Progressive patient care (PPC) aims to provide the optimal level of care for patients based on their needs at the lowest possible cost. PPC involves grouping patients according to their care needs and moving them between intensive care, intermediate care, self-care, long-term care, home care, and ambulatory care units. Benefits of PPC include specialized attention for patients when needed, more efficient use of hospital resources, and assurance that patients receive high-quality nursing care. Key elements of PPC include criteria for admission and discharge from units and adequate staffing of units. Implementation of PPC requires evaluation of patient needs, orientation of staff, and consideration of costs.

2. PROGRESSIVE PATIENT CARE
PPC has been defined as "the right
patient, in the right bed, with the
right services, at the right time"
(Haldeman JC, 1964)

3. PURPOSES OF PROGRESSIVE PATIENT CARE
PPC is to provide optimum level of care to the patient as
per need in minimum cost.
To raise the level of patient care of those critically ill
patients with effective use of nursing personnel and
facilities by grouping the patients as per their nursing care
need.
PPC is also seen as an important method of controlling cost
with provision of nursing care as per the need of various
patients.

5. BENEFITS OF PPC
PATIENT
HOSPITAL
PHYSICIAN
NURSE

6. The
Patient:
The patient
receives the
specialized
attention when
he needs it.
he is assisted in
making his
adjustment first with
the hospital
atmosphere and
later on his return
with tr.'« home and
the community; and
The patients who
are not critically ill
are not deprived
of nursing and
medical attention
as the critically ill
patients are
separated.

7. The
Physician
The physician is given a greater
assurance that his patient is receiving a
high quality of nursing care.
Emergency treatment if necessary is in
the immediate vicinity of the patient

8. THE NURSE
The nurse makes an effective use of her special
capabilities
The problems of providing services by nurses to
critically ill patients are reduced.
It helps the nurses to devote their full attention and skills
to the best to meet the needs of the patient.
It helps the nurses to plan the nursing care for the patients
better as the needs are of almost same degree in each unit.
The nursing staff can also have benefits from the inservice training programme

9. The
Hospital:
The beds,
physical
facilities,
equipment,
supplies and
funds
available in
the hospital
may be used
efficiently.
Use of
trained
personnel
reduces
personnel
turnover and
improved
administratio
n
Improves
public image
of the
hospital in
the
community.
Home care
programme
as a part of
PPC helps
the hospital
to coordinate
its activities
with the
community
health and
social
services.

10. ELEMENTS OF PROGRESSIVE
PATIENT CARE
Intensive Care
Intermediate Care
Self Care
Long Term or Extended Care
Home Care
Ambulatory or Outpatient Care

11. INTENSIVE CARE UNIT

12. ICU
LOCATION - Accessible to OT, OPD, ED.
SIZE - Two to eight percent of total hospital beds
PHYSICAL FACILITIES
AREA - Min 150 sq. feet per bed.
AIR-CONDITIONING – 60-70 degree F
50-60 %humidity

13. c. Ventilation - Positive pressure in ICU should be maintained to
prevent contaminated air from passages into unit. Avoid exhaust
fans creating negative pressure.
d. Lights - The patient area should be uniformly lit. There should
be provision for light below bed level to check the drainage
bottle, water seal.
e. Piped Supply - Piped oxygen with two outlets for each bed
supplying 20 litres per minute at a pressure of 60 pounds per
square feet.
f. Piped vacuum - Central suction with two outlets with
manometer for each bed is necessary and air extraction at 40
litres/minute. The vacuum in pipeline is 500 mm. of Hg.

14. COMMUNICATION
Call bell - attached from each bed to nursing
station
Call bell - attached from nursing station to doctor’s
room.
Telephone — at least two telephones one for
internal and one for external lines.
Paging system should be introduced for calling
consultants and residents from the respective area of
their work place.

15. ELECTRICAL FACILITY
i. 4-5 power plugs arrangements for each bed and a special
socket of 60amperes. 230 volts, single phase for portable
radiographic equipment should be provided.
ii. All outlets and lights should be connected to the emergency
power system.
iii. There should be provision for a stand by generator for ICU.
PATIENT AREA
•Ample visibility of all the patients from the nurses' desk.
•One or two isolation rooms should be attached to unit.
•Each bed should be separated from the other by partition to
provide necessary privacy.

16. ANCILLARY AREA
Nurses'
Station
Store
Medicine
Cabinet
Consultation
Office
Medication
Preparation
Room
Doctors’
Charting
Area

17. SANITARY AREA
The soiled holding or dirty utility
room.
 A toilet
 The water closet should be
equipped with bedpan lugs and
flushing attachment for cleaning
bedpans and for disposing of fluids.
 A sink in counter will take care of
the minor utility functions of this
room. The major utility functions
should be carried out in the main
utility room

18. AUXILIARY AREA
Nurses’ Room
A
doctors'
rest room
Relatives’
waiting
room
Small laboratory

19. EQUIPMENT
1. Wall mounted
sphygmomanometers.
2. Intravenous rods
attached to each bed.
3. Equipment for
respiratory resuscitation
4. Cardiac monitoring
equipment
5. Sets for venisection,
catheterization, lumber
puncture etc.

20. STAFFING
•Medical staff for 24 hours.
•At least one medical officer per shift .
•The medical officer in-charge of the ICU
is usually an anaesthetist for generalized
ICU and the respective specialist for
specialised ICU.
•Nurse - One nursing sister in charge of
the ICU is recommended.
The nurse patient ratio as 2:1.
•Technical Staff like physiotherapist,
Inhalation therapist, ECG technician,
electronic technician, biomedical
engineering and laboratory technician

21. MANAGEMENT
1. ICU committee should be appointed
consisting of one representative of
surgery, medicine, neuro-surgery,
nursing service and hospital
administration and anesthetists as
chairman.
2. The medical officer incharge of the ICU
for day-to-day administration should
have a final authority to transfer in and
out the ICU.
3. Any controversy or problem should be
referred to the ICU committee.
4. A patient who is transferred to ICU is
the responsibility of the transferring unit
for his treatment.

22. 





Admission/Discharge Criteria: Define objective criteria should be laid
down for admission and discharge of patient based on the patient's
condition:
degree of illness,
nursing and medical needs
As a general rule, patients in need of continuous observation and
monitoring of vital signs and the total support of physiological system
should be admitted to ICU.
Usually the terminally ill, contagious disease patients, post operative
thoracic cases with active tuberculosis, violent patients are not
admitted to ICU, Each admission is done with consent of the medical
officer incharge of ICU.
If required, patients can be admitted directly to the ICU. A separate
admission and discharge register is maintained in ICU for record and
study the utilization of ICU.

23. ii. Bed Utilization: Ideal bed occupancy rate for ICU is 75-80 per
cent leaving 20-25 per cent of beds vacant for unforeseen
emergencies.
iii. All treatment and medication should be written.
iv. Special observation chart for each patient should be maintained.
v. Rules for Visitors: (a) visitors should be restricted to immediate
family; (b) one person should be allowed at a time, and (c) duration
of the visit should be very short.
vi. Proper Information System for Relatives: The doctor in charge of
the patient is responsible to inform the relatives about the
condition of the patient.

24. vii. Discharge summary must be made by the attending
physician prior to discharge of the patient from ICU.
viii. Dietary Services: The nutritional requirements of these
patients must be evaluated on a daily basis. Mostly the patients
will require modified diet consisting primarily of liquids and soft
food.
ix. Training of Staff: For each staff to be appointed to ICU,
training programmes should be organized. If special training for
ICU is not available, in-service training for at least three months
in the hospital should be arranged.

25. PROBLEMS
1. To determine the size, type of hospital where this can be implemented
2. To determine the size of Intensive Care Unit
3. It is difficult to decide its location
.
.
.
4. In determining the layout of the unit in already existing hospital
.
5. It is difficult to staff the unit adequately.
6. It becomes difficult to make the supply system function efficiently and to provide
continuous supply of life saving drugs and materials
.
7.
Problems regarding admission and transfer of patients to and from ICU
.
8 It is difficult to have biomedical engineering services available for the maintenance
of the equipment specially sophisticated electronic equipment
.
9.
Political and outside interferences to admission and transfer of patients
.
10.Team building which is very much essential for critical care becomes difficult. It
becomes problematic to have coordination among various units
.
11.It posts psychological stress on the relations and at times on patients
.

26. INTERMEDIATE CARE

27. •30 to 35 beds.
•few single bed rooms, few double bed rooms and the rest in
4 to 6 bed rooms.
•Ancillary areas include - Nurse’s station
Stores
Clean room
Treatment room.
•This unit will require more toilets and bathrooms.
•Supportive areas - Clinical teaching room
Side laboratory
Doctors room
Attendants room
Nurses’changing room

28. STAFFING
SHIFT
NURSE : PATIENT
MORNING
1:6
EVENING
1: 8
NIGHT
1 : 12

29. SELF CARE
Ambulatory patients who are convalescing or require diagnosis
or therapy may be cared for in a self care unit. These patients
are like physically self sufficient requiring diagnostic procedure
not feasible on an outpatient basis, the patient requiring daily or
more frequent specialized treatment such as radiation or
physical therapy, the convalescent patients who need a few
more days help in the adjustment of daily routine or activities
etc.

30. SERVICES
EDUCATIONAL
SUPERVISORY
MEDICAL
NURSING
DIETARY

31. MANAGEMENT
HOME LIKE ROUTINE
NO RESTRICTION TO VISITORS
PERMITTED TO GO OUT

32. PHYSICAL FACILITIES
The self care unit should be located convenient to diagnostic
facilities, the dining room or cafetaria and to the main hospital
entrance.
As these patients demand maximum privacy single bed rooms with
toilets are preferred.
Since an ambulant patient is likely to spend less time in his room
than a bed patient the room can be of minimal size with a small
desk and chair, desk lamp, an easy chair and a bedside small table.

33. The nurses’ station can be of minimal size with glazed
partitions to permit easy supervision of the adjoining areas.
An office with attached toilet should be provided for the
Head Nurse.
An examination-cum-treatment room should be provided.
There should be a demonstration room where patients can
be taught self treatment.
Provision for social recreation facilities for the patient on the
self care unit is important.

34. The spaces required for are as follows:
1. A dayroom.
2. A nourishment room
3. A storage closet for games and
recreational equipment.
4. Toilet facilities for visitors.
5. A sitting room
6. A public telephone booth.

35. STAFFING
ONE TRAINED NURSE WITH
TWO AUXILLARY NURSES IN
EACH SHIFT FOR AN
AVERAGE SIZE OF 30 BEDS

37. PHYSICAL FACILITIES
Optimum size for the long term care unit may be 35 to 40
beds.
The unit may be located anywhere in the hospital.
Patient rooms should be large enough to permit patients
to move freely on wheelchairs, crutches, canes, walkers.
Two bed rooms are recommended, 4 bed rooms may also
be used. A few single bed rooms should be provided.

38. The required minimum area per each bed in multiple bed rooms is100
square feet and for a single bed room 125 sq. feet.
There should be 4-5 feet space left in between 2 beds and 3 feet of
clearance between the adjacent wall and the bed should be maintained.
The space between two ends of beds should be of minimum five feet.
Provision of toilets adjacent to each patient room is recommended for the
convenience of both patients and staff.
Day room and dining space is recommended to encourage early
ambulation.

39. ANCILLARY FACILITIES
CLEAN WORK
ROOM
SOILED
HOLDING
ROOM
TREATMENT
ROOM
NURSES’
STATION
STRETCHER AND
WHEELCHAIR
STORAGE
STORE

40. STAFFING
SHIFT
NURSE : PATIENT
MORNING
1:3
EVENING
1:4
NIGHT
1:6
SERVICES OF PHYSIOTHERAPIST AND OCCUPATIONAL
THERAPIST FOR REHABILITATION.
NURSES’ AIDS AND MEDICAL SOCIAL WORKER.

41. NURSING ROLE

42. HOME CARE

43. SERVICES
DIRECT MEDICAL SERVICES
 NURSING CARE IN COMMUNITY
 SOCIAL SERVICES
 SUPPORTIVE SERVICES
 LIKE PHYSICAL THERAPY,
SPEECH THERAPY etc.

44. NURSING ACTIVITIES
FACILITIES

45. AMBULATORY CARE
It means care of the ambulatory
patients requiring diagnostic, curative,
preventive and rehabilitative services
and who are not registered as
inpatients in the hospitals
.

46. CATEGORIES OF OUTPATIENT
GENERAL OUTPATIENT CARE
REFERRED OUTPATIENT
EMERGENCY OUTPATIENT

47. PLANNING OF PROGRESSIVE PATIENT CARE
Depends upon hospital layout
Need of people served by hospital
Principles and objectives of different levels of care
Developing policies and procedures of implementation
Existing patient care facilities.
Modification needed.
Orientation and motivation of staff
Scheduling of doctors and staff.

48. STEPS OF INTRODUCTION OF PROGRESSIVE
PATIENT CARE CONCEPT
1 Familiarity with the PPC
2 Development of Teamwork
3. Evaluation of Needs:.
4 Orient Staff
5. Estimation of Costs

49. Acceptance to some staff to PPC is not
welcomed and slow.
Rapid change of area and treating staff cut
away the patient staff relation.
Patient not accepting self care in the
hospital.
Observation of nursing care inadequate in
long term patient area.
Patient’s resistance to being transferred
between units.
No separate male and female wards in
different care areas.
Level and nature of duties of nursing staff
is not similar in different care areas.