Patient Care in Ancillary Services

OBJECTIVE

To ensure proper performance of the following procedures in Diagnostic and other Ancillary services.

SCOPE

This defines the duties and responsibilities of the Radiology Technologist, Medical Technologists, Physical Therapists and Nurses in compliance with these guiding instructions.

DEFINITION

KUB       Kidney UreterBladder

IVP         Intravenous Pyelogram

TVS        Transvaginal ultrasound

VCH        Vertical Cassette Holder

GUIDELINES

1. RADIOLOGY AND IMAGING
1. Ask for the DRF
2. The Radiology Technologist/technician gives brief orientation and instructions about the procedure to be done and asks the patient to sign consent in special procedure like KUB/IVP and TVS. For special procedures needing preparations, pamphlets are available for easy reference.
3. Tag patient on the CMS module.
4. Assist patient to change from street clothes to clinic gowns as needed.
5. The technician performs the procedure.
6. Encodes results on the CMS module.
1. X-RAY
1. Ask the patient about any previous x-ray exposures. If the patient had a previous chest x-ray in the past 6 months and the examination request is part of APE, the patient may opt not to undergo chest x-ray anymore. But for pre-employment purposes, consent of the employer is needed. For female patients, the date of the last menstrual period (LMP) is determined. Those with delayed menses and are unsure if they are pregnant must be referred to the doctor for evaluation before proceeding with x-ray exposure.
2. Mark the film with proper patient identification.
3. Make the patient comfortable and assist in proper positioning.
4. Put the film in the VCH for vertical positioning and in the Bucky under the table top if the patient has to lie down.
5. The collimator will be focused on the desired spot or site.
6. Set the proper factor on the x-ray machine based on the type of x-ray to be done.(Refer to RS-RAD-001 posted on the control panel area).
7. Advise patient to hold position during exposure.
8. The Radiology Technician sets the rotor, repeats instructions to hold the position, then shoots and exposes the film.
9. Remove the cassette from the holder.
10. Film is immediately developed and reviewed for acceptability (GL-ANC-001). If there’s a need for a repeat (e.g. artifacts, positioning and over factor), repeat steps (b) above onward.
2. ULTRASOUND SECTION
1. Assist the patient on some questions re the examination
2. Explain to patient the special instructions for required procedure. Pamphlets are available for easy reference.
3. Schedule the patient according to their preference and doctor’s availability.
4. Advise patient to return on the scheduled date of the examination, bringing the request/referral form along with them. They will be attended on a first-come first-served basis.
5. On the date of the examination, ask for the DRF. Confirm from the patient if they were able to follow the special instructions. If not, re-instruct and give them time to do so, or re-schedule as needed.
6. Advise patient to wait outside of the ultrasound room for their name to be called.
7. Perform the necessary preparations before every procedure: enter patient data into the machine, switch settings to the specific examination, and prepare the transducer.
8. Ask patient for previous records (if any) of ultrasound tests for comparative purposes.
9. Assist the patient and the Sonologist during and after every procedure.
10. Tag the patient on the CMS module
11. Advise patient to wait for the results and consult their respective physicians for the findings.
• For Private consults: results can be given the same day
• For HMO consults: endorse the results to the nurse-on-duty
12. Encodes results on the CMS module
13. File duplicates of films/print out results in chronological order.

ULTRASOUND Preparations:

1. LOWER ABDOMEN
• For Pelvic/KUB/Prostate ultrasound:

Instruct patient to:

• No fasting
• Drink 6-8 hours glasses of water before the examination.
• Do not urinate or void until after the examination is done.
• Report to the Ultrasound Section with full bladder before the examination
• Mention immediately to ultrasound staff if pregnant
2. UPPER ABDOMEN
• LIVER, GALLBLADDER, SPLEEN

Instruct patient to:

• Take a light, fat-free meal the night before the scheduled examination.
• Before bedtime (8 pm) take 30-60 cc of CASTOR OIL and two (2) tablets of DULCOLAX at (9pm)
• Do not eat or drink anything 8-hours prior to examination and NO BREAKFAST, even milk or coffee, candies and smoking
• Report to Imaging Dept on time.
• PELVIC ULTRASOUND (FOR PREGNANT PATIENTS)

Instruct patient to:

• 1st Trimester -             Same preparations as for pelvic ultrasound.
• 2nd Trimester -            No preparations needed.
• 3rd Trimester -             No preparations needed.
3. TRANSVAGINAL ULTRASOUND
1. Check the order of the OB/Gyne or Surgical Specialist about request for a certain procedure/DRF
2. All minors (aged 18 years and below) to undergo the procedure should be accompanied by a parent or guardian. The consent form should be signed by the parent or guardian who was given the patient information / education on the procedure.
3. Write clearly the name of the patient, age, gender, diagnosis and the request “for Transvaginal Ultrasound” on the space provided for the test requested.
4. Give thorough instruction of what to expect on the procedure. This may be through the Patient Information Sheet on Transvaginal Ultrasound or through one-on-one discussion with the nurse.
5. Patient then signs the consent form to indicate that she understands the procedure very well.
6. The nurse then hands over the signed consent form to the Technician for reference.
7. The Technician or Sonologist does the procedure.
7. After the exposure or imaging escort the patient back to the dressing room to change.
8. Give instructions if the patient is to be discharged or return to the consultation area depending on the doctor’s order.
9. Record all x-ray examination to the x-ray / ultrasound log sheets and prepare result. (GL-GEN-001).
4. KUB/IVP
1. Secure a valid DRF
2. Ensure that patient is instructed well on the necessary preparation needed and properly scheduled for KUB/IVP. Pamphlets are available for easy reference.
3. Ask the patient to sign the consent form QR-NSD-COF).
4. Perform proper testing prior to KUB/IVP examination. A test done of 1 ml of Urimiro (dye) is initially applied to the patient. If pruritus(itchiness), vomiting, dizziness, rashes and a flushed face appear, the examination will not be done anymore. The decision not to continue with the procedure is given by the radiologist.
5. Tag patient on the CMS
6. Encode results on the CMS module
7. Films are filed numerically inside the binder file for easy retrieval of result.(GL-GEN-001)
• UPPER GI SERIES, KUB-IVP and BARIUM ENEMA

Instruct patient to:

• Take a light, fat-free meal 1 day before the scheduled examination (take only soup, noodles, lugaw)
• Before bedtime (8 pm) take 30-60 cc of CASTOR OIL and two (2) tablets of DULCOLAX at (9pm)
• Nothing by mouth after 12MN until the time of examination
• Do not eat or drink anything 8-hours prior to examination and NO BREAKFAST, even milk or coffee, candies and smoking
• Insert 1 dulcolax suppository at around 4-5am.
• Report to Radiology Dept on time as instructed.
2. DIAGNOSTIC
1. ECG
1. Secure a valid request form (DRF) and make sure that the patient has gone to the Cashier.
2. Give instructions to the patient regarding removal of any metals in the body or clothing, shoes and socks and opens or removes blouse prior to procedure.
3. Connect the grounding and the power cords correctly and ensure that the chart paper is properly set-up.
4. Position the patient in bed.
5. Ensure the completeness of data gathered and recorded by properly labeling the needed materials with the patient’s name, company, age, sex date and leads.
6. Tag patient on the CMS
7. Encode results. (GL-GEN-001)
2. 2D-ECHO
1. Schedule an appointment for the patient’s request.
2. Inform patient to call the day before the scheduled date for confirmation, and advise to bring the request/referral form along on the date of examination.
3. On examination date:
• Confirm whether patient’s request was indeed scheduled.
• Get the approval code listed by the nurse for HMO clients. Ask for the DRF
4. Inside the 2D Echo room:
• For female patient: ask to have upper garments taken off, and wear the lab gown instead.
• For male patient: ask to have upper garments taken off.
• Advise patient to lie on the bed and position on the side.
• Perform procedure (approximately 30-40 minutes/patient)
5. Allow patient to change clothes. Instruct to follow-up results through the telephone after 3 working days. From then on results shall be ready for release.
6. Tag patient on CMS module
7. Prepare results and keep records
3. TREADMILL TESTING
1. Secure a valid request form (DRC) and give the necessary instructions the day before the scheduled test. Pamphlets are available for easy reference.
2. Secure consent from the patient.
3. Take vital signs accordingly.
4. Ask the Cardiologist what protocol to use with the certain patient.
5. Plug on machine and while it warms up, inform the patient that while the test is not considered painful the test can be extremely fatiguing.
6. Prepare client skin where electrodes are to be placed.
7. Attach electrodes on designated sites.
8. Inform the patient accordingly the progress of the procedure.
9. Inform the doctor from time to time any unusual sensation, which may develop during the test like chest pain, nausea and dizziness.
10. Let the patient rest on chair after the recovery stage and take the last blood pressure.
11. Ready all emergency medications and the defibrillator for any emergency situation.
12. The Internist or Cardiologist monitors the treadmill stress testing while in progress.
13. Tag patient on CMS module
14. Advise patient on release of result. (GL-GEN-001)
3. REHABILITATION
1. If it is the patient’s first consult with the Rehab section, refer patient to Physiatrist or Rehabilitation Medicine Specialist.
2. If the patient is for follow up, patient will be advised to proceed to the Physical Therapy Section.
3. PT Clinical Supervisor schedules the patient.
4. If patient is an HMO card holder or has a Corporate Account, the Clinical Supervisor or PT staff will have the Physical Therapy sessions approved.
5. For walk-in patients, the therapy session can start right away.
6. PT/Nurse/Cashier dispenses at CMS
7. The Clinical Supervisor/PT staff then evaluates the patient and uses the Initial Evaluation form (QR-REHAB-IE)
8. Do the actual Physical Therapy session to the patient.
9. Tag patient on the CMS module
10. Running notes are made throughout the course of the treatment and are placed at the PT Notes form (QR-REHAB-NOTES)
11. Upon previous instructions, the patient is re-evaluated upon request. Re-evaluation form is used (QR-REHAB-RE-EVAL)
12. As previously arranged, the patient is sent back to the Physiatrist for Re-evaluation.
13. If the patient is recommended for additional PT treatment, go back to step 2.
14. If the patient is for discharge, the patient is sent to the PT section. The Clinical Supervisor uses the Discharge Summary form (QR-REHAB-DS)
15. If the patient is for transfer, the Clinical Supervisor uses the Treatment Summary & Endorsement Form (QR-REHAB-PTEN)
• Outgoing Interns will make use of the Endorsement Form to transfer functions and other specific details pertaining to patient’s behavior during treatment to the incoming interns.

REFERENCES:

GL-GEN-001                    Preparation and Release of Results

QUALITY RECORDS:

RS-RAD-001                     Reference guide for setting KV factor

QR-NSD-COF                  Consent Form

QR-REHAB-DS                Discharge Summary

QR-REHAB-NOTES         PT Notes

QR-REHAB-PTEN            PT Endorsement Notes

QR-REHAB-IE                  Initial Evaluation

QR-REHAB-RE-EVAL     Re-evaluation

QR-REHAB-CSN              Clinical Supervisor’s Notes

QR-REHAB-DRC              Daily Rehab Census

QR-RAD-DRC                   Daily Radiology Census

QR-UTZ-DUC                   Daily Ultrasound Census

QR-NSD-DTC                   Daily Treatment Census