CONCEPT OF CRITICAL CARE

INTRODUCTION

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.
THE INTENSIVE CARE TEAM.

This team
Doctor
Nurses
Therapists
Nutritionists
Chaplains and other support
staff, builds an environment
for healing or dying.
CRITICAL CARE NURSING
Critical care nursing is that specialty
within nursing that deals specifically
with human responses to life-
threatening problems.
CRITICAL CARE NURSING
Critical care nursing is that specialty
within nursing that deals specifically
with human responses to life-
threatening problems.
SEVEN 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).

CRITICAL 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 .

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.

THE 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.
THE 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 .
HISTORICAL 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
Bennett, D. et al. BMJ 1999;318:1468-1470
Bennett, D. et al. BMJ 1999;318:1468-1470
Bennett, D. et al. BMJ 1999;318:1468-1470
HISTORICAL 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.
HISTORICAL 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.
CONTEXTUAL 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
TYPES 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.
ICUS CAN BE CLASSIFIED AS:

Level I: This can be referred as high
dependency is where close monitoring,
resuscitation, and short term ventilation
<24hrs 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.
STAFFING

Large hospital requires bigger team.
Medical 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.

NURSING 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 1:1 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.

UNIT 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.
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.

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.


NURSE 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
NURSE 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
Critical 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.
Critical 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.
RESPIRATORY 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.
RESPIRATORY 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.

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:
PHYSICIAN SUBSPECIALISTS
General surgeon or trauma surgeon
Neurosurgeon
Cardiovascular surgeon
Obstetric-gynecologic surgeon
Urologist
Thoracic surgeon
Vascular surgeon
Anesthesiologist
Cardiologist with interventional capabilities
Pulmonologist
PHYSICIAN SUBSPECIALISTS

Gastroenterologist
Hematologist
Infectious disease specialist
Nephrologist
Neuroradiologist (with interventional
capability)
Pathologist
Radiologist (with interventional capability)
Neurologist
Orthopedic surgeon
S.NO
.
THERAPIST FUNCTION
1. Physiotherap
ists

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. Microbiologi
sts
Advise on treatment and
infection control
5. Medical
physics
technicians
Maintain equipment,
including patient monitors,
ventilators, haemofiltration
machines, and blood gas
analysers
OTHER 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.
LABORATORY 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.
Radiology 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.
ORGANIZATION 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.

ORGANIZATION 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.

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.
DEFINITION 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.

PURPOSE

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
DESCRIPTION

Intensive care unit equipment
includes:-
patient monitoring
life support and emergency
resuscitation devices
diagnostic devices
PATIENT MONITORING
EQUIPMENTS
Acute care physiologic monitoring
system
Pulse oximeter
Intracranial pressure monitor
Apnea monitor
Bennett, D. et al. BMJ 1999;318:1468-1470
LIFE SUPPORT & RESUSCITATIVE
EQUIPMENTS
VENTILATOR
INFUSION PUMP
CRASH CART
INTRAAORTIC BALOON PUMP
Bennett, D. et al. BMJ 1999;318:1468-1470
DIAGNOSTIC EQUIPMENTS
MOBILE X-RAYS
PORTABLE CLINICAL LAB. DEVICES
BLOOD ANALYZER

THERAPEUTIC 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.

THERAPEUTIC 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.
ICU deign should be approached
by multidisciplinary team
consisting of :-
ICU MEDICAL DIRECTORS
ICU NURSE MANAGER
THE CHIEF ARCHITECT
THE OPERATING ENGINEERING
STAFF

ENVIORNMENTAL ENGINEER
INTERIOR DESIGNERS
STAFF NURSES
PHYSICIANS
PATIENTS
FAMILIES
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.
FLOOR 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.

FLOOR 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.
FLOOR 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
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.
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
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 .
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
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.
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.
RECEPTIONIST 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.
Special 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.

Special 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
Clean 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.
Clean 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.

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.
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 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.
Staff 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.
.
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.
Visitors' 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.

Visitors' 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.

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.
When elevator transport is required, an
oversized keyed elevator, separate from
public access, should be provided.
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.
Supply 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 .

Patient 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).
Patient 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.

Patient 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.

Patient 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.
Patient 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

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.

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.

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.



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 .
ELECTRIC 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.
Water 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.
Lightning

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
Environmental 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.
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.

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.
Bedside terminals facilitate
patient management by permitting
nurses and physicians to remain at
the bedside during the charting
process.
OTHER FACILITIES
Voice Intercommunication
Systems
Satellite Laboratory
Physician On-Call Rooms
Administrative Offices