SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES

Prasanthigram, Anantapur Dt.515134

SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

ORTHOPAEDIC
DEPARTMENT
MANUAL

Issued By Approved by:

Prepared By (Department DIRECTOR
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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

REFERENCE NO. SSSIHMS-PG/Manual/ ORTHOPAEDICS

AUTHOR RESPONSIBLE: Dr Koushik Narayan S

APPROVED ON 1st June 2017

NEXT REVIEW DATE 1st June 2018

RATIFIED BY Director Dr. Gurumurthy

DATE RATIFIED 5th June 2017

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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Distribution List
Authorized holders of the Controlled copy of Departmental Manual.

CONTROLLED COPY NO CONTROLLED COPY HOLDER

01 HOD
02 Director/NABH Coordinator

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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Amendment Record Sheet

S. Page Clause Date of Amendment Reasons for Sign of

N No. No. Amendment Made Amendment Quality
o Coordinator

1
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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Table of Contents

S. No. Particulars
1 Introduction
2 Scope of Services (Available & Not Available)
3 Glossary of terms
4 Departmental Hierarchy
5 Objectives
6 Roles and responsibilities
7 Core departmental procedures
8 Protocols
9 Process Flow Charts
10 Departmental Future Plans
11 Professional Continuing Education
12 List of Forms, Formats and registers

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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

1. INTRODUCTION

With the Divine Blessings of Bhagawan Sri SathyaSai Baba, the Department of Orthopaedics, SSSIHMS - PG,

started functioning on 11th July, 2006. The Department has shown consistent progress in all aspects of

Orthopaedics as a specialty. The facility is equipped with the most modern technologically advanced

equipment and is staffed by well qualified, experienced consultants. The Department is approved by the

National Board of Examination, New Delhi, for Post-Graduate training in Orthopaedics.

2. SCOPE OF SERVICES:

The Department of Orthopedics is steadfast in providing quality treatment, excellent care combined

with teamwork in the service of our people.

The SSSIHMSPG provides services to multinational expatriates and natives draining in from the whole

of India as well as neighboring countries.

We specialize in providing the best possible Orthopaedic services in the areas of Orthopedic Trauma,

Pediatric Orthopaedics, Arthroscopy and Sports Medicine, Arthroplasty, Lumbar Spine Surgery, and

Deformity Correction such as Illizarov methodology.

We provide 24 hours orthopedic services for Emergency Orthopaedic cases

Our Orthopedic Services include:

o Orthopaedic Trauma services: management of fractures of long bones both in adults and

children, treatment of open fractures, management of Non Union, Malunion and post

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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

traumatic deformity, soft tissue injuries such as tendon injury, muscular tears, open joint

injuries and similar other cases.

o Joint Replacement

Hip Hemiarthroplasty

Total Hip Arthroplasty

Total Knee, Arthroplasty

Surgical management of small joint arthritis of hand

o Sports Medicine Including Arthroscopic Surgery Diagnostic and Surgical Procedure:

Knee Elbow

Shoulder Hip

Ankle

Wrist

o Pediatric Orthopedic Surgery:

DDH- Treatment Leg lengthening limb length

TalipesEquinovarus inequality

deformity management Foot disorders complex foot

Cerebral palsy surgery

Polio/ Congenital Spine deformities

o Tumor Surgery Benign bone and soft tissue tumors

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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Simple excision Curettage with bone graft

o Spinal Surgery

Standard lumbar Thoraco-lumbar Spine: Management of

laminectomy dissectomy fracture and/or dislocation

Multiple level extensive Injuries of Thoraco-lumbar Spine:

decompression for lumbar Anterior fusion with or without fixation

spinal stenosis Infections such as Tuberculosis Thoraco-

Surgical management of lumbar Spine: Anterior/Posterior fusion

lumbar/lumbosacral with or without fixation

spondylolisthesis

o Hand Surgery

Congenital hand problems Fracture fixation

Peripheral nerve conditions Ligament repair

Tendon Repair and/or

Reconstruction

Hand space infections

Occupational injuries of the

hand not requiring

reimplantation

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Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Services not offered in the specialty are

o Malignant musculoskeletal tumors

o Trauma with associated visceral injuries

o Elective Amputations

o Scoliosis

o Cervical spine cases

o Microvascular surgery and re-mplantation

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Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

3. Glossary of abbreviations used

HOD Head Of The Department

OPD Out Patient Department

OT Operation Theatre

OR Operation room

ICU Intensive Care Unit

MM Medical Management

MRD Medical Record Department

BP Blood Pressure

Inj Injection

I/V Intravenous

G. A. General Anaesthesia

ECG Electrocardiogram

ABG Arterial Blood Gas

POP Plaster of Paris

CSSD Central Sterile Supply Department

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Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

ETO Ethylene Di oxide

EL Earned Leave

HPL Half Paid Leave

CL Casual Leave

ML Maternity Leave

DNB Diplomate Of National Board

4. Regulatory

Not Applicable

5. ORGANOGRAM

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Director

Chairman

HOD

Meidcal Staff

Manager

In-Charge nurse

Nursing staff

Technicians

OT Assistants

Sweepers

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

6. Roles & Responsibilities (Job Title, Reporting to, Qualification, Experience & Skill
sets)

Sl Job Title Reporting Qualification Experience Skills

N To
o
1 Chairman Director MS, Ortho / Senior Professor Orthopaedic surgery
DNB

2 HOD Chairman MS, Ortho / Sr. Consultant Orthopaedic surgery

DNB

3 Sr. Consultant HOD MS, Ortho / 14 years of Orthopaedic surgery

DNB experience post
MS/ DNB

4 Addl Sr. HOD MS, Ortho / 10 years of Orthopaedic surgery

Consultant DNB experience post
MS/ DNB

5 Consultant HOD MS, Ortho / 6 years of Orthopaedic surgery

DNB experience post
MS/ DNB

6 Jr. Consultant HOD MS, Ortho / 3 years of Orthopaedic surgery

DNB experience
post MS/
DNB

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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

7 Sr. Resident HOD MS / DNB- Orthopaedic surgery

Ortho
8 DNB HOD M.B.B.S
Students
9 Manager HOD M.B.A. General management

10 Sister In- HOD & BSc Nursing/

charge manager Diploma
Nursing/Nursi
ng
Assistant/AN
M
11 Staff Nurses Sister in- BSc
Charge Nursing/Diplo
ma
Nursing/Nursi
ng
assistant/ANM
12 Technicians Manager Graduates Physiotherapist, Anesthesia
13 Assistants Manager 12th OT & ICU
Sister in-
Charge
14 Sweepers Manager OT, ICU & Ward
Sister in-
Charge
15 Volunteers Sister in- Assisting ward boys in non-
(sevadal) Charge clinical areas

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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

7. Core Departmental procedures

General administration

Front office management

Liaisoning activities

HOD office management

Departmental meetings

Asset management

Capital budgeting

Personnel management

Patient communication

In OPD

Patient and his accomplice demographic verification

Screening and Registration

Data entry

Daily Outpatient clinics

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Specialty clinics

Investigation

Treatment plan

Pre-admission documentation of the patient

Issuing authenticated medical reports and certificates

Surgical scheduling

Referral procedure

Revisit appointment

Plaster application

Patient education and Counselling

Physiotherapy

Admission order

In Ward

Patient identification

Inpatient documentation verification

Data entry

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Allocation of beds

Patient assessment

Treatment procedures

Investigation

Pre-operative preparation

Daily Rounds

Grand Round

Diet

Patient Shifting procedures

Referral/cross consultation procedures

Blood transfusion

Post-surgical management

Inpatient documentation and maintenance of medical records

General nursing procedures

Minor procedures like Catheterisation, Wound dressing, wound suction, epidural

catheter removal, I/V line access and maintenance

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Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Barrier nursing

Physiotherapy

Patient education and Counselling

Discharge plan

Discharge advise

Discharge summary

Sub store management

Linen maintenance

Equipment maintenance

Inpatient dispensary

Crash cart maintenance

Inpatient census board

Nurses record maintenance

OT list preparation and scheduling

Audit

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

In OT (Dedicated to only Ortho surgeries)

Patient identification

Surgical team identification

Verification of instrument ,implant and equipment

Nursing trolley preparation

Surgical site verification

Anaesthesia procedures

Preparing patient for surgery (Catheterisation, Intubation, tourniquet application,

Scrubbing the surgical site)

Operative procedures

Investigations

Blood transfusion

Shifting to ICU

Cleaning operation theatre

Preparation of instrument sets and packs

Instrument cleaning and maintenance procedure

Sterility procedures

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Inventory maintenance and management

Equipment maintenance

Use of narcotic drugs

Daily meetings

Documentations of OR records, anaesthesia records ,surgical records and nursing

records

Cross consultation and referral activity

Audit

Surgical demonstration

Orientation

Biomedical waste management

Data entry

Post op patient management discussion and strategies

Personnel safety measures and activities

Patient safety measures

Liaison activities through front office

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Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Emergency surgical procedure activities

In Orthopaedic emergency

All patients needing orthopaedic emergency care will be attended to

Patient receiving and identification

Registration

Emergency care activities

Investigations

Biomedical waste management

Crash cart management

Minor procedures like Cast application, splint application, wound dressing, wound

suturing, incision and drainage, arthrocentesis, close reductions and bandage

Issuing of medical reports and certificates

Admission

Patient shifting activities

Patient preparation activities

Patient documentation and maintenance of medical records

Patient appointment

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Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Cross consultation and referral activities

Diet

Nursing reports and records

Sub store management

Linen maintenance

Equipment maintenance

Emergency dispensary

Cleaning operation theatre

Preparation of instrument sets and packs

Instrument cleaning and maintenance procedure

Sterility procedures

Inventory maintenance and management

Liaison activities with front office

Maintenance of emergency services

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

In ICU

Patient verification and receiving

Nursing assessment

Bed allocation

Surgical site identification and marking

Treatment procedures

Sterility procedures

Ventilation procedures

Intubation and extubation procedure

Catheterisation

Wound dressing

Suction

Daily rounds

Diet

Patient dispensary

Linen maintenance

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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Patient resuscitation

Crash cart maintenance

Nursing record

I/V line and airway monitoring

Referrals and cross consultation

Equipment maintenance

OT record and register maintenance

Audit

Investigation

Monitoring

Data recording

Patient care procedure

Blood transfusion

Infection control procedure

Shifting procedures

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Academic activities

Scheduled academic meetings

Bedside clinics

Case demonstration

Case discussion

Journal clubs

Guest and faculty lectures

In house Nurses training

Continuous Medical Education

Surgical demonstration

8. Protocols (Outpatient services, Inpatient services)

Outpatient Services

Definition

New patient Reporting to the hospital for the 1st time

1st Visit patient Patients who are registered under Orthopaedics in SRB and sent for further

evaluation in Orthopaedic OP clinics

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Revisit patient

Regular OPD follow up patients

Post-operative follow-up patients

Discharged follow up patients

Post treatment follow up patients

Referred to speciality clinic

Surgical scheduled patients

Cross consultation referrals

Screening And Registration Block

Examination of Patient and report Reviewing :

o All new patients are examined thoroughly by adopting standard clinical

procedure

o All the pertinent reports of patients are reviewed

o Patient needing further evaluation are registered in Ortho OPD as 1st visit

patient

o All the other patients are treated for relevant conditions/ referred

Performer Orthopaedic Resident Doctor

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Registration -

Patient who need further evaluation are registered as 1st visit for Ortho OPD

Performer - Screening and registration block Registration clerk

OUT PATIENT DEPARTMENT

Registrations

o First visit registrations as per SRB protocols

o Revisit registrations are registered at the front office in accordance

with the appointment system

Performer Front office clerk, OPD nurse

Evaluation of 1st visit patients -

o Patient are from the SRB registrations

o Thorough clinical evaluation and relevant laboratory and radiological
investigations
o Appointment for revisit / surgical scheduling / Follow up / Treatment
/ Referral
Performer- Orthopaedic Resident Doctor

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Evaluation of revisit

o Scheduled patients re-evaluation carried out

o Patient treatment protocol strategies

IP admission

Surgical scheduling

Referral to speciality clinics

Further advice, evaluation and management

Referral

Discharge from further follow up

Performer Senior residents, Consultant

IN-PATIENT SERVICES

In Ward

All patients admitted should have the following information charted as soon as

possible:

o Patient is identified and documents are verified

o Diagnosis and treatment plan

o A complete history and examination sheet should be documented

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

o Relevant investigations should be attached in the case file.

o All such patients above the age of 40 scheduled for surgery underproposed

G.A. should have recent E.C.G. (within last 2 weeks) and above 50 should

have X-ray chest (within last 4 weeks).

o Patients with co-morbid medical problems such as diabetes mellitus,

epilepsy,drug reactions etc should be labeled as "Diabetic" or "Epileptic", etc.

as per institution procedures

o Patients previous/present drug history must be recorded

o Patients who are already on medications other than prescribed by the

attending Physician must be checked and confirmed. Same must be

documented.

o Patient with medically hazardous condition/patient requiring barrier nursing

should be highlighted as per institution procedures and admitted in isolation

cubicle.

o Communicable disease/ Allergies, a warning sticker on top of the file.

Performer Nurse in-charge of the patient in the ward

The bed is allocated to the patient by the In-Charge nurse of the ward

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 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Nursing assessment and investigations are verified by the nurse In-Charge

Ward Nurse in-charge verifies preoperative medical records (informed consent, PAC,

medical consultation, cardiac / dental / urology / plastic surgery / Paediatric

consultations for elective procedures has been obtained.)

Actual side and site of the operation is verified. (Performer : nurse In-Charge)

The surgical site is prepared for surgery in the ward(Performer : nurse In-Charge)

The pre-operative patient is shifted to ICU on call (Performer : nurse In-Charge)

In ICU (Pre operative)

The pre-operative patient scheduled for surgery/patient shifted from casualty/any

orthopaedic patient requiring intensive care is identified by the nurse in the ICU

The patient documents are verified in the ICU(Performer : nurse In-Charge)

Nursing assessment is done pre-operatively.(Performer : nurse In-Charge)

Bed is allocated to the patient.(Performer : nurse In-Charge)

The patients are evaluated by the anesthesiologist pre-operatively.

Pre anaesthesia treatment procedures are carried out by nurse In-Charge/Anaesthesia

technician

The surgical site is identified and marked by the nurse.

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SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

The patient is shifted to operation theatre on call for surgery.(Performer : nurse In-

Charge)

In OT

The patient is identified in O.R. (Performer: OT I/C Nurse and )

the patient is identified by the surgical team and anesthesiologist

The instrument, implant and equipment required for the surgical procedure are

verified(Performer: Physician)

Surgical site of the patient is verified in the O.R.(Performer: Physician and Nurse)

The Anaesthesia procedures such as catheterisation, intubation are performed by the

anaesthesia team.

The patient is prepared for the surgery.(Performer: OT Technician/Assistant surgeon)

The proposed surgical procedure is performed in the O.R.(Performer: Surgical Team)

In ICU (Post operative)

After recovery from anesthesia, the patient is shifted to ICU under supervision post-

operatively.(Performer : Anaesthesia team)

Patient is monitored and due post-operative care is begun in the ICU(Performer :

Anaesthesia team)

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In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Patient monitoring is carried out.(Performer : Nurse In-Charge)

Anaesthesia procedures are performed

the patient is stabilized and declared fit for shifting. (Performer : Anaesthesiologist)

Patient is shifted to the ward and verified. (ICU nurse and ward nurse)

In Ward

The patient is verified in the ward.(Performer : Nurse In-Charge)

The bed is allocated in the post-op ward.

General nursing procedures are performed on the patient.(Performer : Nurse In-

Charge)

Minor procedures such as catheterisation, wound dressing are performed by the

concerned nurse as ordered by the physician.

Due post-operative care is performed. (Performer: Surgical team and Nurse In-Charge)

Barrier nursing is performed for infected patients.(Performer : nurse In-Charge)

Physiotherapy procedures are performed as per the orders of

physician.(Physiotherapist)

Patient is counselled for further post-operative care.(Performer: Physician)

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In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

The discharge plan is made by the physician as per the condition of the

patient.(Performer: Surgical Team)

The patient is discharged from the ward.(Performer: Physician)

9. Process flow charts

Definition:

Elective patient: Patient with chronic orthopaedic problem

Chronicity: Symptoms more than one week

Emergency patient: Patient presenting immediately or within 24 hours of injury/any life

threatening or limb threatening Orthopaedic conditions

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In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Elective Patient Process Flow

Issued By Approved by:

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Page 34 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Emergency Patient Process Flow

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 35 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

10. Departmental Future plans

Goals of the Department

o To follow principles of Sai Ideal healthcare.

o Our Goal is to provide the best and complete orthopaedic care with love, free of

cost, using evidence-based, modern medical and surgical treatment, and inculcating the

principles of our Founder and Inspiration, Bhagawan Sri Sathya Sai Baba.

Clinical (Patient Care) Objectives

o To develop patient education program in accordance with the local prevailing

health problems particularly skeletal fluorosis and osteoporosis

o To develop preventive healthcare strategies

o To provide quality patient care with love, irrespective of caste, colour, creed,

religion, place or financial status.

o To improve pain management and rehabilitation procedures for better

healthcare delivery.

o To provide comprehensive orthopaedic care

o To incorporate evidence based medicine in clinical practice

o To develop research based facilities

Issued By Approved by:

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Page 36 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

o Providing established standards of Orthopaedic surgical practice

o Continued up gradation and incorporation of developing surgical trends.

o To further strengthen and reinforce resident training program

o To develop comprehensive orthopaedic sub specialty practice

o To develop a model for achieving excellence in academic training

o To establish an Implant Bank for the Department.

o To establish and maintain well-equipped Emergency Care.

o To follow the standard guidelines of the Infection Control Committee and

achieve international standards for orthopaedic infection rates (< 1%).

Academic Objectives

o To teach evidence-based, modern orthopaedics integrated with Human Values.

o To train DNB candidates in their psychomotor skills for surgical excellence and

intellectual discrimination in diagnosis in modern orthopaedic science.

o To increase the number of presentations and publications of scientific papers.

o To improve the academic standards of the Department.

o To obtain recognition as a DNB Orthopaedic Examination Centre.

Issued By Approved by:

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Page 37 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

o To integrate the Department of Orthopaedics, Whitefield General Hospital,

Bangalore with the Department of Orthopaedics, SSSIHMS, Prasanthigram

o To successfully host the Sri Sathya Sai International Orthopaedics Conference -

2015 on "Ilizarov - Evolution and Applications" in December 2015.

o To expand Orthopaedic books in the Central / Orthopaedic Library.

Research Objectives

o To improve Basic Science Research Activities in collaboration with SSSIHL.

o To establish an Orthopaedic Basic Science Research Wing.

11. Professional Continuing Education

Academic Programs:

Every Saturday academic meeting is held from 3:30 to 4:30 pm

Academic discussion on Monday and Tuesday from 7am to 8 am

Clinical Meetings: Discussions of important and rare cases on Friday and Saturday.

Grand Rounds: Each unit of the department assembles in the ward on their out-patient

days to assess pre op, post-op and admitted patients to discuss the cases.

Issued By Approved by:

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Page 38 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Case Presentations of various categories of Orthopaedic cases as a preparation for

practical examinations.

Journal Club: Presentations on topics concerning recent advances or interesting case

reports.

12. List of forms, formats & registers

Register maintained in Ortho O.T.

Ortho O.T Register.

Utilization form. ( For patient consumption.)

Inventory register.

Linen register.

Donation item register.

Emergency register.

Infected cases register.

Arthroscopy register.

Arthroplasty register.

Spine instrument register.

DHS implant register.

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 39 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Intramedullary nail register.

DCP, LCP register.

Cortical, CCS, Drill bit register.

Suture register.

Drug register.

Narcotic register.

Blood transfusion register.

Epidural steroid cases register.

Monthly stats report.

ACL patient register.

Instrument register.

Bio-medical dispatch register.

Illizarov & JESS fixator register.

Radiation exposure register.

CSSD register.

VM implant DC register.

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 40 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Sharma implant DC register.

Implant monthly requirement register.

Sutures register.

Surveillance Form

Ortho Emergency Register List

Ortho emergency duty register.

Minor O.T register.

POP register.

Referred MLC register.

Fumigation & Carbolization registration.

Statistics register.

Emergency O. T register.

Infection register.

Diet book.

CSSD book.

Investigation book.

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 41 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Sentinels events register.

Observation patients register.

Linen, Equipment & Furniture registration.

Nurse's duty roster book.

Leave register.

Emergency patient's report book ( Admission & Emergency patients posted for

surgery)

Complaint form. ( mrd no -128 ).

Prescription. ( mrd/ com 06).

Outpatient / Inpatient requesting or physiotherapy. (mrd 137 ).

Admission form. ( sssihms/pg/mrd/com-42).

To whomsoever it may concern form. (SSSIHMS/DO/93MRD). (mrd -121).

Application for casual leave form. ( mrd 120 A ).

Application for Earned/Halfpay/Extra oridinary/Commuted/Maternity leave

Joining report form. ( mrd 120 ).

Clinical chart. ( mrd/com/18).

Issued By Approved by:

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Page 42 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Nurses chart. ( mrd 13 Modified ).

Consent for surgery. ( mrd 141 ).

Checklist before skin incision. ( mrd / com 44 ).

Checklist before patient leaves the OT. ( mrd /com 44 ).

Pre anesthesia record / Intra Operative anesthesia record. ( mrd / com 28 ).

Doctor's order form.(sssihms/pg /mrd/com 12).

Physician progress notes. ( mrd 142 ).

History & Physical examination form. ( mrd 140 ).

Physiotherapy record. ( mrd 136 ).

Consultant notes. ( mrd 135).

Discharge summary with review date for sutures removal.

Ortho ICU forms and Registers

Doctor's order form. ( mrd -14 ).

Physician progress notes. ( mrd 142 ).

Clinical chart. ( mrd -55).

Nurses chart. ( mrd 13 Modified ).

Issued By Approved by:

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Page 43 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

I/O Charts. ( mrd 36 ).

Pre anesthesia record / Intra Operative anesthesia record. ( mrd / com 28 ).

Consent for surgery. ( mrd 141 ).

Specific consent for high risk procedure. ( mrd 7 A ).

Operation record. ( mrd 8 ).

History & Physical examination form. ( mrd 140 ).

Consultant notes. ( mrd 135)..

Transfer-register.

Inventory & linen registration.

Wound debridement register.

Nurses report book.

Narcotic register.

Leave register.

Nurses day censes book.

Needle prices register.

Blood transfusion book.

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 44 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Dustbin covers dispatching register.

MRD Death tiles dispatching register.

Report on sentinel events register.

General indent book.

Laundry book.

Dietary register.

Crash card daily checking register.

Drugs maintaining register.

Ortho OPD Registers and forms

Speciality

clinic register

Arthritis register

Dietary register

Inward and outward Register

Issued By Approved by:

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Page 45 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

register for visiting consultant

Dispatch register

Leave register

Email answer book

Laundry register

Store register

Attendance register

stock register

Outpatient requesting for

physiotherapy

patient registration card

Admission authorization form

doctor's order form

History and physical examination form

Anaesthesia record form

Pre aneasthesia record form

Physician progress notes

Issued By Approved by:

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Page 46 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Nurses chart

Consent for surgery

Clinical chart

Consultant notes

Physiotherapy record

Declaration of free treatment

Discharge with medical advice

Register maintained in O.T.

Ortho O.T Register.

Utilization form. (For patient consumption)

Inventory register.

Linen register.

Donation item register.

Emergency register.

Infected cases register.

Arthroscopy register.

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 47 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Arthroplasty register.

Spine instrument register.

DHS implant register.

Intramedullary nail register.

DCP, LCP register.

Cortical, CCS, Drill bit register.

Suture register.

Drug register.

Narcotic register.

Blood transfusion register.

Epidural steroid cases register.

Monthly stats report.

ACL patient register.

Instrument register.

Bio-medical dispatch register.

Illizarov & JESS fixator register.

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 48 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Radiation exposure register.

CSSD register.

VM implant DC register.

Sharma implant DC register.

Implant monthly requirement register.

Sutures register.

Surveillance Form

Emergency Register List

Ortho emergency duty register.

Minor O.T register.

POP register.

AR copy register.

Fumigation &Carbolization registration.

Statistics register.

Emergency O. T register.

Infection register.

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 49 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Diet book.

CSSD book.

Investigation book.

Sentinels events register.

Observation patients register.

Linen, Equipment & Furniture registration.

Nurse's duty roster book.

Leave register.

Emergency patient's report book ( Admission & Emergency patients posted for

surgery) :-

Complaint form. ( mrd no -128 ).

Prescription. ( mrd/ com 06).

Outpatient / Inpatient requesting or physiotherapy. (mrd 137 ).

Admission form. ( sssihms/pg/mrd/com-42).

To whomsoever it may concern form. (SSSIHMS/DO/93MRD). (mrd -121).

Application for casual leave form. ( mrd 120 A ).

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 50 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Application for Earned/Halfpay/Extra oridinary/Commuted/Maternity leave

Joining report form. ( mrd 120 ).

Clinical chart. ( mrd/com/18).

Nurses chart. ( mrd 13 Modified ).

Consent for surgery. ( mrd 141 ).

Checklist before skin incision. ( mrd / com 44 ).

Checklist before patient leaves the OT. ( mrd /com 44 ).

Pre anesthesia record / Intra Operative anesthesia record. ( mrd / com 28 ).

Doctor's order form.(sssihms/pg /mrd/com 12).

Physician progress notes. ( mrd 142 ).

History & Physical examination form. ( mrd 140 ).

Physiotherapy record. ( mrd 136 ).

Consultant notes. ( mrd 135).

Discharge summary with review date for sutures removal.

ICU forms and Registers

Doctor's order form. ( mrd -14 ).

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 51 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Physician progress notes. ( mrd 142 ).

Clinical chart. ( mrd -55).

Nurses chart. ( mrd 13 Modified ).

I/O Charts. ( mrd 36 ).

Pre anesthesia record / Intra Operative anesthesia record. ( mrd / com 28 ).

Consent for surgery. ( mrd 141 ).

Specific consent for high risk procedure. ( mrd 7 A ).

Operation record. ( mrd 8 ).

History & Physical examination form. ( mrd 140 ).

Consultant notes. ( mrd 135)..

Transfer-register.

Inventory & linen registration.

Wound debridement register.

Nurses report book.

Narcotic register.

Leave register.

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 52 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Nurses day censes book.

Needle prices register.

Blood transfusion book.

Dustbin covers dispatching register.

MRD Death tiles dispatching register.

Report on sentinel events register.

General indent book.

Laundry book.

Dietary register.

Crash card daily checking register.

Drugs maintaining register.

OPD Registers and forms

Paediatric orthopaedics clinical register

Spine Clinic register

Arthritis Clinic register

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 53 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Review Arthritis register

Dietary register

Inward and outward Register

register for visiting consultant

Dispatch register

Leave register

Email answer book

Laundry register

Store register

Attendance register

stock register

Outpatient requesting for physiotherapy

patient registration card

Admission authorization form

doctor's order form

History and physical examination form

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 54 of 55
In Charge/HOD)
 SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES
Prasanthigram, Anantapur Dt.515134
SSSIHMS-PG/Manual/ Orthopaedics Issue Date: 17th March 2015
Issue No: 01
Department Manual -Orthopaedics Rev Date: 1st June 2017
Rev No: 01
Reference NABH standard 3rd Edition Effective Date: 5th June 2017

Anaesthesia record form

Pre anaesthesia record form

Physician progress notes

Nurses chart

Consent for surgery

Clinical chart

Consultant notes

Physiotherapy record

Declaration of free treatment

Discharge with medical advice

Issued By Approved by:

Prepared By (Department DIRECTOR
Page 55 of 55
In Charge/HOD)