Kingdom of Saudi Arabia

Ministry of Health

IPP
TITLE POLICY NUMBER APPLIES TO APPROVAL DATE REVISION DUE 1.0 PURPOSE

INSTITUTIONAL POLICY AND PROCEDURE ADMISSION TO ICU ICU-IPP- MOH-002E (1) All ICU staff 01.08.1432 01.08.1434 EFFECTIVE DATE NO. OF PAGES 01.09.1432 4 REPLACES NUMBER New

To provide guidelines for efficient mechanism of admission and safe transfer of the patient to ICU. 2.0 DEFINITION NA 3.0 RESPONSIBILITY 3.1 Most Responsible Physician (MRP) Responsible for sending written consultation and to have verbal communication with ICU physician. He also designs the plan of care regardless of ICU admission. His team member escorts the patient to ICU and endorses the case to ICU physician. 3.2 ICU physician Responsible for acceptance of consultations, examination and assessment of the patient bedside, and makes decision for the patients admission to ICU. When the case is accepted for admission he/she informs his/ her unit physician and the charge nurse. 3.3 ICU Charge Nurse Supervises all the arrangement, supplies equipments, and communicate with the patients transferring staff on floor/ED/OR. 3.4 Assigned ICU Nurse Responsible for preparation of the bed, bed side area, equipments and patients file. She/ he receives handover of the case from the transferring staff nurse and assists the physician in ICU clinical procedures conducted on patients. 4.0 EQUIPMENTS/ MATERIAL 8.1 IV stand 8.2 Cardiac Monitor
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Kingdom of Saudi Arabia

Ministry of Health

8.3 Defibrillator 8.4 Pulse oxymeter 8.5 Oxygen cylinder 5.0 POLICY 5.1 The physician in-charge of ICU with the MRP jointly makes the decision to admit the patient to ICU. 5.2 Only those patients who are likely to get benefit from ICU care will be admitted to ICU (ref to ICU Admission Criteria policy). 5.3 The patients who require emergency care must be stabilized first in transferring unit/service before transfer. 5.4 The transferring team remains responsible for organizing transfer arrangements, and the provision and continuity of care until the patient is accepted and undertook by the critical care team in ICU. 5.5 Patient and his/her family should be made aware of the transfer decision as soon as possible. 6.0 PROCEDURE For all patients with request for admission/ transfer to ICU: 6.1 The MRP or team member calls ICU to discuss the case with ICU physician on-duty (responsible for consultation). Not only a verbal consultation but also a written one shall be formally delivered and notified. 6.2 The ICU physician will examine and assess the patient in his/ her ward. After assessment he/shell (discuss the case with on-call consultant Intensivist, if available, and) take decision for admission. 6.3 Once the patient is accepted for ICU admission, the ICU physician will inform his/her unit (ICU physician on-duty and charge nurse) about patients admission and the needs of the patient, and provide the following data for preparation of the bed: 6.3.1 Bed number given to the patient. 6.3.2 Patients current clinical condition. 6.3.3 ICU protocol to be prepared. 6.3.4 Need for preparation of ventilator. 6.3.5 Need for preparation of equipment(s) for special procedure. 6.4 The MRP shall be available to design the plan of care with ICU team. A treatment plan has to be given regardless of patients admission to ICU. 6.5 The treating physician will continue attending the patient until his/ her arrival to the ICU. 6.6 Transferring departments charge nurse will call ICU charge nurse, provide all the data as provided by the physician and will ask for readiness of the bed. 6.7 MRP team physician and assigned nurse will escort the patient during transportation till handed over to ICU team. Patients hemodynamics, cardiac rhythm & oxygen saturation will be monitored during transfer. 6.8 The patients file with laboratory and radiology investigations shall be available during transfer. 6.9 Accompanying physician will endorse/handover the case to ICU physician. Accompanying staff nurse will endorse/ handover to receiving ICU assigned nurse and hand over file, drugs and other belonging assets. 6.10 The ICU physician on-duty will write the revised orders in patient medical record and assigned nurse will
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Kingdom of Saudi Arabia

Ministry of Health

follow the orders. 6.11 Upon patients arrival to ICU the staff nurse will do the following: 6.11.1 Place the patient on bed, with proper care while transferring from bed to bed. 6.11.2 Connect the patient to cardiac monitor, check and record initial vital signs in patient medical record. 6.11.3 Observe skin condition. 6.11.4 Obtain information from transferring ward nurse, check and record in patient medical record: 6.11.4.1 Patients full data. 6.11.4.2 Investigations done and availability of results e.g. (X-Ray, CT scan, ECG, lab investigation etc). 6.11.4.3 Pertinent documents about the patient. 6.11.4.3.1 Records with complete nursing documentation. 6.11.4.3.2 Primary police report of medico-legal cases, if applicable. 6.11.4.3.3 Consultation sheets. 6.11.4.3.4 Admission sheet. 6.11.4.3.5 Any other valuable document. 6.11.4.3.6 Patients old file, if available. 6.11.5 Assess patient and document in patient medical record. 6.11.6 Assist the physician for any procedure to be done such as : 6.11.6.1 Central Venous Line insertion. 6.11.6.2 Arterial line insertion. 6.11.6.3 Endotracheal intubation. 6.11.7 Record patient data in the admission register and inform the diet department about the patient diet. 6.11.8 Check for ID wristband; if not present put the one. 6.11.9 Collect old patient file, if present. 6.11.10 Attend the patient needs. 6.11.11 Record all findings and treatment done in patient medical record. 6.12 Fast track Unit 6.12.1 Eligible patient 6.12.1.1 Postoperative patients 6.12.1.2 Medical patients who are expected to stay less than 48 hours. 6.12.1.3 Patients requiring procedure (bronchoscopy, esophagogastroscopy etc.) 6.12.2 Patients shouldn't be admitted if they are: 6.12.2.1 Referred from another hospital (MedEvac) 6.12.2.2 In hospital patients for more than 72 hours. 6.12.2.3 Known to be colonized with any MDR pathogen. 6.12.2.4 Patients with tracheostomy.
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Kingdom of Saudi Arabia

Ministry of Health

6.12.3 Admission order 6.12.3.1 Postoperative order 6.12.3.2 ICU order sheet 6.12.4 Nursing care 6.12.4.1 Patient priority usually 1 to2 6.12.4.2 Nursing patient ration 1:1-2 6.12.5 If at any time the patient is found to be cultured positive for MDR (Gram negative or positive) organism he/she should move out from the fast track unit. 6.12.6 If the patient is unexpectedly stayed in the fast track unit for more than 72 hours, he/she should be considered for moving from fast track unit to other ICU area. 7.0 REFERENCES 7.1 Gary Smith and Mick Nielsen. ABC of Intensive Care- Criteria for admission. BMJ 1999;318;1544-1547 7.2 Egol AB, Fromm RE, Guntupalli KK, et al of the Task Force. Guidelines for ICU Admission, Discharge, and Triage Crit Care Med 1999 Mar; 27(3):633-638 7.3 Williams & Wilkin, Lippincott. Critical Care Nursing. 2007 8.0 APPROVAL: Name Prepared By Dr. Title Consultant Signature Date

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ICU-IPP-MOH-002E(1) KSA MOH IPP Manual