For better patient care, our health systems need to keep evolving. Based on our first hand experience at SKIMS Soura, we have put together some suggestions that we feel will go a great deal in ensuring that patients fare better at this Institute. We appeal to the Government of J&K and SKIMS administration to consider these at the earliest.
1. Help desk- At first contact: The helpdesk at the reception of the emergency needs immediate strengthening. The helpdesk must be equipped with adequate human resource/volunteers, necessary equipment like trolleys, wheelchairs, portable oxygen cylinders etc. This can be achieved by collaborating with the State Disaster Management Authority (SDMA), State Disaster Response Force (SDRF) and credible NGOs. A proper helpdesk can be a great relief in a situation of distress.
2. Availability of Oxygen: Availability of oxygen with required pressure to the needy patient is of paramount importance particularly during the COVID-19 pandemic. The availability of high-pressure oxygen could only be achieved through the provision of oxygen cylinders. The transportation of oxygen cylinders from the oxygen plant/facility (Manifold) at SKIMS to the wards is a tedious process and needs immediate attention and improvement.
3. It is suggested that proper and timely sterilization of humidifiers in heated humidified high-flow therapy (HFNC) and oxygen ports should be ensured to avoid hospital acquired pneumonia.
4. Essential equipment: The availability of an inadequate quantity of essential equipment like side screens, glucometers, trolleys, wheelchairs, etc. in the wards is a matter of concern and needs immediate strengthening. It is observed that the patients/attendants struggle for the same in an already stressed condition. At times the demand and requirement for this equipment by different patients at the same time resulted in a scuffle between the attendants.
5. Hygiene: The cleanliness and hygiene on and around the wards and working areas of the Institute is a great challenge and needs immediate attention and strengthening. The janitors are observed to be ill-equipped and working without appropriate personal protective equipment (PPE). The presence of stray dogs in the hospital premises poses a serious threat to the patients, attendants, visitors and healthcare professionals. Instances of stray cats inside the critical care wards have also been observed which is a matter of serious concern and needs to be addressed. The hospital waste management is very poor. The color-coded dustbins are available but no one including staff follows hospital waste disposal protocol.
6. It must ensure proper and timely servicing of the reverse osmosis (R.O) water purifiers besides ensuring service date mentioned on them since the drinking water is used by patients.
7. The nurses use the same set of gloves to provide intravenous (IV) injections to all patients without sanitizing hands in between. Proper hand hygiene must be followed with sanitizing hands between patients by nurses to avoid sepsis. Many patients are getting infected resulting in serious complications.
8. Signage: It is suggested that the pictorial signage should also be put in place for the benefit of people who are not able to read. The absence of appropriate signages resulted in chaos and confusion and we had to struggle to find and reach important facilities in the institute.
9. Attendant management: During phase 2 of the COVID-19 pandemic the attendants have been allowed to take care of their patients along with the healthcare professionals in the hospitals. It is observed that most of the attendants are ignorant and not aware of the Standard Operating Procedure (SOP) to tackle the coronavirus impact and fulfil the requirements of affected patients. This needs serious introspection and thoughtful decision. It is suggested the number of attendants must be limited to a maximum of three healthy willing persons for 24-hour assistance. These attendants must be registered on the admission of the patient and issued cards and provided with appropriate PPE for safety. The attendants also need to be provided guidance and SOP about the handling of the COVID-19 affected patients. This can be achieved by providing information brochures, pamphlets, displaying messages through posters etc. This is very important as these attendants are potential carriers of the coronavirus and may facilitate the spread of the virus in society if not regulated properly.
10. It is observed that during phase-2 of the COVID-19 pandemic there is no cap on the visitors visiting patients at the SKIMS. This is a serious issue that needs immediate attention and regulation.
11. The morale of healthcare professionals needs a boost, particularly in such disaster conditions. The morale-boosting and motivational tools must be employed to get short 4 and long-term results by involving professional trainers. Train-the-trainer approach is an available option to get immediate and short-term results.
12. Coordination, Monitoring and Accountability: A sense of accountability has to be instilled in the healthcare professionals from top to bottom. An efficient monitoring and coordination system will help in bringing a sense of accountability to the system. The healthcare professionals are to be repeatedly reminded of the code of ethics that is taught during training. For and on behalf of the undersigned and the general public, we request you to pay heed to the aforesaid points in the larger interest of the society and the SKIMS as a major tertiary healthcare institute of the region.