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