CHAPTER 110. VETERANS HEALTH ADMINISTRATION - MENTAL HEALTH AND BEHAVIORAL PATIENT CARE UNITS CONTENTS PARAGRAPH PAGE 1. Approval of Criteria 110-1 2. Definition 110-1 3. Program Data Required 110-1 4. Space Determinations 110-1 5. Design Considerations 110-7 Distribution: RPC: O862 assigned FD CHAPTER 110. VETERANS HEALTH ADMINISTRATION - MENTAL HEALTH AND BEHAVIORAL PATIENT CARE UNITS 1. APPROVAL OF CRITERIA Criteria approved by the Department of Veterans Affairs (VA) on June 13, 1980. 2, DEFINITION a. A patient care unit is a dedicated area for: inpatient accommodations, delivery of health care, direct supportive facilities, and institutional services b. Institutional services are defined as: SPD (Supply Processing and Distribution); Dietetics, Laundry, Environmental Management, etc. c. Mental Health and Behavior Patient Care Units include: (1) Psychiatric Units (2) Substances Abuse Units (a) Drug Abuse Treatment (b) Alcohol Dependency 3. PROGRAM DATA REQUIRED a. Staffing projections by categories b. Projected number of beds for the following categories: (1) Psychiatric (2) Drug Abuse Treatment (3) Alcohol Dependency Treatment c. Is a serving line to be provided? 4. SPACE DETERMINATIONS a. One-Bed Room 11.2 NSM (120 NSF) The total number of beds in 1-bed rooms will not exceed 25 percent of total number of operating beds in patient care unit. b. Two-Bed Room 19.5 NSM (210 NSF) The total number beds in 2-bed rooms will not exceed 35 percent of total number of operating beds in the patient care unit. c. Four-Bed Room 34.4 NSM (370 NSF) d. Seclusion Room 11.2 NSM (120 NSF) Two per patient care unit included in total number of 1-bed rooms. (1) Anteroom 4.7 NSM ( 50 NSF) (Includes circulation space and door swings) e. Bathroom or Toilets for Patient Rooms (1) Bathroom or toilets may be private or shared (a) Wheelchair (Maximum 20 percent of all-bed rooms.) (b) Not more than 4 patient beds will be served by 1 bathroom or toilet. (2) Bathrooms (a) Regular bathroom (Including shower, lavatory, water closet) 1. Private bathroom 4.2 NSM ( 45 NSF) 2. Shared bathroom 5.5 NSM ( 59 NSF) (b) WHEELCHAIR BATHROOM (Including shower, lavatory, water closet) 1. Private bathroom 7.0 NSM ( 75 NSF) 2. Shared bathroom 5.5 NSM ( 59 NSF) (3) Toilets (a) Regular toilet (Including lavatory, water closet) 1. Private toilet 2.3 NSM ( 25 NSF) 2. Shared toilet 3.3 NSM ( 36 NSF) (b) Wheelchair toilet (Including lavatory, water closet) 1. Private wheelchair toilet 4.8 NSM ( 52 NSF) 2. Shared wheelchair toilet 6.0 NSM ( 64 NSF) f. CONGREGATE FACILITIES (Provided only where space or structural restrictions prohibit private or shared facilities.) (1) Number of Fixtures (a) One water closet or urinal and 1 lavatory per 6 beds not served by private or shared facilities. (Ratio of 2 water closets of 1 urinal.) (b) A minimum of 1 water closet enclosure and 1 lavatory per patient care unit must accommodate wheelchair patients. (2) Area Required (a) Vestibule, privacy, vision screening Minimum of (Always to be included) 2.8 NSM ( 30 NSF) (b) Wheelchair toilet 6.2 NSM ( 67 NSF) (Including lavatory, water closet) (c) Wheelchair urinal 3.4 NSM ( 37 NSF) (Including lavatory, water closet) (d) Regular toilet 3.4 NSM ( 37 NSF) (Including lavatory, water closet) NOTE: First toilet in congregate facilities must be wheelchair toilet including privacy and vision screening, water closet and lavatory. g. Bathing Facilities (1) Entrance Vestibule Minimum = 2.8 NSM ( 30 NSF) (2) Stretcher Shower 3.7 NSM ( 40 NSF) (3) Tubs (a)1. One hydrotherapy, supine position, per 2 patient care units 3.7 NSM ( 40 NSF) 2. One hydrotherapy, with seat, per 2 patient care units 4.5 NSM ( 48 NSF) (When 2 or more contiguous patient care units are involved, these bathing units should be used alternately.) If bedrooms are not served by private or shared facilities provide: (b) One tub or shower per 7 beds not served by private or shared facilities 2.3 NSM ( 25 NSF) (4) Patient Toilet 4.7 NSM ( 50 NSF) (Wheelchair water closet and lavatory.) (Must have direct access from bathing facilities.) h. Support Facilities (1) Communications Center (Nurses' Station) Up to 30 beds 18.1 NSM (195 NSF) Over 30 beds 18.1 NSM (195 NSF) plus 0.2 NSM ( 2.5 NSF) per bed over 30 beds (When computer data handling equipment is included in Communications Center, add 3.7 NSM (40 NSF).) This area serves as the working and control center for the nursing staff and includes space for maintenance of the patients' records, and may include computerized data handling equipment. (2) Doctors' Charting, Dictating Area 5.6 NSM ( 60 NSF) This is a separate area interconnected with the Nurses' Area for Physicians' Orders Charting. (3) Ward Clerk 11.2 NSM (120 NSF) (Separate room, adjust and interconnected with nurses areas) The ward clerk space should be adjacent and interconnected with nurses are of the Communications Center for performance of Medical Administration Service duties and daily routine of the patient care unit. (4) Medication Room 5.1 NSM ( 55 NSF) This room accommodates the medications assigned for the unit from Pharmacy Medication preparation area. (5) Staff Toilet 2.3 NSM ( 25 NSF) This toilet must be near the Communications Center. (6) Nourishment Station 5.6 NSM ( 60 NSF) This area accommodates a self-contained unit for the storage and preparation of nonscheduled nourishments. It also contains an ice dispensing machine and storage bin. (7) Head Nurse's Office 9.3 NSM (100 NSF) This office is located in proximity to the Communications Center. (8) Physician's Office and Examination/Treatment Room 14.9 NSM (160 NSF) (9) Physician Assistant/Nurse Clinicians' Office Single Occupancy 6.5 NSM ( 70 NSF) Two or more occupants in the room 4.7 NSM ( 50 NSF) per person (10) Psychologist's Office 11.2 NSM (120 NSF) (When assigned 5/8th time or more to patient care unit) (11) Chaplain's Office 11.2 NSM (120 NSF) (When assigned 5/8th time or more to patient care unit.) (12) Psychiatrist's Office 11.2 NSM (120 NSF) (13) Multipurpose Office 11.2 NSM (120 NSF) (Only on substances abuse patient care units when offices are not provided for psychologists, chaplains, or psychiatrists.) (14) Social Worker's Office 11.2 NSM (120 NSF) (Provide if assigned to specific patient care unit. Do not duplicate space in Chapter 282.) (15) Dietitian's Office 11.2 NSM (120 NSF) (Provide if assigned to specific patient care unit. Do not duplicate space in Chapter 224.) (16) Nursing Supervisor's Office 11.2 NSM (120 NSF) (Provide only when such facilities are not provided in nursing administration area (1 office/4 patient care units.) (17) Clean Utility Room 0.3 NSM ( 3.5 NSF) per bed (9.3 NSM (100 NSF) Minimum) This room provides storage for sterile and nonsterile supplies except linen and medications, used in delivery of patient care. (18) Soiled Utility Room 0.3 NSM ( 3 NSF) per bed (7.4 NSM ( 80 NSF) Minimum) Cleanup of equipment, instruments, utensils, and the disposal of waste material is accomplished in this room. It also provides a temporary holding area for materials to be dispatched to SPD. (19) Linen Rooms (a) Clean Linen Room 5.6 NSM ( 60 NSF) This room is utilized for the storage of clean linen on carts and/or fixed shelves. (b) Soiled Linen Room (If chute is not available) 7.4 NSM ( 80 NSF) (20) Disposal Chutes Vestibule 1.9 NSM ( 20 NSF) (Linen and/or Trash) This is an enclosed room (Code Requirements) for trash and/or linen chute openings. (21) Storage Room (Equipment) 0.3 NSM ( 3 NSF) per bed (9.3 NSM (100 NSF) Minimum) This room is used for the storage of bulk equipment required for patient care on an "as needed basis" and is stored on the patient care unit. (22) Day Room Recreation 2.6 NSM ( 28 NSF) per bed The dayroom provides an area for patients recreational and therapeutic activities (e.g., activities of daily living, recreation, and occupational therapies). (23) Quiet Room 0.7 NSM ( 7 NSF) per bed (14.9 NSM (160 NSF) Minimum) This room is adjacent or even interconnected with the dayroom. It provides privacy or is used for quiet activities. (24) Stretchers, Wheelchairs, Storage Alcove 6.5 NSM ( 70 NSF) This alcove provides an area for storing stretchers, wheelchairs, and walkers used on the patient care units. (25) Housekeeping Aids Closet 3.7 NSM ( 40 NSF) (26) Building Management Equipment Room 9.3 NSM (100 NSF) per Nursing floor (For initial planning purposes use 3 patient care units per floor.) (27) Visitors' Facilities (For initial planning purpose use 3 patient care units per floor.) (a) Male Toilet 4.8 NSM ( 52 NSF) per Nursing floor (b) Female Toilet 4.8 NSM ( 52 NSF) per Nursing floor (28) On Call Facility See chapter 274 (29) Lockers, Lounges, Toilets, Shower See chapter 410, LLTS (30) Bulk Food Carts 2.8 NSM ( 30 NSF) per cart (One hot and one cold bulk cart for each 100 meals) (31) Serving Line For: 80-120 beds 87.4 NSM ( 940 NSF) 121-160 beds 108.3 NSM (1165 NSF) 161-240 beds 118.4 NSM (1273 NSF) (32) Nonfood Storage: 60-100 beds 10.4 NSM (112 NSF) 100-200 beds 10.4 NSM (112 NSF) plus 0.1 NSM (.64 NSF) per bed in excess of 100 beds 201-400 beds 16.7 NSM (180 NSF) plus 0.1 NSM (.574 NSF) per bed in excess of 200 beds (33) Housekeeping Aids Closet 3.7 NSM ( 40 NSF) (34) Dining Space 1.5 NSM ( 16 NSF) per bed This space includes allowance for wheelchair patients. (35) Interview/Consultation Room 11.2 NSM (120 NSF) This room is used for patients' interviewing and counseling by Medical staff. i. ADMINISTRATIVE OFFICES (1) Rehabilitation Medicine Therapist and Vocational Rehabilitation Specialist Single Occupancy 6.5 NSM ( 70 NSF) Two or more occupants in the room 4.7 NSM ( 50 NSF) per person (2) Rehabilitation Technician 11.2 NSM (120 NSF) (Includes interview space) j. EDUCATION The following increments of educational space will be provided within or contiguous to the patient care unit. (This space was approved March 5, 1980, as a part of Educational Facilities and should not be duplicated.) (1) Office, House Staff 11.2 NSM (120 NSF) per house staff (2) Office, Nursing Instructor and Student Work Room 13.9 NSM (150 NSF) (If included in staffing guidelines) This room will be used by the Nurse Instructor to accomplish office related duties, including scheduling and counseling, and as a work/study area for nursing students. (3) Demonstration/Classroom 27.9 NSM (300 NSF) (This room will also be utilized for Group Therapy) per two patient care units This room will be used primarily for nurse and allied health training for both affiliated and nonaffiliated programs. The space will be utilized for Group Therapy and be shared with other services as needed. Storage area per classroom 1.9 NSM ( 20 NSF) This area will be used to store audiovisual and instructional material used in the trainee classroom. 5. DESIGN CONSIDERATIONS a. The approximate size of psychiatric and substance abuse patient care units will be 30 beds. b. Figures 110.F1 through 110.F3 provide the interrelationship of the functions within the patient care unit. c. Figure 110.F4 provides a matrix to show the interfunctional relationships between the patient care units and service where considerable traffic can be expected. d. The commonly accepted practice of patient care includes placing the patient's bed to enable the patient to view activities of the outside world and activities in the hospital corridor. e. Patients' Bedrooms (1) The net square footage allowance per bedroom does not include the following: (a) An entrance vestibule, including the door swing. (b) If provided, the service alcove area with lavatory. (c) Toilet and/or bathing accommodations. (2) Two single bedrooms per patient care unit, with an anteroom and bathroom, will be designed in a manner to accommodate a patient for security purposes. These rooms will be located adjacent to the Communication Center (Nurses' Station) to facilitate visual observation and control. f. In new construction all patient bedrooms will have a private or connecting bathroom with water closet, shower and lavatory. g. One hydrotherapy tub with seat accessible on 3 sides and installed on the floor, not on a raised platform, per patient care unit, and 1 hydrotherapy tub supine position per 2 patient care units will be provided. h. Congregate toilet and bathing facilities are provided for those modernization projects where space restriction of other considerations limit the number of private or shared facilities. i. The location of the Communication Center should: (1) Afford visibility and control of all visitors to the patient care unit and visual control of the patients' dayroom. (2) Be conveniently accessible from any point within the patient care unit with the distance to the farthest patient's room not exceeding 36.6 m (120'). j. Consideration for Handicapped Architectural design should accommodate the requirements for the handicapped. (See Construction Standard CD-28.) k. The Seclusion Room will be designed in such a manner as to eliminate self-injury by the patient. The room will be located close to the Communication Center and be served by an anteroom which acts as a buffer zone between the patient's room and the outside corridor. The door from the patient's room and for the bathroom will open out into the anteroom and will not have hardware on the patient's side. l. The patient (Nurse) server units will not be utilized. FIGURE 110.F1 - NO SCALE NURSING UNIT. FIGURE 110.F2 - NO SCALE PATIENT CARE UNIT. FIGURE 110.F3 - COMMUNICATIONS CENTER (NURSES' STATION). MENTAL HEALTH AND BEHAVIORAL PATIENT CARE UNITS INTERFUNCTIONAL RELATIONSHIPS MATRIX (Relationship of Mental Health and Behavioral Science Patient Care Units to Services Listed Below) DRUG PSYCHIATRIC ALCOHOL DEPENDENCY PATIENT CARE TREATMENT TREATMENT NAME UNIT UNIT UNIT ALCOHOL TREATMENT UNIT 3 AMBULANCE ENTRANCE 4 4 AMBULATORY CARE 4 3 4 CANTEEN-BARBER SHOP & BEAUTY SHOP 4 X X CANTEEN-DINING FACILITIES 4 X X CHAPLAIN 4 4 4 DAY HOSPITAL 3 3 3 DAY TREATMENT CENTER 3 4 DENTAL SERVICE 4 DIETETIC SERVICE ADMIN. 4 4 4 DIETETIC SERVICE NUTRITION THERAPY 4 4 DIETETIC-CLINICAL DIETITIAN OFFICE 3 3 3 DIETETIC-FOOD PROCESSING 4 4 DOMICILIARY 4 DRUG DEPENDENCY CLINIC 4 3 3 DRUG DEPENDENCY TREATMENT UNIT 3 4 EEG. LABORATORY 4 4 ENGINEERING SERVICE SHOPS X X X HEMODIALYSIS UNIT 4 4 4 LAB AUTOPSY SUITE 4 4 LIBRARY 4 4 4 MAS TELEPHONE SWITCHBOARD X MAIN LOBBY AND RECEPTION 4 4 4 MEDICAL ICU 4 4 MEDICAL MEDIA 3 MEDICAL PATIENT CARE UNIT 4 4 4 MENTAL HYGIENE CLINIC 3 4 4 NEUROLOGICAL PATIENT CARE UNIT 4 NURSING HOME CARE UNIT 4 NURSING SERVICE ADMIN. 4 4 4 PHARMACY OP SATELLITE X PHARMACY SERVICE 4 PHARMACY SERVICE 4 4 PSYCHIATRIC PATIENT CARE UNIT 3 3 PSYCHOLOGY SERVICE 3 3 PSYCHOLOGY SERVICE ADMIN. 2 3 3 FIGURE 110.F4. - INTERFUNCTIONAL RELATIONSHIPS - MENTAL HEALTH AND BEHAVIORAL PATIENT CARE UNITS INTERFUNCTIONAL RELATIONSHIPS MATRIX (Cont'd) (Relationship of Mental Health and Behavioral Science Patient Care Units to Services Listed Below DRUG PSYCHIATRIC ALCOHOL DEPENDENCY PATIENT CARE TREATMENT TREATMENT NAME UNIT UNIT UNIT QUARTERS, ON-CALL 3 4 RADIOLOGY MAIN SUITE 4 4 REHABILITATION MEDICINE 3 3 3 RESEARCH-ANIMAL RESEARCH X X X RESPIRATORY CARE PROGRAM 4 4 SCI PATIENT CARE UNIT 4 X SOCIAL WORK SERVICE-INDIVIDUAL OFFICE 2 1 1 STROKE PATIENT CARE UNIT 4 SUPPLY WAREHOUSE X SUPPLY-SPD 3 3 3 SURGERY OPERATING ROOMS X X X SURGICAL PATIENT CARE UNITS X VETERANS ASSISTANCE UNIT 4 4 4 VOLUNTARY SERVICE 4 4 4 LEGEND: 1 = ADJACENT 2 = CLOSE/SAME FLOOR 3 = CLOSE/DIFFERENT FLOOR 4 = LIMITED TRAFFIC X = MUST BE DISTANT BLANK NO RELATIONSHIP FIGURE 110.F4 - INTERFUNCTIONAL RELATIONSHIPS - MENTAL HEALTH AND BEHAVIORAL PATIENT CARE UNITS Department of Veterans Affairs VA HANDBOOK 7610 (110) Washington, DC 20420 June 13, 1980 110-i VA HANDBOOK 7610 (110) June 13, 1980 June 13, 1980 VA HANDBOOK 7610 (110) 110-2 110-1