Head walls or booms??

[NotReady4PrimeTime, RN]

Our combined PICU/PCICU as well as our NICU are undergoing redevelopment. :) The PCICU is going into an empty but previously designated space while the PICU and NICU will be a total gut and rebuild. The basic footprints have been drawn up and now we're moving on to the design phase. In the interest of getting the most bang for our buck, we're hoping to take advantage of bulk purchasing. The most pressing issue we're up against at this point in the planning is whether to go with head walls or booms. Our current head wall arrangements are not ergonomic or adequate and we really want to do it right, since we have this opportunity to make our workspace as close to perfect as we can. We've run some sims with both a head wall and booms, with mixed results. So my questions to you are:

1) Is your unit relatively new construction or has it been renovated in the recent past (say 5 years)?

2) Do you have head walls or booms?

3) What do you like and dislike about how you're accessing electrical, vacuum and medical gas outlets?

4) If you use booms, are your IV pumps on a separate pole? If not, what do you do for road trips?

5) If you could change what you have, what would you do?

6) What is important to you in terms of physical environment of your bedsides?

Any other comments about working through a renovation of this scale would be super helpful.

[umcRN, BSN, RN]

Our unit was recently built and opened a little over 3 years ago.

We have booms and 99% of the time I love them. The only part I do not like is that only one boom has the necessary oxygen/medical air ports for vents and usually the other boom is reserved for the built in IV poles and monitors so if a parent wants to hold an intubated patient you have to transfer IV pumps onto the transport pole so everything can reach (not always if it's a newborn in a warmer but if its an older baby in a bed/crib it can be tricky). Otherwise all the ports/suction/O2 is always pretty easily accessible.

IV poles are included on the boom and we use transport poles for roadtrips, personally I prefer this and we are the only unit in the hospital (including picu/nicu) to have the IV poles set up this way. I think it looks neater...

We have large patient rooms and the booms are set up probably 2/3rd's into the room, the back 1/3rd is reserved for family (couch/rocker/tv/storage/bathroom). The rest of the room is patient, the beds face out with the boom on either side. This does mean for toddlers and older children who are more awake they cannot see their parents unless there is room for the parents to move the rocker next to the bed. On the other hand for more stable/long term kiddos (vads/kids awaiting transplant) we can actually swing the booms towards one wall so the pt has their parents and window on one side and the door to the unit on the other.. It creates more of a "bedroom" feel for some of our kids who can't go to the floor for whatever reason but are stable enough and don't need to be facing out of the unit all the time (also makes for easier movement around the room for family).

Another thing about booms is that they and all the things they hold can be moved pretty easily to accomodate for more stuff, need room for a vent? no problem, need to add an ecmo machine? just shift everything a foot or so to the left, dialysis? go right ahead, it can get crowded with all that stuff but the booms I think are more accomodating to relocating things than a headboard would be, they also move far enough back into the room that we could take over the parent space if necessary as well as far enough forward that if you wanted to face the bed the other way (towards the back of the room) you can and everything still works. OH and portable head CT's (we do a lot of those on our post arrest ecmo kids). The CT scanner can get as far into the room as possible then as we move the patient onto the scanner we can slowly inch the booms/monitors/iv's/suction etc up as we move the patient, then slowly move everything back when we're done and we almost never have to disconnect anything.

It's hard to explain but our booms move in three directions on three different "joints" if you will. You can move one part or all three so they are really customizable to the patient and their needs

they look something like this:

_____

_____

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That probably makes no sense but at each area where the lines touch they can be moved almost 360

One thing I definitely wish we had more of is contained patient storage. Right now each patient has a larger countertop with a computer access (rarely used unless emergent situation/pt on ecmo and ecmo tech needs own space) and a small (like 1.5ft x 1ft) counter with a computer which is the one the nurse usually uses. We have cabinets for linen but otherwise supplies typically line the larger counter out in the open things like diapers, bath supplies, trach/wound care, formula etc all stacked into bath basins). For longer term kids it can look cluttered and messy, we would prefer closed cabinets for this (sometimes we use the parent ones if they don't have stuff in them).

Anyways I prefer the booms, I used to work in the NICU and we have headboards there which I didn't like as much and definitely don't think I'd like that if I had a big kid in a bed, the PICU sort of uses a combined headboard/boom system, their booms don't have IV poles so they need transport poles for all their kids and if you're intubating, someone has to jump over lines/monitors to get between the headboard and head of the bed to intubate opposed to in our unit the head of the bed is usually easily accessible.

[NotReady4PrimeTime, RN]

Thanks for this. It's very helpful information. Do you know the manufacturer of your booms? I didn't see the ones they were using in our sim setup but what I've been told is that they were in the way during a mock code/ECPR scenario. I would guess they were the least costly ones available...

I agree closed storage is a great advantage to have and we'll be making sure we have enough. The rooms will be arranged similar to yours but without a bathroom. (No money in the budget or space to spare in the footprint.) The beds will be centered in the space with the head close to the wall. I like the notion of having the head of the bed completely accessible and may argue for that. One of our existing rooms was at one time occupied by two patients with a great deal of equipment (low air-loss bed, wheelchair, 2 wall-mounted computer systems, 2 wall-mounted monitors, 2 IV poles, 2 bedside supply carts, standard patient bed, a vent, several family chairs and so on). One of the kids needed emergent intubation and the physician had to literally crawl under the bed to get to the kid's head. He narrowly missed banging his head on the monitor as he stood up. So not ideal.