Admissions & Refusals
No admission is to be refused without discussion with the Duty Consultant.
Details of ALL admission refusals, whether due to bed shortage or inappropriate referral, must be entered into the REFUSAL BOOK (which is found in the clinical staff hub next to bed 4)
Patients refused admission who are subsequently admitted to a General Ward must be followed up within 8 hours. This can be done by the ICU Liaison Nurse if available, but after hours must be done by the ICU Registrar or Resident.
ENQUIRIES ABOUT THE ICU BEDSTATE
Do not respond to enquiries about ICU’s current capacity (or “bed state”) from non-ICU staff. When non-ICU staff hear or think that we are full, they often transfer patients out without checking with our ICU. However, as ICU capacity and occupancy is fluid, often we actually do have a bed and the transfer is unnecessary.
If you are asked whether we have a bed, ask in return if the caller has a patient, and if so, they should make a formal referral: we will then assess the patient and make a decision accordingly.
“HEADS UP”ABOUT UNWELL PATIENTS
Do not accept phone calls or requests for you “to be aware of a sick patient on the ward”, ie a “heads up” or “just to let you know” about an unwell patient. This gives the false impression that ICU has either responsibility, jurisdiction, or both, in the management of this patient. Either the staff member is making a referral for admission to ICU, or they are not. If you are approached like this, ask for a formal referral.
UROLOGY INSERTED INDWELLING CATHETERS
Urology inserted IDCs should be treated as surgical drains and not removed without discussion with the Urology team.
IV PARACETAMOL
Do not prescribe regular intravenous paracetamol unless authorised by the Duty Consultant.
COLOXYL AND SENNA
Do not prescribe stimulant aperients to patients with a new anastomosis. If an aperient is being considered in a patient post laparotomy or bowel surgery, please discuss with the Intensivist and surgical team prior to prescribing (consider lactulose if required).
SHARPS
After all procedures in which sharps are involved, it is the responsibility of the proceduralist (ie you) to dispose of the sharps. DO NOT delegate this responsibility to the nursing staff or medical students.
PROLONGED ABSENCE FROM THE UNIT
If the Registrar is absent from the Unit for more than 60 minutes (eg prolonged resuscitation in ED), the Intensivist on duty must be informed, regardless of the time of day.
Details of ALL admission refusals, whether due to bed shortage or inappropriate referral, must be entered into the REFUSAL BOOK (which is found in the clinical staff hub next to bed 4)
Patients refused admission who are subsequently admitted to a General Ward must be followed up within 8 hours. This can be done by the ICU Liaison Nurse if available, but after hours must be done by the ICU Registrar or Resident.
ENQUIRIES ABOUT THE ICU BEDSTATE
Do not respond to enquiries about ICU’s current capacity (or “bed state”) from non-ICU staff. When non-ICU staff hear or think that we are full, they often transfer patients out without checking with our ICU. However, as ICU capacity and occupancy is fluid, often we actually do have a bed and the transfer is unnecessary.
If you are asked whether we have a bed, ask in return if the caller has a patient, and if so, they should make a formal referral: we will then assess the patient and make a decision accordingly.
“HEADS UP”ABOUT UNWELL PATIENTS
Do not accept phone calls or requests for you “to be aware of a sick patient on the ward”, ie a “heads up” or “just to let you know” about an unwell patient. This gives the false impression that ICU has either responsibility, jurisdiction, or both, in the management of this patient. Either the staff member is making a referral for admission to ICU, or they are not. If you are approached like this, ask for a formal referral.
UROLOGY INSERTED INDWELLING CATHETERS
Urology inserted IDCs should be treated as surgical drains and not removed without discussion with the Urology team.
IV PARACETAMOL
Do not prescribe regular intravenous paracetamol unless authorised by the Duty Consultant.
- Oral or enteral paracetamol is absorbed in the stomach, so is effective in patients who are “nil by mouth” or have an ileus.
- Each time an intravenous line is accessed, the risk of a line infection increases
- Intravenous paracetamol is much more expensive than oral / enteral paracetamol, and is no more effective if the patient has a working GIT.
COLOXYL AND SENNA
Do not prescribe stimulant aperients to patients with a new anastomosis. If an aperient is being considered in a patient post laparotomy or bowel surgery, please discuss with the Intensivist and surgical team prior to prescribing (consider lactulose if required).
SHARPS
After all procedures in which sharps are involved, it is the responsibility of the proceduralist (ie you) to dispose of the sharps. DO NOT delegate this responsibility to the nursing staff or medical students.
PROLONGED ABSENCE FROM THE UNIT
If the Registrar is absent from the Unit for more than 60 minutes (eg prolonged resuscitation in ED), the Intensivist on duty must be informed, regardless of the time of day.