Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Student Information and Induction Workbook Paediatric Critical Care Unit Queens Medical Centre Nottingham Reviewed C Whittaker/K Broom Aug 2014 1 Dear ____________________ On behalf of all the staff in the children’s critical care unit we would like to welcome you to Paediatric Critical Care Unit (PCCU) Your first day on the unit will be an informal induction day between 8-3. We look forward to seeing you. During your placement you will have at least two mentors. Your mentors are _____________________________ ____________________________ Shifts / Off Duty Our shift times are as follows:Long day 07.00 – 20.00 Early 07.00 – 13.30 Late 13.30 – 20.00 Night 19.30 – 07.30. Off duty is allocated by the student coordinators. You will be required to work these shifts unless requested prior to your placement or negotiated with the student link nurses. All off duty changes to be done by the student coordinators only. Contact Direct phone number for PCCU 0115 9709232. Your student link nurses are Carli Whittaker (Critical Care Educator) Kirstin Broom (Junior Sister), Beth Broughton (Junior Sister) and Joanne Bernardini (Staff Nurse). Location We are located on E floor, East block at Queens Medical Centre campus. We are located adjacent to the lifts. Notice board There is a student Notice board located in the staff room which holds lots of useful information. Sickness/absence If you are late for shift or need to go off sick, please speak to the nurse in charge as soon as possible. It is also your responsibility to inform the school of nursing of any absence. Uniform/Presentation You must always comply in full to the uniform policy with your university/hospital identification clearly on display. If you do not comply, you will not be allowed to work. Health and Safety Emergency number for cardiac arrest / Fire etc 2222. Reviewed C Whittaker/K Broom Aug 2014 2 Paediatric Intensive Care Unit Philosophy of care Our aim is to provide all children with individualised holistic care. We believe in acknowledging all cultural, religious and spiritual values and to encourage family participation in their child’s care. We try to provide a relaxed friendly atmosphere, encouraging an open and honest relationship between family and carers. We offer educational information boards and leaflets in various languages and scripts. We aim to practise named nursing, delegating to each family a nurse responsible for planning, implementing and evaluating their child’s care. We aim to provide continuity of care to allow the child and family to develop trusting partnerships with a few familiar nurses. We aim to have experienced, knowledgeable nursing staff and we encourage all staff to undertake further training. We strive to offer research based care and to offer nursing care of the highest standard. The Unit The Paediatric Critical Care Care Unit (PCCU) at QMC campus of Nottingham University Hospitals Trust is expanding to a capacity of 14 critical care beds with a combination of 8 PICU and 6 PHDU beds. The combined units have an 8-bedded open area and 2 cubicles that are used for isolation or to provide the family with privacy on PICU then 3 2 bedded bays and 2 cubicles on PHDU. Admissions to PCCU arrive from various sources; paediatric A&E, the wards, theatres (routine or emergency), and retrievals from referring hospitals. Nottingham University Hospitals Trust are the regional centres for oncology, neurosurgery, renal, spinal surgery, tracheostomy surgery and therefore the critical care unit admits many children from other regional hospitals for treatment. We offer care to children from the ages of 0 to 16 years. Their individual needs will vary depending on the nature of their admission. Each bed space is equipped in the same way. Daily safety checks are carried out to ensure the safety of staff and patients. You will be expected to be involved in these checks at the beginning of each shift. Handover starts at 0830 and Ward round starts at around 1000. Each patient is discussed in detail and parents are asked to leave the ward during this period for confidentiality reasons. During your placement you will come into close contact with the patients on the unit. In accordance with NMC guidance your activities should always be under the supervision of a registered nurse. You will be observing care that is given, helping provide care and later, fully participating in providing care and managing your own work load. At all times you should work only within your level of understanding and competence, asking appropriate questions to clarify uncertainty. Reviewed C Whittaker/K Broom Aug 2014 3 As a pre-registered student you are never professionally accountable in the way that would later affect an application to the NMC. As far as the NMC is concerned it is the registered practitioners with whom you are working, who are professionally responsible for the consequences of your actions or omissions. This is why you must always work under direct supervision of a registered nurse. This does not mean however, that you can never be called to account by your university or by the law, for the consequences of your actions or omissions. Mentorship As a team we take student learning very seriously and aim to support you as well as we can. The aim of this Critical Care placement is to provide an environment in which you can learn and practically apply transferable acute care skills. In this placement you will need to be able to apply theoretical knowledge to the practice of assessment, planning, implementation and evaluation of nursing care. It will be helpful for you to revise the basic anatomy and physiology of the main body systems so you can observe and understand the effects illness and disease have on all the systems of the body and on the individual as a whole. We are aware that you will have several skills assessments to complete during this placement and that it is important for you to achieve a number of them. From experience however, we feel you will get the most of this placement if you also try and consider other learning opportunities. In addition to your skills, suggested Learning outcomes include: Be part of the morning ward round, both medical and with the physiotherapists (as appropriate). Understand infection control issues in the acute care environment. Ensure that you are familiar with Trust policies. Understand how to communicate effectively with members of this large MDT, the patients and the families. Understand principles of IV therapies including blood transfusions. You will get many opportunities to become familiar with handling IV medications, so use them. Become confident in the use of the observation charts, recording the observations, balancing fluids and checking the bed space at the start of each shift. Be familiar with managing your own patient workload. Observe on a crash call if the opportunity arises. Reviewed C Whittaker/K Broom Aug 2014 4 Expectations of learners: To contact the clinical area 2 weeks prior to commencing your placement. Adhere to our philosophy of care. To identify your learning needs at the start of your placement and discuss how they will be met during your first interview with your mentor. To be receptive to the learning opportunities available and be proactive in engaging in activities designed to meet your learning needs. To utilise the mid- and end-interview to jointly reflect on your own progress. Flexibility in the shift pattern in order to maximise contact time with your mentor and experience the 24 hour care of the NHS. If you change your off duty it is your responsibility to ensure that you work the minimum number of shifts with your mentors. To notify your mentor and/or other members of the team if you have a concern about this placement. If not able to discuss concerns with your mentor then please find another member of staff whom you feel comfortable with, or raise it with your university link lecturer. Evaluate the placement by giving constructive feedback. Expectations of Placement All students should receive as a minimum: You will be allocated at least two mentors for the duration of your placement and will be allocated to work with them as often as possible. A tour of the unit, placement area. An explanation of relevant policies procedures and guidelines. A copy of the unit student information pack. You should have your preliminary interview within the first 2 shifts of working with your mentor. You and your mentor should arrange provisional dates for intermediate and interviews. You will be welcomed onto the ward and be treated as a valued member of staff by all of the MDT. Learning opportunities will be made available to students by all staff members where appropriate. All staff are responsible for student learning. Reviewed C Whittaker/K Broom Aug 2014 final 5 The Team There are four Consultant Paediatric Intensivists, who rotate on a weekly basis to manage the unit. Lead Consultant: Dr Patrick Davies Dr Shri Alurkar Dr Dusan Raffaj Dr Haris Kotsonis Paediatric registrars and senior house officers also support the unit. Sue Mager leads the nursing staff on PCCU. There are approximately 80 members of nursing staff on the unit, many of which hold the Specialist Paediatric Intensive Care Nursing Course. The unit employs a:PCCU Assistant/Housekeepers – Linda Benson, Jane Inger , Paul Wainwright PCCU Clinical Development Nurse - Rachel Bower PCCU Educator– Carli Whittaker PCCU Foundation Programme Educator- Louise Brown PCCU Receptionists–Sue Clarke, Lisa Smith, Pat McGrath and Hannah Scutter. PCCU Retrieval Co-ordinator – Abi Hill PCCU Sisters- Sarah Johnson, Anita Jarvis, Amanda Griffiths RETRIEVAL SERVICE We have an active 24-hour retrieval service. The team will retrieve children from hospitals where specialised intensive care for children is unavailable. Retrieval nurses under take specialist training and must fulfil certain criteria prior to becoming a team member. Please take the opportunity to go out with the team if space is available. Training nurses and doctors take priority. RESEARCH PCCU has a strong commitment to research and nursing staff are greatly encouraged to participate and contribute their views. We are currently undertaking several studies; please feel free to speak with link nurses or research nurse for more information. Reviewed C Whittaker/K Broom Aug 2014 6 Workbook Airway and Breathing Assessment How would you perform a respiratory assessment? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ __________________________________________________________________________ What adjuncts can be used to support airway and breathing? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________ Signs of respiratory distress * * * * * * * * * * * * Reviewed C Whittaker/K Broom Aug 2014 7 The above picture shows the equipment needed for Intubation. Where would this equipment be located on PICU? Can you name all the equipment in this picture? The above picture shows a patient being intubated orally. You could research the procedure used for intubation and what things are done/assessed to ensure that intubation has been successful. Reviewed C Whittaker/K Broom Aug 2014 8 Tracheostomy Often on PCCU you may be caring for a patient with a tracheostomy, often this is due to respiratory and / or cardiac conditions. These patients sometimes require Long Term Ventilation. To enhance their lung capacity, gaseous exchange and optimise their breaths with this ventilatory support. This can be provided via a face or nasal mask, however on PCCU we specialise in patient with LTV via a tracheostomy. In most respects the care required for these children is no different to that of any other child you will care for. It may be necessary to suction the child through the tracheostomy fairly regularly to prevent a blockage that would inhibit their breathing. Nebulisers are also often required to loosen secretions. The tapes securing the tracheostomy need to be changed daily and the tracheostomy tube is changed weekly along with the circuits if they are receiving ventilation. Children with a tracheostomy will have an emergency box in case of a blockage that requires an emergency tracheostomy change. It is important that this is checked with your normal safety checks at the beginning of the shift to ensure all equipment required is present. Many of these children will go home with their tracheostomy with or without ventilation depending on the child’s condition. An important part of the care of these children therefore is discharge planning and working with parents and professional teams within the community to allow the child to return home as soon as possible. Great Ormond Street Hospital (2007) Reviewed C Whittaker/K Broom Aug 2014 9 Types of Ventilation on PICU On PICU we use a variety of different types of ventilation Modes and settings. The most common ventilator used on PICU is the Evita XL. Along side this there is the Sensor Medics HFOV 3100A/3100B and the SIPAP infant ventilator. Whilst on PICU you may see these machines used. Take some time researching the following types of ventilation, what they mean and how they work. BiPAP_________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________ SIMV__________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________________________________________________ CPAP_________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________________________ HFOV_________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________________________ NIV/SIPAP_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________________________________________________________________ ST____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Reviewed C Whittaker/K Broom Aug 2014 10 Please name the following machines 1. 2. 3. Reviewed C Whittaker/K Broom Aug 2014 11 4. 5. Calculating Endotracheal tube (ETT) size and length. ETT Size Age (yrs) +4 4 Length Oral: Age(yrs)+12 Nasal: Age(yrs)+15 2 2 Reviewed C Whittaker/K Broom Aug 2014 12 Ventilator Observations. Fio2- ____________________________________________________ Frequency- _______________________________________________ PIP-_____________________________________________________ PEEP-. __________________________________________________ Minute Volume_____________________________________________ Minute Volume Leak-________________________________________ VTi and VTe- ______________________________________________ Slope/Ramp_______________________________________________ Example; 10kg patient. What would the expected TV be: The expected tidal volume range is._____________________________ T insp ____________________________________________________ PASB ____________________________________________________ Trigger- __________________________________________________ Reviewed C Whittaker/K Broom Aug 2014 13 Blood Gases Terminology: ABG - Arterial blood gas VBG - Venous blood gas CBG - Capillary blood gas ABG PH 7.35 – 7.45 PCO₂ 4.5 – 6 PO₂ 10 – 14 HCO₃ 22- 26 BE ±2 SpO₂ 96 – 100 There are no reference values for VBGs and CBGs. Both have lower pO2 and are unreliable measurements, however they are good for monitoring the pCO2. When measuring pCO2 the reference values are the same as an ABG. Analysing blood gases allows you to see how well the respiratory system and metabolic systems are working. It shows the interaction between the lungs, blood and kidneys. Guide to Interpreting Blood Gases: Look at pH to determine alkalosis or acidosis Look at pCO₂ to determine if it is a respiratory disorder Look at HCO₃ and BE to determine if it is a metabolic disorder Remember they can have components of both. Is there a compensatory mechanism happening? Now try and interpret the examples given below and list the common causes for these derangements. Reviewed C Whittaker/K Broom Aug 2014 14 Examples 1. 2. 3. 4. pH 7.24 pCO₂ 9.8 Description: __________________ ________________________ p0₂ 12 Causes: _______________________ HCO₃ 42 ־ BE +0.5 ________________________ _________________________ pH 7.53 pCO₂ 3.2 Description:_____________________ _________________________ pO₂ 11 Cause: _________________________ HCO₃ 24 BE +1 _________________________ _________________________ pH 7.22 pCO₂ 5.3 Description:_____________________ _________________________ pO₂ 12 Cause: _________________________ HCO₃ 14 BE –8 _________________________ _________________________ pH 7.5 pCO₂ 5.5 Description_____________________ _________________________ PO₂ 14.9 Cause: ________________________ HCO₃ 32 BE +5 _________________________ _________________________ Reviewed C Whittaker/K Broom Aug 2014 15 Cardiovascular Assessment How would you perform a cardiovascular assessment? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Estimated Weight Calculator 0-12 Months (0.5 x age in months) +4 1-5 years (2x age in years) +8 6-12 years (3x age in years)+ 7 Reviewed C Whittaker/K Broom Aug 2014 16 Fluid Management Fluid management is an essential part in a patients care. Calculating that your patient is receiving the correct amount of fluid is part of your daily safety checks. There are complete guidelines that can be found on the ward. Normal maintenance fluid requirements apply as they would typical, however in some circumstances restrictions or additions may be a made. Example A child might be restricted to 80% fluid. The child weights 8kg Normal 100% allowance 8 x 100 = 800mls per 24hrs 80% restrictions 8 x 80 = 640mls per 24 hours Now try this example A child has a 90% restriction in place The child weights 12kg ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ The Intravenous fluid of choice is currently 0.9% NaCl and 5% Dextrose however this does not apply to all patients. From the Fluid Management guidelines what fluid is recommended for Head Injury patients? _____________________________________________________________ The PICU chart allows you to keep an accurate record of a patient’s fluid balance. You will be part in calculating the overall balance of your patient and changing your plan of care accordingly. Some patients require additional fluid, three reasons are show below Fluid Resuscitation for Shock Bolus of 10-20ml/kg is given and can be repeated if necessary. This is normally 0.9% NaCl, 4.5% Human Albumin Solution or commercial colloid ie Gelofusin. Replacement of Pre-existing Fluid Losses To calculate fluid deficit, Fluid deficit (ml) = weight (kg) x % dehydration x 10 This fluid should be replaced over the next 24 hours Replacement of Ongoing Fluid Losses. Fluid losses should be replaced ml for ml, usually with 0.9% NaCl +/- KCL. If there is significant blood loss, packed cells may be used. Reviewed C Whittaker/K Broom Aug 2014 17 Inotropes. Inotropic drugs or catecholamines are widely used for a range of problems, these include: Cardiac arrest Myocardial failure Acute and chronic cardiac failure Renal dysfunction Septic and cardiogenic shock. The role of an inotrope is to maximise cardiac output and optimize its distribution. Children who require Inotropic therapy also require continuous cardiac, blood pressure, respiration and saturation monitoring. The measurement of central venous pressure is also desirable. The most commonly used inotropes used on PICU are: Adrenaline, Noradrenaline, Dopamine, Dobutamine and Milrinone Inotropic Action is _______________________________________ Chronotropic Action is ____________________________________ Vasoconstriction is _______________________________________ Vasodilation is __________________________________________ Nursing Implications for Inotropes. -Continuous monitoring of heart rate, arterial blood pressure, respiration rate and oxygen saturations are essential. -Central venous access is required for administration of medication- can easily cause extravasations and lead to necrosis. -Interruptions in the infusion may result in an alteration of the blood pressure/ heart rate. This means that they must not be stopped. 3 way tapes are inserted into the inotrope lines to enable double pumping. -An inadvertent flush may result in a large increase in heart rate and blood pressure. -Can run with other Inotropic drugs, but nil else. -Patient requires accurate fluids balance for duration of administration -Weaning of drug required to prevent rapid decrease/increase of heart rate and blood pressure, while keeping the drugs within a therapeutic range. Reviewed C Whittaker/K Broom Aug 2014 18 Receptors and Sites Receptor Site Peripheral vascular beds. 1 Myocardium 2 Presynaptic Central 1 Myocardium 2 Airway smooth muscle. Myocardium Peripheral Vascular beds DA1 Renal and splanchnic beds Myocardium Peripheral vascular beds DA2 Presynaptic neural endings Clinical actions of Catecholamines Drug Adrenaline Receptor 1 2 1 Noradrenaline 1 1 Dopamine Dobutamine DA1 DA2 1 Actions Inotropic and chronotropic. Peripheral vasodilation. Peripheral vasoconstriction At high doses Peripheral vasoconstriction Inotropic and chronotropic 2 Renal and splanchnic vasodilator. Renal and splanchnic vasodilator. Peripheral vasoconstriction At high doses Inotropic and chronotropic at high doses. 1 2 1 Inotropic and minimal chronotropic. Peripheral vasodilation Minimal peripheral vasoconstriction. Reviewed C Whittaker/K Broom Aug 2014 19 DISABILITY How would you assess the neurological status? ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ INFECTION PREVENTION & CONTROL Infection Control Link Professionals We currently have several link nurses, try to find out who they are and put their names here _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Infection Control is high on the Trust’s agenda - MRSA ~ less than 4 new bacteraemia cases per month - C.Diff ~ 5% reduction in new cases each month Apron & gloves for ALL patient contact - Familiarise yourself with apron colour coding Weekly hand washing audits (Mondays) MRSA screening of all PICU patients - Routinely screen ALL patients every Tuesday - Screen all admissions regardless of where they are from - Screen all pts with previous MRSA colonisation - All patients MSRA status to be checked and documented on care plans. Ongoing monthly audit of invasive lines: PVC CVC – CVL days Renal dialysis catheters Urinary Catheters Ventilators …as part of DoH “Saving Lives” initiative (2007) Matching Michigan Infection Control Policies kept in wardrobes behind desk and online Results of Audits displayed in staff room Reviewed C Whittaker/K Broom Aug 2014 20 PCCU Drug Calculations On the ward you will find a variety of Paediatric medication formularies, and it is good to get into the habit of checking the doses of the medications prescribed for your patient. You can also find out information from the bedside folders. We also use a Drug Infusion Calculator on PCCU. Every patient will have one printed out on admission and one of the bedside safety checks is to ensure that it is present. Group these drugs into the appropriate categories found on the following page inotropes, analgesics, sedation, paralysis etc Adenosine Adrenaline Aminophylline Amoxicillin Atenolol Atrovent Captopril Cefotaxime Chloral Hydrate Ranitidine Clonidine Dexamethasone Dnase Dobutamine Dopamine Erythromicin Fentanyl Frusemide Gentamicin Ibruprofen Lorazepam Mannitol Midazolam Milronone Morphine Noradrenaline Pancuronium Paracetamol Penicillin Phenobarbitone Phenytoin Salbutamol Spironolactone Vancomycin Reviewed C Whittaker/K Broom Aug 2014 21 Paralysing agents Analgesics Sedatives Anti-convulsant drugs Respiratory drugs Antibiotics Inotropes Diuretics Cardiac drugs (include for heart failure, anti arrhythmias) Other Reviewed C Whittaker/K Broom Aug 2014 22 Now calculate the following, show your workings out at the side. Paracetamol (120mg in 5 mls) 210mg________________________________________________________ 45mg ________________________________________________________ 80mg________________________________________________________ 100mg________________________________________________________ 240mg________________________________________________________ Ibuprofen (100mg in 5 mls) 40mg, ________________________________________________________ 60mg, ________________________________________________________ 35mg, ________________________________________________________ 90mg, ________________________________________________________ 160mg.________________________________________________________ Chloral hydrate (500mg in 5 mls) 100mg________________________________________________________, 60mg________________________________________________________, 350mg________________________________________________________, 75mg________________________________________________________, 40mg________________________________________________________. Phenytoin (oral 30mg in 5 mls) 20mg________________________________________________________, 70mg________________________________________________________, 50mg________________________________________________________, 45mg________________________________________________________. Reviewed C Whittaker/K Broom Aug 2014 23 Phenytoin (IV 250mg in 5 mls) 20mg________________________________________________________, 45mg________________________________________________________, 100mg________________________________________________________, 125mg________________________________________________________ 225mg________________________________________________________. Metronidazole (500mg in 100mls). 70mg________________________________________________________, 100mg________________________________________________________, 350mg________________________________________________________, 165mg________________________________________________________. Gentamycin (80 mg in 2 mls) 50mg________________________________________________________, 20mg________________________________________________________, 35mg________________________________________________________. 100mg________________________________________________________. Ranitidine (50mg in 2mls) 22mg________________________________________________________ 14mg________________________________________________________ 36mg________________________________________________________ 42mg________________________________________________________ 45mg. ________________________________________________________ Reviewed C Whittaker/K Broom Aug 2014 24 Infusions Refer to the PCCU infusion prescription sheet to calculate the dose and diluting fluid. Conversion for micrograms/kg/hr Amount of drug x1000 Divide by patients weight Divide by volume in syringe Conversion for micrograms/kg/min Amount of drug x1000 Divide by patients weight Divide by volume in syringe Divide by 60 ( minutes in 1hr) Morphine Sulphate Two strengths- 10mg in 1 ml and 60mg in 2 ml. Calculate dose to be added to a 50ml syringe for the following. Calculate how many mcg/kg/hr = 1 ml for each weight 9kg__________________________________________________________ 28kg_________________________________________________________ Midazolam Strength 10 mg in 2 ml Calculate dose to be added to 50mls . Calculate how many mcg/kg/hr = 1 ml for each weight. 9kg__________________________________________________________ 28kg_________________________________________________________ Noradrenaline Strength 1mg in 1 ml Calculate dose to be added to 50mls Calculate how many mcg/kg/min = 1 ml for each weight. 9kg__________________________________________________________ 28kg_________________________________________________________ Dopamine Strength 200 mg in 5 ml Calculate dose to be added to 50mls. Calculate how many mcg/kg/min = 1 ml for each weight. 9kg__________________________________________________________ 28kg_________________________________________________________ Rocuronium Strength 200mg in 20 ml Calculate how many mcg/kg/hr = 1 ml for each weight. 9kg__________________________________________________________ 28kg_________________________________________________________ Reviewed C Whittaker/K Broom Aug 2014 25 PCCU Floor plan Back door Blood gas Drugs Linen Sluice room Room Reception Retrieval Room Resource Room Staff toilet Equipment Room Parent’s toilet Parents Sitting room Managers Office Quiet Office Staff Room Quiet Room S Reviewed C Whittaker/K Broom Aug 2014 26