Rules and regulations in the ICU

. Visiting and accompanying system

1. Visitors, except preschool children and infectious patients, are allowed in the specified time and two at a time.
2. To visit critical patients, visitors can go to medical and nursing staffs with a critical condition list for special arrangement.
3. Companions must observe the hospital regulations and follow medical staffs instructions. Keep clean, tidy and quiet in the ward. Take care of public property. Without permission, dont read patients case history or other medical record, nor to take patients out of the hospital. Dont talk about matters that are harmful for patients health and treatment. Dont sleep in patients beds. No smoking. No liquor. No waste of water and electricity.
4. Any visitors or companions need compensate the hospital goods that they damage or lose.

. Management system of small cabinets in the ward

1. All medicines in the small cabinets are only for in-patients, used according to doctors instruction. No one else can take them privately.
2. The small cabinets should be staffed with particular personnel to take charge of the drugs dispensing and safekeeping.
3. Check and examine the drugs at regular intervals to prevent the drugs from overstocking and deteriorating. Stop taking discolored and overdue drugs or drugs which have precipitate or fuzzy labels, and report to Pharmacy department.
4. Narcotics, marijuana and other restricted drugs should be stored and locked up in special drawers. Meanwhile, keep certain base number of the drugs. Strictly perform according to the management and regulation of narcotics, marijuana and other restricted drugs after any restricted drugs are used.
5. Pharmacy department should examine and check whether the types and number of drugs are right, whether any drugs are overdue and deteriorated and whether the management of narcotics, marijuana and other restricted drugs accords with regulations in the ward small cabinets at regular intervals

. Principles for Admittance into ICU

ICU is for treatment of critical patients. Any patients who have unstable vital signs and hope of survival can enter ICU. In principle, patients are transferred to ICU after they get hemodynamic stability and respiratory channel to avoid danger in the transferring.

Specific diseases:
1) Various severe shocks;
2) severe heart failure;
3) severe miocardial infarction;
4) severe arrhythmia;
5) acute lung injury, ARDS;
6) severe respiratory failure;
7) severe intrarenal acute renal insufficiency;
8) severe hepatic insufficiency;
9) MODS(MOF)
10) DIC
11) severe metabolic balance dysfunction;
12) coma;
13) severe body fluid imbalance;
14) all kinds of severe poisoning;
15) severe heat stroke;
16) severe trauma with multiple injuries;
17) crush syndrome;
18) fat embolism syndrome;
19) severe obstetrical complication;
20) after operation of CPCR;
21) after major operations and general anesthesia

In the following circumstances, patients are not allowed to transfer to ICU in principle.

1. Infectious diseases
2. End-stage of all kinds of chronic diseases, e.g. terminal malignant tumor
3. Inferior economic status

. Rules and Regulations for Patients in ICU

1. ICU responsibilities are to maintain important organs function, the stability of vital signs, nutritional support and every kind of detection and monitoring, to correct the imbalance of water-electrolyte and to control and prevent infection, and so on and so forth.
2. Clinical departments and ICU should cooperate whole heartedly with each other on the basis of mutual understanding. The issues of severe combined injuries, inter-departmental patients, major alteration and implementation of treatment project, and the choice of patients indications in and out of ICU, etc. should be settled by joint consultation between ICU and every department in principle. ICU should fully respect treatment suggestions of departments. When they have different treatment plans, they can organize consultation in the hospital. When they have disagreement on indications and the direction of transferring, director of ICU can make the final decision, shouldering both power and responsibility.
3. ICU should speed up turnover of patients according to their disease condition, benign or malignant, chronic or acute, in order to increase the utilization ratio.
4. Various systems related to medical management, e.g. discussion of difficult and complicated cases and of death issues, have to be carried out according to unified regulations. Both ICU and related departments should be involved in the implementation when necessary.
5. ICU and clinical departments share both profits and risks as far as the distribution principle is concerned.

. Rules and Regualtions for the Ward

1. Head-nurse is in charge of the management of the wards with active assistance of doctors-in-charge and senior resident doctors.
2. In order to ensure a good working environment for intensive care and prevent patients from cross-infection, no companions are allowed to stay in the wards. Family members can leave a telephone number to keep in touch.
3. Doctors at all levels do their own part with different areas of responsibilities. Chief physicians need to go the rounds of the wards at least once every week while doctors-in-charge twice every week. Critical patients need to be visited at any time.
4. Major rescuing matters concerned need to be reported to the department director, the division of medical affairs and related leaders. Get involved in the rescuing by commanding. Patients rescue concerning various problems and controversies should be reported to the division of medical affairs and other related departments in time.
5. Keep the ward clean, tidy, quiet and safe. Avoid noises. Do everything quietly including walking, closing door, running business and talking.
6. Medical staffs must wear clean and tidy work clothes, and wear respirators when necessary. No smoking in the ward.
7. Hospital staffs must hold their positions, strictly go through relief system and execute various regulations of technical operation, and work up various critical patients rescuing procedures and intensive care criterion.
8. Head-nurse takes overall responsibilities for safekeeping the property and equipment in the ward, and respectively assigns dedicated personnel to supervise, establish accounts and check the amount at regular intervals. Any loss caused, they should find out reasons in time and deal with it according to the regulation. When supervising people are transferred, go through the hand-over formalities.
9. In the ward fully prepare a wide variety of salvage equipment and drugs. Ensure that there are dedicated personnel who take care of them, and that they are in a fixed place and ready for using at any moment. Besides, there are specified people responsible for their check-up, supplementation, renewal, maintenance and disinfection.

. Rules concerning Medical Disputes

1. Reception personnel should have a strong sense of responsibility, listen to visitors patiently and make notes carefully. Dont make quick comments on any problems. Try hard to do guiding work.
2. Reception personnel should keep calm and cool. Dont give positive or negative answers immediately. Explain work patiently to visitors after analysis of investigation. Any department or individual can not give definite answers to any medical dispute without permission before the malpractice appraising committee makes definite conclusion after discussion.
3. Any medical treatment record is sealed up for keeping by the record room, which is informed by Medical Department. Any individual has no right to borrow or read the record after sealing except people who are in charge of the medical dispute. If the department needs the record for case discussion, the record should be kept by director of the department or specified person and returned to the record room in time. Dont scatter or lose any record.
4. If disputes are caused by transfusion, check out immediately the voucher in the process of drawing, send the residual liquid to be tested, and seal original package of liquid properly until the disputes are resolved. If disputes are caused by medicine, keep well the empty ampoule or the medicine itself. If disputes are caused by all kinds of apparatus, make sure there are witnesses making field inspection before leaving the scene.
5. Disputes related to death, mobilize the family members to agree on autopsy in order to find out the cause of death. If the family members disagree, there is no other way to investigate responsibilities. People who disagree on autopsy take the responsibility for any consequences.
6. Inform the family members and work unit of the patient who has signs to injure himself or herself or suicide in hospital and take precautionary measures. If anything like this happens, take rapid on-spot-rescue if the patient has hope of survival and report to Medical Department and the security department immediately. It is legal to move the patient to the rescue room for salvage rather than destroy the scene. If the patient has no hope of survival, leave him or her where he or she is before the security department and Public Security Organs put on records. If there is any missing patient during his or her hospitalization, try every means to look for him or her at once and report to Security Section, Medical Department and Nursing Department.
7. Once disputes are investigated and verified, give reply to patients family members. Handle the disputes based on related evidence, principle and policy.
8. Minor medical disputes should be resolved in good time after investigation by administrators in Medical Department. Major medical disputes which can not be resolved in good time should be brought up to do accident appraisal.

. Rules and Regulations about Ward Round

1. Resident doctors go the rounds of the wards every working day, observe the changes in patients condition, make a diagnosis and give treatment, and learn about patients thought and living condition. When superior doctors visit the wards, doctors-in-charge should make ready for report of the state of illnesses.
2. The chief resident doctor or doctors on duty take resident doctors, refresher doctors and interns to go the night rounds of the wards.
3. Doctors-in-charge need to pay regular ward visits to the patients in the unit or ward every week and one special visit to every ward every day. Check medical care quality, pay special attention to the diagnosis and treatment of difficult cases and do clinical teaching.
4. The director of the department, the chief physician and the associate chief physician go the rounds of the wards of their department once every week or the associate chief physician twice every week. Check the quality of medical care, solve difficult problems and organize clinical teaching in a planned way. Doctors-in-charge, the chief resident doctor, head-nurse and people concerned need to accompany them to go the rounds of the wards.
5. Doctors at all levels should make more rounds of the critical patients before and after major operations or after special examination. Keep track of the changes in patients condition. Deal well with emergent cases and report difficult problems to superior doctors or apply for consultation.
6. Head-nurse together with nursing personnel go the nursing rounds of the wards once every week. Ask for supervision of directors of departments, chief physicians and associate chief physicians or doctors-in-charge. Check the quality of nursing, resolve difficult problems and organize clinical teaching.

. Rules and Regulations about watchkeeping and shifts

1. Arrange on-duty-doctors and add second-line and third-line on-duty-doctors when necessary. Keep an on-duty log.
2. On-duty-doctors come to the position before after work every day and undertake medical task from doctors at all levels and make their rounds of the wards. Take over the shift of critical patients at bed-side. When doctors on duty have not come to relieve guard, sickbed doctors in charge cannot leave.
3. Sickbed resident doctors in charge should write down key patients state of diseases and treatment on the shift log before off-duty. On-duty-doctors should keep record of course of disease and write them down on the log briefly.
4. On-duty-doctors are responsible for temporary treatment for patients and report to their superior doctors if there are difficult problems.
5. On-duty-doctors are responsible for initial diagnosis and treatment for admitted emergency patients and complete the emergency admission case history.
6. On-duty-doctors are responsible for emergency consultation in the hospital.
7. On-duty-doctors must stay at the specified place. Tell nurses on duty their whereabouts when they have to leave for work.
8. The next morning on-duty-doctors should hand over the disease state and treatment of emergency and key patients when relieving guard.

. Rules and Regulations about Transfer

   1) Due to constraint of technology and equipment in the hospital, incurable patients can be transferred to another hospital. It first has to be discussed within the department or put forward by the director of the department, and then submitted to Director of the hospital or the vice-director in charge of the professional work through Medical Department for approval. With their approval and contact in advance with the hospital which agrees to admit the patient, the patient can be transferred.
   2) When the patient needs to be transferred to a hospital in another city for treatment, it should be put forward by the director of the department, verified by Medical Department, approved by Director of the hospital or the vice-director in charge of the professional work, and submitted to provincial and city Basic Medical Insurance Office for Urban Workers for approval and going through formalities.
   3) Patients whose transfer to another hospital might make patients condition even worse or cause death should stay in the hospital for treatment. They can be transferred after their condition becomes stable or after danger. Critical patients should be accompanied by medical personnel during transferring.

Rules and Regulations in Emergency Department

Director of Emergency Department is

1) in charge of medical treatment, teaching, scientific research, prevention and administrative management;
2) responsible for making work-plan in the department, its implementation, regular supervision and examination, and summary report on schedule;
3) responsible for administrative management, professional guiding, checking on attendance and work of personnel on duty in various emergency section, and strengthening the connection and coordination with each medical department;
4) responsible for the ideological and political and medical moral education of the staff, and the improvement of the quality of medical services;
5) responsible for the improvement in the management of emergency observation room, making the rounds of the wards regularly, and resolving the problems in the diagnosis and treatment of critical, difficult and complicated cases;
6) required to organize medical care personnel to carry out professional studies, developing new technology and new therapy with the aid of advanced medical experience at home and abroad, doing scientific research work and summing up experience in time;
7) responsible for organizing and leading rescue work for critical patients;
8) obliged to check and supervise the personnel in the department to follow the technical operation convention of rules and regulations; preventing or dealing with any mistake or accident in time;
9) responsible for the arrangement of the shifts of emergency doctors, the decision-making in the admission to hospital and transfer, and organizing discussions and consultations of clinical cases;
10) responsible for the professional training and technical examination of the department personnel, proposing promotion, rewards and punishment, and arranging appropriately the training of staffs for advanced studies and interns;
11) to be assisted by vice-director of the department with corresponding work.

Responsibility system of initial emergency treatment

1) Common emergency cases are treated according to responsibility system of initial emergency treatment for outpatients. Nurses in the emergency room inform doctors on duty in related department.
2) For critical patients who are not belong to the category of the department, doctors giving initial emergency treatment should carry out regular rescue work in the first place and immediately inform doctors on duty in related department. When the reception doctors arrive, inform them of patients state of illnesses and emergency measures before leaving. If they leave before the receiving doctors arrival, doctors giving initial emergency treatment should be responsible for all the problems in the period.
3) If there is any complicated case which needs two or more than two departments cooperation during rescuing, the initial doctor should first carry out necessary rescue work and then inform Medical Department in order to immediately assemble doctors on duty in related departments, nurses and personnel concerned. When all the medical personnel arrive, the doctor who has the highest title of a technical post takes charge of the rescue work.

Working system in Emergency Department

1) Emergency Department should be open in 24 hours and receive patients at any time including holidays. Working personnel must make certain of the quality and task of emergency work and strictly follow the responsibility system of initial emergency treatment and rescue rules, procedures, obligations and the technical operation convention of rules and regulations. Master first-aid medical theory and rescue technique. Implement first-aid measures and follow the rescue system, separate treatment system, shift system, check system, treatment and nursing system, work system in observation room, work system in care unit and rescue room, medical record writing system, ward visit and outpatient system and sterilization isolation system. Personnel in each level should strictly perform their responsibility.
2) Nurses on duty should not leave the reception room. Nurses on duty should immediately inform doctors on duty in related departments of an emergency case and at the same time give certain medical treatment, e.g. body temperature, pulse, blood pressure, etc., and register the patients name, gender, age, address, exact arriving time and his or her work unit. Informed of an emergency case, doctors on duty should come to make a diagnosis in 5 to 10 minutes and give treatment. For any doctor on duty who refuses to come to emergency room to treat patients or who does not arrive after 10 minutes, nurses on duty can inform Medical Department or hospital leaders or contact with people in charge in related department. Find out the cause and seriously deal with it.
3) Clinical departments should choose doctors with high technical level to shoulder the emergency task and every chosen doctor needs to work at least for 6 months. Interns and practical nurses cannot keep watch on their own. Doctors attending in advanced studies can keep watch with the agreement of department director and the approval of Medical Department.
4) Medicine and equipment for rescuing in the Emergency Department should be fully prepared and managed by specified personnel. They should be kept in fixed places, examined regularly, supplemented, renewed, maintained and disinfected in time to ensure the need for rescuing.
5) With strong sense of responsibility and sympathy to emergency cases, medical personnel should make timely, right and swift treatment. Observe closely the change of their illness state and take careful notes. Difficult and critical patients should be rescued in the Emergency Department and sent to the wards when their state of illnesses becomes stable. For patients who need instant operations, send them to operation room without delay. Emergency doctors should have over the shift directly to the wards or operation room. Any department or individual cannot refuse to admit emergency patients or critical patients with any excuse.
6) After emergency cases are admitted to emergency observation room, emergency doctors write medical records and doctor advice and emergency nurses take charge of treatment. Observe closely the change of the illness state of emergency cases and take careful notes in order to adopt effective treatment measures. Observation time does not exceed 3 days or a week at most.
7) If there are any severe emergency patients, report to Medical Department, and leaders concerned in Nursing Department come to command in person. Any patients involved in legal disputes, try hard to rescue them and at the same time report to related department.

Watch keeping and shift system

1) Every department should have doctors on duty out of office hours or in holidays. Doctors can keep watch together or alone according to the size of the department and number of beds.
2) Doctors on duty come to the department before after work every day and undertake medical task from doctors at all levels. Go the rounds of the wards and get to know critical patients state of illnesses after taking over the shift. Take over the shift well, especially the shift at bed-side.
3) Doctors in every department should write down the state of illnesses and treatment of newly admitted patients and critical patients on the shift log before off-duty and hand it over well. As for newly admitted patients and critical patients, they even should hand the shift over at patients bed-side. On-duty-doctors keep records of course of disease and medical treatment measures for critical patients and write them down on the log briefly.
4) Doctors on duty are responsible for temporary medical work and temporary medical treatment for patients. Examine promptly inpatients of emergency, write their medical records and give necessary medical treatment.
5) Doctors on duty should ask doctors in charge or their superior doctors for treatment when they come across difficult problems. When doctors in charge or superior doctors are not able to come in time, doctors on duty should ask the general on-duty-doctor for treatment in emergent rescuing.
6) Doctors on duty must stay in the watch-room overnight and should not presume to leave. When informed by nurses, they must go and see patients at once. If they leave for emergent consultation between departments or being second-line doctors of outpatient, they must tell nurses on duty their whereabouts and telephone second-line doctors in the department to take their place.
7) Doctors on duty still do routine work. If they do have no rest because of rescuing patients, they can be given compensatory time off according to specific circumstances.
8) Doctors on duty must report to doctors in charge or chief physicians the illness state of newly admitted inpatients and critical patients as keynote on the next morning meeting and hand over the treatment of critical patients and remaining work to be dealt with.