MIS FORMAT FOR SUBMITTING DATA BY HOSPITALS

Transcription

1 MIS FORMAT FOR SUBMITTING DATA BY HOSPITALS Hospital K.E.M. Month December Year From To General Information : Telephone No Fax e- mail Id asmckemh@kem.edu Name of Head of Hospital Dr. Avinash Surname Supe Designation Dean No of Beds 1,800 No of Wards 54 No of Operation Theatres Whether Hospital has Blood Bank 17 Yes 2. Out Patients 1. No. of days OPD worked during the 2. No. of Out Patients registered during the a) Old OPD b) New OPD 3. No.of OPD Registration counter days ( to calculate the counter days add the actual number of ,889 53, registration counters opened for each working OPD day in the ) 3. Inpatients a) General 1. Total Admissions during the 6, Average stay of patient (days) (*) 7.71 (Total No.of days stayed by discharged patients divided by No. of discharged patients during the ) 3. Average bed occupancy (%) (**) 0.90 No. of occupied bed days / total No. of available bed day X 100 ( to calculate the occupied bed day add the No. of occupied beds for each day in the. to calculate the total available bed days multiply the total bed strength by the No. of days in the ). b) Details of Wards with bed occupancy greater than 100% Use of Floor Beds for the full Ward Bed Strength No.of days occup-ancy was more than 100% Total excess bed days A , A , c) Operations carried out during the Major Operations 2,557 Minor Operations 2,664 d) No.of deaths during the Total No( i +ii ) 497 i)natural 399 ii)un Natural No. of Blood Bottles Used : (Please enter previous stock balance in a) from value in e) of last ) a)stock at the beginning of the 367 b)from Hospital Blood Bank without replacement 196 c)from Hospital Blood Bank with voluntary replacement 1,960 d)from outside 331 e)stock at the end of the 293

2 5 Complaints : Please enter backlog in columns 2 from balance in column 5 of last Complaints Backlog at the beginning of the Received Disposed Balance at the end of =(2)+(3)-(4) a) Regarding Food b) Regarding Linen c) Regarding Drugs d) Regarding Staff e) Miscellaneous Drugs 1) Stock Please enter backlog in columns 2 from balance in column 6 of last Drug Stock at the beginning of the Quantity supplied to the OPD Quantity received during the Quantity supplied to Inpatients (Wards.OTs,et c.) Stock at the end of the =(2)+(3)- [(4)+(5)] 4<= (2)+(3) 5<= (2)+(3) 6 >= 0 1)Anti-Pyretic Syrup(Bottles) 7,975 3,000 1, ,825 2)Anti-Pyretic Tablets(Nos) 9,813 50,000 3,000 2,250 54,563 3)Anti-Pyretic Injections(Vials) , ,500 5,400 4)Anti-biotics Syrup(Bottles) 5, ,988 5)Anti-biotics Capsules(Nos) 25,715 10,000 12, ,865 6)Anti-biotics Injections(Vials) 33,152 3, ,500 28,152 7)Anti-Tuberculosis Tablets(Nos) )IV Fluids 5% Glucose(Bottles) 12,000 21, ,000 25,000 9)IV Fluids Glucose Saline(Bottles) 28,000 30, ,000 38,000 10)IV Fluids Ringer Lactate(Bottles) 9,000 30, ,000 31,000 11)Anaesthesia drugs Injections(Vials) 7,314 1, ,500 6,314 12)Vitamins Syrup(Bottles) 7,190 1,500 1, ,365 13)Vitamins Tablets(Nos) ,000 25,000 4, ,968 14)Ointments Tubes(Nos) )Mixtures/Syrups (Bottles) 26,943 1,500 1, ,588

3 2)Purchased from outside Drug 1 Quantity 2 Cost(Rs) 3 3=(4)+(5) Local Purchase(Cost Rs) Poor Box Fund From Imprest 4 5 1)Anti-Pyretic Syrup(Bottles) )Anti-Pyretic Tablets(Nos) )Anti-Pyretic Injections(Vials) )Anti-biotics Syrup(Bottles) )Anti-biotics Capsules(Nos) )Anti-biotics Injections(Vials) )Anti-Tuberculosis Tablets(Nos) )IV Fluids 5% Glucose(Bottles) )IV Fluids Glucose Saline(Bottles) )IV Fluids Ringer Lactate(Bottles) )Anaesthesia drugs Injections(Vials) )Vitamins Syrup(Bottles) )Vitamins Tablets(Nos) )Ointments Tubes(Nos) )Mixtures/Syrups (Bottles) )Drugs not utilised for more than 6 s : Name of the Drug Quantity Unit Cost No.of s not used Action suggested Injection I.V.Fluid Chemical Tablet Non - Schedule Linen(No of Pieces) Please enter backlog in columns 2 from balance in column 5 of last Linen Opening Balance at the beginning of the Received during the Issued to Wards Balance at the end of the = (2)+(3)-(4) i) Operation Linen 35, ,000 33,560 ii) Bed Linen 10, ,005 7,692 iii) Patient s Linen 1, ,942 iv) Surgeon s Linen 2, ,472

4 8. Equipment(in Use or not in Use) Equipment Total Nos. of Units provided CT Scan 2 0 E.E.G. 3 0 E.C.G. Machine 12 0 Anaestasia Machine 40 0 Operation Tables 50 0 X-Ray Machine 16 0 Lifts 26 0 Ventilators A.C.Plants 5 0 Water Pumps 6 0 Oxygen Supply System 2 0 Cath-Lab 3 0 Dental Chairs 5 0 D.G.Sets 6 0 ABG Machine 10 0 OPG 0 0 Ultra Sonic Scanner 11 0 M.R.I. 1 0 B. Status of Equipment Purchase/Replacement Proposals sanctioned (Costing more than Rs. 5 Lakhs) a) New Purchase Proposals Please enter backlog in columns 2 from balance in column 5 of last Backlog at the beginning of the 1 Sanctioned during the Completed (Equipment procure/replac ed) Proposals Cancelled Equipment out of Order(A) 5 Proposals Balance at the end of the Operator/s Absent(B) 6 Remarks =(1)+(2)- 6 [(3)+(4)] b) Equipment Replacement Proposals Please enter backlog in columns 1 from balance in column 5 of last Backlog at the beginning of Proposals the Cancelled Sanctioned during the 2 No.of break downs during the 3 Completed (Equipment procure/replac ed) Total Equip Days Not Used 4 4=(5)+(6)+ (7)+(8) Break up of not used equip-days according to reason Proposals Balance at the end of the Remarks =(1)+(2)- 6 [(3)+(4)] Both A&B 7 Others 8

5 C. Repairs of Equipment (costing more than 5 lakhs) Please enter backlog in columns 1 from balance in column 4 of last Backlog Break downs Repaired Balance during the during the Total Nos. Under repair > 3 s 5 5<=(4) <=(1)+(2) 4=(1)+(2)-(3) Staff Details A-Attendance Category Total Mandays Available* 2 1 Total Mandays Present** 3 3<=(2) 1. Doctors A. Full Time 12,710 12,070 B. Honoraries 0 0 C. Residents 24,800 24, Nursing Staff 22,100 18, Paramedical staff (Other than nursing) 8,855 8, Engineers Equipment Operators(X- Ray Tech.,ECG Tech.,etc.) 2,335 2,300 Remarks 6. Class IV Employees 40,069 29, Administrative Staff 6,985 6,592 Note :- (*) To calculate total Man-days available, find the number of working days during the for each category of staff and multiply by number of filled staff of that category. (**) To calculate Man-days present add the number of days absent for all the employees of each category and substract from total man-days available for that category. 9. Staff Details B-Vacant Posts Category Total No. of Posts No.Vacant Vacant for more than 6 s Schd. Non-Schd. Schd. Non-Schd. Schd. Non-Schd <=(2) 5<=(3) 6<=(4) 7<=(5) 1. Doctors A. Full Time B. Honoraries C. Residents Nursing Staff Paramedical staff (Other than nursing) Engineers Equipment Operators(X- Ray Tech.,ECG Tech.,etc.) Class IV Employees 2, Administrative Staff

6 10. Budget : Figures in Rs progressive (cummulative) upto the end of the reporting Budget Head Cumulative Booking end of the Reporting 1 Allocation for Current Financial Year 2 Amount 3 3<=(2) % 4 Cumulative Expenditure upto end of the reporting Amount 5 5<=(2) Establishment Plant & Machinery Medicines & Diet Repairs & Maintenance Contingencies Stores Deputation , Miscellaneous % 6 Remarks, if any Services(Select Sactisfactory/Needs Improvement/Poor for each service in Rating column) Rating of quality/ Service Areas Name of the Agency Rating Suggestions/Remarks if any Repairs & Maintenance Civil by Department Satisfactory Electrical/Mechanical by Department Satisfactory A/C & Refregeration Electro-Medico Other Services Laundry Transport/Ambulance, Hearse, etc. Security Stores Canteen Voltas,Blue Star E.E.Mech. Satisfactory Satisfactory Privately Satisfactory Ex.Engineer(Tr. Ambulance) Satisfactory by Department Satisfactory by Department Satisfactory Privately Satisfactory 12 Collection & Disposal of Bio-Medical Waste Expected Bio Medical Waste Total Kgs.(0.25Kg per bed per day) 12,589 Bio-Medical Waste Collected and sent to Central Disposal Site at Sewri(i+ii) 29,139 i) For Incineration 9,425 ii)for Autoclaving 19, Remarks of Dean/MS/Ch. M.O computerisation of records / Biometrix in progress Signature Designation

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