Daily ICU Routine

Patients in Intensive Care are reviewed many times a day by the various staff involved in their care, and continuously by the nurse at the bedside.

A typical day on ICU is very busy. A general guide is below but the daily schedule will depend on what each patient needs:

07.30 – 08.00: Nurse changeover/handover to incoming team

08.30 – 09.00: Medical changeover/handover to incoming team

09.00 - 12.00: Medical and healthcare professional ward round

                          Therapy review/rehabilitation

                           Investigations or scans as required

12:00- 13:00:  Lunch / Rest time 

13.00 – 17.00: Therapy review/rehabilitation

                           Investigations or scans as required

 19.00 – 19.30: Nurse changeover/handover to incoming team

20.00 – 20.30: Medical changeover/handover to incoming team

• Personal care and medication rounds happen throughout the day.
• If calling for an update about your relative, you may find it best to call during the afternoon when the team can provide you with the most up-to-date information.

Handover and ward rounds –

The nurses start the shift by hearing about the patient's progress since they came into Intensive Care and over the previous shift. At the beginning of each shift the nurse will carry out a full assessment of the patient by checking their charts (including things like vital signs, blood results and medications), checking that all equipment is working as it should and carrying out a full body assessment (e.g., checking the patient's skin, including any wounds and dressings, and listening to their chests).

At the beginning of each shift (both day and night), the outgoing medical team hands over to the incoming team, discussing each patient in turn. This will include things like the patient's vital signs (blood pressure, heart rate, temperature, etc), their blood results, X rays, medications, and medical notes, among others.  This is led by the intensivist (consultant in intensive care medicine) and other members of the critical care team will also be present.

A ward round is also done once each shift (both day and night). The ward round during the day usually involves many different members of the ICU staff: the doctors, nurses, pharmacist, dietitian, physiotherapist etc. The patient will be reviewed in detail, and the relevant members of the ICU team will be invited to make recommendations for patient care, based on their own expertise.  

Personal care is the word we use to cover all the intimate care the nurse gives, such as washing the patient, looking after their skin and mouth. Whilst patients are in ICU the nurse will give a bed bath or a complete wash in bed at least once a day or whenever else it is needed. The mouth is cleaned and moisturised every 2 to 3 hours with soft moist sponges.  The nurse will pay special attention to the patient’s skin. The nurse will change the patient’s position in bed, every 2-4 hours to prevent pressure sores on the skin.

Infection control

Patients who are in Intensive Care are more at risk of getting infections. This is mainly due to patients being so unwell but also due to some of the procedures necessary when critically ill. The breathing (or endotracheal) tube, for example, provides essential breathing support, but can increase the risk of chest infections. The IV tubes and drips we use to monitor the patient or give fluids and medications can also increase the risk of infections in the blood. To help reduce infections, we ask visitors to clean their hands when they enter and leave the unit by using the spray foam, alcohol gel or by washing their hands.  Visitors will also be asked to wear a plastic apron at the bedside. All the staff on the ICU’s will wear raspberry-coloured uniforms (‘scrubs’), aprons and gloves and must always clean their hands before and after caring for patients.

PPE- Personal protective equipment – staff in the clinical areas are currently wearing PPE to protect against the spread of COVID-19. We are asking patients and visitors to follow national guidance on the use of face masks whilst in hospital.

Investigations/procedures/transfers-  

Whilst patients are on ICU, they might need tests or investigations and undergo procedures. These are done to help diagnose what is medically wrong. Wherever possible the tests and procedures are done on the ICU for example an  X-ray, bronchoscopy (camera into the wind pipe/ lungs), endoscopy (camera into the body). However, some tests such as a CT scan or MRI scan will be done in the radiology department, where the specialist equipment is situated.

A doctor and a nurse will go with the patient to ensure continuous monitoring, and to give essential treatment during the entire process.

Medications

Medication are an essential part of the care provided in the ICU. The amount and type of drugs given to a patient will vary according to their condition and progress. ICU staff will explain your relative’s individual needs. Commonly patients will be given drugs to stop pain, as well as sedatives.