Graphic Standards: Critical Care


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Graphic Standards: Critical Care

  1. 1. lc Critical Care Graphic Standards Programming and Schematic Design June 1999
  2. 2. Critical Care Critical Care 2lc Table of Contents Table of Contents Function 3 Staff 4 Advantages of Movable Modular Casework 5 Functional Areas 6 Nurses Station 6 Medication Preparation 8 Nourishment/Nutrition 9 Patient Room 10 Isolation Room 11 Equipment Storage 12 Clean Utility 13 Soiled Utility 14 Satellite Lab 15 Satellite Pharmacy 16 Administrative Office 17 Conference Room 17 Waiting Area/Lounge 18 Family Consultation 18 Functional Program 19 Bubble Diagram 20 Block Diagram 21 Preliminary Plan 22 Schematic Plan 23 Future Trends 24
  3. 3. Critical Care Critical Care 3lc Function Function From the beginning of organized nursing care, it was recognized that nurses were able to provide the best nursing care if the sickest patients were placed closest to the nurses station, often with a higher nurse/patient ratio for these patients. From this concept, both the surgical recovery room and the critical care unit have developed and withstood the test of time. Critical care units are patient units responsible for a specifically defined and limited number of acutely ill, unstable, or potentially unstable patients who require constant instrument monitoring and a core of full-time nurses and staff with specialized training. Critical care units are intensive and stressful environments, and it is common for these patients to experience multiple “emergencies” during their stay. Accordingly, these units are normally equipped and provided with a much higher quantity of medical/surgical supplies, a larger variety of medications, and more types of support equipment and procedure capabilities in order to deal with this high incidence of “emergen- cies” without a time delay. Patient stays in the critical care unit are usually short, and once a stable condition is maintained, they are transferred to another appropriate patient unit. The most common critical care units include cardiac care units (CCUs) and intensive care units (ICUs). The larger and more specialized hospitals will provide more specialized types of critical care. Respiratory Intensive Care Unit (RICU) This medical unit is most frequently found in regions of the country subject to environmental stress (smog) and/or industrial conditions (mines, chemical plants), and care is directed toward patients with severe respiratory illnesses. Burn Unit This highly specialized unit cares exclusively for victims of burn accidents and their constant need for intense infection control. This unit often contains an operating room for skin grafting and debridement, as well as hydrotherapy equipment. Neurological Intensive Care Unit (NICU) This surgical unit cares for patients who have undergone neurological or cerebral surgery. Neonatal Intensive Care Unit (NICU) This unit provides exclusive care to the premature and/or distressed newborn. Transitional Care Unit (TCU/Step-Down Unit) The focus of this unit may vary among hospitals, but care is usually given to the stabilized “graduate” of the critical care unit, who still needs more nursing care than that provided on the standard patient unit. Types of Critical Care Units A small community hospital may have one or two critical care units; one for general intensive care and one for coronary care. Larger regional and/or teaching hospitals may have several specialty critical care units. The most common are the following: Medical Intensive Care Unit (MICU) This unit will usually treat acutely ill patients with medical diseases or problems such as diabetes, drug reactions, respiratory infections, and cerebral vascular conditions. Surgical Intensive Care Unit (SICU) Patients in this unit will have had major surgical procedures or complications requiring more than the normal post- operative care. Coronary/Cardiac Care Unit (CCU) This unit is a specialized medical unit restricted to patients with acute cardiac conditions. Cardiovascular/Open Heart Unit (CVU) This unit is a specialized surgical unit for patients following open-heart or major vascular surgery. Pediatric Intensive Care Unit (PICU) Patients in this unit range in age from the newborn (excluding neonates) to sixteen years of age, and cover a wide range of pediatric medical and surgical acute illnesses. Children require specialized and unique nursing care and need to be isolated from adult intensive care units.
  4. 4. Critical Care Critical Care 4lc Staff Staff Physician Staff Physicians The physician coverage consists of the attending physician and the appropriate house staff. Because of the complexity of illnesses, there may be many specialized consulting physicians, (e.g., a neurolo- gist) and a chief physician assigned to the unit to oversee the medical practices of the unit. Nursing Staff Nurse Manager The nurse manager, sometimes called head nurse or nursing care coordinator, is a professional registered nurse (RN), often with advanced education, training, and experience in critical care nursing. This position is responsible for the management of the entire unit, including the standards of patient care, capabilities of the nursing staff, and consultation and interface with the medical staff on patient care problems. Assistant Nurse Manager/Charge Nurse The charge nurse is a professional registered nurse (RN), usually with additional training and experience, and is the primary resource or management staff on a particular work shift. The responsibilities of the charge nurse are similar to those of the nurse manager for day-to-day operations. Staff Nurse The staff nurse is a registered nurse (RN) with the primary responsibility for the total management of the patient’s care, or a portion of that care, including the administration of standard nursing procedures and treatments, and the evaluation of the patient’s condition and responses to treatments. Licensed Vocational Nurse Licensed vocational nurses (LVN), licensed practical nurses (LPN), or patient care assistants, having less skilled training and education than RNs, are responsible for only those duties appropriate to their experience. Patient care is supervised by the RN. Support Staff Unit Secretary/Clerk Clerical staff within the critical care unit perform such tasks as receptionist, physician order entry, filing of reports, telephone communication, and coordinating administrative activities. Unit Staff Technicians, orderlies, and volunteers assist staff nurses in the routine and simple tasks in caring for patients, always under the supervision of an RN. Support Staff A variety of other ancillary staff may have limited functions on the unit, such as IV therapists, phlebotomists, respiratory therapists, pharmacists, and
  5. 5. Critical Care Critical Care 5lc Advantages of Movable Modular Casework Financial Advantages The initial cost of movable modular casework is competitive with fixed casework or millwork. However, the life cycle cost of movable modular casework is far less than fixed casework because of · Longer product life. · Minimal maintenance cost. · Continual reuse of the components for new or different functions. · Ability to install and reconfigure with little downtime. · Accelerated depreciation rate, especially important to “for- profit” organizations. For preliminary budget purposes, movable modular casework for a critical care unit has an average price in the range of $320 to $479 per linear foot. This range will be affected by the density of overhead and under- counter storage components and the type of support structure used (wall- mounted versus panels). Movable Modular Casework The use of movable modular casework in the critical care unit offers the following major advantages and differences when compared with fixed casework or millwork: · Ability to reuse, relocate, or reconfigure all components as functions change. · Better use of vertical space where needed. · Individual parts replaceable. Additionally, movable modular casework can be used advantageously in three distinct functional areas: · Med prep areas. · Nurses station. · Storage of medical/surgical supplies. Med Prep Areas Movable modular casework com- ponents provide a transport system for replenishment or exchange of medica- tions as well as a double-locking capability for securing controlled substances and narcotics. Cantilevered workstations with modular drawers, cassettes, and sinks provide space for mixing IVs or preparing medications. Advantages of Movable Modular Casework Hospital critical care units may differ somewhat in square footage, method of operation, and staffing based on the size of the hospital, type of hospital, and scope of services, but each hospital’s critical care units have certain functional areas in common. The following pages describe the advantages of movable modular casework, give a brief description of the functional areas of critical care units, and provide typical plan views of movable modular casework applications. Nurses Station The nurses station designed using movable modular casework provides the flexibility to accommodate the changes in technology and in nursing care philosophy: · Ability to install and reconfigure to meet changing needs and staffing requirements. · Ability to accommodate and continually change the numbers and sizes of monitors and patient information systems. · Unlimited electrical capabilities as well as quick and easy access to electrical power. · Integral interior and exterior lighting. · Integral computer support components such as keyboard trays, turntables, etc. · Integral form trays and chart racks as components of the modular system. Medical/Surgical Supply Storage The storage of medical/surgical supplies in a critical care unit is located as close to the patient’s bedside as possible with a wide variety of back-up supplies located in a clean utility room, medication, and/or treatment room. Movable modular casework components function as a movable system, utilizing a variety of cart sizes for handling procedures and supplies: · Lockers for replenishment or exchange. · L carts. · Procedure/supply carts. · Bulk supply carts. · Crash carts. · Wire carts.
  6. 6. Critical Care Critical Care 6lc Functional Areas Nurses Station The nurses station is the critical care unit’s communication center, with a central location in the unit, allowing full vision of all patient beds and quick access to patients. The location should be immediately identifiable to visitors, staff, and patients and located in a position to control personnel traffic, access to patient rooms, and delivery and retrieval of supplies and medications. The critical care unit nurses station is commonly considered a workstation for centralization of administrative tasks associated with patient care. Nurses stations are generally busy, intense environments that support many functions, processes, staff members, and pieces of equipment. Within the nurses station, the staff manages patient records and charts, communicates regarding the patient’s condition, views patient monitors, orders tests and treatments, and dispenses medications. Nurses stations tend to be most congested during the first and second shifts when physicians are making rounds, visitors are present, tests and medications are ordered, specimens are collected, and most supplies are being delivered or retrieved. Hospitals may decentralize nurses stations to place activities and supplies closer to patients. Decentralized stations tend to support a sub-set of activities found in the central workstation. Nurses Station Doctors’ Dictation An area, usually a sit-down area with some acoustical control and access to telephones, should be provided for physicians to review patients’ charts, dictate progress notes, and write patient orders. Charting A stand-up or sit-down area should be provided with access to patient charts by nurses and physicians. This area is generally maintained by the unit clerk or unit secretary. With the advent of bedside computerized patient charting, there may be a reduction of the charting space required within the nurses station. Cart Storage An area must be provided to store and quickly access crash carts and procedure carts. This area should be accessible to supplies for restocking carts and have electrical access to maintain rechargeable equipment. Regulations for Nurses Stations National, state, and local legislation/codes will impact planning decisions such as · The requirements for regular- or hospital-grade electrical receptacles. · The amount of paper stored in the nurses station. · Access for persons with disabilities. · Prevention of cumulative trauma disorders (CTDs). · Accommodation of appropriate ergonomic principles into computer/ monitor work areas. Monitor Station This is the most rapidly changing area of the critical care unit. There is continual change in size and numbers of monitors due to constant changes in monitoring technology. The size, activity, space requirements, and number and types of monitors in a nurses station will vary with the number of beds and the acuity level of the patients it serves. Often the monitor station will require a separate room for the CPU (with uninterrupted power source) and electrical equipment (printers, etc.). There are two methods for integrating monitors with nursing care. Unit staffing may require nurses to view both the patient and the monitor. The alternative is a monitor station which requires a technician dedicated solely to continuous viewing of patient monitors. Because of the stress of the responsibil- ity and fatigue incurred in the repetitive nature of the work, the layout of the monitor station will need to include such ergonomic considerations as · Viewing range, heights, and angles. · Dissipation of heat generated by the equipment. · Monitor screen glare and overhead lighting. · Seating appropriate for three shifts of personnel. · Distractions from other areas.
  7. 7. Critical Care Critical Care 7lc Nurses Station Plan View of a Nurses Station The nurses station will vary in size and configuration depending on the number of patients it serves and the complexity of the equipment it must accommodate. A critical care unit nurses station will range in size from 1200 to 2400 square feet. 92 linear feet work surface 8 linear feet overhead storage 400 filing inches 4 lockers 1750 square feet Movable Modular Casework and Furniture Systems Applications A modular frame system may be used for the structural design of the nurses station with the following components as required: · Cantilevered work surfaces. · Monitor shelves and angled monitor work surfaces. · Computer tools and keyboard trays. · Unlimited high- and low-voltage electrical capabilities, including integration with emergency power systems. • Maximum cable management. · Pass-through chart shelves. · Internal task lighting. · External identification lighting. · Lateral filing components. · Procedure and crash carts.
  8. 8. Critical Care Critical Care 8lc Medication Preparation Plan View of a Medication Preparation Area A medication preparation area will range in size from 80 to 200 square feet. 25 linear feet work surface 2 emergency carts 2 procedure carts 2 medication carts 152 square feet Movable Modular Casework Applications These areas may vary from unit to unit. The amounts and types of medical supplies stored here also will vary depending on the type of replenishment or exchange system used. Movable modular casework components can be used for work areas and storage and may include Medication Preparation The medication preparation area in critical care is similar to a general medical unit except that it may include more STAT drugs of all types and more IVs and injectables than oral unit dose medication. A refrigerator, usually under the counter, is required for medications that require temperature control. There also will be a need for a lockbox for controlled substances. It is common to find medication stored by the patient’s bedside so it is immediately accessible rather than on a medication cart. Medications may also be inventoried in an automated dispensing machine. · Cantilevered work surfaces with modular drawers or cassettes. · Lockers with drawers or cassettes. · Medication cart. · Double-locking drawers for the necessary security of controlled substances and narcotic medications. · Cantilevered sink unit.
  9. 9. Critical Care Critical Care 9lc Nourishment/Nutrition Nourishment/Nutrition Critical care patients are frequently fed intravenously so there is less need here for a dedicated nourishment room. Regardless of its size and location, there will be a need for an ice machine, refrigerator, and space to prepare tube feedings. Movable Modular Casework Applications Movable modular casework components can be used for work areas and storage and may include · Cantilevered work surfaces with drawers. · Overhead shelving. · Cantilevered sink unit. Plan View of a Nourishment/Nutrition Area A nourishment/nutrition area will range in size from 80 to 150 square feet. 12 linear feet work surface 16 linear feet overhead storage 80 square feet
  10. 10. Critical Care Critical Care 10lc Patient Room Patient Room Critical care patient rooms are generally larger to accommodate large amounts of equipment and supplies and will vary according to the unit’s specialty. The most common environment is a ward with beds sectioned (for privacy) by cubicle curtains and a nurses station placed in the center of the room allowing full view of the patients. Often, critical care units will have individual patient rooms, usually with video monitors (allowing nurses to view patients) or a glass wall on the front of the patient room to ensure visibility. Cardiac and other units may dim the lighting at all times to maximize patient sleep. Usually, any necessary minor surgical procedures are performed here to avoid moving the patient to another area. Treatment rooms are generally not found on critical care units; treatment is usually confined to the patient’s room. There generally is a “headwall” behind each patient’s bed or a freestanding utility column to mount monitors and equipment and to supply suction, air, oxygen, and regular electrical and emergency electrical services. Movable Modular Casework Applications Movable modular components for the patient room may include Plan View of a Patient Room Patient rooms will range in size from 160 to 250 square feet. 6 linear feet work surface 10 linear feet overhead storage 1 L cart or C frame storage unit for bedside storage 1 locker for supplies 210 square feet · Bedside supplies placed in an L cart with drawers or in a C frame storage unit hung on a rail next to the bed. · Locker within or adjacent to the patient room to house immediate necessary supplies and linen. · Cantilevered work surface or mobile table with a keyboard tray as a station for nurse charting done on a bedside computer.
  11. 11. Critical Care Critical Care 11lc Isolation Room Movable Modular Casework Applications Movable modular components within an isolation room may include · L cart with drawers used as a bedside stand for general patient care items, such as bed pan and wash basin. · L cart with C frame storage unit and drawers placed in an anteroom or outside in the hall and used as an isolation cart to hold gowns, masks, head coverings, and gloves for staff entering the isolation room. · Locker placed in an anteroom to house necessary medical/surgical supplies. Plan View of an Isolation Room An isolation room will range in size from 160 to 300 square feet. 8 linear feet work surface 12 linear feet overhead storage 1 L cart or C frame storage unit for bedside storage 1 locker for supplies 1 isolation cart 280 square feet Isolation Room Isolation rooms are used by patients with highly communicable diseases or those who are unusually susceptible to infection. Cleanliness and contamination are key concerns in these rooms. Only the most necessary supplies are stored in these rooms. An anteroom is provided, usually with a sink and protective clothing supplies for those entering the room.
  12. 12. Critical Care Critical Care 12lc Equipment Storage An equipment storage room is often available on critical care units and is relatively large because of the large amount of equipment used here (e.g., ventilators, dialysis machines, cardiac and respiratory equipment, etc.). Much of the equipment must be accessible to electrical outlets to maintain battery charges. Movable Modular Casework Applications Movable modular casework components can be used to store large and small equipment and may include · Modular shelving units. · Bulk supply carts. Plan View of an Equipment Storage Room An equipment storage room will range in size from 120 to 250 square feet. 16 linear feet storage 1 bulk supply cart 180 square feet Equipment Storage
  13. 13. Critical Care Critical Care 13lc Clean Utility Plan View of a Clean Utility Room A clean utility room will range in size from 120 to 200 square feet. 8 linear feet work surface 16 linear feet overhead storage 5 lockers 1 bulk supply cart 145 square feet Clean Utility The clean utility room on the critical care unit requires more space than provided on medical/surgical units; many more supplies, linens, procedure trays, and procedure carts are used on critical care units. The more specialized the unit, the more specialized are the supplies stored for future use. This room may or may not have a sink depending on codes. Movable Modular Casework Applications Movable modular casework components can be used for work areas and storage and may include · Cantilevered work surfaces with drawers. · Extra-deep modular shelving units. · Lockers for medical supplies and linen. · Bulk supply carts. · Procedure carts.
  14. 14. Critical Care Critical Care 14lc Soiled Utility Plan View of a Soiled Utility Room A soiled utility room will range in size from 120 to 200 square feet. 6 linear feet work surface 6 linear feet overhead storage 155 square feet Soiled Utility The soiled utility room houses the soiled linen and used equipment and supplies awaiting collection for disposal or reprocessing. This room typically has a sink and a flushing-rim sink. Movable Modular Casework Applications Movable modular components can be used for work areas and overhead storage including · Cantilevered work surfaces with drawers. • Cantilevered sink unit. · CST frame storage units or extra- deep modular shelving units for overhead storage.
  15. 15. Critical Care Critical Care 15lc Satellite Lab Plan View of a Satellite Lab A satellite lab will range in size from 150 to 400 square feet. 43 linear feet work surface 65 linear feet overhead storage 1 locker (optional) 332 square feet Movable Modular Casework Applications Work areas can be different configura- tions based on the size and space of the critical care unit the satellite lab services and generally require · Stand-up and sit-down work surfaces for specimen preparation. · Heavy-duty work surfaces and/or process tables for automated instruments. · Process tables at seated height for microscope use. · Overhead shelving for reagents and manuals. Satellite Lab A satellite lab makes it possible to decentralize a lab’s services to respond quickly to a department’s specific needs. These labs usually will have “mini” versions of the chemistry, hematology, and urinalysis areas found in the primary lab.
  16. 16. Critical Care Critical Care 16lc Satellite Pharmacy Satellite Pharmacy A small satellite pharmacy may exist on the critical care unit. This decentraliza- tion of the pharmacy function allows for more rapid response to the needs of the patient and allows the pharmacist more involvement in the clinical therapy of the patient. The satellite pharmacy is staffed, stocked, and serviced by the primary pharmacy department. The space will vary in size but will usually contain a small drug picking area, sink, refrigerator, computer, printer, label printer, and controlled substance storage. Some satellite pharmacy areas may have a small laminar flow hood. Modular carts are appropriate for the transfer of medications to the satellite pharmacy. Movable Modular Casework Applications The same movable modular casework components used in the main pharmacy are appropriate for the satellite pharmacy, allowing for continual flexibility and change in the space. Plan View of a Satellite Pharmacy A satellite pharmacy will range in size from 120 to 250 square feet. 18 linear feet work surface 28 linear feet overhead storage 80 drug bins average 1 medication cart 1 locker 140 square feet
  17. 17. Critical Care Critical Care 17lc Administrative Office, Conference Room Administrative Office There may be a need for private offices within the units for small conferences and meetings with staff that require some privacy and confidentiality. Movable Modular Casework and Furniture Systems Applications Administrative offices may be furnished with modular furniture systems and seating. Either full-height fixed, demountable walls or freestanding modular panels are appropriate. Consistency between systems used in administrative and clinical areas allows for compatibility and flexibility when dealing with future changes. Plan View of an Administrative Office An administrative office will range in size from 90 to 120 square feet. 8 linear feet work surface 12 linear feet overhead storage 40 filing inches 93 square feet Movable Modular Casework and Furniture Systems Applications These areas may be furnished with modular furniture systems and seating. Conference Room Critical care units may require a variety of meeting spaces. These areas range from large rooms for staff meetings to smaller rooms where physicians or nurses consult with a patient’s family members. Plan View of a Conference Room A conference room will range in size from 150 to 300 square feet. 12 linear feet work surface 24 linear feet overhead storage 80 filing inches 220 square feet Shelf storage, tackboards, and marker boards are helpful in these rooms.
  18. 18. Critical Care Critical Care 18lc Waiting Area/Lounge, Family Consultation Waiting Area/Lounge Waiting rooms and lounges may be available for visitors of one or more units. Sometimes critical care units will have smaller private areas for family members who spend extended time at the hospital. The areas should be accessible to public phones. Seating generally is organized in small groupings. A workstation usually is provided for the volunteer assigned to the information desk. Movable Modular Casework and Furniture Systems Applications These areas may be furnished with modular furniture systems and seating. Freestanding modular panels are appropriate to divide the space into smaller, more private groupings. Plan View of a Waiting Area/Lounge A waiting area/lounge will range in size from 160 to 300 square feet. 216 square feet Family Consultation Critical care units tend to have one room designated for private meetings with family members or for patient home care training. Movable Modular Casework and Furniture Systems Applications These areas may be furnished with modular furniture systems and seating and may include a table, marker board, shelving, and comfortable seating. Plan View of a Family Consultation Room A family consultation room will range in size from 100 to 150 square feet. 4 linear feet storage 125 square feet
  19. 19. Critical Care Critical Care 19lc Functional Program Functional Program Number Department Area Square Feet Movable Modular Casework Nurses Stations @________ sq. ft. Dictation Areas @________ sq. ft. Medication Preparation Areas @________ sq. ft. Nourishment/Nutrition Areas @________ sq. ft. Patient Rooms @________ sq. ft. Isolation Rooms @________ sq. ft. Equipment Storage Rooms @________ sq. ft. Clean Utility Rooms @________ sq. ft. Soiled Utility Rooms @________ sq. ft. Satellite Labs @________ sq. ft. Satellite Pharmacies @________ sq. ft. Staff Toilets @________ sq. ft. Janitor’s Closet Subtotal Modular Furniture Systems Administrative Offices @________ sq. ft. Conference Rooms @________ sq. ft. Waiting Areas/Lounges @________ sq. ft. Family Consultation Rooms @________ sq. ft. Subtotal TOTAL NET SQUARE FEET Net-to-Gross Conversion Factor X TOTAL GROSS SQUARE FEET
  20. 20. Critical Care Critical Care 20lc Bubble Diagram The bubble diagram of the critical care unit demonstrates typical departmental relationships and interaction between areas. Necessary adjacencies within the department become clear. Bubble Diagram NURSES STATION NOURISH ADMIN CONFERENCE EQUIPMENT MEDICATION FAMILY CONSULTATION PATIENT ROOMS WAITING CLEAN UTILITY SOILED UTILITY
  21. 21. Critical Care Critical Care 21lc Block Diagram Block Diagram The block diagram demonstrates the adjacencies and relative sizes for the areas within a typical critical care unit. Evaluation of the work flow and materials flow from the bubble diagram has determined this initial general layout. The size of each area is determined by combining the typical movable modular casework plans for each identified function. Traffic patterns are developed, and an overview of the general work process can be evaluated.
  22. 22. Critical Care Critical Care 22lc Preliminary Plan Preliminary Plan The preliminary plan clarifies the critical care unit space requirements by showing the location of all the fixed walls and open areas and identifies entrances, exits, and exact traffic patterns.
  23. 23. Critical Care Critical Care 23lc Schematic Plan Schematic Plan The schematic plan shows all of the specific movable modular casework, modular furniture systems, and materials handling components appropriate for a typical critical care unit. NURSES STATION
  24. 24. Critical Care Critical Care 24lc Future Trends Methods of Patient Care Nursing care is moving toward the “patient-focused” care concept. The emphasis of this concept creates a non- institutional environment, breaking down barriers between the staff and the patient, bringing services to the patient rather than taking the patient to the services, and encouraging family interactions with the staff and patient. Critical care units moving toward this method of nursing care will be creating new spaces for social, educational, and functional activities and providing an atmosphere of comfort, dignity, and control for the individual patient and the family: · Traditional nurses stations will change due to the use of bedside computers for documentation of patient care, and conference areas will increase so the family can play an active part in the care plan. · More medical supplies, linen, and individual patient medications may be stored in closer proximity to the patient room. · Satellite pharmacies are becoming an integral part of critical care units. Future Trends Increased Levels of Acuity in Patients Because of the increasingly aging population, there will continue to be an increase in the level of acuity of the inpatient census. The census of the critical care units will continue to rise. The treatment of these more acutely ill patients will continue to require increased supplies, medications, and support staff on the critical care units. Healthcare delivery will continue to move toward being a more high-risk business, forcing extensive new regulations and policies, and thus continue to produce constant changes in medical procedures and nursing functions performed on the critical care units. New Technologies Rapidly changing technology, new instrumentation, and more sophisticated methods of treatment will necessitate re- evaluation of the use of space, movement of supplies and inventories, and particularly the ability to make rapid changes with minimal downtime. For example, automated medication dispensing machines are appearing on critical care units.
  25. 25. lc For the location of the sales facility or dealer near you, visit or call (800) 628 0058. © 1999 Herman Miller, Inc., Zeeland, Michigan ® Z, Y, Action Office, Aeron, Ambi, Arrio, Beirise Collection, Co/Struc, Custom Choices, Eames, Equa 2, Ergon 3, Ethospace, E-Wall, Frottage, Ground Cloth, Harmonics, Hollington, Intersite, Kinemat, Liaison, Meridian, Milcare, Mosaic, Newhouse Group, Pellicle, Perspectives, Proper, Pulsar, Rapid Response, Relay, Response Plus, Scooter, Super Room, Systems Bridge, Timepiece, V-Wall, and Wild Card are among the registered trademarks of Herman Miller, Inc. ™ Y, Aeron Chair Configuration, Ambassador, Burdick Group, Chadwick, CLT, CoActive, DIAMOND, Flex-Edge, Florence, ID, Iota, Milafin, Myriad, Passage, Potomac, Puzzle, Q, Raleigh, Rapunzel, and Traverse are among the trademarks of Herman Miller, Inc. SM OASIS is a service mark of Herman Miller, Inc.