or do they?
No. To create an ICU you need a team of nurses.
The question is, how can we tell which ICUs have a team, and which do not?
Here is a proposal
CCNEPal wants to create a system of certifying ICUs that value nursing and that value team behavior. When an ICU meets the criteria for certification, they receive a certificate, and each member gets a nifty pin to wear. ( not designed yet)
I looked back at a blog entry from May 2014 where I first listed the criteria, and – I think these still serve.
A Nurse replies
here would be my list of practical, boots-on-the-ground things that define whether the critical care area is functional. You can take this list and make a checklist out of it to assess the ability to function, the learning needs, etc. In my view, if you don’t have these, you don’t have an ICU.
1) at all times, there is a nurse available who can identify Ventricular fibrillation; initiate the team response; and use the defibrillator safely.
2) all staff are trained in CPR.
3) all staff can identify ecg rhythms at least to the level of “the basic six rhythms”
4) there is a standing protocol for nurses to treat ecg rhythms while waiting for the doctor to arrive, or in the absence of the doctor.
5) nurses use vaso-active drips and assess for intended effect as well as side-effects. Nurses give all IV push drugs using procedures recommended by current pharmacological references. (duration, dilution, compatibility, etc)
6) nurses are trained to do fluid volume resuscitation, including transfusion. Nurses can do a complex I & O. Nurses routinely listen to lung sounds and can identify what they hear.
7) nurses can maintain an airway, including endotracheal tube and using a bag-valve-mask.
8) nurses can identify proper “phasing in” during mechanical ventilation.
9) nurses use a “VAP Bundle” including sterile suctioning technique.
10) nurses in all departments are aware of “failure to rescue” and there is a plan to identify at-risk patients prior to arrest.
11) nurses know the chest pain protocol.
12) oxygen, suction and pulse oximetry are available at all times.
13) for all biomedical equipment in place, there is a maintenance and repair plan, and an adequate supply of nonreusable disposable parts ( such as stick-on pads for ecg monitoring in the case of ecg)
to the above, I would add, having a designated trainer for the skills and a system to keep records of who is trained and who is not.
What do you think?
CCNEPal wants to hear from nurses and docs in Nepal about this idea. Do you think it’s a good way to publicize the need for training? does your ICU do these things? How can we promote the best possible ICU care throughout the country?