CARE OF VULNERABLE PATIENT
JINO JACOB,ANS
PURPOSE
Identify the population at risks, and provide safety during the care.
Develop plan of care, for the staff to know on how to take care of identified
vulnerable patients.
Establish guidelines for the evaluation and management of vulnerable patients in
order to reduce or eliminate situations that put them at risk.
Provide guideline instructions to ensure a safe environment for vulnerable patients
(Neonates, children and frail, dependent elderly patients who are also at risk for
abuse, comatose patients, pregnant women, and physically and mentally ill patient).
DEFINITION
• Vulnerable Patient - A person who is in need of medical care
services by reason of mental or other disability, age or illness
and who is unable to take care of him or herself, or unable to
protect him or herself against significant harm or exploitation.
POLICY
The physiological, mental, and sociological care needs of vulnerable patients shall receive the required attention by the All India
Institute Medical Science (AIIMS Rishikesh) staff involved in the patient care process.
Vulnerable patients shall receive assistance through the admitting and discharge process (if not accompanied by other family
members).
Relevant records / information of any vulnerable patient should be clear, accessible, and comprehensive. Careful professional
judgments should be made on the basis of this information, so that appropriate care could be rendered.
AIIMS Rishikesh shall take appropriate measures to protect children, elderly patients, and other vulnerable patients, by imposing
safety and security measures adopted by the hospital.
Patients who are brought to the hospital and identified as victim of abuse, shall be reported as police case.
PROCEDURE:
The admitting unit (ER or OPD) nursing staff shall facilitate the
admission of the vulnerable patients after the attending physician
order for admission, by giving them priority and reduce their
waiting time. They shall expedite the admission as arranged with
nursing staff in charge of the receiving unit, in coordination with
the appropriate Allied Medical Services.
PROCEDURE:
The patient’s-social need spsychoshallbeassessed by the
medical, nursing, and social services staff and findings shall
be documented on their respective notes in the patient’s
medical record file.
The medical and nursing staff shall encourage family members
of vulnerable patients to spend more time with them while in
the hospital. Watchers can be allowed if deem possible in
regular wards.
Care of Neonates and Pediatrics
The admitting unit (ER or OPD) staff shall admit all neonates and children after the attending physician order for
admission, as arranged with nursing staff in charge to the specific care areas designated for each category, in coordination
with the appropriate Allied Medical Services.
Neonates born in AIIMS Rishikesh shall be admitted directly to the Wellborn Nursery or NICU, according to their medical
condition, ensuring that right infant banded against right mother.
Admission of neonates born outside AIIMS Rishikesh to NICU is restricted, unless otherwise accepted by the
Neonatologist on duty as a transferred case, under special criteria.
Children from age 1 day to 12 years shall be admitted to the pediatric units according to their medical condition and acuity
level.
Trained Nurses and Healthcare Professionals shall provide appropriate care to neonates and children in pediatric units.
Children admitted to the pediatric units shall be provided with age appropriate play activities by the Female Social Workers
in the Pediatric Playroom.
Care of vulnerable Elderly/Comatose
patients
Evaluation of the vulnerable elderly/comatose patients on
admission shall include diagnosis, pre-hospital and current
medications, and cognitive status.
Elderly / comatose patients shall be provided with safety
measures by the nursing and medical staff because they are
susceptible to complications that cannot be easily recognized as
they cannot verbalize their conditions.
Care of vulnerable Elderly/Comatose
patients
Vulnerable patients who are determined to be at complete bed rest for prolonged period of time
shall receive proper pressure ulcer prevention and care.
The “Braden Scale for Predict shall be used for assessing patientson admission and at regular intervals.
All pressure ulcers must have a full wound assessment and care plan with appropriate dressing
selection.
Special care shall be given to elderly bed-ridden, diabetic patients to prevent pressure ulcer.
Special care shall be given to prevent deep vein thrombosis and pulmonary embolism (for patients
with risk of venous thrombosis) by using the available physical and pharmaceutical means as
determined by the medical staff.
Care of vulnerable Elderly/Comatose
patients
All vulnerable patients shall be assessed for fall by the nursing staff using the Fall
Risk Assessment Tool (Morse fall Scale for adult, and Humpty Dumpty for
pediatrics and neonates), and shall be reassessed for fall on a weekly basis and as
their condition evolves.
Patients identified as fall risk shall receive specific fall management
interventions according to the Policy on Patient Falls Precaution, which
includes general precautions for all settings and a system to identify and
manage patients at risk for falls. (ADM-Gen 01-038)
Patients identified Not at Fall Risk shall be provided with a set of guidelines
Awaboutreness”“Falland it shall b Patient's file.
Care of vulnerable Mentally ill patients
A patient who is dangerous to himself and to others shall be
admitted against his/her will on condition that a next of kin or
relative signs the consent for admission, or permission from the
administration, or in cases brought by police for assessment,
treatment or both.
Psychiatric patients who are admitted in the ward shall have a safe
therapeutic environment including the protection of the patient
from any injuries.
Care of vulnerable Mentally ill patients
Patients, manifesting disturbed behavior of self-injury or to others, or property, and who cannot
be controlled by other means, are restrained with the written order of physician. (Please refer to
Restraint Policy)
• Administer immediately the ordered chemical restraints (medication) before physical
restraints.
• Four points restraints (hands and feet restraints) and a body restraint is being used. Proper
restraint materials can be used as available.
• Restraints should not be too tight so as not to obstruct the circulation and cause edema. And
it must be released once every 15 minutes and documented with time and signature.
Care of vulnerable Mentally ill patients
Adult family members are allowed to visit, unless
otherwise there is a written order from the physician not to
allow a specific visitor.
• Male visitors are not allowed in the female
ward and vice - versa.
• Visitors below twelve (12) years old are not
allowed inside the ward.
Provision of Health Education
Before patient is being discharged home, the physician must provide appropriate health-teachings on the following:
• Disease condition
Medication
– Activities of Daily Living
– Diet and Exercise
– Protection and prevention
The Physician shall involve patient’s relatives or c discharge instructionsand how to cope up with daily living at home.
The nursing staff shall inform the relative regarding the unaccompanied family member (patient) who is already for
discharge.
Provision of Health Education
Physician;
• Identify and respond appropriately to the needs of vulnerable patients.
Nurses;
• Promote a safe environment and care for vulnerable patients and others.
Social Workers;
• Should be available to extend necessary help especially in contacting the patients relatives
whenever necessary.
