Guidelines for the Construction and Management of Critical Care Medicine Department (for Trial Implementation)
Editing Chapter I General Provisions of this paragraph
Article 1 In order to strengthen the construction and management of critical care medicine department in medical institutions, ensure the quality of medical services, improve the level of medical technology, and rationally use medical resources, it is formulated in accordance with the Law on Medical Practitioners, the Regulations on the Administration of Medical Institutions and the Regulations on Nurses. Article 2 The department of critical care medicine in hospitals shall be constructed and managed with reference to this guideline. Article 3 The Department of Critical Care Medicine is responsible for timely providing comprehensive, systematic, continuous and strict monitoring and treatment for critically ill patients. Article 4 The Department of Critical Care Medicine is set up independently, focusing on the treatment of comprehensive critical patients, and the beds are open to the whole hospital. Fifth health administrative departments at all levels should strengthen the guidance and inspection of the department of critical care medicine in hospitals; Hospitals should strengthen the standardized construction and management of critical care medicine, implement its functions and tasks, keep the channels for patients to transfer to and from critical care medicine unblocked, ensure medical quality and safety, and safeguard the legitimate rights and interests of both doctors and patients.
editing the basic conditions of chapter ii of this paragraph
article 6 the department of critical care medicine should have places, equipment, facilities and personnel conditions suitable for its functions and tasks. Article 7 The Department of Critical Care Medicine must be equipped with a sufficient number of medical staff who have received special training, mastered the basic concepts, basic knowledge and basic operation techniques of critical care medicine and have the ability to work independently. The ratio of doctors to beds should be above .8:1, and the ratio of nurses to beds should be above 3:1. An appropriate number of medical auxiliary personnel can be equipped according to the needs, and hospitals with conditions can also be equipped with relevant equipment technology and maintenance personnel. Article 8 The Department of Critical Care Medicine shall be equipped with at least one physician with professional and technical post qualifications above the subtropical high school as the director, who shall be fully responsible for medical care and quality construction. The head nurse of the Department of Critical Care Medicine should have the qualification of professional and technical positions above the intermediate level, have worked in the field of critical care for more than 3 years, and have certain management ability. Article 9 The Department of Critical Care Medicine must be equipped with necessary monitoring and treatment equipment to ensure the treatment needs of critically ill patients. Article 1 The relevant departments of the hospital should have sufficient technical support capacity, and can provide bedside B-ultrasound, blood purifier, X-ray film and other imaging, as well as biochemical and bacteriological laboratory examinations for the intensive medicine department at any time. Article 11 The number of beds in intensive care should meet the needs of hospital functions and tasks and the actual treatment of severe patients. The number of beds in intensive care in tertiary general hospitals is 2%-8% of the total number of beds in hospitals, and the bed utilization rate should be 75%. When the annual bed utilization rate exceeds 85% on average, the scale should be appropriately expanded. Critical care medicine department should keep at least l empty beds every day for emergency use. Twelfth intensive care medicine each bed use area of not less than 15 square meters, bed spacing is more than 1 meter; Each ward shall be equipped with at least one single ward with a usable area of not less than 18 square meters for treating isolated patients. Article 13 The Department of Critical Care Medicine is located in an area convenient for patients' transportation, examination and treatment, and should be close to the operating room, medical imaging department, laboratory department and blood transfusion department (blood bank).
Edit Chapter III Quality Management of this paragraph
Article 14 The Department of Critical Care Medicine shall establish and improve various rules and regulations, job responsibilities, relevant technical specifications and operating procedures, and strictly abide by them to ensure the quality of medical services. Fifteenth intensive care medicine department should strengthen quality control and management, and designate full-time (part-time) staff to be responsible for medical quality and safety management. Hospitals should strengthen the management and evaluation of medical quality in the Department of Critical Care Medicine, and the management departments of medical treatment, nursing and hospital infection should perform daily supervision functions. Article 16 The Department of Critical Care Medicine accepts the following patients: (1) Patients with acute, reversible and life-threatening organ or system failure who may recover in a short time after close monitoring and intensive treatment. (two) there are various high-risk factors, which are potentially life-threatening, and the risk of death may be reduced through close monitoring and effective treatment. (3) Patients with acute aggravation and life-threatening on the basis of chronic organ or system dysfunction, who may recover to the original state or close to the original state after close monitoring and treatment. (four) other patients who are suitable for monitoring and treatment in the Department of Critical Care Medicine. Patients with chronic wasting diseases, terminal state of tumors, irreversible diseases and patients who cannot benefit from intensive monitoring and treatment are generally not admitted to the Department of Critical Care Medicine. Article 17 Patients with the following pathological conditions should be transferred from the Department of Critical Care Medicine: (1) Acute organ or system failure has been basically corrected and needs further diagnosis and treatment by other specialties; (2) The illness turns into a chronic state; (3) Patients can't benefit from continuous intensive care and treatment. Eighteenth patients in the Department of Critical Care Medicine shall be managed by the doctors in the Department of Critical Care Medicine, and other specialists shall provide consultation in time when the patients need treatment. Nineteenth hospitals should take measures to ensure that doctors and nurses in critical care medicine have appropriate technical operation ability and make regular assessments. Twentieth patients admitted to the Department of Critical Care Medicine should be evaluated for the severity of the disease, so as to provide a basis for evaluating the suitability of the use of resources in the Department of Critical Care Medicine and the quality of diagnosis and treatment. Twenty-first hospitals should establish and improve the information management system of critical care medicine, so as to ensure that the critical care medicine department can obtain the inspection results of medical technology departments in time, as well as the information of quality management and hospital infection monitoring. Article 22 The management and use of drugs and disposable medical consumables in the Department of Critical Care Medicine shall be standardized and recorded. Twenty-third instruments and equipment in the Department of Critical Care Medicine must be kept in use at any time, quality control should be carried out regularly, and special personnel should be responsible for maintenance and disinfection, and rescue items should be stored in a fixed place.
Edit Chapter IV Management of Hospital Infection in this paragraph
Article 24 The Department of Critical Care Medicine should strengthen the management of hospital infection, strictly implement the hand hygiene standards and isolate patients with special infections. Strictly implement various measures to prevent and control ventilator-associated pneumonia, blood-borne infection caused by intravascular catheter and infection caused by indwelling catheter, strengthen the management of drug-resistant bacteria infection, and monitor infection and its high-risk factors. Article 25 The overall layout of the Department of Critical Care Medicine should make the medical area where beds are placed, the medical auxiliary room area, the sewage treatment area and the medical staff living auxiliary room area relatively independent, so as to reduce mutual interference and control hospital infection. Twenty-sixth intensive care medicine should have good ventilation and lighting conditions. The temperature in the medical area should be maintained at about (24 1.5)℃. Have enough non-contact hand washing facilities and hand disinfection devices, one for each bed in a single room, and at least one for every two beds in an open bed. Twenty-seventh infected patients should be isolated according to their route of infection, and patients infected by air should be placed in negative pressure wards for isolation treatment. Twenty-eighth intensive care medicine should have a reasonable medical direction, including personnel flow and logistics, and hospitals with conditions can set up different access channels. Twenty-ninth Department of Critical Care Medicine should strictly limit the visits of non-medical personnel; If you really need to visit, you should wear isolation gown and follow the regulations on prevention and control of nosocomial infection. Article 3 The building of the Department of Critical Care Medicine shall meet the convenient observation conditions for medical staff and access to patients as soon as possible when necessary. Decoration must follow the principles of no dust, no dust accumulation, corrosion resistance, moisture and mildew prevention, anti-static, easy cleaning and meeting fire prevention requirements.
editing chapter v supervision and management of this paragraph
article 31 the provincial health administrative department may set up a provincial quality control center for critical care medicine or other relevant organizations to conduct quality evaluation, inspection and guidance for the critical care medicine departments of medical institutions within its jurisdiction. Thirty-second medical institutions shall cooperate with the administrative department of health and its entrusted quality control center for critical care medicine or other organizations to carry out inspection and guidance on critical care medicine, and shall not refuse or obstruct or provide false materials.
Edit Chapter VI Supplementary Provisions of this paragraph
Article 33 Departments and wards located in relevant departments of medical institutions to carry out undergraduate treatment of critically ill patients shall be managed with reference to this guide. Article 34 The Ministry of Health shall be responsible for the interpretation of this Guide. Attachment: 1. Basic skills requirements for medical staff in critical care department 2. Basic equipment in critical care department
Edit this paragraph Attachment 1 Basic skills requirements for medical staff in critical care department
Edit this paragraph 1. Physicians
(1) Have passed strict professional theoretical and technical training and passed the examination. (2) To master the theory and skills of monitoring and supporting the functions of important organs and systems of critically ill patients, and to have sufficient rapid response ability to abnormal information of organ functions and life: shock, respiratory failure, cardiac insufficiency, severe arrhythmia, acute renal insufficiency, central nervous system dysfunction, severe liver dysfunction, gastrointestinal dysfunction and gastrointestinal hemorrhage, acute coagulation dysfunction, serious endocrine and metabolic disorder, water electrolyte and acid-base balance disorder, and intestinal and intestinal disorders. It is necessary to master the evaluation methods of recovery and disease severity. (3) In addition to mastering the common diagnosis and treatment techniques in clinical departments, they should have the ability to independently complete the following monitoring and support techniques: cardiopulmonary resuscitation, intracranial pressure monitoring technology, establishment and management of artificial airway, mechanical ventilation technology, deep vein and artery catheterization technology, hemodynamic monitoring technology, continuous blood purification, fiberoptic bronchoscopy and other technologies.
Edit this paragraph II. Nurses
(1) have undergone strict professional theoretical and technical training and passed the examination. (2) Mastering the professional skills of intensive care: clinical application and nursing of infusion pump, nursing of various surgical catheters, oxygen therapy, airway management and artificial respiration machine monitoring, hemodynamic monitoring of circulatory system, ECG monitoring and defibrillation technology, blood purification technology, water, electrolyte and acid-base balance monitoring technology, chest physical therapy technology, nutritional support technology for critically ill patients, and rescue cooperation technology for critically ill patients. (3) In addition to mastering the professional skills of intensive care, they should have the following abilities: nursing of critically ill patients in various systems, prevention and control of nosocomial infection in intensive care medicine, pain management of critically ill patients, and psychological nursing in intensive care.
Edit Annex 2 of this paragraph, Basic Equipment of Critical Care Department
1. Each bed is equipped with complete functional equipment belts or functional racks to provide functional support such as electricity, oxygen, compressed air and negative pressure suction. Each monitoring sickbed is equipped with more than 12 power sockets, more than 2 oxygen interfaces, 2 compressed air interfaces and more than 2 negative pressure suction interfaces. Medical electricity and domestic lighting electricity lines are separated. The power supply of each bed should be supplied by an independent feedback circuit. Critical care medicine department should have standby uninterruptible power system (UPS) and leakage protection device; Each circuit socket shall have an independent circuit breaker on the main panel. Two, should be equipped with suitable beds, equipped with bedsore mattress. Three, each bed is equipped with bedside monitoring system, ECG, blood pressure, pulse oxygen saturation, invasive pressure monitoring and other basic vital signs monitoring. In order to transport patients safely, each intensive care unit should be equipped with at least one portable monitor. In principle, the intensive care department of a fourth-and third-level general hospital should be equipped with one ventilator per bed, and the intensive care department of a second-level general hospital can be equipped with an appropriate number of ventilators according to actual needs. Each bed is equipped with a simple respirator (resuscitation airbag). In order to transport patients safely, each intensive care unit should have at least one portable ventilator. Five, each bed should be equipped with infusion pump and microinjection pump, of which microinjection pump in principle, more than 4 per bed. Also equipped with a certain number of enteral nutrition infusion pumps. 6. Other necessary equipment: electrocardiograph, blood gas analyzer, defibrillator, cardiopulmonary resuscitation rescue equipment vehicle (equipped with laryngoscope, endotracheal tube, various pipe joints, first-aid drugs and other rescue appliances, etc.), fiberoptic bronchoscope, temperature-rising and cooling equipment, etc. Third-level hospitals must be equipped with blood purification devices, hemodynamic and oxygen metabolism monitoring equipment.