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Department/Area:
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Personnel
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Preface and context
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Main Audit
Sitting/Layout
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The ICU should be a separate unit within the hospital with access to the emergency department, operating theatres, and radiology.
Layout of the Unit
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Visual contact with both bedspaces is able to be maintained simultaneously.
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The walls and floors constructed of sound absorbing materials.
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For the psychological well-being of patients and staff, windows with access to natural light allowing a clear day/night.
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There is adequate air conditioning which allows control of temperature, humidity and air change.
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X-ray viewing facilities to view multiple x-rays simultaneously is available.
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There adequate telephones and communication systems available.
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There adequate space and facilities for staff rest periods.
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There is 1 isolation room every 6 beds – with its own basin, en suite 3m2 ante room and airflow control.
Layout of the Individual Bedspace
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There is at least 20m2 of floor area for each bed.
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There is adequate space to enable physical contact during routine care, procedures and in an an emergency.
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There is adequate space to conduct administrative duties while maintaining visual contact with the patient.
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Regularly used medical materials are available at the bedside.
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There is adequate space for patient monitoring, resuscitation equipment and medical storage areas. E.g. for monitors, ventilators, infusion pumps, trolleys, linen, large items of special equipment?
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There is adequate space to allow clean and rapid drug and fluid preparation?
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Privacy measures such as curtains are available.
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There is a clock at the bedspace.
Outlets Available in Each Bedspace
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At least 4 oxygen outlets are available.
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At least 3 suction outlets are available.
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At least 3 air outlets are available.
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At least 4 data outlets are available.
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At least 16 electrical outlets are available.
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Electrical wiring meets Cardiac Protected Status AS3003.
Dirty Utility
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An area is allocated for cleaning appliances, urine testing, emptying and cleaning bed pans and urine bottles.
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Unit is designed to provide appropriate movement pathways for<br>contaminated equipment.
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A cleaners area for storage of equipment and materials is allocated.
General Equipment
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Ventilators for invasive and/or non-invasive ventilation
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Hand ventilating assemblies
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Suction apparatus
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Airway access equipment, including a bronchoscope and equipment to assist with the management of the difficult airway.
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Vascular access equipment
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Monitoring equipment, both non-invasive and invasive
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Defibrillation and pacing facilities
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Equipment to control patient temperature
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Chest drainage equipment
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Infusion and specialised pumps
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Portable transport equipment
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Specialised beds
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Lifting/weighing equipment
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Access to ultrasound for placement of intravascular catheters
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Refrigerator
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Other equipment for specialised diagnostic or therapeutic procedures (e.g.<br>renal replacement therapy, intra-aortic balloon counter pulsation,<br>echocardiography, extra-corporeal membrane oxygenation etc.) should be<br>available when clinically indicated and in order to support the delineated<br>role of the ICU.
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Portable equipment for mechanical ventilation and monitoring of<br>ventilation and respiratory and circulatory status as outlined above must<br>be available for patient transports.
Patient Monitoring Equipment
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Pressure monitoring - equipment to monitor and continuously and simultaneously display arterial, central venous and at least one other pressure (eg pulmonary artery, intracranial pressure).
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Non-invasive arterial pressure monitoring
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Electrocardiograph - equipment to monitor and continuously display the<br>electrocardiograph.
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Temperature – capacity to monitor central and cutaneous temperature
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Pulse oximeter
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End tidal CO2 monitor - capnography must be available at each bed in the Intensive Care Unit and must be used to confirm tracheal placement of the endotracheal or tracheostomy tube immediately after insertion, and continuously in patients who are ventilator dependent.
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Continuous monitoring of ventilation – when a ventilator is in use, ventilator volumes should be measured although it is accepted that this is not always possible with some ventilators used for paediatric and neonatal patients. Airway and respiratory circuit pressure must be monitored continuously and prompt warning given of excessive pressures.
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Endotracheal cuff monitoring – equipment to measure cuff pressure intermittently.
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Other equipment - when clinically indicated, equipment must be available to measure other physiological variables such as cardiac output and derived variables, neuromuscular transmission etc.
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Patient monitoring equipment is modular, with trending capability, visible and audible alarms and unobstructed, comfortable viewing and capacity for alarm recording and hard copy.
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There is networking capability and uniformity with monitoring equipment in the operating theatres and emergency department.
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There is a bright high definition screen and all devices are designed to an appropriate level of electrical safety.
Clinical Policy
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Clinical management of the patient is achieved within the framework of agreed policies.
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Protocols and policy documents are immediately available to staff.
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Patient care protocols are immediately available to staff.
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Drug administration protocols are immediately available to staff.
Operational Policy
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Admission protocols are immediately available to staff.
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Discharge protocols are immediately available to staff.
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Referral protocols are immediately available to staff.
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Evacuation policies are immediately available to staff.
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Infection control policies are immediately available to staff.
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Isolation protocols are immediately available to staff.
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There is a surge capacity plan to cope with an emergency/epidemic immediately available.
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There is a demonstrable and documented formal audit and review of its activities and outcomes.
Equipment Policy
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Designated policies for the procurement, maintenance and disposal of equipment.
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Protocols and in-service training for medical and nursing staff need to be available for the use of all equipment, including steps to be taken in the event of malfunction.
Staff Education
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There is a documented orientation program for new staff.
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Educational programs for medical staff and a formal nursing education<br>program.
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There is access to an appropriate range of clinical resources, textbooks, journals, manuals.
Level I ICU
Capability Requirements
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The provision of mechanical ventilation and simple invasive cardiovascular monitoring for more than 24 hours is acceptable when the treating specialist is a Fellow of the College. In circumstances where the treating specialist is not a Fellow of the College this should only occur within the context of ongoing daily discussion with the referral Level II or Level III unit as outlined above.
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The number of ICU beds and number of patient admissions should be sufficient to maintain clinical skills by both medical and nursing staff. The number of beds should be based on demand and have flexibility to meet increased demand.
Medical Staffing Requirements
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The ICU has a medical director who takes overall responsibility for the operation of the Unit. The director should be a CICM Fellow however this requirement may not always be met in Level I ICUS’s. If a Fellow cannot be recruited the Medical Director must be a registered medical specialist who is experienced in intensive care medicine and who has credentials in intensive care medicine, anaesthesia, emergency medicine or general medicine and who meets the CPD requirements of the College.
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There must be at least one specialist for every 8-15 beds, rostered to the unit at all times
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There must be at least one other registered medical practitioner with an appropriate level of experience rostered to the ICU at all times. Must be orientated, trained and competent in ALS.
Nurse Staffing Requirements
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There must be a nurse in charge of the unit with a post registration qualification in intensive care.
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ACCESS (Assistance Coordination Contingency Education Supervision Support) nurses may be required depending upon the number of nurses with post registration qualifications in intensive care.
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There is a minimum of 1:1 nursing for ventilated and other similarly critically ill patients (clinically determined), and 1:2 nursing staff for lower acuity patients (clinically determined).
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There is a nurse in charge of the unit with a post registration qualification in intensive care.
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There should be a minimum of 50% (optimum 75%) of nursing staff with a post registration qualification in intensive care for every shift.
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All nursing staff in the unit responsible for direct patient care being registered nurses. Enrolled nurses (Division 2 RNs) may be allocated duties to assist registered nurses, however any activities that involve direct contact with the patient must always be performed in the immediate presence of a Division 1 registered nurse.
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A minimum of two registered nurses present in the unit at all times when there is a patient admitted to the unit.
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Enrolled nurses (Division 2 RNs) may be allocated duties to assist registered nurses, however any activities that involve direct contact with the patient must always be performed in the immediate presence of a Division 1 registered nurse.
Support Staff
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Support staff are available as appropriate, e.g. biomedical engineer, clerical and scientific staff.
Educational Requirements
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The unit should have a documented educational program for medical, nursing and other staff.
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There should be at least one nurse educator for every 50 nurses on the roster.
Operational Requirements
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All patients admitted must be referred for management to the rostered intensive care specialist.
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Clinical management should include two bedside ward rounds per day conducted by the rostered intensive care specialist and junior medical staff and nursing staff.
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Clinical management of the patient must be achieved within the framework of agreed policies (e.g. procedural and infection control, including defined antibiotic policies).
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There is defined patient care and drug administration protocols, admission, discharge, referral and evacuation policies. These should be immediately available to staff.
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There is a surge capacity plan to cope with an emergency/epidemic.
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There is demonstrable and documented formal audit and review of its activities and outcomes.
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There is a documented orientation program for new staff.
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Educational programs for medical staff and a formal nursing education program are in place.
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Suitable infection control and isolation procedures and facilities are available.
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24 hour access to pharmacy, pathology, operating theatres and imaging services commensurate with the designated role of the hospital and appropriate access to physiotherapy and other allied health services when necessary.
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An active research program is desirable.
Unit Design
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A self-contained area, with easy access to the emergency department, operating theatres and organ imaging.
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Appropriate design, providing a suitable environment with adequate space for patient care delivery, storage, staff accommodation (including office space), education and research.
Equipment and Monitoring
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The type and quantity of equipment and monitoring suitable for the function of the unit and appropriate as judged by contemporary standards.
Conclusion
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Completed by:
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