MINIMUM REQUIREMENTS OF AN ICU. Dr.Rubina Aman Module 1 MCCM

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1 MINIMUM REQUIREMENTS OF AN ICU Dr.Rubina Aman Module 1 MCCM

2 What is an ICU? A specialized section of a hospital that provides comprehensive and continuous care for critically ill patients, who can benefit from treatment.

3 Purpose of an ICU The purpose is simple the practice is complex. Healthcare professionals provide around-the the- clock intensive monitoring and treatment of patients seven days a week. Patients are likely to benefit from the level of care provided. Intensive care benefits patients who are severely ill and medically unstable potentially life- threatening disease or disorder.

4 Who needs ICU care? Criteria for admission excluding patients too well or too sick to benefit from intensive care patients who require an intensive level of care (monitoring and treatment). Patients requiring intensive monitoring who may also require emergency interventions. Medically unstable or critically ill,who do not have much chance for recovery due to the severity of their illness or traumatic injury. Patients generally not eligible for ICU admission as not expected to survive.

5 The ICU team ICU care requires a multidisciplinary team that consists of : Intensivists Pharmacists nurses; respiratory care therapists; other medical consultants including surgery, pediatrics, and anesthesiology.

6 Who is an intensivist? Physician who specializes in intensive care. Responsibilties: Coordinates care with other specialties and allied health professionals. Devotes majority of his professional activity to ICU responsible for patient care in ICU.

7 Who is ICU director? Each ICU or department of Intensive care must have a Director (intensivist( intensivist) In hospitals with several ICUs grouping them in a single directorate is ideal. Responsibilites: Patient care, admission and discharge policies treatment protocols,liaison with relatives. ICU administration,budgeting, collection of data, quality assurance Participation in education and research. Liaison with public re. ethical & social issues related to ICU

8 Specialist equipment Facilities for cardiac monitoring. Invasive haemodynamic monitoring. Temporary cardiac pacing. Ventilatory support Pump controlled administration of drugs Facilities for blood gas and electrolytes in ICU or close vacinity.

9 Demographics 5-8% of hospital beds should be ICU beds Average size of ICU beds Small <100 bed hospitals have 1ICU Large >600 bed hospitals several ICUs Pediatric ICUs bed units Relation b/w ICU vol.and QoCare:High vol better care.

10 Approach to treatment System Approach vs SOAP Major organs/systems supported in ICU cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract (and nutritional condition), hematology, microbiology (including sepsis status), peripheries (and skin), renal (and metabolic), respiratory system

11 Organizational Models of ICU Open units: Patients remain in the service of the admitting physician. Closed Units: ICU director /Intensivist screens all admissions / discharges and assumes direct care Reduction in LOS, morbidity and mortality Requires more doctors

12 P.FerdinandeMembers of the Task Force1of the European Societyof Intensive Care Medicine Recommendations on minimal requirements for Intensive CareDepartments Intensive Care Med (1997) 23:

13 Levels of care Level of care Nurse/patient No. of full time eq./icd bed III 1/1 6 II 1/1.6 4 I 1/3 2

14 Operational guidelines I Department of Intensive care II Multidisciplinary approach size of the functional unit beds Presence of Med.Director Medical staff qualified in intensive care min.3 for 6 beds,24 hr expert cover Nursing staff: Head nurse experienced in intensive care, N/P1/3-1/1 Workload /nurse <40-50 TSS Physiotherapist 1per 12 beds Radiology technician x24h Medical secretary 1/12 beds Cleaning personel specific to ICU trained in infection control III Floor plan Distinct entity, horizontal access to ER, OT recovery room

15 Operational guidelines Accomodation20-25m2/bed 25m2/bed Management Function. communication,flow sheets Visual observation of the patient in nursing area Bedside layout access to head /neck area.minimal hinderance to sockets Vacuum 2outlets/bed Oxygen 3-4/bed grounded socket /bed. Water sinks 2/patient area Hand hygiene /bed Monitoring modular system, visible and audible alarms, unobstructed viewing

16 Operational guidelines Offices, nursing station stores, staff lounge Central services Communication Alarm call Management of equipment

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