facility design and upgrading · renovation of an existing facility. there are two points to take...
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section 9
Contents
• Overviewofhealthandresidentialcarefacilitydesign
• HealthfacilitydesignstandardsrelevanttoNew Zealand
• Facilitydesignprocess
• Ceilingtrackingandhoists
• Accessdesignfeatures
– Corridors
– Floorspacesforpassingandturning
– Doorways
– Flooring
– Ramps
– Handrails
• Clienthandlingareas
– Bedrooms
– Bathrooms,toiletsandshowers
– Dayanddiningrooms
– Clinicalsuites
– Otherclienthandlingareas
– Staffandclientcallsystems
• Equipmentstorage
• Maintainingworkingspacesforclienthandling
• Facilitydesignforbariatricclients
• Overviewofupgradingfacilities
• Assessingexistingspacesforupgrading
• Strategiesforupgradingfacilities
• Referencesandresources.
Facility design and upgrading
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9.1 Overview of health and residential care facility design
Thissectionprovidespracticalrecommendationstohelpmanagers,architects,plannersanddesignersinvolvedindesigningandredevelopinghealthcarefacilities.Itcanalsobeusedbymanagersandmovingandhandlingadvisersasaguidewhenreviewingtheirfacilities;forexample,whencompletingaworkplaceprofileoranannualmovingandhandlingprogrammeaudit.Theinitialpartsofthesectioncoverinformationaboutthebuildingdesignspacesandfeaturesneededforeffectivemovingandhandling.Laterpartsinthissectionprovidemoredetailaboutupgradingexistingfacilities.
Theaimoffacilitydesignistoprovidespacesthatallowcarerstoworkinsafeenvironments.Facilitiesforhealthcare,agedcareanddisabilitycareshouldbeplanned,designedandbuiltwithmovingandhandlingspacerequirementsasstandard,notasanafterthoughtorasaspecialconsideration.Facilitydesignshouldbebasedoninformationfromworkplaceprofiles,discussionswithendusersandtheinformationinthissection.Itismostcosteffectivetoincludemovingandhandlingfeaturesduringtheplanningstage;itismuchmoreexpensivetoaddsuchfeatures later.
Asnotedinearliersections,buildingorfacilitydesignisacrucialcomponentinanoverallprogrammetoreducetherisksassociatedwithmovingandhandlingpeople.Theinformationinthissectionincorporatescurrentbestpracticeinbuildingdesignformovingandhandlingpeople.Designersandpeopleinvolvedwithmovingandhandlingneedtoadoptoradapttheinformationfornewbuildingdesigns.Itisimportanttoconductapreliminaryassessmentoftheproposeddesignforanewfacilitytoensurerenovationsmeetthemovingandhandlingneedsofboththepeoplebeingcaredforandtheircarers.
Acommonbeliefisthataddingtherecommendeddesignspacesandfeaturesformovingandhandlingpeoplewilladdconsiderablytothecostofanewfacilityortherenovationofanexistingfacility.Therearetwopointstotakeintoaccountaboutadditionalcosts:
• First,severalresearchreportshavenotedthatthereturnoninvestmentfromaddingmovingandhandlingfeaturesisaroundthreeyears(estimatesarebetween2.5andfouryears).1Theadditionalcostsofincludingtherecommendedfeaturesformovingandhandlingpeoplewillgenerallybecoveredinaboutthreeyearsbycostsavingsresultingfromreducedinjuriesandlowerstaffabsenteeismandturnover.Afterthreeyearstherearelikelytobecontinuingcostsavingsinfacilityoperatingcosts
• Second,thecostofchangingfacilitydesignfeaturesafterafacilityhasbeenbuiltorrenovatedisconsiderablyhigherthanwhenthesedesignfeatures
1. See,forexample,Chhokaretal,2005.
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Section 9: facility design and upgrading
areincludedatthedesignstageforanewfacilityorduringrenovations.Forexample,itcosts10timesasmuchtowidenadoorwayinanexistingfacilityasitdoestoincludeawiderdoorwayinthedesignphase.2
In2011,thestateofhealthfacilitydesigninNew Zealandinrelationtomovingandhandlingpeoplewasgenerallypoor,inspiteofTheNew ZealandPatientHandlingGuidelinesbeingavailablesince2003.Numerousexamplesofpoorbuildingdesignfeatureswereobservedorbroughttotheattentionoftherevisionpanelatthetimeofwritingin2010‑2011(seeBox9.1).
Box 9.1
Examples of poor facility design in New Zealand
• Newlyinstalledceilingtrackinginhospitalpatientroomsnotextendedintoadjacent bathrooms
• Poorlydesignedstoragespaceswheremobilehoistsarestoredinfrontofshelves,blockingaccessto slings
• Toiletsinnewlybuiltfacilitiesplacedinthecornersofbathrooms,notallowingcareraccesstobothsidesoftoilets
• Anewsurgicaltheatreforgastricbandingoperationswithoperatingtablesanddoorwaystoosmallforobesepatients
• Wall‑hungtoiletsthatarenotdesignedtotakeheavypatients,butareeasytoclean.
Source:Observationsmadebyrevisionpanelmembers,2010
Opportunitiestoincorporatebestpracticeformovingandhandlingpeopleinfacilitydesignincludeplanninganewfacilityandundertakingminorrenovationsoramajorupgradeofanexistingfacility.SomeexamplesofdesignfeaturesthatmightbeincludedduringtheseopportunitiesareshowninTable9.1.Moredetailedinformationaboutplanningforfacilityupgradingisprovidedlaterinthissection.
2. New ZealandAssociationofOccupationalTherapists.(2006).Submission on Review of the Building Code.p.5.
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Table 9.1 Opportunities for improving facility design and function
Example of facility development
Examples of design features to consider for moving and handling people
Newbuildingdesign Ceilingtrackspecified
Minimumwidthspecifiedfordoorsandcorridors
Clientrooms
Bathroomdesign
Equipmentstorage
Areasforbariatricclients
Renovatingorupgradinganexistingfacility–mayrangefromspecificandrelativelyminormodificationstomajorchanges,possiblyincludingstructuralchanges
Doorwayswidened
Bathroomredesigned
Ceilingtrackinginstalledorretrofitted
Equipmentstorageadded
Accessformobilehoists
Rampstodoorways
Grabrails
Theguidelinesinthissectionarebasedonergonomicprinciplesthatfocusonmatchingthedesignandlayoutfeatureswiththeneedsofboththepeoplebeingmovedandtheircarers.Movingaclientinaconfinedspacemakesitdifficulttomanoeuvreequipmentandputsstaffandtheclientatrisk.Theaimistoprovideanenvironmentwherepeoplecanbemovedinanefficientmannerthatreducesrisksforboththecarersandthepeoplebeingmoved.Inpracticalterms,thismeansensuringthatfacilitiesaresuitableforthetechniquesandequipmentrequiredforeffectivemovingandhandling(seeBox9.2).Itisalsoimportanttodesignfacilitiesinawaythatencouragesclientindependenceandreducestheneedforhandling.
TherecommendationsincludedinthissectionarebasedonconsultationwithmovingandhandlingcoordinatorsandassessmentsoftheliteratureonhealthcarefacilitydesigninAustralia,CanadaandtheUnitedKingdom.Allnewdesignsshouldbeassessedusingindustrystandards3andthedevelopmentprocessshouldinvolvemanualhandlingadvisersandrelevantcliniciansearlyinthedesignstages.
3. TheWorkSafeVictoria(Australia)2007publication,A Guide to Designing Workplaces for Safer Handling of Peopleisparticularlyrecommendedfordesignersandfacilityprojectmanagersinvolvedinfacilityplanningandrenovation.
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Section 9: facility design and upgrading
Box 9.2
The main facility design considerations for moving and handling people
Therearefivekeyareasoffacilitydesignforensuringreducedrisksinmovingandhandlingpeople.These are:
1. Access:Corridorsanddoorsshouldbesufficientlywidetoallowtheclient,thecarerandequipmenttopassthroughandfortwobedsorwheelchairstopasseachother
2. Space requirements:Thereshouldbeenoughspacearoundfurniture,beds,toilets,showersandbathstoallowtheuseofappropriatemovingandhandlingtechniquesand equipment
3. Handrails and grab rails:Thesehelppeoplewhoarepartiallymobiletomove.Theyrequirecarefulplacementsothattheydonotobstructhandlingoperationsorthemovementofequipment
4. Floor surfaces and friction:Floorsshouldbedesignedtoenhancethesafetyofclients(fromfalls)andstaffwhopushorpullwheeledequipment
5. Equipment storage:Thereneedstobesuitablestorageforequipmentclosetohandlingareas,sothatequipmentisreadilyaccessibleforuseandeasytoputawayafteruse.
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9.2 Health facility design standards relevant to New Zealand
TheprimaryNew Zealandstandardsforbuildingdesignandconstruction(collectivelyknownas‘buildingcontrols’)aretheBuilding Regulations (1992)(withintheBuilding Act (2004))andtheBuildingCode,whichistheFirstScheduletotheBuildingRegulations.4Thepurposesoftheselawsaretoprovidecontrolsandtoensurebuildingsaresafeandsanitaryandhaveadequatefireescapes.Thesectionscoveringfiresafety,accessandtheinteriorenvironmentsofbuildingsareparticularlyrelevanttomovingandhandlingpeople.
TheNew ZealandStandard4121:2001Design for access and mobility: Buildings and associated facilities(NZS4121DesignforAccess)providesguidelinesfordesignandsetsoutaccessandfacilityrequirementsforpeoplewithdisabilitieslivingindependently.SomeaspectsoftheNZS4121Design for Accessrecommendationsarenotsuitablefordependentdisabledpeoplewhorequireassistancefromoneortwocarers.Forexample,thebathroomrecommendationsaretoosmalltoallowsufficientspaceforcarersandmovingandhandlingequipment.
Thereareseveralitemsoflegislationthatemployersanddesignersmusttakeintoaccount.The Health and Safety in Employment Act (1992)(includingthe2002amendments)requiresallpracticablestepstobetakentoensurethereisasafeandhealthyworkplace.5DesignersandmanagershavespecificdutiessetoutundertheHealth and Safety in Employment Regulations (1995).
TheNew ZealandMinistryofHealthgenerallyrequiresuseoftheAustralasian Health Facility Guidelines(AustralianHealthInfrastructureAlliance,2009)forbuildingsandfacilitiesforDistrictHealthBoards(DHBs).TheAustralasian Health Facility GuidelinesaregenerallyappropriateforNew Zealand.However,wheretherearedifferencesbetweentheAustralasianguidelinesandthissectiononfacilitydesign,werecommendthatthespecificationsdescribedintheseGuidelinesbeused.NotethatsomeofthebathroomrecommendationsintheAustralasian Health Facility Guidelinesaretoosmallandmaynotallowsufficientspaceformovingandhandlingandusingequipment.Alltoiletsandbathroomsinhealthcarefacilitiesshouldallowsufficientspacefortwocarerstoassist.
4. Source:www.dbh.govt.nz/building‑law‑and‑compliance,retrieved19December2010.5. Seepamphleton‘Takingallpracticablesteps’atwww.osh.dol.govt.nz/order/catalogue/hse‑factsheets.shtml.
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9.3 Facility design processWithanyfacilitydevelopment,itisimportanttouseasystematicapproachsothatphysicalspacesneededformovingandhandlingpeoplearegivenadequateconsideration.Twospecificstagesshouldtakeplace:
• Amovingandhandlingassessmentdocumentisdevelopedbyamovingandhandlingcoordinatororhealthandsafetystaff.Thisdocumentidentifiesdesignspecificationsforspaces,outliningthemanualhandlingtasks,includingmovingandhandlingpeople,thatwilltakeplaceinthosespaces
• Setupaspecificprojectforfacilitydevelopment.
Forthefirststage,adocumentisprepared(withatitlesuchasMoving and Handling Assessment for Facility Design).Thisdocumentwillprovideanevolvingplanforthedevelopmentoffacilitiesthateliminatestheneedformanualliftingofdependentclients(seeBox9.3).Oncedeveloped,thisdocumentcanbeusedtoassesscurrentfacilitiesandplanchangestobuildingswheneveropportunitiesforfacilityupgradingoccur.Thisdocumentshouldbeusedintheinitialbudgetcalculationsforthestrategicplanninginthenextstage.
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Box 9.3
Example: Moving and Handling Assessment for Facility Design
ThepurposeofaMoving and Handling Assessment for Facility Design(MAHA)istodevelopfacilitiesprogressivelytoeliminatetheneedformanuallyliftingorhandlingdependentclients,patientsorresidents.Theplanwillusuallybedevelopedbyfacilitystaffasabriefingforanexternaldesignteam.Thepurposeoftheplanistoensurethatphysicalchangesmadetobuildingsandfixturesincorporatebestpracticeformovingandhandlingpeoplewheneveropportunitiesfornewfacilitiesorupgradingoccur.PreparinganMAHAtakesseveralsteps.
1. Assessthephysicaldependencyneedsoftheclientsorresidentpopulationbydeterminingthedegreeofassistancetheycharacteristicallyrequireineachcarearea.Dothisfirstforspecificwardsorunitsbeingupgraded.Foreacharea,identifyandlisttheequipmentneeded,aswellasanystorageandservicerequirementsfortheequipment.Itisimportanttoconsultstaffworkingintheseareasandseektheinputofthemanualhandlingcoordinatororequivalentperson.
2. TheMAHAdetailsshouldbecollatedandprovidedtotheteampreparingthedesignplan.TheMAHAcanbeusedtoinformprojectspaceanddesignrequirements,addressingallarchitectural,structuralandutilityplanningandcoordinationissues.
3. Amock‑upoftheproposedchangesshouldbeconstructed.Thiscanbeassimpleasusingtapeonafloortomock‑uptheareaandwherefurnitureandequipmentwillbeplaced.Thiswillprovideusefulinformationabouthowpracticaltheplanis.Askstafffortheirinputatthemock‑upstage.
4. Modifytheplanwiththeinformationgatheredfromthemock‑up.Themodifiedplanshouldthenbesenttotheexternaldesignteamsothatthefacilitydesigncanbedevelopedfurtherpriortoconstruction.
5. Followingcompletionofthefacilityconstructionorrenovation,managersshouldensurethatcarersandotherfacilitystaffarefamiliarisedwiththenewfacility,andknowhowtouse,serviceandmaintainallequipmentinthefacility.
6. ThepreparationofaMAHAisonlyrequiredforeachareainwhichclientorresidenthandlingwilltakeplace.Itcanbeanindispensabletoolforincreasingstaffandclientsafety,andassistingclientmobilisationand rehabilitation.
Adaptedfrom:Leib&Cohen,2010.
Asecondstageistosetupaspecificprojectforafacilitydevelopment.ThestepsinvolvedforaspecificfacilitydesignprojectaresummarisedinTable9.2andaredescribedinmoredetailbelow.Wherethereisanexternaldesignteam,thesestepsareintendedforaninternalfacilityprojectteamthatisliaisingwiththeexternaldesignteam.Thestepsaremostrelevantfordesigningnewbuildingsandformajorrenovationstoexistingfacilities.Abrieferversioncanbeusedforsmaller‑scalefacilitiesupgrades.
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Table 9.2 Steps in the facility design or renovation process
Step Main activity
Step 1Strategicplanning Identifyneedsandsetgoals,developaplan
Step 2Initialconsultationandactionplan
Gaincommitmentfromdecision‑makers,setupprojectworkinggroup.Developactionplanandtimetable.Assign responsibilities
Step 3Facilityreviewanddevelopmentofdesignbrief
Reviewexistingfacilityandfutureneeds.Collectspecificinformationfordecision‑making.Collateandprepareafacilityreport.Prepareadesignbrief
Step 4Facilitydesign Consultstaffandkeypeople.Finalisedesign
Step 5Implementationoffacilitybuildingorupgrade
Approvalsandbudgetconfirmed,workcommenced
Step 6Commissionreportandongoingreview
Closingreportthatrecordstheprogressoftheproject.Regularlyinspectandreviewfacilities
Step 1 Strategic planning
Thefirststepistodevelopastrategicplanthatsetsouttheprojectgoalsandstrategies.Theplanshould:
• Identifythehealthcareservicesneedednowandforthenextfiveyears
• Describethemodelofcarethatwillunderpinservicedelivery.Forexample,ifitistoassistelderlypeopletoliveasindependentlyaspossibleandmaintainmaximumcontrolovertheirlives,thismodelofcarewillhavedesign implications
• Definethescopeoftheproject.Forinstance,isthisbuildinganewcentreorredesigninganexistingone?
• Setouttheprojectgoalsandyourstrategiesforreachingthem
• Setouthowyouwillcommunicatewithandconsultstafftogaintheir commitment
• Definehowtheclienthandlingfacilitydesignprocessfitsintotheoverallredesignorbuildproject
• Ensurethatthefacilityis‘futureproofed’byallowingforserviceorclientdemographicchanges.
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Step 2 Initial consultation and action plan
Theprojectshouldgainthecommitmentofpeoplethroughouttheorganisation,especiallythosewhocaninfluencetheoutcomeoftheproject,suchasthosewhomakethedecisions,controltheresourcesandunderstandtheworkprocessesandissues.Setupaworkinggroupofkeypeople,including:
• Management,financerepresentatives
• Keyclinicalstaff
• Thedesignerorarchitect
• Healthandsafetyunitrepresentatives
• Themovingandhandlingcoordinator
• Anemployeeorunionrepresentative.
Involvingclinicalstaffandemployeerepresentativesisimportantbecausetheyarelikelytobefamiliarwiththepracticalissuesinvolvedinmovingandhandlingpeopleandcanprovidevaluableideasrelatedtotheirworkactivitiesandclientneeds.
Theactionplanincludessettingtimelinesandspecificprojecttaskssothatkeypeopleareclearabouttheirrolesandresponsibilities,andthereisaclearpathtofollowtoachievetheprojectobjectives.Thiswillincludethefollowingtasks:
• Identifyandprioritisetheprojectobjectives
• Assignresponsibilitieswithintheprojectgroup
• Decidewhatinformationisneededandhowtogatherit(seeStep5)
• Developaninitialplanandtimelinefortheproject
• Identifywhatthecommunicationstrategywillbebetweenthedesignteam andtheorganisation’sbuildingcommitteeormanagementteam(e.g. meetingschedules,keystakeholdersandcontacts,agendasanddistributionof minutes)
• Ensuretheprojectplanisincorporatedintotheoveralldevelopmentplanforthefacility.
Step 3 Facility review and development of design brief
Beforemakinganychanges,areviewoftheexistingfacilitiesshouldbecarriedoutsothatissuesrelatedtothefacilitydesignandlayoutcanbeidentified.Thereareseveralpotentialsourcesofspecificinformationthatcanbeusedtohelpthedevelopmentofthedesignbrief.Theseincludetheuseofexistingrecords,thefacilityprofileand simulations.
• Existing records:Mosthealthcareorganisationshaveoperationalrecordsofclientpopulations,handlingtasksperformedandequipmentused.Accident
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andinjurydatashouldalsobeavailable.Theremaybeinformationfromsourcessuchasclientandworkplaceprofiles,staffquestionnairesandworkplaceaudits.Archiveddocumentsfrompreviousprojectsshouldbereadfor‘lessonslearned’.
• Current facility profile:Compileaprofileofthecurrentstateofthefacilityusingmethodssuchaswalkthroughaudits(seeSection13onconductingaudits),groupdiscussionsandstaffself‑reportquestionnaires.Topicstobereviewedincludemovingandhandlingpolicies,staffandclientneeds,equipmentuse,workflowanalysis(includinganytime‑and‑motionstudiesandstaffingandresidentprofiles)andthestateofcurrentfacilitiessuchasworkspaces,roomlayout,accesswaysandstorage.
• Simulations:Itisstrongly recommendedthatmock‑upsofphysicallayoutsbeusedtoassesswhetherplannedspacesareadequate.Onewayofdoingthisistouseatapedlayoutonanemptyfloorspacesothatallstaffworkinginthatareacantrialtheworktasksthatwillbehappening.
Oncetheinformationhasbeengatheredandcollated,prepareafacilityreportsothattheprojectgroupcanreviewthefindingsanddecideifmoreinformationisneeded.Oncethereviewiscomplete,seniormanagementshouldappointkeypeoplefromtheworkinggrouptodevelopthedesignbrief,preferablyincludingorconsultingamovingandhandlingcoordinator.Thebriefsetsspecificationsforworkspaces,layouts,accessways,fixtures,fittingsandotherfeatures.Theprojectplanmayneedupdatingatthis point.
Step 4 Facility design
Therewillusuallybeseveraldesignstages,frominitialconceptstofinishedplans.Itisimportantthatkeypeopleareconsultedateachstage.Themovingandhandlingcoordinatorwillensurethatthedesignis‘userfriendly’andpromoteslow‑riskclienthandlingpractices.Staffshouldbeaskedforfeedback,astheywillprovidepracticalviewsbasedontheirexperienceofmovingandhandlingoperations.
Step 5 Implementation of facility building or upgrade
Thisstepinvolvesgainingapprovalsandbudgets,obtainingpricesortenders,commissioningthework,andmonitoringprogresstoensuretheworkiscarriedoutto specifications.
Step 6 Commission report and ongoing review
Oncetheprojecthasbeencompletedandpriortofacilityuse,thereshouldbeaclosingreportthatrecordstheprogressoftheproject,listinganyproblems,deviationsfromplanandresolutions.Oncethishasbeenarchiveditcanbeused
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asaguideforfutureprojectsasa‘lessonslearned’document.Ongoingandregularreviewsoffacilitiesareneeded.Informationtoassistthisprocesscanbeobtainedfromresourcessuchastheaudittool,staffquestionnaireandworkplaceprofile–seeSections12and13intheseGuidelinesformoredetails.Regularreviewsoffacilitiesandidentifyingsafetyissuesarecriticalpartsoftheriskassessmentprocessandshouldbedoneatleastonceayear.Addressingissuesandupgradingfacilitiesshouldbepartoftheprocessofcontinuingqualityimprovement.
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9.4 Ceiling tracking and hoistsOneofthemostimportantdesignfeaturestoincludeinallnewbuildingprojectsandrenovationsistheinstallationofceilingtracking,whichallowstheuseofceiling‑mountedhoists.Ceilinghoistsfacilitatemovingandhandlingandsavespace.Ceilingtrackingcanalsoberetrofittedtoexistingfacilities.Asaminimumfornewbuildings,ensurethattheceilingstructureissufficientlystrongtoallowlaterfittingofceilingtrackingandhoistswhenfundsareavailable.
Ceilinghoistssupportverticalandlateraltransferswithminimalmanualeffortbycarers.Thehoistsoperatefromceiling‑mountedtrackingandmostarebatteryoperated.Theyallowtheliftingandtransferofpeopleinslingswithinareascoveredbythetrack.
Researchhasshownthattheinstallationofceilinghoistsleadstosignificantreductionsinmusculoskeletalinjuriesandphysicalstresstocarers.6Italsoincreasessafetyforclients.Paybackperiods(basedonreturnsoninvestmentthroughreducedinjuriesandabsenteeism)forceilinghoistsvaryfromlessthanayeartothreeyears,dependingontheequipmentpurchasedandtheextentoftrainingprovided.Injuryreductionratesof58%to72%havebeenachievedwithinonetothreeyears.7
• Specificadvantagesandfeaturesofceilinghoistsare:
• Ceilinghoistsrequirefewercarerstocarryouttransfertasksandtakelesstimetousethanmobilehoists
• Ceilinghoistscanbeeffectiveforenvironmentsthatareproblematicformobilehoists,suchasrestrictedspacesandspaceswithcarpetedfloors
• Theycanreducetheneedforotherstructuralchangesrequiredinaclient’shome,suchasdoorwaysandbathrooms
• Theinitialcostsofceilinghoistsaretypicallymorethanthoseofothertransfermethods–theyaremostcosteffectivewheninstalledinnewbuildings
• Transfersbyceilinghoistcanonlybeprovidedintheareaswithtracks installed.
Layout options for ceiling tracking
Therearemultipledesignsforceilingtracksystems–singleandmultipletracksystems,andstraight,angled,curvedandmultidirectionaltracksystems.Thetypeofceilingtracksystemselectedwilldependonthetypesofuseintended.Forsingle
6. Jung&Bridge,2009.7. CeilingHoists,WorkplaceHealthandSafety,Queensland(Australia).Retrieved7January2011fromwww.deir.qld.gov.au/workplace/subjects/
ceilinghoists/index.htm.
Ceiling tracking with hoist
figure 9.1
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rooms,straighttrackingmaybetheeasiesttoinstall.However,itsmajorlimitationisthatitonlyallowstheliftingandmovementofclientsinastraightline.Addingcurvedsectionsoftrackingallowsincreasedcoverageandrepositioningflexibility,especiallyinbathrooms(seeFigure9.2).Innewdesignswherethebedandtoiletlocationsareknown,itmaybepossibletoorganiseastraighttrackfromneartheheadendofthebedtothetoiletbyappropriatepositioningofthedoorway.Thiscanresultinsignificantcostsavings.
Themostversatiletrackingsystemisaparalleltrackingpatterncalledthe‘XY’system,whichprovidesfullroomcoverage.Withthissystemaclientcanbemovedanywhereintheroom.TheXYsystemhastwostraightsectionsoftrackoneachsideoftheroom,paralleltoeachother,withanothertrackjoiningthetwo.Thejoiningtrackcanslidealongthetwoparalleltracks.
Morecomplextracksystemsareavailableforhealthcarefacilitieswheretransfersbetweenrooms,suchasbedroomtotoilet,arerequired.Forexample,‘gates’(fortransitbetweentwoadjacenttracksystems)and‘turntables’(whichallowmovingfromonetracktoanotherattrackjunctions)canalsobefittedtoincreasetheversatilityofceilingtrackingsystems.MoreinformationaboutthetypesofceilinghoistusedwithceilingtrackingisprovidedinSection7Equipmentformovingandhandlingpeople.
Designing for ceiling tracking and hoists
Ceiling support structures:Aprimarydesignfeatureistoensurethattheceilingsupportstructureisadequatefortheadditionalloadsimposedbyaceilingtrackingsystemandhoist(seeBox9.4).Manyceilingtrackingsystemswithhoistshaveasafeworkingload(SWL–weightofpersonlifted)of200kilogramsand270kg.AdditionalsystemsareavailablethathaveSWLcapacitiesof363kgand454kg.Thefollowingdesignspecificationsarerecommended:
1. Fornewinstallations,therecommendedminimumSWLforthehoistshouldbe 270kg
2. Boththetrackingandtheceilingsupportstructuresshouldbeabletosupport1.5timestheSWLforaperiodof20minutes
3. Whereceilinghoisttrackscouldbesubjecttomorethanonehoistloadingatatime,engineeringapprovalmustbeobtained
4. Duringinstallation,allceilingtrackingmustbeclearlylabelledwiththeSWLatregularintervalsalongthetracking
5. Iftheinitialdesigndoesnotprovideforhoists,everyattemptshouldbemadetoprovideadesignthatmaximisestheopportunityforfuturehoistandtrack
Example of curved ceiling tracking in bathroom
figure 9.2
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installation(e.g.avoidtheinstallationoffalseceilingsorservicesabovewheretracksmaygointhefuture).
Box 9.4
Australasian Health Facility Guidelines: Ceiling tracking
TheAustralasian Health Facility Guidelines(AUSHFG2009)notethefollowingdesignspecificationsforceilingtracking:
501441Roomswithceilingmountedequipment,suchasX‑RayRoomsandOperatingRoomsorotherroomswhereceiling‑mountedpatientliftingdevicesarefittedmayrequireincreasedceilingheights.Heightsshouldcomplywithequipmentmanufacturers’recommendations.Themostcommonceilingheightinsuchareasis3000mm.(AUSHFG2009pp.851‑852)
501444Reinforcementoftheceilingsupportstructureshouldbeprovidedforoverheadpatienthoistswhereinstalled.Thisshouldbenotedintheprojectbrief.Inaddition,informationprovidedbyequipmentmanufacturersshouldbereviewedintermsoftheneedsofparticularitemsofequipmentforpassagethroughfullheightdooropeningse.g.toensuitebathrooms;orthatmayaffectthepositioningofbedscreentracksorothersuchfixturesinmultiple‑bedrooms.
Ceiling heights:Forceilingheights,allowing3,000mminnewbuildingsprovides dequatespaceforceilingtrackingandscreeningcurtaintracking.Specifyingadoorwayheightthatextendstotheceilingwillassistintheplacementofceilingtrackingtoconnectrooms.
Doorways:Typicaltransfertasksoccurbetweenrooms,soceilingtrackingneedstogoacrossrooms,throughdoorwaysandintoadjacentareassuchasbathrooms.Usuallyfull‑heightdoorwaysshouldbespecifiedwhenceilingtrackingistobeinstalled.
Screening curtains:Whenscreeningcurtainsareusedinconjunctionwithceilingtracking,specificplanningisneededduringcurtaintrackinginstallation.Curtaintrackingistypicallyinstalledbelowceilingtrackingandlocatedsothatscreeningcurtainscanbepulledclearoftheceilingtrackingandceilinghoists.However,someceilingtrackingsystemsallowcurtaintrackingtobeplacedaboveceilingtracking.Thereareseveraloptionsforcurtaintrackingthataredesignedtobecompatiblewithceilingtracking.
Figure9.4showsasuggestedconfigurationforceilingtrackingandcurtaintracksforaroomwithmultiplebedsandadjacentensuitebathroom.Ceilingtrackingandhoistsshouldreachwithin1000mmoftheheadsofbeds.
Example of curved ceiling tracking in bathroom
figure 9.3
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Figure 9.4
Example of ceiling and curtain tracking in rooms with multiple beds
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Section 9: facility design and upgrading
9.5 Access design featuresCorridorwidths,doorwidths,flooringandhandrailfeaturesaffectaccessforstaffandclientsbetweenthevariousfunctionalareasofahealthcarefacility.Thissectionrecommendssuitabledimensionsforaccesswaysandturningandpassingspaces,withdrawingsshowingsuggesteddesigndetails.Themovementofclientsrequiresassistancefromcarers,whomayneedtouselargeequipmentsuchasbeds,trolleys,hoistsandwheelchairstotransferclients.Theuseofhandrails,grabrailsandlightingisalsocovered.
Corridors
Corridorsareexpensivetobuildandmaintain,sotheminimumwidthsrecommendedreflectabalancebetweenuserequirementsandcost.Themainconsiderationsincludewherethecorridorislocated,frequencyofusebystaffandclientsandequipmentthatisused(suchasbeds,trolleys,wheelchairsandhoists).
• Major corridorsarehigh‑usecorridorswheretheunrestrictedmovementofclientsisimportant.Theyareusuallyemergencyevacuationroutesandhigh‑frequency‑usecorridors.
Minimum clearance widths for corridors
Major corridors need adequate clearance widths
figure 9.5 figure 9.6
• Regular corridorsneedclearpassagesforassistedclientmovementsandmaybelower‑frequency‑usecorridors.
Therecommendedminimumwidthsdescribedbelowallowstafftomoveclientsduringtheirnormaldailytasks,aswellasduringemergencyevacuations.Thesewidthsmustbeclearandunobstructed.Fixedandportableitemssuchashandrails,basins,trolleysandfurnitureshouldnotbeplacedwheretheyreducetheclearwidth–oradditionalspaceshouldbeprovidedfortheseitems.
• 2,200mmclearwidthformajorcorridorssuchasinterdepartmentalandpublic routes.
• 1,800mmclearwidthforregularcorridorswhereclientsmaybemovedinlargeequipment(suchasbeds)andwherepassingisrequired,andcorridorswithin
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wardswhereclientsaremovedwithlargeequipmentitemsandareoftenassistedbycarers.
Corridorsneedtocomplywiththerelevantbuildingcodes.8
Floor spaces for passing and turning
Thewidthsforcorridorsalsoapplytospaceswherepassingorturningclientsinwheelchairsislikely,orwhenusingotherlargeequipment.Thewidthsspecifiedrefertoclearspacesbetweenhandrailsandanyotherfixtures.Widthsforthesespacesarelistedbelow.
Forclientbeds,theminimumpassingspacesare:
• 2,200mmminimumclearwidthforbedpassing
• 1,800mmminimumclearwidthforotherpassing–thisincludespassingspaces forclientsassistedbycarersandforlargeclienthandlingequipment,includingmobilehoists,mobilesittostandhoists,wheelchairs,commodechairsand trolleys.
Minimum turning spaces
Forturningwheelchairs,commodechairsandwalkingframes:
• 1,800mmminimumturningcirclediameterspaceforcarerstorotatechairswithclients
• 1,500mmminimumturningcirclediameterspaceforpeopleusingself‑propelledchairsandwalking frames.
Foracarertoturnabed,wheelchairorhoistthrough90°whenenteringorleavinga room:
• 1,800mmminimumwidthforturning beds
• 1,500mmminimumwidthforturningwheelchairsorhoists.
8. TheseincludetheBuilding Act (2004),theFireSafetyandAccessRouteprovisionsoftheBuilding Regulations (1992)andNZS4121Design for Access).
Bed passing space
figure 9.7
Turning circle for assisted and unassisted wheelchairs
figure 9.8
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Doorways
Therecommendationsprovidedrefertothedimensionsoftheclearspaceinthedoorwaywhenthedoorisfullyopen,andapplytobothswingingandslidingdoors.
Doorway height:Theminimumheightis2,030mmtoenableequipmenttopassthroughthedoorway.
Doorway width:Forcorridors,theminimumdooropeningwidthis1,800mm(doubleopeningswingingdoorswitha900‑900mmsplit).
Forbedroomsandotherroomsusedbyclients,theminimumdooropeningwidthis1500mm(doubleopeningswingingdoors,forexamplewitha1,050–1,450mmsplit;seeFigure9.10)wherelargeequipmentmaypassthrough.
Fortoilets, showers and bathrooms,theminimumdooropeningwidthis1,200mm.Slidingandswingingdoorsareacceptable.Doorsshouldnotswingintotoilets.
Inotheraspects,dooropeningsneedtocomplywithNZS4121Design for Access.
Flooring
Choosingfloorcoveringsthatmeettheneedsofstaff,clientsandmanagerscanbechallengingfornewandrenovatedfacilities.Floorcoveringsneedtobe:
• Safeforstaffandclients
• Comfortableforclientsandstaff
• Functionalfromacleaningandmaintenanceperspective.
Somecommonrisksrelatingtofloorcoveringsinhealthworkplacesincludestrainsandinjuriescausedbymanoeuvringwheeledequipmentandinjuriesfromslips,tripsandfalls.Somesoftfloorcoverings(e.g.carpet)candoubletheforcesrequiredformanoeuvringmobilehoistscomparedwithhardsurfacessuchasvinyl.Smalllipsorjoinsbetweendifferentfloorcoveringscanincreasetheforcesrequiredtomanoeuvrewheeledequipmentsuchasmobilehoistsbetweenrooms.
Ensure adequate doorway widths
figure 9.9
Door opening 1500mm width with 1,050–1,450mm split
figure 9.10
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Wherecarersaremovingandhandlingclients,somerecommendationsforflooringare:
• Floorcoveringsshouldbetightlyfittedtoavoidtriphazards
• Jointsinfloormaterialsmustbepermanentlysealedtoavoidgapsandlooseedgesthatcouldcausetrippingorrestrictthemovementofclienthandlingequipment.Jointsshouldbelevelwiththemainfloortoavoidbeingobstaclesforwheeledequipment
• Wherewheeledclienthandlingequipmentisused,selecthardfloorcoveringssuchasvinylinsteadofcarpettomakemovingequipmenteasier
• Ensureedgingstripsinflooringarebevelledandnotmorethan10mmabovethefloor.9
Forwetareas,makesuretheflooringisnon‑slipwhenwet.Slopethefloorfourwayswithaminimumfallofatleast1:50tostopwaterpooling.Laptheflooringupshowerwallsatleast150mm,andupthewallsofdressingareasatleast75‑100mmtoavoid leaks.
FloorsshouldcomplywithfiresafetyrequirementsandtherelevantAustralianandNew Zealandstandardsforslipresistance.10
Ramps
Rampsareusedinmanyhealthcareandresidentialcarefacilitiesaswellasinprivatehomes.Asageneralrule,rampspresentsignificanthazardstocarersandpeopleinmanualwheelchairsbecauseoftheforcesrequiredtopushwheeledequipmentupthem.Rampsalsopresenthazardstobothcarersandclientswhenmanoeuvringwheeledequipmentdownthem.Acurrentdesignviewistoavoidrampsifpossiblebecauseofthepotentialhazardstheycreate.However,avoidingrampsmaynotbefeasibleinsomeprivatehomes.
Iframpsareinuseandcannotberemoved,severalcriteriaarerelevanttodecreasingthehazardsrampscreate.Asageneralrule,thesteeperrampsare,themorehazardoustheybecome.Manydesignstandardsspecifyapreferredgradientof1:14forpeoplewithdisabilitiesandamaximumgradientof1:10(5.7°).Rampswithgradientsgreaterthan1:8(7.12°)aredifficulttousebyelderlyanddisabledpeople.Evenwithgradientsthatarenottoophysicallydemanding,landingsarenecessaryasrestingplaces.Moststandardslimitthedistanceoframpsbetweenlandingstoaround 9,000mm.11
Rampflooringshouldbeofnon‑slipmaterial.Outsiderampsthatcangetwetrequirespecialconsiderationforflooring.
9. SeeWorkSafeVictoria(2007,pp.35‑44)formoreinformationonflooring.10. ThesestandardsincludeAS/NZS4586‑2004andAS/NZS4663‑2004–seeAustralian/New ZealandStandards,2004aand2004binthe
referencelist.11. SeeTempler(1992,p.44)foradetaileddiscussionoframpdesign.
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Handrails
Handrailsorgrabrailsshouldbeprovidedinmultiplelocations,suchasbathroomsandotherspaces,forsemi‑mobileclients.Ahandrailisusedforgeneralsupportandmayoccasionallytakeaclient’sfullweightiftheytriporfall.Anexampleishandrailsalongthesidesofcorridors.AllhandrailsandgrabrailsshouldhaveknownSWLsandtheseshouldbevisiblewhereappropriate,suchasongrabrailsbesidetoilets.
Agrabrailprovidesstrongersupportthanahandrail.Itcantakeaclient’sfullweightduringhandlingoperations;forinstance,acombinedhorizontal/verticalgrabrailfittedadjacenttoatoiletcanhelpaclienttostand.12Grabrailsinareasusedbybariatricclientsmayneedwallswithadditionalload‑bearingcapacity.
12. StandardsforhandrailandgrabraildesignsareinNZS4121Design for Access–seeNew ZealandStandards,2001.
Fit handrails and grab rails where needed
figure 9.11
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9.6 Client handling areasThedesignofallhealthcarefacilitiesshouldenableindependentmobilitybyclientsandallowcarerstoworkwithclientsinwaysthatreduceriskstoclientsandcarers.Effectivemovingandhandlingplacesadditionaldesignrequirementsonfacilities.Extraspaceisneededforcarerstoworkalongsideclientsandtoallowsuitableequipmenttobeused.Howmuchextraspaceisneededdependsonthenumberofcarersrequired,thelevelofmobilityofclients,theequipmentbeingusedandthespecifictechniquesusedtomoveclients,andpossiblechangesintheprofilesofclientsinthefacilityorunit.
Themainareaswheremovingandhandlingtaskstakeplacearebedrooms,bathrooms(includingtoilets,showersandbaths),corridors,dayrooms,diningroomsandclinicalsuites.Eachonehasspecialrequirements.Inthissection,suggestedlayoutsandfittingsforeachtypeofroomareprovided.Akeydesignfeaturethatshouldbeconsideredearlyinthedesignprocessistheinstallationofceilingtrackingtoallowtheuseofceilinghoists.
Bedrooms
Theareasadjacenttobedsneedtoallowcarerstouseeffectiveworkingposturestocarryouthandlingtechniques.Thereshouldalsobesufficientclearspacetoallowmovingandhandlingequipment,suchasmobilehoistsandwheelchairs,tobeused.
Accessspaceshouldbeprovidedsothatequipmentsuchasmobilehoistscanbemovedfreelybetweenbedsanddoorways.Keepfurnitureoutoftheseareas,orensurethatitiseasytomove.Ifhandbasinsorotherfixturesaretobeinstalled,spaceshouldbeaddedtoallowsufficientclearspaceformovingandhandling.
Dimensions for bedrooms
Thefollowingclearspacesarerequiredformovingandhandlingandapplytoatypicalbedthatis2,200mmlongby1,000mmwide.Theseclearspacesareconsistentwiththerecommendationsmadeinareviewofbedspacesforclientsreceivinghealthcare.13
• 1,200mmclearspaceoneachsideofthebedsothatcarerscanworkwithequipmentitemssuchasmobilehoists.Ceilingtrackhoistsandwheelchairsneedlessspacethanthis,butallowing1200mmenablesmosttransfertaskstobeperformedeffectively
• 1,500mmclearspacebesidethebedwherestandinghoistsandbedtotrolleytransfersmayberequired14
• 1,200mmclearspaceatthefootofthebedsothatequipmentcanbemovedfromthebedtothedoor.Thisallowsahoisttobepositionedandaclienttobetransferredtoachairatthefootofthebed.
13. SeeHignett&Lu,2010.14. SeeWorkSafeVictoria,2007,pp.46and47.
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Furniture in bedrooms
• Bedsshouldbeheightadjustablesothatmovingandhandlingtaskscanbecarriedoutatthecorrectworkingheight
• Bedsshouldhaveanunder‑bedclearanceofatleast150mmtoaccommodatemobilehoists
• Bedsshouldbeoncastorssothatcarerscanmovethebedstocreateextraspaceifneeded
• Providechairswitharmreststohelpclientsstandup
• Providefurnitureoncastorssothatitiseasyforcarerstomoveittoallowspaceforlargemovingandhandlingequipment
• Ifreclinerchairsareused,theyshouldbeelectricandhaveeasy‑to‑cleansurfacessuchasvinyl.
General features for bedrooms and other client areas
• Provideastaffcallingsysteminasmanylocationsaspossibleandwithineasyreachofclients,sothatclientsandcarerscancallforhelpifnecessary.Thesystemactivationlightshouldoperatesothatitcanonlybecancelledattheactivationpoint
• Havesufficientelectricaloutletsinclientareassothatpowercordsdonotneedtocrossaccessways.Itisrecommendedthattherebeadoublegeneralpoweroutletundereachbedandanotheronasidewall(e.g.underawindow)forelectricarmchairs
• Wherefeasibletoinstall,slidingdoorsallowmoreeffectiveuseofspace.
Single bedrooms
Figure9.12showsanexampleofasingle‑roomlayout.Inthisexample,toprovidefor1,200mmclearspaceoneachsideofthebed,theminimumbedroomdimensionsshouldbe4000mmwidetoallowforfixedwallfittingsandfurnitureononeside,and3,400mmdeep.
Fortransfersfromabedtoatrolleyusingatransferboard,thereneedstobeatleasta1,200mmclearareabesidethetrolley,sothatthecarercanadoptasafeworkingposture.Providingfor1,200mmoneachsideofthebedallowslargerspacesforbedtotrolleytransfersifthebedispushedtooneside.
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Figure 9.12
Example of a single‑room layout
Rooms with two or more beds
Theminimumspacerecommendationsforsingleroomscanbeusedasaguideforroomswithmultiplebeds(seeFigure9.13).Inbedroomswithmultiplebeds,thereshouldbeminimumclearspacesof2,400mmbetweenbedsthataresidetosideand2,400mmbetweenbedsthatareendtoend.Itisassumedthatthetypicalbedsizeis2,200mmlongby1000mmwide.Thesedimensionsmayneedtobelargerforbedswithadditionalequipmentandaccessoriesattached.
For beds that are side by side
• 3,400mmbetweenbedcentrelines
• Allowatleast1,200mmbetweenthebedandthescreeningcurtainforuseofequipmentwithintheprivacycurtain.Ifceilingtrackhoistsareinstalled,allowing1,000mmbetweenthebedandcurtainenablesclientmovementstobeperformedeffectively
• 1,200mmclearancebetweenthefootendofthebedandtheprivacycurtain.
• 900mm‑widecorridorspaceoutsidetheprivacycurtainattheendofthebedforaccessbetweenthebedandthedoor.
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For beds that are end to end
• 2,400mmclearancebetweenbedfootends
• 1,200mmclearancebetweenthefootofthebedandtheprivacycurtain
• 900mm‑widecorridorbetweenprivacycurtainsforaccesstodoorwhenprivacycurtainsareused.
Figure 9.13
Example of a room layout with four beds
Bathrooms, toilets and showers
Thelayoutsforbathroomswilldependonthespecificneedsofthefacility.Thetextbelowdescribeslayoutsforbothseparatefacilities,inwhichtoilets,showersandbathsareinseparaterooms,andcombinedfacilitiessuchasensuitebathrooms,wheretoiletsandshowersareprovidedinthesameroom.Thegenerallayoutprinciplesforseparatetoiletsandshowerscanbeadaptedwherethesefacilitiesarelocatedinasingleroom.
Toilet spaces
Toiletsneedadequatespacearoundtoiletbowlsandsinks,plusclearpassagestoallowcarerstoassistclientsanduselargeequipmentifneeded.Formultiple‑bedfacilities,atleastoneall‑genderaccessibletoiletshouldbeprovidedineachward
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orunit.AcommondesignerrorinNew Zealandhealthfacilitiesistoplacetoiletsincornersofbathrooms,withthebacksofthetoiletstooclosetothewalls.
Theamountofspacerequireddependsonhowmanycarersareinvolvedandtheequipmentused.Movingandhandlingactivitiesandequipmentintoiletsincludetransfersfromawheelchairorcommodechair(eithersideonorfronton),clientswalkingwithframes,andstandinghoists.
Figure9.14givesthetypicalspacesthatwouldbeadequateforatoiletinahealthcarefacility.Forroomswithasingletoiletandforensuitebathrooms,theminimumrecommendeddimensionsrequiredforcarersandequipmentare:
• Dooropening:minimum1,200mmclearwidth
• Depthofroom:minimum2,200mmfromdooropening
• 1,500mmclearspaceinfrontoftoilettoallowforequipmentfortoilet transfers.
Figure 9.14
Toilet plan allowing space for carers and equipment
Fordoorsintoensuiteandotherbathrooms,considerationcouldbegiventohavingcornerswithtwoslidingdoorssothattheentirecornerscanbeopenedforaccess.
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Forspacebetweenthetoiletbowlandwall:
• Thefrontofthetoiletseatneedstobe700‑750mmfromthebackwall
• Fortwocarers,thereneedstobeatleast950mmoneachsidefromthetoiletbowlcentre,plus200mmononesideforindependentdisabledsidetransfers
• Infacilitieswithmostlymobileresidents,itmaybeadequatetoprovideforonecarerwithatleast950mmononesideand450mmontheothersidefromthetoiletbowlcentre,plus200mmforindependentdisabledsidetransfers.
Anotherdesignalternativefortoiletspaceistoanglethewallandthetoiletpedestaltoprovidespaceoneachsideofthetoilet(seeFigure9.16).Thiscanbeacost‑effectiveoptionforsmalltoiletareas.
Toilet fittings:Astableandsecuretoiletseatisimportantasitmakesiteasytotransferpeople.Thetoiletbowlheightneedstoallowforequipmentthatmaybeused.Forexample,allowforacommodechairbeingusedoverthebowl.Inaunitthatprovidescareforbariatricclients,largetoiletseatsmaybeneeded.Infacilitiescaringforpeoplewithdementia,toiletseatsshouldbedifferentcoloursfromthepedestals.
Handrails:Handrailsorgrabrailsextendingfromthewalloneachsideofthetoiletcanhelppeopletomoveonandofftoilets.Horizontaldrop‑downgrabrails700mmfromthefloor,thatcanbefoldedaway,aremostsuitable(seeFigures9.15and9.17).
Basins:Whenpositioningbasins,thecentreofeachbasinshouldbeatleast400mmfromanyadjacentwall,sothatthebasincanbeusedbyaclientinachair.Allowaclearspaceofatleast800mmwideby1,200mmdeepinfrontofthebasinforwheelchairandequipmentaccess.Thereshouldbeaclearanceof50‑60mmbetweenthetapsandanyobstructionorwall.
Allowatleast675mmclearspaceunderthebasinforusebyaseatedclient(Figure9.17).Ensurepipesandwasteoutletsdonotobstructthespaceunderthebasin.
Toilet with space for carers and equipment
figure 9.15
Angled toilet pedestal
Figure 9.16 Angled toilet pedestal
figure 9.16
Floor heights for toilets and basins
figure 9.17
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Shower rooms
Adequatespaceshouldbedesignedforshowerroomssothatcarerscanassistclientstoshower,dry,moveandtransfer,andtoallowaccessforlargeclienthandlingequipmentsuchaswheelchairsandcommodechairs.Thereshouldbenoplinth,raisededgesorotherobstaclesinashowerunitthatmaylimitwheelchairaccess.Allfloorsneedtobedesignedwithfallstostopwaterfrompooling,withincreasedfallsincurtained‑offshowercubicles.Thefloorsshouldhavenon‑slipfloormaterial.
Figure 9.18
Shower room with space for a shower trolley
Showerroomsneedenoughspaceforcarersandequipmentinbothwetanddryingareas(seeFigure9.18).
• Wetshowerareas:1,800mmby 1,000mm
• Dryingspace:1,800mmby1,800mmor2,200mmby2,200mmiflargemobileshowertrolleysareusedandforbariatricclients.
Mobileshowertrolleysvaryinsize,butareusually600‑750mmwideand1,500‑2,200mmlong.Thedryingspaceneedstobeatleast2,200mmby2,200mm
Shower room fittings
figure 9.19
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tomovemostshowertrolleysintoposition.Lessspacemaybeneededwhenusingsmallershowertrolleys.
Forshowerroomfittingsthefollowingfeaturesaredesirable(seeFigures9.18and 9.19):
• Ahingeddrop‑downseatintheshowercubiclethatisatleast600mmwidecanhelpclientswhoarepartiallymobile.Theseatcanbehingedoutofthewayforclientswhoarewalkingorusingcommodechairs.Adisadvantageisthathingedseatsrequireregularcleaningandmayimpedemobileshower trolleys
• Afixedgrabrailwithhorizontalandverticalarmsneartheshowerseatcanhelpclientstostand
• Theshowershouldhaveadetachable,height‑adjustableshowerheadandahoseatleast1,500mmlongclosetotheshowerseat.Ifashowertrolleyisused,thehoseneedstobeatleast2,000mmlong.
Combined shower and toilet rooms
Combinedshowerandtoiletroomscanbeusefultocarers,becausetheyprovideimmediateaccesstoatoiletifaclientneedsonewhileshowering.Aceilingtrackhoistwithacurvedsectionaroundthebathroomwillhelpcarerstomoveclientsbetweentheshowerandtoiletmoreeasily(seeFigure9.20).Therearemultipleoptionsforlayingoutacombinedshowerandtoiletroom.Itismostimportanttoallowadequatespaceinshoweringanddryingareassothatcarerscanuselargeequipmentif required.
Figure 9.20
Example of ceiling tracking through into bathroom
Figure9.21showstheminimumspacerequiredforthesingle‑doorwayoption.Ifacombinedshowerandtoiletroomissharedbetweenrooms,extraspacewillbeneededforanotherdoor.Thiscanbedonebyextendingtheroomlengthfrom2,700mmto3,350 mm.
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Figure 9.21
Combined shower and toilet room
TherecommendedrequirementsforcombinedshowerandtoiletroomfittingsareshowninFigure9.22.NZS4121Design for Accesshasfurtherinformationondesigningshowersandcombinedshowerandtoiletareasfordisabledpeople.
Figure 9.22
Fittings for combined shower and toilet room
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Rooms with baths
Asbathshavebeenlargelyreplacedbyshowers,fewbathsareinstalledinnewandrenovatedhealthcarefacilities.Ifabathisinstalled,therecommendeddimensionsforspaceareshowninFigure9.23.Wherefeasible,installceilingtracking.Ifceilingtrackingisnotavailable,allow1,200mmonbothsidesofthebathtomoveapersonfromawheelchairtothebathusingamobilehoist.Considermountingthebathonaplinth(300mmhigh),otherwisecarerscanfindbendingoverthebathstressfulontheirlumbarspines.Haveatleast150mmclearspaceunderneathsothatamobilehoistcanbepositionedoverthebath.Birthingpoolsneedceilingtrackingaboveforhandlingandemergencyevacuations.
Figure 9.23
Layout for a room with a bath
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Day and dining rooms
Fordayroomsanddiningrooms,Figure9.24showsthetypicalspacesneeded.Somekeypointsare:
• Allowadequatespacearoundchairsanddiningtablessothatclientsusingmobilityaidsandwheelchairscanaccessthefurnitureeasily
• Makesuretheaccessareabetweentheentrancedoorwayandseatingareasisatleast1,500mmwidesothatclientsandtheircarershavespacetomoveand pass
• Provideextraspaceforthetemporarystorageofequipment,suchaswalkingaidsandwheelchairs,whileitisnotbeingused.
Figure 9.24
Spaces needed around furniture in day rooms
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Clinical suites
Clinicalsuitesaretakentoincludemedicalimagingsuites,obstetricdeliverysuites,operatingsuitesandmortuaryandautopsysuites.Thelayoutofclinicalsuitesneedsspecialconsideration,asbedsmaybesurroundedbyequipmentandcannoteasilybemovedifmorespaceisneededforhandlingtasks.
Thefollowingarerecommendationsforclearareasandspacesrequiredforclinical suites:
• Allowa1,200mmspaceonbothsidesofthebedtoaccommodateclienthandlingequipmentandtransfertrolleys.Ifthisisnotpractical,700mmononesideofthebedand1,200mmontheothermaybesufficient–facilitiesforbariatricclientsshouldallow1,500mmonbothsidesofthebed
• Clinicalsuitesshouldhavedouble‑openingdoors.Doorwaysneedtobeatleast1,500mmwidetoallowforequipmentitems
• Thepathwayfromthedoortothemaincareareashouldbeatleast1,500mm wide
• Allowatleast1,200mmclearspaceatthefootofthebed
• Keepallequipmentawayfromclearspaces,orputequipmentoncastorstoallowittobemovedeasily.
Thespacesneededaroundbedsinpre‑andpost‑medicalroomsaresimilartothoserequiredaroundbedsintypicalunitsandbedroomsforclients.
Other client handling areas
Thereareseveralotherareasthatmayneedtobeincludedinthedesignofclienthandlingspaces.Theseincludeliftsinmulti‑storeybuildings,externalaccesstobuildingsandoutdoorareassuchasgardens.
Lifts:Keyelementstobeconsideredforliftdesigninclude:
• Dooropenings–ensurethewidthandheightaccommodatelargeequipmentandpeople
• Internaldimensions–allowforstafftostandoneithersideofabedortrolley
• Positionofliftcontrols–ensuretheyareeasytoreach
• Doorhold‑opentimes–allowtimeforthepositioningofequipmentand people
• Accuracyoflevellingbetweenliftfloorandexternalfloor–itshouldnotcreateatriphazard
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• Thehorizontalwidthofthegapbetweentheliftfloorandtheexternalfloors,relativetothediameterofthewheelsofmobileclienthandlingequipment,includingliftingmachinesandbeds–allowforsmoothmovement.15
External access to buildings:Considerbuildingaccessandexitpointsforpeopleandvehiclestoreduceclienthandlingandotherrisks.Forpedestrianaccess,staff,clientsandvisitorsneedeasyaccessfromcarparksandfrompublictransport.Mainentrancedoorsshouldbeuseablebyalltypesofmobilityequipment,includingwheelchairs,walkingframesandelectricscooters.Twospecificfeaturestoassistaccessareautomaticopeningdoorsandcoveredentrancesatgroundlevel.Enquiryorreceptionareasshouldbelocatedatmainentrancestoassistpeopleinwheelchairsandusingothermobilityequipment.
Whenplanningforvehicularaccess,identifythetypesofvehiclethatneedaccess.Thesemightincludeambulancesandotheremergencyvehicles,clientandstaffvehicles,funeralcarsandvehiclesusedbysuppliersofgoodsandservices.Planningforappropriatevehicleaccessneedstotakeintoaccountvehicleturningcircles.Vehicleaccesspointstobuildingsshouldbeseparatefromthemainpedestrianaccesspointstobuildings.Vehicleaccessareasshouldprovidesufficientspacefortheuseoflargeequipmentsuchaswheelchairs,stretchersandtrolleys.
Outdoor areas:Somefacilitiesprovideclientsandstaffwithaccesstooutdoorareassuchasgardensandcourtyards.Theseshouldfunctioneffectivelyfromstaffsafetyandqualityofcareperspectives.Inaged‑careandcommunitysettings,outdoorareasareimportantforthewellbeingandmobilityofclients.Asafeenvironmentforclientsincreasestheirmobilityandreducesthepotentialriskstoemployees.Ifadequatelydesigned,suchareashavehightherapeuticvalue,providingopportunitiesforwalking,recreationandsittingspace,particularlyforpeoplewithdementiaandthoseindisabilityhousing.
Carersmaybeinvolvedinthefollowingtasksinanoutdoorsetting:
• Pushingwheelchairsandotherequipment
• Assistingwithtransferstoandfromseating
• Assistingwalking
• Assistingclientsinvolvedinactivitiessuchasgardening.
Checkoutdoorenvironmentsforthefollowinghazardsthatmaycreaterisks:
• Accessdoorsthatpresentbarrierssuchasraisedsteps
• Pathsordoorsthataretoonarrow,notprovidingspaceforclientsandtheirmobilityequipmentandcarers
• Steepslopes,rampsandstairs,particularlyformobilityaidsandwheeled equipment
15. AdaptedfromWorkSafeVictoria,2007,p.32.
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• Unevenorroughgroundsurfacescausingtriphazardsandobstaclesforwheeledequipment
• Courtyardsthataretoosmallforthenumberofpeoplelikelytousethem
• Outdoorfurniturethatistoolowanddifficultforclientstogetintoandoutof
• Sharpfoliage,poisonousplantsandwaterdisplays,whichmaypresentriskstopeoplewithdementia.
Staff and client call systems
Providingstaffandclientcallsystemscanplayanimportantroleinthehandlingofclients,particularlyinemergencies.Duringtheplanningofnewbuildings,ensurethatadequatecallsystemsareinstalled.Duringrenovations,considerupgradingcallsystems.Planthelocationsofcallbuttonstofacilitateeaseofuseandreduceawkwardpostures.
Intoilets,wheredrop‑downgrabrailsareinstalledonbothsidesofatoilet,thecallbuttonshouldbeaccessiblewhetherthegrabrailisdownorfoldedaway.Twocallbuttonsmaybeneeded.
Inbedrooms,callbuttonsshouldbeaccessibleforuseoneithersideofthebedsandturn‑offswitchesshouldbelocatedwitheasyaccessforstaff.
Inshowers,callbuttonsmustbelocatedataheightthatisaccessiblebyapersonwhohasfallen.
Inclinicalandtreatmentrooms,callbuttonsshouldbelocatedsothattheyareeasilyidentifiableandaccessiblebystaffandclients.
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9.7 Equipment storageThenumberofstorageareas,andwheretheyarelocated,dependonthelayoutofthemainfacilityroomsandonthetypesofmovingandhandlingequipmentused.Somethingstoconsiderwhenplanningstorageareasare:
• Allowspaceforbothlargeandsmallitemsofequipment
• Storageareasneedtobelocatedinthewardorunit,within2,000mmofhandlingareasandwithin1,000mmofasupervisorstation
• Storageareasshouldnotblockorreduceaccessways
• Doorwaysshouldbeatleast1,200mmwideforstorageareasforlargeequipmentitemssuchasmobilehoists.
Formobileandstandinghoistsandotherbattery‑operatedequipment,itisimportanttoensurethatsuchequipmentisstoredclosetowhereitwillbeused.Ifitisstoredtoofaraway,carersmaybereluctanttousetheequipmentbecauseoftheincreasedtimetoaccessit.Suchequipmentshouldbeavailablewithin2,000mmofitsprimaryareaofuse.Apreferredoptionisdirectlyoffamaincorridorinarecessedalcovewithapowersupply.Anyequipmentaccessories,suchasslingsforhoists,mustbeinthesameplacetoreducethetimeneededtoaccesstheequipment.
Theamountofspaceneededforstoringequipmentdependsonwhatequipmentisneededandhowmanyitemsthereare.Workplaceprofilescanhelptoidentifystorage needs.16Althougheachwardorunitinalargefacilitymayhavesomewhatdifferentequipmentitems,standardisestorageareasasmuchaspossibleacrossunitsorwardssothatwhenstaffrotatetodifferentunitstheycanfindequipmenteasily.Designersandplannersshouldrefertoequipmentmanualsforspecificsize details.
Avoidusingstorageroomsforstoringdamagedequipment.Movingandhandlingequipmentshouldbewellmaintained,andrepairedorreplacedwhendamaged.
Storage layout
Thereareseveraloptionsforconfiguringstorageareassuchasastorageroomorrecessedbayinacorridor.Storagelayoutshouldprovideeasyaccesstotheequipmentbeingstored.Ensurethatequipmentstoragedoesnotobstructclearspacesincorridors.Storagedesignoptionsinclude:
Long,narrowstoreroomswithaislesdownthemiddleandspaceonthewallsforstoragearegenerallybetterthansquarestorerooms,whereitisoftenhardtoretrieveitemsnearthewallsasthemiddleoftheroomscanbecomeclutteredwithequipment
Storagebaysaccessiblefromthecorridorcanbeaneffectiveoptionforstorage,insteadofbuildingaroom
Shelvingthatisheightadjustableallowsforflexibilityintheitemstobestored.
16. Forresidentialcare,areasonablebenchmarkforequipmentstorageistoallowonesquaremetreperresident.
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9.8 Maintaining working spaces for client handlingAkeymaintenancetaskforstaffistoensurethatareasusedformovingandhandlingremainfreeofstoredfurnitureandotheritemsthatreducetheworkingspace.Ongoingroutinesshouldinvolvetheremovalofitemsthatimpedeclearspace.Suggestedproceduresarenotedbelow.
Bedrooms
• Keepclientbedroomstidyandfreeofclutter
• Createapermanentclearpassagefromthefootofthebedtothedoor,sothereisalwaysclearaccesstomoveequipmentfromthedoortothebed
• Insmallroomswherespaceisatapremium,attachcastorstothefurnituresothatitcanbeeasilymovedoutofthewayduringmovingandhandlingtasks.Forchairsorbedswithwheels,brakesshouldalsobefitted
• Makesurethatbedsareheightadjustable
• Makesurethatchairshavearmreststohelpclienttransfers
• Trytolocateclientswhoneedtousewheelchairsclosetodayanddiningroomstominimisethedistancetheyhavetotravel
• Provideplentyofelectricalsockets,topreventtrailingleads.
Toilets, showers and bathrooms
• Iftoiletsaresmall,inaccessibleanddifficultplacesinwhichtoperformclienthandlingtaskssafely,considerusingothertoiletingmethodssuchascommodes,pansandbottles.
• Iftheshowerorbathroomistoosmallandinaccessibleforlargemovingandhandlingequipment,considerbedbathinguntilanalternativeisfound,orusingashowerchairthatcanbepushedintotheshowerorbathroom
• Installgrabrailsintoilets,showersandbathroomstoencourageclientstostandandsitindependently.
Corridors and doors
• Checkthatcorridorsandaccessroutesarefreeofitemsthatrestrictminimumrecommendedwidths
• Ensurethatitemsarenotstoredbehinddoorsthatcanpreventthemfully opening
• Installcontinuoushandrailsalongcorridorsandstairs
• Ifthresholdsorstairsimpedewheeledequipment,fittemporaryrampstoeliminatetherisksassociatedwithliftingequipmentoverthresholds.
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9.9 Facility design for bariatric clientsHealthcareandotherfacilitiesprovidingcareforbariatricclientsneedtoprovideadequatespacesfortheseclients.Anyfacilitydesignshouldtakeintoaccountboththecurrentdemographicprofileofclientsandchangesthatmayoccurinthefuture.SuchplanningshouldtakeintoaccountSWLsandrequirementsforlargepeople.Planningforabariatricclient’sentrytoafacilitystartswithrampsandhandrailsatentrancestofacilitateaccesstothebuilding.Ensurethatbariatricwheelchairsareavailableandthatthefacility’smainentrancehassufficientclearance.Liftsshouldhaveadequatedoorclearanceandweightcapacity.17
Increaseddoorclearancesandstoragespacesarealsonecessarytoaccommodateoversizedwheelchairs,stretchers,trolleysandbeds,aswellasmobilehoists.Although1,500mmhasbeenrecommendedasthedesignstandardfordoorwaywidths,largerdoorwaywidthsmaybeneededfordiagnosticandtreatmentrooms,inpatientroomsandsurgicalsuitesinareaswherebariatricclientsaretreated.
Forclientrooms,increasethespaceforeachroombyapproximately10squaremetresabovethesizeofastandardroom,andprovidefora1,750mmclearancearoundbeds.Thisadditionalroomspaceisnecessaryforspecialisedequipmentsuchaswheelchairsandmobilehoists,aswellasforadditionalnursingstaffrequiredtocareforbariatricclients.Ifceilingtrackingisfittedintoareasforbariatriccare,ceilingsrequireadditionalsteelreinforcementtobedesignedintothestructure.
Inbathrooms,biggershowerstallsshouldfeatureheavy‑dutyhandbars.Otheroptionsforshowersaremultiplehandrails,largeseatsandhand‑heldshowerheads.Largetoiletseatsarealsoneeded.Toiletfixturesandsinksshouldbefloormounted,althoughcareshouldbetakenthatfloor‑mountedsinksdonotinterferewithwheelchairs.Bathroomsshouldbesizedtoallowforstaffassistanceontwosidesofclientsatthetoiletsandshowers,forcaseswherebothlargepeoplewillbetransferredandlargeequipmentisneeded.
17. PartsofthissectionwereadaptedfromWignall,2008.SeealsoCollignon,2008.
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9.10 Overview of upgrading facilitiesForfacilitieswithlimitedresources,andforhome‑basedcare,upgradingexistingfacilitiesisoftenthemostfeasibleoptiontomakeexistingworkspacessaferforbothclientsandcarers.Thispartprovidesanoverviewoffacilityupgrading,describestheassessmentsofexistingspacesaspartofplanningupgrades,andoutlinessomestrategiesforupgradingfacilities.
Inmanycasesitmaybefeasibletomodifyexistingbuildingsandspacestoallowmoreeffectivemovingandhandlingofclients.Forlargeorganisations,suchasfacilitiesoperatedbyDHBsandprivatehospitalswhereextensiverenovationsornewbuildingsarebeingplanned,thedesignfeaturescoveredearlierinthissectionmayprovetobemostrelevant.
Whereexistingfacilitiesposedifficultiesformovingandhandlingpeople,theupgradingoffacilitiesandspacesleadstoimprovementsinclientcareandcarerefficiency.Designimprovementsarelikelytodecreaseclientcarecostssubstantially,despitetheinitialset‑upcostsformodificationsandequipment.Forhomecareclients,itmaymeanthattheclientscanremainathomeratherthanmoveintomanagedcarefacilities.Itmayalsoreducethenumberofhomevisits,orthetimerequirementsofcarersmakinghomevisits.Estimatesofthepaybacktimefromthecostsoffacilityupgradingandmovingandhandlingequipmentrangefromtwotofour years.
Therearealsolikelytobeotherbenefits,suchasimprovementsinthequalityofcare,increasedcarermoraleanddecreasedassociatedcosts.Therearealsopotentialbenefitsforclients.Costsavingshavebeenestimatedtobeashighasfivetimestheupgradingandequipmentcosts,butmorecommonlyarearoundtwotimes.18
18. Cohenetal,2010,p.43.
Box 9.5
Example of building modifications reducing injury risks
Thecasedescribedbelowillustrateshowasimpleredesignofflooringreducedriskstostaffatafacilityin Australia.
‘WorkCoverNSWundertookastudytoinvestigateseriousshoulderinjuriesassociatedwithmovingaloadedmobileliftinghoistbetweenabedroomandanensuite.Thestudyfoundthatinjurieswerecausedbythehighforcesinvolvedinpushingthehoistoveraridgeinthefloor(anedgingstripbetweenthecarpetofthebedroomandthevinyloftheensuite).Duetothenarrowdoorwayintotheensuite(740mm)thestaffmemberneededtostopthehoistattheentranceandcarefullypullitthroughthedoortoavoidastrikingrisk.Theresultantpullforcemeasured44kg,whichexceededmaximumlimitsforinitialforcerecommendedbySnook.Redesignofthefloorcoveringstoensureflatjoinsbetweendifferentfloortypes,combinedwithawiderdoorway,wouldreducerisksforstaffmovingaloadedhoistfrombedroomtoensuite.’
Source:WorkSafeVictoria,2007,p.38
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ExamplesofdesignfeaturesthatmaybeincludedwhenupgradingfacilitiesareshowninTable9.3.
Table 9.3 Improving facility design and function in existing facilities
Type of facility development
Examples of design features for moving and handling people
Upgradinganexistingfacility Ceilingtrackinginstalled
Providingaccessformobilehoists
Installinghandrails
Doorwayswidened
Bathroomsre‑designed
Equipmentstorageareasadded
Specificmodificationstosmallunitsandhomes
Ceilingtrackinginstalled
Increasingspacetoaccommodateequipmentintoiletandshowerareas
Providingaccessformobilehoists
Providingrampstobypassstairs
Installinghandrails
Opportunitiesformodificationstobuildingsandfacilitiesmayalsoarisewhereahazardorotherproblemformovingandhandlingisidentified.Whenbuildingrenovationsareplannedforotherpurposes,therecanalsobeopportunitiestoincludechangestoimprovemovingandhandlingandreducehazardsandinjuryrisks.
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9.11 Assessing existing spaces for upgradingAkeyphaseinbuildingandfacilityrenovationsistocarryoutareviewandassessmentoftheexistingspacesintermsoftheirsuitabilityformovingandhandling.Themainfeaturesrelevanttoassessingexistingspacesforbuildingrenovationsarelikelytoinclude:
• Thecurrentmobilityprofileofclients
• Aninventoryofexistingmovingandhandlingequipment
• Whatadditionalequipmentisrequiredforimprovingclientmobilityandcarer safety
• Spacesrequiredformovingandhandling
• Modificationsneededtoexistingspaces
• Future‑proofingthefacilityforchangesintypesofclientorfacilityuse.
Client profile and renovations
InformationaboutassessingclientmobilityisincludedinSection3Riskassessment.Iftherenovationisforasingleclientlivingathome,theassessmentwillinclude:
• Thecurrentmobilityoftheclient
• Anychangesinclientmobilityorprofile
• Theextenttowhichcarerswillberequiredtoassisttheclient,andwhatequipmentwillbeneededforthat.
Itisalsousefultolookatthenumberandcostsofcarersneededcomparedwiththepotentialcostsofequipmentorrenovations.Sometimesitwillcostlesstoupgradefacilitiesandprocuresuitablemovingandhandlingequipment.
Forsmallandmediumfacilities,suchasthosecateringfor10‑20clients,aclientprofilewillbeneeded.Theclientprofileshouldinclude:
• Anassessmentofthemobilitystatusandcognitivestatusofclients
• Aninventoryofexistingmovingandhandlingequipment
• Possiblefuturepurchasesoracquisitionsofnewequipmentbasedonthemobilityprofileofclients.
DescriptionsofmovingandhandlingequipmentareincludedinSection7ofthese Guidelines.
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Client destination assessment
Oneapproachrecommendedforplanningspacesformovingandhandlingisdescribedasa‘clientdestinationassessment’.19Thisinvolvesidentifyingthedestinationpointsforclientstowhichtheyneedtobemoved.Therearetwotypesofclientdestinationpoints:
1. Thoseusedbycarerstoprovideclientcare
2. Thoseusedbyclientsforinvolvementinactivitiesandrelationshipsthatareimportanttothem.
Informationonthereasonsforclientmovementsandthedestinationstowhichclientsaremovedcanthenbeusedto:
• Identifyanychangesneededtospacestoensuretheyaresuitableforthetypesofequipmentneededformovingandhandling
• Developafacilityupgradedesignthatsupportstheequipmentneededandencouragesself‑mobilisationofclientstomaintainandimproveclient functioning
• Planthetypesofspacethatassistcarerefficiencybyreducingturnsandtraveldistancesalongtheroutestothemostfrequentdestinations
• Identifyfloorcoverings,handraillocationsandrestareasthatencourageboththeassistedmovementofclientsandclientself‑mobilisation.
Forspecificmedicalandresidentialcarefacilitiesitmaybeusefultodistinguishshort‑stay,acute‑careroomsandspacesfromlong‑stayresidents’roomsandspaces,bearinginmindthatthesemaychange.Onepracticalwaytocarryouttheassessmentistowalktheroutewiththeequipmentandclient,notingalltherisksanddifficultiesencounteredalongtheway.Identifyredesignsolutionsforeachofthehazardsandrisksencountered.Inlargefacilities,thefunctionsofroomsandspacesmaychangeconsiderably,sofutureproofingshouldbeconsidered.
Short‑stay, acute‑care rooms and spaces
Inshort‑staycarefacilities,suchasacute‑carehospitalsandrehabilitationfacilities,movementstospecificdestinationsusuallystartfromclients’rooms.Clientmovementsbetweenlocationsmaybebywheelchair,stretcherorhoist.Thefollowingdestinationsmayberelevantfortheassessmentprocess:
• Toilets
• Bathingandshoweringareas
• Changesinclients’roomsowingtochangesinacuityorpreparingforclient discharge
• Diagnosticandtestingareasforexamination
19. ThissectionhasbeenadaptedfromCohenetal,2010,p.35.
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• Surgicalsuites
• Therapyareasforgroupsupportandtherapy
• Lobby,cafeteria,vendingmachinesandoutdoorsforvisiting,exercise,foodandachangeofscenery.
Long‑term‑care resident rooms and spaces
Inlong‑stayclientfacilities,suchaschroniccarehospitalsandresidentialcarefacilities,thefollowingactivitiesmayrequiretransportbywheelchairorhoisttoparticulardestinations:
• Toiletinaprivateorsharedbathroom
• Bathingandshoweringinanadjacentroomorasharedfacility
• Dininginashareddiningarea
• Meetingplacesforresidentsandgroupssuchasfamily,friendsand organisations
• Exercisespacesthatmaybeoutdoors,exerciseroomsorgroupexercise spaces
• Examinationandtreatmentroomsandspaces
• Specialinterestactivities,suchascraftrooms,kitchenandchapel
• Socialising,suchastearoom,lounge,outdoorsandcorridors(bywalkingorassistedmovement)
• Therapy,suchasphysical,occupationalandspeechtherapyareas.
Modifications needed to existing spaces
Aspartoftheassessmentprocess,itisusefultoconsiderthespecifictypesofmodificationandfeaturethatmaybeneededtoreducehazardsformovingandhandling.Table9.4listssomeofthecommontypesofmodificationthatarelikelytoimprovemovingandhandlingoperations.
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Table 9.4 Examples of specific modifications to facilitate moving
and handling
Type of modification Purpose of modification
Doorwayswidened Improveaccessforwheelchairs,mobilehoistsandelectric beds
Doorsillsandstepsremovedor bypassed
Improveaccessforwheelchairs,mobilehoistsandwalking frames
Handrailsfitted Improvesafetyinbathrooms,showersandtoilets
Floorcoveringsorseparators changed
Improvemobilityforwheelchairsandmobilehoistsorimproveinfectioncontrol
Electricalwallplugsinstalled Accessforchargingbatteriesonmobilehoistsandwheelchairsorinstallingelectricbeds
Roomlayoutchanged Improveaccessforwheelchairs,mobilehoistsandelectric beds
Spacerequirementsformanoeuvringequipment
Providestoragespaceforequipment
Followingamovingandhandlingneedsassessment,specificmodificationsareplanned,whichincludedetailsofthechangesneededinthebuildingandclientspacestousetheequipmentrequiredformovingandhandling.
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9.12 Strategies for upgrading facilitiesThereisaseriesofstepsneededintheprocessforplanningandimplementingrenovationsinhealthcarefacilities(seeBox9.6).Thesestepscanbeadaptedtosuitthescopeandbudgetavailableforaspecificrenovationproject.
Forhousingmodifications,theMinistryofHealthprovidesdetailsaboutapplicationproceduresthroughthewebsite‘accessable’(www.accessable.co.nz).Italsoprovidesaprocessdocumentforcomplexhousingmodifications.20
Box 9.6
Example of steps for renovation of health facilities
1. Perceivingtheproblemsanddeterminingthattheyaresolvable
2. Appointingamedicalfacilitiesconsultantandabuildingdesigner(suchasanarchitect)
3. Assessingthefacilitiestoidentifypreciselytherenovationneeds
4. Prioritisingthefacilitiesandtheworktobedoneinthem
5. Establishingabudgetnotonlytocoverthecostsfortheproposedrenovationsbutalsoforunanticipatedworkthatarisesduringthe renovations
6. Agreeingwiththestakeholdersineachfacilityontherenovationsneeded
7. Developingdesignsandtechnicalspecificationswithcostestimates
8. Contractingtheconstructionworktoprivateagenciesoragovernment department
9. Supervisingtheconstructionandrespondingtounforeseenchanges
10.Confirmingthattheconstructionhasbeencarriedoutaswasdesignedand specified
11. Installingequipmentandcommissioning(startingtouse)therenovated space
12. Formalinaugurationofthefacility.
Source:Mavalankar&Abreu,2002,p.26
Aswellasthetechnicalfeaturesfornewbuildingdesignandbuildingrenovations,somekeystepstoincludewhenplanningbuildingrenovationsare:
• Theformationofaprojectplanninggrouptosteertheprojectandsolicitinputfromkeystaffandusergroups.Thisgroupshouldincludeamovingandhandlingspecialistandthehealthandsafetymanager.Foraclientlivingintheirownhome,theclient,familymembers,primarycarersandthebuildermayneedtomeettoputaplantogether
• Discussionswithmanagersandstaffregardingfeaturesneededforeffectivemovingandhandling,giventheclientprofileofthefacilityorunit
20. SeeMinistryofHealth,2008.
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• Theidentificationofspacesanddesignfeaturesintheexistingfacilitythatneedimprovement
• Thedevelopmentofthedraftplanforthenewfacility,oralistofchanges needed
• Communicationoftheconstructionscheduleortimetabletokeyusergroupspriortoandduringtheconstructionphase
• Thedevelopmentofaplanformaintainingservicesduringrenovations
• Planningapost‑occupancyreviewreportaftertherenovationshavebeencompletedandtheareaisfullyoperational.Thisreportshouldbearchivedandusedforfutureprojectsasaguideorreference.
Maintaining services during renovations
Undertakingamajorbuildingconstructionorrenovationprojectatahealthfacilityisachallengethatcanbefraughtwithunanticipatedeventsthatcandisruptservicesandhavemajorimpactsonstaffandclients.Forafacilityanditsassociatedservicestocontinuefunctioningadequatelyduringabuildingorrenovationproject,adetailedtransitionplanisneededtoallowstafftocontinuetodeliverqualitycareinanefficientmanner.
Manyprojectmanagersspendagreatdealoftimeonarchitecturalandconstructionplanning.Thetransitionalplanningforservicedeliverythatisessentialtoaproject’ssuccesscaneasilybeoverlooked,especiallyintermsofimpactsonclients,staffandothers.Failuretoplanfortransitionaloperationsduringarenovationprojectcanresultinsubstantialincreasesinstaffworkloads,delaysinscheduledservicedeliveryanddelaysintherenovationtimetable,allofwhichcancompromiseclientqualityof care.
Beforecompletingarenovationplanthatinvolvesbuildingmodifications,considertheinterimmovesandadjustmentsthatmayberequiredforthecontinuedoperationofunitsandservices.Oncetheconstructiontimetablehasbeenprepared,developadetailedplanofhowthefacility’sserviceswillfunctionduringeachstepoftheconstructionprocess.Whichroomswillbefunctionalduringeachphase?Whatequipmentwillbeoutofserviceduringeachphase?Whatcontingencyplans(suchasequipmentloansandrentals)areneededtomaintainfunctionality?Whatistheproject’simpactonclientadmissions,careanddischarges?Iftheclientislivingintheirownhome,dotheyneedtobemovedintosuitableaccommodationwhilerenovationsareinprogresstoenablethemtousethetoiletandshower?
Communicationisakeyaspectoftransitionarrangements.Renovationprojectsinvolvingmultipleunitsrequiredetailedplanningtoensureeffectivecommunicationwithallaffectedgroups.Disseminateadetailedmovesequenceforallunitsthatrequirerelocationpriortoconstructionstarting.Updatethesequenceduring
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constructionasneeded.Thiswillenablesupportservicesthatworkwiththeaffectedunitstoplanforthemoveaswell.
Somekeyissuestoconsiderforaservices’transitionplanare:
• Whataspectsoftheshiftfromtheexistingsystemtothecompletedrenovationswillbeconductedbyoutsidemovers,equipmentsuppliersandinternalstafforunits?
• How,whenandwherewillnewequipment,furniture,fittingsandsignagebeinstalled,inspectedandinventoried?
• Howwillcarersbetrainedintheuseandmaintenanceofthenewequipment?
• Howwillyoubriefstaffaboutthenewspace,equipmentandoperational systems?
• Howwillyounotifyclients,staffandfamiliesofthechanges?
Post‑occupancy review
Oncethebuildingmodificationshavebeencompletedandthenewpremisesoccupied,itisusefultocarryoutapost‑occupancyreview.Mostnewfacilitieshaveteethingproblems,suchaslackofsigns,fittingslocatedinthewrongpositions,andfeaturesthathavenotbeenfinishedproperly.
Whencarryingoutapost‑occupancyreview,developarunninglistofissues,encouragingallstafftocontribute.Conductaformalpost‑occupancyassessmentinvolvingbothusergroupsandthedesigners.Notepositiveandnegativeaspectsofthenewfacility,andnotewhichfeaturesneedpost‑occupancymodifications.Transferknowledgegainedtootherusergroupsanddesignprojects.Keystakeholdersshouldformallycontributetothereviewandarchivethereportforfuturereference.
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References and resourcesAustralasianHealthInfrastructureAlliance.(2009).Australasian Health Facility
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