Hello and welcome to the Intensive Care Unit at the Royal Derby Hospital.
We have put this short film together to help you understand
a little bit about the Intensive Care Unit
and the people who work within it;
and to give you an insight into what to expect during a patients stay.
We hope you find it useful and informative and would welcome any feedback.
You are more than welcome to speak to any member of the team.
My name is Sally Spencer and I have responsibility
for the day to day running of the unit.
If you are watching this film,
it is likely that you are visiting a friend or loved one
who is in either intensive care or high dependency.
I will be talking about some of the pertinent points to bear in mind
with regard to the general layout of the unit;
about the patient day and visiting and about some of the key roles
of some of the staff that you will meet whilst visiting Intensive Care.
Firstly it might be useful to explain to you the differences
between being called an intensive care patient or a high dependency patient.
Our intensive care patients are generally those
who require some help with their breathing
and are attached to a ventilator to support this.
These patients usually have a dedicated nurse to care for them.
Our high dependency patients are those who can
support their own breathing but require a higher level
of intervention and care than can be provided by a general ward.
One nurse will generally care for 2 of these patients.
The Intensive care unit itself is a large department
with the patient care area being split into two distinct areas.
We call them side 1 and side 2.
In general we aim to keep our intensive care patients on side 1
and our high dependency patients on side 2;
however during busy spells this isn't always possible.
When our intensive care patient's condition improves
we will probably move them from a bay in side 1 to another in side 2.
This benefits the patient psychologically
as they see a progression in their care.
Along the bottom of the screen you will see the visiting times for the unit.
Visiting is restricted to two at a time at the bedside
unless agreed with the nurse in charge of that shift.
We would ask that you arrange your visits within these time frames,
although we appreciate that there may be times
and circumstances when visiting outside of these hours is necessary.
This is arranged on an individual patient basis
and we would ask you to discuss this with the nurse in charge of the shift.
The very nature of Intensive Care means that procedures and interventions
are being undertaken throughout the day.
We ask for and appreciate your patience
if you are asked to take a seat in the waiting area
until these are completed before being allowed back into the unit to visit;
unfortunately the wait can sometimes be lengthy
however the unit staff will always aim to ensure you are kept updated.
Please also make the receptionist aware of your presence
before entering the unit as we are a large unit and
consequently have other patients to consider.
The reception desk is staffed during the daytime wherever possible.
If there is no-one available on reception when you visit
please can we ask that you speak to a member of the unit staff via the
intercom before entering the unit.
You will also see telephone numbers for the unit
along the bottom of the screen.
Please note that there are specific numbers for side 1 and side 2.
Infection control is an important issue to us;
at various points around the unit you will see the red alcohol foam dispensers.
You can help in protecting your loved one from infection
by using these to cleanse your hands when entering or leaving the unit.
You will receive all of this information in the visitors' information booklet.
If you do not already have a copy, please ask the receptionist for one.
You will encounter many different health care personnel,
wearing a variety of different uniforms,
and it may help at this point to explain who some of them are:
Sisters and charge nurses wear navy blue uniforms
there is a team of 6 sisters and 1 charge nurse,
one of whom will be shift co-ordinator and take charge of each shift.
The shift co-ordinators name and the consultants of the day names
will be displayed on the board in the waiting area
should you wish to speak to them.
In addition all of the intensive care unit consultants,
sisters and charge nurse photographs are displayed
in the waiting area so that you can put a name to a face.
All of our staff nurses wear royal blue uniforms.
Our clinical support staff wear either green or grey.
The housekeeper wears a maroon red shirt and black waistcoat.
Nurse specialists and educators wear a blue and white striped uniform.
Doctors either wear their own clothing or theatre scrubs.
In addition to this, you may also see other members of the
multi-disciplinary team such as the matron who wears a
black uniform with red piping; pharmacist, physiotherapists,
dieticians, occupational therapists and
speech and language therapists
who all have their own individual uniforms.
The intensive care nursing team comprises nearly one hundred
individuals but you can be assured that the nurses caring for your
loved one will introduce themselves and be there for you too.
If you have any queries or questions do not hesitate to ask them.
In addition we have a team of support staff
who look after the administration of the unit, this includes our
receptionists who wear a navy blue diamond patterned blouse
and the secretarial & audit staff.
Any member of the team is more than happy to help you should you require it.
I will now pass you on the Dr James Low,
one of our Consultant anaesthetists who specialises in Intensive Care Medicine.
Hello my name is James Low and I'm the lead clinician for Intensive Care in Derby.
I work with a team of ten consultants who cover the Intensive Care Unit day and night.
When your relative is admitted to Intensive Care
there will always be an Intensive Care Consultant that's in charge of their care.
We have two consultants that are on the Intensive Care Unit during the day
and a nominated consultant who is always on call thereafter.
They may be present on the Intensive Care Unit or not depending on what the requirements
are.
Our day is fairly structure to ensure that everything gets done that needs to be done.
We start at eight o'clock in the morning with a hand over round
we're told about any problems that occurred during the night
and we are informed about patients that have urgent problems
that we need to sort out as a priority.
Thereafter we perform a ward round to see how patients are progressing
and to determine a patient plan for the day.
Once that is completed then the junior doctors and consultants
will perform the routine tasks that need to be done, for every patient every day on ICU.
We have a board on the Intensive Care Unit that has all the patients' names on it.
You may find that your relative is moved around in the Intensive Care Unit
depending on their priority and what their needs are,
so do not be surprised if your relative is moved around from day to day.
In the relatives waiting room you will see there's some photographs on the wall.
Those photographs are of the Intensive Care Consultants
with their names either to ensure that you're aware which consultant
is looking after your relative on any day.
We will always endeavour to try to speak to you
as often as you would like to be spoken to about the condition of your relative.
However it must be taken into account that sometimes we have clinical priorities
that means that we have to dedicate more time to some patient's than others.
If you feel that you would like to speak to a consultant
all you need to do is ask the nurse and she will come and find us
and we will come and talk to you with pleasure.
We don't always say that we know the answers
but we will always do our best to find them if we don't know them.
Generally having worries that we can help you with
are better to be talked about with us than to let them bottle up inside.
We're there to help you if we can help.
Hello my name's Barbara Day and this is Karen Greatorex
and we're members of the nursing team here on Intensive Care.
We've been joined by one of our colleagues
who's very kindly volunteered to play the part to the patient
so that we can demonstrate to you some of the things that you may
witness during a stay in Intensive Care.
So Karen, could you tell us why patients might be admitted to Intensive Care?
Yes, there are a number of reasons why patients are admitted to us.
Generally they've had major surgery and they need close monitoring
and observation and we're expecting them during the course of the day.
Or there's those that come to us unexpectedly either through having a
serious accident or their blood pressure becoming very low,
needing close monitoring or their having difficulty with their breathing
and needing help with that or even that their kidneys are failing
and we need to support their kidneys.
The equipment that you see in Intensive Care can seem quite frightening at first
as there's a lot of it displaying various different things.
It might help us to understand what's going on
if we can understand some of what this display means.
So Karen, can you tell us a little about the equipment that we see around the bed space
here?
Yes, every patient in Intensive Care will be attached to a monitor.
The monitor will give us heart rate and rhythm,
it will monitor their blood pressure at a reading we can understand
and also monitor their respiratory rate and the saturation levels.
We may also have patients who require ventilatory support,
so that is when they're breathing insufficiently
and the ventilator is doing their breathing for them.
We also have pumps by the bed space some to give infusions into
veins in their necks or into their limbs,
other are to feed them through a tube that goes into the nose and down into their stomach.
Thank you Karen, so with all this equipment round the bed space,
is it alright to touch the patient?
Generally yes.
We ask that all visitors to Intensive Care wash their hands
when they come in and before they leave,
whether that's with soap and water or with the hand gel.
It's usually quite reassuring for the patient in the bed
too know that there's somebody with them.
And what about nursing staff, is it one nurse to one patient?
The aim is for one nurse to one patient if the patient is on a ventilator,
otherwise if the patient's breathing for themselves
we generally have one nurse to two patients.
Okay, and are all patients in Intensive Care asleep?
No their not,
generally the ones who are on the ventilators are the ones we keep asleep
so that we can control their breathing pattern.
Otherwise we give medication for pain relief
which makes people sleepy but it's not to induce sleep.
So if the patient is sedated and appears to be asleep,
how do you communicate with them,
can they hear you?
We presume that the patients can hear us and we always speak to them normally
as if they could hear us anyway and also contact with the hands,
the touching is also a very good way of communicating.
Thank you.
Karen is there anything that visitors and relatives can help with,
with the patient care?
They can help by generally talking to the patient;
give them some orientation as to what's happening at home
and reality checks really in what's going off in the big wide world.
But they can help with brushing their hair or help with cleaning their teeth
if they haven't got a tube in their mouth or washing hands,
just ask if they're interested in doing anything like that.
Thank you Karen,
so is there a daily routine in Intensive Care?
We try to stick to a routine for the day for the patients.
Obviously there's bed baths generally in the morning.
Physios come at nine o'clock, twelve o'clock and three o'clock.
Doctors do a ward round generally in the beginning of the morning
and then they'll come and assess the patients during the course of the day.
There is obviously turns to be done,
investigations such as x-rays or ECGs.
So although we do try to stick to routine, it can be very varied.
Thank you and it just seemed that patients in Intensive Care
can be particularly vulnerable,
so how do you protect them again the potential for
infection and cross-contamination from other places?
To reduce the risk of infection in Intensive Care,
we generally wash our hands every time before we go to our patient.
Each patient has their own coloured aprons and
there's a set of gloves with those aprons.
We have ANTT for when we're giving medications,
so that we don't touch the key parts and introduce infection that way.
The bed spaces the cleaned every day and
we encourage everybody that visits the department to
wash their hands before and after leaving.
Thank you Karen that was very helpful.
It can be very frightening to be told that your relative or friend is
being admitted to Intensive Care,
and it's very important to make sure that you look after yourself as well.
Making sure that you eat properly and sleep properly
can help you to understand the information that's being given to you
and thereby help you, to help your loved one recover from their stay in Intensive Care.
We will endeavour to make sure that we communicate with you effectively
and quickly and efficiently all the information that you might need
and rest assured that your loved one is in safe hands while their in Intensive Care.
Thank you for taking the time to watch this short film.
We hope that it has been useful in answering
some the questions that you may have.
If you have any questions now please see the reception staff at the desk.