ICU Tours TemiYembra, Sarah Manning, Stephanie Allen, Sukanya Bhattacharya, SurabhiSatam, and Kruti Shah
Piedmont Hospital There were 5 ICUs ICU Green • Built in 1970 • Medical surgical ICU • Very small rooms with odd angles Round shaped ICU with central nurse station Advantages: Visibility into all rooms Disadvantage: Not enough movement space for equipment and furniture.
Piedmont Hospital ICU Blue • Medical, surgical ICU - built 5 years ago • 12 bed ICU • Moderate room size • No provision for family accommodation • Room monitors are connected with the Central mother monitor ICU Red • Open heart ICU
Piedmont Hospital 5 East ICU • Newly built about 2,3 years ago • 10 beds ICU - small rooms Stepdown Unit • Converted general patient rooms in ICU • Total 9 beds and rooms are very small • Nurse station is far Disadvantage - visualization problem
General Information Visitation is open except during hand-off Nurses 12 hour shifts 1:1 or 1:2 depending on patient condition Physicians in ICU • Intensivists - Who specializes in the care of critically ill patients, mostly in ICU. • Extenders – Expert physicians or nurses that replace experienced doctors in the ICU in the midnight to early morning shift.
Problem - Clinical Documentation Changed to electronic 7 years ago Physician and progress notes still on paper Electronic medical records do not all talk to each other
Solution - Clinical Documentation Develop a software to integrate medical records - Within the hospital - Ability to access records from other hospitals - Helps know what medication the patient is taking
Problem - Patient Falls Prevalent within men in their 50s - 60s Side effects from getting up after receiving narcotics
Solution - Patient Falls Created a falls protection program Provide susceptible patients with green armbands to be recognized If possible, place such patients in rooms with cameras Follow checklists and protocol
Other problems Size of ICUs - Too many cabinets in rooms - Converted from regular patient rooms Most walls are concrete made which is a problem in - Taking any new telephone line through walls - Making changes in the present room size
Scottish Rite Average Staffing Ratio is 2 patients to 1 nurse Age Ranges of populations Served • Neonate, 30 days • Infant, 30 days to 1 year • Early Childhood, 1 year to 5 years • Late Childhood, 5 years to 13 years • Adolescent, 13 years to 17 years • Adult, 17+ years
Scottish Rite • Neonatal ICU (NICU) • 35 beds (3 isolation rooms) • Pinwheel Design • Sterile and non-sterile areas • Typical healing time : 28 days • Three types of alarms system - Orange: To call the nurse - White : Parents need help - Blue : Patient in crisis
Scottish Rite • Pediatric ICU (PICU) • 26 beds in 3 L-shaped Pods • Private Rooms (helps reduce infection rate) • Overhead Boom • 3 separate entrances- 2 for staffs 1 for visitor • Typical healing time: 4 days
Problem - Privacy in NICU • Open layout (see and hear activity in other patient areas) • No Visitors During Shift Changes (7am and 7pm • May discourage parents from staying at the bedside
Research Opportunities • Best practices in communication • Alternative communication • Mobile alerts • Pagers • Online access to full/limited medical records • NICU Layouts • Bowling Ally • Pinwheel • Private Rooms
Problem - Family Space in ICU Overarching Issue: ALL patients must have a parent/guardian present to consent NICU • Parents/Visitors typically sit in "hallway" area • There is very limited privacy for parents • Area not suited for overnight visits • Alternatives • NICU Family Waiting Area • 7 Private Rooms Hospital-wide • Ronald McDonald House
Problem - Family Space in ICU PICU • One sleeper chair per room • No designated family area in room • If in Pod 2 or 3 the travel to the family waiting area is far
Research Opportunity • Effectiveness of layout in Rehab at Scottish Rite • Ample floor space • Designated Family Area • Allows for less strict visitation policy • Effectiveness of family oriented-layout at other hospitals
Research Opportunity • Waiting Area Design and Amenities • Seating Area • Sleeping Area • Eating Area • Secure Storage • Entertainment Area • Paging/Locating System
Problem - POUS in PICU • Nurses and Respiratory Therapists frequently leave room to retrieve supplies • RN comment: Visit OMNI Cell 20+ times per day • OMNI cell is very far away for some pods • RN loses visual when retrieving supplies
Research Opportunity • Space in PICU ICU rooms allows more supply storage • Are carts being used effectively? • Are drawers and cabinets being used effectively? • What is the optimal par level of supplies in room? • What kinds of supplies are charged to the patient and charged to the department?