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Graphic Standards Programming and Schematic Design
June 1999
Table of Contents
Table of Contents
Function Staff Advantages of Movable Modular Casework 3 5 6 Functional Areas
Order Entry/Review Unit Dose Picking/Dispensing IV Admixture Compounding/Packaging Controlled Substance Storage STAT Dispensing Outpatient Picking/Dispensing Technician's Workstation Inventory Control Bulk and Active Storage Cart Holding Pharmacist Office Secretary/Reception Break Room/Staff Lounge Outpatient Consultation Satellite Pharmacy
7 9 11 12 13 14 15 16 16 17 17 18 19 20 22 23
Functional Program Bubble Diagram Block Diagram Preliminary Plan Schematic Plan Future Trends
24 25 26 27 28 29
Conference/Drug Information Center 21
Pharmacy 2
The primary function of the hospital pharmacy is the management of medications dispensed in the hospital, including the procurement, compounding, packaging, and distribution of those medications for both inpatients and outpatients. In addition and of equal importance, the pharmacy staff is responsible for the recordkeeping of information regarding medications, including the patient drug profile or history, drug usage and cost data, and drug inventory and security. The pharmacy is responsible for providing drug information to healthcare personnel, as well as being involved in drug educational programs. Pharmacists increasingly are becoming involved in patient care as members of the medical team. The hospital pharmacy function is monitored and regulated by national organizations, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the American Society of Health System Pharmacists (ASHP), as well as state and local organizations, such as the State Board of Pharmacy.
Methods of Medication Distribution
The original medication order written by the physician is usually referred to as the "first dose," "first order," or "STAT" (immediate administration) order. This "first dose" is filled when received in the pharmacy, and sufficient dosage is supplied to cover the time until the next delivery of medications to the patient unit. The methods of continual repeat distribution of the medication by the hospital pharmacy usually fall into one of the following categories:
Conventional Floor Stock System Combination System
A combination of a unit dose exchange system and conventional floor stock may be used. The floor stock is usually limited and consists of those generic medications of high usage such as aspirin, antacid, cough mixture, etc., while the majority of specific drugs are distributed by unit dose cassette exchange.
Other Methods
A given amount or par level of medications are stored in medication rooms at the nurses station and restocked by the pharmacy staff at a predetermined time. Measurement and administration of the medication and appropriate documentation are done by the nursing staff. Floor stock distribution alone is not widely used due to the lack of control, a high incidence of errors, and the waste of medications.
Unit Dose Cassette Exchange System
Medications are also administered in intravenous (IV) fluids. The addition of the medication to the sterile IV fluid is usually performed under a laminar flow hood by the pharmacist. Intravenous fluids of various types come in glass bottles, plastic bags, or syringes. Those IV fluids containing medications added by the pharmacist are then delivered to the patient units from the pharmacy.
A unit dose (single dose) of packaged medication is prepared by the pharmacist. This unit dose is loaded into a small drawer designated for a specific patient, with all of that patient's medications for a given time frame (usually twenty-four hours) located in the drawer. Groups of these drawers, or cassettes, are loaded into a cart and transported to the patient units. Either the cassettes or the entire cart are exchanged for the existing cassettes or cart on the unit.
Pharmacy 3
Flow of Medication Orders and Medications
Medication orders are always initiated by the physician in written form. The most common method of drug distribution used today is the unit dose system. The following chart shows the typical path or flow of the written drug order and the medication to, through, and from the pharmacy.
Pharmacy 4
lc Pharmacy 5 . The responsibility of this position is the total management of the direction and operation within the pharmacy including administrative. nursing. It is their responsibility to perform tasks. interns. picking. and medical staff. word processing. inventory. or inventory. The pharmacist is licensed or registered to provide pharmaceutical services. Pharmacist Technicians may have various levels of education. functional. In addition. The responsibility of the position is the management of the daily function of the department. technical. Clerical positions within the pharmacy may include receptionist. or residents and interfacing with patients. primarily the accuracy of drug distribution. as directed by the pharmacist. the director establishes relationships and interfaces with other hospital staff and committees as well as pharmaceutical representatives. It is the responsibility of the director to meet or exceed the standards of compliance of regulatory and accreditation organizations. and policy issues. labeling. The pharmacist's accountability also includes the management and review of work done by technicians.Pharmacy Staff Staff Pharmacists Director of Pharmacy Technicians Pharmacy Technicians Support Staff Clerical Staff The director of the pharmacy is a registered pharmacist often holding an advanced education degree. and/or procurement responsibilities. such as packaging.
All movable modular casework components can be easily rearranged or reused by the end user. type of hospital. medication carts and satellite pharmacies using the same components. However. fixed casework is difficult to install. Continual reuse of the components for new or different functions. · · For preliminary budget purposes. Movable Modular Casework In the past. using the same components. Ability to install and reconfigure with little downtime.Pharmacy Advantages of Movable Modular Casework Advantages of Movable Modular Casework Hospital pharmacies may differ somewhat in square footage. hospital pharmacies were planned using fixed casework or millwork. either minor or major reconfigurations. However. but each hospital pharmacy has certain functional areas in common. for example. inflexible mass. By comparison with movable modular casework. and provide typical plan views of movable modular casework applications. allowing ongoing changes with new technology. the life cycle cost of movable modular casework is far less than fixed casework because of · Movable modular casework components require less square footage within a pharmacy department. Energy capabilities within the movable modular casework system allow the immediate addition or reconfiguration of all new and existing electrical equipment. especially important to "for-profit" organizations. Movable modular casework offers the following major advantages and differences when compared with fixed casework or millwork: Financial Advantages The initial cost of movable modular casework is competitive with fixed casework or millwork. Additional components can be added at any time. This range will be affected by the density of overhead and undercounter storage components and the type of support structure used (wall-mounted versus panels). fixed construction does not respond to the rapidly changing technology seen in healthcare facilities today. method of operation." While these cabinets may be offered in many different widths for "flexibility. Movable modular casework components have been designed to function as a movable system allowing the pharmacy to integrate with the patient units they serve. reconfigure. Accelerated depreciation rate. give a brief description of the functional areas of hospital pharmacies. and staffing based on the size of the hospital." they are attached to a custom-sized countertop to form an immovable. and reuse. The following pages describe the advantages of movable modular casework. Minimal maintenance cost. and scope of outpatient services. · · lc Pharmacy 6 . This fixed casework is often inaccurately described as "modular. · · · · · · Longer product life. Movable modular casework components have been specifically designed to meet the functional requirements of the pharmacy department. movable modular casework for a pharmacy has an average price in the range of $177 to $265 per linear foot.
as well as sufficient file and equipment space (telephone. · · · · · lc Pharmacy 7 . computers. the order is assigned to a pharmacist or technician for selection and then rechecked by the pharmacist. Task lighting under transactional counter. Cantilevered work surfaces. etc. From this location. Work space must be provided for several people. and printers). fax.Pharmacy Order Entry/Review Functional Areas Order Entry/Review This area of the pharmacy is the "communications hub" of the department and is often in a central or front location. printers. Electrical capabilities for continual integration of phones. Overhead storage for manuals and technical reference materials. Corner work surfaces with keyboard trays or drawers to accommodate computers and printers. A written medication order is received in order entry and reviewed by the pharmacist. fax machine. Movable Modular Casework and Furniture Systems Applications The entire order entry/review station can be planned using a freestanding panel or frame system with movable modular components to provide the following: Movable modular components may include · · · · Maximum utilization of space. Above work surface counter or transactional work surface. Continual integration of computer technology. Lateral and pedestal files. copy machine. copiers. All original written orders may be stored in this area. Orders are compared with the patient's medication history or "profile" to prevent the administration of antagonistic or duplicated drugs.
2" 10 linear feet work surface 20 filing inches 50 square feet 7' ORDER ENTRY/REVIEW lc Pharmacy 8 . Plan A 18 linear feet work surface 40 filing inches 100 square feet 11' .2" ORDER ENTRY/REVIEW Plan B Plan B 7' .Pharmacy Order Entry/Review Plan Views of Order Entry/Review Stations Plan A 9' An order entry/review station will range in size from 50 to 150 square feet based on the size of the hospital and the amount of electronic equipment and staff requirements.
lc Pharmacy 9 . and the number of technicians using the station." The creation of a U-shaped workstation provides a space of limited dimensions containing a maximum quantity of drugs and allows the pharmacist to "pick" the appropriate drug. time-saving manner has led to the development of the unit dose "picking station. Work surfaces for clerical and computer needs can be incorporated into the station at any time. The use of a freestanding panel system for the configuration of the stations provides the most efficient use of space as well as the capability of storing the maximum number of medications. Multiple stations can be planned based on the number of drugs used and the number of hospital beds.Pharmacy Unit Dose Picking/Dispensing Unit Dose Picking/Dispensing Hospital-dispensed medications are packaged in single doses for accuracy and efficiency of dosage administration. The pharmacist can fill drug orders with little wasted time and motion having high-volume or fastmoving drugs within arm's length. Medication containers (subcontainers) can be arranged in a gravity-feed position or on flat shelves. These single dose packages are referred to as "unit dose" and are usually the most frequently ordered or high-volume-use medications. The organization of these medications will vary among hospitals. The need for the retrieval of the most frequently used medications in an efficient. additional functions and equipment within the station. A standard may be one picking station per 100 beds. Movable Modular Casework Applications The components for unit dose picking stations can be planned in many different configurations based on the space parameters. number of drugs to be dispensed.
6 1/2" UNIT DOSE PICKING 6' .6 1/2" UNIT DOSE PICKING 10' .6 1/2" Plan B 6' .6 1/2" 8' .6 1/2" Plan D 8' .6 1/2" Plan C 8' . Drug Bins Work Surface Square Feet UNIT DOSE PICKING 6' .6 1/2" Plan A B C D 255 190 450 480 avg avg avg avg 6 6 8 10 LF LF LF LF 55 42 72 90 8' .6 1/2" UNIT DOSE PICKING lc Pharmacy 10 . The number of stations and square footage depends on the size of the hospital and the number of drugs in the formulary.Pharmacy Unit Dose Picking/Dispensing Plan Views of Unit Dose Picking Stations Plan A Unit dose picking stations will vary in size and configuration.
The size of an IV admixture room will vary based on the size of the hospital.Pharmacy IV Admixture IV Admixture A specific area of the pharmacy is designated for the function of adding medications to intravenous (IV) fluids prior to administration to the patient. Mobile process tables and smaller mobile L carts for movable work areas adjacent to the flow hood. refrigerators. The injection of the medication into the IV fluid is carried out under a laminar flow hood. HOOD 46 linear feet work surface 92 linear feet overhead storage 2 lockers for IV storage 1 L cart 407 square feet 18' . Although code requirements may differ. It is recommended that IV admixture be in a closed room with positive pressure for isolation and cleanliness in preventing contamination. Movable Modular Casework Applications Movable modular casework components are used for work areas and storage of fluids and medications and may include · · Cantilevered work surfaces for clerical and technical work areas. types of medications being added to fluids. REF IV ADMIXTURE HOOD 22' Plan View of an IV Admixture Room An IV admixture room will range in size from 160 to 500 square feet. and the number of hoods needed.6" CHEMO HOOD lc Pharmacy 11 . · · Lockers to store intravenous fluids and additives. computers. this area must be the cleanest part of the department. and work areas. Lockers on wheels (TR3 cart) moved to the storage area for restocking of fluids. as well as sinks. The IV admixture room should provide space for a limited supply of intravenous fluids and medications.
medication storage. and sufficient work surface. Movable Modular Casework and Furniture Systems Applications Plan Views of Compounding/Packaging Areas Compounding and packaging areas combined will range in size from 75 to 150 square feet. Compounding 10 linear feet work surface 16 linear feet overhead storage 50 square feet 10' . compounding and packaging may be combined in the same location. In many smaller hospitals. medications in both liquid and tablet form that are not manufactured as a single-dose unit can be divided and packaged as needed. In the packaging area. The area is usually configured along an existing wall to access plumbing. 2' Packaging 8 linear feet work surface 16 linear feet overhead storage 40 square feet 8' .Pharmacy Compounding/Packaging Compounding/Packaging The compounding area of the pharmacy is the section where liquid and topical medications are mixed and stored. Additional storage and work space can be planned using freestanding panels. computer. label printer. and overhead supply storage can be programmed with movable modular components.1" PACKAGING 2' lc Pharmacy 12 . There is a need for a sink. All of the work surfaces. sink units. Large mobile tables for labeling and packaging equipment provide flexibility for the packaging function.1" COMPOUNDING A combination of both wall-mounted and freestanding modular components are appropriate for this area.
8" A controlled substance storage room will range in size from 45 to 120 square feet.8" CONTROLLED SUBSTANCE STORAGE Plan View of a Controlled Substance Storage Room 10' .Pharmacy Controlled Substance Storage Controlled Substance Storage Narcotics and other governmentcontrolled drugs are stored in a vault or locked room in the pharmacy. 7' . 4 linear feet work surface 52 linear feet storage 80 square feet lc Pharmacy 13 . usually located away from the primary entrance but in a highly visible location. Movable Modular Casework Applications Modular shelving is applicable for the controlled substance storage room within the pharmacy. Double-locking modular medication carts are used for transporting controlled substances to the patient units.
and cantilevered work surfaces. rather than waiting for the next routine floor delivery.1 1/2" lc Pharmacy 14 . these STAT orders can be filled without disrupting the flow of normal order picking and filling. that order needs to be filled and delivered to the patient unit as soon as possible.4" STAT DISPENSING Plan View of a STAT Dispensing Station A STAT dispensing station will range in size from 60 to 120 square feet. Hence. hanging drug containers. this STAT picking area should be configured using freestanding panels. 8' . 12 linear feet work surface 24 linear feet overhead storage 165 drug bins average 80 square feet 10' . An area of the pharmacy is often set aside for STAT dispensing and contains smaller quantities of frequently ordered drugs. Movable Modular Casework Applications Similar to the unit dose picking station.Pharmacy STAT Dispensing STAT Dispensing When a "STAT" or immediate drug order is issued by a physician.
In some smaller hospitals.Pharmacy Outpatient Picking/Dispensing Outpatient Picking/Dispensing The hospital pharmacy also may dispense medications to outpatients. this may be a major department. Movable Modular Casework Applications The same movable modular casework components used in the primary pharmacy are applicable in the outpatient area and may include · · · · Cantilevered work surfaces. teaching. and maintain separate stock for outpatients. refrigerator).0 1/2" 8' . The outpatient dispensing area requires sufficient medication storage space. Cantilevered sink unit. 10 linear feet work surface 12 linear feet overhead storage 64 square feet lc Pharmacy 15 . The size of this space depends on the size of the hospital and the number of outpatient orders received. while in others. work surface. This area should be visible from the reception or order entry station and should be secure from the primary area of the pharmacy. label printer. an area should be provided for patients to wait while their medication orders are filled. and space for equipment (computer. this may be an isolated alcove.4" OUTPATIENT PICKING 8' . and veterans hospitals. Drug bins.1 1/2" OUTPATIENT DISPENSING 8' . printer. 8 linear feet work surface 42 linear feet storage 165 drug bins average 70 square feet Plan View of an Outpatient Dispensing Station An outpatient dispensing station will range in size from 50 to 100 square feet. This can be provided as a seating area in an alcove or small room at the primary entrance to the pharmacy.7" Plan View of an Outpatient Picking Station An outpatient picking station will range in size from 60 to 100 square feet. To avoid direct competition with the retail pharmacy. the hospital pharmacy must purchase. 8' . discount. Regular and extra-deep modular shelving units. Picking and dispensing areas may be separated in larger hospitals. If the outpatient dispensing function of the pharmacy warrants. such as military.
and filing capabilities. 10 linear feet work surface 16 linear feet overhead storage 20 filing inches 55 square feet 6' .6 1/2" TECH WORKSTATION Inventory Control A small workstation adjacent to bulk and active storage provides a space for maintaining information regarding the inventory of the pharmacy. and reading medical manuals and reports.1 1/4" INVENTORY CONTROL STATION lc Pharmacy 16 . Movable Modular Casework and Furniture Systems Applications Wall-mounted or panel-hung modular components can be used in this area providing work surface. accessing computer programs. Inventory Control Technician's Workstation Technicians in the pharmacy need small workstations or office areas for completing paperwork. and procure medications as needed.6 1/2" Plan View of a Technician's Workstation A technician's workstation will range in size from 45 to 90 square feet. Movable Modular Casework and Furniture Systems Applications Components for these stations.Pharmacy Technician's Workstation. 8' . monitor supplies within the pharmacy. 8' . telephone conferencing. the staff will log in drugs at arrival in the department. storage. offer the most flexibility for use of the space. From this area. Freestanding panels offer varying degrees of privacy and can be configured based on individual needs.1 1/2" Plan View of an Inventory Control Station 10 linear feet work surface 20 linear feet overhead storage 40 filing inches 40 square feet 4' . either wall-mounted or panel-hung.
Movable Modular Casework Applications A modular medication cassette transfer cart will allow integration with the movable modular casework. and packaging and house the slowermoving medications not included in the picking station. The active storage area contains readyto-use supplies in smaller quantities than bulk storage and is accessed to restock unit dose picking stations. Movable Modular Casework Applications Freestanding modular shelving and mobile carts are appropriate for the bulk and active storage areas. or stored in an anteroom outside of the pharmacy because of the associated dust and dirt from the outer packaging.6 1/2" BULK/ACTIVE STORAGE 2' . prior to delivery to the pharmacy. Bulk storage space can be conserved by using a movable aisle system. shelving both sides 25 square feet per 4-foot section 10' . 30".4 1/2" Cart Holding The cart holding area of the pharmacy should allow sufficient space for storing medication and/or transfer carts for the patient units awaiting delivery or exchange. Cart Holding Bulk and Active Storage Bulk storage is the area of the pharmacy where medications and intravenous fluids are stored in bulk quantities. The amount of space will depend on the method of cart replenishment or exchange. These bulk supplies are generally removed from the shipping boxes. Shelving units can be configured with shelves of 24". compounding.Pharmacy Storage. Plan View of Shelving for Bulk and Active Storage 40 linear feet per 4-foot section.2 3/4" CASSETTE TRANSFER CART lc Pharmacy 17 . or 48" widths and can be arranged in many different combinations.11 3/4" 2' . 4' .
Pharmacy Pharmacist Office Pharmacist Office The director of the pharmacy.9 1/2" PHARMACY DIRECTOR Plan View of a Pharmacy Director's Office 14 linear feet work surface 24 linear feet overhead storage 40 filing inches 150 square feet 13' .7 1/2" Plan View of an Assistant Pharmacy Director's Office 8 linear feet work surface 20 linear feet overhead storage 136 filing inches 10' .9 1/2" 100 square feet lc Pharmacy 18 .6" ASSISTANT DIRECTOR 9' . Small conferences and meetings with drug representatives and other hospital staff may require privacy and confidentiality. demountable walls or freestanding modular panels are appropriate. may have private offices within the department. Movable Modular Casework and Furniture Systems Applications Either full-height fixed. 10' . as well as other pharmacists. Consistency between systems used in administrative and clinical areas allows for compatibility and flexibility when dealing with future changes.
and hanging or freestanding lateral files. NOTE: Pharmacies are required to display all their various licenses. File storage in pedestal drawers.9 1/4" Plan View of a Secretary/Reception Area A secretary/reception area will range in size from 75 to 150 square feet. Task lights and personal lights. Freestanding tables or peninsula work surfaces for conferencing. and open shelves for storing manuals and books. · 8' . display shelves.7 3/4" SECRETARY/ RECEPTION lc Pharmacy 19 . hanging drawers. These should be located toward the front of the pharmacy to discourage traffic into the clinical areas where medications are accessible. · · · · Tackboards or display shelves to display documents. Flipper storage. 12 linear feet work surface 16 linear feet overhead storage 40 filing inches 75 square feet 8' . Corner work surfaces with keyboard tray or drawer to accommodate computers and printers.Pharmacy Secretary/Reception Secretary/Reception Most hospital pharmacies will have administrative areas for secretaries and clerks. Movable Modular Casework and Furniture Systems Applications Modular furniture system components can be used to furnish these areas and may include · · Tool bars and accessories for paper handling.
Pharmacy Break Room/Staff Lounge Break Room/Staff Lounge Pharmacy departments generally provide a staff lounge for coffee breaks and meals. and supplies. Movable Modular Casework and Furniture Systems Applications The break room/lounge area can be planned using modular components and may include · Wall strips with cantilevered work surface and overhead storage or heavy-duty storage work surface with C frame storage units and drawers. Space should be provided for a refrigerator. It is important to locate this break room close to or within the pharmacy department especially for staff working the second and third shifts. · · BREAK ROOM/LOUNGE 11' . coffee maker.9 1/2" lc Pharmacy 20 . it is preferred that they do not leave the area for breaks and be on hand for STAT orders or emergencies. Tables and seating. microwave oven. Tackboards to display information.7" Plan View of a Break Room/Staff Lounge A break room/staff lounge will range in size from 100 to 200 square feet. 8 linear feet work surface 12 linear feet overhead storage 125 square feet 10' . Since the number of staff working these shifts is small.
Task lights to illuminate work surfaces for reading. Movable Modular Casework and Furniture Systems Applications Movable modular casework components and modular furniture systems allow for future flexibility and change.6 1/2" lc Pharmacy 21 . A conference type of table and seating are available for reading or studying. A large amount of shelving is provided to house current periodicals and other reference manuals. Limited filing for articles and reports. 9' . including the pharmacists. and nurses. A space is usually provided in larger hospital pharmacies that is accessible for this purpose. Tables or work surfaces for sitting and reading.9" CONFERENCE/ DRUG INFORMATION CENTER Plan View of a Conference/Drug Information Center 40 linear feet storage 48 filing inches 150 square feet 15' .Pharmacy Conference/Drug Information Center Conference/Drug Information Center It is the responsibility of the pharmacy to provide current drug information and education for the medical staff. physicians. The requirements of this area will be unique to each pharmacy but may include · · Extra-deep modular shelving units to hold large reference manuals. · · · Comfortable seating. as well as a small copy machine and space for a computer.
and tackboards.9" OUTPATIENT CONSULTATION Plan View of an Outpatient Consultation Room 32 linear feet storage 120 square feet 12' . Movable Modular Casework and Furniture Systems Applications Movable modular casework components and modular furniture systems allow for future flexibility and change. 9' . and possible drug complications. there is often a consultation room within the pharmacy which allows for the privacy of these meetings. In larger hospitals.Pharmacy Outpatient Consultation Outpatient Consultation The pharmacist will often meet with patients and their families to discuss a medication program. marker boards. expected drug results. instruction in administration. The requirements for this area may include · · Conference tables and seating. Wall strips with shelves.5" lc Pharmacy 22 .
The satellite pharmacy is staffed. surgery. Modular carts are appropriate for the transfer of medications to the satellite pharmacy. printer. emergency departments. label printer. sink. This decentralization of the pharmacy function allows for more rapid response to the needs of the patient and allows the pharmacist more involvement in the clinical therapy of the patient. allowing for continual flexibility and change in the space. computer. and controlled substance storage.3" SATELLITE PHARMACY HOOD 11' . and serviced by the primary pharmacy department.3" lc Pharmacy 23 . Plan View of a Satellite Pharmacy A satellite pharmacy will range in size from 120 to 250 square feet. stocked. Some satellite pharmacy areas may have a small laminar flow hood. refrigerator. and chemotherapy units. Movable Modular Casework Applications The same movable modular casework components used in the main pharmacy are appropriate for the satellite pharmacy. 18 linear feet work surface 28 linear feet overhead storage 80 drug bins average 1 locker 1 medication cart 140 square feet 12' . such as critical care units.Pharmacy Satellite Pharmacy Satellite Pharmacy Small satellite pharmacies may exist in any patient unit or service department but are more commonly placed in the more acute care units. The space will vary in size but will usually contain a small drug picking area.
Inventory Control Station Pharmacist's Offices @ _______ sq. ft. ft. IV Admixture Room Compounding Area Packaging Area Controlled Substance Storage Room STAT Dispensing Station Outpatient Picking Stations @ _______ sq. Outpatient Dispensing Stations @ _______ sq.Pharmacy Functional Program Functional Program Number Department Area Square Feet Movable Modular Casework Unit Dose Picking/Dispensing Stations @ _______ sq. Secretary/Reception Staff Lounge Conference Room Drug Information Center Outpatient Consultation Room Subtotal TOTAL NET SQUARE FEET Net-to-Gross Conversion Factor TOTAL GROSS SQUARE FEET X lc Pharmacy 24 . Bulk Storage Area Active Storage Area Cart Holding Area Staff Toilets @ _______ sq. ft. ft. ft. ft. Janitor's Closet Subtotal Modular Furniture Systems Order Entry/Review Station Technician's Workstations @ _______ sq.
Pharmacy Bubble Diagram Bubble Diagram The bubble diagram of the pharmacy department demonstrates typical departmental relationships and interaction between areas. Necessary adjacencies within the department become clear. ORDER ENTRY RECEIVING OUTPATIENT DISPENSING BULK STORAGE IV ADMIXTURE COMPOUNDING OUTPATIENT CONSULTING PACKAGING PICKING ACTIVE STORAGE SECRETARY/ RECEPT CART HOLDING NARCOTICS OFFICES lc Pharmacy 25 .
Traffic patterns are developed. lc Pharmacy 26 . Evaluation of the work flow and materials flow from the bubble diagram has determined this initial general layout. and an overview of the general work process can be evaluated.Pharmacy Block Diagram Block Diagram The block diagram demonstrates the adjacencies and relative sizes for the areas within a typical pharmacy. The size of each area is determined by combining the typical movable modular casework plans for each identified function.
and exact traffic patterns. lc Pharmacy 27 . exits.Pharmacy Preliminary Plan Preliminary Plan The preliminary plan clarifies the pharmacy space requirements by showing the location of all the fixed walls and open areas and identifies entrances.
modular furniture systems. 65' .3" ASS'T DIR SECRETARY RECEPTION WAIT OUTPATIENT WAITING OUTPATIENT PICKING STAT DISPENSING OUTPATIENT DISPENSING DIRECTOR CONFERENCE DRUG INFO ORDER ENTRY/ REVIEW NIGHT CONSULTATION TOPICALS UNIT DOSE PICKING TECH WORK AREA TECH WORK AREA TECH WORK AREA LIQUIDS 70' .10" STAFF LOCKER ROOM CART STORAGE CART STORAGE ACTIVE STORAGE BREAK ROOM/ LOUNGE IV ADMIXTURE IV STORAGE BULK STORAGE INVENTORY CONTROL RECEIVING/BREAKDOWN PACKAGING CONTROLLED SUBSTANCE STORAGE COMPOUNDING lc Pharmacy 28 .Pharmacy Schematic Plan Schematic Plan The schematic plan shows all of the specific movable modular casework. and materials handling components appropriate for a typical pharmacy.
often dispensed by automated equipment. New dosage forms. with patient counseling and patient monitoring showing the most growth. and transdermal delivery. and nurses will carry bar code wands to tabulate drug administration. hyperalimentation. consulting. First doses. and formulary practices increase. prime vendors. and narcotics will be kept in cabinets in nurses stations. Medication Dispensing Most unit dose packs will be bar coded with operational and cost savings. The unit dose concept will continue to grow. Bulk storage will decrease as computers.Pharmacy Future Trends Future Trends Administration New pharmacy practices will continue to grow. Traffic congestion and traffic patterns are becoming more complex with patient consultations within the pharmacy growing at a rapid rate. Automated drug dispensing machines will become more prevalent within the pharmacy. controlled release systems. lc Pharmacy 29 . Layout The relative proportions of office. are appearing. and drug distribution spaces will be constantly shifting and changing. There will be an increase in the number of "STAT" or first doses coming from the pharmacy or satellite pharmacy because very ill patients require more medication changes. storage. The pharmacists will more often be stationed in the satellite pharmacy on the patient unit with more patient contact. PRN doses. expensive. and the mix of several drugs in one IV. such as osmotic pumps. IV admixture use is increasing with more complicated. and evaluation of drug therapy. and perishable drugs such as biotech drugs. reference. The size of IV admixture rooms will increase because of the increased volume of medications administered by this method. "Pharmaceutical care" will concentrate on the prevention of drug-related problems.
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Pharmacy Clean Room 1 Technical Bulletin June 1999 .
Pharmacy Clean Room Table of Contents Glossary Traditional Preparation of Sterile Products and Associated Problems Description of Clean Room and Activities What is a Clean Room? Clean Room Activities 3 Typical Installations Plan View 1 5 Plan View 2 5 5 5 Plan View 3 List of Appropriate Herman Miller Product Anteroom Clean Room Herman Miller Contact Information Allied Suppliers of The Clean Room Package V-Wall Modular Wall Systems Gencorp 13 15 10 11 Clean Room Standards and Guidelines 6 Federal Standard 209E 6 Technical Assistance Bulletin (TAB) Guidelines 6 Risk Levels Established by the Technical Bulletin 6 Enforcement of Guidelines Anteroom Description and Activities 7 7 16 16 16 16 16 16 16 CRI (Clean Rooms International) 17 List of V-Wall Representatives 18 Material Transfer Between Anteroom and Clean Room 8 Considerations For Planning And Design 8 Clean Room Construction Methods 8 Allocated Space 8 Clean Room Size 8 Supply Management Operational Management Allocation of Responsibilities Design Requirements 9 9 9 9 1 Technical Bulletin 2 .
by the same individual(s). Critical Area Any area in the controlled area where products or containers are exposed to the environment. would be preferable..5 micron and larger per cubic foot of air. repackaging. withdrawal. filters.5 micron and larger per cubic foot of air. in a single discrete process. pyrogen-free needle. Inc. Used for preparation of toxic.000 clean room may not exceed a total of 10. the air particle count in a Class 10. Closed-System Transfer The movement of sterile products from one container to another in which the container-closure system and transfer devices remain intact throughout the entire transfer process.000001 meter). These terms may be used interchangeably. when available. This activity would include dilution. carried out during one limited time period. HEPA Filter A high-efficiency particulate air (HEPA) filter composed of pleats of filter medium separated by rigid sheets of corrugated paper or aluminum foil that direct the flow of air forced through the filter in a uniform parallel flow. infectious. horizontal or bio-safety hood.e. Controlled Area The area designated for preparing sterile products. admixture. and other manipulations of sterile products. (A clean zone is defined as space in which the concentration of airborne particles is controlled to meet a specified airborneparticulate cleanliness class. Anteroom handles distribution and particle-producing activities which should be separated from the clean room.3 micron or larger. Horizontal Flow Hood Airflow hood used for preparation of nontoxic sterile products which pose no danger to the technician. packaging. or equivalent needle-free system through a designated stopper or port to effect transfer. when applicable) beyond which a product should not be used (i. however. Clean Room A room in which the concentration of airborne particles is controlled and there are one or more clean zones. NOTE: Circumstances may occur in which the expiration date and time arrive while an infusion is in progress. an environment can be created consistent with standards for a Class 100 clean room. Biological Safety Cabinet Also known as a bio-safety hood. Laminar Air Flow Hood Generic term for a vertical. the use of a rubberstoppered vial. Organizational policies on this should be clear. This will always be a vertical flow hood. judgment should be applied in determining whether it is appropriate to discontinue that infusion and replace the product. Batch Preparation Compounding of multiple sterile-product units. HEPA filters remove 99. The closure is compromised only by the penetration of a sterile. Compounding The mixing of substances to prepare a medication for patient use. Aseptic Preparation The technique involving procedures designed to preclude contamination (of drugs. When this occurs. or supplies) by microorganisms during processing. reconstitution. CRI (Clean Rooms International) A co-operative supplier of clean room air pumps. or delivery. Critical Site An opening providing a direct pathway between a sterile product and the environment or any surface coming in contact with the product or environment. Micron A unit of measure equal to one-millionth of a meter (. Expiration Date The date (and time. ASHP American Society of Health System Pharmacists. Critical Surface Any surface that comes into contact with previously sterilized products or containers.97% of all air particles 0.000 particles of 0. or sterile substances. and lighting equipment.Pharmacy Clean Room Glossary Anteroom A support area adjacent to the clean room. Also known as a Laminar Flow Hood. 1 Technical Bulletin 3 . Clean Room Manufacturer A company which provides a variety of products and services for clean room environments. equipment.) Clean rooms are classified based on the maximum number of allowable particles 0. the product should be discarded beyond this date and time). When HEPA filters are used as a component of a horizontalor vertical-laminar-airflow hood. For example. cannula. Withdrawal of a sterile solution from an ampule in a Class 100 airflow hood would generally be considered acceptable.
" V-Wall A modular wall system affiliated with Herman Miller. at a minimum concentration of 10 organisms per square centimeter of filter surface.2 micron or less) that will produce a sterile effluent when challenged with a solution containing the microorganism Pseudomonas diminuta. Authors of a pharmacy advisory document entitled "Dispensing Practices for Sterile Products Intended for Home Use. Temperatures (USP) Frozen means temperatures between -20 and -10°C (-4 and 14°F). Room temperature means temperatures between 15 and 30°C (59 and 86°F). USPC United States Pharmacopeial Convention. USP Procedures and products that adhere to United States Pharmacopeial standards. 1 Technical Bulletin 4 . Vertical Flow Hood Airflow hood used for preparation of toxic sterile substances such as chemotherapeutic agents. Generally referred to as USP. Sterilizing Filter A filter (of 0. Inc. such as a syringe or ophthalmic container. and sterility. Refrigerated means temperatures between 2 and 8°C (36 and 46 °F). Inc. The HEPA filtered air emerges from the top and passes downward through the work area to protect the technician when preparing toxic substances. An agency which sets pharmaceutical standards. components (e. and final sterile products prepared meet predetermined requirements with respect to identify purity. containers).g. V-Wall modular walls integrate with Herman Miller CO and AO components.Pharmacy Clean Room Quality Assurance Activities used to ensure that the processes followed in the preparation of sterile drug products lead to products that meet predetermined standards of quality. that can be used to create a certified Clean Room. Quality Control Testing activities used to determine that the ingredients. non-pyrogenicity. Validation Documented evidence providing a high degree of assurance that a specific process will consistently produce a product meeting its predetermined specifications and quality attributes. Repackaging The subdivision or transfer from a container or device to a different container or device.
conditioned air in an average office space is exchanged six times an hour. These hoods are used to protect the technician when preparing toxic substances such as chemotherapeutic agents.Pharmacy Clean Room Traditional Preparation of Sterile Products and Associated Problems For many years. in a common clean room. standard practice in many pharmacies has been to prepare sterile products within the microenvironment of an unidirectional airflow hood. biotech research. the ASHP's Technical Assistance Bulletin has formalized recommendations for creating a clean environment to surround the airflow hood microenvironment.5 micron) from standing surfaces and incoming air. For example. (ASHP). the TAB now makes clean room technology desirable for most pharmacies. the pharmacy profession has now established recommendations to promote higher quality standards for prepared sterile products. a clean room can be a highnoise and high-heat environment. There are two types of hoods used in admixture areas. The airflow hood kept the immediate preparation area clean but surfaces surrounding the hood were subjected to airborne particles and contaminants. The key issue in the clean room is to provide an area for IV preparation that is free of contamination and limited in the number of airborne particles.9% of particles that are 0. the USP intends to expand its scope and context to include the preparation of sterile products in pharmacies. Since 1993 there has been a significant upgrading of performance requirements for institutional pharmacies. A clean room is a confined area in which the air must be so pure that even micron-sized particles are screened out. air is filtered and fully exchanged 60 or more times an hour. Recently clean rooms have been adapted for pharmacy. Often the airflow hood was set up in an area adjacent to the main pharmacy. and syringes of medication are prepared in the clean room area of the pharmacy. The USPC has also distributed an advisory document entitled "Dispensing Practices for Sterile Products Intended for Home Use. This admixture process occurs under a horizontal or vertical airflow hood that is found inside a clean room or clean area in the pharmacy. HEPA-filtered air emerges from the top and passes downward through the work area. For example. This directs vapors and splashes away from the technician. The term "laminar" indicates that the final filter channels air into parallel streams to promote uniform air flow. However. The clean room may also be known as the clean area or critical area.000 particles of 0. Other types of IVs require a separate medication to be added to the solution in a process called IV admixture. Clean room technology has been used for many years in microelectronics assembly. Under a laminar airflow hood there is a constant pressure of twice-filtered clean air that flows in a laminar pattern across the work surface at approximately 90 linear feet per minute. piggybacks. For size comparison. the particle count in a Class 10. 1 Technical Bulletin 5 . The reason for filtering these particles is to prevent microbes from migrating independently. These contaminants could potentially compromise the quality and aseptic integrity of sterile products. Because documented cases of sterileproduct contamination have occurred. thereby virtually eliminating airborne particles. In a vertical flow hood. Inc. Description of Clean Room and Activities What is a Clean Room? In essence." While this document is intended for home care. Because of this airflow rate and the number of filters and air pumps required to sustain it. To compare this level of purity. This air purity is achieved through the creation of a shell or secluded area that is sealed off from the rest of the environment. This upgrading has been prompted by the "Technical Assistance Bulletin (TAB) on Quality Assurance for PharmacyPrepared Sterile Products" published in November 1993 by the American Society of Health System Pharmacists. The process of preparing IVs may also be known as sterile preparation of parenteral products or IV admixture. This clean air physically sweeps the work area and prevents the intrusion of contaminated room air.000 clean room may not exceed a total of 10.5 micron or larger per cubic foot of air. a micron is equal to onemillionth of a meter. The clean room can effectively remove viable microbes by removing particles (less than or equal to 0. Microbes are typically carried by airborne dust and organic particles. Many IVs arrive from the manufacturer already containing a solution and will not require additional preparation. and pharmaceutical manufacturing. The bulletin has also created more awareness among pharmacists concerning clean room procedures. Some pharmacists regard the TAB as a guideline only and choose not to follow all the recommendations.3 micron or larger. In both types the air is drawn through a High-Efficiency Particulate Air ("HEPA") filter which removes 99. Clean Room Activities IVs.
patient safety.000 clean room with positive air pressure relative to adjacent pharmacy areas. community pharmacies. Risk Level 1— Requires sterile products to be prepared inside a horizontal or vertical laminar airflow hood (Class 100 environment). Other areas (such as the anteroom) should be separated from the controlled area by an air barrier.000 condition allows no more than 100. Clean rooms are classified according to the number and size of particles found in a given cubic foot of space once the room is operational. increasing from least potential risk (Level 1) to greatest potential risk (Level 3). The Technical Bulletin is organized by several categories: • Policies and Procedures • Personal Education • Training and Evaluation • Storage and Handling • Facilities and Equipment • Aseptic Preparation Techniques • Process Validation • Expiration Dating • Labeling • Product Evaluation and Documentation Although you should gain general knowledge regarding the Technical Bulletin. and facility design. Level 2 includes products prepared for longer-term usage and carries higher risk to the patient if the product is contaminated. more stringent requirements are appropriate. potentially damaging particles should be regulated. nursing homes.Pharmacy Clean Room A horizontal flow hood moves air toward the worker. The "Technical Assistance Bulletin (TAB) on Quality Assurance for Pharmacy-Prepared Sterile Products. The standard states that to achieve the goals of clean room operation. It has set up a classification system called (at time of publication) Federal Standard 209E. Each risk level has different quality assurance recommendations for product integrity. Or prepared in a properly maintained and monitored Class 100 clean room (without a hood). The quality assurance activities for risk Level 3 are even more demanding in terms of process and facility requirements. laminar flow of air. therefore.5 microns and larger per cubic foot of air. Level 1 preparation is the least demanding. The number of particles determines the class of the room.000 clean room which has a positive pressure differential relative to other pharmacy areas.000 • 1 Technical Bulletin 6 . the section most applicable to Herman Miller is "Facilities And Equipment. The recommendations apply to pharmacy services in hospitals. home health care organizations. Risk Level 3— Sterile products should be prepared: • In a Class 100 horizontal or vertical laminar airflow hood that is properly situated in a Class 10. Technical Assistance Bulletin (TAB) Guidelines Pharmacists are responsible for the aseptic preparation of sterile products. Risk Level 2— Calls for a Class 100. Risk Levels Established by the Technical Bulletin The Technical Bulletin groups sterile products into three levels of risk to the patient.000 particles 0.000 room allows no more than 10. enteral and parenteral nutrition) that are not a threat to the technician. Class 100 Class 100. a Class 100. Horizontal flow hoods are used for preparation of nontoxic parenterals (antibiotics." You will also need to become familiar with the risk level of products as discussed in the Technical Bulletin. describes appropriate practice procedures for preparation of sterile products matched with potential risks posed to the patients. The guidelines recommend that the hood be placed in a limited access area sufficiently separated from other pharmacy operations to minimize the potential for contamination from outside sources. For example. The horizontal movement allows a more uniform. A Class 10. Clean Room Standards and Guidelines Federal Standard 209E The Federal Standards Bureau determines how clean a clean room must be.000 sub-micron particles per cubic foot and a Class 100 room allows no more than 100 submicron particles per cubic foot. and other settings. with drugs and supplies stored on shelving above the floor." published by the ASHP in November 1993.
Terminally-Sterilized Solutions should be prepared in a Class 100 laminar flow hood situated in a Class 100.000) depending on the risk level of sterile products being prepared in the critical area. The support area (anteroom) adjacent should meet Federal Standard 209E Class 100. partition. It is up to the board of pharmacy in each state to interpret guidelines.000 requirements and should be separated from the critical area by a barrier (for example.Pharmacy Clean Room • Each air-controlled area must have a positive pressure differential of at least 0. a plastic curtain.05" of water relative to adjacent areas that are less clean. Customer opinion on this issue varies widely.000 control area. Herman Miller workstations and cart products are used in the anteroom more often than in the clean room. This support perimeter reduces the risk of contamination in the clean room. The anteroom may also require a clean room rating (usually Class 100. The final decision is up to individual pharmacies. or wall). Anteroom Description and Activities The anteroom is critical to meeting TAB recommendations because it forms a protective perimeter around the clean room. The anteroom is usually located adjacent to the clean room. Enforcement of Guidelines Clean rooms found in pharmacies may or may not be certified or built to meet the TAB recommendations. The Pharmacy Manager should consult with the state board of pharmacy (the organization responsible for licensing of pharmacy operations) in making this decision. and how (and if) they will be enforced. Its key function is to create an area in close proximity to the clean room where technicians perform support tasks. determine if they will be followed. • 1 Technical Bulletin 7 .
Modular or Retrofit — Both are built with prefabricated materials/components. order checking Computer entry. the personnel requirements. or any disturbance that produces air currents capable of introducing contaminants into the hood. Herman Miller Subcontainers can contain and organize these sterile preparation orders. Position laminar flow hoods away from excess traffic. and printers should be placed in the anteroom. The pass-through is usually installed at standing height — 48" (1219mm) — in the wall between the clean room and anteroom. Gain an understanding of the types of products that will be prepared and their associated risk levels. As the Herman Miller representative you can assist the pharmacy in this space analysis. Clean Room Size The size of the clean room depends on the volume and risk level of IVs and the types of medications prepared each day. and how much space will be required to support these activities. the Pharmacy Manager should conduct a complete analysis of the work process flow to determine the most efficient allocation of space for the clean room and the anteroom. additives. Herman Miller Process Tables and L Carts can be used for order checking. and large quantities of IVs are usually stored in the anteroom.000 clean rooms. they accommodate modular or hardwired electrical power. Complete V-Wall information is listed later in this document. and how many pass-through module locations will be required? Will an anteroom even be needed? Identify the necessary activities. Drywall — More or less a custom application. Herman Miller carts can be used for this purpose. This affects the number and type of hoods needed (horizontal and/or vertical). and takes the most time to build. The anteroom also handles sterileproduct distribution from the clean room to all other pharmacy and user areas. and they integrate with CO and AO components. A shelf in the pass-through facilitates transfer traffic. doors. a modular floor-to-ceiling wall system that has been used to create certified Class 10. Sinks.Pharmacy Clean Room In general the TAB recommends that particle-producing activities be performed in the anteroom. supplies. Packaging should be removed in the anteroom and not be allowed in the clean room • • • • Order processing. Allocated Space In conjunction with the Herman Miller Sales/Design team. Typical depth is 18" (457mm) to 30" (762mm). air vents. also the most disruptive. Herman Miller has an alliance with V-Wall. V-Wall modular systems have several advantages: they can be reconfigured for later use. number of people. How will materials move in and out of the clean room. These products facilitate cleaning because they are easy to move. Most costly. Pass-through modules allow such transfer without compromising air quality. dusty. Typical dimensions range from 18" wide by 18" high (457mm by 457mm) to 24" wide by 48" high (610mm by 1219mm). and dirty. The shelf may receive incoming orders for sterile preparation. least flexible. the lower area may receive completed orders ready for return to the anteroom and further distribution. not in the clean room. generating labels and affixing them to orders Hand scrubbing and gowning Bulk supply storage The pass-through is basically an airlock with two gasketed. Softwall — A clean room environment constructed with vinyl walls (curtains). Ampules. Microenvironment — A specific cabinet built for a workstation that separates the technician from the product. SM-Series Shelves create inclined storage space and Wire Carts can be used for bulk storage. the other to the anteroom. The only items typically stored in the clean room are supplies used in the sterile preparation process. 1 Technical Bulletin 8 . computers. location where the activities will be performed. This is the construction method where Herman Miller can be most helpful. Subcontainers removed from the pass-through can be placed on a Process Table for clean room transfer and parking at the airflow hood. This may be a tabletop model that is not a good solution for high volumes of sterile-product preparations. Material Transfer Between Anteroom and Clean Room Controlled material transfer is critical for sterile products at risk Level 2 and Level 3. These activities include: • Removing IV solutions and supplies from manufacturers' packaging. Lab Modules. can also be mounted on wheels. or Wall Strips. transparent acrylic doors — one opens to the clean room. Considerations for Planning and Design Clean Room Construction Methods There are many ways to construct clean rooms and clean areas. and space allocation. Workstations can be created with work surfaces on Herman Miller Support Panels.
• • • • Operational Management Consider the continuation of existing pharmacy operations during the construction stage.000? Should the clean room be closed off from the rest of the pharmacy? An environmental testing or certifying agency will need to be identified in order to obtain clean room certification and to establish continual room monitoring. determine the specifications for lighting. Requests for these products should be directed to a clean room supplier such as CRI. humidity). type.000 or 100. and outside clean room contractor(s). • • • • • • • • • • There will be a number of miscellaneous items also required in the clean room that are outside of Herman Miller's typical product package. At this stage. CRI's contact information is listed later in this document. you may leverage other suppliers (such as V-Wall) through your involvement. temperature. Design Requirements The following is a useful list of questions to determine design requirements: • • • What risk level or clean room classification is needed? Is positive air pressure required? How will the clean room be separated from other areas in the pharmacy? How many and what types of hoods will be required? Where will they be located? Where will supplies. additives. and location of air filters required to meet clean room classifications. Many people — and many suppliers — will be involved in planning and design.Pharmacy Clean Room When determining the size and layout of the clean room. the pharmacy department. In all probability the entire project will be managed by the Pharmacy Manager. These items need to be stored conveniently near the clean room without compromising sterile preparation. Are there slow and busy times? Is it open 24 hours? How can we provide effective solutions during the slow and busy times and increase productivity during peak hours? Determine the risk level of the most commonly prepared medications. Usually the clean room manufacturer. such as Clean Rooms International. How will the transition from the old to the new space be executed? Understand the nature of the work operation in the clean room. humidity. Allocation of Responsibilities Early in the process it is very important to identify those who will be involved in designing and building the clean room — architects. Clean Rooms International (CRI) is a company that can be helpful in this determination. 10. • • • 1 Technical Bulletin 9 . will: • Determine the number of air exchanges needed per hour to achieve the desired clean room classification Discuss what types of light levels are required Recommend appropriate lighting and ceiling fixtures Determine the acceptable noise levels Determine necessary HVAC requirements (heating. IVs. hospital maintenance engineers. you can bring in Clean Rooms International to consult with the end user and determine these specifications. identify the quantity. Herman Miller's opportunity is to be a resource to the Pharmacy Manager. and other supplies will be used throughout the day. syringes. Once these parameters are established. additives) will be stored and understand the transport requirements. Though Herman Miller is a small part of the entire process. air conditioning. piggybacks. What clean room classification is required — Class 100. Large quantities of IVs. ampules and other injectable medications be stored? In the clean room or anteroom? How many people will work in the clean room? In the anteroom? How will supplies and sterile preparations be transported between the anteroom and clean room? How many and what types of passthroughs are required? How will sterile preparations be transported to the hospital floor? How will biohazard waste be handled? What are the ceiling and lighting specifications? Will the clean room be certified and continually monitored for air quality? What agency will be used? Are security measures required? How will access be limited to authorized personnel only? How many hours per day will the clean room be in operation? When are the peak hours? How will pharmacy operations be maintained during the construction phase? How will HVAC issues be addressed? Supply Management Determine where the supplies (IVs. and noise.
There are many configurations for anterooms and clean rooms which will comply with ASHP Guidelines.000 or 100. All the clean room examples are shown as Class 10. The structural walls are shown in solid black lines.Pharmacy Clean Room Typical Installations The following three plan views represent typical anteroom and clean room installations. The plan views presented here are for discussion purposes. The three views are variations based on the same architecture of structural walls. they illustrate three examples of possible designs. Actual requirements may vary based on the risk level need.000. open lines represent V-Wall Modular Wall construction. 1 Technical Bulletin 10 .
V-Wall easily facilitates future room design changes. Herman Miller carts can be used for bulk storage of IVs. Process Tables can also be easily rearranged to increase productivity as work flow needs change. patient profile review. Sinks and waste disposal are confined to the anteroom. Herman Miller workstations create the Administrative Area which supports computer use. order printing. Vinyl offers the best solutions for cleaning. The bench is hinged and can be swung out of the way to allow cart passage. Pass-through refrigerators allow for bulk IV transfer. Wire Carts can exit the anteroom through the exterior airlock for sterile-product distribution to the floor. A sink unit is situated near the airlock for pre-passage scrubbing. A second function of the bench is to block unauthorized passage of material. For seating. Two additional airlocks provide air quality protection. V-Wall provides a convenient solution for accessing or removing the laminar flow hoods for repair or replacement. 1 Technical Bulletin 11 . Inside the clean room are two Class 100 airflow hoods. Herman Miller recommends the use of a moveable wall system such as V-Wall Modular Walls.000 and is separated from the main pharmacy by an airlock. They can also be situated to transfer materials within the anteroom and to the clean rooms. Herman Miller recommends chairs and stools with vinyl upholstery for all clean room and anteroom areas. Within the second airlock is a bench where technicians exchange shoes or place booties over street shoes. materials are carried on an L Cart. The anteroom is certified at Class 100. The hoods are supplied by two pass-through modules. The Wire Cart provides transport and bulk supply storage of stock solutions. Because the wall panels are removable. and labeling. Clean Room The air exchange rate inside this room is approximately 65X/hour. This area also stores reference material.Pharmacy Clean Room Plan View 1 Anteroom This plan view is drawn for a pharmacy requiring high-volume sterile preparations at the highest risk level — Risk Level 3. Herman Miller flipper doors used here should be vinyl-surfaced for ease of cleaning. The Order Assembly and Checking Areas use Process Tables that can be rolled away for easy floor cleaning. order processing. The first airlock opens to a convenient changing room for gowning with a Locker for garment storage.
000 Order Checking Wire Cart Process Table Pass-Thru Process Table Pass-Thru Hood Process Table Locker Changing Room Air Lock Class 10.000 Pass-Over Bench Hood Wire Cart Not to Scale 1 Technical Bulletin 12 . Sink Sink Outgoing Herman Miller Work Surface and Overhead Storage Administrative Area 5-High Pharmacy Shelf Unit with Wire Cart Below L Cart Order Assembly Process Table Locker Anteroom Class 100. Process Table Pass-thru Ref.000 Air Lock Class 100.Pharmacy Clean Room Structural Walls Incoming V-Wall Modular Walls Pass-thru Ref.000 L-Cart Risk Level 3 IV Prep Class 10.000 Air Lock Class 10.
Herman Miller recommends the use of a moveable wall system such as V-Wall Modular Walls. Anteroom This plan view is drawn for a pharmacy requiring less volume than the installation shown in Plan View 1. Computer use. Because the wall panels are removable. Order Assembly and Checking are combined at the single pass-through module. It can be cost effective to increase air pump capacity rather than add the construction expense of airlocks. reference materials. order printing. Clean Room Technicians wash and gown in the anteroom. then go directly into the clean room. the anteroom and clean room are separated by vinyl curtains. Certifications of Class 100. Herman Miller Carts are used to transfer materials within the anteroom and distribute sterile products to the floor. Movable Process Tables transfer orders from the passthrough to the hood.000 are attainable without airlocks by increasing air pressure and rate of air exchange. 1 Technical Bulletin 13 . Process Tables facilitate material transfer and allow easy floor cleaning. The critical area has two Class 100 airflow hoods served by a single pass-through module. V-Wall easily facilitates future room design changes.000 and 10. V-Wall provides a convenient solution for accessing or removing the laminar flow hoods for repair or replacement.Pharmacy Clean Room Plan View 2 Instead of airlocks. The Wire Cart provides transport and bulk supply storage of stock solutions. and sinks are located in the anteroom.
Pharmacy Clean Room Structural Walls V-Wall Modular Walls Wire Cart Locker Herman Miller Work Surfaces and Overhead Storage Storage Area 9-High Pharmacy Shelf Unit Administrative Area Anteroom Class 100.000 or 100.000 L Cart Wire Cart Process Table Hood Not to Scale 1 Technical Bulletin 14 .000 Order Assembly and Checking Area Process Table Process Table Wire Cart Pass-Thru Sink Hood Process Table Vinyl Curtain Risk Level 1 or 2 IV Prep Class 10.
this installation uses vinyl curtains and focused horizontal air flow from the back of the room and higher pressure to attain Class 10. Wire Cart Administrative Area Anteroom/Order Prep Class 100.Pharmacy Clean Room Plan View 3 Instead of airlocks.000 certification.000 or No Rating Herman Miller Work Surface and Overhead Storage Pass-Thru Module V-Wall Modular Walls Vinyl Curtain Process Table Process Table Risk Level 1 or 2 IV Prep Class 10.000 L Cart Hood Hood Not to Scale 1 Technical Bulletin 15 . noise levels can be high. Structural Walls Storage Area Double Wide Bulk Supply Cart Herman Miller Work Surfaces and Overhead Storage Sink 9-High Pharmacy Shelf Unit Wire Cart Wire Cart Ref.000 or 100. Because of high rate of air flow.
and syringes while working. Inform decision makers of the following V-Wall advantage: V-Wall is modular. each with an airflow hood. president. Anteroom • Wire Carts to deliver IV solutions and piggybacks waiting for preparation. Wall hanger strips can be concealed with standard V-Wall product if necessary. V-Wall easily facilitates future room design changes. and Subcontainers Wire Carts for bulk supply transport and storage of stock solutions Herman Miller Contact Information For additional information on clean room planning and technical assistance. Stipple vinyl with PreFixx can be cleaned with mild soap and water. contact: Jack Eichner Herman Miller for Healthcare.000 clean rooms. For technical questions about V-Wall product capabilities contact your regional wall service center. Equa® or Ergon® work chairs and stools with vinyl covering. It can accept any number and size of pass-through modules necessary for clean room operation. which is the wall covering recommended for use with V-Wall clean room application. Bleach in concentrations of 1 cup to 1 gallon of water is acceptable if the surface is rinsed thoroughly with water after application.Pharmacy Clean Room List of Appropriate Herman Miller Product Herman Miller has opportunities to support clean room installations with the following products: Herman Miller Wire Carts are ideal for anterooms and clean rooms because they provide a minimum of static horizontal surface where contaminant particles can accumulate. It is less costly and accommodates modular or hardwired electrical solutions. Herman Miller support components include work surfaces or Process Tables in combinations of sit-down and standup heights to access IVs. V-Wall integrates with other ceiling manufacturers or provides standard solutions of its own. AO components. V-Wall Modular Wall Systems V-Wall is a modular wall system that integrates with CO and AO components. 2855 44th Street. • Clean Room • • • • It is important to communicate to decision makers that costly stainless steel surfaces are not required for Class 10. meds. Vinyl curtains also integrate with V-Wall. There is zero survival of staphylococcus aureus and klebsiella pneumoniae. It prevents the migration of most staining agents into the vinyl. MI 49418 (616) 654-8000 Gencorp Gencorp is the provider of Stipple 2 vinyl. and relocatable. V-Wall provides a convenient solution for accessing or removing the laminar flow hoods for repair or replacement. For more information. and drawers. and are compatible with V-Wall Modular Walls. It promotes less dust than conventional construction. L Carts. Lockers. and Subcontainers. including work surfaces. reusable. Ohio 43537-4060 (214) 951-9255 (Kay Tomsic) • • • • Allied Suppliers of the Clean Room Package With alliances to the following cooperative suppliers. shelves. 409 All Purpose Cleaner) and solvent-type cleaners. PreFixx is also effective against mold and mildew.or AOSeries) or Dispensing Rail with Subcontainers to hold stocks of meds and syringes. V-Wall components can be finished with the Stipple 2 vinyl covering collection which does not promote microbial growth. Pharmacy shelf storage (SM. Cart surfaces and surfaces of CO or AO components can be cleaned easily. Work chairs and stools with vinyl fabrics. Alcohol may also be used. piggybacks. CO transport components including Process Tables. Inc. see "Gencorp" below. SW Grandville. addresses are listed on the last page of this document. and protects against surface growth of fungi and bacteria. household cleaners (Fantastic. There may be several work areas. Bulk Supply Carts or Wire Carts for distributing meds to the floor. Lockers. are less costly. Stipple vinyl is treated with PreFixx. CO transport components including Process Tables. Because the wall panels are removable. a protective finish with excellent cleanability and stain resistance. Quaternary ammonium compounds and phenol-based compounds are not recommended. Contact the manufacturer directly for swatch cards or detailed questions relating to cleaning and staining data: Gencorp 1722 Indian Woods Circle Maumee. L Carts. Herman Miller is strongly positioned to participate in opportunities in the clean room market. You may also call (800) 255-9255 and ask for Bill Griftner. 1 Technical Bulletin 16 .
Additional References • Technical Bulletin "Principles of Sterile Product Preparation" — reprints available from ASHP by calling (301) 651-3000 American Society of Health System Pharmacists (ASHP) — (301) 657-3000 United States Pharmacopeial Convention. • • • • • • • • • • • Pass-through modules Ceiling filter modules Fan filters HEPA fan filters (interface with hospital ventilation system) Air purifiers Laminar flow modules (interface with hospital ventilation system) Approved lighting fixtures Softwall clean rooms Vinyl curtains Ceiling grids General consultative services for complete clean room installation CRI has a national network of authorized distributors who provide product and consulting services to Herman Miller. (USPC) — (800) 227-8772 • • 1 Technical Bulletin 17 . CRI specializes in consulting and supply of the following clean room equipment.Pharmacy Clean Room CRI (Clean Rooms International) CRI is an experienced designer and builder of laminar flow systems and equipment for clean rooms. Call (800) 333-7111 for the location of the dealer nearest you. Inc.
New Hampshire.C. Pennsylvania. Kansas. Utah. North Carolina.Northeast Fabricated Wall Systems. Mississippi. Wyoming and Pacific Rim Region 3 . Massachusetts.Dick Wood P.Robert Ruso 5605 McAdam Road Mississauga. South Carolina. Virginia. Inc. 1-800-966-5058 Sales Support . 11A Old Windsor Rd. . Missouri. 1-800-262-3613 Sales Support . New Jersey. South Dakota. Texas 75227 214-381-0101 FAX 214-275-6533 Areas Covered Arkansas. Inc. New Mexico. Inc.Mick McCormick 13902 Giles Road Omaha. CANADA FAX 905-712-2468 Areas Covered All of Canada Region 5 . Maryland.Tom Holden Region 2 . Region 6 . Inc.Southeast Environamics. North Dakota.Paul Holden Order Information . Washington.Pharmacy Clean Room List of V-Wall Representatives Information — Bill Griftner 1-800-255-9255 8200 Lovett Avenue Dallas. Arizona. Hawaii. Nevada. Georgia. Vermont. New York. Kentucky. Wisconsin Region 4 . Bloomfield. Bland Street Charlotte.Sharon Baker 940 West 3160 South West Valley City.Canada Designboard Industries.Southwest Wall Services. Delaware.Chris Weiss Order Information .Harry Johnson 200 E. 1-800-647-9255 Sales Support . Iowa. Louisiana. Nebraska 68138 402-896-5520 FAX 402-896-9445 Areas Covered Illinois. West Virginia 1 Technical Bulletin 18 . 1-905-712-2466 Sales Support . Minnesota. 1-800-875-9255 Sales Support . Nebraska.Dick Lasnier Order Information .Ed Burns Order Information . Texas and Mexico Region 1 .Midwest ICS/Wall Service Center 1-800-642-9255 Sales Support . California. North Carolina 28203 704-376-3613 FAX 704-376-0246 Areas Covered Alabama.West The Wall Center. Oregon.Robert Ruso Order Information . Michigan. Indiana. Montana. Box 0837. Ohio. Washington D. Oklahoma. Colorado. Florida. Idaho. Inc. Tennessee.Ron Weddell Order Information . Ontario L4Z-1N4. Rhode Island.O. Utah 84119 801-973-8989 FAX 801-973-0307 Areas Covered Alaska. Connecticut 06002 203-242-1960 FAX 203-242-8225 Areas Covered Connecticut. Maine.
Rapunzel. V-Wall. Rapid Response. Co/Struc.. and Wild Card are among the registered trademarks of Herman Miller. ™ Y. Ground Cloth. Timepiece. DIAMOND. Ambi. Pellicle. Iota. Intersite. Ethospace. ID. CLT. Proper. Kinemat. and Traverse are among the trademarks of Herman Miller. Frottage. Hollington. visit www. Chadwick. Perspectives.For the location of the sales facility or dealer near you. Passage. Inc. Ergon 3. E-Wall. Equa 2. Florence. Systems Bridge. Potomac. Y. Milafin. Meridian. Custom Choices. Inc. Flex-Edge. Ambassador. Puzzle. Action Office. Scooter. Inc. Newhouse Group. CoActive. Burdick Group. Raleigh.hermanmiller. Zeeland. . Liaison. Aeron Chair Configuration. © 1999 Herman Miller. Arrio. Harmonics. Relay. Aeron. Milcare. Beirise Collection. Mosaic. lc SM OASIS is a service mark of Herman Miller. Inc. Pulsar. Eames. Response Plus. Myriad. Michigan ® Z.com/healthcare or call (800) 628 0058. Super Room. Q.


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Proform 590 T Treadmill from ProForm
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Introducing: Proform 590 T Treadmill from ProForm
My Treadmill Reviews are happy to present the brilliant Proform 590 T Treadmill.
With so many available these days, it is good to have a make you can recognise. The Proform 590 T Treadmill is certainly that and will be a perfect acquisition.
For this great price, the Proform 590 T Treadmill is highly recommended and is always a popular choice with many people. ProForm have provided some excellent touches and this means good value.
Manufacturer Description
Introducing the ProForm Power 995 Treadmill. Featuring revolutionary technology and a powerful design, this treadmill delivers undeniable results. Compatible with iFit Live Technology, the Power 995 delivers workouts Powered by Google Maps, training with Jillian Michaels and personalized workout programs downloaded wirelessly to the console every day. Plus, with Nike + iPod compatibility, you can track your performance and watch your progress online. Other features include ProShox Elite 2 Cushioning, QuickSpeed and Quick Incline controls and a powerful 3.0 CHP Mach Z Commercial Motor.
|The Proform 590 T Treadmill
|590 T Console Detail with 6" Backlit display and Quick Controls
|The 590 T's SpaceSaver Design
Features and Specifications:
- 2.25 CHP Mach Z Motor: Experience expanded power with this quiet, self-cooling drive system. Employing an axial fan, this motor reduces noise as it cools internal components enhancing your workout environment and extending the motor's life.
- ProResponse Cushioning: This innovative cushioning integrates firmer support zones at the foot strike and takeoff portion of your stride and a softer support zone throughout the rest.
- 6" Backlit Display: Keep track of your workout progress on this 6" display that displays your speed, time, distance, incline, pulse and calories burned.
- 0–10 MPH QuickSpeed Control: Instantly change the speeds between 0–10 MPH with the touch of a button.
- 0–10% Quick Incline Control: The best and most convenient incline adjustment allows you to change inclines with the touch of a button.
- 16 Workout Apps: Get the workout you want with 16 built-in workout apps designed by a Certified Personal Trainer.
- Dual-Grip EKG Heart Rate Monitor: Make the most out of every workout by monitoring your heart rate with these built-in handlebar sensors.
- SpaceSaver Design with EasyLift Assist: This revolutionary design allows your treadmill to fold vertically for storage. To make it even easier, this treadmill includes a powerful shock that will help lift the deck with an easy push.
- 20" x 55" TreadBelt: A vital component of the drive system, this roomy treadmill belt is designed to operate both smoother and quieter than the average treadmill belt.
- Compatible Music Port for iPod: Rock your workout to your favorite music!
- 300 lb. Weight Capacity: The ProForm 590 T Treadmill accommodates up to 300 lbs.
- Warranty: Lifetime Frame Warranty, 25-Year Motor Warranty and 1-Year Parts & Labor Warranty
ProResponse Cushioning reduces impact on your joints.
The 590 T features iFit Live compatibility
iFit Live Technology Built-In Workouts Powered by Google MapsAcross the street or around the world—you draw it and iFit Live Technology turns it into a workout! Powered by Google Maps, workouts recreate the route, automatically adjusting the incline to match the terrain. The treadmill does what the street does! Choose a pre-drawn workout or draw a map anywhere in the world! Watch your progress on a Google Maps satellite, map or street view. Plus, compete against other iFit Live community members; race and compare your time with people from around the world!
Jillian Michaels, America's Toughest TrainerLose weight with America's Toughest Trainer, Jillian Michaels. The ultimate motivation, Jillian's voice coaches you through your unique weight-loss program to help you burn calories, slim down and reach your goals! A new workout is automatically downloaded every day to the 590 T Treadmill. Each workout in your personalized 8-week program is progressive from start to finish and automatically controls your speed and incline to maximize your results!
Personalized TrainingGet training from a real personal trainer in the comfort of your living room. Whether you want to lose weight or train for a marathon, workouts are created just for you! A Certified Personal Trainer creates a unique, personalized program and loads the workouts right onto your equipment through iFit Live? Technology. Workouts automatically adjust the speed and incline of the treadmill to maximize your results.
Track and Share ResultsTrack your nutrition, weight goals, event training and other activities on iFit.com. Your workout results from any map, Jillian Michaels or manual workout are automatically uploaded in real time to your personal profile. Plus, for extra motivation, you can share your workout and interact with your Facebook friends!
T Series Treadmills from ProForm
|iFit Live
|Yes, Compatible
|Yes, Compatible
|Display Type
|6" Back-lit Display
|6" Back-lit Display
|2.25 CHP Mach Z Commercial Pro
|2.5 CHP Mach Z Commercial Pro
|Built-In Workouts
|Workout Programs
|8 Performance, 8 Weight-Loss
|8 Performance, 8 Weight-Loss
|Speed Adjusatbility
|Incline Adjustability
|0 degree decline - 10 degree incline
|0 degree decline - 12 degree incline
|AutoBreeze Workout Fan
|Dual-Grip EKG Hear Rate Monitor
|Weight Capacity
|300 lbs.
|325 lbs.
|Lifetime Frame and Motor, 5 Year Parts and 2 Year Labor
|Lifetime Frame and Motor, 2 Year Parts and 1 Year Labor
Product Features
- 3.0 CHP Mach Z Commercial Motor
- 0-12 MPH QuickSpeed Control
- 0-15% Quick Incline Control
- 20" x 60" Treadbelt
- iFit Live Technology Compatible
View our full range of Proform Treadmills

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Accredited member of the British Association of Removers (BAR)
- Set-price quotes – guaranteed
- Disclosure Scotland certified moving team & staff
- Free removals insurance and packing materials
Accredited member of the British Association of Removers (BAR)
"Just a quick note to say I thought the guys did a brilliant job this morning. Very professional, took great care with my belongings, and above all they were really friendly. Makes all the difference. Please pass on my thanks again."
Get a Callback
Get a Callback
- Set-price quotes – guaranteed no additional costs
- Full-time Disclosure Scotland certified staff
- Free removals insurance and packing materials
- Personal moving team guaranteed door to door
This Code applies to all furniture removal activities for UK consumers dealing with a UK-based BAR Member
BAR and its Members recognise that moving home is a stressful experience and the purpose of this Code is to ensure that Members trade in a fair and reasonable manner. In the event that this does not happen, the Code sets out in-company procedures that should enable complaints to be resolved. If this fails, then BAR as Code Sponsor provides a conciliation service aimed at resolving problems quickly and fairly. Should this fail, a low-cost arbitration scheme operated by IDRS Ltd, a subsidiary of the Chartered Institute of Arbitrators is available.
There is a range of disciplinary processes and sanctions built into the Code including expulsion for persistent or serious failure to comply with the Code.
Only bona fide Members of BAR may legally use the BAR logo on vehicles, signage, websites, letterheads and promotional or packaging material.
Compliance with this Code is mandatory upon BAR Members who are also required to advertise their adherence to this Code.
You may always contact BAR Head Office on 01923 699480 to check that the company is a Member or you can visit the BAR website at www.bar.co.uk
No Code of this kind can lay down detailed rules of behaviour to cover every occasion. The Code's effectiveness is dependent on the observance of its provisions in the spirit as well as the letter. Compliance with this Code by Members of BAR is a powerful factor in maintaining and raising standards in the professional removal industry.
Download the full British Association of Removers Code of Practice (.pdf 109kb)
"Just a quick note to say I thought the guys did a brilliant job this morning. Very professional, took great care with my belongings, and above all they were really friendly. Makes all the difference. Please pass on my thanks again."
Ms A Lyall
Edinburgh removals.
"I found the service from RSS, excellent. Communication before and during the move was good, truck turned up on time. The team was really friendly and efficient. I was on a tight schedule and the lorry got loaded quickly. Delivery was as promised and there were no breakage. I was 100% satisfied."
Mr A Gibson
England to Scotland removals.
"Two and a half years ago, RSS uplifted various goods and 40 prepacked boxes from our first floor flat and took them into store. The staff arrived promptly, were very well-presented and courteous, extremely efficient and respectful of our premises and belongings. Recently, we withdrew the goods from store and the RSS staff arrived as promised, […]"
Mr B Innes
Edinburgh removals and storage.
Check out our recent blog activity
Keep track of what you have to do – download our moving checklist!
The Ultimate Family Moving Guide
Whether you've survived a family move before or this is your very first move, we have created this guide especially for you. Our aim is to help you and your family from A to B in one piece, sanity intact.
We explained to the Telegraph 'How to pack your house like a pro'.


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Valentines Cards / January 4, 2019 / Laurel Hawkins
Life is after all about sharing happy moments together in love. There are funny Valentine cards of all kinds and shapes. If you wish to find good cards that are funny you just have to search in all the right places. Even before you search consider making a funny card. You may be gifted when it comes to humor and what better way of sharing what you have with others. To make funny Valentine cards you need to make sure that you have an idea that is sure to tantalize all your recipients. You can use the materials you have as well as funny pictures to communicate your funny Valentine message. There is nothing more interesting than knowing that people are going to marvel at your joke for Valentine. However not all people make this a success and if you are one of them you do not have to worry.
It came from a time of collecting these types of catchy cute sayings and riddles. These can still be found today on the Valentines that are purchased out of the box. The Cards The cards used to fill a box with a variety of different styles and designs. Common ones were those of fruits and vegetables with these puns on them or they could include a few pictures of cute animals. Today childrens Valentines are more often in their favorite cartoon character. Homemade Valentines While children may not feel comfortable with providing homemade Valentines to their classmates today they can and should still make them for their friends outside the classroom for their adult friends and other loved ones. Not only is it a fun task to do but it helps with motor skills and creativity as well. All that is needed is a simple piece of paper.
With crochet you can create almost anything you want and attach it to the Valentine card. Flowers hearts letters words and more. When making small crochet pieces you dont need much yarn at all you can just use leftovers you have from other creations. For Valentines Day some small crochet hearts would suit perfectly as decorations attach to the Valentine card. If you are not sure how to make these hearts you can use the free receipt for a small crochet heart that I found on the website noted at the bottom of this article. These hearts are also suitable to decorate presents with. Just glue them to the paper or use double-sided tape to attach them. A Valentine card does not necessarily have to be a typical folded card there are no rules to follow. Use your creativity and make something new fun and different.
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Freevbcode Code Snippet: Return Image Type And Size From . Sitemap Image 112 .. This is the snippet Return image type and size from JPEG, GIF, BMP, & PNG files. on FreeVBCode. The FreeVBCode site provides free Visual Basic code, examples, snippets, and articles on a variety of other topics as well. Products & Services | Image Blinds Image Blinds offers high quality blinds, awnings and shutters at competitive prices for home and business owners across Brisbane, the Gold Coast and Sunshine Coast.
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The symptoms of erectile dysfunction include difficulty achieving an erection, trouble maintaining an erection, and a reduced interest in sex. Because male sexual arousal is a fairly complex process, it can sometimes be difficult to identify a specific cause. Arousal starts in the brain but it also involves the nerves, muscles, and blood vessels and can be impacted by hormones and emotions. If a problem develops with any of these things, erectile dysfunction could be the consequence.
Having learned a great deal more about erectile dysfunction including its risk factors and causes, you should be equipped to assess your own erectile function. If you have experienced erectile issues or you have some of the risk factors mentioned above, it may be worth making a trip to your doctor's office. If you choose to seek help, give your doctor as much information as you can about your symptoms including their frequency and severity as well as the onset. With your doctor's help, you can determine the best course of treatment to restore sexual function.
Does drinking water improve erectile dysfunction? Erectile dysfunction or ED is a common concern for men. Everyday factors, such as hydration levels, may affect a person's ability to get or maintain an erection. Drinking water may, therefore, help some men with ED. In this article, learn about the link between hydration and ED, and other factors that can cause ED. Read now
A larger national study, the National Health and Social Life Survey, looked at sexual function in men and women.4 This study surveyed 1,410 men aged 18 to 59 and also documented an increase in ED with age. Additionally, the study found a decrease in sexual desire with increasing age. Men in the oldest cohort (50 to 59) were more than 3 times as likely to experience erection problems and to report low sexual desire compared with men 18 to 29. Experience of sexual dysfunction was more likely among men in poor physical and emotional health. The study also concluded that sexual dysfunction is an important public health concern and that emotional issues are likely to contribute to the experience sexual dysfunction.
Think of erectile dysfunction as your body's "check engine light." The blood vessels in the penis are smaller than other parts of the body, so underlying conditions like blocked arteries, heart disease, or high blood pressure usually show up as ED before something more serious like a heart attack or stroke. ED is your body's way of saying, "Something is wrong." And the list of things that cause erectile dysfunction can include:
Clinical experience in switching medications to improve ED has been disappointing in that improvement does not often occur. Nonetheless, it is important to try to discontinue possible offending medications before proceeding to more invasive ED treatment options. Oral ED medications have changed the way clinicians discontinue medications in patients with ED and has improved the approach. For example, a patient may develop ED on a thiazide diuretic. The diuretic may be withdrawn, but a trial of oral ED therapy can be initiated during the observation period while the patient is waiting to see if any spontaneous improvement in ED occurs after drug withdrawal. Alternatively, if diuretic therapy is effective, well tolerated, and controlling blood pressure, oral ED therapy can be used on an ongoing basis to treat the side effect of ED.
Transdermal preparations of testosterone utilize the fact that the skin readily absorbs steroid hormones. Initial transdermal preparations took the form of scrotal patches with testosterone loaded on to a membranous patch. Absorption from the scrotal skin was particularly good and physiological levels of testosterone with diurnal variation were reliably attained. The scrotal patches are now rarely used because they require regular shaving or clipping of scrotal hair and because they produce rather high levels of dihydrotestosterone compared to testosterone (Behre et al 1999). Subsequently, non-scrotal patches were developed but the absorptive capacity of non-scrotal skin is much lower, so these patches contain additional chemicals which enhance absorption. The non-scrotal skin patches produce physiological testosterone levels without supraphysiological dihydrotestosterone levels. Unfortunately, the patches produce a high rate of local skin reactions often leading to discontinuation (Parker and Armitage 1999). In the last few years, transdermal testosterone gel preparations have become available. These require daily application by patients and produce steady state physiological testosterone levels within a few days in most patients (Swerdloff et al 2000; Steidle et al 2003). The advantages compared with testosterone patches include invisibility, reduced skin irritation and the ability to adjust dosage, but concerns about transfer to women and children on close skin contact necessitate showering after application or coverage with clothes.


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Interior Design Ideas For Dining Room
Interior Design Ideas For Dining Room
Interior Design Ideas For Dining Room is free HD wallpaper. This wallpaper was upload at November 14, 2017 upload by amri in Dining rooms.
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Planning for your home needs a a lot of extensive approach and plenty of higher cognitive process to do compare to once buying one. Finding the proper building heap is already a challenge, designing how your future abode will look like is another challenge. creating your dream home style on the current lot that you simply have moreover as balancing the act of designing and budgeting are often quite tough and will need professional facilitate.
Research for your dream home design. One should take what type of home they're getting ready to build before actually coming up with how it looks like. it'd be recommended to have a list of the things that you just wish your home to possess prior to making the blueprint. House designs nowadays have completely different offerings, therefore it'd be wise to browse for concepts before really golf shot of these concepts into paper.
A quick sketch would conjointly facilitate in conceptualizing your dream home. Since you do not have to be compelled to implement this style nevertheless, you'll still get concepts and mix and match the items that you simply wish to possess within and outdoors your home. However, it's important to understand the basics that will be included in your home such as the quantity of rooms, family areas, dining rooms, garage, kitchen options and toilet features that you simply would wish to own. designing for internet connections in addition as the cable and phone connections is additionally recommended.
Check local partitioning laws and building permits. Upon the completion of your blueprint, succeeding step necessary would be getting the necessary permits and existing division laws and standards in your space. be sure to implement structural specifications needed for buildings that square measure constructed in your area. this can save you many headaches that you may expertise throughout the actual construction of your home.
Designing at intervals your budget. in spite of however beautiful you will wish your home to appear and desire, you continue to have to be compelled to give a precise quantity of cash to be able to execute your arrange. Compare your current plan with the budget that you just have and willing to spare for your dream home and adjust accordingly to fit. observe that disbursement too much may lead you not having enough to shop for furnishings for your dream home.
Plot wherever your current budget will get you through with the development of your home and budget accordingly on what you'll be able to extremely acquire as your budget during the particular construction. it is higher to adjust currently together with your plan instead of having to sacrifice the quality of the development of your home once your budget starts to hurt.
Design to fit your plot. take into account the particular lot area that you just have prior to implementing your house plans. do you want to have a large field and a backyard? do you wish to locate your home just a few meters away from the road to maximize the world of the plot that you just have? Slopes ought to even be taken into consideration to be ready to control backfilling and excavation prices that will be required to execute the look that you just wish for your home.
Locate bedrooms in areas where you get to relish the privacy that you need and place windows in areas that will help in making your homes a lot of energy efficient.
Maximize your house efficiency. make certain that you just have a logical flow on your home design. The kitchen and laundry areas ought to be set near each other to conserve on plumbing installations. design areas just just like the kitchen with access to areas like the garage or areas wherever you need such accessibility. Be sure that your actual furniture would fit in the layout that you have created.
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