Circular No. 07/2011/TT-BYT guiding the nursing work on patient care in hospitals

CIRCULAR

Guidelines for Nursing Care of Patients in Hospitals

_____________________________

Pursuant to Decree No. 188/2007/NĐ-CP dated December 27, 2007 of the Government on the functions, tasks, powers, and organizational structure of the Ministry of Health,

The Ministry of Health issues guidelines for nursing care of patients in hospitals as follows:

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation

These guidelines cover nursing care of patients in hospitals including health centers and research institutes with hospital beds.

Article 2. Interpretation of Terms

In this Circular, the following terms are understood as follows:

1. Patient care in hospitals includes supporting and meeting the basic needs of each patient to maintain respiration, circulation, body temperature, eating, excretion, posture, movement, personal hygiene, sleep, rest; psychological care; treatment support; and preventing risks from the hospital environment for patients.

2. Nursing process is a scientific method applied in the field of nursing to systematically implement patient care continuously, safely, and effectively, including assessment, nursing diagnosis, planning, implementation, and evaluation of nursing care outcomes.

3. Care record is a form recording the patient's disease progression and nursing interventions performed by nurses and midwives.

4. Patients requiring Level I care are critically ill patients, those in critical condition, comatose, experiencing respiratory failure, circulatory failure, immobile, and requiring comprehensive and continuous care from nurses and midwives.

5. Patients requiring Level II care are those with difficulties and limitations in performing daily activities and need monitoring and support from nurses and midwives.

6. Patients requiring Level III care are those capable of performing daily activities independently but require guidance in self-care from nurses and midwives.

Article 3. Principles of Patient Care in Hospitals

1. Patients are at the center of care and must be provided with comprehensive, continuous care ensuring satisfaction, quality, and safety.

2. Monitoring and caring for patients is the responsibility of the hospital, with nursing care activities and monitoring carried out and overseen by nurses and midwives.

3. Nursing interventions must be based on professional requirements and the assessment of each patient's needs to provide appropriate care.

Chapter II

DUTIES OF PATIENT CARE

Article 4. Counseling and Health Education Guidance

1. The hospital shall establish and organize appropriate forms of counseling and health education guidance.

2. Hospitalized patients shall receive health education counseling, self-care guidance, and disease prevention monitoring during their stay and post-discharge from nurses and midwives.

Article 5. Spiritual Care

1. Patients shall be cared for and communicated with by nurses, midwives, and other medical practitioners with kindness and empathy.

2. Patients and their families shall be encouraged to feel secure about treatment and cooperate with medical practitioners throughout the treatment and care process.

3. Patients and their families shall have their concerns and questions promptly addressed during treatment and care.

4. Ensure security, safety, and quietness to avoid affecting the mental state and spirit of patients.

Article 6. Personal hygiene care

1. Daily personal hygiene care for patients includes oral hygiene, body cleaning, assistance with bowel movements, urination, and changing clothing.

2. Responsibilities for personal hygiene care:

a) Patients requiring Level I care shall be provided by nursing aides, midwives, and nurses.

b) Patients requiring Level II and Level III care shall perform their own personal hygiene under the guidance of nursing aides, midwives, and shall receive support when necessary.

Article 7. Nutritional Care

1. Nursing aides and midwives shall cooperate with treating physicians to assess the nutritional status and dietary needs of patients.

2. Each day, patients shall be prescribed a diet regimen suitable for their condition by the treating physician.

3. Patients on special diets shall be provided with appropriate meals at the treatment department and their adherence to the diet shall be recorded on the Care Record Form.

4. Patients shall be assisted with eating when necessary. For those who require feeding through a tube, this must be performed directly by nursing aides or midwives.

Article 8. Functional Recovery Care

1. Patients shall be guided and supported by nursing aides and midwives to engage in early rehabilitation exercises to prevent complications and restore bodily functions.

2. Collaboration between clinical departments and physical therapy/rehabilitation departments shall be conducted to evaluate, advise, guide, and implement rehabilitation exercises for patients.

Article 9. Care for Patients Scheduled for Surgery or Procedures

1. Patients shall be instructed and assisted by nursing aides and midwives to prepare for surgery or procedures according to the requirements of the specialty and the treating physician.

2. Prior to transporting patients for surgery or procedures, nursing aides and midwives must:

a) Complete administrative procedures;

b) Recheck the preparation work done on the patient according to the requirements of the surgery or procedure;

c) Assess vital signs and the patient's condition, and report any unusual changes to the treating physician.

3. A nursing aide, midwife, or nurse shall transport the patient to the surgery or procedure location and hand over the patient and medical records to the designated person responsible for receiving the patient at the surgery or procedure unit.

Article 10. Medication Administration and Monitoring for Patients

When administering medication to patients, nursing aides and midwives must:

1. Administer medication strictly according to the treating physician's prescription.

2. Prepare sufficient and appropriate equipment for patients to take medication; when administering medication via injection, they must have the emergency drug box and shock protocol ready, and prepare the solvent correctly and sufficiently as per the manufacturer's instructions.

3. Check the medication (name, concentration/dose, single dose, number of doses within 24 hours, interval between doses, time and route of administration compared to the prescription). Check the expiration date and quality of the medication visually: color, smell, integrity of tablets, vials, or bottles.

4. Guide and explain to patients to ensure compliance with the treatment regimen.

5. Ensure the five rights in medication administration: right patient, right drug, right dose, right route, right time.

6. Ensure that patients take their medication immediately at their bedside under the observation of nursing aides or midwives.

7. Monitor and detect any adverse reactions or post-medication complications and promptly report them to the treating physician.

8. Record or mark medications administered to patients and implement appropriate public disclosure methods as stipulated by the hospital.

9. Coordinate among physicians, pharmacists, nursing aides, and midwives in medication administration to enhance therapeutic effectiveness and minimize errors in medication prescription and usage for patients.

Article 11. Care for patients in terminal stage and deceased patients

1. Patients in the terminal stage shall be allocated appropriate hospital rooms conducive to care and treatment without affecting other patients.

2. Inform and explain to the family members about the patient's condition and facilitate their presence beside the patient.

3. Encourage and comfort both the patient and their family members.

4. When a patient dies, nursing assistants or midwives shall cooperate with nurses to perform post-mortem hygiene and carry out necessary procedures such as managing the deceased's personal belongings and transferring the body to mortuary staff.

Article 12. Implementation of Nursing Techniques

1. Hospitals shall establish and update nursing technique regulations and procedures based on the guidelines issued by the Ministry of Health.

2. Nurses and midwives must adhere to professional technical procedures and sterile techniques.

3. Nurses and midwives shall implement preventive measures, monitor, detect, and promptly report any complications to the treating physician for timely intervention.

4. Medical equipment used in invasive techniques and procedures must be sterilized and processed according to Articles 2 and 3 of Circular No. 18/2009/TT-BYT dated October 14, 2009, issued by the Ministry of Health on Guidelines for Implementing Infection Control Activities in Healthcare Facilities and other regulations on infection control.

Article 13. Monitoring and Evaluating Patients

1. Patients visiting for consultation shall be initially assessed by nurses and midwives from the Outpatient Department to prioritize and sequence consultations.

2. Nurses and midwives shall collaborate with the treating physician to evaluate, classify care levels, and provide appropriate monitoring and care for each patient.

3. Patients requiring Level I care shall have their care needs assessed by the treating physician, nurses, and midwives to implement suitable care interventions.

4. The hospital shall establish specific regulations regarding monitoring and recording vital signs and appropriate nursing interventions consistent with the specialty and requirements of each department.

5. Patients shall be evaluated and monitored for disease progression; if abnormal signs are detected, nurses, midwives, and technicians must immediately take appropriate actions within their scope of practice and report to the treating physician for prompt intervention.

Article 14. Ensuring Safety and Preventing Professional Technical Errors in Patient Care

1. Hospitals shall develop and implement specific safety regulations for patients tailored to the disease model of each specialty.

2. Nurses and midwives shall implement measures to prevent hospital-acquired infections, ensure safety, and avoid medication, surgery, and procedure errors for patients.

3. The hospital shall establish a system for collecting and reporting incidents, mistakes, and professional technical errors in departments and throughout the hospital. Regularly analyze, report incidents and professional technical errors in care, and implement effective preventive measures.

Article 15. Recording medical records

1. The care materials for patients in medical records include: life function monitoring forms, nursing care forms, and other forms according to Decision No. 4069/QD-BYT dated September 28, 2001 on the issuance of medical record models by the Ministry of Health, and according to the specialty as specified by the hospital.

2. Care materials for patients in medical records must meet the following requirements:

a) Record accurate and objective information about the patient.

b) Unify information regarding the care work of nurses, midwives, and treating doctors. Differences in assessments, observations, and evaluations of the patient's condition must be promptly discussed and agreed upon among those directly caring for and treating the patient.

c) Fully and timely record the progression of the disease and nursing interventions.

3. Medical records must be stored in accordance with the provisions of Clause 3, Article 59 of the Law on Medical Examination and Treatment.

Chapter III

CONDITIONS TO ENSURE PATIENT CARE WORK IN HOSPITALS

Article 16. Nursing Care Organization System

1. Hospital-level nursing management organization

a) Public hospitals from Class III and above establish a Nursing Council and a Nursing Department.

b) Other hospitals establish a Nursing Council, a Nursing Department, or a Nursing Team depending on each hospital's conditions.

c) The organization, tasks, and activities of the Nursing Council are stipulated in Appendix I attached to this Circular.

d) The Nursing Department has a Head, Deputy Heads responsible for different sections. The organization and tasks of the Nursing Department are stipulated in Appendix II attached to this Circular.

e) The duties and powers of the Head of the Nursing Department are stipulated in Appendix III attached to this Circular.

2. Ward-level nursing management organization

a) Each ward has a Chief Nurse, Chief Midwife, or Chief Technical Officer. The Chief Nurse, Chief Midwife, and Chief Technical Officer are appointed by the Hospital Director.

b) The duties and powers of the Chief Nurse and Chief Midwife are stipulated in Appendix IV attached to this Circular.

c) The duties and powers of the Chief Technical Officer are stipulated in Appendix V attached to this Circular.

d) The scope of practice of nurses is based on the Vocational Standards for Health Workers in the Nursing Cadre at Decision No. 41/2005/QD-BNV dated April 22, 2005 of the Minister of Home Affairs and related regulations of the Minister of Health.

Article 17. Human Resources for Patient Care

1. Hospitals must ensure sufficient nursing and midwifery staff according to Circular Joint No. 08/2007/TTLT-BYT-BNV dated June 5, 2007 of the Ministers of Health and Home Affairs on Guidelines for Staffing Levels in State Healthcare Facilities to ensure continuous patient care.

2. Hospitals should build a structure of qualifications for nurses and midwives suitable to the nature of their specialties and hospital classification. Ensure that the ratio of nurses and midwives with college and university degrees meets the requirements of the Agreement on Recognition of Healthcare Services signed by the Government with ASEAN countries on December 8, 2006.

3. Hospitals should reasonably allocate nursing and midwifery staff daily across wards and within each shift.

4. The Nursing Department collaborates with the Personnel Department to propose to the Hospital Director to promptly mobilize and supplement nurses, midwives, technical officers, attendants, and health workers when required to ensure the quality of patient care and service.

Article 18. Work Organization

1. The hospital applies one of the following care models based on the specialty characteristics of each department:

a) Primary nursing care model: One nurse or midwife is primarily responsible for assessing, planning, organizing, and implementing care with the assistance of other nurses or midwives, and monitoring and evaluating care for a number of patients during their hospital stay.

b) Group care model: A group consisting of 2-3 nurses or midwives is responsible for caring for a number of patients in a unit or several wards.

c) Team care model: A team including doctors, nurses, midwives, and other healthcare practitioners is responsible for treating and caring for a number of patients in a unit or several wards.

d) Task-oriented care model: This model is applied in emergency disaster situations or in specialized departments requiring specialized nurses to perform special care techniques on patients.

2. The hospital organizes shifts for nurses and midwives in departments, particularly in the Emergency Department, Intensive Care Unit, Surgery Department, Obstetrics Department, and Neonatal Department. Each shift applies a care assignment model suitable for the specialty characteristics of each department.

Article 19. Equipment for Patient Care

The hospital equips sufficient devices and means below to ensure patient care requirements:

1. Specialized equipment, tools, medical consumables, and protective gear serving the professional work of nurses and midwives.

2. Means serving the daily life of patients.

3. Each clinical department has at least one procedure room, one isolation room, and one instrument processing room designed according to standards and equipped adequately to meet infection control requirements as stipulated in the Law on Prevention and Control of Infectious Diseases and Circular No. 18/2009/TT-BYT dated October 14, 2009 of the Ministry of Health on guiding the implementation of infection control activities in healthcare facilities.

4. Staff rooms, duty rooms, restrooms, and other working conditions and services for nurses and midwives.

Article 20. Financial Resources for Care Activities

Annually, the hospital allocates regular funds for the following activities:

1. Purchasing equipment and tools for patient care and service.

2. Implementing, maintaining, and improving patient care quality.

3. Continuous training to enhance practical skills for nurses, midwives, and technicians.

4. Rewarding units and individuals who perform well in patient care activities.

Article 21. Continuous Medical Knowledge Training

1. The hospital develops and implements orientation training programs for newly recruited nurses and midwives.

2. Nurses and midwives are continuously trained to update their professional knowledge and skills, ensuring a minimum study time of 24 hours as prescribed in Circular No. 07/2008/TT-BYT dated May 28, 2008 of the Minister of Health on Guidelines for Continuous Training for Healthcare Personnel.

3. The hospital organizes training and guides practical exercises and confirms the practice process for nurses, midwives, and technicians who have practiced at their own facilities as stipulated in Article 24 of the Law on Diagnosis and Treatment.

4. The hospital organizes for nurses, midwives, and technicians to participate in scientific research and apply research results and technical improvement initiatives in care.

5. The hospital conducts knowledge and skill assessments of nurses and midwives at least once every two years.

Article 22. Auxiliary Nursing Care Work

1. Based on actual conditions, the hospital shall arrange auxiliary nursing care personnel to provide routine care for patients.

2. Auxiliary nursing care personnel must:

a) Hold a certificate from a training program for auxiliary nursing care issued by the Minister of Health;

b) Absolutely not perform specialized procedures that should be carried out by nurses or midwives.

Chapter IV

IMPLEMENTATION RESPONSIBILITIES

Article 23. Responsibilities of the Hospital Director

1. Organize the implementation of this Circular: disseminate the Circular, issue specific regulations, and fully implement all provisions of this Circular.

2. Ensure funding, material resources, human resources, equipment, and supplies for patient care.

3. Direct the organization of training, research, inspection, and supervision of patient care activities.

4. Promote competitive movements and implement rewards and disciplinary actions related to patient care work.

Article 24. Responsibilities of Heads of Functional Departments

1. The Head of the Human Resources Department shall cooperate with the Nursing Department in planning recruitment, assignment, transfer, evaluation of nurses, midwives, and technicians.

2. The Head of the Planning and General Affairs Department and other relevant functional departments shall cooperate with the Nursing Department to develop continuous training plans for nurses, midwives, and technicians. They shall also cooperate in inspecting and supervising the quality of patient care and service.

3. The Head of the Medical Equipment and Administrative Management Department shall ensure timely provision and repair of equipment and facilities serving patient care.

Article 25. Responsibilities of Department Heads

1. Be responsible to the Hospital Director for organizing the full implementation of patient care tasks as stipulated in this Circular.

2. Cooperate with the Nursing Department and the Human Resources Department in arranging human resources, organizing appropriate care models, and regularly inspecting and evaluating the quality of patient care.

3. The Pharmacy Department and Infection Control Department shall ensure the supply of medicines, delivery and receipt of medical consumables, and textiles for patients in treatment areas.

Article 26. Responsibilities of Treating Physicians

1. Closely cooperate with nursing staff, midwives, and technicians in the department to assess and classify patient care needs and coordinate in implementing care plans for each patient.

2. Collaborate with nursing staff, midwives, and technicians in performing surgeries, procedures, and health education for patients.

3. Inspect the implementation of treatment orders, monitoring, and patient care by nursing staff, midwives, and technicians.

Article 27. Responsibilities of Nurses and Midwives

1. Strictly fulfill patient care duties as specified in this Circular.

2. Closely cooperate with treating physicians, nursing staff, midwives, and technicians in patient care activities.

3. Adhere to nursing technical procedures and regulations of the Ministry of Health and the hospital.

4. Implement conduct rules and communication practices with colleagues, patients, and patient family members.

Article 28. Responsibilities of teachers, students, and interns

1. Strictly perform the patient care tasks as prescribed in this Circular and the internal regulations and rules of the hospital and the department where they are assigned for internship.

2. Nursing and midwifery students may only carry out nursing procedures and techniques on patients with permission and under the supervision of teachers or nursing/midwifery instructors responsible for them.

Article 29. Responsibilities of Patients and Their Accompanying Family Members

1. Fulfill the obligations of patients as stipulated in the Law on Medical Examination and Treatment.

2. Strictly adhere to the internal regulations and rules of the hospital and the treatment department, and follow the guidance of healthcare staff.

Chapter V

IMPLEMENTING PROVISIONS

Article 30. Effective Date

1. This Circular takes effect from March 1, 2011.

2. Abolish the following regulations: Comprehensive Patient Care; Position, Functions, Duties, and Organization of the Nursing Department (Nursing); Duties, Authorities, and Responsibilities of the Head of the Nursing Department (Nursing); Duties, Authorities, and Responsibilities of the Chief Nurse (Nursing) and Chief Midwife of the Department; Duties, Authorities, and Responsibilities of the Chief Technical Officer of the Department; Duties, Authorities, and Responsibilities of the Ward Nursing (Nursing) Care Officer as set forth in the Hospital Regulations issued together with Decision No. 1895/1997/QĐ-BYT dated September 19, 1997 of the Minister of Health.

Article 31. Reference Provisions

In cases where referenced documents in this Circular are replaced or amended, the replacement or amended documents shall apply.

Article 32. Implementation Organization

The Director of the Department of Medical Examination and Treatment, the Directors of hospitals and institutes under the Ministry of Health with beds, the Directors of Health Services of provinces and centrally-administered cities, and the Heads of health services of various sectors are responsible for organizing the implementation and monitoring the enforcement of this Circular./.