Operation Policy

 

 

 

 

 

 

As'ad Al Hamad

Dermatology Center

 

 

 

November 2017

 

 

 

 

 

 

 

 

 

OPERATIONAL POLICY

AS’AD AL-HAMAD DERMATOLOGY CENTER

 

Mission

 

As’ad Al-Hamad Dermatology center performs two main functions:

·        Secondary health service to patients seeking general dermatology care through their referral to the center from catchments health areas.

 

·        Tertiary health service that provides specialty and subspecialty dermatological care services, whether diagnostic or therapeutic, to all patients in Kuwait.

 

·        To accomplish this, a Referral Policy to As’ad Al-Hamad Dermatology center has been set.

 

Vision

 

·        We plan to provide best dermatological services including diagnostic and therapeutic modalities through upgrading and updating the lab and other diagnostic procedures and also the therapeutic equipments. 

·        We also plan to set interdepartmental co-operation through clear referral protocols so as to utilize the services available in our center aiming at reaching a true tertiary care dermatological health services.

·        We also aim at improving the doctors skills and update their knowledge through:

·        Inviting visiting consultants in different subspecialties in dermatology through the Ministry of Health and other sponsoring bodies all round the year. This will also permit a better service to the patients by presenting problem cases to these experts.

·        Daily morning clinical meeting at 7:30 am and closing meeting at 1:15 pm to discuss the inpatients, new admissions, and consultations of previous day

·        Weekly academic meeting every Tuesday.

 

 

Functions

 

Referral Policy to As’ad Al-Hamad Dermatology Center:

 

a)     Being a referral specialty, As’ad Al-Hamad Dermatology Center does not allow walk-in patients except for emergencies

 

b)     We are OPD only not urgent care clinics, any urgent case should be directed to emergency at Sabah hospital and we can get consulted.

 

c)     Each patient must have a referral letter from his/ her treating doctor, and should come on appointment basis.

 

d)     Direct referral from the polyclinics and primary care clinics to specialty units and specialty clinics in the center that provide tertiary care services is not accepted. Such referral should be only through dermatology doctors.

 

e)     Regular patients referred through primary care doctors should belong to the catchment health area of As’ad Al-Hamad Dermatology Center (Appendix 2)

 

f)      Cases referred to As’ad Al-Hamad Dermatology Center for Lab investigation (Immuno lab, Histopathology) or treatment in the various specialty units and specialty clinics are accepted on condition that these cases are referred by a dermatologist from dermatology departments or affiliated dermatology units/clinics. A referral letter from the dermatologist should be given to the patient with a brief history or summary of the case and the requested procedure to be carried out. (New opening file form  Appendix 3)

 

g)     Referral from within the center should be through the doctors using the special forms designed for each specialty unit

 

Appendix 4: Dermatopathology,

Appendix 5: (A) Immunodermatology

                                 (B) Protocol for Immunodermatology

Appendix 6: Mycology,

Appendix 7: Medical Photography

 

h)     Cases referred to the center from one of the hospitals of Al-Sabah Specialty Health Area will be seen as a new case and thereafter evaluated by at least a registrar. The doctor will do the consultation, plan will be written and the referral to the dermatologist in the dermatology center in which patients belong to. The dermatologist at Assad alhamad center can do a service (skin biopsy, immuno etc) if not available at the center that patient belongs to.   Thereafter the patient has to be referred to the treating doctor in the patients’ residence catchments area for follow-up.

 

Internal Policy for As’ad Al-Hamad Dermatology Center

 

       I.            General

 

a)     All patients who are receiving regular treatment and follow-up in As’ad Al-Hamad Dermatology Center should have a medical file that is used for the same patient whether he/she is followed up in the outpatient clinics, specialty clinics, or the specialty units.

 

b)      Every patient needs a file according  to accreditation guidelines 

 

c)     New patients who will receive treatment in the outpatient clinics in As’ad Al-Hamad Dermatology Center are seen in the first 3 visits on casualty paper MR3 but a file must be opened for any chronic disease who require frequent visits and follow up or any patient require special medication according to the list from the pharmacy. ( Appendix 23)

 

d)     All patients who are referred to As’ad Al-Hamad Dermatology Center and will receive treatment and will be followed-up in the specialty clinics or specialty units should open a file

 

e)     For patients referred from outside the catchment area, justification should be attached from the referring doctor.

 

f)      Before referring to specialty clinics or services, the referring dermatologist at the OPD at Asad Al-Hamad should open a file, and no patient will be accepted to do any specialty service without a file.

 

g)     All patients who were referred to As’ad Al-Hamad Dermatology Center from outside the center for treatment in the specialty clinics or specialty units, upon completing their treatment course should be referred back to their treating doctors in the relevant health area according to their residency. A full medical report for these patients should be sent to their treating doctors.

 

h)     Surgery:  All patients referred for skin biopsies, should receive preoperative information about their surgical procedure that will be carried out (Appendix 11). Post-operative instructions need be given to these patients and   include: post-excision biopsy instructions (Appendix12), postelectrosurgery / shave biopsy instructions (Appendix13), and post-subcision surgery instructions (Appendix 14). Information is available in both English and Arabic languages. Skin surgery appointments has to be done through the technician-in-charge (phone: 24831996/7 ext 246). A special booking notice (English/ Arabic) will be handled to the patient (Appendix 15). A questionnaire about patients past history, medications, allergies, and infectious diseases has to be filled out by the patient before carrying out surgical procedures and to be kept in his file (Appendix 15b).

 

i)       Photography to be done in the medical photography unit prior to the biopsy after signing the photography consent. If the patient refuses photography, this should be mentioned in his file and the biopsy will be carried out. If the referring doctor will decide not to do photograph then this would be his responsibility.

 

j)       All appointments of the patients should be manually recorded on the special yellow card, and should also be registered in the computer system at the OPD appointments desk.

 

k)     The waiting period for new cases should not exceed one week in the OPD and Phototherapy.

 

l)       All Dermatology Departments and affiliated Units and Clinics should use special dermatology sheets for the outpatient clinics inside the medical files that have been approved previously by the Council of the Dermatology Departments. These sheets will be added to the patient file for use by the dermatologist.

 

m)   The following papers should be included in any OPD file: MR2 (appendix 16), MR7 (appendix 17 A) then MR1 (Appendix 17B), body drawing sheet and prescription sheet.

 

n)      The following papers should be included in any Phototherapy file: MR2, MR7, DERM3, DERM4, DERM5, body drawing sheet then MR1 and prescription sheet

Appendix 18: Photo Therapy  History and Examination sheet (Derm3)

Appendix 19: Photo Therapy  Follow-up notes sheet (Derm4)

Appendix 20: Photo Therapy  PASI sheet (Derm5)

Appendix 21: Body Drawing  sheet.

 

o)     Old files should be replaced with new file system by medical record staff

 

p)     Dispensing treatment for the patients from the pharmacy is not allowed except on the formal treatment papers used in the center on MR3. If the patient has a file then the treatment sheet inside the file is used. Patients who are treated temporarily on casualty papers can have medication dispensed according to MOH regulations.

 

q)     Certain medications are dispensed on file numbers, some of the medications are prescribed for Kuwaitis only (through Ministry of Health regulations), and Biologics are prescribed per patient through Medical Boards. A list of these medications should be available in the pharmacy (Appendix 23).

 

r)      Some medications like Roaccutane and Neotigasone/ Acitretin need special informed consent to be filled out by the patient (Appendix 24, Appendix 25 respectively).

 

s)      No files should be handled to the patient at any time and under all circumstances. The file transfer from the reception to the outpatients’ clinics or the specialty units should be arranged by the medical records section. 

 

 

   II.            On-Call:

 

·        All the staff of the department will have afternoon duties at the rate of once per week (at least) plus a Friday or a Saturday duty every month.  On these days, all members of the duty will be present physically in the department for at least 3 hours (from 5:00-8:00 pm on weekdays and 9 am -12 pm on Saturdays. Ramadan duty hours are subject to change and delegated by Ministry of Health.  Doctors will be on-Call for the 24 hours (7 am – 7 am next day) on their duty day to cover all consultations.

 

·        The doctor should inform the secretary for any change in their phone number.

 

·         Regulations regarding on-call procedures and system will follow the Job Description set forth by the Council of the Dermatology Departments

 

·        Starting from March 2005, a change of the afternoon duties has been set after it was discussed in the Department Council Meeting in February 2005.

 

·        Accordingly, the doctors who are first on call will be responsible for the consultations  (hospital requests) on group basis for the hospitals:

 

 

1.   First on-call (A) doctor: responsible for requests from Al-Sabah Hospital Departments including Zain Center, NBK buildings and Al Rashed Allergy hospital.

 

2.    First on-call (B) doctor: responsible for requests from Al-Razi, Maternity, Physiotherapy, Rehabilitation, Infectious Diseases, Psychiatry and Addiction hospitals.

 

3.    First on-call in PUVA (1) doctor: responsible for requests from Cardiology, TB-Chest  hospitals, Bait Abdulla, and Sabah Al-Ahmad Nephrology Center

 

4.    First on-call in PUVA (2) doctor: responsible for requests from Ibin-Sina, Babtain, Hamed Al-Essa, KCC, Al-Bahar, Al-Naffisi, and Chemotherapy hospitals.

 

5.   In case no First on-call (A) Doctor available , then First on-call  ( B) will cover and visa versa. In case no First on-call PUVA (1) Doctor, available , then First on-call  PUVA ( 2) will cover and visa versa. In Case no first on call A and B, then first on call PUVA 1 and 2 will cover ( A to 1, B to 2)

 

6.   No PUVA oncall doctors on Saturday. An exception to the above-mentioned grouping of hospital rule is when there is only one First on-call doctor (as for example in Fridays), in this condition the doctor(s) in the schedule is/are responsible for requests from ALL  hospitals on that day

 

7.   Trainee doctors including those who are enrolled in the Dermatology Board Program should accompany the second on-call or third on-call doctors during the in-patients round, also they have to accompany the First on-call doctor during the requests round, and then they have to discuss it with the senior doctor in the afternoon duty.

8.   The first oncall doctor may refer to the second  oncall and subsequently third oncall for further consultation if required.

 

·        Duties of each doctor are mentioned in the job description from MOH, (Appendix  26)

 

·        Change of the duties between doctors should be on a special form (Appendix 27).

 

·        All minor procedures that can be preformed bedside should be carried out during the afternoon duties, or during the call time if needed urgently, and if the senior doctor approves  it

 

·        Also, all consultations for incoming requests are discussed in the daily morning meeting of the department.

 

·        The handover policy (Appendix 33a) must be implemented for all in-patients and consultations requiring F/U ( appendix 33b)

 

 

 

 

 

 

 

III.            Reports:

 

·        Patients who are referred to the center for a medical certificate denoting that he/she is free from Syphilis are given this certificate (Appendix 28 -A) after being investigated. The result of the tests is mentioned in the certificate that should be countersigned by the Director of As’ad Al Hamad Dermatology Center. The protocol of treating Syphilis. See  Appendix 28B, and follow-up sheet (Appendix 28C)

 

·        No medical report should be issued to a patient except after an official application signed by the patient or his legal representative.

 

·        The medical report should be prepared and signed by the treating doctor. If the treating doctor is not available for a prolonged time, e.g. on leave, then any doctor assigned by the head of the department should prepare and sign the report on behalf of the treating doctor

 

·        The report should be counter signed by the Head of Dermatology  Department and the Director of As’ad Al Hamad Dermatology Center before being handled to the patient.

 

·        Incident reports should be submitted by the person in-charge according to the situation AND PUT IN THE BOX assigned in the hallway Appendix 47

 

IV.            Medical board:

 

·        The patient must go to travel abroad committee with the medical report to get the request approved then to take it to As’ad Al Hamad Dermatology Center to hold a special committee based on appointment for the patient in order to decide about the case.

 

·        The medical boards for treatment abroad are held only for patients covered by Sabah area, on Mondays every week in As’ad Al Hamad Dermatology Center. The patient should be directed to the secretary of the Head of Department of the As’ad Al Hamad Dermatology Center to get an appointment on any Monday. Each board consists of 3 members (that should include the Head of the Department or his deputy) and should include consultants, senior specialists or specialists. A senior registrar can be included in the board if there is shortage of specialists.  medical boards must be counter signed by the Head of Dermatology  Department and the Director of As’ad Al Hamad Dermatology Center.

 

 

 

 

 

 

   V.            Statistics:

 

·        Detailed statistics of all activities including the general and specialty outpatient clinics, and specialty units should be daily and regularly carried out by both, the medical records personnel and the nursing staff using a special form (Appendix 29).  Since 2007, the monthly, bi-annual and annual statistics were  the direct responsibility of Statistics Department of Sabah Hospital. 

 

·        Any doctor who wants to review a patient’s file that is kept at the reception should fill out a special form (Appendix 37 A). This form will be kept at the reception to show the location of the file.

VI.            Consent:

 

·        The following procedures should be carried out only after an informed consent has been signed by the patient or guardian:

 

1.      Skin biopsy and other surgical procedures (Appendix 30 A).

2.      Laser therapy consent (Appendix 31 A-L).

3.      Phototherapy consent (Appendix 32 A and B). 

4.      Medical photography consent (Appendix 34).

5.       DPCP therapy consent for Alopecia Areata and (Appendix 35).

VII.            Emergency:

 

·        There are 2 sets of master keys for the center that open all the doors. These sets are kept with the head of the department, and the administrative secretary. The securities have 2 keys; one for each, the main front door, and back door of the center. The master keys do not open the pharmacy doors which are opened by a key kept by the chief pharmacist. As of 2008, Emergency Doors Keys are kept in sealed small Glass Boxes adjacent to each Emergency Door in the Center. Glass of the Boxes to be broken and keys used during emergencies only. Any misuse of the boxes or keys to be reported to the Head of the Department and to be included in the incident report. All employees were notified about the emergency boxes by internal circulars.

·        Nurses should be present at all time during the patient visit.  One of the medical staff should be a member of the same sex of the patient during the examination.  An emergency kart including all the emergency medications and tools have to be readily available for use. All staff should know the location. It is the nursing staff responsibility to regularly check for the expiry dates and for any missing items.

·        Locations: Currently there are 3 emergency kits; one in the outpatient clinics: in treatment room  (nursing room), the second in the phototherapy Unit  and the third in the surgical unit, consultation room

·        All medical staff need to be up to date in Basic life support  BLS and  Advanced cardiac life support ACLS certifications

VIII.            Professional issues:

 

·        White coat, every physician must wear white lab coat during clinical work.

·        All department staff must put on the official I.D. badge showing clearly their names and job title. 

·        Anybody scrubbing for any minor procedure should not have any rings, watches or jewellery on the hands or wrists.

·        Eating and drinking is not allowed in any part of the department except in the designated areas.

·        No pharmaceutical representatives to be allowed to visit any doctor in the clinics or units except after 12:30 p.m.

·        Smoking is not permitted inside the building

·        Any doctor who wants to be excused from work for two to three hours has to get a written permission from both the supervisor doctor and the head of the department by filling a special form (Appendix 36). This form will be kept in the file of the doctor for future reference. Each doctor has the right to get three permissions each month unless there is shortage of staff.

 

IX.            Complaints from patients:

 

·        When there is a complaint the following procedure to be followed: The complaint should be submitted in writing to the person in-charge according to the situation. The name of the person who is complaining should be known and the complaint should be signed by him or his legal representative. If it was submitted directly to the head of the department then the person in-charge will be asked to do an investigation and asks all involved persons to write down their views. The head of the department will decide whether the problem to be solved locally or to be referred to the director of Asa’d Al Hamad Dermatology Center for further action.

 Structure:

 As’ad Al-Hamad Dermatology Center:

 

This center provides both, secondary dermatology services to the catchments areas and certain tertiary health care services to all Kuwait. It contains the following:

I)   Secondary Dermatology Health Care Services to the catchments health areas through the general outpatients clinics:

 

·        All clinics are numbered (1-21) and the patients’ files should show the number of the clinic of the treating doctor rather than the name of the doctor. Appointments of the patients are also referred to by the number of the clinic, whether on the appointment yellow card or in the computer.

·        Some of the outpatient clinics work on certain days of the week because the doctor is involved in running either a specialty clinic or involved in a specialty unit

·        For details of the doctors names and their assigned clinics please refer to (Appendix 37i).

II)    Tertiary Dermatology Health Care Services to all Kuwait through The specialty outpatient clinics and specialty units:

 

a) The Specialty Outpatients Clinics:

·        These are specialty clinics that provide advanced care for certain diseases. Each clinic is run by a registrar (or more, according to the number of patients seen in the clinic) who should be under supervision of a senior registrar (or a higher rank).

·        All specialty clinics should use special forms for the patients that should be inserted in the patients’ files:

-    Appendix   38 A: Management of Alopecia Areata with  DPCP. 38 B: DPCP application form.

-    Appendix 39 A: Instructions sheet for Cutaneous Mastocytosis. 39 B: Sick-Kids Clinic

-    Appendix 40 A: Psoriasis clinic.

-    Appendix 41 A: Bullous Diseases clinic Interdepartmental Policy for management of Bullous Diseases. 41 B: Bullous Diseases clinic Form sheet.

-    Appendix 42 A: Cutaneous T-Cell   Lymphoma Clinic. 42 B: Immunophenotype of neoplasm lymphocytes. 42 C: CTCL proforma.

Currently the center contains the following specialty outpatient clinics:

                               I.            Pediatric Dermatology clinics

                            II.            Psoriasis clinics

                         III.            Autoimmune Bullous Diseases Clinics

                         IV.            Alopecia Areata clinics

                            V.            Contact Dermatitis clinic

                         VI.            Sick-Kids clinic

                      VII.            Hair Disorders Clinic

                   VIII.            Connective Tissue Diseases Clinic

                         IX.            The Lymphoma clinic

 

 

       I.            Pediatric Dermatology clinics:

Location

Clinic 15 Dr. Arti Nanda (Consultant)

Clinic 4 Dr Anwar Alsmait (Specialist)

Clinic 17 Dr Nadia Al Naki (Specialist)

Clinic 18 Dr. Rana Al-Noun (Registrar)

 

The pediatric clinics run at present time on Sundays and Wednesdays. These clinics provide dermatology care for pediatric cases referred by dermatologists or pediatricians.

Statistical record of all new pediatric dermatology cases seen since 2000 is maintained. Guidelines of care sheets are given to the parents of children with atopic dermatitis and eczema (Appendix 43 Arabic and English versions).

   II.            Psoriasis clinic:

It is run by one consultant Dr. Hesham Hanafy, Clinic 3

One Senior Specialist Dr Haneen Al Raqom, Clinic 8

One Specialist Dr. Nadia Al Naki, Clinic 17

One Senior Registrar Dr. Sarah Al Musallam, Clinic 11

One Registrar Dr. Magdy Fathallah, Clinic 3

Currently it is working twice per week (Sunday & Wednesday).

 

III.            Autoimmune Bullous Diseases Clinics:

Location:

Dr Arti Nanda (Consultant) room 15

Dr Eman Masry (Consultant) room 1

Dr Najla AlKharafi (Senior Specialist) Room 10

Dr Jihan Raji (Registrar)   room 8

Currently is working once per week (Tuesdays).

Rituximab protocol (Appendix 53 A), and 53 B: Rituximab Form.

IViG protocol ( Appendix 54)

 

 IV.            Alopecia Areata clinic:

 Location:

 In the doctors office in the corrective unit.

It is run by one Senior Specialist  (Dr. Rafaat Madbouli) and one Specialist (Dr Ghadeer Alalawi)

Currently it is working once per week (Thursdays).

    V.            Contact Dermatitis clinic:

 It is running by Dr Atlal Lafi (Senior Specialist) and Dr Jihan Raji (Registrar)

The doctors of this clinic are responsible for doing patch testing for patients referred from general dermatology and for the employee referred from the General Medical Council. The results of the latter tests should be recorded on a special form (Appendix 44) that will be handled to the patient. A copy of this report to be kept in the clinic.

Currently is running every Sunday & Wednesday

Form:(Appendix  22 A)

Protocol: (Appendix 22B)

 

 VI.            Sick-Kids clinic: 

In order to provide better quality care to sick pediatric dermatology cases, this clinic is running on Wednesdays. Location:  clinic 15 

 It is run by one Consultant (Dr. Arti Nanda). This clinic will provide specialized dermatology care services to pediatric patients suffering from:

·         Severe cases of eczema and  atopic  dermatitis

·         Lupus Erythematosus in children.

·         Genodermatosis

 

VII.            Hair Disorders Clinic:

This is a specialized clinic for diagnosing hair disorders including: Androgenic Alopecia in males and females, Hirsutism (non-endocrine in origin), Primary Hair Disorders, and Acute and Chronic Telogen Effluvium.

The clinic has started operation on February 2003 and is run by Dr. Ibrahim AI-Aradi (Consultant) a once weekly on Mondays from 10:30 – 12:30). Referral of the patients should be through a written note in the patient's file and should include brief history, examination and tests done for the patient. Any patient referred without a note will not be accepted. Booking of appointments will be through the nurse-in-charge of this clinic. For the Protocol of this clinic, please refer to Appendix 45.

VIII.            Connective Tissue Diseases Clinic:

The clinic has started operation on November 2010 and is run by Dr Ghadeer Al Alawi (Specialist). It is run once per week currently (Mondays) and is located in Clinic No 7.

 IX.            The Lymphoma clinic

Starting from March 2011 Dr Jihan Raji (Registrar) is running a joint clinic in KCC for MF and CTCL cases on second Monday. This clinic was requested by Dr Salem Al-Shammari and was officially approved. It is for better care of these patients who are jointly treated and followed up by both departments.

One special clinic (Lympoma Clinic) running by Dr. Mariam Al Shammary (Consultant) on every Wednesday.

 

b)  The Specialty Units:

1.      Phototherapy Unit:

This is run by 6 registrars (Dr. Ihab Nour El-Dein, Dr. Jihan Raji, Dr Mohammed Taha, Dr Ahmad Fekry (except on Mondays:surgery, and Thursdays:outpatients), Dr Isra Yaqout (except on Wednesdays:mycology), and Dr Riham Ashour. The unit  is  supervised by one Specialist (Dr Abeer Arboud who is physically available in the unit on Mondays and Thursdays,) and a specialist (Dr. Abeer Abdalla ), The doctors are helped by trained nursing staff.

It provides phototesting and phototherapy (Systemic and Topical PUVA, UVB, UVA) for the indicated diseases. Each doctor working in this unit should follow the treatment protocol provided by the center for this unit (Appendix 46).  And all non-Kuwaiti patients receiving phototherapy should be charged (Appendix 10). Topical application of medication for Topical PUVA should be carried out by the nursing staff and not be the patients themselves.

The unit works 5 days a week and, at present, accepts new cases from Sundays to Thursdays

Phototesting is done on Sundays, Mondays, and Thursdays for oral PUVA, and daily except Thursdays for UVB.

The unit also provides afternoon treatment services from 4:30 to 8:30 p.m. for Kuwaiti patients and from 5 – 8 pm to non Kuwaiti patients.

Each patient is given verbal and written information and instruction about the phototherapy and its possible side effects.

2.     The medical photophysics laboratory

The medical photophysics laboratory is run by 5 assistant physicists and is under supervision of a highly qualified physicist (Dr Hanan Bu-Abbass). The unit is involved in the following activities:

1-     Set up of photo physics lab., Workshop, UVA and UVB treatment rooms and phototesting rooms.

2-     Training the nursing staff who are involved in the treatment of patients with PUVA and UVB.

3-     Calibration of PUVA and UVB units periodically.

4-     Calibration of different instrument and detectors in the lab.

5-     Photo-testing of patients of different skin types using Applied Photo physics Photo-irradiator and Multiport solar simulator (Model XPS 200)

6-     Measurement of the absorbency (or light transmission) of sunglasses for patients treated with photosensitizers, to protect their eyes from UVR.

 

3.      Equipments available in the Phototherapy Unit

  (The Treatment Rooms and the Photophysics Lab):

·         Four Ultraviolet machines (UVA Standing Cabinet) for treatment of patient

·         Two Ultraviolet machines of the UVA1

·         Nine Ultraviolet machines NBUVB

·         Six UVA for local treatment of lesions on extremities.

·         Spectroradiometer for calibration of the Ultraviolet machines and for measuring the ultraviolet light emitted from the sun.

·         One Solar Simulator machine.

·         UV test machines: one UVA, one UVB, and two NB-UVB machines.

·         One NB-UVB for local treatment of lesions on face.

·         Two UVA for  local treatment of lesions on scalp

 

4.      Laser and corrective unit

The laser unit is a specialized unit to evaluate cases referred by dermatologist for laser therapy. The unit is under supervision of a consultant dermatologist (Dr.  Hanin Al-Raqam).

 

There are 8 rooms and 29 different laser and machines.

 

The medical staff in this unit:

 

All Doctors have laser license

 

Sunday         : Dr Rafat Madbouli    Dr Amr Eraqui or Dr Ghadeer AlAlawi

 

Monday        :Dr Magdi Fathallah , Dr Amr Eraqui, Dr wgiuh Waheeb

 

Tuesday        :Dr Haneen AlRaqom, Dr Ghadar AlAlawi, Dr Wqgiuh Waheeb

 

Wednesday  :Dr Magdi, Dr Rafat Dr Amr

 

Thursday      : Dr Hisham Hanafi

 

The patients need to be referred from the outpatient department. If the patient is a candidate for laser therapy, he will bereferred from the outpatient department. If the patient is a candidate for laser therapy, he will have detailed consultation about the treatment, the outcome, side effects, and asked to sign a consent.

 

The patient will be sent for medical photography and referred hack to his referring dermatologist to open a file if it does not exist. The patient will be given an appointment for laser therapy and will be followed up by laser unit for laser therapy be given an appointment for laser therapy and will be followed up by laser unit for laser therapy. if- patient finished the treatment or has other dermatological condition, the patient must consult the referring dermatologist at- outpatient..

 

Doctors who want a clinical attachment in the Laser Unit should follow a certain protocol (Appendix 37 F). The doctors have to apply a special form (Appendix 37 G). and upon completion of this rotation he has to get his log book (Appendix 37 H)  signed by the Laser Unit in-charge doctor.

 

The laser unit offers different treatments:

 

1-     Vascular laser therapy for different conditions such as rosacea, vascular malformation and Keloids.

 

2-     Pigment laser therapy for tattoo removal, nevus of Ota, and freckles

 

3-     Resurfacing lasers for scar revision, acne scars ,and thermal burn scars.

 

4-     Excimer laser for vitiligo.

 

Equipments:

 

1-     Vascular lasers

 

A.    Pulsed dye laser

B.     Two Dual yellow lasers

C.     Exolaser diode laser

D.    Long pulsed Nd:YAG

E.     One TPL/Nd:YAG laser

 

2-     Pigment lasers

 

A.    Alex trivantage laser

B.     Two Qplus lasers

C.     Qunta system laser

 

3-     Resurfacing lasers:

 

A.    Active CO2 laser

B.     Active and deep laser

C.     AquPulse CO2 laser

D.    Erbuim laser

 

4-     Excimer laser

 

A.    Two Excimer  laser

B.     Two EXCimer lamps

C.     Two GME excimer lamp:

D.    B-clear

E.     Relum

 

5-     Vacums:

 

Three Smoke Evacuator machines

 

6-     Cooling machines:

 

Two machines

 

7-     Hyfercator

 

Three  Conmed hyfrecator

 

 

5.     Dermatologic Surgery Unit

The unit is under supervision of a Consultant Dermatologic Surgeon (Dr Ibrahim Al-Aradi) and is helped by:

·        Consultant, Dr Iman El-Masry and  Dr Maryam Al Shammary)

·        Specialist (Dr Anwar Al Sumait, and Dr Nadia Al Naki), Senior Registrar (Dr Sarah Al Musallam).

·        Registrars (Dr Tariq Karam) and Dr Ahmed Fikri

·        Doctors are helped by trained nurses.

The unit works on:

·                                                        Sunday           : Dr Ibrahim Al-Aradi, Dr Maryam Al Shammary, Dr Tariq Karam

·        Monday         : Dr Ibrahim Al-Aradi and Dr Ahmed Fekri.

·                                                        Tuesday         :  Dr Ibrahim Al-Aradi, and Dr Nadia Al Naki, Dr Sarah Al Musallam

·                                                        Wednesday   : Dr Ibrahim Al-Aradi, and Dr Tariq Karam, (Mohs microscopic surgery)

·                                                        Thursday       : Dr Ibrahim Al-Aradi, Dr Iman El Masry ,   Dr Anwar Al Sumait, and Dr Sarah Al Musallam.

The unit has one room for major procedures, one room for some minor procedures, and one room for preparing the patients for surgery.

The Staff nurse helping the dermatology surgeons are: Praba Haris and Staff nurse Joby Thomas

The unit receives surgical consultations from all dermatology centers in Kuwait and AlBabtain center, and other senior specialists from other specialties.

 Working days schedule

Day

Procedures under L/A

Sunday

·        Electrosurgery,

·        Cryosurgery

·        resistant wart surgery

·        acne scaring corrective surgery (subcision, excision, dermabrasion)

·        chemical peeling for xanthelesma,

·        excision of benign tumors etc

·        keloid injection

Monday

·        Hair clinic and  general skin biopsies

Tuesday

·        General skin biopsies and procedures

Wednesday

·        Mohs micrographic surgery for malignant tumors

·        Excision of malignant tumors with postoperative flaps & grafts repairs

·        Surgical treatment of keloids & adjuvant therapy

·        Keloidectomy

·        Vitiligo punch transplant surgery

Thursday

·        General skin biopsies

 

·        Doctors from the department or from other dermatology departments who are interested to attend the surgical procedures are permitted to do so according to a time schedule that changes every 3 months and after approval of the Head of the Dermatologic Surgery unit.

·        Doctors who want a clinical attachment in the Surgery Unit should follow a certain protocol (Appendix 37b). The doctor has to apply a special form (Appendix 37c), and upon approval of his rotation, the doctor has to use a log book (Appendix 37d). A final report (Appendix 37e) about the performance of the doctor during the attachment will be put by the person-in-charge of the Dermatosurgery Unit.

·        Unit receives urgent requests for skin biopsies from hospitals at Sabah area in-patient’s and OPD at As’ad Al Hamad center from at least senior registrar. Otherwise the patients will be assessed as urgent matter by the pathologist and the derm surgeon.

·        Any patients who referred from other dermatologists from Kuwait for skin biopsy, should have the skin biopsy pathology request with the patient in order to be seen directly by the derm surgery unit and pathology staff, otherwise if the referring dermatologist wrote a regular consultation letter, that patient will be directed to the OPD at Asa’ad  Al Hamad to be assessed by the dermatologist first then fill the skin biopsy pathology request in order to be seen by the derm surgery and pathology unit

·        Any patient on Aspirin, Plavix can get skin biopsy without stopping it. Any patients on Warfarin, INR should be therapeutic before 48 hours  (INR 2-3). Major procedures like Mohs surgery, the surgeon will decide whether to hold anticoagulants or not before surgery. If platelets are under 20,000, then skin biopsy should be postponed until its more than that level, otherwise the hematologist should transfuse FFP and platelets.

·        Diabetic patients  should check their blood sugar at the derm surgery unit,  with our glucometer, if they refused to do so or if the patient insisted to do the biopsy without checking or the derm surgeon wants to do the  procedure in spite of high blood sugar, the patient should be aware for any complication and sign a consent.

·        The referring Doctor at As’ad AlHamad has to open a file for each patient that belongs to our catchment area before doing a skin biopsy and filling the request form for dermatopathology (appendix 4)

·        The derm surgeon will open a file if the patient is referred from other specialist

·        Photography is obligatory for selected cases

·        Nurse will do assessment and give the patient a questionnaire to fill (appendix15B), and measure vital signs

·        Patients booked for Mohs surgery will be handed information sheet and consent (Appendix 15C)

·        Consent will be signed by the patient before any procedure MR5 ( appendix 30)

·        The group of dermatopathologist and the derm surgeon will assess the patient to get the clinico-pathological correlation

·         Surgical check list will be attached to file (appendix 30B)  and MR10 ( appendix 30 A)

·        The results of the biopsy will take 7-14 days, the patient will get the results from the dermatopathology unit.

·        Unit members meet every 6 months to improve work

 

The surgical check list protocol as follows:

“Time out” immediately before starting the procedure, Time out should be conducted in the OP/ procedure room before the incision. It should involve the entire operative team, use active communication, be briefly documented, such as in a check list

Should include:

a.         The correct patient identity ( triple name and CID, and match them to the specimen bottle and request form)

b.         Correct side and site ( match identity and site if multiple specimens)

c.         Agreement on the procedure to be done (MR5)

How to do it:

·        Make the mark at or near the incision site. Do not mark any non operative site(s).

 

·        The mark should be unambiguous, Do Not use X on the site.

 

·        The mark should be positioned to be visible after the patient is prepped and draped.

 

·        The mark should be made using a marker that is sufficiently permanent to remain visible after completion of the skin prep. Adhesives site markers should not be used.

 

·        The method or marking should be consistent through out the organization.

 

·        The marking should be made by individual that is familiar with the patient and is involved with the patient procedure. This individual is encouraged to be the surgeon or individual permitted through residency program to participate in the procedure.

 

·        Marking should take a place with the patient involved, wake and aware, If possible.

 

·        Final verification of the site mark should take a place during Time Out.

·        Exception: Cases in which the individual doing the procedure is in continuous attendance with the patient from the time of decision to do the procedure and consent from the patient though to the conduct of the procedure may be exempted from the site marking requirement. The requirement for TIME OUT final verification still applies.

 

Equipment at the Dermatologic Surgery Unit:

8-        Elman Surgitron equipments (1)

9-        Diathermy equipments (Hyfrecators 2000) 2 machines

10-   Surgical tools for minor surgeries done under local anesthesia. 18 biopsy sets.

11-   CryoLab Container and Gun (2)

12-   Electrosurgery Vacuum Machines (2)

13-   Examination (Operation) Tables (4)

14-   Examination (Table) Lights (3)

15-   Emergency trolley with Defibrillator (1)

16-   Magnifying light (2)

17-   Suction apparatus (1)

18-   O2 cylinder with flow meter (1)

19-   Examination Dental chairs (1)

 

6.      Dermatopathology:

This is run by a qualified Dermatopathologists:

Dr. Humoud Al-Sabah

They are helped by 2 technicians. The unit is responsible for dermatopathological diagnosis of skin biopsies.

Routine, special stains, direct and indirect immunofluorescence, and immuno-histochemical staining are done as indicated. If a procedure is not available in the center, the specimen (or tissue block) is sent to Pathology department at Sabah Hospital, to Kuwait Cancer Center, or to the Faculty of Medicine for processing. 

All patients’ information and pathology report should be entered in the computer system by the secretary working in the pathology unit. A print-out of the pathology report should be signed by the doctor in-charge of the pathology unit.

Equipment at Dermatopathology Unit 

(The Lab and Doctor’s office):

1)        Microtome for cutting paraffin blocks.

 

2)        Embedding machine for embedding the processed biopsy specimen in paraffin.

 

3)        Tissue processor for fixing the biopsy specimen in different steps.

 

4)        Incubator for fixing the slides and incubation (staining).

 

5)        Water bath for stretching the cut sections and to take it on slides.

 

6)        Multi-headed Microscopes.

 

7)        One light microscope for examining the quality of the sections.

 

8)        Three microscopes in doctor’s office, used for examining and reporting the slides and also photography of the slides when needed plus for teaching purposes.

 

9)        Hot Plate for heat fixing the slides.

 

10)   Oven for incubation at high temperature.

 

11)   Fume Hood for absorbing toxic gases.

 

12)   Microwave processor for immunostaining and immediate processing.

 

13)   Weighing machine for preparation of various reagents and solutions.

 

 

 

Refrigerator                   

7.      Immunodermatology:

This is run by two Senior Specialists Dr Vector Lazarevik and Dr. Najla Al-Kharafi and helped by 4 technicians. It provides diagnostic facilities essential for autoimmunebullous diseases

 The tests performed in immunodermatology lab:

1.      Direct immunofluorescence test using patient’s skin biopsy.

2.      Indirect immunofluorescence test using patient’s serum. Different substrates are used depending on the case:

·        Monkey esophagus

·        Normal human skin

·        Human split skin

·        HEP-2 cells for ANA screening tests

 

3.      ELISA:

·        DsG1

·        DsG3

·        BP180

·        BP230

 

4.      Direct smear to diagnose cases of Leishmaniasis

The unit receives cases from our OPD as well as from all other centers, as most of the tests are performed solely in or lab.

If a test is not available in our lab, we send the specimen to Behbehani center immunology lab or the Faculty of Medicine.

All patients’ information and immunology report are entered in the computer system. A print out of the immunology report is signed by the doctors of the immunodermatology unit.

Equipment at the Immunodermatology Unit:

1)                       Ordinary Centrifuge.

2)                       Cryostat for cutting sections for DIF and IIF tests, and Moh’s surgery.

3)                       Two Fluorescent microscopes for reading and reporting DIF and IIF tests.

4)                       Ordinary microscope.

5)                       Deep Freezer (-80 C) for long time storing of valuable samples.

6)                       Freezer (-25 C) for short time storing of samples.

7)                       Refrigerator (-15 C  -4 C).

8)                       Analytical Balances.

9)                       Two sets of computers with printers

10)      Digital Camera DP-70 for recording immunofluorescence and histopathology microscope samples.

 

11)                  Incubator

 

12)                  Fumehood for absorbing toxic gases and chemicals.

 

13)                  ELISA reader for measuring Dsd1, Dsg3, BP180, BP230 antibody titers.

 

14)                  ELISA washer.

 

8.      Dermatomycology:

This unit is under supervision of a Senior Registrar (Dr Abeer Abdulla) and a Registrar (Dr Isra Yaqout). This unit is running once per week (Wednesdays)

The unit provides diagnostic facilities essential for fungal diseases of the skin including direct scrapings and cultures. A detailed referral form should be completed by the referring dermatologist. Mycology report should be signed out by the doctor in-charge of the mycology unit.

 

Equipment at the Dermatomycology Unit:

1)           Two incubators for cultures of mycology specimens.

 

2)           Ordinary microscope for examining the direct smears for evidence of fungal infection.

 

9.      Medical photography:

Being an essential part for dermatology, medical photography of patients is done for follow-up of cases and for teaching purposes. It is run by one specialist (Dr Vector Lazarevik) on Sundays, Tuesdays, and Thursdays, helped by a nurse.

 A special form should be used for each patient to be photographed (Appendix 7) and an informed consent to be signed (Appendix 7).

Information about the photographed patient including name, referring doctor, date, and reference number of photographs is given to the patient in a special sheet (Appendix 49) that should be returned to the treating doctor and kept in patient’s file. For internal use in the unit, a special form is used that will facilitate the filing of the photographs (Appendix 50).

The unit will also help the doctors to keep records of interesting cases and storing them in s presentation format through the use of special forms (Appendix 51 and Appendix 52).

Equipment at the Outpatient Clinics:

1)           Birtcher-Hyfrecator in each clinic for removal of warts, skin tags etc.,

 

2)           Liquid Nitrogen drums are used to distribute liquid nitrogen in small containers to be used by the doctor in his clinic for treatment of warts etc.,

 

3)           Hand-held Liquid Nitrogen cylinders (Appendix 8 and 9)

 

 

 

 

The Pharmacy

This consists of a dispensing area, lab for preparation of some formulas, and a store. It is under supervision of pharmacy head of As’ad Al Hamad Dermatology Center. Several pharmacists or assistant pharmacists (number is not fixed) are working daily in the pharmacy.

The pharmacy works in morning hours and the afternoon duty hours from Sunday through Wednesday. Patients seen in the afternoon duty of Thursday, who need urgent treatment, are referred to the casualty medical pharmacy to dispense medication. Otherwise, the patient can dispense the prescribed medication next day.

The pharmacy keys are separate and different from the master keys of the center. These are kept with the chief pharmacist.

Function of the Department Council:

 

1.         The Department Council is chaired by the Chairperson of Department (or his deputy).

2.         Membership of the Department Council:

3.         Setup of the council included all Consultants, Senior Specialists, Specialists, Senior Registrars, and one Registrar representative for all junior doctors. The latter to be changed on rotational basis yearly. Also, person in-charge of the Labs, Pharmacist in-charge, person in-charge of the Medical Records, and one representing Nursing staff.

4.         It is held regularly every 2 months.

5.         The Department Council will determine the size of the adequate team to run the different units in the department according to the norms set by the Dermatology Council for the dermatology service4. The council will ensure implementation of the Job Description set forth by the Council of the Dermatology Departments and in accordance with the general rules laid by the Ministry of Health.

6.         The council will be responsible for implementation, maintaining, and reviewing compliance with the clinical guidelines of care set by the Council of the Dermatology Departments.

7.         The Council will identify, initiate and maintain Bylaws, Rules and Regulations for the proper functioning of the department staff.

8.         The Council will identify the problems that might be met with during running of the department and units and should put forward suggestions to solve such problems.

9.         The Department Council will suggest to the Chairperson of the department, the needed medical equipments and tools, scientific books and periodicals, and names of consultant visitors. The Chairperson in turn will discuss these matters with his colleagues in the Council of the Dermatology Departments.

10.    The Council during its meeting should discuss the detailed statistics carried out by the Person in-charge of the Medical Records regarding various activities of the department and its units, and find out any indicators of deviation from normal and expected findings. Abnormal findings should be discussed and investigated by members of the council and proper solutions to be suggested.

11.    The Council should contribute in planning of the Annual Vacations of the department and units.

12.    The Department Council should be aware of the steps and principals of the Emergency Plans set by the Council Board of the Hospital and should be able to implement these plans whenever needed (Appendix 62).

13.    Promotions, shortages, proposed plans, change of structure will be discussed in the Council’s meeting.

14.    The Council will review and evaluate on continuing basis the clinical privileges of the staff, to ensure a high level of professional performance by all persons authorized to practice in the department.  Senior members of the Council in a closed meeting will decide on the appropriateness of the professional performance and ethical conduct of members of the department.

15.    The Council will support the appropriate utilization of the department resources, and support all clinical and non-clinical activities that serve to promote and maintain accreditation of the department locally and internationally.

16.    The Council will discuss the duties of running the day to day business e.g., minor operation theatre, phototherapy, post-graduate and in-service training, the morbidity/mortality, research, the medical records etc.,

17.    The Department Council will decide on the appropriate educational setting which will maintain scientific standards and continuous advancement of professional knowledge and skills through the following:

a.      The department weekly clinical meeting (for details, please. Refer to the Department Teaching and Training Activities section).

b.      The Department Council will encourage the contribution of the staff members of the department in the Grand Clinical c) The Department Council should encourage active participation of the staff members in various scientific meetings inside and outside the country, and should put forward a plan and policy for nomination of the participants in the conferences.

c.      The Chairperson will advertise all academic and clinical meetings.

18.    The Department Council should review the accumulated CME/CPD points of staff, and evaluate the CME/CPD activities of the department (for details please refer to the Teaching, Training and Continuous Professional Development CPD/CME section).

19.    The Department Council will discuss the outcome of the Medical Records Chart Review (for details, please refer to the       Department Medical Records Chart Review section), and will take the necessary actions

20.    Discussion of Incident reports.

21.    Evaluation of the operational policy, twice per year, and to be updated and re-printed at least once per year. The evaluation should include: Strength, Weaknesses, Opportunities, and Threats.

22.    Discussing the Dermatology Audit (refer to The Dermatology Audit section for details).

23.    The Department Mortality and Morbidity Committee is responsible for discussing mortality and morbidity of in-patients whenever applicable

 

 

Role of the Chairperson of the Department:

 The Chairperson of the department is responsible for the following activities:

1)     All clinically related activities of the department, unless otherwise specially delegated to heads of units in writing.

2)     All administratively related activities of the department other than those specifically delegated to heads of units in writing including the supervision of the performance of the nursing staff, the technicians, and the pharmacists in liaison with the concerned supervisors.

3)     The integration of the department into the primary functions of the hospital and other services of the Ministry of Health. 

4)     The development and implementation of Operational Policies and Procedures in accordance with the updating and reviewing them in the departmental council.

5)     The recommendations for the appointment of adequate number of qualified and competent persons to provide quality care.

6)     Continuing surveillance of the professional performance of all individuals who have clinical responsibilities in the department

7)     Recommending to the Departmental Council the clinical privileges of the members of the department.

8)     The continuous review and improvement of the quality of care and services provided through nomination of Quality Assurance coordinators, and the maintenance of Quality Assurance program in the department. This will be maintained through nomination of a Medical Record Chart Review Committee in the department.  The committee will ensure that all Medical Records are documented accurately and are readily accessible and provide prompt retrieval of information (for details, please refer to the Department Medical Records Chart Review section).

9)     The orientation and continuing education of all persons in the department.

10)      Recommendations for space and other facilities needed by the department.

11)   Nominating names of the members of Medical Boards.

12)   Participating in the function of the Council of Dermatology.

13)   Investigating the complaints submitted to the head of the department, following the procedure mentioned in the Internal Policy section.

The Department Medical Records Chart Review Committee and Function:

This should be announced by the Chairperson and includes some of the Senior Registrars, Specialists, Senior Specialists and Consultants

The committee will report to the Department Council at least once per month.

It will assure that all patients who are being followed-up at As’ad Al-Hamad   Dermatology Center must have a medical record according to the Referral Policy mentioned previously.

The content of the medical record should be sufficiently detailed to enable any other on-duty or consulted doctor to provide continuing care to the patient. The committee will use a standard form to evaluate the charts (Appendix 55b).

Minimum information should include: identification data, medical  history of the patient, detailed physical examination of all body systems, presenting problems and other associated problems, diagnostic and therapeutic plan, progress notes (in measurable terms relevant to patient's condition).

Members of the committee will conduct monthly Chart Review of the Medical Records and identify medical record deficiencies accordingly to medical record deficiency check-list (Appendix 56).

They will decide on the non-compliance and refer these cases to the Department Council.

The committee will make sure that the medical records contain sufficient information to assure the continuity of care.

The following standards of review, together with those of the Medical Records Department Review Chart (Appendix 57), shall be utilized making their decision:

1. The record contains the scope and details of information appropriate to the diagnosis.

2. The record substantiates the final diagnosis.

3. The record refers to important abnormalities, laboratory or     other special examinations.

4. The record identifies important risk factors that have a bearing on choice and application of treatment.

5. If admitted, the record should include a concise summary of the reason for admission, listing of problems in chronological order, findings, treatment given or procedures performed condition of the patient on discharge and any pertinent discharge instructions.

6. The record should be signed clearly and stamped by the treating doctor.

  The record will consist of:

History: past, present.

Provisional diagnosis.

Investigation plan.

Therapeutic plan.

Progress Note (relevant to patient's problem in measurable terms).

Consultations:

Change of management plan.

Change of therapeutic plan.

Discharge summary.

Follow-up appointments.

Discharge Rx and dietary plan

Re-admission plan.

Operative report.

Consultation Report.

 

Risk management activates  (Patient/ Staff Safety and Incident Report):

1-      It is the responsibility of the person-in charge of each unit in the department to inform the head of the department or the administrative secretary about any problem in the equipments in his unit so as to call the workshop people to repair the equipment so as to ensure the continuity of the service and the safety of the personnel and the patients.

 

2-     The Infection Control Measures against transmission of HIV and other Blood-borne infections for safety of health-care workers distributed by the Quality Assurance and Infection Control Department, Al-Sabah Hospital (Appendix 58) should be followed-up.

 

3-     In case of reportable diseases identified,( Appendix 60)  must be filled.

 

4-     In the event of a pin-prick or other blood/body fluids exposure, the policy for Incident Report for Exposure to Blood/Body Fluids that was distributed by the Quality Assurance and Infection Control Department, Al-Sabah Hospital (Appendix 59 A and B) will be followed.

 

5-     Any incident that happens in the department during a treatment procedure should be recorded as an incident report, and inserted in the box assigned for.

 

·      The person, who is responsible to collect the incident reports, will hand them to Risk Management Committee to discuss and make root cause analysis if needed.

 

·      Then the person who attended the committee will take the minutes and discuss them at the Risk management team at Asa’ad AlHamad center and discuss them with the whole team of doctors at the center.

 

·      Risk management committee on regular bases discussing the incident reports.

 

Admission and Discharge Policies:

a)     Admission Policy:

·              As there are no wards for dermatology, the patients are admitted usually to the medical department or pediatric department of the hospital to which the dermatology department is affiliated. For As’ad Al-Hamad Dermatology Center, admission is done to the medical department or pediatric department of Al-Sabah Hospital. Once admitted, the patient will be followed under the unit in which he was first admitted.

·              The Consultants, specialists or Senior Registrars should approve the admission of patients. The treating doctor (or the doctor on-duty if the treating doctor is not available) will admit the case and is responsible for writing the in-patient sheet including full history and examination notes, together with the investigations to be requested. The Consultants or Senior Registrars/specialists on duty should examine the patient after being admitted on the same day of admission, review the admission chart including the investigations requested, and to write down the treatment plan. After being admitted, the patient must be followed up by the Consultants or Senior specialists, Specialists, or Senior Registrars/ on call on daily basis. During week-ends and holidays the doctor on duty is responsible for following up the admitted patients and should report to the Consultants or Senior specialists, Specialists, or Senior Registrars  on call.

·              Admitting doctor must fill MR4 (appendix 48A), MR7, and MR12 (appendix 48B) , in-patient prescription paper (appendix 48C) and the patient will sign consent form for admission (Appendix1) on the same day of admission, special medication order (Appendix 48D)

·              Once patient is planned for admission, the nurse from dermatology department (As’ad Al-Hamad) will contact the casualty nurse to arrange a bed in the ward.

b)      Discharge Policy:

·           It is the responsibility of the Consultants or Senior specialists, Specialists, or Senior Registrars on-call to discharge the in-patients when they are fit for discharge. A discharge summary should be written and a referral letter to the treating dermatologist should be given to the patient for follow-up.

·           According to the diagnosis, the patient is referred to either the general outpatient clinics, the specialty outpatient clinics, or the specialty units for follow-up

·           Discharge form must be filled by the admitting department and the doctor on-call  in dermatology unit that day of discharge using MR13 (appendix 48 D).

 

 

Evaluation of the Departmental Policy: strengths, weaknesses, opportunities, and threats.

Evaluation of the operational policy should be done at least twice each year by the department council. Revision of the policy will be done and suggestions discussed. Input from all the doctors of the department should be encouraged.

Strengths:

1.  As’ad Al-Hamad Dermatology center providing a tertiary care service makes it a unique department of dermatology in Kuwait. The center provides certain specialty and subspecialty dermatological care services to the patients allover Kuwait through the available equipments and personnel in the specialized clinics and units.

 

2.  The center is recognized as a teaching and training center for candidates enrolled for the Kuwait Board of Dermatology program.

 

3.  International collaboration for problem cases has been established recently. For example, consultations on genetic skin diseases are sent to Dr.  John McGrath, professor  and Head of Dermatology Department, Guys and St Thomas Hospital,  University of London, U.K. for diagnostic consultations and reporting.

 

 4.   An electronic calling system is available for calling the patients in the out-patients area, the Phototherapy area, and the Pharmacy waiting area.

 

5.   The available computer network permits a modern service through registering patients’ information and appointments, follow-up of patients by their electronic medical files, and writing the patients reports retrieved from their electronic medical records. Various statistics including the diagnoses of patients based on the ICD 10 protocol became available through the computer system. At present there are several software modules available for the following applications:

 

a)     Patient registration (at Reception).

b)     Patient electronic medical files (available for all the doctors in the general and specialty clinics).

c)     Phototherapy program (available for the photo therapy unit).

d)     Pathology program for pathology reports.

e)     Mycology program for mycology results and reports.

f)       Biopsy Appointments.

 6.   Advanced audiovisual facilities are available in the center including digital cameras and data show that, together with the computer network, enable presentations of clinical cases and pathology slides in the daily morning meeting and the weekly and grand meetings. Also these facilities are used to present problem cases seen by visiting professors and consultants in seminars held for all dermatologists to attend the comments of these visitors regarding these cases. In addition, there are facilities for conference slides processing and for publications.

 7.  Free WiFi Internet connection in the center is available all the day for all the doctors to facilitate scientific and medical search of literature and internet services in the medical field.

 8.   There is a web site for the center on the internet (www.dermakuwait.com) that provides link to vast dermatology services worldwide. Also, this operational policy and the treatment guidelines for the ten most common skin diseases are available in the site for viewing and for downloading.

9.  Appointments schedule by internet is now available through the center website for the patients to request their appointments.

10.  A health issue magazine is produced 2 times per year and is addressing mainly the patients about various dermatology diseases.

 Weaknesses:

1.      As’ad Al-Hamad Dermatology center is a secondary and tertiary care service center will not allow walk-in of non-emergency cases. Also, all referred patients should come on an appointment bases. This is not always the case, and in many instances we are obliged to treat such patients because of lack of support.

2.      In spite of the spacious nature of the center, recently and because of expansion of the services in the center, we are in need for extra rooms to be used not only for expanding dermatology services but also for providing extra clinics for  training of the Kuwait Board candidates, and also for  general stores  bedsides  rooms for sorting the non-clean laundry. We have suggested building extension building  in a space that is available outside the current building of the center near the employee parking.

3.      There is discrepancy between the catchments areas of As’ad Al-Hamad Dermatology center and those of Al-Sabah Hospital. This leads to problems in interdepartmental co-operation and interdepartmental policies. Unifying the catchments areas for both should be considered.

Continuous Professional Development CPD/ CME

Teaching, Training and Continuous Professional Development CPD/CME:

1.       Department teaching and training activities:

a)     The center will have a daily clinical meeting at 7:30 am and a daily closing meeting at 1:15 pm to discuss the inpatients, new admissions, and consultations of previous day. In addition, a clinical meeting once per week. The weekly clinical meeting will be a minimum of 2 hours session that is held currently on Tuesdays, starting at 12:00 noon. All the doctors of the department will participate. Active participation of the Registrars and Assistant Registrars must be encouraged. The activities will include presentation of problem cases, lectures and journal club. Problem cases are seen physically in the outpatients. Special form for each patient should be filled out by the presenting doctor (Appendix 55 A).  All patients should be photographed by the doctor in charge of the photography unit using the special photography form (Appendix 7). The cases are then reviewed and discussed in the clinical meeting room through retrieval of the patients photographs using the computer network in the center. This meeting has been accredited by the KIMS as Category II CME program. During this weekly clinical meeting, discussion of the in- patients admitted to the medical wards will be carried out regarding various investigative procedures and management of these cases.

b)     The staff members of the center participate in the Grand Clinical Meetings that are held in collaboration with other Dermatology Departments of  the Ministry of Health 4 times a year.

c)     The staff members of the center should have active participation in various scientific meetings inside and outside the country.

d)     The center is involved in teaching a pediatric dermatology course for the 6th undergraduate students, and a general dermatology course for the 7th year medical students through the clinical tutors approved by the ministry.

e)     The center, through the senior registrars and higher ranks, are also involved in medical training and teaching of the family doctors and trainees of Kuwaiti board of Medicine and Pediatrics sent for this purpose by the KIMS. Also, they are responsible for postgraduate doctors sent for Canadian board in Dermatology, in General Medicine, or in Pediatrics who spend an elective course in dermatology in the Center whenever assigned by the KIMS.

After the daily round with the senior staff, the candidates might be distributed to the outpatient clinics (general or specialty clinics) or the specialty units to build up clinical experience in dermatology.

f)      Since 2003 the center is involved in teaching and training the Candidates of Kuwait Board of Dermatology. Details of the teaching schedule of these doctors are available on KIMS website.

The department council will organize and maintain the following:

            1.  The annual CPD/CMEs of the department.

             2.  The minimum score of CPD/CME points for each member of staff.

                   3.  Evaluation of the efficacy of the CPD/CME programmers, and the quality of different components (Departmental lectures, seminars, workshops, clinical rounds, teaching rounds, clinical review meetings..etc)

The Dermatology Audit:

Clinical Auditing. This can be a function of The Department Medical Records Chart Review. It should include the following:

1.      Number of readmissions within one month.

2.      Number of incidents of unauthorized drug use.

3.      Number of medication errors.

4.      Accuracy of diagnosis.

5.      Number of patient/family complaints regarding drug therapy.

6.      Length of stay of in-patients more than 30 days.

7.      Patient satisfaction questionnaire result.

8.      Number of requests where the response was delayed more than 24 hours and the reason for that delay.

9.      Number of treatment refusals by the patient.

10.  The appropriateness of investigations.

 

          Dermatology Department Committees

 

Committee

Doctor

Quality improvement

Dr. Abeer Al Arboud

Hospital utilization

Dr. Ghadeer Al Alawi

Policy and procedures

Dr. Nadia Al Nakki

Health information

 

Mortality and morbidity

 

Accreditation.

Dr. Nadia Al Nakki and Dr Sara Almusallam

Infection control and Waste Management.

Dr Eman Almasry

Safety and risk management.

Dr Atlal Lafi

Medical Records.

Dr. Abeer Abdalla

Emergencey.

Dr Mohammed Alotaibi

Antibiotics.

Dr Eman Elmasry

Utilization Review.

Dr. Ghadeer Alalawi