Dashboard

Document Sample
Dashboard Powered By Docstoc
					                                                                            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

				
DOCUMENT INFO