ICU HousekeepingNov 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?

Are we missing anything?

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

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

…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?

Good practice points VTE prophylaxis

Ventilator and line care

Gastric protection

Delirium

Paperwork Freehand clerking

Proforma for discharge

Try and use the electronic xray requests, paper accepted for now

ICU specific charts

Discharging Does everyone agree?

Does the parent team know?

Is there a plan for readmission/CPR?

CVC peripheral?

Active problem prevention – i.e. physio

Summary The daily review

Good practice points

Paperwork

Discharge planning

Proactive care