Professional Documents
Culture Documents
Lecture classes
Tutorial session
Symposium
use
DAY 10
Gynaec history taking, Gynaec cases
DAY 11
Infertility
DAY 12
Lucorrhoea
DAY 13
Descending PV, Mass abdomen
DAY 14
Post menopausal bleeding
4
TH
SEMESTER
-4 weeks-
3 weeks
- AN history taking,Obs palpitation,Gyn. History taking , cases
4
th
week- Family Planning
Family planningDay 1 - Natural family planning & Barrier
methodsDay 2- IUCDDay 3- OCPDay 4 - Other hormonal
contraceptives
5
Day 5- InjectableDay 6- FemaleDay 7- Male sterilisation
5
TH
SEMESTER
-4 weeks-Clinical assessment &Management in brief
III A MBBS students
are attending clinical posting for a period of 6weeks
6
TH
SEMESTER
-6 weeks-
Clinical assessment
Peripheral centers postings
III MBBS Part A students:
⇒
Postgraduates are posted in OPD, Labourward, Antenatal
ward,Gynaec ward & Postnatal ward, peripheral posting by
rotation as peruniversity regulations.
⇒
The postgraduate students are posted under a particular
faculty inan unit by rotation.
⇒
Attendance register is maintained and the monthly
attendancereport is sent to the academic cell.
⇒
Postgraduates are mainly involved in examining patients,
followingup, management and progress of the patient.
⇒
They are also involved in bed side teaching & OMP
⇒
They see OP cases with a faculty presiding.
⇒
Complicated cases are shown and discussed by the
postgraduatewith unit faculties.
⇒
They are trained to perform minor procedures like D & C,
puerperalsterilization, IUCD insertions assistance in all major
and minorObstetric and Gynaec procedures.
⇒
They perform caesarean section, hysterectomy and
othergynaecological procedures with consultant assistance.
⇒
A separate logbook is maintained by each postgraduate student
forrecording academic activities
⇒
Classes scheduled by monthly and displayed in
postgraduate’snotice board. The monthly teaching schedule
consists of class topic,time and the faculty name.
1.
At patient entry, they register at the Medical Record
Departmentdepending on the complaints is registered to the
concerneddepartment
2.
Once the registration is made the OP file (medical record) of
thepatient is transferred to the outpatient department by the
MRDattender. The OP file is checked weather the file is
transferred toproper department or not and then received by
the departmentsecretary.
3.
The patients are called in the order of registration time and a
tokenis placed for every attended patient’s file serially. If the
calledpatient is not in the OP waiting hall, it will be informed to
the MRDand checked up for proper registration.
4.
The called patients are checked for Height & Weight by the
staff nurse.
5.
Patient is asked to wait till their turn comes. If the patient
conditionwarrants immediate treatment, she will be consulted
by aGynaecologist immediately.
6.
The patient’s history & presenting complaints will be entered
in thefile by the junior doctor. The patient history
includes:1.Presenting complaints2.Menstrual history3.Marital
history4.Obstetric history5.Previous gynaecological
history6.Medical & Surgical history7.Family history8.Personal
history
7.
A general examination is done by the junior doctor and
recorded onthe case sheet. The general examination includes
the following: BP,Pulse, pallor, edema, CVS, RS and
temperature.
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8.
Then the patient will be consulted by a consultant
Gynaecologist.9.The patient is thoroughly examined by the
consultant and aprovisional diagnosis arrived at. The
examinations are:Abdominal examinationVaginal
examinationSpeculum examination
10.
The required investigation to substantiate the diagnosis
isrecommended after counseling the patient & their attender.
11.
After the sample collected for the investigations the patient
isadvised about the probable time taking for investigation
report andthe report copy will be available on the patient’s file
at all. Theprobable time taken for investigation report is 2-3 hrs
from, someinvestigation report takes few days like culture
takes 3 days, forhistopathology 7 days, etc.12.The patient is
advised about the review date and if any medication.
13.
On report review, if any procedure is indicated by the
investigation,patient & the attender is explained about
procedure & its risks. Dateis fixed for the procedure if the
patient is willing to undergo thefurther procedure. If the
condition warrants and immediate medical /surgical treatment,
she is counseled regarding the treatment andadmitted. The
admission orders written by the Gynaecologist in thecase
sheet.14.The admission patient is shifted from the outpatient
area to theward by the OPD attender with the OP file and the
patient attenderis informed for wait in the IP patient attender
area.15.Day care procedure which do not warrant admission
and deal with inthe OPD and the patient discharged on the
same after when she isstable.
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Inpatient department
1.
Following admission to the ward, the patient is assessed and
if intensive care is necessitated the patient is admitted to the
criticalcare units of ward & monitored intensively.
2.
If the patient is admitted for a major / minor procedure the
requiredinvestigations which were ordered by the consulted
Gynaecologistare sent results are collected by the ward staff.
Pre-op protocolfollowed.3.If the patient is admitted for
observation, the results of theinvestigations and the patient
status are followed and informed bythe concerned ward interns
& resident doctor to the consultant.4.All nursing as well as
medical work is supervised by the unitconcerned in a standard
manner which includes conventional wardrounds taken, thrice
a day, in the morning, after noon and lateevening5.If any
complaints encounteded during the night is handled
byconsultant & resident on duty.
4.JOB SPECIFICATIONSHead of the department:
The HOD will function as the administrative head of her/his
department inaddition to the professional responsibilities
•
List of registers maintained in OG ward6.Format of work
instruction (operational instruction)Out Patient department
:
1.
Patient registeration at MRD
2.
File (Medical record) arrival to OP waiting area by MRD
attender
3.
Patient is called by the staff nurse and checked for patient
presencein OPD. If patient not present at OPD waiting area
verification isdone by OPD secretary.
4.
Patient is checked for Height & Weight by the staff nurse
5.
Patient is first seen by Resident doctor and the patient’s history
withpresenting complaints is taken by the Resident
doctor.6.Subsequently the patient is consulted, examined and
diagnosed bya Gynaecologist
7.
Advised for the investigation required, proposed line of
treatment.8.Explained for probable charges and duration stay if
anyhospitalization required.9.Procedures done in OPD:a.USG –
Pelvis, Obstetricsi.Patient takes a prior appointment, pays the
bill on thatparticular day & get USG doneii.It is done on the
same day depends on the urgencyiii.Explained consent
obtained for obstetric scanb.IUCD insertioni.Patient is advised
for IUCDii.Patient purchases IUCD at pharmacy
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iii.IUCD is inserted by the consultant and advised
aboutmedication and followupiv.The patient has to pay the
insertion procedure chargeand the miscellaneous
chargesc.Colposcopy & cervical biopsy
i.
Usually done by Papsmear result’s indication.ii.Colposcopy
directed biopsy is taken. If Colposcopy isnormal, no need for
cervical Biopsy
iii.
After the procedure the patient is advised for medicationand
report review (Histopathology report processing time- 7 days)
d.
Cryo cautary: following the histopathology report, if
indicatedpatient is offered cryocautery in post menstrual
phase.
10.
Inpatient :
•
Patient will be investigated for fitness for the surgical
procedureeither as an outpatient or inpatient depending on the
patientdecision.
•
The patient is admitted 2 days prior to the surgical procedure if
thepatient wants to do all investigations and fitness opinion as
aninpatient.
•
If high risk, patient will be admitted earlier depending on the
risk.
•
General Physician opinion and Anaesthethic fitness will be
soughtprior to the surgical procedure.
•
Instructions given pre-op includes1.Preparation of the surgical
site and site of locoregionalanaesthesia by the ward staffs
2.
Enema is given night prior to and the morning of the
surgicalprocedure by the ward staffs3.Xylocaine and antibiotic
test dose given on the morning of the surgery.4.Patient is kept
nil per-mouth from previous midnight and alsopre-anaesthetic
medication is administered5.IV hydration is maintained.
6.
The patient is shifted to pre-op room half an hour before
thesurgical procedure7.The patient attender is informed when
the patient has shiftedinto the theater block.8.During the
process of shifting the _______ standards areadhered to
Per-operative :
⇒
In the pre-op room the anaesthetist re-examines the patient
toascertain the fitness for the surgical procedure.
19
⇒
Inside the operation theatre, the full dose of antibiotic
isadministered during induction of anaesthesia.
⇒
The patient is placed in the required position
(dorsal/lithotomy) forthe surgical procedure
⇒
The patient is intensely monitored during the surgical
procedure.
⇒
Strict aseptic precautions are followed during the
surgicalprocedure.
⇒
After the surgical procedure is completed the patient is shifted
tothe post-operative care ward for monitoring.
⇒
The patient attender is explained & informed about the
patientstatus and the procedure done by the surgeon.
Post-operative instructions:
⇒
Patient is monitored for vitals half an hourly still stable, then
twohourly for a minimum of 6 hours to 24 hours in the post-
operativeward.
⇒
When the patient is stable, shifted to the ward and informed
⇒
The patient is monitored by team of intensives, interns and
staff nurses.
⇒
The patient who is presently on IV hydration will be started on
oralhydration 4-6 hours after the surgical procedure.
⇒
Broad spectrum antibiotics are administered for minimum
period of 48 hours
⇒
DVT prophylaxis started 6 hours following the surgical
procedure forpatient at risk for the same.
⇒
Post-op analgesia is maintained with parenteral or epidural
opioids
⇒
Post-op physiotherapy and early ambulation is advised.
⇒
If there is deterioration of patient status, will be retained in the
post-op ward, treated further and then shifted to ward once
stable.
8.Protocols for Day care procedures
20
•
List of day care procedure
1.Fractional curettage
2.
1
st
trimester MTP3.Medical abortion4.Vulval biopsy5.Cervical
biopsy6.Suction evacuation
•
Pre-procedure instructions:
a.The indication for the procedure and its risks involved
areexplained to the patient & patient attender by the treating
doctor.
b.
Patient is examined & investigated for fitness of the day
careprocedure. The routine investigations are as follows:
Haemoglobin
Urine routine
Blood sugar
USG if requiredc.If the patient is fit for the procedure, a written
informedconsent is obtained from the patient & patient
attender and thepatient is shifted to the day care room by the
OPD staffsd.The following orders will be instructed by the
doctor
Preparation of parts
Inj. TT 1 dose
•
Per-procedure instructions:
a.For Fractional curettage & Suction evacuation:
21
IM sedation – Fortwin or Pethidine 1 amp with 12.5
mgPhenargan given by the day care room junior doctor