NEMA SBP 5-2015 Considerations in Planning Code Call Implementation in Health Care Facilities.pdf

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1、NEMA Standards PublicationNational Electrical Manufacturers AssociationNEMA SBP 5-2015Considerations in Planning Code Call Implementation in Health Care FacilitiesA NEMA Healthcare Communications and Emergency Call Systems White Paper SBP 5-2015 Considerations in Planning Code Call Implementation in

2、 Health Care Facilities Published by: National Electrical Manufacturers Association 1300 North 17th Street, Suite 900 Rosslyn, Virginia 22209 www.nema.org The requirements or guidelines presented in this NEMA white paper are considered technically sound at the time they are approved for publication.

3、 They are not a substitute for a product sellers or users own judgment with respect to the particular product discussed, and NEMA does not undertake to guarantee the performance of any individual manufacturers products by virtue of this document or guide. Thus, NEMA expressly disclaims any responsib

4、ility for damages arising from the use, application, or reliance by others on the information contained in this white paper. 2015 National Electrical Manufacturers Association. All rights, including translation into other languages, reserved under the Universal Copyright Convention, the Berne Conven

5、tion for the Protection of Literary and Artistic Works, and the International and Pan American copyright conventions.NEMA SBP 5-2015 Page 2 2015 National Electrical Manufacturers Association Introduction Code calls (a.k.a. Code Blue, Code Pink, emergency resuscitation, or Code Call in general) are c

6、onsidered to be the highest priority nurse call alarm events in a health care facility. They are initiated when a patient is in urgent and immediate need of specialized care and are associated with emergencies such as a patients heart stopping, a patient not breathing, the occurrence of severe bleed

7、ing, and more. For these types of emergencies, response time is critical and of absolute priority. State-of-the-art Nurse Call systems (a.k.a. Code Call systems) have a variety of ways to support Code Blue protocol. This document is intended to assist facility developers and owners in designing a co

8、de call system and associated call handling processes, with the purposes of optimizing response time and complying with regulatory requirements. Scope Health care facilities are highly complex and highly regulated organizations. When designing a code call system and the associated call handling proc

9、esses, the following minimum considerations need to be addressed: Regulatory Requirements o Clinical requirements o Code call system requirements Areas to be covered and responsibilities of the code response teams Code response team personnel Code call protocol including: o Call initiation o Call no

10、tification o Expected response time o Code response procedures o Code response team responsibilities o Supporting staff responsibilities o Call completion and termination Training Code call system maintenance Code events recording, records retention, and reporting requirements Other related concerns

11、 Regulatory Requirements There are two categories of regulations that apply to code call implementation. The first is in the form of clinical regulations that prescribe the protocol and procedures for code events handling (i.e., the interventions and actions required of the health care delivery orga

12、nization and staff responsible for patient care). These regulations might also prescribe staffing requirements, training, or events reporting, for example. It is the administrative duty of each responsible organization to determine, address, and comply with the requirements that are set forth in thi

13、s category of regulations. NEMA SBP 5-2015 Page 3 2015 National Electrical Manufacturers Association The other category of regulations, established in the NFPA 99 Health Care Facilities Code, 2012 Edition and later, prescribes the physical architecture, implementation, and operational characteristic

14、s of a nurse call system, which are required of all Category 1 and 2 health care facilities. It is the further administrative duty of each responsible organization to determine, address, and comply with the requirements that are set forth in this national code. In addition to the NFPA 99 code, the N

15、FPA 70 National Electrical Code (NEC) and state and local building code requirements apply. While most states typically rely on the NFPA 99 and NEC codes, with little if any change, to establish state and local code requirements, it remains the administrative duty of each responsible organization to

16、 know and understand the state regulations that govern construction, electrical safety, and Code Call requirements governing their facilities. As a reference when creating NFPA 99 and state and local building codes, the Guidelines for Design and Construction of Health Care Facilities, published by t

17、he Facility Guidelines Institute (FGI), is used by code developers to determine the architecture of a Code Call system. The Guidelines define the types of Code, emergency, and call-for-help stations that should be provided, as well as the general locations and numbers of call stations that should be

18、 installed in different areas of a facility. Using this document as a basis of reference, the NFPA 99 code and state and local building codes are developed. Collectively, the NFPA 99 code, the NEC, state and local building codes, and the Guidelines drive determination of Code Call system implementat

19、ion, installation, and acceptance requirements for the local Authority Having Jurisdiction (AHJ). It is important to note that the Guidelines specifically reference the NFPA 99 Health Care Facilities code, the NEC, and the ANSI/UL 1069 Hospital Signaling and Nurse Call Equipment standard. Also, as o

20、f the 2015 Edition of the NFPA 99 code, Nurse Call Systems are required for installation in Category 1 and Category 2 facilities and are required to be listed to ANSI/UL 1069 by a Nationally Recognized Testing Laboratory (NRTL). In general, NFPA 99 is concerned with “the operational fire protection

21、for the many activities that occur in various types of health care facilities.” It includes provisions for “patient care areas (e.g., wards, ICUs, ORs, and hyperbaric facilities), several facility-wide systems, and the overall emergency planning for a facility in the event of an emergency, which may

22、 interrupt the delivery of patient care.” This building code defines the performance requirements of electrical systems to ensure optimal level of safety, specifically tailored to health care facilities. As of the NFPA 99 2012 Edition, chapter 7 establishes the requirements for nurse call systems, w

23、hereby there is a strong correlation with the Guidelines in terms of system architecture and functional descriptions. The NEC is concerned with the ways in which electrical systems must be installed to best achieve the desired levels of performance prescribed in other NFPA standards. Therefore, ther

24、e is a great deal of cross-referencing between the NFPA 99 and NEC codes. As for the ANSI/UL 1069 standard, detailed and specific construction, reliability, performance, and safety requirements for a Nurse Call system and equipment are defined. The standard defines the fundamental operations of a Nu

25、rse Call system and the requirements for installation and user operation, all of which are in accordance with requirements set forth in the NFPA 99 and NEC codes. Overall, the ANSI/UL 1069 standard defines the mechanical and electrical safety requirements that ensure protection from electric shock a

26、nd fire hazards, thereby ensuring safe operation at the clinical level for use in patient care areas. To ensure this level of safety, Nurse Call systems and other associated equipment intended to perform Nurse Call fundamental operation must be submitted for independent third-party testing and evalu

27、ation by a Nationally Recognized Testing Laboratory. Only those systems and equipment items that have passed NRTL evaluation and assessment can be deemed compliant, “listed,” and suitable for use in a regulated health care facility. NEMA SBP 5-2015 Page 4 2015 National Electrical Manufacturers Assoc

28、iation Areas to Be Covered and Responsibilities of Code Response Teams The needs and operational characteristics of each health care facility are unique and, as such, drive different demands for Code response team make-up and charter responsibilities. Some facilities might have a single response tea

29、m unit that is responsible for handling Code Call responsibilities for an entire building or campus, whereas other facilities might designate a number of teams responsible for servicing specific and specialized skill areas (e.g., NICU, OR, ICU). The type of code response team has a direct impact on

30、how the Code Call system should be implemented and configured. Therefore, much thought and user input must be applied to the planning phase of facility conceptualization. Among the chief considerations that must be resolved is: What will be the worst case “travel time” from the various locations whe

31、re team members might be at any given time, relative to where a Code Call can originate? While the intention of this paper is not to specify or recommend what should be a typical or desired Code Call response time, which might actually be governed by clinical regulation, the purpose is to instead em

32、phasize that a maximum code team response time must be determined by the responsible organization. It is imperative to determine whether the code response team is actually capable of responding to a Code Call event within the “end-to-end” required time, throughout all parts of the facility. Doing so

33、 subsequently drives the implementation and installation of the Code Call system. In particular, determining the locations and distribution of Code Call initiation stations throughout the facility will have a direct impact on whether or not the desired Code Call response time can be achieved. The Co

34、de Call response team and system implementation will then necessarily comply with any clinical regulation and all national, state, and local building code requirements that might apply. Note that there might be other extenuating factors or obstacles that can have a counter or negating influence on a

35、chieving desired code call response times. Therefore, it is recommended that a comprehensive and detailed risk analysis be performed for each Code Call response team, with respect to desired Code Call response handling requirements and implementation of the Code Call system. Code Call Response Team

36、Personnel As each health care facility will have its own unique Code Call response team composition, these teams will have specific skill sets and will require specialized medical equipment and instruments (such as a defibrillator) necessary to provide immediate life-saving treatment. While Code Cal

37、l response team members might be dedicated solely to Code Call protocol handling, or might have other duties that can be immediately dropped when responding to a Code Call, of particular importance is the assignment of an operator or dedicated staff member who will be responsible for announcing Code

38、 Calls over the paging system. This position is an extremely important and often overlooked one to address. The designated individual would need to be capable of clearly announcing the Code Call condition and associated room or area where the call was initiated. It is usually a 24-hour, staffed posi

39、tion and is typically assigned to an operator or security person. Provision must also be made for when this person goes off duty or needs to leave their assigned post for any reason. The position must always be covered, with a trained and competent attendant. It is highly recommended that this centr

40、ally located Code Call response team member be equipped with the necessary resources (e.g., a back-up communication device, such as a walkie-talkie or other portable communication device) to verify that voice audio pages actually do go out over the paging system and have been heard and acknowledged

41、by the rest of the response team. It is also necessary for this individual to be trained in Code Call system implementation and its operation, as well as in all Code Call NEMA SBP 5-2015 Page 5 2015 National Electrical Manufacturers Association response protocols that are enacted throughout the faci

42、lity, and to be completely familiar with the facility layout, rooms, and area designations (e.g., NCIU, ICU, OR). Code Call Response Protocol At the highest level, Code Call response protocol covers three specific sequences: Initiation; Notification to the response team; and the desired response tim

43、e of team to react to the Code Call. 1) Code Call Initiation While national, state, and local building codes might define minimum requirements for Code Call system implementation, each responsible organization has the opportunity to determine additional (and in some cases alternate) locations for Co

44、de Call initiation stations. For example, some facilities might choose to have a Code Call station in all patient rooms or in care areas beyond those required by building codes (e.g., all examination and treatment rooms), while others might choose to have a station available at each nurses control c

45、onsole. It is generally understood by responsible organizations and AHJs that Code Calls are initiated only by trained staff, the premise being that a patient who has regressed into a Code condition cannot be expected to initiate a Code Call alarm on their own. Even if a family member or visitor hap

46、pens to be in the room or area where the Code event happens, its unlikely that they would be trained in the Code Call process or response requirement. State-of-the-art nurse call systems offer many options for Code Call initiation stations. They can be built into a standard patient station or instal

47、led as a unique dedicated station. A common option for many facilities, especially for use in ICUs, is the addition of a Code Call timer. This is typically a digital clock that begins a “count up” process at the moment a Code Call is initiated. The counter timer is intended to be used by the Code re

48、sponse team to monitor their progress during an event. The timer can be stopped only by a dedicated manual cancel button that is separate and unique from the Code Call system. If the Code Call is reset or canceled at the Nurse Call initiation station, the counter will continue counting until it is m

49、anually and purposefully canceled or reset as a required separate action. 2) Code Call Notification Both the NFPA 99 code and the ANSI/UL1069 standard require Nurse Call systems to have redundant local notification, meaning that a Code Call initiated in a room must be visibly and (optionally) audibly annunciated at the call initiation station, as well as visibly annunciated by the illumination of one or more associated room corridor lights. All Code Calls must be audibly and visually annunciated at a primary nurse control console. Additional notifications might