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provide multi-channel speech communication between the patient and nursing staff. It is important to note the

number of PoE nurse call devices could be considerable, maybe in excess of 1000 on a large site. Therefore, the special requirements and thermal management of the racks for housing the switches, and the UPS system to supply them needs to be considered. It is often the case that the nurse call supplier and the site-wide IT network installer would work in partnership to develop and co-ordinate the design and installation process. It is important to consider the

Figure 3: Structured wired nurse call system providing full IP to the bedhead.

principles, this solution is ideal for ward refurbishments where existing containment and very often wiring can be re-used. We call our version of this Codem. Although we use LonWorks there are a number of other types of bus protocol used by different systems, the main alternative being RS485. The wards are connected together using IP.

Each network link is wired back to a standard Ethernet switch. The advantage of this design is that the wards are wired completely separately to the LAN, so they can be commissioned and operated without the need for, or reliance on, the LAN. If the network connection fails the ward will continue to

operate stand-alone. IP to a zone: An alternative solution is to

use structured wiring principles for the nurse call system. (see Fig. 2) This allows the IP element to be connected at a ‘zone’ – a sub division of the ward or department. A single device is connected by a Cat5+

cable to a switch. However, in this type of system the connection from the switches to the nurse call device is using LonWorks or another similar protocol — but not Ethernet — hence the ‘switches’ referred to in the diagram as Local Area Routers are not standard Ethernet switches but instead are a hybrid device which would be supplied by the nurse call manufacturer. The nurse call equipment connected at

the switches is identical to the bus wired system described earlier, but they now receive data and power down the structured wired cable. It is important to note that while this is power down a Cat5+ cable it is not PoE as there is no Ethernet, and therefore it should not be misconstrued as ‘full IP’ to the bedhead. For compliance with HTM 08-03

the local area routers should be powered from the UPS system if they do not have a battery backup built in. Ancillary devices, such as over doors and

pull cords, are still wired from the nurse call equipment the same as for the previous bus wired system. The connection between the local area switches is IP and each network link is wired back to a proprietary Ethernet switch. A key advantage of this design is that the

installation is fully structured wired and so allows for the system to be easily upgraded at some time in the future. It is an ideal ‘half- way’ house between the previous system and a full IP to the bed system. It would, typically, be used on new builds where containment was installed to suit structured wiring but cost constraints or functionality required did not justify the more expensive system. As with the previous example the majority

of testing and commissioning can also be carried out before the LAN is complete and spare capacity can be built in at the design

stage to allow for future expansion. IP to the bed: The final example is a

structured wired nurse call system (see Fig. 3) which provides full IP to the bedhead. It utilises proprietary PoE (Power over Ethernet) switches and is wired identically to any other structured wired system. As it is unlikely that ancillary devices will require the full IP functionality of a bedhead they are still normally wired from the nearest bedhead, or IP interface unit. This type of system is typically used in new

build installations, where the full benefits of IP at the bedhead can be realised. This might be, for example, integration with a third-party VoIP (Voice over IP) telephony system to

The actual IP element can extend just to ward level or right down to the bedhead unit… or anywhere in between.


resilience of the nurse call system during the design process. For example, the health checking of the nurse call equipment within a

ward and call logging is performed by a ward monitor unit. While in theory a single monitor device could do this from anywhere on the LAN, for resilience it makes good sense to use one per ward. Because this system is fully IP, it could

actually be a part of the site IT LAN, although, of course if the system is to be an integral part of the site LAN then it cannot be commissioned until the LAN is fully installed and tested. Alternatively, and probably more likely, it could be a separate nurse call LAN which is then connected to the site LAN at strategic points. These are important issues which need to be considered at the design stage.

Summary There is no doubt that IP-based systems are here to stay. Modern nurse call systems that are compliant with current standards, practice and guidance now have access to technology and applications that have never hitherto been available. However there are different types of IP systems with differing levels of integration that allow a choice of features and functionality within a range of budgets. It is important to consider the technology

alongside engagement with end-users, designers, client teams and installers to ensure that the solution offered is appropriate in all respects. Thought should be given to the system and IP network design to ensure a balance between resilience and cost. This should be considered along with any installation constraints and restrictions and with a thought about future expansion and flexibility. In conclusion, although much has changed

in hospitals since Florence Nightingale’s days at the turn of the century and through the 1970s, the principles established in those early days still revolve around patient safety and nursing management. The focus from nurse call manufacturers and suppliers needs to be on how technology, applied to their systems, can properly and effectively support these objectives.


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