Admission Criteria in ICU: Admission criteria are used to select patients
who are likely to benefit from care in ICUs.
Patients who meet any of the following criteria shall be admitted to the
ICUs at the request of the consultant. While we make every effort to strictly
adhere to admission criteria, we accommodate requests from consultants who
clinically feel that a patient would benefit from close monitoring in the
critical care unit even through not strictly meeting the criteria stated below:
1)
Respiratory:
1.1.1.1
Acute
respiratory failure (PaO2 < 60 mm Hg).
1.1.1.2
Respiratory
rate > 30 breaths/minute and <8 breath/mt.
1.1.1.3
Patients
requiring ventilatory support (invasive or non-invasive).
1.1.1.4
Pulmonary
emboli with haemodynamic instability.
1.1.1.5
Massive
Haemoptysis
2)
Surgical:
1.1.2.1
Post-operative
patients requiring haemodynamic monitoring, ventilator support or extensive
nursing care.
1.1.2.2
Patients
with surgical abdomen requiring preoperative fluid and/or electrolyte
resuscitation.
1.1.2.3
Polytrauma
with significant injury to thoracic / abdominal organs requiring surgical
intervention
3)
Renal:
1.1.3.1
Patient
who has acute renal failure with accompanying respiratory or hemodynamic
components require close monitoring & respiratory/ hemodynamic support.
1.1.3.2
Significant
acidosis or alkalosis.
1.1.3.3
Hypo or
hyperkalemia with dysrhythmias or muscular weakness.
1.1.3.4
Hypo or
hypernatremia with seizures, altered mental status.
1.1.3.5
Severe
hypercalcemia with altered mental status, requiring close neurological
monitoring.
1.1.3.6
Hypo or
hypermagnesemia with haemodynamic compromise or dysrhythmias or muscular
weakness
4)
Drug Ingestion and overdose:
1.1.4.1
Drug
ingestion with significantly altered mental status & inadequate airway
protection / hemodynamic instability.
1.1.4.2
Seizures
following drug ingestion
5)
Endocrine:
1.1.5.1
Diabetic
ketoacidosis complicated by hemodynamic instability, altered mental status,
respiratory insufficiency, or severe acidosis.
1.1.5.2
Thyroid
storm or myxedema coma with hemodynamic instability.
1.1.5.3
Hyperosmolar
state with coma with and/or hemodynamic instability.
1.1.5.4
Other
endocrine problems such as adrenal crisis with hemodynamic instability
6)
Miscellaneous:
1.1.6.1
Environmental
injuries (lighting, near drowning, hyperthermia or hypothermia).
1.1.6.2
Any other
clinical conditions requiring ICU level nursing care
1.1.6.3
Suicidal
gestures including partial hanging, drug overdoses and other self-inflicted
injuries.
1.2
Discharge Criteria:
1)
Written
discharge order by the attending physician.
2)
Substantial
resolution of the problems responsible for admission.
3)
Anticipation
of prolonged medical stability.
4)
Elimination
of need for mechanical ventilation/ airway protection.
1.3
The admission of a patient to these units shall be done by the Medical
Director who in turn shall inform the specialists / doctors who are trained to
handle emergency care in Intensive Care Units.
1.4
The specialist shall give written instructions to trained nursing
staff for the management and treatment of a particular patient in such units.
1.5
Each patient shall be under the care of one nurse, always
maintaining the patient to nurse ratio of 1:1 / as advised by ICU doctor
in-charge.
1.6
Emergency medicines with resuscitative equipments shall always be
kept ready for use. (Ref: Checklist for emergency medicines and equipments).
1.7
Specialized life support equipments like, ventilators,
defibrillators, infusion pumps, Central oxygen supply and suction, etc., are
readily available.
1.8
The staff on duty is trained to handle and use this highly
technical equipment properly and at the right time.
1.9
All staff shall be trained periodically on how to handle critical
care equipments so as to minimize break down and loss.
1.10
Staff in charge of these units shall check that these equipments
are kept in proper working condition at all times.
1.11
Bio medical engineer shall on a daily basis check the equipments
of the intensive care units.
1.12
Bio medical engineer shall also take care of the maintenance and
calibration of equipments of the intensive care units.
1.13
This shall be reviewed by the head nurse and supervisor of the
intensive care units.
1.14
In the event of a large number of patients arriving to these units
which exceed the capacity of the established beds, the nursing superintendent shall
be contacted and she shall arrange for extra beds to be placed in the areas and
provide more staff to meet the demand.
1.15
Sterility of these units shall be strictly maintained.
1.16
Restricted entry of one or two close relatives shall be permitted
during visiting hours only. Whenever such visitors are allowed inside, measures
shall be taken to maintain the sterility of the area. Foot wear shall not be
allowed, and they shall wear only the foot wears provided for exclusive use
inside the area. Cap, masks, shoe covers are also to be worn by the
visitor/relative.
1.17
Transfer of the patients to the normal ward or the patient’s home
is done after the treating doctor gives specific orders for the same.
1.18
Proper instructions on further treatment, advice on preventive
aspects and follow up are given to the patient / attendee by the doctor or
senior staff nurse.
1.19
In order to maintain the quality of care in these departments, the
recipients of these services are interviewed from time to time and their
satisfaction in the treatment provided is assessed.
1.20
When a patient is discharged, details about the investigation,
treatment given, condition on discharge, advice on discharge, medications,
diet, exercise, follow up, when and how to seek care in case of emergency
and details visit schedule shall be
written in the discharge card duly named, signed, dated and time by the
treating doctor.
1.21
A copy of all reports shall be given to the patient along with the
discharge summary.
1.22
Infectious cases need isolation.