Page 45 - ACCCN's Critical Care Nursing

22 S C O P E O F C R I T I C A L C A R E

BOX 2.1 Business case: sample headings TABLE 2.3 Basic equipment requirements
Title Monitoring Therapeutic
Purpose
Background Monitors (including central station) Ventilators (invasive and
non-invasive)
End-tidal CO 2 monitoring
Key issues Arterial blood gas analyser Infusion pumps
Cost–benefit analysis (±electrolytes) Syringe drivers
Recommendations Invasive monitoring CVVHDF
Risk assessment ● arterial EDD-f
● central venous pressure Resuscitators
● intracranial pressure Temporary pacemaker
● PiCCO Defibrillator
● pulmonary artery Suctioning apparatus
Access to image intensifier
In summary, the business case is an important tool that Ultrasound
is increasingly required at all levels of an organisation to Access to CT/MRI
clearly define a proposed change or purchase. This docu-
ment should include clear goals and outcomes, a cost- CT = computerised tomography; CVVHDF = continuous veno-venous
haemodiafiltration; EDD-f = extended daily dialysis filtration; MRI =
benefit analysis and timelines for achievement of the magnetic resonance imaging; PiCCO = pulse-induced contour cardiac
solution. output.
CRITICAL CARE ENVIRONMENT

A critical care unit is a distinct unit within a hospital that non-essential), data points and task lighting sufficient for
has easy access to the emergency department, operating use during the performance of bedside procedures.
theatre and medical imaging. It provides care to patients Further detailed descriptions are available in various
with a life-threatening illness or injury and concentrates health department documents. 26
the clinical expertise and technological and therapeutic
resources required. The College of Intensive Care Medi- EQUIPMENT
26
cine (CICM) defines three levels of intensive care to
support the role delineation of a particular hospital, Since the advent of critical care units, healthcare delivery
dependent upon staffing expertise, facilities and support has become increasingly dependent on medical techno-
services. Critical care facilities vary in nature and extent logy to deliver that care. Equipment can be categorised
27
between hospitals and are dependent on the operational into several funding groups: capital expenditure (gener-
policies of each individual facility. In smaller facilities, ally in excess of $10,000), equipment expenditure (all
the broad spectrum of critical care may be provided in equipment less than $10,000), and the disposable prod-
combined units (intensive care, high-dependency, coro- ucts and devices required to support the use of equip-
nary care) to improve flexibility and aid the efficient use ment. This section examines how to evaluate, procure and
of available resources. 26 maintain that equipment.

ORGANISATIONAL DESIGN INITIAL SET-UP REQUIREMENTS
The functional organisational and unit designs are gov- Critical care units require baseline equipment that allows
erned by available finances, an operational brief and the the unit to deliver safe and effective patient care. The list
building and design standards of the state or country in of specific equipment required by each individual unit
which the hospital is located. A critical care unit should will be governed by the scope of that unit’s function. For
have access to minimum support facilities, which include example, a unit that provides care to patients after neu-
staff station, clean utility, dirty utility, store room(s), rosurgery will require the ability to monitor intracranial
education and teaching space, staff amenities, patients’ pressure. Table 2.3 lists the basic equipment requirements
ensuites, patients’ bathroom, linen storage, disposal for a critical care unit.
room, sub-pathology area and offices. Most notably, the
actual bed space/care area for patients needs to be well PURCHASING
designed. 26
The procurement of any equipment or medical device
The design of the patient’s bed-space has received consid- requires a rigorous process of selection and evaluation.
erable attention in the past few years. In Australia, most This process should be designed to select functional, reli-
state governments have developed minimum guidelines able products that are safe, cost-effective and environ-
to assist in the design process. Each bed space should be mentally conscious and that promote quality of care
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a minimum of 20 square metres and provide for visual while avoiding duplication or rapid obsolescence. In
privacy from casual observation. At least one handbasin most healthcare facilities, a product evaluation commit-
per single room or per two beds should be provided tee exists to support this process, but if this is not the case
26
to meet minimum infection control guidelines. Each it is strongly recommended that a multidisciplinary com-
bed space should have piped medical gases (oxygen and mittee be set up, particularly when considering the pur-
air), suction, adequate electrical outlets (essential and chase of equipment requiring capital expenditure. 29