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Massachusetts Department of Public Health
Influenza Specialty Care Unit (ISCU) Planning Matrix
Name of Facility
Comments
Administrative
Facility Safety - basic fire/safety provisions
Building Necessities - basic services
Dietary Requirements - basic services to meet age specific nutritional needs
Utility Necessities - basic utility services
Housekeeping - basic housekeeping services (directly or indirectly provided)
Essential Medical Equipment/Supplies - basic provisions to meet adult/ped medical
equip. needs
Personal Hygiene Supplies - basic provisions to meet hygiene needs
Other Recommendations - provisions to address minimum financial/security needs
Total bed space (approx 80 Sq.ft. per bed)
August 2006 Dashboard
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Administrative
Item # Description
System to communicate with external authorities and community and internal
1 management/staff, including provision of Status Reports to State as requested (e.g.
# admissions/discharges, discharge disposition, staffing needs, etc)
Policies and procedures for the services the ISCUs will provide: develop
2
mechanism to credential or receive pre-credentialed staff to work in ISCU
System to manage staffing plan (e.g. medical, nursing, pharm, social work,
3 respiratory therapy, health assistants, clerks, security, housekeeping, maintenance,
med rec. personnel and volunteers)
4 System to orient and train personnel for ISCU services
5 Personnel oversight/support
6 System for Incident reporting
7 Laboratory system (specimen collection, transport, analysis, reporting)
8 Fiscal plan to address expenses; Reimbursement Coding System
Patient Admissions and Medical Record Systems, including information regarding
9
patient identification, transfers, admissions, assessments and discharges
10 Treatment planning and discharge planning systems
11 Building Management Services
12 Laundry system (on or off site)
Communication Systems (telephone, internet access, analog/landline and including
13 TTY, pictographs, and translated versions of written documents
etc.)
14 Patient and Family Information System
System to address interpreter service needs, such as translators for individuals who
15 are deaf/hard of hearing and individuals who do not speak English
Transportation Plan (between sites as necessary, collaborate with local
16
communities/Elder Affairs, etc)
August 2006 Administrative
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Facility Safety - basic fire/safety provisions
Item # Description
1 Staff fire/safety training plan
2 Exit and entrance signs and emergency lighting
3 Fire extinguishers
Fire alarm system (mandatory for inpatient care &
4
optional for outpatient only care)
Sprinkler system (mandatory for inpatient care & optional
5
for outpatient only care)
6 Security system
7 Relevant signage including no smoking
Emergency power/generator or portable generator
8
system
August 2006 Facility Safety
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Building Necessities - basic services
Item # Description
Toilets/sinks to meet needs of large numbers of
1 patients/staff, including portable toilet units as necessary
(indoor/outdoor as appropriate)
2 Showers/place for patients to wash
Private space can be created or exists (*State will provide
3
privacy screens as needed and as available)
4 Isolation area for a minimum of two people
5 Storage space
6 Access to parking
7 Total bed space (approx 80 Sq.ft. per bed)
8 Waiting/reception area
9 Triage area
August 2006 Building Necessities
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Item # Description
Food services (refrigerator, cooking appliances, etc.), or ability to
1 provide through food delivery arrangement, or other means, e.g.
in a tent, or other building on campus
2 Cleaning supplies/system
Disposable or non-disposable dinnerware/flatware (utensils,
3
plates, trays, etc.)
4 Potable water/ other drinks
5 Non-perishable food including baby formula
6 Food disposal system
August 2006 Dietary Requirements
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Utility Necessities - basic utility services
Item # Description
1 Plumbing- functioning hot and cold water
2 Lighting
Communication devices (e.g. telephone, fax, copier, computers,
two-way radio) *State will supplement as needed
3
4 Electricity
5 Heating & ventilation systems
August 2006 Utility Necessities
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Housekeeping - basic housekeeping services (directly
or indirectly provided)
Item # Description
Cleaning disinfection supplies for incidental cleaning at a
minimum (e.g., mops, pails, bleach, disinfectants, brooms,
1
shovels) *State will supply if not provided by the hospital or
contract service
2 Covered trash containers and trash removal system
Infectious and physically dangerous medical waste containers
3
or removal system*
4 Laundry containers for clean and soiled linen/removal system
August 2006 Housekeeping
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Essential Medical Equipment/Supplies - basic provisions to meet adult/ped
medical equip. needs
Item # Description
1 Automated External Defibrillators
2 Emergency cart supplies*
3 First aid supplies*
Respiratory Therapy supplies (included oxygen concentrators) and appropriate
4
storage area*
Portable x-ray equipment or access to x-ray (optional- please specify if x-ray
5
equipment will be provided)
6 Locked medication storage area
7 Medication refrigerator*
8 Medications (supportive of influenza care only)*
9 Other medications as needed and available
10 Morgue packs
11 Intravenous fluids/related equipment and IV poles*
12 Emesis basins*
13 Bed pans/urinals/commodes*
14 Personal Protective Equipment- gloves, masks, gowns, etc*
15 Antimicrobial waterless hand sanitizer/dispensers*
16 Transport-Wheel Chair(s), Stretchers
17 Walkers
18 Glucometer(s), urine/blood dipsticks*
August 2006 Essential Medical Equipment
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Essential Supplies & Tools - basic provisions to meet
supply/tool needs
Item # Description
1 Bed linens, cloth towels, patient gowns, slippers*
2 Beds/Cots/cribs/sleeping bags*
3 Lockers/bedside tables*
4 Battery operated radio
5 Flashlights, batteries*
6 Waterproof containers for clinical records, matches, etc*
7 Plastic bags*
8 Fans*
9 Basic tool set*
10 Office supplies*
August 2006 Essential Supplies
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Personal Hygiene Supplies - basic provisions to meet hygiene
needs
Item # Description
Personal hygiene supplies (e.g. shampoo, soap, toothpaste, toothbrush,
1
deodorant, lotion feminine hygiene)*
2 Diapers - infant/child/adult*
3 Toilet paper, paper towels, facial tissues, towelettes and dispensers*
file reference: 9ad20535-4a24-4046-8e50-6402d1134a8b.xls Personal Hygiene
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey - Confidential Document
Other Recommendations - provisions to address minimum financial/security
needs
Item # Description
1 Financial security needs - valuables storage
2 Credit card/petty cash as necessary
Age appropriate activity supplies- books, magazines, playing cards, board games, paper
3
writing materials, television, VCR/DVD, etc.
4 Allergy-free foods (peanuts/peanut oil, milk/eggs/dairy)
5 Air filtration systems
file reference: 9ad20535-4a24-4046-8e50-6402d1134a8b.xls Other Recommendations
Influenza Specialty Care Unit (ISCU)
Infrastructure Survey- Confidential Document
Comments
file reference: 9ad20535-4a24-4046-8e50-6402d1134a8b.xls Comments
