TALON GENERAL HOSPITAL

INTENSIVE CARE UNIT

TRAINING MANUAL

NURSING SERVICE DEPARTMENT VISION 2007 – 2012

We envision a well-organised department with high-quality nursing service equipped with high-quality nursing service equipped with compentence, strong commitment and passion.

By 2012, the department would have a monitoring system in place that ensures procedures, standards and guideline are properly implemented for efficient and effective delivery of nursing care with the available facilities and equipment. We would continuously establish networking, training programs and education that would maintain professional, ethical and moral holistic healthcare.

ORGANIZATIONAL STRUCTURE

CHIEF NURSE

SUPERVISING NURSE

ICU HEAD NURSE

ICU NURSE IN CHARGE

STAFF NURSES

TIMETABLE FOR TRAINEES’EXPOSURE AT ICU

A new trainee may be anxious about starting in a new area. Try to create a comfortable environment and remember not to overwhelm the novice with too much information on the first day or week. Orientation is a continuing process, so there will be plenty of time to give the trainee all the necessary information.

WEEK I

DAY 1

Give a warm welcome and try to reduce any nervousness the trainees may feel Discuss your plan for the first day Introduce the organizational chart that the trainee will be working with Show the trainees around the unit

o Main ICU has five bed capacitieso Isolation ICU (Garnet) has 2 bed capacities

Review your job descriptions Review your office’ policies and procedures including working hours, unit organization

(schedules, forms, manuals, etc.), unit resources (equipment, supplies/stocks, etc.)

o Refer to manuals, forms used usually in the unit including the unit kardex, stock checklist, and papers that may help introducing the unit

Expectations from the unit exposure (including verbalization of special requests or any considerations during his/her stay in the area so he could make arrangements with HN/SN and CN)

Enumerate the expectations to the trainee during his/her rotation period in the unit Brief orientation to unit policies and procedures, practices like:

o Looking for MD available for informationo Charging of stocks o Requesting of supplies

Observation during his duty for the day Question/ clarification before the shift needs

DAY 2

Evaluation of learning from day 1 experience Additional expectations, questions, clarifications, from trainee Continuation of discussion on nursing procedures, measures usually done in the area Recap of unit procedures and practices for clarifications and additional discussions Introduction, brief discussion and return demonstration, if possible, of nursing

procedures usually done in the area

o Intubationo Suctioningo CPRo Ambubaggingo Defibrillationo IFC insertiono NGT insertiono Tube feeding o VS/NVS monitoringo Proper moving and turning of patiento Tracheostomy and endotracheal tube care

Hands on demonstration on how to operate and care of equipment and instrument in the area

o Cardiac monitorso Suction machineso Laryngoscopeo Defibrillatoro Pulse oximeter

Observation for the rest of the day

DAY 3

Continuation of discussions of nursing procedures, unit practices Allow familiarization of unit stocks and supplies by assisting him/her in checking stocks

and supplies completeness

Allowing with assistance on charging of used stocks Teach and assist in doing vital signs or neuro vital signs monitoring Mainly observation for the rest of the day

DAY 4

Allow to do VS/NVS still with assistance of staff nurse Allow to fill out request forms for diagnostic exams with the supervision of staff nurse Fill out Kardex and other forms with senior nurse Observe the On-Handling of charts, carrying out of doctor’s orders, filling out of forms Allow to participate on all activities/procedures (giving of medication/s, vital signs

monitoring, etc.) during his/her shift but with supervision and assistance from senior nurse.

DAY 5-7

Review of all learned skills, knowledge for the week Allow hands on practice of procedures with assistance Evaluation of learning experience, skills learned Evaluate his/her performance for improvement

WEEK II

Allow the trainee to assist the senior nurse on skills and procedures learned. The trainee may do VS/NVS on his/her own but still the senior nurse checks for accuracy especially during abnormal readings/results. The trainee is also allowed to prepare medications (oral, parenteral) but has to be checked by the senior nurse before and during administration. He/she may also be allowed to perform simple procedures like insertion of IFC/NGT and NGT feeding.

Depending on the census of the unit, and the cases handled and trainee’s work efficiency for the week, the extent of the procedures, he/she may be allowed to do or perform.

WEEK III

The trainee will be allowed to handle procedures on his own, (depending on performance for the past week/s) with just the assistance from the senior nurse. More hands-on experiences are allowed during this week.

The trainee will remain to assume the bed side nurse during this week, but may be oriented on being the charge nurse. The trainee will be taught on how to carry out orders, referring of patients, decision making skills, and charting. He will also be trained on endorsing patients to the incoming nurse or to the other areas of the hospital

Learning skills may depend on the census of patients and performance of the trainee.

WEEK IV

Based on his performance evaluation, his workload may vary. This week, he would be allowed to perform measures on his/her own, with less assistance from the senior nurse but still with supervision.

He may be allowed to handle patients as the charge nurse depending on cases he could manage on his/her own. During this stage of unit exposure, it will be tried to bring out on him essential skills like decision making.

NOTE:The succeeding weeks of exposure to the unit will be more on hand on handling of

patient, motivation to improve his/her skills and improvement of quality and speed of work. But whatever action the trainee will do, the senior nurse will remain liable of his actions, thus, assistance and supervision is still vital no matter how good or efficient the novice may be.

PROCEDURES COMMONLY PERFORMED IN THE ICU

NGT INSERTION

1. Check for physician’s order.2. Review the client’s medical history (to assess for any nostril surgery and

abnormal bleeding).3. Assess client’s consciousness and ability to understand. Explain the procedure.

(Decreases anxiety and promotes cooperation for conscious patients).4. Prepare the equipment, putting tissues, a cup of water and an emesis basin

nearby.5. Prepare the environment; raise the bed and place it in a HIGH FOWLER’S

POSITION.6. Wash hands on then put on gloves.7. Use a penlight to view the client’s nostrils. Assess client’s nostrils with penlight

and have the client blow her nose one nostril at a time. (Choosing the more capable nostril for insertion decreases discomfort and unnecessary trauma)

8. Using the NG tube, measure the distance from the bridge of the nose to the earlobe and then to the xiphoid process of the sternum and mark the distance on the tube with a piece of tape.

9. Lubricate the first four inches of the tube with water soluble lubricant.10. Ask the client to slightly flex the neck backwards to make the insertion easier.11. Gently insert the tube to the selected naris. 12. Ask the client to tip his/her head forward once the tube reaches the

nasopharynx. If the client continues to gag, stop the insertion for a moment.13. Advance the tube several inches at a time as the client swallows water or ice

chips if possible.14. Withdraw the tube immediately if there are signs of respiratory distress.15. Advance the tube until the taped mark is reached.16. Split 4-inch of tape 2-inch lengthwise. Secure the tube with the tape by placing

the wide portion of the tape on the bridge of the nose and wrapping the split ends around the tube.

17. Check the placement of the tube: Attach the syringe to the end of the tube and injecting 10cc of air

while auscultating over the epigastric area Aspirate sample gastric content and measure with chemstrip PH Prepare the client for x-ray check up, if prescribed.

18. Connect the distal end of the tube to suction, draining bag, or adapter to establish an appropriate pathway for intervention.

19. Secure the tube with rubber band and safety pin to client’s gown or bed sheet.20. Remove gloves, dispose of contaminated materials in proper container and wash

hands.21. Document procedure.

NGT FEEDING

1. Check the physician’s or qualified practitioner’s order for the feeding tube.2. Wash hands and apply gloves.3. Assess placement of the tube by auscultation:

Place stethoscope over the upper quadrant of the abdomen Quickly inject 10-20ml air with the 60ml syringe Assess for resistance Listen for sound

4. Proceed with feeding and medication. Continue to monitor the client for discomfort.

5. Remove gloves and wash hands.

MEASURING INTAKE AND OUTPUT

INTAKE

1. Wash hands.2. Explain rules of I & O record. All fluids taken orally must be recorded on the

client’s intake and output form.3. Measure all oral fluids in accordance with agency policy. Record all IV fluids

as they are infused.4. Record time and amount of all fluid intake in the designated space on I & O

form (oral, tube feedings, IV fluids).5. Record all 8 hour total form of fluid intake in the appropriate column of the

24-hour record.6. Complete 24 hour intake record by adding all 8-hour totals.

OUTPUT

7. Apply non sterile gloves.8. Empty urinal, bedpan, or foley drainage bag into graduated container or

commode hat. Other output may also be recorded, including nasogastric suction, suction bulb or chest tubes.

9. Remove gloves and wash hands.10. Record time and amount of output on I & O form.11. Complete 24 hour output record by totaling all 8-hour totals.12. Wash hands.

INSERTING AN INDWELLING CATHETER: MALE

1. Check for physician’s order.2. Gather the equipment needed.3. Provide for privacy and explain procedure to client.4. Set the bed to a comfortable height to work, and raise the side rail on the

side opposite you.5. Assist the client to a supine position with legs slightly spread.6. Drape the client’s abdomen and thighs if needed.7. Ensure adequate lighting of the penis and perineal area.8. Wash hands, apply disposable gloves and wash the perineal area.9. Open the catheterization kit, use the wrapper to establish a sterile field.10. Attach the catheter to the urine drainage bag if it is not preconnected.11. Generously coat the distal portion of the catheter with water-soluble, sterile

lubricant and place it nearby on the sterile field.12. With your non-dominant hand, gently grasp the penis and retract the

foreskin (if present). With your dominant hand, cleanse the glans penis with a povidone iodine solution or other anti microbial cleanser.

13. Hold the penis perpendicular to the body and gently pull up.14. Holding the catheter in your dominant hand, steadily insert the catheter

about 8 inches, until urine is noted in the drainage bag or tubing.15. Continue inserting until the hub of the catheter is met.16. Reattach the water filler syringe to the inflation port.17. Inflate the retention balloon with sterile water per manufacturer’s

recommendation or the physician’s order.

18. Once the balloon has been inflated, gently pull the catheter until the retention balloon is resting snugly against the bladder neck (resistance will be felt when the balloon is properly seated).

19. Secure the catheter according to institutional policy. Securing it to either the client’s thigh or abdomen is generally acceptable.

20. Place the drainage bag below the level of the bladder. Do not let it rest on the floor. Secure the drainage tubing to prevent pulling on the tubing on the catheter.

21. Remove gloves, dispose equipment, and wash hands.22. Assess and document the amount, color, odor, and quality of urine.

INSERTING AN INDWELLING CATHETER: FEMALE

1. Check for physician’s order.2. Gather the equipment needed.3. Provide for privacy and explain procedure to client.4. Set the bed to a comfortable height to work, and raise the side rail on the

side opposite you.5. Assist the client to a supine position with legs spread and feet together or to

a side –lying position with upper leg flexed.6. Drape the client’s abdomen and thighs for warmth if needed.7. Ensure adequate lighting of the perineal area.8. Wash hands and apply disposable gloves.9. Wash perineal area.10. Open catheterization kit, using aseptic technique. Use the wrapper to

establish a sterile field.11. Attach the catheter to the urine drainage bag if it is not preconnected.12. Generously coat the distal portion of the catheter with water-soluble, sterile

lubricant and place it nearby on the sterile field.13. Place the fenestrated drape from the catheterization kit over the client’s

perineal area with the labia visible through the opening.14. Gently spread the labia minora with the fingers of your non dominant hand

and visualize the urinary meatus.15. Holding the labia apart with your non dominant hand, use the forcep to pick

up a cotton ball soaked in povidone iodine, and cleanse the periurethral mucosa. Use one downward stroke for each cotton ball and dispose. Keep the labia separated with your dominant hand until you insert the catheter.

16. Holding the catheter in the dominant hand, steadily insert the catheter into the meatus until urine is noted in the drainage bag or tubing.

17. Reattach the water filled syringe to the inflation port.18. Inflate the retention balloon using the manufacturer’s recommendations or

according to the physician’s order.19. Once the balloon has been inflated, gently pull the catheter until the

retention balloon is resting snugly against the bladder neck.20. Tape the catheter to the abdomen or thigh snugly, yet with enough slack so it

will not pull on the bladder.21. Place the drainage bag below the level of the bladder. Do not let it rest on

the floor. Make sure the tubing lies over not under the leg.22. Remove gloves, dispose of equipment, and wash hands.23. Assess and document the amount, color, odor, and quality of urine.

MAINTAINING AND CLEANING TRACHEOSTOMY TUBE

1. Wash hands and apply gloves.2. Remove soiled dressing and discard.3. Cleanse neck plate of tracheostomy tube with cotton applicators

moistened with hydrogen peroxide.4. Rinse neck plate of tracheostomy tube with applicators moistened with

sterile water or saline.5. Cleanse skin under the neck plate of tube with cotton applicator

moistened with hydrogen peroxide.6. Rinse skin under neck plate with applicators moistened with sterile water

or saline.7. Dry skin under neck plate with cotton applicators.8. Prepare tracheostomy ties.

Cut a length of twill tape that will fit around the client’s neck, plus 6 inches. Cut the ends of the twill tape diagonally.

Open Velcro ties on continuous neck band.9. Leaving the old tracheostomy ties in place, insert one end of the new

tracheostomy ties through the hole in the tracheostomy neck plate from the back to front. Pulls the ends even, and slide both ends of the tape around the back of the head to the other side.

10. Insert one end of tape through the opening on the other side of the tracheostomy tube neck plate from back to front.

11. Tie the two ends of the new tape with a square knot at side of neck. Keep two fingers under the tape as the knot it tied. Without putting pressure on the neck plate or the tape, pull on the know to make sure it will stay tied.

12. Cut and remove old tracheostomy tapes and discard. Hold the neck plate firmly with one hand while cutting old tapes.

13. Place one finger under the tracheostomy ties to check for tightness and security.

14. Discard all used materials and wash hands.

SUCTIONING ENDOTRACHEAL AND TRACHEAL TUBES.

1. Assess depth and rate of respirations; auscultate breath sounds.2. Assemble supplies on bedside table.3. Wash hands.4. Connect suction tube to source of negative pressure.5. Administer oxygen or use ambu bag before beginning procedure.6. Apply sterile gloves.7. Open sterile suction catheter or use the reusable closed system catheter.

The sterile suction catheter is removed from the package with our dominant, sterile hand. Wrap the catheter tubing around your hand from the tip of the catheter down to the port end. Attach catheter to suction.

8. Insert the catheter into the trachea without suction.9. Apply suction intermittently while gently rotating the catheter and

removing it. In a disposable catheter, suction is applied by placing the thumb of your dominant hand over the open port of the catheter connector.

10. Wrap the disposable suction catheter around your sterile, dominant hand while withdrawing it from the endotracheal tube.

11. Suction for no more than 10 seconds.12. Administer oxygen using the high function on the ventilator or using an

ambu bag.13. Assess airway and repeat suctioning as necessary.14. Remove gloves and discard.15. Wash hands.

16. Record the procedure and client’s tolerance of the procedure, including the amount and consistency of secretions.

ADMINISTERING CARDIOPULMONARY RESUSCITATION (CPR)

1. Assess responsiveness of patient, including vital signs.2. Cardiac compressions are performed as follows:

Maintain a position on knees parallel to sternum. Position hands for compression.

o Using the hand nearest to the legs, use the index finger to locate the lower rib margin and quickly move the fingers up to the location where the ribs connect to the sternum.

o Place the middle finger of this hand on the notch where the ribs meet the sternum and the index finger next to it.

o Place the heel of the opposite hand next to the index finger on the sternum.

o Remove the first hand from the notch and place it on top of the hand that is on the sternum so that they are on top of each other.

o Extend or interlace fingers and do not allow them to touch the chest.

o Keep arms straight with shoulders directly over hands on sternum and lock elbows.

o Compress the adult chest at the rate of 80 to 100 compressions per minute.

o The heel of the hand must completely release the pressure between compressions, but it should remain in constant contact with the client’s skin.

o Use the mnemonic “one and two, two and three and…” to keep rhythm and timing.

o Ventilate client.3. Maintain the compression rate for 80-100 times/minute, injecting

ventilation after 15 compressions.4. Reassess the client after 4 cycles.

DEFIBRILLATION

OVERVIEW: Defibrillation is achieved by delivering a strong electric current though electrodes placed on the surface of a patient’s chest wall. Proper electrode placement ensures that the axis of the heart is directly situated between the sources of current (defibrillator paddles). Since dysrhythmias are chaotic with no coordinated ventricular response, the electric current is delivered randomly. It is through implementation of emergent defibrillation that ventricular fibrillation and pulseless ventricular tachycardia can be terminated and cardiac output restored.

PURPOSE:

1. To eradicate life-threatening ventricular fibrillation or pulseless ventricular tachycardia.

2. To restore cardiac output lost due to dysrhythmias and reestablish tissue perfusion and oxygenation.

PROCEDURE:

1. Verify V-fib or V-tach by ECG and correlate with clinical state. Assess to determine absence of pulse. Call for help and perform CPR until defibrillator and crash cart arrives.

2. Prepare for defibrillation

a. Turn power "ON". Defaults to 200 joules.b. Select correct paddles- adult, pediatric or internal.c. Prepare patient and/or paddles with proper conductive agent.d. Checks that defibrillator is in asynchronous mode.

*** If other than 200 joules desired, press "ENERGY SELECT" and select desired amount

3. Turn on ECG recorder for continuous printout.4. Places one paddle at the heart’s Apex just left of the nipple in midaxillary line.

Place the other paddle just below the right clavicle to the right of the sternum, applying 25 lbs. / square inch pressure to paddles.

5. ***Press "CHARGE" on defibrillator front panel or on the Apex paddle. Wait until indicator stops flashing to indicate fully charged.

6. ***State "ALL CLEAR" and visually check that all personnel are clear of contact with bed, patient and equipment.

7. ***Checks rhythm immediately before discharge.

8. 8. Depress both buttons simultaneously and maintain pressure until electrical current delivered. (Maintain 25 lbs/in2)

9. ***Assess conversion of dysrhythmia.10. 10. If first defibrillation unsuccessful, immediately charge paddles to 300 joules

and repeat steps 2 through 9.11. If second defibrillation unsuccessful, immediately charge paddles to 360 joules

and repeat steps 2 through 9.12. If third attempt is unsuccessful, continue CPR, initiate ACLS protocols, intubate

and obtain IV access. Assess patient status and precipitating factors to prevent further decompensation of patient.

13. Clean defibrillator and paddles, discard supplies, and wash hands.14. Documents procedure in patient record.

POLICIES AND REQUIREMENTS OF THE DEPARTMENT

UNIFORM

The staff, when on duty, must wear the prescribed uniform at all times:

Prescribed clean white uniform – should be made of white, non sheen, non transparent material with the prescribed design and official hospital logo.

Company ID – should wear the updated and own ID at all times. Have the updated PRC license, IVT ID always available for reference.

Clean white shoes – must be closed and low heeled. Rubber shoes are not allowed. Shoes shall always be clean and well polished. Socks should be all white without any print

Nurse cap for females – should be clean and ironed. Wrist watch with minute hand – nurse may wear their school rings;

married nurses may wear their wedding bands. Small ear studs may be worn by female nurses whose ears are pierced. Earrings are not allowed for male nurses.

SCHEDULE

Regular time schedules are 6AM to 2PM, 2PM to 10PM and 10PM to 6AM Schedule is prepared by the supervising nurse and approved by the chief

nurse. Any changes in the schedule should be made and approved by the HN, SN, and CN.

Four hours prior to scheduled duty, notification should be made for sick call.

Exchanges with the schedules should be made and approved by HN, SN, and CN.

MEETINGS

Unit meetings are made once a month to discuss concerns regarding the area. Secretary or a staff is assigned to take notes of the minutes of the meetings. Attendance is a must to all staff. A prior notice is given if a staff can’t come to the said meetings. A penalty is imposed by HN, SN, and CN.

TRAININGS AND SEMINARS

Any staff interested to attend seminars/ training must inform the chief nurse beforehand for the scheduling. A letter or request by the chief nurse is submitted in the personnel office for approval if training hours are considered official business.

CLEANLINESS AND SAFETY

Nurses station must be kept clean always, fix things in their proper placement.

Keep sink clean and dry. Scrubbing should be done every shift as needed. Observe proper disposal of garbage. Properly labeled bins must be used

strictly. Linens and gowns of the patients should be clean at all times or as

necessary.

GENERAL UNIT POLICIES

Only 1 watcher is allowed inside the ICU, however, a maximum of 2 watchers may be allowed if necessary.

Only the patients are allowed to eat inside. Watchers and visitors are not allowed to eat, smoke and make noise inside the unit.

Infectious cases are admitted to the Isolation (Garnet) room while non contagious cases are admitted at the main ICU.

ICU is under the direct supervision of the Medical Director in coordination with the attending physician.

Used needles should be thrown properly on a sealed container. Curtains, draped should be changed regularly every month and as

needed.

Watchers are advised not to bring a lot of belongings inside the unit since food, linen, hospital gowns and other paraphernalia are provided by the hospital to the patients.

Silence should be observed inside the unit. Cell phones are not allowed to be used inside the unit. Only the on duty staff nurses are allowed to stay inside the unit. Cleanliness of the area should be observed at all times. Daily

housekeeping is a routine in the unit like cleaning of bed sides, sweeping and mopping of the floor using disinfectants, collecting garbage, dusting of shelves, equipment and cabinets and scrubbing the comfort room.

The sink should be scrubbed every sink. Stocks and equipment should be checked before the shift ends. Hand towels should be washed every shift or as needed. Suction tips and PNSS should be changed at least every 8 hours or as

needed. Suction machine and bottles should be cleaned every 8 hours or as

needed. No reuse policy should be observed including the change of pool drains

for suction machines for every patient. Cardiac monitors and other equipment should be well kept after use. Always check all the instrument and equipment’s readiness for use at all

times. Once the unit is vacant, ask the housekeeping department for general

cleaning and exposing of unit to UV light radiation. Periodic culture of strategic areas is done. ICU equipment/apparatus that are out of order should be reported

immediately to the AAO for the technician to repair them. Empty gas tanks, unnecessary things like empty dextrose bottles, etc.,

should be remove because they may be causes of barriers during critical care cases.

Post-operative patients may stay at the ICU for recovery and transfer them when stable to room of choice.

Children are not allowed to enter the ICU premises. Waste should be thrown accordingly. Applying restraints to patient should be well explained to relatives with

consent from relatives after checking AP’s order. Document all procedures and interventions done with the patient.

GUIDELINES: DISCHARGING PATIENT FROM ICU

HAMA – Home Against Medical Advice and HPR – Home Per Request

1. Explain the consequences that may arise due to their decision.2. Name and explain hospital policies and protocols regarding HAMA/HPR

cases to patient and/or relatives.3. Notify AP on patient/relatives request; secure PF and final diagnosis.4. Transcribe AP’s orders or specific instructions, if any.5. Carry out AP’s orders.6. Secure HAMA/HPE waiver or consent form to patient and/or relatives.7. Collate and input all unit charges to certain patient.8. Notify other areas/departments (let staff sign on the IC billing notebook.)9. Have the billing personnel receive the chart of the patient, with charges,

if any. Let them sign on the ICU billing notebook.10. Secure a copy of discharge slip, notify linen staff for signing.11. Remove all paraphernalia attached to the patient.12. Call transport aides (carriers) to bring patient to hospital gate/vehicle.

NB: for cases like paraphernalia (e.g. IVF, IFC, NGT) to be taken home, secure AP’s order, if possible, consent/waiver; instruct clearly of special instructions and/or measures.

HAMA – Intubated patient

1. Explain the consequences that may arise due to their decision.2. Name and explain hospital guidelines /protocols regarding this case.3. Notify AP on patient and/or relatives request; secure PF and final Dx.4. Transcribe AP’s orders or specific instructions, if any.5. Secure HAMA waiver/consent from relative.6. Collate and input all unit charges to certain patient, if any.7. Notify other departments.8. For billing out.9. Secure discharge notice and notify linen staff.10. Remove all paraphernalia attached to the patient.11. Have relatives turn the respirator off.12. Continuous ambubagging while transport aides carries patient to vehicle.13. Extubate patient prior to departure.

CADAVER

1. Notify AP of patient’s death, if pronounced on his absence; secure PF and final Dx.

2. Perform post mortem care.3. Charge and input all stocks/supplies used.4. Notify all departments.5. Have billing personnel receive the chart and other charges.6. Instruct/assist relatives to call for funeral service.7. Secure discharge notice.8. Have relative sign the cadaver receipt form.9. Release the cadaver to funeral service personnel with relatives.

TRANSFERRING PATIENT

o FROM ICU TO REGULAR ROOM

1. Verify AP’s order/s for transfer to ROC.2. Ask patient and/or relative room preference, explaining room rates (refer

to admitting staff if necessary)3. Notify concerned areas/staff:

Admitting staff for availability or reservation of room of choice. Linen staff and male attendants for room preparation including

equipment to be prepared. Receiving NOD of patients transfer with pertinent data.

4. Prepare patient for transfer, remove paraphernalia if necessary.5. Coordinate with transport aides for transferring of patient to ROC.6. Accompany the patient to room while transferring.7. Assist transport aide in transferring patient to bed.8. Stabilize condition of patient, hook to any equipment, if any.9. Endorse to ward NOD

o NB: always indicate/note date and time of transfer.

o THOC – TRANSFER TO HOSPITAL OF CHOICE

PER PATIENT’S/RELATIVE’S REQUEST

1. Explain the consequences that may arise during the transferring of patient.

2. Explain hospital guidelines/protocol regarding this situation.3. Notify AP of patient/relative’s desire to transfer patient to other institution, if

not AP’s suggestions.4. Secure THOC consent/waiver form from patient or relatives.5. Coordinate with HOC ER/Admitting staff.6. AP/ROD will coordinate AP/ROD of HOC, ICU NOD will take charge if possible

with receiving HOC guidelines.7. Provide with referral letter, including medicines given, photocopies of work-

ups done.8. Arrange transport vehicle to be used an SP nurse who will accompany

patient.o If hospital ambulance will be used, SP in necessary.o If own vehicle is used, SP nurse is optional with condition of

terminating all paraphernalia9. Notify all departments for charges.10. Billing personnel receives chart and charge slips, if any.11. Secure discharge notice, notify linen staff.12. Endorse to SP nurse, if necessary.

ADMITTING PATIENT

FROM ER TO ICU

1. Receives call from ER staff/NOD regarding admission.2. Gather pertinent information regarding patient like name, age, case,

condition, LOC, equipment/paraphernalia needed, special procedure to be anticipated.

3. Admitting staff should coordinate with linen staff for ICU admission.4. ICU NOD confirms with linen staff the bed assignment for incoming

patient.5. Prepares equipment, paraphernalia, other devices needed for incoming

patient with male attendants, linen staff or RTOD, if necessary.6. ER NOD should verify to ICU NOD and linen staff the readiness of area to

accommodate incoming patient.7. Patient should be transported by transport aides assisted/accompanied

by ER NOD, ROD and AP if necessary.8. Patient should be transported and positioned safely and accordingly to

bed.9. Stabilize the patient; connect to devices/equipment to necessary by NOD

and/or RTOD.10. Receive endorsement from ER NOD, verifying stat

medications/procedures properly done.

11. Accomplish patient’s chart, kardex and other required forms of documentation.

WARD TO ICU

1. Receives call from ward staff/NOD regarding trans in of patient (ordered by ROD/AP).

2. Gather pertinent information regarding patient like name, age, case, condition, LOC, equipment/paraphernalia needed, special procedure to be anticipated.

3. Originating staff should coordinate with linen staff and male attendants for bed preparation, to male aides for equipment to be prepared.

4. ICU NOD confirms with linen staff and male attendants bed assignment and equipment to be prepared.

5. Prepares equipment, device needed for incoming patient with male attendant, linen staff and RTOD if necessary.

6. Ward NOD coordinated with ICU NOD for preparedness of receiving area, calls for transport aides for transferring patient, thereafter.

7. Transfer and position to bed safely by transport aides and NOD.8. Stabilize patient; connect to device, paraphernalia needed.9. Receive endorsement from WARD NOD.10. Accomplish patient’s chart, kardex and other required forms of

documentation