NURSING PROTOCOLS FOR CRITICAL CARE

(BY SIHFW RAJASTHAN)

1. No critical care patient will be left without a nurse in attendance.
2. Each nurse will be responsible for the entire care of his/her patient, and acts to coordinate care with other health team professionals.
3. Breaks will be arranged according to unit need/safe coverage by mutual agreement between each nurse and his/her coworkers. The nurse must give a full report to another staff nurse prior to leaving for a break. 
4. The staff nurse will report any changes in his/her patient's condition directly to the physician.
5. All critical care patients will have continual ECG monitoring.
6. Alarms must be left on the ECG and arterial lines at all times. Appropriate limits will be selected at the nurse's discretion according to institutional policy.
7. For a stable, non-acute patient without invasive monitoring equipment, vital signs are measured at least every hour.
8. The turning of all critically ill patients every two hours around the clock is done unless contraindicated, with skin assessment recorded as part of the every four-hour assessment.
9. All Critical Care patients will have mouth care done every four hours with inspection for oral skin sores.
10. The Critical Care nurse may restrain patients at his/her discretion. Provided documentation done according to hospital policies and procedures.
11. All dressings unless otherwise indicated will be changed daily.
12. Nursing care will be spaced out to allow periods of rest.
13. Procedures will be explained to patients; person, place and time being repeatedly stated to the patient.
14. Information and emotional support needs for the family and patient will be provided by the nurse/physician/social work/palliative care, as required.
15. The environment will be maintained in a mechanically safe condition through: dry floors, good repair of furniture, proper placement of machines and equipment, cleanliness, freedom from clutter, and good repair of equipment.
16. Isolation technique will be followed as per infection control manual.
17. Any containers of body fluids (i.e. suction canisters or chest drainage sets) must be disposed in the appropriate biohazard bag or box.
18. All medications will be reviewed by the Critical Care physicians (upon admission to Unit.) and either reordered or stopped. Nursing staff will ensure this has been done prior to carrying out any medication, treatment or investigative orders. Each treatment/medication must be listed.
19. Respiratory orders may only be carried out when written by the patient's physician. Ventilatory changes will only be done upon receipt of written order.
20. All orders written other than by the Critical Care physicians will be brought to the attention of the Critical Care physician by the nurse prior to being carried out.
21. Narcotics MAY NOT be kept at the bedside. If use is not immediate after withdrawal from the narcotic cabinet, wastage as per narcotic protocol will be carried out.
22. Visiting is negotiated between the nurse and family, with consideration given to unit activity and institutional policy.
23. The nurse/physician will notify families of significant deteriorations in the patient's condition.
24. All staff working at a bedside where an acute trauma or actively bleeding patient is being managed will wear protective goggles, masks and gloves. Protective gear is also required anytime risk of splash from body fluids exists e.g. suctioning.