Saturday, June 9, 2007

Chief Medical Officer In charge --Handing over of charge

Handing over of charge
The Chief Medical Officer In charge while proceeding on leave/ transfer will hand over the charge of the dispensary to the senior most Medical Officer of the dispensary if the name of specified medical officer is not mentioned by the competent authority. He will prepare a list of articles in quadruplicate to be handed over to the relieving Officer, one copy to the Zonal Headquarters, third, copy will be kept by the relieved Officer and fourth Copy will be in the dispensary file.
The following articles shall be handed over to the relieving Officer:

1. Duplicate Keys.
2. Guard File.
3. Compendium.
4. Chit Books.
5. Impress ledger.
6. Inspection Book.
7. Complaint Book, “.
8. Surprise Check Register.
9. Attendance Register.
10. Casual Leave Register.
11. Compensatory Off Register.
12. Confidential files.
13. He should obtain ‘No Demand Certificate’ from the store-keeper of the dispensary duly countersigned by the relieving Medical Officer In charge. One copy- of no demand certificate should be for warded to the Zonal Headquarters.

14. Brass Seal
15. Any other important records, files and articles



Dr Marwah

Grant of Child Adoption Leave for 135 days to the female Govt. servants on adoption of a child upto one year of age

No.130181412004-Estt.(L)
Government of India
Ministry of Personnel, PG. & Pensions
Department of Personnel & Training
New Delhi, the 31st March, 2006
OFFICE MEMORANDUM


Sub: Grant of Child Adoption Leave for 135 days to the female Govt. servants on adoption of a child upto one year of age —
*****
The undersigned is directed to refer to this Department’s OM No. 130 18/4/89-Estt.(L) dated 25th October, 1989 regarding grant of leave to female Govt. servants on adoption of a child and to say that on having considered the justifications given by the Association of Adoptive Parents (ATMAJA) and the views of the Ministry of Health & Family Welfare as well as those of the Department of Women & Child Development., it has been decided to extend the benefit of leave for 135 days to the adoptive mothers with fewer than two surviving children as ‘Child Adoption Leave’ on adoption of a child upto one year of age, on the lines of maternity leave admissible to natural mothers.
2. During the period of Child Adoption leave, she shall be paid leave salary equal to the pay drawn immediately before proceeding on leave.
3. Child Adoption leave may be combined with leave of any other kind.
4. In continuation of ‘Child Adoption leave’, the adoptive mothers may also be granted, if applied for, leave of the kind due and admissible (including Leave not due and Commuted leave not exceeding 60 (sixty) days without production of Medical certificate)
for a period upto one year reduced by the age of the adopted child on the date of legal adoption without taking into account the period of Child Adoption leave, subject to the following conditions.
i) This facility shall not be admissible to an adoptive mother already having two surviving children at the time of adoption.
(ii) The maximum period of one year leave of the kind due & admissible (including Leave not due and Commuted leave upto 60 days without production of Medical certificate) will be reduced by the age of the child on the date of adoption without taking into account Child Adoption leave as in following illustrations:
- if the age of the adopted child is less than one month on the date of adoption leave upto one year may be allowed.
- If the age of child is six months and above but less than seven months, leave upto 6 months may be allowed.
- If the age of the child is 9 months and above but less than ten months, leave upto 3 months may be allowed.
5. Child Adoption leave shall not be debited against the leave account
6. So far as persons serving in the Indian Audit & Accounts Departments are concerned, these orders are being issued after consultation with the C&AG of India.
7. Relevant rule is being incorporated/amended.
8. These orders will have effect from the date of issue.
9. Hindi version will follow.

(S. Meenakshisundararn)

Deputy Secretary to the Govt. of India

To
All the Ministries/Departments of the Govt. of India etc.
No. 13018/4/2004-Estt.(Leave) New Delhi, 313t March,2006 Copy also forwarded to:—
1. Office of the Comptroller & Auditor General of India.
2. Office of the Controller General of Accounts, Ministry of Finance.
3. Secretaries to Union Public Service Commission/Supreme
Court of India/ Lok Sabha Sectt. / Rajya Sabha Sectt I Cabinet
Sectt. / Central Vigilance Commission/President’s Sectt. / Vice-
President’s Sectt. / Prime Minister’s Office/Planning
Commission/Central Information Commission.
4. All State Governments and Union Territories.
5. Governors of all States/Lt. Governors of all Union Territories.
6. Secretary, National Council of JCM (Staff Side), 13—C, Feroz Shah Road, New Delhi,
7. All Members of the Staff Side of the National Council of JCM / Departmental Council.
8. All Officers/Sections of the Department of Personnel &
Training/Department of Administrative Reforms & Public
Grievances/Department of Pension & Pensioners
Welfare/ PESB.
9. Ministry of Finance, Deptt. of Expenditure, with reference to their U.O.No.45/EV/2006 dated 31.1.2006.
10. Official Language Wing (Legislative Deptt.), Bhagwan Das Road, New Delhi.
11. Railway Board, New Delhi.
12. 300 spare copies.

(S. MEENAKSHISUNDARAM)

DEPUTY SECRETARY TO THE GOVT. OF INDIA


Wednesday, June 6, 2007

THINGS THAT PATIENTS DON'T WANT TO HEAR

THINGS THAT PATIENTS DON'T WANT TO HEAR

 

Certain phrases can quickly anger or annoy. Here are some hot buttons you and your staff should avoid pushing.

One key secret to good patient relations is avoiding certain hot-button phrases. With this in mind, here are some things that patients don't want to hear.

"I don't know." No one in your office should ever utter those three words. If a staffer doesn't know the answer to a patent's question—and it doesn't concern sensitive clinical or financial information—she should promise to get an answer as soon as possible.

"We can't do that." This one's guaranteed to get your patent's blood boiling. For one thing, it's often not true. A better response: "Boy, that's a tough one. Let me see what I can do." It's almost always possible to come up with a solution. Encourage staff who find themselves in such situations to come to you or your office manager for advice. On the rare occasion when you're absolutely unable to help someone, be honest and say, "We sure tried for you, but it looks like you may have us on that one." Then ask what suggestions the patient has to solve the problem.

"You'll have to . . . " Patients have plenty of options, and they'll exercise them if you or your staff begin too many sentences with this phrase. Rather than issue a command, soften the request by saying something like, "Here's how we can help you with that."

"You should have . . . " It won't help your practice to blame frustrated or angry patients for the problem, even if they are at fault. Instead, try, "The next time that happens, here's what you can do."

"Hang on a second." This line, usually delivered over the phone, irritates patients because it's never the truth. "Right back" often turns out to be several minutes. People will respond better if your employees are honest with them up front: "It may take me two or three minutes to get that information. Are you able to hold while I check?" Better yet, they should take the patent's number and call back with the answer.

"No." At the beginning of a sentence, the word "no" is useless and conveys total rejection. By thinking before speaking, you and your staff can turn every answer into a positive response. For instance, instead of saying, "No, Dr. A can't see you until Friday," your receptionist might respond, "I'm sorry, Dr. A's schedule is filled, but Dr. B can see you at 2 o'clock today. Will that be all right?" Instead of saying "No, you don't need an ENT referral," you can say "Let's try this medication for two weeks; if you're not feeling better then, we'll explore other options."

"It's our policy." Sometimes, your staff won't be able to accommodate a patent's wishes. When they have to deliver the bad news, it's a good idea for them to give the reason for it. Too often, though, the reason given includes the "P" word: "It's our policy." This is akin to a parent telling a child, "Because I said so." It's not an informative or satisfying explanation.

Sure, medical practices need policies, and your staff should be well trained in what they are and how to use them. But avoid the "P" word. And, if you can't come up with a good reason for the rejection, maybe it's time to dump the policy and give patients what they want.

"I understand, but . . . " The clinker in this phrase is "but." It tells patients that everything they have just said is about to be invalidated by what they're about to hear. Just leave it out.

"I'm new here." This is in the same family as "Nobody told me" and "That's not my department." When patients have problems, they don't want to hear anyone ducking responsibility—they want help. If an employee is new or doesn't know how to assist a patient, have her say something like, "I can't help you with that. Let me get my senior." Or, "Suman usually handles that, and she's away. I'll discuss this with her as soon as she returns."


 I came across this article. It seems to me relevant in our settings.
--
Dr Marwah

Tuesday, June 5, 2007

ROLE AND RESPONSIBILITIES OF CHIEF MEDICAL OFFICER IN CHARGE

ROLE AND RESPONSIBILITIES OF CHIEF MEDICAL OFFICER IN CHARGE

CLINICAL WORK

He will provide Primary Health Care/Comprehensive Health Care to the CGHS beneficiaries. He will ensure that emergency services are provided through the dispensaries 24hrs*365days.
He will implement all the National Programmes like Reproductive & Child Health Programme, Universal Immunization Programme, Vector Borne Diseases Control Programme, Revised National Tuberculosis Control Programme, National Leprosy Eradication Programme and National programme for Control of blindness.

FAMILY WELFARE PROGRAMME & M C.H.

He will be overall in charge of Family Welfare Programme.He will conduct and supervise the Family Welfare Programme to achieve the target successfully. H e will be responsible to promote the Family Welfare Program by educating the eligible couples and creating the community awareness about type of contraceptives available, sources of contraceptives and their availability, provision of MTP services and permanent method of contraception (vasectomy, tubectomy).

PREVENTIVE PROPHYLACTIC TREATMENTS
He will organize Preventive and Prophylactic treatment to the beneficiaries. The various immunization Programmes and antenatal Check-ups should be organized in the dispensary.

EVACUATION OF SERIOUS PATIENTS
He should ensure safe evacuation of serious patient by calling the ambulance from the hospital/any other arrangements depending upon the Seriousness of illness.
MINOR SURGICAL WORK

The facilities for minor surgical Work such as opening of abscess or stitching of wound should be available in the dispensary.

HEALTH EDUCATION
The Health Education Programme should be Organized in the dispensary. He will create awareness by educating the beneficiaries about personal hygiene, role of exercises, good food habits, use of O.R.S., breastfeeding and weaning foods, Immunization Schedules, safe sex and avoidance of AIDS etc.

He will adjust his own patient's load keeping in view his additional duties.

He will ensure as far as possible patients load is equally distributed among Medical Officers posted to this dispensary.

ADMINISTRATION
Chief Medical Officer In charge will take round daily to observe whether all staff is in their respective place of duty. He should also make surprise round in between to ensure smooth functioning of the dispensary. He will ensure that all staff is in position to start work at the scheduled time. He will maintain an attendance register for his staff, which he will place on his table and he will ensure that all, members of the staff note down the time of arrival and departure in the attendance register. He will countersign the attendance register daily which will be in his personal custody and which he will remove from his table half an hour after opening hour of the dispensary and at the time of closing of the dispensary. He will record absence or leave, late arrival etc. appropriately in red and take —suitable action and/or report defaulter to the competent authority.

CASUAL LEAVE COMPENSATORY OFF STATION LEAVE PERMISSION
He will maintain the Casual Leave record and grant Casual Leave and Compensatory off to all staff working in the dispensary other than him/her. He can also grant station leave permission. In exceptional cases he may consult Addl Director for advice.

RESIDENTIAL ADDRESS OF STAFF
The Chief Medical Officer In charge will maintain the record of residential addresses of all the staff members along with Telephone numbers if any.

He will be responsible for maintenance of discipline and order in the dispensary.

UNIFORM
The Chief Medical officer in charge should ensure that all staff wears the prescribed uniform while on duty.

PUNCTUALITY
He will ensure punctuality and deduct day Casual Leave from Casual Leave account for late coming, for each late attendance. But late attendance up to an hour on not more than two occasions in a month may be condoned by the Competent authority, if he is satisfied that it is due to unavoidable reasons. In case such a course 'does not ensure punctual attendance, suitable disciplinary action may be taken against the Govt Servant concerned in addition to deducting half a day's casual leave to his casual leave account for each occasion of such late attendance.

He will arrange a Group 'D' staff to take over the charge from the Chowkidar in the morning session and to hand over the charge to the Chowkidar in the evening session.


SAFAI WORK IN ABSENCE
OF SAFAIWALA

The Chief Medical Officer in charge is authorized to appoint one Safaiwala on daily wages basis as and when required.

MAINTENANCE OF BUILDING

He has to keep good liaisons with the CPWD for the proper maintenance of building.

FINANCIAL MANAGEMENT

He will be responsible for disbursement of pay of dispensary according to the instructions.

IMPREST MONEY
Imprest money register will be maintained by the Chief Medical Officer In charge. He will send paid up vouchers duly certified to Zone for recoupment.

PREPARATION OF ACQUAINTANCE ROLL:
1. Separate Sheet should be used for each category of staff e.g. one sheet of staff Nurse, one sheet for L.D.C. , one sheet for Storekeeper etc. or as per the direction of D.D.Os.
2. Name of dispensary in block letters.
3. Stamp of the dispensary at the top with date in each sheet.
4. Each sheet should have serial number and initial of Medical Officer in charge.

Checking of Chemist Bill
CMO I/C should examine the chemist bill and forward to the concerned authority within the stipulated time. He should ensure that Local Chemist should write the different rates uniformly on the indent forms i.e. He should write ones under ones, tens under tens, hundreds under hundreds etc. Bills should be checked thoroughly. Rates have been already checked while receiving the indents so more attention can be given to calculations horizontally as well as vertically. Where the packing size is different than the usual 10 more attention is to be given in horizontal calculations. Costly medicines are also to be checked. Here we can apply ABC analysis and HML analysis. Find out the 10% items where 70 % of budget is consumed and pay more attention to those items rates and calculations. Out of others (hml analysis) take the costly items and check thoroughly. From the rest, the random items may be checked. Items like loprin which has very less value, in single /double figures; putting single digit in front is very easy not to get noticed. Take steps to prevent that. Ask the chemist to put 0 under hundreds. Tens as the case may be. Always recheck from the dispensary copy. Keep all the L P vouchers month wise and if possible get it bounded.

IMPORTANT CIRCULAR FILE (GUARD FILE)
He will maintain the guard file and all important circulars should be filed serially with page mark and keep the file in his personal custody.

DAILY DIARY
He will maintain a daily diary and record all the important incidents occurring in the dispensary.

AUTHORITY BOOKS AND CHIT BOOKS:
The Chief Medical Officer In charge will keep an account of Authority Books and Chit Books and issue the Chit Books to the Medical Officers as per proforma lay down.

CONDEMNATION AND WEEDING OUT OF OLD RECORDS
The Chief Medical Officer in charge will undertake the condemnation and weeding out of old records.

ACCOUNTING OF STORES
He will scrutinize and countersign- the expenditure of drugs from the stock ledgers of medicines issued by the store-keeper to various units of the dispensary as per demand register. He will countersign all the entries in receipt column of medicines as per vouchers of indents.

He will be responsible for overall consumption of issue of drugs etc. He will be at par with the Specialist regarding issue of Specialist items listed in CGHS formulary. To do the surprise checks of store, dispensing counter.

PROCUREMENT OF MEDICINES FROM LOCAL CHEMISTS THROUGH LOCAL PURCHASE INDENT / BY HAND AUTHORITY

Medicines available should not be indented. Prescriptions should be signed and stamped by the specialist if out of CGHS formulary drugs are prescribed. If the prescriptions is signed by the registrar/ junior or senior resident than it should be signed and stamped by the specialist if out of CGHS formulary drugs are prescribed.

Only valid prescriptions are to be indented, if time barred fresh opinion of specialist is essential. The prescriptions of recognized hospitals are only to be entertained.

Prescriptions and local purchase indents must be legible.

Advertised and food products, cosmetics, ayurvedic drugs prescribed by allopathic physician, inadmissible items declared and imported drugs should not be indented.

H O D items of formulary must be prescribed or countersigned by consultants only. Quantity indented must not be more than the quantity prescribed and the strength of each item must be indicated.

The index card of the beneficiary should be invariably being checked from the record. Date and the quantity indented and supplied should be written legibly in the prescription.

A photocopy of prescription required in case of- cost more than Rs 1000/- per medicine. These photocopies of prescriptions should be paged, numbered, indexed and got properly bound month wise. Medicines should be supplied in full by the local chemist. Write clearly and legibly and in capital letters and mention the strength of medicine.

To bring transparency in the system give code to each medicine. Code should also be different in case of same medicine but different strength. Avoid overwriting and all cuttings should be verified by cmo i/c. Quantity of indented/ supplied medicines to be written in words also. Mention the name of "prescribing doctor" along with hospital in the relevant column.

Medicines not supplied to be indicated as not available. Substitute medicines should not be received. Substitute means medicines of different company/ strength.

The pharmacist should also sign along with his name.

The indent should be entered in register with the following columns

No. And date of indent

No. Of items indented.

No. Of items received

No. Of pages sent

Remarks

Local chemist should indicate batch no/ company name/ mfg. Date/ exp. Date, mrp, local tax and the quantity in the prescribed columns while supplying to the dispensary. Mrp and local tax should be shown separately.

Local chemist should not supply the inadmissible items. Pharmacist receiving the medicines should also ensure it.

While receiving the indent, pharmacist should check the batch no, expiry date, mrp and strength of the medicines. Medicines should be kept separately day wise for one week.

The medicines, left undistributed, should be kept separately. After 15 days unclaimed medicines should be taken on charge and to be distributed to the first beneficiary came for the indent. A separate register should be maintained for above purpose. The pharmacist should verify the name and address of the beneficiary from the token card. Listed items should be taken on charge and separate register should be maintained for the purpose. No separate chit is required. Beneficiary should not be asked to get registered for the purpose. The pharmacist should submit the list of beneficiaries to the entry clerk at the end of the day. Weekly summery of listed drugs and if possible of out of formulary medicines should be made. This summery will be useful for taking the medicine under the formulary and for the provisioning at a later stage.

To avoid the misuse and to bring transparency in the system, all the medicines should be leveled as CGHS supply not for sale and all the sealed items should be handed over to the beneficiary after breaking the seal in front of him as per the store procedures. Medicines should be leveled in such a way that name batch number expiry date etc should always be visible clearly.

Re circulated medicines should not be accepted and matter should be brought to the notice of cmo i/c. The pharmacist should be polite and also explain the doses duration, frequency of medicines to be taken. And any adverse reactions expected to the beneficiary in their language.

BY HAND AUTHORITY

He will ensure that patients get the medicine of short durations for emergency treatment immediately on by hand authority. He will take all the precautions mentioned above in procuring medicines.

PENALTIES
In case of indent for specific brand of medicines, the same shall not be substituted. If any such case is noticed during subsequent scrutiny after or before the payment, then supplier will be penalized for Rs.1000 + cost of the specific brand of medicines for each such default.

The delivery of supplies in full will be made on the next working day by 8.30 a.m. or at the opening hours of unit/dispensary, whichever is later, at the premises of the dispensaries indenting the supplies or in case of emergency at the residence of the patients as directed by CMO I/c of the dispensary/unit. In the event of non-supply of indented medicines in time as aforesaid, Rs. 500/- will be deducted from the bill of the Chemists for each delay.

Forecasting

He will forecast and prepare the demand for the dispensary for the future year.

A time series is a sequence of observations which are ordered in time. Inherent in the collection of data taken over time is some form of random variation. There exist methods for reducing of canceling the effect due to random variation. Widely used techniques are "smoothing". These techniques, when properly applied, reveals more clearly the underlying trends. Moving averages rank among the most popular techniques for the preprocessing of time series. They are used to filter random "white noise" from the data, to make the time series smoother or even to emphasize certain informational components contained in the time series.

Brass Seal
He should ensure sealing of stores with brass seal and the brass seal should be in his personal custody.

BEST CLEAN DISPENSARY

For the best clean dispensary, the following activities were performed: Cleanliness of dispensary, Display of Posters, Keep up of Notice Board, Maintenance of store, F. W. activities, working in Hindi.

To save the staff from legal consequences under Law of Torts and to provide better facilities to beneficiaries, instructions were displayed prominently at the Notice Board outside the injection room, Doctors' room, local purchase counter, Dressing room, Medicine Counters under the guidance of CMO I/C.

PERMISSION FOR INVESTIGATIONS AND TREATMENT IN PRIVATE RECOGNIZED HOSPITALS

CMO i/c shall issue permission for Investigations / Treatments procedures as per the specific tests / treatment procedures as advised by CGHS / GOVERNMENT Specialist / CMO in a CGHS recognized Diagnostic Centre / Hospital of the choice of beneficiary in respect of pensioners / Ex-Mps, Freedom fighters, CGHS staff.
Such permission in respect of serving employees is granted by HOD.

GRIEVANCE COMMITTEE
The Chief Medical Officer In charge will form Grievance Committee in consultation with Area Welfare Officer and hold meetings regularly preferably on second Saturday to solve the problems of the dispensary. The committee will have two members of Resident Welfare Association, Pensioners respectively. The Committee will try to settle any complaint against the dispensary/Staff. The minutes of the meeting should be recorded and forwarded to the Zonal Headquarter/Addl Director (HQ).
Revalidation of Pensioner Card:
The Chief Medical Officer In charge is to revalidate the pensioner Card as and when required. It should be done both annually or bi-annually i.e. June and December.
RELIEVING DUTY OF MEDICAL OFFICERS
The Chief Medical Officer In charge will depute Medical Officers on relieving duty in turn.

MONTHLY REPORTS

Monthly reports are prepared. It includes the number of cards, beneficiaries, new patients, old patients, working days and average daily attendance. Monthly Hindi report is also prepared.
EMPLOYEES STRIKE OR LOCAL CHEMIST STRIKE
He will take all the measures so that the beneficiaries are not harassed during the employees strike or Local Chemist strike.
CPIO
He will act as CPIO for the dispensary under the RTI act.

Any other work assigned by the Additional Director.

Dr Marwah