Hospital Management System Project with Complete Information

Critical care refers to specialized medical care provided to patients who are facing life threatening Conditions or severe injuries. This type of care is typically administered in intensive care units (ICUs) or similar settings where patients receive close monitoring and treatment by a multidisciplinary team of healthcare professionals.

A. CCU

B. MICU

C. GLMICU

D. SICU

E. NICU

F. Neurology / STROKE ICU

G. CTVS ICU

H. GOVT. ICU

I. RICU

J. RICU EXTN..

K. POST-OP Sicu

L. Liver Transplant Intensive Care Unit (LICU)

M. CTVS Step Down

N. Pediatric Intensive Care Unit (PICU)

O. Onco Surgery ICU

Admission of a patient means allowing a patient to stay in the hospital for observation, investigation, treatment of the disease he/she is suffering from.

Types of admission

• Planned admission

• Admission from Doctor’s office

• Admission from the Emergency room

Planned admission: A planned admission an inpatient admission of a patient pre-planned in advance of the patient’s presentation for inpatient care.

Admission from Doctor’s office: Patient’s admitted by Consultants directly from their offices

Admission from the emergency room: Emergency room patients requiring inpatient admission

Admission Procedure

• Telephonic information from admission counters to Ward secretary / Team leader / Charge Nurse/Housekeeping supervisor

• Ensure room preparation with all necessary equipment as per patient’s requirements

• Greet the patient and introduce yourself by name

• Receive the patient and provide a comfortable position as per condition and  check for any special instruction from doctor

• Check the general condition of the patient.

• Assess the patient’s general appearance and dependability and provide safety measures accordingly

• Confirm patient’s identity with Face sheet (use two identifiers).

• Apply ID Band with Name, Bed no, Sex, IP No, and ID NO.

• Orient the patient and family to the hospital facilities / policies like call bell, side rails, bed & key, bathroom, toilet, diet, telephone, room service and visitation policy

• Assess for vulnerability and provide safety measures accordingly.

• Inform them about patient and family rights

 Right to medical care

 Clinical identity

 A second opinion

 Dignity

 Confidentiality

 Privacy

 Informed consent

• Give patient and family education ( PFE)

 Safety measures

 Infection control

 Pain

 Medications

• Provide hospital dress to the patient

• Check the skin for any discoloration or cyanosis, haematoma or bed sore.   If any, document in admission assessment sheet

• If the patient is having any valuables / belongings like jewellery, dentures, hearing aids, eye glasses etc, hand over to the relatives and take signature in the nursing assessment form. 

• If there is no attendant and the patient is unconscious, deposit the valuable in the cloak room/safety locker.  Obtain the signature of security officer.

• Ask for any allergies or any adverse reactions and document it in the Clinical Chart, Nursing Admission Assessment Form and Drug Chart. If there are any allergies enter in the computer while indenting the medicine and inform the treating team.

• Inform the Charge Nurse, Duty Doctor and Consultant regarding admission and ensure that they visit the patient at the earliest

• Record vital signs, weight and height in the clinical chart and in nursing assessment form and initiate Safety first program as required

• Complete Nursing Admission Assessment within the time stipulated by the organization

• Give special attention to pain assessment and Fall Risk Assessment

• Complete Fall Risk Assessment soon after completion of history and physical assessment form and physician order sheet

• Check the written order and carry out immediately

• Assigned nurse/ Ward secretary will enter the diet in the computer

• Inform ward secretary to enter the diet in the computer

• Indent approved disinfectant and thermometer for the patient after checking with patient

• Indent medicines as per the doctor’s written order

• Ensure the following is done at the earliest after receiving the patient, i.e. diet and medicines delivery, investigations and doctor’s visit ( check TAT protocol)

• Initiate investigation and treatment at the earliest on receiving the orders

• Assess nursing needs and provide care accordingly.

CRITICAL CARE ENVIRONMENT, SAFETY AND IPC

Importance of Team Work in Critical Care Unit.

1. Complex Patient Needs

Patients in a CCU often have complex, multi-faceted health issues requiring the expertise of various specialists. A cohesive team ensures that all aspects of the patient’s condition are addressed, from medical to psychological.

2. Effective Communication

Clear, ongoing communication among team members is essential to provide coordinated care. This includes sharing updates on patient status, treatment plans, and any changes in condition. Effective communication helps prevent errors and ensures that everyone is on the same page.

3. Multidisciplinary Approach

A ICU team typically includes doctors, nurses, respiratory therapists, pharmacists, and other specialists. Each professional brings unique skills and perspectives that contribute to a comprehensive approach to patient care. Teamwork allows for a more thorough assessment and more innovative solutions to complex problems.

Intensive Care Unit Rounds.

The visit of the consultant to the patients for the purpose of deciding and reviewing the treatment.

Nursing Responsibilities:

• Use Consultant Instruction and Intervention (CII) form while conducting doctor’s rounds. Keep the form in clipboards for ease of access.

• Anticipate and prepare for any procedures to be done at the bed side (e.g., dressing, suture/ drain removal).

• Keep the patient’s file updated with relevant reports and details of patient’s status.

• Identify the consultant

• Use English as a means of communication and follow professional ettiquettes.

• Communicate any special/ unnatural observation or complaints of the patient or relative.

• Accompany the consultant along with the patient file and CII Form.

• Note down the doctor’s instruction parallely in the CII form.

• In case of any doubts clarify with the doctor during rounds itself.

• Carry out written orders in time and document the same.

• Escalate in case of any special instructions / investigations/ procedure etc.

EVIDENCE BASED PRACTICE AND QUALITY IN CRITICAL CARE UNIT [NURSING SKILLS]

Models, process of Integrating Evidence Based Practices [FASTHUGBIDS FOLLOW]

FAST HUGS BID

FAST HUGS BID " is an acronym used in critical care and ICU settings to summarize essential aspects of patient care and management. Each letter represents a specific area of focus, highlighting nursing responsibilities and key actions:

Nursing Responsibilities:

F - Feeding:

o Ensure enteral or parenteral feeding is initiated as appropriate.

o Monitor intake and assess tolerance.

o Collaborate with dietitians and healthcare team to adjust feeding regimen based on patient's condition.

A - Analgesia:

o Assess pain using standardized scales.

o Administer analgesics promptly and titrate doses to achieve pain relief.

o Monitor for side effects and effectiveness of pain management.

S - Sedation:

o Evaluate sedation levels using sedation scales (e.g., Richmond Agitation-Sedation Scale).

o Adjust sedative medications to achieve optimal sedation goals (e.g., sedation vacation).

o Monitor for sedation-related complications (e.g., oversedation, delirium).

T - Thromboembolic Prophylaxis:

o Implement mechanical prophylaxis (e.g., compression stockings, intermittent pneumatic compression devices).

o Administer pharmacological prophylaxis (e.g., anticoagulant therapy) based on risk assessment and protocols.

o Monitor for signs of bleeding or thrombosis.

H - Head-of-Bed Elevation:

o Ensure patient's head-of-bed is elevated to 30-45 degrees, unless contraindicated.

o Monitor and maintain proper positioning to prevent complications like ventilator-associated pneumonia (VAP).

o Educate patient and caregivers on the importance of head-of-bed elevation.

U - Ulcer Prophylaxis:

o Administer prophylactic medications (e.g., proton pump inhibitors) to prevent stress ulcers.

o Assess risk factors for gastrointestinal bleeding and adjust prophylaxis accordingly.

o Monitor for signs of gastrointestinal bleeding and intervene promptly.

G - Glucose Control:

o Monitor blood glucose levels regularly using point-of-care testing.

o Administer insulin and adjust doses according to established protocols.

o Educate patient and family on glucose monitoring and management strategies.

S - Spontaneous Breathing Trials (SBT):

o Collaborate with respiratory therapists and physicians to conduct SBTs.

o Monitor respiratory status closely during trials.

o Document findings and communicate outcomes to the healthcare team.

B - Bowel Care:

o Assess bowel function regularly.

o Implement measures to promote bowel regularity (e.g., early ambulation, adequate hydration, fiber intake).

o Manage bowel elimination issues such as constipation or diarrhea promptly.

I - Indwelling Catheter Removal:

• Nursing Responsibilities:

o Monitor urine output and assess for signs of urinary retention or complications.

o Use aseptic technique during removal, educate patients about the process, and document outcomes, ensuring patient comfort and readiness for removal.

D - Drug De-escalation No. of days, delirium:

• Nursing Responsibilities:

o Monitor patient response and laboratory results to assess the appropriateness of current antimicrobial therapy.

o Collaborate with the healthcare team to adjust therapy based on culture and susceptibility results, aiming to use the narrowest effective spectrum.

CRITICAL CONDITION PATIENT CARE, MECHANICAL VENTILATION AND CARE

Principles and various modes of Mechanical Ventilation

Principles of Mechanical Ventilation:

1. Ventilation vs. Oxygenation: Mechanical ventilation serves two main purposes:

o Ventilation: Removing CO2 from the lungs.

o Oxygenation: Providing sufficient oxygen to the lungs.

2. Patient-Ventilator Interaction: Coordination between the patient's spontaneous breaths and the ventilator-delivered breaths is crucial to avoid patient discomfort and minimize work of breathing.

3. Positive Pressure Ventilation: The ventilator generates positive pressure to push air into the lungs, contrasting with natural breathing where negative pressure is generated to pull air into the lungs.

4. Controlled vs. Assisted Modes: Ventilators can operate in controlled (ventilator sets the rate and tidal volume) or assisted (ventilator assists the patient's breathing efforts) modes.

5. Monitoring: Continuous monitoring of respiratory mechanics (e.g., tidal volume, airway pressures) and blood gases (e.g., PaO2, PaCO2) is essential to adjust ventilator settings.

Various Modes of Mechanical Ventilation:

1. Volume-Controlled Ventilation (VCV):

o Description: Delivers a preset tidal volume at a fixed flow rate.

o Advantages: Ensures consistent tidal volume delivery.

o Disadvantages: May cause high peak pressures if compliance decreases.

2. Pressure-Controlled Ventilation (PCV):

o Description: Delivers a set inspiratory pressure for a preset time.

o Advantages: Limits peak airway pressures; useful in patients with ARDS (Acute Respiratory Distress Syndrome).

o Disadvantages: Tidal volume may vary depending on lung compliance.

3. Pressure Support Ventilation (PSV):

o Description: Assists spontaneous breaths by providing support with a preset inspiratory pressure.

o Advantages: Enhances patient comfort and synchrony.

o Disadvantages: Requires patient effort to trigger breaths.

4. Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP):

o Description: Provides continuous positive pressure throughout the respiratory cycle (CPAP) or different pressures during inspiration and expiration (BiPAP).

o Indications: Used to support patients with obstructive sleep apnea or acute respiratory failure.

5. Inverse Ratio Ventilation (IRV):

o Description: Prolongs the inspiratory phase relative to the expiratory phase to improve oxygenation.

o Indications: Severe ARDS or refractory hypoxemia.

6. Neurally Adjusted Ventilatory Assist (NAVA):

o Description: Adjusts ventilator support based on the patient's diaphragmatic electrical activity.

o Advantages: May improve patient-ventilator synchrony.

By this video, you will learn that how a patient discuss his problem with a doctor.