Page 46 - ACCCN's Critical Care Nursing

Resourcing Critical Care 23

provided in-house by individual facility biomedical
BOX 2.2 Example criteria for product departments or as part of a service contract arrangement
evaluation 28,29 with the vendor company. The provision of a maintenance/
service plan should be clearly identified during the pro-
● Safety curement phase of the equipment’s purchase process.
● Performance While equipment maintenance is not the direct respon-
● Quality sibility of the nurses in charge of the unit, they should be
● Use aware of the maintenance plan for all equipment and
● purpose ensure that timely maintenance is undertaken.
● ease of Routine ongoing care of equipment is outlined in the
● Cost–benefit analysis product information and user manuals that accompany
● include disposables devices. This documentation clearly outlines routine care
● Cleaning required for cleaning, storage and maintenance. All staff
● central sterilising supply unit (CSSU) involved in the maintenance of clinical equipment should
● infection control be trained and competent to carry it out. As specialist
● Regulatory control equipment is a fundamental element of critical care,
● Therapeutic Goods Administration effective resourcing includes consideration of the pur-
● Australian Standards chase, set-up, maintenance and replacement of equip-
● Adaptability to future technological advancements ment. Equipment is therefore an important aspect of the
● Service agreements budget process.
● Training requirements
STAFF

The product evaluation committee should include Staffing critical care units is an important human resource
members who have an interest in the equipment being consideration. The focus of this section is on nursing
considered and should comprise, for example, biomedi- staff, although the important role that medical staff and
cal engineers and representatives from the central sterile other ancillary health personnel provide is acknowledged.
supply unit (CSSU), administration, infection control, Nurses’ salaries consume a considerable portion of any
end users and other departments that may have similar unit budget and, owing to the constant presence of nurses
needs. Once a product evaluation committee has been at the bedside, appropriate staffing plays a significant role
established, clear, objective criteria for the evaluation of in the quality of care delivered. Nurse staffing levels influ-
the product should be determined (Box 2.2). Ideally, the ence patient outcomes both directly, through the initia-
committee will screen products and medical devices tion of appropriate nursing care strategies, and indirectly,
before a clinical evaluation is conducted to establish its by mediating and implementing the care strategies of
viability, thus avoiding any unnecessary expenditure in other members of the multidisciplinary healthcare team.
time and money. 28 Therefore, ensuring an appropriate skill mix is an impor-
tant aspect of unit management. This section considers
The decision to purchase or lease equipment will, to some how appropriate staffing levels are determined and the
extent, be governed by the purchasing strategy approved factors, such as nurse–patient ratios and skill mix, that
by the hospital or state government. The advantages of influence them.
leasing equipment include the capital expenditure being
defrayed over the life of the lease (usually 36 months),
with ongoing servicing and product upgrades built into STAFFING ROLES
the lease agreement and price structure. Any final presen- There are a number of different nursing roles in the ICU
tation from the product evaluation committee should nursing team, and various guidelines determine the
therefore include a recommendation to purchase or lease, requirements of these roles. Both the Australian College
based on a cost–benefit analysis of the ongoing expendi- of Critical Care Nurses (ACCCN) (see Appendix B2) and
ture required to maintain the equipment. the World Federation of Critical Care Nurses (WFCCN)
(see Appendix A2) have position statements surrounding
REPLACEMENT AND MAINTENANCE the critical care workforce and staffing. A designated

The process for replacement of equipment is closely nursing manager (nursing unit manager/clinical nurse
aligned with the process for the purchase of new equip- consultant/nurse practice coordinator/clinical nurse
ment. The stimulus for the process to begin, however, can manager, or equivalent title) is required for each unit to
be either the condemning of equipment by biomedical direct and guide clinical practice. The nurse manager
engineers or the planned replacement of equipment must possess a post-registration qualification in critical
27,30
nearing the end of its life cycle. In general, capital equip- care or in the clinical specialty of the unit. A clinical
ment is deemed to have a life cycle of five years. This time nurse educator (CNE) should be available in each unit.
frame takes into account both the longevity of the physi- The ACCCN recommends a minimum ratio of one full-
cal equipment and its technology. time equivalent (FTE) CNE for every 50 nurses on the
roster, to provide unit-based education and staff develop-
Ongoing maintenance of equipment is an important part ment. 27,30 The clinical nurse consultant (CNC) role is
of facilitating safety within the unit. Maintenance may be utilised at the unit, hospital and area health service level