1. ICU Housekeeping Nov 2013

2. Outline  The daily review  Good practice points  Paperwork  Discharge planning

3. Daily review  Brief consultant led ward round, then need a thorough review  Examine, check charts, check bloods, ask nursing staff  Does the patient need parent/specialty review?  Are we missing anything?

4. A suggested structure…  Airway  Breathing  Ventilator settings, gases, chest examination  Circulation  Circulatory status, inotropes  Disability  GCS, pain, actively look for delirium, sedation, sedation hold?  Electrolytes  Na/K/Mg/PO 4

5. A suggested structure…  Fluids  24hr balance, UO, urea & creat, renal replacement, fluid balance  Gastro  Abdo exam, nutrition, bowels, N&V, LFT’s  Haem  Hb, clotting, bleeding  Infection  WCC, CRP, Abx, lines

6. …and the rest  Review the drug charts  Check for outstanding test results  Is the patient on:  LMWH?  Chlorhexidine?  PPI?  What does the nurse think?  Is there something missing?

7. Good practice points  VTE prophylaxis  Ventilator and line care  Gastric protection  Delirium

8. Paperwork  Freehand clerking  Proforma for discharge  Try and use the electronic xray requests, paper accepted for now  ICU specific charts

9. Discharging  Does everyone agree?  Does the parent team know?  Is there a plan for readmission/CPR?  CVC  peripheral?  Active problem prevention – i.e. physio

10. Summary  The daily review  Good practice points  Paperwork  Discharge planning  Proactive care