Our Colourful Board

This is our Ward 21 board... its FULL :) .. this is usual, for us, and with 28 patients.. we have at least 2 nurses working in one shift.

As you can see from the above picture, we have few colours on board.. those are the codes :). Usually early in the morning when the Medical Officers come to start their round, they will stop by at our counter and check on their patients according to the colours. 

As far as I know, the ward was actually coded BAY by BAY (Bay is the bigger section of the beds cubicle), but some patients has their priority, for e.g. needs of oxygen bed etc, therefore, its all jumbled up and scattered all over, but then again, we are trying our best to put the same colour code in one BAY as, each bay is usually being delegated to one NURSE. (eh macam tunggang tebalik kan ayat ku heheh). 

Therefore when a group of ONE colour is placed in one bay, that will make us easier, to follow the doctor's when they are doing their routine rounds, especially, when the foreign doctors who need translation are doing their rounds, 'cos when they don't see any nurse accompanying them they'll start "NURSE! WHo's doing rounds with me?" hahaha.. kesian kan.. :)

So that's all for now, re: Colour Coding.. I'll update some more on introduction to our Ward Management system ... (The Basic ones lah hehehe)

Welcome to Ward 21 and 22 - Male Medical Ward

WAKTU MELAWAT

The Internal Medicine Wards are basically, well known as the "Medical" ward, actually consist of the Female Medical Wards (Ward 19 and Ward 20), Male Medical Wards (Ward 21 and Ward 22), and The Neurology and Respiratory ward (Ward 4 - Mix Ward).

Our ward (Ward 21 and 22) is now merged, as one ward, where Ward 22 made as the ACUTE BAY and First Class rooms (only few available 'cos most of it are made as general room, in view of shortage of bed), where we receive new acute cases which needs close monitoring and those stable cases will be monitored in Ward 21. 

Our Cases :

Gastroenterology - Coded RED

Oncology - Coded RED

Endocrinology - Coded GREEN

Rheumatology - Coded GREEN

Cardiology - Coded YELLOW

Nephrology / Renal - Coded PINK

Cases we received (when there's no vacant bed in Ward 4):

Neurology - Coded BLUE

Respiratory - Coded BLUE

As claimed, we have the largest number of nurses working per shift, (excluding the ICU's nurses), also, we have the largest number of bed (it can reach up to 60 beds, includes the bunga which sometimes we make it up as a general room). Apart from having all these, we have made our best to meet up every patient's daily needs as patients' needs (physically and mentally) are our first priority. 

Until then, I will update some more.. SOON! ;)

p/s:

PATUHILAH WAKTU MELAWAT, BAGI MEMUDAHKAN PEMERIKSAAN DAN RAWATAN DI JALANKAN KE ATAS SAUDARA MARA, ABISKITA, SEKIAN TERIMA KASIH ATAS KERJASAMA YANG DI BERIKAN

Eid Mubarak

Selamat Hari Raya kepada Semua pegawai dan kakitangan Jabatan Perubatan Dalaman, Hospital RIPAS, Negara Brunei Darussalam, yang berugama Islam.

Daripada:

Jabatan Perubatan Dalaman

Ward 21 dan 22

Reverse Barrier Nursing

First of all, been trying to search for our MPK (Manual Procedure Kerja) for this issue, and I even searched it in our Nursing Procedure Manual, its either, I was too tired sampai nda ternampak or memang inda ada tia kali.

Anyhoo, talking (blogging) from experience (honestly aku ani baru jua setahun jagung *grins*).

What? and Who?

Say, a patient's FBC was found to have LOW WBC (White Blood Cell Count), the normal count will be 4000 to 11,000 cells per microlitre, this patient, should be imediately put in an isolation room. This patient will be having increases the risk of serious infection. (http://www.mayoclinic.com/health/low-white-blood-cell-count/AN00726)

Why?

Because .. White blood cells, or leukocytes, are cells of the immune system defending the body against both infectious disease and foreign materials (http://en.wikipedia.org/wiki/White_blood_cell).

How?

This is our Reverse Barrier Nursing notice sign, which we usually put up in our ward.

Additional:

If you are having flu, cold or fever, please do not enter the room. High risk of infection, that is.
Any outside food, are not advisable.
The patient should be advised to practice a healthy and hygienic environment.
Gargle, frequently.. not too frequent lah hehe

Where?

The patient should be isolated in a clean room, where, if it's possible, it shouldn't be just a room, but a room with his private bathroom and toilet.

I will elaborate more on these, when I have ample of information on these. Any comments or suggestion are almost welcome.

What We Have Been Doing... After Duties .. *grins*

Fizah and Uma at our February Picnic...

C Mas... Dengan makanannya (Pot Luck we had)

The future generations... TARIIkkk~

The Mom and Mommies to be... Yang sorang tu bila lagi? hehe

Iklan Minyak?

Boxing Day Outing

Bakat Terpendam *grins*

BBQ at SN Hjh Rahmah's place

The Nightingalessssssss????

Manager atu manager tah jua ehehehe

Ngaga Open Houses.. Tee Hee.. Mamam...

Not forgetting our spouses pun inda ketinggalan

Outing, cuci mata...

Mamam again... andang acivity sepanjang tahun ni, lepak makan.. Hi Tea.. Sungkai.. Busday party hehehehe

Lapas makan liat football match *winks*

Ulcers?

What's that white thingy? Any idea?

He was admitted few days ago, with history of swelling at both legs and having big "wound" at both legs, and not healing. He is bedridden and non-communicate. According to the relatives he used to crawl with his both legs and his butt support his movement, honestly I don't know how to explain (my English can be very bad sometimes.. teehee), and according to his daughter, he has not been eating for the past few days. That white thingy is actually his tendon, at the back of one of his right knee

Anyhoo the ulcer/sore which I uploaded above, is not actually build up from our care. He was admitted along with these! Guys... anything to comment? Please do.

Our usual nursing care for these is usually, turning, as in, you know, turning them to different position in every few hours (usually 2 hours). But how frequent are we doing it? Despite of the jobs pending that need to be attended, and also the shortage of staffs issues (no comment!). But at least we can do this in between our other jobs or as it should be called, nursing procedures. *grins*

Until then, I left this for you to think and discuss or even argue (I know one of these days, this issue will come up)

(The swelling actually had reduced, you can see from this picture :) )

p/s: Any social updates and activities are almost welcome :)

Losec Infused Intravenously around the clock??

Well, maybe some of you, might encounter and had done this before. But as for some of us, and as far as we know, Losec (Omeprazole) usually given intravenously, in bolus form.

Okay, here's the scenario:

A patient admitted with abdominal pain and malaena stool, who's actually a known case of Acute Duodenal Ulcer. On admission his had a low HB count, which I can't remember heeeheee, and for sure he had 2 pints of packed cell and emergency OGD.

He was then prescribed, IV Losec 80mg over 24 hours, and to our understanding, it means, around the clock. And so the nurses, started the infusion, diluting it with 100mls of Normal Saline and infused it continously.

The day after, one of the nurse manager realised, that the solution (diluted in the Burrette) had changed its color. Well go to basic pharmacology and the 5R's.. when it changes it's colour, you should've start to query, isn't it?

For over 24 hours, the solvent changed its colour, and according to the delegated pharmacist, it wasn't usually administered that way i.e. around the clock.

And so, the nurse manager started to query out with the doctors and pharmacists on duty. Then our pharmacist on duty give us a leaflet for referring :

Recommended Method of reconstitution and preparation

1. With a syringe, draw 10mL of solvent from ampoule.
2. Slowly add approximately 5mL of solvent into the vial with the freeze-dried Omeprazole.
3. Withdraw as much as air as possible from the vial back into the syringe in order to reduce positive pressure. This will make it easier to add the remaining solvent.
4. Add the remaining solvent into the vial & ensure adequate mixing of the content.
5. Please note that upon reconstitution and preparation of infusion mix. The solution shall be kept below 25 degrees Celcius and to be use within 4 hours.
6. Thus infusion mix needs to be changed every 4 hours and dose to be adjusted.
7. Infusion bag should be protected from light after preparation and during infusion period.
8. Example of Rx: 8mg/hr for 72 hours. Therefore total dose in 4 hours = 32mg. Withdraw 32mg out of the reconstituted vial and add in 100mL - 250mL (depending on fluid requirement/restriction) of Glucose 5% or Sodium Chloride 0.9%

The Nightingales

Nursing profession basically was founded as the modern profession by Florence Nightingale (1820 - 1910), who was well-known as "The Lady with the Lamp". There is where I had the idea to put this blog title after her name. Although, I had Rufaidah binti Sa'ad in my mind, but please don't argue why I didn't put her name. No Comment. Ahaks.

Anyhoo, this blog is especially dedicated to Internal Medicine (Ward 21 and 22) of RIPAS Hospital, Brunei Darussalam.

Any updates, or CNE stuffs, will be uploaded here.