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1- GENERAL POLICY
2- HEMATOLOGY POLICY
3- NEUROLOGY POLICY
4- DEVELOPMENTAL POLICY
5- ENDOCRINE POLICY
6- PICU POLICY
Department of Pediatrics
Al Sabah Hospital
NBK
STATEMENT OF PURPOSE AND AIMS OF THE DEPARTMENT
Purpose : To care, to heal, to teach and research
Aims :
1. To provide comprehensive medical care (including emergency and
medical care) to sick children.
2. To promote child welfare through active interaction with parents or
legal guardians, schools and other relevant agencies.
3. To provide general and specialist Pediatrics training to graduate
doctors.
4. To promote clinical research and in-service training and continuous
medical education.
DEPARTMENTAL ORGANIZATION
1st. Bed Allocation
· Currently the department has 4 General Wards:
· Wards 2, 4, 5 - each has 16 Beds
· Ward 7 has 11 Private Rooms
· Sub-specialty units in NBK Hospital :
1. Sub-specialty Hematology Unit:
· Ward 2 : 20 beds for leukemia cases
· Ward 1 : 30 beds for day care; 14 beds for hematological diseases
other than leukemia
2. Neurology sub-specialty unit : 20 Beds
3. Growth and Development unit : has no beds, but 5 out patient clinics
daily
4. Endocrine unit : has beds in the general wards.
· An Intensive Care Unit : has 12 beds (7 beds not used because of
shortage of nursing staff)
· A Casualty Unit
· An Out Patient Clinic
2nd. Medical Staff
1. The medical staffs are deployed in 4 general wards.
Each ward is made up of at least 1 consultant who is the head of the
unit, 1 senior registrar, 3 registrars and 2 assistant registrars. Each
unit function as a semi-independent cell within the organic whole. The
consultant in charge, with the assistance of the senior registrar, is
responsible for supervision of the care of the patients in the unit and
assignment of duties to the staff. He also ensures that the wards
doctors participate actively in all the academic of the department.
B. There are currently 5 sub-specialty units:
(One) Hematology unit that has 1 consultant, 1 specialist, 1 senior
registrar and 6 registrars.
(Two) Neurology unit has 2 consultants, 2 senior registrars, 2
registrars.
(Three) Growth and development unit has 1 senior registrar and 5
registrars.
(Four) ICU has 1 consultant, 1 senior registrar and 2 registrars.
(Five) Endocrine unit has 3 consultants.
There are other consultants affiliated to the department who run
sub-specialty clinics (Genetic and Psychiatry).
C. The Casualty is manned by 5 doctors, who daily provide round-the
clock coverage. They are part from all the units in the hospital. The
doctors are under the supervision of 1 consultant, 1 senior registrar,
and the departmental chairman.
3rd. Work Schedule
Hours of Duty: Work starts at 7.00 am and finishes at 2.00 pm on
weekdays and starts at 7.30 am on weekends and holidays for the on-call
team. From 2.00 pm on weekdays till the next morning, 4 residents share
the duty in the casualty and another 2 are responsible for the wards. In
addition, there is a senior registrar and a consultant on-call daily.
The senior registrar is responsible also for calls from nearby hospitals
like Ibn Sina, Chest, Al Razi and KCC hospital, in addition to calls
from Surgical and ENT department.
The neurology calls are covered daily in addition to the ward doctor by
a consultant neurologist who is responsible also for calls from Al Jahra
and Farwania hospital. The ICU unit is covered daily by 1 consultant, 1
senior registrar and 1 registrar, the ICU unit receives referral from
all hospitals in Kuwait including the private hospital. Endorsement of
patients takes place twice daily one at 7.30 am and again at 1.30 pm so
that a handing over of problem cases is done. New admission are made
into the 3 General wards: W2, W4, W5 daily and transferred to the
private W7 if requested.
ADMISSION AND DISCHARGE POLICY
A. Admission Rules:
1. Any patient admitted to a Pediatric ward should have the name of the
"doctor-in-charge" clearly mentioned on the admission slip.
2. The "doctor-in charge" should not be less than a consultant, i.e.
each patient should be under the care of a consultant.
3. The consultant-in-charge of any patient is responsible for the
over-all well being of the patient both ethically and legally until
discharged from the hospital.
4. Transfer of patient care between units, i.e. consultants can only be
done after mutual agreement of both consultants. This transfer of care
has to be clearly documented in the patient's notes.
5. Admission to the Department of Pediatrics comes from two sources i.e.
the Pediatric Emergency unit and the Pediatrics Out Patients clinic.
Patients are admitted under each of the 3 different units in turn.
5.1 Admission from the Emergency Room:
The Pediatrics team on-call should decide on immediate admission or
discharge of such patients from the emergency room after a maximum of 2
hours observation/emergency treatment. This time limit should be adhered
to because : (i) the patient and his relatives need to know for sure
what the next line of management is within a reasonable time, (ii) to
reduce the congestion and bed occupancy in the emergency room.
5.2 Admission from the Pediatrics Out-Patient Clinic:
The patients referred to the out patient clinic from different sources,
e.g. Polyclinics, colleagues from different departments and hospitals.
The doctor-in-charge of the clinic carries out detailed assessment
including history, clinical examination any or relevant investigations.
2nd. Patient Assessment on Admission:
On admission to the ward, the patient is seen by the designated junior
doctor in the unit who should take a full history and carry out a full
physical examination. He/she should collect and reviews all the
investigations, which were carried out in the out patient. The junior
doctor should then formulate a plan of management, which should include
a diagnostic plan, therapeutic plan and the follow up plan. The junior
doctor then present the case to the Senior Registrar (within 2 hours),
who should verify the diagnosis, see the relevant investigations and
review the chronological sequence of the problem, review the management
plan formulated by the junior including patient and family education.
The senior registrar would then present the case to the
consultant-in-charge.
3rd. In-Hospital Patient assessment:
1. Each unit carries out a business round every morning, under the
supervision of the senior registrar. At these rounds, the registrar of
the unit presents the cases and the new problems to the senior registrar
who would take the final responsibility in taking the appropriate
decision for each problem. The latter would brief the
consultant-in-charge about the new problems and management plans.
2. The daily in-patient assessment is carried out according to the
problem-oriented plan, i.e. SOAP as follows:
S "Subjective" : The junior doctor records the patient's new complaint
at the time of the clinical interaction with the patient.
O "Objective" : The junior doctor records his observations "clinical
examination" and results of any new investigations.
A "Assessment" : After listening to the patient, carrying out the
clinical examination and reviewing the relevant lab results, the junior
doctor should record his/her assessment of the present condition of the
patient, e.g. chest infection, dehydration, anemia etc.
P "Plan" : The junior doctor should then indicate what are his/her plans
to verify the condition suspected under assessment above. This plan
should be :
Diagnostic : investigations to prove or disprove the suspected condition
Therapeutic : treatment provided to treat the condition and help the
patient.
The SOAP method of follow up has many benefits:
One. It encourages the junior doctor to take full history and carry out
full clinical examination to reach an assessment and management plan.
Two. It enforces better patient care.
Three. With time the junior doctor will see for him/herself the
improvement in his/her assessment and management plans.
D. Consultation from other units and second opinion referrals.
1. The time and date of each admissions have to be clearly documented in
the patient's notes.
2. All referrals for a second opinion either to sub-specially unit in
the department or to other consultants outside the department should
always be in writing.
3. All opinions or management plans suggested by the consulted person
are only suggestions and it is the responsibility of the consultant
in-charge of the patient to discuss the suggested plan, accept it,
modify or even reject it.
4. It is always preferable to reach a consensus by personal contact and
discussion of each consultation.
E. Discharge Policy
Once the patient has recovered from his/her acute illness and is fit for
discharge, the following points are observed :
1. The patient's condition is carefully explained to the parents and the
patient (where appropriate).
2. In patients with chronic or genetic illness, proper counseling is
done with the family as appropriate, making sure that there is as much
understanding of the condition as possible.
3. The future plan for the patient's care is explained carefully to the
parents and/or guardian.
4. Detailed information should be provided to the parents of patients
referred to other hospitals or faculties about their immediate needs and
when and how to get to where from have been referred.
5. All discharged patients should be provided with a "discharge summary"
form, which should be filled in all. This form is essential as the
patient can use it on seeing his/her primary care physician and in
coming back to the hospital in case of emergency.
6. All discharged patients are given follow up appointment in the out
patient clinic run by one of the senior registrars in the unit. Patients
who were originally admitted to specialty or sub-specially clinic are
given appointments in such cases, care is the responsibility of the
doctor(s) in the clinics.
6th. Ward Rounds:
Each ward carries out daily business rounds, organized by the senior
registrar. Each patient is reviewed and notes on complaints, physical
finding and diagnosis are reviewed and notes on complains, physical
findings, diagnosis and investigations ordered and results received are
made in the patient's chart.
Any difficult cases and requests/results of any specialized tests e.g.
CT scan, MRI, Echocardiography etc are discussed with the consultant. A
summary is written when each patient discharged from the unit. Each unit
has 2 consultant rounds weekly, which the consultant leads, with all the
doctors in the unit in attendance. This gives an opportunity to review
the diagnosis and plan management of new admission and the on-going care
of previously admitted patient. It is also a valuable teaching
experience for the junior staff. The sub-specialty units are responsible
for looking after their patients when on admission. They also provide
consultation about patients as requested by any of the other units, and
other nearby hospitals like Ibn Sina, Al Razi, Chest and KCC hospital
and other hospitals like Al Farwania, Jahra and Fever hospitals.
7th. Outpatient Clinics:
Consultants, senior specialists, specialists and senior registrars, each
has one general pediatrics outpatient clinic per week. In addition,
sub-specialty clinics are held weekly by the consultants with
sub-specialty interests. The patients are seen strictly by referral. The
following are the current clinics:
(a). Saturday:
ICU sub-specialty unit.
(b). Sunday:
a. 1 senior registrar general clinic
b. 1 consultant general clinic
c. Hematology sub-specialty clinic (Follow up + chemotherapy)
d. Neurology sub-specialty clinic
e. Genetic sub-specialty clinic
f. Endocrine sub-specialty clinic (Endocrine disorders in cured ALL)
g. Inborn error metabolism sub-specialty clinic.
(Three) Monday:
i Asthma sub-specialty clinic
ii Endocrine sub-specialty clinic
iii Hematology (Hematological diseases other than
leukemia)
iv Immunology sub-specialty clinic
(Four) Tuesday:
i 1 consultant general clinic
ii neurology sub-specialty clinic
iii Nephrology sub-specialty clinic
iv Endocrine unit : a doctor runs an endocrine clinic in
Mubarak hospital
(Five) Wednesday :
i Hematology sub-specialty clinic (Thalassemia cases)
ii Endocrine sub-specialty clinic (Endocrine disorders in
thalassaemia and sickle cell anemia
iii Psychiatry sub-specialty clinic
NOTE:
· The endocrine and hematology clinics serve all Kuwait areas.
· The neurology clinic serves Al Sabah hospital, nearby hospitals,
Farwania and Al Jahra hospital.
· Neuro-physiology lab accepts EEG referral from all Kuwait areas and
there is plan for EMG in the future.
8th. Casualty :
Between 7 am and 2 pm one doctor is in the casualty covered by a senior
registrar and a consultant to help in different cases. Between 2 pm till
9 pm there are 2 doctors and between 9 pm till 7 am there are 2 doctors
in-charge in the casualty.
The doctor in-charge decides which child should be given emergency
treatment or send home after observation. Any patient seemed to require
admission is send to the floor for further review by the on-call team.
Patients who require follow up are given appointment in the relevant out
patient clinic.
9th. Call Duty:
Call duty starts at 2 pm on week days and at 7.30 am on weekends and
holidays. Two registrars are on call for the pediatric wards, there is a
senior registrar or specialist on call every day and a consultant is
always available. The registrars on call are physically in the hospital
during the call hours.
The senior registrar makes round with the other doctors between 8 and 10
pm on weekdays. On weekends and on holidays, there is another ward round
in the morning between 8 and10 am. The consultant on call is always
available to review any difficult cases.
KIMS Program:
The department of pediatrics runs a structured postgraduate program
under the auspices of the Kuwait Institute for Medical Specialization,
leading to the Fellowship of the Kuwait Medical Board. This is a 4 year
program and the candidates rotates only through the 2 sub-specialty unit
in Al Sabah hospital : ICU and Hematology unit.
IT IS EMPHASIZED THAT ACTIVE PARTICIPATION OF JUNIOR STAFF IN THE
ACADEMIC ACTIVITIES WILL BE GIVEN EXTRA WEIGHTAGE FOR PROMOTION PURPOSES
IN THE DEPARTMENT.
MANAGEMENT GUIDELINES AND PROTOCOLS:
Easy-to-follow, concise and specific guidelines/protocols for the
management of common pediatric emergencies have been compiled by the
consultant staff in the department (a copy is attached). To ensure
standardized care, all residents and doctors in the department are
expected to comply with the recommendations. A committee has been set up
to review these guidelines on an on-going basis.
Academic activities:
These academic activities form a critical core of the educational
program of the department. It affords an opportunity of interaction
between the junior staff and the senior consultants. The juniors get an
opportunity to make presentations to the whole department.
The senior members of the department also get a feed back on the
performance of these juniors. All members of the department are expected
to attend all activities. The following is the schedule of the
activities held on a regular basis in the department.
Saturday : Clinical Meeting
Sunday : Casualty doctors clinical meeting
Tuesday : Journal club
Wednesday : Trainee and Asst. Registrar clinical meeting.
1. Hand-over (endorsement) meetings: These are held every morning at
7.30 and after 1.30 between the unit doctors and the on-call team. This
ensures continuity of care and identifies patients who need extra
attention.
2. Clinical Meeting: This meeting, which is held every Saturday at 12.30
pm, focuses on a patient presenting with diagnostic or therapeutic
challenges, offering a teaching opportunity. It usually lasts about an
hour and the case is exhaustively discussed. The different units take
turns in presenting cases, in addition to the sub-specialty unit.
3. Journal club: This is held every Tuesday at 12.30 pm. Interesting and
topical articles usually relevance to the local practice are presented
in a critical manner and fully discussed. The 4 units and the
sub-specialty unit take turns in presenting at these meetings. The
junior staff in the units are encouraged to search for interesting
articles in the Faculty of Medicine library. This exercise fosters
criticism and encourages research.
4. Trainee and Assistant Registrar Forum: This is geared towards the
trainees rotating through the department and holds on Wednesdays at
12.30 pm. It provides an opportunity to orientate and sensitize them
towards pediatric care. Important topics of relevance to critical care
are presented under the moderation of a specialist or senior specialist
in the department and presented by consultants in different specialty.
5. Mortality meeting: This is scheduled monthly to discuss any mortality
in patients admitted to any of the wards or pediatric casualty. The
meeting affords and opportunity for reviewing the whole management of
the child, highlighting any shortcomings so that everyone learns from
the experience. These deaths are also presented at the hospital
mortality meeting.
CLINICAL TRAINING AND ACADEMIC ACTIVITIES
The department receives new medical graduates (trainees), registrars.
One of the missions of the department is to teach and all senior staff
in the department have an obligation to train and teach junior doctors.
Graduate Training:
1. The entire junior doctors in the department, registers, assistant
registrars and trainees are considered to be in a training program.
2. Trainees, i.e. these are fresh medical graduates who rotate through
the department for 8 weeks during which they are attached to one of the
service unit.
3. An essential part of the clinical teaching of the junior staff is get
them to take good medical history and perform through medical
examination with the aim of reaching the right diagnosis. Eventually
they are also expected to be able to formulate rational management
strategies.
4. The junior doctors, through their daily activities, on-call hours and
other patient contacts, are in full interaction with more senior staff
(senior registrars and consultants). These encounters are geared towards
the basic principles of pediatric training. Though direct supervision
and continuous instructions, the clinical skills of the junior mature
within 3-4 years of joining the department. By the end of their
training, these doctors are eligible for examination on different
certifying bodies e.g the Kuwait Medical Board, Royal College etc.
5. Ethical and moral issues are given prominent importance. These ideals
are emphasized on daily basis to all junior staff in the department. Our
aim is to produce good clinicians with excellent moral and ethical
values.
6. All through their training, they are taught skills of communication
with patients and guardians. This is even more important in patients
with chronic illness or genetic disorders.
IN THE DEPARTMENT THERE IS DEPARTMENTAL COUNCIL
1. Membership of the Department Council:
Consultants, Senior specialist, specialists and one representative of
Registrars, Casualty Officer and they are non-voting members.
2. The Departmental Council chaired by the Chairperson of Department,
will have minimum of one monthly meeting.
3. All promotions, shortages, problems, major complaints, proposed
plans, change of structure and other business concerning the running of
the department discussed in the Council's meeting.
4. The Council support the appropriate utilization of hospital
resources, risk management activities and support all hospital clinical
and non-clinical activities that serves to promote and maintain
accreditation of the hospital locally and internationally.
5. The Council elect the concerned committees to delegate duties of
running the day-to-day business e.g. casualty committee, postgraduate
and in-service training committee, the morbidity/mortality committee and
the medical record committee.
6. The Council nominate their representatives to the various hospital
activities and councils.
Continuous Professional Development
CPD/CME for Al Sabah Hospital
The Annual CPD/CME’s of the Department
1. Clinical meeting weekly on Saturdays
(0.5 credit point/hour)
2. Clinical meeting weekly on Sundays
(0.5 credit point/hour)
3. Journal club weekly on Tuesdays
(0.5 credit point/hour)
4. Mortality meeting monthly on Wednesday
(0.5 credit point/hour)
The minimum score of CPD/CME points for member of staff/year (48 points
( up )
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2- HEMATOLOGY POLICY
1- Pediatric Hematology Unit at NBK Children Hospital is a part of
Pediatric Department, Al-Sabah Hospital as far as the administration is
concerned.
2- For general operational Policy, please see the operational policy of
Pediatric Department
3.0 Staff at Pediatric Hematology Unit .
Senior Consultant
Senior Specialist
Specialist – post vacant
Senior Registrar
Registrars
3.1 Haematology – Oncologist and Paediatricians are involved in the care
of patients in this unit .
3.2 NBK Haematology lab is under the care of Haematology Consultant from
the Main Haematology lab at Al-Sabah Hospital. See operational policy of
Medical Laboratories Services.
3.3 Lab Haematology Consultant with his team is responsible for routine
and specialised blood testes and bone marrow evaluation .
4.0 NBK Haematology Lab functions from 7AM to 2PM on Saturday to
Wednesday, except on public holidays. Blood tests from 2PM to 7AM and on
week ends and public holidays are carried out at Main Haematology Lab at
Al-Sabah Hospital .
4.1 NBK Haematology Lab carries out mainly CBC, Peripheral smear exam,
Retics and ESR for NBK Hospital as well as Paediatric Department for the
time being. Other blood testes all are done in the Main Haematology Lab
at Al-Sabah Hospital .
5.0 Bone Marrow aspiration and L.P under general anaesthesia are
performed at Mini operation theater on the Ground Floor
5.1 Elective Bone Marrow aspiration is carried out on Tuesday morning.
Urgent bone marrow examination can be done on any other day as per
arrangement with lab haematologist and anaesthetist .
6.0 Outpatient : Paediatric Haematology outpatient is in the ground
floor.
6.1 Outpatient timing : 8AM to 1.45PM on Sunday, Monday and Wednesday.
6.2 Doctors for outpatient : Consultant, Senior Specialist, Specialist,
Senior registrar and Registrars.
6.3 New patients are seen in the outpatient by referral. The referring
doctor should provide a report stating clinical problem, lab results and
medications given. Children under 15years of age with leukaemia and
children under 12years of age with other Paediatric Haematological
disorders are accepted for management in our Unit.
6.4 Follow up patients of the unit are seen by appointment, though
emergency cases can be seen at anytime.
6.5 Out-patient on Sunday : For children with Leukaemia .
6.6 Out-patient on Monday: For children with haematological diseases
other than Leukaemia, Thalassaemia and Sickle Cell Diseases.
6.7 Out-patient on Wednesday : For children with Thalassaemia and Sickle
Cell Disease.
7.0 Admissions to the Wards.
7.1 New cases are admitted to the ward by referral from other hospitals.
7.2 The referring doctor should contact ward doctor by Telephone #
4835826 and 4818219 or Fax 4835826 and make sure a bed is available for
the patient before the child is sent for admission
7.3 The referring doctor should provide a report with patient giving
details of medical history, physical findings, lab results and treatment
given.
7.4 Regular patients of the unit can be admitted at any time by the unit
doctor depending on the clinical problem.
8.0 Haematology ward # 1 has 14 private rooms and a Day Care Unit and is
situated in the first floor.
8.1 Haematology ward # 1 for children with diseases other than Leukaemia
. New cases up to 12years of age are eligible for management in this
ward .
8.2 Children admitted in the private rooms should be accompanied by
mother.
9.0 Day Care Unit has 6 group rooms each room having 5 beds.
9.1 Day Care Unit operates from 7AM to 2PM Saturday to Thursday except
on public holidays.
9.2 Day Care Unit admits children with thalassaemia and Sickle cell who
require regular blood transfusion and intensive I.V.chelation with
Desferral .
9.3 Admission to Day Care is by appointment.
9.4 Blood transfusion in Day Care is from Saturday to Wednesday except
on holiday.
9.5 Boys given blood transfusion on Monday and Tuesday .
Girls receive Blood transfusion on Saturday , Sunday and Wednesday.
9.6 Thalassaemia children requiring emergancy blood transfusion will be
admitted to the ward accompanied by mother except for children over 12
years who will be referred to Medical Department, Al-Sabah Hospital or
other regeonal Hospitals depending on their area of residence.
9.7 Intensive I.V. chelation with Desferral in the Day Care Unit is only
on Thursday, alternating with boys and girls.
10.0 Haematology Ward # 2. This ward is in the 1st floor and has 16
private rooms and 4 isolation rooms. This ward is for management of
children with Leukaemia. New cases of Leukaemia upto the age of 15years
are accepted for admission .
10.1 Children admitted in the ward are to be accompanied by mother.
11.0 Chemotherapy for outpatient and inpatients are given under aseptic
condition by the doctors in the chemotherapy rooms in the haematology
ward-2.
11.1 L.P (Diagnostic and Therapeutic) done under Emla Cream and sedation
in the ward or under general anaesthesia in the Minitheater in the
Ground floor.
12.0 Intensive care : children who need intensive care are referred to
PICU at the Paediatric Department where the doctors from our unit also
take part in the care of the children .
13.0 Other investigations.
13.1 Biochemical analysis: Main lab at Al-Sabah Hospital.
13.2 Microbiological analysis: Main lab at Al-Sabah Hospital .
13.3 Virology Screening : Main lab at Al-Sabah Hospital .
13.4 CSF analysis : Main lab at Al-Sabah Hospital .
13.5 Immunophenotyping : Immunophenotype lab at KCCC.
13.6 Cytogenetic analysis : Cytogenetic lab, KCCC.
13.7 Please see operational policy for Medical Labortries .
13.8 Routine X-rays : At NBK X-ray unit from 7AM to 2PM Saturday to
Wednesday except on holidays. At other times X-rays are done in the main
Radio diagnosis department at Al-Sabah Hospital. Emergancy X-rays for
inpatients are done at anytime in the ward with Portable X-ray machine.
13.9 Ultrasonography : Routine U/S done in the NBK X-ray Unit from 7AM
to 2PM on every Saturday except on public holiday. At other times U/S
done in the main Radiodiagnosis Unit at Al-Sabah Hospital.
13.10 Barium studies : At main Radiodiagnosis Unit, Al-Sabah Hospital .
13.11 MCUG : At main Radiodiagnosis Unit, Al-Sabah Hospital .
13.12 CT, MRI, MRA : At main Radiodiagnosis Unit, Al-Sabah Hospital .
13.13 Doppler studies : At main Radiodiagnosis Unit , Al-Sabah Hospital.
13.14 Echo-Cardiogram: At Cardiac Unit, Chest Hospital .
13.15 Isotop scan : Isotop Scan Unit at KCCC.
13.16 HLA typing : Tissue typing Lab at Hamad Al-Essa Organ Transplant
Center.
14.0 Management of various haematological disorder.
14.1 Leukaemia : All the children with leukaemia under 15years of age in
Kuwait are treated and followed up in this Unit. The treatment is as per
current leukaemia protocol. Ward 2 is for the management of these
children.
14.2 Thalassaemia : 70% of children with thalassaemia under 12years of
age in Kuwait are managed in this Unit: other cases are treated in other
regeonal hospitals, though we are pleased to provide care for all
children with thalassaemia in Kuwait. Follow-up upto the age of 18years
after which the patients are referred to Adult haematology Unit at other
regeonal hospitals nearer to their residence. Management as per current
protocol in the unit.
14.2 Battery Operated Syringe pump for Desferral infusion : Thalassaemia
children who need desferral infusion are provided with battery operated
syringe pumps from this unit against a Deposit of KD 25. Those who can
not afford the payment may be given the pump by some other means.
14.3 Sickle cell disease: 50-60% of children with sickle cell disease
under 12years of age are managed in this unit, others being treated at
other regeonal hospitals nearer to their residence, though we can indeed
give care to all the children with this disease in Kuwait. Follow up is
up to 15years of age after which they are referred to Adult
haematologist at other regeonal hospitals nearer to their residence.
Management is as per current protocol in the Unit.
14.4 Other anaemias : Patients mainly from our draining area. Management
as per current protocol in this unit.
14.5 I.T.P : Children under 12 years of age with ITP are managed in the
unit. The patients are mainly from the draining area of Al-Sabah
Hospital. Also some problem cases are referred to us from other
hospitals. Treatment as per current protocol in the unit.
14.6 Platelet dysfunction disorder: The patients are mainly from our
draining area plus problem cases from other hospitals. The Management as
per current protocol in the Unit .
14.7 Haemophilia and other coagulation disorders: Patients mainly from
our draining area plus problem cases from elsewhere. Management as per
current protocol in the Unit.
14.8 Thrombotic disorders: Patients mainly from our draining area plus
problem cases from other hospitals. Management as per protocol in the
Unit.
14.9 Bone Marrow Failure : Most of the children with this problem in
Kuwait are referred to our Unit. Management as per current protocol.
14.10 Myelodysplasia : Most of the children with this disease in Kuwait
are referred to out Unit. Management as per current protocol in the
Unit.
14.11 Specialist consultation : If specialist consultation is required
for any patient, this is obtained from near by concerned specialist
unit. Children with infections diseases are referred to Infections
Disease Hospital.
14.12 Central line (Portacath, Hickman catheter) : This is inserted in
all our Leukaemia children and in some cases of other haematological
disorders by vascular surgeon at near by Renal Transplant Unit at Hamed
Al-Essa Hospital. The care of the central line and management of
catheter related complications are as per protocol in our Unit.
14.13 Bone Marrow Transplant (BMT): Kuwaiti children who need Allogeneic
BMT are sent abroad if HLA compatible donor sib or parent is available .
14.14 Transfusion of Blood and Blood products: See operational policy
for Medical Laboratories – Pages 33 to 41.
14.15 Antibiotic Policy- as per current protocol in the Unit.
15.0 Teaching Programme.
15.1 Teaching ward round : On Tuesday by senior consultant and on
Saturday and Wednesday by specialists. CME approved for credit point
0.5/hr. Category II.
15.2 Journal Club – Monday . CME approved for credit points 0.5/ hr.
Category II.
15.3 Clinical Meeting of Paediatric Department : On Saturday. Case
presentation and discussion as per time table. CME approved for credit
point 0.5/hr . Category II.
15.4 Mortality meeting – once per month on Wednesday. CME approved for
credit point 0.5/hr category II.
15.5 Post graduate teaching: The unit is recognised for Teaching of Post
graduate students from Kuwait Paediatric Board under Kuwait institute
for Medical specialisation (KIMS).
Our Motto
Optimum Care, Longterm event-free-survival and least mortality.
Editorial Team.
DR.K.C.ABOOBACKER.
Chief Editor
Members :
DR.Mona H.Bourahma
DR.Eman R.Al-Matar
DR.Ebtisam Al-Oneizi.
{up}
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3- NEUROLOGY POLICY
Paediatric Neurology Unit – Ward 3- NBK
Neurology sub-specialty unit
v Medical staff include:
2 Senior Specialists
2 Specialists
2 Registrars
1 Assistant Registrar
v The Paediatric Neurology services include:
1. An Inpatient Ward – 3: 20 beds runned by skilled nursing staff who
deals with epilepsy and different neurological problems efficiently.
2. An Out Patient Clinic on Sunday & Tuesday, the number of patients
ranges between 230-323/month.
3. Consultations are covered daily in addition to the ward by a
consultant
neurologist who is responsible for calls from Al Jahra and Farwania,
Fever, Chest, the Al Sabah area specialty hospitals including
(Neurosurgery, general paediatric surgery at Ibn Sina, Ophthalmology, Al
Babtain Centre), ENT, Al Razi, Maternity Neonatal unit, Cancer and
Oncology Hospitals.
4. A Neurophysiology lab service runned every day, referral from all
over Kuwait health areas. It is fully equipped with EEG, EMG and Evoked
Potential based on arranged appointment, either urgent, acute or regular
one. The number ranges from 137-180/month.
5. Medical Boards held in the hospital and the Al Sabah area specialty
hospitals as well as Farwania, AL Jahra, Maternity neonatal Unit, Al
Razi and Physical Medicine & Rehabilitation hospitals.
6. Social worker requested as in the current situation this not active,
however this is provided the whole hospital service.
7. Psychologist
v ADMISSION & DISCHARGE POLICY
As for the general ward.
v Neurology Unit Activities:
1. Neurology unit provide Teaching and Training Rounds for medical
professionals carried by the Senior Specialists and Specialists twice
per week. Continuous Professional Development CPD/CME for Al Sabah
Hospital, beside daily service rounds.
2. Academic scientific meeting and Journal club once per week planned
for CME & CPD.
3. Unit Counsel meeting for administrative and developmental plans once
per month or closer when needed.
4. Joint meeting with neuroradiologist for clinical and radiological
review of patient case discussions twice/month.
5. The Unit invites Consultant Neurologist visitor Dr. David Neubauer
who would see patients and difficult problem cases on yearly basis and
participate in teaching and training activities.
6. Neurology Unit organize for Scientific Meeting and workshops for
paediatric epilepsy surgery in the year 1999, paediatric neurology
updates in 2000, and in 2001.
7. The Unit co-operate with Kuwait Paediatric Society and Kuwait Medical
Association for arranging international conference, the forthcoming in
November 2002, Paediatric Neurology Congress.
Dr. Asma A. Al Tawari
Head of Paediatric Neurology Unit
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4- DEVELOPMENTAL POLICY
The Developmental Paediatrics Unit consists of 1 specialist, 3 registrar
who see patients on daily basis. The patients are all out patients
divided into new patients and follow ups.
The patients are referred from all over Kuwait. They are referred from
other departments, other hospitals, polyclinics, schools and specialized
centres.
On average we see about 350 patients/month.
v The following clinics run in the Unit:
1. Daily Clinics:
For both new patients and follow ups.
When the patient comes for the 1st time, the social worker and the
psychologist see him. Full social history is taken and IQ assessment is
done by the psychologist mainly using Stanford-Binet Psychological
Assessment.
The patient is then seen by the doctor who takes full history, makes
full physical examination and then does developmental assessment using
the tools needed for each case. The patient is investigated as needed
and referred to other departments for his specific problems like
physiotherapy department, hearing and speech centre, genetic centre and
special educational centres.
2. Specialized clinics: by Dr. Fatma
For patients with Autism, ADHD & CP. For further evaluation and
assessment applying the specific tools for each case.
CP and other neurological patients are seen on regular basis with Dr.
Mohammed Owaidha, paediatric neurologist for further evaluation and
investigations.
Co-operation with other hospitals, centres and schools
We do involve the school psychologists and teachers when we discuss
about schooling and school progress.
Working with other departments like Physiotherapy, Occupational Therapy
and Speech Therapy as well as with Genetic Centre, Kuwait Centre for
Autism, the Social Affairs and the School for Children with Special
Needs. This is to emphasize the multidisciplinary approach for the
children with developmental problems.
v CME activities:
1. Patient Review Meetings:
On daily basis to discuss the new patients seen by the doctors.
2. Journal Clubs:
Every Wednesday a topic related to our unit and subspecialty is
prepared, presented and discussed by one doctor.
v The Unit also includes:
1. Psychologists : They do the IQ assessment mainly applying Stanford-Binet
test. They are involved with the team dealing with the children and
parents and helping in schooling.
2. A nurse
3. 2 Medical Secretaries
4. An employer for the filing system
v Teaching & Training:
The unit provides teaching and training for doctors joining the unit
from:
1. Our department
2. Family Medicine Program
v Medical Boards : are also held in the unit for the patients.
The unit participates in the different activities that take place in the
department.
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5- ENDOCRINE POLICY
The Endocrine unit include two sub-specialities:-
1. The Endocrine clinic
2. The inborn error of metabolism clinic
Both clinics serve all Kuwait areas.
The unit are coverd by 3 consultants
The work schedule for this unit is:-
I On Sundays, there are 2 OPD clinics
A. Inborn error of metabolism clinic and have been running by Dr. Dina
Ramadan. Patients are also seen during other days according to their
clinical situation.
B. Leukaemia in remission clinic and have been running by Dr. Zaidan Al
Mazidi and the total number patients ; 130
II On Monday, there is one clinic which is the main general endocrine
clinic.
Number of patients/month ranges between 250-300.
The clinic also see diabetic patients of
Sabah area.
Both Dr. Zaidan Al Mazidi and Dr. Dina Ramadan are running this clinic.
A doctor from Amiri Hospital, Children department is attending the
clinic for training.
There are joint clinics which work together with this general endocrine
clinic and these are:-
1. Nutrition clinic – which looks after patients with obesity,
underweight, diabetic patients, dyslipidemies and the inborn error of
metabolism.
2. Social & Psychologist clinic – this clinic assess the IQ of patient
with congenital hypothyroidism and other endocrine disorders.
3. Other related clinics as renal, neurology and asthma clinics.
4. The endocrine and inborn error of metabolism clinics are provided
with a well trained nurse’s team because these clinics require
provocative and dynamic tests and sometimes a long fasting tests. These
blood tests are critical and needs well trained nurses.
III On Tuesdays – Dr. Zaidan is running an endocrine clinic in Mubarak
Hospital, Children department.
STATEMENT OF PURPOSE AND AIMS OF THE DEPARTMENT
Purpose : To care, to heal, to teach
and research
Aims :
1. To provide comprehensive medical care (including emergency and
medical care) to sick children.
2. To promote child welfare throught active interraction with parents or
legal guardians, schools and other relevant agencies.
3. To provide general and specialist Paediatrics training to graduate
doctors.
4. To prpmote clinical research and in-service training and continuous
medical education.
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6- PICU POLICY
I. INTRODUCTION
The pediatric intensive care unit (PICU.) in pediatric Department of Al-
Sabah Hospital, is the first of it’s kind in Kuwait. In 1987, Ministry
of Health, Kuwait decided to establish this unit in Pediatric Department
of Al –Sabah Hospital and start it’s functioning since March, 1988.
Normally from neonatal to children up to 12 years who needs intensive
care for their medical problems are eligible for admission for this
unit. But there are some special cases where age barrier is relaxed.
PICU receives patients from all government and private hospitals in
Kuwait. PICU is well equipped and from its beginning it is run by
Kuwaiti doctors in collaboration with physician from Lujbliana Clinical
center, Slovenia. The maximum capacity of PICU is 12 beds, however, due
to a shortage of staff only 7-8 .
II. AIM
1- To assist a critically disabled child to recovered from a serious and
crippling disease with minimum physical, neurological & psychological
damage allowing his /her to go back to, and fulfill useful roles in our
society.
2- To provide specialized & heavy care and treatment in a carefully
controlled care environment.
3- To offer continuous electronic monitoring & frequent clinical
observation/ assessment so that care of these patients may be routinely
and ,axially achieved.
4- To offer complicated, often mechanical management.
III. OBJECTIVE: TRAINING
1. To develop proficiency & skill in the field of intensive care .
2. To develop confidence in judgment even under stress.
3. To develop clinical sensitivity in such a way that will enable the
physician.
In Training to depend less on electronic monitoring.
4. To simulate develop their interest for research and investigation.
5. To develop professionalism and social consciousness.
6. To develop creativity in improvisation of equipment utilizing
indigenous materials.
IV. OBJECTIVES:
1. To determine the outcome of treatment on a long term basis.
2. To determine the risk factors per disease entity.
3. To develop improvised equipment utilizing indigenous materials.
V. PICU COMMITTEE:
1. The members of the committee will be responsible for the on – going
operation & management & review policies / operational procedures .
A. Medical director.
B. Hospital administration.
C. Representative physicians from all concerned segments of the medical
staff, including anesthesiology.
D. Electrical engineer
E. Nursing Director
F. Head nurse
VI. Doctor & Nursing Staff
1. PICU Consultant 2
2. PICU S .Registrar 1
3. PICU Registrar 3
4. Head Nurse 1
5. Assist Head nurse 1
6. Staff Nurse
VII. SOCIAL WORKER:
1. Works with patient, nursing personnel& families.
2. Meets with PICU nurses to discuss problems within the working unit,
in periods convenient to her .
VIII. PICU STANDING ORDERS:
1. For CPR
2. Routine on admission
3. Emergency
4. Discharges or transfer
5. Over-census
6. Spread of infection
IX. DAILY WORK:
1- Responsibilities of residents on call:
a.) Responsible for the management of the PICU patients .
b.) Responsible for the admission and discharge to and from the unit
during the 24-hr. period .
c.) Responsible for recording patient care plans for that day during
morning patient rounds .
d.) Writes admission and discharge respiratory therapy orders and notes
in the chart . Orders are to be completely rewritten and updated daily .
e.) Responsible for the respiratory aspect of cardio-pulmonary
resuscitations occurring throughout the hospital .
2- Responsibilities of on call residents :
a.) Organization of morning rounds, presenting patients and planning
patient management for that day including total follow-up case
presentation of patients assigned to him .
b.) Assisting the on call residents with the day’s work .
c.) Completing a daily data summary for each patient, thereby ensuring
that all test, x-rays and procedures have been accomplished .
3- Physician consultant:
A physician with a sub-specially who may be referred to as the need for
his/her expertise arises .
4- Head nurse:
a.) Responsible for overall organization and management of nursing care
on all there shifts .
b.) Responsible for admission, discharge in procedures and policies as
discussed with the PICU chairman .
c.) she must be present during the morning rounds .
5- Staff nurse:
a.) Responsible for the care of the patient assigned to her during her
shift .
b.) Attends morning rounds and conferences on their patients .
6- How to handle medical inquiries:
- Attending physicians must answer all inquiries concerning status of
patients.
- The pediatric residents and ICU consultant in – charge of the patient
should
communicate with parents and relatives of their respective patients and
answer
all inquiries. Complaints, problems, interpersonal or otherwise should
be
relayed to the head of ICU .
7- Decorum:
- Residents and fellows in their capacity as PICU physicians, are
expected to
maintain proper professional decorum at all times in their relationship
with
parents, patients and personnel. Inappropriate levity in the presence of
critically ill children and their parents may result in poor public
relations
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