setting-up picu - RM Solutions

SETTING-UPPEDIATRIC INTENSIVECARE UNIT(PICU)Abdul-Rahman M. Abu-Taleb, MDChairman, Department of PediatricsPediatric IntensivistKAMC, KKNGH, JEDDAH

SETTING-UP PICUINTRODUCTION‣ Managing critically ill children used tofocus mainly on a biomedical approach‣ Care should move more and take aholistic approach focusing on a patientandfamily-centered care

SETTING-UP PICUINTRODUCTION• Patient acuity, over the last 10-15 years, hasincreased, resulting in a growing need for morePICU beds and sophisticated monitoringequipment.

SETTING-UP PICUINTRODUCTIONAlong with these positive developments, requirementswere identified to set higher standards in all directionsincluding: To optimize the physical environment for critically illchildren and their families To involve parents in the care of their child To have patient- and family-centered approach

SETTING-UP PICUPICU optimal physical environment‣ The role of the actual physical environment has a major impact on thesuccessful management and optimal healing outcome of critically illchildren.‣ Aside from location, space, and staffing the potential of future PICUs tofulfill patients and families needs is by fulfilling additional requirementssuch as:• Ambient and atmospheric features• Functional and technological settings• Psychological, spiritual, and cultural needs• Social support for patients and families to meet their psychosocialneeds

SETTING-UP PICUPICU optimal physical environmentAmbient and atmospheric features address:• Acoustic (noise) The continuous sounds from ventilatorsand beeping of monitors create additional stress• WHO max noise level < 40 dB (35-30 dB)• Hypertension, sleep disturbance, HR• Light PICU tends to be a brightly illuminated place• TemperatureAs PICU tends to be a noisy and brightly illuminated place due tocontinuous procedures and the large number of care providers

SETTING-UP PICUPICU optimal physical environment• Dim lighting tends to reduce the level of activity and noise of staff• Temperature (air-conditioning) and lighting controls should be within reachof staff and families• Private and semiprivate rooms as well as soffits will decrease noise level.• Additional friendlier physical environment approach in PICU is:• Selection of appropriate color schemes• Décor• Selection of interior finishes

SETTING-UP PICUPICU optimal physical environment• Applying a zoning system within a patientroom for patient, family and care givers• Visibility between patientshould be maintainedand care givers

SETTING-UP PICUPICU optimal physical environment• Provision of windows for daylight to maintain circadianrhythms• These suggestions should not compromise unitfunctionality regarding infection control, easymaintenance, durability, stain resistance, flameresistance, non-toxicity and cost effectiveness.

SETTING-UP PICUALLOCATION OF SPACE PICU location should be within or close to pediatric services andas close as possible to important support services:• Operating room• Recovery room• Emergency department• Radiology department• Laboratory• Cardiac Catheterization laboratory• Elevators Proximity to the physician’s on-call-rooms, medical and nursingdirector’s offices, family waiting and sleeping areas is essential.

SETTING-UP PICUALLOCATION OF SPACE Access to the PICU should be controlled & monitored with nothrough traffic Size of the unit is strongly dependent on the number of beds,isolation rooms, private rooms, semiprivate rooms andsupport services area needed.It is highly recommended to have site visits to well establishedPICUs.

SETTING-UP PICUPATIENT CARE AREAS Factors that influence optimal PICU bed number in a given center:• Addresses the population to be served• Existing services and planned projects• Size of the active pediatric department• Number of acutely ill pediatric patients previouslytreated in the center• Maximal occupancy• Average length of stay• High turnover and short stays

SETTING-UP PICUPATIENT CARE AREAS The need for isolation rooms has increased• Infectious diseases• Immunocompromised patients The recommendation in general is to provide atleast one isolation room for each 10 beds however,test results, have shown that usually more than oneisolation room is necessary.

SETTING-UP PICUPATIENT CARE AREAS• If Isolation rooms are used for immunocompromisedchildren, they are best prepared with an anteroom (includinga sink, place to change gowns and drawers to keep gloves,masks, protective eyewear and other items) and havecontrolled airflow (negative and positive pressure airflowcapabilities) to minimize the spread of air-borne infections.

SETTING-UP PICUPATIENT CARE AREAS Thoughts should be given to private and semiprivaterooms versus multiple-bed area or a combination of both• Support Patient- and family- centered approach• Decreased rate of infection• Decreased level of noise

SETTING-UP PICUPATIENT CARE AREASThe required space per bed must be large enough to accommodateroutine (monitors, ventilator, IV poles and pumps) and special equipmentsuch as (HFOV), hemodialysis, (ECMO), echocardiography, ultrasoundand x-ray. The minimal space requirement for an open PICU bed is:• 200-225 sf (18.58–20.9 m 2 ) with at least 5 to 8 feet (1.52–2.44 m)distance (clearance) between beds. Isolation rooms as well as private rooms require at least:• 250 sf (around 23.23 m 2 ) to have adequate workspace for theequipment and other life-support systems that is often necessaryin critical care situations.

SETTING-UP PICUPATIENT CARE AREAS The designated space per bed and theclearance between beds must accommodateemergency procedures such as resuscitationand rapid airway access Full range of accessibility to the patient(360 degree)

SETTING-UP PICUPATIENT CARE AREAS Equipment columns suspended from theceiling are very helpful in organizingworkspace

HEADWALLS-HORIZONTAL

SETTING-UP PICUPATIENT CARE AREAS Hand washing facilities in the unit and ineach room

SETTING-UP PICUPATIENT CARE AREAS• At least 24 electrical outlets for each bed are required, 12 outof them should be linked and connected to the emergencypower source that will quickly resupply power in the event ofpower interruption.• Gas outlets requirements are 4 outlets for each, oxygen,vacuum and air, and need to be arranged on the headwallsor columns of each bed.

SETTING-UP PICUPATIENT CARE AREAS In each room within the family zone:• daybed• recliner or comfort chair• bathroom• TV/VCR• storage spaceto enable parents to stay at their child’s bedside.

SETTING-UP PICUSUPPORT SERVICES Requirements for support areas within the PICU include:• Separate rooms for clean and soiled linens• Laboratory area for rapid determination of blood gasesand electrolytes• Respiratory therapist area• Medication room (including a refrigerator and a narcoticslocker)• A satellite pharmacy to provide routine and emergencymedications at the point of ordering

SETTING-UP PICUSUPPORT SERVICES• A large storage room for equipment• Staff lounge• Restrooms and lockers for staff and families• Physician’s on-call-rooms• Offices for unit director, nurse manager

SETTING-UP PICUSUPPORT SERVICES Nursing stations with enough working spacefor nurses, and fully networked. The unit must include a multi-levelcommunication system.

SETTING-UP PICUSUPPORT SERVICES The presence of picture archiving and communicationsystem (PACS) terminals. Pneumatic tube system connecting the PICU with othersupport services.

SETTING-UP PICUSUPPORT SERVICES Other services that should be proximate to the unit include:• Dietary services• Social services• Family waiting area• family lounge with vending areas and telephone booths.• Grieving room• Quiet room• Separate room for family counseling• Conference room• Staff toilets• Secretarial area / offices

SETTING-UP PICUPATIENT- AND FAMILY-CENTEREDAPPROACH It is especially important to involve familiesin the care of their children and promotethem as partners in the care It does not only help ease parents anxiety tobe nearby, but recent studies indicate thattheir presence can actually reduce recoverytime.

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