1. NUH Critical Care Induction Paperwork (Run as a slide show, will transition automatically)
August 2015

2. Paperwork
Drug charts
Admission summary
Daily review sheet

3. Drug Charts There are 2 used for all our patients
Standard trust drug chart
Critical care infusion chart

4. Standard Trust Drug Chart
We only use the adult general charts
Not the paediatrics, neonates, ophthalmology etc…
Used for…
Antibiotics
IV drugs not given by infusion
Some IV loading infusions (phenytoin)
PO/NG/NJ drugs
VTE prophylaxis

5. Standard Critical Care Prescriptions
VTE prophylaxis
Enoxaparin (and TEDS or Flowtrons)
Please also complete the NOTIS assessment
Stress ulcer prophylaxis
IV Ranitidine (50mg TDS, reduce in renal impairment)
PO/NG Ranitidine if suitable (150mg BD)
PPI (Increased risk of C-Diff and Bleeding)

6. Critical Care Infusion Chart
Insulin (not the trust insulin prescription)
Sedatives
Vasopressors/inotropes
Amiodarone
Electrolytes
IV fluid

7. Please ensure patient details are documented.
Please detail any ALLERGIES
We use a standard sliding scale if blood glucose is in excess of 11.1 mmol/L
With the sliding scale a source of Glucose must be prescribed

8. Sedatives are pre-prescribed
Default sedation is Propofol and Morphine
Please ensure that strengths are also prescribed

9. Inotropes and Vasopressors:
If there is a possibility your patient will need them, prescribe them
on admission
AF is common amongst ICU patients; Remember that Amiodarone is a
NEGATIVE INOTROPE

10. Potassium can ONLY be given centrally, IDEALLY Potassium should be in the
4.0 – 4.5 mmol/L range
Please check pressure bags, they should
be SALINE only; SIGN THE STICKER!
Phosphate replacement, NOTE it contains Potassium; It is rare to use
This and NEAT Potassium together

11. PLEASE Prescribe fluids on the AICU
Drug chart

12. Admission Summary
Fill out on admission for all patients newly admitted (or re-admitted) to critical care
There is no need to complete an admission summary for a patient transferred between critical care areas
4 pages long – mostly filling in boxes so doesn’t take long

13. The form is relatively self explanatory
Please fill in patient details AND referring team/consultant
Admitting diagnosis and immediate history to include as many relevant details as possible
Previous exercise tolerance is extremely important
Please clearly document allergies

14. Grade of laryngoscopy is extremely important
Insert the most recent ABG
Please record any lines/drains/tubes
Important for all patients, vital for the Neurosurgical patients

15. Carefully record any injuries, lines, tubes and drains in as much detail as possible
Document the most recent bloods
A clearly documented infection and antibiotic history will prevent repeat drug doses and errors

16. It is very important to fill in the assessment of Mental capacity
Care bundles are standards of care, please document if they are not followed

17. Top Tips for Admission Summaries
Patient details, date and time
Referring Consultant (“Major Trauma” not good enough)
Alcohol Hx
Missed recently, led to a pt falling and injuring themselves
Drug Hx
Writing “as per drug chart” or “see attached” is a guaranteed way to irritate people
Examine everything – front and back of the patient

18. Daily Review Sheet Started by the night team
Written on during the morning handover
Completed by the team everyday
Written on during microbiology ward round
Radiology review
Often the morning review by parent teams
Used for audit and your defence

19. The morning ward
round details and
daily plan goes in here;
Filled in by the
Consultants
Include all details or changes from overnight; Known plans and scans
for the day and communications with other teams

20. As with the admission sheets, the daily review sheets are self explanatory. Fill in
EVERY box as the detail is important.
The Standards of care will be audited.
Please take care to ensure that they are
met, or if not then please find out why not
Formulate a management plan
Discuss it with the consultants or senior
Trainee`s
Action as much as possible

21. MICRO round is every day on AICU, twice a week on E12
Fill in any positive Micro, any changes or any cessations of
Antibiotics.
The Details of the consultant ward round are to be filled here, a lot
of us write for ourselves; it is useful to have the blood results from
The day, and a reminder the review imaging…

22. Top Tips for Daily Reviews
Ask the nurses if they have any additional concerns or things they want doing
Enter the time of your review
Ensure you complete the how old the lines are section

23. The other paperwork Discharge summaries Weaning from ventilator plans
Only required when patient is leaving critical care
Weaning from ventilator plans
The trust insulin charts
Used very occasionally
Stickers
Lines, some prescriptions, blood cultures, etc…