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Building Design
The unit should be light, and airy with low windows to
enable sitting patients to look out, but with blinds if privacy is
required. Building should be designed for natural heat cooling in
summer and retention in winter. Plants on exterior and window boxes?
Internal Blinds/Curtains, for use as divisions/privacy screens should
work as such and be of a heavy material designed to some degree to
block sound, reflect heat and block draughts, when required. Inbuilt
reflective heatscreen.
Walls : Acoustic dampening to reduce
machine noise. Also clocks!
Doors and Security
Steel security doors on main entrances to unit to
prevent theft of equipment eg TV's and Video's etc.
Heating/Ventilation
Air conditioning: Only if it works! and is Unit
Controlled, must cope from heat from machines.
Rooms : sluice, kitchen, staff
kitchen/coffee room, Stock/storage room with racks and trolleys,
Patient waiting area.
Large room setup with curved central staff station. Hand rails for
unstable/less mobile patients.
Machines : aesthetically pleasing (as
possible), Gambro/Drake and Wilcox (Hospals are ugly!!) Someone
please tell Hospal this!!!
Ducting: to deliver water supply, oxygen etcetera
Also Sound (for television)/Radio, ports to allow patients to watch
television (on overhead brackets) with out disturbing others.
Individual television's? Internet Access (ISDN link) (Server)????
A fan installed above each patient allows cooling if necessary. Spot
lighting above each station will prevent eyestrain.
Facilities , Kitchen, with stove fridge
microwave sink.
Toilets: with most importantly, a mirror and decent mixer tap.
Also mirrors above sinks in unit. Hand rails for around unit ( could
be combined as trolley crash bars) unstable/less mobile patients.
Visible clocks around unit.
Design to aid partially sighted, partial hearing.
Transport Decent transport which arrives
and picks up at a relevant time.
Each patient will have a shelf/cupboard/locker to place coats and if
necessary other items regularly used, including non perishable
foodstuffs. Area should be cool and dry. (Possible ventilation for
wet coats etcetera).
Also for each patient, a small rack box (detachable rack system) for
patients personal set of tapes, tourniquet and headphones, (for
listening to television/Radio)
Curtains/divisions : curtain rail on a
curtain rail type, with heavy sound dampening material. Should reach
floor, or just above.
Staff/Patient support
Staff rank should be clearly identifiable from their
uniforms, eg no confusion between healthcare workers and staff
nurses. Name badges should be large easy to read and positioned so
that they are not obscured by aprons.
Social Worker should know what claims are
relevant to dialysis and which forms to fill in. Also be able to
advise on working/education whilst on long term dialysis. Especially
important for those whose work/education may have been interrupted or
lost due to illness.
Occupational therapist/tutor
Tutor to advise student patients, improve life
skills?
Psychologist/ Physiotherapist.
Nursing Staff: not less than staff:patient 1:3
minimum , more if possible. Healthcare
workers available for observations.
Observations : BP, Pulse, Temperature and
Weight recorded pre and post, and checked before take off. Automatic
blood pressure temperature probes are allowable, but manual equipment
should be available in case of malfunction/power failure.
Tables for packs cleaned prior to put on and take off. Table should
be of easily adjustable height
Food : Hot meals or sufficient/substantial
sandwiches (brown and white) provided. Domestic
available for mid end of dialysis food and drink. Should be suitable
sandwich filling, ham (eg not excessively salty), chicken, turkey
etcetera
Machine Setup: Standard machine disinfect
pre/post dialysis. Machine exterior clean post dialysis. Cleaning of
chair and pillows post dialysis. Closed circuit connection. Setup by
nurses or patients if trained and time available.
Setup BiCart/Dialysate for next patient, during
prior patients dialysis (standard dialysate only)
Machine Technicians available during
treatment times, and on call at other times, in case of
acutes.
Sharps Bins with Each Machine. At a safe level
Rubbish Facility on machine eg paper bag,
hooked waste bag. Recycling of materials such as BiCarts should be
encouraged. (as in US)
Patient boxes/baskets for 'self
sufficient' patients.
Bloods : taken minimum 1/week (U&E,
FBC) on all new and any unstable patients for minimum of 3 months, or
as necessary? Also on request if patient has eaten a suspect food and
may need alternate .
Patients known to be 'very stable' may have sample
frequency reduced, if they feel this is valid.
Pharmaceuticals/ Prescriptions
Regular subscriptions should be available from GP, if
obtained via the unit they should be prescribed and ordered in
advance as it should be possible to predict when supplies are needed.
Satellite units must have a communications system with main unit for
prescriptions etc. Whether by telephone, email or dedicated ISDN
line, good communication must be maintained.
DISCLAIMER:
The above are guidelines only, and ideas outlined are suggestions
based on experience, no responsibility will be taken for harm to any
person as a result of this document.
All work remains property and Copyright to the author.
James Warham, Thursday, January 15, 1998
As this is a draft copy it may well contain errors, it will be
updated eventually and published in a text editable form, in the
meantime; comments and suggestions to:
kidney@cyberdude.com
