INFECTIOUS DISEASE Division SERVICE CHARTER

Transcription

1 INFECTIOUS DISEASE Division SERVICE CHARTER Piazza dell Ospitale Trieste;

2 INFECTIOUS DISEASE Division Maggiore Hospital Piazza Ospitale, Trieste Preferably enter the hospital from Piazza Ospitale 1, walk across the yard, step into the glass elevator and press the -1 button. Follow the directions and walk the short route in the basement. 2

3 INTEGRATED ACTIVITY DEPARTMENT SPECIALIST MEDICINE SERVICES Director: prof. Roberto Luzzatti INFECTIOUS DISEASE Division Director: prof. Roberto Luzzati Tel: ; Fax: Nurse Coordinator: Alessandro Conzina Tel: ; Fax: aots.sanita.it USEFUL NUMBERS TELEPHONE/FAX Administrative office Tel Fax Inpatient wards 3 rd floor Tel Fax Outpatient clinic Day Hospital Tel malattie-infettive@aots.sanita.fvg.it MEDICAL STAFF: Dott. Ivo Crosato tel: Dott.ssa Donatella Giacomazzi tel: Dott.ssa Marta Mascarello tel: Dott.ssa Gilda Tonziello tel Dott.ssa Romina Valentinotti tel

4 INTRODUCTION Welcome to the Infectious Disease Division. In the past, the term infection used to be associated to words such as plague, cholera, isolation, quarantine. Nowadays, the definition infectious diseases mainly refers to hepatitis, HIV infection, meningoencephalitis, tuberculosis, as well as non-transmissible infections, such as cutaneous and subcutaneous tissue infections, bone and joint infections, tropical infections, protracted fevers, and many more. Thanks to the new knowledge acquired, the primary goal of protecting the community has been replaced by a provision of care that is responsive to individual patients' needs, optimizing and individualizing care without putting other individuals at risk. This approach will enable You to have a safe stay and receive treatment at our hospital, while safeguarding Your health and that of the people around You (other Patients, relatives and visitors, healthcare professionals). This booklet provides information on your stay at our inpatient facility so that You can achieve the best recovery results in a comfortable setting. 4

5 HOW TO RECOGNIZE STAFF BY THE COLOUR OF THEIR UNIFORMS white green with dark green collar Physicians, biologists, chemists, physicists, pharmacists Nurse coordinators green Registered nurses yellow General nurses blue with white collar OTA, OSS (technical and healthcare assistants) blue Auxiliary staff pale blue with white collar Head technicians pale blue with dark blue collar Physical therapists, speech therapists, orthoptists, occupational therapists pale blue Technicians (radiology, laboratory ) white with orange pocket trim Administrative staff 5

6 In the wards you may meet volunteers who are recognizable from their white coats as well as the badges showing their names and the Associations they belong to. Not all the Staff working at this hospital division belong to the ward: Rehabilitation is carried out by physical therapists; pale blue uniform. Patients are transported to the various hospital services by the porters of the Patient Transfer Team (Squadra Accompagnamento Degenti) employed by a private cooperative; burgundy trousers and white tunic. The cleaning services are supplied by a contracted company; whose staff wears white trousers and a white and cyclamen striped tunic. Meals are provided by a contracted company; white uniform. Staff in training, nursing undergraduates; white uniform. 6

7 As a patient of Ospedali Riuniti di Trieste University Hospital You are entitled to: TRUST All hospital patients are entitled to be treated as trustworthy individuals. QUALITY This University Hospital, a Centre of National Relevance and high specialization, has the purpose of carrying out its healthcare, teaching and research functions in a joint and coordinated way, so as to improve public health provision, enhance the quality of educational processes, develop biomedical knowledge and technological innovation, in the effort of enhancing the functions and activities of both hospital and university staff. The Hospital provides professional healthcare services on a continuous basis, focussing on patients, ensuring a multidisciplinary and integrated organizational approach, as well as understanding and respecting patients and their families. SAFETY All patients are entitled to the necessary healthcare services without having to suffer any further damage due to malfunctioning facilities or services. In order to guarantee such rights, the Hospital is constantly committed to controlling the risk factors and ensuring maintenance for both facilities and hospital medical equipment. The Hospital is also committed to providing continuous training to all healthcare professionals (Law n 338 of 23 December, 2000). PROTECTION Because of their health conditions, all patients are vulnerable and have the right to be protected and taken care of. The same right to receive special protection also applies to the children who may be admitted to our Hospital. 7

8 By way of exception, the competent offices of the University Hospital can only take into their custody the personal belongings of patients admitted in emergency or unable to keep their valuables safe. Patients are recommended not to bring any valuables to the hospital (money, gold items, jewellery) during their period of stay. NORMALITY All patients are entitled to receive treatment at our University Hospital without any of their habits or social and family relationships having to change more than needed. CERTAINTY All patients are entitled to certainty of treatment, without becoming victims of professional or organisational conflicts nor of favouritism on the basis of their economic and social status. The Hospital has the duty to determine the waiting times for the provision of services, according to specific standards and depending on the level of urgency of each case. Patients who so request are entitled to see the waiting lists, provided privacy is respected. PARTICIPATION All patients, their families, the safeguarding bodies and volunteer associations can contribute to improving the quality of the healthcare services and activities of the University Hospital through: Civic Audit surveys perceived quality surveys joint working groups on specific issues reports and complaints. Participation in the healthcare process also includes the patient s right to know the name of the physician in charge of his/her care as well as the qualifications of the professionals involved in the treatment process. DIFFERENCE All patients are entitled to receiving customized treatments according to their needs, and having their individuality respected, without any 8

9 discrimination based on age, gender, nationality, race, language, political opinions, professed religion, or culture. The Hospital is committed to satisfying, as far as possible, the requests for religious or spiritual assistance, by contacting ministers of the different religions. TIME All patients are entitled to having their time respected. Whenever it is not possible to comply with the agreed waiting times, patients shall be informed of the length of the delay and the reasons for it. If the Hospital is unable to provide a service within the maximum time expected, it shall make available an alternative service of comparable quality. PRIVACY AND CONFIDENTIALITY All patients are entitled to the confidentiality of personal data, including information concerning their health conditions and the possible diagnostic and/or therapeutic procedures to undergo, as well as the right to the protection of their privacy during diagnostic examinations, specialist visits and medical-surgical treatments in general. The healthcare professionals of the University Hospital are committed to supplying patients and their families with communications on the patients admission and health conditions, except in cases of explicit dissent. Updated information will be supplied throughout the care process and will be documented in the patients records. A copy of the clinical records can be requested by patients or any other person provided with the delegating person s identification document (or a copy of it) or a self-certification. The application for a copy of the clinical records can be submitted either upon discharge or in the days immediately following (before the record is sent to the archive). The application has to be filed at the Centralized Booking Office (CUP) desks of the Maggiore and Cattinara Hospitals. As from 1/6/2005 applying for a copy of the clinical records from the CUP will require a minimum down payment of The difference shall be settled on collecting the document. Please note that the Medical Record Archive is open Mondays to Fridays, from 7 am to 2 pm and can be contacted by dialling for any enquiry, especially if concerning clinical records preceding

10 DIGNITY All patients, even if affected by incurable diseases, are entitled to receive respect for their personal dignity, by suffering as little as possible and receiving all the necessary care. Our Hospital recognizes and respects the needs of the terminally-ill patients by treating the primary and secondary symptoms, by managing pain, by responding to the emotional, religious, cultural problems of patients and their families. RIGHT TO INFORMATION AND CONSENT All patients are entitled to receive, within reasonable time, exhaustive information on their diagnosis, therapy and prognosis, especially in the case of risky procedures requiring the patients explicit consent. Patients have the right to give or deny their consent to the proposed treatments or tests. During their hospital stay, patients are asked to give a general and a specific consent, in compliance with the regulations in force, for all invasive and/or complex procedures. If the informed consent is not signed, the physician will not be allowed to carry out any diagnostic and therapeutic activity, with the exception of the cases provided for by the law and the situations of necessity and urgency, when the patient s life is in imminent danger. Patients will receive clear and exhaustive information on clinical experimentation and will be able to participate only after signing the relevant informed consent. HEALTHCARE INFORMATION AND DOCUMENTATION Physicians and healthcare professionals ensure that patients receive clear, simple, essential, thorough and comprehensible information. Patients are entitled to participate in the definition of their care plan, to be informed on what impact a disease can have on their lives as well as the therapies and healthcare solutions capable of resolving or at least relieving suffering and pain. 10

11 They are entitled to see their clinical record and to request a copy of it. The Clinical Record shall be clear, legible and complete with all information regarding the diagnosis, treatments and procedures carried out. Patients are entitled to receive a discharge summary at the end of their hospital stay. If the diagnosis is not yet complete, patients have the right to receive a discharge summary with the provisional conclusions. All patients can discontinue their therapy at any stage of the clinicaltherapeutic process or reject a particular treatment. Healthcare providers have the obligation to inform patients of the possible consequences of such behaviour. COMPLAINTS AND REDRESS Patients can file complaints with the Customer Relations Office (U.R.P.) when their rights are violated. The University Hospital has the duty to give a reply on the subject matter of the complaint. Patients and their families can exercise this right in person or over the phone during the office opening hours or by mail, fax, or by filling out the forms available at the info points and dropping them into the appropriate complaint boxes. In the case of easily solvable issues, the Customer Relations Office (U.R.P.) will guarantee a reply in real time or, at the latest, within 15 days. For the most complex cases, requiring a certain amount of investigation, the reply will be given within 30 days. This notwithstanding, patients have the right to take legal action in order to receive compensation for the damage suffered. ORGAN DONATION As provided for by Law 91/99, Patients can consent to become organ donors by making a declaration of will at the Info Point of the Customer Relations Office (U.R.P.) of Cattinara Hospital. The staff of the above-mentioned office is at patients disposal for any further information on this matter. 11

12 As a patient of Ospedali Riuniti di Trieste University Hospital It is your duty to: Respect the hospital staff s work and professionalism as a prerequisite to implement an appropriate therapy and care program. Behave responsibly and respectfully towards other users. Be respectful of the rooms, equipment, furniture and fittings of the Hospital facilities. Observe the established deadlines and times so that the hospital activity can be carried out normally. Smoking is prohibited throughout the hospital facilities. The use of mobile phones is forbidden as they can interfere with the operation of the electromedical equipment (infusion pumps, automatic respirators, etc.) Animals are not allowed inside the perimeter of the University Hospital. With the aim of safeguarding the health of minors, their access to the inpatient wards should be limited. In particular circumstances, exceptions may be agreed with the ward staff. DESCRIPTION OF THE INFECTIOUS DISEASE DIVISION The Infectious Disease Division is located on the 2 nd and 3 rd floor of the infectious patient building, adjacent to the Maggiore Hospital (on the via Gatteri side). The administrative office, the doctors offices and the Day Hospital/Outpatient Service areas are on the 2 nd floor. The inpatient ward is on the 3 rd floor and includes 17 rooms (with one or two beds), the nurses working areas, the Nurse Coordinator s office, a kitchen and a visitors washroom. Inpatient rooms are all provided with private bathrooms and showers. Patients are allowed to use their own portable television sets in their rooms. In the corridor, a fridge is at the patients disposal to store food; patients are reminded to write their surname on the food package, as well as their room number and the date when the product was first opened, with the recommendation to check the expiration date of the 12

13 same. Patients shall be requested their authorization whenever a video-surveillance system is to be used inside an inpatient room. PROTECTIVE ISOLATION Protective isolation is required because a number of well defined infectious diseases can pose a risk of contagion to other inpatients, relatives or friends as well as the hospital staff. Some immunodepressed patients (e.g. those who have undergone chemotherapy or were administered immunosuppressants), in their turn, require isolation to be protected from microorganisms which may be transmitted by the staff or visitors. The range of microorganisms that play an important role in human infections is very wide and includes bacteria, viruses, fungi and protozoa. The various transmission modes of microorganisms require different prevention measures to guarantee a safe and serene stay. The three fundamental pieces of information required to implement isolation are the following: source of infection, host and transmission mode. TRANSMISSION MODE: cutaneous contact percutaneous contact (through broken skin) sexual contact (through genital secretions) by airborne droplets (distance under 1-2 m) through the air (any distance) inanimate vectors (e.g. water, food, any material contaminated by germs) external vectors (e.g. insects) MEASURES TO ADOPT WHEN ISOLATING A PATIENT hand washing and hygiene individual protection devices (gloves, mask, goggles, coats) patients to be accommodated in single rooms cleaning/disinfection of the environment disposal and treatment of linen and waste instrument decontamination and disinfection 13

14 STANDARD PRECAUTIONS WHAT Hand washing Gloves Protection masks, goggles and coats WHEN before and after coming into contact with the patient and, above all, the patient s biological fluids (for the patient s relatives, a sink is available in the filter zone) before coming into any contact with biological fluids before coming into contact with the patient (when so required) to wear before entering the patient s room and to dispose of after leaving the room to enter the filter zone (when so required) In the case of clinical suspicion or confirmed diagnosis of an airborne-droplet infection (e.g. tuberculosis), additional measures shall be adopted, such as the use of a single room with negativepressure ventilation, the use of filter masks to enter the room, doors (to filter zone and inpatient room) to be closed in sequence. This information will be given to you in detail by the staff upon admission to the ward. Outside each room there is an illustrated poster alerting visitors about the precautions to be adopted. 14 How to wear a protection mask appropriately

15 2 nd Floor OUTPATIENT CLINIC - DAY HOSPITAL Tel Our outpatient clinic provides care to patients with cutaneous/subcutaneous infections (e.g. infected ulcers of the diabetic foot ), HIV infection, viral hepatitis, sexually transmitted infections, tropical infections, bone and joint infections, immunodepressed patients infections, and other diseases caused by infectious agents. Furthermore, the following is provided: medical check-ups and follow-up tests after discharge HIV test (anonymous and free of charge) with pre- and post-test consultancy anti-hepatitis vaccinations specialist infectivological advice Opening hours: SPECIMEN COLLECTION - 8:00 to 10:00 am EXAMINATIONS 9:30 am to 12:30 pm PATIENTS ENQUIRIES Patients can make enquiries about their health from the medical and nursing staff who will give information verbally and, occasionally, illustrative material. Medical information shall be provided to relatives or friends, if authorized by the patient, every day from Mondays to Fridays from 12 noon to on the second floor of the building (medical office area). The Director/Chief Physician receives patients relatives on Mondays and Thursdays from 11:30 am to 12:30 pm or on appointment (administrative office, second floor, tel ). The hospital certificate, required to justify absence from work, study, or for insurance purposes, is issued by the Administrative Admission Office located in the basement (on the Via Pietà side, near the Emergency Department), Mondays to Fridays, from 8:00 am to 1:00 pm 15

16 FAMILY INVOLVEMENT The patient s overall wellbeing is closely linked to that of his/her family or the community where he/she lives. "Family care" is a way of providing care while recognizing the central role played by the family in the care plan. Attention should be paid, therefore, not only to patients needs, but also to those of their families who are just as committed to the process of health recovery. Family-centred healthcare consists, among other things, of offering families the possibility to take care of their hospitalized relatives under the supervision of nurses and physicians through a process of involvement, participation and collaboration. The goal is to maintain and, if possible, strengthen the roles and the ties between the various patient s family members. The activity carried out by physicians and nurses is particularly busy in the mornings. For this reason, save for exceptional cases, relatives and friends are requested not to pay visits outside the official visiting hours. Visits are allowed every day from 12 noon to 2 pm and 6 pm to 10 pm; not more than one visitor at a time shall be allowed into the room. Visitors are kindly requested not to bring along children under twelve years of age. Any exception to the official visiting hours shall be agreed with the ward Physician or the Nurse Coordinator. INFORMED CONSENT At admission, patients will receive the informed consent forms regarding the communication of information on the patient s health conditions to his/her relatives and the switching on of a videocamera in his/her room. The videocamera will enable the staff to monitor the patient on a continuous basis. Patients are reminded that, by signing the dissent form, they can choose not to inform their relatives of their health conditions. The same can be said for the decision to switch off the surveillance videocamera. Patients may be asked to sign additional informed consent forms in the event that invasive, but useful, diagnostic or therapeutic procedures have to be carried out. 16

17 HOW TO APPLY FOR CLINICAL RECORDS A copy of the clinical records can be requested by the Patient or another trusted person provided with a written authorization, his/her ID card and the patient s ID card; both of the latter must be valid. If the clinical record belongs to a minor, a parent or guardian shall attach a self-certification to the application, explaining his/her relationship to the minor. If the application concerns the clinical record of a deceased person, it shall include a self-certification by the person making the application confirming that he/she is the legitimate heir of the deceased. The application for a copy of the clinical records has to be submitted at the Centralised Booking Office (CUP) of either Cattinara or Maggiore hospitals. Where to pick them up Clinical records can be collected from the CUP desks or, otherwise, they can be sent to your home address, if postage is prepaid. How to pick them up Clinical records can be picked up by the patient or another authorized person, in which case a photocopy of the patient s ID document will be necessary. When requesting a copy of the clinical records from the CUP desk, patients shall make a fixed down payment, while on picking up the documents, they will be requested to pay a variable fee, depending on the number of pages to be photocopied. HOW TO PLAN THE CARE CONTINUUM When care continuum is required after discharge, the communication of the need of continuing care provision will be notified to the relevant district health authority during the first days of hospitalization by the Nurse Coordinator or another staff member in authority (the communication will be automatic for patients over 75 years of age). For any further clarifications or requirements for the post-discharge period, the Nursing Staff will be at your disposal to provide help. 17

18 The care continuum between the Ospedali Riuniti di Trieste University Hospital and the Trieste District Health Authority n 1 (Azienda per i Servizi Sanitari n 1 Triestina ) has the purpose of planning and ensuring a smooth discharge for the patient, who will be taken care of by the District Services and the General Practitioner, in collaboration with the Social and Health Services and the Volunteer Associations. The process involves the coordination of the hospital wards and the continuum home care services at District level with the aim of: increasing the number of patients with a planned discharge, especially if elderly and affected by heart diseases, bronchial disorders, phlebitis and diabetes, with a history of repeated hospitalizations. guaranteeing timely and effective care. During the hospital stay, the best healthcare pathway and therapy programme after hospitalization are agreed with the patient and his/her family. Patients affected by particular sub-acute or chronic diseases may be transferred to Pineta del Carso or a long term and rehabilitation facility (RSA) so as to continue their rehabilitation in a sheltered centre. ACTIONS TARGETED AT PROTECTING THE PATIENT S PRIVACY See the informed consent paragraph. A closed-circuit videosurveillance system is active in patients rooms. Patients are informed that a videocamera is being used. Should they disagree on its use, the Staff will switch off the videocamera installed in the patient s room. 18

19 REMEMBER THAT ALL INFORMATION SUPPLIED DURING YOUR HOSPITAL STAY WILL BE TREATED CONFIDENTIALLY AND THAT YOUR PRIVACY WILL BE RESPECTED. AUTHORISATIONS FOR CUSTOMIZED CARE BY EXTERNAL CAREGIVERS Customized care provided by external caregivers or other staff trusted by the Patient or his/her family shall be agreed with the Nurse Coordinator or another hospital staff member in authority. Caregivers, if any, shall observe all the hospital provisions adopted for the safeguard of the Patient and their work. HOW TO REQUEST RELIGIOUS ASSISTANCE AND CULTURAL MEDIATION SERVICES All inpatients are guaranteed respect for their religious faith. Receiving ministers of one s religion is allowed. A catholic priest is available on call at all times. A cultural mediator is a professional who, by using the same language spoken by the foreign patient, helps him/her understand what is required, prescribed or suggested by the physician, the healthcare staff and the hospital professionals. The cultural mediator is called in, so that a foreign patient can correctly understand: the health problem affecting him/her the most urgent healthcare needs the explanation and the execution methods of the clinical tests planned, including the required informed consents the therapeutic and behavioural recommendations to be followed after discharge. 19

20 SPECIFIC ACTIONS TAKEN FOR PATIENT SAFETY IN THE WARD At the Infectious Disease Division, measures have been adopted for the protection of patients and their correct identification (by using identification wristbands). Measures have also been taken to improve the management of high risk drugs. Adopted measures aim at: Reducing the risk of healthcare-associated infections; Reducing the risk of fall-related injuries; Preventing medical errors and analyze sentinel events; Identifying patients accurately; Communicating with patients and family members in an effective way; Reducing delays in the various healthcare processes. Inpatient facilities are constantly assessed; electromedical devices are submitted to regular checks, safety evaluations and maintenance. INFORMATION ON DIETS AND MEALS Breakfast is served from 8:30 to 9:30 am; lunch from 12:00 noon to 1:00 pm; dinner from 6:00 pm to 7:00 pm. Patients have the possibility to choose their meals from a menu, though within the limits of the prescribed diet and according to their health conditions. For particular cases, a customized diet can be requested through the hospital Dietary Service. The adoption of an ad-hoc food diet, especially in the case of specific diseases (gastroenteritis, acute hepatitis, etc), can lead to a more rapid recovery for the Patient. In case of gastroenteritis (bowel inflammation with vomiting and diarrhea) the most effective food therapy consists of letting the bowel and the stomach rest, by drinking only tea, chamomile tea or water to restore lost fluids. Subsequently, starchy foods (rice, pasta, rusks) and chicken meat can be gradually reintroduced. However, fibres (fruit and vegetables) and dairy products (milk, yogurt and cheese) are to be avoided until recovery is complete. In the presence of hepatitis, the diet is free, although fat meat (pork, lamb and duck) as well as sausages, fat cheese (cheese spread, 20

21 gorgonzola, mascarpone), and mushrooms are to be avoided; butter, lard, fried food and all wines and spirits are strictly banned! It is advisable for inpatients not to receive food and drinks without prior approval by the healthcare staff. Any allergy, intolerance and eating habit has to be reported to the staff. Alcoholic drinks are not allowed during the hospital stay. Cigarette or pipe smoking is strictly forbidden by Law. INFORMATION ON PAIN MANAGEMENT AND ACTIONS UNDERTAKEN Pain control is a very important aspect of Patients care and this hospital is very much committed to the goal of being a PAIN-FREE HOSPITAL. Despite all efforts made to control pain, this goal may not be always fully achieved. Pain shall be monitored on a 0 (no pain) to 10 (maximum pain) scale. The physician will prescribe painkillers, but Patients are encouraged to inform a nurse or physician when medications do not achieve the desired effect. GUIDELINES FOR DISCHARGE (POST- ADMISSION PHASE) The date of discharge shall be agreed by the Physician together with the patient and his/her family and, in general, the patient will be able to leave hospital after 3:00 pm on the day of discharge. Upon discharge, a discharge summary shall be handed to the patient with all the main information concerning his/her hospital stay (diagnostic 21

22 tests, clinical course, final diagnosis and therapy) to be delivered to the G.P. or physician of trust. Furthermore, if required, the patient will be given a cycle of medication for the first 2-4 weeks of therapy. In some circumstances, the patient will be transferred to a rehabilitation centre or an RSA (long term and rehabilitation facility), in this case, too, with a discharge summary for the physician in charge of treatment. NOTE This booklet contains information valid at time of printing and is periodically updated. Among the other issue, however, may intervene in the operation changes Drafted in collaboration with the Customer Relations Office and the Communication Office, on the basis of texts provided by the Infectious Disease Division. tel ; ; fax comunicazione@aots.sanita.fvg.it Strada di Fiume Trieste 22 Revision 06 of 1/8/2013