I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: Designstudent on January 15, 2007, 04:39:39 PM
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here are some of my images.. these are exerpts from a presentation of about 20 slides. although this was a group project, tony and i produced our own concepts in hopes of possibly combining them, so he may post some of his if has time.
please comment :2thumbsup;, i will reply with our thoughts or reasons as to why we did what we did.. again all of our work is not represented and its not finalized either.
alan
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more images
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Here are MY opinions, please see attached images. I feel you guys concentrated NOT on patient comfort, but on cost effective constructing of dialysis cubicles. Sorry but I do not like the designs and as I said it appears you guys did not have patient comfort in mind, and that was the whole point wasn't it? To me it looks very futuristic but not one bit comfortable and in your designs you guys left out vital components and would appeal more to a company that wanted to set up portable dialysis units, not a permanent unit. Sorry guys but you are lucky I'm not your professor, he may LOVE it but he/she is not a dialysis patient I would bet.
- Epoman
Owner/Admin
See attached images:
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i will begin addressing some of the concerns raised by Epoman in his post in our other (incorrect, sorry) post.
first being the issue that we werent focusing not on patient comfort but rather on cost effectiveness:
i really couldnt disagree more, although i would like to hear the specifics on why you think this way because we are obviously are somewhat biased. but just as an example, we NEVER considered cost, obviously we didnt design a multimillion dollar system with robots doing everything, but we did not discard any ideas becasue of cost. alos related to this is the fact that we couldnt go past the receptionist desk at any dialysis center we tried to visit (4 in total). here is a link with an explanation why, since i guess it wasnt understood that the main reason we came here was since it was out of our means to obtain a tour.
http://ihatedialysis.com/forum/index.php?topic=1513.0
basically we had to apply to the governing body with a $400 application fee and also pay the hourly wage of whoever would be escorting us for however long it took, AND it would take a few weeks just to get approved even IF we could afford it! :o
with that said, the looks we could sneak in and see from pictures gave us the indication that the systems we came up with would easily cost double of any system that is currently used, so cost was definately not something that we tried to keep us back.
second, our professor is not a patient..
he is a designer, so he did not have really any knowledge of dialysis, only design aesthetics, agian, thats why we came here and conducted phone interviews with people who DID know. :2thumbsup;
next would be addressing a few things that didnt 'look' right or even appear at all in my concept drawings..
this is kind of a tricky topic, but basically what you see are just concepts, drawings of ideas we had in our heads that we present to people to try and make them better. it was also our intention to design the chair separately from the environment. so the chair that is seen is merely a 'representation' of a chair.. not our chair design, we have not finished that yet. i wouldn't expect you all to know that, but now you know that the chair in those drawings was not designed at all, just sketched in there in a matter of seconds for scale representation.
next would be the saline bags and the housing around the dialysis machine. the saline bags i imagined hanging on a mobile cart near the dialysis machine, and that would be looked upon as an accesory piece that we generally would leave out and just express verbally. basically because the overall system is whats important for our sponsor or class so we dont draw in things like that that basically make it harder to read the drawings, so things like trash cans, and what not are generally not represented, but are understood. againm i wouldnt expect you to know this, but im saying it for clarification purposes.
also for the housing of the dialysis unit, again it was basically posing the question of, "how would you like it if the unit was integrated into the environment aesthetically rather than just sitting in an area?" if we decided to go forward with this idea we would work out how the unit fit in the housing to make sure it works properly.
epoman also mentioned a weigh-in area, unless this is something that is much more than a couple scales and possible a recording device it isnt something we would be concentrating on (simsilar to the saline bag racks), unless you can give an exaple of how the weigh-in areas now present major problems that affect the entire process, in which case we would love to hear them.
addressing epomans concern about the small tv...
i pictured a widescreen tv somewhere between about 17 or 23 inches widescreen, i didnt think it looked like a 13 inch but alot of it is opinion, also it should be noted that if you look at the top view, the television would be no more than 5 feet away from the patient, so any thing much bigger would be a bit much, and at that distace i feel even a 13" would be adequate, although we are going bigger.
addressing the filter room, reuse room, dietician, social offices, etc...
most of these rooms i will admit... we have no knowledge of! :o but again that goes back to that fact that we could not visit a center, but the design of our building allows for additional rooms to be added behind the receptionist desk without changing the design, rather just plugging rooms in, increasing the overall length.
but please infor us on what the reuse and filter rooms are used for ???, i think nutritioninst and social worker offices are pretty self explanitory.
next would be the storage area..
as represented it is about 400 sq/ft, (i understand that there is no scale in that drawing, but you can look at it like this... the cubicles are about 10 feet wide. you may alos notice that there are 'half cubes' and approximately another 150 sq/ft of space at the end of each wing of the building... these are for storage as well. we had to guesstimate on the storage, but if that is not enough then we can revise.
also, epoman asked about the bathrooms
there are 2 pairs of bathrooms reprsneted in the floor plan next to the receptionist desk, the smaller ones are for employees and the larger ones are for patients and can be accessed from the dialsys area.
lastly i would like to state that we are not dialysis patients and we know that you are not deisigners so there will be some misunderstandings, we are used to this. so i hope that i clarified a few thing s that you can consider when giving us feedback. also it wll help us greatly if instead of saying "i dont like how it looks", rather tell is what it is specifically that makes you not like its looks so we can consider it. so when you see a concept like the removable panels try not to just look at what colors the panels are, ask yourself "would it be a good feature to be able to have these types of things AND be able to move them around in my cubicle?" or would i rather have it the way it is now?
also i would like iot to be known that when the project was given to us we were only asked to concentreate 1 station, we took it upon ourselves once we looked at the feedback you gave us, and the peeks we got of the places we tried to visit to redo the WHOLE building, knowing that it was a large undertaking.
also, in reference to the floorplan, please try not to focus on how big the storage area is, the whole reason for the building is to layout the cubes in an opposite facing orientation, giving each patient a view of a beautiful landscape and providing privacy while making it easy for the nurses to be centrally located, consider that when looking at the floorplan. the things like the storage and bathrooms we understand are necessary, but are not our focus and we dont want any of you to get hung up on them. they are just representations for the most part.
i greatly apprecite epoman for giving such detailed feedback, since it exposed areas where we are not on the same page, and what i would like you all to concentate on. but by all means hold nothing back, i am used to getting alot of negative feedback, industrial design inst a field where you get patted on the back all day. i am greatly appreciating all of you opinions and im sure there will be more situations that will need clarification. :beer1;
thanks,
alan
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How do the nurses keep an eye on the patients in this layout? They can't see if a patient is having trouble from their seating area. Even call buttons wouldn't solve that problem - if I crash fast enough, having access to a call button wouldn't help me - I won't be able to press it.
My dialysis unit allows visitors. I go to a unit in Petoskey. It wouldn't be a horribly long drive from Kalamazoo. If you want to come see a real unit, I'm on a T, TR, Saturday schedule, so you could visit on a Saturday to keep from missing classes.
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How do the nurses keep an eye on the patients in this layout? They can't see if a patient is having trouble from their seating area. Even call buttons wouldn't solve that problem - if I crash fast enough, having access to a call button wouldn't help me - I won't be able to press it.
My dialysis unit allows visitors. I go to a unit in Petoskey. It wouldn't be a horribly long drive from Kalamazoo. If you want to come see a real unit, I'm on a T, TR, Saturday schedule, so you could visit on a Saturday to keep from missing classes.
the nurses hub would have electronic monitoring, especially on blood pressure (the nurse we spoke with said that this is the main thing they have to monitor, please clarify if this is incorrect) so they can view the machines feedback and patients would also have simple call button interface with a couple different situational buttons that would light up/flash on the nurses console if any monitary systems were out of range or if the patient just felt that there was a matter that needed attention, but the technology now is at apoint where visully monitorying the patient seems to simply be the cheapest way.
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I know before I started dialysis I wanted to visit a center to see if they had changed any in the past 20 years (and they have) but they would not let me in. I know now that I could have just walked in like I owned the place and sat next to a patient and started talking and no one would have even noticed.
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How do the nurses keep an eye on the patients in this layout? They can't see if a patient is having trouble from their seating area. Even call buttons wouldn't solve that problem - if I crash fast enough, having access to a call button wouldn't help me - I won't be able to press it.
My dialysis unit allows visitors. I go to a unit in Petoskey. It wouldn't be a horribly long drive from Kalamazoo. If you want to come see a real unit, I'm on a T, TR, Saturday schedule, so you could visit on a Saturday to keep from missing classes.
the nurses hub would have electronic monitoring, especially on blood pressure (the nurse we spoke with said that this is the main thing they have to monitor, please clarify if this is incorrect) so they can view the machines feedback and patients would also have simple call button interface with a couple different situational buttons that would light up/flash on the nurses console if any monitary systems were out of range or if the patient just felt that there was a matter that needed attention, but the technology now is at apoint where visully monitorying the patient seems to simply be the cheapest way.
Yes, blood pressure is probably the main thing they have to monitor. But I'm still not getting how they are going to monitor for crashes electronically. We are attached to the dialysis machine with one arm, and have a blood pressure cuff on the other. The nurses manually start the bp machines on an hourly basis. If they notice a patient having a problem, or if we say we don't feel well, then they will check it between. Is there a machine which constantly monitors blood pressure? I've never seen one that did that, even in an ICU setting. I don't think the technology exists yet to let the nurses be out of visual range. The other option would be a video camera - which would be worse than having them able to see me face to face at all times, if you ask me. I despise being on camera, and having one focused on me for hours at a time would just make the whole experience worse.
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I know before I started dialysis I wanted to visit a center to see if they had changed any in the past 20 years (and they have) but they would not let me in. I know now that I could have just walked in like I owned the place and sat next to a patient and started talking and no one would have even noticed.
haha, yea thats what we thought after we tried to do it the 'right way'
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My first thought was also about how the nurses would monitor the patients.
Often the machines will alarm for a clot or out of saline or any number of other things. Now sure, if tech existed to pipe those machines readouts to the main station would be great, but really right now the nurses like a visual view of their charges because the machine may not alarm and someone may have crashed right away or have some other problem.
The other thing you may not have thought about is the plumbing for the water supply. I think they need purified (? epo?) water into the machines, so that would create an access issue to the cubicles.
The other thought I had is about the chair. It looks like it is reasonably flush to the wall of the cubicle.. Now that's fine if you're a left arm access point.. but what if your fistula is on the right arm (and I am not sure about Catheters since I don't have one). That would not work for the techs to do needling, and access the area.. unless either the chair could be turned around (but then your tv is behind you?!) or something... or did I misread the space between the chair and the wall?
I apprieciate the ideas that have gone into this project but I am not so sure about how this would work in reality, but it could definitely be a stepping stone....
Thanks for sharing your work with us and taking our constructive criticism!
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Is there a machine which constantly monitors blood pressure?
I am not sure about how other machines work, but I know the 2008K machines from Fresenius are programable. Fresenius policy is that BP has to be taken every half hour, so the machines are set to take every 30 min. That time can be changed though.
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OK I understand that you were only out to design the treatment cubicle, but you took it upon yourself to design more than just that so I'll comment on more than just that. I'm not trying to offend anyone here, I'm just stating a few facts that have been overlooked. First off I have to agree with Epoman on the fact that there are a lot of things missing that are of importance to this kind of setting. I know you said they are "understood", but I have been through a remodeling of a dialysis clinic. The things that the designers say are understood really aren't, and it leads to big headaches for the clinic staff and patients. Unfortunately, just as you have not been in a clinic neither have the designers of the clinics.
1. A weighing area is of great importance to a patients treatment. If you don't have an accurate weight for the patient coming in the door you have no clue as to how much has to be removed form the patient to even start a treatment. You also have to have an accurate weight as they leave.
2. It's hard to tell from the print, but don't you think that there is a really far distance for a patient to have to walk to get from the waiting room to the farthest chairs. Not all patients are healthy or strong enough to walk that kind of distance. Falls are not something the patients or the staff want in the clinic.
3. There need to be many additional rooms in a dialysis clinic. You need to have a room for repairing the machines, a room for the dietitian, a room for the social worker, a room for the clinic manager, a room for the medical director / nephrologists, a room for the water treatment system, a room for the medical waste, a room for the making of acid and bicarb (components of dialysate used during a treatment. These could be put the water room or stock room), a breakroom for the staff, a locker area for the staff, and room for all the janitorial supplies.
4. For the amount of supplies you would need to operate a clinic with this many chairs you would need a stock room about 3X's the size.
5. Staff bathrooms should be the same size as patient bathrooms to be handicapped accessable. Plus, staff bathrooms off the waiting room is a little bit ridiculous don't you think.
6. Cubicle panels are an interesting concept but lead to MANY problems, especially if they are customizable. The first thing is where do the treatment supplies go in the cubicle. Second is what about regular and biohazzard waste? What if the first patient likes the sky design, but the next patient wants the blaq. Do you have to keep one set of every design available for each room. Or do you just pick one and tell the patients that this is what they get? Who is going to change all those freakin panels between each patient based on their likes? It's a great idea, but something like video screens that could change color or display pictures I think would be a better idea. The other thing is everything is held up using electromagnets. What happens during a power outage? Does everything just come crashing down because there is no longer any electricity holding it in place. Even if you have a back up generator there is still that time between the power going out and it kicking on or being turned on. With all that electricity flowing around it lends itself to many hazards. You could have electrocutions from a short in a panel that someone touches. Since it is all magnetic you will have things drawn to the walls unless it is a very weak field. You could have creditcards being erased. But even more important you could cause interference with the machines operation, or patients with heart devices.
7. Staff has to be able to monitor it's patients. There are computers that can hook up to the machines and record the data. I'm sure it could be viewed from another location, but there are signs that a patient is going out that just isn't going to show up on those screens. Patient safety is of the utmost importance, and though it may not give them complete privacy it is a necessity of this evil we call dialysis.
8. Though it may not be pretty, the machine and the patient chair need to be close together. Remember the further away the machine is the longer the blood lines have to be. This means that more rather than less of the patients blood is running around outside their bodies. This is not a good thing at all. The other thing is you can't have the machines enclosed like that. You need to have ready access to all parts of the machine for setup or emergency purposes. Plus having the machines enclosed like that would cause over heating issues.
9. I agree the chairs don't look very comfy, and are positioned too close to the wall on one side. Not everyone has their accesses on the same side of their bodies, or in the same location within those sides. I also don't think the floor stop concept would work very well. First off adhesive will never stay in place forever especially if you take into account the bleach water that has to be used on the floor to clean it. Bleach eats adhesive up. I also don't think that if a "larger" patient was in the chair that a nurse would be able to "easily pull the chair loose using minimal force" in a emergency or any other time for that matter.
For a beginning design it has some promise, but it is no where near being completely thought through enough to submit to anyone. I guess I'm done with this. If I think of anything else I will add to it later.
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Is there a machine which constantly monitors blood pressure?
I am not sure about how other machines work, but I know the 2008K machines from Fresenius are programable. Fresenius policy is that BP has to be taken every half hour, so the machines are set to take every 30 min. That time can be changed though.
That's exactly what I was thinking. I know mine is set to every 30 min but if my BP starts coming down I reset mine to every 10 min ;) Ididn't realize not all machines can have this programmed in. I thought it was just smart.
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I thought the designs were cool! I am going to look at them some more then come back with some ideas for you all. But over all it looked real interesting. Don't give up just becasue we are giving you lots of feedback. We just really care what the future centers might look like and want them to be comfortable!
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OK I understand that you were only out to design the treatment cubicle, but you took it upon yourself to design more than just that so I'll comment on more than just that. I'm not trying to offend anyone here, I'm just stating a few facts that have been overlooked. First off I have to agree with Epoman on the fact that there are a lot of things missing that are of importance to this kind of setting. I know you said they are "understood", but I have been through a remodeling of a dialysis clinic. The things that the designers say are understood really aren't, and it leads to big headaches for the clinic staff and patients. Unfortunately, just as you have not been in a clinic neither have the designers of the clinics.
1. A weighing area is of great importance to a patients treatment. If you don't have an accurate weight for the patient coming in the door you have no clue as to how much has to be removed form the patient to even start a treatment. You also have to have an accurate weight as they leave.
2. It's hard to tell from the print, but don't you think that there is a really far distance for a patient to have to walk to get from the waiting room to the farthest chairs. Not all patients are healthy or strong enough to walk that kind of distance. Falls are not something the patients or the staff want in the clinic.
3. There need to be many additional rooms in a dialysis clinic. You need to have a room for repairing the machines, a room for the dietitian, a room for the social worker, a room for the clinic manager, a room for the medical director / nephrologists, a room for the water treatment system, a room for the medical waste, a room for the making of acid and bicarb (components of dialysate used during a treatment. These could be put the water room or stock room), a breakroom for the staff, a locker area for the staff, and room for all the janitorial supplies.
4. For the amount of supplies you would need to operate a clinic with this many chairs you would need a stock room about 3X's the size.
5. Staff bathrooms should be the same size as patient bathrooms to be handicapped accessable. Plus, staff bathrooms off the waiting room is a little bit ridiculous don't you think.
6. Cubicle panels are an interesting concept but lead to MANY problems, especially if they are customizable. The first thing is where do the treatment supplies go in the cubicle. Second is what about regular and biohazzard waste? What if the first patient likes the sky design, but the next patient wants the blaq. Do you have to keep one set of every design available for each room. Or do you just pick one and tell the patients that this is what they get? Who is going to change all those freakin panels between each patient based on their likes? It's a great idea, but something like video screens that could change color or display pictures I think would be a better idea. The other thing is everything is held up using electromagnets. What happens during a power outage? Does everything just come crashing down because there is no longer any electricity holding it in place. Even if you have a back up generator there is still that time between the power going out and it kicking on or being turned on. With all that electricity flowing around it lends itself to many hazards. You could have electrocutions from a short in a panel that someone touches. Since it is all magnetic you will have things drawn to the walls unless it is a very weak field. You could have creditcards being erased. But even more important you could cause interference with the machines operation, or patients with heart devices.
7. Staff has to be able to monitor it's patients. There are computers that can hook up to the machines and record the data. I'm sure it could be viewed from another location, but there are signs that a patient is going out that just isn't going to show up on those screens. Patient safety is of the utmost importance, and though it may not give them complete privacy it is a necessity of this evil we call dialysis.
8. Though it may not be pretty, the machine and the patient chair need to be close together. Remember the further away the machine is the longer the blood lines have to be. This means that more rather than less of the patients blood is running around outside their bodies. This is not a good thing at all. The other thing is you can't have the machines enclosed like that. You need to have ready access to all parts of the machine for setup or emergency purposes. Plus having the machines enclosed like that would cause over heating issues.
9. I agree the chairs don't look very comfy, and are positioned too close to the wall on one side. Not everyone has their accesses on the same side of their bodies, or in the same location within those sides. I also don't think the floor stop concept would work very well. First off adhesive will never stay in place forever especially if you take into account the bleach water that has to be used on the floor to clean it. Bleach eats adhesive up. I also don't think that if a "larger" patient was in the chair that a nurse would be able to "easily pull the chair loose using minimal force" in a emergency or any other time for that matter.
For a beginning design it has some promise, but it is no where near being completely thought through enough to submit to anyone. I guess I'm done with this. If I think of anything else I will add to it later.
Awesome, awesome, post "Hawkeye" Thanks for taking the time to go into detail. You brought up some very good points I had overlooked. :thumbup;
- Epoman
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I have couple of comments about the design or at least about patient needs. In the hospital based unit that hubby goes to there are patients who are dialyzed in a bed. Generally these are inpatients but not always. In addition several patients on his shift require a hoyer lift to transfer them from their wheelchair to the chair. It does not look like there is room in the cubicles to handle these situations.
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I think the design is very modern and would like a centre that looks like it.
Centres in the UK are always pushed for space so an open floor plan with beds/ chairs next to machines will win out most days.
I appreciate the fact that it is more the design for the cubicle and that additional storage/ bathrooms could be added on. You could have one area where you have beds that is more open plan for patients that are less stable and there BP drops in view of the nurses desk and More stable patients who do not get low during dialysis to have the more private cubicles.
I feel as a preliminary design considering you have not seen the inside of a dialysis centre to have promise to build on. I feel the second stage would be to consult with the head of the centre with your designs for the more practical requirements.
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Awesome, awesome, post "Hawkeye" Thanks for taking the time to go into detail. You brought up some very good points I had overlooked. :thumbup;
- Epoman
No problem. There are many things that as a patient you don't see that I do, and visa versa.
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I thought of one other thing that would need to be altered. I already mentioned that the stock room would need to be tripled in size, but I forgot to mention that it needs outside access. The way the supplies are delivered is by semi truck with the supplies on skids. You either need a dock door / garage door for access or a double wide door leading to the outside so those skids can be brought in directly. You do not want the skids being hauled through the clinic to get to the stock room. The pallet jacks really mess up tile and carpet floors and during a rain storm or snow they leave nasty tracks all over the place that need to be cleaned up.
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I do think the cubicles are a good way to go. Currently hubby's unit has these. He really has no interest in socializing with other patients, many of whom are very elderly and ill and would rather watch his TV in quiet - or what passes for quiet there.
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to address hawkeyes feedback...
first.. thanks for being so thorough! :2thumbsup;
1. A weighing area is of great importance to a patients treatment. If you don't have an accurate weight for the patient coming in the door you have no clue as to how much has to be removed form the patient to even start a treatment. You also have to have an accurate weight as they leave.
i understnd the weighing issue, but as previously stated, if it is not going to be more than scales placed at the head of each wing then its really not something that we will spend time on, i understand what you are sayiong about leaving detail sout when they DO make the centers, but we arent actually making this so we have to leave out small details like that because it will just weigh us down.
2. It's hard to tell from the print, but don't you think that there is a really far distance for a patient to have to walk to get from the waiting room to the farthest chairs. Not all patients are healthy or strong enough to walk that kind of distance. Falls are not something the patients or the staff want in the clinic.
from the 4 centers we were allowed to 'walk' into, this distance is no more, even possibly less than what would have to be travelled in from the waiting room to the farthest station in those centers. i believe all 4 we got to at least walk into were fresennius.
3. There need to be many additional rooms in a dialysis clinic. You need to have a room for repairing the machines, a room for the dietitian, a room for the social worker, a room for the clinic manager, a room for the medical director / nephrologists, a room for the water treatment system, a room for the medical waste, a room for the making of acid and bicarb (components of dialysate used during a treatment. These could be put the water room or stock room), a breakroom for the staff, a locker area for the staff, and room for all the janitorial supplies.
i did note this from epomans critique and as previously stated that wont be a problem to add in, although it may add to the distance travelled to get to a cubicle. also, how many stations do most of your clinics have? if the average is less than we have here then we could make the walk shorter.
5. Staff bathrooms should be the same size as patient bathrooms to be handicapped accessable. Plus, staff bathrooms off the waiting room is a little bit ridiculous don't you think.
please clarify ??? i dont understand what is rediculous about it.
6. Cubicle panels are an interesting concept but lead to MANY problems, especially if they are customizable. The first thing is where do the treatment supplies go in the cubicle. Second is what about regular and biohazzard waste? What if the first patient likes the sky design, but the next patient wants the blaq. Do you have to keep one set of every design available for each room. Or do you just pick one and tell the patients that this is what they get? Who is going to change all those freakin panels between each patient based on their likes? It's a great idea, but something like video screens that could change color or display pictures I think would be a better idea. The other thing is everything is held up using electromagnets. What happens during a power outage? Does everything just come crashing down because there is no longer any electricity holding it in place. Even if you have a back up generator there is still that time between the power going out and it kicking on or being turned on. With all that electricity flowing around it lends itself to many hazards. You could have electrocutions from a short in a panel that someone touches. Since it is all magnetic you will have things drawn to the walls unless it is a very weak field. You could have creditcards being erased. But even more important you could cause interference with the machines operation, or patients with heart devices..
this is a good topic. first, we do have the storage shelf 'panels', that could be placed anywhere in the cube, and could have 2-3 shelves on them... not just the way thery are represented in this drawing. on the topic of biohazard.. we posted a new thread asking about that as it is a phase that we are now working on :2thumbsup; addressing the different wall choices... i would hope that the center admin. would make a desision based on their patients likes and dislikes, and mosty likely they would have all flavors represented in their center to give patients a choice, i guess the only other option is that you have no choice and you get what is given to you, but i dont like that i i doubt anyone else would, it isnt meant that the panels are changed at each visit, rhather they can be orientated in a coupe different ways so a patient can choose which orientation works best for them and it can be there for them each time, panes would be changed by the staff and would not be very hard at all..... i have to get to class but i will try and adress all comments after... thanks again! :clap;
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In my experience the scales are not merely an item set in the hallway but a built in design with rails and usable to weigh someone in a wheelchair. Just thought this might be useful.
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3. There need to be many additional rooms in a dialysis clinic. You need to have a room for repairing the machines, a room for the dietitian, a room for the social worker, a room for the clinic manager, a room for the medical director / nephrologists, a room for the water treatment system, a room for the medical waste, a room for the making of acid and bicarb (components of dialysate used during a treatment. These could be put the water room or stock room), a breakroom for the staff, a locker area for the staff, and room for all the janitorial supplies.
i did note this from epomans critique and as previously stated that wont be a problem to add in, although it may add to the distance travelled to get to a cubicle. also, how many stations do most of your clinics have? if the average is less than we have here then we could make the walk shorter.
Actually the number of stations you have is about average if not on the light side.
5. Staff bathrooms should be the same size as patient bathrooms to be handicapped accessable. Plus, staff bathrooms off the waiting room is a little bit ridiculous don't you think.
please clarify ??? i don't understand what is ridiculous about it.
Everytime a staff member needs to use the restroom they have to walk out into the lobby area. It's really more of a convenience and privacy thing. If the staff bathrooms are off the staff office area they are more convenient for the majority of the staff. Plus who really wants to hear or smell me squeezing off a loaf. It is also a time thing. This may sound bad, but sometimes you don't have time to chat with the patients. I will stand around and talk to the patients in the lobby when I have time, but when you are really busy and a patient stops you to shoot the breeze it makes getting things done difficult. I don't want to be rude to the patient so I will talk for a min., but if I had to go to the lobby everytime I needed to take a leak it would drastically slow down my day.
6. Cubicle panels are an interesting concept but lead to MANY problems, especially if they are customizable. The first thing is where do the treatment supplies go in the cubicle. Second is what about regular and biohazzard waste? What if the first patient likes the sky design, but the next patient wants the blaq. Do you have to keep one set of every design available for each room. Or do you just pick one and tell the patients that this is what they get? Who is going to change all those freakin panels between each patient based on their likes? It's a great idea, but something like video screens that could change color or display pictures I think would be a better idea. The other thing is everything is held up using electromagnets. What happens during a power outage? Does everything just come crashing down because there is no longer any electricity holding it in place. Even if you have a back up generator there is still that time between the power going out and it kicking on or being turned on. With all that electricity flowing around it lends itself to many hazards. You could have electrocutions from a short in a panel that someone touches. Since it is all magnetic you will have things drawn to the walls unless it is a very weak field. You could have creditcards being erased. But even more important you could cause interference with the machines operation, or patients with heart devices..
this is a good topic. first, we do have the storage shelf 'panels', that could be placed anywhere in the cube, and could have 2-3 shelves on them... not just the way they are represented in this drawing. on the topic of biohazard.. we posted a new thread asking about that as it is a phase that we are now working on :2thumbsup; addressing the different wall choices... i would hope that the center admin. would make a decision based on their patients likes and dislikes, and most likely they would have all flavors represented in their center to give patients a choice, i guess the only other option is that you have no choice and you get what is given to you, but i don't like that i i doubt anyone else would, it isn't meant that the panels are changed at each visit, rather they can be orientated in a coupe different ways so a patient can choose which orientation works best for them and it can be there for them each time, panes would be changed by the staff and would not be very hard at all..... i have to get to class but i will try and address all comments after... thanks again! :clap;
I guess one of the things you are forgeting, and that I didn't really think of mentioning because I assumed (We all know what assuming does) you would realize it is that not all patients are the same. Everybody comes from a different walk of life. Some were more well off than others, some are immigrants, some have different heritage, some younger, and some older. In a normal clinic you are running 3 shifts a day, with your designs I believe (without looking at the print) that is around 54 patients a day. How do you manipulate your cubicles or schedule to accommodate all those people. You have to jockey everybody around to try and give them what they want that day. What if today I like green and tomorrow I like Blaq? People change their minds on things on a daily basis. You also fail to realize that most of the patients dialyze on a M-W-F or T-Th-S schedule, not everyday so you have 108 and patients you have to please. How does the clinic admin. decide what is best for all those people? Besides those points the patient population changes on a fairly regular basis. Some people move, get transplants, or unfortunately people pass on. You may have a core group of patients that stay the same, but the rest change from month to month. From an operational stand point the cubicle panels take time and effort away from patient care where it belongs. I still say video screen walls would be a better way to go to offer this customizeable clinic.
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You do have some good ideas. However I think some of it is unrealistic for unit.
Storage needs to be bigger as alot of supplies are used in dialysis as many units run at least 2 shifts and 6 days a week.
Reuse room and storage of cleaned filters
Water treatment room
Break room for nurses and separate bathroom.
Nurses station is much too small. It needs to be much bigger. Our unit is only 20 stations and and the nurses station is at least 3 -4 times the size of the one you have. Our unit stores day medication, patient records, crash carts etc etc there.
Also there needs to be room for computers at the dialysis stations. Here for each two stations here there is a separate computer by them for nurses to log the information on.
Dialysis stations need to be big enough for beds to be put in and have room for transfer scales as some patients are bedridden and must be weighed and transfered by hoist scale at the station itself.
I see a problem with future expansion of the unit with the building built like that.
Also the nurses need to be able to see all patients with ease. There are times after a shift gets put on that half of the nurses go to breakfast around 8:30 here leaving the other half to monitor patients. Quick sight lines to patients are needed to evaluate them and machines.
This wouldn't be on your end but I wouldn't mind seeing some sort of small LED unit attached to the side or top of the tv that would let the patient see what their venous, artierial pressures, bp, time and fluid removed are
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6. Cubicle panels are an interesting concept but lead to MANY problems, especially if they are customizable. The first thing is where do the treatment supplies go in the cubicle. Second is what about regular and biohazzard waste? What if the first patient likes the sky design, but the next patient wants the blaq. Do you have to keep one set of every design available for each room. Or do you just pick one and tell the patients that this is what they get? Who is going to change all those freakin panels between each patient based on their likes? It's a great idea, but something like video screens that could change color or display pictures I think would be a better idea. The other thing is everything is held up using electromagnets. What happens during a power outage? Does everything just come crashing down because there is no longer any electricity holding it in place. Even if you have a back up generator there is still that time between the power going out and it kicking on or being turned on. With all that electricity flowing around it lends itself to many hazards. You could have electrocutions from a short in a panel that someone touches. Since it is all magnetic you will have things drawn to the walls unless it is a very weak field. You could have creditcards being erased. But even more important you could cause interference with the machines operation, or patients with heart devices.
to continue on this topic.... i guess the idea behind the differnet panels is choice, yea, maybe my cube is green and I like it but the next person who uses it is a child, yes it would be nice for them to have the kids panels, but its not gonna be changed out every time (they werent meant to), so then the question becomes why have different panels then? well... why not, it almost seems that you are saying that you would be ok with the panels but you only want one color... well, who pics that color? going back to the point you made about handling over 100 patients a day.. what color will everyone agree on? they wont agree on anything, so thats why alot of office and medical system furniture are the same color... boring plain blues or off whites usually. i suppose i could have just did that, but wheres the creativity there? at least if these are manufactured with 5 colorways then each specific treatment center can make their own decisions and they dont have to be the same. or maybe they switch them out every 6 months, or maybe even let the patients vote on what color combo to have that year. i guess i just feel i would always prefer a porduct that gives me a choice reather than no choice. we as designers (even as students) have to remember to design for the people, but ALSO we have to cater to who will be buying these, and how they can be marketed, and i guess thats more of what i was thinking with the color combos, not necessarily that each patient picks theirs, but the people who buy the system can have options.
and in reference to the video screens. im not sure if you mean put screens in the walls ive shown or just stand alone screens? if it just displays a static image then it would be an extremely expensive way to do so, the panels i have presented could have fabric printing of images or even have a tackboard surface to place pictures. i guess you'd have to describe it a little better before i give that idea any real feedback.
on the matter of electromagnets (which is an entirely different concept having nothing to do with the panels).... the power outage would really cause no real problem because the magnets are simply holding the devices into a horizontal position on the wall, not actually holding then 'on' the wall (the channel molded intho the wall is a mechanical lock holding the devices 'in' the wall, so if there was no electro magnets it would still be perfectly fine, just that you could move the devices left and right in the channels. in theory the only way the devices would move if there was no electricity is if they were physically moved by something or if the entire cube was titled off center, so i hope that clarifys that concept. :2thumbsup; and even if you still saw that as a concern it would be an easy fix to have a battery backup or power source to power these magnets since the amount of energy to give them a charge is TINY. but on the matter of the magnetic interference, i cannot really speak to that, im not an engineer, im merely presenting this as a possibility, maybe it is a small enough field and maybe not :-\, there will always be what ifs, but if the question is never asked then noting will ever change.
7. Staff has to be able to monitor it's patients. There are computers that can hook up to the machines and record the data. I'm sure it could be viewed from another location, but there are signs that a patient is going out that just isn't going to show up on those screens. Patient safety is of the utmost importance, and though it may not give them complete privacy it is a necessity of this evil we call dialysis.
i agree with giving patient safety for sure, but what are the particular signs that you speak of that wont show? are you referring to a patients overall appearance (which has to be observed by some sort of human eye i suppose, or are you referrng to things that just cannot be monitored by common technology?
8. Though it may not be pretty, the machine and the patient chair need to be close together. Remember the further away the machine is the longer the blood lines have to be. This means that more rather than less of the patients blood is running around outside their bodies. This is not a good thing at all. The other thing is you can't have the machines enclosed like that. You need to have ready access to all parts of the machine for setup or emergency purposes. Plus having the machines enclosed like that would cause over heating issues.
i believe i already mentioned the machine housing, but as far as the chair location... the layout we presented was what we found to be the best way to have the chair near a storage panel on the wall while still allowing space behind the chair to recline into trendellemberg pos. so the machine was placed as close as possible. although the housing for the machine is not set in stone and the machine would be on casters so im assuming the tech would roll it to its nearest safest position.
9. I agree the chairs don't look very comfy, and are positioned too close to the wall on one side. Not everyone has their accesses on the same side of their bodies, or in the same location within those sides. I also don't think the floor stop concept would work very well. First off adhesive will never stay in place forever especially if you take into account the bleach water that has to be used on the floor to clean it. Bleach eats adhesive up. I also don't think that if a "larger" patient was in the chair that a nurse would be able to "easily pull the chair loose using minimal force" in a emergency or any other time for that matter.
again, the chair is being designed separately (in process now) so what you see are merely representations of a 'chair-like shape' :D the chair stop system on the last slide i presented would be removable so that it could be mirrored to the other side, and the adhesive was only one of many configurations for it (not uploaded), although adhesives are at a point where they will hold nearly forever, many adhesives are used in airplane engineering, thats why they dont use rivets or welding as much anymore (not to mention many other permanent applications), but another idea would be for it to be on a floor tile that could be removed and replaced into the location of another tile on the other side of the cube, which would be easy since there would only really be 2 possible locations to place it once the optimum spot is determined, so those 2 tiles in each cube could be interchanged. or a mechanical lock could be used such as a nut/bolt installation. either way its a pretty easy fix , but it was looked at as a alternative to having brakes at each wheel on a chair that has to be set individually (which was the case on many of the chairs we saw.
as far as the larger patinet... obviousluy the concept would have to go through engineering to determine surface angles and depth to try and find a design to accomidate the 95th percentile. the other question i have is what happends when ther eis an emergency(as far as a patient in the chair)? since we didnt obtain much of that info, is the chair wheeled to another location in the building? i guess basically the question is where do the current chairs go when a person in then is in an emergency situation? but again i wont say that i guarantee the engineering of this concept will work, but i sure wont say it wont. it could be made so that a heavy patient could be pulled out somewhat easily, the more important question i suppose is how much braking resistance is needed if you are just sitting stationary? not much i would suppose.
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im having trouble with all the quoting so im gonna italicize the quotes im responding to....
Everytime a staff member needs to use the restroom they have to walk out into the lobby area. It's really more of a convenience and privacy thing. If the staff bathrooms are off the staff office area they are more convenient for the majority of the staff. Plus who really wants to hear or smell me squeezing off a loaf. It is also a time thing. This may sound bad, but sometimes you don't have time to chat with the patients. I will stand around and talk to the patients in the lobby when I have time, but when you are really busy and a patient stops you to shoot the breeze it makes getting things done difficult. I don't want to be rude to the patient so I will talk for a min., but if I had to go to the lobby everytime I needed to take a leak it would drastically slow down my day.
understood... our lack or the necessary rooms in the center prevented us from seeing this problem.
I guess one of the things you are forgeting, and that I didn't really think of mentioning because I assumed (We all know what assuming does) you would realize it is that not all patients are the same. Everybody comes from a different walk of life. Some were more well off than others, some are immigrants, some have different heritage, some younger, and some older. In a normal clinic you are running 3 shifts a day, with your designs I believe (without looking at the print) that is around 54 patients a day. How do you manipulate your cubicles or schedule to accommodate all those people. You have to jockey everybody around to try and give them what they want that day. What if today I like green and tomorrow I like Blaq? People change their minds on things on a daily basis. You also fail to realize that most of the patients dialyze on a M-W-F or T-Th-S schedule, not everyday so you have 108 and patients you have to please. How does the clinic admin. decide what is best for all those people? Besides those points the patient population changes on a fairly regular basis. Some people move, get transplants, or unfortunately people pass on. You may have a core group of patients that stay the same, but the rest change from month to month. From an operational stand point the cubicle panels take time and effort away from patient care where it belongs. I still say video screen walls would be a better way to go to offer this customizeable clinic.
this particular quote particularly concerns me, because these are the things that we pretty much BASED our project on. and what we got from you all and from the peeks we did get form the placed we tried to get into or saw pictures of was that there was NOTHING done to address the very things you are mentioning, many of the ones we saw had no privacy (which many of you on here did not like at all) and all the gear was on rollers spread throughout the centers huge treatment room, which makes it wasy to move and clean underneath of, but it sure dosent look like a place id want to spend 15+ hours a week of my life at. now im not saying you would love my design, but i feel that it at least gives the OPTION to change the look, the configuration, and the enviroment. when we do what it is we do (design) we know that there is no 'perfect' solution, for us to expect that or for a consumer to expect that is unrealistic, but we still strive for it. so i have no problem accepting criticism, but at the same time im kind of at a loss for how we can get tremendous feedback on wanting privacy walls, wanting a place to put your things, wanting to have a chair for a visitor, wanting to be able to have a window or some color in the enviroment... and then when we implement those things to have someone say that we didnt think about the people using it? its just strange, maybe hawkeye is just playing the devils advocate, which i understand, but i do feel that that particulat statement is unwarranted. i have learned alot already from the feedback, and i was expecting it, so im not trying to deflect criticism by any means, but its much more effectinve to say something like "the nurses station at my clinic is much larger and has to have emergency carts to accomodate that many patients" than to say "its obvious you didnt talk to a nurse because your nurses station wouldnt work" (just an example). and at the same time i have to take each opinion for what its worth, i wont give a extremely positive opinion any more weight than an extremely negative one, because i understand that people are different and that you cannot please everyone, especially through a drawing :D
from BigSky:
Also there needs to be room for computers at the dialysis stations. Here for each two stations here there is a separate computer by them for nurses to log the information on.
we are working on a in-cube i.t. station that will hopefully accomidate this while using the existingo or possible a secondary monitor and recording system.
Dialysis stations need to be big enough for beds to be put in and have room for transfer scales as some patients are bedridden and must be weighed and transfered by hoist scale at the station itself.
good point :thx;, we will have to look at our floorplan to see if we can fit a bed in the existing cubes or make them a bit bigger so that a hiost scale can be fit into the extra space.
I see a problem with future expansion of the unit with the building built like that.
i understand what you mean here, but then agin any building that is built will have a given capicity before ot can hold no more. the the solution would be that if what we have represented is an average size clinic (based on # of stations) then we would want to make the wings a little bit longer to be able to add more cubes if necessary, and maybe a nurse station and storage area at the end of each wing so to cover the extra space that needs to be moniroted.
Also the nurses need to be able to see all patients with ease. There are times after a shift gets put on that half of the nurses go to breakfast around 8:30 here leaving the other half to monitor patients. Quick sight lines to patients are needed to evaluate them and machines.
another tech related topic... any data form any electronic device can be relayed to a nurses station to be monitored, so my concern switches to the specific things that a nurse sees when she looks at a patient to determine something is wrong, wothout going too deep into human physiology (which is not my major ;) ) i would assume that a particular 'look' that is reflected from a patient will have its own physiological stamp that could possibly be preventatively monitored. on a side note, all other groups in our class are all doing medical related projects, and one group who was doing a home healthcare project found that there is new technology currently being utilized where things like blood pressure, body temp, heart rate and a number of other things can be monitored throught the use of cameras or devices that merely are in contact with the skin. so that is another thing we try to do... completely discard what is currently done or possible and try to guesstimate what will be used or possible in 5-10 years, since disigning for the present will not get you anywhere but middle of the pack (from a corporate standpoint)
This wouldn't be on your end but I wouldn't mind seeing some sort of small LED unit attached to the side or top of the tv that would let the patient see what their venous, artierial pressures, bp, time and fluid removed are
its funny you say that because that point is much more on our end than the size and locations of storage rooms and bathrooms :D :banghead; but then again i understand because many people dont really know where the lines between marketing, industrial design and engineering are, heck they are so grayed that even students and professionals can hardly pace them anymore ??? but again the multimedia system we are trying to implement will provide patient monitoring along with the entertainment preiveliges.
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Don't get me wrong I understand what you are trying to do, and I give you cudos for it. You are trying to develop a clinic for the patients. As most people know I am not a patient, I am Biomed Tech. for a Fresenius clinic. Because of this I understand the operations side of the clinic environment. I am responsible for the repair and maintenance of all dialysis machines, TV's, water and dialysate systems, ancillary equipment, and general building maintenance. I also order all the medical supplies, and office supplies. To top it all off I also pay all the bills. I understand very well what it takes to operate a clinic, and what is needed to make it work. I love your designs and think it is great that you are trying to find a different avenue than what is being offered currently. I just have to say what I see wrong knowing the things that go on behind the scenes. I'm not trying to put your ideas down in any way. If anything I hope I am pushing you to maybe take another look at them and improve upon them. I am only going to make one other comment at this time.
Also the nurses need to be able to see all patients with ease. There are times after a shift gets put on that half of the nurses go to breakfast around 8:30 here leaving the other half to monitor patients. Quick sight lines to patients are needed to evaluate them and machines.
another tech related topic... any data form any electronic device can be relayed to a nurses station to be monitored, so my concern switches to the specific things that a nurse sees when she looks at a patient to determine something is wrong, without going too deep into human physiology (which is not my major ;) ) i would assume that a particular 'look' that is reflected from a patient will have its own physiological stamp that could possibly be preventively monitored. on a side note, all other groups in our class are all doing medical related projects, and one group who was doing a home healthcare project found that there is new technology currently being utilized where things like blood pressure, body temp, heart rate and a number of other things can be monitored through the use of cameras or devices that merely are in contact with the skin. so that is another thing we try to do... completely discard what is currently done or possible and try to guesstimate what will be used or possible in 5-10 years, since designing for the present will not get you anywhere but middle of the pack (from a corporate standpoint)
Even if you could have all these other monitoring devices attached to the patient (not that they really want more things hanging off their bodies) it still leaves out one big medical problem. That is accountability. We as medical staff are accountable for the well fare of the patients in the clinic. You can have a million different things attached to that patient but if something happens saying "well I didn't see anything on the monitor" isn't a good enough excuse. Yes, if a patient is "going out" there are usually a few tell tale visual signs that can be caught just by being able to see the patient. Will those signs be backed up by some type of patient monitor I don't know. The other thing is there can be other things other than just the patient themselves that could cause serious problems that could really only be able to be seen if the patient can be seen. For example, what if a patient is asleep and the needle in their access becomes dislodged, or the bloodline develops a leak. Not that this happens very often, but by the time one of the sensors goes off the patient will have already lost a good amount of blood. There are too many other issues that could cause harm to the patient if not properly monitored by the staff. I understand the want for privacy, but I also understand the need for patient safety and the medical institutes responsibility for the patients well being.
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Don't get me wrong I understand what you are trying to do, and I give you cudos for it. You are trying to develop a clinic for the patients. As most people know I am not a patient, I am Biomed Tech. for a Fresenius clinic. Because of this I understand the operations side of the clinic environment. I am responsible for the repair and maintenance of all dialysis machines, TV's, water and dialysate systems, ancillary equipment, and general building maintenance. I also order all the medical supplies, and office supplies. To top it all off I also pay all the bills. I understand very well what it takes to operate a clinic, and what is needed to make it work. I love your designs and think it is great that you are trying to find a different avenue than what is being offered currently. I just have to say what I see wrong knowing the things that go on behind the scenes. I'm not trying to put your ideas down in any way. If anything I hope I am pushing you to maybe take another look at them and improve upon them. I am only going to make one other comment at this time.
Even if you could have all these other monitoring devices attached to the patient (not that they really want more things hanging off their bodies) it still leaves out one big medical problem. That is accountability. We as medical staff are accountable for the well fare of the patients in the clinic. You can have a million different things attached to that patient but if something happens saying "well I didn't see anything on the monitor" isn't a good enough excuse. Yes, if a patient is "going out" there are usually a few tell tale visual signs that can be caught just by being able to see the patient. Will those signs be backed up by some type of patient monitor I don't know. The other thing is there can be other things other than just the patient themselves that could cause serious problems that could really only be able to be seen if the patient can be seen. For example, what if a patient is asleep and the needle in their access becomes dislodged, or the bloodline develops a leak. Not that this happens very often, but by the time one of the sensors goes off the patient will have already lost a good amount of blood. There are too many other issues that could cause harm to the patient if not properly monitored by the staff. I understand the want for privacy, but I also understand the need for patient safety and the medical institutes responsibility for the patients well being.
i appreciate the feedback hawkeye, and it makes more sense knowing your background, i havent been on the forums long enough or dug deep enough to know that, so now i understand why you are focusing on certain points that i didnt necessarily mean to be focus points.
but to go back to the second comment you made... i understand what you are saying, but for example if there is a leak in the bloodline that is something that the machine should be able to monitor, and if it cant tell that the blood isnt going where it needs to be or if it cant sense a drop in pressure.. then THE MACHINE needs to be redesigned/engineered, that seems to be like too simple of a problem to go unsolved, if they have sensors that do monitor this,(you mentioned the sensors go off too late) then the problem is in the machine and if it were operating properly then it would alleviate the need to be constantantly checking in on the patients. now im not trying to say that the nurse will never have to check on the patient, maybe they intercom them every 15 mins if it that patient that has had recent problems, and they also walk the aisles every half hour, basically find the meduim, because from what you are saying the only solution would be to have a nurse sit across from every patient and watch them for the duration of their treatment. i assume that at any given center a patient is not watched long enough for something to go wrong, at least a few times a day, so i think our concept could be implememted with the same amount of risk, if not less, especially if the machines are operating properly and more physical measurements are monitored. and this is much simpler to do than what is being done now, so its not like the patiend will have more things 'hooked' to them.
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At my center there is always at least one nurse able to see every patient at all times. We are never left unmonitored. Some of the first signs of a crash include things like restlessness, yawning, and turning pale. These things show up before anything a machine could see.
You may be right about the machine needed to be redesigned, but no matter how fancy they get, they still won't be able to warn of problems as effectively as observation.
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You may be right about the machine needed to be redesigned, but no matter how fancy they get, they still won't be able to warn of problems as effectively as observation.
And observation by the human eye, not by video camera. This is not Star Trek.
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but to go back to the second comment you made... i understand what you are saying, but for example if there is a leak in the bloodline that is something that the machine should be able to monitor, and if it cant tell that the blood isn't going where it needs to be or if it cant sense a drop in pressure.. then THE MACHINE needs to be redesigned/engineered, that seems to be like too simple of a problem to go unsolved, if they have sensors that do monitor this,(you mentioned the sensors go off too late) then the problem is in the machine and if it were operating properly then it would alleviate the need to be constantly checking in on the patients. now I'm not trying to say that the nurse will never have to check on the patient, maybe they intercom them every 15 mins if it that patient that has had recent problems, and they also walk the aisles every half hour, basically find the medium, because from what you are saying the only solution would be to have a nurse sit across from every patient and watch them for the duration of their treatment. i assume that at any given center a patient is not watched long enough for something to go wrong, at least a few times a day, so i think our concept could be implemented with the same amount of risk, if not less, especially if the machines are operating properly and more physical measurements are monitored. and this is much simpler to do than what is being done now, so its not like the patient will have more things 'hooked' to them.
Mind you I am a Fresenius Biomed Tech. so all I know of is how their machines work. Currently the only pressure the machine senses is the blood pressure pressure of the patient. A low blood pressure only makes the machines alarm, it does not stop the treatment. The way the machine tells if there is blood in the system is with an air detector. Basically, the machine sends electrical pulses through the blood chamber on the Venus line of the blood tubing. If it detects any bubbles or air in that chamber it clamps off the system stopping treatment and the machine alarms. This is what I mean when I said sensors going off. To do what you ask the machine would have to be completely redesigned. The problem with that is that it takes several years for a new machine to pass FDA inspection to be used in the USA. There has been a discussion about machines and the FDA here http://ihatedialysis.com/forum/index.php?topic=594.0. In Europe they are on the 5008 series machine, while here we are on the 2008 series. This is because of the FDA and how long it takes or them to release new technology to be used. As far as monitoring the patients with the way it works here we have 2/3 nurses for the entire floor and 1 patient care tech. to every 4 patients. The patients aren't watched like a hawk the entire treatment, but if something should go wrong it won't be missed either.
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At my center there is always at least one nurse able to see every patient at all times. We are never left unmonitored. Some of the first signs of a crash include things like restlessness, yawning, and turning pale. These things show up before anything a machine could see.
You may be right about the machine needed to be redesigned, but no matter how fancy they get, they still won't be able to warn of problems as effectively as observation.
thanks for the feedback jbeany... these are exactly the things i was wondering about. so if a person goes pale it has a biological cause, same with restlessness, a person dosent just say 'im gonna be restless now', it is caused by something.. i dont know what these things are, but they should be able to be monitored. again, im not trying to eliminate the human presence, but rather a nurse should be able to be at a hub and know when a persons body temp, blood pressure, or heartrate changes to what could be potentially a risk, its definately within the realm of possibility, it isnt star trek technology, these things are being used now, and in 15 years they will be common, (i never look at what is presently possible, rather what will be possible without going completely 'blue sky') kind of like a tornado warning.. so they would check on the patient before they actually go pale, if the person is already pale then in my opinion its too late (that is my opinion of where a possibility for improvement is, i want to strive for that point).
and thanks for the info on the machines hawkeye :2thumbsup; but thats what i mean about possibilities.. if the european machine is currently capable of doing more things, then at this point the 2008 series dosent exist to me anymore.. its past and im designing for futute use, but i dont necessarily mean that the machine has to do these things (it could be monitored by a separete device that dosent have to tap into the patient). but i do have a question.. the system you mentioned for the machine to monitor the blood, are you saying that by looking for air bubbles in the line that it isnt necessarily monitoring the pressure in the lines but rather its consistancy? and if so would monitoring the actual pressure be better? not considering if it is being done now or not. or are you saying it does both but only the electrical pulse system will actually stop treatment?
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the system you mentioned for the machine to monitor the blood, are you saying that by looking for air bubbles in the line that it isn't necessarily monitoring the pressure in the lines but rather its consistency? and if so would monitoring the actual pressure be better? not considering if it is being done now or not. or are you saying it does both but only the electrical pulse system will actually stop treatment?
The pressure that the machine monitors is blood pressure (Alarms only), Venus chamber, and arterial chamber (both will stop blood flow if out of range). Then you have the air detector I mentioned before. I kinda forgot to put those in before, my brain was stuck on patient blood pressure not machine pressure. They do measure the pressure in the Venus and arterial sides of the bloodlines. Even with that being added there can still be instances where that isn't enough warning.
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Okay, don't get too wrapped in blood pressure, though. It's not the only thing they have to watch out for, just one of the most important. My blood pressure could be perfectly fine, or going up for that matter - that doesn't mean I'm not about to throw up. And cramps don't register on the machine, and I doubt there is any technology coming that will show them before they arrive - but the nurses need to be close enough to help when they hit. Or how about being close enough to catch a sleeping patient when they start to slump over sideways in their chair and almost fall out? There are far too many reasons for the nurses to be in eyeshot of the patients that no amount of technology will change.
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Okay, don't get too wrapped in blood pressure, though. It's not the only thing they have to watch out for, just one of the most important. My blood pressure could be perfectly fine, or going up for that matter - that doesn't mean I'm not about to throw up. And cramps don't register on the machine, and I doubt there is any technology coming that will show them before they arrive - but the nurses need to be close enough to help when they hit. Or how about being close enough to catch a sleeping patient when they start to slump over sideways in their chair and almost fall out? There are far too many reasons for the nurses to be in eyeshot of the patients that no amount of technology will change.
i see what you are saying but at the same time i respectfully disagree. i wont pretend to be a medical expert, but i know that sports related cramps are caused by a lack of oxygen, and one of the new medical devices i was referring to that is non-intrusive can monitor both blood o2 and co2 levels. falling out of the chair.. yea i guess ther eisnt much that can be done there, other than make a chair that wont allow you to fall out, and the throwing up, i have no answer there either at the moment, but again i dont want to take the human element away, i still want to have nurses on patrol. and even so, the things you bring up im sure still occur now, if you get a sense of vomiting you can call the nurse, but there is no guarantee that she will always be able to get to you in time with a basin or whatever to contain it. Im not expecting our solution to be a 'fix all' but if there is a way to provide a better enviroment while still keeping the same level of safety i would consider it a big improvement.
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What is the legality of a nurse not being able to monitor all patients visually. What happens if a persons arm starts to bleed or they are eating something and start to choke. Blood pressure can change in minutes. If it only registers on a monitor every half hour they could be passed out or dead before a nurse sees the blood pressure drop on the monitor. Some people like the socializing. I know most days hubby would hate being in the cubicle and not having somebody to talk to. Since he started nocturnal he says the social part is the only thing he misses about in center, He made some really good friends on his morning shift. I spend a lot of time at the unit with hubby. At that center you were not even allowed to pull the curtains around you. There wer times when one of us had to yell at a nurse because they were with other patients that somebody was sick or had passed out or were crazy in pain with a cramp.. I just wonder who would be responible if anything happened to one of the patients??
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Cramps on dialysis are caused by the fluid removal. They are taking fluid out of the blood stream, and the fluid in the muscles is shifting out to restore the balance. I can't see any way to monitor warning signs for that . . .
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Cramps on dialysis are caused by the fluid removal. They are taking fluid out of the blood stream, and the fluid in the muscles is shifting out to restore the balance. I can't see any way to monitor warning signs for that . . .
I'm not on dialysis but I have a mild form of that kind of cramp from my long term undertreated hypothyroidism -- as the fluid from the myxedema is being removed from my leg tissue it is an indescribable pain and there is no way it compares to a muscle cramp. I'd suffer an hour of a muscle cramp rather than have 5 minutes of the ones that come from fluid redistribution. The only way I can sleep through them is hydrocodone taken at bedtime. I agree with you, I can't imagine a system that would monitor for that during dialysis.
As far a visual observation of the dialysis stations -- the only ways I see to do that would be with strategically placed mirrors, or a constellation type setup with the stations in a circle and the nurses in the center. But what do I know, I'm not a patient. ;D
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I know from being on the unit that some people have visual signs that they are sick. Going pale, shaking (almost like having a seizure), a cramp so bad they can't say anything. None of this is going to show up on a blood pressure monitor when your blood pressure is done every 30 minutes. Blood pressure can be fine when it is taken and drop in minutes. I have seen it happen. I personally would feel much better if my husband was on a unit where nurses and other people could see him.
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I know from being on the unit that some people have visual signs that they are sick. Going pale, shaking (almost like having a seizure), a cramp so bad they can't say anything. None of this is going to show up on a blood pressure monitor when your blood pressure is done every 30 minutes. Blood pressure can be fine when it is taken and drop in minutes. I have seen it happen. I personally would feel much better if my husband was on a unit where nurses and other people could see him.
there is existing technology where blood pressure can be monitored real time... not saying it solves all the issues being brought up, but it solves the blood pressure one (there are alot of problems being mentioned that are only limited by the technology that many of you are aware of, which is a problem in this discussion because as design students we are not instructed or expected to design things locked into present technology, because at that point it usually cannot get much better that where its presently at, same with cost). and as far as the cramps, patients will still be able to call a nurse, and a nurse will still be able to scan the area, its also one of our slides that werent presented that our cubes can be placed in a traditional layout for centers who do not want to adopt our building layout, since it would provide certain advantages and disadvantages. also, it is a easy fix to put cameras n the cubes to provide visual feedback to nurses to recognize cramps and shaking attacks, it was merely left out because of so much of the opinions voices on our forum about a lack of privacy.
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our cubes can be placed in a traditional layout for centers who do not want to adopt our building layout, since it would provide certain advantages and disadvantages. also, it is a easy fix to put cameras n the cubes to provide visual feedback to nurses to recognize cramps and shaking attacks, it was merely left out because of so much of the opinions voices on our forum about a lack of privacy.
Don't get us wrong - I, for one, would love the cube walls around me for privacy. It would be lovely to not have the feeling that everyone who walks by is looking at you. It's the layout of the floor plan that prevents the nurses from seeing everyone that is the issue. Reconciling those two issues may not be possible.
Of course, if you are designing without cost being a consideration, then each patient would get a nurse to themselves. . .
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Okay, so here is my :twocents;.
I like the idea of outside of the center being beautiful so when we have windows and can look out on something other than a nasty old street scene or a brick wall.
I think you are going to have to look into design of a dialysis chair that is comfortable and cleanable. The drawing you have here show basic, basic design of a really uncomfy looking chair. Have you looked into the style of chairs you will have in this cubicle?
I think the ideas of different design colors in the cubicle is a good idea. Often white and green or gray seems to be the design colors in dialysis units.
The dialysis machine probably cannot be a wall unit unless there are hookups for water intake and outgo in the wall system you have designed. The machines have to have room for dilayzers in the front of them, slaine bags on top, and water intake and outgo at the back. Have you taken into account how the water flow goes in this design for the machines and for the building?
If the unit is using primarily NXstage units as machines your design might work really well, since NX stage users are using machines independently anyway. As a clinic design overall some reworking might be needed. Privacy concerns are addressed really well with the cubicle idea, however the ideas of nurses being able to see patients are good ones. A camera on me throughout treatment would really bother me and I would not like it at all. Big brother concerns here and all of that. I thin you have addressed the patient privacy need admirably in your design. How about a nurses cubicle or station for three cubicles in the design instead of the one big station? This would put the RNs and techs right near the patients instead of off to one side. I hate it when the techs and RNs all gather at the nurse's station and are not in the patient area.
The storage unit beside the chair, how large is it? Is it easily accessible to the patient? Can it hold items and be moved and stored out of the way until the next treatment in the center? Or is it just for when the patient is there on the machine at one time? Is there a table for computers or DVD players available? Where does my ice cup go so it is accessible to me? Where is the computer hook up or are we Wireless? Does the patient entertainment center hookup into the patient data center? Not a good idea if my entertainment has to be interrupted so data can be input into the computer. Are patients providing entertainment such as computers, DVDs, and music, or will the center have an entertainment unit provided for each patient?
I bet you are ready to run screaming in the next county! We love you for trying. Keep up the designing!
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Lighting, what is the lighting like in this new unit? I hate the lighting in my unit. The big floursescent lights are overhead and it is hard to sleep. Where is the lighting for patient reading? Can the techs see with enough light to cannulate a patient? Can you dim the lights?
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The drawing you have here show basic, basic design of a really uncomfy looking chair. Have you looked into the style of chairs you will have in this cubicle?
the chair shown is not our final design.. merely an indication of where a chair would be in the cubicle. the main inspiration for our chair design can be found by looking at the aeron chair by herman miller, it is reguarded as the most comfortable chair for office use (where people have to sit in it for 8 hours a day) but PLEASE, no comments on the aeron design because thats just an inspiration image, not what we are gonna do.
The dialysis machine probably cannot be a wall unit unless there are hookups for water intake and outgo in the wall system you have designed. The machines have to have room for dilayzers in the front of them, slaine bags on top, and water intake and outgo at the back. Have you taken into account how the water flow goes in this design for the machines and for the building?
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in our building design it would utilize raised floors, but in current dialysys centers i imagind they are ren through the walls or possibly ceiling? if so we would most likely have a notch or cutout for the water/electricity line to be able to pass underneath the cubicle frame and get to the machines.
If the unit is using primarily NXstage units as machines your design might work really well, since NX stage users are using machines independently anyway. As a clinic design overall some reworking might be needed. Privacy concerns are addressed really well with the cubicle idea, however the ideas of nurses being able to see patients are good ones. A camera on me throughout treatment would really bother me and I would not like it at all. Big brother concerns here and all of that. I thin you have addressed the patient privacy need admirably in your design. How about a nurses cubicle or station for three cubicles in the design instead of the one big station? This would put the RNs and techs right near the patients instead of off to one side. I hate it when the techs and RNs all gather at the nurse's station and are not in the patient area.
this point was brought up before, and i think a good solution would be in a traditional building setting with the cubes lining the perimenter of the building having 2-5 nurses hubs centrally located depending on the # of patients. and in our layout, have additional hubs at the end of each wing as well as the central hub.
The storage unit beside the chair, how large is it? Is it easily accessible to the patient? Can it hold items and be moved and stored out of the way until the next treatment in the center? Or is it just for when the patient is there on the machine at one time?
the storage unit is to be placed right next to the patient chair so that you can reach it wasity with your off hand to acces whatever things you may have brought with you (i tried to show that in the top view of the cube layout). This particular storage unit is meant to house the things you bring with you to pass time i.e. books, knitting, sketch pads, whatever (think of it as like a bookshelf, about 24" wide and 12" deep or so). Although it was only meant for temporary storage, we spent alot of time trying to determine if we would have permanent storage or not, and actually came up with a few concepts for it, but ultimately decided that it would just make more work and more process for everyone (stoing the storage bins, having a locking system, etc), and we also determined that most of the patents hopefully wouldnt be bringing more than the shelving would accomidate since....
Is there a table for computers or DVD players available? Where does my ice cup go so it is accessible to me? Where is the computer hook up or are we Wireless? Does the patient entertainment center hookup into the patient data center? Not a good idea if my entertainment has to be interrupted so data can be input into the computer. Are patients providing entertainment such as computers, DVDs, and music, or will the center have an entertainment unit provided for each patient?
we worked with the concept of having a chair 'table' for a bit, then decided that there is no need for it if we implement some common technology. utilizing each cubicles lcd monitor as a multimedia monitor that connects wiith each cubes own pc, eigher housed in a sotrage room or housed right in a panel. since we figures the main usages for the 'chair table' would be to hold your laptop, dvd player or other electronic devices. this multimeda center would eliminate that since you would have wireless internet, headphones and dvd players built right into the cube, also a touchpad on the armrest of your chair to navigate the system. now im sure you guys could name a number of reasons that you would use the tabletop surface for, but it may be a sacrifice in our design, although we are still trying to integrate it as a 'just in case' option, as long as it fits in with the other parts of our chair.
also, the nurses will have thier own pda type devices to log any and all data so that they do not have to utilize YOUR monitor.
and finally the ice cup... no we didnt forget.. if you look at the slide that shows the different interchangeable panels you will see that the storage panel also has a flip out cupholder! ;D another reason we placed the storage panel right next to the chair.
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Lighting, what is the lighting like in this new unit? I hate the lighting in my unit. The big floursescent lights are overhead and it is hard to sleep. Where is the lighting for patient reading? Can the techs see with enough light to cannulate a patient? Can you dim the lights?
we envision the center having its own overhead lighting, and patinet lighting is via the 'light' fitted panels that are illustrated in the slide, they will be user controlled from the multimedia menu, and would use led's so that you can change the color and intensity of your lighting, specific task lighting may not be offered, we may just try and design the light panel so that it could be angled by the user.
our cubes can be placed in a traditional layout for centers who do not want to adopt our building layout, since it would provide certain advantages and disadvantages. also, it is a easy fix to put cameras n the cubes to provide visual feedback to nurses to recognize cramps and shaking attacks, it was merely left out because of so much of the opinions voices on our forum about a lack of privacy.
Of course, if you are designing without cost being a consideration, then each patient would get a nurse to themselves. . .
great point ;) but yea, we wnat to be able to have enough nurses to provide a safe enviroment while still giving the patient a respectable level of privacy. :2thumbsup;
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Cool! :2thumbsup;
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I don't thiink the way to go for a new design for dialysis units is totally technological. Technology stuff breaks down. Who would be accountable if something happened to a patient because the technological monitoring did not work?? What happens to the human aspect and the people who want to socialize (a lot do) Hubby would not like the idea of a camera being on him all the time. What about if you had to scratch certain body parts. Dialysis cramps are not always caused by co2 levels they are usully caused by being too dry or taking off fluid too fast.. Ask any dialysis patient and they will tell you that a cramp on dialysis is like no other cramp you can get. Some people can't even speak they are in so much pain. Sorry be be negative but a don't like the design without human contact and being able to be monitored by a real live human not a monitor!!
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I don't thiink the way to go for a new design for dialysis units is totally technological. Technology stuff breaks down. Who would be accountable if something happened to a patient because the technological monitoring did not work?? What happens to the human aspect and the people who want to socialize (a lot do) Hubby would not like the idea of a camera being on him all the time. What about if you had to scratch certain body parts. Dialysis cramps are not always caused by co2 levels they are usully caused by being too dry or taking off fluid too fast.. Ask any dialysis patient and they will tell you that a cramp on dialysis is like no other cramp you can get. Some people can't even speak they are in so much pain. Sorry be be negative but a don't like the design without human contact and being able to be monitored by a real live human not a monitor!!
point taken del. but i think you are either reading into what im saying too much or im coming off too strong on the technology side. the things we want to implement are to make everyones life easier. for instance, i rarely deal with needles or get my blood pressure taken, but if i did i would like it to be easier and more painfree (i hate the blood pressure sleeves, for some reason they make me really uncomfortable). but for instance, having the blood pressure monitored without a sleeve is a technological benefit, and like many technological systems there always has to be a foolproof backup, like having the sleeves or some other manual device around to make sure the e-system holds true, i could make examples for every other tech. gadget to be implemented but i think you get my point.
so basically, i dont want you to assume that if i say nurses hub with monitoring system that i expect the nurse to never check on you. also with the privacy issue; we found with this, like many other design problems encountered, that if you give people 'privacy' they may not feel safe or may even reccomend that a camera or nurse be able to watch them all the time, yet if you put an eye on them at all times they ask for privacy. our best medium was to implement the media center into each cube to allow the patients to be able to instant message or video conference with each other if they wanted to interact. if someone dosent like that idea then so be it, i dont mind personal opinion on that matter. in our problem statement we chose to focus on privacy, if you or someone else is a patient that prefers a more social/open atmosphere then you may not like it as much, that was a decision we thought about and acted accordingly though.
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You guys, continue what you're doing. ;)
Remember, a camel was a horse, designed by a committee.
:beer1;