Canterbury DHB

Context

Intensive Care Unit (ICU)

Written in conjunction with Dr Louise Hitchings, Intensive Care Specialist.

In This Section

ICU Background Information

Referral of Patients to ICU

ICU Response Time

Transfer of Patients to ICU

ICU Management of Haematology Patients

Haematology Management of Patients in ICU

Other Support Available to Haematology Patients in ICU

Communications

Discharge from ICU

ICU Background Information

ICU is staffed by 7 Senior Medical Officers and 18 registrars. The ICU service is available 24 hours a day, seven days a week to review patients and transfer to ICU if necessary.

ICU has two isolation rooms with anterooms. These rooms can be switched to either positive or negative pressure (rooms 10 and 11) depending on requirements.

Microbial minimisation is managed in ICU by ensuring immunosuppresed/neutropenic patients are cared for in a positive pressure room. The anterooms have facilities for hand hygiene and barrier precautions/PPE. Clearly displayed signage at the entrance to the room provides instructions for staff and visitors to follow to help minimise microbial contamination.

Referral of Patients to ICU

Patients can be referred for ICU review based on the New Zealand Early Warning Score and Policy, or if any clinician is concerned about the patient's status, independent of their EWS score.

Acute Unstable Patients: contact the ‘clinical emergency response’ system (emergency button). This team includes an ICU registrar.

Other Patients: contact the ICU Outreach nurse (pager 8073, phone 027 706 5608) or via the ICU Outreach Registrar (pager 8155, phone 027 706 6445).

For all communications follow the ISBAR Handover/Communication Policy. ISBAR = Identify, Situation, Background, Assessment, Recommendation/Request.

Possible care options for reviewed patients include:

For more information, see Intensive Care Requests on Hospital HealthPathways.

ICU Response Time

Patients referred to ICU outreach will normally be seen within 15 minutes of referral. Response time may vary depending on patient acuity and workload. All patients seen by the ICU outreach service will be discussed with the on-call ICU specialist in a timely manner 24 hours a day/seven days a week.

Patients may be reviewed by ICU more than once, depending on need.

Transfer of Patients to ICU

For patients transferring to ICU, ICU will facilitate this in a time-frame appropriate to clinical need and resource availability (ideally within 60 minutes).

The BMTU staff member involved in the transfer must ensure the patient’s Haematology Consultant is made aware of the transfer of the patient to ICU.

ICU Management of Haematology Patients

An ICU junior doctor/RMO is immediately available to the patient at all times. Each patient in isolation is nursed on a 1:1 basis by ICU nursing staff, with back up from BMTU nursing staff.

The patient will be reviewed by an ICU specialist at least once, more commonly 2-3 times, on a daily basis. There will always be an ICU consultant on call available to offer immediate telephone advice, or to physically attend the patient within 30 minutes as required.

ICU Therapies available include:

Haematology Management of Patients in ICU

A Haematology Consultant (scheduled BMTU ward consultant) or registrar will visit the Haematology patient in ICU at least once per day and liaise with the attending intensive care consultant.

BMTU Nurses will deliver chemotherapy agents as indicated.

The BMTU Nurse in Charge will liaise with ICU nursing staff at least once a day on any protocols/procedures specific to the nursing care of haematology patients.

Decisions regarding haematological care/ chemotherapy/ blood product support/ GCSF will be lead by the haematology team, in consultation with ICU staff. Other decisions about patient care are likely to be determined by ICU staff, in consultation with haematology staff if needed.

Haematology consultant and/or registrar should attend the weekly ICU multidisciplinary ward round (Thursday 10.30am) when a haematology patient is present in ICU. Liaise with the ICU team to determine the timing of the discussion of the haematology patient.

Other Support Available to Haematology Patients in ICU

Allied Health Specialists (dietitian, social work, physiotherapy, speech therapy, occupational therapy), as appropriate.

Other medical specialists/specialities will be involved as appropriate. In particular, infectious disease physicians attend the ICU on a daily basis to advise on antibiotic management.

Communications

Discharge from ICU

About this Canterbury DHB document (66669):

Document Owner:

Mark Smith (see Who's Who)

Issue Date:

October 2017

Next Review:

October 2019

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 66669