STANDARD STAFF PROTOCOLS FOR THE HEALTH SERVICES CLINIC

The Mapua Institute of Technology Health Services Clinic is an Outpatient Care Facility designed to provide basic medical and dental preventive, consultative, diagnostic and curative services for the students, faculty members and personnel of the institution. As such, it follows certain protocols for its daily operations. Below is a list of Standard Operating Procedures for the Medical Clinic, as amended:

1. Operating Hours
2. Drugs, Equipment and Documents
3. Procedures for Outpatient Medical Consultations
4. Emergency Medical Consultations
5. Hospital Referral/Transport of Emergency Cases
6. Hospital Referral/Transport of Non-Emergency Cases
7. Patient’s Refusal for Hospital Referral or Treatment

Operating Hours

• The clinic shall be open from 7:00AM-9:00PM six days a week (Mondays thru Saturdays), when regular classes are ongoing. During quarterly breaks, including the enrollment period, the clinic shall be open during business hours only (8:00AM-5:00PM). The clinic shall also be open during Sundays when there are ROTC/NSTP/Workshop classes. However, Sunday/holiday overtime modifications shall apply. (see Staff Schedules)
• Staff Schedules: On regular days, the Medical Clinic shall be comprised of 3 full-time nurses and a physician. The Head of Health Services shall have the prerogative of assigning the work hours and off-days of the staff. Full-time nurses are required to put in 8 hours of duty a day; part-time physicians are required to work 4 hours a day.
• If a member of the staff is to be absent, it is his/her responsibility to coordinate with the Head as early as the day before but not later than 1 hour before his/her duty hours, so schedule adjustments can be made.
• Sunday skeletal duties are determined and scheduled by the Head. These are considered special/holiday overtime hours. A minimum of 6 hours (usually starting at 8:00AM) shall be required of the person doing Sunday overtime duty. If for any reason the person on-duty cannot stay in the clinic for the prescribed number of hours, he/she should clear the matter first with the Head before he/she leaves her post.

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Drugs, Equipment and Documents

The clinic stores a supply of medications and equipment essential to its daily operations. These shall be in the custody of the physician/nurses-on-duty.

• Dispensation of medicines shall be done only by authorized personnel of the clinic after medical/dental consult. The kind and amount of drugs given to the student/faculty/employee of MIT shall be the prerogative of the clinic personnel dispensing the medicine. A total Hands-off policy shall be implemented for unauthorized persons regarding this matter, to minimize the occurrence of untoward drug reactions/poisoning.
• All medical/dental equipment in the clinic, with the exception of the weighing scale, shall not be operated by unauthorized persons to prevent abuse and subsequent breakdown of equipment. The following equipment shall be kept clean after use at all times to minimize spread of infections: Lavatory, sinks, waste areas, nebulizer, forceps and scissors, oxygen tank/masks, etc.
• Official logbooks, posters and other documents are to be kept from vandalism and theft. Anyone caught vandalizing/stealing said articles shall be reported to the Security Office/ OSA/ respective colleges.
• An inventory of medicines and equipment shall be made periodically to check expiration dates and general condition. Expired or contaminated (opened) medications should immediately be disposed. Defective equipment should be reported to the Head and a requisition for repair or replacement of said equipment shall be accomplished as soon as possible.
• A first-aid kit shall be kept in a conspicuous area at all times.

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Procedures for Outpatient Medical Consultations

• All students, faculty members and employees seeking medical consult in the clinic not requiring emergency care will have to write the required data in the clinic’s official logbook first. These patients shall be attended to on a first-come, first-served basis by the medical personnel on duty.
• Should the physician on-duty prescribe medications available in the clinic, the patient is entitled to get his first dose of the said medicine from the clinic. Subsequent medicine intake shall be the responsibility of the patient.
• The school does not have clinical laboratory facilities, thus all laboratory tests requested for the patient shall have to be done outside of the school. All cases requiring follow-up shall be compiled and follow-up dates shall be noted. In case the patient is unable to keep follow-up consultations, he/she will be reminded of the fact via the Cardinal System (for students) or inter-office communication (for employees and faculty).

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Emergency Medical Consultations

All cases requiring emergency medical treatment shall be attended to immediately. The official logbook shall be filled up for the patient by the clinic personnel after initial assessment and management has been accomplished. The Cardinal Medical System data of the patient shall be accessed at once and pertinent medical history shall be extracted. Relatives/ guardians shall be contacted, depending on the gravity of the patient’s condition and the recommendations of the physician-on-duty.

Scenario 1: Patient in respiratory distress but ambulatory (e.g., Bronchial Asthma, Anxiety Attacks, Tachycardia, Tachypnea, etc.)

• Assessment and history-taking by physician/ nurse-on-duty
• Management of condition
• Referral to another medical facility as needed. (See section on Hospital Referral/Transport of Emergency Cases)

Scenario 2: Patient is in distress and non-ambulatory but conscious (e.g., Neurocirculatory Asthenia, Electrolyte Imbalance, Suspected CVA, limb fractures, etc.)

• Follow the steps in Scenario 1
• Consider Ambulance Transport for the patient with suspected CVA and limb fractures. (See section on Hospital Referral/ Transport of Emergency Cases)

Scenario 3: Patients with Psychiatric Illness (e.g. Violent Tendencies, Psychosis, Uncontrollable Hysteria, Catatonia, Unpredictable Behavior, etc.)

• Assess the patient.
• Keep the number of people around the patient to a minimum.
• Talk calmly to the patient and keep him/her from getting agitated.
• For patients with unpredictable behavior or hysteria, consider giving anxiolytics.
• Contact guardian/ next-of-kin and discuss hospital referral of patient. If the guardian/ kin decide to take custody of the patient, have them sign the Medical Clinic Release Form when they arrive.
• The patient should always be accompanied by a security officer on-duty.
• Unless in extreme cases, do not restrain the patient with handcuffs, rope ties or any form of bondage.

Scenario 4: Trauma Patients (Conscious and Unconscious, including Seizure Cases)

The clinic shall respond to emergency cases occurring inside the physical premises of MIT, to assess and administer available first-aid treatment. For cases occurring outside the clinic, a physician or nurse on-duty must carry with him/her the first-aid kit, sphygmomanometer and stethoscope. In cases when the sick student/employee/faculty member has already exited the MIT premises, he/she MUST be brought back inside MIT for him/her to be attended to by MIT’s medical personnel.

Since the clinic is not equipped to administer Advanced Cardiac Life Support Measures, ambulance transport is MANDATORY in these cases.

• Assess the patient quickly. Do not move the patient, unless he/she is in a precarious place (ledge, stairs or steep incline).
• Call ambulance service immediately. Inform next-of-kin, if known.
• Apply first-aid procedures for superficial wounds, as warranted.
• Monitor vital signs until the Emergency Medical/Ambulance Team arrives.
• A nurse or a physician shall accompany the patient to the nearest hospital facility.

All emergency cases shall be reported to the Head of Health Services.

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Hospital Referral/Transport of Emergency Cases

When an emergency case requires medical care beyond the capability of the Health Services Department, such as in cases of cerebral trauma, multiple skeletal fractures or psychosis, it is the sole discretion of the nurse/ physician on-duty to call for ambulance transport. If a school vehicle is available for use and the patient does not require medical stabilization during transport, the school vehicle may be used (with accompanying driver). This shall be coordinated with the Campus Development and Maintenance Department (CDM).

• IN NO CASE SHALL A TRAUMA PATIENT BE TRANSPORTED VIA A PUBLIC UTILITY VEHICLE, UNLESS PATIENT IS IN STABLE CONDITION. Nevertheless, in the event that public transport is used, the patient shall be brought to the nearest hospital for referral.
• If the patient is a student, the Office of Student Affairs shall be informed of the matter and ambulance transport shall be arranged in coordination with the OSA. If the matter occurs beyond office hours, the OSA shall be informed of the matter the next day and relatives of the patient shall be directed to their office for advisement.
• If the patient is an employee, the Human Resources Department (HRD) shall be informed of the case, even before the patient is transported out of the MIT premises.
• If the patient is a faculty member, the Dean’s Office of their respective colleges shall be informed immediately.
• The patient shall be accompanied by a nurse/physician on-duty to the nearest hospital, provided that at least one (1) clinic personnel is left inside the clinic to attend to other patients, so that the operations of the clinic will not be hampered. If the physician/nurse-on-duty is alone in the clinic, he/she must not vacate the clinic. Rather, the patient shall be accompanied by a Security Officer to the hospital. If the incident happens on a Sunday, the clinic personnel on-duty must inform the Head immediately and act on the Head’s decision accordingly.
• The nurse/ physician accompanying the patient to the hospital should have the contact numbers of the patient’s relatives in hand, so he/she can follow-up on the relatives’ whereabouts. He/She is to wait for these relatives to arrive before he/she leaves the patient in the hospital.
• All expenses incurred by the accompanying nurse or physician shall be reimbursed by the school. Projected expenses shall include the following:

  Transportation – P 50.00
  Communication (via phone/cellphone) – P 30.00
  Miscellaneous (food/prescribed emergency drugs – submit receipt) – P 200.00

  The expense list above is by no means comprehensive or absolute. It is merely a rough estimate of expenses usually incurred in cases like this.

If the relatives of the patient cannot come to the hospital immediately and the nurse/ physician is required to stay in the hospital beyond his/her clinic duty hours, he/she shall be entitled to file for overtime.

• Clinic personnel should follow-up the patient’s condition 24 hours after the incident, either via phone or personal visit, if warranted.
• An Incident Report Form shall be accomplished by the nurse/ physician who attended to the patient and submitted to the Head for signature within 48 hours of the incident. This form shall be reproduced in triplicates: 1 for the clinic’s record, 1 for the office concerned and 1 for the patient himself/herself.

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Hospital Referral/Transport of Non-Emergency Cases

For cases such as those mentioned in Section IV (Scenarios 1 and 2), referral to a hospital facility shall depend on the physician’s recommendation and the patient’s/ guardian’s decision. The choice of transportation to use shall also be determined together by the clinic personnel and the patient/guardian.

• For the safety and protection of our clinic personnel, the nurse/physician on-duty shall only be required to accompany a patient with a non-emergency case to the nearest hospital, specifically Manila Doctors’ Hospital, Philippine General Hospital, or any hospital within the Manila City Area only. For patients who want to be confined in a hospital in Quezon City, Cavite, Marikina, Pasig, Bulacan, etc., his/her relatives will be contacted and the patient shall have to wait for them in the MIT clinic so they can accompany him/her.
• If the patient is to be accompanied by clinic personnel, the protocol in Section V, items 2-9 shall also be followed. However, for Sunday duties, non-emergency case patients will not be accompanied outside the school premises by clinic personnel.

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Patient’s Refusal for Hospital Referral or Treatment

All patients have the right to self-determination of health. This basic right must be respected. If the patient is of sound mind and legal age, the patient has a right to reject recommendations made by clinic personnel. If the patient still refuses to follow treatment suggestions even after advisement regarding his/her condition has been given, the clinic personnel cannot be made accountable for the consequences of the patient’s decision.

• If the patient is of legal age (21 years old and above) and of sound mind, he/she must sign a Release Form to be given by clinic personnel, stating that the patient is aware of his condition and is going against medical advice.
• If the patient is not yet of legal age (21 years old), the nearest guardian/ relative is informed and made to fetch the patient. If the guardian or relative refuses treatment for the patient, he/she must also sign the Release Form.
• If the patient is a student and has no guardian/relative to fetch him/her despite reasonable efforts to locate them, the matter is forwarded to the Office of Student Affairs for deliberation and final decision. If the case happens after office hours and the OSA is unavailable, the patient’s personal decision is honored and he/she is given the Release Form to sign. However, these Release Forms must be submitted for countersigning by a representative of the OSA the next working day, before it is notarized.
• No patient being treated inside the clinic is allowed to exit its premises without the consent of the nurse/physician in-charge.
• An Incident Report shall also be filled up by the nurse/physician-on-duty and attached to the Release Form within 48 hours.

The Release Forms shall be collated and duplicated for the clinic’s records. At the end of each quarter, all signed Release Forms shall be notarized as legal documents by the MIT legal department. Release Forms shall be stored in the Record Files for a minimum of five (5) years before they are discarded.

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