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Wards and inpatient areas

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Abstract

The inpatient area of the practice primarily contain patient accommodation, as well as space for support activities and cleaning, together with an isolation area where space allows. It is important to take time to consider what requirements are essential if space is limited. This chapter explores design and layout, patient accommodation, specific ward areas and managing the ward areas.

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Figures

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7.1 Several smaller ward areas are preferable to one large space. In this example, glass partitioning keeps the areas light and allows easy observation of all the patients.
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7.2 Dog ward with vinyl flooring, walk-in kennel, plenty of storage and sink with drainer.
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7.4 Ceiling socket unit with hooks for trailing leads.
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7.5 This ward preparation area contains a fridge, a microwave, a sink, plenty of bench and storage space, and a trolley for individual patient treatments and for carrying food.
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7.6 Making good use of wall space. Clippers can be wall-mounted on an extension reel. Stretcher stations located in choice places around the practice will encourage use.
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7.7 Inpatient medication should be stored safely and with easy access for nurses. Individual drawers are ideal.
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7.8 Metal filing trays are useful for storing paper records and bulk blank forms, and keeping them accessible. Wall-mounted racks can also be used for storing blank forms.
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7.10 Dog kennels may be made from a range of materials. PVC cages over blockwork kennels. Walk-in kennel with stainless steel walls. Walk-in kennel with glazed stainless steel doors.
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7.11 These glazed-door PVC cages have rear ventilation grilles. With extraction ventilation, anaesthetic gases can be ducted away and humidity reduced.
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7.12 Walk-in kennels built of blockwork with stainless steel gates and epoxy flooring. These walk-in kennels have vinyl flooring material both on the floor and vertically, with heat-welded seams.
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7.13 Walk-in kennels should be available for large or giant breeds.
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7.14 When walking patients in a non-enclosed area, a secure named collar and lead are essential. Faecal waste bins should be emptied regularly and a supply of bags or a shovel should be close to hand.
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7.15 A raised area for cats to sit on is appreciated, particularly by longer-stay patients.
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7.16 An old cardboard box makes a good hiding place for a cat and makes them feel more secure.
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7.17 A water fountain will encourage some cats to drink.
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7.18 Small quiet clippers are useful for clipping hair on conscious cats.
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7.19 Hospitalized rabbits need space for several hops, and height to stand on their hindlegs. A private area, toileting area and appropriate fresh food are essential.
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7.20 The avian and reptilian ward of an exotic animal practice. The room is kept at a constant 25oC and has a range of different accommodation types. marks a tortoise tray, made of light plastic, which can be lifted out for cleaning. A full-spectrum light hangs over one end on a cord, so that its height can be varied to adjust the temperature at the basking area. marks a bank of Aquabrooder units, where the animal accommodation is surrounded by thermostatically controlled heated water. is one of three large, traditional-style vivaria in the ward; these are more suited to large reptiles. is an intensive care unit; the temperature and humidity can be set on this unit, which can also be used for critical care of collapsed small mammals. © Avian and Exotic Animal Clinic.
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7.21 A disposable recovery (survival) blanket in use. Note also the syringe driver fixed to the cage door and the use of a kneeling pad by the veterinary nurse.
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7.22 Recovery cages can be situated in the ‘prep’ area. Note the blue physiotherapy balls on top of the cages.
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7.23 A portable suction machine should be ready at all times, with sterile tubing and attachments ready for use.
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7.24 A cat requiring oxygen therapy can be housed in an incubator.
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7.25 Intensive care area in use. Note the patient on a floor mattress, the dog parking hook and monitoring equipment.
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7.26 Kneeling pads situated in convenient places throughout the practice will encourage use and protect nurses’ knees.
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7.27 A mobile oxygen generator.
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7.28 Oxygen therapy. This simple oxygen therapy cage has an overlapping glass door with a delivery unit and flowmeter attached to the front. The oxygen level in the cage can be monitored by a patient multi-parameter anaesthetic monitor with oxygen module. Ex-hospital incubators can be very useful for warming and for oxygen delivery. Care is needed in dismantling, cleaning and reassembling. Intranasal oxygen is useful for larger patients, though can be poorly tolerated.
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7.29 Small bench-top incubator for warming intravenous fluids before administration.
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7.30 A selection of infusion pumps (back) and syringe drivers (front).
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7.31 Infusion pumps can be mounted on wall bars above caging.
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7.32 Infusion pump, warming equipment and syringe driver mounted on one stand.
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7.33 Clear signage, including clinical and nursing care responsibilities, are essential when hospitalizing patients with suspected infectious disease.
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7.34 Disposable bedding and protective clothing can be used in the isolation unit and disposed of securely.
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7.35 In this isolation unit, red leads and pink bedding and hospitalization sheets indicate that this patient is being barrier-nursed.
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7.36 Large machines that use a disinfecting agent such as ozone are preferable for practices with large quantities of laundry and sufficient space.
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7.37 This custom-made dog bath has a non-slip ramp to reduce the need for lifting, and a fold-down platform for showering smaller dogs. ( A shower and drainage can be installed inside a walk-in kennel or wet room if space is at a premium.
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7.38 This purpose-made shower area includes a wall-mounted dryer.
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7.39 Underwater treadmills are increasingly seen in practices with a high orthopaedic caseload.
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7.41 Bins in ward areas should have hands-free operation such as this mobile, pedal-operated sack bin.
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7.42 Hand-washing posters, such as this one produced by the University of Liverpool, are helpful memory aids for staff.
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7.44 Barrier-nursing a patient in a communal area is always a challenge and a compromise, but a clear protocol and demarcation of the area helps.
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7.45 A dog that requires a harness for exercising should also wear a neck lead to ensure maximum safety.
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7.46 Where animals or equipment are to be handled at a high level, a risk assessment should be in place. Secure steps with a handrail should be used. These should be non-slip, checked regularly and maintained in good condition.
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7.47 Nurses must have sufficient time to support patients with feeding, and to plan and adapt individual care.
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7.50 The patient should be closely observed and clinical parameters monitored until it is able to move around in a controlled manner.
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7.51 Hospitalization forms can be designed and printed in house. In this rack, each clinician has forms of a different colour for easy identification of case responsibility.
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7.52 Coloured alert or reminder labels can be helpful on hospitalization records and accommodation.
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7.53 Bathing a patient when necessary is an integral part of patient care. Gloves should always be worn when bathing patients.
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7.54 A raised dog bath minimizes bending and makes bathing easier.
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7.55 Remote observation. A camera can be attached to a drip stand and moved to the best position to observe the patient. The patient can then be observed throughout the building on any networked computer.
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7.57 Where possible, owners should not be discouraged from visiting their pets, and wards should be managed to accommodate this.
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7.58 Discharge explanations and instructions should not be rushed, and should be supported by written materials which should be explained. It is often better if the patient is not present.

Supplements

Sample questionnaires, care plan and hospital charts

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