Introduction

A balance of:

Clinical judgement vs standardisation

• We are trying to standardise as much treatment as possible - including stress ulcer prophylaxis, VTE prophylaxis, transfusion triggers, nutrition, antibiotics (type and duration), pro-kinetics, ventilation and resuscitation planning are some examples. This is an attempt to reduce unnecessary variation and give a framework for the junior doctors and nurses to work in.

Parent unit input vs. using your judgement

• Listen to their input and opinion. It will often need to be sought out. Be as collaborative as you can without letting them drive care that is not in keeping with your judgement.

Giving the ICU junior doctors and nurses authority vs patient safety

• We give the registrars as much responsibility as they can handle. Let the ICU registrar take the ward rounds and make decisions, even if they are different to how your approach and provided it’s not against patients’ best interests.

 
ICU registrars are instructed to:

• Make a management plan and institute it provided you and the nurses are happy.
• Call us if:

1. You are anxious about the plan
2. The nurse is unhappy with the plan
3. The plan isn’t working