Intensive care services

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Intensive care services

  1. 1. PLANNING AND ORGANIZATION OF INTENSIVE CARE SERVICES DR.N.C.DAS
  2. 2. PLANNING AND ORGANIZATION OF INTENSIVE CARE SERVICES <ul><li>Intensive care is defined as the provision of sophisticated life support. </li></ul><ul><li>Used for a variety of adult and paediatric patients. </li></ul><ul><li>In a setting of close and constant monitoring. </li></ul><ul><li>A policy guideline to be developed for planning a ICU by the hospital by framing a committee. </li></ul>ICU PLANNING COMMITTEE MEDICAL SUPERINTENDENT NURSING SUPERINTENDENT HODs ANAESTHESIA CPWD ARCHITECT SURGEON, NEURO SURGEON PLYSICIAN, PAEDIATRICIAN
  3. 3. DECISION MAKING <ul><li>The planning committee will take the following decisions </li></ul><ul><li>Critical care need of the hospital. </li></ul><ul><li>Type and size of the ICU. </li></ul><ul><li>Appointment of ICU in charge. </li></ul><ul><li>Appointment of ICU Matron. </li></ul><ul><li>Planning, designing and physical facilities. </li></ul><ul><li>Guide lines, policies and procedure in ICU functioning. </li></ul>
  4. 4. PRE-REQUISITE <ul><li>Training of Nursing and Medical Staff </li></ul><ul><li>Procurement of beds and equipments </li></ul><ul><li>Developing protocols for monitoring and life support techniques </li></ul><ul><li>Training of supporting staff </li></ul><ul><li>Commissioning and opening </li></ul>
  5. 5. PHYSICAL PLANNING PHYSICAL PLANNING LOCATION PHYSICAL FACILITIES DESIGNING ENVIROMENTAL PLANNING SIZE
  6. 6. ORGANIZATION STAFFING POLICIES & PROCEDURES TYPE OF ICU ADMISSION CRITERIA
  7. 7. LOCATION: <ul><li>Should be centrally located with easy access to emergency and other wards, OT and OPD. </li></ul><ul><li>Easily approachable </li></ul><ul><li>Away from general hospital traffic. </li></ul><ul><li>Restricted entry </li></ul>SIZE: <ul><li>Size of ICU depends on the type of services provided. </li></ul><ul><li>In super specialty hospital 10% of the total beds. </li></ul><ul><li>In general hospitals 2% of hospital beds. </li></ul><ul><li>Optimum size is 14 beds, minimum 4 beds. </li></ul><ul><li>If no. of beds required is more than 14, two ICUs be opened. Ideal </li></ul><ul><li>ICU is 10 bedded. </li></ul>
  8. 8. DESIGNING OF ICU PRINCIPLE OF DESIGNING ALL PATIENTS CAN BE CLOSELY OBSERVED PIPED GAS SUPPLY AMPLE SPACE AROUND BED FOR FREE MOVEMENT ADEQUATE LIGHT & ELECTRIC FIXTURES
  9. 9. LAY OUT DESIGNING <ul><li>Circular placement of beds with Central Nursing Station . </li></ul><ul><li>Rectangular with Central Monitoring System. </li></ul><ul><li>Semi circular with monitoring station at the front. </li></ul><ul><li>The lay out design depends on the availability of space. </li></ul><ul><li> </li></ul>
  10. 10. PHYSICAL FACILITIES PHYSICAL FACILITIES PATIENT AREA ENTRANCE AUXILLARY AREA ANCILLARY AREA
  11. 11. ENTRANCE TO ICU ENTRANCE BROAD CORRIDOR TOILET RECEPTION COUNTER CHANGING ROOM, SHOES,GOWN, MASKS ENTRANCE DOUBLE DOOR SWINGING 5’ TO 6’ WIDTH TELEPHONE VISITORS LOUNGE 2 sq ft/ VISITOR SNACK BAR
  12. 12. PATIENT CARE AREA PATIENT CARE BED SPACE EQUIPMENTS NURSING MONITORING STATION HAND WASHING CALL BELL SYSTEM WALL FIXERS
  13. 13. BED SPACE <ul><li>Sufficient space is required for each bed for free movement and keeping ventilator, monitoring system and other equipments. </li></ul><ul><li>They are required for each bed 100-120 sq ft in open ICU and 140-180 sq ft in cubicle. </li></ul><ul><li>Minimum 15 sq ft of clear area. </li></ul><ul><li>Head wall space 1-2 feet. </li></ul><ul><li>Space between two beds 5- 8 ft. </li></ul><ul><li>The cubicles must have glass partitions or transparent curtains for clear observation from monitoring station. </li></ul>
  14. 14. BED HEAD FIXTURES AND CALL BELL SYSTEM <ul><li>High intensity spot light connected to generator. </li></ul><ul><li>Wall panels and call button near the bed. </li></ul><ul><li>Sufficient electric sockets for plugging. </li></ul><ul><li>Wall suction tubes and piped oxygen supply. </li></ul><ul><li>Small Wash Basin </li></ul><ul><li>No extension wire to be used. </li></ul><ul><li>Equipments with CV stabilizer/ UPS. </li></ul>
  15. 15. EQUIPMENTS <ul><li>Ventilators, fluids stand </li></ul><ul><li>Defibrillator, pulse oximeter </li></ul><ul><li>Monitor and minor procedure trolley </li></ul><ul><li>Infusion pump, bop and dialysis machine </li></ul>NURSING STATION <ul><li>- Central Monitoring System </li></ul><ul><li>Counter, case records and essential drugs </li></ul><ul><li>Complete visibility of all patients </li></ul><ul><li>Two way communication/ paging/ intercom system </li></ul>
  16. 16. AUXILLARY AREA AUXILLARY AREA MEDICATION & NURSING AREA ISOLATION ROOM/ AREA PANTRY CLEAN & DIRTY UTILITY ROOM DOCTOR’S DUTY ROOM DRESSING ROOM STORE EQUIPMENT MAINTENANCE NURSES CHANGING AREA
  17. 17. ISOLATION AREA The working area is equal to total bed area and separated by clean corridor from patient area. This area has the 14 sq yards area comprises of :- <ul><li>Washing, utility area </li></ul><ul><li>Securable Cabinets for staff room </li></ul><ul><li>Clean Supply Room </li></ul><ul><li>Work room with separate sink </li></ul><ul><li>Toilet, dirty utility </li></ul><ul><li>X-ray viewing, special examination/ procedure </li></ul><ul><li>24 hours lab, radiology and pharmacy </li></ul>
  18. 18. ANCILLARY AREA <ul><li>Office space and record room </li></ul><ul><li>Staff lounges, toilets </li></ul><ul><li>Telephone Facility </li></ul><ul><li>Staff Rest Room </li></ul><ul><li>Janitor’s Room </li></ul><ul><li>ICU Matron’s Office </li></ul>
  19. 19. MEDICAL ENVIRONMENT Air Condition: <ul><li>ICU must be air conditioned </li></ul><ul><li>Temp. maintained at 25 0 – 27 0 C & 40-50 % humidity. </li></ul><ul><li>Plenty of sunlight, large windows </li></ul>Ventilation: <ul><li>6/8 air changes per hour. </li></ul><ul><li>Filters less than 10 microns </li></ul><ul><li>Positive pressure flow from patient area to outside </li></ul>Lighting: <ul><li>Varying degree of illuminations for patient area, working area </li></ul><ul><li>Intensity 1 to 30 lumens as per need </li></ul><ul><li>Soothing and Glare free </li></ul><ul><li>Provision of dimmer lights </li></ul>Noise: <ul><li>To be noise free </li></ul><ul><li>Soft & light music </li></ul><ul><li>TV & clock in each cubicle </li></ul><ul><li>Noise absorbable materials </li></ul><ul><li>Walls reflection free, light colour </li></ul><ul><li>Floor mosaic </li></ul>
  20. 20. ORGANIZATION OF ICU SERVICES ORGANIZATION STAFFING POLICIES & GUIDELINES TYPES ADMINISTRATION ADMISSION CRITERIA
  21. 21. TYPES OF ICU There are four ways of organizing an ICU. ICU TRADITIONAL BY CLENTRALLY BY ORGAN SYSTEM BY CLINICAL SYNDROME <ul><li>By Traditional Specialties: Surgical, Medical, Paed </li></ul><ul><li>By Organ System: Cardiac, Neuro, Renal, Respiratory </li></ul><ul><li>By Clinical Syndrome: Burn, Trauma , Stroke </li></ul><ul><li>4. By Clientele: Neonatal, Paed., Gynae </li></ul>
  22. 22. STAFFING STAFFING NURSING STAFF ANCILLARY STAFF MEDICAL STAFF TECHNICAL STAFF
  23. 23. STAFF REQUIRED PER SHIFT <ul><li>NURSING STAFF: </li></ul><ul><li>Ideally 1:1 ratio during day and 1:2 during night </li></ul><ul><li>Broadly 4 to 5 nurses per bed including reliever </li></ul><ul><li>One ANS for administration </li></ul><ul><li>MEDICAL STAFF: </li></ul><ul><li>One physician per 5 beds </li></ul><ul><li>Consultant ICU - One </li></ul><ul><li>Senior Resident - Two </li></ul><ul><li>Junior Resident - Two </li></ul>Per Shift <ul><li>TECHNICAL STAFF: </li></ul><ul><li>Respiratory Therapist - One </li></ul><ul><li>Physiotherapist - One </li></ul><ul><li>ICU Technician - One </li></ul><ul><li>Lab. Technician - One </li></ul><ul><li>OT Assistant - One </li></ul><ul><li>Safety Officer - One </li></ul>Per Shift <ul><li>ANCILLARY STAFF: </li></ul><ul><li>Receptionist - One </li></ul><ul><li>Ward Boys - Four </li></ul><ul><li>Stretcher Bearer - Two </li></ul><ul><li>Safaiwala - Two </li></ul>Per Shift
  24. 24. ORGANOGRAM OF ICU HOD (Anaesthesia) Director ICU (Anaesthesia) Physician 24 hours ANS Nursing Staff 24 hours Supporting Staff Technical Staff Respiratory Physiotherapist ICU Tech. Lab. Tech Receptionist Safety Officer Bio-Med. Engg . Bio- Med. Tech .
  25. 25. ADMISSION AND TREATMENT POLICY ICU is a place for potentially salvageable critically ill patient in need of constant monitoring, life support and requiring specialized treatment and trained nursing care . LEVEL OF ICU CARE LEVEL-I LEVEL-II LEVEL-III <ul><li>Monitoring </li></ul><ul><li>Observation </li></ul><ul><li>Short term ventilation </li></ul><ul><li>Monitoring </li></ul><ul><li>Observation </li></ul><ul><li>Long term ventilation </li></ul><ul><li>(Intensive Care) </li></ul><ul><li>Intensive Care </li></ul><ul><li>Invasive Procedures </li></ul><ul><li>Haemo- Dialysis </li></ul><ul><li>Constant Support </li></ul>
  26. 26. ADMISSION CRITERIA <ul><li>There should be fixed admission criteria for admission. </li></ul><ul><li>Priority to be given to the patients, who have fair chance of reversible </li></ul><ul><li>condition or chances of improvement . </li></ul>CRITERIA TRAUMA/ HEAD INJURY TRANSPLANTATION PATIENT MAJOR OPERATION REQUIRING VITAL MONITORING TOXAEMIA & SEPTICEMIA REQUIRING AIRWAY SUPPORT & ARTIFICIAL VENTILATION HAEMORRHAGIC SHOCK ELECTROLYTIC IMBALANCE
  27. 27. TREATMENT POLICY <ul><li>Responsibility lies with the in charge of unit admitting the case. </li></ul><ul><li>A vacant bed is allocated in original ward for patient return. </li></ul><ul><li>No direct admission to ICU but transferred from unit. </li></ul><ul><li>Admission only on recommendation of ICU director subjected to available </li></ul><ul><li>of bed. </li></ul><ul><li>20% beds to be kept vacant for emergency admission. </li></ul><ul><li>Continuity of treatment is the per view of ICU in charge in consultation </li></ul><ul><li>with unit in charge. </li></ul>
  28. 28. POLICIES AND PROCEDURES <ul><li>Standard treatment protocol to be followed. </li></ul><ul><li>Silence to be observed </li></ul><ul><li>All new admission/ discharge to be informed to ICU in charge. </li></ul><ul><li>All admissions/ discharges to be registered </li></ul>STAFF STANDING ORDER <ul><li>Joint round at the time of shift change and proper handing/ taking. </li></ul><ul><li>Instruction and maintenance of input- output chart. </li></ul><ul><li>Cleaning and maintenance of equipments. </li></ul><ul><li>Checking and replacement of essential drugs. </li></ul><ul><li>Proper maintenance of records. </li></ul><ul><li>Daily round of physician and I/c ICU combined to take decision for </li></ul><ul><li>change in treatment. </li></ul>
  29. 29. DISCHARGE POLICY <ul><li>Decision to discharge is taken in consultation with in- charge parent unit. </li></ul><ul><li>Patients who have recovered, stable and does not require artificial ventilation can be shifted to intermediate care or high dependency area. </li></ul><ul><li>Patient who are not progressing and chances of recovery is remote to be discharged for allotting bed to patient having fair chance of recovery when demand is acute. </li></ul><ul><li>4. When there is no demand, patient is kept in ICU till death . </li></ul>
  30. 30. QUALITY ASSURANCE IN ICU <ul><li>To maintain high standard by hygiene and cleanliness. </li></ul><ul><li>To prevent hospital acquired infection. </li></ul><ul><li>Proper treatment and disposal of BMW. </li></ul><ul><li>Daily maintenance/ checking of vital equipments. </li></ul><ul><li>Priority on patient comfort and home feeling. </li></ul><ul><li>Exit interview of patients and relatives to increase the standard and quality of care. </li></ul>
  31. 31. INTENSIVE CORONARY CARE UNIT <ul><li>The requirements here are as that of ICU. </li></ul><ul><li>The patients here are conscious/ semiconscious. </li></ul><ul><li>Require constant observation and monitoring. </li></ul><ul><li>Should have acoustic and visual privacy. </li></ul><ul><li>There should be partitions/ cubicle for each patient . </li></ul>
  32. 32. Hospital Administration Made Easy http//hospiad.blogspot.com An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. hospi ad DR. N. C. DAS

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