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Integrated
Critical Care Unit
A survival guide for staff
new to critical care –
Don’t Panic
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Contents Introduction
Philosophy of Care
Unit Layout
Useful Information
Unit personnel and the Multi-professional team
Ward-rounds
Communication
Daily routine
Laboratory investigations
Admissions, discharges and transfers
Relatives and visiting
Continuing education
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Introduction
Welcome to the Integrated Critical Care Unit!
We are an 18-bedded unit comprising of:
8 level 3 (ITU) beds and
10 level 2 (HDU) beds.
The configuration of the unit is one four bedded bay for level
3 patients, 4 single side-wards, 2 isolation / barrier nursing
rooms and two 4 bedded bays for level 2 patients. All the beds
are flexible however, and patients can be ventilated and
monitored in any area.
We hope that you will enjoy working in ICCU and that you will
gain a wide range of experience in different situations,
developing your skills in critical care.
As you develop in ICCU a series of objectives will provide
direction and challenge to your work, and aid you in your
professional development.
A preceptor / mentor will be assigned to you to guide your
progress through your orientation period, and provide support
and advice along the way as part of an ongoing relationship.
You will also have a team leader (a sister / charge nurse) to
oversee and direct your progress, guide you in your
professional development and assist you with any difficulties
you may experience.
Many of your nursing and medical colleagues have a great deal
of experience in critical care and are here to help you. Don’t
be afraid to ask if you have any queries!
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Philosophy of Care
The staff of the ICCU will provide a 24-hour service to
critically ill patients and their families or carers within
Sunderland Royal Hospital, striving to deliver the highest
possible standards of care based upon sound research and best
evidence.
We will show consideration for the individuality of each
patient, recognising and respecting his or her differing
physical, emotional spiritual and cultural needs. We will
maintain the patient’s dignity, privacy and confidentiality at all
times, whilst promoting maximum independence wherever
possible.
Each patient within the ICCU will have a named nurse,
responsible for the planning, co-ordination and delivery of care
within the multi-professional team.
We will offer support to relatives and carers, and endeavour to
keep them informed of any changes in condition or treatment.
We will encourage involvement in discussions relating to the
care of the patient, and participation in their care (where
appropriate).
ICCU Unit Layout
Room 1-4 - Single side wards
Room 5 - 4 bedded bay (level 3)
Room 6 & 7 - Isolation / barrier nursing rooms
Room 8 & 9 - 4 bedded bays (level 2)
* * - Crash trolley / defibrillators
* *
* * - Other emergency trolleys
Room 5
*
*
Room 4
Room 3
Room 6
Room 2
Room 7
Sluice
Room 8
Room 1
Clean Utility * *
* *
Room 9
Office
Linen Storage
Visitors
Waiting
Area
Pay phone
Resource
room
Quiet room Storage area – disposables
Female/c
Beverage bay
Hand wash
area
Patient w/c
Staff lounge
Reception Domestic
store
Storage
Area – equipment
(workshop)
Waste
Disposal
Patient
access
Dr’s on call suite
Visitors
W/c
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Useful Information Shift Patterns
Early - 7.15am - 2.45pm
Late - 1.15pm - 8.45pm
Nights - 8.15pm - 7.45am
Off Duty
Off duty is usually prepared 2-3 weeks in advance. Self-
rostering is currently in operation. Students must work a
minimum of 2 shifts / week with their primary mentor.
Night Duty
Rotation to night duty is compulsory. All staff rotate
according to a roster that can be found at the nurses’ station.
Rotation usually takes the form of 2 weeks night duty followed
by 4-6 weeks days. However please see C.N. Duncan who will
try to accommodate you if you would like to do a longer stint of
nights. Students are also encouraged to work nights alongside
their mentor.
On Call
An on-call rota is in place to cover for staff shortages and
sickness. Once you have completed your introductory period if
you wish to participate in the on-call system place your name on
the rota (according to the guidelines for numbers of staff
required per shift.) The nurse in charge will advise you if you
are required to come out.
Enhanced Hours
Weekend, night duty, unsociable hours and bank holidays all
attract enhanced hour’s payments. These forms are to be
completed retrospectively on a monthly basis by the nurse in
charge. It is your responsibility to ensure that your enhanced
hours claims are checked at the end of the month and signed
for. If you do not check your claim we cannot ensure that
your enhance hours payments will be correct. If you have any
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queries about your enhanced hours claims, please see one of
the G-grades who will be happy to help. On-call claim forms
should also be completed monthly by you, and certified by the
nurse in charge.
Annual Leave
All annual leave is to be approved by C/N Todd. Holiday
request forms are available in a file at the nurses’ station.
Holidays are allocated on a ‘first come – first served basis’. As
there is a large number of staff working on the unit it is
advisable to get your requests in early to avoid disappointment!
Uniforms
Uniforms can be obtained from the sewing room, ext. 42182.
They are laundered in the hospital, and should not be worn to
or from work. Clean uniforms will be found in the staff
changing rooms situated on B-floor. Comfortable trainers may
be worn.
Lockers
Lockers are available in the staff changing room, which is only
accessible with a ‘swipe card’. It is advisable to lock away all
personal belongings. Handbag lockers are available on the unit
in the staff sitting room. Keys should not be taken home, and
lockers left empty at the end of your shift, as there are a
limited supply.
Equipment
When you first start you will be given a tour of the unit. Don’t
worry too much about remembering where things are kept – it
takes time! Try to familiarise yourself with the layout and
situation of the fire exits, emergency equipment etc.,
whenever you have a spare moment. To make things easier,
certain pieces of equipment that is needed in an emergency or
for an admission are stored together on trolleys.
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These are:
‘Crash’ trolleys with defibrillator (See plan of unit for
Arterial and central line trolley location of these items)
Chest drain trolley
PA catheter trolley
Tracheostomy trolley
Unit office
All CHS policy and procedure files are kept in here; you must
familiarise yourself with these.
Resource Room
This room is available for meetings, teaching sessions, private
study etc. If you wish to use the room please book it in
advance with the receptionists who keep a diary for this
purpose. A computer is available in here for general use, as
well as reference books, journals and CD’s. Please remember
that these items are for reference only, and should not be
taken off the unit. Please have some consideration for others
who may want to use them after you.
Patient Allocation
At the beginning of each shift the nurse in charge will allocate
patients to the nurses on duty. A named nurse system is in
operation on the unit, whereby F/E grade staff act as named
nurse and D grade staff as associate nurses. Usually, the
named nurse will be the nurse present on admission of the
patient. The named nurse will be responsible for the care of
the patient for the duration of their stay in ICCU, and when
possible will be allocated to their particular patient when on
duty. However, this may not always be possible due to skill mix,
holidays, staff shortages etc.
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Unit Personnel and the Multi-Professional team
Matron
Carole Gibson is based in the matrons’ office on B-floor, and
has professional responsibility for all nursing staff in the
Theatre Directorate. She can be contacted on Bleep 51384 to
advise on any professional issues.
Nurse Consultant
Lesley Durham has over 15 years of ‘hands on’ critical care
experience. Her role is to integrate policy, education, practice
development and research relative to the needs of the
critically ill, with the overall effect of improving the quality of
patient care. She is also responsible for the introduction of
the Critical Care Outreach Team (CCOT).
Practitioner-Lecturer
Debbie Cheetham also has over 10 years critical care
experience. She is responsible for the co-ordination and
facilitation of education and training within the unit, and the
delivery of critical care skills training to ward staff within the
trust. Her time is split working between Northumbria
University and CHS.
Consultants
On ICCU we have a team of both Consultant Anaesthetists /
Intensivists who share responsibility for the unit on a rota
basis. The consultants attached to the unit are:
Dr. J. (John) Green - Anaesthetist
(Clinical Director)
Dr. A. (Andy) Morrison - Anaesthetist
(Lead Clinician ICCU)
Dr. A. (Tony) Taylor - Anaesthetist
Dr. H. (Bhaskar) Bhaskar - Anaesthetist
Dr. P. (Phil) Cudworth - Anaesthetist
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Dr. A (Alistair) Roy - Anaesthetist
Dr. G. (Gary) Lear - Anaesthetist
Dr. P (Paul) McAndrew - Anaesthetist
Critical Care Co-ordinators
On each shift there is a sister or charge nurse, responsible for
the co-ordination of the unit. They also act as team leaders
for a designated group of nursing staff and health care
assistants.
Sisters – Chris Tippins, Sue Cockburn, Eileen Lawton,
Michelle Smithson.
Charge Nurses - Ian Todd, Chris Welsh, Rob Duncan.
Nurses
All other nurses in ICCU are at D, E or F grade, with usually 1
bedside nurse for each level 3 (intensive care) patient, and 1
nurse for 2 patients who are classified as level 2 (high
dependency).
Health Care Assistants are an essential part of the ICCU team
and assist with the smooth running of the unit. Among their
many duties they help with the cleaning and testing of
equipment, take specimens to the lab and collect blood
products, assist with patient care and help with the resetting
of bed areas once patients have been discharged from ICCU.
However, this is not solely the responsibility of the HCA’s – it
is part of the nurses role to ensure equipment is cleaned and
bed-spaces are correctly reset ready for the next admission.
Administrative Assistants (Receptionists) are again an
essential part of the ICCU team. They are based in the
reception area, which is manned from 8.30 am unit 8.30 p.m.,
and are the first point of contact for visitors to ICCU. They
greet relatives and other visitors to the unit, and direct
telephone enquiries to the appropriate areas. As well as this
admin assistants are responsible for all aspects of clerical
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work, including input of admission data into the computer, filing
and care of patient notes, and the ordering of stationary and
other stores.
Physiotherapists
Physio’s generally visit the unit 3 times per day to perform
chest physio and limb exercises on ICCU patients. On-call
physio’s can be bleeped via switchboard out of working hours,
and extra visits may be pre-booked through the patients
allocated physiotherapist.
Dietician
It is vital to ensure our patients are adequately nourished, and
it is our aim to commence nutritional support (either enteral or
parenteral) as soon as possible after admission to ICCU. Th
unit has a feeding policy in situ with a protocol based on up to
date research guidelines. The dietician visits the unit on a
regular basis (usually daily) and to assess the nutritional
requirements of the patients. She can also be contacted via
bleep if necessary.
Pharmacist
The pharmacist usually visits the unit on a daily basis to assess
drug regimes and offer advice. A pharmacy technician also
visits the unit daily to order stock drugs, enteral feeds and
I/V fluids etc.
The nurse in charge orders urgent, non-stock and controlled
drugs on a daily basis, usually.
Chaplains
Chaplains are available for people of all denominations, and are
pleased to visit patients and relatives on the unit. They can be
contacted via switchboard or bleep system as required. The
chapel is also available to be used by visitors and staff as a
place of peace and tranquillity.
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Ward Rounds
Ward rounds take place on a daily basis at 0900hrs. The team
usually consists of:
ICCU consultant
Registrar / SHO on –call
Nurse in charge
Microbiologist
The pharmacist and dietician also join in when available.
The nurse looking after each patient should also be present
during the ward round. Major decisions regarding the
treatment and care of the patient are usually made at this
time, and it is the nurse’s responsibility to ensure that any
changes are implemented and documented accordingly, and
passed on to other members of staff during the handover.
Numerous ‘mini-rounds’ may also take place during the day; it is
up to the bedside nurse to keep the nurse in charge informed
of any changes.
As ICCU patients will come from or go to other wards they also
have a consultant for the speciality they are admitted under
e.g. Surgery, medicine etc. who will visit regularly and liase with
the ICCU doctors.
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Communication
HISS System
City Hospitals Sunderland uses the HISS computer system.
Patient admissions, care plans, evaluations, lab requests and
results are contained on the system. Your mentor / preceptor
will identify any training needs and organise appropriate
sessions.
A MOX system of messaging exists. Please remember to read
your messages on a regular basis, as important information is
often disseminated this way.
E-mails
The e-mail facility on the Computers is by far the quickest and
easiest way to communicate with other members of staff. A
message can be sent to all members of staff via this system.
Please remember to read your messages on a regular basis, as
important information is often disseminated this way.
Notice boards
Are situated in the staff sitting room and by the nurses’
station. Off duty, information regarding study days, and any
changes to the unit are posted here.
Handover
At the commencement of each shift staff receive a brief
handover for the patients in the area they are working in,
followed by a more detailed report for their allocated patient.
A series of safety checks are completed by both nurses, which
includes ventilator settings, alarm parameters and drug
infusions.
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Daily Routine
0715 - Changeover of staff, handover and safety checks.
Bed-spaces should damp dusted and restocked.
8000 - Blood specimens taken as required and sent to labs.
0900 - Ward round
Changes implemented as required
1000 - Physiotherapy
Individual patient care
1315 - Changeover of staff, safety checks as 0715.
Individual patient care and hygiene needs.
1400 - Physiotherapy.
1530 Physiotherapy
1800 - Individual patient care and hygiene needs.
TPN changed daily.
2015 - Changeover of staff, safety checks as 0715.
2200 - Individual patient care and hygiene needs met.
0000 - Enteral feed discontinued.
0200 - Individual patient care and hygiene needs met.
0600 - Individual patient care and hygiene needs met.
Enteral feeding recommenced.
Ventilatory weaning commenced and sedation
stopped if appropriate.
This is intended as a guideline only, and is adapted to the
requirements of the patient as appropriate. Every effort is
made to ensure that all patients receive holistic, individualised
care, usually prescribed by the named nurse.
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Laboratory Investigations
Investigations are carried out routinely on a daily basis, or as
required for the individual patient.
Bloods sent daily are:
FBC (purple bottle, marked as urgent)
U&E, albumin, glucose (green bottle, marked as urgent)
LFT’s (green bottle, non-urgent)
Coagulation (blue bottle, marked as urgent)
Abg’s (heparinised syringe, analysed on unit)
Other requested investigations:
Bone profile (Monday, Wednesday, Friday)
Sputum C&S (Monday, Wednesday, Friday)
Cardiac enzymes (green bottle, non-urgent on patients with
known/suspected M.I.)
Therapeutic drug levels (e.g. Vancomycin, Theophylline,
Digoxin, usually gold-topped bottle.)
CRP/PCT (On patients suspected to be septic. Gold top
bottle, given directly to microbiologist, and returned to unit
for PCT analysis)
Other common investigations:
Sputum - C+S, Gram Stain
Urine – C+S, Electrolytes and Osmolarity
Blood – C+S
Swabs – C+S, MRSA
Line Tips – C+S
Specimens are sent to the lab via the pneumatic chute system.
This operates at the following times:
8am – 8pm Routine and Urgent specimens
8pm – 8am Urgent specimens only
All urgent specimens outside of normal hours (8am-8pm),
antibiotic assays and urgent microbiology samples should be
telephoned to the relevant department prior to despatch.
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Admissions, Discharges and Transfers
Admissions
Although many admissions to ICCU are emergencies, via
theatre, from wards, A&E or from other hospitals, patients
who are admitted to ICCU are may also be planned surgical
patients who come from theatre requiring close monitoring
(usually level 2) and sometimes ventilation (level 3). The
patient’s consultant should make admission referrals to the
ICCU consultant. A diary for booking of elective admissions is
kept at the nurses’ station.
Pre-operative visits
For those planned surgical admissions, whenever possible we
arrange for a nurse from the unit to visit the patient on their
ward prior to theatre. This allows us to give them and their
families’ information regarding their stay in ICCU, hopefully
alleviating some of their anxiety.
Transfers
We occasionally transfer patients to other hospitals within the
critical care ‘network’ of other hospitals within the region.
This is usually done if the patient requires specialist care from
another unit e.g. Cardio-thoracic, neuro-surgery and burns. A
qualified nurse and anaesthetist will accompany the patient.
Transfers
When patients are ready to leave the unit, they then go the
ward of their speciality consultant. Beds can be arranged by
bleeping the bed manager on-call. It is also important that the
appropriate medical team and ward staff are informed of the
patient’s readiness to transfer to ensure continuity of care. A
patient transfer documented should be completed for all
patients transferred from ICCU and a discharge summary
completed by the medical staff for level 3 patients who are
transferred.
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Relatives and visiting
The staff of ICCU aim to provide a supportive environment for
the relatives of ICCU patients. We endeavour to ensure that
close relatives are provided with adequate information,
emotional support and help to better equip them to deal with
events or traumas they may encounter in ICCU.
Visiting Times
A flexible, open-visiting policy is in place in ICCU for immediate
relatives of patients. However due to the nature of the unit a
period of ‘protected patient care time’ must be maintained
between 0800hrs and 1130hrs to allow for ward rounds etc.
Visitors are encouraged to visit between 2pm and 8pm, which
will enable them to spend quality time with their relatives.
Several short visits are advised to allow the patient to have
important rest periods. It is also necessary to stress the
importance of removing outdoor coats and hand-washing prior
to visiting patients on the unit, and reminding visitors that we
are not able to accept fresh flowers for the patients due to
the infection risks.
Facilities are available for the comfort of visitors such as a
sitting room with television and drinks machine, payphone as
well as a quiet room for interviews. We are also able to
arrange overnight accommodation in the ‘Woodford Williams’
patient hotel for visitors who do not live locally or who are
required to be close at hand in the case of an emergency.
Children
Visiting by children under the age of 11 years is allowed at the
discretion of the nurse in charge. Parents must be reminded
that children visiting the unit should be supervised at all times
for their own and other patients’ safety.
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Continuing Education
Induction Programme
During your first weeks on the unit you will be given a clinical
competency programme. This will give you aims and objectives
to help you to develop your knowledge and skills in critical care.
Here on ICCU we are committed to providing learning
opportunities for our staff to aid with their professional
development and deliver the highest possible standard of
patient care.
There are opportunities for in-service training both within the
unit and City Hospitals Sunderland with both formal and
informal teaching sessions. Allocated places for study days
and courses such as Foundations in Critical Care, Adult Critical
Care Module and PP126/7 are also available.
Requests for places on courses and study days should be
identified through appraisal with your team leader and
negotiated with the practitioner / lecturer who will advise you
of relevant forms to complete etc.
Mandatory Study sessions
It is compulsory to attend annual fire, manual handling and CPR
updates. It is your responsibility to ensure that you attend
these sessions. Dates are clearly displayed on notice boards.
Many of the sessions are actually performed on the unit, so you
have no excuses!
Remember!
In accordance with NMC requirements for PREP it is your
responsibility to ensure that you undertake a minimum of 5
days study relevant to your area of clinical practice every 3
years in order to demonstrate professional development.
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Sister Tippins also requires to see your NMC PIN number when
you start on the unit and each time you re-register.
Preceptorship co-ordinator
Sue Cooper facilitates induction into the trust and induction
programmes. She can be contacted on Ext. 42578 (afternoons
only) to offer help and advice for newly qualified staff and
staff new to City Hospitals Sunderland.
We hope this booklet proves useful to you in the coming weeks
as you settle into ICCU. Please do not hesitate to ask any
member of staff if you have any queries, no matter how small
or trivial they may seem, we are only too happy to help.
Most of all, enjoy your time in ICCU, and don’t panic!
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Created by M.Smithson
Updated May 2005