July 2015 CCU Report Purulia(1)
25
[This format should be available in all CCU & HDU and send report to Swasthya Reporting Month: 1 Purulia 2 Name o Deben Mahato (Sadar) Hospital 3 Name o Bankura Sammilani Medical College & Hospital 4 Name o Dr.Nilanjana Sen 5 Name o Dr.P.K Mukherjee 6 Date o 41829 7 No. of 12 8 No. of 10 9 No. of 4 10 No. of 4 11 Type o This Month Cumulativ M = Ma M F C ANM PNM Total M This details to be given in Annexure III, not to be given here Report Regarding Patient Admission 12 This Month Cumulativ M = Male, M F C ANM PNM Total M 0 13 Name of the District No. of patients admitted Report regardin g Patient intake (Already under T/t in outside hospital s)
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Transcript of July 2015 CCU Report Purulia(1)
[This format should be available in all CCU & HDU and send report to Swasthya Bhavan every month] Reporting Month:
1 Purulia
2 Name oDeben Mahato (Sadar) Hospital
3 Name oBankura Sammilani Medical College & Hospital
4 Name oDr.Nilanjana Sen
5 Name oDr.P.K Mukherjee
6 Date of 41829
7 No. of 12
8 No. of 10
9 No. of 4
10 No. of 4
11 Type ofThis Month Cumulative this year
M = MaM F C ANM PNM Total M FThis details to be given in Annexure III, not to be given hereReport Regarding Patient Admission
12 This Month Cumulative this year
M = Male, M F C ANM PNM Total M F0
13
MONTHLY REPORT OF CCU / HDU Annexure I
Name of the District
No. of patients admitted
Report regarding Patient intake (Already under T/t in outside hospitals)
13.1
0
13.2
0
13.3TOTAL 0 0 0 0 0 0 0 0
1414.1 Patient directly admitted from Emergency / OPD 0
14.2 No. of patients transferred in from other Dept. of the same Insti 0
14.3 TOTAL 0 0 0 0 0 0 0 0Report Regarding Procedure done on Patients
No. of patients Referred in from other Government Institutes
No. of patients Referred in from other Private Institutes
Report regarding Patient intake (Already under T/t in same hospital / New patient)
15
15.1
0
15.2
0
15.3
0
15.4TOTAL N 0 0 0 0 0 0 0 0
Report regarding Invasive Mechanical Ventilation
No. of Patient put on Invasive Mechanical Ventilation (within 24 hrs of admission)
No. of Patient put on Invasive Mechanical Ventilation (after 24 hrs of admission)
Mean duration of Invasive Mechanical Ventilation
16
16.1
0
16.2
0
16.3
0
Report regarding Non Invasive Mechanical Ventilation
No. of Patient put on Non Invasive Mechanical Ventilation (within 24 hrs of admission)
No. of Patient put on Non Invasive Mechanical Ventilation (after 24 hrs of admission)
Mean duration of Non Invasive mechanical Ventilation
16.4TOTAL N 0 0 0 0 0 0 0 0
17
17.1
0
17.2
0
17.4TOTAL 0 0 0 0 0 0 0 0
18Total No. of Lumbar Puncture done 0
Report regarding Outcome of Patients19 Report regarding referral
19.1 No. of patients Referred out (within 24 hrs of admission) 019.2 No. of patients Referred out (after 24 hrs of admission) 019.3 Total No. o 0 0 0 0 0 0 0 0
20 Report regarding LAMA (Leave against Medical Advice) 20.1 No. of patients LAMA (within 24 hrs of admission) 020.2 No. of patients LAMA (after 24 hrs of admission) 020.3 Total No. o 0 0 0 0 0 0 0 0
21 Report regarding patient Discharged cured/ relieved / Transfer to General ward of same hospital
Treport regarding Temporary pacemaker insertion
No. of Temporary pacemaker inserted (within 24 hrs of admission)
No. of Temporary pacemaker inserted (after 24 hrs of admission)
21.1 Within 24 hrs of admission 021.2 After 24 hrs of admission 021.3 Total No. o 0 0 0 0 0 0 0 0
22 Report regarding Absconded patient22.1 No. of patients absconded (within 24 hrs of admission) 022.2 No. of patients absconded (after 24 hrs of admission) 022.3 Total no. o 0 0 0 0 0 0 0 0
23 Report regarding Patient's death23.1 No. of patients Died (within 24 hrs of admission) 023.2 No. of patients Died (after 24 hrs of admission) 023.3 Total No. o 0 0 0 0 0 0 0 0
Report regarding Patients APACHE scoring and regarding Mechanical & Non- Mechanical Ventilation
24 Total No. of Patient for whom APACHE II Score calculated 025 OUTCOME PThis Month Cumulative this year
Survived Died Under T/t Total Survived25.1 No. of Patient with APACHE II score calculated 025.2 No. of patient with APACHE II score 0-4 025.3 No. of patient with APACHE II score 5-9 025.4 No. of patient with APACHE II score 10-14 025.5 No. of patient with APACHE II score 15-19 025.6 No. of patient with APACHE II score 20-24 025.7 No. of patient with APACHE II score 25-29 025.8 No. of patient with APACHE II score 29-34 025.9 No. of patient with APACHE II score >34 025.1 TOTAL 0 0 0 0 0
26 Outcome of Invasive Mechanical Ventilation 027 Outcome of Non Invasive Mechanical Ventilation 028 Bed Turnover Rate (BTR)29 In-patient Bed Occupancy Rate (BOR)30 Average Le5-6- Days
Signature of In-charge, CCU / HDU
Cumulative Since Inception
C ANM PNM Total M F C ANM PNM Total
Cumulative Since Inception
C ANM PNM Total M F C ANM PNM Total
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0
0 00 0
0 0 0 0 0 0 0 0 0 0
0 00 0
0 0 0 0 0 0 0 0 0 0Report regarding patient Discharged cured/ relieved / Transfer to General ward of same hospital
0 00 0
0 0 0 0 0 0 0 0 0 0
0 00 0
0 0 0 0 0 0 0 0 0 0
0 00 0
0 0 0 0 0 0 0 0 0 0
0 0Cumulative Since Inception
Died Under T/t Total Survived Died Under T/t Total0 00 00 00 00 00 00 00 00 0
0 0 0 0 0 0 00 00 0
00
Signature of MSVP / Superintendent
[This format should be available in all CCU & HDU and send report to Swasthya Bhavan every month] 1 Name of HoD.M (Sadar) Hospital, Purulia2 Name of SuDr.Nilanjana Sen 3 Phone no. 9.43E+094 Name of AssSantanu Mukherjee5 Phone no. o8.44E+096 E-mail ID [email protected] Alternate [email protected] Name of SupDr.P.K Mukherjee
8.1 Phone no. o9.43E+098.2 E-mail ID [email protected] Alternate [email protected]
9 Name of SupDr.K Bose9.1 Phone no. o9.43E+099.2 E-mail ID oN/A9.3 Alternate EN/A10 Name of t Mobile No.Original Posting
10.1 Dr.A Sengu 8.94E+0910.2 Dr.S.S Das 9.48E+0910.3 Dr.T.K Man 9.75E+0910.4 Dr Santanu 9.43E+0910.510.610.710.810.910.1
10.1110.1210.1310.1410.15
11 Name of traMobile No.Original Posting11.1 Dipali Pal 8.9E+0911.2 Sraddha Pa 9.33E+0911.3 Tanushree 9.43E+0911.4 Santoshi C 9.93E+0911.511.611.711.811.911.1
11.1111.1211.1311.14
Manpower Status of CCU / HDU Annexure II
11.1511.1611.1711.1811.19
11.211.2111.2211.2311.2411.25
12 Name of t Mobile No.Original Posting12.112.212.312.412.5
Number of House keeping staff present (Dedicated for CCU)Signature of In-charge, CCU / H Signature of MSVP / Superintendent
Patient Profile Report of CCU / HDU Annexure III
Sl. No. Patient Na Age Date of Ad Date of O
1 Jaydeep chM 40 1 1.07.15 1 4.7.15 hanging with psychatric2 CharamoniPNM 1 1.7.15 1 3.7.15 LUCS3 Rubi bibi PNM 22 1 2.7.15 1 3.7.15 Respiratory distress4 Prabati maPNM 25 1 2.7.15 1 4.7.15 LUCS5 Rabiswar sC 9 1 3.7.15 1 6.7.15 malaria PF positive6 Anil chandM 71 1 3.7.15 1 5.7.15 T2 DMwith gangrenous foot7 Rebkha bhaF 76 1 3.7.15 2 12.7.15 CardiovascuCVA8 Rebkha bauF 22 1 3.7.15. 1 10.7.15 laperotomy9 Arcana majPNM 19 1 4.7.15 1 6.7.15 LUCS with eclampsia
10 Rita bauri PNM 22 1 4.7.15 1 6.7.15 LUCS with high BP11 Suji mahatF 65 1 4.7.15 1 26.7.15 laperotomy 12 Juthi sarkaF 79 1 5.7.15 3 12.7.15 Heamatomeasis with melena13 Suresh ku M 50 1 5.7.15 3 12.7.15 laperotomy followed by temporary colostomy14 Mandira mF 65 1 6.7.15 1 6.7.15 Chest pain15 Sarbeswar M 50 1 6.7.15 1 9.7.15 snake bite16 Tumpa bagPNM 20 1 6.7.15 1 8.7.15 LUCS with eclampsia17 Lagani ha PNM 25 1 6.7.15 1 8.7.15 post partum eclampsia18 Sujan das M 55 1 7.7.15 1 20.7.15 open cholecycestectomy 19 Debasing mM 27 1 8.7.15 1 11.7.15 pain abdomen with vomiting 20 Paul sen F 70 1 8.7.15 1 11.7.15 Respiratory distress with cough21 Meru baurF 62 1 9.7.15 1 10.7.15 Inferior wall MI22 Prabati maF 25 1 10.7.15 2 16.7.15 LUCS with high BP 23 Thandi kalPNM 30 1 10.7.15 1 10.7.15 CRF with post op subtotal hystectomy
M = Male, F = Female, C = Child (<12 yr), ANM = Ante Natal Mother, PNM = Post Natal Mother2 = Referred in from other Govt. Hospital3 = Referred in from other Private Hospital
2 = Expired3 = Transfer out4 = Leave Against Medical Advice (LAMA)
Diagnosis (Mention Main Clinical Diagnosis)Co-morbid condition (if any)
hanging with psychatric
T2 DMwith gangrenous footY
YHeamatomeasis with melenalaperotomy followed by temporary colostomy
post partum eclampsiaopen cholecycestectomy pain abdomen with vomiting Respiratory distress with cough
CRF with post op subtotal hystectomy
Invasive Mechanical Ventillation given (Mention only Yes / No)Non - invasive Mechanical Ventillation given (Mention only Yes / No)
