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Ward Protocols

How to Receive a New Patient

A new patient usually comes into the wards either from emergency or from out-patient department (OPD). Following things need to be carried out when receiving a patient:

1. Initial Assessment

  • Take vitals of the patient — BP, Pulse, Temperature, Respiratory Rate
  • If you find anything serious or unexpected (e.g., fits in a patient of stroke, or high blood sugar in a patient admitted for a routine hernia operation), inform your senior on call immediately

    • 2. Review Admission Notes

  • Carry out any urgent advice written on the emergency chart or on the admission slip
  • Review the reason for admission and preliminary diagnosis

    • 3. Create Ward Chart

  • Make a new chart for the patient — the ward chart
  • Fill in the patient's Biodata with date and time of admission
  • Append the admission slip (if from OPD) or the emergency chart to the new ward chart

    • 4. Write Receiving Notes

  • Under "Receiving Notes", document:

    • - Vital signs

    - Current clinical status (e.g., "patient is in respiratory distress and is irritable")

    - Any immediate concerns

    5. Baseline Investigations

  • If admitted through OPD, send baseline investigations:

    • - CBC (Complete Blood Count)

    - RBS (Random Blood Sugar)

    - RFTs (Renal Function Tests)

    - LFTs (Liver Function Tests)

  • If patient is above 40, diabetic, or has known heart disease: ECG
  • If patient has cardio-respiratory problem or needs general anaesthesia: Chest X-ray

    • 6. Emergency Investigations

  • If the patient came from emergency, ensure all investigation reports are collected
  • Review the reports and notify your senior of any abnormal findings
  • Append reports to the patient's chart and take necessary action

    • 7. Drug Chart

  • Write drug chart according to the Ward Advice written on the emergency chart
  • When in doubt, ask your Postgraduate (PG)
  • Ensure the new patient receives first doses of prescribed medicines

    • 8. Special Considerations

  • A large number of drugs that are otherwise used routinely may be contraindicated or need dose modification in patients who are:

    • - Pregnant or lactating

    - Have renal and/or hepatic impairment

  • Be very careful when writing drug charts for these patients
  • If in doubt, consult the pharma guide and your seniors

    • 9. Pregnancy Check

  • In female patients of childbearing age, ascertain if she is pregnant
  • If the patient is not sure, consider a pregnancy test
  • Investigations involving radiation exposure (X-rays, CT scans, contrast studies, radionuclide scans) are generally contraindicated during pregnancy