CONCEPT OF CRITICAL CARE - PowerPoint PPT Presentation

Loading...

PPT – CONCEPT OF CRITICAL CARE PowerPoint presentation | free to view - id: 58e2ca-NDE4N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

CONCEPT OF CRITICAL CARE

Description:

CONCEPT OF CRITICAL CARE ELECTRIC SUPPLY Grounded 110 volt electrical outlets with 30 amp circuit breakers should be located within a few feet of each patient's bed . – PowerPoint PPT presentation

Number of Views:1699
Avg rating:3.0/5.0
Slides: 107
Provided by: HiT46
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: CONCEPT OF CRITICAL CARE


1
CONCEPT OF CRITICAL CARE
  • PRESENTED BY-
  • JASPREET KAUR SODHI
  • MSc.FINAL YEAR

2
INTRODUCTION
  • The intensive care unit is not merely a room or
    series of room filled with patients attached to
    interventional technology it is the home of an
    organization the intensive care team.

3
THE INTENSIVE CARE TEAM.
  • This team
  • Doctor
  • Nurses
  • Therapists
  • Nutritionists
  • Chaplains and other support staff, builds an
    environment for healing or dying.

4
CRITICAL CARE NURSING
  • Critical care nursing is that specialty within
    nursing that deals specifically with human
    responses to life-threatening problems.

5
CRITICAL CARE NURSING
  • Critical care nursing is that specialty within
    nursing that deals specifically with human
    responses to life-threatening problems.

6
SEVEN Cs OF CRITICAL CARE
  • Compassion
  • Communication (with patient and family).
  • Consideration (to patients, relatives and
    colleagues) and avoidance of Conflict.
  • Comfort prevention of suffering
  • Carefulness (avoidance of injury)
  • Consistency
  • Closure (ethics and withdrawal of care).

7
CRITICAL CARE NURSE
  • A critical care nurse is a licensed professional
    nurse who is responsible for ensuring that
    acutely and critically ill patients and their
    families receive optimal care .

8
CRITICAL CARE UNIT
  • Critical care unit is a specially designed and
    equipped facility staffed by skilled personnel to
    provide effective and safe care for dependent
    patients with a life threatening problem.

9
THE AIM OF THE CRITICAL CARE-
  • is to see that one provides a care such that
    patient improves and survives the acute illness
    or tides over the acute exacerbation of the
    chronic illness.

10
THE EVOLUTION OF CRITICAL CARE
  • Forty years of development in critical care and
    critical care nursing has given rise to a
    recognized speciality in nursing practice .
  • Critical care units have evolved over the last
    four decades in response to medical advances .

11
HISTORICAL PRESPECTIVES
  • Florence nightingale recognized the need to
    consider the severity of illness in bed
    allocation of patients and placed the seriously
    ill patients near the nurses station.
  • 1923, John Hopkins University Hospital developed
    a special care unit for neurosurgical patients .
  • Modern medicines boomed to its higher ladder
    after world war 2

12
(No Transcript)
13
Bennett, D. et al. BMJ 19993181468-1470
14
Bennett, D. et al. BMJ 19993181468-1470
15
Bennett, D. et al. BMJ 19993181468-1470
16
HISTORICAL PRESPECTIVES
  • As surgical techniques advanced it became
    necessary that post operative patient required
    careful monitoring and this came about the
    recovery room.
  • In 1950, the epidemic of poliomyelitis
    necessitated thousands of patients requiring
    respiratory assist devices and intensive nursing
    care.
  • At the same time came about newer horizons in
    cardiothoracic surgery, with refinements in
    intraoperative membrane oxygen techniques.

17
HISTORICAL PRESPECTIVES
  • In 1953, Manchester Memorial Hospital opened a
    four bedded unit at Philadelphia was started.
  • By 1957, there were 20 units in USA and
  • In 1958,the number increased to 150.

18
CONTEXTUAL FORCES
  • The expansion of American hospital system and
    hospital insurance.
  • Architectural, hospital changes towards private
    and semi private accommodations.
  • Reallocations for direct patient care
    responsibility and creations of new forms of
    care.
  • During 1970s,the term critical care unit came
    into existence which covered all types of special
    care

19
TYPES OF ICUs
  • There are two types of ICUs,
  • An open -. In this type, physicians admit,
    treat and discharge and
  • A closed in this type, the admission, discharge
    and referral policies are under the control of
    intensivists.

20
ICUS CAN BE CLASSIFIED AS
  • Level I This can be referred as high dependency
    is where close monitoring, resuscitation, and
    short term ventilation lt24hrs has to be
    performed.
  • Level II Can be located in general hospital,
    undertake more prolonged ventilation. Must have
    resident doctors, nurses, access to pathology,
    radiology, etc.
  • Level III Located in a major tertiary hospital,
    which is a referral hospital. It should provide
    all aspects of intensive care required.

21
STAFFING
  • Large hospital requires bigger team.

22
Medical staff
  • Carrier intensivists are the best senior medical
  • Staff to be appointed to the ICU.
  • He/she will be the director.
  • Less preferred are other specialists viz. From
    Anaesthesia, medicine and chest who have clinical
    Commitment elsewhere.
  • Junior staff are intensive care trainees and
    trainees on deputation from other disciplines.

23
NURSING STAFF
  • The major teaching tertiary care ICU will require
    trained nurses in critical care.
  • It may be ideal to have an in house training
    programme for critical Care nursing.
  • The number of nurses ideally required for such
    units is 11 ratio.
  • In complex situations they may require two
    nurses per patient.
  • The number of trained nurses should be also
    worked out by the type of ICU, the workload and
    work statistics and type of patient load.

24
UNIT DIRECTOR-
  • Specific requirements for the unit director
    include the following
  • Training, interest, and time availability to give
    clinical, administrative, and educational
    direction to the ICU.
  • Board certification in critical care medicine.
  • Time and commitment to maintain active and
    regular involvement in the care of patients in
    the unit.

25
  • Availability (either the director or a similarly
    qualified surrogate) to the unit 24 hrs a day, 7
    days a week for both clinical and administrative
    matters.
  • Active involvement in local and/or national
    critical care societies.

26
  • Participation in continuing education programs in
    the field of critical care medicine.
  • Hospital privileges to perform relevant invasive
    procedures.
  • Active involvement as an advisor and participant
    in organizing care of the critically ill patient
    in the community as a whole.
  • Active participation in the education of unit
    staff.
  • Active participation in the review of the
    appropriate use of ICU resources in the hospital.

27
NURSE MANAGER
  • An RN (registered nurse) with a BSN (bachelor of
    science in nursing) or preferably an MSN (master
    of science in nursing) degree
  • Certification in critical care or equivalent
    graduate education
  • At least 2 yrs experience working in a critical
    care unit
  • Experience with health information systems,
    quality improvement/risk management activities,
    and healthcare economics
  • Ability to ensure that critical care nursing
    practice meets appropriate standards .
  • Preparation to participate in the on-site
    education of critical care unit nursing staff

28
NURSE MANAGER
  • Ability to foster a cooperative atmosphere with
    regard to the training of nurses, physicians,
    pharmacists, respiratory therapists, and other
    personnel involved in the care of critical care
    unit patients
  • Regular participation in ongoing continuing
    nursing education
  • Knowledge about current advances in the field of
    critical care nursing
  • Participation in strategic planning and redesign
    efforts

29
Critical Care Unit nursing requirements-
  • All patient care is carried out directly by or
    under supervision of a trained critical care
    nurse.
  • All nurses working in critical care should
    complete a clinical/didactic critical care course
    before assuming full responsibility for patient
    care.
  • Unit orientation is required before assuming
    responsibility for patient care.
  • Nurse-to-patient ratios should be based on
    patient acuity according to written hospital
    policies.

30
Critical Care Unit nursing requirements -
  • All critical care nurses must participate in
    continuing education.
  • An appropriate number of nurses should be trained
    in highly specialized techniques such as renal
    replacement therapy, intra-aortic balloon pump
    monitoring, and intracranial pressure monitoring.
  • All nurses should be familiar with the
    indications for and complications of renal
    replacement therapy.

31
RESPIRATORY CARE PERSONNEL REQUIREMENTS
  • Respiratory care services should be available 24
    hrs a day, 7 days a week.
  • An appropriate number of respiratory therapists
    with specialized training must be available to
    the unit at all times. Ideal levels of staffing
    should be based on acuity, using objective
    measures whenever possible.
  • Therapists must undergo orientation to the unit
    before providing care to ICU patients.

32
RESPIRATORY CARE PERSONNEL REQUIREMENTS
  • The therapist must have expertise in the use of
    mechanical ventilators, including the various
    ventilatory modes.
  • Proficiency in the transport of critically ill
    patients is required.
  • Respiratory therapists should participate in
    continuing education and quality improvement
    related to their unit activities.

33
  • Ideally, 24-hr in-house coverage should be
    provided by intensivists who are dedicated to the
    care of ICU patients and do not have conflicting
    responsibilities.
  • Ideal intensivist-to-patient ratios vary from ICU
    to ICU depending on the hospitals unique patient
    population. Hospitals should have guidelines for
    these ratios based on acuity, complexity, and
    safety considerations.
  • The following physician subspecialists should be
    available and be able to provide bedside patient
    care within 30 mins

34
PHYSICIAN SUBSPECIALISTS
  • General surgeon or trauma surgeon
  • Neurosurgeon
  • Cardiovascular surgeon
  • Obstetric-gynecologic surgeon
  • Urologist
  • Thoracic surgeon
  • Vascular surgeon
  • Anesthesiologist
  • Cardiologist with interventional capabilities
  • Pulmonologist

35
PHYSICIAN SUBSPECIALISTS
  • Gastroenterologist
  • Hematologist
  • Infectious disease specialist
  • Nephrologist
  • Neuroradiologist (with interventional capability)
  • Pathologist
  • Radiologist (with interventional capability)
  • Neurologist
  • Orthopedic surgeon

36
S.NO. THERAPIST FUNCTION
1. Physiotherapists prevents and treat chest problems, assist mobilization, and prevent contractures in immobilized patients
2. Pharmacists A advise on potential drug interactions and side effects, and drug dosing in patients with liver or renal dysfunction
3. Dietitians Advise on nutritional requirements and feeds
4. Microbiologists Advise on treatment and infection control
5. Medical physics technicians Maintain equipment, including patient monitors, ventilators, haemofiltration machines, and blood gas analysers
37
OTHER PERSONNEL
  • A variety of other personnel may contribute
    significantly to the efficient operation of the
    ICU. These include-
  • Unit clerks
  • physical therapists
  • occupational therapists
  • Advanced practice nurses
  • Physician assistants
  • Dietary specialists, and
  • Biomedical engineers.

38
LABORATORY SERVICES
  • A clinical laboratory should be available on a
    24-hr basis to provide basic hematologic,
    chemistry, blood gas, and toxicology analysis.
  • Laboratory tests must be obtained in a timely
    manner, immediately in some instances. "STAT" or
    "bedside" laboratories adjacent to the ICU or
    rapid transport systems.

39
Radiology and imaging services
  • The diagnostic and therapeutic radiologic
    procedures should be immediately available to ICU
    patients, 24 hrs per day.
  • Portable chest radiographs affect decision making
    in critically ill patients.

40
ORGANIZATION OF ICU
  • It requires intelligent planning.
  • One must keep the need of the hospital and its
    location.
  • One ICU may not cater to all needs.
  • An institute may plan beds into multiple units
    under separate management by single discipline
    specialist viz. medical ICU, surgical ICU, CCU,
    burns ICU, trauma ICU, etc.

41
ORGANIZATION OF ICU
  • The number of ICU beds in a hospital ranges from
    1 to 10 per 100 total hospital beds.
  • Multidisciplinary requires more beds than single
    speciality. ICUs with fewer than 4 beds are not
    cost effective and over 20 beds are unmanageable.
  • ICU should be sited in close proximity to
    relevant areas viz. operating rooms, image logy,
    acute wards, emergency department.
  • There should be sufficient number of lifts
    available to carry these critically ill patients
    to different areas.

42
ORGANIZATIONAL MODELS FOR ICUs
  • the open model allows many different members of
    the medical staff to manage patients in the ICU.
  • the closed model is limited to ICU-certified
    physicians managing the care of all patients and
  • the hybrid model, which combines aspects of open
    and closed models by staffing the ICU with an
    attending physician and/or team to work in tandem
    with primary physicians.

43
DEFINITION OF INTENSIVE CARE UNIT EQUIPMENTS-
  • Intensive care unit (ICU) equipment includes
    patient monitoring, respiratory and cardiac
    support, pain management, emergency resuscitation
    devices, and other life support equipment
    designed to care for patients who are seriously
    injured, have a critical or life-threatening
    illness, or have undergone a major surgical
    procedure, thereby requiring 24-hour care and
    monitoring.

44
PURPOSE
  • An ICU may be designed and equipped to provide
    care to patients with a range of conditions, or
    it may be designed and equipped to provide
    specialized care to patients with specific
    conditions

45
DESCRIPTION
  • Intensive care unit equipment includes-
  • patient monitoring
  • life support and emergency resuscitation devices
  • diagnostic devices

46
PATIENT MONITORING EQUIPMENTS
  • Acute care physiologic monitoring system
  • Pulse oximeter
  • Intracranial pressure monitor
  • Apnea monitor

47
Bennett, D. et al. BMJ 19993181468-1470
48
LIFE SUPPORT RESUSCITATIVE EQUIPMENTS
  • VENTILATOR
  • INFUSION PUMP
  • CRASH CART
  • INTRAAORTIC BALOON PUMP

49
Bennett, D. et al. BMJ 19993181468-1470
50
DIAGNOSTIC EQUIPMENTS
  • MOBILE X-RAYS
  • PORTABLE CLINICAL LAB. DEVICES
  • BLOOD ANALYZER

51
  • DESIGN OF ICU

52
(No Transcript)
53
  • PHYSICAL SET UP OF 5 BEDDED ICU

54
(No Transcript)
55
THERAPEUTIC ELEMENTS IN ICU ENVIORNMENT
  • Window and art that provides natural views views
    of nature can reduce stress, hasten recovery,
    lower blood pressure and lower pain medication
    needs.
  • Family participation ,including facilities for
    overnight stay and comfortable waiting rooms.

56
THERAPEUTIC ELEMENTS IN ICU ENVIORNMENT
  • Providng a measure of privacy and personal
    control through adjustable curtains and blinds
    ,accessible bed controls ,and TV ,VCR and CD
    players.
  • Noise reduction through computerized pagers and
    silent alarms.
  • Medical team continuity that allows one team to
    follow the patient through his or her entire stay.

57
(No Transcript)
58
ICU TEAM
  • ICU deign should be approached by
    multidisciplinary team consisting of -
  • ICU MEDICAL DIRECTORS
  • ICU NURSE MANAGER
  • THE CHIEF ARCHITECT
  • THE OPERATING ENGINEERING STAFF

59
OTHER ADDITIONAL MEMBERS
  • ENVIORNMENTAL ENGINEER
  • INTERIOR DESIGNERS
  • STAFF NURSES
  • PHYSICIANS
  • PATIENTS
  • FAMILIES

60
  • THE CHIEF ARCHITECT -He must be experienced in
    hospital space programming and hospital
    functional planning.
  • ENGINEER He should be experienced in the
    design of mechanical and electrical systems For
    hopitals,especially critical care unit.

61
(No Transcript)
62
FLOOR PLAN AND DESIGN
  • IT SHOULD BE BASED ON-
  • Patient admission pattern
  • Staff visitor traffic patterns
  • Need for support facilities such a nursing
    station ,Storage, clerical space,
  • Administrative educational requirements.
  • Services that are unique to the individual
    institution.

63
FLOOR PLAN AND DESIGN
  • Eight to twelve beds per unit is considered best
    from a functional perspective .
  • Each healthcare facility should consider the
    need for positive- and negative pressure
    isolation rooms within the ICU.
  • This need will depend mainly upon patient
    population and State Department of Public Health
    requirements.

64
FLOOR PLAN AND DESIGN
  • Each intensive care unit should be a
    geographically distinct area within the hospital,
    when possible, with controlled access.
  • No through traffic to other departments should
    occur. Supply and professional traffic should be
    separated from public/visitor traffic.
  • Location should be chosen so that the unit is
    adjacent to, or within direct elevator travel to
    and from, the Emergency Department, Operating
    Room, intermediate care units, and Radiology
    Department

65
PATIENT AREAS.-
  • Patients must be situated so that direct or
    indirect (e.g. by video monitor) visualization by
    healthcare providers is possible at all times.
    This permits the monitoring of patient status
    under both routine .and emergency circumstances.
    The preferred design is to allow a direct line of
    vision between the patient and the central
    nursing station.
  • In ICUs with a modular design, patients should
    be visible from their respective nursing
    substations.
  • Sliding glass doors and partitions facilitate
    this arrangement, and increase access to the room
    in emergency situations.

66
RECOMMENDED NOISE RANGES
  • Signals from patient call systems, alarms from
    monitoring equipment, and telephones add to the
    sensory overload in critical care units.
  • The International Noise Council has recommended
    that noise levels in hospital acute care areas
  • not exceed 45 dB(A) in the daytime,
  • 40 dB(A) in the evening,
  • 20 dB(A) at night.
  • ?Notably, noise levels in most hospitals are
    between 50-70 dB(A) with occasional episodes
    above this range

67
(No Transcript)
68
CENTRAL STATION
  • A central nursing station should provide a
    comfortable area of sufficient size to
    accommodate all necessary staff functions.
  • When an ICU is of a modular design, each nursing
    substation should be capable of providing most if
    not all functions of a central station.
  • There must be adequate overhead and task
    lighting, and a wall mounted clock should be
    present.
  • Adequate space for computer terminals and
    printers is essential when automated systems are
    in use.
  • Patient records should be readily accessible .

69
CENTRAL STATION
  • Adequate surface space and seating for medical
    record charting by both physicians and nurses
    should be provided.
  • Shelving, file cabinets and other storage for
    medical record forms must be located so that they
    are readily accessible by all personnel requiring
    their use.
  • Although a secretarial area may be located
    separately from the central station, it should be
    easily accessible as well

70
(No Transcript)
71
X-RAY VIEWING AREA.
  • A separate room or distinct area near each ICU or
    ICU cluster should be designated for the viewing
    and storage of patient radiographs.
  • An illuminated viewing box or carousel of
    appropriate size should be present to allow for
    the simultaneous viewing of serial radiographs.
  • A "bright light" should also be available.

72
WORK AREAS AND STORAGE
  • Work areas and storage for critical supplies
    should be located within or immediately adjacent
    to each ICU.
  • There should be a separate medication area of at
    least 50 square feet containing a refrigerator
    for pharmaceuticals, a double locking safe for
    controlled substances, and a sink with hot and
    cold running water.
  • Countertops must be provided for medication
    preparation, and cabinets should be available for
    the storage of medications and supplies.

73
(No Transcript)
74
RECEPTION AREA
75
RECEPTIONIST AREA
  • Each ICU or ICU cluster should have a
    receptionist area to control visitor access.
  • Ideally, it should be located so that all
    visitors must pass by this area before entering.
  • The receptionist should be linked with the
    ICU(s) by telephone and/or other
    intercommunication system.
  • It is desirable to have a visitors' entrance
    separate from that used by healthcare
    professionals.
  • The visitors' entrance should be securable if the
    need arises.

76
Special Procedures Room.
  • If a special procedures room is desired, it
    should be located within, or immediately adjacent
    to, the ICU.
  • One special procedures room may serve several
    ICUs in close proximity.
  • Consideration should be given to ease of access
    for patients transported from areas outside the
    ICU.
  • Room size should be sufficient to accommodate
    necessary equipment and personnel.

77
Special Procedures Room.
  • Monitoring capabilities, equipment, support
    services, and safety considerations must be
    consistent with those provided in the ICU proper.
  • Work surfaces and storage areas must be adequate
    enough to maintain all necessary supplies and
    permit the performance of all desired procedures
    without the need for healthcare personnel to
    leave the room

78
Clean and Dirty Utility Rooms.
  • Clean and dirty utility rooms must be separate
    rooms that lack interconnection.
  • They must be adequately temperature controlled,
    and the air supply from the dirty utility room
    must be exhausted.
  • Floors should be covered with materials without
    seams to facilitate cleaning.
  • The clean utility room should be used for the
    storage of all clean and sterile supplies, and
    may also be used for the storage of clean linen.

79
Clean and Dirty Utility Rooms.
  • Shelving and cabinets for storage must be located
    high enough off the floor to allow easy access to
    the floor underneath for cleaning.
  • The dirty utility room must contain a clinical
    sink and a hopper both with hot and cold mixing
    faucets.
  • Separate covered containers must be provided for
    soiled linen and waste materials.
  • There should be designated mechanisms for the
    disposal of items contaminated by body substances
    and fluids.
  • Special containers should be provided for the
    disposal of needles and other sharp objects.

80
Equipment Storage
  • An area must be provided for the storage and
    securing of large patient care equipment items
    not in active use.
  • Space should be adequate enough to provide easy
    access, easy location of desired equipment, and
    easy retrieval.
  • Grounded electrical outlets should be provided
    within the storage area in sufficient numbers to
    permit recharging of battery operated items.

81
Nourishment Preparation Area
  • A patient nourishment preparation area should be
    identified and equipped with food preparation
    surfaces, an ice-making machine, a sink with hot
    and cold running water, a countertop stove and/or
    microwave oven, and a refrigerator.
  • The refrigerator should not be used for the
    storage of laboratory specimens.
  • A hand washing facility should be located in or
    near the area.

82
Staff Lounge.
  • A staff lounge must be available on or near each
    ICU or ICU cluster to provide a private,
    comfortable, and relaxing environment.
  • Secured locker facilities, showers and toilets
    should be present.
  • The area should include comfortable seating and
    adequate nourishment storage and preparation
    facilities, including a refrigerator, a
    countertop stove and/or microwave oven.
  • The lounge must be linked to the ICU by telephone
    or intercommunication system, and emergency
    cardiac arrest alarms should be audible within.

83
Conference Room.
  • A conference room should be conveniently located
    for ICU physician and staff use.
  • This room must be linked to each relevant ICU by
    telephone or other intercommunication system, and
    emergency cardiac arrest alarms should be audible
    in the room.
  • The conference room may have multiple purposes
    including continuing education, house staff
    education, or multidisciplinary patient care
    conferences.
  • A conference room is ideal for the storage of
    medical and nursing reference materials and
    resources, VCRs, and computerized interactive and
    self-paced learning equipment.
  • If the conference room is not large enough for
    educational activities, a classroom should also
    be provided nearby.

84
Visitors' Lounge/Waiting Room.
  • A visitors' lounge or waiting area should be
    provided near each ICU or ICU cluster.
  • Visitor access should be controlled from the
    receptionist area. One and one-half to two seats
    per critical care bed are recommended.
  • Public telephones (preferably with privacy
    enclosures) and dining facilities must be
    available to visitors.
  • Television and/or music should be provided.
  • Public toilet facilities and a drinking fountain
    should be located within the lounge area or
    immediately adjacent.

85
Visitors' Lounge/Waiting Room.
  • Warm colours, carpeting, indirect soft lighting,
    and windows are desirable .
  • A variety of seating, including upright, lounge,
    and reclining chairs, is also desirable.
  • Educational materials and lists of hospital and
    community-based support and resource services
    should be displayed.
  • A separate family consultation room is strongly
    recommended.

86
Patient Transportation Routes
  • Patients transported to and from an ICU should be
    transported through corridors separate from those
    used by the visiting public.
  • Patient privacy should be preserved and patient
    transportation should be rapid and unobstructed.
  • When elevator transport is required, an oversized
    keyed elevator, separate from public access,
    should be provided.

87
Supply and Service Corridors
  • A perimeter corridor with easy entrance and exit
    should be provided for supplying and servicing
    each ICU.
  • Removal of soiled items and waste should also be
    accomplished through this corridor.
  • This helps to minimize any disruption of patient
    care activities and minimizes unnecessary noise.

88
Supply and Service Corridors
  • The corridor should be at least 8 feet in width.
  • Doorways, openings, and passages into each ICU
    must be a minimum of 36 inches in width to allow
    easy and unobstructed movement of equipment and
    supplies.
  • Floor coverings should be chosen to withstand
    heavy use and allow heavy wheeled equipment to be
    moved without difficulty .

89
Patient Modules
  • Ward-type icus should allow at least 225 square
    feet of clear floor area per bed.
  • Icus with individual patient modules should
    allow at least 250 square feet per room (assuming
    one patient per room),
  • Provide a minimum width of 15 feet, excluding
    ancillary spaces (anteroom, toilet, storage).

90
Patient Modules
  • Isolation rooms should each contain at least 250
    square feet of floor space plus an anteroom.
  • Each anteroom should contain at least 20 square
    feet to accommodate hand-washing, gowning, and
    storage.
  • If a toilet is provided, it must be private.

91
Patient Modules
  • A cardiac arrest/emergency alarm button must be
    present at every bedside within the ICU. The
    alarm should automatically sound in the hospital
    telecommunications center, central nursing
    station, ICU conference room, staff lounge, and
    any on-call rooms. The origin of these alarms
    must be discernable.
  • Space and surfaces for computer terminals and
    patient charting should be incorporated into the
    design of each patient module as indicated.

92
Patient Modules
  • Storage must be provided for each patient's
    personal belongings, patient care supplies, linen
    and toiletries. Locking drawers and cabinets must
    be used if syringes and pharmaceuticals are
    stored at the bedside.
  • Personal valuables should not be kept in the ICU.
    Rather, these should be held by Hospital Security
    until patient discharge.
  • Every effort should be made to provide an
    environment that minimizes stress to patients and
    staff. Therefore, design should consider natural
    illumination and view.

93
Patient Modules
  • Windows are an important aspect of sensory
    orientation, and as many rooms as possible should
    have windows to reinforce day/night orientation .
  • Drapes or shades of fireproof fabric can make
    attractive window coverings and serve to absorb
    sound.
  • Window treatments should be durable and easy to
    clean, and a schedule for their cleaning must be
    established

94
IMPROVING SENSORY ORIENTATION
  • Additional approaches to improving sensory
    orientation for patients may include -
  • the provision of a clock, calendar, bulletin
    board,
  • pillow speaker connected to radio and
    television.
  • Televisions must be out of reach of patients and
    operated by remote control.
  • If possible, telephone service should be
    provided in each room.

95
  • Comfort considerations should include methods for
    establishing privacy for the patient. Shades,
    blinds, curtains, and doors should control the
    patient's contact with his/her surroundings.
  • A supply of portable or folding chairs should be
    available to allow for family visits at the
    bedside. An additional comfort consideration is
    the choice of color scheme for the room, which
    should promote rest and have a calming effect.

96
  • To provide for visual interest, one or more walls
    within patient view may be selected for an accent
    color, texture, graphic design or picture .
  • Advice from environmental engineers and designers
    should be sought to deinstitutionalize patient
    care areas as much as possible.

97
Utilities
  • Each intensive care unit must have -
  • Electrical power,
  • Water, oxygen,
  • Compressed air,
  • Vacuum, lighting,
  • And environmental control systems
  • that support the needs
    of the patients and critical care team under
    normal and emergency situations, and these must
    meet or exceed regulatory and accreditation
    agency codes and standards .

98
ELECTRIC SUPPLY
  • Grounded 110 volt electrical outlets with 30 amp
    circuit breakers should be located within a few
    feet of each patient's bed .
  • Sixteen outlets per bed are desirable.
  • Outlets at the head of the bed should be placed
    approximately 36 inches above the floor to
    facilitate connection,
  • To discourage disconnection by pulling the power
    cord rather than the plug.
  • Outlets at the sides and foot of the bed should
    be placed close to the floor to avoid tripping
    over electrical cords.

99
Water Supply.
  • The water supply must be from a certified source,
    especially if hemodialysis is to be performed.
  • Zone stop valves must be installed on pipes
    entering each ICU to allow service to be turned
    off should line breaks occur.
  • Hand-washing sinks deep and wide enough to
    prevent splashing, preferably equipped with
    elbow-, knee-, foot-, or sonar-operated faucets,
    must be available near the entrances to patient
    modules, or between every two patients in
    ward-type units.

100
Lightning
  • Total luminance should not exceed 30
    foot-candles .
  • It is preferable to place lighting controls on
    variable-control dimmers located just outside of
    the room.
  • Night lighting should not exceed 6.5 fc for
    continuous use or 19 fc for short periods.
  • Separate lighting for emergencies and procedures
    should be located in the ceiling directly above
    the patient and should fully illuminate the
    patient with at least 150 fc shadow-free
  • A patient reading light is desirable, and should
    be mounted

101
Environmental Control Systems.
  • A minimum of six total air changes per room per
    hour are required, with two air changes per hour
    composed of outside air.
  • For rooms having toilets, the required toilet
    exhaust of 75 cubic feet per minute should be
    composed of outside air.
  • Central air-conditioning systems and recirculated
    air must pass through appropriate filters.

102
  • Air-conditioning and heating should be provided
    with an emphasis on patient comfort.
  • For critical care units having enclosed patient
    modules, the temperature should be adjustable
    within each module.

103
Computerized Charting
  • These systems provide for "paperless" data
    management, order entry, and nurse and physician
    charting. If and when a decision is made to
    utilize this technology, it is important to
    integrate such a system fully with all ICU
    activities.
  • Bedside terminals facilitate patient management
    by permitting nurses and physicians to remain at
    the bedside during the charting process.

104
OTHER FACILITIES
  • Voice Intercommunication Systems
  • Satellite Laboratory
  • Physician On-Call Rooms
  • Administrative Offices

105
(No Transcript)
106
  • THANK YOU.
About PowerShow.com