Roberto J. Canales
Project Manager, BSME
Tenet Health - San Ramon Pharmacy Addition Project
facts at a glance
Location: San Ramon, California
Project Start Date: September 2018
Estimated Completion: November 2019 (Tentative)
Project Budget: ~$3.5 million
Architects: Pratt Architecture
Bidding Subcontractors: Devicenzi, Concord Ironworks, BT Mancini, Sonoma Fabricators, Hellwig Mechanical, Siemens, Kirkes, Cen-Cal, Contract Decor.
Section Contents:
1. Architectural Layout
The existing pharmacy at the San Ramon Regional Medical Center began to show its dated facilities beginning in 2015 when patient demand began to slowly outpace capabilities. Tenet Health Capital Projects called upon Pratt Architects and Swinerton Builders to provide a solution to a growing problem in a preferential, non-competitive bid process. What resulted were detailed design and construction plans to build a compounding capable pharmacy addition into an adjacent courtyard and just 100 feet away from a very busy Mother-Baby Unit. The challenges: Get existing landscaping out, and get compaction soil, concrete, steel, men and materials into the courtyard while observing the strictest infection control procedures and keeping staff and patient disruptions to near zero.
Fig. 1.1: The 1,885 square foot pharmacy addition would expand into an existing courtyard space. It was to include a staff breakroom, 2 anterooms, 2 staff bathrooms, a materials receiving area, and a hazardous compounding room capable of maintaining a negative pressure environment.
2. Coordination Items
As with any project, a thorough investigation into existing conditions vs. proposed contract drawings and specifications took place prior to submitting a finalized bid package to the Owner/Architect Teams. Construction activities taking place near occupied, sensitive patient care areas are absolutely critical and require careful and thoughtful planning, especially if newly constructed facilities are expected to interface with existing MEP systems seamlessly.
Fig. 2.1: The coordination issue depicted above was one of many to be discovered. The compounding pharmacy addition sewage and supply Heated /Chilled water lines were to tie into the hospital's existing 4" line. However, the existing lines are located above and below a busy hallway leading to Neonatal Services, Intensive Care, and Reception Services departments. The challenge was to determine a construction sequence that would avoid disruption if possible, or minimize it as much as necessary.
Fig. 2.2: An issue that is all too common throughout commercial and industrial MEP design is misplacing equipment in the overhead plenum space. Whether it's a large branch duct blowing through corner wall studs, structural beams, or medical support equipment, or devices such as Variable Air Volume Units or Terminal Box units places right above 'hard lid' ceilings, it is always important for a designer to be cognizant of the practicality, feasibility, and serviceability of his design at all times...(continued below)
Fig. 2.2 (continued): ...the above situation illustrates just 1 example out of dozens, sometimes hundreds of coordination items that must be hashed out before appropriate field use construction drawings can be produced. The terminal box was moved West to the adjacent hallway as installing a service hatch in the hard lid ceiling was not feasible due to the negative pressure requirements of the adjacent chemical compounding rooms.
Fig. 2.3: The complexity of building in an occupied space can be seen in this image. The color coded mark-ups denote steel beams comprising the pharmacy addition structure. A maximum load limit of 1700 lbs. was to be observed due to the fact that the crane picks would be flying material over occupied Patient Recovery areas. Swinerton and the design team began searching for ways to minimize net loads per pick, and sectioning the certain structural steel members was part of that effort.
3. Site Plan
The delivery and staging of equipment and material is always an important consideration for any successful project. This coordination step is imperative if the project is to move forward in an occupied hospital that is to remain operation throughout the duration of construction activities.
Fig. 3.1: Overhead view of the proposed site plan. The main facility located in the center of the image, houses the courtyard new construction site. Construction team parking and material staging is located south (on the right) of the image...(continued)
Fig. 3.1 (continued): ...3D map of the proposed site plan. Orange marked area denotes proposed Lieber crane and material drop off and pick up locations. Site access to construction crews and equipment is marked on both drawings and designed in such a manner to allow staff and patients uninterrupted access to all buildings in the hospital.
4. Bidding, Scope Abstracts, and Leveling
Upon receiving a formal request for proposal from Pratt and Tenet Health Capital Projects, my immediate responsibilities aside from analyzing the contract documents, was to gather a list of reliable subcontractors interested in bidding the project. From concrete, steel, HVAC, plumbing, and interior finishes, I compiled a list of contractors Swinerton had successfully worked with on past projects to begin drafting up the specific scope abstracts that defined the roles and responsibilities for the project. Once subs received and reviewed the contract documents, I received quotes for the project and assembled them in leveling sheets for value comparison. Below are a few examples of the aforementioned documents produced as part of a complete bidding package.