INTRODUCTION We know that intensive care is a part of medicine that deals with patients suffering pathophysiological changes with a severity level that present a threat to life so that Critically ill patients are called.
is a multidisciplinary specialty that represents the last step of care. His main field of action is under the Hospital Intensive Care Service. Are usually central services, which are versatile, directly under the Hospital Medical Director, and work in close connection with other hospital services and health area. Therefore
critically ill patients in order to survive they must provide much more specialized care, which can not be submitted anywhere, why they were created intensive care units where work is done here specialty care, which provides medical and nursing care permanently unstable critical patients. It is characterized with highly complex technologies, which are only available in these units. The attention given to the critically ill patient should be from a holistic perspective.
Therefore the quality of all resources should be excellent in order to deliver quality care, that is, we must ensure that there is a correct implementation with all the necessary equipment for critical patients as well as infrastructure conditions . If we meet the minimum requirements we have the proper operation of the units, thanks to the work of the health team.
Organizing Units critical patient allows scientific and technological upgrades required for a highly complex group of patients will result in fewer complications, sequelae, improved quality of life and less mortality.
We now know that the UPC on the premises lie in the ICU, and have no intermediate, and whether there are separated from the ICU. The new model that seeks to pose an ICU where there also be a UTI, so going to meet patient needs which are constantly changing.
The objective is to optimize the utilization of human resources and technology associated with them.
IMPLEMENTATION AND OPERATION IN ICU
criteria and organizational location
Location
The location of the ICU within the hospital, should be a protected area of \u200b\u200bnormal traffic flow of patients, visitors and staff of other services.
Because the patient is in critical condition and depends on the support equipment that is connected, we must take into account the vulnerability of both support systems, such as enclosure. You must have expeditious evacuation routes and safe.
The UCI with ICUs should be near each other due to their functional and administrative links with the To optimize the use of administrative resources (staff and space). This allows both units to share some administrative offices. As a clinical meeting room, office, etc or concentrate units of service as the waiting room.
unit should be placed on the mechanical floors, where they settle and distribute the special facilities it requires. Avoid crossing facilities for the disposal of sewage, directly or slabs entrecielos clinical compounds of this unit.
The location of the UCI in relation to other clinical and support services of the hospital has to be schematized according to the degree of proximity and frequency with which they are linked.
The ICU should be in constant interaction with other clinical and support units, so it is very important that the UCI has access 24 hours a day to:
-
surgical ward - emergency units
- UTI
- Sterilization
- Hemodialysis
- Radiology
- Scanner
-
Laboratory - Blood Bank
- Pharmacy
internal and external flows
internal flows are those originating from the proper function of task and hospital of Unit. External flows are those that are caused mainly by people from outside of the hospital activities (visits and family).
The UCI should be located in an easily accessible and from the emergency unit and surgical wards, which can be achieved by locating the units in the same level or by rapid vertical connection systems and direct.
CRITERIA OF PHYSICAL PLANT ORGANIZATION OF INTENSIVE CARE UNITS
criteria plant organization of the ICU, are given by architectural and functional aspects of health prevention aspects of hospital infections (NI) FUNCTIONAL ASPECTS
These units are organized into five main areas: clinical
Area Area Area
clinical support medical residency and be personal
Administrative area
public waiting area should be separated
administrative sectors with areas of the patient and technical support they require more privacy, it is also very important to keep separate accesses access visits of patients, staff and supplies.
enclosures Areas ICU
Clinical Area:
- Cubicles patients
- Station Area
nursing clinical support:
- clean work
Sector - Sector
dirty work -
input Bodega - Bodega
clean clothes - Bodega
equipment - Hall lavachatas
- Dirty clothes
- WC
- Bath
personal
Administrative area:
- office secretary
-
chief medical office - office supervising nurse
-
family room - meeting room
- wardrobe
visits - office supplies warehouse area nursing home
and be personal:
- Bedroom residence
- Living Area staff expects
public:
-
waiting room - public toilet
The clinical area includes the sites that relate more directly to the patient and which are the core of the organization of an ICU. This area considers the cubicles for patient care, the nursing station and central monitoring. Cubicle
ICU patient care
basic unit is the individual care to the patient, where they must respect their privacy while staff is in achieve turn have a direct view from the central station for optimal control and surveillance. In these cubicles is concentrated almost all special electrical installations, clinical gases, ventilation and support systems and medical equipment patient support
AREAS OF WORK CLEAN AND DIRTY
Sector clean work.
Campus work is intended to support the work of preparation of drugs and solutions for patients, which is located near the nursing station. The size of 9 m2 is required to develop appropriate and preparedness activities of cars and space for the simultaneous work of two to three operators.
dirty work industry.
This site is intended for temporary storage of clinical material used in the procedures performed to patients in the unit prior to shipment to the central sterilization.
In this place is done cleaning up some items or pieces of equipment. Regardless of the number of beds at the unit this building will have 7 m2.
CLINICAL EQUIPMENT AND INTENSIVE CARE UNIT INTERMEDIATE CARE
equipment cubicle patient's intensive care unit.
1 bed intensive clinical MATRESSES cardiac
1 monitor ability to access central:
-
1 channel - 2 channels of invasive pressure
- 1 non-invasive pressure channel
- 1 pulse oximeter
-
Temperature Control - Alarms for
1 fan
Volume 2 takes backbone Oxygen 2 inlet valves
central compressed air supply 1 5
medical infusion pumps 1 pump
enteral nutrition
1 bag of PEEP valve insufflation nebulizer
1 1 1
procedures lamp or wall cuff monitor vital signs 1 stethoscope
facilities in the intensive care unit
1 car to stop, defibrillator, heart monitor, bag inflation PEEP
1
1 portable heart monitor portable external pacemaker defibrillator
1 fan
1 car transfer procedures bronchoscope
1 2 stretchers transfer
2 bottles oxygen
1 Team
ray laptop A central monitor to 6 bedded
2 viewboxes quadruple
2 laryngoscope
per 3 beds 1 bed 1 radiolucent
noninvasive ventilator
1 hemodialysis machine, whose operation depends on the nursing staff of the hemodialysis unit.
1 set of measuring intra cranial pressure
fiber next to the address of the hospital should establish a policy relating to the maintenance of the equipment in order to prevent irreparable damage, or prolonged periods of equipment out of use. Must be available and personal knowledge of the operation manuals of the different teams.
access to other computers.
-
plasmapheresis machine - emergency endoscopy
-
conventional hemodialysis machine - Machine hemodiafiltration for renal replacement therapy should ideally have the option of conventional dialysis
- 1
tomographic multi - image intensifier
- liver dialysis units performing liver transplantation.
To ensure the best quality services recommended that the UCI will develop internal rules and manuals to allow uniform criteria and standardize procedures. Standards knowledge must be updated and available to all staff, and may include rules on: referral of patients, staff safety, in case of brain death and organ donation, hospital infections, disaster and evacuation, plus manual organizational and medical and nursing procedures.
Organization of intensive care unit.
The UCI should be noted for providing quality care to critically ill patients. Required for proper operation of a qualified team of doctors, nurses and paramedics in sufficient quantity, which whose function is to provide a multidisciplinary and comprehensive care.
A) Human Resources.
Endowment d
human resources associated with intensive beds
1) PHYSICIANS: The ICU should have a chief physician and a team of medical residents
CHIEF MEDICAL
Job Description: UCI must have a chief physician, 33 hours, which should be responsible for the functions of planning, coordination of internal work and external relations, must also perform evaluative activities and technical and administrative supervision.
The profile of the chief physician must certify to compete for the position a basic medical specialty, surgery, anesthesia and emergency medicine specialist, is also recommended having knowledge management accredited hospital. Have functions of a managerial assistance, administrative and educational.
Unit: depend administratively Medical Branch Hospital Liability
fee: should be accountable to the Director of the Hospital of the efficient organization and operation of the UCI.
function definition
UCI chief physician - Promote and implement a system of permanent coordination with other clinical services, UTI, sections and other units.
- Ensure the improvement of the unit processes, and identify problems and propose solutions that befits them.
- Ensuring the existence of a proper system of records and indicators that account for the management of the Unit.
- Establish a system of maintenance of the unit (purchase of equipment and instruments for Unity)
- To promote, plan, implement and evaluate continuing education, according to the identified needs of staff.
- Collaborate with the curricula of undergraduate and graduate health careers, as appropriate, according to teacher-assistance agreements in force. MEDICAL RESIDENTS
Job Description: These made permanent shifts to cover the unit. As a prerequisite to enter the office must have the basic specialty of internal medicine, anesthesia, surgery or emergency medicine trained emergency medicine accredited.
The allocation recommended is 1 doctor per shift for each 6 beds, where the units are number of beds than 6, we must increase the number of physicians. Unit
medical residents UCI: depend directly on the head of UCI Medical
Responsibility fee: are responsible for the welfare activities. They should also fully implement the policies and regulations of the UCI for its operations and thereby ensure a good quality of care.
Job Description: must provide care directly to patients, and coordinates the work between the health team in the ICU, so that the medical service is an integrated whole that encourages the patient perspective biopsychosocial (physical, psychological and social).
Another part that meet them is to deliver information clear about the clinical status of patients or their families directly responsible.
2) NURSES: The nurse must possess a strong knowledge and experience to the management of critically ill patients, must also remain in constant training to use diagnostic and therapeutic equipment. The training of nurses in intensive care should be subject to some form of accreditation.
The ICU nursing staff is composed of a nurse coordinator and clinical nurse or traffickers.
ICU NURSE COORDINATOR
Job Description: is in charge of organizing, scheduling, direct and evaluate the activities of the ICU nurses, ensuring timely and effective care. Must have formal training in the area of \u200b\u200badministration and training in the area of \u200b\u200bintensive or critical care patient.
Unit: reports directly to the head of the UCI Medical
charge
Responsibility: Responsible and is responsible for the planning, coordination, monitoring and evaluation of nursing staff and the comprehensive care of ICU patients . The nurse will care functions of an administrative, teaching and research, subject to that entrusted UCI chief or assigned to other officials.
function definition:
- Coordinate nursing actions with other clinical services, support units, sections and general services of the establishment
- and your physician determine the needs, functions and activities of human resources and needs materials, equipment and supplies to provide nursing activities to ensure effective care of patients.
- Continually evaluate care records to monitor compliance with standards, especially the quality of care being delivered.
- Organizing, directing, scheduling, monitoring and evaluating nursing care in the ICU according to the programs and rules in conjunction with the Head of the Unit.
- Coordinate, plan and evaluate training programs for staff of the Unit.
- Participate in development and research work to be scheduled nursing in the ICU. CLINICAL NURSES
The clinical nurse staffing should be 1 nurse for every 3 beds per shift in the ICU is increased according to workloads.
Nurses must have prior training in the area or experience in handling or be critical patients in intensive care specialist if it does not have to be trained in an accredited unit.
Clinic nurses are responsible and accountable for direct patient care, so it should develop, implement and monitor nursing care plan for patients in their care. TECHNICAL ASSISTANT
PARAMEDIC
The ideal endowment is 1 caregiver assistant coach for 2 beds per shift, plus 1 technician paramedic is recommended for daytime reinforcement units of greater complexity.
Job Description: is responsible for the fulfillment of comfort functions and other activities de apoyo, además de realizar controles que son asignados por la enfermera de tueno. Este personal debe contar con una capacitación en la Unidad.
Definición de funciones: Corresponde a la enfermera supervisora de la Unidad establecer las funciones que pertenecen al cargo.
AUXILIAR DE SERVICIO
Descripción del cargo: Es el encargado de cumplir con las funciones de orden y limpieza de la Unidad y de la colaboración para la coordinación con otras dependencias del hospital. La dotación debe ser de 1 auxiliar de servicio por cada 6 camas con un refuerzo de día, siendo el mínimo 1 auxiliar por cada 6 camas en turnos que cubran las 24 horas del
days
Defining Functions: corresponds to the supervising nurse
SECRETARY Job Description: Administrative Officer daytime maintaining UCI coordinating with other departments, units, sections the hospital. Also is responsible for receipt, distribution, storage and dispatch of official correspondence and quiet of the ICU.
For a correct and proper functioning of the UCI should have the necessary capacity in order to deliver quality care to users, so we have access to other professionals as appropriate will nutritionist, social worker and physiotherapist.
CONSTRUCTION CRITERIA FOR INTENSIVE CARE UNIT
COATINGS
floor coverings.
floor coverings shall be resistant to heavy traffic, in its constitution stable over time and easy to clean. Due to heavy traffic of personnel, equipment and conditions of hygiene and cleanliness that has this unit, you should use microvibrations tiles in larger sizes to 30 x 30 cms. It is also recommended as being effective coatings with high traffic PVC heat sealed seams.
However, we must bear in mind that such materials provide a significant amount of fuel load of toxic fumes, which must be considered in calculating fuel load in the study of fire hazards.
use is strictly banned in enclosed carpets clinical patient care and clinical areas and technical support.
is recommended that the sub-base of all precincts in which there is located sanitary ware, is waterproof, especially if these agencies are on high floors on other facilities vulnerable to the action of moisture.
not recommended for ceramic floors, because they have low resistance to impacts of objects, easy to present cracking.
wall coverings.
resistant coatings is recommended wash cycles intense specialized disinfectants for clinical use. Meet this requirement based on polyurethane coatings. Because the patient's cubicle is a site exposed to sudden income transit or some equipment like cars, we recommend the use of side guardamuros brake pads and wheels for the distance of at least 80 inches between the bed and the wall header.
The rest of the surfaces may be coated alternatively with polyurethane-based paint formulated to withstand periodic flushing toilets with agents used for deep.
Coverings heaven.
whose surfaces are recommended coatings are resistant to specialist deep cleaning detergents for clinical use. Therefore continue to meet the requirements based on polyurethane coatings.
in patient care areas is not recommended for use with ceiling linings modular systems knockdown ceilings due to:
- The inability to make adequate cleaning in those areas
- The accumulation of dust in inaccessible areas of the entrecielos and risk of detachment of modules on the patients in cases of high-intensity earthquakes
is recommended plates which are manufactured based on mineral fibers, which must be fireproof characteristics and not produce toxic fumes in a fire.
plates are used in damp rooms should be waterproof coating to prevent absorption of moisture and prevent mildew on it.
widths of doors.
width access doors should ideally be 180 cm or more, because the admission of patients to these units is always performed on stretchers for four or more operators, in addition to the haste with which made the move in emergency situations. SAFETY
alarm systems and fire detection.
Because life-threatening condition that in patients that are treated in the ICU and its unlikely they can survive outside the unit, it should emphasize the prevention and defense against natural disasters and fires.
The purpose of the fire conditions is:
- Minimize the risk of fire
- Preventing the spread of fire, so the rest of the building
- Facilitate the rescue of the occupants of the buildings in case of fire
- Provide fire suppression.
evacuation routes leading out of the ICU will have a minimum width of 240 cm, whereas a patient in bed, support equipment and personnel for the transfer.
The interior corridors or secondary roads where there is Unity movement of patients should have a minimum width of 180 cm, so as to permit the passage of wheelchairs and stretchers.
Every ICU should have at least one emergency exit. The unit must have an automatic system to detect any principle of fire and an alarm system to alert users to allow progressively. This system must have sensors in the following venues: nursing station winery supplies, clean clothing and equipment, cleaning enclosures, cías movement, administrative area, bedroom residence, staff lounges and areas containing large fuel load and have little oversight. You must have the presence of fire extinguishers. FACILITIES
Electrical
must comply with the rules establishing minimum security conditions to be met by domestic electrical installations.
must comply with current regulations issued by the Superintendency of Electricity and Fuels, agencies and statutory bodies existing in that area.
clinical Gases
The cubicles have gas installation and supply of clinical through clinical gas central network, which must meet current safety standards issued by the Chilean standard and Superintendency of Electricity and Fuels.
Each cubicle will have the following footage clinical gases: oxygen 2 shots, 2 shots of vacuum, medical air outlets 1. CONCLUSION
We know the requirements to implement a critical care unit, because the complexity of the patients required an implementation much more advanced in terms of technology and infrastructure, and any aspect that can skip or forget to play against the health of critically ill patients, which would be a failure of attention is given to users.
The proper organization of resources, both human, physical and financial resources enable us to deliver quality care, so it is very important that each implement professional expertise in the area in addition to their function and role clearly meets within the health care team. Never forget that you have to provide comprehensive care to the patient, taking into account the biopsychosocial model. The nursing role is essential in critically ill the patient, giving emotional support to both the patient and family, so you have to allow contact with the sick family members, but will always meet the internal rules of the Unit.
The new model of the UPC is very interesting, as it would help to optimize patient care, as previously noted in our stores know that the units are mostly critical ICU patients, and if there is intermediate care unit separated from it. While both units deliver care at different levels of complexity, but both are within the call to provide care to patients in critical condition, where they remain permanently monitored with the technology and necessary equipment, with the proper space and location as required, and access to support units and medical units. Therefore
is a task and challenge that the new health professionals specializing in intensive medicine to care for the PC, because that much in terms of the number of intensive care units in our country, in addition to attention should be specialized, therefore requires more trained personnel.
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