iNTRODUCTION Our Gurudev Param Pujya Shri Ranchhoddasji Maharaj was an ageless saint. He ...

52 Pages·2010·0.89 MB·English

Introduction

Our Gurudev

Param Pujya Shri Ranchhoddasji Maharaj was an ageless saint. He was divinity incarnate and an ardent
devotee of Lord Ram. He traveled all over the country on foot and after long years of meditation leading to self
realization, he spent his life showing the path to those who were lost at the cross roads of live.

Our Gurudev was a messiah with a vision and missionary zeal. He was a pillar of strength for all depressed and
deprived human beings. He strongly advocated that there is no greater religion than service to humanity. To give
material shape to this spiritual conviction, and to show light to all those who were groping in darkness, he
spearheaded the concept of voluntary service for ameliorating the lot of humanity.

His pioneering efforts gave birth to the concept of organizing fee Eye Camps and relief works during natural calamities
in the early fifties. This work has continued since then in an ever increasing and effective manner. His endearing spirit
and dedication to the benevolent task attracted thousands of followers to his ideology. They flocked to the service
camps and became his ardent disciples. Their concerted efforts metamorphosed into an institution and with the
blessings and inspiration of our revered Guruji, Shri Sadguru Seva Sangh Trust came into existence in 1968. He
gave vision to his followers “Food for Hungry, Clothes for Destitute & Sight for Blind”

Gurudev left for his heavenly abode in the year 1970 but his soul is very much amidst us, guiding, and inspiring us at
every step forever leading from darkness to light.

Our Vision: “Food for Hungry, Clothes for Destitute & Sight for Blind”

Sadguru Netra Chikitsalaya

Sadguru Netra Chikitsalaya (SNC), managed by Shri Sadguru Seva Sangh Trust (SSSST), is providing eye care
services to rural population of Madhya Pradesh, Uttar Pradesh and bordering central Indian states. Ageless saint
Param Pujya Gurudev Shri Ranchhoddasji Maharaj whose mission was to “provide clothes to the needy, food
to the hungry and sight to the blind” is the founder of Trust. He pioneered concept of prevention of blindness
camps in Central India having organized such camps as early as 1950. It was registered as Charitable Trust in the
year 1968 under the Chairmanship of Shri Arvind Bhai N. Mafatlal.

Brief Profile of Sadguru Netra Chikitsalaya:
A 350-bedded state-of-art- Eye Hospital at Chitrakoot is established in the year 2000. Currently 25 full time resident
ophthalmologists are providing their services to rural population under the dynamic leadership of Dr.B.K Jain,
Director & Trustee, Sadguru Netra Chikitsalaya. Since the year 2000 the eye hospital has achieved tremendous
growth in terms of surgeries as well as establishment of specialty clinics and dedicated Community Ophthalmology
Department.

Sadguru Netra Chikitsalaya is certified with ISO 9001:2000 by International Certificate Services (ICS), Mumbai.
Complying with ISO 9001:2000 standards the institution is continuously reviewing its strategies and policies according
to the growth in outpatients and surgeries. Last year 2006-07 SNC performed 55,528 surgeries and the target for
2007-08 is 60,000 surgeries.

Sadguru Manual
(cid:190) The Objective of this manual is to lay out the guidelines for institutional policies and programs. Protocols
provided in this manual are in compliance with ISO 9001:2000.
(cid:190) This manual is an induction tool for new employees as well as a capacity statement for a person who wants to
know about the organization.
(cid:190) The contents and information provided in this manual is subjective to change in
compliance with periodic reviews.

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SADGURU NETRA CHIKITSALAYA

QUALITY POLICY

(cid:57) We, at Sadguru Netra Chikitsalaya, are committed to satisfy our patients as customers by providing eye care
services continually with holistic approach with the help of our trained Ophthalmologists and Nursing staff.
(cid:57) We will upgrade our service quality by providing periodic training to our Ophthalmologists, Nurses and other
related staff towards continual improvement by effective utilization of Quality Management System.
(cid:57) We believe that by satisfactory implementation of ISO-9001: 2000 Quality Management System, we will be
able to satisfy our patients our customers to their expectations.

QUALITY OBJECTIVES

a) To reduce waiting time of patients in OPD area from present timing by 10 minutes.
b) To provide 8 hours training per month to all staff connected to the eye care services.
c) To introduce Quality Improvement Project one in six months for the benefit of the patients as customers.

Rules & Regulations: Shri Sadguru Seva Sangh Trust

Any person employed either permanent staff, on probation, internship, trainee or student will be governed by the
Rules and Regulations of the Trust which may be in force from time to time. Please, especially note –

1. Non vegetarian food is strictly prohibited.
2. Consumption of Alcohol/ Cigarettes is strictly prohibited.
3. Anti-social activities either inside or outside are strictly prohibited.
4. Punctuality in attending duty, classes or training programs.
5. Behave politely with patients, co-staff & seniors.
6. Maintain discipline at workplace as well as in campus during off time.
7. Please note that at no time, should you be employed at the same time with any other organization during your
contract period.
8. Any staff can be posted in community or outreach services depending upon requirements.
9. Any staff can be transferred & deputed in any department depending upon requirements.
10. Any staff can be called for emergency services at any time.

Note: Rules and regulations will be modified as and when required keeping in mind the interest of the hospital and
will be applicable to all.
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Working Hours
Registration: 07:30 to 12:30 & 02:30 to 05:30
OPD: 08:00 to 01:00 & 03:00 to 06:00
Admission: 08:00 to 01:00 & 02:30 to 06:00
Non-Clinical Services: 08:00 to 01:00 & 03:00 to 06:00

Note: During high volume timings for OPD & Admission are flexible and will continue till the last patient.

Hospital Services
Cataract & General Ophthalmology, Refractive Error, Glaucoma, Pediatric Ophthalmology, Retina, Cornea,
Oculoplasty, Low Vision, Lasik & Community Ophthalmology.

Administrative & Clinical Meeting
We believe that meeting of all the teams once in a week is must for institutional progress. SNC conducts
administrative and clinical meeting on every Saturday at 05:30 p.m onwards at meeting all. It is mandatory for all the
ophthalmologists, administrative staff, supervisors & Community Ophthalmology Staff to attend the meeting.

Leave Protocol
The individual will be provided leave according to agreement at the time of joining. Leave without prior permission or
intimation is regarded as absent from duty. A leave format is available with administrative department and community
ophthalmology department. Leave application on plain paper or from any other source is not allowed.

Leave Sanctioning authorities are:
Ophthalmologists: Dy. CMO, MS & Director
Administrative Staff: Director
Community Ophthalmology Department: Department Head & Director
Non-Clinical, Paramedical & nursing: HR Manager
Computer Operators: IT Manager

Photocopy
Depending on institutional needs organization has maintained three modern photocopier machines at Library
Department. Official photocopy could be done by the request of concerned departmental head. For personal
photocopy the individual has to pay according to the rules. Please cooperate with department because the photocopy
boy has to fulfill several other responsibilities.

Note: It is not necessary that all personal photocopy requests accepted. Personal photocopy requests are subject to
number and availability of time.

Photography
A separate audio-video technician is available at Conference room during working hours. Modern digital camera,
computer with audio-video facility, CD/DVD reader & writer are available with department. With the prior permission
of Director/Dy.CMO a live recording surgery can be done from audio-video room. Audio-video technician is
responsible for photography and videography for all ongoing programs of the hospitals and trust. Any call for
photography should be made in advance through authorized permission.

House Keeping
SNC has very strict policy of house keeping in its premises. More than 100 sweepers are continuously engaged in
cleaning hospital premises. Any complaint regarding house keeping should be made directly to House Keeping
Incharge or administrative department. We are practicing established standards for hospital waste management
through implementation of polythene bags with color codes (instructions are displayed at all the points).

Stores
A central stores department is available for multi-purpose stock storage & supply. All the official stationary & hospital
utilities are available with stores department. Any item can be issued from stores by forwarding issue slip with
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signature of department head/incharge. Issue slips are available with all the departments or it can be available from
administrative office. Please keep record of all the utilities & utilization of stationary in departmental record register.

Medical Store
A central medical store department is available in General Hospital. All the essential drugs, drugs & medicines for
regular use are available with medical store all the time. Any medicine or drug can be issued by filling requisition
indent signed by department incharge. Please mention medicine name, purpose of use, location of use & previous
balance in indent slip. Utilization report to be maintained by department in medicine stock register. Please check
medicine manufacturing & expiry date before availing & using of any medicine.

Continuous Medical Education
SNC is adhered to the ethics of medical education through regular CME programs, workshops, seminars and
conferences. Conference room is provided with huge space, modern audio –video system and live surgery recording
facility.

CME for ophthalmologist is regularly conducted on Friday, for MLOP & Non-Clinical Staff every month 8 hours training
is provided according to Quality Policy & Objectives.

Training Clinical
(cid:190) Deputy CMO is the incharge of Junior Ophthalmologist three year program. He is also incharge of Pediatric
Ophthalmology, Phaco training and academic programs.
(cid:190) Medical Superintendent is the incharge of short term SICS training and day to day clinical administration.
(cid:190) Principal of Sadguru School of Paramedical Sciences is the incharge of Paramedical Staff.

Training Non-Clinical
HR Manager, management representative and project managers (COD) are jointly responsible for training of Non-
Clinical personnel.

Training Courses
Short Term Training programme in Pediatric Ophthalmology:
ORBIS International, India recognized Sadguru Netra Chikitsalaya as Regional Pediatric Ophthalmology Training
Centre in Central India. Short term courses have been designed to train Ophthalmologists, Paramedics,
Counselors & Community Outreach Workers from various govt. & non-govt. eye care organizations. Please visit
www.sadgurutrust.org through following link to know more details about the training courses in pediatric
ophthalmology:
Short Term Training programme in Phacoemmulsification & SICS
http://www.sadgurutrust.org/activities_health_snc_short_training.htm

Sadguru School of Nursing & Paramedical School
Following courses are offered through Sadguru Paramedical School:
Diploma in General Nursing (G.N.M) – 3+1 year Internship
Affiliated with Indian nursing council of India
Eligibility 10+2 passed with Biology (45%)
Sex: Female, Unmarried
Age : 17-25 Years

Diploma in Ophthalmic Assistance (DOA) – 2 Years + 1 year Internship
Eligibility 10+2 passed with Biology (45%)
Only M.P Board of education certificate or M.P State residential certificate
Age – 17-25
Sex: Only male, Unmarried

Health Care Worker (H.C.W) – 1 Year training + 1 Year Internship
Eligibility 10 passed (any discipline)
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Age – Should not exceed 25 years
Sex: Male & female

Vision Technician (V.T) – 1 year training + 1 Year Internship
Eligibility 10+2 passed (Biology)
Age – Should not exceed 25 years
Sex: Only male, Unmarried

For details Contact:
Mr. Deepak Wani
Principal, Sadguru School of Nursing & Paramedical
Shri Sadguru Seva Sangh Trust
Jankikund, Chitrakoot
Madhya Pradesh
Mob.[phone]
Phone: [phone] (Extn.: 220)

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Protocol for Visual Acuity Assessment
SNC/WI/123-P1
REV No: 1
EFF Date: June 2005
Call the patient and offer him to sit first
History taking - Systemic diseases
(cid:57) Asthma
(cid:57) Hypertension
(cid:57) Diabetes
(cid:190) Always check the right eye first, then for the left eye.
(cid:190) Check monocular visual acuity with self-illuminated distance Snellen’s chart. The illumination should be 300 lux & the
test distance 6 meters.
(cid:190) Check monocular visual acuity without glasses and with glasses (If visual acuity < 6/6 check the vision with pin hole).
PL & PLPR should be checked in low room illumination.
(cid:190) Refer cases only with complaints of defective vision (refractive errors, early cataract) for refraction.
(cid:190) Patient with VA<6/12 to 6/60 has to referred to Refraction.
(cid:190) Patients with complaints of mature cataract, Corneal ulcer, painful red eye etc. to be referred to Ophthalmologist /
Specialty doctors.
(cid:190) All patients over 35-years should be send for IOP measurement.
(cid:190) If patient is one eyed or having hearing problem, mention it on the top of the medical record.

Protocol of Computerized Tonometer
SNC/WI/123-P2
REV No: 0
EFF Date: June 2005
(cid:57) Call the patient and offer him to sit on the chair.
(cid:57) Explain the procedure.
(cid:57) Ask the patient to put his/her chin on chin rest & set forehead
on the forehead rest.
(cid:57) Always take three readings in each eye.
(cid:57) If reading found as error, send the patient for Schiotz
Tonometery

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Protocol for Keratometer
SNC/WI/123-P3
REV No: 0
EFF Date: June 2005

(cid:57) At least three reading should be taken and to be recorded. Average of three is final the reading.
(cid:57) Before doing keratometery, adjust the eyepiece. (i.e. clear or
focus + sign)
(cid:57) If keratometry is not possible, take the reading of the other eye.
If this is also not possible then use standard keratometery
reading i.e. 44 D for horizontal & vertical both.
(cid:57) Always re-measure in both the eyes, if corneal curvature is < 40
D or more than 47 D.

Note: - 1.00 D error in measurement of Keratometery leads to 0.9 D
(Approx 1.00 D) error in refractive correction.
Protocol for Refraction (Adult )
SNC/WI/123-P4
REV No: 0
EFF Date: June 2005

(cid:57) Call patients & offer him to sit first
(cid:57) Explain the procedure.
(cid:57) Check mono ocular visual acuity without glasses &with
glasses (If visual acuity <6/6,check the vision with pin
hole).
(cid:57) Near vision should be tested monocularly & binocularly
with near vision chart & mention the reading distance
(cid:57) If patient is wearing glasses, check the present glass
power.

CHECK IPD WITH AUTOREFRACTOMETER.

(cid:57) Do dry retinoscopy & subjective refraction.
(cid:57) Standard near vision correction.
(cid:57) Use fogging technique for all young hypermetropes.
(cid:57) Compare the previous glasses with the new correction for any abrupt change.
(cid:57) Keep the room illumination low while doing retinoscopy.
(cid:57) Use your right eye to refract patient right eye & left eye for left eye.
(cid:57) Make a note of the quality of reflex seen (e.g. dull or central shadow or scissors movement etc.).
(cid:57) Always try to neutralize the central reflex.
(cid:57) Retinoscopy finding to be recorded after subtracting working distance.
(cid:57) Check binocularity with worth four-dot test in patients with anisometropia, amblyopia and strabismus.
(cid:57) If cycloplegic / dilated refraction is desired (e.g. in uncooperative patients, fluctuating reflex, high
hypermetropia or myopia, high astigmatism, squint & asthenopia etc.), mention it on the case record and send
the patient to consultant.
(cid:57) Explain the patient about the waiting time & the duration of drug effect.
(cid:57) Check acceptance with dilated pupil
(cid:57) Give the walk in trail with the correction in trail frame for patients with high astigmatism & anisometropia and
check for any distortion or diplopia.
(cid:57) Always give spectacle prescription in neat & clean writing, give proper instruction & sign the prescription with
code.
(cid:57) Write IPD in spectacle prescription slip.
(cid:57) Refer the patient to consultant.
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Protocol for A scan
SNC/WI/123-P5
REV No: 0
EFF Date: June 2005

(cid:57) Clean the probe before measuring for each patient.
(cid:57) Instill anesesthetic drops (Lignocaine 4% or Paracaine)
(cid:57) Ask patient to blink a few times & then ask him/her to fix on the
target.
(cid:57) Approach the patient slowly with probe.
(cid:57) Establish contact with cornea.
(cid:57) Take five readings & always do on both eyes if IOL Power is < 19D
and > 24D.
(cid:57) Anterior corneal curvature & retina spikes should not be less than
70% of height.
(cid:57) Maximum A.C. depth should be preferred.
(cid:57) Use SRK-II formula for calculation.
(cid:57) A- scan reading to be recorded in space allocated in Medical record. Print out should not be attached for all
Phaco patients.

Characteristics of quality in A scan technique

(cid:57) Select proper mode (Phakic, Aphakic, Pseudophakic, normal cataract and dense cataract).
(cid:57) Five principal echo spikes are present, corneal, anterior lens, posterior lens, retina, sclera & orbital fat.
(cid:57) Echo heights are adequate.
o Anterior lens echo is 90% or more of maximum height
o Posterior lens echo is between 50% & 75% of maximum.
o Retinal echo is 75% or more of maximum.
o Echo rise angle must be clear – The take of the retinal spike must be clean
and form a 900 angle with the base line.
(cid:57) Note:- 1mm error in measurement of axial length leads to refractive error of 3.00 D.

Repeat A scan if: -

• Axial length measurement is < 22mm or > 25mm in one eye.
• IOL Power is < 19D and > 24D.
• Patient with poor cooperation or poor fixation.

Management of Adult Cataract (SNC) SNC/WI/123-P20
History:
(cid:131) Systemic Condition
(cid:131) Diabetic Mellitus
(cid:131) Hyper Tension
(cid:131) Bronchial Asthma, Drug Allergy
(cid:131) History of Medical Treatment
(cid:131) History of previous Ocular Surgery
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(cid:131)
Pre-operative evaluation:
• Visual Acuity estimation and refer cases only with complaints of defective vision (Refractive errors,
early cataract) for refraction.
• Patients with complaints of mature cataract, Corneal ulcer, painful red eye etc. to be referred to
Ophthalmologist / Speciality doctors.

• Refraction by Ophthalmic Assistant
• Complete & through evaluation of anterior segment in Slit Lamp for all cases
• Check Pupillary Reaction
• Grading of Cataract
• Fundus examination in all cases.
• B-Scan wherever indicated (Traumatic Cataract, Complicated Cataract, suspected IOFB)
• Prognosis regarding visual outcome after surgery to be explained

Pre-operative investigation:
(cid:131) Blood sugar /Urine/Sugar
(cid:131) BP, Syringing, A-scan Biometry
Type of surgery: ECCE with IOL
Postoperative care:
Steroid + Antibiotic e/drops - 6 times/Dx15 days
- 4 times/Dx15 days
Hemotropine e/d - 3 timesx10 days
Follow all the instructions given at the back of the discharge card & as advised by nursing staff at the time of
discharge

Follow-up after1 month.

GENERAL WARD PROTOCOL
SNC/WI/123-P15
A.
1) Allotment of bed to new admitted patient.
2) Following pre operative investigation to be checked in the wards
a. Sac Syringing
b. Tension
c. A-scan All Patients
d. Blood Pressure
e. Random Blood Sugar (RBS)

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B. PRE OPERATIVE PATIENT CARE
(cid:48) Face Wash and Mouth wash on operating day
(cid:48) Clean dress / gowns to patients.
(cid:48) Full Mydriasis of patients pupil in ward
(cid:48) Pre operative antibiotics (Topical & Systemic)
(cid:48) Sending patient to OT by 8.00 A.M.
(cid:48) Send Guarded Visual Prognosis (GVP) patients to be
operated after 11.00 A.M.
(cid:48) Sticker on the same side of operating eye on forehead.
(cid:48) Cutting eye lashes of correct eye to be operated.
(cid:48) Whenever required contact concerned doctor

C. POST OPERATIVE PATIENT CARE
☺ Proper cleaning & dressing of operated eye by trained personnel.
☺ Proper vision testing for every patient
☺ Doctors Round - Post Operative Patient Examination - 8-8:30 A.M.
☺ Slit Lamp Examination of patient with vision <6/60 in all wards.
☺ Fundus Examination -Direct Ophthalmoscopy and 90D Lens in Ward.
☺ Maintaining of proper patient’s examination record by doctors.
☺ Clear post-operative instruction on patients card and to the ward in-charge by doctors.
☺ Following of the instructions in correct way by ward in-charge.
☺ Clear post-operative instruction to every patient with proper & timely instillation of medications preferably by
ward in-charge/ward staff.
☺ Patients should be clearly explained about discharge medications.
☺ Giving black goggles / Green eye shield to every patient.
☺ Whenever there is a problem with patient care/any complaint expressed by patients doctor concerned must be
informed.
D. GENERAL INSTRUCTIONS FOR WARD IN-CHARGE & WARD ASSISTANTS
(cid:41) No Attendants should be allowed in ward except during visiting hours.
(cid:41) Check attendant card.
(cid:41) Proper maintenance of records (e.g. patient record & medicine stock register)
(cid:41) Admission & diagnosis details to be filled by ward in-charge in case folders(file).
(cid:41) Proper maintenance of all medicines in the Ward.
(cid:41) Ensure up-keep of treatment register
(cid:41) Patients file should not be on patients bed
(cid:41) Make sure that ward is neat & clean (i.e. cleaning schedule to be followed).
(cid:41) Don’t hesitate to ask for any help form doctors/superiors.
(cid:41) Concentrate more on patients need – his satisfaction is our goal.

TREATMENT WARD PROTOCOL

SNC/WI/123-P16
Rev No: 1
GROSS GUIDELINES

(cid:190) All patients are examined at slit lamp in O.P.D.
(cid:190)(cid:190) All clinical findings of both eyes noted in the case sheet and
treatment started immediately.
(cid:190) AA bbeedd aallllootttteedd ttoo eeaacchh ppaattiieenntt,, wwiitthh bbeeddddiinngg,, bbeedd sshheeeett,, ppiillllooww
aanndd bbllaannkkeett
(cid:190) The Treatment Ward has been divided into two sections
I. Infective section
II. Non-infective section
(cid:153) The Doctor Incharge examines all patients during ward rounds
in morning. Slit lamp examination is mandatory for all patients.
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