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ICU Housekeeping

ICU Housekeeping. Nov 2013. Outline. The daily review Good practice points Paperwork Discharge planning. Daily review. Brief consultant led ward round, then need a thorough review Examine, check charts, check bloods, ask nursing staff Does the patient need parent/specialty review?

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ICU Housekeeping

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  1. ICU Housekeeping Nov 2013

  2. Outline • The daily review • Good practice points • Paperwork • Discharge planning

  3. Daily review • Brief consultant led ward round, then need a thorough review • Examine, check charts, check bloods, ask nursing staff • Does the patient need parent/specialty review? • Are we missing anything?

  4. A suggested structure… • Airway • Breathing • Ventilator settings, gases, chest examination • Circulation • Circulatory status, inotropes • Disability • GCS, pain, actively look for delirium, sedation, sedation hold? • Electrolytes • Na/K/Mg/PO4

  5. A suggested structure… • Fluids • 24hr balance, UO, urea & creat, renal replacement, fluid balance • Gastro • Abdo exam, nutrition, bowels, N&V, LFT’s • Haem • Hb, clotting, bleeding • Infection • WCC, CRP, Abx, lines

  6. …and the rest • Review the drug charts • Check for outstanding test results • Is the patient on: • LMWH? • Chlorhexidine? • PPI? • What does the nurse think? • Is there something missing?

  7. Good practice points • VTE prophylaxis • Ventilator and line care • Gastric protection • Delirium

  8. Paperwork • Freehand clerking • Proforma for discharge • Try and use the electronic xray requests, paper accepted for now • ICU specific charts

  9. Discharging • Does everyone agree? • Does the parent team know? • Is there a plan for readmission/CPR? • CVC  peripheral? • Active problem prevention – i.e. physio

  10. Summary • The daily review • Good practice points • Paperwork • Discharge planning • Proactive care

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