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Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
Setting up an Intensive Care unit
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Setting up an Intensive Care unit

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  • 1. SETTING UP AN INTENSIVE CARE UNIT Leah MacadenLeah Macaden COLLEGE OF NURSINGCOLLEGE OF NURSING CMC, VELLORECMC, VELLORE
  • 2. OBJECTIVE • TO PROVIDE A FUNCTIONAL AND USER- FRIENDLY ENVIRONMENT.
  • 3. CORE COMPONENTS OF AN ICU • CONSTANT MONITORINGCONSTANT MONITORING • RAPID SKILLED INTERVENTIONRAPID SKILLED INTERVENTION • MULTI DISCIPLINARY TEAMMULTI DISCIPLINARY TEAM WORKWORK
  • 4. FACTORS TO CONSIDER • SOURCES OF PATIENTS • ADMISSION AND DISCHARGE CRITERIA • EXPECTED RATE OF OCCUPANCY • ECONOMIC INVESTMENT • FINANCIAL VIABILITY • PERSONNEL REQUIRED • TECHNOLOGICAL RESOURCES
  • 5. LEVELS OF ICU CARE • LEVEL I –LEVEL I – PROVIDES MONITORING,PROVIDES MONITORING, OBSERVATION AND SHORT TERMOBSERVATION AND SHORT TERM VENTILATION.VENTILATION. • LEVEL II –LEVEL II – PROVIDES OBSERVATION,PROVIDES OBSERVATION, MONITORING & LONG TERMMONITORING & LONG TERM VENTILATION WITH RESIDENTVENTILATION WITH RESIDENT DOCTORS.DOCTORS.
  • 6. • LEVEL III –LEVEL III – PROVIDES ALL ASPECTSPROVIDES ALL ASPECTS OF INTENSIVE CARE INCLUDINGOF INTENSIVE CARE INCLUDING INVASIVE HAEMO DYNAMICINVASIVE HAEMO DYNAMIC MONITORING & DIALYSIS.MONITORING & DIALYSIS.
  • 7. DESIGNING AN ICU THE TEAM SHOULD CONSIST OFTHE TEAM SHOULD CONSIST OF AN INTENSIVE CARE DIRECTORAN INTENSIVE CARE DIRECTOR NURSING ADMINISTRATORS &NURSING ADMINISTRATORS & SUPERVISORSSUPERVISORS HOSPITAL ADMINISTRATORSHOSPITAL ADMINISTRATORS
  • 8. AN ARCHITECTAN ARCHITECT ENGINEERS (Electrical, Civil,ENGINEERS (Electrical, Civil, Bioengineering, Electronics etc)Bioengineering, Electronics etc) ALL POTENTIAL USERSALL POTENTIAL USERS
  • 9. • ENVIRONMENTAL ENGINEERS, INTERIOR DESIGNERS, STAFF NURSES, PHYSICIANS, PATIENTS AND FAMILIES MAY BE ASKED FOR COMMENTS.
  • 10. DESIGN PNEUMATICS - V • P – PATIENT CAREP – PATIENT CARE • N- NURSINGN- NURSING • E- EATING (Clean area forE- EATING (Clean area for food preparation & delivery)food preparation & delivery) • U- UNCLEAN (Dirty linen &U- UNCLEAN (Dirty linen & equipment)equipment) • M- MEDICATION STORAGEM- MEDICATION STORAGE
  • 11. • A – ADMINISTRATION (CLERKING &A – ADMINISTRATION (CLERKING & STATIONARY)STATIONARY) • T – TEACHINGT – TEACHING • I – INFECTION CONTROL & ELIMINATIONI – INFECTION CONTROL & ELIMINATION (STERILIZATION & DISINFECTION)(STERILIZATION & DISINFECTION) • C – CLEAN AREAC – CLEAN AREA
  • 12. • STORAGESTORAGE • VISITORSVISITORS (OTHERS- BEREAVEMENT / QUIET(OTHERS- BEREAVEMENT / QUIET ROOM, OFFICE ROOMS, DUTY DOCTOR’SROOM, OFFICE ROOMS, DUTY DOCTOR’S ROOM, STAFF LOUNGE, LIBRARY etc).ROOM, STAFF LOUNGE, LIBRARY etc).
  • 13. TECHNICAL SPACE FOR A LAB,TECHNICAL SPACE FOR A LAB, BLOOD GAS ANALYSER etc.BLOOD GAS ANALYSER etc. RELATIVES’ WAITING ROOM WITHRELATIVES’ WAITING ROOM WITH A TELEPHONE, TV, BEVERAGEA TELEPHONE, TV, BEVERAGE FACILITIES etc.FACILITIES etc.
  • 14. LOCATION • Should be a geographically distinct area within the hospital, with controlled access. • No through traffic to other departments should occur. Supply and professional traffic should be separated from public/visitor traffic.
  • 15. • 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 the Radiology Department.
  • 16. BED STRENGTH • IDEALLY 8 TO 12 BEDSIDEALLY 8 TO 12 BEDS • LARGER AREAS – DIFFICULT TO ADMINISTER ANDLARGER AREAS – DIFFICULT TO ADMINISTER AND SMALLER AREAS NOT BEING COST EFFECTIVESMALLER AREAS NOT BEING COST EFFECTIVE • 3 TO 5 BEDS PER 100 HOSPITAL BEDS FOR A LEVEL3 TO 5 BEDS PER 100 HOSPITAL BEDS FOR A LEVEL III ICU / 2 TO 20% OF THE TOTAL NUMBER OFIII ICU / 2 TO 20% OF THE TOTAL NUMBER OF HOSPITAL BEDSHOSPITAL BEDS (In CMC – 68 ICU Beds, 60 Nursery beds, 43 HDU beds)(In CMC – 68 ICU Beds, 60 Nursery beds, 43 HDU beds) • 1 ISOLATION BED FOR EVERY 10 ICU BEDS1 ISOLATION BED FOR EVERY 10 ICU BEDS
  • 17. BED SPACE & BEDS • 150 – 200 SQUARE FEET PER OPEN BED150 – 200 SQUARE FEET PER OPEN BED WITH 8 FEET IN BETWEEN BEDS.WITH 8 FEET IN BETWEEN BEDS. • 225 – 250 SQUARE FEET PER BED IF IN A225 – 250 SQUARE FEET PER BED IF IN A SINGLE ROOM.SINGLE ROOM. • SINGLE ROOM – WITH AN ANTEROOM (20SINGLE ROOM – WITH AN ANTEROOM (20 FEET) FOR HAND WASHING, GOWNING etcFEET) FOR HAND WASHING, GOWNING etc • BEDS - ADJUSTABLE, NO HEAD BOARD,BEDS - ADJUSTABLE, NO HEAD BOARD, SIDE RAILS AND WITH WHEELS.SIDE RAILS AND WITH WHEELS.
  • 18. ACCESSORIES • 3 OXYGEN OUTLETS, 3 SUCTION3 OXYGEN OUTLETS, 3 SUCTION OUTLETS (GASTRIC, TRACHEAL &OUTLETS (GASTRIC, TRACHEAL & UNDERWATER SEAL), TWOUNDERWATER SEAL), TWO COMPRESSED AIR OUTLETS ANDCOMPRESSED AIR OUTLETS AND 16 POWER OUTLETS PER BED.16 POWER OUTLETS PER BED. • STORAGE BY EACH BEDSIDESTORAGE BY EACH BEDSIDE (BUILT IN / ALCOVE).(BUILT IN / ALCOVE).
  • 19. • HAND RINSE SOLUTION BY EACHHAND RINSE SOLUTION BY EACH BEDSIDE.BEDSIDE. • EQUIPMENT SHELF AT THE HEADEQUIPMENT SHELF AT THE HEAD END (MIND THE HEIGHT OF THEEND (MIND THE HEIGHT OF THE CARE GIVER).CARE GIVER).
  • 20. • HOOKS & DEVICES TO HANGHOOKS & DEVICES TO HANG INFUSIONS / BLOOD BAGS –INFUSIONS / BLOOD BAGS – SUSPENDED FROM THE CEILINGSUSPENDED FROM THE CEILING WITH A SLIDING RAIL TOWITH A SLIDING RAIL TO POSITION.POSITION. • INFUSION PUMPS TO BEINFUSION PUMPS TO BE MOUNTED ON STANDS / POLES.MOUNTED ON STANDS / POLES.
  • 21. INFRASTRUCTURE • PATIENTS MUST BE SITUATED SO THAT DIRECT OR INDIRECT (E.G. BY VIDEO MONITOR) VISUALIZATION BY HEALTHCARE PROVIDERS IS POSSIBLE AT ALL TIMES. • THE PREFERRED DESIGN IS TO ALLOW A DIRECT LINE OF VISION BETWEEN THE PATIENT AND THE CENTRAL NURSING STATION. • MODULAR DESIGN – SLIDING GLASS DOORS & PARTITIONS TO FACILITATE VISIBILITY.
  • 22. ENVIRONMENT • SIGNALS & ALARMS – ADD TO THE SENSORY OVERLOAD; NEED TO BE MODULATED. • FLOOR COVERINGS AND CEILING WITH SOUND ABSORPTION PROPERTIES. • DOORWAYS – OFFSET TO MINIMISE SOUND TRANSMISSION. • LIGHT & SOFT MUSIC (EXCEPT 10 PM TO 6LIGHT & SOFT MUSIC (EXCEPT 10 PM TO 6 AM).AM).
  • 23. • LIGHTING – FOCUSSED & CENTRALLIGHTING – FOCUSSED & CENTRAL LIGHTING.LIGHTING. • AIRCONDITIONING (SPLIT / CENTRAL) – 25AIRCONDITIONING (SPLIT / CENTRAL) – 25 + OR – 2 DEGREES CENTIGRADE.+ OR – 2 DEGREES CENTIGRADE. • CLEANING – VACUUM CLEANING & WETCLEANING – VACUUM CLEANING & WET MOPPING OF THE FLOOR. FUMIGATION ISMOPPING OF THE FLOOR. FUMIGATION IS NO LONGER RECOMMENDED.NO LONGER RECOMMENDED.
  • 24. • NATURAL ILLUMINATION AND VIEW - WINDOWS ARE AN IMPORTANT ASPECT OF SENSORY ORIENTATION; HELPS TO REINFORCE DAY/NIGHT ORIENTATION. • WINDOW TREATMENTS SHOULD BE DURABLE AND EASY TO CLEAN, AND A SCHEDULE FOR THEIR CLEANING MUST BE ESTABLISHED.
  • 25. • ADDITIONAL APPROACHES TO IMPROVING SENSORY ORIENTATION FOR PATIENTS MAY INCLUDE THE PROVISION OF A CLOCK, CALENDAR, BULLETIN BOARD, AND/OR PILLOW SPEAKER CONNECTED TO RADIO AND TELEVISION.
  • 26. UTILITIES • ELECTRICAL – ADEQUATE SOCKETS (5AMPS &ELECTRICAL – ADEQUATE SOCKETS (5AMPS & 15 AMPS), GENERATOR SUPPLY & BATTERY15 AMPS), GENERATOR SUPPLY & BATTERY BACK UP.BACK UP. • MEDICAL GAS & VACUUM PIPELINE –MEDICAL GAS & VACUUM PIPELINE – COLOUR CODED AND NOTCOLOUR CODED AND NOT INTERCHANGEABLE.INTERCHANGEABLE. • WATER FROM A CERTIFIED SOURCEWATER FROM A CERTIFIED SOURCE ESPECIALLY IF USED FOR HAEMODIALYSIS.ESPECIALLY IF USED FOR HAEMODIALYSIS.
  • 27. • HANDWASHING AREAS –HANDWASHING AREAS – UNINTERRUPTED WATER SUPPLY,UNINTERRUPTED WATER SUPPLY, DISPOSABLE PAPER TOWELS / HANDDISPOSABLE PAPER TOWELS / HAND DRIER. (NO CLOTH TOWELS PLEASE)DRIER. (NO CLOTH TOWELS PLEASE) • TELEPHONES & COMPUTERS FORTELEPHONES & COMPUTERS FOR COMMUNICATION.COMMUNICATION.
  • 28. • STERILISING AREA – LARGE WATERSTERILISING AREA – LARGE WATER BOILER / GEYSER & EXHAUST FANS.BOILER / GEYSER & EXHAUST FANS. • CLEAN AND A DIRTY UTILITY WITHCLEAN AND A DIRTY UTILITY WITH NO INTERCONNECTION.NO INTERCONNECTION. • SHELVING & CABINETS OFF THESHELVING & CABINETS OFF THE GROUND FOR STORAGE.GROUND FOR STORAGE. • WASTE & SHARPS DISPOSAL.WASTE & SHARPS DISPOSAL.
  • 29. • WORK AREAS AND STORAGE FOR CRITICAL SUPPLIES SHOULD BE LOCATED IMMEDIATELY ADJACENT TO EACH ICU. • ALCOVES SHOULD PROVIDE FOR THE STORAGE AND RAPID RETRIEVAL OF CRASH CARTS AND PORTABLE MONITOR/DEFIBRILLATORS.
  • 30. • 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 TABLE TOP FOR PREPARATION OF DRUGS AND INFUSIONS.
  • 31. EQUIPMENT MONITORING EQUIPMENTMONITORING EQUIPMENT THERAPEUTIC EQUIPMENTTHERAPEUTIC EQUIPMENT DIGITAL & ANALOGUE DISPLAYDIGITAL & ANALOGUE DISPLAY AUDIO & VISUAL ALARMSAUDIO & VISUAL ALARMS BATTERY BACK UP & CHARGINGBATTERY BACK UP & CHARGING
  • 32. PERSONNEL • NURSE PATIENT RATIO – 1: 1.NURSE PATIENT RATIO – 1: 1. • ICU NURSE MANAGERICU NURSE MANAGER AN RN (REGISTERED NURSE) WITH AAN RN (REGISTERED NURSE) WITH A BSN OR PREFERABLY AN MSN DEGREE.BSN OR PREFERABLY AN MSN DEGREE. CERTIFICATION IN CRITICAL CARE ORCERTIFICATION IN CRITICAL CARE OR EQUIVALENT GRADUATE EDUCATIONEQUIVALENT GRADUATE EDUCATION WITH AT LEAST 2 YRS EXPERIENCEWITH AT LEAST 2 YRS EXPERIENCE WORKING IN A CRITICAL CARE UNIT.WORKING IN A CRITICAL CARE UNIT.
  • 33. • EXPERIENCE WITH HEALTHEXPERIENCE WITH HEALTH INFORMATION SYSTEMS, QUALITYINFORMATION SYSTEMS, QUALITY IMPROVEMENT/RISK MANAGEMENTIMPROVEMENT/RISK MANAGEMENT ACTIVITIES, AND HEALTHCAREACTIVITIES, AND HEALTHCARE ECONOMICS.ECONOMICS. • ABILITY TO ENSURE THAT CRITICALABILITY TO ENSURE THAT CRITICAL CARE NURSING PRACTICE MEETSCARE NURSING PRACTICE MEETS APPROPRIATE STANDARDS.APPROPRIATE STANDARDS.
  • 34. • PREPARATION TO PARTICIPATE INPREPARATION TO PARTICIPATE IN THE ON-SITE EDUCATION OFTHE ON-SITE EDUCATION OF CRITICAL CARE UNIT NURSINGCRITICAL CARE UNIT NURSING STAFF.STAFF. • ABILITY TO FOSTER A COOPERATIVEABILITY TO FOSTER A COOPERATIVE ATMOSPHERE WITH REGARD TO THEATMOSPHERE WITH REGARD TO THE MULTIDISCIPLINARY TRAININGMULTIDISCIPLINARY TRAINING PERSONNEL INVOLVED IN THE CAREPERSONNEL INVOLVED IN THE CARE OF CRITICAL CARE UNIT PATIENTS.OF CRITICAL CARE UNIT PATIENTS.
  • 35. • REGULAR PARTICIPATION IN ONGOINGREGULAR PARTICIPATION IN ONGOING CONTINUING NURSING EDUCATION.CONTINUING NURSING EDUCATION. • KNOWLEDGE ABOUT CURRENTKNOWLEDGE ABOUT CURRENT ADVANCES IN THE FIELD OF CRITICALADVANCES IN THE FIELD OF CRITICAL CARE NURSING.CARE NURSING. • PARTICIPATION IN STRATEGICPARTICIPATION IN STRATEGIC PLANNING AND REDESIGN EFFORTSPLANNING AND REDESIGN EFFORTS
  • 36. MEDICAL STAFFING – COVER FOR EVERYMEDICAL STAFFING – COVER FOR EVERY SHIFT WITH COMPETENCE TO HANDLESHIFT WITH COMPETENCE TO HANDLE ANY EMERGENCY.ANY EMERGENCY. ANCILLARY STAFF – THERAPISTS,ANCILLARY STAFF – THERAPISTS, TECHNICIANS, RADIOGRAPHERS etc.TECHNICIANS, RADIOGRAPHERS etc. RECEPTIONIST, CHAPLAIN /RECEPTIONIST, CHAPLAIN / COUNSELLOR.COUNSELLOR.
  • 37. PERSONNEL DEVELOPMENT IN SERVICE EDUCATION PROGRAMMESIN SERVICE EDUCATION PROGRAMMES DEBRIEF SESSIONS – TO BURN OUTDEBRIEF SESSIONS – TO BURN OUT TEAM BUILDING EXERCISESTEAM BUILDING EXERCISES INVOLVEMENT IN POLICYINVOLVEMENT IN POLICY DEVELOPMENTDEVELOPMENT
  • 38. POLICIES & PROTOCOLS • ADMISSION, DISCHARGE &ADMISSION, DISCHARGE & WITHDRAWAL OF SUPPORT.WITHDRAWAL OF SUPPORT. • LEGAL & ETHICAL GUIDELINES & MLCLEGAL & ETHICAL GUIDELINES & MLC POLICIESPOLICIES • STANDING ORDERS.STANDING ORDERS. • ORGAN DONATION.ORGAN DONATION.
  • 39. INFECTION CONTROLINFECTION CONTROL • SURVEILLANCESURVEILLANCE • STERILIZATION & DISINFECTIONSTERILIZATION & DISINFECTION • QUALITY CONTROL & AUDITINGQUALITY CONTROL & AUDITING
  • 40. DOCUMENTATION • CONVENTIONALCONVENTIONAL • ELECTRONIC MEDICAL RECORDS (EMR)ELECTRONIC MEDICAL RECORDS (EMR) Bedside terminals Interfaced with existing hospital data Systems, data retrieval (laboratory Results, x-ray reports, etc.). Remote data transmission capabilities (to offices, on-call rooms, etc.)
  • 41. OTHER FACILITIES • BEREAVEMENT & AFTER CAREBEREAVEMENT & AFTER CARE SERVICESSERVICES • COUNSELLINGCOUNSELLING • LAST OFFICELAST OFFICE • SUPPORT SYSTEMS FOR PATIENTSUPPORT SYSTEMS FOR PATIENT RELATIVES & STAFFRELATIVES & STAFF
  • 42. REFERENCES Guidelines for Intensive Care Unit Design – Crit Care Med 1995 Mar; 23(3):582- 588. John, G. Essentials of Critical Care, Edition IV, (2003), Shakti Prints, Vellore. Worthley, L.I.G. Clinical Examination of the Critically Ill Patient, Edition II, (2000), The Australasian Academy of Critical Care Mediicne, South Australia.
  • 43. HH AA NN KYY OO UU TT

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