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12 Note: This document has been prepared based upon the information contained in the report entitled Functional Program, Family Birthing Unit Expansion, 2008 February prepared by Integrated Planning Resources Inc. (IPR). Any substantive modification of, or supplement to, the information contained in the IPR report is recorded in the attached Addenda sheet. The IPR report may contain information not transferred to this document, by reason that it is considered not relevant to the design process. The reader seeking information related to scope, workload, or staffing rationalization and more extensive description of historical and planned future operations may find such information in the IPR document. FUNCTIONAL DESCRIPTION Scope of Services The FBU will remain in its current location and will expand into the space vacated by the NICU once it moves to new construction in Phase 1A. The Maternal Fetal Medicine Program and Outpatient Services, currently occurring in one zone (Pod IV) of the FBU, will be relocated to the new outpatient facility, thereby freeing up more space for the required expansion. In order to achieve maximum flexibility of use of patient rooms, all patient rooms will be LDRPs, the result being that the existing antepartum rooms will be used for other purposes (possibly, two LDRPs). As appropriate, antepartum patients will be physically cohorted into one of the wings of the FBU. A total of 46 LDRPs will be provided along with two ORs for c-sections. Two of the LDRPs will be configured as semi-private accommodation in order for Fraser Health to be able to provide preferred accommodation to patients. These two LDRPs will be connected by an internal door in order to meet the definition of semi-private accommodation. The key areas of the FBU included in the Acute Services Wing Project are: Reception & registration; Triage; The OR corridor; A new transition nursery; and Various selected support spaces including additional on-call space for anesthesiologists, obstetricians, pediatricians, and general practitioners. Exclusions This specification excludes inpatient and outpatient services/requirements provided elsewhere, including: Maternal Fetal Medicine Program Outpatient Services at OPF; Antepartum Care at Home program at OPF; Critical Care Services provided in Intensive Care Unit; Phase 1A Medical/Surgical beds; Existing Medical/Surgical beds; Phase 1B Medical/Surgical beds; Cardiology Inpatient beds; Pediatric Inpatient beds; Mental Health Inpatient beds; Rehabilitation Inpatient beds; Resource Planning Group Inc August 20

13 Palliative Care beds; Long-Term Care beds; and Acute Care for the Elderly beds Unit 5E. Associated Trends The driving philosophy of the Maternal Program will not change: it is a commitment to the model of holistic family-centred care, a collaboration between clients and their caregivers. Note the following highlights: The goal of family-centred care is to maintain and support the needs and desires of each individual in the family; Families, through respect and informed choice are empowered to take responsibility in their decision-making options; Family-centred maternity care recognizes pregnancy and birth as a normal and healthy process in the beginning of life; however, provision must be immediately available if the process of normal birth changes and medical interventions are necessary; Pregnancy and birth are unique for each woman and must be addressed as such; Respect for the customs of different cultures is engrained in the family-centre care model; Care provided to the newborn is baby-friendly with respect to supporting and encouraging breastfeeding; and Finally, the well-being of the mother and infant are dependent upon each other as both adjust to the many physical, psychological, and social changes after birth. Scope of Education Activity The FBU will be a place for education and training of numerous individuals including: 2 Medical students and medical practitioners; 2 Midwifery students; 12 Nursing students; 4-6 New staff; 1 Pharmacist; 2 Residents; 1 Laboratory technologist student; 1 Laboratory assistant student; 1 Respiratory therapy student; and 1-2 Students in the various allied health professionals. As well, there will be a focus on continuing competency and enhancement of skills of existing staff. In total, there could be up to 20 non-staff people involved with education programs in the component at any one time. Scope of Research Activity The FBU will participate in clinical research studies, as appropriate. Resource Planning Group Inc August 20

14 OPERATIONAL DESCRIPTION Hours of Operation The FBU will function 24-hours, 7-days a week. Patient Management Processes Pre-Registration Pre-registration in the FBU generally occurs by 20-weeks, with the family physician advising the woman to present at the FBU. By connecting with the resources at SMH for orientation, anxiety is decreased and comfort of familiarity is gained. The registration information is passed on to Health Promotion & Prevention electronically. The objective is to achieve a 100% rate for pre-registration. The pre-registration process itself takes, on average, 15-minutes, and women are provided with an information package when pre-registration is complete. At the time of pre-registration, women are advised to come directly to the FBU at 20-weeks and over if there is any concern with the pregnancy. Under 20-weeks, women are advised to present at the Emergency Department. Instead of having to present at the FBU, women are invited to phone into triage for a nursing consult if they wish. This may or may not result in a visit to triage and an assessment. Assessment As well, women are instructed to return to the FBU and present to the registration clerk if they are (or feel they are) in labour or if they have any other concerns related to their pregnancy. At that time, the clerk will immediately inform the triage nurse (via electronic means) and escort the woman to the triage waiting area where the triage nurse will meet the patient. The completion of the registration will occur with the partner or as soon as otherwise possible. Following assessment in triage and upon the decision to admit, the PCC assigns the woman to an LDRP. Following assessment in triage, the decision might also be made to discharge the woman. If an emergency c-section is to be performed, the women will be held in triage until the time of the c- section. Following delivery, generally mother and baby are discharged together, though a number of mothers will be discharged with the babies remaining in the NICU. Rather than presenting at the ED, mothers are instructed to return to the FBU for up to 42-days postpartum for obstetrical issues. After Hours At present, after hours, women coming to the FBU do so without interference because the south entrance is unlocked. Given overall site security issues, the plan is for the whole building to be locked at night and a designated entrance be identified as the nighttime entrance where security personnel will reside to screen anyone entering the building after hours. In fact, security personnel may escort women from that building entrance directly to the FBU. This change in operational policy is currently under review. Resource Planning Group Inc August 20

15 Patient Information Management Health records will be fully automated and accessible by authorized personnel at all clinical service locations in the hospital. Physician reporting will utilize a voice recognition dictation system. Information systems will be fully automated for patient health records, patient scheduling and registration, test orders and results, supplies management, food menus and orders, and administrative records. Access to the system will be available not only at all staff workstations, but also at all patient positions. Wireless connections to the system will be available in all patient care areas. Electronic medical records (EMR) will be available at patient-specific staff workstations located immediately outside the patient rooms, including viewing of digital images. Staff Work Processes Care Delivery A continuum of care with emphasis on education will be an overriding principle of programming. Prenatal education will be provided to pregnant women and their partners in the community. Teaching prior to discharge will continue to occur. Further postnatal education and follow-up will be provided by Health Promotion & Prevention RNs in the community. During pregnancy, various tests, medications, and procedures will be provided on an outpatient basis within the FBU triage. These events are either scheduled or the physician simply calls in, advising that he is sending over a patient, or the patient simply presents herself. Pre-operative interviews for scheduled c-sections are currently informal. A more structured Pre-Op Clinic will function out of the FBU triage area starting with a phone interview (frequently, involving interpreters) followed by an appointment for consultation with a nurse, obstetrical anesthesiologist, and sub-specialists (as necessary). A patient in labour or presenting with a problem will be triaged in appropriate space and either admitted to an LDRP or discharged home. There will be no provision for an early labour lounge in the expanded FBU nor will there be provision for discharge lounge. Triage will be a busy area of the FBU. As well as seeing patients, the triage nurses respond to numerous phone calls from pregnant women having a wide variety of questions. In a recent 24-hour period, a total of 50 phone consults were counted. This number is considered to be an average daily number, with most calls consuming an average of five minutes of nurse time. Excluding the antepartum outpatients who currently attend triage and who will move to the new Outpatient Facility, it is expected that between 60 and 70 patients per day will present at triage. Some will be in labour while others will be presenting for a variety of other maternal and/or fetal assessments, cervical ripening, or for consults. Pre-delivery anesthesia consults currently occur in triage. Potentially 10 patients per week could be scheduled. A recent review of weekly activities in triage indicated peak hours in a random fashion over the 24- hour day, but a block of peak hours tended to be between 4-hours and 7-hours of a day. For planning purposes, it is agreed that there can be a surge of patients at any time, reflecting the complete unpredictability associated with obstetrics, and the staff and physical resources of triage must be able to respond accordingly. Resource Planning Group Inc August 20

16 The average length of stay in triage for those discharged is approximately 2-hours with length of stay in triage for women being admitted ranging from 5-to-200 minutes, depending upon physician accessibility, the complexity of the issues presenting, the delay in an elective c-section, etc. Consequently, for planning purposes, it must be emphasized that a woman can spend a wide range of time in triage. Partners will attend triage with the expectant mothers. Clinical and Logistical Support Services (a) Anesthesia Services There will be 24/7 coverage for peri and postpartum pain management, peri-operative anesthesia management in the two ORs, and participation in the management of medical complications of high-risk patients. Consideration is being given to the addition of an anesthesia technologist. (b) Clinical Dietitian Services The clinical dietitian provides assessment and intervention to antepartum patients. Specifically, the clinical dietitian sees patients with special nutritional needs such as gestational diabetes and allergies. The clinical dietitian very seldom sees women who are in the FBU for labour and delivery. Therefore, workload for the inpatient clinical dietitian is associated with antepartum beds and not LDRP beds. (c) Clinical Pharmacy Services The clinical pharmacist will review the medication profile of the mothers and resolve medication related issues involving the mother and/or fetus (e.g., assess and provide pertinent information to obstetrics staff regarding potential withdrawal syndrome, drugs and breastmilk issues, teratogenic risk, partum risks, etc.). In addition, the clinical pharmacist reviews medication-related protocols, interprets serum drug levels, responds to consultations for complicated drug therapy regimens or other issues, and liaises with the Pharmacy to ensure that drug distribution needs are met. (d) Diagnostic Cardiology ECGs will be provided in the FBU, as required. Cardiac ultrasound will be performed in the Diagnostic Cardiology Department. (e) Laboratory Services Laboratory personnel will be responsible to take blood while nursing staff will continue to collect other specimens, as required. Laboratory personnel will use a computer terminal with a bar-code printer located at each of the nurse stations to label specimens. With the potential for new RFID technology, identification of both patient and specimen can be electronically matched. Porters or the pneumatic tube system will be used to transport specimens to the Laboratory. (f) Language Services Interpreters will be provided, as needed. Resource Planning Group Inc August 20

17 (g) Medical Imaging Services All images will be digitally produced. As clinically needed, though very rare, a portable x-ray machine will be used in the FBU. More frequently, patients will be transported to the Medical Imaging Department, depending upon the diagnostic requirement and condition of the patient. Portable ultrasound will be used in the FBU for fetal positioning and assessment in triage and/or in the LDRPs, as required. (h) Rehabilitation Services Inter-disciplinary services, as required, will be provided, designed to promote optimal health and wellbeing for the child and family. The therapists work closely with other members of the health care team as well as the family of the newborn. Services include assessment, diagnostic input, treatment, and education related to a wide range of physical needs. Physiotherapists are specifically involved in the treatment and education of women within the Antepartum Program who are on bed-rest prior to delivery. Within the context of Rehabilitation Services, the Newborn Hearing Screening Program, a provincially mandated and monitored service, is responsible to screen all babies for potential hearing loss. SMH Audiology staff provide 7-day coverage from 0800 to 1600 for universal newborn hearing screening. (i) Respiratory Therapy At present, respiratory therapists are only called when a newborn is having trouble breathing or is going to need ventilation. In the future, RT staff will attend high-risk deliveries, if required. RTs will be members of transport team taking newborns to the NICU. As well, RTs will attend, if called, Code Pink calls, participate in the Neonatal Resuscitation Program (NRP), and support adult patients having on-going respiratory issues. (j) Social Work Social workers will be a resource, as needed. (k) Biomedical Engineering Biomedical Engineering will be responsible for maintaining fetal monitors, anesthetic machines, IV pumps, etc. Note that it is not necessary to assign space to this service within the FBU. (l) Equipment Management At present, due to a profound lack of equipment storage space, the corridors of the FBU are littered with a wide variety of equipment items. Space permitting, the logistics of managing and storing equipment will be restructured. One aide is available weekdays to assist in equipment management. (m) Food Services Generally speaking, no changes to the current meals and nourishments distribution systems are planned. Women are provided with full meals postpartum during daytime hours after which there Resource Planning Group Inc August 20

18 is only limited service using a small amount of food stored in the unit s refrigerator. Ideally, a full meal should be offered day or night postpartum, as patients wish. The practice of retrieving meal trays following the meal will be reviewed with the objective being to minimize incidences of disturbing the patient who is in early labour or who is resting or breastfeeding. Ideally, the food service workers should be able to retrieve the meal tray without entering into the private space of the patient. Formula will be supplied by the FBU and delivered via stores to the unit. Formula will be stored out of the view of patients and families, in accordance with baby-friendly initiatives. (n) Housekeeping Services Housekeeping staff will provide daily cleaning services to meet the specific needs of the program. All waste and soiled linens will be collected and stored in the soiled holding rooms located within the unit/department. Designated staff will remove waste and soiled linens and transport to the final collection/disposal areas. No change in housekeeping services is planned. The FH guideline for the number of housekeeping closets is one per 650 gsm and one new housekeeping closet will be planned in the OR area as a result of its expansion. Ideally, the corridors of the FBU will be kept free of storage items and equipment in order to allow housekeeping staff to do their work effectively. (o) Linen Services Linen staff will deliver clean linens to the unit/department on a daily basis to meet the specific needs of the program; linen will be delivered to the designated clean holding area located within the unit/department. With the increased number of births, one additional clean linen cart must be accommodated (in pod IV, assuming that it will be renovated for more LDRPs). (p) Pharmaceutical Services Pharmaceutical services will be provided from the main adult based Pharmacy that will be located remotely from the FBU. Pneumatic tube access from the Pharmacy to the FBU will be required. Medication distribution services will be available Monday to Friday from 0800 to 2200 and from 0800 to 1800 on weekends and stat holidays. After-hours services will be available through controlled-access cabinets or on-call services. In support of the region s role and service goals, the SMH Pharmacy is planning to introduce changes to its methods of operation. These initiatives, which are the basis of the region s automation plan for Pharmacy Services, will include: Implementation of a new point-of-use (POU) drug distribution system utilizing controlledaccess cabinets (CACs) automated drug dispensing cabinets on patient care units for the majority of medication requirements in addition to ward stock and narcotic inventories (it is anticipated that the needs of the FBU can be served through a CAC main cabinet plus an auxiliary cabinet); Unit dose packaging of all adult solid oral doses at the PDDC; Resource Planning Group Inc August 20

19 Preparation of patient-specific IV admixture refill doses and batch doses at the PDDC with the exception of pediatrics, TPN, chemotherapy and narcotic infusions requiring mixing, which will all be done on-site (all first doses up to 36-hours will be prepared by the on-site adult-based Pharmacy); Centralized purchasing and inventory control by the PDDC; and Introduction of physician order entry. Assuming the implementation of these initiatives tie into the schedule for the redevelopment of the FBU, physical changes will be required at each medication preparation area. (q) Security Services The FBU shall have the physical capability of immediate electronic lockdown from the rest of the building in a Code Amber situation. Panic buttons will be provided at reception/ registration. (r) Staff Services No changes to process are planned; however, significant improvements in space (both amount and design) will be made. Outer clothing will be stored in staff locker rooms and clinical staff working in the FBU will be provided with scrubs to wear. Students and volunteers will have space for coat storage in the staff locker room. A larger staff lounge than exists at present will be provided within the FBU for breaks and meals. Staff education spaces will also be provided within the FBU. (s) Supply Management At present, supplies for the inpatient portions of the FBU are delivered three times a week. Given the restrictions of space and the fact that workload will be increasing significantly (23.4%), deliveries of supplies will be made on a daily (Monday to Sunday inclusive) basis. Supplies for the ORs will also be made on a daily basis. In addition to the change in delivery frequency, a detailed analysis of the use of each clean supplies space is strongly recommended in order to maximize limited space resources. This should include a new shelving system to assist with error prevention. (t) Information & Communications Systems Eventually, the FBU, as in the rest of the hospital will utilize a fully operational electronic medical record. In the context of this project, appropriate wiring will be provided in spaces being created or renovated where it is anticipated that computers will be installed. It is anticipated that an electronic bed board will be utilized for the improved management of bed occupancy. It is also expected that fetal monitoring tracings will be electronically archived. Resource Planning Group Inc August 20

20 The existing communications systems in the FBU are deficient and a replacement system shall be considered. (u) Wireless Technology It is anticipated that there will be increased use of wireless technology. For example, mothers staying in the FBU who want to visit their newborns in the NICU may use electronic swipe cards. (v) Pneumatic Tube The existing pneumatic tube will be retained. In addition, a pneumatic tube will be added to the Surgical Suite. (w) Physician Dictation Physicians will continue to access the central dictation system through the general Hospital telephone system. (x) Telemedicine The FBU will continue to link with BC Women s Hospital for teleconference rounds and for reading digital images. The FBU will link to the new OPF such that data from the Fetal Monitoring Clinic will be sent electronically to the FBU as necessary. (y) Codes Support The FBU will continue to call for codes on adults. For newborns, the calling of Code Pink will continue to occur with FBU, as required. ACTIVITY CAPACITY Table 1 presents historical and projected workload for the FBU. It is noted that the current number of deliveries has risen significantly and is projected at 4,200 for 08/09. Consequently, the projected number of births in 2010/11 (4,500) could well be underestimated. It should be noted that 75 percent occupancy is considered low. Also percent caesareans births could increase to as high as 40% with the increasing complexity of cases. Table 1: Historical 1 & Projected 1 Workload of the FBU Actual 2003/04 Actual 2005/06 Actual 2006/07 Projected 2010/11 Total Births 3,716 3,366 3,695 4,500 Delivered Maternity Patients 3,656 3,306 3,647 4,433 Delivered as % of Births 98.38% 98.39% 98.70% 98.50% - Vaginal Deliveries 2,568 2,222 2,508 3,103 - Caesarean Deliveries 1,088 1,084 1,139 1,330 - Caesareans as % of Total 29.76% 32.79% 31.23% 30% - Emergency Caesareans* 62.6% 65% Number of ORs Total LDRPs in Use Source: Fraser Health. Resource Planning Group Inc August 20

21 Actual 2003/04 Actual 2005/06 Actual 2006/07 Projected 2010/11 Total AP** Beds in Use in above Separations 4,356 3,941 3,533 Total Days 9,358 9,162 7,930 10,072 - Antepartum Days *** *** *** 1,620 ALOS: Vaginal Delivery ALOS: Caesarean Delivery ALOS: Antepartum *** *** *** 3.0 % Occupancy: LDRPs 77.7% % % Occupancy: Antepartum **** **** **** 75% Notes: * Emergency Caesareans as percentage of Total Caesareans. ** AP = antepartum rooms. *** Refer to the notes above. Current and historical antepartum days and LOS are not finitely known. **** Included in the occupancy of the LBRPs + Antepartum beds = 33 beds. OCCUPANCY The maximum estimated occupancy of this component will be as shown in Table 2. Table 2 Maximum Headcount Occupancy Person Category Day Evening Night Director Administrative Assistant Manager Clinical Nurse Specialist Clinical Nurse Educator Antepartum Coordinator Patient Care Leader Patient Care Coordinator General Duty RN OR/PACU RN Triage RN CRC RN APCAH RNs Birthing Suite Aide* Unit Clerks Health Records Admin. (Grade I) Health Records Supervisor Lactation Consultant Program Clerk*** Respiratory Therapist Social Worker Physiotherapist (varied hours) Occupational Therapist (PRN) Audiologist Clinical Dietitian Clinical Pharmacist Subtotal, Staff Patients Visitors Residents Students Other Resource Planning Group Inc August 20

22 Maximum Headcount Occupancy Person Category Day Evening Night Subtotal, Other Total Notes: * 1 Birthing Suite Aide will work 1130 to 2330 and will straddle days and evenings. ** 1 Unit Clerk will work 1130 to 2330 and will straddle days and evenings. *** An extra Program Clerk will be available two days per week. DESIGN CRITERIA External Relationships Family Birthing Unit 1 NICU 1 Shall provide direct access by non-public circulation to NICU for the movement of patients and staff. 2 ICU 2 Shall provide direct access by non-public circulation to ICU for the movement of patients and staff. 3 Surgical Suite 3 Shall provide direct access by non-public circulation to Surgical Suite for the movement of patients and staff. 4 Diagnostic Imaging 4 Should provide direct access by non-public circulation to Diagnostic Imaging for the movement of patients, for ultrasounds and amniocentesis procedures, and staff. 5 Sterile Processing Department 5 Shall provide direct access by non-public circulation to Sterile Processing Department for the movement of supplies. 6 Central Laboratory 6 Should provide convenient access by general circulation to Central Laboratory for the movement of staff. Internal Design Criteria (a) Overview & Configuration The general configuration of the FBU will remain as-is with the following specific changes: The reception/registration desk will be immediately visible upon entry into the FBU; The reception/registration desk will be located immediately adjacent to triage because the clerical staff will escort women from registration into the triage waiting area; The public waiting area will be located in close proximity to the reception/ registration desk; Resource Planning Group Inc August 20

23 The on-call rooms will be grouped and accessed off a secure private corridor that is accessed electronically from the public corridor. These rooms shall be located away from the patient care areas of the FBU; The new transitional care/observation nursery shall be located adjacent to one of the FBU nursing stations for visualization from the nursing station; Offices and staff support spaces shall be located away from the clinical spaces so as not to interfere with the activities there, but grouped together within the FBU; The office of the perinatologist shall be located adjacent to the new ultrasound room; The two ORs will be accessed off a restricted corridor and shall be configured so as to share the clean core as well as the infant resuscitation room. Scrub stations will be located immediately outside the entrance to each of the ORs in the restricted corridor; The PACU will be located in the immediate vicinity of (virtually adjacent to) the ORs such that transporting the patient from an OR to the PACU will occur in the restricted corridor; and The route from the infant resuscitation room to the new corridor linking the FBU to the new NICU shall be as direct as possible and will not pass through the public entrance zone. (b) Special Considerations Disabled Access In any new or renovated space, physical design attributes shall make accommodation for the blind, deaf, frail, and cognitively challenged; as well as those using wheelchairs and walkers. Provision for the bariatric patient will be made and will include a specially designed OR table. Acoustic Privacy In any new or renovated space, the acoustic requirements for privacy will be addressed during detailed design. Patient Washrooms Two of the eight new LDRPs will require a tub/shower in the patient washrooms. The remaining six patient washrooms will have a European-style shower. Infection Control At present, six existing LDRPs have negative air pressure. No additional rooms are required. All new staff handwashing sinks will be equipped with hands-free controls. Note that a certain number of these sinks will be equipped with tempered eye-wash stations, strategically located during detailed design. Plexiglas splash-guard shields shall be installed on all closed waste services and potential splash areas. Spill clean-up supplies and PPE storage will be provided within the FBU. Resource Planning Group Inc August 20

24 Sharps containers shall be provided at bedside and other points of use. It is assumed that GUS fume-free soak stations will be utilized for sterilization of vaginal probes. Mechanical Systems If formalin is used in the ORs, an appropriate exhaust system shall be designed. Similarly, a nitrous oxide scavenger system shall be included in the ORs. Codes & Standards In addition to the above criteria, the facility must conform to recognized national, provincial, and local building codes and standards as they may relate to safety and accessibility for patients, staff, and visitors. Resource Planning Group Inc August 20

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26 Schedule of Accommodation The following space types, numbers of spaces, and areas of spaces shall be provided as minimum requirements: Note: This schedule is derived from the approved Functional Program prepared by Integrated Planning Resources (IPR) without change to numbers, types, and sizes of spaces. Ref Space Area Requirements Remarks units nsm/unit nsm 01 Replaced Reception/ Registration 02 Replaced General Waiting Area Incl. 2 reception workstations, 2 private registration cubicles, supplies/ work area Incl. 10 seats, children play area Replaced Triage 0 03 Triage Waiting Area Incl. 6 seats, nurse workstation, medications preparation alcove, physician dictation alcove 04 Exam/Consult Rooms Patient Washrooms Stretcher Bay Area Incl. 6 stretchers, staff handwashing sink 07 Charting/Dictation Alcove Incl. 3 workstations 08 Clean Supplies Room Soiled Utility Room Allowance for Circulation Additional LDRPs Additional WCs for LDRPs will have tub/shower, 6 will have European-style showers Transitional Care/ Observational Nursery 0 Re-use room N212A 13 Replaced OR New OR Resource Planning Group Inc August 20

27 Ref Space Area Requirements Remarks units nsm/unit nsm 15 New/Replaced Scrub Stations 16 Replaced Resuscitation Room 17 New Clean Supplies Core for ORs 18 New Soiled Utility Room for ORs 19 New OR Equipment Storage Room Inc. 3 neonate resuscitation spaces, supplies area Pneumatic Tube Station Incl. workcounter 21 Replaced PACU Incl. 2 patient spaces, 1 nurse workstation, 1 clean supplies/linen alcove, 1 soiled utility alcove, 1staff handwashing sink, 1 medications preparation alcove 22 Allowance for Circulation New Staff/Family Education/ Conference Room 24 Storage for Education/ Conference Room New Family Gathering Alcoves Incl. 25 seats, television Re-use existing space 25 New Public Washroom Incl. toilet, sink, paper towel dispenser, soap dispenser, toilet paper holder, wheelchair accessible 26 Replaced Ultrasound Room Replaced Office: Anesthesiologists 28 New Office: Chief of Obstetrics 29 New Office: Program Assistant Resource Planning Group Inc August 20

28 Ref Space Area Requirements Remarks units nsm/unit nsm 30 Replaced Office: Perinatologist 31 Replaced Office: Clinical Nurse Specialist 32 Workstation: Clinical Pharmacist 33 Replaced FBU Health Records 34 Replaced Staff Education Room 35 Replaced Female Staff Locker Room 36 Washroom/Shower, Female 37 Replaced Male Staff Locker Room 38 Washroom/Shower, Male Incl. 2 clerical workstations, 1 supervisor workstation Incl. 25 seats, television Incl. privacy vestibule, lockers Incl. toilet, sink, shower, paper towel dispenser, soap dispenser, toilet paper holder, wheelchair accessible Inca, privacy vestibule, lockers Incl. toilet, sink, shower, paper towel dispenser, soap dispenser, toilet paper holder, wheelchair accessible 39 Replaced Staff Lounge Incl. 12 seats, table and 8 chairs, kitchenette 40 New Additional Staff WC (Pod III) Replaced On-Call Rooms Washroom/Shower Incl. toilet, sink, shower, paper towel dispenser, soap dispenser, toilet paper holder, wheelchair accessible Total Estimated gross 1.10 ratio = CGSM Resource Planning Group Inc August 20

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30 Selected Space Descriptions Note: Room numbers presented in the text refer to the room numbers on the architectural drawings. Physical Layout of the FBU The FBU is configured as back-to-back F s (two distinct sides with four pods of beds) with reception, triage, and the surgical suite in the middle zone. The overall configuration is quite satisfactory though there are some issues with flow/movement of people and supplies as the service elevators enter the floor in close proximity to the main doors to the unit. Ideally, one would separate the service elevators from the entrance area of the unit. As well, the three LDRPs (rooms M255, M256, and M257), currently being used by the Maternal Fetal Medicine Program (Pod IV) but being vacated once the clinic moves to the Outpatient Facility, are isolated from other patient rooms and adjacent to the staff change facilities and therefore are not suitable for safe patient care. It is also noted that the clean supplies elevator serving the c-section OR and the LDRPs is located quite a distance away from the OR at the end of a patient corridor, and quite a distance from the majority of the LDRPs. This is far from an ideal layout. As well, soiled supplies from the OR and the LDRPs must be transported through the unit to the service elevators near the main entrance. Space Allocation Three areas have been highlighted as being seriously deficient. These are described below, followed by commentary on other spaces. Room numbers listed refer to existing room numbers on the FBU. Reception (M201C & M267): This area is the central intake for all patient care and information gathering. There is no privacy for women and their partners when they are answering admission questions. Women needing to be assessed are seen first by a clerical staff rather than a nurse. This is a risk management issue as unit clerks are not educated to provide nursing assessment. Waiting (M201B): The amount of waiting space is significantly inadequate for current use by women and their families. Its proximity to reception results in the ability to readily overhear the conversations occurring at reception. Triage: This area is congested and crowded. There is no privacy for the women as they are assessed on stretchers that are positioned with the foot facing a high-traffic area and a very short distance from the only telephone and documentation station in the area. Curtains separate each stretcher bay but these are often pulled by the people in the next bay by accident, leaving women exposed. The stretchers are approximately only 1.2 m apart (M279). All information is heard by all patients, support persons, and staff. Note that triage in the FBU includes functions associated with women presenting in labour, drop-in assessments and treatments for antepartum patients, scheduled anesthesia consults, and a number of scheduled obstetrical outpatient services. The documentation centre in triage is very small with only standing room for one person. The only handwashing sink in triage is here and paperwork is constantly getting wet as a result. This is also the only counter for lab specimens to be stored while waiting for collection or transfer to the Laboratory. Three stretchers are separated by a room from the other two stretchers, the result being that it is difficult for the triage nurse to keep as close a watch on all five patients as possible. The clean supply area (M279A) is off the corridor that enters the triage area and is very congested. The only patient Resource Planning Group Inc August 20

31 washroom is also in this corridor, making it difficult for women who are in labour or pain to access without being in the way of incoming and outgoing traffic. The final two stretchers (M270) within triage are part of a Cervical Ripening Clinic (CRC) and are also just around the corner, but must be accessed by the same entrance as the main triage area. Other outpatient activities occurring in the triage area are the Fetal Monitoring Clinic and the Nausea & Vomiting Clinic: these will move to the new outpatient facility. The office of the perinatologist (M268) is located at the end of this space and is only accessed by passing through the CRC, again impacting privacy. If a woman is admitted to the Family Birthing Unit following assessment, she must exit the triage area back to the reception area and main entrance before being taken to her assigned birthing room. OR Corridor (M278): The only corridors to connect Pods II and III are the main entrance corridor and the OR corridor that serves the OR, the post-anesthetic recovery unit (PACU), the triage area, and the office of Obstetrical Anesthesia. Although the staff encourage patients and visitors not to use this corridor, it is used daily to get from one side of the unit to the other and by mothers and visitors to access the NICU. As well as affording no privacy for the woman in the OR or while being transported from the OR to the PACU, having the operating room opening into a higher traffic area may contribute to potential contamination of the OR. Having staff use the main entrance corridor as the only access to the different sides of the FBU increases the amount of walking in a day as well as may impact the response time to an emergency. While the travel distance from one side of the unit to the other will not change in the redevelopment, the corridor accessing the ORs and PACU shall be restricted. Caesarean OR (M217): The OR can be accessed via five doors, consuming large amounts of floor area for circulation. One would normally expect access via a maximum of two doors in an OR. As well, so many doors have a negative impact on air circulation and exchange, resulting in concerns with infection control. Furthermore, its area is inadequate at approximately 32 nsm when the smallest recommended OR is just over 37 nsm: there is no room to accommodate the infant warmer at present. OR Scrub (N216): Due to lack of storage space for OR supplies, the scrub room also must accommodate a large medical/surgical supplies cart. This poses sterility risks from getting sterile products wet while scrubbing. PACU (N221): The PACU is a small room in which the patient, clean supplies, medications, and nurse charting are all accommodated. More space is required and functions must be segregated. Although there is no soiled utility room for disposal of wastes, there is a patient toilet located in the corner of the room (with visual privacy provided by a curtain). Infant Resuscitation (N219): The infant resuscitation room, accessed directly off the OR is too small to accommodate resuscitation of twins and is undersized for comfortably accommodating the team needed to prepare a neonate for transport to the new NICU. On-Call Rooms (M271, M272, M273): While adequate in size, there is an inadequate number and one of the LDRPs (room M208W) is used as the fourth on-call room at present. Six on-call rooms are required, including those for use by students. Only five on-call rooms have been programmed. Staff Washrooms: There are staff washrooms in Pod I and II and a change room with washroom in Pod IV, but no washroom in Pod III. Staff therefore must leave Pod III and their patients in order to use the washrooms located in Pod IV or even on the other side of the FBU. This increases walking but also leaves their patients unattended if other nurses are busy attending a birth and cannot respond to the call bells. Resource Planning Group Inc August 20

32 Equipment Storage: Due to the small size of the storage rooms, larger equipment such as infant warmers and various carts are stored in the corridors, creating clutter and limiting access to fire escape routes. More equipment storage space is needed. Staff Lounge (M202W): This room was originally designed as the family lounge. Consequently, there is no sink to wash-up dishes or get water for the kettle, etc. In addition, there is inadequate space to accommodate the number of staff on the Unit at any one time. Education Room (M203W): This room will not be able to accommodate the number of increased staff or medical students and residents anticipated with the move to becoming a teaching hospital. It is currently the only education space available and is undersized for current needs. Nursing Stations: All four nursing stations have inadequate medication preparation areas. The spaces are small with limited counter space. These areas are also very exposed to the public which may increase the theft potential of medication and related supplies not to mention medication errors. As well, none of the nursing stations have adequate space for automated equipment. Clean Supply Closets (M215C, M211W, M227B, M244D): All have only a sliding flexible door that is usually open. This provides undesirable access to supplies by the public. As well, the configuration and size of these rooms do not contribute to efficient use of storage space. The amount of clean supply storage on the Unit is inadequate. Clean Utility Room (M245): This room serves as the vestibule for clean carts being delivered via elevator to the FBU. Because of lack of storage space elsewhere, the room is crowded with a variety of supplies and carts. Soiled Utility Rooms: All soiled utility rooms, with the exception of the one adjacent to the OR, are used as holding rooms for soiled linen and wastes. This makes them unusable as workrooms as there is inadequate space. The Tornado bedpan cleaners are not used and take up a large amount of space as well. The plan is to replace these units with closed waste system units utilizing disposable bedpans. Family Education Room (M216W): This room is used for group family teaching but is not large enough to accommodate women, their infants and their partners. Waiting Areas (227WA & 237A): These areas do not require the pay phone banks as most people have cell phones. The areas are cramped and chairs must be lined up against the wall as they are also used as the access to the outdoor patio. These areas are the only areas where family can congregate while not in a patient room. Staff Change Rooms (M259B & M260): The male and female change areas are too small to accommodate the number of staff on the unit. There is only one shower stall in each room and an inadequate number of lockers and storage area. The actual changing space does not allow for a number of staff to change at the same time. At present, there are 58 half-sized lockers in the female locker room and 20 half-sized lockers plus five full-sized lockers in the male locker room. Antepartum Rooms (M250, M251, M252): These rooms are small and can only be used by antepartum patients. One is a semi-private room (M252), not recommended for this population. With so few antepartum inpatients, these rooms are not utilized fully even though there are times when more LDRPs are needed. Resource Planning Group Inc August 20

33 Anesthesiologist On-Call Room: There is no such on-call room available at present though there is the need for this space. One of the unused LDRPs currently serves as the on-call room (M208W). Office Perinatologist (M268): As indicated earlier, access to this office is only via the CRC, an inappropriate location. This office must be moved but must stay within the FBU. Office Chief of Obstetrics (M275): This room currently accommodates the CNS of Obstetrics and Pediatrics. There is no office at present for the Chief of Obstetrics. Office Manager of Pediatrics & NICU (M264): This space will no longer be required within the footprint of the FBU as the Manager of the NICU will move to the new NICU. It is assumed that the Manager of Pediatrics will be accommodated elsewhere in the building. Office Health Records (M201D): The office of Health Records is too small to accommodate the three clerks plus supervisor. More private space is required for the supervisor. Office Social Work: The office of Social Work is not provide within FBU. Transitional Care/Observational Nursery (N212A): What was originally planned to be a small transitional care nursery at the back of one of the nurse stations has become a multi-use room for storage, rounds, and medications preparation. These three functions are incompatible in one space. Furthermore, the need for a transition nursery is growing. At present, if space is available, a newborn will be held in the NICU, as necessary; or will be held within a nursing station. Both these options are poor practice. In summary, the following spaces must be addressed in the current project as priority one needs: Registration; Triage; Transition nursery; The OR corridor; PACU; Infant resuscitation; The OR along with OR scrub and OR supplies; On-call space (a total of six rooms); Anesthesiologist room; Office: perinatologist (with ultrasound room); Office: health records; Office: CNS obstetrics; Office: Chief of Obstetrics & Gynecology; Soiled utility rooms; Staff lounge; Staff change facilities; Staff education space; and Antepartum room conversions to generic LDRPs. The following spaces ought to be addressed, if possible in the current project as priority two needs: Clean supply rooms; Equipment storage; Resource Planning Group Inc August 20

34 Family education room; and Medication preparation spaces at all nurse stations. Finally, the waiting areas ought to be addressed, if possible, in the current project as a priority three need. As is evident from the above description, numerous areas of the existing FBU must be addressed as part of the Acute Services Wing Project. Note: that the office of the Antepartum Care Coordinator is elsewhere in the building and will remain so. Resource Planning Group Inc August 20

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