P_L5_Routine Care of ICU Patient-converted.pptx

ECCT Training for ICU Nurses

1. Routine Care of ICU Patients E ss en t ial Critical Care T r ai ning 1

2. A case of acute respiratory failure in septic shock got intubated in ER and brought to ICU. He is stable with multiple vasopressors. How will you take care of this patient in ICU? E ss en t ial Critical Care T r ai ning 2 Ca s e

3. To highlight the importance of general care in ICU. To describe elements of routine care FAST HUGS BID VAP bundle CRBSI bundle Prevention of bed sore To discuss ISOBAR technique of hand over. E ss en t ial Critical Care T r ai ning 3 Obje c tiv e s

4. Routine care in the ICU consists mainly of ensuring that the patient does not develop a complication of staying in the ICU. As such, these routine elements are an important part of ICU quality assurance processes. E ss en t ial Critical Care T r ai ning 4 Importance of routine ICU care

5. Standardization of an approach to routine care will lead to uniformity and therefore increased efficiency, which may be a time-saving measure Protocol-driven routine care decisions can be taken equally well by the junior members of medical staff, which empowers them. E ss en t ial Critical Care T r ai ning 5 Rationale for routine elements of care

6. F : Feeding, A :Analgesia, :Sedation, :Thromboembolic prophylaxis , H :Head-of-bed elevation, U :Stress ulcer prophylaxis G :Glucose control S :Spontaneous breathing trial, B :Bowel care, I :Indwelling catheter removal and D :De-escalation of antibiotics E ss en t ial Critical Care T r ai ning (Crit Care Med 2005) 6 FAST HUGS BID

7. F e e ding E ss en t ial Critical Care T r ai ning 7 Goal of nutrition support is to provide individual patients with their optimal nutritional requirements 20-30kcal/kg/day Protein : 1.5 g/kg/day ( 5.3 kcal/g) Lipid : 9.3 kcal/g (40% of total calories ) Carbohydrate: 3.75 kcal/g ( remaining ) Micronutrients

8. Routes of nutrition E ss en t ial Critical Care T r ai ning 8

9. E ss en t ial Critical Care T r ai ning 9 Analgesia and sedation Analgesic and sedative administration optimizes patient comfort and minimizes the acute stress response Pain should be regularly assessed. Preemptive analgesia should be considered for invasive or potentially painful clinical procedures

10. Analgesia and sedation E ss en t ial Critical Care T r ai ning 10 Assess sedation using Richmond Agitation-Sedation Scale Execute sedative interruption to avoid over sedation. Drugs can be given intermittent bolus or continuous infusion Fentanyl or Morphine plus Midazolam or Propofol Dexmedetomidine

11. E ss en t ial Critical Care Training 11 Thromboembolic prophylaxis ICU patients are at high risk of thrombosis. Prophylaxis: Chemoprophylaxis Heparin (5000IU SC 12hrly) Low molecular weight heparin (Inj. Enoxaparin 40 mg SC OD) Mechanical prophylaxis graduated compression stockings sequential compression devices Combination of above

12. Mechanical prophylaxis Graded compression stockings Intermittent pneumatic compression device E ss en t ial Critical Care T r ai ning 12

13. Head-end of bed elevation E ss en t ial Critical Care T r ai ning 13

14. Head-end of bed elevation E ss en t ial Critical Care T r ai ning 14 Elevate at 30–45 degree angle reduces the occurrence of GI reflux and nosocomial pneumonia Ensure patient position periodically, especially after procedures that require the patient to lie flat

15. Stress Ulcer prophylaxis E ss en t ial Critical Care T r ai ning 15 Indicated in patients with sepsis with bleeding risk H2 receptor antagonists: iv ranitidine 50mg 8hourly Proton pump inhibitor iv omeprazole, pantoprazole 40mg BD

16. E ss en t ial Critical Care T r ai ning 16 Glycemic control Indicated irrespective of diabetic status Use regular insulin to achieve target of 140 mg/dl to 180 mg/dl Monitor glucose every 1-2 hours until glu c o s e v a lu e s a n d ins u li n ra t e s ar e st a bl e and then every 4 hours thereafter.

17. Preventing the pressure ulcer E ss en t ial Critical Care T r ai ning 17

18. Preventing the pressure ulcer E ss en t ial Critical Care T r ai ning 18 Take the initiative Understand the risk factor Effective skin care Nutrition Prophylactic dressing Positioning

19. Positioning E ss en t ial Critical Care T r ai ning 19

20. Mouth care E ss en t ial Critical Care T r ai ning 20

21. Eye care E ss en t ial Critical Care T r ai ning 21

22. Bundle care Bundles of care are a structured way of improving process of care and patients outcome. 3-5 components performed collectively and reliably. All or none E ss en t ial Critical Care T r ai ning 22

23. VAP Bundle E ss en t ial Critical Care T r ai ning 23 Head of bed elevation at least 30 degrees Daily sedation interruption with readiness to wean assessment Peptic ulcer disease prophylaxis Deep vein thrombosis prophylaxis Daily oral care with subglottic suctioning

24. E ss en t ial Critical Care T r ai ning 24 Central lines bundles Hand hygiene Maximum barrier precaution during insertion Chlorhexidine skin antisepsis Optimum catheter site selection with avoidance of femoral vein for central venous access in adults Daily review of the lines for necessity and prompt removal of unnecessary lines.

25. Use of Checklist E ss en t ial Critical Care T r ai ning 25 Provide framework Reduce errors and increase compliance.

26. Checklist E ss en t ial Critical Care T r ai ning 26

27. Handover technique in ICU E ss en t ial Critical Care T r ai ning 27 iSOBAR Structured communication tool to overcome barriers to communication Developed for transmission of critical information between healthcare professionals

28. iSOBAR - Component E ss en t ial Critical Care T r ai ning 28 i – Identification S – Situation O – Observation B – Background History A – Agree to a plan (Action) R – Responsibility and risk

29. E ss en t ial Critical Care T r ai ning 29 Su mmar y : Routine care of critically ill patients is very important for improving the quality of care and decreasing overall morbidity and mortality. Protocol driven routine care will be efficient, uniformity and less time consuming Implementation of locally made care of bundles will make easy patient care and outcome. iSOBAR technique of hand over overcomes barrier of communication.

30. E ss en t ial Critical Care T r ai ning 30

31. Thank You . E ss en t ial Critical Care T r ai ning 31