Ongoing patient management
During the day, a clinical examination will occur during the consultant ward round, and be performed by the ICU registrar and documented by the HMO, using a structured format that is then “cut and paste” onto the progress notes within the DMR.
At night, use your discretion as to the degree of clinical examination performed, taking into consideration patient acuity and whether patient is sleeping or sedated.
Each registrar must make at least one note during the shift. Any incident or alteration in condition must be recorded.
At night, use your discretion as to the degree of clinical examination performed, taking into consideration patient acuity and whether patient is sleeping or sedated.
Each registrar must make at least one note during the shift. Any incident or alteration in condition must be recorded.
- All interventions and diagnostic procedures (eg CT) must be recorded along with relevant results / findings.
Drug orders
- All infusion drug orders must be signed by a doctor. Drug chart documentation must adhere to the standards set out by the Australian Commission on Safety and Quality in Healthcare (https://www.safetyandquality.gov.au/wp-content/uploads/2016/03/NIMC-User-Guide.pdf).
- They must be rewritten if they get confusing. If a nurse is unable to read a prescription, it is unsafe and must be rewritten.
- All drugs and infusions must be prescribed according to existing ICU protocols.
Fluid orders
- Review daily fluid balance at the morning round and include a fluid management plan in the daily management plan.
- Review feeding and ensure that the feed amount is included in the day's fluid plan.
- All fluids must be written up in the Fluid Orders chart.
Investigations: X-Rays
- Use your discretion in ordering CXRs. Not all patients require one particularly if the clinical situation is unchanged.
- Routine post-operative patients require a CXR on admission (unless done in theatre) and thereafter only as clinically warranted.
- Routine X-ray investigations can be booked by the Ward Clerk.
- For urgent or complex investigations please speak to the Radiologist directly.
Investigations: Pathology
NB. Bendigo uses a private pathology provider. Please alert the Duty Consultant or director of any issues with the timeliness of receiving pathology results.
- Most patients have FBE & U&E daily at about 05:00, plus any other laboratory investigations necessitated by their clinical status, unless stated by the Duty Intensivist.
- Coagulation profile should be checked on admission and then as clinically indicated.
- CRP and LFTs should be routinely requested on Mondays, Wednesdays and Fridays and only in between if clinically warranted.
- Daily pathology results should be checked before the morning ward round.
- Gram stain must be explicitly requested. This is particularly important for CSF and septic shock.
- All microbiology results must be recorded on the pink Micro sheet daily.
- Urgent and after hours investigations require a phone call to the laboratory.
NB. Bendigo uses a private pathology provider. Please alert the Duty Consultant or director of any issues with the timeliness of receiving pathology results.