1. Adult, Pediatric (ICU/PICU) Scoring: PM (2) FM (3) NM (0) MM (1) Standard
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1 Chapter VII Intensive Care Unit 1. Adult, Pediatric (ICU/PICU) 2. Coronary Care Unit (CCU) 3. Neonate (NICU)
2 1. Adult, Pediatric (ICU/PICU) Scoring: Standard ICU.1. ICU.2. The department head is a qualified physician by training. A qualified registered nurse with training in critical care is the nurse manager. Adult, Pediatric (ICU/PICU) ICU.3. All physicians working in the unit are well trained in critical care and are certified in BCLS, ACLS (for adults)/pals (for pediatrics). ICU.4. The nurse manager develops policies and procedures for the unit and collaborates with other departments as needed for this (e.g. infection control). ICU.5. All nursing staff in the critical care unit (ICU/CCU/PICU) are certified in BCLS and preferably ACLS (for adults) PALS (for pediatric). ICU.5.1 There is a copy of the staff certificate for BCLS and if obtained, ACLS (for adults) PALS (for pediatric) in their personnel file. ICU.6. ICU.7. ICU.8. ICU.9. ICU.10. The medical staff has a staffing plan based on patient volume and patient acuity. There is a nurse staffing plan that is based on patient volume and patient acuity. There is written Admission and Discharge criteria. There is 24-hour physician coverage for the unit that is physically present in the vicinity. There is evidence that nursing staff in critical care units receive continuous training with competency assessment (e.g. written test, return demonstration, etc) and education in the following for the nursing staff: ICU.10.1 ICU.10.2 ICU.10.3 ICU.10.4 ICU.10.5 Using pulse Oximetry. Recognizing arrhythmias Assisting physician in placing central lines or arterial lines. Obtaining blood gases ABG s. Reading central venous pressure (CVP). Page 86
3 Standard ICU.10.6 ICU.10.7 ICU.10.8 ICU.10.9 Knowledge of medications that include vasopressors, narcotics, and controlled substances. Infection control principles. Blood transfusions. Exchange transfusion (neonate). Adult, Pediatric (ICU/PICU) ICU Glasgow coma scale (GSC). ICU Use of the defibrillator. ICU Care of patients on ventilators. ICU Care of patients with tracheotomies. ICU.11. The critical care unit has the following necessary equipment and supplies: ICU.11.1 ICU.11.2 ICU.11.3 ICU.11.4 ICU.11.5 ICU.11.6 Ventilators Tracheostomy set Crash cart that includes all emergency supplies and medications. Defibrillators Pulse Oximetry and vital signs monitor. Transfusion pumps ICU.12. ICU.13. ICU.14. ICU.15. The availability and functionality of all tools and equipment needed for intubations and ventilation are regularly checked. Isolations rooms (preferably negative pressure) are used for all patients (Adult/Peds) with communicable diseases or infections and infection control disease guidelines are applied. The physician in charge of the ICU together with the Most Responsible Physician (MRP) jointly makes the decision to admit and discharge patients from the unit. When the patient is discharged from the unit the ICU physician ensures that the receiving team on the floor is well informed about the patient s status and ongoing patient needs. Page 87
4 Standard ICU.15.1 ICU.15.2 The patient s plan of care and medications are written in detail by the physician including how to continue them on the floor. Any special care requirements are documented (e.g. to watch for drainage tubes) in the medical record. Adult, Pediatric (ICU/PICU) Page 88
5 2. Coronary Care Unit (CCU) Scoring: Standard CCU.1. CCU.2. The department head is a qualified Cardiologist with training in coronary care. A qualified registered nurse with training in critical care is the Nurse Manager. Coronary Care Unit (CCU) CCU.3. The nurse manager develops policies/procedures for the unit and collaborates with other departments as needed (e.g. infection control). CCU.4. All physicians working in the unit are well trained in coronary care and are certified in BCLS, ACLS. CCU.5. All nursing staff are certified in BCLS and preferably, ACLS. CCU.5.1 There is a copy of the staff certificate for BCLS and if obtained, ACLS (for adults) in their personnel file.. CCU.6. The unit has the following necessary equipment and supplies: CCU.6.1 CCU.6.2 CCU.6.3 CCU.6.4 CCU.6.5 CCU.6.6 Ventilators Tracheostomy set Crash cart that includes all emergency supplies and medications. Defibrillators Pulse Oximetry and vital signs monitor. Transfusion pumps CCU.7. CCU.8. CCU.9. CCU.10. The medical staff has a staffing plan based on patient volume and patient acuity. There is a nurse staffing plan that is based on patient volume and patient acuity. There is written Admission and Discharge criteria. There is 24-hour physician coverage for the unit that is physically present on the vicinity. Page 89
6 Standard CCU.11. The availability and functionality of all tools and equipment needed for intubations and ventilation are regularly checked. CCU.12. CCU.13. Isolation rooms are used for all patients with communicable diseases or infections and infection control disease guidelines are applied. When the patient is discharged from the CCU the physician ensures that the receiving team on the floor is well informed about the patient s status and ongoing patient needs. Coronary Care Unit (CCU) CCU.13.1 The patient s medications are written in detail by the physician including how to continue them on the floor. CCU.13.2 Any special care requirements are documented in the medical record. CCU.14. There are policies and procedures that include but not limited to: CCU.14.1 Coronary Angiogram with its squally CCU.14.2 Temporary pace maker CCU.14.3 Permanent pace maker CCU.14.4 Conscious sedation CCU.15. A crash cart is available in the vicinity. Page 90
7 3. Neonate (NICU) Scoring: Standard NICU.1. NICU.2. The department head is a qualified physician with training in neonatology A qualified registered nurse with training in neonatal intensive care is the Nurse Manager. Neonate (NICU) NICU.3. The nurse manager develops policies/procedures for the unit and collaborates with other departments as needed (e.g. infection control) NICU.4. All NICU physicians are certified in BCLS and LS (NRP). NICU.5. All NICU nurses are certified in BCLS and preferably LS (NRP). NICU.5.1 There is a copy of BCLS and if obtained, LS (NRP) Certificates in the staff personnel file. NICU.6. NICU.7. NICU.8. NICU.9. NICU.10. The medical staff has a staffing plan based on patient volume and patient acuity. There is a nurse staffing plan based on patient volume and patient acuity. There is written criteria for the admission to and discharge from the NICU. There is 24-hour physician coverage for the unit that is physically present on the vicinity. There is evidence that staff nurses in NICU receive training with competency assessment (e.g. written test, return demonstration, etc) and education on the following: NICU.10.1 Use of pulse Oximetry. NICU.10.2 Assisting physicians when placing central lines and /or umbilical arterial lines/venous lines. NICU.10.3 Drawing ABG s. NICU.10.4 Knowledge of critical medications that include, surfactant, narcotics etc NICU.10.5 Infection control. Page 91
8 Standard NICU.10.6 Blood transfusions. NICU.10.7 Endo Tracheal tube (ETT) Care. NICU.10.8 Exchange transfusion. NICU.10.9 Blood draw from Umbilical Catheter (arterial or venous). Neonate (NICU) NICU Care of patient on ventilator. NICU Care of patient in incubator. NICU.11. NICU.12. NICU.13. NICU.14. The unit has the following necessary equipment and supplies: NICU.11.1 Ventilators. NICU.11.2 Crash cart that includes all emergency supplies and medications. NICU.11.3 Pulse oximetry/monitor. NICU.11.4 Infant resuscitator NICU.11.5 Incubators NICU.11.6 Portable incubator with portable ventilator NICU.11.7 Infusion pumps/ syringe pumps. NICU.11.8 Trach Sets. The availability and functionality of all tools and equipment needed for intubations and ventilation are regularly checked. Neonates with infectious conditions are cared for in isolation and infection control disease guidelines are applied. The NICU staff encourages mother-infant bonding that includes but is not limited to: NICU.14.2 Breast feeding by either direct breast feeding or by teaching mother how to express and store breast milk for baby. Page 92
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