1. What is Critical Care

2. Intensive Care Unit:-
Specialized area for the sickest patients in the hospital in one place
Staffed by a multidisciplinary team
Has the equipment & medication required to provide multi-organ support
Specialist / tertiary referral centres
Proximity to operating theatres, emergency departments & radiology services

3. Iron Lung Unit

4. Levels of Care
Level 0 :- patients whose clinical needs are met by general ward care
Level 1 :- patients at risk of deterioration on a general ward who require critical care input.
Level 2 :- HDU care (patients requiring intensive observations or single organ support)
Level 3 :- Intensive care (patients requiring advanced respiratory support alone OR two or more organ support)
Level 4 :- Intensive care patients requiring 2 nurses’ input at one time

5. National standards (CC3N)

6. National standards and service specification:

7. ICU
Vary in size
Physical structure
Devices
People
Patients
Staffing

8. 1. Physical space: Efficiently sharing of technology and expertise
Require enough room around bed spaces to move safely from all sides of the bed.
Need an area for relative and to have private conversations with families.
Increasingly ‘without walls’
Marshall et al (2017) Journal of Critical Care (37) p

9. 2.Support and monitoring technology
Continuous monitoring (invasive and non- invasive), display should be available to all
Documentation of obs to look for trends
Respiratory support, CVS support and rneal support are the mainstays of therapy – but each unit will have their own specialism.

10. 3. Human resources: Advanced practice qualifications
Medical staff available day and night

11. 4. Critical care services provided:
Liaison team
Specialist projects like sepsis / EWS / acutely unwell adult teaching
Follow up clinics

12. 5. Research, education and quality improvement:
Improve patient care and contribute to the ICU ‘body of knowledge’
Quality improvement group across all three adult critical care units.

13. Where do Patients come from??
ED - emergency patients will arrive for all specialities
Elective surgery – lists will be prioritised every day by the nurse in charge, and medical staff
Wards – an acute deterioration may lead to ICU admission
Inter hospital transfer – for specialist care not available in the patients local hospital (also known as tertiary referrals)
Length of stay is varied (a lot of patients – 1 night, but can be much longer)

14. Organisation of Care Identification of patients at risk Admission
Ongoing care
Discharge
Follow up

15. Nurses Role in ICU Ensure patient safety
Delivery of patient centered, holistic nursing care based on patient focused assessment
Care of relatives and significant others
Professionalism
Communication
Follow policies/procedures/guidelines

16. References www.ics.org.uk / FICM www.gicu.sgul.ac.uk
BACCN

17. Any Questions ?