Single Patient Room & Intermediate Care Units
Of all the proposed changes, the two most likely to generate the most comments are section 7.2.A1, which calls for single bed patient rooms (unless the functional program demonstrates the value of a multi-bed arrangement) and section 7.3, which establishes guidance on intermediate care units. Both of these topics are addressed in Douglas Erickson's article Major Changes to the 2006 edition of the Guidelines
for the Design and Construction of Hospitals and Health Care Facilities from the January-February 2005 Inside ASHE.
The guidelines revision committee performed extensive research prior to proposing a minimum standard of single bed patient rooms, looking at issues such as first and operating costs, infection control, patient falls, and therapeutic impact. For an overview of these issues and access to the single verse multiple occupancy patient room study commissioned by the Facilities Guidelines Institute, go to www.premierinc.com/all/safety/resources/construction/single-room.jsp. To review the research which supports the decision to go to single bed rooms go to the AIA website at www.aia.org/aah_gd_hospcons.
Proposed language for the Single Patient Room (changed text is in red):
7.2.A. Patient Rooms
Each patient room shall meet the following standards:
*7.2.A1. Unless the functional program demonstrates the value of a multiple-bed arrangement, the maximum number of beds per room shall be one. Where renovation work is undertaken and the present capacity is more than two one patients, maximum room capacity shall be no more than the present capacity, with a maximum of four patients.
Proposed new language for the Intermediate Care Units (new language):
7.3 Intermediate Care Units
Intermediate care units, sometimes referred to as stepdown units, are routinely utilized in acute care hospitals for patients who require frequent monitoring of vital signs and/or nursing intervention that exceeds the level needed in a regular medical/surgical unit but is less than that provided in a critical care unit. Intermediate care units can be progressive care units or specialty units such as cardiac, surgical (i.e., thoracic, vascular, etc.), neurosurgical/neurological monitoring, or chronic ventilator respiratory care units. These standards shall apply to adult beds designated to provide intermediate care, but not pediatric or neonatal intermediate care.
In hospitals that provide intermediate care, beds shall be designated for this purpose. These beds may constitute a separate unit or be a designated part of another unit.
There shall be a separate physical area devoted to nursing management for the care of the intermediate patient.
7.3.A Patient Rooms
The following shall apply to all intermediate care units unless otherwise noted.
7.3.A1. Maximum room capacity shall be four patients.
7.3.A2. In new construction, patient rooms shall be constructed to meet the needs of the functional program and have a minimum of 120 square feet (10.8 square meters) of clear floor area per bed in multiple-bed rooms and 150 square feet (13.94 square meters) of clear floor area for single -bed rooms, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules. The dimensions and arrangement of rooms shall be such that there is a minimum clearance of 4 feet (1.22 meters) between the sides of the beds and other beds, walls, or fixed obstructions. A minimum clearance of 6 feet (1.83 meters) shall be available at the foot of each bed to permit the passage of equipment and beds. Where renovation work is undertaken, every effort shall be made to meet these standards. If it is not possible to meet these minimum standards, the authorities having jurisdiction may grant approval to deviate from this requirement. In such cases, patient rooms shall have no less than 100 square feet (9.29 square meters) of clear floor area per bed in multiple -bed rooms and 120 square feet (10.8 square meters) of clear floor area in single -bed rooms.
7.3.A3. Each patient room shall have a window in accordance with Section 7.31.A10.
7.3.A4. Access to at least one airborne infection isolation room shall be provided unless provided eleswhere in the facility. The number of airborne infection isolation rooms shall be determined on the basis of an Infection Control Risk Assessment. Each room shall contain only one bed and shall comply with the requirements of Section 7.2.C. Special ventilation requirements are found in Table 7.2.
7.3.A5. Handwashing stations shall be provided to serve each patient room. At least one handwashing station shall be provided for every four patients. In new construction and renovation, a handwashing station shall be provided in the patient room in addition to that in the toilet room and located outside the patient's cubicle curtain so that it is convenient to staff entering the room.
7.3.A6. Each patient shall have access to a toilet room without having to enter the general corridor. One toilet room shall serve no more than four beds and no more than two patient rooms. The toilet room shall contain a water closet and a handwashing station, and the room door shall swing outward or be double acting. Where local requirements permit, folding doors may be used, provided adequate provisions are made for acoustical privacy and patient privacy.
7.3.A7. Patients shall have access to bathing facilities within their rooms or in a central bathing facility.
Each shower or bathtub in a central bathing facility shall be in an individual room or enclosure that provides privacy for bathing, drying, and dressing. A water closet and lavatory in a separate enclosure shall be directly accessible to each central bathing facility.
7.3.A8. Each patient shall have within his or her room a separate wardrobe, locker, or closet suitable for hanging full-length garments and for storing personal effects.
7.3.A9. In multiple-bed rooms, visual privacy shall be provided for each patient. The design for privacy shall not restrict patient access to the room entrance, lavatory, toilet, or room windows.
7.3.A10. Nurse calling systems for two-way voice communication shall be provided in accordance with Section 7.35.G. The call system for the unit shall include provisions for an emergency code resuscitation alarm to summon assistance from outside the intermediate care unit.
7.3.B. Service Areas
Provision for the services listed below shall be in or readily available to each intermediate care unit. The size and location of each service area will depend upon the numbers and types of beds served. Identifiable spaces are required for each of the indicated functions. Services may be shared with adjacent units. Where the words "room" or "office" are used, a separate, enclosed space for the one named function is intended; otherwise, the described area may be a specific space in another room or common area.
7.3.B1. Administrative center or nurse station. This area shall have space for counters and storage and shall have convenient access to handwashing stations. The station shall provide direct visual observation of each patient and all traffic into and out of the unit.
7.3.B2. Dictation area. This shall be adjacent to but separate from the nurse station.
7.3.B3. Charting facilities. Charting facilities shall have linear surface space to ensure that staff and physicians may chart and have simultaneous access to information and communication systems.
7.3.B4. Handwashing facilities. Handwashing facilities shall be conveniently accessible to the nurse station, medication station, and nourishment station. One handwashing station may serve several areas if convenient to each.
7.3.B5. Staff lounge facilities. Staff lounge facilities shall be provided and shall be programmatically sized, but shall not be less than 100 square feet (9.3 square meters). These facilities shall be located convenient to the intermediate care unit.
7.3.B6. Toilet room(s). They shall be conveniently located for staff use (may be unisex).
7.3.B7. Storage facilities. Securable closets or cabinet compartments for the personal articles of nursing personnel shall be located in or near the nurse station. At a minimum, they shall be large enough for purses and billfolds. Coats may be stored in closets or cabinets on each floor or in a central staff locker area.
7.3.B8. Examination/treatment room(s). An examination/treatment room shall be located immediately adjacent to the intermediate care unit. Each room shall have a minimum floor area of 120 square feet (11.15 square meters). The room shall contain a handwashing station; storage facilities; and a desk, counter, or shelf space for writing. This service may be shared with the other units on the floor. Provision shall be made to preserve patient privacy from observation from outside the exam room through an open door.
7.3.B9. A clean workroom. This room shall be separate from the soiled workroom. The clean workroom shall contain a work counter, a handwashing station, and storage space for clean and sterile supplies. This room shall have a minimum clear floor area of 100 square feet (9.29 square meters).
7.3.B10. A soiled workroom. This room shall be separate from the clean workroom. The soiled workroom shall contain a clinical sink (or equivalent flushing-rim fixture), a work counter, a handwashing station, and separate space for covered containers for soiled linen and waste. This room shall have a minimum clear floor area of 100 square feet (9.29 square meters).
7.3.B11. Medication station. Provision shall be made for 24-hour distribution of medications. This may be done from a medicine preparation room or unit, from a self-contained medicine dispensing unit , or by another approved system.
a. Medicine preparation room. This room shall be under visual control of the nursing staff. It shall contain a work counter, a sink adequate for handwashing, a lockable refrigerator, and locked storage for controlled drugs. This room shall have a minimum of clear floor area of 50 square feet (4.65 square meters).
b. Self-contained medicine dispensing unit. A self-contained medicine dispensing unit may be located at the nurse station, in the clean workroom, or in an alcove, provided the unit has adequate security for controlled drugs and adequate lighting to easily identify drugs. Convenient access to handwashing stations shall be provided.
7.3.B12. Nourishment area. There shall be a nourishment area with a work counter, a handwashing station, a refrigerator, storage cabinets, and equipment for preparing and serving hot and cold
nourishments between scheduled meals. This room shall have a minimum clear floor area of 50 square feet (4.65 square meters).
7.3.B13. Ice machine. A self-dispensing ice machine shall be provided to supply ice for treatments and nourishment.
7.3.B14. Equipment storage room. An equipment storage room shall be provided for storage of equipment necessary for patient care. This room may serve more than one unit.
7.3.B15. Emergency equipment storage. Space shall be provided for emergency equipment that is under direct control of the nursing staff, such as a cardiopulmonary resuscitation (CPR) cart. This space shall be located in an area appropriate to the functional program, but out of normal traffic.
7.3.B16. A housekeeping room. This service may be shared with the other units on the floor.
7.3.C Mechanical standards. Ventilation, oxygen, vacuum, medical air, electrical and plumbing requirements shall be as per sections 7.35.E2 and 7.35.G4 and Tables 7.2 and 7.5.