NUH Critical Care Induction Paperwork (Run as a slide show, will transition automatically) August 2015

Paperwork Drug charts Admission summary Daily review sheet

Drug Charts There are 2 used for all our patients Standard trust drug chart Critical care infusion chart

Standard Trust Drug Chart We only use the adult general charts Not the paediatrics, neonates, ophthalmology etc… Used for… Antibiotics IV drugs not given by infusion Some IV loading infusions (phenytoin) PO/NG/NJ drugs VTE prophylaxis

Standard Critical Care Prescriptions VTE prophylaxis Enoxaparin (and TEDS or Flowtrons) Please also complete the NOTIS assessment Stress ulcer prophylaxis IV Ranitidine (50mg TDS, reduce in renal impairment) PO/NG Ranitidine if suitable (150mg BD) PPI (Increased risk of C-Diff and Bleeding)

Critical Care Infusion Chart Insulin (not the trust insulin prescription) Sedatives Vasopressors/inotropes Amiodarone Electrolytes IV fluid

Please ensure patient details are documented. Please detail any ALLERGIES We use a standard sliding scale if blood glucose is in excess of 11.1 mmol/L With the sliding scale a source of Glucose must be prescribed

Sedatives are pre-prescribed Default sedation is Propofol and Morphine Please ensure that strengths are also prescribed

Inotropes and Vasopressors: If there is a possibility your patient will need them, prescribe them on admission AF is common amongst ICU patients; Remember that Amiodarone is a NEGATIVE INOTROPE

Potassium can ONLY be given centrally, IDEALLY Potassium should be in the 4.0 – 4.5 mmol/L range Please check pressure bags, they should be SALINE only; SIGN THE STICKER! Phosphate replacement, NOTE it contains Potassium; It is rare to use This and NEAT Potassium together

PLEASE Prescribe fluids on the AICU Drug chart

Admission Summary Fill out on admission for all patients newly admitted (or re-admitted) to critical care There is no need to complete an admission summary for a patient transferred between critical care areas 4 pages long – mostly filling in boxes so doesn’t take long

The form is relatively self explanatory Please fill in patient details AND referring team/consultant Admitting diagnosis and immediate history to include as many relevant details as possible Previous exercise tolerance is extremely important Please clearly document allergies

Grade of laryngoscopy is extremely important Insert the most recent ABG Please record any lines/drains/tubes Important for all patients, vital for the Neurosurgical patients

Carefully record any injuries, lines, tubes and drains in as much detail as possible Document the most recent bloods A clearly documented infection and antibiotic history will prevent repeat drug doses and errors

It is very important to fill in the assessment of Mental capacity Care bundles are standards of care, please document if they are not followed

Top Tips for Admission Summaries Patient details, date and time Referring Consultant (“Major Trauma” not good enough) Alcohol Hx Missed recently, led to a pt falling and injuring themselves Drug Hx Writing “as per drug chart” or “see attached” is a guaranteed way to irritate people Examine everything – front and back of the patient

Daily Review Sheet Started by the night team Written on during the morning handover Completed by the team everyday Written on during microbiology ward round Radiology review Often the morning review by parent teams Used for audit and your defence

The morning ward round details and daily plan goes in here; Filled in by the Consultants Include all details or changes from overnight; Known plans and scans for the day and communications with other teams

As with the admission sheets, the daily review sheets are self explanatory. Fill in EVERY box as the detail is important. The Standards of care will be audited. Please take care to ensure that they are met, or if not then please find out why not Formulate a management plan Discuss it with the consultants or senior Trainee`s Action as much as possible

MICRO round is every day on AICU, twice a week on E12 Fill in any positive Micro, any changes or any cessations of Antibiotics. The Details of the consultant ward round are to be filled here, a lot of us write for ourselves; it is useful to have the blood results from The day, and a reminder the review imaging…

Top Tips for Daily Reviews Ask the nurses if they have any additional concerns or things they want doing Enter the time of your review Ensure you complete the how old the lines are section

The other paperwork Discharge summaries Weaning from ventilator plans Only required when patient is leaving critical care Weaning from ventilator plans The trust insulin charts Used very occasionally Stickers Lines, some prescriptions, blood cultures, etc…