The nurse

All manuals

For KlinikFlow 3.0.0. Each manual is checked against the app itself.

Who this is for

This manual is for OPD nurses and ward nurses in clinics and nursing homes that use KlinikFlow and who sign in with the ready-made Nurse role. It covers the outpatient work — vitals before the doctor, the procedure queue, casualty — and, where the clinic has wards, the ward:

• the ward map and the beds;
• how patients arrive;
• the patient's chart, with the early-warning score;
• intake and output, and nursing notes;
• the medicine chart;
• consents;
• getting a patient ready to go home;
• handing over to the next shift.

Each section says which screen to open and which button to press, using the words on the screen. Where something is the doctor's or the desk's job, the manual says so. If your clinic has given you a role of its own, you may see more or less than is described here.

Contents

1. What the Nurse role can reach
2. Vitals at the OPD
3. The procedure queue
4. Casualty
5. The ward map
6. How a patient arrives on the ward
7. The stay page
8. The patient's chart — taking vitals
9. The early-warning score (NEWS2) and when to call the doctor
10. When the next vitals are due
11. Intake and output
12. Nursing notes
13. The medicine chart — giving doses
14. Consents
15. Ward charges and doctor's visits
16. Preparing for discharge
17. Handing over between shifts
18. Narcotics
19. The theatre
20. The labour room
21. Daily checks and incidents
22. Who does what — nurse, doctor, desk

1. What the Nurse role can reach

Your sidebar shows:

• Ward — first, and where you open. It appears only if the clinic has at least one ward set up.
• Procedures — the procedure queue.
• Casualty
• Vitals — patients waiting for vitals.
• Completed — procedures finished today.

To open a patient's record, use the search box at the top of every screen. It takes a name, phone, patient number or today's token; press / to jump to it.

The ready-made Nurse role can:

• read patient records;
• record vitals;
• do nurse procedures;
• work in casualty;
• work on the ward: admit, move bed, change doctor, discharge, the chart, giving doses, consents and adding charges to a stay.

It cannot:

• consult, prescribe or order tests;
• issue certificates;
• say a patient is fit to go home;
• order, change or stop a stay's medicines;
• set how often vitals are taken;
• write or sign the discharge summary;
• take payments.

Those belong to the doctor or the desk.

2. Vitals at the OPD

A patient reaches the doctor's queue only after their vitals are recorded. Casualty patients, and anyone the doctor has already started seeing, are the exceptions.

How to record vitals for a patient waiting to see the doctor

1. Open Vitals. Waiting for vitals lists today's patients with nothing recorded yet, with their token, doctor and any Allergy chip. The list updates by itself as the desk issues tokens.
2. Click Record beside the patient.
3. The form opens Prefilled from clinic normals — the clinic's own normal values, set by the owner in Settings. Change every value you measured: - BP systolic, BP diastolic - Pulse - Temp °F - SpO₂ % - Weight kg - Children · optional: Height cm and Head circumference cm
4. Set anything you did not measure to 0. A zero is not saved as a reading. To start from empty boxes, click Clear and type it all.
5. Click Save vitals. The vitals reach the doctor's screen at once, and the patient joins the doctor's queue. Vitals are never billed.

Good to know:

• The prefilled values are a starting point, not a reading. Never save the form without checking each number against the patient.
• A patient in a bed also appears on Vitals until a set is taken that day. For them, take vitals on the stay's Chart (section 8) instead: it records the breathing rate, consciousness and oxygen that the early-warning score needs.

3. The procedure queue

How to do a procedure

1. Open Procedures. Paid & waiting lists procedures ready to do: token, patient, procedure, the doctor who ordered it, and any Allergy chip.
2. Click Start when the patient is with you. The procedure moves to In progress, and reception can see the room is busy.
3. When it is finished, write any Notes and click Mark done.
4. Finished procedures are listed under Completed in the sidebar.

Good to know:

• Unpaid outpatient procedures never appear here. The desk must take payment first.
• Work ordered for a casualty patient or a patient in a bed comes straight to the queue without waiting for payment.

4. Casualty

Casualty is shared by the doctor and the nurse working the case. Whoever is free records what happened.

How to work a case

1. Open Casualty. New arrivals registered by the desk are under Just arrived. Click Start case sheet.
2. Choose the Case type — Road traffic accident, Poisoning, Assault, Burns, Animal bite, Cardiac, Collapse or Other — and fill in Brought by.
3. Fill in On arrival and Treatment given. Click Save sheet as you go.
4. Add charges as you go from Add a charge. Treatment is never held up for payment.

Medico-legal cases

Road traffic accident, poisoning, assault and burns are medico-legal.

1. Fill in Police station intimated and Intimation no.
2. Click Record intimation now.

The case cannot be closed until this is done. The sheet locks when the case is closed.

How to close a case

• Close case & send bill — the patient goes home.
• Admitted — ask for a bed — the patient goes on the ward's waiting list.
• Print case sheet prints the sheet at any time.

5. The ward map

Open Ward. The heading shows the number of beds, how many are in use, and the date. Use the chips to see All wards or one ward. Click + Admit to admit a patient (section 6). The map updates by itself whenever a bed changes anywhere.

Bed states

Chips on a bed in use:

• NEWS2 n — the latest early-warning score. It is red when it asks for the doctor.
• MLC — a medico-legal stay.
• going home — the doctor has said fit to go.
• new today

The ward's alerts

The ward's alerts are one list of what needs a nurse now (plate 80b). They are a second line: a monitor's own alarm, at the bed and at its central station, stays the alarm.

• High — an early-warning score of 7 or more, or a reading in the red.
• Medium — a score of 5 or 6, or a dose or an injection more than 30 minutes late.
• Due — vitals or a dose due now.

The list is at the top of the ward map's right-hand side, and its count is in every screen's header (2 alerts, red when one is high). Each alert says the bed, the patient, what and since when.

1. Press Give (a dose) or Take (vitals) to go straight to it, or I'm on it to say you have it. The alert is then yours, with your name and the time.
2. After I'm on it, type what was done (oxygen started, the doctor told) and press Keep it. It stays with the alert on the stay.
3. A high alert nobody takes in five minutes goes to the patient's consultant and the ward's nurse in charge; the list counts the minutes down. Alerts taken or gone stay on the list, greyed, for the shift.

On each screen, press the header's alerts, then Turn on the sound, once: a browser plays nothing until someone has pressed something. A new high alert then sounds on that screen.

The right-hand side

• Doses due across the ward — every dose due now or late, in every bed (section 13).
• Waiting for a bed — patients the doctor or casualty has asked a bed for, with Give a bed. A planned admission two hours past its time asks whether to keep holding the bed.
• Today — who Came in, who is Going home or gone, beds Held for later, and beds Free now.
• Last night's count — patients in beds at 12 AM. This is the figure occupancy is reported from.

Good to know: A bed goes to To be cleaned by itself whenever a patient leaves it or is moved out. It is offered to a new patient only after it is made (Ready or Mark clean). Housekeeping staff do the same from their Beds screen, which shows the beds and nothing about the patients.

6. How a patient arrives on the ward

A doctor decides to admit. Usually the desk gives the bed, but your role can give it too.

How a patient gets onto the waiting list:

• From the doctor's room — the doctor clicks Ask for a bed on the consultation.
• From casualty — the case is closed with Admitted — ask for a bed.
• Directly — someone opens the patient's record and clicks Admit.

How to give a bed

1. On Ward, under Waiting for a bed, click Give a bed. You can also click + Admit and choose the patient from the list.
2. Check the admission: - Coming from shows where the patient came from. - Under — the doctor in charge, filled in from the request. - Why admitted · provisional diagnosis
3. Under Ward and bed, choose the ward, then a free bed. Beds that cannot be chosen are shown greyed. The screen shows the day's bed and nursing charge and any deposit the desk will ask for.
4. Fill in: - Who pays — The patient, or a company account with an Employee ID; - a Package if one applies; - the Estimate told to the family ₹ and What it assumes.
5. Fill in Who to call, Relation and Phone. These are required: this is who you ring at night, and who signs for the patient.
6. Click Admit to [bed]. If the screen warns you, for example about a ward for the other sex, read the warning and click Admit anyway only if it is right.
7. On Admitted, use: - Print admission form — it carries the general consent; - Print wristband; - Open the stay; - Who else is waiting.

What admission changes

• The stay has its own admission number (IP-year-number) on the form, the wristband and every bill.
• Work ordered for the patient — lab, radiology, pharmacy — goes straight to its queue and onto the stay's running bill. It is not paid first.
• A medico-legal case from casualty carries its police details onto the stay. They cannot be removed there.

7. The stay page

Click a bed to open the stay. The title shows the patient's name and admission number. Under it are age and sex, bed, day of stay, the consultant, and when and from where the patient was admitted.

Buttons at the top

• Move bed
• Change doctor
• Admission form — which has its own Wristband and Print buttons
• Print interim bill

The tabs

The Who to call card shows the attendant's name, relation and phone, who pays, and the patient's Allergies.

How to move a patient to another bed

1. Click Move bed.
2. Choose a free bed under To.
3. Leave At blank for now, or give the time it happened. The time cannot be before the admission or in the future.
4. Say Why, and click Move.

The charge follows the new bed. The old bed goes to be cleaned.

How to record another doctor's opinion

1. On The stay tab, click Also seen by….
2. Choose the Doctor and write Their opinion.
3. Click Save.

How to change the doctor in charge

1. Click Change doctor.
2. Choose the Doctor and say Why.
3. Click Save.

The new doctor is in charge from now. The one before stays recorded in the stay.

Good to know: Nothing on The stay is ever edited or deleted. Every action adds a line with the time and the name of whoever did it.

8. The patient's chart — taking vitals

Open the stay and click Chart. The chart is written by the ward and read by the doctor. The desk does not see it.

At the top of the chart is the Latest round: what the doctor found, the plan, and what the round ordered (a medicine stopped or started, a test, how often vitals are taken). Read it first; All rounds opens the Rounds tab. The orders from a round are already on the medicine chart, the stay's orders and the chart — there is nothing to copy across.

How to take vitals on the ward

1. Click Take vitals at the top of the chart.
2. Fill in what you measured: - BP systolic, BP diastolic - Pulse - Temp °F - SpO₂ % - Breathing rate /min — count for a full minute - Consciousness — see the table below - Pain 0–10 — as the patient rates it - On oxygen — tick it if the patient is on any supplemental oxygen when you measure
3. Click Save the vitals.

The new set appears in Vitals since admission: on the graph (pulse, BP, temperature, SpO₂ and breathing rate) and in the table, with your name and its score. 24 hours, 3 days or Whole stay chooses how much of the stay is shown; what casualty or the OPD took before admission is shown hatched, marked before admission, and does not count towards when the next set is due. Print vitals chart prints it on the letterhead.

Good to know:

• Consciousness starts at Alert and On oxygen starts unticked. Change them if they are not true. They count towards the score whether you changed them or not.
• Leave a box empty if you did not measure it. The score then shows + (for example 2+): a reading it needs is missing, and the real score may be higher.
• Vitals cannot be edited or deleted. If a set was wrong, take a new set and write a nursing note saying why.
• Once the patient has left, the chart is kept as it was and nothing more can be added.

9. The early-warning score (NEWS2) and when to call the doctor

Every set of vitals gets a NEWS2 score — the National Early Warning Score 2. It is worked out from seven readings, each scoring 0 to 3, added together:

You type the temperature in °F. KlinikFlow converts it to °C to score it.

When to tell the doctor

At a score of 5 or more, or when any one reading scores 3:

• the chart shows a red banner: "Early-warning score n … — tell the doctor.";
• the score is marked · doctor in the table;
• the bed turns red on the ward map, with its NEWS2 chip.

When you see this:

1. Tell the doctor at once — the consultant on the stay, or the doctor on duty. Use the phone; do not wait for the round.
2. Write a nursing note saying whom you told, when, and what they advised (section 12).
3. Take the vitals again as often as section 10 says. The bed stays red until a new set scores below the line.

Good to know: The score prompts a look. It does not diagnose, and the nurse and the doctor decide. If a patient worries you, call the doctor whatever the score says.

10. When the next vitals are due

Below the vitals table, the chart says when the next set is due:

• The first set is due now. — nothing has been taken on this stay yet.
• Next due [time], with how often: every n hours or every hour, then as the doctor set or as the score asks.
• — overdue, in red, once that time has passed.

Two things set how often vitals are due:

• the doctor's order, which only a doctor can set: every 1, 2, 4, 6, 8, 12 or 24 hours, or "as the score says";
• the latest score (section 9).

Whichever asks for vitals sooner wins. If the doctor ordered 4-hourly vitals but the last score asks for hourly, the next set is due in an hour.

11. Intake and output

The Intake and output card shows one chart day, 8 AM → 8 AM, in three shifts:

Each shift shows what went in and out by route. So far gives the day's totals, and Balance is in minus out since 8 AM. Use the day box to look at an earlier day.

How to record intake or output

1. Click Add in the Intake and output card.
2. Choose In or Out, then What: - in — IV, Oral, Tube, Blood, Other - out — Urine, Drain, Vomit, Stool, Aspirate, Other
3. Fill in Amount, ml — 1 to 10,000.
4. Leave When · blank is now, or give the time. It must be during the stay and not later than now. The entry falls into the shift of that time.
5. Add a Note if useful, for example "Normal saline, 2nd bottle".
6. Click Add.

How to strike out a wrong entry

1. Click Strike beside the entry.
2. Say Why, for example "Typed 1000 for 100".
3. Click Strike through.

The entry stays on the chart, struck through with the reason and your name, and is no longer counted. Then add the correct entry.

Good to know: Intake and output entries are never edited or deleted. A mistake is struck through with why, and the right amount added as a new entry.

12. Nursing notes

The Nursing notes by shift card holds the ward's notes, newest first. They are grouped by day and shift: Morning, Evening, Night. Each note shows the time and who wrote it.

How to write a note

1. Type in Add a note for this shift….
2. Click Add the note.

The note is signed with your name and goes into the shift it is written in.

How to correct a note

1. Click Correct under the note.
2. The card says "Correcting the note of … — it stays as it was." Write the correct text.
3. Click Add the correction.

The old note stays, struck through and marked corrected below. The new note is marked a correction. Click Cancel to stop correcting.

Good to know: Notes are never edited or deleted, only corrected by a new note. Write what you saw, what you did, and whom you told — especially when the score asked for the doctor.

13. The medicine chart — giving doses

Open the stay and click Medicines. The doctor orders, changes and stops medicines. You mark each dose given, held or refused. The patient's Allergies are shown in a warning at the top.

Reading the chart

• Each medicine is a row. It shows the drug and dose, how it is given, how often, any rate and instructions, the day of the course (for example "day 2 of 5"), and who ordered it.
• The day's dose times across all medicines are the columns. The When needed · once column holds when-needed and one-time medicines.
• A stopped medicine is struck through, with when, why and who stopped it.
• ‹, Today and › move between days. Stopped or finished before today lists older orders.

What each cell shows:

How to give a scheduled dose

1. When the cell shows Give or Late · give, give the medicine, then click the button.
2. The dose was: choose Given, Held or Refused.
3. Leave At · blank is now, or give the time you gave it. It cannot be later than now.
4. Under Note, give the reason if the dose was Held or Refused — this is required — for example "NPO for the scan" or "patient vomiting". It is optional for Given.
5. Click Mark given, Mark held or Mark refused. The dose is signed with your name.

How to give a when-needed or one-time medicine

1. In the When needed · once column, click Give.
2. Mark it as above.

A when-needed medicine shows n of max today. Once the daily maximum has been given, KlinikFlow refuses another dose with "the most a day for this medicine is already given — ask the doctor". A one-time medicine can be marked once only.

Doses due across the ward

Doses due across the ward is on the Ward screen and beside the medicine chart. It lists every scheduled dose due within the hour or late, in every bed, most overdue first:

• each line shows the bed, the patient, the drug and dose, and the time;
• the chip shows due now or n min late;
• click a line to open that patient's medicine chart.

The list refreshes every minute. "Nothing due in the next hour." means you are up to date.

What you cannot do

• You cannot order, change or stop a medicine. Ask the doctor.
• You cannot give a dose of a stopped or finished medicine.
• You cannot mark a dose before it is due, or for a time still to come.
• You cannot mark the same dose twice, or change a dose once marked.

Good to know:

• The chart records giving only. It does not take stock from the shelf: medicines reach the ward when the pharmacy issues them to the stay.
• What was given on the chart is what the doctor's discharge summary lists as treatment given, so mark every dose.

14. Consents

Open the stay and click Consents. Consents for this stay lists each one as Signed, Owed or Void. The tab shows · n owed while signed pages are still missing.

• The general consent to admission is always first. Its words print on the admission form. Have it signed when the form is printed, and add the signed page here.
• Leaving against advice is listed here once its form has been printed.

How to make a consent

The doctor explains the procedure and its risks to the patient. You can prepare the form.

1. Under New consent, choose the Kind: - Consent to a procedure or surgery - Consent to anaesthesia - Consent to blood transfusion - High-risk consent - Refusal of treatment
2. Language — English, or English and the patient's language when their record has one. The other language prints only if the clinic has written its own wording for that kind; otherwise the form prints in English alone.
3. What, and its risks — as the doctor gives it to you. Required.
4. Doctor explaining — the doctor who explains it. Required.
5. Signed by — The patient, or A relative, for the patient. For a relative, fill in their name and Relation, and why the patient is not signing, for example "Son (patient drowsy)".
6. Click Make it and print to sign. The print dialog opens.

How to print a consent

Click Print beside an owed consent. The general consent prints as the admission form, and leaving against advice prints as its own form.

How to add the signed page

1. When the patient or relative has signed in front of a witness, click Add the signed page.
2. Under The signed page · a photograph or a scan, choose the file (JPG, PNG or PDF). On a tablet or phone this can open the camera.
3. Fill in: - Signed on — not later than today; - Witness — required; - Signed by — the patient, or a relative with their name and relation.
4. Click Keep it with the stay.

The consent shows Signed, with The signed page to view it.

How to void a consent

For a consent made by mistake, or one the patient will not sign:

1. Click Void.
2. Say Why, and click Void.

It stays on the list, marked void.

15. Ward charges and doctor's visits

Open the stay and click Bill.

• Running bill by day shows everything charged so far: bed and nursing (posted by themselves each midnight), work ordered, medicines issued by the pharmacy and returns.
• What it comes to shows what has been charged, paid and held in deposits, and the balance.

The ward can add charges. Only the desk takes money.

How to add a doctor's visit

1. Click + Doctor's visit.
2. Choose Seen by, and click Add the visit.

It is charged at that doctor's own fee for a visit to a patient in a bed.

How to add another charge

1. Click + Other charge.
2. Search the rate card, for example "Dressing, catheter, nebulisation…", and pick the item.
3. Fill in How many, and click Add.

Beds post themselves and medicines come from the pharmacy, so neither is added here.

The estimate

Estimate at admission shows what the family was told. Give one or Revise records a new estimate; tell the family when you change it. When the bill is well past the estimate, the Bill tab says so.

16. Preparing for discharge

The doctor says when the patient may go home and writes the discharge summary. The ward gets the patient ready and records the discharge.

When the doctor says fit to go

• The bed shows going home on the ward map.
• The patient is listed under Today → Going home.
• The checklist ticks Doctor says fit to go.

How to discharge a patient

1. Open the stay. In the Going home card, choose How the patient leaves: - Home — needs the doctor's Fit to go first. - Against advice — fill in Why, in their words. Click Print the form to sign and have the patient or attendant sign it before they leave. - Referred — fill in Referred to (required). - Left without telling — the patient has gone without notice. - Died — fill in Cause of death (required), as the doctor states it.
2. Fill in Leaving at — blank is now, or the time it happened.
3. Go through Before the patient leaves: - Doctor says fit to go — for going home. Only the doctor can tick this. - Police told of the discharge — for a medico-legal stay, whatever the way of leaving. Once the police have been told, click Told them. - Discharge summary signed / Discharge summary not signed yet — the doctor writes it on the Summary tab. This never stops the patient leaving, but remind the doctor so the patient takes it home. - Bill settled / Bill not settled yet / ₹… left due — the desk prepares the final bill. This never stops the patient leaving.
4. Click Discharge. While something required is missing, the button reads Discharge — n things left and cannot be pressed.

The bed goes to To be cleaned. Click Mark clean on the ward map once it is made.

Before the patient goes

• Open Summary and click Print to print the signed discharge summary for the patient. You can read and print it, but only a doctor can write or sign it.
• Check that every consent owed has its signed page (section 14).
• Explain the Medicines to take at home and the Come back on date printed on the summary.

Good to know: Cancel admission is only for an admission made by mistake — the wrong patient, or one who left before reaching the bed. It needs a reason, and it is refused once any work has been ordered or money taken; such a stay is discharged instead.

17. Handing over between shifts

KlinikFlow has no separate handover form. The handover is read from the ward map, the chart and the medicine chart, which are always up to date and show who did what. A good handover runs like this.

The nurse going off

1. Write a nursing note for each patient before the shift ends: their condition, what was done, what is pending, and anything the doctor said.
2. Make sure every dose you gave, held or refused is marked. Check Doses due across the ward for anything late.
3. Make sure every fluid in and out is entered, so the shift's totals are right.

Going round together

1. Start at the Ward map: - red beds and their NEWS2 scores; - MLC stays; - going home beds; - new today; - Waiting for a bed and beds Held for later.
2. For each patient, open the Chart: - the Latest round and its plan; - the last vitals and score, and Next due (or — overdue); - this shift's notes; - intake and output for the shift and the Balance so far.
3. Open Medicines: what is due next, and anything held or refused with why.

The nurse coming on

Start with Doses due across the ward and any chart showing — overdue.

Good to know: The chart's shifts are the clinic's own morning, evening and night shifts, set by the owner under Settings → Staff; the app's own are 8 AM, 2 PM and 8 PM.

18. Narcotics

Morphine, pethidine, fentanyl and other narcotics are kept by the ampoule.

• On the Medicines tab a narcotic carries a narcotic chip. When you mark a dose Given, say how many ampoules you opened and anything drawn and not given (for example 5 mg of a 10 mg ampoule). Waste needs a witness: a second person chooses their name and types their PIN on your screen. You cannot witness your own.
• Take the empty ampoule back to the pharmacy; they tick it off.
• Ward → Narcotics shows what is in the cupboard and every dose given. At each change of shift, press Count the cupboard with the nurse coming on: type what you count for each medicine, and they type their PIN. If the count does not match the register, it is flagged to the pharmacist and the owner at once — do not recount to make it match; they will look into it.

19. The theatre

Theatre in the sidebar (where the nursing home has a theatre) is each theatre's list for Today, Tomorrow or This week: time, patient and bed, procedure and anaesthesia, the team, and where the patient has got to.

1. + Book a case: choose the patient in a bed, the procedure, the surgeon, the anaesthesia (and the anaesthetist, unless it is under local), the theatre, the time and how long. A day-care case is admitted for the day first, then booked.
2. Press a case to see Before theatre: the consents for the operation and the anaesthesia come from the stay's Consents; tick the pre-anaesthetic check (with its ASA grade), nil by mouth, site marked, blood arranged and investigations seen as they are done, with a note if you like.
3. Into theatre is offered once the consents and the pre-anaesthetic check are done. In an emergency the surgeon's reason is written instead, and kept on the case.
4. Out to recovery, then Back to the ward: each is timed and written on the stay.
5. Cancel the case says why; it stays on the stay's record. Print the list for the theatre's door.

In theatre

Once the patient is in, The case's page (from the list, or the stay's Theatre card) has five tabs.

• Checklist: read each pause aloud with the team — Sign in before anaesthesia, Time out before the incision, Sign out before the patient leaves — tick what was confirmed and press … done. Each comes after the one before. A pause not done is said in the OT register.
• Notes → Counts: when the swabs, needles and instruments are counted, type the counts and Confirm the counts; your name goes on them. The surgeon cannot sign the notes until you have.
• Charges: add the OT time, fees and consumables from the rate card to the stay's bill, and send a specimen to the lab — it becomes a lab order on the stay.
• The OT register (on the list) is every operation of the month, printed when asked.

20. The labour room

Labour room in the sidebar (where the nursing home has a labour ward) lists each woman in labour, with anything the partograph says needs the doctor.

1. + A labour record: choose her stay and type her pregnancy from the antenatal card — gravida, para, living, LMP (the EDD is worked out if you leave it blank), blood group, Hb, the antenatal tests and any risks.
2. + Readings: enter what you have taken — fetal heart, cervix, descent (fifths palpable), contractions in ten minutes and how long, liquor, moulding, pulse, BP, temperature, urine, oxytocin and drugs. A blank time is now. Each is plotted at once.
3. The partograph starts at the first cervix of 4 cm: the alert line runs a centimetre an hour from there, the action line four hours to its right.
4. Crossing a line, a fetal heart under 110 or over 160, meconium, BP of 140/90 or more, or a fetal heart overdue (every half hour; every five minutes once she is fully dilated) is said at the top and goes to the ward's alerts — the doctor is told if nobody takes it.
5. Print the partograph for the case sheet.
6. Record the delivery once the baby is born: how, the time, episiotomy or tear, the third stage and placenta, the blood loss and oxytocin; then each baby — sex, weight, APGAR at one and five minutes, whether they cried, any resuscitation, the first feed and where they are. Add another baby for twins; tick stillborn where it is so. Each live baby becomes a patient of their own, "Baby of" the mother, with the birth doses due. A blood loss of 500 ml or more (1000 after a caesarean) goes to the ward's alerts.

21. Daily checks and incidents

The Ward page shows today's Daily checks the clinic has set up — a crash cart's checklist and seal, a fridge's temperature. Press Check, type what you found, and save; anything missing or out of range is said at once.

If something goes wrong or nearly does — a fall, a wrong dose caught in time, a needle-stick, equipment failing — Account → Report an incident. It is blame-free: say what happened, not who is at fault.

22. Who does what — nurse, doctor, desk

Something broken

Scan the QR label on the machine with your phone's camera, sign in, and press Report it broken: say what is wrong. Whoever looks after the equipment sees it at once. A ventilator, monitor or defibrillator out of use is shown at the top of the ward map until it is back in use.

Your roster

Account → Your roster shows your shifts this week and next once the roster is published. To swap a day, press Ask to swap, choose your day and a colleague's day on the same roster. They accept it in their Account, then the roster's keeper approves it.

Your tax

Account → Your tax: choose the old or new regime (both are worked out for you), declare your rent, 80C, 80D and any home loan, and add a photo of each proof by 31 January. If you worked somewhere else earlier this year, give their salary and the tax they deducted. Your Form 16 is here after the year ends.