We encourage visiting of loved ones, including children of the patient. The visiting times are 10am to 7pm every day with two visitors allowed at the bedside at any one time. There are special circumstances where visiting outside of these hours will be supported as agreed by the Consultant and Nurse in Charge of Critical Care. We also ask that visitors do not take food or drink into the clinical area. These can be consumed within the waiting room and there are a number of areas within the hospital where visitors can go for a break and refreshments. Taking photos of patients is also strictly forbidden where the patient is unable to consent to a picture being taken.
Critical Care
Welcome to the Critical Care Unit. We are a 52-bedded unit, 16 cardiothoracic beds (in 2 pods) and 36 general beds (in 4 pods) for patients requiring a higher level of care. You will sometimes see Critical Care referred to as Intensive Care or Intensive Therapy (ICU or ITU) which are terms to describe the patients on Critical Care who can have life threatening conditions or require a higher level of monitoring and care than can be delivered at ward level.
Our patients are nursed on a 1:1 or 1:2 ratio, dependent on their care needs. Our staff are trained to a high level to meet the needs of patients in this specialist area, with many nurses having a specialist qualification in critical care nursing. Each pod within critical care will have a senior nurse in charge overall as well as a senior nurse in charge for the 2 units.
Critical Care can be a frightening area to be in due to the amount of equipment at each bed space. This equipment enables us to closely monitor our patients as well as provide a range of treatments. The nurse looking after the patient will be happy to explain to you what the equipment is for.
There are a range of staff involved in a patient’s care including intensive care consultants, doctors, practitioners, nurses, therapists, etc. who visit at different times throughout the day. It may be necessary during the course of your visit that you will be asked to step away from the bedside and wait in the reception area whilst treatment is provided to a patient.
When visitors attend the unit for the first time, they can obtain a car parking permit. Two car registrations can be added for the permit which allows free parking for the duration of a patient’s stay on critical care. A supplementary car parking pass can also be purchased for £15 for the week. Forms for all permits are available from the reception team who are there to help and support all visitors. They will also give out a Relative Information Leaflet along with a card that provides details of our visiting times and direct line numbers to the different pods.
Visitors will also be encouraged to write in the Patient Diary which will be provided by the bedside nurse for all our sedated patients. Evidence tells us that a completed diary helps fill in the gaps for a patient when they are awake and helps in their recovery. The bedside nurse, or any of the nursing team, will be happy to provide further information about the diary when you visit.
Our teams
How do our teams at UHNM help critical care patients?
The physiotherapist’s role in critical care focusses on two key areas; respiratory and rehabilitation. Physiotherapists provide 24/7 respiratory care to patients with an emergency service after hours.
Physiotherapists work closely with doctors and the multi-disciplinary team in creating ‘weaning plans’ to regain respiratory muscle strength and reduce the reliance on ventilator support so patients can breathe for themselves.
Physiotherapists play a vital role in maintaining and improving muscle strength and promote functional independence via daily physical rehabilitation, tailored to individual needs in collaboration with patient and family.
Occupational therapy aims to increase function in everyday activities and allows the patients to become as independent as possible. There is evidence to suggest that patients who receive occupational therapy during their critical care stay are more likely to regain independence in daily life and have a reduced length of hospital stay. The assessment and treatment will be uniquely tailored to the needs of the patient to reduce the associated consequences of being admitted to the critical care unit. We will facilitate the patients to engage in normal routine through meaningful activities.
Post Critical Care Rehabilitation (PCCR) Team
The PCCR team is a stand-alone team that works alongside critical care and the wards to provide a fluent, supported journey for patients who have been on critical care for an extended period.
The team will meet patients on the unit before they transfer to a ward (one which does not follow a specific rehabilitation pathway – this could include surgical, medical and renal patients to name a few). The team then work with the patient and family to create personalised rehab goals; individual rehabilitation sessions are then provided in addition to ward level therapy, to help achieve their goals.
The team works on physical, functional and cognitive goals as identified for the patient. Support is also given to help the patient work through events and what has happened to them and to help understand the processes involved in the recovery journey.
Speech and Language Therapists (SLTs) in critical care assess, manage and rehabilitate a wide range of communication, swallowing and cognitive issues that can occur following a critical illness.
Often when patients have been critically unwell, or require a breathing tube, they are not able to communicate as usual. SLTs support patients to use alternative communication methods to enable them to communicate with staff and loved ones. SLTs will also be involved in tracheostomy weaning to support patients to use their voices again.
Some patients may struggle with speech or language impairments, for example, following a brain injury. SLT will work with patients and their families to rehabilitate communication.
Patients in Critical Care may present with dysphagia (swallowing difficulties) impacting their ability to eat and drink safely. SLTs use a variety of methods, (including nasoendoscopy and X-Ray assessments) to determine the safety of introducing oral intake.
We know that having a critical illness and being in critical care can be a frightening and confusing experience, the impact of which can take time to process.
The Clinical Psychologists can help support patients during their critical care unit admission. We can provide psychological screening and assessment, support and signposting and referral on for patients on the unit itself often liaising with other members of the critical care team and the wider healthcare to contribute to patients care.
The dietitians will review patients during their critical care stay to support the provision of nutrition. This is tailored to meet patients’ individual requirements, which can vary dependent upon their medical condition, level of organ support, nutritional status, age and gender.
It is very common for patients to have nutrition delivered via a variety of routes:
- artificially via tubes into their stomach or bowel,
- artificially via IV into the blood
- orally with the support of additional snacks and nutritional supplements
As patients begin to rehabilitate, rely less on organ support and participate more in physical rehabilitation, they may require more energy and protein to support this.
Dietitians will regularly review patients to adapt artificial nutrition and provide oral nutrition support (if appropriate) to support progression with therapy and rehabilitation. The better a patient’s nutrition, the better they can rehabilitate.
The dietitians are actively involved in education, audit and research to ensure we are providing the best nutritional care for our patients.
Rehabilitation coordinators work with patients, their families and clinicians throughout their recovery from critical illness.
They ensure patients receive [when required];
- referrals to appropriate therapies
- setting of individualised goals
- referrals to specialist clinical services
- provision of appropriate literature and advice
- signposting to additional support services and charities
Rehabilitation coordinators support care planning and multi-disciplinary team working through weekly ward rounds and case discussions. They provide education and support to all teams to ensure best practice, good communication, and personalised care.
Patients and families are offered support whilst in critical care, on the ward and then following discharge home, where they can access further advice via telephone.
Critical care pharmacists are key members of the team. They are highly qualified experts in medicines and help to look after the patient by carrying out medication reviews. They review each patient when they are admitted, to understand what medicines the patient usually takes at home, and to make sure that any important medicines are continued.
It is helpful if the patient’s medicines from home are brought into the ward, and if the patient or any relatives can confirm what medicines the patient usually takes – especially if they are on specialist medicines from hospitals or clinics. The pharmacist will check to make sure that any new medicines can be taken safely together or if anything needs to be temporarily stopped whilst the patient is unwell. The pharmacist will consider the patient’s clinical condition and blood results when they are reviewing the medicines.
Critical care pharmacists join the Consultant ward round to review the patient as part of the multidisciplinary team. They help to identify any medicine-related side effects and they are also responsible for the supply of medicines to the ward, and how the medicines are stored on the ward.
Pharmacists also support the nursing and medical staff by developing guidelines, running education sessions, completing quality improvement audits and by contributing to research.