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regarding the use of all or any part of the documents, contact Greater Kailash Hospitals
Pvt. Ltd., Indore, India.

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01 Director
02 Nursing Superintendent
03 Manager Quality

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 Table of Contents

SL NO. CONTENTS PAGE NO.

1 INTRODUCTION 5-6
2 DEFINITION 6
3 PURPOSE 6
4 SCOPE 6
5 RESPONSIBILITIES 6
6 ASSESSMENT OF VULNERABLE PATIENT 7
7 POLICY FOR VULNERABLE PATIENT 8-9
8 LIST OF VULNERABLE PATIENTS 9-33
9 AVAILABLE SAFETY MEASURES 33

VULNERABLE PATIENTS

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I.INTRODUCTION:
Safeguarding is a crucial element of providing care for all patients. It is essential that all
staff understand their role and responsibility in the identification of a vulnerable patient
and how to respond and action in accordance with Trust Policies.
A vulnerable patient may be in need of community care services by reason of mental or
other disability, age, or illness and who is or may be unable to take care of him/herself and
protect him/herself against significant harm or exploitation and those who are ill or
dependent upon another for any of the aids to daily living.
We all have the right to live our lives free from abuse. It is recognised that certain groups
of people may be more likely to experience abuse.

How can you tell if a patient is being abused?

Physical abuse – including hitting, slapping, rough handling, pushing, kicking, misuse of
medication, restraint.
Sexual abuse – including rape and sexual assault.
Psychological abuse – including emotional abuse, threats of harm, intimidation,
harassment, verbal abuse and isolation.
Financial abuse – including theft, fraud, exploitation, pressure in connection with wills
property or inheritance or financial transactions and the misuse or misappropriation of
property, possessions or benefits.
Neglect – including ignoring medical or physical care needs, failure to provide access to
appropriate health and social care services and withholding medication, nutrition and
heating.
All staff must adhere to Trust Policies undertake appropriate training to enable abuse to be
recognized, report and take action to safeguard the individuals.

II. DEFINITION:

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A patient who is or may be for any reason unable to protect and take care of himself or
herself, against significant harm or exploitation.
Or
Those patients who are prone to injury and disease by virtue of their age, sex, physical,
mental and immunological status.

III. PURPOSE: To provide guideline instructions in order to ensure a safe environment

for vulnerable patients.

IV. SCOPE: Hospital wide.

V. RESPONSIBILITIES:
Doctors
Nurses
Physiotherapist
Dietician
Technicians
Housekeeping staffs

VI. ASSESSMENT OF VULNERABLE PATIENTS:

Assessment of vulnerable patients includes neurological status, psychological and mental

status, ability to meet activities of daily living general physical assessment, assessment for
suspected nutritional and functional risk of fall injury, general conditions, medical and
surgical conditions, assessment for a suspected abuse or maltreatment. Thorough
assessment of vulnerable patients and a range of measures to reduce risks to be
implemented in hospital.

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New “multifactorial assessments” covered patients’ mobility, cognitive impairment and
medication while basic safety steps included ensuring patients had safe foot wear and
access to mobility aids whenever they were needed.

The scheme saw the appointment of dedicated nurses, or Fall Safe leads, to raise
awareness and champion fall prevention in their wards. They worked with nursing
colleagues and others professionals including healthcare support workers, doctors,
technicians, physiotherapists, and housekeeping staffs.

VII. POLICY FOR VULNERABLE PATIENTS:

Within the hospital the all vulnerable patients will be given all-necessary care needed
with consideration. The identified vulnerable patients will be under close monitoring at
all times during their hospitalization to minimize risks of health care services. All
healthcare providers will maintain a safe environment, related but not limited to:
equipment, wheelchairs, bed rails, mobility needs, and fall precautions. Staff taking care
of high risk patients must have adequate training and skills.
All healthcare providers will encourage family involvement and support in care delivery,
education and decisions as appropriate. Special consent considerations will be taken
when needed for each individual case following the hospital approved consent policies
once the patient is stabilized with the disease process, they will be fit for the discharge.
The discharge patient will be discharged with follow-up advice.
All documentation required for the team to work and communicate effectively in the care
of high risk patients must be maintained as per hospital documentation policy.

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The Admitting Office and the Billing and Collection staff shall facilitate the admission
and discharge of the vulnerable patients by giving them priority and reduce their waiting
time. They shall facilitate their transport to their destination by arranging for wheelchair
or other appropriate transportation in coordination with the medical and nursing staff.
The medical and nursing staff shall encourage family members of vulnerable patients to
spend more time with them while in the hospital.
The medical and nursing staff shall educate family members of vulnerable patients on the
proper safety and security measures adopted by the hospital Special care shall be given to
elderly bed-ridden, diabetic patients to prevent pressure ulcer.
Vulnerable patients who are determined to be at complete bed rest for prolonged periods
of time shall receive proper pressure ulcer prevention and care. The “Braden Scale for
Predicting Pressure Ulcer Risk” tool shall be used for assessing patients on admission and
at regular intervals.
All patients shall be assessed for fall by the nursing staff using the Fall Risk Assessment
Tool.
If the patient’s condition demands further care which is not available in our hospital,
patient will be transferred to the other hospitals/facilities.
While transferring the patients a staff nurse will be accompany the patient along with the
caregiver.
If the patient’s condition is critical, will be escorted by a doctor and a nurse while
transferring them form hospital to hospital.

VIII. LIST OF VULNERABLE PATIENTS:

We all have the right to live our lives free from abuse. It is recognized that certain groups
of people may be more likely to experience abuse and may include the following:

1) Senior citizens (above 65 years old)

2) Babies and Children (under 12 yrs old)

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3) Mentally challenged patients.
4) Physically challenged patients.
5) Semiconscious/Unconscious patients.
6) Sedated patients.
7) All I.C.U, H.D.U & O.T recovery ward patients.
8) Patients in labour.
9) Amputated Patient.
10) MFS Score from 45 and Higher
11) Cardio Vascular Surgery and Neuro-Surgery patients.
12) Patient those on immuno suppressive and chemotherapeutic agents.
13) One eye/None eye

 Senior citizens (above 65 years old)

Vulnerable senior citizens are considered to be a person who is:

 An adult (aged 65 or over)
 And who is or may be unable to take care of him or herself or take steps to protect
him or herself from significant harm or exploitation.
We have a statutory obligation to uphold the rights of the vulnerable senior citizens to
protect from harm and exploitation. All patients using the services provided by the
Trust have a right to:
 Privacy
 Independence
 Safe and effective clinical care
 Protection and safety
To ensure the rights of vulnerable senior citizens to privacy and dignity, independence,
choice and fulfillment are respected, upheld and promoted by all staff, we take steps to:

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 Establish a mechanism for registering and monitoring vulnerable senior citizens
incidents within the hospital.
 Ensure adequate training and support is available to all staff, promoting awareness of
vulnerable senior citizens in all clinical areas.
 Recognize one’s own and others’ attitudes, values, and expectations about aging and
their impact on care of older adults and their families.
 Adopt the concept of individualized care as the standard of practice with older adults.
 Communicate effectively, respectfully, and compassionately with older adults and their
families.
 Recognize that sensation and perception in older adults are mediated by functional,
physical, cognitive, psychological, and social changes common in old age.
 Adapt technical skills to meet the functional, physical, cognitive, psychological, social,
and endurance capacities of older adults.
 Prevent or reduce common risk factors that contribute to functional decline, impaired
quality of life, and excess disability in older adults.
 Recognize and manage geriatric syndromes common to older adults.
 Appreciate the influence of attitudes, roles, language, culture, race, religion, gender, and
lifestyle on how families and assistive personnel provide long-term care to older adults.
 Promote the desirability of quality end-of-life care for older adults, including pain and
symptom management, as essential, desirable, and integral components of nursing
practice.

 Babies and Children (under 12 yrs old)

We are committed to the safeguarding and welfare of babies and children and have a
range of policies, procedures and training programmes designed to promote child welfare
and protect children.

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All staff are required to undertake basic safeguarding training, whether they work with
children or not. Staffs who care for children carry out further training. Trained nurses and
healthcare professionals shall provide care to neonates and children.
Wherever possible we aim to involve children and young people in planning services.
Staffs are given clear guidelines to follow if they have cause for concern over the welfare
of a child. Examples of causes for concern are:

  If a member of staff directly witnessing the abuse of a child

 If a member of staff receives information regarding the suspected abuse of a child
 If a member of staff identifies signs and symptoms suggestive of abuse
 If a member of staff may identifies injuries and indicators that do not match the history
given.
 A child may disclose information regarding themselves.

 Mentally challenged patients.

People with mentally challenged patients have reduced life expectancy and are more
likely to have poor physical health. Problems associated with mental illness include
serious conditions such as respiratory and cardiovascular diseases, diabetes, cancer and
epilepsy.

Mental health problems can range from self harm, anxiety, depression, confusion or
disturbed behaviour. Disturbed behaviour is defined as behaviour that interferes with a
person’s care or safety of others. There are occasions when such behaviour is due to a
variety of reasons such as physical illness or infection, side effects of medications or
medical interventions, confusion, cognitive impairment, distress, mental illness or

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intoxication. In these situations the Liaison Psychiatry Service can assist the staff to
develop a management plan to alleviate the patient’s stay in hospital.
A patient’s mental health is becoming increasingly important in our hospitals as the
number of patients suffering dementia and other mental health illnesses is increasing.
We have dedicated support at both our main hospitals for patients suffering from mental
health illnesses.
They provide a psychiatric liaison, and bring together practitioners from other mental
health specialties, including substance misuse and old age psychiatry in one team so that
all patients over the age of 16 can be assessed and treated or referred appropriately much
earlier.

 Physically challenged patients.

Handicap & Disability prevents subjects from being independent.

Physical, cognitive, mental, sensory, and emotional or combinations are noted.
Any restriction or lack of ability to perform an activity in the manner normal to an
individual.
Disadvantage for a given individual in his or her social context that limits or prevents the
fulfilment of a role that is normal to an individual.
Enhance and restore functional ability and quality of life to those with physical
impairments or disabilities.
1. Hearing
2. Locomotors handicap: paraplegias
3. Cardiopulmonary handicap: respiratory
4. Inability to speak & Emotionally disturbed
5. Mental handicap: Conditions like Down’s syndrome, dyslexia

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 6. Visual handicap: blindness
7. Primary disabilities are direct consequences of a disease.
E.g. - spinal cord injury, stroke.
Physical Activity/Exercise can improve disability and handicap.

 Semiconscious/Unconscious patients.

Care of semiconscious/unconscious patients (Bedridden, Critically ill, terminally ill)

• Person who has no control upon himself or his environment.
• Is fully dependent upon others for monitoring his/her vital functions.
 Doctors, Nurses, Physiotherapist, Technicians and Housekeeping staffs play an
important role in the care of unconscious (comatose) patient to prevent potential
complications respiratory eg: distress, pneumonia, aspiration, pressure ulcer.
This achieved by:
  1. Maintaining patent airway
Elevating the head end of the bed to degree prevents aspiration.
Positioning the patient in lateral or semi prone position.
Suctioning.
Chest physiotherapy.
Auscultate in every8 hours.
Endo tracheal tube or tracheostomy.
2. Protecting the client
Padded side rails
Restrains.

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 Take care to avoid any injury.
Talk with the client in-between the procedures.
Speak positively to enhance the self esteem and confidence of the patient. 
3. Maintaining fluid balance and managing nutritional needs
Assess the hydration status.
More amount of liquid.
Start IV line.
Liquid diet.
NG tube.
4. Maintaining skin integrity
Regular changing in position. 
Passive exercises. 
Back massage.
Use splints or foam boots to prevent foot drop. 
Special beds to prevent pressure on bony prominences.
5. Preventing urinary retention
Palpate for a full bladder. 
Insert an indwelling catheter.
Condom catheter for male and absorbent pads for females in case of incontinence. 
Inducing stimulation to urinate.
6. Providing sensory stimulation
Provided at proper time to avoid sensory deprivation.
Effort is made to maintain the sense of daily rhythm by keeping the usual day and
night patterns for activity and sleep.
Maintain the same schedule each day.
Orient the client to the day, date, and time accordingly.
Touch and talk.

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 Proper communication.
Always address the client by name, and explain the procedure each time.
7. Family needs
Family support.
Educate the needs of client.

 Sedated patients.

“Minimal sedation/analgesia is defined as a drug-induced state during which patients

respond normally to verbal commands. Although cognitive function and coordination
may be impaired, ventilation and cardiovascular functions are unaffected.”
“Moderate sedation/analgesia is defined as a drug-induced depression of consciousness
during which patients respond purposely to verbal commands, either alone or
accompanied by light tactile stimulations; patients do not require intervention to maintain
a patent airway, maintain adequate spontaneous ventilation, and usually do not require
intervention to maintain cardiovascular function.”
“Deep sedation/analgesia is defined as a drug-induced depression of consciousness
during which the patient cannot be easily aroused, but responds purposely following
repeated or painful stimulation. The ability to maintain independent ventilator function
may be impaired and may cause spontaneous ventilation to be inadequate. The patient
may require assistance in maintaining a patent airway. Spontaneous ventilation may be
inadequate. Cardiovascular function is usually maintained.”
As nurses, we must consider multiple factors in caring for patients who receive sedating
medications. It is not always possible to predict the potential for rapid or profound
changes in sedative or anesthetic depth during sedation.

 All I.C.U, H.D.U & O.T recovery ward patients.

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In the intensive care unit people are constantly looked after and monitored by a highly
specialized team, which includes consultants, physiotherapists, dieticians and nurses,
each of them with specialist knowledge and skills. Specially trained nurses provide
round-the-clock care and monitoring, and there is a high ratio of nurses to patients.

ICU, H.D.U & O.T recovery nurses play a vital role in the patient’s care, including the
following:
Assessing a patient’s condition and planning and implementing patient care plans
Treating wounds and providing advanced life support
Assisting physicians in performing procedures
Observing and recording patient vital signs
Ensuring that ventilators, monitors and other types of medical equipment function
properly
Administering intravenous fluids and medications
Ordering diagnostic tests
Collaborating with fellow members of the critical care team
Responding to life-saving situations, using nursing standards and protocols for treatment
Acting as patient advocate
Providing education and support to patient families
Critical care nurses may also care for pre- and post-operative patients. In addition, some
serve as case managers and policy makers, while others perform administrative duties.

 Patients in labour.

Pregnancy and birth are physiologic processes, unique for each woman, that usually
proceed normally. Most women have normal conception, fetal growth, labour, and birth
and require minimal to no intervention in the process. Women and their families hold

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different views about childbearing based on their knowledge, experiences, belief systems,
culture, and social and family backgrounds.
The clinician’s initial and documentation in labour and delivery shall include at a
minimum:
- reviewing and summarizing the antenatal course;
- Physical exam (including an estimated foetal weight);
- Evaluation of status of labour, including a description of uterine activity, cervical
dilation and effacement, and foetal station and presentation, unless vaginal exam
deferred;
- Evaluation of foetal status, including interpretation of auscultation or electronic foetal
monitoring strips, if generated; and
- The plan for delivery.
If a patient is moved to another room for delivery, foetal monitoring should be
established in that room unless delivery is reasonably expected to occur imminently. For
patients about to undergo caesarean delivery, monitoring should continue as is feasible
until abdominal preparation for surgery is begun.
When the clinician is concerned about the foetal status at delivery, a double-clamped
segment of the umbilical cord should be set aside for possible arterial blood gas
assessment. If the neonatal 5-minute Apgar score is 4 or less, umbilical artery blood
should be sent for analysis whenever possible. Blood can be drawn from the clamped
segment of cord at any time within an hour of delivery.
The clinician must record all the events in the medical record, using forms, notation,
and/or dictation as appropriate to the case. The clinician should be readily available to
return to the unit until the immediate (30 minute) postpartum period is complete and the
patient is stable.

 Amputated Patients. 

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Preoperative care and patient education can be done in cases of elective amputation.
There is time to prepare the patient for what lies ahead. In the case of a traumatic
amputation, this may not be possible.
Preoperative nursing care and patient education for the patient about to undergo
amputation of all or part of a limb includes the following.

(1) Build the patient's strength by implementing muscular exercises for the unaffected
limbs.
(2) Improve the patient's nutritional status by encouraging a balanced diet high in
vitamins and minerals and with adequate protein to enhance wound healing. Maintain
adequate hydration.
(3) Follow the physician's orders for therapeutic measures used to stabilize any chronic
medical conditions such as diabetes, hypertension, or any other condition that may
interfere with surgery or rehabilitation.
(4) If ordered, arrange preoperative counseling with the physical therapist. If a
mobilization aid such as a walker or crutches is to be used postoperatively, it is easier to
provide instruction in the preoperative period. The physical therapist will also inform the
patient about his postoperative rehabilitation program.
(5) If authorized by the physician, schedule a visit from the prosthetic specialist. This
may help to alleviate some of the patient's anxieties about the fitting and wear of
prosthetic devices.
Postoperative nursing care involves routine nursing observation, pain control, positioning
and exercise, stump conditioning, and patient education. Patient education should be done
in conjunction with all nursing interventions.

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(1) Monitor the patient's vital signs closely for changes in pulse or blood pressure that
may indicate hemorrhage under the bulky dressing. A temperature elevation may indicate
the presence of infection.
(2) Check the stump dressing regularly. Evidence of bloody drainage should be marked
with date and time, and excessive bleeding reported to the physician. Check the proximal
end of the stump dressing for swelling. The dressings are applied to provide some
compression of the stump, but a dressing that is too tight may cause ischemia at the
stump end.
(3) Observe the patient for pain. Pain medication may be required for several days post-
operatively. Some patients experience a phenomenon known as "phantom pain" or
"phantom sensation" in which they "feel" the lost limb.
(4) Maintain the prescribed position of the stump. Depending upon the type of procedure
used, the extremity may be in a splint, in traction, or elevated on pillows. Proper
positioning will prevent contracture of the involved muscles.
(5) Encourage prescribed exercises to preserve the range of motion in the affected limb
and to strengthen the remaining limbs.
(6) Remove and reapply the bandage. When the wound is healed, the stump must be
conditioned and shaped for the proper fitting of a prosthesis.
A special bandaging technique is used to shrink and mold the stump to a smooth, conical
shape. During the shaping process, the bandage is worn day and night.
A criss-cross or spiral pattern is used to avoid constricting the stump and interfering with
circulation. One technique for wrapping a stump is illustrated in figure.

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Patient education and quality nursing care are important, but the nursing staff must be
aware of how the patient feels about the amputation. Trying to compensate for a lost limb
is a difficult adjustment for anyone to make. It can easily produce feelings of uselessness
or inadequacy in the patient.

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It is important for the nursing personnel to remember that any amputation results in a
permanent loss that may interfere with the psychological, physical, or social needs of the
individual.

 MFS Score from 45 and Higher

All patients have a falls risk assessment completed using the MFS falls risk Assessment
Tool completed at the following stages:
 On admission or as soon as practical after the admission
 Daily or when a patient's condition changes
 When the patient is transferred from one ward/department to another
 Following a fall incident
The falls risk assessment score is documented in the Care Plan Activity in most of the
inpatient areas and in the patient notes, where the care plan activity is not utilised.
In Medical Short Stay falls risk assessment scores are captured on the Short Stay Clinical
Path or in the patient notes when patients are using alternative clinical paths.
The falls risk assessment tool does not replace clinical judgment, if a patient does not
present with a high risk score but is thought to be high risk by medical or nursing staff,
allied health, parents or carers extra precautions to protect such patients should be
documented and auctioned. 
All falls, including near misses should be reported. The information from reported falls is
used to gain insight of the causes of falls for patients.
Falls are the most common cause of paediatric injury leading to emergency department
visits. It is widely acknowledged that children are at risk of falls in the community, with
many education programs supporting prevention, it is important that this education is
reflected in the hospital environment. Children fall as they grow, develop coordination

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and new skills; often unaware of their limitations, therefore one could conclude that all
children are at some risk of falling.

 Cardio Vascular Surgery and Neuro-Surgery patients.

The most common surgical procedure encountered is the Aorto-Coronary Bypass Graft
(ACBG) for various indications such as left main coronary artery stenosis, severe triple-
vessel disease, angina refractory to medical therapy, or recurrent CHF due to ischemia.

Other surgical procedures, concomitantly with ACBG or alone, include valve repair or
replacements, repair of congenital or acquired defects (ASD, VSD, etc.), and repair or
replacement of the aortic root. Less common are removal of intracardiac tumors and
LV aneurysmectomy.
In some operations involving the aortic root, cross-clamping and cannulation of the
aorta are not feasible.

Care and management of neurosurgical patients

The goal of post-operative neurosurgical care is to prevent or minimize complications

related to anesthesia and the surgical procedure. Careful, frequent neurological
assessments by neurology-trained staff are the cornerstone of post-operative
neurosurgical care. However, management of systemic complications is an essential task
that can help minimize serious neurological consequences.

In most cases, post-operative extubation and subsequent examination can take place soon
after surgery. Periodically, peri-operative circumstances prevent immediate extubation
and an assessment can be obtained only from a temporary sedation "holiday." Patients
who are expected to require post-operative neurological intensive care after elective or
emergent surgery include:

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- Supra- and infratentorial craniotomy for tumor or aneurysm

- Craniofacial and transsphenoidal surgery

- Major spine surgery

- Carotid artery surgery

- Endovascular procedures including embolization of arteriovenous malformations

(AVM) and aneurysms

- Patients with significant medical comorbidities, elderly, or with difficult intra-operative

course

For the patient undergoing a craniotomy for tumor or aneurysm repair, post-operative
care should focus on smooth and timely emergence from anesthesia while optimizing
hemodynamic, respiratory and electrolyte parameters. The postoperative patient is under
a significant amount of physiologic stress that is manifest with fluctuations in blood
pressure, blood glucose, heart rate and variations in systemic oxygen consumption . This
stressful state is modulated by changes in sympathetic tone that control body temperature
and vascular tone, and are responsive to pain and nausea with or without vomiting.

 Patient those on immuno suppressive and chemotherapeutic agents.

Immunosuppressant drugs, which are also called anti-rejection drugs, are used to prevent
the body from rejecting a transplanted organ.

Purpose

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When an organ, such as a liver, heart or kidney, is transplanted from one person (the
donor) into another (the recipient), the immune system of the recipient triggers the same
response against the new organ that it would have against any foreign material, setting off
a chain of events that can damage the transplanted organ. This process is called rejection.
It can occur rapidly (acute rejection), or over a long period of time (chronic rejection).
Rejection can occur despite close matching of the donated organ and the transplant
patient. Immunosuppressant drugs greatly decrease the risks of rejection, protecting the
new organ and preserving its function. These drugs act by blocking the recipient's
immune system so that it is less likely to react against the transplanted organ. A wide
variety of drugs are available to achieve this aim but work in different ways to reduce the
risk of rejection.

In addition to being used to prevent organ rejection, immunosuppressant drugs are also
used to treat such severe skin disorders as psoriasis and such other diseases as rheumatoid
arthritis, Crohn's disease (chronic inflammation of the digestive tract), and patchy hair
loss (alopecia areata). Some of these conditions are termed "autoimmune" diseases,
indicating that the immune system is reacting against the body itself.

The number of patients taking immunosuppressive drugs for the management of

autoimmune inflammatory conditions is increasing. The general practitioner needs to be
active in preventing, monitoring and managing the adverse effects of these drugs even
long after the treatment has ceased. Monitoring is required because immunosuppressive
drugs increase the risks of infection, malignancy, cardiovascular disease and bone
marrow suppression. Some drugs have additional risks which require specific monitoring.
Vigilance is needed as adverse effects may have atypical clinical presentations.

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General risks of immunosuppressive drugs
Drugs which suppress the immune system are inevitably associated with increased risk of
infection and malignancy. Many of these drugs also impact adversely on patients'
cardiovascular risk.

Chemotherapy
Chemotherapy may be used conventionally to:
• Cure patients
• Prolong survival
• Palliative care symptom control
• Chemotherapy administration is among the more hazardous and challenging activities in
all of medicine – Chemotherapy can have toxic adverse effects – Oncology teams often
work in different areas, hand off patients, and follow complex treatment regimens Steps
to Ensure Safety Steps to Ensure Safety
• Protocols are kept: – Out-patient clinic – Inpatient unit – Pharmacy Steps to Ensure
Safety.
• ADMINISTRATION and MONITORING
– utilizing the orders, corresponding to the drug they are administering
– verify information on bag/bottle label to written order
• Spelling patient’s name
• Medical record number
• Drug name, amount, and rate of infusion Steps to Ensure Safety
• Rate of infusion
• Pump settings • Chemotherapy drugs are high cost, high risk
• Systems for safe and high quality medications need organisational support and
executive and clinical leadership to be successful

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• The medication history is used as the basis for therapeutic decision making, for ensuring
continuity of regular medicines while a patient is in hospital and to identify adverse
medicines events.

 One eye/none eye

People who are blind or have low visions have special needs for interpreting their
environment. By following simple guidelines you can help make their hospital stay as
easy and as comfortable as possible.
A good start
Introduce yourself and address the patient by name, so they know you are talking to them
and not to another patient in the next bed.
Introduce the patient to any roommates.
Ask the patient what they are able to see. Few patients are totally blind.
Ask the patient what assistance they need instead of assuming what they need.
Ensure that the patient is included in discussions about procedures and medical plans.
Being blind or vision impaired does not mean they cannot hear or understand what is
being said.
Say goodbye when you finish a conversation and indicate when you are leaving the room.
Patients in bed
Put a 'Patient Identifier sign' above the patient's bed and/or door stations.
Consider extra adjustable lighting for the patient with useful residual vision.
The patient may prefer a corner bed to help make location easier, to avoid confusion with
another patient's equipment and to help them arrange their belongings more easily.
Don't unnecessarily move the patient's belongings. If items are moved, let them know
their new location.

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Always inform the patient before undertaking any procedure; it can be very unnerving for
the patient to be touched without warning.
If bandaging their eyes, make sure the patient's ears and other sensory organs are not
obscured.
Knowing the time can help provide structure to their daily routine. Ensure the patient has
access to a radio, talking clock, talking watch, Braille watch or clock with large numbers.
Mobile patients
Orient the patient to their room by starting from a central point, such as their bed.
When orienting the patient to a new area, walk with them rather than giving only verbal
directions. This helps them learn distances and pick up sensory cues, so next time they
can make the trip independently.
Keep pathways and corridors clear of obstacles where possible and inform the patient of
any changes to their environment.
Ask the patient if they would like to take your arm for guiding purposes. If so, let them
hold your arm above the elbow with their thumb to the front.
Children
Medical staff should talk to parents to discuss any special needs the child may have,
before they are admitted. If this is not possible, initially one parent should stay with the
child or make a lengthy visit while the environment is still unfamiliar.
Babies
Leaving a baby who is blind, lying on their back for long periods, even though they seem
content, puts them at risk of sensory deprivation. Their lack of responsiveness must not
be mistaken for deafness or intellectual handicap. Appropriate, consistent stimulation,
such as soft talking and gentle touching, is imperative.
A baby who is blind learns about their surroundings through mouthing, and later through
tactile exploration. Ensure the baby has familiar and enjoyable toys within easy reach.

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Toys should have varied textures, make interesting noises, and be safe and pleasant for
the mouth.
Toddlers and preschoolers
A toddler should be able to explore their environment freely and as independently as
possible.
Always explain what you are doing and describe new surroundings and situations.
Use a hands-on approach to introduce new objects. Show them where their food or drink
is on the tray and how to open containers.
Avoid talking about their condition in their presence.
Avoid unnecessarily moving furniture and be aware of any possible obstacles or hazards
such as sharp corners and extension cords.
Encourage them to practice their abilities, such as feeding.
Engage in age-appropriate play and group playing.
Mealtimes
Read aloud menu items and let the patient choose their meal.
Tell the patient when their meal has arrived and where their tray is placed.
Colour contrast can be important for people who are vision impaired. Placing a dark tray
or cloth under a light plate can define the plate edges making it easier for them to locate
the food.
Describe the contents of the tray. You can either use the clock-face method, e.g. the meat
is at 6 o'clock, or by saying items are at the top, bottom, right or left side of the plate.
Meat should be placed at 6 o'clock, as this is easiest for cutting.
Ask the patient if they would like assistance with removing packaging from items.
Ask the patient if they need assistance with their meal, rather than offering to cut their
food.
IX. AVAILABLE SAFETY MEASURES FOR VULNERABLE PATIENTS IN
GREATER KAILASH HOSPITAL

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1. Wheelchair accessibility is possible within the hospital.
2. Handrails are provided for the senior citizens to move around the hospital.
3. For children, disabled and elderly patients where ever possible arrangement is made for
bed side accommodation of bystanders.
4. Signage boards with contrasting colors; large fonts in English as well as the regional
language are placed to help senior citizens and disabled people.
5. Parking spaces are reserved for the disabled near to the entrance of the hospital.
6. Clear pathways are provided for the disabled and senior citizens to move around at their
own pace.
7. Washrooms with grab bars are designed mainly for the disabled and aged people.
8. In registration counters senior citizens, physically handicapped are given priority.

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