Title: CONCEPT OF CRITICAL CARE
1CONCEPT OF CRITICAL CARE
- PRESENTED BY-
- JASPREET KAUR SODHI
- MSc.FINAL YEAR
2INTRODUCTION
- The intensive care unit is not merely a room or
series of room filled with patients attached to
interventional technology it is the home of an
organization the intensive care team.
3THE INTENSIVE CARE TEAM.
- This team
- Doctor
- Nurses
- Therapists
- Nutritionists
- Chaplains and other support staff, builds an
environment for healing or dying.
4CRITICAL CARE NURSING
- Critical care nursing is that specialty within
nursing that deals specifically with human
responses to life-threatening problems.
5CRITICAL CARE NURSING
- Critical care nursing is that specialty within
nursing that deals specifically with human
responses to life-threatening problems.
6SEVEN Cs OF CRITICAL CARE
- Compassion
- Communication (with patient and family).
- Consideration (to patients, relatives and
colleagues) and avoidance of Conflict. - Comfort prevention of suffering
- Carefulness (avoidance of injury)
- Consistency
- Closure (ethics and withdrawal of care).
7CRITICAL CARE NURSE
- A critical care nurse is a licensed professional
nurse who is responsible for ensuring that
acutely and critically ill patients and their
families receive optimal care .
8CRITICAL 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.
9THE AIM OF THE CRITICAL CARE-
- is to see that one provides a care such that
patient improves and survives the acute illness
or tides over the acute exacerbation of the
chronic illness.
10THE EVOLUTION OF CRITICAL CARE
- Forty years of development in critical care and
critical care nursing has given rise to a
recognized speciality in nursing practice . - Critical care units have evolved over the last
four decades in response to medical advances .
11HISTORICAL PRESPECTIVES
- Florence nightingale recognized the need to
consider the severity of illness in bed
allocation of patients and placed the seriously
ill patients near the nurses station. - 1923, John Hopkins University Hospital developed
a special care unit for neurosurgical patients . - Modern medicines boomed to its higher ladder
after world war 2
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13Bennett, D. et al. BMJ 19993181468-1470
14Bennett, D. et al. BMJ 19993181468-1470
15Bennett, D. et al. BMJ 19993181468-1470
16HISTORICAL PRESPECTIVES
- As surgical techniques advanced it became
necessary that post operative patient required
careful monitoring and this came about the
recovery room. - In 1950, the epidemic of poliomyelitis
necessitated thousands of patients requiring
respiratory assist devices and intensive nursing
care. - At the same time came about newer horizons in
cardiothoracic surgery, with refinements in
intraoperative membrane oxygen techniques.
17HISTORICAL PRESPECTIVES
- In 1953, Manchester Memorial Hospital opened a
four bedded unit at Philadelphia was started. - By 1957, there were 20 units in USA and
- In 1958,the number increased to 150.
18CONTEXTUAL FORCES
- The expansion of American hospital system and
hospital insurance. - Architectural, hospital changes towards private
and semi private accommodations. - Reallocations for direct patient care
responsibility and creations of new forms of
care. - During 1970s,the term critical care unit came
into existence which covered all types of special
care
19TYPES OF ICUs
- There are two types of ICUs,
- An open -. In this type, physicians admit,
treat and discharge and - A closed in this type, the admission, discharge
and referral policies are under the control of
intensivists.
20ICUS CAN BE CLASSIFIED AS
- Level I This can be referred as high dependency
is where close monitoring, resuscitation, and
short term ventilation lt24hrs has to be
performed. - Level II Can be located in general hospital,
undertake more prolonged ventilation. Must have
resident doctors, nurses, access to pathology,
radiology, etc. - Level III Located in a major tertiary hospital,
which is a referral hospital. It should provide
all aspects of intensive care required.
21STAFFING
- Large hospital requires bigger team.
22Medical staff
- Carrier intensivists are the best senior medical
- Staff to be appointed to the ICU.
- He/she will be the director.
- Less preferred are other specialists viz. From
Anaesthesia, medicine and chest who have clinical
Commitment elsewhere. - Junior staff are intensive care trainees and
trainees on deputation from other disciplines.
23NURSING STAFF
- The major teaching tertiary care ICU will require
trained nurses in critical care. - It may be ideal to have an in house training
programme for critical Care nursing. - The number of nurses ideally required for such
units is 11 ratio. - In complex situations they may require two
nurses per patient. - The number of trained nurses should be also
worked out by the type of ICU, the workload and
work statistics and type of patient load.
24UNIT DIRECTOR-
- Specific requirements for the unit director
include the following - Training, interest, and time availability to give
clinical, administrative, and educational
direction to the ICU. - Board certification in critical care medicine.
- Time and commitment to maintain active and
regular involvement in the care of patients in
the unit.
25- Availability (either the director or a similarly
qualified surrogate) to the unit 24 hrs a day, 7
days a week for both clinical and administrative
matters. - Active involvement in local and/or national
critical care societies.
26- Participation in continuing education programs in
the field of critical care medicine. - Hospital privileges to perform relevant invasive
procedures. - Active involvement as an advisor and participant
in organizing care of the critically ill patient
in the community as a whole. - Active participation in the education of unit
staff. - Active participation in the review of the
appropriate use of ICU resources in the hospital.
27NURSE MANAGER
- An RN (registered nurse) with a BSN (bachelor of
science in nursing) or preferably an MSN (master
of science in nursing) degree - Certification in critical care or equivalent
graduate education - At least 2 yrs experience working in a critical
care unit - Experience with health information systems,
quality improvement/risk management activities,
and healthcare economics - Ability to ensure that critical care nursing
practice meets appropriate standards . - Preparation to participate in the on-site
education of critical care unit nursing staff
28NURSE MANAGER
- Ability to foster a cooperative atmosphere with
regard to the training of nurses, physicians,
pharmacists, respiratory therapists, and other
personnel involved in the care of critical care
unit patients - Regular participation in ongoing continuing
nursing education - Knowledge about current advances in the field of
critical care nursing - Participation in strategic planning and redesign
efforts
29Critical Care Unit nursing requirements-
- All patient care is carried out directly by or
under supervision of a trained critical care
nurse. - All nurses working in critical care should
complete a clinical/didactic critical care course
before assuming full responsibility for patient
care. - Unit orientation is required before assuming
responsibility for patient care. - Nurse-to-patient ratios should be based on
patient acuity according to written hospital
policies.
30Critical Care Unit nursing requirements -
- All critical care nurses must participate in
continuing education. - An appropriate number of nurses should be trained
in highly specialized techniques such as renal
replacement therapy, intra-aortic balloon pump
monitoring, and intracranial pressure monitoring.
- All nurses should be familiar with the
indications for and complications of renal
replacement therapy.
31RESPIRATORY CARE PERSONNEL REQUIREMENTS
- Respiratory care services should be available 24
hrs a day, 7 days a week. - An appropriate number of respiratory therapists
with specialized training must be available to
the unit at all times. Ideal levels of staffing
should be based on acuity, using objective
measures whenever possible. - Therapists must undergo orientation to the unit
before providing care to ICU patients.
32RESPIRATORY CARE PERSONNEL REQUIREMENTS
- The therapist must have expertise in the use of
mechanical ventilators, including the various
ventilatory modes. - Proficiency in the transport of critically ill
patients is required. - Respiratory therapists should participate in
continuing education and quality improvement
related to their unit activities.
33- Ideally, 24-hr in-house coverage should be
provided by intensivists who are dedicated to the
care of ICU patients and do not have conflicting
responsibilities. - Ideal intensivist-to-patient ratios vary from ICU
to ICU depending on the hospitals unique patient
population. Hospitals should have guidelines for
these ratios based on acuity, complexity, and
safety considerations. - The following physician subspecialists should be
available and be able to provide bedside patient
care within 30 mins
34PHYSICIAN SUBSPECIALISTS
- General surgeon or trauma surgeon
- Neurosurgeon
- Cardiovascular surgeon
- Obstetric-gynecologic surgeon
- Urologist
- Thoracic surgeon
- Vascular surgeon
- Anesthesiologist
- Cardiologist with interventional capabilities
- Pulmonologist
35PHYSICIAN SUBSPECIALISTS
- Gastroenterologist
- Hematologist
- Infectious disease specialist
- Nephrologist
- Neuroradiologist (with interventional capability)
- Pathologist
- Radiologist (with interventional capability)
- Neurologist
- Orthopedic surgeon
36S.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
37OTHER PERSONNEL
- A variety of other personnel may contribute
significantly to the efficient operation of the
ICU. These include- - Unit clerks
- physical therapists
- occupational therapists
- Advanced practice nurses
- Physician assistants
- Dietary specialists, and
- Biomedical engineers.
38LABORATORY SERVICES
- A clinical laboratory should be available on a
24-hr basis to provide basic hematologic,
chemistry, blood gas, and toxicology analysis. - Laboratory tests must be obtained in a timely
manner, immediately in some instances. "STAT" or
"bedside" laboratories adjacent to the ICU or
rapid transport systems.
39Radiology and imaging services
- The diagnostic and therapeutic radiologic
procedures should be immediately available to ICU
patients, 24 hrs per day. - Portable chest radiographs affect decision making
in critically ill patients.
40ORGANIZATION OF ICU
- It requires intelligent planning.
- One must keep the need of the hospital and its
location. - 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.
41ORGANIZATION OF ICU
- The number of ICU beds in a hospital ranges from
1 to 10 per 100 total hospital beds. - Multidisciplinary requires more beds than single
speciality. ICUs with fewer than 4 beds are not
cost effective and over 20 beds are unmanageable.
- ICU should be sited in close proximity to
relevant areas viz. operating rooms, image logy,
acute wards, emergency department. - There should be sufficient number of lifts
available to carry these critically ill patients
to different areas.
42 ORGANIZATIONAL MODELS FOR ICUs
- the open model allows many different members of
the medical staff to manage patients in the ICU. - the closed model is limited to ICU-certified
physicians managing the care of all patients and - the hybrid model, which combines aspects of open
and closed models by staffing the ICU with an
attending physician and/or team to work in tandem
with primary physicians.
43DEFINITION OF INTENSIVE CARE UNIT EQUIPMENTS-
- Intensive care unit (ICU) equipment includes
patient monitoring, respiratory and cardiac
support, pain management, emergency resuscitation
devices, and other life support equipment
designed to care for patients who are seriously
injured, have a critical or life-threatening
illness, or have undergone a major surgical
procedure, thereby requiring 24-hour care and
monitoring.
44PURPOSE
- An ICU may be designed and equipped to provide
care to patients with a range of conditions, or
it may be designed and equipped to provide
specialized care to patients with specific
conditions
45DESCRIPTION
- Intensive care unit equipment includes-
- patient monitoring
- life support and emergency resuscitation devices
- diagnostic devices
46PATIENT MONITORING EQUIPMENTS
- Acute care physiologic monitoring system
- Pulse oximeter
- Intracranial pressure monitor
- Apnea monitor
47Bennett, D. et al. BMJ 19993181468-1470
48LIFE SUPPORT RESUSCITATIVE EQUIPMENTS
- VENTILATOR
- INFUSION PUMP
- CRASH CART
- INTRAAORTIC BALOON PUMP
49Bennett, D. et al. BMJ 19993181468-1470
50DIAGNOSTIC EQUIPMENTS
- MOBILE X-RAYS
- PORTABLE CLINICAL LAB. DEVICES
- BLOOD ANALYZER
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53- PHYSICAL SET UP OF 5 BEDDED ICU
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55THERAPEUTIC ELEMENTS IN ICU ENVIORNMENT
- Window and art that provides natural views views
of nature can reduce stress, hasten recovery,
lower blood pressure and lower pain medication
needs. - Family participation ,including facilities for
overnight stay and comfortable waiting rooms.
56THERAPEUTIC ELEMENTS IN ICU ENVIORNMENT
- Providng a measure of privacy and personal
control through adjustable curtains and blinds
,accessible bed controls ,and TV ,VCR and CD
players. - Noise reduction through computerized pagers and
silent alarms. - Medical team continuity that allows one team to
follow the patient through his or her entire stay.
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58ICU TEAM
- ICU deign should be approached by
multidisciplinary team consisting of - - ICU MEDICAL DIRECTORS
- ICU NURSE MANAGER
- THE CHIEF ARCHITECT
- THE OPERATING ENGINEERING STAFF
59OTHER ADDITIONAL MEMBERS
- ENVIORNMENTAL ENGINEER
- INTERIOR DESIGNERS
- STAFF NURSES
- PHYSICIANS
- PATIENTS
- FAMILIES
60- THE CHIEF ARCHITECT -He must be experienced in
hospital space programming and hospital
functional planning. - ENGINEER He should be experienced in the
design of mechanical and electrical systems For
hopitals,especially critical care unit.
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62FLOOR PLAN AND DESIGN
- IT SHOULD BE BASED ON-
- Patient admission pattern
- Staff visitor traffic patterns
- Need for support facilities such a nursing
station ,Storage, clerical space, - Administrative educational requirements.
- Services that are unique to the individual
institution.
63FLOOR PLAN AND DESIGN
- Eight to twelve beds per unit is considered best
from a functional perspective . - Each healthcare facility should consider the
need for positive- and negative pressure
isolation rooms within the ICU. - This need will depend mainly upon patient
population and State Department of Public Health
requirements.
64FLOOR PLAN AND DESIGN
- Each intensive care unit should be a
geographically distinct area within the hospital,
when possible, with controlled access. - No through traffic to other departments should
occur. Supply and professional traffic should be
separated from public/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
65PATIENT AREAS.-
- Patients must be situated so that direct or
indirect (e.g. by video monitor) visualization by
healthcare providers is possible at all times.
This permits the monitoring of patient status
under both routine .and emergency circumstances.
The preferred design is to allow a direct line of
vision between the patient and the central
nursing station. - In ICUs with a modular design, patients should
be visible from their respective nursing
substations. - Sliding glass doors and partitions facilitate
this arrangement, and increase access to the room
in emergency situations.
66RECOMMENDED NOISE RANGES
- Signals from patient call systems, alarms from
monitoring equipment, and telephones add to the
sensory overload in critical care units. - The International Noise Council has recommended
that noise levels in hospital acute care areas - not exceed 45 dB(A) in the daytime,
- 40 dB(A) in the evening,
- 20 dB(A) at night.
- ?Notably, noise levels in most hospitals are
between 50-70 dB(A) with occasional episodes
above this range
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68CENTRAL STATION
- A central nursing station should provide a
comfortable area of sufficient size to
accommodate all necessary staff functions. - When an ICU is of a modular design, each nursing
substation should be capable of providing most if
not all functions of a central station. - There must be adequate overhead and task
lighting, and a wall mounted clock should be
present. - Adequate space for computer terminals and
printers is essential when automated systems are
in use. - Patient records should be readily accessible .
69CENTRAL STATION
- Adequate surface space and seating for medical
record charting by both physicians and nurses
should be provided. - Shelving, file cabinets and other storage for
medical record 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
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71X-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 radiographs. - An illuminated viewing box or carousel of
appropriate size should be present to allow for
the simultaneous viewing of serial radiographs. - A "bright light" should also be available.
72WORK AREAS AND STORAGE
- Work areas and storage for critical supplies
should be located within or immediately adjacent
to each ICU. - 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 sink with hot and
cold running water. - Countertops must be provided for medication
preparation, and cabinets should be available for
the storage of medications and supplies.
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74RECEPTION AREA
75RECEPTIONIST AREA
- Each ICU or ICU cluster should have a
receptionist area to control visitor access. - Ideally, it should be located so that all
visitors must pass by this area before entering. - The receptionist should be linked with the
ICU(s) by telephone and/or other
intercommunication system. - It is desirable to have a visitors' entrance
separate from that used by healthcare
professionals. - The visitors' entrance should be securable if the
need arises.
76Special Procedures Room.
- If a special procedures room is desired, it
should be located within, or immediately adjacent
to, the ICU. - One special procedures room may serve several
ICUs in close proximity. - Consideration should be given to ease of access
for patients transported from areas outside the
ICU. - Room size should be sufficient to accommodate
necessary equipment and personnel.
77Special Procedures Room.
- Monitoring capabilities, equipment, support
services, and safety considerations must be
consistent with those provided in the ICU proper.
- Work surfaces and storage areas must be adequate
enough to maintain all necessary supplies and
permit the performance of all desired procedures
without the need for healthcare personnel to
leave the room
78Clean and Dirty Utility Rooms.
- Clean and dirty utility rooms must be separate
rooms that lack interconnection. - They must be adequately temperature controlled,
and the air supply from the dirty utility room
must be exhausted. - Floors should be covered with materials without
seams to facilitate cleaning. - The clean utility room should be used for the
storage of all clean and sterile supplies, and
may also be used for the storage of clean linen.
79Clean and Dirty Utility Rooms.
- Shelving and cabinets for storage must be located
high enough off the floor to allow easy access to
the floor underneath for cleaning. - The dirty utility room must contain a clinical
sink and a hopper both with hot and cold mixing
faucets. - Separate covered containers must be provided for
soiled linen and waste materials. - There should be designated mechanisms for the
disposal of items contaminated by body substances
and fluids. - Special containers should be provided for the
disposal of needles and other sharp objects.
80Equipment Storage
- An area must be provided for the storage and
securing of large patient care equipment 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
within the storage area in sufficient numbers to
permit recharging of battery operated items.
81Nourishment 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 running water, a countertop stove and/or
microwave oven, and a refrigerator. - The refrigerator should not be used for the
storage of laboratory specimens. - A hand washing facility should be located in or
near the area.
82Staff Lounge.
- A staff lounge must be available on or near each
ICU or ICU cluster to provide a private,
comfortable, and relaxing environment. - Secured locker facilities, showers and toilets
should be present. - The area should include comfortable seating and
adequate nourishment storage and preparation
facilities, including a refrigerator, a
countertop stove and/or microwave oven. - The lounge must be linked to the ICU by telephone
or intercommunication system, and emergency
cardiac arrest alarms should be audible within.
83Conference Room.
- A conference room should be conveniently located
for ICU physician and staff use. - This room must be linked to each relevant ICU by
telephone or other intercommunication system, and
emergency cardiac arrest alarms should be audible
in the room. - The conference room may have multiple purposes
including continuing education, house staff
education, or multidisciplinary patient care
conferences. - A conference room is ideal for the storage of
medical and nursing reference materials and
resources, VCRs, and computerized interactive and
self-paced learning equipment. - If the conference room is not large enough for
educational activities, a classroom should also
be provided nearby.
84Visitors' Lounge/Waiting Room.
- A visitors' lounge or waiting area should be
provided near each ICU or ICU cluster. - Visitor access should be controlled from the
receptionist area. One and one-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/or music should be provided.
- Public toilet facilities and a drinking fountain
should be located within the lounge area or
immediately adjacent.
85Visitors' Lounge/Waiting Room.
- Warm colours, 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 services
should be displayed. - A separate family consultation room is strongly
recommended.
86Patient 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. - When elevator transport is required, an oversized
keyed elevator, separate from public access,
should be provided.
87Supply 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.
88Supply and Service Corridors
- 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
easy and unobstructed movement of equipment and
supplies. - Floor coverings should be chosen to withstand
heavy use and allow heavy wheeled equipment to be
moved without difficulty .
89Patient Modules
- Ward-type icus should allow at least 225 square
feet of clear floor area per bed. - Icus with individual patient modules should
allow at least 250 square feet per room (assuming
one patient per room), - Provide a minimum width of 15 feet, excluding
ancillary spaces (anteroom, toilet, storage).
90Patient Modules
- Isolation rooms should each contain at least 250
square feet of floor space plus an anteroom. - Each anteroom should contain at least 20 square
feet to accommodate hand-washing, gowning, and
storage. - If a toilet is provided, it must be private.
91Patient Modules
- A cardiac arrest/emergency alarm button must be
present at every bedside within the ICU. The
alarm should automatically sound in the hospital
telecommunications center, central nursing
station, ICU conference room, staff lounge, and
any on-call rooms. The origin of these alarms
must be discernable. - Space and surfaces for computer terminals and
patient charting should be incorporated into the
design of each patient module as indicated.
92Patient Modules
- Storage must be provided for each patient's
personal belongings, patient care supplies, linen
and toiletries. Locking drawers and cabinets must
be used if syringes and pharmaceuticals are
stored at the bedside. - Personal valuables should not be kept in the ICU.
Rather, these should be held by Hospital Security
until patient discharge. - Every effort should be made to provide an
environment that minimizes stress to patients and
staff. Therefore, design should consider natural
illumination and view.
93Patient Modules
- Windows are an important aspect of sensory
orientation, and as many rooms as possible should
have windows to reinforce day/night orientation . - Drapes or shades of fireproof fabric can make
attractive window coverings and serve to absorb
sound. - Window treatments should be durable and easy to
clean, and a schedule for their cleaning must be
established
94IMPROVING 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.
95- Comfort considerations should include methods for
establishing privacy for the patient. Shades,
blinds, curtains, and doors should control the
patient's contact with his/her surroundings. - A supply of portable or folding chairs should be
available to allow for family visits at the
bedside. An additional comfort consideration is
the choice of color scheme for the room, which
should promote rest and have a calming effect. -
96- To provide for visual interest, one or more walls
within patient view may be selected for an accent
color, texture, graphic design or picture . - Advice from environmental engineers and designers
should be sought to deinstitutionalize patient
care areas as much as possible.
97Utilities
- Each intensive care unit must have -
- Electrical power,
- Water, oxygen,
- Compressed air,
- Vacuum, lighting,
- And environmental control systems
- that support the needs
of the patients and critical care team under
normal and emergency situations, and these must
meet or exceed regulatory and accreditation
agency codes and standards .
98ELECTRIC SUPPLY
- Grounded 110 volt electrical outlets with 30 amp
circuit breakers should be located within a few
feet of each patient's bed . - Sixteen outlets per bed are desirable.
- Outlets at the head of the bed should be placed
approximately 36 inches above the floor to
facilitate connection, - To discourage disconnection by pulling the power
cord rather than the plug. - Outlets at the sides and foot of the bed should
be placed close to the floor to avoid tripping
over electrical cords.
99Water Supply.
- The water supply must be from a certified source,
especially if hemodialysis is to be performed. - Zone stop valves must be installed on pipes
entering each ICU to allow service to be turned
off should line breaks occur. - Hand-washing sinks deep and wide enough to
prevent splashing, preferably equipped with
elbow-, knee-, foot-, or sonar-operated faucets,
must be available near the entrances to patient
modules, or between every two patients in
ward-type units.
100Lightning
- Total luminance should not exceed 30
foot-candles . - It is preferable to place lighting controls on
variable-control dimmers located just outside of
the room. - Night lighting should not exceed 6.5 fc for
continuous use or 19 fc for short periods. - Separate lighting for emergencies and procedures
should be located in the ceiling directly above
the patient and should fully illuminate the
patient with at least 150 fc shadow-free - A patient reading light is desirable, and should
be mounted
101Environmental Control Systems.
- A minimum of six total air changes per room per
hour are required, with two air changes per hour
composed of outside air. - For rooms having toilets, the required toilet
exhaust of 75 cubic feet per minute should be
composed of outside air. - Central air-conditioning systems and recirculated
air must pass through appropriate filters.
102- Air-conditioning and heating should be provided
with an emphasis on patient comfort. - For critical care units having enclosed patient
modules, the temperature should be adjustable
within each module.
103Computerized 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. - Bedside terminals facilitate patient management
by permitting nurses and physicians to remain at
the bedside during the charting process.
104OTHER FACILITIES
- Voice Intercommunication Systems
- Satellite Laboratory
- Physician On-Call Rooms
- Administrative Offices
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