Guidelines and Requirements for Intensive Care Unit

Guidelines and Requirements for Intensive Care Unit

Guidelines for the Staffing and Equipment Requirements of the Intensive Care Units

I. Medical Staff Organization

A. A distinct medical staff critical care organizational entity (department, division, section, or service) exists

1. Privileges (both cognitive and procedural) for members of the critical care physician team arc approved by the medical staff credentials committee based on previous training and experience as defined by the medical staff
2. A section of the medical staff bylaws delineate the regulations governing the implementation of these conditions
3. Budgetary activities relating to unit function, quality assurance, and utilization review are conducted as joint medical / nursing administrative endeavours
4. A critical care representative serves on the medical staff Executive Committee

B. The team is organized and led by an intensivist with time, expertise in, and significant commitment to the care of the critically ill patient within the Asian Hospitals.
C. Patient management is directed by an attending level physician who:

1. Is privileged by the medical staff to have clinical management responsibility for critically ill patients
2. Certified in critical care medicine or has equivalent qualifications
3. Supervises the patient as often as required by acuity but at least twice daily directly or through a surrogate physician. Free for service will be half when an ICU patient is seen through a surrogate physicians.
4. Is either the patient’s attending physician or a consultant who provides direct management of critically ill patients D. Medical Staff members should participate in Bioethical Committee activities.

II. Unit Organization

A. A physician NURSE Unit Coordinator is required.
B. Specific requirement for the Unit Coordinator include:

1. Training, interest, and the time availability to give clinical, administrative, and educational direction to the ICU
2. Qualification/ Certification in critical care medicine.
3. Time and commitment to maintain active and regular involvement in the care of the patients in the unit.
4. Expertise necessary to oversee the administrative aspect of unit management. Including formation of policies and procedures, enforcement of unit policies, and the education of unit staff.
5. The ability to assure the quality safety and the appropriateness of care in the ICU.
6. Availability (either the Coordinator or similarly qualified surrogate) to the unit 24 hrs/day, 7 days/wk for both clinical and administrative matters.
7. Active involvement in local and/or national critical care societies
8. Participation in continuing education programs in the field of critical care medicine.
9. Hospital privileges to perform relevant invasive procedures.
10. Active involvement as an advisor and participant in the organization of the care of the care of the critically ill patient in the community as a whole.
11. Participation in the education of unit staff, other physicians, SHOs, and medical staff as indicated.
12. Participation in scholarly activity.
13. Active participation in the review of the appropriate utilization of ICU resources Hospital.

C. A nurse manager is appointed to provide precise lines of authority, responsibility. And accountability for the delivery of high-quality patient care. Specific requirement for the nurse manager includes:

1. An RN with a BSc or preferably a Masters degree.
2. Certification in critical care or has equivalent graduate education.
3. At least 3 yrs. of experience working in critical care unit.
4. Previous management experience, including experience with health information systems, quality improvement/risk management activities, and healthcare economics.
5. Preparation to participate in the on-site education of critical care unit nursing staff and physicians-in-training.
6. Ability to foster a cooperative atmosphere with regard to the training of nurses, physicians, respiratory therapists, and other personnel involved in the care of critical care patients.
7. Regular participation in ongoing continuing nursing education.
8. Ability to participate in and foster cooperation in, scholarly activity in the ICU.
9. Knowledge about current advances in the field of critical care nursing.
10. Participation in strategic planning and redesign effort.

III. Physician Availability

A. A variety of studies suggests that a full time intensivist improves patient care and efficiency.

1. At least one physician who can manage emergencies, including airway emergencies, and is certified in ACLS. This requirement may be fulfilled by senior SHOs or physician extenders capable of handling emergency situations. An attending physician fully credentialed in critical care medicine must be on call and available within 15 minutes.
2. Critical care physicians appropriately credentialed to provide dedicated care to the critical care unit patients. Critical care fellows may fulfil this requirement.

B. The following physician sub specialist should be available within 30 minutes:

1. General Surgeon
2. Neurosurgeon
3. Cardiovascular Surgeon
4. Obstetric-gynecologic surgeon
5. Urologist
6. Thoracic surgeon
7. Vascular surgeon
8. Anesthesiologist
9. Cardiologist
10. Pulmonologist
11. Gastroenterologist
12. Hematologist
13. Infectious disease specialist
14. Nephrologist
15. Neuroradiologist/Senior Radiologist
16. Pathologist
17. Traumatologist/Emergency Chief
18. Metabolic/Endocrine Specialist
19. Neurologist
20. Orthopaedic surgeon

IV. Nursing Availability

A. All patient care is carried out directly by, or under supervision of, a trained critical care nurse.
B. All nurses working in critical care should have complete a clinical critical care related course/training before assuming full responsibility for patient care.
C. Unit orientation is required before assuming responsibility for patient care.
D. Nurse to patient ratios should be based on patient acuity.
E. All critical care nurses must participate in continuing education.

V. Respiratory Therapy Availability

A. A respiratory therapist available to the unit at all times is required. Ideal levels of staffing are based on acuity, utilizing objective measures whenever possible.
B. A working knowledge of the principles of management of patients with acute respiratory failure is required.
C. The therapist must be familiar with ENDOTRACHEAL INTUBATION mechanical ventilators and with the range of ventilatory modes.
D. Proficiency in the transport of critically ill patients is required.

VI. Pharmacy Services Requirement

A. Unit dosing and intravenous admixture services.
B. Availability of registered pharmacist to monitor drug dosing and administration regiments.
C. Availability of a pharmacist with specialized role in activities such as nutritional support formulations, cardio respiratory resuscitation efforts, and clinical research products.

VII. Other Personnel

A variety of other personnel may contribute significantly to the efficient operation of the ICU. These include unit clerks, physical therapist, occupational therapist, advanced practiced nurse, physician assistant, dietary specialist, and biomedical engineers.

VIII. Laboratory Services

A. A clinical laboratory should be available on a 24 hour basis to provide basic hematologic, chemistry, and blood gas analysis.
B. STAT or “bedside” laboratories adjacent to the ICU or rapid transport system provide an optimum and cost-effective setting for obtaining selected laboratory tests in a timely manner.

IX. Services Provided in the Unit

An ICU has the capability of providing basic monitoring and patient support. In order to do so, the ICU is prepared to provide:

• Continuous monitoring of the electrocardiogram (with high/low alarms) to all patients
• Continuous arterial pressure monitoring (invasive and noninvasive)
• Central venous pressure
• Equipment to maintain the airway, including laryngoscopes and endotracheal tube
• Equipment to ventilate, including Ambu bags, ventilators, oxygen, and compressed air
• Emergency resuscitative equipment
• Equipment to support hemodynamics, including infusion pumps, blood warmer, pressure bags, blood filters
• Transport policies that address transport monitors, transport ventilators, and resuscitative equipment
• Beds with removable headboard and adjustable position
• Adequate lighting for bedside procedure
• Suction
• Hypo-hyperthermia blankets
• Scales
• Temporary pacemakers
• Temperature monitoring devices
• Pulmonary arterial pressure monitoring
• Cardiac output monitoring
• Inspired oxygen monitoring capability for all ventilators
• Hemodialysis
• Peritoneal dialysis
• Capnography
• Transcutaneous oxygen monitoring or pulse oximetry for all patients receiving supplemental oxygen
• In house availability of a CT scanner, cardiac catheterization lab, echocardiography, nuclear medicine testing, and Venous Doppler techniques.
• Fiberoptic and rigid bronchoscopy
• Fluoroscopy capability in unit or readily available in radiology
• Intracranial pressure monitoring