CRITICAL CARE ENVIRONMENT,EQUIPMENT, STAFFING & BUDGET

Learning outcome: -Identify a Critical Care Environment and Equipment's

-Develop a staffing need for the ward
- State types of budget required for running of CCU/ ICU
CCN1 – Sub2
 CRITICAL CARE ENVIRONMENT
 Critical Care Unit (CCU) or Intensive Care Unit (ICU)

 Distinct unit within the hospital that cares for the critically ill or injured
patients
 The Unit has easy access to the emergency department, operating theatre
and medical Imaging

 It provides care to patient with a life threatening illness or injury and

concentrates the clinical expertise, technological and therapeutic resources
required

 CC Facility vary between hospitals in their nature and extent and are
dependent upon operational policies of that Facility
 Organizational design
The functional organization and unit
design are governed by:
 available finance,
 an operational brief and
 the building and designs standards
of the state or country in which the
hospital is located

A bed space, piped medical gases,

suction, electrical outlets, usually the
nursing station is situated in the
middle of the unit.
 STAFF
 Focus in this lecture is on Nursing
 CC patients needs the constant presence of nurses at their bedside
 Appropriate staffing plays a significant role in the quality of care delivered
 Nurse staffing level influence patient outcomes both:
 directly through the initiation of appropriate nursing care strategies and
 Indirectly by mediating and implementing the care strategies of other members of
the multidisciplinary team
 Therefore, ensuring an appropriate skill mix is an important aspect of unit management

1. Staffing roles
2. Staffing level
3. Nurse patient ratio
4. Patient dependency
5. Skill mix
6. rostering
 1. Staffing role
 There are a different number of nursing roles in the ICU/ CCN team
 Various guidelines determine the requirement of theses roles
 For E.g.:
Australian College of Critical Care Nurse (ACCCN) or
World Federation of Critical Care Nurse (WFCCN) position statements

 Various support staff are also required to ensure the efficient function of
the department and these include but are not limited to:
 Administrative/ clerical clerk, domestic or ward assistant staff, biomedical
engineering staff
 2. Staff Level
 Staff establishment refers to a number of nurses required to provide safe,
efficient, quality care to a patients.
 Staffing levels are influenced by many factors including the:

 Economic, political and the individual characteristics of the unit in

question

Others are such as: population served

 The services provided by the hospital and the neighboring hospitals

 The specialties of medical staff working at each hospitals also influence
staffing
 Specific issues to be considered include nurse patient ratio, nursing
competencies and skill mix
 3. Nurse patient ratio
 Nurse patient ratio refers to the number of nursing
hours required to care for a patient with a particular set
of needs
 For example: One nurse to a patient (1:1)
One nurse to two patient or (1:2)

In large wards could be:

One nurse to 4 patient or
One nurse to 31 patients etc….
 4. Patient dependency
 An approach to quantify the care needs of an individual patient
 So as to match these needs to nursing staff workload and skill mix
 For many years patient census was the commonest method for
determining nursing workload within an ICU/CCU
 Based on accepted ratio for nurse patient; 1:1 or 1:2 for HDU

 Nursing workload at the individual patient level, however is also

reflective of patient acuity
 The complexity of care required and both the physical and
psychological status of the patient,
 5. Staff/ Skill mix
 Refers to the ratio of care givers of varying levels of skill, training and
experience within a clinical unit
Example maybe general registered nurse and clinical nurse specialist

 In Critical Care skill mix also refers to the proportion of registered nurses
possessing a formal specialist critical care qualification
Example maybe:
a Neuro & Cardiac nurse

 Staffing level and skill mix should be based on individual unit needs (for
example: unit size and location)
6. Rostering
 Once the nursing establishment for a unit is determined and skill mix
is considered, the rostering format is decided

 In this time of nursing shortages one of the factors identified as

affecting the retention of staff is the in-ability to provide flexibility in
rostering practice

***
 EQUIPMENT

 Since the advent of CCU, HC delivery has become increasingly dependent

on medical technology to deliver that care.
 They are very costly and requires a capital budget to procure.
 Disposable products, devices and accessories required to support this
equipment also are expensive to maintain continuance

Initial set up requirements

 CCU require baseline equipment that allows the unit to deliver safe and
effective patient care
 The list of specific equipment required by individual unit will be governed by
the scope of the units function
 For example:
A unit that provides care to patient
after neurosurgery will require the
ability to monitor intracranial
pressure (ICP)

More specialized doctors, more specialized nurse and

the more specialized equipment's are required
to provide relevant specialized care
 BASIC EQUIPMENT REQUIREMENT

Monitoring Therapeutic
 Monitors  Ventilators
 End-Tidal C0₂ monitoring (invasive/ non invasive)
 Arterial blood gas analyzer
 Infusion pump
(± electrolytes)
 Syringe drivers
 Invasive monitoring
 Resuscitators
-arterial (IAP)
 Temporary pace
-Central Venous Pressure
maker
(CVP)
 Defibrillator
-Intracranial pressure (ICP)
 Suctioning apparatus
-Pulmonary artery (PAP)
 Ultrasound
 Electrocardiogram (ECG)
 BUDGET
• There are essentially three types of
budget to consider as a manager
• Personal, Operational and Capital
budget
• Within this budget there are two
basic cost types; fixed and variable
• Fixed cost are those essential to
the service and are relatively
constant regardless of fluctuations
in workload or throughput
• For example; nurses salary,
security, ventilators
• Variable cost change with
changing throughout
• For example; nurse agency usage
or staff overtime, consumable
items
• Especially if used in response to
influx of demand and resulting
consumables
• Such as linen, dressing and drugs

PERSONNEL BUDGET
1. Health Care is labour
intensive
2. Personnel cost include
productive and non
productive hours
3. Personnel budget turned to
be fixed cost as most staff
are employed permanently
4. A manager will determine
the number of nurses to be
rostered per shift
5. Productive hours are those
utilized to provide service
6. Non productive hours are,
sick leave, holiday leave
maternity leave etc.
TYPES OF BUDGET
OPERATIONAL BUDGET
1. All other non personnel cost
apart from capital budget
turn to be allocated to
operational budget
2. These are;
-Fixed cost as minor
equipment's
-Maintenance contract
-Utility cost (e.g.; electricity)
4. Variable cost that fluctuate
with patient type & number
For example;
-pharmaceuticals
-Consumable supplies as
gloves
-Dressings, laundry etc.
CAPITAL BUDGET
1. CB items are expensive
and large fixed assets
that are considered long
term investments, such
as; Building extensions,
renovations, purchasing
of large equipment's
2. CB items are considered
as assets that are
depreciated over time
3. To request a capital
budget item, a proposal
is required describing the
item & its expected
benefit etc.
SUMMARY

1. Define Critical care environment (2)

2. Describe what critical Care environment looks like (3)
3. What is the staffing like (4)
4. Why is that important ( level/ S. mix) (4)
5. How do you know that the type of care you give is relevant/ required (5)
6. Staffing level of an establishment is influenced by many factors; name 2 (6)
7. What do we mean by nurse patient ratio E.g.: 1:1 or 1:2 (7)
8. Differentiate between staff mix and skill mix (9)
9. What are the two category of basic equipment requirement in CCU (13)
10.Give two examples of each (13)
11. What 3 types of budget do you consider as a manager of CCU (14)
12.Describe each of the 3 budgets (15)
13.Give an example of each budget (15)