Lecture 2 - Layout of the Critical Care Unit.pptx

ICU ORGANIZATION
Dennis Joe BScN | RN – Pwani

Objectives
1. Know the team to use in the organization of a
critical care unit
2. Look at the structures involved
3. ICU tour
14-Mar-24
Dennis Joe - BScN | RN

Introduction
 Requires intelligent planning
 An institute
 May plan beds into multiple units under separate
management by single discipline specialist-
 Medical ICU
 Surgical ICU…
 The number of ICU beds in a hospital ranges from 1- 10
per 100 total beds
 Multidisciplinary requires more beds than single
specialties 14-Mar-24

Organization of ICU
 ICUs with fewer than 4 beds are not cost effective and
over 20 beds are unmanageable
 ICU should be sighted in close proximity to relevant areas-
Operating rooms, Acute wards, emergency department
 There should be sufficient number of lifts available to
carry these critically ill patients to different areas
Therapeutic elements in ICU environment
 Windows and art that provides natural views- Views of
nature can reduce stress, Hasten recovery, lower blood
pressure and lower pain medication needs
14-Mar-24

Organization of ICU
 Family participation, including facilities for overnight stay
and comfortable waiting rooms
 Providing a measure of privacy and personal control
through adjustable curtains and blinds, accessible bed
controls and TV and CD players
 Noise reduction through computerized pagers and silent
alarms
14-Mar-24

ICU Team
 ICU design should be approached by multidisciplinary
team consisting of:
1. ICU medical directors
2. ICU nurse manager
3. The chief architect
4. The operating engineering staff
Other additional members:
1. Interior designer
2. Staff nurses
3. Physicians
14-Mar-24

ICU Team
 The chief architect must be experienced in hospital space
programming and hospital functional planning
 The engineer should be experienced in the design of
mechanical and electrical systems for hospitals especially
critical care units
Floor plan and design:
 Should be based on patient admission pattern
 Need for support facilities such as nursing station, storage,
clerical space, administrative or educational requirements
 Services that are essential to the individual Institutions
14-Mar-24

Requirements
 8-12 beds per unit is considered best from a functional
perspective
 Each health care facility should consider the need for
positive and negative pressure isolation rooms within the
ICU
 The need will depend purely on patient population and
state department of public health requirements
 Each ICU should geographically distinct area within the
hospital with controlled access
14-Mar-24

Requirements
 No through traffic to other departments
 Supply and professional traffic should be separated from
public or 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
14-Mar-24

Patient Areas
 Patients must be situated in a way that direct visualization
by health care providers is possible at all times
 This permits the monitoring of patient status under both
routine and emergency circumstances
 The design is to allow a direct line of vision between the
patient and the central nursing station
 Sliding glass doors and partition are preferred if the
patient is in a room
 This will increase access to the room in emergency
situations
14-Mar-24

Central Station
 A central nursing station should provide a comfortable
area of sufficient size to accommodate all necessary staff
functions
 There must be adequate overhead and task lighting
 A well mounted clock should be present
 Adequate space for computer terminals and printers is
essential when automated systems are in place
 Patients records should be readily accessible
14-Mar-24

Requirements
 Adequate surface space and sitting for medical record
charting by both physicians and nurses should be provided
 Shelving, file cabinets and other storage for medical
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.
14-Mar-24

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’s radiographs
 An illuminated viewing box of an appropriate size should
be present to allow for the simultaneous viewing of serial
radiographs.
 A bright light should also be available
14-Mar-24

Work Areas and Storage
 Work areas and storage for critical supplies should be
located within or adjacent to each ICU.
 There should be a separated medication area of at least
50sq feet containing a refrigerator for pharmaceuticals,
double locking safe for controlled substances and a sink
with hot and cold running water.
 Counter pots must be provided for medication preparation
and cabinets should be available for storage of medication
and supplies.
14-Mar-24

Receptionist Area
 Each ICU or ICU cluster should have receptionist area to
control visitor access.
 Ideally it should be located so that all visitors must pass
by this area before entering the ICU.
 The receptionist should be linked to the ICU by telephone
or other intercommunication system.
 It is desirable to have a entrance that is different from
other healthcare professionals.
 Visitors entrance should be securable if need arises.
14-Mar-24

Special Procedure Room
 If a special procedure is desired it should be located
within or adjacent to the ICU.
 One special procedure room may serve several ICU’s in
close proximity.
 Consideration should be given to ease of access for
patients transported from areas outside the ICU
 Room size should adequate to accommodate necessary
equipment and personnel.
14-Mar-24

Special Procedure Room
 Monitoring capabilities, equipment, support services and
safety considerations must be consistent with those
provided in the ICU.
 Work services and storage areas must be adequate enough
to maintain all necessary supplies and permits the
performance of all desired procedures without the need
for health care personnel to leave the room.
14-Mar-24

Clean And Dirty Utility Rooms
 Clean and dirty utility rooms must be separate rooms and
lack interconnection.
 They must be adequately temperature controlled and the
air supplied from the dirty room must be exhausted.
 Floors should be covered with materials without seams to
facilitate cleanliness.
14-Mar-24

Clean And Dirty Utility Rooms
 The clean utility room should be used for the storage of
all clean and sterile supply and may also be used for the
shelving and cabinets for storage.
 The dirty utility room must contain a clinical sink.
 Separate covered containers must be provided for soiled
linen and waste materials.
 There should be designated mechanism for disposal of
items contaminated by body fluids
 Sharp containers should be available
14-Mar-24

Equipment Storage
 An area must be provided and securing of large patient
care equipments 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 with the
storage area in sufficient numbers to permit recharging of
battery operated items
14-Mar-24

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 water, A
sink with hot and cold running water, microwave and
refrigerator
 The refrigerator should not be used to save laboratory
statements
14-Mar-24

Staff Lounge
 Staff must be available in or near each ICU or ICU cluster
to provide for a comfortable relaxing environment
 Secured locker facilities, showers and toilets should by
present
 The area should include comfortable seating and adequate
nourishment storage & preparation facilities including a
refrigerator, microwave
 The lounge must be linked to the 100 by telephone or
intercommunication system and emergency cardiac arrest
alarms should be audible within
14-Mar-24

Conference Rooms
 A conference should be conveniently located for ICU
physician and staff
 The room must be linked to each relevant ICU by
telephone or other intercommunication system &
emergency cardiac arrest alarms should be audible I the
room
 The conference room may have multiple purposes
including continuing education, house staff education or
multidisciplinary patient care conferences
14-Mar-24

Conference Rooms
 Conference is ideal for the storage for medical & nursing
reference materials and resources, computerized
interactive self paced learning equipment
14-Mar-24

Visitors Lounge / Waiting Room
 A visitor's lounge /waiting area should be provided near
each ICU or ICU cluster
 Visitor access should be controlled from the receptionist
area
 One and a 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 screen should be provided
14-Mar-24

 Public toilet facilities and drinking fountain should be
located within the lounge area or immediate adjacent
 Warm colors, 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 service should be
displayed
14-Mar-24

 A separate family consultation room is strongly
recommended
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 & patient
transportation should be rapid and un obstructed
 When elevator transport is required, an oversized keyed
elevator, separate from public access should be provided
14-Mar-24

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
14-Mar-24

Supply and Service Corridors
 The corridor should be at least 8 feet in width
 Door ways, openings and passages into each ICU must be
36 inches in width to allow easy and unobstructed
movement of equipment & supplies
 Floor coverings should be chosen to withstand heavy use
and allow heavy wheeled equipment to be moved without
difficulty
14-Mar-24

Patient Modules
 Ward type ICUs should at least 225 square feet of clear floor area
per bed
 ICUs with individual patient modules should allow at least 250
squire feet per room
 A cardiac arrest/emergency alarm button must be present and
every bedside within the ICU
 Storage should be provided for each personal belonging, patient
supplies, linen and toiletries
 Locking drawers and cabinets must be used if syringes &
pharmaceutical agents are stored in the bedside
 Personal belonging should not be kept in the ICU, rather these
should be held by hospital security until the patient is discharged
14-Mar-24

Utilities
 Each ICU must have:
1. Electrical power
2. Water, oxygen
3. Compressed air
4. Vacuum
5. lighting
14-Mar-24

Water Supply
 Should be from a certified source
 Dialysis water should further be treated
 Hand washing sinks should be deep and wide enough to
prevent splashing preferably equipped with elbow taps
 Must be available near the patients rooms or bed
14-Mar-24

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
14-Mar-24

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