- Received October 30, 2021
- Accepted November 16, 2021
- Publication January 21, 2022
- Visibility 12 Views
- Downloads 1 Downloads
- DOI 10.18231/j.ijpns.2021.031
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CrossMark
- Citation
Organization and management of nursing services in NICU, levels of transport
- Author Details:
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Javaid Ahmad Mir
-
Bushra Mushtaq
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Onaisa Aalia Mushtaq *
Introduction
Neonatal intensive care is also considered synonymous with providing advanced life support (ALS) to critically sick babies with multisystem organ dysfunction.[1]
Those who weigh < 1500 gms or <32 wks of gestation
3 – 5 % of newborns would need these services depending upon conditions.
Goals
To improve the clinical care of the critically ill neonate
To reduce the neonatal morbidity & mortality
To provide continuing in- service training of medical & nursing personnel in the care of newborn.
Grade of neonatal care
Level — I
Level — ll
Level — lll
Neonatal care
The management of complex life threatening diseases, provision of intensive monitoring and institution of life sustaining therapies in an organized manner to critically ill children in a separate pediatric intensive care unit.
Space
Serve as a referral unit for the infants born outside the hospital
Each infant should be provided with a minimum area of 100 sq. ft. or 10 m2
Space for promotion of breast feeding
Location
Located as close possible to the labor rooms and obstetric operation theatre
Should not be located on the top floor
Brightness and provide ultra violate rays to augment asepsis
Baby care area
Areas and rooms for inborn or intramural babies,
Examination area
Mother’s area for breast feeding and expression of breast milk[2]
Nurses station and charting area
Hand washing and gowning room
Should be located at the entrance
Self closing doors
Examination area
Mother area
Nurses stations
Central area
Newborn charts, hospital forms, computer terminals, telephone lines should be located in this area
Clean utility and soiled utility holding rooms
Stocking clean utility items and sterile disposables, and for disposal of dirty linen and contaminated disposables.
Staff rooms
Ventilation
Effective air ventilation of nursery
Provision of exhaust fan
Do not use chemical air disinfection and ultraviolet lamps
Lighting
Well illuminated and painted while or slightly off
Cool white fluorescent tubes
The number and exact location of fixtures can be worked out taking into account size of the nursery, height of ceiling, and availability or otherwise of sunlight.
Environmental temperature and humidity
26-28°C in order to minimize effect of thermal stress on the babies
The external windows of nursery should be glazed to minimize heat gain and heat loss and baby beds should be located at least 2 feet away from the wall and windows.
Personnel
Availability of sufficient number of adequately trained personnel
Nurse patient ratio in special care and NICU[3]
Medical personnel
Neonatal physician for each 6 to 10 admissions
1:5 ratio of neonatal physician to patient
Resident doctor available for 24hrs
Nursing staff
The nurse to patients ratio should be 1:4 -5 per shift in SICU. While in more intensive care area providing mechanical ventilation support, nurse: baby ratio should be 1:1-2 per shift.[4]
Para medical personnel
1 Respiratory therapist
Nurse: patient ratio: 1:1 in special care units and in PICU, the ratio is 1:3 and Nurse should have specialized degree in neonatal care.[5]
Other Staff
Maintenance staff: 1 sweeper should be there for 24 hrs and 1 laundry boy
1 Lab technician
1 Social worker attached to NICU care[6]
Equipment’s
Thermometer
Stethoscope
Electronic Baby weighing scale
Incubator
Over head radiant warmers
Resuscitation equipment
Heart rate monitor
Respiratory support equipment
Suction facilities
Suction facilities and needles[7]
Management of nursing care
Assessment
Monitoring physiological data
Safety measures
Respiratory support
Thermoregulation
Protection from infection
Hydration
Nutrition
Feeding resistance
Skin care
Administration of medication
Developmental outcome
Facilitating parent-infant relationship
Discharge planning and home care[8]
Neonatal loss
Transport of sick neonates
The goal of every transport is to bring a sick neonate to specialized neonatal center in a stable condition.
To avoid complications during transport, the infant should be as stable as possible before leaving the referring hospital and warm chain should be maintained. [9]
The transport service gives high — risk patients timely access to the appropriate services without interrupting their care.[10]
Transfer patterns in regional system
Level I [Basic Care] — Relatively minor problems
Level II [Speciality Care] — Low birth weight babies (1500 to 2500 gm, 32 to 36 weeks of gestation)
Level III [Subspeciality Care] — Maternal and Neonatal those at high risk (less than 1500 gm birth weight or less than 32 weeks gestation)
Level I to Level II: Complicated cases not requiring intensive care.
Level II to Level III: Complicated cases requiring intensive care. Labor less than 34 weeks gestation.[11]
Reasons for transport
Commonest reason is transport for advanced level of care such a situation may arise due to non availability of:
Pediatric subspecialty (Neurology, nephrology
Specific investigation (MRI, 24 hours EEG etc), specific facility (Advanced ventilation, plasmapheresis or it may be due to non availability of continuous monitoring in the referring hospital).[12]
Preparation for transport
1. Each hospital should be ready with plan for transport of critical child long before such need arises.
2. Each institute should have list of hospitals in the surrounding area which offer specialized facility.[13]
Source of Funding
None.
Conflict of Interest
None.
References
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- N Roy, S Langford. CPQCC. California Perinatal Quality Care Collaborative. Semin Fetal Neonatal 1999. [Google Scholar]
- Introduction
- Goals
- Grade of neonatal care
- Neonatal care
- Space
- Location
- Baby care area
- Hand washing and gowning room
- Examination area
- Clean utility and soiled utility holding rooms
- Staff rooms
- Lighting
- Environmental temperature and humidity
- Personnel
- Medical personnel
- Nursing staff
- Para medical personnel
- Other Staff
- Equipment’s
- Management of nursing care
- Transport of sick neonates
- Transfer patterns in regional system
- Reasons for transport
- Preparation for transport
- Source of Funding
- Conflict of Interest