360 Degree Care
Monday July 28, 2008
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Memorial Sloan-Kettering's redesigned ICU.
(Courtesy Memorial Sloan-Kettering Cancer Center)
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"Our new Intensive Care Unit is patient-friendly, family-friendly, and nurse-friendly," says Marie-Helene Lofland, MSN, CCRN, CNAA, ANP-BC, nurse leader of the ICU and Hemodialysis at Sloan-Kettering. "We worked to create a unit that would make patients more comfortable and at the same time would provide a better work environment for the healthcare providers."
Designed with patients in mind
The new ICU has increased from 12 beds to 20, and has increased in size from 4,000 to 18,000 square feet. "We created an environment that is more private, more tranquil, and more colorful for our patients. We have large windows for ambient light, natural wood cabinetry, and nature-themed artwork on the walls. The patient rooms are larger, so we can accommodate chairs for visitors, and we have E-glass that shades the glass with a touch of a switch, providing privacy for the patient and eliminating the use of curtains." The new design has also incorporated walls made with sound-retardant materials, wireless Internet access, flat-screen televisions, and DVD players.
The equipment that was chosen for the unit makes caring for critical care patients more efficient and safer. "We are using a new total care bed from Hillrom that pivots 360 degrees, performs respiratory percussion and vibration, turns and weighs the patient, and can sit the patient up in a chair position," says Lofland. Its new General Electric Solar monitors provide arterial line readings, respiratory rate, cardiac rhythms, and pulse oximetry, and can be modified for individual patient needs. The nurse can view other patients from each patient room, and the monitors capture 72 hours of information that can be reviewed at a later time.
Rooms are equipped with web cameras that allow staff to monitor patients from locations outside the ICU, and physicians now enter orders on a computer system that produces an electronic medication administration record that calculates dosages and sends reminders to the nurse when medications are due, or are late. Each patient room is also equipped with a lab printer to print out labels and isolation supplies. "We put each of our intensive care patients on contact isolation, so we have the supplies in each room," says Lofland. "We gown up for each patient."
Every room is also equipped with a modular boom that is suspended from the ceiling and holds infusion pumps, monitors, oxygen, suction, power outlets, network jacks, the nurse call button, and the telephone. "The boom serves several purposes," explains Lofland. "First, it makes the equipment easily accessible, without taking up wall and floor space. It moves easily, so patients can also be moved to different locations within the room. Wires and plugs that are usually lying on the floor are off the floor, making cleaning easier and more efficient." The boom also enables staff to have 360 degree access to the patient.
In the fast-paced ICU environment, no nurse wants to spend time searching for equipment, so a major component of the new unit design was to make sure that the nurses have everything they need to do their work. "Each room is equipped with an otoscope, an ophthalmoscope, and a thermometer," says Lofland. "Computer workstations inside the rooms mean that nurses can access information about the patient right at the bedside."
The nurses who sat in on the design meetings helped incorporate bedside equipment drawers and a medication pass-through system where patient medications are delivered right to the patient's room and accessed with the nurse's security card. "All of our staff members also wear two-way wireless communicators," Lofland adds, "that are voice-activated and hands-free, allowing us to talk immediately with any member of the ICU team, anywhere in the hospital." And a nice touch that every nurse can appreciate is the rubberized flooring, which is seamless, easy to clean, quieter, and more comfortable for those long hours of standing.
New visitor accommodations
Often, the most difficult aspect of working in intensive care can be balancing the critical needs of the patient while meeting the needs of the patient's family members, who are anxious, upset, and feeling left out. "The newest part of our unit is our family lounge," says Lofland. "It was designed with small cubicles to give the families privacy and also has a computer area and private conference room." The family lounge has an area for coffee, drinks, and snacks, and a reception desk that is staffed by employees and volunteers.
In the past, ICUs have often emphasized the technological aspects of care while ignoring the needs not only of the patient and family, but also of the staff. "We need to care for our patients, for their families, and for our staff," Lofland says. Even as the technology increases the capability of analyzing and monitoring every aspect of a patient's condition, critical care nurses know that their patients need an environment that is restful, therapeutic, and more humane. This new ICU will go a long way to help its nurses maintain that balance of human needs in a space filled, but not overwhelmed by, high technology.
Carol Dunbar, APRN, is a contributing writer to Nursing Spectrum.
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