DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes A Lecture to OMMC Staff January 26, 2012 Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg Harvey Balucating, MD, DPBS Ariel T. Celzo, MD

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes Backgrounder: Last January 8 to 9, 2012, OMMC was on Code White Alert because of the Black Nazarene Feast. OMMC had a share of about 20 patients coming from the Feast. (10 – Surgery; 7 – IM; 2 Pedia; 1 – OB-GYN)

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting?

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? My perception and observations: Stand-by is oftentimes confined to just knowing “We are on Code White Alert. Be ready for any emergency or disaster. Be ready to come to the hospital when called for. ”

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? My perception and observations: Staff on stand-by inside the hospital would just have a mental stance of being physically ready to respond to an emergency when called for without doing other response preparations like supplies and space preparations.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? My perception and observations: Staff on stand-by outside the hospital would also just have a mental stance of waiting for a call and will just go to the hospital when called without a set response time to be physically present in the hospital.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? My perception and observations: There is usually no structured and comprehensive way of doing things to ensure effective alertness or readiness and effective response when the alert code is elevated to a response code.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes Question I ask / we ask: What usually happens during an activation of a Code White Alert in a hospital setting? ROJoson’s in-depth analysis – January 8 to 14, 2012 (trigger: Black Nazarene Feast) Primer • Hospital Level • Department Level Goal: Promote structured and comprehensive way of doing things to ensure effective alertness or readiness and effective response when the alert code is elevated to a response code.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are hospital emergency and disaster codes? Hospital emergency and disaster codes are codes, usually using colors, being used in hospitals worldwide to • convey essential information quickly to staff during times of potential and actual emergencies and disasters • prevent stress or panic among patients and visitors in the hospitals during response to actual emergencies and disasters

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the uses of hospital emergency and disaster codes? Hospital emergency and disaster codes are being used for two purposes: • to convey need to be alert or ready • to convey type of emergency or disaster occurring in the hospital that needs a corresponding response

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes How are hospital emergency and disaster codes classified? Hospital emergency and disaster codes can be classified into - alert codes - response codes

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes How are hospital emergency and disaster codes classified? Hospital alert codes are mainly used in anticipation of surge of patients from an emergency or disaster occurring outside the hospital. Can also be used for anticipated emergencies and disasters involving the hospital itself, such as when there is a forecast typhoon.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes How are hospital emergency and disaster codes classified? Response codes are mainly used in response to emergencies and disasters occurring within the hospital such as fire, earthquake, flood, and sudden cardiopulmonary arrest of patients, staff, and guests. However, they can also be used in response to external emergencies and disasters.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes How are hospital emergency and disaster codes classified? For alignment purposes, the recommendation is for all hospitals to adopt the alert codes being used by DOH hospitals, as long as the word “Alert” is incorporated in the code, like so, Code White Alert, Code Blue Alert, and Code Red Alert.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes How are hospital emergency and disaster codes classified? Color codes without the word “Alert” being used in hospitals shall be considered as response codes. Response codes can make use of colors also. If there are two similar colors being used in the alert and response codes, the presence of “Alert” makes for the distinction.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes How are hospital emergency and disaster codes classified? Examples Code Red is a response code in cases of fire in the hospital. Code Red Alert is an alert code for more manpower and supplies in preparation for an anticipated extensive surge of patients. Code Blue is a response code in case of sudden cardiopulmonary arrest in the hospital. Code Blue Alert is an alert code.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the conditions in which the different alert codes can be adopted? DOH Conditions in which Code WHITE Alert can be adopted: • Strong possibility of a military operation within the area/region, e. g. , coup attempt • Any planned mass action or demonstration within the catchment area • Forecast typhoons (Signal No. 2 up) the path of which will affect the area • National or local elections and other political exercises • National events, holidays, or celebrations in the area with potential for mass casualty incidents • Any emergency with potential 10 -50 casualties (deaths, injuries) • Any other hazard that may result in emergency • Unconfirmed report of reemerging diseases, e. g. , bird flu, SARS

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the conditions in which the different alert codes can be adopted? DOH Conditions in which Code BLUE Alert can be adopted: • When 20 -50 casualties (red tags) are suddenly brought to the hospital. • Any internal emergency/ disaster in the hospital which brings down their operating capacity (i. e. , vital areas) to 50% or which would require evacuation of patients and setting up of a Field Hospital. • For conditions other than mass casualty incidents, the influx of patients is beyond the capacity of the hospital to handle. • Confirmed/documented report of reemerging diseases (SARS, human to human avian flu) within the catchment area.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the conditions in which the different alert codes can be adopted? DOH Conditions in which Code RED Alert can be adopted: • When more than 50 (red tag) casualties are suddenly brought to the hospital. • An emergency wherein the services of the hospital is paralyzed since 50% of the manpower are themselves victims of the disaster. • Hospital is structurally damaged requiring evacuation and/or transfer of patients. • Conditions requiring mandatory quarantine of hospital and its personnel (e. g. , SARS, avian fl u); uncontrolled human to human transmission of SARS/avian flu within the catchment area.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the general sequential steps in the activation and deactivation of alert codes? • Monitoring of news of potential emergency and disaster that may create a surge of patient incident or event in the hospital. • Assessment of the potential incident or event with a determination on what alert code to activate. • Securing of permission for activation of an alert code from the Hospital Director by the Hospital Disaster Control Director.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the general sequential steps in the activation and deactivation of alert codes? • Activation of an alert code approved by the Hospital Director to be implemented through the Hospital Disaster Control Director. • Surveillance for occurrence of actual emergency and disaster with corresponding response. • Maintenance of readiness of out-of-hospital stand-by staff such that they proceed promptly to the hospital when needed.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the general sequential steps in the activation and deactivation of alert codes? • Securing of permission for deactivation of an alert code from the Hospital Director by the Hospital Disaster Control Director. • Deactivation of an alert code approved by the Hospital Director to be implemented through the Hospital Disaster Control Director.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are main targets of readiness in the alert codes of the hospitals? Having enough manpower and enough supplies to handle anticipated surge of patients to the hospital.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are recommended guidelines in ensuring manpower readiness under each code alert? • Determine the composition of the Hospital Alert Teams as well as Department Alert Teams. • Determine which teams and who should be physically present and which teams and who can be on stand-by outside the hospital in each alert code.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are recommended guidelines in ensuring manpower readiness under each code alert? • Use the checklist on essential steps in responding to a surge of patient emergency as a guide to determine who, how many staff, and what teams should be available and made readily available when needed.

Essential steps in responding to surge of patients Declaration of disaster Creation of an incident command Notification of Disaster Control Officer Chair, Disaster Preparedness Committee Hospital Director Concerned Division and Department Heads Mobilization and organization (task assignment and authorization) of staff Mobilization of ancillary services (laboratory, x-ray, pharmacy, etc) Control of disaster Triage Treatment Referrals / Transport Traffic control Patient log Relatives Information Area Press conference Decongestion and post-disaster reconstruction Post-disaster evaluation and reporting Who Teams How many staff

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are recommended guidelines in ensuring manpower readiness under each code alert? • Use the following checklist as a guide in determining who, how many staff, and what teams should be available and made readily available when needed.

Hospital / Department Alert Teams Administrative Team Corporate Communication Team Medical Team Nursing Team Institutional Worker Team Security Team Telephone Service Team Admitting Team Information Team Ambulance Emergency Room Operating Room Record Team Pharmacy Dietary Finance Others Who / Person-incharge How many staff Teams / Person-incharge

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are recommended guidelines in ensuring manpower readiness under each code alert? Use the following manpower stand-by monitoring sheet as a guide: XYZ Hospital / Department Alert Team Members Stand-by Monitoring Sheet Alert Code: White / Blue / Red (encircle one) Date and Time of Activation: Name of Event / Incident: Name of Consultants / Residents / Interns / Staff Cellphone Nos. Time SMS on / Residence Activation / (City) Deactivation Time SMS response (copied / noted) Whereabout / Time Remarks

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the recommended guidelines on communication system that will ensure adequacy and prompt response of manpower? The primary communication device shall be the cellphone as this is readily available and will facilitate documentation of all activities that transpire which in turn will facilitate evaluation, particularly, on activation and deactivation messages and responses and whereabout messages of members of the surgical teams. The cellphone can be complemented with telephones and other means of communication. Templates for text messages shall be used.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are examples of templates of SMS messages that can be used during the activaiton and deactivation of alert codes? Templates for SMS (text) messages: Messages - Types Templates with Examples Announcing activation of alert Code (COLOR) Alert; Date; Time; Event – Hospital Director / code Hospital Disaster Control Director Ex: Code WHITE Alert; January 9, 2012; 1300 H; Black Nazarene Feast – HD / HDCD Repeating announcement of activation of alert code Txt # - Code (COLOR) Alert; Date; Event – Hospital Director / Hospital Disaster Control Director Ex: Txt 2 - Code WHITE Alert; January 9, 2012; 1300 H; Black Nazarene Feast – HD / HDCD

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are examples of templates of SMS messages that can be used during the activaiton and deactivation of alert codes? Templates for SMS (text) messages: Messages - Types Announcing deactivation of alert code Templates with Examples Deactivation - Code (COLOR) Alert; Date; Time; Event – Hospital Director / Hospital Disaster Control Director Ex: Deactivation - Code WHITE Alert; January 9, 2012; 1300 H; Black Nazarene Feast – HD / HDCD Responding to announcement Noted or Copy. Whereabout of activation of alert code Ex: Noted. Am now at home in Malabon. Copy. Am now in Mall of Asia.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are examples of templates of SMS messages that can be used during the activaiton and deactivation of alert codes? Templates for SMS (text) messages: Messages - Types Templates with Examples Responding to announcement Noted or Copy. of deactivation of alert code Requesting update on whereabouts of members of surgical team on stand-by: Whereabout Update #? Ex: Whereabout Update 1? Whereabout Update 2?

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are examples of templates of SMS messages that can be used during the activaiton and deactivation of alert codes? Templates for SMS (text) messages: Messages - Types Updating status of alert code Templates with Examples Code Update # - still or now Code (COLOR) Alert; Date; Time; Hospital Director / Hospital Disaster Control Director Ex: Code update 1 – still Code WHITE Alert; jan 9; 2000 H; HD / HDCD Code update 2 – now Code BLUE Alert; jan 10, 2000 H; HD / HDCD

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are recommended guidelines in ensuring there are enough supplies to handle anticipated surge of patients to the hospital? Determine the supplies needed for each level of alert code. Use the following supplies monitoring sheet as a guide: XYZ Hospital / Department Supplies Stand-by Monitoring Sheet In Emergency Room / Operating Room / Other Departments (specify) Alert Code: White / Blue / Red (encircle one) Date and Time of Activation: Name of Event / Incident: Item Quantity Needed Red Blue White Current Quantity Remarks

Hospital / Department Alert Teams Administrative Team Corporate Communication Team Medical Team Nursing Team Institutional Worker Team Security Team Telephone Service Team Admitting Team Information Team Ambulance Emergency Room Operating Room Record Team Pharmacy Dietary Finance Others Supplies Needed Other Logistics Needed

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the ultimate criteria to be used in evaluating an alert code activation? The minimum criteria to be used during the evaluation will be adequacy and response time (to be in the Hospital) of manpower on stand-by outside the hospital and the adequacy of prepared supplies based on a must-have list.

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the general parameters and criteria that can be used in evaluating a hospital alert code system? • Presence of policies and procedures on alert code system • General steps followed during activation and deactivation • • Specific guidelines and instructions followed during activation and deactivation • Presence of exercises at least once a year

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the general parameters and criteria that can be used in evaluating a hospital alert code system? • Presence of evaluation after every activation of an alert code (see evaluation checklist) • Presence of continual review and improvement activities

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What are the general parameters and criteria that can be used in evaluating a hospital alert code system? • During actual activation of an alert code: • Presence of adequate manpower on alert standby based on activated alert code • Response time (being in the hospital) of at least 80% of manpower on stand-by outside the hospital within 30 minutes • Presence of adequate prepared supplies based on activated alert code

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Primer on Hospital Alert Codes What is an example of a checklist that one can be used in evaluaitng the quality of an alert code activation and deactivation? XYZ Hospital Alert Code Activation and Deactivation Evaluation Checklist Alert Code: White / Blue / Red (encircle one) Date and Time of Activation: Name of Event / Incident:

Required-activity Statements for Evaluation 1 2 3 The alert code was activated by the Hospital Disaster Control Director with the approval of the Hospital Director. All members of the Hospital / Department Alert Teams were texted announcing the activation of the alert code. The alert code was texted within 30 minutes after a decision to activate the code right away or it was texted promptly (within 30 minutes) at a time determined by the Hospital Director / Hospital Disaster Control Director. Yes / No Remarks (areas for improvement)

Required-activity Statements for Evaluation 4 5 6 The texted message activating the alert code was concise with inclusion of names of the Hospital Director / Hospital Disaster Control Director, official date and time of start of alert, and the object or trigger of the alert. All members of the Hospital / Department Alert Teams receiving the activation text replied with “copy” or “noted” and current exact whereabouts, within 30 minutes after the code activation text was sent. There was a repeat texting of the code activation until at least 80% of the members of the Hospital / Department Alert Teams replied with “copy” or “noted” and current exact whereabouts. This was achieved within 60 minutes after the code activation text was first sent. Yes / No Remarks (areas for improvement)

Required-activity Statements for Evaluation 7 8 9 There was an update report on the status of the alert code at least one every 8 hours from time of activation to time of deactivation or at a shorter interval as deemed necessary by the Hospital Disaster Control Director. There was a repeat texting inquiring on the whereabouts of the members of the Hospital / Department Alert Teams who are staying outside the hospital at least every 8 hours from time of activation to time of deactivation or at a shorter interval as deemed necessary by the Hospital Disaster Control Director. There were update reports on whereabouts of members of the Hospital / Department Alert Teams who were on stand-by outside the Hospital at least every 8 hours from time of activation to time of deactivation or at a shorter interval as deemed necessary by the Hospital Disaster Control Director. Yes / No Remarks (areas for improvement)

Required-activity Statements for Evaluation 10 11 12 The preparation for securing the supplies prescribed within each alert code was completely done within 60 minutes from the official time of activation of the code. Completely means complete in quantities based on the list prescribed under each alert code. The Hospital Disaster Control Director coordinated with hospital administration and other departments, Emergency Room, Operating Room, and Anesthesiology, in particular, in the preparation and implementation of plans for the Hospital’s readiness for the anticipated emergency / disaster. All the members of the Hospital / Department Alert Teams who were on stand-by outside the Hospital were able to arrive to the Hospital within 30 minutes after elevation of a lower code alert to a higher level such as from Code White to Code Blue or Code Red. Yes / No Remarks (areas for improvement)

Required-activity Statements for Evaluation 13 14 15 The alert code was deactivated by the Hospital Disaster Control Director with the approval of the Hospital Director. All members of the Hospital / Department Alert Teams were texted announcing the deactivation of the alert code. The deactivation message was texted within 30 minutes after a decision to deactivate the code. Yes / No Remarks (areas for improvement)

Required-activity Statements for Evaluation 16 17 18 The texted message deactivating the alert code was concise with inclusion of name of the Hospital Disaster Control Director, official date and time of stand-down and the object or trigger of the alert. All text messages from start of the activation of the alert code to stand-down (deactivation) were preserved in the cellphones of all the members of the Hospital / Department Alert Teams for purposes of documentation, monitoring and evaluation. There was an evaluation of the alert code activation within 72 hours after deactivation. Yes / No Remarks (areas for improvement)

Required-activity Statements for Evaluation 19 Areas of improvement were identified during the evaluation. 20 Action plans for areas of improvement were formulated within 7 days after the evaluation. Yes / No Remarks (areas for improvement)

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes What’s next for OMMC? Formulation of Policies and Procedures on OMMC Alert Code System Completion of ALL Departments’ Alert Codes Exercise on Code White Alert

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Department of Surgery Alert Code System Code White Alert Code Blue Alert Code Red Alert Indication for activation of alert codes Presence of events 5 kms outside OMMC in which surge of patients is anticipated. Anticipated surge of 10 patients – Code White Alert 20 patients – Code Blue Alert 30 patients – Code Red Alert

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Department of Surgery Alert Code System Surgical Teams Consultants, residents, and interns Team 1 Team 2 Team 3 10 patients – Code White Alert – 1 Team physically present 20 patients – Code Blue Alert – 2 Teams physically present 30 patients – Code Red Alert - 3 Teams physically present

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Manpower Alert

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Residents: GS Residents Year Level Cellphone Numbers John Lloyd Fonte V 09228707141 Alma Jawali-Lucero V 09228709320 Ariel Celzo IV 09229880406 Glen Mark Gervacio III 09228265129 Onofree O'Connor Voltaire Dela Cruz III 09228728339 09328427398

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Residents: GS Residents Jenny Vi H. de Castro Jessie B. Oracion Rembo Aguda Angelica Montesa Romeo Abad Year Level Cellphone Numbers II 09323530545 II 09228370824 II 09328626283 II 09228912416 II 09223242451

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Residents: GS Residents Princess Beverlie Co Lucas Riel Bersamin Marco Sanico Antonio Sheena Shayne Siapno Glenn Villanueva Year Level Cellphone Numbers I 09228229243 I 09324811368 I 09224285946 I 09228473615 I 09225285356

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Consultants: Complete Name of Consultant Specialty Cellphone Numbers Reynaldo O. Joson General Surgery 09188040304 Harry Go General Surgery 09232520321 Janix De Guzman General Surgery 09228397147 Alfred Philip de Dios General Surgery 09178401013 Rhoby Orata Neurosurgery 09228983455 General Surgery / 09183745322 Colorectal Surgery Plastic and Reconstructive 09209092631 Surgery Plastic and Reconstructive Surgery Catherine Co Carlo Angelo Cajucom Enrico Valera Melvin Sibulo

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Consultants: Complete Name of Consultant Specialty Cellphone Numbers Johnson Sy Urology 09209286025 Miguel Galvez General Surgery / Minimally Invasive Surgery 09228162052 Alfonso Nunez, III General Surgery 09164283309 Gerardo Juan Sison Orthopedic Surgery 09178825377 Joselito Umali Orthopedic Surgery 09225331522 Karlos Noel Aleta TCVS 09175378372 Hazel Turingan General Surgery / TCVS 09228744293/09152981453 Vivian Enriquez General Surgery / Surgical Oncology 09228051650 Roderick Mujer General Surgery / Minimally Invasive Surgery 09228226335

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Consultants: Complete Name of Consultant Specialty Cellphone Numbers 09237024281/ 09274738979 Wilson Ty General Surgery / Pediatric Surgery General Surgery / Hepatobiliary Surgery Medical Oncology Jeffy Guerra General Surgery 09228761224 Marlow Esguerra General Surgery 09228249551 Bong Gonzales General Surgery 09228787647 Edwin Estonillo General Surgery 09228746861 Harvey Balucating General Surgery 09228616790 Jonathan Malabanan General Surgery 09228304107 Rubi Ann Claire Chan Anthony Yap 09228324531

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Consultants: Name Consultants Reynaldo O. Joson Harry Go Janix De Guzman Alfred Philip de Dios Rhoby Orata Catherine Co Carlo Angelo Cajucom Cellphone Numbers 09188040304 09232520321 09228397147 09178401013 09228983455 09183745322 Address Makati Pasay City Laloma, Q. C Quezon City Fairview Q. C

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Consultants: Cellphone Name Consultants Numbers Enrico Valera 09209092631 Address Manila Melvin Sibulo Johnson Sy Miguel Galvez 09209286025 09228162052 Alfonso Nunez, III 09164283309 Gerardo Juan Sison Joselito Umali Karlos Noel Aleta 09178825377 09225331522 09175378372 Ermita, Manila Mandaluyong City Quezon City

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Consultants: Name Consultants Hazel Turingan Vivian Enriquez Cellphone Address Numbers 09228744293/0915 Cavite 2981453 Sampaloc, Manila 09228051650 Roderick Mujer Rubi Ann Claire Chan Anthony Yap Wilson Ty Jeffy Guerra 09228226335 09237024281/ 09274738979 09228324531 Quezon City Alabang City 09228761224 Batangas Marlow Esguerra 09228249551 Sampaloc, Manila

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Consultants: Bong Gonzales Cellphone Numbers 09228787647 Edwin Estonillo 09228746861 Name Consultants Harvey Balucating 09228616790 Jonathan Malabanan 09228304107 Address Bulacan Mandaluyong City Pampanga Calamba, Laguna

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Residents: GS Residents John Lloyd Fonte Alma Jawali. Lucero Ariel Celzo Glen Mark Gervacio Onofree O'Connor Voltaire Dela Cruz Year Level Cellphone Numbers V 09228707141 V 09228709320 IV 09229880406 III 09228265129 III 09228728339 09328427398 Address Sampaloc, Manila Malabon City Malate, Manila Diliman, Q. C Tejeros, Makati Malate, Manila

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Residents: GS Residents Jenny Vi H. de Castro Jessie B. Oracion Rembo Aguda Angelica Montesa Romeo Abad Year Level II Cellphone Numbers 09323530545 II 09228370824 II 09328626283 II 09228912416 II 09223242451 Address Caloocan City San Andres Bukid, Manila Malate, Manila Project 8, Q. C Taguig City

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Residents: GS Residents John Lloyd Fonte Alma Jawali. Lucero Ariel Celzo Glen Mark Gervacio Onofree O'Connor Voltaire Dela Cruz Year Level Cellphone Numbers V 09228707141 V 09228709320 IV 09229880406 III 09228265129 III 09228728339 09328427398 Address Sampaloc, Manila Malabon City Malate, Manila Diliman, Q. C Tejeros, Makati Malate, Manila

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Residents: GS Residents Jenny Vi H. de Castro Jessie B. Oracion Rembo Aguda Angelica Montesa Romeo Abad Year Level II Cellphone Numbers 09323530545 II 09228370824 II 09328626283 II 09228912416 II 09223242451 Address Caloocan City San Andres Bukid, Manila Malate, Manila Project 8, Q. C Taguig City

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Residents: GS Residents Princess Beverlie Co Lucas Riel Bersamin Marco Sanico Antonio Sheena Shayne Siapno Glenn Villanueva Year Level I I I Cellphone Numbers 09228229243 09324811368 09224285946 Address Malabon City BF Homes, Las Pinas Merville, Paranaque Sampaloc, Manila I I 09228473615 09225285356 Malate, Manila

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Clerks and Interns: Mark Hernandez Cellphone Numbers 09175580288 Marie Herrera 09228154328 Name Randolph Hidalgo 09228180999 Beda Igasan Karen Ito Ralph Jacinto Jasmin, Jara Arjay, Jeresano Alexa Jusi 09228076814 09228330987 09233142622 09224866522 09232881612 09224868522 Address San Andres Bukid, Mla Paranaque City East Rembo, Makati Cavite City EDSA, Q. C Malabon City Vito Cruz, Manila Leveriza, Malate, Manila

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Clerks and Interns: April Laude Cellphone Numbers 09222524831 Kaezel Lauigan 09332843818 Malate, Manila Sampaolc, Manila Lea Lauzon Julie Lopez Lalaine Macalalag Julieber Malabag Judee Malubay Monica Mampusti 09328464291 09228971634 09239692022 09234880947 09228310787 09324575521 Novaliches, Q. C Vito Cruz, Manila Malate, Manila Pasay City Bacoor, Cavite Pandacan, Manila Name Address

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Directory of Clerks and Interns: Ron Quimado Cellphone Numbers 09225530624 June Razon 09337200269 Name Address Malate, Manila

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Supplies on Stand-by ER OR

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! CODE WHITE: SUPPLIES NEEDED FOR 10 PATIENTS (INDIVIDUAL PATIENT) Wound Suturing Kit Individual Pack Available in the Dept. NSS 500 m. L/ bottle 1/ patient 5 Available in the Hospital 0 Xylocaine 5 m. L/ ampule Syringe 5 cc 2/patient - 10 1/patient 5 0 Syringe 3 cc 1/patient - 5 Hypodermic Needle 1/patient - 5 Gauze(4 x 4 inches) 10/patient 30 20 Antiseptic (Betadine 60 m. L/ bottle) Silk 4. 0 cutting 1/patient - 5 2/patient 10 0

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! CODE WHITE: SUPPLIES NEEDED FOR 10 PATIENTS (INDIVIDUAL PATIENT) Wound Suturing Kit Individual Pack Available in the Dept. Suturing Instruments 1/patient 10 Available in the Hospital 0 Sterile Gloves 7. 0 2/patient 10 5 Plaster 1 inch 1/patient 10 0 Anti-Tetanus serum 1, 500 u/ampule Tetanus Toxoid 0. 5 m. L/ampule 3/patient - 15 1/patient - 5

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Indigent Patient Help Box

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER Name of Items Macroset Chest tube fr 28 Sterile gloves 6. 5 Sterile gloves 7 Mosquito curve Bandage scissors Metzenbaum scissors Mixter Debakey Needle Holder Iris scissors IV cannula g 18 Blade 10 Blade 11 Silk 4 -0 cutting “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Starting Balance In / From Out / To Values Running Balance (January 01, 2012) (Date) (January 18, 2012) 2 1 5 5 1 1 1 0 0 0 0 2 1 5 5 1 1 1 2 2 2 1 2 5 5 5 0 0 0 0 2 2 2 1 2 5 5 5

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Name of Items Starting Balance (January 01, 2012) In / From (January 01, 2012) Out / To Values Running Balance (Date) (January 18, 2012) Silk 4 -0 round Silk 3 -0 round Silk 2 -0 round Silk-0 cutting Vicryl 2 -0 round Vicryl 4 -0 cutting ET tube size 8 ET tube size 7. 5 PNSS 1 L Cefuroxime 750 mg vial Diclofenac 75 mg amp 5 5 5 3 5 5 1 1 1 5 5 0 0 0 5 5 5 3 5 5 1 1 1 5 5 Tramadol 50 mg amp Ranitidine 50 mg amp Midazolam 5 mg vial 5 5 3 0 0 0 5 5 3

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Hospital Alert Codes What’s next for OMMC? Formulation of Policies and Procedures on OMMC Alert Code System Completion of ALL Departments’ Alert Codes Exercise on Code White Alert

DEPARTMENT OF SURGERY OSPITAL NG MAYNILA MEDICAL CENTER “Towards Patient Safety in Surgery” Promote customer delight. Avoid complaints at all times! Websites Primer on Hospital Alert Codes https: //sites. google. com/site/hospitalsafetypromotion/pri mer-on-hospital-alert-codes OMMC Surgery Alert Codes https: //sites. google. com/site/ommcsurgerysafetypromoon/ Queries: rjoson 2001@yahoo. com