1 Scope

1.1 This standard governs the design, supply, installation, integration, testing, and commissioning of nurse call systems (NCS) providing audible and visual communication between patients and care staff in healthcare facilities.

1.2 This standard applies to new construction and major renovation of facilities classified as NFPA 99 Category 1 or Category 2 occupancies, where ANSI/UL 1069-listed signaling equipment is code-required.

NOTE A nurse call system is the primary means by which a patient summons assistance and by which staff prioritize and respond to that summons; it is a patient-safety system, and its reliability and code defensibility govern every selection in this standard. (1.3)

1.4 The system architecture may be wired/BUS, IP/PoE Ethernet, wireless (Wi-Fi or DECT 6.0), or a hybrid combination, as selected for the project; the requirements herein are architecture-neutral except where a clause is expressly scoped to one architecture.

NOTE The following work is governed by separate standards and is excluded here: essential electrical power feeding NCS equipment, governed by Healthcare Essential Electrical SystemsHealthcare Essential Electrical SystemsResolves to the current edition.sync/healthcare-essential-electrical-systems; structured cabling pathways and backbone serving IP controllers, governed by Structured CablingStructured Cabling SystemsResolves to the current edition.sync/structured-cabling; overhead paging and mass notification, governed by Public Address And PagingPublic Address and Paging SystemsResolves to the current edition.sync/public-address-and-paging; and the general electrical work results common to all communications and electronic safety and security systems, governed by Common Work Results ElectricalCommon Work Results for ElectricalResolves to the current edition.sync/common-work-results-electrical. (1.5)

NOTE The dedicated Code Blue clinical-emergency duress network, fire alarm initiating and notification devices, standalone RTLS access-point infrastructure, staff-duress and wander-management security systems, and EMR/bed-management software platforms are outside this standard; only the NCS integration interface to those systems is in scope. (1.6)

2 Referenced Standards

2.1 Equipment, materials, software, and installation shall comply with the latest adopted edition of each of the following unless a specific edition is cited in the table or by the authority having jurisdiction.

2.2 Where referenced standards conflict, the more stringent requirement shall govern unless the Engineer of Record directs otherwise in writing.

Standard	Title
ANSI/UL 1069	Hospital Signaling and Nurse Call Equipment
NFPA 99	Health Care Facilities Code
NFPA 70	National Electrical Code (Article 517, Health Care Facilities)
NEMA NS 1	Installation Guide for Nurse Call Systems
IEC 60268-16	Sound System Equipment — Objective Rating of Speech Intelligibility by Speech Transmission Index
HL7 v2.x	Health Level Seven Clinical Data Exchange (ADT messaging)
HL7 FHIR R4	Fast Healthcare Interoperability Resources
ANSI/TIA-1179-A	Healthcare Facility Telecommunications Infrastructure Standard

3 System Architecture

NOTE The choice of architecture determines cabling, power, redundancy, and integration requirements for the entire system, and is the first decision the design must resolve. (3.1)

NOTE Wired/BUS systems carry signaling over dedicated multi-conductor cable homerun or daisy-chained to a standalone controller; they remain dominant in large acute-care hospitals because the signaling path is physically independent of the facility data network and is therefore the most code-defensible choice. (3.2)

NOTE IP/PoE systems place a cabled Ethernet drop at each device, power devices from PoE switches, and concentrate logic in a central IP server; they simplify integration and scaling but make the NCS dependent on network infrastructure that this standard requires to be isolated and prioritized. (3.3)

NOTE Wireless systems (Wi-Fi 802.11 or dedicated 1.9 GHz DECT 6.0) eliminate the cable drop to each device but require verified radio-frequency coverage in every patient care area, including bathrooms and shower rooms. (3.4)

3.5 Wireless systems shall not be specified unless a radio-frequency site survey has verified coverage in every patient care area, including bathrooms and shower rooms.

3.6 The system architecture shall be selected and fixed before design development so that cabling, power, and integration provisions are consistent across the project.

System architectureradio

● Wired / BUS (dedicated-conductor serial controller)

○ IP / PoE Ethernet (central IP server)

○ Hybrid (IP backbone with wired sub-zone controllers per unit)

○ Wireless Wi-Fi (802.11 over isolated WLAN)

○ Wireless DECT 6.0 (dedicated 1.9 GHz base-station array)

Facility scale (drives redundancy and station counts)radio

○ Small facility / single unit (under 50 beds)

● Mid-size facility (50 to 100 beds)

○ Large acute-care facility (over 100 beds)

4 Listing and Code Classification

NOTE ANSI/UL 1069 listing is mandatory for equipment serving NFPA 99 Category 1 and Category 2 patient care spaces; listing for Category 3 and Category 4 spaces is not code-required, and specifying it where it is not required adds cost without benefit while omitting it where it is required is a code violation. (4.1)

4.2 The NFPA 99 facility risk category for each patient care space shall be confirmed in writing with the authority having jurisdiction before the specification is finalized.

4.3 In NFPA 99 Category 1 and Category 2 spaces, all patient call stations, emergency call stations, staff stations, dome lights, and central controllers shall be listed to ANSI/UL 1069.

4.4 Equipment shall bear the listing mark of a Nationally Recognized Testing Laboratory for ANSI/UL 1069.

NFPA 99 facility risk category (governs UL 1069 listing requirement)radio

● Category 1 (UL 1069 listing required)

○ Category 2 (UL 1069 listing required)

○ Category 3 (UL 1069 listing not required)

○ Category 4 (UL 1069 listing not required)

5 Submittals

5.1 Action Submittals

5.1.1 The Contractor shall submit the following action submittals for review and approval before fabrication, ordering, or installation:

Product data for every system component (call stations, emergency stations, dome lights, staff and master stations, controllers, servers, and power supplies)
Shop drawings showing device locations, zone boundaries, dome-light color assignments, and conductor or network homerun routing
Riser diagram showing controller-to-device topology, port loading, and cable-run lengths against manufacturer maximums
Bed-status interface data-point map confirmed with the hospital bed manufacturer (where bed integration is included)
HL7 interface specification identifying message types, listener port, and interface engine (where EMR/ADT integration is included)
Network architecture submittal showing VLAN assignment, PoE budget, and switch model (IP systems only)

Action submittals requiredcheckbox

☐ Product data for all components

☐ Shop drawings (device locations, zones, dome colors, routing)

☐ Riser diagram (topology, port loading, run lengths)

☐ Bed-status interface data-point map

☐ HL7 interface specification

☐ Network architecture (VLAN, PoE budget, switches)

5.2 Informational Submittals

5.2.1 The Contractor shall submit the following informational submittals:

Manufacturer ANSI/UL 1069 listing documentation for each component
Radio-frequency site survey report (wireless systems only)
Manufacturer-certified installer qualifications
Battery backup duration calculation for the central controller or server

Informational submittals requiredcheckbox

☐ UL 1069 listing documentation

☐ RF site survey report (wireless)

☐ Certified installer qualifications

☐ Battery backup duration calculation

5.3 Closeout Submittals

5.3.1 The Contractor shall submit the following closeout submittals before final acceptance:

As-built drawings reflecting installed device locations and zone configuration
Commissioning test reports including audible-level and call-escalation verification
System configuration backup (controller and server database) on durable media
Operation and maintenance manuals, including escalation timing and dome-color conventions
Operator and maintenance training records

Closeout submittals requiredcheckbox

☐ As-built drawings

☐ Commissioning test reports

☐ System configuration backup

☐ Operation and maintenance manuals

☐ Training records

6 Quality Assurance

NOTE Nurse call work performed by unqualified installers is a common source of intermittent call failures that surface only after occupancy, when correction is most disruptive; qualification requirements exist to prevent that outcome. (6.1)

6.2 The NCS installer shall be certified by the equipment manufacturer for the specific platform installed.

6.3 The installer shall have completed at least three healthcare nurse call installations of comparable scale within the preceding five years.

6.4 A manufacturer field representative shall be present for system startup and for the commissioning tests specified herein.

6.5 All components of the installed system shall be the product of a single manufacturer's compatible product line; mixing controllers and stations from different manufacturers on one network is prohibited.

7 Environmental and Service Conditions

7.1 Listed nurse call equipment shall operate within an ambient temperature range of 0 °C to 49 °C (32 °F to 120 °F) without degradation of function.

NOTE The central controller, server, and any rack-mounted network equipment require a conditioned space; field experience shows that placing servers in unconditioned closets is a recurring cause of premature failure and summertime outages. (7.2)

7.3 The room housing the central controller or server shall be maintained between 18 °C and 24 °C (65 °F to 75 °F) and shall be coordinated with the facility information-technology group during design.

7.4 The server room location shall be designated on the drawings and shall not be left to be determined by the NCS contractor in the field.

Central equipment room environment (server / controller)select

Conditioned IT/telecom room, 18 to 24 °C

Dedicated NCS equipment room, 18 to 24 °C

Shared low-voltage closet with supplemental cooling

8 Performance and Annunciation

8.1 Audible Alarm Level

8.1.1 The audible alarm at staff annunciation points shall produce 90 dB ± 3 dB measured at 10 ft (3 m), within a frequency range of 300 Hz to 3000 Hz, in accordance with ANSI/UL 1069.

8.1.2 Two-way audio stations in patient rooms shall provide intelligible speech communication, evaluated in accordance with IEC 60268-16 where intelligibility verification is required by the Owner.

Patient-station audio moderadio

● Two-way voice (pillow speaker / intercom)

○ Tone and visual only (no voice)

8.2 Call Priority and Escalation

NOTE Escalation logic ensures that an unanswered call does not remain silent; the number of priority tiers and the timeout before re-annunciation are facility-configurable and must be standardized across the facility before design is complete. (8.2.1)

8.2.2 The system shall support at minimum three call priority tiers: standard call, staff-assist/urgent, and emergency.

8.2.3 Each priority tier shall produce a distinct audible cadence and a distinct dome-light color at staff annunciation points.

8.2.4 An unanswered standard call shall re-annunciate or escalate to the next staff level after a facility-configured timeout.

8.2.5 The default standard-call escalation timeout shall be 3 minutes unless the Owner directs otherwise.

8.2.6 The escalation timeout shall remain configurable from 2 to 4 minutes.

8.2.7 Emergency-tier calls shall annunciate immediately at the master station without escalation delay.

Number of call priority tiersradio

● 3 tiers (standard / urgent / emergency)

○ 4 tiers (standard / urgent / emergency / Code Blue interface)

Standard-call escalation timeoutrange

min

24

Default: 3 min

8.3 Response-Time Logging

8.3.1 The system shall log a timestamp for each call placed and for each staff acknowledgment, retaining records sufficient to demonstrate compliance with the Owner's response-time policy.

8.3.2 Logged data shall be exportable in a non-proprietary format for regulatory and quality reporting.

9 Patient Call Stations

NOTE Patient call stations are the most-touched components of the system and their type is selected to match the clinical setting; an acute-care medical-surgical room is served differently from a memory-care suite. (9.1)

9.2 Each patient bed position shall be provided with a patient call station within reach of the patient from the bed.

9.3 Patient call stations in acute-care rooms shall provide a momentary call pushbutton and a visual indication confirming that the call has been registered.

9.4 Pillow-speaker stations, where provided, shall include patient-accessible controls and a two-way voice path to the staff station.

9.5 Pull-cord stations, where provided, shall reset only at the station, not remotely, so that staff presence at the bedside is required to clear the call.

Patient call station typeradio

● Pillow speaker with two-way audio

○ Pushbutton call station (tone/visual)

○ Pull-cord station

○ Bed-mounted integrated station

○ Combination pushbutton and pull-cord

Patient call stations per bed positionrange

each

12

Default: 1 each

10 Emergency Call Stations

NOTE Bathroom, shower, and toilet emergency call stations protect patients who fall and cannot reach a bedside station; a redundant floor-level cord is what allows a patient who is already on the floor to summon help. (10.1)

10.2 Each patient bathroom, toilet room, and shower shall be provided with an emergency call station.

10.3 Emergency call stations shall be of a type that latches the call and cannot be cleared remotely; the call shall reset only at the station.

10.4 Pull-cord emergency stations shall be provided with a cord extending to within 75 mm (3 in) of the finished floor so that a patient on the floor can reach it.

10.5 Emergency call stations shall annunciate at the urgent or emergency priority tier, distinct from a standard patient call.

10.6 Emergency call stations in wet locations shall be rated for the moisture conditions of the installed location.

Bathroom / shower emergency station typeradio

● Pull-cord with floor-level cord

○ Push-and-hold button with floor-level pull-cord backup

○ Waterproof pushbutton (shower)

11 Staff Annunciation

11.1 Corridor Dome Lights

NOTE Corridor dome lights give staff an immediate, glance-able indication of where a call originates and at what priority; their color conventions must be uniform facility-wide, because differing conventions between nursing units on one server is a documented source of staff confusion and post-occupancy change orders. (11.1.1)

11.1.2 A corridor dome light shall be provided at the corridor side of each patient room door and at the entrance to each multi-bed bay.

11.1.3 Dome lights shall provide illumination visible through a 360° arc along the corridor.

11.1.4 Dome-light color assignments shall be standardized across the entire facility and configured identically on every nursing unit served by a common controller.

11.1.5 Multi-color dome lights, where provided, shall use the facility-standardized color map for call priority.

Dome light typeradio

○ Single-color (one lamp section)

● Multi-section fixed-color (call / staff / emergency)

○ RGB programmable multi-zone

Dome color convention — standard patient callselect

White

Green

Dome color convention — emergency / Code Blueselect

Red

Dome color convention — staff assistselect

Amber

Yellow

11.2 Zone Displays and Staff Stations

11.2.1 Staff duty stations and zone display panels shall be provided at locations indicated staff station and zone display locations.

11.2.2 Each staff duty station shall annunciate calls for its assigned zone and shall permit two-way voice with patient stations where voice is provided.

11.2.3 Staff annunciation may extend to staff-carried devices (pagers, dedicated handsets, or smartphones) where the Owner's workflow requires mobile notification.

Mobile staff annunciation deviceradio

○ None (fixed stations only)

● Dedicated wireless handsets

○ Smartphone application

○ Pocket pagers

11.3 Master Nurse Station

11.3.1 The master nurse station shall provide a console displaying all active calls, their priority, origin, and elapsed time, for every zone it serves.

11.3.2 The master station console shall be sized to support the number of zones served by its controller with capacity for the project's documented future expansion.

Master station console typeradio

● Touchscreen console (PC-based)

○ Touchscreen console (embedded controller)

○ Multi-monitor PC workstation

Zones supported per master stationrange

zones

116

Default: 4 zones

12 Central Controller and Power

12.1 Battery Backup

NOTE Battery backup duration must be coordinated with the essential electrical system transfer time; where the automatic transfer switch restores power in seconds, a short bridging duration suffices, but facilities with long transfer times or a history of extended outages require extended backup, and some authorities require longer durations for Category 1 facilities. (12.1.1)

12.1.2 The central controller or server shall be supported by battery backup providing a minimum of 15 minutes of operation in accordance with ANSI/UL 1069.

12.1.3 The battery backup duration shall be 90 minutes unless the authority having jurisdiction requires a longer duration for the facility risk category.

12.1.4 Wireless device batteries, where used, shall be of a type and capacity that provides the manufacturer's rated standby duration, and the maintenance manual shall state the replacement interval.

Central controller / server battery backup durationradio

○ 15 minutes (UL 1069 minimum)

● 90 minutes (common facility standard)

○ 4 hours (extended, per AHJ for Category 1)

Wireless device battery typeradio

○ Replaceable alkaline

● Rechargeable lithium

12.2 Server Redundancy

NOTE Server redundancy protects the call-routing function from a single hardware failure; the level of redundancy scales with facility size and with the clinical consequence of a routing outage. (12.2.1)

12.2.2 Facilities exceeding 100 beds shall be provided with a hot-standby or N+1 redundant server configuration.

12.2.3 Facilities under 50 beds may be served by a single server supported by an uninterruptible power supply.

Server redundancy configurationradio

● Single server with UPS (under 50 beds)

○ Hot-standby pair

○ N+1 redundant

13 Network Infrastructure (IP Systems)

NOTE NCS traffic mixed onto a general data VLAN suffers priority conflicts and latency precisely when call volume is highest; isolating and prioritizing the NCS network is therefore a reliability requirement, not an optimization. (13.1)

13.2 IP-based nurse call systems shall be assigned a dedicated, isolated VLAN separate from general facility data traffic.

13.3 The PoE budget and switch selection shall be coordinated with the facility information-technology and network engineer before the network submittal is approved.

13.4 Standard powered devices shall be served at minimum by IEEE 802.3af (15.4 W) PoE.

13.5 Room stations incorporating displays shall be served by IEEE 802.3at (30 W) PoE.

13.6 Network switches serving the NCS shall be managed switches with Gigabit uplinks.

13.7 Structured cabling pathways and backbone serving the IP controllers shall comply with Structured CablingStructured Cabling SystemsResolves to the current edition.sync/structured-cabling and ANSI/TIA-1179-A.

PoE standard for powered devicesradio

○ IEEE 802.3af (15.4 W)

● IEEE 802.3at (30 W)

○ IEEE 802.3bt (60 W+)

NCS network isolationradio

● Dedicated VLAN on shared switches

○ Physically separate switch fabric

14 Integration

14.1 EMR / ADT (HL7)

NOTE HL7 ADT integration displays the assigned patient and room name at staff stations by consuming admit/discharge/transfer messages; specifying it as "by others" without naming the responsible party or interface engine is a documented cause of commissioning delay. (14.1.1)

14.1.2 Where EMR/ADT integration is included, the responsible party for the interface and the interface engine (built-in or third-party) shall be identified in the contract documents.

14.1.3 The NCS server shall provide a dedicated HL7 listener port, and the required firewall rules shall be coordinated with the facility information-technology group.

14.1.4 The interface shall consume HL7 v2.x or HL7 FHIR R4 ADT messages to populate patient and room identification at staff annunciation points.

EMR / ADT (HL7) integrationradio

○ None

● HL7 v2.x interface

○ HL7 FHIR R4 interface

HL7 interface engineselect

Built-in NCS interface engine

Third-party interface engine

None (EMR outputs HL7 directly)

14.2 RTLS and Bed-Status

NOTE Smart-bed integration delivers bed-exit, rail-position, and head-of-bed-angle data to the NCS, but the communication protocol and data-point mapping differ by bed manufacturer and must be confirmed before shop drawings are submitted; leaving this scope unresolved between the NCS contractor and the bed vendor is a recurring coordination gap. (14.2.1)

14.2.2 Where bed-status integration is included, the bed communication protocol and the data-point map shall be confirmed in writing with the hospital bed manufacturer before shop drawings are submitted.

14.2.3 Where RTLS caregiver-location integration is included, the integration shall use the NCS open interface to the RTLS middleware, and no RTLS access-point hardware is provided under this standard.

Bed-status integrationradio

● None

○ Bed-exit / occupancy only

○ Full bed status (exit, rail, head-of-bed angle)

RTLS caregiver-location integrationradio

● None

○ Presence (auto-cancel on caregiver entry)

○ Full location and reporting

14.3 Interoperability

NOTE Specifying a proprietary platform with no open interface forecloses future RTLS, mobile-communication, and EMR expansion and can force a full system replacement to add a single feature; an open interface is the hedge against that lock-in. (14.3.1)

14.3.2 Where the Owner anticipates future RTLS, staff-communication, or EMR expansion, the system shall expose a documented open application programming interface for those integrations.

NOTE Code Blue is a clinical emergency response function, not a fire alarm initiating device; cross-connecting the Code Blue annunciation path to the fire alarm system creates false-alarm liability and is prohibited by the respective listing requirements of ANSI/UL 1069 and NFPA 72. (14.3.3)

14.3.4 The Code Blue clinical-emergency function shall not be routed to the fire alarm system.

15 Wiring and Raceway

NOTE Whether Class 2 nurse call wiring requires conduit in patient care areas is frequently misjudged; the NEC exemption is real but facility policy or the authority having jurisdiction can override it, and the resulting requirement surfaces as a rough-in RFI if not resolved in design. (15.1)

15.2 Wired/BUS signal wiring shall be a minimum of 18 AWG twisted pair, or the manufacturer's specified cable, whichever is more stringent.

15.3 Cable runs shall not exceed the manufacturer's maximum run length per controller port, which is typically in the range of 600 m to 1200 m (2,000 ft to 4,000 ft) depending on the platform.

NOTE Under NEC 517.74, Class 2 and Class 3 signaling circuits in patient care areas are exempt from the grounding requirements of 517.13 and the mechanical-protection requirements of 517.30(C) unless the authority having jurisdiction requires otherwise. (15.4)

15.5 The requirement for conduit in patient care areas shall be confirmed with the authority having jurisdiction during design, and conduit shall be provided where required by the AHJ or facility policy notwithstanding the Class 2 exemption.

15.6 Installation shall comply with NEMA NS 1 for raceway, grounding, and conductor practices, and with NFPA 70 Article 517 for all healthcare electrical wiring.

Conduit requirement in patient care areas (wired systems)radio

● Conduit not required (NEC 517.74 Class 2 exemption applies)

○ Conduit required by facility policy / AHJ

16 Installation

NOTE Wireless systems fail most often where coverage was assumed rather than verified; bathrooms and shower rooms are the classic dead zones, and they are exactly where the emergency station that must work is installed. (16.1)

16.2 All devices shall be installed at the mounting heights and locations indicated device mounting heights and locations and in accordance with applicable accessibility requirements.

16.3 For wireless systems, a radio-frequency site survey shall verify coverage in every patient care area, including bathrooms and shower rooms, before device installation proceeds.

16.4 Patient-care-vicinity wiring shall maintain the isolation required by NFPA 70 Article 517.

16.5 Devices, dome lights, and stations shall be labeled with their room, bed, or zone identification matching the as-built drawings.

16.6 The Contractor shall coordinate the NCS server room location, power, UPS, and network access with the facility information-technology group before rough-in.

17 Testing

NOTE Commissioning verifies that every call path actually reaches staff and escalates as configured; a test of every station is what catches the single miswired emergency cord that would otherwise be discovered by a patient. (17.1)

17.2 Every patient call station and every emergency call station shall be tested for correct registration, correct priority annunciation, and correct dome-light indication.

17.3 The audible alarm level at staff annunciation points shall be verified to meet 90 dB ± 3 dB at 10 ft (3 m) in accordance with ANSI/UL 1069.

17.4 Call escalation shall be tested to confirm that an unanswered call re-annunciates or escalates at the configured timeout.

17.5 Battery backup shall be tested by simulating loss of normal power and confirming the system remains operational for the specified duration.

17.6 Each integration interface (HL7, bed-status, RTLS) that is included shall be tested end-to-end with live or simulated data before final acceptance.

17.7 Test results shall be recorded and submitted in the commissioning test report.

18 Delivery, Storage, and Handling

18.1 Equipment shall be delivered in the manufacturer's original packaging with listing marks intact.

18.2 Electronic controllers, servers, and stations shall be stored in a clean, dry, conditioned environment within the manufacturer's storage temperature limits until installation.

18.3 Equipment shall be protected from construction dust, moisture, and physical damage throughout installation.

19 Warranty

19.1 The system manufacturer shall warrant all equipment against defects in materials and workmanship for a minimum of one year from the date of Substantial Completion.

19.2 The installer shall warrant installation workmanship for a minimum of one year from the date of Substantial Completion.

19.3 Software and firmware updates released during the warranty period to correct defects shall be provided to the Owner at no additional cost.

Manufacturer warranty periodradio

● 1 year

○ 2 years

○ 3 years

20 Spare Parts

NOTE Nurse call stations and dome lights are high-touch components subject to physical wear and damage; an on-hand spares allowance lets the facility restore a failed station immediately instead of waiting on procurement. (20.1)

20.2 The Contractor shall furnish spare patient call stations, emergency call stations, and dome lights in the quantities indicated, of the same type and configuration as those installed.

20.3 Spare parts shall be delivered in original packaging and turned over to the Owner at final acceptance.

Spare patient/emergency call stations (% of installed quantity)range

%

010

Default: 3 %

Spare corridor dome lights (% of installed quantity)range

%

010

Default: 3 %