Estructura de las unidades de cuidados intensivos de anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR) / Structure of the anesthesia intensive care units: recommendations of the Intensive Care Section of the Spanish Society of Anaesthesiology

ANTECEDENTES Y OBJETIVO: Los objetivos de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SCI-SEDAR) con el presente trabajo son: establecer nuevas recomendaciones adaptando los estándares publicados por el Ministerio de Sanidad y Política Social, y alineadas con las principales guías internacionales, y desarrollar una herramienta de mejora de la calidad y la eficiencia. MATERIALES Y MÉTODO: A lo largo de 2018, 3 miembros de la SCI-SEDAR definieron la metodología, desarrollaron las recomendaciones y seleccionaron al panel de expertos. Debido a la limitada evidencia de buena parte de las recomendaciones y a la importante variabilidad estructural de las unidades de cuidados intensivos de anestesia actuales, se optó por un abordaje Delphi modificado para determinar el grado de consenso. RESULTADOS: Un total de 24 expertos de 21 instituciones constituyeron el grupo de expertos del presente trabajo. Se establecieron 175 recomendaciones sobre 8 apartados, incluyendo 129 con consenso fuerte y 46 con consenso débil. CONCLUSIONES: La SCI-SEDAR estableció las recomendaciones estructurales de las unidades de cuidados intensivos de anestesia que deberán guiar la renovación o la creación de nuevas unidades

BACKGROUND AND OBJECTIVE: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units

Structure of the Anesthesia Intensive Care Units: Recommendations of the Intensive Care Section of the Spanish Society of Anaesthesiology. / Estructura de las unidades de cuidados intensivos de anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR).

BACKGROUND AND OBJECTIVE: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units.

Use of right lighting levels essential.

Hospital lighting must conform to a wide range of international standards. The purchaser of lights, ranging from bedside lamps to operating theatre units, is responsible for ensuring that a hospital's luminaires comply with relevant legislation. James Verrinder reports.

Detention on a general ward: understanding and applying the law.

From April 2007 there will be two acts of parliament that govern the legal detention of patients in hospitahl: the Mental Health Act 1983 and the Mental Capacity Act 2005. This article addresses common questions posed to liaison psychiatrists by hospital doctors: how to legally detain patients on general wards and how these Acts are applied.

Autonomy and clinical practice. 2: Patient privacy and nursing practice.

This article, the second in a series of three considering issues of autonomy, privacy and informed consent in nurse/patient interactions, focuses on the wider conceptions of patient privacy and confidentiality. Given that patients in institutional care are likely to suffer intrusions into their privacy which would be considered unusual in normal social interaction, it is interesting to note the dearth of literature in this area. Some definitions of privacy are considered in an attempt to begin to raise readers' awareness of the complexity of this notion. It can be argued that privacy is a pertinent notion to consider, both in order to gain a greater understanding of what is meant by the term and in terms of the implications of this understanding for clinical practice.

[The environmental characteristics of patients' rooms and their interactions with the lifting of patients]. / Caratteristiche ambientali del reparto di degenza e loro interazioni con la movimentazione del paziente.

The Law (Presidential Decree) of 14/1/97 requested the regions of Italy to define and develop procedures for the accreditation of their health facilities. Since accreditation promotes the quality of the system, the support of ergonomics can be fundamental. Ergonomics, whose quality objective is harmony of the environment-man-object relationship, is in a position to make a major contribution to the complete application of the procedures for quality certification (ISO regulation 9000) and of the regulations regarding mandatory safety regulations (Law 626/94). The present paper analyzes the tasks of health workers vis-a-vis patients, highlighting the improvement or worsening effect of environmental features which not only have a direct effect on movements and general activity but also have an indirect effect on psychological and behavioural conditions. The first requirement that should be taken into consideration in environments that are also used by patients is that everything that can facilitate or make their walking and access to facilities self-sufficient will certainly make the healthcare workers' tasks easier, which can then be limited to lifting required for treatment and washing. The ward, especially, is an area that is extremely important from the point of view of design because it is where the patient does practically everything and where the staff, too, are mainly engaged in hygiene/treatment tasks, involving both patients and their relatives. The bed must be able to be easily used by potentially disabled patients who have difficulty in walking and moving. The beds should therefore be equipped with or have close by handles and rails that assist the patient to lie down, get up and move from the bed; the bed should also have a manual or electrical device to adjust the height (from 40 to 70 cm) and have four wheels (that can each be blocked) to make it easier to move. The supporting legs should occupy as little space as possible and should not interfere with wheelchairs or other walking aids or with the movements of the staff. The head and foot-boards should have parts that can be used as grips. The space between both sides of the beds should be at least 90 cm and the space between headboard and wall 120 cm; bedside tables should be no deeper than 30 cm and be fitted with wheels. On the question of space distribution design, another important requirement is flexibility. Adequate flexibility of space distribution together with adaptable technological systems mean that the spaces and equipment of the ward can be easily adapted to the great variety of needs.