Department of Orthopaedic Surgery

SOPs

Dept. data last updated on :20/11/2021

Orthopaedic Surgery


Standard operating procedures (SOPs)


Department of Orthopaedic Surgery

J.N.Medical College, Faculty of Medicine, AMU, Aligarh, UP-202002



SOP/OPD5-001, SOP/IPD-002, SOP/OT/EOT-003

SOP/EM-004, SOP/OF-005



Contents

Purpose

Scope

Sops for Orthopaedic OPD-5

SOPS for orthopaedic IPD (ward5&7)

Sops for Orthopaedic Elective and Emergency OTs

SOPs for Orthopaedic Emergency patients

SOPs for Department and Office


1.       Purpose:

  1. the utilization of physical, academic and supportive facilities for Orthopaedic OPD, IPD, OTs (Routine and Emergency), and Emergency care of patients.


2.       Scope:

The scope of this document mainly covers the various patient care facilities and Postgraduate teaching and training activities in the department of Orthopaedic Surgery.



Standard operating procedures (SOPs) for Orthopaedic Outdoor Patient Department (OPD)

SOP/OPD 5-001

Purpose-

Scope- to create a friendly, caring and efficient atmosphere and to maintain a high standard of care to all patients attending the orthopaedic OPD as per the need and expectations of the patients and to enhance patient satisfaction.

Scope-

It covers the old and new patients visiting the Orthopaedic OPD-5 for consultation, diagnosis, investigations.

Responsibility-

The orthopaedic consultants and supportive health care staff including hospital administration will be responsible for the smooth functioning of Orthopaedic OPD.


Standard procedures-

  1. The names of the consultants on respective OPD days will be displayed in the OPD area.

  2. OPD registration desk will be handled by the designated supportive staff.

  3. The patient treatment card will be made at common registration counter in the main reception hall of OPD complex.

  4. Patient will reach the Orthopaedic OPD-5 at the OPD registration desk.

  5. The clerk will register the patient into the OPD register and a token number will be provided to the patient

  6. The consultant on duty and other team members will reach the OPD on time as specified by the hospital administration.

  7. Patients will be assessed by the consultants himself and in his supervision by other team members.

  8. Privacy of the patients will be maintained while doing clinical assessment.

  9. Patient examination tools like knee hammer , goniometer and measuring twill be available in the consultation room

  10. Relevant chief complaints and clinical examination findings will be recorded on the treatment card by the consulting doctor

  11. Request form for x-ray and other blood tests will be filled properly by the trainee doctors and MBBS interns posted in the OPD.

  12. Admission of patients will be done as per the requirement in individual patient.

  13. The process of admission to the patient will be explained to the by trainee doctors

  14. Acutely ill patients will be admitted on priority basis 

  15. Patients needing referral to other OPDs will be referred stating exact problem for which referral is being done?


Standard operating procedures (SOPs) for Orthopaedic Indoor patient Department (IPD)

SOP/IPD-002

Purpose-

Scope- to create a friendly, caring and efficient atmosphere and to maintain a high standard of care to all patients being admitted the orthopaedic IPD as per the need and expectations of the patients and to enhance patient satisfaction.

Scope-

It covers the patients getting admitted to Orthopaedic IPD Ward5 (Male patients) and Ward 7 (Female patients) for the detailed work-up , diagnosis, investigations and treatment.

Responsibility-

The Department of orthopaedic surgery and hospital administration will be responsible for the smooth functioning of Orthopaedic OPD.

Standard procedures


Steps

Activities

Time /No

Responsible Persons



General






A. House keeping

   1. Mopped & Swept the floor

Cleaner/ Ward in-charge / 

   2. Clean toilets

3. Fans, Walls, Roots, Doors & Windows are cleaned dusted.

4. Tap water supply 24 h

5. Attendant (Full time) for serious patient

6. Visitors as per schedule



As per instructions from Hospital administration


Ward boy/Sister / Nursing

Supervisor

A.   Facilities

1. Doctors/Nurse /Aya wear their dress &badges

Aya / wardboy

/ Sister / Nursing

Supervisor

2. Investigation Forms/Registers Report, Record in registration History sheet.


3.Discharge forms, Death certificates,Temp chart, intake & output chart, 

Sister incharge

/ Nursing Supervisor



4. Bed linen, pillow, pillow cover, Bedside locker, Mosquito net, Mosquito net stand available according to need.

Sister in charge

/ Wardboy / Aya / Nursing Supervisor

5. Stock ledger & required register, like handover & takeover of charges (shift wise) made available.

Ward Nurse










Steps


Activities


Time /No

Responsible Persons

STEP-1

Reception and Registration

1.First attend duty room

2.Registration in IPD Register

3.Bed allocation & Preparation

4.Send the Patient to bed

5.inform Doctor on duty


As per instruction from hospital instruction


Hospital administration

STEP-2

A. Examination

* Check c ase sheet supplied from

emergency / OPD

* Ask chief complaints

* History

„                    Present

„                     past

„                    Family

„                    Personal

„                    Menst. & Obst history of female

patients

Physical examination

       Pulse,BP,Temperature, Dehydration

      Anaemia,Cyanosis,Oedema

     Jaundice,Clubbing

     Koilonechia,Height & Weight

    Heart,Lung,Liver,Spleen,Kidney

   Other syst. exam if needed.

   Detailed Orthopaedic Examination


Investigations.

* Necessary investigations:


As per instruction from hospital instruction

Respective doctors








Respective doctors











Pathologist/Radiaologist/ Medicaltechnologist/ Doctors



„                   












Steps


Activities


Time /No

Responsible Persons


B. Diagnosis

* Provisional diagnosis

* (Clinical diagnosis)


* Diagnosis written clearly


C. Treatment

Treatment will be given after Signature of Doctor


D. Diet & Nutrition

Breakfast, Lunch, Dinner


As per instruction from hospital administration

Respective doctor















Ward nurse staff

STEP-3

A. Further treatment

„                    Counseling to the patients needing surgical intervention

„                    Inform patient / attendants well ahead of surgical procedure



As per instructions from Hospital administration





Respective doctor






-Routine Case




-Emergency case at once

Respective doctor


C. Transfer

„                    If the patient is improved then inform the patient regarding discharge.

„                    Verbal advice and explanation needed for illiterate patient



Respective doctor





    Follow up- in The OPD




   






Steps


Activities


Time /No

Responsible Persons



    If death sent to mortuary/ death house/isolation place/ handed over to relatives.


Respective doctor/ward staff



SOPs for Orthopaedic Operation Theatre

SOP/OT/EOT-003


Purpose:

The purpose of this document is to provide a written set of instructions to the concerned health care staff for managing Orthopaedic Operation Theatre for quality patient care for routine elective surgeries.


Scope:

The scope of this procedure covers the patients selected mainly for elective and emergency orthopaedic surgical procedures.

Responsibly

  Theatre Incharge:

a)   Responsible for administrative aspects of OT including the scheduling of surgeries as per priorities and seriousness of posted cases.

b)   Responsible for developing and implementing that OT aseptic and environmental sterility practices mentioned in the Infection Control and Hygiene procedure.

c)   Responsible for formulating the OT protocols and procedures.


OT Assistant (Senior / Junior):

a)  Is responsible for booking & rescheduling of cases to be performed in OT and preparing the OT list for the next day.

b)  Ensure all the instrument / linens are autoclaved / sterilized respectively to be used for subsequent operation,

c)  Performs routine Check & recording of proper functioning of equipment 

d)  Ensures that infected cases are taken at the end of the list of surgeries for the OT,

e)  Ensures that OT is fumigated; instruments / equipment are disinfected and cleaned after infected cases are operated,

Staff Nurses:

a)  Is responsible for receiving & handing over of patient along with respective patient’s case file, diagnostic reports duly filled and signed by concerned doctor / specialist,

b)  Is responsible for preparation of patient for operation including ensuring site shaving, antiseptic application and draping of the site.

d)    Is responsible for setting up of OT table for specific operation with required instruments/ linen/ equipment,

e) Is responsible for assisting the entire surgery team during the process of entire operation,


Sweeper:

a)   Responsible for Cleaning / Scrubbing of the OT, recovery room and associated area as per procedure specifications provided by the infection control program.

b)   Responsible for proper segregation of different categories of wastes generated after every procedure and handing it over to the Biomedical Waste collection personnel.

c)   Responsible for assisting OT I/C & Staff Nurse in Fumigation/ Sterilization/ autoclaving inside OT,


3.       Standard Procedures

Sr. No

Activity

Responsibility

Ref. document /Document

4.1

Scheduling of Surgery



4.1.1

An OT list prepared and dully signed by the surgeon informs the OT technician staff as well as the anesthetist. This OT list includes the date and type of surgery to be performed.

  Surgeon

OT List

4.1.2

The OT Technician and concerned anesthetist prepare as per the requirements in OT list.

OT technician/anesthetist

OT List

4.1.3

He forwards the details of the OT bookings to

the OT Incharge and Anesthetist.

OT Technician


4.1.3

Operating List exhibited on the notice Boards of the theatre.

OT Incharge

Operating list

4.1.4

Emergency cases are accorded priority by the

OT In-Charge of Operation Theatre.

OT Incharge





This may require rescheduling of planned surgeries which is intimated to the concerned

authorities.



4.2

Pre-operative Procedure



4.2.1

Surgeon gives written pre-operative

instructions to ward nurse e.g. Nil orally, enema etc.)

Staff Nurse


4.2.2

Physical Preparations (Shaving of site, enema,

bath, dress, valuables / jewellery) is done

Staff Nurse with assistance from ward attendant


4.2.3

Staff nurses receive the patient sent from the ward and transfers him / her to the pre- operative area with the assistance of the

attendee.

Staff Nurse


4.2.4

Written Consent for Surgery is obtained

from the patients / patient’s relatives.

Staff Nurse

Consent

4.2.5

Staff nurse conducts the following pre- operative checks.

Medications

Patient Identifications

Case Record and Investigation Reports / Films

I.V. Fluids

Blood Requirements

Prophylactic Antibiotics (If prescribed)

Staff Nurse

Preoperative Checklist

4.3

Pre-operative Anesthetic Checks



4.3.1

A pre-operative evaluation of the patient is done by the anesthetist for all cases posted and admitted for surgery a day prior to the surgery. In case the patient is not deemed fit for surgery, the Surgeon and Nursing In- Charge for OT is informed through the ward nurses. In emergency case pre anesthesia

check up is done in emergency/OT.

Anesthetist

PAC form

4.3.2

Post receiving of the patient at the OT the anesthetist verifies the identity of the patient against details provided in the case sheet with

the patient   and does a quick evaluation of the patient’s vitals and records

the same in the case sheet.

Anesthetist

Case Sheet





4.4

In Process Checks during Surgery



4.4.1

The Scrub Nurse controls the number of sponges on the table. At the commencement and the closure of the surgical incision, the scrubbed nurse counts the sponges used and satisfy herself that these are correct & inform

the surgeon accordingly.

Scrub Nurse


4.4.2

The surgeon verifies himself that all swabs have been counted for, before the closure of the surgical incision. In the case of any discrepancy in the number of swabs, the surgeon records this fact on the case sheet of the patient and informs the Civil surgeon/

Deputy medical superintendent.

Surgeon

Case Sheet

4.4.3

The surgeon keeps the scrubbed nurse informed of the location of swabs in the operational field to facilitate her counting. After the first count has been taken, the scrubbed nurse and the surgeon carefully check the number of swabs still in use.

Before the closure of the incision a final count

is to be done

Surgeon/ Scrub Nurse


4.4.4

The scrub nurse checks all the instruments on the operating table and the hemostat clamps immediately before the operation. Under the supervision of the surgeon the scrub nurse checks the instruments and hemostat clamps again before the closure of the surgical

incision

Scrub nurse


4.4.5

The scrubbed nurse counts all the needles on the table before the commencement of the operation. As a rule, the scrubbed nurse does not part with the second needle till the first is returned to her by the surgeon. In the event of

more than one needle being in use at the same

Scrub nurse



time, the scrubbed nurse takes care to see that all the needles are returned to her. The scrubbed nurse makes a count of the needles before the closures of the surgical incision. In the event of any discrepancy, the surgeon is

informed promptly.



4.5

Post-Operative Care of the Patient



4.5.1

Post operation the patient is shifted the Recovery Room or Post Operative Ward and

thereafter supervised by concerned specialist.

Ward Nurses


4.5.2

A provisional Surgery Note containing the details of the surgery is prepared by the surgeon with his signature before the patient

is transferred out of OT complex.

Surgeon

Surgery Note

4.5.3

Detailed post operative care instructions are

documented in the case sheet by the surgeon.

Surgeon

Case Sheet

4.5.4

The patient is transferred from recovery room towards (in case the patient was shifted to recovery room) after verifying his/her progress.

Surgeon and anesthetist


4.5.5

Operative surgeon and if required Anesthetist supervises the Post- Operative Patient in the Post- Operative Ward (in case patient was transferred to Post-Operative

Ward) for the progress.

Surgeon/Anesthetist


4.6

Operation Theater Asepsis and

Environment Management



4.6.1

The staff nurse conducts daily checks of the cleanliness of the OT. She ensures that all areas found soiled are again cleaned under her

Supervision.

Staff nurse


4.6.2

The staff nurse ensures that OT surfaces,

tables and instruments are scrubbed with disinfectant agents on a daily basis.

Staff Nurse


4.6.3

Staff nurse / OT Incharge ensures that the OT is fumigated as per directions from hospital administration.  The details of the

fumigation will be recorded in the Fumigation Register.

OT Incharge

Fumigation Record Register





4.6.4

All personnel entering the OT will wear OT gowns / dress including footwear and undergo proper scrubbing procedure to ensure sterility

of the clean areas.



4.7

OT Documentation



4.7.1

The details of regarding Anesthesia are noted

in the Anesthesia OT notes/Register.

Anesthetist

Anesthesia OT notes/register

4.7.2

Anesthetist notes down all the drugs and consumables, which are used during the surgery in the Operation Theater Indent

Register.

Anesthetist


Anesthesia OT notes

4.7.3

Trainee doctor records the details of each surgery performed in the  Surgery Registers



Trainee doctor

Surgery register for   Orthopedics

4.7.6

Staff Nurses maintains the inventory of

OTconsumables and medicines.

Staff Nurse

Inventory Register

5

Emergency operations theater (EOT) (Orthopaedic Surgery)

5.1.1

Following surgeries will be given priority for operation in the

  • Open/compound fractures

  • Acute infections of the bone and joint

  • Acute compartment syndrome

  • Other cases as per the decision of the concerned orthopaedic consultant

Orthopaedic consultant and team

Patient case sheet

5.1.2

The emergency orthopaedic surgery call to the anesthetist will be sent through a call register

Orthopaedic Consultant and team

Call register

5.1.3

Appropriate preoperative work-up will be done for each patient being operated in the EOT

Orthopaedic Consultant and team

Patient case sheet

5.1.4

Postoperative monitoring of patients being operated in EOT will be done by concerned Orthopaedic and Anesthetist team.

Orthopaedic and anesthesia team

Patient case sheet


Purpose:-

The purpose of this section of present document is to provide written procedures to be followed while delivering orthopaedic healthcare to the orthopaedic emergency patients. 

Scope:-

This section of the document will cover the patients attending the JNMCH modern trauma centre with orthopaedic disorders viz. fractures, dislocations, acute bone and joint infections and other relevant conditions.

Standard procedures:

1.      All patients will report to the emergency and dedicated trauma centre of J.N.Medical College, AMU, Aligarh.

2.      Non ambulatory patients will be provided the facility of wheelchair or stretcher as per the requirement

3.      Assistant casualty medical officer (ACMO) on duty will be the first person to attend the contacted by the patient.

4.      After initial resuscitation and treatment on duty ACMO will inform to Orthopaedic team on duty about the patient, who will attend the patient in emergency department as per the ATLS protocol.

5.      The Emergency orthopaedic team will inform the senior resident on duty about the patient.

6.      Consultant on call will be informed about the patient by senior resident

7.      If patient is stable and ambulatory the patient may be send to emergency orthopaedic team by ACMO

8.      In patients with medico legal implications all MLC formalities will be completed by CMO.

9.      Patients will be assessed by thorough history taking and detailed clinical examination by the orthopaedic team and investigated appropriately.

10.    Patient not requiring surgical interventions will be advised conservative treatment and sent home same day.

11.    The patient requiring surgical intervention will be admitted under the concerned unit.

12.    Life and limb threatening conditions such as Acute compartment syndrome, compound fractures will be given priority for emergency operation theatre

13.    The consultant on call will take the evening round in the emergency.

14.    The case sheets of all admitted patients will be completed and maintained by the resident doctors of the concerned unit.



SOPs Department and Office

SOP/DO-005


  • Purpose:-

  • Scope:-

  • Standard procedures:-

    • The office staff should attend the office regularly and punctually.

    • Any leave to be availed by the office staff should be informed well in advance wherever possible.

    • A movement register will be maintained in the office.

    • Covid-19 appropriate behaviour will be followed in the office of the department.

    • Methods of prevention of Covid-19 will be displayed in the office premises

    • Automatic sanitizer dispenser will be installed at the entry of the department.

    • Various IT resources (viz, desktop devices, portable and mobile devices, networks including wireless networks, Internet connectivity, external storage devices and peripherals like printers and scanners) available in the department of orthopaedic surgery should be utilized as per the guidelines released time to time by the competent authority.

    • Electronic equipment will be switched off when not in use.