GUIDE FOR SUPERVISION AND CONTROL IN HOSPITAL NURSING REGIONAL

TURN LINK VALOR ITEM % CUMPLIMIENTO OBSERVATIONS

1.-Inform the incoming shift of relevant events related to 2
severe patients and aspects of the organization of the service
nursing.
2.- Reception of the outgoing shift, measures implemented regarding 2
of shortages such as medications, supplies, materials, clothing,
etc.
3.-Review of formats, properly filled out and signed by the 1
discharge supervisor. From each service, hospitalization,
["emergencies","ICU","NICU-cribs","radiology","operating room"]
gynecology, clinical services, hemodialysis.
4.-Analyze relevant situations to continue with them. 2
implemented measures.
5.-Intervenes in relevant aspects, communicating to 1
shift coordinator for its control and monitoring.
6.- Execute the daily status record of the hospital status, 2
nursing department.
Nursing Services Journey
1.-Check the attendance by service, in the format control of 2
attendance. Just like unplanned absence.
2.- Run the tour in the nursing services, with the head 1
of the area number of patients and serious patients.
3.-Observe the total attendance of staff by category of 1
according to what was planned in the attendance record.
4.-Confirm information about relevant events with the floor manager. 1
about the shift link.
5.-Request information about shortages of supplies, 1
functioning of equipment.
6.-Check for irregularities with other departments 1
that may interfere with work performance and attention
patient.
7.-Check if there are deviations that require intervention 1
immediate to provide a solution.
8.-Check the hospital status by service, along with each 1
area chief.
9.-Check the number of patients per service in 24 hours. Severe and 1
stable.
DISTRIBUTION OF HUMAN RESOURCES Value of ITEM % OF OBSERVATIONS
COMPLIANCE
1.- Analyze the situation of the existence of the staff with whom 2
provides in each service and its competencies for the assignment
and development of activities related to the type of patients.
2.-Distribute the nursing staff based on the personnel that 2
is present and based on the type of patients per service.
3.- the movement of support personnel in the different 1
services in the daily report.
4.- Register the absenteeism daily in the attendance list. 1
5.- Daily hospital status report to the director of 1
nursing.
6.-Notification to human resources of absenteeism not 1
programmed like the programmed for future replacements.
7.- Reports the daily patient census to the head of 2
nursing
DAILY HOSPITAL STATUS REPORT AND VALUE OF % DE OBSERVATIONS
NURSING SERVICE. PATIENT CONTROL ITEM COMPLIANCE
1.- Register the shift that corresponds to him/her 1
2.-Register the number of sensitive beds by service 1
3.-Register the services with non-sensitive beds 1
4.-Register high-risk and specialized services, the number 1
of procedures and sensitive beds.
5.-Review the number of patients attended in sensitive beds. 1
and not sensible.
6.-Record the health statuses of patients in the census, 1
delicate, stable and serious.
7.-Record the diagnosis and health status in the control of 1
patients per service.
8.-Realiza suma en horizontal y vertical los totales de pacientes. 1
9.-Record relevant data related to human resources. 1
10.-Record special events that have occurred during the 1
shift.
REPORTS
1.-Report if there are voluntary resignations, as well as the reasons. 2
2.-Reports patient transfers to other institutions. 2
3.-Record materials, medications, or other supplies 2
pending to achieve.
4.-Register adverse events or near misses that occurred. 2
5.- Provide feedback to the area heads regarding the uses of 2
equipment, oxygen, nebulizations etc, by means of a call
telephone to avoid omissions in this procedure.
CONTROL OF SCHEDULED ATTENDANCE VALUE OF % OBSERVATIONS
ITEM COMPLIANCE
1.-Staff Role Scheduling 1
2.- Break scheduling 1
3.-Vacation scheduling 1
4.- Review of vacation periods 1
5.- Check the holidays for scheduling days 1
6.-Schedule work days with the staff that is required for 1
cover the demands of users and workload.
Authorize payments for days to the staff that is scheduled to cover. 1
scheduled support needs.
8.- Prepare payroll report based on permits. 1
incapacities, vacations, agreements, etc.
9.- Evaluate the staffing program with scholarships, licenses, 1
agreements, economic permits, and disabilities.

10.-Verify that the personnel fill out the corresponding form. 1

requested day, and signed by the supervision department.
ADMINISTRATIVE
1.- Submit payroll report to nursing management for 2
review and signature.
2.- Deliver to the nursing address for signing the events, 2
payroll and vacation and day scheduling.
3.-Execution of the administrative procedure. 2
4.- Analyze and authorize the attendance and incident registration. 2
5.- Coordinate with human resources the required sanctions by 2
non-compliance.
SUPERVISION OF NURSING SERVICES VALUE OF % OBSERVATIONS
ITEM COMPLIANCE
1.-Develop a format for the different services, ICU, CRADLES 1
UCIN, Emergencies, clinical services, operating room, Hemodynamics,
Imaging.
2.-Patient supervision 1
3.-Conduct tours of the services 1
4.-Review patient by patient 1
5.- Check that the implemented treatment is being followed. 1
patients, along with the floor chief.
6.- Verify the performance of nursing techniques at random. 1
7.-Verify nursing care records. 1
8.- Supervises compliance with security indicators of 1
patient.
9.-Verify that the fall prevention protocol is being followed. 1
10.- Verify compliance with pressure ulcers. 1
SUPERVISION OF TECHNIQUES
1.- Monitor the compliance with safe medication handling. 2
2.- Ensure that the correct transfusion process is followed 2
blood and blood derivatives.
3.- Monitor the compliance of the hand washing process. 2
4.-Monitor the compliance of control processes 2
infections.
5.- Monitor compliance with infection prevention 2
nosocomial
EDUCATION
1.-Promote, guide, and provide feedback on the different processes 1
that are weak in nursing staff.
2.-Make the corresponding reports in the evaluation log. 1
of performance of each evaluated nurse.
3.- Supervision of services that comply with the documents 1
registration necessary.
4.-During the journey, monitor the proper control of the cart. 1
strike by the department heads.
5.- Ensure that the healing cart control is complete. 1
of the necessary supplies.
6.-Supervise that the RPBI is handled correctly 1
7.- Maintains coordination and control with alternate services. 1
["as pharmacy","CEYE","warehouse","dry goods store","nutrition"]
maintenance, biomedical.
8.- Registration of special care and the charge for them in the 1
ASSIST, so that it is charged to the patient's account.
9.-Coordinate with the floor manager, issues, program 1
meetings with the staff.
10.-Publish the meeting schedule. 1
COMMUNICATION AND EVALUATION OF STAFF VALUE OF % DE OBSERVATIONS
NURSING ITEM COMPLIANCE
1.-He presents himself with the staff every time he makes rounds, 1
interview, meeting or link of turn.
2.- Politely addresses the nursing staff and 1
multidisciplinary team.
3.-Schedule evaluations every 3 months and make them known to 1
scheduled personal.
4.- Participate in the evaluation of newly hired personnel. 1
5.-Schedule meetings with the service staff, fosters 1
to express their grievances.
6.-Manage new spaces in the assignment of positions. 1
7.-Evaluate staff performance and report results. 1
8.- Manage support resources in training 1
personal.
9.-Document in the personnel evaluation card the 1
support needs and results.
10.-Create documentation in an anecdotal form based on agreements. 1

1.- Monitor compliance with the uniform and footwear regulations. 1

security measures, as well as the use of personal protection.
2.-Inform the nursing management and coordination of 1
teaching about personnel evaluation results.
Participates in the training of new staff. 1
4.- Participate in the recruitment of personnel. 1
5.- Monitor the compliance of staff job induction 1
new admission.
6.- Supervises nursing students in compliance with 1
goals.
7.-Supervise nursing interns in meeting goals. 1
8.-Quality coordination in nursing 1
9.-Monitor the compliance with established standards. 1
10.-Analysis of health indicators, through the application of 1
surveys.
INDICATORS
1.-Measurement of indicators. 1
2.- Monitoring of indicators. 1
3.- Dissemination of results of indicators in services and with 1
executives.
4.-Review of administrative manuals. 1
5.- Participate in the preparation of manuals and policies. 1
6.-Participation in the evaluation and analysis of complaints. 1
7.-Management of special situations. 1
8.-Review of complaints recurrences. 1
9.- Supervision to ensure compliance with rights and obligations 1
patients.
10.-Supervision of the rights and obligations of nurses. 1
VALUES
1.- Monitor the respectful treatment of patients, families, and staff. 1
multidisciplinary.
2.- Oversees the general proper functioning of the 1
installations.
3.-Oversees compliance with policies and procedures 2
established by department.
4.- Promote leadership within the work team. 1
5.-Motivates its staff for better performance. 2
6.-Document and evaluate sentinel events 2
CONTROLOFATTENDANCEANDSTAYINMYMEDICALUNIT.

The staff of the Regional Hospital must perform a check-in upon arriving and leaving the company daily, which is done through
from the fingerprint that is placed on a system installed at the entrance of the hospital time clock, it registers all the
suppliers and workers upon arrival. This is reviewed by the payroll department to carry out the respective
paid biweekly.

In the attendance and permanence control, it is carried out daily by the nursing supervisor who conducts
pase de lista en cada departamento de acuerdo a la plantilla de personal asignado a cada área, en la cual lo realiza primero
by phone and later on a direct tour of each service where the information and visualization are verified
of the staff.

A separate control is maintained through some forms, where employees request permission for different types.
is filled out in advance to justify their absence, and additionally carries a control agenda in which the days of leave
An economic day is referred to as a day that a unionized worker has the right to a total of 5 in the year, which must be requested.
3 days in advance and registered in the schedule for better staffing of guards.

A personnel schedule is made in advance for better control before the start of the shift and to avoid the
maximum the exposing of patient care services, is anticipated depending on the staff, based on the
occupation, anticipating absenteeism and disabilities at all times.
GUARDDELIVERIESCONTROL

In relation to the shift delivery controls, we have a shift link in which supervision is carried out.
delivery of all patients who are hospitalized in our hospital with their diagnosis, hemodynamic status,
special conditions, general pending services, and of the entire hospital that pertains to the department of
nursing, pending studies, pending transfers, special procedures, special requisitions, etc...

In different areas, a handover link from floor manager to floor manager is managed in which the condition is delivered.
each of the patients, personalized pendants for each patient, special condition and intertwines the care of
systematic way without losing control of the treatment tracking of each patient, is done with a notebook and the
SBAR technique, which easily conveys a lot of important information about our patient, is carried out
along with the medical record of each patient, and the nursing staff reviews and attends to each patient at the moment
from that link of shift.

In the operating room service, the shift handover is also carried out using the shift linking technique and is conducted according to protocol.
established when there is a need to replace surgery, although most of the time the personnel that initiates a
the surgery is over.
CONTROLOFINCOMINGANDOUTGOINGMEDICINESANDHEALINGMATERIALINMYMEDICALUNIT.

In our hospital, there is a general warehouse and a pharmacy where appropriate conditions are maintained.
storage for health supplies is essential to ensure their quality. These two departments have a
previous control with its products, which through the finance and purchasing department, have a general inventory
of materials and medications which control their entry and exit through the computerized inventory system of
which the department heads manage.

The storage systems in both departments include clear instructions on the reception and the
organization of the products; special storage conditions; monitoring and control of the products;
the maintenance of its quality; the construction and design of the storage for medicinal products; the handling of the
waste; and resources.

The storage process aims to ensure the quality of health inputs so that they fulfill their function.
establishing the necessary physical, hygienic, and infrastructure conditions.

Appropriate storage conditions must ensure:

The quality of medications until their use.

Therapeutic efficacy.
Prevent the deterioration or accelerated aging of the supplies.
 The expiration dates of the product are determined based on ideal storage conditions to protect
the quality of the product until its expiration date, which is important for providing adequate service to the
users and economize resources.

In our Regional Hospital, a process is carried out for the disposal of expired medications that involves
nombre: “baja de medicamentos”, este proceso consiste en:

Make a list of the existing medication in the pharmacy, it is worth mentioning that this procedure is done with
three months before the medication expires.
When making the list of medications, the batch number, expiration date, and quantity of medication are noted.
that is discharged.
It is passed to the Administration.

A document is prepared in Administration and passed to Finance, where the elimination process takes place.

The two departments supply the products through a request made by the employees.
that is generated by the internal ASISST system in which each patient that will be used is loaded and is supplied
for each department separately where it reaches the service where it is requested and at the same time it is stored in a
special locker for each patient, which is registered in the patient's account.

This product, if not used by the time the patient is discharged, will be returned to the corresponding service.

Another department responsible for supplying sterile wound care materials is the CEYE service, which has
a warehouse of products that is managed daily by nursing.
Dressing material: The dressing material is requested by the head nurse of the morning shift from Central
Equipment and Sterilization to the warehouse. Supply for 24 and 72 hours, according to the established petty cash.

This service supplies the daily consumption for each operating room and recovery.

PROCESS OF REQUESTING CONSUMABLE MATERIAL RESOURCE

This process in the services is carried out once a week by the administrative staff of each area and a request.
general by the nursing management.

Stationery: There is a supply of essential forms for nursing records and quality indicators.

Fixed staffing: Establishment of fixed staffing for 30 days previously prepared by Head Nurse, deputy head.
and the floor manager in coordination with the accountant of the Unit.
Receiving and stocking method. The floor manager requests and stocks according to the established funds counting
existence and requesting missing items.
The nursing management provides the service according to daily needs, it will be the exclusive responsibility of
the person in charge of providing the necessary stationery for the proper functioning of the service, in case of
faltantes lo notificará por escrito al jefe inmediato dejando copias de tal notificación con el fin de evitar hasta donde
there may be deviations in attention for that reason.
The supply of white sheets is provided every week with 5000 sheets and the required formats are sent for printing.
to the warehouse according to the established stock of stationery.

Cleaning supplies: The input for hand washing, the supplied items are sufficient to cover all shifts of the day.
day shift work (during the day) and completely covered night shift supply of liquid soap, toilet paper in bathrooms,
Sanitas. Only those that are for Nursing use will be requested from the cleaning department.
patient care items such as: soap, cones, toilet paper, and paper towels.

Fixed staffing: It will be established in coordination with the Head Nurse, Deputy Head, Floor Manager, and Administrator.
according to the service needs for 48 and 72 hours.
Method of receiving and supplying to services: It will be supplied daily according to the needs of the area and
per shift.
The head nurse of the floor prepares daily and monthly reports on the supply level of materials for washing.
hands.
The update of fixed medication allocations is carried out at least once every 12 months and
with the participation of the multidisciplinary team
The requirements are made according to the institutional basic table of medications or healing material.
valid.
The theoretical provision derived from the analysis of morbidity, productivity, and clinical practice guidelines is carried out.
taking into account the 10 main causes of highest demand and priority; in coordination with the staff of
supply and pharmacy of the unit.
The head of medical services in General Surgery will be authorized to manage the individual prescription.
request for medications with substantive keys, keys 5000 and narcotic and psychotropic medications.
The request and supply of medications to services through the pharmacy is done in bulk, respecting
original packaging, every 24 hours, from Monday to Friday. Excluding Saturdays, Sundays or holidays. Requesting the
Friday to cover Saturday and Sunday, in case of a holiday, it is requested one day before it.
In the distribution center, they are concentrated in a piece of furniture that guarantees safety for the storage, handling, and
medication custody, in relation to the physical area, conservation, cleaning, doors, arrangement, control of
expiration and cold network.
The head nurse on the floor is responsible for the oversight, management, control, safekeeping, and custody of medications.
the services once they are delivered.
LinenControl

Service clothing calculation

INDICATOR CANT. CLOTHING TOTAL T. MAT 60% T. VESP 20% T. NOC. 20 %
1 x bed 5 games + 15 Fixed sheet 103 62 21 20
%
1 x bed 5 games + 15 Mobile blanket 103 62 21 20
%
1 x bed 5 games + 15 clinical blanket 103 62 21 20
%
1 x bed 5 games + 15 Clinical shelter 103 62 21 20
%
1 x bed 5 games + 15 Stubborn patient 103 62 21 20
%
3 x each 3 games for Limits for isolation 12 7 2 3
isolated x isolated (2) +
shift 15%
1 x bed 5 games + 15 Blankets 103 62 21 20
%
1 x bed 5 games + 15 Towels 103 62 21 20
%
1 x bed 5 games + 15 Patient pillow 103 62 21 20
%
1 x bed 5 games + 15 Pillowcase 103 62 21 20
%
In our institution, a general inventory of clothing is managed in the warehouse where it is concentrated, which is provided by a
external service to the company since there is no laundry service, from there it is distributed in a timely manner to the
hospital services, where stock is managed in each area for use with patients.

The replenishment is through the linen department, which keeps control of existing quantities and management.
with wear and tear, ensuring 100% fulfillment of the requested garments; in the different services
it has a relationship with the amount of garments that need to be kept at all times; a prior control is maintained to avoid the
impact on quality and patient safety indicators, preventing an increase in the risk of infections
nosocomial.

Fixed Allocation: To manage the replenishment of this item, a previously established fixed fund is set up.
the Head Nurse in coordination with the floor manager in coordination with the Head of the laundry or administrator based on
the service needs and installed capacity.

For the withdrawal of each department, there is a septic system that is monitored daily at the time it will be.
removal of the services counting item by item, which are separated and labeled to be sent to the service
of external laundry.

The person in charge of the process in the assigned service keeps a log of hospital clothing control (Receives inventory, counts,
Record entry time of laundry clothing; consumption and signature). Daily, a daily report of the level is recorded.
supply.

DIRTY CLOTHES

Dirty laundry is an important source of contamination within the hospital. For this reason, it is important to carry out its
collection, transport, treatment, and storage using appropriate methods, with a view to eliminating the possibility of
infection.
Being, as we have already said, a source of infection, we have to take a series of measures aimed at preventing it.
the possible causes of infections; for this we will have to consider several factors:

Manipulation.
Pickup.
Storage.
Transportation.
CONCLUSIONS

Supervision and control within the nursing department are very important activities in simple terms it is
Define: who, how, and when will apply the control strategies and evaluate the Critical Success Factors of the
organization, as well as who will take and execute the corrective decisions at the different levels of the entity.

Control is defined as the function that allows for the supervision and comparison of the results obtained against the results.
originally expected, ensuring that the directed action is also being carried out according to the plans of
the organization and within the limits of the structure of the company itself, with control being one of the steps most
important for a company to continue operating correctly and efficiently following the process
administrative.

From this, the great importance of control can be deduced, for it is only through this function that we will achieve
It is necessary to determine if what has been done conforms to what was planned and, in the case of deviations, identify those responsible and correct them.
These errors are an important step in any administrative process, as besides being responsible for accountability, we...
allows us to be aware of the mistakes that have been made in order to generate possible solutions or take precautions in
future projects.

In our workplace, various types of control are carried out in which supervision participates actively.
in addition to the various administrative functions that are carried out following the administrative process.
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