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TALON GENERAL HOSPITAL

INTENSIVE CARE

UNIT



TRAINING MANUAL

NURSING SERVICE DEPARTMENT VISION 2007 – 2012

We envision a well-organised department with high-quality nursing service

equipped with high-quality nursing service equipped with compentence, strong

commitment and passion.

By 2012, the department would have a monitoring system in place that ensures

procedures, standards and guideline are properly implemented for efficient and

effective delivery of nursing care with the available facilities and equipment. We

would continuously establish networking, training programs and education that

would maintain professional, ethical and moral holistic healthcare.



ORGANIZATIONAL STRUCTURE

CHIEF

SUPERVISING

NURSE

ICU HEADNURSE

ICU NURSE IN

CHARGE

STAFF NURSES



TIMETABLE FOR TRAINEES’EXPOSURE AT ICU

A new trainee may be anxious about starting in a new area. Try to

create a comfortable environment and remember not to overwhelm the

novice with too much information on the first day or week. Orientation is a

continuing process, so there will be plenty of time to give the trainee all the

necessary information.

WEEK I

DAY 1

• Give a warm welcome and try to reduce any nervousness the traineesmay feel

• Discuss your plan for the first day

• Introduce the organizational chart that the trainee will be working with

• Show the trainees around the unit

o Main ICU has five bed capacities

o Isolation ICU (Garnet) has 2 bed capacities

• Review your job descriptions

• Review your office’ policies and procedures including working hours,

unit organization (schedules, forms, manuals, etc.), unit resources

(equipment, supplies/stocks, etc.)

o Refer to manuals, forms used usually in the unit including the

unit kardex, stock checklist, and papers that may help

introducing the unit



• Expectations from the unit exposure (including verbalization of special

requests or any considerations during his/her stay in the area so he

could make arrangements with HN/SN and CN)

• Enumerate the expectations to the trainee during his/her rotation

period in the unit

• Brief orientation to unit policies and procedures, practices like:

o Looking for MD available for information

o Charging of stocks

o Requesting of supplies

• Observation during his duty for the day

• Question/ clarification before the shift needs

DAY 2

• Evaluation of learning from day 1 experience

•

Additional expectations, questions, clarifications, from trainee

• Continuation of discussion on nursing procedures, measures usually

done in the area

• Recap of unit procedures and practices for clarifications and additional

discussions

• Introduction, brief discussion and return demonstration, if possible, of

nursing procedures usually done in the area

o Intubation

o Suctioning

o CPR



o Ambubagging

o Defibrillation

o IFC insertion

o NGT insertion

o Tube feeding

o VS/NVS monitoring

o Proper moving and turning of patient

o Tracheostomy and endotracheal tube care

• Hands on demonstration on how to operate and care of equipment and

instrument in the area

o Cardiac monitors

o Suction machines

o Laryngoscope

o Defibrillator

o Pulse oximeter

• Observation for the rest of the day

DAY 3

• Continuation of discussions of nursing procedures, unit practices

• Allow familiarization of unit stocks and supplies by assisting him/her in

checking stocks and supplies completeness

• Allowing with assistance on charging of used stocks



• Teach and assist in doing vital signs or neuro vital signs monitoring

• Mainly observation for the rest of the day

DAY 4

• Allow to do VS/NVS still with assistance of staff nurse

• Allow to fill out request forms for diagnostic exams with the

supervision of staff nurse

• Fill out Kardex and other forms with senior nurse

• Observe the On-Handling of charts, carrying out of doctor’s orders,

filling out of forms

•Allow to participate on all activities/procedures (giving of medication/s,vital signs monitoring, etc.) during his/her shift but with supervision

and assistance from senior nurse.

DAY 5-7

• Review of all learned skills, knowledge for the week

• Allow hands on practice of procedures with assistance

• Evaluation of learning experience, skills learned

• Evaluate his/her performance for improvement

WEEK II

Allow the trainee to assist the senior nurse on skills and procedures

learned. The trainee may do VS/NVS on his/her own but still the senior nurse

checks for accuracy especially during abnormal readings/results. The trainee

is also allowed to prepare medications (oral, parenteral) but has to be

checked by the senior nurse before and during administration. He/she mayalso be allowed to perform simple procedures like insertion of IFC/NGT and

NGT feeding.

Depending on the census of the unit, and the cases handled and

trainee’s work efficiency for the week, the extent of the procedures, he/she

may be allowed to do or perform.



WEEK III

The trainee will be allowed to handle procedures on his own,

(depending on performance for the past week/s) with just the assistancefrom the senior nurse. More hands-on experiences are allowed during this

week.

The trainee will remain to assume the bed side nurse during this week,

but may be oriented on being the charge nurse. The trainee will be taught on

how to carry out orders, referring of patients, decision making skills, and

charting. He will also be trained on endorsing patients to the incoming nurse

or to the other areas of the hospital

Learning skills may depend on the census of patients and performance

of the trainee.

WEEK IV

Based on his performance evaluation, his workload may vary. This

week, he would be allowed to perform measures on his/her own, with less

assistance from the senior nurse but still with supervision.

He may be allowed to handle patients as the charge nurse depending

on cases he could manage on his/her own. During this stage of unit

exposure, it will be tried to bring out on him essential skills like decision

making.

NOTE:

The succeeding weeks of exposure to the unit will be more on hand on

handling of patient, motivation to improve his/her skills and improvement of quality and speed of work. But whatever action the trainee will do, the senior

nurse will remain liable of his actions, thus, assistance and supervision is still

vital no matter how good or efficient the novice may be.



PROCEDURES COMMONLY PERFORMED IN

THE ICU

NGT INSERTION

1. Check for physician’s order.

2. Review the client’s medical history (to assess for any nostril

surgery and abnormal bleeding).

3. Assess client’s consciousness and ability to understand. Explain

the procedure. (Decreases anxiety and promotes

cooperation for conscious patients).

4. Prepare the equipment, putting tissues, a cup of water and an

emesis basin nearby.

5. Prepare the environment; raise the bed and place it in a HIGH

FOWLER’S POSITION.

6. Wash hands on then put on gloves.

7. Use a penlight to view the client’s nostrils. Assess client’s nostrils

with penlight and have the client blow her nose one nostril at a

time. (Choosing the more capable nostril for insertion

decreases discomfort and unnecessary trauma)

8. Using the NG tube, measure the distance from the bridge of

the nose to the earlobe and then to the xiphoid process



of the sternum and mark the distance on the tube with a piece

of tape.

9. Lubricate the first four inches of the tube with water soluble

lubricant.

10. Ask the client to slightly flex the neck backwards to make

the insertion easier.

11.Gently insert the tube to the selected naris.

12. Ask the client to tip his/her head forward once the tube

reaches the nasopharynx. If the client continues to gag, stop the

insertion for a moment.

13. Advance the tube several inches at a time as the client

swallows water or ice chips if possible.

14. Withdraw the tube immediately if there are signs of

respiratory distress.

15. Advance the tube until the taped mark is reached.

16. Split 4-inch of tape 2-inch lengthwise. Secure the tube with

the tape by placing the wide portion of the tape on the bridge of

the nose and wrapping the split ends around the tube.

17. Check the placement of the tube:

Attach the syringe to the end of the tube and

injecting 10cc of air while auscultating over the

epigastric area

Aspirate sample gastric content and measure with

chemstrip PH

Prepare the client for x-ray check up, if prescribed.

18. Connect the distal end of the tube to suction, draining bag,

or adapter to establish an appropriate pathway for intervention.

19. Secure the tube with rubber band and safety pin to client’s

gown or bed sheet.



3. Measure all oral fluids in accordance with agency policy.

Record all IV fluids as they are infused.

4. Record time and amount of all fluid intake in the designated

space on I & O form (oral, tube feedings, IV fluids).

5. Record all 8 hour total form of fluid intake in the appropriate

column of the 24-hour record.

6. Complete 24 hour intake record by adding all 8-hour totals.

OUTPUT

7. Apply non sterile gloves.

8. Empty urinal, bedpan, or foley drainage bag into graduated

container or commode hat. Other output may also be

recorded, including nasogastric suction, suction bulb or chest

tubes.

9. Remove gloves and wash hands.

10. Record time and amount of output on I & O form.

11. Complete 24 hour output record by totaling all 8-hour

totals.

12. Wash hands.

INSERTING AN INDWELLING CATHETER: MALE


2. Gather the equipment needed.

3. Provide for privacy and explain procedure to client.



4. Set the bed to a comfortable height to work, and raise the

side rail on the side opposite you.

5. Assist the client to a supine position with legs slightly spread.

6. Drape the client’s abdomen and thighs if needed.

7. Ensure adequate lighting of the penis and perineal area.

8. Wash hands, apply disposable gloves and wash the perineal

area.

9. Open the catheterization kit, use the wrapper to establish a

sterile field.

10. Attach the catheter to the urine drainage bag if it is not

preconnected.

11. Generously coat the distal portion of the catheter with

water-soluble, sterile lubricant and place it nearby on the

sterile field.

12. With your non-dominant hand, gently grasp the penis and

retract the foreskin (if present). With your dominant hand,

cleanse the glans penis with a povidone iodine solution or

other anti microbial cleanser.

13. Hold the penis perpendicular to the body and gently pullup.

14. Holding the catheter in your dominant hand, steadily insert

the catheter about 8 inches, until urine is noted in the

drainage bag or tubing.

15. Continue inserting until the hub of the catheter is met.

16. Reattach the water filler syringe to the inflation port.

17. Inflate the retention balloon with sterile water permanufacturer’s recommendation or the physician’s order.

18.Once the balloon has been inflated, gently pull the catheter

until the retention balloon is resting snugly against the

bladder neck (resistance will be felt when the balloon is

properly seated).



19. Secure the catheter according to institutional policy.

Securing it to either the client’s thigh or abdomen is generally

acceptable.

20. Place the drainage bag below the level of the bladder. Do

not let it rest on the floor. Secure the drainage tubing toprevent pulling on the tubing on the catheter.

21. Remove gloves, dispose equipment, and wash hands.

22. Assess and document the amount, color, odor, and quality

of urine.

INSERTING AN INDWELLING CATHETER: FEMALE


2. Gather the equipment needed.

3. Provide for privacy and explain procedure to client.

4. Set the bed to a comfortable height to work, and raise the

side rail on the side opposite you.

5. Assist the client to a supine position with legs spread and feet

together or to a side –lying position with upper leg flexed.

6. Drape the client’s abdomen and thighs for warmth if needed.

7. Ensure adequate lighting of the perineal area.

8. Wash hands and apply disposable gloves.

9. Wash perineal area.

10. Open catheterization kit, using aseptic technique. Use thewrapper to establish a sterile field.

11. Attach the catheter to the urine drainage bag if it is not

preconnected.



12. Generously coat the distal portion of the catheter with

water-soluble, sterile lubricant and place it nearby on the

sterile field.

13. Place the fenestrated drape from the catheterization kit

over the client’s perineal area with the labia visible throughthe opening.

14. Gently spread the labia minora with the fingers of your non

dominant hand and visualize the urinary meatus.

15. Holding the labia apart with your non dominant hand, use

the forcep to pick up a cotton ball soaked in povidone iodine,

and cleanse the periurethral mucosa. Use one downward

stroke for each cotton ball and dispose. Keep the labia

separated with your dominant hand until you insert thecatheter.

16. Holding the catheter in the dominant hand, steadily insert

the catheter into the meatus until urine is noted in the

drainage bag or tubing.

17. Reattach the water filled syringe to the inflation port.

18. Inflate the retention balloon using the manufacturer’srecommendations or according to the physician’s order.

19. Once the balloon has been inflated, gently pull the catheter

until the retention balloon is resting snugly against the

bladder neck.

20. Tape the catheter to the abdomen or thigh snugly, yet with

enough slack so it will not pull on the bladder.

21. Place the drainage bag below the level of the bladder. Do

not let it rest on the floor. Make sure the tubing lies over notunder the leg.

22. Remove gloves, dispose of equipment, and wash hands.

23. Assess and document the amount, color, odor, and quality

of urine.



MAINTAINING AND CLEANING TRACHEOSTOMY TUBE

1. Wash hands and apply gloves.

2. Remove soiled dressing and discard.

3. Cleanse neck plate of tracheostomy tube with cotton

applicators moistened with hydrogen peroxide.

4. Rinse neck plate of tracheostomy tube with applicators

moistened with sterile water or saline.

5. Cleanse skin under the neck plate of tube with cottonapplicator moistened with hydrogen peroxide.

6. Rinse skin under neck plate with applicators moistened

with sterile water or saline.

7. Dry skin under neck plate with cotton applicators.

8. Prepare tracheostomy ties.

Cut a length of twill tape that will fit around the

client’s neck, plus 6 inches. Cut the ends of thetwill tape diagonally.

Open Velcro ties on continuous neck band.

9. Leaving the old tracheostomy ties in place, insert one end

of the new tracheostomy ties through the hole in the

tracheostomy neck plate from the back to front. Pulls the

ends even, and slide both ends of the tape around the back

of the head to the other side.

10. Insert one end of tape through the opening on the

other side of the tracheostomy tube neck plate from back

to front.

11. Tie the two ends of the new tape with a square knot

at side of neck. Keep two fingers under the tape as the



knot it tied. Without putting pressure on the neck plate or

the tape, pull on the know to make sure it will stay tied.

12. Cut and remove old tracheostomy tapes and discard.

Hold the neck plate firmly with one hand while cutting old

tapes.

13. Place one finger under the tracheostomy ties to

check for tightness and security.

14. Discard all used materials and wash hands.

SUCTIONING ENDOTRACHEAL AND TRACHEAL TUBES.

1. Assess depth and rate of respirations; auscultate breath

sounds.

2. Assemble supplies on bedside table.

3. Wash hands.

4. Connect suction tube to source of negative pressure.

5. Administer oxygen or use ambu bag before beginningprocedure.

6. Apply sterile gloves.

7. Open sterile suction catheter or use the reusable closed

system catheter. The sterile suction catheter is removed

from the package with our dominant, sterile hand. Wrap

the catheter tubing around your hand from the tip of the

catheter down to the port end. Attach catheter to suction.

8. Insert the catheter into the trachea without suction.

9. Apply suction intermittently while gently rotating the

catheter and removing it. In a disposable catheter, suction

is applied by placing the thumb of your dominant hand

over the open port of the catheter connector.



10. Wrap the disposable suction catheter around your

sterile, dominant hand while withdrawing it from the

endotracheal tube.

11. Suction for no more than 10 seconds.

12. Administer oxygen using the high function on the

ventilator or using an ambu bag.

13. Assess airway and repeat suctioning as necessary.

14. Remove gloves and discard.

15. Wash hands.

16. Record the procedure and client’s tolerance of the

procedure, including the amount and consistency of secretions.

ADMINISTERING CARDIOPULMONARY RESUSCITATION

(CPR)

1. Assess responsiveness of patient, including vital signs.

2. Cardiac compressions are performed as follows:

Maintain a position on knees parallel to sternum.

Position hands for compression.

o Using the hand nearest to the legs, use the

index finger to locate the lower rib margin and

quickly move the fingers up to the location

where the ribs connect to the sternum.

o Place the middle finger of this hand on the

notch where the ribs meet the sternum and the

index finger next to it.

o Place the heel of the opposite hand next to the

index finger on the sternum.



o Remove the first hand from the notch and

place it on top of the hand that is on the

sternum so that they are on top of each other.

o Extend or interlace fingers and do not allow

them to touch the chest.

o Keep arms straight with shoulders directly over

hands on sternum and lock elbows.

o Compress the adult chest at the rate of 80 to

100 compressions per minute.

o The heel of the hand must completely release

the pressure between compressions, but it

should remain in constant contact with theclient’s skin.

o Use the mnemonic “one and two, two and

three and…” to keep rhythm and timing.

o Ventilate client.

3. Maintain the compression rate for 80-100 times/minute,

injecting ventilation after 15 compressions.

4. Reassess the client after 4 cycles.

DEFIBRILLATION

OVERVIEW: Defibrillation is achieved by delivering a strong electric

current though electrodes placed on the surface of a patient’s chest

wall. Proper electrode placement ensures that the axis of the heart is

directly situated between the sources of current (defibrillator paddles).Since dysrhythmias are chaotic with no coordinated ventricular

response, the electric current is delivered randomly. It is through

implementation of emergent defibrillation that ventricular fibrillation

and pulseless ventricular tachycardia can be terminated and cardiac

output restored.



PURPOSE:

1. To eradicate life-threatening ventricular fibrillation or pulseless

ventricular tachycardia.2. To restore cardiac output lost due to dysrhythmias and

reestablish tissue perfusion and oxygenation.

PROCEDURE:

1. Verify V-fib or V-tach by ECG and correlate with clinicalstate. Assess to determine absence of pulse. Call for help andperform CPR until defibrillator and crash cart arrives.2. Prepare for defibrillation

a. Turn power "ON". Defaults to 200 joules.b. Select correct paddles- adult, pediatric or internal.c. Prepare patient and/or paddles with properconductive agent.d. Checks that defibrillator is in asynchronous mode.*** If other than 200 joules desired, press "ENERGYSELECT" and select desired amount

3. Turn on ECG recorder for continuous printout.4. Places one paddle at the heart’s Apex just left of the nipplein midaxillary line. Place the other paddle just below the right

clavicle to the right of the sternum, applying 25 lbs. / square inchpressure to paddles.5. ***Press "CHARGE" on defibrillator front panel or on theApex paddle. Wait until indicator stops flashing to indicate fullycharged.6. ***State "ALL CLEAR" and visually check that all personnelare clear of contact with bed, patient and equipment.7. ***Checks rhythm immediately before discharge.8. 8. Depress both buttons simultaneously and maintainpressure until electrical current delivered. (Maintain 25 lbs/in2)9. ***Assess conversion of dysrhythmia.

10. 10. If first defibrillation unsuccessful, immediately chargepaddles to 300 joules and repeat steps 2 through 9.11. If second defibrillation unsuccessful, immediately chargepaddles to 360 joules and repeat steps 2 through 9.12. If third attempt is unsuccessful, continue CPR, initiate ACLSprotocols, intubate and obtain IV access. Assess patient statusand precipitating factors to prevent further decompensation of patient.



13. Clean defibrillator and paddles, discard supplies, and washhands.14. Documents procedure in patient record.

POLICIES AND REQUIREMENTS OF THE DEPARTMENT

UNIFORM

The staff, when on duty, must wear the prescribed uniform at alltimes:

Prescribed clean white uniform – should be made of white,non sheen, non transparent material with the prescribeddesign and official hospital logo.

Company ID – should wear the updated and own ID at alltimes. Have the updated PRC license, IVT ID alwaysavailable for reference.

Clean white shoes – must be closed and low heeled.

Rubber shoes are not allowed. Shoes shall always be cleanand well polished. Socks should be all white without anyprint

Nurse cap for females – should be clean and ironed.

Wrist watch with minute hand – nurse may wear theirschool rings; married nurses may wear their weddingbands. Small ear studs may be worn by female nurseswhose ears are pierced. Earrings are not allowed for malenurses.

SCHEDULE

Regular time schedules are 6AM to 2PM, 2PM to 10PM and10PM to 6AM



Schedule is prepared by the supervising nurse andapproved by the chief nurse. Any changes in the scheduleshould be made and approved by the HN, SN, and CN.

Four hours prior to scheduled duty, notification should bemade for sick call.

Exchanges with the schedules should be made andapproved by HN, SN, and CN.

MEETINGS

Unit meetings are made once a month to discuss concernsregarding the area. Secretary or a staff is assigned to take

notes of the minutes of the meetings. Attendance is a mustto all staff. A prior notice is given if a staff can’t come tothe said meetings. A penalty is imposed by HN, SN, andCN.

TRAININGS AND SEMINARS

Any staff interested to attend seminars/ training mustinform the chief nurse beforehand for the scheduling. Aletter or request by the chief nurse is submitted in thepersonnel office for approval if training hours areconsidered official business.

CLEANLINESS AND SAFETY

Nurses station must be kept clean always, fix things intheir proper placement.

Keep sink clean and dry. Scrubbing should be done everyshift as needed.

Observe proper disposal of garbage. Properly labeled binsmust be used strictly.



Linens and gowns of the patients should be clean at alltimes or as necessary.

GENERAL UNIT POLICIES

Only 1 watcher is allowed inside the ICU, however, amaximum of 2 watchers may be allowed if necessary.

Only the patients are allowed to eat inside. Watchers andvisitors are not allowed to eat, smoke and make noiseinside the unit.

Infectious cases are admitted to the Isolation (Garnet)room while non contagious cases are admitted at the main

ICU. ICU is under the direct supervision of the Medical Director

in coordination with the attending physician.

Used needles should be thrown properly on a sealedcontainer.

Curtains, draped should be changed regularly every monthand as needed.

Watchers are advised not to bring a lot of belongings insidethe unit since food, linen, hospital gowns and otherparaphernalia are provided by the hospital to the patients.

Silence should be observed inside the unit. Cell phones are not allowed to be used inside the unit.

Only the on duty staff nurses are allowed to stay inside theunit.

Cleanliness of the area should be observed at all times.Daily housekeeping is a routine in the unit like cleaning of bed sides, sweeping and mopping of the floor usingdisinfectants, collecting garbage, dusting of shelves,equipment and cabinets and scrubbing the comfort room.

The sink should be scrubbed every sink.

Stocks and equipment should be checked before the shift

ends. Hand towels should be washed every shift or as needed.

Suction tips and PNSS should be changed at least every 8hours or as needed.

Suction machine and bottles should be cleaned every 8hours or as needed.



No reuse policy should be observed including the changeof pool drains for suction machines for every patient.

Cardiac monitors and other equipment should be well keptafter use.

Always check all the instrument and equipment’s readiness

for use at all times. Once the unit is vacant, ask the housekeeping department

for general cleaning and exposing of unit to UV lightradiation.

Periodic culture of strategic areas is done.

ICU equipment/apparatus that are out of order should bereported immediately to the AAO for the technician torepair them.

Empty gas tanks, unnecessary things like empty dextrosebottles, etc., should be remove because they may becauses of barriers during critical care cases.

Post-operative patients may stay at the ICU for recoveryand transfer them when stable to room of choice.

Children are not allowed to enter the ICU premises.

Waste should be thrown accordingly.

Applying restraints to patient should be well explained torelatives with consent from relatives after checking AP’sorder.

Document all procedures and interventions done with thepatient.

GUIDELINES: DISCHARGING PATIENT FROM ICU

HAMA – Home Against Medical Advice and HPR – HomePer Request

1. Explain the consequences that may arise due to theirdecision.



2. Name and explain hospital policies and protocols regardingHAMA/HPR cases to patient and/or relatives.

3. Notify AP on patient/relatives request; secure PF and finaldiagnosis.

4. Transcribe AP’s orders or specific instructions, if any.

5. Carry out AP’s orders.6. Secure HAMA/HPE waiver or consent form to patient and/orrelatives.

7. Collate and input all unit charges to certain patient.8. Notify other areas/departments (let staff sign on the IC

billing notebook.)9. Have the billing personnel receive the chart of the patient,

with charges, if any. Let them sign on the ICU billingnotebook .

10. Secure a copy of discharge slip, notify linen staff forsigning.

11. Remove all paraphernalia attached to the patient.12. Call transport aides (carriers) to bring patient to

hospital gate/vehicle.

NB: for cases like paraphernalia (e.g. IVF, IFC, NGT) to be takenhome, secure AP’s order, if possible, consent/waiver; instructclearly of special instructions and/or measures.

HAMA – Intubated patient

1. Explain the consequences that may arise due to theirdecision.

2. Name and explain hospital guidelines /protocols regardingthis case.

3. Notify AP on patient and/or relatives request; secure PFand final Dx.

4. Transcribe AP’s orders or specific instructions, if any.5. Secure HAMA waiver/consent from relative.6. Collate and input all unit charges to certain patient, if any.7. Notify other departments.8. For billing out.9. Secure discharge notice and notify linen staff.10. Remove all paraphernalia attached to the patient.



11. Have relatives turn the respirator off.12. Continuous ambubagging while transport aides

carries patient to vehicle.13. Extubate patient prior to departure.

CADAVER

1. Notify AP of patient’s death, if pronounced on his absence;secure PF and final Dx.

2. Perform post mortem care.

3. Charge and input all stocks/supplies used.4. Notify all departments.5. Have billing personnel receive the chart and other charges.6. Instruct/assist relatives to call for funeral service.7. Secure discharge notice.8. Have relative sign the cadaver receipt form.9. Release the cadaver to funeral service personnel with

relatives.

TRANSFERRING PATIENT

o FROM ICU TO REGULAR ROOM

1. Verify AP’s order/s for transfer to ROC.2. Ask patient and/or relative room preference, explaining

room rates (refer to admitting staff if necessary)3. Notify concerned areas/staff:

Admitting staff for availability or reservation of roomof choice.

Linen staff and male attendants for room preparationincluding equipment to be prepared.



Receiving NOD of patients transfer with pertinentdata.

4. Prepare patient for transfer, remove paraphernalia if necessary.

5. Coordinate with transport aides for transferring of patientto ROC.

6. Accompany the patient to room while transferring.7. Assist transport aide in transferring patient to bed.8. Stabilize condition of patient, hook to any equipment, if

any.9. Endorse to ward NOD

o NB: always indicate/note date and time of transfer.

o THOC – TRANSFER TO HOSPITAL OF CHOICE

PER PATIENT’S/RELATIVE’S REQUEST

1. Explain the consequences that may arise during thetransferring of patient.

2. Explain hospital guidelines/protocol regarding this situation.3. Notify AP of patient/relative’s desire to transfer patient to

other institution, if not AP’s suggestions.4. Secure THOC consent/waiver form from patient or relatives.5. Coordinate with HOC ER/Admitting staff.6. AP/ROD will coordinate AP/ROD of HOC, ICU NOD will take

charge if possible with receiving HOC guidelines.7. Provide with referral letter, including medicines given,

photocopies of work-ups done.8. Arrange transport vehicle to be used an SP nurse who will

accompany patient.

o If hospital ambulance will be used, SP in necessary.



o If own vehicle is used, SP nurse is optional with

condition of terminating all paraphernalia

9. Notify all departments for charges.10. Billing personnel receives chart and charge slips, if any.

11. Secure discharge notice, notify linen staff.12. Endorse to SP nurse, if necessary.

ADMITTING PATIENT

FROM ER TO ICU

1. Receives call from ER staff/NOD regarding admission.2. Gather pertinent information regarding patient like name,

age, case, condition, LOC, equipment/paraphernalianeeded, special procedure to be anticipated.

3. Admitting staff should coordinate with linen staff for ICUadmission.

4. ICU NOD confirms with linen staff the bed assignment forincoming patient.

5. Prepares equipment, paraphernalia, other devices needed

for incoming patient with male attendants, linen staff orRTOD, if necessary.

6. ER NOD should verify to ICU NOD and linen staff thereadiness of area to accommodate incoming patient.

7. Patient should be transported by transport aidesassisted/accompanied by ER NOD, ROD and AP if necessary.

8. Patient should be transported and positioned safely andaccordingly to bed.

9. Stabilize the patient; connect to devices/equipment tonecessary by NOD and/or RTOD.

10. Receive endorsement from ER NOD, verifying statmedications/procedures properly done.

11. Accomplish patient’s chart, kardex and otherrequired forms of documentation.



WARD TO ICU

1. Receives call from ward staff/NOD regarding trans in of

patient (ordered by ROD/AP).2. Gather pertinent information regarding patient like name,

age, case, condition, LOC, equipment/paraphernalianeeded, special procedure to be anticipated.

3. Originating staff should coordinate with linen staff andmale attendants for bed preparation, to male aides forequipment to be prepared.

4. ICU NOD confirms with linen staff and male attendants bedassignment and equipment to be prepared.

5. Prepares equipment, device needed for incoming patientwith male attendant, linen staff and RTOD if necessary.

6. Ward NOD coordinated with ICU NOD for preparedness of receiving area, calls for transport aides for transferringpatient, thereafter.

7. Transfer and position to bed safely by transport aides andNOD.

8. Stabilize patient; connect to device, paraphernalia needed.9. Receive endorsement from WARD NOD.10. Accomplish patient’s chart, kardex and other

required forms of documentation