CHAPTER 102. VETERANS HEALTH ADMINISTRATION - INTENSIVE CARE NURSING UNITS CONTENTS PARAGRAPH PAGE 1. Approval of Criteria 102-1 2. Definition 102-1 3. Program Data Required 102-1 4. Space Determinations 102-1 5. Design Considerations 102-3 Distribution: RPC: 0862 assigned FD CHAPTER 102. VETERANS HEALTH ADMINISTRATION - INTENSIVE CARE NURSING UNITS 1. APPROVAL OF CRITERIA Criteria approved by the Department of Veterans Affairs (VA) on February 8, 1977. Minor revisions were approved on October 14, 1979, and December 5, 1979. 2. DEFINITION a. An ICU (Intensive Care Unit) is a specialized nursing facility designed to care for patients too acutely ill to be placed in a conventional nursing unit. These patients require highly skilled care, continuous observation, and a concentration of special equipment. b. Intensive Care Units are categorized as Medical, Surgical, Coronary Care or General Purpose Units. c. General Purpose Intensive Care Units are designated by the Department of Medicine and Surgery for small hospitals and provide intensive care for all categories of acutely ill patients. 3. PROGRAM DATA REQUIRED a. Type or types and number of ICU beds approved by VHA (i.e., Medical, Surgical, Coronary Care, General Purpose). b. Staffing projections by categories. 4. SPACE DETERMINATIONS a. Patient Care Areas (1) Isolation Bedroom (a) Determining the Number of Rooms (based on total of beds in unit) Surgical ICU 20 percent of total beds Medical ICU 15 percent of total beds General Purpose ICU 15 percent of total beds CCU None (b) Area Required 16.7 NSM (180 NSF) per bed (c) Ante Room 3.7 NSM ( 40 NSF) per room These rooms will augment the bed cubicles by providing for patients requiring separation. Noisy patients, patients requiring isolation techniques, and patients who require a quiet, controlled environment make these rooms essential. An ante room (air lock) will also be provided to ensure the isolation technique. The staff will also have a place to change into necessary clothing and wash their hands before entering and upon leaving. (2) Bed Cubicle 16.7 NSM (180 NSF) per bed This will provide one-bed cubicles (to open at one end) for patients who are unable to communicate their needs and, therefore, require extensive specialized care and observation. Individual cubicles are necessary in order to reduce noise, confusion and cross-infection. b. Support Areas (1) Control Center 6 beds or less 3.0 NSM ( 32 NSF) per bed Over 6 beds 17.9 NSM (192 NSF) plus 1.4 NSM ( 15 NSF) This area serves as the central point for all activities conducted within the unit. Specific activities include monitoring of selected physiological parameters and continual visual surveillance. The activities of medication preparation, clerk support, staff consultation and charting should take place adjacent to or behind the Center to facilitate continual visibility of monitors and patients. The medication area should be within an alcove readily accessible from all directions and should function as an adjunct to the unit-dose system (if utilized). The clerk support and staff consultation and charting area will require counter space and should be separated from monitoring activities. (2) Linen Closet 5.6 NSM ( 60 NSF) This room provides storage for clean linens and will be designed to accommodate a linen cart. (3) Clean Utility Room 0.9 NSM ( 10 NSF)per bed (Minimum of 7.4 NSM ( 80 NSF)) This area provides for storage, preparation, and distribution of all sterile and nonsterile supplies. (4) Soiled Utility Room 0.5 NSM ( 5 NSF) (Minimum of 3.7 NSM ( 40 NSF)) This area provides for cleanup of equipment, instruments, utensils, and the disposal of waste material. It also provides for the holding of soiled items and linens. Linens and items for sterilization will be dispatched to SPD (Supply Processing and Distribution). (5) Patient Toilet 4.2 NSM ( 45 NSF) (SICUs will utilize portable commodes in lieu of a toilet) (6) Staff Lounge, Locker and Toilet (a) Lounge 6.5 NSM ( 70 NSF) (b) Lockers 0.6 NSM ( 6 NSF) (One for each male and female permanently per locker assigned to ICU.) (c) Toilet 2.8 NSM ( 30 NSF) Lounge, locker, and toilet facilities will be provided for all male and female personnel permanently assigned to the ICU. The lounge, although minimum in size, will provide a degree of privacy from the rigors of patient care and surveillance. A locker area will provide facilities for changing clothes and storing coats, hats, boots, etc. A toilet should be adjacent to the lounge-locker area. (7) Family Waiting Area 1.9 NSM ( 20 NSF) per bed (Only one required for back to back units) (Minimum = 11.2 NSM (120 NSF)) 10 beds or less: Public toilet 4.2 NSM ( 45 NSF) Over 10 beds: Male Toilet 4.2 NSM ( 45 NSF) Female toilet 4.2 NSM ( 45 NSF) This area serves relatives waiting for scheduled visits with patients. Visits are normally limited to 5 minutes with the total number of visitors closely controlled in respect to the condition of all patients in the unit. Therefore, a waiting area with toilet facilities that open onto the corridor will be required and should be outside, but in proximity to the unit. (8) Consultation/Meditation Room 11.2 NSM (120 NSF) This room provides privacy for bearer relatives or for counseling relatives as to the prognosis of the patient. (9) Head Nurses' Office 11.2 NSM (120 NSF) This office provides space for administrative functions and should be convenient to the Control Center. (10) Equipment Storage 1.9 NSM ( 20 NSF) per bed (Minimum = 11.2 NSM (120 NSF)) This area provides for storage of equipment used in the patient areas on an "as needed basis." (11) Stretcher Storage 3.7 NSM ( 40 NSF) plus 1.1 NSM ( 12 NSF) per 5 beds Room for storing stretchers should be convenient to the entrance to the suite. Wheelchairs will be stored in the equipment storage room. (12) Housekeeping Aids Closet 3.7 NSM ( 40 NSF) This closet is for the equipment and supplies required in the day-to-day housekeeping of the unit. (13) On-Call Room 8.4 NSM ( 90 NSF) This room provides sleeping accommodations for the on-call staff. There will be a private bath contiguous to the bedroom. (14) Bath, On-Call 4.2 NSM ( 45 NSF) 5. DESIGN CONSIDERATIONS a. Figure 102.F1 provides the intrafunctional relationship of the functions within the intensive care units. b. Figures 102.F2, 102.F3, 102.F4 show the interfunctional relationships between the various types of intensive care units and services where considerable traffic can be expected. c. In all new construction the location and design of the various units are essential elements in accomplishing the purpose of these facilities, e.g., the SICU (Surgical Intensive Care Unit) must be located on the same floor as the operating suite; the MICU (Medical Intensive Care Unit) must be adjacent to a medical nursing unit; CCU (Coronary Care Unit) must be located adjacent to the clinical cardiac laboratory; GPICU (General Purpose Intensive Care Unit) should be convenient to the emergency area and the operating suite. Ideally, Intensive Care Units should be located so that continuity of patient care can proceed with minimal interruptions. d. Ready access to hospital functions directly related to ICU's including the clinical cardiac and pulmonary function laboratories, the clinical laboratory, and radiology, must be a planning consideration. e. Floor to ceiling partitions will be used to separate beds. The partitions should be opaque (up to 1070 mm (42") above the floor) to preclude adjacent patients from viewing one another. The remaining portion will be laminated safety glass for visual observation by attending personnel. f. An exterior window is required in every isolation bedroom and bed cubicle. g. A lavatory should be conveniently located outside the patient cubicles; 1 for every 2 patients. h. To achieve good visual surveillance by nursing personnel and to minimize travel from the Control Center to the bedside, a design concept which places the beds in a perimeter-like arrangement is preferred. This arrangement will accommodate the movement of patients as well as a variety of large pieces of mobile equipment. i. Complete patient monitoring capabilities will be available at every bedside. FIGURE 102.F1 INTENSIVE CARE UNITS INTERFUNCTIONAL RELATIONSHIPS MATRIX (Relationship of Intensive Care Units Service to services listed below.) Service Relationship Reason SURGICAL SVC. - OPERATING SUITE 1 INHALATION THERAPY UNIT 2 PATIENT CARE UNITS - SURGICAL 2 AMBULANCE ENTRANCE 3 DIETETIC SVC. - NUTRITION THERAPY 3 E.E.G. 3 ENG. MGNT. AND FIELD SUPPORT OFFICE - BIOMED REP. 3 LABORATORY 3 NUCLEAR MEDICINE SERVICE 3 PATIENT CARE SERVICE ADMIN. 3 PATIENT CARE UNITS - NEUROLOGY 3 RADIOLOGY - MAIN SUITE 3 AMM SVC. - S.P.D. CENTRAL 3 SURGICAL SERVICE ADMIN. 3 ENVIR. MGMT.- LAUNDRY X LOADING DOCK X RESEARCH SVC. - ANIMAL RESEARCH X AMM SVC. - WAREHOUSE X Physical Relationship to Other Services Symbol Relationship Description 1 Especially Important Essential for services to be adjacent 2 Important Services to be in proximity, on the same floor 3 Limited Importance Services within the same building but different floors acceptable X Undesirable Separation desirable Reasons (Use as many as appropriate) A - Common use of resources G - Sequence of work B - Accessibility of supplies H - Patient's convenience C - Urgency of Contact I - Frequent contact D - Noise or vibration J - Need for security E - Presence of odors or fumes K - Others (Specify) F - Contamination hazard L - Closeness inappropriate Figure 102.F2 Interfunctional Relationship Matrix - Surgical Intensive Care Unit INTERFUNCTIONAL RELATIONSHIPS MATRIX (Relationship of Intensive Care Units Service to services listed below.) Service Relationship Reason 1 CLINICAL CARDIAC LABORATORY 1 1 PATIENT CARE UNITS - CCU 1 2 INHALATION THERAPY UNIT 2 2 PATIENT CARE UNITS - MEDICAL & RESPIRATORY 2 2 PULMONARY FUNCTION LAB. 2 3 AMBULANCE ENTRANCE 3 3 E.E.G. 3 3 ENG. MGNT. AND FIELD SUPPORT OFFICE - BIOMED REP 3 3 DIALYSIS CENTER 3 3 LABORATORY 3 3 LIBRARY 3 3 MEDICAL SERVICE ADMIN. 3 3 NUCLEAR MEDICINE SERVICE 3 3 NURSING SERVICE ADMIN. 3 3 PATIENT CARE UNITS - NEUROLOGY 3 3 RADIOLOGY - MAIN SUITE 3 3 AMM SVC. - S.P.D. CENTRAL 3 X ENVIR. MGMT. - LAUNDRY x X LOADING DOCK x X RESEARCH SVC. - ANIM. RESEARCH x X AMM AVC. - WAREHOUSE x Physical Relationship to Other Services Symbol Relationship Description 1 Especially Important Essential for services to be adjacent 2 Important Services to be in proximity, on the same floor 3 Limited Importance Services within the same building but different floors acceptable X Undesirable Separation desirable Reasons (Use as many as appropriate) A - Common use of resources G - Sequence of work B - Accessibility of supplies H - Patient's convenience C - Urgency of Contact I - Frequent contact D - Noise or vibration J - Need for security E - Presence of odors or fumes K - Others (Specify) F - Contamination hazard L - Closeness inappropriate Figure 102.F3 Interfunctional Relationship Matrix - Medical Intensive Care Unit INTERFUNCTIONAL RELATIONSHIPS MATRIX (Relationship of Intensive Care Units Service to services listed below.) Service Relationship CLINICAL CARDIAC LABORATORY 1 PATIENT CARE UNITS - MICU 1 INHALATION THERAPY UNIT 2 PATIENT CARE UNITS - MEDICAL 2 PULMONARY FUNCTION LAB. 2 AMBULANCE ENTRANCE 3 ENG. MGNT. AND FIELD SUPPORT OFFICE - BIOMED REP 3 DIALYSIS CENTER 3 LABORATORY 3 LIBRARY 3 MEDICAL SERVICE ADMIN. 3 NUCLEAR MEDICINE SERVICE 3 RADIOLOGY - MAIN SUITE 3 AMM SVC. - S.P.D. CENTRAL 3 ENVIR. MGMT. - LAUNDRY X LOADING DOCK X RESEARCH SVC. - ANIM. RESEARCH X AMM SVC. - WAREHOUSE X LEGEND: 1 = ADJACENT 2 = CLOSE/SAME FLOOR 3 = CLOSE/DIFFERENT FLOOR 4 = LIMITED TRAFFIC X = MUST BE DISTANT BLANK NO RELATIONSHIP Figure 102.F4 - Interfunctional Relationship Matrix - Cardiac Care Unit Department of Veterans Affairs VA HANDBOOK 7610 (102) Washington, DC 20420 December 5, 1979 102-i VA HANDBOOK 7610 (102) December 5, 1979 December 5, 1979 VA HANDBOOK 7610 (102) 102-6 102-5