Master Plan In Anesthesia Preparetion

Fig. 3 Perspective view of laboratory for general hotpital of 150 to 200 beds.

hospitals labor-Delivery Suite tionalizing valves. Branch tines may he carried from the horizontal wall piping through the center ot the island to serve the benches on both sides (See Figs 3 and 4.)

For safety purposes and to facilitate repairs, each individual piping system should be plainly identified by color, coding, or labeling. All waste piping should be of a noncorrosive material and should be discharged to a dilution pit or should be carried to a point in the piping system where the discharge will be diluted by waste from other areas.

Laboratory sinks should be made of noncorrosive material and should be designed for laboratory service. A waste grinder under the sink in the serology unit is highly desirable for disposal of clotted blood which may otherwise clog the drain.

LABOR-DELIVERY SUITE Locating the Delivery Suite

Since the labor-delivery unit is basically self-sufficient, it may be located adjacent to the newborn nursery and maternity unit or elsewhere in the hospital; wherever possible, it should be located on the same floor. Transportation of mother and infant is reduced and maximum utilization of staff is obtained when alt three units are together-

However, in large hospitals requiring more than one maternity nursing unit, another location may be required.

Planning the Labor-Delivery Unit in the General Hospital, Public Hnalth Service, Department of Health Education, and Welfare 1964

Functional Arrangement of the Delivery Suite

The delivery suite includes three areas of activity: labor, delivery, and recovery. Proper sequential arrangement ot labor, delivery, and recovery areas within the labor-delivery unit facilitates patient care and aids the staff in carrying out proper medical techniques and practices [See Fig. 1.)

Labor, delivery, and recovery rooms should be located and related for easy movement of patients from one area lo another and for good patient observation. In large suites, locating service facilities on subsidiary corridors may help to reduce and control traffic.

From the standpoint of asepsis, location of delivery rooms and service facilities is critical. A location as remote as practicable from the entrance to the suite will reduce traffic, cause less air turbulence, and provide greater privacy for the patient-

Scrub-up areas should be adjacent to delivery rooms so that attending physicians can observe delivery room procedures and the condition of the patient.

A medical preparation facility serving labor and delivery areas should be convenient to both, accessible only to authorized personnel. This is usually located at the nurses' station or control area.

Storage for flammable anesthetics may not connect directly with anesthetizing areas.

A soiled holding room should be convenient for preparing the delivery room for a subsequent patient and tor retaining soiled articles for disposal, processing, or return to central service.

Since the exact time of birth can seldom be determined, labor rooms should be close to delivery rooms but not so close that the two areas are intermixed or that patients in labor can overhear or view delivery room procedures.

A subsidiary corridor, it placed with a separate access to labor rooms, will permit the husband to visit in the labor room without passing through the main corridor end may also serve as a lounge area for ambulant patients and authorized visitors.

A recovery room should be located within the unit in an area: (1) adjacent to delivery rooms, or (2) near the main entrance to the unit. The determining factor may be the policy on permitting visitors to the recovery room. If no visitors ere permitted, the first location has the advantage of immediate accessibility to delivery rooms end close proximity to the attending staff. The second location enables the husband to visit the patient without entering more restricted areas of the unit.

The location of the nurses' station will be determined to some extent by the size of the delivery suite and the nursing staff. A nurses station for a unit of more than two delivery rooms should be placed near the entrance to serve as a control center for admitting and directing patients and performing other administration procedures without permitting these activities to interfere with othei area» of the unit. If continuous attendance is difficult because of a smell staff, the nurses station may be located between labor and delivery areas so that nurses travel to observe patients, keep charts* and participate in delivery room procedures is reduced.

Locker and toilet facilities for the obstetrical nursing staff and attending physicians should be included within the unit and arranged so that they will not enter clean areas in street clothes and will avoid exposure to contaminated areas after changing to obstetric garments- Where possible, entrances to these facilities from outside the unit are desirable.

The doctors lounge and sleeping accommodations should be located within the unit

Typical Open Plan Office
HOSPITAL CORPlDOfî Fig, 1 Labor-delivery unit tor approximately 1,500 birth* par year.

hospitals

Labor~DeHvery Suite adjacent to their locker facilitiea so that the physicians may ba immediately available for patients' needs- Evan in the smallest hospitals, sleeping accommodationa near the labor-delivery unit should be available to attending physicians.

Dictation facilities should be located in or near the doctors' lounge.

Admitting and Preparation Various methods are used to sdmit maternity patients:

1. Through the main hospital admitting desk end then either to a maternity nursing unit or to a labor room in the delivery unit.

2. Directly to tabor rooms in the delivery suite.

3. In an admitting and preparation unit. An odmitting and preparation unit ia desirable in hoapitais where a large daily patient load makes it necessary, after observation, to group patients; those to be returned home, those to be sent to the nursing unit, and those to be admitted to the labor-delivery unit.

If such a unit is provided, two locations are feasible- (1) adjoining the hospital admitting area, and (2) adjacent to but not a part of the delivery suite, The first location facilitates the admitting process and permits immediate patient examination, provided the obstetrical staff is available, and it also prevents patients not In labor or those deslined tor isolation from entering maternity nursing areas, The second location concentrates obstetrical staff activities in a single area of the hospital and ellows immediate availability of the delivery suite in emergency ceses.

Labor Rooms Labor rooms should provide maximum comfort and relaxation for the patient and should have facilities for examination, preparation. and observation. Unless en admitting and preparation unit outside the labor-delivery unit is available, the patient may be admitted directly to the labor room.

Although traditional practice has permitted two or more beds in labor rooms, single occupancy rooms are recommended. They elimínete the necessity for e patient preparation room, separate infectious patients, provide greater privacy, and if in accordance with hospital policy, permit the huaband to visit the patient during tabor. These rooms should have a minimum floor arse of 100 aq ft. Multiple occupancy rooms should have not less than 80 aq ft per bed. If only one delivery room is required, one Isbor room should be arranged as an emergency delivery room and should have a minimum floor area of 180 sq fl.

A toilet and lavatory for each labor room provides privacy for the ambulant patient, and reduces bedpan services; however, patient's use of tha toilet should be controlled If individual toilet rooms are not providad. a single toilet room convenient to all labor rooms will suffice.

One shower and dressing cubicle is sufficient for the labor room area. If admittance, preparation, and shower facilillas are located outaida the unit, the labor area shower may be omitted. Each labor room should have a lavatory with gooaeneck-type spout and toot- or wrist-operated controls, soap dispenser, and paper towel dispenser for handwashing by the patient, the nurse, and the physician,

The minimum width tor labor room doors is 3 ft 8 in. However, to provide for the passage of beda or stretchers, 4 ft is recommended. Each labor bed should be furnished with oxygen and suction outlets and nurses calling stations. Controls to provide adjustment of the level of general room lighting and the bed light are desirable, Air conditioning is recom mended. Music, piped into eech labor room and controlled at the nurses' station, may be considered tor the comfort of the patient. A cut-off in each room is required

Dative«? Room In designing and equipping the delivery room, every facility for tha welfare and safety of the mother and the newborn child should be incorporated. Basic considerations include the immediate availability of equipment and supplies, built-in protection against anesthetic explosion, auxiliary electrical systems in case of power failure, an adequate air-conditioning system, end finiahes that promote aseptic conditions.

Space allowance for equipment and for the staff to circulate freely is a primary factor in determining the size of a delivery room. A clear floor area approximately 17 ft 6 in square is generally large enough

The position of the anesthesiologist in the delivery room is determined by the arrangement of the backup table in the delivery room. This table is located in Ihe cleanest area of the delivery room, away from all traffic and opposite the entrance to the sterilizer and scrubup areas, The feet of the patient ere usuelly located nearest the backup table with the obstetrician at that end end the aneathesiologist at the opposite end, Since most anesthesiologists are right-handed, their equipment is located on the right, and it is desirable to place the door so that the anesthesiologist's equipment can be located where it need not be moved when the patient is brought in.

The view box should be located behind the anesthesiologist so that the circulating nurse may insert or remove films and the obatetrician may observe it without turning

It is assumed that cesarean sections will be performed in the surgical suite.

A minimum ceiling height of 9 ft is required for an obstetrical light, Additional height is advantageous and may be required for some typea of lighting fixtures

Oicygen and vacuum wall outlets should ba installed near the bassinet location for use in resuscitation.

Built-in cabinets in the dalivary room should be kept to a minimum and uaed for storage ot such supplies as sutures and special instruments.

The minimum width for tha delivery room door is 3 ft 8 in.; however, 4 ft is recommended since patients will often be moved to the delivery room on a labor bed

An emergency call system, loot* or elbow-operated, must have atations in each delivery room with a dome light end buzzer in the corridor over each delivery room door and in locker rooms, lounge, nurses station, and other such areas, A nurses* intercom system must be provided between these same areas

Recovery Room The recovery period, after delivery, is critical and may laat from 1 to 3 hours. During this period the mother requires close observation and special care by the labor-delivery nursing staff Soma hospitals insist on continuous bedside attendance during this time. Various locations may ba used for palíenla during the recovery period: a delivery room, a labor room, a bed in the maternity nursing unit, or a recovery room used exclusively for this purpose.

The recovery room has generally been accepted as a necessary facility in ihe delivery suite and should be considered for any hospital requiring three or more labor beds A recovery room provides a location for recovering patients. frees the delivery or labor room for cleanup prior to occupancy by another patient, concentrates patients in similar condition, and facilitates the special nursing care required.

In designing the recovery room, provision should be made for easy movement ot stretchers or beds If a number of patients will be cared for, a sepárale entrence and an exit may be advisable. Space should be provided for a nurse's desk, an instrument cert or table, a clean aupply cert, a soiled linen hamper, and a waste receptacle. The nurse s desk should bo large enough for a telephone, charts, a nurses' calling station, and forms and writing material. Cubicle curtains at each stretcher location should allow clearance for attending tha patient from either side. Oxygen and suction outleta and a nurses calling station should be installed at each stretcher position. Glass view panels between the room and the corridor fecilitate observation.

Nurses' Station The nurses station is the administrative and control center of the labor-delivery unit, its size, complexity, and location will be determined by the extent of reaponei* bilities charged to the obstetrical supervisor as well as by the size and staffing ot the suite.

If patients ara admitted directly to the labor-delivery unit, the nurses' station may be responsible for admitting procedures. Inventory and requisitioning of supplies may bo handled at the nurses' station, although central service would assume this responsibility under a complement system.

If office records are extensive, file cabinets may be necessary. In large units, an office for the obstetrical supervisor may be required. A bulletin board should be provided tor work schedules and hospital bulletina A desk-height counter for the master station of the muses' calling system, medical records, and a telephone may be edequato if the daily workload ia small,

Doctors' Lockers and Lounge This arsa should contain a locker room, a toilet and shower room, a lounge, and sleeping accommodations If ihe staff is not Isrge enough lo warrant separate facilitiea. a toilet-shower room and combined locker-lounge-sleeping room mey serve staff needs.

In hospitals with only one delivery room, a minimum of 6 lockers is recommended; in those with more then one delivery room, a minimum of 5 lookers per delivery room is recommended. The minimum size recommended for a locker is 12 by t 8 by 60 in.

Space should be provided in the locker room for a cart for clean scrub suits and a hamper tor soiled linen

The lounge should accommodai» a couch, chairs, bookcase, magazine table, and a tale-vision set. A recessed film illuminator should elso be provided. If dictation booths are not provided, e suitable dask and chair for thia purpose should be included In the lounge.

Sleeping accommodations for the attending staff should be provided. For flexibility of use by either mala or femala doctora, it is preferable to provide single occupancy rooms for this purpose. In addition to the bed, furnishings should include chair and night table If only a combined locker-lounge-sleeping room i» required, th» couch should open to make a bed.

Scrub-up end Substsrilizing Ateas Hand ecrubbing by tha obstetricien and nurse is an assentiel part of delivery technique. Facilitiea should be next to the delivery room so that the physician can see into the delivery room through a glass view-panel while scrubbing. On tha plan shown in this publication the acrub-up and subataril-

izing aroas «re combined in ona room, A door baiwaan (his room and I he delivery room is recommended The area used for scrubbing should be deep enough so lhat persons scrubbing will not interfere with traffic and so that splashed water will not conatituto a hazard, If one scrub-up area is to be used for two delivery rooms, at least three scrub sinks should be provided-

The substerilixing t*rnn should contain a high-speed washer-sterilizer for emergency sterilization or for processing instruments,

Supply Equipment Storage Supplies The main factor in determining the space allocation for supply storage in the labor-delivery unit is the method end frequency of issuing supplies from central supply areas- Supplies include all items processed by the laundry and central sterile supply and those issued from central service. Excluded are pharmacy, anesthetic, or equipment items. All supplies should be kept in hospital central service and issued to the isbor-deiivery unit only after the required processing,

A more recent storage method uses the same carta on which supplies are delivered from atorage of clean and sterile items. Supplies used only in the delivery room are packed on one cart and those for other uae on other carte-Clean aupply carts may alao be aaaigned to doctors' and nurses' locker rooms lor scrub clothea and towels, This method requires a clean aupply room near the delivery roome for carts containing clean or sterile items

Equipment Storage. Equipment that is infrequently used, such as delivery table parts and duplicate equipment not in use, should be stored in an equipment atorage room in the unit- Thia room ahould have shelves for smell items and floor space for larger equipment.

Methcabont A medication preparetion room or unit should be located near labor and delivery rooms for storage and preparation of drugs, including narcotics-

Medication preparation requires uninterrupted concentration by the nurse, and an enclosure or room with glass viewing panels is suggested lor this function, A work counter with storage for syringes and accessories and a sink with gooseneck-type spout and loot or wrist controls for handwashing are recommended, If stepped shelves, sized for the smaller medicine bottles, are provided, the nurse can read labels quickly and arrange medicines in the order desired A wail cabinet is suggested for bottles of solutions, and an eye-level locked cabinet for narcotics should be furnished- Since soms medicines must be maintained below room temperature, a refrigerator is also required

Aneitiieaie Facilities The anesthesiologist should be consulted early in the planning stage to determine design requirements for anesthesia facilities including what gases are to be piped; the number, size, and location of gas cylinders to be stored; end space required for cleaning end checking the anesthesia equipment.

Piping oxygen and vacuum to delivery rooms and other areas of the hospital Is standard practice. In some hospitals, nitroua oxide is pipad to the delivery room.

A room should be provided in the unit for storing gas cylindare. Flammable gaaas should be stored separately from oxygen and nitrous oxide, which may be stored in any location since there are no hazards involved, Small cylinders sized to fit the anesthesia apparatus may be stored in recks- Cans of volatile liquids may be stored on shelves in the same storage area Shelves should ba provided for equipment such as pressure gauges- Large cylinders should be stored upright in racks Space for a gas cylinder truck or carrier may be necessary. The primary purpose of storage for these gases and volatile liquids within the unit is to assure availability over weekends and at night when main hospital supply rooms may be closed. Storage space for a 48-hour supply of gas is considered maximum, and additional storage space on the unit is not desirable.

Initmawnt Proestung The processing of instruments includea washing, preferably in a washer-sterilizer or by hand, diaasaembling whore necessary, arranging for future use, and sterilizing.

One of several methods may be followed for instrument processing.

1. Soiled instruments are washed in the washer-sterilizer and seni to central sterile supply for processing- The plan shown is based on this assumption.

2- Soiled instruments are sent directly to central aupply for procesaing- The washer-sterilizer is required for emergency sterilization.

3. Processing may take place in the unit under the direction of the obstetrical supervisor. In this case a workroom is required-

Soiled Holding Room All cleanup techniques including housekeeping are originated in this area, and soiled materials are placed here for diaposal or return to central aterila supply tor processing. This room will require a aink with dreinboards for groaa cleaning, a flushing rim sink lor disposal of liquid waatas. a cart for storage of cleaning materials, csrts and hampers to receive soiled articles, and a waste receptacle. Germicidal solutions and utensils used in cleaning should be stored here- If placentas ere savad, a domestic-type deep freeze will be required.

RADIOISOTOPE FACILITY Suggested Plans

Plans 1 end 2 in Fig, 1 show the relationship between the workload and facilities required

Plan I Plan 1 is intended for s hospital antict* pating limiled isotope use in which the bulk of the workload will consist of relatively simple diagnostic lasts such ss thyroid uptake studias and occasional therapy using todme-131 or phosphorus-32. Intrscavitary therapy with colloidal suspensions ot radioisotopes is not anticipated, nor are diagnostic procedures involving organ scsnning. The one-room arrangement shown on Plan t may be sufficient in this case- (See Fig 1*.J

A work counter (4) with built-in sink (5) and splashback is provided. Cabinets (3) and (1) located above and below the counter, respectively. provide storage space Isotopes are stored on the work counter at area marked (A) behind lead bricks Note thai the area of the counter reserved for the isotopes is al maximum distance from the radiation detection instruments in the room, to minimize the possi-

Radioisotope Facilities m the General Hospital Public Health Service, Department of Health, Education, and Welfare 1966

Radioisotope Facility bility of the radiation from the storsd containers interfering with the use of these instruments. Also, the isotope area is on an outaide wall and aa far as possible from the corridor-Two instruments are utilized in this plan, both of which, for the sake of economy, can be operated from the same scaler (10), mounted on a cart. However, in terms of flexibility, a separate scaler for each of the instruments might be preferable. The scintillation well counter (6) is located on the work counter, at the oppoaite and from the isotope storage area, The detector for thyroid uptake work (8) is used in conjunction with a patient examining table {7); both can be enclosed by a curtain (17) for patient privacy. A hook strip (18) is provided in this area for patient clothing.

The desk (12), chair (14), and filing cabinet (13) are for the use of the isotopes technician. It may be desirable to file records for patients, radiation monitoring, and isotope shipments in this area

Because certain radioactive drugs require refrigeration, a small under-counter refrigerator might be added to this room. On the other hand, because the quantity of this heat-labile material commonly on hand in a limited isotope operation is small, the use of refrigeretor space in another department, such as the clinical laboratory, might be feasible. If refrigerator space in another department is used, the radioactive material should be adequately labeled as to its radiation hazard and properly shielded before it leaves the isotope department- A third possibility would be the acquisition of one of the new miniature refrigerators, which are inexpensive. can be used on a counter top, and provide approximately 1 cu ft of interior space.

Plan 2 Plan 2 shows a two-room arrangement in which facilities are included for diagnostic scanning procedures and for occasional intracavitary therapy with radioactivs phosphorus or gold, in addition to the general types of diagnostic procedures thot would be done in the facilities shown In Plan 1. A larger overall isotope workload with more frequent therapy cases is also assumed. (See Fig, 16 )

In the main room, two separate sinks are utilized The clean sink (5) is used only for handling nonradioactive items, whereas the disposal sink (5a) is used to wash glassware contaminated with radioisotopes end to dispose of radioactive waste. To minimize contamination. the dispoaal sink should hava an elbow or knea control,

Isolopes are stored, as in Plan 1, behind lead bricks on the work counter (4) at space marked (A). A refrigerator (15) is provided below the counter top conveniently nearby for the storage of heat-labila items, and space is also planned for a floor-type centrifuge (16) in this area

The detector for thyroid uptake work <8) and the scintillation well counter (6) are operated in thia plan from two separate scalers (10). Because of the larger volume of work, more work counter area is provided in this room lhan in Plan I. The open floor space in the center of the room is larger then might be anticipated lor a standard laboratory, to allow for the positioning of a patient stretcher, so that occesional intracavitary isotope therapy can be carried out here. The use of this room insieed of the patient s room for intracavitary instillations has two advantages: the iaotope area is more easily and safely decontaminated should spillage occur during the procedure; and movement of radioactive material through the hospital is minimized, Curtains hung from a ceiling track are uaed for privacy during these proceduree-

The smaller room accommodates the scan-

hospitals

Radioisotope Facility

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