Module 1.1 Intro to ICU
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Basic Principles of Critical Care
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Module 1.1 Intro to ICU
- 1. INTRODUCTION TO ICUs Gradian Health Systems Basic Principles of Critical Care BASIC PRINCIPLES OF CRITICAL CARE
- 2. Disclaimer Basic Principles of Critical Care Training I Introduction to ICUs Disclaimer: Gradian Health Systems cannot provide formal recommendations or indications regarding medical care and clinical service delivery. The tables, checklists, and other clinical documents referenced in this training have not been validated in all settings. These documents are intended to serve as examples only. We recognize that all clinical training content and activities must be customized to meet the needs of each facility and its clinical staff, factoring in available resources, practitioner skill level, and other environmental considerations. For any questions regarding the contents or applications of this training, please contact Gradian Health Systems: 40 W 25th St, 6th Floor New York, NY 10010 USA +1 212-537-0340 training@gradianhealth.org
- 3. Module 1 Gradian Health Systems Basics Principles of Critical Care Basic Principles of Critical Care
- 4. Module 1: Basic Principles of Critical Care MODULE OVERVIEW Lesson 1 I Introduction to ICUs Lesson 2 I Pain Management and Sedation Lesson 3 I ICU Admission and Discharge Lesson 4 I Infection Prevention and Control Lesson 5 I Total Nursing Care Basic Principles of Critical Care Training I Introduction to ICUs
- 5. Components of the Gradian CCV SystemLesson 1: Introduction to ICUs Lesson Objectives • Describe the benefits and challenges of critical care units and intensive care units • Define roles within the ICU • Explore a multidisciplinary approach to ICU care Basic Principles of Critical Care Training I Introduction to ICUs
- 6. Components of the Gradian CCV SystemLesson 1: Introduction to ICUs Key Concepts • Critical Care Units (CCU) • Intensive Care Units (ICU) • Staffing Basic Principles of Critical Care Training I Introduction to ICUs
- 7. Components of the Gradian CCV SystemIntroduction to ICUs What is critical care? • Specialized care for seriously ill patients • Require experienced, trained personnel • Require specialized equipment for high intensity of service, including treatment and monitoring of physiological parameters Basic Principles of Critical Care Training I Introduction to ICUs
- 8. Components of the Gradian CCV SystemIntroduction to ICUs Intensive Care Unit (ICU) Characteristics • Specially staffed and equipped hospital units to optimize care for critically ill patients • Dedicated to management and monitoring of patients with life- threatening illnesses, injuries, and complications • Separate and self contained • Often separate units for special populations (e.g. cardiac, trauma, surgical, neurological, pediatric, or neonatal patients) Basic Principles of Critical Care Training I Introduction to ICUs
- 9. Components of the Gradian CCV SystemIntroduction to ICUs Intensive Care Unit (ICU) Staffing • High nurse to patient ratio • Intensivists trained to recognize seriousness of dynamic clinical situations Care for critically ill patients is broadly divided into the identification of patients at risk outside of the ICU/CCV and the provision of care within the actual unit Basic Principles of Critical Care Training I Introduction to ICUs
- 10. Components of the Gradian CCV SystemIntroduction to ICUs ICU Types • Medical • Surgical • Pediatric • Neonatal • Neurological Basic Principles of Critical Care Training I Introduction to ICUs
- 11. Components of the Gradian CCV SystemIntroduction to ICUs ICU Staff • Intensivists • Residents/students • Critical care nurses (CCNs) • Physiotherapists • Pharmacists • HRIs • Nutritionists • Biomedical technicians (BMETs) • Others (e.g. support staff, guards, radiographers, social workers, occupational therapists, stores manager, infection prevention and control, researchers, etc.) Basic Principles of Critical Care Training I Introduction to ICUs
- 12. Components of the Gradian CCV SystemIntroduction to ICUs Medical Staff • Medical Director – overall responsibility of ICU operation, recommended to be physician intensivist Nursing Staff • Recommended ratio 1:1 for ventilated patient • Recommended ratio of 1:2 for other / non-ventilated patients • Nurse-in-charge must have ICU training and registration • Shift leader should be ICU trained • Support nurses may be required (depends on availability of ICU trained nurses) Basic Principles of Critical Care Training I Introduction to ICUs
- 13. Components of the Gradian CCV SystemIntroduction to ICUs Educational Staff • Interprofessional education coordinator to manage educational activities Other Staff • Number and type depends on size of CCU/ICU Basic Principles of Critical Care Training I Introduction to ICUs
- 14. Components of the Gradian CCV SystemIntroduction to ICUs ICU Operations • Under care of clinical care specialist who: • Institutes policies • Develops team approach to care • Documented and demonstrable procedures for formal audit, peer review and quality assurance • Active research plan is desirable • Imaging, laboratory, and other diagnostic services required on 24- hour basis Basic Principles of Critical Care Training I Introduction to ICUs
- 15. Components of the Gradian CCV SystemIntroduction to ICUs ICU Structure • Location I easily accessible from emergency department, operating room, and radiography • Design I dependent on space and design; total area should be 2.5- 3x the patient area Basic Principles of Critical Care Training I Introduction to ICUs
- 16. Components of the Gradian CCV SystemIntroduction to ICUs Patient Care Zone • Site of direct patient care • Consists of patient area ad adjacent rooms • Adult patients – minimum 20m2 (multibed) or 25m2 (single bed) and 2.5m traffic area beyond bed area • Single bed design is recommended; advantages include privacy, patient safety, increased sleep quality, reduced patient stress • Other needs in patient area include: • Communication (intercom, alarm) • Administrative area (workstation, monitoring, imaging, viewer) • Storage for drugs and fluids • Ability to observe the patient Basic Principles of Critical Care Training I Introduction to ICUs
- 17. Components of the Gradian CCV SystemIntroduction to ICUs Clinical Support Zone Space for functions closely related to direct patient care, including: • Teamwork areas • Central physiological monitoring • Preparing and dispensing medications • Patient transport paths • Pharmacy • Laboratory • Specialized procedures • Emergency supplies and equipment • Nutrition Basic Principles of Critical Care Training I Introduction to ICUs
- 18. Components of the Gradian CCV SystemIntroduction to ICUs Unit Support Zone Refers to areas where administrative, materials management, and staff support functions occur including: • Offices • Conferences • Supplies • Clean utility • Solid utility • Staff support (tea rooms, on call rooms, rest rooms, lockers, etc.) • Kitchen Basic Principles of Critical Care Training I Introduction to ICUs
- 19. Introduction to ICUs Family Support Zone Refers to areas designed to support families and visitors including: • Signage • Waiting area • Conference / consultation rooms Basic Principles of Critical Care Training I Introduction to ICUs
- 20. Introduction to ICUs Design Considerations When designing an ICU space, attention should be paid to: • Patient type • Functional plan • Staff preferences • Technology trends • Adequate outlets for electrics, medical gases, etc. (with potential future needs considered) • Adequate space for pumps, IV bags, etc. • Medication access and availability • Bedside medication storage able to accommodate large or odd-sized items (IV bags, syringe, etc.) Basic Principles of Critical Care Training I Introduction to ICUs
- 21. Introduction to ICUs Doors • Sized to permit rapid movement of patient, bariatric beds, equipment, and personnel in/out of patient rooms • Sliding glass doors with breakaway capacity may provide additional width and increased visibility to the patient Hand Hygiene, Sinks, and Alcohol Dispensers • Readily available and soap, water, and alcohol gel systems • Located in patient rooms and near entrance • Foot-controlled • Located near paper towel dispenser and trash bins Basic Principles of Critical Care Training I Introduction to ICUs
- 22. Introduction to ICUs Isolation • Used to prevent airborne pathogens from infected patient • Should be available when needed • Negative pressure, relative to adjacent spaces • Space for staff to don protective garments and equipment before entry room (if anteroom or alcove is provided) • Number or percentage of isolation rooms dependent on institution Finishes • Noise reduction • Easily cleanable surfaces (floors, walls, ceiling) • Seamless, chemical inert, resistant Basic Principles of Critical Care Training I Introduction to ICUs
- 23. Introduction to ICUs Essential ICU Equipment • ICU beds and mattresses • Resuscitator bag • Infusion pumps and syringes • Central venous catheter (CVC) • Nasogastric tube (NGT) • Airway equipment (tubes, medical gases, intubation equipment, nebulizers, Ambu bags, oxygen delivery services, fiberoptic bronchoscope) • Bedside hemodynamic monitoring (IBP, NIBP, ETCO2, SPO2, CVP, temperature, respiratory rate) • Compression device • Other catheters (foley, arterial, CVC, feeding tubes, dialysis) Basic Principles of Critical Care Training I Introduction to ICUs
- 24. Introduction to ICUs Essential ICU Equipment • Ventilator • Crash cart (drugs, pacers, defibrillator) • Diagnostic equipment (mobile X-ray, point of care ultrasound, portable lab devices) • Telemetry and EMR • Medical gases • Suction machine Basic Principles of Critical Care Training I Introduction to ICUs
- 25. Introduction to ICUs Level Description I • Abnormal vital signs • Requires minimum 4 hourly observation • Risk of deterioration and potential need for level II care II • Single organ support (except ventilation) III • Advanced respiratory support (e.g. MV, BiPAP, CPAP, ECMO) • Two organ support Levels of Care in ICU Basic Principles of Critical Care Training I Introduction to ICUs
- 26. Introduction to ICUs ICU Challenges • Lack of resources (equipment, consumables, beds) • Inadequate human resources and trained staff (intensivists, intensive care nurses, etc.) • Work overload • Fear of infection • Stressful work environment Basic Principles of Critical Care Training I Introduction to ICUs
Notas del editor
- Critical care medicine specializes in caring for the most seriously ill patients. These patients are best treated in an ICU staffed by experienced personnel.
- An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specially staffed and equipped, separate and self-contained area of a hospital dedicated to the management of patients with life-threatening illnesses, injuries and complications, and monitoring of potentially life-threatening conditions. Some hospitals maintain separate units for special populations (eg, cardiac, trauma, surgical, neurologic, pediatric, or neonatal patients).
- ICUs have a high nurse to patient ratio to provide the necessary high intensity of service, including treatment and monitoring of physiologic parameters. Intensivists are the professionals best suited for this purpose, since they are trained to recognize the seriousness of an always dynamic clinical situation. Care is broadly divided into the identification of patients at risk outside the CCU and the provision of clinical care within the actual Unit.
- The other staff depend on the size of the CCU with larger CCU’s having increased staff.
- The other staff depend on the size of the CCU with larger CCU’s having increased staff.