising temperature at 25, 37, 42, or
56degree Celsius.
o Incubator/oven- a small hot air oven to carry out standard
cultivations and sensitisations.
 Refrigerator – an ordinary household refrigerator with a freezer unit, for
storing preparations, vaccines, blood etc.
 istillation and purification apparatus - it should be made of metal that
resists acid, and alkali and should be free standing.

3) Electrical medical equipment.

 Portable electrocardiograph
 Defibrillator( external)
 Portable anaesthetic unit – 2 small aesthetic units should be obtained,
complete with a range of masks.
 Respirator – it should be applicable for prolonged administration during
post operative care.
 Dental chair unit- a complete unit should be available to carry out
standard dental operations.
 Suction pump –one portable and one other suction pump are required.
 Operating theatre lamp- one main lamp with at least 8 shadows lamp and
an auxiliary of 4 lamp units.
 Delivery table- it should be standard and manually operated.
 Diathermy unit – a standard coagulating unit which is operated by hand
or foot switch, with variable poor control.

4) Other equipment

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  autoclave – for general stabilisation
 Small sterilisers- for specific services- eg. Stabiliser
 cold chain and other preventive medical equipment
 ambulance

5) Small , inexpensive equipment and instruments

 Equipment and instrument, such as BP apparatus, oxygen manifolds,

stethoscope, diagnostic sets and spotlights.

IMPORTANCE TO GOOD WARD MANAGEMENT :

Supplies and equipment are highly important contributing factors to a smooth

running ward which in turn reflects directly on the quality of patient care.

 MATERIALS MAY BE INADEQUATE IN AMOUNT:

An undersupply of materials on the ward results in the use of substitutes

which may be more costly than the proper item. If a sheet is substituted for a
pillow case or a gauze square for a cotton pledget the supply of the substitute
may be depleted and thus further shortages will occur. Unattractive, careless
work frequently results from the lack of materials. When rubber protectors are
not available , mattress ,pillow sheet may be soiled. If trays for giving
treatments are hard to find nurses may lose the habit of using them. If the supply
of material is inadequate , the care of the patient may be jeopardized. The
patient ‘s comfort and welfare are greatly influenced by the adequacy of
supplies and equipments.

 EQUIPMENT MAY BE OUT OF REPAIR :

Equipment which is not in good repair or ready for use is often more
troublesome than if it were missing altogether. The nurse or doctor and the
patient may be ready for a treatment and the light will not work , the stove fails
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to heat, scissors refuse to cut. The situation is not only embarrassing but is
wasteful of time and wearing on the nerves of all concerned. Unclean or
unsterile equipment causes delay especially if discovered after all else is in
readiness for a treatment .

 SUPPILES AND EQUIPMENT MAY BE INACCESSIBILE :

It is probably necessary to lock up excess supplies to prevent the loss and

waste which may occur if the supply is abundant but there should always be
enough available for use and the key to the locked cupboard or drawer
should be accessible at all times to the nurse who is in charge.

 MATERIALS ARE SOMETIMES INCONVENIENTLY LOCATED :

The preparation for a single treatment may take the nurse to several
rooms for equipments. This is unnecessary use of time and energy .For
convenience in working, all necessary equipments and supplies for a
particular treatment should be kept in one unit even though it may mean the
duplication of materials in more than one place. For eg. , a hot water bag,
cover, thermometer and a pitcher for filling the bag should be in one room
near the source of water supply. If trays for sterile treatments are prepared in
one room and unsterile treatment in another there needs to be a supply of
rubber protectors, draping, and cleansing materials in both rooms.

PURCHASE OF SUPPLIES AND EQUIPMENT

The purchase of supplies and equipments in a hospital is carried out through;

1. General store
2. Dietary department and
3. Pharmacy department

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When planning for the purchase of articles , budgeting is done not only for the
actual price of articles  but also for the additional costs that are involved such as
;

 Transport charges ( local delivery reduce the transport charge)

 Incidental costs
 Cost of chemicals and other consumable  to be used with the equipment
(eg; ECG paper   for an ECG machine )
 Operating cost (hiring a technician )
 Cost of maintenance service; 10-20% of hospital equipment may remain
idle if serving is not done periodically.
 Cost of technology obsolesces: when a better quality appears in market
there is tendency to discard the old model.
 Replacement cost of equipment

Selection of article- while buying articles it has to meet the standards. Indian
Standards Institution is the national agency set up to bring standardisation of
articles in India. Articles that meet the criteria specified by the Indian Standard
Institution will be marked by ISI markings. The articles bought should provide
safety to the patient and personnel. Faulty instruments and equipments cause not
only inconvenience in the patient care, but also it may cause the loss of life.

Purchasing article:

 The material used for any equipment should be durable, non-corroding,

non toxic and safe for use.
 Should have standard shapes and dimensions to fit into  various situations
 Reparability and spare part availability of the article
 Interchangability of the article

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  All surgical instruments used in  a hospital should be sterilisable  and
they should stand the tests for leakage , hydraulic pressure tests for
bursting etc
 Should have accuracy in measurements
 Should have ease of operation

The central supply service

Most hospitals have a central department where equipments and supplies are
stored and from which they are distributed to the units. The type of materials
that is kept in the central supply room varies from hospital to hospital. In some
hospital the central soppy room deals with only the sterile supplies and ward
trays. In other hospitals all types of equipment such as oxygen, suction, ward
trays, catheters, syringes etc are stored here.

RESPONSIBILITY OF NURSE ADMINISTRATORS :

The nurse administrator responsibilities in relation to supplies and equipments

may be stated as follows :

a) To keep an adequate supply of materials on hand at all times in good

condition , available for use , and conveniently located
b) To delegate to someone the responsibility for handling supplies and
equipments
c) To be observant of waste and misuse
d) To educate nurses , doctors and other personnel in the economical use of
material
AIDS IN KEEPING AN ADEQUATE SUPPLY ON HAND :

These will be discussed under four separate headings :

Standards

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 Exchange system
Inventory
Requisitions

STANDARDS :

These are established quantities which are required to meet the needs of a
particular ward division. For eg. A ward may have a standard of six 2 cc.
Syringe which is the number the head nurse should keep on hand at all times.
when is broken the pieces are exchanged for a new one if this is the system
which exists in the institution. If one is lost , it should be replaced, but total
number should not exceed six which is the standard for her ward.

FACTORS TO BE CONSIDERED TO DETERMINE THE STANDARD:

1. The bed complement for equipment, the census for supplies. Supplies
being expendable, are ordered frequently, either daily or weekly as a rule. More
will be needed if the ward is fully occupied than if it is half or three-fourths full
of patients. For supplies, in other wards, the standard is not a set figure but is
fixed only to the extent of a given number per patient. Equipment, on the other
hand ,is provided on the basis of the maximum number of patients, that is the
bed complement.
2. Type of service: A surgical ward will need more instruments and
dressings, a medical ward more syringes and physical examination equipment.
3. Age of patients: Children need different types and amounts of equipment
and supplies than adults require.
4. Sex: Men and women sometimes require different kinds of equipment.

5. Degree and types of illness : Neurologic patients may require more

bedsides, rubber mattresses, and linen than patients with another type of illness.

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 6. Cost of items: A head nurse might have as large a standard of inkwells as
she wishes whereas she probably will be limited to one costly ophthalmoscope.

EXCHANGE SYSTEM :

Many hospitals maintain an exchange system for equipment replacement in

order to prevent overstocking or the lowering of equipment standards. The
system requires that a broken or worn piece of equipment be returned to store
room before a new article will be issued. This prevent an increase beyond the
standard. It also assists the head nurse to know when replacements are
necessary and obviates the necessity for making weekly counts of all items of
equipment. The advantage of the exchange system is to study the amount and
type of breakage or deterioration with a view to determining whether it was
caused by inferior quality of material or by careless handling.

INVENTORY :

An inventory is a detailed list of all articles on the ward, their

specification and standard number of quantity. The specification make it
possible to identify the article by size, number or description. The standard
indicates the quantity that should be kept on the floor. When inventory is taken
the count is checked against the standard and correction made as necessary. Not
only does the taking of inventory give an opportunity to determine the standard
has been maintained but it provides a good chance to dispose of excess and
obsolete material to recommend changes in standards to determine the condition
of article of equipment and to order repair or replacement if necessary. It also is
an ideal time to return equipment to its proper place.

REQUISITIONS:

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 A requisition is a written order for supplies and equipment or for their repair,
Requisitions are made by the individual who is responsible for the maintenance
of supplies and equipment. This may be the head nurse or someone else
specifically delegated the responsibility. She should be wholly familiar with the
needs of the ward and the method of ordering. It is important that the same
individual do the ordering from week to week in so far as possible because she
will have a better knowledge of the ward's needs.
Ideally there would be just enough supplies on a ward to meet the day's
demands. Reordering is generally done when the amount on hand reaches a
prescribed minimum. The minimum is set so that there will be a small reserve
on hand when the new stock arrives.
FREQUENCY OF ORDERING :
Hospitals usually designate specific times for ordering certain types of
materials depending upon the following factors :
1. Perishability : foods, such as milk, eggs, fruit must be ordered
daily.Sterile supplies which may become outdated are also ordered
each day or every other day.
2. Storage space on the wards. There may not be room enough for
more than a
week's supply of some items.
3. Cost and convenience of handling and filling requisitions and of
transportation . It is not often practical to have deliveries more frequently
than once a week for most nonperishable supplies. New equipment to 'ring
up the standard is often ordered on a special day such as the first ordering
day of each month.
Requisition Forms.:
The forms used for ordering vary with the hospital. Some have one form
for all supplies and equipment with a separate one for repairs or construction.
Some have different colors designating from which department the supplies

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 come—storeroom, dietary department, surgical supply room, laboratories,
housekeeping department, linen room, pharmacy. Some hospitals use printed
forms, one for each department, listing available articles and the quantities to
be ordered . Sometimes standards for ordering, such as. five pounds soap
powder per ward per week, one cake of soap per patient per week are
included. According to this standard and the amount on hand the head nurse
indicates the quantity needed.
.
 Requisitions for Exchange Items:
Articles for exchange may be listed on the regular requisition form or a
special one. Complete specifications are necessary as with other requisitions.
Duplicate copies of the order may be required, one to accompany the articles
for exchange, the other to be sent with the set of requisitions for approval.
 Requisitions for Replacements:
To bring up the supply to standard or to increase the standard, requisitions
accompanied by a statement explaining their need may be required .
 Requisitions for Repair or Construction:
These are usually written on a special form and give an exact description of
the job to be done.
 Method of Ordering Supplies.

Before writing the order a systematic check needs to be made to determine

the amounts which are on hand. The check may be made by an aide or the ward
clerk. The head nurse then considers her expected needs, compares them with
the amounts on hand and the list of standards for ordering, determines the
amount needed, and writes the requisition. She allows a small margin for
emergencies. As she gains in experience she will be able to judge needs fairly
accurately. If she. inadvertently orders incorrect items or an oversupply, they
usually cannot be returned if the hospital keeps a perpetual inventory. Materials

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in this way may be wasted. This is one of the important reasons why ordering
should be done by the same individual consistently and certainly never by one
who has not received complete instructions and supervision

Ordering Linen.
Methods of ordering linen often vary from those of other supplies.
 METHOD 1.
 Sometimes each ward is issued a standard supply of linen in which
case it is labeled with the name of the ward and the date of issue.
 The latter helps to determine the life of the article. After laundering,
the linen is sorted and returned to the proper win.
 Maintaining standards is achieved by inventory and replacements for
worn or lost linen in the same way as other equipment is replaced.
 This system requires the time of maids to sort it by wards and it also
permits linen to be stocked on the shelves when the census is light.
 A larger total supply is therefore needed than would otherwise be
necessary.
 METHOD 2.
 Some hospitals consider it less expensive and more efficient to use a
central linen room. The linen which is issued is marked with the name
of the hospital but is not designated for a specific ward.
 All linen is returned after laundering to the central linen room, Sorting
of torn articles is done either to the laundry or in the linen room,
preferably the former because tears are more easily detected as articles
are being folded.
 Mending is done in the sewing room. When a central linen room is
used distribution to the wards may be accomplished by one of several
methods.

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  One method requires a requisition from the head nurse who estimates
the ward needs on the basis of a standard; that is, one sheet per patient
per day plus enough extras for patients who need an additional supply
and enough to make up fresh beds following the discharge of patients.
 A daily shelf count must be made as a guide in ordering. This method
involves considerable time on the part of the head nurse and is apt to
lead to shortages due to hoarding on wards where needs are not
accurately estimated.

 METHOD 3.
 TO overcome these disadvantages another distribution method is
sometimes used. Linen issued to the wards daily or at periodic
intervals in accordance with a fixed standard in relation to the number
and type of patients and the number of discharges.
 The calculation of needs is made in the linen room. A shelf count is
made on each ward by a member of the linen room staff or by the
ward maid and the amounts on hand are deducted from the estimated
needs.
 This method saves considerable time for the head nurse and works in a
satisfactory manner in many institutions where it has been tried.
Sometimes linen is put up in bundles, one for each patient, containing
the usual daily allotment of a sheet, pillow case, face towel, and such.
 An extra supply of each item is sent for emergency use and for
patients who may require additional linen. Complete sets of linen each
containing the items necessary to make up a unit are also sent, the
number corresponding with the number of patients to be discharged.
To minimize handling and save time for the ward staff the daily

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 bundles may be delivered directly to patient's rooms the afternoon or
evening before they are to fee used

DELEGATION OF RESPONSIBILITY FOR THE HANDLING OF

SUPPLIES AND EQUIPMENT :

 In a busy ward, the head nurse cannot carry responsibility for all
details of ward management.
 Indeed if she tries to do so she will not be a very successful
administrator. Some aspects of management in regard to supplies and
equipment can easily be delegated to other individuals.
 A student nurse may have a short experience in assuming
responsibility for supplies and equipment, usually in connection with
her treatment room assignment.
 In some instances a nurse's aide or the ward clerk can perform the
mechanical aspects of this function.
 A non-nurse assistant could relieve the head nurse of the entire
responsibility in this area

 KEEPING SHELVES STOCKED.

Any one of these individuals could easily keep a check on the amounts in
cupboards or on shelves ready for use making sure that there is always enough
available. The excess is kept in storage and a small amount removed at a time
to keep the shelves stocked Workers should be instructed to see that the oldest
supplies are placed where they will be used first and to remove outdated
surgical goods for resterilization. Supplies need to be kept well labeled and
arranged so that they can be easily located and quickly identified. Both
equipment and supplies must be protected against damage or deterioration.

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  KEEPING THE TREATMENT ROOM IN ORDER.
If equipment is sterilized on the ward, this responsibility as well as the
task of keeping the treatment room in order and the cupboards and drawers
clears can be specificallv delegated to a nurse with a maid or aide to assist
her. It should be the definite responsibility of one individual to make sure
that ample supplies are available for the evening and night nurses, especially
when it is difficult to obtain materials from a central source after certain
hours.
 TAKING INVENTORY.
The individual assigned to the task of handling supplies and equipment
may also take the periodic (daily and weekly) counts of equipment as
necessary to keep track of it. She keeps the head nurse informed of losses
and misplacement of equipment and shortages in supplies. She also may
make the daily or weekly report of supplies on hand to be used by the head
nurse in writing requisitions. Preparation of broken or worn equipment for
exchange and compiling the necessary lists is a function the head nurse
herself need not perform.

 NEED FOR A ROUTINE PROCEDURE :

The only way to ensure the efficient management of the activities associated
with supplies and equipment is to establish a definite routine and set up
specific directions for its accomplishment. This material should be placed in
writing and used for teaching the person to whom the duties art delegated.
Directions should be in usable form and located conveniently for reference.
Time is saved when methodical measures are adopted for mechanical
functions.
 REPORTING DEFICIENCIES.

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 It should be the function of every individual to report breakage,
equipment which is in need of repair and low stocks of material. Again, if
there is to be efficiency, a definite system for reporting should be instituted.
Preferably a written memorandum is made of the information to be reported.
A notebook or a spindle with pencil and paper at hand are useful if they are
located in a convenient place, are checked daily, and if necessary measures
are taken to correct the shortages. A system for tagging impaired equipment
and a definite place for depositing it should be known to all. Here again it is
advisable that a uniform system be adopted throughout the hospital to save
confusion. Daily review of supplies on hand and frequent checking of the
condition of electric, plumbing and other equipment will minimize the
amount of reporting which the staff will need to do.

EDUCATION OF PERSONNEL IN ECONOMICAL USE OF

HOSPITAL PROPERTY.
It is the duty of the nurse administrator to impress on every member of the
ward staff the need for economy in the use of supplies and the proper use and
care of equipment. She will find that there are many means by which she can
interest the doctors, nurses, and other personnel in economy. The following are
suggestive of methods which have been found of value:
1. Instruction in the causes of breakage and deterioration as well as the
proper care of equipment

The head nurse will find it advisable to review with nurses who are new
to the ward the care to equipment which is specific for the service, stressing the
points which experience has shown to need emphasis. If she can arrange to give
orientation conferences for new interns and medical students, information
relative to the doctors' responsibility for the care of equipment and economical
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use of supplies may be included in the discussion. Conferences of this nature
pay large dividends in general good feeling and cooperation as well as in
economies.
2. Preparation of lists which give amounts and types of sterile goods
needed for dressings and treatments characteristic of the service :
It is wise to come to agreement on matters of this type with the resident of
the service. The lists should be signed by both the head nurse and the resident
and kept in an accessible place. They may be posted on a bulletin board in the
treatment room or placed on cards in a file box. A very convenient method is to
encase them in sheets of washed x-ray film and file them in a loose-leaf note-
book. This permits the lists to be used easily and prevents soiling and wear.
3. Use of illustrative material and bulletin boards to emphasize the costs
of equipment and the need for its careful handling.
Attractive posters and line drawings can be very effective A display of
damaged materials indicating their costs attracts a great deal of attention.
Comparative studies of the cost of supplies or broken equipment are challenging
if the information is made attractive enough to be read. Posters or statements
indicating ways in which wasted money could have been profitably spent are of
interest to all groups. It is well known that any material on a bulletin board must
be attractive to be noticed and changed frequently if it is to be read. Posters can
often be saved and re-used as new groups of students and interns are assigned to
the service.
4. Group conference are an effective method of teaching :
Report on amount of breakage , if short and presented is an interesting way,
can produce discussion which leads to greater awareness of the problem a
display of the broken and worn equipment ready to be sent for exchange may be
accompanied by a discussion of causes and prevention of destruction

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CONCLUSION

Health care services are the result of a number of materials used in the process.
Supplies and equipment are a vital factor in the hospital economy. The hospital
must all times be supplied to meet daily needs and any emergency situation. At
the same time it must realize that idle materials represent a cash outlay which
brings no return. Supplies and equipment contribute in an important way to the
efficiency of the ward and to the quality of patient care.

BIBLIOGRAPHY :

 Jean Barrett, Ward Management and Teaching, Konark publishers, fourteenth edition,
2003
 Dr A G Chandorkar, Hospital Administration and Planning, Paras medical publisher,
first edition, 2004
 http://currentnursing.com/nursing_management/planning_equipments_and_supplies_i
n_hospitals.html

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