ANNEX  B

 

MANILA DOCTORS HOSPITAL EMERGENCY ROOM PROCEDURE ON SARS

 

ER PROCEDURAL GUIDELINES ON HANDLING SARS SUSPECT / PROBABLE SARS

 

 

General Policy: NON-ADMISSION OF SARS SUSPECT

 

 

AT THE GUARD’S FRONT DESK

 

  1. The guard-on-duty asks all patients and companions entering the Emergency Room for history of:

 

                                                               i.      Fever

                                                             ii.      Respiratory symptoms – cough, colds, dyspnea or shortness of breath

 

  1. If with fever or respiratory symptoms, the guard directs the patient to the Triage Area.

 

  1. If without fever and respiratory symptoms, the guard directs the patient to the main ER.

 

THE TRIAGE / HOLDING AREA (ISOLATION ROOM)

 

1.       The Room will be used to isolate SARS SUSPECT to prevent exposing majority of the hospital staff and other clients to the disease. 

 

2.       The room will be divided into:

 

a.       Triage Area where all patients presenting with fever will be triaged before they can be allowed to proceed to the Main ER

 

b.       Holding Area where the following will stay:

 

                                                               i.      SARS Suspects or Probable SARS awaiting conduction to  Research of Tropical Medicine (RITM) or San Lazaro Hospital (SLH)

                                                             ii.      SARS Suspect awaiting CXR and other diagnostic examinations

                                                            iii.      Special cases of Probable SARS who are admitted at MDH and awaits transfer to 11F

 

c.       Comfort Room

 

Note:         The Triage and Holding Areas are separated by a sliding glass door.  This will deter mixing SARS SUSPECT with PROBABLE SARS.

 

3.       The room will contain the following:

 

                                                               i.      O2 tank

                                                             ii.      E-cart (separate from the main ER)

                                                            iii.      Chairs for the patients

                                                            iv.      Stretcher

                                                              v.      Sink with soap and water / alcohol based hand rub at the entrance

                                                            vi.      Hand dryer

                                                           vii.      Exhaust fan for ventilation or provision to attain negative pressure inside the room

                                                         viii.      Intercom to communicate with the main ER

 

 

THE MEDICAL TEAM

 

1.       The Triage Officer (TO)

 

a.       The Post-graduate Intern as agreed by MANCOM is assigned the position.

b.       His functions will encompass the following:

 

                                                                  i.      Interviews the patient to elicit the following:

1.       History of travel to endemic areas for SARS

2.       History of contact with confirmed cases of SARS

 

                                                             ii.      Completes the TRIAGE SCREENING QUESTIONNAIRE form then logs the patient’s name in a separate logbook which contains the following information:

1.       Date of consult

2.       Name, age, sex and contact numbers of the patient

3.       Date of arrival from SARS and / or date of exposure

4.       Disposition made at the ER

 

                                                            iii.      If the patient is diagnosed as “SARS Suspect”, the TO will:

1.       Provide the patient with a surgical mask

2.       Advise the patient that he will be transferred to Research Institute of Tropical Medicine (RITM) or San Lazaro Hospital (SLH)

3.       Facilitate transfer to the referral hospitals using the following MDH transport facilities:                                

                                                                                                                                       i.      Vida for stable patients

                                                                                                                                     ii.      Ambulance for unstable patients

 

4.       Endorse the patient to the institutions to which they will be transferred

5.       Inform the Radiology Department, if the patient wishes to have a chest x-ray done prior to the transfer

6.       Inform the ER Consultant-on-duty of the following:

 

a.       Admission if the patient is unstable for transfer

b.       Inquiries/complaints

                                                            iv.      If the patient is diagnosed as a “non-SARS”, the TO may now direct the patient to the main ER for further evaluation and management.

 

c.       He will conduct the interview with a patient through the intercom while staying at the Main ER to minimize exposure to SARS.

 

2.       The Emergency  Room Officer (Consultant)

 

a.       Aside from his usual functions, he will be responsible for the following:

 

                                                                  i.      Inform the following personalities in case a “SARS SUSPECT’’ is admitted at the ER:

 

1.       Medical Resident-on-duty to admit the patient under the combined services of  Infectious Disease and Pulmonology departments

2.       Admitting Department to assign rooms at the 11F

3.       Dr. Velmonte, Chair of Infectious Control Committee

4.       Dr. Joson, Chair of the MDH SARS Taskforce

5.       Dr. Rex Mendoza, OIC Hospital Administrator, to take charge of any media coverage if the need arises

6.       Dr. Dante Morales,  Medical Director

7.       Miss Rita Wanninger, Assistant Hospital Director

 

                                             However, all information should be treated confidentially.

 

                                                                ii.      To train and impart necessary education and training to the ER personnel and security guards regarding SARS

                                                               iii.      To  be the principal resource person to answer queries, provide advices to clients who will call at the MDH SARS Hotline

 

 

3.       The Emergency Room Officer (Resident / Intern)

 

a.       Aside from the usual functions, they also act as alternative resource person to entertain calls at the SARS HOTLINE

 

4.       The Medical Resident-on-duty

 

a.       He is a senior resident of the department with the following functions:

                                                                  i.      Admits SARS suspect patient to assigned room

                                                                ii.      Informs the assigned Infectious Disease Consultant and Pulmonology Consultant of the admission

                                                               iii.      Accompanies the SARS suspect during ambulance conduction when necessary.

 

5.       The Nursing Staff

 

a.      The  Shift Leader

 

                                                                  i.      Aside from his usual functions, he checks the supplies needed to attend to a Probable SARS patient who is admitted at the ER i.e.: N95 masks, disposable gowns with hood, disposable gloves, goggles, disposable footwear

 

                                                                ii.      He informs the  ff: personnel of the admission:

1.       Nurse supervisor on duty

2.       Staff nurse of the 11F

3.       Radiology Technician on duty for CXR

4.       Medical Technologist on duty for blood extractions

5.       Respiratory Therapist if patient is intubated

 

                                                               iii.      Makes sure that the intercoms are properly disinfected every shift.

                                                               iv.      Updates SARS Advisory located at the façade of the ER daily

 

b.      The Staff Nurse

 

                                                                  i.      Aside from his usual functions 

1.       he carries out the orders of the physician admitting the probable SARS patient

2.       he does the charting

 

 

 

 

LOGGING OF PATIENTS

 

         All patients with fever or respiratory symptoms interviewed at the triage will be logged in a logbook separate from the ER logbook.  The logbook will contain the following information:

 

1.       Date of consult

2.       Name, age, sex and contact numbers of the patient

3.       Date of arrival from SARS and / or date of exposure

4.       Disposition made at the ER

 

The disposition will depend on the DOH SARS guidelines, i.e.

            SARS SUSPECT           -           send to referral hospitals

            NON-SARS SUSPECT   -           advice regarding personal surveillance

                                                            Provide MDH SARS HOTLINE

 

Another logbook will be provided for those patients transferred to a SARS REFERRAL HOSPITAL with the following information logged in:

 

1.       Date and route of transport

2.       Duration of patient transport

3.       Names, contact information, and specific duties of transport personnel

 

PATIENT CONDUCTION

 

         DOH mandates “No self-conduction” for SARS suspect, thus, suspected cases of SARS will be conducted to either the Research Institute of Tropical Medicine (RITM) in Alabang or San Lazaro Hospital (SLH) in Manila using the ff: vehicles for conduction:

 

                                                               i.      Fierra type vehicle of MDH for stable patients

                                                             ii.      Ambulance of MDH for toxic patients

 

         This aims to ensure that the SARS Suspect will proceed to any of the aforementioned hospital for further evaluation and to prevent further spread of the disease to possible contacts like the taxi driver, passenger of public vehicle and others.

 

         SARS SUSPECT patient will be charged a conduction fee of P500.00 for RITM and P100.00 for SLH..

 

         To keep the exposure of the MDH Driver to SARS to a minimum while conducting the SARS patient:

 

                                                                   i.      he is provided with an N95 mask, disposable gloves and gowns

                                                                 ii.      the patient is made to wear a surgical mask which the ER has earlier provided

                                                                iii.      the passenger area of the vehicle  will be enclosed to separate the driver from the patient

 

         In conducting toxic or unstable patients, the assigned Medical Resident on duty and an ER Staff Nurse will accompany the ambulance conduction to the aforementioned referral hospitals.

 

ADMITTING A PROBABLE SARS PATIENT

 

         As a general policy, Manila Doctors Hospital will not admit SARS Suspect except when the SARS Suspect is in severe respiratory distress and needed intubation and transfer to any of the referral hospital is not plausible.

 

         Once admission of a SARS Suspect is inevitable, it is the ER Policy to:

 

                                                               i.      Admit these patients only at the HOLDING AREA. 

                                                             ii.      Minimum number of MDH Staff will attend  to the admission i.e.:

·         Medical Resident on duty to admit the patient

·         Staff Nurse on duty to assist the physician

·         Radiology Technician on duty for CXR

·         Medical Technologist for laboratories

 

If additional staff is necessary, the ER Intern on duty and another staff nurse will provide the needed personnel.

 

                                                            iii.      The aforementioned staff will have to be properly attired i.e.: N95 mask, goggles, disposable gown with hood, disposable footwear and gloves.

                                                            iv.      The patient must be transferred immediately  to the designated room at the 11F which has been arranged by the staff at the main ER

                                                              v.      During the transfer of the patient from the Holding Area to 11F, the ER Staff at the Main ER must wear their N95 masks.

                                                           vi.      Once vacated, the Triage / Holding Areas will be closed temporarily until proper decontamination by the housekeeping will be made.

 

DECONTAMINATION

 

         Thorough and proper decontamination will be provided by the housekeeping in the following scenarios:

 

1. SARS Suspect leaves the Isolation Room.

2. Admitted Probable SARS is transferred to 11F

3. As soon as the MDH Ambulance returns to MDH from conducting SARS Suspect / Probable SARS

 

         The ambulance will be initially decontaminated by the ambulance driver as soon as the patient is transferred to the referral hospital before he leaves the place.  The driver will be provided by the Housekeeping Department with the needed chemicals for decontamination and instructions on the decontamination procedure.

 

REFERRALS

 

         The MDH ER will NOT ACCEPT SARS SUSPECT referrals from other hospitals.

 

SARS HOTLINE

 

         523-6913 will be designated as the SARS Hotline for the hospital.  The phone is situated in the Conference Room of the MDH ER.

 

PROTECTION FOR THE ER STAFF

 

         The ER Staff will be provided with an ordinary surgical mask for daily use.  The N95 mask and other needed personal protection equipments (PPE) will be provided when a particular staff will attend to a SARS Suspect and Probable SARS at the TRIAGE / HOLDING AREA.

 

         The Security force personnel guarding the front and back doors of the ER will be provided with an N95 mask to protect themselves since they will be the first personnel to interview the patients.

 

         The Ambulance Driver who will conduct the SARS Suspect and Probable SARS to referral hospitals will also be provided with an N95 mask and other necessary PPE to protect them.

 

PROTECTION FOR THE PATIENTS

 

         SARS Suspect will be provided with surgical masks prior to transport to referral hospital.

 

         To further protect the patients at the Main ER from possible exposure to SARS, only 1 companion for unstable patients i.e.: patients brought in via stretcher and wheelchair and for pediatric patients will be allowed, otherwise, under no circumstances shall a companion be allowed inside the ER.

 

         When possible, all OPD cases will be directed to the clinics of available MDH consultants and to the Pre-paid Department.

 

         Blood donors who are seen at the ER when the Pre-paid Section is closed will be examined at the Laboratory Department instead to prevent possible exposure at the ER.

 

TRAINING

 

         Frequent updates and training for the ER Personnel and Guards will be conducted by the designated ER Training Officer at the Conference Room.

 

 

These policies are made to guide and protect our Hospital Staff and Clients from possible SARS exposure in every effort that we can.