concept-of-critical-care

1. CONCEPT OF
CRITICAL CARE UNITS
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2. 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.
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3. ICU Design Team
ICU design should be approached by
multidisciplinary team consisting of :-
• ICU Medical Directors
• ICU Nurse Manager
• The Chief Architect
• The Operating Engineering Staff
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4. OTHER ADDITIONAL MEMBERS
• Environmental engineer
• Interior designers
• Staff nurses
• Physicians
• Patients
• Families
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5. 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 5

6. Critical Care Nursing
Critical care nursing is that specialty within
nursing that deals specifically with human
responses to life-threatening problems.
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7. Nurse Manager
• The Nurse manager has the ability to
ensure that critical care nursing practice
meets appropriate standards.
• She prepares nurses to participate in the
on-site education of critical care unit.
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8. Nursing Staff
• ICU requires trained nurses in critical care
units.
• The number of nurses ideally required for
such units is 1:1 ratio (or 1:3 for each
shift) +30% leave reserve
• In complex situations units may require
2:1 nurses per patient.
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9. Organization Of ICU
• It requires intelligent planning.
• 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.
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10. Description
Intensive care unit equipment includes:-
• Patient monitoring devices
• Life support and emergency resuscitation
devices
• Diagnostic devices
• Air Conditioning system
• Waste management area
• Specialized Automated beds
• Emergency equipment & trolley
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12. Life Support & Resuscitative
Equipment
• Ventilator
• Infusion pump
• Crash cart
• Intra-aortic balloon pump (IABP)
• Intra-venous Blood Pressure (IVBP)
• CVP instrument
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13. Bennett, D. et al. BMJ 1999;318:1468-1470
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14. Diagnostic Equipment
• Mobile x-rays
• Portable clinical lab. devices
• Blood analyzer
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19. Central Station
• Adequate space and seating for medical record
charting by both physicians and nurses.
• Shelving, file cabinets and other storage for
medical record forms must be located.
• Although a clerical area may be located
separately from the central station, it should be
easily accessible as well
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21. X-ray Viewing Area
A separate room or distinct area near each ICU
should be designated for the viewing and
storage of patient radiographs.
An illuminated viewing box of appropriate size
should be present to allow for the simultaneous
viewing of serial radiographs.
 A "bright light" should also be available.
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22. Work Areas And Storage
 Work areas and storage for critical supplies should
be located within or adjacent to each ICU.
 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.
 Cabinets should be available for the storage of
medications and supplies.
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24. Reception Area
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25. Special Procedure Room
• Special procedure room should be located
adjacent to, the ICU.
• One special procedure room may serve several
ICUs in close proximity.
• Transport of patient’s from areas outside &
within the ICU for special procedure.
• Room size should be sufficient to accommodate
necessary equipment and personnel.
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26. Clean and Dirty Utility Rooms
• Clean and dirty utility rooms must be separate
rooms.
• They must be adequately temperature controlled,
and the air supply from the dirty utility room must
be exhausted.
• Floors should be covered with covering materials
to facilitate cleaning.
• The clean utility room should be used for the
storage of all clean and sterile supplies.
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27. Equipment Storage
• An area must be provided for the storage of
large patient care equipment 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
to permit recharging of battery operated items.
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28. Staff Lounge
• A staff lounge must be available near each ICU
to provide a private and relaxing environment.
• Secured locker facilities, showers and toilets
should be present.
• The lounge must be linked to the ICU by
telephone or intercommunication system.
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29. Conference Room
• This room must be linked to each relevant ICU
by intercommunication system
• The conference room may have multiple
purposes including continuing education, or
multidisciplinary patient care conferences.
• If the conference room is not large enough for
educational activities, a classroom should also
be provided nearby.
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30. Visitors Lounge/Waiting Room
• A visitors' lounge or waiting area should be
provided near each ICU.
• Visitor access should be controlled from the
receptionist area.
• Public telephones and dining facilities must be
available to visitors.
• Public toilet facilities and a drinking water should
be located.
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31. 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.
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32. Supply and Service Corridors
• A 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.
• 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 unobstructed movement.
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33. 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.
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34. Utilities
Each ICUs must have :-
• Electrical power,
• Water,
• Oxygen/ humidifier lines,
• Compressed air,
• Vacuum, lighting & environmental control
systems that support the needs of the patients
and critical care team under normal and
emergency situations.
These must meet or exceed regulatory
accreditation agency codes and standards.
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35. Computerized Charting
• These systems provide for "paperless" data
management, order entry, and nurse and
physician charting.
• Bedside terminals facilitate patient management
by permitting nurses and physicians to remain at
the bedside during the charting process.
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36. Other Facilities
• Voice Intercommunication Systems
• Satellite Laboratory
• Physician On-Call Rooms
• Administrative Offices
• Isolation Areas
• Hand hygiene area
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37. ISOLATION ROOMS
• 10% of beds (1 or 2) rooms may be used
exclusively as isolation cases like for burns, serious
contagious infected patients or immunosuppressed
patients.
• A separate cubic within ICU may be made for
isolation unit
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38. ROLES OF A NURSE IN ICU
• To provide care to patients who are
experiencing or are at-risk for experiencing life-
threatening conditions.
• To care for patients that had major invasive
surgery, accident and trauma patients, or
patients with multiple organ failure.
• Care for clients requiring constant cardiac and
respiratory monitoring and continual adjustment
of treatments, such as changes in ventilatory
setting
• Critical care nurses must be able to interpret,
integrate and respond to a wide array of clinical
information.
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39. Disaster Preparedness
• ICUs must be designed to handle disasters both
within ICU and outside the ICU.
• Within ICU may be fire, accidents and Infection
or unforeseen incidents.
• Similarly outside the ICU there may be major or
minor disasters like fire, accidents, natural
calamities etc.
• There must be an emergency exit in ICU to
rescue clients in times of internal disaster.
• There should be adequate fire fighting
equipment in side ICU
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40. NOISE CONTROL IN ICU
• The international Noise Council recommends
that the noise levels in an ICU should be under
45 Decibels in the daytime, 40 dBA in the
evening and 20 dBA at night
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41. LIGHTING
Light in room:
• Natural Light – Access to outside natural light is
recommended by regulatory authorities.
• Natural lighting in ICU can decrease power
consumption and the electrical bill which is so
relevant to Indian circumstances.
• High illumination and spot lights is needed for
procedures, like putting Central lines etc.
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42. ICU Staffing
• ICU staffing is one of the most important tasks
and components of the whole programmer.
Dedicated, highly motivated, ready to work in
stress situations for long periods of time are the
type of personal needed. They include
• Intensivist
• Resident doctors
• Nurses,
• Respiratory Therapists,
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43. • Nutritionist
• Physiotherapist
• Technicians,
• Computer programmer,
• Biomedical Engineer, and
• Clinical Pharmacist
• Social worker or counselor
• Other support staff. Like cleaning staff, guards
and Class IV.
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