RUDOLF M.

TAN

CRITICAL CARE
UNIT
CRITICAL CARE UNIT

Critical care unit is a specially designed and equipped facility staffed by

skilled personnel to provide effective and safe care for dependent
patients with a life-threatening problem.
Critical Care Unit (CCU) or an intensive care unit (ICU), also known as
an intensive therapy unit or intensive treatment unit (ITU), is a special
department of a hospital or health care facility that provides intensive
care medicine. CCU or ICU
CRITICAL CARE UNIT
The acronym CCU sometimes stands for a critical care unit. When used this
way, critical care and intensive care have the same meaning and offer the
same type of care. In this instance, CCU and ICU can be used
interchangeably.

In other hospitals, a CCU is a more specialized kind of unit, known as a

cardiac or coronary care unit. Let’s take a closer look at the care that’s
provided in this type of unit. These institutions will specifically designate
each CCU to their special service which that particular CCU provides
CRITICAL CARE UNIT

Critical Care Unit (CCU) or Intensive care units cater to patients with severe or life-
threatening illnesses and injuries, which require constant care, close supervision from life
support equipment and medication in order to ensure normal bodily functions. They are
staffed by highly trained physicians, nurses and respiratory therapists who specialize in
caring for critically ill patients. Critical Care Unit (CCU) or Intensive care units (ICU’s) are
also distinguished from general hospital wards by a higher staff-to-patient ratio and access
to advanced medical resources and equipment that is not routinely available elsewhere.
Common conditions that are treated within CCU or an ICU include acute respiratory
distress syndrome, septic shock, and other life-threatening conditions.
CRITICAL CARE UNIT
An CCU or an ICU is a special facility within a hospital that is dedicated to treating patients who are
critically ill. The patients may be experiencing multiple organ failure, respiratory arrest, or other
serious problems that require intensive monitoring. The staff are specially trained to administer
critical care, and there are sometimes several staffers assigned to each patient to ensure that
patients get the care they need.

Intensive care medicine focuses on the major systems of the body, including the cardiovascular
system, the gastrointestinal tract, the central nervous system, and the respiratory tract. Providers
try to keep these important bodily systems running smoothly so that the patient remains stable. As
the patient's underlying condition is treated, smoothly running bodily systems will greatly improve
the patient's prognosis. In a very unstable patient, CCU or an ICU care may require constant
adjustment of medications and treatment programs, along with a very focused and dedicated staff.
CRITICAL CARE UNIT
Patients may be referred directly from an emergency department or from a ward if they rapidly
deteriorate, or immediately after surgery if the surgery is very invasive and the patient is at high
risk of complications
Patients will be moved into an CCU or an ICU if it is clear that their conditions require constant and
careful monitoring and adjustment. There, the staff can quickly make decisions for their patients to
keep them comfortable and stable, and they have an extensive network of support staff and
specialized equipment to assist them in their important work. Intensive care may also be offered
to some patients after surgery, especially if the surgery has been traumatic or the patient is at risk
for complications.
CRITICAL CARE UNIT
A hospital may also call its ICU a Critical Care Unit, or CCU. It can be a scary place for visitors, since patients are
surrounded by an assortment of machines, and the environment can be very intimidating. In hospitals with
adequate staffing, a staffer will usually sit down with a patient's family to familiarize them with the environment,
and that staffer may act as a liaison to keep a family up to date on a patient's condition and to answer questions.
Families should be aware that the staffers are often very busy, and they may not be able to respond to questions or
concerns immediately; if a family member does not have a staff liaison to talk to, he or she should seek out the head
or charge nurse of the department to discuss any issues that need to be addressed.

Because these patients are critically ill, the death rate can sometimes be very high. Being committed to the CCU or
an ICU is far from a death sentence, however, and the prognosis of an individual patient varies immensely,
depending on his or her general condition and health problems. By installing a patient on an intensive care ward,
hospital staff can ensure that he or she gets the best care possible, with the best chance of a full recovery.
THE AIM OF THE CRITICAL CARE

• is to see that one provides a care such that patient

improves and survives the acute illness or tides over
the acute exacerbation of the chronic illness.
PURPOSE Of A CCU OR AN ICU
A CCU or an ICU may be designed and
equipped to provide care to patients with a
range of conditions, or it may be designed
and equipped to provide specialized care to
patients with specific conditions
What is a CCU or an ICU?
• An ICU is an intensive care unit. The ICU is where you’ll stay if you need 24-
hour critical care or life support.
• The healthcare providers who work in the ICU have extensive training in
intensive care medicine. Typically, each nurse will monitor only one or two
patients at a time.
• The average length of stay in the ICU for the people in this study was 3.4
days.
• The same study found that the use of mechanical ventilation in the ICU was
often associated with longer stays. The researchers found that longer stays,
with or without mechanical ventilation, were associated with higher 1 year
mortality.
TYPES OF CRITICAL CARE UNITS

• CICU or CVICU: cardiac, coronary, or cardiovascular

intensive care unit
• CCCU: critical cardiac, coronary, or cardiovascular unit
• ICCU: intensive cardiac, coronary, or cardiovascular care
unit
• CSRU: cardiac, coronary, or cardiovascular surgery recovery
unit
What are conditions considered as critical
Any person with life threatening condition Patients with:
• ARF
• AMI
• Cardiac Tamponade
• Severe Shock
• heart block
• acute renal failure
• Poly Trauma, Multiple Organ Failure And Organ Dysfunction
• Severe Burns
What types of health issues are managed in
a CCU or an ICU?
Admittance to an ICU means there’s a life-threatening event. You may need to be cared for in the
ICU if you:
• Have Had Major Surgery, Such As Brain Surgery, Open Heart Surgery, Coronary Bypass Surgery,
Or An Organ
• Transplant
• Have Experienced Major Trauma Such As A Head Injury Or Spinal Cord Injury
• Have Had A Heart Attack Or Stroke
• Have Serious Burns
• Can’t Breathe On Your Own
• Have Vital Organ Failure
• Have Life Threatening Complications Of Diabetes
• Have A Life-Threatening Infection
• Are In A Coma
TYPES OF CRITICAL CARE UNITS
ICUs can also be designated into more specific units such as:
• CICU or CVICU: cardiac, coronary, or cardiovascular intensive care unit
• MICU: Medical Intensive Care Unit
• MSICU: Medical Surgical Intensive Care Unit
• NICU: Neonatal Intensive Care Unit
• SCN: Special Care Nursery
• PICU: Pediatric Intensive Care Unit
• SICU: Surgical Intensive Care Unit
• TICU: Trauma Intensive Care Unit
• STICU: Surgical Trauma Intensive Care Unit
• CTICU: Cardiothoracic intensive care unit
• PICU: Psychiatric Intensive Unit
• CCU: Coronary Care Unit
• CSICU: Cardiac Surgery Intensive Care Unit
• CVICU: Cardiovascular Intensive Care Unit
HIGH DEPENDENCY CARE UNITS
• Coronary Care Units (CCU)
• Renal High Dependency Unit (HDU)
• Post operative Recovery Room
• Accident And Emergency Departments
(A&E)
• Intensive Care Units (ICU)
TYPES OF CRITICAL CARE UNIT
Overnight Intensive Recovery (OIR)
Neuroscience/Neurotrauma Intensive Care Unit (NICU)
Neuro Intensive Care Unit (NICU)
Burn Intensive Care Unit (BNICU)
Surgical Intensive Care Unit (SICU)
Trauma Intensive Care Unit (TICU)
Shock Trauma Intensive Care Unit (STICU)
Trauma Neuro Critical Care Intensive Care Unit (TNCC)
Respiratory Intensive Care Unit (RICU)
Geriatric Intensive Care Unit (GICU)
Classification of Critical Care Units

Level I
• Provides basic care and often intermittent monitoring
• Typically provides monitoring and observation and short-
term ventilation.
• Nurse patient ratio is normally 1:3
• Medical Staff are not present necessarily present at the
CCU all the time
Classification of Critical Care Units

Level II
• Provides continuous monitoring with the ability to provide
hemodynamic support and invasive monitoring
• Provides observation, monitoring and long-term ventilation
• Resident Doctors are always available
• Nurse patient ratio 1:2 and
• A Junior Medical is available at the unit all the time
• Consultant medical staff is available if needed
Classification of Critical Care Units

Level III
• Invasive ventilator support along with level 2 care modalities
• Provision of all aspects of intensive care which includes
o Hemodynamic monitoring
o Dialysis
• Nurse Patient ratio is at 1:1
Note that in some health care facility Level II and Level III care areas are
combined in a single facility the only difference will be the resources
available for the unit.
Critical Patient Classification
The four levels are:
• Level 0: normal acute ward care
• Level 1: clients are at risk of deterioration are placed in acute ward
care, with additional advice and support from the critical care team
• Level 2: Clients requiring more detailed observation or intervention.
Clients may have a single failing organ or post operative care.
• Level 3: Clients requiring advanced respiratory support, or basic
respiratory support together with support of at least two organ
systems and at risk for multiorgan failure.
7 C’s of Critical Care
• Compassion
• Communication
• Consideration – of others: patients, patients’ family, colleagues, and
other critical care team members and avoiding of conflicts
• Comfort – protection of patient from suffering
• Carefulness: avoidance of injury
• Consistency: observation and following of care protocols and
standards
• Closure: following Ethical standards of care, withdrawal of treatment:
DNR’s
Principles of Critical Care Nursing
• Anticipatory Nursing Care
• Early Detection and Prompt Action
• Expertise
• Supportive Care
• Communication
• Collaborative Practice
• Preservation of patient’s physiologic defenses
• Prevention of infection
• Crisis intervention
• Stress reduction
• Ethical principles
Anticipatory Nursing Care

Anticipatory Nursing Care – recognition of high-risk patients

and anticipate care requirements, possible complications and
preparedness in case of emergencies. A Critical Care Unit is
organized in such a way that all essential equipment and
supplies are available and accessible in case needed
Early Detection and Prompt Action

Early Detection and Prompt Action – the prognosis or outcome of care

rendered to the patient depends highly on the early detection of patient’s
symptoms and changes monitoring of patient changes particularly signs of
deterioration. Prompt and appropriate action preventing complication and
deterioration. Consistent monitoring following established and evidenced
based standards and doctors’ orders of vital functions such as cardiac and
respiratory are of high priority
Expertise

Expertise – the critical care nurse must possess communication skills,

interpersonal skills, decision making skills, problem solving skills,
observational skills, assessment skills, clinical skills, and critical
thinking skills in a level of expertise to perform the necessary tasks
confronted by a critical care nurse. must possess appropriate
knowledge, attributes and skills to effectively respond to the needs of
critically ill patients, to the demands of society, and to the challenges
of advancing technology.
Supportive Care

Supportive Care – the critical care nurse must be able to provide holistic
supportive care involving the patients psychosocial and spiritual needs, rest
and sleep alteration management, nutrition alteration management, pain
and pain management, end of life care issues and interventions and not
only focusing care on the pathophysiologic dimension of the patient. The
critical care nurse must also be able to provide supportive care to the
patient’s family members.
Communication
• Communication – the critical care nurse must possess communication skills. Critical care nurses
are in regular communication with various people, including patients, members of the healthcare
team, doctors, and family members of the patient. Additionally, ICU nurses must keep patient
reports and data up to date to inform other nurses of patient conditions. Intra professional, inter
departmental, and interpersonal communication has significant importance in the smooth
running of the critical care unit. The essentiality of the use of Collaborative practice
communication model is fundamental. The most important communication skills for nurses
working in the ICU include:
o Active listening
o Non-verbal communication
o Written communication
o Oral communication
o Presentation skills
o Patient education skills
Collaborative Practice

Collaborative Practice – Critical care, which was previously a

subspecialty has now evolved into a comprehensive discipline
which requires a special body of knowledge for the doctors and
nurses working in the critical unit which fosters a partnership for
decision making and ensuring quality and compassionate patient
care. Collaborative practice is now highly necessary in critical care.
Preservation of Patient’s Physiologic Defenses

Preservation of patient’s physiologic defenses – It is

imperative that the critical patient's status is monitored and
improved. Continuous provision of nutritional support and
prevention of infection and physiologic deterioration must
be employed. Improving patient prognosis is a priority and
a focus is keeping the client in optimal level of functioning
Prevention of infection
Prevention of infection – Nosocomial infection cost a lot in health care services.
Critically ill patients requiring intensive care are at a greater risk than other patients due
to their immunocompromised condition among the use of antibiotics, physical stress, use
of invasive lines, interventions and procedures, mechanical ventilator use, prolonged stay
and severity of illness and the general environment of the critical unit itself predisposes
the client to secondary and nosocomial infection.
It is imperative the critical care nurse must minimize if naot prevent any route where
infection may take place and monitors any symptom which may indicate infection and
prevent its progression.
Additionally, the CCU nurse must continue to support all physiologic defenses of the
patient to resist infection and prevent multiorgan failure thru supportive care and
management.
Crisis intervention Stress reduction
Crisis intervention Stress reduction – partnerships are
formulated during crisis. Bonds between nurses, patients and
families are stronger during hospitalization.
The nurse must become the patient advocate and assists the
patient and their family to express fear, allay confusion,
identify grieving patterns, support grieving process, and
provide avenues for positive coping.
Ethical Principles
• Ethical principles - The critical care nurse demonstrates the appropriate
application of knowledge in nursing practice, which complies with the code of
professional conduct, principles of autonomy, beneficence, and justice. The
critical care nurse must also accept personal responsibility for one’s own
professional judgments and actions as well as consequence of one’s behavior.
o The critical care nurse:
a.Has respect for patient / family rights including confidentiality
b.Conducts intensive care nursing practice and makes sound independent
clinical judgment in a way that can be ethically justified
c.Aware of the importance of open discussion with others about his/her own
views on ethical dilemmas
d.Reports all perceived unethical incidents to responsible person such as but
not limited to, responsible use of technology (clinical or administrative);
use of communication devices not related to clinical practice
e.Maintains professional decorum
Personnel Staffing of Critical Care Unit

Medical Staff
The most appropriate would be a Senior Medical Staff to be appointed as
CCU head with Junior Medical Staff who are intensive care trainees must
also be part of the team. An intensivist is a board-certified physician who
provides special care for critically ill patients. Also known as a critical care
physician, the intensivist has advanced training and experience in treating
this complex type of patient is an essential part of the CCU Staff. The
medical staff is in charge of the unit and sets the CCU atmosphere as the
leader of the unit.
Personnel Staffing of Critical Care Unit
Critical Care Nurse and the Unit Nurses
The Critical Care unit must be staffed by trained nurses in the critical care.
Junior nurses must be mentored and receive training from certified senior
critical care nurses. The Critical Care nurse provide close and timely bedside
care to critically ill patients and act as the facilitator, coordinator and
collaborator of care. The client ratio is often 1:1 and at times when a complex
situation occurs it is not unusual that a 1:2 or even more nurses manage a
critical ill patient.
Personnel Staffing of Critical Care Unit
Other Allied healthcare personnel
Other Allied Healthcare personnel collaboratively contribute to the management of the critically ill client for
the effective delivery of Critical Care modalities.
These include:
• Respiratory therapists
• Physical therapist / physiotherapists
• Advance practice nurses
• Physician assistants' Occupational therapists
• Dietary specialists or Nutrition and dietetics
• Pharmacists
• Biomedical engineers
• Microbiologists / medical technologists
• Medical technicians – in charge of diagnostic and medical equipment’s
• Medical Trauma Team
• Clinical Educator
• Social Worker
• Ward personnel and clerks
• Pastoral care or chaplains
• Nurse Managers
Critical Care Unit Equipment’s
Critical care unit equipment includes patient monitors,
respiratory and cardiac support systems, pain management
equipment, emergency resuscitation devices, and other life
support equipment all purposed to aid in the care and
management of patients in biologic crisis, life threatening
condition or illness, have undergone major surgical
intervention requiring close monitoring
DEFINITION OF INTENSIVE CARE UNIT
EQUIPMENT'S
Intensive care unit (ICU) equipment includes patient
monitoring, respiratory and cardiac support, pain
management, emergency resuscitation devices, and
other life support equipment designed to care for
patients who are seriously injured, have a critical or life-
threatening illness, or have undergone a major surgical
procedure, thereby requiring 24-hour care and
monitoring.
Types of Devices

• Patient Monitoring Equipment

• Life support and emergency resuscitation devices
• Diagnostic devices
• Other Devices
Patient Monitoring Equipment
• Hemodynamic monitors
• Arterial Lines
• Central Venous or intra venous lines
• Bedside monitors
• Blood pressure monitors (Sphygmomanometer / digital BP apparatus)
• Electrocardiograph (ECG EKG machine)
• Electroencephalogram (EEG)
• Intracranial Pressure monitor
• Pulse Oximeter
• Glucometer
• Ultrasound machines / echocardiography equipment
Life Support And Emergency Resuscitation Devices
• ICU / CCU Bed
• Medical Stretchers
• Oxygen source or delivery system O2 Nasal Cannula, Face mask, O2 tent etc..
• Tracheostomy or “trach trayk” insertion set
• Laryngoscope
• Airways Tracheal or endotracheal
• Respiratory Ventilators / Mechanical Ventilator
• Infusion pump / Syringe pumps
• Crash cart (resuscitation cart)
• Intra-aortic balloon pump
• Continuous positive airway pressure machine (CPAP)
• Intermittent Positive Airway Pressure Breathing apparatus (IPPB)
• Defibrillator
• Anesthesia Machine
• Enteral Feeding pumps
• Suction machines
Diagnostic devices
• Mobile X-ray units
• Portable laboratory devices
• Bronchoscope
• Colonoscope
• Endoscope
• Gastroscope
Other CCU Equipment
• Disposable equipment includes
o Urinary catheters and bag collectors Foley and straight
o Suction catheters
o Nasogastric and gastric tubes
o Intravenous and arterial lines and catheters
o Feeding tubes
o Breathing tubes Tracheostomy and endotracheal
o Chest tubes
• Patient monitor cables
• Modules
• Power supplies
Acute Care
Physiologic
Monitoring
System
A Typical Emergency Department Room (ER)
A Typical Critical Care Unit
Pulse Oximeter
Intracranial Pressure Monitor
Apnea Monitor
Ventilator
Ventilator
Infusion Pump
The Different Types of IV Infusion Pumps
• If they have prescribed you an IV delivered medication or are receiving care frequently at a
hospital, you’re likely wondering about how to set up an IV infusion pump and the
different infusion pumps that exist.
IV infusion pumps
• are a common sight in hospitals and other healthcare settings, so understanding a little
about how they work can help make your treatment less stressful. There are a few
different IV pumps that exist; read on to learn more about them.
Gravity Infusion Devices
• Gravity infusion devices are one of the most common types of IV systems used and are
what you think of when you think of an IV pump. This system uses gravity to deliver
medication, making it simple and low cost. This was the first infusion pump used and has
been in use since the late 1960s. Depending on the viscosity of the fluid being infused, this
method may not be an option. Additionally, this method may be difficult to use precisely.
Infusion Pump
Volumetric Pumps
• These devices are used for large amounts of medication being delivered. Typically, they’re
more advanced, with many featuring smart pump features, such as alert systems should
something go wrong. However, if you want to know how to set up an IV infusion pump like
this, you’ll need specialized training, meaning this option isn’t always as accessible.
Patient Controlled Analgesia Pumps
• As the name would suggest, these types of pumps allow patients to control their dosage as
necessary. There are highly effective safety systems put in place to prevent overdosing.
These pumps are best implemented for specific medications, rather than long term,
consistent treatment.
Syringe Pumps
• Syringe pumps deliver small doses of high concentration medications over the course of a
longer period of time. Similar to volumetric pumps, these are also often difficult to use and
require specialized training to be implemented.
Infusion Pump
Crash Cart
Crash Cart
Intraaortic Balloon Pump
An intra aortic balloon pump, also known as an IABP, is used to help
the heart to pump more blood around the body. It also improves the
delivery of oxygen to the heart. This device is used in both intensive
and coronary care units.
Intraaortic Balloon Pump
Intraaortic Balloon Pump
DIAGNOSTIC EQUIPMENT’S

• MOBILE X RAY
• PORTABLE CLINICAL LAB DEVICES
• BLOOD ANALYZER
MOBILE X RAY
PORTABLE CLINICAL LAB DEVICES
BLOOD ANALYZER
NURSING STAFF
• The major teaching tertiary care ICU will require trained nurses in critical
care.
• It may be ideal to have an in-house training program for critical Care
nursing.
• The number of nurses ideally required for such units is 1:1 ratio.
• In complex situations they may require two nurses per patient.
• The number of trained nurses should be also worked out by the pe of
• ICU the workload and work statistics and type patient load.
Critical Care Unit Nursing Requirements:
• All patient care is carried out directly by or under supervision of a trained critical care
nurse.
• All nurses working in critical care should complete a clinical/didactic critical care course
before assuming full responsibility for patient care.
• Unit orientation is required before assuming responsibility for patient care.
• Nurse to patient ratios should be based on patient acuity according to written hospital
policies.
• All critical care nurses must participate in continuing education.
• An appropriate number of nurses should be trained in highly specialized techniques such
as renal replacement therapy, intra aortic balloon pump monitoring, and intracranial
pressure monitoring.
• All nurses should be familiar with the indications for and complications of renal
replacement therapy.
LABORATORY SERVICES

• A clinical laboratory should be available on a 24 hrs basis to

provide basic hematologic, chemistry, blood gas, and toxicology
analysis.
• Laboratory tests must be obtained in a timely manner,
immediately in some instances. "STAT" or "bedside“
laboratories adjacent to the ICU or rapid /transport systems.
CONTEXTUAL FORCES

• The expansion of American hospital system and hospital

insurance.
• Architectural, hospital changes towards private and semiprivate
accommodations.
• Reallocations for direct patient care responsibility and creations
of new forms of care.
• During 1970’s,the term critical care unit came int existence
which covered all types of specific care
TYPES OF CCU / ICUs

There are two types of CCU / ICUs

• An open : In this type, physicians admit, treat and discharge
• A closed: in this type, the admission, discharge and referral policies are under the
control of intensivists.
Open Units
Definition
• any attending physician with hospital admitting privileges can be the
physician of record and direct ICU care. (All other physicians are
consultants)
Disadvantage
• lack of a cohesive plan
• Inconsistent night coverage
• Duplication of services
Closed Units
Definition
An intensivist is the physician of record tor ICU patients. (other
physicians are consultants), All orders & procedures carried out by ICU
staff
Advantage
• improved efficiency
• standardized protocol for care
Disadvantage
• potential to lock out private physician
• increase physician conflict
Transitional Units
Definition
• intensives are locally present shared co managed care between ICU staff and
private physician
• ICU staff is a final common pathway for orders and procedures
Advantage
• reduce physician conflict, standard policies and procedures usually present
Disadvantage
• confusion and conflict regarding final authority & responsibilities for patient
care decision
CCU / ICU MODEL CARE
Full time intensivist model :
• patient care is provided by an intensivist
Consultant intensivist model :
• an intensivist consults for another physician to coordinate or assist in critical
care, but dose not have primary responsibility for care
Multiple consultant model:
• multiple specialists are involved in the patient care (esp. R/T doctors for
ventilators), but none is designated especially as the consultant intensivist
Single physician model.
• primary physician provides all ICU care
What is a Good ICU?
A Good ICU is
• Well organized
• trust
• coordinated care
• Full time intensivist: daily round
• protocol & policies ( eg : how to DC elective operation when bed not
• bedside nurses (master degree) or higher
• no intern
A team:
• doctors, nurses, R/T, pharmacists
• led by full time intensivists critical care trained available in a timely fashion
(24hr/day) no
• competing clinical responsibilities during duty
• closed units, if resources allow
CCU / ICU PHYSICAL
SET UP
CCU / ICU PHYSICAL
SET UP
THERAPEUTIC ELEMENTS IN ICU
• Windows and that provides natural views of nature can reduce
stress hasten recovery lower blood pressure and lower pain
medication needs
• Family participation, including facilities for overnight stay and
comfortable waiting rooms
• Providing a measure of privacy and personal control through
adjustable curtains and blinds, accessible bed controls, and TV
VCR CD, internet connectivity
• Noise reduction through computerized pagers and silent alarms
• Medical team continuity that allows one team to follow the patient
through his/her entire stay
UTILITIES
Each intensive care unit must have
• Electrical power
• Water
• Oxygen
• Compressed air
• Vacuum lighting
• And environment and control system
• That supports the needs of the patients and critical care team under
normal and emergency situations, and these must meet or
exceed regulatory and accreditation agency codes and
standards
OTHER FACILITIES

• Voice intercommunication system

• Satellite laboratory
• Physician on call rooms
• Administrative offices
COMPUTERIZED / DIGITAL CHARTING EMR

• Systems that provide for paper less data management, order

entry, and nurse and physician charting. If and when a
decision is made to utilize this technology, it is important to
integrate such a system fully with all ICU activities.
• Bedside terminals facilitate patient management by
permitting nurses and physician to remain at the bedside
during the charting process
COMPUTERIZED / DIGITAL CHARTING EMR